Involuntary glottal closure during inspiration in muscle tension dysphonia

Objective/Hypothesis: The purpose of this study was to examine respiratory function in a group of patients with muscle tension dysphonia (MTD) Design: Cross-sectional analytical study. Methods: Participants included 15 people with a diagnosis of MTD referred to speech pathology for management of their voice disorder, fiberoptic evidence of glottal or supraglottic constriction during phonation with or without posterior chink, or bowing combined and deviation in perceptual voice quality. A second group of 15 participants with no history of voice disorder served as healthy controls,. Baseline pulmonary function test measures included forced expiratory volume in the first second (FEV1), FVC, FEF25 to 75, FIF50, FEV1/FVC, ratio and FEF50/FIF50 ratio. Hypertonic saline challenge test measures included FEV1 and FIF50 after provocation, close response slope, and provocation dose. Results: Compared with healthy controls, participants with MTD demonstrated a higher prevalence of glottal constriction during inspiration after provocation with nebulized hypertonic saline as demonstrated by a reduction in FIF50 after the hypertonic saline challenge. There was no significant difference between the MTD and healthy control groups in baseline pulmonary function testing. Participants with MTD demonstrated a higher prevalence than healthy controls of abnormal glottic closure during inspiration similar to paradoxical vocal fold movement (PVFM). This suggests that they either had previously undiagnosed coexisting PVFM or that the condition of MTD could be expanded to include descriptions of aberrant glottic function during respiration. This study enhances the understanding of PVFM and MTD by combining research advances made in the fields of otolaryngology and respiratory medicine.

ESPIRITISMO E CONVERSÃO: FATORES MOTIVACIONAIS DA MIGRAÇÃO RELIGIOSA PARA O ESPIRITISMO, NO BRASIL.

Este trabalho faz um estudo analítico do fenômeno da conversão religiosa. Particularmente, dos fatores que motivam o trânsito de fiéis de uma religião qualquer para o Espiritismo, no Brasil. Os grupos em estudo, dos quais são provenientes os novos espíritas foram divididos em sete blocos: Catolicismo, Protestantismo, afro-brasileiras, Umbanda, orientais, outras e, nenhuma. Essa análise privilegia os fatores sociais e psicológicos que levam um indivíduo a mudar de religião. Ao explorar o caso brasileiro, este trabalho aborda também, a multiplicidade de religiões, seitas, crenças e movimentos religiosos presentes no cenário brasileiro, dentro da dinâmica de forças que envolvem esse campo religioso. Para isso, é apresentado um resumo da história dos principais movimentos religiosos no caso brasileiro. Dá-se ênfase ao Espiritismo no Brasil e no mundo, como forma de caracterizar os processos de evolução da Doutrina Espírita e os argumentos com que a essa Doutrina compete nesse mosaico de convicções religiosas. A pesquisa se apoia em um questionário distribuído em todo território nacional, que coleta dos respondentes, dados que permitem qualificá-los sob diversos aspectos: renda, educação, localização regional, conhecimento e prática da Doutrina Espírita, etc. Dentro dos quesitos de consulta estão sugeridas 18 opções, como razões da mudança da religião para o Espiritismo e, em outros vinte quesitos, um aprofundamento da opção que, no conjunto anterior se apresentou como a mais frequente. As opções iniciais se distribuem entre as razões mais frequentes da mudança de religião observadas pelo autor em sua experiência pessoal e na literatura. Os dados estatísticos foram coletados de mais de 2.300 depoentes, em mais de 400 municípios, em todos os Estados do Brasil.

Analysis and improvement of performance in LCL filter-based PWM rectifier/inverter application using hybrid damping approach

A hybrid passive-active damping solution with improved system stability margin and enhanced dynamic performance is proposed for high power grid interactive converters. In grid connected active rectifier/inverter application, line side LCL filter improves the high frequency attenuation and makes the converter compatible with the stringent grid power quality regulations. Passive damping though offers a simple and reliable solution but it reduces overall converter efficiency. Active damping solutions do not increase the system losses but can guarantee the stable operation up to a certain speed of dynamic response which is limited by the maximum bandwidth of the current controller. This paper examines this limit and introduces a concept of hybrid passive-active damping solution with improved stability margin and high dynamic performance for line side LCL filter based active rectifier/inverter applications. A detailed design, analysis of the hybrid approach and trade-off between system losses and dynamic performance in grid connected applications are reported. Simulation and experimental results from a 10 kVA prototype demonstrate the effectiveness of the proposed solution. An analytical study on system stability and dynamic response with the variations of various controller and passive filter parameters is presented.

Seismic performance of hybrid fiber reinforced polymer-concrete pier columns

As part of a multi-university research program funded by NSF, a comprehensive experimental and analytical study of seismic behavior of hybrid fiber reinforced polymer (FRP)-concrete column is presented in this dissertation. Experimental investigation includes cyclic tests of six large-scale concrete-filled FRP tube (CFFT) and RC columns followed by monotonic flexural tests, a nondestructive evaluation of damage using ultrasonic pulse velocity in between the two test sets and tension tests of sixty-five FRP coupons. Two analytical models using ANSYS and OpenSees were developed and favorably verified against both cyclic and monotonic flexural tests. The results of the two methods were compared. A parametric study was also carried out to investigate the effect of three main parameters on primary seismic response measures. The responses of typical CFFT columns to three representative earthquake records were also investigated. The study shows that only specimens with carbon FRP cracked, whereas specimens with glass or hybrid FRP did not show any visible cracks throughout cyclic tests. Further monotonic flexural tests showed that carbon specimens both experienced flexural cracks in tension and crumpling in compression. Glass or hybrid specimens, on the other hand, all showed local buckling of FRP tubes. Compared with conventional RC columns, CFFT column possesses higher flexural strength and energy dissipation with an extended plastic hinge region. Among all CFFT columns, the hybrid lay-up demonstrated the highest flexural strength and initial stiffness, mainly because of its high reinforcement index and FRP/concrete stiffness ratio, respectively. Moreover, at the same drift ratio, the hybrid lay-up was also considered as the best in term of energy dissipation. Specimens with glassfiber tubes, on the other hand, exhibited the highest ductility due to better flexibility of glass FRP composites. Furthermore, ductility of CFFTs showed a strong correlation with the rupture strain of FRP. Parametric study further showed that different FRP architecture and rebar types may lead to different failure modes for CFFT columns. Transient analysis of strong ground motions showed that the column with off-axis nonlinear filament-wound glass FRP tube exhibited a superior seismic performance to all other CFFTs. Moreover, higher FRP reinforcement ratios may lead to a brittle system failure, while a well-engineered FRP reinforcement configuration may significantly enhance the seismic performance of CFFT columns.

Novel hybrid columns made of ultra-high performance concrete and fiber reinforced polymers

The application of advanced materials in infrastructure has grown rapidly in recent years mainly because of their potential to ease the construction, extend the service life, and improve the performance of structures. Ultra-high performance concrete (UHPC) is one such material considered as a novel alternative to conventional concrete. The material microstructure in UHPC is optimized to significantly improve its material properties including compressive and tensile strength, modulus of elasticity, durability, and damage tolerance. Fiber-reinforced polymer (FRP) composite is another novel construction material with excellent properties such as high strength-to-weight and stiffness-to-weight ratios and good corrosion resistance. Considering the exceptional properties of UHPC and FRP, many advantages can result from the combined application of these two advanced materials, which is the subject of this research. The confinement behavior of UHPC was studied for the first time in this research. The stress-strain behavior of a series of UHPC-filled fiber-reinforced polymer (FRP) tubes with different fiber types and thicknesses were tested under uniaxial compression. The FRP confinement was shown to significantly enhance both the ultimate strength and strain of UHPC. It was also shown that existing confinement models are incapable of predicting the behavior of FRP-confined UHPC. Therefore, new stress-strain models for FRP-confined UHPC were developed through an analytical study. In the other part of this research, a novel steel-free UHPC-filled FRP tube (UHPCFFT) column system was developed and its cyclic behavior was studied. The proposed steel-free UHPCFFT column showed much higher strength and stiffness, with a reasonable ductility, as compared to its conventional reinforced concrete (RC) counterpart. Using the results of the first phase of column tests, a second series of UHPCFFT columns were made and studied under pseudo-static loading to study the effect of column parameters on the cyclic behavior of UHPCFFT columns. Strong correlations were noted between the initial stiffness and the stiffness index, and between the moment capacity and the reinforcement index. Finally, a thorough analytical study was carried out to investigate the seismic response of the proposed steel-free UHPCFFT columns, which showed their superior earthquake resistance, as compared to their RC counterparts.

Development of thresholds for surface preparation in repair systems with wet lay -up fiber reinforced polymers

Bonded repair of concrete structures with fiber reinforced polymer (FRP) systems is increasingly being accepted as a cost-efficient and structurally viable method of rapid rehabilitation of concrete structures. However, the relationships between long-term performance attributes, service-life, and details of the installation process are not easy to quantify. Accordingly, there is currently a lack of generally accepted construction specifications, making it difficult for the field engineer to certify the adequacy of the construction process. ^ The objective of the present study, as part of the National Cooperative Highway Research Program (NCHRP) Project 10-59B, was to investigate the effect of surface preparation on the behavior of wet lay-up FRP repair systems and consequently develop rational thresholds that provide sufficient performance. ^ The research program was comprised of both experimental and analytical work for wet lay-up FRP applications. The experimental work included flexure testing of sixty-seven (67) reinforced concrete beams and bond testing of ten (10) reinforced concrete blocks. Four different parameters were studied: surface roughness, surface flatness, surface voids and bug holes, and surface cracks/cuts. The findings were analyzed from various aspects and compared with the data available in the literature. As part of the analytical work, finite element models of the flexural specimens with surface flaws were developed using ANSYS. The purpose of this part was to extend the parametric study on the effects of concrete surface flaws and verify the experimental results based on nonlinear finite element analysis. ^ Test results showed that surface roughness does not appear to have a significant influence on the overall performance of the wet lay-up FRP systems with or without adequate anchorage, and whether failure was by debonding or rupture of FRP. Both experimental and analytical results for surface flatness proved that peaks on concrete surface, in the range studied, do not have a significant effect on the performance of wet lay-up FRP systems. However, valleys of particular size could reduce the strength of wet lay-up FRP systems. Test results regarding surface voids and surface cracks/cuts revealed that previously suggested thresholds for these flaws appear to be conservative, as also confirmed by analytical study. ^

Seismic Performance of Hybrid Fiber Reinforced Polymer-Concrete Pier Columns

As part of a multi-university research program funded by NSF, a comprehensive experimental and analytical study of seismic behavior of hybrid fiber reinforced polymer (FRP)-concrete column is presented in this dissertation. Experimental investigation includes cyclic tests of six large-scale concrete-filled FRP tube (CFFT) and RC columns followed by monotonic flexural tests, a nondestructive evaluation of damage using ultrasonic pulse velocity in between the two test sets and tension tests of sixty-five FRP coupons. Two analytical models using ANSYS and OpenSees were developed and favorably verified against both cyclic and monotonic flexural tests. The results of the two methods were compared. A parametric study was also carried out to investigate the effect of three main parameters on primary seismic response measures. The responses of typical CFFT columns to three representative earthquake records were also investigated. The study shows that only specimens with carbon FRP cracked, whereas specimens with glass or hybrid FRP did not show any visible cracks throughout cyclic tests. Further monotonic flexural tests showed that carbon specimens both experienced flexural cracks in tension and crumpling in compression. Glass or hybrid specimens, on the other hand, all showed local buckling of FRP tubes. Compared with conventional RC columns, CFFT column possesses higher flexural strength and energy dissipation with an extended plastic hinge region. Among all CFFT columns, the hybrid lay-up demonstrated the highest flexural strength and initial stiffness, mainly because of its high reinforcement index and FRP/concrete stiffness ratio, respectively. Moreover, at the same drift ratio, the hybrid lay-up was also considered as the best in term of energy dissipation. Specimens with glassfiber tubes, on the other hand, exhibited the highest ductility due to better flexibility of glass FRP composites. Furthermore, ductility of CFFTs showed a strong correlation with the rupture strain of FRP. Parametric study further showed that different FRP architecture and rebar types may lead to different failure modes for CFFT columns. Transient analysis of strong ground motions showed that the column with off-axis nonlinear filament-wound glass FRP tube exhibited a superior seismic performance to all other CFFTs. Moreover, higher FRP reinforcement ratios may lead to a brittle system failure, while a well-engineered FRP reinforcement configuration may significantly enhance the seismic performance of CFFT columns.

Aprender e ensinar na escola inclusiva: desafios na construção da identidade de pedagogos

The democratization of Brazilian education and discussion about the educational rights of persons with disabilities in refer to reflection on the conceptions of teaching and learning and the folding of these concepts in practice and in the formation of professional identity of the teacher educator. Thus, the proposed research in this dissertation aimed to describe educational processes developed by educators in classrooms in which they are enrolled students with disabilities a view to considering how these processes affect the construction of their professional identity of the pedagogue. As the methodology used to research is classified as Case Study. This methodological approach enables the analysis of singularities of educational contexts. In this work, the case investigated consisted of the analytical study of the pedagogical practices developed in classrooms where there are students with disabilities and their relation to the establishment of the professional identity of the teacher in a school linked to a non-governmental organization supporting people with disabilities in the city of Natal / RN. The Data were collected through the use of the following instruments: exploratory questionnaires, observation and respective registration in the field diary of research and interviews with educators in different professional cycles proposed by Huberman. The data reveal didactic and pedagogical aspects common in educational processes in the observed classes and differences concerning the specifics of pedagogues in the teaching profession in different moments of their professional careers. The analysis of the conceptions tell us the nuances of meanings constructed on teaching and learning and its interface with the reflection on teaching practice. As to the meaning assigned to be pedagogue research highlights the professional identification related to the meanings of teaching and learning in school. The experiences in the teaching profession according to the survey data point to changes in teachers conceptions about teaching and learning disabled people in the perspective of inclusion. Therefore, the study concludes that the pedagogical practices with students with disabilities the different experiences add up and can transform conceptions of teachers about teaching and learning interfering with constant reflection on practices and the construction of professional identities of pedagogues.

Qualidade de vida de pessoas com estomias intestinais

Ostomy is an open surgical origin, when it is necessary to deviate temporarily or permanently, the normal transit of food and / or deletions. The patient with ostomy disposal is faced with changes in their physiology, also emerging on the need to care collection bag. This study aimed to analyze the quality of life (QOL) of people living with ostomy Intestinal (EI), who attended the Pediatric and Adult Rehabilitation Center of Rio Grande do Norte (CRI / CRA-RN). It is an analytical study with cross-sectional design and quantitative approach, accomplished with 89 people who had EI. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (CEP / UFRN), CAAE: 19866413.3.0000.5537. Held data collection in the period January-March 2015 using two instruments: an adapted general questionnaire covering socio-demographic, clinical and self-care and a specific instrument for assessing QOL of people with stoma titled as City of Hope Quality of Life - Ostomy Questionnaire (COH-QOL-Q), validated and adapted to Portuguese in 2010, composed of four areas, namely: Welfare Body (BEF), Welfare Psychological (BEP), Welfare (BES ) and Spiritual Well-Being (BEE). The collected data were entered into a database in Microsoft Excel 2007 spreadsheet application and processed in computerized software for descriptive and inferential analysis. The results showed that 83.1% had a colostomy and ileostomy 16.9%. Sociodemographic characteristics prevailed in males (57.3%), over 50 (57.3%), mulatto (46.1%), with presence of companion / a (57.3%), retired / beneficiaries (50.5%), monthly income above the minimum wage (68.5%) and who have studied up to elementary school (67.4%). Regarding clinical aspects, it was observed that the main cause that led to the making of the stoma was the neoplasm (59.6%) followed by trauma (21.3%). The sample showed people with stoma for more than six months (79.8%) of permanently (57.3%), in use sink equipment piece drainable (68.5%) of flat base (82.0%). With respect to self-care, 93.3% emptied and washed the bag alone (care related to hygiene) and 75.3% fixed the new exchange on the skin during the exchange (care related to the stock). Patients with more than six months of ostomy and had no partner (a) had higher averages of self-care related hygiene and purse. The average of respondents QoL scores was 68.90% for General QOL; 68.03% for the BEF; 68.38% for the BEP; 66.46% for BES and 75.41% for BEE. Among the aspects that influenced QOL included: physical strength, pain, suffering and gases (physical domain); appearance, care of the stoma and adaptation to new condition (psychological domain); isolation, interference in personal relationships and social activities (social domain) and going to church or synagogue, spiritual activities and positive change after ostomy (spiritual realm). Based on these results, it is concluded that this was a predominantly adult sample / elderly (between 50 and 70 years), with low education and the cause motivating the stoma, neoplasms. However, such findings did not pass at low percentage levels on the self-care capacity to deliver even at low QOL scores.

Qualidade de vida de pessoas com estomias intestinais

Ostomy is an open surgical origin, when it is necessary to deviate temporarily or permanently, the normal transit of food and / or deletions. The patient with ostomy disposal is faced with changes in their physiology, also emerging on the need to care collection bag. This study aimed to analyze the quality of life (QOL) of people living with ostomy Intestinal (EI), who attended the Pediatric and Adult Rehabilitation Center of Rio Grande do Norte (CRI / CRA-RN). It is an analytical study with cross-sectional design and quantitative approach, accomplished with 89 people who had EI. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (CEP / UFRN), CAAE: 19866413.3.0000.5537. Held data collection in the period January-March 2015 using two instruments: an adapted general questionnaire covering socio-demographic, clinical and self-care and a specific instrument for assessing QOL of people with stoma titled as City of Hope Quality of Life - Ostomy Questionnaire (COH-QOL-Q), validated and adapted to Portuguese in 2010, composed of four areas, namely: Welfare Body (BEF), Welfare Psychological (BEP), Welfare (BES ) and Spiritual Well-Being (BEE). The collected data were entered into a database in Microsoft Excel 2007 spreadsheet application and processed in computerized software for descriptive and inferential analysis. The results showed that 83.1% had a colostomy and ileostomy 16.9%. Sociodemographic characteristics prevailed in males (57.3%), over 50 (57.3%), mulatto (46.1%), with presence of companion / a (57.3%), retired / beneficiaries (50.5%), monthly income above the minimum wage (68.5%) and who have studied up to elementary school (67.4%). Regarding clinical aspects, it was observed that the main cause that led to the making of the stoma was the neoplasm (59.6%) followed by trauma (21.3%). The sample showed people with stoma for more than six months (79.8%) of permanently (57.3%), in use sink equipment piece drainable (68.5%) of flat base (82.0%). With respect to self-care, 93.3% emptied and washed the bag alone (care related to hygiene) and 75.3% fixed the new exchange on the skin during the exchange (care related to the stock). Patients with more than six months of ostomy and had no partner (a) had higher averages of self-care related hygiene and purse. The average of respondents QoL scores was 68.90% for General QOL; 68.03% for the BEF; 68.38% for the BEP; 66.46% for BES and 75.41% for BEE. Among the aspects that influenced QOL included: physical strength, pain, suffering and gases (physical domain); appearance, care of the stoma and adaptation to new condition (psychological domain); isolation, interference in personal relationships and social activities (social domain) and going to church or synagogue, spiritual activities and positive change after ostomy (spiritual realm). Based on these results, it is concluded that this was a predominantly adult sample / elderly (between 50 and 70 years), with low education and the cause motivating the stoma, neoplasms. However, such findings did not pass at low percentage levels on the self-care capacity to deliver even at low QOL scores.

Toothache and social and economic conditions among adolescents in Northeastern Brazil

O objetivo deste estudo foi relacionar dor de dente com condição socioeconômica, acesso aos serviços de saúde bucal e estilo de vida em adolescentes do município de Sobral, Ceará, desenvolvido com delineamento transversal analítico, com amostra composta por 688 indivíduos. A prevalência de dor de dente no grupo pesquisado foi de 31,8%. Para avaliar a relação entre as variáveis independentes e a dor de dente, realizou-se teste de associação pelo qui-quadrado, estimando-se a razão de prevalências por meio da regressão de Poisson. Os fatores que mais demonstraram relação com a dor de dente foram severidade da cárie, motivo do atendimento odontológico relacionado com urgência, frequência ao dentista e recebimento de escova na escola. Observou-se que a alta prevalência de dor de dente em adolescentes está diretamente relacionada às condições de acesso, assim como às características das ações desenvolvidas pelos serviços de saúde. Assim como há necessidade da implantação de serviços vinculados à promoção de saúde, pautados pela equidade e integralidade, é necessária a implantação de serviços de urgência que não simplesmente intervenham na dor de forma mutiladora, mas a encarem como mecanismo de estímulo ao desenvolvimento de procedimentos de prevenção das doenças bucais.

O DISCURSO DE HUMANIZAÇÃO COMO ESTRATÉGIA DE APROXIMAÇÃO COM O CONSUMIDOR NAS PUBLICIDADES DAS MÍDIAS SOCIAIS

Este trabalho propõe o estudo analítico de estratégias discursivas das organizações empregadas nas publicidades das mídias sociais no Brasil em que, na tentativa de aproximação com os consumidores, as empresas emitem discursos de humanização. A pesquisa ocupou-se em identificar e analisar as publicidades das marcas notabilizadas nesse ambiente superabundante de informação, capazes de comunicar-se efetivamente com os consumidores, a ponto de levá-los ao engajamento com os interesses da organização pela interação e compartilhamento dos conteúdos nas mídias sociais, e de torná-los os agentes da marca, aqueles que divulgam voluntariamente os seus benefícios para a sua rede de amigos. Trata-se de uma pesquisa exploratória de teor qualitativo, cuja busca se dará pelas delineações de um espaço discursivo. Utilizou-se a análise do discurso (AD), da linha francesa, sob a perspectiva dos estudos do ethos, cenas de enunciação e contrato de comunicação que contemplam os discursos organizacionais. Além da conceituação teórica e revisão de literatura vinculadas às mídias sociais e cultura organizacional, o trabalho analisou as publicidades em vídeo publicadas no Facebook e YouTube, nos anos de 2014 e 2015, cujo intuito era a aproximação com o consumidor. A pesquisa demonstrou que o ambiente das mídias sociais requer outra postura das organizações, uma linguagem dialógica e interativa com a participação do consumidor nas suas publicidades. A supervalorização do consumidor e a sua inclusão nas narrativas é uma tentativa de humanizar as relações entre organização e seus públicos e demonstram ser o eixo conciliador entre ambos na nova ambiência midiática.

Étude exploratoire du recours à des interventions médicales de type "lourd' pour soulager la souffrance existentielle en fin de vie

Au cours du siècle dernier, des améliorations au niveau des conditions de vie ainsi que des avancées importantes dans les sciences biomédicales ont permis de repousser les frontières de la vie. Jusqu’au début du XXe Siècle, la mort était un processus relativement bref, survenant à la suite de maladies infectieuses et avait lieu à la maison. À présent, elle survient plutôt après une longue bataille contre des maladies incurables et des afflictions diverses liées à la vieillesse et a le plus souvent lieu à l’hôpital. Pour comprendre la souffrance du malade d’aujourd’hui et l’aborder, il faut comprendre ce qu’engendre comme ressenti ce nouveau contexte de fin de vie autant pour le patient que pour le clinicien qui en prend soin. Cette thèse se veut ainsi une étude exploratoire et critique des enjeux psychologiques relatifs à cette mort contemporaine avec un intérêt premier pour l’optimisation du soulagement de la souffrance existentielle du patient dans ce contexte. D’abord, je m’intéresserai à la souffrance du patient. À travers un examen critique des écrits, une définition précise et opérationnelle, comportant des critères distinctifs, de ce qu’est la souffrance existentielle en fin de vie sera proposée. Je poserai ainsi l’hypothèse que la souffrance peut être définie comme une forme de construction de l’esprit s’articulant autour de trois concepts : intégrité, altérité et temporalité. D’abord, intégrité au sens où initialement l’individu malade se sent menacé dans sa personne (relation à soi). Ensuite, altérité au sens où la perception de ses conditions extérieures a un impact sur la détresse ressentie (relation à l’Autre). Et finalement, temporalité au sens où l’individu souffrant de façon existentielle semble bien souvent piégé dans un espace-temps particulier (relation au temps). Ensuite, je m’intéresserai à la souffrance du soignant. Dans le contexte d’une condition terminale, il arrive que des interventions lourdes (p. ex. : sédation palliative profonde, interventions invasives) soient discutées et même proposées par un soignant. Je ferai ressortir diverses sources de souffrance propres au soignant et générées par son contact avec le patient (exemples de sources de souffrance : idéal malmené, valeurs personnelles, sentiment d’impuissance, réactions de transfert et de contre-transfert, identification au patient, angoisse de mort). Ensuite, je mettrai en lumière comment ces dites sources de souffrance peuvent constituer des barrières à l’approche de la souffrance du patient, notamment par l’influence possible sur l’approche thérapeutique choisie. On constatera ainsi que la souffrance d’un soignant contribue par moment à mettre en place des mesures visant davantage à l’apaiser lui-même au détriment de son patient. En dernier lieu, j'élaborerai sur la façon dont la rencontre entre un soignant et un patient peut devenir un espace privilégié afin d'aborder la souffrance. J'émettrai certaines suggestions afin d'améliorer les soins de fin de vie par un accompagnement parvenant à mettre la technologie médicale au service de la compassion tout en maintenant la singularité de l'expérience du patient. Pour le soignant, ceci nécessitera une amélioration de sa formation, une prise de conscience de ses propres souffrances et une compréhension de ses limites à soulager l'Autre.

Childhood Non-Langerhans Cell Histiocytosis – An Atypical Case

Introduction: Histiocytoses correspond to a heterogeneous group of disorders characterized by the proliferation andinfiltration of histiocytes in tissues. For years, many of the histiocytoses where known by numerous names, reflecting the lack of understanding regarding their origin. Case report: A previously healthy, 4-month-old infant presented a cutaneous lesion of progressive growth on his nose since 1 month ago. The mother has a diagnosis of Sjögren syndrome. On examination, there was a firm well-defined erythematous plaque with 30 mm of diameter and raised edges, on the bridge of the nose. At the left cheek, left thoracic region and right arm there were also small erythematous papules with 5 days of evolution. The analytical study showed elevated antinuclear antibodies and anti-SS-A. Histopathological examination confirmed the diagnosis of non-Langerhans cells histiocytosis. Progressively, more annular erythematous papules and plaques appeared scattered over the face, trunk and limbs with spontaneous resolution of the first lesion on the nose. About 2 months after the initial evaluation, all lesions had regressed spontaneously, with normalization of analytical study at one year-old. Conclusion: Many authors believe that the different subtypes of histiocytosis represent only different stages of the same disease. Immunophenotyping of histiocytosis does not always identify the subtype involved, making the occurrence of atypical cases frequent.

Quedas em idosos numa unidade de longa duração e manutenção

Introdução: as quedas são um importante problema na saúde nos idosos, apresentando os idosos institucionalizados um risco específico, determinado pela mudança de ambiente, diminuição da atividade física e alterações na independência funcional. Objetivo: estimar a prevalência e avaliar o risco de quedas nos idosos institucionalizados na ULDM – Sta Maria Maior de Miranda do Douro no período compreendido entre 02/12/2008 e 31/08/2014. Conhecer quais as estratégias de prevenção implementadas para evitar a recorrência de quedas nos idosos com histórico de quedas. Metodologia: Estudo descritivo e analítico de caráter retrospetivo, sobre uma amostra constituída por utentes com idade igual ou superior a 65 anos, internados numa Unidade de Longa Duração e Manutenção, no período compreendido entre 02/12/2008 e 31/08/2014 (N=158). Resultados: A prevalência de quedas foi de 14%. As quedas tiveram como principais fatores de risco a idade avançada, a presença de doenças crónicas, a mobilidade reduzida, défice cognitivo e polimedicação. O quarto e o WC foram os espaços físicos onde ocorreram com mais frequência. As principais causas foram, por esta ordem, a perda de apoio, episódio de desorientação/agitação e a perda de consciência. A maior parte das quedas não tiveram consequências físicas para o idoso ou limitaram-se a lesões traumáticas. As medidas de prevenção mais frequentemente aplicadas foram as medidas de apoio e a contenção física. Conclusão: nos resultados obtidos verifica-se uma prevalência de quedas muito superior quando comparada com outros estudos nesta área. Os dados apontam à necessidade de implementação de políticas institucionais de prevenção de quedas.