Does sealing endotracheal tube cuff pressure diminish the frequency of postoperative laryngotracheal complaints after nitrous oxide anesthesia?

Study Objectives: To study endotracheal tube (ETT) cuff pressures during nitrous oxide (N2O) anesthesia when the cuffs are inflated with air to achieve sealing pressure, and to evaluate the frequency of postoperative laryngotracheal complaints.Design: Prospective, randomized, blind study.Setting: Metropolitan teaching hospital.Patients: 50 ASA physical status I and II patients scheduled for elective abdominal surgery.Interventions: Patients received standard general anesthesia with 66% N2O in oxygen. In 25 patients, the ETT cuff was inflated with air to achieve a sealing pressure (P-seal group). In 25 patients, the ETT cuff was inflated with air to achieve a pressure of 25 cm H2O (P-25 group).Measurements and Main Results: ETT intracuff pressures were recorded before (control) and at 30, 60, 90, 120, and 150 minutes during N2O administration. We investigated the frequency and intensity of sore throat, hoarseness, and dysphagia in patients in the Post-Anesthesia Care Unit (PACU) and 24 hours following tracheal extubation. The cuff pressures in the P-seal group were significantly lower than in the P-25 group at all time points studied (p < 0.001), with a significant increase with time in both groups (p < 0.001). The cuff pressures exceeded the critical pressure of 30 cm H2O only after 90 minutes in the P-seal group and already by 30 minutes in the P-25 group. The frequency and intensity of sore throat, hoarseness, and dysphagia were similar in both groups in the PACU and 24 hours after tracheal extubation (p > 0.05).Conclusions: Minimum ETT sealing cuff pressure during N2O anesthesia did not prevent, but instead attenuated, the increase in cuff pressure and did not decrease postoperative laryngotracheal complaints. (C) 2004 by Elsevier B.V.

Culturally-sensitive complaints of depressions and anxieties in women

Background: Current classifications of Mental Disorders are centered on Westernized concepts and constructs. Cross-cultural sensitivity emphasizes culturally-appropriate translations of symptoms and questions, assuming that concepts and constructs are applicable.Methods: Groups and individual psychiatrists from various cultures from Asia, Latin America, North Africa and Eastern Europe prepared descriptions of main symptoms and complaints of treatment-seeking women in their cultures, which are interpreted by clinicians as a manifestation of a clinically-relevant dysphoric disorder. They also transliterated the expressions of DSM IV criteria of main dysphoric disorders in their cultures.Results: In many non-western cultures the symptoms and constructs that are interpreted and treated as dysphoric disorders are mostly somatic and are different from the Western-centered DSM or ICD systems. In many cases the DSM and ICD criteria of depression and anxieties are not even acknowledged by patients.Limitations: the descriptive approach reported here is a preliminary step which involved local but Westernized clinicians-investigators following a biomedical thinking. It should be followed by a more systematic-comprehensive surveys in each culture.Conclusions: Westernized concepts and constructs of mental order and disorders are not necessarily universally applicable. Culturallysensitive phenomena, treatments and treatment responses may be diversified. Attempts at their cross-cultural harmonization should take into consideration complex interactional multi-dimensional processes. (c) 2006 Elsevier B.V. All rights reserved.

Violência doméstica: análise das lesões em mulheres

Este estudo tem como objetivo avaliar a prevalência de lesões de cabeça e pescoço em mulheres, frente aos inquéritos policiais registrados como lesão corporal e maus-tratos na Delegacia de Defesa da Mulher de Araçatuba, São Paulo, Brasil, no ano de 2002. Foram totalizados 204 inquéritos policiais no ano de 2002, e destes extraídos 33 laudos periciais referentes aos crimes de lesões corporais e maus-tratos em mulheres. Analisou-se nos laudos médicos da perícia, aspectos relativos à idade das vítimas e local das lesões por elas apresentadas na ocasião do exame. Os resultados encontrados revelam que as agressões ocorrem em faixas etárias diversas, com predominância na infância e adolescência. Além disso, ocorreu a maior prevalência de lesões na região da cabeça e pescoço, área de atuação do cirurgião-dentista que necessita estar preparado para atender, entre outros, o paciente vítima de violência.

Stylized facts of income distribution in five countries of Latin America and general guidelines for a redistributive police

Includes bibliography

Delegacia de defesa da mulher: um lugar de queixas - queixas de um lugar

Pós-graduação em Psicologia - FCLAS

Entre Aracne e Atena: professoras em situação de violência doméstica

Este estudo tem como tema a violência doméstica contra professoras e toma como objeto os registros sobre esse fato presentes em Inquéritos Policiais da Delegacia de Atendimento à Mulher de Santarém-PA. A questão central da pesquisa consiste em problematizar: quais articulações entre a condição de violentada e o status profissional de professora são apresentadas no processo de denúncia, via inquérito policial, por professoras em situação de violência doméstica no município de Santarém? A partir dessa indagação central o objetivo geral da pesquisa volta-se para analisar as articulações entre a condição de violentada e o status profissional de professora presentes nos inquéritos policiais, articulado com a investigação das confluências entre as discussões sobre as relações de gênero, a violência doméstica e os direitos humanos das mulheres e a compreensão das formas de atravessamento entre os marcadores sociais das professoras em situação de violência doméstica. O tratamento metodológico foi pautado em um estudo qualitativo que se vale da pesquisa documental, por meio da análise de conteúdo dos Inquéritos Policiais da DEAM de Santarém, documentos estes que registram não só a ocorrência da violência como também o contexto em que ocorreram os atravessamentos dos diferentes marcadores sociais assumidos pelos sujeitos, autores das agressões e agredidas e suas intersecções. O marco teórico da pesquisa está pautado na perspectiva relacional que busca compreender a violência contra as mulheres resultantes das redes de relações de poder entre homens e mulheres e entre estes e os marcadores sociais que assumem. As análises conclusivas evidenciam que as tramas da violência doméstica contra as mulheres são complexas e marcadas por questões, tais como: a persistência na submissão à violência doméstica das docentes embora independam economicamente do agressor; a diferença geracional entre as docentes e os autores das agressões é marcada por homens mais jovens versus mulheres maduras, em processo de envelhecimento; o baixo nível de escolaridade dos agressores e o baixo prestígio da ocupação que desenvolvem em relação ao nível de escolaridade e posição social da profissão das docentes agredidas que possuem profissão definida, de natureza intelectual e reconhecida socialmente; as denúncias contra os autores das agressões só ocorreram após os motivos extremos de ameaças de morte e exposição pública da violência em uma profissão de natureza pública, a de professora; que o registro da ocorrência concretiza a alternância de poder nas relações de gênero e da própria violência doméstica, visto que na dinâmica da circulação de poder com os autores das agressões, as professoras agredidas reconheceram-se também como detentoras de poder, avançando da condição de vítimas para a de protagonistas; que na situação de violentadas, as professoras, foram capazes de perceber fios invisíveis naturalizados na teia da violência doméstica, partindo para o enfrentamento público, a denúncia.

Polícia e controle interno: a Corregedoria de Polícia Federal no Pará de 2007 a 2011

Este trabalho é um diagnóstico das atividades de controle interno do Departamento de Polícia Federal do Pará. Os dados analisados compreendem o período de 2007 a 2011 e têm por objeto os casos de má conduta policial mais frequentes, o contexto em que são cometidos, o perfil dos denunciantes, dos denunciados e dos corregedores, além de analisar os procedimentos adotados quando as denúncias chegam à corregedoria e o resultado final de tais procedimentos. Analisa também a percepção dos policiais federais dos diversos cargos e do principal corregedor do período estudado a respeito da atuação, na prática, da Corregedoria da Polícia Federal do estado do Pará, comparando tais percepções com os resultados formais do setor. O objetivo foi refletir a respeito dos parâmetros que norteiam o funcionamento do controle interno da instituição. A pesquisa evidenciou que as limitações e dificuldades enfrentadas pela Corregedoria de Polícia Federal do Pará são as mesmas verificadas nas várias instituições policiais brasileiras, apesar de restar evidente um esforço constante da Corregedoria em aprimorar seus mecanismos de controle interno. A relevância dessa abordagem decorre da escassez de pesquisas sobre a Polícia Federal brasileira e a inexistência de trabalhos sobre a corregedoria dessa instituição na região norte do Brasil.

Gastrointestinal Complaints During Exercise: Prevalence, Etiology, and Nutritional Recommendations

Gastrointestinal problems are common, especially in endurance athletes, and often impair performance or subsequent recovery. Generally, studies suggest that 30-50 % of athletes experience such complaints. Most gastrointestinal symptoms during exercise are mild and of no risk to health, but hemorrhagic gastritis, hematochezia, and ischemic bowel can present serious medical challenges. Three main causes of gastrointestinal symptoms have been identified, and these are either physiological, mechanical, or nutritional in nature. During intense exercise, and especially when hypohydrated, mesenteric blood flow is reduced; this is believed to be one of the main contributors to the development of gastrointestinal symptoms. Reduced splanchnic perfusion could result in compromised gut permeability in athletes. However, although evidence exists that this might occur, this has not yet been definitively linked to the prevalence of gastrointestinal symptoms. Nutritional training and appropriate nutrition choices can reduce the risk of gastrointestinal discomfort during exercise by ensuring rapid gastric emptying and the absorption of water and nutrients, and by maintaining adequate perfusion of the splanchnic vasculature. A number of nutritional manipulations have been proposed to minimize gastrointestinal symptoms, including the use of multiple transportable carbohydrates, and potentially the use of nutrients that stimulate the production of nitric oxide in the intestine and thereby improve splanchnic perfusion. However, at this stage, evidence for beneficial effects of such interventions is lacking, and more research needs to be conducted to obtain a better understanding of the etiology of the problems and to improve the recommendations to athletes.

Evaluation of hearing protection used by police officers in the shooting range

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Self-perception, complaints and vocal quality among undergraduate students enrolled in a Pedagogy course

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Efficiency of occlusal splints on police officers with TMD

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

High prevalence of orofacial complaints in patients with fibromyalgia: a case-control study

Objective. The aim of this study was to investigate the orofacial complaints and characteristics of patients with fibromyalgia syndrome (FS) compared with controls. Study Design. We evaluated 25 patients diagnosed with FS compared with 25 gender-and age-matched controls by using a detailed clinical protocol for orofacial pain diagnosis and dental examination. Results. FS patients had a higher frequency of temporomandibular disorders (TMD), masticatory complaints, pain with mandibular movements, and pain upon palpation of the head and neck area. There were no significant differences related to the dental exam. Conclusions. Orofacial complaints including TMD may be present either as symptoms of FS or as a comorbidity associated with this condition. A comprehensive evaluation of patients with FS is necessary to identify the need for specific treatments for orofacial complaints. Future studies, especially those with longitudinal design, should clarify whether a cause-effect relationship exists between orofacial complaints and fibromyalgia. (Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:e29-e34)

Need for recovery from work and sleep-related complaints among nursing professionals

The concept of need for recovery from work (NFR) was deduced from the effort recuperation model. In this model work produces costs in terms of effort during the working day. When there is enough time and possibilities to recuperate, a worker will arrive at the next working day with no residual symptoms of previous effort. NFR evaluates work characteristics such as psychosocial demands, professional work hours or schedules. However, sleep may be an important part of the recovery process. The aim of the study was to test the association between sleep-related complaints and NFR. A cross-sectional study was carried out at three hospitals. All females nursing professionals engaged in assistance to patients were invited to participate (N=1,307). Participants answered a questionnaire that included four sleep-related complaints (insomnia, unsatisfactory sleep, sleepiness during work hours and insufficient sleep), work characteristics and NRF scale. Binomial logistic regression analysis showed that all sleep-related complaints are associated with a high need for recovery from work. Those who reported insufficient sleep showed a greater chance of high need for recovery; OR=2.730 (CI 95% 2.074-3.593). These results corroborate the hypothesis that sleep is an important aspect of the recovery process and, therefore, should be thoroughly investigated.

Auditory complaints and audiologic assessment in children with surgically repaired cleft lip and palate

Introduction: At the initial consultation, the speech-language pathologist and audiologist may consider possible diagnostic hypotheses based on the child's history and the parents' complaint. Aim: To investigate the association of hearing complaints with the findings obtained in the conventional audiologic assessment in children with cleft lip and palate. Retrospective study. Methods: We analyzed medical charts of 1000 patients with cleft lip and palate who underwent surgical repair between 1988 and 1995 at a mean age of 6 years 8 months. We excluded charts with records of inconsistent audiological responses and charts with missing data for any of the audiologic evaluations considered. Thus, the sample consisted of 393 records. Results: Two hundred thirty-nine patients presented hearing loss in one or both ears, but only 3.8% reported hearing complaints. The most frequent were otorrhea followed by otalgia. There was no statistical significance between the complaint and gender (p = 0.26) nor between the complaint and hearing loss (p = 0.83). Conclusion: This study showed no association between the hearing complaint and the conventional audiologic assessment

Police Interviews with Victims and Suspects of Violent and Sexual Crimes : Interviewee's experiences and interview outcomes

The police interview is one of the most important investigative tools that law enforcement has close at hand, and police interview methods have changed during the twentieth century. A good police interview is conducted in the frame of the law, is governed by the interview goal, and is influenced by facilitating factors that may affect the elicited report. The present doctoral dissertation focuses on police interviews in cases of very serious crimes of violence and sexual offences. Results reveal crime victims’ and perpetrators’ experiences of being interviewed and police officers’ attitudes towards conducting interviews related to traumatizing crimes. Study 1 revealed that when police officers interviewed murderers and sexual offenders, the interviewees perceived attitudes characterized by either dominance or humanity. Police interviews marked by dominance and suspects’ responses of anxiety were mainly associated with a higher proportion of denials, whereas an approach marked by humanity, and responses of being respected were significantly associated with admissions. In line with Study 1, the victims of rape and aggravated assault in Study 2 also revealed the experience of two police interview styles, where an interviewing style marked by dominance and responses of anxiety was significantly associated with crime victims’ omissions of information. Moreover, a humanitarian interviewing style, and crime victims’ feelings of being respected and co-operative, was significantly related to crime victims providing all information from painful events. Special squad police officers’ attitudes towards interviewing crime victims, in Study 3, also showed a humanitarian approach and two dominant approaches, one affective and the other refusing. The attitude towards interviewing suspects of crimes in focus revealed humanitarian and dominant interviewing attitudes, and an approach marked by kindness. The present thesis shows that, during their entire career, an overwhelming majority of the special squad police officers have experienced stressful events during patrol as well as investigative duty. Results show that symptoms from stressful event exposures and coping mechanisms are associated with negative attitudes towards interviewing suspects and supportive attitudes towards crime victim interviews. Thus, experiences from stressful exposures may automatically activate ego-defensive functions that automatically generate dominant attitudes. Moreover, it is important to offer police officers who have been exposed to stressful events the opportunity to work through their experiences, for example, through debriefing procedures. After debriefings, police officers are better prepared to meet crime victims and suspects and, through conscious closed-loop processes, to conduct police interviews without awaking ego-defensive functions.