Italy: Delayed adaptation of social institutions to changes in family behaviour

Considering its very low fertility and high age at childbearing, Italy stands alone in the European context and can hardly be compared with other countries, even those in the Southern region. The fertility decline occurred without any radical change in family formation. Individuals still choose (religious) marriage for leaving their parental home and rates of marital dissolution and subsequent step-family formation are low. Marriage is being postponed and fewer people marry. The behaviours of young people are particularly alarming. There is a delay in all life cycle stages: end of education, entry into the labour market, exit from the parental family, entry into union, and managing an independent household. Changes in family formation and childbearing are constrained and slowed down by a substantial delay (or even failure) with which the institutional and cultural framework has adapted to changes in economic and social conditions, in particular to the growth of the service sector, the increase in female employment and the female level of education. In a Catholic country that has been led for almost half a century by a political party with a Catholic ideology, the paucity of attention to childhood and youth seems incomprehensible. Social policies focus on marriage-based families already formed and on the phases of life related to pregnancy, delivery, and the first months of a newborn’s life, while forming a family and childbearing choices are considered private affairs and neglected.adaptations, childbearing, Europe, family, fertility, Italy

Avaliaçao eletrencefalográfica em pacientes com doença hepática crônica submetidos a transplante hepático

Orientador : Sergio Monteiro de AlmeidaDissertaçao (mestrado) - Universidade Federal do Paraná, Setor de Ciencias da SaúdeResumo: A encefalopatia hepatica (EH) engloba um grande espectro de disturbios neuropsiquiatricos, geralmente reversiveis, observados em pacientes com significante disfuncao hepatica. Para o estudo do espectro eletrencefalografico dos pacientes portadores de doenca hepatica cronica submetidos a transplante hepatico (TH) pelo Servico de TH do Hospital de Clinicas - UFPR, Curitiba, foi realizada uma avaliacao prospectiva de 20 pacientes acima de 15 anos submetidos a TH, que incluiu exame clinico, classificacao da EH e da doenca hepatica, avaliacao das funcoes cognitivas, mediante o teste do mini-exame do estado mental, teste de trilhas B, subteste de digitos da bateria "Wechsler Adult Intteligence Scale - Revised" (WAIS-R), teste de fluencia verbal (FAR) e categorias (animais) e teste do desenho do relogio; eletrencefalograma (EEG). A EH foi graduada observando-se os dados do exame clinico neurologico, dos testes neuropsicologicos e dos exames eletrencefalograficos. O diagnostico de EH subclinica foi feito quando na ausencia de criterios clinicos para EH, encontrou-se alentecimento no EEG ou pelo menos dois testes neuropsicologicos (TNPS) anormais. A EH subclinica foi encontrada em 60,6% dos casos. O EEG foi avaliado em relacao a seus diferentes parametros de forma evolutiva. A avaliacao foi realizada no periodo do pre-TH imediato e com 30 e 90 dias do pos-TH. A media da frequencia do ritmo de base posterior (FRBP) no pre- TH foi de 8,8 + 1,9 Hz, com 30 dias pos-TH foi de 9,8 + 1,7 Hz e aos 90 dias pos-TH foi de 9,9 +1,7 Hz, com uma melhora nos valores significante, quando se compara a evolucao (p<0,0001). Na analise em relacao a FRBP do grupo controle, os valores do grupo de estudo permanecem inferiores. No pre-TH 9 pacientes (45,0%) apresentavam alentecimento no EEG, 4 casos (44,4%) alentecimento IIA, 4 casos (44,4 %) alentecimento IIIA e 1 paciente IIIC. Quinze pacientes foram submetidos a avaliacao com 30 dias pos-TH, destes 3 casos (20,0%) mostravam alentecimento em seus exames, 1 caso IIA, 1 caso IIIA e 1 caso IIIB. Com 90 dias de pos-TH o EEG foi realizado em 14 pacientes, destes apenas 1 paciente apresentou alentecimento IIIA. Todos os pacientes que apresentavam alentecimento obtiveram melhora no seguimento (p<0,0001). Tres pacientes apresentaram ondas trifasicas nos seus exames. Foram estudados a acuracia da FRBP, o alentecimento da atividade de fundo e a presenca de ondas trifasicas, tendo como padrao ouro no diagnostico de EH os TNPS, os parametros do EEG apresentaram boa especificidade e bons valores preditivos positivos (VPP) e baixa especificidade e valores positivos negativos (VPN). Para avaliacao da melhora da EH no pos-TH, foi considerado padrao ouro a melhora dos TNPS, os parametros do EEG mostraram alta especificidade e alto VPP, com baixa sensibilidade e baixo VPN.Abstract: Hepatic encephalopathy (HE) encompasses a wide spectrum of neuropsychiatric disturbances, usually reversible, observed in patients with significant liver dysfunction. In order to better asses the electroencephalographic changes found in patients with chronic hepatic failure submitted to liver transplantation (LT) at the Servico de Transplante Hepatico do Hospital de Clinicas da UFPR, Curitiba, the authors prospectively followed 20 patients, the youngest one being 15 years old, who had all underwent LT. The variables included physical examination, classification of HE and liver disease, electroencephalogram (EEG) and assessment of cognitive functions with the following neuropsychological tests (NPTS): Mini-Mental State, Trail Making Test Part B, Digit Span subtest used in the Wechsler Adult Intelligence Scale - Revised (WAIS-R), Word Fluency (FAR) and Category Fluency and the Clock Drawing Test. The severity of HE was graded according to the findings of the physical examination, neuropsychological testing and EEG. Subclinical HE was diagnosed when the EEG disclosed a diffuse slowing of background activity or at least two neuropsychological tests were abnormal in the absence of clinical findings. EEG was prospectively evaluated, with a baseline recording in the pretransplantation period (pre-LT) and 30 and 90 days after the transplant (post-LT). Mean posterior baseline rhythm frequency (PBRF) was of 8.8 } 1.9 Hz in the pre-LT period, 9.8 } 1.7 Hz at 30 days post-LT and 9.9 } 1.7 at 90 days post-LT and this increase in the PBRF was considered significant (p< 0,0001). Mean PBRF in the transplantation group was lower than that of the control group. Nine patients (45.0%) had a diffuse slowing of background activity in the EEG in the pre-LT period, with 4 patients (44.4%) presenting with a IIA slowing, 4 patients (44.4%) with a IIIA slowing and one with a IIIC slowing. Fifteen patients were evaluated 30 days after LT, and 3 of them (20.0%) had a slow EEG: 1 with a IIA slowing, 1 with a IIIA and one with a IIIB. EEG recording of 14 patients 90 days after LT disclosed a IIIA slowing in just one patient. All the patients who presented with slowing in their initial EEG had a significant improvement of background activity following LT (p< 0, 0001). Three patients also had triphasic waves in their EEGs. The diagnosis accuracy of PBRF, background slowing and the occurrence of triphasic waves were evaluated in comparison with NPTS as the gold standard for the diagnosis of HE. As a result, EEG parameters had a good specificity and positive predictive values (PPV), with low sensitivity and negative predictive values (NPV). Final assessment of improved HE in the post-LT period considered NPTS as the gold standard, but also demonstrated that EEG abnormalities have high specificity and PPV, but low sensibility and NPV

Avaliação polissonográfica em pacientes com ataxia espinocerebelar tipo 2

Orientador: Prof. Dr. Hélio Afonso Ghizoni TeiveCoorientadora: Profª. Drª. Ana Chrystina de Souza CrippaTese (doutorado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Medicina Interna. Defesa : Curitiba, 28/07/2017Inclui referências : f. 61-67Resumo: A ataxia espinocerebelar tipo 2 (AEC2) fenotipicamente se manifesta por síndrome cerebelar progressiva, lentidão dos movimentos sacádicos, disfunção cognitiva, neuropatia periférica, distúrbios do movimento e distúrbios do sono. É causada por uma mutação caracterizada pela presença do trinocleotídeo citosina-adenina-guanina (CAG) polimórfico, repetido e expandido na região codificadora do gene ATXN2 (12q24.1). Os distúrbios do sono são frequentes nas doenças neurodegenerativas e relatados em vários tipos de AECs. Entretanto, há poucos dados na literatura a respeito do sono e dos parâmetros polissonográficos nos pacientes com AEC2. Os objetivos do estudo foram identificar as alterações e distúrbios no sono de pacientes com AEC2; com ênfase nos dados polissonográficos, comparando os achados às alterações clínicas e genéticas. Investigou-se o sono de 17 pacientes, 10 do gênero masculino e 7 do feminino (46,47 ± 11,41 anos), que faziam acompanhamento no ambulatório de ataxias do Grupo de Distúrbios de Movimento do Complexo Hospital de Clínicas da Universidade Federal do Paraná, com diagnóstico de AEC2 confirmado por teste genético, de março de 2015 a maio de 2016. Realizou-se uma avaliação padronizada com entrevista clínica, exame neurológico e graduação pela escala de avaliação de ataxia (SARA). Seguiu-se a aplicação do Questionário de Pittsburgh e a escala de Sonolência Diurna de Epworth. Os dados polissonográficos dos pacientes com AEC2 foram comparados com os achados de 17 controles saudáveis. O índice de apneiahipopneia obstrutiva (IAH) do sono esteve elevado em 14 (82,35%) pacientes, aumento do índice de despertares breves em 13 (76,47%). Doze apresentaram redução na proporção do sono REM (70,58%), ausência da densidade de REM (DREM) em 13 (76,47%) e redução de DREM em 4 (23,52%). Na análise comparativa com o grupo controle encontrou-se diferença significativa na eficiência do sono (P = 0,03), latência para o sono (P < 0,001), índice de despertares breves (P = 0,02), proporção de sono REM (P < 0,001) e DREM (P < 0,001). Houve correlação entres os registros polissonográficos dos pacientes mais graves de acordo com a escala SARA e a diminuição da DREM (r = -0,6; P = < 0,001); com maior tempo de evolução da doença e a redução da DREM (r = -0,52; P = 0,03) e comprometimento da ES (r = -0,55; P = 0,02). Não se encontrou paralelismo com o número de repetições de CAG. Conclui-se que a síndrome da apneia obstrutiva do sono é um distúrbio comum, os exames polissonográficos revelaram alterações importantes principalmente no sono REM, a DREM apresentou uma correlação com a evolução temporal e clínica da AEC2. Palavras-chave: Ataxia; Sono REM; Densidade do sono REM, Distúrbios do sono.Abstract: Spinocerebellar ataxia type 2 (SCA2) is phenotypically manifested by a combination of progressive cerebellar syndrome, sluggish saccadic movements, cognitive dysfunction, peripheral neuropathy, other variable movement disorders, and sleep disorders. It is caused by a mutation in the coding region of the ATXN2 gene (12q24.1) with an abnormally repeated polymorphic cytosine adenine-guanine (CAG) trinucleotide. Sleep disturbances are rather common in neurodegenerative diseases and have been reported in several types of SCAs. However, there is limited data in the literature regarding sleep and polysomnographic parameters in patients with SAC2. The objectives of this study were to identify the disturbances in sleep of patients with SCA2, with emphasis on polysomnographic abnormalities and to compare them with both clinical and genetic findings. Sleep was investigated in 17 patients (10 males and 7 females; age 46.47 ± 11.41), who were followed up in the Ataxia outpatient clinic of the Movement Disorders Group of the Hospital de Clínicas, Universidade Federal do Paraná, who had a genetically confirmed diagnosis of SCA2 from March 2015 to May 2016. All patients were evaluated according to a standardized assessment, which included a standardized clinical interview, neurological examination and evaluation of impairment according to the validated Brazilian version of the ataxia assessment scale (SARA), as well as evaluation of daytime sleepiness according to the Pittsburgh Questionnaire and the Epworth Daytime Sleepiness Scale. Furthermore, the polysomnographic findings of SCA2 patients were compared with those of 17 healthy controls. The obstructive apnea-hypopnea index (AHI) of sleep was elevated in 14 (82.35%) patients, and there was also an increase in the index of brief awakenings in 13 (76.47%). Twelve subjects had a reduction in the proportion of REM sleep (70.58%), there was absence of REM density (DREM) in 13 (76.47%) and reduction in DREM in 4 (23.52%). In the comparative analysis with the control group, there was a significant difference in sleep efficiency (SE) (P = 0.03), sleep latency (P <0.001), arousal index (P = 0.02), proportion of REM sleep (P <0.001) and DREM (P <0.001). There was an indirect correlation between the polysomnographic records of those patients who were more severely compromised according to the SARA scale and the DREM decrease (r = -0.6; P = <0.001), and alteration of SE (R = -0.52, P = 0.02); with a longer duration of disease progression correlating with a more pronounced reduction in the DREM (r = -0.52, P = 0.03). No parallel was found with the number of CAG repeats. We concluded that Obstructive Sleep Apnea is a common disorder, the polysomnographic examination revealed marked abnormalities, mainly during REM sleep, and there was a correlation between a decrease in DREM with both temporal and clinical evolutions of SCA2. Key-words: ataxia; REM sleep; REM density; Sleep; Sleep disorders

Italy: Delayed adaptation of social institutions to changes in family behaviour

Considering its very low fertility and high age at childbearing, Italy stands alone in the European context and can hardly be compared with other countries, even those in the Southern region. The fertility decline occurred without any radical change in family formation. Individuals still choose (religious) marriage for leaving their parental home and rates of marital dissolution and subsequent step-family formation are low. Marriage is being postponed and fewer people marry. The behaviours of young people are particularly alarming. There is a delay in all life cycle stages: end of education, entry into the labour market, exit from the parental family, entry into union, and managing an independent household. Changes in family formation and childbearing are constrained and slowed down by a substantial delay (or even failure) with which the institutional and cultural framework has adapted to changes in economic and social conditions, in particular to the growth of the service sector, the increase in female employment and the female level of education. In a Catholic country that has been led for almost half a century by a political party with a Catholic ideology, the paucity of attention to childhood and youth seems incomprehensible. Social policies focus on marriage-based families already formed and on the phases of life related to pregnancy, delivery, and the first months of a newborn's life, while forming a family and childbearing choices are considered private affairs and neglected

Late recrudescence of Plasmodium falciparum malaria in a pregnant woman: a case report

More than 90% of imported Plasmodium falciparum malaria infections are diagnosed within five weeks after returning from an endemic area. Here a case of P. falciparum malaria in a pregnant woman is reported, diagnosed four years after her last stay in an endemic area

A INCORPORAÇÃO DO CONHECIMENTO E A INOVAÇÃO EM INDÚSTRIAS DE TRANSFORMAÇÃO DA REGIÃO DE FREDERICO WESTPHALEN

O presente artigo tem por objetivo divulgar o estudo científico realizado no âmbito empresarial, no que se refere à incorporação do conhecimento e a inovação em indústrias de transformação na região de Frederico Westphalen. As transformações ocasionadas pela mudança de um ambiente estático para um ambiente dinâmico estão fazendo com que as organizações busquem, através da inovação, novas formas de gestão e inserção no mercado. A incorporação do conhecimento e a inovação se inserem no contexto da acelerada disseminação das tecnologias modernas, incrementado melhorias, sejam em produto, processo ou prática administrativa, uma vez que a inovação ocorre através de um processo interativo, realizado com a contribuição de vários agentes econômicos e sociais que possuem conhecimentos e informações. O Brasil apresenta um processo crescente de atuação no comércio mundial, em que a qualidade e a confiabilidade são requisitos primordiais, assim, o que se estabelece é a busca constante pelo equilíbrio entre a inovação contínua e a relação de confiança com os clientes.-This article has the purpose to propogate the scientific study made companies ambit in what refers to the knowledge incorporation and to the innovation in transformation industries of the region of Frederico Westphalen. The changes have made transformations from a static environment to a dynamic environment, and they’re dealing with organizations that have to look for, through the innovation, new ways of management and insertion in the market. The knowledge incorporation and the innovation insert themselves in the context of accelerated dissemination of modern technologies, increasing improvements in products, management process and practice, because the innovation occurs through an interactive process, made by the contribution of many economic and social agents which have knowledge and informations. Brazil presents a growing process of action in the world trade, where quality and confiability are fundamental requirements, therefore what one establish es is the constant search for the balance between the continous innovation and the trust relationship with the customers. 

SISTEMAS DE INFORMAÇÃO E O PROCESSO DECISÓRIO: UM ESTUDO DE CASO

Este artigo resulta do relatório de conclusão do curso de administração, configurando estudo de caso em Sistemas de Informação, como ferramenta de apoio ao processo decisório. O objetivo principal foi analisar as atividades envolvidas no processo gerencial, considerando a estrutura existente, para propor um sistema de informação capaz de aprimorar a eficiência interna, maximizar informações no otimizar decisório. Na metodologia, descreveu-se um estudo de caso, através de pesquisa descritiva, bibliográfica e de campo, sendo os dados provenientes da pesquisa informal, observação direta e análise documental, formatada na interpretação qualitativa. Para o desenvolvimento do trabalho foram analisadas as contribuições e as limitações do sistema existente. A partir da análise, a proposta de novo sistema buscou suprir limitações, considerando como elementos importantes a qualidade e utilidade do sistema para o usuário e a integração dos subsistemas administrativos, para a agilidade das operações/transações corriqueiras, melhoria dos controles internos, para que as informações se convertam em decisões gerenciais estruturadas. Entretanto, ao passo que a tecnologia da informação constitui melhoria efetiva na gestão, é necessário que as pessoas envolvidas se adaptem, através de capacitação que permita não apenas uma correta alimentação e processamento de dados como interpretação das informações geradas, além de desenvolver a visão da responsabilidade, autoridade, comunicação e de decisão. A tecnologia e a empresa devem formar um processo conjunto para agregar valor aos serviços e buscar a satisfação dos clientes, já que estas evidenciam razão de ser.-This article results from a final paper, written as one of the requirements for graduation in Administration. It is a case study in Information Systems, seen as a tool to support the decision-making process. The main objective is to analyze the activities involved in the management process, considering its present structure, so as to propose an information system that will improve internal efficiency and optimize the decision making process. A case study is described through descriptive, bibliographical research and field research. Data was obtained from informal research, direct observation and documentary analysis, subjected to qualitative interpretation. In the sequence, contributions and limitations of the existing system were analyzed. As a result, a new system was proposed, having as it is goal supplying former system limitations. The quality and utility of the system for the user, and the integration of administrative subsystems were considered vital to speed current transactions and operations and to improve internal controls, so as to convert information into structuralized management decision. Information technology provides effective improvement in management; however, it is necessary that people be qualified in what concerns data feed and processing and in the interpretation of the data thus generated. Besides, personnel should develop a sense of responsibility, authority, communication and decision-making. The use of technology and qualified personnel must, together, join efforts to add value to the services offered and to search customer satisfaction, which is the reason of being of any business

Protection of calcium silicate/sodium phosphate/fluoride toothpaste with serum on enamel and dentin erosive wear

Objective: To evaluate the effect of a toothpaste containing calcium silicate/sodium phosphate/fluoride associated or not to the boost serum (BS) against erosive tooth wear (ETW) on enamel and dentin. Methodology: Bovine enamel and dentin specimens were subjected to an erosion-abrasion cycling model (1% citric acid - pH 3.6 -2 min / artificial saliva – 60 min, 4×/day, 5 days). Toothbrushing was performed for 15 s (2 min exposed to slurry), 2×/day, with the toothpastes (n=10): control without fluoride (Weleda), Arg/Ca/MFP (Colgate Pro-Relief), Si/PO4/MFP (Regenerate-Unilever), and Si/PO4/MFP/BS (Si/PO4/MFP with dual BS – Advanced Enamel Serum-Unilever). The effect of treatments on the eroded tissues was assessed by surface microhardness in the first day, and surface loss (SL) resulting from ETW was evaluated by profilometry (μm) after three and five days. Additional dentin specimens (n=5/group) were subjected to 20,000 brushing cycles to verify the abrasivity of the toothpastes. Data were subjected to ANOVA and correlation tests (5%). Results: For enamel, no difference in microhardness was observed among the treated groups, and similar SL was obtained after 5 days. For dentin, Si/PO4/MFP/BS resulted in higher microhardness values, but none of the groups presented significantly lower SL than the control. There was no significant correlation between SL and abrasiveness. Conclusion: The calcium silicate/sodium phosphate toothpaste and serum increased microhardness of eroded dentin, but they did not significantly reduce enamel and dentin loss compared to the non-fluoride control toothpaste. The abrasiveness of the toothpastes could not predict their effect on ETW

O letramento científico na BNCC: possíveis desafios para sua prática

Esta pesquisa qualitativa, com análise documental e de dados e revisão de literatura apresentou conceitos e concepções sobre o letramento científico (LC) e analisou como é apresentado na Base Nacional Comum Curricular (BNCC). A referida Base apresenta o conceito de LC na área de Ciências da Natureza com algumas contradições de sentido. Investigou-se possíveis desafios para que a BNCC atinja seus ideais de educação equitativa e LC. Os resultados mostram que na educação nacional ainda há necessidade de melhorias na formação de professores, infraestrutura e recursos dos estabelecimentos e outros desafios que não podem ser ignorados. A disparidade entre sistemas, redes, escolas e condições de trabalho docente é um grande problema para a garantia de uma educação democrática, inclusiva e justa