bluuebunny/crossref_metadata_2025 huggingface dataset:
Turning frequency in adult bedridden patients to prevent hospital‐acquired pressure ulcer: A scoping review
Authors: Jocelyn Chew H‐S , Thiara Emelia , Lopez Violeta , Shorey Shefaly
Published: December 2017

The aim of this study was to identify current research on turning frequencies of adult bed‐bound patients and inform future turning practices for hospitals based on evidence‐based practice. We undertook a scoping review framework that provided a transparent and systematic methodology using 8 electronic databases (CINAHL, PubMed, Cochrane Library, ScienceDirect, PsycINFO, Scopus, ProQuest, and Web of Science) to identify articles published from 2000 to 2016. Articles were included if they focused on the prevention of hospital‐acquired pressure ulcers related to the frequency of turning or repositioning of bed‐bound patients. Literature search and data extraction were performed independently by 3 authors. The study followed the PRISMA guidelines. In total, 911 articles were identified, of which 10 were eligible. Of the eligible articles, 8 studies could not reach a conclusion on the effective frequency of turning and duration for repositioning patients to prevent the development of pressure ulcers. Only 2 studies found significant differences among the intervention and control groups. Results regarding turning and repositioning schedules are inconclusive; however, the topic needs further exploration to improve the outdated guidelines surrounding pressure ulcer prevention. This may, in turn, make the work of nurses more efficient and make treatment cost‐effective for both the patients and the hospitals.
Molecular and dissociative adsorption of a single water molecule on a β‐dicalcium silicate (100) surface explored by a DFT approach
Authors: Zhang Yue , Lu Xinying , He Zhen , Song Dongsheng
Published: December 2017

The adsorption of water on a C2S surface initiates belite to hydrate. In the present work, the adsorption behavior of single water molecule on a β‐C2S (100) surface is explored using density functional theory (DFT) due to the lack of alternative approaches for direct observation. Four possible calcium atom sites on the β‐C2S (100) surface slab are considered in our calculations. The results show that water can adsorb on the 2 five‐coordinated calcium sites only via molecular adsorption with adsorption energies of 0.59 and 0.85 eV, respectively, but can dissociate on the other 2 six‐coordinated calcium sites with higher adsorption energies of 0.96 and 0.99 eV, respectively. The energy barriers to the dissociative adsorption of water at the Ca(III) site(0.10 eV) is much lower than that at the Ca(IV) site, indicating that water prefers to adsorb and dissociate on Ca(III) sites. The dissociative adsorption of water causes more obvious surface calcium shifts and Si–O bond length increases than molecular adsorption. The dissociative adsorption of a water molecule changes the electron distribution, and the overlap between Ca 2p and O 2s orbitals leads to new Ca–O bond formations.
Effect of the densification of C–S–H on hydration kinetics of tricalcium silicate
Authors: Joseph Shiju , Bishnoi Shashank , Van Balen Koen , Cizer Özlem
Published: December 2017

Effect of water to cement (w/c) ratio and temperature profiles on the densification of C–S–H (calcium silicate hydrate gel) and hydration kinetics of triclinic tricalcium silicate (C3S) is studied beyond the first day of hydration. Calorimetry and quantitative X‐ray diffraction/Rietveld analysis show that degree of hydration is unaffected by w/c up to 7 days and marginally thereafter. Coupling the degree of hydration with the portlandite content measured from thermal analysis indicate that C/S ratio of C–S–H decreases with increasing w/c. There is a clear increase in the portlandite content with increasing w/c, even though the degree of hydration is unchanged, due to the variations in C/S ratio of C–S–H. On the other hand, when C3S is initially cured at a lower temperature (20°C) and then at a higher temperature (40°C), there is a significant increase in the reactivity even until 28 days and vice versa. These experimental results were explained using the densified volumetric growth hypothesis, which assumes that hydration kinetics are dependent on the internal surface area of C–S–H.
A cross‐country study on the relationship between financial development and earnings management
Authors: Enomoto Masahiro , Kimura Fumihiko , Yamaguchi Tomoyasu
Published: December 2017

Abstract

This study investigates whether a country's level of financial development is associated with earnings management in an international setting. Financial development is likely to heighten the monitoring and scrutiny of accounting numbers because of strengthened investor protection laws and regulations as well as sophisticated market participants. Therefore, we first hypothesize that both accrual‐based and real earnings management decrease with greater financial development. However, research shows that managers tend to apply real earnings management, instead of accrual‐based earnings management, under strict accounting standards, regulations, and close auditor scrutiny. Thus, we explore the alternative hypothesis that accrual‐based earnings management decreases but real earnings management increases along with higher financial development. We examine the relationship between financial development and both types of earnings management using 56,830 observations in 37 countries covering the period 2009–2012. The results indicate that both types of earnings management are more restrained under higher levels of financial development.
Cholesterol embolization syndrome: An under‐recognized entity in cardiovascular interventions
Authors: Agrawal Akanksha , Ziccardi Mary Rodriguez , Witzke Christian , Palacios Igor , Rangaswami Janani
Published: December 2017

Cholesterol embolization syndrome (CES) is a multi‐systemic disease caused by embolization of atherosclerotic plaque contents from proximal large‐caliber artery to distal small to medium arteries, occurring spontaneously or more commonly after vascular intervention. This report is a comprehensive review of the reported cases of CES found in our literature search. We discuss the risk factors, clinical manifestations, management, and prognosis of CES. The major predisposing factors for CES include older age, male sex, atherosclerotic cardiovascular risk factors, anticoagulation, and femoral access route. The composite incidence of atheroembolic renal disease was 92% and mortality 63%. Our review highlights the importance to recognize this disease entity for the cardiologist and nephrologist.
Intensive care survivor‐reported symptoms: a longitudinal study of survivors' symptoms
Authors: Langerud Anne Kathrine , Rustøen Tone , Småstuen Milada Cvancarova , Kongsgaard Ulf , Stubhaug Audun
Published: December 2017

Background

There is growing interest in potential long‐term outcomes following intensive care, but few researchers have studied the prevalence of multiple symptoms or the association between pain and other symptoms.

Aims

To investigate the prevalence of anxiety, depression, fatigue, sleep disturbance and post‐traumatic stress symptoms (PTSS) among intensive care survivors 3 months and 1 year after being discharged from an intensive care unit (ICU) and to determine whether pain is associated with higher prevalence of these symptoms 3 months and 1 year after ICU stay.

Study design

Exploratory, longitudinal cohort of intensive care survivors from two mixed ICUs in a tertiary referral hospital in Norway.

Methods

Intensive care survivors completed surveys at 3 months (n = 118) and 1 year (n = 89) after ICU discharge. Clinical Trials: NCT02279212.

Results

Prevalence rates of intensive care survivors' symptoms were pain 58 (49·2%), anxiety/depression 24/118 (20·8%), fatigue 18/118(15·3%), PTSS 15 (12·8%) and sleep disturbance 58/118 (49·2%) at 3 months after ICU discharge (n = 118). Prevalence rates at 1 year (n = 89) changed only slightly to pain 34 (38·2%), anxiety/depression 17 (20·0%), fatigue 12 (13·8%), PTSS 13 (15·1%) and sleep disturbance 40/89 (46·5%). Associations were strong between pain and presence of sleep disturbance, anxiety/depression, PTSS and fatigue.

Conclusions

Intensive care survivors have multiple symptoms and the prevalence rates of these symptoms remained almost unchanged from 3 months to 1 year after ICU discharge. The presence of pain was associated with high odds for the presence of sleep disturbance, anxiety/depression, PTSS and fatigue, compared to a no‐pain group. ICU survivors may benefit from targeted interventions designed to alleviate the symptom burden.

Relevance to clinical practice

Knowledge about ICU survivor's prevalence and risk for having multiple symptoms may help health care professionals to give better care, if needed, to the ICU survivors.
Ophiorrhiza jacobii (Rubiaceae) sp. nov. from Western Ghats, India
Authors: Hareesh Vadakkoot Sankaran , Salish Menachery Johnson , Wu Lei , Joseph Ginu , Sabu Mamiyil
Published: December 2017

Ophiorrhiza jacobii (Rubiaceae) is described as a new species from Western Ghats, Kerala, India. The new species is similar to O. pseudofasciculata in its pubescent habit, densely pubescent terminal capitate cyme with linear lanceolate bract and bracteoles, stipules with bifid apex, etc., but differs in having decumbent stem, ovate to broadly ovate stipules, shorter peduncle, pink corolla without white patches and with bulged throat of the tube, glabrous style of long‐styled flower and obcordate capsules. A detailed description, distribution, ecology, phenology and relevant taxonomic notes are provided along with colour illustrations.
Adding “Circle of Security – Parenting” to treatment as usual in three Swedish infant mental health clinics. Effects on parents’ internal representations and quality of parent‐infant interaction
Authors: Risholm Mothander Pia , Furmark Catarina , Neander Kerstin
Published: December 2017

This study presents effects of adding Circle of Security‐Parenting (COS‐P) to an already established comprehensive therapeutic model for early parent‐child intervention in three Swedish infant mental health (IMH) clinics. Parents’ internal representations and quality of parent‐infant interaction were studied in a clinical sample comprised of 52 parent‐infant dyads randomly allocated to two comparable groups. One group consisted of 28 dyads receiving treatment as usual (TAU) supplemented with COS‐P in a small group format, and another group of 24 dyads receiving TAU only. Assessments were made at baseline (T1), 6 months after inclusion (T2) and 12 months after inclusion (T3). Changes over time were explored in 42 dyads. In the COS‐P group, the proportion of balanced representations, as assessed with Working Model of the Child Interview (WMCI), significantly increased between T1 and T3. Further, the proportion of emotionally available interactions, as assessed with Emotional Availability scales (EA), significantly increased over time in the COS‐P group. Improvements in the TAU‐group were close to significant. Limitations of the study are mainly related to the small sample size. Strength is the real world character of the study, where COS‐P was implemented in a clinical context not otherwise adapted to research. We conclude by discussing the value of supplementing TAU with COS‐P in IMH treatment.
Normal reference intervals and the effects of sample handling on dynamic viscoelastic coagulometry (Sonoclot) in healthy adult horses
Authors: Jamieson Camilla A. , Hanzlicek Andrew S. , Payton Mark E. , Holbrook Todd C.
Published: December 2017

Objective

To determine reference intervals and the effect of sample agitation and rest time on Sonoclot analysis in healthy adult horses.

Design

Original prospective study.

Setting

University veterinary medical teaching hospital.

Animals

Sixty healthy adult horses.

Interventions

Blood was collected for assessment of complete blood count, serum biochemical analysis, and Sonoclot analysis.

Measurements and Main Results

Horses were determined to be healthy based upon physical examination, CBC, and serum biochemistry analysis. Blood was analyzed in a glass bead‐containing cuvette using the Sienco Sonoclot analyzer following 2 rest periods (30 mins and 240 min) and with 2 sample handling interventions (agitated and nonagitated), to obtain values for clot rate, time‐to‐peak, activated clotting time, and platelet function. This study failed to detect a significant difference when a rest time of 30 minutes was compared with 240 minutes, but based on wide limits of agreement the 2 rest times were not considered interchangeable. Agitation at both rest times significantly affected all Sonoclot analyses leading to changes indicative of hypercoagulability.

Conclusions

Sample agitation and rest time should be taken into consideration when developing preanalytical guidelines for Sonoclot analysis in horses. Calculated reference intervals were relatively wide. Further research is needed to evaluate the clinical utility of Sonoclot analysis in horses.
Effect of patient rotation on ovary observation during laparoscopic ovariectomy in dogs
Authors: Liehmann Lea M. , Seny Tanja , Dupré Gilles
Published: December 2017

Objective

To describe the optimal recumbency for laparoscopic ovariectomy (LapOVE) in dogs.

Study Design

Prospective clinical trial.

Animals

Sixteen healthy client‐owned female dogs undergoing routine single‐port LapOVE.

Methods

Anesthetized dogs were placed in dorsal recumbency on a tilting operation table. The operating laparoscope was introduced and, after inspection of abdominal organs, directed toward the randomly assigned ovary. Fifteen‐second video recordings were taken at each table rotation of 0°, 22.5°, and 45°. LapOVE was performed using the single‐port technique. The procedure was repeated on the contralateral side. Blinded observers (3 inexperienced [IO], 3 experienced [EO], 1 expert [EE]) evaluated the recordings postoperatively for visibility of ovary/ovarian bursa, ovario‐uterine transition, and other organs.

Results

In the 0° position, ovarian structures were rarely visualized (IO, 13/96 [13.5%]; EO, 7/96 [7.3%]; EE, 5/32 [15.6%]). In the 22.5° position, visualization improved significantly for EO (26/96 [27.1%], P < .001). There was a marked improvement in visualization for all groups when the positioning angle was altered to 45° (IO, 62/96 [64.6%]; EO, 67/96 [69.8%]; EE, 25/32 [78.1%]). The differences between 0° and 45° and between 22.5° and 45° were significant for all groups of observers (all P < .001). There was an advantage for ovary visualization when procedures were started with left ovariectomy.

Conclusion

The 45° table rotation provided the best ovary visualization, regardless of body side or observer experience. There is evidence that procedures should be started with the left ovary when body side declination is used for organ retraction from the ovaries.
A Novel Small-Specimen Planar Biaxial Testing System With Full In-Plane Deformation Control
Authors: Potter Samuel , Graves Jordan , Drach Borys , Leahy Thomas , Hammel Chris , Feng Yuan , Baker Aaron , Sacks Michael S.
Published: December 2017

Simulations of soft tissues require accurate and robust constitutive models, whose form is derived from carefully designed experimental studies. For such investigations of membranes or thin specimens, planar biaxial systems have been used extensively. Yet, all such systems remain limited in their ability to: (1) fully prescribe in-plane deformation gradient tensor F2D, (2) ensure homogeneity of the applied deformation, and (3) be able to accommodate sufficiently small specimens to ensure a reasonable degree of material homogeneity. To address these issues, we have developed a novel planar biaxial testing device that overcomes these difficulties and is capable of full control of the in-plane deformation gradient tensor F2D and of testing specimens as small as ∼4 mm × ∼4 mm. Individual actuation of the specimen attachment points, combined with a robust real-time feedback control, enabled the device to enforce any arbitrary F2D with a high degree of accuracy and homogeneity. Results from extensive device validation trials and example tissues illustrated the ability of the device to perform as designed and gather data needed for developing and validating constitutive models. Examples included the murine aortic tissues, allowing for investigators to take advantage of the genetic manipulation of murine disease models. These capabilities highlight the potential of the device to serve as a platform for informing and verifying the results of inverse models and for conducting robust, controlled investigation into the biomechanics of very local behaviors of soft tissues and membrane biomaterials.
First‐Line Antiarrhythmic Transplacental Treatment for Fetal Tachyarrhythmia: A Systematic Review and Meta‐Analysis
Authors: Alsaied Tarek , Baskar Shankar , Fares Munes , Alahdab Fares , Czosek Richard J , Murad Mohammad Hassan , Prokop Larry J , Divanovic Allison A
Published: December 2017

Background

There is no consensus on the most effective and best tolerated first‐line antiarrhythmic treatment for fetal tachyarrhythmia. The purpose of this systematic review and meta‐analysis was to compare the efficacy, safety, and fetal–maternal tolerance of first‐line monotherapies for fetal supraventricular tachycardia and atrial flutter.

Methods and Results

A comprehensive search of several databases was conducted through January 2017. Only studies that made a direct comparison between first‐line treatments of fetal tachyarrhythmia were included. Outcomes of interest were termination of fetal tachyarrhythmia, fetal demise, and maternal complications. Ten studies met inclusion criteria, with 537 patients. Overall, 291 patients were treated with digoxin, 137 with flecainide, 102 with sotalol, and 7 with amiodarone. Digoxin achieved a lower rate of supraventricular tachycardia termination compared with flecainide (odds ratio [
OR
]: 0.773; 95% confidence interval [
CI
], 0.605–0.987; I
2
=34%). In fetuses with hydrops fetalis, digoxin had lower rates of tachycardia termination compared with flecainide (
OR
: 0.412; 95%
CI
, 0.268–0.632; I
2
=0%). There was no significant difference in the incidence of maternal side effects between digoxin and flecainide groups (
OR
: 1.134; 95%
CI
, 0.129–9.935; I
2
=80.79%). The incidence of maternal side effects was higher in patients treated with digoxin compared with sotalol (
OR
: 3.148; 95%
CI
, 1.468–6.751; I
2
=0%). There was no difference in fetal demise between flecainide and digoxin (
OR
: 0.767; 95%
CI
, 0.140–4.197; I
2
=44%).

Conclusions

Flecainide may be more effective treatment than digoxin as a first‐line treatment for fetal supraventricular tachycardia.
Associations of Lipoprotein(a) Levels With Incident Atrial Fibrillation and Ischemic Stroke: The ARIC (Atherosclerosis Risk in Communities) Study
Authors: Aronis Konstantinos N. , Zhao Di , Hoogeveen Ron C. , Alonso Alvaro , Ballantyne Christie M. , Guallar Eliseo , Jones Steven R. , Martin Seth S. , Nazarian Saman , Steffen Brian T. , Virani Salim S. , Michos Erin D.
Published: December 2017

Background

Lipoprotein(a) (Lp[a]) is proatherosclerotic and prothrombotic, causally related to coronary disease, and associated with other cardiovascular diseases. The association of Lp(a) with incident atrial fibrillation (
AF
) and with ischemic stroke among individuals with
AF
remains to be elucidated.

Methods and Results

In the community‐based
ARIC
(Atherosclerosis Risk in Communities) study cohort, Lp(a) levels were measured by a Denka Seiken assay at visit 4 (1996–1998). We used multivariable‐adjusted Cox models to compare
AF
and ischemic stroke risk across Lp(a) levels. First, we evaluated incident
AF
in 9908 participants free of
AF
at baseline.
AF
was ascertained by electrocardiography at study visits, hospital
International Statistical Classification of Diseases, 9th Revision
(
ICD‐9
) codes, and death certificates. We then evaluated incident ischemic stroke in 10 127 participants free of stroke at baseline. Stroke was identified by annual phone calls, hospital
ICD‐9 Revision
codes, and death certificates. The baseline age was 62.7±5.6 years. Median Lp(a) levels were 13.3 mg/dL (interquartile range, 5.2–39.7 mg/dL). Median follow‐up was 13.9 and 15.8 years for
AF
and stroke, respectively. Lp(a) was not associated with incident
AF
(hazard ratio, 0.98; 95% confidence interval, 0.82–1.17), comparing those with Lp(a) ≥50 with those with Lp(a) <10 mg/dL. High Lp(a) was associated with a 42% relative increase in stroke risk among participants without
AF
(hazard ratio, 1.42; 95% confidence interval, 1.07–1.90) but not in those with
AF
(hazard ratio, 1.06; 95% confidence interval, 0.70–1.61 [
P
interaction for
AF
=0.25]). There were no interactions by race or sex. No association was found for cardioembolic stroke subtype.

Conclusions

High Lp(a) levels were not associated with incident
AF
. Lp(a) levels were associated with increased ischemic stroke risk, primarily among individuals without
AF
but not in those with
AF
.
“A Key Experience”
Authors: Adams Bertram A.
Published: December 2017

Mr. Adams's article was awarded the First Prize in our “A Key Experience” Competition
Provocation—does Paria Add Anything Useful?
Authors: Broadbent Graeme
Published: December 2017

There has been much controversy in recent years relating to aspects of the partial defence of provocation. A particular issue has centred on whether, and in what circumstances, the defendant's characteristics can be taken into account with regard to his ability to exercise self-control. In the recent case of Paria v The State, an appeal originating from Trinidad and Tobago, the Privy Council was invited to apply the decision of the House of Lords in R v Smith (Morgan). In the event, the Privy Council declined to do so, but nonetheless made some observations on that case. This article considers the more fundamental question of whether the Privy Council should have been considering Smith at all, and argues that, for precedent-based reasons, it should not. It draws on criticisms made by other commentators to the effect that observations made by the Privy Council in Paria about Smith are not soundly based, and concludes that the case adds little of value to the law in either England and Wales or Trinidad and Tobago.
Modern Slavery, Unfree Labour and the Labour Market
Authors: Fudge Judy
Published: December 2017

Treating the United Kingdom’s Modern Slavery Act as its focus, this article examines what the legal characterization of labour unfreedom reveals about the underlying conception of the labour market that informs contemporary approaches to labour law in the United Kingdom. It discusses how unfree labour is conceptualized within two key literatures – Marxist-inspired political economy and liberal approaches to modern slavery – and their underlying assumptions of the labour market and how it operates. As an alternative to these depictions of the labour market, it proposes a legal institutionalist or constitutive account. It develops an approach to legal characterization and jurisdiction that is attentive to modes of governing and the role of political and legal differentiation both in producing labour exploitation and unfree labour and in developing strategies for its elimination. It argues that the problem with the modern slavery approach to unfree labour is that it tends to displace labour law as the principal remedy to the problem of labour abuse and exploitation, while simultaneously reinforcing the idea that flexible labour markets of the type that prevails in the United Kingdom are realms of labour freedom.
Educators’ Experiences Identifying Pain Among Students in Special Education Settings
Authors: Quinn Brenna L. , Serna Richard W.
Published: December 2017

If special educators cannot identify pain in students with intellectual disability (ID), students cannot be referred to the school nurse for assessment and management. The purpose of this study was to examine how special educators identify pain in the school setting. Twenty-four special educators participated in focus groups aiming to (1) identify educators’ observations and perceptions of pain in students with ID and (2) determine the decision-making processes educators use to determine the need for student presentation or referral to the health office. Overall, special educators know students well enough to differentiate pain-related behaviors from normal well-child behaviors, prioritize student safety, and draw on personal experiences with pain when addressing pain in students with ID. Special educators welcome opportunities to learn more about pain in children with ID. Teachers, nurses, and other professionals should share knowledge about and experiences of working with students in pain to improve practices.
Care and supportive measures in school-aged children with prenatal substance exposure
Authors: Sandtorv Lisbeth B. , Haugland Siren , Elgen Irene
Published: December 2017

Aims: Prenatal exposure to substances, including alcohol, opiates, and a number of illicit drugs, may have a negative impact on fetal development. Studies have shown that substance exposure can influence a child’s neurodevelopment and the need for care and supportive measures. In this study, we aimed to investigate the care status and the level of supportive measures in school-aged children prenatally exposed to alcohol and other substances. Methods: This study included children aged between 6 and 14 years who were referred to Haukeland University Hospital in Norway with developmental impairment and a history of prenatal substance exposure. Participants were classified according to their main prenatal exposure to either alcohol or other substances. Information on care status and supportive measures was obtained from medical records and participants’ caregivers. We also compared the use of supportive measures for children placed into foster care before and after 1 year of age. Results: A total of 111 (87% of 128 referrals) eligible children participated in the study. Of these 111 children, 96 (86%) were in foster care, of whom 29 (30%) were placed into foster care during their first year of life and 83 out of 90 (92%) had supportive measures, including reinforced foster care and school or social support. Conclusions:A high proportion of the sample lived in foster care and received supportive measures. Findings may reflect an increased need of care and support in school-aged children with prenatal substance exposure, highlighting the importance of awareness among caregivers and public agencies.
In-vivo quantification of mechanical properties of caudal fins in adult zebrafish
Authors: Puri S. , Aegerter-Wilmsen T. , Jaźwińska A. , Aegerter C.M.
Published: December 2017

The caudal fins of adult zebrafish are supported by multiple bony rays that are laterally interconnected by soft interray tissue. Little is known about the fin's mechanical properties that influence the bending in response to hydrodynamic forces during swimming. Here, we developed an experimental setup to measure the elastic properties of caudal fins in-vivo by applying micro-Newton forces to obtain bending stiffness and a tensional modulus. We detected overall bending moments of 1.5 - 4x10−9 Nm2 along the proximal-distal axis of the appendage showing a non-monotonous pattern that is not due to the geometry of the fin itself. Surgical disruption of the interray tissues along the proximal-distal axis revealed no significant changes to the overall bending stiffness, which we confirm by determining a tensional modulus of the interray tissue. Thus, the biophysical values suggest that the flexibility of the fin during its hydrodynamic performance predominantly relies on the mechanical properties of the rays.
Identity of primary health care nurses: perception of "doing everything"
Authors: Fernandes Marcelo Costa , Silva Lucilane Maria Sales da , Silva Maria Rocineide Ferreira da , Torres Raimundo Augusto Martins , Dias Maria Socorro de Araújo , Moreira Thereza Maria Magalhães
Published: December 2017

ABSTRACT Objective: To analyze, in the speeches of nurses, the habitus that conforms their professional identity in the primary health care area. Method: Qualitative study, carried out from March to October 2015, with nurses of primary healthcare units in the cities of Cajazeiras, in the state of Paraíba, and Maracanaú, in the state of Ceará. Data were collected by means of semi-structured interviews, and analyzed through discourse analysis. Results: Nurses, in their practice and perception, perceive that professional identity is linked to the meaning that involves the word "everything". This situation constitutes a habitus that directs the range of daily actions, often distant from the profession's core of knowledge. Final considerations: Trying to be and do everything in primary health care involves negative repercussions in the professional identity of nurses. Strategic guidance is necessary in order to achieve and embrace elements that reflect the essence of this category.
Evaluation of the risk of misidentification of women in a public maternity hospital
Authors: Tase Terezinha Hideco , Quadrado Ellen Regina Sevilla , Tronchin Daisy Maria Rizatto
Published: December 2017

ABSTRACT Objective: To determine the frequency of similar names and hospital records of women in a public teaching maternity hospital and the risk of misidentification resulting from the similarity in spelling and pronunciation of the names and in records. Method: Quantitative, documental and case study of 5,975 admissions that occurred between 2011 and 2014. The data name, admission and discharge date, date of birth, hospital record and bed number were collected from an electronic information system. Analysis encompassed descriptive statistics and design of an algorithm for comparison of text and sound. Results: Examination of the names revealed that 86% of the misidentification cases resulted from identical surnames and 96.5% from a sound similarity in the first names. There were patients with identical first and last names at least one day a week. Conclusion: The risk of misidentification of patients is a reality, which stresses the importance of checking and pronouncing the complete names correctly.
Prevalence and risk factors for latent tuberculosis infection among primary health care workers in Brazil
Authors: Prado Thiago Nascimento do , Riley Lee W. , Sanchez Mauro , Fregona Geisa , Nóbrega Renata Lyrio Peres , Possuelo Lia Gonçalves , Zandonade Eliana , Locatelli Rodrigo Leite , Souza Fernanda Mattos de , Rajan Jayant V. , Maciel Ethel Leonor Noia
Published: December 2017

Health care workers (HCW) are at increased risk of latent tuberculosis infection (LTBI) from occupational exposure to Mycobacterium tuberculosis. The objective was to determine the prevalence of and risk factors for LTBI among primary HCW in five Brazilian cities. We conducted a cross-sectional study, from 2011 to 2013, among primary HCW, using a structured questionnaire and an evaluated for LTBI using the Quantiferon-TB Gold in-tube test. The magnitude of the associations was assessed using hierarchical logistic regression models. Among 708 HCW, the LTBI prevalence was 27% (n = 196; 95%CI: 24%-31%). We found that the following factors were positively associated with LTBI in primary HCW: age > 50 years (OR = 2.94; 95%CI: 1.44-5.99), absence of a BCG scar (OR = 2.10; 95%CI: 1.28-3.43), self-reported ex-smoker status (OR = 1.80; 95%CI: 1.04-3.11), being a nurse (OR = 2.97; 95%CI: 1.13-7.83), being a nurse technician (OR = 3.10; 95%CI: 1.26-7.60), being a community health agent (OR = 2.60; 95%CI: 1.06-6.40), and irregular use of N95 masks (OR = 2.51; 95%CI: 1.11-5.98). In contrast, HCWs who do not work in health care facilities with a TB control program were less likely to have LTBI (OR = 0.66; 95%CI: 0.45-0.97). This study demonstrated a substantial occupational risk of LTBI among primary HCW in Brazil. The Brazilian TB control program, as well as local programs, need to target these high-risk HCW with education, as well as with better personal protective equipment to prevent acquisition of new TB infection.
Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?
Authors: Barra Cristina B. , Fontes Maria Jussara F. , Cintra Marco Túlio G. , Cruz Renata C. , Rocha Janaína A. G. , Guimarães Maíla Cristina C. , Silva Ivani Novato
Published: December 2017

Summary Introduction: Oral corticosteroids (OCS) are a mainstay of treatment for asthma exacerbations, and short-term OCS courses were generally considered to be safe. Nevertheless, frequent short-term OCS courses could lead to hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Our study aimed at investigating the integrity of the HPA axis in children with persistent asthma or recurrent wheezing at the beginning of an inhaled corticosteroids (ICS) trial. Method: Morning basal cortisol was assessed just before the beginning of ICS, and 30, 60, and 90 days later, using Immulite® Siemens Medical Solutions Diagnostic chemiluminescent enzyme immunoassay (Los Angeles, USA; 2006). Results: In all, 140 children (0.3-15 years old) with persistent asthma or recurrent wheezing have been evaluated and 40% of them reported short-term OCS courses for up to 30 days before evaluation. Out of these, 12.5% had biochemical adrenal suppression but showed adrenal recovery during a three-month ICS trial treatment. No significant differences were observed among children with or without adrenal suppression, neither in the number of days free of OCS treatment before cortisol evaluation (p=0.29) nor in the last OCS course duration (p=0.20). The number of short-term OCS courses reported in the year preceding the cortisol evaluation was also not different (p=0.89). Conclusion: Short-term systemic courses of corticosteroids at conventional doses can put children at risk of HPA axis dysfunction. ICS treatment does not impair adrenal recovery from occurring. Health practitioners should be aware of the risk of a blunted cortisol response upon exposure to stress during the follow-up of patients with persistent asthma or recurrent wheezing.
Molduras de uma tragédia anunciada: enquadramentos do desastre de Mariana
Authors: Sampaio Rafael Cardoso , Fontes Giulia Sbaraini , Ferracioli Paulo
Published: December 2017

Resumo Este artigo busca analisar a diversidade de enquadramentos disponíveis nos media sobre a tragédia de Mariana. Baseados na noção de enquadramento de Entman (1993) e de diversidade de enquadramentos de Porto (2007), propomos uma análise de conteúdo das matérias apresentadas em uma mescla de veículos, de forma a englobar um meio local (Estado de Minas), três portais dedicados exclusivamente ao jornalismo online (G1, R7, Uol) e três outros veículos de abrangência nacional (Folha de S. Paulo, O Estado de S. Paulo, O Globo) em uma amostra de conveniência que busca avaliar a repercussão imediata e, também, subsequente. Nossa análise revela uma cobertura que privilegiou as fontes oficiais, dando pouco espaço à perspectiva das pessoas afetadas pelo desastre ou ainda de “interesse público”.
Factors associated with risk of malnutrition in the elderly in south-eastern Brazil
Authors: Damião Renata , Santos Álvaro da Silva , Matijasevich Alicia , Menezes Paulo Rossi
Published: December 2017

ABSTRACT: Objective: The aim of this study was to evaluate the prevalence of malnutrition risk and its association with socioeconomic, behavioral, and health characteristics in the community-dwelling elderly. Methods: A cross-sectional study with individuals aged ≥ 60 years. Nutritional status was evaluated using the Mini Nutritional Assessment. Socioeconomic, behavioral, and health information was also collected from all participants. The association between each variable and the risk of malnutrition was calculated and adjusted using Poisson hierarchical regression. Results: The initial sample consisted of 3,101 elderly people, of whom 28.3% (95%CI 25.3 - 31.4%) were at risk of malnutrition. The multivariate analysis showed that the risk of malnutrition was significantly higher in women without formal education, who did not live with a partner, and identified as black-skinned. The risk of malnutrition was twice as high in individuals with no family income as compared to those who earned at least three minimum wages. Smokers were also more likely to be at risk of malnutrition than individuals who had never smoked. Participants suffering from kidney, respiratory or heart disease were at higher risk of malnutrition than those with no history of such illnesses. Conclusion: These findings could be used to help in the development of health policies and in the establishment of adequate programs aimed at reducing the risk of malnutrition in this population.
Perfil e Trajetória Profissional dos Egressos da Residência em Medicina de Família e Comunidade do Estado de São Paulo
Authors: Rodrigues Elisa Toffoli , Forster Aldaísa Cassanho , Santos Luciane Loures dos , Ferreira Janise Braga Barros , Falk João Werner , Fabbro Amaury Lelis Dal
Published: December 2017

RESUMO O objetivo do estudo foi caracterizar o perfil e a trajetória profissional dos egressos dos Programas de Residência em Medicina de Família e Comunidade do Estado de São Paulo. Métodos: Estudo descritivo, transversal, de abordagem quantitativa, que caracterizou o perfil dos 129 médicos residentes egressos de 17 Programas de Residência em Medicina de Família e Comunidade (PRMFC) do Estado de São Paulo que finalizaram a residência entre 2000 e 2009. Resultados: Dos 234 residentes, (129) 55,1% responderam ao questionário da pesquisa. A maioria (96,9%) era brasileira, natural do Estado de São Paulo (71,2%); 58,1% eram mulheres; 88,4% referiram ter até 39 anos; 89,1% moravam em grandes centros urbanos, tendendo a se fixar mais no Estado de São Paulo (80,0%), onde realizaram a residência médica. Os médicos atuavam na área de Medicina de Família e Comunidade (74,0%), 49,6% ligados à Estratégia Saúde da Família. A permanência na área foi mais favorável entre aqueles que, ao terminarem a graduação, desejavam ser médicos de família (77,6%) em relação aos que não o desejavam (63,6%). Quase a metade dos egressos informou ter dois ou três postos de trabalho e 99,2% continuaram sua formação acadêmica após o término da residência. Observou-se interesse na docência por 48,1% dos entrevistados, que referiram atuar no ensino de graduação e pós-graduação stricto e lato sensu, como programas de residência médica, enquanto um terço referiu atividades de pesquisa. Conclusão: O entendimento mais aprofundado de quem são e de onde se encontram os profissionais preparados para atuar na Atenção Primária à Saúde pode contribuir para a construção da identidade dos médicos de família e, consequentemente, para o fortalecimento dessa especialidade médica. Os resultados do estudo apontaram uma perspectiva favorável da especialidade Medicina Geral de Família e Comunidade no Estado de São Paulo, que não pode ser generalizada para a realidade de um sistema de saúde tão desigual no País, mesmo considerando as melhorias promovidas pelas recentes medidas de regulação da gestão do SUS. A literatura consultada e comentada possibilita ver a potencialidade no campo da formação dos especialistas, mas a graduação tem uma latência maior para mostrar a efetividade dessas alterações.
Traqueostomia no doente crítico na era do consentimento livre e esclarecido
Authors: Rodrigues Filho Edison Moraes , Junges José Roque
Published: December 2017

Resumo A traqueostomia é procedimento frequentemente realizado em doentes críticos com ventilação mecânica prolongada ou presumidamente prolongada, embora suas indicações, benefícios e riscos sejam controversos. O termo de consentimento livre e esclarecido é necessário para procedimentos cirúrgicos e tem sido amplamente instituído, devendo ser obtido antes da traqueostomia em pacientes críticos. Este artigo faz revisão narrativa das indicações do procedimento e, considerando-o no caso de doentes críticos, aborda a aplicação do termo de consentimento livre e esclarecido. Discutiram-se aspectos teóricos; o que deve constar nos documentos escritos; o que deve ser verbalizado para os doentes e seus familiares, além de outros aspectos práticos. Concluiu-se que os atuais termos de consentimento para traqueostomia em doente crítico não privilegiam a autonomia, pois evitam alocação de recursos para indicação do procedimento.
Intervenção Mediacional na aprendizagem do Braille: um estudo com crianças deficientes visuais
Authors: Dionísio Ana Maria Pereira , Vectore Celia
Published: December 2017

Resumo O presente trabalho teve como objetivo construir e avaliar uma proposta de intervenção mediacional junto a crianças pré-escolares, por meio de oficinas de leitura e escrita no Sistema Braille. A proposta está fundamentada nos conceitos de Vigotski sobre a defectologia e na abordagem relativa à Experiência da Aprendizagem Mediada (EAM), desenvolvida por Feuerstein. A pesquisa foi desenvolvida por meio de dez oficinas mediacionais, nas quais se desenvolveu um trabalho com a leitura de uma história infantil e a partir dela atividades de leitura e de escrita no Sistema Braille. Participaram do estudo quatro crianças cegas, de seis e sete anos de uma instituição que atende pessoas com deficiência visual, na cidade de Uberaba/MG. Além das crianças, participaram também as mães e a professora responsável pela sala em que as crianças estudam. Consideramos que há necessidade de uma pesquisa mais aprofundada devido ao número reduzido de participantes.
Investigação das memórias escolares de estudantes universitários
Authors: Luiza Neto Ingrid , Santos Higor Barreira dos
Published: December 2017

Resumo Este trabalho visa investigar as memórias escolares de estudantes universitários por meio do uso de narrativas autobiográficas, buscando compreender o significado que atribuem ao espaço escolar. Embora a escola seja considerada como espaço de transmissão de conhecimentos científica e historicamente produzidos, é importante refletir que se trata de um lugar onde o sujeito se constitui, em termos sociais, físicos, emocionais e culturais. Por meio da análise de conteúdo das narrativas autobiográficas apresentadas por 105 estudantes universitários foi possível identificar 11 categorias de memórias: relacional positiva, conflituosa, lúdica, pedagógica, saudosista, hierárquica, participação familiar, alimentar, grupal transgressora, ruptura familiar e prospectiva. Os resultados indicam que os aspectos relacionais e lúdicos foram mais lembrados do que os pedagógicos. Discute-se que o levantamento de memórias escolares é uma estratégia interessante para aumentar o conhecimento acerca das práticas realizadas no espaço escolar e do significado atribuído à escola.
Eficiência térmica de materiais de cobertura
Authors: Muniz-Gäal Lígia Parreira , Pezzuto Cláudia Cotrim , Carvalho Marcius Fabius Henriques de , Mota Lia Toledo Moreira
Published: December 2017

Resumo Acorreta especificação dos materiais de cobertura pode contribuir tanto para a melhoria da eficiência energética em edificações como para a mitigação do efeito de ilha de calor urbana. No entanto, a carência de caracterização das propriedades térmicas desses materiais ainda é constante. Esta pesquisa investiga a refletância solar em três diferentes tipos de materiais de cobertura: telha cerâmica esmaltada, cerâmica rústica e de concreto com amostras de diferentes cores. A refletância solar das amostras foi medida a partir do espectrômetro portátil ALTA II e posteriormente foi calculado o índice de refletância solar (SRI), baseado na norma ASTM E1980. Os resultados demonstraram que a variabilidade de cores impacta diretamente no desempenho com relação à refletância solar (cerâmica esmaltada de 0,11 - 0,67, concreto de 0,1 - 0,37, cerâmica rústica de 0,25 - 0,47). A telha de concreto apresentou menor SRI (39%). As cores claras mostraram ser mais eficientes apresentando maiores valores de refletância solar. Entretanto, a diversidade de tons claros acarretou variação na refletância solar (0,67, 0,37, 0,47, esmaltada, concreto e rústica, respectivamente). Os resultados relacionados neste estudo apontam a importância da análise da refletância solar dos materiais de cobertura e a necessidade de sua correta especificação em edificações.
Adesão e empoderamento de usuários com diabetes mellitus para práticas de autocuidado: ensaio clínico randomizado
Authors: Macedo Maísa Mara Lopes , Cortez Daniel Nogueira , Santos Jéssica Caroline dos , Reis Ilka Afonso , Torres Heloísa de Carvalho
Published: December 2017

RESUMO Objetivo: Avaliar a adesão e o empoderamento do usuário com diabetes mellitus para as práticas de autocuidado e controle glicêmico na educação em grupo. Método: Ensaio clínico randomizado por cluster, com a participação de usuários com diabetes mellitus tipo 2. Todos os usuários estavam vinculados às Unidades de Estratégia de Saúde da Família do município de Divinópolis/MG, Brasil, durante os anos de 2014 e 2015. Foram coletados dados com relação à adesão às práticas de autocuidado, ao empoderamento e à hemoglobina glicada para comparação entre grupos na linha de base, assim como comparação entre o antes e o depois intragrupo. Foi considerado um nível de significância de 0,05. Resultados: Participaram do estudo 183 usuários, sendo que 72 foram alocados no grupo intervenção e 111 no grupo controle. Os resultados revelaram uma redução estatisticamente significativa (< 0,001) para o valor de hemoglobina glicada e um aumento dos escores referentes à adesão ao autocuidado e à escala de empoderamento para os participantes do grupo intervenção (< 0,001). Conclusão: Os efeitos da educação em grupo proporcionaram o aumento nas escalas da adesão e empoderamento às práticas de autocuidado, além de melhora dos níveis glicêmicos, evidenciada pelos resultados da hemoglobina glicada. Registro Brasileiro de Ensaios Clínicos: RBR-92j38t.
Cronicidad y uso de servicios sanitarios: la formación entre iguales de la Escuela de Pacientes
Authors: Danet Alina , Rodríguez María Ángeles Prieto , Peña Francisco Garrido , Doblas Manuela López , Martín Nuria Luque , Cerdà Joan Carles March
Published: December 2017

RESUMEN Objetivo: Evaluar el impacto de la estrategia formativa de la Escuela de Pacientes en el uso de servicios sanitarios entre las personas con enfermedades crónicas. Método: Diseño cuantitativo de evaluación pretest y postest con una población de 3350 pacientes crónicos de la Escuela de Pacientes (Andalucía, 2013-2015). Se empleó un cuestionario adaptado de la Universidad de Stanford, que midió: salud autopercibida, número de visitas médicas y nivel de confianza y comunicación con el personal sanitario. Se realizó estudio descriptivo y bivariante, estudio de correlación y análisis de ganancias netas pretest/postest. Resultados: Participaron 964 pacientes (28,8% de la población): el 18,8% hombres, edad media 56 años. La formación aumentó la confianza en el personal de Atención Primaria (AP) y Atención Hospitalaria (AH) (0,44 y 0,65 puntos), descendieron las visitas médicas en un 25% y los ingresos hospitalarios en un 51%, con diferencias estadísticamente significativas por sexo y enfermedad. El índice de correlación entre confianza con profesionales y uso de servicios sanitarios fue de −0,215. Conclusión: La estrategia formativa tuvo un impacto positivo en el uso de servicios sanitarios y confianza con personal sanitario, detectándose áreas de mejora a partir de las cuales se establecen recomendaciones.