Fall represents an important cause of death and its relation with the population aging evidences the need of a broad analysis considering different aspects associated with its occurrence. The objective of this study was to compare fatal victims due to unintentional fall among adults, young olds, olds, and oldest olds, according to sociodemographic data, characteristics, and severity of the trauma. This study is a cross-sectional, comparative study analyzing autopsy reports of fatal victims due to fall, admitted to the Medical Legal Institute of Sao Paulo, Sao Paulo, Brazil, in 2015. The following age groups were: adults (≥18 and <60 years), young olds (≥60 and <70 years), olds (≥70 and <80 years), and oldest olds (≥80 years). The Pearson's χ2, Fisher's exact, Kruskal–Wallis, and Dunn tests were applied to compare the groups, with a significance level of 5%. Regarding the 469 fatalities analyzed (57.8% males, mean age: 71.3 ± 18.2 years), there was a higher frequency of oldest olds (43.5%), ground-level falls (70.1%), femoral fractures (35.0%), and delayed deaths (79.6%) due to posttraumatic complications (57.2%). Adults, young olds, olds, and oldest olds differed significantly (p ≤ .005) in relation to the total of analyzed variables, with a special remark on the differences between the age extremes. High frequencies of femoral fractures and delayed deaths due to complications of treatment in low-severity fall victims, especially those older than 70 years, make it necessary to improve fall prevention programs in the older adults and to create a line of care for this population.
The paper analyzes the innovation intensity and adoption characteristics at the base of the pyramid market. The innovation intensity is configured as radical and incremental, while the innovation adoption is configured as early and tardy. As an empirical approach it was conducted a study type survey. Data analysis is based on non-parametric statistics. The results indicate that the base of the pyramid consumers is characterized by adopting incremental innovations tardily, as pointed out by the literature. Furthermore, it was also observed that women have greater decision-making power in the families of this segment.
Background: Thyrotoxic crisis is a rare, multisystemic and lethal condition, especially when its reversal is delayed. The Burch Wartofsky score establishes severity and predicts the indication of plasmapheresis, but once there is organ dysfunction this therapy should be considered despite of the score. When it is added to conventional treatments it is really effective because of the quick clinical compensation of critically ill patients regardless of the main trigger factor of this emergency. Clinical Cases: 5 patients with thyrotoxic crisis, 1 man and 4 women that had Graves’disease (4 cases) or TSH-secreting tumor (1 case). The precipitating factors were: 1 case due to orchitis, 2 due to poor adhesion, 1 due to antithyroid drugs hepatoxicity and 1 due to ketoacidosis. All them had elevated free T4 ranging from 3.38 to >7.77 ng/dL. All them had high Burch Wartofsky scores (55 to 70) and severe organ dysfunctions: 4 cases with hepatopathy (hepatosplenomegaly, jaundice and coagulopathy) and cardiopathy (diastolic dysfunction and pulmonary hypertension) and 1 case with severe diabetic ketoacidosis. Plasmapheresis (2 to 3 sessions were performed) were indicated for clinical compensation and so subsequent definitive treatment: 3 cases received radioiodine therapy and 1 case had total thyroidectomy. All of them progressed well. The patient who died had already severe prior comorbidities. We performed a systematic survey on PubMed of English articles (case reports and reviews) in humans and we analyzed our 5 cases along with the 108 articles about the use of plasmapheresis in thyroid storm from 1970 to 2020 and we compare them to 394 ones of conventional treatments in past 10 years. Our objective was to evidence plasmapheresis is not related to a higher mortality of patients who underwent to it. We found 7% of mortality in both groups. The chi square test showed an Odds Ratio of (CI 95%) = 1,091 reinforcing there is no relation between number of deaths and treatment type. Conclusion: Plasmapheresis is a therapeutic option with few reports in the literature and without clear guidelines about indication criteria or better timing to initiate it. The statistical analysis showed that 3 or more organ dysfunctions in thyroid storm are related to higher death rates. Its early employment within 24 hours of the initial symptoms and the prompt normalization of free T4 are related to lower mortality. It is a safe and effective therapy that allows thyroid storm patients to be compensated to receive definitive treatment with lower chances of death. Reference: Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y. Factors Associated With Mortality of Thyroid Storm: Analysis Using a National Inpatient Database in Japan. Medicine (Baltimore). 2016;95(7):e2848.
Agradeço ao meu orientador, Prof. Antonio Carlos Pedroso de Limo, por seus conselhos, ensinamentos, paciência e confiança em mim depositada desde a graduação.A minha mãe, Sueli, cuja influência foi decisiva na escolha da profissão, agradeço o incondiciollal apoio e companheirismo inclusive nas noites em claro.Agradeço ao meu pai, Wlamir, pela preocupação constante e por acreditei em mim até quando eu ]nesma duvidava.A minha irmã, Gabriela, agradeço as demonstrações de carinho e abeto nos momentos perfeitos.A minha família agradeço por entender minha ausência e distinção nas reuniões e festa sempre tão boas.Agradeço aos meus amigos do IME-USP, eln especial às meninas que estão comigo desde a graduação, cuja amizade foi essencial na superação dos momentos mais difíceis. A Melena Reis agradeço a grande ajuda e paciência.Aos meus atnigos de infância, especialmente à Liana, agradeço o orgulho e interesse que sempre demonstraram pelo meu trabalho.Agradeço aos meus colegas de trabalho que entenderam a necessidade das ausências e, principalmente, agradeço à Sheila Dresdi pelas demonstrações de incentivo.Por fim, agradeço ao Sr. Antânio Hércules Junior que, em nome do "Grupo Estado", acreditou na importância deste trabalho. l Resumo Em pei-íodos de forte declínio nas vendas de jornal é especialn-tente importante pa.ta as empresas do segmento editorial manter seus leitores, garantindo atratividade de anunciantes e gerando receita. Uma forma de manter estes leitores é através da assinatura, sendo, portanto, de extrema relevância o entendimento das características que levam a urn maior risco de cancelamento e a identificação dos momentos mais críticos pata o direcionamento das anões dp rptPnpõn A Análise de Sobrevivência engloba técnicas capazes de auxllial no entendimento destas questões, sendo a mais usual, o modelo de riscos proporcionais de Cox (Cox, 1972). Este modelo adota como premissa que a proporcionalidade dos riscos seja mantida independentemente do período de tempo analisado. Há diversos casos, porém, em que esta premissa não é satisfeita, fazend(»se necessária a busca pol alternativas. Em assinaturas de jornais é, por exemplo, razoável supor que haja, pata assinantes que optaram pela renovação da msinatura, um maior risco de ca.ncelanlento no início do período (caso em que a renovação da assinatura anterior foi automática) ou no final (indicando descontentamento e não renovação futura).Neste contexto foram estudados -e aplicados aos dados sobre assinaturas de jornais -os modelos de riscos aditivos de Aalen (Aalen, 1980) e semiparamétricos (McKeague e Sasieni, 1994), que permitem a introdução da interferência do tempo sobre os efeitos das características que levam ao risco de cancelamento.
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