Percepción de calidad de vida relacionada con la salud en pacientes con síndrome de apnea e hipoapnea obstructiva del sueño

El objetivo de esta investigación es describir la calidad de vida y la calidad del sueño en los pacientes con diagnóstico de Síndrome de Apnea Hipoapnea del sueño, mediante el uso de un grupo de cuestionarios para obtener datos demográficos, la evaluación del grado de somnolencia diurna percibida, la percepción de la calidad del sueño y la percepción de la calidad de vida relacionada con la salud con encuestas en sus respectivas versiones validadas para Colombia.

Motivação e adesão ao exercício físico : um estudo sobre o papel dos treinadores pessoais

Introdução: Procuramos analisar a associação entre a frequência/adesão ao exercício físico (FAEF) em contexto de ginásios e health clubs (GHC) e os constructos previstos pela Teoria da Auto Determinação (TAD) em indivíduos que treinam com Treinador Pessoal (TP)e indivíduos que não treinam com TP. Método: Efetuámos uma revisão sistemática da literatura (RSL), seguida de um estudo observacional onde aplicámos questionários psicométricos para avaliar o clima da sessão de treino, resposta psicológica global, regulação motivacional, satisfação das necessidades psicológicas (NPB), escolha percebida sobre o desempenho em exercício. Foi controlada a FAEF durante 3 meses. A amostra consistiu em 88 clientes (Midade = 41.35, SD = 12.22, MIMC = 25.10, SD = 14.52) Resultados: Na RSL encontrámos 10 estudos, nenhum em contexto de TP. No nosso estudo não se registaram diferenças na FAEF, nem nas regulações motivacionais entre os grupos. No grupo com TP a competência associou-se à FAEF (p=.017) e a autonomia associou-se a menores níveis de mau estar psicológico e de fadiga (p=.032). O Clima de Tratamento do Programa não influenciou nenhum dos outcomes estudados. No grupo sem TP, quanto mais Autonomia (p=.038) e Motivação Intrínseca (p=.001) maior a FAEF. Regulações mais autodeterminadas estão associados a maiores valores de FAEF (p=.009). A motivação intrínseca associou-se positivamente (p=.014) com a FAEF em toda a amostra. Discussão: O suporte das NBP origina uma motivação mais auto regulada o que se reflete numa maior FAEF e bem estar psicológico. No grupo com TP a competência teve um maior contributo para a FAEF, no grupo sem TP a autonomia registou o valor mais elevado. Não se observaram diferenças entre os grupos na regulação motivacional e na FAEF. O suporte de autonomia dado pelo TP não apresentou resultados significativos na FAEF, o que contraria o esperado pela TAD. Estes dados são, por si só reveladores da importância de se aprofundar conhecimentos que auxiliem os TP’s a a motivarem com mais qualidade os seus alunos.

De Generalista a Especialista : Motivações para a formação especializada em enfermagem : o caso das organizações de saúde públicas, na sub-região oeste do distrito de Lisboa

O presente estudo, enquadrado na área de gestão de recursos humanos, tem como principal objectivo identificar os factores motivacionais que orientam a adesão à especialização, no grupo profissional dos enfermeiros. Trata-se de um estudo de natureza exploratória, transversal, descritivo, analítico, comparativo e quantitativo. A população do estudo foi o grupo de enfermeiros portugueses, sendo a sua amostra composta por 150 enfermeiros. Este grupo foi seleccionado a partir de um processo de amostragem probabilística estratificada, sem reposição. O instrumento de recolha de dados foi o inquérito por questionário. Para o efeito usou-se o questionário da motivação para a formação (QMF) de Carré (2001), tendo sido já adaptado para a população portuguesa por Correia (2009). A formação contínua é uma condição importante no desenvolvimento do indivíduo, quer a nível pessoal, quer a nível profissional; assim como no desempenho da organização onde o indivíduo exerce a sua profissão. O presente trabalho pretende, assim, identificar os factores motivacionais na função de enfermeiro, e que conduzem à adesão da especialização, em particular ao Curso de Pós-Licenciatura em Enfermagem. Numa primeira parte, faz-se a definição e avaliação da função, desenhando-se um mapa de competências; identificando-se, em paralelo, os motivos/expectativas que levam estes profissionais da saúde à especialização desta mesma escala. Decorrente dos resultados obtidos, o presente trabalho conclui que as duas principais motivações dos enfermeiros para a frequência do CPLEE são a motivação extrínseca Operacional Pessoal e a motivação extrínseca Operacional Profissional. Foi ainda possível determinar que a idade, o género, o vínculo à instituição e a situação financeira também têm um papel decisivo no que concerne à motivação dos enfermeiros para a frequência do CPLEE. Este estudo permitiu ainda consolidar o questionário da motivação para a formação desenvolvido por Philippe Carré, aplicado à população portuguesa, de forma a analisar a motivação dos enfermeiros portugueses para a frequência do CPLEE. Quanto às implicações práticas, pretende-se contribuir para o desenvolvimento e melhoria das práticas de recursos humanos no sector da saúde. Balança-se aqui, consequentemente, um equilíbrio entre o diagnóstico organizacional, e a prescrição prática. Potencialmente, poderá servir de roadmap para áreas como o recrutamento e selecção, gestão de carreiras, formação e desenvolvimento, desenho de trabalho e de funções; e, adicionalmente, para uma melhor gestão académica do ensino pós-graduado, na carreira da enfermagem.

Grau de procura da acupunctura como opção terapêutica numa amostra da população de Lisboa

Este é um estudo exploratório e correlacional, com um número inicial de 150 participantes, utilizando uma amostra de conveniência constituída por cinco clínicas médicas e cinco casas de medicina tradicional chinesa, em Lisboa, onde os indivíduos foram autorizados a responder voluntariamente a questionários. Apresenta uma taxa de resposta de 74% (N=111). A adesão à acupunctura é maior no sexo feminino e na faixa etária de 31 a 50 anos (40% homens e 48% mulheres). A procura de tratamento de problemas musculares e articulares e para problemas do foro psicológico são as mais descritas, apesar de ser referida como eficaz noutro tipo de queixas, e não ser o primeiro tipo de tratamento que a população procura. É reconhecido que os resultados podem ocorrer a médio e longo prazo, após várias sessões terapêuticas, o que não parece afetar a perceção da população em estudo que se diz satisfeita (53%) com uma muita boa e / ou boa relação benefício-custo. Em geral, a maioria da população (93%) confia na terapia pelo resultado bom ou muito bom (79%) ou razoável (16%) obtido, e deposita confiança (88%) nas competências do profissional de saúde que executa a acupunctura.

O papel do farmacêutico no acompanhamento de doentes com asma

A asma é uma doença inflamatória crónica das vias aéreas que, em indivíduos susceptíveis, origina sintomas característicos. Dada a prevalência, características da doença, utilização segura e correcta dos medicamentos e adesão à terapêutica, é de extrema importância incentivar os profissionais de saúde, doentes e suas famílias a tomarem medidas que permitam um melhor controlo da doença, de forma a obter ganhos em saúde. Assim, foi realizado um estudo descritivo envolvendo os doentes asmáticos da farmácia Santo António, tendo por base um questionário que avaliou o grau de controlo da asma, bem como o conhecimento sobre a doença e cuidados a ter. Após tratamento dos dados, foi possível determinar que 35% dos asmáticos em questão apresentam asma não controlada ou parcialmente controlada, 43% não conhece medidas não farmacológicas relativas a esta patologia e 12% não usa correctamente a medicação prescrita. Os resultados do estudo indicam que é necessário que o farmacêutico intervenha junto da população asmática, nomeadamente através de acções de formação sobre a utilização correcta dispositivos de inalação (no que diz respeito à importância da utilização de medicação SOS apenas nas situações adequadas e não como medicação diária), informação sobre medidas não farmacológicas (que em alguns doentes podem ser um factor decisivo no controlo da doença) e importância da monitorização do controlo da patologia pelo próprio doente.

The politics of weddings at Athens: an iconographic assessment

Despite recent scholarship that has suggested that most if not all Athenian vases were created primarily for the symposium, vases associated with weddings constitute a distinct range of Athenian products that were used at Athens in the period of the Peloponnesian War and its immediate aftermath (430-390 BCE). Just as the subject matter of sympotic vases suggested stories or other messages to the hetaireia among whom they were used, so the wedding vases may have conveyed messages to audiences at weddings. This paper is an assessment of these wedding vases with particular attention to function: how the images reflect the use of vases in wedding rituals (as containers and/or gifts); how the images themselves were understood and interpreted in the context of weddings; and the post-nuptial uses to which the vases were put. The first part is an iconographic overview of how the Athenian painters depicted weddings, with an emphasis on the display of pottery to onlookers and guests during the public parts of weddings, important events in the life of the polis. The second part focuses on a large group of late fifth century vases that depict personifications of civic virtues, normally in the retinue of Aphrodite (Pandemos). The images would reinforce social expectations, as they advertised the virtues that would create a happy marriage—Peitho, Harmonia (Harmony), and Eukleia (Good Repute)—and promise the benefits that might result from adherence to these values—Eudaimonia and Eutychia (Prosperity), Hygieia (Health), and Paidia (Play or Childrearing). Civic personifications could be interpreted on the private level—as personal virtues—and on the public level—as civic virtues— especially when they appeared on vases that functioned both in public and private, at weddings, which were public acknowledgments of private changes in the lives of individuals within the demos.

Time-varying coefficients in the almost ideal demand system: An empirical appraisal

This paper provides a generalisation of the structural time series version of the Almost Ideal Demand System (AIDS) that allows for time-varying coefficients (TVC/AIDS) in the presence of cross-equation constraints. An empirical appraisal of the TVC/AIDS is made using a dynamic AIDS with trending intercept as the baseline model with a data set from the Italian Household Budget Survey (1986-2001). The assessment is based on four criteria: adherence to theoretical constraints, statistical diagnostics on residuals, forecasting performance and economic meaningfulness. No clear evidence is found for superior performance of the TVC/AIDS, apart from improved short-term forecasts.

An assessment of the potential consumption impacts of WHO dietary norms in OECD countries

The member countries of the World Health Organization (WHO) have recently endorsed its global strategy on diet, physical activity and health. The strategy emphasises the need to limit the consumption of saturated fats and trans-fatty acids, salt and sugars, and to increase consumption of fruits and vegetables in order to combat the growing burden of non-communicable diseases. This paper attempts a broad quantitative assessment of the consumption impacts of these norms in OECD countries using a mathematical programming approach. We find that adherence to the WHO norms would involve a significant decrease in the consumption of vegetable oils (30%), dairy products (28%), sugar (24%), animal fats (30%) and meat (pig meat, 13.5%, mutton and goat 14.5%) and a significant increase in the human consumption of cereals (31%), fruits (25%) and vegetables (21%). (c) 2005 Elsevier Ltd. All rights reserved.

Re-engineering construction: going against the grain

An overtly critical perspective on 're-engineering construction' is presented. It is contended that re-engineering is impossible to define in terms of its substantive content and is best understood as a rhetorical label. In recent years, the language of re-engineering has heavily shaped the construction research agenda. The declared goals are to lower costs and improve value for the customer. The discourse is persuasive because it reflects the ideology of the 'enterprise culture' and the associated rhetoric of customer responsiveness. Re-engineering is especially attractive to the construction industry because it reflects and reinforces the existing dominant way of thinking. The overriding tendency is to reduce organizational complexities to a mechanistic quest for efficiency. Labour is treated as a commodity. Within this context, the objectives of re-engineering become 'common sense'. Knowledge becomes subordinate to the dominant ideology of neo-liberalism. The accepted research agenda for re-engineering construction exacerbates the industry's problems and directly contributes to the casualization of the workforce. The continued adherence to machine metaphors by the construction industry's top management has directly contributed to the 'bad attitudes' and 'adversarial culture' that they repeatedly decry. Supposedly neutral topics such as pre-assembly, partnering, supply chain management and lean thinking serve only to justify the shift towards bogus labour-only subcontracting and the associated reduction of employment rights. The continued casualization of the workforce raises real questions about the industry's future capacity to deliver high-quality construction. In order to appear 'relevant' to the needs of industry, it seems that the research community is doomed to perpetuate this regressive cycle.

Assessing the accuracy of a computerized decision support system for digoxin dosing in primary care: an observational study

Background: This study was carried out as part of a European Union funded project (PharmDIS-e+), to develop and evaluate software aimed at assisting physicians with drug dosing. A drug that causes particular problems with drug dosing in primary care is digoxin because of its narrow therapeutic range and low therapeutic index. Objectives: To determine (i) accuracy of the PharmDIS-e+ software for predicting serum digoxin levels in patients who are taking this drug regularly; (ii) whether there are statistically significant differences between predicted digoxin levels and those measured by a laboratory and (iii) whether there are differences between doses prescribed by general practitioners and those suggested by the program. Methods: We needed 45 patients to have 95% Power to reject the null hypothesis that the mean serum digoxin concentration was within 10% of the mean predicted digoxin concentration. Patients were recruited from two general practices and had been taking digoxin for at least 4 months. Exclusion criteria were dementia, low adherence to digoxin and use of other medications known to interact to a clinically important extent with digoxin. Results: Forty-five patients were recruited. There was a correlation of 0·65 between measured and predicted digoxin concentrations (P < 0·001). The mean difference was 0·12 μg/L (SD 0·26; 95% CI 0·04, 0·19, P = 0·005). Forty-seven per cent of the patients were prescribed the same dose as recommended by the software, 44% were prescribed a higher dose and 9% a lower dose than recommended. Conclusion: PharmDIS-e+ software was able to predict serum digoxin levels with acceptable accuracy in most patients.

An ECOOP web portal for visualising and comparing distributed coastal oceanography model and in situ data

As part of a large European coastal operational oceanography project (ECOOP), we have developed a web portal for the display and comparison of model and in situ marine data. The distributed model and in situ datasets are accessed via an Open Geospatial Consortium Web Map Service (WMS) and Web Feature Service (WFS) respectively. These services were developed independently and readily integrated for the purposes of the ECOOP project, illustrating the ease of interoperability resulting from adherence to international standards. The key feature of the portal is the ability to display co-plotted timeseries of the in situ and model data and the quantification of misfits between the two. By using standards-based web technology we allow the user to quickly and easily explore over twenty model data feeds and compare these with dozens of in situ data feeds without being concerned with the low level details of differing file formats or the physical location of the data. Scientific and operational benefits to this work include model validation, quality control of observations, data assimilation and decision support in near real time. In these areas it is essential to be able to bring different data streams together from often disparate locations.

An investigation of the expression and adhesin function of H7 flagella in the interaction of Escherichia coli O157: H7 with bovine intestinal epithelium

Enterohaemorrhagic Escherichia coli O157 : H7 is a bacterial pathogen that can cause haemorrhagic colitis and haemolytic uremic syndrome. In the primary reservoir host, cattle, the terminal rectum is the principal site of E. coli O157 colonization. In this study, bovine terminal rectal primary epithelial cells were used to examine the role of H7 flagella in epithelial adherence. Binding of a fliC(H7) mutant O157 strain to rectal epithelium was significantly reduced as was binding of the flagellated wild-type strain following incubation with H7-specific antibodies. Complementation of fliC(H7) mutant O157 strain with fliC(H7) restored the adherence to wild-type levels; however, complementation with fliC(H6) did not restore it. High-resolution ultrastructural and imunofluorescence studies demonstrated the presence of abundant flagella forming physical contact points with the rectal epithelium. Binding to terminal rectal epithelium was specific to H7 by comparison with other flagellin types tested. In-cell Western assays confirmed temporal expression of flagella during O157 interaction with epithelium, early expression was suppressed during the later stages of microcolony and attaching and effacing lesion formation. H7 flagella are expressed in vivo by individual bacteria in contact with rectal mucosa. Our data demonstrate that the H7 flagellum acts as an adhesin to bovine intestinal epithelium and its involvement in this crucial initiating step for colonization indicates that H7 flagella could be an important target in intervention strategies.

Periplasmic adaptor protein AcrA has a distinct role in the antibiotic resistance and virulence of Salmonella enterica serovar Typhimurium

Objectives: AcrA can function as the periplasmic adaptor protein (PAP) in several RND tripartite efflux pumps, of which AcrAB-TolC is considered the most important. This system confers innate multiple antibiotic resistance. Disruption of acrB or tolC impairs the ability of Salmonella Typhimurium to colonize and persist in the host. The aim of this study was to investigate the role of AcrA alone in multidrug resistance and pathogenicity. Methods: The acrA gene was inactivated in Salmonella Typhimurium SL1344 by insertion of the aph gene and this mutant complemented with pWKS30acrA. The antimicrobial susceptibility of the mutant to six antibiotics as well as various dyes and detergents was determined. In addition, efflux activity was quantified. The ability of the mutant to adhere to, and invade, tissue culture cells in vitro was measured. Results: Following disruption of acrA, RT-PCR and western blotting confirmed that acrB/AcrB was still expressed when acrA was disrupted. The acrA mutant was hypersusceptible to antibiotics, dyes and detergents. In some cases, lower MICs were seen than for the acrB or tolC mutants. Efflux of the fluorescent dye Hoechst H33342 was less than in wild-type following disruption of acrA. acrA was also required for adherence to, and invasion of, tissue culture cells. Conclusions: Inactivation of acrA conferred a phenotype distinct to that of acrB::aph and tolC::aph. These data indicate a role for AcrA distinct to that of other protein partners in both efflux of substrates and virulence.

Negotiating social identities: the influence of gender, age and ethnicity on young people’s ‘Street Careers’ in Tanzania

This paper explores the diverse ways that children and young people negotiate their social identities and construct their life course trajectories on the street, based on ethnographic research with street children in Tanzania. Drawing on the concept of a ‘street career’, I show how differences of age, gender and ethnicity intersect with the time spent on the street, to influence young people’s livelihood strategies, use of public space, access to services, and adherence to cultural rites of passage. Using the notion of ‘gender performativity’, I analyse how young people actively reconfigure gender norms and the concept of ‘the family’ on the street.

Sensitivity and out-of-sample error in continuous time data assimilation

Data assimilation refers to the problem of finding trajectories of a prescribed dynamical model in such a way that the output of the model (usually some function of the model states) follows a given time series of observations. Typically though, these two requirements cannot both be met at the same time–tracking the observations is not possible without the trajectory deviating from the proposed model equations, while adherence to the model requires deviations from the observations. Thus, data assimilation faces a trade-off. In this contribution, the sensitivity of the data assimilation with respect to perturbations in the observations is identified as the parameter which controls the trade-off. A relation between the sensitivity and the out-of-sample error is established, which allows the latter to be calculated under operational conditions. A minimum out-of-sample error is proposed as a criterion to set an appropriate sensitivity and to settle the discussed trade-off. Two approaches to data assimilation are considered, namely variational data assimilation and Newtonian nudging, also known as synchronization. Numerical examples demonstrate the feasibility of the approach.