Qualidade de vida de mulheres com baixa massa óssea na pós-menopausa

OBJETIVO: avaliar a qualidade de vida de pacientes com osteoporose e osteopenia, acompanhadas em ambulatórios especializados em osteoporose e climatério, comparando-as com pacientes com densidade mineral óssea (DMO) normal. MÉTODOS: estudo de série de casos transversal, observacional, que se propôs a analisar, por meio do questionário Medical Outcomes Study 36 Short-Form Health Survey (SF-36), a qualidade de vida de mulheres com osteopenia e osteoporose. Foram avaliadas 124 mulheres na pós-menopausa divididas em três grupos: 55 pacientes com diagnóstico densitométrico de osteoporose, 35 com o de osteopenia e 34 que apresentavam DMO normal. Os três grupos foram comparados com relação aos dados demográficos, características clínicas e de estilo de vida e aos diferentes domínios do SF-36. RESULTADOS: as pacientes dos grupos osteopenia e DMO normal apresentaram menor idade média (56,7±7,1 e 52,9±5,4 anos), maior índice de massa corpórea (IMC) (28,6±3,7 e 30,9±5,1 kg/m²) e menor tempo de menopausa (8,4±5,9 e 5,8±4,5 anos) quando comparadas ao grupo osteoporose (61,8±10,1 anos, IMC de 25,7±5,3 kg/m², 15,5±7,5 anos, respectivamente; p<0,05). de acordo com o SF-36, não houve diferença significativa entre os grupos com relação aos domínios, à exceção do domínio vitalidade, que se mostrou superior no grupo osteoporose. Com relação à impressão pessoal sobre seu estado de saúde, das pacientes que o consideraram bom, um maior percentual pertencia ao grupo osteoporose, e entre aquelas que o consideraram ruim, um percentual menor pertencia ao grupo osteopenia. CONCLUSÃO: a qualidade de vida foi similar em mulheres com osteoporose e osteopenia, em relação às com DMO normal, à exceção do domínio vitalidade, que foi superior, paradoxalmente, nas pacientes com osteoporose.

Accuracy of Tc-99m-sestamibi scintimammography for breast cancer diagnosis

Scintimammography using Tc-99m-sestamibi is a noninvasive and painless diagnostic imaging method that is used to detect breast cancer when mammography is inconclusive Because of the advantages of labeling v '7,ith Tc-99m-sestamibi and its high efficiency in detecting carcinomas, it is the most widespread agent for this purpose Its accumulation in the tumor has multifactorial causes and does not depend on the presence of architectural distortion or local or diffuse density variation in the breast The objective of tfiis study was to evaluate the accuracy of scintimammography 1 for detecting breast cancer One hundred and fifty-seven patients presenting 158 palpable and non-palpable breast nodules were evaluated Three patients were male and 154 were female, aged between 14 and 81 years All patients underwent scintimammography, and the nodule was subjected i to cytological or histological study, i e, the gold standard for diagnosing cancer One hundred and eleven malignant and 47 benign nodules were detected, with predominance of ductal carcinomas (n=94) and fibroadenoma/fibrocysiic condition (n=11/n=11), respectively The mean size was 3 11 cm (7-10 cm) among the malignant nodules and 2 07 cm among the benign nodules (0 5-10 cm) The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 89, 89, 95, 78 and 89%, respectively Analysis on the histological types showed that the technique was more effective on tumors that were more aggressive, such as ductal carcinoma In this study, Tc-99m-sestamibi scintim immography was shown to be an important tool for diagnosing breast cancer when mammography was inconclusive

A redefinição do espaço urbano de Natal/RN a partir da influência dos serviços: uma análise das avenidas Bernardo Vieira e Engenheiro Roberto Freire

This paper analyzes the influence of trade and services in the reconfiguration of urban space in Natal, with the Avenues Bernardo Vieira end Roberto Freire Engineer as privileged analysis. Initially, we discussed the concepts of production and reproduction of urban space, urban centralities, decentralized, services and public policies, especially transport and tourism. Then, we show the construction of urban space from Natal, highlighting the historical formation of the districts of Ribeira, Cidade Alta and Alecrim, pioneers in the service sector, noting that currently there is an ongoing process of decentralization in the city of such activities, to other areas of the urban fabric of Natal. Later, we studied the Avenues Bernardo Vieira to Roberto Freire Engineer, noting, in both the distribution of commercial activities and services, and issues related to transportation, traffic, tourism and socio-economic problems, identified them. Finally, testify that Natal, from the 1980s, underwent a process of decentralization of services, both to the south, and north of the city on the ball. In this process of decentralization we ascertain the role of public policies on transport and tourism, complementing the action of private enterprise, through the real estate market, on Avenue Roberto Freire Engineer.

Frequência de fatores de risco cardiovascular em voluntários participantes de evento de educação em saúde

INTRODUCTION. Cardiovascular diseases (CVD) are the main cause of death in Brazil.OBJECTIVE. To evaluate the frequency of CVD risk factors In a population attending a health education community event.METHODS. Retrospective study that included 428 completed forms with clinical and demographic information of volunteers attending a public event, in May, 2006. Data were expressed by means and standard deviation or proportions and compared by Student's t test or Chi-square test. Associations between Arterial Hypertension (AH), Diabetes Mellitus (DM) and clinical variables were analyzed by multinomial logistic regression. Significance level was p<0.05.RESULTS. Mean age was 57 +/- 14years, and women represented 58% of the total population. The main cardiovascular risk factors were AH (39.5%), DM (15.4%) and dyslipidemia (25.89%). The frequency of unawareness about these risk factors was respectively 8.4%, 17.5% and 33.1%.. Family history of CVD was reported by 41% while only 67% reported having any information about DM or dyslipidemia. Among obese individuals (IMC >= 30 Kg/m2, 27.3% of the population), systolic blood pressure (133 +/- 16mmHg), diastolic blood pressure (84 +/- 11.5mmHg) and casual glycemia (124 +/- 52.5mg/dl) were higher when compared to non-obese (p<0.05). There was a significant association between obesity and dyslipidemia (p=0.04). Age and IMC were independently associated with AH and DM.CONCLUSION. The high frequency of modifiable cardiovascular risk factors in this population suggests the need for educational programs to promote primary prevention, mainly for the elderly and overweight. [Rev Assoc Med Bras 2009; 55(5): 606-10]

Quality of life and its association with cardiovascular risk factors in a community health care program population

OBJECTIVE: To evaluate quality of life in a population that attended a specific community event on health care education, and to investigate the association of their quality of life with the presence of cardiovascular risk factors INTRODUCTION: Interest in health-related quality of life is growing worldwide as a consequence of increasing rates of chronic disease. However, little is known about the association between quality of life and cardiovascular risk factors. METHODS: This study included 332 individuals. Demographics, blood pressure, body mass index, and casual glycemia were evaluated. The brief version of the World Health Organization Quality of Life questionnaire on quality of life was given to them. The medians of the scores obtained for the physical, psychological, emotional, and environmental domains were used as cutoffs to define higher and lower scores. A multinomial logistic regression model was used to define the parameters associated with lower scores. RESULTS: Diabetes mellitus, dyslipidemia, and obesity were associated with lower scores in the physical domain. Dyslipidemia was also associeted with lower scores in the psychological domain. Male gender and regular physical activity had protective effects on quality of life. Aging was inversely associated with decreased quality of life in the environmental domain. CONCLUSION: The presence of cardiovascular risk factors is related to a decreased quality of life. Conversely, male gender and regular physical activity had protective effects on quality of life. These findings suggest that exercising should be further promoted by health-related public programs, with a special focus on women.

Proposta de questionário para caracterização da prevalência de sintomas digestivos nas doenças difusas do tecido conjuntivo

RACIONAL: As doenças difusas do tecido conjuntivo afetam vários sistemas orgânicos, inclusive o digestório. Neste, as lesões variam em intensidade e freqüência na dependência da doença envolvida. A descrição das diferentes manifestações digestivas tem sido pouco freqüente, pouco detalhada e, não raro, baseada em experiências individuais e levantamentos retrospectivos. Tais formas de registro de dados produzem resultados muitas vezes conflitantes entre as diferentes casuísticas. OBJETIVO: Estabelecer de forma mais consistente, por intermédio de entrevista e questionário predefinido de sintomas, o conjunto e freqüência dos sintomas digestivos observados na esclerose sistêmica progressiva, artrite reumatóide, polimiosite/dermatomiosite, doença mista do tecido conjuntivo e lúpus eritematoso sistêmico. PACIENTES E MÉTODO: Estudaram-se 99 pacientes, 90% mulheres, com idade média de 45 anos. do total, 35 tinham artrite reumatóide, 26 esclerose sistêmica progressiva, 21 lúpus eritematoso sistêmico, 12 dermatomiosite/polimiosite e 5 doença mista do tecido conjuntivo. Todos foram submetidos, por investigador treinado, a entrevista e preenchimento de um questionário de sintomas digestivos, composto de 17 itens, previamente definidos. RESULTADOS: O estudo revelou elevada prevalência de sintomas gastrointestinais nas cinco doenças investigadas, muitas vezes afetando mais de 50% dos casos. Chamou a atenção a presença significativa de sintomas negligenciados pela literatura como a incontinência fecal. Discordante de trabalhos anteriores, os pacientes desta série com artrite reumatóide apresentaram variadas queixas digestivas, surpreendendo o achado de disfagia em 1/3 deles. CONCLUSÕES: As doenças difusas do tecido conjuntivo são causas de freqüentes e numerosos sintomas digestivos. O uso de questionários predefinidos mostrou-se instrumento válido na identificação de substancial número de sintomas, alguns deles ainda não referidos pela literatura. Por fim, foi constatada escassez de trabalhos passados e atuais relativos às manifestações gastrointestinais das doenças difusas do tecido conjuntivo, o que prejudicou análises comparativas mais amplas.

AT1-receptor mediated vascular damage in myocardium, kidneys and liver in rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

O efeito da autocorrelação no desempenho do gráfico T2 de hotelling: caso bivariado

The chart of control of Hotelling T2 has been the main statistical device used in monitoring multivariate processes. Currently the technological development of control systems and automation enabled a high rate of collection of information of the production systems in very short time intervals, causing a dependency between the results of observations. This phenomenon known as auto correlation causes in the statistical control of the multivariate processes a high rate of false alarms, prejudicing in the chart performance. This entails the violation of the assumption of independence and normality of the distribution. In this thesis we considered not only the correlation between two variables, but also the dependence between observations of the same variable, that is, auto correlation. It was studied by simulation, the bi variate case and the effect of auto correlation on the performance of the T2 chart of Hotelling.

Timoma em cão. Relato de caso

Uma cadela, Dachshund, quatro anos, foi encaminhada ao H.V. da FMVZ-UNESP-Botucatu-SP com histórico de prostração, emagrecimento progressivo, anorexia, cansaço e tosse seca. Ao exame clínico observou-se apatia, secreção nasal serosa bilateral e dispnéia intensa. Radiografia torácica demonstrou efusão pleural, edema pulmonar acentuado, desvio dorsal da traquéia e possível massa mediastinal. A ultra-sonografia, após drenagem torácica, confirmou a presença de massa mediastinal, sendo classificada como neoplasia maligna de origem epitelial pela citologia aspirativa por agulha fina. O animal veio a óbito logo após o diagnóstico de neoplasia. À necropsia constatou-se massa mediastinal encapsulada, consistência macia e superfície de corte com coloração branco-acinzentada e áreas necrótico-hemorrágicas, localizada na região ântero-ventral do tórax. O exame histopatológico demonstrou células epiteliais neoplásicas, células linfóides (timócitos) com morfologia normal, vasos sangüíneos de pequeno e médio calibre, formações císticas com conteúdo eosinofílico e corpúsculos de Hassall. A imunohistoquímica apresentou positividade para citoqueratina AE1/AE3 e UCHL, confirmando o diagnóstico de timoma.

Grafico misto de controle da media com amostragem em dois estagios

This paper proposes a new control chart to monitor a process mean employing a combined npx-X control chart. Basically the procedure consists of splitting the sample of size n into two sub-samples n1 and n2 determined by an optimization search. The sampling occur in two-stages. In the first stage the units of the sub-sample n1 are evaluated by attributes and plotted in npx control chart. If this chart signs then units of second sub-sample are measured and the monitored statistic plotted in X control chart (second stage). If both control charts sign then the process is stopped for adjustment. The possibility of non-inspection in all n items may promote a reduction not only in the cost but also the time spent to examine the sampled items. Performances of the current proposal, individual X and npx control charts are compared. In this study the proposed procedure presents many competitive options for the X control chart for a sample size n and a shift from the target mean. The average time to sign (ATS) of the current proposal lower than the values calculated from an individual X control chart points out that the combined control chart is an efficient tool in monitoring process mean.

Risk factors of oropharyngeal carriage of Pseudomonas aeruginosa among patients from a Medical-Surgical Intensive Care Unit

Oropharyngeal carriage of Pseudomonas aeruginosa is associated with increased risk of infection and may provide a source for spread of drug-resistant strains. In order to assess the incidence and risk factors of oropharyngeal carriage, we conducted a retrospective cohort study based on results of surveillance cultures (oropharyngeal swabs) from a medical-surgical intensive care unit, collected from March 2005 through May 2006. Variables investigated included demographic characteristics, comorbid conditions, invasive procedures, use of devices and use of antimicrobials. Thirty case patients with P. aeruginosa carriage were identified. Other 84 patients with surveillance cultures negative to P. aeruginosa were enrolled as control subjects. Case patients were more likely to have a solid malignancy (Odds Ratio [OR] = 12.04, 95% Confidence Interval [CI] = 1.93-75.09, p=0.008), Acquired Immunodeficiency Syndrome (AIDS, OR = 7.09, 95% CI=1.11-45.39, p = 0.04), central nervous system disease (OR = 4.51, 95% CI = 1.52-13.39, p = 0.007), or to have a central venous catheter placed (OR = 7.76, 95% CI = 1.68-35.79, p=0.009). The use of quinolones was a protective factor (OR = 0.13, 95% CI = 0.03-0.47, p = 0.002). The predominance of comorbidities as risk factors points out a group of patients to whom preventive measures should be directed.

Trabalhadores de verão : políticas públicas, turismo e emprego no litoral potiguar

El turismo en el Estado de Rio Grande do Norte (RN) se presenta constantemente por los medios de comunicación de massa como fuente de desarrollo regional y local , delante de las inversiones generadas y la posibilidad verdadera/potencial de trabajos en sus diversos sectores. Las políticas públicas del sector fueran y son responsables por la captación de inversiones privadas y su generación consiguiente de puestos de trabajo. En los años 90, el gobierno del RN puso el Programa de Desarrollo del Turismo en Rio Grande do Norte PRODETUR/RN I, con vistas a la competitividad local como destinación regional y nacional. El programa relacionado fue responsable por las inversiones diversas en infraestructura en los espacios implicados, aunque de forma asimétrica. Tales inversiones han contribuido para consolidar los discursos positivos con respecto al binomio turismo y trabajo . Con respecto a los discursos acríticos relacionados a este tema, mientras generador de trabajos y del desarrollo local es que se ha planteado esta investigación, puesto que la calidad de los trabajos generados por la actividad turística no se questiona y, de forma análoga, los costes sociales de la política pública, es decir, la importancia de su modelo de desarrollo , tampoco es questionado. Desde la problematica que se ha delineado arriba las questones que han norteado la investigación fueran: ¿de que forma la política pública del turismo llamada de PRODETUR/RN fue eficaz para generar empleo y renta a las ciudades en que se ha llavado a cabo? ¿Cuales son las características de estos trabajos? ¿ como estos trabajos se dividen en el espacio de las ciudades? Así el área delimitada para el estudio englobou las seis ciudades apoyadas por este Programa: Natal, Parnamirim, Ceará-Mirim, Nísia Floresta, Extremoz y Tibau do Sul. El recorte temporal de la pesquisa corresponde a la implantación de este programa (1996) hasta los dias actuales. La investigación de campo fue basada en el uso de 186 encuestas con los trabajadores en la actividad del turismo de litoral sur de Rio Grande do Norte, más allá de la realización (secundaria) de ocho entrevistas con agentes sociales que tienen relación con el tema. Como consideraciones finales de la investigación, se creer que hay una asimetría en el espacio turístico potiguar, donde Natal es la zona que más ha recibido las ventajas más grandes proporcionadas por la actividad, mientras que el restante de las ciudades son el eje para la sustentación de la actividad turística de Natal. De esta forma, las ciudades periféricas (todas, excepto Natal) incluidas en PRODETUR/RN ejercen el papel del subproducto de la ciudad capital, donde la precarización de las relaciones de trabajo se evidencian, todavía más en estas ciudades secundarias . La política pública en vez de intentar ecualizar las ventajas de la actividad en las seis ciudades, contribuye más, todavía para consolidar el nivel de centralizad de Natal. El PRODETUR/RN I fue capaz de generar, indirectamente, trabajos significativos, sin embargo la mayoría de éstos si presentan en los niveles operacionales de la actividad, con las características puestas en esta investigación (baja escolaridad, bajas rentas, falta de formalidad, levantadas horas de trabajo, bajo grado de sindicación y otros más); los puestos de trabajos creados si hallan sobretodo en Natal; y las demás ciudades sirven como elementos de apoyo para la capital mientras producto central de las decisiones sobre el turismo en el Estado del RN

A produção do espaço rural no município de Ceará-Mirim

This research intended to study the process of production of the rural space in the municipal district of Little Ceará-Mirim, looking for to identify the transformations in him happened, above all in the last thirty years. Since the beginning of your historical formation, the area in study had as element modelador and transformer of the physiognomy of your territory the culture canavieira that printed in your economy and in your society marks of a powerful nobility. The sugar-cane is covered of a cyclical character facing acme phases and decadence, as the one that it happens at the present time. Simultaneously, the sphere rural cearimirinense is going by changes by the implantation of modern companies gone back to the papaya production destined to the internal market and more precisely to the external market. Of this context they also consist the supplying farms of this same product. In the group of the establishments in the rural landscape here analyzed, they still interfere the mixed farms, the ones that practice agriculture, the ones that were devoted to the livestock, as well as the farms and the ranches. Another innovation is the caprinocultura developed in modern molds, using the system voisin of pasture rodízio being constituted in a pioneering experience in Brazil. Of that reality they announce other elements, to example of the establishments, being configured as new forms of use of the soil. In the perspective of turning them productive, the challenge resides of overcoming the difficulties in them existent. The reality of the space in screen is replete of lacks in all the instances. It is inferred that the municipal district possesses an enormous potential, however the performance of the administrative components is seen as deficient. He becomes urgent that the municipal public power promotes changes, mainly in what it respects to the social area, with a better attendance to the rural communities, for them to act positively in the process of the development of this municipal district