Qualidade de vida em diálise

Este artigo pretende descrever e comparar a qualidade de vida relacionada com a saúde nas pessoas com insuficiência renal crónica em diálise de acordo com os diferentes tipos de admissão. Foi desenvolvido um estudo não experimental, transversal e descritivo numa amostra de 231 pessoas com insuficiência renal crónica, conforme o tipo de admissão à diálise e que efectuavam tratamento dialítico no nordeste transmontano. Utilizou-se o instrumento de medição KDQOL constituído por uma medida genérica de saúde — o SF-36 — e uma específica deste quadro clínico — o ESRD. Dos participantes estudados, a maioria era do sexo masculino (56,3%), casados (68,4%), reformados ou pensionistas (84,9%), provenientes de zona rural (67,4%) e com um nível de instrução básico ou inferior (89,1%). A idade dos respondentes variou entre os 18 e os 88 anos, com uma média de 61,6 anos e uma mediana de 65 anos. O tempo de diálise destes doentes foi entre 15 dias e 24 anos e o tipo de tratamento mais prevalente foi a hemodiálise (94,8%). A maior parte dos doentes apresentou outras doenças associadas (56,3%) e complicações (91%), tendo sido a diabetes a doença associada mais referida (26,4%) e o cansaço (69,7%), as mãos e pés adormecidos (58,9%), as cãibras (54,5%), as dores musculares (52,4%) e a comichão (51,5%), as complicações mais assinaladas. Os doentes com admissão programada para diálise apresentaram uma qualidade de vida mais satisfatória do que os admitidos de forma urgente, com diferenças estatisticamente significativas na actividade profissional, no desempenho físico, no desempenho emocional, na função social e na vitalidade. Os resultados evidenciaram também um impacto negativo de algumas variáveis sócio-demográficas e clínicas. Nesta investigação é reconhecida a importância da avaliação da qualidade de vida relacionada com a saúde, como um indicador de excelência dos cuidados de saúde, reflectindo a voz do utente

Learning to Read Better: Training Decoding, Comprehension and Perceptual Skills

The present study is a program evaluation designed to evaluate an elementary school remedial reading instructional program using Carr\u27s model (1982) of reading ability. The Learning to Read Better program evolved from Anes\u27 (1979a, 1979b, 1981) study and experience In teaching children with reading problems. The program is structured according to the components of the reading process, with time in the reading room and teaching responsibility allocated so that learning in each component occurs during every remedial session. Four key components of the reading process emphasized in this program are: visual-perceptual training, decoding, oral reading, and comprehension

Stadion Olahraga Di Woloan-tomohon. Hi-tech Architecture

Olahraga adalah salah satu kegiatan manusia untuk menjaga kebugaran tubuh. Pada era sekarang olahraga pun mulai diminati kembali. Dapat dilihat dari perkembangan yang ada dibeberapa daerah, salah satunya di Kota Tomohon, Kota ini memiliki banyak potensi olaharaga untuk dikembangkan namun sayangnya fasilitas yang ada dalam daerah ini masih belum memadai, kurangnya fasilitas daerah menjadikan animo masyarakat mulai menurun terhadap olahraga. Perancangan Stadion Olahraga di Kota Tomohon dapat menjadi satu wadah untuk menjawab kekurangan yang ada dalam daerah ini. Dalam penulisan ini kajian diawali dengan mempelajari tentang Stadion Olaharaga tersebut, standar-standar perancangan dan perencanaan bangunan Stadion Olaharaga, pengertian dan ciri-ciri High Tech Arsitektur, serta studi banding beberapa Stadion yang telah ada. Dilakukan juga tinjauan mengenai Kota Tomohon terlebih untuk lokasi yang berada di Woloan. Pendekatan perancangan arsitektural dilakukan dengan konsep High Tech Arsitektur. Selain itu dilakukan pendekatan fungsional, kinerja, teknis, dan kontekstual. Sebagai kesimpulan, program ruang sangat diperlukan, serta gambar-gambar 2 dimensi dan 3 dimensi sebagai ilustrasi desain

Relating organizational knowledge with ISO 9001: 2015: An empirical approach

In a business market environment highly marked by competition, standardisation has proven distinctive in answering continuous challenges. Thus, organisations have been investing in obtaining ISO certifications, being "ISO 9001 – Quality Management System" among the most popular. The present empirical study aims to discover what is, in the opinion of managers expressed by their answers to the questionnaire, the relationship between the implementation of Knowledge Management practices, the Quality System and Organizational Performance while verifying if the introduction of Knowledge Management principles in the Standard ISO 9001 has affected the company's overall organisational performance. The proposed analysis methodology is supported by applying a questionnaire to 36 Portuguese Small and Medium Enterprises sample. The investigation results allowed us to infer that, in the managers' opinion expressed by the answer to the questionnaire, Knowledge Management acts as a mediator between the Quality System and performance while not directly influencing organisational performance. Within the companies studied, holders of the certification ISO 9001, through the application of Knowledge Management practices, show improvements in the management of the Quality System, with a consequent increase in organisational performance.info:eu-repo/semantics/publishedVersio

Damage evaluation under complex fatigue loading conditions

Fatigue damage and life assessment of multiaxial loadings is still an issue yet to resolve. Many methods have been proposed with promising agreements with the experimental results. However, the performance of such methods is, more than often, purely based on fatigue tests with simple loading conditions. In this work the stress scale factor (SSF) criterion and the virtual cycle counting (vcc) method are used to estimate fatigue life and damage accumulation with two damage accumulation rules. Fatigue tests were carried out with three different variable amplitude random loadings, applied to several specimens made from a 42CrMo4 high-strength steel. Fatigue crack plane measurements were compared with predictions from several critical plane models. The applied methods provided very acceptable results making the SSF package (SSF equivalent stress and virtual cycle counting method) a good method to estimate fatigue life and assessment of the damage accumulation in random fatigue loadings

Intralesional expression of mRNA of interferon- gamma, tumor necrosis factor- alpha, interleukin-10, nitric oxide synthase, indoleamine-2,3-dioxygenase, and RANTES is a major immune effector in Mediterranean spotted fever rickettsiosis

BACKGROUND: The mechanisms of immunity to Rickettsia conorii that have been elucidated in mouse models have not been evaluated in human tissues. METHODS: In this study, quantitative real-time polymerase chain reaction was used to determine the levels of expression of inflammatory and immune mediators in skin-biopsy samples collected from 23 untreated patients with Mediterranean spotted fever (MSF). RESULTS: In all 23 patients, the levels of intralesional expression of mRNA of tumor necrosis factor (TNF)- alpha , interferon (IFN)- gamma , interleukin (IL)-10, RANTES, and indoleamine-2,3-dioxygenase (IDO), an enzyme involved in limiting rickettsial growth by tryptopha degradation, were higher than those in control subjects; 6 of the 23 patients had high levels of inducible nitric oxide synthase (iNOS), a source of microbicidal nitric oxide. Positive correlations between TNF- alpha , IFN- gamma , iNOS, IDO, and mild/moderate MSF suggest that type 1 polarization plays a protective role. Significantly higher levels of intralesional expression of IL-10 mRNA were inversely correlated with levels of intralesional expression of IFN- gamma mRNA and TNF- alpha mRNA. The mRNA-expression level of the chemokine RANTES was significantly higher in patients with severe MSF. CONCLUSION: Mild/moderate MSF is associated with a strong and balanced intralesional proinflammatory and anti-inflammatory response, with a dominant type 1 immunity, whereas severe MSF is associated with increased expression of chemokine mRNA. Whether these factors are simply correlates of mild and severe MSF or contribute to antirickettsial immunity and pathogenesis remains to be determined

The smaller the market, the better the rent capturing: electrification in North Portugal during the Interwar Period

This article analyses the origin of the persistently high level of electricity prices that hampered the expansion of electricity consumption during the interwar period in Porto. Initially, the rent-seeking behaviour of both the supply firm and the City Hall at the local level affected the expansion of the local electricity market. During the 1930s, this collusion at municipal level coincided with unpredictable energy policies at state level. This circumstance impeded the indispensable increase of scale and the building of a regional market of electricity in north Portugal. The literature on regulation and institutional analysis has proved very useful. Finally, though equally important, primary sources from company archives and institutional bodies were also employed.Este artículo analiza el origen de los elevados precios de la electricidad en Oporto entre las dos guerra mundiales y su secuela, su lenta electrificación. La colusión entre la compañía suministradora y el municipio limitó la expansión al comenzar el servicio hidroeléctrico; luego, la expectativa reiteradamente frustrada de una mayor intervención gubernamental fue en detrimento de mayores inversiones. Se impidió así el necesario aumento de escala, la plena integración del mercado eléctrico del Norte de Portugal y, en consecuencia, los precios eléctricos se mantuvieron elevados y la electrificación sufrió un persistente atraso. La adopción de una perspectiva institucional se ha revelado muy útil para esclarecer el funcionamiento de este mercado, que se ha examinado consultando fuentes empresariales, municipales y gubernamentales.This research has been financed by the Fundaçao Ciência e Tecnologia de Portugal

Cyanoacrylate closure for peripheral veins: Consensus document of the Australasian College of Phlebology

Background: Cyanoacrylates are fast-acting adhesives used in procedural medicine including closure of superficial wounds, embolization of truncal vessels pre-operatively, vascular anomalies, visceral false aneurysms, endoleaks, gastrointestinal varices and gastrointestinal bleeding. More recently, catheter-directed cyanoacrylate adhesive closure was introduced as an alternative to endovenous thermal ablation (ETA) to occlude superficial veins of the lower limbs. Objectives: To formulate policies for the safe and effective delivery of cyanoacrylate adhesive closure procedures in Australasia, based on current experience and evidence. Methods: A panel of phlebologists including vascular surgeons, interventional radiologists, dermatologists and research scientists systematically reviewed the available data on cyanoacrylate products used in medicine and shared personal experience with the procedure. The reviewed material included bibliographic and biomedical data, material safety data sheets and data requested and received from manufacturers. Results and recommendations: Cyanoacrylate adhesive closure appears to be an effective treatment for saphenous reflux with occlusion rates at 36 months of 90–95%. We recommend a maximum dose of 10 mL of cyanoacrylate per treatment session. Serious complications are rare, but significant. Hypersensitivity to acrylates is reported in 2.4% of the population and is an important absolute contraindication to cyanoacrylate adhesive closure.1 Post-procedural inflammatory reactions, including hypersensitivity-type phlebitis, occur in 10–20% of patients.2 In the long term, cyanoacrylate adhesive closure results in foreign-body granuloma formation within 2–12 months of the procedure. We recommend against the use of cyanoacrylate adhesive closure in patients with uncontrolled inflammatory, autoimmune or granulomatous disorders (e.g. sarcoidosis). Caution should be exercised in patients with significant active systemic disease or infection and alternative therapies such as thermal ablation and foam sclerotherapy should be considered. Conclusions: Cyanoacrylate adhesive closure appears to be an effective endovenous procedure, with short-term closure rates comparable to ETA and therefore greater efficacy than traditional surgery for treating superficial veins of the lower limbs. Ongoing data collection is required to establish the long-term safety

Identification of a Novel Gene Product That Promotes Survival of Mycobacterium smegmatis in Macrophages

BACKGROUND: Bacteria of the suborder Corynebacterineae include significant human pathogens such as Mycobacterium tuberculosis and M. leprae. Drug resistance in mycobacteria is increasingly common making identification of new antimicrobials a priority. Mycobacteria replicate intracellularly, most commonly within the phagosomes of macrophages, and bacterial proteins essential for intracellular survival and persistence are particularly attractive targets for intervention with new generations of anti-mycobacterial drugs. METHODOLOGY/PRINCIPAL FINDINGS: We have identified a novel gene that, when inactivated, leads to accelerated death of M. smegmatis within a macrophage cell line in the first eight hours following infection. Complementation of the mutant with an intact copy of the gene restored survival to near wild type levels. Gene disruption did not affect growth compared to wild type M. smegmatis in axenic culture or in the presence of low pH or reactive oxygen intermediates, suggesting the growth defect is not related to increased susceptibility to these stresses. The disrupted gene, MSMEG_5817, is conserved in all mycobacteria for which genome sequence information is available, and designated Rv0807 in M. tuberculosis. Although homology searches suggest that MSMEG_5817 is similar to the serine:pyruvate aminotransferase of Brevibacterium linens suggesting a possible role in glyoxylate metabolism, enzymatic assays comparing activity in wild type and mutant strains demonstrated no differences in the capacity to metabolize glyoxylate. CONCLUSIONS/SIGNIFICANCE: MSMEG_5817 is a previously uncharacterized gene that facilitates intracellular survival of mycobacteria. Interference with the function of MSMEG_5817 may provide a novel therapeutic approach for control of mycobacterial pathogens by assisting the host immune system in clearance of persistent intracellular bacteria