Cost-utility analysis of diagnostic methods for arterial hypertension in primary care for Brazil: ABPM vs. OBPM vs. HBPM.

INTRODUCTION: Arterial hypertension (AH) is diagnosed using three methods: office blood pressure measurement (OBPM), home blood pressure monitoring (HBPM), and ambulatory blood pressure monitoring (ABPM). No economic studies have evaluated the impact of incorporating these strategies for AH diagnosis into the Brazilian public health system. METHODS: A Markov model was created to evaluate the costs associated with AH diagnosis using the ABPM, HBPM, and OBPM. Patients were entered into the model with SBP ≥ 130 mmHg or DBP ≥ 85 mmHg obtained using OBPM. The model was based on cost, quality adjusted life-years (QALYs), and incremental costs per QALY. In the economic analysis, the costs were calculated from the perspective of the payer of the Brazilian public health system. RESULTS: In the cost-utility analysis of the three methods, ABPM was the most cost-effective strategy compared to HBPM and OBPM in all groups over 35 years of age. Compared with OBPM, ABPM was a cost-effective strategy, as it presented higher costs in all scenarios, but with better QALYs. Compared to HBPM, ABPM was the dominant strategy for all age groups, presenting lower costs and higher QALYs. When comparing HBPM with OBPM, the results were similar to those described for ABPM (i.e. it was a cost-effective strategy). CONCLUSION: With a willingness-to-pay threshold of R$35 000 per QALY gained, both ABPM and HBPM are cost-effective methods compared with OBPM in all scenarios. In Brazilian healthcare facilities that currently diagnose AH using OBPM, both ABPM and HBPM may be more cost-effective choices.

La simulación como herramienta de enseñanza y aprendizaje quirúrgico / Surgical simulation as a teaching and learning tool

La simulación es la técnica de replicar un proceso o situación. El objetivo de la simulación quirúrgica es transferir de manera efectiva las habilidades adquiridas en el laboratorio al quirófano, reduciendo las curvas de aprendizaje y los costos operativos. Objetivos : Describir la utilización, ventajas, desventajas, y estado actual de la práctica basada en simulación como método de enseñanza y aprendizaje para la capacitación de residentes y cirujanos en los programas de formación quirúrgica, según lo reportado en la literatura científica actual. Métodos : Se realizó una búsqueda en la literatura utilizando palabras claves. Se sintetizaron los hallazgos de cada estudio en una revisión narrativa. Resultados : La simulación quirúrgica es una herramienta educativa que confiere ventajas únicas. Permite el desarrollo de programas de formación flexibles e individualizados, enfatiza el aprendizaje basado en problemas, basado en competencias y basado en destrezas, y acelera el proceso de aprendizaje al ofrecer entornos seguros para practicar procedimientos quirúrgicos complejos. Además, respalda la retroalimentación y el análisis posterior, fomenta la formación multidisciplinaria y facilita la investigación y la innovación, mejorando en última instancia la calidad de la atención médica. Conclusiones : Las ventajas prácticas de los programas de formación estructurados han convertido a la educación basada en la simulación en un método de enseñanza factible, confiable y altamente atractivo. La simulación no solo contribuye al desarrollo profesional de los residentes, sino que también mejora la seguridad del paciente y la calidad general de los servicios de salud(AU)

Simulation is the act of replicating a process or situation. The objective of surgical simulation is to effectively transfer the skills acquired in the laboratory to the operating room, reducing the learning curves and operational costs. Objectives: To describe the use, advantages, disadvantages, and current state of simulation-based practice as a method of teaching and learning for the training of residents and surgeons in surgical training programs, as reported in the current scientific literature. Methods: A literature search was conducted using keywords. The findings of each study were synthesized in a narrative review. Results: Surgical simulation is an educational tool that offers unique advantages. It allows for the development of flexible and individualized training programs, emphasizes problem-based, competency-based, and skill-based learning, and accelerates the learning process by providing safe environments to practice complex surgical procedures. Furthermore, it supports feedback and post-analysis, encourages multidisciplinary training, and facilitates research and innovation, ultimately enhancing the quality of healthcare. Conclusions: The practical benefits of structured training programs have made simulation-based education a feasible, reliable, and highly attractive teaching method. Simulation not only contributes to the professional development of residents but also improves patient safety and the overall quality of healthcare services(AU)

Situación actual de la enseñanza quirúrgica por simulación en Venezuela / Current status of surgical training with simulation in Venezuela

La simulación constituye un instrumento beneficioso para la adquisición de destrezas quirúrgicas. Su disponibilidad en países en vías de desarrollo representa un obstáculo importante en la educación quirúrgica contemporánea.Objetivo : Identificar centros de capacitación quirúrgica en Venezuela que utilicen la simulación para el entrenamiento de habilidades técnicas y conocer la opinión de los miembros de la Sociedad Venezolana de Cirugía (SVC) acerca de su uso para desarrollar habilidades en cirugía abierta.Métodos : Estudio transversal y descriptivo. Se enviaron encuestas por correo electrónico a todos los miembros activos de la SVC. Se utilizó estadística descriptiva para el análisis y presentación de los datos.Resultados : De 1115 encuestas enviadas, 111 fueron completadas; 67,6 % de los participantes no tienen conocimientos sobre la existencia de centros de entrenamiento basados en simulación quirúrgica; el 99,1 % están de acuerdo con implementar la simulación como método de capacitación complementario y consideran importante el entrenamiento de habilidades en cirugía abierta; 94,6 % manifestó que el entrenamiento debe estructurarse y ejecutarse en módulos que inicien con tareas básicas para luego avanzar hacia procedimientos más complejos; 75 % de los procedimientos avanzados que deben practicarse con mayor frecuencia corresponden al sistema gastrointestinal, destacando las anastomosis intestinales (74,7 %).Conclusión : la gran mayoría de los cirujanos en las Instituciones de salud de Venezuela no tienen acceso a la simulación como herramienta educativa, a pesar de estar de acuerdo con que su implementación es altamente potenciadora para el desarrollo de habilidades técnicas(AU)

Simulation represents a beneficial tool for acquiring surgical skills. Its availability in developing countries poses a significant obstacle in contemporary surgical education.Objective : To identify surgical training centers in Venezuela that use simulation for technical skills training, and to understand the opinion of members of the Venezuelan Society of Surgery (SVC) regarding its use for developing open surgical skills.Methods : A cross-sectional, descriptive study. Surveys were sent via email to all active SVC members. Descriptive statistics were used for data analysis and presentation.Results : Of the 1,115 surveys sent, 111 were completed. 67.6% of the participants were unaware of the existence of simulation-based surgical training centers. 99.1% agreed with implementing simulation as a complementary training method and considered training in open surgery skills important. 94.6% stated that training should be structured and conducted in modules starting with basic tasks and progressing to more complex procedures; 75% of the advanced procedures that should be practiced more frequently were related to the gastrointestinal system, with intestinal anastomoses (74.7%) being particularly highlighted.Conclusion : The majority of surgeons in Venezuelan healthcare institutions do not have access to simulation as an educational tool, despite agreeing that its implementation is highly beneficial for the development of technical skills(AU)

Variabilidade do estado de humor durante uma competição: estudo com atletas juvenis de basquetebol / Variability of mood state during competition: study with youth basketball athletes / Variabilidad del estado de ánimo durante una competición: estudio con jóvenes deportistas de baloncesto

Objetivou-se avaliar a variabilidade do estado de humor de atletas juvenis de basquetebol durante uma competição estadual. Participaram 27 atletas de basquetebol, do mesmo clube, do sexo masculino, com idade entre 13 e 15 anos. Todos responderam a Escala de Humor de Brunel em seis jogos durante o campeonato. Os resultados demonstraram que os atletas investigados apresentaram, durante toda a competição, elevados escores de vigor e baixos escores de confusão mental e tensão. Quanto à variabilidade, os atletas não apresentaram variabilidade durante a competição, ou seja, mantiveram-se com níveis elevados de humor positivo. Pode-se concluir que essa amostra apresentou o perfil de humor denominado de iceberg, durante toda a competição (AU).

The objective was to evaluate the variability of the mood state of youth basketball athletes during a state competition. 27 male basketball players from the same club, aged between 13 and 15 years, participated. All responded to Brunel's Humor Scale in six games during the championship. The results showed that the athletes investigated had, throughout the competition, high scores of vigor, and lowered the scores of mental confusion and tension. As variability, the athletes did not show variability during the competition, that is, they maintained high levels of positive mood. It can be concluded that this sample presented the mood profile called iceberg, throughout the competition (AU).

El objetivo fue evaluar la variabilidad del estado de ánimo de los jóvenes deportistas de baloncesto durante una competición estatal. Participaron 27 jugadores de baloncesto masculinos del mismo club, con edades comprendidas entre 13 y 15 años. Todos respondieron a la escala de humor de Brunel en seis juegos durante el campeonato. Los resultados mostraron que los atletas investigados tenían, a lo largo de la competencia, puntuaciones altas de vigor y redujeron las puntuaciones de confusión y tensión mental. Como variabilidad, los atletas no mostraron variabilidad durante la competencia, es decir, mantuvieron altos niveles de ánimo positivo. Se puede concluir que esta muestra presentó el perfil de estado de ánimo denominado iceberg, durante toda la competencia (AU).

Variabilidade dos níveis de ansiedade pré-competitiva ao longo de uma competição: estudo de caso com o basquetebol / Variability of pvariability of pre-competitive anxiety levels during a competition: a case study with basketball

O presente manuscrito teve o objetivo de avaliar a variabilidade dos níveis de ansiedade pré-competitiva de atletas de Basquetebol ao longo de uma competição, utilizando-se de um estudo de caso. Para isso, acompanhou-se uma pequena amostra de um clube, que foi escolhida por conveniência. O estudo foi composto por 27 atletas de Basquetebol das categorias de base do clube, com idade entre 13 e 15 anos (M = 14,00, DP ± 0,733) e todos do sexo masculino, pertencentes a duas categorias da base: sub-15 e sub-14, que eram treinados pela mesma comissão técnica. Os atletas participaram do estudo de forma voluntária. Os participantes preencheram o termo de assentimento, pois todos eram menores de idade, e seus responsáveis preencheram o termo de consentimento livre e esclarecido. Após essa etapa, todos os atletas responderam ao CSAI-2r, o qual foi respondido em seis jogos ao longo do campeonato, sendo o primeiro jogo a estreia das equipes e o sexto jogo a final da competição. No presente estudo, como não houve normalidade dos dados, utilizou -se de testes não paramétricos para análises dos resultados. Os resultados demonstraram que não houve diferenças entre as equipes, para nenhuma variável e jogo avaliado (p>0,05). Os atletas investigados apresentaram, durante toda a competição, elevados níveis de autoconfiança e baixos níveis de ansiedade (somática e cognitiva) (p<0,05 em todos os jogos). Além disso, no decorrer da competição os atletas conseguiram, diminuir os níveis de ansiedade somática (p<0,05). Por fim, pode-se concluir que os atletas investigados não apresentaram elevados níveis de ansiedade, pois a autoconfiança foi significativamente (p<0,05) superior, e apresentaram variabilidade apenas para ansiedade somática (p<0,05) ao long. (AU)

The present manuscript aimed to assess the variability of the pre-competitive anxiety levels of Basketball athletes throughout a competition, using a case study. For this, a small sample of a club was followed, which was chosen for convenience. The study consisted of 27 basketball athletes from the club's grassroots categories, aged between 13 and 15 years (M = 14,00, DP ± 0,733) old and all male, belonging to two categories of the base: sub-15 and sub-14, who were trained by the same technical committee. The athletes participated in the study voluntarily. The participants filled out the consent form, since all were minors, and their guardians filled out the free and informed consent form. After this stage, all athletes responded to CSAI-2r, which was answered in six games throughout the championship, the first game being the teams' debut and the sixth game the final of the competition. In the present study, as there was no normality of the data , non-parametric tests were used to analyze the results. The results showed that there were no differences between the teams, for any variable the game evaluated (p>0,05). The investigated athletes presented, throughout the competition, high levels of self-confidence and low levels of anxiety (somatic and cognitive) (p<0,05 in all games). In addition, during the competition, the athletes were able to reduce the levels of somatic anxiety (p <0,05). Finally, it can be concluded that the investigated athletes did not show high levels of anxiety, as their self-confidence was significantly (p <0.05) higher, and showed variability only for somatic anxiety (p <0.05) throughout the competition (decreased scores), given that cognitive anxiety and self-confidence did not show variability throughout the competition (p> 0.05). (AU)

Variabilidade do estado de humor durante uma competição: estudo com atletas juvenis de basquetebol / variability of mood state during competition: study with youth basketball athletes / Variabilidad del estado de ánimo durante una competición: estudio con jóvenes deportistas de baloncesto

Objetivou-se avaliar a variabilidade do estado de humor de atletas juvenis de basquetebol durante uma competição estadual. Participaram 27 atletas de basquetebol, do mesmo clube, do sexo mas-culino, com idade entre 13 e 15 anos. Todos responderam a Escala de Humor de Brunel em seis jogos durante o campeonato. Os resultados demonstraram que os atletas investigados apresentaram, durante toda a competição, elevados escores de vigor e baixos escores de confusão mental e tensão. Quanto à variabilidade, os atletas não apresentaram va-riabilidade durante a competição, ou seja, mantiveram-se com níveis ele-vados de humor positivo. Pode-se concluir que essa amostra apresentou o perfil de humor denominado de iceberg, durante toda a competição.

The objective was to evaluate the variability of the mood state of youth basketball athletes during a state competition. 27 male basketball players from the same club, aged between 13 and 15 years, participated. All responded to Brunel's Humor Scale in six games during the championship. The results showed that the athletes investigated had, throughout the competition, high scores of vigor, and lowered the scores of mental confusion and tension. As variability, the athletes did not show variability during the competition, that is, they maintained high levels of positive mood. It can be concluded that this sample presented the mood profile called iceberg, throughout the competition.

El objetivo fue evaluar la variabilidad del estado de ánimo de los jóvenes deportistas de baloncesto durante una competición estatal. Participaron 27 jugadores de baloncesto masculinos del mismo club, con edades comprendidas entre 13 y 15 años. Todos respondieron a la escala de humor de Brunel en seis juegos durante el campeonato. Los resultados mostraron que los atletas investigados tenían, a lo largo de la competencia, puntuaciones altas de vigor y redujeron las puntuaciones de confusión y tensión mental. Como variabilidad, los atletas no mostraron variabilidad durante la competencia, es decir, mantuvieron altos niveles de ánimo positivo. Se puede concluir que esta muestra presentó el perfil de estado de ánimo denominado iceberg, durante toda la competencia.

Conhecimento sobre terapias para úlcera de pressão: uma revisão integrativa / Knowledge on therapies for pressure ulcer: an integrative review

RESUMO Objetivo analisar as evidências acerca das terapias para tratamento das lesões por pressão. Métodos revisão integrativa com artigos publicados entre 2014 e 2019 nas bases de dados SciELO, MEDLINE, LILACS, BDENF, IBECS e CINAHL. Os descritores utilizados foram: lesões por pressão, terapêutica e cuidados de enfermagem. Resultados encontrados 12 artigos que atenderam ao objetivo do estudo. Os dados dos estudos elegíveis foram extraídos por meio do instrumento de coleta de dados. Após essa etapa, os mesmos foram categorizados e sintetizados, de forma descritiva, e elencados em quatro categorias: conhecimento dos profissionais sobre as terapias; adequado gerenciamento de terapias; terapias com agentes biofísicos; terapias não convencionais. Conclusão os artigos analisados refletem sobre a utilização de algumas terapêuticas e estratégias para tratar as lesões por pressão. As diversas terapias abordadas nas pesquisas sobre o tratamento dessas lesões se mostraram efetivas, no entanto, são insuficientes para garantir a sua ampla e segura utilização.

ABSTRACT Objective to analyze the evidences on therapies for the treatment of pressure ulcers. Methods integrative review with articles published between 2014 and 2019 in SciELO, MEDLINE, LILACS, BDENF, IBECS and CINAHL databases. The descriptors used were: pressure ulcer, therapeutics and nursing care. Results twelve articles were found that met the study´s objectives. Data from the eligible studies were extracted using the data collection instrument. After this step, they were categorized and synthesized, in a descriptive way, and listed in four categories: professionals' knowledge about therapies; adequate management of therapies; therapies with biophysical agents; and non-conventional therapies. Conclusion the analyzed articles reflect on the use of some therapies and strategies to treat pressure ulcers. The various therapies addressed in the research on the treatment of these ulcers proved to be effective, however, they are insufficient to ensure their wide and safe use.

Coesão de grupo no basquetebol: olhares nas categorias de base / Group cohesion in basketball: a look at the base categories

O presente estudo teve como objetivo investigar o nível de coesão de grupo em atletas de Basquetebol de categorias de base, comparando os níveis de coesão de grupo no início (abril de 2018) e no final (novembro de 2018) da temporada. Participaram do estudo 26 atletas com idade entre 13 e 15 anos. O instrumento utilizado foi o Questionário de Ambiente de Grupo ­ QEG. Os resultados demonstraram que os atletas de Basquetebol investigados apresentaram elevados escores nas dimensões relacionadas à tarefa, com maiores escores para dimensão AI-T (Atração Individual para o Grupo-Tarefa), independentemente de a análise ser no início ou no final da temporada. Assim, pode-se considerar que os atletas investigados neste estudo apresentaram coesão em prol da tarefa, o que é considerado adequado para o desempenho esportivo.

This study aimed at investigating the level of group cohesion in basketball athletes in base categories, comparing group cohesion levels at the beginning (April 2018) and at the end (November 2018) of the season. A total of 26 athletes aged 13 to 15 years old participated in the study. The instrument used was the Group Environment Questionnaire - QEG. The results showed that the investigated basketball athletes presented high scores on the task-related dimensions, with higher scores for the IA-T dimension (Individual Attraction for the Task Group) regardless of whether the analysis was at the beginning or at the end of the season. Thus, it can be considered that the athletes investigated in this study presented cohesion in favor of the task, which is considered adequate for the sport performance.

Estado de humor de atletas da base de uma equipe de basquetebol / Mood State of athletes from the base of a basketball team / Estado del ánimo de deportistas desde la base de un equipo de baloncesto

O presente estudo investigou o estado de humor de atletas de Basquetebol das categorias de base de um Clube, comparando o estado de humor no início e no final da temporada de 2018. Participaram 26 atletas, voluntários, do sexo masculino, federados, com idades entre 13 e 15 anos. Os atletas responderam a Escala de Humor de Brunel - BRUMS. Os resultados demonstraram que os atletas apresentaram um estado de humor positivo, pois tanto no início quanto no final da temporada a subescala Vigor obteve os maiores escores. Em relação as comparações entre o início e o final da temporada, os atletas aumentaram os escores das subescalas Vigor e Tensão, além de diminuírem os escores da subescala Fadiga. Pode-se concluir que durante a temporada de 2018 os atletas foram capazes de manter o estado de humor positivo, com valores de Vigor superiores aos demais fatores, o que é caracterizado como ideal para o rendimento esportivo.

The present study investigated the mood states of Basketball athletes from the base categories of a Club, comparing mood states at the beginning and end of the 2018 season. Twenty-six athletes, male volunteers, with ages between 13 and 15 years. The athletes responded to Brunel's Humor Scale - BRUMS. The results showed that the athletes presented a positive state of mood, both at the beginning and at the end of the 2018 season, because the Vigor factor presented the highest scores at the two moments of collect. In addition, the Vigor factor increased its score throughout the season, and the Fatigue factor decreased. It can be concluded that during the 2018 season athletes were able to maintain a positive mood, with Vigor values higher than the other factors, which is characterized as ideal for sports performance.

El presente estudio investigó los estados de humor de jugadores de baloncesto de las categorías básicas de un club, comparando los estados de humor al principio y al final de la temporada 2018. Veintiséis hombres, federados, hombres, Entre 13 y 15 años. Los jugadores respondieron a la Escala de Humor de Brunel - BRUMS. Los resultados mostraron que los jugadores presentaron un estado de humor positivo, tanto al principio como al final de la temporada 2018, porque el factor Vigor presentó las puntuaciones más altas en los dos momentos de la recolección. Además, el factor Vigor aumentó su puntaje durante la temporada, y el factor Fadiga disminuyó. Se puede concluir que durante la temporada 2018, los jugadores pudieron mantener un estado de humor positivo, con valores de Vigor superiores a los otros factores, lo que se caracteriza por ser ideal para el rendimiento deportivo.

Estado de Humor em atletas de categoria de base da modalidade Basquetebol / Mood State of base Basketball category athletes / Estado de Humor de atletas de categoría de base de la modalidad Baloncesto

O estudo teve o objetivo de investigar o estado de humor de atletas de Basquetebol de um clube da cidade de São Paulo no início e no final da temporada de 2018. Assim, foi utilizada a Escala de Humor de Brunel (BRUMS), aplicada numa amostra composta por 26 atletas (Sub- 13 e Sub-15), voluntários, do sexo masculino, federados, com idades entre 13 e 15 anos. Os resultados demonstraram que os dois grupos apresentaram estado de humor similar no início e final da temporada, com o fator Vigor sendo superior aos demais. Além disso, o Sub-13 au- mentou os escores dos fatores Vigor e Tensão entre o início e o final da temporada, e o Sub-15 diminuiu os escores do fator Fadiga no decorrer da temporada. Pode-se concluir que os atletas apresentaram o perfil de humor denominado de iceberg .

The purpose of this study was to investigate the mood of basketball athletes of a club in the city of Sao Paulo at the beginning and end of the 2018 season. Thus, the Brunel Humor Scale (BRUMS), applied in a sample composed of 26 male and female volunteers (Sub- 13 and Sub-15), aged 13 to 15 years, was used. The results showed that the two groups had similar mood at the beginning and end of the season, with the Vigor factor being higher than the others. In addition, Sub-13 increased Vigor and Tension factor scores between the beginning and the end of the season and Sub-15 decreased Fatigue factor scores throughout the season. It can be concluded that the athletes presented the humor profile called iceberg.

El estudio tuvo el objetivo de investigar el estado de humor de atletas de baloncesto de un club de São Paulo al inicio y al final de la temporada de 2018. Así, se utilizó la Escala de Humor de Brunel (BRUMS), aplicada en una muestra compuesta por una muestra compuesta 26 atletas (Sub-13 y Sub-15), voluntarios, del sexo masculino, federados, con edades entre 13 y 15 años. Los resultados demostraron que los dos grupos de investigación presentaron estado de humor similar al inicio y final de la temporada, con el factor Vigor siendo superior a los demás. Además, el Sub-13 aumentó los escores de los factores Vigor y Tensión entre el inicio y el final de la temporada y el Sub-15 disminuyó los escores del factor Fatiga en el transcurso de la temporada. Se puede concluir que los atletas presentaron el perfil de humor denominado de iceberg.

MR Imaging Findings in Molecular Subtypes of Breast Cancer According to BIRADS System.

To evaluate magnetic resonance imaging (MRI) findings, according to Breast Imaging-Reporting and Data System (BI-RADS), and to relate them with molecular subtypes of breast cancer. The MRI findings were reviewed retrospectively in 201 women diagnosed of invasive breast cancer confirmed by surgery and were compared with the molecular subtypes. Following the BI-RADS, MRI findings included disease type, size, enhancement, morphology and contrast kinetics. In mass-like lesion types were studied shape, margin and enhancement, and in nonmass-like lesion types, distribution modifiers and internal enhancement. Chi-squared analysis showed significant association (p < 0.01) between molecular subtypes and lesion type on MRI and histologic grade. Shape, margin and mass enhancement (p < 0.05) also showed significant association among molecular subtypes. Triple negative were more frequently unifocal and mass-like lesion, high histologic grade, round shape, smooth margin, and rim enhancement. Luminal-A were more frequently low grade, mass-like lesion, irregular shape and spiculated or irregular margin. Luminal-B were more frequently moderate-low grade, mass-like lesion, nonirregular shape and spiculated margin. HER-2-enriched were more frequently moderate grade, nonmass-like lesion and multicentric lesions were more present than in other subtypes. There are significantly different MRI features, according to BI-RADS, between the molecular subtypes breast cancer.

[Prevalence of Dental Caries in Type 1 Diabetic Patients Treated with Insulin Pump]. / Prevalência da Cárie Dentária de Doentes Diabéticos Tipo 1 Tratados com Bomba Infusora de Insulina.

INTRODUCTION: Type 1 diabetes mellitus and oral health are strictly related on a reciprocal basis, and an increased susceptibility to a wide variety of oral diseases is recognised in these patients. The aim of the present study was to establish a relationship between the prevalence of dental caries in Type 1 diabetic patients treated with insulin pump and that of non-diabetic patients. MATERIAL AND METHODS: An observational clinical study of analytical and cross-sectional nature was conducted. The sample consisted of 30 adults with diabetes mellitus treated with insulin pump (selected from the Coimbra Hospital and Universitary Centre) and 30 nondiabetic adults (selected from the ones accompanying the diabetic patients). One dentist evaluated all of the patients between January and May of 2015 in the Faculty of Medicine of the University of Coimbra. During the clinical evaluation a case report form adapted to the objectives of the investigation was completed. Data analysis was performed and the significance level was set at 5%. RESULTS: Diabetic patients showed similar levels on the caries and plaque index to non-diabetic patients. There were no statistically significant differences between the two groups as regards oral hygiene habits and frequency of visits to the dentist. Discussão: Although diabetics' diet is less abundant in carbohydrates, which provides a smaller exposure to cariogenic food, the regularity of meals can increase the risk of caries since the critical pH for demineralization is reached frequently throughout the day. However, the existence of a chronic condition may determine a high concern for general preventive care, resulting in an overall improvement of their oral health, which could justify the results. CONCLUSION: Type 1 diabetic patients treated with insulin pump don't have a higher prevalence of dental caries.

Introdução: A diabetes mellitus tipo 1 e a saúde oral relacionam-se de forma estrita e recíproca, reconhecendo-se nos pacientes diabéticos uma maior suscetibilidade a uma grande variedade de patologias orais. O objetivo do presente estudo consistiu em investigar a relação entre a prevalência da cárie dentária em indivíduos diabéticos tipo 1 tratados com bomba infusora de insulina e a de indivíduos não diabéticos.Material e Métodos: Realizou-se um estudo clínico observacional, analítico e transversal. Incluíram-se no grupo de estudo 30 indivíduos adultos com diabetes mellitus tipo 1 tratados com bomba infusora de insulina (selecionados do Centro Hospitalar da Universidade de Coimbra) e no grupo de controlo 30 doentes não diabéticos (selecionados por entre os acompanhantes dos primeiros). Os elementos de ambos os grupos foram observados entre janeiro e maio de 2015, na Faculdade de Medicina da Universidade de Coimbra, por um médico dentista. A avaliação clínica foi acompanhada do preenchimento de um formulário clínico adaptado aos objetivosda investigação. Para análise estatística assumiu-se um nível de significância de 5%.Resultados: O grupo de estudo apresentou valores semelhantes de índice de cárie dentária e de placa bacteriana aos registados no grupo de controlo. Não se registaram diferenças estatisticamente significativas entre os dois grupos no que diz respeito a hábitos de higiene oral e à frequência de visitas ao médico dentista.Discussão: Embora a dieta dos doentes diabéticos seja menos abundante em hidratos de carbono, prevendo uma menor exposição a alimentos cariogénicos, o elevado número de refeições ingeridas de forma fracionada pode aumentar o risco de cárie, uma vez que o valor de pH crítico para desmineralização é atingido mais vezes ao longo do dia. No entanto, a existência de uma patologia crónica pode determinar um elevado nível de cuidados preventivos gerais, inclusivamente resultando numa melhoria global do seu nível de saúde oral, o que poderá justificar os resultados obtidos.Conclusão: A presença de diabetes mellitus tipo 1 em doentes tratados com bomba de insulina não está associada a um aumento da prevalência de lesões de cárie dentária.

Institucionalização da Vigilância em Saúde de Campinas (SP) na perspectiva da Análise Institucional sócio-histórica / Institutionalization of Health Surveillance in Campinas (SP) through the perspective of socio-historical Institutional Analysis

Este artigo teve como objetivo analisar o processo de institucionalização da Vigilância em Saúde em Campinas (SP), a partir do referencial teórico e metodológico da Análise Institucional, na vertente sócio-histórica. Foram realizadas entrevistas com sujeitos escolhidos por sua relevância em relação ao tema, articuladas a documentos que resgataram o contexto das políticas e modelos de saúde. Concluiu-se que apesar do importante significado da Vigilância em Saúde em Campinas, pouco se conhecia a respeito da sua trajetória, e analisar este tema na perspectiva dos sujeitos possibilitou resgatar processos ainda desconhecidos a respeito da Vigilância em Campinas.

This article aims to analyze the process of institutionalization of the Health Surveillance in Campinas (SP), taking into consideration the theoretical and methodological reference of Institutional Analysis in the socio-historical dimension. Interviews with subjects chosen by their relevance in relation to the theme were carried out and articulated to documents which rescued the context of politics and health models. It is concluded that, despite the significant importance of Health Surveillance in Campinas, little was known about its journey, and analyzing that theme through the perspective of the subjects, made it possible to rescue yet unknown processes about Health Surveillance in Campinas.

Estrategias de articulación entre atención primaria y vigilancia en salud y la interfaz entre los sujetos / Strategies for linkage between primary care and health surveillance and the interface among subjects / Estratégias de articulação entre atenção primária e vigilância em saúde e a interface entre os sujeitos

Este artículo es un estudio cualitativo cuyo objetivo fue describir las articulaciones entre la Vigilancia en Salud y la Atención Primaria de la Salud (APS) y los dispositivos utilizados para que tales procesos se realicen. La colecta de datos se realizó por medio de la observación participante del sistema de Vigilancia en el ámbito nacional y del municipio de Moreno (provincia de Buenos Aires). Los datos se registraron en un diario de campo y los resultados se analizaron a partir de algunos conceptos desarrollados por Lourau, en el Análisis Institucional, como analizador, institución e implicación. Los resultados mostraron que la circulación de afectos y de subjetividades entre los sujetos involucrados en el proceso facilita la creación de dispositivos de articulación entre áreas y jurisdicciones. La importancia de este estudio consiste en una mirada externa que contribuya a reflejar los procesos de trabajo.

This paper is a qualitative study that aimed to describe the linkages between health surveillance and primary healthcare and the devices used to put these processes into effect. Data gathering was conducted through participant observation of the surveillance system, at the national level and in the municipality of Moreno, province of Buenos Aires. The data were recorded in a field diary. The results were analyzed from the perspective of institutional analysis, based on concepts developed by Lourau such as analyzer, institution and involvement. The results showed that the feelings and subjective views that circulated among the subjects involved in the process facilitated creation of devices for linking between areas and jurisdictions. The importance of this study is that the external view helped to reflect on the work processes.

Trata-se de estudo qualitativo com objetivos de descrever as articulações entre a Vigilância em Saúde e a Atenção Primária da Saúde (APS) e os dispositivos utilizados para que estes processos se efetivem. A coleta de dados foi realizada por meio da observação participante do sistema de Vigilância em nível nacional e do município de Moreno – província de Buenos Aires. Os dados foram registrados em um diário de campo e os resultados analisados a partir de alguns conceitos elaborados por Lourau, na Análise Institucional, como analisador, instituição e implicação. Os resultados mostraram que a circulação de afetos e de subjetividades entre os sujeitos envolvidos no processo facilita a criação de dispositivos de articulação entre as áreas e jurisdições. A importância deste estudo consiste em um olhar externo que contribui para refletir os processos de trabalho.

High Concentrations of Ketocarotenoids in Hepatic Mitochondria of Haemorhous mexicanus.

Vertebrates cannot synthesize carotenoid pigments de novo, so to produce carotenoid-based coloration they must ingest carotenoids. Most songbirds that deposit red carotenoids in feathers, bills, eyes, or skin ingest only yellow or orange dietary pigments, which they oxidize to red pigments via a ketolation reaction. It has been hypothesized that carotenoid ketolation occurs in the liver of vertebrates, but this hypothesis remains to be confirmed. To better understand the role of hepatocytes in the production of ketolated carotenoids in songbirds, we measured the carotenoid content of subcellular components of hepatocytes from wild male house finches (Haemorhous mexicanus) that were molting red, ketocarotenoid-containing feathers (e.g., 3-hydroxy-echinenone). We homogenized freshly collected livers of house finches and isolated subcellular fractions, including mitochondria. We found the highest concentration of ketocarotenoids in the mitochondrial fraction. These observations are consistent with the hypothesis that carotenoid pigments are oxidized on or within hepatic mitochondria, esterified, and then transported to the Golgi apparatus for secretory processing.

A systematic approach for using DICOM structured reports in clinical processes: focus on breast cancer.

This paper describes a methodology for redesigning the clinical processes to manage diagnosis, follow-up, and response to treatment episodes of breast cancer. This methodology includes three fundamental elements: (1) identification of similar and contrasting cases that may be of clinical relevance based upon a target study, (2) codification of reports with standard medical terminologies, and (3) linking and indexing the structured reports obtained with different techniques in a common system. The combination of these elements should lead to improvements in the clinical management of breast cancer patients. The motivation for this work is the adaptation of the clinical processes for breast cancer created by the Valencian Community health authorities to the new techniques available for data processing. To achieve this adaptation, it was necessary to design nine Digital Imaging and Communications in Medicine (DICOM) structured report templates: six diagnosis templates and three summary templates that combine reports from clinical episodes. A prototype system is also described that links the lesion to the reports. Preliminary tests of the prototype have shown that the interoperability among the report templates allows correlating parameters from different reports. Further work is in progress to improve the methodology in order that it can be applied to clinical practice.

[Validation and verfication of microbiology methods]. / Validación y verificación analítica de los métodos microbiológicos.

Clinical microbiologists should ensure, to the maximum level allowed by the scientific and technical development, the reliability of the results. This implies that, in addition to meeting the technical criteria to ensure their validity, they must be performed with a number of conditions that allows comparable results to be obtained, regardless of the laboratory that performs the test. In this sense, the use of recognized and accepted reference methodsis the most effective tool for these guarantees. The activities related to verification and validation of analytical methods has become very important, as there is continuous development, as well as updating techniques and increasingly complex analytical equipment, and an interest of professionals to ensure quality processes and results. The definitions of validation and verification are described, along with the different types of validation/verification, and the types of methods, and the level of validation necessary depending on the degree of standardization. The situations in which validation/verification is mandatory and/or recommended is discussed, including those particularly related to validation in Microbiology. It stresses the importance of promoting the use of reference strains as controls in Microbiology and the use of standard controls, as well as the importance of participation in External Quality Assessment programs to demonstrate technical competence. The emphasis is on how to calculate some of the parameters required for validation/verification, such as the accuracy and precision. The development of these concepts can be found in the microbiological process SEIMC number 48: «Validation and verification of microbiological methods¼ www.seimc.org/protocols/microbiology.

Dual gene transfer of fibroblast growth factor-2 and platelet derived growth factor-BB using plasmid deoxyribonucleic acid promotes effective angiogenesis and arteriogenesis in a rodent model of hindlimb ischemia.

The protein infusion of basic fibroblast growth factor-2 (FGF-2) and platelet derived growth factor-BB (PDGF-BB) have been shown to promote the formation of a stable and functional vascular network in small and large animal models of ischemia. Here, we sought to determine whether a similar effect could be obtained using a gene-therapy-based strategy with nonviral vectors. Rats underwent a surgical procedure to create hindlimb ischemia and were injected with a combination of plasmids that expressed FGF-2 and PDGF-BB. Anatomical and functional parameters of the angiogenesis and arteriogenesis response were evaluated after 4 weeks. The results were compared with rats injected with plasmids that expressed a reporter gene or the extensively studied vascular endothelial growth factor (VEGF165) alone. Treatment with the FGF-2/PDGF-BB combination increased the angiogenesis and arteriogenesis response compared with the empty plasmid, and it was as effective as VEGF165. In terms of safety, the combination allowed the use of a 50% lower individual dose of each plasmid and in addition promoted the formation of more stable vessels than VEGF165. In conclusion, the dual gene transfer of FGF-2 and PDGF-BB using nonviral vectors is safe and effective in promoting the formation of a functional vascular network in a rodent model of hindlimb ischemia.

Perfil biopsicossocial de pacientes renais crônicos em tratamento hemodialítico / Biopsychological and social profile of chronic renal patients in hemodialysis

Objetivo: Traçar o perfil biopsicosocial de renais crônicos em terapia hemodialítica. Métodos: Em 40 renais crônicos sob tratamento hemodialítico regular na Unidade de Terapia Renal Substitutiva da Irmandade do Hospital da Santa Casa de Poços de Caldas, foi aplicado o questionário SF-36, utilizado para medida da qualidade de vida em oito dimensões; coletados dados sócio-demográficos, clínicos e nutricionais. Os resultados foram apresentados na forma de análise descritiva. Resultados: A amostra foi constituída por 16 mulheres (40

), e 24 homens (60