Background Cardiovascular disease in the context of human immunodeficiency virus infection has become a major clinical concern in recent years. In the current report we assess hospitalizations due to cardiovascular disease in human immunodeficiency virus patients in a Social Security reference hospital in Peru. Methods A retrospective study was carried out between January 1996 and December 2012 in a General Hospital in Lima, Peru. Results We included 26 patients hospitalized due to cardiovascular disease. Mean age was 46.3 years (SD 12.5), predominantly male (57.7%). Ten patients (38.4%) were in Acquired Immunodeficiency Syndrome stages. Seventeen (65.4%) received high-active-antiretroviral therapy. Eleven (42.3%) had cardiac involvement and 15 (57.7%) had non-cardiac vascular involvement. The most frequent causes of cardiac involvement were pericardial effusion and myocardial infarction. On the other hand, deep vein thrombosis and stroke were the most frequent for non-cardiac vascular involvement. Conclusions Cardiovascular disease is an important cause of hospitalization in Peruvian human immunodeficiency virus patients, with differences between immunosuppression stages. Further studies analyzing associated factors are warranted. / germanvrodriguez@yahoo.com / Revisión por pares

Paediatric acquired brain injury (pABI) can lead to an array of long term physical, cognitive, emotional, and behavioural difficulties. Due to the long-term sequelae of more severe pABI, it presents a significant challenge to the child’s family. Studies have suggested that social support can positively impact psychological adjustment following a stressful life event, and can aid personal resilience. There remains limited qualitative investigation of subjective family and parental adjustment experiences following pABI. Researchers have argued for future research that include the experiences of parents who have children younger than 16 years old, and are able to shed light on the individual experiential journey of parents. The current study used interpretative phenomenological analysis (IPA) to explore to the experiences of adjustment and social support of parents of children with pABI. Purposive sampling was used to recruit 10 participants who were individually interviewed. Five superordinate themes emerging from the data were identified: 1) Lives changed forever, 2) Sense of self, 3) Interaction with services, 4) The psychological experience, 5) Coping and adjustment. Relevant literature and implications for future research and clinical practice are discussed.

nÃo hà / Desde que a SÃndrome da ImunodeficiÃncia Adquirida (AIDS) comeÃou a ser reconhecida como problema de saÃde pÃblica, tem havido preocupaÃÃo crescente com o papel desempenhado pelos usuÃrios de drogas na disseminaÃÃo global do VÃrus da ImunodeficiÃncia Adquirida (HIV), sendo esta, atualmente, a segunda causa de morte entre eles. O estudo apresenta como objetivo geral promover, por meio dos CÃrculos de Cultura, espaÃo crÃtico-reflexivo acerca da prevenÃÃo do HIV/aids junto aos jovens usuÃrios de cocaÃna/crack. Trata-se de pesquisa-aÃÃo, realizada de janeiro a setembro de 2012. Os sujeitos do estudo foram dez jovens usuÃrios de cocaÃna/crack, do sexo masculino, com idade entre 18 e 24 anos, acompanhados para tratamento de dependÃncia na comunidade terapÃutica Desafio Jovem do CearÃ. Os instrumentos e as tÃcnicas utilizados para coleta das informaÃÃes foram: entrevista semiestruturada, observaÃÃo-participante, registro fotogrÃfico, gravaÃÃo dos discursos e registro em diÃrio de campo. Como mÃtodo e tÃcnica para articular a dimensÃo coletiva e interativa da investigaÃÃo proposta pela pesquisa-aÃÃo, utilizou-se o CÃrculo de Cultura. Deste modo, foram realizados seis CÃrculos de Cultura construÃdos de acordo com as seguintes etapas: o conhecer do universo individual e coletivo, seleÃÃo dos temas, dinÃmicas de sensibilizaÃÃo e problematizaÃÃo, reflexÃo teÃrico-prÃtica, construÃÃo coletiva do conhecimento e avaliaÃÃo de cada cÃrculo. Neste sentido, os jovens discutiram e refletiram sobre: o viver dos jovens com as drogas, a vulnerabilidade do usuÃrio de drogas ao HIV/aids, a relaÃÃo da Aids com as drogas, a prevenÃÃo e a transmissÃo do HIV/aids e o que aprendemos sobre Aids? Os resultados dessas discussÃes foram os seguintes: no inÃcio dos cÃrculos, os jovens demonstraram conhecimento sobre a aids bastante incipiente e desarticulado, com predominÃncia de mitos; relataram nunca terem feito uso de drogas injetÃveis, porÃm se consideravam vulnerÃveis Ãs DST/aids visto que o compartilhamento de canudos e cachimbos para o uso da cocaÃna/crack e a perda da consciÃncia favoreciam ao nÃo uso do preservativo durante as relaÃÃes sexuais e à multiplicidade de parceiros; os amigos desses jovens foram os principais fatores de risco para que viessem a experimentar as drogas; as festas, as âravesâ eram lugares propÃcios para o inÃcio do uso de drogas, porÃm casas abandonadas, escolas, e casas dos amigos, tambÃm foram incluÃdas como opÃÃes para o consumo de drogas, e que a religiÃo era muito importante para que os jovens decidissem nÃo usar mais as drogas e iniciassem o tratamento para dependÃncia. O processo educativo despertou nos nossos jovens o interesse e a necessidade de conversar com seus pares acerca da problemÃtica que envolvia as DST/aids e as drogas, e alÃm disso ensinou vÃrias maneiras de trabalhar a questÃo das drogas nas escolas com crianÃas e adolescentes que ainda nÃo sÃo usuÃrios, ratificando que o cÃrculo possibilita a reflexÃo e a transformaÃÃo do sujeito e do meio no qual ele està inserido. Diante do exposto, o enfermeiro pode trabalhar com metodologias dialÃgicas e participativas, como a de Paulo Freire, para favorecer a reflexÃo crÃtica do educador e educando em prol da prevenÃÃo de DST/aids em usuÃrios de cocaÃna/crack.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A violÃncia sexual caracteriza-se como um grave problema de saÃde pÃblica que acarreta distÃrbios no desenvolvimento biopsicossocial e sexual de suas vÃtimas, principalmente quando essa agressÃo ocorre na fase da adolescÃncia, pois esses sujeitos se encontram numa etapa da vida marcada por mudanÃas e adaptaÃÃes, especialmente no Ãmbito da sexualidade. Portanto, as crenÃas e valores das vitimas de violÃncia sexual precisam ser compreendidas para promover a adoÃÃo de comportamentos sexuais saudÃveis. Objetivou-se compreender como as crenÃas e valores das adolescentes vitimas de violÃncia sexual influenciam no comportamento de prevenÃÃo das DST e da AIDS com base no Modelo de CrenÃas em SaÃde (MCS) . Trata-se de uma pesquisa qualitativa, descritiva, realizada numa InstituiÃÃo de Acolhimento no Municipal de Fortaleza, no perÃodo de maio a julho de 2011, com oito adolescentes vitimas de violÃncia sexual. Foram utilizados como instrumentos e procedimentos para a coleta de informaÃÃes: a observaÃÃo participante de todos os encontros, que foram registrados no diÃrio de campo; todo o material produzido durante os grupos focais, como cartazes, desenhos, entre outros; e a transcriÃÃo da gravaÃÃo dos diÃlogos durante as estratÃgias de grupo e do roteiro de entrevista semiestruturada. As informaÃÃes foram organizadas conforme as dimensÃes do MCS. Todos os aspectos legais e Ãticos da pesquisa envolvendo os seres humanos foram respeitados. Inicialmente, foi necessÃrio caracterizar as participantes do estudo e observou-se que as histÃrias de vida dessas adolescentes estavam condizentes com a literatura. Em relaÃÃo Ãs categorias criadas conforme o MCS: as adolescentes tem um dÃfice de conhecimento em relaÃÃo a essas doenÃas e nÃo se consideraram susceptÃveis as DST/AIDS por acreditarem que nÃo irÃo se relacionar sexualmente com homens, mesmo identificando a maior vulnerabilidade da mulher a essas patologias; em relaÃÃo à percepÃÃo da gravidade, elas classificaram essas doenÃas como graves, incurÃveis e que alteram o convÃvio social, demonstrando medo de contrair uma dessas patologias; identificaram como benefÃcios e barreiras do mÃtodo preventivo ser de fÃcil acesso e utilizaÃÃo e prevenir tanto doenÃas como gravidez, mas interferem no prazer sexual; e seu uso està relacionado com questÃes culturais e sociais, ressalta-se tambÃm, que o abuso de Ãlcool e drogas intervÃm na adoÃÃo de comportamentos saudÃveis. Conclui-se que as crenÃas e valores dessas adolescentes as tornam vulnerÃveis a DST/AIDS, sendo necessÃrio refletir sobre as consequÃncias da violÃncia sexual na vida dessas adolescentes para a elaboraÃÃo de estratÃgias e aÃÃes preventivas voltadas para esse publico-alvo no que concerne ao desenvolvimento da sexualidade de forma segura, minimizando traumas e sofrimentos advindos dessa experiÃncia na vida dessas adolescentes, tornando-as conscientes dos seus direitos sexuais e reprodutivos. / Sexual assault is characterized as a serious public health problem that leads to disorders in the bio-psychosocial and sexual development of the victims, especially when the aggression happens in adolescence, because these subjects are in a stage of life marked by changes and adaptations, especially concerning sexuality. Therefore, the values and beliefs of the victims of sexual assault must be understood to promote the adoption of a healthy sexual behavior. It was aimed to understand how beliefs and values of adolescent victims of sexual assault influence the behavior of prevention of STD/AIDS based on the Health Belief Model. It is a qualitative descriptive research carried out at a Host Institution in the City of Fortaleza from May to July 2011 with eight adolescent victims of sexual assault. Using as tools and procedures for data collection: participant observation of all meetings, which were registered in a field diary; all the material produced during the focus groups, such as posters, drawings, among others; and the transcription of the dialogue recording during the group strategies and semi-structured interviews. The information was organized according to the Health Belief Model dimensions. All legal and ethical aspects of researches involving human beings were respected. Initially, it was necessary to characterize the study participants and it was found that the life stories of these adolescents were consistent with the literature. Regarding the categories created according to the Health Belief Model: the adolescents lack knowledge about these diseases and don't considered them susceptible to STD/AIDS because they believe that they will not relate sexually with men, in spite identifying the greater vulnerability of women to such pathologies; concerning the perception of gravity, they classified these diseases as serious, incurable, and that changes social life, demonstrating fear of contracting these diseases; they identified as benefits and barriers of preventive method: it is easy to access and use, and prevents both diseases as pregnancy, but interferes with sexual pleasure; and its use is related to cultural and social issues, we also emphasize that the abuse of alcohol and drugs interferes in the adoption of healthy behaviors. We conclude that the beliefs and values of these adolescents make them vulnerable to STD/AIDS, being necessary to reflect on the consequences of sexual violence in their lives to build strategies and preventive actions aimed at this target audience in terms of a safe development of sexuality, minimizing trauma and suffering resulting from this experience in their lives, making them aware of their sexual and reproductive rights.

Hospital-acquired conditions cause harm to patients and increase mortality. In addition to lowering the quality of patient care, hospital-acquired conditions also negatively affect financial performance, which makes them a business problem for hospital administrators. The purpose of this single case study, which was grounded in the theory of high reliability, was to explore strategies used to reduce the number of hospital-acquired conditions. The sample consisted of 13 senior leaders of a large academic medical center in the southeastern United States, who shared successful strategies used to reduce hospital-acquired conditions. Data collection took place through semistructured interviews and a review of plans and reports that showed rates of hospital-acquired conditions from 2014 to 2017. Data analysis involved using Yin's 5-step process as well as coding interview text and data from documents and then grouping related words to develop themes. Themes that emerged from this study included leadership style, communication practices, and trust. A key finding was the importance of positive and trusting leadership behaviors by senior leaders planning to reduce hospital-acquired conditions. Another key finding was the confirmation that hospital administrators can and should prioritize quality and financial improvement simultaneously. The implications of this study for positive social change include the potential to reduce health care costs and save patients' lives by reducing the number of hospital-acquired conditions.

This research explores the empirical association between takeover bid premium and acquired goodwill, and tests whether the empirical association changes after the passage of approved accounting standard AASB1013: Accounting for Goodwill. AASB1013 mandates capitalization and amortization of acquired goodwill to the profit and loss account, over a maximum time period of 20 years. Using real options and contracting cost frameworks, this study argues that reducing the variety of accounting policy options available to bidder management after an acquisition results in a systematic loss in firm value. An empirical model developed by Robinson and Shane (1990) and Choi and Lee (1991) is used to measure the average effect on bid premiums of the mandatory change in accounting rule, after controlling for a range of confounding variables including mode of payment, managerial share ownership, and bidder prior share ownership. Based on a final sample consisting of 127 pre-AASB1013 bids and 134 post-AASB1013 bids, the results show that the goodwill accounting rule contained in AASB1013 significantly reduces both the mean and median level of bid premium and the strength of the association between acquired goodwill and bid premium.

Background: Ventilator-associated pneumonia is a major cause of morbidity and mortality for patients in an intensive care unit. Once present, ventilator-associated pneumonia is known to increase the duration of mechanical ventilation, time in the intensive care unit, and length of hospital stay. Patients with acquired brain injury are commonly admitted to the intensive care unit and considered to be at a high risk for the development of respiratory complications such as ventilator-associated pneumonia, which could potentially impact on the intensive care unit costs and outcomes. Respiratory physiotherapy is often provided to prevent and/or treat ventilator-associated pneumonia in patients with acquired brain injury. The theoretical rationale of the respiratory physiotherapy is to improve airway clearance and enhance ventilation which may reduce the incidence of pulmonary infections and thus ventilator-associated pneumonia, and may in turn decrease the duration of mechanical ventilation, prevent the need for tracheostomy and hence result in reduced costs and shorter hospital stay. Although respiratory physiotherapy may be beneficial in reversing or preventing ventilator-associated pneumonia, to date there are no data concerning the effectiveness of respiratory physiotherapy in patients with acquired brain injury. Hence from an evidence-based perspective, at present there is no justification for the role of respiratory physiotherapy in the management of patients with acquired brain injury in the intensive care unit. Aim: This two-part, prospective randomised controlled trial aimed to investigate the effect of regular prophylactic respiratory physiotherapy on the incidence of ventilator-associated pneumonia, duration of mechanical ventilation, and length of intensive care unit stay in adults with acquired brain injury, as compared to a control group (Part A). / The second part of the study (Part B) randomised those subjects from Part A who developed a ventilatorassociated pneumonia into a treatment or control group to establish if the provision of a regimen of regular respiratory physiotherapy influenced the outcome of ventilator-associated pneumonia. Additionally, this study also aimed to provide the first description of the financial costs of respiratory physiotherapy time in providing interventions to patients with acquired brain injury in the intensive care unit and investigated the cost effectiveness of respiratory physiotherapy interventions in decreasing the incidence of ventilator-associated pneumonia, duration of mechanical ventilation and length of intensive care unit stay. Subjects: 144 adult patients with acquired brain injury admitted with a Glasgow Coma Scale of nine or less, requiring intracranial pressure monitoring, and invasive ventilatory support for greater than 24 hours, were randomised to a treatment group or a control group. Methods: For subjects randomised to the treatment groups, the regimen of respiratory physiotherapy treatment was repeated six times per 24-hour period and continued until the subject was weaned from mechanical ventilatory support. Each respiratory physiotherapy intervention of 30 minute duration comprised a regimen of positioning, manual hyperinflation and suctioning. In both Parts A and B, the control group received standard nursing and medical care but no respiratory physiotherapy interventions. Results: Consent was obtained for 144 subjects, with 72 randomised for treatment in Part A. Part A groups were comparable with respect to demographic variables, with the exception of body mass index and gender distribution. / Using intention to treat philosophy, there were no significant differences for incidence of ventilator-associated pneumonia [Treatment Group 14/72 (19.4%) vs. Control 19/72 (26.4%); p = 0.32], duration of mechanical ventilation (hr) [172.8 vs. 206.3); p = 0.18], or length of intensive care unit stay (hr) [224.2 vs. 256.4; p = 0.22]. For subjects with acquired brain injury receiving this prophylactic regimen of respiratory physiotherapy in the intensive care unit, in an attempt to prevent ventilator-associated pneumonia, the cost of physiotherapy was $487 per subject. Comparatively the intensive care unit mechanical ventilation bed day cost was $33,380 per subject. The cost of Part A respiratory physiotherapy time for Treatment Group 1 was 1.7 per cent of the cost of subject's intensive care unit mechanical ventilation bed days. Thirty-three subjects (22.9%) from Part A developed ventilator-associated pneumonia, and were transferred to Part B and re-randomised, 17 to the Treatment Group 3. Part B groups were comparable with respect to demographic variables. No significant differences were detected in the dependent variables for Part B of the study, with similar duration of mechanical ventilation (hr) [342.0 vs. 351.0); p = 0. 89], and length of ICU stay (hr) [384.7 vs. 397.9; p = 0.84] noted. In those subjects with acquired brain injury in whom ventilator-associated pneumonia developed, the regimen of respiratory physiotherapy for the remaining duration of mechanical ventilation following diagnosis of ventilator-associated pneumonia costed an average of $788. Comparatively the intensive care unit bed day cost for the period of mechanical ventilation was $43,865. The cost of Part B respiratory physiotherapy time for Treatment Group 3 was 1.8 per cent of the cost of their intensive care unit mechanical ventilation bed days. / Subjects with a ventilator-associated pneumonia were significantly younger, were admitted with a lower Glasgow coma scale, and more likely to have been admitted with a chest injury than subjects without a ventilator-associated pneumonia. Duration of mechanical ventilation and length of intensive care unit stay were significantly increased in subjects with ventilatorassociated pneumonia, but length of hospital stay was not significantly different. Significant differences in the costs of respiratory physiotherapy and intensive care unit mechanical ventilation bed day costs were evident between those subjects with ventilator-associated pneumonia as compared to those without ventilator-associated pneumonia. For subjects with ventilator-associated pneumonia, the respiratory physiotherapy time cost was $1,029 per subject, compared to $510 for subjects without ventilator-associated pneumonia. The intensive care unit mechanical ventilation bed day cost for subjects with ventilator-associated pneumonia was $61,092 per subject, and $25,142 for those without a ventilator-associated pneumonia, giving an incremental health cost of $35,950 per episode of ventilatorassociated pneumonia. No significant differences were evident in the cost of respiratory physiotherapy as a per cent of the cost of their intensive care unit mechanical ventilation bed days, with findings of 1.4 per cent in those with ventilator-associated pneumonia and 1.1 per cent in those without ventilator-associated pneumonia. / Conclusion: Use of a regular prophylactic respiratory physiotherapy regimen comprising of positioning, manual hyperinflation and suctioning, in addition to routine medical and nursing care, did not appear to prevent ventilator-associated pneumonia, reduce length of ventilation or intensive care unit stay in adults with acquired brain injury. Furthermore, in those acquired brain injury subjects with ventilator-associated pneumonia, regular respiratory physiotherapy did not appear to expedite recovery in terms of reducing length of ventilation or intensive care unit stay. It can be concluded from the findings of this study that the presence of ventilator-associated pneumonia has a significant influence on morbidity and costs in subjects with acquired brain injury. Whilst statistically significant results were not found with clinical variables, it is suggested that the provision of a prophylactic respiratory physiotherapy regimen costing $487 per subject is a worthwhile investment in attempts to avoid the incremental health cost of $35,950 per episode of ventilator-associated pneumonia. In subjects with ventilator-associated pneumonia it is concluded that the cost of respiratory physiotherapy would not appear to be justified in attempts to reduce the duration of mechanical ventilation.

hesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2007.

Hospital-acquired Legionnaires¡¦ Disease (LD) is a bacterial pneumonia caused by the genus of Legionella. It is an opportunistic pathogen with the characteristic of widespread distribution in the environment. Its source of infection associates with potable water systems. Proactively culturing hospital water supply for Legionella as a strategy for prevention of nosocomial LD has been widely adopted in other countries. Nosocomial LDs has been hardly reported in Taiwan. In addition, environmental cultures of Legionella in potable water systems in hospitals have not been systematically implemented. Thus, the purpose of the research is to confirm if LD presents in the hospital in Taiwan, and developing risk management strategy in hospital-acquired LD. To practice one-year prospective surveillance program for LD, we choose a military hospital in Southern Taiwan, collecting the specimens from the nosocomial and community-acquired pneumonia patients for legionella investigations. In the meanwhile, we collect water samples for hospital epidemiological investigation every 3 months. Isolated Legionella pneumophila is serotyped and analyzed by pulsed-field gel electrophoresis. From Nov 1, 2006 to Oct 30, 2007, within 54 cases of nosocomial and 300 cases of community-acquired pneumonia, only one case of nosocomial LD was found. Environmental investigations detected L. pneumophila in 17(20.7%) of the 84 water samples, of which 82.4% (14/17) belonged to serogroup 1. The result demonstrated the infection source of the only positive case of nosocominal pneumonia is the potable water supply system of another hospital. In conclusion: 1. The infection source of nosocomial LD is the potable water supply system of the hospital. 2. The positive rate of distal outlets for L. pneumophila is a reasonable and reliable indicator in risk management for nosocomial LD. 3. Uncovered cases of nosocomial LD will be found in prospective clinical surveillance for LD. Suggestions: 1. Routine water-quality monitoring should be added in environmental water culture for L. pneumophila in the institution, such as hospital, nursing home, hotel, restaurant, SPA, swimming pool, hot spring, school, army, etc. 2. We advise that government health department carries out national surveillance for hospital water environment in determining the risk of hospital-acquired LD. 3. Education and training program need to be provided for medical staffs in the diagnostic skills of nosocomial LD to avoid misdiagnosing and delaying the treatment.

Objective: The aim of this study was to examine the impact of social identity, coping style and cognitive impairment, on quality of life and well-being in a group of people with head injury compared to patients with chronic pain. Design: A correlational design using sixty participants recruited from Devon was employed: thirty adults with acquired brain injuries (ABI) were recruited from a charity and thirty adults with chronic pain difficulties from a NHS pain management service. Results: Analysis showed that there was little difference between the two groups on the variables measured. The role of social identity was not associated with better psychosocial outcome or coping style. Maladaptive coping strategies were associated with poorer adjustment in the ABI group and support-seeking strategies were correlated with improved outcomes in the chronic pain group. Objective neuropsychological variables were not associated with coping style, however, a relationship was observed between maladaptive coping styles and self-reported executive functioning. Conclusions: The results add to the literature on social identity, coping and quality of life post-ABI including improved understanding of how cognitive impairment might influence the use of particular coping strategies. The findings are discussed in relation to improved interventions to increase the use of more adaptive coping strategies.