Atitudes do enfermeiro face às infecções associadas aos cuidados de saúde

ENQUADRAMENTO: As infecções adquiridas em consequência da prestação de cuidados constitui um problema grave, com morbilidade e mortalidade significativas. Estas infecções são evitáveis em cerca de um terço dos casos, pelo que a capacidade de as prevenir pode constituir um dos indicados de qualidade dos cuidados. É um problema escondido, transversal que nenhuma instituição ou país ainda conseguiu resolver. Em cada ano, centenas de milhares de doentes em todo o mundo são afectados pelas IACS, sendo considerado o evento adverso mais frequente durante a prestação de cuidados, em todo o mundo. OBJECTIVOS: Caracterizar as Atitudes adoptadas pelos Enfermeiros face às IACS; Analisar em que medida as variáveis sócio-profissionais e a formação acerca das IACS influenciam as atitudes do Enfermeiro MÉTODOS: O estudo transversal de natureza observacional assenta numa lógica de análise descritivo – correlaciona e foi realizado numa amostra definida pelo método não probabilístico, de forma acidental, durante um período de tempo, constituída por 142 Enfermeiros prestadores de cuidados na ULS da Guarda. O perfil médio revela enfermeiros do sexo feminino (76,80%), com idade média de 36 anos, a exercer a profissão entre os 10-19 anos (40,80%) com uma média 13,04 anos, licenciados (69,50%), com a categoria profissional de Enfermeiro graduado (50,00%), com horário na instituição de 35h/semana (70,40%), com vínculo à Função pública (61,30%) e sem duplo emprego (77,47%). De forma a caracterizar as atitudes do enfermeiro, utilizou-se um instrumento de colheita de dados constituído por uma caracterização sócio-profissional e formação acerca das IACS, a Escala de Atitudes face às IACS (Barroca, Cruz, Gaspar e Valdemar, 2006) e uma resposta aberta acerca das condições no serviço que favorecem a infecção nosocomial. RESULTADOS: Constatou-se que os enfermeiros adoptam atitudes consideradas adequadas, com uma média de 103 respostas adequadas. Nas variáveis pessoais (sexo e idade) infere-se que não há relação entre o sexo e as atitudes do enfermeiro face às IACS. Das variáveis profissionais dos enfermeiros, apenas o duplo emprego influência as atitudes do enfermeiro face às IACS. Por outro lado inferimos que existe uma relação de dependência entre os enfermeiros com formação acerca das IACS e as atitudes do enfermeiro face às IACS. A idade, o tempo de exercício profissional e o número de horas de formação não se revelam preditoras das atitudes do enfermeiro face às IACS. CONCLUSÕES: As evidências encontradas neste estudo referem que o duplo emprego e a formação dos profissionais acerca das IACS influência as atitudes do enfermeiro face a esta problemática. As soluções para os problemas das IACS baseiam-se em medidas de prevenção e controlo de infecção, que requerem a responsabilização e a mudança de comportamentos por parte dos profissionais de saúde.ABSTRACT FRAMEWORK: Acquired infections as a result of prevision of care remain a serious problem of significant morbidity and mortality. These infections are avoidable by almost a third of the cases thus the preventing capacity could be a quality indication of cares. This is a hidden transversal problem which still has been solved by neither institution nor country. Each year, many hundreds of thousands of patients worldwide are affected by the IACS, it may be viewed as the most frequent adverse event during the prevision of care elsewhere in the world. OBJECTIVES: To characterize the attitude adopted by nurses in the face of IACS; to analyse what extent the socio-professional variables and the formation regarding the IACS influence the nurse´s attitudes. METHODS: The transversal study of the observational nature is based on descriptive analysis defined accidentally not by the provavilistic method– It was made during a certain period of time with a random sample composed of 142 nurses care providers at the ULS in Guarda. The average profile shows nurses of the female sex (76,80%), with average of 36 years of age, practising the profession between 10 to 19 years (40,80%) an average of 13,04 years, graduates (69,50%), with the professional category of graduated nurse (50,00%), with institution's schedule of 35-hour workweek (70,40%), connected with the public service (61,30%) and without double employment (77,47%). In order to characterise the nurse´s attitudes, collection of data was made with an instrument constituted by a socio-professional characterization and formation , the scale of attitudes regarding the IACS (Barroca, Cruz, Gaspar e Valdemar, 2006) as well as an open answer regarding the conditions of the service which can lead to nosocomial infection. RESULTS: It was found the nurses adopt attitudes considered adequate, with an average of 103 adequate answers. In relation to the personal variables (gender and age) we can conclude that there is no relation between the gender of the nurse and his attitude towards the IACS. Relative to the nurse professional variables, only double employment influences his attitude towards the IACS. In other hand, we can conclude that there is a dependent relation between nurses with preparation on IACS and is attitude towards the IACS. Age, professional experience and number of formation hours cannot predict the conduct from nurses towards IACS. CONCLUSIONS: We found evidences in this study that double employment and formation from the professional about the IACS, influences his conduct towards this problem. Solutions to the IACS problem reside in prevention and control of infection which requires responsibility and change in the health professional’s behaviour

A verdade como valor primordial e o contributo da Educação Moral e Religiosa Católica para o seu aprofundamento : contributo para a primeira Unidade Letiva do 4º ano Ser Verdadeiro : do programa de escolaridade da Educação Moral e Religiosa Católica

É urgente mais do que nunca, na sociedade atual, uma educação baseada nos valores morais, na responsabilidade que cada um assume na sua liberdade de escolha. Ao longo da nossa vida somos interpelados por inúmeras situações que requerem uma escolha moral, entre o bem e o mal, entre o caminho da verdade e da mentira. Concretamente em contexto escolar, a abordagem a assuntos que implicam estados de consciência de atitudes, nunca foram tão necessários, mas também requerentes de uma atitude muito coerente e exigente por parte dos educadores. No presente Relatório Final da Prática Supervisionada (PES), é apresentada uma reflexão acerca do valor moral da verdade. Para melhor enquadramento do tema principal, é elaborada uma reflexão teológica sobre a verdade. Parte-se de uma definição geral do conceito para posteriormente ser enriquecido com o ponto de vista dos vários Papas que compõem a história da Igreja bem como a sábia visão de Santo Agostinho Numa segunda parte deste relatório é explanada a minha experiência enquanto aluna da PES no núcleo de Estágio do Colégio do Amor de Deus, numa análise ao meu desempenho ao longo do ano, baseada numa reflexão minuciosa do que foi a minha passagem por esta escola, mencionando progressos e dificuldades. Acrescenta-se ainda uma reflexão crítica à UL 2: Ser verdadeiro, do 4ºano de escolaridade Por fim como atividade pedagógica é sugerida a implementação de um jogo incluída numa planificação de aula, tendo em vista a exploração da UL em análise, que tem como objetivo demonstrar os benefícios do jogo como ferramenta pedagógica e essencial no processo de aprendizagem das crianças.In today's society, there is an urgent need for education based on moral values, on the responsibility that each person assumes in their freedom of choice. Throughout our lives we are challenged by countless situations that require a moral choice, between good and evil, between the path of truth and lies. Concretely in a school context, the approach to subjects that imply states of awareness of attitudes, have never been more necessary but also require a very coherent and demanding attitude on the part of educators. In this Final Report on Supervised Practice (PES), a reflection on the moral value of the truth is presented. For a better framing of the main theme, a theological reflection on the truth is elaborated. It starts with a general definition of the concept to later be enriched with the point of view of the various Popes that make up the history of the Church as well as the wise vision of Saint Augustine In a second part of this report, my experience as an ESP student in the Internship nucleus of the Colégio do Amor de Deus is explained, in an analysis of my performance throughout the year, based on a detailed reflection of my time at this school, mentioning progress and difficulties. A critical reflection is added to UL 2: Being true, from the 4th year of schooling. Finally, as a pedagogical activity, the implementation of a game included in a lesson plan is suggested, in view of the exploration of the UL under analysis, which aims to demonstrate the benefits of the game as an educational and essential tool in the children's learning process

Role of integrins and neuregulins in axoglial interaction in central nervous system myelination

Oligodendrocytes in the central nervous system (CNS) are responsible for wrapping axons with myelin in order to insulate them and allow for a faster conduction of the nervous impulse. The axonal signals that determine whether an axon is myelinated, and what regulates the number of wraps is still not fully understood. The importance of signals that initiate myelination is significant because they may point to novel therapies for Multiple Sclerosis, where remyelination prevents the axon degeneration that is thought to underlie chronic disease. Neuregulin 1 (Nrg1) has been identified as a key axonal signaling molecule that regulates myelin thickness and glial fate in the peripheral nervous system (PNS). In the PNS, neuregulin I type III is a necessary and sufficient signal that regulates axoglial interaction. The role of neuregulin in the CNS remains unclear and controversial. Integrins, the major family of extracellular matrix (ECM) receptors are involved in the regulation of many fundamental cellular functions. Interaction with a wide range of receptors including growth factor receptors is well described. Our lab showed that α6β1 integrin regulates oligodendrocyte survival signaling by amplification of neuregulin activity. We have found that mice expressing a dominant-negative β1 integrin (that reduces β1 integrin signaling independently of ligand binding) in myelinating oligodendrocytes require a larger axon diameter to initiate myelination. These results suggest that there are other signals in the axon that also contribute to initiation of myelination. We therefore hypothesized that β1 integrin and neuregulin act in concert and play a role in axoglial interactions that sense the axon size and initiate myelination. By crossing the dominant negative β1 integrin mice with heterozygous mice for neuregulin 1 and analyzing myelination, we have found that neuregulin does not enhance the phenotype previously described. This result together with previous reports that mice lacking NRG1, ErbB3 or ErbB4 (the neuregulin receptors expressed on oligodendrocytes) have normal CNS myelin sheaths demonstrates that neuregulin 1 is not required for CNS myelination. Interestingly, neuregulin 1 has been associated as a susceptibility gene in schizophrenia, a disease independently associated with myelin abnormalities (Davis et al., 2003; Hakak et al., 2001). Post-mortem brains of schizophrenic patients showed an increased level of neuregulin 1 type IV. We have analysed mice overexpressing neuregulin 1 type IV (Nrg1 type IV) and show that increased levels of neuregulin 1 type IV does not alter the brain morphology or myelin pattern and integrity. A possible explanation is that since neuregulin 1 type IV is human specific, the mice lack species-specific receptors or other neuregulins have compensatory equilibrium mechanism that are not destabilized by overexpression of neuregulin 1 type IV

Newly graduated doctors: solid general education or solid specialized training?

OBJETIVO: Investigar os efeitos da especialização precoce - dedicação seletiva a uma especialidade médica no período de graduação - sobre a formação geral dos médicos recém-formados. CASUÍSTICA E MÉTODOS: Candidatos ao processo seletivo a Programas de Residência Médica 2008 (PSPRM), formados na FMUSP em 2007 (universo = 163), destacados e agrupados por carreira pretendida (CP). Este estudo foca o desempenho no PSPRM e no histórico escolar. Análise intergrupos - candidatos a determinada CP x demais candidatos FMUSP e intragrupos - desempenho em diferentes áreas de conhecimento (AC) x média nas demais áreas. Coeficientes de correlação - entre fases do PSPRM e histórico. P < 0,05. RESULTADOS E CONCLUSÕES: Existe correlação entre histórico e PSPRM. De acordo com os dados investigados, houve tendência de especialização precoce em GO (obstetrícia e ginecologia), PQ (psiquiatria) e PED (pediatria), com prejuízo em áreas de conhecimento não diretamente relacionadas à carreira pretendida. Candidatos à CM (clínica médica) apresentaram desempenho globalmente superior ao dos demais nas provas e no histórico, possivelmente devido ao interesse mais abrangente por toda a Medicina, que levaria a uma formação mais ampla e sólida.OBJECTIVE: To investigate the effects of early specialization (defined here as concentrated dedication to a single specialty during undergraduate medical school) on the general skills of newly graduated doctors. SAMPLE AND METHODS: Applicants for Admission to Medical Residency Programs at the University of São Paulo who had recently finished the undergraduate medical course at the same institution (n=163), grouped by specialty of choice. The study focused on applicants' performance in admissions exams and their undergraduate grade point average. Intergroup analysis - Applicants for a specific career versus other applicants. Intra-group analysis - Performance in each respective field of knowledge versus mean performance in the other areas studied. Correlation coefficients - between each admissions exam, and between undergraduate GPA and exams. Significance level: p<0.05. RESULTS AND CONCLUSIONS: There was a tendency towards early specialization in Obstetrics-Gynecology, Psychiatry, and Pediatrics, with a loss of performance in areas not directly related to the specialty choice. Applicants for the Residency Program in Internal Medicine showed overall higher grades on the residency admissions exam and undergraduate GPA, possibly due to a broader and more comprehensive interest in Medicine

Implementation of thinnings in individual tree and diameter distribution growth models; an application to maritime pine stands in Portugal

The purpose of this research was to analyze the methods used for implementation of thinnings in three models developed to manage maritime pine stands in Portugal: (1) Pbirrol, an individual tree model that can be applied to uneven-aged stands, (2) Pinaster, an individual tree model to be used in even-aged stands, and (3) ModisPinaster, a diameter distribution model to be used in even-aged or uneven-aged stands. In these models, the decision of which trees are thinned is based on a probability function that can be associated to a cut-off or a density variable (e. g., Wilson’s factor, residual basal area, SDI). To assess the suitability of how thinnings are implemented in these models, two analyses were made: (1) even-aged models, Pinaster and ModisPinaster, were used to simulate the thinning practice of several plots of a thinning trial and stand variables estimates after thinning were compared with the measured values, and (2) forest inventory plots were used as a starting point to analyze the effect of considering an uneven-aged or an even-aged stand management using Pbirrol and Pinaster, respectively.info:eu-repo/semantics/publishedVersio

Português : caminhos de aprendizagem/aquisição por alunos chineses

Comunicação apresentada no Encontro sobre Português como Língua Não Materna, Lisboa, 2008

Aspects of the germination of assa-peixe seeds (Vernonia polyanthes Less.)

O objetivo do presente trabalho foi avaliar o efeito da temperatura e luz na germina??o de sementes de assa-peixe (Vernonia polyanthes Less.). Para tanto foram testadas seis temperaturas constantes (15, 20, 25, 30, 35 e 40?C) e quatro combina??es de temperaturas alternadas (15-20, 15-25, 20-30 e 20-35?C) na presen?a e aus?ncia de luz, a qual foi fornecida durante os per?odos de temperaturas mais altas, quando avaliada a altern?ncia. As vari?veis avaliadas foram: teor de ?gua, germina??o e vigor (primeira contagem e velocidade de germina??o). O delineamento experimental adotado foi o inteiramente casualizado e os resultados foram submetidos ? an?lise da vari?ncia, com as m?dias comparadas pelo teste de Tukey a 5% de probabilidade. Sementes da esp?cie V. polyanthes s?o fotobl?sticas preferenciais, com germina??o favorecida pela presen?a de luz, mas as maiores porcentagens de germina??o e n?veis de vigor dessas sementes foram obtidas em temperaturas de 25?C constante e de 15-25?C alternada, na presen?a de luz.Funda??o de Amparo ? Pesquisa do Estado de Minas Gerais (FAPEMIG)Empresa de Pesquisa Agropecu?ria de Minas Gerais (EPAMIG)Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico (CNPq)Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES)The objective of this research was to evaluate the effect of temperature and light on germination of Vernonia polyanthes Less. seeds. Therefore were tested six constant temperatures (15, 20, 25, 30, 35 and 40?C), and four combinations of alternating temperatures (15-20, 15-25, 20-30 and 20-35?C) in the presence and absence, which was provided during periods of higher temperatures, when evaluating the rotation. The variables evaluated were: degree of moisture, germination and vigor (first count of germination and speed of germination). The completely random design was used and the results were submitted to analysis of variance with means compared by Tukey test at 5% probability. Seeds of the Vernonia polyanthes species are preferential photoblastic with germination favored in the presence of light. The highest percentage of germination and seed vigor levels of the seeds of V. polyanthes were obtained in temperatures of 25?C constant and alternating 15-25?C in the presence of light

The Development of Research Skills in Nursing Postgraduate Training

Funding: This research was funded by the Lisbon Center for Nursing Research, Innovation and Development (CIDNUR) and the POCTEP 4IE+ Project.Abstract: The objective of this study was to understand the contribution of postgraduate training to the development of research skills, aiming at their application in clinical practice. Method: This was a qualitative, exploratory, and descriptive study conducted with eight nurses in the Local Health Unit of Baixo Alentejo, in Portugal, who had postgraduate training. The researchers conducted a group interview, or discussion group, using a semi-structured interview, which was assessed by two reviewers. The data were submitted to content analysis, and the results underwent a validation process with the participants and two reviewers. This study was approved by the institution’s ethics committee. Result: In terms of the research skills developed in nursing postgraduate education, the following indicators emerged from the participants’ discourse: understanding the research process, searching databases, developing literature reviews, assessing the quality of articles, developing research projects, communicating about science, and translating knowledge into clinical practice. Conclusion: The participants developed research skills in their nursing postgraduate training and reported developing these skills in their clinical practice.info:eu-repo/semantics/publishedVersio

Mauriac Syndrome: A Rare Hepatic Glycogenosis in Poorly Controlled Type 1 Diabetes

Background: Hepatic glycogenosis (HG) is a complication of poorly controlled type 1 diabetes mellitus (T1DM), characterized by glycogen accumulation in hepatocytes. Mauriac syndrome (MS) is a glycogenic hepatopathy, initially described in 1930, characterized by growth failure, delayed puberty, cushingoid appearance, hepatomegaly with abnormal liver enzymes, and hypercholesterolemia. HG is a condition with good prognosis and fast resolution after adequate glycemic control (although it has potential for relapse), with no case of evolution to end-stage liver disease described. Case: We describe a 26-year-old female, with T1DM complicated by severe retinopathy. The patient maintained poor glycemic control since childhood, presenting glycated hemoglobin persistently higher than 10% and recurrent episodes of ketoacidosis. In adolescence, she developed hepatomegaly and fluctuating elevation of aminotransferases and triglycerides. A small, nonrepresentative hepatic biopsy suggested macrovacuolar steatosis and mild fibrosis. After 15 years of diabetes, the patient was referred for gastroenterology clinic due to chronic diarrhea and exuberant hepatomegaly. Laboratory showed persistent elevation of aminotransferases and triglycerides. Bilirubin, iron metabolism, and coagulation were normal; viral serologies and autoimmune study were negative. Upper endoscopy, ileocolonoscopy, and enteroscopy presented no lesions. Abdominal magnetic resonance imaging displayed massive hepatomegaly. Liver biopsy was repeated showing marked nuclear glycogenization, mild steatosis, and no fibrosis; electron microscopy revealed very large deposits of glycogen and pleomorphic mitochondria with an unusually dense matrix, described for the first time in this entity. The diagnosis of MS variant and diarrhea due to autonomic neuropathy were assumed. Conclusion: Currently, HG is a well-recognized disease that occurs at any age and can be present without the full spectrum of features initially described for MS. In the era of insulin therapy, this entity represents a rare complication, caused by low therapeutic compliance

The cyberjournal as a teaching tool: from technique to practice

the interdisciplinary work that culminated in the creation of the cyberjournal Jornalismo- PortoNet (JPN) in March 2004. The primary purpose of JPN was to provide an academic training post for last term students, simulating the editorial office of a newspaper. Taking advantage of the interdisciplinary and human resources of the course, a scheme has been implemented for editing and publishing news material, involving teachers from particular fields of Design, Computer Science and Journalism. The idea was to make the most of the potentialities offered by internet, choosing news building structures to suit this new process (open, in tree, multilinear, and with parallel linkages), by means of text blocks hyperconnected to one another. The goals proposed in this initial phase of JPN which lasted until the first days in June were globally reached. Although JPN was not widely advertised, its visibility was good, reaching some twenty thousand visits in the two and half months of intensive work. In all, more than 900 articles and dozens of radio and television reports were prepared and transmitted. These results make the authors conclude that the cyberjournal is an excellent tool in Journalism teaching, considering its low production and distribution costs and the internet potentialities as medium of communication wherein all the other media converge