Computerized Tomography Contrast Induced Nephropathy (CIN) among adult inpatients

Introduction: Contrast induced nephropathy (CIN) is one of the complications of the use of intravascular contrast agents, being defined as a reduction of the glomerular filtration rate caused by the iodinated contrast. Most CIN data derive from the cardiovascular literature, which identified as the most consistent risk factors pre-existing chronic renal insufficiency and diabetes mellitus. However, these studies limit their conclusions to a more specific patient population. Computerized tomography as a cause of CIN has been studied less often. Objective: To report on the incidence of computerized tomography contrast induced nephropathy (CIN) in an inpatient population of a tertiary general hospital, identifying potentially avoidable risk factors. Methods: We performed a prospective cohort study with inpatients admitted at a tertiary hospital requiring contrast-induced CT. The primary outcome was the development of CIN, measure by the alteration of serum creatinine or glomerular filtration rate in 48 or 72 hours. Through clinical interview, we verified possible risk factors and preventive measures instituted by the medical team and their association with development of CIN. Results: Of a total of 410 patients, 35 (8.5%) developed CIN. There was a positive correlation between CIN and the presence of diabetes mellitus (OR = 2.15; 95%CI 1.35-4.06; p = 0.02), heart failure (OR = 2.23; 95%CI 1.18-8.8; p = 0.022), and renal failure (OR = 3.36; 95%CI 1.57- 7.17; p = 0.002) Conclusion: Incidence of CIN varies according to the population. Diabetes mellitus, heart failure and renal failure were independent risk factors for the development of CT-associated CIN. Further studies are needed to better understand and treat CT-associated CIN.

Korkeasti koulutettujen selviytyminen työn menetyksestä ja pitkittyneestä työttömyydestä

Tämän pro gradu -tutkielman tavoitteena oli ymmärtää ja kuvata korkeasti koulutettujen henkilöiden selviytymistä työn menetyksestä ja pitkittyneestä työttömyydestä. Tutkimuksessa tarkasteltiin pakotettua uramuutosta ja työttömyyttä sekä siitä selviytymistä yksilön kokemuksen näkökulmasta. Lisäksi tutkittiin työttömyyden tukipalveluiden hyödyllisyyttä. Tutkimus toteutettiin kvalitatiivisena kuvailevana tapaustutkimuksena. Tutkimuksen empiirinen aineisto kerättiin haastattelemalla 13 korkeasti koulutettua uusimaalaista työtöntä henkilöä. Haastattelut toteutettiin puolistrukturoitua teemahaastattelumenetelmää käyttäen. Tutkimuksen tulosten perusteella voidaan havaita, että työn menetyksellä koettiin olevan sekä negatiivisia että positiivisia vaikutuksia. Työn menetys koettiin osittain helpotuksena ja hengähdystaukona. Henkilöt selviytyivät itse työn menetyksen tilanteesta jokseenkin hyvin, etenkin jos muutokseen oli voinut varautua ja irtisanomisperusteet olivat selkeät. Korkeasti koulutetut henkilöt käyttivät monipuolisesti sekä tunne- että ongelmakeskeisiä selviytymisstrategioita selviytyäkseen työttömyydestä. Näistä aktiivinen työnhaku sekä opiskelu korostuivat selviytymiskeinoina. Työttömyyden pitkittyminen heikensi selvästi yksilön hyvinvointia ja vertaistuen merkitys korostui työttömyyden pitkittyessä. Tutkimuksesta ilmeni, että julkiset työvoimapalvelut eivät tue riittävästi korkeasti koulutettuja työttömiä. Tukipalveluja tulisi kehittää vastaamaan paremmin muuttuneiden työmarkkinoiden vaateita, sillä työmarkkinoiden muutokset haastavat urien uudenlaiseen tarkasteluun.

Triadic Perspective to Sport Sponsorship Relationships

Often the empirical studies about sport sponsorship co-operation have concentrated on the relationships between the sponsor and the sponsored target excluding the phenomenon sports manager, i.e. the intermediating actor from further examination. In this study the purpose was to contribute to the research gap in the current literature by thoroughly describing the roles and relationships in the sport sponsorship co-operation that includes an intermediating actor, that is a triad. The main objective was pursued to fulfill with the help of two sub-level research questions that were identified as ”What is the nature of the sport sponsorship triad?” and ”What is the role of the intermediating actor within the sport sponsorship triad?” First, the theorethical framework was constructed based on the existing literature of business relationship triads and sponsorship co-operation that were integrated in the synthesis of the theories the purpose of which was to produce a framework for empirical research. Then a qualitative research was conducted by using a single-case study approach. The data was collected through a semi-structured theme interview in person with the sports manager. Similar questionnaires were sent out to the sponsor and the athlete and answered in writing. After collecting the data, the actor roles’ and their relationships were examined individually, after which the analysis of the results was carried out and divided according to the research questions. The nature of the sport sponsorship triad was found to be a serial triad that could be likened to a system of two dyads connected by the intermediating actor. Each actor seemed to occupy a specific justifiable position within the co-operation, even though the relationships were found to be unbalanced in terms of resources, power/strength, interaction patterns and interconnectedness. The core role of the intermediating actor was found to be the role of a mediator, which was seen to increase the other parties’ dependence of the manager’s performance. Therefore, the role of the intermediating actor should be considered crucial for the very existence of the sport sponsorship co-operation, especially in cases where the nature of the triad is a serial triad.

Unaccompanied minors in Canada: How social and legal services affect their lives in Ontario

This qualitative research examines how service provisions affect lives of unaccompanied minors in Canada. In this study I utilized a semi-structured individual interview method. Among thirteen participants in my study, five came to Canada as unaccompanied minors and eight are professionals involved with service providing organizations in the Niagara region. The unaccompanied children that I interviewed had mixed experiences. Social and legal supports were made available to some of them while one was deported. This paper employs Bhabha’s postcolonial perspective and Foucault’s governmentality to illustrate unaccompanied minors’ post-arrival situation in Canada. This paper also attempts to look at children’s rights from Hanson and Nieuwenhuys’s (2013) perspective of living rights, social justice and translations. This paper explores how the change in recent immigration law affects the lives of unaccompanied minors. Findings of this study suggest that it is important to have a consensus on the definition of an unaccompanied minor; improved data collection and record-keeping on the number of unaccompanied minors; and, having a government-approved follow up mechanism. The study recommends policy makers, service providers and scholars pay increased attention to the experiences of unaccompanied minors to ensure that adequate social and legal services are offered to an unaccompanied minor in Canada.

Une évaluation qualitative d’un programme de préparation à l’examen professionnel québécois à partir de la perception des candidates infirmières

Depuis 2000, l’examen professionnel de l’Ordre des infirmières et infirmiers du Québec (OIIQ) est constitué d’une partie écrite et d’une partie pratique sous la forme d’un examen clinique objectif structuré (ECOS). Des programmes de préparation à l’examen professionnel ont été mis en place par différents milieux afin d’aider les candidates à l’exercice de la profession infirmière (CEPI) à se préparer pour cet examen, toutefois aucune évaluation de ces programmes n’a encore été effectuée. Cette étude avait pour but d’évaluer qualitativement un programme de préparation à l’examen professionnel. Des groupes de discussion ont été organisés avec des CEPI ayant participé au programme de préparation afin d’obtenir leur perception quant à l’impact de ce programme sur leur expérience de l’examen professionnel. La méthode d’analyse par questionnement analytique de Paillé et Mucchielli (2008) a été utilisée pour réaliser l’analyse des données. L’approche par compétences de deuxième génération développée par Goudreau, Pepin, Dubois, Boyer, Larue et Legault (2009) fut utilisée comme cadre de référence pour cette étude. L’analyse des données a permis d’identifier les attentes des CEPI à l’égard du programme de préparation et les impacts de celui-ci sur leur expérience à l’examen professionnel. Ainsi, le programme permettrait aux CEPI d’évaluer leurs forces et leurs faiblesses afin d’orienter l’étude préparatoire, tout en diminuant le stress relié à l’inconnu et en augmentant leur motivation et leur confiance en elles. Le parcours ECOS et la rétroaction sont les activités du programme jugées les plus pertinentes dans une perspective d’approche par compétences. L’examen écrit serait toutefois moins représentatif de l’examen professionnel et moins pertinent pour le développement des compétences. Des suggestions d’amélioration pour le programme de préparation découlent des entrevues avec les participantes et des recommandations pour la gestion, la pratique, la formation et la recherche en sciences infirmières ont également été émises à la suite de cette étude.

L'évaluation systématique de la lombalgie selon les données probantes.

Les illustrations accompagnant le texte ont été dessinées par monsieur Mathieu Gagnon.

Treating delusional disorder : a comparison of cognitive-behavioural therapy and attention placebo control

Objective: Cognitive-behavioural therapy (CBT) has proved effective in treating delusions, both in schizophrenia and delusional disorder (DD). Clinical trials of DD have mostly compared CBT with either treatment as usual, no treatment, or a wait-list control. This current study aimed to assess patients with DD who received CBT, compared with an attention placebo control (APC) group. Method: Twenty-four individuals with DD were randomly allocated into either CBT or APC groups for a 24-week treatment period. Patients were diagnosed on the basis of structured clinical interviews for mental disorders and the Maudsley Assessment of Delusion Schedule (MADS). Results: Completers in both groups (n = 11 for CBT; n = 6 for APC) showed clinical improvement on the MADS dimensions of Strength of Conviction, Insight, Preoccupation, Systematization, Affect Relating to Belief, Belief Maintenance Factors, and Idiosyncrasy of Belief. Conclusion: When compared with APC, CBT produced more impact on the MADS dimensions for Affect Relating to Belief, Strength of Conviction, and Positive Actions on Beliefs.

Validez y confiabilidad, versión hispana Instrumento de Tamizaje Juvenil

Objetivos: evaluar la validez y confiabilidad de la versión hispana del instrumento de Tamizaje Juvenil (Encuesta de Salud Juvenil, ESJ) de la Universidad de Columbia aplicados en 2009 por el Programa de Salud Mental Juvenil de la Universidad del Rosario (UR) en el 8avo grado del Centro Educativo Integral de Colsubsidio (CEIC) en Bogotá, Colombia Metodología: Diseño observacional de evaluación de prueba diagnóstica tipo tamizaje en las dos etapas consecutivas del Programa de Tamizaje Juvenil aplicado en 183 alumnos. Evaluación de la reproducibilidad de las pruebas aplicadas a una sub muestra de 63 alumnos calculado con un muestreo aleatorizado por afijacion proporcional en un intervalo de 20 días. Resultados: el instrumento Encuesta de Salud Juvenil (ESJ) mostró una alta sensibilidad (100 %) y adecuada especificidad (89,09 %), un valor predictivo positivo del 85,88 % lo que le confiere adecuada validez. La confiabilidad y consistencia interna de la prueba son buenas, Alfa de Cronbach: 0,700, así como la concordancia de la ESJ inicial y la entrevista clínica de la segunda etapa del tamizaje (Kappa de 0.867, error estándar de 0.037 (p<0.001)). La reproducibilidad mostró un índice de Kappa de 0,645 en la sub muestra evaluada 20 días después. Conclusiones: la versión hispana del instrumento de Tamizaje Juvenil de la Universidad de Columbia tiene validez y confiabilidad adecuada para la detección de conducta suicida y signos de enfermedad mental en adolescentes.

O trabalho cooperativo entre professores nos diferentes grupos de área disciplinar na mesma escola

O trabalho cooperativo nas comunidades escolares apresenta inúmeras vantagens ao nível do desenvolvimento dos alunos, dos professores e da própria escola. No entanto, continuam a existir várias lacunas neste tipo de actividades e, especificando Portugal, existem muitos trabalhos de tipo diagnóstico, que não chegam para implantar cultura de cooperação. Quando falamos da implementação da cooperação nas escolas, temos de atender, obrigatoriamente, à cultura de escola vivenciada nas mesmas e à liderança, pois influenciam a cooperação. Este trabalho tem como finalidade verificar até que ponto existe trabalho cooperativo entre professores e perceber como se desenvolve a cultura de cooperação entre professores nos diferentes grupos de área disciplinar duma mesma escola. Para verificar este objectivo, participaram 13 responsáveis dos diferentes grupos de Áreas Disciplinares de uma escola secundária da zona do Estoril. Estes foram inquiridos através da aplicação de um questionário adaptado, daquele que foi validado e utilizado por Bolam et al (2005), e através de uma entrevista semi-estruturada, para análise da percepção que os mesmos têm sobre a cooperação e a cultura vivenciada dentro dos seus Grupos de Área Disciplinar. No geral, verificou-se que, relativamente à cooperação e à cultura cooperativa de grupo, os Departamentos de Área Curricular não diferem significativamente entre si, não existindo um grande sentido de cooperação. De acordo com as percepções dos inquiridos, verificou-se que existe uma fraca participação dos professores em acções cooperativas focalizadas no desenvolvimento profissional docente e focalizadas no desenvolvimento da cultura cooperativa ou através das precárias condições ou práticas extrínsecas a este desenvolvimento. Analisando a globalidade das mudanças verificadas nos últimos dois anos, constatou-se que os Grupos de Área Disciplinar estão a viver um momento de estagnação na maioria das questões inquiridas. Averiguou-se, também, que a não/fraca liderança por parte dos responsáveis de grupo de área disciplinar, resulta numa fraca participação dos professores em questões cooperativas. Através deste estudo, pode-se concluir que existe uma fraca cooperação entre os professores do mesmo Grupo de Área Disciplinar desta escola. Conclui-se também que a escola atravessa um momento de estagnação, não existindo um real desenvolvimento da cultura cooperativa na escola.

Caracterização psicológica dos pacientes com obesidade severa, antes e depois da cirurgia bariatárica

Apesar de a prevalência de psicopatologia entre candidatos de cirurgia bariátrica ser superior à da população não obesa, sabe-se pouco sobre o impacto da cirurgia em termos psicopatológicos. O principal objectivo deste estudo foi caracterizar a evolução de morbilidade psicopatológica em doentes submetidos a cirurgia bariátrica. Estudo observacional longitudinal. Foram incluídos todos os doentes submetidos a cirurgia bariátrica entre Março 2008 e Junho 2010 num hospital geral da região sul de Portugal. A avaliação psicológica foi feita através de entrevista clínica estruturada, com aplicação do MCMI-III (mesmo protocolo antes e 12 meses após a cirurgia). Participaram 20 doentes (19 mulheres). Os síndromes de eixo 1 do DSM-IV mais prevalentes antes da cirurgia foram: ansiedade (40%), distimia (20%), perturbação somatoforme e perturbação delirante (15% cada). Depois da cirurgia, os mais prevalentes foram: ansiedade (40%), perturbação bipolar, distimia, e perturbação delirante (15% cada). A perturbação da personalidade mais prevalente (pré-cirurgia) foi a compulsiva (15%). Depois da cirurgia, foram: histriónica, compulsiva, e paranóide (10% cada). Em conclusão, a cirurgia bariátrica parece não ser eficaz, por si só, para a remissão de psicopatologia associada à obesidade severa.

Postpartum GAD is a risk factor for postpartum MDD: the course and longitudinal relationships of postpartum GAD and MDD

Background The objective was to examine the course and longitudinal associations of generalized anxiety disorder (GAD) and major depressive disorder (MDD) in mothers over the postpartum 2 years. Method Using a prospective naturalistic design, 296 mothers recruited from a large community pool were assessed for GAD and MDD at 3, 6, 10, 14, and 24 months postpartum. Structured clinical interviews were used for diagnoses, and symptoms were assessed using self-report questionnaires. Logistic regression analyses were used to examine diagnostic stability and longitudinal relations, and latent variable modeling was employed to examine change in symptoms. Results MDD without co-occurring GAD, GAD without co-occurring MDD, and co-occurring GAD and MDD, displayed significant stability during the postpartum period. Whereas MDD did not predict subsequent GAD, GAD predicted subsequent MDD (in the form of GAD + MDD). Those with GAD + MDD at 3 months postpartum were significantly less likely to be diagnosis free during the follow-up period than those in other diagnostic categories. At the symptom level, symptoms of GAD were more trait-like than those of depression. Conclusions Postpartum GAD and MDD are relatively stable conditions, and GAD is a risk factor for MDD but not vice versa. Given the tendency of MDD and GAD to be persistent, especially when comorbid, and the increased risk for MDD in mothers with GAD, as well as the potential negative effects of cumulative exposure to maternal depression and anxiety on child development, the present findings clearly highlight the need for screening and treatment of GAD in addition to MDD during the postpartum period.

Health in Madeira: a comprehensive study of aging, body composition, physical activity and functional fitness

Physical Activity (PA) and functional fitness (FF) are predictors of a healthy and independent lifestyle in older adults. The purpose of this study was: (1) to construct reference values for FF; (2) to describe sex- and age-related changes in FF, balance, gait, PA, body composition, and bone health/strength; and (3) to determine their variation and co-variation with respect to PA. This cross-sectional study included 401 males and 401 females aged 60-79 years old. FF was assessed using the Senior Fitness test and balance by the Fullerton Advance Balance scale (FAB). Gait parameters: gait velocity (GV), stride length (SL), cadence and gait stability ratio (GSR) were measured. Femoral strength index (FSI) and bone mineral density (BMD) of the total body, lumbar spine, hip region and total lean tissue mass (TLTM) and total fat mass (TFM) were determined by dual-energy x-ray absorptiometry-DXA. PA was assessed during face-to-face interviews using the Baecke questionnaire. Demographic and health history information were obtained by structured telephone interview. In both sexes, a significant main effect for age-group was found for FF parameters, balance scores, gait performances, TLTM and hip, LS and total BMD and FSI. Likewise there were significant main effects for age-group for total PA in women and sports related PA in men. Men scored significantly better than women in FF (except in upper- and lower-body flexibility), balance, GV, SL, GSR and had higher BMD and TLTM compared with women. Active subjects scored better in FF, balance, and gait than their average and non-active peers. PA and FF exerted only a minor influence in the differentiation of BMD and FSI among the elderly while constitutive factors like age, height, body mass, TLTM and TFM entered as the most significant contributors. This study gives scientific support to public policies at the community level, targeted to increase PA, FF and TLTM, thereby contributing to improved quality of life in older adults.

Obsessive-compulsive disorder: Prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000

Objective: There is little information about obsessive-compulsive disorder in large representative community samples. The authors aimed to establish obsessive-compulsive disorder prevalence and its clinical typology among adults in private households in Great Britain and to obtain generalizable estimates of impairment and help-seeking.Method: Data from the British National Psychiatric Morbidity Survey of 2000, comprising 8,580 individuals, were analyzed using appropriate measurements. The study compared individuals with obsessive-compulsive disorder, individuals with other neurotic disorders, and a nonneurotic comparison group. ICD-10 diagnoses were derived from the Clinical Interview Schedule-Revised.Results: the authors identified 114 individuals (74 women, 40 men) with obsessive-compulsive disorder, with a weighted 1-month prevalence of 1.1%. Most individuals (55%) in the obsessive-compulsive group had obsessions only. Comorbidity occurred in 62% of these individuals, which was significantly greater than the group with other neuroses (10%). Co-occurring neuroses were depressive episode (37%), generalized anxiety disorder (31%), agoraphobia or panic disorder (22%), social phobia (17%), and specific phobia (15%). Alcohol dependence was present in 20% of participants, mainly men, and drug dependence was present in 13%. Obsessive-compulsive disorder, compared with other neurotic disorders, was associated with more marked social and occupational impairment. One-quarter of obsessive-compulsive disorder participants had previously attempted suicide. Individuals with pure and comorbid obsessive-compulsive disorder did not differ according to most indices of impairment, including suicidal behavior, but pure individuals were significantly less likely to have sought help (14% versus 56%).Conclusions: A rare yet severe mental disorder, obsessive-compulsive disorder is an atypical neurosis, of which the public health significance has been underestimated. Unmet need among individuals with pure obsessive-compulsive disorder is a cause for concern, requiring further investigation of barriers to care and interventions to encourage help-seeking.

Detecção do risco de suicídio nos serviços de emergência psiquiátrica

OBJETIVO: Auxiliar o profissional de saúde na identificação dos fatores de risco e de proteção, e no manejo de pacientes com risco de suicídio, por meio de entrevista clinica, no contexto de emergência médica. MÉTODO: Revisão seletiva da literatura para identificar achados clínicos relevantes e ilustrativos. RESULTADO: A entrevista clinica é o melhor método para avaliar o risco suicida e tem dois objetivos: 1) apoio emocional e de estabelecimento de vínculo; 2) coleta de informações. Existe um número considerável de informações a serem coletadas durante a entrevista: fatores de risco e proteção (predisponentes e precipitantes), dados epidemiológicos, caracterização do ato, aspectos psicodinâmicos, antecedentes pessoais e familiares, modelos de identificação, dados sobre saúde física e rede de apoio social. Dificuldades ao longo da entrevista serão encontradas, mas com conhecimento e treinamento adequado, o profissional poderá abordar e ajudar adequadamente o paciente. Embora várias escalas tenham sido propostas, nenhuma delas demonstrou eficiência para a detecção de risco de suicídio. CONCLUSÃO: Não há como prever quem cometerá suicídio, mas é possível avaliar o risco individual que cada paciente apresenta, tendo em vista a investigação detalhada e empática da entrevista clinica. Impedir que o paciente venha a se matar é regra preliminar e fundamental.

Vinegar as an antimicrobial agent for control of Candida spp. in complete denture wearers

The use of denture is known to increase the carriage of Candida in healthy patients, and the proliferation of Candida albicans strains can be associated with denture-induced stomatitis. The aim of this study was to evaluate the use of vinegar as an antimicrobial agent for control of Candida spp. in complete upper denture wearers. Fifty-five patients were submitted to a detailed clinical interview and oral clinical examination, and were instructed to keep their dentures immersed in a 10% vinegar solution ( pH less than 3) overnight for 45 days. Before and after the experimental period, saliva samples were collected for detection of Candida, counting of cfu/mL and identification of species by phenotypical tests ( germ tube formation, chlamidoconidia production, and carbohydrate fermentation and assimilation). The results were analyzed using Spearman's correlation and Student's t-test (p=0.05). Candida yeasts were present in 87.3% of saliva samples before the treatment. A significant reduction was verified in CFU/mL counts of Candida after treatment. A positive correlation between Candida and denture stomatitis was verified, since the decrease of cfu/mL counts was correlated with a reduction in cases of denture stomatitis. Although it was not able to eliminate C. albicans, the immersion of the complete denture in 10% vinegar solution, during the night, reduced the amounts (cfu/mL) of Candida spp. in the saliva and the presence of denture stomatitis in the studied patients.