Profiling of 19-norandrosterone sulfate and glucuronide in human urine: implications in athlete's drug testing.

19-Norandrosterone (19-NA) as its glucuronide derivative is the target metabolite in anti-doping testing to reveal an abuse of nandrolone or nandrolone prohormone. To provide further evidence of a doping with these steroids, the sulfoconjugate form of 19-norandrosterone in human urine might be monitored as well. In the present study, the profiling of sulfate and glucuronide derivatives of 19-norandrosterone together with 19-noretiocholanolone (19-NE) were assessed in the spot urines of 8 male subjects, collected after administration of 19-nor-4-androstenedione (100mg). An LC/MS/MS assay was employed for the direct quantification of sulfoconjugates, whereas a standard GC/MS method was applied for the assessment of glucuroconjugates in urine specimens. Although the 19-NA glucuronide derivative was always the most prominent at the excretion peak, inter-individual variability of the excretion patterns was observed for both conjugate forms of 19-NA and 19-NE. The ratio between the glucuro- and sulfoconjugate derivatives of 19-NA and 19-NE could not discriminate the endogenous versus the exogenous origin of the parent compound. However, after ingestion of 100mg 19-nor-4-androstenedione, it was observed in the urine specimens that the sulfate conjugates of 19-NA was detectable over a longer period of time with respect to the other metabolites. These findings indicate that more interest shall be given to this type of conjugation to deter a potential doping with norsteroids.

Professional Nursing Duties in the Central Services: Hospital Pharmacy Nurses.

Introduction.The new demands of a fast changing world necessitate expanding the traditional concepts of nursing, extending the classical aspects to cover new areas. Purpose. Based on their professional duties, the nursing team in the pharmacy of a second level hospital aimed to establish a theoretical and situational framework for nurses working in the central services. Material and Methods. Application of the nursing process to nursing work in an area with no direct contact with patients. Results and Discussion. The application of the NANDA diagnoses to professional practice enabled the establishment of a nursing diagnosis with the implementation of measures designed to overcome a stressful situation with a risk of becoming unmotivated. Main Conclusion. The capacity to adapt the nursing profession to undertake new roles in the field of healthcare and the power of nursing own methodological resources permit the indirect care of “faceless” patients to be complemented with the inclusion of nurses from other services as clients, forming the focus of care, who can thus be helped with their daily care work.

Swiss Interdisciplinary Management Programme for Heart Failure (SWIM-HF): a randomised controlled trial study of an outpatient inter-professional management programme for heart failure patients in Switzerland.

PRINCIPLES: International guidelines for heart failure (HF) care recommend the implementation of inter-professional disease management programmes. To date, no such programme has been tested in Switzerland. The aim of this randomised controlled trial (RCT) was to test the effect on hospitalisation, mortality and quality of life of an adult ambulatory disease management programme for patients with HF in Switzerland.METHODS: Consecutive patients admitted to internal medicine in a Swiss university hospital were screened for decompensated HF. A total of 42 eligible patients were randomised to an intervention (n = 22) or usual care group (n = 20). Medical treatment was optimised and lifestyle recommendations were given to all patients. Intervention patients additionally received a home visit by a HF-nurse, followed by 17 telephone calls of decreasing frequency over 12 months, focusing on self-care. Calls from the HF nurse to primary care physicians communicated health concerns and identified goals of care. Data were collected at baseline, 3, 6, 9 and 12 months. Mixed regression analysis (quality of life) was used. Outcome assessment was conducted by researchers blinded to group assignment.RESULTS: After 12 months, 22 (52%) patients had an all-cause re-admission or died. Only 3 patients were hospitalised with HF decompensation. No significant effect of the intervention was found on HF related to quality of life.CONCLUSIONS: An inter-professional disease management programme is possible in the Swiss healthcare setting but effects on outcomes need to be confirmed in larger studies.

Triade de la femme sportive [Female athlete triad]

The practitioner, as well as specialist such as gynecologist and endocrinologist, may face in their office women with eating disorders, abnormalities of menstrual cycles and low bone mass, which may be the first hints of the female athlete triad. In these situations, the practitioner may search other findings of these triad by looking at some particular physical findings and by using appropriate questionnaire. In some advanced forms of this triad specific abnormalities of eating disorders (anorexia and boulimia) may be present as well as amenorrhea and osteoporosis, which may disturb the well-being and cause health damages of women practising sport either as amateur or in a elite setting. An appropriate handling of such disorders has to be proposed to these women.

Visita professional als serveis bibliotecaris d'universitats anglosaxones

Informe de l'estada per a formació i adquisició d’experiència professional becada per la Universitat Politècnica de Catalunya, convocatòria de mobilitat de PAS de la UPC 2007.

Traduir i interpretar les llengües de la immigració a Catalunya: cap a la formació i acreditació d’un perfil professional emergent

El projecte que sol•licitem és el resultat natural d’una recerca iniciada l’any 2008 pel grup de recerca MIRAS (Mediació i Interpretació: Recerca en l’Àmbit Social) de la Universitat Autònoma de Barcelona. La recerca del grup MIRAS ha tingut com a objectiu general, durant els darrers dos anys, la definició del perfil professional del traductor/intèrpret als serveis públics. Aquesta figura emergent i encara poc reconeguda al nostre país va començar a sorgir a partir del boom migratori de les darreres dècades a Catalunya com a resposta als problemes de comunicació freqüents entre la població nouvinguda i els serveis públics locals. Per a assolir l’objectiu esmentat, la primera fase de la recerca del grup MIRAS s’ha centrat en el disseny, distribució, buidatge, anàlisi i creuament de dades de 250 qüestionaris semioberts dirigits als tres principals agents implicats en la interacció comunicativa que estudiem: els traductors/intèrprets, els usuaris i els proveïdors dels serveis. Els resultats d’aquest estudi han demostrat, entre d’altres qüestions rellevants, la manca d’una formació específica per als traductors/intèrprets als serveis públics, així com una absència de regulació de la professió que aquests exerceixen. Un cop realitzat aquest primer estudi pilot, i en vista dels resultats obtinguts, ens sembla doncs evident que el següent pas de la nostra recerca ha d’anar orientat cap a la formació i regulació professional dels traductors/intèrprets als serveis públics. En concret, en el projecte que sol•licitem ens proposem dissenyar una formació especialitzada per a traductors/intèrprets als serveis públics que compleixi amb els següents tres prerequisits: a) estar oberta a tot tipus de persones, independentment del seu nivell d’estudis; b) oferir un ampli ventall de llengües, principalment les llengües de la immigració a Catalunya (per a una primera selecció d’aquestes llengües, vegeu informe demogràfic de la SIM de l’1 de gener de 2010 i resultats de l’estudi pilot de MIRAS), i c) conduir a una acreditació nacional que reguli l’exercici de la professió de traductor/intèrpret als serveis públics de Catalunya. La implementació d’un sistema d’acreditació, segon objectiu del projecte que presentem, és essencial ja que no només permetrà la regulació d’una professió fins avui poc o mal definida, sinó que també garantirà la qualitat dels serveis oferts per aquests professionals en el futur.

Trajectòries d'èxit de joves immigrants a l'ensenyament superior i al món professional

L’educació dels immigrants és un tema prioritari a les agendes polítiques de molts països de la OCDE. En molts casos, els governs s’han preocupat especialment de la seva integració al món del treball però creix l’interès en els seus resultats al sistema educatiu i en la revisió de les polítiques adreçades a respondre a les seves necessitats educatives i formatives. La majoria d’aquests estudis es situen a l’esfera de l’educació infantil, primària, secundaria i formació professional, per això resulta pràcticament impossible trobar estudis que analitzin el baix percentatge d’accés d’estudiants immigrants extracomunitaris a la universitat (al voltant de 3,3% en el cas de Catalunya); que contribueixin a entendre els factors que configuren les trajectòries d’èxit escolar i d’integració laboral dels estudiants immigrants que accedeixen i completen els estudis universitaris; que puguin donar pautes per desenvolupar polítiques educatives que millorin els resultats d’aprenentatge dels estudiants immigrants; i que puguin servir com a mirall i incentiu per a altres persones immigrants i, perquè no, també del país. Aquest projecte ha estudiat el conjunt d’elements que condicionen l’accés dels joves immigrants als estudis universitaris, i a l’estatus laboral que els hauria de possibilitar la seva formació universitària. L’estudi ha consistit en una metaanàlisi dels documents existents sobre el tema i en la realització de 8 narratives biogràfiques; quatre de persones cursant diferents estudis a les universitats catalanes i quatre que ja s’han incorporat al món del professional. Aquestes narratives venen acompanyades de 8 vídeos que exploren noves maneres de visibilització d’aquesta població i es transformen en una pràctica d’autoria. Aquest material visual pot servir com a recurs educatiu, en la mida que pugui ser un mirall i un incentiu per a altres persones immigrants i del país. Finalment, presenta un seguit de recomanacions per als responsables de les polítiques i dels centres educatius.

Marco metodológico para la definición de un perfil profesional en educación superior = Methodological framework for the definition of a professional profile in higher education

En el marco del Espacio Europeo de Educación Superior 1 se inscriben innumerables acciones que están desarrollando todas las universidades europeas con la intención de llegar al 2010 con un bagaje lo suficientemente importante como para afrontar este cambio con entereza y sobretodo conservando (o incrementando) la calidad de los procesos de enseñanza- aprendizaje que hasta el momento han predominado. Dentro de este amplio proceso de transformación se encuentra el diseño de los nuevos Grados que brinda la oportunidad de replantear los planes de estudios, por tanto, la organización de las asignaturas, estructura de los contenidos, metodologías y sistemas de evaluación. Toda esta reflexión debe girar, a nuestro entender, alrededor de tres núcleos que se encuentran en estado deinterdependencia: los escenarios profesionales, los perfiles profesionales y las competencias que en ellos se inscriben.Para poder plantear los nuevos Grados en coherencia con la era del EEES debe hacerse un análisis minucioso de los perfil profesionales demandados por el mercado de trabajo que, al fin y al cabo será el destino de los profesionales que se forman en nuestras universidades, es por ello, que la tarea de definir el perfil profesional a priori del diseño de los nuevos Grados resulta una máxima para garantizar la calidad de estos. En este trabajo se presenta un ejemplo de metodología a seguir para la definición de un perfil profesional en Educación Superior, concretamente, el del Ingeniero TIC mediante el Análisis Funcional.

Department of Commerce Iowa Professional Licensing and Regulation Division Performance Report, FY 2004

Agency Performance Report from the Professional Licensing and Regulation Division

Moral distress: challenges for an autonomous nursing professional practice

Constantly experiencing limiting situations that hinder a professional practice coherent with its principles - of autonomy and advocacy of users' interests -, and often conditioned to experience moral distress, the nursing profession plays a prominent role in the current health model because it has the characteristic of managing the care rendered to users in a perspective of social inclusion, both in the basic health network and in hospitals. Aiming at carrying out a reflection on the nursing practice and the difficulties present in its work routine, and considering its characteristics as a profession, this article sought to make a reflection between the practice of nursing and the numerous moral challenges imposed by the routine, resulting, in many cases, in a value crisis that can reverberate directly on the quality of the service rendered, and in abandonment of the ideals of advocacy for users.

The hematology laboratory in blood doping (bd): 2014 update on the athlete biological passport (APB)

Introduction: Blood doping (BD) is the use of Erythropoietic Stimulating Agents (ESAs) and/or transfusion to increase aerobic performance in athletes. Direct toxicologic techniques are insufficient to unmask sophisticated doping protocols. The Hematological module of the ABP (World Anti-Doping Agency), associates decision support technology and expert assessment to indirectly detect BD hematological effects. Methods: The ABP module is based on blood parameters, under strict pre-analytical and analytical rules for collection, storage and transport at 2-12°C, internal and external QC. Accuracy, reproducibility and interlaboratory harmonization fulfill forensic standard. Blood samples are collected in competition and out-ofcompetition. Primary parameters for longitudinal monitoring are: - hemoglobin (HGB); - reticulocyte percentage (RET); - OFF score, indicator of suppressed erythropoiesis, calculated as [HGB(g/L) * 60-√RET%]. Statistical calculation predicts individual expected limits by probabilistic inference. Secondary parameters are RBC, HCT, MCHC-MCH-MCV-RDW-IFR. ABP profiles flagged as atypical are review by experts in hematology, pharmacology, sports medicine or physiology, and classified as: - normal - suspect (to target) - likely due to BD - likely due to pathology. Results: Thousands of athletes worldwide are currently monitored. Since 2010, at least 35 athletes have been sanctioned and others are prosecuted on the sole basis of abnormal ABP, with a 240% increase of positivity to direct tests for ESA, thanks to improved targeting of suspicious athletes (WADA data). Specific doping scenarios have been identified by the Experts (Table and Figure). Figure. Typical HGB and RET profiles in two highly suspicious athletes. A. Sample 2: simultaneous increases in HGB and RET (likely ESA stimulation) in a male. B. Samples 3, 6 and 7: "OFF" picture, with high HGB and low RET in a female. Sample 10: normal HGB and increased RET (ESA or blood withdrawal). Conclusions: ABP is a powerful tool for indirect doping detection, based on the recognition of specific, unphysiological changes triggered by blood doping. The effect of factors of heterogeneity, such as sex and altitude, must also be considered. Schumacher YO, et al. Drug Test Anal 2012, 4:846-853. Sottas PE, et al. Clin Chem 2011, 57:969-976.

Organization of healthcare and assistance to the elderly indigenous population: synergies and particularities of the professional context

This study aimed to describe the effects of the organization of primary healthcare on the assistance provided to the elderly Kaingang population, according to the perception of health professionals that work in this area. It is a qualitative and descriptive study, supported by ethnography methodological references, and was conducted with ten healthcare professionals that work in Faxinal, an indigenous territory in the state of Paraná, in Brazil. Data was collected from November 2010 to February 2012 through participant observation and interviews. The results revealed that health professionals strive to meet the health needs of the elderly Kaingang people; however, there are negative effects that hinder the professional care, especially limited human resources, lack of training and material resources, heavy workload and high turnover rates. This study highlights the need to improve work conditions in order to provide better healthcare.

Professional competencies in primary health care for attending to older adults

Objective To identify and analyze the necessary competencies in primary health care for attending to older adults. Method An exploratory, descriptive, and quali-quantitative study was developed. Three rounds of the Delphi Technique were conducted with participants from primary health care services and a multidisciplinary committee. The first questionnaire asked participants to indicate the competencies needed for attending to older adults in primary health care. They were compiled into a list and added to a Likert Scale (from 1 to 5) for the second and third questionnaires. A consensus criterion of 70% was adopted. Results Twenty eight competencies were reached by consensus and were classified into twelve domains. Conclusion The competencies reflect Brazilian health care policy and constitute a reference for professional health practice and education when caring for the older adult in primary health care.

Professional knowledge in primary health care of the person/family in mental distress: Le Boterf perspective

Aim of this study was to identify knowing-doing actions constituted the practice of Family Health (FH), in view of nurses in relation to the person and family care in mental distress in terms of professional knowledge of Le Boterf. Method: Descriptive exploratory qualitative study, to deepen contruction of nurse in FH. The survey was conducted in 3 Units FH. Result: Doing a thematic analysis, came to the following categories: “Knowing how to act and react with relevance”; “Knowing how to combine resources and mobilize them in a professional context”; “Knowing how to interact with multiple knowledges”; “Knowing how to transpose”; “Knowing how to learn and knowing how to learn to learn”; “Knowing how to engage”. Final considerations: the greatest difficulty was "be able to transpose," and that the daily demand of the FH teams requires a lot of this knowledge. Little transposition of knowing-doing in real situations has been verified.