Noncompaction Cardiomyopathy. A Review of Eight Cases

A miocardiopatia não compactada isolada é uma doença geneticamente determinada cuja patogénese parece envolver uma paragem no desenvolvimento do endomiocárdio. Morfologicamente caracteriza-se pela presença de trabeculações proeminentes separadas por profundos recessos preenchidos por fluxo e como tal por Doppler a cor no estudo ecocardiográfico. No sentido de melhor caracterizar esta entidade recentemente descrita, de prognóstico pouco esclarecido, fazemos uma revisão dos casos diagnosticados no nosso hospital, descrevendo as características clínicas, electrocardiográficas e ecocardiográficas, bem como a terapêutica instituída e seguimento clínico. A propósito da revisão dos casos, é feita uma exposição e discussão da literatura mais relevante relativamente a etiopatogenia, clínica, critérios de diagnóstico, terapêutica e prognóstico

Evaluation of a quality improvement intervention for labour and birth care in Brazilian private hospitals: a protocol

© 2018 The Author(s). Background: In Brazilian private hospitals, caesarean section (CS) is almost universal (88%) and is integrated into the model of birth care. A quality improvement intervention, “Adequate Birth” (PPA), based on four driving components (governance, participation of women and families, reorganisation of care, and monitoring), has been implemented to help 23 hospitals reduce their CS rate. This is a protocol designed to evaluate the implementation of PPA and its effectiveness at reducing CS as a primary outcome of birth care. Methods: Case study of PPA intervention conducted in 2017/2018. We integrated quantitative and qualitative methods into data collection and analysis. For the quantitative stage, we selected a convenient sample of twelve hospitals. In each of these hospitals, we included 400 women. This resulted in a total sample of 4800 women. We used this sample to detect a 2.5% reduction in CS rate. We interviewed managers and puerperal women, and extracted data from hospital records. In the qualitative stage, we evaluated a subsample of eight hospitals by means of systematic observation and semi-structured interviews with managers, health professionals and women. We used specific forms for each of the four PPA driving components. Forms for managers and professionals addressed the decision-making process, implemented strategies, participatory process in strategy design, and healthcare practice. Forms for women and neonatal care addressed socio-economic, demographic and health condition; prenatal and birth care; tour of the hospital before delivery; labour expectation vs. real experience; and satisfaction with care received. We will estimate the degree of implementation of PPA strategies related to two of the four driving components: “participation of women and families” and “reorganisation of care”. We will then assess its effect on CS rate and secondary outcomes for each of the twelve selected hospitals, and for the total sample. To allow for clinical, socio-demographic and obstetric characteristics in women, we will conduct multivariate analysis. Additionally, we will evaluate the influence of internal context variables (the PPA driving components “governance” and “monitoring”) on the degree of implementation of the components “participation of women and families” and “reorganisation of care”, by means of thematic content analysis. This analysis will include both quantitative and qualitative data. Discussion: The effectiveness of quality improvement interventions that reduce CS rates requires examination. This study will identify strategies that could promote healthier births

Corporate Social Responsibility (CSR) practices developed by Brazilian companies: an exploratory study

© 2017 Informa UK Limited, trading as Taylor & Francis Group. In a world where companies have major influence over the economy, politics, and environment, they must be held accountable for their actions. With this in mind, the publication of sustainability reports is in a company’s best interest, since the disclosure of Corporate Social Responsibility (CSR) and sustainable practices can bring enormous advantages, largely related to a company’s image. The amount of information presented in sustainability reports turns them into valuable sources for research data, allowing analyses related to CSR and management practices, stakeholder relations, language used, among others. However, there is no a paper in the literature that analyzes theses information jointly for the Brazilian companies, and then we decided to explore this theme. This research aimed to identify advances and gaps of CSR practices performed by Brazil companies, through the analysis of 30 sustainability reports published between 2014 and 2015. The main findings indicate that, in general, the analyzed companies are experienced in sustainability reporting; however, there is still room for improvements, including a better mapping and reporting of practices involving the integration of CSR to organizational structure, stakeholder engagement, and continuous improvement practices

Climate change and health: An analysis of causal relations on the spread of vector-borne diseases in Brazil

The increases in greenhouse gas concentrations caused by anthropogenic activities such as industrial emissions, transport and burning of forests and other resources, recorded over the past decades, are known to have an impact on the global environment. In particular, this paper reviews the evidence that climate change has an impact on human health as a whole and on the spread of vector-borne diseases in particular. It offers an analysis of previous research on the connections between climate change and health, with a case study from Brazil, and lists some areas which may guide future policy-making

Dengue during pregnancy and live birth outcomes: a cohort of linked data from Brazil

OBJECTIVES: Dengue is the most common viral mosquito-borne disease, and women of reproductive age who live in or travel to endemic areas are at risk. Little is known about the effects of dengue during pregnancy on birth outcomes. The objective of this study is to examine the effect of maternal dengue severity on live birth outcomes. // DESIGN AND SETTING: We conducted a population-based cohort study using routinely collected Brazilian data from 2006 to 2012. // PARTICIPATING: We linked birth registration records and dengue registration records to identify women with and without dengue during pregnancy. Using multinomial logistic regression and Firth method, we estimated risk and ORs for preterm birth (<37 weeks' gestation), low birth weight (<2500 g) and small for gestational age (<10thcentile). We also investigated the effect of time between the onset of the disease and each outcome. // RESULTS: We included 16 738 000 live births. Dengue haemorrhagic fever was associated with preterm birth (OR=2.4; 95% CI 1.3 to 4.4) and low birth weight (OR=2.1; 95% CI 1.1 to 4.0), but there was no evidence of effect for small for gestational age (OR=2.1; 95% CI 0.4 to 12.2). The magnitude of the effects was higher in the acute disease period. // CONCLUSION: This study showed an increased risk of adverse birth outcomes in women with severe dengue during pregnancy. Medical intervention to mitigate maternal risk during severe acute dengue episodes may improve outcomes for infants born to exposed mothers

An imaging spectroscopic survey of the planetary nebula NGC 7009 with MUSE

Aims. The spatial structure of the emission lines and continuum over the 5000 extent of the nearby, O-rich, PN NGC 7009 (Saturn Nebula) have been observed with the MUSE integral field spectrograph on the ESO Very Large Telescope. This study concentrates on maps of line emission and their interpretation in terms of physical conditions. Methods. MUSE Science Verification data, in <0.600 seeing, have been reduced and analysed as maps of emission lines and continuum over the wavelength range 4750–9350 Å. The dust extinction, the electron densities and temperatures of various phases of the ionized gas, abundances of species from low to high ionization and some total abundances are determined using standard techniques. Results. Emission line maps over the bright shells are presented, from neutral to the highest ionization available (He II and [Mn V]). For collisionally excited lines (CELs), maps of electron temperature (Te from [N II] and [S III]) and density (Ne from [S II] and [Cl III]) are available and for optical recombination lines (ORLs) temperature (from the Paschen jump and ratio of He I lines) and density (from high Paschen lines). These estimates are compared: for the first time, maps of the differences in CEL and ORL Te’s have been derived, and correspondingly a map of t 2 between a CEL and ORL temperature, showing considerable detail. Total abundances of only He and O were formed, the latter using three ionization correction factors. However, the map of He/H is not flat, departing by ∼2% from a constant value, with remnants corresponding to ionization structures. An integrated spectrum over an area of 2340 arcsec2 was also formed and compared to 1D photoionization models. Conclusions. The spatial variation of a range of nebular parameters illustrates the complexity of the ionized media in NGC 7009. These MUSE data are very rich with detections of hundreds of lines over areas of hundreds of arcsec2 and follow-on studies are outlined