Efeitos Imediatos da Mobilização com Movimento na Rotação Medial da Gleno-umeral em Jogadores de Andebol

Introdução: No andebol, o ombro é elevado numa amplitude superior a 90º e move-se com elevada velocidade de execução o que pode originar deslocação anterior da cabeça do úmero e diminuição da rotação medial. A técnica MWM pode ser uma mais valia na correção da falha posicional e recuperação da amplitude de movimento de rotação medial da articulação gleno-umeral. Objetivo: Este estudo teve como objetivo verificar os efeitos imediatos da técnica de MWM na amplitude de movimento de rotação medial da articulação gleno-umeral em jogadores de andebol. Métodos: O presente estudo, duplamente cego, é do tipo experimental. Foram incluídos no estudo 30 indivíduos do sexo masculino, jogadores de andebol, distribuídos, aleatoriamente, em dois grupos de 15, experimental e controlo. Em ambos os grupos foi avaliada a amplitude de movimento da rotação medial da gleno-umeral, em dois momentos, pré e pós intervenção. O grupo experimental foi submetido à técnica de MWM no movimento de rotação medial da gleno-umeral no membro dominante. Ao grupo de controlo, foi solicitada a realização do movimento ativo de rotação medial no membro dominante, o fisioterapeuta manteve os mesmos contactos manuais mas não aplicou pressão na cabeça do úmero. Para a comparação entre os grupos experimental e controlo recorreu-se ao teste de Mann-Whitney e para analisar diferenças entre os dois momentos, para cada grupo, foi utilizado o teste de Wilcoxon. Resultados: Foram encontradas diferenças significativas no grupo experimental e controlo, contudo essa diferença foi superior no grupo experimental. Após a intervenção, o grupo experimental apresentou amplitudes de rotação medial da gleno-umeral significativamente mais elevadas às do grupo de controlo (U=0,50; p <0,001). Conclusão: A técnica de MWM para rotação medial produziu um aumento significativo na amplitude desse movimento.

The World Health Organization Multi-Professional Patient Safety Curriculum : implementation of key modules and its impact on patient safety knowledge, skills, and attitudes of medical students at the University of Algarve

ABSTRACT - Objectives: We attempted to show how the implementation of the key elements of the World Health Organization Patient Safety Curriculum Guide Multi-professional Edition in an undergraduate curriculum affected the knowledge, skills, and attitudes towards patient safety in a graduate entry Portuguese Medical School. Methods: After receiving formal recognition by the WHO as a Complementary Test Site and approval of the organizational ethics committee , the validated pre-course questionnaires measuring the knowledge, skills, and attitudes to patient safety were administered to the 2nd and3rd year students pursuing a four-year course (N = 46). The key modules of the curriculum were implemented over the academic year by employing a variety of learning strategies including expert lecturers, small group problem-based teaching sessions, and Simulation Laboratory sessions. The identical questionnaires were then administered and the impact was measured. The Curriculum Guide was evaluated as a health education tool in this context. Results: A significant number of the respondents, 47 % (n = 22), reported having received some form of prior patient safety training. The effect on Patient Safety Knowledge was assessed by using the percentage of correct pre- and post-course answers to construct 2 × 2 contingency tables and by applying Fishers’ test (two-tailed). No significant differences were detected (p < 0.05). To assess the effect of the intervention on Patient Safety skills and attitudes, the mean and standard deviation were calculated for the pre and post-course responses, and independent samples were subjected to Mann-Whitney’s test. The attitudinal survey indicated a very high baseline incidence of desirable attitudes and skills toward patient safety. Significant changes were detected (p < 0.05) regarding what should happen if an error is made (p = 0.016), the role of healthcare organizations in error reporting (p = 0.006), and the extent of medical error (p = 0.005). Conclusions: The implementation of selected modules of the WHO Patient Safety Curriculum was associated with a number of positive changes regarding patient safety skills and attitudes, with a baseline incidence of highly desirable patient safety attitudes, but no measureable change on the patient safety knowledge, at the University of Algarve Medical School. The significance of these results is discussed along with implications and suggestions for future research.

Les valeurs des ergothérapeutes : résultats quantitatifs d’une étude exploratoire

Article

Contenu verbalisé par l’enfant victime d’agression sexuelle lors de la thérapie (TF-CBT) et diminution des symptômes

Cette étude exploratoire vise à examiner le lien entre le contenu verbalisé (nombre et types de détails) par l’enfant victime d’agression sexuelle (AS) lors de la Trauma-Focused Cognitive-Behavioral Therapy et la diminution des symptômes après la thérapie. L’échantillon est composé de 28 enfants âgés entre 6 à 13 ans. Les résultats pré-thérapie et post-thérapie observés à l’aide des versions françaises du Children’s Impact of Traumatic Events Scale-Revised et du Child Behavior Checklist ont permis de répartir les enfants en deux groupes; soit si l’on observe une diminution ou une persistance des symptômes de stress post-traumatique, des symptômes intériorisés et extériorisés après la thérapie. Les verbatims des séances de thérapie concernant les détails associés à l’AS ont été transcrits et cotés en tant que nouveaux détails (divulgués une seule fois) ou détails répétés ainsi qu’en 12 catégories. Les résultats aux tests de Mann-Whitney n’indiquent aucune différence significative entre les groupes pour ce qui est du nombre moyen total de détails nouveaux et répétés divulgués. Toutefois, lorsque comparé au groupe persistance des symptômes, le groupe diminution des symptômes a verbalisé significativement plus de nouveaux détails pour les catégories action et lieu.

Effects of transformation processes in 'jubraka' agroforestry systems of the Nuba Mountains, Sudan, on nutrient fluxes

Intensification processes in homegardens of the Nuba Mountains, Sudan, raise concerns about strongly positive carbon (C) and nutrient balances which are expected to lead to substantial element losses from these agroecosystems, in particular via soil gaseous emissions. Therefore, this thesis aimed at the quantification of C, nitrogen (N), phosphorus (P) and potassium (K) input and output fluxes with a special focus on soil gaseous losses, and the calculation of respective element balances. A further focus in this thesis was rainfall, a valuable resource for rain-fed agriculture in the Nuba Mountains. To minimize negative consequences of the high variability of rainfall, risk reducing mechanisms were developed by rain-fed farmers that may lose their efficacy in the course of climate change effects predicted for East Africa. Therefore, the second objective of this study was to examine possible changes in rainfall amounts during the last 60 years and to provide reliable risk and probability statements of rainfall-induced events of agricultural importance to rain-fed farmers in the Nuba Mountains. Soil gaseous emissions of C (in form of CO2) and N (in form of NH3 and N2O) of two traditional and two intensified homegardens were determined with a portable dynamic closed chamber system. For C gaseous emission rates reached their peak at the onset of the rainy season (2,325 g CO2-C ha-1 h-1 in an intensified garden type) and for N during the rainy season (16 g NH3-N ha-1 h-1 and 11.3 g N2O-N ha-1 h-1, in a traditional garden type). Data indicated cumulative annual emissions of 5,893 kg CO2-C ha-1, 37 kg NH3-N ha-1, and 16 kg N2O-N ha-1. For the assessment of the long-term productivity of the two types of homegardens and the identification of pathways of substantial element losses, a C and nutrient budget approach was used. In three traditional and three intensified homegardens observation plots were selected. The following variables were quantified on each plot between June and December in 2010: soil amendments, irrigation, biomass removal, symbiotic N2 fixation, C fixation by photosynthesis, atmospheric wet and dry deposition, leaching and soil gaseous emissions. Annual balances for C and nutrients amounted to -21 kg C ha-1, -70 kg N ha-1, 9 kg P ha-1 and -117 kg K ha-1 in intensified homegardens and to -1,722 kg C ha-1, -167 kg N ha-1, -9 kg P ha-1 and -74 kg K ha-1 in traditional homegardens. For the analysis of rainfall data, the INSTAT+ software allowed to aggregate long-term daily rainfall records from the Kadugli and Rashad weather stations into daily, monthly and annual intervals and to calculate rainfall-induced events of agricultural importance. Subsequently, these calculated values and events were checked for possible monotonic trends by Mann-Kendall tests. Over the period from 1970 to 2009, annual rainfall did not change significantly for either station. However, during this period an increase of low rainfall events coinciding with a decline in the number of medium daily rainfall events was observed in Rashad. Furthermore, the availability of daily rainfall data enabled frequency and conditional probability calculations that showed either no statistically significant changes or trends resulting only in minor changes of probabilities.

Adaptación inicial del instrumento Espacio de Vida de la Familia (FLS) : Localidad de Kennedy , Bogotá, D.C.

El propósito de la presente investigación fue realizar la adaptación inicial del instrumento Espacio de Vida de la Familia (FLS) en el contexto de la localidad de Kennedy. La investigación tomó desde la teoría los pasos para la adaptación de pruebas e instrumentos sugeridos por autores reconocidos, además definió las dimensiones y factores del instrumento; contó con el concepto de tres jueces expertos para determinar el nivel de acuerdo de los factores del mismo; en la aplicación piloto se administraron los instrumentos espacio de vida de la familia FLS y el Inventario de satisfacción marital en la versión adaptada ACI para esta investigación; esto permitió hacer los ajustes para la aplicación en la muestra de 5 parejas en crisis y en 5 parejas que no estaban en crisis. Los resultados obtenidos mostraron una asociación fuerte entre los 2 instrumentos y al realizar la prueba de U de Mann-Whitney se evidenciaron diferencias significativas entre los dos grupos salvo en el factor de relaciones con otras personas. Concluyendo que el instrumento espacio de vida de la familia FLS no permite diferenciar el factor de relación con otras personas y por tanto no se ajusta al contexto local. Finalmente la investigación estableció unas normas de administración y aplicación del instrumento espacio de vida de la familia FLS.

Prevalencia de burnout en docentes de colegio bilingüe de Bogotá

Determinar la prevalencia de burnout en maestros que laboran en un Colegio Bilingüe de la ciudad de Bogotá Metodología: Se realizó un estudio transversal, mediante la aplicación de la escala Maslach Burnout Inventory-Human Services Survey (versión validada en español) y datos sociodemográficos como edad, sexo, estado civil, personas a cargo, número de hijos, tipo de vivienda, estrato, escolaridad, ocupación, cargo, años laborados, incapacidades y patología psiquiátrica; a 75 docentes de un colegio privado de la ciudad de Bogotá. Resultados: El análisis final detectó escasos casos de agotamiento emocional, ningún caso de despersonalización y alto nivel de realización personal en todos los docentes. Se realizó la prueba U de Mann Withney utilizando los puntajes obtenidos en la dimensión agotamiento emocional para comparar entre edades menor y mayor de 40 años, estado civil, hijos y personas a cargo, en ninguno de los casos la distribución de los puntajes mostró diferencias estadísticamente significativas entre los grupos. Conclusiones: No se evidenciaron casos en los que hubiese presencia de burnout en la población de docentes estudiada. Se considera necesario ampliar la muestra poblacional con otras instituciones y realizar un estudio comparativo con el fin de obtener resultados que puedan alcanzar mayor significancia estadística

Existen diferencias farmacocinéticas y tiempos de despertar entre mujeres y hombres con anestesia total intravenosa

Introducción: La anestesia total intravenosa (TIVA) es ampliamente usada y reportada en la literatura como técnica para disminuir la respuesta a la laringoscopia e intubación, en la inducción y mantenimiento de una adecuada anestesia, además de una mejor estabilidad hemodinámica y recuperación pos anestésica; sin embargo no existen un gran número de estudios que comparen el uso de TIVA, determinando si existen diferencias en el perfil farmacocinético según el género del paciente. Objetivo: Describir diferencias farmacocinéticas y de los tiempos de despertar y salida a la unidad de cuidados pos anestésicos (descarga), según el género; en pacientes que reciben TIVA, con remifentanil y propofol, orientado por Stangraf. Metodología: Estudio observacional analítico de corte transversal, en pacientes llevados a cirugía bajo TIVA en el Hospital Occidente de Kennedy en el periodo de junio de 2013 a Enero de 2014.Usando SPSS versión 20 Windows, se analizaron los datos mediante pruebas Kolmogorov-Smirnov y Shapiro-Wilk y U de Mann Withney. Un valor de p menor 0.05 fue aceptado como estadísticamente significativo. Resultados: Se aplicaron pruebas de normalidad y no se encontraron diferencias estadísticamente significativas entre género. El tiempo de despertar fue 9.36 minutos para mujeres y 11.26 minutos para hombres. Los tiempos de descarga fueron 10.71 minutos para mujeres y 12.82 minutos para hombres. Discusión. El tiempo de despertar y descarga no es diferente entre mujeres y hombres en los pacientes analizados. Se requieren estudios adicionales entre grupos poblacionales de diversas condiciones farmacocineticas para corroborar los datos.

Desenlaces de las infecciones respiratorias en la unidad de cuidado intensivo de la fundación neumologica colombiana

Las infecciones asociadas a ventilación mecánica (VM) son frecuentes en la unidad de cuidado intensivo (UCI). Existen dos infecciones: neumonía (NAV) y traqueobronquitis (TAV). NAV genera impacto negativo en los desenlaces de los pacientes al aumentar la morbilidad, mortalidad y los tiempos en UCI y VM, pero no se conoce el impacto de TAV. El objetivo de este estudio fue identificar si hay diferencias entre NAV y TAV. Materiales y métodos: Se realizó un estudio de cohortes entre 2009 y 2013 en la UCI de la Fundación Neumológica Colombiana. De los pacientes con NAV y TAV se obtuvieron datos demográficos, epidemiológicos, microbiológicos y desenlaces como tiempos de estancia en UCI, VM y de hospitalización y mortalidad. Se compararon estadísticamente mediante t de Student y Chi2 para datos normales y prueba de Mann-Whitney para datos no normales. Resultados: Los pacientes con NAV y TAV fueron similares en la condición de ingreso a UCI. Al diagnóstico de la infección hubo diferencias significativas entre grupos en la oxigenación y tiempo de estancia hospitalaria, en UCI y VM. La microbiología fue con predominio de gérmenes Gram negativos y presencia de multirresistencia en el 52.5% de casos, sin diferencias significativas entre grupos. En los desenlaces, se observó diferencias en los tiempos totales de estancia en UCI, hospitalización y VM, pero sin diferencia en ellos después del diagnóstico. No hubo diferencias significativas en mortalidad. Conclusiones: NAV y TAV son similares en el impacto sobre la evolución de los pacientes en cuanto a morbilidad, estancias y mortalidad.

Visual strategies used during the performance of an obstacle course

Vision is the sense that provides precise information about one’s position in the environment in relation to objects. The visual system is essential to guide people safely when moving around in the environment. The perception that an individual gets from a particular scene of her/his surroundings is accomplished by eye movements. The current study aims to identify differences in visual strategies between 15 women and 15 men within the age range of 18-24 years, who have been given a task to walk through an obstacle course drawn on the laboratory´s floor. They should start and finish at a predefined location. Twelve pylons were used as obstacles to be avoided during the walking.The participants' eye movements were recorded using the Mobile Eye model 1.35. The Wilcoxon-Mann-Whitney Test was used for the statistical analysis. Significant differences occurred between men and women, in the duration of fixations: the men spend more time observing the finishing area than women (z=-1.929, p=.054); and in the number of fixations: before starting the task, the men fixate more often the middle phase of the obstacle course (z=-2.085, p=.037). Once they commence, the women fixate more the points outside the obstacle course than the men (z=-2.093, p=.036).

Statistical methods for ordered categorical data based on a constrained odds model

The proportional odds model provides a powerful tool for analysing ordered categorical data and setting sample size, although for many clinical trials its validity is questionable. The purpose of this paper is to present a new class of constrained odds models which includes the proportional odds model. The efficient score and Fisher's information are derived from the profile likelihood for the constrained odds model. These results are new even for the special case of proportional odds where the resulting statistics define the Mann-Whitney test. A strategy is described involving selecting one of these models in advance, requiring assumptions as strong as those underlying proportional odds, but allowing a choice of such models. The accuracy of the new procedure and its power are evaluated.

Apical negative pressure irrigation versus conventional irrigation plus triantibiotic intracanal dressing on root canal disinfection in dog teeth

Objective. The aim of this study was to compare in vivo the efficacy of 2 root canal disinfection techniques (apical negative pressure irrigation versus apical positive pressure irrigation plus triantibiotic intracanal dressing) in immature dog teeth with apical periodontitis. Study design. Two groups of root canals with pulp necrosis and apical periodontitis were evaluated according to the disinfection technique: group 1: apical negative pressure irrigation (EndoVac system); and group 2: apical positive pressure irrigation (conventional irrigation) plus triantibiotic intracanal dressing. The first sample (S1) was collected after lesions were radiographically visible, and the second sample (S2) was collected after apical negative pressure irrigation (group 1) or conventional irrigation/triantibiotic dressing (group 2). All samples were seeded in a culture medium for anaerobic bacteria. Colony-forming unit counts were analyzed statistically by the Mann-Whitney test (alpha = .05). Results. Microorganisms were present in 100% of canals of both groups in S1. In S2, microorganisms were absent in 88.6% of group 1`s canals and 78.28% of group 2`s canals. There was no significant difference between the groups in either S1 (P = .0963) or S2 (P = .0566). There was significant (P < .05) bacterial reduction from S1 to S2 in both groups. Conclusion. In immature teeth with apical periodontitis, use of the EndoVac system can be considered to be a promising disinfection protocol, because it provided similar bacterial reduction to that of apical positive pressure irrigation (conventional irrigation) plus intracanal dressing with the triantibiotic paste, and the use of intracanal antibiotics might not be necessary. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e42-e46)

Effects of Cobalt Chloride in Junctional Epithelium and Reduced Enamel Epithelium of the Rat Maxillary First Molar

Cobalt is one of the main components of cast metal alloys broadly used in dentistry. It is the constituent of 45 to 70% of numerous prosthetic works. There are evidences that metal elements cause systemic and local toxicity. The purpose of the present study was to evaluate the effects of cobalt on the junctional epithelium and reduced enamel epithelium of the first superior molar in rats, during lactation. To do this, 1-day old rats were used, whose mothers received 300mg of cobalt chloride per liter of distilled water in the drinker, during lactation. After 21 days, the rat pups were killed with an anesthetic overdose. The heads were separated, fixed in ""alfac"", decalcified and embedded in paraffin. Frontal sections stained with hematoxylin and eosin were employed. Karyometric methods allowed to estimate the following parameters: biggest, smallest and mean diameters, D/d ratio, perimeter, area, volume, volume/area ratio, eccentricity, form coefficient and contour index. Stereologic methods allow to evaluate: cytoplasm/nucleus ratio, cell and cytoplasm volume, cell number density, external surface/basal membrane ratio, thickness of the epithelial layers and surface density. All the collected data were subjected to statistic analysis by the non-parametric Wilcoxon-Mann-Whitney test. The nuclei of the studied tissues showed smaller values after karyometry for: diameters; perimeter, area, volume and volume/area ratio. Stereologically, it was observed, in the junctional epithelium and in the reduced enamel epithelium, smaller cells with scarce cytoplasm, reflected in the greater number of cells per mm3 of tissue. In this study, cobalt caused epithelial atrophy, indicating a direct action on the junctional and enamel epithelium.

Clinical comparison between the bleaching efficacy of 37% peroxide carbamide gel mixed with sodium perborate with established intracoronal bleaching agent

Objective. The aim was to evaluate the bleaching efficacy of sodium perborate/37% carbamide peroxide paste and traditional sodium perborate/distilled water for intracoronal bleaching. Study design. Thirty patients with dark anterior teeth were divided into 2 groups (n = 15): group A: sodium perborate/ distilled water; and group B: sodium perborate/37% carbamide peroxide paste. The bleaching treatment limited each patient to the maximum of 4 changes of the bleaching agent. Initial and final color shades were measured using the Vita Lumin shade guide. Results. Data was analyzed with Wilcoxon test for initial and final comparison according to the bleaching agent, demonstrating efficacy of the bleaching treatment with both agents. Mann-Whitney test was used for comparison of the efficacy of the bleaching agents, showing that there was no significant difference between them. Conclusion. The sodium perborate/37% carbamide peroxide association for intracoronal bleaching has proven to be as effective as sodium perborate/distilled water. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: e43-e47)

Comparison of two methods for collecting free-living ticks in the Amazonian forest

In the present study, we compared 2 methods for collecting ixodid ticks on the verges of animal trails in a primary Amazon forest area in northern Brazil. (i) Dragging: This method was based on passing a 1-m(2) white flannel over the vegetation and checking the flannel for the presence of caught ticks every 5-10 m. (ii) Visual search: This method consisted of looking for guesting ticks on the tips of leaves of the vegetation bordering animal trails in the forest. A total of 103 adult ticks belonging to 4 Amblyomma species were collected by the visual search method on 5 collecting dates, while only 44 adult ticks belonging to 3 Amblyomma species were collected by dragging on 5 other collecting dates. These values were statistically different (Mann-Whitney Test, P = 0.0472). On the other hand, dragging was more efficient for subadult ticks, since no larva or nymph was collected by visual search, whereas 18 nymphs and 7 larvae were collected by dragging. The visual search method proved to be suitable for collecting adult ticks in the Amazon forest: however, field studies should include a second method, such as dragging in order to maximize the collection of subadult ticks. Indeed, these 2 methods can be performed by a single investigator at the same time, while he/she walks on an animal trail in the forest. (C) 2010 Elsevier GmbH. All rights reserved.