bluuebunny/crossref_metadata_2025 huggingface dataset:
Dehydration: subcutaneous fluid administration
Authors: Noble-Adams Rae
Published: August 2014

Dehydration is a common problem in the elderly and a frequent complication of advanced cancer. Subcutaneous fluid administration is an alternative method of parenteral rehydration that is effective and easy to initiate. This article will describe the indications for its use, the method and guidelines, efficacy, benefits, side effects and the nursing implications of this novel and underused technique.
Staff stress and satisfaction in small staffed houses in the community: 2
Authors: Potts Maggie , Halliday Sabrina , Plimley Caroline , Wright Judith , Cuthbertson Andrew
Published: August 2014

The first part of this article focused on the stresses and satisfactions arising out of the performance of the direct care role for staff working in three houses in the community for young people with severe learning disabilities and challenging behaviour. This article focuses on the experience of home/work conflict by staff and the impact of organisational issues in relation to staff-staff and staff-management communication, the processes for decision making and standard setting, operational policies and rotating shifts and their effects on the morale and stress levels of staff.
Community integration of people with learning disabilities must continue
Authors: Kay Brian
Published: August 2014

When Mr and Mrs Goodfellow were first informed that their 4-year-old son Tommy had a learning disability (was mentally subnormal) the experience was painful and memorable and was similar to the majority of parents in this situation in the 1960s and early 1970s. A busy, caring but somewhat abrupt consultant psychiatrist, based in a strange and foreboding hospital, usually some miles away from the parents' home would, in the space of 15 minutes, advise them that: ‘Your son is clearly mentally subnormal, with an IQ of below 50.’ The usual pattern of advice to follow would be in the nature of:
A clinical study of schizophrenia family work
Authors: Kalia Anita , Raghoo Nick , Gamble Catherine
Published: August 2014

This article presents a care study which outlines the interventions that are necessary to enhance a family's knowledge of schizophrenia, daily living, performance and coping skills.
Oxygen therapy
Authors: Ashurst Steve
Published: August 2014

It is essential that nurses understand the potentially harmful effects of oxygen therapy. This article reviews the biochemical role of oxygen, particularly its vital physiological function, and discusses clinical situations in which oxygen is used as therapy. It also outlines how patients receiving oxygen may be effectively monitored in order to optimise treatment.
Oral hygiene
Authors: Buglass Edith Ann
Published: August 2014

The major purpose of oral care is the maintenance of a functional and comfortable oral cavity to enhance self-esteem and reduce bacterial activity in the mouth and the risk of both local and systemic infection.
How effective is reality orientation for elderly, confused patients?
Authors: Jones Adrian
Published: August 2014

Nurses still use reality orientation as a form of therapy, with care plans still discussing orientation in terms of time, place and person. This article aims to explore and review selected studies in an attempt to quantify the effects, if any, and concludes with relevant ethical considerations inherent within the technique.
Cavi-Care
Authors: Williams Clare
Published: August 2014

Many will be familiar with Silastic foam cavity wound dressing, the first silicone foam dressing. This product has been redesigned, improved and relaunched by Smith and Nephew as Cavi-Care.
Should nurses strike?
Authors: Castledine George
Published: August 2014

On 27 April 1995, the ruling Council of the RCN made the historic decision to recommend a change in the RCN's rule prohibiting industrial action. The Council will take an emergency resolution to the RCN Congress in Harrogate this month and a ballot of the RCN's 300 000 members will probably follow in June.
Validity: a concept at the heart of research
Authors: Nolan Mike , Behi Ruhi
Published: August 2014

This article considers the nature of validity and further explores the relationship between validity and reliability. The different forms of validity are discussed and the importance of developing more valid measures of nursing activity is highlighted.
Antimicrobial pharmacology and infections of the eye
Authors: Hindle Edward
Published: August 2014

Infection of the eye and adnexa is a frequently encountered event in both primary and secondary care. Such infections can range from benign but inconvenient to sight threatening. A range of antimicrobial therapies are at our disposal to counter such infections. This article focuses on commonly encountered ocular infections and the antimicrobial agents available to treat them. The pharmacological properties of antimicrobial agents are described in the context of use for ocular infection.
Caring for children undergoing eye surgery: from admission to discharge
Authors: Choleva Paraskevi , Sale Steven
Published: August 2014

Eye surgery at a young age can be a challenging experience for both the child and their family. A holistic approach is needed to reduce the risk of the surgery and the anxiety of all concerned. Working with a specialist team of nurses and doctors who are familiar with managing children is essential for effective management of the surgical patient during and after surgery. Follow-up care also contributes to reduced anxiety and improved compliance to treatment for a good recovery.
Diagnosing Acanthamoeba keratitis: what does the future hold?
Authors: Carnt Nicole A , Dart John KG
Published: August 2014

Acanthamoeba keratitis is a rare cause of infectious keratitis. It is often diagnosed late because of both its insidious onset and confusion with herpes simplex keratitis. The diagnosis must be considered in all indolent cases of keratitis, particularly in contact lens users and in those cases that have not responded to antibiotics or antivirals. Polymerase chain reaction analysis and confocal microscopy are important ancillary diagnostic aids.

Acanthamoeba keratitis is difficult to treat due to: delayed diagnosis; the resistance of the cysts to medical therapy; and the severe extracorneal host inflammation that occurs in some cases. In developed countries, about 85% of cases occur in contact lens users. Topical biguanides are the only consistently effective drugs in vitro, if not always in vivo. Topical and systemic anti-inflammatory treatment is needed for the management of severe inflammatory complications. Prolonged therapy is required with a median treatment period of 4–6 months. The inflammatory response is variable and, when severe, is associated with poor outcomes. Currently, only 75–85% of patients will retain useful vision without the need for a keratoplasty. There is active research into new drugs, the organisms and the causes of the inflammatory response.
Using a simple mental health screen in vision rehabilitation needs assessment: the PHQ-4
Authors: Fitzgerald John , Fitzgerald Claire
Published: August 2014

Mental health difficulties often go unrecognised and untreated in both elderly and visually impaired populations. This can result in older, vision-impaired individuals: failing to access vision support and rehabilitation services; making less use of the services they do access; and receiving less benefit from rehabilitation. Against this background, the Blind Foundation provided training for vision rehabilitation needs assessment staff in the use of the Patient Health Questionnaire–4 (PHQ-4), a four-step depression and anxiety screening measure, to examine whether such a measure would affect differential referral rates between: having no support; having access to support groups; and being supported by in-house counselling services.

The PHQ-4 was completed by over 1 500 adult Blind Foundation service users over a two-year period, with simple completion being associated with higher rates of referral to support groups and above threshold scores for depression and anxiety being associated with referral to counselling providers. These results suggest that the data were being used to assist in referral decision-making. The staff were also asked to comment on the barriers and benefits of PHQ-4 use. The data can be used to focus training and ongoing support for mental health screening by non-mental health practitioners.
Nurse-led intravitreal injection clinics: defining the ophthalmic nurse's scope of practice and educational needs
Authors: Wilson-Miller Rebecca , Stanley Helen
Published: August 2014

This article critically explores ophthalmic nurses’ scope of practice and educational needs when undertaking the intravitreal injection. This topic has been more widely discussed since The Royal College of Ophthalmologists recommended that injections of anti-vascular endothelial growth factor (anti-VEGF) medicines can be administered by non-medical health professionals ( Kirkby, 2013 ). The increasing pressure on eye departments to deliver intravitreal therapy in a timely manner for thousands of new and existing patients led to the consideration of the development of nurse-led intravitreal injection clinics ( Kirkby, 2013 ).

An in-depth critical review of the literature demonstrates excellent outcomes and patient satisfaction from nurse-led treatments. When undertaking this advanced role, it is therefore important that nurses are given the opportunity to adhere to the Nursing and Midwifery Council's code (2008) and the Royal College of Nursing's ophthalmic nurse competencies (2012) to clearly define their scope of practice and educational needs. This article will offer ophthalmic nurses and stakeholders a discussion on the ophthalmic nurse's scope of practice, and how investing in nurse training will result in highly skilled ophthalmic nurses who are equipped to deliver a well-rounded service that results in benefits to patient care and cost-effective service delivery.
One year on: a report on the Moorfields’ Patient Support Service
Authors: Thombs Jasmine , Board Louise de
Published: August 2014

In December 2012, the Moorfields’ counselling service was launched as part of the newly established patient support service team. All patients attending Moorfields Eye Hospital over the age of 18 years were offered access to short-term counselling. This article considers patients who attended the service in the first year. Quantitative data relating to patients age, gender and ethnicity, as well as qualitative data are analysed. In particular, the authors reflect on the reasons that patients were referred to the counselling service. Visual impairment is associated with a higher than normal rate of depression. It is hoped that the themes that emerge from this article will reinforce the importance of psychological and emotional support for visually impaired people and for those attending an eye hospital.
Family members' experiences of the impact of the LCP in a palliative care unit and a geriatric ward in Sweden
Authors: Ekeström Marie-Louise , Olsson Mariann , Runesdotter Sara , Fürst Carl Johan
Published: August 2014

Background:

The Liverpool Care Pathway for the Dying Patient (LCP) was developed to transfer palliative care standards for the last hours or days of life, including family support, from hospice to other care settings.

Aim:

This study sought to explore family members' experiences of end-of-life care in a palliative care unit and in a general geriatric ward in Sweden before and after implementation of the LCP.

Methods:

Experiences were evaluated in relation to the goals of the LCP. Family members of patients deceased before and after implementation answered a questionnaire 3–6 months after the death. Comparisons between the samples were assessed by non-parametric tests.

Results:

There were significant differences concerning dialogue about existential issues that arise and about emotions and practical issues faced in bereavement. Significant improvements after the implementation of the LCP were reported in experiences regarding physicians' ability to listen to family members' concerns.

Conclusion:

The results suggest that using a structure such as that provided by the LCP may improve communication between physicians and the families of dying patients.
Exploring Yamatji perceptions and use of palliative care: an ethnographic study
Authors: Dembinsky Melanie
Published: August 2014

Background:

The Yamatji people comprise several Aboriginal groups living in the Midwest region of Western Australia. Palliative care remains underutilised among Aboriginal groups, but little is known about Yamatji people's thoughts about and experiences of accessing services.

Aim:

As part of a broader study focusing on Yamatji's lived experiences of breast cancer, this study analysed their perceptions and use of palliative care services.

Methods:

The study used grounded theory and 28 in-depth interviews with Aboriginal and non-Aboriginal health-care providers as well as Yamatji patients, carers, and families.

Results:

Palliative care services are underutilised by Yamatji breast cancer patients. The reasons for this include misperceptions about what palliative care entails, cultural and structural barriers to adequate service provision, and the inflexibility of institutionalised death.

Conclusions:

Efforts to raise awareness among Yamatji that palliative care is broader than end-of-life care would be a step in the right direction, but would not be sufficient to significantly increase uptake among Yamatji if culturally specific perceptions of death and dying are not included in the dialogue.
Third-year Australian nursing students' attitudes, experiences, knowledge, and education concerning end-of-life care
Authors: Adesina Oluwatomilayo , DeBellis Anita , Zannettino Lana
Published: August 2014

Background:

Nurses have a vital role in providing end-of-life care to patients and their families, and it is important that nursing students are adequately prepared for this role.

Aim:

This article reports on qualitative findings from research that explored a cohort of third-year undergraduate Australian nursing students' attitudes, experiences, knowledge, and education concerning end-of-life care.

Methods:

The study used open-ended questions in a purpose-designed, self-administered questionnaire and thematic analysis of the responses.

Findings:

Five themes emerged from the analysis: the importance of the students' values and beliefs, the influence of experience, their views on what constitutes a good or bad death, their knowledge of ethics and legislation surrounding end-of-life care, and how they perceived their level of education and knowledge.

Conclusion:

The need for more education on end-of-life care has implications for curriculum development in undergraduate nursing programmes, which need to provide graduating nurses with the necessary knowledge and skills to deliver quality care to patients who are dying and their families.
Jordanian critical care nurses' attitudes toward and experiences of do not resuscitate orders
Authors: Khalaileh Murad Al
Published: August 2014

Background:

Do not resuscitate (DNR) decisions are an issue of considerable sensitivity for patients and their relatives, as well as health professionals.

Purpose:

The aim of this study was to explore Jordanian critical care nurses' attitudes towards and experiences of DNR decisions in clinical practice.

Methods:

A cross-sectional survey design was used. The sample consisted of 111 nurses working in intensive care units in three government hospitals in Jordan.

Results:

Fifty nine per cent of the participants were female. Most were under the age of 35 (69%) and 75% had a bachelor's degree. Most (67%) thought that the patient's family should be involved in DNR decision making. The majority (81%) reported that they preferred a coding system documenting DNR decisions in either the physician or nursing notes. Fifty eight per cent agreed that a standard DNR form should be kept with the patient's medical notes. Only 21% reported actual participation in DNR decisions.

Conclusion:

This study demonstrates that Jordanian critical care nurses are willing to participate in DNR discussions and decision-making processes. Each hospital in the country should have a written DNR policy to guide and discipline health-care providers' practice.
Research Roundup
Authors: Nicholson Craig
Published: August 2014

Brief synopses of a selection of recently published research articles of relevance to palliative care.
Politics and palliative care: Costa Rica
Authors: Smyth Dion
Published: August 2014

Dion Smyth's review of the internet for palliative nursing
Enhancing a Geriatric Emergency Department Care Coordination Intervention Using
Automated Health Information Exchange-Based Clinical Event Notifications
Authors: Gutteridge David L. , Genes Nicholas , Hwang Ula , Kaplan Benjamin , GEDI WISE Investigator The , Shapiro Jason
Published: August 2014

Purpose: In a health care system where patients often have numerous providers and
multiple chronic medical conditions, interoperability of health information technology
(HIT) is of paramount importance. Regional health information organizations (RHIO) often
provide a health information exchange (HIE) as a solution, which gives stakeholders
access to clinical data that they otherwise would not otherwise have. A secondary use of
preexisting HIE infrastructure is clinical event notification (CEN) services, which send
automated notifications to stakeholders. This paper describes the development and
implementation of a CEN service enabled by a RHIO in the New York metropolitan area to
improve care coordination for patients enrolled in a geriatric emergency department care
coordination program.Innovation: This operational CEN system incorporates several
innovations that to our knowledge have not been implemented previously. They include the
near real-time notifications and the delivery of notifications via multiple pathways:
electronic health record (EHR) “in-baskets,” email, text message to internet
protocol-based “zone” phones, and automated encounter entry into the EHR. Based on these
alerts the geriatric care coordination team contacts the facility where the patient is
being seen and offers additional information or assistance with disposition planning
with the goal of decreasing potentially avoidable admissions and duplicate
testing.Findings: During the nearly one-year study period, the CEN program enrolled 5722
patients and sent 497 unique notifications regarding 206 patients. Of these
notifications, 219 (44%) were for emergency department (ED) visits; 121 (55%) of those
notifications were received during normal business hours when the care coordination team
was available to contact the ED where the patient was receiving care. Hospital
admissions resulted from 45% of ED visits 17.8% of these admissions lasted 48 hours or
less, suggesting some might potentially be avoidable.Conclusions and Discussion: This
study demonstrates the potential of CEN systems to improve care coordination by
notifying providers of the occurrence of specific events. Although it could not directly
be demonstrated here, we believe that widespread use of CEN systems have potential to
reduce potentially avoidable admissions and duplicate testing, likely leading to
decreased costs.
Stigma without Sanctions: The (Lack of) Impact of Private School Vouchers on Student Achievement
Authors: Bowen Daniel H. , Trivitt Julie R.
Published: August 2014

Under the Florida A+ Accountability Program, Florida’s schools are graded based on student performance on the Florida Comprehensive Assessment Test. Previously, when schools would earn their second failing grade within four years, students assigned to these schools were offered school vouchers which parents and guardians could use to transfer students to a private or another traditional public school. In January of 2006 the Florida Supreme Court declared that private school voucher component of the Florida A+ Accountability Program was unconstitutional, eliminating the threat of having these students and funds leaving to attend private schools. This exogenous shock allows us to test whether private voucher threats and the funding tied to these students led to increases in student achievement. We find no evidence that the private school voucher threats drive academic improvement beyond what is seen in schools when this private school voucher threat is removed.
Research on Application of Terminal Blended Asphalt Rubber in Steel Deck Pavement
Authors: Wu Chunying , Liu Kaiqiong , Li Aifang , Liu Aihua
Published: August 2014

Viscosity and elasticity properties are investigated of a new type of asphalt rubber that was named terminal blended asphalt rubber (TBAR) that has quite good storage stability. The elastic recovery capacity of TBAR and other types of asphalt was evaluated by low-temperature elastic recovery, extreme elastic recovery, and fatigue elastic recovery tests. The results show that TBAR exhibits excellent elastic recovery capacity. The performance of TBAR mixture is shown superior to that of SMA13 mixed with styrene-butadiene-styrene (SBS)-modified asphalt, which indicates that it is an ideal material for steel deck pavement. TBAR is proven to have good performance in this initial application, but long-term performance needs further observation.
Laboratory Investigation of the Effect of Warm Mix Asphalt (WMA) Additives on the Properties of WMA Used in China
Authors: Xie Zhaoxing , Shen Junan , Fan Wenzhong , Wang Lili
Published: August 2014

To investigate and compare the influence of various commonly used warm mix asphalt (WMA) additives on the physical, mechanical, and performance properties of WMA, a series of laboratory testing programs such as air void, voids in mineral aggregate, freeze-thaw splitting, wheel tracking test, and bending beam tests were performed. The experimental design of WMA mixtures included the use of three WMA additives of Sasobit, Evotherm and Rediset, two asphalt binders of SK-70 base asphalt, and a styrene-butadiene-styrene (SBS)-modified one. The testing results of WMA were also compared to that hot mix asphalt (HMA) as controls. Results from this study showed that: (1) volumetric properties (air voids and VMA) of WMAs did not have significant difference from the controls; (2) WMA with Sasobit had the greatest Marshall stability, followed by the WMA with Rediset, whereas all WMAs with Evotherm had the least, regardless of the types of asphalt; and (3) for WMA with modified asphalt, the dynamic stability of WMA with Rediset was a slightly greater than other two WMAs. For WMAs with base asphalt, the dynamic stability with Evotherm and Sasobit was similar to the control and greater than that with Rediset: (4) The WMAs with Sasobit have slightly greater indirect tensile strength (ITS) and tensile strength ratio (TSR) than the other two, regardless of the types of asphalt. (5) WMAs with Rediset had the greatest bending failure strain, regardless of the types of asphalt. Among all asphalt mixtures, most of WMAs had lower bending failure strain than the controls.
Primary piRNA biogenesis: caught up in a Maelstrom
Authors: Pandey Radha Raman , Pillai Ramesh S
Published: August 2014

Precursors for most Piwi‐interacting RNAs (piRNAs) are indistinguishable from other RNA polymerase II‐transcribed long non‐coding RNAs. So, it is currently unclear how they are recognized as substrates by the piRNA processing machinery that resides in cytoplasmic granules called nuage. In this issue, Castaneda et al (2014) reveal a role for the nuage component and nucleo‐cytoplasmic shuttling protein Maelstrom in mouse piRNA biogenesis.
Diversity and convergence in the mechanisms establishing L/R asymmetry in metazoa
Authors: Coutelis Jean‐Baptiste , González‐Morales Nicanor , Géminard Charles , Noselli Stéphane
Published: August 2014

Differentiating left and right hand sides during embryogenesis represents a major event in body patterning. Left–Right (L/R) asymmetry in bilateria is essential for handed positioning, morphogenesis and ultimately the function of organs (including the brain), with defective L/R asymmetry leading to severe pathologies in human. How and when symmetry is initially broken during embryogenesis remains debated and is a major focus in the field. Work done over the past 20 years, in both vertebrate and invertebrate models, has revealed a number of distinct pathways and mechanisms important for establishing L/R asymmetry and for spreading it to tissues and organs. In this review, we summarize our current knowledge and discuss the diversity of L/R patterning from cells to organs during evolution.
Emergence of robust growth laws from optimal regulation of ribosome synthesis
Authors: Scott Matthew , Klumpp Stefan , Mateescu Eduard M , Hwa Terence
Published: August 2014

Bacteria must constantly adapt their growth to changes in nutrient availability; yet despite large‐scale changes in protein expression associated with sensing, adaptation, and processing different environmental nutrients, simple growth laws connect the ribosome abundance and the growth rate. Here, we investigate the origin of these growth laws by analyzing the features of ribosomal regulation that coordinate proteome‐wide expression changes with cell growth in a variety of nutrient conditions in the model organism Escherichia coli. We identify supply‐driven feedforward activation of ribosomal protein synthesis as the key regulatory motif maximizing amino acid flux, and autonomously guiding a cell to achieve optimal growth in different environments. The growth laws emerge naturally from the robust regulatory strategy underlying growth rate control, irrespective of the details of the molecular implementation. The study highlights the interplay between phenomenological modeling and molecular mechanisms in uncovering fundamental operating constraints, with implications for endogenous and synthetic design of microorganisms.
Adaptação transcultural para o português (Brasil) da Vulnerability to Abuse Screening Scale (VASS) para rastreio da violência contra idosos
Authors: Maia Rodrigo da Silva , Maia Eulália Maria Chaves
Published: August 2014

A literatura aponta a insuficiência de instrumentos disponibilizados em português para a detecção da violência contra idosos. Assim, parece oportuno disponibilizar versões lusófonas de ferramentas advindas de outras culturas. A Vulnerability to Abuse Screening Scale (VASS) contém 12 itens que constatam o risco à violência contra idosos. Este trabalho objetivou promover a adaptação transcultural para o Brasil da VASS. Verificou-se que o conceito utilizado para a construção do instrumento, bem como seus itens mostram-se adequados à investigação do fenômeno. Evidenciou-se boa equivalência semântica entre os itens das retrotraduções e do instrumento original, especialmente quanto aos resultados de T1 – R1. Os juízes optaram pelo uso de 11 itens de T1 à versão-síntese. A equivalência operacional mostrou-se satisfatória. Em geral, os resultados apresentados mostram-se aceitáveis. Destaca-se que o instrumento ainda não apresentou resultados satisfatórios que indiquem viabilidade de seu uso. Conclui-se que é necessário revisar, replicar o instrumento para a verificação da validade.
O agir leigo e o cuidado em saúde: a produção de mapas de cuidado
Authors: Cecilio Luiz Carlos de Oliveira , Carapinheiro Graça , Andreazza Rosemarie , Souza Ana Lúcia Medeiros de , Andrade Maria da Graça Garcia , Santiago Silvia Maria , Meneses Consuelo Sampaio , Reis Denizi Oliveira , Araújo Eliane Cardoso , Pinto Nicanor Rodrigues da Silva , Spedo Sandra Maria
Published: August 2014

O estudo teve como objetivo caracterizar que outras lógicas de regulação, para além da governamental, resultam na produção do cuidado, por meio de pesquisa qualitativa realizada em dois municípios do ABCD Paulista, São Paulo, Brasil, em duas etapas. Na primeira, foram realizadas entrevistas com atores estratégicos (gestores e políticos) e atores-trabalhadores-chave. Na segunda, foram coletadas histórias de vida de 18 pessoas com elevada frequência de utilização de serviços de saúde. A análise de implicação dos pesquisadores com o campo permitiu uma melhor compreensão das narrativas. Foram caracterizados quatro regimes de regulação (governamental, profissional, clientelístico e leigo), indicando que a regulação é campo em permanente disputa, é uma produção social. Com o seu agir, os usuários produzem mapas de cuidado que nos indicam como há outros arranjos possíveis de sistemas de saúde, representando um convite para experimentarmos a cogestão do cuidado entre equipes e usuários, como caminho promissor para a inadiável necessidade de reinvenção da saúde.
The association between skin color/race and health indicators in elderly Brazilians: a study based on the Brazilian National Household Sample Survey (2008)
Authors: Oliveira Bruno Luciano Carneiro Alves de , Thomaz Erika Barbara Abreu Fonseca , Silva Raimundo Antonio da
Published: August 2014

This study analyzed racial inequalities in health in 18,684 elderly Brazilians 65 years or older, interviewed in the National Household Sample Survey in 2008 (PNAD 2008), and who reported their color/race as white, brown, or black. Associations were estimated between self-rated health status, functional incapacity, and number of chronic conditions according to crude and adjusted regression analyses (α = 0.01). The majority of the elderly were white (56.2%). In the adjusted analysis, brown color/races was associated with worse self-rated health status (OR = 1.11; 95%CI: 1.03-1.18) and black color/race was associated with more chronic diseases (PR = 1.07; 95%CI: 1.02-1.13). Brown color/race appeared as a protective factor against functional incapacity. When brown and black elderly were combined in one category (“black”), “black” elderly continued to show worse self-rated health status (OR = 1.09; 95%CI: 1.02-1.16) and lower odds of functional incapacity (OR = 0.83; 95%CI: 0.76-0.92). “Black” color/race lost the association with number of chronic diseases. Color/race explained part of the health inequalities in elderly Brazilians, but other socioeconomic variables had a more striking effect.
Utilização de serviços de saúde no Brasil: associação com indicadores de excesso de peso e gordura abdominal
Authors: Tomasi Elaine , Nunes Bruno Pereira , Thumé Elaine , Silveira Denise Silva da , Siqueira Fernando Vinholes , Piccini Roberto Xavier , Silva Suele Manjourany , Dilélio Alitéia Santiago , Facchini Luiz Augusto
Published: August 2014

O objetivo do trabalho foi analisar a associação entre o uso de serviços de saúde e obesidade em adultos brasileiros. Realizou-se estudo transversal de base populacional em 100 municípios de 23 estados brasileiros. Os desfechos foram: atendimento domiciliar, utilização de serviço médico na unidade básica de saúde (UBS), uso de serviços médicos fora da UBS, uso de pronto-socorro e internação hospitalar. O excesso de peso foi avaliado por aferição do IMC e da circunferência abdominal (CA). Entre os 8.603 sujeitos estudados, o atendimento médico na UBS foi 14% e 18% maior entre obesos e com CA de risco muito aumentado, respectivamente, após ajuste para as variáveis sociodemográficas e sedentarismo, mas perdeu significância quando ajustado para hipertensão e diabetes autorreferidos. Para o pronto-socorro, ambas as exposições implicaram um aumento de cerca de 20% na probabilidade de uso deste serviço, após ajustes. O excesso de peso aumentou a probabilidade de utilização de consulta médica na UBS e em serviços de urgência e emergência.
Virologia ambiental e saneamento no Brasil: uma revisão narrativa
Authors: Prado Tatiana , Miagostovich Marize Pereira
Published: August 2014

Os serviços de saneamento básico têm papel fundamental no controle da transmissão de diversos agentes patogênicos de veiculação hídrica, especialmente vírus responsáveis por causar gastroenterites agudas e hepatites. Entre os agentes virais de maior impacto para a saúde pública, podem ser destacados os vírus das hepatites A, os rotavírus e norovírus, adenovírus e enterovírus, os quais são responsáveis pela contaminação de diversos ecossistemas aquáticos brasileiros. A alta circulação de vírus no ambiente vem sendo relacionada às condições sanitárias inadequadas das comunidades, incluindo a falta na cobertura de serviços ou ineficácia de tecnologias convencionais na eliminação ou redução da carga viral presente na água ou no esgoto. Este estudo aborda uma revisão das relações entre virologia, saúde e saneamento, enfatizando a epidemiologia das infecções virais de transmissão hídrica e o impacto na saúde pública.
Concepções e tipologia de conflitos entre trabalhadores e gerentes no contexto da atenção básica no Sistema Único de Saúde (SUS)
Authors: Carvalho Brígida Gimenez , Peduzzi Marina , Ayres José Ricardo de Carvalho Mesquita
Published: August 2014

Este estudo objetivou analisar percepções de conflito entre trabalhadores e gerentes de unidade básica de saúde e apresentar tipologia de conflitos vivenciados no trabalho. Trata-se de estudo de caso, de caráter compreensivo-interpretativo, de abordagem critica-hermenêutica. As técnicas de coleta foram: grupo focal com gerentes, observação do trabalho e entrevista com trabalhadores, realizadas de abril a novembro de 2011. Os resultados foram triangulados e apontam a convivência de distintas concepções de conflito. Foram tipificadas seis modalidades de conflitos, relacionados à falta de colaboração no trabalho; ao desrespeito decorrente de relações assimétricas entre trabalhadores; ao comportamento do funcionário-problema; aos problemas pessoais; à assimetria com outros níveis de gestão e à infraestrutura deficitária dos serviços. Destaca-se a relevância do (não) reconhecimento mútuo, na perspectiva proposta por Axel Honneth, na interpretação da gênese e implicações práticas desses conflitos.
Coordenação das redes de atenção à saúde pela atenção primária: validação semântica de um instrumento adaptado
Authors: Rodrigues Ludmila Barbosa Bandeira , Leite Andrea Cristina , Yamamura Mellina , Deon Keila Cristiane , Arcêncio Ricardo Alexandre
Published: August 2014

Objetivou-se efetuar a validação semântica do instrumento de avaliação da coordenação das redes de atenção à saúde pela atenção primária, adaptado do checklist de avaliação do grau de integração das redes de atenção à saúde, considerando a relevância, a coerência e a compreensão de cada item para a população de referência do estudo. Trata-se de um estudo metodológico de corte transversal. A amostra foi composta de 56 profissionais de saúde que atuam na Estratégia Saúde da Família, em Alfenas, Minas Gerais, Brasil. O instrumento possui cinco dimensões e 78 itens com respostas do tipo Likert. O processo envolveu três etapas: avaliação e adaptação dos itens pelo grupo de especialistas, avaliação e sugestão dos itens por 50 profissionais de saúde e confirmação dos itens por seis profissionais de saúde. Ao final da validação semântica, os itens do instrumento se mostraram compreensíveis pela população de referência. Ao término do processo de validação, o instrumento poderá ser uma ferramenta útil para subsidiar a tomada de decisão de gestores para a reorganização dos sistemas locais de saúde.
Oral health technicians in Brazilian primary health care: potentials and constraints
Authors: Aguiar Dulce Maria Lucena de , Tomita Nilce Emy , Machado Maria de Fátima Antero Sousa , Martins Cleide Lavieri , Frazão Paulo
Published: August 2014

Different perspectives on the role of mid-level workers in health care might represent a constraint to health policies. This study aimed to investigate how different agents view the participation of oral health technicians in direct activities of oral healthcare with the goal of understanding the related symbolic dispositions. Theoretical assumptions related to inter-professional collaboration and conflicts in the field of healthcare were used for this analysis. A researcher conducted 24 in-depth interviews with general dental practitioners, oral health technicians and local managers. The concepts of Pierre Bourdieu supported the data interpretation. The results indicated inter-professional relations marked by collaboration and conflict that reflect an action space related to different perspectives of primary care delivery. They also unveiled the symbolic devices related to the participation of oral health technicians that represent a constraint to the implementation of oral health policy, thus reducing the potential of primary health care in Brazil.
Comunidades quilombolas de Vitória da Conquista, Bahia, Brasil: autoavaliação de saúde e fatores associados
Authors: Kochergin Clavdia Nicolaevna , Proietti Fernando Augusto , César Cibele Comini
Published: August 2014

Este estudo objetiva analisar a prevalência da autoavaliação de saúde negativa e fatores associados na população quilombola de Vitória da Conquista, Bahia, Brasil. Realizou-se um inquérito domiciliar com 797 adultos, em 2011. Os dados sobre autoavaliação de saúde, condições socioeconômicas e demográficas, estilo de vida, suporte social, situação de saúde e acesso a serviço de saúde, foram obtidos por meio da aplicação de questionários. A análise multivariável foi realizada por regressão logística ordinal, ajustada por sexo e idade. A prevalência de autoavaliação negativa de saúde foi de 12,5%. Após modelagem estatística as seguintes variáveis permaneceram associadas à autoavaliação de saúde: cor, escolaridade, consumo satisfatório de frutas e verduras, presença de doença crônica, limitações físicas, apoio social e ao menos uma consulta médica nos últimos 12 meses. A autoavaliação de saúde foi associada às dimensões: socioeconômica/demográfica, hábitos de vida, suporte social e situação de saúde.
Conhecimento sobre anticoncepção de emergência entre adolescentes do Ensino Médio de escolas públicas e privadas
Authors: Chofakian Christiane Borges do Nascimento , Borges Ana Luiza Vilela , Fujimori Elizabeth , Hoga Luiza Akiko Komura
Published: August 2014

O objetivo do estudo foi analisar o nível de conhecimento sobre anticoncepção de emergência entre adolescentes do Ensino Médio de escolas públicas e privadas. Estudo transversal com a participação de 705 estudantes de 15 a 19 anos, matriculados no Ensino Médio de escolas públicas e privadas de um município do Estado de São Paulo, Brasil. Utilizou-se amostragem probabilística estratificada por tipo de escola e sistemática por turma. Cerca de 24,9% dos adolescentes das escolas privadas e 32% das escolas públicas haviam iniciado a vida sexual e usado a anticoncepção de emergência. A média de escore de conhecimento foi de 3,87 (DP = 2,12) nas escolas públicas e 5,14 (DP = 2,00) nas escolas privadas. Análise de regressão linear múltipla mostrou que adolescentes de escolas privadas, do sexo feminino, com mais idade, que já tinham iniciado a vida sexual, usado a anticoncepção de emergência e conheciam alguém que já usou o método, foram as que alcançaram o maior escore de conhecimento. Conclui-se que poucos adolescentes estão corretamente informados sobre o método e muitos têm ideias equivocadas.
Acesso à detecção precoce do câncer de mama no Sistema Único de Saúde: uma análise a partir dos dados do Sistema de Informações em Saúde
Authors: Azevedo e Silva Gulnar , Bustamante-Teixeira Maria Teresa , Aquino Estela M. L. , Tomazelli Jeane Glaucia , dos-Santos-Silva Isabel
Published: August 2014

A redução recente na mortalidade por câncer de mama em países de alta renda é atribuída à detecção precoce e melhorias no tratamento. O câncer de mama é o tipo mais frequente de câncer feminino no Brasil, e, desde 2004, o governo recomenda o exame clínico anual das mamas para mulheres a partir dos 40 anos e rastreio mamográfico bienal entre 50 e 69 anos. Este artigo investiga o nível de implementação dessas recomendações usando os dados dos sistemas de informações do SUS de 2010 por macrorregião e grupo etário. Evidenciou-se uma cobertura baixa de mamografia entre a população alvo (32%: 50-59 anos; 25%: 60-69 anos). A proporção de mulheres com achados radiológicos anormais submetidas à biópsia também foi baixa (27%: 50-59 anos; 63%: 60-69 anos). O número de cirurgias para câncer de mama foi maior do que o número de casos detectáveis pela mamografia, mas muito inferior ao número estimado de casos incidentes para 2010. Existem marcadas desigualdades regionais no acesso à detecção precoce e à cirurgia, sendo o acesso mais baixo na Região Norte e mais alto na Região Sul.
Trends in spending on eating away from home in Brazil, 2002-2003 to 2008-2009
Authors: Claro Rafael Moreira , Baraldi Larissa Galastri , Martins Ana Paula Bortoletto , Bandoni Daniel Henrique , Levy Renata Bertazzi
Published: August 2014

The study aims to describe trends in food consumption away from home in Brazil from 2002-2003 to 2008-2009 and to analyze the influence of income on this behavior. The authors used data collected by the Household Budget Surveys conducted by the Brazilian Institute of Geography and Statistics (IBGE) in 2002-2003 and 2008-2009. The information analyzed in this study involves records of food and beverage purchases for consumption away from home. Trends in eating away from home were estimated for the total population and according to demographic and economic strata. The association between the share of food consumed away from home and income was studied using regression models to estimate income elasticity coefficients. The share of eating away from home increased 25% during the period, reaching 28% of total spending on food. Each 10% increase in mean per capita income leads to a 3.5% increase in the share of food consumed away from home. This suggests that income growth will result in future increases in the share of eating away from home.
The teaching and learning experience of home care in undergraduate nursing programs
Authors: Hermann Ana Paula , Favero Luciane , Backes Vânia Marli Schubert , Bernardino Elizabeth , Lacerda Maria Ribeiro
Published: August 2014

The objectives of this research were interpreted as the teaching and learning home care is experienced by students and teachers at the Nursing Undergraduate Course, at the Federal University of Paraná and build a theoretical model that explain this experience. It is a qualitative research that used the Grounded Theory method. Semi-structured interviews were performed with eight of the last academic year of nursing undergraduate course and five professors of content related to the topic. The experience in home care occurs and grows out in contact with reality through interaction between practical and theoretical issues and stage with specific working hours. The student comes across various nuances of this type of assistance, which allows understanding the health system and knowledge expansion related to home care. This fact shows that this area of expertise should be part of nursing undergraduate course because it is in expanding process and requires trained professionals to perform it.
Mobile emergency care service: the work on display
Authors: Velloso Isabela Silva Cancio , Araújo Meiriele Tavares , Nogueira Jéssica Dias , Alves Marília
Published: August 2014

The aim of the present study was to discuss the way visibility constitutes a power device in the everyday practice of the Mobile Emergency Care Service in Belo Horizonte, Minas Gerais, Brazil. A qualitative case study was developed and data were collected through semi-structured interviews with 31 workers of the service (five physicians, 11 nurses, seven nursing assistants and eight ambulance drivers) and submitted to discourse analysis. The analysis of power relations in the service allowed to verify that there is not an only one source from which the power emanates in this organizational structure. Power is exercised through many techniques and their sources are scattered, diffuse, interchangeable and even confusing. Although there is a hierarchical structure formally established, a parallel network to this structure is formed. It was also observed that the visibility generated by radio communication provides constant supervision, which generates tension within the team.
Psycometric characteristics of the Moral Distress Scale in Brazilian nursing professionals
Authors: Barlem Edison Luiz Devos , Lunardi Valéria Lerch , Lunardi Guilherme Lerch , Tomaschewski-Barlem Jamila Geri , Almeida Anderson Sousa de , Hirsch Carolina Domingues
Published: August 2014

The Moral Distress Scale was designed to assess the severity and frequency of the moral distress experienced by nursing professionals in everyday situations. The objective of this study was to analyze the psychometric characteristics of the Moral Distress Scale adapted to Brazilian nursing. Through factor analysis, five constructs were identified: lack of competence in the work team; disregard for patient autonomy, inadequate working conditions, denial of the nursing role as an advocate in terminal patients; denial of the nursing role as an advocate of the patient. The proposed pentafactorial solution is statistically and semantically more appropriate to the Brazilian nursing scenario. Based on these results, the scale is considered to be valid and reliable, showing the necessary requirements regarding convergent and discriminating validity as well as internal consistency to be used while evaluating the intensity and frequency of moral distress in Brazilian nursing professionals.
The incidence of phlebitis in a Medical Clinical Unit
Authors: Abdul-Hak Charifi Kamel , Barros Ângela Ferreira
Published: August 2014

The objective of this study was to verify the incidence of phlebitis in a clinical medical unit. A prospective cohort study was conducted using nonparticipatory observations guided by a structured questionnaire, with 100 patients admitted to the clinical medical unit, in whom 234 peripheral venous accesses were used. Phlebitis was identified in 60% of patients and in 55.6% of the peripheral venous accesses, and most of them remained intact for more than 72 hours (53%). The presence of phlebitis per patient was associated with longer hospitalization on the clinical unit (p=0.002) and a greater number of accesses per patient (p<0.001). Length of retention of venous access for more than 72 hours was also associated with the presence of phlebitis (p<0.001). Phlebitis occurred in the majority of the patients and peripheral venous accesses analyzed. Therefore, it is necessary to intensify the training protocols for nursing staff in order to reduce the rates of phlebitis.
Desenvolvimento de sistema de apoio com depósito cerâmico para soldagem e processamento por atrito com pino não consumível
Authors: Santos Tiago F. A. , Torres Edwar A. , Hermengildo Tahiana F.C. , Ramirez Antonio J.
Published: August 2014

A mesa suporte das peças a serem unidas normalmente se deforma durante o processo de soldagem por atrito com pino não consumível devido às altas cargas envolvidas. Consequentemente, a obtenção de juntas soldadas com penetração total, bem como a vida útil da amostra e da ferramenta podem ser afetadas, causando paradas não programadas e comprometendo a produtividade do processo e deslocando mão de obra para uma etapa de manutenção não prevista na cadeia do processo de soldagem. Este trabalho apresenta uma mesa de apoio com depósito cerâmico para o processamento e soldagem por atrito com pino não consumível. Para o desenvolvimento da mesa foram testados quatro depósitos cerâmicos, sob uma placa de aço, dos quais o de menor porosidade atingiu melhor desempenho. Essa mesa permitiu a realização de juntas soldadas com penetração completa de aços inoxidáveis duplex; resistir às altas cargas durante a soldagem de aços baixa liga alta resistência e realizar juntas dissimilares aço-alumínio, sem aderência do material mais macio à mesa suporte; bem como outras importantes características como confinar o calor e o metal plastificado, assim como determinar parâmetros de soldagem estáveis.