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BACKGROUND: Millions of people have fled from their countries, due to war or conflict, in order to find a safer environment for themselves and their children. One common destination is Europe, which people can reach only through the sea from the Turkish coast to the Greek coast after walking hundreds of kilometers through the mountains. This long journey has a significant impact on refugee children’s health and that is primarily observed in the Greek islands were they can seek for emergency health care. The aim of this study is to investigate the reasons that the refugee children seek for emergency help in the hospital of Lesbos, Greece.   METHODS: Primary data collection from the medical records of the Pediatric department of the hospital of Lesbos. Statistical analysis of the data with R commander 3.2.1.The results will be presented in diagrams and tables, showing the most common symptoms/clinical findings, diagnoses, origin, gender, hospitalization or not of the refugee children and the relation of the symptoms and diagnoses in accordance with the seasonality, age, gender and origin calculated with Chi² and Chi² Fischer test.   RESULTS: Respiratory tract infections and gastro-intestinal tract infections are the first two most common diagnoses by far. Almost half of the refugee children that were submitted in the Hospital of Lesbos needed hospitalization and further treatment. More than half of the refugee children that sought after emergency help in the hospital of Lesbos were Syrians and boys. Mental health was also a big issue.   CONCLUSION: The journey that the refugee children are undertaking in order to reach the Greek islands and the prolonged living in refugee camps and detention centers is affecting their mental and physical health, with respiratory tract infections and gastro-intestinal tract infections being the major diagnoses.

The primary purpose of the study was to develop an expert system that could C D perform medical diagnoses In selected problem areas, and C2) provide diagnostic Insights to assist medical students In their training. An expert system Is a computer-based set of procedures and algorithms that can solve problems In a given domain. Two research questions were proposed. The first was "Given a problem space defined by a matrix of diseases and symptoms, can a computer-based model be derived that will consistently perform accurate and efficient diagnoses of cases within that problem area?" The second question was "If the techniques derived from the model are taught to a medical student, is there a subsequent improvement of diagnostic skill?" An expert system was developed which met the objectives of the study. It was able to diagnose cases in the two problem areas studied with an accuracy of 94-95%. Furthermore, it was able to perform those diagnoses in a very efficient manner, often using no more than the theoretical minimum number of steps. The expert system employed three phases: rapid search by discrimination, confirmation by pattern matching against prototypes, and elimination of some candidates (impossible states) by making use of negative information. The discrimination phase alone achieved accuracies of 73-78%. By comparison, medical students achieved mean accuracies of 54-55% in the same problem areas. This suggests that novices could improve their diagnostic accuracy by approximately 20% by following the simple rules used in the first phase of the expert system. Curricular implications are discussed. When 49 first-year medical students at the Texas College of Osteopathic Medicine were exposed to some of the insights of the expert system by means of a videotaped 10- minute lecture, their diagnostic approach was modified and the accuracy of their diagnoses did improve. However, the degree of Improvement was not statistically significant. Recommendations for further research are made.

A acurácia de uma variável consiste na capacidade de a mesma representar realmente o que ela deveria representar. A definição conceitual de acurácia diagnóstica é baseada no pressuposto de que há uma ampla variedade de diagnósticos possíveis nas situações clínicas além dos diagnósticos que são altamente acurados. O objetivo desta pesquisa foi desenvolver um instrumento para estimar a acurácia de diagnósticos de enfermagem a partir de dados escritos da avaliação de paciente. Tratou-se de estudo quantitativo de desenvolvimento metodológico, realizado em 3 fases: teórica, empírica e analítica. Na fase teórica elaborou-se a definição de acurácia do diagnóstico de enfermagem e os itens do instrumento, submetendo-os a validação de conteúdo e teste piloto; na fase empírica, o instrumento definido na etapa anterior foi aplicado por enfermeiros especialistas em diagnóstico de enfermagem com a finalidade de estimar a validade e a confiabilidade do instrumento na fase analítica. O instrumento elaborado foi denominado de Escala de Acurácia de Diagnóstico de Enfermagem – EADE, e foi estruturado com base no conceito de que a acurácia de um diagnóstico de enfermagem é o julgamento de um avaliador quanto ao grau de relevância, especificidade e coerência das pistas existentes para o diagnóstico. O instrumento ficou composto por 4 itens: Presença de pistas (manifestações dos pacientes que representam indícios, vestígios, sinais, indicações ou características de um diagnóstico de enfermagem - item graduado em “sim"ou “não"); Relevância da pista (propriedade de uma pista de ser importante como indicador de um diagnóstico de enfermagem - item graduado em “alta/moderada" ou “baixa"); Especificidade da pista (propriedade de uma pista de ser própria e distintiva de um diagnóstico de enfermagem - item graduado em “alta/moderada" ou “baixa/nula"); Coerência da pista (propriedade de uma pista de ser consistente com o conjunto das informações disponíveis - item graduado em “alta/moderada" ou “baixa/nula"). Como indicativo de validade da EADE, os dados estatísticos mostram que os 4 itens do instrumento foram importantes para predizer diagnósticos de enfermagem acurados: Pista (OR 1,95 /IC 95% [1,78 ? 2,14], p = 0,000); Relevância (OR 1,73 /IC 95% [1,52 ? 1,98], p = 0,000); Especificidade (OR 2,41 IC 95% [2,11 ? 2,76], p = 0,000); Coerência (OR 3,92 /IC 95% [3,40 ? 4,53], p =0,000). A EADE obteve coeficiente de confiabilidade de Kuder-Richardson de 0,92 e de Hoyt de 0,92, indicando alta confiabilidade. A EADE mostrou boa sensibilidade e especificidade: área sob a curva ROC = 0,79, p = 0,000 e IC 95% [0,78?0,79]. O estudo atual permitiu desenvolver um instrumento para avaliar a acurácia de diagnósticos de enfermagem a partir de dados escritos. A EADE será refinada em estudos futuros / The accuracy of a variable consists of its capacity to actually represent what it was meant to represent. The conceptual definition of diagnosis accuracy is based on the presupposition that there is a wide variety of possible diagnosis in clinical situations, besides those diagnoses that are highly accurate. This research has set out to develop an instrument to estimate the accuracy of nursing diagnoses from the written data of patient evaluation. A quantitative study of methodological development was carried out, in 3 phases: a theoretical, an empirical and an analytical one. In the theoretical phase, the definition of accuracy of nursing diagnosis and the items of the instrument were shaped and subjected to content validation and pilot testing; in the empirical phase, the instrument defined previously was applied by nurses who are specialists in nursing diagnosis, aiming at estimating the validity and reliability of the instrument in the analytical phase. The instrument was named Escala de Acurácia de Diagnóstico de Enfermagem - EADE, and was structured according to the concept that the accuracy of a nursing diagnosis is the judgment of a rater in relation to the degree of relevance, specificity and coherence of the existing cues for the diagnosis. The instrument was made of 4 items: Presence of cues (manifestations of those patients who represent evidences, vestiges, signals, indications or characteristics of a nursing diagnosis - item graded as “yes" or “no"); Relevance of the cue (the property of a cue being important as an indicator of a nursing diagnosis - item graded as “high/moderate" or “low"); Specificity of the cue (the property of a cue being proper and distinctive of a nursing diagnosis - item graded as “high/moderate" or “low/nil"); Coherence of the cue (the property of a clue being consistent with the amount of information available - item graded as “high/moderate" or “low/nil"). As an indicator of the validity of the EADE, the statistic data showed that the 4 items of the instrument were important to predict accurate nursing diagnoses: Cue (OR 1,95 /IC 95% [1,78 ? 2,14], p = 0,000) Relevance (OR 1,73 /IC 95% [1,52 ? 1,98], p = 0,000); Specificity (OR 2,41 IC 95% [2,11 ? 2,76], p = 0,000); Coherence (OR 3,92 /IC 95% [3,40 ? 4,53], p = 0,000). The EADE had the Kuder-Richardson coefficient of reliability of 0.92 and the Hoyt coefficient of 0,92, which indicates high reliability. The EADE showed good sensitivity and specificity: area under curve ROC = 0,79, p = 0.000 and IC 95% [0,78 ? 0,79]. This study has led to the development of an instrument to assess the accuracy of nursing diagnoses from written data. The EADE shall be refined in future studies

Os fitoplasmas são procariotos sem parede celular pertencentes à classe Mollicutes. Um grande número de doenças de plantas cultivadas estão associadas aos fitoplasmas, incluindo tanto aquelas que afetam grandes culturas como aquelas ocorrentes em diversas espécies de ornamentais. Em cana-de-açúcar, uma doença conhecida como síndrome do amarelecimento foliar ou amarelinho causou danos expressivos à cultura e provocou a substituição de uma cultivar muito produtiva e extensivamente plantada no estado de São Paulo. A doença também foi registrada em outros países e investigações sobre a etiologia evidenciaram a ocorrência de vírus e fitoplasma como agentes. Em primavera (Bougainvillea spectabilis), uma espécie de origem brasileira bastante apreciada como ornamental, foram observados sintomas de clorose foliar, superbrotamento de ramos, deformações foliares e florais e declínio, sintomas característicos de infecção causada por fitoplasmas. O presente trabalho teve como finalidade investigar a etiologia desta nova doença encontrada em primavera, denominada de superbrotamento, e identificar molecularmente o fitoplasma envolvido com a síndrome do amarelecimento foliar da cana-de-açúcar. Para isso, amostras de plantas sintomática e assintomáticas de cana-de-açúcar e primavera foram submetidas à extração do DNA total. A partir deste DNA, a detecção molecular foi conduzida com PCR duplo usando-se os iniciadores P1/Tint na primeira reação e R16 F2n/R2 na segunda reação. Posteriormente à detecção, foi realizada a identificação através de PCR duplo com iniciadores específicos e análises de RFLP com as enzimas de restrição AluI, RsaI, KpnI, MseI, HhaI, HpaII, e MboI. Análises filogenéticas foram baseadas nas sequências nucleotídicas do 16S rDNA dos fitoplasmas detectados na cana e na primavera, bem como nas sequências de outros fitoplasmas disponíveis em banco de dados. O teste de transmissão usou plantas infectadas de primavera e plantas sadias de vinca, interligados por filamentos de cuscuta. Os resultados mostraram que fragmentos genômicos de aproximadamente 1.2kb foram amplificados em 33% e 60% das amostras de DNA extraído de plantas sintomáticas de cana-de-açúcar e de primavera, respectivamente. O uso de iniciadores específicos demonstrou a presença de fitoplasmas dos grupos 16SrI e 16SrIII associados ao superbrotamento da primavera e de um fitoplasma do grupo 16SrI associado à síndrome do amarelecimento foliar. Análises de RFLP, confirmaram a ocorrência de fitoplasmas membros dos grupos 16SrI e 16SrIII em plantas de primavera, e revelaram que estes fitoplasmas poderiam ser classificados nos subgrupos 16SrI-B e 16SrIII-B. A identificação evidenciou que o fitoplasma encontrado em cana-de-açúcar é um representante do grupo 16SrI, sub-grupo B. Análises filogenéticas e de mapas de sítios putativos de restrição, confirmaram os resultados obtidos com os testes de PCR e com as análises de RFLP para os fitoplasmas relacionados às duas doenças estudadas. A transmissão dos fitoplasmas presentes em primavera para plantas de vinca através da cuscuta demonstrou, biologicamente, que ambos são agentes causais do superbrotamento. Em quase todas as amostras de cana-de-açúcar positivas para fitoplasma também foi detectada a presença de um luteovírus, através do uso de RT-PCR, demonstrando que o amarelecimento foliar da cana-de-açúcar no estado de São Paulo está associado a um complexo formado por fitoplasma e vírus. No caso da primavera, este trabalho se constituiu no primeiro relato da ocorrência de fitoplasmas como agente de doença nessa espécie. / Phytoplasmas are wall-less prokaryote belonging to class Mollicutes. Several hundred plant species, including food crops and ornamental species have been reported as hosts of phytoplasmas, which are associated with important diseases. In sugarcane, a disease known as yellow leaf syndrome caused serious damage and led to replacement of a cultivar with high yield and widely distributed in the São Paulo State. The syndrome has also been described in other countries and studies about etiology evidenced the occurrence of virus and phytoplasmas as causal agents. In bougainvillea (Bougainvillea spectabilis), a native specie from Brazilian territory, were observed typical symptoms of phytoplasmas, characterized by leaf chorosis, proliferation of branches, deformation of leaves and flowers, decline, and death. The aim of this study was to investigate the etiology of the disease observed in bougainvillea and to identify molecularly the phytoplasma associated with sugarcane yellow leaf. Thus, DNA was extracted from samples collected of naturally symptomatic plants of sugarcane and bougainvillea. Nested PCR primed by P1/Tint-R16F2n/R2 was used for detection, while specific primers were used for identification. RFLP with restriction enzymes AluI, RsaI, KpnI, MseI, HhaI, HpaII, MboI and phylogenetic analysis based on nucleotide sequences of 16S rDNA were also used to identify the phytoplasmas detected in sugarcane and boungainvillea. Transmission of phytoplasmas from bougainvillea to periwinkle by dodder was conducted to demonstrate the pathogenecity of this agents. Results showed that genomic fragments of 1.2kb were amplified, evidencing the presence of phytoplasmas in 33% and 60% of symptomatic sugarcane and bougainvillea plants, respectively. PCR with specific primer pairs demonstrated that phytoplasmas affiliated to groups 16SrI and 16SrIII were associated with bougainvillea proliferation, while a phytoplasma belonging to group 16SrI was present in sugarcane plants exhibiting symptoms of yellow leaf. RFLP and phylogenetic analysis revealed that phytoplasmas found in bougainvillea could be classified within subgroups 16SrI-B and 16SrIII-B, and that phytoplasma detected in sugarcane is a representative of subgroup 16SrI-B. Almost the totality of symptomatic sugarcane plants showed the presence of virus, by using RT-PCR, indicating that a coinfection of virus and phytoplasma could be responsible by inducing the disease. Positive results for transmission revealed that both phytoplasmas found in boungainvillea are causal agents of the disease. This is the first report of phytoplasma as agent of disease in that species.

Orientador: Magda Cristina Queiroz Dell'Acqua / Resumo: Introdução: A lesão renal aguda (LRA) é caracterizada pela perda abrupta da função renal, com redução da taxa de filtração glomerular, acúmulo de produtos nitrogenados e presença de distúrbios hidroeletrolíticos e ácido-básico. Quando há alteração da função renal a equipe de enfermagem é requerida de forma intensa. Contribui sobremaneira com a segurança e a qualidade da assistência o uso de ferramenta metodológica, o Processo de Enfermagem (PE). A utilização de linguagem padronizada corrobora para a operacionalização do PE, como a taxonomia da Nanda Internacional (NANDA-I), Classificação dos Resultados de Enfermagem (NOC) e Classificação das Intervenções de Enfermagem (NIC). Objetivo geral: Identificar o perfil clínico e sociodemográfico dos pacientes com lesão renal aguda em terapia dialítica em unidade de terapia intensiva, a prevalência e o perfil dos diagnósticos, resultados e intervenções de enfermagem, com a utilização da NANDA-I, NOC e NIC. Método: Estudo transversal com pacientes com LRA em tratamento dialítico em UTI. O local do estudo foram as UTIs do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IC- HCFMUSP). Amostra de 98 pacientes e a coleta de dados foram de março a julho de 2016, por meio de consulta de enfermagem, composta por anamnese, exame físico e dados do prontuário. Houve a aprovação pelo comitê de ética conforme o parecer n° 1.440.974. Foi utilizado software SPSS v21.0 para estimação da prevalência, co... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Prior to the 1990s, bipolar disorder, a behavioral disorder characterized by severe mood fluctuations, was not considered an suitable diagnosis for children. However, in recent decades, an increase in pediatric bipolar disorder (PBD) diagnosis has occurred in the U.S. The purpose of this study was to explore the perceptions and lived experiences of licensed mental health clinicians regarding their decision-making processes used during assessment and diagnosis of PBD. This phenomenographic study utilized individual, semi-structured interviews to explore the perceptions and lived experiences of 14 licensed clinicians in the Commonwealth of Massachusetts who assess and diagnose PBD. Data were collected with a 7-question face to face interview. Using NVivo 10 software several key phrases and words were identified, coded, and used to locate patterns, themes, and concepts. Data analysis revealed that significant issues related to PBD assessment and diagnosis may exist, including: inconsistencies in assessment/diagnostic processes; reticence to diagnose the disorder; failure to use available assessment instruments; a lack of attention to comorbidities; and trouble differentiating between PBD symptoms and other issues, such as trauma or dysfunctional family dynamics. Given the reluctance of these mental health professionals to diagnose PBD, implications for social change underscore the important role of education, training, and ongoing clinical supervision to help other mental health professionals accurately assess and diagnose PBD. Recommendations emanating from study findings suggest further research on PBD assessment and diagnosis to help professionals develop more effective diagnostic frameworks for clinical training and practice.

Ämnet neuropsykiatriska funktionsnedsättningar valdes eftersom det är aktuellt inom skolans värld. Tidigare forskning har visat att lärares kompetens inom området ofta brister och att den svenska skolan inte alltid lyckas i att vara en skola för alla. Syftet med arbetet var att undersöka nio lärares erfarenhet gällande inkludering av elever med neuropsykiatriska diagnoser. Frågeställningarna var: Vilken kompetens har lärarna för att kunna inkludera diagnosticerade elever i sin undervisning och på vilka sätt har de erhållit den? Vilka möjligheter och hinder upplever lärarna att det finns i arbetet med inkludering av diagnosticerade elever? På vilka sätt anpassar lärarna sin undervisning för att elever med neuropsykiatrisk diagnos ska uppnå kursmålen? Kvalitativa intervjuer av nio informanter har utgjort metoden. Huvudresultatet har visat att lärare ansett sig sakna kunskap om NPF när de börjat jobba, de har erhållit kompetensen de besitter idag genom arbetet med elever som har en neuropsykiatrisk diagnos. En möjlighet lärarna upplever med att dessa elever inkluderas är att skolan blir en representant för hur samhället ser ut. Hinder kan vara ramfaktorer, främst tidsbrist. Anpassning av undervisning kan ske genom strukturerade lektioner med korta instruktioner, förlängd provtid och anpassade uppgifter. Undervisningen för elever med neuropsykiatriska funktionsnedsättningar skulle kunna förbättras genom att lärare får en större kunskap inom området och att de ges fler resurser, främst i form av tid och mindre klasser. / The topic of neuropsychiatric diagnoses was chosen because it is very current within the school today. Former research has shown that the competence of teachers very often tends to fail and the Swedish school does not succeed in being a school for everybody. The purpose of this thesis was to investigate nine teachers’ experience of inclusion of students with neuropsychiatric diagnoses. The problems were: What capability do the teachers have to include students with a diagnosis in their education and in what ways have they received it? What possibilities and what obstacles do the teachers believe there are with inclusion of students with diagnoses? In which ways do the teachers adjust their education in order to make the students with neuropsychiatric diagnoses achieve the goals of the curriculum? Qualitative interviews with nine informants have constituted the method. The main result has shown that the teachers have found themselves without knowledge within the neuropsychiatric area when they began their career, they have received the competence they possess today by working with students with neuropsychiatric diagnoses. Pros with inclusion of these students is that the school should be a representative of society as it really is, obstacles with inclusion may be lack of time and too large classes. Adjustment of the education might be done by structured classes with short instructions, extended time when writing tests and adjusted tasks. The conclusion is that teachers don’t get any education within this topic; instead they have to learn by themselves by trial and error. The education for students with neuropsychiatric diagnoses could improve by educating teachers and giving them better resources like time and smaller classes.

Att sjuksköterskor ställer giltiga omvårdnadsdiagnoser är betydelsefullt för att patienter ska få den omvårdnad som de behöver. Trots att denna förmåga är något som sjuksköterskeutbildningen är ålagd att utrusta blivande sjuksköterskor med är omvårdnadsdiagnostisk förmåga inte utrett hos sjuksköterskestudenter. Inget verktyg för att mäta denna förmåga finns tillgänglig i Sverige idag. Syftet med denna metodologiska studie var att utveckla ett verktyg som avsåg mäta omvårdnadsdiagnostisk förmåga. Genom kognitiva intervjuer, i dialog med experter samt genom att studenter och sjuksköterskor testade att genomföra en omvårdnadsdiagnostisk uppgift utifrån två patientfall utvecklades verktyget stegvis. Verktyget validerades mot omvårdnadslitteratur och mätinstrument samt mot en expertgrupp. Förutom den omvårdnadsdiagnostiska uppgiften utgjordes verktyget även av ett poängsättningsformulär, manual samt en rättningsmall. Studien frambringade ett verktyg som var känsligt för kunskapsvariationer och föreföll ha utrymme för förbättrade resultat. Poängsättningsformuläret med tillhörande manual och rättningsmall visade en hög reliabilitet. Det framtagna verktyget mäter förmågan att urskilja relevanta kännetecken, göra en analys av kännetecken och etiologi samt att rubricera diagnosen; d.v.s. analytisk förmåga, logiskt resonemang och till viss del yrkeskunnande i omvårdnad. Omvårdnadsdiagnostisk förmåga utgörs av fler delförmågor och alla dessa går inte att mäta med det framtagna verktyget. / The fact that nurses identify valid nursing diagnoses is important in order for patients to recieve the nursing care they need. Even though it is imposed on the nurse education to equip the future nurses with this ability, diagnostic competency in nursing isn’t tested among nurse students. There is in Sweden today no tool available for measuring diagnostic competency. The aim of this methodological study was to develop a tool that indended to measure diagnostic competency in nursing. The tool was developed gradually through cognitive interviews, in dialogue with experts and by having students and nurses complete a test in nursing diagnostics based on two case studies. The tool was validated in relation to nursing literature and measuring instruments along with an expert group. In addition to the test in diagnostic competency, the tool was also constituted of a point form, a manual for awarding points and a correcting model. The study created a tool that was sensitive for variations in knowledge within the test group and that seemed to have room for improved results. The point form, the manual for awarding points and the correcting model showed a high reliability. The abilities that the tool measure is the capability to distinguish relevant characteristics, make an analysis of the characteristics and the etiology together with labeling the diagnosis; i.e. analytic ability, logical reasoning and to some extent professional skills in nursing. Diagnostic competency embodies several different abilities and all of these can’t be measured by the developed tool.

I denna vetenskapliga essä har jag låtit mina tankar kring livsberättelser, möta författare,filosofer, psykologer och litteraturvetares, tankar om berättelsens makt i individens liv ochskapandet av identitet. Vilka berättelser väljer jag att berätta för andra och hur påverkar deberättelserna synen på mig själv? I denna essä, finns ett smakprov på hur jag i arbetet medindivider, använder mig av traditionella berättelser, som sagor, myter och legender, för attskapa en begriplig ram i en annars oordnad tillvaro. Jag uppmärksammar det faktum att flerasöker lösningar utanför sig själv, på det som tidigare sågs som ett ifrågasättande av livet. Jaghar tagit hjälp av forskning som har studerat förutsättningarna för mitt yrke och sett på mitteget lyssnade i samtal med hjälpsökande i en verksamhet där jag är starkt påverkad avmålstyrning. Hur påverkas mitt förhållningssätt till individen av de inre och yttre faktorerna imitt yrke som coach? Genom att bland annat utgå ifrån ett samtal med en ung kvinna har jagundersökt mitt förhållningssätt till det hon berättar för mig. / In this scientific essay I have let my thoughts on life stories, meet writers, philosophers, psychologists and literary scholars, on the story of power in the life of the individual and thecreation of identity. What stories do I tell others, and how do they affect the stories view ofmyself? In this essay, I give an example of my work with individuals, using traditional stories, as fairy tales, myths and legends, to create a meaningful framework in an otherwise disordered existence. I pay attention to the fact that many are seeking solutions outside themselves, on what previously was seen as a questioning of life. With the assistance of research which have studied the conditions of my own profession and seen from my ownlistening of conversations with individuals seeking aid in situations where I am strongly influenced by performance management. How is my approach to the subject of the internal and external factors in my profession as a coach? By including assumed a conversation with a young woman, I have examined my attitude to what she tells me.