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Nesta pesquisa, obteve-se o levantamento e a análise de oito obras de edifícios verticais comerciais e residenciais, com características construtivas semelhantes. O resultado foi a determinação de um índice médio de consumo de 0,4886 metros cúbicos de água para cada metro quadrado de construção. Paralelamente, estudou-se o mercado de Palmas/TO quanto à execução de poços com profundidade superior a 70 metros. Assim, obtiveram-se os dados de oito poços, gerando uma vazão média de 11.200 litros por hora, uma profundidade média de 123 metros, nível estático médio de 16 metros e nível dinâmico médio de 52 metros. Dessa forma, calculou-se o índice mensal de consumo para o mês de pico das obras, resultando em 0,055 metros cúbicos por metro quadrado de obra construída. Com a somatória do custo de construção do poço teórico, seu consumo de energia elétrica e taxas de licenciamento ambiental, foi obtido o valor de R$ 34.850,52. Ao cruzar os dados coletados e calculados, gerou-se uma delimitação em metros quadrados de área construída de 2.248,42 metros quadrados para obras verticais, ou seja, concluiu-se que, no caso de obras com áreas construídas maiores do que a apresentada, torna-se economicamente viável a execução de poços artesianos profundos como alternativa à rede pública de abastecimento de água. In this research, it was obtained the survey and the analysis of eight works of vertical commercial and residential buildings, with similar constructive characteristics. The result was the determination of an average consumption index of 0.4886 cubic meters of water for each square meter of construction. At the same time, the Palmas / TO market was studied for the execution of wells with a depth of more than 70 meters. Thus, data were obtained from eight wells, generating an average flow of 11,200 liters per hour, an average depth of 123 meters, an average static level of 16 meters and an average dynamic level of 52 meters. In this way, the monthly consumption index was calculated for the peak month of the works, resulting in 0.055 cubic meters per square meter of constructed work. With the sum of the cost of construction of the theoretical well, its consumption of electric energy and environmental licensing fees, the amount of R $ 34,850.52 was obtained. When crossing the data collected and calculated, a delimitation in square meters of constructed area of 2,248.42 square meters was generated for vertical works, that is, it was concluded that, in the case of works with larger built-up areas than the one presented, it becomes economically viable the execution of deep artesian wells as an alternative to the public water supply network.

El dolor crónico es una patología muy prevalente a nivel mundial que se encuentra tratada de manera subóptima en numerosos casos, produciendo un elevado sufrimiento en la población. A pesar de los avances realizados en la caracterización de los mecanismos precisos por los que se desencadena el dolor, el enfoque actual de tratamiento continúa siendo principalmente analgésico. El problema radica en la limitada eficacia de estos tratamientos en muchos pacientes, así como en los severos efectos adversos y la dependencia y tolerancia que generan. En este trabajo, se revisa el abordaje del tratamiento del dolor crónico desde un punto de vista multidimensional, teniendo en cuenta las terapias clásicas analgésicas y su relación con otro tipo de patologías a nivel psicológico (como la depresión), así como los avances en la identificación de sus mecanismos que han permitido descubrir nuevas dianas farmacológicas y, por tanto, la aparición de fármacos con mayor selectividad y eficacia. Además, se analiza también el papel del amplio e innovador campo de la terapia génica orientado al alivio del dolor crónico, que está aportando resultados prometedores.

Background: Inclusive higher education aims to transform and improve the competence role of the future doctors in relation to people with disabilities (PwD), a vulnerable and prevalent population group which needs Quality Care to fulfil the right to health. Aim: To analyse and assess the awareness and training received of an experience developed in the School of Medicine related to the comprehensive care for PwD. Method: A before- and after-intervention, with no control group, of 120 students enrolled in the School of Medicine. Results: Students perceive a lack of training on this topic and are aware of their health and social role to reduce inequalities in PwD. The professional knowledge that significantly improved with the intervention are the related with the rights of PwD, risk factors, degree of disability, universal design, positive action measures, and curriculum adaptations. As regards to the competences that must be acquired, the awareness of social and communications skills needed should be noted, as well as the ability to issue medical reports about disability. Conclusion: The training intervention is effective in terms of awareness about the importance of the medical role related to PwD, and consequently, the knowledge and skills needed to achieve a better Health Care are assessed., Fundamento: La educación inclusiva universitaria trata de transformar y mejorar el rol competencial de los futuros médicos en relación con las personas con discapacidad (PcD), grupo poblacional vulnerable y prevalente que necesita una atención de calidad para hacer efectivo su derecho a la salud. Objetivo: Analizar y valorar la sensibilización y la formación de una experiencia desarrollada en Medicina en relación con la atención integral a las PcD. Método: Se ha realizado un estudio de intervención, tipo antes y después, sin grupo control, en 120 alumnos del grado de Medicina. Resultados: Los estudiantes perciben que falta de formación en este tema y son conscientes de su rol sanitario y social en la reducción de desigualdades en las PcD. Entre los conocimientos profesionales que mejoran con la intervención, de manera significativa, están los relacionados con los derechos de las PcD, los factores de riesgo, el grado de discapacidad, el dise˜no universal, las medidas de acción positiva y las adaptaciones curriculares asociadas a la educación inclusiva. En relación con las competencias que deben ser adquiridas, se debe destacar su sensibilización sobre la necesidad de habilidades sociales y de comunicación, y la capacidad para emitir informes médicos sobre la incapacitación. Conclusión: La intervención formativa se muestra efectiva en relación con la sensibilización sobre la importancia del rol del médico en relación con los pacientes con discapacidad y, en consecuencia, se valoran los conocimientos y competencias necesarias para conseguir una mejor atención sanitaria

¿Supondrá Trump una ruptura inédita y, hasta hace bien poco, impensable? ¿Asistiremos a una conversión en el trayecto que recuperará elementos de continuidad en la política norteamericana? Aquí se repasan los datos principales sobre los que apoyar una u otra conjetura.

A American Academy of Family Physicians (AAFP) atualizou, em 2012, as “Recommendations for Clinical Preventive Services”, com base na publicação homônima editada pela United States Preventive Services Task Force (USPSTF). Estas recomendações são fornecidas como um auxílio para os médicos na tomada de decisões clínicas quanto aos cuidados de seus pacientes. Refletem as melhores evidências clínicas existentes no momento da publicação. Devem ser usadas com o claro entendimento de que o desenvolvimento de novos conhecimentos pode resultar na necessidade de atualizações e modificações nas condutas recomendadas. Dentre essas recomendações algumas são importantes na prática clínica com o paciente idoso, sendo apresentadas em conjunto com de outras sociedades científicas.

Made available in DSpace on 2014-10-01T13:08:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-08-01Bitstream added on 2014-10-01T14:03:07Z : No. of bitstreams: 1 S1676-24442013000400002.pdf: 129576 bytes, checksum: 85312292074aa6a1120b74c641d0e191 (MD5) O peptídeo natriurético tipo B (BNP) ou o seu precursor, a forma inativa do fragmento N terminal do pró-BNP (NT-pró-BNP), são os parâmetros laboratoriais mais estudados atualmente no espectro da insuficiência cardíaca (IC). Por meio da mensuração de seus níveis no sangue, informações valiosas quanto a probabilidade, gravidade e prognóstico da doença podem ser reunidas. Esta revisão tem como objetivo descrever os determinantes biológicos, os fatores interferentes nas concentrações desses peptídeos, os valores de corte sugeridos para diagnóstico da IC e o uso deste biomarcador na avaliação da função cardíaca. B type natriuretic peptide (BNP) and its precursor, the inactive form of NT-pro-BNP, are currently the most studied laboratory parameters in the heart disease spectrum. The assessment of their blood concentrations provides invaluable information on the likelihood, severity and prognosis of the disease. The present review aims to describe the biological determinants, the factors that influence these peptide concentrations, the suggested cutoff values for the diagnosis of heart failure and the use of this biomarker in the assessment of cardiac function. UNESP Medical School UNESP Medical School

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:29:38Z No. of bitstreams: 0 Made available in DSpace on 2014-05-27T11:29:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-06-01 Influenza exacts a heavy burden on the elderly, a segment of the population that is estimated to experience rapid growth in the near future. In the past decade most developed and several developing countries have recommended influenza vaccination for those > 65 years of age. The World Health Organization (WHO) set a goal of 75% influenza vaccination coverage among the elderly by 2010, but it was not achieved. In 2011, the Technical Advisory Group at the Pan American Health Organization, Regional Office of WHO for the Americas, reiterated the influenza vaccine recommendation for older adults. Relatively little information has been compiled on the immunological aspect of aging or on reducing its impact, information particularly relevant for clinicians and gerontologist with firsthand experience confronting its effects. To fill this data gap, in 2012 the Americas Health Foundation (Washington, D.C., United States) and the nonprofit, Fighting Infectious Diseases in Emerging Countries (Miami, Florida, United States), convened a panel of Latin American clinicians and gerontologists with expertise in influenza to discuss key issues and develop a consensus statement. The major recommendations were to improve influenza surveillance throughout Latin America so that its impact can be quantified; and to conduct laboratory confirmation of influenza for all patients who have flu-like symptoms and are frail, immunosuppressed, have comorbidities, are respiratory compromised, or have been admitted to a hospital. The panel also noted that: since evidence for antivirals in the elderly is unclear, their use should be handled on a case-by-case basis; despite decreased immunological response, influenza vaccination in older adults is still crucial; indirect immunization strategies should be encouraged; and traditional infection control measures are essential in long-term care facilities. Fighting Infectious Diseases in Emerging Countries (FIDEC) University of Miami, Miami, FL Sección Infectología Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires Departamento de Infectología Instituto Nacional de Cancerología, Mexico City Centro Médico de Caracas and Centro Médico Trinidad, Caracas Departamento de Enfermedades Infecciosas Escuela de Medicina de la Pontíficia Universidad Católica de Chile, Santiago Universidade Estadual Paulista (UNESP), Botucatu Universidade Estadual Paulista (UNESP), Botucatu

Aim: This article demonstrates how controlled hyperthermia at the cellular level can be achieved. Materials & methods: The method is based on the simultaneous intracellular incorporation of fluorescence nanothermometers (CdSe quantum dots) and metallic nanoheaters (gold nanorods). Results: Real-time spectral analysis of the quantum dot emission provides a detailed feedback about the intracellular thermal loading caused by gold nanorods excited at the plasmon frequency. Based on this approach, thermal dosimetry is assessed in such a way that the infrared laser (heating) power required to achieve catastrophic intracellular temperature increments in cancer cells is identified. Conclusions: This pure optical method emerges as a new and promising guide for the development of infrared hyperthermia therapies with minimal invasiveness. Original submitted 6 March 2012; Revised submitted 3 July 2012; Published online 2 December 2012

In this work we report on the ability of Er/Yb co-doped NaYF4 nano-crystals and CdTe Quantum Dots as two-photon excited fluorescent nano-thermometers. The basic physical phenomena causing the thermal sensitivity of the two-photon excited emission bands have been discussed and the maximum thermal resolution achievable in each case has been estimated. The practical application of both systems for thermal sensing at the micro-scale in biological systems is demonstrated. In particular, they have been used to evaluate the thermal loading induced by tightly focused laser beams in both living cells and fluids.

Polysaccharides are substances that modify the biological response to several stressors. The present study investigated the antitumor activity of the soluble fraction of polysaccharides (SFP), extracted from cabernet franc red wine, in Walker-256 tumor-bearing rats. The monosaccharide composition had a complex mixture, suggesting the presence of arabinoglactans, mannans, and pectins. Treatment with SFP (30 and 60mg/kg, oral) for 14days significantly reduced the tumor weight and volume compared with controls. Treatment with 60mg/kg SFP reduced blood monocytes and neutrophils, reduced the tumor activity of N-acetylglucosaminidase, myeloperoxidase, and nitric oxide, increased blood lymphocytes, and increased the levels of tumor necrosis factor α (TNF-α) in tumor tissue. Treatment with SFP also induced the expression of the cell necroptosis-related genes Rip1 and Rip3. The antineoplastic effect of SFP appears to be attributable to its action on the immune system by controlling the tumor microenvironment and stimulating TNF-α production, which may trigger the necroptosis pathway.

Orientador : Prof. Dr. Guilherme Lanzi Sassaki Dissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências Biológicas, Programa de Pós-Graduação em Ciências : Bioquímica. Defesa: Curitiba, 25/02/2016 Inclui referências : f. 90-108 Resumo: Existem poucos trabalhos sobre caracterização de polissacarídeos de vinhos. A estrutura e as quantidades de polissacarídeos liberados dependem do processo de vinificação e podem influenciar as propriedades sensoriais, a qualidade dos vinhos e possivelmente os benefícios para a saúde. No entanto, não foram encontrados na literatura científica, estudos que mostrem alguma relação entre os polissacarídeos encontrados nos vinhos e atividades biológicas, como a anti-inflamatória. Com isso, esse trabalho teve como objetivo a caracterização estrutural dos polissacarídeos encontrados em três tipos de vinhos: Cabernet Franc (ACF), Cabernet Sauvignon (ACS) e Sauvignon Blanc (ASB) e avaliação da capacidade das amostras estudadas de inibirem mediadores inflamatórios in vitro. Os vinhos foram concentrados e os polissacarídeos foram obtidos por meio de precipitação etanólica seguida de centrifugação, diálise, liofilização, congelamento e degelo, precipitação de Fehling e fracionamento por coluna de troca iônica. Os polissacarídeos foram caracterizados estruturalmente por métodos químicos, por ressonância magnética nuclear (RMN) 1D e 2D de 1H e 13C, cromatografia gasosa acoplada à espectrometria de massas de ionização eletrônica (GC-MS), análise de metilação e cromatrografia líquida de exclusão estérica acoplada à índice de refração de espalhamento de luz laser em multiângulos (HPSEC-MALLS). Os rendimentos dos polissacarídeos dos vinhos foram: 0,16% (ACF), 0,05% (ACS) e 0,02% (ASB). A composição monossacarídica mostrou a presença de Gal, Ara, Rha, GalA, Glc, 2-O-metil-Xyl, 2-O-metil-Fuc e Man em diferentes concentrações. Todas as frações apresentaram teor de

[ES] El estudio tiene por objetivo analizar la calidad de la información en relación con la automedicación en las páginas web de internet y estimar si se cumplen criterios de calidad. Para conseguir dicho propósitose efectuó un estudio observacional tipo transversal basado en la valoración de 15 páginas web institucionales relacionadas con la automedicación y que fueron seleccionadas aleatoriamente para ser revisadas por 59 usuarios habituales de internet como herramienta fundamental en su trabajo profesional. Como instrumento de medida se utilizó un cuestionario elaborado específicamente para este trabajo de investigación. El 66 % de los usuarios del estudio confirmaron la existencia de información sobre automedicación en dichas web. De acuerdo con las observaciones realizadas por los usuarios -la mayor parte de páginas web con información sobre automedicación- en 9 (60 %) se cumplen criterios de calidad en un 70-75 %. Las variables mejor evaluadas han sido la actualización de la información, la responsabilidad y la accesibilidad. Las peor evaluadas han sido la arquitectura de la información y la existencia de acreditación o sello de calidad en la web. La calidad de las web analizadas es aceptable, pero mejorable en accesibilidad universal, acreditación y/o certificación. Las web mejor valoradas globalmente han sido la del Ministerio de Sanidad, Política Social e Igualdad de España y la de la Organización Mundial de la Salud.

Breakthroughs in nanotechnology have made it possible to integrate different nanoparticles in one single hybrid nanostructure (HNS), constituting multifunctional nanosized sensors, carriers, and probes with great potential in the life sciences. In addition, such nanostructures could also offer therapeutic capabilities to achieve a wider variety of multifunctionalities. In this work, the encapsulation of both magnetic and infrared emitting nanoparticles into a polymeric matrix leads to a magnetic-fluorescent HNS with multimodal magnetic-fluorescent imaging abilities. The magnetic-fluorescent HNS are capable of simultaneous magnetic resonance imaging and deep tissue infrared fluorescence imaging, overcoming the tissue penetration limits of classical visible-light based optical imaging as reported here in living mice. Additionally, their applicability for magnetic heating in potential hyperthermia treatments is assessed.

During the last decade inorganic luminescent nanoparticles that emit visible light under near infrared (NIR) excitation (in the biological window) have played a relevant role for high resolution imaging of cancer. Indeed, semiconductor quantum dots (QDs) and metal nanoparticles, mostly gold nanorods (GNRs), are already commercially available for this purpose. In this work we review the role which is being played by a relatively new class of nanoparticles, based on lanthanide ion doped nanocrystals, to target and image cancer cells using upconversion fluorescence microscopy. These nanoparticles are insulating nanocrystals that are usually doped with small percentages of two different rare earth (lanthanide) ions: The excited donor ions (usually Yb3+ ion) that absorb the NIR excitation and the acceptor ions (usually Er3+, Ho3+ or Tm3+), that are responsible for the emitted visible (or also near infrared) radiation. The higher conversion efficiency of these nanoparticles in respect to those based on QDs and GNRs, as well as the almost independent excitation/emission properties from the particle size, make them particularly promising for fluorescence imaging. The different approaches of these novel nanoparticles devoted to "in vitro" and "in vivo" cancer imaging, selective targeting and treatment are examined in this review, J.A.C. is a Concordia University Research Chair in Nanoscience and is grateful to Concordia University for financial support of his research. J.A.C. and F.V. are grateful for financial support from the Natural Sciences and Engineering Research Council (NSERC) of Canada. R.N. is grateful for NSERC financial support through the Alexander Graham Bell Graduate Scholarship Program. B.F.Z. is grateful to les Fonds Québécois de Recherche sur la Nature et les Technologies (FQRNT) for financial support through the Graduate Scholarship Program. This work was also supported in part by the Universidad Autónoma de Madrid and Comunidad Autónoma de Madrid (Projects CCG087-UAM/MAT-4434 and S2009/MAT-1756), by the Spanish Ministerio de Educación y Ciencia (MAT 2010–16161). EMR acknowledges financial support from Fundación Alfonso Martín Escudero and Marie Curie IOF Fellowship Program (project 274404 LUNAMED)

Rationale and aim The aims of the Cochrane systematic reviews are to make readily available and up-to-date information for clinical practice, offering consistent evidence and straightforward recommendations. In 2004, we evaluated the conclusions from Cochrane systematic reviews of randomized controlled trials in terms of their recommendations for clinical practice and found that 47.83% of them had insufficient evidence for use in clinical practice. We proposed to reanalyze the reviews to evaluate whether this percentage had significantly decreased. Methods A cross-sectional study of systematic reviews published in the Cochrane Library (Issue 7, 2011) was conducted. We randomly selected reviews across all 52 Cochrane Collaborative Review Groups. Results We analyzed 1128 completed systematic reviews. Of these, 45.30% concluded that the interventions studied were likely to be beneficial, of which only 2.04% recommended no further research. In total, 45.04% of the reviews reported that the evidence did not support either benefit or harm, of which 0.8% did not recommend further studies and 44.24% recommended additional studies; the latter has decreased from our previous study with a difference of 3.59%. Conclusion Only a small number of the Cochrane collaboration's systematic reviews support clinical interventions with no need for additional research. A larger number of high-quality randomized clinical trials are necessary to change the ‘insufficient evidence’ scenario for clinical practice illustrated by the Cochrane database. It is recommended that we should produce higher-quality primary studies in active collaboration and consultation with global scholars and societies so that this can represent a major component of methodological advance in this context.

In Latin America, adult influenza is a serious disease that exacts a heavy burden in terms of morbidity, mortality, and cost. Although much has been written about the disease itself, relatively little information has been compiled on what could be done to reduce its impact across the region, particularly from the perspective of clinicians with first-hand experience in confronting its effects. To fill this data gap, in 2011, the Pan American Health and Education Foundation (PAHEF) and the U.S.-based nonprofit Fighting Infectious Diseases in Emerging Countries (FIDEC) organized a conference and convened a panel of Latin American scientist-clinicians with experience and expertise in adult influenza in the region tol) discuss the major issues related to the disease and 2) develop and produce a consensus statement summarizing its impact as well as current efforts to diagnose, prevent, and treat it. The consensus panel concluded a more concerted and better-coordinated effort was needed to reduce the adverse impact of seasonal influenza and future pandemics, including more surveillance, more active involvement by both governmental and nongovernmental organizations, and a much greater effort to vaccinate more adults, especially those at high risk of contracting the disease. In addition, a new approach for diagnosing influenza was recommended.

Regenerative properties of skin decrease with age, and thus, the search for substances that minimize cutaneous ageing has increased in the last few years. The secretion of the mollusc Cryptomphalus Aspersa (SCA) is a natural product that bears regenerative properties when applied topically. The purpose of this work is to study the in vitro effects of SCA on cell proliferation and migration, as well as on cell-cell (E-cadherin and β-catenin) and cell-substrate (vinculin and β1-integrin) adhesion proteins expression, using a human keratinocyte cell line (HaCaT cells) and primary dermal fibroblasts (HF). We tested the effects of SCA on cell proliferation using a colorimetric assay. In addition, SCA-induced changes on cell migration were studied by wound-healing assays. Besides, Western blot and immunofluorescence microscopy were carried out to test the expression of different cell adhesion proteins. We found that SCA promotes proliferation and migration of HaCaT cells in a time- and dose-dependent manner. Moreover, treatment with SCA increases the migratory behaviour and the expression of adhesion molecules in both HaCaT and HF. Finally, SCA also improves cell survival and promotes phosphorylation of FAK and nuclear localization of β-catenin. These results shed light on the molecular mechanisms underlying the regenerative properties of SCA, based on its promoting effect on skin cell migration, proliferation and survival. Moreover, these results support future clinical uses of SCA in the regeneration of wounded tissues.

Background As a result of amitriptyline's vast array of actions, it could potentially be used as an intraspinal adjuvant in neuraxial anesthesia and/or in the treatment of refractory neuropathic pain. None of the previous studies examining the safety profile of intraspinal single doses of amitriptyline found signs of toxicity at concentrations below 15.4 mM/L (0.5%) and the current hypothesis regarding the pathophysiology of amitriptyline toxicity suggests it might be safe at low concentrations while still having relevant clinical effects. Hence, we conducted this study to assess the clinical and histological toxicity of intraspinal amitriptyline at the lowest dosages previously known to be effective. Methods Twenty-one dogs were randomized to receive a 1-mL single intraspinal dose of one of the three solutions: saline (0.9%), amitriptyline (0.15%), or amitriptyline (0.3%). The dogs were evaluated clinically 1 h after awakening from anesthesia and 21 days later. At 21 days, all animals were killed, and histological sections of the spinal cord and surrounding meninges were retrieved for analysis. Results All dogs recovered motor function, anal sphincter tone and sensibility. With the exception of one dog in the 0.15% amitriptyline group, all animals in both amitriptyline groups had marked adhesive arachnoiditis, which was absent in the control group. No evidence of direct neural damage was found on histological sections stained by glial fibrillary acidic protein technique in any of the study animals. Conclusion The intraspinal administration of amitriptyline to dogs even in low concentrations is strongly associated with the development of intense meningeal adhesive arachnoiditis and is not safe even at low concentrations for which there was no previous evidence of toxicity.

As folhas recém-colhidas de Jatropha gossypifolia (Euphorbiaceae) foram letais para ovinos em administrações únicas de 40g/kg. A dose de 5g/kg não causou sintomas de intoxicação; as doses intermediárias provocaram a morte de parte dos animais. A evolução da intoxicação foi de 6 a 22 dias. O quadro clínico-patológico nos ovinos experimentais era caracterizado por perturbações digestivas, pulmonares, cardíacas e ainda alterações regressivas leves somente evidenciadas através de exames histológicos, hepáticas e renais. Esses achados são semelhantes aos observados em experimentos com as sementes de Jatropha curcas em caprinos, ovinos e bezerros, e com os com os frutos e as folhas de Jatropha glauca e Jatropha aceroides em caprinos, realizados por outros autores. Estas comparações indicam que, independentemente das espécies, as folhas de Jatropha spp. devem conter compostos semelhantes aos encontrados nas sementes.

O crescimento da população idosa é um fenômeno global e com ele as questões médicas e sociais têm assumido destaque. A violência contra as pessoas idosas se tornou problema de saúde pública em consequência do alto índice de morbimortalidade associada a ela. A identificação de idosos submetidos a maus-tratos é dever de todos, principalmente de médicos, para que desfechos negativos não ocorram. A divulgação de informações sobre as características das vítimas e dos agressores e dos principais tipos de violência é uma forma de manter os profissionais de saúde alertas, fato este que justifica a realização deste estudo. Foi realizado estudo descritivo transversal através de informações do Ministério da Saúde sobre as notificações de violência doméstica envolvendo pessoas acima de 60 anos de idade de ambos os sexos. O período analisado foi de janeiro de 2009 a dezembro de 2014. Os resultados do estudo mostraram que o número de notificações de violência doméstica contra o idoso aumentou progressivamente no período analisado, que a maioria das agressões ocorreu na residência das vítimas e os agressores mais frequentes foram os filhos. As mulheres foram as mais agredidas, mas os homens mostraram maior frequência de mortalidade; as agressões físicas e a negligência foram as mais relatadas. Apesar de ter havido crescimento de notificações, esses valores ainda estão distantes da realidade, em função da probabilidade de subnotificação. Os médicos precisam estar alertas quanto às possibilidades de maus-tratos e notificar os casos confirmados ou suspeitos, como determina a lei brasileira.

Objective To perform a systematic review to analyze the association between occupational exposure to wood dust and cancer. Methods A systematic literature search of entries made in the MEDLINE-PubMed database between 1957 and 2013 was conducted to identify studies that had assessed the relationship between occupational exposure to wood dust and different types of cancer. A meta-analysis of selected case-control and cohort studies was subsequently performed. Results A total of 114 studies were identified and 70 were selected for review. Of these, 42 studies focused on the relationship between wood dust and nasal cancer (n = 22), lung cancer (n = 11), and other types of cancer (n = 9). Low-to-moderate quality evidence that wood dust acts as a carcinogen was obtained, and a stronger association between wood dust and nasal adenocarcinoma was observed. A lesser association between wood dust exposure and lung cancer was also observed. Several studies suggested that there is a relationship between wood dust and the onset of other cancers, although there was no evidence to establish an association. A meta-analysis that included four case-controls studies showed that workers exposed to wood dust exhibited higher rates of nasal adenocarcinoma than other workers (odds ratio = 10.28; 95% confidence interval: 5.92 and 17.85; P

To improve the quality of care in a Mental Health Hospital and identify the level of patient satisfaction.A descriptive, longitudinal, and retrospective study was conducted on 666 patients who completed treatment in the Mental Health Day Hospital of Salamanca, during the period 1994-2012, using the Hospital Management Annual Reports. A questionnaire designed for this purpose was used as the measurement tool.Most of the patients satisfactorily valued aspects, such as the general impression of the treatment (90% said «good/fairly good») and perception of being helped (94% perceived «very/fairly helped»); with 83% believing that the hospital is accessible. As regards empathy-understanding, it was noted that 14% feel discontent. While 18% of patients expected to be completely cured, the 83% of patients that finished their treatment have said that, in their opinion, the symptoms have subsided «very or somewhat». As regards the knowledge that they have about their disease, 30% believe it has advanced «a lot.»Based on the perceptions reported by patients, it may be said that in general, the level of user satisfaction in the Mental Health Day Hospital is high. Assessing quality through the user opinions helps control the quality, considering that patient satisfaction is a good indicator of result of the care received during their hospitalisation.

Laser-induced thermal effects in optically trapped microspheres and single cells are investigated by quantum dot luminescence thermometry. Thermal spectroscopy has revealed a non-localized temperature distribution around the trap that extends over tens of micrometers, in agreement with previous theoretical models besides identifying water absorption as the most important heating source. The experimental results of thermal loading at a variety of wavelengths reveal that an optimum trapping wavelength exists for biological applications close to 820 nm. This is corroborated by a simultaneous analysis of the spectral dependence of cellular heating and damage in human lymphocytes during optical trapping. This quantum dot luminescence thermometry demonstrates that optical trapping with 820 nm laser radiation produces minimum intracellular heating, well below the cytotoxic level (43 °C), thus, avoiding cell damage.

The exposure to unethical and unprofessional behavior is thought to play a major role in the declining empathy experienced by medical students during their training. We reflect on the reasons why medical schools are tolerant of unethical behavior of faculty. First, there are barriers to reporting unprofessional behavior within medical schools including fear of retaliation and lack of mechanisms to ensure anonymity. Second, deans and directors do not want to look for unethical behavior in their colleagues. Third, most of us have learned to take disrespectful circumstances in health care institutions for granted. Fourth, the accreditation of medical schools around the world does not usually cover the processes or outcomes associated with fostering ethical behavior in students. Several initiatives promise to change that picture.

Se presenta una propuesta de Programación Didáctica para la asignatura de Física y Química del curso de 1º Bachiller, según la LOMCE, junto con una innovación a aplicar en el curso relacionada con el deporte y sus aplicaciones en la Física.

The purpose of this study was to assess, by applying probabilistic record linkage (PRL) methodology, the excess mortality and underlying causes of death in a cohort of elderly patients who underwent hip fracture surgical repair during 1995 in Rio de Janeiro, Brazil. We searched the Brazilian Hospital Admission Information System (HAIS) for the city of Rio de Janeiro, identifying all cases of elderly patients who had hip fracture surgery between January 1 and December 31, 1995, and by means of the PRL methodology and RecLink software, crosslinked those data with the Brazilian Mortality Information System (MIS) for the same region for a follow-up period of 1 year. We calculated age- and gender-adjusted standardized mortality ratios (SMR) for three periods of time—1–30 days, 31–90 days, and 91–365 days after hospital admission—and analyzed the basic cause of death as reported in the death certificates and noted the death occurred at the index admission or after hospital discharge. We found an overall 21.5% (95% CI 18.2–24.9) mortality rate in 1 year and a statistically significant SMR of 1,080 (95% CI 794–1450) and 512.8 (95% CI 366.4–698.3) for the first two periods, 1–30 days and 31–90 days after hospital admission, respectively. For the last period the SMR displayed a statistically nonsignificant trend of 137 (95% CI 99–183). Even in the first 15 days after the index hospital admission, most deaths (55.1%) occurred after hospital discharge, reinforcing the importance of linking hospital mortality databases with general population mortality information systems. The leading three basic causes of death, as reported in death certificates, were cardiovascular events, falls, and infections. This study represents an example of the application of PRL methodology to produce relevant data on hip fracture, a subject of rising epidemiological importance in developing countries.

Objective. The aim of the study was to analyze tuberculosis treatment outcomes in a health area of the National Health System. Material and Methods. Analytical cohort study of tuberculosis' cases treated in the hospital care of the health area of Salamanca (Spain) 6 months. The clinical record constituted the basic source of data, whose information was complemented by a clinical interview to the patient. The microbiological records were additionally used for classifying the therapeutic outcomes in satisfactory outcome (SO), potentially unsatisfactory outcome (PUO) and death. A total of 146 patients met the inclusion criteria; 108 patients were interviewed. Their average age was 49 years. Out of them, 29.6% (32/108) showed some social risk factor (SRF). Results. The SO level was 55.6% (IC 95%: 55.6±9); the variables associated with the SO were young elderly patients, living in family and patterns of 6 months. The PUO proportion stood at 40.7% (IC 95%: 40.7±9); the variables which increased the PUO probability were adulthood, residing in other provinces, living alone, comorbidity, human immunodeficiency virus (HIV), alcoholism and social maladjustment. The variables included in the final model for PUO in logistic regression were adult, comorbidity and SFR, while the institutional conditions associated the mortality. Conclusions. The SO rates can be improved. The PUO level is conditioned by high loss rates, 31.5% (95% CI: 31.5 ± 9), so measures should be established for reduction and improve the effectiveness of the overall treatment.

Internal Medicine Department Universidade Estadual Paulista (UNESP), 18618-970, Botucatu, SP

Geriatrics Division Department of Internal Medicine Universidade Estadual Paulista, Botucatu, SP

Univ Estadual Paulista, Div Geriatr, Dept Internal Med, Botucatu Med Sch, Botucatu, SP, Brazil

1 Puromycin aminonucleoside (PAN)-induced nephrosis is a model of human minimal change disease. In rats, PAN induces nephrotic-range proteinuria, renal epithelial cell (podocyte) damage, infiltration of mononuclear leukocytes, and apoptosis of several renal cell types. 2 Retinoic acid (RA) modulates a wide range of biological processes, such as inflammation and apoptosis. Since renal damage by PAN is characterized by inflammatory infiltration and epithelial cell death, the effect of treatment with all-trans RA (tRA) was examined in the PAN nephrosis model and in the cultured differentiated podocyte. 3 Treatment with tRA 4 days after PAN injection did not inhibit the proteinuria peak but reversed it significantly. However, treatment with tRA both before and 2 days after the injection of PAN protected the glomerular epithelial cells, diminishing the cellular edema and diffuseness of the foot process effacement. Preservation of the podocyte architecture correlated with the inhibition of proteinuria. The anti-inflammatory effect of tRA was evidenced by the inhibition of PAN-induced interstitial mononuclear cell infiltration and the decreased renal expression of two molecules involved in monocyte infiltration: fibronectin and monocyte chemoattractant protein-1. TUNEL assays showed that tRA inhibited the PAN-induced apoptosis of cultured differentiated mouse podocytes. 4 We conclude that tRA treatment may prevent proteinuria by protecting the podocytes from injury and diminishing the interstitial mononuclear infiltrate in the model of PAN nephrosis. Retinoids are a potential new treatment for kidney diseases characterized by proteinuria and mononuclear cell infiltration.

Este artigo discute o ensino de conteúdos de Saúde Coletiva no curso de graduação de Medicina, com base numa experiência desenvolvida na Faculdade de Medicina da UFRJ, Brasil. A monitoria virtual (MV) funciona como um instrumento complementar de ensino e constitui-se de um serviço de respostas a perguntas de alunos, de um website e de um serviço de mala-direta eletrônica. Este artigo mostra os resultados da avaliação da utilização e receptividade dos serviços MV no período entre 2000 e 2002. A metodologia consistiu da análise das mensagens enviadas e da avaliação dos serviços, pelos alunos. Neste período, a MV recebeu 153 mensagens contendo 239 perguntas. Mais de 60% dos alunos receberam alguma mensagem em sua caixa postal e 10% tiveram contato com as mensagens através de outro aluno. Menos de 20% enviaram mensagens para a MV. A análise do número de mensagens enviadas mostra uma variação durante o curso com maior concentração de envio próximo às provas da disciplina (35%). As mensagens continham "dúvidas acadêmicas" em 59% dos casos. A MV foi avaliada por 86% dos alunos, dos quais 61% ficaram totalmente satisfeitos com as respostas recebidas, 18% afirmaram que a MV aumentou sua freqüência de uso da Internet e 88% consideraram uma boa idéia a incorporação do serviço em outras disciplinas. O site foi acessado por 64% dos alunos. A maioria (65%) realizou entre três e dez acessos. A metodologia utilizada permitiu realizar uma análise exploratória dos possíveis fatores associados à incorporação da intervenção proposta.This article discusses the teaching of course contents in Collective Health during undergraduate medical school, based on the experience at the School of Medicine of the Federal University in Rio de Janeiro (UFRJ), Brazil. Virtual Tutoring (VT) is used as a complementary teaching tool, comprising a service that provides answers to students' questions through a website and an e-mail list. This article discusses the results from the evaluation of the utilization of (and receptiveness to) VT services from 2000 to 2002. The methodology consisted of an analysis of messages submitted and student evaluation of the services. During this period, VT received 153 messages containing 239 questions. More than 60% of the students had received some message in their mailboxes, and 10% had contacted the messages through other students. Fewer than 20% had sent messages to the VT. The analysis of the number of messages submitted showed a variation during the course schedule, with a peak concentration of questions close to exam time (35%). The messages contained "academic doubts" in 59% of the cases. The VT was evaluated by 86% of the students, of whom 61% were completely satisfied with the answers they had received, some 18% reported that VT had increased their frequency of Internet use, and 88% agreed with the idea of incorporating the service into other disciplines. The website was accessed by 64% of the students. The majority (65%) had made from 3 to 10 hits. The study methodology allowed for an exploratory analysis of possible factors associated with the assimilation of the proposed intervention.

Este artigo discute o ensino de conteúdos de Saúde Coletiva no curso de graduação de Medicina, com base numa experiência desenvolvida na Faculdade de Medicina da UFRJ, Brasil. A monitoria virtual (MV) funciona como um instrumento complementar de ensino e constitui-se de um serviço de respostas a perguntas de alunos, de um website e de um serviço de mala-direta eletrônica. Este artigo mostra os resultados da avaliação da utilização e receptividade dos serviços MV no período entre 2000 e 2002. A metodologia consistiu da análise das mensagens enviadas e da avaliação dos serviços, pelos alunos. Neste período, a MV recebeu 153 mensagens contendo 239 perguntas. Mais de 60% dos alunos receberam alguma mensagem em sua caixa postal e 10% tiveram contato com as mensagens através de outro aluno. Menos de 20% enviaram mensagens para a MV. A análise do número de mensagens enviadas mostra uma variação durante o curso com maior concentração de envio próximo às provas da disciplina (35%). As mensagens continham "dúvidas acadêmicas" em 59% dos casos. A MV foi avaliada por 86% dos alunos, dos quais 61% ficaram totalmente satisfeitos com as respostas recebidas, 18% afirmaram que a MV aumentou sua freqüência de uso da Internet e 88% consideraram uma boa idéia a incorporação do serviço em outras disciplinas. O site foi acessado por 64% dos alunos. A maioria (65%) realizou entre três e dez acessos. A metodologia utilizada permitiu realizar uma análise exploratória dos possíveis fatores associados à incorporação da intervenção proposta.

A partir de pesquisa realizada com dez adolescentes do sexo feminino das camadas médias de Ribeirão Preto-SP, este trabalho analisa a constituição da identidade de gênero dessas adolescentes, suas relações com a família e com o grupo de pares e os vínculos afetivos com parceiros com os quais se fica e com namorados. A análise dos dados sugere que apesar da mudança nos padrões culturais e da nova posição assumida pelas mulheres, a constituição da identidade de gênero das adolescentes é marcada por ambigüidades em torno dos papéis femininos, o que contribui para que elas incorporem essas mesmas ambigüidades em sua conduta. On the basis of a survey of middle-class adolescent girls from Ribeirão Preto, the present study analyzes the constitution of gender identity of these girls, their relations with family and with peer group and the affective ties with occasional or steady boy friends. Analysis of the data suggests that, despite the change in cultural patterns and of the new positions of women, the constitution of gender identity of girls is marked by ambiguities about female roles, a fact that causes these girls to incorporate these same ambiguities into their behavior.

Background The increasing prevalence of genomic analysis (genome/exome sequencing and array-based measures) in psychiatric research generates complex novel challenges for investigators. A critical challenge is how to manage the clinically relevant information that can be generated with these technologies, such as risk for cancer, heart disease, or psychiatric disorders. There is an emerging ethical consensus that genomics researchers have a duty to offer findings identified in the course of research that are clinically valid, medically important, and medically actionable. This consensus is mainly based on the beneficence argument that these findings may aid health care or life planning; and that it would be disrespectful to participants’ autonomy to deny them the opportunity to decide whether to know this type of genomic findings. This has led to an increasing practice of returning results to individual participants in genomic research. However, there is little guidance about the return of results in psychiatric research, including what genomic findings should be returned and what is the scientific, ethical, and legal rationale for returning these. Methods We conducted ethical and legal analysis of current return of results practices, relevant guidelines, and policies to generate a framework to guide determinations about the types of results that should be offered to psychiatric genomics research participants. The framework was developed for a genomic study with patient-participants suffering from treatment-resistant psychosis, but it is applicable to other psychiatric genomics research scenarios and populations. Results Our analysis shows that, as in studies of other medical conditions, when resources allow, psychiatric genomics researchers should offer to return findings generated in the course of research that are clinically valid, medically important, and medically actionable (e.g., BRCA1/2 pathogenic variant). Notably, we conclude that due to potential benefit to participants, when resources allow, psychiatric genomics researchers should also offer to return “clinically valuable” genomic findings. In this framework, clinically valuable genomic findings are those obtained in the course of research that, even if not medically actionable, have the potential to aid current or future health care because they: 1) are clinically valid findings that provide information about important health risks; 2) help corroborate or reject a psychiatric diagnosis; or 3) are rare variants of unknown significance in genomic loci known to be associated with a psychiatric disorder, particularly if consistent with a participant’s known phenotypes. Discussion Studies show that only about 4% of genome-wide association studies (GWAS) return findings to individual participants. This is in part because GWAS do not often generate findings with immediate clinical relevance. However, as large-scale GWAS identify more clinically relevant findings and genomic sequencing becomes more accessible and prevalent in psychiatric research, investigators will increasingly confront the challenge of having to manage clinically relevant findings in an ethically sound and legally valid fashion. This framework for the return of results in psychiatric genomics research will help investigators make determinations about a key aspect of the return of results: what findings should be offered.