A preliminary investigation of the effectiveness of a sleep apnea education program

Objectives: This study aimed to evaluate a standardised sleep apnea patient education program and develop a study design that may be used to evaluate other such education programs. Method: Thirty-four adults diagnosed with obstructive sleep apnea hypopnea syndrome (OSAHS) underwent a standard sleep apnea education program and completed measures of knowledge of and beliefs about sleep apnea before, after, and 3 months following education. Two outcome measures were used: the Apnea Knowledge Test (AKT) and the Apnea Beliefs Scale (ABS). Results: AKT results showed significant knowledge gains posteducation, which were maintained at follow-up. Patients also reported more positive beliefs about their ability to change their behaviour and comply with continuous positive airway pressure (CPAP) treatment recommendations after education. Discussion: Findings from this preliminary investigation suggest that the education program used in this study may improve patients' knowledge of CPAP and promote functional beliefs about OSAHS treatment. This program clearly warrants further research, and ultimately such programs may prove important in improving CPAP compliance. (C) 2004 Elsevier Inc. All rights reserved.

Two new tools for assessing patients' knowledge and beliefs about obstructive sleep apnea and continuous positive airway pressure therapy

Background and purpose: Patients' knowledge and beliefs about their illnesses are known to influence a range of health related variables, including treatment compliance. It may, therefore, be important to quantify these variables to assess their impact on compliance, particularly in chronic illnesses such as Obstructive Sleep Apnea (OSA) that rely on self-administered treatments. The aim of this study was to develop two new tools, the Apnea Knowledge Test (AKT) and the Apnea Beliefs Scale (ABS), to assess illness knowledge and beliefs in OSA patients. Patients and methods: The systematic test construction process followed to develop the AKT and the ABS included consultation with sleep experts and OSA patients. The psychometric properties of the AKT and ABS were then investigated in a clinical sample of 81 OSA patients and 33 healthy, non-sleep disordered adults. Results: Results suggest both measures are easily understood by OSA patients, have adequate internal consistency, and are readily accepted by patients. A preliminary investigation of the validity of these tools, conducted by comparing patient data to that of the 33 healthy adults, revealed that apnea patients knew more about OSA, had more positive attitudes towards continuous positive airway pressure (CPAP) treatment, and attributed more importance to treating sleep disturbances than non-clinical groups. Conclusions: Overall, the results of psychometric analyses of these tests suggest these measures will be useful clinical tools with numerous beneficial applications, particularly in CPAP compliance studies and apnea education program evaluations. (C) 2004 Elsevier B.V. All rights reserved.

Regional Variation on Rates of Bronchopulmonary Dysplasia and Associated Risk Factors

Background. An abnormally high incidence (44%) of bronchopulmonary dysplasia with variations in rates among cities was observed in Colombia among premature infants. Objective. To identify risk factors that could explain the observed high incidence and regional variations of bronchopulmonary dysplasia. Study Design. A case-control study was designed for testing the hypothesis that differences in the disease rates were not explained by differences in city-of-birth specific population characteristics or by differences in respiratory management practices in the first 7 days of life, among cities. Results. Multivariate analysis showed that premature rupture of membranes, exposure to mechanical ventilation after received nasal CPAP, no surfactant exposure, use of rescue surfactant (instead of early surfactant), PDA, sepsis and the median daily FIO2, were associated with a higher risk of dysplasia. Significant differences between cases and controls were found among cities. Models exploring for associations between city of birth and dysplasia showed that being born in the highest altitude city (Bogotá) was associated with a higher risk of dysplasia (OR 1.82 95% CI 1.31–2.53). Conclusions. Bronchopulmonary dysplasia was manly explained by traditional risk factors. Findings suggest that altitude may play an important role in the development of this disease. Prenatal steroids did not appear to be protective at high altitude.

Incidencia de eventos cardiovasculares en pacientes diagnósticados de síndrome de apnea del sueño. Factores de riesgo e impacto del tratamiento

OSAS is an increasingly common disease in general population. In Spain, the prevalence is estimated of being around 20%. This is an important public health problem, both due to the use of health resources involved and the consequences on the quality of life of the patients. Its main risk factor is obesity, a disease whose prevalence is increasing, which consequently will also cause a long term increase in the number of OSAS diagnosis. On the other hand, cardiovascular diseases are the leading cause of death in Spain and also pose high health care costs. Therefore, the union of OSA and cardiovascular disease cause a high consumption of health resources and generates a large number of comorbidities and increased mortality rates. It is because of this that the early diagnosis and treatment are of great importance. Treatment with CPAP in these patients is very effective and reduces the number of cardiovascular complications...

Como tornar uma fazenda pantaneira mais sustentável?

Pesquisadores desenvolvem uma ferramenta para fazer múltiplas avaliações e responder a esta pergunta de maneira clara para os tomadores de decisão.

O segredo está nas raízes.

Por cima da terra, seja no Cerrado ou no Pantanal, várias árvores da mesma espécie são bem semelhantes debaixo do solo.

O jacaré-do-pantanal e suas artimanhas.

2016

Fazendas pantaneiras agora sob nova orientação.

2016

Veado-campeiro, patrimônio pantaneiro.

A espécie é uma das mais comuns no Pantanal, mas nem por isso dispensa estudos e atenção dos cientistas. Sua presença como podador ajuda a moldar a paisagem.

Limnoperna fortunei (Dunker, 1857) (Mollusca, Bivalvia, Mytilidae): first record in the São Francisco River basin, Brazil.

Limnoperna fortunei (Dunker, 1857) is a small mytilid native to Southeast Asia. It was introduced in South America in early 1990 and has dispersed from Argentina to central Brazil, and until 2014 has been restricted mainly to the Paraná and Uruguay river basins. The present note reports the occurrence of Limnoperna fortunei for the first time in the São Francisco River basin in northeastern Brazil. The establishment of L. fortunei in these regions will require close attention from the government and also by society.

Uso de resíduos da indústria de papel e celulose em plantios florestais: aspectos técnicos e legais.

Introdução; Principais resíduos sólidos e semi-sólidos gerados em complexos integrados de celulose e papel; Aspectos técnicos e legais voltados à elaboração de projeto agronômico para uso de resíduos em plantios florestais; Caracterização e classificação dos resíduos quanto aos seus riscos potenciais ao meio ambiente e à saúde pública; Caracterização de resíduos sob o aspecto agronômico; Critérios para definição de doses, épocas e formas de aplicação; Avaliação de problemas de ordem ambiental; Avaliação da viabilidade econômica; Seleção e caracterização das áreas de aplicação; Monitoramento agronômico e ambiental da área de aplicação; Manuseio, transporte e armazenamento; Processos adicionais de tratamento.

Cuidados de enfermería en el paciente crítico con ventilación mecánica no invasiva

El desarrollo biotecnológico en el siglo XX, y la progresión mantenida en el siglo XXI, generan un gran cambio en los cuidados a los pacientes. Como disciplina y profesión sanitaria la Enfermería debe ser capaz de adaptarse a los cambios y a las necesidades de los usuarios, con el fin de garantizar y procurar la excelencia del cuidado. La Ventilación Mecánica No Invasiva (VMNI) es un soporte ventilatorio que, sin invadir la vía aérea, logra mantener presiones positivas. Sus beneficios y utilidades son diversos según sus modos –BiPAP, CPAP-. El hecho de no ser invasiva conlleva que el paciente debe estar consciente y colaborar con la técnica ventilatoria, evitando de este modo la sedación y el riesgo de infección relacionado con los dispositivos supra e infra glóticos. Sin duda, como toda intervención también están descritas sus contraindicaciones y, el abordaje de cuidados por parte de enfermería debe ser constante, con el fin de garantizar la calidad de dicho procedimiento. La VMNI a través de un flujo generado por una turbina / respirador, logra la presión positiva en el paciente al ceñir una interfaz a la superficie facial. Existen múltiples interfaces en función del tamaño del usuario, de la vía aérea a ventilar –boca, nariz y boca-nariz- y de los puntos de apoyo donde se realiza la presión con el fin de ceñir la máscara y evitar fugas. Al generar presión a NIMVel tisular, existe un alto riesgo per se. Enfermería debe de valorar, diagnosticar y planificar los objetivos e intervenciones con el fin de preservar la dermis y la epidermis de lesiones; evaluando de manera periódica los resultados obtenidos y adaptando sus cuidados a las nuevas necesidades del paciente. A la intervención propiamente de la VMNI le acompañan otros procedimientos habitualmente, como son la monitorización gasométrica del paciente, la aerosolterapia y todas aquellas actividades que el profesional de Enfermería realiza para evitar las infecciones. Además, durante la evaluación continua de todo el proceso, la agudización de la situación del paciente puede conllevar la necesidad de permeabilizar la vía aérea, por lo que hay que conocer la Secuencia Rápida de Inducción e Intubación. La presente Tesis da respuesta a cómo se deben realizar los cuidados que Enfermería durante el complejo manejo del paciente crítico que precisa Ventilación Mecánica No Invasiva. Con el fin de mejorar el confort de los usuarios y favorecer la limpieza de la vía aérea, el intercambio gaseoso y mejorar el patrón respiratorio se han diseñado y ejecutado cinco estudios y dos proyectos de investigación, con el fin de generar nuevas y futuras líneas de investigación en las que ya se están trabajando. Las conclusiones alcanzas determinan la necesidad de cambio en las actividades en dos de las intervenciones descritas en la clasificación normalizada de Enfermería –NIC-: “Manejo de la Ventilación Mecánica: prevención de la Neumonía” y “Manejo de la Ventilación Mecánica: No Invasiva”. Además, de la necesidad de desarrollar e incluir a la NIC: “Administración de medicación: aerosolterapia durante la ventilación mecánica no invasiva: inhalatoria”.

Stepwise evolution of the centriole-assembly pathway

The centriole and basal body (CBB) structure nucleates cilia and flagella, and is an essential component of the centrosome, underlying eukaryotic microtubule-based motility, cell division and polarity. In recent years, components of the CBB-assembly machinery have been identified, but little is known about their regulation and evolution. Given the diversity of cellular contexts encountered in eukaryotes, but the remarkable conservation of CBB morphology, we asked whether general mechanistic principles could explain CBB assembly. We analysed the distribution of each component of the human CBB-assembly machinery across eukaryotes as a strategy to generate testable hypotheses. We found an evolutionarily cohesive and ancestral module, which we term UNIMOD and is defined by three components (SAS6, SAS4/CPAP and BLD10/CEP135), that correlates with the occurrence of CBBs. Unexpectedly, other players (SAK/PLK4, SPD2/CEP192 and CP110) emerged in a taxon-specific manner. We report that gene duplication plays an important role in the evolution of CBB components and show that, in the case of BLD10/CEP135, this is a source of tissue specificity in CBB and flagella biogenesis. Moreover, we observe extreme protein divergence amongst CBB components and show experimentally that there is loss of cross-species complementation among SAK/PLK4 family members, suggesting species-specific adaptations in CBB assembly. We propose that the UNIMOD theory explains the conservation of CBB architecture and that taxon- and tissue-specific molecular innovations, gained through emergence, duplication and divergence, play important roles in coordinating CBB biogenesis and function in different cellular contexts.

Tratamiento quirúrgico del síndrome de apnea hipopnea obstructiva del sueño en la Clínica Rivas, Bogotá – Colombia

Introducción: El Síndrome de Apnea Hipopnea Obstructiva del Sueño es un trastorno respiratorio del sueño mayor ampliamente conocido, con importantes implicaciones para los pacientes y cuya incidencia ha venido en aumento durante los últimos años; comprende diversas manifestaciones clínicas que varían desde el ronquido hasta consecuencias cardiovasculares importantes. Objetivo: Describir la experiencia de los procedimientos quirúrgicos más utilizados para el tratamiento de pacientes con Trastornos Respiratorios del Sueño en la Clínica Rivas. Diseño: Estudio observacional descriptivo. Métodos: Revisión de 366 historias clínicas de pacientes con diagnóstico clínico y Polisomnográfico de SAHOS intervenidos quirúrgicamente debido al Trastorno Respiratorio del Sueño por rechazo de terapia de presión positiva en 3 años de observación. Resultados: Se evaluaron diferencias en medianas de los cambios del IAH, índice de Saturación de oxigeno basal y mínima, y el índice de microdespertares nocturnos tanto prequirúrgica como postquirúrgicamente. Como medida de evaluación secundaria se evaluaron las complicaciones quirúrgicas. Conclusión: En nuestra institución, como centro de referencia en apnea del sueño, la cirugía ha demostrado que disminuye de forma significativa gravedad del SAHOS y disminuye el riesgo de los pacientes con trastornos respiratorios del sueño que han rechazado el dispositivo de presión positiva.

Embrapa Monitoramento por satélite: um estudo a partir de periódicos indexados.

O trabalho tem por objetivo maior obter inferências sobre o direcionamento da produção científica da Embrapa Monitoramento por Satélite a partir da análise do comportamento dos artigos de periódicos publicados pela instituição, no período de 2010 a 2014. Nessa vertente, busca-se conhecer o impacto gerado na comunidade científica, medido pelo número de citações, bem como os principais artigos e periódicos utilizados para publicação.