Quality of life in children and adolescents with congenital heart disease

Purpose: The Quality of life is currently a major topic discussed in our society. The World Health Organization (WHO) has been developing a unifying and transcultural definition of QOL. They considered it as 'the individual's perception of his or her position in life, within the cultural context and value system he or she lives in, and in relation to his or her goals, expectations, parameters and social relations. It is a broad ranging concept affected in a complex way by the person's physical health, psychological state, level of independence, social relationships and their relationship to salient features of their environment (WHOQOL, 1997, p. 1). Congenital heart disease is the most prevalent congenital disease in Portugal. Despite the advances in cardiac treatment and an early correct diagnosis that could increase the survival of children with congenital heart disease, this condition influences the quality of life of children, adolescents and their parents. Knowing the perception of quality of life could help healthcare professionals, nurses in particular, providing suited care to the needs of these families, establishing priorities in their interventions, sensing predictors of a poor quality of life, promoting adherence to treatment and boosting compliance with treatment, and fostering greater satisfaction for these children, adolescents and their parents. 'As part of broader research and with the awareness that the chronic conditions could impact the quality of life and considering that all advances on treating congenital cardiac diseases we have defined this main objective: To determine the quality of life in children and adolescents with congenital heart disease (CHD) and the perception of their parents, as well as factors that influence it. Methods: It is a quantitative, descriptive and correlational research. The data collection tool was a questionnaire, which consisted of four parts: socio-demographic and educational characteristics, clinical characteristics, and quality of life, obtained using the Pediatric Cardiac Quality of Life Inventory ? PCQLI - (Marino, Tomlinson, Wernovsky, Drotar , Newburger, Mahony et al., 2010) translated into Portuguese. Data collection took place between February and July 2014, in compliance with ethical research guidelines. The sample comprised 59 children, 59 parents of children, 80 adolescents and 80 parents of adolescents. Results: The results indicated that children, adolescents, and their parents have high level of perceived health. The results are similar in all groups: children and parents and adolescents and parents. In the group of children, we observed the classification of "Good" in 66.10%, followed by the "Very Good" at 18.65% and "fair" in 15.25% of cases. The parents of the children responded in about half the cases that the health of their children was "good" (50.85%), "very good" in 30.51% "fair" in 11.86% and "Excellent "in 6.78%. In turn, the group of adolescents can be seen that 46.25% rate their health as "good", 32.50% as "very good", 16.25% as "Average" and 5% as "Excellent". Parents of teenagers classify the health of their children mostly as "good" in 42.50%, 31.25% as "very good", 20% as "fair" and 6.25% as "excellent". To point out that none of the respondents pointed out the option of a health status "Bad". About the quality of life, in general the results indicated that children, adolescents and their parents have high levels of quality of life, and that perceptions of parents and children are similar. Only in the children?s group (8 to 12 years old), was no influence of socio-demographic, school or clinical variables on quality of life observed. For adolescents (13 to 18 years old), school, special education, school retention, the age of diagnosis of congenital heart disease, cardiac catheterization and surgical intervention influenced their quality of life. Perception of quality of life of parents of children and of adolescents was influenced by socio-demographic and clinical variables. The results partly agree with the literature in this field. About the influence of some variables: The perception of quality of life expressed by children and adolescents with congenital heart disease and parents are related, with statistical significance. There were no statistically significant relationships between the quality of life of children and adolescents and their age, gender or socioeconomic status. Adolescents differ statistically significant between their quality of life and their education, the frequency of special education and the existence of grade retention. The severity of heart disease, the number of cardiac catheterizations or surgery and the presence of other health disorders are unrelated to the quality of life of children and adolescents. Adolescents revealed that the level of quality of life is influenced by the age of diagnosis of CHD by cardiac catheterization and surgery. For parents of children and adolescents gender and their education don?t influence their perception of quality of life. Only the socioeconomic status of parents of teens has statistically significant difference to quality of life. Parents of children and adolescents do not show statistically significant relationship between the perceived level of quality of life and severity of disease, age at diagnosis, the number of surgical interventions and the existence of other health disorders. There is a relationship of statistical significance between cardiac catheterization and the perceived quality of life by parents of adolescents; between the number of cardiac catheterizations and the perception of quality of life of parents of children; and between performing surgery and the perception of parents of children and adolescents. Conclusion: To analyze the quality of life of children and adolescents with CHD must be a key focus of attention in caring for this population, allowing the identification of individual differences, interests, preferences, and prevent potential problems. The knowledge acquired along with clinical experience contributes to improve the quality of life of children and families, facilitating their growth, psycho-emotional development and social integration. Nevertheless, the reading and interpretation of these results must be prudent and cautious, there are limitations to this research, including: the use of a range of specific quality of life for the Congenital heart disease in children, adolescents, and parents but whose validation process could not be completed in this study; the low prevalence of severe conditions in our sample; the absence of national studies to enable comparison with the results obtained. We intend to continue the process of validation of instrument and enlarge the research to Lisbon and Oporto, other major centers where the cardiac conditions can be treated.

Cultural Values Change in the Rehabilitation of Historic Schools in Portugal

Despite the importance of the preservation of the historic built environment for the benefit of present and future generations, there is a lack of knowledge of the effects of architectural rehabilitation decisions on the cultural significance of historic buildings. Architectural heritage conservation literature has focused almost exclusively on providing principles and guidelines, describing intervention methodologies, and discussing predicted impacts of design on material values. This thesis argues that a focus on the actual effects is needed if the sociocultural sustainability of historic buildings significance is to be achieved. Supported by an extensive literature review and informed by personal insights from the researcher’s everyday practice, an adapted model of the Theory of Change based on Weiss (1995) was designed, providing a tool to evaluate the effects of rehabilitation on cultural significance [ERECS]. Using a selection of six recently rehabilitated historic secondary schools in Portugal (liceus), this research investigated architectural decisions and their effects on the cultural values of this building typology for education, focusing on three objectives, corresponding to three stages of interventions: understanding the existing cultural significance, identifying the design strategies applied and assessing the short-term effects of design decisions on the cultural values. Stressing the role of stakeholders in rehabilitation processes, data were collected from the buildings and architectural projects, the decision makers in the conservation process, and the school community. Although confirming that the evaluation of the effects of architectural decisions on cultural values is a complex task, the findings demonstrate that the historic liceus have historical, architectural and sociocultural values, and whilst strategies did not value social values, material cultural values were generally considered and preserved, contributing to the enhancement of intangible values. The implications of this theory-based and evidence-based research highlight the importance of evaluating actual effects for cultural heritage theory, architectural conservation practice and heritage management policy.

Self-care in older people with functional deficit: needs of long-term care.

The group of 65-year-olds is becoming more numerous and with greater needs for health care. So, is necessary the reflection about new models of provision, organization, and allocation of health resources. According to the United Nations Organization, 2015, in 2050 elderly people will reach two million people (20% of the world’s population), what mean that the number of people over 60 years old will exceed a population of young people under 15 years. Parallel to aging, less healthy lifestyles have contributed to the prevalence of chronic diseases, especially cerebrovascular diseases. Hypertension and diabetes mellitus are risk factors and increase predisposition to other diseases. With aging, there is an increased risk for developing chronic, oncological and degenerative diseases, which account for more than 50% of the burden of diseases, with profound implications on independency, use of health care and services.

A Pedagogical Strategy for Integrated Education of Spanish in the 4th to 6th Grades of the General Basic Education

Language teaching has become a priority in the Costa Rican educational system, considering it as a tool for communication and development of thought. Without language, there is no access to other curriculum disciplinary knowledge. A successful experience conducted some years ago, with students from 4th to 6th grade, was the basis for the design and implementation of a professional development activity addressed to promoting an integration strategy previously adjusted according to the Ministry’s requirements and the existing national regulations. This study is developed in the framework of a qualitative paradigm including research-action and systematization. A purposive sample was selected based on a suitability factor, through which individuals are informed about the strategy, and then the strategy is applied to a group of students from urban-marginal areas. The techniques used include literature review, analysis of curriculum and Ministry’s regulations, application of an in-depth interview, discussions from the course’s participant in a portfolio, and discussions from students to whom the strategy was applied. We analyzed the considerations of teachers and students, as well as the theoretical and regulatory information by triangulation. The study’s conclusion is the necessity of a communicative approach in language teaching and our recommendation is to implement the strategy developed in the Costa Rican classrooms as provided in this paper.

Competencies Required in Education Research and Teaching Systematization according to Students from the Preschool, Primary and Secondary Education Programs of the University of Costa Rica

The purpose of this paper is to present the results of two online forums carried out with the participation of 42 students of the Licenciaturas  in Preschool Education, Primary Education and Secondary Education of the University of Costa Rica. The main purpose of the forums was to determine the insights of the participant students about the competencies they have achieved in the field of education research, and which have been the essential tools for them to systematize their own teaching practices. The discussion forums were part of the course FD5091 Métodos de Investigación Educativa [Education Research Methods] of the School of Teacher Education, delivered from March-April 2010.  Of the sample, 60 percent were students of the Preschool teaching program, 35 percent were from the Primary Education teaching program and 5 percent were from the Secondary Education teaching program in the fields of Science, Mathematics and Social Studies. According to the insights and beliefs showed by the participants –both, the future teachers and the profession practitioners–, there are no opportunities for research or systematization of their own teaching mediation, in the current work situation.(1) Translator’s Note: In Costa Rica, the “Licenciatura” is a one-year post-Bachelor study program, usually including thesis. “Primary Education” refers to students from the 1st to 6th grades, and “Secondary Education” refers to students from the 7th to 11th grades.

Environmental accounting and reporting in Italian local governments: a longitudinal analysis of changes in context, content and process

This research aims at contributing to a better understanding of changes in local governments’ accounting and reporting practices. Particularly, ‘why’, ‘what’ and ‘how’ environmental aspects are included and the significance of changes across time. It adopts an interpretative approach to conduct a longitudinal analysis of case studies. Pettigrew and Whipp’s framework on context, content and process is used as a lens to distinguish changes under each dimension and analyse their interconnections. Data is collected from official documents and triangulated with semi-structured interviews. The legal framework defines as boundaries of the accounting information the territory under local governments’ jurisdiction and their immediate surrounding area. Organisational environmental performance and externalities are excluded from the requirements. An interplay between the local outer context, political commitment and organisational culture justifies the implementation of changes beyond what is regulated and the implementation of transformational changes. Local governments engage in international networks to gain access to funding and implement changes, leading to adopting the dominant environmental agenda. Key stakeholders, like citizens, are not engaged in the accounting and reporting process. Thus, there is no evidence that the environmental aspects addressed and related changes align with stakeholders’ needs and expectations, which jeopardises its significance. Findings from the current research have implications in other EU member states due to the harmonisation of accounting and reporting practices and the common practice across the EU in using external funding to conceptualise and implement changes. This implies that other local governments could also be representing a limited account related to environmental aspects.

Weak reasoning argumentative theory. A dialogical approach for the discovery of philosophy in high schools

In the literature on philosophical practices, despite the crucial role that argumentation plays in these activities, no specific argumentative theories have ever been proposed to assist the figure of the facilitator in conducting philosophical dialogue and to enhance student’s critical thinking skills. The dissertation starts from a cognitive perspective that challenges the classic Cartesian notion of rationality by focusing on limits and biases of human reasoning. An argumentative model (WRAT – Weak Reasoning Argumentative Theory) is then outlined in order to respond to the needs of philosophical dialogue. After justifying the claim that this learning activity, among other inductive methodologies, is the most suitable for critical thinking education, I inquired into the specific goal of ‘arguing’ within this context by means of the tools provided by Speech Act Theory: the speaker’s intention is to construct new knowledge by questioning her own and other’s beliefs. The model proposed has been theorized on this assumption, starting from which the goals, and, in turn, the related norms, have been pinpointed. In order to include all the epistemic attitudes required to accomplish the complex task of arguing in philosophical dialogue, I needed to integrate two opposed cognitive accounts, Dual Process Theory and Evolutionary Approach, that, although they provide incompatible descriptions of reasoning, can be integrated to provide a normative account of argumentation. The model, apart from offering a theoretical contribution to argumentation studies, is designed to be applied to the Italian educational system, in particular to classes in technical and professional high schools belonging to the newly created network Inventio. This initiative is one of the outcomes of the research project by the same name, which also includes an original Syllabus, research seminars, a monitoring action and publications focused on introducing philosophy, in the form of workshop activities, into technical and professional schools.

Economic preferences in the health setting. Three case studies concerning the needs of breast cancer patients, pain management in oncology and extreme end-of-life decisions

The thesis describes three studies concerning the role of the Economic Preference set investigated in the Global Preference Survey (GPS) in the following cases: 1) the needs of women with breast cancer; 2) pain undertreament in oncology; 3) legal status of euthanasia and assisted suicide. The analyses, based on regression techniques, were always conducted on the basis of aggregate data and revealed in all cases a possible role of the Economic Preferences studied, also resisting the concomitant effect of the other covariates that were considered from time to time. Regarding individual studies, the related conclusion are: 1) Economic Preferences appear to play a role in influencing the needs of women with breast cancer, albeit of non-trivial interpretation, statistically "resisting" the concomitant effect of the other independent variables considered. However, these results should be considered preliminary and need further confirmation, possibly with prospective studies conducted at the level of the individual; 2) the results show a good degree of internal consistency with regard to pro-social GPS scores, since they are all found to be non-statistically significant and united, albeit only weakly in trend, by a negative correlation with the % of pain undertreated patients. Sharper, at least statistically, is the role of Patience and Willingness to Take Risk, although of more complex empirical interpretation. 3) the results seem to indicate an obvious role of Economic Preferences, however difficult to interpret empirically. Less evidence, at least on the inferential level, emerged, however, regarding variables that, based on common sense, should play an even more obvious role than Economic Preferences in orienting attitudes toward euthanasia and assisted suicide, namely Healthcare System, Legal Origin, and Kinship Tightness; striking, in particular, is the inability to prove a role for the dominant religious orientation even with a simple bivariate analysis.

Rest energy expenditure is decreased during the acute as compared to the recovery phase of sepsis in newborns

Background: Little is known with respect to the metabolic response and the requirements of infected newborns. Moreover, the nutritional needs and particularly the energy metabolism of newborns with sepsis are controversial matter. In this investigation we aimed to evaluate the rest energy expenditure (REE) of newborns with bacterial sepsis during the acute and the recovery phases. Methods: We studied nineteen neonates (27.3 +/- 17.2 days old) with bacterial sepsis during the acute phase and recovery of their illness. REE was determined by indirect calorimetry and VO(2) and VCO(2) measured by gas chromatography. Results: REE significantly increased from 49.4 +/- 13.1 kcal/kg/day during the acute to 68.3 +/- 10.9 kcal/kg/day during recovery phase of sepsis (P < 0.01). Similarly, VO(2) (7.4 +/- 1.9 vs 10 +/- 1.5 ml/kg/min) and VCO(2) (5.1 +/- 1.7 vs 7.4 +/- 1.5 ml/kg/min) were also increased during the course of the disease (P < 0.01). Conclusion: REE was increased during recovery compared to the sepsis phase. REE of septic newborns should be calculated on individualized basis, bearing in mind their metabolic capabilities.

SPITZER OBSERVATIONS OF A1763. II. CONSTRAINING THE NATURE OF ACTIVITY IN THE CLUSTER-FEEDING FILAMENT WITH VLA AND XMM-NEWTON DATA

The A1763 superstructure at z = 0.23 contains the first galaxy filament to be directly detected using mid-infrared observations. Our previous work has shown that the frequency of starbursting galaxies, as characterized by 24 mu m emission is much higher within the filament than at either the center of the rich galaxy cluster, or the field surrounding the system. New Very Large Array and XMM-Newton data are presented here. We use the radio and X-ray data to examine the fraction and location of active galaxies, both active galactic nuclei (AGNs) and starbursts (SBs). The radio far-infrared correlation, X-ray point source location, IRAC colors, and quasar positions are all used to gain an understanding of the presence of dominant AGNs. We find very few MIPS-selected galaxies that are clearly dominated by AGN activity. Most radio-selected members within the filament are SBs. Within the supercluster, three of eight spectroscopic members detected both in the radio and in the mid-infrared are radio-bright AGNs. They are found at or near the core of A1763. The five SBs are located further along the filament. We calculate the physical properties of the known wide angle tail (WAT) source which is the brightest cluster galaxy of A1763. A second double lobe source is found along the filament well outside of the virial radius of either cluster. The velocity offset of the WAT from the X-ray centroid and the bend of the WAT in the intracluster medium are both consistent with ram pressure stripping, indicative of streaming motions along the direction of the filament. We consider this as further evidence of the cluster-feeding nature of the galaxy filament.

Comparison of univariate and multivariate calibration for the determination of micronutrients in pellets of plant materials by laser induced breakdown spectrometry

The application of laser induced breakdown spectrometry (LIBS) aiming the direct analysis of plant materials is a great challenge that still needs efforts for its development and validation. In this way, a series of experimental approaches has been carried out in order to show that LIBS can be used as an alternative method to wet acid digestions based methods for analysis of agricultural and environmental samples. The large amount of information provided by LIBS spectra for these complex samples increases the difficulties for selecting the most appropriated wavelengths for each analyte. Some applications have suggested that improvements in both accuracy and precision can be achieved by the application of multivariate calibration in LIBS data when compared to the univariate regression developed with line emission intensities. In the present work, the performance of univariate and multivariate calibration, based on partial least squares regression (PLSR), was compared for analysis of pellets of plant materials made from an appropriate mixture of cryogenically ground samples with cellulose as the binding agent. The development of a specific PLSR model for each analyte and the selection of spectral regions containing only lines of the analyte of interest were the best conditions for the analysis. In this particular application, these models showed a similar performance. but PLSR seemed to be more robust due to a lower occurrence of outliers in comparison to the univariate method. Data suggests that efforts dealing with sample presentation and fitness of standards for LIBS analysis must be done in order to fulfill the boundary conditions for matrix independent development and validation. (C) 2009 Elsevier B.V. All rights reserved.

A History of Eating in Sao Paulo (1920 to 1950)

This paper proposes a way to analyze the history of eating in Sao Paulo (Brazil) between 1920 and 1950. It addresses the relative absence of research on this topic for this period characterized by the rapid expansion of the city, which became a key market, an important regulator of consumption habits, and a meeting place for diverse social groups. An abundance of sources makes it possible to undertake a social history of eating. On the one hand, intellectuals of different backgrounds and interests produced a good deal of work on popular food habits. On the other, the article points to the possibility of using lifestyle studies and surveys on eating habits from this period in order to gain insight into the lives of different sectors of the population.

Quantitative Trait Loci Mapping and The Genetic Basis of Heterosis in Maize and Rice

Despite its importance to agriculture, the genetic basis of heterosis is still not well understood. The main competing hypotheses include dominance, overdominance, and epistasis. NC design III is an experimental design that. has been used for estimating the average degree of dominance of quantitative trait 106 (QTL) and also for studying heterosis. In this study, we first develop a multiple-interval mapping (MIM) model for design III that provides a platform to estimate the number, genomic positions, augmented additive and dominance effects, and epistatic interactions of QTL. The model can be used for parents with any generation of selling. We apply the method to two data sets, one for maize and one for rice. Our results show that heterosis in maize is mainly due to dominant gene action, although overdominance of individual QTL could not completely be ruled out due to the mapping resolution and limitations of NC design III. For rice, the estimated QTL dominant effects could not explain the observed heterosis. There is evidence that additive X additive epistatic effects of QTL could be the main cause for the heterosis in rice. The difference in the genetic basis of heterosis seems to be related to open or self pollination of the two species. The MIM model for NC design III is implemented in Windows QTL Cartographer, a freely distributed software.

Pedagogical work and the 'cult of the body': Considering the role of HPE in the context of the 'new public health'

Physical education, now often explicitly identified with health in contemporary school curricula, continues to be implicated in the (re)production of the 'cult of the body'. We argue that HPE is a form of health promotion that attempts to 'make' healthy citizens of young people in the context of the 'risk society'. In our view there is still work to be done in understanding how and why physical education (as HPE) continues to be implicated in the reproduction of values associated with the cult of body. We are keen to understand why HPE continues to be ineffective in helping young people gain some measure of analytic and embodied 'distance' from the problematic aspects of the cult of the body. This paper offers an analysis of this enduring issue by using some contemporary analytic discourses including 'governmentality', 'risk society' and the 'new public health'.

Behavior and interactions of children in cooperative groups in lower and middle elementary grades

The study investigated the behaviors and interactions of children in structured and unstructured groups as they worked together on a 6-week social studies activity each term for 3 school terms. Two hundred and twelve children in Grade 1 and 184 children in Grade 3 participated in the study. Stratified random assignment occurred so that each gender-balanced group consisted of 1 high-, 2 medium-, and 1 low-ability student. The results show that the children in the structured groups were consistently more cooperative and they provided more elaborated and nonelaborated help than did their peers in the unstructured groups. The children in the structured groups in Grade 3 obtained higher reading and learning outcome scores than their peers in the unstructured groups.