Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery

BackgroundThis is an update of a Cochrane Review first published in The Cochrane Library 2008, Issue 3.Upper abdominal surgical procedures are associated with a high risk of postoperative pulmonary complications. The risk and severity of postoperative pulmonary complications can be reduced by the judicious use of therapeutic manoeuvres that increase lung volume. Our objective was to assess the effect of incentive spirometry compared to no therapy or physiotherapy, including coughing and deep breathing, on all-cause postoperative pulmonary complications andmortality in adult patients admitted to hospital for upper abdominal surgery.ObjectivesOur primary objective was to assess the effect of incentive spirometry (IS), compared to no such therapy or other therapy, on postoperative pulmonary complications and mortality in adults undergoing upper abdominal surgery.Our secondary objectives were to evaluate the effects of IS, compared to no therapy or other therapy, on other postoperative complications, adverse events, and spirometric parameters.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE, EMBASE, and LILACS (from inception to August 2013). There were no language restrictions. The date of the most recent search was 12 August 2013. The original search was performed in June 2006.Selection criteriaWe included randomized controlled trials (RCTs) of IS in adult patients admitted for any type of upper abdominal surgery, including patients undergoing laparoscopic procedures.Data collection and analysisTwo authors independently assessed trial quality and extracted data.Main resultsWe included 12 studies with a total of 1834 participants in this updated review. The methodological quality of the included studies was difficult to assess as it was poorly reported, so the predominant classification of bias was 'unclear'; the studies did not report on compliance with the prescribed therapy. We were able to include data from only 1160 patients in the meta-analysis. Four trials (152 patients) compared the effects of IS with no respiratory treatment. We found no statistically significant difference between the participants receiving IS and those who had no respiratory treatment for clinical complications (relative risk (RR) 0.59, 95% confidence interval (CI) 0.30 to 1.18). Two trials (194 patients) IS compared incentive spirometry with deep breathing exercises (DBE). We found no statistically significant differences between the participants receiving IS and those receiving DBE in the meta-analysis for respiratory failure (RR 0.67, 95% CI 0.04 to 10.50). Two trials (946 patients) compared IS with other chest physiotherapy. We found no statistically significant differences between the participants receiving IS compared to those receiving physiotherapy in the risk of developing a pulmonary condition or the type of complication. There was no evidence that IS is effective in the prevention of pulmonary complications.Authors' conclusionsThere is low quality evidence regarding the lack of effectiveness of incentive spirometry for prevention of postoperative pulmonary complications in patients after upper abdominal surgery. This review underlines the urgent need to conduct well-designed trials in this field. There is a case for large RCTs with high methodological rigour in order to define any benefit from the use of incentive spirometry regarding mortality.

Resposta de plantas de alho livres de vírus ao nitrogênio em ambiente protegido

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Best practices for the implantation of ISO 14001 norms: a study of change management in two industrial companies in the Midwest region of the state of São Paulo - Brazil

Among the difficulties found in the implementation of ISO 14001 systems, resistance to change can always be found. It is mainly a consequence of the hurry to change, loss of focus, concentration of decision making at the level of top management, arbitrary imposition of objectives and results, faulty communication, and the absence of motivational and financial incentive for change.Therefore, the main objective of this paper is to present best practices with respect to the management of organizational change due to the implementation of ISO 14001 norms in two industrial companies in the Midwest region of the State of São Paulo - Brazil. (C) 2008 Elsevier Ltd. All rights reserved.

Determination of the antimutagenicity of an aqueous extract of Rhizophora mangle L. (Rhizophoraceae), using in vivo and in vitro test systems

An aqueous extract of Rhizophora mangle L. bark is used as raw material in pottery making in the State of Espirito Santo, Brazil. This extract presents large quantities of tannins, compounds possessing antioxidant properties. Tannin antioxidant activity, as a plant chemical defense mechanism in the process of stabilizing free radicals, has been an incentive to studies on anti-mutagenicity. The present work aimed to evaluate possible antimutagenic activity of a R. mangle aqueous extract, using the Allium cepa test-system and micronuclear (MN) assay with blockage of cytokinesis in Chinese hamster ovary cells (CHO-K1). The Allium cepa test-system indicated antimutagenic activity against the damage induced by the mutagenic agent methyl methanesulfonate. A reduction in both MN cell frequency and chromosome breaks occurred in both the pre and post-treatment protocols. The MN testing of CHO-K1 cells revealed anti-mutagenic activity of the R. mangle extract against methyl methanesulfonate and doxorubicin in pre, simultaneous and post-treatment protocols. These results suggest the presence of phyto-constituents in the extract presenting demutagenic and bio-antimutagenic activities. Since the chemical constitution of Rhizophora mangle species presents elevated tannin content, it is highly probable that these compounds are the antimutagenic promoters themselves.

Enraizamento de estacas herbáceas de nespereira (Eriobotrya japonica Lindl)

O cultivo da nespereira (Eriobotrya japonica Lindl) tem despertado interesse no Brasil, devido ao bom rendimento que proporciona aos produtores e à facilidade de comercialização. Com isso, cada vez mais se buscam métodos de propagação que preservem as características genéticas de interesse, induzam precocidade na formação da muda e no início de produção, além de baixo custo. O método de estaquia se adequa a estas características; sendo assim, o objetivo deste experimento é avaliar o efeito do tipo de estaca herbácea na produção de mudas de nespereira, num experimento conduzido na Faculdade de Ciências Agrárias e Veterinárias - FCAV/UNESP, Câmpus de Jaboticabal (SP), utilizando plantas matrizes de nespereiras, plantadas em 1977, da variedade Mizuho, pertencentes à coleção de plantas frutíferas da Universidade. Utilizaram-se estacas apicais herbáceas com e sem meristema apical, com 2 ou 4 folhas inteiras ou cortadas pela metade, num total de 6 tratamentos, 4 repetições e 12 estacas por parcela, em delineamento inteiramente casualizado. Após 120 dias do plantio das estacas em bandejas com vermiculita e mantidas sob câmara de nebulização, concluiu-se que a porcentagem de estacas vivas e a presença de calos foram significativamente maiores nas estacas apicais sem meristema e com quatro folhas inteiras, e não há efeito do tipo de estaca herbácea sobre o número de estacas enraizadas, número e comprimento médio de raízes. A presença de calos na base das estacas indica a possibilidade de estímulo natural de enraizamento que pode ser potencializada com a utilização de fitorreguladores.

Conteúdos lúdicos, expressivos e artísticos na educação formal

A prática de atividades lúdicas ou o incentivo ao fluir expressivo e artístico são propostas que permeiam a Educação, desde a Antiguidade Clássica. Atualmente, a necessidade premente de atentar para a inclusão contextualizada dessas práticas, vem sendo convalidada pelas diretrizes propostas pelos Parâmetros Curriculares tanto das disciplinas de Educação Física, como da Educação Artística. Entretanto esse espaço, ainda sutil, merece enfoque mais incisivo, por meio de estudos mais aprofundados acompanhados de práticas direcionadas que convalidem sua relevância. Assim, este estudo, de natureza qualitativa, objetivou investigar se essas variáveis estão disponíveis dentro dos conteúdos disseminados pelos professores e se possuem um espaço destinado ou não dentro da Educação formal. Para tanto, foi realizado um estudo exploratório com trinta professores voluntários, de ambos os sexos, pesquisados in loco, com consentimento livre e esclarecido, das disciplinas de Educação Física e Artística, utilizando como instrumento, para a coleta de dados, um questionário com perguntas mistas. Os dados foram analisados descritivamente, indicando que é possível notar a presença do lúdico e da arte, em ambas as disciplinas; mediando os processos de aprendizagem. Além disso, que os professores utilizam amplamente desses recursos, no entanto, nem sempre, de forma consciente e contextualizada, e que, apesar da implantação dos parâmetros curriculares desde 1998, esse espaço ainda não está consolidado.

Atenção odontológica no Programa de Saúde da Família de Campos dos Goytacazes

Durante décadas, a política de saúde bucal no Brasil foi centrada na prestação de assistência à doença, e ainda hoje grande parcela da população brasileira não tem acesso a cuidados odontológicos. Pela Portaria nº 1.444, de 28 de dezembro de 2000, o Ministério da Saúde estabelece incentivo financeiro para a reorganização da atenção à saúde bucal aos municípios. Insere-se, assim, a Odontologia no programa e, conseqüentemente, a possibilidade de ampliar e reorientar a atenção odontológica no Brasil. Dentro desse contexto, este estudo teve por objetivo avaliar a situação da equipe de saúde bucal inserida no Programa de Saúde da Família (PSF) do município de Campos dos Goytacazes - RJ, em 2002. Os resultados demonstraram algumas limitações na inclusão e funcionamento da Odontologia no PSF da cidade. A atenção odontológica deve ser inserida no PSF, atendendo aos princípios básicos do Plano de Reorganização das Ações de Saúde Bucal na Atenção Básica, proposto pelo Ministério da Saúde, e à consolidação do Sistema Único de Saúde.

Palm heart harvesting in the Brazilian Atlantic forest: changes in industry structure and the illegal trade

1. Until the late 1960s, Euterpe edulis was the most important edible palm species in the Brazilian markets. Since then, overharvesting of natural stands and the limited scope of plantations have caused the industry to shift to the multistemmed E, oleracea from the Amazon river estuary.2, As a result of the relocation of the industry, the structure of the palm harvesting industry has changed and illegal trade has continued to exploit the remaining natural stands of E, edulis.3, it is suggested that, to avoid the total harvesting of E. edulis and to achieve sustainable management of the palm heart, it will be necessary to diversify the local economy, create incentives for small land owners to improve their management practices, while keeping their competitiveness against the illegal trade, create the incentive of new sources of palm hearts and create a 'green stamping' For management palms.4, Transformation of the illegal structure of the palm heart industry is probably the only solution to avoid the total depletion of the wild stands of E. edulis.

A QUANTITATIVE APPROACH TO SUBSIDIZE THE PRECAUTIONARY MANAGEMENT of THE SMALL-SCALE FISHERIES IN ITAIPU RESERVOIR, BRAZIL

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Identificacao e mapeamento de areas de desertificacao sob clima umido no Brasil

Environmental management mistakes are now strongly affecting some areas such as the agricultural areas of the southwest of the State of Rio Grande do Sul. The sandy soils in this region are adequate for the beefcattle activity, but ignoring technical reports great incentive was given to the soybean culture. The result was a very fast degradation of the arable layer and several places are considered real small deserts. The objective of this work is the mapping of these areas as well instable areas and gathering all the technical measures which were suggest for the land reclamation. -from English summary

Energia de briquetes produzidos com rejeitos de resíduos sólidos urbanos e madeira de Eucalyptus grandis

The incentive for consumption and production in large quantity in modern society generates enormous amounts of urban solid residues in the form of municipal solid waste (MSW). With the intention of reducing these residues of the municipal waste tips and to generate energy, briquettes with mixtures of MSW and residues of Eucalyptus grandis were produced. The briquettes were manufactured with 0, 5, 10, 15, 20 and 25% of MSW in the mixture with wood waste and 12% of moisture content. The analyzed parameters used to choose the best treatments were combustion analysis versus ash content, mechanical strength and energy content. The briquettes up to 10% of MSW showed low resistance, and above 15% showed large increase in ash content. Therefore, the treatment that fulfilled the requirements for combustion versus ash content and mechanical resistance was of at least 15% of MSW, since the source of the ash is unidentified. Considering the net energy content, the best treatment was 25% of MSW, with 17,175 kJ kg-1. Nevertheless, it is strongly advised that further studies related to gas emissions are necessary.

Grupo interdisciplinar: Construção de unidade educacional sistematizada em aprendizagem baseada em problemas

In 2003 the construction team of the 1st grade of the medical and nursing courses from a medical school began a work aiming at curriculum reconstruction, and restructured cognitive contents and the integration of basic and clinical aspects, in order to adapt to the incentive program for Curriculum Changes (PROMED) which allows for the continuity of curricular innovations. This team worked considering the group dynamics, a method already used in tutorial sessions which teachers have some familiarity with. For a good group performance the team participants were divided into two subgroups: one for constructing educational problems and the other for doing cognitive assessment exercises. The team and the subgroups met weekly, and every 15 days the group met for socialization of information, identifying the strengths and weaknesses of the process and/or products. A good adhesion, an active involvement of participants and satisfaction expressed by each participant with their inclusion in the group were reflected in the final product and contributed to the subjects' commitment to the proposal. This way, in the process the individual transformations and relations in a situation requiring the collaboration of professionals were essential in the process of permanent curricular reconstruction.

Plano municipal de saúde: Análise do instrumento de gestão

Among planning instruments used by manager instances of Brazilian Health System it pointed the Health Municipal Plan (PMS) that should be built collectively showing political intentions, directresses, priorities, objectives, goals framework, estimative of resources and need costs to get the goals of the health sector. The aim of this work was to analyze the plans in relation to attendance of legal requirements which manage the Brazilian Health System, its constitution and showing of essential items. The study included three municipalities form São Paulo State. It was used the documental analysis as research technique. Near all plans showed an analysis of situation with detailed descriptions of general situation of municipality, and only one of them realized critical analysis of their epidemiological data; the financial income applied on health was decrypted by only one municipality. About programming, all municipalities described the main problems and its solutions. Although they had goals framework, the question about cost estimative to get the goals was not approached. Any municipality showed an annual review, being one of them delayed over than two years. It was observed no participation of Municipal Health Council on elaboration and review of plans. It was concluded that there was a deficiency in the plans analyzed. It's necessary to execute continuing education with managers in relation to importance of systematic elaboration of plans and to incentive the promotion of active participation of Municipal Health Council promotion of aiming to became true the social control of health actions.

Uma pesquisa sobre a opinião pública sobre incentivos financeiros para doação de óvulos no Brasil

Objective: The objective of this study was to assess the opinions of the Brazilian population about incentives for oocyte donation. Methods: A cross-sectional descriptive approach was used to consult the Brazilian public. The data collection involved the use of a structured questionnaire about legal and ethical issues surrounding oocyte donation. Individuals were randomly selected from the general population using different e-mail lists. Potential participants were contacted by e-mail and invited to participate in the study by completing an online web survey. Results: A total of 1,565 people completed the survey, including 1,284 women(82%) and 281 men(18%). Among the respondents, 1,309(83.6%) were university graduates, 1,033(66%) had a personal income ≥1,250 US dollars/month, 1,346(86%) considered themselves to be religious and 518 (33.1%) were health professionals. While many participants believed that women may donate their oocytes for altruistic reasons, the majority believed that a lack of oocyte donations is due to the prohibition of payments(64.3%) and that incentives would facilitate the decision to donate oocytes(84.7%). The majority of the participants(65.3%) agreed that a financial incentive(i.e., paying the donor) would be the most practical solution for increasing the number of oocyte donations. These results tended to be independent of gender, age, income, religion, education level and profession. Conclusion: While the Brazilian Federal Council of Medicine prohibits payments for oocyte donation, the majority of study participants had no objection to compensating oocyte donors. Moreover, most of the participants agreed that a financial incentive is the most practical solution to increasing the number of oocyte donations.

Entre o sofrimento e a esperança: A reabilitação da incontinência urinária como componente interveniente

This is a qualitative study seeking to understand Brazilian women's experience of urinary incontinence (UI) and design a representative theoretical model for the experience. Theoretical saturation occurred after analysis of the 18th non-directive interview in accordance with Grounded Theory. Two phenomena emerged: living with the challenges of UI and experiencing the hope and disappointment of rehabilitation from UI. Upon re-alignment of the components, the core category emerged, namely: between suffering and hope - rehabilitation from urinary incontinence as an intervening component. From the analysis in light of symbolic interactionism, pregnancy and vaginal birth were observed to be symbols of women's vulnerability to the suffering from living with the moral and physio-psychosocial challenges of UI. It is also inferred that the lack of consideration of the Unified Health System (SUS) in investing in the process of rehabilitation from UI may be having a negative effect on the incentive programs for promoting vaginal birth. Most of all, it reveals the ongoing suffering of women with UI, most of whom do not have access to rehabilitation due to the lack of programs geared to the real needs of these users of the Unified Health System.