Avaliação crítica do uso do DIU por mulheres atendidas no ambulatório de anticoncepção do serviço de reprodução humana, do departamento de tocoginecologia, da maternidade do hospital de clínicas da Universidade Federal do Paraná

Orientadora : Claudete Reggiani MelloDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Tocoginecologia. Defesa: Curitiba, 23/08/2002Sem resumo e abstrac

Energy Deposition around Swift Carbon-Ion Tracks in Liquid Water

Energetic carbon ions are promising projectiles used for cancer radiotherapy. A thorough knowledge of how the energy of these ions is deposited in biological media (mainly composed of liquid water) is required. This can be attained by means of detailed computer simulations, both macroscopically (relevant for appropriately delivering the dose) and at the nanoscale (important for determining the inflicted radiobiological damage). The energy lost per unit path length (i.e., the so-called stopping power) of carbon ions is here theoretically calculated within the dielectric formalism from the excitation spectrum of liquid water obtained from two complementary approaches (one relying on an optical-data model and the other exclusively on ab initio calculations). In addition, the energy carried at the nanometre scale by the generated secondary electrons around the ion's path is simulated by means of a detailed Monte Carlo code. For this purpose, we use the ion and electron cross sections calculated by means of state-of-the art approaches suited to take into account the condensed-phase nature of the liquid water target. As a result of these simulations, the radial dose around the ion's path is obtained, as well as the distributions of clustered events in nanometric volumes similar to the dimensions of DNA convolutions, contributing to the biological damage for carbon ions in a wide energy range, covering from the plateau to the maximum of the Bragg peak

Companions of Bright Barred Shapley Ames Galaxies

Companion galaxy environment for a subset of 78 bright and nearby barred galaxies from the Shapley Ames Catalog is presented. Among spiral barred galaxies there are Seyfert galaxies, galaxies with circumnuclear structures, galaxies not associated with any large scale galaxy cloud structure, galaxies with peculiar disk morphology (crooked arms) and galaxies with normal disk morphology; the list includes all Hubble types. The companion galaxy list includes number of companion galaxies within 20 diameters (D25), their Hubble type and projected separation distance. Additionally, companion environment was searched for four known active spiral galaxies, three of them are Seyfert galaxies, namely, NGC 1068, NGC 1097, NGC 5548 and one is a starburst galaxy, M82. Among the results obtained it is noted that the only spiral barred galaxy classified as Sy 1 in our list has no companions within a projected distance of 20 diameters; 6 out of 10 Sy 2 bar galaxies have no companions within 10 diamters, 6 out of 10 Sy 2 galaxies have one or more companions at projected separation distances between 10 and 20 diameters; 6 out of 12 galaxies with circumnuclear structures have 2 or more companions within 20 diametersComment: Accepted for publication in the Astronomical Journal, 40 pages incl. 3 figure

A Cross‐Sectional Assessment of Frailty, Falls and Perceptions of Ageing in People Living with HIV Using an mHealth Platform

Objective: To evaluate frailty, falls and perceptions of ageing among clinically stable individuals with HIV, engaged with remote healthcare delivered via a novel smartphone application. Methods: This was a multi-centre European cross-sectional, questionnaire-based sub-study of EmERGE participants. Frailty was assessed using the five-item FRAIL scale. Present criteria were summed and categorized as follows: 0, robust; 1-2, pre-frail; 3-5, frail. Falls history and EQ-5D-5L quality of life measure were completed. Participants were asked their felt age and personal satisfaction with ageing. Results: A total of 1373 participated, with a mean age of 45 (± 9.8) years. Frailty was uncommon at 2%; 12.4% fell in the previous year, 58.8% of these recurrently. Mood symptoms and pain were prevalent, at 43.3% and 31.8%, respectively. Ageing satisfaction was high at 76.4%, with 74.6% feeling younger than their chronological age; the mean felt age was 39.3 years. In multivariable analysis, mood symptoms and pain were positively associated with frailty, falls and ageing dissatisfaction. An increase in pain severity and mood symptoms were respectively associated with 34% and 63% increased odds of pre-frailty/frailty. An increment in pain symptoms was associated with a 71% increase in odds of falling. Pain was associated with ageing poorly, as were mood symptoms, with odds of dissatisfaction increasing by 34% per increment in severity. Conclusions: Although uncommon, frailty, falls and ageing dissatisfaction were seen in a younger cohort with medically stable HIV infection using a remote care model, promoting screening as advocated by European guidelines. These were more common in those with pain or mood symptoms, which should be proactively managed in clinical care and explored further in future research.info:eu-repo/semantics/publishedVersio

Medical oncology future plan of the Spanish Society of Medical Oncology: challenges and future needs of the Spanish oncologists

Purpose: The SEOM Future Plan is aimed at identifying the main challenges, trends and needs of the medical oncology speciality over the next years, including potential oncologist workforce shortages, and proposing recommendations to overcome them. Methods: The estimations of the required medical oncologists workforce are based on an updated Medical Oncologist Register in Spain, Medical Oncology Departments activity data, dedication times and projected cancer incidence. Challenges, needs and future recommendations were drawn from an opinion survey and an advisory board. Results: A shortage of 211 FTE medical oncologist specialists has been established. To maintain an optimal ratio of 158 new cases/FTE, medical oncology workforce should reach 1881 FTE by 2035. Conclusions: Main recommendations to face the growing demand and complexity of oncology services include a yearly growth of 2.5% of medical oncologist’s workforce until 2035, and development and application of more accurate quality indicators for cancer care and health outcomes measure

Characterization of methicillin-resistant Staphylococcus aureus strains colonizing the nostrils of Spanish children

Objective: To characterize the Staphylococcus aureus strains colonizing healthy Spanish children. Methods: Between March and July 2018, 1876 Spanish children younger than 14 years attending primary healthcare centers were recruited from rural and urban areas. Staphylococcus aureus colonization of the anterior nostrils was analyzed. MecA and mecC genes, antibiotic susceptibility, and genotyping according to the spa were determined in all strains, and the following toxins were examined: Panton-Valentine leucocidin (pvl), toxic shock syndrome toxin (tst), and exfoliative toxins (eta, etb, etd). Multilocus sequence typing (MLST) and staphylococcal cassette chromosome (SCCmec) typing were performed on methicillin-resistant Staphylococcus aureus (MRSA) strains, as well as pulsed-field gel electrophoresis (PFGE). Results: 619 strains were isolated in 1876 children (33%), and 92% of them were sent for characterization to the Spanish National Centre of Microbiology (n = 572). Twenty (3.5%) of these strains were mecA-positive. Several spa types were detected among MRSA, being t002 the most frequently observed (30%), associating with SCCmec IVc. Among MSSA, 33% were positive for tst, while only 0.73% were positive for pvl. The 20 MRSA strains were negative for pvl, and 6 (30%) harbored the tst gene. Conclusions: methicillin-resistant Staphylococcus aureus nasal colonization in Spanish children is rare, with t002 being the most observed spa type, associated with SCCmec IVc. None of the MRSA strains produced pvl, but up to 30% of S. aureus strains were positive for tst

The effect of feeder system and diet on welfare, performance and meat quality, of growing-finishing Iberian × Duroc pigs under high environmental temperatures

The present study investigated the replacement of 5% of starch (ST) by 5% of sunflower oil (SO), with or without feed restriction, in the diet of growing-finishing Iberian × Duroc pigs exposed to heat stress conditions. The effects of these strategies on the welfare, performance and meat quality of the animals were evaluated. Seventy-two crossbred males [51.00 ± 6.29 kg body weight (BW)] were housed in collective pens and randomly distributed according to their initial BW in climate-controlled rooms under heat stress conditions (30–32 °C; 35%–50% humidity). The experiment was carried out in a randomized block design, in a 2 × 2 factorial design composed of two diets (control or oil) and two feed management (ad-libitum and restriction) types. The investigated treatments were: 1) control diet (5% ST × 0% SO) with ad-libitum feed intake, 2) oil diet (replacement of 5% of ST by 5% SO) with ad-libitum feed intake, 3) control diet with restriction feed intake, and 4) oil diet with restriction feed intake. The pigs’ behavior and dirtiness score were observed daily, and their performance was assessed weekly. Furthermore, three blood samples were collected from each animal for hemogram analysis during the period of study. The analysis of meat and carcass quality was performed 24 h post-mortem once the animals had reached an average BW of 130–140 kg. Statistical analyses were performed using the PROC MIXED and PROC GENMOD procedures of the Statistical Analysis System (SAS). The diet-regimen interaction produced no effects (P > 0.05) on the analyzed variables, except for behavior. Animals on the control diet associated with ad-libitum feed management spent more time in the lateral decubitus position and showed reduced activity. In addition, pigs fed ad-libitum and those that received the control diet displayed the highest level of dirtiness during the experiment. Evaluation of performance revealed that pigs receiving the oil diet showed reduced feed intake (P < 0.05) with no difference in average daily gain and consequently presented better feed conversion values compared to animals on the control diet. Furthermore, the oil diet resulted in a higher (P < 0.05) carcass yield as well as a higher oleic fat content in the meat. Pigs on restricted feeding management with lower body and carcass weights produced higher values of leanness percentage and carcass compared to animals in the ad-libitum group. In conclusion, the replacement of 5% of starch by 5% of sunflower oil in the pigs’ diet during high ambient temperatures improved the animals’ welfare, feed efficiency, and carcass characteristics.info:eu-repo/semantics/acceptedVersio

Glucemia como factor de riesgo en pacientes internados en la Unidad de Cuidados Intensivos de Adultos del Hospital de Clínicas

Objetivo: Determinar la relación entre glucemias al ingreso y la evolución de los pacientesadmitidos a la Unidad de Cuidados Intensivos de Adultos (UCIA). Material y Métodos: estudio de cohorte retrospectivo de pacientes en la UCIA, tomando un muestreo, según distintos estratos de glucemia en mg/dL (Gl65; G2 66 a 79; G3 80 a 199 y G4200). Resultados: 413 pacientes, con edad media 48.89 años ±19; glucemia media al ingreso de 168.8 mg/dL (±93). 11.9% eran diabéticos conocidos. Al ingreso el Apache II fue 16±9, con una mortalidad global de 39.7%. Se constataron infecciones intrahospitalarias en 22.8%. La mortalidad en G4 fue de 49,5% vs. 35.4% en G3 (RR 1,41 p=0.008); en cirugías programadas fue en G4 de 30.6% y 14.7% en G3 (RR 2,07 p=0,04), con una tendencia significativa en las cirugías cardiacas (RR 2,33 p=0,11) y neurológicas (RR 3,33 p=0,26); la mortalidad en las cirugías de urgencia fue en G4 44,4% vs. 44,1% en G3 (RR 1,01 p=0,97). Los cuadros médicos en general presentaron una mortalidad de 76 % en G4 vs. 45% en G3 (RR 1,53 p=0,004). Los cuadros coronarios reportaron una mortalidad en G4 de 42 % vs. 10% en G3 (RR 7,13 p=0,001); en cuanto a hipoglucemia, existió una tendencia a mayor mortalidad general en G1 en comparación a G2 y G3 (35% vs. 63,6%) (RR 1,80 p=0,05) Conclusiones: La mortalidad general, de cirugías programadas y síndromes coronarios agudos fue mayor en forma significativa cuando la glucemia de ingreso fue 200 mg/dL

Efficiency of the EmERGE Pathway of Care in Five European HIV Centres

Objective: We aimed to calculate the efficiency of the EmERGE Pathway of Care in five European HIV clinics, developed and implemented for medically stable people living with HIV. Methods: Participants were followed up for 1 year before and after implementation of EmERGE, between April 2016 and October 2019. Micro-costing studies were performed in the outpatient services of the clinics. Unit costs for outpatient services were calculated in national currencies and converted to US$2018 OECD purchasing parity prices to enable between clinic comparisons in terms of outcomes and costs. Unit costs were linked to the mean use of services for medically stable people living with HIV, before and after implementation of EmERGE. Primary outcome measures were CD4 count and viral load; secondary outcomes were patient activation (PAM13) and quality of life (PROQOL-HIV). Out-of-pocket expenditure data were collected. Results: There were 2251 participants: 87-93$ purchasing parity prices. Primary and secondary outcome measures of participants did not change during the study. Conclusions: EmERGE is acceptable and provided cost savings in different socio-economic settings. Antiretroviral drug costs remain the main cost drivers in medically stable people living with HIV. While antiretroviral drug prices in local currencies did not differ that much between countries, conversion to US$ purchasing parity prices revealed antiretroviral drugs were more expensive in the least wealthy countries. This needs to be taken into consideration when countries negotiate drug prices with pharmaceutical vendors. Greater efficiencies can be anticipated by extending the use of the EmERGE Pathway to people with complex HIV infection or other chronic diseases. Extending such use should be systematically monitored, implementation should be evaluated and funding should be provided to monitor and evaluate future changes in service provision.info:eu-repo/semantics/publishedVersio