A construção do conhecimento da enfermagem baseada no método construtivista

Este artigo teve o objetivo de realizar uma reflexão acerca da teoria de Vygotsky no processo de construção do conhecimento dos profissionais de enfermagem. Na abordagem vygotskyana, o homem é visto como alguém que transforma e é transformado nas relações que acontecem em uma determinada cultura, caracterizado por uma interação dialética desde o nascimento entre o ser humano e o meio social e cultural em que se insere. A proposta do construtivismo encaixa-se nesse contexto, pois busca explicar como se modificam as estratégias de conhecimento do indivíduo no decorrer da sua vida. As ideias construtivistas preconizadas por Vygotsky podem representar um método alternativo para os estudos teórico-práticos na área da saúde, especialmente quanto à dimensão subjetiva do processo de trabalho junto à equipe de enfermagem.

Hepatic deficiency in transcriptional cofactor TBL1 promotes liver steatosis and hypertriglyceridemia.

The aberrant accumulation of lipids in the liver ("fatty liver") is tightly associated with several components of the metabolic syndrome, including type 2 diabetes, coronary heart disease, and atherosclerosis. Here we show that the impaired hepatic expression of transcriptional cofactor transducin beta-like (TBL) 1 represents a common feature of mono- and multigenic fatty liver mouse models. Indeed, the liver-specific ablation of TBL1 gene expression in healthy mice promoted hypertriglyceridemia and hepatic steatosis under both normal and high-fat dietary conditions. TBL1 deficiency resulted in inhibition of fatty acid oxidation due to impaired functional cooperation with its heterodimerization partner TBL-related (TBLR) 1 and the nuclear receptor peroxisome proliferator-activated receptor (PPAR) α. As TBL1 expression levels were found to also inversely correlate with liver fat content in human patients, the lack of hepatic TBL1/TBLR1 cofactor activity may represent a molecular rationale for hepatic steatosis in subjects with obesity and the metabolic syndrome.

RAPPORT NATIONAL SUR L'ETAT DE LA BIODIVERSITE

Informations de base sur la République du Cap Vert L'archipel du Cap Vert est constitué par dix îles et huit îlots situés à environ 500 km de la côte occidentale africaine. Sa superficie est de 4033 km2. Les îles sont d'origine volcanique et sont implantées sur la zone sud-ouest de la plate-forme sénégalaise sur la croûte océanique d'âge comprise entre 140 et 120 millions d'années. Le relief est très accidenté dans les îles les plus jeunes (Fogo, Santiago, Santo Antão et S. Nicolau), mais relativement plat dans les îles plus anciennes (Maio, Boavista e Sal). Les sols sont peu évolués, avec des horizons pédologiques peu différenciés. Par sa situation géographique, dans une zone d'aridité météorologique, le climat du Cap Vert est sahélien du type tropical sec, soumis aux vents alizés du nordest, avec des températures modérées (environ 24ºC) et une faible amplitude thermique dû à l'environnement atlantique. Les précipitations sont généralement faibles sur l'ensemble du pays, ne dépassant pas les 300 mm de moyenne annuelle pour les 65% du territoire situé à moins de 400 m d'altitude. Les zones sous l'influence des alizés étant encore plus sèches (150 mm de moyenne annuelle). Sur les versants situés à plus de 500 m d'altitude faisant face aux alizés, on peut atteindre ou dépasser les 700 mm. Les pluies sont irrégulières et généralement mal distribuées dans le temps et dans l'espace. Le peuplement et son influence sur la biodiversité Après leur colonisation par les humains au cours du XVème siècle, les îles du Cap Vert ont été soumises à une forte exploitation des ressources biologiques. Des facteurs anthropiques avec conséquences directe et indirecte sur la végétation, tels que l'agriculture pluviale, dans la plupart des cas pratiquée sur les fortes pentes des versants, l'utilisation du bois de feu, le surpâturage et l'introduction des espèces exotiques ont contribué à la dégradation graduelle de la végétation et des habitats de l'archipel. Le rôle de ces facteurs a été encore accentué par l'action passif des facteurs intrinsèques tels que l'insularité et la fraction importante du territoire occupée par des zones arides et semi-arides. La végétation des zones arides et semi-arides qui occupent, au Cap Vert, plus de 70% du sol arable du territoire, a un faible pouvoir de régénération. Sa flore insulaire est sensible par le fait d'avoir évolué en l'absence de prédateurs et d'être issues de petites populations avec une diversité génétique limitée et par une aire de dissémination très limitée. La diversité des espèces Il existe au Cap Vert, 110 espèces de bryophytes dont 15 sont endémiques. Du total, 36% sont extinctes ou menacées. Parmi les endémiques 40% sont menacées. Les espèces d’angiospermes sont en nombre de 240 dont 45 sont endémiques. A noter que 27% du total sont extinctes ou menacées. Parmi les endémiques, 54% sont en danger de disparition. La biodiversité animale cours des risques majeures de survie. Des 37 espèces de gastéropodes existantes, 15 sont endémiques dont 67% sont menacées. Les arachnides sont au nombre de 111 dont 46 sont endémiques. Parmi les endémiques, 78% sont menacées. Il existe 470 espèces d'insectes (coléoptères) dont 155 sont endémiques. 84% des taxa endémiques sont menacées. On suppose que du total des 470 espèces, 64% sont disparues ou en danger. L'état actuel de la faune et de la flore a été donné par la Première Liste Rouge du Cap Vert, publiée en 1996 et qui indique un certain nombre de statistiques effrayantes : sont menacées plus de 26% des angiospermes, plus de 40% des bryophytes, plus de 65% des ptéridophytes et plus de 29% des lichens ; plus de 47% des oiseaux, 25% des reptiles terrestres, 64% des coléoptères, plus de 57% des arachnides, plus de 59% des mollusques terrestres. L'archipel du Cap Vert est situé dans la zone tropicale où, selon Nunan (1992), si on exclue les espèces migratoires on peu compter environ 273 espèces de poissons, dont 70% sont endémiques. La liste des espèces de poissons des îles du Cap Vert est assez diversifiée et compte environ une centaine d'espèces appartenant à différentes familles. En matière de diversité biologique marine l'exploitation des ressources dans la ZEE (Zone Economique Exclusive) sont encore loin d'atteindre le potentiel estimé. Néanmoins, il existe quelques espèces qui sont en danger, notamment les tortues et les langoustes. Dans les eaux capverdiennes il existe 5 espèces de tortues : Dermocelys coriacea, Chelonia mydas, Eretmochelys imbricata, Caretta caretta et Lepidochelys olivacea. Les tortues sont d'une façon générale soumises à une exploitation irrationnelle depuis des décades. La viande et les oeufs, surtout de la tortue mâle sont très appréciés. La carapace est utilisée dans la bijouterie (boucles, bagues, colliers, etc.). Parmi les quatre familles de langoustes connues, l'archipel du Cap Vert recèle deux : la Palinuridae (langouste rose, verte et marron) et la Scyllaride (langouste de pierre). A signaler également une espèce endémique, le Palinuris charlestoni. Toutes les espèces existantes au Cap Vert sont exploitées, souvent à la limite de la durabilité. La République du Cap Vert et la Convention sur la Biodiversité Le Cap Vert a signé la Convention sur la biodiversité en juin 1992 et l'a ratifié en mars 1995. Pour remplir les obligations découlant de l'adoption de la Convention, le pays a complété sa Stratégie Nationale et Plan d'Action sur la Biodiversité en février 1999. Une institution responsable pour la mise en oeuvre de la politique nationale en matière de l'environnement a été créée, le Secrétariat Exécutif pour l'Environnement (SEPA). Le Plan d'Action National a identifié 21 objectifs divisés en huit groupes thèmatiques et contient des activités jusqu'à l'an 2010. Parallèlement à ces actions, la Loi de Base pour l'Environnement, le Code de l'Environnement, le Code de l'Eau et le Code Forestier ont été adoptés. Ce nouveau Code Forestier a été élaboré afin d'actualiser les normes pour une gestion durable des ressources et le transfert des compétences aux régions et communautés. Au niveau stratégique le Cap Vert a élaboré son Programme d'Action National pour l'Environnement (PANA) et a développé le Programme d'Action National de Lutte Contre la Désertification (PAN-LCD) en utilisant l'approche participative faisant appel à tous les acteurs de la société civile y inclus les associations et ONG. Au niveau international le Cap Vert a adhéré aux conventions telles que la biodiversité, les changements climatiques et le contrôle de la désertification. Le pays a également signé les conventions suivantes : Convention des Nations Unies sur le Droit de la Mer, Convention relative à la Protection du Patrimoine Mondial Culturel et Naturel, Convention de Bâle sur les mouvements trans-frontaliers, Convention internationale pour la Prévention de la pollution par des bateaux, Convention de Vienne sur la protection de la couche de l'ozone, Protocole de Montréal sur les substances qui appauvrissent la couche de l'ozone. La mise en oeuvre de la stratégie nationale sur la Diversité Biologique permettra une meilleure gestion de l'eau, des ressources naturelles et des espaces, l'introduction de nouvelles espèces et de nouvelles technologies alternatives pour l'agriculture et l'élevage ainsi que la création de nouveaux emplois alternatifs, à partir des activités génératrices de revenus, et de diminuer ainsi, la pression sur les ressources naturelles.

Need of reduced and harmonized bureaucracy in multi-centre clinical research - a case-report from a Swiss trial

Introduction: We launched an investigator-initiated study (ISRCTN31181395) to evaluate the potential benefit of pharmacokinetic-guided dosage individualization of imatinib for leukaemiapatients followed in public and private sectors. Following approval by the research ethics committee (REC) of the coordinating centre, recruitment throughout Switzerland necessitatedto submit the protocol to 11 cantonal RECs.Materials and Methods: We analysed requirements and evaluation procedures of the 12 RECs with associated costs.Results: 1-18 copies of the dossier, in total 4300 printed pages, were required (printing/posting costs: ~300 CHF) to meet initial requirements. Meeting frequencies of RECs ranged between 2 weeks and 2 months, time from submission to fi rst feedback took 2-75 days. Study approval was obtained from a chairman, a subor the full committee, the evaluation work being invoiced by0-1000 CHF (median: 750 CHF, total: 9200 CHF). While 5 RECs gave immediate approval, the other 6 rose in total 38 queries before study release, mainly related to wording in the patient information, leading to 7 different fi nal versions approved. Submission tasks employed an investigator half-time over about 6 months.Conclusion: While the necessity of clinical research evaluation by independent RECs is undisputed, there is a need of further harmonization and cooperation in evaluation procedures. Current administrative burden is indeed complex, time-consuming and costly. A harmonized electronic application form, preferably compatible with other regulatory bodies and European countries, could increase transparency, improve communication, and encourage academic multi-centre clinical research in Switzerland.

Subcontracting and vertical integration in the Spanish cotton industry

This paper examines changes in the organization of the Spanish cotton industry from 1720 to 1860 in its core region of Catalonia. As the Spanish cotton industry adopted the most modern technology and experienced the transition to the factory system, cotton spinning and weaving mills became increasingly vertically integrated. Asset specificity more than other factors explained this tendency towards vertical integration. The probability for a firm of being vertically integrated was higher among firms located in districts with high concentration ratios and rose with size and the use of modern machinery. Simultaneously, subcontracting predominated in other phases of production and distribution where transaction costs appears to be less important.

Analysis of the genetic diversity in Metopolophium dirhodum (Walker) (Hemiptera, Aphididae) by RAPD markers

The emergence of host-races within aphids may constitute an obstacle to pest management by means of plant resistance. There are examples of host-races within cereals aphids, but their occurrence in Rose Grain Aphid, Metopolophium dirhodum (Walker, 1849), has not been reported yet. In this work, RAPD markers were used to assess effects of the hosts and geographic distance on the genetic diversity of M. dirhodum lineages. Twenty-three clones were collected on oats and wheat in twelve localitites of southern Brazil. From twenty-seven primers tested, only four primers showed polymorphisms. Fourteen different genotypes were revealed by cluster analysis. Five genotypes were collected only on wheat; seven only on oats and two were collected in both hosts. Genetic and geographical distances among all clonal lineages were not correlated. Analysis of molecular variance showed that some molecular markers are not randomly distributed among clonal lineages collected on oats and on wheat. These results suggest the existence of host-races within M. dirhodum, which should be further investigated using a combination of ecological and genetic data.

Management of patient dose and image noise in routine pediatric CT abdominal examinations.

The aim was to propose a strategy for finding reasonable compromises between image noise and dose as a function of patient weight. Weighted CT dose index (CTDI(w)) was measured on a multidetector-row CT unit using CTDI test objects of 16, 24 and 32 cm in diameter at 80, 100, 120 and 140 kV. These test objects were then scanned in helical mode using a wide range of tube currents and voltages with a reconstructed slice thickness of 5 mm. For each set of acquisition parameter image noise was measured and the Rose model observer was used to test two strategies for proposing a reasonable compromise between dose and low-contrast detection performance: (1) the use of a unique noise level for all test object diameters, and (2) the use of a unique dose efficacy level defined as the noise reduction per unit dose. Published data were used to define four weight classes and an acquisition protocol was proposed for each class. The protocols have been applied in clinical routine for more than one year. CTDI(vol) values of 6.7, 9.4, 15.9 and 24.5 mGy were proposed for the following weight classes: 2.5-5, 5-15, 15-30 and 30-50 kg with image noise levels in the range of 10-15 HU. The proposed method allows patient dose and image noise to be controlled in such a way that dose reduction does not impair the detection of low-contrast lesions. The proposed values correspond to high- quality images and can be reduced if only high-contrast organs are assessed.

Genome-wide association analyses identify 18 new loci associated with serum urate concentrations.

Elevated serum urate concentrations can cause gout, a prevalent and painful inflammatory arthritis. By combining data from >140,000 individuals of European ancestry within the Global Urate Genetics Consortium (GUGC), we identified and replicated 28 genome-wide significant loci in association with serum urate concentrations (18 new regions in or near TRIM46, INHBB, SFMBT1, TMEM171, VEGFA, BAZ1B, PRKAG2, STC1, HNF4G, A1CF, ATXN2, UBE2Q2, IGF1R, NFAT5, MAF, HLF, ACVR1B-ACVRL1 and B3GNT4). Associations for many of the loci were of similar magnitude in individuals of non-European ancestry. We further characterized these loci for associations with gout, transcript expression and the fractional excretion of urate. Network analyses implicate the inhibins-activins signaling pathways and glucose metabolism in systemic urate control. New candidate genes for serum urate concentration highlight the importance of metabolic control of urate production and excretion, which may have implications for the treatment and prevention of gout.

Parent-of-origin-specific allelic associations among 106 genomic loci for age at menarche.

Age at menarche is a marker of timing of puberty in females. It varies widely between individuals, is a heritable trait and is associated with risks for obesity, type 2 diabetes, cardiovascular disease, breast cancer and all-cause mortality. Studies of rare human disorders of puberty and animal models point to a complex hypothalamic-pituitary-hormonal regulation, but the mechanisms that determine pubertal timing and underlie its links to disease risk remain unclear. Here, using genome-wide and custom-genotyping arrays in up to 182,416 women of European descent from 57 studies, we found robust evidence (P < 5 × 10(-8)) for 123 signals at 106 genomic loci associated with age at menarche. Many loci were associated with other pubertal traits in both sexes, and there was substantial overlap with genes implicated in body mass index and various diseases, including rare disorders of puberty. Menarche signals were enriched in imprinted regions, with three loci (DLK1-WDR25, MKRN3-MAGEL2 and KCNK9) demonstrating parent-of-origin-specific associations concordant with known parental expression patterns. Pathway analyses implicated nuclear hormone receptors, particularly retinoic acid and γ-aminobutyric acid-B2 receptor signalling, among novel mechanisms that regulate pubertal timing in humans. Our findings suggest a genetic architecture involving at least hundreds of common variants in the coordinated timing of the pubertal transition.

De la relation pharmaciens-usagers : reconfigurations et négociations dans une pharmacie suisse

À partir d'entretiens et d'observations réalisés dans une pharmacie de garde de Suisse romande, cette étude explore les relations que les pharmaciens d'officine entretiennent avec les usagers. Dans un contexte de démocratisation des savoirs relatifs à la santé, l'enquête effectuée montre que cette relation se reconfigure, selon la nature du problème de santé, au profit d'une plus grande autonomie des usagers. En effet, dans certaines situations, les usagers peuvent exprimer le désir de se passer de la compétence du pharmacien. Mais, dans d'autres circonstances, bien que s'efforçant de s'adapter aux demandes des usagers, les professionnels peuvent réaffirmer leur autorité d'expert si le problème soulevé ou les médicaments désirés nécessitent plus de vigilance. La relation pharmacien-usager oscille donc dans une négociation constante selon la marge de manoeuvre dont, dans une situation donnée, les uns et les autres disposent.

Outpatient prescriptions practice and writing quality in a paediatric university hospital.

BACKGROUND: The writing of prescriptions is an important aspect of medical practice. This activity presents some specific problems given a danger of misinterpretation and dispensing errors in community pharmacies. The objective of this study was to determine the evolution of the prescription practice and writing quality in the outpatient clinics of our paediatric university hospital.¦METHODS: Copies of prescriptions written by physicians were collected from community pharmacies in the region of our hospital for a two-month period in 2005 and 2010. They were analysed according to standard criteria, including both formal and pharmaceutical aspects.¦RESULTS: A total of 597 handwritten prescriptions were reviewed in 2005 and 633 in 2010. They contained 1,456 drug prescriptions in 2005 and 1,348 in 2010. Fifteen drugs accounted for 80% of all prescriptions and the most common drugs were paracetamol and ibuprofen. A higher proportion of drugs were prescribed as International Nonproprietary Names (INN) or generics in 2010 (24.7%) compared with 2005 (20.9%). Of the drug prescriptions examined, 55.5% were incomplete in 2005 and 69.2% in 2010. Moreover in 2005, 3.2% were legible only with difficulty, 22.9% were ambiguous, and 3.0% contained an error. These proportions rose respectively to 5.2%, 27.8%, and 6.8% in 2010.¦CONCLUSION: This study showed that fifteen different drugs represented the majority of prescriptions, and a quarter of them were prescribed as INN or generics in 2010; and that handwritten prescriptions contained numerous omissions and preventable errors. In our hospital computerised prescribing coupled with advanced decision support is eagerly awaited.

The State of the Judiciary, 2009

Thank you for inviting me again this year to talk with you about the condition of Iowa’s judicial branch. As your partner in government, we look forward to working with you on issues affecting the administration of justice. If I could capture the condition of our courts, indeed the condition of our state, in a few words, it would be: “We live in challenging times.” No one knows the true meaning of this phrase better than those Iowans hit by natural disasters. But my focus today is, of course, on the courts. Ensuring the delivery of equal, affordable and accessible justice is always challenging work, but it will be especially so this year and the next in light of the State’s budget problems. Given the magnitude of this challenge, it is even more imperative that we work together in the spirit of unity, candor and cooperation. And I address you today in this spirit. We are deeply concerned, as you are, about the present financial situation and its effect on individual Iowans. Naturally, we are particularly troubled about its impact on the delivery of justice to our citizens. Even in good economic times, the administration of justice is difficult to fulfill given the sheer volume and complexity of problems Iowans bring to their courthouses. Because of the effects of the nation’s economic downturn, people will need access to justice now more than ever. We already see this happening. The number of mortgage foreclosure cases in Iowa rose 14% in the past year. Debt collection cases increased 20% in the same time. An increase in these types of cases is predictable in tough economic times, but other types of problems may escalate as well. Some experts fear that a recession may also give rise to more crime, child abuse, domestic violence, and substance abuse. Naturally, for the sake of the people who may be harmed by these problems, we hope they do not occur. If they do, however, these matters will demand our immediate attention.

Sweet diversity: Colonial goods and the rise of European living standards after 1492

When did overseas trade start to matter for living standards? Traditional real-wage indices suggest that living standards in Europe stagnated before 1800. In this paper, we argue thatwelfare rose substantially, but surreptitiously, because of an influx of new goods as a result ofoverseas trade. Colonial luxuries such as tea, coffee, and sugar transformed European diets afterthe discovery of America and the rounding of the Cape of Good Hope. These goods became household items in many countries by the end of the 18th century. We use three different methodsto calculate welfare gains based on price data and the rate of adoption of these new colonialgoods. Our results suggest that by 1800, the average Englishman would have been willing to forego 10% or more of his income in order to maintain access to sugar and tea alone. These findings are robust to a wide range of alternative assumptions, data series, and valuation methods.

The major genetic determinants of HIV-1 control affect HLA class I peptide presentation.

Infectious and inflammatory diseases have repeatedly shown strong genetic associations within the major histocompatibility complex (MHC); however, the basis for these associations remains elusive. To define host genetic effects on the outcome of a chronic viral infection, we performed genome-wide association analysis in a multiethnic cohort of HIV-1 controllers and progressors, and we analyzed the effects of individual amino acids within the classical human leukocyte antigen (HLA) proteins. We identified >300 genome-wide significant single-nucleotide polymorphisms (SNPs) within the MHC and none elsewhere. Specific amino acids in the HLA-B peptide binding groove, as well as an independent HLA-C effect, explain the SNP associations and reconcile both protective and risk HLA alleles. These results implicate the nature of the HLA-viral peptide interaction as the major factor modulating durable control of HIV infection.