Stress, coping and presenteeism in nurses assisting critical and potentially critical patients

Objective to verify the associations between stress, Coping and Presenteeism in nurses operating on direct assistance to critical and potentially critical patients. Method this is a descriptive, cross-sectional and quantitative study, conducted between March and April 2010 with 129 hospital nurses. The Inventory of stress in nurses, Occupational and Coping Questionnaire Range of Limitations at Work were used. For the analysis, the Kolmogorov-Smirnov test, correlation coefficient of Pearson and Spearman, Chi-square and T-test were applied. Results it was observed that 66.7% of the nurses showed low stress, 87.6% use control strategies for coping stress and 4.84% had decrease in productivity. Direct and meaningful relationships between stress and lost productivity were found. Conclusion stress interferes with the daily life of nurses and impacts on productivity. Although the inability to test associations, the control strategy can minimize the stress, which consequently contributes to better productivity of nurses in the care of critical patients and potentially critical.


Medidas de Perda na Avalia ção do Desempenho de Fundos de Investimentos

Uma das medidas de performance mais utilizada e a medida de Sharpe. A sua utiliza c~ao e inadequada quando as rendibilidades n~ao seguem uma distribui c~ao normal, assim originou o aparecimento de uma variedade de medidas alternativas. Em fun c~ao disso, surge ent~ao a quest~ao de saber se essas medidas alternativas produzem rankings signi cativamente diferentes da que se obt em com a medida de Sharpe. Apesar da exist^encia de muitos estudos emp ricos sobre esta problem atica a resposta n~ao e consensual. Neste trabalho fez-se a compara c~ao entre o ranking produzido pela medida de Sharpe e as algumas medidas alternativas, as que se baseiam no Low Partial Moments (Omega, Sortino, Kappa3 e Upside Potential Ratio) e, as que se baseiam no VaR - Value-at-Risk (ERV - Excess Return on VaR, ERMV - Excess Return on Modi ed VaR, ERCV - Excess Return on Conditional VaR e ERV? - Excess Return com VaR hist orico). Utilizando 26 fundos de investimentos norte-americanos, com registo di ario das rendibilidades para o per odo de Janeiro 2000 a Setembro 2009, encontrou-se um elevado coe ciente de correla c~ao de Spearman e de Kendall entre a medida de Sharpe e as alternativas, bem como as alternativas entre si, excepto para Upside Potential Ratio que os coe cientes s~ao relativamente baixos. Os resultados permitem concluir que existe uma medida que proporciona ordena c~oes diferentes.

Myocardial flow reserve by Rb-82 cardiac PET improves the selection of patients eligible for invasive coronary angiography

Aim: We asked whether myocardial flow reserve (MFR) by Rb-82 cardiac PET improve the selection of patients eligible for invasive coronary angiography (ICA). Material and Methods: We enrolled 26 consecutive patients with suspected or known coronary artery disease who performed dynamic Rb-82 PET/CT and (ICA) within 60 days; 4 patients who underwent revascularization or had any cardiovascular events between PET and ICA were excluded. Myocardial blood flow at rest (rMBF), at stress with adenosine (sMBF) and myocardial flow reserve (MFR=sMBF/rMBF) were estimated using the 1-compartment Lortie model (FlowQuant) for each coronary arteries territories. Stenosis severity was assessed using computer-based automated edge detection (QCA). MFR was divided in 3 groups: G1:MFR<1.5, G2:1.5≤MFR<2 and G3:2≤MFR. Stenosis severity was graded as non-significant (<50% or FFR ≥0.8), intermediate (50%≤stenosis<70%) and severe (≥70%). Correlation between MFR and percentage of stenosis were assessed using a non-parametric Spearman test. Results: In G1 (44 vessels), 17 vessels (39%) had a severe stenosis, 11 (25%) an intermediate one, and 16 (36%) no significant stenosis. In G2 (13 vessels), 2 (15%) vessels presented a severe stenosis, 7 (54%) an intermediate one, and 4 (31%) no significant stenosis. In G3 (9 vessels), 0 vessel presented a severe stenosis, 1 (11%) an intermediate one, and 8 (89%) no significant stenosis. Of note, among 11 patients with 3-vessel low MFR<1.5 (G1), 9/11 (82%) had at least one severe stenosis and 2/11 (18%) had at least one intermediate stenosis. There was a significant inverse correlation between stenosis severity and MFR among all 66 territories analyzed (rho= -0.38, p=0.002). Conclusion: Patients with MFR>2 could avoid ICA. Low MFR (G1, G2) on a vessel-based analysis seems to be a poor predictor of severe stenosis severity. Patients with 3-vessel low MFR would benefit from ICA as they are likely to present a significant stenosis in at least one vessel.

Social network of family caregivers of disabled and dependent patients

Cross-sectional study that used the Social Network Index and the genogram to assess the social network of 110 family caregivers of dependent patients attended by a Home Care Service in São Paulo, Brazil. Data were analyzed using the test U of Mann-Whitney, Kruskal-Wallis and Spearman correlation. Results were considered statistically significant when p<0,05. Few caregivers participated in activities outside the home and the average number of people they had a bond was 4,4 relatives and 3,6 friends. Caregivers who reported pain and those who had a partner had higher average number of relatives who to trust. The average number of friends was higher in the group that reported use of medication for depression. Total and per capita incomes correlated with the social network. It was found that family members are the primary caregiver’s social network.





A Atitude do Contabilista perante Dilemas Éticos

Casos de fraudes têm ocorrido, frequentemente no mercado mundial. Diversos são os profissionais envolvidos nesses casos, inclusive os da contabilidade. Os escândalos contabilísticos, especialmente os mais famosos, como os incidido nas empresas Enron e Wordcom, acenderam para uma maior preocupação em relação a conduta ética dos profissionais da contabilidade. Como consequência há uma maior exigência quanto a transparência e a fidedignidade das informações prestadas por estes profissionais. Esta preocupação visa, sobretudo, manter a confiança das empresas, investidores, fornece-dores e sociedade em geral, de entre outras, na responsabilidade ética do contabilista, de-negrida pelo envolvimento nas fraudes detectadas. Desta forma, o presente estudo teve como objectivo verificar a conduta ética dos contabilistas, quando, no exercício da sua profissão, depararem com questões relacionadas a fraudes. Nesse sentido considerou-se factores que podem vir a influenciar o processo decisório ético de um indivíduo, demonstrados através do modelo de tomada de decisão, desenvolvido por Alves, quanto a motivar um indivíduo a cometer uma fraude, evidenciada através do modelo desenvolvido por Cressey. Tentando responder a questão norteadora desta pesquisa, executou-se a análise descritiva e estatística dos dados. Em relação a análise descritiva, foram elaboradas tabelas de frequência. Para a análise estatística dos dados foi utilizado o teste não paramétrico de Spearman. Os resultados demonstraram que a maioria dos contabilistas, da amostra pesquisada, reconhece a questão moral inserida nos cenários, e discordam dos actos dos agentes de cada cenário, e, ainda os classificam como graves ou muito graves. A pesquisa revelou maior aproximação desses profissionais a corrente teleológica, uma vez que a intenção de agir é mais influenciada por alguns factores como a oportunidade, a racionalização e principalmente a pressão. Alguns factores individuais apresentam influências sob o posicionamento ético dos contabilistas entrevistados nesta pesquisa. Cases of fraud have occurred, in the word market. Several are involved in these cases, including the accounting class. The accounting scandals, especially the most famous, such as focusing on companies and Enron Word Com, kindled to greater concern about the ethical conduct of professional accounting. As a result there is a greater demand on the transparency and reliability of information provide by these professionals This concern is aimed, primarily, to maintain the confidence of businesses, investor, suppliers and society, among others, the ethical responsibility of the meter, denigrated, by involvement in the fraud detected. Thus, this study aimed to verify the ethical conduct of accounts in when, in the exercise of their professional activities, is confronted with issues related to fraud. This is considered some factors that can both come to influence the ethical decision making of an individual, demonstrated by the model of decision making, developed by Alves, as a motivated individual to commit a fraudulent act, developed by Cressey. Seeking to answer question, guiding this study, performed to exploratory and confirmatory analysis of data. For exploratory data analysis were made table of frequencies. For confirmatory analysis of data, were used non parametric tests of Spearman. The results showed that the majority of accountings professionals, the sample, recognizing the moral issue included in the scenarios, disagrees the acts of agents of each scenario, and also classifies such acts as serious and very serious. However, we found that these accounting professionals tend to have a position more toward the teleological theory, since the intention to act is influenced by factors as opportunity, rationalization and particularly the pressure. Some individual factors also had influence on the ethical position of the professional interviewed is this research.

Medidas de Perda na Avaliacão do Desempenho de Fundos de Investimentos

Uma das medidas de performance mais utilizada e a medida de Sharpe. A sua utilizacão e inadequada quando as rendibilidades não seguem uma distribuicão normal, assim originou o aparecimento de uma variedade de medidas alternativas. Em fun c~ao disso, surge então a questão de saber se essas medidas alternativas produzem rankings signi cativamente diferentes da que se obt em com a medida de Sharpe. Apesar da existencia de muitos estudos emp ricos sobre esta problem atica a resposta não e consensual. Neste trabalho fez-se a comparacão entre o ranking produzido pela medida de Sharpe e as algumas medidas alternativas, as que se baseiam no Low Partial Moments (Omega, Sortino, Kappa3 e Upside Potential Ratio) e, as que se baseiam no VaR - Value-at-Risk (ERV - Excess Return on VaR, ERMV - Excess Return on Modi ed VaR, ERCV - Excess Return on Conditional VaR e ERV? - Excess Return com VaR hist orico). Utilizando 26 fundos de investimentos norte-americanos, com registo di ario das rendibilidades para o per odo de Janeiro 2000 a Setembro 2009, encontrou-se um elevado coe ciente de correla c~ao de Spearman e de Kendall entre a medida de Sharpe e as alternativas, bem como as alternativas entre si, excepto para Upside Potential Ratio que os coe cientes s~ao relativamente baixos. Os resultados permitem concluir que existe uma medida que proporciona ordena c~oes diferentes.

Avaliação da carga de trabalho no pós-operatório de cirurgia cardíaca segundo o Nursing Activities Score

RESUMO Objetivo Identificar os fatores associados à carga de trabalho de enfermagem no cuidado a pacientes no pós-operatório de cirurgia cardíaca. Método Estudo de coorte prospectivo, conduzido com 187 pacientes da Unidade de Terapia Intensiva Cirúrgica (UTI) do Instituto do Coração. Os dados foram coletados nas primeiras 24 e 72 horas do paciente na UTI. A variável dependente foi a carga de trabalho calculada por meio do Nursing Activities Score (NAS) e as independentes foram de natureza demográfico-clínicas e escores de morbimortalidade. Para análise dos dados utilizou-se os testes de Wilcoxon-Mann-Whitney e de correlação de Spearman, e a regressão linear com modelo de efeitos mistos. Resultados A maioria dos pacientes era do sexo masculino (59,4%), com média de idade de 61 anos (±12,7) e 43,9% desenvolveram algum tipo de complicação no pós-operatório. Nas 24 horas, a carga de trabalho foi de 82,4% (±3,4) e foi de 58,1% (±3,4) nas 72 horas. Os fatores associados ao aumento do NAS foram: tempo de internação do paciente na UTI (p=0,036) e a presença de complicações (p<0,001). Conclusão A gravidade do paciente nas 24 horas, em oposição a inúmeros estudos, não influenciou no aumento da carga de trabalho, a qual se mostrou associada ao tempo de internação e às complicações.

Carga de trabalho de enfermagem em transplante de células-tronco hematopoiéticas: estudo de coorte

RESUMO Objetivo Mensurar a carga de trabalho de enfermagem requerida por pacientes submetidos ao transplante de células-tronco hematopoiéticas (TCTH), autólogo e alogênico e analisar as atividades do Nursing Activities Score (NAS) executadas pela equipe de enfermagem durante a internação para o TCTH. Método Coorte prospectiva realizada de janeiro/2013 a abril/2014 com 62 pacientes internados na unidade de TCTH de um hospital universitário de Campinas/SP, Brasil. Mediu-se a carga de trabalho por meio do NAS e analisaram-se os dados utilizando os testes Qui-quadrado ou Exato de Fisher, Mann-Whitney e o coeficiente de correlação de Spearman; considerou-se nível de significância de 5%. Resultados A média da carga de trabalho de enfermagem foi de 67,3% (DP 8,2) em pacientes de TCTH autólogo e de 72,4% (DP 13,0) no TCTH alogênico (p=0,1380). O item Monitorização e controles apontou, em mais de 50% das observações, que os pacientes demandaram intensificação deste cuidado, exigindo duas horas ou mais em algum turno de trabalho por motivos de segurança, gravidade ou terapia. Conclusão A carga de trabalho de enfermagem e os itens do NAS mais pontuados refletem a magnitude, complexidade e especificidade dos cuidados demandados pelos pacientes submetidos ao TCTH.

Measuring spiritual well-being in older rehabilitation patients using the facit-sp

Objectives: To determine psychometric properties of the Functional Assessment of Chronic Illness Therapy-Spiritual well-being (FACIT-Sp) in a cohort of older patients admitted to rehabilitation. Method: Patients aged 65+, with MMSE score>19, admitted consecutively over 6 months in post-acute rehabilitation were enrolled (N=144, 81.27.2 years, 68.8% women). Data on medical, functional, and mental status were systematically collected upon admission. Spiritual well-being was assessed within 3 days after admission using the FACIT-Sp (12 items, score from 0 to 48, high spiritual well-being defined as a score ≥36) and the single question "Are you at peace?" (score from 0 to 10 on a visual analog scale). Results: FACIT-Sp scores ranged from 7 to 44(mean=29.87.7). Overall, 24.3% of the patients had high spiritual well-being. Internal consistency was optimal for total score (Cronbach's alpha =0.85). Itemto- total correlations were all significant, ranging from 0.28 to 0.73. A confirmatory factorial analysis yielded a 2-factor solution, consistent with Meaning and Faith proposed subscales and accounting for 52% of the variance . FACIT-Sp total score correlated positively with the question «Are you at peace ?» (Spearman's rho 0.49, P<.001) and negatively with depressive symptoms (Spearman's rho -0.37, P<.001), confirming FACIT-Sp validity. Compared to the others, patients with higher spiritual well-being had significantly better function at admission (Barthel's score 74.817.1 vs 68.514.1, P=.014). Conclusions: The FACIT-Sp remains a reliable and valid measure to assess spiritual well-being in older patients undergoing rehabilitation. The relatively low proportion of patients with high spiritual well-being deserves further investigation.

Exact tests for correlation and for the slope in simple linear regressions without making assumptions

We present an exact test for whether two random variables that have known bounds on their support are negatively correlated. The alternative hypothesis is that they are not negatively correlated. No assumptions are made on the underlying distributions. We show by example that the Spearman rank correlation test as the competing exact test of correlation in nonparametric settings rests on an additional assumption on the data generating process without which it is not valid as a test for correlation.We then show how to test for the significance of the slope in a linear regression analysis that invovles a single independent variable and where outcomes of the dependent variable belong to a known bounded set.

Padrões de Distribuição da Flora Exótica em Cabo Verde: o Papel dos Factores Antrópicos e Ecológicos

Dada a relevância a nível global do impacto da introdução de espécies exóticas, e tendo sido identificada uma grande escassez de estudos nesta área de investigação em Cabo Verde, pretendeu-se com este estudo actualizar a lista dos taxa exóticos naturalizados deste arquipélago, fornecendo dados sobre a sua distribuição, caracterização taxonómica e principais grupos funcionais. Com o objectivo de averiguar quais são os factores que influenciam os padrões de distribuição da flora exótica nestas ilhas, efectuaram-se correlações de Spearman entre o número de taxa exóticos e várias variáveis ambientais e antrópicas. Sendo conhecida a importância que os factores antrópicos têm na composição e distribuição da flora introduzida, procurou-se ainda perceber se a flora da única ilha desabitada do arquipélago (Santa Luzia) poderá ser indicadora de características invasoras das espécies introduzidas. Os resultados obtidos indicaram um total de 403 taxa exóticos, correspondendo a 55% da flora de Cabo Verde, sendo as Poaceae, Fabaceae e Asteraceae as famílias com maior número de espécies. Verificou-se também que predominam as espécies herbáceas e o tipo biológico mais frequente é o terófito. Além disso, a população rural é o factor que mais fortemente e positivamente correlacionado com os padrões de distribuição da flora exótica em Cabo Verde. Correlações positivas muito significativas foram também encontradas para a área e altitude máxima de cada ilha. A análise da flora exótica da ilha desabitada de Santa Luzia revelou que, embora os taxa exóticos registados nesta ilha estejam presentes em quase todas as outras ilhas, as espécies inventariadas parecem não exibir um comportamento invasor ou de ameaça à flora nativa. Para finalizar, espera-se que os resultados obtidos possam contribuir com informação que fundamente futuras estratégias de conservação da Biodiversidade das ilhas de Cabo Verde.

Serum procalcitonin as a marker of post-cardiac arrest syndrome and long-term neurological recovery, but not of early-onset infections, in comatose post-anoxic patients treated with therapeutic hypothermia.

OBJECTIVE: To examine the relationship of early serum procalcitonin (PCT) levels with the severity of post-cardiac arrest syndrome (PCAS), long-term neurological recovery and the risk of early-onset infections in patients with coma after cardiac arrest (CA) treated with therapeutic hypothermia (TH). METHODS: A prospective cohort of adult comatose CA patients treated with TH (33°C, for 24h) admitted to the medical/surgical intensive care unit, Lausanne University Hospital, was studied. Serum PCT was measured early after CA, at two time-points (days 1 and 2). The SOFA score was used to quantify the severity of PCAS. Diagnosis of early-onset infections (within the first 7 days of ICU stay) was made after review of clinical, radiological and microbiological data. Neurological recovery at 3 months was assessed with Cerebral Performance Categories (CPC), and was dichotomized as favorable (CPC 1-2) vs. unfavorable (CPC 3-5). RESULTS: From December 2009 to April 2012, 100 patients (median age 64 [interquartile range 55-73] years, median time from collapse to ROSC 20 [11-30]min) were studied. Peak PCT correlated with SOFA score at day 1 (Spearman's R=0.44, p<0.0001) and was associated with neurological recovery at 3 months (peak PCT 1.08 [0.35-4.45]ng/ml in patients with CPC 1-2 vs. 3.07 [0.89-9.99] ng/ml in those with CPC 3-5, p=0.01). Peak PCT did not differ significantly between patients with early-onset vs. no infections (2.14 [0.49-6.74] vs. 1.53 [0.46-5.38]ng/ml, p=0.49). CONCLUSIONS: Early elevations of serum PCT levels correlate with the severity of PCAS and are associated with worse neurological recovery after CA and TH. In contrast, elevated serum PCT did not correlate with early-onset infections in this setting.

Los lobos marinos y su relación con la abundancia de la anchoveta peruana durante 1979 - 2000

Se presenta información sobre la importancia de la anchoveta en la dieta de lobos marinos para el período 1996-1999 y se analizan gráficamente, y mediante pruebas no paramétricas, las relaciones entre la abundancia de lobos marinos y las biomasas acústicas de anchoveta y con las capturas anuales de la pesquería de anchoveta a partir de 1984. Utilizando los estimados de biomasas acústicas, se observan tendencias similares de una recuperación de las poblaciones de lobos marinos y anchoveta entre 1984 y principios de la década de los noventa, altos niveles poblacionales entre 1993 y 1997, una drástica disminución durante 1997-1998 y una recuperación desfasada entre 1999 y el 2000. Resultados muy similares se obtienen al comparar las poblaciones de lobos marinos y las capturas de la pesquería de anchoveta . No se obtuvieron correlaciones significativas entre la abundancia de lobos finos y las biomasas y capturas de anchoveta (r SPEARMAN= 0,43; 0,14} y lo mismo para los lobos chuscos (r SPERMAN= 0,26; 0,6), pero sí una correlación altamente significativa entre el número de crías de lobos finos y la biomasa de anchoveta a partir de 1984 {r SPERMAN=0,9 43,p<0,01). Estos resultados muestran que se estarían presentando relaciones directas entre la abundancia de lobos marinos y la biomasa de anchoveta a diferencia de lo reportado por Muck y Fuentes (1987) para el período 1952 a 1984.

Test of four colon cancer risk-scores in formalin fixed paraffin embedded microarray gene expression data.

BACKGROUND: Prognosis prediction for resected primary colon cancer is based on the T-stage Node Metastasis (TNM) staging system. We investigated if four well-documented gene expression risk scores can improve patient stratification. METHODS: Microarray-based versions of risk-scores were applied to a large independent cohort of 688 stage II/III tumors from the PETACC-3 trial. Prognostic value for relapse-free survival (RFS), survival after relapse (SAR), and overall survival (OS) was assessed by regression analysis. To assess improvement over a reference, prognostic model was assessed with the area under curve (AUC) of receiver operating characteristic (ROC) curves. All statistical tests were two-sided, except the AUC increase. RESULTS: All four risk scores (RSs) showed a statistically significant association (single-test, P < .0167) with OS or RFS in univariate models, but with HRs below 1.38 per interquartile range. Three scores were predictors of shorter RFS, one of shorter SAR. Each RS could only marginally improve an RFS or OS model with the known factors T-stage, N-stage, and microsatellite instability (MSI) status (AUC gains < 0.025 units). The pairwise interscore discordance was never high (maximal Spearman correlation = 0.563) A combined score showed a trend to higher prognostic value and higher AUC increase for OS (HR = 1.74, 95% confidence interval [CI] = 1.44 to 2.10, P < .001, AUC from 0.6918 to 0.7321) and RFS (HR = 1.56, 95% CI = 1.33 to 1.84, P < .001, AUC from 0.6723 to 0.6945) than any single score. CONCLUSIONS: The four tested gene expression-based risk scores provide prognostic information but contribute only marginally to improving models based on established risk factors. A combination of the risk scores might provide more robust information. Predictors of RFS and SAR might need to be different.

Exposure of highway maintenance workers to fine particulate matter and noise

In this study, we assessed the mixed exposure of highway maintenance workers to airborne particles, noise, and gaseous co-pollutants. The aim was to provide a better understanding of the workers' exposure to facilitate the evaluation of short-term effects on cardiovascular health endpoints. To quantify the workers' exposure, we monitored 18 subjects during 50 non-consecutive work shifts. Exposure assessment was based on personal and work site measurements and included fine particulate matter (PM2.5), particle number concentration (PNC), noise (Leq), and the gaseous co-pollutants: carbon monoxide, nitrogen dioxide, and ozone. Mean work shift PM2.5 concentrations (gravimetric measurements) ranged from 20.3 to 321 μg m(-3) (mean 62 μg m(-3)) and PNC were between 1.6×10(4) and 4.1×10(5) particles cm(-3) (8.9×10(4) particles cm(-3)). Noise levels were generally high with Leq over work shifts from 73.3 to 96.0 dB(A); the averaged Leq over all work shifts was 87.2 dB(A). The highest exposure to fine and ultrafine particles was measured during grass mowing and lumbering when motorized brush cutters and chain saws were used. Highest noise levels, caused by pneumatic hammers, were measured during paving and guardrail repair. We found moderate Spearman correlations between PNC and PM2.5 (r = 0.56); PNC, PM2.5, and CO (r = 0.60 and r = 0.50) as well as PNC and noise (r = 0.50). Variability and correlation of parameters were influenced by work activities that included equipment causing combined air pollutant and noise emissions (e.g. brush cutters and chain saws). We conclude that highway maintenance workers are frequently exposed to elevated airborne particle and noise levels compared with the average population. This elevated exposure is a consequence of the permanent proximity to highway traffic with additional peak exposures caused by emissions of the work-related equipment.