A qualitative study of GPs' views towards obesity: are they fighting or giving up?

OBJECTIVES: Several studies indicate that general practitioners (GPs) are not taking the issue of obesity as seriously as they should. Therefore, the aim of this study was to understand GPs' views about obesity and obese people and how these professionals perceive their role in the treatment of this disease. STUDY DESIGN: Qualitative study using semi-structured interviews. METHODS: Sixteen semi-structured interviews were conducted with Portuguese GPs. Data were analyzed according to thematic analysis procedures. RESULTS: GPs are negative about their own role in obesity treatment. Although they believe it is part of their job to advise obese patients on the health risks of obesity, the majority of doctors think they are not making any difference in getting their patients to make long term lifestyle changes. GPs hold negative attitudes towards these patients blaming them for being unmotivated and non-compliant and are also pessimistic about their ability to lose weight. Doctors are facing a dilemma in their practices: they want to play an active role but, due to a set of negative beliefs and perceived barriers, they are playing a relatively passive role, feeling defeated and unmotivated, which is reflected in a decrease of efforts and a willing to give up on most of the cases. CONCLUSIONS: This issue should be taken in to account during physicians' education since doctors should be aware of how their own beliefs and attitudes influence their behaviour and practices, compromising, therefore, the adherence to and the success in obesity treatment. They seem to need more precise guidelines and better tools for screening and management of obesity, more referral options, and improved coordination with other specialities.

Worker evaluation of a macroergonomic intervention in a Brazilian footwear company.

This article presents a macroergonomic intervention in a Brazilian footwear company and its evaluation by the workers. Using participatory ergonomics, the traditional Taylor/Ford production system was transformed into a socio-technical one and tested by 100 volunteers working during 3.5 years in a pilot production line. Multiskilling and teamwork were the major changes promoted to enlarge and enrich work and make it more flexible. The workers' evaluation pre- and post-intervention showed an increase in overall satisfaction with the work and more commitment to the results and company targets. STATEMENT OF RELEVANCE: This study showed that problems and solutions can be identified through participatory ergonomics, that it is easier to involve workers than the managerial staff, and that a macroergonomic intervention, mainly focusing on work organization, led to positive personnel, health and production outcomes, despite management's resistance to changes.

Cost-benefit analysis of a socio-technical intervention in a Brazilian footwear company.

This article presents a costs-benefits analysis of a macroergonomic intervention in a Brazilian footwear company. Comparing results of a pilot line (composed by 100 multiskilled workers organized in teams) with eight traditional lines (still working in a one human being/one task model) the intervention showed to be worth pursuing since achieved gains were higher than intervention costs: there was a reduction in human resource costs (80% reduction in industrial accidents, 100% reduction in work-related musculoskeletal disorders or WMSD, medical consultations and turnover, and a 45.65% reduction in absenteeism) and production improvement (productivity increased in 3% and production waste decrease to less than 1%). The net intervention value of the intervention was around U$ 430,000 with a benefit-to-cost ratio of 7.2. Moreover, employees who worked in the pilot line understood that their quality of work life improved, compensating the anxiety brought up by the radical changes implemented.

Magnetic superspace groups and symmetry constraints in incommensurate magnetic phases.

Superspace symmetry has been for many years the standard approach for the analysis of non-magnetic modulated crystals because of its robust and efficient treatment of the structural constraints present in incommensurate phases. For incommensurate magnetic phases, this generalized symmetry formalism can play a similar role. In this context we review from a practical viewpoint the superspace formalism particularized to magnetic incommensurate phases. We analyse in detail the relation between the description using superspace symmetry and the representation method. Important general rules on the symmetry of magnetic incommensurate modulations with a single propagation vector are derived. The power and efficiency of the method is illustrated with various examples, including some multiferroic materials. We show that the concept of superspace symmetry provides a simple, efficient and systematic way to characterize the symmetry and rationalize the structural and physical properties of incommensurate magnetic materials. This is especially relevant when the properties of incommensurate multiferroics are investigated.

Symmetry and magnetic field driven transitions in the 2D triangular lattice compound RbFe(MoO4)2.

The temperature versus magnetic field phase diagram of the 2D triangular lattice and multiferroic compound RbFe(MoO(4))(2) is analysed from the point of view of symmetry. The paramagnetic space group and its irreducible representations are used in order to obtain the magnetic symmetry of the possible modulated phases and characterize the restrictions imposed by this symmetry on the corresponding magnetic structures. Superspace symmetry is considered in the case of incommensurate phases. It is shown that the experimentally observed phases correspond to different isotropy subgroups originating in the same irreducible representation of the paramagnetic symmetry group. The relevant couplings between the primary transverse spin modulation and the electric polarization, the in-plane magnetization and the secondary longitudinal magnetic modulation are discussed. The mechanisms for the destabilization of the improper ferroelectric chiral phase and the origin of the different orientation of the spins with respect to the external field in the two collinear phases are analysed from a symmetry based perspective.

Influence of a programme of professional calibration in the variability of landmark identification using cone beam computed tomography-synthesized and conventional radiographic cephalograms.

OBJECTIVES: The validity of any measurement obtained through a cephalogram largely depends on the reproducibility of the cephalometric landmarks. The purpose of this study is to evaluate the influence of a programme of professional calibration (PPC) on the variability of landmark identification comparing conventional radiographs and cone beam CT (CBCT)-synthesized cephalograms. METHODS: 5 graduate students in oral radiology identified 20 cephalometric landmarks from cephalograms generated from conventional radiographs (RADs), Ray-Sum CBCT-synthesized cephalograms (CBTs) and half-skull CBT (HSTs) from 10 patients. After a period of reinforcement on instruction and calibration with inter- and intraexaminer assessment of reproducibility (intraclass coefficient correlation scores > 0.75) for RADs, CBTs and HSTs obtained from 5 different patients, observers were asked to repeat the analysis of the first 10 patients under the same circumstances. Values in millimetres represented each landmark in a table of Cartesian co-ordinates (x- and y-axes). RESULTS: ANOVA showed significant reduction in variability levels after the PPC, and there were no differences among the methods of image acquisition. Repeated measures ANOVA indicated that the PPC accounted for reduction in variability levels in 14 of 20 landmarks. CONCLUSIONS: The results suggest that a PPC has more influence than the type of image acquisition on variability of landmark identification based on two-dimensional cephalometric analysis. Cephalograms obtained from RAD or CBCT can be considered equivalent for clinical and experimental applications.

Neuropsychological predictors of quality of life in focal epilepsy.

Spontaneous complaints of outpatients with focal epilepsy often stress the relationship between cognitive deficits and Quality of Life (QOL). Consequently, the aim of the present study was to find the best neuropsychological predictors of QOL in individuals with focal epilepsy, in order to guide their ambulatory health care. A sample of 71 Portuguese patients was studied: 40 female, 47 married, with a mean age of 37.48 years (S.D.=11.79, 16-62), mean education of 7.93 (S.D.=4.05, 3-17), and focal epilepsy of moderate severity. A Socio-demographic and Clinical Questionnaire, the SF-36 v1, the Cognitive Functioning Scale from the ESI-55, a Seizure Control scale (items from the Liverpool Seizure Severity Scale), and several neuropsychological tests were used. Semantic Fluency was the only predictor of Physical Functioning, Role Functioning - Physical, and Mental Health; I.A. Test predicted Bodily Pain; and Attentive Matrices predicted General Health, Vitality, and Role Functioning - Emotional. The Mental Component of the SF-36 v1 was predicted by Attentive Matrices, and the Physical Component was predicted by Semantic Fluency. Cognitive Functioning was predicted by the Token Test. Social Functioning and Seizure Control presented no statistically significant correlation with the neuropsychological indicators used. These results underscore the importance of cognitive performance to the QOL of individuals with focal epilepsy, supporting the systematic screening of cognitive performance in this population. Additionally, they suggest cognitive rehabilitation has the potential to improve these individuals' QOL.

Orientation-switching transition and ferroelectricity in betaine arsenate.

This paper reports a detailed investigation of the low frequency dielectric relaxation of betaine arsenate near the ferroelectric phase transition. The dielectric relaxation data are complemented with polarized infrared reflectivity data taken at low temperatures. The reported results allow us to identify several low frequency modes that clarify the complex behaviour of the dielectric response near the Curie temperature T(c2)≈120 K. It is suggested that the important slow dynamics observed is linked to the reorientation of the betaine molecular group. The roles of the different molecular units in the structural changes are briefly discussed and a new and more complex phase transition sequence is proposed.

The oligopeptide (opp) gene cluster of Streptococcus mutans: identification, prevalence, and characterization.

INTRODUCTION: The Opp system is an ATP-binding cassette-type transporter formed by membrane-associated proteins required for the uptake of oligopeptides in bacteria. In gram-positive bacteria, the Opp system, and particularly the oligopeptide-binding protein (OppA), has been shown to be involved in different aspects of cell physiology, including intercellular communication and binding to host proteins. METHODS: In the present study we began to investigate the Opp system of Streptococcus mutans, the main etiological agent of dental caries. RESULTS: Five opp genes (oppABCDF) organized in a single operon were identified in the genome of the S. mutans UA159 strain. Amino acid sequence analyses showed that the S. mutans OppA is closely related to an ortholog found in Streptococcus agalactiae. Incubation of S. mutans UA159 cells with an anti-OppA-specific serum did not inhibit biofilm formation on polystyrene plates. Moreover, S. mutans UA159 derivatives carrying deletions on the oppA or oppB genes did not show significant growth impairment, increased sensitivity to aminopterin, or defective capacity to form biofilms on polystyrene wells in the presence or not of saliva. Remarkably, only two out of three laboratory strains and one out of seven clinical strains recovered from tooth decay processes harbored a copy of the oppA gene and expressed the OppA protein. CONCLUSION: Collectively, these results indicate that, in contrast to other Streptococcus species, the S. mutans Opp system, and particularly the OppA protein, does not represent an important trait required for growth and colonization.

The infrared dielectric tensor and axial dispersion in caesium L-malate monohydrate.

Caesium hydrogen L-malate monohydrate (CsH(C(4)H(4)O(5))·H(2)O) is a novel coordination compound of L-malic acid and caesium that crystallizes into a monoclinic structure and shows promising properties for application as a piezoelectric, pyroelectric and electro-optic material. In the present work we use polarized infrared reflectivity measurements to investigate the dielectric tensor of the material in the spectral range of 40-4000 cm(-1). The use of a three-polarization technique allows us to obtain from the reflectivity data the parameters that characterize the B phonons with wavevectors varying in the plane perpendicular to the monoclinic axis. Consequently, we are able to monitor the frequency dependence of the orientation of the principal dielectric axes in this plane. Using these results we can evaluate the role of polar phonons in the low frequency dielectric response, characterize the dielectric tensor in the terahertz frequency range and describe the axial optical and dielectric dispersion over the frequency range investigated.

Infrared reflectivity study of the phase transitions in sodium ammonium sulfate dihydrate.

This work reports a detailed infrared reflectivity investigation of the phase transitions in single crystals of sodium ammonium sulfate dihydrate (SASD). The polarized reflectivity spectra allow us to follow the temperature dependence of the polar vibrational modes and detect the critical behaviour of the vibrational parameters through the two low temperature structural phase transitions observed in the compound. The results obtained show that the mechanism of the transitions in SASD is complex, involving a strong coupling between pseudo-spins and phonons. In the paraelectric phase, the driving mechanism of the first phase transition (T(c1) = 95 K) appears to be related to a relaxation with a characteristic frequency that is much lower than the phonon frequencies. In the temperature range corresponding to the first ferroelectric phase (T(c1)>T>T(c2) = 79 K), the dynamics of the lattice change considerably and the parameters characterizing several vibrational modes display anomalous temperature dependences. The second phase transition occurring at T(c2) is marked by an important and discontinuous change of the spectral shape, indicating that a considerable lattice distortion is involved.

Quality of life is a primary end-point in clinical settings.

The objective of this review is to present and discuss the quality of life (QOL) construct, more specifically the QOL in the field of health and disease also designated as health-related quality of life (HRQOL). QOL is an everyday language concept with a relatively short history in the health field. It became a principal end-point in health care as a consequence of the development of patients' rights movements. It is important for clinical, economic and political decisions. There is no gold standard way to measure QOL and the existence of a huge number of measures and related QOL concepts makes it difficult to discuss QOL. This means that many times we are using the same expression "QOL" but we are not talking about the same thing. So we submit that it is important to keep looking for the good construct and the good measure. The reason why we decide to evaluate QOL influences the measures we choose. In general, QOL measures are based on questionnaires that must be short and easy to answer. The interest in these kind of soft measures (in opposition to the traditional hard physiologically or biochemically oriented measures) is growing fast.

Structure of the X-phase of 38% brominated betaine calcium chloride dihydrate.

The structures of the high- and low-temperature phases of 38% brominated BCCD [betaine (trimethylammonioacetate) calcium chloride dihydrate], the latter being known as the X-phase, have been determined by single-crystal neutron diffraction at 295 and 20 K, respectively. The symmetry of the X-phase is described by the P2(1)2(1)2(1) space group. The distortion with respect to the high-temperature Pnma phase is characterized by anti-symmetric displacements of the betaine molecules as well as of the Ca octahedra. On the basis of a symmetry-mode analysis, we propose an interpretation of the direct phase transition that occurs around 80 K between these two phases.

[Changes in cognitive function performance in patients after anesthesia]. / Alterações no desempenho de funções cognitivas em doentes submetidos a anestesia.

This study evaluates the mental performance of 112 patients (ASA grade 1 and 2) submitted to Orthopaedic, Urologic, Gynecologic, General and ENT surgery in Santo Antonio General Hospital. These patients received different types of anaesthesia: General Balanced Anaesthesia--GBA (n = 80), Total Intravenous Anaesthesia--TIVA (n = 17) and Regional Anaesthesia--RA (n = 15). Cognitive function was tested using the mini mental state test (MMS), which was done 24 hours before and 24 hours after anaesthesia. There was a high correlation between pre and postoperative MMS scores (R = 0.94). Patients in the GBA group show a significant (p < 0.001) decrease in cognitive performance 24 hours after surgery in comparison to the preoperative test. No differences were observed between the pre and postoperative MMS tests in the TIVA and RA groups.

Impact of epilepsy on QOL in a Portuguese population: exploratory study.

OBJECTIVES: To develop an outcome measure of QOL (quality of life) for the Portuguese population; describe QOL in epileptics; analyse how QOL is affected by epilepsy and analyse how QOL is affected by patients' characteristics. PATIENTS AND METHODS: Study of a consecutive sample of 92 epileptics from an outpatient clinic, men and women, aged 15-65, having the basic education level. Firm diagnosis of epilepsy (with or without seizures) without other illness. A questionnaire based on ESI-55 and Health Insurance Experiment Short-Forms was used. Principal component analysis (orthogonal varimax) showed a solution explaining 55.6 of total variance. After the inspection, the 33 items were grouped into 5 sub-scales (dimensions). RESULTS: Results showed that QOL was poor for people with partial seizures. The best scores were found on patients now free from seizures. CONCLUSION: The QOL measure is sensitive to cultural differences, demographic and disease variables which could explain the results found.

Tratamento da luxacao anterior recidivante do ombro pela tecnica de Magnuson-Stack - avaliacao de resultados. / Treatment of anterior recurrent dislocation of the shoulder by the Magnusson-Stack technic - results evaluation

Os autores apresentam o resultado de duas series de pacientes operados pela tecnica de Magnuson-Stack. A 1a. com 24 anos de evolucao (apenas 3 casos), e a 2a., 14 pacientes com 4 anos. Os resultados mostraram ser iguais em ambas, que aliados a simplicidade da operacao e a satisfacao dos pacientes operados,faz-nos indicar esta tecnica em pacientes portadores de Luxacao Anterior Recidivante de Ombro