Qualidade de vida na perspectiva de idosos institucionalizados no Município de Natal - RN

A descriptive and exploratory Study, quantitative in nature, with the aim to assess the Quality of Life (QL) of the elderly leaving in a Long Residence Institution (LRI) according to their own perception. It was conducted in six Public Institutions of Long Residence for Seniors, in the municipality of Natal - RN, in the period of July to August 2007. The data was collected using two structured interview forms: the first, containing questions about socio-demographic aspects and the second - the WHOQUOL-OLD, prepared by the World Health Organization to assess elderly s quality of life. The reference population was 266 old persons, and a random sample, of 43, being 28 women and 15 men, who account for 30%. The results indicated there is a predominance of older women (65.1%) and the average age is 76.6 years; the predominant religion is the Catholic - 44.2% and, 32.6% are unmarried without children. As for schooling and precedence, 41.9% are illiterate and 67.4% come from the rural area. The time of residency in the institution goes between 1 to 5 years for 69.8% of the elderly, 37.2% of them residing in the institution for not having another option. Most elderly informed using medicines. 51.3% said they are taking anti-hypertensive. As for the other aspects of QL: sensory aspects, autonomy, past, present and future activities, social participation, death and dying and intimacy, the WHOQOL-OLD, showed an average total score of 52.9% (scale of 0 to 100), with a tendency to neutrality, denoting that the elderly, in this study, evaluated their QL as neither satisfactory or unsatisfactory. Of all the facets of the instrument of QL, the sensory facet secured the highest average scores (68,1%), showing that the elderly are "happy" in the situation in which they find themselves, not showing significant disabilities. The facet of autonomy, which refers to the independence and the ability to make decisions on their own life, received the lowest average scores (40.7%), showing the dissatisfaction of the elderly on this aspect. The evaluation of the elderly on other facets were: social participation (48.2%); activities past, present and future (44.6%) and intimacy (50.6%), all perceived as neither unsatisfactory or satisfactory. On the item death and dying, the elderly people declared themselves satisfied, with average score of 65.5%. The analysis of the reliability of the WHOQOL-OLD by the Cronbach Alpha showed 0.57, considering the 24 items that cover the instrument, showing regular internal reliability of the instrument, in our reality. The result is probably due to differences between the regions south and east and the broader sociocultural diversity. We believe that the elderly in this study, tended to realize their QL as neutral, considering it as neither unsatisfactory or satisfactory, result likely related to the resignation with the destine, characterized, at the time, by the finitude of life, feeling very common among elderly, or perhaps, even for an accommodation, often accompanied by discouragement, present in the daily life of many of them

Custo-efetividade da terapia compressiva no processo de cicatrização de úlceras venosas

Analytical study of therapeutic nonrandomized intervention type, intra-group controlled, with the aim of analyzing the cost-effectiveness of compression therapy with manipulated Unna boot in relation to conventional therapy in the healing of venous ulcers (VU) of patients treated in ambulatory clinic. The study population was composed by patients with VU treated by angiologists in Surgical Clinic Ambulatory of the Onofre Lopes University Hospital (HUOL) with a sample of 18 patients. It obtained the assent of the HUOL Ethics in Research Committee (Protocol 276/09). Data collection was performed over a period of four months by the own master's student and 34 nursing students, through the application of the research instrument in the admission of patients to the study and in the ten subsequent evaluations, performed at the time of changing Unna boot, weekly, for a maximum period of 10 weeks. The data were analyzed with SPSS 15.0 software, using descriptive and inferential statistics, and presented as tables, charts and graphs. Among those surveyed, prevailed: females, mean age 57.6 years, low education and income levels, most retired, unemployed or off work, with the standing position more than six hours per day and up to eight hours daily of domestic or occupational activities. In health status profile of respondents there were predominantly sleep, rest and inadequate elevation of the lower limbs, no smoking and/or alcohol use, presence of hypertension and no use of drugs. Most presented the first VU for over 10 years, recurrences, present VU for more than five years, involvement of left leg, in malleolar and / or distal leg region, mild edema, hyperpigmentation, lipodermatosclerosis, telangiectasies, reticular and varicose veins, mild pain, serous exudate in moderate quantity, small lesions (up to 50cm2), with predominance of granulation tissue and / or epithelialization and demarcated, elevated and irregular borders, with crusts and macerated. Most patients reported that in the 10 weeks prior to admission, made bandages at home and / or Basic Health Unit and / or ambulatory, with nursing aides or technicians, daily, and on weekends or holidays, performed by patients themselves, using healing ointment on the lesion, being observed granulation / epithelialization and increase in VU prevalent in the 10 weeks of traditional treatment. After follow up with manipulated Unna boot, was observed a decrease of lesions in all study patients, with complete healing in 27.8% of those between 1 and 5 weeks of treatment, with satisfactory evolution of the lesions, pain and ankle and calf circumferences, and unsatisfactory development of the borders of ulcers, edema, sleep, rest and elevation of the lower limbs, especially in more chronic patients. Furthermore, patients who achieved total healing and exhibited the greatest percentage reduction of lesions had a higher number of wound healing factors ( 61; = 0.01 and 61; = 0.027, respectively). The manipulated Unna boot showed better results in those patients with shorter duration of injury, leading them to a satisfactory outcome within a short period of treatment. After the cost-effectiveness analysis, we conclude that the manipulated Unna boot is more effective than conventional therapy in the healing process of VU and is more cost-effective in patients with shorter lesions ( 61; = 0.001), shorter treatment ( 61; = 0.000) and greater number of wound healing factors ( 61; = 0.005).

Viabilidade do processo de enfermagem no contexto hospitalar

The Nursing Process (NP) is considered as the dynamics of the systemized and inter-related actions of human care. We believe that the nursing manager, as the representative of all the nursing care provided in the hospital setting, is an important agent for the implementation of institutional policies, such as the NP, in the service. However, there is little information in the literature about the NP in the perspective of the nurse manager. The objective of this study was to analyze the viability of the Nursing Process in the hospital context based on the attitudes of the nurse managers toward the Process. We conducted a descriptive-exploratory research study, of quantitative approach, with a population of 45 nurse managers that worked in the state hospitals located in Natal, RN and in the university hospitals of the UFRN. Two instruments were used for the collection of data: a nursing process questionnaire, constructed for use in this study, and the scale for the measurement of the attitudes titled Positions on the Nursing Process. The population is predominantly feminine (91,0%) and have relative nursing practice experience (Mean=17,6 years). However, they have little experience in management (Mean=8,6 years). They express little knowledge of the PE nursing terms and little experience with the Process. They have a positive atitude toward the NP (Mean = 110,9); are favorable to its developement in the service (86,7%); 48,9% indicated little possibility of institutionalization in the service and 37,8% indicated large possibility. The Spearman test for association between the variables of attitude about the NP and the possibility of its institutionalization demonstrated a weak negative association in the total individual scores of the attitudes (-,316) as in the 20 itens of the instrument, with coefficients varying from 0,014 to 0,464. Factorial analysis of the instrument identified three underlying factors to the attitudes of the managers in this study: relevance, operationalization and collaboration, with Cronbach Alpha coeficients of 0,955, 0,844 and 0,807, respectively, and 0,956 for the whole instrument, indicating that the scale and its factorial subscales have internal consistency. We conclude that there is a weak tendency for the managers with a favorable attitude to have a negative perception about the possibility of institutionalization of the NP in the service. The favorable position does not appear to be sufficient for the viability of this methodology in the hospital sector, results that is worrisome for nursing. This situation suggests that the difficulties with the institution of the NP in the hospitals may be related to other factors, including the organizational conditions. We believe that the institucionalization of the NP in a servisse where it is not known and not practiced, constitutes the introduction of an innovative work technology that involves many demands, among them the adherence of the persons to the proposed innovation. This demands time and the institutional adjustments and the human resources necessary. In this process, the involvement of the health professional of the institution is necessary. This situation brings to light the discussions of professional autonomy, the action limits and perspectives, the redefinition of roles, delimiation (or consensus) of the objects of study and of the work processes, among others.

Diagnósticos de enfermagem em pacientes submetidos à hemodiálise: semelhanças entre o modelo de adaptação e a NANDA internacional

The nurses in the hemodialysis has an important role in the nursing process implementation, in the context of a theoretical referential. Among the nursing theories, highlights the Roy´s adaptations model, who considers a person as an holistic adaptive system that aims to adapt customers to different living conditions. Thus, it is believed that the Roy´s nursing process will guide nursing care to patients on dialysis. Therefore, the study aimed to analyze the nursing diagnosis present in patients with chronic kidney disease on hemodialysis based on the theoretical model of Roy and NANDA-International. Descriptive and cros-sectional study, performed at a dialysis center in a city in northeastern Brazil. Sample of 178 patients and consecutive sampling by convenience. Data collection ocurred from October/2011 until February/2012, through interview and physical examination forms. Data analysis was initiated by clinical reasoning, diagnosis judgment and similarity relation. Then, the data were entered into SPSS program, 16.0 version, generating descriptive statistics. The project was approved by the Ethics Research Committee (protocol nº 115/11) with a Presentation Certificate for Ethics Appreciation (in 0139.0.051.000-111) and was funded by the Universal edict MCT / CNPq 14/2010. The results revealed that most patients were male (52.2%), married (62.9%) and residents in the Natal´s metropolitan region (54.5%). The mean age was 46.6 years and the years of study, 8,5. Regarding nursing diagnosis obtained an average of 6.6, especially: Risk of Infection (100%), excessive fluid volume (99.4%) and hypothermia (61.8%). On the other hand the adaptive problems average was 6.4, and the most common: intracellular fluid retention (99.4%); Hyperkalemia (64.6%); Hypothermia (61.8%) and edema (53.9%). Were established 20 similarity relations between the NANDA-International nursing diagnosis and adaptive problems of Roy, namely: risk of falls / injury risk and potential for injury, impaired physical mobility and walking mobility and / or restricted coordination, dressing self-care deficit and loss of self-care ability; hypothermia and hypothermia; impaired skin integrity and impaired skin integrity; excessive fluid volume and intracellular fluid retention / Hyperkalemia / Hypocalcemia / edema; imbalanced nutrition: less than body requirements and Nutrition less than the body's needs; constipation and constipation, acute pain and acute pain, chronic pain and chronic pain, sensorial perception disturbed: visual, tactile and auditory disabilities and a primary sense: sight, hearing and tactile; sleep deprivation and insomnia, fatigue and intolerance to activities; ineffective self health and fails in the role; sexual dysfunction and sexual dysfunction; situational low self-esteem and low self-esteem, and diarrhea and diarrhea. We conclude that there is similarity between the typologies and was required a model´s analysis, because they present different ways to establish the nursing diagnosis. Moreover, the nursing process use, under the context of a theory and a classification system, subsidizes the care and contributes to the strengthening of nursing science

Breeding value accuracy estimates for growth traits using random regression and multi-trait models in Nelore cattle

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

Análise estatística das emissões de CO e HC produzidas por gases da exaustão veicular oriundos de gasolina, GNV e mistura álcool/gasolina

The vehicles are the main mobile sources of carbon monoxide (CO) and unburned hydrocarbons (HC) released into the atmosphere. In the last years the increment of the fleet of vehicles in the municipal district of Natal-RN it is contributing to the increase of the emissions of those pollutants. The study consisted of a statistical analysis of the emissions of CO and HC of a composed sample for 384 vehicles with mechanization Gasoline/CNG or Alcohol/Gasoline/CNG of the municipal district of Natal-RN. The tests were accomplished in vehicles submitted to Vehicular Safety's Inspection, in the facilities of INSPETRANS, Organism of Vehicular Inspection. An partial gases analyzer allowed to measure, for each vehicle, the levels of CO and HC in two conditions of rotation of the motor (900 and 2500 rpm). The statistical analysis accomplished through the STATISTICA software revealed a sensitive reduction in the efficiency of the converters catalytic after 6 years of use with emission average it is of 0,78% of CO and 156 (ppm) of HC, Which represents approximately 4 (four) times the amount of CO and the double of HC in comparison with the newest vehicles. The result of a Student s t-test, suggests strongly that the average of the emissions of HC (152 ppm), at 900 rpm, is 40% larger than at 2500 rpm, for the motor without load. This result reveals that the efficiency of the catalytic conversion is limited kinetically in low engine speeds. The Study also ends that when comparing the emissions of CO and HC considering the influence of the fuels, it was verified that although the emissions of CO starting from CNG are 62% smaller than arising from the gasoline, there are not significant differences among the emissions of HC originating from of CNG and of the gasoline. In synthesis, the results place the current criteria of vehicular inspection, for exhaust gases, in doubt, leading the creation of emission limits of pollutant more rigorous, because the efficiency of the converters catalytic is sensibly reduced starting from 6 years of use. It is also raised the possibility of modifications in the test conditions adopted by the current norms, specifically in the speed engine, have seen that in the condition without load the largest emission indexes were registered in slow march. That fact that allows to suggest the dismissal of the tests in high speed engine, reducing the time of inspection in half and generating economy of fuel

Lixiviação de potássio em função da textura e da disponibilidade do nutriente no solo

O manejo correto da adubação potássica pode minimizar perdas assim como evitar o esgotamento de K do solo. Objetivou-se estudar a dinâmica do K no perfil do solo em função do teor de argila e do teor do nutriente resultantes da adubação da soja. Foram coletados solos de texturas média e argilosa, que vinham sendo adubados com 0, 60, 120, e 180 kg ha-1 de K2O na soja por 6 anos. O experimento foi conduzido em casa de vegetação, em tubos de PVC estratificados nas profundidades de 0-5, 5-10, 10-20, e 20-40 cm. Na superfície das colunas, aplicaram-se mais 80 kg ha-1 de K2O. Durante 16 semanas, foi aplicada, semanalmente, água em quantidade equivalente a 100 mm de chuva. em cada aplicação, o volume de solução percolada foi determinado, assim como as quantidades de K contidas nessa solução. Após a desmontagem das colunas de solo, foram determinados os teores de K trocável e não-trocável nas diferentes profundidades. A percolação de K foi maior no solo de textura argilosa, que tinha mais K disponível devido ao maior efeito residual da adubação potássica anterior. A intensidade de lixiviação foi proporcional ao teor de K disponível, mas inicialmente a lixiviação foi mais intensa no solo mais arenoso, decrescendo com o tempo. No argiloso, as perdas foram mais constantes. Houve proporcionalidade entre teor inicial e lixiviação no perfil do solo, nas duas formas de K e nos dois tipos de solo. Conclui-se que o efeito residual da adubação potássica aumentou as quantidades de K percolado. A movimentação de K no perfil do solo teve boa relação com o teor inicial de K no solo, resultante da adubação potássica anterior nos dois tipos de solo. A passagem de K considerado não-trocável para trocável foi rápida e influenciou na lixiviação.

A leitura como instrumento facilitador da compreensão matemática

This research builds on a qualitative approach and proposes action research to develop, implement and evaluate a strategy grounded in the teaching of geometry reading from different text types, in order to enhance the understanding of mathematical concepts by students in the 6th grade of elementary school. The teaching of mathematics, strengthened by a reading practice that fosters a greater understanding of science, because it would contribute to the expansion of vocabulary, acquire a higher level of reasoning, interpretation and understanding, providing opportunities thus a greater contextualization of the student, making out the role of mere spectator to the builder of mathematical knowledge. As a methodological course comply with the following steps: selecting a field of intervention school, the class-subject (6 years of elementary school) and teacher-collaborator. Then there was a diagnostic activity involving the content of geometry - geometric solids, flat regions and contours - with the class chosen, and it was found, in addition to the unknown geometry, a great difficulty to contextualize it. From the analysis of the answers given by students, was drawn up and applied three interventional activities developed from various text (legends, poems, articles, artwork) for the purpose of leading the student to realize, through reading these texts, the discussions generated from these questions and activities proposed by the present mathematics in context, thus getting a better understanding and interaction with this discipline as hostility by most students. It was found from the intervention, the student had a greater ability to understand concepts, internalize information and use of geometry is more consistent and conscientious, and above all, learning math more enjoyable

A desistência de alunos na licenciatura em física no Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Norte (IFRN): causas e sugestões para o combate

This dissertation proposes studying the issue of withdrawal undergraduate in physics at the Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Norte (IFRN) and collaborate with suggestions for dealing with this problem. The first chapter begins with an overview of two significant problems in the Brazilian educational system: the high dropout rates in degrees in physics and the lack of teachers with specific training in this science. Then, we discuss the relevance of this research to the area of physics teaching, as well as justify its completion as part of a professional master's degree. After, we present a proper definition for the term withdrawal, which is based on the existing problem in the IFRN. And, in the same chapter, we explicitly the focus, the objectives and the methodological aspects of this work. The results obtained in our investigation are presented in next four chapters. In the second chapter of this dissertation, we present: a brief history of the creation of IFRN degree in physics, the functioning of this course and the foundation of classrooms 2004.2 and 2006.1. We also show a kind of map of the withdrawal of the groups investigated (the dropout rate was 84.4% in both groups) and an analysis of the relationship between the curricula of each of them and the number of dropouts. In the third chapter, we display a descriptive statistics of the students which dropout and found that the largest dropout occurred with students who are women, married, parents of one kid; workers, joined with a minimum age of 23 years and completed high school at least 6 years. Then in the fourth chapter, we reveal and discuss the students' reports on the causes of their dropout. From the data presented, we can say that the answer to the question "What was the main reason for your dropout?" Is mainly in personal injury claims: another option for upper-level course and lack of time to devote to the course. In the fifth chapter, we show the results related to teacher s opinions about the phenomenon in question. We detected three main causes for the abandonment, according to teachers: the lack of dedication, the lack of interest and lack of integration in the course. In the sixth and final chapter, we discuss the results and present our conclusion and the proposed report - the product of this dissertation, presented as Annex. This report contains mainly suggestions for curricular and institutional actions that can contribute to reducing the dropout degree in Physics in the IFRN. The main actions suggested are: implementation of the curriculum in disciplines, implementation of programs or actions to combat this poor content of basic training, implementation of specific programs or actions for the student worker, and dissemination of IFRN degree in physics in schools through seminars or workshops

Comparação entre diferentes métodos para estimativa de gordura corporal de ciclistas brasileiros de elite

O objetivo do estudo foi comparar diferentes métodos de estimativa de gordura corporal em ciclistas de elite. A amostra foi composta por 15 atletas de alto nível, do sexo masculino, com idade média de 28,6 anos. Gordura corporal foi estimada pela equação para espessura de dobras cutâneas (EDC), análise da bioimpedância elétrica (BIA) e absortometria de radiológica de dupla energia (DEXA) (utilizada como referência). O teste t pareado comparou as diferenças entre os métodos e o coeficiente de correlação intraclasse analisou o relacionamento entre os mesmos. Foi observado que os valores do percentual de gordura corporal estimado pela BIA (p= 0,029), mas não o estimado pela EDC (p= 0,094) diferiram das estimativas da DEXA. Dessa maneira, é possível concluir que EDC apresentou estimativas mais próximas daquelas fornecidas pelo DEXA.

Relacionamento de diferentes domínios da atividade física habitual com indicadores de risco cardiovascular em adultos jovens do sexo masculino

Objectives: To analyze different physical activities domains in healthy adults and correlate with cardiovascular risk factors. Methods: The sample was composed by 32 Physical Education undergraduate students, with mean age of 22.6 years old. Adiposity was assessed by waist circumference (WC), body mass index (BMI) and bioelectrical impedance. Additionally, fast glucose (10-12 hours), systolic (SBP) and diastolic (DBP) blood pressure were assessed. Physical activity level was assessed by questionnaire (Baecke et al., 1982). Results: sports activities and leisure time were not related with cardiovascular risk factors. However, job activities were negatively related with %BF, SBP and DBP. Conclusion: Different physical activity domains should be considered when analyzing its associations with health indicators.

Indicadores cardiovasculares em repouso e durante um teste incremental em jovens do sexo masculino

O presente estudo comparou valores de glicemia, frequência cardíaca em repouso e durante exercício, além da composição corporal entre hipertensos e normotensos. A amostra foi composta por 32 jovens do sexo masculino, com média de idade de 22,6 anos. Inicialmente, aferiu-se a pressão arterial, para divisão em dois grupos: hipertensos e normotensos. Posteriormente foram mensurados, glicemia em jejum, impedância bioelétrica, antropometria, e a frequência cardíaca no repouso, durante o teste de esforço máximo e na fase de recuperação. A análise estatística foi composta pelo teste t- Student e análise de variância para medidas repetidas two-way, entre os grupos. O valor de significância adotado foi p = 0,05. Os dados analisados mostraram que indivíduos hipertensos apresentam maiores índices metabólicos e valores hemodinâmicos do que indivíduos normotensos, sendo estes indicadores de risco cardiovascular.

Capacidade funcional de hemiparéticos crônicos submetidos a um programa de fisioterapia em grupo

Este estudo tem como objetivos analisar a eficácia da fisioterapia em grupo sobre a marcha, o equilíbrio corporal e o risco de queda, e verificar se há correlação entre a capacidade funcional da marcha e o equilíbrio em indivíduos com hemiparesia crônica. Participaram do estudo 21 adultos hemiparéticos, com idade média de 58,9±10,6 anos, com seqüela de no mínimo 1 ano após acidente vascular encefálico isquêmico ou hemorrágico. Os sujeitos foram submetidos a um programa de 1 hora de fisioterapia em grupo duas vezes por semana durante seis meses. Foram avaliados por meio da escala de equilíbrio de Berg (EEB) e do teste de levantar e caminhar cronometrado TLCC (TUG, na sigla em inglês de timed up & go) antes do programa, após 13 e ao fim de 26 semanas. Os resultados mostram uma redução progressiva, embora não-significativa, no tempo de execução do TLCC e aumento progressivo, também não-significativo, do escore na EEB. Foi observada forte correlação entre as duas escalas (r=0,7, p<0,05). Assim, a terapia não foi efetiva para produzir melhora nos escores dos testes, mas contribuiu para manter a mobilidade.

Efeitos agudos do alongamento estático antes e após exercício e as características neuromusculares do membro inferior: estudo controlado, randomizado e cego

Objective: To evaluate the acute effects of static stretching before and after isokinetic exercise, neuromuscular and biomechanical properties of muscles Biceps Femoris (BF) and semitendinosus (ST). Methods: Eighty-nine volunteers of both genders, healthy and physically active, with a mean age of 22.52 ± 2.6 years and mean BMI 23.86 ± 3.2 kg/m² were randomized into 4 groups: Control Group (CG) made only one Protocol Exercise (PE) without performing the stretching, the Experimental Group 1 (EG1) did stretching before PE; EG2 did the stretching after PE and EG3 did stretching before and after PE. The volunteers were evaluated on the following variables: Range of motion (ROM), soreness, dynamometric variables concentric and eccentric, Neuromuscular Latency Time (NLT) and electromyographic. In the data analysis was assigned a significance level of 5%. Results: ADM and TLNM reported significant reduction in CG, but remained unchanged in GE with p<0,05 and p<0,01, respectively. As for the soreness, no differences between the groups. The electromyographic activity of the BF and ST, in the concentric phase, showed a significant decrease in all groups (p<0,01). However, in the eccentric phase, ST revealed reduction in all groups (p <0.01), except for the CG, while the BF remained unchanged in all groups. The PT showed significant reduction in both conditions (concentric and eccentric) for all groups, with no difference between them (p<0,01). Conclusion: The results of this study do not favor the use of static stretching, even of short duration, before physical activity. However, after exercise or at times unrelated to the sport, he should be given with the aim of avoiding muscle shortening

Avaliação de lesões brancas de cáries: um estudo de prognóstico

Objective: The aim of the present study is to assess the current situation of white enamel lesions on vestibular surfaces of permanent upper incisors, diagnosed 6 years ago, without clinical intervention. Methods: A prospective study reassessed 53 students of both sexes, aged between 13 and 18 years old, all attending the public school system in Natal, Brazil. Data collection was performed by duly calibrated examiners, and a clinical chart consisting of demographic data on dental caries, oral hygiene, and gingival condition was prepared. A tactile-visual examination was conducted using a clinical mirror and periodontal probe. Data compilation and analysis were carried out using a SPSS software. In this analysis the chi-squared test was used for qualitative independent variables. To identify the net effect of treatment, multiple logistic analysis with forward stepwise model selection was performed. Results: The final sample was composed of 106 lesions in the 53 individuals, with mean age of 15.02 years, visible plaque index (VPI) of 23.34%, and gingival blood indices (GBI) of 25.92%. A statistically significant relationship (p = 0.003) was found between initial DMFS and prognosis of white enamel lesion. Conclusions: We observed that past caries experience and dental plaque were the main predictive factors for negative lesion outcomes, demonstrating the need for oral hygiene control through continuing preventive measures