The identification of the pillars of education in the class comprehensiveness in healthcare

The objective of the present study was to verify, based on the analysis of student portfolio narratives, if the four pillars of education were approached in the class "Comprehensiveness in health care", part of the integrated curriculum of the Baccalaureate in Nursing Program of the University of Sao Paulo at Ribeirao Preto College of Nursing. A qualitative, documental study was performed using 46 portfolios constructed during the classes. Data collection was performed using an assessment tool that contained items addressing cognitive and affective dimensions. The data were submitted to thematic categorical analysis using the pillars of education as predefined categories. The results show that the pillars of education were, apparently, included in the class. Despite the present study findings, no evidence was found that the expected competencies were actually discussed among students and faculty, according to the records regarding the evaluations of each pedagogical cycle of the studied class.

Eucalyptus growth promotion by endophytic Bacillus spp

Clonal eucalyptus plantings have increased in recent years; however, some clones with high production characteristics have vegetative propagation problems because of weak root and aerial development. Endophytic microorganisms live inside healthy plants without causing any damage to their hosts and can be beneficial, acting as plant growth promoters. We isolated endophytic bacteria from eucalyptus plants and evaluated their potential in plant growth promotion of clonal plantlets of Eucalyptus urophylla x E. grandis, known as the hybrid, E. urograndis. Eighteen isolates of E. urograndis, clone 4622, were tested for plant growth promotion using the same clone. These isolates were also evaluated for indole acetic acid production and their potential for nitrogen fixation and phosphate solubilization. The isolates were identified by partial sequencing of 16S rRNA. Bacillus subtilis was the most prevalent species. Several Bacillus species, including B. licheniformis and B. subtilis, were found for the first time as endophytes of eucalyptus. Bacillus sp strain EUCB 10 significantly increased the growth of the root and aerial parts of eucalyptus plantlets under greenhouse conditions, during the summer and winter seasons.

Atenção primária à saúde e a construção de sentidos para a saúde bucal: leitura construcionista social sobre discursos de idosos

Dentistry is nowadays open to new ideas about the constructions of meanings for oral health. This openness tallies with the social production of health and shows the need to contextualize the social, historical and sundry knowledge in the development of oral health for different communities. The scope of this research is to build meanings for oral health with a group of elderly people. With this in mind, we propose an approximation between the discourses of the elderly on oral health and the Social Constructionist discourse. Thus, we interviewed 14 elderly people registered with a Family Health Unit in Ribeirao Preto in the State of Sao Paulo in the first semester of 2010. This enabled us to identify two Interpretative Repertoires with the use of Discourse Analysis, which showed the relationship between: 1 Lack of dental information and assistance in childhood; and 2 - Primary Healthcare constructing meaning for oral health. We concluded that Social Constructionism assists epistemologically for the construction of meaning for oral health and that Primary Healthcare is essential for valuing healthcare for the construction of meaning for oral health on the part of the elderly by fostering conditions for self care and healthy attitudes.

Low-dose plasmid DNA treatment increases plasma vasopressin and regulates blood pressure in experimental endotoxemia

Background: Although plasmid DNA encoding an antigen from pathogens or tumor cells has been widely studied as vaccine, the use of plasmid vector (without insert) as therapeutic agent requires further investigation. Results: Here, we showed that plasmid DNA (pcDNA3) at low doses inhibits the production of IL-6 and TNF-alpha by lipopolysaccharide (LPS)-stimulated macrophage cell line J774. These findings led us to evaluate whether plasmid DNA could act as an anti-inflammatory agent in a Wistar rat endotoxemia model. Rats injected simultaneously with 1.5 mg/kg of LPS and 10 or 20 mu g of plasmid DNA had a remarkable attenuation of mean arterial blood pressure (MAP) drop at 2 hours after treatment when compared with rats injected with LPS only. The beneficial effect of the plasmid DNA on MAP was associated with decreased expression of IL-6 in liver and increased concentration of plasma vasopressin (AVP), a known vasoconstrictor that has been investigated in hemorrhagic shock management. No difference was observed in relation to nitric oxide (NO) production. Conclusion: Our results demonstrate for the first time that plasmid DNA vector at low doses presents anti-inflammatory property and constitutes a novel approach with therapeutic potential in inflammatory diseases.

Rapid morphological changes in populations of hybrids between Africanized and European honey bees

African honey bees, introduced to Brazil in 1956, rapidly dominated the previously introduced European subspecies. To better understand how hybridization between these different types of bees proceeded, we made geometric morphometric analyses of the wing venation patterns of specimens resulting from crosses made between Africanized honey bees (predominantly Apis mellifera scutellata) and Italian honey bees (A. mellifera ligustica) from 1965 to 1967, at the beginning of the Africanization process, in an apiary about 150 km from the original introduction site. Two virgin queens reared from an Italian parental were instrumentally inseminated with semen from drones from an Africanized parental. Six F-1 queens from one of these colonies were open mated with Africanized drones. Resultant F-1 drones were backcrossed to 50 Italian and 50 Africanized parental queens. Five backcross workers were collected from each of eight randomly selected colonies of each type of backcross (N = 5 bees x 8 colonies x 2 types of backcrosses). The F-1 progeny (40 workers and 30 drones) was found to be morphologically closer to the Africanized than to the European parental (N = 20 drones and 40 workers, each); Mahalanobis square distances = 21.6 versus 25.8, respectively, for the workers, and 39.9 versus 46.4, respectively, for the drones. The worker progenies of the backcrosses (N = 40, each) were placed between the respective parental and the F-1 progeny, although closer to the Africanized than to the Italian parentals (Mahalanobis square distance = 6.2 versus 12.1, respectively). Consequently, the most common crosses at the beginning of the Africanization process would have generated individuals more similar to Africanized than to Italian bees. This adds a genetic explanation for the rapid changes in the populational morphometric profile in recently colonized areas. Africanized alleles of wing venation pattern genes are apparently dominant and epistatic.

Quedas em idosos e sua relação com a capacidade funcional

OBJETIVO: determinar a prevalência de quedas em idosos e sua relação com a capacidade funcional. MÉTODO: trata-se de estudo epidemiológico transversal de base populacional, com uma amostra por conglomerado de duplo estágio de 240 sujeitos, com idade acima de 60 anos, de ambos os sexos, residentes em Ribeirão Preto, SP. Os dados foram coletados entre novembro de 2010 e fevereiro de 2011 e utilizaram-se os questionários: perfil social, avaliação de quedas, Medida de Independência Funcional e Escala de Lawton e Brody. Foi adotado o nível de significância de 0,05. Para a identificação da ocorrência das quedas e sua relação com a capacidade funcional, foram utilizadas razão de prevalência e de chances de prevalência e regressão logística múltipla. RESULTADOS: a média de idade foi de 73,5 anos (±8,4), 25% com 80 anos ou mais, predomínio do sexo feminino; 48,8% estudaram de 1 a 4 anos. Média de 1,33 quedas (±0,472); com maior prevalência em mulheres e idosos mais jovens; o local mais frequente foi o quintal e o banheiro. Houve forte correlação entre o nível de independência funcional e as atividades instrumentais com a idade, e não houve relação entre os idosos que sofreram queda e as variáveis sexo e idade. CONCLUSÃO: houve predomínio de mulheres que sofreram quedas relacionadas à independência funcional, podendo-se prevenir com estratégias de promoção à saúde ao idoso, política essa para oferecer condição de vida à pessoa no processo de envelhecer.

Predicted preoperative maximal static respiratory pressures in adult cardiac surgeries: evaluation of two formulas

Objectives: Cardiac surgery (CC) determines systemic and pulmonary changes that require special care. What motivated several studies conducted in healthy subjects to assess muscle strength were the awareness of the importance of respiratory muscle dysfunction in the development of respiratory failure. These studies used maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) values. This study examined the concordance between the values predicted by the equations proposed by Black & Hyatt and Neder, and the measured values in cardiac surgery (CS) patients. Methods: Data were collected from preoperative evaluation forms. The Lin coefficient and Bland-Altman plots were used for statistical concordance analysis. The multiple linear regression and analysis of variance (ANOVA) were used to produce new formulas. Results: There were weak correlations of 0.22 and 0.19 in the MIP analysis and of 0.10 and 0.32 in the MEP analysis, for the formulas of Black & Hyatt and Neder, respectively. The ANOVA for both MIP and MEP were significant (P <0.0001), and the following formulas were developed: MIP = 88.82 - (0.51 x age) + (19.86 x gender), and MEP = 91.36 -(030 x age) + (29.92 x gender). Conclusions: The Black and Hyatt and Neder formulas predict highly discrepant values of MIP and MEP and should not be used to identify muscle weakness in CS patients.

Percutaneous sciatic nerve block with tramadol induces analgesia and motor blockade in two animal pain models

Local anesthetic efficacy of tramadol has been reported following intradermal application. Our aim was to investigate the effect of perineural tramadol as the sole analgesic in two pain models. Male Wistar rats (280-380 g; N = 5/group) were used in these experiments. A neurostimulation-guided sciatic nerve block was performed and 2% lidocaine or tramadol (1.25 and 5 mg) was perineurally injected in two different animal pain models. In the flinching behavior test, the number of flinches was evaluated and in the plantar incision model, mechanical and heat thresholds were measured. Motor effects of lidocaine and tramadol were quantified and a motor block score elaborated. Tramadol, 1.25 mg, completely blocked the first and reduced the second phase of the flinching behavior test. In the plantar incision model, tramadol (1.25 mg) increased both paw withdrawal latency in response to radiant heat (8.3 +/- 1.1, 12.7 +/- 1.8, 8.4 +/- 0.8, and 11.1 +/- 3.3 s) and mechanical threshold in response to von Frey filaments (459 +/- 82.8, 447.5 +/- 91.7, 320.1 +/- 120, 126.43 +/- 92.8 mN) at 5, 15, 30, and 60 min, respectively. Sham block or contralateral sciatic nerve block did not differ from perineural saline injection throughout the study in either model. The effect of tramadol was not antagonized by intraperitoneal naloxone. High dose tramadol (5 mg) blocked motor function as well as 2% lidocaine. In conclusion, tramadol blocks nociception and motor function in vivo similar to local anesthetics.

SOBRECARGA E DESCONFORTO EMOCIONAL EM CUIDADORES DE IDOSOS

A finalidade deste estudo foi descrever a sobrecarga e o desconforto emocional dos cuidadores de idosos. Estudo epidemiológico e transversal conduzido em 2009 com 124 cuidadores residentes na comunidade de Ribeirão Preto-SP, por meio dos instrumentos: Escala de Sobrecarga de Zarit e Self-Reporting Questionaire (SRQ-20) para o cuidador. A análise dos dados foi realizada no aplicativo SPSS, 15.0, de forma descritiva, univariada (tabelas de frequência) e bivariada (tabelas de contingência para variáveis qualitativas). Os cuidadores, 85,6% do sexo feminino, média de 56,5 anos, utilizaram, em média, 12,4 horas diárias para o cuidar e 57,6% dos cuidadores apresentaram de leve a moderada sobrecarga. Dependência funcional do idoso, sexo do cuidador e tempo em horas para o cuidado, foram preditores da sobrecarga (p<0,05). Encontrou-se, também, que a sobrecarga é fator de risco para desconforto emocional (p<0,05). Cabe aos enfermeiros utilizarem protocolos de avaliação, com base nos fatores de risco, para prevenir a sobrecarga.

Bioelectrical impedance with different equations versus deuterium oxide dilution method for the inference of body composition in healthy older persons

There is no consensus regarding the accuracy of bioimpedance for the determination of body composition in older persons. This study aimed to compare the assessment of lean body mass of healthy older volunteers obtained by the deuterium dilution method (reference) with those obtained by two frequently used bioelectrical impedance formulas and one formula specifically developed for a Latin-American population. A cross-sectional study. Twenty one volunteers were studied, 12 women, with mean age 72 +/- 6.7 years. Urban community, Ribeiro Preto, Brazil. Fat free mass was determined, simultaneously, by the deuterium dilution method and bioelectrical impedance; results were compared. In bioelectrical impedance, body composition was calculated by the formulas of Deuremberg, Lukaski and Bolonchuck and Valencia et al. Lean body mass of the studied volunteers, as determined by bioelectrical impedance was 37.8 +/- 9.2 kg by the application of the Lukaski e Bolonchuk formula, 37.4 +/- 9.3 kg (Deuremberg) and 43.2 +/- 8.9 kg (Valencia et. al.). The results were significantly correlated to those obtained by the deuterium dilution method (41.6 +/- 9.3 Kg), with r=0.963, 0.932 and 0.971, respectively. Lean body mass obtained by the Valencia formula was the most accurate. In this study, lean body mass of older persons obtained by the bioelectrical impedance method showed good correlation with the values obtained by the deuterium dilution method. The formula of Valencia et al., developed for a Latin-American population, showed the best accuracy.

Burden of care and its impact on health-related quality of life of caregivers of individuals with spinal cord injury

Objective: to analyze the impact and burden of care on the Health-Related Quality of Life (HRQOL) of caregivers of individuals with a spinal cord injury (SCI). Method: cross-sectional observational study carried out by reviewing medical records and applying questionnaires. The scale Short Form 36 (SF-36) was used to assess HRQOL and the Caregiver Burden Scale (CBScale) for care burden. Results were analyzed quantitatively. Most patients with SCIs were male, aged 35.4 years old on average, with a predominance of thoracic injuries followed by cervical injuries. Most caregivers were female aged 44.8 years old on average. Results: tetraplegia and secondary complications stand out among the clinical characteristics that contributed to greater care burden and worse HRQOL. Association between care burden with HRQOL revealed that the greater the burden the worse the HRQOL. Conclusion: Preventing care burden through strategies that prepare patients for hospital discharge, integrating the support network, and enabling access to health care services are interventions that could minimize the effects arising from care burden and contribute to improving HRQOL.

Body changes: antiretroviral therapy and lipodystrophy syndrome in people living with HIV/aids

Objective: to identify the different types of morphological alterations from lipodystrophy syndrome (LS) in outpatients and relate them to the therapeutic regimen used. Method: a cross-sectional study which recruited 60 patients with HIV and LS and 79 without LS, who consented to interview and data collection from their medical notes. Results: the region most affected by lipoatrophy was the face; by lipohypertrophy, the abdomen, and by the mixed form, the alterations to the abdomen, face, and upper and lower limbs. Conclusion: among the therapeutic regimens, that comprised of zidovudine, lamivudine and efavirenz seemed to protect against LS. Nursing can act in the early identification of the changes, as well as providing guidance and support for patients affected by the changes in their body image.

Pain pressure threshold algometry of the abdominal wall in healthy women

The objective of this study was to determine the inter- and intra-examiner reliability of pain pressure threshold algometry at various points of the abdominal wall of healthy women. Twenty-one healthy women in menacme with a mean age of 28 +/- 5.4 years (range: 19-39 years) were included. All volunteers had regular menstrual cycles (27-33 days) and were right-handed and, to the best of our knowledge, none were taking medications at the time of testing. Women with a diagnosis of depression, anxiety or other mood disturbances were excluded. Women with previous abdominal surgery, any pain condition or any evidence of inflammation, hypertension, smoking, alcoholism, or inflammatory disease were also excluded. Pain perception thresholds were assessed with a pressure algometer with digital traction and compression and a measuring capacity for 5 kg. All points were localized by palpation and marked with a felt-tipped pen and each individual was evaluated over a period of 2 days in two consecutive sessions, each session consisting of a set of 14 point measurements repeated twice by two examiners in random sequence. There was no statistically significant difference in the mean pain threshold obtained by the two examiners on 2 diferent days (examiner A: P = 1.00; examiner B: P = 0.75; Wilcoxon matched pairs test). There was excellent/good agreement between examiners for all days and all points. Our results have established baseline values to which future researchers will be able to refer. They show that pressure algometry is a reliable measure for pain perception in the abdominal wall of healthy women.

Adaptation and validation of the Patient Expectations and Satisfaction with Prenatal Care instrument among Brazilian pregnant women

Objective: to adapt and validate the Patient Expectations and Satisfaction with Prenatal Care instrument for use in Brazil. It contains 41 items divided into two dimensions: expectations and satisfaction. The adapted version was submitted to analysis for stability, convergent construct validity, and internal consistency (Cronbach’s alpha) for distinct groups and dimensions. Method: 119 pregnant women receiving prenatal care were interviewed and 26 of these women answered the instrument twice (retest). Internal consistency was appropriate (Cronbach’s alpha ≥ 0.70); test-retest presented strong correlation (r=0.82; p<0.001) for the domain expectations and moderate correlation (r=0.66; p<0.001) for the satisfaction domain. The analysis confirmed that the instrument’s adapted version is valid in the studied group. Results: there is strong evidence for the validity and reliability of the instrument’s adaptation. Conclusion: the instrument needs to be tested in groups of pregnant women with different social characteristics.

Teaching of the Integrated Management of Childhood Illness strategy in undergraduate nursing programs

Objective: To describe and analyze the teaching of the Integrated Management of hildhood Illness (IMCI) strategy on Brazilian undergraduate nursing programs. Method: Integrating an international multicentric study, a cross-sectional online survey was conducted between May and October 2010 with 571 undergraduate nursing programs in Brazil Results: Responses were received from 142 programs, 75% private and 25% public. 64% of them included the IMCI strategy in the theoretical content, and 50% of the programs included IMCI as part of the students’ practical experience. The locations most used for practical teaching were primary health care units. The ‘treatment’ module was taught by the fewest number of programs, and few programs had access to the IMCI instructional manuals. All programs used exams for evaluation, and private institutions were more likely to include class participation as part of the evaluation. Teaching staff in public institutions were more likely to have received training in teaching IMCI. Conclusion: In spite of the relevance of the IMCI strategy in care of the child, its content is not addressed in all undergraduate programs in Brazil, and many programs do not have access to the IMCI teaching manuals and have not provide training in IMCI to their teaching staff.