Dor crônica e a crença de auto-eficácia

O tratamento de doentes com dor crônica inclui a modificação de crenças, atitudes, valores e com-portamentos pouco adaptativos. Crenças disfuncionais podem se tornar o problema central e determinar os resultados do tra-tamento. Dentre as crenças importantes para a vivência e manejo da dor crônica, a de auto-eficácia merece destaque. Auto-eficácia, de acordo com Bandura, é a crença sobre a habilidade pessoal de desempenhar com sucesso determinadas tarefas ou comportamentos para produzir um resultado desejável. Este estudo é uma revisão crítica da literatura sobre a crença de auto-eficácia relacionada à dor crônica e sobre os métodos para sua avaliação. Estudos existentes nas ba-ses Medline (1992 a 2002), Lilacs e Dedalus (toda a base) foram analisados. Os descritores utilizados foram pain and self-efficacy, dor e auto-eficácia.

A stratified approach for modeling the distribution of a threatened ant species in the Swiss National Park

We present models predicting the potential distribution of a threatened ant species, Formica exsecta Nyl., in the Swiss National Park ( SNP). Data to fit the models have been collected according to a random-stratified design with an equal number of replicates per stratum. The basic aim of such a sampling strategy is to allow the formal testing of biological hypotheses about those factors most likely to account for the distribution of the modeled species. The stratifying factors used in this study were: vegetation, slope angle and slope aspect, the latter two being used as surrogates of solar radiation, considered one of the basic requirements of F. exsecta. Results show that, although the basic stratifying predictors account for more than 50% of the deviance, the incorporation of additional non-spatially explicit predictors into the model, as measured in the field, allows for an increased model performance (up to nearly 75%). However, this was not corroborated by permutation tests. Implementation on a national scale was made for one model only, due to the difficulty of obtaining similar predictors on this scale. The resulting map on the national scale suggests that the species might once have had a broader distribution in Switzerland. Reasons for its particular abundance within the SNP might possibly be related to habitat fragmentation and vegetation transformation outside the SNP boundaries.

County Clare, une auto blindée sur le pont d'Ennis [automitrailleuse Austin, patrouille du 17ème bataillon du Royal Tank Corps, près de la caserne de la Royal Irish Constabulary à Ennis] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57114

Avaliação do apoio social e da auto-estima por indivíduos coronariopatas, segundo o sexo

Este estudo descritivo teve como objetivo avaliar o apoio social e a auto-estima de pacientes coronariopatas internados para tratamento clínico dessa doença. Uma amostra de 80 pacientes, sendo 49 homens, 52 casados e com idade média de 52 anos, foram entrevistados de agosto de 2005 a junho de 2006. Os dados coletados foram analisados por estatística descritiva, e as medidas de apoio social e auto-estima foram comparadas pelo teste de Mann-Whitney, de acordo com o sexo. As consistências internas das escalas foram verificadas, obtendo-se valores que indicam boa consistência interna para ambas. Os resultados indicaram valores elevados de apoio social e auto-estima no grupo estudado. Não constatamos diferenças estatisticamente significantes entre estes valores, segundo o sexo dos pacientes. Essas variáveis têm sido apontadas como favorecedores no processo de reabilitação dos pacientes cardíacos após a alta.

Repercussões na auto-estima provocadas pela tricotomia em craniotomia

O objetivo do estudo foi avaliar a repercussão da tricotomia na autoestima do paciente no pós-operatório de craniotomia. Estudo quantitativo do tipo prospectivo. Os dados mostram que a maioria dos pacientes referiu não ter sua autoestima alterada em função da tricotomia; predomina a manutenção da autoestima entre os pacientes que receberam orientação sobre a tricotomia; a maioria fez uso de acessórios como estratégia para ocultar a área raspada, e acredita que a tricotomia não prejudica a qualidade de vida nem interfere nas relações sociais. Conclui-se que os sentimentos relacionados à diminuição da autoestima são a perda da atração, a insegurança e a vergonha; há a necessidade de uso de acessórios para melhorar a auto-imagem, e os profissionais da saúde devem trabalhar com os aspectos psicossociais dos pacientes no pré e pós-operatórios.

Realização do auto-exame das mamas por profissionais de enfermagem

Os tumores da mama, na maioria, são detectados pela mulher, portanto o autoexame das mamas (AEM) ainda é uma estratégia eficaz. Objetivou-se analisar a realização do AEM por profissionais de enfermagem e fatores que dificultam a adesão dessa prática. Estudo descritivo, quantitativo, desenvolvido com 159 profissionais, sendo 40 enfermeiras, 48 auxiliares e 71 agentes de saúde, de 19 Unidades Básicas de Saúde de Fortaleza, Ceará. Os dados foram coletados com questionário autoaplicável e analisados com base na Teoria do Autocuidado. Das 159 profissionais, 86 (54%) realizavam o AEM mensalmente. Das 73 que não realizavam, 60 (82%) referiram como motivo o esquecimento, 38 (52%) por não confiar na sua técnica/não sabiam a técnica correta, e 35 (48%) por falta de atenção à saúde. Constatou-se que, apesar da maioria declarar fazer o AEM, as profissionais se sentiam inseguras e gostariam de aperfeiçoar esta prática.

Modeling the biophysical impacts of global change in mountain biosphere reserves

Mountains and mountain societies provide a wide range of goods and services to humanity, but they are particularly sensitive to the effects of global environmental change. Thus, the definition of appropriate management regimes that maintain the multiple functions of mountain regions in a time of greatly changing climatic, economic, and societal drivers constitutes a significant challenge. Management decisions must be based on a sound understanding of the future dynamics of these systems. The present article reviews the elements required for an integrated effort to project the impacts of global change on mountain regions, and recommends tools that can be used at 3 scientific levels (essential, improved, and optimum). The proposed strategy is evaluated with respect to UNESCO's network of Mountain Biosphere Reserves (MBRs), with the intention of implementing it in other mountain regions as well. First, methods for generating scenarios of key drivers of global change are reviewed, including land use/land cover and climate change. This is followed by a brief review of the models available for projecting the impacts of these scenarios on (1) cryospheric systems, (2) ecosystem structure and diversity, and (3) ecosystem functions such as carbon and water relations. Finally, the cross-cutting role of remote sensing techniques is evaluated with respect to both monitoring and modeling efforts. We conclude that a broad range of techniques is available for both scenario generation and impact assessments, many of which can be implemented without much capacity building across many or even most MBRs. However, to foster implementation of the proposed strategy, further efforts are required to establish partnerships between scientists and resource managers in mountain areas.

O senso de auto-eficácia na manutenção de comportamentos promotores de saúde de idosos

Esta é uma investigação com abordagem qualitativa, que foi desenvolvida junto a idosos participantes de um centro de lazer em Porto Alegre (Brasil). O objetivo foi compreender a influência do senso de auto-eficácia na manutenção dos comportamentos promotores de saúde dessas pessoas. Foram entrevistados 11 idosos, que alcançaram escores com um desvio-padrão igual ou acima da média do grupo (>85,18), no questionário WHOQOL-bref. Na análise de conteúdo das entrevistas, surgiram quatro categorias: atitudes e atributos pessoais positivos; expectativa de viver melhor; expectativa de viver mais tempo; e priorizar comportamentos promotores de saúde. A investigação evidenciou que esses indivíduos mantêm comportamentos promotores de saúde similares aos recomendados pelos profissionais e pelas organizações de saúde. Além disso, supomos que a manutenção de tais comportamentos foi determinada pelo senso positivo de auto-eficácia desses indivíduos.

Genetic and genomic analysis modeling of germline c-MYC overexpression and cancer susceptibility

Background: Germline genetic variation is associated with the differential expression of many human genes. The phenotypic effects of this type of variation may be important when considering susceptibility to common genetic diseases. Three regions at 8q24 have recently been identified to independently confer risk of prostate cancer. Variation at 8q24 has also recently been associated with risk of breast and colorectal cancer. However, none of the risk variants map at or relatively close to known genes, with c-MYC mapping a few hundred kilobases distally. Results: This study identifies cis-regulators of germline c-MYC expression in immortalized lymphocytes of HapMap individuals. Quantitative analysis of c-MYC expression in normal prostate tissues suggests an association between overexpression and variants in Region 1 of prostate cancer risk. Somatic c-MYC overexpression correlates with prostate cancer progression and more aggressive tumor forms, which was also a pathological variable associated with Region 1. Expression profiling analysis and modeling of transcriptional regulatory networks predicts a functional association between MYC and the prostate tumor suppressor KLF6. Analysis of MYC/Myc-driven cell transformation and tumorigenesis substantiates a model in which MYC overexpression promotes transformation by down-regulating KLF6. In this model, a feedback loop through E-cadherin down-regulation causes further transactivation of c-MYC.Conclusion: This study proposes that variation at putative 8q24 cis-regulator(s) of transcription can significantly alter germline c-MYC expression levels and, thus, contribute to prostate cancer susceptibility by down-regulating the prostate tumor suppressor KLF6 gene.

Personalized modeling for drug concentration prediction using Support Vector Machine

Building a personalized model to describe the drug concentration inside the human body for each patient is highly important to the clinical practice and demanding to the modeling tools. Instead of using traditional explicit methods, in this paper we propose a machine learning approach to describe the relation between the drug concentration and patients' features. Machine learning has been largely applied to analyze data in various domains, but it is still new to personalized medicine, especially dose individualization. We focus mainly on the prediction of the drug concentrations as well as the analysis of different features' influence. Models are built based on Support Vector Machine and the prediction results are compared with the traditional analytical models.

Viver com mais idade em contexto familiar: dependência no auto cuidado

A finalidade deste estudo é contribuir para a melhoria da assistência de enfermagem à pessoa dependente e sua família. O trabalho teve como objetivos: descrever o grau de dependência de idosos em contexto familiar; identificar características sociodemográficas dos idosos dependentes em contexto familiar; descrever a principal causa que originou a dependência nos idosos que se encontram no domicílio. A opção metodológica foi uma abordagem quantitativa de natureza exploratória descritiva. No período de outubro 2007 a junho de 2008 foram seleccionadas 108 famílias, de uma região norte de Portugal, com um idoso dependente. Foi uma amostra de conveniência. Para a colheita de informação recorremos a um inquérito onde incluímos o índice de Barthel. Os resultados mostraram que os idosos são predominantemente mulheres, viúvas, com média de idade de 81 anos, com nível grave de dependência, cuja principal causa foram as doenças do sistema circulatório.

Student modeling based on fuzzy inference mechanisms

The paper presents a competence-based instructional design system and a way to provide a personalization of navigation in the course content. The navigation aid tool builds on the competence graph and the student model, which includes the elements of uncertainty in the assessment of students. An individualized navigation graph is constructed for each student, suggesting the competences the student is more prepared to study. We use fuzzy set theory for dealing with uncertainty. The marks of the assessment tests are transformed into linguistic terms and used for assigning values to linguistic variables. For each competence, the level of difficulty and the level of knowing its prerequisites are calculated based on the assessment marks. Using these linguistic variables and approximate reasoning (fuzzy IF-THEN rules), a crisp category is assigned to each competence regarding its level of recommendation.

Prediction of infant drug exposure through breastfeeding: population PK modeling and simulation of fluoxetine

BACKGROUND: Risks of significant infant drug exposurethrough breastmilk are poorly defined for many drugs, and largescalepopulation data are lacking. We used population pharmacokinetics(PK) modeling to predict fluoxetine exposure levels ofinfants via mother's milk in a simulated population of 1000 motherinfantpairs.METHODS: Using our original data on fluoxetine PK of 25breastfeeding women, a population PK model was developed withNONMEM and parameters, including milk concentrations, wereestimated. An exponential distribution model was used to account forindividual variation. Simulation random and distribution-constrainedassignment of doses, dosing time, feeding intervals and milk volumewas conducted to generate 1000 mother-infant pairs with characteristicssuch as the steady-state serum concentrations (Css) and infantdose relative to the maternal weight-adjusted dose (relative infantdose: RID). Full bioavailability and a conservative point estimate of1-month-old infant CYP2D6 activity to be 20% of the adult value(adjusted by weigth) according to a recent study, were assumed forinfant Css calculations.RESULTS: A linear 2-compartment model was selected as thebest model. Derived parameters, including milk-to-plasma ratios(mean: 0.66; SD: 0.34; range, 0 - 1.1) were consistent with the valuesreported in the literature. The estimated RID was below 10% in >95%of infants. The model predicted median infant-mother Css ratio was0.096 (range 0.035 - 0.25); literature reported mean was 0.07 (range0-0.59). Moreover, the predicted incidence of infant-mother Css ratioof >0.2 was less than 1%.CONCLUSION: Our in silico model prediction is consistent withclinical observations, suggesting that substantial systemic fluoxetineexposure in infants through human milk is rare, but further analysisshould include active metabolites. Our approach may be valid forother drugs. [supported by CIHR and Swiss National Science Foundation(SNSF)]

The challenge of modeling nuclear receptor regulatory networks in mammalian cells.

Nuclear receptors are a major component of signal transduction in animals. They mediate the regulatory activities of many hormones, nutrients and metabolites on the homeostasis and physiology of cells and tissues. It is of high interest to model the corresponding regulatory networks. While molecular and cell biology studies of individual promoters have provided important mechanistic insight, a more complex picture is emerging from genome-wide studies. The regulatory circuitry of nuclear receptor regulated gene expression networks, and their response to cellular signaling, appear highly dynamic, and involve long as well as short range chromatin interactions. We review how progress in understanding the kinetics and regulation of cofactor recruitment, and the development of new genomic methods, provide opportunities but also a major challenge for modeling nuclear receptor mediated regulatory networks.