Integrating multiple blockchains to support distributed personal health records.

Blockchain technologies have evolved in recent years, as have the use of personal health record (PHR) data. Initially, only the financial domain benefited from Blockchain technologies. Due to efficient distribution format and data integrity security, however, these technologies have demonstrated potential in other areas, such as PHR data in the healthcare domain. Applying Blockchain to PHR data faces different challenges than applying it to financial transactions via crypto-currency. To propose and discuss an architectural model of a Blockchain platform named "OmniPHR Multi-Blockchain" to address key challenges associated with geographical distribution of PHR data. We analyzed the current literature to identify critical barriers faced when applying Blockchain technologies to distribute PHR data. We propose an architecture model and describe a prototype developed to evaluate and address these challenges. The OmniPHR Multi-Blockchain architecture yielded promising results for scenarios involving distributed PHR data. The project demonstrated a viable and beneficial alternative for processing geographically distributed PHR data with performance comparable with conventional methods. Blockchain's implementation tools have evolved, but the domain of healthcare still faces many challenges concerning distribution and interoperability. This study empirically demonstrates an alternative architecture that enables the distributed processing of PHR data via Blockchain technologies.

Genetic cancer risk assessment: A screenshot of the psychosocial profile of women at risk for hereditary breast and ovarian cancer syndrome.

OBJECTIVE: There is a lack of information describing Brazilian women at risk of hereditary breast and ovarian cancer syndrome (HBOC) who undergo genetic cancer risk assessment (GCRA). This study aims to characterize the psychosocial profile of women at risk for HBOC at their first GCRA to obtain an overview of their families' profiles and the challenges of the oncogenetics setting. METHODS: This was a cross-sectional study in which interviews were conducted with 83 cancer-affected women at their first GRCA appointment after the pedigree draw. Tools to evaluate psychological outcomes were applied. The pedigree genogram and ecomap were constructed and analyzed with content analysis using the "life course perspective" theory. RESULTS: Individuals perceived their breast/ovarian cancer risk to be equal to that of the general population, although they were highly concerned about developing cancer. No evidence of anxiety or depressive symptoms was identified. Participants used the coping strategy of searching for religiosity. The genograms and ecomaps resulted in five major themes: support and social support; attitudes, feelings and emotions; cancer causes; communication; and relationships with relatives. Individuals between 20-29 years of age and those with no family history of cancer tended not to communicate with relatives, which may indicate future problems in the GCRA process regarding genetic testing. CONCLUSIONS: This study demonstrated that knowing the families who undergo the GCRA process can help professionals provide more individualized and thorough attention during GCRA and genetic testing, which results in better follow-up and prevention strategies.

Mapping Bioethics in Latin America: History, Theoretical Models, and Scientific Output.

OBJECTIVE: To present a narrative review of the history of bioethics in Latin America and of scientific output in this interdisciplinary field. METHODS: This was a mixed-methods study. RESULTS: A total of 1458 records were retrieved, of which 1167 met the inclusion criteria. According to the Web of Science classification, the predominant topics of study were medical ethics (n= 488), social sciences and medicine (n= 354), and environmental and public health topics (n= 279). Four themes of bioethics output in the Latin American literature have emerged: (a) issues involving the beginning and end of life, (b) ethics in human research, (c) patient-provider relationships, and (d) ethics training for health professionals. CONCLUSION: Although bioethics is a growing interdisciplinary field in Latin America, its academic impact is still very low, and programmes are highly concentrated in large urban centres in a few countries. Challenges includes the regional and international impact of local scientific output.

"Why throw away something useful?": Attitudes and opinions of people treated for bipolar disorder and their relatives on organ and tissue donation.

In regard to mental illness, brain donation is essential for the biological investigation of central pathology. Nevertheless, little is known about the thoughts of people with mental disorders on tissue donation for research. Here, our objective was to understand the attitudes and opinions of people treated for bipolar disorder and their relatives regarding donation in general, and particularly donation for research. This is a qualitative study that used in-depth interviews to determine the thoughts of participants regarding tissue donation for research. Theoretical sampling was used as a recruitment method. Grounded theory was used as a framework for content analyses of the interviews. A semi-structured interview guide was applied with the topics: donation in general; donation for research; mental health and body organs; opinion regarding donation; feelings aroused by the topic. Although all participants were aware of organ donation for transplant, they were surprised that tissue could be donated for research. Nevertheless, once they understood the concept they were usually in favor of the idea. Although participants demonstrated a general lack of knowledge on donation for research, they were willing to learn more and viewed it as a good thing, with altruistic reasons often cited as a motive for donation. We speculate that bridging this knowledge gap may be a fundamental step towards a more ethical postmortem tissue donation process.

Factors associated with recurrence of alcohol-related traffic violations in southern Brazil

Objective: To analyze variables associated with recurrence of blood alcohol content (BAC)-related traffic violations among drivers in southern Brazil. Method: This cross-sectional study included 12,204 driving-under-the-influence (DUI) offenders according to data provided by the Rio Grande do Sul state Transportation Department. Sociodemographic characteristics, license duration, license category, and psychological assessment results were analyzed. Drivers convicted of DUI more than once in 2009/2010 were considered recidivists. Variables were evaluated using descriptive statistical analysis and Poisson regression, adjusted by sex, age, and education level. Results: A total of 538 (4.41%) drivers were considered recidivists. The following variables showed the strongest associations with recidivism: being aged 41-50 years (prevalence ratio [PR] = 3.41), being licensed for ≥ 12 years (PR = 1.86), being licensed for motorcycles, cars and trucks (PR = 1.36), having a license with psychological restrictions (PR = 1.33), and driving a truck or a similar vehicle at the moment of notification (PR = 1.08). Conclusions: In the age group with the highest risk for recurrence, drivers showed a higher probability of having a diagnosis of alcohol dependence and other psychiatric comorbidities that hinder the control of alcohol use. Psychological assessments seem to be important in predicting repeat offenses, especially when limited aptitudes are suspected, and should therefore be better investigated. .

Factors associated with recurrence of alcohol-related traffic violations in southern Brazil.

OBJECTIVE: To analyze variables associated with recurrence of blood alcohol content (BAC)-related traffic violations among drivers in southern Brazil. METHOD: This cross-sectional study included 12,204 driving-under-the-influence (DUI) offenders according to data provided by the Rio Grande do Sul state Transportation Department. Sociodemographic characteristics, license duration, license category, and psychological assessment results were analyzed. Drivers convicted of DUI more than once in 2009/2010 were considered recidivists. Variables were evaluated using descriptive statistical analysis and Poisson regression, adjusted by sex, age, and education level. RESULTS: A total of 538 (4.41%) drivers were considered recidivists. The following variables showed the strongest associations with recidivism: being aged 41-50 years (prevalence ratio [PR] = 3.41), being licensed for ≥ 12 years (PR = 1.86), being licensed for motorcycles, cars and trucks (PR = 1.36), having a license with psychological restrictions (PR = 1.33), and driving a truck or a similar vehicle at the moment of notification (PR = 1.08). CONCLUSIONS: In the age group with the highest risk for recurrence, drivers showed a higher probability of having a diagnosis of alcohol dependence and other psychiatric comorbidities that hinder the control of alcohol use. Psychological assessments seem to be important in predicting repeat offenses, especially when limited aptitudes are suspected, and should therefore be better investigated.

The effect of outpatient physical therapy intervention on pelvic floor muscles in women with urinary incontinence.

OBJECTIVE: To assess the effect of a weekly, short-term physical therapy intervention on the pelvic floor muscles and urinary incontinence (UI) among patients of the public health system. METHOD: Quasi-experimental before-and-after study. Clinical history and function evaluation were performed using perineal bidigital maneuvers and perineometry. The intervention consisted of transvaginal electrical stimulation and pelvic floor kinesiotherapy. Data were analyzed using the paired t test or Wilcoxon signed-rank test, Pearson product-moment correlation coefficient or Spearman's rank correlation coefficient. A value of P<0.05 was considered significant. RESULTS: Eight-two women 55.1±10.9 years-old were evaluated. Mixed urinary incontinence (MUI), stress urinary incontinence (SUI) and urge urinary incontinence (UUI) were observed in 52.4%, 36.6% and 11%, respectively. The length of UI was 6.0 years (3.0-10). Approximately 13.64 physical therapy sessions were held on average. There was no difference in perineometry measurements following the intervention (40.6±24.1 versus 41.7±25.4, P=0.098). Muscle function significantly increased (P<0.01) in the bidigital maneuver. The patients reported being continent or satisfied with the treatment in 88.9% of cases. CONCLUSIONS: The results demonstrated an increase in muscle function and the attainment of urinary continence or treatment satisfaction in most cases.

Li-Fraumeni and Li-Fraumeni-like syndrome among children diagnosed with pediatric cancer in Southern Brazil.

BACKGROUND: Pediatric cancers are a feature in patients with Li-Fraumeni syndrome and its variant Li-Fraumeni-like syndrome (LFS/LFL). To the best of the authors' knowledge, TP53 germline mutations are currently the only molecular defect known to be associated with this disease. Recently, a specific germline mutation in this gene, p.R337H, has been reported at a high prevalence in Brazil. METHODS: The prevalence of LFS/LFL was investigated in children with cancer who were diagnosed with tumors on the LFS/LFL spectrum and in a small consecutive series of controls without cancer. The prevalence of the germline p.R337H mutation and of other germline TP53 mutations was investigated in a general group of children with cancer and exclusively in children fulfilling the clinical criteria for LFS/LFL, respectively. RESULTS: Among the 65 children without cancer, 1.5% had a family history of LFL whereas of the 292 children with cancer, 25.3% had a family history of LFL (P < .001). Screening for the p.R337H mutation identified 11 carriers (3.7%), 9 of whom were diagnosed with adrenocortical carcinomas (ACC) and 2 of whom were diagnosed with choroid plexus carcinomas. One of the ACC probands was homozygous mutant. The Brazilian founder haplotype and loss of heterozygosity at the p.R337H locus were present in all carriers. In addition, direct sequencing of the entire TP53 coding region and gene rearrangement analysis of probands fulfilling the criteria for LFL (Eeles 2 criteria, Birch and/or Chompret criteria) and who were negative for the p.R337H mutation revealed a DNA-binding domain pathogenic mutation, p.G245S, in 1 child. CONCLUSIONS: TP53 p.R337H testing should be offered to Brazilian children diagnosed with ACC and choroid plexus carcinoma. A significant percentage of children with cancer in southern Brazil fulfill the criteria for LFL and should be referred for genetic risk assessment.

The effect of outpatient physical therapy intervention on pelvic floor muscles in women with urinary incontinence / Influencia da intervencao fisioterapeutica ambulatorial sobre a musculatura do assoalho pelvico em mulheres com incontinencia urinaria

OBJECTIVE: To assess the effect of a weekly, short-term physical therapy intervention on the pelvic floor muscles and urinary incontinence (UI) among patients of the public health system. METHOD: Quasi-experimental before-and-after study. Clinical history and function evaluation were performed using perineal bidigital maneuvers and perineometry. The intervention consisted of transvaginal electrical stimulation and pelvic floor kinesiotherapy. Data were analyzed using the paired t test or Wilcoxon signed-rank test, Pearson product-moment correlation coefficient or Spearman's rank correlation coefficient. A value of P<0.05 was considered significant. RESULTS: Eight-two women 55.1±10.9 years-old were evaluated. Mixed urinary incontinence (MUI), stress urinary incontinence (SUI) and urge urinary incontinence (UUI) were observed in 52.4%, 36.6% and 11%, respectively. The length of UI was 6.0 years (3.0-10). Approximately 13.64 physical therapy sessions were held on average. There was no difference in perineometry measurements following the intervention (40.6±24.1 versus 41.7±25.4, P=0.098). Muscle function significantly increased (P<0.01) in the bidigital maneuver. The patients reported being continent or satisfied with the treatment in 88.9% of cases. CONCLUSIONS: The results demonstrated an increase in muscle function and the attainment of urinary continence or treatment satisfaction in most cases. .

OBJETIVO: Verificar a influência de uma intervenção fisioterapêutica semanal e de curta duração sobre a musculatura do assoalho pélvico e sobre a incontinência urinária (IU) em usuárias da rede pública de saúde. MÉTODO: Estudo quase-experimental do tipo antes e depois. Foi realizada anamnese e avaliação da função perineal por meio da manobra bidigital e perineometria. A intervenção consistiu em eletroestimulação transvaginal e cinesioterapia pélvica. Os dados foram analisados por meio do teste t pareado ou Wilcoxon, regressão linear de Pearson ou Spearman. Um valor de P<0,05 foi considerado como significativo. RESULTADOS: Foram avaliadas 82 mulheres com idade de 55,1±10,9 anos. Incontinência urinária mista (IUM), incontinência urinária de esforço (IUE) e incontinência urinária de urgência (IUU) foram observadas em 52,4%, 36,6% e 11%, respectivamente. A duração da IU foi de 6,0 anos (3,0-10). Foram realizadas, em média, 13,64 sessões fisioterapêuticas. Não houve diferença, após a intervenção, nas medidas da perineometria (40,6±24,1 versus 41,7±25,4, P=0,098). Na manobra bidigital, a função muscular aumentou significativamente (P<0,01). Em 88,9% dos casos, as pacientes informaram estar continentes ou satisfeitas com o tratamento. CONCLUSÕES: Os resultados mostraram aumento da função muscular e obtenção da continência urinária ou satisfação com o tratamento na maioria dos casos. .

Clinical profile, quality of life and depressive symptoms of women with urinary incontince attending a university hospital.

OBJECTIVES: To describe the characteristics of urinary incontinence (UI) and to evaluate its impact on health-related quality of life (QOL) and depressive symptoms in women referred for physical therapy at a university hospital. METHODS: A descriptive cross-sectional study with demographic data collection related to UI. All women were evaluated through examination and also through depression and QOL questionnaires. RESULTS: Forty-eight women were evaluated (53.8±10.9 years), 47.9% with mixed UI (MUI), 39.6% with stress UI (SUI) and 12.5% with urge UI (UUI). In 50% of the cases the urinary loss lasted between 3.3 and 10 years. There was no significant difference in the pelvic floor muscle strength among the different types of UI (P>0.05). Depressive symptoms were detected in 37% of the women. Changes in the QOL were observed in all three groups of women with UI. According to the King's Health Questionnaire (KHQ), women with MUI presented more compromised health perception and greater physical, social, daily activity and personal relationship limitations (P<0.05). The women with MUI presented a worse health perception (P<0.05) according to the WHOQOL-Bref. CONCLUSION: Depressive symptoms were detected in more than a third of the women whose quality of life was adversely affected and the greatest impact was observed in the patients with MUI.

Assisted reproduction: what factors interfere in the professional's decisions? Are single women an issue?

BACKGROUND: With the development of medical technology, many countries around the world have been implementing ethical guidelines and laws regarding Medically Assisted Reproduction (MAR). A physician's reproductive decisions are not solely based on technical criteria but are also influenced by society values. Therefore, the aim of this study was to analyze the factors prioritized by MAR professionals when deciding on whether to accept to perform assisted reproduction and to show any existing cultural differences. METHODS: Cross-sectional study involving 224 healthcare professionals working with assisted reproduction in Brazil, Italy, Germany and Greece. Instrument used for data collection: a questionnaire, followed by the description of four special MAR cases (a single woman, a lesbian couple, an HIV discordant couple and gender selection) which included case-specific questions regarding the professionals' decision on whether to perform the requested procedure as well as the following factors: socio-demographic variables, moral and legal values as well as the technical aspects which influence decision-making. RESULTS: Only the case involving a single woman who wishes to have a child (without the intention of having a partner in the future) demonstrated significant differences. Therefore, the study was driven towards the results of this case specifically. The analyses we performed demonstrated that professionals holding a Master's Degree, those younger in age, female professionals, those having worked for less time in reproduction, those in private clinics and Brazilian health professionals all had a greater tendency to perform the procedure in that case. A multivariate analysis demonstrated that the reasons for the professional's decision to perform the procedure were the woman's right to gestate and the duty of MAR professionals to help her. The professionals who decided not to perform the procedure identified the woman's marital status and the child's right to a father as the reason to withhold treatment. CONCLUSION: The study indicates differences among countries in the evaluation of the single woman case. It also discloses the undervaluation of bioethics committees and the need for a greater participation of healthcare professionals in debates on assisted reproduction laws.

Ethical, legal and social issues related to alcohol and drug research.

PURPOSE OF REVIEW: To present some highlights and comments about ethical, legal and social issues related to alcohol and drug research. RECENT FINDINGS: Alcohol and drug research has a lack of scientific production related to ethical, legal and social issues. Many papers simply describe summarily the informed consent process and other related issues. SUMMARY: Informed consent process is one of the most important issues in research ethics. Obtaining a valid consent from a prospective research participant is always a challenge. We present many different ways to reach ethical, legal and social adequacy related to the informed consent process.

Clinical profile, quality of life and depressive symptoms of women with urinary incontince attending a university hospital / Perfil clínico, qualidade de vida e sintomas depressivos de mulheres com incontinência urinária atendidas em hospital-escola

OBJECTIVES: To describe the characteristics of urinary incontinence (UI) and to evaluate its impact on health-related quality of life (QOL) and depressive symptoms in women referred for physical therapy at a university hospital. METHODS: A descriptive cross-sectional study with demographic data collection related to UI. All women were evaluated through examination and also through depression and QOL questionnaires. RESULTS: Forty-eight women were evaluated (53.8±10.9 years), 47.9 percent with mixed UI (MUI), 39.6 percent with stress UI (SUI) and 12.5 percent with urge UI (UUI). In 50 percent of the cases the urinary loss lasted between 3.3 and 10 years. There was no significant difference in the pelvic floor muscle strength among the different types of UI (P>0.05). Depressive symptoms were detected in 37 percent of the women. Changes in the QOL were observed in all three groups of women with UI. According to the King's Health Questionnaire (KHQ), women with MUI presented more compromised health perception and greater physical, social, daily activity and personal relationship limitations (P<0.05). The women with MUI presented a worse health perception (P<0.05) according to the WHOQOL-Bref. CONCLUSION: Depressive symptoms were detected in more than a third of the women whose quality of life was adversely affected and the greatest impact was observed in the patients with MUI.

OBJETIVOS: Descrever as características da incontinência urinária (IU) e avaliar seu impacto na qualidade de vida (QV) relacionada à saúde e aos sintomas depressivos de mulheres encaminhadas para atendimento fisioterapêutico em hospital universitário. MÉTODOS: Estudo descritivo transversal com coleta de dados demográficos e dos relacionados à IU. Todas as mulheres foram avaliadas por meio de exame físico e por escalas de depressão e QV. RESULTADOS: Foram avaliadas 48 mulheres (53,8±10,9 anos); 47,9 por cento com incontinência urinária mista (IUM), 39,6 por cento com incontinência urinária de esforço (IUE) e 12,5 por cento com incontinência urinária de urgência (IUU). Em 50 por cento dos casos, a perda urinária durou entre 3,3 e 10 anos. Não houve diferença na força da musculatura perineal nos diferentes tipos de IU (P>0,05). Sintomas depressivos foram detectados em 37 por cento das mulheres. Observou-se alteração da QV nos três grupos de mulheres portadoras de IU. No King's Health Questionnaire (KHQ), portadoras de IUM apresentaram uma percepção de saúde mais comprometida, maiores limitações físicas, sociais, nas atividades diárias e nas relações pessoais (P<0,05). No WHOQOL-Bref, observou-se uma pior percepção da saúde no grupo com IUM (P<0,05). CONCLUSÃO: Foram detectados sintomas depressivos em mais de um terço das mulheres, cuja QV foi adversamente afetada, sendo o maior comprometimento observado nas mulheres com IUM.

Posicionamento de médicos residentes frente a dilemas éticos com pacientes pediátricos / Attitudes of residents cancerning ethical dilemmas with pediatric pacients

O objetivo é avaliar as atitudes dos residentes frente aos dilemas éticos através de questionários que descrevem situações clínicas aplicadas com um ano de diferença. É um estudo de coorte de 85 médicos residentes que responderam um questionário com três casos clínicos pediátrico, modificados de um estudo validado anteriormente. Os casos clínicos foram propostos em dois períodos diferentes, com um ano de intervalo, contemplando os princípios da justiça, beneficiência e autonomia. Nenhuma outra intervenção educacional foi feita durante este período. 85 residentes responderam ao estudo(47 residentes pediátricos e 38 não pediátricos), de um total de 106. A concordância entre os dois períodos do estudo(2002 vs 2003) frente a paresentação dos casos contemplanto os princípios da justiça, benefciência e autonomia foi repectivamente Kappa(IC95%)=0,20 e 0,10, mostrando que as atitudes éticas mudaram significamente depois de um ano de programa de residência. A exceção foi em relação ao princípio da justiça, entre homens com moderado grau de concordência(K+0,42).

Staphylococcus sp. coagulase-negativa em hemoculturas de pacientes com menos de sessenta dias de idade: infecçäo versus contaminaçäo / Coagulase-negative Staphylococcus sp. in blood cultures from infants less than 60 days old: infection versus contamination

Objetivo: O presente estudo teve como objetivo determinar a prevalência de infecçäo versus contaminaçäo em pacientes com menos de 60 dias de vida, que possuíram hemoculturas positivas para Staphylococus sp. coagulase negativa. material e Métodos: Foram estudadas 45 hemoculturas positivas para essa bactéria de 41 pacientes, no período de 1§. de fevereiro a 31 de julho de 1993. Conforme informaçöes clínicas e laboratoriais obtidas através da revisäo dos prontuários, os pacientes foram separados em 3 grupos: I - pacientes infectados, II - pacientes näo infectados e III - casos duvidosos. Resultados: Os resultados mostraram que 11 pacientes (26,8 por cento) pertenciam ao grupo I 25 (61 por cento) pertenciam ao grupo II (hemoculturas contaminadas) e 5 (12,2 por cento), ao grupo III...

Perfil e prática profissional de psiquiatras no Brasil / Professional profile and practice of psychiatrists in Brazil

Com o objetivo de identificar o perfil profissional de psiquiatras do Brasil, foram escolhidos para estudo cinco Estados representativos de cada regiäo do País (Bahia, Pará, Rio de Janeiro, Säo Paulo, Rio Grande do Sul, além do Distrito Federal). A amostra consistiu de 430 membros da ABP, que responderam a questionário enviado pelo correio. Os dados foram analisados pelo sistema EPI-INFO. Verificou-se que 76,5 por cento dos psiquiatras estudados fazem ou fizeram supervisäo de seu trabalho, 65, 1 por cento participam de grupos de estudo, 51,9 por cento submeteram-se a psicoterapia pessoal, 71,2 por cento foram ou säo pacientes de psicanálise. Quanto à atividade profissional, 30,2 por cento do tempo säo dedicados a instituiçöes públicas, 11,6 por cento a instituiçöes privadas e 48,3 por cento ao consultório particular. Neste, predominam as técnicas psicoterápicas

Perfil e pratica profissional de psiquiatras no Brasil

Com o objetivo de identificar o perfil profissional de psiquiatras do Brasil, foram escolhidos para estudo cinco Estados representativos de cada regiao do Pais (Bahia, Para, Rio de Janeiro, Sao Paulo, Rio Grande do Sul, alem do Distrito Federal). A amostra consistiu de 430 membros da ABP, que responderam a questionario enviado pelo correio. Os dados foram analisados pelo sistema EPI-INFO. Verificou-se que 76,5 por cento dos psiquiatras estudados fazem ou fizeram supervisao de seu trabalho, 65,1 por cento participam de grupos de estudo, 51,9 por cento submeteram-se a psicoterapia pessoal, 71,2 por cento foram ou sao pacientes de psicanalise. Quanto a atividade profissional, 30,2 por cento do tempo sao dedicados a instituicoes publicas, 11,6 por cento a instituicoes privadas e 48,3 por cento ao consultorio particular. Neste, predominam as tecnicas psicoterapicas.