Décès pendant une simulation médicale : perspectives des apprenants et impacts sur le stress et la performance des réanimateurs

L’acceptabilité d’un décès lors d’une simulation médicale reste débattue mais il existe peu de données sur la perspective des apprenants. Des médecins résidents ont effectué une pratique de code et ont rempli un questionnaire pré et post-simulation. Ils ont été exposés à deux scénarios où un bébé naissait sans signe de vie: 1. Nouveau-né ne répondant pas aux manœuvres de réanimation (DCD); 2. Nouveau-né s’améliorant avec une réanimation adéquate (REA). Les performances étaient évaluées à l’aide de la grille standardisée du Programme de Réanimation Néonatale. Le stress objectif (cortisol salivaire) et subjectif a été mesuré après le code. La rétroaction («feedback»), individuelle et en groupe, fut analysée à l’aide de méthodologies qualitatives. 59/62 apprenants ont répondu au questionnaire et 42 ont participé à la simulation. Tous les résidents trouvent les simulations bénéfiques et souhaitent y être exposés davantage. Le type et l’ordre des scénarios n’ont pas eu d’impact sur la performance. Un seul résident a interrompu les manœuvres de réanimation après 10 minutes d’asystolie, tel que recommandé, et 31% ont poursuivi après 20 minutes. Les participants trouvaient le scénario DCD plus stressant. Les niveaux de cortisol salivaire ont augmenté après les simulations (p<0.001) et ce, pour les deux scénarios. Cette augmentation était indépendante du scénario (p=0.06) et n’était pas associée à la performance. Les réponses à la question « Comment a été votre expérience? », ont permis d’identifier deux thèmes: 1. Le mannequin ne meurt pas en simulation médicale; 2. Le décès lors de la simulation signifie une réanimation inadéquate. Le décès lors d’une pratique de code est stressant, mais n’interfère pas avec la performance des soignants. Les apprenants trouvent cet exercice acceptable et bénéfique à leur pratique future.

Élaboration d’un modèle de gestion de risques pour le transfert des technologies médicales dans le nouveau bâtiment du projet de modernisation au CHU Sainte-Justine.

Rapport de stage présenté à la Faculté de médecine en vue de l'obtention du grade de Maître ès sciences appliquées (M.Sc.A.) en génie biomédical, option génie clinique.

Stabilité temporelle du Thermomètre de détresse et de l'Échelle d'évaluation des symptômes d'Edmonton-révisée chez des parents de survivants d'une tumeur pédiatrique

Essai doctoral présenté à la Faculté des arts et des sciences en vue de l’obtention du grade de Docteur en psychologie, option psychologie clinique (D.Psy.)

Étude des liens entre l’orientation mentale paternelle et le développement des manifestations morales à l’âge préscolaire

Essai présenté à la Faculté des arts et des sciences en vue de l’obtention du doctorat en psychologie (D.Psy.)

Interregional migration 'wage premia': the case of creative and science and technology graduates in the UK

We analyze the migration behavior of graduates from UK universities with a focus on the salary benefits they receive from the migration process. We focus on sequential interregional migration and specifically examine the case of Science, Technology, Engineering and Mathematics (STEM) and Creative subject graduates. Our analysis differs from previous studies in that it accounts explicitly for migrant selectivity through propensity score matching, and it also classifies graduates into different migration behavior categories. Graduates were classified according to their sequential migration behavior first from their pre-university domicile to university and then from university to first job post-graduation. Our results show that ‘repeat migration’, as expected, is associated with the highest wage premium (around 15%). Other migration behaviors are also advantageous although this varies across different types of graduates. Creative graduates, for instance, do not benefit much from migration behaviors other than repeat migration. STEM graduates, on the contrary, benefit from both late migration and staying in the university area to work.

Conflicts of law and the mutual recognition of same-sex unions in the EU

My thesis uses legal arguments to demonstrate a requirement for recognition of same-sex marriages and registered partnerships between EU Member States. I draw on the US experience, where arguments for recognition of marriages void in some states previously arose in relation to interracial marriages. I show how there the issue of recognition today depends on conflicts of law and its interface with US constitutional freedoms against discrimination. I introduce the themes of the importance of domicile, the role of the public policy exception, vested rights, and relevant US constitutional freedoms. Recognition in the EU also depends on managing the tension between private international law and freedoms guaranteed by higher norms, in this case the EU Treaties and the European Convention on Human Rights. I set out the inconsistencies between various private international law systems and the problems this creates. Other difficulties are caused by the use of nationality as a connecting factor to determine personal capacity, and the overuse of the public policy exception. I argue that EU Law can constrain the use of conflicts law or public policy by any Member State where these are used to deny effect to same-sex unions validly formed elsewhere. I address the fact that family law falls only partly within Union competence, that existing EU Directives have had limited success at achieving full equality and that powers to implement new measures have not been used to their full potential. However, Treaty provisions outlawing discrimination on grounds of nationality can be interpreted so as to require recognition in many cases. Treaty citizenship rights can also be interpreted favourably to mandate recognition, once private international law is itself recognised as an obstacle to free movement. Finally, evolving interpretations of the European Convention on Human Rights may also support claims for cross-border recognition of existing relationships.

Survival, Population Size, and Gonotrophic Cycle Duration of Nyssomyia neivai (Diptera: Psychodidae) at an Endemic Area of American Cutaneous Leishmaniasis in Southeastern Brazil

The survival, absolute population size, gonotrophic cycle duration, and temporal and spatial abundance of Nyssomyia neivai (Pinto) were studied in a rural area endemic for American cutaneous leishmaniasis (ACL) in Conchal, Sao Paulo State, southeastern Brazil, using mark-release-recapture techniques and by monitoring population fluctuation. The monthly abundance exhibited a unimodal pattern, with forest and domicile habitats having the highest relative abundances. A total of 1,873 males and 3,557 females were marked and released during the six experiments, of which 4.1-13.0% of males and 4.1-11.8% of females were recaptured. Daily survivorship estimated from the decline in recaptures per day was 0.681 for males and 0.667 for females. Gonotrophic cycle duration was estimated to be 4.0 d. Absolute population size was calculated using the Lincoln Index and ranged from 861 to 4,612 males and from 2,187 to 19,739 females. The low proportion of females that reach the age when they are potentially infective suggests that N. neivai has a low biological capacity to serve as a vector and that factors such as high biting rates and opportunistic feeding behavior would be needed to enable Leishmania (Viannia) braziliensis Vianna transmission. This agreed with the epidemiological pattern of ACL in southeastern Brazil that is characterized by low incidence, with isolated cases acquired principally within domiciliary habitats.

Medicines and other Resources Utilized in Order to Cope Infants Diseases in the Family Daily Life: a qualitative study

Medicines and other Resources Utilized in Order to Cope Infants Diseases in the Family Daily Life: a qualitative study. The study proposes to investigate the use of medications, medicinal plants and other therapeutic resources to cope infants diseases in the domestic realm in an urban area. The ethnographic research method was utilized as referential, guiding the study for 10 months with 20 fortnight meetings in the domicile of 15 families. The study followed up 180 episodes of disease, 74,5% were treated, in a first instance, at home, resulting in the use of 212 therapeutic resources. The main type of therapeutic resource utilized was industrialized medicines, differing considerably from its clinic recommendations. The realm of the health services was more mobilized as a second treatment option. In the community realm, treatment of diseases known from the popular culture was performed via blessings and prayers. The families use medicines as cultural practices and the acceptance of some type of treatment depends on the expectations and experiences of the family.

Programa PNAD: uma construção científica

Estudo sobre o processo de revisão dos parâmetros conceituais e metodológicos norteadores da Pesquisa Nacional por Amostra de Domicilios - PNAD, da Fundação Instituto Brasileiro de Geografia e Estatistica IBGE, abrangendo o periodo de 1989 a 1992. Objetiva-se mostrar o processo de produção estatistica, bem como compreender as relações entre objeto, teoria e método em investigações voltadas para a mensuração do real. A luz de reflexões sobre a construção do conhecimento cientifico e o papel do método no processo de pesquisa, discute-se a especificidade do método estatistico. Os resultados indicam que o processo de construção da PNAD se afirma como um fazer cientifico.

Acesso aos serviços odontológicos e incidência de cárie em adolescentes e fatores de risco em município do Nordeste Brasileiro, 2006

The aims of this study were to analyze the access of dental services by child population, to determine the prevalence of dental caries, gingivitis and malocclusion in resident children from the municipal district of Sobral Ceará and to evaluate the incidence of the dental decay in adolescents associated with the factors related to socioeconomic condition, access to health services and self-perception. This study had as main factor the multidisciplinary represented by the participation of health professional (doctors, dentists, nurses) in the development of the survey's initial reference; student from Human Sciences area to apply the structured questionnaire in domiciliary visits; statistics professionals in the orientation of the analysis to be held and family health team (community health agents, dentists and dental clinic assistants) in the scheduling of domiciliary visits and the accomplishment of oral exam. The sample was determined from the domicile record that included children born between 1990 and 1994 to develop the research Children health conditions in the municipal district of Sobral Ceará . The first sample comprised 3425 parents of children from 5 to 9 years old, living in the urban area at the municipal district of Sobral Ceará, aiming at identifying the most important factors associated to the access to dental service. From this sample, 1021 children were selected in a systematic way, for the accomplishment to the epidemiological study of decay, gingivitis and malocclusion. In the study's third phase, in order to arrange the group to be followed, 688 adolescents were examined and interviewed, by means of the active search from the 1021 individuals that had been previously examined. It was observed that 50.9% of the children had access to dental service at least once in a lifetime. Of this total, 65.3% accomplished it during the last year, and 85.4% of these did in public services, what allows to identify the importance of this sector in the access to dental services. It was observed that the factors that most affected the access to dental 129 services were related to socioeconomic condition, such as the access to health plan, the possession of toothbrush, garbage collecting, mother s schooling, sewerage treatment and malnutrition. In relation to oral diseases, an increase in the DMF-T index according the age was observed, from 0.10 in five years old to 1.66 in the nine years old, while with the dmf-t index, the inverse happened, since the index decreased from 3.59 in five years old to 2.69 in nine years old. In relation to gingivitis, an average 32.7% of the children presented gum bleeding. In what concerns malocclusion, it was observed that 60.3% of the children didn't present any problem, 30.17% had light malocclusion and 9.5% severe malocclusion. The average incidence of dental caries was 1.86 teeth per youngster. Among the studied variables, tooth pain in the last six months, mother's income and school snack, adjusted by the perception about the need of treatment, the mother's schooling and the dentist's appointment at least once in a lifetime, were the variables that presented positive relationship with the high incidence of dental caries on this population by logistic regression. Variables of socioeconomic nature, related to the access to health services and behavior and biological variables presented a relationship with the high caries incidence. The study point out to the need of developing health actions in a humanized way, by an oral health team effectively bound to the population's interest, with the great objective to provide, with the public health services managers, adequate conditions to improve oral health

Esquizofrenia: intervenção em Instituição Pública de Saúde

Les premiers concepts de schizophrénie comprenaient des définitions non-spécifiques sur le trouble schizophrénique. Ce n est qu en 1980 que Crow a proposé la classification la plus connue pour ce trouble: la distinction en soustypes I et II, de symptomatologie positive ou négative, les symptômes du syndrome positif correspondant aux hallucinations et aux délires et ceux du syndrome négatif au repli affectif et à la pauvreté du discours. Bien que la thérapie médicamenteuse présente des avancées dans le traitement de la maladie, la psychothérapie est la plus indiquée pour remédier aux préjudices sociaux et interpersonnels que celle-ci provoque. L objectif de cette étude est de relater une intervention comportementale, dans un Centre de Soins Psychosocial, auprès d une patiente de 19 ans, en utilisant des Exercices de Réadaptation Psychosociale (SAT) en tant que la possibilité de traitement de la schizophrénie. Ce processus a contribué à une réduction du stéréotype de la maladie chez la jeune patiente, considérant qu elle a élargi son répertoire social et a rendu possible des avancées dans les sphères psychologique, sociale et professionnelle.

Algoritmo treansgenético na solução do problema do Caixeiro Viajante

The Traveling Purchaser Problem is a variant of the Traveling Salesman Problem, where there is a set of markets and a set of products. Each product is available on a subset of markets and its unit cost depends on the market where it is available. The objective is to buy all the products, departing and returning to a domicile, at the least possible cost defined as the summation of the weights of the edges in the tour and the cost paid to acquire the products. A Transgenetic Algorithm, an evolutionary algorithm with basis on endosymbiosis, is applied to the Capacited and Uncapacited versions of this problem. Evolution in Transgenetic Algorithms is simulated with the interaction and information sharing between populations of individuals from distinct species. The computational results show that this is a very effective approach for the TPP regarding solution quality and runtime. Seventeen and nine new best results are presented for instances of the capacited and uncapacited versions, respectively

Características do apoio social oferecido a idosos de área rural assistida pelo PSF

Trata-se de um trabalho epidemiológico do tipo transversal, com o objetivo de descrever as características do apoio social e identificar associações entre as variáveis sociodemográficas e categorias de suporte social, em população rural do Bairro dos Aleixos, no município de Taquarituba ­ SP. Para medir o apoio social, utilizou-se da escala Medical Outcomes Study (MOS), traduzida para o português e validada em nosso meio. A população caracterizou-se por mulheres, predominantemente da raça branca, entre 60 a 69 anos, casadas e/ou vivendo em concubinatos, de baixa renda e residindo em domicílios multigeracionais. Escores de apoio médios elevados foram identificados, indicando situação favorável entre os idosos estudados. em termos médios, a categoria de apoio com pior escore foi interação social positiva. A análise bivariada demonstrou uma diferença significativa entre escore de apoio afetivo e de apoio emocional com número de pessoas no domicílio e maior freqüência de escores altos de interação social (3º tercil) em idosos do sexo masculino e naqueles com maior grau de escolaridade. O estudo apontou ainda que escores de apoio social menores foram mais freqüentes em mulheres, analfabetos, viúvos ou solteiros, idosos com renda entre um e dois salários mínimos.

Sobre pedras, entre rios: modernização do espaço urbano de Caicó/RN (1950/1960)

thèse de maîtrise, qui a été idealizée et exécutée à partir de la réunion et les relations dialogiques établies entre la géographie et l'histoire, et l'espace et le temps, a considéré l'environnement urbain comme le thème général et, comme la référence empirique, l'espace urbain de Caicó, incrusté dans les terres semi-arides du Sertão do Seridó Potiguar, plus précisément à la mi-sud de l'État du Rio Grande do Norte. Dans cet espace, à travers de recherche des fragments de mémoires acquis de diverses sources historiques, on a tenté de faire des investigations sur les transformations urbaines qui ont eu lieu dans la ville au cours des années 50 et 60 du XXe siècle. Ces transformations, dans l espace urbain de Caicó à un moment du pic de l'activité de développement de coton, reflétaient et conditionnaient les propres projets de modernization urbaine qui représentants des élites locales eurent conçu avec l'objectif de la construction d une ville idéal dans les regions isolées du Seridó: moderne, civilisé, progressive et capitale régionale du Seridó. Pour cette construction, les nouveaux équipements et services urbains ont passé du plan imaginaire à l espace réel, installés dans plusieurs quartiers de la ville en transformant le paysage urbain. Face à cette situation, cinémas, magasins, station de radio, énergie électrique, institutions de l'éducation, téléphonie, maison de soins infirmiers, usine de bénéficiement de coton, banques, politiques urbaines, hygiéniques et sanitaires, modes de comportement, sociabilités urbaines distincttes, parmi d'autres éléments géographiques se sont institués à travers la réalisation de certains idéaux de progrès social et dans un esprit de modernité urbaine, dans de nouveaux espaces et pratiques inventés, tramés et éprouvés sur les rochers et entre le cours d eau au milieu d'un quotidien urbain marqué par ruptures et permanence de certaines coutumes et habitudes antiques et de certains paysages et environnement ridé

A vilegiatura marítima e a urbanização em Tibau/RN

This research aims the analysis of the urbanization process that has taken place in the coastal city of Tibau/RN in the period comprising 1980-2012, due to the (re) production of space to consumption of leisure and recreation, through the so called practice of Maritime Villeggiatura. Such practice exists so that people settle temporarily on the beach as a second home, interfering in the Regulation of the land use as well as in the urban planning of Tibau, promoting urbanization based in the logic of leisure, with enormous capacity for appropriation and space consumption. The practice of Maritime Villeggiatura in Tibau began in the late nineteenth century, becoming more relevant in the 1980s, when the practice became fashionable for the citizens of Mossoró City, in view of their economic strength, and consumption power to invest in this type of domicile. Tibau has become a great depository of second homes for leisure practice, which contributed even to the city administrative and political emancipation in 1997. The intensification of Real Estate activities, expanding second homes along the coast, results in the urbanization of Tibau territory with the assistance of Local Government, whom was interested in entering Tibau on the State tourism routes. The used methodology comprised literature review, data collection and local observation. Questionnaires were applied in the form of interviews to the villeggiaturistas, local residents, business and trade services local companies, a local agricultural firm named Agricultura Famosa Ltda., Municipal government and the Association of Senior Citizens of the municipality of Tibau. A photographic record was made to visualize the urbanization evolution of Tibau. It has also been taken georeference measures of the area object of study in this research, in order to analyze the use and occupation of the territory by urban and social agents villeggiaturistas and residents. The conclusion is that the urbanization process that has been taken in Tibau occurred along the coast shore, with low population density, and therefore creating difficulties to governance of the Municipal government. Real Estate Sector has been promoting the value increase of urban land in order to fragment the space with private condominiums segregating local resident population to outlying areas of the city, away from the coastline and lacking infrastructure and basic urban services