Metabolic control and quality of life in type 1 diabetes: Do adherence, family support, and school support matter?

This study analyzed the relationship between clinical and demographic variables, family support, school support, and adherence on adolescents' metabolic control and quality of life (QoL) based on Adaptation to Chronic Disease in Childhood's model. The sample included 100 adolescents and 100 parents. Adolescents were assessed on adherence, family support, school support, and QoL. Parents were assessed on family functioning and parental coping. A path analysis was performed to assess the adequacy of the theoretical model to the sample. Daily glycemic monitoring was associated with better metabolic control and diabetes hospitalizations with worse metabolic control. The final model showed adherence, family support, school support, and family functioning having an indirect effect on the relationship between adolescence stage, number of daily glycemic monitorings, number of hospitalizations, and metabolic control/QoL. Adherence had an indirect effect on the relationship between glycemic monitoring and family and school support, suggesting that adolescents need both types of support to perform diabetes self-care tasks. QoL showed a direct effect on metabolic control revealing the importance of QoL in the design of interventions to promote metabolic control in adolescents.

Visual Defects in Patients With Pituitary Adenomas: The Myth of Bitemporal Hemianopsia.

OBJECTIVE: The objective of this study was to test the hypothesis that bitemporal hemianopsia (BHA) is the most common visual field (VF) defect in patients with pituitary macroadenoma and to assess the degree of optic pathway compression necessary to produce visual defects. MATERIALS AND METHODS: We reviewed the MRI findings and medical records of 119 patients with pituitary macroadenoma who had undergone formal assessment of VFs. We then evaluated the degree of optic pathway displacement caused by the pituitary macroadenoma, as observed on MR images. The classifications of optic pathway displacement included no contact, abutment but no displacement, mild displacement (< 3 mm), and moderate displacement (≥ 3 mm). Qualitative analysis classified VFs as normal or as having defects that were monocular, bitemporal, mixed (bitemporal with additional defects), homonymous, or nonspecific. RESULTS: A total of 89 of 115 patients had an abnormal VF. Only one patient had true BHA. The most common defects were bitemporal or mixed defects (in 49 of 115 patients [42.6%]), likely because more than just the chiasm is often compressed by the pituitary macroadenoma. Classification of optic pathway displacement by the pituitary macroadenoma was as follows: 23 patients had no contact, eight had abutment but no displacement, 27 had mild displacement, and 57 had moderate displacement. In 78 of the 92 patients (84.8%) with pituitary macroadenoma that had contact with the optic pathway, contact was with the optic chiasm and the prechiasmal optic nerve. Of the 49 patients with bitemporal or mixed defects, 42 had moderate displacement of the optic pathway caused by their tumors. CONCLUSION: BHA is exceedingly uncommon in patients with pituitary macroadenoma. However, although bitemporal and mixed defects are the most common abnormal VF findings, they were found in only 42.6% of patients. Such defects rarely occur if the tumor displaces the optic pathway less than 3 mm from baseline.

Clinical features of sellar and suprasellar meningiomas.

Meningiomas account for about 1% of sellar masses. Although they can mimic pituitary adenomas, they are more vascularized and invasive. To gain insights that would enhance our ability to establish a pre-surgical diagnosis of meningioma, we performed a retrospective study of these tumors. Query of the surgical pathology database identified 1,516 meningiomas operated at out institution between January 2000 and May 2012. Cases were matched to the radiology database to identify a strictly defined sellar and/or suprasellar location. We identified 57 meningiomas. F:M ratio was 6:1. The mean age was 52 years (median 50, range 30-78). The most common symptoms were visual disturbance (58%), headache (16%) and incidental finding (12%). The mean duration of symptoms was 13 months. Hyperprolactinemia was found in 36%, with mean value of 51.6 ng/ml (median 41.8, range 22.5-132). Mean maximal diameter was 2.9 cm (median 2.7, range 0.9-6.8), and most tumors enhanced homogeneously on MRI after gadolinium. A "dural tail" sign was reported in a third. The radiologist reported "likely meningioma" in 65%, "possible meningioma" in 8.7%, and pituitary adenoma in 11%. After surgery, visual disturbances improved in most patients (80%) but headache only in 7%. Post-operative complications at 1 and 3 months occurred 38.6 and 33.3% respectively. There was no mortality. Sellar/suprasellar meningiomas represent 4% of all meningiomas, and have a particularly high female predominance. The diagnosis is suggested by the radiologist in approximately 2/3 of the cases. An improved method to differentiate preoperatively these tumors from adenomas would be desirable.

Dry eye disease.

Dry eye (DED) is a multifactorial disease that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface, accompanied by increased osmolarity of the tear film and inflammation. DED is a common clinical problem and is among the most frequent diagnoses in ophthalmology. It substantially affects quality of life because of the constant ocular discomfort and decrease in visual function. This review discusses the etiology, classification, diagnosis procedures, clinical, and surgical treatments of dry eye.

[Simplified posterior sciatic nerve block at mid gluteofemoral dulcus: comparison of different 1% lidocaine volumes]. / Bloqueio do nervo isquiático por abordagem posterior simplificada no ponto médio do sulco glúteo-femoral: estudo com diferentes volumes de lidocaína a 1%

BACKGROUND AND OBJECTIVES: Subgluteus sciatic nerve block has been successfully described in a previous study and is one more option among several possible approaches. The sciatic nerve becomes superficial at inferior gluteus maximus muscle where it is easily located and accessed with minor discomfort and low risk of accidental great vessels puncture. Our study aimed at evaluating this simplified sciatic nerve block approach with different 1% lidocaine volumes. METHODS: Participated in this study 40 patients submitted to leg or foot procedures, who were distributed in two groups. Patients were placed in the prone position after monitoring and blockade was induced at mid gluteofemoral sulcus with the aid of neurostimulator and with beveled insulated 5 cm needle, with 300 mg (G1) or 200 mg (G2) of 1% plain lidocaine. RESULTS: Used volumes and concentrations have promoted adequate anesthesia in all patients. Blockade time was 8.6 +/- 5.7 min (G1) and 5.6 +/- 5.7 min (G2). Onset time was 5.98 +/- 1.4 min (G1) and 6.7 +/- 2.9 min (G2). Sensory and motor block duration was 243 +/- 37 min and 152 +/- 30 min (G1), and 235 +/- 39 min and 149 +/- 59 min (G2), respectively. There were no statistically significant differences between groups. CONCLUSIONS: This is an effective and easy approach and total anesthetic dose may be decreased without impairing quality.

Empregabilidade e competências: uma análise de universitários sob a ótica de gestores de recursos humanos / Employability and competency: the point of view of human resource managers on undergraduate students

A empregabilidade pode ser compreendida como um conjunto de competências e habilidades necessárias para uma pessoa conquistar e manter um trabalho. A pesquisa objetivou identificar as características mais importantes e as principais dificuldades percebidas para a contratação sob o ponto de vista dos gestores de recursos humanos, bem como as habilidades e competências exigidas atualmente. Participaram 156 empresas do Estado de São Paulo, que responderam a um questionário com dados de identificação e sete questões de múltipla escolha sobre empregabilidade. A coleta ocorreu de forma coletiva em um evento empresarial. Os resultados apontam que a entrevista é a fase de maior dificuldade num processo seletivo e que as maiores limitações para se encontrarem candidatos qualificados profissionalmente são a falta de experiência e a falta de preparo técnico. No âmbito pessoal, a falta de iniciativa e de motivação ou interesse se destacou, e, no âmbito acadêmico, a falta de cursos complementares e de atualização foi o ponto principal. Verificou-se que, para efetivação, as empresas procuram, em alto grau, candidatos que possuam comprometimento ou interesse e responsabilidade(AU)

The employability can be understood as a group of necessary skills and competences to gain and maintain a job. The researcher intending to identify the most important characteristics and the main existent difficulties for hiring professionals in the point of view of the Human Resources Managements. As well as the skills and competence currently required. A hundred fifty six São Paulo state's companies answered a seven-multiple-choice questionnaire about employability.The datas were collectively attained in a business event. The results show the interview as the most difficult part in the selecting process; the biggest limitations to obtain qualified candidates in the professional aspect are: lack of experience and technical preparation. In the personal area the lack of initiative and motivation/interest stood out, and in the academic area the lack of complementary courses and updatings were the main point. It was observed that the companies highly search for responsible, compromised/interested candidates to become permanent workers(AU)

Empregabilidade e competências: uma análise de universitários sob a ótica de gestores de recursos humanos / Employability and competency: the point of view of human resource managers on undergraduate students

A empregabilidade pode ser compreendida como um conjunto de competências e habilidades necessárias para uma pessoa conquistar e manter um trabalho. A pesquisa objetivou identificar as características mais importantes e as principais dificuldades percebidas para a contratação sob o ponto de vista dos gestores de recursos humanos, bem como as habilidades e competências exigidas atualmente. Participaram 156 empresas do Estado de São Paulo, que responderam a um questionário com dados de identificação e sete questões de múltipla escolha sobre empregabilidade. A coleta ocorreu de forma coletiva em um evento empresarial. Os resultados apontam que a entrevista é a fase de maior dificuldade num processo seletivo e que as maiores limitações para se encontrarem candidatos qualificados profissionalmente são a falta de experiência e a falta de preparo técnico. No âmbito pessoal, a falta de iniciativa e de motivação ou interesse se destacou, e, no âmbito acadêmico, a falta de cursos complementares e de atualização foi o ponto principal. Verificou-se que, para efetivação, as empresas procuram, em alto grau, candidatos que possuam comprometimento ou interesse e responsabilidade.

The employability can be understood as a group of necessary skills and competences to gain and maintain a job. The researcher intending to identify the most important characteristics and the main existent difficulties for hiring professionals in the point of view of the Human Resources Managements. As well as the skills and competence currently required. A hundred fifty six São Paulo state's companies answered a seven-multiple-choice questionnaire about employability.The datas were collectively attained in a business event. The results show the interview as the most difficult part in the selecting process; the biggest limitations to obtain qualified candidates in the professional aspect are: lack of experience and technical preparation. In the personal area the lack of initiative and motivation/interest stood out, and in the academic area the lack of complementary courses and updatings were the main point. It was observed that the companies highly search for responsible, compromised/interested candidates to become permanent workers.

Bloqueio do nervo isquiático por abordagem posterior simplificada no ponto médio do sulco glúteo-femoral: estudo com diferentes volumes de lidocaína a 1 por cento / Simplified posterior sciatic nerve block at mid gluteofemoral dulcus: comparison of different 1 percent lidocaine volumes

JUSTIFICATIVA E OBJETIVOS: O bloqueio do nervo isquiático por via subglútea foi descrito com sucesso em estudo anterior, sendo mais uma opção entre as várias abordagens possíveis. O nervo isquiático torna-se superficial na borda inferior do músculo glúteo máximo, permitindo seu acesso com fácil localização, pouco desconforto e baixo risco de punção acidental de grandes vasos. O objetivo deste estudo foi avaliar o bloqueio do nervo isquiático por esta abordagem simplificada com diferentes volumes de lidocaína a 1 por cento. MÉTODO: Foram estudados 40 pacientes com intervenções cirúrgicas na perna ou no pé distribuídos em dois grupos. Após monitorização, eles foram posicionados em decúbito ventral e realizado bloqueio no ponto médio do sulco glúteo-femoral, com auxílio de neuroestimulador e agulha de 5 cm eletricamente isolada, utilizando 300 mg (G1) ou 200 mg (G2) de lidocaína a 1 por cento sem adrenalina. RESULTADOS: Obteve-se anestesia adequada em todos os casos com o volume e a concentração usados. O tempo de execução do bloqueio foi de 8,6 ± 5,7 min (G1) e 5,6 ± 5,7 min (G2). A latência foi de 5,98 ± 1,4 min (G1) e 6,7 ± 2,9 min (G2). A duração sensitiva e motora do bloqueio foi de 243 ± 37 min e 152 ± 30 min (G1) e 235 ± 39 min e 149 ± 59 min (G2), respectivamente. Não foram observadas diferenças estatísticas significativas entre os grupos estudados. CONCLUSÕES: Essa abordagem é eficaz e de fácil execução, podendo a dose total de anestésico ser reduzida sem comprometimento da qualidade.