a intervenção de enfermagem em grupos multifamiliares

Sendo a família um sistema social constituído por um elevado número de interações, é compreensível que um acontecimento que afeta um elemento da família tenha repercussões em todos os elementos. Baseado numa perspetiva sistémica o presente estudo assenta na temática da resiliência familiar. A resiliência familiar é de natureza dinâmica, e considera a multiplicidade de respostas adaptativas das famílias quando confrontadas com uma situação de adversidade. À luz dos Cuidados de Enfermagem Baseados nas Forças, este estudo visa contribuir para a promoção da resiliência das famílias de crianças com dificuldades na linguagem/socialização, através da intervenção em grupo terapêutico multifamiliar. Para tal foram definidos os seguintes objetivos: Identificar os níveis de resiliência nos pais de crianças com dificuldades na linguagem /socialização; perceber quais são os fatores protetores, os recursos que o grupo encontra através da partilha e troca de experiências; compreender o processo evolutivo do grupo multifamiliar; promover o processo de resiliência familiar. O grupo terapêutico multifamiliar aqui caracterizado revelou ser um espaço de partilha de dificuldades, dúvidas, emoções, conquistas e aprendizagens num ambiente contentor onde até os mais séticos conseguiram criar empatia, facilitada pela partilha de situações semelhantes. O enfermeiro compartilhando com as famílias a responsabilidade pelo cuidado, possibilitou que as mesmas partilhassem as suas realidades e construíssem conjuntamente novas alternativas, recursos e possibilidades para resolução dos seus problemas. Concluiu-se que a intervenção de enfermagem em grupo multifamiliar pode ser uma estratégia de intervenção na promoção da resiliência familiar uma vez que através da partilha em grupo os pais redescobrem os seus fatores protetores, as suas forças e competências, criam redes de apoio e empoderam-se para fazer face às adversidades nos diferentes estádios do ciclo familiar tornando toda a família mais resiliente

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status