Abstract Objective To evaluate the performance of the Berlin Questionnaire, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale in screening for the disease in adults of different age groups by comparing them with polysomnography. Methods Cross-sectional study with prospective patient allocation, in which individuals underwent a medical interview, completion of the three screening instruments, and polysomnography. Individuals were categorized into three age groups: 18-39, 40-59, and ≥60 years. The results of the screening instruments were compared to the diagnostic criteria of the International Classification of Sleep Disorders—third edition. Performance was assessed using 2 × 2 contingency tables, estimating sensitivity, specificity, predictive value, likelihood ratio, and accuracy. Receiver Operating Characteristic curves were also constructed and the area under the curve was estimated for each instrument by age group. Results We obtained a sample with 321 individuals suitable for analysis. The mean age was 50 years, with a predominance of females (56%). The prevalence of the disease in the overall sample was 79%, more prevalent in males in any age group and more frequent in the middle age group. The analyzes revealed that STOP-Bang performed better, both for the overall sample and for all age groups, followed by Berlin Questionnaire and Epworth Sleepiness Scale. Conclusion In an outpatient setting with individuals with characteristics similar to those in this study, it seems sensible to choose the STOP-Bang as a screening tool for the disease, regardless of age group. Level of evidence according the guide for authors: level 2.

Abstract The current economic and political scenario in Brazil has allowed small, medium and large companies to adopt cost cutdown and productivity increase strategies. Diesel fuel consumption by off-highway haul trucks stands for one of the largest costs at the Sossego Mine operational management department. Based on this fact, as well as on the 8% increase in the budgeted diesel fuel cost for 2017, the mining unit has decided to implement a project, previously implemented at the Capão Xavier mine site, which makes use of a high-fidelity haul truck simulator for operators' qualification, by working on the major factors impacting fuel consumption. The application of the simulator has been observed to be a potential upturn for the identification and correction of major failures and bad habits impacting fuel consumption. The results suggest a significant diesel fuel consumption cutdown, as well as enhanced haul truck operation ability and performance.

Resumo Fundamento: A intervenção coronariana percutânea (ICP) é o tratamento invasivo mais frequentemente realizado na doença isquêmica do coração (DIC). Estudos capazes de prover informação sobre a sua efetividade são importantes. Objetivo: Avaliar a sobrevida em até 15 anos de pacientes submetidos a ICP no estado do Rio de Janeiro (ERJ). Métodos: Bases de dados administrativas (1999-2010) e de óbitos (1999-2014) dos residentes com idade ≥ 20 anos do ERJ submetidos a uma única ICP paga pelo Sistema Único de Saúde (SUS) entre 1999-2010 foram relacionadas. Os pacientes foram agrupados em 20-49, 50-69 ou ≥ 70 anos, e as ICP em primária (ICP-P), sem stent (ICP-SS) e com stent convencional (ICP-CS). As probabilidades de sobrevida em 30 dias, um ano e 15 anos foram estimadas pelo método de Kaplan-Meier. Modelos de regressão de risco de Cox foram utilizados para comparar riscos entre sexo, faixas etárias e tipos de ICP. Resultados dos testes com um valor de p < 0,05 foram considerados estatisticamente significativos. Resultados: Foram analisados os dados de 19.263 pacientes (61±11 anos, 63,6% homens). A sobrevida de homens vs. mulheres em 30 dias, um ano e 15 anos foram: 97,3% (97,0-97,6%) vs. 97,1% (96,6-97,4%), 93,6% (93,2-94,1%) vs. 93,4% (92,8-94,0%), e 55,7% (54,0-57,4%) vs. 58,1% (55,8-60,3%), respectivamente. Idade ≥ 70 anos foi associada à menor taxa de sobrevida em todos os períodos. A ICP-CS foi associada a uma sobrevida maior do que a ICP-SS até dois anos de acompanhamento, e após este período ambos os procedimentos apresentaram taxas de sobrevida semelhantes (HR 0,91, IC 95% 0,82-1,00). Conclusões: Mulheres apresentaram maiores taxas de sobrevida em 15 anos após ICP, e o uso de stent convencional não esteve associado a um aumento de sobrevida em longo prazo.

Abstract Background: Percutaneous coronary intervention (PCI) is the most frequently used invasive therapy for ischemic heart disease (IHD). Studies able to provide information about PCI's effectiveness should be conducted in a population of real-world patients. Objectives: To assess the survival rate of IHD patients treated with PCI in the state of Rio de Janeiro (RJ). Methods: Administrative (1999-2010) and death (1999-2014) databases of dwellers aged ≥ 20 years old in the state of RJ submitted to one single PCI paid by the Brazilian public healthcare system (SUS) between 1999 and 2010 were linked. Patients were grouped as follows: 20-49 years old, 50-69 years old and ≥ 70 years old, and PCI in primary PCI, with stent and without stent placement (bare metal stent). Survival probabilities in 30 days, one year and 15 years were estimated by using the Kaplan-Meier method. Cox hazards regression models were used to compare risks among sex, age groups and types of PCI. Test results with a p-value < 0.05 were deemed statistically significant. Results: Data of 19,263 patients (61 ± 11 years old, 63.6% men) were analyzed. Survival rates of men vs. women in 30 days, one year and 15 years were: 97.3% (97.0-97.6%) vs. 97.1% (96.6-97.4%), 93.6% (93.2-94.1%) vs. 93.4% (92.8-94.0%), and 55.7% (54.0-57.4%) vs. 58.1% (55.8-60.3%), respectively. The oldest age group was associated with lower survival rates in all periods. PCI with stent placement had higher survival rates than those without stent placement during a two-year follow-up. After that, both procedures had similar survival rates (HR 0.91, 95% CI 0.82-1.00). Conclusions: In a population of real-world patients, women had a higher survival rate than men within 15 years after PCI. Moreover, using a bare-metal stent failed to improve survival rates after a two-year follow-up compared to simple balloon angioplasty.

Fundamento: Os pacientes em hemodiálise continuam tendo um significativo aumento na morbiletalidade, especialmente a causada por doenças cardiovasculares. A análise dos fatores genéticos ligados ao sistema renina-angiotensina que influenciam na sobrevivência destes pacientes poderá ajudar na busca por melhores resultados. Objetivo: Avaliar a sobrevida em hemodialisados e sua associação com polimorfismo dos genes do sistema reninaangiotensina: deleção/inserção do gene que codifica a enzima conversora da angiotensina I e o M235T do angiotensinogênio. Métodos: Estudo observacional desenhado para ver o papel dos genes do sistema renina-angiotensina. Foram analisados 473 pacientes tratados com hemodiálise crônica em quatro unidades de diálise do Estado do Rio de Janeiro. As taxas de sobrevida foram calculadas pelo método de Kaplan-Meier e as diferenças entre as curvas avaliadas pelos testes de: Tarone-Ware, Peto-Prentice e Log-rank. Foram utilizados também modelos de regressão logística e multinomial. Um valor de p ≤ 0,05 foi considerado estatisticamente significativo. O comitê de ética aprovou este estudo. Resultados: A idade média dos pacientes foi de 45,8%. A taxa de sobrevida global foi de 48% em 11 anos. As principais causas de óbito foram: doenças do aparelho circulatório (34 %) e infecções (15%). A análise de regressão logística encontrou significância estatística para as seguintes variáveis: idade, o TT do angiotensinogênio e a renda familiar acima de cinco salários mínimos, esta última como fator de proteção (p valor: 0,000038, 0,08261 e 0,03089, respectivamente). Conclusões: Nossos dados sugerem que o risco de letalidade em pacientes em hemodiálise pode ser influenciado também pelo polimorfismo TT do angiotensinogênio.

Background: End-stage kidney disease patients continue to have markedly increased cardiovascular disease morbidity and mortality. Analysis of genetic factors connected with the renin-angiotensin system that influences the survival of the patients with end-stage kidney disease supports the ongoing search for improved outcomes. Objective: To assess survival and its association with the polymorphism of renin-angiotensin system genes: angiotensin I-converting enzyme insertion/deletion and angiotensinogen M235T in patients undergoing hemodialysis. Methods: Our study was designed to examine the role of renin-angiotensin system genes. It was an observational study. We analyzed 473 chronic hemodialysis patients in four dialysis units in the state of Rio de Janeiro. Survival rates were calculated by the Kaplan-Meier method and the differences between the curves were evaluated by Tarone-Ware, Peto-Prentice, and log rank tests. We also used logistic regression analysis and the multinomial model. A p value ≤ 0.05 was considered to be statistically significant. The local medical ethics committee gave their approval to this study. Results: The mean age of patients was 45.8 years old. The overall survival rate was 48% at 11 years. The major causes of death were cardiovascular diseases (34%) and infections (15%). Logistic regression analysis found statistical significance for the following variables: age (p = 0.000038), TT angiotensinogen (p = 0.08261), and family income greater than five times the minimum wage (p = 0.03089), the latter being a protective factor. Conclusions: The survival of hemodialysis patients is likely to be influenced by the TT of the angiotensinogen M235T gene.

FUNDAMENTO: A cirurgia de revascularização do miocárdio (RVM) é um procedimento consolidado no tratamento das doenças isquêmicas do coração (DIC), requerendo constante avaliação. OBJETIVO: Avaliar a qualidade na RVM, através das características clínicas dos pacientes, taxas de letalidade até um ano após a alta hospitalar, causas básicas de morte e complicações pós-operatórias, em quatro hospitais públicos do Município do Rio de Janeiro, de 1999 a 2003. MÉTODOS: Foram selecionados aleatoriamente prontuários de pacientes submetidos à RVM. Informações sobre características clínicas, complicações e óbitos foram coletadas retrospectivamente dos prontuários e das declarações de óbitos. As taxas de letalidade foram estimadas nos períodos intra-hospitalar e até um ano pós-alta. RESULTADOS: As prevalências das características pré-operatórias foram: mulher: 31,9%, hipertensão arterial: 90,7%, dislipidemia: 67,4%, diabete: 37,2%, tabagismo: 22,9%, obesidade: 18,3%, doença pulmonar obstrutiva crônica: 8,2%, acidente vascular encefálico prévio: 5,8%, arteriopatia extracardíaca: 12,7%, elevação da creatinina: 4,1%, estado crítico pré-operatório: 3,7%, infarto agudo do miocárdio recente: 23,5%, angina instável: 40,8%, síndrome coronariana aguda: 50,0%, RVM prévia: 2,4%, disfunção ventricular esquerda: 27,3%, lesão de tronco da coronária esquerda: 3,9% e associada com lesão em outro sistema: 19,8%. As taxas de letalidade nos hospitais variaram de 7,0% a 14,3% no período intra-hospitalar e de 8,5% a 20,2% até um ano pós-alta. As DIC representaram as causas de mais de 80% dos óbitos. O grupo de complicações pós-operatórias mais frequente foi de hemorragia ou baixo débito pós-procedimento. Sessenta por cento dos óbitos apresentaram cinco ou mais complicações enquanto que 40% dos sobreviventes nenhuma. CONCLUSÃO: As taxas de letalidade e de complicações foram elevadas. Mesmo nos sobreviventes as complicações foram mais frequentes do que o esperado.

BACKGROUND: Coronary artery bypass grafting (CABG) is a consolidated procedure for the treatment of ischemic heart diseases (IHDs), which requires continuous assessment. OBJECTIVE: To assess the quality of CABG surgery by reviewing patients' clinical characteristics, mortality rates up to one year after hospital discharge, primary causes of death and postoperative complications, at four public hospitals in Rio de Janeiro from 1999 to 2003. METHODS: CABG patient charts were randomly selected. A retrospective review was conducted to collect data on clinical characteristics, complications and deaths from patient medical charts and statements of death (SDs). Mortality rates were estimated for the hospitalization period and for up to one year after hospital discharge. RESULTS: The prevalence of preoperative patient characteristics were: women: 31.9%; arterial hypertension: 90.7%; dyslipidemia: 67.4%; diabetes: 37.2%; current smoking status: 22.9%; obesity: 18.3%; chronic obstructive pulmonary disease: 8.2%; prior stroke: 5.8%; extracardiac artery disease: 12.7%; elevation of creatinine levels: 4.1%; critical preoperative status: 3.7%; recent acute myocardial infarction: 23.5%; unstable angina: 40.8%; acute coronary syndrome: 50.0%; prior CABG: 2.4%; left ventricular dysfunction: 27.3%; left main coronary artery lesion: 3.9%; and associated with lesion in another system: 19.8%. In-hospital mortality rates ranged from 7.0% to 14.3%, and up to one year after hospital discharge from 8.5% to 20.2%. Ischemic heart disease (IHD) accounted for more than 80% of the deaths, and the most frequent complications after surgery were hemorrhage or post-procedural low cardiac output. Sixty percent of the patients who died had five or more complications, whereas 40% of those who survived had none. CONCLUSION: Mortality and complication rates were high. Even among those patients who survived, complications were more frequent than expected.

FUNDAMENTO: La cirugía de revascularización del miocardio (RVM) es un procedimiento consolidado en el tratamiento de las enfermedades isquémicas del corazón (EIC), requiriendo constante evaluación. OBJETIVO: Evaluar la calidad en la RVM, a través de las características clínicas de los pacientes, tasas de letalidad hasta un año tras el alta hospitalaria, causas básicas de muerte y complicaciones posoperatorias, en cuatro hospitales públicos del Municipio del Rio de Janeiro, de 1999 a 2003. MÉTODOS: Se seleccionaron aleatoriamente prontuarios de pacientes sometidos a RVM. Informaciones sobre características clínicas, complicaciones y óbitos se recolectaron retrospectivamente de los prontuarios y de las declaraciones de defunción. Las tasas de letalidad se estimaron en los períodos intrahospitalarios y hasta un año posalta. RESULTADOS: Las prevalencias de las características preoperatorias fueron: mujer: Un 31,9%, hipertensión arterial: un 90,7%, dislipidemia: un 67,4%, diabetes: un 37,2%, aquismo: un 22,9%, obesidad: un 18,3%, enfermedad pulmonar obstructiva crónica: un 8,2%, accidente vascular encefálico previo: un 5,8%, arteriopatía extracardíaca: un 12,7%, elevación de la creatinina: un 4,1%, estado crítico preoperatorio: un 3,7%, infarto agudo de miocardio reciente: un 23,5%, angina inestable: un 40,8%, síndrome coronario agudo: el 50%, RVM previa: un 2,4%, disfunción ventricular izquierda: un 27,3%, lesión de tronco da coronaria izquierda: un 3,9% y asociada con lesión en otro sistema: un 19,8%. Las tasas de letalidad en los hospitales variaron del 7% a un 14,3% en el período intrahospitalario y de un 8,5% a un 20,2% hasta un año pos la dada de alta. Las EIC representaron las causas de más del 80% de los óbitos. El grupo de complicaciones posoperatorias más frecuente fue de hemorragia o bajo débito posprocedimiento. Sesenta por ciento de las muertes presentaron cinco o más complicaciones mientras que el 40% de los supervivientes presentaron ninguna. CONCLUSIÓN: Las tasas de letalidad y de complicaciones se elevaron. Aun en los supervivientes las complicaciones fueron más frecuentes que lo esperado.

O estudo analisa a letalidade hospitalar nas angioplastias coronárias, pagas pelo Sistema Único de Saúde (SUS), realizadas nos hospitais do Estado do Rio de Janeiro, Brasil, de 1999 até 2003. As informações sobre as angioplastias coronárias provieram do banco de Autorizações de Internações Hospitalares da Secretaria de Estado de Saúde do Estado do Rio de Janeiro. As taxas de letalidade foram estimadas segundo faixas etárias, sexo, diagnósticos e hospitais. A letalidade geral foi de 1,9% em 8.735 angioplastias coronárias. A taxa mais baixa ocorreu nas anginas (0,8%), as mais elevadas nos infartos agudos do miocárdio (6%) e em outros diagnósticos (7%). A letalidade foi menor nas mulheres na faixa etária entre 50 e 69 anos, e a partir dos setenta anos foi quase três vezes maior que a dos mais jovens (de 1,4 a 4%), em ambos os sexos. Ocorreu grande variabilidade entre as taxas de letalidade nas angioplastias coronárias nos diferentes hospitais (entre 0 e 6,5%). Portanto, é necessário acompanhar de modo contínuo a adequação da utilização da angioplastia coronária. Em conclusão, a performance deste procedimento no âmbito da modalidade de atenção pelo SUS nos hospitais, dentro do período estudado, não foi satisfatória.

This study analyzes hospital case fatality associated with percutaneous transluminal coronary angioplasties (PTCA) covered by the Brazilian Unified National Health System (SUS) and performed in hospitals in the State of Rio de Janeiro from 1999 to 2003. PTCA data were obtained from the State Health Department's database on Authorizations for Hospital Admissions. Case fatality rates were estimated according to age, gender, diagnosis, and hospital. Overall case fatality was 1.9% in 8,735 PTCAs. The lowest rate was associated with angina (0.8%) and the highest rates with acute myocardial infarction (6%) and other diagnoses (7%). In the 50-69-year bracket, case fatality was higher in women. In the over-70 group, it was almost three times that of the youngest group (4% versus 1.4%). There was great variability among PTCA case fatality rates in different hospitals (from 0 to 6.5%). Ongoing monitoring of PTCAs is thus necessary in clinical practice. In conclusion, PTCA performance was still unsatisfactory under the Unified National Health System.

O estudo analisa a letalidade hospitalar nas angioplastias coronárias, pagas pelo Sistema Único de Saúde (SUS), realizadas nos hospitais do Estado do Rio de Janeiro, Brasil, de 1999 até 2003. As informações sobre as angioplastias coronárias provieram do banco de Autorizações de Internações Hospitalares da Secretaria de Estado de Saúde do Estado do Rio de Janeiro. As taxas de letalidade foram estimadas segundo faixas etárias, sexo, diagnósticos e hospitais. A letalidade geral foi de 1,9% em 8.735 angioplastias coronárias. A taxa mais baixa ocorreu nas anginas (0,8%), as mais elevadas nos infartos agudos do miocárdio (6%) e em outros diagnósticos (7%). A letalidade foi menor nas mulheres na faixa etária entre 50 e 69 anos, e a partir dos setenta anos foi quase três vezes maior que a dos mais jovens (de 1,4 a 4%), em ambos os sexos. Ocorreu grande variabilidade entre as taxas de letalidade nas angioplastias coronárias nos diferentes hospitais (entre 0 e 6,5%). Portanto, é necessário acompanhar de modo contínuo a adequação da utilização da angioplastia coronária. Em conclusão, a performance deste procedimento no âmbito da modalidade de atenção pelo SUS nos hospitais, dentro do período estudado, não foi satisfatória.

This study analyzes hospital case fatality associated with percutaneous transluminal coronary angioplasties (PTCA) covered by the Brazilian Unified National Health System (SUS) and performed in hospitals in the State of Rio de Janeiro from 1999 to 2003. PTCA data were obtained from the State Health Department's database on Authorizations for Hospital Admissions. Case fatality rates were estimated according to age, gender, diagnosis, and hospital. Overall case fatality was 1.9% in 8,735 PTCAs. The lowest rate was associated with angina (0.8%) and the highest rates with acute myocardial infarction (6%) and other diagnoses (7%). In the 50-69-year bracket, case fatality was higher in women. In the over-70 group, it was almost three times that of the youngest group (4% versus 1.4%). There was great variability among PTCA case fatality rates in different hospitals (from 0 to 6.5%). Ongoing monitoring of PTCAs is thus necessary in clinical practice. In conclusion, PTCA performance was still unsatisfactory under the Unified National Health System.

This study examines the behavior of well known simple thermal micro-actuators. This work describes some unexplored aspects of the employed methodology to produce these electro-thermal micro-actuators (ETMs). These information could be time saving for new groups to start research and development on electro-thermal actuators. The focus of the applied methodology is the use of the finite element method (FEM) applied to an iterative procedure to predict the behavior of the micro-actuators before production. The computational model is adjusted based on measurements of force and displacement. To be correctly applied, this methodology requires a sensitivity study of the material properties. The results emphasize the need to use FEM with more accurate thermal and mechanical properties, and to consider also the variation of these properties with temperature. We must also consider a careful definition of thermal boundary conditions and the effects of heat convection and radiation, due to deviations between experimental results and FE results. In this investigation, the structural material applied was Nickel, plated at about 1 µm/min. The experimental characterization was carried out in a micro probe station with a CCD (charge-coupled device) camera attached to it, and used a controlled voltage source.

OBJETIVO: Estimar a letalidade nos procedimentos de doenças isquêmicas do coração (DIC) aguda e crônica e por revascularização miocárdica (RVM) e angioplastia coronariana (AC) nos hospitais cadastrados no SIH/SUS (Sistema de Informações Hospitalares/Sistema Único de Saúde) no Estado do Rio de Janeiro (ERJ), de 1999 a 2003. MÉTODOS: Os procedimentos considerados de RVM e de AC provieram do Datasus. As taxas foram padronizadas por sexo, idade e gravidade de doença, tendo como padrão todos os procedimentos de alta complexidade cardiovascular, realizados no ERJ em 2000. Os grupos de DIC são: angina, infarto agudo do miocárdio, outras DIC agudas e DIC crônicas. RESULTADOS: As letalidades por angina, IAM, outras DIC agudas e DIC crônicas foram de 2,8%, 16,2%, 2,9% e 3,9%, respectivamente, no ERJ. As taxas de letalidade, ajustadas por idade, sexo e grupo diagnóstico, nas RVM e AC foram elevadas, variando entre 1,9% e 12,8% nas RVM, e atingindo 3,2% nas AC, e de 2,3% e 11,1%, quando o tratamento clínico era realizado. CONCLUSÃO: As RVM e AC no tratamento das DIC no ERJ vêm aumentando progressivamente. A letalidade esteve acima do desejável, principalmente nas internações por DIC crônicas (5,4% e 1,7%, respectivamente). O tratamento clínico otimizado parece boa opção terapêutica, reservando-se as RVM e AC para os casos de pior prognóstico. A letalidade no IAM com tratamento clínico foi semelhante à existente quando não se utilizam trombolíticos (16,7%).

OBJECTIVE: To estimate the lethality rate of acute and chronic ischemic heart disease (IHD) procedures, coronary artery bypass graft (CABG) procedures and percutaneous transluminal coronary angioplasty (PTCA) procedures in the hospitals that are registered as service providers for the Hospital Information System / Single Healthcare System (SIH/SUS) plan in the state of Rio de Janeiro (RJ) between 1999 and 2003. METHODS: The procedures considered as CABGs and PTCAs were provided by Datasus (SUS databank). The rates were standardized in accordance with gender, age, and disease severity. The common factors among these procedures are that they are highly complex cardiovascular procedures performed in RJ in the year 2000. The IHD groups are: angina, acute myocardial infarction, other acute IHDs and chronic IHDs. RESULTS: Lethality rates for angina, acute myocardial infarction (AMI), other acute and chronic IHDs were 2.8%, 16.2%, 2.9% and 3.9%, respectively, in the RJ. The lethality rates for CABG and PTCA, adjusted by age, sex and diagnostic groups, were elevated ranging from 1.9% to 12.8% for CABG procedures and as high as 3.2% for PTCA. When medical therapy was performed the rates were 2.3% for CABG and 11.1% for PTCA. CONCLUSION: There has been a progressive increase in the number of CABG and PTCA procedures to treat IHDs in the RJ. Lethality rates were above the desirable level, mainly for chronic IHD hospital admissions (5.4% and 1.7%, respectively). Optimized medical therapy appears to be a worthwhile therapeutic option, reserving CABG and PTCA procedures for the cases with the worst prognoses. Lethality rates for AMI with medical therapy was comparable to current rates when thrombolytics were not used (16.7%).