O ensino de cuidados de saúde no Brasil entre os séculos XVI e XIX / The teaching health care in Brazil between the 16 th and 19 th centuries

Resumo Introdução: Entre os anos de 1500 e 1822, o Brasil esteve sob o domínio colonial de Portugal, e apenas em 1808 as duas primeiras escolas oficiais de Medicina foram abertas em seu território. Por mais de três séculos após o descobrimento, a falta de instituições locais para formar profissionais de saúde foi um problema diante de uma população vulnerável tanto às doenças tropicais quanto às enfermidades importadas. Nesse contexto, predominava a disseminação de conhecimentos, crenças e práticas dos padres jesuítas, pajés indígenas e africanos escravizados, frequentemente com perspectivas conflitantes. Desenvolvimento: Este ensaio tem como objetivos abordar o ensino dos cuidados de saúde no Brasil colonial e refletir sobre esse período histórico e suas influências para a formação de médicos no país. Conclusão: A educação médica tem enfrentado atualmente muitos desafios, e entendemos que os avanços pedagógicos, científicos e tecnológicos devem ser adotados, sem desconsiderar os contextos histórico e cultural, e a pluralidade da população e do sistema de saúde nacional. Mais de 500 anos se passaram desde a chegada dos portugueses, e ainda hoje o Brasil continua sendo um país com complexidades territorial, étnica, cultural, econômica e religiosa ímpares.

Abstract Introduction: Between 1500 and 1822, Brazil was under the colonial rule of Portugal, and it was only in 1808 that the first two official medical schools were opened in its territory. For more than three centuries after the European discovery of Brazil, the lack of local institutions to train health professionals was a problem for a population vulnerable to both tropical and imported diseases. In this context, the knowledge, beliefs and practices of Jesuit priests, indigenous shamans and enslaved Africans predominated, often with conflicting perspectives. Development: This essay aims to address the teaching of health care in colonial Brazil and reflect on this historical period and its influences on the training of doctors in the country. Conclusion: Medical education is currently facing many challenges, and we understand that pedagogical, scientific and technological advances must be adopted, but without disregarding the historical and cultural context and the plurality of the population and the national health system. More than five hundred years have passed since the arrival of the Portuguese, and to this day Brazil remains a country with unique territorial, ethnic, cultural, economic and religious complexity.

Extracts from the Leaf of Couroupita guianensis (Aubl.): Phytochemical, Toxicological Analysis and Evaluation of Antioxidant and Antimicrobial Activities against Oral Microorganisms.

The study of phytotherapy in dentistry holds great relevance because of the scarcity of research conducted on the treatment of oral pathologies, specifically, caries and periodontal disease. Therefore, this research aimed to analyze the chemical composition of extracts from Couroupita guianensis Aubl. leaves, evaluate their toxicity, and assess their antioxidant and antimicrobial properties against Staphylococcus aureus, Streptococcus mutans, and Candida albicans. Three extracts were prepared using assisted ultrasound and the Soxhlet apparatus, namely, Crude Ultrasound Extract (CUE), Crude Soxhlet Extract (CSE), and the Ethanol Soxhlet Extract (ESE). Flavonoids, tannins, and saponins were detected in the chemical analysis, while LC-DAD analysis revealed the presence of caffeic acid, sinapic acid, rutin, quercetin, luteolin, kaempferol, and apigenin in all extracts. GC-MS analysis identified stigmasterol and ß-sitosterol in the CUE and CSE. The ESE showed higher antioxidant activity (2.98 ± 0.96 and 4.93 ± 0.90) determined by the DPPH• and ABTS•+ methods, respectively. In the toxicity evaluation, the CUE at 50 µg/mL and the ESE at 50 µg/mL stimulated the growth of Allium cepa roots, while all extracts inhibited root growth at 750 µg/mL. None of the extracts exhibited toxicity against Artemia salina. Antibacterial activity was observed in all extracts, particularly against the microorganisms S. aureus and S. mutans. However, no antifungal activity against C. albicans was detected. These results suggest that extracts of C. guianensis have therapeutic potential for controlling microorganisms in the oral microbiota.

Adding guidance to deliberate reflection improves medical student's diagnostic accuracy.

CONTEXT: Diagnostic competence in students is a major medical education goal. Adding instructional guidelines to prompt deliberate reflection fosters medical students' diagnostic proficiency. This study investigates the effects of this teaching strategy on diagnostic accuracy in solving clinical cases of different complexity levels by novice and senior students. METHOD: Eighty third-year and 62 sixth-year medical students participated in this three-phase experimental study. First, participants were randomly assigned to one of three experimental conditions (free reflection, cued reflection and worked example) to diagnose 12 clinical text-based cases, following different levels of deliberate reflection. In an immediate test and a delayed test, the participants diagnosed varied sets of 12 cases, six involving the same diseases (four routine and two rare). The main outcomes were the diagnostic accuracy scores achieved for the cases assessed by repeated measures of analysis of variance for each category. RESULTS: There was a significant primary effect of experimental condition (P < .001), year of training (P < .001) and study phase (P < .001) on the diagnostic accuracy achieved. The use of deliberate reflection in addition to instructional guidelines resulted in improved results in the immediate test for all cases evaluated (P < .001), regardless of participants' seniority. In the delayed test, this benefit was maintained for simple cases (P < .001). For complex cases, the benefit was maintained only for senior students (P < .001). The cued reflection and worked example groups did not differ in performance (P > .05), but both groups surpassed the free reflection group (P < .001), regardless of the students' learning stage and case complexity.

Case presentation methods: a randomized controlled trial of the one-minute preceptor versus SNAPPS in a controlled setting.

INTRODUCTION: One-minute preceptor (OMP) and SNAPPS (a mnemonic for Summarize history and findings; Narrow the differential; Analyze the differential; Probe the preceptor about uncertainties; Plan management; and Select case-related issues for self-study) are educational techniques developed to promote learners' expression of clinical reasoning during the case presentation in the workplace. The aim of this present study was to compare the content of the case presentation between the SNAPPS and the OMP methods. METHODS: This was a randomized controlled trial comparing SNAPPS and OMP in 60 medical students at the beginning of their fifth year of medical school. After an introduction session, students presented and discussed two cases based on real patients and provided in written format. All case presentations were recorded and evaluated by two researchers. The assessed elements of the case presentations were divided into three subgroups related to expression of clinical reasoning, time and initiative to guide the presentation. RESULTS: There were 30 participants in each group. There was no difference in the expression of clinical reasoning between OMP and SNAPPS groups (number of differential diagnoses, justification of most likely diagnosis and differential diagnosis, expression of comparing and contrasting hypotheses). However, students in the SNAPPS group expressed significantly more questions and uncertainties (p < 0.001), and more often took the initiative to present and justify the most likely diagnosis, differential diagnosis and management plan than students in the OMP group, both in simple and complex cases (all p values <0.001) without extending the length of the teaching session. CONCLUSION: OMP and SNAPPS equally promote medical students' expression of clinical reasoning. The SNAPPS technique was more effective than the OMP technique in helping students to take on an active role during case presentation. We propose SNAPPS as an effective learning tool, engaging students and promoting the expression of their clinical reasoning as part of a case presentation.

Honey from Tiúba stingless bees (Melipona fasciculata) produced in different ecosystems: physical and sensory studies.

BACKGROUND: Honey from Tiúba stingless bees (Melipona fasciculata) produced in three different ecosystems in Brazil (Cerrado, Litoral and Baixada), as well as a sample of honey from Apis mellifera bees from the Baixada region for comparison, were evaluated regarding viscosity, color, sensory profile and sensory acceptance. RESULTS: The honey from Tiúba was less viscous, with a darker color and lower purity of the color (chroma) in relation to honey from Apis mellifera. The sensory profile firmly differentiates the honeys. The Apis honey was mainly described as opaque, viscous and adhesive. Tiúba honey from the Cerrado region stood out as semi-bright, acid taste, alcoholic, propolis, bitter taste and spicy. Tiúba honey from the Litoral region was characterized by its yellow color, woody odor and medicine flavor. The Tiúba honey from the Baixada region was described as gold colored, fluid and citric. The Tiúba honey from the Cerrado region had similar sensory acceptance to the Apis honey, probably because it was specifically characterized through attributes of odor and flavor. On the contrary, the Tiúba honey from the Litoral and from the Baixada regions was less well accepted. CONCLUSION: The honeys are different regarding their physical and sensory properties, differences that result from the bee species and from the geographical origin of the honey. This study could contribute to the creation of a standard identity and specific quality for Melipona fasciculata honey, also contributing to its production and commercialization not only in Brazil, but also internationally. © 2020 Society of Chemical Industry.

Using mouse tracking to investigate auditory taboo effects in first and second language speakers of American English.

Researchers have argued that bilingual speakers experience less emotion in their second language. However, some studies have failed to find differences in emotionality between first and second language speakers. We used computer mouse tracking in an auditory lexical decision task to examine taboo effects - more efficient processing of taboo than neutral words - in first (L1) and second (L2) language speakers of American English. As predicted, we found an effect of language (L1 participants processed words more efficiently than L2 participants did) and a taboo effect (taboo words were processed more efficiently than neutral words). Interestingly, the language by taboo interaction (less emotionality in second language) emerged in number of errors and in the mouse trajectories, but it did not emerge in reaction times. We discuss how different aspects of participants' responses are likely to capture different underlying cognitive processes. We conclude, as other researchers have reported and many bilinguals experience, that language processing in second language is less emotional.

Attitudes of undergraduate university women towards HPV vaccination: a cross-sectional study in Ottawa, Canada.

BACKGROUND: Persistent infection with certain subtypes of human papillomavirus (HPV) is a necessary cause of cervical cancer. Although two prophylactic vaccines have been licensed in Canada against cancerous subtypes of HPV, vaccine uptake has been lower than anticipated. The primary objective of this study was to determine the acceptability of catch-up HPV vaccination to undergraduate university women under the age of 25, by assessing their perceptions of HPV vaccination. METHODS: A total of 401 University of Ottawa female undergraduate students participated in a cross-sectional bilingual web-based survey on HPV vaccination. RESULTS: The prevalence of immunization with at least 1 HPV vaccine dose was 49% in the study population. Although the overall attitude of study participants towards the vaccine was positive, vaccinated respondents had a more favourable attitude towards the vaccine than non-vaccinated respondents. Approximately half of the non-vaccinated respondents were interested in receiving the vaccine at some point in the future. The primary barriers to HPV vaccination identified by non-vaccinated respondents were lack of knowledge about the vaccines, potential vaccine side effects and cost of vaccination. Multivariable analysis comparing non-vaccinated respondents who intended to be vaccinated and those who did not suggests that the former group had a more favourable attitude towards the vaccine and would be influenced by doctor recommendation. CONCLUSIONS: Offering HPV vaccination for women aged 18 to 25 provides an opportunity to address suboptimal vaccination coverage in the population and may reduce health inequities demonstrated by variations in cervical cancer incidence within jurisdictions.

Microbiological and physical-chemical characteristics of honeys from the bee Melipona fasciculata produced in two regions of Brazil / Características microbiológicas e físico-químicas de méis de abelha Melipona fasciculata produzidos em duas regiões do Brasil

ABSTRACT: The honey from Tiúba bees (Melipona fasciculata) is commercially important in the Brazilian state of Maranhão. However, the absence of any specific legislation for this kind of honey is an obstacle to its increased production and commercialization. Determining the microbiological and physical-chemical characteristics of different Tiúba honey can inform the elaboration of specific legislation. Thus, honey samples from two Water Catchment Areas in Maranhão (Munim and Pericumã, sample size 20 for each) were collected and submitted for microbiological analysis (total coliforms, thermotolerant coliforms, molds and yeasts, Clostridium sulfite reducers and Salmonella sp.) and physical-chemical analysis (moisture content, reducing and non-reducing sugars, insoluble and soluble solids, ash content, acidity and pH). Most of honeys sampled were suitable for human consumption, except for one sample from Pericumã. Honeys from the two water catchment areas presented differences in some physicochemical characteristics, which can be attributed to the botanic, soil and climatic diversity of the two areas. Still, these Tiúba honey samples did not fall within the Brazilian legislation for Apis mellifera honey for some of the physical-chemical characteristics, and so is not properly regulated, thus reinforcing the need for specific legislation for this type of honey.

RESUMO: O mel de Tiúba (Melipona fasciculata) tem importância comercial na região do estado do Maranhão, no entanto a ausência de uma legislação específica para este mel entrava a ampliação de sua produção e comercialização. Dessa forma, faz-se necessário determinar as características microbiológicas e físico-químicas de méis de Tiúba, com o objetivo de fornecer subsídios para a elaboração de uma legislação específica. Assim, amostras de méis provenientes de duas bacias hidrográficas do Maranhão (Munim n = 20, e Pericumã n = 20) foram coletadas e submetidas às análises microbiológicas (coliformes totais, coliformes termotolerantes, bolores e leveduras, Clostridium sulfito redutores e Salmonella sp.) e físico-químicas (umidade, açúcares redutores e não redutores, sólidos insolúveis e solúveis, cinzas, acidez e pH). A maioria dos méis apresentou-se adequado microbiologicamente ao consumo humano, exceto uma amostra de mel proveniente de Pericumã. Os méis provenientes das duas bacias hidrográficas apresentaram diferenças em algumas características físico-químicas, o que pode ser atribuído à diversidade botânica, edáfica (solo) e climática das duas bacias. Ainda, os méis de Tiúba não se adequaram à legislação brasileira de Apis mellifera para algumas características físico-químicas, o que não permite sua regulamentação e, assim, reforça a necessidade de legislação específica para este tipo de mel.

Determinants of Outcome in Hospitalized Patients With Methicillin-Resistant Staphylococcus aureus Bloodstream Infection: Results From National Surveillance in Canada, 2008-2012.

BACKGROUND Bloodstream infection (BSI) due to methicillin-resistant Staphylococcus aureus (MRSA) is associated with considerable morbidity and mortality. OBJECTIVE To determine the incidence of MRSA BSI in Canadian hospitals and to identify variables associated with increased mortality. METHODS Prospective surveillance for MRSA BSI conducted in 53 Canadian hospitals from January 1, 2008, through December 31, 2012. Thirty-day all-cause mortality was determined, and logistic regression analysis was used to identify variables associated with mortality. RESULTS A total of 1,753 patients with MRSA BSI were identified (incidence, 0.45 per 1,000 admissions). The most common sites presumed to be the source of infection were skin/soft tissue (26.6%) and an intravascular catheter (22.0%). The most common spa types causing MRSA BSI were t002 (USA100/800; 55%) and t008 (USA300; 29%). Thirty-day all-cause mortality was 23.8%. Mortality was associated with increasing age (odds ratio, 1.03 per year [95% CI, 1.02-1.04]), the presence of pleuropulmonary infection (2.3 [1.4-3.7]), transfer to an intensive care unit (3.2 [2.1-5.0]), and failure to receive appropriate antimicrobial therapy within 24 hours of MRSA identification (3.2 [2.1-5.0]); a skin/soft-tissue source of BSI was associated with decreased mortality (0.5 [0.3-0.9]). MRSA genotype and reduced susceptibility to vancomycin were not associated with risk of death. CONCLUSIONS This study provides additional insight into the relative impact of various host and microbial factors associated with mortality in patients with MRSA BSI. The results emphasize the importance of ensuring timely receipt of appropriate antimicrobial agents to reduce the risk of an adverse outcome.

Lesão de Morel-Lavallée: relato de caso / Morel LavalléeLesion: case report

A lesão de Morel-Lavallée, descrita inicialmente no século XIX pelo cirurgião francês Victor Auguste François Morel-Lavallée, constitui lesão de partes moles, sobretudo nas áreas que revestem as protuberâncias ósseas. Sua fisiopatologia consiste no deslocamento da pele e do tecido celular subcutâneo sobre a fáscia muscular, provocado por forças tangenciais súbitas e intensas, secundárias a traumatismos. No espaço criado pela avulsão dos tecidos, acumulam-se sangue, linfa e debris gordurosos. O diagnóstico é baseado na história clínica, no exame físico e nos exames de imagem. O tratamento geralmente é conservador e o prognóstico é bom, nas lesões menores. Em casos de lesões extensas podem ocorrer graves complicações. O diagnóstico diferencial inclui bursite, hematoma, abscesso, tumores benignos e neoplasias malignas. O presente relato visa alertar o pediatra sobre a possibilidade diagnóstica de lesão de Morel-Lavallée, garantindo-se sua abordagem precoce e adequada, especialmente quando se considera a prática de esportes cada vez mais comum entre crianças e adolescentes, além do risco da sua ocorrência por traumas associados às atividades lúdicas próprias da faixa etária pediátrica.(AU)

The injury of Morel-Lavallée, first described in the nineteenth century by the French surgeon Victor Auguste François Morel-Lavallée, is a soft tissue injury, particularly in the linimg areas of the bony prominences. The patophysiology consists in the displacement of the skin and the fascia subcutaneous tissue caused by sudden and intense shear forces, secondary to trauma. In the space created by tissue avulsions acumulates blood, lymph and fatty debris. Diagnosis is based on clinical history, physical examination and imaging studies. Treatment is usually conservative and the prognosis is good, in the minor injuries. In cases of extensive lesions the result can be serious complications. The differential diagnosis includes bursitis, hematoma, abscess, benign and malignant neoplasms. This report aims to alert the pediatrician about the diagnostic possibility of Morel-Lavallée lesion nsuring their early and appropriate approach, especially when we consider the practice of sports, increasingly common among children and adolescents, and the risk of their occurrence of traumas associated with own play activities of pediatric patients.(AU)

[Mortality from meningococcal disease in the city of São Paulo, Brazil: characteristics and predictors]. / Mortalidade por doença meningocócica no Município de São Paulo, Brasil: características e preditores.

This study aimed to describe the magnitude, mortality, and case-fatality rate from meningococcal disease and to investigate predictors of death from this cause in the city of São Paulo, Brazil, from 1986 to 2004, using unconditional multiple logistic regression. We analyzed 10,087 cases of meningococcal disease in the city. Mean annual mortality was 1.0/100,000 inhabitants, ranging from 0.2 to 1.8. Case-fatality was 20.5%, with major differences according to age, serogroup, and type of hospital. Predictors of death from meningococcal disease were age, especially the age brackets from one to two years and 40 years and older, and serogroup W. The results can contribute to the elaboration of public policies with a focus on the organization of hospital care and protocols to promote greater treatment effectiveness and application of vaccination strategies that decrease the incidence in groups at greatest risk of death from meningococcal disease.

Mortalidade por doença meningocócica no Município de São Paulo, Brasil: características e preditores / Mortality from meningococcal disease in the city of São Paulo, Brazil: characteristics and predictors / Mortalidad por enfermedad meningocócica en el municipio de São Paulo, Brasil: características y predictores

O estudo objetiva descrever a magnitude, as características da mortalidade e da letalidade por doença meningocócica e investigar preditores de óbito por essa causa, no Município de São Paulo, Brasil, de 1986 a 2004. Utilizou-se a regressão logística múltipla não condicional para a investigação dos preditores de óbitos. Foram estudados 10.087 casos de doença meningocócica no município. A taxa anual média de mortalidade foi de 1,0/100 mil habitantes/ano, variando de 0,2 a 1,8; a letalidade foi de 20,5% com grandes diferenças segundo idade, sorogrupo e tipo de hospital. Os preditores de óbito por doença meningocócica foram idade, especialmente as faixas etárias de um a dois anos e de 40 anos ou mais e o sorogrupo W. Os resultados obtidos podem contribuir para a elaboração de políticas públicas com foco na organização da assistência hospitalar e elaboração de protocolos que promovam a maior efetividade do tratamento e a aplicação de estratégias de vacinação que diminuam a incidência nos grupos de maior risco para óbito por doença meningocócica.

This study aimed to describe the magnitude, mortality, and case-fatality rate from meningococcal disease and to investigate predictors of death from this cause in the city of São Paulo, Brazil, from 1986 to 2004, using unconditional multiple logistic regression. We analyzed 10,087 cases of meningococcal disease in the city. Mean annual mortality was 1.0/100,000 inhabitants, ranging from 0.2 to 1.8. Case-fatality was 20.5%, with major differences according to age, serogroup, and type of hospital. Predictors of death from meningococcal disease were age, especially the age brackets from one to two years and 40 years and older, and serogroup W. The results can contribute to the elaboration of public policies with a focus on the organization of hospital care and protocols to promote greater treatment effectiveness and application of vaccination strategies that decrease the incidence in groups at greatest risk of death from meningococcal disease.

Los objetivos fueron describir la magnitud y las características de la morbilidad y mortalidad por enfermedad meningocócica e investigar los predictores de muerte. Fueron estudiados 10.087 casos de enfermedad meningocócica ocurridos en São Paulo, entre 1986 y 2004. Los predictores de muerte por enfermedad meningocócica se investigaron por regresión logística no condicional. La tasa anual media de mortalidad por enfermedad meningocócica en el periodo del estudio fue de 1,0/100 mil habitantes/año, variando de 0,2 a 1,8, con distribución desigual, afectando fuertemente a los distritos más pobres. La letalidad fue de 20,5% con grandes diferencias según edad, serogrupo y tipo de hospital. Los principales predictores de muerte fueron la edad, especialmente, menores de dos años, y serogrupo W. Los resultados pueden contribuir a la elaboración de las políticas públicas con un enfoque en la organización de la atención hospitalaria y elaboración de protocolos que promuevan una mayor eficacia del tratamiento y la aplicación de las estrategias de vacunación para reducir la incidencia de los grupos con mayor riesgo de muerte por enfermedad meningocócica.

Routine Medical Emergency Team Assessments of Patients Discharged From the PICU: Description of a Medical Emergency Team Follow-Up Program.

OBJECTIVE: This study describes one follow-up program in the Ontario Rapid-Response System project consisting of routine medical emergency team visits of patients discharged from the PICU consisting of two planned visits within 48 hours following discharge. Study purpose was to describe interventions provided and the patient characteristics associated with medical emergency team utilization. DESIGN: Retrospective cohort study. SETTING: Tertiary Pediatric Hospital, Children's Hospital of Eastern Ontario, Ottawa, Canada. PATIENTS: Discharged pediatric patients from PICU. INTERVENTIONS: Data over 41 months were obtained from a prospectively maintained rapid-response system database. Major medical emergency team support was defined as an early unplanned visit, intervention, or readmission during the follow-up period. MEASUREMENTS AND MAIN RESULTS: Interrupted time-series analysis comparing the 2 years preceding rapid-response system implementation with the subsequent 4 years demonstrated a statistically significant immediate change in PICU readmission rate (-5.5%, p = 0.0001). There were 1,805 patients followed after PICU discharge. During the 48-hour planned follow-up period, 4% of patients received an unplanned medical emergency team visit and 13% received an active intervention. Analysis of the first medical emergency team visit identified that 10% received major medical emergency team support. After the initial visit, 6% of patients received major medical emergency team support with predictive characteristics being an unplanned first visit (odds ratio, 3.7; 95% CI, 1.6-8.5) or an intervention during the first visit (odds ratio, 3.5; 95% CI, 2.1-5.8). Multiple diseased organs were associated with major medical emergency team support after the initial visit for recent surgical patients (odds ratio, 3.0 vs 1.2; p = 0.03). CONCLUSIONS: Routine medical emergency team visits following PICU discharge reduced the risk of early readmission. Our results suggest that one in seven patients in the follow-up program receive major medical emergency team support. We suggest a follow-up program with at least one routine medical emergency team visit within the first 24 hours of discharge with a second planned visit reserved for complex postsurgical patients.

Avaliação das funções cognitivas, qualidade de sono, tempo de reação e risco de quedas em idosos institucionalizados / Evaluation of cognitive functions, quality of sleep, reaction time and risk of falls in institucionalized elderly

O processo de envelhecimento e acompanhado por uma serie de alterações psicossociais e biológicas, dentre as quais esta incluído o declínio cognitivo. Dependendo das condições genéticas, estilo de vida, atividades e interações sociais do idoso, o declínio pode ser acelerado ou retardado. O objetivo deste trabalho foi avaliar o perfil cognitivo, o tempo de reação, o risco de quedas e a qualidade do sono de idosos institucionalizados da cidade de Uruguaiana-RS. Foram avaliados 10 idosos de ambos os sexos utilizando como instrumentos o Mini-Exame do Estado Mental (MEEM), a Escala de Depressão Geriátrica (EDG), o Inventario de Ansiedade Traco-Estado, o Teste de Tempo de Reação (TTR), a Escala de Eficácia de Quedas (EEQ) e o Índice de Qualidade de Sono de Pittsburgh (IQSP). Os resultados apontaram a presença de declínio cognitivo em 40% dos idosos, indícios de depressão em 60% deles e tendência ao desenvolvimento de ansiedade. 76% dos idosos classificaram a qualidade de seu sono como boa, mencionando alguns fatores que interferem na mesma, e 64% revelaram haver preocupação ou medo de cair. No TTR os idosos apresentaram escore médio de 2,175+- 0,32 s. Estes resultados podem estar relacionados ao estilo de vida adotado pela maioria dos idosos institucionalizados, fora do seu convívio familiar, favorecendo seu isolamento e sua inatividade física e mental, gerando declínio da capacidade cognitiva. Nossos resultados demonstram um percentual significativo de risco de demência, depressão e/ou ansiedade nos idosos institucionalizados avaliados.

The aging process is accompanied by a series of biological and psychosocial changes, among which is included cognitive decline. Depending on genetics, conditions of life, activities and social interactions of the elderly, the decline can be accelerated or decelerated. The objective of this work was evaluate the cognitive profile, the reaction time, the risk of falls and the quality of sleep of institutionalized elderly of Uruguaiana-RS. We evaluated 10 elderly of both sexes using as instruments the Mini-Mental State Examination, the Geriatric Depression Scale, the State-Trait Anxiety Inventory, the Reaction Time Test, the Falls Efficacy Scale and the Pittsburgh Sleep Quality Index. The results indicated presence of cognitive decline in 40% of elderly, signs of depression in 60% and tendency to the development of anxiety. 76% of elderly rated their quality of sleep as good, mentioning some factors that interfere in it, and 64% of the elderly revealed they have concern or fear of falling. In the reaction time score the elderly showed a mean of 2.175 + - 0.32 s. These results might be related to the lifestyle adopted by most of the institutionalized elderly, out of their family context, often contributing to their isolation and their physical/mental inactivity, generating cognitive decline. Our results demonstrate a significant percentage of risk of dementia, depression and/or anxiety in evaluated institutionalizated elderly.

Avaliação das funções cognitivas, qualidade de sono, tempo de reação e risco de quedas em idosos institucionalizados / Evaluation of cognitive functions, quality of sleep, reaction time and risk of falls in institucionalized elderly

O processo de envelhecimento e acompanhado por uma serie de alterações psicossociais e biológicas, dentre as quais esta incluído o declínio cognitivo. Dependendo das condições genéticas, estilo de vida, atividades e interações sociais do idoso, o declínio pode ser acelerado ou retardado. O objetivo deste trabalho foi avaliar o perfil cognitivo, o tempo de reação, o risco de quedas e a qualidade do sono de idosos institucionalizados da cidade de Uruguaiana-RS. Foram avaliados 10 idosos de ambos os sexos utilizando como instrumentos o Mini-Exame do Estado Mental (MEEM), a Escala de Depressão Geriátrica (EDG), o Inventario de Ansiedade Traco-Estado, o Teste de Tempo de Reação (TTR), a Escala de Eficácia de Quedas (EEQ) e o Índice de Qualidade de Sono de Pittsburgh (IQSP). Os resultados apontaram a presença de declínio cognitivo em 40% dos idosos, indícios de depressão em 60% deles e tendência ao desenvolvimento de ansiedade. 76% dos idosos classificaram a qualidade de seu sono como boa, mencionando alguns fatores que interferem na mesma, e 64% revelaram haver preocupação ou medo de cair. No TTR os idosos apresentaram escore médio de 2,175+- 0,32 s. Estes resultados podem estar relacionados ao estilo de vida adotado pela maioria dos idosos institucionalizados, fora do seu convívio familiar, favorecendo seu isolamento e sua inatividade física e mental, gerando declínio da capacidade cognitiva. Nossos resultados demonstram um percentual significativo de risco de demência, depressão e/ou ansiedade nos idosos institucionalizados avaliados.(AU)

The aging process is accompanied by a series of biological and psychosocial changes, among which is included cognitive decline. Depending on genetics, conditions of life, activities and social interactions of the elderly, the decline can be accelerated or decelerated. The objective of this work was evaluate the cognitive profile, the reaction time, the risk of falls and the quality of sleep of institutionalized elderly of Uruguaiana-RS. We evaluated 10 elderly of both sexes using as instruments the Mini-Mental State Examination, the Geriatric Depression Scale, the State-Trait Anxiety Inventory, the Reaction Time Test, the Falls Efficacy Scale and the Pittsburgh Sleep Quality Index. The results indicated presence of cognitive decline in 40% of elderly, signs of depression in 60% and tendency to the development of anxiety. 76% of elderly rated their quality of sleep as good, mentioning some factors that interfere in it, and 64% of the elderly revealed they have concern or fear of falling. In the reaction time score the elderly showed a mean of 2.175 + - 0.32 s. These results might be related to the lifestyle adopted by most of the institutionalized elderly, out of their family context, often contributing to their isolation and their physical/mental inactivity, generating cognitive decline. Our results demonstrate a significant percentage of risk of dementia, depression and/or anxiety in evaluated institutionalizated elderly.(AU)

Patient characteristics and disposition after pediatric medical emergency team (MET) activation: disposition depends on who activates the team.

OBJECTIVES: This study focused on health care staff (HCS) responsible for activating the medical emergency team (MET) at a pediatric tertiary hospital using a well-established rapid response system. Our goals were to report the patient characteristics, MET interventions, and disposition by activating HCS. METHODS: This is a retrospective cohort study of pediatric patients who received MET activation at the Children's Hospital of Eastern Ontario in Ottawa, Canada. Data were obtained from a prospectively maintained rapid response system database. The primary outcome was PICU admission, with the number and type of interventions performed as secondary outcomes. RESULTS: The most common MET activators were physicians (410, 53.3%) with nurses generating a comparable number (367, 47.7%). Significant differences in PICU admission rates were observed between activator groups, with physicians having statistically higher PICU admission rates when compared with nurses (25.2% vs 15.0%, P = .001). Compared with physicians, nursing-led activations on surgical patients had significantly lower odds of PICU admission relative to medical patients (odds ratio 0.19 vs 0.67; P = .03). No significant difference was observed in the type or number of interventions between any subgroup based on patient (surgery vs medical) or activator type. CONCLUSIONS: This study suggests that when nurses activate MET, patients are less likely to be transferred to the PICU despite receiving similar type and number of interventions. Our study results may help direct education initiatives aimed at enhancing the effectiveness of the afferent limb through informing specific HCS as to the importance of their role in using the MET.

Trends in antiviral therapy of adults hospitalized with influenza in Canada since the end of the 2009 pandemic.

BACKGROUND: Multiple observational studies have associated antiviral treatment of patients hospitalized with influenza with improved outcome, including reduced mortality. During the 2009-2010 H1N1 pandemic increased use of antiviral treatment of hospital patients was reported. We have carried out prospective surveillance for influenza in patients in a large network of Canadian hospitals since 2006. We wished to assess trends in antiviral use in the two seasons (2010-2011 and 2011-2012) since the end of the pandemic. FINDINGS: Adults (>16 years) testing positive for influenza at the time of or during admission to participating Canadian hospitals were prospectively reviewed. In 2009-2010 there were 1132 confirmed cases, 1107 in 2010-2011 and 631 in 2011-2012. Information on antiviral therapy was available in >95% in each year. Rising to 89.6% in 2009, the proportion of adult patients treated with antiviral therapy fell to 79.9% and 65.7% in the two subsequent seasons (p < 0.001). Oseltamivir was the antiviral agent used in >98% of cases in each year. The median time from onset of symptoms to initiation of antiviral therapy was three days. The treatment proportion fell across all age groups, co-morbid conditions and disease severity. CONCLUSION: Despite evidence for benefit of antiviral therapy, and clinical practice guidelines recommending treatment of this population, antiviral therapy of Canadian adults hospitalized with influenza has progressively fallen in the two seasons since the end of the 2009-2010 influenza pandemic.