Aspectos psicossociais associados à percepção da dor pós-operatória em indivíduos submetidos a cirurgia coronária

Objectivo: Identificar os factores psicossociais que influenciam a percepção da dor pós-operatória em doentes submetidos a cirurgia de revascularização do miocárdio (CRM). Material e Métodos: Estudo exploratório correlacional de 91 doentes (71 homens e 20 mulheres) submetidos a CRM (pontagem aortocoronária) por esternotomia). A idade média era de 63,8 ± 9,6 anos (entre 39 e 84). Foram utilizados os seguintes instrumentos: Escala Analógica Visual às 24, 48 e 96 horas do pós-operatório; Questionário de Caracterização Demográfica; Mental Health Inventory de 5 itens; Percepção de Saúde Geral (SF-36); Escala de Expectativas de Dor; Escala de Percepção de Apoio; Escala de Expectativas de Auto-eficácia; Satisfação com o tratamento, médicos e enfermeiros (American Pain Society Questionnaire) aplicados às 96 horas após a cirurgia. Resultados: Os doentes que apresentaram expectativas elevadas de dor, percepcionaram maior apoio, apresentaram níveis elevados de auto-eficácia para lidar com a dor ou, se pertenciam ao sexo masculino, sentiram menos dor. De igual modo, os doentes que apresentaram melhor saúde mental, percepcionaram a sua saúde como boa e os doentes que expressaram maior satisfação com o tratamento sentiram menos dor. A dor não foi influenciada pela idade, grau de escolaridade ou pela satisfação com a conduta de médicos e enfermeiros. Conclusão: Após as primeiras 48 horas do pós-operatório, a experiência de dor é influenciada por factores psicossociais, em oarticular pela expectativa de dor, expectativa de auto-eficácia, apoio percebido, percepção da saúde geral, percepção de saúde mental e satisfação com o tratamento para a dor. Perante os resultados, evidencia-se a necessidade de conjugar conhecimentos no sentido de dar respostas mais alargadas e de carácter multidisciplinar no tratamento da dor pós-operatória em CRM devendo, a par de outros aspectos, focar-se na gestão das expectativas dos doentes. ABSTRACT - Objective: To identify the psychological factors that influence post-surgery pain perception in patients undergoing coronary artery bypass graft surgery (CABG). Methods: This was an exploratory correlational study of 91 patients (71 men and 20 women) who underwent CABG (aortocoronary anastomosis) by sternotomy. Mean age was 63.8 ± 9.6 years (between 39 and 84). The following instruments were used: visual analogical scales at 24, 48 and 96 hours of post-surgery; demographic characteristics survey; pain expectations scale; perceived support scale; self-efficacy scale, Mental Inventory (5 items); health perception scale; and satisfaction with treatment, doctors and nurses (American Pain Society questionnaire) at 96 hours after surgery. Results: Patients who had presented high expectations of pain, perceived more support, presented high levels of self-efficacy to deal with pain or were male, felt less pain. Furthermore, patients who presented better mental health, perceived their general health as being good, or expressed greater satisfaction with treatment, felt less pain. Pain was not influenced by age, level of education or satisfaction with doctors and nurses. Conclusion: After the first 48 hours following surgery, the pain experience is influenced by psychosocial factors, in particular by expectation of pain and of self-efficacy, perceived support, perception of general and mental health, and satisfaction with pain treatment. The results confirm the need to bring together different kinds of knowledge for a broad, multidisciplinary approach to postoperative CABG pain treatment, focusing, along with other aspects, on management of patients’ expectations.

Seasonal variation of total particulate matter and children respiratory diseases at Lisbon primary schools using passive methods

In this work, 14 primary schools of Lisbon city, Portugal, followed a questionnaire of the ISAAC - International Study of Asthma and Allergies in Childhood Program, in 2009/2010. The questionnaire contained questions to identify children with respiratory diseases (wheeze, asthma and rhinitis). Total particulate matter (TPM) was passively collected inside two classrooms of each of 14 primary schools. Two types of filter matrices were used to collect TPM: Millipore (IsoporeTM) polycarbonate and quartz. Three campaigns were selected for the measurement of TPM: Spring, Autumn and Winter. The highest difference between the two types of filters is that the mass of collected particles was higher in quartz filters than in polycarbonate filters, even if their correlation is excellent. The highest TPM depositions occurred between October 2009 and March 2010, when related with rhinitis proportion. Rhinitis was found to be related to TPM when the data were grouped seasonally and averaged for all the schools. For the data of 2006/2007, the seasonal variation was found to be related to outdoor particle deposition (below 10 μm).

A inclusão de alunos com necessidades educativas especiais no 2º ciclo do ensino básico: o papel da educação visual e tecnológica

O presente estudo incide sobre a inclusão de alunos com necessidades educativas especiais em turmas regulares do 2º ciclo do ensino básico e teve como orientação principal compreender qual o contributo da Educação Visual e Tecnológica no processo de inclusão de alunos com necessidades educativas especiais. O estudo, de carácter exploratório e descritivo, foi realizado em duas escolas, integradas em agrupamentos verticais, pertencentes a dois concelhos do distrito de Lisboa. Em cada uma das unidades de ensino, participaram cinco professores de Educação Visual e Tecnológica com experiência em turmas inclusivas e um professor de Educação Especial. No presente estudo, foram efectuadas 12 entrevistas semi-estruturadas e foram analisados, nas duas unidades de ensino, 35 PEI de alunos com NEE, incluídos nas turmas ou em clubes orientados pelos professores de Educação Visual e Tecnológica entrevistados. Relativamente aos PEI, analisaram-se ainda as respectivas adequações curriculares e Currículos Específicos Individuais, elaborados para a disciplina. Em síntese, podemos concluir que os professores de EVT aceitam a inclusão dos alunos com necessidades educativas especiais, nas duas escolas abrangidas no estudo. A nível dos objectivos e conteúdos, os professores de EVT afirmam não sentir necessidade de efectuar adequações curriculares para estes alunos. No entanto, consideram necessárias adequações a nível da diferenciação de actividades e recursos. Perante os resultados do estudo é possível perceber que nas duas escolas existem diferenças no atendimento às necessidades educativas especiais, nomeadamente no que concerne aos alunos com CEI. Em geral, os professores de EVT entrevistados consideram que a disciplina de EVT e as artes plásticas podem ser promotoras da inclusão.

The development of a scale to measure concepts of schizophrenia: experience among Brazilian psychiatrists

INTRODUCTION: Among psychiatric disorders schizophrenia is often said to be the condition with the most disputed definition.The Bleulerian and Schneiderian approaches have given rise to diagnostic formulations that have varied with time and place. Controversies over the concept of schizophrenia were examined within European/North American settings in the early 1970s but little has since been reported on the views of psychiatrists in developing countries. In Brazil both concepts are referred to in the literature. A scale was developed to measure adherence to Bleulerian and Schneiderian concepts among psychiatrists working in S. Paulo. METHODOLOGY: A self-reported questionnaire comprising seventeen visual analogue-scale statements related to Bleulerian and Schneiderian definitions of Shizophrenia, plus sociodemographic and training characteristics, was distributed to a non-randomised sample of 150 psychiatrists. The two sub-scales were assessed by psychometric methods for internal consistency, sub-scale structure and test-retest reliability. Items selected according to internal consistency were examined by a two-factor model exploratory factor analysis. Intraclass correlation coefficients described the stability of the scale. RESULTS: Replies were received from 117 psychiatrists (mean age 36 (SD 7.9)), 74% of whom were made and 26% female. The Schneiderian scale showed better overall internal consistency than the Bleulerian scale. Intra-class correlation coefficients for test-retest comparisons were between 0.5 and 0.7 for Schneiderian items and 0.2 and 0.7 for Bleulerian items. There was no negative association between Bleulerian and Schneiderian scale scores, suggesting that respondents may hold both concepts. Place of training was significantly associated with the respondent's opinion; disagreement with a Bleulerian standpoint predominated for those trained at the University of S. Paulo. CONCLUSIONS: The less satisfactory reliability for the Bleulerian sub-scale limits confidence in the whole scale but on the other hand this questionnaire contributes to the understanding of the controversy over Bleulerian and Schneiderian models for conceptualisation of schizophrenia, the former requiring more inference and therefore being prone to unreliability.

Epidemiological methods for research with drug misusers: review of methods for studying prevalence and morbidity

Epidemiological studies of drug misusers have until recently relied on two main forms of sampling: probability and convenience. The former has been used when the aim was simply to estimate the prevalence of the condition and the latter when in depth studies of the characteristics, profiles and behaviour of drug users were required, but each method has its limitations. Probability samples become impracticable when the prevalence of the condition is very low, less than 0.5% for example, or when the condition being studied is a clandestine activity such as illicit drug use. When stratified random samples are used, it may be difficult to obtain a truly representative sample, depending on the quality of the information used to develop the stratification strategy. The main limitation of studies using convenience samples is that the results cannot be generalised to the whole population of drug users due to selection bias and a lack of information concerning the sampling frame. New methods have been developed which aim to overcome some of these difficulties, for example, social network analysis, snowball sampling, capture-recapture techniques, privileged access interviewer method and contact tracing. All these methods have been applied to the study of drug misuse. The various methods are described and examples of their use given, drawn from both the Brazilian and international drug misuse literature.

Evaluation of a program to reduce back pain in nursing personnel

OBJECTIVE: To evaluate the effectiveness of a program designed to reduce back pain in nursing aides. METHODS: Female nursing aides from a university hospital who had suffered episodes of back pain for at least six months were included in the study. Participants were randomly divided into a control group and an intervention group. The intervention program involved a set of exercises and an educational component stressing the ergonomic aspect, administered twice a week during working hours for four months. All subjects answered a structured questionnaire and the intensity of pain was assessed before and after the program using a visual analogue scale (VAS). Student's t-test or the Wilcoxon Rank Sum Test for independent samples, and Chi-square test or the Exact Fisher test for categorical analysis, were used. The McNemar test and the Wilcoxon matched pairs test were used to compare the periods before and after the program. RESULTS: There was a statistically significant decrease in the frequency of cervical pain in the last two months and in the last seven days in the intervention group. There was also a reduction in cervical pain intensity in the two periods (2 months, 7 days) and lumbar pain intensity in the last 7 days. CONCLUSIONS: The results suggest that a program of regular exercise with an emphasis on ergonomics can reduce musculoskeletal symptoms in nursing personnel.

Children visual screening protocol: validation by a focus group panel of experts

Screening programs, particularly the inclusion of specific orthoptic tests to detect visual abnormalities, varies among countries. This study aims to: 1) describes expert perception of issues related with children visual screening; 2) identify specific orthoptic tests to detect visual abnormalities in children visual screening.

Structural and Microanalytical Studies of CrO2 Thin Films on c-Sapphire by High Resolution Electron Microscopy Methods

Chromium dioxide (CrO2) has been extensively used in the magnetic recording industry. However, it is its ferromagnetic half-metallic nature that has more recently attracted much attention, primarily for the development of spintronic devices. CrO2 is the only stoichiometric binary oxide theoretically predicted to be fully spin polarized at the Fermi level. It presents a Curie temperature of ∼ 396 K, i.e. well above room temperature, and a magnetic moment of 2 mB per formula unit. However an antiferromagnetic native insulating layer of Cr2O3 is always present on the CrO2 surface which enhances the CrO2 magnetoresistance and might be used as a barrier in magnetic tunnel junctions.

Visual Screening Competencies Questionnaire (VSCQ) and orthoptic practice

The identification of core competencies which are important for undertaking accurate visual screening by orthoptists is considered in this study. The aim was to construct and validate a questionnaire for orthoptists to assess visual screening competency. This study comprised three steps. The first step involved a 69-item self-assessment questionnaire constructed to assess orthoptists' perception of their competencies in visual screening programs for children. This questionnaire was constructed with statements from the Orthoptic Benchmark Statement for Health Care Programmes (Quality Assurance Agency for Higher Education, UK) and included three competency dimensions: interpersonal (IP), instrumental (IT) and systemic (ST). The second step involved questionnaire translation.

PHYLOViZ: phylogenetic inference and data visualization for sequence based typing methods

Background: With the decrease of DNA sequencing costs, sequence-based typing methods are rapidly becoming the gold standard for epidemiological surveillance. These methods provide reproducible and comparable results needed for a global scale bacterial population analysis, while retaining their usefulness for local epidemiological surveys. Online databases that collect the generated allelic profiles and associated epidemiological data are available but this wealth of data remains underused and are frequently poorly annotated since no user-friendly tool exists to analyze and explore it. Results: PHYLOViZ is platform independent Java software that allows the integrated analysis of sequence-based typing methods, including SNP data generated from whole genome sequence approaches, and associated epidemiological data. goeBURST and its Minimum Spanning Tree expansion are used for visualizing the possible evolutionary relationships between isolates. The results can be displayed as an annotated graph overlaying the query results of any other epidemiological data available. Conclusions: PHYLOViZ is a user-friendly software that allows the combined analysis of multiple data sources for microbial epidemiological and population studies. It is freely available at http://www.phyloviz.net.

Participação ocupacional do idoso com deficiência visual: sua percepção

O estudo apresentado visava responder às necessidades emergentes de justificação da intervenção da Terapia Ocupacional na população idosa com deficiência visual. Teve como objectivo explorar as perspectivas dos idosos com deficiência visual na experiência que têm da sua participação ocupacional. Paralelamente a este objectivo procurou-se, também, conhecer as atitudes e comportamentos em relação ao apoio da Terapia Ocupacional. Para estudar estas questões utilizou-se uma metodologia qualitativa, a fenomenologia, que permitiu descrever fielmente a experiência que se pretendia conhecer. A recolha de dados foi feita através de duas sessões de focus groups distintas, onde num dos grupos participaram idosos com deficiência visual que tiveram apoio de Terapia Ocupacional e no outro idosos com deficiência visual que não usufruíram deste apoio. Após a análise do conteúdo resultante dos focus groups emergiram os seguintes temas: impacto da deficiência visual, onde foram englobadas as categorias de implicações psicossociais da deficiência visual e restrições nas actividades e ocupações do idoso com deficiência visual; o segundo tema onde se incluíram as categorias de apoio e atitudes sociais, instituições e recursos acessíveis e estratégias utilizadas; por fim o tema dos benefícios percebidos, do qual fazem parte as categorias, benefícios psicológicos e participação. Estes temas permitiram perceber as perspectivas de participação ocupacional do idoso, após o aparecimento da deficiência visual, bem como conhecer as melhorias ao nível dessa participação após intervenção especializada, destacando-se a relevância da intervenção do terapeuta ocupacional na população idosa com deficiência visual.

Integrated vehicle classification system

This paper presents an integrated system for vehicle classification. This system aims to classify vehicles using different approaches: 1) based on the height of the first axle and_the number of axles; 2) based on volumetric measurements and; 3) based on features extracted from the captured image of the vehicle. The system uses a laser sensor for measurements and a set of image analysis algorithms to compute some visual features. By combining different classification methods, it is shown that the system improves its accuracy and robustness, enabling its usage in more difficult environments satisfying the proposed requirements established by the Portuguese motorway contractor BRISA.

Typical load profiles in the smart grid context – a clustering methods comparison

The present research paper presents five different clustering methods to identify typical load profiles of medium voltage (MV) electricity consumers. These methods are intended to be used in a smart grid environment to extract useful knowledge about customer’s behaviour. The obtained knowledge can be used to support a decision tool, not only for utilities but also for consumers. Load profiles can be used by the utilities to identify the aspects that cause system load peaks and enable the development of specific contracts with their customers. The framework presented throughout the paper consists in several steps, namely the pre-processing data phase, clustering algorithms application and the evaluation of the quality of the partition, which is supported by cluster validity indices. The process ends with the analysis of the discovered knowledge. To validate the proposed framework, a case study with a real database of 208 MV consumers is used.