Risk factors for sudden infant death syndrome in a developing country

OBJECTIVE: To analyze whether previously identified risk factors for sudden death syndrome have a significant impact in a developing country. METHODS: Retrospective longitudinal case-control study carried out in Porto Alegre, Southern Brazil. Cases (N=39) were infants born between 1996 and 2000 who died suddenly and unexpectedly at home during sleep and were diagnosed with sudden death syndrome. Controls (N=117) were infants matched by age and sex who died in hospitals due to other conditions. Data were collected from postmortem examination records and questionnaires answers. A conditional logistic model was used to identify factors associated with the outcome. RESULTS: Mean age at death of cases was 3.2 months. The frequencies of infants regarding gestational age, breastfeeding and regular medical visits were similar in both groups. Sleeping position for most cases and controls was the lateral one. Supine sleeping position was found for few infants in both groups. Maternal variables, age below 20 years (OR=2, 95% CI: 1.1; 5.1) and smoking of more than 10 cigarettes per day during pregnancy (OR=3, 95% CI: 1.3; 6.4), significantly increased the risk for the syndrome. Socioeconomic characteristics were similar in both groups and did not affect risk. CONCLUSIONS: Infant-maternal and socioeconomic profiles of cases in a developing country closely resembled the profile described in the literature, and risk factors were similar as well. However, individual characteristics were identified as risks in the population studied, such as smoking during pregnancy and maternal age below 20 years.

O efeito da técnica de inibição de Jones nos músculos Masseter e temporal nas disfunções temporomandibulares

Introdução: A disfunção temporomandibular (DTM), de causa muscular, caracteriza-se por uma dor músculo-esquelética crónica, com sinais e sintomas específicos como a presença de Trigger Points (TrPs). Objetivo: Avaliar o efeito da Técnica de Inibição de Jones (TIJ) nos músculos masseter e temporal em indivíduos com DTM, e a identificação dos sinais e sintomas, a relação entre a severidade da DTM, a ansiedade e a qualidade de sono. Métodos: Estudo quasi-experimental, constituído por 16 indivíduos no grupo experimental (GE) e 17 grupo controle (GC). O grau de severidade foi avaliado pelo Índice de Helkimo e as alterações do sono pelo questionário de Pittsburgh sobre a qualidade do sono. Apenas o GE foi sujeito a uma TIJ nos TrPs latentes dos músculos masseter e temporal. Os dois grupos foram avaliados pré-intervenção (M0), pós-intervenção (M1) e 3 semanas após (M2), as amplitudes de movimento ativas de abertura, lateralidade direita/esquerda e protusão da boca bem como a dor (EVA) em repouso e na abertura máxima. Resultados: Foi possível observar que quanto maior o grau de DTM, maior a frequência de ansiedade e pior a qualidade do sono. Observou-se um decréscimo de TrPs, no GE, após a aplicação da técnica, principalmente no masseter. Não foi possível verificar diferenças inter-grupos. Contudo, observou-se no GE uma melhoria em todas as amplitudes avaliadas entre o M0 e o M2. Em relação à EVA em repouso e na abertura máxima, o GE demonstrou diminuição da dor no M1 e manteve valores inferiores no M2. Conclusão: Verifica-se uma diminuição dos TrPs, uma melhoria das amplitudes ativas bem como uma diminuição da dor após a aplicação da TIJ no GE. Já ao longo do tempo, o efeito é menos expressivo contudo observam-se valores inferiores comparativamente a M0.

ECO-betão com adição de resíduo da indústria petrolífera

Dissertação de natureza Científica para obtenção do grau de Mestre em Engenharia Civil na Área de Especialização em Edificações

Validity of the Brazilian version of WHOQOL-BREF in depressed patients using Rasch modelling

OBJECTIVE: To assess the validity of the Brazilian version of the World Health Organization Quality of Life Instrument - Abbreviated version (WHOQOL-BREF) in adults with major depression, using Rasch modelling. METHODS: Study analyzing data from the baseline sample of the Longitudinal Investigation of Depression Outcomes in Brazil, including a total of 208 patients with major depression recruited in a primary care service in Porto Alegre (Southern Brazil), in 1999. The Center for Epidemiological Studies Depression Scale was used to assess intensity of depression; the WHOQOL-BREF to assess generic quality of life; and the Composite International Diagnostic Interview version 2.1 for the diagnosis of depression. RESULTS: In the Rasch analysis, the four domains of WHOQOL-BREF showed appropriate fit to this model. Some items needed adjustments: four items were rescored (pain, finances, services, and transport); two items (work and activity) were identified as having dependency of responses, and one item was deleted (sleep) due to multidimensionality. CONCLUSIONS: The validation of the WHOQOL-BREF Brazilian version using Rasch analysis complements previous validation studies, evidencing the robustness of this instrument as a generic cross-cultural quality of life measure.

Energy-conscious tasks partitioning onto a heterogeneous multi-core platform

Modern multicore processors for the embedded market are often heterogeneous in nature. One feature often available are multiple sleep states with varying transition cost for entering and leaving said sleep states. This research effort explores the energy efficient task-mapping on such a heterogeneous multicore platform to reduce overall energy consumption of the system. This is performed in the context of a partitioned scheduling approach and a very realistic power model, which improves over some of the simplifying assumptions often made in the state-of-the-art. The developed heuristic consists of two phases, in the first phase, tasks are allocated to minimise their active energy consumption, while the second phase trades off a higher active energy consumption for an increased ability to exploit savings through more efficient sleep states. Extensive simulations demonstrate the effectiveness of the approach.

Enhanced Race-to-halt: a leakage-aware energy management approach for dynamic priority systems

With progressing CMOS technology miniaturization, the leakage power consumption starts to dominate the dynamic power consumption. The recent technology trends have equipped the modern embedded processors with the several sleep states and reduced their overhead (energy/time) of the sleep transition. The dynamic voltage frequency scaling (DVFS) potential to save energy is diminishing due to efficient (low overhead) sleep states and increased static (leakage) power consumption. The state-of-the-art research on static power reduction at system level is based on assumptions that cannot easily be integrated into practical systems. We propose a novel enhanced race-to-halt approach (ERTH) to reduce the overall system energy consumption. The exhaustive simulations demonstrate the effectiveness of our approach showing an improvement of up to 8 % over an existing work.

Slow down or race to halt: towards managing complexity of real-time energy management decisions

Existing work in the context of energy management for real-time systems often ignores the substantial cost of making DVFS and sleep state decisions in terms of time and energy and/or assume very simple models. Within this paper we attempt to explore the parameter space for such decisions and possible constraints faced.

Chronic use of benzodiazepines among older adults

OBJECTIVE To analyze the perception of and motivation for the chronic use of benzodiazepine among older adults. METHODS A qualitative study was conducted on 22 older adults living in Bambuí, MG, Southeastern Brazil, who were taking benzodiazepines and had the clinical and cognitive ability to respond to interview questions. The collected data were analyzed on the basis of the “signs, meanings, and actions” model. RESULTS The main reasons pointed out for the use of benzodiazepines were “nervousness”, “sleep problems”, and “worry” due to family and financial problems, everyday problems, and existential difficulties. None of the interviewees said that they used benzodiazepines in a dose higher than that recommended or had been warned by health professionals about any risks of their continuous use. Different strategies were used to obtain the prescription for the medication, and any physician would prescribe it, indicating that a bond was established with the drug and not with the health professional or healthcare service. Obtaining and consuming the medication turned into a crucial issue because benzodiazepine assumes the status of an essential food, which leads users to not think but sleep. It causes a feeling of relief from their problems such as awareness of human finitude and fragility, existential difficulties, and family problems. CONCLUSIONS Benzodiazepine assumes the characteristics of polyvalence among older adults, which extrapolate specific clinical indications, and of essentiality to deal with life’s problems in old age. Although it relieves the “nerves”, the chronic use of benzodiazepines buffers suffering and prevents older adults from going through the suffering. This shows important difficulties in the organization and planning of strategies that are necessary for minimizing the chronic use in this population.

Metabolic syndrome in fixed-shift workers

OBJECTIVE To analyze if metabolic syndrome and its altered components are associated with demographic, socioeconomic and behavioral factors in fixed-shift workers.METHODS A cross-sectional study was conducted on a sample of 902 shift workers of both sexes in a poultry processing plant in Southern Brazil in 2010. The diagnosis of metabolic syndrome was determined according to the recommendations from Harmonizing the Metabolic Syndrome. Its frequency was evaluated according to the demographic (sex, skin color, age and marital status), socioeconomic (educational level, income and work shift), and behavioral characteristics (smoking, alcohol intake, leisure time physical activity, number of meals and sleep duration) of the sample. The multivariate analysis followed a theoretical framework for identifying metabolic syndrome in fixed-shift workers.RESULTS The prevalence of metabolic syndrome in the sample was 9.3% (95%CI 7.4;11.2). The most frequently altered component was waist circumference (PR 48.4%; 95%CI 45.5;51.2), followed by high-density lipoprotein. Work shift was not associated with metabolic syndrome and its altered components. After adjustment, the prevalence of metabolic syndrome was positively associated with women (PR 2.16; 95%CI 1.28;3.64), workers aged over 40 years (PR 3.90; 95%CI 1.78;8.93) and those who reported sleeping five hours or less per day (PR 1.70; 95%CI 1.09;2.24). On the other hand, metabolic syndrome was inversely associated with educational level and having more than three meals per day (PR 0.43; 95%CI 0.26;0.73).CONCLUSIONS Being female, older and deprived of sleep are probable risk factors for metabolic syndrome, whereas higher educational level and higher number of meals per day are protective factors for metabolic syndrome in fixed-shift workers.

Occupational conditions and the risk of the use of amphetamines by truck drivers

OBJECTIVE To test whether the occupational conditions of professional truck drivers are associated with amphetamine use after demographic characteristics and ones regarding mental health and drug use are controlled for.METHODS Cross-sectional study, with a non-probabilistic sample of 684 male truck drivers, which was collected in three highways in Sao Paulo between years 2012 and 2013. Demographic and occupational information was collected, as well as data on drug use and mental health (sleep quality, emotional stress, and psychiatric disorders). A logistic regression model was developed to identify factors associated with amphetamine use. Odds ratio (OR; 95%CI) was defined as the measure for association. The significance level was established as p < 0.05.RESULTS The studied sample was found to have an average age of 36.7 (SD = 7.8) years, as well as low education (8.6 [SD = 2.3] years); 29.0% of drivers reported having used amphetamines within the twelve months prior to their interviews. After demographic and occupational variables had been controlled for, the factors which indicated amphetamine use among truck drivers were the following: being younger than 38 years (OR = 3.69), having spent less than nine years at school (OR = 1.76), being autonomous (OR = 1.65), working night shifts or irregular schedules (OR = 2.05), working over 12 hours daily (OR = 2.14), and drinking alcohol (OR = 1.74).CONCLUSIONS Occupational aspects are closely related to amphetamine use among truck drivers, which reinforces the importance of closely following the application of law (Resting Act (“Lei do Descanso”); Law 12,619/2012) which regulates the workload and hours of those professionals. Our results show the need for increased strictness on the trade and prescription of amphetamines in Brazil.

Consumo de benzodiazepinas por idosos institucionalizados: inapropriação, qualidade de sono e contributo para a segurança na medicação

A racionalização do uso de medicamentos constitui-se como um fator contribuinte para a melhoria da segurança do doente, particularmente no que respeita à segurança na medicação, tendo-se tornado prioritária para as organizações e instituições de saúde. A avaliação do uso de medicamentos inapropriados no idoso constitui-se como uma medida que concorre para evitar, prevenir ou corrigir eventos adversos associados ao seu uso. As benzodiazepinas são uma das classes de medicamentos mais prescritas em idosos. No entanto, e apesar de sua utilidade clínica, algumas benzodiazepinas são consideradas inapropriadas nesta faixa etária por potenciarem o efeito sedativo e aumentar a incidência de quedas e fraturas. A longo prazo, na promoção da qualidade do sono, a sua efetividade é discutível já que a toma de uma benzodiazepina para a resolução de um problema como o sono, muitas vezes pontual, passa a ser um problema crónico de exigência de toma contínua, sem que a qualidade deste seja restabelecida, pondo em risco a segurança do doente. Este estudo tem como objetivo caracterizar o consumo de benzodiazepinas por idosos institucionalizados, numa instituição de longa permanência do concelho de Sesimbra, sua inapropriação e a relação com a qualidade de sono. Foi desenvolvido um estudo descritivo e transversal, assente no paradigma qualitativo, com a recolha de dados a decorrer em três momentos: registo de informação em grelha própria da caracterização sociodemográfica e da caracterização do consumo de benzodiazepinas; aplicação do índice de Katz para determinar a funcionalidade dos participantes; aplicação do questionário adaptado do Pittsburgh Sleep Quality Index para avaliação da qualidade do sono. A inapropriação foi avaliada pela aplicação dos critérios de Beers. Após aplicação dos critérios de inclusão (idade superior a 65 anos e capacidade funcional) aos 97 utentes da instituição, a amostra foi constituída por 51 utentes. Foi recolhido consentimento informado de todos os participantes. Os resultados obtidos mostram que 46% das benzodiazepinas consumidas são de duração intermédia de ação, observando-se ainda um valor considerável de consumo de benzodiazepinas de longa duração de ação (36%). Estes valores correspondem a um grau elevado de inapropriação, potenciando os riscos para a segurança do doente nesta faixa etária. O lorazepam 2,5mg é a benzodiazepina mais utilizada como hipnótico. Mas, apesar do consumo deste grupo de medicamentos 81,6% dos idosos que consumem benzodiazepinas não apresentam boa qualidade de sono (PSQI>5), enquanto 77% dos idosos que não consomem benzodiazepinas apresentam boa qualidade de sono (PSQI≤5). Nos idosos que consomem benzodiazepinas, a média de tempo despendido na cama até adormecer foi de cerca de 55 minutos, valor superior ao grupo que não consome benzodiazepinas, onde a média é de 27 minutos. Neste grupo de idosos, o consumo de benzodiazepinas não só é inapropriado como não contribuiu para uma melhoria na qualidade de sono nem para a segurança do doente, como são os consumidores de benzodiazepinas que apresentam uma pior qualidade de sono, nas suas várias dimensões.

Optimização das fugas pela boca durante o CPAP nasal: banda submentoniana versus máscara facial

Introdução: O CPAP nasal é o tratamento de eleição para os pacientes com Síndrome da Apneia Obstrutiva do Sono (SAOS). Com a máscara nasal podem ocorrer fugas de ar pela boca, que podem por em causa a aderência do paciente ao tratamento devido muitas vezes ao desconforto que provocam, ao aumento do trabalho respiratório e por afectarem a qualidade do sono. Objectivos: Este estudo tem como principal objectivo verificar a eficácia da banda submentoniana e da máscara facial na correcção das fugas pela boca em pacientes com SAOS. Métodos e Participantes: Uma amostra de conveniência de 15 pacientes (8 homens) com SAOS e a fazerem CPAP com máscara nasal, foi recrutada. Foram divididos em dois grupos A e B, onde no grupo A se colocou a banda submentoniana e no grupo B se alterou a interface para máscara facial. Medidas e Resultados: As variáveis avaliadas neste estudo foram as fugas, o IAH, o percentil 95 da pressão de tratamento, a Sa,O2 e os efeitos adversos das duas intervenções. O nível de fugas reduziu no grupo A de 38±11,27 para 24,55±14,30L/min (p=0,002) e no grupo B de 34,34±16,50 para 18,51±16,22L/min (p=0,008). O IAH aumentou no grupo B de 2,60±2,13 para 4,41±3,88 (p=0,016). Relativamente ao percentil 95 da pressão de tratamento aumentou nos dois grupos (Grupo A de 10,15±2,63 para 12,08±2,45cmH2O (p=0,008) e no Grupo B 10,51±1,88 para 12,64±1,29cmH2O (p=0,008)). A Sa,O2 mínima aumentou e o tempo<90% diminui no grupo A com p=0,008, p=0,031, respectivamente. Quanto ao uso auto-reportado verificaram-se poucos efeitos adversos, salientando-se apenas a facilidade de colocação da banda submentoniana, a secura da boca nos dois grupos, a pressão no queixo provocada pela banda e a dor no dorso do nariz provocada pela máscara facial. Conclusão: Ambas as estratégias provaram ser mais eficazes a reduzir a fuga que a máscara nasal. Foram bem toleradas e com poucos efeitos adversos.

Race-to-halt energy saving strategies

Energy consumption is one of the major issues for modern embedded systems. Early, power saving approaches mainly focused on dynamic power dissipation, while neglecting the static (leakage) energy consumption. However, technology improvements resulted in a case where static power dissipation increasingly dominates. Addressing this issue, hardware vendors have equipped modern processors with several sleep states. We propose a set of leakage-aware energy management approaches that reduce the energy consumption of embedded real-time systems while respecting the real-time constraints. Our algorithms are based on the race-to-halt strategy that tends to run the system at top speed with an aim to create long idle intervals, which are used to deploy a sleep state. The effectiveness of our algorithms is illustrated with an extensive set of simulations that show an improvement of up to 8% reduction in energy consumption over existing work at high utilization. The complexity of our algorithms is smaller when compared to state-of-the-art algorithms. We also eliminate assumptions made in the related work that restrict the practical application of the respective algorithms. Moreover, a novel study about the relation between the use of sleep intervals and the number of pre-emptions is also presented utilizing a large set of simulation results, where our algorithms reduce the experienced number of pre-emptions in all cases. Our results show that sleep states in general can save up to 30% of the overall number of pre-emptions when compared to the sleep-agnostic earliest-deadline-first algorithm.

Nunca mais é sexta-feira: o impacto do processo de recuperação de recursos durante o fim de semana no engagement

Orientação: Doutora Maria Alexandra Pacheco Ribeiro da Costa

Cartografia e avaliação geotécnica de blocos rochosos em plataformas costeiras (Gaia, NW Portugal)

Mestrado em Engenharia Geotécnica e Geoambiente