Emergências em Medicina Dentária

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária

Avaliação dos protocolos de diagnóstico e de controle da hiperglicemia materna: impacto na prevalência de Diabetes Melito Gestacional (DMG) e de Hiperglicemia Gestacional Leve (HGL) e nos resultados perinatais

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Household food expenditure and its contribution to socioeconomic inequalities in purchasing foods consistent with Australian dietary guideline recommendations

Aim: To examine the amount of money spent on food by household income, and to ascertain whether food expenditure mediates the relationship between household income and the purchase of staple foods consistent with Australian dietary guideline recommendations. ----- ----- Methods: In face-to-face interviews (n = 1003, 66.4% response rate), households in Brisbane, Australia were asked about their purchasing choices for a range of staple foods, including grocery items, fruits and vegetables. For each participant, information was obtained about their total weekly household food expenditure, along with their sociodemographic and household characteristics. ----- ----- Results: Household income was significantly associated with food expenditure; participants residing in higher-income households spent more money on food per household member than those from lower-income households. Lower income households were less likely to make food purchasing choices of dietary staples that were consistent with recommendations. However, food expenditure did not attenuate the relationship between household income and the purchase of staple foods consistent with dietary guideline recommendations. ----- ----- Conclusions: The findings suggest that food expenditure may not contribute to income inequalities in purchasing staple foods consistent with dietary guideline recommendations: instead, other material or psychosocial factors not considered in the current study may be more important determinants of these inequalities. Further research should examine whether expenditure on non-staple items and takeaway foods is a larger contributor to socioeconomic inequalities in dietary behavior.

Most relevant strategies for preventing surgical site infection after total hip arthroplasty : guideline recommendations and expert opinion

BACKGROUND: Numerous strategies are available to prevent surgical site infections in hip arthroplasty, but there is no consensus on which might be the best. This study examined infection prevention strategies currently recommended for patients undergoing hip arthroplasty. METHODS: Four clinical guidelines on infection prevention/orthopedics were reviewed. Infection control practitioners, infectious disease physicians, and orthopedic surgeons were consulted through structured interviews and an online survey. Strategies were classified as "highly important" if they were recommended by at least one guideline and ranked as significantly or critically important by >/=75% of the experts. RESULTS: The guideline review yielded 28 infection prevention measures, with 7 identified by experts as being highly important in this context: antibiotic prophylaxis, antiseptic skin preparation of patients, hand/forearm antisepsis by surgical staff, sterile gowns/surgical attire, ultraclean/laminar air operating theatres, antibiotic-impregnated cement, and surveillance. Controversial measures included antibiotic-impregnated cement and, considering recent literature, laminar air operating theatres. CONCLUSIONS: Some of these measures may already be accepted as routine clinical practice, whereas others are controversial. Whether these practices should be continued for this patient group will be informed by modeling the cost-effectiveness of infection prevention strategies. This will allow predictions of long-term health and cost outcomes and thus inform decisions on how to best use scarce health care resources for infection control.

Australian Diabetes Foot Network : practical guideline on the provision of footwear for people with diabetes

Trauma, in the form of pressure and/or friction from footwear, is a common cause of foot ulceration in people with diabetes. These practical recommendations regarding the provision of footwear for people with diabetes were agreed upon following review of existing position statements and clinical guidelines. The aim of this process was not to re-invent existing guidelines but to provide practical guidance for health professionals on how they can best deliver these recommendations within the Australian health system. Where information was lacking or inconsistent, a consensus was reached following discussion by all authors. Appropriately prescribed footwear, used alone or in conjunction with custom-made foot orthoses, can reduce pedal pressures and reduce the risk of foot ulceration. It is important for all health professionals involved in the care of people with diabetes to both assess and make recommendations on the footwear needs of their clients or to refer to health professionals with such skills and knowledge. Individuals with more complex footwear needs (for example those who require custom-made medical grade footwear and orthoses) should be referred to health professionals with experience in the prescription of these modalities and who are able to provide appropriate and timely follow-up. Where financial disadvantage is a barrier to individuals acquiring appropriate footwear, health care professionals should be aware of state and territory based equipment funding schemes that can provide financial assistance. Aboriginal and Torres Strait Islanders and people living in rural and remote areas are likely to have limited access to a broad range of footwear. Provision of appropriate footwear to people with diabetes in these communities needs be addressed as part of a comprehensive national strategy to reduce the burden of diabetes and its complications on the health system.

The implementation of a guideline of care for patients with a Sengstaken-Blakemore tube in situ in a general intensive care unit using transitional change theory

The use of the Sengstaken–Blakemore tube as a life-saving treatment for bleeding oesophageal varices is slowly becoming the least preferred method possibly due to the potential complications associated with its placement. Nursing practice pertaining to the care of this patient group appears ad hoc and reliant on local knowledge and experience as opposed to recognised evidence of best practice. Therefore, this paper focuses on the application of Lewin's transitional change theory used to introduce a change in nursing practice with the application of a guideline to enhance the care of patients with a Sengstaken–Blakemore tube in situ within a general intensive care unit. This method identified some of the complexities surrounding the change process including the driving and restraining forces that must be harnessed and minimised in order for the adoption of change to be successful.

Antioxidants in Athlete's Basic Nutrition: Considerations towards a Guideline for the Intake of Vitamin C and Vitamin E

Antioxidants in acute physical exercise and exercise training remain a hot topic in sport nutrition, exercise physiology and biology, in general (Jackson, 2008; Margaritis and Rousseau, 2008; Gomez-Cabrera et al., 2012; Nikolaidis et al., 2012). During the past few decades, antioxidants have received attention predominantly as a nutritional strategy for preventing or minimising detrimental effects of reactive oxygen and nitrogen species (RONS), which are generated during and after strenuous exercise (Jackson, 2008, 2009; Powers and Jackson, 2008). Antioxidant supplementation has become a common practice among athletes as a means to (theoretically) reduce oxidative stress, promote recovery and enhance performance (Peternelj and Coombes, 2011). However, until now, requirements of antioxidant micronutrients and antioxidant compounds for athletes training for and competing in different sport events, including marathon running, triathlon races or team sport events involving repeated sprinting, have not been determined sufficiently (Williams et al., 2006; Margaritis and Rousseau, 2008). Crucially, evidence has been emerging that higher dosages of antioxidants may not necessarily be beneficial in this context, but can also elicit detrimental effects by interfering with performance-enhancing (Gomez-Cabrera et al., 2008) and health-promoting training adaptations (Ristow et al., 2009). As originally postulated in a pioneering study on exercise-induced production of RONS by Davies et al. (1982) in the early 1980s, evidence has been increasing in recent years that RONS are not only damaging agents, but also act as signalling molecules for regulating muscle function (Reid, 2001; Jackson, 2008) and for initiating adaptive responses to exercise (Jackson, 2009; Powers et al., 2010). The recognition that antioxidants could, vice versa, interact with the signalling pathways underlying the responses to acute (and repeated) bouts of exercise has contributed important novel aspects to the continued discussion on antioxidant requirements for athletes. In view of the recent advances in this field, it is the aim of this report to examine the current knowledge of antioxidants, in particular of vitamins C and E, in the basic nutrition of athletes. While overviews on related topics including basic mechanisms of exercise-induced oxidative stress, redox biology, antioxidant defence systems and a summary of studies on antioxidant supplementation during exercise training are provided, this does not mean that this report is comprehensive. Several issues of the expanding and multidisciplinary field of antioxidants and exercise are covered elsewhere in this book and/or in the literature. Exemplarily, the reader is referred to reviews on oxidative stress (Konig et al., 2001; Vollaard et al., 2005; Knez et al., 2006; Powers and Jackson, 2008; Nikolaidis et al., 2012), redox-sensitive signalling and muscle function (Reid, 2001; Vollaard et al., 2005; Jackson, 2008; Ji, 2008; Powers and Jackson, 2008; Powers et al., 2010; Radak et al., 2013) and antioxidant supplementation (Williams et al., 2006; Peake et al., 2007; Peternelj and Coombes, 2011) in the context with exercise. Within the scope of the report, we rather aim to address the question regarding requirements of antioxidants, specifically vitamins C and E, during exercise training, draw conclusions and provide practical implications from the recent research.

The development of a guideline of care for patients with a Sengstaken-Blakemore Tube insitu in a general Intensive Care Unit using translational change theory

Aims & Objectives - identify and diagnose the current problems associated with patient care with regard to the nursing management of patients with Sengstaken-Blakemore tubes insitu; - Identify current nursing practice currently in place within the ICU and the hospital; identify the method by which the assessment and provision of nursing care is delivered in the ICU

Application of phytotoxicity data to a new Australian soil quality guideline framework for biosolids

To protect terrestrial ecosystems and humans from contaminants many countries and jurisdictions have developed soil quality guidelines (SQGs). This study proposes a new framework to derive SQGs and guidelines for amended soils and uses a case study based on phytotoxicity data of copper (Cu) and zinc (Zn) from field studies to illustrate how the framework could be applied. The proposed framework uses normalisation relationships to account for the effects of soil properties on toxicity data followed by a species sensitivity distribution (SSD) method to calculate a soil added contaminant limit (soil ACL) for a standard soil. The normalisation equations are then used to calculate soil ACLs for other soils. A soil amendment availability factor (SAAF) is then calculated as the toxicity and bioavailability of pure contaminants and contaminants in amendments can be different. The SAAF is used to modify soil ACLs to ACLs for amended soils. The framework was then used to calculate soil ACLs for copper (Cu) and zinc (Zn). For soils with pH of 4-8 and OC content of 1-6%, the ACLs range from 8 mg/kg to 970 mg/kg added Cu. The SAAF for Cu was pH dependant and varied from 1.44 at pH 4 to 2.15 at pH 8. For soils with pH of 4-8 and OC content of 1-6%, the ACLs for amended soils range from 11 mg/kg to 2080 mg/kg added Cu. For soils with pH of 4-8 and a CEC from 5-60, the ACLs for Zn ranged from 21 to 1470 mg/kg added Zn. A SAAF of one was used for Zn as it concentrations in plant tissue and soil to water partitioning showed no difference between biosolids and soluble Zn salt treatments, indicating that Zn from biosolids and Zn salts are equally bioavailable to plants.

Developing a Best Management Practice guideline for the Australian Banana Industry

Demonstrating environmental performance and sustainability is a strategic priority for the Australian banana industry. Development, delivery and uptake of an EMS will allow the industry to demonstrate this. It will maintain community confidence in the Australian banana industry and its commitment to careful environmental management and the protection of key Australian icons like the Great Barrier Reef and the Wet Tropics and ensure the industry’s right to farm, now and in the future.

The good, the bad and the ugly of bone-anchored prostheses: Guideline to assess true clinical outcomes

The aim of this study is to share the key elements of an evaluation framework to determine the true clinical outcomes of bone-anchored prostheses. Scientists, clinicians and policy makers are encouraged to implement their own evaluations relying on the proposed framework using a single database to facilitate reflective practice and, eventually, robust prospective studies.

Rethinking Service Companies’ Business Logic: Do We Need a Customer-Dominant Logic as a Guideline?

Purpose –This paper explores and expands the roles of customers and companies in creating value by introducing a new a customer-based approach to service. The customer’s logic is examined as being the foundation of a customer-based marketing and business logic. Design/methodology/approach – The authors argue that both goods-dominant logics and service-dominant logics are provider-dominant. Contrasting the customer-dominant logic with provider-dominant logics, the paper examines the creation of service value from the perspectives of value-in-use, the customer’s own context, and the customer’s experience of service. Findings –Moving from a provider-dominant logic to a customer-dominant logic uncovered five major challenges to service marketers: Company involvement, company control in co-creation, visibility of value creation, locus of customer experience, and character of customer experience. Research limitations/implications – The paper is exploratory. It presents and discusses a conceptual model and suggests implications for research and practice. Practical implications –Awareness of the mechanisms of customer logic will provide businesses with new perspectives on the role of the company in their customer’s lives. We propose that understanding the customer’s logic should represent the starting-point for the marketer’s business logic. Originality/value – The paper increases the understanding of how the customer’s logic underpins the customer-dominant business logic. By exploring consequences of applying a customer-dominant logic, we suggest further directions for theoretical and empirical research.

Redes inalámbricas de uso comunitario : un análisis comparativo de protocolos

Resumen: Las redes malladas inalámbricas (Wireless Mesh Networks) son en particular un dominio rápidamente creciente y esto trae muchos desafíos. La principal función de los protocolos de encaminamiento es seleccionar el camino entre el nodo fuente y destino de una manera rápida y fiable. Estas redes pueden utilizar los protocolos de encaminamiento de otras redes ya existentes, pero modificándolos para que funcionen correctamente con ellas. En este trabajo se analizan distintos protocolos de encaminamiento y se presentan sus descripciones para luego compararlos de acuerdo al Tipo de Protocolo, Alcance de trasmisiones y Métrica de ruteo.

Evaluación de la efectividad de tres protocolos de sincronización en vaquillas de la finca San Antonio, comarca Kurinwas, municipio de Santo Domingo del departamento de Chontales durante el período enero a abril 2013

La investigación se realizó en la finca San Antonio del municipio de Santo Domingo. Los objetivos fueron; Evaluar la efectividad de tres protocolos de sincronización en vaquillas. El trabajo consistió en la comparación de tres protocolos (DIB, Prostaglandina + Prostaglandina y una sola dosis de Prostaglandina) para la sincronización de celo en vaquillas. Para el experimento se conformaron tres grupos de 20 vaquillas cada uno, con una edad promedio de 2.5 años, las cuales se examinaron por el método de palpación para definir el estado ginecológico de ellas, se definió el estado corporal por medio de la observación de la condición corporal (CC) y las variables evaluadas fueron: (1) Porcentaje de Preñez a Primer Servicio (PPPS) (2) Porcentaje de Preñez a Segundo Servicio (PPSS) (3) Porcentaje de Preñez Acumulada Sincronización más Toro (PAST) Los resultados derivados del análisis para tratamiento 1 (DIB) elporcentaje de preñez al primer servicio fue del 80% y a segundo servicio fue de 50% para una preñez acumulada del 90%, con el tratamiento 2 (PGF2α + PGF2α) el resultado de preñez a primer servicio fue 50% y a segundo servicio fue de 33.33% con una preñez acumulada de 60%, con el tratamiento 3 (una sola aplicación de PGF2 α) el resultado de preñez a primer servicio fue 40 % y a segundo servicio fue de 7.70% para una preñez acumulada del 40 %, el grupo testigo presento una efectividad de 30 %. Se concluye que bajo las condiciones en que se realizó el experimento las vaquillas responden a los tratamientos hormonales exógenos, y se puede obtener un 90 % de éxito en la preñez. Asimismo se puede disminuir el tiempo de la incorporación de las vaquillas a primer servicio lo que se traduce en una mayor vida útil del animal y una mayor cantidad de partos, además, este tratamiento es una alternativa efectiva para enfrentar el problema de detección de celo en los rebaños, además, las vaquillas presentaron ciclicidad post tratamiento. Se recomienda la utilización del DIB pues permite obtener buenos resultados en la taza de preñez también recomendamos el uso del protocolo prostaglandina más prostaglandina en fincas con difícil acceso a la inseminación artificial, pues, es un método de bajo costo y fácil utilización para el productor y se puede implementar el uso de toros, se debe realizar estudios con la categoría de vacas paridas para determinar el comportamiento en la reproducción, se debe tomar en cuenta el estado nutricional y la condición corporal de los animales ya que es determinante para obtener buenos resultados en el programa y realizar chequeo ginecológico periódico en las vaquillas que tienen peso y edad adecuados con el fin de realizar tratamientos y evitar así preñeces tardías.

Evaluación de dos protocolos de sincronización de celo (BAYER vs SYNTEX) en vacas lechera en la finca Jalisco, Comalapa, Chontales, 2014

La investigación se realizó en la finca Jalisco del municipio de Comalapa. Los objetivos fueron evaluar dos protocolos de sincronización celo en vacas lecheras. El trabajo consistió en la comparación de dos protocolos (DIB de syntex + Bay OvSynch Bayer) para la sincronización de vacas lecheras. Para el experimento se conformaron tres grupos de 12 vacas cada uno, con un periodo post-parto de 80±10 días, las cuales se examinaron por el método de palpación rectal para definir su estado ginecológico y ciclicidad, se definió el estado corporal por medio de la observación de la condición corporal (CC). Fecha de parto de acuerdo a los registro que lleva el productor y las variables a evaluar fueron las siguientes: (1)Tasa de Concepción (TC) (2) Porcentaje de Preñez a Primer Servicio (PPPS) (3)Porcentaje de Preñez a Segundo Servicio (PPSS) (4)Porcentaje de Preñez Acumulada Sincronización más Toro(PAST). así como el Análisis de Costo de los tratamientos. Los resultados derivados del análisis para el tratamiento 1 DIB syntex el porcentaje de preñez a primer servicio fue del 66.66 % y a segundo servicio fue del 50% para una preñez acumulada del 83.33%, con el tratamiento 2 Bay OvSynch Bayer el resultados de preñez a primer servicio fue del 50% y a segundo servicio fue del 50% con una preñez acumulada del 75%, el grupo testigo presento una efectividad del 25%. Se puede concluir que las vacas sometidas a estudio respondieron con éxito a los tratamientos hormonales exógenos pudiéndose obtener porcentajes de hasta 83.33% de éxito en la preñez. Lo que se traduce a una mayor rentabilidad del hato obteniendo un ternero cada año. Se recomienda el tratamiento DIB SYNTEX para la sincronización de celo en vacas lecheras pues se obtuvo buenos resultados 83.33% en las gestaciones acumuladas, Se debe tomar en cuenta el estado nutricional, la condición corporal y de igual manera la ciclicidad de los animales, pues se vuelve determinante para obtener buenos resultados en estos programas, sobre todo en el Bay Ovsynch que no tiene buenos resultados en vacas acíclicas o los resultados son muy bajos; a la vez recomiendo Realizar chequeo ginecológico periódico en las vacas que tienen peso y edad adecuados con el fin de realizar los tratamientos para evitar así preñeces tardías y mejorar los índices reproductivos del hato.