A hybrid methodology for breast screening and cancer diagnosis using thermography.

Breast cancer is the second most common cancer in the world. Early diagnosis and treatment increase the patient's chances of healing. The temperature of cancerous tissues is generally different from that of healthy neighboring tissues, making thermography an option to be considered in the fight against cancer because it does not use ionizing radiation, venous access, or any other invasive process, presenting no damage or risk to the patient. In this paper, we propose a hybrid computational method using the Dynamic Infrared Thermography (DIT) and Static Infrared Thermography (SIT) for abnormality screening and diagnosis of malignant tumor (cancer), applying supervised and unsupervised machine learning techniques. We use the area under receiver operating characteristic curve, sensitivity, specificity, and accuracy as performance measures to compare the hybrid methodology with previous work in the literature. The K-Star classifier achieved accuracy of 99% in the screening phase using DIT images. The Support Vector Machines (SVM) classifier applied on SIT images yielded accuracy of 95% in the diagnosis of cancer. The results confirm the potential of the proposed approaches for screening and diagnosis of breast cancer.

Lumbar extensor muscle profile of rural milk production workers.

BACKGROUND: Milk production is a work system that comprises several tasks from cattle handling, feeding and milking to product consumption. Isometric lumbar extension dynamometry is considered a satisfactory instrument for occupational evaluation and monitoring, especially for populations of workers whose activities demand high levels of strength. OBJECTIVE: To investigate isometric lumbar extension strength among rural milk production workers. METHODS: The sample comprised 47 rural milk production workers affiliated with the Technical Assistance and Rural Outreach Company/Southern Credit and Rural Assistance Company (Empresa de Assistência Técnica e Extensão Rural/Associação Sulina de Crédito e Assistência Rural - EMATER/ASCAR), Rio Grande do Sul, Brazil. The participants were analyzed based on a sociodemographic questionnaire and lumbar extensor muscle strength testing by means of an isometric dynamometry system. RESULTS: Participants were 20 men with average age 50.45±9.44 years old and 27 women with average age 46.15±7.56 years old. The isometric lumbar extension strength was 1,169±289.96 N for the men and 571.34±190.36 N for the women. CONCLUSION: The lumbar extensor muscle profile of rural milk production workers was characterized by higher values for the men, which might be attributed to the fact that men exhibit higher body mass levels, and consequently produce greater force.

INTRODUÇÃO: A atividade leiteira é um sistema de trabalho que envolve diversas tarefas, que vão desde o manejo com o gado, alimentação, ordenha, até o consumo do produto final. A dinamometria isométrica de extensão lombar tem sido descrita como um bom instrumento de avaliação e acompanhamento laboral, sobretudo de populações que exercem muita força para desempenhar suas atividades. OBJETIVO: Avaliar a força isométrica de extensão lombar de produtores rurais na atividade leiteira. MÉTODOS: A amostra contou com 47 trabalhadores rurais que exercem atividade leiteira cadastrados na Empresa de Assistência Técnica e Extensão Rural/Associação Sulina de Crédito e Assistência Rural do Rio Grande do Sul, que foram avaliados por meio de questionário sociodemográfico e testaram a força muscular de extensão lombar por meio de um sistema de dinamometria isométrica. RESULTADOS: Participaram do estudo 20 homens com idade média de 50,45±9,44 anos e 27 mulheres com idade média de 46,15±7,56 anos. Quanto à força isométrica de extensão lombar, o grupo masculino alcançou 1169±289,96 N e o grupo feminino 571,34±190,36 N. CONCLUSÃO: Podemos concluir que o perfil da musculatura extensora lombar de trabalhadores rurais na atividade leiteira alcança valores superiores em indivíduos do gênero masculino, o que pode ser atribuído ao fato de homens apresentarem maiores níveis de massa corporal e consequentemente gerarem maior força.

Guidelines for the Management of Extremely Premature Deliveries: A Systematic Review.

BACKGROUND AND OBJECTIVES: Available data on survival rates and outcomes of extremely low gestational age (GA) infants (22-25 weeks' gestation) display wide variation by country. Whether similar variation is found in statements by national professional bodies is unknown. The objectives were to perform a systematic review of management from scientific and professional organizations for delivery room care of extremely low GA infants. METHODS: We searched Embase, PubMed, and Google Scholar for management guidelines on perinatal care. Countries were included if rated by the United Nations Development Programme's Human Development Index as "very highly developed." The primary outcome was rating of recommendations from "comfort care" to "active care." Secondary outcomes were specifying country-specific survival and considering potential for 3 biases: limitations of GA assessment; bias from different definitions of stillbirths and live births; and bias from the use of different denominators to calculate survival. RESULTS: Of 47 highly developed countries, 34 guidelines from 23 countries and 4 international groups were identified. Of these, 3 did not state management recommendations. Of the remaining 31 guidelines, 21 (68%) supported comfort care at 22 weeks' gestation, and 20 (65%) supported active care at 25 weeks' gestation. Between 23 and 24 weeks' gestation, much greater variation was seen. Seventeen guidelines cited national survival rates. Few guidelines discussed potential biases: limitations in GA (n = 17); definition bias (n = 3); and denominator bias (n = 7). CONCLUSIONS: Although there is a wide variation in recommendations (especially between 23 and 24 weeks' GA), there is general agreement for comfort care at 22 weeks' GA and active care at 25 weeks' GA.

Neonatal palliative care: developing consensus among neonatologists using the Delphi technique in Portugal.

Pediatric palliative care in Portugal is improving, but there is still additional work to do concerning programs or guidelines for this subject. In Portugal, physicians are the stakeholders in the decision-making process with reference to the transition to palliative care in the neonatal intensive care unit, and it was considered very important to raise their awareness and motivation about neonatal palliative care. Our research was based on Catlin and Carter's protocol from 2002 and the main goal was to assess neonatologists' willingness to build a palliative care and end-of-life protocol that could be acceptable nationwide. The survey used the Delphi technique and was developed in 3 rounds. The expert panel was composed of 57 participants who represented 41% of the Portuguese neonatologists. The study was conducted via the Internet, based in a researcher-created private Web site, and e-mail was used for data collection and feedback. Neonatologists agreed on 7 areas: (1) planning (medical education, resources, and local), (2) prenatal palliative care, (3) neonatal palliative care criteria, (4) the parents (presenting neonatal palliative care to parents, including then in the daily care of newborns and in family-centered care), (5) physicians' needs, (6) pain and symptom management, and (7) end-of-life care (withholding/withdrawing ventilation and hydration/nutrition).

[Pain scales used in the newborn infant: a systematic review]. / Escalas de avaliação da dor utilizadas no recém-nascido: revisão sistemática.

For many years, appropriate relevance has not been given for pain in newborn infants, but research brought to light this important subject in neonatal medicine. Pain scores have been organized in scales and validated to be used in clinical practice. Currently, there are several scales based on different pain indicators. These scales should be used according to different circumstances. With the purpose of helping health professionals, a systematic review of neonatal pain scales based on gestational age, duration of painful episode and type of pain indicator was carried out. Data concerning validation of the scales were also analyzed and two scales for use in clinical practice or in research are suggested.

[Pregnancy and smoking: an opportunity to change behaviours]. / Gravidez e tabagismo: uma oportunidade para mudar comportamentos.

INTRODUCTION: Maternal smoking during pregnancy is related not only to perinatal adverse events but also to important postnatal problems. Smoking is very prevalent in women with several socio-demographic factors playing an important role. AIMS: To assess the frequency of smoking as well as mothers' change in behaviours during pregnancy. To identify socio-demographic factors associated to smoking and to assess women's knowledge and sources of information about adverse effects of smoking during pregnancy. METHODS: We started a cohort study between March and October 2003 at the Maternity, Hospital Santa Maria. After an informed consent the mothers in the post natal ward were asked to fill in a questionnaire. RESULTS: Four hundred and seventy five mothers responded to the questionnaire and among them 30% were smokers before pregnancy. Thirty five percent stopped smoking during pregnancy and those who continued significantly reduced the number of cigarettes per day. Smoking was less prevalent in married women, with higher educational level and with stable employment (statistically significant correlations). Forty five percent of the mothers were misinformed or had no information about the adverse effects of smoking during pregnancy. Their main source of information were the media. DISCUSSION: Smoking prevalence was high (30%) among the respondents but the pregnancy lowered the numbers of cigarettes per day. The percentage of misinformed mothers concerned about the adverse effects of smoking during pregnancy was high (45%), which also showed that doctors' role as a source of information was surpassed by the media. The study also brought to light the need for the health professionals to improve their competences in their role on prevention of smoking during pregnancy and the postnatal period.