bluuebunny/crossref_metadata_2025 huggingface dataset:
ANALISIS PENGARUH KINERJA KEUANGAN DAN VARIABEL MAKROEKONOMI TERHADAP RETURN SAHAM SUBSEKTOR PERKEBUNAN
Authors: Mubarok Faizul , Siregar Hermanto , Nuryartono Nunung
Published: February 2016

EVA and MVA are used to indicate the creation of value in an investment. Arbitrage Pricing Theory (APT) explained that macroeconomic variables have a systematic effect on return. The aim of this study is to analyze and to measure the effect of financial performance and macroeconomic variables on the stock return of estate plantation sub-sector at Indonesia Stock Exchange. Data are processed by using panel data, analysis which consist of six companies which are listed on the estate plantation sub-sector and using quarterly data from 2007 to 2013. By using the Pooled Least Square (PLS) the result show that the variables of MVA, oil, inflation, interest rate and crisis have significant effects on the stock return of estate plantation sub-sector while the variables of MVA and the world oil price do not have significant effect on the stock return of estate plantation sub-sector.DOI: 10.15408/sjie.v3i2.2058
PAJAK DAERAH dan PENGARUHNYA TERHADAP PDRB di PROPINSI KALIMANTA TIMUR
Authors: Mutiara Dwika Julia
Published: February 2016

This  study  aims  to  see  the  influence  of  local  taxes,  retribution,  capital expenditure  and  labor  force  participation  rates  on  regional  gross  domestic product  in the District/Municipalities of East Kalimantan Province period 2004-2013. This study uses panel data by selecting best model that is the Fixed Effects Model (FEM). The results show  that the variables of local taxes and retribution have a significant effect and has positive relationship to regional gross domestic product, while capital expenditure  have no significant effect on regional gross domestic product.  For  variable  labor  force  participation  rate  (LFPR)  is  significantly influence but negative correlation to the regional gross domestic product . Based on the results obtained by the coefficient determination of 98,42% variable means of local taxes, levies, capital expenditures and LFPR in this study may explain the dependent variable is the regional gross domestic product.DOI: 10.15408/sjie.v4i1.2296
Gergő Endre materialista pszichológiája a XX. Század elején
Authors: Holovicz Attila
Published: February 2016

Gergő Endre az akadémiai intézményrendszeren kívül, autodidaktaként foglalkozott pszichológiával, filozófiával és fiziológiával. Törekvése a pszichológiának a fiziológiára történő elméleti visszavezetése. Érvelésének fő célpontja az introspekció mint megismerési módszer, amelyet tökéletesen elhibázottnak tart. Az introspekciót végző személy nem megismeri a saját maga számára közvetlenül adott lelkiállapotait, hanem csak átél valamilyen élményt. E különbségtételre alapozza az introspekció elleni érvelését. Elméletét nem csupán pszichológiai célzattal fogalmazza meg. Anyagelvű pszichológiai nézeteit egy átfogó materialista bölcseleti szemléletmód érdekében dolgozza ki. Ez utóbbi teszi figyelemre méltóvá, mivel a magyar filozófia történetében a következetes mechanikus materializmus, a bölcseleti szintre emelt anyagelvű pszichológia ritkaságnak számít.
Islands Out of Time
Authors: Rainbird Paul
Published: February 2016

Island biogeography was developed in the 1960s but derives from a long heritage of treating islands as distinct and special places when compared to continental situations. The ancestry of such views can be traced through western literature since the 16th century and, it is proposed here, has led to a bias against island peoples in Anglo-American thought. In this paper the bias is traced through popular literature, anthropology and on to its incorporation in contemporary island archaeology. In conclusion, it is proposed that island archaeologists - whether they work in the Mediterranean, the Pacific, the Caribbean or elsewhere - need to relinquish this inheritance and look to alternative ways of understanding in order to develop an even-handed and more appropriate interpretation of island societies in the past.
Cleft Lip and Cleft Palate Surgery: Malpractice Litigation Outcomes
Authors: Justin Grant A. , Brietzke Scott E.
Published: February 2016

Objective

This study examined malpractice claims related to cleft lip and cleft palate surgery to identify common allegations and injuries and reviewed financial outcomes.

Design

The WestlawNext legal database was analyzed for all malpractice lawsuits and settlements related to the surgical repair of cleft lip and palate.

Main Outcomes Measures

Inclusion criteria included patients undergoing surgical repair of a primary cleft lip or palate or revision for complications of previous surgery. Data evaluated included patient demographics, type of operation performed, plaintiff allegation, nature of injury, and litigation outcomes.

Results

A total of 36 cases were identified, with 12 unique cases from 1981 to 2006 meeting the inclusion criteria. Six cases (50%) were decided by a jury and six by settlement. Five cases involved complications related to the specific surgery, and the other seven were associated with any surgery and perioperative care of children and adults. Cleft palate repair (50%) was the most frequently litigated surgery. Postoperative negligent supervision was the most common allegation (42%) and resulted in a payout in each case (mean = $3,126,032). Death (42%) and brain injury (25%) were the most frequent injuries reported. Financial awards were made in nine cases (after adjusting for inflation, mean - $2,470,552, range - $0 to $7,704,585). The awards were significantly larger for brain injury than other outcomes ($4,675,395 versus $1,368,131 after adjusting for inflation, P - .0101).

Conclusion

Malpractice litigation regarding cleft lip and palate surgery is uncommon. However, significant financial awards involving perioperative brain injury have been reported.
Serum Glucocorticoid–Regulated Kinase 1 Blocks CKD–Induced Muscle Wasting Via Inactivation of FoxO3a and Smad2/3
Authors: Luo Jinlong , Liang Anlin , Liang Ming , Xia Ruohan , Rizvi Yasmeen , Wang Yun , Cheng Jizhong
Published: February 2016

Muscle proteolysis in CKD is stimulated when the ubiquitin-proteasome system is activated. Serum glucocorticoid–regulated kinase 1 (SGK-1) is involved in skeletal muscle homeostasis, but the role of this protein in CKD–induced muscle wasting is unknown. We found that, compared with muscles from healthy controls, muscles from patients and mice with CKD express low levels of SGK-1. In mice, SGK-1-knockout (SGK-1-KO) induced muscle loss that correlated with increased expression of ubiquitin E3 ligases known to facilitate protein degradation by the ubiquitin-proteasome, and CKD substantially aggravated this response. SGK-1-KO also altered the phosphorylation levels of transcription factors FoxO3a and Smad2/3. In C2C12 muscle cells, expression of dominant negative FoxO3a or knockdown of Smad2/3 suppressed the upregulation of E3 ligases induced by loss of SGK-1. Additionally, SGK-1 overexpression increased the level of phosphorylated N-myc downstream–regulated gene 1 protein, which directly interacted with and suppressed the phosphorylation of Smad2/3. Overexpression of SGK-1 in wild-type mice with CKD had similar effects on the phosphorylation of FoxO3a and Smad2/3 and prevented CKD–induced muscle atrophy. Finally, mechanical stretch of C2C12 muscle cells or treadmill running of wild-type mice with CKD stimulated SGK-1 production, and treadmill running inhibited proteolysis in muscle. These protective responses were absent in SGK-1-KO mice. Thus, SGK-1 could be a mechanical sensor that mediates exercise-induced improvement in muscle wasting stimulated by CKD.
Le Terme di Viterbo: dal termalismo sociale ai progetti di rilancio nel segno del turismo del benessere
Authors: Strangio Donatella , Teodori Marco
Published: February 2016

Le motivazioni sottese a questo studio riguardano alcuni aspetti finora meno studiati del termalismo in Italia, in particolare le trasformazioni prodotte sul settore termale dall’intervento dello Stato a partire dagli anni tra le due guerre; tale intervento, intensifi catosi nel corso della seconda metà del Ventesimo secolo, produsse un nuovo modello di sviluppo, fuori dalle logiche di mercato, incentrato sul termalismo sociale assistito. Divenuto insostenibile dal punto di vista fi nanziario, dalla fi ne del Novecento l’apporto statale si ridusse drasticamente costringendo le imprese del settore ad elaborare nuovi percorsi per uscire da un profondo stato di crisi.Dopo aver fornito un inquadramento generale, tali processi sono stati studiati attraverso un particolare caso di studio, quello delle Terme di Viterbo. Le vicende di questa stazione termale sono state analizzate storicamente ricorrendo a fonti archivistiche inedite, ma sono state anche inquadrate nei loro assetti odierni sulla base di recenti indagini condotte dalle istituzioni locali, mosse dall’obiettivo di rivitalizzare i fl ussi turistici anche attraverso un nuovo connubio tra termalismo e benessere.
Social versus Spatial Mobility? Mongolia’s Pastoralists in the Educational Development Discourse
Authors: Stolpe Ines
Published: February 2016

When it comes to education for mobile pastoralists, Mongolia is an exceptional case. Until fifty years ago, herders comprised the majority of the Mongolian population. Although a satellite of the Soviet Union, the Mongolian People’s Republic was a state in which mobile pastoralism was not challenged, and herders were not constructed as social outcasts. Equally exceptional was the country’s modernisation, witnessed in its decided alignment with equal opportunities. In Mongolia, it was not ‘nomadism’ that was associated with backwardness, but illiteracy. Policy-makers aimed to combine spatial with social mobility by building schools further and further out in the grasslands, employing locals as teachers, and fostering interplay between modern formal education and extensive animal husbandry. Yet after 1990, when development discourse pigeon-holed post-socialist Mongolia as a Third World country, the so-called shock therapy led to severe cuts in education. Herders were essentialised as ‘nomads’, which caused donor-driven policies of educational planning to construe pastoralists as challenges. Ironically, during the initial decade of Education for All, the younger generation had—for the first time in Mongolia’s history—less educational opportunities than their parents. This article discusses narratives of inclusion and the political consequences of ascribed social identities.
1.2% Rosuvastatin Versus 1.2% Atorvastatin Gel Local Drug Delivery and Redelivery in Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Placebo‐Controlled Clinical Trial
Authors: Pradeep A.R. , Garg Vibhuti , Kanoriya Dharmendra , Singhal Sandeep
Published: February 2016

Background: Statins (3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitors) are an important group of hypolipidemic drugs that are able to modulate inflammation and alveolar bone loss. Rosuvastatin (RSV) and atorvastatin (ATV) are known to inhibit osteoclastic bone resorption and have been proposed to have osteostimulative properties. The aim of this study is to evaluate and compare the efficacy of 1.2% RSV and 1.2% ATV gel local drug delivery (LDD) and redelivery systems, in addition to scaling and root planing (SRP), for the treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP).

Methods: A total of 90 individuals with 90 IBDs was randomly allocated to treatment with SRP followed by LDD of 1.2% RSV, 1.2% ATV, or placebo gel. Clinical and radiographic parameters, including plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), clinical attachment level (CAL), and IBD depth, were recorded at baseline and 6 and 9 months.

Results: All three groups showed significant reduction in PI and mSBI at all intervals. Mean mSBI and PD reductions, CAL gain, and IBD depth reduction with statin drugs were significantly greater than with placebo gel LDD. Improvements in these parameters were significantly greater with RSV LDD than ATV or placebo gels at 6 and 9 months.

Conclusion: LDD of 1.2% RSV results in significantly greater clinico‐radiographic improvement than 1.2% ATV or placebo gels as adjunct to mechanical periodontal therapy.
Positioning A Radio Station
Authors: Donthu Naveen , Rust Roland T.
Published: February 2016

We present a density estimation based product positioning approach to best position a radio station in a new market or reposition itself in an existing market. We also combine perceptual research with music research to provide a programming strategy in the form of a recording artist list that is associated with the radio stations suggested image.
Cash Flow Information And The Prediction Of Financially Distressed Mining, Oil And Gas Firms: A Comparative Study
Authors: Ward Terry J.
Published: February 2016

This study tests whether cash flow information is more useful to creditors in predicting financially distressed mining, oil and gas firms than it is in predicting financial distress in other industries. The results of this study suggest that cash flows are more useful to creditors in predicting financially distressed mining, oil and gas firms than they are predicting financially distressed firms in other industries. Results also show that different cash flows are useful in predicting financial distressed mining, oil and gas firms than are useful in predicting financially distressed control firms.
Accounting Income Smoothing And Stockholder Wealth
Authors: Wang Zhemin , Williams Thomas H.
Published: February 2016

Contrary to the widespread view that the accounting income smoothing phenomenon is a revelation of cheating and misleading on the part of the firms management, this study demonstrates that income smoothing enhances the informational value of reported earnings. Furthermore, this study documents consistent evidence indicating that smoothed income numbers are viewed favorably by the markets, and firms with smoother income series are perceived as being less risky. The findings suggest that income smoothing can be beneficial to both existing stockholders and prospective investors.
Department Store Cross-Shoppers
Authors: Cassill Nancy L. , Williamson Nicholas C. , McEnally Martha , Thomas Jane
Published: February 2016

With todays retail department store competitiveness, it is necessary to examine department store cross-shoppers of three department store types: traditional, national chain, and discount. Regular shoppers of one type as well as two or more department store types are examined. The multi-item constructs consist of behaviors and attitudes of these different department store shoppers. The needs of cross-shoppers are dramatically different from the needs of core department store customers suggesting the folly of looking only to the needs of their store loyal customers for the structuring of store strategy.
Gender-Based Differences Of Partners In CPA Firms: Evidence From Kentucky
Authors: Schaefer James , Peluchette Joy Van Eck
Published: February 2016

This paper investigates whether a relationship exists between situation-centered factors and the holding of partner status in a public accounting firm, and to determine if gender differences exist in the relationship between these variables. From a sample of 1227 Kentucky public accountants, it was found that the population of a county, number of other partners and associates in a firm, and years of experience are significantly related to the holding of partner status. However, women are less likely to be a partner in a firm with a larger number of associates and population does not appear to influence a womans chances of being a partner. The authors discuss the implications of these findings for practicing public accountants and provide suggestions for future research.
Sales Force Training Evaluation
Authors: Tan Kim , Newman Eric
Published: February 2016

An important indicator of an effective sales force training program is the evaluation of whether or not the training has directly impacted professional selling in retail organizations as defined by sales volume, sales personnel performance as well as other bottom line metrics. Despite spending thousands of dollars training their sales force every year, retail organizations often fail to follow through in evaluating the effectiveness of their training programs, thereby not allowing corrective actions for improvements to take root. This article investigates the importance of sales training evaluations and provides insights into the challenges and impediments faced by retailers in conducting sales training evaluation. This study essentially propose utilizing Kirkpatrick's Four-Level Training Evaluation Model (Donald Kirkpatrick, 1994) to examine the interrelationships among its four levels of training evaluation (reaction, learning, behavior change, and organizational outcomes) and how they can be applied in determining sales training effectiveness in retail organizations. Future research emphasis and implications are then discussed that may help retailers better evaluate their sales training provisions while developing effective and accountable sales training efforts that will increase overall sales force productivity.
 
Evaluation Of Machine Learning Tools For Distinguishing Fraud From Error
Authors: Zhang Mei
Published: February 2016

Fraud and error are two underlying sources of misstated financial statements. Modern machine learning techniques provide a potential direction to distinguish the two factors in such statements. In this paper, a thorough evaluation is conducted evaluation on how the off-the-shelf machine learning tools perform for fraud/error classification. In particular, the task is treated as a standard binary classification problem; i.e., mapping from an input vector of financial indices to a class label which is either error or fraud. With a real dataset of financial restatements, this study empirically evaluates and analyzes five state-of-the-art classifiers, including logistic regression, artificial neural network, support vector machines, decision trees, and bagging. There are several important observations from the experimental results. First, it is observed that bagging performs the best among these commonly used general purpose machine learning tools. Second, the results show that the underlying relationship from the statement indices to the fraud/error decision is likely to be non-linear. Third, it is very challenging to distinguish error from fraud, and general machine learning approaches, though perform better than pure chance, leave much room for improvement. The results suggest that more advanced or task-specific solutions are needed for fraud/error classification.
A Comparative Analysis: The Impact Of Non-Operating Revenues On Financial Viability Of Urban And Rural Hospitals
Authors: Morey Jim , Wallis Ken , Lee Hoseoup , Scherzer Gary , Orilio Robert
Published: February 2016

Fifty New York hospitals, 25 urban facilities and 25 rural facilities, were chosen at random for analysis.  They were examined to determine whether non-operating revenue – contributions, gifts, grants (as defined by IRS, Form 990) – plays an important role in fiscal viability .  Three years of data, 2005 – 2007, for each hospital was selected, and several financial variables were used to construct a fiscal viability index. The purpose of this study was to determine whether there is a positive difference in the fiscal health of hospitals when the hospitals can solicit more income from non-healthcare/non-operating activities in the form of outside gifts and grants.  Another main purpose of this study was to determine which hospital sector, if any – urban vs. rural – is more dependent upon non-operating revenues for their fiscal viability.
Identity Analytics And Belief Structures
Authors: Katzan, Jr. Harry
Published: February 2016

Personal identity is an important topic in information systems in general and data analytics in particular.  Normally associated with digital security and privacy, the scope of identity is much greater and affects most aspects of everyday life.  Related subjects are behavioral tracking, personal-identifiable information (PII), privacy data relevance, data repurposing, identity theft, and homeland security.  The purpose of this paper is to establish a context for using analytics to combine evidence to categorize certain subjects based on belief structures.   
Fração Exalada de Óxido Nítrico no Controlo e Abordagem Terapêutica da Asma
Authors: Melo Bruno , Costa Patrício , Afonso Ariana , Machado Vânia , Moreira Carla , Gonçaves Augusta , Gonçalves Jean-Pierre
Published: February 2016

Introdução: A asma é uma doença respiratória crónica caracterizada pela hiper-reactividade e inflamação brônquica. A inflamação brônquica destes doentes pode ser monitorizada através da medição da fração exalada de óxido nítrico. Este estudo tem por objetivo determinar a associação do valor da fração exalada de óxido nítrico com o débito expiratório máximo instantâneo e com o controlo da asma determinado pela Classificação da Iniciativa Global para a Asma.Material e Métodos: Estudo observacional, analítico e transversal de crianças com asma, 6-12 anos, seguidas na Consulta Externa de Patologia Respiratória do Hospital de Braga. Informação sociodemográfica e clínica colhida através de um questionário. Determinado o valor da fração exalada de óxido nítrico, através do analisador portátil Niox Mino®, e do débito expiratório máximo instantâneo,através do debitómetro.Resultados: A amostra é constituída por 101 crianças asmáticas, 63 (62,4%) do sexo masculino e 38 (37,6%) do sexo feminino. A idade média dos participantes na amostra é de 9,18 (1,99) anos. A regressão logística, realizada com o valor de cutoff obtido pela curva de ROC, revelou que a fração exalada de óxido nítrico tem um efeito estatisticamente significativo (bNíveis do FENO = 0,85; χ2Wald (1) = 8,71; OR = 2,33; p = 0,003) sobre a probabilidade de mudar de nível de controlo da asma. Por cada nível de fração exalada de óxido nítrico incrementado o odds de passar a não controlada é 2,33 vezes superior.Discussão e Conclusão: A probabilidade de uma criança asmática mudar o seu nível de controlo da asma, de ‘controlada’ para ‘parcialmente controlada/não controlada’, tendo em consideração uma alteração no seu nível da fração exalada de óxido nítrico, aumenta 133%.
Hipocalcemia Crónica por Anticorpos Anti-Recetor do Cálcio
Authors: Marques Pedro , Santos Rita , Cavaco Branca , Leite Valeriano
Published: February 2016

Introdução: O hipoparatiroidismo cursa com hipocalcemia e é mais frequentemente registado após cirurgia cervical. A etiologia autoimune é mais rara e difícil de diagnosticar.Caso clínico: Mulher, 52 anos, sem antecedentes pessoais, medicamentosos ou familiares relevantes, referenciada por hipocalcemia e calcificação dos núcleos da base, detetados no decurso de investigação de quadro de mialgias. Além de hipocalcemia (4,6 mg/dL), foi verificada hiperfosfatemia (8,7 mg/dL), hormona paratiroideia indetetável, calciúria, fosfatúria e magnesúria baixas. A análise molecular do gene CaSR excluiu mutações germinais. A pesquisa de anticorpos anti-receptor sensível do cálcio (anti-CaSR) foi positiva. Atualmente está assintomática e normocalcémica sob terapêutica com cálcio e vitamina D.Discussão: Embora rara, a hipocalcemia por hipoparatiroidismo autoimune deve ponderar-se em adultos sem antecedentes de cirurgia cervical, medicação hipocalcemiante, história familiar ou fenótipo sugestivo de doença genética. Hormona paratiroideia diminuída ou indetetável exclui pseudohipoparatiroidismo e a positividade para anti-CaSR confirma o diagnóstico.Palavras-chave: Hipocalcemia; Hipoparatiroidismo; Receptores de Detecção de Cálcio.
Recovery of Cochlear and Vestibular Function after Labyrinthine Haemorrhage
Authors: Araújo-Martins José , Melo Patrícia , Ribeiro Cristóvão , Barros Ezequiel
Published: February 2016

Inner ear haemorrhage is a rare disorder with disabling symptoms. Prognosis is generally considered to be poor with essentially no chance of functional recovery. The most common aetiologies are related to blood dyscrasias, anticoagulant therapy or local trauma. The association with autoimmune diseases is exceptional. The authors report a case of sudden deafness with vertigo in a patient with rheumatoid arthritis, caused by labyrinthine haemorrhage. Clinical picture and progress of audiovestibular function are described along with imagiological features from magnetic resonance imaging. Inner ear haemorrhage is a rare disorder with disabling symptoms and poor prognosis. To the best of the authors’ knowledge, this is the first case described with documented vestibular function recovery following labyrinthine haemorrhage.Keywords: Ear, Inner; Hearing Loss, Sudden; Hemorrhage; Vertigo; Vestibular Evoked Myogenic Potentials; Vestibular Function Tests; Vestibule, Labyrinth.
O Papel dos Testes de Estimulação Farmacológica no Diagnóstico da Deficiência de Hormona do Crescimento em Crianças e Adolescentes
Authors: Gonçalves Jean-Pierre , Correia Filipa , Cardoso Helena , Borges Teresa , Oliveira Maria João
Published: February 2016

Introdução: A incidência da deficiência de hormona do crescimento é de 1:4000 a 1:10000, sendo a principal indicação para tratamento com hormona do crescimento recombinante.Objectivos: Avaliar os resultados dos testes de estimulação da hormona do crescimento e identificar factores preditivos para o diagnóstico da deficiência de hormona do crescimento.Material e Métodos: Estudo observacional, analítico e transversal. Foram analisados dados clínicos e auxológicos e os resultados dos exames de diagnóstico de crianças e adolescentes submetidos a testes de estimulação farmacológica da hormona do crescimento (01/01/2008 a 31/05/2012). O diagnóstico definitivo de deficiência de hormona do crescimento foi efectuado mediante dois testes com estímulos farmacológicos diferentes negativos (pico máximo da hormona do crescimento < 7 ng/mL) ou um teste negativo associado à presença de alterações anatómicas da região hipotálamo-hipofisária, observadas na ressonância magnética cerebral. Para análise estatística, foram realizados o testes de t student, do qui- quadrado, correlação de Pearson e a regressão logística. Foi considerado como nível de significância estatística (p) um valor igual ou menor que 0,05.Resultados: Realizaram-se testes de estimulação em 89 doentes, com mediana de idade igual a 10 [3-17] anos, 67% do sexo masculino e 77% pré-púberes. Os fármacos utilizados no primeiro teste de estimulação foram a clonidina (n = 85) e a insulina (n = 4). Foram diagnosticados 22 casos de deficiência de hormona do crescimento. Nos casos submetidos a dois testes, os valores máximos de hormona do crescimento apresentaram uma correlação moderada entre si (r = 0,593, p = 0,01). Verificou-se que as variáveis estatura (z-score) e pico máximo de hormona do crescimento obtido no primeiro teste têm valor preditivo no diagnóstico de deficiência de hormona do crescimento.Discussão: A determinação do IGF-1 não demonstrou ser preditor de deficiência de hormona do crescimento.Conclusão: Os testes de estimulação são uma ferramenta de diagnóstico da deficiência de hormona do crescimento e que devem ser enquadrados nos parâmetros clínicos e auxológicos.Palavras-chave: Alterações do Crescimento; Hormona do Crescimento Humano.
Traumatic Brain Injury in Portugal: Trends in Hospital Admissions from 2000 to 2010
Authors: Dias Celeste , Rocha João , Pereira Eduarda , Cerejo António
Published: February 2016

Introduction: Traumatic brain injury has a considerable socio-economic impact, being a major cause of morbi-mortality, often with permanent disability. We sought to characterize health resource utilization of adult traumatic brain injury patients in Portugal between 2000 and 2010.Material and Methods: Retrospective study of medical records of adult patients with ICD9 diagnostic code of traumatic brain injury included in the National Diagnosis Related Groups Database from 2000–2010. Descriptive statistical analysis was performed and trends during the decade were evaluated.Results: We analysed 72 865 admissions to 111 hospitals, 64.1% males, mean age 57.9 ± 21.8 years (18-107). We found a decrease in number of traumatic brain injury in younger patients and an increase in older ones. The number of traffic accidents decreased and the number of falls increased. There was an increase of moderate to severe traumatic brain injury admissions: 47.2% in 2000 / 80% in 2010. Patients admitted in Intensive Care have nearly doubled (15.8% vs 29.5%) as well as the number submitted to neurosurgical procedures (8.2% vs 15.2%). Total mortality increased from 7.1% to 10.6%.Discussion: The decrease of traumatic brain injury may be associated with the trauma prevention campaigns, road network improvement and health politics. The increase in mortality may be related to better pre-hospital care, enabling more severe cases to arrive in hospital alive, and although treated more frequently in Intensive Care and requiring more neurosurgical procedures, they end up having higher mortality. Also this may be due to an increase in patients’ age and worse pre-morbid status.Conclusion: Traumatic brain injury in Portugal is changing. Although hospital admissions due to global traumatic brain injury have decreased, mortality rate has increased.Keywords: Intensive Care Units; Brain Injuries; Hospitalization; Portugal.
Artrite Séptica Meningocócica Primária em Lactente de Dois Meses
Authors: Jacinto Teresa , Rego Helena , Gonçalves Juan , Paz Ferreira Virgílio
Published: February 2016

A artrite meningocócica primária, isolada de contexto de sépsis meningocócica, é um fenómeno raro, em especial na idade pediátrica. O atingimento monoarticular é ainda menos frequente nas infecções a Neisseria spp. Apresentamos o caso de lactente de 2 meses de idade, sexo feminino, caucasiana, apresentando quadro de febre elevada com 4 dias de evolução e choro durante a manipulação do membro inferior esquerdo na muda de fralda. Sem sépsis clínica ou analiticamente. Sem vacinação anti-meningocócica prévia. A ecografia articular revelou presença de líquido intra-articular. O exame bacteriológico do drenado purulento por artrotomia foi positivo para Neisseira meningitidis. Apresentou boa resposta à antibioterapia e evolução favorável após a alta. A artrite séptica meningocócica, ainda que rara, constitui uma urgência pediátrica, e é diagnóstico diferencial perante uma criança com quadro febril e queixas articulares.Palavras-chave: Artrite Infecciosa; Infecções Meningocócicas; Lactente; Neisseria meningitidis.
Incidental Asymptomatic Accessory Mitral Valve: a Differential Diagnosis for Intracardiac Mass
Authors: Donmez Esra , Seker Taner , Icen Yahya Kemal , Elbasan Zafer , Gur Mustafa , Cayli Murat
Published: February 2016

Accessory mitral valve is a rare entity which is commonly detected in children. It might present as a cause for left ventricularoutflow obstruction, aortic regurgitation or a source for thromboembolic event. Diagnosis is based on echocardiographic findings, transesophageally when possible. Usually treatment is not required however treatment decisions are based on associated abnormalities and symptoms. Our aim is to report a case which was referred to our clinic as a suspected intracardiac mass.Keywords: Heart Defects, Congenital; Mitral Valve/abnormalities.
Fracturas Femorais Atípicas e o Tratamento com Bifosfonatos: É um Factor de Risco?
Authors: Geada Nuno , Mafra Inês , Barroso Rogério , Franco José
Published: February 2016

Introdução: Os bifosfonatos têm eficácia comprovada na prevenção das fracturas osteoporóticas. Contudo, têm sido descritas fracturas femorais atípicas associadas à toma prolongada de bifosfonatos com um padrão radiológico bem definido. Os objectivos no nosso estudo foram caracterizar os doentes de idade ≥ 65 anos com fracturas femorais (subtrocantéricas/diafisárias) consideradas típicas e atípicas e avaliar a relação entre a ocorrência das fracturas atípicas e o uso de bifosfonatos.Material e Métodos: Realizámos um estudo caso-controlo com os doentes admitidos no nosso Hospital por fractura subtrocantérica ou diafisária do fémur, num período de cinco anos e meio. Após aplicação dos critérios de exclusão, as 92 fracturas (91 doentes) foram classificadas como atípicas ou típicas. A determinação do tratamento prévio com bifosfonatos foi obtida através do historial clínico dos doentes.Resultados: Foram encontradas 11 fracturas atípicas (10 doentes) e 81 fracturas típicas (81 doentes). A idade mediana entre os dois grupos foi estatisticamente diferente (72 anos - atípicas vs 80 anos - típicas, p < 0,01). A razão do uso de bifosfonatos foi de 0,60 nas fracturas atípicas e de 0,01 nas típicas, traduzindo um odds ratio de 101,1 (p < 0,01).Discussão: Na generalidade, os nossos resultados são apoiados e estão de acordo com os estudos publicados referentes à ocorrência de fracturas femorais atípicas associadas à toma de bifosfonatos.Conclusão: Apesar do pequeno número de casos foi possível demonstrar a relação, estatisticamente, significativa entre as fracturas femorais atípicas e a toma de bifosfonatos. De notar que estas fracturas atípicas ocorreram em doentes, significativamente, mais jovens do que os doentes com fracturas típicas.Palavras-chave: Difosfonatos; Fracturas do Fémur; Factores de Risco.
Optimal Cut-Off Value for Homeostasis Model Assessment (HOMA) Index of Insulin-Resistance in a Population of Patients Admitted Electively in a Portuguese Cardiology Ward
Authors: Timóteo Ana Teresa , Miranda Fernando , Carmo Miguel Mota , Ferreira Rui Cruz
Published: February 2016

Introduction: Insulin resistance is the pathophysiological key to explain metabolic syndrome. Although clearly useful, the Homeostasis Model Assessment index (an insulin resistance measurement) hasn’t been systematically applied in clinical practice. One of the main reasons is the discrepancy in cut-off values reported in different populations. We sought to evaluate in a Portuguese population the ideal cut-off for Homeostasis Model Assessment index and assess its relationship with metabolic syndrome.Material and Methods: We selected a cohort of individuals admitted electively in a Cardiology ward with a BMI < 25 Kg/m2 and no abnormalities in glucose metabolism (fasting plasma glucose < 100 mg/dL and no diabetes). The 90th percentile of the Homeostasis Model Assessment index distribution was used to obtain the ideal cut-off for insulin resistance. We also selected a validation cohort of 300 individuals (no exclusion criteria applied).Results: From 7 000 individuals, and after the exclusion criteria, there were left 1 784 individuals. The 90th percentile for Homeostasis Model Assessment index was 2.33. In the validation cohort, applying that cut-off, we have 49.3% of individuals with insulin resistance. However, only 69.9% of the metabolic syndrome patients had insulin resistance according to that cut-off. By ROC curve analysis, the ideal cut-off for metabolic syndrome is 2.41. Homeostasis Model Assessment index correlated with BMI (r = 0.371, p < 0.001) and is an independent predictor of the presence of metabolic syndrome (OR 19.4, 95% CI 6.6 – 57.2, p < 0.001).Discussion: Our study showed that in a Portuguese population of patients admitted electively in a Cardiology ward, 2.33 is the Homeostasis Model Assessment index cut-off for insulin resistance and 2.41 for metabolic syndrome.Conclusion: Homeostasis Model Assessment index is directly correlated with BMI and is an independent predictor of metabolic syndrome.Keywords: Glucose Tolerance Test; Homeostasis; Insulin Resistance Metabolic Syndrome.
Angiogenesis as a Therapeutic Target in Endometriosis
Authors: Djokovic Dusan , Calhaz-Jorge Carlos
Published: February 2016

Introduction: Angiogenesis is a key factor for the successful establishment and growth of endometriotic lesions.Material and Methods: We performed a literature search in PubMed and reviewed the most pertinent studies published until January 2014 and focused on the endometriosis-associated angiogenesis and/or anti-angiogenic strategies for the treatment of this gynecological disorder.Results: The present review provides a concise summary of the known molecular mechanisms that promote vascularization of endometriotic lesions and may serve as potential therapeutic targets. We also present a systematic overview of the inclusive and exclusive anti-angiogenic agents that have been already studied in cell cultures, animal models and/or endometriosis patients.Discussion and Conclusion: The integration of anti-angiogenic approaches in the multimodal management strategies for endometriosis patients will be conditioned by the outcomes of future assessments regarding the effectiveness of such treatments, the risk of drug resistance development and the incidence of unacceptable side effects.Keywords: Angiogenesis Inhibitors/therapeutic use; Endometriosis/drug therapy.
Estudo FATA: Prevalência de Fibrilhação Auricular e Terapêutica Antitrombótica nos Cuidados de Saúde Primários de um Concelho do Norte de Portugal
Authors: Gomes Eva , Campos Rui , Morais Renata , Fernandes Marta
Published: February 2016

Introdução: A fibrilhação auricular é a arritmia sustentada mais prevalente. Está provada a eficácia da anticoagulação oral na prevenção do acidente vascular cerebral nestes doentes. Contudo, este parece ser um tratamento subutilizado.Objectivos: determinar a prevalência de fibrilhação auricular conhecida numa população dos Cuidados de Saúde Primários; identificar as principais comorbilidades, a terapêutica antitrombótica em curso e avaliar a sua adequação segundo as recomendações da European Society of Cardiology.Material e Métodos: Estudo observacional transversal analítico. População: todos os utentes com idade igual ou superior a 30 anos, inscritos em oito Unidades de Saúde Familiar de Vila Nova de Gaia, com diagnóstico de fibrilhação auricular.Resultados: A prevalência de fibrilhação auricular foi de 1,29% (n = 940), sendo superior no género masculino (p = 0,01) e aumentando com a idade (p < 0,001). As comorbilidades mais frequentes foram a hipertensão arterial (76,4%), a insuficiência cardíaca (32,0%) e a diabetes mellitus (28,2%). Um total de 52% realizava terapêutica anticoagulante, 29% antiagregantes plaquetários e 4% ambas as terapêuticas. Dos utentes com baixo risco trombótico, 63,6% estava a fazer erradamente algum tipo de terapêutica antitrombótica; dos utentes com elevado risco ou doença valvular 56,8% estava adequadamente sob terapêutica anticoagulante.Conclusão: A prevalência de fibrilhação auricular bem como a frequência das principais comorbilidades estão de acordo com a maioria dos estudos. Apesar de a maioria dos doentes se encontrar sob anticoagulação oral, apenas 56,8% dos utentes com fibrilhação auricular fazia terapêutica antitrombótica adequada segundo as recomendações da European Society of Cardiology, verificando-se uma subutilização acentuada deste tratamento.Palavras-chave: Fibrilhação Auricular; Anticoagulantes; Acidente Vascular Cerebral; Cuidados de Saúde Primários; Portugal.
Fraturas Ósseas em uma Unidade de Cuidados Intensivos Neonatais
Authors: Machado Ângela , Rocha Gustavo , Silva Ana Isabel , Alegrete Nuno , Guimarães Hercília
Published: February 2016

Introdução: As fraturas ósseas são raras durante o período neonatal. Algumas das fraturas, sobretudo as de ossos longos, podem ocorrer durante o parto. Por outro lado, os recém-nascidos internados em Unidades de Cuidados Intensivos Neonatais têm um risco aumentado de fraturas ósseas por várias razões.Objetivo: Avaliar a incidência e caracterizar as fraturas ósseas nos recém-nascidos internados numa Unidade de Cuidados Intensivos Neonatais nível III.Material e Métodos: Análise retrospetiva dos recém-nascidos internados na Unidade de Cuidados Intensivos Neonatais com o diagnóstico na alta de uma ou mais fraturas ósseas, entre janeiro de 1996 a junho de 2013.Resultados: Oitenta recém-nascidos apresentaram uma ou mais fraturas ósseas. Em 76 (95%) recém-nascidos, as fraturas foram atribuídas a traumatismo do parto. A fratura mais comum foi da clavícula em 60 (79%) recém-nascidos, seguida da fratura craniana em 6 (8%) recém-nascidos. Em dois (2,5%) recém-nascidos, prematuros de extremo baixo peso, as fraturas foram interpretadas como decorrentes de osteopenia da prematuridade. Ambos apresentaram fraturas múltiplas, um dos quais de várias costelas.Conclusão: Uma mudança das práticas obstétricas, aliada à melhoria dos cuidados prestados ao recém-nascido prematuro contribuíram para a diminuição da incidência de fraturas ósseas no período neonatal. Contudo nos recém-nascidos prematuros o seu diagnóstico pode estar subestimado, dado o elevado risco de desenvolvimento de fratura que estes recém-nascidos apresentam.
Estudo de Fiabilidade da Escala de Capacidade de Controlo da Diabetes: Versão Breve
Authors: Aveiro Marcelo , Santiago Luiz Miguel , Lopes Ferreira Pedro , Simões José Augusto
Published: February 2016

Objetivo: Avaliar a correlação entre o valor obtido pelo instrumento de medição Diabetes Empowerment Scale - Short Form e o controlo da pessoa com diabetes medido pelo valor da hemoglobina glicada A1c.Material e Métodos: Estudo observacional transversal pela aplicação do Diabetes Empowerment Scale - Short Form a pessoas com diabetes de três Unidades de Saúde Familiar da Região Centro de Portugal após realização de teste e reteste (primeiro por escrito e, passados cinco minutos, oralmente) para determinação da coerência interna através do valor de alfa de Cronbach em 20 elementos que não foram depois estudados. A aplicação a pacientes diabéticos foi feita após a consulta de enfermagem e antes da entrada na consulta médica. Foi realizada estatística descritiva e inferencial apos verificação da normalidade dos dados.Resultados: Na primeira fase o valor de alfa de Cronbach de 0,90 a 1,00 relativamente aos oito itens da escala. Na aplicação escrita, a média de resultados foi de 3,78 ± 0,71 e na aplicação oral de 3,79 ± 0,65, p = 0,629. A amostra da segunda fase foi de 81 pessoas com diabetes, sendo 55,6% do sexo masculino. A idade média foi de 68,5 ± 1,1 anos com uma HbA1c média de 6,8 ± 0,2 e um tempo de evolução desde o diagnóstico de 9,2 ± 0,9 anos. A média da pontuação final da escala foi de 4,1 ± 0,8. Verificou-se uma correlação significativa entre a pontuação final e os níveis de Hba1C (ρ = -0,114; p = 0,312).Conclusão: A Escala de Capacidade de Controlo da Diabetes – Versão Breve revelou ser uma escala fiável para medir a capacitação em doentes diabéticos em Portugal. Confirmou-se a presença de uma correlação estatisticamente significativa entre o resultado obtido no final da escala e o valor de HbA1c.
Mumps Outbreak among Highly Vaccinated Teenagers and Children in the Central Region of Portugal, 2012-2013
Authors: Cordeiro Eugénio , Ferreira Muriel , Rodrigues Fernanda , Palminha Paula , Vinagre Elsa , Pimentel João Pedro
Published: February 2016

Introduction: Mumps vaccine was introduced in the National Immunization Program in Portugal in 1987, rapidly reaching a national coverage > 92%, with important reduction in the annual incidence of the disease. We report a mumps outbreak in the Central Region of Portugal, occurred in the winter 2012-13.Material and Methods: Cases of salivary-gland swelling and other symptoms compatible with mumps were investigated. Geodemographics, clinical, laboratory and vaccination data were analyzed.Results: Over six months, 148 outbreak-related cases were reported: 87.8% occurred in three of the 16 affected counties and 78.4% had a known epidemiological link. Median age was 14.5 years (2-62) and 70.3% were 11-20 years old; 61.5% were male. The mean duration of disease was seven days (2-20). The disease was generally mild; 80.4% had fever and in 55.4% there was unilateral involvement of the parotid gland. Seven cases had orchitis, one oophoritis and one had nephritis. Two cases were hospitalized. School transmission predominated and class attack rates were < 30%. Most of the cases occurred in vaccinated individuals (92%) of whom 86.8% had received 2 doses; 17.7% had received one dose of the vaccine containing the Rubini strain. Mumps virus genotype G was identified in 4 cases.Discussion: This mumps outbreak among a highly vaccinated population, occurring mostly in teenagers at school, could be due to the partial effectiveness of the vaccine against the disease (particularly in the group vaccinated with Rubini strain), waning immunity overtime and genotype mismatch.Conclusions: This outbreak report shows the importance of discussion about the need of more booster dose of the actual vaccine or new vaccine including more genotypes to improve immunogenicity.
Epidemiologia da Demência e da Doença de Alzheimer em Portugal: Estimativas da Prevalência e dos Encargos Financeiros com a Medicação
Authors: Santana Isabel , Farinha Filipa , Freitas Sandra , Rodrigues Vítor , Carvalho Álvaro
Published: February 2016

Introdução: A incidência e prevalência de demência e de Doença de Alzheimer aumentam com a idade, duplicando a cada cinco anos após a sexta década de vida. Portugal é um país envelhecido, previsivelmente com um número crescente de casos de demência. No entanto, os dados epidemiológicos são escassos e os estudos sobre os custos da doença praticamente inexistentes. Propomo-nos apresentar uma estimativa actualizada da prevalência de demência/ Doença de Alzheimer em Portugal e inferir, a partir da prescrição específica para demência, o número de diagnósticos efectivos e os encargos financeiros com esses medicamentos.Material e Métodos: À população residente em Portugal (2013), aplicámos os valores de prevalência de demência para a Europa Ocidental (estudo da Alzheimer’s Disease International). A estimativa dos diagnósticos efectivos de Doença de Alzheimer e dos encargos financeiros com medicação específica baseou-se nas informações do Intercontinental Marketing Services Health (IMSH) – 2013.Resultados: O número estimado de Portugueses com mais de 60 anos e com demência foi 160287, o que corresponde a 5,91% deste universo populacional. Sabendo que a Doença de Alzheimer representa 50-70% dos casos, inferimos que existirão entre 80144 e 112201 doentes. Por outro lado, os dados da IMSH indicam que estarão diagnosticados e a receceber anti-demenciais 76250 doentes, representando um encargo financeiro de 37 M€/ano.Conclusão: O envelhecimento da população incrementa o número de casos de demência. Aparentemente, nem todos os doentes com Doença de Alzheimer recebem a medicação aconselhada, sugerindo que esta condição ainda está sub-diagnosticada. A evolução tem sido positiva, com incremento do número de doentes tratados e redução dos custos com fármacos específicos.