Fatores de risco no ambiente do trabalho de enfermagem em um hospital universitário

Pesquisa realizada em um Hospital Universitário do Estado do Rio de Janeiro, através de uma abordagem quantitativa descritiva, com objetivo de identificar os fatores de riscos ambientais presentes nas situações de trabalho dos profissionais de enfermagem, a partir da observação sistemática dos locais de trabalho pelos profissionais de saúde e segurança do trabalho e dos chefes de enfermagem de clínicas de um Hospital Universitário, visando gerar resultados que possam trazer a discussão, os riscos ocupacionais aos quais estão expostos os profissionais de enfermagem, seu conhecimento a respeito destes riscos e sua atuação na identificação e ação sobre os mesmos. A população foi composta por treis profissionais de saúde e segurança no trabalho e trinta enfermeiros chefes de unidade de internação. Para a coleta de dados foi utilizado um questionário fechado proposto no Guia de Avaliação de Riscos nos Locais de Trabalho de Boix e Vogel (1997) e adaptado para aplicação em estabelecimentos de saúde por Mauro (2001). Os dados foram analisados através do software Statical Package for the Social Sciences (SPSS) versão 15.0. Os resultados evidenciaram que os fatores de riscos ocupacionais de maior relevância do estudo foram: os sistemas inadequados de prevenção de incêndio, de saída de emergência e dispositivos e instruções de segurança e manutenção preventiva inadequada, exposição à riscos biológicos, desenho arquitetônico dos locais de trabalho inadequado, distribuição inadequada de pessoal e conhecimento ergonômico insuficiente do trabalhador. Estes fatores atuam de forma direta ou indireta nos locais de trabalho, propiciando aos profissionais um ambiente desfavorável para a realização das atividades, o que pode comprometer a sua saúde e vida profissional. Concluiu-se que os profissionais enfermeiros no cargo de gestores, em sua maioria, não possuem a visibilidade sobre os fatores de riscos aos quais eles próprios e a equipe sob sua gerência encontram-se expostos, mesmo porque desempenham suas tarefas quase em sua integralidade com alto risco de acidentes e doenças. O estudo proporcionou melhor compreensão dos fatores de risco presentes no ambiente, suas repercussões no processo de trabalho de enfermagem e na saúde dos profissionais, da importância da inserção e comprometimento dos gestores sobre os fatores de risco no ambiente de trabalho e da ergonomia participativa na análise e prevenção de riscos ocupacionais.

在盐胁迫下外源维生素浸种对小麦发芽及幼苗生长的影响

维生素(Vitamin)又称维他命，为“万年青”产品，是维持人体生命健康必需的一类低分子有机化合物质。维生素对人体健康的作用人们研究很多, 维生素可以增强人体对感染的抵抗力，降低出生缺陷及降低癌症和心脏病发病率等，一旦缺乏，肌体代谢就会失去平衡，免疫力下降，各种疾病，病毒就会趁虚而入；而维生素对作物影响的研究却很少。目前为止，尚无对用维生素浸种的方法来研究外源维生素是否对小麦种子萌发及幼苗生长起调节作用的报道，且对其在小麦抗逆性方面影响的研究甚少，对盐的胁迫抗性研究尚未有人报道。小麦（Triticum aestivum L.）属于拒盐的淡土性作物。盐害不利于小麦生长，严重影响小麦的产量和品质。本研究采用4 种不同维生素VB1、VC、VB6、VPP，分别对供试小麦品种川育12（红皮）、川育16（白皮）小麦浸种后，在一般自然条件下和逆境（盐胁迫条件）下，进行试验。探讨在正常情况下与在不同盐浓度条件下，各维生素及盐浓度对小麦发芽及幼苗生长的影响，并且比较两种不同皮色的小麦在相同盐胁迫条件下的差异表现，同时研究维生素处理的特异性，且哪种维生素对盐害缓解作用最佳。研究结果表明：在无盐胁迫（自然）条件下，对用4 种不同维生素VB1、VC、VB6、VPP 浸种小麦川育12、川育16 后的种子萌发及幼苗生长（幼苗的根长、根重、苗高、苗鲜重）的研究结果表明：4 种外源维生素浸种均对小麦发芽有调节作用，都能提高其最终发芽率。但是提高幅度有所差异。用VB6 浸种后的小麦提高幅度最多，VC 次之，VPP 提高幅度最小。同时，4 种外源维生素浸种对小麦种子的出芽速度及芽后长势也有一定的影响。VB6、VC 处理的小麦种子出芽速度最快，萌发后长势最好；VB1 出芽速度相对较慢，VPP 最慢,但都大于对照；VB1 处理长势略高于对照，VPP 处理的小麦长势则低于对照。从整体来看，VB6、VC处理促进效应明显， VB1 次之，而VPP 在某些方面无效甚至产生负效应。此外，相同的维生素处理对不同的品种的种子萌发、生长效果也存在差异，各种维生素作用于川育12 的效应均强于对川育16。进一步对幼苗根系TTC 还原力及幼苗叶片中硝酸还原酶活性进行测定、分析。研究发现：并非所有种类的维生素对幼苗根系TTC 还原力及幼苗叶片中硝酸还原酶活性的提高都有帮助。幼苗根系TTC 还原力在不同维生素处理下存在显著差异，而与小麦品种关系甚微。经VB6、VC 处理后，根系TTC 还原力测定值均显著高于对照，VB1 不明显，VPP 则略低于对照。VB6、VC 处理的幼苗叶片中硝酸还原酶的含量大于对照，VB1 与对照相差无几，而VPP 处理的川育12 幼苗叶片中的硝酸还原酶活性比对照CK 略高，而在川育16 中则略比对照CK 有所下降，呈现出抑制效应。综上结果表明：VB6、VC 具有促进种子发芽，幼苗生长及根系生长的作用，是较好的促生长剂；VPP 具有抑制作用，是较好的抑制剂，可进一步研究、开发利用。在盐胁迫条件下，对用4 种不同维生素VB1、VC、VB6、VPP 浸种川育12、川育16 后的种子萌发及幼苗生长（幼苗的根长、根重、苗高、苗鲜重）的研究结果表明：在不同盐浓度胁迫条件下， 各处理的种子萌发及幼苗生长均受到不同程度的抑制。随着盐浓度的增加, 发芽率、发芽指数和活力指数成下降趋势；幼苗的根长、根重、苗高、苗鲜重不断降低。4 种维生素处理间也表现出较大差异。VB6、VC 在每个处理中均保持对盐害的缓解作用，VB6 较VC 更易于促进发芽及幼苗生长。最终发芽率高，根系多、长、重，苗高高、重。而VB1、VPP 则表现出抑制作用。在高盐浓度150mM 时，4 种维生素浸种后的种子，其最终发芽率均不能达到40％，但VB6、VC 处理最终发芽率、苗重、根重均高于对照，VPP 最终发芽率、苗重、根重均低于对照。进一步对幼苗根系TTC 还原力及幼苗叶片中脯氨酸含量进行测定、分析。研究发现：不同盐浓度，不同维生素处理、不同品种间存在差异。随着盐浓度的增加（75mM，100mM，150mM），幼苗根系TTC 还原力活性成下降趋势，幼苗叶片中脯氨酸的积累量成上升趋势。VB6 处理脯氨酸含量增加最为明显，VC 次之，VPP 与对照接近，其变化幅度最小。经VB6、VC 处理后的幼苗根系还原强度，在不同盐浓度下，测定值均显著高于对照，VB1 不明显，VPP 则低于对照，产生负效应。此外，品种间表现不尽相同，相同的维生素处理，相同的盐浓度对不同的品种的种子萌发、生长效果也存在差异， 4 种维生素对川育16 的作用均强于川育12，但其影响趋势是一致的。说明VB6、VC 具有耐（抗）盐性，可以促进种子发芽和幼苗生长，是较好的耐（抗）盐拌种剂。 Vitamin is one kind of necessary low molecular compound for humans tosustain health and life. Lots of Studies have been done on the effectc of the vitaminsfor people. Vitamin can help people improve the body's natural resistance to disease,Drop the rate of birth defects、cacers and the incidence of the heart diseases. Ifpeople have less of them, the metabolism of the organism may throw off balance,immunity may drop off, and catch disease; Though the effects for Vitamin to thecrops are limited. up to now, there’s no one use soking seeds of wheats with vitaminsas a method, to study on how the effects will happen on the wheat seed germinationand seedling growth, and there are only few reserches on antireversion force forwheats ,none for the antireversion force in Sault stress condition.Wheat（Triticum aestivum L.）is sensitive to the salt, so the salt damage will doharm to wheat’s growth, it will have an unfavorable impact on the output and thequality of wheat.On this reaserch, we Soaking CHY12(red)、CHY16 (white) wheat seeds withVitamin C, B1, PP, B6 (50mg/L) as a pretreatment first. Then under two condition: one is in the normal environment the other is in different Salinity, we begin ourexperiments. Then disscuss on if the vitamin and salinity affect the wheat seedgermination and seedling growth, and what is the different between the two of them,the result shows that:Under the normal condition, after soaking seeds with VB1、VC、VB6、Vpp，we study on the their seed germination and the seeding growth(the root length andweights, The seedling heights and weights), it shows that all of those four kinds ofvitamin can adjust the seed germination, but different in The growth rate. VB6 isbest for increase, VC comes second,VPP is the worst. Meanwhile, those four vitaminalso have effect on the speed of the sprouting of the wheat. VB6、Vc can faster theseed germination most, and the seedlings are all doing well; VB1 do little effects onthe budding, Vpp is the worst, but all treatments are better than CK; but in Vi, VB1some what above the CK, while VPP lower than that. On the whole, the acceleratingeffect of VB6、VC are obvious, VB1 takes second place, but VPP in some aspects arenoneffective even have negative effect. Furthermore, different kind of seeds with thesame vitamin may different in seed germination and seedling growth, four vitaminson CHY16 is better than CHY12.More studies on TTC reductive capacity of roots and the activity of nitratereductase in the leaves, the reasult shows not all the vitamin can help the seedlings toimprove the TTC reductive capacity and the activity of nitrate reductase. TTCreductive capacity in different treatments shows significant differences,but notcorrelate to the variety of the wheat. The TTC reductive capacity of VB6、Vctreatments are all higher than CK, VB1 is nearly the same as CK, VPP is a littlelower than CK. Through the study of acivity of nitrate reductase, it shows that,VB6、VC are higher than CK ,VB1 is nearly the same as CK also, VPP is a little higher inthe CK of CHY12 but lower in CHY16. Through all the results above: VB6、Vc helpthe wheat seed germination, seedling growth and the growth of roots, is theperfectable factor of stimulating the growth; Vpp is a inhibition, that’ll be furtherreserch,and well develop and utilize in the future.Under the different Salinity condition, after soaking seeds with VB1、VC、VB6、Vpp，we study on the their seed germination and the seeding growth(the root lengthand weights, The seedling heights and weights), it shows that: under differentsalinity, the seed germination and the seedling growth of any treatment are inhibited.With the increase of the concentration, the germination rate, Vi、Gi all had fallen; theroot length and weight, the seedling heights and weights steadily sank down. There are also have pronounced difference between all treatments with four differentvitamins.VB6、VC in all treatments are alleviative the salt damage, VB6 is easier tocause to put forth buds than VC, and it’s quantitative value is the highest in theultimate germination rate, in root and seedlings’ hight and weight. Though the VPP、VB1 are seems to inhibite its growth. Under the high concentration150mM Nacl, theultimate germination rate in all treatments are below the 40%, but VB6、VC’squantitative values in any experiments are higher than CK,while VPP lower thanCK.Then we study on the TTC reductive capacity of roots and the content of Polinein leaves, the result shows that between the different salinity, different vitamintreatments, different varieties of the wheat have discrepancy.along with theincreasing concentraion of the salinity（75mM，100mM，150mM），TTC reductivecapacity of roots decreases, the accumulation of the content of Poline in leaves havean upward trend. The increase of VB6’s treatment are obviously, VC comessecond,VPP is nearly come up with CK, changes a little. In TTC reductive capacity of roots’s reserch, VB6、VC are higher than CK at any time,VB1 is not palpable,VPP is lower than CK, makes negative affect on wheat. In addition, varieties of thewheats are remain different, no matter it shows promoting or inhibiting, all fourvitamins have moreobvious effects on CHY16 than CHY12, but the tendency of theeffection are the same. It is say that VB6、VC can help wheat to standwith the saultwell, and promot in growth，they are the better reagent to mix with the seed.

Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia

Background: This is an update of a previous review (McGuinness 2006). Hypertension and cognitive impairment are prevalent in older people. Hypertension is a direct risk factor for vascular dementia (VaD) and recent studies have suggested hypertension impacts upon prevalence of Alzheimer's disease (AD). Therefore does treatment of hypertension prevent cognitive decline?
Objectives: To assess the effects of blood pressure lowering treatments for the prevention of dementia and cognitive decline in patients with hypertension but no history of cerebrovascular disease.
Search strategy: The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group, The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS as well as many trials databases and grey literature sources were searched on 13 February 2008 using the terms: hypertens$ OR anti-hypertens$. Selection criteria: Randomized, double-blind, placebo controlled trials in which pharmacological or non-pharmacological interventions to lower blood pressure were given for at least six months.
Data collection and analysis: Two independent reviewers assessed trial quality and extracted data. The following outcomes were assessed: incidence of dementia, cognitive change from baseline, blood pressure level, incidence and severity of side effects and quality of life.
Main results: Four trials including 15,936 hypertensive subjects were identified. Average age was 75.4 years. Mean blood pressure at entry across the studies was 171/86 mmHg. The combined result of the four trials reporting incidence of dementia indicated no significant difference between treatment and placebo (236/7767 versus 259/7660, Odds Ratio (OR) = 0.89, 95% CI 0.74, 1.07) and there was considerable heterogeneity between the trials. The combined results from the three trials reporting change in Mini Mental State Examination (MMSE) did not indicate a benefit from treatment (Weighted Mean Difference (WMD) = 0.42, 95%CI 0.30, 0.53). Both systolic and diastolic blood pressure levels were reduced significantly in the three trials assessing this outcome (WMD = -10.22, 95% CI -10.78, -9.66 for systolic blood pressure, WMD = -4.28, 95% CI -4.58, -3.98 for diastolic blood pressure). Three trials reported adverse effects requiring discontinuation of treatment and the combined results indicated no significant difference (OR = 1.01, 95% CI 0.92, 1.11). When analysed separately, however, more patients on placebo in Syst Eur 1997 were likely to discontinue treatment due to side effects; the converse was true in SHEP 1991. Quality of life data could not be analysed in the four studies. Analysis of the included studies in this review was problematic as many of the control subjects received antihypertensive treatment because their blood pressures exceeded pre-set values. In most cases the study became a comparison between the study drug against a usual antihypertensive regimen.
Authors' conclusions: There is no convincing evidence fromthe trials identified that blood pressure lowering in late-life prevents the development of dementia or cognitive impairment in hypertensive patients with no apparent prior cerebrovascular disease. There were significant problems identified with analysing the data, however, due to the number of patients lost to follow-up and the number of placebo patients who received active treatment. This introduced bias. More robust results may be obtained by conducting a meta-analysis using individual patient data.

Statins for the prevention of dementia

Background: This is an update of a Cochrane review first published in 2001. At that stage there was insufficient evidence to recommend statins for the prevention of Alzheimer's disease (AD). The scope of this review has been expanded to include all forms of dementia.
Objectives: To assess the effects of statins in the prevention of dementia.
Search strategy: The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group, The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 10 October 2007 using the terms statin*, lovastatin*, pravastatin*, simvastatin*, fluvastatin*, atorvastatin* and rosuvastatin*. The CDCIG Register contains records from many healthcare databases, SIGLE, LILACS as well as many trials databases and is updated regularly.
Selection criteria: Double-blind randomized placebo-controlled trials of statins in people at risk of AD and dementia.
Data collection and analysis: Two independent reviewers extracted and assessed data independently and agreement was reached after discussion. Adverse effects were noted.
Main results: Two trials were identified with 26,340 participants; HPS 2002 and PROSPER 2002. Age range was 40-82 years across the two studies, PROSPER 2002 included 5804 patients aged 70-82 years and HPS included 20,536 patients with 5806 at least 70 years old at study entry. Mean total cholesterol 5.9 mmol/l, LDL cholesterol 3.4 mmol/l at study entry with mean reduction in LDL cholesterol of 1.0mmol/l in simvastatin treated patients compared to placebo in HPS 2002. Mean total cholesterol 5.7 mmol/l, LDL cholesterol 3.8 mmol/l at study entry with mean reduction in LDL cholesterol of 1.02 mmol/l in pravastatin treated patients compared to placebo in PROSPER 2002. Mean follow-up 3.2 years in PROSPER, 5 years in HPS 2002. Cognition was measured at different times and with different scales so could not be combined in a meta-analysis. There was no difference in incidence of dementia in HPS 2002 (31 cases in simvastatin group, 31 cases in placebo group) nor in performance on the modified Telephone Interview for Cognitive Status at final follow-up (23.7% simvastatin group cognitively impaired vs 24.2% in placebo group). There was no difference in cognition between groups either in relation to age at study entry or previous history of cerebrovascular disease. Cognitive function declined at the same rate in both treatment groups in PROSPER 2002, there was no significant difference between pravastatin treated and placebo groups in performance on letter digit codes, picture word learning test, Stroop and Mini Mental State Examination. There was no evidence that statins were detrimental to cognition.
Authors' conclusions : There is good evidence from RCTs that statins given in late life to individuals at risk of vascular disease have no effect in preventing AD or dementia. Biologically it seems feasible that statins could prevent dementia due to their role in cholesterol reduction and initial evidence from observational studies was very promising. Indication bias may have been a factor in these studies however and the evidence from subsequent RCTs has been negative.

Physical Activity and Cognitive Function in the Elderly: a Systematic Review

Background: Physical activity appears important contributor for healthy aging, including cognitive function. However, it is unclear whether late life physical activity alone is beneficial to cognitive function. We performed a systematic review to examine the effect of late life physical activity in maintaining cognitive function in older persons.
Methods: Search Strategy and Selection criteria: The search sources consisted of PubMed, MEDLINE, CINAHL, Cochrane Controlled Trials Register (CENTRAL), and the University of Washington Medical School Library Database between July 15, 2011 and August 15, 2012 with language restricted to English. Studies that were published in journals on or after January 2000 with participants older than 60 years of age were reviewed. Randomized controlled trials including at least 30 participants and lasting for at least 6 months and all observational studies of at least 100 participants and lasting at least 1 year in duration were eligible for inclusion Two reviewers assessed the applicability and results of these studies.
Results: Twenty-six studies fulfilling the inclusion criteria are included. Twenty-one studies reported that late life physical activity resulted in maintenance or enhancement of cognitive function. Three studies reported a dose-response relationship between physical activity and cognition.
Conclusions: Late life physical activity is beneficial for cognitive function in the elderly. However, the majority of the evidence is of medium quality with moderate risk of bias. Larger, randomized controlled trials are needed to better define the association between late life physical activity and cognitive function. Further research is required to determine which types of exercise have the greatest benefits on specific cognitive domains. Despite these caveats, current data are sufficient to recommend that moderate level, late life physical activity may be an effective method to improve cognitive function and delay the onset and progression of cognitive disease in the elderly.

O interesse socioeducativo (e as dificuldades) de traduzir em português-espanhol

O Projeto que apresentamos insere-se nos estudos do Mestrado em Tradução Especializada dentro da vertente da Saúde e Ciências da Vida; é por isso que, partindo de um texto/suporte que visa promover uma alimentação saudável nas escolas (manual de referência difundido pelos Ministérios da Educação e Ciência e Ministério da Saúde de Portugal), procedemos à tradução (de português para espanhol) de um conteúdo que suscita, nos nossos dias, um grande interesse socioeducativo e cultural. É preciso destacar que o facto de ter nascido e vivido na Venezuela durante doze anos permitiu-me superar com êxito os meus estudos de espanhol na Licenciatura e no referido Mestrado; mas, ao mesmo tempo, tive que me adaptar, enquanto cidadã portuguesa, ao complexo e inacabado processo de ir interiorizando estas duas línguas – português/espanhol – tão próximas e no entanto com sistemas linguísticos bem distintos. Esta evidência encontra a sua maior justificação no grande capítulo dos erros (de forma e de significado) que consegui detetar e analisar graças à ajuda da minha professora orientadora, ao longo deste meu primeiro trabalho académico (texto traduzido para espanhol). Só agora, depois da minha primeira e “ingénua” tradução desse texto/manual, sou capaz de perceber com toda nitidez a dimensão do erro na atividade tradutora, assim como das suas consequências. Além desta importante reflexão, também o facto de elaborar este projeto permitiu-me abordar um aspeto linguístico da língua espanhola que me cativa pessoalmente (no que me diz respeito): o das variantes lexicais do castelhano nos países hispanofalantes. Não duvido em apontar um outro aspeto fundamental: o esforço de ter tido que corrigir minuciosamente e com rigor esta tarefa tradutora (com os seus respetivos comentários tradutológicos) converteu-se numa fonte de múltiplas satisfações pessoais; são aquelas que têm a ver com o cultivo de valores tais como o esforço, o espírito de superação, o exercício da responsabilidade e o (re)conhecimento da honestidade intelectual, entre outros.

Adesão ao regime terapêutico na pessoa com enfarte agudo do miócardio: contributo dos enfermeiros no internamento hospita

RESUMO: O Enfarte Agudo do Miocárdio (EAM) representa um dos principais problemas de saúde pública em Portugal. A rápida intervenção nos factores de risco determinantes da saúde cardíaca pode ter um impacto positivo em vários indicadores de saúde. O objectivo final dessa intervenção passa por capacitar a pessoa, para que, autonomamente, adopte um conjunto de comportamentos de saúde, baseados em estilos de vida protectores da saúde cardíaca, que favorecem positivamente o processo de reabilitação. Esta procura e aquisição do comportamento de saúde, adesão ao regime terapêutico, deve ser desenvolvido em parceria com os profissionais de saúde. O hospital representa a porta de entrada da pessoa com EAM no sistema de saúde. É neste contacto que se inicia uma intervenção de sensibilização e promoção da adesão ao regime terapêutico. Sendo os enfermeiros um grupo profissional que estabelece uma relação continua com a pessoa, importa conhecer um conjunto de dimensões do desempenho dos enfermeiros na promoção da adesão ao regime terapêutico. Breve referência ao desenho de estudo. Foram incluídas no estudo 143 enfermeiros de 9 serviços hospitalares da Região de Saúde de Lisboa e Vale do Tejo. Os dados foram obtidos através de um questionário auto-preenchido. Os dados mostraram que a população de enfermeiros é jovem (M= 30,5: dp= 8,0), 49% têm uma idade £ 26 anos e apresenta pouca experiência profissional (M=7,7; dp= 7,6), 48,2% exerce a profissão há menos de 3 anos. A antiguidade no serviço actual é reduzida (M= 4,7; dp= 4,6), 48,9% estão no serviço há menos de 2 anos. Os enfermeiros acreditam que deviam intervir com mais frequência nos factores de risco fisiológicos e comportamentais que nos factores psicossociais e ambientais; a confiança que têm nas capacidades para intervir nos factores de risco fisiológicos e comportamentais é maior que nos factores psicossociais e ambientais e no último ano, intervieram mais frequentemente nos factores de risco fisiológicos e comportamentais que nos psicossociais e ambientais. O “ensaio” da validação da escala de Will scale de Anderson et al (2004), sobre a capacidade de intervenção na saúde cardíaca, mostrou que o teste de Esfericidade de Bartlett e Medida de adequação da amostragem de Kaiser-Meyer- Olkin (KMO) permitiram a realização da análise factorial em componentes principais (AFCP). Da AFCP emergiram 16 factores, os mesmos que no estudo original de Anderson et al (2004), que revelaram boa consistência interna, com valores de alpha de Cronbach que variaram entre 0,71 a 0,98. Os resultados revelam a necessidade de sensibilizar os enfermeiros para valorizar a intervenção no âmbito dos factores de risco psicossociais e ambientais para promover a adesão ao regime terapêutico. Sugerem ainda que a intervenção baseada na evidência pode ser potenciada de forma a melhorar as práticas de cuidados dos enfermeiros. ABSTRACT: Myocardial infarction (MI) is one of the most important problems in public health in Portugal. A prompt intervention in cardiac health determinants means a positive impact in health outcomes, individually and collectively. The main purpose of this intervention lays on patient’s empowerment so he or she becomes able to choose healthy behaviours, based on heart health protective life styles, and therefore to manage his/hers therapeutic regime. This search and acquisition of health behaviours leading to therapeutic regime adherence may positively have an influence on the whole rehabilitation process and it must be developed in partnership with health workers. MI patients’ first contact with the Health System usually happens at the Hospital. Here the first steps are taken to start an intervention in order to promote therapeutic regime adherence. Nurses are a group of health workers who establish a unique and continuous relation with patients, so it matters to have knowledge of their performance skills that can actually promote a healthy behaviours and increase therapeutic regime adherence. Short Study design The study sample includes 143 nurses working on 9 different hospital wards, belonging to the Lisboa and Tejo’s Valley Health Region, in the district of Lisbon. Data were collected trough a self-administered questionnaire. It revealed that the nurses sample is a young population (M=30,5; dp=8,0), 49% of whom are aged less than 26 years old and has little professional experience (M=7,7; dp= 7,6); 48,2% work has nurses for less than 3 years. There’s a low percentage of seniority (M=4,7; dp=4,6), 48,9% of nurses work in these wards for less than 2 years. Nurses believe they should have intervene more frequently in physiological and behaviour risk factors than in psychological, social and environmental factors; they have greater confidence in their ability to intervene in physiological and behaviour risk factors than to intervene in psychological, social and environmental factors. In last year they took interventions more frequently in physiological and behaviour risk factors than in the other health determinants. The Scale Validation “essay” on Will Scale (Anderson et al, 2004), about heart health intervention capacity, revealed that the Bartlett’s test sphericity and the Kaiser-Meyer- Olkin’s (KMO) appropriate sample measure allowed the factorial analysis on main components (FAMC). From FAMC emerged 16 factors, the same number found on Anderson’s et al (2004) study, revealing good internal consistence, with Cronbach’s alpha values that varied between 0,71 and 0,98. The results point a need for nurses to attribute bigger value to other health determinants intervention - such as psychological, social and environmental determinants - so they’ll take part in promoting therapeutic regime adherence. The results also suggest t

Facteurs de risque de sévérité de la papillomatose respiratoire juvénile

La papillomatose respiratoire récurrente (PRR) juvénile est causée par les génotypes 6 et 11 du virus du papillome humain (VPH). Cette maladie est caractérisée par des verrues récurrentes généralement au larynx. La forme sévère peut avoir un impact dévastateur sur la santé et la qualité de vie de l’enfant atteint et de sa famille en raison des conséquences des multiples chirurgies nécessaires et du risque d'obstruction des voies respiratoires. Objectif: Examiner les facteurs de risque associés aux manifestations sévères de la PRR. Méthode: Étude rétrospective des 31 cas diagnostiqués entre janvier 1995 et décembre 2008. Les données démographiques, cliniques, génétiques et virologiques ont été évaluées. Des régressions logistiques furent effectuées afin d'évaluer le rôle des variables indépendantes sur la sévérité de la maladie. Résultats: Nos données suggèrent que les facteurs de risque de sévérité de la PRR seraient associés au genre féminin (Rapport de cotes (RC)=2.60, intervalles de confiance (IC) 95% : 0.44-15.44), au fait d’être premier-né (RC=3.51, IC 95% : 0.17-72.32), à un statut économique faible (RC=5.31, IC 95% : 0.17-164.19), à un jeune âge (RC=0.83, IC 95% : 0.68-1.01), à une charge virale élevée (RC=3.81, IC 95% : 0.23-63.16) et aux condylomes chez la mère pendant la grossesse (RC=12.05, IC 95% : 0.97-149.85). Conclusion: La sévérité de la PRR serait le résultat d'une combinaison de déterminants qui favoriseraient la croissance cellulaire particulièrement chez les jeunes enfants. Des mesures préventives et thérapeutiques visant à restreindre la contamination et la réplication du virus pourraient réduire le fardeau de la maladie.

Les bases cognitives et cérébrales du traitement sémantique des personnes célèbres : étude chez le jeune adulte et la personne âgée saine, atteinte de TCL, ou de dépression.

Les connaissances que nous avons sur les personnes familières et célèbres représentent un des grands domaines de la mémoire sémantique. Elles ont une valeur sociale importante puisqu'elles nous permettent de reconnaître et d'identifier les personnes que nous connaissons et de les distinguer de personnes que nous ne connaissons pas. La présente thèse comporte deux volets : le premier volet porte sur l’étude des substrats cérébraux du traitement sémantique sur les personnes célèbres chez le jeune adulte, alors que le deuxième volet porte sur l’étude des connaissances sémantiques sur les personnes célèbres chez la personne âgée sans troubles cognitifs, atteinte d’un Trouble cognitif léger de type amnésique (TCLa), d’un Trouble cognitif léger de type amnésique avec symptômes dépressifs (TCLa-D) ou de dépression tardive. Plus précisément, ce dernier volet étudie la relation entre les troubles sémantiques et la présence de symptômes dépressifs. Le premier volet a donc pour objectif d’explorer en imagerie par résonance magnétique fonctionnelle (IRMf) les substrats cérébraux sous-tendant le traitement sémantique de visages célèbres comparé au traitement perceptif (Article 1). Le rôle des régions temporales postérieures (occipito-temporales) dans le traitement perceptif des visages est aujourd’hui bien établi. Les lobes temporaux antérieurs (LTA) semblent avoir un rôle particulièrement important dans l’identification des visages familiers et connus, mais le rôle précis de cette région dans le traitement sémantique des visages connus demeure encore mal compris. Le premier article met ainsi en lumière les régions corticales impliquées dans le processus de reconnaissance de visages, soit du traitement perceptif au traitement sémantique qui nous permet d’identifier et de retrouver des informations biographiques sur le visage qui nous est présenté. Les présents résultats appuient le modèle proposé par Haxby et collègues (2000) selon lequel la région des lobes temporaux antérieurs (LTA) soit associée au traitement sémantique des visages de personnes célèbres. Quant au deuxième volet, il a pour objectif d’étudier au niveau comportemental l’intégrité des connaissances sémantiques biographiques spécifiques et générales chez des personnes âgées sans troubles cognitifs, atteinte d’un TCLa ou d’un TCLa avec symptômes dépressifs (TCLa-D) ou de dépression tardive. (Article 2). La dépression a été jugée comme étant un facteur interdépendant pouvant jouer un rôle dans la variabilité de la présentation clinique des individus TCLa. En effet, il semble que la présence de symptômes dépressifs influence le profil cognitif des individus TCLa, surtout en ce qui à trait aux fonctions exécutives et à la mémoire épisodique. Cependant, aucune étude n’a à ce jour étudié l’impact des symptômes dépressifs sur la mémoire sémantique des personnes célèbres chez les individus TCLa. Les présents résultats indiquent que les individus TCLa montrent des déficits pour le traitement sémantique des personnes célèbres, et que ces déficits sont modulés par la présence d’une symptomatologie dépressive. La dépression à elle seule ne peut toutefois engendrer des déficits sémantiques puisque le groupe ayant une dépression tardive n’a démontré aucune atteinte de la mémoire sémantique. Les implications théoriques et cliniques de ces résultats seront discutées, ainsi que les limites et perspectives futures.

Verbesserung der seismischen Kapazität von Mauerwerkswänden durch Verwendung von Elastomerlagern

Ein großer Teil der Schäden wie auch der Verluste an Gesundheit und Leben im Erdbebenfall hat mit dem frühzeitigen Versagen von Mauerwerksbauten zu tun. Unbewehrtes Mauerwerk, wie es in vielen Ländern üblich ist, weist naturgemäß einen begrenzten Erdbebenwiderstand auf, da Zugspannungen und Zugkräfte nicht wie bei Stahlbeton- oder Stahlbauten aufgenommen werden können. Aus diesem Grund wurde bereits mit verschiedenen Methoden versucht, die Tragfähigkeit von Mauerwerk im Erdbebenfall zu verbessern. Modernes Mauerwerk kann auch als bewehrtes oder eingefasstes Mauerwerk hergestellt werden. Bei bewehrtem Mauerwerk kann durch die Bewehrung der Widerstand bei Beanspruchung als Scheibe wie als Platte verbessert werden, während durch Einfassung mit Stahlbetonelementen in erster Linie die Scheibentragfähigkeit sowie die Verbindung zu angrenzenden Bauteilen verbessert wird. Eine andere interessante Möglichkeit ist das Aufbringen textiler Mauerwerksverstärkungen oder von hochfesten Lamellen. In dieser Arbeit wird ein ganz anderer Weg beschritten, indem weiche Fugen Spannungsspitzen reduzieren sowie eine höhere Verformbarkeit gewährleiten. Dies ist im Erdbebenfall sehr hilfreich, da die Widerstandfähigkeit eines Bauwerks oder Bauteils letztlich von der Energieaufnahmefähigkeit, also dem Produkt aus Tragfähigkeit und Verformbarkeit bestimmt wird. Wenn also gleichzeitig durch die weichen Fugen keine Schwächung oder sogar eine Tragfähigkeitserhöhung stattfindet, kann der Erdbebenwiderstand gesteigert werden. Im Kern der Dissertation steht die Entwicklung der Baukonstruktion einer Mauerwerkstruktur mit einer neuartigen Ausbildung der Mauerwerksfugen, nämlich Elastomerlager und Epoxydharzkleber anstatt üblichem Dünnbettmörtel. Das Elastomerlager wird zwischen die Steinschichten einer Mauerwerkswand eingefügt und damit verklebt. Die Auswirkung dieses Ansatzes auf das Verhalten der Mauerwerkstruktur wird unter dynamischer und quasi-statischer Last numerisch und experimentell untersucht und dargestellt.

El SIDA: incidencias en el mercado asegurador desde una perspectiva financiera y de tutela a los derechos humanos

Debe propugnarse por la existencia de un equilibrio entre la libertad contractual y viabilidad financiera de la industria aseguradora, y los derechos humanos de las personas viviendo con el VIH/SIDA, entre estos se debe encontrar la posibilidad de acceder a seguros de salud y vida. Los aseguradores deben colaborar, junto con el resto de estamentos de la sociedad, en la activa prevención de la pandemia, con base en un principio de solidaridad e interés general, pero también como parte de una estrategia acorde con su actividad.

Factores asociados a calidad de vida en pacientes de hemodiálisis incidentes y prevalentes

Introducción: la insuficiencia renal crónica IRC ha aumentado su prevalencia en los últimos años pasando de 44.7 pacientes por millón en 1993 a 538.46 pacientes por millón en 2010, los pacientes quienes reciben terapia de remplazo renal hemodiálisis en Colombia cada vez tienen una mayor sobrevida. El incremento de los pacientes y el incremento de la sobrevida nos enfocan a mejorar la calidad de vida de los años de diálisis. Metodología: se comparó la calidad de vida por medio del SF-36 en 154 pacientes con IRC estadio terminal en manejo con hemodiálisis, 77 pacientes incidentes y 77 pacientes prevalentes, pertenecientes a una unidad renal en Bogotá, Colombia. Resultados: se encontró una disminución de la calidad de vida en los componentes físicos (PCS) y metales (MCS) de los pacientes de hemodiálisis en ambos grupos. En el modelo de regresión logística la incapacidad laboral (p=0.05), el uso de catéter (p= 0,000), el bajo índice de masa corporal (p=0.021), la hipoalbuminemia (p=0,033) y la anemia (p=0,001) fueron factores determinantes en un 78,9% de baja calidad de vida de PCS en los pacientes incidentes con respecto a los prevalentes. En el MCS de los pacientes incidentes vs. Prevalentes se encontró la hipoalbuminemia (p=0.007), la anemia (p=0.001) y el acceso por catéter (p=0.001) como factores determinantes en un 70.6% de bajo MCS Conclusiones: la calidad de vida de los pacientes de diálisis se encuentra afectada con mayor repercusión en el grupo de los pacientes incidentes, se debe mejorar los aspectos nutricionales, hematológicos y de acceso vascular en este grupo.

Grado de pérdida de capacidad laboral asociada a la comorbilidad de los desórdenes músculo esqueléticos en la junta de calificación de invalidez regional Huila, 2009-2012

Resumen: Los desórdenes músculo esqueléticos son entidades que generan un efecto en la salud relacionados con la calidad de vida, dado al impacto global en la condición física, el bienestar psicológico y funcional. Estas entidades generan un gran número de indemnizaciones y en algunas oportunidades según el grado de pérdida de capacidad laboral la invalidez. Objetivo: Determinar la asociación del grado de perdida de la capacidad laboral con la comorbilidad de los desórdenes músculo esqueléticos y otros factores asociados. Materiales y métodos: Se realizó un estudio de corte transversal, basado en registros e historias clínicas. Los registros iniciales fueron 1427 casos, de los cuales 513 presentaban diagnóstico de DME y de estos 240 solicitaron la pérdida de capacidad laboral a la junta de invalidez regional Huila en el periodo comprendido del 2009 al 2012. Resultados: La distribución del grado de la pérdida de capacidad laboral generada de los DME por incapacidad permanente parcial fue del 73,3% y por invalidez el 26,7%. Se encontró una asociación significativa con respecto a la edad (p=0,002), donde el rango de 50-65 años presento mayor pérdida de capacidad laboral; con el género (p=0,047), siendo el femenino más prevalente la invalidez (34,7%) que en el masculino (23,2%) y la comorbilidad (p=0,019), donde los desórdenes músculo esqueléticos y los trastornos depresivos generaron mayor pérdida de capacidad laboral. No se encontró asociación significativa con la escolaridad (p=0,167), oficio (p=0,442) y actividad económica (p=0,118). En el análisis multivariado se encontró asociación significativa con el origen común (OR=4.028, IC 95%: 2.010, 8.072), el sexo femenino (OR=2.565, IC 95%: 1.140, 5.771), y el nivel de escolaridad técnico (OR=12.208, IC 95%: 1.372, 108.634). Conclusiones: La comorbilidad generó mayor pérdida de capacidad laboral, aunque los factores que en conjunto mostraron asociación fueron la edad avanzada, el género femenino, el origen común y el menor nivel educativo.

Eficiencia de los sistema de salud en los países de América Latina y del Caribe desde el indicador de esperanza de vida al nacer para los años 1990 y 2012 frente al gasto total en salud como porcentaje del producto interno bruto para el año 1995 y 2012 “una oportunidad de brenchmarking para el sistema de protección social colombiano”

Para los países emergentes en América Latina y El Caribe se hace necesario determinar la eficiencia de su sistema de salud para generar beneficios a su población desde el indicador de esperanza de vida al nacer y los recursos que se hacen uso desde Colombia en comparación con sus homólogos. Se evidencia que a pesar de Colombia poseer una economía fuerte durante el análisis de los dos momentos se mantiene en la tendencia general de los demás países y con los mismos resultados del indicador. A su vez se concluye que el momento en que se tomaron las decisiones de cambio del sistema de salud es un factor diferenciador en los resultados obtenidos como fue el caso de Costa Rica identificado con el de mejor desempeño en la relación Indicador de esperanza de vida al nacer y Porcentaje de gasto en salud como parte del Producto interno bruto.

Autoreporte de la calidad de vida en niños y adolescentes colombianos: Estudio FUPRECOL

RESUMEN Introducción: El EQ-5D-Y proxy es un cuestionario genérico, de fácil comprensión y aplicación, que evalúa distintas dimensiones de la salud percibida. El objetivo del siguiente estudio fue describir por autoreporte la calidad de vida relacionada con la salud (CVRS) en una población escolar de Bogotá, Colombia, pertenecientes al estudio FUPRECOL. Métodos: Estudio descriptivo y transversal, realizado en 3.245 niños y 3.354 adolescentes, entre 9 y 17.9 años de edad, de 24 instituciones educativas oficiales de Bogotá, Colombia. Se aplicó de manera auto-administrada la versión validada al castellano por Olivares et al. (2009) del instrumento de CVRS infantil EQ-5D-Y proxy. Se analizaron los datos por medidas de tendencia central y se realizó una comparación de los observados en Colombia con estudios internacionales. Resultados: De la población evaluada, el 58,3% (n=3.848), fueron mujeres. En general, se observa puntuaciones elevadas en la CVRS en niños y adolescentes de ambos sexos. Al comparar por género, las dimensiones del EQ-5D-Y proxy “sentirse triste/preocupado o infeliz” y “tener dolor/malestar”, presentaron la mayor frecuencia de repuesta en el grupo de las mujeres. Al comparar los resultados de este estudio, por grupos de edad, con trabajos internacionales de niños y adolescentes, se observa que las puntuaciones del EQ-5D-Y proxy fueron superiores a los reportados en Suráfrica, Alemania e Italia. Conclusión: Se presentan valores de la CVRS según edad y sexo que podrán ser usados en la evaluación de la salud percibida en el ámbito escolar. Se hace necesario evaluar las propiedades psicométricas del EQ-5D-Y proxy en población Colombiana.