Relação espacial dos óbitos e internações por tuberculose com indicadores sociais em Ribeirão Preto (SP)

Objetivo: Propôs-se analisar a relação espacial dos óbitos e internações evitáveis por TB com indicadores sociais em Ribeirão Preto/SP. Métodos: Trata-se de um estudo ecológico em que foram considerados os casos de óbitos e internações, tendo como causa básica do óbito e motivo principal da internação, a tuberculose (CID A15.0 a A19.9), ocorridos na zona urbana de Ribeirão Preto e registrados respectivamente no Sistema de Informação sobre Mortalidade e no Sistema de Internação Hospitalar do Sistema Único de Saúde no período de 2006 a 2012. Foi realizada a análise univariada das variáveis sociodemográficas e operacionais dos casos investigados. Para construção dos indicadores sociais utilizou-se a análise de componentes principais, sendo selecionados dados das áreas de abrangência do município, considerando os dados do Censo Demográfico de 2010. A geocodificação dos casos foi processada no TerraView versão 4.2.2. Recorreu-se à regressão linear múltipla, pelo método dos mínimos quadrados e à regressão espacial para análise da relação de dependência espacial entre os indicadores sociais e as taxas de mortalidade e de internações por TB. A autocorrelação nos resíduos da regressão linear múltipla foi testada por meio do Teste Global de Moran, as análises foram realizadas considerando os softwares Arcgis-versão 10.1, Statistica versão 12.0, OpenGeoDa versão 1.0 e R versão 3.2.3. Para o diagnóstico do melhor modelo de regressão espacial, utilizou-se o teste Multiplicador de Lagrange. Em todos os testes, foi fixado o nivel de significancia de alfa em 5% (p< 0,05). Resultados: Foram registrados 50 casos de óbitos e 196 casos de internações por TB. A maioria dos casos registrados em ambos os sistemas se deu em pessoas do sexo masculino (n=41; 82%/n=146; 74,5%) e com a forma clínica pulmonar (n=44; 80,0%/n=138; 67,9%). Na construção dos indicadores sociais, três novas variáveis surgiram, apresentando respectivamente variância total de 46,2%, 18,7% e 14,6% sendo denominadas como indicadores de renda, desigualdade social e equidade social. Na modelagem para verificar relação espacial entre os óbitos e os indicadores sociais observou-se que a equidade social foi indicador estatisticamente significativo (p=0,0013) com relação negativa a mortalidade, sendo o Modelo da Defasagem Espacial o melhor método para testar a dependência espacial, com valor de ? (rho) estimado em 0,53 e altamente significativo (p=0,0014). Já na modelagem da relação espacial entre as internações por tuberculose e os indicadores sociais, o indicador de renda apresentou-se estatisticamente significativo (p=0,015) com relação negativa a internação e o melhor método para testar a dependência espacial também foi o Modelo da Defasagem Espacial com valor de ? (rho) estimado em 0,80 e altamente significativo (p<0,0001). Conclusão: O estudo contribuiu no avanço do conhecimento de que a mortalidade e as internações por tuberculose são eventos socialmente determinados, o que sugere investimento por parte da gestão

The Use of Humor in Therapy : Research-Based Training Recommendations

Despite its essential and universal nature, humor has historically received limited attention from the behavioral sciences, particularly as compared to other affective experiences like anger and sadness. Some authors (e.g., Bell & Malhi, 2009; Provine, 2000a; Roeckelein, 2002) suggest that this is because researchers have traditionally failed to "take humor seriously" and, according to O'Connell (cited in Roeckelein, 2002), have too often pursued its study in a piecemeal manner lacking scientific rigor, resulting in "no comprehensive network of facts about the development and purposes of humor in human existence" (p. 1). Roeckelein (2002) found not a single mention of humor, laughter, wit, comedy, or theories relating to these topics in introductory psychology textbooks published between 1930 and 1996.While research interest in the area has grown, especially over the last decade, it remains an elusive and nebulous topic, more likely to be examined in specialty psychology texts (e.g., social psychology and child development) than general ones (Martin, 2007; Roeckelein, 2002). Organizations (e.g., The International Society for Humor Studies; The Association for the Advancement of Therapeutic Humor), journals (e.g., Humor: International Journal of Humor Research) and internet phenomena such as "The Humor Project" (www.humorproiect.com) have made great strides in integrating information about humor from discreet fields such as the arts and humanities, biological and social sciences, education, and business management. Still, the therapeutic potential of humor remains a relatively young subject of serious scientific inquiry (Marci, Moran, & Orr, 2004; Sala, Krupat, & Roter, 2002). While humor does make appearances in self-help books and publications addressing clinical applications, these sources are much ...

Detección de eventos adversos en cirugía general mediante la aplicación de la metodología "trigger tool"

Desde la publicación del trabajo de Brenan, Harvard Medical Practice Study, en los años 90, el estudio de los eventos adversos (EA) se ha convertido en objetivo fundamental de los sistemas sanitarios. Este estudio surgió con el objetivo de identificar los motivos del enorme gasto económico que suponían los procesos judiciales y las indemnizaciones derivadas de la asistencia sanitaria y en el se constató que el 3,7% de los ingresos hospitalarios sufrieron al menos un EA. El informe publicado por “The Institute of Medicine” en el año 1999 estimó que en Estados Unidos, aproximadamente 1 millón de pacientes padecían algún tipo de EA, y que el 7 % de estos EA podrían producir la muerte del paciente. Entre 44.000 y 98.000 pacientes morían como consecuencia de los EA. Hasta la actualidad decenas de trabajos con metodología similar al de Brenan se han llevado a cabo en diversos países. Sin embargo las motivaciones de los estudios posteriores, que se orientaban a la mejora de calidad más que la búsqueda de responsabilidades legales, dejaron de manifiesto que alrededor de un 10 % de las pacientes asistidos en hospitales sufrían algún EA...

Mineralogical composition of the upper 300m of Hole 302-M0002A

During the Arctic Coring Expedition (ACEX), a 428-m-thick sequence of Upper Cretaceous to Quaternary sediments was penetrated. The mineralogical composition of the upper 300 m of this sequence is presented here for the first time. Heavy and clay mineral associations indicate a major and consistent shift in provenance, from the Barents-Kara - western Laptev Sea region, characterized by presence of common clinopyroxene, to the eastern Laptev-East Siberian seas in the upper part of the section, characterized by common hornblende (amphibole). Sea ice originating from the latter source region must have survived at least one summer melt cycle in order to reach the ACEX drill site, if considering modern sea ice trajectories and velocities. This shift in mineral assemblages probably represents the onset of a perennial sea ice cover in the Arctic Ocean, which occurred at about 13 Ma, thus suggesting a coeval freeze in the Arctic and Antarctic regions.

Age control and stratigraphy of a sediment profile from the Lomonosov Ridge, Arctic Ocean

The upper 200 m of the sediments recovered during IODP Leg 302, the Arctic Coring Expedition (ACEX), to the Lomonosov Ridge in the central Arctic Ocean consist almost exclusively of detrital material. The scarcity of biostratigraphic markers severely complicates the establishment of a reliable chronostratigraphic framework for these sediments, which contain the first continuous record of the Neogene environmental and climatic evolution of the Arctic region. Here we present profiles of cosmogenic 10Be together with the seawater-derived fraction of stable 9Be obtained from the ACEX cores. The down-core decrease of 10Be/9Be provides an average sedimentation rate of 14.5 ± 1 m/Ma for the uppermost 151 m of the ACEX record and allows the establishment of a chronostratigraphy for the past 12.3 Ma. The age-corrected 10Be concentrations and 10Be/9Be ratios suggest the existence of an essentially continuous sea ice cover over the past 12.3 Ma.

Core correlation data and revised composite depth scale of Exp302 (ACEX) cores

Expedition 302 of the Integrated Ocean Drilling Program (IODP), also known as the Arctic Coring Expedition (ACEX), successfully penetrated a sequence of Cenozoic sediments draping the crest of the Lomonosov Ridge in the central Arctic Ocean. The cumulative sedimentary record spans the last 57 m.y. and was recovered from three sites located within 15 km of each other. Merging the recovered cores onto a common depth scale that accurately reflects their stratigraphic placement below the seafloor is a fundamental step toward interpreting this unique sedimentary record. However, the lack of overlapping recovery in adjacent holes and intervals of high core disturbance complicated traditional methods of stratigraphic correlation. Here we present a revised composite depth scale for the ACEX sediments, generated in part by performing a regional stratigraphic correlation with sediments recovered from previous expeditions to the Lomonosov Ridge. The revised depth scale also reassesses the offsets for cores in the upper 55 meters below seafloor, where no overlapping recovery was acquired, and proposes modifications to these depths.

Pollen abundances, and temperature and precipitation reconstruction for the Eocene to Oligocene transition in northern high latitudes

A profound global climate shift took place at the Eocene-Oligocene transition (~33.5 million years ago) when Cretaceous/early Palaeogene greenhouse conditions gave way to icehouse conditions (Zachos et al., 2001, doi:10.1126/science.1059412; Coxall et al., 2005, doi:10.1038/nature03135; Lear et al., 2008, doi:10.1130/G24584A.1). During this interval, changes in the Earth's orbit and a long-term drop in atmospheric carbon dioxide concentrations (Pagani et al., 2005, doi:10.1126/science.1110063; Pearson and Palmer, 2000, doi:10.1038/35021000; DeConto and Pollard, 2003, doi:10.1038/nature01290) resulted in both the growth of Antarctic ice sheets to approximately their modern size (Coxall et al., 2005, doi:10.1038/nature03135; Lear et al., 2008, doi:10.1130/G24584A.1) and the appearance of Northern Hemisphere glacial ice (Eldrett et al., 2007, doi:10.1038/nature05591; Moran et al., 2006, doi:10.1038/nature04800). However, palaeoclimatic studies of this interval are contradictory: although some analyses indicate no major climatic changes (Kohn et al., 2004, doi:10.1130/G20442.1; Grimes et al., 2005, doi:10.1130/G21019.1), others imply cooler temperatures (Zanazzi et al., 2007, doi:10.1038/nature05551), increased seasonality (Ivany et al., 2000, doi:10.1038/35038044; Terry, 2001, doi:10.1016/S0031-0182(00)00248-0) and/or aridity (Ivany et al., 2000, doi:10.1038/35038044; Terry, 2001, doi:10.1016/S0031-0182(00)00248-0; Sheldon et al., 2002, doi:10.1086/342865; Dupont-Nivet et al., 2007, doi:10.1038/nature05516). Climatic conditions in high northern latitudes over this interval are particularly poorly known. Here we present northern high-latitude terrestrial climate estimates for the Eocene to Oligocene interval, based on bioclimatic analysis of terrestrially derived spore and pollen assemblages preserved in marine sediments from the Norwegian-Greenland Sea. Our data indicate a cooling of ~5 °C in cold-month (winter) mean temperatures to 0-2 °C, and a concomitant increased seasonality before the Oi-1 glaciation event. These data indicate that a cooling component is indeed incorporated in the d18O isotope shift across the Eocene-Oligocene transition. However, the relatively warm summer temperatures at that time mean that continental ice on East Greenland was probably restricted to alpine outlet glaciers.