Paisagem e sua relação com o lazer nos planos diretores de Campinas / Landscape and its relatioship with leisure in Campinas master plans

Este estudo analisa a operacionalização do conceito de paisagem nos Planos Diretores de Campinas de 2006 e 2016. Metodologicamente, foram analisadas as legislações em busca dos termos-chave "lazer" e "paisagem" e suas interações. Ainda que o Estatuto da Cidade (2001) vise ordenar as funções sociais da propriedade urbana, sua abordagem generalista carece de diretrizes específicas para os Planos Diretores, deixando lacunas na definição de aspectos como lazer e paisagem. Os Planos Diretores campineiros historicamente deram pouco espaço à tais temas; somente a partir de 2006 houve uma incorporação mais profunda desses aspectos, especialmente em 2018, onde o lazer passou a ser considerado como um direito social e a paisagem foi abordada de forma mais abrangente.

This study examines the operationalization of the landscape concept in the Master Plans of Campinas from 2006 to 2016. Methodologically, legislation was analyzed to identify key terms such as "recreation" and "landscape" and their interactions. Although the City Statute (2001) aims to organize the social functions of urban property, its generalist approach lacks specific guidelines for Master Plans, resulting in gaps in defining aspects like recreation and landscape. Historically, Campinas' Master Plans have given little attention to such topics; only from 2006 onward has there been a deeper incorporation, particularly in 2018, where recreation is recognized as a social right and landscape is addressed more comprehensively.

Antitumor activity of essential oils-based nanostructured lipid carriers on prostate cancer cells.

Prostate cancer (PCa) is the second most frequent malignancy in men worldwide. Essential oils (EOs) are natural products which can act in cancer suppression by several mechanisms. In this work, a nanotechnological approach was used to develop and evaluate the antineoplastic effects of EOs loaded by nanostructured lipid carriers (NLCs). Three different NLC systems composed of cinnamon, sage or thyme EOs were optimized using factorial design (23). The optimal formulations were characterized in terms of biophysical parameters, structure, stability, in vivo safety and efficacy. All optimized NLC formulations exhibited excellent structural properties and stability over a year (25 °C). They proved to be in vitro and in vivo biocompatible on PNT2 normal prostate cells and on chicken embryos (CE), respectively. In PC3 PCa cells, optimized NLCs inhibited cell proliferation and migration and changed its morphology. In CE xenograft tumor, NLCs have inhibited tumor growth and angiogenesis. The results from this work suggested that all developed EO-based NLC formulations had their stability improved while the biological activity remains unchanged.

Influence of age and sex on the blood biochemical constituent values of broiler breeders during the egg-laying stage.

This study aimed to evaluate the influence of age and sex on the blood biochemical constituents of broiler breeders during the egg production stage. The analysis was performed in an industrial broiler breeder farm, and blood samples were collected from males and females at five different ages. Biochemical elements analysed in each serum sample were total proteins, albumin, globulins, uric acid, total cholesterol and triglycerides, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), creatine kinase (CK), alkaline phosphatase (PAL), calcium and phosphorus, beside the glycaemic status. At most ages, females had higher values of total proteins, albumin, globulins, triglycerides, cholesterol, glucose, calcium, phosphorus, Ca/P (calcium and phosphorus) ratio and gamma-glutamyltransferase (GGT). The values of uric acid, aspartate aminotransferase (AST), creatine kinase (CK) and alkaline phosphatase (PAL) were higher in males. The lowest protein values were found at 28 and 60 weeks old. The mean albumin values were significantly higher at 44 and 52 weeks old in males and females. A trend of increasing globulin values with increasing age up to 52 weeks old was observed. Although calcium and phosphorus did not vary according to age, the Ca/P ratio was lowest at 36 weeks old. Comparing the means of both sexes, the AST and GGT values were significantly higher in 60-week-old birds. The highest serum levels of CK occurred at 28 and 52 weeks old. The physiological levels of serum biomarkers presented in this work are important for evaluating productivity performance, welfare and disease indication in breeding flocks.

Prevalência de lesão periapical radiolúcida nos pacientes com síndrome de Sjögren primária / Prevalence of radiolucid periapical injury in patients with primary Sjögren syndrome

Introdução: Pacientes com Síndrome de Sjögren Primária (SSP) apresentam maior incidência de cárie dentária. Como consequência da cárie, podem ocorrer lesões periapicais radiolúcidas (LPR). Objetivo: Determinar a prevalência de LPR nos pacientes com SSP e caracterizar radiologicamente os dentes associados às LPR. Métodos: Estudo transversal envolvendo pacientes com SSP, recrutados em uma Clínica de Reumatologia (HUCAM-ES), que foram submetidos, inicialmente, a um questionário socioeconômico e avaliação clínica do fluxo salivar. Posteriormente, radiografias foram obtidas por um sistema digital intrabucal, com posicionador para a técnica periapical do paralelismo. Realizou-se a estatística descritiva por meio da média e desvio-padrão para as variáveis quantitativas, e frequências absoluta e relativa para as variáveis qualitativas. Realizou-se o teste qui-quadrado com IC95% e o teste t de Student para comparação dos pacientes com e sem lesão periapical. Resultados: No total, 24 pacientes fizeram parte do estudo, todos do sexo feminino (20 - 71 anos). O número médio de dentes/paciente foi de 23,3 ± 3,1, com prevalência de LPR dentária de 7,86%. Do total de pacientes, 70,8% tinham pelo menos uma LPR. Na comparação dos dentes com e sem LPR, os dentes com LPR apresentaram maior porcentagem de canal tratado e cárie. Conclusão: De acordo com os resultados, pode-se concluir que as LPR encontradas nos pacientes com SSP são uma condição frequente, principalmente quando associadas a dentes com canal(is) obturado(s) (AU).

Introduction: Patients with Primary Sjögren Syndrome (PSS) have a higher incidence of dental caries. As a conse- quence, radiolucent periapical lesions (RPL) may appear. Objective: To determine the prevalence of RPL in patients with PSS and to radiologically characterize the teeth associated with RPL. Methodology: Cross-sectional study involving patients with PSS, recruited at the Rheumatology Clinic (HUCAM-ES), who were initially submitted to a socioeconomic questionnaire and clinical evaluation of salivary flow. Subsequently, radiographs were obtained by a digital intraoral system with positioner for the periapical parallelism technique. Descriptive statistics were calculated by the mean and standard deviation for quantitative variables, and absolute and relative frequencies for qualitative variables. Chi-square test with 95% CI and Student t test were applied to compare patients with and without periapical lesion. Results: Over-all, 24 patients participated in the study and all were females (20-71 years). The mean number of teeth per patient was 23.3±3.1, with prevalence of dental RPL of 7.86%. Among all patients, 70.8% had at least one RPL. When comparing teeth with and without RPL, teeth with RPL showed higher percentage of treated canal and caries. Conclusion: According to the results, it can be concluded that RPL in patients with PSS is a frequent condition, especially when associated with teeth with obturated root canals (AU).

First Report of Genetic Variability of Erysipelothrix sp. Strain 2 in Turkeys Associated to Vero Cells Morphometric Alteration.

Erysipelas is a disease caused by the Erysipelothrix genus, whose main species is the E. rhusiopathiae, the causative agent of animal erysipelas and human erysipeloid. We isolated Erysipelothrix sp. strain 2 (ES2) from turkey's organs during an outbreak in Brazilian commercial and breeder flocks with sepsis and high mortality levels. We studied 18 flocks, accounting for 182 samples, being eight flocks (84 samples) as ES2 positive with individuals demonstrating clinical symptoms and high mortality. We obtained the genetic variability of 19 samples with PFGE and found two clones, both from the same flock but different samples, and two clusters. Interestingly, we found 15 strains with high genetic variability among and within flocks. We have found a positive association between the proximity of ES2 positive turkey flocks and commercial swine sites through epidemiological analysis. We infected Vero cells with two different isolates and three distinct concentrations of ES2. After performing the morphometry, we recorded enlargement of the nucleus and nucleolus. Moreover, we performed fluorescence assays that resulted in apoptotic and necrotic cells. We demonstrated that ES2 could multiply in the extracellular medium and invade and survive inside Vero cells. For the first time, our finds show that ES2 may have similar behavior as E. rhusiopathiae as a facultative intracellular microorganism, which may represent a hazard for humans.

Time of catheter removal in candidemia and mortality.

BACKGROUND: The impact of central venous catheter (CVC) removal on the outcome of patients with candidemia is controversial, with studies reporting discrepant results depending on the time of CVC removal (early or any time during the course of candidemia). OBJECTIVE: Evaluate the effect of time to CVC removal, early (within 48h from the diagnosis of candidemia) vs. removal at any time during the course of candidemia, on the 30-day mortality. METHODS: Retrospective cohort study of 285 patients with candidemia analyzing CVC removal within 48h (first analysis) or at any time (second analysis). RESULTS: A CVC was in place in 212 patients and was removed in 148 (69.8%), either early (88 patients, 41.5%) or late (60 patients, 28.3%). Overall, the median time to CVC removal was one day (range 1-28) but was six days (range 3-28) for those removed later. In the first analysis, APACHE II score (odds ratio [OR] 1.111, 95% confidence interval [95% CI] 1.066-1.158), removal at any time (OR 0.079, 95% CI 0.021-0.298) and Candida parapsilosis infection (OR 0.291, 95% CI 0.133-0.638) were predictors of 30-day mortality. Early removal was not significant. In the second analysis APACHE II score (OR 1.122, 95% CI 1.071-1.175) and C. parapsilosis infection (OR 0.247, 95% CI 0.103-0.590) retained significance. CONCLUSIONS: The impact of CVC removal is dependent on whether the optimal analysis strategy is deployed and should be taken into consideration in future analyses.

Time of catheter removal in candidemia and mortality

ABSTRACT Background: The impact of central venous catheter (CVC) removal on the outcome of patients with candidemia is controversial, with studies reporting discrepant results depending on the time of CVC removal (early or any time during the course of candidemia). Objective: Evaluate the effect of time to CVC removal, early (within 48 h from the diagnosis of candidemia) vs. removal at any time during the course of candidemia, on the 30-day mortality. Methods: Retrospective cohort study of 285 patients with candidemia analyzing CVC removal within 48 h (first analysis) or at any time (second analysis). Results: A CVC was in place in 212 patients and was removed in 148 (69.8%), either early (88 patients, 41.5%) or late (60 patients, 28.3%). Overall, the median time to CVC removal was one day (range 1-28) but was six days (range 3-28) for those removed later. In the first analysis, APACHE II score (odds ratio [OR] 1.111, 95% confidence interval [95% CI] 1.066-1.158), removal at any time (OR 0.079, 95% CI 0.021-0.298) and Candida parapsilosis infection (OR 0.291, 95% CI 0.133-0.638) were predictors of 30-day mortality. Early removal was not significant. In the second analysis APACHE II score (OR 1.122, 95% CI 1.071-1.175) and C. parapsilosis infection (OR 0.247, 95% CI 0.103-0.590) retained significance. Conclusions: The impact of CVC removal is dependent on whether the optimal analysis strategy is deployed and should be taken into consideration in future analyses.

Secular trends of candidemia at a Brazilian tertiary care teaching hospital.

BACKGROUND: Candidemia is the most frequent invasive fungal disease in hospitalized patients, and is associated with high mortality rates. The main objective of this study was to evaluate changes in the epidemiology of candidemia at a tertiary care hospital in a 21-year period. METHODS: We evaluated all episodes of candidemia diagnosed between 1996 and 2016 at a University-affiliated tertiary care hospital in Brazil. We arbitrarily divided the study period in 3: 1996-2002 (period 1), 2003-2009 (period 2) and 2010-2016 (period 3). Incidence rates were calculated using hospital admissions as denominator. RESULTS: We observed 331 episodes of candidemia. The incidence was 1.30 episodes per 1000 admissions, with no significant change over time. Candida albicans (37.5%), C. tropicalis (28.1%), C. parapsilosis (18.4%) and C. glabrata (6.9%) were the most frequent species. The proportion of patients receiving treatment increased (65.5%, 79.4% and 74.7% in periods 1, 2 and 3, respectively, p = 0.04), and the median time from candidemia to treatment initiation decreased from 4 days in period 1 (range 0-32 days) to 2 days in period 2 (range 0-33 days) and 2 days in period 3 (range 0-14 days, p < 0.001). We observed a significant decrease in the use of deoxycholate amphotericin B (47.4%, 14.8% and 11.9%), and an increase in the use of echinocandins (0%, 2.8% and 49.1%; p < 0.001). The APACHE II score increased over time (median 16, 17.5, and 22, p < 0.001). The overall 30-day mortality was 58.9%, and did not change significantly over the study period. CONCLUSIONS: There was an improvement in patient care, with an increase in the proportion of patients receiving treatment and a decrease in the time to treatment initiation, but no improvement in the outcome, possibly because the proportion of sicker patients increased over time.

Secular trends of candidemia at a Brazilian tertiary care teaching hospital

ABSTRACT Background Candidemia is the most frequent invasive fungal disease in hospitalized patients, and is associated with high mortality rates. The main objective of this study was to evaluate changes in the epidemiology of candidemia at a tertiary care hospital in a 21-year period. Methods We evaluated all episodes of candidemia diagnosed between 1996 and 2016 at a University-affiliated tertiary care hospital in Brazil. We arbitrarily divided the study period in 3: 1996-2002 (period 1), 2003-2009 (period 2) and 2010-2016 (period 3). Incidence rates were calculated using hospital admissions as denominator. Results We observed 331 episodes of candidemia. The incidence was 1.30 episodes per 1000 admissions, with no significant change over time. Candida albicans (37.5%), C. tropicalis (28.1%), C. parapsilosis (18.4%) and C. glabrata (6.9%) were the most frequent species. The proportion of patients receiving treatment increased (65.5%, 79.4% and 74.7% in periods 1, 2 and 3, respectively, p= 0.04), and the median time from candidemia to treatment initiation decreased from 4 days in period 1 (range 0-32 days) to 2 days in period 2 (range 0-33 days) and 2 days in period 3 (range 0-14 days, p< 0.001). We observed a significant decrease in the use of deoxycholate amphotericin B (47.4%, 14.8% and 11.9%), and an increase in the use of echinocandins (0%, 2.8% and 49.1%; p< 0.001). The APACHE II score increased over time (median 16, 17.5, and 22, p< 0.001). The overall 30-day mortality was 58.9%, and did not change significantly over the study period. Conclusions There was an improvement in patient care, with an increase in the proportion of patients receiving treatment and a decrease in the time to treatment initiation, but no improvement in the outcome, possibly because the proportion of sicker patients increased over time.

Quantification and distribution of circumvallate lingual papillae in saanen goats / Quantificação e distribuição das papilas circunvaladas de caprinos da raça saanen

The present study aimed to describe the disposition and amount of circumvallate lingual papillae in Saanen goats using 26 goat tongues from the Laboratory of Animal Anatomy and Morphology of the Federal Rural University of Rio de Janeiro, which were previously fixed in 10% formaldehyde solution for later dissection of tongues that were removed from the oral cavity for the necessary studies. After identification, morphometric data were tabulated and submitted to statistical analysis for further description. In descriptive statistics, the mean of 17.85 was close to the median of 17.5 and the overall dispersion (standard deviation) was relatively low (2.24), which represents a coefficient of variation (CV) of 12.8 %. Confidence interval for mean with 95 % with 99 % confidence was also performed. Regarding the distribution of papillae, 21 tongues (80.7 %) of the total samples were located on the side of the tongue root, 3 tongues (11.5%) were distributed on the side of the tongue root, migrating toward the tongue median sagittal plane, 1 tongue (3.8 %) was located in the concave position on the side of the tongue root and 1 tongue (3.8 %) was disposed on the sides of the tongue, with some papillae arranged close to the region of the tongue median sagittal plane.

O presente estudo objetivou descrever a disposição e quantidade das papilas circunvaladas das línguas de cabras da raça Saanen, utilizando línguas de 26 cabras da raça, provenientes do Laboratório de Anatomia e Morfologia Animal da Universidade Federal Rural do Rio de Janeiro, que foram fixadas previamente em solução de formaldeído a 10% para posterior dissecção das línguas que foram retiradas da cavidade oral para os estudos necessários. Após identificação, os dados morfométricos foram tabulados e submetidos à análise estatística para posterior descrição. Na estatística descritiva, a média de 17,85 ficou próxima da mediana de 17,5 e a dispersão geral (desvio padrão) foi relativamente baixo (2,24) que representa um coeficiente de variação (CV) de 12,8%. Também foi feito o Intervalo de Confiança para a média com 95% e com 99% de confiança. Em relação a distribuição, à forma de distribuição das papilas, 21 línguas (80,7%) do total de amostras apresentadas encontravam-se dispostas nas laterais da raiz da língua, 3 línguas (11,5%), apresentavam distribuição nas laterais da raiz da língua migrando em direção ao plano sagital mediano da língua, 1 língua (3,8%) apresentava-se disposta de forma côncava nas laterais da raiz da língua e 1 língua (3,8%) encontrava-se disposta nas laterais da língua, com algumas papilas dispostas próximo a região do plano sagital mediano da língua.

Caveolinas y modulación del sistema del óxido nítrico en el hipotiroidismo según avanza la edad / Age-related Influence of Hypothyroidism on Caveolins and Nitric Oxide Modulation

Introducción El hipotiroidismo y la edad impactan sobre la producción de óxido nítrico (NO) cardíaco y renal. Las caveolinas, moduladores negativos de la actividad enzimática de la NO sintetasa (NOS), se afectan con ambos factores. Objetivos Evaluar la implicación de las caveolinas (cav) en la modulación de la actividad de la NOS cardíaca y renal en animales hipotiroideos adultos. Material y métodos Se utilizaron ratas macho Sprague-Dawley eutiroideas e hipotiroideas [metimazol 0,02% (v/v) en el agua de bebida durante 28 días]. Los animales fueron sacrificados para extraer el corazón y los riñones. Resultados La actividad de la NOS en la aurícula derecha disminuyó con la edad y el hipotiroidismo. La expresión de cav-1 aumentó con la edad y el hipotiroidismo. La actividad de la NOS en el ventrículo izquierdo aumentó con el avance de la edad y el hipotiroidismo. La expresión de ambas caveolinas disminuyó en los grupos adulto e hipotiroideo. En la médula renal, el hipotiroidismo disminuyó la actividad de la NOS en jóvenes y la aumentó en adultos. La expresión de cav-1 disminuyó con la edad y en jóvenes hipotiroideos. Los niveles proteicos de cav-3 disminuyeron en animales adultos hipotiroideos. Conclusiones El hipotiroidismo impacta sobre la actividad de la NOS y de sus moduladores, las caveolinas, en el sistema cardiovascular y renal. El hipotiroidismo intensifica los efectos del avance de la edad en ambos sistemas.

Introduction Hypothyroidism and age impact on cardiac and renal nitric oxide (NO) production. Caveolins, which are negative modulators of NO synthase (NOS) activity, are affected by both factors. Objectives The aim of this study was to evaluate caveolin (CAV) participation in the modulation of renal and cardiac NOS activity in adult hypothyroid animals. Methods Euthyroid and hypothyroid [methimazole 0.02% (v/v) in the drinking water during 28 days] male Sprague-Dawley rats were used. Animals were sacrificed to remove the heart and kidneys. Results Right atrial NOS activity decreased with age and hypothyroi-dism. Caveolin-1 expression increased with age and hypothyroidism. Conversely, left ventricular NOS activity increased with aging and hypothyroidism and the expression of both CAV isoforms decreased in adult and hypothyroid groups. In the renal medulla, hypothyroidism reduced NOS activity in young and raised it in adult animals and CAV-1 expression decreased with age and in hypothyroid young animals. Caveolin-3 protein levels decreased in adult hypothyroid animals. Conclusions Hypothyroidism impacts on NOS activity and on that of its modulators, caveolins, in the cardiovascular and renal systems. Hypothyroidism enhances the effects of aging in both systems.

Acompanhamento presencial e à distância para o tratamento da enurese noturna com alarme / Face-to-face and long-distance protocols in treatment of enuresis by alarm

A enurese é definida como a micção normal que ocorre durante o sono. Para o seu diagnóstico, são necessárias a idade mínima de cinco anos e frequência de pelo menos um episódio por mês. As causas mais consensuais são a poliúria noturna, dificuldades em despertar e a hiperatividade detrusora. O objetivo deste trabalho foi comparar crianças e adolescentes enuréticos que se submeteram ao tratamento com alarme, divididas entre dois protocolos de tratamento: presencial e à distância. Participaram do trabalho 61 crianças e adolescentes com idades entre seis e 17 anos e suas famílias. Todos participaram de duas sessões presenciais nas quais foram fornecidas informações sobre a enurese e o tratamento baseado no programa de espectro total. Os participantes foram alocados randomicamente entre protocolos de acompanhamento presencial (n=27) e à distância (n=34). Verificou-se que as crianças e adolescentes acompanhados à distância apresentam resultado comparável ao relatado na literatura, sendo uma alternativa viável ao acompanhamento presencial.

Nocturnal enuresis is defined as natural urination during sleep occurring at least once a month among children aged five years or older. There is a relative consensus in literature regarding possible causes: nocturnal polyuria, difficulties in waking up and a hyperactive bladder. The objective of this work was two compare two treatment protocols which used an alarm to treat enuresis: face-to-face and long distance. Sixty one enuretic children aged between 6 and 17 and their parents or caregivers participated in the study. They all attended two initial face-to-face sessions in which they received information on the treatment based on the full-spectrum programme. Participants were randomly allocated to the face-to-face (n=27) and long-distance (n=34) protocols. The long-distance protocol recorded outcome rates comparable to those cited in literature and thus offered a feasible alternative to the face-to-face protocol.

Determinação de prognóstico: quando tratar e quando extrair / Determining the prognosis: When to treat and when to extract

Introdução: o advento dos implantes reativou a discussão de um dos grandes dilemas da clínica odontológica, que é a identificação, baseada no prognóstico, de quando um dente deve ser extraído ou quando outras opções terapêuticas podem ser consideradas. Características periodontais, endodônticas e restauradoras devem ser cautelosamente avaliadas para determinação do prognóstico e da previsibilidade terapêutica e consequente elaboração do plano de tratamento. Objetivo: diante da relevância do tema, o objetivo desse trabalho é, por meio de uma revisão de literatura, ajudar o cirurgião-dentista a avaliar situações clínicas em que seja necessária a tomada de decisão entre extrair ou manter um dente, estabelecendo para tal um correto prognóstico. Resultados: achados na literatura mostram que autores divergem entre abordagens mais conservadoras e a colocação de implantes. Fatores que podem distinguir esses casos são o conhecimento técnico-científico e a experiência do profissional, o comprometimento do paciente com sua higiene bucal, bem como suas condições sistêmicas, dentárias e financeira. Contudo, não existe na literatura um consenso a respeito da soberania de uma técnica sobre outra para o tratamento das diferentes situações clínicas. Conclusão: assim, o que irá nortear a escolha do clínico é uma análise crítica e científica da relação custo/benefício para estabelecimento de um plano de tratamento individualizado, multidisciplinar e com maior previsibilidade.

Introduction: The advent of implants revived the discussion of one of the great dilemmas of clinical dentistry,which is the identification, based on prognosis, of when a tooth must be extracted or when other treatment options can be considered. Periodontal, endodontic and restorative characteristics must be carefully evaluated to determine prognosis and treatment predictability and consequent development of the treatment plan. Objective: Due to the relevance of this topic, the objective of this work is, by means of a literature review, to assist the dentist in evaluating clinical situations requiring decision making between keeping or extracting a tooth, establishing a correct prognosis. Results: Findings in the literature show that authors disagree among more conservative approaches and implant placement. Factors that can distinguish those cases are the technical and scientific knowledge and professional experience, commitment to their patient’s oral hygiene, as well as its systemic, dental and financial conditions. However, there is a consensus in the literature regarding the sovereignty of one technique over another for the treatment of different clinical situations. Conclusion: What will guide the clinician’s choice is a critical and scientific analysis of the cost-benefit to establish an individualized, multidisciplinary and with greater predictability treatment plan.

Behavioral alarm treatment for nocturnal enuresis.

PURPOSES: To investigate the efficacy of alarm treatment in a sample of Brazilian children and adolescents with nocturnal enuresis and relate treatment success to age and type of clinical support. MATERIALS AND METHODS: During 32 weeks, 84 children and adolescents received alarm treatment together with weekly psychological support sessions for individual families or groups of 5 to 10 families. RESULTS: 71% of the participants achieved success, defined as 14 consecutive dry nights. The result was similar for children and adolescents and for individual or group support. The time until success was shorter for participants missing fewer support sessions. CONCLUSIONS: Alarm treatment was effective for the present sample, regardless of age or type of support. Missing a higher number of support sessions, which may reflect low motivation for treatment, increased the risk of failure.

Behavioral alarm treatment for nocturnal enuresis

PURPOSES: To investigate the efficacy of alarm treatment in a sample of Brazilian children and adolescents with nocturnal enuresis and relate treatment success to age and type of clinical support. MATERIALS AND METHODS: During 32 weeks, 84 children and adolescents received alarm treatment together with weekly psychological support sessions for individual families or groups of 5 to 10 families. RESULTS: 71 percent of the participants achieved success, defined as 14 consecutive dry nights. The result was similar for children and adolescents and for individual or group support. The time until success was shorter for participants missing fewer support sessions. CONCLUSIONS: Alarm treatment was effective for the present sample, regardless of age or type of support. Missing a higher number of support sessions, which may reflect low motivation for treatment, increased the risk of failure.

[Economic analysis of rituximab in combination with cyclophosphamide, vincristine and prednisolone in the treatment of patients with advanced follicular lymphoma in Portugal]. / Análise económica de rituximab em associação com ciclofosfamida, vincristina e prednisolona no tratamento de doentes com linfoma folicular avançado em Portugal.

OBJECTIVE: Evaluate costs and benefits of rituximab in combination with cyclophosphamide/vincristine/prednisolone chemotherapy regimen (R-CVP), in previously untreated patients with indolent non-Hodgkin lymphoma (NHL), compared to CVP alone from a Portuguese National Health System (NHS) perspective. METHODS: Cost-effectiveness (Life Years Gained--LYG) and cost-utility analysis (Quality Adjusted Life Years--QALYs) were performed for a time horizon of 10 years, according to a Markov economic model with three health states (progression free survival, progression and death) and monthly cycles for a population of previously untreated patients with indolent NHL. Data from a phase III clinical trial was used and expanded to include unpublished 53-month median follow-up data. Survival after first-line therapy was estimated from the Scotland and Newcastle Lymphoma Group registry data and utilities were derived from a study in the UK performed in patients with follicular lymphoma. Resource consumption was estimated by a Portuguese expert panel (Delbecq Panel). Costs were calculated from the Portuguese NHS perspective through official data with prices updated to 2008. Only direct medical costs were considered. Costs and clinical outcomes were discounted at 5% per annum. Deterministic and probabilistic sensitivity analysis were performed around assumptions on the time horizon, costs, utilities and excess mortality rate due to progression applied in the base-case analysis. RESULTS: The 10-year base-case analysis showed a lower total cost per patient with CVP alone (€ 85,838) in comparison with R-CVP (€ 87,774). Life expectancy and Quality adjusted life expectancy per patient were higher with R-CVP (6.361 and 4.166, respectively) than with CVP alone (5.557 and 3.438, respectively), representing increases of 0.804 in LYG and 0.728 (8.7 months) in QALYs gained. The incremental cost per LYG was € 2,407 and the incremental cost per QALY gained was € 2,661. The probabilistic sensitivity analysis confirmed the robustness of the base-case analysis results. CONCLUSIONS: This study demonstrates that the combination R-CVP in previously untreated indolent NHL patients improves life expectancy and is a cost-effective alternative to CVP in Portugal.

Grupo de espera recreativo como instrumento de avaliação diagnóstica / Recreational waiting group as an instrument of diagnostic evaluation

Estudos mostraram que as clínicas-escola de psicologia não atingiam seus objetivos de atendimento à comunidade. Foram propostas novas formas de atendimento, dentre elas o Grupo de Espera Recreativo - GER (grupo com crianças que, após triagem, brincam na clínica semanalmente, até serem atendidas pelos psicólogos). Objetiva-se diminuir a evasão e observar interações entre os participantes, auxiliando a avaliação-diagnóstica. Observaram-se as sessões do GER nas quais estavam presentes as crianças que foram encaminhadas para atendimento individual após o período de espera recreativa. Registrou-se a freqüência de comportamentos dentro de categorias negativas pré-determinadas das crianças referidas para atendimento individual e grupal. As crianças encaminhadas para atendimento individual apresentaram uma maior freqüência de comportamentos nas categorias. O GER mostrou-se útil como instrumento de avaliação-diagnóstica; possibilitando a observação comportamental antes do atendimento e a realização dos encaminhamentos adequados. Concluiu-se que o GER parece permitir alcançar um melhor atendimento à comunidade que procura os serviços da clínica-escola.

Studies have shown that the support offered by psychological clinical-school centers do not fulfill the requirements of the community. New proposals have been made, including the Recreational Waiting Group RWG (group of children that, after screening, played at the clinic weekly, up to treatment beginning). The objective was to reduce the treatment evasion and to observe interactions between the participants, assisting the process of diagnostic evaluation. The sessions where the children who had been referred to individual therapy were present were those observed. The frequency of pre-determined negative behaviors was registered either for children referred to individual as to group therapy. The children who had been referred to individual attendance showed higher frequency. The RWG worked as a diagnostic evaluation instrument; it made the observation of behaviors before treatment possible and the referee process more adjusted. Conclusion was that RWG seens to allow a better attendance to the community that uses the clinical-school services.