Explicit evidence-based prescribing criteria - an important step in achieving quality therapeutics in nursing homes

Reaction between 5-(4-amino-2-thiabutyl)-5-methyl-3,7-dithianonane-1, 9-diamine (N3S3) and 5- methyl-2,2-bipyridine-5-carbaldehyde and subsequent reduction of the resulting imine with sodium borohydride results in a potentially ditopic ligand (L). Treatment of L with one equivalent of an iron( II) salt led to the monoprotonated complex [Fe(HL)](3+), isolated as the hexafluorophosphate salt. The presence of characteristic bands for the tris( bipyridyl) iron( II) chromophore in the UV/vis spectrum indicated that the iron( II) atom is coordinated octahedrally by the three bipyridyl (bipy) groups. The [Fe( bipy) 3] moiety encloses a cavity composed of the N3S3 portion of the ditopic ligand. The mononuclear and monomeric nature of the complex [Fe(HL)](3+) has been established also by accurate mass analysis. [Fe(HL)](3+) displays reduced stability to base compared with the complex [Fe(bipy)(3)](2+). In aqueous solution [Fe(HL)](3+) exhibits irreversible electrochemical behaviour with an oxidation wave ca. 60 mV to more positive potential than [Fe(bipy)(3)](2+). Investigations of the interaction of [Fe(L)](2+) with copper( II), iron( II), and mercury( II) using mass spectroscopic and potentiometric methods suggested that where complexation occurred, fewer than six of the N3S3 cavity donors were involved. The high affinity of the complex [Fe(L)](2+) for protons is one reason suggested to contribute to the reluctance to coordinate a second metal ion.

The efficacy of a psychosocial intervention for HIV/AIDS caregiving dyads and individual caregivers: a controlled treatment outcome study

The present study examined the comparative efficacy of intervening at the caregiver/care-recipient dyadic level, versus the individual caregiver level, for caregivers and their care-recipients with HIV/AIDS. Participants were randomly assigned to a Dyad Intervention (DI), a Caregiver Intervention (CI) or Wait List Control group (WLC), and assessed by interview and self-administered scales immediately before treatment and eight weeks later. Participants in the intervention groups also completed a four-month follow-up assessment. Dependent variables included global distress, social adjustment, dyadic adjustment, subjective health status, HIV/AIDS knowledge and target problem ratings. Results showed that caregivers in the DI group showed greater improvement from pre- to post-treatment on global distress, dyadic adjustment and target problems than the CI and WLC caregivers. The CI and DI caregivers showed greater improvement than the WLC group on all dependent variables except social adjustment. Care-recipients in the DI group improved significantly from pre- to post-treatment on dyadic adjustment, social adjustment, knowledge, subjective health status and Target Problem 1, whereas the CI and WLC care-recipients failed to improve on any of these measures. The treatment gains made by the DI caregivers and care-recipients on most dependent variables were maintained at a four-month follow-up. Findings support a reciprocal determinism approach to the process of dyadic adjustment and suggest that intervening at the caregiver/care-recipient level may produce better outcomes for both the caregiver and care-recipient than intervening at the individual caregiver level.

Behaviour of caregivers to protect their infants from exposure to the sun in Queensland, Australia.

Exposure to the sun by infants has been demonstrated to increase the risk of the development of melanoma and other skin cancers later in life. A cohort of 508 women who delivered healthy Caucasian babies were followed up at 1 year to determine their knowledge, attitudes and practices regarding sun protection towards themselves and their child. In addition, the 1-year-old infants were assessed by a trained nurse for the number of nevi they had on their skin. Results indicate caregivers reported a high level of sun-protection practices towards their child, with 93% of the caregivers reporting usually or always placing the child in the shade when going outside. Further, 81% of the caregivers reported usually or always placing a hat on the child, while 64% reported usually or always applying sunscreen to the child's exposed skin. Interestingly, only 61% of the caregivers reported that they stayed in the shade to reduce sun exposure and only 42% wore a hat when out in the sun. Mother's own personal sun-protection methods predicted the method of sun protection that she would most likely use for the child. While children appear to be reasonably protected from the sun, they are influenced by their mother's own behaviors.

Ambient assisted living technology: comparative perspectives of users and caregivers

Developed societies are currently facing severe demographic changes: the world population is ageing at an unprecedented rate. This demographic trend will be also followed by an increase of people with physical limitations. New challenges are being raised to the traditional health care systems, not only in Portugal, but also in all other European states. There is an urgent need to find solutions that allow extending the time people can live in their preferred environment by increasing their autonomy, self-confidence and mobility. AAL4ALL is a project currently being developed in cooperation with 34 Portuguese interdisciplinary partners, from industry to academia, R&D and social disciplines, which employs a novel conceptual approach through the development of an ecosystem of products and services for Ambient Assisted Living (AAL) associated to a business model and validated through large scale trial. This paper presents a comparative perspective of the needs and attitudes towards technology of the AAL users and caregivers identified in the analysis of a set of three different surveys: a users survey targeted at the Portuguese seniors and pre-seniors; an informal caregivers survey targeted at the family, friends and neighbours who provide care without any financial compensation; and a formal caregivers survey targeted at physicians, nurses,psychologists, social workers, and direct-care workers providing care to elders. The first results indicate that AAL solutions must be affordable,user friendly and have a true perceived benefit to their users.

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.

Impacto de um programa de relaxamento na percepção de stress nos cuidadores formais de um lar do concelho de Águeda

O papel de cuidador formal é, habitualmente, exercido por profissionais devidamente qualificados, designadamente, médicos, enfermeiros psicólogos, assistentes sociais, terapeutas ocupacionais, fisioterapeutas e auxiliares. A sua formação académica, profissional é específica para o desempenho deste papel, integrada no contexto de uma actividade profissional onde são exercidas competências, no âmbito da saúde. Nos lares, hospitais, instituições comunitárias, entre outros, existem indivíduos que se enquadram no perfil traçado, a actividade é desgastante, quer física, quer psicologicamente, o que muitas vezes facilita o aparecimento da ansiedade e a percepção do stress. O relaxamento enquanto técnica terapêutica poderá atenuar o seu surgimento. Este trabalho teve como objectivo avaliar o impacto de um programa de relaxamento, na percepção de stress, nos cuidadores formais do lar da Liga de Amigos de Aguada de Cima. Para este fim, consideramos adequado um estudo do tipo experimental. Assim aplicámos á nossa amostra, dezasseis funcionárias, antes e depois da aplicação do programa de relaxamento progressivo de Jacobson, questionários de auto-preenchimento, adaptados à população portuguesa. Para além disso, nas dezasseis sessões que efectuámos, medimos a tensão arterial e a frequência cardíaca com um esfigmomanómetro digital de pulso, no período antes e depois da implementação do programa. Pela análise dos resultados que obtivemos, constatámos que não houve diferenças significativas do ponto de vista estatístico, entre a ansiedade e a percepção do stress, após o programa de relaxamento Jacobson. Confirmámos porém, que existiram diferenças em alguns itens dos questionários após a implementação do programa de relaxamento, assim como uma diminuição da pressão arterial diastólica e da correlação positiva entre a ansiedade e a percepção de stress. Desta forma, parece existir uma indicação de que o programa de relaxamento progressivo de Jacobson talvez tenha contribuído para minimizar o nível de stress das funcionárias do lar da Liga de Amigos de Aguada de Cima

Quality of life of the caregivers of people with aphasia. A systematic review.

Purpose: Systematic review to identify the factors associated to the quality of life (QOL) of the caregivers of people with aphasia (PWA). Methods: Studies were searched using Medline, Pubmed, Cochrane Library, CINAHL, PsycINFO and Web of Science databases. Peer-reviewed papers that studied the QOL of PWA’s caregivers or the consequences of aphasia in caregivers’ life were included. Findings were extracted from the studies that met the inclusion criteria. Results: No data is available reporting particularly the QOL of PWA caregivers’ or their QOL predictors. Nevertheless, it was possible to extract aspects related to QOL from the studies that report the consequences of aphasia, and life changes in PWA’s caregivers. Nine (9) studies including PWA’s caregivers were found, but only 5 reported data separately on them. Methodological heterogeneity impedes cross-study comparisons, although some considerations can be made. PWA’s caregivers reported life changes such as: loss of freedom; social isolation; new responsibilities; anxiety; emotional loneliness; need for support and respite. Conclusions: Changes in social relationships, in emotional status, increased burden and need for support and respite were experienced by PWA’s caregivers. Stroke QOL studies need to include PWA caregivers’ and report separately on them. Further research is needed in this area in order to determine their QOL predictors and identify what interventions and referrals better suit their needs.

Spatial segregation of calving and nursing Risso's dolphins (Grampus griseus), and its conservation implications

"Conhecer o Mar dos Açores III - Fórum científico de apoio à decisão". Biblioteca Pública e Arquivo Regional João José da Graça, Horta, Faial, Açores, 19-20 de setembro de 2013.

Assessment of nursing students and nurses' orientation towards patient-centeredness

Background - Being patient centered is a core value for nursing. Patient centered-care has been related to patient and health provider satisfaction, better health outcomes, higher quality of care and more efficient health care delivery. Objectives - The purpose was to assess the orientation adopted by nurses and students in patient care, using The Patient-Practitioner Orientation Scale, as well as to compare the results between resident nurses and students from different academic years. Settings - Public School of Nursing and a Central Hospital, in Lisbon (Portugal). Participants - Students in the first, second and fourth year of nursing school and nurses participated in the study. Methods - For data collection, we used The Patient-Practitioner Orientation Scale (European Portuguese version), an instrument designed to measure individual preferences toward the dimension of caring a sharing in health professional-patient relationship. Students and nurses also filled out two additional questions about their perception of competence in technical and communication skills. Additional demographic information was also collected, including gender, age, academic year and length of professional experience. Results - A total of 525 students (84.7% female) and 108 nurses (77.8% female) participated in this study. In general, caring sub-scores, measuring the preference of about attending to patient emotional aspects, were higher than sharing sub-scores, measuring beliefs about giving information and perceiving patient as a member of the health team. Students were significantly more patient-centered throughout their nursing education (p<0.001). Comparing to students in the second and fourth academic years (p<0.001) nurses' scores were significantly lower both in total PPOS and in caring and sharing subscales. Conclusions - These results reinforce the idea that patient centeredness may be developed in academic context. The scores obtained highlight the importance of studies that aim to identify factors that may explain the decrease of patient centeredness in professional practice.

Health-related quality of life and working conditions among nursing providers

OBJECTIVE: To evaluate working conditions associated with health-related quality of life (HRQL) among nursing providers. METHODS: Cross-sectional study conducted in a university hospital in the city of São Paulo, Southeastern Brazil, during 2004-2005. The study sample comprised 696 registered nurses, nurse technicians and nurse assistants, predominantly females (87.8%), who worked day and/or night shifts. Data on sociodemographic information, working and living conditions, lifestyles, and health symptoms were collected using self-administered questionnaires. The following questionnaires were also used: Job Stress Scale, Effort-Reward Imbalance (ERI) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Ordinal logistic regression analysis using proportional odds model was performed to evaluate each dimension of the SF-36. RESULTS: Around 22% of the sample was found to be have high strain and 8% showed an effort-reward imbalance at work. The dimensions with the lowest mean scores in the SF-36 were vitality, bodily pain and mental health. High-strain job, effort-reward imbalance (ERI>1.01), and being a registered nurse were independently associated with low scores on the role emotional dimension. Those dimensions associated to mental health were the ones most affected by psychosocial factors at work. CONCLUSIONS: Effort-reward imbalance was more associated with health than high-strain (high demand and low control). The study results suggest that the joint analysis of psychosocial factors at work such as effort-reward imbalance and demand-control can provide more insight to the discussion of professional roles, working conditions and HRQL of nursing providers.

Association between sleep quality and quality of life in nursing professionals working rotating shifts

OBJECTIVE To analyze the association between sleep quality and quality of life of nursing professionals according to their work schedules.METHODS A prospective, cross-sectional, observational study was conducted between January and December 2010, with 264 nursing professionals, drawn from 989 subjects at Botucatu General Hospital and stratified by professional category. The Pittsburg Sleep Quality Index and the WHOQOL-bref were administered to evaluate sleep quality and quality of life, respectively. Self-reported demographic data were collected with a standard form. Continuous variables were reported as means and standard deviations, and categorical variables were expressed as proportions. Associations were evaluated using Spearman’s correlation coefficient. The association of night-shift work and gender with sleep disturbance was evaluated by logistic regression analysis using a model adjusted for age and considering sleep disturbance the dependent variable. The level of significance was p < 0.05.RESULTS Night-shift work was associated with severe worsening of at least one component of sleep quality in the model adjusted for age (OR = 1.91; 95%CI 1.04;3.50; p = 0.036). Female gender was associated with sleep disturbance (OR = 3.40; 95%CI 1.37;8.40; p = 0.008). Quality of life and quality of sleep were closely correlated (R = -0.56; p < 0.001).CONCLUSIONS Characteristics of the nursing profession affect sleep quality and quality of life, and these two variables are associated.