Qualidade de vida da mulher incontinente urinária

Enquadramento: A incontinência urinária feminina é uma patologia muito frequente, com interferência significativa na qualidade de vida. O tratamento desta patologia é hoje possível na maior parte das doentes. No entanto, o primeiro passo para o sucesso terapêutico é a correcta caracterização do tipo de incontinência, fundamentalmente através do exame clínico (história e exame físico) da doente. Devem ser identificadas as eventuais causas reversíveis ou agravantes e realizar o seu tratamento específico. Objetivos: Este estudo tem como objetivos determinar a qualidade de vida das mulheres com incontinência urinária; analisar a influência dos indicadores pessoais obstétricos, ginecológicos, estilo de vida, e impacto da incontinência na qualidade de vida da mulher com incontinência urinária e determinar a influência da vulnerabilidade ao stresse na qualidade de vida das mulheres com IU. Metodologia: O estudo é exploratório, descritivo e transversal com uma componente correlacional, em 200 mulheres que procuraram o ambulatório de urologia e ginecologia dos hospitais de Viseu, Covilhã e Guarda, no período de março a dezembro de 2012. Como critérios de inclusão temos o facto de as mulheres referirem episódios de perdas urinárias de pelo menos uma vez por semana, nos últimos três meses. Foram excluídas pacientes em período gestacional ou em período de amamentação. Utilizou-se um questionário que permitiu a caracterização socio-demografica, caracterização obstétrica e ginecológica e estilos de vida e as escalas: Impacto da IU (ICIQ-SF), Valorização da IU; Qualidade de Vida em Mulheres com IU (KHQ) e Vulnerabilidade ao Stresse (23 QVS). Resultados: Há uma percentagem significativa de mulheres acima dos 58 anos com IU moderada. As mulheres abaixo dos 57 anos tendem a apresentar valores mais elevados de IU de urgência. As mulheres com profissões intelectuais e técnicas apresentam IU de esforço. As mulheres com IU de urgência tiveram parto normal. As mulheres com IU grave têm IU de esforço e IU de urgência. Não foi encontrada associação entre a IU de esforço e a IU de urgência quanto ao estado civil, área de residência, IMC, nº de gravidezes e nº de filhos. Relativamente à vulnerabilidade ao stresse, as mulheres com IU não são vulneráveis contudo, as entrevistadas referiram a existência de stresse no trabalho e nos afetos. As participantes com menos de 57 anos apresentam maior vulnerabilidade ao stresse face ao perfecionismo, inibição, condição de vida e subjugação. As que residem em zona urbana com profissões intelectuais tendem a ser mais vulneráveis ao stresse. As mulheres com IU acima dos 58 anos têm melhor QDV face à sua limitação física e às suas medidas de gravidade. As mulheres com QDV moderada têm profissões técnicas, têm 1 filho e têm um impacto de IU muito grave. As mulheres com QDV fraca fizeram cesariana. As mulheres com QDV elevada têm um impacto da IU moderada. São fatores preditores das dimensões da QDV: (1) perceção da saúde - nível do IMC, perfecionismo e impacto da IU de esforço; (2) impacto da IU - vulnerabilidade ao stresse, IU de urgência e dramatização; (3) limitação no desempenho das tarefas - IU de urgência, vulnerabilidade ao stresse, dramatização e perfecionismo; (4) limitação física - vulnerabilidade ao stresse e IU de urgência; (5) limitação social - impacto da IU de urgência, à deprivação, à dramatização e ao perfecionismo; (6) relações pessoais - inibição, idade e IU de urgência; (7) emoções - inibição, IU de urgência, deprivação, dramatização e carência; (8) sono e energia - idade, carência e deprivação; (9) medidas de gravidade - dramatização, carência, perfecionismo e vulnerabilidade ao stresse. Conclusão: A qualidade de vida das mulheres com IU é influenciada pela idade, profissão, nº de filhos, tipo de parto, impacto da IU, pela deprivação e dramatização associada ao stresse e, ainda, pelo impacto da IU de urgência. Palavra-Chave: Incontinência urinária; Fatores de risco; Qualidade de vida; Saúde da mulher; Enfermagem.ABSTRACT Theory: The women’s urinary incontinence is a very frequent pathology, with significant interference in the life quality. The treatment of this pathology is today possible in most of the patients. However, the first step for the therapeutic success is the certain characterization of the incontinence type, fundamentally through the clinical exam (history and physical exam) of the patient. They should be identified the eventual reversible causes or added difficulties and to accomplish his specific treatment. Objective:This study has as objectives to determine the women's quality of life with urinary incontinence; to analyze the influence of the obstetric, gynecological personal indicators, lifestyle, and impact of the incontinence in the woman's quality of life with urinary incontinence and to determine the influence of the vulnerability to the stresse in the women's quality of life with IU. Methods: The study is exploratory, descriptive and traverses with a correlation, in 200 women that sought the urology clinic and gynecology of the hospitals of Viseu, Covilhã and Guard, in the period of March to December of 2012. The patients included in the study were considered incontinent to declare episodes of urinary losses of at least once a week, in the last three months. They were excluded patient in gestation period or in breast-feeding period. We used a questionnaire that allowed the characterization socio-demographic, obstetric and gynecological characteristics and lifestyles and scales: Impact of UI (ICIQ-SF), Valuing UI, Quality of Life in Women with UI (KHQ) and Vulnerability to Stress (23 QVS). Results of the impact of IU: There is a significant percentage of women above the 58 years with moderate IU. The women below the 57 years tend to present higher values of urgency IU. The intellectual and technical professions present IU of effort. The women with urgency IU had normal childbirth. The women with serious IU have IU of effort and urgency IU. It was not found association between IU of effort and urgency IU as for the marital status, residence area, IMC, pregnancies number and children's number. Results of the stress vulnerability: The women with IU are no vulnerable however; the women interviewees referred the stress existence in the work and in the affections. The women below the 57 years present larger to the stress vulnerability face to the perfectionism, inhibition, life condition and subjugation. The women that live in urban area with intellectual professions tend to be more to the stress vulnerable. Results of the quality life: The women with IU above the 58 years have better QDV to his physical limitation and their gravity measures. The women with moderate QDV have technical professions, they have 1 son and they have an impact of very serious IU. The women with weak QDV made Cesarean. The women with high QDV have an impact of moderate IU. Factors that predict QDV: (1) perception of the health - level of IMC, perfectionism and impact of IU of effort; (2) impact of IU - stress vulnerability, urgency IU and dramatization; (3) limitation in the acting of the tasks - urgency IU, stress vulnerability, dramatization and perfectionism; (4) physical limitation - stress vulnerability and urgency IU; (5) social limitation - impact of urgency IU, to the affections privation, to the dramatization and the perfectionism; (6) relationships - inhibition, age and urgency IU; (7) emotions - inhibition, urgency IU, affections privation, dramatization and lack; (8) sleep and energy - age, lack and affections privation; (9) gravity measures - dramatization, lack, perfectionism and stress vulnerability. Conclusion: The quality of the women's life with IU is influenced by the age, profession, number of children, childbirth type, impact of IU, for the affections privation and dramatization associated to the stress and, still, for the impact of urgency IU. Key words: Urinary incontinence; Risk factors; Quality of life; Women’s health; Nursing

Imunokromatografski test za dokaz invazije vrstama Babesia caballi i Babesia equi Laveran 1901 (Theileria equi Mehlhorn i Schein, 1998) (Phylum Apicomplexa) u fi lipinskih konja u usporedbi s dokazom parazita u krvnim razmascima

Sera collected from 71 slaughtered and 33 racing horses were assayed for Babesia spp. infection using immunochromatographic (ICT) assay. The ICT strips which were developed at the National Research Center for Protozoan Diseases (NRCPD), Obihiro University, Hokkaido, Japan contained a recombinant B. caballi 48-kDa rhoptry protein (rBc48) and a recombinant truncated B. equi merozoite antigen 2 (rEMA-2t) for the detection of anti-horse Babesia spp. antibodies. The 63 sero-positive blood samples consisted of 41(57.7%) and 22 (66.7%) cases in slaughtered and racing horses, respectively. Twelve sera (19.0%) reacted with both B. caballi and B. equi antigens, 45 sera (71.0%) reacted with rBc48 antigen only, and six sera (10.0%) were positive for B. equi antibodies only. Babesia caballi infection accounted for 90.5% cases. Infection with B. caballi and/or B. equi confirmed in Giemsa-stained blood smears prepared from racing horse samples only revealed 22 (66.7%) seropositive cases. Paired pear or crescent-shaped merozoites (0.5-1.25 μm), characteristic of B. caballi were observed in 20 blood smears, while only two seropositive cases revealed the presence of both B. caballi and the Maltese cross or tetrad-shaped merozoites (0.62-0.95 μm) generally associated with Theileria sp. (B. equi) parasite. To our knowledge, this is the first immunochromatographic assay of equine babesiosis in the Philippines validated by the detection of specific etiologic agent(s) in blood smears.Uzorci seruma 71 zaklanog konja i 33 športska konja bili su pretraženi na prisutnost protutijela za babezije imunokromatografskim testom (ICT). Testovi razvijeni u Nacionalnom istraživačkom centru za protozojske bolesti u sklopu Sveučilišta Obihiro u Hokaidu u Japanu sadržavali su rekombinantni protein od 48-kDa (rBc48) vrste B. caballi i rekombinantni krnji merozoitski antigen 2 (rEMA-2t) vrste B. equi za određivanje protutijela za vrste roda Babesia. Od ukupno 63 serološki pozitivna konja, 41 (57,7%) pripadao je skupini kojoj je krv bila uzeta pri klanju, a 22 (66,7%) bila su iz skupine športskih konja. Dvadeset uzoraka seruma (19,0%) bilo je pozitivno na oba antigena (B. caballi i B. equi), 45 uzoraka (71,0%) samo na antigen rBc48, dok je svega šest uzoraka (10%) bilo pozitivno na protutijela za vrstu B. equi. Protutijela za vrstu B. caballi bila su dokazana u 90,5% pretraženih uzoraka. Pretragom krvnih razmazaka obojenih po Giemzi babezije su bile dokazane u svega 22 (66,7%) športska konja. Kruškaste tvorevine (0,5-1,25 μm), karakteristične za merozoite protozoona B. caballi bile su dokazane u 20 razmazaka krvi. Samo u dva serološki pozitivna uzorka dokazana je vrsta B. caballi i merozoiti razmješteni u obliku malteškoga križa (0,62-0,95 μm) što je i karakteristika protozoa iz roda Theileria (B. equi). Ovim istraživanjem prvi put je dokazana prikladnost imunokromatografskoga testa za određivanje protutijela za babezije konja na Filipinima, a rezultati su uspoređeni s nalazom uzročnika u krvnim razmascima

Estimating future bidding performance of competitor bidders in capped tenders

Research in Bid Tender Forecasting Models (BTFM) has been in progress since the 1950s. None of the developed models were easy-to-use tools for effective use by bidding practitioners because the advanced mathematical apparatus and massive data inputs required. This scenario began to change in 2012 with the development of the Smartbid BTFM, a quite simple model that presents a series of graphs that enables any project manager to study competitors using a relatively short historical tender dataset. However, despite the advantages of this new model, so far, it is still necessary to study all the auction participants as an indivisible group; that is, the original BTFM was not devised for analyzing the behavior of a single bidding competitor or a subgroup of them. The present paper tries to solve that flaw and presents a stand-alone methodology useful for estimating future competitors’ bidding behaviors separately

Evaluación experimental de la capacidad de drenaje de tuberías perforadas colectoras utilizadas en botaderos de ripios lixiviados – resultados preliminares

93 p.La estabilidad física en acopios de materiales granulares provenientes de procesos mineros es un tema importante para la ingeniería, y los acopios aterrazados llamados botaderos de ripios no son la excepción. La estabilidad de taludes puede verse afectada por múltiples aspectos, dentro de los cuales se encuentran, alzamientos y fluctuaciones de niveles freáticos en su interior, debido al: tipo de material, riego incorporado, o por un mal funcionamiento del sistema de drenaje. El funcionamiento del sistema de drenaje en botaderos de ripios contiene una componente de incertidumbre en el sector minero, en relación con el caudal efectivo, tanto encamados de gravas (cover) como tuberías perforadas inmersas en el material post lixiviación. Debido a esto, el objetivo principal es la evaluación experimental de la capacidad de drenaje de tuberías perforadas colectoras utilizadas en botaderos de ripios lixiviados. En el presente estudio se abordaron diferentes metodologías de análisis y estimación de infiltraciones a fin de poder evaluar la distribución y capacidad de flujo del sistema de drenaje compuesto por tuberías perforadas espaciadas e inmersas en el interior del botadero. Se consideró para este efecto una caracterización de un suelo con propiedades similares a la matriz fina de un material tipo ripio post lixiviación y un modelamiento numérico de infiltraciones en 2 dimensiones. Sumado a lo anterior, se realizó un modelo físico a escala 1:10 que consideró acopios aterrazados de material arcilla - arena arcillosa y las tuberías del sistema de drenaje mediante microtubos con diámetro de 4 mm. Finalmente, los resultados obtenidos para caudales en modelamiento numérico (1,22 ∗ 10−4 3/ ) y en una de las pruebas del modelo físico ( 5 ∗ 10−3 3/ ), presentaron una leve diferencia producto de errores que pueden ocurrir durante este último, tanto los taponamientos de tuberías, la componente tasa de riego, homogeneidad del material, entre otros. Estos resultados dieron cuenta del comportamiento de tuberías perforadas y su capacidad en el proceso de drenaje, evidenciando el efecto producido por la granulometría de este debido a su chancado químico y cómo podría afectar la estabilidad del botadero de ripios. // ABSTRACT: Physical stability in stockpiles of granular materials from mining processes is an important issue for engineering, and terraced stockpiles called gravel dumps are no exception. The stability of slopes can be affected by multiple aspects, within which are, elevations and fluctuations of wáter table levels inside, due to the: type of material, built-in irrigation, or by a malfunction of the drainage system. The operation of the drainage system in gravel dumps contains a component of uncertainty in the mining sector, in relation to the effective flow, both bedridden gravel(cover)and perforated pipes immersed in the post-leaching material. Because of this, the main objective is the experimental evaluation of the drainage capacity of perforated collector pipes used in leachate gravel dumps. In the present study, different methodologies of analysis and estimation of infiltrations were addressed to be able to evaluate the distribution and flow capacity of the drainage system composed of perforated pipes spaced and immersed inside the dump. It was considered for this purpose a characterization of a soil with properties like the fine matrix of a gravel-type material post leaching and a numerical modeling of infiltrations in 2 dimensions. In addition to the above, a physical model was made at 1:10 scale that considered terraced collections of clay-clay sand material and the pipes of the drainage system by means of microtubes with a diameter of 4 mm. Finally, the results obtained for flow rates in numerical modeling (1,22 ∗ 10−4 3/ ) and in one of the tests of the physical model (5 ∗ 10−3 3/ ), presented a slight difference product of errors that can occur during the latter, both the plugging of pipes, the component irrigation rate, homogeneity of the material, among others. These results showed the behavior of perforated pipes and their capacity in the drainage process, evidencing the effects produced by the granulometry of this due to its chemical crushing and how it could affect the stability of the gravel dump

Incidencia del fondo común municipal en el gasto municipal chileno

110 p.La presente investigación busca contribuir a la evidencia empírica sobre los efectos que las transferencias del Fondo Común Municipal (FCM) tiene sobre el gasto municipal per cápita chileno. En específico, se testea la existencia del efecto flypaper y su hipótesis de asimetría. Chile posee un grado considerable de descentralización respecto al gasto municipal, pero con fuerte centralización por el lado de la recaudación, creando una alta dependencia de las comunas a las transferencias intergubernamentales. En atención a esto, es importante indagar los efectos de las transferencias incondicionadas a nivel local, ya que encontrar evidencia del efecto flypaper sugeriría que dichos recursos incitan a los gobierno locales a expandir el gasto público muy por encima del socialmente óptimo, lo que a largo plazo podría traducirse en una situación fiscal insostenible, pero más preocupante, es que revelaría que las decisiones presupuestaria que toman los gobernantes municipales, así como las políticas públicas locales no estarían respondiendo a las necesidades y carencias de los habitantes, sino más bien a otro tipo de intereses como los políticos, siendo contraproducente para el bienestar de los habitantes y el desarrollo de las comunas. Para el análisis empírico, se utiliza una muestra de 300 comunas chilenas para el periodo 2009-2017, se construyó una base de datos de panel y se estimaron los modelos considerando efectos fijos. Los resultados revelan la presencia del efecto flypaper, indicando que el gasto municipal total per cápita es más sensible a los ingresos provenientes del FCM que a los provenientes de fuentes propias. Además, se evidencia un comportamiento asimétrico del tipo “reemplazo fiscal”. Por otra parte, se confirma que la pertenencia del alcalde a la misma coalición política del gobierno en turno y el ciclo económico son factores determinantes del gasto municipal chileno, caso contrario los niveles de pobreza monetaria y multidimensional y los indicadores de carencias, que no son elementos a considerar en la toma de decisiones sobre el gasto municipal chileno. // ABSTRACT: This research seeks to contribute to the empirical evidence on the effects that transfers from the Municipal Common Fund (FCM) have on chilean municipal spending per capita. Specifically, the existence of the flypaper effect and its hypothesis of asymmetry are tested. Chile has a considerable degree of decentralization with respect to municipal spending, but with strong centralization on the revenue side, creating a high dependence of the municipality on intergovernmental transfers. In view of this, it is important to investigate the effects of unconditional transfers at the local level, since finding evidence of the flypaper effect would suggest that these resources encourage local governments to expand public spending well above the socially optimal, which in the long run, could translate into an unsustainable fiscal situation, but more worryingly, it would reveal that the budgetary decisions made by municipal leaders, as well as local public policies, would not be responding to the needs and deficiencies of the inhabitants, but rather to other types of interests such as political ones, being counterproductive for the well-being of the inhabitants and the development of the municipalities. For the empirical analysis, a sample of 300 chilean municipalities are used for the period 2009 - 2017, a panel database was built and the models were estimated considering fixed effects. The results reveal the presence of the flypaper effect, indicating that the total municipal expenditure per capita is more sensitive to the revenues from the FCM than to those from its own sources. In addition, there is evidence of asymmetric behavior of the “fiscal replacement” type. On the other hand, it is confirmed that the mayor's membership of the same political coalition of the current government and the economic cycle are determining factors of chilean municipal spending, in contrary, the levels of monetary and multidimensional poverty and the deprivation indicators, which are not elements to consider when making decisions about Chilean municipal spending

Detecting abnormal and collusive bids in capped tendering

Recent developments in the area of Bid Tender Forecasting have enabled bidders to implement new types of easy-to-use tools for increasing their chances of winning contracts. Although these new tools (such as iso-Score Curve Graphs, Scoring Probability Graphs, and Position Probability Graphs) are designed for bidders in capped tendering (tenders with an upper price limit), some of their principles can also be applied by a Contracting Authority to detect which bidders do not follow a standard pattern, that is, their bids are extremely high or low. Since a collusive bid generally needs to be sufficiently high or low to make an impact on the bid distribution, any person in charge of supervising capped tenders can be alerted to any bidder that might be involved in a cartel after identifying the same abnormal behavior in a series of tenders through simple calculations and a new type of graph

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation