Acurácia dos indicadores clínicos do diagnóstico de enfermagem falta de adesão em pessoas vivendo com AIDS

In the early 1990s, a major milestone in the treatment of Acquired Immune Deficiency Syndrome was the development of highly active combination antiretroviral therapy. The great benefit generated by the use of this therapy was prolonging the survival of the people who got this disease, since it is no longer considered fatal, becoming a chronic condition. Despite improvements generated by this therapy, there are still many difficulties to be overcome. One is the patient adherence to their treatment, bringing challenges to services and health professionals. Hence the need for early identification of nursing diagnosis Lack of Accession so that solutions are sought by the nurse with the patient and his family. With this problem, adds to the difficulty of hospital nurses in inferring that diagnosis, especially in identifying their defining characteristics. In this context, the objective was to evaluate the accuracy of clinical indicators of nursing diagnosis Lack of Adherence to antiretroviral treatment for people living with the Acquired Immunodeficiency Syndrome. The research took place in two stages. The first consists of the evaluation of the diagnostic indicators in the study; and second, the diagnostic inference performed by specialist nurses. The first step took place in a referral hospital in the treatment of infectious diseases in the Northeast of Brazil, and data were collected through an instrument for carrying out history and physical examination and analyzed for the presence or absence of the diagnostic indicators. In the second stage, the data were sent to experts, who judged the presence or absence of the diagnosis in the studied clientele. The project was submitted to the Ethics Committee of the Federal University of Rio Grande do Norte, obtaining approval with the General Certificate for Ethics Assessment (CAAE) No 46206215.3.0000.5537. Data were analyzed using descriptive and inferential statistics. Test were used Fisher's exact, chi-square test of Pearson and logistic regression. Since the accuracy of clinical indicators was measured by sensitivity, specificity, predictive values, likelihood ratios. As a result, we identified the presence of diagnosis Lack of Accession on 69% (n = 78) of the study patients. The defining characteristics that showed statistically significant association with the diagnosis studied were: lack of adherence behavior, complications related to development, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. The characteristic with greater sensitivity was missing scheduled appointments and the highest specificity behavior of noncompliance. The logistic regression showed as predictors for the diagnosis Lack of Accession: lack of adherence behavior, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. It was concluded that the identification of clinical indicators accurately enabled a good prediction of the nursing diagnosis Lack of Accession on people living with the Acquired Immune Deficiency Syndrome, helping nurses develop early on strategies for promoting adherence to the use of antiretrovirals.

Smoking and dietary inadequacy among Inuvialuit women of child bearing age in the Northwest Territories, Canada

Objective. The prevalence of smoking in Aboriginal Canadians is higher than non-Aboriginal Canadians, a behavior that also tends to alter dietary patterns. Compared with the general Canadian population, maternal smoking rates are almost twice as high. The aim of this study was to compare dietary adequacy of Inuvialuit women of childbearing age comparing smokers versus non-smokers. Research methods & procedures. A cross-sectional study, where participants completed a culturally specific quantitative food frequency questionnaire. Non-parametric analysis was used to compare mean nutrient intake, dietary inadequacy and differences in nutrient density among smokers and non-smokers. Multiple logistic regression analyses were performed for key nutrients inadequacy and smoking status. Data was collected from three communities in the Beaufort Delta region of the Northwest Territories, Canada from randomly selected Inuvialuit women of childbearing age (19-44 years). Results: Of 92 participants, 75% reported being smokers. There were no significant differences in age, BMI, marital status, education, number of people in household working and/or number of self employed, and physical activity between smokers and non-smokers. Non-parametric analysis showed no differences in nutrient intake between smokers and non-smokers. Logistic regression however revealed there was a positive association between smoking and inadequacies of vitamin C (OR = 2.91, 95% CI, 1.17-5.25), iron (OR = 3.16, 95% CI, 1.27-5.90), and zinc (OR = 2.78, 95% CI, 1.12-4.94). A high percentage of women (>60%), regardless of smoking status, did not meet the dietary recommendations for fiber, vitamin D, E and potassium. Conclusions: This study provides evidence of inadequate dietary intake among Inuvialuit of childbearing age regardless of smoking behavior.

The Broader Impact of Disability Research: Aligning Public Policy with the Experiences of People with Disabilities and Healthcare Providers

Thesis (Ph.D.)--University of Washington, 2016-07

Workforce Patterns and the Prevention of Mother-to-Child Transmission of HIV Option B Cascade in Côte d'Ivoire

Thesis (Master's)--University of Washington, 2016-08

Digital collaborations and entrepreneurship – the role of shareconomy and crowdsourcing in the era of smart city

The thesis begins with the classical cooperation and transfers it to the digital world. This work gives a detailed overview of the young fields of research smart city, shareconomy and crowdsourcing and links these fields with entrepreneurship. The core research aim is the finding of connections between the research fields smart city, shareconomy and crowdsourcing and entrepreneurial activities and the specific fields of application, success factors and conditions for entrepreneurs. The thesis consists of seven peer-reviewed publications. Based on primary and secondary data, the existence of entrepreneurial opportunities in the fields of smart city, shareconomy and crowdsourcing could be confirmed. The first part (publications 1-3) of the thesis are literature reviews to secure the fundamental base for further research. This part consists of newly created definitions and an extreme sharpening of the research fields for the near future. In the second part of the thesis (publications 4-7), empirical field work (in-depth interviews with entrepreneurs) and quantitative analyses (fuzzy set/qualitative comparative analysis and binary logistic regression analysis) contribute to the field of research with additional new insights. Summarizing, the insights are multi-layered: theoretical (e.g. new definitions, sharpening of the research field), methodical (e.g. first time application of the fuzzy set/qualitative comparative analysis in the field of crowdfunding) and qualitative (first time application of in-depth interviews with entrepreneurs in the fields of smart city and shareconomy). The global research question could be answered: the link between entrepreneurship and smart city, shareconomy and crowdfunding could be confirmed, concrete fields of application could be identified and further developments could be touched upon. This work strongly contributes to the young fields of research through much-needed basic work, new qualitative approaches, innovative methods and new insights and offers opportunities for discussion, criticism and support for further research.

Socioeconomic Status and Health Behavior in Nepal

Thesis (Master's)--University of Washington, 2016-07

Financing social ventures by crowdfunding: The inflluence of entrepreneurs’ personality traits

Purpose – This research aims to understand the role played by social entrepreneurs’ personality traits on the choice between the traditional donation model and social crowdfunding (CF) to finance social projects. Design/methodology/approach – Social CF is examined as an instrument to capture funds for social projects, and the particular case of the Portuguese Social Stock Exchange (PSSE) is presented. The approach is quantitative in nature and the data were collected through a questionnaire that was emailed to non-governmental organizations in Portugal and founders of the projects listed on PSSE. Logistic regression was employed to predict the probability that a social entrepreneur would use PSSE rather than traditional financing. The predictor variables were based on the big five personality traits. Findings – Our investigation reveals that the agreeableness and neuroticism factors were not even considered in the results of the factorial analysis, which indicates the minor importance of these personality traits in the funding decisions of the Portuguese social entrepreneurs. The same applies to the factors of openness to new experiences and extraversion, which, although considered in the logistic analysis, showed no statistical significance. Finally, the conscientiousness personality trait seems to be the only factor that might explain the use of the PSSE platform.Originality/value – Studies on the profile of the social entrepreneurs that use CF for financing social projects are relatively rare, specifically in the context of Social Stock Exchange platforms. Additionally, there is a need to carry out more empirical evidence about the effect of social entrepreneurs’ personality traits on the decision to finance social projects through social CF platforms vis-a-vis the traditional donation model.

Mapping tissue inhomogeneity in acute myocarditis: a novel analytical approach to quantitative myocardial edema imaging by T2-mapping

BACKGROUND: The purpose of the present study was to investigate the diagnostic value of T2-mapping in acute myocarditis (ACM) and to define cut-off values for edema detection. METHODS: Cardiovascular magnetic resonance (CMR) data of 31 patients with ACM were retrospectively analyzed. 30 healthy volunteers (HV) served as a control. Additionally to the routine CMR protocol, T2-mapping data were acquired at 1.5 T using a breathhold Gradient-Spin-Echo T2-mapping sequence in six short axis slices. T2-maps were segmented according to the 16-segments AHA-model and segmental T2 values as well as the segmental pixel-standard deviation (SD) were analyzed. RESULTS: Mean differences of global myocardial T2 or pixel-SD between HV and ACM patients were only small, lying in the normal range of HV. In contrast, variation of segmental T2 values and pixel-SD was much larger in ACM patients compared to HV. In random forests and multiple logistic regression analyses, the combination of the highest segmental T2 value within each patient (maxT2) and the mean absolute deviation (MAD) of log-transformed pixel-SD (madSD) over all 16 segments within each patient proved to be the best discriminators between HV and ACM patients with an AUC of 0.85 in ROC-analysis. In classification trees, a combined cut-off of 0.22 for madSD and of 68 ms for maxT2 resulted in 83% specificity and 81% sensitivity for detection of ACM. CONCLUSIONS: The proposed cut-off values for maxT2 and madSD in the setting of ACM allow edema detection with high sensitivity and specificity and therefore have the potential to overcome the hurdles of T2-mapping for its integration into clinical routine.

EXPLORING THE EFFECTS OF THE RELATIONSHIP BETWEEN SCHOOL CHARACTERISTICS, TEACHER CHARACTERISTICS, ADMINISTRATIVE SUPPORT, AND SCHOOL CLIMATE ON VOLUNTARY INTRA-DISTRICT TEACHER MIGRATION

This quantitative research study utilized a binary logistic regression in a block design to investigate exogenous and endogenous factors influencing a teacher’s decision to make an intra-district move. The research focused on the following exogenous factors: classroom characteristics (size of class, percent minority, percent of students with an individualized education plan, and percent of students that are English language learners) and teacher characteristics (experience and gender). The following endogenous factors were examined: direct administrative influence (administrative support, rules enforced, school vision, teacher recognition, and job security) and indirect administrative influence (school climate, student misbehavior, parental support, materials, staff collaboration). The research was conducted by using information available from the National Center for Educational Statistics, the SASS from 2011-2012 and TFS from 2012-2013. The 2012-2013 Teacher Follow-up Survey identified 60 teachers who made a voluntary intra-district move. Results illustrate there is a statistically significant relationship between percentage of English Language Learners and overall job satisfaction and teachers choosing to make an intra-district move.

FERTILISER CREDIT AND AGROECOLOGICAL USE OF ORGANIC SOIL AMENDMENTS IN NORTHERN GHANA

Contemporary African agricultural policy embodies the African Green Revolution’s drive towards modernisation and commercialisation. Agroecologists have criticised this movement on ecological, social and political grounds. Northern Ghanaian fertiliser credit schemes provide a good example through which these critiques can be examined in a context where agricultural policy reflects the African Green Revolution’s ideals. This study aimed to determine the relationship of such credit schemes to farmers’ use of organic amendments, elucidate other factors related to organic amendment use, and comment on the relevance of this modernisation policy and its relationship to agroecology. A first research phase employed semi-structured key informant interviews. Qualitative data from these informed construction of a semi-structured questionnaire that was used in a survey of 205 farmers. Multistage sampling purposively identified five villages and selected farmers within who had joined government and donor-funded fertiliser credit schemes. The use of organic and inorganic amendments was compared to that of peers who had not taken part in such schemes. Quantitative data were used in binomial logistic regression, inferential and descriptive statistics. Qualitative data were content analysed. Credit group membership was associated with higher fertiliser application and yield, but had little influence on the extent of commercialisation. Farmers who applied organic amendments were 40% less likely to belong to a fertiliser credit scheme than not, indicating substitution between organic and inorganic fertilisers. Organic amendments were 40% more likely to be applied to compound farms than outfields and six times more likely to be applied by household heads than other household members. However, household heads also preferentially joined credit groups. This was part of an agroecological soil fertility management strategy. Household heads appreciated the soil moisture retention properties of organic amendments, and applied them to compound farms to reduce risk to their household food supply in a semi-arid environment. They simultaneously accessed fertiliser to enhance this household provisioning strategy. They appreciated the increased yields this achieved, yet complained that the repayment terms of credit schemes were unfair, fertiliser did not enhance yields in dry conditions and fertilisers were supplied late. Farmers’ use of credited fertiliser alongside their existing agroecological strategy is helpful to the extent that it raises yields, yet is problematic in that it conflicts with risk-reduction strategies based on organics. There is some potential for modernised and agroecological management paradigms to coexist. For fertiliser credit to play a role in this, schemes must use fairer repayment terms and involve a focus on simultaneous use of organic amendments.

Examining the Validity of the GRE General Test Scores and Undergraduate GPA for Predicting Success in Graduate School at a Large Racially and Ethnically Diverse Public University in Southeast Florida

The purpose of the study was to determine the degree of relationships among GRE scores, undergraduate GPA (UGPA), and success in graduate school, as measured by first year graduate GPA (FGPA), cumulative graduate GPA, and degree attainment status. A second aim of the study was to determine whether the relationships between the composite predictor (GRE scores and UGPA) and the three success measures differed by race/ethnicity and sex. A total of 7,367 graduate student records (masters, 5,990; doctoral: 1,377) from 2000 to 2010 were used to evaluate the relationships among GRE scores, UGPA and the three success measures. Pearson’s correlation, multiple linear and logistic regression, and hierarchical multiple linear and logistic regression analyses were performed to answer the research questions. The results of the correlational analyses differed by degree level. For master’s students, the ETS proposed prediction that GRE scores are valid predictors of first year graduate GPA was supported by the findings from the present study; however, for doctoral students, the proposed prediction was only partially supported. Regression and correlational analyses indicated that UGPA was the variable that consistently predicted all three success measures for both degree levels. The hierarchical multiple linear and logistic regression analyses indicated that at master’s degree level, White students with higher GRE Quantitative Reasoning Test scores were more likely to attain a degree than Asian Americans, while International students with higher UGPA were more likely to attain a degree than White students. The relationships between the three predictors and the three success measures were not significantly different between men and women for either degree level. Findings have implications both for practice and research. They will provide graduate school administrators with institution-specific validity data for UGPA and the GRE scores, which can be referenced in making admission decisions, while they will provide empirical and professionally defensible evidence to support the current practice of using UGPA and GRE scores for admission considerations. In addition, new evidence relating to differential predictions will be useful as a resource reference for future GRE validation researchers.

Niveles de actividad física y su relación con los desórdenes musculo esqueléticos en profesores de educación física en Bogotá - Colombia.

La actividad física regular desempeña un papel fundamental en la prevención y control de los desórdenes musculo esqueléticos, dentro de la actividad laboral del profesor de educación física. Objetivo: El propósito del estudio fue determinar la relación entre los niveles de actividad física y la prevalencia de los desórdenes musculo esqueléticos, en profesores de educación física de 42 instituciones educativas oficiales de Bogotá-Colombia. Métodos. Se trata de un estudio de corte transversal en 262 profesores de educación física, de 42 instituciones educativas oficiales de Bogotá - Colombia. Se aplicó de manera auto-diligenciada el Cuestionario Nórdico de desórdenes músculos esqueléticos y el Cuestionario IPAQ versión corta para identificar los niveles de actividad física. Se obtuvieron medidas de tendencia central y de dispersión para variables cuantitativas y frecuencias relativas para variables cualitativas. Se calculó la prevalencia de vida y el porcentaje de reubicación laboral en los docentes que habían padecido diferentes tipo de dolor. Para estimar la relación entre el dolor y las variables sociodemográficas de los docentes, se utilizó un modelo de regresión logística binaria simple. Los análisis fueron realizados en SPSS versión 20 y se consideró como significativo un valor p < 0.05 para el contraste de hipótesis y un nivel de confianza para la estimación de parámetros. Resultados: El porcentaje de respuesta fue del 83.9%, se consideraron válidos 262 registros, 22.5% eran de género femenino, la mayor cantidad de docentes de educación física se encuentraon entre 25 y 35 años (43,9%), frente a los desórdenes musculo esqueléticos, el 16.9% de los profesores reporto haberlos sufrido alguna vez molestias en el cuello, el 17,2% en el hombro, 27,9% espalda, 7.93% brazo y en mano el 8.4%. Los profesores con mayores niveles de actividad física, reportaron una prevalencia menor de alteraciones musculo esqueléticas de 16,9 % para cuello; 27.7% para dorsal/lumbar frente a los sujetos con niveles bajos de actividad física. La presencia de los desórdenes se asoció a los años de experiencia (OR 3.39 IC95% 1.41-7.65), a pertenecer al género femenino (OR 4.94 IC95% 1.94-12.59), a la edad (OR 5.06 IC95% 1.25-20.59), y al atender más de 400 estudiantes a cargo dentro de la jornada laboral (OR 4.50 IC95% 1.74-11.62). Conclusiones: En los profesores de Educación Física no sé encontró una relación estadísticamente significativa entre los niveles de actividad física y los desórdenes musculo esqueléticos medidos por auto reporte.

Evaluación del desempeño pronóstico de dos puntajes de predicción de mortalidad a siete días en pacientes adultos oncológicos críticamente enfermos admitidos a una unidad de cuidados intensivos en Bogotá

Introducción Los sistemas de puntuación para predicción se han desarrollado para medir la severidad de la enfermedad y el pronóstico de los pacientes en la unidad de cuidados intensivos. Estas medidas son útiles para la toma de decisiones clínicas, la estandarización de la investigación, y la comparación de la calidad de la atención al paciente crítico. Materiales y métodos Estudio de tipo observacional analítico de cohorte en el que reviso las historias clínicas de 283 pacientes oncológicos admitidos a la unidad de cuidados intensivos (UCI) durante enero de 2014 a enero de 2016 y a quienes se les estimo la probabilidad de mortalidad con los puntajes pronósticos APACHE IV y MPM II, se realizó regresión logística con las variables predictoras con las que se derivaron cada uno de los modelos es sus estudios originales y se determinó la calibración, la discriminación y se calcularon los criterios de información Akaike AIC y Bayesiano BIC. Resultados En la evaluación de desempeño de los puntajes pronósticos APACHE IV mostro mayor capacidad de predicción (AUC = 0,95) en comparación con MPM II (AUC = 0,78), los dos modelos mostraron calibración adecuada con estadístico de Hosmer y Lemeshow para APACHE IV (p = 0,39) y para MPM II (p = 0,99). El ∆ BIC es de 2,9 que muestra evidencia positiva en contra de APACHE IV. Se reporta el estadístico AIC siendo menor para APACHE IV lo que indica que es el modelo con mejor ajuste a los datos. Conclusiones APACHE IV tiene un buen desempeño en la predicción de mortalidad de pacientes críticamente enfermos, incluyendo pacientes oncológicos. Por lo tanto se trata de una herramienta útil para el clínico en su labor diaria, al permitirle distinguir los pacientes con alta probabilidad de mortalidad.

Factores de riesgo preoperatorios asociados a conversión a técnica abierta en colecistectomía laparoscópica de urgencia

Introducción: la colecistectomía laparoscópica es la técnica de elección en pacientes con indicación de extracción quirúrgica de la vesícula; sin embargo, en promedio 20% de éstos requieren conversión a técnica abierta. En este estudio se evaluaron los factores de riesgo preoperatorios para conversión en colecistectomía laparoscópica de urgencia. Metodología: se realizó un estudio de casos y controles no pareado. Se obtuvo información sociodemográfica y de variables de interés de los registros de historias clínicas de pacientes operados entre el 2013 y 2016. Se identificaron los motivos de conversión de técnica quirúrgica. Se caracterizó la población de estudio y se estimaron asociaciones según la naturaleza de las variables. Mediante un análisis de regresión logística se ajustaron posibles variables de confusión. Resultados: se analizaron los datos de 444 pacientes (111 casos y 333 controles). La causa de conversión más frecuente fue la dificultad técnica (50,5%). Se encontró que la mayor edad, el sexo masculino, el antecedente de cirugía abierta en hemiabdomen superior, el signo de Murphy clínico positivo, la dilatación de la vía biliar, la leucocitosis y la mayor experiencia del cirujano, fueron factores de riesgo para conversión. Se encontró un área bajo la curva ROC= 0,743 (IC95% 0,692–0,794, p= <0,001). Discusión: existen unos factores que se asocian a mayor riesgo de conversión en colecistectomía laparoscópica. La mayoría se relacionan con un proceso inflamatorio más severo, por lo que se debe evitar la prolongación del tiempo de espera entre el inicio de los síntomas y la extirpación quirúrgica de la vesícula.

No evidence for association of ataxia-telangiectasia mutated gene T2119C and C3161G amino acid substitution variants with risk of breast cancer

Background There is evidence that certain mutations in the double-strand break repair pathway ataxia-telangiectasia mutated gene act in a dominant-negative manner to increase the risk of breast cancer. There are also some reports to suggest that the amino acid substitution variants T2119C Ser707Pro and C3161G Pro1054Arg may be associated with breast cancer risk. We investigate the breast cancer risk associated with these two nonconservative amino acid substitution variants using a large Australian population-based case–control study. Methods The polymorphisms were genotyped in more than 1300 cases and 600 controls using 5' exonuclease assays. Case–control analyses and genotype distributions were compared by logistic regression. Results The 2119C variant was rare, occurring at frequencies of 1.4 and 1.3% in cases and controls, respectively (P = 0.8). There was no difference in genotype distribution between cases and controls (P = 0.8), and the TC genotype was not associated with increased risk of breast cancer (adjusted odds ratio = 1.08, 95% confidence interval = 0.59–1.97, P = 0.8). Similarly, the 3161G variant was no more common in cases than in controls (2.9% versus 2.2%, P = 0.2), there was no difference in genotype distribution between cases and controls (P = 0.1), and the CG genotype was not associated with an increased risk of breast cancer (adjusted odds ratio = 1.30, 95% confidence interval = 0.85–1.98, P = 0.2). This lack of evidence for an association persisted within groups defined by the family history of breast cancer or by age. Conclusion The 2119C and 3161G amino acid substitution variants are not associated with moderate or high risks of breast cancer in Australian women.