Radiation safety measures in diagnostic nuclear medicine, based on the potential radiation dose emitted by radioactive patients.

Objective: To measure the potential radiation dose emitted by patients who have recently undergone diagnostic nuclear medicine procedures, in order to establish optimal radiation safety measures for such procedures. Materials and Methods: We evaluated the radiation doses emitted by 175 adult patients in whom technetium-99m, iodine-131, and fluorine-18 radionuclides were administered for bone, kidney, heart, brain, and whole-body scans, as measured with a radiation detector. Those values served as the basis for evaluating whole-body radiopharmaceutical clearance, as well as the risk for the exposure of others to radiation, depending on the time elapsed since administration of the radiopharmaceutical. Results: The mean time to clearance of the radiopharmaceuticals administered, expressed as the effective half-life, ranged from 1.18 ± 0.30 h to 11.41 ± 0.02 h, and the mean maximum cumulative radiation dose at 1.0 m from the patients was 149.74 ± 56.72 µSv. Even at a distance of 0.5 m, the cumulative dose was found to be only half and one tenth of the limits established for exposure of the general public and family members/caregivers (1.0 mSv and 5.0 mSv per episode, respectively). Conclusion: Cumulative radiation doses emitted by patients immediately after diagnostic nuclear medicine procedures are considerably lower than the limits established by the International Commission on Radiological Protection and the International Atomic Energy Agency, and precautionary measures to avoid radiation exposure are therefore not required after such procedures.

Objetivo: O objetivo deste trabalho foi levantar o potencial de dose de radiação emitida por pacientes em procedimentos diagnósticos, visando a estabelecer cuidados de radioproteção mais otimizados. Materiais e Métodos: Taxas de dose de radiação emitidas por 175 pacientes administrados com os radionuclídeos 99mTc, 131I e 18F para cintilografias óssea, renal, cardíaca, cerebral e corpo inteiro, foram mensuradas com um detector de radiação, servindo para avaliar o clareamento do radiofármaco no organismo e risco de exposição após administração dos radiofármacos. Resultados: O clareamento, representado pela meia-vida efetiva, variou de 1,18 ± 0,30 h até 11,41 ± 0,02 h e a dose de radiação máxima acumulada oferecida pelos pacientes a 1,0 m foi de 149,74 ± 56,72 µSv. Mesmo para distâncias de 0,5 m, as doses estimadas foram, respectivamente, duas e dez vezes inferiores ao nível de restrição para o público geral (1,0 mSv) e exposição médica (5,0 mSv/episódio). Conclusão: Doses de radiação oferecidas por pacientes em procedimentos diagnósticos são inferiores aos níveis de restrição recomendados pela International Commission on Radiological Protection e International Atomic Energy Agency, e assim, cuidados de radioproteção são geralmente desnecessários.

Radiation safety measures in diagnostic nuclear medicine, based on the potential radiation dose emitted by radioactive patients / Cuidados de radioproteção em medicina nuclear diagnóstica baseados no potencial de dose de radiação emitida por pacientes radioativos

Abstract Objective: To measure the potential radiation dose emitted by patients who have recently undergone diagnostic nuclear medicine procedures, in order to establish optimal radiation safety measures for such procedures. Materials and Methods: We evaluated the radiation doses emitted by 175 adult patients in whom technetium-99m, iodine-131, and fluorine-18 radionuclides were administered for bone, kidney, heart, brain, and whole-body scans, as measured with a radiation detector. Those values served as the basis for evaluating whole-body radiopharmaceutical clearance, as well as the risk for the exposure of others to radiation, depending on the time elapsed since administration of the radiopharmaceutical. Results: The mean time to clearance of the radiopharmaceuticals administered, expressed as the effective half-life, ranged from 1.18 ± 0.30 h to 11.41 ± 0.02 h, and the mean maximum cumulative radiation dose at 1.0 m from the patients was 149.74 ± 56.72 µSv. Even at a distance of 0.5 m, the cumulative dose was found to be only half and one tenth of the limits established for exposure of the general public and family members/caregivers (1.0 mSv and 5.0 mSv per episode, respectively). Conclusion: Cumulative radiation doses emitted by patients immediately after diagnostic nuclear medicine procedures are considerably lower than the limits established by the International Commission on Radiological Protection and the International Atomic Energy Agency, and precautionary measures to avoid radiation exposure are therefore not required after such procedures.

Resumo Objetivo: O objetivo deste trabalho foi levantar o potencial de dose de radiação emitida por pacientes em procedimentos diagnósticos, visando a estabelecer cuidados de radioproteção mais otimizados. Materiais e Métodos: Taxas de dose de radiação emitidas por 175 pacientes administrados com os radionuclídeos 99mTc, 131I e 18F para cintilografias óssea, renal, cardíaca, cerebral e corpo inteiro, foram mensuradas com um detector de radiação, servindo para avaliar o clareamento do radiofármaco no organismo e risco de exposição após administração dos radiofármacos. Resultados: O clareamento, representado pela meia-vida efetiva, variou de 1,18 ± 0,30 h até 11,41 ± 0,02 h e a dose de radiação máxima acumulada oferecida pelos pacientes a 1,0 m foi de 149,74 ± 56,72 µSv. Mesmo para distâncias de 0,5 m, as doses estimadas foram, respectivamente, duas e dez vezes inferiores ao nível de restrição para o público geral (1,0 mSv) e exposição médica (5,0 mSv/episódio). Conclusão: Doses de radiação oferecidas por pacientes em procedimentos diagnósticos são inferiores aos níveis de restrição recomendados pela International Commission on Radiological Protection e International Atomic Energy Agency, e assim, cuidados de radioproteção são geralmente desnecessários.

3D Bioprinting: An Enabling Technology to Understand Melanoma.

Melanoma is a potentially fatal cancer with rising incidence over the last 50 years, associated with enhanced sun exposure and ultraviolet radiation. Its incidence is highest in people of European descent and the ageing population. There are multiple clinical and epidemiological variables affecting melanoma incidence and mortality, such as sex, ethnicity, UV exposure, anatomic site, and age. Although survival has improved in recent years due to advances in targeted and immunotherapies, new understanding of melanoma biology and disease progression is vital to improving clinical outcomes. Efforts to develop three-dimensional human skin equivalent models using biofabrication techniques, such as bioprinting, promise to deliver a better understanding of the complexity of melanoma and associated risk factors. These 3D skin models can be used as a platform for patient specific models and testing therapeutics.

Immuno-stimulatory effect and toxicology studies of salt pan bacteria as probiotics to combat shrimp diseases in aquaculture.

The shrimp aquaculture industry has experienced serious economic losses due to diseases caused by Vibrio species. The application of antibiotics to combat diseases has led to environmental hazards, antibiotic-resistance in pathogens and accumulation of antibiotics in tissues. This study explores the use of probiotics as an alternative to antibiotics. A probiotic consortium SFSK4 (comprising salt pan bacteria Bacillus licheniformis TSK71, Bacillus amyloliquefaciens SK27, Bacillus subtilis SK07, Pseudomonas sp. ABSK55) was used as a water additive during shrimp culture. It significantly increased shrimp (Litopenaeus vannamei) immunity i.e. total hemocyte count, phagocytosis, total plasma protein, respiratory burst and bactericidal activity as compared to the control. It also stimulated the phenoloxidase activity by two-fold. Proteomic analysis revealed the differential expression of 50 immune proteins (39 up-regulated and 11 down-regulated) in SFSK4 treated shrimps. Four major immune modulation proteins viz. Caspase2, GTPase activating protein, Hemocyanin and Glucan pattern-recognition lipoprotein involved in cell mediated immune response were identified in SFSK4 treated shrimp hemolymph. SFSK4 decreased shrimp mortality by more than 50% against pathogens. Toxicology studies revealed that administration of the highest dose of probiotic (1012 CFU/mL) showed no adverse effect on shrimp survival (LC50 analysis) and neither exhibited cytotoxicity. Genotoxicity study confirmed that the probiotic did not cause DNA damage in shrimps. The findings suggest that the probiotic SFSK4 is an eco-friendly water additive to enhance shrimp immunity against diseases in aquaculture, which could help curtail environmental hazards as an effective alternative to antibiotics.

Probiotic Role of Salt Pan Bacteria in Enhancing the Growth of Whiteleg Shrimp, Litopenaeus vannamei.

Development of probiotics to improve the growth of cultured species is a key to sustainable aquaculture. The present study investigates the potential of salt pan bacteria as probiotics for Litopenaeus vannamei. Halotolerant bacteria (100) were screened for enzyme production and mucus adhesion in vitro. The bacteria (SK07, SK27, ABSK55, FSK444, TSK17, TSK71) exhibiting promising enzyme activity and adhesive property in vitro were selected to study their effect on the growth and metabolism of L. vannamei in vivo. When administered to shrimps individually as a water additive in experiment I, SK07, SK27 and TSK71 significantly (p < 0.05) increased shrimp weight as compared to the control. In experiment II, a lyophilized bacterial consortium (test) prepared with the four best isolates (SK07, SK27, ABSK55, TSK71), exhibited significantly higher weight gain of shrimps, better feed efficiency and final yield as compared to control. Total enzyme activity (amylase, protease, lipase) in the shrimp gut was significantly higher in the test than the control. The four isolates showed 99% nBLAST similarity with Bacillus subtilis, Bacillus amyloliquefaciens, Bacillus licheniformis and Pseudomonas sp. Presence of these bacteria in the shrimp gut was confirmed by using specific PCR-based molecular probes and 16S rDNA sequencing. Safety evaluation by antibiotic susceptibility test and hemolytic activity test indicated that the bacteria are safe as bioinoculants. The increased enzyme activity by colonisation of the isolates in the shrimp gut, along with improved growth and feed utilisation efficiency, strongly confirms that these salt pan bacteria are prospective probiotics in shrimp aquaculture.

Complementary Medicine & Spirituality: Health-Seeking Behaviors of Indian Immigrants in the United States.

Over 3 million India-born immigrants live in the United States, yet their health-seeking behaviors are little understood. Information on health and access to care was collected from 20 adult Indian immigrants living in the United States. Participants preferred complementary and alternative medicine home remedies to address their health needs, although they accessed health services more quickly for their children. They also reported barriers in using insurance and accessing healthcare.

The Quality of Dying and Death in a Residential Hospice.

CONTEXT: Residential hospices may be an optimal compromise between home and hospital settings for end-of-life care, but there has been little systematic research regarding the quality of dying and death in such locations. OBJECTIVES: The objective of this study was to assess the quality of dying and death of patients who received end-of-life care in a residential hospice and its relationship to hospice length of stay (LOS) and prior receipt of palliative care. METHODS: A total of 100 caregivers of patients who died in a residential hospice in downtown Toronto, Canada, were recruited four to six months after patient's death. The quality of dying and death was measured, based on interviews with bereaved caregivers, using the Quality of Dying and Death (QODD) questionnaire. RESULTS: The overall mean QODD score was 68.85 ± 11.62, which is in the intermediate ("neither good nor bad") range (30-70) of the scale. The lowest QODD subscale score was on the Transcendence subscale, which evaluates death-related concerns; this was 59.48 ± 25.37, with ratings in 14.6% of the sample in the "terrible to poor" (0-29) range. QODD scores were higher for patients with hospice LOS of more than one week (72.21 ± 9.64) than for those with a shorter LOS (60.38 ± 11.92) (P < 0.001). CONCLUSION: Overall quality of dying and death was perceived as average to above average, in an urban residential hospice, although death-related distress was present in a substantial minority of patients. The association of better QODD with hospice LOS of more than one week may be due to better clinical status on admission and/or longer duration of time that is needed to achieve optimal outcomes.

Do moderate aerobic exercise and strength training influence electromyographic biofeedback of the pelvic floor muscles in female non-athletes?

[Purpose] To assess the influence of moderate physical exercise on pelvic floor muscle electromyographic (EMG) biofeedback signal in female non-athletes. [Subjects and Methods] A prospective, non-randomized study of 90 adult females (age ≥18 years) divided into three groups: Intervention (I), which began physical exercise upon study enrollment; Moderate Exercise (ME), comprising those who already engaged in physical activity; and Sedentary (S), comprising those who had a sedentary lifestyle. All participants underwent EMG biofeedback of the pelvic floor muscles upon study enrollment (T1) and at the end of the third subsequent month (T2). [Results] Mean age was 35.7 (SD: 7.5) years, with no significant difference between groups. T1 values in groups I and S were significantly lower than in group ME. There was no statistically significant difference between groups S and I. On comparison between groups at T2, values were highest in group I (18.5 µV vs. 15.3 µV in group S, vs. 16.1 µV in group ME). There was no significant difference between groups S and ME. On age-adjusted analysis, group I exhibited the greatest change between T1 and T2 (I, 4.7 µV; ME, 2.1 µV; S, 1.5 µV). [Conclusion] Females who exercise exhibit better pelvic floor muscle function than those who do not engage in physical activity.

Changes in social engagement and depression predict incident loneliness among seriously ill home care clients.

ABSTRACTObjective:This study identified the predictors of incident loneliness in a group of seriously ill older adults (aged 65+) receiving home care. METHOD: Existing data collected with the Resident Assessment Instrument for Home Care (RAI-HC) were utilized. A cohort of clients (N = 2,499) with two RAI-HC assessments and no self-reported loneliness at time 1 were included. Self-reported loneliness, upon reassessment, was the outcome of interest. Clients with a prognosis of less than six months or severe health instability were included. RESULTS: The average length of time between assessments was 5.9 months (standard deviation = 4.10). During that time, 7.8% (n = 181) of the sample developed loneliness. In a multivariate regression model, worsening symptoms of depression, a decline in social activities, and not living with a primary caregiver all increased the risk of loneliness. SIGNIFICANCE OF RESULTS: These results highlight how changes in psychosocial factors over time can contribute to loneliness, which can inform clinicians as they seek to identify those who may be at risk for loneliness.

DREAM: Empowering Preclinical Medical Students With Labor Support.

Introduction: Delivery Resources, Experiences, and Advocacy for Moms (DREAM) is an interprofessional service-learning program that empowers preclinical medical students by training them to provide labor support. Boston Medical Center is a safety-net hospital featuring an in-house doula service with limited coverage capacity. Consequently, many patients do not receive continuous labor support, although evidence shows that continuous labor support improves outcomes and may help reduce birth-outcome health disparities. We present a pragmatic approach to integrating preclinical students as labor-support staff and outline the methods and content of the training process as well as the evaluations used to assess program effectiveness. Methods: Students were trained by doulas (Birth Sisters) and midwives to provide prenatal, labor, and postpartum support. Students completed an orientation and training workshop and then partnered with a Birth Sister for one prenatal visit, labor, and postpartum visit prior to working independently. Student leaders provided structure, mentoring, and support for preclinical students. Pre- and postsurveys assessed student confidence and obstetric knowledge acquisition. Budget, logistics, and program evaluation process are reviewed. Results: Students demonstrated increased knowledge, as well as confidence in communication, advocacy, and support. Although balancing DREAM with academics was stressful, students continued to meet academic standards and felt their participation was gratifying and worthwhile. Student reflections and patient statements on their experience show the program was mutually beneficial. Discussion: Preclinical students need gratifying clinical opportunities to develop confidence in communication and advocacy skills. Partnering them with underserved women to provide labor support is a pragmatic and clinically valuable intervention.

Evidências sobre o uso de aspirina na prevenção primária de doenças cardiovasculares / Pruebas sobre el uso de la aspirina en la prevención primaria de las enfermedades cardiovasculares / Evidence on the use of aspirin in the primary prevention ofcardiovascular diseases

Objetivo: identificar as recomendações de uso da aspirina para a prevenção primária de doenças cardiovasculares, pesando seus benefícios e riscos, conforme a literatura disponível. Método: Trata-se de uma revisão integrativa, a coleta de dados aconteceu no mês de maio de 2014, aceitaram-se publicações do período entre 2009 e 2013, em inglês, português e espanhol. Resultados: Foram selecionados sete estudos, com excelentes níveis de recomendação. Evidenciou-se que o uso da aspirina para a prevenção primária de doenças cardiovasculares deve ser baseado em uma análise criteriosa de cada caso, avaliando seus benefícios e riscos. Conclusão: Conclui-se que são necessárias ferramentas de estratificação de riscos, para, assim, recomendar ou não o uso da aspirina. Ainda que, há necessidade de capacitação especial à equipe de enfermagem para um melhor acompanhamento e tratamento destes pacientes.

Objective: to identify the use of aspirin recommendations for primary prevention of cardiovascular disease, weighing its benefits and risks, according to the available literature. Methods: This is an integrative review, data collection took place in May 2014, accepted up period of publications between 2009 and 2013 in English, Portuguese and Spanish. Results: 07 studies were selected, with excellent levels of recommendation. It was evident that the use of aspirin for primary prevention of cardiovascular disease should be based on a careful analysis of each case, assessing its benefits and risks. Conclusion: It is concluded that are required risk stratification tools, thus, recommend or not the use of aspirin. Although, there is need for special training for nursing staff to better monitoring and treatment of these patients.

Objetivo: identificar el uso de las recomendaciones de la aspirina para la prevención primaria de la enfermedad cardiovascular, sopesando SUS beneficios y riesgos, de acuerdo con la literatura disponible. Método: Este es un examen integrador, la recopilación de datos tuvo lugar en mayo de 2014, aceptada por periodo de publicaciones entre 2009 y 2013 en Inglés, Portugués y Español. Resultados: Se seleccionaron 07 estudios, com excelentes niveles de recomendación. Era evidente que el uso de la aspirina para la prevención primaria de las enfermedades cardiovasculares debe basarse en un análisis cuidadoso de cada caso, la evaluación de sus benefícios y riesgos. Conclusión: se concluye que se requieren herramientas de estratificación del riesgo, por lo tanto, recomendar o no el uso de la aspirina. Aunque, existe la necesidad de una formación especial para el personal de enfermería para un mejor control y tratamiento de estos pacientes.

Awakening to the politics of food: Politicized diet as social identity.

In this qualitative study, the process of developing a politicized identity around diet was explored through a social psychological lens. Applying one of the most influencial models of group identity development proposed by Cross (1978) in which an "encounter" experience spurs an awakening into a politicized identity, we asked 36 participants who followed alternative diets due to political reasons to describe their unique encounter experiences that brought them to their politicized awakening. Their self-identified diets included pescetarian, vegetarian, vegan, raw, non-GMO/organic, and reduced meat consumption. Participants described the rationale for their diets, their "encounter" or awakening to their politicized diets, and whether they viewed their diet as a part of their identity. Using thematic analysis, we identified four key types of encounters that sparked their politicization: a series of integrated events, exposure to educational materials, a direct visceral emotional experience, and guidance from a role model. We discuss the results with regard to the politics of food, the nature of the politicized dieter's identity as part of a minority food culture, and the difficulties of engaging in political action through one's diet. The underexplored benefits of applying social psychological theories of identity to research on dietary subcultures is also discussed.

Comorbidade psiquiátrica em dependente de crack e outras drogas: um relato de experiência / Psychiatric comorbidity in dependent on crack and other drugs: case studies / La comorbilidad psiquiátrica dependiente de crack y otras drogas: estudios de caso

Objetivo: relatar a experiência de discentes da graduação em enfermagem no cuidado a uma paciente portadora de comorbidade psiquiátrica do tipo psicose (esquizofrenia) somada a uso de drogas ilícitas (crack e maconha). Método: estudo descritivo, do tipo relato de experiência, de abordagem qualitativa. A experiência foi vivenciada durante os meses de agosto e setembro de 2013, nas dependências do hospital psiquiátrico do município de Teresina (PI), Brasil. Resultados: o processo de enfermagem foi aplicado ao quadro clínicopsiquiátrico vivenciado, em toda sua completude. O relacionamento terapêutico, o cuidado individualizado e as melhores práticas em saúde baseadas em evidências são essenciais para um bom prognóstico. Conclusão: a experiência com um quadro de dependência química, acompanhada de sintomas psicóticos contribuiu para que compreendêssemos a importância do papel do enfermeiro e de seu objeto de trabalho, a Sistematização da Assistência de Enfermagem.(AU)

Objective: reporting the students experience of undergraduate nursing in the care of a patient with psychiatric comorbidity of psychosis type (schizophrenia) plus the use of illegal drugs (crack and marijuana). Method: a descriptive study of type case estudies of a qualitative approach. The experience was experienced during the months of August and September 2013, on the premises of the psychiatric hospital in the city of Teresina (PI), Brazil. Results: the nursing process was applied to the experienced clinical and psychiatric condition, in all its completeness. The therapeutic relationship, individualized care and better health in evidence-based practices are essential for a good prognosis. Conclusion: the experience with a chemical dependency framework, followed by psychotic symptoms helped us to understand the importance of the nurse's role and its work object, the systematization of nursing care.(AU)

Objetivo: reportar la experiencia de los estudiantes de pregrado en enfermería en el cuidado de un paciente con comorbilidad psiquiátrica tipo de paciente psicosis (esquizofrenia), más el uso de drogas ilegales (de crack y marihuana). Método: un estudio descriptivo del tipo informe de la experiencia de un enfoque cualitativo. La experiencia se vivió durante los meses de agosto y septiembre de 2013, en las instalaciones del hospital psiquiátrico de la ciudad de Teresina (PI), Brasil. Resultados: el proceso de enfermería se aplicó a la condición clínica y psiquiátrica con experiencia, en toda su integridad. La relación terapéutica, la atención individualizada y una mejor salud en las prácticas basadas en la evidencia son esenciales para un buen pronóstico. Conclusión: la experiencia con un marco de dependencia química, acompañada de síntomas psicóticos nos ayudó a entender la importancia del papel de la enfermera y su objeto de trabajo, la sistematización de la atención de enfermería.(AU)

Síndrome de burnout entre profissionais de enfermagem: revisão integrativa / Burnout Syndrome among Nursing Professionals: Integrative Literature Review / Síndrome de desgaste profesional entre los enfermeros profesionales: revisión integradora

Objetivos: Caracterizar e sintetizar as evidências científicas sobre a síndrome de burnout entre profissionais de enfermagem provenientes da produção científica nacional e internacional publicada entre 2010 e 2014. Método: Revisão integrativa realizada nas bases de dados Lilacs, Medline, BDENF e IBECS. Aceitaram-se artigos na íntegra, publicados entre 2010 e junho de 2014. Em um universo de 3.467 estudos, 24 foram selecionados. O foco de análise foram as conclusões extraídas a partir da análise empreendida, e agrupadas e reagrupadas de forma interpretativa, por semelhanças em categorias temáticas. Resultados: A análise reafirma que a síndrome é uma doença multidimensional, implica em consequências para o profissional, cliente e organização, e que são necessárias estratégias focadas no ambiente de trabalho. Conclusão: Demonstrou-se que se trata de um problema psicossocial da atualidade que merece atenção e abordagens que permitam o desenvolvimento de mecanismos de minimização do sofrimento psíquico do profissional de enfermagem.

Objectives: To characterize and summarize the scientific evidence on the Burnout Syndrome among nursing professionals from the national and international scientific literature published between 2010 and 2014. Method: Integrative review conducted on the Lilacs, Medline, BDENF, and IBECS. Accepted up full articles, published between 2010 and June 2014. In a universe of 3467 studies, 24 were selected. The focus of analysis were the conclusions drawn from the analysis undertaken, and grouped and regrouped interpretively, by similarities in thematic categories. Results: The analysis confirms that the syndrome is a multidimensional disease, imply consequences for the professional, client and organization, and are necessary strategies focused on the desktop. Conclusion: It was shown that it is a today's psychosocial problem that deserves attention and approaches to the development of mechanisms to minimize the psychological suffering of the nursing professional.

Objetivos: Caracterizar y resumir la evidencia científica acerca del síndrome de desgaste profesional entre los profesionales de enfermería de la literatura científica nacional e internacional publicada entre 2010 y 2014. Método: Revisión integrativa realizada sobre las bases de datos Lilacs, Medline, BDENF e IBECS. Se aceptaron artículos completos, publicados entre 2010 y junio de 2014. En un universo de 3467 estudios, se seleccionaron 24. A partir del análisis de tales artículos, la información extraída se reagrupó interpretativamente por similitudes en categorías temáticas. Resultados: El análisis confirma que este síndrome es una enfermedad multidimensional que implica consecuencias para el profesional, el cliente y la organización, y son necesarias estrategias centradas en el ambiente de trabajo. Conclusión: Se demostró que es un problema psicosocial que merece atención y se acerca al desarrollo de mecanismos para minimizar el sufrimiento psicológico de los profesionales de enfermería.

Aleitamento materno: situação encontrada em uma maternidade de referência / Breastfeeding: situation found in a maternity of reference / Lactancia: situación encontrada en una maternidad de referencia

Objetivo: caracterizar o aleitamento materno em uma maternidade de referência do nordeste brasileiro. Método: estudo exploratório-descritivo, transversal, com abordagem quantitativa, no qual participaram 260 mulheres de uma maternidade pública. Os dados foram coletados em visitas às participantes no alojamento conjunto. A análise foi realizada com subsídio do programa SPSS 18.0. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa (Parecer 74247/12). Resultados: a amostra tinha idade entre 14 e 42, a maioria com ensino médio, casada, católica, do lar, e renda mensal individual entre 1 e 2 salários mínimos, primigestas, primiparas, sem aborto prévio, que amamentavam por razões de saúde, em livre demanda, e receberam informações do enfermeiro. Conclusão: somente a informação não basta para que as mulheres tenham sucesso em sua experiência de amamentar ou fiquem motivadas a fazê-lo, por ser o aleitamento materno um processo biopsicossocial e econômico.(AU)

Objective: characterizing breastfeeding in a maternity of reference in northeastern Brazil. Method: an exploratory, descriptive, cross-sectional study of a quantitative approach, in which participated 260 women from a public maternity hospital. Data were collected on visits to participating in rooming. The analysis was performed with SPSS 18.0 program grant. The research project was approved by the Research Ethics Committee (Opinion 74247/12). Results: the sample was aged 14 to 42, most with high school, married, Catholic, housewives, with individual monthly income between 1 and 2 minimum wages, first pregnancy, primiparous, without previous abortion, that breastfeeding for health reasons, in demand, and received information from the nurse. Conclusion: only the information is not enough for women to succeed in their breastfeeding experience or be motivated to do so, as the breastfeeding being a biopsychosocial and economic process.(AU)

Objetivo: caracterizar la lactancia materna en una maternidad de referencia en el noreste de Brasil. Método: un estudio exploratorio, descriptivo, transversal, con un enfoque cuantitativo, a la que asistieron 260 mujeres de una maternidad pública. Los datos fueron recolectados en las visitas a la participación en el alojamiento conjunto. El análisis se realizó con la subvención del programa SPSS 18.0. El proyecto de investigación fue aprobado por el Comité de Ética en la Investigación (Opinión 74247/12). Resultados: la muestra tenía de 14 a 42 años de edad, la mayoría de ellas con la escuela secundaria, casadas, católicas, del hogar, y con el ingreso mensual individual entre 1 y 2 salarios mínimos, primer embarazo, primíparas, sin aborto previo, que hacían la lactancia materna por razones de salud, en la demanda, y recibieron información de enfermería. Conclusión: sólo la información no es suficiente para que las mujeres tengan éxito en su experiencia de lactancia o estar motivadas para hacerlo, porque la lactancia es un proceso biopsicosocial y económico.(AU)

A comparison between end-of-life home care clients with cancer and heart failure in Ontario.

Individuals with heart failure experience complex symptoms and have a poor prognosis, comparable to those with cancer. However, people with heart failure are less likely to be recognized as needing palliative care. We compared seriously ill home care clients with cancer versus those with heart failure to explore differences between them using existing data from the Resident Assessment Instrument for Home Care (RAI-HC). The sample included 1,475 older adults (65+) in Ontario who had a prognosis of less than 6 months or severe health instability. Clients with heart failure were significantly older (p < .0001) and experienced significantly higher rates of impairment in activities of daily living (p = .005), cognitive impairment (p < .0001), and severe health instability (p < .0001), but were significantly less likely to have a prognosis of less than 6 months (p < .0001). Home care clients with heart failure have needs similar to those with cancer yet are typically not identified as having a terminal prognosis.

Avaliação manométrica anorretal de mulheres adultas com diagnóstico clínico e urodinâmico de bexiga hiperativa / Anorectal manometry evaluation in adult women with clinical and urodynamic diagnostics of overactive bladder

RACIONAL: A manometria anorretal é método diagnóstico empregado na prática clínica para avaliação de distúrbios funcionais anorretais e do assoalho pélvico. As disfunções miccionais, anorretais e do assoalho pélvico tem sido consideradas como fatores contribuintes dos sintomas de bexiga hiperativa. OBJETIVO: Avaliar os resultados obtidos com manometria anorretal em mulheres adultas com diagnóstico clínico e urodinâmico de bexiga hiperativa. MÉTODOS: Vinte e cinco mulheres adultas (média de idade de 45.5±11.9 anos) com diagnóstico clínico e urodinâmico de bexiga hiperativa submeteram-se à manometria anorretal e os resultados obtidos nesta avaliação foram comparados aos de um grupo controle de 18 mulheres (média de idade de 33.9 ±10.7 anos) assintomáticas do ponto de vista urinário e sem critérios clínicos para diagnóstico de bexiga hiperativa. O grupo de mulheres com bexiga hiperativa foi denominado BH e controle C. RESULTADO: Ocorreram seis (24%) casos de contração paradoxal do puborretal no grupo BH e nenhuma no Grupo C. Houve 13 (52%) ocorrências de hipertonia de repouso isolada ou associada à hipertonia de contração no Grupo BH e sete (39%) no Grupo C. A média de pressão de repouso foi de 80.1 mmHg no Grupo BH e 67.6 mmHg no Grupo C. O total de ocorrência de hipertonia de contração no Grupo BH foi de 7(28%) e 11(61%) no Grupo C. A média de pressão de contração foi de 182.2 mmHg no Grupo BH e 148.1 mmHg no Grupo. Com relação ao reflexo inibitório retoanal, a sensibilidade e a capacidade retal máxima não houve diferença estatisticamente significante entre os dois grupos. CONCLUSÃO: As mulheres com bexiga hiperativa apresentaram maior ocorrência de contração paradoxal do puborretal em relação às do grupo controle.

BACKGROUND: Anorectal manometry is a diagnostic method often used in clinical practice for assessing functional anorectal disorders and pelvic floor. The dysfunctional voiding, anorectal and pelvic floor has been considered as contributing factors of the symptoms of overactive bladder. AIM:To evaluate the results with anorectal manometry in adult women with clinical and urodynamic diagnostics of overactive bladder. METHODS: Twenty-five adult women (mean age 45.5±11.9 years) with clinical and urodynamic diagnostic of overactive bladder underwent anorectal manometry and the results of this assessment were compared to a control group of eighteen women (mean age 33.9±10.7 years) with no urinary or intestinal disorders and without clinical criteria for diagnosis of overactive bladder. RESULTS: Paradoxical puborectalis contraction occurred in six patients in the overactive bladder group and none of the controls. There were no significant between group differences in the following manometric parameters: rectoanal inhibitory reflex, rectal sensitivity, maximum tolerable volume, resting pressure, and hypertonia at rest. Mean squeeze pressure was 182.2 mmHg in the overactive bladder group versus 148.1 mmHg in the control group. CONCLUSION: Women with overactive bladder had increased incidence of paradoxical puborectalis contraction than women in the control group.

Anorectal manometry evaluation in adult women with clinical and urodynamic diagnostics of overactive bladder.

BACKGROUND: Anorectal manometry is a diagnostic method often used in clinical practice for assessing functional anorectal disorders and pelvic floor. The dysfunctional voiding, anorectal and pelvic floor has been considered as contributing factors of the symptoms of overactive bladder. AIM: To evaluate the results with anorectal manometry in adult women with clinical and urodynamic diagnostics of overactive bladder. METHODS: Twenty-five adult women (mean age 45.5 ± 11.9 years) with clinical and urodynamic diagnostic of overactive bladder underwent anorectal manometry and the results of this assessment were compared to a control group of eighteen women (mean age 33.9 ± 10.7 years) with no urinary or intestinal disorders and without clinical criteria for diagnosis of overactive bladder. RESULTS: Paradoxical puborectalis contraction occurred in six patients in the overactive bladder group and none of the controls. There were no significant between group differences in the following manometric parameters: rectoanal inhibitory reflex, rectal sensitivity, maximum tolerable volume, resting pressure, and hypertonia at rest. Mean squeeze pressure was 182.2 mmHg in the overactive bladder group versus 148.1 mmHg in the control group. CONCLUSION: Women with overactive bladder had increased incidence of paradoxical puborectalis contraction than women in the control group.

Neurones express glutamine synthetase when deprived of glutamine or interaction with astrocytes.

Glutamine synthetase (GS) forms glutamine by catalyzing the ATP-dependent amidation of glutamate. In healthy brains, GS is restricted to astrocytes but in Alzheimer's disease and cell culture, GS has been detected in neurones. The present study demonstrates the expression of functional GS in cultured cerebellar granule cells and investigates conditions required to reduce this expression. Cerebellar granule cells from neonatal rats were grown in the absence of glutamine. Immunostaining revealed that the majority of neurones contained GS in their somata and dendrites. Treatment of neuronal cultures with glutamine greatly reduced the enzymatic activity of GS and also reduced the intensity of GS immunolabelling in dendrites. GS activity was reduced by 32% in neurones that had been transiently co-cultured with astrocytes, whereas GS immunoreactivity was largely abolished from neurones that had been directly seeded onto astrocytic monolayers. These results imply that GS expression in neurones occurs in response to a reduced availability of glutamine from astrocytes, and that neuronal GS expression represents a default phenotype which is normally suppressed via direct contacts with astrocytes. The aberrant expression of GS in sporadic neurones in Alzheimer's disease may indicate an impairment of such interactions.