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INTRODUÇÃO: os principais aspectos clínicos da esquistossomose mansônica (EM) são determinados pelas lesões vasculares e suas repercussões na hemodinâmica portal. O acesso não-invasivo a essas alterações tem importância fundamental na avaliação da morbidade da doença e na identificação de pacientes com maior risco de complicações. Este estudo de campo realizado em três áreas com níveis distintos de endemicidade, objetivou: a) verificar a viabilidade da USDoppler em estudos de campo; b) identificar os sinais de morbidade relacionados à EM e correlacioná-los com a endemicidade das áreas estudadas; c) determinar os valores dopplervelocimétricos do sistema vascular esplâncnico na EM; e d) determinar as alterações hemodinâmicas na EM. CASUÍSTICA E MÉTODOS: foram examinados por meio da US-Doppler, 554 pacientes esquistossomóticos, divididos em três grupos, de acordo com o local de realização do exame: área de baixa endemicidade (n=109); área de média endemicidade (n=255) e área de alta endemicidade (n=190). Avaliaram-se o fígado, o baço, a vesícula biliar, os vasos portais, as artérias hepática e esplênica, as veias hepáticas e os vasos colaterais. Para análise da morbidade da doença, foi utilizado o protocolo do Niamey Working Group (2000). O protocolo Doppler foi elaborado para fins específicos desta pesquisa. RESULTADOS: houve correlação estatisticamente significante entre as frequências de: espessamento periportal, esplenomegalia, espessamento da parede da vesícula biliar, aumento do calibre dos vasos portais, redução do lobo direito e o nível de endemicidade das áreas. Não houve relação significativa entre a hipertrofia do lobo esquerdo e a endemicidade das áreas. Considerando-se os achados ultrassonográficos de espessamento periportal e/ou esplenomegalia, os pacientes foram alocados em quatro grupos de acordo com a forma de apresentação da doença. As formas hepatointestinal e hepatoesplênica foram mais frequentes na área de alta endemicidade, demonstrando associação significativa entre o nível de endemicidade e a gravidade da doença. A velocidade máxima de fluxo da veia porta apresentou valores normais na maioria dos casos. O fluxo hepatofugal, a trombose portal e a circulação colateral foram pouco frequentes e identificados apenas na área de alta endemicidade. A veia gástrica esquerda foi a colateral prevalente. As veias hepáticas apresentaram padrão de fluxo alterado em 1/4 dos casos, alteração essa relacionada à presença e à intensidade de espessamento periportal. A artéria hepática não apresentou alterações significativas nos parâmetros avaliados. As alterações da artéria esplênica (aumento do calibre, da velocidade de pico sistólico e do índice de resistividade) foram mais frequentes na área de alta endemicidade e na forma hepatoesplênica, com diferença significativa entre os grupos. CONCLUSÃO: a US-Doppler mostrouse viável e adequada para avaliação das alterações hemodinâmicas da EM em estudos de campo. Os sinais de morbidade detectados ultrassonograficamente são parâmetros fidedignos do nivel de endemicidade da EM, e, as informações funcionais do sistema portal obtidas pela US-Doppler, contribuem para o diagnóstico mais preciso das formas clínicas da doença nas áreas endêmicas / INTRODUCTION: The main clinical aspects of schistosomiasis mansoni (SM) are determined by vascular lesions and their effects on the portal hemodynamic. The non-invasive access to these alterations has fundamental importance in assessing the morbidity of the disease and in identifying patients at higher risk of complications. This field study, carried out in three areas with different levels of endemicity, aimed to: a) assess the feasibility of Doppler ultrasound (US) in fieldbased studies; b) identify the signs of morbidity related to SM and correlate them with the endemicity of the studied areas; c) determine the dopplervelocimetric values of the splanchnic vascular system in SM; and d) determine the hemodynamic changes in SM. PATIENTS AND METHODS: Doppler US was performed in 554 patients with SM, divided into three groups according to the local of the examination: low endemicity area (n=109), medium endemicity area (n=255), and high endemicity area (n=190). The liver, the spleen, the gallbladder, the portal vessels, the hepatic and splenic arteries, the hepatic veins and collateral vessels were evaluated. The Niamey Working Group (2000) protocol was used for the disease morbidity analysis. The Doppler protocol was developed for the specific purposes of this study. RESULTS: There was a statistically significant correlation between the frequency of: periportal thickening, splenomegaly, gallbladder wall thickening, dilatation of the portal vessels, right lobe atrophy and the endemicity level of the areas. No significant correlation between the left lobe hypertrophy and the endemicity level was observed. Taking into account the US findings of periportal thickening and/or splenomegaly, the patients were allocated in four groups according to the form of the disease. The hepatointestinal and hepatosplenic forms were more frequent in the high endemicity area, showing a significant association between the endemicity level and the disease severity. The maximum flow velocity in portal vein showed normal values in most cases. The hepatofugal flow, portal vein thrombosis and collateral vessels were infrequent and identified only in the area of high endemicity. The left gastric vein was the prevalent collateral. The hepatic veins flow pattern was abnormal in 1/4 of the cases, with significant relation to the presence and intensity of periportal thickening. The hepatic artery had no significant alterations in the evaluated parameters. The splenic artery changes (increase of its diameter, peak systolic velocity and resistive index) were more frequent in the high endemicity area and in the hepatosplenic form, with significant difference between the analysed groups. CONCLUSION: Doppler US proved to be feasible and appropriate for the evaluation of the SM hemodynamic changes in field-based studies. The morbidity signs detected by ultrasound are reliable parameters of the endemicity level of SM, and the functional information of the portal system obtained by Doppler US, contributes to a more accurate diagnosis of clinical forms of the disease in endemic areas

Adverbial connectors join together sentences and units in a text to signal logical relations. Appropriately used, they can help the reader to make sense of the text. The usage of adverbial connectors can create problems for foreign language learners, and is often shown as under- , over- and misuse of connectors. In this study, a quantitative analysis of connector usage of advanced EFL learners’ and native speakers’ student writing is presented. For the current corpus-based study, three sub-corpora of the SUSEC (Stockholm University Student English Corpus) were chosen. The sample includes 164 linguistic essays from students at Stockholm University and 82 linguistic essays from students at King’s College in London. The analysis, where the learners’ connector usage is compared to that of native speakers, is based on 69 connectors. The results show that both the learners and the native speakers rely on a rather small set of these connectors in their writing. As a group, the advanced Swedish EFL learners underuse connectors in their written production. Additionally, the learners significantly overuse 12 and underuse 6 connectors. Similarities between the learners and the native speakers were found in the positioning of the connectors. Both groups prefer the most frequently used connectors in the medial position of a sentence, and prefer mostly the same set of connectors in the different positions of a sentence, although some differences in the positioning were also found. The findings create a basis for future research where a qualitative analysis of the connector usage could be carried out in order to increase knowledge of the interlanguage of the learners. The findings could also be used for pedagogical purposes.

We carried out a population-based study on low-grade diffuse gliomas in the Canton of Zurich, Switzerland (population 1.16 million). From 1980 to 1994, 987 astrocytic and oligodendroglial tumors were diagnosed, of which 122 (12.4%) were low-grade (WHO grade II). The incidence rates adjusted to the World Standard Population, per million population per year, were 2.28 for low-grade diffuse astrocytomas, 0.89 for oligoastrocytomas, and 2.45 for oligodendrogliomas. The survival rate (mean follow-up 7.5±4.8 years) was highest for patients with oligodendroglioma (78% at 5 years, 51% at 10 years), followed by those with oligoastrocytoma (70% at 5 years, 49% at 10 years) and fibrillary astrocytoma (65% at 5 years, 31% at 10 years). Survival of patients with gemistocytic astrocytoma was poor, with survival rates of 16% at 5 years and 0% at 10 years. Younger patients (<50 years) survived significantly longer than older patients (>50 years; P=0.013). DNA sequencing, performed in 84% of cases, revealed that TP53 mutations were most frequent in gemistocytic astrocytomas (88%), followed by fibrillary astrocytomas (53%) and oligoastrocytomas (44%), but were infrequent (13%) in oligodendrogliomas. The presence of TP53 mutations was associated with shorter survival of patients with low-grade diffuse gliomas (log-rank test; P=0.047), but when each histological type was analyzed separately, an association was observed only for oligoastrocytoma (P=0.05). Loss on 1p and 19q were assessed by quantitative microsatellite analysis in 67% of cases. These alterations were frequent in oligodendrogliomas (1p, 57%; 19q, 69%), less common in oligoastrocytomas (lp, 27%; 19q, 45%), rare in fibrillary astrocytomas (lp, 7%; 19q, 7%), and absent in gemistocytic astrocytomas. None of these alterations were predictive of survival. These results establish the frequency of key genetic alterations in low-grade diffuse gliomas at a population-based level. Multi-variate Cox's regression analysis indicates that only age and histological type, but not genetic alterations, are significant predictive factors.

Background: Stroke is a global health problem and one of the most common causes of death and disability in Sweden. In the event of an ischemic stroke, parts of the brain tissue lose circulation due to thrombosis, embolism or brain hemorrhage leading to brain damage. Due to brain injury, the stroke affected patient may have neurological impairments and will find themselves in a sudden elevated need of care. The patient may be affected somatically as well as cognitively with difficulties regarding, among other things, mobilization, speech and language as a result. The nurse is responsible for the care among all hospitalized patients.  Aim: The aim of this literature based study was to describe the experiences of stroke-affected patients of nurse’s care in stroke units. Method: The chosen method was a literature study based on the analysis of qualitative scientific articles. Results: The results showed that patients appreciated nurses who took time to acknowledge them, listen to them and who were involved in their rehabilitation. Due to lack of communication, active listening and initiative to make conversations with the patients, the person-centered care failed on many occasions. Conclusion: Updated knowledge about person-centered care needs to be implemented to reduce the asymmetric care relationship between patient and nurse to promote patients' health and well-being.

Made available in DSpace on 2016-03-22T17:27:39Z (GMT). No. of bitstreams: 1 LUCIANO SOUZA.pdf: 168635 bytes, checksum: 94c46027ad00ab09128c27fe9b95c3a6 (MD5) Previous issue date: 2006-10-31 / The aim of this study was to identify factors associated to high depressive sintomatology in adolescents with ages between 11 and 15 years in Pelotas - south of Brazil. In this cross-sectional population-based investigation, 79 of the 448 sections of Pelotas were randomly selected. All of the residences of the selected sections were visited seeking to the youths who answered to a self-report and secret questionnaire that contained a scale for depressive symptoms - Children's Depression Inventory (CDI). In total, 1265 adolescents were located for the research team and 1145 answered to the questionnaire. The prevalence found for high depressive sintomatology was 2,1%. After logistic regression adjusted to a hierarchical model, a worse socioeconomic condition of environment, history of academic disapproval, absence of religious practice, to have taken drunkenness in the last month as well as the indicative of conduct disorder, increased the adolescents chances to present high depressive sintomatology. Therefore, the needs of a review on public politics that approach the themes associated to the depressive sintomatology are evidence / O objetivo deste estudo foi identificar os fatores associados à elevada sintomatologia depressiva em adolescentes com idades entre 11 e 15 anos em Pelotas sul do Brasil. Nesta investigação transversal de base populacional, 79 dos 448 setores censitários de Pelotas foram selecionados aleatoriamente. Todas as residências dos setores selecionados foram visitadas visando à captação de jovens que respondessem a um questionário auto-aplicado e sigiloso que continha uma escala para aferição da sintomatologia depressiva Children's Depression Inventory (CDI). No total, 1265 adolescentes foram localizados pela equipe de pesquisa sendo que 1145 responderam ao questionário. A prevalência de elevada sintomatologia depressiva encontrada foi de 2,1%. Após a regressão logística ajustada a um modelo hierárquico, uma pior condição sócio-econômica da ambiente, história de reprovação acadêmica, ausência de prática religiosa, ter tomado porre no último mês assim como o indicativo de transtorno de conduta, aumentaram as chances dos adolescentes em estudo apresentarem elevada sintomatologia depressiva. Portanto, se evidenciam as necessidades de reformulações de políticas públicas que abordem os temas associados à sintomatologia depressiva.

This study is a survey concerning learning on equal terms. The purpose of the survey is to get a look into how teachers of today integrate students to obtain an individually adapt education. A good education is where every single student can evolve from an individual level and how education is adapted to let high-achieving students keep their motivation and thus develop from their own level of knowledge. Data has been collected through a qualitative method using semi-structured interviews. In the result the answers of the interviews are presented and it shows that teachers turn their focus towards low-achieving students. Low-achieving students are more in need of support to reach the required amount of knowledge, but that the high-achieving students must not be forgotten by the teachers.

Clostridium difficile colitis (CDC) is associated with a higher risk of acute death among hospitalized ulcerative colitis (UC) patients. However, the risk of colectomy with CDC in these patients has varied across studies. No study has assessed the long-term health impact of CDC in UC patients. Therefore, the present study evaluated the impact of CDC on five-year health outcomes of hospitalized UC patients based on Ontario health administrative data. No overall association was observed between CDC and five-year risks of colectomy or death in overall cohort. However, patients who were discharged from hospital without undergoing colectomy demonstrated marginally higher five-year risks of colectomy and hospital re-admission. Mortality risk and length of stay during index hospitalization were also higher in patients with CDC. Analysis of a parallel cohort of UC patients derived using a published case definition corroborated most of these results, but demonstrated a higher five-year mortality risk with CDC.

Clostridium difficile colitis (CDC) is associated with a higher risk of acute death among hospitalized ulcerative colitis (UC) patients. However, the risk of colectomy with CDC in these patients has varied across studies. No study has assessed the long-term health impact of CDC in UC patients. Therefore, the present study evaluated the impact of CDC on five-year health outcomes of hospitalized UC patients based on Ontario health administrative data. No overall association was observed between CDC and five-year risks of colectomy or death in overall cohort. However, patients who were discharged from hospital without undergoing colectomy demonstrated marginally higher five-year risks of colectomy and hospital re-admission. Mortality risk and length of stay during index hospitalization were also higher in patients with CDC. Analysis of a parallel cohort of UC patients derived using a published case definition corroborated most of these results, but demonstrated a higher five-year mortality risk with CDC.

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