Discrimination of malignant from benign thyroid lesions through neural networks using FTIR signals obtained from tissues.

The current gold standard in cancer diagnosis-the microscopic examination of hematoxylin and eosin (H&E)-stained biopsies-is prone to bias since it greatly relies on visual examination. Hence, there is a need to develop a more sensitive and specific method for diagnosing cancer. Here, Fourier transform infrared (FTIR) spectroscopy of thyroid tumors (n = 164; 76 malignant, 88 benign) was performed and five (5) neural network (NN) models were designed to discriminate the obtained spectral data. PCA-LDA was used as classical benchmark for comparison. Each NN model was evaluated using a stratified 10-fold cross-validation method to avoid overfitting, and the performance metrics-accuracy, area under the curve (AUC), positive predictive value (PPV), negative predictive value (NPV), specificity rate (SR), and recall rate (RR)-were averaged for comparison. All NN models were able to perform excellently as classifiers, and all were able to surpass the LDA model in terms of accuracy. Among the NN models, the RNN model performed best, having an AUC of 95.29% ± 6.08%, an accuracy of 98.06% ± 2.87%, a PPV of 98.57% ± 4.52%, a NPV of 93.18% ± 7.93%, a SR value of 98.89% ± 3.51%, and a RR value of 91.25% ± 10.29%. The RNN model outperformed the LDA model for all metrics except for the AUC, NPV, and RR. In conclusion, NN-based tools were able to predict thyroid cancer based on infrared spectroscopy of tissues with a high level of diagnostic performance in comparison to the gold standard.

The Importance of Model Structure in the Cost-Effectiveness Analysis of Primary Care Interventions for the Management of Hypertension.

BACKGROUND: Management of hypertension can lead to significant reductions in blood pressure, thereby reducing the risk of cardiovascular disease. Modeling the course of cardiovascular disease is not without complications, and uncertainty surrounding the structure of a model will almost always arise once a choice of a model structure is defined. OBJECTIVES: To provide a practical illustration of the impact on the results of cost-effectiveness of changing or adapting model structures in a previously published cost-utility analysis of a primary care intervention for the management of hypertension Targets and Self-Management for the Control of Blood Pressure in Stroke and at Risk Groups (TASMIN-SR). METHODS: The case study assessed the structural uncertainty arising from model structure and from the exclusion of secondary events. Four alternative model structures were implemented. Long-term cost-effectiveness was estimated and the results compared with those from the TASMIN-SR model. RESULTS: The main cost-effectiveness results obtained in the TASMIN-SR study did not change with the implementation of alternative model structures. Choice of model type was limited to a cohort Markov model, and because of the lack of epidemiological data, only model 4 captured structural uncertainty arising from the exclusion of secondary events in the case study model. CONCLUSIONS: The results of this study indicate that the main conclusions drawn from the TASMIN-SR model of cost-effectiveness were robust to changes in model structure and the inclusion of secondary events. Even though one of the models produced results that were different to those of TASMIN-SR, the fact that the main conclusions were identical suggests that a more parsimonious model may have sufficed.

The Effects of Environmental Factors on the Efficiency of Clinical Commissioning Groups in England: A Data Envelopment Analysis.

Clinical Commissioning Groups (CCGs) were created in 2013 to make the NHS more responsive, efficient and accountable. A large number of different indicators can be used to measure the quality and outcomes of services provided by CCGs, however there is currently no single measure of overall efficiency available. The performance of CCGs may also be confounded by environmental factors such as deprivation, population size and burden of disease. Data Envelopment Analysis (DEA) is a linear programming technique that can be used to measure the relative efficiency of a given set of organisations. To use DEA to measure the efficiency of English CCGs and assess the impact of environmental factors. This study estimates the technical efficiency of 208 CCGs in England using DEA. The inputs and outputs used include budget allocation, number of general practitioners, mortality rates, patient satisfaction and Quality and Outcomes Framework achievement scores. Regression analysis is used to assess the effects of environmental factors on efficiency, such as population size, prevalence of disease, and socio-economic status. Twenty-three percent (47/208) of CCGs were efficient compared to the others. Three environmental factors were statistically significant predictors of efficiency: CCGs with smaller population sizes were more efficient than those with larger ones, while high unemployment rates and a high prevalence of chronic obstructive pulmonary disease led to a decrease in efficiency scores. Comparative deprivation was not a significant predictor of efficiency. The finding that the relationship between deprivation and efficiency is not statistically significant suggests that NHS England's adjustment for environmental factors within the CCG-level budget allocation is broadly successful. This study shows the potential of DEA for assessing technical efficiency at CCG-level in the English NHS.

A Systematic Review of Research Guidelines in Decision-Analytic Modeling.

BACKGROUND: Decision-analytic modeling (DAM) has been increasingly used to aid decision making in health care. The growing use of modeling in economic evaluations has led to increased scrutiny of the methods used. OBJECTIVE: The objective of this study was to perform a systematic review to identify and critically assess good practice guidelines, with particular emphasis on contemporary developments. METHODS: A systematic review of English language articles was undertaken to identify articles presenting guidance for good practice in DAM in the evaluation of health care. The inclusion criteria were articles providing guidance or criteria against which to assess good practice in DAM and studies providing criteria or elements for good practice in some areas of DAM. The review covered the period January 1990 to March 2014 and included the following electronic bibliographic databases: Cochrane Library, Cochrane Methodology Register and Health Technology Assessment, NHS Economic Evaluation Database, MEDLINE, and PubMed (Embase). Additional studies were identified by searching references. RESULTS: Thirty-three articles were included in this review. A practical five-dimension framework was developed that describe the key elements of good research practice that should be considered and reported to increase the credibility of results obtained from DAM in the evaluation of health care. CONCLUSIONS: This study is the first to critically review all available guidelines and statements of good practice in DAM since 2006. The development of good practice guidelines is an ongoing process, and important efforts have been made to identify what is good practice and to keep these guidelines up to date.

Cost-effectiveness of optimizing acute stroke care services for thrombolysis.

BACKGROUND AND PURPOSE: Thrombolysis in acute stroke is effective up to 4.5 hours after symptom onset but relies on early recognition, prompt arrival in hospital, and timely brain scanning. This study aimed to establish the cost-effectiveness of increasing thrombolysis rates through a series of hypothetical change strategies designed to optimize the acute care pathway for stroke. METHODS: A decision-tree model was constructed, which relates the acute management of patients with suspected stroke from symptom onset to outcome. Current practice was modeled and compared with 7 change strategies designed to facilitate wider eligibility for thrombolysis. The model basecase consisted of data from consenting patients following the acute stroke pathway recruited in participating hospitals with data on effectiveness of treatment and costs from published sources. RESULTS: All change strategies were cost saving while increasing quality-adjusted life years gained. Using realistic estimates of effectiveness, the change strategy with the largest potential benefit was that of better recording of onset time, which resulted in 3.3 additional quality-adjusted life years and a cost saving of US $46,000 per 100,000 population. All strategies increased the number of thrombolysed patients and the number requiring urgent brain imaging (by 9% to 21% dependent on the scenario). Assuming a willingness-to-pay of US $30,000 per quality-adjusted life year gained, the potential budget available to deliver the interventions in each strategy ranged from US $50,000 to US $144,000. CONCLUSIONS: These results suggest that any strategy that increases thrombolysis rates will result in cost savings and improved patient quality of life. Healthcare commissioners could consider this model when planning improvements in stroke care.

Skilled lactation support using telemedicine in the neonatal intensive care unit.

BACKGROUND: NICU mothers face unique challenges in initiating and sustaining breastfeeding, but previous studies have focused on outpatient breastfeeding support. We conducted a retrospective study of NICU breastfeeding outcomes before and after implementing telelactation. METHODS: Pre-Telemedicine mothers received in-person support by NICU lactation consultants, while Telemedicine mothers received solely telemedicine consults after maternal discharge. RESULTS: Exclusive breastmilk feeding at discharge increased in the Telemedicine group. Notably, babies in the Telemedicine cohort who were fed any formula on admission experienced significant improvement in exclusive breastmilk feeding at discharge, and those whose mothers received at least one NICU lactation consult had the greatest improvement in exclusive breastfeeding rates at discharge. CONCLUSIONS: This study is the first to validate the use of telemedicine as a means of maintaining access to skilled lactation support in the NICU when in-person consults are not feasible. Incorporating telemedicine can ensure access and continuity of skilled lactation support, and sustain breastfeeding rates.

Bird nest building: visions for the future.

Successful reproduction for most birds requires them to have built 'good' nests. The remarkable diversity of nests across approximately 10 000 species of living birds suggests that 'good' nest design depends critically on a species' microhabitat, life history and behaviour. Unravelling the key drivers of nest diversity remains a key research priority-bolstered by renewed appreciation for nest museum collections and increasing correlational field and experimental laboratory data. Phylogenetic analyses-coupled with powerful datasets of nest traits-are increasingly shedding light on the evolution of nest morphology and there are functional questions yet to be addressed. For birds, at least, developmental and mechanistic analyses of building (behaviour, hormones, neuroscience) itself, rather than measurements and analyses of nest morphology, are already becoming the next major challenge. We are moving towards a holistic picture in which Tinbergen's four levels of explanation: evolution, function, development, and mechanism, are being used to explain variation and convergence in nest design-and, in turn, could shed light on the question of how birds know how to build 'good' nests. This article is part of the theme issue 'The evolutionary ecology of nests: a cross-taxon approach'.

Clinical characteristics and outcomes for patients with non­metastatic castration-resistant prostate cancer.

This study used linked, routinely-collected datasets to explore incidence, clinical characteristics and outcomes of prostate cancer (PC) patients who experience a rise in prostate-specific antigen (PSA) levels despite androgen deprivation therapy (ADT), without evidence of metastases in their patient record, termed non-metastatic castration-resistant PC (nmCRPC). Routinely collected administrative data in Wales were used to identify patients diagnosed with PC and nmCRPC from 2000-2015. Logrank tests and Cox proportional hazard models were used to compare time-to-events across subgroups defined by PSA doubling time and age. Of 38,021 patients identified with PC, 1,465 met nmCRPC criteria. PC incidence increased over the study period, while nmCRPC categorizations reduced. Median time from PC diagnosis to nmCRPC categorization was 3.07 years (95% confidence interval [CI] 2.91-3.26) and from nmCRPC categorization to metastases/death was 2.86 years (95% CI 2.67-3.09). Shorter PSA doubling time (≤ 10 months, versus > 10 months) was associated with reduced time to metastases or death (2.11 years [95% CI 1.92-2.30] versus 5.22 years [95% CI 4.87-5.51]). Age was not significantly associated with time to metastases/death. Our findings highlight key clinical characteristics and outcomes for patients with nmCRPC prior to the introduction of recently approved treatments.

GSTM1 and GSTT1 Genetic Polymorphisms and Breast Cancer Risk in Selected Filipino Cases

Background: The association of genetic polymorphisms with cancer development has been shown to be race- and tumor site-specific. Thus, this study aimed to determine whether polymorphisms in the GSTM1 and GSTT1 genes are associated with breast cancer among selected Filipinos. Methods: A total of 136 histologically confirmed breast cancer cases were age- and sex-matched with 136 clinically healthy controls. Genomic DNA extracted from blood samples of participants were screened for GSTM1 and GSTT1 genetic polymorphisms by multiplex PCR. Results: The frequency of null genotypes among the cases (GSTM1: n=78; 57.4%; GSTT1: n=61; 44.9%) was not significantly different (p>0.05) from the controls (GSTM1: n=93; 68.4%; GSTT1: n=59; 43.4%). It was also demonstrated that risk for breast cancer was increased in passive smokers carrying the GSTM1 null (OR=2.56; 95% CI=1.38-4.75) or GSTT1 positive (OR=2.00; 95% CI=1.05-3.83) genotypes. Moreover, risk was decreased in alcohol users carrying the GSTT1 null (OR=0.39; 95% CI=0.16-0.97) genotype. Conclusion: This study suggests that variants of GSTM1 and GSTT1 may not be risk factors for breast cancer development among Filipinos. However, the risk may be increased when these genotypes were combined with lifestyle or environmental factors.

XRCC4 c.1394G>T Single Nucleotide Polymorphisms and Breast Cancer Risk among Filipinos

Background: The identification of cancer-associated single nucleotide polymorphisms (SNP) and mutation genes is a promising approach in recognizing individuals who are at risk of developing cancer. Hence, this study was conducted to determine the association between XRCC4 c.1394G>T SNP and breast cancer development among Filipinos. Methods: Genotyping for XRCC4 c.1394G>T SNP was performed on breast cancer patients (n=103) and their age- and sex- matched clinically healthy controls (n=103) by polymerase chain reaction ­ restriction fragment length polymorphism. Results: Significant difference in genotype (p=0.007) and allele (p=0.003) frequencies in XRCC4 c.1394G>T was observed between the breast cancer cases and controls. Carriers of the XRCC4 c.1394 G>T genotype were observed to have significantly higher risk of developing breast cancer compared to individuals with T/T genotype (OR=2.67, 95% CI: 1.36 ­ 5.25). XRCC4 c.1394G>T combined with passive smoking may also significantly increase risk of breast cancer (OR=14.73; 95% CI= 9.88-18.86). Conclusion: XRCC4 c. 1394G>T may be associated with breast cancer development among Filipinos.

Marine Oomycetes (Halophytophthora and Salispina): A Potential Source of Fatty Acids with Cytotoxic Activity Against Breast Adenocarcinoma Cells (MCF7).

Marine oomycetes are ubiquitous, fungus-like eukaryotes known to produce fatty acids with potential anticancer activity. The long chain omega-3 and omega-6 fatty acids are currently popular and considered as safe when used as nutraceuticals in cancer treatment. In this study, crude fatty acids from three marine oomycetes, Halophytophthora spp. (T12GP1 and T12YBP2) and Salispina hoi (USTCMS 1611), were explored for their cytotoxic and apoptotic potentials against human breast adenocarcinoma cells (MCF7) and normal human dermal fibroblasts (HDFn). Extracts from mycelia mats consisted of diverse saturated, monounsaturated, and polyunsaturated fatty acids such as linoleic, α-linolenic, γ-linolenic, eicosatrienoic and eicosapentaenoic acids. The crude fatty acids from all three oomycetes in in vitro assays for cytotoxicity showed no toxicity (30% toxicity values) on HDFn cells. On MCF7 cells, however, IC50 values of 23.44, 15.63, and 26.15 µg/mL were obtained with extracts from Halophytophthora T12GP1 and T12YBP2 and S. hoi, respectively. Treated MCF7 cells exhibited deformed cell membrane in MTT assay and also aggregation of DNA and disruption of nuclear membrane aggregation in nuclear staining; further, green signals indicative of apoptosis was recorded in caspase 3/7 assay.

Do Economic Evaluations in Primary Care Prevention and the Management of Hypertension Conform to Good Practice Guidelines? A Systematic Review.

Background: Results of previous research have identified the need for further investigation into the compliance with good practice guidelines for current decision-analytic modeling (DAM). Objective: To identify the extent to which recent model-based economic evaluations of interventions focused on lowering the blood pressure (BP) of patients with hypertension conform to published guidelines for DAM in health care using a five-dimension framework developed to assess compliance to DAM guidelines. Methods: A systematic review of English language articles was undertaken to identify published model-based economic evaluations that examined interventions aimed at lowering BP. The review covered the period January 2000 to March 2015 and included the following electronic bibliographic databases: EMBASE and Medline via Ovid interface and the Centre for Reviews and Dissemination's (CRD) NHS-EED. Data were extracted based on different components of good practice across five dimensions utilizing a framework to assess compliance to DAM guidelines. Results: Thirteen articles were included in this review. The review found limited compliance to good practice DAM guidelines, which was most frequently justified by the lack of data. Conclusions: The assessment of structural uncertainty cannot yet be considered common practice in primary prevention and management of hypertension, and researchers seem to face difficulties with identifying sources of structural uncertainty and then handling them correctly. Additional guidelines are needed to aid researchers in identifying and managing sources of potential structural uncertainty. Adherence to guidelines is not always possible and it does pose challenges, in particular when there are limitations due to data availability that restrict, for example, a validation process.

Cost-effectiveness analysis of different systolic blood pressure targets for people with a history of stroke or transient ischaemic attack: Economic analysis of the PAST-BP study.

BACKGROUND: The PAST-BP trial found that using a lower systolic blood pressure target (<130 mmHg or lower versus <140 mmHg) in a primary care population with prevalent cerebrovascular disease was associated with a small additional reduction in blood pressure (2.9 mmHg). OBJECTIVES: To determine the cost effectiveness of an intensive systolic blood pressure target (<130 mmHg or lower) compared with a standard target (<140 mmHg) in people with a history of stroke or transient ischaemic attack on general practice stroke/transient ischaemic attack registers in England. METHODS: A Markov model with a one-year time cycle and a 30-year time horizon was used to estimate the cost per quality-adjusted life year of an intensive target versus a standard target. Individual patient level data were used from the PAST-BP trial with regard to change in blood pressure and numbers of primary care consultations over a 12-month period. Published sources were used to estimate life expectancy and risks of cardiovascular events and their associated costs and utilities. RESULTS: In the base-case results, aiming for an intensive blood pressure target was dominant, with the incremental lifetime costs being £169 lower per patient than for the standard blood pressure target with a 0.08 quality-adjusted life year gain. This was robust to sensitivity analyses, unless intensive blood pressure lowering reduced quality of life by 2% or more. CONCLUSION: Aiming for a systolic blood pressure target of <130 mmHg or lower is cost effective in people who have had a stroke/transient ischaemic attack in the community, but it is difficult to separate out the impact of the lower target from the impact of more active management of blood pressure.

Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70 years with suboptimal control and established cardiovascular disease or additional cardiovascular risk diseases (TASMIN-SR).

BACKGROUND: A previous economic analysis of self-management, that is, self-monitoring with self-titration of antihypertensive medication evaluated cost-effectiveness among patients with uncomplicated hypertension. This study considered cost-effectiveness of self-management in those with raised blood pressure plus diabetes, chronic kidney disease and/or previous cardiovascular disease. DESIGN AND METHODS: A Markov model-based economic evaluation was undertaken to estimate the long-term cost-effectiveness of self-management of blood pressure in a cohort of 70-year-old 'high risk' patients, compared with usual care. The model used the results of the TASMIN-SR trial. A cost-utility analysis was undertaken from a UK health and social care perspective, taking into account lifetime costs of treatment, cardiovascular events and quality adjusted life years. A subgroup analysis ran the model separately for men and women. Deterministic sensitivity analyses examined the effect of different time horizons and reduced effectiveness of self-management. RESULTS: Base-case results indicated that self-management was cost-effective compared with usual care, resulting in more quality adjusted life years (0.21) and cost savings (-£830) per patient. There was a 99% chance of the intervention being cost-effective at a willingness to pay threshold of £20,000 per quality adjusted life year gained. Similar results were found for separate cohorts of men and women. The results were robust to sensitivity analyses, provided that the blood pressure lowering effect of self-management was maintained for more than a year. CONCLUSION: Self-management of blood pressure in high-risk people with poorly controlled hypertension not only reduces blood pressure, compared with usual care, but also represents a cost-effective use of healthcare resources.

Perfil físico y psicológico del adolescente victimario de Bullying, según percepción de los docentes, Barquisimeto, estado Lara / Physical and psychological profile of the adolescent victimary of Bullying

El término Bullying se refiere a cualquier forma de maltrato psicológico, verbal o físico producido entre escolares de forma reiterada a lo largo de un tiempo determinado tanto en el aula, como a través de las redes sociales, con el nombre específico de ciberacoso. Objetivo: determinar el perfil físico y psicológico del victimario de bullying. Método: estudio descriptivo transversal, con una población y muestra conformada por 15 docentes de educación básica y diversificada de la Unidad Educativa Colegio Inmaculada Concepción. Barquisimeto. El instrumento de recolección de datos fue una encuesta que permitió recabar datos sobre el perfil psicológico y físico del victimario. Los datos fueron procesados, analizados y se presentaron en cuadros y gráficos. Resultados: De los docentes estudiados casi la mitad imparten clases en educación diversificada y son del sexo masculino. El victimario de bullying fue percibido por los docentes con las siguientes características: fuerte y descuidado, insensible ante el sufrimiento, ofende a los demás, pierde el control ante situaciones de tensión, pierde la calma ante los conflictos, es inquieto e incapaz de aceptar normas, incumple con sus asignaciones escolares y los padres no muestran interés en la conducta asumida por su hijo/a. Conclusión: se logró obtener información detallada respecto al victimario del bullying para describir su perfil físico y psicológico, lo cual podría contribuir a tomar medidas preventivas para disminuir esta forma de agresión a nivel escolar.

Bullying refers to any form of psychological, verbal or physical abuse that occurs among school children repeatedly over a given period of time, both in the classroom and through social networks, this last form with the specific name of cyber bullying. Objective: to determine the physical and psychological profile of the bullying victimizer. Method: cross-sectional descriptive study. A group of 15 teachers from basic and diversified education of the Inmaculate Conception Educational Unit in Barquisimeto, Lara state were included. Data were collected by means of a survey that allowed the construction of the psychological and physical profile of the victimary. Data were processed, analyzed and presented in tables and graphs. Results: Almost half of the teachers were male and teach in diversified education. The bullying perpetrator was perceived by teachers as having the following characteristics: strong and careless, insensitive to suffering, offensive to others, loses control in tense situations, loses his temper in the face of conflict, is restless and unable to accept rules, does not comply with their school assignments and his parents are careless about the behavior assumed by their child. Conclusion: detailed information regarding the bullying victim was obtained. This allowed the description of their physical and psychological profile, which may contribute to the implementation of preventive measures to decrease this form of aggression at school.

Eritema multiforme minor: A propósito de un caso / Erythema multiforme minor: Clinical case presentation

El eritema multiforme o polimorfo (EM) puede presentarse como reacción adversa al uso de medicamentos o como consecuencia de una infección por diversos agentes. Es una enfermedad cutánea autolimitada, cuya duración puede ser de 4 a 6 semanas, en ocasiones recurrente, que se caracteriza por lesiones "en diana", que se distribuyen principalmente en extremidades y cara, aunque puede comprometer el tronco. En un alto porcentaje puede comprometer una o más mucosas. Clásicamente se ha subdividido en una forma menor y otra mayor, esta última con lesiones más extensas y con mayor compromiso del estado general. Se presenta el caso de un preescolar masculino con EM y se realiza una revisión de los aspectos clínicos, centrándose sobre todo en las lesiones en escarapela o diana.

Erythema multiforme or polymorph (EM) may occur as an adverse reaction to medication or due to infection by various agents. It is a self-limiting skin disease that lasts four to six weeks, sometimes recurring, characterized by target lesions mainly distributed in extremities and face, but can also compromise torso. It may compromise one or more mucous in a high percentage of cases. Classically, EM has been subdivided into two types of clinical presentation: minor and a major, the latter with more extensive lesions and greater general compromise. We present the case of a preschooler boy with EM and a review of the most important clinical aspects with special emphasis on target lesions.

Melanosis pustulosa neonatal transitoria: A propósito de un caso / Transient neonatal pustular melanosis: Presenting a case

La melanosis pustulosa neonatal transitoria (MPNT) es un proceso benigno caracterizado por la presencia de máculas, vesículas y pústulas visibles desde el momento del nacimiento y con resolución en las primeras semanas o meses de vida. Esta patología tiene una prevalencia global menor a 1% y no requiere tratamiento, pero es fundamental su reconocimiento y así realizar un buen diagnóstico diferencial para poder tranquilizar a los padres y evitar actitudes terapéuticas innecesarias que pueden ser iatrogénicas. Se presenta el caso de un recién nacido de 48 horas de edad, con lesiones pustulosas generalizadas, que se resolvieron al sexto día de edad, dejando máculas hiperpigmentadas.

Transient neonatal pustular melanosis (TNPM) is a benign condition characterized by the development of maculae, vesicles and pustules that are present at birth. It resolves within the early weeks and months of life. This pathology has a global minor prevalence of 1 % and requires no treatment. However, it is important that a correct differential diagnosis is performed in order to reassure the parents and avoid unnecessary therapeutic approaches that may be iatrogenic. This study presents the case of a newborn child of 48 hours of age, with widespread pustular injuries that resolved by the sixth day of age, with hyperpigmented maculas as sequelae.

[Evaluation of egressing students of the specialization course on Family Care Health in Espírito Santo State, Brazil]. / Avaliação dos egressos do curso de especialização em Saúde da Família no Espírito Santo, Brasil.

The purpose of this study was to evaluate the contribution of the specialization course on Family Health Care (PG-PSF), in Espírito Santo State, for the reorientation of the practices in health. It is a cross-sectional study with a population of 47 egressing students of the PG-PSF course in 2007. It was used a semi-structured questionnaire for data collection data. The analysis of the generated contributions showed some reports regarding the changes in the work actions after the acquired knowledge during the course. The majority of the students declared that the acquired knowledge have applicability in their daily work. They also declared that can plan their actions based in the epidemic profile of the area where worked. The relevance of this course was verified for the egressing students, with the perspective of a constant adaptation of the contents and improvement of the didactic-pedagogic process, through a system of continuous education or permanent education, as well as the attendance processes and supervision in service.

Doença de Chagas nas mulheres em idade fértil da Comunidade Hispana Armênia em São Paulo / Chagas disease in women of childbearing age from the Armenian Hispana Community in São Paulo

INTRODUÇÃO: Programas de controle da transmissão vetorial e transfusional da doença de Chagas alcançaram sucesso no Brasil, Chile e Uruguai, porém, a transmissão congênita vem demonstrando importância crescente e pode ocorrer em 71% dos recém-nascidos de mães com infecção aguda durante a gravidez e em 1,6% na fase crônica de doença. A migração de mulheres em idade fértil de outros países da América Latina para o Brasil pode aumentar a incidência da transmissão vertical no País, justificando a necessidade de acompanhamento médico adequado em mulheres grávidas e tratamento imediato de crianças com infecção congênita, já que são altas as taxas de cura. Os objetivos do estudo foram estimar a prevalência da doença em mulheres com idade fértil da Comunidade Hispana Armênia, informar e esclarecer dúvidas a respeito da doença. MÉTODO: Depois de realizada a coleta de 5 ml de sangue, em tubo ativador de coágulo com gel separador, de cada voluntária, o diagnóstico da doença de Chagas foi estabelecido por dois testes sorológicos de imunofluorescência indireta e um teste imunoenzimático - ELISA indireto. RESULTADOS: Das 84 coletas realizadas, quatro resultados foram excluídos, por serem de mulheres menopausadas. De 80 amostras analisadas, duas apresentaram resultado positivo para doença de Chagas. CONCLUSÃO: Conclui-se que na comunidade estudada, a preocupação com a transmissão vertical da doença de Chagas é baixa, o que não exclui a necessidade de implementar programas de saúde pública que contemplem orientação, esclarecimentos contínuos, a triagem de rotina em gestantes e recém-nascidos, assegurando assim, a detecção e tratamento de casos agudos e crônicos. (AU)

Avaliação dos egressos do curso de especialização em saúde da família no Espírito Santo, Brasil / Evaluation of egressing students of the specialization course on family care health in Espírito Santo State, Brazil

Este estudo tem por objetivo descrever o perfil dos egressos e avaliar a contribuição do curso de pós-graduação lato sensu em Saúde da Família (PG-PSF), no Estado do Espírito Santo, para a reorientação das práticas em saúde. É um estudo do tipo descritivo de corte transversal, sendo a amostra composta por quarenta e sete egressos do curso PG-PSF em 2007. Para a coleta de dados, aplicou-se um questionário semiestruturado, contendo questões abertas e fechadas. A análise das contribuições geradas revelou mudanças nas ações de trabalho após os conhecimentos adquiridos durante o curso. A maioria afirmou que tais conhecimentos têm aplicabilidade no cotidiano do trabalho e grande parte dos entrevistados conseguiu, após o curso, planejar suas ações com base no perfil epidemiológico da área na qual atua. Constatou-se a relevância do curso para a capacitação profissional dos alunos, com a constante adequação dos conteúdos do processo didático-pedagógico, através de uma consistente política de educação permanente que tenha impactos e incorporação nos processos de trabalho, além da necessidade de programas de educação continuada que dêem conta das necessidades específicas de cada prática profissional e da institucionalização dos processos de avaliação e autoavaliação como parte inseparável da organização do trabalho.

The purpose of this study was to evaluate the contribution of the specialization course on Family Health Care (PG-PSF), in Espírito Santo State, for the reorientation of the practices in health. It is a cross-sectional study with a population of 47 egressing students of the PG-PSF course in 2007. It was used a semi-structured questionnaire for data collection data. The analysis of the generated contributions showed some reports regarding the changes in the work actions after the acquired knowledge during the course. The majority of the students declared that the acquired knowledge have applicability in their daily work. They also declared that can plan their actions based in the epidemic profile of the area where worked. The relevance of this course was verified for the egressing students, with the perspective of a constant adaptation of the contents and improvement of the didactic-pedagogic process, through a system of continuous education or permanent education, as well as the attendance processes and supervision in service.