GLP-1 metabolite GLP-1(9-36) is a systemic inhibitor of mouse and human pancreatic islet glucagon secretion.

AIMS/HYPOTHESIS: Diabetes mellitus is associated with impaired insulin secretion, often aggravated by oversecretion of glucagon. Therapeutic interventions should ideally correct both defects. Glucagon-like peptide 1 (GLP-1) has this capability but exactly how it exerts its glucagonostatic effect remains obscure. Following its release GLP-1 is rapidly degraded from GLP-1(7-36) to GLP-1(9-36). We hypothesised that the metabolite GLP-1(9-36) (previously believed to be biologically inactive) exerts a direct inhibitory effect on glucagon secretion and that this mechanism becomes impaired in diabetes. METHODS: We used a combination of glucagon secretion measurements in mouse and human islets (including islets from donors with type 2 diabetes), total internal reflection fluorescence microscopy imaging of secretory granule dynamics, recordings of cytoplasmic Ca2+ and measurements of protein kinase A activity, immunocytochemistry, in vivo physiology and GTP-binding protein dissociation studies to explore how GLP-1 exerts its inhibitory effect on glucagon secretion and the role of the metabolite GLP-1(9-36). RESULTS: GLP-1(7-36) inhibited glucagon secretion in isolated islets with an IC50 of 2.5 pmol/l. The effect was particularly strong at low glucose concentrations. The degradation product GLP-1(9-36) shared this capacity. GLP-1(9-36) retained its glucagonostatic effects after genetic/pharmacological inactivation of the GLP-1 receptor. GLP-1(9-36) also potently inhibited glucagon secretion evoked by ß-adrenergic stimulation, amino acids and membrane depolarisation. In islet alpha cells, GLP-1(9-36) led to inhibition of Ca2+ entry via voltage-gated Ca2+ channels sensitive to ω-agatoxin, with consequential pertussis-toxin-sensitive depletion of the docked pool of secretory granules, effects that were prevented by the glucagon receptor antagonists REMD2.59 and L-168049. The capacity of GLP-1(9-36) to inhibit glucagon secretion and reduce the number of docked granules was lost in alpha cells from human donors with type 2 diabetes. In vivo, high exogenous concentrations of GLP-1(9-36) (>100 pmol/l) resulted in a small (30%) lowering of circulating glucagon during insulin-induced hypoglycaemia. This effect was abolished by REMD2.59, which promptly increased circulating glucagon by >225% (adjusted for the change in plasma glucose) without affecting pancreatic glucagon content. CONCLUSIONS/INTERPRETATION: We conclude that the GLP-1 metabolite GLP-1(9-36) is a systemic inhibitor of glucagon secretion. We propose that the increase in circulating glucagon observed following genetic/pharmacological inactivation of glucagon signalling in mice and in people with type 2 diabetes reflects the removal of GLP-1(9-36)'s glucagonostatic action.

Valuing the future at different temporal points: The role of time framing on discounting.

The rate of delay discounting exhibited by individuals has been experimentally altered by manipulating the way in which time is described, a specific application of the framing effect. Previous research suggests that using specific dates to describe delays tends to lower temporal discounting and change the shape of the discounting function. The main purpose of this study was to assess the influence of framing on discounting in different temporal contexts. Participants chose between hypothetical monetary gains (gains group), or between hypothetical monetary losses (losses group). Each group completed eight discounting tasks over two sessions (two choice tasks [SmallNow/SmallSoon] by two time frames [dates/calendar units] by two magnitudes. The results indicate that Mazur's model adequately described the observed discounting functions in most conditions. However, the decrease in discounting rate when both consequences were delayed only occurred when calendar units (but not dates) were used for both gains and losses. These findings suggest that framing affects the influence of a shared delay instead of changing the shape of the discounting function. Our results support the idea that time influences behavior similarly in humans and nonhumans when they choose between two delayed consequences.

Genome-wide association study of cassava starch paste properties.

An understanding of cassava starch paste properties (CSPP) can contribute to the selection of clones with differentiated starches. This study aimed to identify genomic regions associated with CSPP using different genome-wide association study (GWAS) methods (MLM, MLMM, and Farm-CPU). The GWAS was performed using 23,078 single-nucleotide polymorphisms (SNPs). The rapid viscoanalyzer (RVA) parameters were pasting temperature (PastTemp), peak viscosity (PeakVisc), hot-paste viscosity (Hot-PVisc), cool-paste viscosity (Cold-PVisc), final viscosity (FinalVis), breakdown (BreDow), and setback (Setback). Broad phenotypic and molecular diversity was identified based on the genomic kinship matrix. The broad-sense heritability estimates (h2) ranged from moderate to high magnitudes (0.66 to 0.76). The linkage disequilibrium (LD) declined to between 0.3 and 2.0 Mb (r2 <0.1) for most chromosomes, except chromosome 17, which exhibited an extensive LD. Thirteen SNPs were found to be significantly associated with CSPP, on chromosomes 3, 8, 17, and 18. Only the BreDow trait had no associated SNPs. The regional marker-trait associations on chromosome 18 indicate a LD block between 2907312 and 3567816 bp and that SNP S18_3081635 was associated with SetBack, FinalVis, and Cold-PVisc (all three GWAS methods) and with Hot-PVisc (MLM), indicating that this SNP can track these four traits simultaneously. The variance explained by the SNPs ranged from 0.13 to 0.18 for SetBack, FinalVis, and Cold-PVisc and from 0.06 to 0.09 for PeakVisc and Hot-PVisc. The results indicated additive effects of the genetic control of Cold-PVisc, FinalVis, Hot-PVisc, and SetBack, especially on the large LD block on chromosome 18. One transcript encoding the glycosyl hydrolase family 35 enzymes on chromosome 17 and one encoding the mannose-p-dolichol utilization defect 1 protein on chromosome 18 were the most likely candidate genes for the regulation of CSPP. These results underline the potential for the assisted selection of high-value starches to improve cassava root quality through breeding programs.

Similar attention and performance in female and male CD1 mice in the peak procedure.

Inaccurate and distorted timing are associated with neurodegenerative disorders such as Alzheimer's disease and schizophrenia in humans, which generates interest in the discovery and understanding of the factors behind such timing difficulties. Timing research in mice has taken an important role, because the availability of genetically-altered strains allows establishing the causal role of specific genes on such neurodegenerative disorders. Nevertheless, few studies have considered mice's sex and some have found sex differences in timing, although results are not yet conclusive. We tested female and male CD1 mice, an outbred strain not yet studied in a peak procedure. By varying the percentage of peak trials and the presence of a gap and/or a distractor in the tests, we found no sex differences in accuracy, precision, or attention. Both females and males followed a stop-clock strategy after distractor and gap + distractor trials. This suggests that both male and female CD1 mice may be exposed to a peak procedure to study factors associated to neurotoxicology or neurogenesis.

The vascular architecture of the pancreatic islets: A homage to August Krogh.

The vascular network supporting the islets of Langerhans represents a highly specialised system of arterioles, capillaries and venules. Several features of the islet vasculature (density and fenestration of the capillaries) ensure rapid exchange of nutrients and hormones, which is central to the islets' capacity to control of systemic metabolism via reciprocal changes of insulin and glucagon secretion. Here we discuss how changes in islet blood flow may underlie pulsatile insulin secretion, which becomes impaired in type-2 diabetes. Improved understanding of the architecture and regulation of pancreas/islet blood flow may therefore illuminate the causes underlying this common metabolic disorder. The pioneering work of August Krogh on blood flow, oxygen diffusion and capillary anatomy (that was awarded with the Nobel Prize in 1920) is a cornerstone in these efforts and remains relevant to today's research.

Therapeutic Efficacy of a Mixed Formulation of Conventional and PEGylated Liposomes Containing Meglumine Antimoniate, Combined with Allopurinol, in Dogs Naturally Infected with Leishmania infantum.

The treatment of dogs naturally infected with Leishmania infantum using meglumine antimoniate (MA) encapsulated in conventional liposomes (LC) in association with allopurinol has been previously reported to promote a marked reduction in the parasite burden in the main infection sites. Here, a new assay in naturally infected dogs was performed using a novel liposome formulation of MA consisting of a mixture of conventional and long-circulating (PEGylated) liposomes (LCP), with expected broader distribution among affected tissues of the mononuclear phagocyte system. Experimental groups of naturally infected dogs were as follows: LCP plus Allop, receiving LCP intravenously as 2 cycles of 6 doses (6.5 mg Sb/kg of body weight/dose) at 4-day intervals plus allopurinol at 30 mg/kg/12 h per os (p.o.) during 130 days (LCP+Allop); LC plus Allop, receiving LC intravenously as 2 cycles of 6 doses (6.5 mg Sb/kg/dose) plus allopurinol during 130 days (LC+Allop); Allop, treated with allopurinol only; and a nontreated control. Parasite loads were evaluated by quantitative PCR in liver, spleen, and bone marrow tissue and by immunohistochemistry in the ear skin, before treatment, just after treatment, and 4 months later. The LCP+Allop and LC+Allop groups, but not the Allop group, showed significant suppression of the parasites in the liver, spleen, and bone marrow 4 months after treatment compared to the pretreatment period or the control group. Only LCP+Allop group showed significantly lower parasite burden in the skin in comparison to the control group. On the basis of clinical staging and parasitological evaluations, the LCP formulation exhibited a more favorable therapeutic profile than the LC one, being therefore promising for the treatment of canine visceral leishmaniasis.

Realização de testes rápidos de sífilis em gestantes por enfermeiros da atenção básica / Realización de exámenes rápidos de sífilis en gestantes por enfermeros de la atención primaria / Rapid syphilis tests in pregnant women by primary care nurses

Objetivo: conhecer de que forma os enfermeiros da atenção básica realizam os testes rápidos para sífilis em gestantes. Método: pesquisa qualitativa realizada em um município do sul do Brasil. Os dados foram coletados em 2018 por entrevistas semiestruturadas e submetidos à Análise de Conteúdo. Resultados: referiram que a doença pode ser assintomática, mas tem três estágios. Citaram como sintomas uma ferida vaginal que some e após aparecem manchas no corpo. A doença pode causar no recém-nascido má-formação. Houve desconhecimento acerca da doença. Notificam os casos positivos e iniciam imediatamente o tratamento da gestante. Ressaltaram a não adesão dos parceiros ao tratamento. Conclusão: destaca-se o importante papel do enfermeiro na realização do pré-natal e do teste rápido de sífilis. Observa-se que são necessárias ações de educação continuada melhorando os indicadores da doença no país.

Objective: to find out how primary care nurses perform rapid tests for syphilis in pregnant women. Method: this is a qualitative research conducted in a municipality in southern Brazil. Data were collected in 2018 by semi-structured interviews and submitted to Content Analysis. Results: thee nurses reported that the disease can be asymptomatic, but it has three stages. The symptoms mentioned were a vaginal wound that disappears and after that spots appear on the body. The disease can cause malformation in the newborn. The disease was unknown. When they noticed positive cases, they immediately began treatment of the pregnant woman. They emphasized the non-adherence of partners to treatment. Conclusion: the nurse's important role in prenatal and rapid syphilis testing is highlighted. Continuing education actions are needed to improve the disease indicators in the country.

Objetivo: conocer de qué forma los enfermeros de la atención primaria realizan los exámenes rápidos para sífilis en gestantes. Método: es una investigación cualitativa realizada en un municipio del sur de Brasil. Los datos fueron recogidos en 2018 por entrevistas semi-estructuradas y sometidos al Análisis de Contenido. Resultados: reportaron que la enfermedad puede ser asintomática, pero tiene tres etapas. Como síntomas, citaron una herida vaginal que desaparece y después aparecen manchas en el cuerpo. La enfermedad puede causar mala formación en el recién nacido. Se desconocía acerca de la enfermedad. Notificaron casos positivos e iniciaron inmediatamente el tratamiento de la gestante. Resaltaron la no adherencia de los compañeros al tratamiento. Conclusión: se destaca el importante papel del enfermero en la realización del prenatal y del examen rápido de sífilis. Se observa que son necesarias acciones de educación continuada mejorando los indicadores de la enfermedad en el país.

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)

Nexos e reflexos da adaptação do enfermeiro à cultura organizacional / Nexus and reflections of the nurse's adaptation to organizational culture / Nexos y reflejos de la adaptación del enfermero a la cultura organizacional

Objetivo: compreender os nexos e reflexos da adaptação do enfermeiro à cultura organizacional do cuidado de enfermagem no âmbito hospitalar. Método: pesquisa qualitativa, exploratório-descritiva, cujos dados foram coletados por meio de entrevistas semiestruturadas com 12 enfermeiros. Para a análise dos dados, foi escolhido o método de análise de conteúdo, por envolver e apreender aspectos subjetivos, emergindo duas categorias: a normalização do cuidado e sobrepujando a adaptação normalizadora. Resultados: o enfermeiro, ao disponibilizar o cuidado, permite que a cultura da organização faça um agenciamento sobre si, sendo esta adaptação otimizada pela falta de exercício da autonomia pelos enfermeiros e por uma identidade singular pouco consolidada. Considerações finais: o reflexo da adaptação à cultura organizacional faz com que o cuidado disponibilizado se fragilize, fomentando de forma insuficiente a proatividade do enfermeiro. Um maior tempo de trabalho favorece a produção de subjetividade singular.

Aim: to understand the nexus and reflexes of nurses' adaptation to the organizational culture of nursing care in the hospital setting. Method: qualitative, exploratory-descriptive research, whose data were collected through semi-structured interviews with 12 nurses. For data analysis, the content analysis method was chosen, since it involves and apprehends subjective aspects, emerging two categories: the normalization of care and overcoming the normalizing adaptation. Results: the nurse, by providing the care, allows the organization's culture to make an agency on itself, being this adaptation optimized by the lack of exercise of the autonomy by the nurses and by a singular identity little consolidated. Final considerations: the reflex of the adaptation to the organizational culture makes the available care fragile, insufficiently promoting the nurse's proactivity. A longer working time favors the production of singular subjectivity.

Objetivo: comprender los nexos y reflejos de la adaptación del enfermero a la cultura organizacional del cuidado de enfermería en el ámbito hospitalario. Método: investigación cualitativa, exploratorio-descriptiva; los datos fueron recolectados por medio de entrevistas semiestructuradas con 12 enfermeros. Para el análisis de los datos fue elegido el método de análisis de contenido, por involucrar y aprehender aspectos subjetivos, y del cual emergió dos categorías: la normalización del cuidado y sobreponiendo la adaptación normalizadora. Resultados: el enfermero, al desarrollar el cuidado, permite que la cultura de la organización haga un agenciamiento sobre sí, siendo esta adaptación optimizada por la falta de ejercicio de la autonomía por los enfermeros y por una identidad poco consolidada. Consideraciones finales: el reflejo de la adaptación a la cultura organizacional fragiliza el cuidado disponible, fomentando de forma insuficiente la proactividad del enfermero. Un tiempo más largo de trabajo favorece la producción de subjetividad singular.

Uncontrollable chronic stress affects eating behavior in rats.

The issue of whether the decrease in food intake induced by inescapable shock is due to the uncontrollability of the stressor or the shock per se has not yet been settled. Besides, whether food intake is differentially affected by an uncontrollable chronic stressor has been explored only by a few studies. Thus, we evaluated the effects of chronic escapable or inescapable electric shocks on eating behavior. Rats were exposed to shock sessions for 20 days in two occasions separated by baseline sessions with no shock in an ABAB design. Results showed a reduction in food and water intake and body weight gain during stress periods, especially with inescapable shocks. The findings support a close link between learned helplessness, chronic stress, and eating behavior.

Toward a Unifying Account of Impulsivity and the Development of Self-Control.

Impulsivity has traditionally been thought to involve various behavioral traits that can be measured using different laboratory protocols. Whereas some authors regard different measures of impulsivity as reflecting fundamentally distinct and unrelated behavioral tendencies (fragmentation approach), others regard those different indexes as analogue forms of the same behavioral tendency, only superficially different (unification approach). Unifying accounts range from mere intuitions to more sophisticated theoretical systems. Some of the more complete attempts at unifying are intriguing but have validity weaknesses. We propose a new unifying attempt based on theoretical points posed by other authors and supplemented by theory and research on associative learning. We then apply these assumptions to characterize the paradigms used to study impulsivity in laboratory settings and evaluate their scope as an attempt at unification. We argue that our approach possesses a good balance of parsimony and empirical and theoretical grounding, as well as a more encompassing scope, and is more suitable for experimental testing than previous theoretical frameworks. In addition, the proposed approach is capable of generating a new definition of impulsivity and outlines a hypothesis of how self-control can be developed. Finally, we examine the fragmentation approach from a different perspective, emphasizing the importance of finding similarities among seemingly different phenomena.

Sources of hepatic glycogen synthesis in mice fed with glucose or fructose as the sole dietary carbohydrate.

PURPOSE: The positional analysis of hepatic glycogen enrichment from deuterated water (2 H2 O) by 2 H NMR has been applied previously to resolve the contributions of glucose and fructose to glycogen synthesis in rodents fed a high sucrose diet. To further validate this method, this analysis was applied to mice fed with synthetic diets whose carbohydrate components consisted solely of either glucose or fructose. METHODS: Eight glucose-fed and 12 fructose-fed mice were given 2 H2 O followed by ad libitum feeding overnight. Mice were then euthanized, hepatic glycogen was isolated and derivatized to monoacetone glucose, and 2 H-enrichment of positions 2, 5, and 6S were measured by 2 H NMR. From these data, the fraction of overnight glycogen appearance from the direct pathway and/or glycogen cycling and indirect pathway were estimated. Indirect pathway fractions were resolved into Krebs cycle and triose-phosphate sources-the latter including contributions from fructose metabolism. RESULTS: After overnight feeding, the fraction of overnight glycogen appearance derived from direct pathway and/or glycogen cycling in glucose-fed-mice was 63 ± 1%. For the indirect pathway, Krebs cycle and triose-phosphate sources contributed 22 ± 1% and 15 ± 1%, respectively. For fructose-fed-mice, glycogen appearance was dominated by triose-phosphate sources (60 ± 2%) with lesser contributions from Krebs cycle (14 ± 1%) and direct and/or glycogen cycling (26 ± 2%). CONCLUSIONS: 2 H NMR analysis of hepatic glycogen 2 H enrichment from 2 H2 O provides realistic profiles of dietary glucose and fructose contributions to hepatic glycogen synthesis in mice fed with diets containing 1 or the other sugar as the sole carbohydrate source.

Canine Leishmaniasis: An Overview of the Current Status and Strategies for Control.

Canine leishmaniasis (CanL) is a vector-borne disease caused by Leishmania infantum and is transmitted by female phlebotomine sand flies primarily between animals and secondarily to humans. The course of infection may be different from one individual dog to another, ranging from spontaneous cure to acute evolution that leads to death, if proper management and therapy are not adopted. A parasitological cure is rarely achieved and clinical recurrences in CanL are frequent. Vaccination associated with the use of topical insecticides is undoubtedly the most effective form of prevention and control of the disease. In order to integrate the most important scientific knowledge of the literature in one objective publication, this review proposes a short overview of the main points of CanL.

Impulsive mechanisms influencing relapse in alcohol drinking.

Impulsivity has been related to different features of addictive behaviors. Growing data, generated in separated lines of research, suggest that different processes underlying impulsivity are associated to relapse in alcohol drinking. Considering the evidence, relapse can be understood as an impulsive choice or as an impulsive action. In the first case, the return to drinking behavior is a consequence of insensitive to delayed consequence, that is, to the discounting of delayed rewards. In the second case, relapse is a consequence of failures to inhibit prepotent responses. Nevertheless, conditions that control the action of each mechanism or their interaction to influence relapse still unknown. We hypothesize that both mechanisms interact to produce relapse depending on framing effects, the moments of a drinking episode or context. The implication of the hypothesis is that relapse prevention strategies need to reduce discounting rate, but also to increase behavioral inhibition in the presence of cues related to alcohol.

Jogos sérios em ambiente virtual para ensino-aprendizagem na saúde / Serious games in virtual environments for health teaching and learning

Objetivo: identificar na literatura como tem evoluído o uso de jogos sérios em ambiente virtual para o ensinoaprendizagem na saúde. Métodos: revisão integrativa, com buscas nas bases de dados: Web of Science, National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature. Resultados: identificaram-se 82.779 artigos, dos quais 13 foram analisados na íntegra. Jogos sérios apresentam menor custo comparados às simulações de procedimentos cirúrgicos, fácil acessibilidade e adequação ao desenvolvimento de habilidades cirúrgicas, treino de pacientes, aptidões, raciocínio clínico e tomada de decisão. Conclusão: os jogos sérios têm sido desenvolvidos por meio da elaboração de softwares e ferramenta de interatividade específica, principalmente os direcionados ao desenvolvimento de habilidades; com uso de componentes via internet, especialmente, na Medicina e Enfermagem; e utilizam periféricos dos próprios computadores nas estratégias de ensino-aprendizagem para incentivar o raciocínio clínico e a tomada de decisão. (AU)

Gestão em saúde na fronteira: revisão integrativa da imbricância para a assistência hospitalar / Gestión de la salud en la frontera: revisión integradora de su impacto en laatención hospitalaria / Health management in frontier: integrative review on its impact for hospital care

Objetivo: Identificar os subsídios propiciados pela produção científica à gestão hospitalar de saúde em áreas de fronteira. Métodos: Trata-se de uma revisão integrativa que explorou o universo de 24 artigos indexados na Biblioteca Virtual de Saúde, na base de dados Literatura Latino-Americanae do Caribe em Ciência da Saúde (LILACS). Resultados: Aspectos socioeconômicos da gestão em saúde na fronteira que evidenciaram a mobilidade de pessoas e a gestão dos serviços de saúde e; aspectos clínicos para a gestão em saúde na fronteira que destacou os aspectos do serviço e as características da clientela. Conclusão: A saúde em área de fronteira pela produção científica explorada subsidia a gestão hospitalar ao indicar os aspectos socioeconômicos como determinantes do processo saúde-doença. Determinação que acarreta na ampliação da demanda e da necessidade de tecnologia diagnóstica em saúde.

Objective: To identify the subsidies provided by scientific production to hospital health management in frontier areas. Methods: This is an integrative review that explored the universe of 24 articles indexed in the Virtual HealthLibrary, the database of Latin American and Caribbean Health Sciences (LILACS). Results: Socioeconomic health management aspects at the border that showed the mobility of people and the management of health services and; clinical aspects of health management at the border which highlighted aspects of service and customer characteristics. Conclusion: Health in the frontier area explored in scientific production subsidizes the hospital management to indicate the socioeconomic factors as determinants of the health-disease. Determination which results in increased demand and the need for health diagnostic technology.

Objetivo: Identificar subsidios propiciados por la producción científicade la gestión hospitalaria de salud en las zonas fronterizas. Métodos: Se trata de una revisión integradora que explora el universo de 24 artículos indexados en la Biblioteca Virtual en Salud, en la base de datos de América Latina y el Caribe de la Salud Ciencia (LILACS). Resultados: Aspectos socioeconómicos de Gestión de la Salud en la Frontera que demuestran la movilidad de las personas y la gestión de los servicios de salud y; Aspectos clínicos para la Gestión de la Salud en la Frontera que destacaron los aspectos de las características del servicio y atención al cliente. Conclusión: Salud en el área de frontera de producción científica explorado presentado subvenciona la gestión hospitalaria para indicar los aspectos socioeconómicos como determinantes de la salud-enfermedad. Determinación de que implica la expansión de la demanda y la necesidad de tecnología de diagnóstico en salud.

Reinforcement value and fixed-interval performance.

The concept of reinforcement value summarizes the effect of different variables, such as reinforcement delay, reinforcement magnitude, and deprivation level, on behavior. In the present set of experiments, we evaluated the effect of reinforcement devaluation on performance under FI schedules. The literature on timing and reinforcement value suggests that devaluation generates longer expected times to reinforcement than the same intervals trained under control conditions. We devalued reinforcement with delay in Experiments 1A, 1B, and 2, and diminished deprivation in Experiments 3A and 3B. Devaluation reduced response rates, increased the number of one-response intervals, and lengthened postreinforcement pauses, but had inconsistent effects on other timing measures such as quarter life and breakpoint. The results of delayed reinforcement and diminished deprivation manipulations are well summarized as reinforcement devaluation effects. These results suggest that devaluation may reduce stimulus control. In addition, we argue that the process by which delayed reinforcement affects behavior might also explain some effects observed in other devaluation procedures through the concept of reinforcement value.

Telenursing Intervention for Clean Intermittent Urinary Catheterization Patients: A Pilot Study.

Telenursing is a promising strategy to make nursing care feasible in different health situations, mainly to help patients with chronic illnesses. The aim in this study was to test the feasibility (acceptability and usability) of a telenursing intervention in care delivery to patients using clean intermittent urinary catheterization. This descriptive study focused on an intervention involving urology outpatients. The telenursing intervention was implemented synchronously by audio calls and chat and asynchronously by e-mail as part of a pilot study. The contact between nurse and patient was undertaken through an active search or on spontaneous demand, in which the patient contacted the nurse when necessary. During the 5 weeks of study, 21 telenursing care sessions took place, including 13 (61.9%) on spontaneous demand and eight (38.1%) on active demand. With regard to the technological resource used, 13 telenursing sessions (61.9%) took place by telephone call and eight (30.1%) by e-mail. The pilot study demonstrated the potential of the telenursing intervention to achieve important results, and as a complement to the patients' traditional health treatment. In addition, it revealed various barriers that need to be overcome for this type of care to take place effectively.

Percepções de puérperas sobre o cuidado de enfermagem no alojamento conjunto / Las percepciones de las madres acerca de los cuidados de enfermería enalojamiento conjunto / Perceptions of puerperas on nursing care in rooming-in accommodation

Objective: To know the perception of the mothers on the care of nursing professionals in Rooming-in accommodations. Methods: A descriptive exploratory qualitative study in a medium-sized hospital in the interior of Rio Grande do Sul with 15 women in the immediate postpartum period. The project was approved by the Ethics Committee in Research of the University of the Campaign Region under number 62/2013 CAAE. We used the letter “P” to identify postpartum women, followed by the sequential number of the interviews. Data were collected through semi-structured interviews applied to postpartum women in the months from October to November 2013. Data analysis was used to treat the data. Result: The statements gave rise to two categories: care provided by nursing as a whole and accommodation guidelines about self-care and care of the newborn. Conclusion: The perception of the mothers as to the care of the nursing staff was positive, but educational activities proved fragile.

Objetivo: Conhecer a percepção das puérperas sobre o atendimento dos profissionais de Enfermagem no alojamento conjunto. Métodos: Estudo qualitativo exploratório-descritivo, realizado em um hospital de médio porte no interior do Rio Grande do Sul com 15 mulheres no puerpério imediato. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade da Região da Campanha, sob o número do CAAE 62/2013. Utilizou-se a letra “P” para identificar as puérperas, seguidos pelo número sequencial das entrevistas. Os dados foram coletados por meio de entrevista semiestruturada aplicadas às puérperas nos meses de outubro a novembro de 2013. Para tratamento dos dados utilizou-se a análise de conteúdo. Resultado: Os depoimentos deram origem a duas categorias: cuidados prestados pela Enfermagem no alojamento conjunto e orientações a cercado autocuidado e cuidados com o recém-nascido. Conclusão: A percepção das puérperas quanto ao atendimento da equipe de Enfermagem foi positiva, porém as ações educativas mostraram-se frágeis.

Objetivo: Conocer la percepción de las madres sobre el cuidado de los profesionales de enfermería en alojamientos colectivos. Métodos: Un estudio cualitativo exploratorio descriptivo en un hospital de tamaño medio en el interior de Río Grande do Sul, con 15 mujeres en el posparto inmediato. El proyecto fue aprobado por el Comité de Ética en Investigación de la Universidad de la Región Campaña con el número 62/2013 CAAE. Se utilizó la letra “P” para identificar a las mujeres después del parto, seguido por el número secuencial de las entrevistas. Los datos fueron recolectados a través de entrevistas semi-estructuradas aplicadas a madres después del parto en los meses de octubre a noviembre de 2013. Para el tratamiento los datos recogidos se utilizó el análisis de contenido. Resultado: Las declaraciones dieron lugar a dos categorías: atención fornecida por la enfermería en su conjunto y de alojamiento a las directrices sobre el autocuidado y el cuidado del recién nacido. Conclusión: La percepción delas madres en cuanto a la atención del personal de enfermería fue positiva,pero las actividades educativas resultó frágil.

Telenursing manual for providing care to patients using clean intermittent urinary catheterization / Manual de teleenfermería para la atención al usuario de cateterismo urinario intermitente limpio / Manual de telenfermagem para atendimento ao usuário de cateterismo urinário intermitente limpo

Objective: To develop and evaluate apparent and content validity of a telenursing manual to support nurses in the care delivery of patients using clean intermittent urinary catheterization. Methods: Methodological study addressing the development and validation of a telenursing manual. The expert group who validated the telenursing manual was composed of 11 nurses. An inter-rater level of agreement of 70% was considered for each aspect of the instrument. Results: The following levels of agreement were obtained for each aspect: Language 97%, Content 97.7% and Objectives, Relevance, Functionality and Usability 100% each. Conclusion: The manual is available for access and represents an important initiative for the field of telenursing in Brazil, assisting nurses in the telecare provided to patients using clean intermittent urinary catheterization.

Objetivo: Elaborar y validar la apariencia y el contenido de un manual de teleenfermería para apoyar al enfermero en la atención al cliente que usa catéter urinario intermitente limpio. Método: Estudio metodológico sobre la construcción y validación de manual de teleenfermería. La apariencia y el contenido del manual fueron validados por 11 enfermeros peritos, considerando para validación un nivel de concordancia del 70% entre los peritos para cada aspecto del instrumento utilizado. Resultados: El manual de teleenfermería fue validado en apariencia y contenido considerando el nivel de concordancia entre los peritos para cada uno de estos aspecto: Lenguaje 97%; Contenido 97,7%; y, Objetivos, Relevancia, Funcionalidad y Usabilidad 100% cada uno. Conclusiones: El manual está disponible para ser accedido y representa una iniciativa importante para el campo de la teleenfermería en Brasil, ayudando al enfermero en la práctica de la teleatención al usuario de cateterismo urinario intermitente limpio.

Objetivo: Elaborar e validar em aparência e conteúdo um manual de telenfermagem para subsidiar o enfermeiro no atendimento ao cliente com bexiga neurogênica, usuário de cateterismo urinário intermitente limpo. Método: Estudo metodológico sobre a construção e validação de manual de telenfermagem. O manual foi validado em aparência e conteúdo por 11 enfermeiros peritos; para tanto, considerou-se válido cada aspecto do instrumento que atingiu o nível mínimo de concordância de 70% entre os peritos. Resultados: O manual obteve, para cada aspecto avaliado, os seguintes níveis de concordância - Linguagem: 97%; Conteúdo: 97,7%; e Objetivos, Funcionalidade, Usabilidade e Relevância: 100% cada. Conclusão: O manual encontra-se disponível para acesso e representa uma iniciativa importante para o campo da telenfermagem no Brasil, auxiliando o enfermeiro na realização do teleatendimento e atendimento ao usuário de cateterismo urinário intermitente limpo.