Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil

BACKGROUND: Chronic leg ulcer may have an impact on patients' quality of life.OBJECTIVES:This study aimed to identify the impact of leg ulcers on patient's quality of life using the Dermatology Life Quality Index and to define the main factors correlated with this perception.METHOD:Cross-sectional, non-probabilistic sampling study. We included patients with chronic leg ulcers being treated for at least 3 months. A sociodemographic and clinical survey was conducted to assess the profile of the ulcers. We administered a screening for depressive symptoms and the Dermatology Life Quality Index. We performed a descriptive statistical analysis, chi-square test and Mann-Whitney test for categorical data, Pearson for numeric variables, and multiple regression for categorical data.RESULTS:Forty-one patients were assessed. Their mean age was 61.78 years. Venous ulcers (48.8%) were the most prevalent. Seventy-three percent of the sample perceived no impact/low impact on quality of life in the past week, and 26.8% perceived moderate/high impact. A multiple regression analysis identified the causes of lesion, pain related to the ulcers, time of onset, and severity of the depressive symptoms as the variables that had an influence on quality of life.CONCLUSIONS:The majority of the sample perceived low or no impact of the condition on the quality of the life. The variables etiology of the lesion (p<0.001), pain related to the ulcers (p=0.001), time of onset (p=0.006), and severity of the depressive symptoms (p<0.001) had an influence on the quality of life, suggesting the need for further studies with more robust designs to confirm the causal relationship between these characteristics and quality of life.

Tomada de decisão em grupo na seleção de processos para auditoria interna

L’audit, c’est un outil de gestion très important pour que les organisations puissent accomplir la réussite. Selon le fait qu’il n’y a pas des modèles d’aide à l’audit, il existe une opportunité de recherche. En considerant les Méthodes d’Aide à la Décision, il y a des plusieurs type d’applications. L’objectif de la recherche c’est la proposition d’un modèle capable de sélectionner des processus pour faire l’audit dans une distributeur de carburant en considerant la prise de décision en groupe. La modélisation normative empirique c’est la méthode de recherche utilisée. Un modèle qui utilise l’Analytic Hierarchy Process (AHP) et la prise de décision en groupe a été proposé face aux difficultés d’un département d’Audit Interne. Le modèle proposé présente les poids des processus et permet leur priorisations dans un scénario determiné. Pour l’application de ce modèle présenté, on a utilisé cinq critères et 26 alternative (processus). L’information de jugement a été bien founi par trois spécialistes du département. Quelques rendez-vous avec les participants ont été pris pour obtenir et réviser les donnés ainsi que discuter les résultats. Les résultats obtenus par le modèle permettent d’identifier les processus qu’il faut plus d’attention. L’équipe a considéré le modèle comme une proposition d’aide à la prise de décision très pertinent pour le département d’Audit Interne

Leishmania sp. amastigotes identification in canine transmissible venereal tumor

Leishmaniasis is a vector-borne disease with Leishmania chagasi being the etiological agent of canine visceral leishmaniasis in South America. Canine venereal tumor is a transplantable round cell tumor of histiocytic origin which is mostly observed in sexually active male and female intact dogs. It has been shown that Leishmania amastigotes have higher tropism for the canine male genital tract tissues and venereal leishmaniasis transmission has been documented in dogs but, to date, a canine venereal tumor-dependent transmission route has not been fully demonstrated. In this report, a 10-year-old, mixed breed, intact female dog presented a vaginal venereal transmissible tumor but no other clinical abnormalities otherwise. Unexpectedly, tumor tissue imprint smears examination revealed Leishmania sp. amastigotes within infiltrating macrophages. In addition to the cytological direct identification, the protozoan was confirmed within the neoplastic tissue by means of immunohistochemistry and polymerase chain reaction. This report illustrates an asymptomatic Leishmania sp. infection that may have started on or from the canine venereal tumor tissue, the latter option further supporting previous evidence of such an alternative vector-independent route of transmission for canine visceral leishmaniasis in areas where these diseases coexist.

Children’s Play in Cross-Cultural Perspective: A New Look at the Six Cultures Study

A qualitative and quantitative reanalysis of the Six Cultures data on children’s play, collected in the 1950s, was performed to revisit worlds of childhood during a time when sample communities were more isolated from mass markets and media than they are today. A count was performed of children aged 3 to 10 in each community sample scored as engaging in creative-constructive play, fantasy play, role play, and games with rules. Children from Nyansongo and Khalapur scored lowest overall, those from Tarong and Juxtlahuaca scored intermediate, and those from Taira and Orchard Town scored highest. Cultural norms and opportunities determined how the kinds of play were stimulated by the physical and social environments (e.g., whether adults encouraged work versus play, whether children had freedom for exploration and motivation to practice adult roles through play, and whether the environment provided easy access to models and materials for creative and constructive play).

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.

In/Out Las Palmas de Gran Canaria

[ES]Intervención en el Barranco de Tamaraceite con un parque urbano y un hotel de congresos.