CPR training in households of patients with chest pain

The objectives of this study are to (1) quantify prior cardiopulmonary resuscitation (CPR) training in households of patients presenting to the Emergency Department (ED) with or without chest pain or ischaemic heart disease (IHD); (2) evaluate the willingness of household members to undertake CPR training; and (3) identify potential barriers to the learning and provision of bystander CPR. A cross-sectional study was conducted by surveying patients presenting to the ED of a metropolitan teaching hospital over a 6-month period. Two in five households of patients presenting with chest pain or IHD had prior training in CPR. This was no higher than for households of patients presenting without chest pain or IHD. Just under two in three households of patients presenting with chest pain or IHD were willing to participate in future CPR classes. Potential barriers to learning CPR included lack of information on CPR classes, perceived lack of intellectual and/or physical capability to learn CPR and concern about causing anxiety in the person at risk of cardiac arrest. Potential barriers to CPR provision included an unknown cardiac arrest victim and fear of infection. The ED provides an opportunity for increasing family and community capacity for bystander intervention through referral to appropriate training. (C) 2003 Published by Elsevier Science Ireland Ltd.

Optimising high-intensity treadmill training using the running speed at maximal O-2 uptake and the time for which this can be maintained

The aim of this study was to compare the effects of two high-intensity, treadmill interval-training programs on 3000-m and 5000-m running performance. Maximal oxygen uptake ((V) over dot O-2max), the running speed associated with (V) over dot O-2max (nu (V) over dot O-2max), the time for which nu (V) over dot O-2max can be maintained (T-max), running economy (RE), ventilatory threshold (VT) and 3000-m and 5000-m running times were determined in 27 well-trained runners. Subjects were then randomly assigned to three groups; (1) 60% T-max (2) 70% T-max and (3) control. Subjects in the control group continued their normal training and subjects in the two T-max groups undertook a 4-week treadmill interval-training program with the intensity set at nu (V) over dot O-2max and the interval duration at the assigned T-max. These subjects completed two interval-training sessions per week (60% T-max = six intervals/session, 70% T-max group = five intervals/session). Subjects were re-tested on all parameters at the completion of the training program. There was a significant improvement between pre- and post-training values in 3000-m time trial (TT) performance in the 60% T-max group compared to the 70% T,,a, and control groups [mean (SE); 60% T-max = 17.6 (3.5) s, 70% T-max = 6.3 (4.2) s, control = 0.5 (7.7) s]. There was no significant effect of the training program on 5000-m TT performance [60% T-max = 25.8 (13.8) s, 70% T-max = 3.7 (11.6) s, control = 9.9 (13.1) s]. Although there were no significant improvements in (V) over dot O-2max, nu (V) over dot (2max) and RE between groups, changes in (V) over dot O-2max and RE were significantly correlated with the improvement in the 3000-m TT. Furthermore, VT and T-max were significantly higher in the 60% Tmax group post-compared to pre-training. In conclusion, 3000-m running performance can be significantly improved in a group of well-trained runners, using a 4-week treadmill interval training program at nu (V) over dot O-2max with interval durations of 60% T-max.

Mechanisms of exercise training in patients with heart failure

Background The reduction of exercise capacity because of fatigue and dyspnea in patients with heart failure can be improved with exercise training. We sought to examine the mechanisms of exercise training, as an adjunctive treatment strategy for patients with heart failure. Methods a reviewed the published data on the possible mechanisms of effect of exercise training in heart failure. Results Symptoms of heart failure may be explained on the basis of abnormal skeletal muscle perfusion and structure and endothelial function. Exercise training has been shown to engender changes in muscle structure and biochemistry and vascular function, although effects on cardiac function have not been detected uniformly and may require longer training periods. Conclusions A suitable, long-term program of exercise training may reverse unfavorable interactions among the heart, vessels, and skeletal muscles. These improvements may be preserved with an ongoing maintenance program.

Vitamin C: Effects of exercise and requirements with training

Ascorbic acid or vitamin C is involved in a number of biochemical pathways that are important to exercise metabolism and the health of exercising individuals. This review reports the results of studies investigating the requirement for vitamin C with exercise on the basis of dietary vitamin C intakes, the response to supplementation and alterations in plasma, serum, and leukocyte ascorbic acid concentration following both acute exercise and regular training. The possible physiological significance of changes in ascorbic acid with exercise is also addressed. Exercise generally causes a transient increase in circulating ascorbic acid in the hours following exercise, but a decline below pre-exercise levels occurs in the days after prolonged exercise. These changes could be associated with increased exercise-induced oxidative stress. On the basis of alterations in the concentration of ascorbic acid within the blood, it remains unclear if regular exercise increases the metabolism of vitamin C. However, the similar dietary intakes and responses to supplementation between athletes and nonathletes suggest that regular exercise does not increase the requirement for vitamin C in athletes. Two novel hypotheses are put forward to explain recent findings of attenuated levels of cortisol postexercise following supplementation with high doses of vitamin C.

Plasma zinc and immune markers in runners in response to a moderate increase in training volume

Changes in plasma zinc concentration and markers of immune function were examined in a group of 10 male runners (n = 10) following a moderate increase in training over four weeks. Seven sedentary males acted as controls. Fasting blood samples were taken at rest, before (T0) and after T4) four weeks of increased (+ 16 %) training and after two weeks of reduced (- 31 %) training (W. Blood was analysed for plasma zinc concentration, differential leucocyte counts, lymphocyte subpopulations and lymphocyte proliferation using incorporation of H-3-thymidine. The runners increased their training volume by 16 % over the four weeks. When compared with the nonathletes, the runners had lower concentrations of plasma zinc (p = 0.012), CD3(+) (p = 0.042) and CD19(+) lymphocytes (p = 0.010) over the four weeks. Lymphocyte proliferation in response to Concanavalin A stimulation was greater in the runners (p = 0.0090). Plasma zinc concentration and immune markers remained constant during the study. Plasma zinc concentration correlated with total leucocyte counts in the athletes at T6 (r = -0.72, p < 0.05) and with Pokeweed mitogen stimulation in the nonathletes at T6 (r = -0.92, p < 0.05). Therefore, athletes are unlikely to benefit from zinc supplementation during periods of moderately increased training volume.

Modified logit life table system: Principles, empirical validation, and application

Despite its widespread use, the Coale-Demeny model life table system does not capture the extensive variation in age-specific mortality patterns observed in contemporary populations, particularly those of the countries of Eastern Europe and populations affected by HIV/AIDS. Although relational mortality models, such as the Brass logit system, can identify these variations, these models show systematic bias in their predictive ability as mortality levels depart from the standard. We propose a modification of the two-parameter Brass relational model. The modified model incorporates two additional age-specific correction factors (gamma(x), and theta(x)) based on mortality levels among children and adults, relative to the standard. Tests of predictive validity show deviations in age-specific mortality rates predicted by the proposed system to be 30-50 per cent lower than those predicted by the Coale-Demeny system and 15-40 per cent lower than those predicted using the original Brass system. The modified logit system is a two-parameter system, parameterized using values of l(5) and l(60).

O agir cotidiano dos gestores da Estratégia Saúde da Família em um município do Espírito Santo

O Sistema único de Saúde (SUS) pode ser considerado uma das maiores conquistas sociais consagradas na Constituição de 1988, representando a materialização de uma nova concepção acerca da saúde no Brasil. As diretrizes do SUS são importantes instrumentos indutores de mudanças e modernização da gestão, incluindo aspectos relativos à organização da assistência, como sua humanização e também a busca de maiores níveis de desempenho e responsabilidade institucional para com os resultados alcançados. Diversos autores tem se debruçado sobre o tema gestão, porém, qual o modelo de gestão que conseguiria combinar um papel ativo, de liderança e de coordenação para gestores com autonomia? Este estudo objetiva analisar a prática da gestão nos serviços de saúde do município de Itapemirim/ES, buscando compreender as múltiplas e complexas dimensões que orientam essa prática, tendo como principal fonte as entrevistas de seus gestores. O município adota uma política de gestão participativa na saúde com várias instâncias formais e pratica um investimento em saúde acima do preconizado pela Constituição Federal o que permite um investimento em estruturação e oferta de serviços públicos. Do ponto de vista metodológico, o estudo adota a abordagem qualitativa através de entrevistas semiestruturadas, focalizando a gestão como um mundo social e expressão dos processos presentes nas organizações e que atravessam os relatos coletados. Foram entrevistados três gestores, sendo esses, Secretário Municipal de Saúde, Diretora da Atenção Primária em Saúde e Coordenadora de Estratégia Saúde da Família do município de Itapemirim. A análise do material empírico teve como um de seus eixos o estudo do percurso profissional dos gestores, especialmente os processos que os levaram à função de gestão. A contingência marca essas trajetórias que se desenrolam em um contexto em que, em alguns dos casos, percebe-se que não existe qualquer exigência quanto à formação de gestão. Outro eixo abordado são as práticas de gestão onde são examinados os sentidos que o exercício da função de gestor tem para os sujeitos, como também as suas estratégias de trabalho, planejamento e ferramentas de uso. O exame das práticas de gestão norteia-se pela análise das possibilidades e limites para desencadear processos de mudança. Os depoimentos apontam as características dessas experiências de gestão, que procuram construir condições para processos de mudança, seja através das experiências anteriores desses gestores ou das estratégias de trabalho e do sistema de gestão articulado que procuram desenvolver. Os projetos profissionais dos gestores entrevistadas vão claramente se definindo no âmbito da gestão: se veem, não mais como profissionais de sua área de formação original (enfermeiro, farmacêutico ou cirurgião dentista), mas acima de tudo como gestores, alimentados pelo reconhecimento de suas capacidades de mobilização e de desenvolvimento de mudanças relativas a outras realizações no campo da gestão.

Interfaces da comunicação e saúde na mídia impressa

O campo da Comunicação e Saúde engloba tanto os conhecimentos peculiares à Comunicação quanto os conhecimentos da área da Saúde, os quais tratados em conjunto e explorados as potencialidades de cada ciência, se interrelacionam, interagem e convergem para um amplo campo interdisciplinar. O objetivo deste trabalho foi compreender, discutir e problematizar, a partir da opinião dos sujeitos, a dinâmica da divulgação midiática da saúde/doenças na mídia impressa do Espírito Santo (ES) e identificar possíveis temáticas de saúde negligenciadas. Trata-se de um estudo qualitativo no qual foram realizadas entrevistas com os atores-chave envolvidos na discussão/veiculação da saúde/doenças nos dois principais jornais do estado: A Tribuna e A Gazeta, gestores da Secretaria de Estado as Saúde do ES (SESA), bem como integrantes da Assessoria de Comunicação da SESA e conselheiros de saúde representante dos usuários no Conselho Estadual de Saúde. O material empírico coletado foi analisado por meio da Análise de Conteúdo a partir da temática. A compreensão das relações que permeiam a mídia impressa e a divulgação midiática da saúde no Espírito Santo resultou em importantes apontamentos os quais podem auxiliar jornalistas e comunicadores na transmissão de informações pertinentes à Saúde Coletiva de forma clara, ética e política e que corresponda às necessidades de saúde da população. Nas interfaces das relações entre os atores entrevistados e a compreensão da dinâmica das notícias de saúde, foram identificadas Doenças Midiaticamente Negligenciadas e apontadas estratégias para lidar com esse silenciamento midiático. Conclui-se que dentre as interfaces do campo da Comunicação e Saúde se encontra as relações com o campo da Saúde Coletiva e por isso, as sugestões para o enfrentamento da negligência midiática de alguns temas incluem uma capacitação em Saúde Coletiva para repórteres dos jornais; a mobilização dos doentes; a gestão fomentar a pauta pública; e a participação social.

Interests and Values in Obama's foreign Policy: Leading from Behind?

Abstract This study will exam the relative importance of values and interests in Obama's foreign policy, focusing on crucial cases: the military actions related to Afghanistan, Iraq, Libya, Non-Syria, Al-Qaeda and ISIL. We will argue that his "leading from behind" strategy is not very distant from the foreign and defense strategies of his post-Cold War predecessors, by which democracy is seen as an assurance to security. According to Obama's strategy, Americans will only provide support for the building of democracy in the target countries, while this task should be performed by the locals themselves. Americans will provide military training to the new governments as well so they can be responsible for their own security, including preventing regrouping of terrorists in their soil. If Obama opposes the imposing of democracy by the use of force, empirical data shows that his administration is "not prepared to accept" any option that threats US security or American liberal-democratic values, bringing in this way values and interests very close to each other.

A laparoscopic surgery training interface

Laparoscopy is a surgical procedure on which operations in the abdomen are performed through small incisions using several specialized instruments. The laparoscopic surgery success greatly depends on surgeon skills and training. To achieve these technical high-standards, different apprenticeship methods have been developed, many based on in vivo training, an approach that involves high costs and complex setup procedures. This paper explores Virtual Reality (VR) simulation as an alternative for novice surgeons training. Even though several simulators are available on the market claiming successful training experiences, their use is extremely limited due to the economic costs involved. In this work, we present a low-cost laparoscopy simulator able to monitor and assist the trainee’s surgical movements. The developed prototype consists of a set of inexpensive sensors, namely an accelerometer, a gyroscope, a magnetometer and a flex sensor, attached to specific laparoscopic instruments. Our approach allows repeated assisted training of an exercise, without time constraints or additional costs, since no human artificial model is needed. A case study of our simulator applied to instrument manipulation practice (hand-eye coordination) is also presented.

Factors Influencing the Implementation of the Balanced Scorecard in Portugal: Empirical Evidence From Privately Owned and Publicly Owned Organizations

In this paper we aim to identify and analyze a set of variables that can potentially influence the adoption and knowledge of the Balanced Scorecard (BSC) in Portugal. Hypotheses were tested using data obtained from a questionnaire sent to 591 publicly-owned organizations (local governments, municipal corporations and hospitals) and 549 privately-owned organizations (large companies and small and medium enterprises) in Portugal. The results allow us to conclude that although the majority of respondents claimed to know the BSC, its use in Portugal is still limited and very recent, particularly in the public sector organizations. However, it should be noted that its use has increased in Portugal in recent years. The study also reveals that in spite of the noticeable differences between public and private sector, the BSC is used in the public sector after a few adjustments to the traditional model. Using as theoretical framework the contingency and institutional theories, we found that decentralization, vertical differentiation and the degree of higher education are associated with the implementation of the BSC.

The Knowledge and Use of the Balanced Scorecard in Portugal: Empirical Evidence of the 250 Largest Companies

Balanced Scorecard (BSC) is recognized, both in the academic and business world, as one of the most powerful strategic management accounting tools. Thus, we launched in October 2004 a questionnaire survey applied to the 250 largest Portuguese companies aiming at observing the knowledge, use, and companies’ characteristics which are adopting this management instrument. Despite the majority of the companies inquired recognize BSC more as a strategic management tool than a performance valuation system, the results show that there is still a reduced and recent utilization of BSC in Portugal. Similarly to other countries Portugal is still in the initial state of BSC utilization. Our work has shown that the companies that use more BSC belong mainly to the secondary sector of industry. Nevertheless, unlike other studies, we did not get empirical evidence on the influence of variables such as geographical localization, dimension and internationalization, in the use and knowledge of BSC in Portugal.

Disclosure of Intangible Assets: an Empirical Study of Financial Corporations in the Iberian Peninsula

The purpose of this paper is to analyse, firstly, to what extent intangible assets in the consolidated accounts of seven Portuguese banks and seven Spanish banks between 2006 and 2009 are disclosed and, secondly, to analyse what the most influential factors are in the above mentioned disclosure. In order to do this, before reviewing the existing literature and on the basis of other studies on this topic, a disclosure index has been created based on the requirements related to the intangible assets as stated in IAS 38. Then, two statistical analyses have been made: a univariate one for each of the explanatory variables and a multivariate one, in which all variables have been analysed. Both analyses led to the conclusion that the disclosure index of intangible assets is 0.96, where the bank dimension and the internationalization degree are the variables that are considered explanatory of the variation of the disclosure index in the regression analysis.

Determinant factors of the implementation of the balanced scorecard in Portugal: empirical evidence in public and private organizations

In this article we aim to identify and analyze a set of variables that can potentially influence the adoption of the Balanced Scorecard (BSC)in Portugal. Hypotheses were tested using data obtained from a questionnaire sent to 591 publicly-owned organizations (local governments, municipal corporations and hospitals) and 549 privately-owned organizations (large companies and small and medium enterprises) in Portugal, with an overall response rate of 31.3%. The results allow us to conclude that although the majority of respondents claimed to know the BSC, its use in Portugal is still limited and very recent, particularly in the public sector organizations. However, it should be noted that its use has increased in Portugal in recent years. Using as theoretical framework the contingency and institutional theories, we found that decentralization, vertical differentiation and the degree of higher education are associated with the implementation of the BSC.