Criação de indicadores para o cuidado respiratório e mobilização precoce em uma unidade de cuidado intensivo

Objetivo: Diseñar indicadores para medir procesos y resultados de algunas intervenciones del cuidado respiratorio y movilización temprana en la unidad de cuidado intensivo (UCI). Método: Se llevó a cabo un estudio descriptivo con tres fases: 1) diseño de indicadores, 2) prueba piloto de los indicadores propuestos y 3) validación y ajuste. En este documento se presentan los resultados de la primera fase del estudio. Se realizó revisión de la literatura, discusión con panel de expertos y fisioterapeutas con experiencia en la atención del paciente críticamente enfermo, se consideró la validez de constructo y la validez de criterio. Resultados: Se diseñaron quince indicadores de efectividad (ocho relacionados con el cuidado respiratorio y siete relacionados con la movilización temprana). El 66 % fueron indicadores de resultado. Conclusiones: Los indicadores propuestos consideran la medición de los procesos y resultados de algunas intervenciones de cuidado respiratorio y de movilización temprana del paciente crítico, por lo tanto, permitirán mejorar la evaluación e intervención en UCI con la consecuente mejoría en la calidad de la atención. Objetivo: criar indicadores para medir processos e resultados de algumas intervenções do cuidado respiratório e mobilização precoce na unidade de cuidado intensivo (UCI). Materiais e metodos: levou-se a cabo um estudo descritivo com três fases 1) criação de indicadores, 2) prova piloto dos indicadores propostos e 3) validação e ajuste. Neste documento apresentam-se os resultados da primeira fase do estudo. Realizou-se revisão da literatura, discussão com painel de expertos e fisioterapeutas com experiência na atenção do paciente criticamente doente, se considerou a validez de constructo e a validez de critério. Resultados: criaram-se quinze indicadores de efetividade (oito relacionados com o cuidado respiratório e sete relacionados com a mobilização precoce). O 66% foram indicadores de resultado. Conclusões: os indicadores propostos consideram a medição dos processos e resultados de algumas intervenções de cuidado respiratório e de mobilização precoce do paciente crítico, portanto, permitiram melhorar a avaliação e intervenção em UCI com a consequente melhoria na qualidade da atenção.Objective: To design indicators for measuring processes and outcomes of some respiratory care interventions, and the early mobilization in the intensive care unit (ICU). Method: A descriptive study was conducted in three phases: i) design of the indicators, ii) pilot test of the proposed indicators, and iii) validation and adjustment. This document presents the results of the first phase of the study. The selected literature was reviewed, and a discussion with a panel of experts and physiotherapists with experience in caring for critically ill patients was held. Construct validity and criterion validity were considered. Results: The study designed 15 effectiveness indicators (eight related to respiratory care and seven related to early mobilization). 66% were result indicators. Conclusions: The proposed indicators consider measuring processes and outcomes of some respiratory care interventions and early mobilization of critically ill patients, thus enhancing assessment and intervention in ICU with a consequent improvement in the quality of care

Results from Bottom Trawl Survey on Flemish Cap of June-July 2021

A stratified random bottom trawl survey on Flemish Cap was carried out from 12 July to 9 August 2021. Following the same procedures as in previous years, the area surveyed extends up to depths of 800 fathoms (1460 meters) and 181 fishing stations were planned. The survey was carried out by the R/V Vizconde de Eza with the usual survey gear (Lofoten). A total of 181 valid hauls were made, 120 up to 730 meters depth and 61 up to 1460 meters. Survey results are presented, including abundance indices of the main commercial species and age distributions for cod, redfish, American plaice, Greenland halibut, roughhead grenadier, squid and shrimp. The general indexes for this year are estimated taken into account the traditional swept area (strata 1-19, up to depths of 730 m.) and the total area surveyed (strata 1-34, up to depths of 1460 m.).Versión del editor

Assessment of metabolic phenotypic variability in children's urine using 1H NMR spectroscopy

The application of metabolic phenotyping in clinical and epidemiological studies is limited by a poor understanding of inter-individual, intra-individual and temporal variability in metabolic phenotypes. Using 1H NMR spectroscopy we characterised short-term variability in urinary metabolites measured from 20 children aged 8-9 years old. Daily spot morning, night-time and pooled (50:50 morning and night-time) urine samples across six days (18 samples per child) were analysed, and 44 metabolites quantified. Intraclass correlation coefficients (ICC) and mixed effect models were applied to assess the reproducibility and biological variance of metabolic phenotypes. Excellent analytical reproducibility and precision was demonstrated for the 1H NMR spectroscopic platform (median CV 7.2%). Pooled samples captured the best inter-individual variability with an ICC of 0.40 (median). Trimethylamine, N-acetyl neuraminic acid, 3-hydroxyisobutyrate, 3-hydroxybutyrate/3-aminoisobutyrate, tyrosine, valine and 3-hydroxyisovalerate exhibited the highest stability with over 50% of variance specific to the child. The pooled sample was shown to capture the most inter-individual variance in the metabolic phenotype, which is of importance for molecular epidemiology study design. A substantial proportion of the variation in the urinary metabolome of children is specific to the individual, underlining the potential of such data to inform clinical and exposome studies conducted early in life

Impact of HIV-Associated Conditions on Mortality in People Commencing Anti-Retroviral Therapy in Resource Limited Settings

To identify associations between specific WHO stage 3 and 4 conditions diagnosed after ART initiation and all cause mortality for patients in resource-limited settings (RLS). DESIGN, SETTING: Analysis of routine program data collected prospectively from 25 programs in eight countries between 2002 and 2010

Componentes de la dinámica familiar asociados a conductas no asertivas, en la interacción de los niños y niñas de 3 a 4 años del centro de desarrollo infantil la “alegría de los niños” en San Sebastián de Mariquita 2012-2013.

Palabras claves, albún fotográfico, instrumentosEste trabajo corresponde a la investigación en el Centro de Desarrollo Infantil “La Alegría de los niños”, en San Sebastián de Mariquita, Tolima, entre 2012 y 2013, en la cual se indagó por los componentes de la dinámica familiar y las conductas no asertivas en la interacción de niños y niñas de 3 a 4 años, para una propuesta de orientación familiar con estrategias diagnósticas, participativas y enfoque crítico social. La estructura metodológica utilizó el enfoque cualitativo y la observación participante, se apoyo teóricamente en las caracterizaciones de la dinámica familiar de Oliveira, Eternod y López, las conductas según Skinner, las etapas del aprendizaje de Bandura y los procesos de Bertalanffy. El enfoque fue cualitativo, en el se abordo la problemática relacionada con las conductas no asertivas en los niños mediante una entrevista Semiestructurada, técnica de observación, juego de roles, sociodrama; donde se valoraron 9 niños y 11 niñas. La condición socioeconómica de esta población es baja-baja. , la muestra fue extraída del centro de desarrollo infantil (CDI) en el Municipio de San Sebastian de Mariquita. Las categorías analizadas fueron, dinámica familiar (primer orden), conductas no asertivas (segundo orden). Interacción entre niños y niñas con comportamientos de agresividad (tercer orden). Los resultados de esta investigación permiten identificar que los factores de comunicación padre /hijo(a), tienen una influencia importante en los componentes de la dinámica familiar asociados a conductas no asertivas en niños y niñas. La interacción infantil se da en condiciones de violencia y otras que lo afectan negativamente.This work corresponds to the investigation in the Center of Infantile Development " The Happiness of the children ", in San Sebastian of Mariquita, Tolima, between 2012 and 2013, in which it was investigated by the components of the familiar dynamics and the not assertive conducts in the interaction of children and girls from 3 to 4 years, for an offer of familiar orientation with diagnostic, participative strategies and critical social approach. The methodological structure participant used the qualitative approach and the observation; I rest theoretically on the characterizations of the familiar dynamics of Oliveira, Eternod and Lopez, the conducts according to Skinner, the stages of Bandura's learning and Bertalanffy's processes. The approach was qualitative, in I approach the problematics related to the not assertive conducts in the children by means of a Semistructured, technical interview of observation, game of roles, sociodrama; where 9 children and 11 girls were valued. The socioeconomic condition of this population is fall - fall., the sample was extracted from the center of infantile development (CDI) in San Sebastian's Municipality of Mariquita. The analyzed categories were, familiar dynamics (the first order), not assertive conducts (the second order). Interaction between children and girls with behaviors of aggressiveness (the third order). The results of this investigation allow to identify that the factors of communication father / son (a), they have an important influence in the components of the familiar dynamics associated with not assertive conducts in children and girls. The infantile interaction gives itself in conditions of violence and others that affect it negatively

Incidence of WHO stage 3 and 4 conditions following initiation of Anti-Retroviral Therapy in resource limited settings

To determine the incidence of WHO clinical stage 3 and 4 conditions during early anti-retroviral therapy (ART) in resource limited settings (RLS)

Cross-cultural neuropsychological assessment in Europe:Position statement of the European Consortium on Cross-Cultural Neuropsychology (ECCroN)

Objective: Over the past decades European societies have become increasingly diverse. This diversity in culture, education, and language significantly impacts neuropsychological assessment. Although several initiatives are under way to overcome these barriers – e.g. newly developed and validated test batteries – there is a need for more collaboration in the development and implementation of neuropsychological tests, such as in the domains of social cognition and language. Method: To address these gaps in cross-cultural neuropsychological assessment in Europe, the European Consortium on Cross-Cultural Neuropsychology (ECCroN) was established in 2019. Results: ECCroN recommends taking a broad range of variables into account, such as linguistic factors, literacy, education, migration history, acculturation and other cultural factors. We advocate against race-based norms as a solution to the challenging interpretation of group differences on neuropsychological tests, and instead support the development, validation, and standardization of more widely applicable/cross-culturally applicable tests that take into account interindividual variability. Last, ECCroN advocates for an improvement in the clinical training of neuropsychologists in culturally sensitive neuropsychological assessment, and the development and implementation of guidelines for interpreter-mediated neuropsychological assessment in diverse populations in Europe. Conclusions: ECCroN may impact research and clinical practice by contributing to existing theoretical frameworks and by improving the assessment of diverse individuals across Europe through collaborations on test development, collection of normative data, cross-cultural clinical training, and interpreter-mediated assessment

The patient journey : a report of skin cancer care across Europe

Summary - Background: There are poorly documented variations in the journey a skin cancer patient will follow from diagnosis to treatment in the European Union. Objectives: To investigate the possible difficulties or obstacles that a person with a skin malignancy in the European Union may have to overcome in order to receive adequate medical screening and care for his/her condition. In addition, we wished to explore differences in European health systems, which may lead to health inequalities and health inequities within Europe. Methods: Ten European countries took part in this investigation (in alphabetical order): Finland, Germany, Greece, Italy, Malta, Poland, Romania, Spain, the Netherlands and the U.K. The individual participants undertook local and national enquiries within their own country and completed a questionnaire. Results This exercise has identified important differences in the management of a skin cancer patient, reflecting major disparities in health care between European countries. Conclusions: Further investigation of health disparities and efforts to address health inequalities should lead to improvements in European health care quality and reduction in morbidity from skin cancer.This publication arises from the EPIDERM project, which was funded by the European Commission’s Executive Agency for Health and Consumers (EPIDERM project: PHEA 2007- A ⁄100994 HI). Funding for publication of this supplement was provided by the European Skin Cancer Foundation (ESCF).peer-reviewe

Association of BMI Category Change with TB Treatment Mortality in HIV-Positive Smear-Negative and Extrapulmonary TB Patients in Myanmar and Zimbabwe

OBJECTIVE: The HIV epidemic has increased the proportion of patients with smear-negative and extrapulmonary tuberculosis (TB) diagnoses, with related higher rates of poor TB treatment outcomes. Unlike in smear-positive pulmonary TB, no interim markers of TB treatment progress are systematically used to identify individuals most at risk of mortality. The objective of this study was to assess the association of body mass index (BMI) change at 1 month (±15 days) from TB treatment start with mortality among HIV-positive individuals with smear-negative and extrapulmonary TB. METHODS AND FINDINGS: A retrospective cohort study of adult HIV-positive new TB patients in Médecins Sans Frontières (MSF) treatment programmes in Myanmar and Zimbabwe was conducted using Cox proportional hazards regression to estimate the association between BMI category change and mortality. A cohort of 1090 TB patients (605 smear-negative and 485 extrapulmonary) was followed during TB treatment with mortality rate of 28.9 per 100 person-years. In multivariable analyses, remaining severely underweight or moving to a lower BMI category increased mortality (adjusted hazard ratio 4.05, 95% confidence interval 2.77-5.91, p<0.001) compared with remaining in the same or moving to a higher BMI category. CONCLUSIONS: We found a strong association between BMI category change during the first month of TB treatment and mortality. BMI category change could be used to identify individuals most at risk of mortality during TB treatment among smear-negative and extrapulmonary patients

Seroprevalence of transfusion-transmissible infections and evaluation of the pre-donation screening performance at the Provincial Hospital of Tete, Mozambique

<p>Abstract</p> <p>Background</p> <p>The World Health Organization recommends universal and quality-controlled screening of blood donations for the major transfusion-transmissible infections (TTIs): human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis. The study objectives were to determine the seroprevalence of these TTIs among blood donors at the Provincial Hospital of Tete, Mozambique, and to assess the local pre-donation screening performance.</p> <p>Methods</p> <p>All consenting voluntary and replacement candidate blood donors were consecutively included from February to May 2009. Sera of all candidates, independent of deferral by questionnaire, were submitted to screening with quality-assured rapid or simple assays for HIV, HBV surface antigen (HBsAg), HCV and syphilis. Assays locally used by the blood bank for HBV and syphilis screening were run in parallel to quality-assured external assays supplied during the study, and all discordant samples were submitted to confirmation testing in reference laboratories in Mozambique and Belgium.</p> <p>Results</p> <p>Of 750 consenting candidates (50.5% of voluntary donors), 71 (9.5%) were deferred by the questionnaire, including 38 specifically because of risk behavior for TTI. Of the 679 non-deferred candidates, 127 (18.7%) had serological confirmation of at least one TTI, with a lower prevalence in voluntary than in replacement donors (15.2% versus 22.4%, p = 0.016). Seroprevalence of HIV, HBsAg and syphilis infections was 8.5%, 10.6 % and 1.2%. No confirmed HCV infection was found. Seroprevalence of TTIs was similar in the 38 candidates deferred for TTI risk as in the non-deferred group, except for HBsAg (26.3 % versus 10.6 %; p = 0.005). The local assays used for HBV and syphilis had sensitivities of 98.4% and 100% and specificities of 80.4% and 98.8% respectively. This resulted in the rejection of 110 of the 679 blood donations (16.2%) because of false positive results.</p> <p>Conclusions</p> <p>The seroprevalence of TTIs after questionnaire screening is high in Tete, Mozambique, but HCV infection does not appear as a major issue. The questionnaire did not exclude effectively HIV-infected donor candidates, while the locally used assays led to unnecessary rejection of many safe donations. A contextualized questionnaire and consistent use of quality-assured assays would considerably improve the current screening procedure for blood donation.</p