TEORIA DAS JANELAS QUEBRADAS: UMA REFLEXÃO NO ORDENAMENTO JURÍDICO BRASILEIRO

This work brings a reflection on the theory of broken windows, seeing its applicability in the Brazilian legal system, given the high crime rate, which generates fear and insecurity. The hypothetical-deductive method was used in the methodology, analyzing from the general to the particular. The institute of criminology will be approached in a succinct manner, pointing out its concept and purposes, as well as in what differs from criminal law. After the brief introduction, the theory of broken windows will be discussed in order to understand it, emphasizing its origin and a parallel of its application in relation to disorder and criminality. We conclude the present article, demonstrating the solidification of the applicability of broken window theory in our Brazilian legal system.Este trabalho traz uma reflexão sobre a teoria das janelas quebradas, vislumbrando sua aplicabilidade no ordenamento jurídico brasileiro, haja vista a alta taxa de criminalidade existente, geradora de temor e insegurança. Utilizou-se, na metodologia, o método hipotético-dedutivo, analisando-se do geral para o particular. Abordar-se-á o instituto da criminologia, de forma sucinta, apontando seu conceito e finalidades, bem como no que se difere do direito penal.  Feito o breve introito, a teoria das janelas quebradas será discutida a fim de compreendê-la, enfatizando sua origem e um paralelo de sua aplicação com relação entre a desordem e a criminalidade. Conclui-se o presente artigo, demonstrando a solidificação da aplicabilidade da teoria das janelas quebradas em nosso ordenamento jurídico brasileiro.&nbsp

Mechanical Prevention of Distal Embolization During Primary Angioplasty

Background— Effective myocardial reperfusion after primary percutaneous coronary intervention (PCI) may be limited by distal embolization. We tested the safety, feasibility, and efficacy of the FilterWire-Ex (FW), a distal embolic protection device, as an adjunct to primary PCI. Methods and Results— Fifty-three consecutive patients undergoing primary PCI with FW protection were compared with a matched control group treated by primary PCI alone. Successful FW positioning was obtained in 47 patients (89%) without complications. Histological analysis of the content of the last 13 filters showed multiple embolic debris in all cases. FW use was associated with lower postinterventional corrected TIMI frame count (22±14 versus 31±19; P =0.005) and higher occurrence of grade 3 myocardial blush (66% versus 36%; P =0.006) and early ST-segment elevation resolution (80% versus 54%; P= 0.006). At multivariate analysis, FW use was the only independent predictor of early ST-segment elevation resolution and of grade 3 myocardial blush. FW patients showed lower peak creatine kinase-MB release (236±172 versus 333±219 ng/mL; P =0.013) and greater improvement at 30 days in left ventricular wall motion score index (−0.30±0.19 versus −0.18±0.26; P= 0.008) and ejection fraction (+7±4% versus +4±7%; P =0.012). Conclusions— FW use during primary PCI is feasible and safe. Distal embolization prevention appears to exert a beneficial effect on markers of myocardial reperfusion and on left ventricular function improvement at 30 days

Changes in the Oswestry Disability Index after a 3-week in-patient multidisciplinary body weight reduction program in adults with obesity

The aim of this study was to examine the short-term changes in disability after an inpatient, multidisciplinary body weight reduction program (BWRP) in adults with obesity. A total of 160 individuals (males: 52, females: 108, BMI > 35 kg/m2) hospitalized for a 3-week multidisciplinary BWRP were recruited into the study. Body composition, lower limb muscle power, fatigue severity, and disability were measured at the beginning and end of the intervention by means of bioimpedance analysis, a stair climbing test (SCT), the Fatigue Severity Scale (FSS), and the Oswestry disability index (ODI), respectively. At the end of the 3-week BWRP, an average body weight reduction of 5.0 kg (CI 95% -5.3; -4.6, p < 0.001) was determined, as well as an improvement in all parameters measured. Clinically meaningful reductions in disability were observed in the moderate disability (Δ = -11.8% CI 95% -14.3; -9.3, p < 0.001) and severe disability (Δ = -15.9% CI 95% -19.6; -12.2, p < 0.001) groups. Reductions in disability were explained only by improvements in the SCT (Δ = -2.7 CI 95% -4.1; -1.4, p < 0.001) and the FSS (Δ = -0.3% CI 95% -0.4; -0.1, p < 0.001). These findings demonstrate the importance of incorporating approaches into a BWRP that increase lower limb muscle power and decrease fatigue severity and thus reduce disability in adults with obesity

Differences in spinal postures and mobility among adults with Prader-Willi syndrome, essential obesity, and normal-weight individuals

Introduction: Spinal kinematics/motion are reported to be altered in adolescents and adults with essential obesity, while no information is available in patients with Prader-Willi syndrome so far. The aim of this study was to examine cross-sectionally the characteristics of spinal postures and mobility in 34 patients with PWS, in 35 age- and sex-matched adults with essential obesity, and in 37 normal-weight individuals. Methods: Spinal posture and mobility were assessed using a radiation-free back scan, the Idiag M360 (Idiag, Fehraltorf, Switzerland). Differences in spinal posture and mobility between the three groups were determined using a two-way analysis of variance. Results: Adults with Prader-Willi syndrome had greater thoracic kyphosis [difference between groups (Δ) = 9.60, 95% CI 3.30 to 15.60, p = 0.001], less lumbar lordosis (Δ = -6.50, 95% CI -12.70 to -0.30, p = 0.03) as well as smaller lumbar and hip mobility than those with normal weight. Discussion: Although the characteristics of the spine in patients with Prader-Will syndrome appear to be similar to that found in subjects with essential obesity, Prader-Willi syndrome was found to influence lumbar movements more than thoracic mobility. These results provide relevant information about the characteristics of the spine in adults with Prader-Willi syndrome to be taken into careful consideration in the management of spinal conditions. These findings also highlight the importance of considering the musculoskeletal assessment of spinal postures and approaches targeting spinal and hip flexibility in adults with Prader-Willi syndrome

Differences in spinal postures and mobility among adults with Prader-Willi syndrome, essential obesity, and normal-weight individuals

IntroductionSpinal kinematics/motion are reported to be altered in adolescents and adults with essential obesity, while no information is available in patients with Prader-Willi syndrome so far. The aim of this study was to examine cross-sectionally the characteristics of spinal postures and mobility in 34 patients with PWS, in 35 age- and sex-matched adults with essential obesity, and in 37 normal-weight individuals.MethodsSpinal posture and mobility were assessed using a radiation-free back scan, the Idiag M360 (Idiag, Fehraltorf, Switzerland). Differences in spinal posture and mobility between the three groups were determined using a two-way analysis of variance.ResultsAdults with Prader-Willi syndrome had greater thoracic kyphosis [difference between groups (Δ) = 9.60, 95% CI 3.30 to 15.60, p = 0.001], less lumbar lordosis (Δ = -6.50, 95% CI -12.70 to -0.30, p = 0.03) as well as smaller lumbar and hip mobility than those with normal weight.DiscussionAlthough the characteristics of the spine in patients with Prader-Will syndrome appear to be similar to that found in subjects with essential obesity, Prader-Willi syndrome was found to influence lumbar movements more than thoracic mobility. These results provide relevant information about the characteristics of the spine in adults with Prader-Willi syndrome to be taken into careful consideration in the management of spinal conditions. These findings also highlight the importance of considering the musculoskeletal assessment of spinal postures and approaches targeting spinal and hip flexibility in adults with Prader-Willi syndrome

Switch to maraviroc with darunavir/r, both QD, in patients with suppressed HIV-1 was well tolerated but virologically inferior to standard antiretroviral therapy: 48-Week results of a randomized trial

Objectives Primary study outcome was absence of treatment failure (virological failure, VF, or treatment interruption) per protocol at week 48. Methods Patients on 3-drug ART with stable HIV-1 RNA &lt;50 copies/mL and CCR5-tropic virus were randomized 1:1 to maraviroc with darunavir/ritonavir qd (study arm) or continue current ART (continuation arm).Results In June 2015, 115 patients were evaluable for the primary outcome (56 study, 59 continuation arm). The study was discontinued due to excess of VF in the study arm (7 cases, 12.5%, vs 0 in the continuation arm, p = 0.005). The proportion free of treatment failure was 73.2% in the study and 59.3% in the continuation arm. Two participants in the study and 10 in the continuation arm discontinued therapy due to adverse events (p = 0.030). At VF, no emergent drug resistance was detected. Co-receptor tropism switched to non-R5 in one patient. Patients with VF reported lower adherence and had lower plasma drug levels. Femoral bone mineral density was significantly improved in the study arm. Conclusion Switching to maraviroc with darunavir/ritonavir qd in virologically suppressed patients was associated with improved tolerability but was virologically inferior to 3-drug therap

The Impact of Adherence to Screening Guidelines and of Diabetes Clinics Referral on Morbidity and Mortality in Diabetes

Despite the heightened awareness of diabetes as a major health problem, evidence on the impact of assistance and organizational factors, as well as of adherence to recommended care guidelines, on morbidity and mortality in diabetes is scanty. We identified diabetic residents in Torino, Italy, as of 1st January 2002, using multiple independent data sources. We collected data on several laboratory tests and specialist medical examinations to compare primary versus specialty care management of diabetes and the fulfillment of a quality-of-care indicator based on existing screening guidelines (GCI). Then, we performed regression analyses to identify associations of these factors with mortality and cardiovascular morbidity over a 4 year- follow-up. Patients with the lowest degree of quality of care (i.e. only cared for by primary care and with no fulfillment of GCI) had worse RRs for all-cause (1.72 [95% CI 1.57–1.89]), cardiovascular (1.74 [95% CI 1.50–2.01]) and cancer (1.35 [95% CI 1.14–1.61]) mortality, compared with those with the highest quality of care. They also showed increased RRs for incidence of major cardiovascular events up to 2.03 (95% CI 1.26–3.28) for lower extremity amputations. Receiving specialist care itself increased survival, but was far more effective when combined with the fulfillment of GCI. Throughout the whole set of analysis, implementation of guidelines emerged as a strong modifier of prognosis. We conclude that management of diabetic patients with a pathway based on both primary and specialist care is associated with a favorable impact on all-cause mortality and CV incidence, provided that guidelines are implemented

Switch to maraviroc with darunavir/r, both QD, in patients with suppressed HIV-1 was well tolerated but virologically inferior to standard antiretroviral therapy: 48-Week results of a randomized trial

Objectives: Primary study outcome was absence of treatment failure (virological failure, VF, or treatment interruption) per protocol at week 48. Methods: Patients on 3-drug ART with stable HIV-1 RNA &lt;50 copies/mL and CCR5-tropic virus were randomized 1:1 to maraviroc with darunavir/ritonavir qd (study arm) or continue current ART (continuation arm). Results: In June 2015, 115 patients were evaluable for the primary outcome (56 study, 59 continuation arm). The study was discontinued due to excess of VF in the study arm (7 cases, 12.5%, vs 0 in the continuation arm, p = 0.005). The proportion free of treatment failure was 73.2% in the study and 59.3% in the continuation arm. Two participants in the study and 10 in the continuation arm discontinued therapy due to adverse events (p = 0.030). At VF, no emergent drug resistance was detected. Co-receptor tropism switched to non-R5 in one patient. Patients with VF reported lower adherence and had lower plasma drug levels. Femoral bone mineral density was significantly improved in the study arm. Conclusion: Switching to maraviroc with darunavir/ritonavir qd in virologically suppressed patients was associated with improved tolerability but was virologically inferior to 3-drug therapy

Mulheres como agentes multiplicadores do uso correto e seguro dos agrotóxicos no Vale do Ribeira

A falta de instrução e de treinamento quanto à manipulação de agrotóxicos e as atitudes dos trabalhadores rurais que, geralmente, desconhecem as medidas de segurança, de proteção e de higiene a serem adotadas, evidencia a necessidade de se ter um processo educativo no uso seguro e ambientalmente responsável dos agrotóxicos. Neste contexto, a "Mulher", tem uma importante atuação como elo entre a realidade do campo e as necessidades de mudanças nas atitudes dos trabalhadores rurais, gerenciando os costumes e hábitos de sua família. Através da parceria UNESP-FEHIDRO, o projeto busca conhecer o perfil e as realidades das mulheres relacionadas com agricultores usuários destes produtos, bem como transmitir informações do uso correto e seguro dos agrotóxicos para elas por meio de cursos temáticos. Concomitantemente a estes cursos, são realizadas oficinas educativas para crianças, podendo, cada mãe, levar uma criança. As oficinas tem por objetivo a realização de atividades lúdicas e educacionais, visando a orientar as crianças em relação aos cuidados e perigos no manuseio e uso destes agrotóxicos. Etapas concluídas: busca do apoio de prefeituras, sindicatos, escolas rurais, cooperativas, associações, CATI e outras entidades; elaboração de um logo utilizado no veículo tipo furgão adquirido e em pastas e documentos do projeto; elaboração de folder, certificados, pré-questionário e pós-questionário, aplicados por meio de entrevistas; material didático para ministrar os cursos temáticos; elaboração de uma publicação infanto-juvenil de nome "Diversão e Segurança no Campo", cujo ISBN é 978-85-64951-01-3, além de cartazes e jogos didáticos para as oficinas infantis. Também foi construído um painel de madeira para apresentação de um teatro de fantoches para as crianças e um esboço de uma peça teatral. Até o momento, foram aplicados os pré-questionários em 107 mulheres, nos municípios de Juquiá, Pariquera-Açú e Registro. Foram ministrados oito cursos temáticos. Após o termino dos cursos, as mulheres responderam aos pós-questionários. Foram realizadas seis oficinas infantis, beneficiando 63 crianças. As oficinas infantis foram ministradas com o apoio dos estagiários bolsistas e alunos voluntários e supervisionadas por um docente. Foram distribuídos materiais didáticos para mulheres e crianças. Até o presente momento, foi concedida uma entrevista para o Jornal Regional de Registro e o projeto foi citado em três sites da internet. Os dados estão sendo tabulados para analise. A expectativa do projeto é que estas mulheres e crianças passem a atuar como agentes multiplicadoras junto a seus familiares, minimizando os riscos de contaminação ambiental e humana no Vale do Ribeira