Neurodevelopment outcomes in the first five years of the life of children with Transposition of the Great Arteries surgically corrected in the neonatal period

As doenças cardíacas congénitas são as anormalidades mais comuns ao nascimento, resultando em muitas consequências a curto e longo prazo. Em pacientes com Transposição das Grandes Artérias (TGA), a correção cirúrgica pode alcançar o tratamento definitivo, portanto, um conhecimento profundo dos resultados a longo prazo, particularmente os resultados do neurodesenvolvimento, é essencial. Assim, realizamos uma revisão sistemática e meta-análise para estudar os desfechos do neurodesenvolvimento nos primeiros cinco anos de vida de crianças submetidas à cirurgia corretiva de TGA no período neonatal. Um total de 18 artigos de 17 estudos foram incluídos na revisão sistemática e meta-análise, avaliando 809 indivíduos com TGA corrigida cirurgicamente. Os resultados do neurodesenvolvimento foram avaliados com as Escalas Bayley de Desenvolvimento Infantil (BSID) e a Escala Wechsler de Inteligência para Crianças (WISC). O Índice de Desenvolvimento Mental (MDI) e o Índice de Desenvolvimento Psicomotor (PDI) estavam dentro dos valores médios do primeiro ao terceiro ano de idade, e os scores médios de QI global, QI verbal e QI de desempenho, dos quatro aos cinco anos, estavam dentro a faixa de referência. Este estudo não revelou alterações significativas nos scores globais de neurodesenvolvimento até os cinco anos de idade em crianças submetidas à cirurgia corretiva de TGA no período neonatal. Mais estudos são necessários para identificar fatores de risco específicos e marcadores precoces de comprometimento tardio do neurodesenvolvimento para orientar o estabelecimento de intervenções precoces.Congenital heart defects are the most common abnormalities at birth, resulting in many short and long-term consequences. In patients with Transposition of the Great Arteries (TGA), surgical correction may achieve definitive treatment, so a thorough knowledge of the long-term outcomes, particularly neurodevelopment outcomes, is essential. Therefore, we conducted a systematic review and meta-analysis to study the neurodevelopment outcomes in the first five years of the life of children submitted to corrective surgery for TGA in the neonatal period. A total of 18 reports from 17 studies were included in the systematic review, assessing 809 individuals with surgically corrected TGA. The neurodevelopmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development (BSID) and the Wechsler Intelligence Scale for Children (WISC). Mean Mental Development Index (MDI) and Psychomotor Development Index (PDI) were within the average values from 1 to 3 years of age, and mean full-scale global IQ, verbal IQ and performance IQ scores, from four to five years, were within the reference range. This study revealed no major impairments in global neurodevelopment scores until five years of age in children submitted to corrective surgery for TGA in the neonatal period. Further studies are needed to identify specific risk factors and early markers of later impairment to guide the establishment of early interventions

Power, heart rate and perceived exertion responses to 3x3 and 4x4 basketball small-sided games

Despite the interest drawn by game adaptations in players' performance development, no study examined the effects of these task constraints in basketball games exercise intensity. Therefore, the aim of this study is to identify differences in power, heart rate and perceived exertion responses to 3x3 and 4x4 basketball small-sided games. Eight young male basketball players participated in this study. Player's individual peak heart rate value and global perceived exertion was registered immediately after two small-sided games, 3x3 and 4x4. Additionally, squat jump and countermovement jump were used to assess power. Our results show that both small-sided games promoted high physiological demands, whereas the players performed the tasks above 80% of HRmax. Nevertheless, another interesting finding of this study is related to the fact that 3x3 contributed to higher physiological demands than the 4x4. The significant increase in the countermovement jump posttest jump results could suggest that the 4x4 were not played as quickly nor intensely as the 3x3. Decreases of the space and number of players in game allow greater self-recreation of players and greater intervention in game. Therefore, the heart rate response during the series displays a higher physiologic impact in 3x3 than in 4x4

The impact on our valuation when changing critical inputs

In this part I present a scenario analysis on our valuation. In fact, our valuation in highly dependent on four inputs, which we forecast a behavior for them, that we are not sure will happen. Therefore, I used our valuation as a base case scenario, which I gave a probability of 60%. Moreover, I also did a best and worst case scenario, giving 20% of probability of occurrence to which one

Physical, psychological and social impact of scleroderma in Europe and Brazil

Scleroderma involves several physical changes in visible parts of the body, as face and hands. Scleroderma affects body image and is associated with depressive and anxiety symptoms and sexual dysfunction. These physical disfiguring changes are in visible and important interpersonal contact body parts. Scleroderma symptoms can be painful, such as digital ulcers, Raynaud's phenomenon, skin changes, joint contractures and gastroesophageal reflux, and the severity of these symptoms is associated with depression. This study aims mainly to characterize the most common symptoms of scleroderma, the impact felt by patients, assess satisfaction with medical care, psychological symptoms and illness perception. This study has 563 participants belonging to various European countries and Brazil. These participants are mostly woman. The instruments used in this study were the Canadian Scleroderma Patient Survey of Health Concerns and Research Priorities and The Brief Illness Perception Questionnaire. The five most common symptoms reported by patients were: joint pain, fatigue, Raynaud's, muscle pain and hardening / tightening skin. Fatigue was the symptom reported as having more impact on the daily lives of participants. Participants who reported more symptoms, also reported higher impact of symptoms. Just under one fifth of the participants had a diagnosis of scleroderma with the first doctor consulted. Participants with more years of diagnosis revealed to be more satisfied with the medical care they receive. Almost a third of participants reported that they do not have access to all medical care due to its cost. In sum, almost half the participants showed that scleroderma affects their ability to work. Regarding depression, 38% of participants have sensitivity for sever depression, and younger participants reported more symptoms of depression. Depressive symptoms are associated with the impact perceived of symptoms and not with the frequency of symptoms. In relation to anxiety, 32% of participants reported symptoms of generalized anxiety and participants with worse body image reported more symptoms of anxiety. Participants with symptoms of generalized anxiety reported more symptoms of pain. The symptoms of social phobia are reported by 30% of the participants. More than half of participants reported that they avoid activities which they are the center of attention. Participants with social phobia reported worse body image. Participants reported a high degree of concern with scleroderma and 84% reported concerns with body image due scleroderma

Sintomas de doença e adaptação psicológica em pacientes brasileiros com esclerodermia

OBJECTIVE: To characterize the prevalence and impact of symptoms of scleroderma in Brazilian patients and to describe their satisfaction with medical care and psychological symptoms. METHODS: One-hundred and twenty eight Brazilian scleroderma patients participated in an online survey by filling out a Portuguese version of the Canadian Scleroderma Patient Survey of Health Concerns and Research Priorities. The mean age of participants was 38 years old (SD = 12.33), and most of the participants were females (n = 108, 88%). RESULTS: Hardening/tightening of skin, itchy skin and joint pain were symptoms reported as being most frequent, whereas muscle pain and difficulty climbing stairs were symptoms reported as having a higher impact. Participants reported dissatisfaction regarding the medical care. Psychological evaluations suggested that participants who scored above clinical values for depression was significantly high (90%; n = 77). In addition, 48% (n = 42) of participants fit the clinical criteria for anxiety disorder, and 40% (n = 35) of participants fit the clinical criteria of social phobia. Finally, body image disturbance was reported by 69% (n = 88) of participants. CONCLUSIONS: The physical and psychological symptoms associated with scleroderma have a significant impact on patient quality of life. The Brazilian patients in the current sample report higher levels of dissatisfaction with medical care than patients from Canada and European countries. These Brazilian patients also report more psychopathology, particularly symptoms of depression. The current results suggest that there is a need for professionals to consider and attend to the individual problems of scleroderma patientsObjetivo: Caracterizar a prevalência e o impacto dos sintomas de esclerodermia em pacientes brasileiros e descrever sua satisfação com o atendimento médico e sintomas psicológicos. Métodos: Cento e vinte e oito pacientes brasileiros com esclerodermia participaram em uma pesquisa online preenchendo a versão portuguesa do Canadian Scleroderma Patient Survey of Health Concerns and Research Priorities. A média de idade dos participantes foi 38 anos (DP = 12,33) e a maioria dos participantes era constituída por mulheres (n = 108, 88%). Resultados: Endurecimento/retesamento da pele, coceira na pele e dor articular foram sintomas informados como mais freqüentes, enquanto que dor muscular e difi culdade para subir escadas foram sintomas informados como tendo maior impacto. Os participantes informaram insatisfação em relação ao atendimento médico. As avaliações psicológicas sugeriram que o percentual de participantes com pontuação acima dos valores clínicos para depressão foi signifi cativamente elevado (90%; n = 77). Além disso, 48% (n = 42) dos participantes se enquadravam nos critérios clínicos para transtorno da ansiedade e 40% (n = 35) dos participantes se enquadravam nos critérios clínicos de fobia social. Finalmente, 69% (n = 88) dos participantes informaram transtornos da imagem corporal. Conclusões: Os sintomas físicos e psicológicos associados com esclerodermia têm impacto signifi cativo na qualidade de vida dos pacientes. Na presente amostra, os pacientes brasileiros informam níveis mais altos de insatisfação com o atendimento médico, em comparação com pacientes do Canadá e de países europeus. Esses pacientes brasileiros também informam mais casos de psicopatologia, particularmente sintomas de depressão. Nossos resultados sugerem que há necessidade que os profi ssionais levem em consideração os problemas individuais dos pacientes com esclerodermia e cuidem desses problemas.(undefined

A performance musical e a crise de autoridade : corpo e gênero

A derrocada do formalismo na música deflagrou uma crise de autoridade na performance musical. Entretanto, os ecos prolongados do autoritarismo ainda se fazem presentes na prática da performance. A demanda contemporânea da criatividade na performance musical requer uma desconstrução da estrutura normativa que tem regulado a nossa prática por quase dois séculos. Utilizando as definições de Goehr dos dois ideais de performance, examino a relação entre a tradição e o ideal do Werktreue, bem como o papel do corpo traçado de acordo com os dois ideais, enfocando a separação mente/corpo e as divisões de gênero.The debunking of musical formalism has created an authority crisis in musical performance. However, the lingering echoes of authoritarianism are still present in musical performance practice. The contemporary demand for creativity in musical performance requires a deconstruction of the normative structure that has regulated our practice for roughly two centuries. Using Goehr’s definition of the two ideals of performance practices, I examine the relationship between tradition and the Werktreue ideal, as well as the role of the body in each of the practices in relation to the mind/ body split and gender divisions