TEORIAS DE ENFERMAGEM: IMPORTÂNCIA DA CORRETA APLICAÇÃO DOS CONCEITOS

Theoretical-reflexive research, whose aim is to analyze the clarity of concept stimulus in the Roy Model, for best comprehension in nursing practice. It was developed in three phases: 1- Search of studies that utilized the Roy Model; 2- Conducted reading for comprehension of the concept stimulus and 3- Analysis of clarity of the concept. The three studies were conducted at master level. The analysis of the studies shows deficiency in the clarity of the concept stimulus, being predominant the ambiguity in the classification and differentiation of the focal and contextual stimuli, without the existence of consistency and uniformity. The need arises to deepen the theories of nursing for adequate application in the areas of research: nursing education and practice, optimizing and improving its use, as well as, enabling the comprehension of determined concepts that are not sufficiently clear. The worries that arise among the nurses will provide a more profound approach to the study, enabling the advance of theories, as well as new findings, leading to necessary changes.  Investigación teórico-reflexiva cuyo objetivo fue analizar la claridad del concepto estímulo según el  modelo de Roy, para mayor comprensión en la práctica de enfermería. Desarrollada en tres etapas: 1ª- Levantamiento de estudios que utilizaron el Modelo de Roy; 2ª - Lectura dirigida hacia la comprensión del concepto estímulo y 3ª - Análisis de la claridad del concepto. Fueron utilizados tres estudios, a  nivel de maestrado. El análisis de los estudios demuestra deficiencia en la claridad del concepto estímulo, predominando ambigüedad en la clasificación y diferenciación de los estímulos focales y contextuales, sin consistencia y uniformidad. Se evidencia la necesidad de profundizar en las teorías de enfermería, para su aplicación adecuada en las áreas de investigación, enseñanza y práctica, optimizando y mejorando su uso, además de posibilitar la comprensión de determinados conceptos no suficientemente claros. Las inquietudes surgidas entre los enfermeros podrán motivar un abordaje más profundo de los estudios, posibilitando el avance de las teorías, así  como nuevos descubrimientos, dirigiendo los cambios necesariosPesquisa teórico-reflexiva, objetivando analisar a clareza do conceito estímulo no modelo de Roy, para maior compreensão na prática de enfermagem. Desenvolvido em três etapas: 1ª- Levantamento de estudos que utilizaram o Modelo de Roy; 2ª - Leitura dirigida para a compreensão do conceito estímulo e 3ª - Análise da clareza do conceito. Foram utilizados três estudos, em nível de mestrado. A análise dos estudos demonstra deficiência na clareza do conceito estímulo, predominando ambigüidade na classificação e diferenciação dos estímulos focais e contextuais, não existindo consistência e uniformidade. Evidencia-se a necessidade do aprofundamento nas teorias de enfermagem, para a aplicação adequada nas áreas de pesquisa, ensino e prática, otimizando e aprimorando seu uso, além de possibilitar a compreensão de determinados conceitos, não suficientemente claros. As inquietações surgidas entre os enfermeiros poderão proporcionar o aprofundamento nos estudos, possibilitando o avanço das teorias, assim como novos achados, direcionando as mudanças necessárias

Cooling interventions for athletes: An overview of effectiveness, physiological mechanisms, and practical considerations.

Exercise-induced increases in core body temperature could negative impact performance and may lead to development of heat-related illnesses. The use of cooling techniques prior (pre-cooling), during (per-cooling) or directly after (post-cooling) exercise may limit the increase in core body temperature and therefore improve exercise performance. The aim of the present review is to provide a comprehensive overview of current scientific knowledge in the field of pre-cooling, per-cooling and post-cooling. Based on existing studies, we will discuss 1) the effectiveness of cooling interventions, 2) the underlying physiological mechanisms and 3) practical considerations regarding the use of different cooling techniques. Furthermore, we tried to identify the optimal cooling technique and compared whether cooling-induced performance benefits are different between cool, moderate and hot ambient conditions. This article provides researchers, physicians, athletes and coaches with important information regarding the implementation of cooling techniques to maintain exercise performance and to successfully compete in thermally stressful conditions

Whole-genome amplified DNA from stored dried blood spots is reliable in high resolution melting curve and sequencing analysis

<p>Abstract</p> <p>Background</p> <p>The use of dried blood spots (DBS) samples in genomic workup has been limited by the relative low amounts of genomic DNA (gDNA) they contain. It remains to be proven that whole genome amplified DNA (wgaDNA) from stored DBS samples, constitutes a reliable alternative to gDNA.</p> <p>We wanted to compare melting curves and sequencing results from wgaDNA derived from DBS samples with gDNA derived from whole blood.</p> <p>Methods</p> <p>gDNA was extracted from whole blood obtained from 10 patients with lone atrial fibrillation (mean age 22.3 years). From their newborn DBS samples, stored at -24°C, genomic DNA was extracted and whole-genome amplified in triplicates. Using high resolution melting curve analysis and direct sequencing in both wgaDNA and gDNA samples, all coding regions and adjacent intron regions of the genes <it>SCN5A </it>and <it>KCNA5 </it>were investigated.</p> <p>Results</p> <p>Altered melting curves was present in 85 of wgaDNA samples and 81 of gDNA samples. Sequence analysis identified a total of 31 variants in the 10 wgaDNA samples. The same 31 variants were found in the exact same pattern of samples in the gDNA group. There was no false positive or negative sequence variation in the wgaDNA group.</p> <p>Conclusions</p> <p>The use of DNA amplified in triplicates from DBS samples is reliable and can be used both for high resolution curve melting analysis as well as direct sequence analysis. DBS samples therefore can serve as an alternative to whole blood in sequence analysis.</p

Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies

Promotion of good mental health, prevention, and early intervention before/at the onset of mental disorders improve outcomes. However, the range and peak ages at onset for mental disorders are not fully established. To provide robust, global epidemiological estimates of age at onset for mental disorders, we conducted a PRISMA/MOOSE-compliant systematic review with meta-analysis of birth cohort/cross-sectional/cohort studies, representative of the general population, reporting age at onset for any ICD/DSM-mental disorders, identified in PubMed/Web of Science (up to 16/05/2020) (PROSPERO:CRD42019143015). Co-primary outcomes were the proportion of individuals with onset of mental disorders before age 14, 18, 25, and peak age at onset, for any mental disorder and across International Classification of Diseases 11 diagnostic blocks. Median age at onset of specific disorders was additionally investigated. Across 192 studies (n = 708,561) included, the proportion of individuals with onset of any mental disorders before the ages of 14, 18, 25 were 34.6%, 48.4%, 62.5%, and peak age was 14.5 years (k = 14, median = 18, interquartile range (IQR) = 11–34). For diagnostic blocks, the proportion of individuals with onset of disorder before the age of 14, 18, 25 and peak age were as follows: neurodevelopmental disorders: 61.5%, 83.2%, 95.8%, 5.5 years (k = 21, median=12, IQR = 7–16), anxiety/fear-related disorders: 38.1%, 51.8%, 73.3%, 5.5 years (k = 73, median = 17, IQR = 9–25), obsessive-compulsive/related disorders: 24.6%, 45.1%, 64.0%, 14.5 years (k = 20, median = 19, IQR = 14–29), feeding/eating disorders/problems: 15.8%, 48.1%, 82.4%, 15.5 years (k = 11, median = 18, IQR = 15–23), conditions specifically associated with stress disorders: 16.9%, 27.6%, 43.1%, 15.5 years (k = 16, median = 30, IQR = 17–48), substance use disorders/addictive behaviours: 2.9%, 15.2%, 48.8%, 19.5 years (k = 58, median = 25, IQR = 20–41), schizophrenia-spectrum disorders/primary psychotic states: 3%, 12.3%, 47.8%, 20.5 years (k = 36, median = 25, IQR = 20–34), personality disorders/related traits: 1.9%, 9.6%, 47.7%, 20.5 years (k = 6, median = 25, IQR = 20–33), and mood disorders: 2.5%, 11.5%, 34.5%, 20.5 years (k = 79, median = 31, IQR = 21–46). No significant difference emerged by sex, or definition of age of onset. Median age at onset for specific mental disorders mapped on a time continuum, from phobias/separation anxiety/autism spectrum disorder/attention deficit hyperactivity disorder/social anxiety (8-13 years) to anorexia nervosa/bulimia nervosa/obsessive-compulsive/binge eating/cannabis use disorders (17-22 years), followed by schizophrenia, personality, panic and alcohol use disorders (25-27 years), and finally post-traumatic/depressive/generalized anxiety/bipolar/acute and transient psychotic disorders (30-35 years), with overlap among groups and no significant clustering. These results inform the timing of good mental health promotion/preventive/early intervention, updating the current mental health system structured around a child/adult service schism at age 18

Doppler and birth weight Z score: predictors for adverse neonatal outcome in severe fetal compromise

BACKGROUND: An adequate placental perfusion is crucial for the normal growth and well being of the fetus and newborn. The blood flow through the placenta can be compromised in a variety of clinical situations, always causing important damage to the gestation. Our objective is to identify significant predictors for adverse neonatal outcome in severe fetal compromise. METHODS: Consecutive premature fetuses at between 25 and 32 weeks with severe placental insufficiency were examined prospectively. Inclusion criteria were: (i) singletons (ii) normal anatomy; (iii) abnormal umbilical artery Doppler pulsatility index (PI); (iv) abnormal cerebroplacental ratio; (v) middle cerebral artery (MCA) PI < - 2SD ("brain sparing"); (vi) last Doppler examination performed within 24 hours prior to delivery. All 46 patients that met criteria and started the study were followed to the end. We considered as independent potential predicting variables: absent or reversed end diastolic flow in umbilical artery, abnormal ductus venosus S/A ratio, absent or reversed flow during atrial contraction in the ductus venosus and birth weight Z score. Outcome parameters were: neonatal mortality and severe neonatal morbidity. RESULTS: Backward stepwise logistic regression analysis was used to determine the optimal model for the prediction of neonatal mortality and severe neonatal morbidity. In this analysis birth weight Z score index showed the strongest association OR = 1,87 [1,17-2,99] with all neonatal outcome, all other independent variables were excluded for the optimal model. There was no mortality for the group with normal birth weight Z score. CONCLUSION: Our study suggests that birth weight Z score is the strongest predictor of adverse neonatal outcome in severe placental insufficiencies. Such use of Z scores, allowing to get rid of gestational age or sex covariates could be extended to estimated fetal weight and might help in making important decisions in the management of compromised pregnancies