Gerência do cuidado de enfermagem em cenários hospitalares: a construção de um conceito

Este estudo teve como objetivo construir e apresentar a definição teórica do conceito de gerência do cuidado de enfermagem em cenários hospitalares, a partir de base literária específica. Optou-se pela utilização das estratégias para construção de conceitos da Análise de Conceito, as regras de formação de conceito da Análise Arqueológica e a Análise Lexical como referencial teórico-metodológico. A operacionalização das estratégias e das regras de formação de conceito possibilitou a construção do conceito gerência do cuidado de enfermagem em cenários hospitalares. O conceito construído apresentou, em sua natureza, a capacidade de integrar dialeticamente os aspectos relativos ao saber-fazer do cuidar e gerenciar. A definição teórica do conceito Gerência do Cuidado de Enfermagem em Cenários Hospitalares deu significado ao termo, no contexto inicial de construção de uma teoria, a Gerência do Cuidado de Enfermagem em Serviços de Saúde.

Avaliação do nível de esperança de vida de idosos renais crônicos em hemodiálise

O presente estudo teve por objetivo avaliar o nível de esperança dos idosos renais crônicos em hemodiálise, por meio da Escala de Esperança de Herth (EEH). Trata-se de um estudo descritivo transversal, realizado em uma Unidade de Terapia Renal Substitutiva do interior do estado de São Paulo. A amostra foi composta por 50 idosos em tratamento hemodialítico. Após o consentimento em participar da pesquisa, realizou-se entrevistas individuais com os referidos idosos aplicando-se um instrumento de caracterização e a Escala de Esperança de Herth. Todos os preceitos éticos foram respeitados (protocolo 512/2009). Quanto aos resultados, houve predomínio do sexo masculino (60%) e idade média de 70,20 (±6,1) anos. O escore médio obtido com a aplicação da Escala de Esperança de Herth foi de 36,20 (±2,90). Conclui-se que em comparação com o estudo brasileiro de validação da Escala de Esperança de Herth, o nível de esperança dos sujeitos do presente estudo foi mais baixo, indicando a necessidade de intervenção sobre esse sentimento.

Pilot licensing after aortic valve surgery.

Background and aim of the study: Bicuspid aortic valve is the most common congenital heart malformation, and a high percentage of patients with this condition will develop complications over time. It is rare that pilots undergo aortic valve surgery, and the confirmation of flight-licensing requirements after aortic valve replacement (AVR) is a challenge for the patient's cardiac surgeon and, particularly, for the Aeromedical Examiner (AME). Only AMEs are able to determine the flight status of pilots. Furthermore, in military and in civil aviation (e.g., Red Bull Air Race), the high G-load environment experienced by pilots is an exceptional physiological parameter, which must be considered postoperatively. Methods: A review was conducted of the aeronautical, surgical and medical literature, and of European pilot-licensing regulations. Case studies are also reported for two Swiss Air Force pilots. Results: According to European legislation, pilots can return to flight duty from the sixth postoperative month, with the following limitations: that an aortic bioprosthesis presents no restrictions in cardiac function, requires no cardioactive medications, yet requires a flight operation with co-pilot, the avoidance of accelerations over +3 Gz and, in military aviation, restricts the pilot to non-ejection-seat aircraft. The patient follow up must include both echocardiographic and rhythm assessments every six months. Mechanical prostheses cannot be certified because the required anticoagulation therapy is a disqualifying condition for pilot licensing. Conclusion: Pilot licensing after aortic valve surgery is possible, but with restrictions. The +Gz exposition is of concern in both military and civilian aviation (aerobatics). The choice of bioprosthesis type and size is determinant. Pericardial and stentless valves seem to show better flow characteristics under high-output conditions. Repetitive cardiological controls are mandatory for the early assessment of structural valve disease and rhythm disturbances. A pre-emptive timing is recommended when reoperation is indicated, without waiting for clinical manifestations of structural valve disease.

Internações por Condições Sensíveis à Atenção Primária em uma metrópole brasileira

Este estudo tem como objetivo descrever o perfil das Internações por Condições Sensíveis à Atenção Primária (ICSAP) no município de Curitiba no período de 2005 a 2007. Foi realizado um estudo ecológico, com dados obtidos no Sistema de Informações Hospitalares. Para análise, foi utilizada a estatística descritiva. Observou-se que em Curitiba as ICSAP seguem tendência de estabilização, sendo as causas mais frequentes a angina e a insuficiência cardíaca, maior frequência para o sexo feminino e a faixa etária ≥ 65 anos. Os resultados observados assemelham-se aos de outros estudos e foram, quase na totalidade, altamente significativos do ponto de vista estatístico. Entretanto, devem ser vistos com cuidado, pois se se trata de um indicador que apresenta algumas limitações, dentre as quais a própria confiabilidade do diagnóstico e o uso de dados secundários.

Duration of smoking cessation for the prevention of surgical wound healing complications

The study aimed to find scientific evidence about the duration of preoperative smoking cessation required to reduce surgical wound healing complications. An integrative review was performed in the databases, Latin American and Caribbean Literature on Health Sciences (LILACS) and Medical Literature Analysis and Retrieval System Online (MEDLINE), from 08/17/2012 to 09/17/2012, using the keywords: tobacco use cessation and wound healing; tobacco use cessation and preoperative period; tobacco use cessation and perioperative period (LILACS) and tobacco use cessation and perioperative period; tobacco use cessation and wound healing (MEDLINE). Out of the 81 eligible studies, 12 were included. The duration of smoking cessation needed to reduce healing complications was at least four weeks (four studies with level of evidence I, three studies with level of evidence II, two studies with level of evidence IV, and one study with level of evidence VII).

Relatório sobre a Situação da População Mundial 2011

Como nos tornamos tão numerosos? Qual a quantidade de pessoas que a Terra pode sustentar? Essas são questões importantes, mas, talvez, não as mais adequadas para nossos tempos. Quando nos centramos apenas nas enormes quantidades, corremos o risco de sermos subjugados e perdermos a visão das novas oportunidades de tornar a vida melhor para todas e todos no futuro. Assim, ao invés de indagar questões como “Somos uma população grande demais?” deveríamos perguntar: “O que posso fazer para melhorar o mundo em que vivemos?” ou “Como podemos transformar nossas cidades em constante crescimento em forças a favor da sustentabilidade?” Deveríamos também perguntar-nos o que cada um de nós pode fazer para empoderar as pessoas mais idosas, de forma que possam atuar mais ativamente em suas comunidades. O que podemos fazer para soltar a criatividade e o potencial da maior população de jovens que a humanidade jamais viu? E o que podemos fazer para remover as barreiras que impedem a igualdade entre mulheres e homens de maneira que todas e todos tenham o pleno poder de tomar suas próprias decisões e realizar seu pleno potencial? O relatório sobre a Situação da População Mundial 2011 examina as tendências – as dinâmicas – que estão definindo nosso mundo de 7 bilhões de habitantes e mostra o que as pessoas em países e circunstâncias muito diferentes estão realizando em suas próprias comunidades para extrair o melhor deste mundo. Algumas tendências são notáveis: Hoje, existem 893 milhões de pessoas acima de 60 anos em todo o mundo. Na metade deste século, esse número subirá para 2,4 bilhões. Cerca de uma em cada duas pessoas vive em cidades e, em aproximadamente 35 anos, duas entre três o farão. As pessoas com menos de 25 anos já compõem 43% da população mundial, chegando a 60% em alguns países.

Gender and attachment representations in the preschool years: comparisons between five countries

Bowlby proposed that the individual's social experiences, as early as in infancy, contribute to the construction of Internal Working Models (IWMs) of attachment, which will later guide the individual's expectations and behaviors in close relationships all along his or her life. The qualitative, individual characteristics of these models reflect the specificity of the individual's early experiences with attachment figures. The attachment literature globally shows that the qualities of IWMs are neither gender specific nor cultural specific. Procedures to evaluate IWMs in adulthood have been well established, based on narrative accounts of childhood experiences. Narrative procedures at earlier ages (e.g., in the preschool years) have been proposed, such as Bretherton's Attachment Story Completion Task (ASCT), to evaluate attachment representations. More than 500 ASCT narratives of preschoolers, coming from five different countries, have been collected, in the perspective of examining possible interactions between gender and culture regarding attachment representations. A specific Q-Sort coding procedure (CCH) has been used to evaluate several dimensions of the narratives. Girls' narratives appeared as systematically more secure than those of same-age boys, whatever their culture. The magnitude of gender differences, however, varied between countries. Taylor's model of gender-specific responses to stress and Harwood's and Posada's hypothesis on inter-cultural differences regarding caregiving are evoked to understand the differences across gender and countries.

Supplemental nursing staff´s experiences at a Spanish hospital: Qualitative phenomenology research

The objective of this study was to describe the Supplemental Nursing Staff´s experiences at different hospital units. A qualitative phenomenological approach was conducted; a purposeful and theoretical sampling was implemented with supplemental nursing staff at Santa Barbara Hospital of Soria (Spain), to gain a more in-depth understanding of the Supplemental Nursing Staff ´s experience. Data were collected by in-depth interviews and through a field notebook. Data were analyzed using the Giorgi proposal. Twenty-one nurses with a mean age of 46 years were included. Three main topics emerged from the data analysis: building the first contact, carving out a niche and establishing interprofessional/interpersonal relationships. We conclude that the experience of hosting the supplemental nursing staff in changing clinical environments is conditioned by various factors. It is necessary for nurses and hospital managers to establish clear objectives with regard to the supplemental nursing staff´s role in the units.

Primary Care Sensitive Hospitalization: users detect flaws on the access to services

The aim of this study is to analyze and understand the reasons for the occurrence of sensitive hospitalizations in accordance with users. Qualitative study conducted with users who were admitted to Pedreira General Hospital, in São Paulo. The data was collected through semi structured interviews and thereafter, transcribed and processed in the electronic program Alceste. When analyzing the content, the access was seized fundamentally as an empirical category, bringing up problems that later deserved, from the Brazilian Ministry of Health, a specific Program to improve the quality and access to primary care. The hierarchical and pyramidal organization shape from the health system in the city of São Paulo can be one of the important aspects for the access matter and established as an important restricting factor in the primary care role in reducing or even preventing the occurrence of these hospitalizations.

Family dynamics in face of Alzheimer's in one of its members

Abstract OBJECTIVE To understand the family dynamics when there is a member in the residence with Alzheimer's disease. METHOD A study of qualitative approach, using the creative sensitive method (CSM), and with participation of two families who had a member with Alzheimer's disease at home. RESULTS Three categories emerged: Effects of Alzheimer's disease and the family dynamics; Development process of Alzheimer's disease and Coping strategies in face of the disease. CONCLUSION It was possible to know the manifestations and consequences of Alzheimer's disease in the family, such as mutual help, the mobilization of resources to activate memories of the past, spirituality and faith. There was also understanding of the structure of family dynamics.

Evaluating predictive densities of U.S. output growth and inflation in a large macroeconomic data set

We evaluate conditional predictive densities for U.S. output growth and inflationusing a number of commonly used forecasting models that rely on a large number ofmacroeconomic predictors. More specifically, we evaluate how well conditional predictive densities based on the commonly used normality assumption fit actual realizationsout-of-sample. Our focus on predictive densities acknowledges the possibility that, although some predictors can improve or deteriorate point forecasts, they might have theopposite effect on higher moments. We find that normality is rejected for most modelsin some dimension according to at least one of the tests we use. Interestingly, however,combinations of predictive densities appear to be correctly approximated by a normaldensity: the simple, equal average when predicting output growth and Bayesian modelaverage when predicting inflation.

Secretion of an endogenous subtilisin by Pichia pastoris strains GS115 and KM71.

The methylotrophic yeast Pichia pastoris is widely used for the expression of heterologous enzymes. While the purity of the desired expression product is of major importance for many applications, we found that recombinant enzymes produced in methanol medium were contaminated by a 37-kDa endogenous yeast protease. This enzyme was completely inhibited by phenylmethanesulfonyl fluoride (PMSF) but not by 1,10-phenanthroline, EDTA, and pepstatin A, suggesting the nature of a serine protease. Its secretion was abolished in P. pastoris strains GS115 and KM71 by specific mutagenesis of a subtilisin gene (SUB2) but not by inactivation of the gene encoding vacuolar proteinase B (PRB). Bioinformatic comparisons of Sub2 protein with subtilisins from other fungal genomes and phylogenetic analyses indicated that this enzyme is not an orthologue of the vacuolar protease cerevisin generally present in yeasts but is more closely related to another putative subtilisin found in a small number of yeast genomes. During growth of P. pastoris, Sub2 was produced as a secreted enzyme at a concentration of 10 microg/ml of culture supernatant after overexpression of the full-length SUB2 gene. During fermentative production of recombinant enzymes in methanol medium, 1 ml of P. pastoris culture supernatant was found to contain approximately 3 ng of Sub2, while the enzyme was not detected during growth in a medium containing glycerol as a carbon source. The mutant strain GS115-sub2 was subsequently used as a host for the production of recombinant proteases without endogenous subtilisin contamination.

How binding are legal limits? Transitions from temporary to permanent work in Spain

This paper studies the duration pattern of xed-term contracts and the determinantsof their conversion into permanent ones in Spain, where the share of xed-termemployment is the highest in Europe. We estimate a duration model for temporaryemployment, with competing risks of terminating into permanent employment versusalternative states, and exible duration dependence. We nd that conversion rates aregenerally below 10%. Our estimated conversion rates roughly increase with tenure,with a pronounced spike at the legal limit, when there is no legal way to retain theworker on a temporary contract. We argue that estimated di¤erences in conversionrates across categories of workers can stem from di¤erences in worker outside optionsand thus the power to credibly threat to quit temporary jobs.

Ancrage/institutionnalisation des actions de l'OFSP visant à la réduction des problèmes liés à la toxicomanie : l'appréciation des responsables des programmes

[Table des matières] 1. Introduction. 2. Concepts et modèles d'ancrage. 3. Méthode. 4. Analyse de l'ancrage des programmes. 4.1 Programme Prévention des dépendances dans les communes (RADIX). 4.2 Programme Voilà. 4.3 Programme Fil rouge. 4.4 Programme Funtasy Projects. 4.5 Programme-cadre Ecoles et santé / REES-CH. 4.6 La "Formation des médiateurs scolaires de Suisse romande et du Tessin" et le Projet "Médication" (Ecoles et santé). 4.7 Programme "Drogue ou Sport?", Service "Drogues et sport", Programme "Sport et drogues" / LaOla. 4.8 Les projets soutenus par le Bureau suisse pour la réduction des risques liés aux drogues (OSEO). 4.9 Matériel de prévention de la toxicomanie produit par l'ISPA. 5. Conclusions : Les éléments transversaux d'ancrage des programmes. 6. Annexes.