929 resultados para Older Sub-acute ED Presentations


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Responding to calls for a better understanding of the relationship between social enterprises and their environments, this article focuses on contextual influences on social entrepreneurship in sub-Saharan Africa. We identify four predominantly African contextual dimensions, i.e., acute poverty, informality, colonial history, and ethnic group identity, and explore their influence on the way social ventures perceive themselves and on their choice of activities. Our empirical study of 384 social enterprises from 19 sub-Saharan African countries suggests that ethnic group identity and high poverty levels influence both self-perception and activity choices, while the country’s colonial history only influences self-perception and informality has no significant influence on either. These findings point to the need to consider both self-perception and the choice of activities in defining social entrepreneurship. Our study also highlights the importance of African contextual dimensions for understanding social entrepreneurship, and underlines the added value of incorporating insights from African data into management research more broadly.

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Background In the UK occupational therapy pre-discharge home visits are routinely carried out as a means of facilitating safe transfer from the hospital to home. Whilst they are an integral part of practice, there is little evidence to demonstrate they have a positive outcome on the discharge process. Current issues for patients are around the speed of home visits and the lack of shared decision making in the process, resulting in less than 50 % of the specialist equipment installed actually being used by patients on follow-up. To improve practice there is an urgent need to examine other ways of conducting home visits to facilitate safe discharge. We believe that Computerised 3D Interior Design Applications (CIDAs) could be a means to support more efficient, effective and collaborative practice. A previous study explored practitioners perceptions of using CIDAs; however it is important to ascertain older adult’s views about the usability of technology and to compare findings. This study explores the perceptions of community dwelling older adults with regards to adopting and using CIDAs as an assistive tool for the home adaptations process. Methods Ten community dwelling older adults participated in individual interactive task-focused usability sessions with a customised CIDA, utilising the think-aloud protocol and individual semi-structured interviews. Template analysis was used to carry out both deductive and inductive analysis of the think-aloud and interview data. Initially, a deductive stance was adopted, using the three pre-determined high-level themes of the technology acceptance model (TAM): Perceived Usefulness (PU), Perceived Ease of Use (PEOU), Actual Use (AU). Inductive template analysis was then carried out on the data within these themes, from which a number of sub-thmes emerged. Results Regarding PU, participants believed CIDAs served as a useful visual tool and saw clear potential to facilitate shared understanding and partnership in care delivery. For PEOU, participants were able to create 3D home environments however a number of usability issues must still be addressed. The AU theme revealed the most likely usage scenario would be collaborative involving both patient and practitioner, as many participants did not feel confident or see sufficient value in using the application autonomously. Conclusions This research found that older adults perceived that CIDAs were likely to serve as a valuable tool which facilitates and enhances levels of patient/practitioner collaboration and empowerment. Older adults also suggested a redesign of the interface so that less sophisticated dexterity and motor functions are required. However, older adults were not confident, or did not see sufficient value in using the application autonomously. Future research is needed to further customise the CIDA software, in line with the outcomes of this study, and to explore the potential of collaborative application patient/practitioner-based deployment.

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Flavonoids are polyphenolic compounds found in varying concentrations in many plant-based foods. Recent studies suggest that flavonoids can be beneficial to both cognitive and physiological health. Long term flavonoid supplementation over a period of weeks or months has been extensively investigated and reviewed, particularly with respect to cognitive ageing and neurodegenerative disease. Significantly less focus has been directed towards the short term effects of single doses of flavonoids on cognition. Here, we review 21 such studies with particular emphasis on the subclass and dose of flavonoids administered, the cognitive domains affected by flavonoid supplementation, and the effect size of the response. The emerging evidence suggests that flavonoids may be beneficial to attention, working memory, and psychomotor processing speed in a general population. Episodic memory effects are less well defined and may be restricted to child or older adult populations. The evidence also points towards a dose-dependent effect of flavonoids, but the physiological mechanisms of action remain unclear. Overall, there is encouraging evidence that flavonoid supplementation can benefit cognitive outcomes within an acute time frame of 0–6 h. But larger studies, combining cognitive and physiological measures, are needed to strengthen the evidence base.

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Objective: To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). Design: Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. Setting: 3 acute and 13 primary care National Health Service Trusts in England. Participants: 16 continence service leads in England actively treating and managing older people with UI. Results: In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and highquality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work. Conclusions: Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.

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Introdução: As infecções virais do trato respiratório (IVTR) têm sido freqüentemente identificadas em associação com asma aguda (AA) em crianças, porém poucos estudos têm mostrado resultados similares em adultos com asma. Objetivos: Avaliar a prevalência de infecção viral na asma aguda em pacientes atendidos no setor de adultos do departamento de emergência (DE), comparando as características entre os grupos com amostras positivas e negativas para os vírus respiratórios. Material e Métodos: Conduzimos um estudo transversal de pacientes que se apresentaram com AA no setor de adultos do DE (idade igual ou maior que 12 anos) do Hospital de Clínicas de Porto Alegre. Um aspirado nasofaríngeo foi obtido para detecção de antígeno com a técnica de coloração de imunofluorescência indireta (vírus sincicial respiratório, adenovírus, influenza e parainfluenza tipo 1, 2, 3 e 4). Foram coletados dados referentes a características demográficas, medicações regulares, história médica pregressa, crise que levou à atual visita ao DE e desfechos da crise. Resultados: No período de março de 2004 a novembro de 2005, 111 pacientes foram examinados para IVTR. Foram identificados vírus respiratórios em 15 pacientes (8 com Adenovírus, 1 com RSV, 2 com Influenza A, e 4 com Parainfluenza tipo 1). Utilizando a análise de regressão logística, as variáveis com (p < 0,10), índice de massa corporal (IMC) e febre no domicilio, foram significativamente associados à identificação de vírus respiratório. Sessenta e seis por cento dos pacientes com IVTR apresentaram febre no domicílio, enquanto que somente 27% dos pacientes sem infecção viral apresentaram febre a domicílio, (p = 0,006). Não houve outra diferença significativa nas características clínicas, tempo de permanência e desfechos. Conclusão: Este estudo mostra uma prevalência de 13,5% de IVTR na AA em pacientes com idade igual ou maior que 12 anos atendidos na sala de emergência, confirmando a infecção viral como importante desencadeante nesta faixa etária. Dentre as características clínicas estudadas, febre no domicílio e IMC elevado, apresentam maior chance de identificação viral positiva.

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A partir de um acidente causado pela picada de uma formiga falsa tocandira na mão de um pescador amador, os autores descrevem os achados clínicos locais observados, tais como edema, eritema e dor excruciante e a evolução do envenenamento, que cursou com fenômenos sistêmicos imediatos, como sudorese fria, náuseas, vômitos, mal estar, taquicardia e linfadenopatia axilar à esquerda. Após três horas, a dor intensa persistia e o paciente apresentou um episódio de hematoquesia, sem história anterior de enfermidades do trato digestivo, hematológicas ou vasculares. O uso de analgésicos (Tramal® 300 mg/dia), água quente e gelo não melhorou a dor, que arrefeceu em oito horas, tendo permanecido por cerca de 24 horas. São apresentados ainda os aspectos folclóricos, farmacológicos e clínicos relacionados às picadas de tocandiras.

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This study evaluated the expression of heat shock protein 70 kD (hsp70) in broiler chicken embryos subjected to cold (Experiment 1) or high incubation temperature (Experiment 11). In each experiment, fertile eggs were distributed in three incubators kept at 37.8degreesC. At day 13 (D13), D16, and D19 of incubation, the embryos were subjected to acute cold (32degreesC) or heat (40degreesC) for 4-6 hr. Immediately after cold or heat exposure, samples from the liver, heart, breast muscle, brain, and lungs of 40 embryos were taken per age and treatment (control or stressed embryos), A tissue pool from 10 embryos was used as 1 replication. The levels of hsp70 in each tissue sample was quantified by Western blot analysis. The data were analyzed in a 3 x 2 factorial arrangement of treatments with four replications. hsp70 was detected in all embryo tissues, and the brain contained 2- to 5-times more hsp70 protein compared to the other tissues in either cold or heat stressed embryos. hsp70 increases were observed in the heart and breast muscle of cold stressed embryos at D16 and D19, respectively. Heat stressed embryos showed an increase of hsp70 in the heart at D13 and D19, and in the lung at D19 of incubation. Younger embryos had higher hsp70 synthesis than older embryos, irrespective of the type of thermal stressor. The results indicate that the expression of hsp70 in broiler chicken embryos is affected by cold and heat distress, and is tissue- and age-dependent. (C) 2004 Wiley-Liss, Inc.

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The purpose of this study was to investigate if chronic eccentric strength training (ST) affects heart rate (HR) and heart rate variability (HRV) during sub-maximal isometric voluntary contractions (SIVC). The training group (TG) (9 men, 62 ± 2) was submitted to ST (12 weeks, 2 days/week, 2 - 4 sets of 8-12 repetitions at 75-80% peak torque (PT). The control group (CG) (8 men, 64 ± 4) did not perform ST. The HR and the HRV (RMSSD index) were evaluated during SIVC of the knee extension (15, 30 and 40% of PT). ST increased the eccentric torque only in TG, but did not change the isometric PT and the duration of SIVC. During SIVC, the HR response pattern and the RMSSD index were similar for both groups in pre- and post-training evaluations. Although ST increased the eccentric torque in the TG, it did not generate changes in HR or HRV. © Springer-Verlag 2008.

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Physical activity is considered an extremely effective therapy in cases of type 1 diabetes (DM-1), as it promotes glucose uptake independent of insulin action. However, there are few studies on the effect of a single session of exercise on glucose uptake in DM-1 (i.e., in the absence of insulin). Therefore, the purpose of this study was to assess the effect of a single exercise session on glucose homeostasis in DM-1 rats. For this purpose, 30 male rats were divided into three groups: sedentary control (SC), sedentary diabetic (SD), and exercise diabetic (ED). DM was induced by administration of alloxan and identified by the value of fasting glucose. The physical activity consisted of a single swimming session at the anaerobic threshold intensity for diabetic rats (3.5% body weight overload) for 30 min. The oral glucose tolerance test (OGTT) was performed immediately after the physical activity. The animals were sacrificed 48 hr after the OGTT, and samples were taken from the blood, liver, gastrocnemius, and mesenteric and subcutaneous adipose tissue. We observed that DM caused significant reduction in body weight. A single session of physical activity did not modify the response to the OGTT or glucose. However, it resulted in increased HDL cholesterol and hepatic glycogen content. These results suggest that, despite not having an effect on glucose homeostasis, acute physical activity performed at anaerobic threshold intensity leads to beneficial changes in the context of type 1 diabetes.

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Aims of our study were to describe the long-term survival in patients surviving an acute tubular necrosis (ATN) episode and determine factors associated with late mortality. We performed a prospective cohort study that evaluated the long-term outcome of 212 patients surviving an ATN episode. Mortality at the end of followup was 24.5%, and the probability of these patients being alive 5 years after discharge was 55%. During the followup, 4.7% of patients needed chronic dialysis. Univariate analysis showed that previous CKD (P = 0.0079), cardiovascular disease (P = 0.019), age greater than 60 years (P < 0.0001), and higher SCr baseline (P = 0.001), after 12 months (P = 0.0015) and 36 months (P = 0.004), were predictors of long-term mortality. In multivariate analysis, older age (HR = 6.4, CI 95% = 1.2-34.5, P = 0.02) and higher SCr after 12 months (HR = 2.1, 95% CI 95% = 1.14-4.1, P = 0.017) were identified as risk factors associated with late mortality. In conclusion, 55% of patients surviving an ATN episode were still alive, and less than 5% required chronic dialysis 60 months later; older age and increased Scr after 12 months were identified as risk factors associated with late death. © 2012 G. A. Brito et al.

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The circulating level of cortisol is regulated by the hypothalamic-pituitary-adrenal axis through a neuroendocrine feedback circuit. This circuit can be activated by physiological stimuli such as stress, diseases, and exercise. High levels of serum cortisol hormone normally occur as a byproduct of aging, and can cause several types of damage to the organism and exacerbate immunosenescence. There is a great deal of variability in the cortisol response with regard to type, intensity, volume, and frequency of exercise. However, these relationships have been extensively studied with respect to the acute effects of exercise. Despite the well-known effects of acute exercise on cortisol response, it is unclear how it is affected by chronic exercise and the aging process. Therefore, the aim of this study was to conduct a review of studies that attempt to analyze the influence of chronic exercise on serum cortisol hormone in older people. In order to accomplish this goal, a review from 1970 to June 2012 period was performed using the following databases: Biological Abstracts, PsycINFO, PubMed/Medline, and the Web of Science. Eight articles met the criteria used in this study. Based on the included articles, chronic exercise may influence the serum levels of cortisol levels in older people. Despite this evidence, these results may not be generalized to the entire population of older people, given the few number of studies and especially because the studies showed diversity in variables and methodologies. © 2013 European Group for Research into Elderly and Physical Activity (EGREPA).

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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O metabissulfito de sódio é um sal habitualmente usado no cultivo de camarão a fim de se evitar a melanose. Infelizmente o efeito toxicológico deste xenobiótico em caranguejos decápodes é desconhecido. O presente estudo objetiva investigar o LC50 - 96 h do metabissulfito de sódio na espécie Ucides cordatus em manguezal. A coleta dos caranguejos foi realizada nas margens do canal de maré estuarino em Bragança/PA. Os caranguejos foram submetidos a um teste preliminar (screening) e posteriormente ao teste definitivo, e foram expostos a cinco concentrações diferentes e um grupo controle com cinco repetições, com dois caranguejos por recipiente (5 L) durante 96 horas. Houve correlação negativa no aumento da concentração de metabissulfito de sódio com o oxigênio dissolvido e pH. No final do experimento foram obtidos os seguintes níveis de índice de mortalidade em relação s concentrações de metabissulfito de sódio: 100% em 86,0 mg.L-1, 74% em 62,0 mg.L-1, 52% em 52,0 mg.L-1, 44% em 38,0 mg.L-1. O valor da LC50 96h para U. cordatus foi determinado em 42,58 mg.L-1/Na2S2O5. Os resultados indicam que o metabissulfito de sódio é tóxico para U. cordatus e este caranguejo pode ser usado para biomonitoramento do impacto ambiental.

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Euterpe oleracea Mart. é uma típica palmeira da Amazônia, que cresce espontaneamente nos estados do Pará e Amapá, apreciada por sua atrativa beleza e valor nutricional. O fruto de Euterpe oleracea, comumente conhecido como açaí, tem demonstrado exibir significante capacidade anti-oxidante in vitro, o que pode ter benefícios à saúde. Estudos químicos revelaram a presença de ácidos graxos, antocianinas e esteroides. O objetivo deste trabalho foi caracterizar fitoquimícamente o óleo fixo dos frutos desta espécie (OEO) e avaliar em modelos inflamatórios e hiperalgésicos in vivo, o possível envolvimento dos compostos nas respostas inflamatória e analgésica. Para tanto, os modelos experimentais usados foram: teste de contorção induzida por ácido acético, edema de pata de rato, teste do granuloma em ratos, permeabilidade vascular em ratos, migração leucocitária em ratos e eritema de orelha induzida por óleo de cróton em camundongos. Doses orais de 500, 1000 e 1500 mg/kg de OEO inibiu o número de contorções em 33,67%, 45,88% e 55,58, respectivamente. O OEO produziu efeito dose-dependente, e a dose média efetiva encontrada foi de 1226,8mg/kg. Com a administração oral da dose de 1226,8 mg/kg, o OEO inibiu o processo inflamatório em 29,18% quando comparado ao grupo controle. A administração diária de OEO por 6 dias inibiu a formação do tecido granulomatoso em 36,66%. No eritema de orelha por óleo de cróton, o OEO provocou efeito inibitório significativo em 37,9%. No teste de permeabilidade vascular, o OEO inibiu a permeabilidade vascular em 54,5%. Na peritonite induzida por carragenina, o OEO reduziu o número de neutrófilos quando comparado ao grupo controle (inibição de 80,14%). A partir dos resultados obtidos, sugere-se que o OEO apresenta atividade anti-inflamatória, sobre os processos inflamatórios agudo e crônico, e atividade antinociceptiva, provavelmente de origem periférica.