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Fall represents an important cause of death and its relation with the population aging evidences the need of a broad analysis considering different aspects associated with its occurrence. The objective of this study was to compare fatal victims due to unintentional fall among adults, young olds, olds, and oldest olds, according to sociodemographic data, characteristics, and severity of the trauma. This study is a cross-sectional, comparative study analyzing autopsy reports of fatal victims due to fall, admitted to the Medical Legal Institute of Sao Paulo, Sao Paulo, Brazil, in 2015. The following age groups were: adults (≥18 and

Objective To analyze prevalence of venous thromboembolism (VTE) after ultrasound guided foam sclerotherapy. Method Clinical retrospective study with patients treated from 2004 to 2014. Charts with incomplete data and follow-up less than 60 days were excluded. Polidocanol foam (Tessari method) was used. The primary outcome was the prevalence of VTE and the secondary were possible risk factors. Chi-square test and Marascuillo prodecure were applied at a significance level of 5%. Results 2,616 patients were included with 4,712 lower limbs treated. The mean age was 50.7±0.86, in majority female, 83.7%. VTE occurred in 0.49% (pulmonary embolism 0,3%) in a mean time of 44.0±42.2 days. Male gender, personal or family history of phlebitis or DVT and high caliber varicose veins were significantly associated to VTE. Conclusion incidence of VTE is low, male gender, personal or family history of VTE and caliber of varicose veins greater than 7 mm increased the risk.

Background: Thyrotoxic crisis is a rare, multisystemic and lethal condition, especially when its reversal is delayed. The Burch Wartofsky score establishes severity and predicts the indication of plasmapheresis, but once there is organ dysfunction this therapy should be considered despite of the score. When it is added to conventional treatments it is really effective because of the quick clinical compensation of critically ill patients regardless of the main trigger factor of this emergency. Clinical Cases: 5 patients with thyrotoxic crisis, 1 man and 4 women that had Graves’disease (4 cases) or TSH-secreting tumor (1 case). The precipitating factors were: 1 case due to orchitis, 2 due to poor adhesion, 1 due to antithyroid drugs hepatoxicity and 1 due to ketoacidosis. All them had elevated free T4 ranging from 3.38 to >7.77 ng/dL. All them had high Burch Wartofsky scores (55 to 70) and severe organ dysfunctions: 4 cases with hepatopathy (hepatosplenomegaly, jaundice and coagulopathy) and cardiopathy (diastolic dysfunction and pulmonary hypertension) and 1 case with severe diabetic ketoacidosis. Plasmapheresis (2 to 3 sessions were performed) were indicated for clinical compensation and so subsequent definitive treatment: 3 cases received radioiodine therapy and 1 case had total thyroidectomy. All of them progressed well. The patient who died had already severe prior comorbidities. We performed a systematic survey on PubMed of English articles (case reports and reviews) in humans and we analyzed our 5 cases along with the 108 articles about the use of plasmapheresis in thyroid storm from 1970 to 2020 and we compare them to 394 ones of conventional treatments in past 10 years. Our objective was to evidence plasmapheresis is not related to a higher mortality of patients who underwent to it. We found 7% of mortality in both groups. The chi square test showed an Odds Ratio of (CI 95%) = 1,091 reinforcing there is no relation between number of deaths and treatment type. Conclusion: Plasmapheresis is a therapeutic option with few reports in the literature and without clear guidelines about indication criteria or better timing to initiate it. The statistical analysis showed that 3 or more organ dysfunctions in thyroid storm are related to higher death rates. Its early employment within 24 hours of the initial symptoms and the prompt normalization of free T4 are related to lower mortality. It is a safe and effective therapy that allows thyroid storm patients to be compensated to receive definitive treatment with lower chances of death. Reference: Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y. Factors Associated With Mortality of Thyroid Storm: Analysis Using a National Inpatient Database in Japan. Medicine (Baltimore). 2016;95(7):e2848.

Modalidade de ensino em crescimento no Brasil desde o início dos anos 2000 e com expectativa de contínua expansão, especialmente em função da cada vez maior facilidade de comunicação, seja via Internet, seja via celular ou tablet, a educação a distância (EaD) permite que indivíduos de áreas remotas ou aqueles com pouca disponibilidade de rotina regular para frequentar um curso tradicional, possam obter um diploma superior. Do ponto de vista das instituições de ensino, porém, as altas taxas de evasão são um obstáculo à manutenção e ampliação da oferta desta tipologia de curso. Para que haja a queda destas taxas, é necessário aumentar a lealdade dos estudantes e, para tanto, o valor percebido no curso, que, no caso da educação, faz sentido supor que seja criado entre alunos e universidade; isto porque, além de haver a necessidade de ambos os agentes para a prestação de serviço, o aluno possui papel fundamental para o sucesso do que se oferece (qualificação acadêmica). A literatura acadêmica do setor de serviços indica que, apesar de existir relação entre [cocriação de] valor e lealdade, esta, em geral, se apresenta mediada por qualidade e/ou satisfação. É neste contexto que este trabalho está inserido, apresentando como objetivo identificar os aspectos de cocriação de valor determinantes para a qualidade percebida e lealdade, com foco em educação a distância, por meio de uma pesquisa quantitativa com estudantes desta modalidade de ensino. Esta pesquisa foi antecedida pela exploração do tema com especialistas do setor que contribuíram com seus conhecimentos e experiências. Para a pesquisa quantitativa foi enviado questionário online de autopreenchimento para endereço eletrônico de estudantes de graduação EaD fornecidos por parceria com faculdades privadas e empresa de pesquisa voltada à educação. Ao final, foram obtidas 400 respostas válidas, usadas para entender o comportamento do aluno perante cocriação de valor e suas relações com demais dimensões de interesse (qualidade percebida, satisfação e lealdade). Duas vertentes mostraram-se relevantes na composição da cocriação de valor: coprodução, que engloba o compartilhamento de conhecimento, a interação faculdade-aluno e transparência na transmissão de valores e interesses da faculdade; e valor em uso, refletindo a experiência, o relacionamento e a capacidade de personalização do serviço educacional. Como era suposto, a cocriação mostrou-se influente na explicação dos construtos e tem a imagem da faculdade como uma dimensão importante em sua explicação. Quando observadas as relações entre variáveis latentes segundo o perfil do aluno, encontra-se que aqueles pertencentes à Geração Y são os que mais condicionam sua satisfação e lealdade à participação na criação do valor. Growing type of education in Brazil since the early 2000s and with expectations of continued expansion, especially given the increasing ease of communication, whether via the Internet, whether via mobile phone or tablet, distance education (DE) allows individuals from remote areas or those with limited availability of regular routine to attend a traditional course, get a higher degree. From the perspective of educational institutions, however, the high dropout rates are an obstacle to the maintenance and expansion of supply of this type of course. In order to make these rates fall, it is necessary to increase the loyalty of students and, therefore, the perceived value, which in the case of education, it makes sense to assume created between students and university; this is because in addition to be a need for both agents to provide service, the student has fundamental role in the success of what is offered (academic qualification). The academic literature in the service sector indicates that although there is a relationship between [co-creation of] value and loyalty, this relation is usually presents mediated by quality and/or satisfaction. In this context, this work is inserted, aiming to identify the aspects of value co-creation that are determinants for perceived quality and loyalty, focusing on distance education, through a quantitative survey of students of this type of education. This research was preceded by an exploration of the theme with specialists of the sector who contributed with their knowledge and experiences. For the survey, an online self-completion questionnaire was sent to the e-mail of undergraduate students provided by a partnership with private colleges and a research company focused on education. In the end, 400 valid answers were obtained, used to understand the student\'s behavior in relation to value creation and their relationships with other dimensions of interest (perceived quality, satisfaction and loyalty). Two aspects have been relevant in the composition of value co-creation: co-production, which includes knowledge sharing, college-student interaction and transparency in the transmission of values and interests of the college; and value-in-use, reflecting the experience, the relationship and the capacity of personalization on the educational service. As was supposed, co-creation has proved to be influential in the explanation of constructs, and the image of college is an important dimension in its explanation. When the relationships between latent variables were observed according to the profile of the student, it was found that those belonging to Y Generation are the ones that present their satisfaction and loyalty conditioned to participation in the creation of value.

em períodos de forte declínio nas vendas de jornal é especialmente importante para as empresas do segmento editorial manter seus leitores, garantindo atratividade de anunciantes e gerando receita. Uma forma de manter estes leitores é através da assinatura, sendo, portanto, de extrema relevância o entendimento das características que levam a um maior risco de cancelamento e a identificação dos momentos mais críticos para o direcionamento das ações de retenção. A Análise de Sobrevivência engloba técnicas capazes de auxiliar no entendimento destas questões, sendo a mais usual, o modelo de riscos proporcionais de Cox. Este modelo adota como premissa que a proporcionalidade dos riscos seja mantida independentemente do período de tempo analisado. Há diversos casos, porém, em que esta premissa não é satisfeita, fazendo-se necessária a busca por alternativas. Em assinaturas de jornais é, por exemplo, razoável supor que haja, para assinantes que optaram pela renovação da assinatura, um maior risco de cancelamento no início do período (caso em que a renovação da assinatura anterior foi automática) ou no final (indicando descontentamento e não renovação futura). Neste contexto foram estudados - e aplicados aos dados sobre assinaturas de jornais - os modelos de riscos aditivos de Aalen e semiparamétricos, que permitem a introdução da interferência do tempo sobre os efeitos das características que levam ao risco de cancelamento. not available

The paper analyzes the innovation intensity and adoption characteristics at the base of the pyramid market. The innovation intensity is configured as radical and incremental, while the innovation adoption is configured as early and tardy. As an empirical approach it was conducted a study type survey. Data analysis is based on non-parametric statistics. The results indicate that the base of the pyramid consumers is characterized by adopting incremental innovations tardily, as pointed out by the literature. Furthermore, it was also observed that women have greater decision-making power in the families of this segment., O artigo analisa as características da intensidade e da adoção da inovação no mercado da base da pirâmide. A intensidade da inovação se configura como radical e incremental, enquanto que a adoção da inovação se configura como inicial e tardia. Como recorte empírico foi realizada uma pesquisa do tipo survey. A análise dos dados se fundamenta na estatística não paramétrica. Os resultados apontam que os consumidores da base da pirâmide se caracterizam por adotarem inovações incrementais de forma tardia, conforme aponta a literatura. Ademais, foi possível concluir também que as mulheres possuem maior poder de decisão nas famílias deste segmento.