Patients Receiving Physical Rehabilitation: Records of Sexual Function Before the Introduction of Erectogenic Drugs

The objective of this study is to evaluate the entries associated to the sexual function of patients undergoing physical disability rehabilitation, as well as the course of changes and medical approach through a retrospective review of medical charts. Methods: Medical records referring to the period between July and September, 1998 were evaluated. The data was divided into two groups, records containing physician`s entries on sexual function and/or entries of other health care professionals. The following aspects were investigated: whether complaints were spontaneously voiced by the patient, and whether diagnosis had been reached, with corresponding management. Results: Out of 245 medical records investigated, 17 (6.9%) contained clinical observations on the sexual function; out of those, 14 reached diagnosis. Twelve records (4.9%) had information by non-medical healthcare professionals. Out of 17 entries by doctors, 16 referred to male patients, which was found to be significant (p = 0.0202). Conclusions: Records for the sexual function of patients undergoing physical rehabilitation are scarce. In this population, the sexual function of male patients had more extensive investigation on the part of physicians when compared to other health care professionals.

Performance of a Brazilian population on the test of functional health literacy in adults

OBJECTIVE: To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS: The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS: The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not significant when the effects of education were held constant (rp=-0.031, p=0.584). A significant association (B=3.877, Beta =0.733; p<0.001) was found between schooling and scores. Age was not a significant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS: The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classified as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.

Programa de formação pós-graduada em fisioterapia respiratória

RESUMO: A fisioterapia caminha inevitavelmente para a especialização em determinadas áreas de intervenção (WCPT, 2007), nomeadamente na da fisioterapia respiratória. Este facto ocorre, por um lado, por se tratar de uma área de intervenção da fisioterapia com um papel específico e de carácter especializado e, por outro lado, devido à enorme procura deste tipo de serviços, causada também pelo aumento da prevalência de doenças respiratórias crónicas, que se tem vindo a verificar e que se prevê que se continue a verificar (OMS, 2005), e ainda à enorme transversalidade deste tipo de intervenção. A formação pós-graduada em fisioterapia respiratória, com o objectivo de fornecer aos formandos competências teórico-práticas que os apetreche para uma prática baseada na evidência, parece ser fundamental, mas a formação de adultos acarreta um compromisso com os princípios da aprendizagem específicos desta população. Os modelos de formação nesta área específica deverão incluir metodologias e conteúdos que cumpram objectivos reais, baseados não totalmente em curricula pré-estabelecidos, mas nas necessidades e expectativas de quem vive esta realidade, para além de se sustentarem nos referenciais teóricos. Assim, este estudo pretende avaliar a eficácia de um programa de formação pósgraduada em fisioterapia respiratória, baseado nas necessidades e expectativas dos sujeitos que estão envolvidos neste processo, e sustentado nos referenciais teóricos que se conhecem sob a forma de “standards”, “guidelines” ou recomendações. Os nossos objectivos específicos foram: a) Aferir quais as características que são importantes para garantir a eficácia de metodologia de um programa de formação pós-graduada na área da fisioterapia respiratória, ou seja, a “dinâmica” do processo. b) Aferir quais os conteúdos base que deverão fazer parte dessa formação e, c) Aferir se há vantagens distintas para formandos que já detenham experiência clínica e para recém-licenciados, e que frequentem o referido curso, ou seja, aferir o público-alvo. O desenho metodológico considerado para atingir os objectivos a que se propõe este estudo teve como base uma abordagem essencialmente qualitativa, mas recorreu a preciosas ferramentas quantitativas. Trata-se assim de uma abordagem de carácter misto. A nossa amostra, de conveniência, foi constituída pelos 22 formandos que se matricularam no único curso de pós-graduação em fisioterapia respiratória, que neste momento existe no nosso país. A recolha de dados obedeceu a uma estratégia comum nas abordagens qualitativas e que incluiu a “triangulação” de várias fontes e de vários métodos de recolha, a fim de permitir articular diferentes pontos de vista sobre um mesmo objecto. Assim, após a análise de referenciais teóricos considerados relevantes, recorreu-se à opinião de diferentes sujeitos, através de painéis, e de questionários, (questionários de opinião, questionários de caracterização, questionários de avaliação de conhecimentos e atitudes, à entrada e no final) bem como à avaliação de comportamentos, competências e atitudes, observados em ambiente simulado e real. A filosofia de formação que esteve subjacente ao nosso programa foi um constante compromisso entre a teoria, a prática e a clínica, em que o fenómeno de “transfert” foi potencializado por algumas características como o “fio condutor” entre os conteúdos, a presença de utentes reais nas aulas, os workshops temáticos e os estágios profissionais, a apresentação e discussão de estudos de caso com profissionais de referência, e os períodos de pausa entre seminários, em que estão facilitadas a reflexão, aplicação e experimentação de novas competências. Estas características estiveram na base dessa estreita relação entre a teoria, a prática e a clínica. Os critérios de selecção do corpo docente, capazes de funcionar como fontes de informação credível e actual e, sobretudo, capazes de funcionar como modelos profissionais, foram cruciais. Também o conhecimento das expectativas iniciais dos formandos e a monitorização facilitaram o processo de aprendizagem e o ajuste do programa ao longo do período de formação, assim como as avaliações formativas frequentes. Acreditamos que estas características do nosso programa foram fundamentais para a eficácia do mesmo, e que através delas obtivemos resultados positivos, em que se destacam a obtenção dos melhores resultados situados, sobretudo, nos níveis de complexidade relativos à resolução de problemas, e a valorização das competências ao do domínio afectivo. Corroborámos a teoria de que pessoas com formações e /ou experiências diferentes agem de maneiras diferentes, e aprendem de maneiras diferentes, e concluímos que os resultados nos estadios de aprendizagem e nas expectativas e necessidades colmatadas são generalizadamente positivos, o que torna qualquer dos grupos estudados, um público-alvo deste tipo de formação, embora possam ser apontadas algumas vantagens distintas conforme a experiência profissional de cada um, sendo os formandos com mais experiência, aqueles que mais evoluem em todos os domínios de aprendizagem. O aumento da empregabilidade dos formandos, directa ou indirectamente relacionado com a frequência do curso, parece ter sido um resultado positivo e inesperado. A possível caducidade do programa, o acompanhamento do grupo após o término do curso, o peso que os métodos de avaliação podem ter tido nos resultados, são algumas questões que ficam por esclarecer, e que merecem estudos futuros. Apesar disto, julgamos poder afirmar que este modelo de formação foi eficaz.

How effective are brief interventions in smoking cessation: project of a cohort study in a family health care unit

ABSTRACT: Tobacco use remains the most significant modifiable cause of disability, death and illness1. In Portugal, 19,6% of the population aged ten years or more smoke3. A Cochrane review of 20087 concluded that a brief advice intervention (compared to usual care) can increase the likelihood of a smoker to quit and remain nonsmoker 12 months later by a further 1 to 3 %. Several studies have shown that Primary Care Physicians can play a key role in these interventions8,9,10. However we did not find studies about the effectiveness of brief interventions in routine consultations of Family Doctors in Portugal. For this reason we designed a Cohort Study to make an exploratory study about the effectiveness of brief interventions of less than three minutes in comparison with usual care in routine consultations. The study will be implemented in a Family Healthcare Unit in Beja, during six months. Family Doctors of the intervention group should be submitted for an educational and training program before the study begin. Quit smoking sustained rates will be estimated one year after the first intervention in each smoker. If, as we expect, quit smoking rates will be higher in the intervention group than in the control group, this may change Portuguese Family Doctors attitudes and increase the provision of brief interventions in routine consultations in Primary Healthcare Centers.

Aprender a gostar de poesia: contributos para uma didática do texto poético em contexto de Educação Pré-Escolar e Ensino do 1º Ciclo

Relatório de estágio de mestrado em Educação Pré-Escolar e Ensino do 1º Ciclo do Ensino Básico

A 10-year experience in paediatric spontaneous cerebral hemorrhage: which children with headache need more than a clinical examination?

INTRODUCTION: When a child is seen in a clinic with a headache, stroke is certainly not the first on the list of differential diagnoses. In western countries, stroke is typically associated with adults and the elderly. Although rare, haemorrhagic strokes are not exceptional in the paediatric population, as their incidence is around 1/100 000/year. Prompt diagnosis is essential, since delayed treatment may lead to disastrous prognosis in these children. MATERIALS AND METHODS: This is a retrospective review of paediatric cases with spontaneous cerebral haemorrhage that presented in two university hospitals in the last ten years. The experience of these primary and tertiary referral centres comprises 22 consecutive cases that are analysed according to aetiology, presenting symptoms, treatment and outcome. RESULTS: 77% of the children diagnosed with haemorrhagic stroke presented with headaches. 41% of them had a sudden onset, while 9% developed headaches over a period of hours to weeks. While 9% presented only with headaches, the majority had either subtle (diplopia, balance problems) or obvious (focal deficits, unilateral weakness and decreased level of consciousness) concomitant neurological signs. 55% had an arteriovenous malformation (AVM), 18% had an aneurysm and 14% had a cavernous malformation. In 14% the aetiology could not be determined. The majority of haemorrhages (82%) were supratentorial, while 18% bled into the posterior fossa. All children underwent an emergency cerebral CT scan followed by specific investigations. The treatment was dependent on the aetiology as well as the mass effect of the haematoma. In 23% an emergent evacuation of the haematoma was performed. Two children (9%) died, and 75% had a favourable clinical outcome. CONCLUSION: Headaches in children are a common problem, and a small minority may reveal an intracranial haemorrhage with poor prognosis if not treated promptly. Although characterisation of headaches is more difficult in a paediatric population, sudden, unusual or intense headaches should lead to imaging work-up. Any neurological finding, even one as subtle as hemianopsia or dysmetria, should alarm the physician and should be followed by emergency imaging investigation. If the cerebral CT reveals a haemorrhage, the child should be referred immediately to a neurosurgical referral centre without further investigation. The outcome is grim for children presenting in coma with fixed, dilated pupils. The long-term result overall for children after spontaneous intracranial haemorrhage is not dismal and depends critically on specialised management.

Advanced trauma life support, 8th edition, the evidence for change.

The American College of Surgeons Committee on Trauma's Advanced Trauma Life Support Course is currently taught in 50 countries. The 8th edition has been revised following broad input by the International ATLS subcommittee. Graded levels of evidence were used to evaluate and approve changes to the course content. New materials related to principles of disaster management have been added. ATLS is a common language teaching one safe way of initial trauma assessment and management.

Glomérulonéphrite rapidement progressive: une urgence diagnostique et thérapeutique [Rapidly progressive glomerulonephritis: a diagnostic and therapeutic emergency]

Rapidly progressive glomerulonephritis (RPG) is a rare clinical syndrome characterized by kidney damage that can lead to irreversible kidney failure. RPG can be caused by primary glomerular disease or can be part of a systemic autoimmune disorder. All RPG have a similar pathophysiology (proliferation of cells in Bowman's capsule and formation of crescents) and clinical evolution (rapidly progressive kidney failure with proteinuria and an active urine sediment). Immunosuppressive therapy and sometimes plasma exchanges are required. Overall- and kidney survival are closely linked to the blood creatinine level at presentation, the percentage of damaged glomeruli, and to the underlying cause. RPG is therefore a diagnostic and therapeutic emergency that needs quick referral to a nephrologist.

Visualizing anti-tumor immune responses in vivo.

Real-time imaging of stromal and immune cells in tumors is an emerging field that will greatly help us to understand the role of these non-malignant tumor components in tumor progression and therapy.

Effects of increased intensity of intermittent training in runners with differing VO2 kinetics.

The purpose of this study was to test the hypothesis that athletes having a slower oxygen uptake ( VO(2)) kinetics would benefit more, in terms of time spent near VO(2max), from an increase in the intensity of an intermittent running training (IT). After determination of VO(2max), vVO(2max) (i.e. the minimal velocity associated with VO(2max) in an incremental test) and the time to exhaustion sustained at vVO(2max) ( T(lim)), seven well-trained triathletes performed in random order two IT sessions. The two IT comprised 30-s work intervals at either 100% (IT(100%)) or 105% (IT(105%)) of vVO(2max) with 30-s recovery intervals at 50% of vVO(2max) between each repeat. The parameters of the VO(2) kinetics (td(1), tau(1), A(1), td(2), tau(2), A(2), i.e. time delay, time constant and amplitude of the primary phase and slow component, respectively) during the T(lim) test were modelled with two exponential functions. The highest VO(2) reached was significantly lower ( P<0.01) in IT(100%) run at 19.8 (0.9) km(.)h(-1) [66.2 (4.6) ml(.)min(-1.)kg(-1)] than in IT(105%) run at 20.8 (1.0) km(.)h(-1) [71.1 (4.9) ml(.)min(-1.)kg(-1)] or in the incremental test [71.2 (4.2) ml(.)min(-1.)kg(-1)]. The time sustained above 90% of VO(2max) in IT(105%) [338 (149) s] was significantly higher ( P<0.05) than in IT(100%) [168 (131) s]. The average T(lim) was 244 (39) s, tau(1) was 15.8 (5.9) s and td(2) was 96 (13) s. tau(1) was correlated with the difference in time spent above 90% of VO(2max) ( r=0.91; P<0.01) between IT(105%) and IT(100%). In conclusion, athletes with a slower VO(2) kinetics in a vVO(2max) constant-velocity test benefited more from the 5% rise of IT work intensity, exercising for longer above 90% of VO(2max) when the IT intensity was increased from 100 to 105% of vVO(2max).

Influencia de sobrepeso y obesidad sobre la infertilidad: Plan de cuidados y programa educacional

The scientific evidence, demonstrates that the obesity reduces the possibility that a woman, conceive naturally and diminishes the success of the treatment for the fertility. Nurses of the Unit of Attended Reproduction and of the Units of Nutrition and Dietary, they consider necessary to design an educational program of Formation and Information, to change attitudes related with the overweight and the obesity, in even not fertile. The strategy of this Program is based in the control and reduction of the weight, assuring the adhesion to the treatment of fertility, with interactive works shops for the change of alimentary habits, giving emotional support and indications to practice adapted physical exercise. This Nursing Intervention is applied like one tool that develops abilities for the learning and training; never using diets or products of the denominated miracle. The narrow collaboration and investigating participation among the nurses of these Units, bear the design of a methodology channeled to the obtaining of some prospective results that can be evaluated regarding the obtained results.