Atitudes, práticas, barreiras e conhecimentos sobre a avaliação e controlo da dor : eficácia de uma intervenção estruturada a profissionais da saúde

Tese de mestrado, Ciências da Dor, Faculdade de Medicina, Universidade de Lisboa, 2014Objetivos: Avaliar as atitudes, práticas, barreiras e os conhecimentos dos médicos e enfermeiros em relação à avaliação e controlo da dor; avaliar o impacto de uma intervenção estruturada nas atitudes, práticas, barreiras e nos conhecimentos dos médicos e enfermeiros em relação à avaliação e controlo da dor e determinar a taxa de prevalência e características da dor nos doentes internados nos serviços de cirurgia geral, antes e após a intervenção estruturada foram os principais objetivos deste estudo. Métodos: Para atingir os objetivos foram desenvolvidos três estudos em três amostras: médicos, enfermeiros e doentes a quem foram aplicados instrumentos (questionários) construídos no presente estudo. Numa subamostra dos profissionais foi realizada uma intervenção estruturada de formação na área da dor com avaliação das variáveis antes e depois dessa intervenção. Participaram 73 dos médicos (57,9% do universo) e 120 dos enfermeiros (55,8% do universo). Na avaliação do impacto da intervenção, foram emparelhados 14 de um universo de 26 médicos e 15 de um universo de 39 enfermeiros. Colheram-se dados de 47 doentes antes da intervenção e de 35 depois da intervenção. Neste estudo os doentes não foram emparelhados. Os dados foram colhidos num Hospital da Zona Centro do Pais. Resultados: Em média a amostra dos profissionais mostrou atitudes positivas face à dor. Apenas 6 dos 27 itens, no caso dos médicos e 2 de 21, no caso dos enfermeiros, mostraram atitudes menos positivas e estas estavam relacionadas com a utilização de opióides. Em relação às práticas, detetaram-se pontos a melhorar, nomeadamente na utilização de opióides fortes. Foram determinadas as características psicométricas da escala das barreiras tendo a mesma mostrado boas propriedades psicométricas (α=0,783 na escala dos médicos e α=0,793 na dos enfermeiros). A análise factorial com rotação varimax permitiu extrair dois factores tanto na escala dos médicos (Barreiras dos doentes, Barreiras dos profissionais e instituição de saúde) como na escala dos enfermeiros (Barreiras associadas à avaliação e administração de medicação e Barreiras dos profissionais de saúde). Os médicos concordaram mais com as barreiras associadas aos doentes e os enfermeiros com as barreiras associadas à avaliação da dor e administração de medicamentos. Ao avaliar o impacto da intervenção dirigida aos profissionais, verificou-se diferença significativa (p<0,05) em alguns dos itens das atitudes e nas práticas. A melhoria no nível dos conhecimentos foi estatisticamente significativa (p <0,01) tanto nos enfermeiros como nos médicos. Na avaliação dos doentes antes e depois da intervenção, houve uma diminuição de prevalência de dor nas 24 horas de 61,7% para 45,7%. Os doentes mostraram-se satisfeitos com a avaliação e controlo da dor nos dois momentos analisados. Conclusão: Este estudo está de acordo com o referido na literatura: para um maior impacto no controlo da dor é necessário um envolvimento institucional, educativo e envolvimento do doente e da sua família. Não chega só a formação. No entanto, a melhoria dos conhecimentos dos profissionais e a ligeira melhoria das atitudes e das práticas, com uma prevalência de dor a baixar, leva à reflexão de que valerá a pena melhorar e ampliar a formação proposta, propô-la a mais serviços do Centro Hospitalar e envolver a instituição, no sentido de continuar o projeto de melhor controlo da dor.Objective: To determine attitudes, practices, barriers and knowledge regarding pain assessment and management among physicians and nurses. Assess the impact of a educational program on attitudes, practices, barriers and knowledge regarding pain assessment and management among physicians and nurses of the surgical wards. Evaluate pain prevalence and pain characteristics among hospitalized surgical patients, before and after the educational program. Methods: To achieve the proposals, three studies were developed, in three samples: questionnaires (developed in this study) were applied to physicians, nurses and patients. In the surgical wards they were applied before and after the educational intervention. 73 physicians (57,9%) and 120 nurses (55,8%) responded to the survey. To assess the impact of the educational intervention, 14 physicians, from a total of 26 and 15 nurses from a total of 39 were compared. Data from 47 patients before the intervention and 35 after the intervention were collected. This patients were not paired. Data were collected in an Hospital from the Center of Portugal. Results: On average, health professionals have had positive attitudes toward pain. Only 6 in 27 items, among physicians, and 2 in 21 items, among nurses, showed less positive attitudes which were related to opioid management. Practices evaluation detected some aspects to improve, namely strong opioids management. Barriers survey psychometric properties were determined and showed to be good (α=0,783 in physicians survey and α=0,793 in nurses survey). Factorial analysis with varimax rotation allowed to extract two factors in both physicians and nurses surveys. In the physicians survey: patients barriers and professionals and health institution barriers. In the nurses survey: assessment and drugs administration barriers and health care professionals barriers. Physicians agreed most with patient barriers. Nurses agreed most with pain assessment and drugs administration barriers. Impact’s evaluation of the educational intervention showed significant differences (p<0,05) in some attitudes and practice items. Knowledge improvement was statistically significant (p<0,01) both in physicians and nurses. Patient evaluation before and after the intervention showed a pain prevalence in the last 24 hours decrease from 61,7% to 45,7%. In both moments patient were satisfied with pain assessment and management. Conclusion: This study reflects the literature: to a major pain management, institutional and educative involvement are necessary as well as incorporating the patient and his family. Educational interventions alone are not enough. In this survey, the knowledge improvement, the slight better attitudes and practices and low pain prevalence shows that the proposed educational intervention can be enlarged, ameliorated and expanded to other health care providers, from other wards and specialties. It is also important to involve the institution, so this project to improve pain assessment and management can be continued

Collagen and microvascularization in placentas from young and older mares

Research Areas: Veterinary SciencesIn older mares, increasing collagen fibers (fibrosis) in the endometrium and oviduct predisposes to sub-fertility and infertility. In this study, (i) gene transcription of collagen (qPCR: COL1A1, COL1A2, COL3A1, COL5A1); (ii) total collagen protein (hydroxyproline); (iii) collagen distribution (Picrosirius red staining; polarized light microscopy); and (iv) microvascular density (Periodic acid-Schiff staining), were evaluated in mares’ placenta, and related to mares age, and placenta and neonate weights. Samples were collected from the gravid horn, non-gravid horn, and body of the placenta from younger (n = 7), and older mares (n = 9) of different breeds. Transcripts of COL1A1, COL3A1 and COL5A1, total collagen protein, chorionic plate connective tissue thickness, and microvascularization increased in the gravid horn of older mares’ placentas, compared to the youngest (P < 0.05). Although in other species placenta fibrosis may indicate placental insufficiency and reduced neonate weight, this was not observed here. It appears that older fertile mares, with more parities, may develop a heavier, more vascularized functional placenta with more collagen, throughout a longer gestation, which enables the delivery of heavier foals. Thus, these features might represent morphological and physiological adaptations of older fertile mares’ placentas to provide the appropriate nutrition to the equine fetus.info:eu-repo/semantics/publishedVersio

Conceptual maps : representations of History teachers’ knowledge

Este texto pretende discutir o papel dos mapas de conceitos como representações gráficas do conhecimento do professor de história, aquando o desenho de um trajecto didáctico específico. Identificar-se-ão as dificuldades inerentes à sua construção assim como possíveis modos de utilização na sala de aula de História do Ensino Básico.This text intends to discuss the role of conceptual maps as graphic representations of History teachers’ knowledge, when they draw a didactic plan. We aim also to identify the problems teachers faced during the maps construction, and as well to point out possible ways to use them in 2nd and 3rd cycle history classrooms

Eradication of Mycoplasma gallisepticum and M. synoviae from...

A chicken breeding flock of 3,464 hens, naturally infected withMvcoplasma gallisepticum (MG) and M. svnoviae (MS), was subjected to a mycoplasma eradication scheme, based on antimicrobial treatment of eggs and their hatched dayold chicks. The egg injection sites utilized were the air cell and the small end (albumen), and the antibiotics used were tylosin at two different doses (3 mg or 5 mg per egg) and gentamicin (0.6 mg/egg). For the chicks treatment, a combination of spectinomycin and lincomycin, diluted in dextrose-vitamin complex solution, was employed. The differences in hatchability for the egg air cell-embryo (17.2%), egg small end (albumen)-3mg tylosin (72.4%) and egg small end (albumen)-5mg tylosin (42.1%) injection procedures were significantly different by Chi-square analysis (

A formação crítica do educando orientada através da abordagem steam / The critical formation of the student guided through the steam approach

A formação crítica do educando a décadas é fruto de diversas reflexões e também a base de diversas correntes teóricas, como a tendência histórico crítica, nessa perspectiva diversas metodologias e abordagens buscam meios para desenvolver o currículo escolar visando à formação integral do aluno, dentre elas o STEAM, acrônimo de Ciências, Tecnologia, Engenharia, Arte e Matemática, nesse contexto essa pesquisa visa analisar a relação existente entre a teoria histórico crítica e a aplicação da abordagem STEAM na formação crítica dos educandos dos anos finais do ensino fundamental. Para alcançar este objetivo a pesquisa realizou uma análise bibliográfica dos documentos curriculares nacionais, os principais pensadores que abordam a tendência histórico crítica e o conceito e a aplicação da abordagem STEAM na formação do estudante, onde constatou-se que a abordagem apresentada é coerente com o construtivismo abordado por Piaget e Vygotsky, pois os mesmos afirmam que o objetivo da educação é o desenvolvimento da autonomia do educando, e isso só é possível quando o estudante é estimulado a ser criativo, independente, capaz de resolver problemas, ou seja, ser um ser agente de sua própria aprendizagem, como preconiza a abordagem STEAM

Extracellular vesicles shed by trypanosoma brucei brucei manipulate host mononuclear cells

Funding Information: Funding: This study was supported by FCT—Foundation for Science and Technology, I.P., through research grant PTDC/CVT-CVT/28908/2017 and by national funds within the scope of Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA, UIDB/00276/2020) and Global Health and Tropical Medicine (GHTM, UID/04413/2020). Funding Information: This study was supported by FCT?Foundation for Science and Technology, I.P., through research grant PTDC/CVT-CVT/28908/2017 and by national funds within the scope of Centro de Investiga??o Interdisciplinar em Sanidade Animal (CIISA, UIDB/00276/2020) and Global Health and Tropical Medicine (GHTM, UID/04413/2020). Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.African trypanosomiasis or sleeping sickness is a zoonotic disease caused by Trypanosoma brucei, a protozoan parasite transmitted by Glossina spp. (tsetse fly). Parasite introduction into mammal hosts triggers a succession of events, involving both innate and adaptive immunity. Macrophages (MΦ) have a key role in innate defence since they are antigen-presenting cells and have a micro-bicidal function essential for trypanosome clearance. Adaptive immune defence is carried out by lymphocytes, especially by T cells that promote an integrated immune response. Like mammal cells, T. b. brucei parasites release extracellular vesicles (TbEVs), which carry macromolecules that can be transferred to host cells, transmitting biological information able to manipulate cell immune response. However, the exact role of TbEVs in host immune response remains poorly understood. Thus, the current study examined the effect elicited by TbEVs on MΦ and T lymphocytes. A combined approach of microscopy, nanoparticle tracking analysis, multiparametric flow cytometry, colourimetric assays and detailed statistical analyses were used to evaluate the influence of TbEVs in mouse mononuclear cells. It was shown that TbEVs can establish direct communication with cells of innate and adaptative immunity. TbEVs induce the differentiation of both M1-and M2-MΦ and elicit the expansion of MHCI+, MHCII+ and MHCI+ MHCII+ MΦ subpopulations. In T lymphocytes, TbEVs drive the overexpression of cell-surface CD3 and the nuclear factor FoxP3, which lead to the differentiation of regulatory CD4+ and CD8+ T cells. Moreover, this study indicates that T. b. brucei and TbEVs seem to display opposite but complementary effects in the host, establishing a balance between parasite growth and controlled immune response, at least during the early phase of infection.publishersversionpublishe

Suscetibilidade da vegetação ao fogo no sul do amazonas sob condições meteorológicas atípicas durante a seca de 2005

Weather conditions play an important role in the behavior of fires both in agricultural and pasture management and in forest wildfires in Amazonia. In severe drought years, the fires used for the management of land can escape from human control and burn large areas of vegetation. Meteorological parameters and hotspot locations were used to evaluate the susceptibility of the vegetation to fire in the southern portion of the state of Amazonas in a year without drought (2004) and a year with severe drought (2005). The number of cells susceptible to fire was 84% higher in 2005 (72%) compared with 2004 (39%). In 2005, the number of cells with hotspots increased by 66% and the number of hotspots by 121%. In 2004, 65% of the hotspots occurred in locations with 40 and 90 mm precipitation, 96% with an average temperature of 26 to 28 º C, and 89% with less than 65% humidity. In 2005, 83% of the hotspots occurred when rainfall was less than 70 mm, 96% with average temperature between 24 and 28 º C and 99% with air humidity below 65%. The meteorological parameters differed between years but not between areas with and without hotspots (PC1 = 84%). There was a higher amplitude variation in these meteorological parameters in the severe drought year, providing hotter and drier weather, thus increasing the susceptibility of vegetation to fire. © 2015, Sociedade Brasileira de Meteorologia. All rights reserved