Comparação de modelos de assistência ao parto em hospitais públicos

OBJETIVO Comparar os modelos colaborativo e tradicional na assist&#234;ncia ao parto e nascimento. M&#201;TODOS Estudo transversal realizado com 655 prim&#237;paras em quatro hospitais do sistema &#250;nico de sa&#250;de em Belo Horizonte, MG, em 2011 (333 mulheres do modelo colaborativo e 322 do modelo tradicional, incluindo aquelas com trabalho de parto induzido e prematuro). Os dados foram coletados em entrevistas e levantamento de prontu&#225;rios. Foram aplicados os testes Qui-quadrado para compara&#231;&#227;o e regress&#227;o log&#237;stica m&#250;ltipla para determinar associa&#231;&#227;o entre o modelo e os desfechos analisados. RESULTADOS Houve diferen&#231;as significativas entre os modelos em rela&#231;&#227;o ao n&#237;vel de escolaridade e trabalho remunerado. No modelo colaborativo houve menor utiliza&#231;&#227;o da ocitocina (50,2% no modelo colaborativo versus 65,5% no modelo tradicional; p < 0,001), da ruptura artificial das membranas (54,3% no modelo colaborativo versus 65,9% no modelo tradicional; p = 0,012) e da taxa de episiotomia (16,1% no modelo colaborativo versus 85,2% no modelo tradicional; p < 0,001), e maior utiliza&#231;&#227;o de m&#233;todos n&#227;o farmacol&#243;gicos para al&#237;vio da dor (85,0% no modelo colaborativo versus 78,9% no modelo tradicional; p = 0,042). A associa&#231;&#227;o entre o modelo colaborativo e a redu&#231;&#227;o no uso da ocitocina, da ruptura artificial das membranas e da episiotomia manteve-se ap&#243;s o ajuste para fatores de confundimento. O modelo assistencial n&#227;o esteve associado a complica&#231;&#245;es neonatais ou maternas nem &#224; utiliza&#231;&#227;o de analgesia de condu&#231;&#227;o. CONCLUS&#213;ES Os resultados sugerem que o modelo colaborativo poder&#225; reduzir as interven&#231;&#245;es na assist&#234;ncia ao trabalho de parto e parto com resultados perinatais semelhantes.

Integração e continuidade do cuidado em modelos de rede de atenção à saúde para idosos frágeis

Foi realizada revis&#227;o cr&#237;tica da literatura sobre modelos que tenham avaliado a efetividade de redes assistenciais integradas e coordenadas para a popula&#231;&#227;o idosa. Foram pesquisadas as seguintes bases bibliogr&#225;ficas: Pubmed, The Cochrane Library, Lilacs, Web of Science, Scopus e SciELO. Doze artigos sobre cinco modelos diferentes foram inclu&#237;dos para a discuss&#227;o. A an&#225;lise da literatura mostrou que a presta&#231;&#227;o de servi&#231;os pautava-se na aten&#231;&#227;o b&#225;sica incluindo servi&#231;os domiciliares. Os usu&#225;rios contavam com a integra&#231;&#227;o de aten&#231;&#227;o prim&#225;ria, hospitalar, centros dia, servi&#231;os domiciliares e servi&#231;os sociais. O plano de cuidados e a gest&#227;o de caso foram elementos chaves para a continuidade de cuidado. Essa abordagem mostrou-se efetiva nos estudos, reduzindo o uso da aten&#231;&#227;o hospitalar, o que resultou em economia para o sistema financiador. Houve redu&#231;&#227;o da preval&#234;ncia de perda funcional, melhora na satisfa&#231;&#227;o e na qualidade de vida dos usu&#225;rios e de seus familiares. A an&#225;lise da literatura refor&#231;a a necessidade de se modificar a abordagem de assist&#234;ncia &#224; sa&#250;de dos idosos, e a integra&#231;&#227;o e coordena&#231;&#227;o dos servi&#231;os s&#227;o formas eficientes para iniciar essa mudan&#231;a.

Monitoring chlorophyll-a with remote sensing techniques in the Tagus Estuary

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Gestão e Sistemas Ambientais

O portefólio em faixas etárias precoces: potencialidades e constrangimentos

Mestrado em Ensino Precoce do Inglês

Women with HIV: gender violence and suicidal ideation

OBJECTIVE To analyze the relationship between gender violence and suicidal ideation in women with HIV. METHODS A cross-sectional study with 161 users of specialized HIV/AIDS care services. The study investigated the presence of gender violence through the Brazilian version of the World Health Organization Violence against Women instrument, and suicidal ideation through the Suicidal Ideation Questionnaire. Statistical analyses were performed with the SPSS software, using the Chi-square test and Poisson multiple regression model. RESULTS Eighty-two women with HIV reported suicidal ideation (50.0%), 78 (95.0%) of who had suffered gender violence. Age at first sexual intercourse < 15 years old, high number of children, poverty, living with HIV for long, and presence of violence were statistically associated with suicidal ideation. Women who suffered gender violence showed 5.7 times more risk of manifesting suicidal ideation. CONCLUSIONS Women with HIV showed a high prevalence to gender violence and suicidal ideation. Understanding the relationship between these two grievances may contribute to the comprehensive care of these women and implementation of actions to prevent violence and suicide.

Fractional dynamics in liquid manipulation

This paper presents a fractional calculus perspective in the study of signals captured during the movement of a mechanical manipulator carrying a liquid container. In order to study the signals an experimental setup is implemented. The system acquires data from the sensors, in real time, and, in a second phase, processes them through an analysis package. The analysis package runs off-line and handles the recorded data. The results show that the Fourier spectrum of several signals presents a fractional behavior. The experimental study provides useful information that can assist in the design of a control system and the trajectory planning to be used in reducing or eliminating the effect of vibrations.

Determinants of the exclusive breastfeeding abandonment: psychosocial factors

OBJECTIVE To assess the determinants of exclusive breastfeeding abandonment. METHODS Longitudinal study based on a birth cohort in Vi&#231;osa, MG, Southeastern Brazil. In 2011/2012, 168 new mothers accessing the public health network were followed. Three interviews, at 30, 60, and 120 days postpartum, with the new mothers were conducted. Exclusive breastfeeding abandonment was analyzed in the first, second, and fourth months after childbirth. The Edinburgh Postnatal Depression Scale was applied to identify depressive symptoms in the first and second meetings, with a score of &#8805; 12 considered as the cutoff point. Socioeconomic, demographic, and obstetric variables were investigated, along with emotional conditions and the new mothers&#8217; social network during pregnancy and the postpartum period. RESULTS The prevalence of exclusive breastfeeding abandonment at 30, 60, and 120 days postpartum was 53.6% (n = 90), 47.6% (n = 80), and 69.6% (n = 117), respectively, and its incidence in the fourth month compared with the first was 48.7%. Depressive symptoms and traumatic delivery were associated with exclusive breastfeeding abandonment in the second month after childbirth. In the fourth month, the following variables were significant: lower maternal education levels, lack of homeownership, returning to work, not receiving guidance on breastfeeding in the postpartum period, mother&#8217;s negative reaction to the news of pregnancy, and not receiving assistance from their partners for infant care. CONCLUSIONS Psychosocial and sociodemographic factors were strong predictors of early exclusive breastfeeding abandonment. Therefore, it is necessary to identify and provide early treatment to nursing mothers with depressive symptoms, decreasing the associated morbidity and promoting greater duration of exclusive breastfeeding. Support from health professionals, as well as that received at home and at work, can assist in this process.

Solid-State bipolar Marx modulator modeling

A mathematical model that simulates the operation of a solid-state bipolar Marx modulator topology, including the influence of parasitic capacitances is presented and discussed as a tool to analyze the circuit behavior and to assist the design engineer to select the semiconductor components and to enhance the operating performance. Simulations show good agreement with experimental results, considering a four stage circuit assembled with 1200 V isolated gate bipolar transistors and diodes, operating at 1000 V dc input voltage and 1-kHz frequency, giving 4 kV and 10-mu s output pulses into several resistive loads. Results show that parasitic capacitances between Marx cells to ground can significantly load the solid-state switches, adding new operating circuit conditions.

Analysis of the domain of applicability of an algorithm for a resources system selection problem for Distributed/Agile/Virtual Enterprises integration

The process of resources systems selection takes an important part in Distributed/Agile/Virtual Enterprises (D/A/V Es) integration. However, the resources systems selection is still a difficult matter to solve in a D/A/VE, as it is pointed out in this paper. Globally, we can say that the selection problem has been equated from different aspects, originating different kinds of models/algorithms to solve it. In order to assist the development of a web prototype tool (broker tool), intelligent and flexible, that integrates all the selection model activities and tools, and with the capacity to adequate to each D/A/V E project or instance (this is the major goal of our final project), we intend in this paper to show: a formulation of a kind of resources selection problem and the limitations of the algorithms proposed to solve it. We formulate a particular case of the problem as an integer programming, which is solved using simplex and branch and bound algorithms, and identify their performance limitations (in terms of processing time) based on simulation results. These limitations depend on the number of processing tasks and on the number of pre-selected resources per processing tasks, defining the domain of applicability of the algorithms for the problem studied. The limitations detected open the necessity of the application of other kind of algorithms (approximate solution algorithms) outside the domain of applicability founded for the algorithms simulated. However, for a broker tool it is very important the knowledge of algorithms limitations, in order to, based on problem features, develop and select the most suitable algorithm that guarantees a good performance.

Adaptive tackling of the swinging problem for a 2 DOF crane – payload system

The control of a crane carrying its payload by an elastic string corresponds to a task in which precise, indirect control of a subsystem dynamically coupled to a directly controllable subsystem is needed. This task is interesting since the coupled degree of freedom has little damping and it is apt to keep swinging accordingly. The traditional approaches apply the input shaping technology to assist the human operator responsible for the manipulation task. In the present paper a novel adaptive approach applying fixed point transformations based iterations having local basin of attraction is proposed to simultaneously tackle the problems originating from the imprecise dynamic model available for the system to be controlled and the swinging problem, too. The most important phenomenological properties of this approach are also discussed. The control considers the 4th time-derivative of the trajectory of the payload. The operation of the proposed control is illustrated via simulation results.

Collaborative environment to support a professional community

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Engenharia Electrotécnica e de Computadores

INbreast: Toward a Full-field Digital Mammographic Database

Rationale and Objectives Computer-aided detection and diagnosis (CAD) systems have been developed in the past two decades to assist radiologists in the detection and diagnosis of lesions seen on breast imaging exams, thus providing a second opinion. Mammographic databases play an important role in the development of algorithms aiming at the detection and diagnosis of mammary lesions. However, available databases often do not take into consideration all the requirements needed for research and study purposes. This article aims to present and detail a new mammographic database. Materials and Methods Images were acquired at a breast center located in a university hospital (Centro Hospitalar de S. João [CHSJ], Breast Centre, Porto) with the permission of the Portuguese National Committee of Data Protection and Hospital's Ethics Committee. MammoNovation Siemens full-field digital mammography, with a solid-state detector of amorphous selenium was used. Results The new database—INbreast—has a total of 115 cases (410 images) from which 90 cases are from women with both breasts affected (four images per case) and 25 cases are from mastectomy patients (two images per case). Several types of lesions (masses, calcifications, asymmetries, and distortions) were included. Accurate contours made by specialists are also provided in XML format. Conclusion The strengths of the actually presented database—INbreast—relies on the fact that it was built with full-field digital mammograms (in opposition to digitized mammograms), it presents a wide variability of cases, and is made publicly available together with precise annotations. We believe that this database can be a reference for future works centered or related to breast cancer imaging.

ERICA: prevalence of asthma in Brazilian adolescents

ABSTRACT OBJECTIVE To describe the prevalence of asthma and physician-diagnosed asthma in Brazilian adolescents. METHODS Cross-sectional, national, school-based study with adolescents from 12 to 17 years old, participants in the Study of Cardiovascular Risks in Adolescents (ERICA). The study stratified the sample by region and grouped according to schools and classes with representativeness to the set of cities with more than 100,000 inhabitants of the Country, macro-regions, capitals, and Federal District. A questionnaire collected data through a self-filled in method. We calculated the prevalences and their confidence intervals of 95% (95%CI) according to sex, age group, type of school and skin color. RESULTS Between 2013 and 2014, 74,589 adolescents were evaluated, 55.3% of the female sex. The total prevalence of active asthma was of 13.1% (95%CI 12.1-13.9), being higher in girls (14.8%; 95%CI 13.7-16.0) when compared to boys (11.2%; 95%CI 10.3-12.2) in all geographical strata examined. It was also higher between students of private schools (15.9%; 95%CI 14.2-17.7) when compared to public ones (12.4%; 95%CI 11.4-13.4). It was higher in the Southeast region (14.5%; 95%CI 12.9-16.1), and in the city of Sao Paulo (16.7%; 95%CI 14.7-18.7). The lowest prevalence was observed in North region (9.7%; 95%CI 9.7-10.5), and in Teresina (6.3%; 95%CI 4.9-7.7). The prevalence of physician-diagnosed asthma was of 8.7% (95%CI 8.2-9.1); higher in the North region (13.5%; 95%CI 12.7-14.2), and in Porto Alegre (19.8%; 95%CI 17.5-22.3). It was lower in the Midwest (6.9%; 95%CI 6.0-7.8), and in Cuiaba (4.8%; 95%CI 3.8-5.9). We found no significant difference in the expression of this rate between the sexes, as well as in other variables evaluated by the study. CONCLUSIONS The prevalence of asthma in Brazilian adolescents is high. Rates of active asthma and physician-diagnosed asthma vary widely in different regions and capitals evaluated by the ERICA. These results may assist in the preparation of preventive programs and policies on health and a better understanding of the factors associated with asthma in this age group.

Real-time fault injection using enhanced on-chip debug infrastructures

The rapid increase in the use of microprocessor-based systems in critical areas, where failures imply risks to human lives, to the environment or to expensive equipment, significantly increased the need for dependable systems, able to detect, tolerate and eventually correct faults. The verification and validation of such systems is frequently performed via fault injection, using various forms and techniques. However, as electronic devices get smaller and more complex, controllability and observability issues, and sometimes real time constraints, make it harder to apply most conventional fault injection techniques. This paper proposes a fault injection environment and a scalable methodology to assist the execution of real-time fault injection campaigns, providing enhanced performance and capabilities. Our proposed solutions are based on the use of common and customized on-chip debug (OCD) mechanisms, present in many modern electronic devices, with the main objective of enabling the insertion of faults in microprocessor memory elements with minimum delay and intrusiveness. Different configurations were implemented starting from basic Components Off-The-Shelf (COTS) microprocessors, equipped with real-time OCD infrastructures, to improved solutions based on modified interfaces, and dedicated OCD circuitry that enhance fault injection capabilities and performance. All methodologies and configurations were evaluated and compared concerning performance gain and silicon overhead.

Robotic manipulators with vibrations: short time fourier transform of fractional spectra

This paper analyzes the signals captured during impacts and vibrations of a mechanical manipulator. In order to acquire and study the signals an experimental setup is implemented. The signals are treated through signal processing tools such as the fast Fourier transform and the short time Fourier transform. The results show that the Fourier spectrum of several signals presents a non integer behavior. The experimental study provides valuable results that can assist in the design of a control system to deal with the unwanted effects of vibrations.