Avaliação da função pulmonar em obesos mórbidos com sonolência diurna excessiva

Background: Obesity impairment to the pulmonary function related to the magnitude of adiposity and is associated with excessive daytime sleepiness (EDS) and snoring, among others symptoms of respiratory disorders related to sleep. It is possible that obese individuals with excessive daytime sleepiness may make changes in lung function on spirometry monitored during the day as a consequence of fragmented sleep or episodes of nocturnal hypoventilation that cause respiratory and changes that can persist throughout the day. The combination of these findings alone sleepiness observed by subjective scales with pulmonary function in obese patients is unknown. Objective: To assess the influence of EDS and snoring on pulmonary function in morbidly obese and distinguish between different anthropometric markers, the snoring and sleepiness which the best predictors of spirometric function and respiratory muscle strength and endurance of these patients. Methods: We evaluated 40 morbidly obese markers on the anthropometric, spirometric respiratory variables, maximal inspiratory and expiratory pressures (MIP and MEP) and maximal voluntary ventilation (MVV) and the measured excessive daytime sleepiness (the Epworth sleepiness scale) and snoring (snoring scale of Stanford). The data were treated when the differences between the groups of obese patients with and without sleepiness, whereas the anthropometric variables, respiratory and snoring. Pearson's correlation was performed, and multiple regression analysis assessed the predictors of pulmonary function. For this we used the software SPSS 15.0 for windows and p <0.05. Results: 39 obese patients were included (28 women), age 36.92+11.97y, body mass index (BMI) 49.3+5.1kg/m², waist-hip ratio (WHR) 0.96+0.07 and neck circumference (NC) 44.1+4.2 cm. Spirometric values and respiratory pressures were up 80% of predicted values, except for endurance (MVV <80%). Obese with EDS have lower tidal volume. Positive correlation was observed between BMI and EDS, EDS and NC and between snoring and BMI, and negative correlation between EDS and tidal volume (TV), and between snoring and snoring FVC and FEV1. In linear regression the best predictor of pulmonary function was snoring, followed by NC. NC has more obese with higher strength (MEP, p = 0.031) and endurance (MVV p = 0.018) respiratory muscle. Conclusion: Obese with EDS tend to have lower TV. In addition, snoring and NC can better predict pulmonary function in obese when compared with other anthropometric markers or EDS. Obese patients with higher NC tend to have greater capacity for overall strength of respiratory muscles, but may have low muscle endurance

Funcionalidade em pacientes após acidente vascular encefálico: relação com o sono e ritmo de atividade-repouso

It is known that sleep plays an important role in the process of motor learning. Recent studies have shown that the presence of sleep between training a motor task and retention test promotes a learning task so than the presence of only awake between training and testing. These findings also have been reported in stroke patients, however, there are few studies that investigate the results of this relationship on the functionality itself in this population. The objective of this study was to evaluate the relationship between functionality and sleep in patients in the chronic stage of stroke. A cross-sectional observational study was conducted. The sample was composed of 30 stroke individuals in chronic phase, between 6 and 60 months after injury and aged between 55 and 75 years. The volunteers were initially evaluated for clinical data of disease and personal history, severity of stroke, through the National Institute of Health Stroke Scale, and mental status, the Mini-Mental State Examination. Sleep assessment tools were Pittsburgh Sleep Quality Index, the Questionnaire of Horne and Ostberg, Epworth Sleepiness Scale, the Berlin questionnaire and actigraphy, which measures were: real time of sleep, waking after sleep onset, percentage of waking after sleep onset, sleep efficiency, sleep latency, sleep fragmentation index, mean activity score. Other actigraphy measures were intraday variability, stability interdiária, a 5-hour period with minimum level of activity (L5) and 10-hour period with maximum activity (M10), obtained to evaluate the activity-rest rhythm. The Functional Independence Measure (FIM) and the Berg Balance Scale (BBS) were the instruments used to evaluate the functional status of participants. The Spearman correlation coefficient and comparison tests (Student's t and Mann-Whitney) were used to analyze the relationship of sleep assessment tools and rest-activity rhythm to measures of functional assessment. The SPSS 16.0 was used for analysis, adopting a significance level of 5%. The main results observed were a negative correlation between sleepiness and balance and a negative correlation between the level of activity (M10) and sleep fragmentation. No measurement of sleep or rhythm was associated with functional independence measure. These findings suggest that there may be an association between sleepiness and xii balance in patients in the chronic stage of stroke, and that obtaining a higher level of activity may be associated with a better sleep pattern and rhythm more stable and less fragmented. Future studies should evaluate the cause-effect relationship between these parameters

Controle circadiano e homeostático do sono-virgília em pacientes com acidente vascular encefálico e correlações com a qualidade de vida e o nível de atividade física

The cerebral vascular accident is a neurological dysfunction of vascular origin that leds to development of motor sensibility, cognitive, perceptive and language deficits. Despite the fact that the main sleep disorders in stroke patients are well known, it is still necessary to analyze which mechanisms of regulation of sleep and wakefulness are affected. The objective of this study was to evaluate the changes in the circadian and homeostatic control of sleep-wakefulness in stroke patients and the correlations with quality of life and level of physical activity. The study analyzed 22 stroke patients (55± 12 years old) and 24 healthy subjects (57 ±11 years old). The instruments used in this study were questionnaires on sleep quality, daytime sleepiness, quality of life, physical activity level and the actigraphy. The data were analyzed using the Student `t test, Mann-Whitney test, ANOVA and Spearman's correlation tests. The results showed stability in the sleep-wake circadian expression with changes in the amplitude of the rhythm. However, significant changes were found related to the homeostatic component characterized by increased sleep duration, increased latency, fragmented sleep and lower sleep efficiency. Additional data showed decreased quality of sleep and increased daytime sleepiness, as well as decreased quality of life and level of physical activity. The results indicate that the interaction of circadian and homeostatic control of sleep-wake is compromised and the main reason might be because of the homeostatic component and the lower activity level resulting from the brain damage. Thus, further studies may be developed to evaluate whether behavioral interventions such as increased daytime activity and restriction of sleep during the day can influence the homeostatic process and its relation to circadian component, resulting in improved quality of nocturnal sleep in stroke patients

Dinâmica reprodutiva e parasitária de quatro espécies de peixes das águas costeiras do Sudoeste do Oceano Atlântico, Brasil

The present study investigated the reproductive dynamics and parasitism of four species of marine fishes: serra Spanish mackerel, Scomberomorus brasiliensis, Atlantic leatherjacks, Oligoplites saurus and O. palometa,, and Atlantic bumper, C. chrysurus, during the period of August, 2005 to July, 2007, in the coastal waters of Southwest Atlantic Ocean, Brazil. The collected fish samples were measured, weighed, dissected, the gonads were weighed and examined to separate the sex. The gonadosomatic index (GSI), fecundity, type of spawning, the breeding season, the macro and microscopic characterization of the gonads were determined. The ectoparasites from the branchial chambers and bucal cavity of the fish were collected, measured, weighed and identified. The sex ratio of the study fish species were approximately 1M:1F, however, there was a predominance of males of O. palometa (3M:2F). The GSI of fishes varied according to their reproductive cycle and the stage of gonadal maturation. The highest values of GSI and the spawning period coincided with the rainy period of the region. The females presented total spawning and the fecundity was positively correlated with the weight of the ovary and the body. Four stages of development of the gonads immature, maturing, mature and spent were identified macroscopically and histological analyses of ovaries revealed the different phases of oocyte development. Three species of isopod parasites were identified in the study fishes: Livoneca redmmanni, Rocinela signata and Cimothoa spinipalpa. The first two species occurred in the branchial cavities of C. chrysurus and S. brasiliensis. The isopod C.spinipalpa (a new species) was registered for the first time in the bucal cavity of O. saurus and O. palometa. The parasitic isopods preferred the branchial chambers and the bucal cavity of the host fishes as these were protected microhabitats. The isopods parasitized the immature, maturing and mature fishes. The prevalence of infection of isopods in the hosts varied from 16 to 21%, though in O. palometa it was 60%. In the rainy period the highest isopod parasitic occurrence was registered, however, this did not prejudice the normal reproductive cycle of the host fish.

Ecologia comportamental de tropidurus Hispidus e Tropidurus Semitaeniatus (Squamata, Tropiduridae) em Simpatria, em área de caatinga do nordeste do Brasil.

This study evaluated the spatial, time and alimentary niches of Tropidurus hispidus and Tropidurus semitaeniatus in sympatry in a caatinga of Rio Grande do Norte, Brazil, as well as their foraging and termoregulatory behaviors, the activity body temperature and their reproductive and fat body cycles. Monthly excursions, from October 2006 to May 2008, were conducted at the Ecological Station of the Seridó (ESEC Seridó), Serra Negra do Norte municipality, using specific methodology for investigation of the aforementioned objectives. The two species presented similarities in space niche use, mainly in rocky habitat, however they differed in vertical microhabitat use with T. hispidus using a larger vertical microhabitat range. In the dry season the time of activity of both species was bimodal. In the wet season T. semitaeniatus showed a unimodal activity period, while T. hispidus maintained an bimodal activity period. In terms of importance in the diet, to both species, Hymenoptera/Formicidae and Isoptera predominated during the dry season. In the wet season, although Hymenoptera/Formicidae had larger importance among the prey items, lizards opportunistically predated on Lepidoptera larvae, Coleoptera larvae/adults and Orthoptera nymphs/adults. The foraging intensity revealed differences between the species, mainly in the wet season, when T. semitaeniatus was more active than T. hispidus. The mean activity body temperature of T. semitaeniatus was significantly higher than that of T. hispidus. The thermoregulatory behavior showed that during the dry season T. hispidus and T. semitaeniatus spent more time in shade or under filtered sun. In the wet season, T. hispidus did not show differences in the amount of time spent among the light exposure locations, however T. semitaeniatus spent most of their time exposed to direct sun or filtered sun. The reproductive cicle of T. hispidus and T. semitaeniatus occurred from the middle of the dry season to the beginning of the wet season. In both species, female reproductive activity was influenced by precipitation, whereas males exhibited spermatozoa in their testes throughout the year, and their reproductive activity was not related with any of the climatic variables analysed. In the two species, the fat storage varied inversely with reproductive activity, and there was no difference in fat body mass between females and males. We concluded that the segregation between T. hispidus and T. semitaeniatus in this caatinga area occurs in vertical space use, in the largest vagility of T. hispidus in microhabitat use and larger range size of their alimentary xviii items. Additionally, significant seasonal differences in relation to the activity period, body temperature, and foraging and termoregulatory behaviors between these two Tropidurus species facilitate their coexistence.

Uso de ferramentas por macacos-prego em manguezais

The present study discusses the geographical distribution and the context on the occupation of mangrove swamp areas by capuchin monkeys. In addition, we assess how the dispersion to the mangrove allowed the exploration of different food items, permitting the development of predation by ambush and the use of cracking tools. From 2004 to 2008 we surveyed the main estuaries of Brazilian Amazon coast, from northeastern state of Pará to the eastern boundary of the state of Maranhão, and recorded the presence of two species of capuchin monkeys in the mangrove forest areas. Cebus apella has been widely distributed in the mangrove at the estuaries examined (excluding C. libidinosus areas). Its presence is often related to Amazon forest remnants in the neighbourhood of the mangrove swamps and thus it is possible that some groups live in both kinds of habitats. However, we recorded some populations restricted only to mangrove swamp surrounded by open areas. On the other hand, Cebus libidinosus had a distribution more restricted and isolated in mangroves. Its pattern of habitat use is consistent with geographic distribution in mangrove patches. It seems that the possible contact zone previously proposed in the literature for that two species has no evident barriers in the mangrove. Furthermore, we record cracking sites and systematic observations on the tool use, carnivory and predation by ambush in Cebus libidinosus from 2006 to 2008. Cebus libidinosus is the only Neotropical primate species in which the tool use has been systematically recorded in nature. However all previous studies had been obtained is open areas (Cerrado and Caatinga). Thus, the present study is first one to report that behaviour in forested habitats in which the tool use to cracking by capuchin monkeys is associated with the consumption of meat. In the Caatinga and Cerrado, food shortages and terrestriality has been proposed by different authors to explain the evolution of tool use in primates. Here, we analyzed the relative contribution of these two variables as selective pressures for the tool use by capuchin monkeys in the mangrove forests, an ecological scenario in which food resources is available around the year and terrestriality is limited by structural habitat features, as the presence of stilt roots and muddy soil

Estudo da organização funcional do sistema circadiano por meio de ferramentas computacionais e matemáticas

Circadian rhythms are variations in physiological processes that help living beings to adapt to environmental cycles. These rhythms are generated and are synchronized to the dark light cycle through the suprachiasmatic nucleus. The integrity of circadian rhythmicity has great implication on human health. Currently it is known that disturbances in circadian rhythms are related to some problems of today such as obesity, propensity for certain types of cancer and mental disorders for example. The circadian rhythmicity can be studied through experiments with animal models and in humans directly. In this work we use computational models to gather experimental results from the literature and explain the results of our laboratory. Another focus of this study was to analyze data rhythms of activity and rest obtained experimentally. Here we made a review on the use of variables used to analyze these data and finally propose an update on how to calculate these variables. Our models were able to reproduce the main experimental results in the literature and provided explanations for the results of experiments performed in our laboratory. The new variables used to analyze the rhythm of activity and rest in humans were more efficient to describe the fragmentation and synchronization of this rhythm. Therefore, the work contributed improving existing tools for the study of circadian rhythms in mammals

Uso de habitat, orçamento temporal e influência da maré da geomorfologia do fundo sobre o comportamento do boto Sotalia guianensis Van Bénéden, 1864 (Cetacea: Delphinidae) no Porto de Maceió - Alagoas, Brasil

The physical and environmental factors presented by each habitat and the rhythm of behavior patterns strongly influence the ecology and behavior of the all living beings. At same time this factors may provide clues about the structure of a population and its ecological balance. The organizational structure, ecology and behavior of a species appraised in a region if we know be in balance when compared to the same type of appraisal made in a degraded area can provide a clear view of how the anthropogenic influences acted on these species and what steps can be taken in order to mitigate the effects and keep the population. The region where this study was conducted is, like most areas of port, subject to intense physical and environmental degradation. With the emerging interest of change in the quality of these environments also by the companies themselves that use the port services, the proposed study aimed to characterize the use of habitat, the distribution of behavioral activities carried out throughout the day and influence of geomorphology of the bed, depth and variation of tide on the expression of the behavior of Sotalia guianensis in the port of Maceio - Alagoas. From this information will be possible establish parameters for comparison with other populations of S. guianensis and establish conservation measures for the population occurring in the port of Maceio - AL, serving also as a basis for conservation actions future performed in other port regions

As políticas sociais na formação graduada do psicólogo no Piauí: análise curricular dos cursos

This research aimed to investigate the place of social policies in Psychology undergraduate programs from Piauí/Brazil. A documental study was done by analysing the Projeto Pedagógico de Curso (PPC) from five universities. Also, interviews were conducted, for each program, with a coordinator and a professor who teaches subjects related to social policies. The main results indicates that the Psychology undergraduate programs in Piauí are recent, created between the late 1990s and early 2000s, when professionals in this area were in demand. The social policies appear in PPC related to student profile; curricula emphasis, subjects and internships; albeit in a peripheral condition. Furthermore, disconnection between proposed profile and the curriculum; fragmentation and insufficient content about social policies; and predominance of clinical area were perceived in these institutions. It is noteworthy that health policies stand out in PPC while social assistance policy or other social policies were poorly mentioned. Therefore, the place of social policies must be reviewed in Psychology undergraduate programs from Piauí in order to include other social policies and improve the subjects articulation, assuming a central, critical and policy perspective

Práticas educativas e integralidade na saúde da família: um estudo etnográfico

Primary Health Care, especially in the family health strategy, it is expected that the joint assistance and actions of health promotion. The Ministry of health (BRAZIL, 2007) defines health education as an eyeshadow strategy of prevention and health promotion, based on reflective practices, which allow the user to their condition of historical, social and political subject, under the vision of an expanded clinic on the part of health professionals. In this sense, there are guidelines for it professionals to develop educational activities and that they can interfere in the health/disease process of the population, with a view to the development of autonomy of the subject. This research had as objective to understand in the light of the integrality of the care, as is the production of health education practices, within the framework of the family health strategy from ethnographic study in a family health unit (USF). The location of the research was the unit of USF Felipe Camarão II in West Health District, in the city of Natal, RN, Brazil, selected from preliminary mapping of educational practices deployed in units of health of the family of this municipality, based on criteria such as time-to-deployment of USF and sustainability of existing actions. Immersion in the field consisted of participant observation with journaling, held during the period of August 2012 to January 2013, in which she accompanied team work processes in clinical-welfare actions on the USF, in households and in educational activities of group character. The results presented in ethnographic description were analyzed based on the axes proposed by Ayres (2009) for identification of integrality in health practices:the axis of the needs; the axis of the purposes; the joint axis; and the axis of the interactionsThe evidence described from observation point the presence of each axle up health education practices developed by the teams, even incipient form, namely: articulation and appreciation of knowledge and practices of popular culture with local initiatives (Pastoril do Peixe Boi Encantado, Auto de Natal e Grupo Terapia e Arte); Clinical integration with health promotion actions and coordination of multidisciplinary knowledge, with professional-user link (course for pregnant women). However, a few challenges were identified to be faced in order to move forward in these practices in integral care: the need to break with the fragmentation of actions; strengthening teamwork; need for greater sustainability policy of collective actions; intersectoral work aimed at a better role of the State in the face of the health-disease process, adding to the action of individuals.The analysis produced from observation of the processes experienced indicates the need for a better recognition of local managers that actions similar to those that occur in the USF Felipe Camarão II enable advances in completeness as allows inclusion of actors involved in the processes of health work, and stimulate participation and shared responsibility in the fight for health-disease situations

Trabalho e reestruturação produtiva no Brasil neoliberal: precarização do trabalho e redundância salarial

O objetivo do artigo é tratar das mutações sociais que ocorrem no mundo do trabalho a partir da era neoliberal no Brasil. Examina-se a precarização do trabalho como sendo elemento compositivo do novo metabolismo social que emerge com a reestruturação produtiva do capital e a constituição do Estado neoliberal. Apresenta-se como bases objetivas da precarização do trabalho, a intensificação (e ampliação) da exploração (e espoliação) da força de trabalho, o desmonte de coletivos de trabalho e de resistência sindical-corporativa; assim como a fragmentação social nas cidades em virtude do crescimento exacerbado do desemprego em massa.

Algorítmo evolucionário para a distribuição de produtos de petróleo por redes de polidutos

The distribution of petroleum products through pipeline networks is an important problem that arises in production planning of refineries. It consists in determining what will be done in each production stage given a time horizon, concerning the distribution of products from source nodes to demand nodes, passing through intermediate nodes. Constraints concerning storage limits, delivering time, sources availability, limits on sending or receiving, among others, have to be satisfied. This problem can be viewed as a biobjective problem that aims at minimizing the time needed to for transporting the set of packages through the network and the successive transmission of different products in the same pipe is called fragmentation. This work are developed three algorithms that are applied to this problem: the first algorithm is discrete and is based on Particle Swarm Optimization (PSO), with local search procedures and path-relinking proposed as velocity operators, the second and the third algorithms deal of two versions based on the Non-dominated Sorting Genetic Algorithm II (NSGA-II). The proposed algorithms are compared to other approaches for the same problem, in terms of the solution quality and computational time spent, so that the efficiency of the developed methods can be evaluated

Genética e biologia reprodutiva de vriesea minarum (Bromeliaceae): em busca de estratégias de conservação no quadrilátero ferrífero, minas gerais

Vriesea minarum is a rupiculous bromeliad species, with naturally fragmented populations, restricted to the Iron Quadrangle, Minas Gerais, Brazil. It is a threatened species, which is suffering from habitat loss due to the growth of cities and mining activities. The knowledge of genetic variability in plant populations is one of the main branches of conservation genetics, linking genetic data to conservation strategies while the knowledge about plant reproductive biology can aid in understanding key aspects of their life story, as well as in the comprehension of their distribution and survival strategies. Thus, the study of diversity, richness, and genetic structure, as well as the reproductive biology of populations of V. minarum can contribute to the development of conservation actions. Chapter 1 presents the transferability of 14 microsatellite loci for V. minarum. Among the results of this chapter, we highlight the successful transferability of 10 microsatellite loci described for other species of Bromeliaceae, all of which are polymorphic. In Chapter 2, we present the genetic analyses of 12 populations of V. minarum that are distributed throughout the Iron Quadrangle. We used the 10 microsatellite loci tested in Chapter 1. The results show a low population structuring (Fst = 0.088), but with different values of genetic richness (mean = 2.566) and gene diversity (mean = 0.635) for all populations; and a high inbreeding coefficient (Gis = 0.376). These may be the result of pollinators action and/or efficient seed dispersal, thus allowing a high connectivity among populations of naturally fragmented outcrops. The reproductive biology and floral morphology of a population of V. minarum, located in the Parque Estadual da Serra do Rola-Moça, are studied in Chapter 3. This reserve is the only public environmental protection area where the species occurs. As a result of field experiments and observations, we found that the species has its flowering period from January to March, with flowers that last for two days and that it has a mixed pollination syndrome. It is primarily alogamous, but also has the capacity to be self-ferilized. It is expected that data obtained in chapters 1, 2 and 3 serve as basis for other studies with species from the ferruginous rocky fields, since until now, to our knowledge, there are no other survey of endemic species from the Iron Quadrangle, seeking to merge the genetic knowledge, with the data of the reproductive biology, with the ultimate aim of biodiversity conservation. Considering the great habitat loss for the species by mining, it becomes crucial to analyze the creation of new protected areas for its conservation

Redesenho das configurações estruturais na gestão universitária: ações derivadas da inovação e flexibilidade na legislação pós-LDB 1996

This paper is set in a scenario in which higher education institutions suffer from external pressure to increase efficiency. The legislation after the Law of Directives and Bases for Education (LDBE), from 1996, is characterized by the fragmentation in its implementation, raising a concern with flexibility and innovation in several normative devices as well as aspects that must be incorporated to its organizational structure. The policies examined in this thesis are: Distance Education (DE); Law of Innovation and the Program of Support to Restructuring and Expansion of Federal Universities (PSREFU). This thesis aims to observe to what extent the characteristics of innovation and flexibility, which mark the new post- LDBE educational legislation, influence the organizational redesign of the Federal University of Ceará (UFC). For being about implementation policies, using contingency approach in order to collect the internal dynamics permeating the redesign of higher education institutions, the thesis focuses on the impacts caused by flexibility and innovation. This is a qualitative research, with case study methods, archive research and semi-structured interviews with members of the university administration. The results don t allow us to confirm the adoption of a more flexible and innovative configuration in the university but it is possible to identify the presence of those elements in the implementation changes, characterizing the hybrid structure. The changes mainly expose the extension of the management of projects to the administrative and academic components related to the institution. In terms of projection, the study found changes in the elements which characterize the current setting and the tendency of the university for adopting a diverse organizational structure. However, if the decentralization of management persists, the academic units may adopt their own structural solutions, but with no evidence of changes in the professional organization in most units. In this perspective, this thesis states that there are difficulties when incorporating innovation and flexibility to their organizational structure, which lead to improvised solutions, superposing skills through the redundancy of structures created with the same purpose or copying exogenous solutions

A ousadia como horizonte: religando vida e ideias na formação em enfermagem

A proposal of formation in health/nursing built on classic science, on reducing thought and flexnerian paradigm is insufficient to comprehend and intervening with an amplified way on health needs of population, given that it is produced by fragmentation of knowledge, rationalization of thought, mechanizing and biological attitudes. It is necessary that formation in health/nursing allows the construction of effectiveness of principles and guidelines of Unique System of Health (Sistema Único de Saúde - SUS). In this context of emergency of a complex formation in health/nursing, life trajectories and formation of the nurses: Abigail Moura, Francisca Valda and Raimunda Germano are examples of transgressor and successful experiences which allow inquietude, changing and transforming formation patterns and self-formation. The present study is built from the comprehension of method as strategy , defended by Morin and complexity sciences. Has as objects building biographies of formation of these three nurses who express a formation model more totalizing and humanitarian, analyzing and discussing starting from the three biographic fragments guiding principles for the current process of formation in health/nursing. From the biographies, the courage and humbleness emerge as landmarking principles of their experiences. Humbleness neither as self-depreciation nor humiliation but as consciousness of our uncompleted and unfinished essence, acceptance of boundaries and potential and reduction of intellectual vanity. Courage, for its part, is the human pulsing, uncertain for nature, which brings us to act, to face and persevere on moments of fear and difficulties. A formation in health and nursing based on courage and humbleness allows the subjects to be taken away from indifference, arrogance, inertia, pragmatism: bets on ethic and political subjects capable of minimizing unequal, inhumane and excluding processes. Na intellectual and Professional attitude which politizes the thought and science is what must be expected from a complex formation in health field, in latu mode on nursing, in particular