bluuebunny/crossref_metadata_2025 huggingface dataset:
Standardized Diagnostic Instruments for Autism Spectrum Disorders: the Use of ADOS-2 and ADI-R
Authors: Sorokin A.B. , Davydova E.Y. , Samarina L.V. , Ermolaeva E.E. , Antokhina K.Y. , Kuzembayeva E. , Khaustov A.V. , Balandina O. , Mamokhina U.A.
Published: May 2021

Standardized diagnostic methods for autism spectrum disorders (ASD) have been internationally used by professionals for diagnosis validation, diagnostic classification for intervention planning, structured collection of behavioral and developmental data as well as stand-alone diagnostic instruments. Recently, two of such instruments — Autism Diagnostic Observation Schedule ADOS-2 and Autism Diagnostic Interview ADI-R — became available in Russian. The article briefly describes both instruments and presents expert assessment of potential and possible limitations of Russian-language ADOS-2 and ADI-R. Preliminary ADOS-2 psychometric data attests to sufficient sensitivity and positive predictive value to be used as an observation instrument. More research is needed to confirm its differential diagnostic ability.
Cognitive Features in Adults with Autism Spectrum Disorder, Diagnosed in Childhood without Intellectual Disabilities
Authors: Ivanova M.M. , Borodina L.G.
Published: May 2021

A study of cognitive features in autism spectrum disorders (ASD) adults without intellectual disabilities involved 20 participants diagnosed in childhood with Asperger’s syndrome and atypical autism, 20 respondents with schizophrenia spectrum disorders, and 20 neurotypical adults. Following psychological instruments were used “Comparison of concepts” (15 pairs of words), “Fifth extra”, “Fourth extra”. Tools were modified to identify formal thinking disorders in adults. A free-form story was also used. It was found that answers in a sample of adults with ASD, diagnosed in childhood are significantly more often indicating a distortion of the generalization process, rather than answers in a group of neurotypical participants. At the same time, this trend in the autism group is significantly lower than in the schizophrenia group. Following trend also revealed — answers identifying a decrease in the level of generalization and disorders of the motivational cognitive component. This trend is very similar in the groups of autism and schizophrenia, but significantly exceeds in the group of neurotypical subjects
Expert Commentary to the Article of C.I. Parente, R.M. Tsipan, R.L. Hendren «Integrating Treatment for Autism: Psychiatric Comorbidities and Comprehensive Treatment
Authors: Shaposhnikova A.F.
Published: May 2021

A child psychiatrist practitioner commentary on an article «Integrating Treatment for Autism: Psychiatric Comorbidities and Comprehensive Treatment» by american clinical investigators published in the current issue of the journal. The commentary refers to the similarities and differences in the medical approaches to the treatment of autism spectrum disorders (ASD) in Russia and in the United States. The issue of the need for drug therapy in the treatment protocol for autism in childhood is specifically addressed. Differences in the clinical recommendations of psychiatrists of both countries on the use of certain antipsychotics therapy are considered. It is concluded that an integrated approach to treatment and a reasonable combination of drug and non-drug methods due to the existing gaps in understanding the etiology and pathogenesis of ASD are necessary
The Development of Social Communication Skills and Socially Acceptable Behavior in Children with ASD within the Organized Excursion Activities
Authors: Popova S.P.
Published: May 2021

The data on the implementation of the program of additional education “Environmental Holidays in the Museum’’ presented. Program aimed at the development of social and communication skills of students with autism spectrum disorders (ASD). The events held in the 2019—2020 academic year in cooperation with the professionals of the Yalu- torovsk Museum Complex of the Tyumen Region. For the implementation of the program, an integrated group of younger schoolchildren was organized, consisting of 5 children with ASD and 9 children with visual impairments. Age of the group participants varied from 8 to 11 years. Following methods were used during presented work: observation, social stories, polls. Most of the classes conducted in a playful and interactive form based on the museum, each was built taking into account the age and psychological characteristics of the students. Nine field excursions conducted. As a result, all children with ASD showed positive dynamics in the development of socially acceptable behavior and a positive attitude to the new format of educational work, and there were attempts to interact with peers and outside adults. A survey of parents confirmed the positive dynamics in the develpment of certain communication and social skills of their children.
Longitudinal Observation of the Psychosocial and the Intellectual Development of a Patient with Autism
Authors: Dokukina T.V. , Osipchik S.I. , Grigorieva N.K. , Alyko T.N. , Lapysh O.M. , Truschenko M.N.
Published: May 2021

The article describes the experience of observation and medical support of a patient with Kanner’s syndrome from an early age to 27 years in the framework of complex medical, psychological and educational support. Long-term medical and psycho-educational support and family work allowed the patient to develop social skills and artistic abilities. The positive dynamics of intellectual and aesthetic development, smoothing of negative behavioral characteristics of the patient are demonstrated. The importance of joint well-coordinated work of a psychiatrist, speech therapist-special teacher, psychologist and parents is emphasized. The complex of rehabili- tation measures of professionals and parents gave a positive result: the young man is socialized and no longer needs special continuous medical and psychological support. As part of the supported employment, he attends an art workshop at the monastery and is engaged in painting. His personal exhibition had success. Such cases are an incentive for the constant active work of parents and teachers with children with severe forms of autistic disorders, and for the development of new effective methods of treatment, habilitation and rehabilitation, espe- cially in difficult to manage cases.
Betonarme Binalar için Perde Duvar Etkinliğinin Belirlenmesi
Authors: ERDİL Barış , GÜNDÜZ Yusuf
Published: May 2021

Betonarme binaların güçlendirilmesi durumunda kullanılacak perde duvarların kat alanına oranı ile ilgili olarak çeşitli öneriler geliştirilmiştir. Önerilen oranlar global anlamda olup bu oranların perde duvarlar sayısı ve/veya konumu ile ilişkisi üzerinde durulmamıştır. Örneğin %1 oranında perde duvar kullanılması ile kontrollü hasar performans seviyesinin sağlanacağı belirtildiğinde, bu %1’lik perde duvarın en fazla kaç parçaya bölünebileceği, bölünen bu perde duvarların planın hangi noktasında daha etkin olabileceği hususu belirsizdir. Bu belirsizlikler sebebi ile mühendisler çoğunlukla deneme yanılma yöntemi ile perde duvarları yerleştirmektedir. Bu çalışmada betonarme binaların güçlendirilmesi durumunda kullanılacak perde duvarların etkinliğini belirlemek amacı ile farklı sayı ve kalınlıkta tasarlanmış perde duvarlar, planda farkı alanlara yerleştirilmiştir. Yapılan analizler neticesinde aynı alana sahip perde duvarların parçalara ayrılarak binaya yerleştirilmesinin perde duvar kesme kuvveti ve moment etkinliğini azalttığı, perde duvar boyunun kısalması neticesinde binanın global rijitliğinin azaldığı ve nihayetinde deplasmanlar ile periyotların arttığı, belirlenmiştir. Perde duvarların etkinlikleri kat sayısı arttıkça azalmaktadır. Perde duvarların bina merkezine yakın yerleştirilmeleri ile kesme kuvveti etkinlikleri artırılmakta, göreli kat ötelemeleri ve yapı periyodu düşmektedir. Dış akslara perde duvar yerleştirilmesi ile de perde duvarların moment etkinlikleri artırılabilmektedir.
Современный мировой порядок: структурные реалии и соперничество великих держав
Authors: Сафранчук Иван , Лукьянов Федор
Published: May 2021

Статья предлагает рассматривать существующий мировой порядок, т.е. систему взаимодействия ключевых мировых и региональных игроков, не как переходную, а как устойчивую. Авторы исходят из того, что в последние тридцать лет в мире имели место серьезные трансформации, связанные с изменением материального положения многих стран: в результате сложился обновленный состав значимых мировых и региональных игроков. Это формирует новый, полицентричный hardware мировой системы. Ее software определяется современными структурными реалиями, которые авторы концептуализируют как сочетание материальной глобальности и идейной негомогенности: второе подталкивает к конкуренции, первое задает ограничения для масштабов ее эскалации. Выделяются формы конкуренции между ведущими державами, которые служат заменой открытому конфликту: непрямое воздействие на конкурентов и управляемое столкновение интересов. Модальность такой конкуренции исключает реализацию неолиберальных, институциональных построений, но в ней также оказывается невозможно зафиксировать баланс сил, как предписывают неореалисты. В результате имеет место и не win-win, и не winlose взаимодействие главных игроков. Авторы концептуализируют современную конкуренцию в терминах “дилеммы заключенного” – как lose – not-lose, а международное взаимодействие в рамках такой конкуренции как построение гибких коалиций в модальности not-lose – not-lose, соответственно объединяющих тех, кто не заинтересован в проигрыше друг друга.
НАТО под прицелом COVID-19
Authors: Антюхова Екатерина
Published: May 2021

Вспыхнувшая в 2020 г. и охватившая весь мир эпидемия COVID-19 поставила под вопрос эффективность стратегии ключевых международных акторов в новых реалиях, а также стала важным испытанием организационных и функциональных возможностей многих международных институтов. В статье исследуются ключевые аспекты деятельности НАТО на фоне мировой пандемии, связанные с комплексом мероприятий, предпринятых руководством альянса в организационной и информационной сферах. Отдельное внимание отводится анализу воздействия чрезвычайных обстоятельств, вызванных пандемией, на стратегические приоритеты НАТО в области военно-политического планирования, а также на взаимоотношения организации с другими ключевыми акторами мировой политики. Обозначившиеся на начальном этапе пандемии проблемы в США и некоторых европейских государствах свидетельствуют о просчетах в системе оперативного планирования деятельности альянса в чрезвычайных обстоятельствах. Вместе с тем события, связанные с распространением COVID-19, оказали определенное воздействие на понимание руководством НАТО приоритетов своей долгосрочной стратегии, способствуя дальнейшему развитию концепции “глобальной ответственности” альянса. Анализ процессов, происходивших в рамках НАТО, представляет принципиальную значимость как с позиции понимания логики текущих мирополитических процессов в целом, так и с точки зрения оценки динамики развития взаимоотношений Российской Федерации с ключевыми западными акторами – участниками военно-политических объединений.
Белоруссия: новая геополитическая реальность?
Authors: Коктыш Кирилл
Published: May 2021

Начавшиеся после президентских выборов в Белоруссии массовые протесты породили целый ряд вопросов политической теории и практики. В какой степени эти события явились очередной попыткой “цветной революции”, а в какой – результатом внутренних противоречий и ошибок власти? Почему весьма высокий политтехнологический уровень обеспечения протестов не повлиял на конечный исход белорусского противостояния? В числе причин последнего автор выделяет неудачу протеста в части создания собственного “символического пространства”, которое могло бы стать смысловым и управленческим центром, провал попыток расколоть правящую элиту (в результате врагом стала объявляться “система в целом”) и взятый протестом на вооружение негативный концепт свободы (по сути восходящий еще к вольтерьянской традиции, в рамках логики которой свобода – “это то, что было утеряно” с появлением государства, но не то, что можно определить позитивным образом). Легко увидеть, что в такой когнитивной рамке “врагом свободы” назначено государство, но неясным остается то, что такое свобода, как и на какой траектории она может быть обретена. Неопределенность концепта вскоре трансформировалась в определенность национализма, и протест стал оформляться как противостояние “новой нации” “отжившему государству”. При этом не возникло никакой позитивной программы “завтрашнего дня”. Понесло потери и государство: идеология “пробелорусскости”, представлявшая собой синтез концепта порядка и культурного национализма, раскололась, государство осталось с “оголенным” концептом порядка, тогда как протестующие приватизировали национализм. Кроме того, в рамках прагматики сближения с Западом после 2014 г. белорусский режим фактически закрыл глаза на утрату собственного доминирования в информационном пространстве. Борьба в этом пространстве обрела форму противостояния “идеи без институтов институтам без национальной идеи”, т.е. идеи нового национализма – идее порядка. Такое противопоставление оказалось выигрышным для государства и проигрышным для протеста: протестная идея в итоге деградировала до симулякра, содержательное управление которым едва ли возможно. Автор задается вопросом о возможностях и направлениях анонсированной внесением правок в конституцию “пересборки” белорусской политсистемы. Эти правки наверняка будут сводиться к увеличению роли партий, в силу чего существуют риски, что нынешнее противостояние может быть не столько разрешено, сколько трансформировано, адаптировано к новым формам. Поэтому России в отношениях с Белоруссией придется прибегать как к межпарламентской, так и межпартийной дипломатии.
Дискурсы социальной справедливости в китайском и российском культурных контекстах
Authors: Черныш Михаил , Хэ Ицзинь
Published: May 2021

Справедливость рассматривается в классических работах как набор универсальных принципов, применимых к анализу любого общества. Этот подход развивается, в частности, в работах Джона Ролза, определяющего главные принципы справедливости с помощью “нулевой социальной позиции”. Индивид, находящийся в этой позиции тотальной изоляции от внешнего мира и лишенный выраженных социальных характеристик, словно заново конструирует справедливый социальный порядок. Амартья Сен подверг этот подход критике, полагая, что представления о социальной справедливости могут варьироваться в широких пределах в зависимости от общества, в котором живет человек, а также от той социальной группы, к которой он принадлежит. В статье делается предположение, что социальная справедливость реализуется через набор принципов и практик, имеющих в основании как специфическое, исторически обусловленное начало, так и универсальное, общечеловеческое содержание. Эффективность этого подхода демонстрируется авторами в ходе сравнения представлений о социальной справедливости в китайской и российской общественной мысли. Справедливость, в разные эпохи понимаемая по-разному, широко обсуждалась в Древнем Китае как необходимое условие гармоничного устроения общества. В ранних работах Конфуция – как полное равенство, в поздних – как распределение по заслугам, с учетом разделения труда и места в социальной иерархии. В российской общественной мысли само понятие справедливости появилось в тот момент, когда российское государство приблизилось к современности, когда в российское общество проникли идеи социального равенства и достоинства человеческой личности. Общим для столь разных подходов к справедливости является понимание того, что принципы справедливости и их реализация не только и не столько определяются универсалистской идеалтипической моделью гражданской нации и правового государства, но в значительной степени зависят от установившихся в обществе отношений господства, отношений между государем (верховной властью) и подданными. В обеих культурах “благожелательность” высшей власти, ее способность заботиться о населении рассматривается как важнейшее условие справедливости и важнейший принцип социальной гармонии.
AI Health Check Monitoring and Managing Content Up and Data in CMS World
Authors: Paruchuri Harish
Published: May 2021

The advent of artificial intelligence (AI) as a means for improved health care bids extraordinary prospects to advance clinical lineup results and patient, reduce costs, and influence populace health. A1 health check monitoring jobs can take care of executing certain basic and advice rules of cleaning up repositories of data which are not getting used to managing the assets which are referred for a long time deleted that big companies with huge contents and assets struggle in keeping the server up and running 24/7. Thus, the objective of this article is to understand the “why to” and the “how-to” of employing all the major health systems in the CMS world. Also review artificial intelligence when compared to human intelligence in the health sector, Data bias, diversity in artificial intelligence teams, and impacts of artificial intelligence on the patient-provider relationship. To give this subject matter, we deployed literature approaches to examine major content that will help in achieving the purpose of this study. The review shows the need for a combination of artificial intelligence and human intelligence produces an augmented intelligence that focuses on creating a more assisting and supportive role for the algorithm. Also, it portrays trust, equity and inclusion need to be prioritized in the healthcare artificial intelligence development and deployment processes, and data management.
Diabetes Detection using Machine Learning: A Systematic Literature Review
Authors: Fadziso Takudzwa
Published: May 2021

As with the other sectors, the health sector also has a huge amount of data that should be utilized for handling the different diseases. One of the increasing diseases is diabetes that can be handled if it is detected at an early stage. For this purpose, the algorithms of ML can be used. We have discussed the various algorithms of ML and the attributes that can be used to train these algorithms for detecting diabetes.
Breve 22: El acceso a medicamentos en Chile y el papel de las farmacias municipales
Authors: Atal Juan Pablo
Published: May 2021

El acceso a medicamentos seguros y de calidad es un eje esencial para garantizar el derecho a la salud de la población. Alrededor del mundo, los gobiernos desempeñan diversos papeles para facilitar el acceso a medicamentos seguros y de calidad. Esto incluye desde la certificación de calidad, regulaciones de precios en las distintas etapas de la cadena de valor, hasta distintas formas de actuación en la cobertura financiera del costo de los medicamentos. El objetivo de este documento es analizar la política de farmacias públicas de dependencia municipal, como herramienta de política de medicamentos. A diferencia de las políticas tradicionales basadas en regulaciones, las farmacias municipales buscan mejorar el acceso a medicamentos, tanto en términos económicos como geográficos, otorgando a los gobiernos locales un papel protagónico en la distribución de medicamentos a la población. Este documento centra la discusión en la experiencia de Chile con la introducción de farmacias municipales a partir del año 2015.
Navigating Challenges after Xen
Authors: V Vera , M Shah , T Smith , LA Pinto , H Reitsamer
Published: May 2021

The XEN Gel Stent is a surgical implant for the treatment of glaucoma unresponsive to maximum tolerated medical therapy, with higher predictability and fewer sight-threatening complications than trabeculectomy or tube shunts. While complications following XEN implantation may be less common than in other glaucoma procedures, they are not completely avoidable. This paper elaborates the most commonly reported complications following XEN implantation with an aim to mitigate their occurrence by understanding the pathophysiology behind them. In addition, the authors provide insights from the literature and their own experience and make recommendations for management when complications do occur.
Genre and Attitude to Support Character Development in Children Stories
Authors: Santosa Riyadi , Djatmika Djatmika , Khrisna Dyah Ayu Nila
Published: May 2021

This paper examines how character development is analyzed through attitude, genre’s stages, and phases in children's stories. Relying on ten children's stories purposively selected from two children's storybooks, the results show that all ten stories are written as narratives with a number of absences of attitude, stages, and phases of the narrative genre. most stories succeed to fulfill the obligatory stages of narrative: orientation, complication, evaluation, and resolution, even others add the optional stage, coda. However, a number of stories fail to satisfy the presence of evaluation. in addition, all stories do not exploit attitude in every phase of every stage of the narrative. Even, a number of stories miss exploiting Attitude in a number of prominent phases such as introducing the character in orientation, development, and peak of the conflict in complication, and plan and act in resolution. Besides, all ten stories do not explore all types of attitude and their sub-classifications, in which each type will contribute to the holistic description of the character. Thus, although all stories can be considered to develop character along the obligatory stages of the narrative genre, they still fail to build a more complex character development through positive-negative-positive evaluation through stages and phases of the stories.Keywords: character development; genre; stages; phases; attitude
Science, Business, and Policy: A long-term reflection on multidisciplinary work-based learning in a master’s track for societal integration of Science
Authors: Grooters Saskia , Zaal Emma , Gerkema Menno
Published: May 2021

A strong theoretical approach with a specific focus on disciplinary research characterizes the common science master’s education in the Netherlands. However, a work-based learning (WBL) approach may as well be expedient and suitable for science education at master’s level. In this paper, a case study is presented of a WBL-program designed for an academic setting: the one year Science, Business and Policy (SBP) master’s track, offered at the Faculty of Science and Engineering of the University of Groningen. The paper describes the design and curriculum of the track, including its underlying theoretical framework, courses, multidisciplinary projects and work placements. Based on the SBP-track’s design we identified six possible indicators of a successful elaboration of an academic WBL-program: the SBP-track 1) is designed in response to the Bologna process; 2) is offered fully within the curriculum of a master’s program of a research university; 3) requires a sufficient academic level and disciplinary knowledge at entrée; 4) follows an educational project approach; 5) focuses on the integration and implementation of knowledge, and; 6) applies learning objectives that are specifically formulated to match the WBL educational method. A directed content analysis of SBP work placements revealed an increase in the number of SBP-students between 2003 and 2019, with an overrepresentation of life science students, as well as a large variety of real-case problems addressed for both business and policy organisations diverse in sector, size and region. Students’ grades showed a positive correlation between the initial theoretical preparation and the report made during the work placement. In conclusion, the societal interpretation of the Bologna process has been implemented successfully with SBP, by combining academic learning with gaining professional experience using a WBL-approach.

Received: 03 December 2020Accepted: 09 April 2021
The Generic skills challenge for higher education institutions: Experience of public universities in Chile
Authors: Sandoval Luis , Ormazábal María
Published: May 2021

In recent decades in Chile, generic skills have been made explicit in the graduation profiles and curricula of all programs of higher education institutions, following global trends that relate to labor market expectations on the employability of graduates. The institutional characteristics, mission, educational model, and institutional seal condition the choice of the generic skills that are developed. There are no current standards for the process of definition of generic skills sets in the various programs for the different universities. The same is true for the modality of implementation for them. The present article has the purpose of contributing to the knowledge of both the definition and implementation of generic skills inside higher education institutions in Chile. This process becomes relevant in the context of the new demands of students and graduates who face additional employment challenges.
Received: 03 March 2020Accepted: 05 March 2021
The future challenges of scientific and technical higher education
Authors: Cesco Stefano , Zara Vincenzo , De Toni Alberto F. , Lugli Paolo , Evans Alexander , Orzes Guido
Published: May 2021

The world is experiencing significant changes, including exponential growth of the global population, global warming and climate change, biodiversity loss, international migration, digitalization, smart agriculture/farming, synthetic biology, and most recently a global human health pandemic. These trends pose a set of relevant challenges for the training of new graduates as well as for the re-skilling of current workers through lifelong learning programs. Our paper seeks to answer two research questions: (1) are current study programs suitable to prepare students for their professional future and (2) are study programs adequate to deliver the needs of current and new generations of students? We analyzed the professional figures and the skills required by the job market, as well as the number of students enrolled in technical-scientific HE study programs in Europe. We discuss the needs of future students considering how the teaching tools and methods enabled by digitalization might contribute to increasing the effectiveness of training these students. Finally, we shed light on the different types of HE study programs that can meet the educational challenges of the future.

Received: 23 June 2020Accepted: 04 May 2021
CARCINOMA METAPLÁSICO DE MAMA EM PACIENTE JOVEM: UM RELATO DE CASO
Authors: Damasceno Matheus Fávero , Soares Alice Assumpção , Delgado Carolina Silva , Paiva Patricia Fraga , Assis Emilio Pereira
Published: May 2021

RESUMO

CONTEXTUALIZAÇÃO: O câncer de mama é a 2ª neoplasia mais comum entre as mulheres no Brasil e no mundo. Essa doença, relativamente rara antes dos 35 anos possui características altamente heterogêneas, patologia específica e comportamento biológico distinto. Dentre os Subtipos, o Carcinoma Mamário Metaplásico possui uma incidência de apenas 0,2-5% nos casos de câncer de mama. O objetivo desse estudo é relatar, a partir de uma comparação e revisão de literatura, o caso de uma paciente portadora do carcinoma mamário metaplásico, abaixo de 40 anos, pela raridade do tipo histológico e de seu comportamento agressivo. DESCRIÇÃO DA EXPERIÊNCIA: A paciente inicialmente aos 28 anos apresentou o Papiloma Atípico e 2 anos depois desenvolveu o Carcinoma Mamário Metaplásioco, além de múltiplos nódulos metastáticos pulmonares, comum desse subtipo, e hepáticos. CONSIDERAÇÕES FINAIS: Deve-se destacar que é difícil extrair conclusões definitivas quanto ao prognóstico e tratamento destas lesões, uma vez que elas são muito infrequentes na maior parte de série de casos publicados.  

Palavras-chave: Carcinoma Mamário Metaplásico, Carcinoma Mamário, Neoplasia Mamária Malígna, Câncer de Mama.

ABSTRACT

CONTEXT: The breast cancer is the 2nd most common neoplasia among women in Brasil and around the world. This disease, relatively rare before the age of 35 years, has highly heterogeneous characteristics, especific pathology and distinct biological behavior. Among the subtypes, the Metaplastic Breast Carcinoma has an incidence of only 0,2-5% between the breast cancer cases. The purpose of this study is to report, from a comparison and literature review, the case of a patient with Metaplastic Breast Carcinoma, below 40 yers old, due to the rarity of the histological type and its aggressive behavior. EXPERIENCE DESCRIPTION: The patient, inicially 28 years old presented the Atipic Papilloma and 2 years later developed the Metaplastic Breast Carcinoma, in adittion to multiple metastatic pulmonary nodes, common of the type, and hepatic. FINAL CONSIDERATIONS: It should be noted that it is difficult to draw definitive conclusions about the prognosis and treatment of these lesions, since they are very infrequent in most of the series of published cases.

Keywords: Metaplastic Breast Carcinoma, Breast Carcinoma, Malign Breast Neoplasia, Breast Cancer.
PERFIL DE GESTANTES COMFIRMADAS PARA ZIKA VÍRUS E ASSISTÊNCIA PRÉ-NATAL NA ATENÇÃO PRIMÁRIA À SAÚDE DE PALMAS, TOCANTINS, 2016
Authors: Vanderlei Juliana da Silva , Franchi Eliane Patricia Lino Pereira , Gomes Nábia Souza , Oliveira Alice Kelly Reis de , Monteiro Lorena dias
Published: May 2021

RESUMO

Objetivo: descrever a assistência pré-natal e perfil das gestantes confirmadas para zika vírus na atenção primária à saúde de Palmas, Tocantins no ano de 2016. Métodos: Trata-se de um estudo descritivo, com dados obtidos do SINAN, SISPRENATAL e SINASC. Foram confirmadas 63 gestantes com a infecção por Zika vírus por exame laboratorial. Resultados: A média de idade das gestantes foi de 26 anos. Os casos confirmados foram notificados predominantemente nas unidades de pronto atendimento (41,27%) e no hospital materno de referência (47,62%). Houve predomínio de gestantes pardas (61,90%), sem ensino médio completo (73,02%), em união estável (47,62%) e jovens (58,73%), que foram atendidas em quase totalidade nos serviços públicos de atenção secundária e terciária. Conclusão: Os resultados deste estudo mostraram a necessidade de melhoria para a assistência pré-natal às gestantes positivas na atenção primária e trouxe evidências do caráter da vulnerabilidade social da infecção pelo Zika vírus na capital do Tocantins.  

Palavras-chave: Cuidado Pré-Natal; Epidemiologia; Zika vírus; Atenção Primária à Saúde.

ABSTRACT

Objective: describe the prenatal care and profile of confirmed pregnant women for zika virus in the primary health care of Palmas city, Tocantins, in the year 2016. Methods: This is a descriptive study, with data obtained from SINAN, SISPRENATAL and SINASC. Sixty-three pregnant women with Zika virus infection were confirmed by laboratory examination. Results: The mean age of pregnant women was 26 years. The confirmed cases were predominantly reported in the emergency care units (41.27%) and in the maternal reference hospital (47.62%). There was a predominance of brown pregnant women (61.90%), without complete secondary education (73.02%), in a stable union (47.62%) and young women (58.73%), who were attended almost entirely in public services of secondary and tertiary care. Conclusion: The results of this study showed the need for improvement for prenatal care to positive pregnant women in primary care and brought evidence of the social vulnerability of the Zika virus infection in the capital of Tocantins.

Keywords: Prenatal care; Epidemiology; Zika virus; Primary Health Care.
AVALIAÇÃO NECROSCÓPICA DE CHOQUE SÉPTICO POR COMPLICAÇÕES DE COLECISTITE LITIÁSICA AGUDA
Authors: Lucena Larissa Cardoso , Tomazelli Ana Paula , Souto Alexandre Arguelio , Lucena Letícia Cardoso , Carvalho Arthur Alves Borges de
Published: May 2021

RESUMO

A colecistite litiásica aguda é uma inflamação aguda da vesícula biliar, desencadeada em 90% dos casos pela obstrução do colo ou ducto cístico. Esse tipo de colecistite ocorre com frequência em pacientes diabéticos que possuem cálculos biliares assintomáticos. Em casos mais severos, a vesícula torna-se um órgão necrótico, chamada colecistite gangrenosa, com perfurações, A invasão de organismos anaeróbios, notadamente clostridia, e coliformes podem causar sérias complicações. O objetivo deste estudo foi relatar um caso de óbito natural em idosa com 99 anos de idade, sexo feminino, com complicações de colecistite que levaram ao óbito. A necropsia, associada aos informes clínicos, evidenciou choque séptico com complicações associadas de colelitíase e colecistite, exibindo necrose em vesícula, com extensão do processo inflamatório e infeccioso, através da adventícia, para peritonite aguda fibrinosa, septicemia e óbito.  

Palavras-chave: Colecistite; Choque séptico; Necropsia.

ABSTRACT

Acute lithiasis cholecystitis is an acute inflammation of the gallbladder, triggered in 90% of cases due to obstruction of the cervix or cystic duct. This type of cholecystitis occurs frequently in diabetic patients who have asymptomatic gallstones. In more severe cases, the gallbladder becomes a necrotic organ, called gangrenous cholecystitis, with perforations. The invasion of anaerobic organisms, notably clostridia, and coliforms can cause serious complications. The objective of this study was to report a case of natural death in a 99-year-old female, with complications of cholecystitis leading to death. Necropsy, associated with clinical reports, evidenced septic shock with associated complications of cholelithiasis and cholecystitis, exhibiting necrosis in the gallbladder, with an extension of the inflammatory and infectious process, through the adventitia, to acute fibrinous peritonitis, septicemia and death.

Keywords: Cholecystitis; Septic Shock; Autopsy.
USO DO FÓRCEPS: UMA REVISÃO DE LITERATURA
Authors: Machado Leonardo de Oliveira , Said Neto Mamud
Published: May 2021

RESUMO

Introdução A família Chamberlen inventou o fórceps obstétrico nos anos 1600 e, desde então, tem havido várias centenas de versões. Atualmente, os dois tipos mais usados no Reino Unido são Neville Barnes '(NBF) e o fórceps de Wrigley (WF). Metodologia Foi realizada uma pesquisa nas bases Science Direct, Pub Med e Google Scholar para publicações recentes sobre o uso do fórceps utilizando a palavra chave: forceps use. A seleção de estudos potenciais a serem incluídos foi feita revisando os títulos, resumos e data de publicação, sendo selecionados apenas artigos em inglês. Finalmente, foram incluídos para a revisão 21 artigos. Não houve seleção com base na metodologia do estudo, de modo que foram incluídos vários tipos de artigos. Resultados A taxa de partos instrumentais está diminuindo, particularmente o uso de fórceps, que está mais ou menos fora de prática em alguns países europeus como a Romênia. As taxas de parto vaginal instrumental variam amplamente, de 0,5% na Romênia a 16,4% na Irlanda, com um valor mediano de 7,5% na Europa. Conclusão Há mais partos a vácuo sendo realizadas na Europa e em outros países pelos obstetras. No entanto, muitos obstetras preferem usar dispositivos de extração a vácuo do que fórceps, ou realizar cesarianas em vez de partos vaginais operatórios em geral, com medo de litígio, e a crença de que essas são opções mais seguras.  

Palavras-chave: fórceps obstétrico, partos instrumentais, uso de fórceps.

ABSTRACT

Introduction The Chamberlen family invented obstetric forceps in the 1600s, and since then there have been several hundred versions. Currently, the two most commonly used types in the UK are Neville Barnes' (NBF) and Wrigley Forceps (WF). Methodology A search was made at the bases Science Direct, Pub Med and Google Scholar for recent publications on the use of forceps using the keyword: forceps use. The selection of potential studies to be included was done by reviewing the titles, abstracts and date of publication, selecting only articles in English. Finally, 21 articles were included for the review. There was no selection based on the study methodology, so several types of articles were included. Results The rate of instrumental deliveries is declining, particularly the use of forceps, which is more or less out of practice in some European countries such as Romania. Rates of instrumental vaginal delivery vary widely, from 0.5% in Romania to 16.4% in Ireland, with a median value of 7.5% in Europe. Conclusion There are more vacuum deliveries being performed in Europe and in other countries by obstetricians. However, many obstetricians prefer to use vacuum extraction devices than forceps, or perform cesarean deliveries instead of operative vaginal delivery in general, with fear of litigation, and the belief that these are safer options.

Keywords: obstetric forceps, instrumental deliveries, forceps use.
HEMORRAGIA PÓS-PARTO
Authors: Macedo Pollyana de Cássia , Lopes Hanna Helena
Published: May 2021

RESUMO

Introdução: A hemorragia pós-parto é a principal causa de morbimortalidade materna no mundo, sendo responsável por cerca de 25% do óbitos maternos mundiais, tratando-se, pois, de uma condição potencialmente grave e importante para a saúde pública. Métodos: Foi realizada uma revisão de literatura no banco de dados MEDLINE, PUBMED e SCIELO, selecionando artigos que tratavam principalmente do manejo, da prevenção e dos fatores de risco relacionados à hemorragia pós-parto. Resultados: O conhecimento dos fatores de risco, bem como o manejo ativo no terceiro período, com o uso de uterotônicos, clampeamento do cordão em tempo oportuno e tração controlada do cordão, são eficazes na redução da hemorragia pós-parto. A identificação de sinais e sintomas da hemorragia deve ser precoce para iniciar o manejo terapêutico, o qual divide-se em manutenção da estabilidade hemodinâmica e tratamento específico segundo a etiologia. Inicialmente é preferido o tratamento clínico, com fármacos e manobras, e em caso de falha terapêutica, o tratamento cirúrgico deve ser indicado e realizado o quanto antes. Conclusão: A redução da morbimortalidade por hemorragia pós-parto baseia-se em três pilares de atendimento: assistência pré-natal e durante o trabalho de parto de qualidade, manejo ativo no terceiro período e manejo terapêutico rápido e eficaz.  

Palavras-chave: Hemorragia pós-parto; Prevenção; Fatores de risco; Manejo terapêutico; Trabalho de parto; Terceiro período.

ABSTRACT

Introduction: Postpartum haemorrhage is the main cause of maternal mortality and morbidity worldwide, and its being responsible for nearly 25% of maternal deaths. Methods: The research was conducted through a literature review of MEDLINE, PUBMED and SCIELO database, and the articles were selected that discussed mainly about management, prophylaxis and risk factors related to postpartum haemorrhage. Results: The risk factors knowledge, as well as the active management in the Third Period, with uterotonics use, opportunal cord clampeament and controled cord traction are effective in reduce postpartum haemorrhage. The identification of the signs and symptons of haemorrhage is essential to iniciate the therapeutic management, which is divided in haemodynamic establizitation maintanace and especif treatment, directed towards the etiology. Inicially the clinical treatment is preferred, with the use of drugs and techiniques, and if therapeutic failure, surgical treatment must be indicated and early managed. Conclusion: Postpartum haemorrhage morbimortality reduction is based in three attendance pilars: antenatal, intrapartum and postpartum qualified assistance, active management of the third period and fast and effective therapeutic managem.

Keywords: Postpartum haemorrhage; Prevention; Risk factors; Therapeutic management; Delivery; Third period.
RUPTURA PREMATURA DE MEMBRANAS: UMA REVISÃO DE LITERATURA
Authors: Chagas Ribeiro Jessye Christie , Gama Ana Virginia
Published: May 2021

Introdução Ruptura prematura de membranas (RPM) é a ruptura das membranas fetais antes do início do trabalho de parto. A incidência da RPM é de 2,7 a 7% na China e de 5 a 15% na América. Na maioria dos casos, isso ocorre a curto prazo; no entanto, quando a ruptura da membrana ocorre antes de 37 semanas de gestação, ela é conhecida como ruptura prematura pré-termo das membranas (RPPM). Metodologia Foi realizada uma pesquisa nas bases Science Direct e Google Scholar para publicações recentes sobre a ruptura prematura de membranas. Não houve seleção com base na metodologia do estudo. Resultados As faixas de idade gestacional na RPPM são amplas e diferem amplamente entre os estudos. Portanto, os resultados gerais não estratificados não permitem comparações apropriadas. Amostras pequenas não fornecem estimativas precisas. Conclusão Melhorar o prognóstico dessas gestações provavelmente requer repensar as políticas de atenção de forma multidisciplinar, envolvendo obstetras, neonatologistas, redes de atenção, associações de pais e formuladores de políticas.
Rethinking the Meaning of Transformed Historic Environment Through the Non-Muslim Religious Structures of Izmir
Authors: Severoğlu Ceren , Akkurt Hümeyra Birol
Published: May 2021

Izmir city, which is the focus of the study, has hosted many different historical periods and their cultural outputs from past to present. In the city, the traces of different cultural periods such as civilizations of antiquity, Beyliks, Ottomans and Turkish Republic can be examined at the same time. Due to the developments in the marine trade in 19th century, the physical, economical and social structure of the port city Izmir was improved. The enriched structure of Izmir can still be observed through its historical environment. Within this heritage, the role of religious buildings in terms of urban identity, environmental impact and social belonging have a great importance. Furthermore, the preservation / transformation implementations of these structures reshape the physical and social structure of the city.In this sense, the subject of this study is to examine the environmental and social impact of the transformed non-Muslim religious structures of Izmir. Through the site analyses, the effect of the preservation implementations and the new urban roles of these monumental buildings are to be defined while the continuity of the cultural values and contributions to the urban identity will be questioned. The findings of the research will be evaluated over a set of parameters such as environmental impact, sense of belonging, continuity of the spatial identity and the sufficiency of the new uses.
Web-Based Medical Examinations During the COVID-19 Era: Reconsidering Learning as the Main Goal of Examination
Authors: Manteghinejad Amirreza
Published: May 2021

Like other aspects of the health care system, medical education has been greatly affected by the COVID-19 pandemic. To follow the requirements of lockdown and virtual education, the performance of students has been evaluated via web-based examinations. Although this shift to web-based examinations was inevitable, other mental, educational, and technical aspects should be considered to ensure the efficiency and accuracy of this type of evaluation in this era. The easiest way to address the new challenges is to administer traditional questions via a web-based platform. However, more factors should be accounted for when designing web-based examinations during the COVID-19 era. This article presents an approach in which the opportunity created by the pandemic is used as a basis to reconsider learning as the main goal of web-based examinations. The approach suggests using open-book examinations, using questions that require high cognitive domains, using real clinical scenarios, developing more comprehensive examination blueprints, using advanced platforms for web-based questions, and providing feedback in web-based examinations to ensure that the examinees have acquired the minimum competency levels defined in the course objectives.
Design of the Maternal Website EMAeHealth That Supports Decision-Making During Pregnancy and in the Postpartum Period: Collaborative Action Research Study
Authors: Artieta-Pinedo Isabel , Paz-Pascual Carmen , Bully Paola , Espinosa Maite ,   EmaQ Group
Published: May 2021

Background

Despite the benefit maternal education has for women, it needs new tools to increase its effectiveness and scope, in tune with the needs of current users.

Objective

We attempted to develop a multifunctional personalized eHealth platform aimed at the self-management of health in relation to maternity, which can be considered a flexible and adaptable maternal education tool.

Methods

The International Patient Decision Aid Standards (IPDAS) were applied. A website prototype was developed for implementation in the public health system using a collaborative action research process, in which experts and patients participate, with qualitative research techniques, as well as focus groups, prioritization, and consensus techniques.

Results

We have proposed a website that includes (1) systematically updated information related to clinical practice guidelines, (2) interaction between peers and users/professionals, (3) instruments for self-assessment of health needs as a basis for working on counseling, agreement on actions, help in the search for resources, support in decision-making, and monitoring and evaluation of results, and (4) access for women to their clinical data and the option of sharing the data with other health agents. These components, with different access requirements, would be reviewed through iterative cycles depending on the frequency and effectiveness resulting from their use and would be accessible from any digital device.

Conclusions

A website that supports maternal education should contain not only information, but also resources for individual attention and social support. Its usefulness for the health and satisfaction of women should be evaluated in various different environments.
Mengapa PBL (Masih) Diperdebatkan di Fakultas Kedokteran?
Authors: Rukmini Elisabeth
Published: May 2021

Problem-based learning (PBL) has been implemented widely in most of faculty of medicine in Indonesia. Nevertheless, PBL as a learning method is still debated. This article tried to unravel the debate of PBL implementation in medical schools, as well as recommending important notes in order to find a well-defined PBL and to improve its implementation. PBL should be acknowledged as one of the student centered learning methods. Therefore, this condition would not rule out the possibility of the empirical progress in PBL implementation in faculty of medicine in Indonesia.
Mini-CEX Sebagai Metode Penilaian Keterampilan Klinis Mahasiswa Program Pendidikan Kepaniteraan Klinik Fakultas Kedokteran Universitas Gadjah Mada - Studi Pendahuluan
Authors: Munandar Reza M. , Suhoyo Yoyo , Hadianto Tridjoko
Published: May 2021

Background: Mini-CEX was developed to assess clinical skills by direct observation. Mini-CEX as a clinical skills assessment tool had to fulfill four requirements: validity, reliability, effects on students, and practicality. The purpose of this study is to understand validity, reliability, and feasibility of Mini-CEX as a clinical skills assessment tool in medical core clerkship program at Faculty of Medicine Universitas Gadjah Mada.Method: Seventy four clerkship students from Internal Medicine and 42 clerkship students from Neurology Department were asked to do an observed Mini-CEX encounter for minimum amount of four in Internal Medicine and two in Neurology Department in the period of September 2010 to January 2011. The validity was analyzed with Kruskal-Wallis method for Internal Medicine, and Mann-Whitney Method for neurology Department, reliability was analyzed based on G coefficient, and feasibility was analyzed using descriptive statistic.Results: Mini-CEX’s validity is shown by p < 0,001 in Internal Medicine and p = 0,250 in Neurology Department, G coefficient for Internal Medicine and Neurology Department is 0,98 and 0,61 respectively. Feasibility in Internal Medicine and Neurology Department is 79,7 % and 100% respectively.Conclusion: Mini-CEX is valid and reliable in Internal Medicine but not in Neurology Department. Feasibility is good for both Internal Medicine and Neurology Department.