What do Cochrane systematic reviews say about non-surgical interventions for urinary incontinence in women?

BACKGROUND: Urinary incontinence is a highly prevalent condition that impacts self-esteem and overall quality of life. Many non-surgical treatment options are available, ranging from pharmacological approaches to pelvic exercises. We aimed to summarize the available evidence regarding these non-surgical interventions. DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM-UNIFESP). METHODS: A sensitive search was conducted to identify all Cochrane systematic reviews that fulfilled the inclusion criteria. Titles and abstracts were screened by two authors. RESULTS: We included 20 Cochrane systematic reviews: 4 assessing methods of vesical training, 3 evaluating pharmacological interventions, 4 studying pelvic floor muscle training approaches and 9 aimed at other alternatives (such as urethral injections, weighted vaginal cone use, acupuncture, biostimulation and radiofrequency therapy). The reviews found that the evidence regarding the benefits of these diverse interventions ranged in quality from low to high. CONCLUSIONS: This review included 20 Cochrane systematic reviews that provided evidence (of diverse quality) for non-pharmacological interventions for patients with urinary incontinence. Moderate to high quality of evidence was found favoring the use of pelvic floor muscle training among women with urinary incontinence. To establish solid conclusions for all the other comparisons, further studies of good methodological quality are needed.Univ Fed Sao Paulo Unifesp, Escola Paulista Med, Discipline Evidence Based Hlth, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Escola Paulista Med, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Escola Paulista Med, Dept Gynecol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Escola Paulista Med, Discipline Evidence Based Hlth, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Escola Paulista Med, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Escola Paulista Med, Dept Gynecol, Sao Paulo, SP, BrazilWeb of Scienc

Simultaneous bilateral femoral neck fracture in a patient with renal osteodystrophy

AbstractWe present a unique case of displaced simultaneous bilateral fractures, Garden 3 type, in a 49year woman treated with non-cemented total hip arthroplasty. The patient showed a Harris hip score of 86 on the right hip and a 81 on the left side on the fourth postoperative year, besides a bilateral Trendelenburg gait, more pronounced on the right side. She needed a cane to walk, and felt pain in the left thigh. The X-ray showed a shortening of 0.9cm and a left femoral varus. The other arthroplasty components showed good osseointegration and position.We found that the use of the uncemented total hip arthroplasty to treat a simultaneous bilateral fracture in renal osteodystrophy patients has satisfactory results at a four year follow-up.According to the OCEBM Levels of Evidence Working Group, this study is graded as a Level of Evidence IV

CONDIÇÕES DE TRABALHO EM UMA MADEIREIRA EM BELO JARDIM, PERNAMBUCO

O setor madeireiro, apesar de possuir destaque dentro do cenário industrial brasileiro, caracteriza-se como um setor com grande potencial de ocorrência de acidentes e desencadeamento de doenças ocupacionais, mostrando que este não gera impacto somente na natureza, mas na qualidade de vida. O objetivo desse trabalho foi identificar as condições de trabalho em uma indústria de beneficiamento de madeira em Belo Jardim, Pernambuco, sob o ponto de vista da salubridade e da segurança, a fim de propor melhorias e adequações a serem realizadas de acordo com a legislação trabalhista vigente. A partir das metodologias das Normas de Higiene Ocupacional, verificou-se a necessidade de mudanças pontuais no layout da empresa, além da necessidade de trocar o protetor auricular e desenvolver um projeto para otimizar a iluminação da fábrica de maneira geral. Para atendimento à legislação trabalhista, existe a necessidade de elaboração de laudo técnico de condições ambientais do trabalho, formação de comissão interna de prevenção de acidentes e desenvolvimento de um programa de controle médico e saúde ocupacional, incentivando a prática de realização de exames periódicos nos funcionários.Palavras-chave: salubridade; ergonomia; segurança do trabalho; legislação trabalhista. WORKING CONDITIONS IN A WOOD INDUSTRY IN BELO JARDIM, PERNAMBUCO ABSTRACT: The timber industry in general has a great prominence within the Brazilian industrial scenario, is still a sector with great potential for accidents and triggering of occupational diseases, showing that this does not only impact on nature, but on the quality of life This study aimed to identify the working conditions in a wood processing industry in Belo Jardim, Pernambuco, from the point of view of health and safety, in order to adapt them according to the current labor legislation. Based on the methodologies of Occupational Hygiene Standards, it was verified the need for specific changes in the company layout, change the hearing protector and develop a project to optimize the lighting of the factory. In order to comply with labor legislation, there is a need for the preparation of a technical report on environmental conditions of work, formation of an internal accident prevention committee, and development of a medical control and occupational health program, encouraging the practice of periodic exams for employees.Keywords: health; ergonomics; workplace safety; labor legislation

Continuing education: vocational training in the context of hospital pharmacy as a strategy for integration in a multidisciplinary team of specialized hospital Sergipe

A realidade atual das instituições hospitalares exige profissionais cada vez mais qualificados que assumam funções que requerem alto nível de conhecimento técnico e científico. O estágio supervisionado em farmácia hospitalar tem como objetivo formar o futuro profissional com consciência crítica e capacidade de compreender a realidade e atuar sobre a mesma Este estudo consiste em um relato de experiência dos discentes do estágio supervisionado III do curso de graduação em Farmácia da Universidade Federal de Sergipe. Inicialmente os discentes realizaram visitas nos setores de farmácia, almoxarifado, unidade de tratamento intensivo (UTI), urgência e emergência para fazer o diagnóstico situacional tanto dos aspectos físicos quanto dos aspectos relacionados às informações referentes aos medicamentos pelos profissionais de enfermagem. Posteriormente foram realizadas palestras, as mesmas foram direcionadas para os profissionais de saúde e os auxiliares administrativos da farmácia. A partir dos resultados obtidos pode-se observar que a implementação da educação continuada foi de grande importância para a qualificação dos profissionais da farmácia/almoxarifado e equipe de enfermagem, no qual os participantes tiveram a possibilidade de interagir ativamente com o farmacêutico e estagiários. Essa interação refletiu em uma maior comunicação e entendimento mais concreto de equipe multidisciplinar._________________________________________________________________________________________ ABSTRACT: The current reality of hospitals increasingly require professionals qualified to assume roles that require high levels of technical and scientific knowledge. The supervised internship in hospital pharmacy aims to train future professionals with critical awareness and ability to understand the reality and act on it. This study consists of an report of the experience of students supervised III internship of the graduate course in Pharmacy, Federal University of Sergipe. Initially the students made visits in the fields of pharmacy, warehouse, intensive care unit (ICU), emergency care to make the diagnosis of both situational and physical aspects of the information relating to medicines by nursing professionals. Later lectures were held, they were directed to health professionals and administrative staff of the pharmacy. From the results we observed that implement continuing education was of great importance to the quality of pharmacy professionals / warehouse and nursing staff, in which participants were able to actively interact with pharmacists and interns. This interaction reflected in increased communication and more concrete understanding of the multidisciplinary team

Evolução na utilização e nos gastos de uma operadora de saúde

Brazil’s aging population and the rising number of people reliant upon the country’s supplementary healthcare system have elicited the concern of public and private managers regarding the increase in healthcare costs. In this paper, the costs per gender, per type of medical expenses and per age group of a major Brazilian self-managed healthcare provider between 2007 and 2013 were analyzed. This healthcare provider is of interest because, besides portraying a single condition of revenue growth restricted to the existing contributors, it also replicates the demographic profile expected for Brazil in 2050, when approximately one-third of its population will be over 60 years of age. The analyses confirm the current literature as they show an increase in healthcare plan usage by the elderly and the difference between admission rates by gender. They also reveal an increase in average length of stay in hospital and the increase in medical costs far above inflation, especially for materials and medicines. It is hoped that this study will help scholars and others interested in comparisons of medical expense trends, especially by age and sex, and that it encourages further collaboration on the sustainability of health insurance providers in Brazil

Taxa de ovulação de vacas holandesas em relação ao ECC no período pós parto / Ovulation rate of Dutch cows in relation to ECC in the postpartum period

A condição corporal ao parto apresenta grande influência na ciclicidade reprodutiva e no restabelecimento da condição uterina. Objetivou-se neste trabalho avaliar o efeito do Escore de Condição Corporal (ECC) na atividade ovariana, caracterizada pela ovulação no período pós-parto de vacas holandesas. Avaliou-se 58 vacas holandesas em lactação, sendo estas avaliadas por exame ginecológico ultrassonográfico e identificado o período de ovulação pós parto (PP) e classificando-os em três grupos: ovulação precoce (menor que 45 dias PP), ovulação intermediaria (entre 45 e 90 dias PP), ovulação tardia (acima de 90 dias PP). Os animais foram classificados segundo o ECC por um veterinário treinado em dois grupos: ECC baixo (inferior a 2,5) e ECC alto (superior ou igual a 2,5). Verificou-se que vacas com escore corporal superior a 2,5 apresentaram ovulação mais precoce. 

Ecosystem-based management of Amazon fisheries and wetlands

Infrastructure development and overfishing in the Amazon make it imperative to define adequate scales for the ecosystem-based management of commercial fisheries and the wetlands on which they depend. We mapped fisheries and fish ecology data from Brazil, Peru, Bolivia and Colombia to an explicit GIS framework of river basins and mainstems. Migratory species account for more than 80% of the known maximum catches of commercial fisheries across the Amazon. Of these migratory species, we nominated six long-distance migratory fish taxa as flagship species to define the two main commercial fishery regions. The migrations of at least one goliath catfish species define a large-scale longitudinal link joining the Andes, Amazon Lowlands and Amazon River estuary. Migratory Characiforms demonstrate interbasin wetland connectivity between nutrient-rich and nutrient-poor rivers over at least 2 million km2, or about one-third of the Amazon Basin. We show that flooded forest area is the most important wetland variable explaining regional variations in migratory characiforme biomass as indicated by maximum annual fishery catches. The sustainable management of Amazon fisheries will require transnational cooperation and a paradigm shift from local community management alone to a more integrated approach that considers both rural and urban consumers and challenges, and the realistic life histories of migratory species. © 2018 The Authors. Fish and Fisheries Published by John Wiley & Sons Ltd