Classificação internacional de funcionalidade, incapacidade e sáude - CIF nos cursos de graduação em terapia ocupacional

Dissertação (mestrado)—Universidade de Brasília, Instituto de Psicologia, Programa de Pós-Graduação em Processos de Desenvolvimento Humano e Saúde, 2013.As Diretrizes Curriculares Nacionais em 2001, coerentes com o Ministério da Saúde, influenciaram no processo de formação de todos os profissionais de saúde, direcionando as práticas de ensino dos serviços dessa área para a utilização do modelo biopsicossocial, em consonância com o Sistema Único de Saúde – SUS. Paralelamente a essas mudanças, em 2001 a Organização Mundial de Saúde (OMS) aprovou e recomendou a Classificação Internacional de Funcionalidade, Incapacidade e Saúde – CIF nos serviços de saúde de todos os países membros, incluindo o Brasil. Entretanto, ainda é escasso o número de cursos de Terapia Ocupacional que aderiram a essas recomendações. Este trabalho averiguou informações referentes à graduação em Terapia Ocupacional no Brasil através do sistema e-MEC e analisou os Projetos Pedagógicos dos Cursos (PPCs) disponíveis em sites de Instituições de Ensino Superior (IES) e em sites de busca com o objetivo de verificar se houve mudança de paradigma no modelo de saúde e se a CIF foi inserida na graduação nos últimos 10 anos. A pesquisa foi caracterizada como exploratória por meio de análise documental e revelou que existem 63 cursos de Terapia Ocupacional em atividade no país, 44 em IES privadas e 19 em públicas. O trabalho evidencia que os cursos ainda são norteados pelo modelo biomédico e que a aplicabilidade da CIF e a inserção do modelo biopsicossocial são relevantes na prática de ensino. Além disso, revelou-se um quadro de desequilíbrio na distribuição das IES que oferecem os cursos por regiões, apontando um número muito superior de IES públicas na região Sudeste. Os resultados dessa pesquisa poderão contribuir para os avanços nos estudos relacionados à inserção da CIF e do modelo biopsicossocial na graduação de Terapia Ocupacional, além de colaborar com a expansão do projeto REUNI no país, para a otimização das vagas em IES públicas nas regiões onde estão desprovidas.The National Curriculum Guidelines in 2001, consistent with the Ministry of Health, have influenced the training of all health professionals, directing the teaching practices of services in this area for the use of the biopsychosocial model, in line with the National Health System - SUS. Alongside these changes, in 2001 the World Health Organization (WHO) approved and recommended to the International Classification of Functioning, Disability and Health - ICF in health services for all member countries, including Brazil . However, it is still only very few courses in Occupational Therapy adhering to these recommendations. This study examined information pertaining to graduation in Occupational Therapy in Brazil through the system e-MEC, examined and the Pedagogical Project Courses (PPCs) available on websites of Higher Education Institutions (HEIs) and search sites in order to check whether there has been a paradigm shift in the health model and the ICF was inserted at graduation in the last 10 years. The research was characterized as exploratory through document analysis revealed that there are 63 courses in Occupational Therapy active in the country , 44 in private institutions and 19 public . The study shows that the courses are still guided by the biomedical model and the applicability of the ICF and the insertion of the biopsychosocial model are relevant in teaching practice. Furthermore, it was revealed a picture of imbalance in the distribution of HEI offering courses by region, pointing to a much larger number of public HEIs in the Southeast. The results of this research will contribute to advances in studies related to the insertion of the ICF and the biopsychosocial model in undergraduate occupational therapy, as well as collaborating with the expansion project RALLY in the country, for the optimization of the vacancies in public HEIs in the regions where they are lacking

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)