Medical care and deaths due to coronary artery disease in Brazil, 1980-1999

OBJECTIVE: To estimate the frequency of medical care preceding deaths due to coronary artery diseases (CAD) in different Brazilian regions and capitals and to describe trends in medical care from 1980 to 1999. METHODS: Information on medical care preceding deaths due to coronary artery diseases/acute myocardial infarction in adults > 20 years from 1980 to 1999 was collected in the DATASUS, the databank of the Brazilian Health Ministry. Sex, states, and capitals selected for 1999 were analyzed in the study. Medical care was stratified as follows: with, without, and ignored medical care. The descriptive analysis comprised frequencies, ratios of frequency, test for proportions, and increments or reductions in frequencies. RESULTS: Acute myocardial infarction (AMI) represented 75 to 85% of the CAD in the period; the frequency of deaths with medical care ranged from 48.9 to 63%, and that of ignored medical care ranged from 27.2 to 41.5%. The frequency of other CAD with medical care ranged from 56 to 76%. The frequency of deaths preceded by medical care decreased by 17.8%, and that with ignored medical care increased by 36.5% (RF=2). The values for the other CAD were -20.2% and +64.6% (RF=44.4). Deaths preceded by medical care were more frequent in females at all ages and in all Brazilian regions. CONCLUSION: The results show a high frequency of sudden death and suggest errors in diagnosis or codification and overestimation of the statistics about mortality. Validation of the death certificate diagnosis and frequent surveillance are required.

Utilización de biomarcadores para la evaluación integrada de la calidad del agua de la cuenca del río Suquía.Utilization of biomarkers for the integrated evaluation of water quality of the Suquía River Basin.

En los últimos años el grupo de investigación ha caracterizado la calidad de los cuerpos de agua, detectando gradientes de calidad ambiental que se manifiestan por la aparición de tóxicos que generan cambios en la calidad del agua, sedimento y especialmente en la biota. El presente proyecto propone una evaluación integrada de la contaminación de los recursos hídricos abarcando el estudio de las causas de la contaminación y las respuestas biológicas que se producen ante dichas alteraciones. Por ello nuestro objetivo principal es evaluar la contaminación de los recursos acuáticos a través del desarrollo y aplicación de diversas herramientas. El enfoque multidisciplinario del mismo permitirá integrar los análisis de las diferentes áreas de estudio, con el fin de brindarán soluciones al problema generalizado de la contaminación acuática. El fin último es alcanzar una mejor valoración de los cambios temporales y espaciales en la calidad de las cuencas hídricas. Se propone analizar la presencia y concentración de tóxicos en agua, suelo, sedimento y biota conjuntamente con la evaluación de los efectos sobre los organismos a diferentes niveles de organización, lo que permitirá determinar y seleccionar los indicadores más eficientes de la contaminación ambiental. Se desarrollarán biomarcadores moleculares basados en expresión genética en la biota acuática y biomarcadores morfológicos, histológicos y bioquímicos. Además se evaluará el efecto del estrés tóxico sobre los hábitos natatorios de peces utilizando un software recientemente desarrollado por el grupo. También se intensificará la búsqueda de biomarcadores específicos de disrupción endocrina en peces tales como aromatasa, vitelogenina, parámetros estáticos y dinámicos de espermatozoides y comportamiento de cortejo y cópula. Así, el plan propuesto brindará un conjunto de herramientas, con diverso grado de complejidad, para ser usadas en la correcta evaluación del impacto ambiental de las actividades humanas. El grupo de trabajo pretende realizar una fuerte contribución a los conocimientos de base para crear conciencia sobre el problema de las diferentes cuencas en estudio, a fin de llevar a cabo un control sostenido de la calidad de los recursos acuáticos.

Prevalencia de Trastornos Mentales en consultantes de Centros de Atención Primaria de la Ciudad de Córdoba, Argentina.Prevalence of Mental Disorders among Consultants in Primary Health Care Centers of the City of Córdoba, Argentina

El informe de la Organización Mundial de la Salud (2001), refiere que en un plazo de 20 años los trastornos mentales pasarán a ser la segunda causa dentro de la carga de morbilidad a nivel mundial, y en la actualidad una de cada cuatro personas padece de algún trastorno mental en alguna etapa de su vida. Los estudios realizados en diversos países revelan que una proporción importante de los consultantes de la atención primaria en salud presentan algún tipo de trastornos mentales. Desde esta perspectiva, la atención primaria de la salud ofrece una oportunidad de intervenir en el manejo de los trastornos mentales de forma temprana y eficaz. En Argentina, es limitada la información acerca del registro epidemiológico en salud mental, no contando con estudios abordados desde la Atención Primaria en la provincia de Córdoba. El objetivo general del proyecto es estimar la prevalencia de trastornos mentales entre los consultantes de atención primaria por problemas de salud general. Para ello se propone: Estimar la prevalencia de trastornos mentales en una muestra representativa de consultantes adultos por problemas de salud general, de centros de atención primaria de la ciudad de Córdoba, identificar y describir los tipos de trastornos mentales que presentan estos consultantes adultos de centros de atención primaria y analizar la prevalencia de los trastornos mentales por sexo y edad de la población en estudio. Metodología: el estudio se realizará en consultorios de Atención Primaria de Salud distribuídos en todo el éjido de la ciudad, teniendo en cuenta la representación de las 12 zonas de CPC. La muestra es probabilística, estratificada, polietápica de pacientes que consultan en el primer nivel de atención. Se entrevistarán 1200 pacientes utilizando la versión computorizada del CIDI 3.0, que proporciona diagnóstico de acuerdo a la DSM IV y la CIE-10. La confiabilidad y la validez del instrumento ha sido ampliamente documentada y la traducción de la encuesta al español fue realizada conforme a las recomendaciones de la OMS. El análisis efectuado será de prevalencia de Trastornos Mentales y del Comportamiento (TMC),asociación entre factores sociodemográficos y TCM estimados calculando las razones de disparidad (odds ratio), regresión logística a fin de ajustar los resultados por la posible interacción entre variables, análisis de la asociación de todas las variables con los TMC, análisis univariado de la asociación de cada variable con los TMC, controlando sexo y edad, se construirá un modelo de regresión logística. En todos los casos el nivel de significación será de 0,05. El equipo de trabajo, de cooperación internacional entre profesionales de la UNC y de la Universidad de Chile, y con la participación en colaboración de los profesionales dependientes de la Secretaría de Salud de la municipalidad de Córdoba, representa un avance para trabajar en los centros de salud de esta ciudad, constituyéndose en un avance, cualitativo y cuantitativo de la actividad científica en Atención Primaria en salud mental con abordaje epidemiológico. Se espera contribuir al conocimiento acerca de la prevalencia de los problemas de salud mental de esta población en la ciudad de Córdoba, proporcionando información a los funcionarios y responsables por la gestión de las áreas vinculadas a la salud mental, aportando conocimiento que promueva una temprana identificación de riesgos iniciales en salud mental y conductas de cuidado en la población como potencial de bienestar.Así mismo, se espera sistematizar una experiencia que pueda ser replicada en otros sitios geográficos. Por todo lo anterior, esta propuesta permitirá conocer por primera vez en la ciudad de Córdoba la frecuencia y características de los problemas de salud mental entre consultantes de Atención Primaria, información fundamental para el desarrollo posterior de estrategias que busquen mejorar la detección y el tratamiento de estos problemas. According to the WHO Report (2001), in 20 years, mental health disorders (MHDs) will be the world’s second most frequent cause of morbidity. Primary care offers the opportunity to handle MHDs efficiently at an early stage. In Argentina, the epidemiologic data on mental health (MH) is limited, and there are no records for Córdoba. The aim of this project is to assess the prevalence of MHDs among consultants who resort to primary health centers (PHCCs) in the city of Córdoba for common health problems, by using a representative sample of adult consultants, identifying and describing the types of MHDs evinced, and analysing prevalence by sex and age group under study. Methodology:the study will be carried out in PHCCs located in the municipal area of Córdoba, covering the 12 zones corresponding to the CPCs (municipal branch offices for each zone). A multi-stage stratified random sample of 1200 patients will be interviewed using the program CIDI 3.0 to produce a diagnostic according to DSM IV and CIE-10, a tool with proven reliability and validity.The aspects to be analysed are prevalence of mental and behavior disorders, their association with socio-demographic factors estimated by odds ratios, logistic regression for adjustment of potential interaction among variables, association with all variables, and univariate analysis for association with each variable. Significance level will be 0.05 in all cases. The international teamwork including professionals from the Universities of Córdoba, Chile and the Public Health Department of the Municipality of Córdoba constitutes a qualitative and quantitative step forward in the field of primary health care studies with an epidemiologic approach. This project aims at providing administrators in the MH area with data for the early detection of initial risks in MH and the promotion of prevention habits. This will be the first study conducted in Córdoba, and is aimed at facilitating replication in other geographical areas.

Does the provision of full day care improve the quality of life for children and their parents

This study sought to explore and examine if the provision of full day care improves the quality of life for children and their parents. Owing to the effects of the Celtic Tiger, life in Ireland has changed considerably over the past five to ten years. Because of the booming economy there are now 60.8% of women employed in the workforce. This means many changes for children, parents and families. Findings in the literature review are based on international studies. The researcher utilised both qualitative and quantitative research methodologies for the study. She interviewed 31 respondents; 27 childcare managers; 3 politicians and the chairperson of a childcare committee. Furthermore, 325 questionnaires were completed in a survey by working parents in the statutory and voluntary sectors in and around Sligo town and in two childcare facilities in Letterkenny, Co. Donegal. Babies as young as 4 months are being cared for in childcare facilities from 6.45am until 6.pm daily, 5 days per week. Some children are spending up to 11 hours per day in childcare facilities. The study has not categorically concluded that full day care is either positive or negative for children. Childcare facilities are providing good quality childcare encompassing various services; however, 25 out of 27 childcare managers reported to the researcher that they would not leave their child in full day care. Parents are finding it difficult to manage work life balance. Health dominated quality of life issues. Two hundred and thirty five (235) parents reported being stressed. The study also found that 315 working parents feel that the government is not doing enough to support working parents. On a positive note, 241 parents said they are happy in general with the quality of life for them, their family and their children. In addition, the researcher has identified a number of recommendations for future changes in policy and further study.

Design, development and testing of a CAD integrated design for environment software tool.

The research described in this thesis was developed as part o f the Information Management for Green Design (IMA GREE) Project. The 1MAGREE Project was founded by Enterprise Ireland under a Strategic Research Grant Scheme as a partnership project between Galway Mayo Institute o f Technology and C1MRU University College Galway. The project aimed to develop a CAD integrated software tool to support environmental information management for design, particularly for the electronics-manufacturing sector in Ireland.

Computer integrated testing for the transport refrigeration systems industry.

This is a study of a state of the art implementation of a new computer integrated testing (CIT) facility within a company that designs and manufactures transport refrigeration systems. The aim was to use state of the art hardware, software and planning procedures in the design and implementation of three CIT systems. Typical CIT system components include data acquisition (DAQ) equipment, application and analysis software, communication devices, computer-based instrumentation and computer technology. It is shown that the introduction of computer technology into the area of testing can have a major effect on such issues as efficiency, flexibility, data accuracy, test quality, data integrity and much more. Findings reaffirm how the overall area of computer integration continues to benefit any organisation, but with more recent advances in computer technology, communication methods and software capabilities, less expensive more sophisticated test solutions are now possible. This allows more organisations to benefit from the many advantages associated with CIT. Examples of computer integration test set-ups and the benefits associated with computer integration have been discussed.

Development of an integrated approach to reliability management and operation

The research described in this thesis has been developed as a part of the Reliability and Field Data Management for Multi-component Products (REFIDAM) Project. This project was founded under the Applied Research Grants Scheme administered by Enterprise Ireland. The project was a partnership between Galway-Mayo Institute of Technology and Thermo King Europe. The project aimed to develop a system in order to manage the information required for reliability assessment and improvement of multi-component products, by establishing information flows within the company and information exchange with fleet users.

Critical Care in in Neurology

Neurocritical care is an ever-changing field. The publishers and author of The Flying Publisher Guide to Critical Care in Neurology have made every effort to provide information that is accurate and complete as of the date of publication. However, in view of the rapid changes occurring in medical science, as well as the possibility of human error, this site may contain technical inaccuracies, typographical or other errors. It is the responsibility of the reading physician who must rely on experience and knowledge about the patient to determine the best treatment and care pathway. The information contained herein is provided “as is”, without warranty of any kind. The contributors to this book, including Flying Publisher & Kamps, disclaim responsibility for any errors or omissions or for results obtained from the use of information contained herein.

Managed Care in der Schweiz : eine empirische Analyse des Verhaltens von Allgemeinmedizinern

Managed Care, physicians' behavior, primary practice, efficiency, econometric analysis

Synthesis of integrated chemical processes for the production of single enantiomers

Magdeburg, Univ., Fak. für Elektrotechnik und Informationstechnik, Diss., 2011

Development and implementation of an integrated technical management system

Quality Management, Integrated Technical Management Systems, ITMS, Technical Elements, Environment, Occupational Health and safety, OH&S, Standards, ISO, General Regulations, Integration, Management Functions, Computer Centre, Suc-cess Concepts, Documentation, PCT, QMS, EMS, OH&S-MS, Portioning, Evaluation, Technical Cycle, Technical Compliance, Framework

Comparison of Cardiovascular Risk Factors in Different Areas of Health Care Over a 20-Year Period

Background:Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Knowledge about cardiovascular risk factors (CVRFs) in young adults and their modification over time are measures that change the risks and prevent CVDs.Objectives:To determine the presence of CVRFs and their changes in different health care professionals over a period of 20 years.Methods:All students of medicine, nursing, nutrition, odontology, and pharmacy departments of Federal University of Goiás who agreed to participate in this study were evaluated when they started their degree courses and 20 years afterward. Questionnaires on CVRFs [systemic arterial hypertension (SAH), diabetes mellitus, dyslipidemia, and family history of early CVD, smoking, alcohol consumption, and sedentarism] were administered. Cholesterol levels, blood sugar levels, blood pressure, weight, height, and body mass index were determined. The Kolmogorov-Smirnov test was used to evaluate distribution, the chi-square test was used to compare different courses and sexes, and the McNemar test was used for comparing CVRFs. The significance level was set at a p value of < 0.05.Results:The first stage of the study included 281 individuals (91% of all the students), of which 62.9% were women; the mean age was 19.7 years. In the second stage, 215 subjects were reassessed (76% of the initial sample), of which 59.07% were women; the mean age was 39.8 years. The sample mostly consisted of medical students (with a predominance of men), followed by nursing, nutrition, and pharmacy students, with a predominance of women (p < 0.05). Excessive weight gain, SAH, and dyslipidemia were observed among physicians and dentists (p < 0.05). Excessive weight gain and SAH and a reduction in sedentarism (p < 0.05) were observed among pharmacists. Among nurses there was an increase in excessive weight and alcohol consumption (p < 0.05). Finally, nutritionists showed an increase in dyslipidemia (p < 0.05).Conclusion:In general, there was an unfavorable progression of CVRFs in the population under study, despite it having adequate specialized knowledge about these risk factors.

I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes

Background:Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil.Objective:Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF.Methods:Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events.Results:A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included.Conclusion:The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence.

integrated method for improving risk analysis using human factors methods and virtual reality

Magdeburg, Univ., Fak. für Informatik, Diss., 2009