The Proinflammatory Environment in Potential Heart and Lung Donors: Prevalence and Impact of Donor Management and Hormonal Therapy

BACKGROUND: Brain stem death can elicit a potentially manipulable cardiotoxic proinflammatory cytokine response. We investigated the prevalence of this response, the impact of donor management with tri-iodothyronine (T3) and methylprednisolone (MP) administration, and the relationship of biomarkers to organ function and transplant suitability. METHODS: In a prospective randomized double-blinded factorially designed study of T3 and MP therapy, we measured serum levels of interleukin-1 and -6 (IL-1 and IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein, and procalcitonin (PCT) levels in 79 potential heart or lung donors. Measurements were performed before and after 4 hr of algorithm-based donor management to optimize cardiorespiratory function and +/-hormone treatment. Donors were assigned to receive T3, MP, both drugs, or placebo. RESULTS: Initial IL-1 was elevated in 16% donors, IL-6 in 100%, TNF-alpha in 28%, CRP in 98%, and PCT in 87%. Overall biomarker concentrations did not change between initial and later measurements and neither T3 nor MP effected any change. Both PCT (P =0.02) and TNF-alpha (P =0.044) levels were higher in donor hearts with marginal hemodynamics at initial assessment. Higher PCT levels were related to worse cardiac index and right and left ventricular ejection fractions and a PCT level more than 2 ng x mL(-1) may attenuate any improvement in cardiac index gained by donor management. No differences were observed between initially marginal and nonmarginal donor lungs. A PCT level less than or equal to 2 ng x mL(-1) but not other biomarkers predicted transplant suitability following management. CONCLUSIONS: There is high prevalence of a proinflammatory environment in the organ donor that is not affected by tri-iodothyronine or MP therapy. High PCT and TNF-alpha levels are associated with donor heart dysfunction. (C) 2009 Lippincott Williams & Wilkins, Inc.

Concepções de mulheres com deficiência física sobre a maternidade

The study aimed to understand the concept of women with physical disabilities about their ability to gestate, give birth or care a child. This is an exploratory, descriptive study with qualitative approach developed in three non-governmental organizations in Natal, Rio Grande do Norte, Brazil. The data collection occurred in the period from April to June, 2014, through semi-structured interviews, using a script composed by sociodemographic questions and a guiding one. It was obtained a priori the permission from the association’s directors, the approval from the Research Ethics Committee, of the Federal University of Rio Grande do Norte, CAAE nº 27442814.7.0000.5537 and the assent n° 618.045, as well as the participant’s formal authorization by signing the Informed Consent Statement. Participated in the study 12 women, selected according to the following inclusion criteria: to have physical disability, to be aged 18 to 49 years old, and to affirm the existence of limiting characteristics from early childhood (0-3 years). The information obtained in the interviews were subjected to the precepts of Content Analysis according to Bardin, under the thematic analysis technique. From this process, three categories emerged: Conceiving motherhood in front of disability; Conceiving the capacity to be mother with disability; and Conceiving the support during pregnancy and puerperium period. As the theoretical framework we adopted the principles of symbolic interactionism proposed by Blumer. The discussion was supported by literature findings on women's health care in the context of reproduction. The interviewees conceive motherhood as an accomplishment and believe in their own ability to gestate, give birth and care a child. However, the desire for the maternal role tends to be influenced by adverse feelings and limitations raised by disability, social barriers and prejudices. They also referred the importance of support from partner, family and health professionals in the care of child. Upon these findings, it is understood that although there are barriers to the realization of their desire, these barriers were not enough to make them give up on becoming a mother. Therefore, it is necessary that health professionals, highlighted the nurse, be trained to care for women with disabilities in the context of reproductive health care in order to offer adequate support to their needs

Biolipídio B2: desenvolvimento de um veículo estável para reposição hormonal transdérmica nanoestruturada

The hormone administration by the oral route is frequently related with different many side effects. The aim of this study was to evaluate the safety and efficacy of a new product intended to transdermal hormone replacement nanostructured (TRHN) therapy, based on a patented under No. US 2013/0123220A1 formulation. This formulation was able to restore serum levels of estradiol (0.1%) + estradiol (0.25%) in 122 postmenopausal women with a mean age of 56.88 (± 6.27). The assessment is part of a longitudinal prospective study. Clinical parameters, including the degree of satisfaction with symptom relief, serum concentrations of estradiol, weight, blood pressure, were compared between the beginning and the end of treatment. The findings show that BIOLIPÍDEO B2® was safe and effective in restoring hormonal serum levels without side effects. The satisfaction with treatment was 92%. Serum concentrations of estradiol was significantly higher after treatment (p <0.05). Weight and systolic and diastolic blood pressure showed no significant differences (p> 0.05) during treatment. No vaginal bleeding was observed. Evaluation of bilateral breast mammography treatment found normal results in all women. This study shows for the first time the effectiveness of a transdermal formulation nanostructured in the transdermal delivery of estradiol and estriol measured in vivo using Confocal Raman Spectroscopy. The formulation of BIOLIPÍDEO/B2® is safe and effective in restoring serum estradiol levels and alleviates menopausal symptoms. The formulation can serve as a good choice for hormone replacement therapy to protect against post-menopausal symptoms.

Desenho de deficiência visual: uma experiência no ensino de artes visuais na perspectiva da educação inclusiva

Over the past 30 years, Art Education in interface with disabilities has been a subject of increasing interest in research in academia, especially with regard to Special Education, but still has some shortages in terms of socialization studies to discuss this type of teaching from the perspective of inclusive education. In this scenario, this paper presents an analysis from the field of teaching Visual Arts in the context of school inclusion, with emphasis on teaching drawing to the visually impaired. The conducted literature indicates a number of authors who discuss teaching drawing to people with visual disabilities, who are dedicated primarily to the Special Education context. In this sense, the shortage of research that discuss this teaching from the perspective of inclusive education, this research aimed at the inclusive approach to teaching drawing in the school context. Thus, the aim of this study was to develop a proposal for a pedagogical intervention in Visual Arts, with reference to drawing and its construction process, with the participation of seeing and unseeing students. Therefore, the methodological approach, which was qualitative, was the intervention research, in the light of the Bakhtinian principles of dialogism and otherness, with exploratory study characteristics. The locus of the research was the State School Admiral Newton Braga Faria, which is located in Alecrim, on the East Zone of Natal / RN and is near the Institute for Education and Rehabilitation of the Blind - IERC / RN. The class chosen for intervention was the 7th grade “C” afternoon shift, which had children aged 12 to 16, with 27 students enrolled, three students with disabilities: 02 blind girls and 01 deafblind boy with light hearing and visual loss. As interlocutors of the research, we could also count on the Art teacher who served as a collaborator, as well as teacher in the school’s Multifunction Resource Room. The instruments and research procedures were observation, semi-structured interview, field diary and the photo / video recording. In the development of research, we conducted 10 workshops with multisensory teaching sequences, articulating the physical, tactile and graphical expressions as intrinsic to the reading and production of drawing for both seeing and unseeing students. The process and data built on research allowed for a reflection on cultural experiences with drawing in the school context and on the interactions between seeing and unseeing students in the production and analysis of tactile-visual drawings. They also point out the construction of a teaching approach to drawing, in the context of the common class, from educational workshops that enable artistic and aesthetic interactions from the perspective of school inclusiveness. Thus, we argued that the mobilization of the tactile, physical and graphical expressions can be adopted in a multisensory approach that enables a pedagogical focus that involves all students and is not restricted to the presence of students with visual impairment.

Inclusão de estudantes com deficiência no Instituto Federal da Paraíba a partir da ação TEC NEP

The current research developed in the Federal Institute of Paraíba – IFPB, João Pessoa Câmpus, aimed at analyzing the inclusion of students with disabilities in undergraduate courses based on the TEC NEP Action. It departs from the discussion about professional and special education in an inclusive perspective, focusing on people with disabilities, in the social context of these two modalities of education, considering the world scenario and the current Brazilian educational policy. It discusses the TEC NEP Action within the national and local context through the analysis of the official documents with the objective of getting familiarized and evaluating the process of educational inclusion in the IFPB João Pessoa Câmpus. The theoretical reference used contributed to the analysis of the policy which focused on inclusion in federal undergraduate institutions for professional education. The methodology used presents a qualitative analysis, having as subject of the research students with disabilities from undergraduate courses in the IFPB João Pessoa Câmpus who are supported by NAPNE. The results based on the analyzed data show that volunteer students from this research evaluate their process of inclusion in the appointed institution as positive, in spite of challenges specially the ones related to architectural barriers. It is concluded that the foundation of the House for Supporting People with Special Education Needs – (NAPNE) through the TEC NEP Action had crucial importance in the basis for the discussion about inclusion in the institution, widening the vision towards the demands of students with disabilities in order to facilitate access, permanence and academic success of these students.

Práticas pedagógicas e inclusão escolar: o processo de ensino-aprendizagem de alunas com deficiência intelectual

This research aimed to know and analyze the pedagogical practices that have been developed in the teaching and learning of students with Intellectual Disability (DI), enrolled at common class of elementary school I. The study was conducted in a public school at Natal/RN, involving two students with DI, a multipurpose teacher, a teaching assistant, a teacher of arts and educational coordinator. As for methodological choice, we chose to develop a qualitative study, undertaking a case study. As tools for the construction of the data we use: semi-structured interviews, participant observation, field diary and document analysis. Data analysis reveals that the institution in which the research was undertaken gradually implementing changes in order to develop an inclusive practice, consistent with its assumptions. Regarding the practices developed in the teaching and learning of students with intellectual disabilities, it was possible to realize the fulfillment of certain adjustments in relation to the objectives, activities and some content, involving the use of resources and varied strategies. With regard to educational activities, we found that these had different levels of complexity, covering both basic goals as more complex objectives. From the observations, we realize that the Assistant Professor of mediations during varied activities as challenging tool in intellectual processes. We note, too, a dynamic classroom in which disabled students were under the guidance of Assistant Professor, and other students with all-round teacher who had a fairly traditional teaching methodology. It created thus an isolation situation, since there was no proposition practices to be developed with all students, and interaction among classmates, generally quite restricted. Although were highlighted developments in the social and academic learning of the surveyed students, the teachers said they did not feel prepared to work freight inclusion. The study reveals the need for teachers reviewing some actions undertaken, in order to develop more democratic pedagogical practices of education, stimulating the interactions between students, by proposing challenging activities that promote the formation and concepts. In addition, it points to the need of the education system invest and encourage the qualification of teachers with regard to education in an inclusive perspective, through actions that promote lifelong learning. It needs to be developed on the teacher a reflective attitude, resulting in a view that due diligence must be entered in practice inherent in teaching in order to use to enhance their educational experience.

Práticas pedagógicas e inclusão escolar: o processo de ensino-aprendizagem de alunas com deficiência intelectual

This research aimed to know and analyze the pedagogical practices that have been developed in the teaching and learning of students with Intellectual Disability (DI), enrolled at common class of elementary school I. The study was conducted in a public school at Natal/RN, involving two students with DI, a multipurpose teacher, a teaching assistant, a teacher of arts and educational coordinator. As for methodological choice, we chose to develop a qualitative study, undertaking a case study. As tools for the construction of the data we use: semi-structured interviews, participant observation, field diary and document analysis. Data analysis reveals that the institution in which the research was undertaken gradually implementing changes in order to develop an inclusive practice, consistent with its assumptions. Regarding the practices developed in the teaching and learning of students with intellectual disabilities, it was possible to realize the fulfillment of certain adjustments in relation to the objectives, activities and some content, involving the use of resources and varied strategies. With regard to educational activities, we found that these had different levels of complexity, covering both basic goals as more complex objectives. From the observations, we realize that the Assistant Professor of mediations during varied activities as challenging tool in intellectual processes. We note, too, a dynamic classroom in which disabled students were under the guidance of Assistant Professor, and other students with all-round teacher who had a fairly traditional teaching methodology. It created thus an isolation situation, since there was no proposition practices to be developed with all students, and interaction among classmates, generally quite restricted. Although were highlighted developments in the social and academic learning of the surveyed students, the teachers said they did not feel prepared to work freight inclusion. The study reveals the need for teachers reviewing some actions undertaken, in order to develop more democratic pedagogical practices of education, stimulating the interactions between students, by proposing challenging activities that promote the formation and concepts. In addition, it points to the need of the education system invest and encourage the qualification of teachers with regard to education in an inclusive perspective, through actions that promote lifelong learning. It needs to be developed on the teacher a reflective attitude, resulting in a view that due diligence must be entered in practice inherent in teaching in order to use to enhance their educational experience.

Currículo escolar e inclusão de estudantes com deficiência: diálogos com uma escola pública

This work of qualitative approach, has as its study object the school curriculum, resulting from the implementation of public policies for inclusion in the Brazilian educational field and of the teaching organization in State School Despertar. While we acknowledge advances in government discussions and proposals related to school inclusion in our country, it is still important to develop studies and interventions in the context of basic education focused on the curriculum. With methodological basis in collaborative-critical action research and contribution by Barbier, the survey was conducted in 2013, in a state school in the Natal - Rio Grande do Norte - school system, and aimed to analyze the curriculum of the State School Despertar, in particular issues related to the inclusion of students with disabilities in common teaching classes expressed in the school and in collective situations of continuing education with teachers and interpreter of Brazilian Sign Language (Libras). The school was previously chosen because it had already been locus of research in a study conducted by a professor at the Federal University of Rio Grande do Norte promoting the knowledge of their formative needs. The study subjects were 26 teachers in the early years and the end of elementary school and a Libras interpreter. The instruments were direct observation, semi-structured interviews, document analysis and a proposal for continuing education called Collaborative Group on School Inclusion (GCEI), established with the participating subjects and the other research collaborators. The analyzed data showed eight dialogues built with the State School Despertar, being basic the contributions of Goffman (1988) on stigma and of Forquin (1993) on school culture. As a theoretical framework, there were important contributions on School Curriculum (SACRISTÁN, 2000; 2007; APPLE, 2006; 2008), School Inclusion (BUENO, 2008), Continuing Education (NÓVOA, 2002; GATTI, 2003) and the existing studies on the dialogues between Curriculum and Special Education (MAGALHÃES, 2002; SILVA, 2008; 2010; OLIVEIRA, 2004; VIEIRA, 2012). The study highlighted the importance of extending the dialogue, the theoretical deepening of GCEI for the understanding of school curriculum and the specifics of any students, with or without disability. It will be necessary to revisit the school teaching practices that do not correspond to the students, for instance the formation of classes made in classrooms. It is also important to consider the organization of the school day and its interface with the pedagogical functions of each member of the school in building curriculum practices consistent with the diversity of modes and learning styles. Subliminal aspects of the curriculum should be reviewed, given its implications in the context of the classroom and management. However, significant changes identified in the practices of some teachers, such as the use of audio description, stimulus to the participation of students with disabilities and use of images, favored the development of other students, who benefit of more exciting and participatory classes. Based on the conducted research, we conclude on the importance of collectively discuss the conditions for / in schooling of different students and the (re)thinking of curriculum practices in the school as a whole, and therein lies a paradox because, on the one hand, it is not about minimizing the specific knowledge in dealing with the needs of students with disabilities, on the other, we are not interested in distancing these needs from those inherent in human nature, therefore peculiar to the other students. The questioning of our own practices is the challenge imposed, not to special education, or its target audience, but this is undoubtedly task of education.

Currículo escolar e inclusão de estudantes com deficiência: diálogos com uma escola pública

This work of qualitative approach, has as its study object the school curriculum, resulting from the implementation of public policies for inclusion in the Brazilian educational field and of the teaching organization in State School Despertar. While we acknowledge advances in government discussions and proposals related to school inclusion in our country, it is still important to develop studies and interventions in the context of basic education focused on the curriculum. With methodological basis in collaborative-critical action research and contribution by Barbier, the survey was conducted in 2013, in a state school in the Natal - Rio Grande do Norte - school system, and aimed to analyze the curriculum of the State School Despertar, in particular issues related to the inclusion of students with disabilities in common teaching classes expressed in the school and in collective situations of continuing education with teachers and interpreter of Brazilian Sign Language (Libras). The school was previously chosen because it had already been locus of research in a study conducted by a professor at the Federal University of Rio Grande do Norte promoting the knowledge of their formative needs. The study subjects were 26 teachers in the early years and the end of elementary school and a Libras interpreter. The instruments were direct observation, semi-structured interviews, document analysis and a proposal for continuing education called Collaborative Group on School Inclusion (GCEI), established with the participating subjects and the other research collaborators. The analyzed data showed eight dialogues built with the State School Despertar, being basic the contributions of Goffman (1988) on stigma and of Forquin (1993) on school culture. As a theoretical framework, there were important contributions on School Curriculum (SACRISTÁN, 2000; 2007; APPLE, 2006; 2008), School Inclusion (BUENO, 2008), Continuing Education (NÓVOA, 2002; GATTI, 2003) and the existing studies on the dialogues between Curriculum and Special Education (MAGALHÃES, 2002; SILVA, 2008; 2010; OLIVEIRA, 2004; VIEIRA, 2012). The study highlighted the importance of extending the dialogue, the theoretical deepening of GCEI for the understanding of school curriculum and the specifics of any students, with or without disability. It will be necessary to revisit the school teaching practices that do not correspond to the students, for instance the formation of classes made in classrooms. It is also important to consider the organization of the school day and its interface with the pedagogical functions of each member of the school in building curriculum practices consistent with the diversity of modes and learning styles. Subliminal aspects of the curriculum should be reviewed, given its implications in the context of the classroom and management. However, significant changes identified in the practices of some teachers, such as the use of audio description, stimulus to the participation of students with disabilities and use of images, favored the development of other students, who benefit of more exciting and participatory classes. Based on the conducted research, we conclude on the importance of collectively discuss the conditions for / in schooling of different students and the (re)thinking of curriculum practices in the school as a whole, and therein lies a paradox because, on the one hand, it is not about minimizing the specific knowledge in dealing with the needs of students with disabilities, on the other, we are not interested in distancing these needs from those inherent in human nature, therefore peculiar to the other students. The questioning of our own practices is the challenge imposed, not to special education, or its target audience, but this is undoubtedly task of education.

Role of Hormonal Treatment in Prostate Cancer Patients with Nonmetastatic Disease Recurrence After Local Curative Treatment : A Systematic Review

Peer reviewed

Adaptação e validação da escala GenCat de calidade de vida para a população adulta portuguesa com deficiência

Para melhorar o apoio social prestado às pessoas com deficiência em Portugal, urge perceber como esta população perceciona a própria Qualidade de Vida (QV). Este trabalho tem como objetivos: adaptar e validar a escala Gencat de Calidade de vida à população portuguesa adulta com deficiência; estudar como se manifesta a Qualidade de Vida na população portuguesa adulta com deficiência; analisar a relação de QV com algumas variáveis socio demográficas da população portuguesa adulta com deficiência, tipos de incapacidades e gravidade da amostra. A escala Gencat foi aplicada a 303 pessoas com perturbações motoras, sensitivas e/ou do desenvolvimento. Foi realizada a caraterização sociodemográfica do informador e da pessoa avaliada e a caracterização da gravidade da perturbação sofrida. O estudo psicométrico resultou numa escala de 54 itens e 8 domínios: Autodeterminação, Suporte Institucional, Satisfação Ocupacional, Bem-Estar Emocional, Inclusão Social, Condições Habitacionais e Comunitárias, Auto-eficácia e Bem-estar Físico. A escala apresenta boas propriedades psicométricas. A idade está inversamente correlacionada com as dimensões apoio institucional e bemestar físico da escala de Gencat. A população analfabeta apresenta menor QV global, nomeadamente na autodeterminação, suporte institucional, inclusão social e bem-estar físico. As pessoas institucionalizadas relativamente às que vivem em contexto familiar apresentam valores mais baixos de QV, nomeadamente na autodeterminação, suporte institucional, inclusão social e auto-eficácia, mas apresentam pontuações melhores condições habitacionais e comunitárias. O grau de incapacidade e a intensidade das perturbações cognitiva, motora, autismo e cegueira correlaciona-se inversamente com a QV, nomeadamente na autodeterminação, no suporte institucional, na inclusão social e o bem-estar físico.

Cervical cancer precursors and hormonal contraceptive use in HIV-positive women: application of a causal model and semi-parametric estimation methods.

OBJECTIVE: To demonstrate the application of causal inference methods to observational data in the obstetrics and gynecology field, particularly causal modeling and semi-parametric estimation. BACKGROUND: Human immunodeficiency virus (HIV)-positive women are at increased risk for cervical cancer and its treatable precursors. Determining whether potential risk factors such as hormonal contraception are true causes is critical for informing public health strategies as longevity increases among HIV-positive women in developing countries. METHODS: We developed a causal model of the factors related to combined oral contraceptive (COC) use and cervical intraepithelial neoplasia 2 or greater (CIN2+) and modified the model to fit the observed data, drawn from women in a cervical cancer screening program at HIV clinics in Kenya. Assumptions required for substantiation of a causal relationship were assessed. We estimated the population-level association using semi-parametric methods: g-computation, inverse probability of treatment weighting, and targeted maximum likelihood estimation. RESULTS: We identified 2 plausible causal paths from COC use to CIN2+: via HPV infection and via increased disease progression. Study data enabled estimation of the latter only with strong assumptions of no unmeasured confounding. Of 2,519 women under 50 screened per protocol, 219 (8.7%) were diagnosed with CIN2+. Marginal modeling suggested a 2.9% (95% confidence interval 0.1%, 6.9%) increase in prevalence of CIN2+ if all women under 50 were exposed to COC; the significance of this association was sensitive to method of estimation and exposure misclassification. CONCLUSION: Use of causal modeling enabled clear representation of the causal relationship of interest and the assumptions required to estimate that relationship from the observed data. Semi-parametric estimation methods provided flexibility and reduced reliance on correct model form. Although selected results suggest an increased prevalence of CIN2+ associated with COC, evidence is insufficient to conclude causality. Priority areas for future studies to better satisfy causal criteria are identified.

Hormonal factors and insulin-like growth factor-1 in North American postmenopausal women

Background: Mechanisms underlying the effect of estrogen exposure on breast cancer risk remain unclear. Insulin-like growth factor-1 (IGF-1) levels have been positively associated with breast cancer and are a potential mechanism. Objectives: The objectives of this thesis are: 1) to explore whether the reproductive risk factors and the lifetime cumulative number of menstrual cycles (LCMC), as measures for long-term estrogen exposure, are associated with IGF-1 levels, and 2) to examine the effect of an aromatase inhibitor (AI) on IGF-1 levels, and the potential interaction with BMI. Methods: A cross sectional study and a randomized controlled trial nested with the MAP.3 chemoprevention trial were used to address objective 1 and 2, respectively. 567 postmenopausal women were selected. Anthropometric measurements, lifestyle factors, reproductive characteristics and serum IGF-1 concentrations were collected at baseline and one year. Objective 1. The LCMC was computed as a composite measure of the reproductive characteristics. Multivariable linear regression models were used to assess the association between IGF-1 levels and LCMC and the hormonal risk factors, while adjusting for potential covariates. Objective 2. Changes in IGF-1 were compared between the exemestane and placebo, and effect modification by BMI was tested with an interaction term. Results: Objective 1. Women aged 55 years or older at menopause had 16.26 ng/mL (95% CI: 1.76, 30.75) higher IGF-1 compared to women aged less than 50 years at menopause. Women in the highest category of menstrual cycles (≥500 cycles) had an average 19.00 ng/mL (95%CI: 5.86, 32.14) higher concentration of IGF-1 compared to women in the lowest category (<350). Exogenous hormones had no effect on postmenopausal IGF-1 levels. Objective 2. Exemestane significantly increased IGF-1 levels by 18% (95% CI: 14%-22%); while, placebo had no effect on IGF-1. The changes in IGF-1 were significantly different between the treatment arms (P<0.0001) and no significant interaction was observed between treatment and BMI on IGF-1 changes (P=0.1327). Conclusion: Objective 1. Larger number of menstrual cycles and a later age at menopause are positively associated with IGF-1. IGF-1 may be one mechanism by which prolonged estrogen exposure increases cancer risk. Objective 2. We conclude that the reduced cancer risk observed with AI therapy likely occurs in an IGF-1 independent mechanism. Further studies exploring the clinical consequences of increased IGF-1 on AI therapy are needed.