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Made available in DSpace on 2018-12-11T16:50:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-10 BASF Empresa Brasileira de Pesquisa Agropecuária Crop-livestock-forest (CLFi) and crop-livestock (CLi) systems are among the most recent agricultural developments in Brazil, and aligned with the principles of cleaner production. Such integrated systems can provide at least three types of product from the same land area over a defined period. This paper presents a holistic sustainability evaluation using life cycle assessment to compare combinations of integrated and conventional systems in the Brazilian Cerrado region. The study assesses a comprehensive set of indicators in the three sustainability dimensions: environmental, economic, and social (socio-eco-efficiency). By prioritizing CLFi, the production area to meet the demand of grains, meat and energy for 500 Brazilians, from 2007 to 2014, reached 70 ha, while the conventional systems would need 420 ha to meet the same demand. This result shows that it is possible to increase production to meet the growing food global demand without the need of expanding the agricultural frontier, preserving the remaining forestland. CLFi combinations systems decreased 55% in climate change potential (2389 t of CO2 equivalent), when compared to the conventional systems. It was also observed that the more integrated systems improved the quality of employment, promoted future generation investments in society, and decreased the total production costs in 54%, when compared to conventional systems. Therefore, intensification achieved through good practices such as association, rotation, and succession by an agroforestry system, optimization of inputs (including water, energy, fertilizers, and crop protection agents), land use, soil quality, biodiversity and social aspects. FEE – Fundação Espaço ECO® BASF SA Estrada Ribeirão Soldado, 230, Botujuru BASF SE Sustainability Strategy, CDS/S – C104 São Paulo State University (Unesp) Institute of Science and Technology, Av. Três de Março 511 Universidade Federal do ABC Center of Engineering Modelling ans Applied Social Sciences - Avenida dos Estados, 5001, Bairro Santa Terezinha São Paulo State University (Unesp) Institute of Science and Technology, Av. Três de Março 511

Resumen Objetivo Identificar que tecnicas y/o terapias se utilizan en la actualidad para la mejora del control postural y/o el equilibrio en ninos con paralisis cerebral infantil (PCI). Estrategia de busqueda Se ha llevado a cabo una revision bibliografica en 5 bases de datos electronicas (Cochrane Database, Physiotherapy Evidence Database (PEDro), Pubmed, CINAHL y Scopus) entre febrero y abril de 2014. Seleccion de estudios Se han seleccionado un total de 26 estudios que cumplieron los criterios de inclusion establecidos: publicados entre 2009-2014, que midan el efecto de una tecnica y/o protocolo utilizado, cuyo objetivo sea mejorar el control postural y/o el equilibrio en sujetos con PCI con edades entre 0 y 18 anos. Se han excluido: articulos de opinion, cartas al director, fichas tecnicas, a proposito de un caso, comunicaciones a congresos y estudios en los que se describe una intervencion pero no se presentan resultados. Sintesis de resultados Los articulos que mas se han publicado en los ultimos anos abordan: utilizacion de realidad virtual, uso de terapias o actividades asistidas con caballos y entrenamiento en tapiz rodante. Conclusiones Las terapias-tecnicas y recursos terapeuticos que mas se utilizan para la mejora del control postural y/o equilibrio en la PCI son muy variadas, siendo las mas estudiadas y utilizadas la realidad virtual, la hipoterapia y el entrenamiento en tapiz rodante.

Introduction: Virtual reality (VR) is used in the field of rehabilitation/physical therapy to improve patients’ functional abilities.The last 5 years have yielded numerous publications on the use of VR in patients with neurological disease which aim to establish whether this therapeutic resource contributes to the recovery of motor function. Development: The following databases were reviewed: Cochrane Original, Joanna Briggs Connect, Medline/Pubmed, Cinahl, Scopus, Isi Web of Science, and Sport-Discus.We included articles published in the last 5 years in English and/or Spanish, focusing on using RV to improve motor function in patients with stroke.From this pool, we selected 4 systematic reviews and 21 controlled and/or randomised trials. Most studies focused on increasing motor function in the upper limbs, and/or improving performance of activities of daily living. An additional article examines use of the same technique to increase motor function in the lower limb and/or improve walking and static-dynamic balance. Discussion and conclusions: Strong scientific evidence supports the beneficial effects of VR on upper limb motor recovery in stroke patients. Further studies are needed to fully determine which changes are generated in cortical reorganisation, what type of VR system is the most appropriate, whether benefits are maintained in the long term, and which frequencies and intensities of treatment are the most suitable. Resumen: Introducción: La realidad virtual (RV) se utiliza en rehabilitación con el objetivo de mejorar las capacidades funcionales.Es en estos últimos 5 años cuando aparece el mayor número de publicaciones sobre la utilización de RV en pacientes con patología neurológica, con el objetivo de determinar si este recurso terapéutico aporta mejoras en la recuperación de la función motora. Desarrollo: Se ha realizado una revisión sistemática consultando las bases de datos Cochrane Original, Joanna Briggs Connect, Medline/Pubmed, Cinahl, Scopus, Isi Web of Science y Sport-Discus.Se han incluido artículos publicados en los últimos 5 años, publicados en inglés y/o español, realizados en pacientes con ictus, y que utilicen la RV para mejorar la función motora.Finalmente, se han seleccionado 4 revisiones sistemáticas y 21 ensayos clínicos controlados y/o aleatorizados.La mayoría de los estudios tienen como objetivo mejorar la función motora del miembro superior, y/o mejorar la realización de las actividades de la vida diaria, aunque también hay algún artículo cuyo objetivo es mejorar la función motora del miembro inferior-mejorar la marcha, así como mejorar el equilibrio estático-dinámico. Discusión y conclusiones: Hay fuertes evidencias científicas de los efectos beneficiosos de la RV en la recuperación motora del miembro superior en pacientes con ictus. Se necesitan estudios que profundicen en cuáles son los cambios generados en la reorganización cortical, qué tipo de sistema de RV es mejor utilizar, determinar si los resultados se mantienen a largo plazo, y definir qué frecuencias e intensidades de tratamiento son las más adecuadas. Keywords: Virtual reality, Stroke, Rehabilitation, Palabras clave: Realidad virtual, Ictus, Rehabilitación

Background Previously, we have demonstrated that dietary supplementation with resveratrol (RSV) lowers synovial hyperplasia, chemokines and oxidative damage in an acute antigen-induced arthritis (AIA) model developed in rats, and that autophagic cell death and limiting angiogenic response were involved1. Objectives Here, we investigated the autophagic flux induced by RSV and its relation with serum interleukin (IL)−1β levels, since autophagy could regulate IL-1β via inflammasome. Moreover, C-reactive protein (CRP) and prostaglandin E2 (PGE2), which are also closely linked to inflammation and correlated with disease activity, were also evaluated. Methods Animals were randomly divided into 3 groups: healthy, AIA, and RSV-treated AIA group. RSV (12,5 mg/kg/day) was given orally 8 weeks before AIA induction until sacrifice day (48 hour after intra-articular injection). Healthy and AIA animals were administered 100 µl of water. RSV effects on autophagy were evaluated by the expression of the autophagy proteins, microtubule-associated protein 1 light chain 3 (LC3), and Beclin1 (an autophagic-related protein which up-regulation is associated with increased autophagosome formation), and p62 (an autophagic adaptor protein whose accumulation is associated with autophagic degradation dysfunction), by confocal and immunohistochemistry, respectively. Specific enzyme-linked immunosorbent assay kits and cytokine magnetic milliplex were used to measure CRP and PGE2 and IL-1β in serum samples, respectively. Results At the end of the study, RSV significantly reduced the serum levels of IL-1 β, CRP and PGE2 (p≤0.01 for IL-1β and PCR, and p≤0.05 for PGE2). In relation to autophagy proteins, results showed that the expression of LC3 was greater in the AIA synovial membranes than in control synovial samples, in which the presence of vesicles was easily observed. Interestingly, the synovial tissues from the RSV group showed a significatively (p≤0.001) higher signal for LC3, compared with the AIA samples. As compared with healthy controls, AIA synovial membranes showed increased p62 expression, which was markedly inhibited by RSV treatment (p≤0.01). The protein level of Beclin 1 was higher in AIA synovial membranes than in healthy samples; however, RSV did not increase the signal of Beclin 1. Moreover, there was a significant correlation between p62 expression and serum IL-1β levels (p≤0.05 and r=0.617), PGE2 (p≤0.01 and r=0. 604), and PCR (p≤0.001 and r=0.692). Conclusions These data suggest that resveratrol is capable of inducing the non-canonical (Beclin1 independent) autophagy pathway, and in consequence, modulates the cross-talk existence with inflammation in an acute AIA model, which could also ameliorate the severity of rheumatoid arthritis. Reference [1] Riveiro-Naveira R, Valcarcel N, Almonte M, Vaamonde C, Hermida L, Lopez E, Blanco F, Lopez-Armada MJ. Resveratrol lowers synovial hyperplasia, inflammatory markers and oxidative damage in an acute antigen-induced arthritis model. Rheumatology2016;55(10):1889–900. Disclosure of Interest None declared

Background Previously, we have demonstrated that dietary supplementation with resveratrol lowers synovial hyperplasia, inflammatory markers and oxidative damage in an acute antigen-induced arthritis (AIA) model. Objectives In this work, we investigated whether resveratrol can also regulate this abnormal proliferation of synovial tissue in an acute AIA model by inducing cell death pathways and by modifying the angiogenesis in the synovial membrane. Methods Animals were randomly divided into 3 groups: control, AIA, and resveratrol-treated AIA group. Resveratrol (12,5 mg/kg/day) was given orally 8 weeks before AIA induction until sacrifice day (48 h after intra-articular injection). Control and AIA animals were administered 100 μl of water. Resveratrol effects on autophagy and apoptosis were evaluated by LC3 and active caspase-3 expression (confocal and immunohistochemistry, respectively). Angiopoietin 1 (Ang-1), vascular endothelial growth factor (VEGF), and the nuclear factor NF- kappa -B p65 subunit (p65) were also determined by immunohistochemistry and cartilage degradation with Safranin-O. Results Resveratrol significantly reduced the histological score of synovial tissue. Results showed a significant higher expression of LC3 signals in the AIA synovial membranes, compared with control samples, in which the presence of vesicles was easily observed. Interestingly, the synovial tissues from the resveratrol group showed a significantly (p≤0.001) higher signal for LC3, compared with the AIA samples. Active caspase-3 expression was up-regulated at the same level in the synovial membranes of AIA group than in resveratrol-treated AIA group; however, in resveratrol-treated AIA group active caspase-3 signal was mainly located in the inflammatory cells. Resveratrol consumption significantly attenuated Ang-1 signal, whereas expression of VEGF showed a non significant reduction. Resveratrol administration also mitigated, even not significantly, p65 expression that was significantly higher in the AIA animals than those from the control animals. In addition, resveratrol decreased articular cartilage degradation. Conclusions These data suggest that resveratrol is able to modulate synovial hyperplasia by increasing autophagic cell death and limiting angiogenic response in an acute AIA model, which could also modulate the inflammatory and destructive processes for rheumatoid arthritis. Acknowledgements Instituto de Salud Carlos III-Ministerio de Economia y Competitividad N° Expediente PI12/02771. Uniόn Europea-Fondo Europeo de Desarrollo Regional (FEDER) “Una manera de hacer Europa” Disclosure of Interest None declared

Resumen Objetivos Determinar la prevalencia del sindrome de desgaste profesional (burnout) en el personal sanitario de distintas Unidades de Cuidados Intensivos (UCI).Conocer la asociacion entre el burnout, sus dimensiones y variables sociodemograficas-laborales. Comparar dimensiones del burnout, caracteristicas del personal y de los pacientes de distintas UCI. Material y metodos Estudio analitico comparativo transversal, realizado en UCI de un hospital terciario, en noviembre de 2006. La muestra fue 289 profesionales. Se entrego el cuestionario Maslach Burnout Inventory y variables sociodemograficas-laborales. Se valoro en UCI: Therapeutic Intervention Scoring System (TISS), Nine Equivalents of Nursing Manpower Use Score (NEMS), mortalidad, estancia, aislamientos y desplazamientos terciarios. Se empleo la prueba de la χ2, Fischer, Kruskall-Wallis y analisis multivariable de regresion logistica. Resultados Contestaron el 73% de los trabajadores, edad 37 ± 9 y un 81% eran mujeres. Prevalencia de burnout 14%, afectados el 16% de enfermeros, 14% de residentes, 13% de medicos y 10% de auxiliares. El burnout se asocio a satisfaccion profesional baja, relacion con companeros regular, reconocimiento laboral bajo, y tiempo trabajado y experiencia en UCI a un cansancio emocional elevado, con una p Conclusiones La prevalencia del sindrome de burnout en nuestra muestra fue del 14%, siendo los profesionales de enfermeria los mas afectados. Detectamos niveles elevados de despersonalizacion y niveles medios de cansancio emocional y de realizacion profesional. Las variables relacionadas con el sindrome de desgaste profesional fueron satisfaccion profesional baja, relacion con companeros regular, reconocimiento laboral bajo y un cansancio emocional elevado en el personal mas experto. La UCI con mayor prevalencia de burnout, durante el mes estudiado, atendio a pacientes con mayor: TISS, NEMS, mortalidad, estancia y aislamientos.

Resumen Introduccion Los objetivos del estudio fueron comprobar la correlacion entre distintas escalas de valoracion de la sedacion (EVS) del paciente critico con ventilacion mecanica, asi como conocer la asociacion entre las EVS, datos clinicos y dosis de sedoanalgesia en perfusion (SAP). Material y metodos Estudio analitico longitudinal prospectivo, realizado en una Unidad de Cuidados Intensivos Polivalente de un hospital terciario, desde octubre a diciembre de 2006. La muestra incluyo a pacientes que precisaron administracion de SAP y ventilacion mecanica. Se valoraron: caracteristicas de los pacientes, escala de Ramsay, escala de sedacion-agitacion (SAS), escala de agitacion-sedacion de Richmond (RASS), escala de evaluacion de la actividad motora (MAAS), dosis de SAP, tension arterial media, frecuencia cardiaca, tamano pupilar y frecuencia respiratoria. Se empleo el coeficiente de correlacion de Spearman para valorar la relacion entre las diferentes escalas. Resultados Se realizaron 2.412 mediciones de cada variable: EVS, datos clinicos y dosis de SAP, en 30 pacientes con distintas patologias, 63% varones, edad 53 ± 19 anos, APACHE II 23,8 ± 8,54, SAPS II 44,93 ± 16,52, mortalidad al alta en Unidad de Cuidados Intensivos (UCI) 34%. Mediana y rango intercuartilico de estancia en UCI 15,5 y 20 dias, de ventilacion mecanica 9 y 14 dias, de SAP 6 y 5,5 dias y de relajacion en perfusion (RP) 2 y 5 dias, respectivamente. Se detecto correlacion entre todas las EVS, con una p Conclusion La escala de Ramsay, no validada, tiene una fuerte correlacion con el resto de las EVS estudiadas, ya validadas. Las EVS son subjetivas y no se correlacionan con los datos clinicos y las dosis de SAP, probablemente por el reducido tamano y heterogeneidad muestral.

Resumen En este trabajo se pretende describir las alteraciones posturales mas frecuentes en la paralisis cerebral infantil (PCI), traumatismo craneoencefalico (TCE), y en la hemiplejia; y analizar como influyen estas en las alteraciones orofaciales, presentes en la mayoria de estos pacientes. Se presenta una valoracion de fisioterapia analitica de la disfuncion orofacial, y se muestra un posible tratamiento de fisioterapia,adaptable a las diferentes alteraciones presentes en estos pacientes.

Resumen El dolor, sensacion organica y emocional que produce displacer, y manifestacion clinica por excelencia que marca el primer contacto paciente-fisioterapeuta, es, en este articulo, el objetivo tematico principal junto a su tratamiento fisioterapico. De forma mas concreta se abordaran algunos de los agentes fisicos utilizados por la Fisioterapia, con el objeto de disminuir y/o disipar este sintoma, presente, de forma constante, en la patologia que afecta a la articulacion temporo-mandibular (ATM), ya sea artritica, artrosica o de tipo funcional. Analizaremos para ello los distintos efectos fisiologicos, terapeuticos y mecanismo de accion analgesico de la electroestimulacion nerviosa transcutanea (TENS), onda corta (O.C.), ultrasonoterapia y laserterapia, como principales medidas fisicas a utilizar en los procesos algidos que afectan a los tejidos relacionados de una forma u otra con la ATM.

Virtual reality (VR) is used in the field of rehabilitation/physical therapy to improve patients' functional abilities. The last 5 years have yielded numerous publications on the use of VR in patients with neurological disease which aim to establish whether this therapeutic resource contributes to the recovery of motor function.The following databases were reviewed: Cochrane Original, Joanna Briggs Connect, Medline/Pubmed, Cinahl, Scopus, Isi Web of Science, and Sport-Discus. We included articles published in the last 5 years in English and/or Spanish, focusing on using RV to improve motor function in patients with stroke. From this pool, we selected 4 systematic reviews and 21 controlled and/or randomised trials. Most studies focused on increasing motor function in the upper limbs, and/or improving performance of activities of daily living. An additional article examines use of the same technique to increase motor function in the lower limb and/or improve walking and static-dynamic balance.Strong scientific evidence supports the beneficial effects of VR on upper limb motor recovery in stroke patients. Further studies are needed to fully determine which changes are generated in cortical reorganisation, what type of VR system is the most appropriate, whether benefits are maintained in the long term, and which frequencies and intensities of treatment are the most suitable.

[Resumen] Las habilidades comunicacionales constituyen una parte importante de la entrevista clínica. Para una mejor comprensión pueden dividirse en los siguientes apartados: contexto, escucha, comprensión, estrategia y resumen general. Se detallan en cada uno de ellos (a excepción del contexto por haber sido bordado en otro artículo) una serie de técnicas o consideraciones de interés que facilitan una mejora en la interacción del profesional de la salud (fisioterapeuta) con el consultante. Esta mejora repercute tanto en una mayor calidad de los resultados como a nivel afectivo y emocional en ambos protagonistas de la relación. [Abstract] The communication skills are an important part of the clinical interview. To get a better comprehension they can be divided into the following steps: context, listening, acknowledgement, strategy and summary. Some techniques or interesting considerations which can improve health care provider (physiotherapist) patient relationship are explained in each one (but the context because it has been considered in another article). This improvement is involved with not only better clinical outcomes, but also affective and emotional level for both relationship's main characters

[Resumen] El síndrome de Smith-Magenis es una alteración del desarrollo psicomotor de origen genético, incluido en el grupo de enfermedades raras. En el caso clínico que se presenta, se realizó una valoración inicial de la coordinación, la marcha y el equilibrio a través del test de desarrollo psicomotor (TEPSI), un circuito diseñado específicamente, la prueba del tablero de clavijas de Purdue y el test Timed up and Go. Al finalizar los 3 meses que duró el tratamiento, basado en actividades de tipo lúdico, se realizó una valoración final con las mismas pruebas, encontrándose importantes diferencias objetivas en los resultados obtenidos, además de una mejoría subjetiva reportada por los padres del paciente. A pesar de que la evidencia sobre el tratamiento de fisioterapia en este síndrome es escasa, atendiendo a los resultados encontrados creemos que dicho tratamiento está totalmente justificado en el abordaje integral de los pacientes que lo padecen. [Abstract] The Smith-Magenis syndrome is a genetic psychomotor development disorder included in the group of rare diseases. In the clinical case presented, we performed an initial assessment of coordination, gait and balance using four different tests. These were psychomotor development test (TEPSI scale), Purdue pegboard, time up and go test, and a circuit designed specifically for this clinical case. At the end of the 3 months of treatment, and based on recreational type activities, a final assessment was made with the same tests. Significant objectives differences in the results as well as subjective improvement reported by the patient's parents were found. Although there is little evidence on physiotherapy treatment for this syndrome, in accordance with the results found, we believe that this treatment is totally justified in the comprehensive approach to patients suffering this disorder.

To determine the prevalence of the professional burnout syndrome in health care personnel of different Intensive Care Units (ICUs). To know the association between burnout, its dimensions and sociodemographic-laboral variables. To compare the dimensions of burnout, characteristics of the personnel and of the patients of the different ICUs.Analytic, comparative, cross-sectional study performed in the ICU of a tertiary hospital in November 2006 performed in a sample of 289 professionals. The Maslach Burnout Inventory questionnaire and sociodemographic-laboral variables were provided. The following were evaluated in the ICUs: Therapeutic Intervention Scoring System (TISS), Nine Equivalents of Nursing Manpower Use Score (NEMS), mortality, stay, isolations and travel of third parties. The chi2 test, Fischer test, Kruskall-Wallis test and multivariate logistic regression analysis were used.A total of 73% of the workers answered. Ages ranged from 37 +/- 9 and 81% were women. The prevalence of burnout was 14%, this affecting 16% of the nurses, 14% of residents, 13% physicians and 10% auxiliary workers. Burnout was associated to low professional satisfactions, relationship with regular colleagues, low work recognition and time worked and experience in the ICU to high emotional tiredness, with a p0.05. In a polyvalent ICU, higher values of the following were obtained: TISS 42 +/- 11, NEMS 35 +/- 10, mortality 18%, stay 5 +/- 9, isolation 21%, burnout syndrome 17%, elevated emotional tiredness 49%, elevated depersonalization 63% and low professional performance 44%.The prevalence of the burnout syndrome in our sample was 14%, those being affected most being the nursing professionals. We detected elevated levels of depersonalization and middle levels of emotional tiredness and professional performance. The variables related with professional burnout syndrome were low professional satisfaction, relationship with regular colleagues, low work recognition, and elevated emotional tiredness in the more expert personnel. The ICU with the greatest prevalence of burnout during the month studied attended patients with greater TISS, NEMS, mortality, stay and isolations.

This study aimed to verify the relationship between different Sedation Rating Scales (SRSs) for critical patients on mechanical ventilation and to know the relationship between the SRSs, clinical information and the dose of sedative and analgesia drugs (SAD).A longitudinal, prospective analytic pilot study conducted in a Medical-Surgical Intensive Care Unit of a tertiary hospital from October-December 2006. The sample included patients who required administration of SAP and mechanical ventilation. The following biological parameters and scales were evaluated: patient's demographics, RAMSAY, Sedation Agitation Scale (SAS), Richmond Agitation Sedation Scale (RASS), Motor Activity Assessment Scale (MASS), SAD dose, mean blood pressure, cardiac rate, pupil diameter and respiratory frequency. Spearman coefficient of interrelation was used to compare the relationship between the different scales.A total of 2.412 measurements were made for each variable: SRS, clinical information and SAD dose in 30 patients with different diseases, 63 % males, age 52 +/- 19 years, APACHEII 24 +/- 8, SAPSII 44 +/- 16, with an ICU mortality UCI 34 %. Median and IQ range of stay in ICU 15.5 and 20 days, of mechanical ventilation 9 and 14 days, of SAD 6 and 5.5 days and of paralyzing drugs (PD) 2 and 5 days, respectively. Interrelation was detected between all the SRSs, with p0.0001. The relationship between SAS, RASS and MASS was direct, whereas these were related inversely to RAMSAY. No evidence of interrelation was found between the SRSs, the clinical information and the SAD doses.The RAMSAY scale that has not been validated in ICU patients has a strong interrelation with the other already validated SRSs. SRSs are subjective and do not correlate with the clinical information and the SAD doses, probably due to the sample's small size and heterogeneity.

[Resumen] Los programas de reeducación fisioterápica de la región perineal deben basarse en una completa entrevista clínica y valoración funcional de la esfera abdomino-pelvi-perineal. A partir de los datos obtenidos, estableceremos los objetivos de tratamiento y la selección de las técnicas manuales e instrumentales para alcanzar los objetivos planteados. Además de la anamnesis, realizaremos una exploración física exhaustiva del suelo pélvico, que comprenderá la exploración visual y palpatoria, la valoración muscular, la valoración de la estática de los órganos pélvicos y la exploración neurológica; completaremos la valoración específica del suelo pélvico con la valoración abdominal, del diafragma y de la región lumbopélvica. [Abstract] All the physical therapist reeducation programs of the pelvic floor must be based on a thorough clinical interview and functional assessment of the abdominal region, the pelvis and the pelvic floor. From all these data, we will establish the goals o/ the treatment and we will select the manual and instrumental technics to reach the aims we have set out. Besides the clinical interview, we must carry out a comprehensive physical examination of the pelvic floor, which covers the visual and palpable examination, the muscle assessment, the assessment of the biomechanical position of the pelvic organs, and the neurological examination; we must complete the specific assessment of the pelvic floor with the examination of the abdominal region, the diaphragm and the low back.