O presente trabalho teve como objetivo identificar e caracterizar as causas de morte de aves de rapina de vida livre da região do município de São Paulo e áreas vizinhas. O estudo incluiu 114 aves de rapina, sendo 40 da ordem Falconiformes e 74 da ordem Strigiformes, atendidas pela Divisão de Fauna do município de São Paulo, São Paulo, Brasil, durante o período de outubro de 2002 a maio de 2006. As causas de morte identificadas foram: eutanásia (41,2%); causas não-infecciosas (32,5%); causas infecciosas (19,3%); causas parasitárias (3,5%) e causas indeterminadas (3,5%). As lesões traumáticas osteoarticulares foram o motivo mais freqüente de eutanásia (51,1%), seguindo-se das lesões em tecidos moles (17,0%), lesões isquêmicas das extremidades das asas (17,0%), tricomoníase (10,6%) e causas variadas (4,3%). Os traumas se destacaram como uma importante causa de morte natural ou induzida (eutanásia). Dentre as causas de morte infecciosas, as infecções por protozoários (tricomoníase) (54,5%) foram as mais freqüentes, seguindo-se das infecções bacterianas (40,9%). O presente trabalho permitiu identificar os principais processos que causam a morte de aves de rapina, Falconiformes e Strigiformes na região de São Paulo, fornecendo importantes subsídios para o atendimento clínico e tratamento das condições mais comumente encontradas nessa população. / The goal of this work was to identify and characterize the causes of death of free-living birds of prey from São Paulo city and its surroundings. In the present work 114 raptors were studied, 40 of them belonging to the Falconiformes order and 74 to the Strigiformes order, all admitted at the São Paulo City Fauna Division, Brazil, during the period of October 2002 to May 2006. The causes of death were determined as: euthanasia (41,2%), non-infectious causes (32,5%), infectious causes (19,3%), parasitic diseases (3,5%) and indeterminate (3,5%). Bones and joints lesions were the most frequent cause that lead to euthanasia (51,1%), followed by soft tissue lesions (17%), wing tips ischemic lesions (17%), Trichomoniasis (10,6%) and various causes (4,3%). Trauma outstands as an important cause of natural or induced death, while in the field of infectious diseases trichomoniasis (54,5%) was the most frequent, followed by bacterial infections (40,9%). The present study allowed us to identify the principal processes that cause the death of raptorial birds at São Paulo City. These findings also provided important information for clinical attendance and medical treatment for the most common conditions in this population.

Neste trabalho foi proposto o estudo prospectivo de gestações após a 40a semana, objetivando: a) verificar os índices de morbidade e mortalidade perinatais; b) identificar os testes de avaliação da vitalidade fetal mais adequados para a vigilância destas gestações; c) comparar os resultados dos testes de avaliação da vitalidade fetal com os resultados perinatais na 1a e 2a semana, após a 40a semana de gestação, para testar o protocolo do Serviço. Para a realização do estudo, selecionaram-se 52, gestantes divididas em 2 grupos: GI (1a semana) com 32 gestantes e GIl (2a semana) com 20 gestantes. Acompanhou-se a vitalidade fetal com a Cardiotocografia de Repouso e Intraparto, Teste da Estimulação Sônica, Avaliação do Volume do Líquido Amniótico através da Técnica dos Quatro Quadrantes, Perfil Biofisico Fetal e Dopplerfluxometria Uterina e Umbilical, realizados 2 vezes na semana. Os resultados neonatais e os índices de morbidade foram: Índices de Apgar no 10 e 50 minutos (alterados < 7), pH da artéria umbilical (alterado < 7,20), peso dos recém-nascidos, tempo de internação dos recém-nascidos, oligoidrâmnia, líquido amniótico meconial, alterações na cardiotocografia com presença de desacelerações e índices de cesárea. O estudo permitiu como resultados e conclusões: a) a incidência de oligoidrâmnio foi de 44,23%, líquido meconial de 28,85%, cardiotocografia alterada, 50,00% e partos cesáreos, 57,70%, não havendo óbito fetal ou neonatal. Não houve alterações significativas nos índices de Apgar, pH da artéria umbilical e tempo de internação dos recém-nascidos. b) A cardiotocografia e, principalmente, a avaliação do volume do líquido amniótico, pelo índice de líquido amniótico, foram os métodos mais adequados na detecção de alterações verificadas neste grupo de gestantes. Do parâmetro ultra-sonográfico do Perfil Biofisico Fetal, apenas o Volume do Líquido Amniótico demonstrou ser importante. A Dopplerfluxometria (uterina e umbilical) não revelou nenhuma utilidade na vigilância destas gestações. c) A distribuição dos casos com oligoidramnia, líquido meconial, cardiotocografia alterada, índices de cesárea e pH da artéria umbilical < 7,20, semelhante na 41a semana (GI) e 42a semana (GIl), valida o protocolo do Serviço. d) Adicionalmente, este estudo permite ainda as seguintes observações: 1) importância da oligoidrâmnia e líquido meconial na determinação dos elevados índices de cesáreas; 2) incidência elevada (50,00) de nulíparas nesta casuística. / This study proposed pros.pectively the evaluation of the gestations after 40 weeks with these objectives: a) Analysis of the perinatal outcome. b) Identification of the proper test for fetal well-being assessment for this gestation. c) Comparation of these tests results with perinatal outcome at the first and second weeks after 40 weeks, therefore, testing the protocol of this Service. It recruited 52 patients divided in two groups: GI (1st week) with 32 patients and Gil (2nd week) with 20 patients. The fetal surveillance was assessed by antepartum and intrapartum cardiotocography, acoustic stimulation test, amniotic fluid volume assessment by the ultrasonographic four quadrant technique (amniotic fluid index), fetal biophysical profile and umbilical and uterine doppler velocimetry, ali tests were performed twice weekly. The neonatal outcome results and morbidity parameters were: Apgar index in 1st and s\" minutes (alterated < 7), umbilical artery pH (alterated < 7,20), the new born weight, oligohydramnios, meconium stained, deceleration (DIP 11 or umbilical deceleration) and cesarean section rates. The study permitted these results and conclusions: a) The oligohydramnios, meconium stained, cardiotocography alterations and cesarean section incidences were 44,23%, 28,85%, 50,00% and 57,70%, respectively. There was no fetal death. b) The cardiotocography and amniotic fluid assessment by the amniotic fluid index, were the best tests to detect the alterations verified. The amniotic fluid volume was the most important parameter in the fetal biophysical profile. Doppler (uterine and umbilical) revealed no utility. c) The equal distribution of the oligohydramnios, meconium stained, altereted cardiotocography, cesarean section and umbilical artery pH < 7,20 cases in the group studied reassure the Service protocol. d) In addition this study also permitted observation of: 1) The importance of the meconium stained in the cesarean section rate. 2) The nuliparus elevated incidence (50,00%) in this group.

Made available in DSpace on 2016-04-26T14:54:41Z (GMT). No. of bitstreams: 1 Bernadete de Oliveira.pdf: 9001908 bytes, checksum: 5fe5469188e85fd48ffd88d87ee8a3a1 (MD5) Previous issue date: 2014-04-25 / The present study was prompted by the question Who will look after us in 2030? . It was derived from an anthropological perspective and gradually evolved into sociopolitical questions. Research was developed as a quantitative, qualitative and prospective study carried out at the Regional Health Department 1 (DRS1) in the Greater São Paulo Area (covering all the municipalities in the São Paulo Metropolitan Region) between January 2011 and December 2012. The study relied on the recommendations set forth by the National Elderly Health Care Policy and the Book of Primary Care 19 published by the Brazilian Ministry of Health. Study Objective: To investigate opinions from the São Paulo City Health Department (SMS) representatives and users at the City Health Council (CMS) and from elderly representatives at the Elderly Council (CMI) within the DRS1 about the initiatives undertaken in elderly health care so as to provide a consensual perspective on that question. Methodology and Results: In the first phase of the study, recorded face-to-face interviews and a mixed questionnaire were used with 109 subjects. The following council member categories were identified: users (n=37; 34.0%), managers (n=27; 24.8%), workers (n=12; 11.0%), as well as government (n=18; 16.5%) and civil society (n=15; 13.8%) segments predominantly within the age cohorts of 50 years and older, whereas females (n=57; 52.3%) and married individuals (n=70; 62.2%). The average education level is 13.3 years (±4.5); knowledge on elderly care by the majority of respondents comes from participation in related events. The standard response on the political role of council members was scattered with most subjects indicating a watchdog role. Decision-making to approve policies originating at different power levels was not even mentioned by respondents. In the second phase of the study, the Delphi Method was used and 51 subjects presented a prospective view and reached an opinion by consensus. Responses to the questionnaire were sent by e-mail. Respondents were thus categorized: 13 from the elderly group (72.2%), 14 from the SMS group (70.0%), 22 from the user group (73.3%). Statistical analysis of the findings revealed consensus on the following topics: elderly reception, global assessment, health education, what they like best about healthcare facilities, active aging, promotion of active aging, medium and high complexity health care, pharmaceutical care, elderly accessibility. In all groups, elderly people seek public healthcare services to have their prescription changed and medical treatment . Among the questions disregarded by respondents is the one about elderly services and actions deemed necessary... in which the SMS group unanimously responded that a support hospital for the elderly to recover and return home with independence and autonomy would not be necessary. With regard to skilled professionals trained to deliver elderly healthcare services and actions by 2030 , the SMS group was convinced that all healthcare professionals in public services would have to be trained . All groups agreed that they will need caregiving in old age, while the SMS elderly group wishes that my family and trained healthcare professionals would take care of me in old age... . Final Considerations: In the near future, City Councils are likely to become a powerful social participation tool, an instrument of achievement in the public sphere and of public policies that can satisfactorily meet the demands of the future, especially in old age. Furthermore, both the State and civil society require structural strengthening and organization, so that power can circulate in a decentralized manner and empowerment is established for the exercise of full citizenship of society members within a democratic perspective / Estudo norteado pela pergunta Quem cuidará de nós em 2030 , partiu de uma perspectiva antropológica e mergulhou, paulatinamente, em questionamentos sociopolíticos. Pesquisa definida como quantitativo, qualitativo e prospectivo, desenvolvido no Departamento Regional de Saúde 1 (DRS1): Grande São Paulo (100% dos municípios da Região Metropolitana de São Paulo), no período de janeiro de 2011 a dezembro de 2012. Ancorado nas recomendações da Política Nacional da Saúde do Idoso e do Caderno de Atenção Básica 19 , do Ministério da Saúde. Objetivo: investigar as opiniões de representantes da Secretaria Municipal de Saúde (SMS) e dos usuários, no Conselho Municipal de Saúde (CMS), e de representantes dos idosos, no Conselho Municipal do Idoso (CMI), no DRS1, a respeito de iniciativas na área de atenção à saúde do idoso, a fim de fornecer perspectivas consensuais àquela pergunta. Aporte Metodológico e Resultados: Na primeira etapa, Entrevista presencial gravada, utilizou-se o Questionário misto, participaram 109 sujeitos e foram identificadas as categorias de conselheiros: segmentos usuário (n=37; 34,0%), gestor (n=27; 24,8%) e trabalhador (n=12; 11,0%), do governo (n=18; 16,5%) e da sociedade civil (n=15; 13,8%); com predominância nas faixas etárias de 50 anos e mais de idade, no sexo feminino (n=57, 52,3%) e no estado civil casado (n=70; 62,2%); 13,3 anos de estudo (±4,5) em média; para a maioria que tem conhecimento na área do idoso, este advém da participação em eventos. O padrão de resposta sobre o papel político foi disperso, a maioria indicou a função de fiscalizador. A tomada de decisões para a aprovação de políticas originadas nos diferentes níveis de Poder não foi sequer mencionado por eles. Na segunda etapa, Método Delphi, 51 sujeitos chegarem a visão prospectiva e ao consenso de opiniões ao responderam formulários, via correio eletrônico; estes opinantes foram desta maneira classificados: 13 do grupo dos idosos (ou 72,2%), 14 do grupo da SMS (ou 70,0%), 22 do grupo dos usuários (ou 73,3%). Na análise estatística dos resultados detectou-se o consenso de opiniões em torno dos temas: acolhimento, avaliação global, educação em saúde, o que gostam nas unidades básicas de saúde, envelhecimento ativo, promoção do envelhecimento ativo, atendimento em média e alta complexidades, assistência farmacêutica, acessibilidade. Para todos os grupos, os idosos buscam serviços de saúde para troca de receita e encaminhamentos . Das respostas preteridas ( voto nulo ), destaca-se aquela a respeito dos serviços e ações considerados necessários... , o grupo da SMS, unanimemente, julgou que não deveria vir a ser instituído um hospital de retaguarda para o idoso se recuperar e voltar para casa com independência e autonomia . A respeito dos profissionais capacitados para desenvolver serviços e ações na atenção à saúde do idoso em 2030 , este mesmo grupo estava convicto acerca de que Todos os profissionais da rede pública precisariam ser capacitados . Todos os grupos admitiram que irão necessitar de cuidados na velhice; o grupo dos idosos e da SMS desejam Que minha família e profissionais capacitados cuidassem de mim... . Considerações finais: Os Conselhos Municipais podem vir a tornar-se, num futuro próximo, um poderoso instrumento de participação social, de consecução da esfera pública e daquelas políticas públicas que atenderiam de maneira satisfatória as demandas do devir, especialmente, da velhice. Neste ínterim, tanto Estado como sociedade civil demandam fortalecimento estrutural e organização, para que o poder circule de forma descentralizada e se estabeleça o empoderamento e o exercício da cidadania plena de seus membros, dentro de uma perspectiva democrática

Foram estudados prospectivamente os linfonodos, em 19 pacientes com adenocarcinoma de reto distal através de tomografia pélvica e linfocintilografia pélvica e realizado o estudo comparativo dos métodos, tendo como base à anatomia patológica e o estadiamento clinico-cirúrgico. Foram comparados os exames obtendo-se que os métodos não são concordantes. E a linfocintilografia é método mais sensível para linfonodos do que a tomografia / They were studied prospectivamente the lymph nodes, in 19 patient with adenocarcinoma of distal rectum through pelvic tomography and pelvic lymphoscintigraphy and accomplished the comparative study of the methods, having as based to the pathological anatomy and the staging practise-surgical. It compared the exams to each other obtaining itself that the methods are not concordant. And the lymphoscintigraphy is more sensitive method for lymph nodes than for

The ACT automated admissions system was adopted by the Colleges and Universities in the Utah system of higher education in 1974. The automated admission system was conceived at a time when College enrollment all over the United States was decreasing, and thus was viewed by its proponents as a positive step in alleviating some of the articulation problems between post secondary institutions, high school counselors and prospective students. Educators who developed the program felt that it would be an advantage to prospective students by providing an admissions decision shortly after the ACT was taken. Automated admissions appears to be an advantage to high school counselors because it eliminates the need for a high school transcript in the admissions process, and because it reduces the amount of time the counselor is involved in the mechanics of the admissions process. This study represents an effort to determine the impact of the Automated Admissions system on the high school counselor and on prospective college students. The results of this study indicate that a significant number of Utah high school counselors favor the Automated Admissions system as opposed to "traditional" admissions systems formerly in use, because of the reduction in clerical work required of the counselor.

Despite the widespread use of project risk management, the results of such efforts are often underwhelming. Do project risk management practices somehow miss the point? To explore this idea I use a critical management studies framework to study project risk management. The approach prescribed in the Project Management Institute's Project Management Body of Knowledge is compared to the very different approach of a professional project manager. A theorised analysis of the difference between these approaches finds that they employ the logic of different knowledge-constitutive interests thereby making them suitable for different purposes. The study concludes with a discussion of how the results of this analysis can be presented to practitioners in a way consistent with the emancipatory agenda of critical management studies.

This thesis presents data on two separate areas relevant to the prevention of HIV and sexually transmitted infection (STI) transmission in homosexual men. These data arise from the community-based Health in Men (HIM) cohort of HIV-negative homosexual men in Sydney. First, the association of circumcision status with HIV and STIs was examined. Older age, ethnicity and country of birth were demographic factors independently associated with circumcision status. Self-report was a valid measure of circumcision status in this population. Overall, being circumcised was associated with a non-significant reduced risk of HIV seroconversion in the HIM cohort (HR 0.76, 95% CI 0.41-1.41, p=0.381). Among the one-third of participants predominantly practising the insertive role in anal intercourse (AI), being circumcised was associated with a significantly reduced risk of HIV infection (HR 0.15, 95% CI 0.03-0.80, p=0.026). Circumcised HIM participants also had a lower risk of incident syphilis (HR 0.35, 95% CI 0.15-0.84, p=0.019), however circumcision status had no significant effect on the remainder of prevalent and incident STIs examined. Second, risk factors for pharyngeal gonorrhoea and chlamydia were investigated. The BD ProbeTec nucleic acid amplification test (NAAT) had a positive predictive value (PPV) for pharyngeal gonorrhoea diagnosis of only 30.4% (95% CI 25.2-36.1%) when compared to a previously validated NAAT targeting the gonococcal porA pseudogene. Pharyngeal gonorrhoea was common in HIM, mostly occurred without concurrent anogenital infection and may frequently spontaneously resolve. Infection was independently associated with younger age (p-trend=0.001), higher number of male partners (p-trend=0.002), contact with gonorrhoea (p<0.001) and insertive oro-anal sex with casual partners (p-trend=0.044). Pharyngeal chlamydia was less common but a high prevalence/incidence ratio suggested that infection may persist in the pharynx for long periods. Pharyngeal chlamydia was independently associated with receptive penile-oral sex with casual partners (p-trend=0.009). In conclusion, circumcision may have a role as an HIV prevention intervention among the subgroup of homosexual men who predominantly practise insertive rather than receptive AI. Regular screening of the pharynx including a validated supplemental NAAT for gonorrhoea diagnosis may prevent much transmission to anogenital sites, whereas chlamydia occurs too infrequently in the pharynx to recommend routine screening in homosexual men.

Les facteurs alimentaires intervenant aux différents stades de la cancérogenèse colorectale (petit adénomes, gros adénomes et cancer colorectal) ont été étudiés à partir des données françaises de l'étude E3N. <br />L'étude E3N (Etude Epidémiologique auprès de femmes de l'Education nationale) composante française de l'étude EPIC (European prospective into Cancer and Nutrition) porte sur 100 000 femmes, âgées de 40 à 65 ans en 1990, adhérentes de la Mutuelle Générale de l'Education Nationale. Les données alimentaires, recueillies par un auto-questionnaire, sont disponibles pour 75 000 femmes. Les 517 sujets ayant développé un adénome entre 1993 et 1997 ont été comparés à 4695 sujets indemnes de polypes (coloscopie déclarée normale). La population d'étude des cancers était constituée de 173 cas de cancer et 64937 sujets indemnes. L'estimation des risques a été modélisée par un modèle de Cox.<br />Des effets délétères de la consommation d'alcool sur la survenue d'adénome et de la consommation de charcuterie sur la survenue de cancer ont été observés. Un apport élevé en calcium était associé à une diminution significative du risque de petit adénome et à une diminution non-significative du risque de gros adénome et de cancer colorectal. Les apports en fibres diminuaient non-significativement le risque d'adénome et de cancer colorectal. Des effets protecteurs, proches de la significativité, des fibres de légumes sur le risque de petit adénome et des fibres de céréales sur le risque de cancer ont été observés.<br />Un effet différent des facteurs alimentaires selon le stade de la séquence adénome-cancer a été confirmé

L'idée générale de la thèse est de proposer une modélisation d'un système d'information adaptable à tout type de projet mettant en présence des acteurs de territoires séparés, de cultures plurielles et de contingences structurelles et conjoncturelles différentes. La finalité sera de mettre en place un véritable « code de communication » autour d'un « projet de coopération » appropriable par l'ensemble des acteurs en intégrant leurs spécificités et celles de leurs environnements. Plus largement, cette thèse est un cadre de recherche permanent à capitalisation qui doit amener à enrichir « l'art projet » notamment en termes de valorisation des flux d'informations et de connaissances. Les deux dernières décennies ont été caractérisées par l‘émergence d'un environnement dont la complexité s'accroît de manière vertigineuse au vu du magma des flux d'informations à traiter. L'impact sur les entreprises, et plus généralement les organisations, a fondamentalement changé leur management et en particulier dans tous les processus « projet ». Au-delà des concepts de globalisation, de mondialisation, de mutation, nombre d'organisations vont chercher à créer de la valeur dans la mise en place de « projet de coopération ». Ces projets présentent des typologies bien particulières où l'information et la connaissance sont aussi bien des matières premières que des produits finis à leur réalisation. Dans cette optique, la notion de « l'environnement projet » devient de plus en plus prégnant d'autant que sa complexité se voient augmenter par une conjugaison de facteurs et d'acteurs qui ne sont pas uniquement issus de « l'environnement de proximité » du projet mais aussi d'un « environnement de connexion territoriale » qui redéfinit ainsi les « enjeux géospaciaux » du projet et qui pourrait se résumer à l'adage suivant : « penser global et agir local ». A travers cette lecture de l'environnement du projet, quel code de communication commun peut-on partager pour permettre de la mise en place d'une « architecture projet » en recherche d'efficience et qui doit amener un effet surgénérateur au projet, c'est-à-dire produire plus de richesses que de ressources consommées. Apporter une réponse à cette problématique, c'est avant tout faire émerger un modèle conceptuel de « proactivité managériale de l'information » autour de la notion de projet qui peut se décliner en différents éléments permettant de positionner précisément le projet dans son environnement en tenant compte « glocalement » de ses facteurs et de ses acteurs. Cette recherche est cadrée sur la genèse des composantes d'un « management proactif informationnel » au travers de retours d'expériences et résultats de construction d'un « modèle conceptuel informationnel projet » issu de mes travaux de recherches commencés en 1993.

<p>During a three-year period (1989-91), all patients living in the county of Uppsala, Sweden, with a radiographically verified fracture of the clavicle were prospectively, consecutively followed (n=245). </p><p>The epidemiological study (I) was restricted to the two first years with 187 fractures in185 patients. The short term study (II) with 6 months follow-up included 222 patients. The long term study (III) with 10 years follow-up included 208 patients. The malunion study (IV) included eight patients and the nonunion study (V) 24 patients all of whom were consecutively operated between 1988-2000.</p><p>Displacement, especially with no bony contact in the initial radiographs, was a statistically significant risk factor for sequelae.</p><p>Comminute fractures, especially if including transversally placed fragments, were associated with a significantly increased risk of remaining symptoms. An increasing number of fragments was also associated with an increased risk of sequelae.</p><p>Patients with remainig symptoms after 6 months were on average older at the time of injury as compared to patients without remaining symptoms. Advancing age was also a significant risk factor for sequelae – specifically pain at rest – still after 10 years.</p><p>There was no difference between gender with respect to the risk of sequelae, except for nonunion.</p><p>Fracture location did not predict outcome, except for more cosmetic defects (middle part).</p><p>Shortening defined as overlapping at the fracture site was a significant risk factor for cosmetic defects after 10 years.</p><p>Patients who experience pain at rest and/or cosmetic defects more than twelve weeks after the fracture have a higher risk for sequelae.</p><p>The radiographic examination should always consist of two projections: the AP (0°) view and the 45° tilted view. Transversally placed fragments are not seen in the 0° view.</p><p>Removal of excessive callus in patients with persistent symptoms even several years after the fracture showed a good outcome. One does not have to stabilize the clavicle when excising the hypertrophic callus.</p><p>Symptomatic clavicular nonunions should be treated with surgery. Reconstruction plate combined with cancellous bone gives a faster and more reliable healing rate than external fixation.</p>