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- ItemSomente MetadadadosBiomarkers of Spontaneous Preterm Birth: An Overview of the Literature in the Last Four Decades(Sage Publications Inc, 2011-11-01) Menon, Ramkumar; Torloni, Maria Regina [UNIFESP]; Voltolini, Chiara; Torricelli, Michela; Merialdi, Mario; Betran, Ana Pilar; Widmer, Mariana; Allen, Tomas; Davydova, Iulia; Khodjaeva, Zulfiya; Thorsen, Poul; Kacerovsky, Marian; Tambor, Vojtich; Massinen, Tytti; Nace, Judith; Arora, Chander; Univ Texas Med Branch; Universidade Federal de São Paulo (UNIFESP); Univ Siena; WHO; Fed Res Ctr Obstet & Gynecol & Perinatol; Lillebaelt Hosp; Hradec Kralove Charles Univ; Perkin Elmer Corp; Univ Tubingen; Cedars Sinai Med CtrBackground: Understanding spontaneous preterm birth ([PTB] < 37 weeks) is difficult due to heterogeneities associated with multitudes of risk factors and pathophysiological pathways. Several biomarkers are routinely used clinically for predicting preterm labor; however, these factors are either nonspecific or detected too late. Objective: Systematic review of literature on PTB biomarkers in the last 40 years to map out the existing knowledge and gaps in understanding PTB biomarkers. Search strategies: Five electronic databases were searched for human studies on PTB biomarkers published in any language between 1965 and 2008. Selection criteria: the phenotype of interest for final data extraction was exclusively spontaneous PTB with no rupture of membranes. Data extraction included (a) general characteristics of the study (clinical setting, period, and study design), (b) study/participant characteristics (inclusion and exclusion criteria, race/ethnicity, number of participants, gestational age at sampling, (c) characteristics of the biomarker (type, rationale for its selection, type of biological sample, and assay used, and (d) concentration of biomarkers in cases and controls. Data collection and analysis: the search yielded 7255 citations and data were extracted from 217 articles which met our inclusion and exclusion criteria. Main results: A total of 116 different biomarkers were reported and these were assayed 578 times in the 217 included studies. Over two thirds of the 217 studies were performed on North American or European populations. No reliable biomarkers emerged as a risk predictor of PTB. Conclusions: Identifying similar studies on biomarkers for the prediction of PTB was a very challenging task due heterogeneities in study design, sampling issues (types, timing and processing), assay methods, and analyses. Major areas of concern identified in this review include poor phenotype definition, nonideal study designs and poor rationale for biomarker selection and assays and population stratification issues.
- ItemSomente MetadadadosTécnicas lúdicas de dessensibilização e ambientação para aquisição de exame de ressonância magnética de crânio(Universidade Federal de São Paulo (UNIFESP), 2015-06-10) Miranda, Walter Alves de [UNIFESP]; Jackowski, Andrea Parolin Jackowski [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Scanning children is a challenge for clinical and research purposes since movement artifact affects severely the quality of the exam. Although clinical protocols have been optimized to reduce movement on acquiring a high quality pediatric brain scan without sedation, the success is limited. Moreover, for research purposes, alternative methods to sedation have been proposed with positive outcome but with intensive training and time consuming. Aims: In this study, we evaluated the use of a thirty-minute playful technique for preparing children and adolescents for a brain MRI research protocol. Methods: A total of 781 subjects (430M/351F) from 6-14 years-old were invited to perform a brain MRI protocol in two centers. In one center the intervention was individual and in the other was in group. Prior to the scan, subjects underwent a playful technique which included dance, relaxation, music, and recreational and interactive games. Results: Overall, 96% of the children (749/781) submitted to the playful intervention performed an MRI scan. All scans had diagnostic quality. Older children had a higher change of performing a scan without movement (OR= 1.16, p= 0.004), and overtime the chance of delivering a MRI sequence without movement decreases (OR= 0,43; p<0,001). The success rate of acquiring a scan without movement varied from 98,5-70 % overtime. Children who received individual intervention had 3.53 chances (p<0.001) of a successful imaging (i.e., without movement) compared to those who were exposed to group intervention. No gender effect was observed on images quality (OR=- 0,72; p=0,081). Conclusion: Our results suggest that our therapeutic protocol is effective in preparing children and adolescents for a research MRI scan and should be considered as a potential alternative technique to be used in medical diagnostic imaging centers.
- ItemSomente MetadadadosThrombectomy versus medical management for large vessel occlusion strokes with minimal symptoms: an analysis from STOPStroke and GESTOR cohorts(Bmj Publishing Group, 2018) Haussen, Diogo C.; Lima, Fabricio O.; Bouslama, Mehdi; Grossberg, Jonathan A.; Silva, Gisele Sampaio [UNIFESP]; Lev, Michael H.; Furie, Karen; Koroshetz, Walter; Frankel, Michael R.; Nogueira, Raul G.Introduction It remains unclear whether patients presenting with large vessel occlusion strokes and mild symptoms benefit from thrombectomy. Objective To compare outcomes of endovascular therapy versus medical management in patients with large vessel occlusion strokes and National Institute of Health Stroke Scale (NIHSS) score 5. Methods This was a retrospective analysis combining two large prospectively collected datasets including patients with (1) admission NIHSS score 5, (2) premorbid modified Rankin Scale (mRS) score 0-2, and (3) middle cerebral-M1/M2, intracranial carotid, anterior cerebral or basilar artery occlusions. Groups receiving (1) endovascular treatment and (2) medical management were compared. The primary and secondary outcome measures were NIHSS shift (discharge NIHSS minus admission NIHSS) and the rates of mRS 0-2 at discharge and 3-6 months, respectively. Univariate, multivariate, and matched analyses were performed. Results Eighty-eight patients received medical management and 30 thrombectomy. Multivariable analysis indicated thrombectomy was the only predictor of favorable NIHSS shift ( -3.7, 95%CI -6.0 to -1.5, p=0.02), as well as independence at discharge ( -21.995% CI -41.4to -20.8, p<0.01) and 3-6-month follow-up ( -21.1, 95% CI -39.1 to -19.7, p<0.01). A matched analysis (based on age, baseline NIHSS and intravenous tissue plasminogen activator use) produced 26 pairs. Endovascular therapy was statistically associated with lower NIHSS at discharge (p=0.04), favorable NIHSS shift (p=0.03), and increased independence rates at discharge (p=0.03) and 3-6-month follow-up (p=0.04). Conclusion In patients presenting with minimal stroke symptoms (NIHSS score 5) and large vessel occlusion strokes, mechanical thrombectomy appears to be associated with a favorable shift of NIHSS at discharge, as well as higher rates of independence at discharge and long-term follow-up. Confirmatory prospective studies are warranted.
- ItemAcesso aberto (Open Access)Tradução e adaptação do Pay Attention - um programa de treinamento dos processos da atenção para crianças(Curso de Pós-Graduação em Psicologia da Universidade Federal do Rio Grande do Sul, 2014-12-01) Barbosa, Deise Lima Fernandes; Miranda, Mônica Carolina [UNIFESP]; Bueno, Orlando Francisco Amodeo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)This research report describes the translation, adaptation and analysis of clinical applicability process related to the Pay Attention! Program to Brazilian Portuguese. The process followed all the steps internationally recommended to adequate instruments to other languages: translation/adaptation based on rules that preserve original features and cultural characteristics; analysis by expert judges; pilot studies, and analysis of clinical applicability in a group of 10 children with Attention Deficit and Hyperactivity Disorder (ADHD). Results of pilot studies were qualitatively analyzed in the phase of translation/adaptation. In the clinical group, the program was implemented in 20 individual sessions analyzing the individual evolution, as stated in the manual. Results showed that the Portuguese version of the Pay Attention! Program is appropriate, becoming an important tool for the interventions in attention deficits in children.
- ItemRestritoTranstorno Alimentar, cotidiano e hábito: o papel da Terapia Ocupacional na produção de cuidado(Universidade Federal de São Paulo, 2022-02-14) Meira, Ana Paula Gomes [UNIFESP]; Bernardo, Julia Ferreira [UNIFESP]; Frutuoso, Maria Fernanda Petroli [UNIFESP]; http://lattes.cnpq.br/4750299902344077; http://lattes.cnpq.br/0320347559106090; Universidade Federal de São Paulo (UNIFESP)Os transtornos alimentares são patologias graves, de etiologia multifatorial e que causam grande impacto na saúde física e mental. Considerando o significante desdobramento destes transtornos na vida cotidiana, este estudo tem como objetivo compreender as possibilidades de atuação da Terapia Ocupacional na área, através de uma pesquisa qualitativa em duas partes. A primeira, uma busca bibliográfica, revelou um número escasso de produções sobre o tema por terapeutas ocupacionais, levando à necessidade de outra estratégia, as entrevistas em profundidade com terapeutas ocupacionais que têm ou tiveram experiência no cuidado da população acometida por transtornos alimentares, feita através de um roteiro semiestruturado. A amostra foi composta por dois profissionais, e as entrevistas foram examinadas através da análise de conteúdo, identificando a importância do trabalho com transtornos alimentares. Os resultados apontam que o processo de cuidado nos transtornos alimentares é complexo, multiprofissional e conta com o trabalho da terapia ocupacional para lidar com a vida cotidiana, pensando nas atividades de vida diária, lazer, trabalho e adaptação de hábitos para a possibilitar autonomia e uma vida saudável. Retrata-se então, a necessidade de aprimoramento de estudos sobre as possibilidades da terapia ocupacional de forma mais consistente na área pesquisada.