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1.
Einstein (Sao Paulo) ; 18: eAO4784, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553356

RESUMO

OBJECTIVE: To evaluate the effect of three types of muscular resistance training on adiposity, inflammation levels and insulin activity in Swiss mice with fat-rich diet-induced obesity. METHODS: Lean and obese male Swiss mice were selected and allocated to one of eight groups comprising eight mice each, as follows: standard diet + no training; standard diet + muscular resistance training; standard diet + hypertrophy training; standard diet + strength training; high-fat diet + no training; high-fat diet + muscular resistance training; high-fat diet + hypertrophy training; high-fat diet + strength training. The training protocol consisted of stair climbing for a 10-week period. Blood samples were collected for lactate analysis, glucose level measurement and insulin tolerance test. After euthanasia, adipose tissues were removed and weighed for adiposity index determination. Fragments of epididymal adipose tissue were then embedded for histological analysis or homogenized for tumor necrosis factor alpha level determination using the ELISA method. RESULTS: Ausency of differences in total training volume and blood lactate levels overall emphasize the similarity between the different resistance training protocols. Body weight loss, reduced adipocyte area and lower adiposity index were observed in trained obese mice, regardless of training modality. Different training protocols also improved insulin sensitivity and reduced inflammation levels. CONCLUSION: Resistance training protocols were equally effective in reducing body fat, inflammation levels and insulin resistance in obese mice.


Assuntos
Adiposidade/fisiologia , Hipertrofia/fisiopatologia , Inflamação/fisiopatologia , Resistência à Insulina/fisiologia , Exercícios de Alongamento Muscular/métodos , Obesidade/fisiopatologia , Condicionamento Físico Animal/fisiologia , Tecido Adiposo Branco/fisiopatologia , Animais , Glicemia/análise , Peso Corporal/fisiologia , Dieta Hiperlipídica , Ensaio de Imunoadsorção Enzimática , Masculino , Camundongos , Camundongos Obesos , Reprodutibilidade dos Testes , Treinamento de Resistência/métodos , Fatores de Tempo , Fator de Necrose Tumoral alfa/análise
2.
Einstein (Sao Paulo) ; 18: eAO4739, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553355

RESUMO

OBJECTIVE: To use magnetic resonance imaging to assess the prevalence of foot and ankle ligament injuries and fractures associated with ankle sprain and not diagnosed by x-ray. METHODS: We included 180 consecutive patients with a history of ankle sprain, assessed at a primary care service in a 12-month period. Magnetic resonance imaging findings were recorded and described. RESULTS: Approximately 92% of patients had some type of injury shown on the magnetic resonance imaging. We found 379 ligament injuries, 9 osteochondral injuries, 19 tendinous injuries and 51 fractures. Only 14 magnetic resonance imaging tests (7.8%) did not show any sort of injury. We observed a positive relation between injuries of the lateral complex, syndesmosis and medial ligaments. However, there was a negative correlation between ankle ligament injuries and midfoot injuries. CONCLUSION: There was a high rate of injuries secondary to ankle sprains. We found correlation between lateral ligament injuries and syndesmosis and deltoid injuries. We did not observe a relation between deltoid and syndesmosis injuries or between lateral ligamentous and subtalar injuries. Similarly, no relation was found between ankle and midfoot injuries.


Assuntos
Traumatismos do Tornozelo/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Traumatismos do Tornozelo/diagnóstico por imagem , Brasil/epidemiologia , Cartilagem Articular/lesões , Criança , Feminino , Humanos , Ligamentos Laterais do Tornozelo/lesões , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
3.
Estud. pesqui. psicol. (Impr.) ; 18(4): 1049-1067, out.-dez. 2019. ilus
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-994958

RESUMO

Recorrentemente, o psicólogo-historiador se vê diante da questão, endereçada por seus pares ou alunos: por que estudar História da Psicologia? Tal questão é tão recorrente que livros-texto de História da Psicologia reservam um espaço para apresentar respostas, justificativas, a tal provocação. Diante disso, este artigo endereça uma resposta a tal questão, a partir da hipótese de que a História da Psicologia é uma ferramenta para compreensão de rupturas e permanências de fenômenos históricos vinculados aos campos Psi e, esta compreensão, nos auxilia em uma visão mais crítica do presente. Para atingir tal objetivo, são apresentados dois exemplos de questões históricas, mais ainda contemporâneas, na Psicologia brasileira: (a) a definição de campos de atuação e técnicas de atuação do psicólogo e (b) discursos e práticas normatizantes com pessoas homossexuais. Assim, a partir de tais exemplos que nos permitem ver a história na Psicologia e, também, a Psicologia na história, conclui-se que a História da Psicologia pode, sim, contribuir com uma análise mais crítica do momento presente. Para tanto, faz-se necessário a pesquisa em História da Psicologia e o ensino de sua história, para uma formação crítica do psicólogo brasileiro.(AU)


Frequently, the psychologist-historian of Psychology finds himself faced with the question, addressed by his peers or students: why should we study the History of Psychology? Textbooks on the History of Psychology reserve some sections to present such justifications to their readers, indeed. Therefore, we aim to give an answer to that question, based on the hypothesis that the History of Psychology is a tool for understanding ruptures and permanencies of Psychological phenomena in the history, and this understanding helps us to build up a more critical view of the present. In order to achieve that goal, two examples of historical issues in Brazilian Psychology ­ that are still contemporary - are presented: (a) the definition of fields of application and their techniques, and (b) normative discourses and practices with homosexual people. Thus, from such examples that allow us to see history in Psychology and also Psychology in history, we conclude that the History of Psychology would contribute for a more critical analysis of the present. Therefore, it is necessary to research in History of Psychology and to teach its history, for a critical formation of the Brazilian psychologist.(AU)


Frecuentemente, el psicólogo-historiador se ve ante la cuestión, direccionada por sus pares o alumnos: ¿por qué estudiar Historia de la Psicología? Tal cuestión es tan recurrente que libros didácticos de Historia de la Psicología reservan un espacio para presentar respuestas, justificaciones, a tal provocación. Por lo tanto, este artículo brinda una respuesta a tal cuestión, a partir de la hipótesis de que la Historia de la Psicología constituye una herramienta para la comprensión de rupturas y permanencias de fenómenos históricos vinculados a los saberes Psi y que esta comprensión nos auxilia en una visión más crítica del presente. Para alcanzar tal objetivo, se presentan dos ejemplos de cuestiones históricas, más aún contemporáneas, en la Psicología brasileña: (a) la definición de campos de actuación y técnicas de actuación del psicólogo y (b) discursos y prácticas de normativización con personas homosexuales. Así, a partir de tales ejemplos que nos permiten ver la historia en la Psicología y, también, la Psicología en la historia, se concluye que la Historia de la Psicología sí puede contribuir a un análisis más crítico del momento presente. Para ello, se hace necesaria la investigación en Historia de la Psicología y la enseñanza de su historia, para una formación crítica del psicólogo brasileño.(AU)


Assuntos
Humanos , Psicologia/história , Psicologia/métodos , Ensino/psicologia , Psicologia
4.
Estud. pesqui. psicol. (Impr.) ; 18(4): 1068-1086, out.-dez. 2019. tab
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-994961

RESUMO

Neste artigo, buscamos apresentar algumas das abordagens teóricas, grupos de pesquisa e instituições que fizeram e fazem parte do vasto (e diverso) campo da psicologia social brasileira. Para isso, em um primeiro momento, retomamos o modo como a história dessa ciência costuma ser contada - colocando a "crise de referência" da década de 1970 como um importante momento de inflexão, no qual ganham força a oposição ao modelo positivista de ciência e a necessidade de desenvolver abordagens críticas e comprometidas com a transformação social. Em um segundo momento, apresentamos algumas das abordagens teórico-metodológicas desenvolvidas após esse momento de "crise". Mais especificamente, abordamos o desenvolvimento da análise institucional, da psicologia sócio-histórica, da teoria das representações sociais e das abordagens construcionistas.(AU)


In this article, we aim to present some of the theoretical approaches, research groups and institutions that that have been part of the vast (and diverse) field of Brazilian social psychology. With this in mind, we begin with the history of the subject as it is usually told, placing the "crisis of reference" of the 1970's as an important turning point and two important ideas which gain ground then: opposing forces to the positivistic model of science and the recognition of the need to develop critical approaches committed to social transformation. After that, we present some of the theoretical-methodological approaches developed after this moment of "crisis". More specifically, we will tackle the development of institutional analysis, social-historical psychology, social representation theory and constructionist perspectives.(AU)


En este artículo, buscamos presentar algunos de los abordajes teóricos, grupos de investigación e instituciones que formaron y forman parte del vasto (y diverso) campo de la psicología social brasileña. Para ello, en un primer momento, retomamos el modo en que la historia de esta ciencia suele ser relatada - colocando la "crisis de referencia" de la década de 1970 como un importante momento de inflexión, en el que ganan fuerza la oposición al modelo positivista de ciencia y la necesidad de desarrollar enfoques críticos y comprometidos con la transformación social. En un segundo momento, presentamos algunos de los enfoques teórico-metodológicos desarrollados después de ese momento de "crisis". Más específicamente, abordamos el desarrollo del análisis institucional, de la psicología socio-histórica, de la teoría de las representaciones sociales y de los abordajes construccionistas.(AU)


Assuntos
Psicologia Social/história , Psicologia Social/métodos , Decisões
5.
Estud. pesqui. psicol. (Impr.) ; 18(4): 1106-1117, out.-dez. 2019.
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-994977

RESUMO

O presente artigo se propõe a apresentar as práticas psicoterapêuticas utilizadas pela psiquiatria brasileira no Hospício Nacional de Alienados, instituição psiquiátrica situada no Rio de Janeiro e fundada no ano de 1852. A pesquisa se debruçou sobre artigos, livros autorais e manuais médicos do Hospital Nacional de Alienados e professores da cátedra de Psiquiatria e Moléstias Mentais da Faculdade de Medicina do Rio de Janeiro. Como referencial teórico, o artigo se apoia em Chartier (1990) para indicar que, ao circular no Brasil do início do século XX, as diferentes psicoterapias tiveram que se acomodar ao contexto para poderem circular. Em especial, demonstra-se como a psicanálise foi apropriada e negociada de acordo com os repertórios disponíveis no contexto psiquiátrico local, bem como frente aos diversos interesses individuais e profissionais presentes, tendo que se adaptar para ganhar credibilidade e aceitação no ambiente da medicina mental brasileira da primeira metade do século XX. Apenas no final da década de 1950 é que se constituiria como uma disciplina independente e autônoma frente aos outros saberes psi com os quais teve que se mesclar ao longo do século.(AU)


This article proposes to present the psychotherapeutic practices used by the Brazilian psychiatry in the Hospício Nacional de Alienados, a psychiatric institution located in Rio de Janeiro and founded in the year 1852. The research focused on articles, books and medical manuals of the Hospital Nacional de Alienados and professors of the chair of Psychiatry and Mental Disorders of the Faculty of Medicine of Rio de Janeiro. As a theoretical reference, the article is based on Chartier (1990) to indicate that, when circulating in Brazil in the early twentieth century, different psychotherapies had to be accommodated to the context to be able to circulate. In particular, it is shown how psychoanalysis was appropriated and negotiated according to the repertoires available in the local psychiatric context, as well as to the various individual and professional interests present, having to adapt to gain credibility and acceptance in the Brazilian mental medicine environment of the first half of the twentieth century. Only in the late 1950s would it be constituted as an independent and autonomous discipline against the other psychological knowledge with which it had to blend throughout the century.(AU)


El presente artículo se propone presentar las prácticas psicoterapéuticas utilizadas por la psiquiatría brasileña en el Hospicio Nacional de Alienados, institución psiquiátrica situada en Rio de Janeiro y fundada en el año 1852. La investigación se centró en artículos, libros de autor y manuales de médicos del Hospital Nacional de Alienados y de profesores de la cátedra de Psiquiatría y Molestias Mentales de la Facultad de Medicina de Rio de Janeiro. Como referente teórico, el artículo se apoya en Chartier (1990) para indicar que, al circular en Brasil desde el inicio del siglo XX, las diferentes psicoterapias tuvieron que acomodarse al contexto local para poder circular. En particular, se demuestra cómo el psicoanálisis fue apropiado y negociado de acuerdo a los repertorios disponibles en el contexto psiquiátrico local, así como frente a los diversos intereses individuales y profesionales presentes, teniendo que adaptarse para ganar credibilidad y aceptación en el ambiente de la medicina mental brasileña de la primera mitad del siglo XX. Sólo a finales de la década de 1950 se constituiría como una disciplina independiente y autónoma frente a los otros saberes psi con los que tuvo que mezclarse a lo largo del siglo.(AU)


Assuntos
Psicoterapia/história , Psicanálise , Brasil , Metodologia , História
7.
Medicine (Baltimore) ; 98(38): e16655, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567931

RESUMO

In this study, we first reported of a modified hybrid fixation method in expansive open-door laminoplasty (EOLP) in order to reduce medical costs. The purpose of the present study is to compare the surgical outcomes and cost-effectiveness of the modified fixation with all levels miniplate fixation in EOLP for multilevel cervical spondylotic myelopathy.Data of 67 patients who underwent EOLP from July 2015 to June 2016 were retrospectively analyzed, with 33 in the modified group and 34 in the all miniplate group based on their surgical approaches. Laminae were kept open with alternate levels miniplate and anchor fixation in the modified group, while with all levels miniplate fixation in the all miniplate group. Medical costs and clinical results including Japanese Orthopedic Association (JOA) scores, Visual Analogue Scale (VAS) scores and occurrences of complications were investigated and compared between the 2 groups. After evaluation on X-ray, CT, and MRI, radiographic data reflecting cervical alignments, spinal canal enlargement and spinal cord decompression were collected and compared within each group and between the 2 groups.After a follow-up period of about 18 months, no significant differences in operation time, intraoperative blood loss, complication rates, VAS scores, neurological recovery rates and postoperative hospital stays were observed between the 2 groups. However, EOLP with the modified fixation costed less. When comparing the 2 groups, cervical curvature index (CCIs) which reflected cervical alignments and anteroposterior diameters (APDs) reflecting spinal canal enlargement at all the follow-ups had no significant differences. Postoperative open angles which reflected spinal cord decompression of C4 and C6 were significantly smaller in the modified group. However, that difference was no longer detected at the final follow-up. Within each group, APDs increased significantly after surgery. However, no significant differences in CCIs and open angles at different follow-ups were observed in each group.Compared with all miniplate fixation, the modified hybrid fixation in EOLP showed almost the same clinical and radiographic results. However, the modified hybrid fixation method could reduce costs.


Assuntos
Placas Ósseas , Vértebras Cervicais/cirurgia , Laminoplastia/métodos , Espondilose/cirurgia , Adulto , Idoso , Desenho de Equipamento , Feminino , Humanos , Laminoplastia/economia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espondilose/diagnóstico por imagem , Resultado do Tratamento , Escala Visual Analógica
8.
Medicine (Baltimore) ; 98(38): e17211, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567974

RESUMO

This study aims to evaluate the feasibility and effectiveness of minimally invasive puncture treatment by positioning the simple bedside for spontaneous cerebellar hemorrhage.From January 2017 to March 2018, the investigators applied simple bedside positioning to perform the intracranial hematoma minimally invasive surgery for 21 patients with cerebellar hemorrhage.For these 21 patients, the bleeding amount and Glasgow Coma Scale (GCS) score before the operation were 18.5 ±â€Š5.0 cc and 9.5 ±â€Š3.3, respectively; 24 hours after the operation, the GCS score was 11.0 ±â€Š4.6. Five patients died within 7 days of the operation and the head computed tomography (CT) was re-examined. It was found that the average bleeding amount was 3.4 ±â€Š0.9 cc, the operation success rate was 76.2%, and the accurate puncture rate was 100%. Six months later, the Modified Rankin Scale (MRS) score was 2.5 ±â€Š2.0. The postoperative recovery was good. The situation shows that patients with favorable outcomes (MRS score 0-2) accounted for 38.1% (8/21), and the fatality rate was 33.3% (7/21).The efficacy of the intracranial hematoma minimally invasive surgery by positioning the simple bedside for spontaneous cerebellar hemorrhage with severe brainstem dysfunction is good.


Assuntos
Tronco Encefálico/fisiopatologia , Doenças Cerebelares/cirurgia , Hemorragia Cerebral/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Paracentese/métodos , Posicionamento do Paciente , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/fisiopatologia , Feminino , Humanos , Masculino , Neuroimagem , Posicionamento do Paciente/métodos , Tomografia Computadorizada por Raios X
9.
Medicine (Baltimore) ; 98(38): e17228, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567984

RESUMO

OBJECTIVE: To determine whether psychological intervention (PI) changes the levels of immune indicators in cancer patients. METHODS: We conducted a systematic search published up to July 2018, followed by a manual search. Randomized controlled trials were included. Two reviewers independently screened and extracted data, which were analyzed using Review manager 5.3. RESULTS: Twenty-nine studies were included including four kinds of PI. Only stress management didn't result in immune changes; only cognitive behavior therapy affect NK cell activity. PI did not change immune indicators on cancer patients who completed therapy. Compared to patients not receiving PI, those received PI had significantly higher NK cell count and activity in whole blood; and serum levels of IL-2, IL-4, IFN-γ, lgA, and lgG. However, the differences in the serum levels of IL-6, IL-10, TNF-α, and IgM were not significant (P > .05), and the changes recorded for the CD3, CD4, and CD8 cell count, and CD4/CD8 ratios were inconsistent. CONCLUSIONS: Although there are considerable evidences of PI's immune effect, but its magnitude was moderate. Therefore, it may be premature to conclude whether PI affects immunity of cancer patients. Further research is warranted, with special focus on the PI types and treatment methods.


Assuntos
Neoplasias/psicologia , Psicoterapia , Humanos , Imunidade , Neoplasias/imunologia , Neoplasias/terapia , Psicoterapia/métodos
10.
Medicine (Baltimore) ; 98(38): e17230, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567986

RESUMO

RATIONALE: Liver transplantation is an increasingly common treatment for patients with liver cirrhosis or hepatocellular carcinoma. Liver transplantation in patients with heart disease can pose a significant challenge to the transplant teams. PATIENT CONCERNS: A 46-year-old woman was diagnosed with hepatitis B virus-related hepatocellular carcinoma 3 years ago and had received 3 times transarterial chemoembolization. DIAGNOSES: The patient was diagnosed as end-stage liver disease due to hepatocellular carcinoma and was scheduled to undergo living-donor liver transplantation. The preoperative echocardiogram revealed mass in the right atrium and the inferior vena cava. INTERVENTIONS: The patient underwent mass removal under cardiopulmonary bypass followed by liver transplantation. OUTCOMES: A month later, she was discharged without any complications. LESSONS: There have only been a few reported cases of anesthetic liver transplantation after a cardiopulmonary bypass. The successful experience described in this case report suggests that some patients may be eligible to undergo a liver transplantation after a cardiopulmonary bypass.


Assuntos
Ponte Cardiopulmonar , Transplante de Fígado , Carcinoma Hepatocelular/cirurgia , Feminino , Humanos , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/métodos , Pessoa de Meia-Idade
11.
Medicine (Baltimore) ; 98(38): e17237, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567988

RESUMO

INTRODUCTION: With the second-generation antipsychotics (SGAs) widely applied to treat patients with schizophrenia, adverse effects, especially the metabolic syndrome (MetS), were paid more attention following by the efficacy of SGAs. Several studies have suggested that acupuncture could be an effective and safe intervention for MetS. Here, we present a study protocol to investigate the effect of electroacupuncture on MetS due to olanzapine and risperidone. METHODS: This study is a prospective, randomized, single-centered, patient-assessor-blinded, parallel-controlled clinical pilot trial. In all, 36 patients will be randomized to an experimental group or control group by a 1:1 ratio. All patients will receive lifestyle interventions. The experimental group will receive electroacupuncture treatment. The control group will receive sham electroacupuncture treatment. The primary outcomes are body mass index (BMI) and waist circumference (WC). The secondary outcome measures include blood pressure (BP), fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), leptin, and adiponectin. We will assess at baseline, 8 weeks after intervention and at the end of 3 months' follow-up. DISCUSSION: The results of this trial are expected to provide data on the efficacy and safety of electroacupuncture on MetS due to olanzapine and risperidone, and potential biochemical mechanism.


Assuntos
Antipsicóticos/efeitos adversos , Eletroacupuntura , Síndrome Metabólica/terapia , Olanzapina/efeitos adversos , Risperidona/efeitos adversos , Antipsicóticos/uso terapêutico , Protocolos Clínicos , Eletroacupuntura/efeitos adversos , Eletroacupuntura/métodos , Humanos , Síndrome Metabólica/induzido quimicamente , Olanzapina/uso terapêutico , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico
13.
BMJ ; 367: l5383, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31578177

RESUMO

OBJECTIVE: To estimate benefits and harms of different colorectal cancer screening strategies, stratified by (baseline) 15-year colorectal cancer risk. DESIGN: Microsimulation modelling study using MIcrosimulation SCreening ANalysis-Colon (MISCAN-Colon). SETTING: A parallel guideline committee (BMJ Rapid Recommendations) defined the time frame and screening interventions, including selection of outcome measures. POPULATION: Norwegian men and women aged 50-79 years with varying 15-year colorectal cancer risk (1-7%). COMPARISONS: Four screening strategies were compared with no screening: biennial or annual faecal immunochemical test (FIT) or single sigmoidoscopy or colonoscopy at 100% adherence. MAIN OUTCOME MEASURES: Colorectal cancer mortality and incidence, burdens, and harms over 15 years of follow-up. The certainty of the evidence was assessed using the GRADE approach. RESULTS: Over 15 years of follow-up, screening individuals aged 50-79 at 3% risk of colorectal cancer with annual FIT or single colonoscopy reduced colorectal cancer mortality by 6 per 1000 individuals. Single sigmoidoscopy and biennial FIT reduced it by 5 per 1000 individuals. Colonoscopy, sigmoidoscopy, and annual FIT reduced colorectal cancer incidence by 10, 8, and 4 per 1000 individuals, respectively. The estimated incidence reduction for biennial FIT was 1 per 1000 individuals. Serious harms were estimated to be between 3 per 1000 (biennial FIT) and 5 per 1000 individuals (colonoscopy); harms increased with older age. The absolute benefits of screening increased with increasing colorectal cancer risk, while harms were less affected by baseline risk. Results were sensitive to the setting defined by the guideline panel. Because of uncertainty associated with modelling assumptions, we applied a GRADE rating of low certainty evidence to all estimates. CONCLUSIONS: Over a 15 year period, all screening strategies may reduce colorectal cancer mortality to a similar extent. Colonoscopy and sigmoidoscopy may also reduce colorectal cancer incidence, while FIT shows a smaller incidence reduction. Harms are rare and of similar magnitude for all screening strategies.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/normas , Programas de Rastreamento/normas , Modelos Estatísticos , Idoso , Colonoscopia/efeitos adversos , Colonoscopia/normas , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Noruega/epidemiologia , Sangue Oculto , Avaliação de Processos e Resultados (Cuidados de Saúde)/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Sigmoidoscopia/efeitos adversos , Sigmoidoscopia/normas , Sigmoidoscopia/estatística & dados numéricos , Análise de Sobrevida
14.
BMJ ; 367: l5205, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31578187

RESUMO

OBJECTIVES: To determine how clinicians vary in their response to new guidance on existing or new interventions, by measuring the timing and magnitude of change at healthcare institutions. DESIGN: Automated change detection in longitudinal prescribing data. SETTING: Prescribing data in English primary care. PARTICIPANTS: English general practices. MAIN OUTCOME MEASURES: In each practice the following were measured: the timing of the largest changes, steepness of the change slope (change in proportion per month), and magnitude of the change for two example time series (expiry of the Cerazette patent in 2012, leading to cheaper generic desogestrel alternatives becoming available; and a change in antibiotic prescribing guidelines after 2014, favouring nitrofurantoin over trimethoprim for uncomplicated urinary tract infection (UTI)). RESULTS: Substantial heterogeneity was found between institutions in both timing and steepness of change. The range of time delay before a change was implemented was large (interquartile range 2-14 months (median 8) for Cerazette, and 5-29 months (18) for UTI). Substantial heterogeneity was also seen in slope following a detected change (interquartile range 2-28% absolute reduction per month (median 9%) for Cerazette, and 1-8% (2%) for UTI). When changes were implemented, the magnitude of change showed substantially less heterogeneity (interquartile range 44-85% (median 66%) for Cerazette and 28-47% (38%) for UTI). CONCLUSIONS: Substantial variation was observed in the speed with which individual NHS general practices responded to warranted changes in clinical practice. Changes in prescribing behaviour were detected automatically and robustly. Detection of structural breaks using indicator saturation methods opens up new opportunities to improve patient care through audit and feedback by moving away from cross sectional analyses, and automatically identifying institutions that respond rapidly, or slowly, to warranted changes in clinical practice.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Avaliação de Processos (Cuidados de Saúde)/métodos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Anti-Infecciosos/uso terapêutico , Conjuntos de Dados como Assunto , Substituição de Medicamentos/estatística & dados numéricos , Medicamentos Genéricos/uso terapêutico , Inglaterra , Medicina Geral/organização & administração , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos , Humanos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Avaliação de Processos (Cuidados de Saúde)/estatística & dados numéricos , Medicina Estatal/normas , Fatores de Tempo , Infecções Urinárias/tratamento farmacológico
15.
BMJ ; 367: l5515, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31578196

RESUMO

CLINICAL QUESTION: Recent 15-year updates of sigmoidoscopy screening trials provide new evidence on the effectiveness of colorectal cancer screening. Prompted by the new evidence, we asked: "Does colorectal cancer screening make an important difference to health outcomes in individuals initiating screening at age 50 to 79? And which screening option is best?" CURRENT PRACTICE: Numerous guidelines recommend screening, but vary on recommended test, age and screening frequency. This guideline looks at the evidence and makes recommendations on screening for four screening options: faecal immunochemical test (FIT) every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy. RECOMMENDATIONS: These recommendations apply to adults aged 50-79 years with no prior screening, no symptoms of colorectal cancer, and a life expectancy of at least 15 years. For individuals with an estimated 15-year colorectal cancer risk below 3%, we suggest no screening (weak recommendation). For individuals with an estimated 15-year risk above 3%, we suggest screening with one of the four screening options: FIT every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy (weak recommendation). With our guidance we publish the linked research, a graphic of the absolute harms and benefits, a clear description of how we reached our value judgments, and linked decision aids. HOW THIS GUIDELINE WAS CREATED: A guideline panel including patients, clinicians, content experts and methodologists produced these recommendations using GRADE and in adherence with standards for trustworthy guidelines. A linked systematic review of colorectal cancer screening trials and microsimulation modelling were performed to inform the panel of 15-year screening benefits and harms. The panel also reviewed each screening option's practical issues and burdens. Based on their own experience, the panel estimated the magnitude of benefit typical members of the population would value to opt for screening and used the benefit thresholds to inform their recommendations. THE EVIDENCE: Overall there was substantial uncertainty (low certainty evidence) regarding the 15-year benefits, burdens and harms of screening. Best estimates suggested that all four screening options resulted in similar colorectal cancer mortality reductions. FIT every two years may have little or no effect on cancer incidence over 15 years, while FIT every year, sigmoidoscopy, and colonoscopy may reduce cancer incidence, although for FIT the incidence reduction is small compared with sigmoidoscopy and colonoscopy. Screening related serious gastrointestinal and cardiovascular adverse events are rare. The magnitude of the benefits is dependent on the individual risk, while harms and burdens are less strongly associated with cancer risk. UNDERSTANDING THE RECOMMENDATION: Based on benefits, harms, and burdens of screening, the panel inferred that most informed individuals with a 15-year risk of colorectal cancer of 3% or higher are likely to choose screening, and most individuals with a risk of below 3% are likely to decline screening. Given varying values and preferences, optimal care will require shared decision making.


Assuntos
Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/normas , Programas de Rastreamento/normas , Sangue Oculto , Sigmoidoscopia/estatística & dados numéricos , Idoso , Colonoscopia/normas , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Avaliação de Processos e Resultados (Cuidados de Saúde)/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sigmoidoscopia/normas , Fatores de Tempo
16.
Water Sci Technol ; 80(3): 448-457, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31596256

RESUMO

In the present study, continuous-flow column experiments (using glass column, Tygon tubing, and peristaltic pump Manostat Carter) were conducted to investigate the performance of permeable sorption barriers for the removal of cadmium and zinc from synthetic groundwater. Zeolite, ion-exchange resin and granular activated carbon as reactive materials were used. The effectiveness and stability of reactive materials were studied by monitoring of changes of metal ions concentration and selected background anions and cations concentration in groundwater during its flow through columns. Results showed that ion exchange resin was the most effective material of permeable reactive barrier (PRB). Performance of resin barrier remained effective (>99.5% metal ions removal) for the time corresponding to on average of about 10,000 min. The high efficiency of ion-exchange resin in PRB for removal of heavy metals from groundwater was coupled with its reactivity and long barrier lifetime. The breakthroughs in the column tests on activated carbon and zeolite using synthetic groundwater occurred much earlier as compared to resin. Therefore, the system using resin requires smaller amount to treat a given volume of groundwater as compared to other materials. Moreover, the presence of other ions did not impact on activity and permeability of barrier filled with resin.


Assuntos
Cádmio/análise , Água Subterrânea/química , Poluentes Químicos da Água/análise , Purificação da Água/métodos , Zinco/análise , Íons
17.
Water Sci Technol ; 80(3): 458-465, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31596257

RESUMO

In this work, landfill leachate treatment by electrocoagulation process with a novel rotating anode reactor was studied. The influence of rotating anode speed on the removal efficiency of chemical oxygen demand (COD), total dissolved solids (TDS), and total suspended solids (TSS) of raw landfill leachate was investigated. The influence of operating parameters like leachate pH, leachate temperature, current, and inter-distance between the cathode rings and anode impellers on the electrocoagulation performance were also investigated. The results revealed the optimum rotating speed is 150 rpm and increasing the rotating speed above this value led to reducing process performance. The leachate electrocoagulation treatment process favors the neutral medium and the treatment performance increases with increasing current intensity. Furthermore, the electrocoagulation treatment performance improves with increasing leachate temperature. However, the performance reduces with increasing inter-electrode distance.


Assuntos
Eliminação de Resíduos Líquidos/métodos , Poluentes Químicos da Água , Análise da Demanda Biológica de Oxigênio , Eletrocoagulação , Eletrodos
18.
Water Sci Technol ; 80(3): 466-477, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31596258

RESUMO

Wetlands are among the most productive ecosystems that provide services ranging from flood control to climate change mitigation. Wetlands are also critical habitats for the survival of numerous plant and animal species. In this study, we used satellite remote sensing techniques for classification and change detection at an internationally important wetland (Ramsar Site) in Turkey. Sultan Marshes is located at the center of semi-arid Develi closed basin. The wetlands have undergone significant changes since the 1980s due to changes in water flow regimes, but changes in recent years have not been sufficiently explored yet. In this study, we focused on the changes from 2005 to 2012. Two multispectral ASTER images with spatial resolution of 15 m, acquired on June 11, 2005 and May 20, 2012, were used in the analyses. After geometric correction, the images were classified into four information classes, namely water, marsh, agriculture, and steppe. The applicability of three classification methods (i.e. maximum likelihood (MLH), multi-layer perceptron type artificial neural networks (ANN) and support vector machines (SVM)) was assessed. The differences in classification accuracies were evaluated by the McNemar's test. The changes in the Sultan Marshes were determined by the post classification comparison method using the most accurate classified images. The results showed that the highest overall accuracy in image classifications was achieved with the SVM method. It was observed that marshes and steppe areas decreased while water and agricultural areas expanded from 2005 to 2012. These changes could be the results of water transfers to the marshes from neighboring watershed.


Assuntos
Monitoramento Ambiental/métodos , Máquina de Vetores de Suporte , Áreas Alagadas , Conservação dos Recursos Naturais , Ecossistema , Eugenol , Redes Neurais (Computação) , Turquia , Óxido de Zinco
19.
Water Sci Technol ; 80(3): 487-498, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31596260

RESUMO

Methylparaben and triclosan are antimicrobial agents widely used as preservatives in a variety of personal care and pharmaceutical products. Wastewater is considered the main source of these compounds in the environment. Expanded granular sludge bed (EGSB) reactors are a high rate technology for wastewater treatment based on biological processes and have been shown to be efficient in removing different types of compounds; however, little is known about the effect of contaminants such as methylparaben and triclosan on their behavior and effectiveness. In this study, we evaluate and compare the microbial and physicochemical behavior of EGSB systems during methylparaben and triclosan removal. The presence of different concentrations of pollutants had an influence on the cluster organization of microbial communities, especially bacteria. However, this did not affect the stability and performance of the EGSB systems. The banding patterns of the denaturing gradient gel electrophoresis of archaea demonstrated the constant presence and abundance of Methanosaeta concilii throughout all stages of operation, showing that this microorganism played a fundamental role in the stability of the reactors for the production of methane. The type of compound and its concentration influenced the expression of the mcrA and ACAs genes; however, these changes did not alter the stability and performance of the EGSB systems.


Assuntos
Parabenos/análise , Triclosan/análise , Eliminação de Resíduos Líquidos/métodos , Poluentes Químicos da Água/análise , Reatores Biológicos , Esgotos
20.
Water Sci Technol ; 80(3): 499-506, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31596261

RESUMO

We investigated how UV treatment of indoor pool water affects the concentration of trihalomethanes (THMs) and chloramines (NCl3) in the air above one therapy pool. One-hundred and sixty-two samples of tTHMs (sum of the four most common THMs in swimming facilities) and thirty-six samples of NCl3 were collected simultaneously at poolside and in the extract channel in a room with one therapy pool for 2 days a week over a period of 5 weeks. When the UV lamp was on, the concentration of combined chlorine in the water decreased 58%, the concentration of tTHMs in the air increased 37%, and the concentration of NCl3 in the air decreased 15%. Between 42% and 56% of the gases in the air are recirculated back into the poolroom along with the recycled air. The correlation between NCl3 and THMs in the air was stronger when the UV treatment was on (r2 = 0.963) compared to when the UV treatment was off (r2 = 0.472). Using a linear mixed model, 30% of the variability in THMs was attributed to UV treatment. For NCl3, the number of bathers was the most important predictor variable. UV treatment has a limited effect on airborne NCl3 but increases the air concentration of tTHMs.


Assuntos
Poluição do Ar/estatística & dados numéricos , Piscinas , Purificação da Água/métodos , Poluição do Ar/análise , Poluição do Ar/prevenção & controle , Cloretos , Cloro , Trialometanos/análise , Raios Ultravioleta
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