Influenza Vaccination for the Prevention of Cardiovascular Disease in the Americas: Consensus document of the Inter-American Society of Cardiology and the Word Heart Federation.

Background: Cardiovascular mortality is decreasing but remains the leading cause of death world-wide. Respiratory infections such as influenza significantly contribute to morbidity and mortality in patients with cardiovascular disease. Despite of proven benefits, influenza vaccination is not fully implemented, especially in Latin America. Objective: The aim was to develop a regional consensus with recommendations regarding influenza vaccination and cardiovascular disease. Methods: A multidisciplinary team composed by experts in the management and prevention of cardiovascular disease from the Americas, convened by the Inter-American Society of Cardiology (IASC) and the World Heart Federation (WHF), participated in the process and the formulation of statements. The modified RAND/UCLA methodology was used. This document was supported by a grant from the WHF. Results: An extensive literature search was divided into seven questions, and a total of 23 conclusions and 29 recommendations were achieved. There was no disagreement among experts in the conclusions or recommendations. Conclusions: There is a strong correlation between influenza and cardiovascular events. Influenza vaccination is not only safe and a proven strategy to reduce cardiovascular events, but it is also cost saving. We found several barriers for its global implementation and potential strategies to overcome them.

Optical coherence tomography angiography findings in patients with Alport syndrome / Alterações encontradas na angiografia por tomografia de coerência óptica (OCT-A) em pacientes com síndrome de Alport

ABSTRACT Purpose: To describe the findings on optical coherence tomography angiography associated with Alport syndrome. Methods: Descriptive study from a referral ophthalmology service (Hospital Evangélico de Vila Velha, Brazil). Patients diagnosed with Alport syndrome were included. Results: The study group consisted of four patients (one female and three males) diagnosed with Alport syndrome. Visual acuity in the worst eye was between 20/40 and 20/60. All male patients had anterior lenticonus on biomicroscopy. The observed retinal findings included dots and flecks and pigmentary changes in the macula. On optical coherence tomography angiography, the inner retinal layers of all patients displayed thinning (especially in the temporal quadrant of the macula) and an increase in the foveal avascular zone. A thick choroid was observed in both eyes of the two youngest patients. Conclusions: In patients with Alport syndrome, the inner retinal layers suffer changes due to type IV collagen mutations. Optical coherence tomography angiography makes it possible to visualize and document these findings, making it a useful tool in the detection of early retinal findings associated with Alport syndrome.

RESUMO Objetivos: Descrever os achados na angiografia por tomografia de coerência óptica associada à síndrome de Alport. Métodos: Estudo descritivo de um serviço de referência em Oftalmologia (Hospital Evangélico de Vila Velha, Brasil). Os pacientes diagnosticados com síndrome de Alport, foram incluídos. Resultados: O grupo de estudo foi composto por quatro pacientes (um feminino e três homens) com diagnóstico de síndrome de Alport. A acuidade visual no pior olho estava entre 20/40 a 20/60. Todos os pacientes do sexo masculino apresentaram lenticone anterior à biomiscroscopia. Os achados da retina observados incluíram pontos e manchas e alterações pigmentares na mácula. Na angiotomografia de coerência óptica, as camadas internas da retina de todos os pacientes apresentaram afinamento (especialmente na região temporal da mácula) e aumento da zona avascular foveal. Uma coroide espessa foi observada em ambos os olhos dos dois pacientes mais jovens. Conclusões: Em pacientes com síndrome de Alport, as camadas internas da retina sofrem alterações devido à mutação do colágeno tipo IV. A angiotomografia de coerência óptica permite visualizar esses achados, tornando-o uma ferramenta útil na detecção de achados iniciais da retina associados à síndrome de Alport.

Optical coherence tomography angiography findings in patients with Alport syndrome.

PURPOSE: To describe the findings on optical coherence tomography angiography associated with Alport syndrome. METHODS: Descriptive study from a referral ophthalmology service (Hospital Evangélico de Vila Velha, Brazil). Patients diagnosed with Alport syndrome were included. RESULTS: The study group consisted of four patients (one female and three males) diagnosed with Alport syndrome. Visual acuity in the worst eye was between 20/40 and 20/60. All male patients had anterior lenticonus on biomicroscopy. The observed retinal findings included dots and flecks and pigmentary changes in the macula. On optical coherence tomography angiography, the inner retinal layers of all patients displayed thinning (especially in the temporal quadrant of the macula) and an increase in the foveal avascular zone. A thick choroid was observed in both eyes of the two youngest patients. CONCLUSIONS: In patients with Alport syndrome, the inner retinal layers suffer changes due to type IV collagen mutations. Optical coherence tomography angiography makes it possible to visualize and document these findings, making it a useful tool in the detection of early retinal findings associated with Alport syndrome.

Is specialized ophthalmologic evaluation necessary after orbital fractures? A prospective 64-case study.

INTRODUCTION AND OBJECTIVE: The objective of this study was to determine whether there is a need for ophthalmologists to perform a specialized assessment after the occurrence of orbital fractures. MATERIALS AND METHODS: Sixty-three patients (64 orbits) diagnosed with orbital fractures were evaluated preoperatively (up to 24 h after the trauma) and in 90-day postoperative period. RESULTS: Eight injuries required either specialized clinical or surgical ophthalmologic intervention. Of these patients, four required emergency eye surgery: two patients with corneal lacerations had lesions larger than 2 mm. Two patients had extensive ocular lesions after multiple traumas with uveal exposure and without light perception. Another four patients (iridodialysis associated with lens subluxation, anterior uveitis, direct lesion on the optic nerve, and chorioretinitis sclopetaria) received conservative management. CONCLUSION: This study concluded that a specialized ophthalmologic examination as soon as possible is important, particularly in cases in which the signs and symptoms of severity are associated. The non-ophthalmologist surgeon must have the basic medical knowledge required to provide basic primary ophthalmologic care and to discern the severity of the injury.

O encontro da arte com a educação: o papel do saber psicológico / The encounter between art and education: the role of psychological knowledge

RESUMO: O presente artigo é parte de uma pesquisa que problematiza o encontro da arte com a educação, no Brasil, nas últimas duas décadas e o papel da psicologia nesse processo. Realizou-se uma cartografia crítica por meio de um conjunto de artigos de revistas acadêmicas, que pautam de modo prático ou teórico essa relação entre arte e a educação. De modo concomitante buscou-se apreender as estratégias pelas quais se efetivam as práticas de pedagogização da arte e como a discursividade psicológica participa de sua constituição. Notou-se que a partir do encontro da arte com algumas formas da psicologia, promove-se um dispositivo que assume os valores éticos e estéticos do indivíduo como um processo ativo de se constituir como sujeito via uma estimulação.

Abstract This article is part of a research that problematizes the encounter between art and education in Brazil in the last two decades as well as the role of psychology in this process. A critical cartography was perfomed through an archive containing a set of articles from academic journals approaching the relationship between art and education in a practical or theoretical way. Concomitantly, there was an attempt to capture the strategies by which the practices of art pedagogization are carried out and how the psychological discourse participates in its constitution. It was noted that from the encounter of art with some forms of psychology, comes the promotion of a device that takes the ethical and aesthetic values of the individual as an active process of constituting oneself as a subject via stimulation.

Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting

BACKGROUND: We previously reported that there was no significant difference at 30 days or at 1 year in the rate of the composite outcome of death, stroke, myocardial infarction, or renal failure between patients who underwent coronary-artery bypass grafting (CABG) performed with a beating-heart technique (off-pump) and those who underwent CABG performed with cardiopulmonary bypass (on-pump). We now report the results at 5 years (the end of the trial). METHODS: A total of 4752 patients (from 19 countries) who had coronary artery disease were randomly assigned to undergo off-pump or on-pump CABG. For this report, we analyzed a composite outcome of death, stroke, myocardial infarction, renal failure, or repeat coronary revascularization (either CABG or percutaneous coronary intervention). The mean follow-up period was 4.8 years. RESULTS: There were no significant differences between the off-pump group and the on-pump group in the rate of the composite outcome (23.1% and 23.6%, respectively; hazard ratio with off-pump CABG, 0.98; 95% confidence interval [CI], 0.87 to 1.10; P=0.72) or in the rates of the components of the outcome, including repeat coronary revascularization, which was performed in 2.8% of the patients in the off-pump group and in 2.3% of the patients in the on-pump group (hazard ratio, 1.21; 95% CI, 0.85 to 1.73; P=0.29)...

O Estado, a política liberal e a biopolítica / The state, liberal politics and biopolitics

Nesse ensaio, problematizamos ações da política liberal e suas relações com oEstado. Ao considerar algumas de suas proposições, questionamos a quaisrelações de poder essa prática social responde. Em que circunstâncias ela se interessa pelo governo dos homens? A partir do estudo das práticas intituladas como filantropia empresarial podemos indicar algumas estratégias e táticas dessa política. Entre as quais destacamos: a construção do Estado Moderno, a elaboração das diversas técnicas de controle social e as mudanças de foco com relação às análises das forças produtivas do capitalismo, que passaram a intervir nas curvas de normalidade econômica imanentes aos fenômenos da população...

This essay discusses some liberal political actions and their relations with the state. Considering some of their propositions, we ask: what power relations does that social practice respond to? Under what circumstances is the liberal politics interested in the government of men? From a study of the practices called corporate philanthropy we can indicate some strategies and tactics of such politics. Among which: the construction of the modern state, the development of various techniques of social control and the focus changes regarding the analysis of capitalism productive forces that intervene within the economic normality curves inherent in the population phenomena...

O Estado, a política liberal e a biopolítica / The state, liberal politics and biopolitics

Nesse ensaio, problematizamos ações da política liberal e suas relações com oEstado. Ao considerar algumas de suas proposições, questionamos a quaisrelações de poder essa prática social responde. Em que circunstâncias ela se interessa pelo governo dos homens? A partir do estudo das práticas intituladas como filantropia empresarial podemos indicar algumas estratégias e táticas dessa política. Entre as quais destacamos: a construção do Estado Moderno, a elaboração das diversas técnicas de controle social e as mudanças de foco com relação às análises das forças produtivas do capitalismo, que passaram a intervir nas curvas de normalidade econômica imanentes aos fenômenos da população.(AU)

This essay discusses some liberal political actions and their relations with the state. Considering some of their propositions, we ask: what power relations does that social practice respond to? Under what circumstances is the liberal politics interested in the government of men? From a study of the practices called corporate philanthropy we can indicate some strategies and tactics of such politics. Among which: the construction of the modern state, the development of various techniques of social control and the focus changes regarding the analysis of capitalism productive forces that intervene within the economic normality curves inherent in the population phenomena.(AU)

Prophylactic use of ketorolac tromethamine in cataract surgery: a randomized trial.

PURPOSE: To determine the efficacy of topical ketorolac tromethamine in preventing cystoid macular edema (CME) after uncomplicated cataract surgery. METHODS: This single-center, prospective, double-masked, randomized clinical trial consisted of 81 patients who were scheduled for cataract surgery. Patients were randomized to receive hypromellose/dextran 70 as a placebo (n=44) or ketorolac tromethamine 0.4% (n=37) as an adjuvant therapy. These eye drops were administered 4 times daily (QID) for 3 days before surgery and 5 weeks postoperatively. All patients received prednisolone acetate 1% QID during the same period as basal/standard anti-inflammatory therapy. The primary outcome was the incidence of angiographic CME 5 weeks after surgery. The secondary outcomes were mean change in best-corrected visual acuity (BCVA) [Early Treatment Diabetic Retinopathy study (ETDRS)], clinical CME incidence, intraocular pressure, and retinal thickness measured using optical coherence tomography (OCT). RESULTS: In the placebo group, 2/44 (4.5%) patients and in the ketorolac group, 2/37 (5.4%) patients presented with angiographic CME (P=0.624). The mean change in postoperative BCVA was 32±15 letters in the placebo group and 26±16 letters in the ketorolac group (P=0.07). There were no statistically significant between-group differences in the mean central subfield thickness (P=0.679), minimal central thickness (P=0.352), or central macular volume (P=0.729). CONCLUSION: There was no difference between ketorolac tromethamine and a placebo with regard to BCVA results or prevention of CME after uncomplicated cataract surgery.

As práticas de produção da saúde e a gestão das condutas humanas / The practices of health production and the management of human conducts / Las prácticas de producción de salud y la gestión de las conductas humanas / Les pratiques de production de la santé et de la gestion de la conduite humaine

Este artigo propõe trazer para a análise um conjunto de práticas que, em nossos dias, inscrevem-se nos processos de produção de saúde, no contexto do governo das populações, em que se evidenciam certos objetos para a gestão das condutas humanas. A arte, o riso e o lixo serão os campos em análise dessas práticas que dependem da existência de sujeitos livres como objeto de governamentalidade. Para tanto, a análise se encaminha no interior desses diferentes territórios de efetuação da vida. Enfocam-se as experiências de gestão do lixo na cidade, produzidas por discursos e práticas médico-sociais, nas quais se determina que, no cálculo do exercício das práticas das liberdades individuais, devem ser considerados seus custos, tanto para a normalidade das curvas econômicas quanto para a organização pública das cidades visando à efetivação do bem-estar social. No caso das práticas dos palhaços humanitários nas instituições de saúde, elas emergem como elemento capaz de oferecer novos conteúdos para os processos de subjetivação inscritos no interior de uma lógica da prática de si voltada para o desenvolvimento de capital humano e na busca da saúde e da felicidade, mesmo que em situações de experiências-limite da existência humana, como a morte, a guerra e a miséria. Por último, as práticas artísticas, ao circularem hoje por diversos âmbitos, como os da educação e da saúde, em projetos sociais e ações filantrópicas de diversos tipos, respondem a uma demanda de produção de sujeitos livres de que se necessita para se ter uma população útil, saudável e produtiva. As matérias em análise nesses três campos de intervenção e transformação dos elementos que compõem a população serão as estratégias pedagógicas que estarão em circulação na produção de uma razão de cálculo de governo para a promoção de sujeitos livres, saudáveis, felizes, criativos e, portanto, produtivos.(AU)

This article analyses a set of practices that, in our days, are inscribed in the processes of health production, in the context of the government of populations, in which certain objects are evidenced for the management of the human conducts. Art, laughter and waste will be the fields included in the analysis of these practices that depend on the existence of free individuals as objects of governmentality. For such, the analysis is heading within these different territories of effectuation of life. The experiences of waste management in the city, produced by socio-medical discourses and practices, are focused. Within these experiences, it is established, that the costs for both the normality of economic curves and for the public organization of cities for the realization of social welfare, should be consideredin the calculation of the exercise of the individual liberties practices.The humanitarian'sclownspractices in health institutions, on the other hand, emerge as an element able to offer new content for the processes of subjectification. Processes inscribed within the self-focused practiceslogic of on the development of human capital and within the pursuit of health and happiness, even in limit-experiences situationsof the human existence, such as death, war, poverty. Finally, the artistic practices, which circulate nowadays in various fields such as education and health, social projects and philanthropic deeds of various kinds, respond to a demand for production of free individuals, needed in order to have a useful, healthy and productive population. The materials under analysis in these three fields of intervention and transformation of the elements of the population will constitute the pedagogical strategies that will be in circulation in the production of a government calculation reason to promote free, healthy, happy, creative, and, therefore, productive individuals.(AU)

Este artigo propone analizar un conjunto de prácticas que, en nuestros días, se inscriben en los procesos de producción de salud en el contexto del gobierno de las populaciones en que se evidencia ciertos objetos para la gestación de las conductas humanas. El arte, la risa y la basura serán los campus en análisis de estas prácticas que dependen de la existencia de sujetos libres como objeto de gobiernamentalidad. Para eso, el análisis se encamina en el interior de estos distintos territorios de efectuación de la vida. Las experiencias de gestación de la basura en la ciudad, producidas por discursos y practicas médico-sociales en que se determina que, en cálculo del ejercicio de las prácticas de las libertades individuales, deben ser considerados sus costos tanto para la normalidad de las curvas económicas, cuanto para la efectuación del bienestar social. En el caso de las prácticas de los payasos humanitarios en las instituciones de salud, ellas emergen como elemento capaz de ofrecer nuevos contenidos para los procesos de subjetivación inscritos en el interior de una lógica de la práctica de sí, volteada para el desenvolvimiento de capital humano y humana, como la muerte, la guerra, la miseria. Por último, las prácticas artísticas al circundaren hoy, por diversos ámbitos, como los de las educación y de la salud, en proyectos sociales y acciones filantrópicas de diversos tipos, contestan a una demanda de producciones de sujetos libres de que se necesita para obtener una populación útil, saludable y productiva. Las materias en análisis en estes tres campus de intervención y transformación de los elementos que componen la populación serán las estrategias pedagógicas que estarán en circulación en la producción de una ración de cálculo de gobierno para la promoción de sujetos libres, felices, saludables, creativos y, por eso, productivos.(AU)

Cet article propose l'analyse d'un ensemble de pratiques qui est, de nos jours, inscrit dans les processus d'amélioration de la santé dont le contexte est le gouvernement des populations où certains objets pour la gestion des conduites humaines sont mis en valeur. L'art, le rire et l'ordure seront les domaines d'études de ces pratiques. Celles-ci sont dépendantes de l'existence de personnes qui sont libres en ce qui concerne l'objet de la gouvernementalité. Pour tout cela, l'analyse se déplace au sein de ces différents champs de réalisation de la vie. Les expériences de gestion de l'ordure dans une ville sont faites à partir de discours et de pratiques sociales et médicales, avec lesquelles on détermine que les coûts doivent être considérés dans le calcul de l'action des pratiques des libertés individuelles. Ces coûts servent tant pour la normalité des courbes économiques que pour l'organisation publique des villes pour la réalisation du bien-être social. Dans le cas des pratiques des clowns humanitaires, elles apparaissent dans les institutions de santé comme un élément capable d'offrir des nouveaux contenus pour les processus de subjectivation, inscrits à l'intérieur d'une logique de la pratique de lui-même tourné vers le développement du capital humain et, aussi, vers la recherche de la santé et du bonheur, voire dans des situations d'expériences à la limite de l'existence humaine, comme la mort, la guerre et la misère, par exemple. Pour conclure, les pratiques artistiques, lors de leur circulation aujourd'hui dans des divers domaines, comme celles de l'éducation et de la santé ou dans des projets sociaux et philanthropiques de toutes sortes, elles répondent à une demande de formation de personnes libres dont elles ont besoin pour avoir une population utile, saine et productive. Les matières en analyse dans ces trois champs d'intervention et de transformation des éléments qui font partie de la population seront les stratégies pédagogiques qui seront en circulation dans la production d'une raison de calcul de gouvernement pour qu'il y ait une promotion de personnes libres en bonne santé, heureuses, créatives, et donc productives.(AU)

As práticas de produção da saúde e a gestão das condutas humanas / The practices of health production and the management of human conducts / Las prácticas de producción de salud y la gestión de las conductas humanas / Les pratiques de production de la santé et de la gestion de la conduite humaine

Este artigo propõe trazer para a análise um conjunto de práticas que, em nossos dias, inscrevem-se nos processos de produção de saúde, no contexto do governo das populações, em que se evidenciam certos objetos para a gestão das condutas humanas. A arte, o riso e o lixo serão os campos em análise dessas práticas que dependem da existência de sujeitos livres como objeto de governamentalidade. Para tanto, a análise se encaminha no interior desses diferentes territórios de efetuação da vida. Enfocam-se as experiências de gestão do lixo na cidade, produzidas por discursos e práticas médico-sociais, nas quais se determina que, no cálculo do exercício das práticas das liberdades individuais, devem ser considerados seus custos, tanto para a normalidade das curvas econômicas quanto para a organização pública das cidades visando à efetivação do bem-estar social. No caso das práticas dos palhaços humanitários nas instituições de saúde, elas emergem como elemento capaz de oferecer novos conteúdos para os processos de subjetivação inscritos no interior de uma lógica da prática de si voltada para o desenvolvimento de capital humano e na busca da saúde e da felicidade, mesmo que em situações de experiências-limite da existência humana, como a morte, a guerra e a miséria. Por último, as práticas artísticas, ao circularem hoje por diversos âmbitos, como os da educação e da saúde, em projetos sociais e ações filantrópicas de diversos tipos, respondem a uma demanda de produção de sujeitos livres de que se necessita para se ter uma população útil, saudável e produtiva. As matérias em análise nesses três campos de intervenção e transformação dos elementos que compõem a população serão as estratégias pedagógicas que estarão em circulação na produção de uma razão de cálculo de governo para a promoção de sujeitos livres, saudáveis, felizes, criativos e, portanto, produtivos.

This article analyses a set of practices that, in our days, are inscribed in the processes of health production, in the context of the government of populations, in which certain objects are evidenced for the management of the human conducts. Art, laughter and waste will be the fields included in the analysis of these practices that depend on the existence of free individuals as objects of governmentality. For such, the analysis is heading within these different territories of effectuation of life. The experiences of waste management in the city, produced by socio-medical discourses and practices, are focused. Within these experiences, it is established, that the costs for both the normality of economic curves and for the public organization of cities for the realization of social welfare, should be consideredin the calculation of the exercise of the individual liberties practices.The humanitarian'sclownspractices in health institutions, on the other hand, emerge as an element able to offer new content for the processes of subjectification. Processes inscribed within the self-focused practiceslogic of on the development of human capital and within the pursuit of health and happiness, even in limit-experiences situationsof the human existence, such as death, war, poverty. Finally, the artistic practices, which circulate nowadays in various fields such as education and health, social projects and philanthropic deeds of various kinds, respond to a demand for production of free individuals, needed in order to have a useful, healthy and productive population. The materials under analysis in these three fields of intervention and transformation of the elements of the population will constitute the pedagogical strategies that will be in circulation in the production of a government calculation reason to promote free, healthy, happy, creative, and, therefore, productive individuals.

Este artigo propone analizar un conjunto de prácticas que, en nuestros días, se inscriben en los procesos de producción de salud en el contexto del gobierno de las populaciones en que se evidencia ciertos objetos para la gestación de las conductas humanas. El arte, la risa y la basura serán los campus en análisis de estas prácticas que dependen de la existencia de sujetos libres como objeto de gobiernamentalidad. Para eso, el análisis se encamina en el interior de estos distintos territorios de efectuación de la vida. Las experiencias de gestación de la basura en la ciudad, producidas por discursos y practicas médico-sociales en que se determina que, en cálculo del ejercicio de las prácticas de las libertades individuales, deben ser considerados sus costos tanto para la normalidad de las curvas económicas, cuanto para la efectuación del bienestar social. En el caso de las prácticas de los payasos humanitarios en las instituciones de salud, ellas emergen como elemento capaz de ofrecer nuevos contenidos para los procesos de subjetivación inscritos en el interior de una lógica de la práctica de sí, volteada para el desenvolvimiento de capital humano y humana, como la muerte, la guerra, la miseria. Por último, las prácticas artísticas al circundaren hoy, por diversos ámbitos, como los de las educación y de la salud, en proyectos sociales y acciones filantrópicas de diversos tipos, contestan a una demanda de producciones de sujetos libres de que se necesita para obtener una populación útil, saludable y productiva. Las materias en análisis en estes tres campus de intervención y transformación de los elementos que componen la populación serán las estrategias pedagógicas que estarán en circulación en la producción de una ración de cálculo de gobierno para la promoción de sujetos libres, felices, saludables, creativos y, por eso, productivos.

Cet article propose l'analyse d'un ensemble de pratiques qui est, de nos jours, inscrit dans les processus d'amélioration de la santé dont le contexte est le gouvernement des populations où certains objets pour la gestion des conduites humaines sont mis en valeur. L'art, le rire et l'ordure seront les domaines d'études de ces pratiques. Celles-ci sont dépendantes de l'existence de personnes qui sont libres en ce qui concerne l'objet de la gouvernementalité. Pour tout cela, l'analyse se déplace au sein de ces différents champs de réalisation de la vie. Les expériences de gestion de l'ordure dans une ville sont faites à partir de discours et de pratiques sociales et médicales, avec lesquelles on détermine que les coûts doivent être considérés dans le calcul de l'action des pratiques des libertés individuelles. Ces coûts servent tant pour la normalité des courbes économiques que pour l'organisation publique des villes pour la réalisation du bien-être social. Dans le cas des pratiques des clowns humanitaires, elles apparaissent dans les institutions de santé comme un élément capable d'offrir des nouveaux contenus pour les processus de subjectivation, inscrits à l'intérieur d'une logique de la pratique de lui-même tourné vers le développement du capital humain et, aussi, vers la recherche de la santé et du bonheur, voire dans des situations d'expériences à la limite de l'existence humaine, comme la mort, la guerre et la misère, par exemple. Pour conclure, les pratiques artistiques, lors de leur circulation aujourd'hui dans des divers domaines, comme celles de l'éducation et de la santé ou dans des projets sociaux et philanthropiques de toutes sortes, elles répondent à une demande de formation de personnes libres dont elles ont besoin pour avoir une population utile, saine et productive. Les matières en analyse dans ces trois champs d'intervention et de transformation des éléments qui font partie de la population seront les stratégies pédagogiques qui seront en circulation dans la production d'une raison de calcul de gouvernement pour qu'il y ait une promotion de personnes libres en bonne santé, heureuses, créatives, et donc productives.

Effect of preoperative use of topical prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery: a randomized trial.

PURPOSE: To compare the effects of preoperative use of topical anti-inflammatory prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery. DESIGN: Randomized clinical trial. MATERIALS AND METHODS: This single-center, masked, randomized clinical study comprised 140 patients scheduled for cataract surgery. Patients (35 in each group) were randomized to receive placebo, prednisolone acetate, ketorolac tromethamine 0.4% or nepafenac. These eye drops were administered three times daily for the two days prior to surgery. The pupillary diameters were measured by the surgeon using a compass prior to the corneal section and at the end of surgery. The primary outcome was the number of patients with pupil ≥ 6mm at the end of the surgery; the secondary outcome was the number of patients with pupil ≥ 6mm at the beginning of the surgery. RESULTS: All the patients achieved pupil ≥ 6mm at the beginning of the surgery. The number of patients in the prednisolone (29/35), nepafenac (31/35) and ketorolac (30/35) groups with pupil ≥ 6mm was greater than in the placebo group in the maintenance of intraoperative mydriasis (19/35 - P =0.003). There was no statistical difference among the prednisolone, nepafenac and ketorolac groups in the maintenance of intraoperative mydriasis (P =.791). There were no complications during surgery or related to the preoperative use of the eye drops. CONCLUSION: Preoperative use of ketorolac, prednisolone and nepafenac was effective in maintaining intraoperative mydriasis when compared with placebo.

Detection and follow-up of cardiovascular disease and risk factors in the Southern Cone of Latin America: the CESCAS I study.

INTRODUCTION: Cardiovascular diseases (CVD) are increasing throughout the world and cause 16.7 million deaths each year, 80% of which occur in low and middle income countries. In Argentina, Chile and Uruguay, the available data on cardiovascular risk factors come predominantly from cross-sectional studies that are principally based on self-report or studies conducted with small convenience samples. The CESCAS I study will generate reliable estimates of the prevalence and distribution of and secular trends in CVD and its risk factors in this region. METHODS AND ANALYSIS: CESCAS I is an observational prospective cohort study with a multistage probabilistic sample of 8000 participants aged 35-74 years from four mid-sized cities representing the Southern Cone of Latin America: Bariloche and Marcos Paz in Argentina, Temuco in Chile and Pando-Barros Blancos in Uruguay. In the first phase, baseline data regarding exposure to risk factors and prevalence of CVD will be collected in two stages: (1) in homes and (2) in health centres. Information will be gathered on medical history, risk factors, lifestyles and health utilisation through specific questionnaires, physical measurements, an ECG and an overnight, fasting blood sample to measure levels of serum lipids, glucose and creatinine. In the second phase, annual follow-up data will be obtained on the incidence rate of CVD events and the association between exposure and events. ETHICS AND DISSEMINATION: The protocol has obtained formal ethics approval from institutional review boards in Argentina, Chile, Uruguay and the USA. The lack of follow-up studies has prevented Argentina, Chile and Uruguay from implementing risk factor stratification and management strategies at a population level. However, the CESCAS I study data will help the development of public health strategies based on primary care intervention, thus helping to improve cardiovascular health in this region.

A política empresarial: a responsabilidade social como mecanismo de segurança / The business political: the social responsibility as security mechanism

Neste ensaio, tomamos como problema as ações da política empresarial no Brasil, em específico a política de responsabilidade social das empresas, por entender que existe nessa iniciativa um status de inovação tecnológica que precisa ser interrogado, pois se inscreve no interior de uma racionalidade que objetiva o governo das populações e tem como instrumento técnico, para realizar esse fim, uma sociedade controlada por mecanismos de segurança. Para tanto, partimos da análise de três procedimentos efetivados por alguns projetos sociais desenvolvidos por empresas brasileiras - a pesquisa científica, o protagonismo juvenil e a metodologia participativa. A referência de análise são textos de diversas naturezas, veiculados por esses projetos e disponíveis ao acesso público.(AU)

In this research we discuss some political business actions, in Brazil, in particular the politics of social responsibility of companies, understanding that there is in this initiative a technological innovation status that needs to be questioned. Therefore it refers to the rationality that aims the management of populations. It has as technical device to achieve this a society controlled by security mechanisms. We take therefore as the axis of analysis three procedures enforced by some social projects developed by Brazilian companies - the scientific research, the juvenile protagonism and the participative methodology. The reference to the analysis are texts of many kinds from these projects and available to public access.(AU)

A política empresarial: a responsabilidade social como mecanismo de segurança / The business political: the social responsibility as security mechanism

Neste ensaio, tomamos como problema as ações da política empresarial no Brasil, em específico a política de responsabilidade social das empresas, por entender que existe nessa iniciativa um status de inovação tecnológica que precisa ser interrogado, pois se inscreve no interior de uma racionalidade que objetiva o governo das populações e tem como instrumento técnico, para realizar esse fim, uma sociedade controlada por mecanismos de segurança. Para tanto, partimos da análise de três procedimentos efetivados por alguns projetos sociais desenvolvidos por empresas brasileiras - a pesquisa científica, o protagonismo juvenil e a metodologia participativa. A referência de análise são textos de diversas naturezas, veiculados por esses projetos e disponíveis ao acesso público.

In this research we discuss some political business actions, in Brazil, in particular the politics of social responsibility of companies, understanding that there is in this initiative a technological innovation status that needs to be questioned. Therefore it refers to the rationality that aims the management of populations. It has as technical device to achieve this a society controlled by security mechanisms. We take therefore as the axis of analysis three procedures enforced by some social projects developed by Brazilian companies - the scientific research, the juvenile protagonism and the participative methodology. The reference to the analysis are texts of many kinds from these projects and available to public access.

Apixaban in patients with atrial fibrillation

Background Vitamin K antagonists have been shown to prevent stroke in patients with atrial fibrillation. However, many patients are not suitable candidates for or are unwilling to receive vitamin K antagonist therapy, and these patients have a high risk of stroke. Apixaban, a novel factor Xa inhibitor, may be an alternative treatment for such patients.Methods In a double-blind study, we randomly assigned 5599 patients with atrial fibrillation who were at increased risk for stroke and for whom vitamin K antagonist therapy was unsuitable to receive apixaban (at a dose of 5 mg twice daily) or aspirin (81 to 324 mgper day), to determine whether apixaban was superior. The mean follow up period was 1.1 years. The primary outcome was the occurrence of stroke or systemic embolism.Results Before enrollment, 40% of the patients had used a vitamin K antagonist. The data and safety monitoring board recommended early termination of the study because of a clear benefit in favor of apixaban. There were 51 primary outcome events (1.6% per year) among patients assigned to apixaban and 113 (3.7% per year) among those assigned to aspirin (hazard ratio with apixaban, 0.45; 95% confidence interval [CI],0.32 to 0.62; P<0.001). The rates of death were 3.5% per year in the apixaban group and 4.4% per year in the aspirin group (hazard ratio, 0.79; 95% CI, 0.62 to 1.02; P = 0.07).There were 44 cases of major bleeding (1.4% per year) in the apixaban group and 39 (1.2% per year) in the aspirin group (hazard ratio with apixaban, 1.13; 95% CI, 0.74 to 1.75; P = 0.57); there were 11 cases of intracranial bleeding with apixaban and 13 with aspirin. The risk of a first hospitalization for cardiovascular causes was reduced with apixaban as compared with aspirin (12.6% per year vs. 15.9% per year, P<0.001). The treatment effects were consistent among important subgroups...