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Background: Constipation has been linked to cognitive impairment development in Parkinson's disease (PD). Objective: Our aim was to analyze cognitive changes observed in PD patients and controls from a Spanish cohort with regards to the presence or not of constipation. Methods: PD patients and controls recruited from 35 centers of Spain from the COPPADIS cohort from January 2016 to November 2017 were followed-up during 2 years. The change in cognitive status from baseline (V0) to 2-year follow-up was assessed with the PD-CRS (Parkinson's Disease Cognitive Rating Scale). Subjects with a score >= 1 on item 21 of the NMSS (Non-Motor Symptoms Scale) at baseline (V0) were considered as "with constipation". Regression analyses were applied for determining the contribution of constipation in cognitive changes. Results: At V0, 39.7% (198/499) of PD patients presented constipation compared to 11.4% of controls (14/123) (p < 0.0001). No change was observed in cognitive status (PD-CRS total score) neither in controls without constipation (from 100.24 +/- 13.72 to 100.27 +/- 13.68; p = 0.971) and with constipation (from 94.71 +/- 10.96 to 93.93 +/- 13.03; p = 0.615). The PD-CRS total score decreased significantly in PD patients with constipation (from 89.14 +/- 15.36 to 85.97 +/- 18.09; p

COPPADIS Study Group., [Introduction] In a degenerative disorder such as Parkinson’s disease (PD), it is important to establish clinical stages that allow to know the course of the disease. Our aim was to analyze whether a scale combining Hoehn and Yahr’s motor stage (H&Y) and the nonmotor symptoms burden (NMSB) (assessed by the nonmotor symptoms scale (NMSS)) provides information about the disability and the patient’s quality of life (QoL) with regard to a defined clinical stage., [Materials and Methods] Cross-sectional study in which 603 PD patients from the COPPADIS cohort were classified according to H&Y (1, stage I; 2, stage II; 3, stage III; 4, stage IV/V) and NMSB (A: NMSS = 0–20; B: NMSS = 21–40; C: NMSS = 41–70; D: NMSS ≥ 71) in 16 stages (HY.NMSB, from 1A to 4D). QoL was assessed with the PDQ-39SI, PQ-10, and EUROHIS-QOL8 and disability with the Schwab&England ADL (Activities of Daily Living) scale., [Results] A worse QoL and greater disability were observed at a higher stage of H&Y and NMSB (). Combining both (HY.NMSB), patients in stages 1C and 1D and 2C and 2D had significantly worse QoL and/or less autonomy for ADL than those in stages 2A and 2B and 3A and 3B, respectively (; e.g., PDQ-39SI in 1D [n = 15] vs 2A [n = 101]: 28.6 ± 17.1 vs 7.9 ± 5.8; )., [Conclusion] The HY.NMSB scale is simple and reflects the degree of patient involvement more accurately than the H&Y. Patients with a lower H&Y stage may be more affected if they have a greater NMS burden.

[Background and objective] Diplopia is relatively common in Parkinson’s disease (PD) but is still understudied. Our aim was to analyze the frequency of diplopia in PD patients from a multicenter Spanish cohort, to compare the frequency with a control group, and to identify factors associated with it., [Patients and Methods] PD patients who were recruited from January 2016 to November 2017 (baseline visit; V0) and evaluated again at a 2-year ± 30 days follow-up (V2) from 35 centers of Spain from the COPPADIS cohort were included in this longitudinal prospective study. The patients and controls were classified as “with diplopia” or “without diplopia” according to item 15 of the Non-Motor Symptoms Scale (NMSS) at V0, V1 (1-year ± 15 days), and V2 for the patients and at V0 and V2 for the controls., [Results] The frequency of diplopia in the PD patients was 13.6% (94/691) at V0 (1.9% in controls [4/206]; p < 0.0001), 14.2% (86/604) at V1, and 17.1% (86/502) at V2 (0.8% in controls [1/124]; p < 0.0001), with a period prevalence of 24.9% (120/481). Visual hallucinations at any visit from V0 to V2 (OR = 2.264; 95%CI, 1.269–4.039; p = 0.006), a higher score on the NMSS at V0 (OR = 1.009; 95%CI, 1.012–1.024; p = 0.015), and a greater increase from V0 to V2 on the Unified Parkinson’s Disease Rating Scale–III (OR = 1.039; 95%CI, 1.023–1.083; p < 0.0001) and Neuropsychiatric Inventory (OR = 1.028; 95%CI, 1.001–1.057; p = 0.049) scores were independent factors associated with diplopia (R2 = 0.25; Hosmer and Lemeshow test, p = 0.716)., [Conclusions] Diplopia represents a frequent symptom in PD patients and is associated with motor and non-motor severity., Martínez-Martin P. has received honoraria from National School of Public Health (ISCIII), Editori-al Viguera and Takeda Pharmaceuticals for lecturing in courses, and from the International Parkinson and Movement Disorder Society (MDS) for management of the Program on Rating Scales. Mir P. has received honoraria from AbbVie, Abbott, Allergan, Bial, Merz, UCB, and Zambon and have received grants from the Spanish Ministry of Economy and Competitiveness [PI16/01575], co-founded by ISCIII (Subdirección General de Evaluación y Fomento de la Investigación) and by Fondo Europeo de Desarrollo Regional (FEDER), the Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía [CVI-02526, CTS-7685], the Consejería de Salud y Bienestar Social de la Junta de Andalucía [ PI-0437-2012, PI-0471-2013], the Sociedad Andaluza de Neurología, the Jacques and Gloria Gossweiler Foundation, the Fundación Alicia Koplowitz, the Fundación Mutua Madrileña.

Esta pesquisa avalia os impactos e estratégias da comercialização de alimentos da agricultura familiar no Distrito Federal e Entorno durante as restrições impostas pela pandemia de Co-vid-19. A crise social causada pelo coronavírus resultou em mudanças abruptas e imprevisíveis para agricultura familiar. As associações e cooperativas que representam os pequenos agricultores precisaram se reorganizar rapidamente para reduzir as perdas e desenvolver alternativas de comercialização. Os dados foram coletados em entrevistas semiestruturadas com presidentes e gestores de 17 associações e cooperativas agrícolas do DF e Entorno. Apesar do prejuízo, associações e cooperativas desenvolveram estratégias de comercialização e intensificaram canais de distribuição de alimentos. Políticas públicas, como o Programa de Aquisição de Alimentos (PAA) e o Programa Nacional de Alimentação Escolar (Pnae), foram importantes nesse contexto de pandemia para manter a produção viável, evitar perdas e manter a renda do agricultor. Ao mesmo tempo, essas políticas auxiliam no abastecimento de alimentos à população dependente desses programas, como os alunos atendidos na rede pública de ensino e seus familiares, que fazem parte de uma população de grande fragilidade socioeconômica. Made available in DSpace on 2021-05-24T17:25:57Z (GMT). No. of bitstreams: 1 Covid-19-impactos.pdf: 260453 bytes, checksum: 8f141361598f07b256572b19cc098725 (MD5) Previous issue date: 2021

Houve um boom no consumo e no preço das commodities no período entre 2003 e 2011 (com uma retração entre 2008 e 2009), impulsionados especialmente pelo aumento da demanda da China. Tais produtos são ?ativos? que podem gerar riqueza nos países produtores, mas também podem levar esses países a terem perdas no longo prazo (segundo análises que fortalecem os argumentos acerca da ?reprimarização? dos países produtores de commodities). Ainda, com o aumento da população e da renda nos países em desenvolvimento, especialmente os do leste asiático, acredita-se que a produção e o fornecimento de commodities (minerais, metais e agrícolas) para o mundo se tornam crescentemente uma fonte de ?poder geopolítico?. Embora a recente pandemia do SARS-COV-2 tenha abalado o comércio internacional, a necessidade importação de produtores agrícolas por alguns países continua forte. Não é à toa que o PIB do agronegócio brasileiro avançou 24,31% em 2020.

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Quality of life (QOL) plays an important role in independent living in Parkinson's disease (PD) patients, being crucial to know what factors impact QoL throughout the course of the disease. Here we identified predictors of QoL impairment in PD patients from a Spanish cohort. PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016, to November 2017, were followed up during 2 years. Health-related QoL (HRQoL) and global QoL (GQoL) were assessed with the 39-item Parkinson's disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8), respectively, at baseline (V0) and at 24 months +/- 1 month (V2). Clinically significant QoL impairment was defined as presenting an increase (PDQ-39SI) or decrement (EUROHIS-QOL8) at V2 >= 10% of the score at baseline (V0). A comparison with a control group was conducted for GQoL. GQoL did not change significantly in PD patients (N = 507; p = 0.686) or in the control group (N = 119; p = 0.192). The mean PDQ-39SI was significantly increased in PD patients (62.7 +/- 8.5 years old; 58.8% males; N = 500) by 21.6% (from 16.7 +/- 13 to 20.3 +/- 16.4; p < 0.0001) at V2. Ninety-three patients (18.6%) presented a clinically significant HRQoL impairment at V2. To be younger (OR = 0.896; 95% CI 0.829-0.968; p = 0.006), to be a female (OR = 4.181; 95% CI 1.422-12.290; p = 0.009), and to have a greater increase in BDI-II (Beck Depression Inventory-II) (OR = 1.139; 95% CI 1.053-1.231; p = 0.001) and NMSS (Non-Motor Symptoms Scale) (OR = 1.052; 95% CI 1.027-1.113; p < 0.0001) total scores from V0 to V2 were associated with clinically significant HRQoL impairment at the 2-year follow-up (Hosmer-Lemeshow test, p = 0.665; R-2 = 0.655). An increase in >= 5 and >= 10 points of BDI-II and NMSS total score at V2 multiplied the probability of presenting clinically significant HRQoL impairment by 5 (OR = 5.453; 95% CI 1.663-17.876; p = 0.005) and 8 (OR = 8.217; 95% CI, 2.975-22.696; p = 0.002), respectively. In conclusion, age, gender, mood, and non-motor impairment were associated with clinically significant HRQoL impairment after the 2-year follow-up in PD patients.

COPPADIS Study Group., Quality of life (QOL) plays an important role in independent living in Parkinson’s disease (PD) patients, being crucial to know what factors impact QoL throughout the course of the disease. Here we identified predictors of QoL impairment in PD patients from a Spanish cohort. PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016, to November 2017, were followed up during 2 years. Health-related QoL (HRQoL) and global QoL (GQoL) were assessed with the 39-item Parkinson’s disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8), respectively, at baseline (V0) and at 24 months ± 1 month (V2). Clinically significant QoL impairment was defined as presenting an increase (PDQ-39SI) or decrement (EUROHIS-QOL8) at V2 ≥ 10% of the score at baseline (V0). A comparison with a control group was conducted for GQoL. GQoL did not change significantly in PD patients (N = 507; p = 0.686) or in the control group (N = 119; p = 0.192). The mean PDQ-39SI was significantly increased in PD patients (62.7 ± 8.5 years old; 58.8% males; N = 500) by 21.6% (from 16.7 ± 13 to 20.3 ± 16.4; p, Mir P. has received honoraria from AbbVie, Abbott, Allergan, Bial, Merz, UCB and Zambon and have received grants from the Spanish Ministry of Economy and Competitiveness [PI16/01575] co-founded by ISCIII (Subdirección General de Evaluación y Fomento de la Investigación) and by Fondo Europeo de Desarrollo Regional (FEDER), the Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía [CVI-02526, CTS-7685], the Consejería de Salud y Bienestar Social de la Junta de Andalucía [PI-0437-2012, PI-0471-2013], the Sociedad Andaluza de Neurología, the Jacques and Gloria Gossweiler Foundation, the Fundación Alicia Koplowitz, the Fundación Mutua Madrileña.

BACKGROUND: Although depression is known to be frequent in Parkinson's disease (PD), it is unclear how mood can change and/or impact on patient's quality of life (QoL) over time. Our aim was to analyze the frequency of depression, mood related factors and the contribution of mood to a patient's QoL perception in regard to disease duration. METHODS: PD patients recruited from the COPPADIS cohort from January 2016 to November 2017 were included in this cross-sectional study. Three groups were defined

SUMMARY OBJECTIVE To evaluate the physical and financial participation of private health insurance beneficiaries in the TH located in the State of Sao Paulo, regarding the care of Brazilian Unique Health System patients, in the year 2017. METHODS The research data were obtained from the System of Evaluation of the Teaching Hospitals (SAHE), of the State Department of Health of São Paulo (SES/SP). RESULTS It was observed that, on average, the TH analyzed provide 17% of their operational vacancies for the Supplementary Health System, and that the financial return is better in the philanthropic ones. CONCLUSIONS The health care services provided by TH deserve to be deepened, evaluating the real advantages obtained in the provision of services, given that supplementary health care requires differentiated infrastructure, and mainly the knowledge of operational costs in order to stipulate the procedures’ price. RESUMO OBJETIVO Avaliar a participação física e financeira do atendimento aos beneficiários de planos privados de saúde nos Hospitais de Ensino (HE) do Estado de São Paulo (ESP), em relação ao atendimento a pacientes do Sistema Único de Saúde, no ano de 2018. MÉTODOS os dados da pesquisa foram obtidos do Sistema de Avaliação dos Hospitais de Ensino (SAHE), da Secretaria de Estado da Saúde do Estado de São Paulo e do Departamento de Informática do SUS (DATASUS) do Ministério da Saúde. RESULTADOS observou-se que, em média os HE analisados ofertam 18,7% dos leitos operacionais para a Saúde Suplementar (SS), e que o retorno financeiro é melhor nos filantrópicos. CONCLUSÕES o atendimento a planos de saúde pelos HE merece ser aprofundado, avaliando-se as reais vantagens obtidas na prestação dos serviços e que o atendimento à SS exige infraestrutura diferenciada, e, principalmente o conhecimento de custos operacionais para estipulação de preços dos procedimentos.

Introduction: The aim of the present study was to examine the frequency of self-reported sleep problems and their associated factors in a large cohort of PD patients. Methods: PD patients and controls, recruited from 35 centers of Spain from the COPPADIS cohort were included in this cross-sectional study. Sleep problems were assessed by the Spanish version of the Parkinson's disease Sleep Scale version 1 (PDSS-1). An overall score below 82 or a score below 5 on at least 1 item was defined as sleep problems. Results: The frequency of sleep problems was nearly double in PD patients compared to controls: 65.8% (448/681) vs 33.5% (65/206) (p < 0.0001). Mean total PDSS score was lower in PD patients than controls: 114.9 +/- 28.8 vs 132.8 +/- 16.3 (p < 0.0001). Quality of life (QoL) was worse in PD patients with sleep problems compared to those without: PDQ-39SI, 19.3 +/- 14 vs 13 +/- 11.6 (p < 0.0001); EUROHIS-QoL8, 3.7 +/- 0.5 vs 3.9 +/- 0.5 (p < 0.0001). Non-motor symptoms burden (NMSS; OR = 1.029; 95%CI 1.015-1.043; p < 0.0001) and impulse control behaviors (QUIP-RS; OR = 1.054; 95%CI 1.009-1.101; p = 0.018) were associated with sleep problems after adjustment for age, gender, disease duration, daily equivalent levodopa dose, H&Y, UPDRS-III, UPDRS-IV, PD-CRS, BDI-II, NPI, VAS-Pain, VAFS, FOGQ, and total number of non-antiparkinsonian treatments. Conclusion: Sleep problems were frequent in PD patients and were related to both a worse QoL and a greater non-motor symptoms burden in PD. These findings call for increased awareness of sleep problems in PD patients.

Made available in DSpace on 2020-12-12T02:01:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-04-01 Associação Brasileira de Saúde Coletiva Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background and objective In the present study, we compared the effect of diabetic pregnancy on the rectus abdominis muscle (RAM) in humans and rats. We hypothesized that our animal model could provide valuable information about alterations in the RAM of women with Gestational Diabetes (GDM). Method Newborns female rats (n = 10/group) were administered streptozotocin (100 mg/kg body weight) subcutaneously and were mated on reaching adulthood, to develop the mild hyperglycemic pregnant (MHP) rat model. At the end of pregnancy, the mothers were sacrificed, and the RAM tissue was collected. Pregnant women without GDM (non-GDM group; n = 10) and those diagnosed with GDM (GDM group; n = 8) and undergoing treatment were recruited, and RAM samples were obtained at C-section. The RAM architecture and the distribution of the fast and slow fibers and collagen were studied by immunohistochemistry. Results No statistically significant differences in the maternal and fetal characters were observed between the groups in both rats and women. However, significant changes in RAM architecture were observed. Diabetes in pregnancy increased the abundance of slow fibers and decreased fast fiber number and area in both rats and women. A decrease in collagen distribution was observed in GDM women; however, a similar change was not observed in the MHP rats. Conclusion Our results indicated that pregnancy- associated diabetes- induced similar structural adaptations in the RAM of women and rats with slight alterations in fiber type number and area. These findings suggest that the MHP rat model can be used for studying the effects of pregnancy-associated diabetes on the fiber structure of RAM. Perinatal Diabetes Research Center University Hospital Botucatu Medical School Univ. Estadual Paulista-UNESP Department of Gynecology and Obstetrics São Paulo State University (UNESP) Botucatu Medical School Department of Physiotherapy and Occupational Therapy São Paulo State University (UNESP) School of Philosophy and Sciences Department of Health Sciences Universidade Sagrado Coração Department of Anatomy São Paulo State University (UNESP) Institute of Biosciences Department of Biostatistics São Paulo State University (UNESP) Bioscience Institute Universidade Estadual Paulista Case Western Reserve University Pontificia Universidad Catolica de Chile Imperial College London Universidade Federal de São Paulo Universidade Católica de Pernambuco Faculdade de Medicina de Marília Maastrich University Charité Universitätsmedizin Berlin Universidade do Sagrado Coração Faculdades Integradas de Bauru Perinatal Diabetes Research Center University Hospital Botucatu Medical School Univ. Estadual Paulista-UNESP Department of Gynecology and Obstetrics São Paulo State University (UNESP) Botucatu Medical School Department of Physiotherapy and Occupational Therapy São Paulo State University (UNESP) School of Philosophy and Sciences Department of Anatomy São Paulo State University (UNESP) Institute of Biosciences Department of Biostatistics São Paulo State University (UNESP) Bioscience Institute Universidade Estadual Paulista FAPESP: #2014/26852-6 FAPESP: #2016/01743-5 FAPESP: #2016/09710-9

C-reactive protein (CRP) is a biomarker of systemic inflammation that has been linked to accelerated decline in walking speed in older adults. The aim of the present study was to compare the CRP levels of PD patients with vs patients without freezing of gait (FOG). Patients and controls participating in the COPPADIS-2015 study that performed blood extraction for determining molecular serum biomarkers were included. Patients with FOG were identified as those with a score of 1 or greater on item-3 of the Freezing of Gait Questionnaire (FOG-Q). Immunoassay was used for determining ultrasensitive CRP (US-CRP) level (mg/dL). In the PD group (n = 225; 61.8 +/- 9.5 years old, 61.8% males), 32% of the patients presented FOG but none in the control group (n = 65; 60.3 +/- 6.1 years old, 56.9% males) (p < 0.0001). Differences in US-CRP level were significant in patients with FOG vs patients without FOG and vs controls (0.31 +/- 0.52 vs 0.16 +/- 0.21 vs 0.21 +/- 0.22; p = 0.04). Significant differences were also observed between patients with vs without FOG (p = 0.001) but not between patients and controls (p = 0.163). US-CRP level was related to FOG (OR = 4.369; 95% CI 1.105-17.275; p = 0.036) along with H&Y (OR = 2.974; 95% CI 1.113-7.943; p = 0.030) and non-motor symptoms burden (NMSS total score; OR = 1.017; 95% CI 1.005-1.029; p = 0.006) after adjusting for age, gender, disease duration, equivalent daily levodopa dose, number of non-antiparkinsonian drugs per day, motor fluctuations, cognition, motor phenotype, and chronic use of anti-inflammatory drugs. The present study suggests that serum US-CRP level is related to FOG in PD patients. Inflammation could be linked to FOG development.

Background and purpose In Parkinson's disease (PD), the course of the disorder is highly variable between patients. Well-designed, prospective studies for identifying PD progression biomarkers are necessary. Our aim was to show the results of baseline evaluations of an ongoing global PD project, COPPADIS-2015 (Cohort of Patients with PArkinson's DIsease in Spain, 2015). Methods This was an observational, descriptive, nationwide study (Spain). The recruitment period ended in October 2017. Baseline evaluation included more than 15 validated scales and complementary studies in a subgroup of participants. Results In total, 1174 subjects from 35 centres were considered valid for baseline analysis: 694 patients (62.6 +/- 8.9 years old, 60.3% males), 273 caregivers (58.5 +/- 11.9 years old, 31.8% males) and 207 controls (61 +/- 8.3 years old, 49.5% males). The mean disease duration was 5.5 +/- 4.4 years. Hoehn and Yahr stage was 1 or 2 in 90.7% of the patients whilst 33.9% and 18.1% of them presented motor fluctuations and dyskinesias, respectively. The mean Non-Motor Symptoms Scale total score was 45.4 +/- 38.1, and 30.4% of the patients presented cognitive impairment, 16.1% major depression, 12.7% impulse control disorder, 7.2% compulsive behaviour, 57.2% pain and 13.2% falls. Compared to the control group, PD patients presented a significantly higher burden of non-motor symptoms and a worse quality of life. More than 300 subjects conducted complementary studies (serum biomarkers, genetic and neuroimaging). Conclusions Parkinson's disease is a complex disorder and different non-motor symptoms are frequently present and are more prevalent than in controls. In real clinical practice it is important to ask for them.

Article The thermal environment inside a broiler house has a great influence on animal welfare and productivity during the production phase. Among the importance of the chicken litter is the function of absorbing moisture, provide thermal insulation and provide a soft surface for broilers. The skin temperature is an important physiological parameter to quantify the thermal comfort of animals, its variations may occur as a function of thermal variables. So, the aim of this work was to analyse the magnitude and spatial variability of chicken litter temperature and relative humidity of the air and to correlate them with the spatial distribution of chicks’ skin surface temperature throughout the broiler house during the 7th, 14th and 21st days of the chicks’ life, using geostatistical techniques. The experiment was performed in a commercial broiler house located in the western mesoregion of Minas Gerais, Brazil, where 28,000 male Cobb chicks were housed. The heating system consisted of an industrial indirect-fired biomass furnace. The heated air was inflated by an AC motor, 2,206 W of power, 1,725 RPM. Geostatistical techniques were used through semivariogram analysis and isochore maps were generated through data interpolation by kriging. The semivariogram was fitted by the restricted maximum likelihood method. The used mathematical model was the spherical one. After fitting the semivariograms, the data were interpolated by ordinary kriging. The semivariograms along with the isochore maps allowed identifying the non-uniformity of spatial distribution of the broiler litter temperature throughout the broiler house for 3 days of chicks’ life. It was observed that skin surface presented a positive correlation with the litter temperature and a negative correlation with the air humidity. The semivariograms along with the isochore maps allowed identifying the non-uniformity of spatial distribution of the litter temperature, air humidity and skin temperature of chicks throughout the broiler aviary for the three days. In addition, the use of geostatistics and distribution maps made possible to identify different environmental conditions in regions inside the broiler house that may harm the development of chicks.

Objective: To identify factors related to a poor health-related and global quality of life (QoL) in a cohort of nondemented Parkinson's disease (PD) patients and compare to a control group. Methods: The data correspond to the baseline evaluation of the COPPADIS-2015 Study, an observational, 5-year follow-up, multicenter, evaluation study. Three instruments were used to assess QoL: (1) the 39-item Parkinson's disease Questionnaire (PDQ-39), (2) a subjective rating of global QoL (PQ-10), and (3) the EUROHIS-QOL 8-item index (EUROHIS-QOL8). Multiple linear regression methods were used to evaluate the direct impact of different variables on these QoL measures. Results: QoL was worse in PD patients (n = 692; 62.6 +/- 8.9 years old, 60.3% males) than controls (n = 206; 61 +/- 8.3 years old, 49.5% males): PDQ-39, 17.1 +/- 13.5 vs 4.4 +/- 6.3 (p < 0.0001); PQ-10, 7.3 +/- 1.6 vs 8.1 +/- 1.2 (p < 0.0001); EUROHIS-Q0L8, 3.8 +/- 0.6 vs 4.2 +/- 0.5 (p < 0.0001). A high correlation was observed between PDQ-39 and Non-Motor Symptoms Scale (NMSS) (r = 0.72; p < 0.0001), and PDQ-39 and Beck Depression Inventory-II (BDI-II) (r = 0.65; p < 0.0001). For health-related QoL (PDQ-39), non-motor symptoms burden (NMSS), mood (BDI-II), and gait problems (Freezing Of Gait Questionnaire [FOGQ]) provided the highest contribution to the model (beta = 0.32, 0.28, and 0.27, respectively; p < 0.0001); whereas mood and gait pro- blems contributed the most to global QoL (PQ-10, beta = -0.46 and -0.21, respectively; EUROHIS-QOL8, beta = - 0.44 and - 0.23, respectively). Conclusions: QoL is worse in PD patients than in controls. Mood, non-motor symptoms burden, and gait problems seem to be the most relevant factors affecting health-related and global perceived QoL in non-demented PD patients.

Com 25 anos de duração, o Sistema Único de Saúde - SUS - enfrenta problemas no financiamento e na qualidade dos serviços produzidos. Seus desafios envolvem mudanças nas necessidades de saúde (transições demográfica e epidemiológica) e na tecnologia médica (encarecimento). O desenvolvimento do SUS necessita superar a fragmentação da atenção, estabelecer redes de atenção à saúde, buscar melhorias na gestão, produção e qualidade das ações de saúde e soluções para a formação e alocação de recursos humanos.

O processo que envolve a doação e retirada de órgãos é complexo e tem um custo elevado para os hospitais que o realizam. Neste artigo é estimado o custo médio total envolvido nesse processo, comparando-o com a remuneração paga pelo Sistema Único de Saúde. OBJETIVO: Levantar os gastos com captação, manutenção do doador e retirada de órgãos para transplante. MÉTODOS: É um estudo retrospectivo, baseado no levantamento dos prontuários de 32 doadores admitidos na Organização de Procura de Órgãos do Instituto Dante Pazzanese de Cardiologia, São Paulo, no período de janeiro a dezembro de 1999. Os gastos levantados foram em relação aos seguinte itens: recursos humanos, material de consumo, utilidade pública, exames complementares, depreciação de equipamentos, material permanente e transporte. RESULTADOS: O estudo realizado encontrou o custo médio de R$ 2.883,34 para o processo de doação, captação e retirada de órgãos, desde a avaliação até a entrega do corpo a família. O valor pago pelo SUS é de R$ 1. 853,71. Este custo cobre 65% do custo médio real. CONCLUSÃO: O artigo demonstra a importância da realização de estudos de custos, de procedimentos, com o objetivo de orientar a definição/atualização das tabelas de remuneração de serviços.The process of organ donation and retreat is complex and involves a high cost for hospitals that do it.PURPOSE: to survey the expenses with the process of donation and retreat of organs.METHODS: retrospective study based on medical records of 32 donors, admitted in the Search Organs Organisation do Instituto Dante Pazzanese de Cardiologia, during the period from January to December of 1999.RESULTS: the process is complex and involves a special structure as well as 24 hours of activities, making it costly. Expenses were related with the following items: human resources, permanent material, public utilities, complementary examinations, depreciation of equipment and transportation. A comparison with the values reimbursed by the Single Health System (SUS) followed.CONCLUSION: the total cost was high than the reimbursement provided by SUS, showing the necessity of research about cost of procedures and the reinvestment margin.

O desenvolvimento tecnológico e o aparecimento de novas especialidades médicas motivaram um aumento na divisão de trabalho nos hospitais, com conseqüente criação de subáreas. A redistribuição dos recursos humanos nos hospitais passa, então, a ser uma meta importante para o alcance da eficiência. Através de entrevistas realizadas entre maio e outubro de 1993, com diretores e superintendentes de oito hospitais em São Paulo, Brasil, o presente estudo descreveu e analisou a distribuição dos recursos humanos em quatro grandes áreas: infra-estrutura; internação clínico-cirúrgica; área complementar de diagnóstico e terapêutica; ambulatório e emergência. O estudo analisou também a proporção de funcionários por leito, além de traçar uma comparação entre hospitais públicos e privados. Os resultados revelaram que, em média, a relação funcionários/leito é igual a 6,8. A distribuição percentual de funcionários por grandes áreas, conforme o estudo, foi de 46,9% na infra-estrutura, 10,7% na área complementar de diagnóstico e terapêutica, 32,0% na internação e 10,3% na área de ambulatório/emergência.Technological development and the appearance of new medical specialties have led to increased division of labor in hospitals, with the resultant creation of subareas. Therefore, the redistribution of human resources in hospitals has become an important aim in order to achieve efficiency. On the basis of interviews conducted between May and October 1993 with the directors and superintendents of eight hospitals in São Paulo, Brazil, this study describes and analyzes the distribution of human resources in four broad areas: infrastructure, clinico-surgical inpatient care, the complementary area of diagnostics and therapeutics, and emergency and outpatient care. The study also analyzed the ratio of employees per bed, besides outlining a comparison of public and private hospitals. The results revealed that, on average, the ratio of employees to beds was 6.8. The proportional distribution of employees by broad areas was found to be 46.9% in infrastructure, 10.7% in diagnostics and therapeutics, 32.0% in inpatient care, and 10.3% in outpatient/emergency care.

OBJECTIVES: To investigate whether delirium is associated with an unbalanced inflammatory response or a dysfunctional interaction between the cholinergic and immune systems. DESIGN: Cohort observational study. SETTING: General hospital orthopedic ward. PARTICIPANTS: One hundred one individuals aged 60 and older with no previous cognitive impairment undergoing elective arthroplasty. MEASUREMENTS: Incidence of postoperative delirium, plasma cholinesterase activity (acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE)) and inflammatory mediators (C-reactive protein (CRP), interleukin (IL)-1 beta, tumor necrosis factor alpha, IL-6, IL-8, IL-10) before and after surgery. RESULTS: Thirty-seven participants developed postoperative delirium and had greater production of CRP and proinflammatory to anti-inflammatory ratio after surgery. In participants with delirium, but not in controls, preoperative levels of plasma cholinesterase activity correlated with ΔCRP (AChE: ρ = 0.428, P = .008 and BuChE: ρ = 0.423, P = .009), ΔIL-6 (AChE: ρ = 0.339, P = .04), and ΔP/A ratio (AChE: ρ = 0.346, P = .04). CONCLUSION: Delirium was associated not only with an unbalanced inflammatory response, but also with a dysfunctional interaction between the cholinergic and immune systems. Comprehensive understanding of the relationship between the cholinergic and immune systems is crucial to developing new insights into delirium pathophysiology and novel therapeutic interventions

BACKGROUND: delirium is a frequent neuropsychiatric syndrome affecting medical and surgical elderly patients. Cholinergic dysfunction has been implicated in delirium pathophysiology and plasmatic acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) activities are suppressed in patients with delirium. In this cohort study, we investigated whether these changes emerge during delirium or whether they are present before its onset. METHODS: plasma activities of AChE and BuChE were measured pre- and postoperatively in consecutive patients ≥60 years old undergoing elective total hip replacement surgery. In addition to a comprehensive clinical and demographic baseline evaluation, venous blood samples were collected from each subject in the morning of hospital admission's day and in the morning of the first postoperative day. Delirium was screened daily with confusion assessment method (confirmed with diagnostic and statistical manual of mental disorders (DSM-IV)-TR). RESULTS: preoperatively, plasma esterase activity was significantly lower in patients who developed delirium compared with the remaining subjects. Following surgery BuChE activity was lower in the delirium group but this difference disappeared after controlling for preoperative values. Plasma cholinesterase activity correlated positively with calcium and haemoglobin and negatively with total bilirubin and international normalised ratio. CONCLUSION: plasma cholinesterase activity can be a useful candidate biomarker to identify subjects at greater risk of developing postoperative delirium.

FUNDAMENTO: La cirugia de revascularizacion de miocardio (CRM) es la cirugia cardiaca mas frecuentemente practicada en el pais, con la mayor parte realizada por el Sistema Unico de Salud (SUS). OBJETIVO: Evaluar los resultados de la CRM no asociada a otros procedimientos. METODOS: Se analizaron las informaciones del banco de datos SIH/DATASUS, disponible online. Este banco de datos contiene informaciones relativas a: sexo, edad, permanencia hospitalaria, valor de la autorizacion de internacion hospitalaria (AIH), numero de cirugias realizadas por hospital y mortalidad hospitalaria. Se evaluaron solamente las CRM realizadas sin procedimientos asociados. RESULTADOS: Entre 2005 y 2007 se llevaron a cabo 63.529 cirugias en 191 hospitales. Se excluyeron 16 hospitales de muy bajo volumen quirurgico, restando 63.272 cirugias para analisis final. La mortalidad hospitalaria total fue del 6,22%, con mayor indice en los hospitales de pequeno volumen que en los de gran volumen (≥300 cirugias en el periodo), el 7,29% versus el 5,77% (p

FUNDAMENTO: A cirurgia de revascularização do miocárdio (CRM) é a cirurgia cardíaca mais frequentemente praticada no país, sendo a maior parte realizada pelo Sistema Único de Saúde (SUS). OBJETIVO: Avaliar os resultados da CRM, não associada a outros procedimentos. MÉTODOS: Analisaram-se as informações do banco de dados SIH/DATASUS, disponibilizado on-line. Esse banco de dados contém informações relativas a: sexo, idade, permanência hospitalar, valor da autorização de internação hospitalar (AIH), número de cirurgias realizadas por hospital e mortalidade hospitalar. Avaliaram-se apenas as CRM realizadas sem procedimentos associados. RESULTADOS: Entre 2005 e 2007 foram realizadas 63.529 cirurgias em 191 hospitais. Foram excluídos 16 hospitais de muito baixo volume cirúrgico, restando 63.272 cirurgias para análise final. A mortalidade hospitalar total foi de 6,22%, sendo maior nos hospitais de pequeno volume do que nos de grande volume (> 300 cirurgias no período), 7,29% versus 5,77% (p 65 anos), 4,21% versus 9,36% (p

Myocardial revascularization surgery (MRS) is the most common surgery in this country, with most being performed through the National Health System(SUS).To assess MRS results when not associated to other procedures.The information from the Hospital Information System (SIH/DATASUS) made available online was submitted to analysis. The data include information on gender, age, hospital stay period, hospital admission authorization (AIH) costs, number of surgeries at each hospital, and in-hospital mortality rate. Only MRS with no associated procedures were analyzed.A total of 63,529 surgeries were performed in the period between 2005 and 2007 at 191 hospitals. Sixteen hospitals reporting very low surgery volume were excluded. The remaining total number of surgeries came down to 63,272 for the final analysis. In-hospital mortality rate was 6.22%, with small surgery volume hospitals reporting higher rate than high volume hospitals (or=300 surgeries in the time period under study), 7.29% versus 5.77% (p0.001). Average hospital stay time length was 12 days, with no difference having been reported between low (12.08+/-5.52) and high volume (12.15+/-7.70) hospitals. Males reported lower mortality rate than females - 5.20% versus 8.25% (p0.001), similarly to younger individuals when compared to the elderly (or= 65 years of age), 4.21% versus 9.36% (p0.001). A slight variation was observed in AIH values between the Southern Region (R$ 7.214,63 - approximately US$ 3,600.00) and the Northeastern Region (R$ 6.572,03 - approximately US$ 3,280.00) (p0.01). Regional distribution of surgeries was not comparable in all regions in the country, with Southern and Southeastern Regions having reported 77% of them.MRS performed by SUS has reported high mortality rate in low volume hospitals, among women, and among the elderly. Future prospective studies are deemed to be necessary.

Este trabalho contempla a síntese e caracterização espectroscópica de dois compostos carbonílicos heterometálicos do tipo [Fe(CO)3(m-CS2)(PPh3 )(CuX)], X = Cl, ClO4. Os dados provenientes da espectroscopia no infravermelho e de RMN de 31P{¹H} foram conclusivos quanto à proposição da geometria octaédrica distorcida ao redor do átomo de ferro (0), como também sobre a natureza bimetálica de ambos compostos. Estes dados esclareceram o modo de coordenação dos grupos carbonilos, da trifenilfosfina (PPh3), bem como a disposição do ligante dissulfeto de carbono em ponte entre os átomos de Fe (0) e Cu (I). This work describes the one pot syntheses and characterization of two new heterometallic carbonyl compounds of the type [Fe(CO)3(m-CS2)(PPh3 )(CuX)], X = Cl, ClO4. Both compounds were investigated by infrared and 31P{¹H} NMR spectroscopies in order to clarify the coordination mode of the carbonyl groups, as well the bridging disposition of the carbon disulfide between iron (0) and copper (I) atoms.