Lunch eating patterns during working hours and their social and work-related determinants : Study of Finnish employees

Work has a central role in the lives of big share of adult Finns and meals they eat during the workday comprise an important factor in their nutrition, health, and well-being. On workdays, lunch is mainly eaten at worksite canteens or, especially among women, as a packed meal in the workplace s break room. No national-level data is available on the nutritional quality of the meals served by canteens, although the Finnish Institute of Occupational Health laid out the first nutrition recommendations for worksite canteens in 1971. The aim of this study was to examine the contribution of various socio-demographic, socioeconomic, and work-related factors to the lunch eating patterns of Finnish employees during the working day and how lunch eating patterns influence dietary intake. Four different population-based cross-sectional datasets were used in this thesis. Three of the datasets were collected by the National Institute for Health and Welfare (Health Behaviour and Health among the Finnish Adult Population survey from 1979 to 2001, n=24746, and 2005 to 2007, n=5585, the National Findiet 2002 Study, n=261), and one of them by the Finnish Institute of Occupational Health (Work and Health in Finland survey from 1997, 2000, and 2003, n=6369). The Health Behaviour and Health among the Finnish Adult Population survey and the Work and Health in Finland survey are nationally representative studies that are conducted repeatedly. Survey information was collected by self-administered questionnaires, dietary recalls, and telephone interviews. The frequency of worksite canteen use has been quite stable for over two decades in Finland. A small decreasing trend can be seen in all socioeconomic groups. During the whole period studied, those with more years of education ate at worksite canteens more often than the others. The size of the workplace was the most important work-related determinant associated with the use of a worksite canteen. At small workplaces, other work-related determinants, like occupation, physical strain at work, and job control, were also associated with canteen use, whereas at bigger workplaces the associations were almost nonexistent. The major social determinants of worksite canteen availability were the education and occupational status of employees and the only work-related determinant was the size of the workplace. A worksite canteen was more commonly available to employees at larger workplaces and to those with the higher education and the higher occupational status. Even when the canteen was equally available to all employees, its use was nevertheless determined by occupational class and the place of residence, especially among female employees. Those with higher occupational status and those living in the Helsinki capital area ate in canteens more frequently than the others. Employees who ate at a worksite canteen consumed more vegetables and vegetable and fish dishes at lunch than did those who ate packed lunches. Also, the daily consumption of vegetables and the proportion of the daily users of vegetables were higher among those male employees who ate at a canteen. In conclusion, life possibilities, i.e. the availability of a canteen, education, occupational status, and work-related factors, played an important role in the choice of where to eat lunch among Finnish employees. The most basic prerequisite for eating in a canteen was availability, but there were also a number of underlying social determinants. Occupational status and the place of residence were the major structural factors behind individuals choices in their lunch eating patterns. To ensure the nutrition, health, and well-being of employees, employers should provide them with the option to have good quality meals during working hours. The availability of worksite canteens should be especially supported in lower socioeconomic groups. In addition, employees should be encouraged to have lunch at a worksite canteen when one is available by removing structural barriers to its use.

Pain measurement and management in elderly patients : Clinical studies in long term hospital care and after cardiac surgery

The proportion of patients over 75 years of age, receiving all different types of healthcare, is constantly increasing. The elderly undergo surgery and anaesthetic procedures more often than middle-aged patients. Poor pain management in the elderly is still an issue. Although the elderly consumes the greatest proportion of prescribed medicines in Western Europe, most clinical pharmacological studies have been performed in healthy volunteers or middle-aged patients. The aim of this study was to investigate pain measurement and management in cognitively impaired patients in long term hospital care and in cognitively normal elderly patients after cardiac surgery. This thesis incorporated 366 patients, including 86 home-dwelling or hospitalized elderly with chronic pain and 280 patients undergoing cardiac surgery with acute pain. The mean age of patients was 77 (SD ± 8) years and approximately 8400 pain measurements were performed with four pain scales: Verbal Rating Scale (VRS), the Visual Analogue Scale (VAS), the Red Wedge Scale (RWS), and the Facial Pain Scale (FPS). Cognitive function, depression, functional ability in daily life, postoperative sedation and postoperative confusion were assessed with MMSE, GDS, Barthel Index, RASS, and CAM-ICU, respectively. The effects and plasma concentrations of fentanyl and oxycodone were measured in elderly (≥ 75 years) and middle-aged patients (≤ 60 years) and the opioid-sparing effect of pregabalin was studied after cardiac surgery. The VRS pain scores after movement correlated with the Barthel Index. The VRS was most successful in the groups of demented patients (MMSE 17-23, 11-16 and ≤ 10) and in elderly patients on the first day after cardiac surgery. The elderly had a higher plasma concentration of fentanyl at the end of surgery than younger patients. The plasma concentrations of oxycodone were comparable between the groups. Pain intensity on the VRS was lower and the sedation scores were higher in the elderly. Total oxycodone consumption during five postoperative days was reduced by 48% and the CAM-ICU scores were higher on the first postoperative day in the pregabalin group. The incidence of postoperative pain during movement was lower in the pregabalin group three months after surgery. This investigation demonstrates that chronic pain did not seem to impair daily activities in home-dwelling Finnish elderly. The VRS appeared to be applicable for elderly patients with clear cognitive dysfunction (MMSE ≤17) and it was the most feasible pain scale for the early postoperative period after cardiac surgery. After cardiac surgery, plasma concentrations of fentanyl in elderly were elevated, although oxycodone concentrations were at similar level compared to middle-aged patients. The elderly had less pain and were more sedated after doses of oxycodone. Therefore, particular attention must be given to individual dosing of the opioids in elderly surgical patients, who often need a smaller amount for adequate analgesia than middle-aged patients. The administration of pregabalin reduced postoperative oxycodone consumption after cardiac surgery. Pregabalin-treated patients had less confusion, and additionally to less postoperative pain on the first postoperative day and during movement at three months post-surgery. Pregabalin might be a new alternative as analgesic for acute postoperative and chronic pain management in the elderly. Its clinical role and safety remains to be verified in large-scale randomized and controlled studies. In the future, many clinical trials in the older category of patients will be needed to facilitate improvements in health care methods.

Artificial intelligence approaches to network management: recent advances and a survey

With increased number of new services and users being added to the communication network, management of such networks becomes crucial to provide assured quality of service. Finding skilled managers is often a problem. To alleviate this problem and also to provide assistance to the available network managers, network management has to be automated. Many attempts have been made in this direction and it is a promising area of interest to researchers in both academia and industry. In this paper, a review of the management complexities in present day networks and artificial intelligence approaches to network management are presented. Published by Elsevier Science B.V.

Broughton Archipelago Clam Terrace Survey : final report

During a 1995 aerial video survey of the coastline of Johnstone Strait, an unusual shoreline feature was noted and termed “clam terraces” (inset) because of the terrace-type morphology and the apparent association with high clam productivity on the sandflats. Typical alongshore lengths of the terrace ridges are 20-50m, and across-shore widths are typically 20-40m. An area with an especially high density of clam terraces was noted in the Broughton Archipelago, between Broughton and Gilford Islands of southeastern Queen Charlotte Strait. Clam terraces in this area were inventoried from the aerial video imagery to quantify their distribution. The terraces accounted for over 14 km of shoreline and 365 clam terraces were documented. A three-day field survey by a coastal geomorphologist, archeologist and marine biologist was conducted to document the features and determine their origin. Nine clam terraces were surveyed. The field observations confirmed that: the ridges are comprised of boulder/cobblesized material, ridge crests are typically in the range of 1-1.5m above chart datum, sandflats are comprised almost entirely of shell fragments (barnacles and clams) and sandflats have very high shellfish production. There are an abundance of shell middens in the area (over 175) suggesting that the shellfish associated with the terraces were an important food source of aboriginal peoples. The origin of the ridges is unknown; they appear to be a relict feature in that they are not actively being modified by present-day processes. The ridges may be a relict sea-ice feature, although the mechanics of ridge formation is uncertain. Sand accumulates behind the ridge because the supply rate of the shell fragments exceeds the dispersal rate in these low energy environments. The high density areas of clam terraces correspond to high density areas of shell middens, and it is probable that the clam terraces were subjected to some degree of modification by aboriginal shellfish gatherers over the thousands of years of occupation in the region. (Document contains 39 pages)

Interim report on the progress of an inventory of artesian wells in Florida: leading to the enforcement of sections 370.051 - 370.54, Florida statues

One of the causes of lower artesian pressure, water waste and aquifer contamination is the misuse and insufficient care of artesian wells. In 1953, Senate Bill No. 57, entitled "An Act to Protect and Control the Artesian Waters of the State" (see Appendix) became a law. This law was passed through the efforts exerted by leading members of the Senate and the House of Representatives, who understood the need for a wise and controlled expenditure of our most valuable natural resource. The State Geologist and his authorized representatives were designated by this law to enforce this conservation measure; however, no financial provision was included for the 1953-55 biennium. The proposed program of the Florida Geological Survey for this biennium did not include the funds nor provide any full-time personnel for the enforcement of this statute. As a result, little actual work was accomplished during these two years, although much time was given to planning and discussion of the problem. Realizing that this program could provide additional basic data needed in the analysis of the water-supply problem, the State Geologist sought and was granted by the 1955 Legislature adequate funds with which to activate the first phase of the enforcement of Florida Statute No. 370.051-054. Enumerated below is a summary of the progress made on this investigation as outlined previously: 1. Data have been collected on 967 wildly flowing wells in 22 counties. 2. Chloride determinations have been run on 850 of the 967 wells. 3. Of the 967 wells, 554 have chlorides in excess of the 250 ppm, the upper limit assigned by the State Board of Health for public consumption. 4. Water escapes at the rate of 37, 762 gallons per minute from these 967 wells. This amounts to 54, 377, 280 gallons per day. The investigation is incomplete at this time; therefore, no final conclusions can be reached. However, from data already collected, the following recommendations are proposed: 1. That the present inventory of wildly flowing wells be completed for the entire State. 2. That the current inventory of wildly flowing wells be expanded at the conclusion of the present inventory to include all flowing wells. 3. That a complete statewide inventory program be established and conducted in cooperation with the Ground Water Branchof the U.S. Geological Survey. 4. That the enforcement functions as set down in Sections 370.051/.054, Florida Statutes, be separated from the program to collect water-resource data and that these functions be given to the Water Resources Department, if such is created (to be recommended by the Water Resources Study Commission in a water policy law presented to the 1957 Legislature). 5. That the research phase (well inventory) of the program remain under the direction of the Florida Geological Survey. (PDF contains 204 pages.)

Studies of physical, chemical, and biological oceanography in the vicinity of the Revilla Gigedo Islands during the “Island Current Survey” of 1957

ENGLISH: The tendency of the tunas, especially the yellowfin (Neothunnus macropterus) to be more abundant in the near vicinity of islands and seamounts, or "banks", than in the surrounding oceanic areas, is well known to commercial fishermen. This has been confirmed by statistical analysis of fishing vessel logbook records, which demonstrates that the catch-per-day's-fishing is, indeed, higher in the near vicinity of these features. It is hypothesized that islands and seamounts cause changes in the physical circulation or the biochemical cycle resulting in greater supplies of food for tunas in their immediate environs. In order to examine this hypothesis, and in order to study possible mechanisms involved, the "Island Current Survey" was undertaken from 8 May to 12 June, 1957, under the joint auspices of the Inter-American Tropical Tuna Commission and the Scripps Institution of Oceanography. Surveys of varying nature and extent were made from M/V Spencer F. Baird near Alijos Rocks, Clarion Island, Shimada Bank and Socorro Island (Figure 1). These studies sought to provide knowledge of the action of islands and seamounts in arresting, stalling or deflecting the mean current past them, in establishing convergence and divergence in the surface flow, in producing vertical motion (mixing and upwelling), and in influencing the primary production and the standing crops of phytoplankton and zooplankton. Each survey is discussed below in detail. Observations made at a front on 10 June will be discussed in another paper. SPANISH: Los pescadores que realizan la pesca comercial conocen muy bien la tendencia de los atunes, en particular del atún aleta amarilla (Neothunnus macropterus), de presentarse en mayor abundancia en las cercanías inmediatas a las islas y cimas submarinas, o "bancos", que en las áreas oceánicas circundantes. Este hecho ha sido confirmado par el análisis estadístico de los registros de los cuadernos de bitácora de las embarcaciones pesqueras, demostrándose que la captura par dias de pesca es, en efecto, más abundante en la inmediata proximidad de tales formaciones. Hipotéticamente se admite que las islas y las cimas submarinas provocan cambios en la circulación física o en el ciclo bioquímico, lo cual se pone de manifiesto a través de un mejor abastecimiento de alimento para los atunes en sus cercanías inmediatas. Con la finalidad de verificar esta hipótesis y de estudiar los mecanismos que ella involucra, se realizó la “Island Current Survey” del 8 de mayo al 12 de junio de 1957, bajo los auspicios de la Comisión Interamericana del Atún Tropical y de la Institución Scripps de Oceanografia. Con el barco Spencer F. Baird se hicieron observaciones de distintas clases y alcances cerca de las Rocas Alijos, la Isla Clarion, el Banco Shimada y la Isla Socorro (Figura 1). Estos estudios tuvieron por objeto adquirir conocimientos sobre la acción que ejercen las islas y cimas submarinas sobre la corriente promedio, ya sea deteniéndola, reduciendo su velocidad o desviando su curso, así como estableciendo convergencia o divergencia en su flujo de superficie, o provocando un movimiento vertical (mezcla y afloramiento) e influyendo en la producción primaria y en las existencias de fitoplancton y zooplancton. Cada operación será tratada a continuación por separado. Las observaciones hechas el dia 10 de junio sobre un frente serán objeto de otra publicación.

The survey of Lake Victoria's fishers

The findings are presented of a survey conducted regarding the fishers of Lake Victoria, which examined the relationships affecting supply flows of raw material on to the market, and also the characteristics of fishing activities and their effects on fish quality and distribution. Fish marketing plays a vital role in the lives of much of the lake basin's population, both in terms of employment and nutrition. The results of the survey comprise, in part, a base-line data set which will facilitate further research, analysis and management decision-making in relation to stakeholders of the lake's resources. Data collection, methods and research difficulties encountered are described and details given of a profile of a boat owner/renter and aslo of a profile of a crew member. The survey shows that Lake Victoria's fishery is one of very limited diversity. The fishers recount that they consistently target one or more of the 3 most common species within the lake (Nile perch, tilapia and dagaa) and very rarely consider any other species type. The largest proportion of fishers on the lake are Nile perch fishers; there is considerable demand for this species, and hence fishers have little incentive to either target alternative fish species, not to try and establish firm marketing outlets through the creation of arrangements with their principal buyers. In Kenyan waters, however, the number of Nile perch fishers is equaled by the number of dagaa fishers; this fish now commands a considerable portion of the market for fish from Lake Victoria through its availability as well as its relatively low prices. The tilapia fishery is in decline, and all 3 riparian states would not appear to be attracting investment almost certainly as a result of declining catches. For many of those working in Lake Victoria's fishery, the problems faced appear most often to be associated with the vagaries of an unstable market which may rise or fall depending on the state of the international market or the state of access roads to fish landings. (PDF contains 42 pages)

The nutritional status of pre-school children, Kainji Lake communities, Nigeria: a baseline survey

This survey was carried out to provide the Kainji Lake Fisheries Promotion Project (KLFPP), whose overall goal is the improvement of the standard of living of fishing communities around Kainji Lake, Nigeria, and an increase in the availability of fish to consumers, with nutritional status baseline data for long-term monitoring and evaluation of the overall project goal. In a cross-sectional survey, baseline anthropometric data was collected from 768 children, aged 3-60 months in 389 fisherfolk households around the southern sector of Kainji Lake, Nigeria. In addition, data was collected on the nutritional status and fertility of the mothers, vaccination coverage of children and child survival indicators. For control purposes, 576 children and 292 mothers from non-fishing households around Kainji Lake were likewise covered by the survey. A standardised questionnaire was used to collect relevant information, while anthropometric measurements were made using appropriate equipment. Data compilation and analysis was carried out with DATAEASE registered and EPI-INFO registered software, using NCHS reference data for the analysis of anthropometric measurements. The prevalence of stunted children in fishing households was high at 40%, while the prevalence of wasted and underweight children was likewise high at 10% and 29% respectively. Children from non-fishing households had a marginally lower prevalence of stunting, wasting and underweight with 37%, 7% and 25 % respectively, although these differences were not statistically significant. Considering the fact that the survey was carried out during a period of relative food abundance, the prevalence of wasting and underweight children is likely to be much higher during periods of food shortage. The prevalence of stunting, wasting and underweight was relatively high for children aged 3 to 23 months, suggesting an increased risk of malnutrition during this period, most likely associated with inadequate weaning practices. The prevalence of malnourishment amongst women of child-bearing age was relatively high, irrespective of occupation of the household, with an average of 11% undernourished and 6% wasted. Vaccination coverage was very low while infant and child mortality were extremely high with about 1 in 5 children dying before their fifth birthday. Based on the ethical obligation to maximise the potential benefits of the survey, recommendations for activities to improve community nutrition and health were made for communication to relevant authorities. (PDF contains 52 pages)

National report of IFMP catch assessment survey (CAS) for August 2005

The first comprehensive CAS was carried out during the month of July 2005 This is the second report of CAS for the month of August 2005 following the July report. The design and methodology followed was the same as in July. This report highlights the results obtained in August catch assessment survey. The report gives estimates of mean catch rates in Kgs./boat/day, total catches in M.tons and values of the catch by species. The total catch for August was 31,633.0 M. tons. This is lower when compared with the July catch which was 39,745.1 M. tons. In August the catch composed of Dagaa (45%), Nile perch (33%), Haplochromines (16%), Tilapiines (5%) and all other species combined (1%). (PDF contains 14 pages)

Preparo e administração de medicamentos por sondas em pacientes que recebem nutrição enteral

O objeto de estudo foi o preparo e a administração de medicamentos por cateter pela enfermagem em pacientes que recebem nutrição enteral. O objetivo geral foi investigar o padrão de preparo e administração dos medicamentos por cateter em pacientes que recebem nutrição enteral concomitante. Os objetivos específicos foram apresentar o perfil dos medicamentos preparados e administrados de acordo com a possibilidade de serem administrados por cateter enteral e avaliar o tipo e a freqüência de erros que ocorrem no preparo e administração de medicamentos por cateter. Tratou-se de uma pesquisa com desenho transversal de natureza observacional, sem modelo de intervenção. Foi desenvolvida em um hospital do Rio de Janeiro onde foram observados técnicos de enfermagem preparando e administrando medicamentos por cateter na Unidade de Terapia Intensiva. Foram observadas 350 doses de medicamentos sendo preparados e administrados. Os grupos de medicamentos prevalentes foram os que agem no Sistema Cardiovascular Renal com 164 doses (46,80%), seguido pelos que agem no Sistema Respiratório e Sangue com 12,85% e 12,56% respectivamente. Foram encontrados 19 medicamentos diferentes do primeiro grupo, dois no segundo e cinco no terceiro. As categorias de erro no preparo foram trituração, diluição e misturas. Encontrou-se uma taxa média de 67,71% no preparo de medicamentos. Comprimidos simples foram preparados errados em 72,54% das doses, e todos os comprimidos revestidos e de liberação prolongada foram triturados indevidamente entre sólidos a categoria de erro prevalente foi trituração com 45,47%, preparar misturando medicamentos foi um erro encontrado em quase 40% das doses de medicamentos sólidos. A trituração insuficiente ocorreu em 73,33% das doses de ácido fólico, do cloridrato de amiodarona (58,97%) e bromoprida (50,00%). A mistura com outros medicamentos ocorreu em 66,66% das doses de bromoprida, de besilato de anlodipina (53,33%), bamifilina (43,47%), ácido fólico (40,00%) e ácido acetilsalicílico (33,33%). Os erros na administração foram ausência de pausa e manejo indevido do cateter. A taxa média de erros na administração foi de 32,64%, distribuídas entre 17,14% para pausa e 48,14% para manejo do cateter. A ausência de lavagem do cateter antes foi o erro mais comum e o mais incomum foi não lavar o cateter após a administração. Os medicamentos mais envolvidos em erros na administração foram: cloridrato de amiodarona (n=39), captopril (n=33), cloridrato de hidralazina (n=7), levotiroxina sódica (n=7). Com relação à lavagem dos cateteres antes, ela não ocorreu em 330 doses de medicamentos. O preparo e administração inadequados de medicamentos podem levar à perdas na biodisponibilidade, diminuição do nível sérico e riscos de intoxicações para o paciente. Preparar e administrar medicamentos são procedimentos comuns, porém apresentou altas taxas de erros, o que talvez reflita pouco conhecimento desses profissionais sobre as boas práticas da terapia medicamentosa. Constata-se a necessidade de maior investimento de todos os profissionais envolvidos, médicos, enfermeiros e farmacêuticos nas questões que envolvam a segurança com medicamentos assim como repensar o processo de trabalho da enfermagem.

Fatores associados ao aleitamento materno exclusivo em Juiz de Fora, MG

Este trabalho teve como objetivos identificar e analisar fatores associados ao aleitamento materno exclusivo, com significância estatística, em crianças menores de quatro meses residentes em Juiz de Fora, Minas Gerais. Fornece informações básicas para planejamento de política de amamentação neste município, estudando fatores influentes no desmame e criando Banco de Dados em Aleitamento Materno no Centro de Computação do Núcleo de Assessoria Técnica aos Estudos em Saúde da Universidade Federal de Juiz de Fora, disponível pára uso público. Compara os resultado desta pesquisa aos de outras cidades brasileiras com estudo de metodologia semelhante. Para atingir os objetivos propostos foi realizada pela autora desta tese uma pesquisa no período de 10 de agosto a 13 de setembro de 2002, época da campanha de vacinação na cidade, em uma amostra por conglomerado, tendo sido entrevistadas 1859 pessoas, sendo 625 mães e acompanhantes de crianças menores de 4 meses, em 24 postos de vacinação. A terminologia empregada deu-se de acordo com a recomendação da OMS (1991). Aplicou-se um questionário por intermédio de 268 entrevistadores voluntários, previamente treinados, incluindo estudantes da área de saúde. A pesquisa fez parte de um estudo multicêntrico em conjunto com o Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde da Universidade de São Paulo e do Núcleo de Investigação em Saúde da Mulher e da Criança, Instituto de Saúde, Secretaria Estadual de Saúde de São Paulo denominado Avaliação das práticas alimentares no primeiro ano de vida em dias nacionais de vacinação. A análise dos dados foi processada utilizando-se o programa Statiscal Package for The Social Sciences (SPSS) e os resultados foram descritos utilizando-se o teste do qui-quadrado para verificar a significância estatística da associação dos fatores independentes com o fator de desfecho aleitamento materno exclusivo. Para estudar possíveis fatores de confusão foi aplicada a técnica de análise de regressão logística. A pesquisa evidenciou que a prevalência de Aleitamento Materno Exclusivo aos 4 meses é baixa, sendo que esta é menor que as taxas da maioria das capitais brasileiras, com exceção de Cuiabá. Os hábitos de usar chupetas e mamadeiras são muito freqüentes no município. Os fatores de risco para interrupção do aleitamento materno exclusivo até os quatro meses encontrados foram: primiparidade, nascimento em hospital público ou público-privado, não disponibilidade para amamentar, uso de chupetas ou mamadeiras. A maioria das crianças inicia a amamentação no primeiro dia de vida em casa mas não de forma exclusiva. À medida que a idade aumenta, o índice de amamentação vai diminuindo progressivamente, indicando a necessidade urgente de programas de apoio e incentivo ao aleitamento materno, em especial de sua forma exclusiva, bem como de promoção do mesmo no município. Deve ser dada ênfase nesta atenção às mulheres primíparas e àquelas mulheres cujos partos ocorreram em hospitais públicos ou públicos-privados, que não tenham disponibilidade para amamentar e que utilizam mamadeiras ou chupetas para seus filhos.

Promoção de Segurança Alimentar e Nutricional na Estratégia Saúde da Família: uma aproximação a partir da escuta de diferentes atores sociais

A garantia de Segurança Alimentar e Nutricional (SAN) remete à necessidade de ações intersetoriais que articulem as dimensões alimentar e nutricional, além da questão contemporânea da sustentabilidade e da perspectiva do direito humano à alimentação adequada. O setor saúde tem funções específicas e importantes que contribuem para o conjunto das políticas de governo voltadas para a garantia da SAN a população. Desta forma, ações promotoras de SAN devem ser desenvolvidas em todos os níveis de atenção do Sistema Único de Saúde, sendo a Atenção Básica à Saúde, por meio da Estratégia Saúde da Família (ESF), um campo privilegiado de implementação dessas ações, uma vez que está configurada como a porta preferencial de entrada dos usuários no sistema de saúde e como o centro norteador da rede de assistência. Este é um estudo exploratório e descritivo de abordagem qualitativa que teve como objetivo conhecer o que profissionais de equipes de saúde da Família, gestores dos âmbitos federal e municipal ligados à ESF, além de representantes de organizações da sociedade civil atuantes no campo da SAN entendem sobre SAN e sobre práticas promotoras de SAN na ESF. A construção das informações ocorreu por meio de entrevistas semi-estruturadas e grupos focais. Os profissionais referiram-se a SAN como a garantia de uma alimentação que atenda às necessidades nutricionais e que seja segura para o consumo, enquanto que entre os representantes da sociedade civil organizada e gestores predominou uma compreensão mais ampla da SAN. Os diferentes atores identificaram a ESF com um espaço promotor de SAN a partir do levantamento de ações já desenvolvidas ou que possam vir a ser desenvolvidas, porém as ações citadas encontram-se majoritariamente ligadas à dimensão nutricional da SAN. Os atores referiram um conjunto de problemas estruturais que desencadeiam dificuldades no cotidiano da organização dos serviços e das práticas dos profissionais e consequentemente na execução de ações promotoras de SAN nessa estratégia. Este trabalho levantou a necessidade de difundir a interdependência entre saúde e SAN entre gestores e profissionais ligados à ESF para que estes possam identificar melhor nas ações dos serviços de saúde elementos promotores da SAN, e desta forma compreender seu papel de agentes promotores de saúde e SAN.

Day and night abundance, distribution, and activity patterns of demersal fishes on Heceta Bank, Oregon

Most shallow-dwelling tropical marine fishes exhibit different activity patterns during the day and night but show similar transition behavior among habitat sites despite the dissimilar assemblages of the species. However, changes in species abundance, distribution, and activity patterns have only rarely been examined in temperate deepwater habitats during the day and night, where day-to-night differences in light intensity are extremely slight. Direct-observation surveys were conducted over several depths and habitat types on Heceta Bank, the largest rocky bank off the Oregon coast. Day and night fish community composition, relative density, and activity levels were compared by using videotape footage from a remotely operated vehicle (ROV) operated along paired transects. Habitat-specific abundance and activity were determined for 31 taxa or groups. General patterns observed were similar to shallow temperate day and night studies, with an overall increase in the abundance and activity of fishes during the day than at night, particularly in shallower cobble, boulder, and rock ridge habitats. Smaller schooling rockfishes (Sebastes spp.) were more abundant and active in day than in night transects, and sharpchin (S. zacentrus) and harlequin (S. variegatus) rockfish were significantly more abundant in night transects. Most taxa, however, did not exhibit distinct diurnal or nocturnal activity patterns. Rosethorn rockfish (S. helvomaculatus) and hagfishes (Eptatretus spp.) showed the clearest diurnal and nocturnal activity patterns, respectively. Because day and night distributions and activity patterns in demersal fishes are likely to influence both catchability and observability in bottom trawl and direct-count in situ surveys, the patterns observed in the current study should be considered for survey design and interpretation.

Trajetórias educacionais de crianças com necessidades especiais no município do Rio de Janeiro

O estudo tem como tema os Percursos trilhados pelas famílias para a garantia do direito à educação de crianças com necessidades especiais. Este estudo surgiu pela demanda dos integrantes do Núcleo de Estudos da Infância: Pesquisa & Extensão (NEI:P&E/UERJ), coordenado pela Prof Dr Vera Vasconcellos, em compreender como ocorreu a trajetória de escolarização de crianças acompanhadas em dois estudos realizados em creches do município do Rio de Janeiro, em 2009, após a saída delas das referidas instituições. Os estudos foram: i) Crianças focais: a triangulação educação-família-saúde na creche, realizado em 2008 e 2009 na Creche Institucional Dr. Paulo Niemeyer; e ii) Infância, Educação e Inclusão: um estudo de caso, realizado em 2009 na Creche Municipal de Odetinha Vidal de Oliveira. A pesquisa atual tem como proposta um estudo de follow-up, onde demos continuidade às duas anteriores, a partir da análise do percurso de três (3) famílias (mãe) na tentativa de garantir uma educação inclusiva de qualidade para seus filhos. Inicialmente, foi realizado um levantamento bibliográfico e documental sobre o tema. Em seguida voltou-se às famílias das crianças com o objetivo de investigar de que modo à escolarização foi sendo propiciadas a estas crianças e como suas dificuldades de aprendizagem têm sido entendidas nos espaços educacionais que frequentam. Adotamos o Estudo de Caso como proposta metodológica. Foram realizadas duas entrevistas com as mães das crianças, respectivamente em 2012 e 2013 e solicitado que elas respondessem um questionário (Caracterização Familiar), que delineava o perfil das mesmas destacando suas características sóciodemograficas. Os dados produzidos foram sistematizados através da abordagem de Análise de Conteúdo por temáticas, com ênfase nas trajetórias das crianças e suas famílias em prol da garantia ao direito à Educação. A pesquisa conclui que as crianças do estudo não encontraram espaço no sistema regular de educação, público e/ou privado, em contraste ao que garante os documentos nacionais e municipais. As trajetórias e experiências foram repletas de inseguranças e expectativas negativas por parte das escolas quanto ao desenvolvimento e escolarização das crianças. Conclui também que não é suficiente conhecer os direitos à educação da criança com necessidades especiais, as instituições precisam reconhecer os familiares como parceiros privilegiados na construção de alternativas para a produção de conhecimentos das crianças com necessidades especiais. Os dados demonstraram a importância social das escolas especiais no atendimento especializado de crianças com necessidades especiais. Os lugares ocupados por essas instituições são reconhecido pelas famílias como fundamental rede de apoio e suporte às crianças e famílias no processo de educação e inclusão escolar.

Fatores de risco para infecções hospitalares em crianças críticas

O objetivo desta tese foi avaliar a influências da exposição a diversos fatores de risco e ocorrência de infecção hospitalar (IH) e examinar fatores de risco relacionados às pneumonias associadas ao uso de ventilador mecânico (PAV) em crianças críticas. Usamos os métodos de estudo prospectivo envolvendo uma coorte de 268 crianças menores de três anos, realizado em unidade de pacientes graves, de janeiro de 1997 e setembro de 2000. Aplicou-se técnica de regressão de Poisson para estimar razões de risco e estratégia de abordagem hierárquica para identificar fatores de risco associados à IH. Apenas para 179 crianças críticas que usaram ventilador mecânico, aplicou-se a regressão de Cox para estimar razões de risco e identificar fatores de risco associados à PAV. Os resultados apresentaram 74 infecções hospitalares diagnosticadas no total, com taxa de incidência de 48,1 IH por 1000 pacientes-dia. Foi determinante para ocorrência de infecção hospitalar, idade superior a dois anos (Razão de Risco) [RR]: 2,66; intervalo de confiança [IC]: 95%: 1,46-4,58), uso de sonda vesical (RR: 2,92; IC 95%: 1,47-5,80), uso de nutrição parenteral (RR: 1,90; IC 95%: 1,15-3,13), realização de broncoscopia (RR: 1,84; IC 95%: 1,03-3,27), tempo de exposição ao cateter vascular central (RR: 2,36; IC 95%: 1,18-4,71) e ao ventilador mecânico (RR: 1,72; IC 95%: 0,94-3,15). Observou-se PAV em 29 crianças (16,3%), com taxa de incidência de 29,3 casos por 1000 dias de ventilação mecânica (IC 95%: 20,34-42,11), dos quais 50% dos eventos ocorreram até o quinto dia de ventilação. A taxa de risco diária aumentou até um máximo de 2,3%, observada no 7 dia de ventilação, e reduziu a partir daí. Foram fatores de risco para PAV na análise multivariada hierarquizada, idade acima de 1 ano (RR: 3,49; IC 95%; 1,64-7,45), cirurgia do aparelho digestivo (RR: 5,05; IC 95%; 2,17-11,78) e nutrição parenteral (RR: 2,68; IC 95%: 1,24-5,8). /exposição a antibióticos antes da internação conferiu proteção (RR: 0,29; IC 95%: 0,13-0,66). Concluímos que os resultados encontrados neste estudo indicam que a influência do tempo de exposição é determinante para a ocorrência de infecções hospitalares e está associado aos processos de cuidados do paciente crítico. Políticas institucionais direcionadas ao controles e prevenção das IH devem fazer de estratégias fundamentais para a qualidade da assistência e segurança do paciente internado. Vigilância de Saúde Pública e componentes longitudinais de estudo de fatores de risco para infecções hospitalares e para pneumonias associadas ao ventilador podem ajudar avaliar prognósticos e planejar e testar medidas preventivas, concentrando-se esforços na primeira semana de ventilação.