Hip fracture prognosis: could bioimpedance be an alternative to conventional nutritional assessment?

Background: Risk-factors for mortality in hip fractures encompass nutritional status, nominally body mass index, but not body composition. Given the difficulty of anthropometric assessment in bedridden patients a prospective study with bioimpedance analysis was designed. Methods: Elderly patients with hip fracture were consecutively recruited. Biochemical tests, primitive bioimpedance measurements (resistance, reactance and phase angle) and follow-up till one year were targeted. Results: Patients (N = 69, 81.2 +/- 8.1 years old, 72.5% females) stayed in the hospital for 15.5 +/- 17.1 days, and 18.8 %(13/69) required further hospitalization during the ensuing months. Mortality was 11.6% within 30 days, coinciding with hospital mortality, and an additional 11.6% till one year, thus reaching 23.2%. Anemia, hypoalbuminemia and low transferrin, along with elevated glucose and urea were frequent, suggesting undernutrition with metabolic derangements. Reactance, urea and creatinine were different in patients suffering both early and late demise. Resistance, white blood cell count and osteoporosis were risk factors for early mortality only, and anemia exclusively for late mortality. Conclusions: Primitive bioimpedance measurements, which had not been hitherto investigated, were prognostically related to early and late mortality. These markers of disease-related malnutrition and especially reactance should be further studied in patients unfit for anthropometric evaluation due to fracture and immobility.

Detection of nosocomial malnutrition is improved in Amazon region by a standard clinical nutrition education program

Background: In Brazil hospital malnutrition is highly prevalent. physician awareness of malnutrition is low, and nutrition therapy is underprescribed. One alternative to approach this problem is to educate health care providers in clinical nutrition. The present study aims to evaluate the effect of an intensive education course given to health care professionals and students on the diagnosis ability concerning to hospital malnutrition. Materials and methods: An intervention study based on a clinical nutrition educational program, offered to medical and nursing students and professionals, was held in a hospital of the Amazon region. Participants were evaluated through improvement of diagnostic ability, according to agreement of malnutrition diagnosis using Subjective Global Assessment before and after the workshop, as compared to independent evaluations (Kappa Index, k). To evaluate the impact of the educational intervention on the hospital malnutrition diagnosis, medical records were reviewed for documentation of parameters associated with nutritional status of in-patients. The SPSS statistical software package was used for data analysis. Results: A total of 165 participants concluded the program. The majority (76.4%) were medical and nursing students. Malnutrition diagnosis improved after the course (before k = 0.5; after k = 0.64; p < 0.05). A reduction of false negatives from 50% to 33.3% was observed. During the course, concern of nutritional diagnosis was increased W = 17.57; p < 0.001) and even after the course, improvement on the height measurement was detected chi(2) 12.87;p < 0.001). Conclusions: Clinical nutrition education improved the ability of diagnosing malnutrition; however the primary impact was on medical and nursing students. To sustain diagnostic capacity a clinical nutrition program should be part of health professional curricula and be coupled with continuing education for health care providers.

Robotic Surgery: History and Teaching Impact

Context: The purpose of this article is to review the history of robotic surgery, its impact on teaching as well as a description of historical and current robots used in the medical arena. Summary of evidence: Although the history of robots dates back to 2000 years or more, the last two decades have seen an outstanding revolution in medicine, due to all the changes that robotic surgery has made in the way of performing, teaching and practicing surgery. Conclusions: Robotic surgery has evolved into a complete and self-contained field, with enormous potential for future development. The results to date have shown that this technology is capable of providing good outcomes and quality care for patients. (C) 2011 AEU. Published by Elsevier Espana, S.L. All rights reserved.

Nutritional recommendation alone does not change the obesity profile of health professionals

Objective: To evaluate the frequency of overweight and obesity in health professionals, before and after a single specialized dietary recommendation. Methods: Anthropometric measures of 579 workers of a general hospital in the city of Sao Paulo, Brazil were taken. The weight (f), height (h) and waist circumference (wc) were interpreted according to the WHO and NCEP ATP III guidelines. Nutrition specialist provided dietary and behavioral recommendations. The entire sample underwent a new evaluation one year later. Results: At the first evaluation, 79 employees presente WC >= 102 cm (male) or WC >= 88 cm (female). The association between WC >= 102 cm (men) or WC >= 88 cm (women) and BMI >= 30 kg/m(2) was found in 12.8 % (69 subjects). The BMI distribution per age group indicated that the increase in overweight and obesity was directly proportional to the age increase. Physical activities were not practiced by 75% of the subjects studied. A year later, the evaluation indicated lack of statistical differences regarding the BMI and waist circumference of the sample and only 2.8% started to practice a physical activity. Conclusion: Dietary recommendation alone failed to promote changes in the eating habits of health professionals who work at a general hospital or to encourage them to practice exercise.

Comparison of bioelectrical impedance with skinfold thickness and x-ray absorptiometry to measure body composition in HIV-infected with lipodistrophy

Introduction: Human immunodeficiency virus (HIV)associated lipodystrophy syndrome (LS) includes body composition and metabolic alterations. Lack of validated criteria and tools make difficult to evaluate body composition in this group. Objective: The aim of the study was to compare different methods to evaluate body composition between Brazilians HIV subjects with (HIV+LIPO+) or without LS (HIV+LIPO-) and healthy subjects (Control). Methods: in a cross-sectional analyses, body composition was measured by bioelectrical impedance analysis (BIA), skinfold thickness (SF) and dual-energy x-ray absorptiometry (DXA) in 10 subjects from HIV+LIPO+ group; 22 subjects from HIV+LIPO- group and 12 from Control group. Results: There were no differences in age and body mass index (BMI) between groups. The fat mass (FM) (%) estimated by SF did not correlate with DXA in HIV+LIPO+ group (r = 0,46/p >0,05) and had fair agreement in both HIV groups (HIV+LIPO+ =0,35/ HIV+ LIPO- = 0,40). BIA had significant correlation in all groups (p < 0,05) and strong agreement, meanly in HIV groups, for FM (HIV+LIPO+ = 0,79/ HIV+LIPO- = 0,85/Control = 0,60) and for fat free mass (FFM) (HIV+LIPO+ = 0,93/ HIV+LIPO- = 0,92 / Control = 0,73). Discussion: Total fat mass can be measured by BIA with good precision, but not by SF in HIV-infected patients with LS. Segmental BIA, triciptal SF, circumferences of arms, waist and legs maybe alternatives that need more studies.

Determination of temperature variation during the individual steps of the production of hospital diets of modified consistency

Background & aim: Many disease outbreaks of food origin are caused by foods prepared in Food Service and Nutrition Units of hospitals, affecting hospitalized patients who, in most cases, are immunocompromised and therefore at a higher risk of severe worsening of their clinical status. The aim of this study was to determine the variations in temperature and the time-temperature factor of hospital diets. Methods: The time and temperature for the preparation of 4 diets of modified consistency were determined on 5 nonconsecutive days in a hospital Diet and Nutrition Unit at the end of preparation and during the maintenance period, portioning and distribution at 3 sites, i.e., the first, the middle and the last to receive the diets. Results and discussion: All foods reached an adequate temperature at the end of cooking, but temperature varied significantly from the maintenance period to the final distribution, characterizing critical periods for microorganism proliferation. During holding, temperatures that presented a risk were reached by 16.7% of the meats and 59% of the salads of the general diet, by 16.7% of the garnishes in the bland diet and by 20% of the meats and garnishes in the viscous diet. The same occurred at the end of distribution for 100% of the hot samples and of the salads and for 61% of the desserts. None of the preparations remained at risk temperature for a time exceeding that established by law. Conclusion: The exposure to inadequate temperature did not last long enough to pose risks to the patient.

Forma????o de carreiras para a gest??o p??blica contempor??nea: o caso dos especialistas em pol??ticas p??blicas e gest??o governamental

O artigo analisa o curso de forma????o inicial para a carreira de Especialista em Pol??ticas P??blicas e Gest??o Governamental (EPPGG), recentemente reformulado. Conclui-se que as mudan??as realizadas no curso, tendo em vista os problemas enfrentados em edi????es anteriores, os desafios contempor??neos da administra????o p??blica, a crescente complexidade dos problemas e as demandas da sociedade, proporcionaram respostas bastante adequadas. No entanto, persistem in??meros desafios, dentre os quais se destacam o aprimoramento do ensino de aplica????o e novas tecnologias. Ao longo das nove edi????es do curso, percebe-se que os principais objetivos do projeto inicial da carreira permaneceram, mesmo com todas as descontinuidades administrativas. Preservaram-se o perfil generalista e as policompet??ncias na forma????o do EPPGG, a fim de permitir ao profissional uma vis??o abrangente e integrada dos complexos problemas da administra????o p??blica e desenvolver a capacidade de analisar, decidir e buscar os melhores resultados em prol do cidad??o, conduzindo as rela????es e as atividades profissionais de acordo com os princ??pios da ??tica p??blica.

Pr??-equidade de g??nero: incorporando pol??ticas de a????o afirmativa no mundo do trabalho

A institui????o do Programa Pr??-equidade de G??nero ?? o reconhecimento p??blico da desigualdade de tratamento e de oportunidades, que ainda permanece entre mulheres e homens. A implementa????o ?? consolidada com a coloca????o em pr??tica dos planos de a????es firmados entre a Secretaria Especial de Pol??ticas para as Mulheres (SPM) e as organiza????es aderentes. A pesquisa explorat??ria teve como objetivo apresentar o programa e discuti-lo com base no modelo "policy cycle como aprendizado", de Silva e Melo (2000). Os resultados subsidiar??o pesquisa futura sobre a avalia????o do programa. Dentro da estrat??gia adotada, a coleta de dados ocorreu em documentos institucionais e dados bibliogr??ficos em mar??o de 2009, com o seguinte resultado: a avalia????o n??o trata de forma clara da efetividade e da sustentabilidade do programa. Este trabalho est?? dividido em seis partes: descri????o do m??todo utilizado; apresenta????o do Programa Pro-equidade de G??nero; avalia????o de suas duas primeiras edi????es; breve contextualiza????o das pol??ticas p??blicas no Brasil e o modelo "policy cicle como aprendizado"; rela????es entre o programa e o modelo; e considera????es finais.

Las evaluaciones externas en la Ley Orgánica para la mejora de la calidad educativa de España

De acuerdo con la información aportada por el Instituto Nacional de Evaluación (2012), España ha participado en las ediciones de 1990, 2006 y 2011 de PIRLS y en las ediciones de 1995 y de 2011 de TIMSS. Por otra parte, en el año 2009, nuestro país participó por primera vez en el Estudio Internacional de Civismo y Ciudadanía (Instituto de Evaluación, 2010). Finalmente, España participa en el Programa para la Evaluación Internacional de los Alumnos (PISA). Por otra parte, junto a estas evaluaciones internacionales, tanto a nivel estatal como autonómico, se han implementado otras pruebas externas. Esta tendencia se ha visto reafirmada y ampliada por la nueva Ley Orgánica para la Mejora de la Calidad Educativa (LOMCE), aspecto que será analizado en esta comunicación. La proliferación de estas prácticas puede ser analizada desde diversas perspectivas. En esta comunicación se realiza una aproximación sustentada en numerosos escritos recientes (Pérez y Soto, 2011, Perrenoud, 2008; Stake, 2006), que advierten sobre los impactos de los sistemas de evaluación en las prácticas de enseñanza. Por otra parte, desde esta aproximación crítica, se sostiene que las evidencias sobre lo que éstas aportan para la mejora de la educación no parecen ser tan abundantes.

Serum Zn Levels in Dysphagic Patients Who Underwent Endoscopic Gastrostomy for Long Term Enteral Nutrition

Background and aims: Dysphagic patients who underwent endoscopic gastrostomy (PEG) usually present protein-energy malnutrition, but little is known about micronutrient malnutrition. The aim of the present study was the evaluation of serum zinc in patients who underwent endoscopic gastrostomy and its relationship with serum proteins, whole blood zinc, and the nature of underlying disorder. Methods: From patients that underwent gastrostomy a blood sample was obtained minutes before the procedure. Serum and whole blood zinc was evaluated using Wavelength Dispersive X-ray Fluorescence Spectroscopy. Serum albumin and transferrin were evaluated. Patients were studied as a whole and divided into two groups: head and neck cancer (HNC) and neurological dysphagia (ND). Results: The study involved 32 patients (22 males), aged 43-88 years: HNC = 15, ND = 17. Most (30/32) had low serum zinc, 17/32 presented normal values of whole blood zinc. Only two, with traumatic brain injury, presented normal serum zinc. Serum zinc levels showed no differences between HNC and ND patients. There was no association between serum zinc and serum albumin or transferrin. There was no association between serum and whole blood zinc. Conclusions: Patients had low serum zinc when gastrostomy was performed, similar in HNC and ND, being related with prolonged fasting and unrelated with the underlying disease. Decrease serum zinc was unrelated with low serum proteins. Serum zinc was more sensitive than whole blood zinc for identifying reduced zinc intake. Teams taking care of PEG-patients should include zinc evaluation as part of the nutritional assessment, or include systematic dietary zinc supply.

Recensões

Revista do IHA, N.4 (2007), pp.323-328

Entrevista a: Prof. Dña. Manuela Romo: Profesora de la Facultad de Psicología de la Universidad Autónoma de Madrid y experta en Psicología de la Creatividad

Breve CV de Prof. Manuela Romo: Ha centrado su investigación en la creatividad durante más de treinta años, publicando cuatro libros, entre ellos el libro Psicología de la Creatividad, y numerosos artículos y trabajos de investigación. Es co-autora de un ensayo para evaluar la creatividad en los niños: TCI, Test de Creatividad Infantil (TEA Ediciones, 2008, Madrid). Fue el contribuyente español en los libros Creativity's Global Corresponsales, de 1998 a 2003 publicado por Morris Stein. Winslow Press (N.York) Ha dado más de 60 conferencias y numerosos cursos y talleres por toda España, Portugal, Italia, el Reino Unido y muchos países de América Latina. En 2000 organizó el Primer Encuentro Nacional de Profesores Universitarios e Investigadores de la creatividad en su universidad. Ha sido directora del Doctorado en Creatividad Aplicada de la Universidad Autónoma de Madrid desde que se ofreció por primera vez en el año 2000 hasta la actualidad. También, es directora de un título en Creatividad Aplicada en su universidad (2015-2015). Ha participado en la organización de siete reuniones internacionales sobre la creatividad. Además, fue co-fundadora y actualmente es vicepresidente de la Asociación La Creatividad en España: ASOCREA. Ha contribuido en diversos proyectos de I + D centrados en la creatividad.

La formación b-learning en el máster de español segunda lengua y lengua extranjera de la Universidade do Minho: innovación pedagógica y desafíos educativos

En el actual marco de creciente innovación pedagógica, debido entre otros factores, a la irrupción de nuevas herramientas informáticas, la enseñanza a distancia (e-learning y/o b-learning) va ocupando cada vez más espacio en la oferta educativa de diversas instituciones. En esta dirección, en la Universidade do Minho, y concretamente en el Área de Estudos Espanhóis e Hispano-Americanos,[1] hemos dedicado considerables esfuerzos a la ampliación de nuestra oferta desde 2010: primero en la elaboración e implementación del Curso de Formación Especializada en Español Lengua Extranjera, modalidad b-learning (3 ediciones; 2010-2013), y, actualmente, con el Máster Universitario en Español Lengua Segunda / Lengua Extranjera (vid. www.melsle.ilch.uminho.pt), también b-learning. En las siguientes páginas, nos proponemos compartir una serie de experiencias y reflexiones que han ido surgiendo durante estos años acerca de la formación universitária de profesores de Español Lengua Extranjera, en general, con recurso a la modalidade b-learning; para ello, nos centraremos en los siguientes aspectos: (i) caracterización general y problematización de la enseñanza a distancia en la Universidade do Minho; (ii) descripción del Máster Universitario en Español Lengua Segunda / Lengua Extranjera, acerca del cual detallaremos algunas prácticas adoptadas, relacionadas com la enseñanza e-learning como, por ejemplo, (iii) la coordinación pedagógica o (iv) los enfoques metodológicos adoptados a partir de la experiencia de una Unidad Curricular concreta.

Las Mascotas en los Juegos de la Olimpiada, indispensables desde su aparición

Documento publicado por el CEO-UAB el año 1997 como parte de la colección Working Papers y que se presentó en la Asignatura Campus de la Universitat Autònoma de Barcelona (UAB) “Olimpismo, Sociedad y Deporte” durante el curso académico 1996/97. El texto analiza las características y dimensiones de distintas mascotas a lo largo de varias ediciones de los Juegos.