Associação entre as atividades desenvolvidas e os fatores de risco para doenças cardiovasculares de enfermeiros de um hospital universitário

Trata-se de um estudo de caráter descritivo, transversal com abordagem quantitativa. Este estudo transversal de base populacional possui como população de estudo enfermeiros trabalhadores de um hospital universitário do Estado do Rio de Janeiro. Possui como objetivo primário do estudo estimar a magnitude da associação entre as atividades profissionais dos enfermeiros e os fatores de risco para doenças cardiovasculares, e como objetivos secundários descrever o perfil demográfico e profissional dos enfermeiros do estudo; correlacionar a presença dos fatores de risco para doenças cardiovasculares com o tipo de atividade desenvolvida; e estabelecer a relação dos fatores de risco para doenças cardiovasculares com o nível de estresse dos enfermeiros. Selecionou-se para o estudo um total de 61 participantes. Os sujeitos foram acessados através de suas chefias imediatas e pela chefia geral de Enfermagem do hospital, que se dispusera a ajudar nesse contato. Listas com os nomes e setores foram disponibilizadas e os contatos assim foram realizados. As variáveis que foram analisadas no estudo são do tipo sociodemográficas, variáveis laborais e variáveis relacionadas aos fatores de risco para doenças cardiovasculares. Foi utilizado um questionário estruturado para a avaliação de variáveis socioeconômicas; variáveis sobre conhecimento da hipertensão, diabetes, dislipidemia, tabagismo, etilismo e atividade física; aferições sobre peso, altura e pressão arterial; informações sobre o trabalho. Para a avaliação de estresse no trabalho foi utilizada a Escala Bianchi de Estresse.. Após análises estatísticas secundárias, a mensuração do Escore Bianchi de Estresse e Escore de Risco Global para doenças cardiovasculares, foi identificado que as variáveis estatisticamente significativas associadas ao risco cardiovascular foram sexo, idade e o grupo de estresse (baixo e médio). Com a regressão logística foi possível identificar o tamanho da associação. O sexo masculino possui a chance de apresentar risco cardiovascular 5,66 vezes maior que o sexo feminino. A faixa etária entre 40 e 59 anos apresenta um risco cardiovascular 4,37 vezes maior que a faixa etária entre 20 e 39 anos. Os sujeitos com Escore de Bianchi de Estresse (EBS) classificados como Médio apresentam risco cardiovascular 6,63 vezes maior do que quem tem EBS baixo. A associação entre estresse e risco cardiovascular foi de 3,23. Concluiu-se que o existe uma nítida associação entre estresse, avaliado pelo Escore Bianchi de Estresse e aumento do risco cardiovascular global, através da ER Global. Os profissionais que trabalham em setores fechados apresentam um maior risco cardiovascular global. Os enfermeiros conhecem os fatores de risco para doenças cardiovasculares. Paradoxalmente encontramos que os enfermeiros que possuem apenas um emprego apresentam um risco global intermediário. Os profissionais homens, em nosso estudo, apresentam um risco cardiovascular global maior que as mulheres.

Distribution, age, and growth of young-of-the year greater amberjack (Seriola dumerili) associated with pelagic Sargassum

Patterns of distribution and growth were examined for young-of-the-year (YOY) greater amberjack (Seriola dumerili) associated with pelagic Sargassum in the NW Gulf of Mexico. Seriola dumerili were collected off Galveston, Texas, from May to July over a two-year period (2000 and 2001) in both inshore (<15 nautical miles [nmi]) and offshore zones (15−70 nmi). Relative abundance of YOY S. dumerili (32−210 mm standard length) from purse-seine collections peaked in May and June, and abundance was highest in the offshore zone. Ages of S. dumerili ranged from 39 to 150 days and hatching-date analysis indicated that the majority of spawning events occurred from February to April. Average daily growth rates of YOY S. dumerili for 2000 and 2001 were 1.65 mm/d and 2.00 mm/d, respectively. Intra-annual differences in growth were observed; the late-season (April) cohort experienced the fastest growth in both years. In addition, growth was significantly higher for S. dumerili collected from the offshore zone. Mortality was approximated by using catch-curve analysis, and the predicted instantaneous mortality rate (Z) of YOY S. dumerili was 0.0045 (0.45%/d).

Age structure, growth and mortality estimates of an endemic Ptychobarbus dipogon (Regan, 1905) (Cyprinidae: Schizothoracinae) in the Lhasa River, Tibet

Ptychobarbus dipogon is an endemic fish in the Yarlung Tsangpo River, but its biology is poorly known. We sampled 582 specimens (total length, TL, between 70.6 and 593.0 mm) from April 2004 to August 2006 in the Lhasa River, Tibet. We estimated ages based on the counts of alternating opaque and translucent zones (annuli) in thin transverse sections of lapilli otoliths. Ages ranged from 1(+) to 23(+) years for males and 1(+) to 44(+) for females. The observed 44(+) years was the oldest reported for schizothoracine fishes. Females attained a larger size than males. The TL weight relationship was W=7.12 x 10(-6)TL(3.006) for combined sexes. The growth parameters fitted von Bertalanffy growth functions were L-infinity = 598.66 mm, k=0.0898 year(-1), t(0)=-0.7261 year and W-infinity = 1585.38 g for females and L-infinity = 494.23mm, k=0.1197 year(-1), t(0)=-0.7296 year and W-infinity = 904.88g for males. The longevities of 32.7 year for females and 24.3 year for males were similar to the observed ages. Using an empirical model we estimated the instantaneous rate of total mortality (Z) at 0.28 per year in the lower reaches. Z in the upper and middle stocks was close to the M because of unexploited or lightly exploited stock. Protracted longevity, slow growth, low natural mortality and large body size were typical characteristics of P. dipogon. The current declining trend of P. dipogon could be prevented by altering fishing regulations.

Valve surgery in active infective endocarditis: a simple score to predict in-hospital prognosis

Aims Surgery for infective endocarditis (IE) is associated with high mortality. Our objectives were to describe the experience with surgical treatment for IE in Spain, and to identify predictors of in-hospital mortality. Methods Prospective cohort of 1000 consecutive patients with IE. Data were collected in 26 Spanish hospitals. Results Surgery was performed in 437 patients (43.7%). Patients treated with surgery were younger and predominantly male. They presented fewer comorbid conditions and more often had negative blood cultures and heart failure. In-hospital mortality after surgery was lower than in the medical therapy group (24.3 vs 30.7%, p = 0.02). In patients treated with surgery, endocarditis involved a native valve in 267 patients (61.1%), a prosthetic valve in 122 (27.9%), and a pacemaker lead with no clear further valve involvement in 48 (11.0%). The most common aetiologies were Staphylococcus (186, 42.6%), Streptococcus (97, 22.2%), and Enterococcus (49, 11.2%). The main indications for surgery were heart failure and severe valve regurgitation. A risk score for in-hospital mortality was developed using 7 prognostic variables with a similar predictive value (OR between 1.7 and 2.3): PALSUSE: prosthetic valve, age ≥ 70, large intracardiac destruction, Staphylococcus spp, urgent surgery, sex [female], EuroSCORE ≥ 10. In-hospital mortality ranged from 0% in patients with a PALSUSE score of 0 to 45.4% in patients with PALSUSE score > 3. Conclusions The prognosis of IE surgery is highly variable. The PALSUSE score could help to identify patients with higher in-hospital mortality.

Egzystencjalna teoria umysłu. Konstrukcja narzędzia pomiarowego

Wydział Nauk Społecznych: Instytut Psychologii

Fractures in myelomeningocele.

BACKGROUND: In patients with myelomeningocele (MMC), a high number of fractures occur in the paralyzed extremities, affecting mobility and independence. The aims of this retrospective cross-sectional study are to determine the frequency of fractures in our patient cohort and to identify trends and risk factors relevant for such fractures. MATERIALS AND METHODS: Between March 1988 and June 2005, 862 patients with MMC were treated at our hospital. The medical records, surgery reports, and X-rays from these patients were evaluated. RESULTS: During the study period, 11% of the patients (n = 92) suffered one or more fractures. Risk analysis showed that patients with MMC and thoracic-level paralysis had a sixfold higher risk of fracture compared with those with sacral-level paralysis. Femoral-neck z-scores measured by dual-energy X-ray absorptiometry (DEXA) differed significantly according to the level of neurological impairment, with lower z-scores in children with a higher level of lesion. Furthermore, the rate of epiphyseal separation increased noticeably after cast immobilization. Mainly patients who could walk relatively well were affected. CONCLUSIONS: Patients with thoracic-level paralysis represent a group with high fracture risk. According to these results, fracture and epiphyseal injury in patients with MMC should be treated by plaster immobilization. The duration of immobilization should be kept to a minimum (<4 weeks) because of increased risk of secondary fractures. Alternatively, patients with refractures can be treated by surgery, when nonoperative treatment has failed.

Measuring the comprehensibility of Z specifications

The effects of natural language comments, meaningful variable names, and structure on the comprehensibility of Z specifications are investigated through a designed experiment conducted with a range of undergraduate and post-graduate student subjects. The times taken on three assessment questions are analysed and related to the abilities of the students as indicated by their total score, with the result that stronger students need less time than weaker students to complete the assessment. Individual question scores, and total score, are then analysed and the influence of comments, naming, structure and level of student's class are determined. In the whole experimental group, only meaningful naming significantly enhances comprehension. In contrast, for those obtaining the best score of 3/3 the only significant factor is commenting. Finally, the subjects' ratings of the five specifications used in the study in terms of their perceived comprehensibility have been analysed. Comments, naming and structure are again found to be of importance in the group when analysed as a whole, but in the sub-group of best performing subjects only the comments had an effect on perceived comprehensibility.

Cardiovascular disease risk profiles among 'healthy' siblings of patients with early-onset cardiovascular disease:Application of the new SCORE system

BACKGROUND: Cardiovascular disease (CVD) occurs more frequently in individuals with a family history of premature CVD. Within families the demographics of CVD are poorly described. DESIGN: We examined the risk estimation based on the Systematic Coronary Risk Evaluation (SCORE) system and the Joint British Guidelines (JBG) for older unaffected siblings of patients with premature CVD (onset ≤55 years for men and ≤60 years for women). METHODS: Between August 1999 and November 2003 laboratory and demographic details were collected on probands with early-onset CVD and their older unaffected siblings. Siblings were screened for clinically overt CVD by a standard questionnaire and 12-lead electrocardiogram (ECG). RESULTS: A total of 790 siblings was identified and full demographic details were available for 645. The following siblings were excluded: 41 with known diabetes mellitus; seven with random plasma glucose of 11.1 mmol/l or greater; and eight with ischaemic ECG. Data were analysed for 589 siblings from 405 families. The mean age was 55.0 years, 43.1% were men and 28.7% were smokers. The mean total serum cholesterol was 5.8 mmol/l and hypertension was present in 49.4%. Using the SCORE system, when projected to age 60 years, 181 men (71.3%) and 67 women (20.0%) would be eligible for risk factor modification. Using JBG with a 10-year risk of 20% or greater, 42 men (16.5%) and four women (1.2%) would be targeted. CONCLUSIONS: Large numbers of these asymptomatic individuals meet both European and British guidelines for the primary prevention of CVD and should be targeted for risk factor modification. The prevalence of individuals defined as eligible for treatment is much higher when using the SCORE system. © 2007 European Society of Cardiology.

Age-related changes in energy efficiency of gait, activity, and participation in children with cerebral palsy

Aim
The aim of this study was to use a prospective longitudinal study to describe age-related trends in energy efficiency during gait, activity, and participation in ambulatory children with cerebral palsy (CP).

Method
Gross Motor Function Measure (GMFM), Paediatric Evaluation of Disability Inventory (PEDI), and Lifestyle Assessment Questionnaire-Cerebral Palsy (LAQ-CP) scores, and energy efficiency (oxygen cost) during gait were assessed in representative sample of 184 children (112 male; 72 female; mean age 10y 9mo; range 4–16y) with CP. Ninety-four children had unilateral spastic CP, 84 bilateral spastic CP, and six had other forms of CP. Fifty-seven were classified as Gross Motor Function Classification System (GMFCS) level I, 91 as level II, 22 as level III, and 14 as level IV). Assessments were carried out on two occasions (visit 1 and visit 2) separated by an interval of 2 years and 7 months. A total of 157 participants returned for reassessment.

Results
Significant improvements in mean raw scores for GMFM, PEDI, and LAQ-CP were recorded; however, mean raw oxygen cost deteriorated over time. Age-related trends revealed gait to be most inefficient at the age of 12 years, but GMFM scores continued to improve until the age of 13 years, and two PEDI subscales to age 14 years, before deteriorating (p<0.05). Baseline score was consistently the single greatest predictor of visit 2 score. Substantial agreement in GMFCS ratings over time was achieved (?lw=0.74–0.76).

Interpretation
These findings have implications in terms of optimal provision and delivery of services for young people with CP to maximize physical capabilities and maintain functional skills into adulthood.