Violence against adolescents: an analysis based on the categories gender and generation

Exploratory and descriptive study based on quantitative and qualitative methods that analyze the phenomenon of violence against adolescents based on gender and generational categories. The data source was reports of violence from the Curitiba Protection Network from 2010 to 2012 and semi-structured interviews with 16 sheltered adolescents. Quantitative data were analyzed using SPSS software version 20.0 and the qualitative data were subjected to content analysis. The adolescents were victims of violence in the household and outside of the family environment, as victims or viewers of violence. The violence was experienced at home, mostly toward girls, with marked overtones of gender violence. More than indicating the magnitude of the issue, this study can give information to help qualify the assistance given to victimized people and address how to face this issue.

Psychological transformations in kidney transplantation: A prospective qualitative study

The aim of this IRB-approved study was to prospectively analyze psychological transformations in ESRD patients before and after transplantation (KT). Semi-structured interviews were conducted in 30 patients (mean age = 53±10) after their inclusion on the waiting-list (Gr. A). Follow-up interviews were performed 6 months later in 15 patients still awaiting KT (Gr. B6), and in 15 patients 6 months (Gr. C6) and 12 months (Gr. C12) after KT. Qualitative analysis was performed. Gr: A:All patients underlined loss of freedom, 87% devoted much energy to maintain normality, 57% modified medical directives. All reported emotional fragility related to dialysis and loss of quality of life (QOL), negative (43%) or suicidal thoughts (20%). Professional stigma was underlined (26%). Gr: B6:40% reported no change, 60% mentioned increase of illness intrusiveness, 46% dialysis side-effects, 40% communication problems, 33% tension with medical staff and waiting list handling. Fear of emotional breakdown (40%), couple problems (47%) and worsened professional difficulties (20%) were reported. Gr: C6:All patients mentioned improved QOL and freedom recovery (87%). All expressed concerns about possible acute rejection, 73% were anxious about laboratory results, 93% experienced dependence to immunosuppressants, 47% reported difficulties in handling medication, 21% feared to forget them, 47% were concerned about side-effects, 67% had resumed work but medical constraints led to professional tension (40%). Gr: C12:All mentioned recovered QOL. Medical controls were accepted as a routine (87%) and adherence to medication was mandatory (100%). All mentioned the limited long-term graft survival and 47% were anxious about possible return to dialysis, especially younger patients (27%). Positive identity and existential changes were reported (60%). This prospective qualitative study identifies psychological modifications in the course of KT. It provides a basis to adequately address concerns, but it shows also that KT is clearly associated with positive psychological transformations.

Understanding the experiences of caregivers of children with tuberculosis in directly observed therapy

Objective To understand the situations and communications experienced by caregivers of children with tuberculosis (TB) with regard to directly observed therapy (DOT). Method A descriptive exploratory study with a qualitative approach was applied and developed in the ambulatory of Programa Einstein na Comunidade de Paraisópolis (PECP). The data were collected using semi-structured interviews of 13 caregivers of children with TB in DOT. The Collective Subject Discourse (CSD) method was used to analyze the data. Results Seven CSDs were identified and grouped into four categories: "Living in a difficult situation", "Changing the family routine", "Responsibility almost always fall son the mother", and "Adapting to the DOT". Conclusions The difficulties faced by the caregiver of the child at the beginning of DOT significantly changed the familiar routine. The responsibility for its continuity was assigned to the mother, who must adapt to the demands of the treatment and face the situation.

Cumulative Vulnerability: A Case Study on intrafamilial violence, Drug Addiction and Adolescent Pregnancy

A pregnant adolescent’s vulnerability increases when she is a victim of intrafamilial violence and drug addiction, which cause physical and biopsychosocial damage to the mother and her baby. Objective Present and analyze the case of an adolescent who is addicted to drugs, pregnant and the victim of lifelong intrafamilial violence. Method A case study based on a semi-structured interview conducted in the Obstetrics Emergency Unit at the Teaching Hospital of the University of São Paulo. The data were interpreted and analyzed using Content Analysis. Results intrafamilial violence experienced at the beginning of the adolescent’s early relationships seriously affected her emotional maturity, triggering the development of psychopathologies and leaving her more susceptible to the use and abuse of alcohol and other drugs. The adolescent is repeating her history with her daughter, reproducing the cycle of violence. Conclusion Adolescent pregnancy combined with intrafamilial violence and drug addiction and multiplies the adolescent’s psychosocial vulnerability increased the adolescent’s vulnerability.

DISTINCT TEMPORALITIES IN THE BREAST CANCER DISEASE PROCESS

Comprehensive approach study aimed understanding the reflections and contrasts between personal time and medical therapy protocol time in the life of a young woman with breast cancer. Addressed as a situational study and grounded in Beth’s life story about getting sick and dying of cancer at age 34, the study’s data collection process employed interviews, observation and medical record analysis. The construction of the analytic-synthetic box based on the chronology of Beth’s clinical progression, treatment phases and temporal perception of occurrences enabled us to point out a linear medical therapy protocol time identified by the diagnosis and treatment sequencing process. On the other hand, Beth’s experienced time was marked by simultaneous and non-linear events that generated suffering resulting from the disease. Such comprehension highlights the need for healthcare professionals to take into account the time experienced by the patient, thus providing an indispensable cancer therapeutic protocol with a personal character.

Probing the T-cell receptor repertoire with deep sequencing.

PURPOSE OF REVIEW: To review major findings on the T-cell receptor (TCR) repertoire diversity in response to several viral infections based on conventional methods of PCR, cloning and sequencing and to discuss their limitations in light of the recent methodological advances in deep sequencing.¦RECENT FINDINGS: Direct sequencing of TCR expressed by Ag-specific T cells isolated ex vivo has revealed that the TCR repertoire is not as restricted as previously estimated. Furthermore, analyses performed independently of the T-cell clonal hierarchy have brought to light an unexpected diversity. The choice of methods is critical to characterize the complexity of the repertoire. Recent advances in deep sequencing have uncovered the diversity of the TCR repertoire and shown that the size of the repertoire in naive and Ag-experienced memory T cells is three-fold to 15-fold larger than formerly estimated. Interestingly, the TCR complementary determining region 3 sequences are not randomly selected and a certain degree of shared TCR repertoire has been observed between different individuals.¦SUMMARY: Deep sequencing is a major methodological advance allowing more accurate molecular characterization of the TCR repertoire. In the near future, such technologies will further contribute to delineate the complexity of pathogen-specific T-cell response and help defining correlates of a protective immunity.

Präoperative Azidose und Entwicklung von Säuglingen nach Operation angeborener Herzfehler Preoperative acidosis and infant development following surgery for congenital heart disease.

OBJECTIVE: Prenatal diagnosis has been shown to decrease pre-operative acidosis and might prevent the occurrence of disturbed developmental outcome. The aim of this study is to evaluate parameters for acidosis and their predictive value on developmental outcome in newborns with congenital heart disease. METHODS: A total of 117 patients requiring surgery for structural heart disease in the first 31 days of life were included. Diagnosis was established either pre- or postnatally. Preoperative values of lactate, pH and base excess levels were compared to the occurrence of disturbed developmental outcome, i.e. an underperformance of more than 10% on the P90 of a standardized Dutch developmental scale. Patients were divided into groups according to blood levels of acidosis parameters, using receiver operating characteristics curves to determine cut-off values for pH, base excess and lactate. RESULTS: No significant difference in developmental outcome was found using values for pH or base excess as a cut-off level. Preoperative lactate values exceeding 6.1 mmol/l resulted in a significant increase in impaired development compared to infants with a pre-operative lactate lower than 6.1 mmol/l: 40.9% vs 15.1% in (p=0.03). CONCLUSIONS: Pre-operative lactate values might have a prognostic value on developmental outcome in newborns with congenital heart disease. The limited prognostic value of pH can be explained by the fact that pH can be easily corrected, while lactate better reflects the total oxygen debt experienced by these patients.

Pouvoir discrétionnaire et redevabilité de la bureaucratie de guichet : les taxateurs d'une caisse de chômage comme acteurs de mise en oeuvre

Résumé en français La thèse de doctorat porte, de manière générale, sur le rôle des acteurs administratifs dans la mise en oeuvre de l'action publique. En particulier, dans le contexte de l'implémentation de la politique suisse d'assurance-chômage, la recherche se focalise sur l'étude de la bureaucratie de guichet, à savoir un type spécifique d'administrations et d'agents publics situés aux premières lignes de l'action étatique et qui sont en contact direct et quotidien avec les usagers. La thèse a pour objectif principal d'obtenir une compréhension détaillée des impacts concrets dont sont porteurs deux types de réformes majeures du secteur public : les réformes de Nouvelle Gestion Publique (NGP) et les nouvelles technologies informatiques. Le questionnement central de la recherche consiste en une étude approfondie des effets de ces réformes sur les bureaucraties de guichet, et en particulier sur deux aspects centraux les concernant : d'une part, le niveau de pouvoir discrétionnaire que les agents publics de base disposent dans l'application de la loi fédérale sur l'assurance-chômage, autrement dit leur marge de manoeuvre ; d'autre part, les manières au travers desquelles ces mêmes agents sont appelés à rendre des comptes quant à leurs actions et leurs décisions, à savoir l'enjeu plus large de la redevabilité publique des acteurs administratifs. Ces enjeux ont été analysés au niveau empirique dans le contexte organisationnel d'une caisse publique cantonale de chômage ayant expérimenté les réformes évoquées ci-dessus. L'organisation choisie a été investiguée au travers d'une étude de cas ethnographique approfondie (observation directe du travail quotidien des agents, entretiens semi-directifs, analyse de documents) pendant une période de six mois environ entre 2008 et 2009. L'analyse empirique fournit quatre résultats : a) de manière générale, les taxateurs de la caisse de chômage disposent d'un faible niveau de pouvoir discrétionnaire ; b) le degré de pouvoir discrétionnaire varie selon le type de tâche ; c) les agents sur le terrain rendent des comptes auprès d'une multiplicité d'acteurs, sur une variété d'aspects de leur travail et au travers de différents mécanismes de contrôle ; d) les outils de NGP et les nouvelles technologies informatiques ont peu d'impact sur l'étendue du pouvoir discrétionnaire des agents mais contribuent à influencer le type de redevabilité publique pratiquée à ce niveau. Summary in English This PhD dissertation deals with the role of public administration in policy implementation. In the Swiss context of unemployment insurance policy, it focuses on street-level bureaucracy, a specific type of public organisations and agents located at the frontline of public action, that is to say low-level civil servants who are in direct, daily and face-to-face contact with citizens. The dissertation aims at a deep understanding of what are the concrete impacts of two main important changes touching public sector organizations : New Public Management reforms (NPM) and Information and Communication technologies (ICT). The main research question consists in assessing the impacts of those reforms on two central issues regarding street-level bureaucrats : on the one hand, the effective degree of discretion frontline agents do have in implementing the federal law on unemployment insurance ; on the other hand, the ways through which these bureaucrats are held accountable about their action and decisions, i.e. accountability regimes at the street-level. These issues have been empirically addressed in the organisational context of a cantonal Unemployment Insurance Funds having experienced the above mentioned reforms. The organisation has been investigated through an in-depth ethnographic case-study (direct observation of daily work, semi-structured interwiews, documentary analysis) in 2008 and 2009 for approximately six months. The empirical analysis indicates that a) in general, street-level agents do exert low degree of policy discretion; b) the level of discretion is variable from one specific task to another ; c) frontline workers are held accountable to many actors, on various aspects of their work and through different mechanisms of control ; d) NPM and ICT instruments have few impact on the issue of policy discretion but more on the type of street-level accountability which is concretely practised at this level.

The (un)receptive experiences of female rape victims who seek healthcare services

OBJECTIVE To know the structure and functioning of healthcare services from the perspective of women who have suffered rape. METHOD A qualitative study conducted with 11 women who experienced rape, monitored in a maternity in the state of Alagoas, Brazil. Data were systematically based on content analysis. RESULTS It allowed for understanding the path taken by women in search of support from health services, as well as the limitations and capabilities of these services. CONCLUSION The assistance received in healthcare services leans towards a revictimization process of women who already carry trauma from the rape. It is necessary to reflect about care practices aimed at sexually victimized women.

A Importância do Empreendedorismo na Actividade Turística

Na actualidade, o empreendedorismo vem impulsionando o desenvolvimento de negócios em diferentes sectores com ênfase na qualidade dos serviços, tendo em vista não só a satisfação mas também a difícil tarefa de conquistar a lealdade dos clientes a médio e longo prazo. No mercado turístico, a satisfação do cliente é importante para que a actividade possa manter-se competitiva, uma vez que os clientes tornam-se mais exigentes à medida que vão-se tornando experientes. Neste contexto, o empreendedorismo aparece como forma de desenvolvimento do turismo, sendo que os resultados que se esperam das acções empreendedoras são a entrada em novos negócios, inovação, agregação de valor aos produtos/serviços e maior qualidade dos produtos/serviços. O objectivo central do trabalho é demonstrar a importância do empreendedorismo na actividade turística e como o mesmo contribui para agregação de valor e geração de resultados económicos. Para melhor compreensão do assunto da pesquisa, dividimos o enquadramento teórico em três momentos. No primeiro, abordamos o empreendedorismo, no segundo o turismo e, por fim, o empreendedorismo no turismo. O enquadramento teórico permitiu responder à questão: será que o empreendedorismo contribui para agregar valor e gerar resultados económicos na actividade turística? Os resultados do questionário aplicado aos proprietários das empresas turísticas evidenciaram que estes possuem características geralmente patentes nos empreendedores. No entanto, os resultados não são conclusivos quanto ao seu potencial empreendedor. In the present, time the entrepreneurship is driving the businesses development in different sector with emphasis on services quality in order not only satisfaction but also the difficult task of winning the costumers loyalty in the medium and long term. In the tourist market, the costumer’s satisfaction is important in order to remain the activity competitive, because the costumers become more demanding while they become experienced. In this context, the entrepreneurship shows up like a way to develop the tourism, because the expected results of entrepreneurial activities are entry in new businesses, innovation, the aggregation of value and more quality of the products/services. The central objective of this work is to demonstrate the importance of the entrepreneurship in to the tourism and how it contributes for adding value and generating economics results. To better understand the research’s subject, we divided the theoretical framework in three moments. At first one we approached entrepreneurship, then the tourism, and finally, we approached entrepreneurship in the tourism. The theoretical framework to allowed answer to the question: will the entrepreneurship contributes to add value and generate economics results in the tourism? The results of the questionnaire applied to the owners of tourists’ enterprises evidence that they possess the characteristics usually presented by the entrepreneurs. However, the results are not conclusive relatively to their potential entrepreneur.

Burnout and associated factors in employees of a Swiss teaching hospital

Background Working in a teaching hospital is a highly stressful occupation, which can lead to burnout. The consequences of burnout in health professionals can be very serious, both for themselves and patients. The aim of this cross-sectional study was to assess the extent of burnout and associated factors in hospital employees. Methods In the Fall of 2007, all employees of a Swiss teaching hospital were invited to complete a job satisfaction survey. It included the work-related burnout scale (scored 0-100) of the Copenhagen Burnout Inventory (CBI-French version), measuring the degree of physical and psychological fatigue and exhaustion perceived as related to the person's work; a high degree of burnout was defined as a score _50. Logistic regression analyses were used to determine factors associated with a high degree of burnout. Results A total of 4575 individuals returned the questionnaire (response rate 54%). Of them, 1503 (33%) had a high degree of burnout. The rate of burnout was higher among women (34.3% versus 30.5%, P = 0.012) and respondents younger than 40 years (37.7% versus 28.6%, P < 0.001). Executives were less prone to burnout than employees (27.1% versus 33.9%, P < 0.0019). Rates of burnout differed by profession: nurses and physicians had higher rates than administrative and logistic staff (42.8% and 37.4% versus 25.6% and 20.9%, respectively P < 0.001). Burnout was inversely associated with job satisfaction. In multivariate analysis, factors associated with burnout were overall dissatisfaction (OR 3.23; 95% CI 2.66-3.91), dissatisfaction with workload (OR 2.09; 95% CI 1.74-2.51) and work-life balance (OR 2.25; 95% CI 1.83-2.77), being a woman (OR 1.56; 95% CI 1.28-1.90), working fulltime (OR 1.41; 95% CI 1.08-1.85) and working as a nurse, a physician or in the psychosocial sector. Conclusions One-third of respondents, mostly nurses and physicians, experienced burnout and had lower levels of job satisfaction. The factors associated with burnout may help to tailor programmes aiming at reducing burnout at both the individual and organizational level within the hospital.

Evaluation of Virtual Reality Snowplow Simulator Training, January 2007

Each winter, Iowa Department of Transportation (Iowa DOT) maintenance operators are responsible for plowing snow off federal and state roads in Iowa. Drivers typically work long shifts under treacherous conditions. In addition to properly navigating the vehicle, drivers are required to operate several plowing mechanisms simultaneously, such as plow controls and salt spreaders. There is little opportunity for practicing these skills in real-world situations. A virtual reality training program would provide operators with the opportunity to practice these skills under realistic yet safe conditions, as well as provide basic training to novice or less-experienced operators. In order to provide such training to snowplow operators in Iowa, the Iowa DOT purchased a snowplow simulator. The Iowa DOT commissioned a study through Iowa State University designed to (1) assess the use of this simulator as a training tool and (2) examine personality and other characteristics associated with being an experienced snowplow operator. The results of this study suggest that Iowa DOT operators of all ages and levels of experience enjoyed and seemed to benefit from virtual reality snowplow simulator training. Simulator sickness ratings were relatively low, implying that the simulator is appropriate for training a wide range of Iowa DOT operators. Many reported that simulator training was the most useful aspect of training for them.

Life experiences of elderly with cancer pain: the existential comprehensive approach

OBJECTIVE Understanding the experiences of elderly with cancer pain. METHOD Qualitative research based on Heidegger's phenomenology. 12 elderly cancer patients from a city in northwest Paraná were interviewed from November 2013 to February 2014. RESULTS Analysis performed by vague, median and interpretive understanding which resulted in two ontological themes: Cancer pain: unveiling the imprisonment and impositions experienced by the elderly, and Unveiling the anguish of living with cancer pain; it revealed not only how the elderly experience pain in their daily lives, but also how hard it is to live with its particularities. CONCLUSION Cancer pain has biopsychosocial repercussions for the elderly, generating changes in their existence in the world, requiring holistic and authentic care.

The effects of tourism, beachfront development and increased light pollution on nesting Loggerhead turtles Caretta caretta (Linnaeus, 1758) on Sal, Cape Verde Islands

Loggerhead Caretta caretta is now the only species of marine turtle nesting on the island of Sal, Cape Verde Islands. Since 2008, ADTMA - SOS Tartarugas has patrolled all the southern beaches of the island in order to protect nesting females and to collect nesting data. Although hunting is still a major issue, with 90 turtles killed in 2009, habitat loss and light pollution are becoming an ever more serious threat. Construction sites, hotels, apartment buildings and restaurants close to beaches, bright lights and illegal removal of sand are contributing to a marked decrease in the total number of nesting turtles on some beaches. In 2009, beaches on Sal experienced an average increase in nests of 200%, while the beach most affected by construction (Tortuga Beach) saw a decrease of nests of 7.3% (from 19.1% of total number of nests in 2008 to 11.8% in 2010). This beach also recorded a much lower nest to emergence ratio than normal (17.6% of emergences resulting in nests compared to 29.9% in other areas), indicating reluctance to nest due to light pollution and other disturbances.

Triage at the Emergency Department: association between triage levels and patient outcome

AbstractOBJECTIVEIdentify association between sociodemographic, clinical and triage categories with protocol outcomes developed at Hospital São Paulo (HSP).METHODSRetrospective cohort study conducted with patients older than 18 years submitted to the triage protocol in August 2012. Logistic regression was used to associate the risk categories to outcomes (p-value ≤0,05).RESULTSMen with older age and those treated in clinical specialties had higher rates of hospitalization and death. Patients in the high-priority group had hospitalization and mortality rates five and 10.6 times, respectively (p < 0.0001).CONCLUSIONThe high-priority group experienced higher hospitalization and mortality rates. The protocol was able to detect patients with more urgent conditions and to identify risk factors for hospitalization and death.