El método de clasificación de mortinatos "Condición Obstétrica Relevante de la Muerte Fetal" (CORM) reduce la frecuencia de muerte fetal de causa inexplicable / The stillbirth classification method "Relevant Obstetric Condition of Stillbirth" (CORM) reduces the frequency of unexplained fetal death

RESUMEN Introducción: La muerte fetal (MF) es el principal contribuyente de la mortalidad perinatal. Objetivo: Analizar la eficiencia del método de clasificación de mortinatos, condición obstétrica relevante de la MF (CORM). Métodos: Estudio cohorte retrospectivo, de las MF ocurridas en la Maternidad del Hospital San Borja Arriarán durante 10 años. Los datos provienen de los informes de las auditorías de mortinatos. Se aplicó el método de clasificación CORM, que usa la biopsia placentaria, los datos clínicos y de laboratorio analizados por un obstetra y un patólogo. Resultados: Ocurrieron 56.130 nacimientos y 479 MFs. Tasa de MF, 8.5 por 1000 nacimientos. Se identificaron el 93.5% de las condiciones obstétricas de MF y 6.5% fueron inexplicables. Las más frecuentes fueron: infección bacteriana ascendente (IBA) 24.9%, anomalía congénita 18.0%, y patología placentaria 14.0%. La restricción del crecimiento fetal intrauterino (RCIU) se presentó en el 49.7% de los mortinatos, la mayoría 93.7%, fue secundaria a condición obstétrica primaria. La asfixia durante el parto fue el 0.8% de los mortinatos y se presentó en embarazos de término. El parto prematuro (PP) representó el 80% de los casos de MF. La condición más frecuente asociada con PP fue IBA (38.5% y 38.2% de las MF menores de 30 semanas y menores de 1000 gramos respectivamente). Conclusiones: El método clasificación de mortinatos CORM, es más eficiente que los métodos convencionales en detectar la causa de MF porque identifica la mayoría de las condiciones obstétricas responsables de la MF. Es reproducible, requiere estudio histopatológico de la placenta y no de autopsia fetal. Permite elaborar guías de prevención por causa.

SUMMARY Introduction: Stillbirth is the main contributor to perinatal mortality. Aim: To analyze the efficiency of the method for classification of fetal death (FD), "obstetric condition relevant to the death (OCRD). Methods: Retrospective cohort study of the FD that occurred in the Maternity Hospital of San Borja Arriarán for ten years. The data comes from the reports of the stillborn audits. We applied the classification method OCRD, which uses placental biopsy, clinical and laboratory data analyzed by a single obstetrician and a single pathologist. Results: 56,130 births and 479 FD occurred. FD rate, 8.5 per 1000 births. We identified 93.5% of the obstetric conditions of FD and 6.5% were unexplained. The most frequent were: ascending bacterial infection (ABI) 24.9%, congenital anomaly 18.0%, and placental pathology 14.0%. The intrauterine fetal growth restriction (IUGR) was present in 49.7% of the stillbirths, the majority 93.7%, was secondary to primary obstetric condition. Asphyxia during delivery was 0.8% of the stillbirths and occurred in term pregnancies. Preterm birth (PB) represented 80% of FD cases. The most frequent condition associated with PB was ABI (38.5% and 38.2% of the FD less than 30 weeks and less than 1000 grams respectively). Conclusions: The OCRD stillbirth classification method is more efficient than conventional methods in detecting the cause of MF because it identifies most of the obstetric conditions responsible for FD. It is reproducible, requires histopathological study of the placenta and not fetal autopsy. It allows developing guidelines of prevention for cause.

Advances in coamorphous drug delivery systems

In recent years, the coamorphous drug delivery system has been established as a promising formulation approach for delivering poorly water-soluble drugs. The coamorphous solid is a single-phase system containing an active pharmaceutical ingredient (API) and other low molecular weight molecules that might be pharmacologically relevant APIs or excipients. These formulations exhibit considerable advantages over neat crystalline or amorphous material, including improved physical stability, dissolution profiles, and potentially enhanced therapeutic efficacy. This review provides a comprehensive overview of coamorphous drug delivery systems from the perspectives of preparation, physicochemical characteristics, physical stability, and performance. Furthermore, the challenges and strategies in developing robust coamorphous drug products of high quality and performance are briefly discussed.

Classificação dos alimentos quanto ao processamento industrial: uma revisão bibliográfica / Food classification for industrial processing: a review

Introdução: O processamento artificial de alimentos tem sido considerado um fator de risco importante na saúde. O objetivo deste estudo é revisar a literatura científica quanto à definição da classificação dos alimentos referente ao seu grau de processamento industrial. Métodos: revisão narrativa de artigos publicados nas bases de dados indexadas MEDLINE (PubMed) e LILACS e guias alimentares disponíveis na página online da Food and Agriculture Organization of the United Nations (FAO). A estratégia de busca utilizada compreendeu os seguintes descritores: Processed food OR Unprocessed food OR Artisanal food OR Minimally processed food OR Highly processed OR Ultra-processed food OR Industrial food processing. Não houve restrição quanto ao idioma utilizado nas publicações. Resultados: foram identificados 1301 artigos nas bases de dados PubMed e LILACS e 35 na página da FAO. Definições de alimentos processados ou ultraprocessados foram encontradas em diretrizes de apenas 8 dos 34 países avaliados nessa revisão. Apenas três diretrizes eram baseadas na classificação NOVA, utilizada no Brasil. Os demais países que utilizam classificações baseadas no grau de processamento industrial se pautam em definições variadas, baseadas na quantidade de aditivos, açucares, gorduras e outras substâncias. Além disso, apenas quatro países utilizam a classificação de ultraprocessados para alimentos altamente industrializados. Conclusões: apesar dos riscos já evidenciados em relação ao consumo destes alimentos, as evidências demonstram que o conceito em relação ao grau de processamento industrial de alimentos não apresenta uma definição padronizada.

Introduction: artificial food processing has been considered a major health risk factor. The objective of this study is to review the scientific literature regarding the definition of food classification related to its degree of industrial processing. Methods: narrative review. Articles published in MEDLINE (PubMed) and LILACS indexed databases and food guides available on the Food and Agriculture Organization of the United Nations (FAO) website were evaluated. The search strategy used included the following descriptors: Processed food OR Unprocessed food OR Artisanal food OR Minimally processed food OR Highly processed OR Ultra-processed food OR Industrial food processing. There was no restriction on the language used in the publications. Results: 1301 articles in the PubMed and LILACS databases and 35 on the FAO website were identified. Food classifications based on the degree of industrial processing were found in only 8 of 34 countries included in this review. Of those, only three guidelines were based on the NOVA classification, currently used in Brazil. Other countries with food classifications based on industrial processing used definitions characterized by the addition of sugars, chemical additives, fats and other substances. Furthermore, only four countries used definitions for ultraprocessed foods specifically. Conclusion: the evidence demonstrates the concept in relation to industrial processing does not present a standard definition, despite the risks already evidenced in relation to the consumption of these.

Predictive efficacy of different intrauterine adhesion (IUA) classification systems on the prognosis of patients with IUA / 解放军医学杂志

Objective To explore the effects of different intrauterine adhesion (IUA) classification systems on predicting the IUA prognosis.Methods One hundred cases were selected as the subjects in present study from those diagnosed with IUA and underwent surgery in Zhujiang Hospital of Southern Medical University from Jan.2010 to Jan.2017,and were followed up for two years.According to the actual situation,all patients were scored by March,AFS,ESGE and Chinese classification for comparing the effects of different IUA classification systems on predicting the pregnancy rate,live birth rate and effective rate within 2 years after surgery.Results ESGE classification had a good effect on predicting the postoperative live birth rate and effective rate,and a certain predictive effect on pregnant rate,with the area under curve (AUC) of 0.722,0.754 and 0.635,respectively.March classification had a certain effect on predicting the postoperative live birth rate and effective rate with AUC of 0.635,0.754,respectively,but had a poor effect on predicting pregnant rate.AFS classification and China classification had poor effect on predicting the IUA prognosis.Conclusion ESGE classification system is better than the other systems including March,AFS and Chinese classification,on predicting the IUA prognosis,but further verification in large sample size is still required.

A comparative study of risk classification systems for drug use during pregnancy / 中国药学杂志

OBJECTIVE: To compare and analyze three risk classification systems for drug use during pregnancy, so as to provide evidence for drug safety used in pregnancy. METHODS: The drugs included in the risk classification systems from the US Food and Drug Administration (FDA), the Australian Drug Evaluation Committee (ADEC) and the Swedish Catalogue of Approved Drugs (FASS) were searched, and descriptive analysis was performed in terms of definition of category, allocation of drugs and difference of categories. RESULTS: FDA uses animal studies and human observations studies in pregnancy to define the risk of drugs in pregnancy. The classification systems of ADEC and FASS are similar, which use experience in human and animal research for defining the drug safety during pregnancy. The category assignments for 1113 drugs in FDA system, 1232 in ADEC system and 983 in FASS system were compared. Only 367 (11.6% ) drugs among the total of 3167 in the three systems were placed in the same risk level category, which accounted for 33.0%, 29. 8% and 37.3% of FDA, ADEC and FASS systems, respectively. The main differences existed in drugs in X and C categories between FDA and ADEC/FASS systems. CONCLUSION: Differences in category allocation for the same drug can be a source of great confusion among users of the classification systems, and may limit the usefulness and reliability of risk classification systems.

A comparative study between conventional system and the Bethesda system applied for reporting thyroid cytopathology.

Aim and objectives: To compare the conventional and the Bethesda system for reporting thyroid cytopathology (TBSRTC), to correlate the cases with histology wherever available and to determine the sensitivity, specificity and false positive rates of both the methods. Material and methods: A Total of 240 patients who presented with thyroid gland swelling were subjected to thyroid fine needle aspiration cytology (FNAC) and the smears were made followed by H&E staining and reporting was done The convential system used at our centre includes description of microscopic findings of the case along with an impression at the end. The categorization according to the Bethesda system of reporting thyroid cytology were done using criteria published in the atlas and related literature. The cytological diagnosis was correlated with the histological diagnosis wherever it was available. The sensitivity, specificity, false positive rates were calculated considering cytology as screening test for differentiating between neoplastic and non-neoplastic lesions. Results: When the results of the conventional system were compared with the Bethesda adapted method was found to be more superior. Sensitivity of Bethesda system was significantly high (100%) as compared to conventional system (77%). Specificity of Bethesda system was also significantly high (82.5%) as compared to conventional system (69%). Conclusion: Our findings were consistent with others who used the Bethesda cytopathology reporting system.

Evaluación de la Implementación del Sistema de Clasificación y Categorización de Canales Bovinas en Plantas Beneficiadoras en la Región Central de Venezuela / Evaluation of Beef Carcass Grading System Implementation in Slaughterhouses in the Central Region of Venezuela

El sistema de clasificación y categorización vigente, basado en el Decreto Presidencial N°1896 de 1997, establece criterios a seguir para realizar la evaluación de canales bovinas; sin embargo, hasta el presente, poco se ha reportado de cómo es aplicado dicho sistema en las plantas beneficiadoras del país. En este sentido, se visitaron 3 plantas beneficiadoras de bovinos en la región central de Venezuela, 45% del total de plantas existentes en los estados Aragua y Carabobo, con la finalidad de evaluar la implementación de este sistema, mediante la observación documentada del proceso de clasificación y categorización en cada planta, utilizando una guía de observación. Paralelamente a este levantamiento de información en planta, se aplicó una encuesta a los médicos veterinarios clasificadores. Ambos resultados fueron tabulados y evaluados mediante estadística descriptiva. Posteriormente, al analizar esta información se comprobó que, a pesar de estar estipulado en todos esos establecimientos aplicar este sistema, esto no se realiza de forma homogénea en todos ellos. Los niveles de cumplimiento en la medición de las variables estuvieron entre 43% y 21%. De igual forma, se conoció que no se evalúan las canales en estado refrigerado como está establecido en la normativa oficial. El análisis comparativo de la encuesta con la observación documentada confirmó que, aún cuando el sistema se basa en el Decreto 1896 y su respectivo instructivo, no todas las plantas beneficiadoras lo aplican, tal y como está establecido. Se evidenció que el sistema de clasificación y categorización de canales bovinas en la región central de Venezuela se aplica de manera discrecional en cada establecimiento, basándose en criterios de “practicidad”, en aras de hacer más expedito el procedimiento. Esto refleja la necesidad de revisar la normativa y establecer mecanismos para asegurar su fiel cumplimiento en todas las plantas beneficiadoras.

The classification and categorization system for evaluating cattle carcasses, based on the existing Decree No. 1896 of 1997, establishes the criteria to be followed; however, to date, little has been reported as to its application in Venezuela slaughterhouses. To evaluate the implementation of this system, 3 cattle slaughterhouses of the States of Aragua and Carabobo, which correspond to 45% of all existing plants from those states located in the central region of Venezuela, were visited. The assessment was performed by documented observation of the process of classification and categorization of each slaughterhouse, using an observation guide. Parallel to this collection of information on the plant, a survey was applied to veterinarians in charge of classifying meat. Both results were tabulated and evaluated using descriptive statistics. Once the information was analyzed, it was found that, despite being stipulated, the implementation of this system was not performed in a homogenous way in any of the establishments evaluated. Compliance levels in variables measuring were between 43 and 21%. Likewise, it was known that refrigerated carcasses are not evaluated, as required by official regulations. The comparative analysis of the survey along with the documented observation confirmed that, even when the system is based on Decree 1896 and its respective instructions, not all slaughterhouses apply it, as the law establishes. It was evident that the system of classification and categorization of cattle carcasses in the central region of Venezuela is applied in a discretionary manner in each meat processing plant, based on practicality criteria, to expedite the procedure. This reflects the need to review the regulations and mechanisms to ensure faithful compliance in all cattle slaughterhouses.

O projeto research domain criteria e o abandono da tradição psicopatológica / The research domain criteria project and the abandonment of the tradition of psychopathology / Le projet research domain criteria (RDoC) et le renoncement à la tradition psychopatologique / El proyecto research domain criteria y el abandono de la tradición psicopatológica

O artigo explora os pressupostos epistemológicos do Research Domain Criteria (RDoC) - projeto de investigação empírica dos transtornos mentais, dentro de uma plataforma biológica - promovido pelo National Institute of Mental Health (NIMH). Discute-se o ataque feito ao sistema DSM, pouco antes do lançamento de sua quinta versão, a partir da perspectiva neurocientífica adotada pelo RDoC. A aposta na patofisiologia, combinada com a exclusão da experiência descrita em primeira pessoa, aponta um cenário em que a pesquisa e a clínica se divorciam, com o risco do advento de uma estranha psiquiatria sem psique e sem pathos.

This article explores the epistemological underpinnings of the Research Domain Criteria (RDoC), launched by the National Institute of Mental Health (NIMH) - USA. The project has the objective of empirically investigating mental disorders in a biological framework. We discuss the sharp criticism received by the DSM shortly before its fifth edition came out, based as it was on the neuroscientific approach adopted by the RDoC. The preference for pathophysiology, combined with the exclusion of first-person experience, points to a scenario where research and clinical work are irrevocably divorced, and runs the risk of fostering an odd psychiatry with neither psyche nor pathos.

Cet article examine les présupposés épistémologiques de l'initiative dénommée Research Domain Criteria (RDoC) proposée aux Etats-Unis par le National Institute of Mental Health (NIHM). Ce projet s'inscrit dans le cadre d'une approche des troubles mentaux ancrée dans une perspective essentielment biologique et empirique. Il faut remarquer que ce programme a été lancé à la veille de la presentation de la cinquième version du système DSM. On s'interroge si la mise en ouvre d'un tel projet, largement fondé sur l'axe de recherche neuroscientifique et physiopathologique - divorcée des toutes complexités de l'expérience vécue en première personne - ne donneront pas naissance à une étrange créature: la psychiatrie sans pathos et sans psyché.

El artículo examina los presupuestos epistemológicos del Research Domain Criteria (RDoC) - proyecto de investigación empírica de los transtornos mentales, dentro de una plataforma biológica - promovido pelo National Institute of Mental Health (NIMH). Discute el ataque dirigido al sistema DSM, poco antes de la publicación de su quinta edición, desde una perspectiva neurocientífica adoptada pelo RDoC. La apuesta por la fisiopatología, combinada con la exclusión de la experiencia descrita en la primera persona, apunta para un escenario en el cual investigación y clínica se divorciam con el riesgo del adviento de una psiquiatría extraña, sin psiquis y sin pathos.

Type I Dentinal Dysplasia—Proposal of A New Classification System Combined with A Variant Case Presentation

Dentine dysplasia is an extremely rare autosomal dominant hereditary condition primarily characterized by defective dentine formation affecting both the deciduous and permanent dentitions. The aetiology of dentinal dysplasia remains imprecise to date, in spite of the numerous hypotheses put forward by various authors. Also, of late, new case reports of type I dentine dysplasias are emerging with clinical and radiographic findings which are unique and variant from the classical characteristic features of this anomaly, rendering it difficult to fit into the previously established classification systems. In this article, after a thorough review and understanding of the drawbacks of the previous classification systems and the cumulative findings from the published case reports in literature, we propose a new classification system for dentine dysplasia type I. We also present a case report which exhibited an absence of familial hereditary pattern, the absence of periradicular radiolucent lesions and osseous pathologies as well as atypical morphological defects of the molar roots which were diverse from the classical findings of the various sub types of dentine dysplasia type I reported to date. Early diagnosis and implementation of preventive and curative therapy is crucial for avoiding premature exfoliation of deciduous and permanent dentition and associated residual ridge resorption, thereby overcoming functional and aesthetic deficits. The new classification proposed in this article will help clinicians to diagnose and categorize the patients effectively, facilitating proper treatment and supportive care for all.

"Doidas e putas": usos das categorias travesti e transexual / "Locas y putas": usos de las categorías travesti y transexual / "Freaks and whores": uses of travesti and transsexual categories

Neste artigo discuto os usos das categorias travesti e transexual com base em trabalho de campo realizado entre 2008 e 2009 com participantes das reuniões denominadas Terças Trans. A questão central que norteou a análise foi como as diferentes pessoas observadas utilizavam categorias relacionadas a identidades sexuais e de gênero e como acionavam e articulavam diversas associações convencionais nesse processo para produzir sentidos e diferenças acerca destas categorias. Embora as convenções do discurso médico sejam referências centrais para a definição de corpos, subjetividades e identidades das pessoas pesquisadas, foi possível observar também uma variedade de reelaborações e deslocamentos de sentidos. Procuro desenvolver o argumento de que travesti e transexual são categorias performativas, e que tal performatividade não se esgota apenas em enunciados de gênero e sexualidade, mas também pode ser expressa por meio de articulações contingentes que remetem a diferenças de classe, cor/raça e geração.

Se discuten en este artículo los usos de las categorías travesti y transexual, a partir de un trabajo de campo realizado entre 2008 y 2009 con participantes de reuniones denominadas Martes Trans. La cuestión central que orientó el análisis fue cómo las diferentes personas observadas utilizaban categorías relacionadas a identidades sexuales y de género, y cómo accionaban y articulaban diversas asociaciones convencionales en este proceso, para producir sentidos y diferencias acerca de dichas categorías. Aun cuando las convenciones del discurso médico son referencias centrales para la definición de cuerpos, subjetividades e identidades de las personas involucradas en la investigación, se pudo observar también una variedad de reelaboraciones y desplazamientos de sentido. Se procura desarrollar el argumento de que travesti y transexual son categorías performativas, y que tal performatividad no se agota sólo en enunciados de género y sexualidad, sino que pueden también expresarse por medio de articulaciones contingentes que remiten a diferencias de clase, color/raza y generación.

In this article I discuss the uses of travesti and transexual categories based on fieldwork carried out from 2008 to 2009 with people who joined at Terças Trans. The main issue that frames my analysis was how people researched used categories regarding sexual and gender identities, especially travesti and transsexual and how they agency and articulate several conventional associations in this process to produce meanings and differences about these categories. Although the conventions of medical discourse are key references for the definition of bodies, subjectivities and identity of people surveyed, it was possible to note also a variety of re-elaborations and displacements of meanings. I try to develop the argument that travesti and transexual categories are performatives, and that this performativity is not limited only in statements of gender and sexuality, but can also be expressed by means of contingent articulation which refer to differences of class, color/race and generation.

A new method for classifying distal radius fracture: the IDEAL classification / Um novo método de classificação para as fraturas da extremidade distal do rádio – a classificação IDEAL

OBJECTIVES: To describe the new IDEAL method from classifying distal radius fractures. METHODS: IDEAL classification system is based on the most important literature evidences about clinical and radiographic characteristics that influence in the treatment and prognosis for patients that suffered from a distal radius fractures. In this method, we classify the fracture in patients first consultation, in which we collect demographical (age and trauma energy) and radiographic characteristics ( fracture deviation, articular fracture, and associated lesions). For each feature a score is attributed for grouping purposes. Group I - Stable fractures, good prognosis; Group II - potentially unstable fractures, commonly treated by surgical methods. Prognosis depends on surgeons' success after method choice. Group III - complex and instable fractures, poor outcome is expected. CONCLUSION: IDEAL classification staging rationale was presented, which is based on the best available evidence. The evidence of its scientific plausibility will be settled with the assessment of the classification reliability and its capacity to aid in therapeutical decisions and as a tool to predict prognosis. Further studies are under development to support these properties.

OBJETIVOS: Descrição do método de Classificação IDEAL - para as fraturas da extremidade distal do rádio. MÉTODOS: O sistema de classificação IDEAL fundamenta-se nas principais evidências da literatura sobre fatores clínicos e radiográficos que influenciam o tratamento e prognóstico das fraturas do rádio distal. Classificamos as fraturas no atendimento inicial do paciente mediante a verificação de dois dados epidemiológicos e três dados radiográficos: Idade do paciente, energia do trauma, desvio dos fragmentos, incongruência articular e lesões associadas. RESULTADOS: Conforme a pontuação obtida, agrupamos os casos em três grupos: Grupo I - fraturas estáveis com bom prognóstico, Grupo II - fraturas potencialmente instáveis que normalmente exigem tratamento cirúrgico, e que o prognóstico depende do sucesso do tratamento adotado, Grupo III - fraturas instáveis e complexas, decorrentes de traumatismos de alta energia e cujo prognóstico é reservado independente do tratamento adotado. CONCLUSÃO: Apresentamos descrição e método de categorização deste sistema de classificação, alicerçados nas melhores evidências disponíveis. A comprovação de sua plausibilidade científica se estabelecerá com a análise de resultados de estudos clínicos que mensurem sua reprodutibilidade e capacidade de determinar o tratamento e inferir o prognóstico destas frequentes fraturas e encontram-se em desenvolvimento.

Assistência de enfermagem a uma puérpera utilizando a teoria de horta e a cipe® / Atención de enfermería a una puérpera usando la teoría de horta y la cipe® / Nursing care postpartum women using the horta's theory and incp®

Trata-se de um estudo de caso fundamentado na Teoria das Necessidades Humanas Básicas de Horta, com o objetivo de operacionalizar o processo de enfermagem a uma puérpera com anemia. Para coleta de dados utilizou-se um roteiro adaptado às necessidades psicobiológicas, psicossociais e psicoespirituais. Para a identificação dos diagnósticos de enfermagem empregou-se a CIPE®, estabelecendo-se os resultados esperados e as intervenções de enfermagem, que foram implementadas e avaliadas. A partir das necessidades psicobiológicas e psicossociais afetadas na puérpera foram identificados os seguintes diagnósticos: Higiene oral prejudicada, Dor moderada, Ingurgitamento mamário, Trauma mamilar, Constipação e Solidão. Conclui-se que a implementação do processo de enfermagem a puérpera com anemia foi direcionado aos problemas da lactação e seu manejo e a melhoria da qualidade de vida.

Estudio de caso basado en la Teoría de las Necesidades Humanas Básicas de Horta, con objetivo de poner en práctica el proceso de enfermería a una puérpera con anemia. Para la recolección de datos, se utilizó un guión adaptado a las necesidades psicobiológicas, psicosociales y psicoespirituais. Para la identificación de los diagnósticos de enfermería, utilizó la CIPE®, estableciéndose los resultados esperados y las intervenciones de enfermería que fueron implementadas y evaluadas. A partir de las necesidades psicobiológicas y psicosociales afectadas en las mujeres fueron identificadas los siguientes diagnósticos: alteración de higiene oral, dolor moderado, ingurgitación mamaria, trauma del pezón, estreñimiento y soledad. La aplicación del proceso de enfermería a una puérpera con anemia se dirigió a los problemas de la lactancia materna y su gestión y mejoría de la calidad de vida.

This is a case study based on the Theory of Basic Human Needs of Horta, with the aim to operationalize the nursing process to a postpartum anemia. For collect data, we used a script adapted to psychobiological, psychosocial and psycho spiritual needs. For the identification of nursing diagnoses was used to ICNP®, establishing nursing outcomes and interventions that were implemented and evaluated. From psychobiological and psychosocial needs of affected puerperal women were identified in the following diagnoses: impaired oral hygiene, moderate pain, breast engorgement, nipple trauma, constipation, and solitude. It is concluded that the implementation of the nursing process with postpartum anemia was directed to the problems of breastfeeding and their management and improving the quality of life.

Radial Head Fractures: Mason Johnston’s Classification Reproducibility

Background: The purpose of the study was to evaluate interand intra-observer reproducibility of Mason Johnston classification of radial head fractures in adults. Materials and Methods: Thirty radiographic images of radial head fractures (anteroposterior and lateral views) from adult patients were examined by five professionals in the field of Orthopaedics and Traumatology, including an expert member of the Brazilian Society of Orthopaedics, an experienced orthopaedic surgeon specialising in the elbow and shoulder, and three resident physicians (one each in the 1st, 2nd and 3rd years of residency at an Orthopaedics and Trauma unit). Inter- and intra-observer concordances were assessed using the kappa coefficient of agreement (κ). Results: The intra-observer reproducibility of the Mason Johnston classification system ranged from moderate to good whilst the inter-observer agreement varied from weak to good. Conclusion: The Mason Johnston´s classification system, although used throughout the world, possesses questionable reproducibility with respect to the assessment of radial head fractures. The level of professional expertise did not influence the outcome of the study.

A Dynamic Systems: constraints approach to rehabilitation / Uma abordagem dos sistemas dinâmicos: restrições para a reabilitação

BACKGROUND: Classification systems (Nagi, International Classification for Function [ICF]) have become popular for categorizing the level of ability (ICF) or disability (Nagi) associated with movement disorders. Nevertheless, these classifications do not explore the ways in which one level may influence other levels. For example, how might the weakness and stiffness associated with some cases of cerebral palsy result in a stereotypical toe-gait? In this overview we describe a dynamic systems/constraints (DS/C) approach to understand relationships between levels, and how the approach can be used to rationalize a novel process for the evaluation and treatment of movement disorders. OBJECTIVES: There are three specific aims in this paper: first to present a general systems approach to understanding behavior at different levels; second to present tools of, and the results of empirical work using the DS/C approach; third to discuss the clinical implications and results of clinical interventions motivated by DS/C analysis for children with cerebral palsy, and individuals with Parkinson disease.

CONTEXTUALIZAÇÃO: Sistemas de classificação (Nagi e Classificação International de Funcionalidade (CIF)) têm se tornado populares para categorização do nível de habilidade (CIF) ou de incapacidade (Nagi) associado com distúrbios do movimento. No entanto, essas classificações não exploram as formas pelas quais um nível pode influenciar outros níveis; por exemplo, como a fraqueza e a rigidez observadas em alguns casos de paralisia cerebral podem resultar no padrão estereotipado de marcha equina. Neste artigo, descreve-se uma abordagem denominada sistemas dinâmicos/restrições (DS/C) para compreender as relações entre níveis e como ela pode ser utilizada para racionalizar um novo processo que norteie a avaliação e a intervenção de distúrbios do movimento. OBJETIVOS: Este artigo tem três objetivos específicos: apresentar uma abordagem geral sistêmica para compreender o comportamento em diferentes níveis de análise; apresentar ferramentas e resultados de estudos empíricos que utilizaram a abordagem DS/C e, por fim, discutir as implicações clínicas e os resultados de intervenções motivadas pela análise DS/C voltadas para crianças com paralisia cerebral e indivíduos com Doença de Parkinson.

El sacrificio de la validez a expensas de la habilidad en psicopatología: mirando por un cristal opaco / Sacrificing validity for feasibility in psychopathology: seeing through a dark glass

La mejora en el acuerdo interexaminadores y test-retest en el diagnóstico psiquiátrico puede ser considerada como uno de los grandes logros de la Psiquiatría en el último cuarto de siglo. No obstante, la homogeneización y operativización de criterios puede presentar algunos inconvenientes: el incremento de la comorbilidad entre trastornos y la validez probablemente deficitaria de algunas entidades nosológicas podrían señalarse como los más destacables. El empleo de sistemas diagnósticos operativos no ha redundado en una mayor profundización en el análisis psicopatológico, dejando de lado una rica y compleja información, necesaria para profundizar en la etiopatogenia de los trastornos, correlacionar la clínica con las alteraciones biológicas subyacentes y tomar decisiones pronosticas y terapéuticas. Analizamos las repercusiones que este hecho tiene en la validez de diversas categorías diagnósticas, pasando por la "depresión mayor" (cuya validez podría ser menor que la de la melancolía clásica), los trastornos de ansiedad, distimias y somatomorfos (de menor estabilidad y validez que el "neuroticismo" como dimensión internalizadora ante el estrés y el denominado "síndrome neurótico general") y los trastornos de personalidad (que presentan una escasa estabilidad diagnóstica y gran variabilidad de prevalencia en distintos estudios, excepción hecha del trastorno antisocial).

The improvement in interater and test-retest reliability could be considered as one of the better conquests for the last-quarter-of-XXth-century Psychiatry. However, this homogeneity and operativizing of diagnostic criteria has added some disadvantages to diagnostic procedure: high ratios of comorbidity and loss of categorial validity could be considered as undesirable consequences of this event. The use of operative diagnostic systems but not the go-deeply-into psychopathological analysis has removed an important and rich information. This loss of information could compromise the study of ethiopatogenia; correlations between symptoms and neurobiological alterations; and prognosis and therapeutic decisions. We analyze the consequences of this event in the validity of diagnosis, from "major depression" (that may be considered as a less valid category than classical melancholia) to anxiety disorders, dysthymia and somatoform disorders (lossing stability and validity in relation to "neurotic general syndrome" or "neuroticism" as an internalizing condition), and also personality disorders (characterized by longitudinal diagnostic unstability and differents ratios of prevalence, excluding antisocial personality disorder).

Agreement evaluation of a newly proposed system for malocclusion classification / Acuerdo de evaluación de un sistema de nuevas propuestas de clasificación de la maloclusión

The current malocclusion classification systems, routinely used in orthodontic practice, still yield different disagreement values among examiners who evaluate one and the same clinical case. Objectives: The purpose of this study was to evaluate the agreement effectiveness of a Newly Proposed System for malocclusion classification – in the anteroposterior orientation -, conceived by the present authors. Thirty-four examiners evaluated 15 malocclusion cases using Angle's, Katz’sand the Newly Proposed System classifications to determine which system shows the highest degree of agreement and accuracy when results were communicated among examiners. A comparison of the classifications attributed to each individual case and the mean figures found for the total data in each classification showed that the methods advanced by the Newly Proposed System yielded a higher degree of agreement (73.33 percent) than Angle’s (26.66 percent) and Katz’s (26.66 percent). The Newly Proposed System proved to be an outstanding malocclusion classification system with a high degree of agreement among examiners. On the other hand, however, further studies involving a wider sample of malocclusions and a greater number of examiners are strongly recommended if more conclusive results are to be achieved.

Los sistemas actuales de clasificación de maloclusión, habitualmente utilizados en la práctica de ortodoncia, siendo los distintos valores un desacuerdo entre los examinadores que evalúan un caso clínico y o el mismo caso. El objetivo de este estudio fue evaluar la eficacia de un nuevo sistema propuesto para la clasificación de maloclusión - en la orientación anteroposterior -, concebida por los autores de este estudio. Treinta y cuatro examinadores evaluaron 15 casos de maloclusión utilizando las clasificaciones de Angle, Katz y el nuevo sistema propuesto de clasificación, para determinar cual de los sistemas muestran el mayor grado de acuerdo y precisión cuando los resultados fueron comunicados entre los examinadores. La comparación de las clasificaciones atribuidas a cada caso particular y las medias encontrada para los datos totales de cada clasificación mostró que los métodos avanzados del nuevo sistema propuesto dio un mayor grado de acuerdo (73,33 por ciento) que (Angle 26,66 por ciento) y Katz (26,66 por ciento). El nuevo sistema propuesto demostró ser un sistema de clasificación de la maloclusión con un alto grado de acuerdo entre los examinadores. Sin embargo, otros estudios con una muestra más amplia de maloclusiones y un mayor número de examinadores se recomienda para alcanzar resultados más concluyentes.

The Surgical Management of the Rheumatoid Wrist / 대한류마티스학회지

The wrist joint is often involved in the early stages of the rheumatoid arthritis (RA) and is regarded as a main target of the disease. Since the wrist plays a key role in the articulations of the upper extremities, appropriate treatment of this joint will preserve the patient's work ability and independence. When surgical intervention is considered, determining the disease extent is as important as the type of rheumatoid involvement. This can be achieved by performing an extensive clinical and functional assessment of the extremities. In addition, understanding radiological findings also helps to determine the type of rheumatoid destruction, and the subsequent treatment algorithms. Success of surgical management depends on a well-considered strategy in the timing of different procedures. Prophylactic surgery, such as a synovectomy of the joint or tendon could be performed in the early stages to prevent further destruction and deformation. As destruction at the radiocarpal level progresses in the later stages of the disease, reconstructive surgery such as partial joint fusion combined with ulnar head resection, total wrist fusion or wrist arthroplasty could be considered. In the event of severe destruction, definitive stabilization by total wrist fusion is indicated. A pain-free, stable wrist joint often outweighs immobility.

Classificação Internacional para a Prática de Enfermagem: instrumental tecnológico para a prática profissional / International Classification for Nursing Practice: technological instrument for professional practice / Clasificación Internacional para la Práctica de Enfermería: intrumentral tecnológico para la práctica profesional

Considera-se o uso de tecnologias de informação como instrumentos que podem fazer com que a prática de enfermagem se torne visível no conjunto de dados de saúde, locais, nacionais e internacionais, de modo a influenciar na elaboração de políticas de saúde e de educação. Aborda-se o desenvolvimento dos sistemas de classificação em enfermagem, com ênfase na Classificação Internacional para a Prática de Enfermagem - CIPE®, como instrumental tecnológico para a prática profissional, que tem como um dos principais critérios para sua construção o de ser suficientemente ampla e sensível à diversidade cultural, de modo que sirva aos múltiplos propósitos requeridos pelos distintos países onde será utilizada.

The use of information technologies are considered as instruments that can do that nursing practice becomes visible in health data, local, national and internationally, in way to influence the elaboration of health and education policies. The development of nursing classification systems is approached, with emphasis in the International Classification for Nursing Practice - ICNP®, with technological instrument for professional practice, which has as one of the principal criteria for its construction to be sufficiently wide and sensitive to cultural diversity, so that it serves to the multiples purposes requested by the different countries where it will be used.

El uso de tecnologías de información es considerado como instrumentos que pueden hacer la práctica de enfermería visible en los datos de salud, local, nacional e internacionalmente, de manera a influir en la elaboración de políticas de salud y educación. Aborda-se el desarrollo de los sistemas de la clasificación en enfermería se aproxima, con énfasis en la Clasificación Internacional para la Práctica de Enfermería - CIPE®, cono instrumental tecnológico para la practica profesional, que tiene como uno de los criterios para su construcción el de ser suficientemente ancho y sensible a la diversidad cultural, para que sirva a los múltiplos propósitos requeridos por los diferentes países dónde se la usará.