The quality of primary care in a country with universal health care coverage

Cet article a été réalisé dans le but d'évaluer la qualité des soins fournie à une population âgée de 50 à 80 ans suivie dans 4 policliniques médicales universitaires de Suisse, à savoir Bâle, Zurich, Genève et Lausanne. Nous avons sélectionné 37 indicateurs de qualité qui ont été développés et préalablement évalués au Etats-Unis. Ces indicateurs ont été divisés en 2 sous-groupes distincts : les indicateurs de prévention et les indicateurs concernant les facteurs de risque cardiovasculaires.¦L'étude a inclus des patients âgés de 50 à 80 ans avec un suivi d'un minimum de 1 an par un médecin dans l'une des policliniques de Suisse. Nous avons limité notre étude à ce groupe d'âge, afin d'avoir une prévalence élevée de facteur de risque cardiovasculaire et plus d'indications à des tests de dépistages. Les dossiers médicaux des patients ont été sélectionnés selon un mode aléatoire en prenant 250 dossiers par centre.¦L'enjeu principal de cette étude était de déterminer le niveau de soins fournis en Suisse dans les policliniques médicales universitaires. Il a été également possible de mettre en évidence les secteurs de prévention pour lesquels le taux d'application est encore insuffisant. Nous avons par la même occasion comparé nos résultats à ceux obtenus aux Etats-Unis, sachant que ce pays a un système d'évaluation de la qualité des soins qui fournit chaque années des statistiques à ce sujet.¦Les résultats de notre étude montrent qu'en Suisse les adultes reçoivent 69% des mesures de prévention recommandées mais que ces taux diffèrent d'un indicateur à l'autre. Les indicateurs à propos de la tension artérielle et de la mesure du poids (les 2 95%) ont plus souvent été réalisés durant les consultations que les indicateurs concernant l'arrêt du tabagisme (72%), les cancers du sein (40%), du colon (35%) et la vaccination annuelle contre la grippe (35.2% chez les patients de >65 ans et 29.3% chez les patient de <65 ans avec une maladie chronique). 83% des patients reçoivent les mesures préventives concernant les facteurs de risque cardiovasculaire, avec >75% pour l'hypertension, le diabète et la dyslipidémie. Cependant, l'examen des pieds est effectué chez seulement 50% des patients présentant un diabète.¦De même, nous avons pu démontrer que les femmes (65.3%) et les personnes âgées de plus de 65 ans (68.0%) reçoivent moins de mesures préventives que les hommes (72.2%) et les personnes plus jeunes (70.1%).¦Ce travail de recherche a donc permis de mettre en évidence les domaines de la prévention encore insuffisamment proposés aux patients et de rendre attentif le personnel médical sur le fait qu'il existe en Suisse des groupes de personnes qui reçoivent moins de prévention que d'autres groupes. Dans le futur, l'accent devrait être d'avantage mis durant les études de médecine et lors de la formation post-graduée sur les mesures préventives pas assez exploitées en Suisse en particulier le dépistage des cancers et la vaccination annuelle contre la grippe.

Factors affecting the quality of cardiopulmonary resuscitation in inpatient units: perception of nurses

Abstract OBJECTIVE To identify, in the perception of nurses, the factors that affect the quality of cardiopulmonary resuscitation (CPR) in adult inpatient units, and investigate the influence of both work shifts and professional experience length of time in the perception of these factors. METHOD A descriptive, exploratory study conducted at a hospital specialized in cardiology and pneumology with the application of a questionnaire to 49 nurses working in inpatient units. RESULTS The majority of nurses reported that the high number of professionals in the scenario (75.5%), the lack of harmony (77.6%) or stress of any member of staff (67.3%), lack of material and/or equipment failure (57.1%), lack of familiarity with the emergency trolleys (98.0%) and presence of family members at the beginning of the cardiopulmonary arrest assistance (57.1%) are factors that adversely affect the quality of care provided during CPR. Professional experience length of time and the shift of nurses did not influence the perception of these factors. CONCLUSION The identification of factors that affect the quality of CPR in the perception of nurses serves as parameter to implement improvements and training of the staff working in inpatient units.

Parent perceived quality of life is age-dependent in children with food allergy.

Food allergy in children significantly affects their quality of life. Its impact can be analyzed by quality of life questionnaires. The aim of our study was to validate the French version of disease-specific questionnaires and to evaluate the quality of life in children with IgE-mediated food allergy. Two validated food allergy-specific questionnaires for quality of life, the parent's and children's forms (FAQLQ-PF and FAQLQ-CF), were translated from English to French and submitted to children with food allergy and their parents. Questionnaires were analyzed in terms of emotional impact, food anxiety, and social and food limitations. NCT 01480427. Sixty-two parents of children aged 0-12 yrs answered the FAQLQ-PF, and 32 children aged 8-12 yrs the FAQLQ-CF. Construct validity of both questionnaires was assessed by correlation between the FAQLQs and FAIM (r = 0.85 and 0.84, respectively). Both FAQLQs had good internal consistency (Cronbach's α = 0.748 and 0.67, respectively). Young children (0-3 yrs old) showed better quality of life scores than older children (FAQLQ-PF global score: p = 0.02). Worse scores were also shown among children with previous severe systemic reactions (FAQLQ-PF global score: p = 0.039), the ones with an allergic mother (FAQLQ-PF global score: p = 0.002), or allergic siblings (FAQLQ-PF emotional impact score: p = 0.034), the ones with multiple food allergy (more than 1 food) (FAQLQ-PF anxiety score: p = 0.04) and among the girls (FAQLQ-CF global score: p = 0.031). Older children, the ones with severe systemic reactions, or with mothers or siblings also affected by allergies, as well as girls, and children with multiple food allergies show worse quality of life scores.

Characterization of instrumental and sensory quality of papaya ‘Solo' and 'Local' produced in Santiago - Cape Verde and critical analysis on the importation of papaya

O estudo teve por objectivo fazer a caracterização dos atributos de qualidade de duas variedades (Solo e Local) de papaia produzida em Santiago, Cabo Verde, e definir os atributos que os distribuidores procuram. Foram realizadas avaliações físico-químicas, sensorial e um estudo de mercado. Os parâmetros avaliados foram o peso, cor interior e exterior, textura, espessura da polpa, pH, acidez titulável, SST, fez-se avaliação sensorial a aplicação de um questionário aos importadores de papaia. Os parâmetros SST, Acidez, pH e peso variam significativamente com as variedades, sendo as papaias da variedade Local mais pesadas. A textura varia em função dos graus de maturação, a firmeza apresenta uma diminuição ao longo do amadurecimento, na deformação percebe-se um decréscimo com avançar da maturação, nos parâmetros de cor interna e externa as diferenças encontram-se na interacção entre Variedade e Estado de maturação. A variedade Solo foi mais valorizada na avaliação sensorial assim como no preço, certificação/selo qualidade e doçura pelos distribuidores.

Quality of assessement of CMR images in the setting of the European cardiovascular magnetic resonance registry : description and validation of standardized criteria

l'imagerie par résonance magnétique (IRMC) est une technologie utilisée depuis les aimées quatre¬-vingts dans le monde de la cardiologie. Cette technique d'imagerie non-invasive permet d'acquérir Ses images du coeur en trois dimensions, dans n'importe quel, plan, sans application de radiation, et en haute résolution. Actuellement, cette technique est devenue un référence dans l'évaluation et 'l'investigation de différentes pathologies cardiaques. La morphologie cardiaque, la fonction des ventricules ainsi que leur contraction, la perfusion tissulaire ainsi que la viabilité tissulaire peuvent être caractérisés en utilisant différentes séquences d'imagerie. Cependant, cette technologie repose sur des principes physiques complexes et la mise en pratique de cette technique se heurte à la difficulté d'évaluer un organe en mouvement permanent. L'IRM cardiaque est donc sujette à différents artefacts qui perturbent l'interprétation des examens et peuvent diminuer la précision diagnostique de cette technique. A notre connaissance, la plupart des images d'IRMC sont analysées et interprétées sans évaluation rigoureuse de la qualité intrinsèque de l'examen. Jusqu'à présent, et à notre connaissance, aucun critère d'évaluation de la qualité des examens d'IRMC n'a été clairement déterminé. L'équipe d'IRMC du CHUV, dirigée par le Prof J. Schwitter, a recensé une liste de 35 critères qualitatifs et 12 critères quantitatifs évaluant la qualité d'un examen d'IRMC et les a introduit dans une grille d'évaluation. L'objet de cette étude est de décrire et de valider la reproductibilité des critères figurant dans cette grille d'évaluation, par l'interprétation simultanée d'examens IRMC par différents observateurs (cardiologues spécialisés en IRM, étudiant en médecine, infirmière spécialisée). Notre étude a permis de démontrer que les critères définis pour l'évaluation des examens d'IRMC sont robustes, et permettent une bonne reproductibilité intra- et inter-observateurs. Cette étude valide ainsi l'utilisation de ces critères de qualité dans le cadre de l'imagerie par résonance magnétique cardiaque. D'autres études sont encore nécessaires afin de déterminer l'impact de la qualité de l'image sur la précision diagnostique de cette technique. Les critères standardisés que nous avons validés seront utilisés pour évaluer la qualité des images dans le cadre d'une étude à échelle européenne relative à l'IRMC : "l'EuroCMR registry". Parmi les autres utilités visées par ces critères de qualité, citons notamment la possibilité d'avoir une référence d'évaluation de la qualité d'examen pour toutes les futures études cliniques utilisant la technologie d'IRMC, de permettre aux centres d'IRMC de quantifier leur niveau de qualité, voire de créer un certificat de standard de qualité pour ces centres, d'évaluer la reproductibilité de l'évaluation des images par différents observateurs d'un même centre, ou encore d'évaluer précisément la qualité des séquences développées à l'avenir dans le monde de l'IRMC.

Structural quality of a no-tillage red latosol 50 months after gypsum aplication

Gypsum application may enhance the soil quality for plants in terms of soil chemical and physical properties. The objective of this study was to evaluate the effects of gypsum application on the structural quality of a no-tillage Red Latosol. The experiment was initiated in September 2005 in Guarapuava-PR, with gypsum applications of 0; 4; 8; and 12 Mg ha-1 on the soil surface. In November 2009, two soil blocks were sampled from the 0-0.3 m layer for visual evaluation of the soil structure quality (Sq) and to determine the aggregate-tensile strength (ATS). Soil penetration resistance (PR) and gravimetric moisture (H%) of the 0-0.300 m layer were evaluated, and soil cores were collected (layers 0.000-0.075 and 0.075-0.150 m), to determine soil bulk density (BD), total soil porosity (TP), microporosity (Mi), and macroporosity (Ma). Data were subjected to analysis of regression at 5 %. No significant effects of gypsum application on ATS and H % of aggregates were observed, but for Sq, a quadratic effect (0.000-0.075 m) and linear increase (0.075-0.150 and 0.150-0.300 m) were stated, indicating soil quality decrease, although Sq remained mostly below 3.0, with good to intermediate soil quality. Soil PR increased with gypsum, but also remained below critical levels. No effect was observed for soil H % at the moment of PR determination on the field. The gypsum applications decreased BD in the 0.075-0.150 m layer, and increased PT and Ma, while in 0.000-0.075 m some Ma was converted to Mi, without affecting PT and BD. These last results indicate a gain in soil structural quality by gypsum applications, but the higher scores of soil structure and values of soil penetration resistance, though still below thresholds, should be monitored to prevent limitations to soil use in the future.

Structural quality of polyacrylamide-treated cohesive soils in the coastal tablelands of Pernambuco

Water-soluble polymers are characterized as effective flocculating agents due to their molecular features. Their application to soils with horizons with structural problems, e.g, a cohesive character, contributes to improvements in the physical quality and thus to the agricultural suitability of such soils. The purpose of this study was to evaluate the structural quality of soils with cohesive horizons of coastal tablelands in the State of Pernambuco treated with polyacrylamide (PAM) as chemical soil conditioner. To this end, three horizons (one cohesive and two non-cohesive) of a Yellow Argisol (Ultisol) were evaluated and to compare cohesive horizons, the horizon of a Yellow Latosol (Oxisol) was selected. The treatments consisted of aqueous PAM solutions (12.5; 50.0; 100.0 mg kg-1) and distilled water (control). The structural aspects of the horizons were evaluated by the stability (soil mass retained in five diameter classes), aggregate distribution per size class (mean weight diameter- MWD, geometric mean diameter - GMD) and the magnitude of the changes introduced by PAM by measuring the sensitivity index (Si). Aqueous PAM solutions increased aggregate stability in the largest evaluated diameter class of the cohesive and non-cohesive horizons, resulting in higher MWD and GMD, with highest efficiency of the 100 mg kg-1 solution. The cohesive horizon Bt1 in the Ultisol was most sensitive to the action of PAM, where highest Si values were found, but the structural quality of the BA horizon of the Oxisol was better in terms of stability and aggregate size distribution.

Addition of nitrogen had no effect on yield and quality of apples in an high density orchard carrying a dwarf rootstock

The effect of N addition on apple yield and quality may vary according to the tree vigor. Apple trees developed over vigorous rootstocks had shown no response to N application in Brazil. In this study it was evaluated the effect of N addition to the soil on yield and quality of ´Royal Gala´ apples grafted on a dwarf rootstock (M.9). The orchard was planted in 1995 (2,857 trees ha-1) on an Oxisol containing 40 g kg-1 of organic matter and pH 6.0. The experiment was carried out from 1998 up to 2005. Treatments consisted of rates of N (0, 50, 100 and 150 kg ha-1 year-1 from 1998 to 2001, and respectively 0, 100, 200 and 300 kg ha-1 afterwards), all broadcasted within the tree row in two equal splits, at bud break and after harvest, as ammonium sulfate. Addition of N to the soil had no effect on fruit yield over the six years regardless of the applied rate. Averaged across treatments and years, fruit yield was 52.3 t ha-1. Nitrogen in the leaves (average of 24 g kg-1) or in the fruits (average of 346 mg kg-1) as well as some attributes related to fruit quality (color, firmness, acidity, soluble solids, physiological disorders) were unaffected by N addition. Some plant parameters related to tree vigor, however, grew higher with the increase on N rate. Thus, it is not necessary to apply N to deep Brazilian soils containing high organic matter in order to assure good fruit quality and yield on high-density orchards carrying dwarf rootstocks probably because the N required for tree growth and fruit production is supplied from soil organic matter decay.

Growth, production and quality of pineapple in response to herbicide use

In pineapple fields, weed competition is exacerbated by the fact that the crop is small and has a very slow vegetative development. The objective of this study was to determine the effects of herbicides on growth, yield and quality of pineapple, cultivar 'Pérola'. The experimental design was in randomized blocks with four treatments and four replications. Treatments consisted of weeding by hoe and the herbicides diuron; fluazifop-p-butyl and atrazine + S-metolachlor applied in post-emergence. The characteristics evaluated monthly during the vegetative stage were stem diameter, D-leaf length, number of leaves, number of emitted leaves and percentage of natural floral induction. In the reproductive phase, evaluations were made of average fruit weight (g) with and without crown, fruits length and diameter, number of slip, slip-sucker and sucker type seedlings, determination of soluble solids and pH in the pulp. There was no effect of herbicide treatment on the vegetative growth characteristics. Stem diameter increased until 330 days after planting, showing a decrease after this period. The D-leaf grew over time in all treatments, although phytotoxicity symptoms were observed after the first application of herbicides. The traits evaluated on the reproductive phase showed no significant differences in response to treatments. Therefore, the use of diuron fluazifop-p-butyl and atrazine + S-metolachlor did not affect growth, yield and fruit quality of pineapple, cultivar 'Pérola'.

RELATIONSHIP BETWEEN LIGNIN CONTENT AND QUALITY OF Pinus taeda SEEDLINGS1

ABSTRACT The essay objective was to correlate lignin content resulting from tigmomorphogenesis induced by stem swaying with survival and post-planting growth of P. taeda seedlings. Seedlings were subjected to daily frequencies (0, 5, 10, 20 and 40 movements) of stem swaying for 60 days. By the end of the treatments, we determined lignin content of below and aboveground seedling tissues. Four replicates per treatment were planted in a area cultivated with pines. Ninety days after planting, survival and increments of seedling height, stem diameter and stem volume were quantified. Application of 20 stem swayings increased lignin in both below and aboveground plant tissues. Outplanted seedling survival was reduced with 40 stem swayings while growth increments were increased with both 10 and 20 stem swayings. Lignin content from belowground plant tissues was positively correlated with outplanted seedling survival while lignin from aboveground tissues correlated with height and stem volume increments. P. taeda seedlings with higher lignin content have higher survival chances after planting.

On the impact of rigorous approaches on the quality of development

Software systems are expanding and becoming increasingly present in everyday activities. The constantly evolving society demands that they deliver more functionality, are easy to use and work as expected. All these challenges increase the size and complexity of a system. People may not be aware of a presence of a software system, until it malfunctions or even fails to perform. The concept of being able to depend on the software is particularly significant when it comes to the critical systems. At this point quality of a system is regarded as an essential issue, since any deficiencies may lead to considerable money loss or life endangerment. Traditional development methods may not ensure a sufficiently high level of quality. Formal methods, on the other hand, allow us to achieve a high level of rigour and can be applied to develop a complete system or only a critical part of it. Such techniques, applied during system development starting at early design stages, increase the likelihood of obtaining a system that works as required. However, formal methods are sometimes considered difficult to utilise in traditional developments. Therefore, it is important to make them more accessible and reduce the gap between the formal and traditional development methods. This thesis explores the usability of rigorous approaches by giving an insight into formal designs with the use of graphical notation. The understandability of formal modelling is increased due to a compact representation of the development and related design decisions. The central objective of the thesis is to investigate the impact that rigorous approaches have on quality of developments. This means that it is necessary to establish certain techniques for evaluation of rigorous developments. Since we are studying various development settings and methods, specific measurement plans and a set of metrics need to be created for each setting. Our goal is to provide methods for collecting data and record evidence of the applicability of rigorous approaches. This would support the organisations in making decisions about integration of formal methods into their development processes. It is important to control the software development, especially in its initial stages. Therefore, we focus on the specification and modelling phases, as well as related artefacts, e.g. models. These have significant influence on the quality of a final system. Since application of formal methods may increase the complexity of a system, it may impact its maintainability, and thus quality. Our goal is to leverage quality of a system via metrics and measurements, as well as generic refinement patterns, which are applied to a model and a specification. We argue that they can facilitate the process of creating software systems, by e.g. controlling complexity and providing the modelling guidelines. Moreover, we find them as additional mechanisms for quality control and improvement, also for rigorous approaches. The main contribution of this thesis is to provide the metrics and measurements that help in assessing the impact of rigorous approaches on developments. We establish the techniques for the evaluation of certain aspects of quality, which are based on structural, syntactical and process related characteristics of an early-stage development artefacts, i.e. specifications and models. The presented approaches are applied to various case studies. The results of the investigation are juxtaposed with the perception of domain experts. It is our aspiration to promote measurements as an indispensable part of quality control process and a strategy towards the quality improvement.

Incidence of deep vein thrombosis and quality of venous thromboembolism prophylaxis

OBJECTIVE: to determine the incidence of deep vein thrombosis and prophylaxis quality in hospitalized patients undergoing vascular and orthopedic surgical procedures. METHODS: we evaluated 296 patients, whose incidence of deep venous thrombosis was studied by vascular ultrasonography. Risk factors for venous thrombosis were stratified according the Caprini model. To assess the quality of prophylaxis we compared the adopted measures with the prophylaxis guidelines of the American College of Chest Physicians. RESULTS: the overall incidence of deep venous thrombosis was 7.5%. As for the risk groups, 10.8% were considered low risk, 14.9%moderate risk, 24.3% high risk and 50.5% very high risk. Prophylaxis of deep venous thrombosis was correct in 57.7%. In groups of high and very high risk, adequate prophylaxis rates were 72.2% and 71.6%, respectively. Excessive use of chemoprophylaxis was seen in 68.7% and 61.4% in the low and moderate-risk groups, respectively. CONCLUSION: although most patients are deemed to be at high and very high risk for deep vein thrombosis, deficiency in the application of prophylaxis persists in medical practice.

PHYSIOLOGICAL QUALITY OF SOYBEAN SEEDS DEPENDING ON THE PREHARVEST DESICCATION

ABSTRACTDepending on the cultivar, the use of desiccants in the preharvest can favor maintenance of physiological quality. The objective of the study was to assess the physiological quality of soybean seeds as due to the use of apreharvest desiccant and desiccation time in two harvests (2011/12 and 2012/13). The treatments were five soybean cultivars, two growth stages of application, a control (without desiccant application), and three desiccants (glufosinate-ammonium, carfentrazone-ethyl and paraquat) (2011/12 harvest). In the 2012/13 harvest the carfentrazone-ethyl desiccant was replaced by diquat. The physiological quality of seeds was assessed by the percentage of viability and vigor (cold test, tetrazolium test and accelerated aging test). In 2011/12 harvest, there was an early harvest in six days with the use of glufosinate-ammonium and paraquat desiccants, when desiccation was done in stage R7.1, with maintenance of seed quality; however it was dependent on the cultivar. In the 2012/13 harvest there was no early harvesting due to the presence of rain in the preharvest and the use of desiccation did not affect the physiological quality of the seeds either. Cultivar NA5909 RG was more tolerant to remaining in the cultivation environment and maintained higher viability than 90% and greater vigor of 71% by the cold test compared to cultivar BMX Turbo (2011/12 harvest). It is concluded that desiccation can be a viable alternative to the soybean early harvesting, but it depends on the cultivar, the time of desiccation, the active principle of the desiccant and the absence of rain in preharvest.

Evaluation of the quality of a molded sweet biscuit enriched with okara flour

The objective of this research was to test the addition of soymilk residue, also known as okara, to a molded sweet biscuit (MSB). The okara was provided by two soymilk producing companies whose production systems are based on hot disintegration of decorticated (company B) or non-decorticated (company A) soybeans and separation of the soymilk. Okaras A and B were dehydrated in a flash dryer and then ground to a flour (< 200 mesh). The okara flours showed high protein (35 g.100 g-1 dwb), lipid (17 g.100 g-1 dwb), and fiber (17 to 21 g.100 g-1 dwb) contents. The water holding capacity, protein solubility, emulsifying capacity, emulsion stability and isoflavone contents found in flour A were significantly higher (p < 0.05) than in flour B. The formulation of MSB, replacing 30% (w/w) of the wheat flour with okara flour was tested. The results of the physical measurements, brittleness and water activity of the MSB with flours A and B did not differ significantly (p < 0.05) from those of the standard. The color, flavor and overall quality of the MSB with 30% of okara flour B did not differ significantly from those of the standard biscuit, demonstrating its potential for application in confectionery products.

Quality of yellow passion fruit stored under refrigeration and controlled atmosphere

In this study, it was evaluated the quality of yellow passion fruits stored under refrigeration and controlled atmospheres of different composition aiming to extend the postharvest life of the fruits. The characteristics of skin color, appearance, mass loss, as well as the chemical quality of the juice of yellow passion fruits stored at: 21% O2 plus 0.03% CO2; 1% O2 plus 0.03% CO2; 5% O2 plus 0.03% CO2; 12% O2 plus 5% CO2; and 5% O2 plus 15% CO2, with 1 control treatment (refrigeration at 13 ºC and 90% UR) were determined. The analyses were performed before and after 30 days of storage and after removing the controlled atmospheres and storage for 9 days under refrigeration at ambient atmosphere. The data were interpreted by simple statistical analysis using the test by confidence intervals with 95% of probability. It was concluded that the application of atmospheres with low oxygen concentration and high carbon dioxide level minimized quality losses. At atmosphere with 5% O2 and 15% CO2, it was observed the lowest color change indexes and mass loss, and also the smallest decrease in acidity, soluble solids content, vitamin C, reducing sugars, and total soluble sugars.