Factores asociados al patrón de sueño en pacientes con insuficiencia cardíaca

O estudo teve como objetivo descrever o padrão de sono em pacientes com insuficiência cardíaca (IC) e analisar associações do sono com as seguintes variáveis: sexo, idade, fadiga, fadiga ao esforço, atividade física, classe funcional, terapia medicamentosa, dispneia e índice de massa corporal. A amostra não probabilística foi de 400 pacientes (idade média 57,8 anos; 64,8% eram homens; escolaridade média de 6,1 anos; 82,5% em classe funcional II ou III). A prevalência de maus dormidores foi de 68,5% e 46,5% classificou o sono como ruim ou muito ruim. Escores que sugerem categoria de mau dormidor foram associados a: sexo feminino, não empregados, fadiga, fadiga ao esforço, dispneia e classes funcionais mais elevadas da IC. A proporção de maus dormidores entre os pacientes com IC está entre as mais altas nas doenças crônicas. Dispneia e fadiga, sintomas comuns a essa enfermidade, aumentam significativamente a chance de ser mau dormidor.The objective of this study was to describe sleep patterns in patients with heart failure (HF) and analyze associations between sleep and the following variables: gender, age, fatigue, fatigue on exertion, physical activity, functional class, drug therapy, dyspnea, and body mass index. The nonprobability sample consisted of 400 patients (mean age 57.8 years; 64.8% were men, average schooling of 6.1 years; 82.5% Functional Class II or III). The prevalence of poor sleepers was 68.5%, and 46.5% rated sleep as poor or very poor. Scores suggest that the bad sleeper category was associated with: female, unemployed, fatigue, fatigue on exertion, dyspnea and higher functional classes of HF. The proportion of poor sleepers among patients with HF is among the highest in chronic diseases. Dyspnea and fatigue, common symptoms of this disease, significantly increase the chance of being a bad sleeper.Estudio que objetivó describir el patrón de sueño en pacientes con insuficiencia cardíaca y analizar asociaciones del sueño con las siguientes variables: sexo, edad, fatiga, fatiga ante esfuerzo, actividad física, clase funcional, terapia medicamentosa, disnea e índice de masa corporal. La muestra no probabilística fue de 400 pacientes (edad media 57,8 años; 64,8% hombres, escolaridad media de 6,1 años; 82,5% en clase funcional II o III). La prevalencia de afectados por transtornos del sueño fue de 68,5%, y 46,5% clasificó su sueño como malo o muy malo. Puntajes que sugieren categoría de transtornos del sueño se asociaron con: sexo femenino, desempleados, fatiga, fatiga ante esfuerzo, disnea y clases funcionales más elevadas del IC. La proporción de afectados por transtornos del sueño entre pacientes con IC está entre las más altas en enfermedades crónicas. Disnea y fatiga, síntomas comunes en esa enfermedad, aumentan significativamente la chance de sufrir alteraciones del sueño.Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPES

Infraventus-internationalizing a renewables business to Kenya

Infraventus – Internationalizing a Renewables Business to Kenya Infraventus is a renewable energy development company, with a consolidated experience, since 1988, in developing, constructing and operating projects mainly in Portugal, but also in other countries: Spain, Poland, France, Australia, Finland and Panama, and is now regarding Kenya as a possible destiny. Kenya is the biggest economy of East Africa, with a growing GDP around 5% and a low level of electric grid coverage thru its territory, 33% of national access to electricity. Kenya energy policy is intended to promote the investment in renewables; wind and sun are existing resources in good measures. Kenya is an interesting destiny to Infraventus, but has many risks. The objective of this dissertation is to evaluate the possible advantages of this investment and risks and propose recommendations about how to mitigate them considering alternative entry mod

A responsabilidade social e a performance nas PMEs: o papel da inovação

A Responsabilidade Social é fundamental para as empresas do séc. XXI, dada a crescente procura, da comunidade, por uma atitude mais responsável das mesmas. A incorporação da RSE como parte integrante da estratégia das empresas, motiva o estudo do seu impacto ao nível do desempenho empresarial. Por outro lado, a inovação é entendida como um fator de competitividade chave e um importante determinante da relação da RSE com a performance empresarial. Assim, esta dissertação contribui de forma totalmente inovadora, ao explorar a ligação entre RSE e a inovação neste contexto. Além disso, enriquece a literatura existente, que se encontra escassa relativamente a estudos sobre este tema, em contexto português. A não existência de um índice de RSE para Portugal, motivou o desenvolvimento de um instrumento novo e aplicado, através de um questionário, que permitiu a obtenção de um número significativo de respostas, possibilitando uma análise com metodologias econometricamente sólidas. Desta análise, direcionada às PMEs da região de Aveiro, concluiu-se que as atividades de RSE são importantes para a criação de valor nas empresas, apresentando um impacto positivo na evolução de todos os indicadores de performance apresentados. A Imagem e reputação global é destacada como o benefício, resultante destas práticas, mais significativo para as PMEs em estudo. A performance inovadora, apresenta-se, como elemento chave no acréscimo de valor da RS na performance financeira e na evolução das vendas. Especificando, ainda mais, esta análise, verificámos que diferentes atividades de RSE influenciam diferentes indicadores de performance empresarial. À semelhança da performance, a inovação mostra-se igualmente importante na adoção e frequência com as atividades de RSE são praticadas. Empresas com boa performance inovadora estão associadas a um nível superior de RSE. Estes resultados validam a importância da Responsabilidade Social como mecanismo importante para as empresas serem mais eficientes e lucrativas. Para além disso, estas práticas associadas a uma boa performance inovadora tornam-se ainda mais benéficas. Acreditamos no interesse deste trabalho enquanto fio condutor para a tomada de decisão consciente de gestores, criação de novas leis e, também, do interesse de investigadores académicos.Social Responsibility is fundamental for 21st century companies, given the growing demand, in the community, for a more responsible attitude from them. An incorporation of CSR as an integral part of the companies' strategy, motivation, or study of its impact on their performance level. On the other hand, innovation is understood as an important competitive factor and a determinant of the relationship between CSR and business performance. Thus, this dissertation contributes in a totally innovative way, by exploring a link between CSR and innovation in this context. In addition, it contributes to the existing literature, which is scarce in relation to studies on this topic, in Portuguese context. The lack of an CSR index for Portugal, motivated the development of a new and applied instrument, through a questionnaire, which allows the use of a significant number of responses, allowing an analysis with economically used methods. This analysis, aimed at SMEs in the Aveiro region, concluded that CSR activities are important for creating value in companies, with a positive impact on the evolution of all performance indicators presented. The global image and reputation is highlighted as the most important benefit that results from these practices. Innovative performance is presented as a key element in the value of increasing the value of RS in financial performance and in the evolution of sales. Further specifying this analysis, it was found that different CSR activities influence different business performance indicators. Like performance, an innovation proves to be equally important in the adoption and frequency with which CSR activities are practiced. Companies with good innovative performance are associated with a higher level of CSR. These results validate the importance of Social Responsibility as an important mechanism for companies be more efficient and profitable. In addition, these practices associated with good innovative performance become even more beneficial. We believe in the interest of this work as the guiding thread for the conscious decision making of managers, the creation of new laws and, also, interest in academic researchers.Mestrado em Economi

Mobilidade e qualidade de vida em mulheres sedentárias e praticantes de alongamento

Orientador: Julimar Luiz PereiraA cópia impressa do anexo está apagada no original.Monografia (licenciatura) - Universidade Federal do Paraná. Setor de Ciências Biológicas. Curso de Educação Física

THE IMPORTANCE OF CA-125 FOR EARLY DIAGNOSIS OF ENDOMETRIOSIS

Introduction: Endometriosis is a gynecological, inflammatory disease characterized by the presence of extrauterine endometrial tissue. In Brazil, more than 7 million women are affected by the disease. The main symptoms are pelvic pain, dysmenorrhea, dyspareunia and infertility. Despite the high prevalence, there is a delay in diagnosis, which is performed around 8 years after the onset of symptoms, which cause psychosocial damage and trigger other diseases such as depression and also extend to the economic scope due to the high hospitalization rates and surgical procedures. Objectives: Demonstrate the use of CA-125 dosage for endometriosis early diagnosis, including approaches that increase test specificity, and identify the most commonly used diagnostic methods. Methodology: A narrative bibliographic review was developed, based on the main scientific literature databases, such as: PUBMED, MEDLINE and SciELO. Results and Discussion: Prospective and meta-analysis studies have shown that women with deep endometriosis have higher mid-cycle CA-125 levels than women without the disease. When mid-cycle CA-125 is negative, the measurement of this marker in the menstrual phase may be useful because if this value is positive in this phase, there is a high probability of endometriosis. The measurement of ΔCA-125 is useful in women with low-dose marker in both phases. Conclusion: CA-125 performs well like a rule-in test to endometriosis. To minimize the false negative rate, indiscriminate use of CA-125 should be avoided and limited to women with endometriosis symptoms, when there is high suspicion and prevalence of the disease. Thus it gets more confidence for the diagnosis, before a therapeutic intervention. Key words: serum marker; pelvic pain; infertility.Introdução: A endometriose é uma doença ginecológica, inflamatória que se caracteriza pela presença de tecido endometrial extrauterino. No Brasil, mais de 7 milhões de mulheres são acometidas pela doença. Os sintomas principais são dor pélvica, dismenorreia, dispareunia e infertilidade. Apesar da alta prevalência, observa-se um atraso no diagnóstico em torno de 8 anos após o início dos sintomas, estes provocam prejuízos psicossociais, desencadeiam outras doenças como a depressão e influenciam  também o âmbito econômico devido às altas taxas de internações e procedimentos cirúrgicos. Objetivos: Demonstrar o uso da dosagem de CA-125 para o diagnóstico precoce da endometriose, incluindo abordagens que aumentam a especificidade do teste, além de identificar os métodos diagnósticos mais utilizados. Metodologia: Foi desenvolvida uma revisão bibliográfica narrativa, pautada nos principais bancos de dados de literatura científica, como: PUBMED, MEDLINE e SciELO. Resultados e Discussão: Estudos prospectivos e de metánalise demonstraram que mulheres com endometriose profunda apresentam níveis mais elevados de CA-125 no meio do ciclo do que mulheres não portadoras da doença. Quando o CA-125 no meio do ciclo é negativo, a mensuração de tal marcador na fase menstrual pode ser útil, pois se nessa fase o valor for positivo, há uma alta probabilidade de endometriose. A mensuração do ΔCA-125 é útil em mulheres que apresentam o marcador com baixa dosagem em ambas as fases. Conclusão: Pode-se afirmar que o CA-125 funciona bem como rule-in test (teste de inclusão) para endometriose. Para minimizar a taxa falso negativo, o uso indiscriminado do CA-125 deve ser evitado, limitando-se às mulheres com sintomas de endometriose, onde há uma alta suspeita e prevalência da doença. Desta forma ele adquire maior confiança para o diagnóstico, antes de uma intervenção terapêutica. Palavras-chave: marcador sérico; dor pélvica; infertilidade

A implementação da Musicoterapia como cuidado paliativo de enfermagem durante o tratamento de pacientes acometidos pelo câncer

The aim was to investigate the benefits derived from the implementation of music therapy palliative care in patients diagnosed with neoplasms. This is exploratory bibliographic research where the databases used were: LILACS, MedLine, magazines and books using keywords such as: "cancer", "music therapy", "music", "palliative care", “psychology”, “musicotherapy”, “mental health”, through treatments suggests the possibility of applying musical interventions, during clinical treatment, to reduce psycho-emotional issues such as anxiety disorders, depression, and panic attacks. The results obtained in the research indicate that Music Therapy helps in the process of recovery and cure of the disease and in the emotional therapy of patients who used the described care. It is concluded that Music Therapy is one of the best palliative care to be implemented for patients affected by cancer.Objetivou-se investigar os benefícios derivados da implementação do cuidado paliativo Musicoterápico em pacientes com Diagnóstico de Neoplasias. Trata-se de uma pesquisa bibliográfica de caráter exploratório onde as bases de dados utilizadas foram: LILACS, MedLine, revistas e livros através do uso de palavras chaves como: “câncer”, “musicoterapia”, “música”, “cuidados paliativos”, “psicologia”, “musicoterapy”, “mental health”, mediante aos tratamentos sugere a possibilidade de aplicar meios de intervenções musicais, no decorrer do tratamento clínico, para reduzir as questões psicoemocionais como transtornos de ansiedade, depressão e ataques de pânico. Os resultados obtidos na pesquisa designam-se que a Musicoterapia auxilia no processo de recuperação e cura da doença e na terapia emocional dos pacientes que fizeram uso do cuidado descrito. Conclui-se que a Musicoterapia é um dos melhores cuidados paliativos a serem implementados para os pacientes acometidos pelo Câncer

Application of Revised Nursing Work Index and the Maslach Burnout Inventory for registered nurses from public health institutions, Sao Paulo, Brazil

Session presented on Thursday, July 24, 2014: Purpose: The aim of this research was to verify the relationship between the results of the Revised Nursing Work Index (NWI -R) and the Maslach Burnout Inventory (MBI). Methods: The Revised Nursing Work Index (NWI-R) (1) is a tool that measures the practice environment. It consists of 57 items, in which 15 of the 57 items were divided in 4 subscales: autonomy, control over the practice setting, doctor nurse relationship and organizational support (1). The autonomy subscale consists of five items and the control over the practice setting subscale comprises of seven items. The doctor nurse relationship subscale is formed by three items. The organizational support subscale consists of ten items derived from the subscales cited above (1). The scale used in the NWI-R is the Likert and can vary from one to four. The lower the score, the greater the favorable attributes of the nursing practice. The scores for the subscales are obtained by averaging the scores of the subjects\u27 responses. They can vary from one to four points (1). The MBI aims to measure the physical and emotional exhaustion of workers by assessing their feelings towards work. It has 22 items divided into three domains: emotional exhaustion reduced personal accomplishment and depersonalization. The sum of the responses for each topic determines the variation of each domain: nine to forty-five points for emotional exhaustion, eight to forty points for personal fulfillment and five to twenty-five points for depersonalization and (5). The scores for the emotional exhaustion and depersonalization items are considered as follow: the higher the score, the greater the emotional exhaustion feeling and depersonalization perceived by nurses. Regarding the decrease in the personal fulfillment item, higher scores depict high personal achievement Professional (2.5). In this study five categories of response (never, rarely, sometimes, often, always) were used. They differ slightly from the seven original categories. The choice of the five categories was due to the fact that Brazilian professionals had difficulties to discriminate between the seven original categories of response (8). This study was conducted in hospitals and public clinics under direct supervision of the Coordinator of Health Services of the State Secretariat of Sao Paulo, Brazil Health, and it is part of a larger study whose objective was to know the nursing records and variables associated with them. Among the 43 eligible health institutions invited, three institutions did not take part in the study. Thus, 40 health institutions, whose collection took place between January 2011 and January 2012, were included in the study. The questionnaires were completed by nurses who worked or were responsible for sectors where there were patients. The project was submitted to the Ethics Committee of the School of Nursing for evaluation of the ethical aspects. Participants who provided information by self-report were informed about the study and its procedures and, if agreed, signed the Informed Consent Form. The Pearson correlation coefficient was used to verify the correlation between variables. The correlation strength used was that proposed by Levin, Fox (2004 ) in which perfect correlation was attributed for those that reached 1.0, strong correlation for those between 0.9 and 0.6, moderate correlation for those between 0.59 and 0.3, and weak correlation for those below 0.3. Analysis of clusters was used to identify groups of similar institutions. The method of K-means was employed and it was based on the Euclidean distance (6-7). The results of the MBI and these groups of institutions were compared by Analysis of Variance (ANOVA). In the case of significant difference between groups, the identification of these groups was done by multiple comparisons using the Bonferroni test. In all analyzes, the significance level of 5 % was established. Results: The NWI profile represented 40 institutions. The MBI was completed by 745 nurses with an average age of 43 years (SD = 9.6), average training time of 14 years (SD = 8.5) and on average 9 years of working in the participating institution (SD = 9.4). The study was comprised of 23 general institutions, 11 institutions and 6 psychiatric outpatient services. The NWI-R showed reliability of 0,962 for the total items, 0,695 for autonomy items, 0.794 for control over the practice setting, 0.773 for doctor nurse relationship and 0,815 for organizational support. Regarding the MBI, the reliability was 0.602 for the total items, 0,877 for emotional exhaustion, 0.549 for the depersonalization and 0.723 for personal fulfillment. The mean NWI-R was 2.27 in the total sample, standard deviation (SD) 1.03, median two, minimum and maximum values of 1 and 4, respectively. As for the MBI, the mean and SD of domains found in this population were: emotional exhaustion 22.37 ( 6.47), depersonalization 8.98 ( 3.04) and decreased job satisfaction 31.74 ( 3.98). Pearson correlation coefficient Table 1 shows that the correlation between emotional exhaustion and NWI-R total score, autonomy, control over the practice setting and organizational support were moderate and positive. The same results were found between the depersonalization and autonomy variables. Moderate negative correlation was present in the analysis between decreased job satisfaction and the total score of NWI-R, autonomy and organizational support. The results of the analysis of the remaining correlations NWI-R and MBI were weak, both among total scores, and between the domains of MBI subscales and the NWI-R. In cluster analysis, four groups of hospitals with similar profile were identified from the four subscales of the NWI -R. In characterizing these groups, we found that group 4 had the lowest scores on all subscales of the NWI -R. Group 3 received the highest scores on three subscales of the instrument (autonomy, control over the practice setting and organizational support). The highest values of subscale doctor nurse relationship were identified in group 1 (Table 2). There was no difference between groups in relation to the total MBI and decrease the area of personal fulfillment. Difference between groups was observed for emotional exhaustion ad depersonalization (p\u3c 0.05) domains. Considering multiple comparisons by the Bonferroni test, it was found that there were differences only between groups 3 and 4 in relation to emotional exhaustion, and groups two and three, on the depersonalization domain. Group 4, as the NWI -R, gathered the institutions with the most unfavorable for the nursing practice, which might have contributed to the physical and emotional exhaustion of nurses in these institutions. Conclusion: The group of public hospitals in Sao Paulo, Brazil with the best nursing practice showed significant statistical difference for the emotional exhaustion and depersonalization domains compared to groups of hospitals with less favorable characteristics

A implementação da Musicoterapia como cuidado paliativo de enfermagem durante o tratamento de pacientes acometidos pelo câncer

The aim was to investigate the benefits derived from the implementation of music therapy palliative care in patients diagnosed with neoplasms. This is exploratory bibliographic research where the databases used were: LILACS, MedLine, magazines and books using keywords such as: "cancer", "music therapy", "music", "palliative care", “psychology”, “musicotherapy”, “mental health”, through treatments suggests the possibility of applying musical interventions, during clinical treatment, to reduce psycho-emotional issues such as anxiety disorders, depression, and panic attacks. The results obtained in the research indicate that Music Therapy helps in the process of recovery and cure of the disease and in the emotional therapy of patients who used the described care. It is concluded that Music Therapy is one of the best palliative care to be implemented for patients affected by cancer.Objetivou-se investigar os benefícios derivados da implementação do cuidado paliativo Musicoterápico em pacientes com Diagnóstico de Neoplasias. Trata-se de uma pesquisa bibliográfica de caráter exploratório onde as bases de dados utilizadas foram: LILACS, MedLine, revistas e livros através do uso de palavras chaves como: “câncer”, “musicoterapia”, “música”, “cuidados paliativos”, “psicologia”, “musicoterapy”, “mental health”, mediante aos tratamentos sugere a possibilidade de aplicar meios de intervenções musicais, no decorrer do tratamento clínico, para reduzir as questões psicoemocionais como transtornos de ansiedade, depressão e ataques de pânico. Os resultados obtidos na pesquisa designam-se que a Musicoterapia auxilia no processo de recuperação e cura da doença e na terapia emocional dos pacientes que fizeram uso do cuidado descrito. Conclui-se que a Musicoterapia é um dos melhores cuidados paliativos a serem implementados para os pacientes acometidos pelo Câncer

Urinary peptidomics and bioinformatics for the detection of diabetic kidney disease

The aim of this study was to establish a peptidomic profle based on LC-MS/MS and random forest (RF) algorithm to distinguish the urinary peptidomic scenario of type 2 diabetes mellitus (T2DM) patients with diferent stages of diabetic kidney disease (DKD). Urine from 60 T2DM patients was collected: 22 normal (stage A1), 18 moderately increased (stage A2) and 20 severely increased (stage A3) albuminuria. A total of 1080 naturally occurring peptides were detected, which resulted in the identifcation of a total of 100 proteins, irrespective of the patients’ renal status. The classifcation accuracy showed that the most severe DKD (A3) presented a distinct urinary peptidomic pattern. Estimates for peptide importance assessed during RF model training included multiple fragments of collagen and alpha-1 antitrypsin, previously associated to DKD. Proteasix tool predicted 48 proteases potentially involved in the generation of the 60 most important peptides identifed in the urine of DM patients, including metallopeptidases, cathepsins, and calpains. Collectively, our study lightened some biomarkers possibly involved in the pathogenic mechanisms of DKD, suggesting that peptidomics is a valuable tool for identifying the molecular mechanisms underpinning the disease and thus novel therapeutic targets

USO DO METRÔNOMO NA RESSUSCITAÇÃO CARDIOPULMONAR EM UMA UNIDADE DE TERAPIA INTENSIVA

Objetivo: relatar a vivência de três enfermeiras assistenciais na utilização do metrônomo durante manobras de ressuscitação cardiopulmonar em unidade de terapia intensiva. Método: trata-se de um relato de experiência que reflete a troca de informações, no cotidiano de trabalho, de três enfermeiras que atuam na unidade de terapia intensiva de um hospital de grande porte em Salvador, Bahia, Brasil. Resultados: o uso continuado do equipamento na ressuscitação cardiopulmonar tem sido indicado para auxiliar na realização das compressões torácicas. O som emitido pelo dispositivo não indica o término de cada ciclo na reanimação e/ou assegura a adequação da profundidade das compressões. Acrescenta ruídos ao ambiente, dificulta a comunicação da equipe multiprofissional e é mais um aparelho a ser configurado no momento da ressuscitação cardiopulmonar, impactando de forma negativa. Conclusão: o metrônomo, nessa experiência, não assegurou a qualidade na ressuscitação cardiopulmonar. Descritores: Parada Cardíaca. Reanimação Cardiopulmonar. Unidade de Terapia Intensiva. Cuidados Críticos. Enfermagem de Cuidados Críticos. Ruído