Orientador: José Ricardo de Arruda Miranda / Banca: Madileine Francely Américo / Banca: Débora Cristina Damasceno / Resumo: Trata-se de um estudo qualitativo que teve como objetivo compreender o desenvolvimento de habilidades comunicativas no aluno de graduação em Enfermagem e a atuação do professor neste processo de ensino aprendizagem considerando diferentes tipos de organização curricular. O referencial teórico utilizado foi pautado nos estudos de Braga e Silva para a compreensão da competência em comunicação no aprendizado e ensino da Enfermagem, e a Análise de Conteúdo, segundo Bardin, como referencial metodológico. O estudo foi realizado em duas instituições públicas de ensino superior, situadas no interior do estado de São Paulo, que empregam metodologias de ensino diferenciadas; o Curso de Graduação em Enfermagem da Faculdade de Medicina de Botucatu, UNESP, localizado no município de Botucatu e o Curso de Graduação em Enfermagem da Faculdade de Medicina de Marília, FAMEMA, localizado no município de Marília. A coleta de dados foi realizada a partir da perspectiva dos docentes e discentes do 2º e 4ª anos de Enfermagem, com o apoio de questões norteadoras por meio de entrevistas gravadas e formulários de auto-preenchimento, respectivamente. As questões éticas foram consideradas de acordo com a resolução 466/12 do Conselho Nacional de Saúde (CNS) e da Comissão Nacional de ética em Pesquisa (CONEP), obtendo parecer favorável da Faculdade de Medicina de Botucatu, UNESP, com número CAAE: 18459013.0.3001.5413 e parecer nº 417.358. Em seguida, o projeto de pesquisa foi submetido ao parecer do CEP da Faculdade de Medicina de Marília, FAMEMA, obtendo aprovação com parecer nº 432.360. Nos resultados do estudo emergiram, na perspectiva dos docentes, as seguintes categorias temáticas sobre os fatores que influenciam no desenvolvimento de habilidades comunicativas nos graduandos de Enfermagem: a prática promove a aquisição de habilidades comunicativas; as características individuais dos estudantes; a utilização de... / Abstract: This is a qualitative study aiming at understanding the development of communication skills in undergraduate Nursing students and their teachers' action in such teaching-learning process by considering different types of curricular organizations. The theoretical framework used was based on the studies by Braga and Silva in order to understand communication competence in Nursing teaching and learning. Content analysis according to Bardin was used as a methodological framework. The study was performed in two public institutions of higher education located in inner São Paulo state which employ differentiated teaching methodologies: the Undergraduate Nursing Program of Botucatu Medical School, UNESP, located in the city of Botucatu, and the Undergraduate Nursing Program Marília Medical School, FAMEMA, located in the city of Marília. Data were collected from the perspective of professors and students of the 2nd and 4th years of the Nursing Program, based on guiding questions by means of taped interviews and selfadministered questionnaires, respectively. Ethical issues were considered according to Resolution 466/12 by the National Health Care Council (Conselho Nacional de Saúde - CNS) and the National Research Ethics Committee (Comissão Nacional de Ética em Pesquisa - CONEP), thus obtaining approval by the Botucatu Medical School, UNESP, according to CAAE number: 18459013.0.3001.5413 and Process Number 417.358. Next the research project was submitted to evaluation by the Research Ethics Committee of Marília Medical School, FAMEMA, and approved according to Process Number 432.360. The following thematic categories concerning the factors that influence the development of communication skills in undergraduate Nursing students emerged in the results of the study, according to the professors' perspective: the practice promotes the development of communication skills; the students' individual characteristics; the use of active ... / Mestre

Imatinib mesylate has been associated with the changes in bone turnover. We report a case of the development of tissue calcification in a patient on long-term therapy with this drug. A 48-year-old male patient with gastrointestinal stromal tumor and liver metastasis complained of abdominal pain. His treatment included hepatic artery chemoembolization and partial hepatectomy in addition to chronic imatinib mesylate for 4 years. On physical examination, he had a peritoneal mass just beneath the laparotomy incision scar that, after resection, was found to be dystrophic bone formation. Based on the previous studies suggesting bone changes due to chronic therapy with imatinib mesylate, we believe that the patient's new bone formation was causally related to the use of this drug. To our knowledge, there are no similar reported cases in the literature.

The Pacific Northwest is known for its once-abundant wild salmonid populations that have been in decline for more than 50 years due to habitat destruction and commercial overexploitation. To compensate, federal and state agencies annually release hundreds of thousands of hatchery-reared fish into the wild. However, accumulating data indicate that hatchery fish have lower fitness in natural environments, and that hatchery rearing negatively influences return rates of anadromous salmonids. Recently, mounting evidence revealed that the richness and diversity of intestinal microbial species influence host health. We examined the gut microbiota of pre-migratory hatchery-reared steelhead (Oncorhynchus mykiss) to assess microbial community diversity. The Cascade Mountains serve as an allopatric border between two distinct clades of steelhead that show significant differences in genomic and mitochondrial diversity. We identified differences in core microbiota of hatchery-reared fish that correlate with this divergent phylogeographic distribution. Steelhead sampled from hatcheries east of the Cascades had overall greater core gut microbiota diversity. These differences were found despite similarities in diet and rearing conditions. In addition to taxonomic variation across the geographic divide, we identified significant differences in metabolic pathways using PICRUSt gene prediction software. Our analysis revealed significant enrichment of genes associated with lipid metabolism in the gut microbiome of western fish. 8 of 19 individual lipid metabolism pathways were more prominent in western populations. Lipids are a vital nutritional component for teleost species involved in migration and subsequent return for spawning in natal environments. We hypothesize that the observed differences in lipid metabolism across this phylogenetic divide results from an increased ability of eastern Cascade (O. m. gairdneri) fish to utilize lipids taken in via the diet. This increased absorption and utilization would make lipids less available for the intestinal microbiota of the eastern fish, as evidenced by the lower abundance of lipid metabolism genes in the east. Our research utilizes information from the microbiome to understand the phenotypic implications occurring in segregated populations of hatchery-reared steelhead, further confirming elements of coevolution between an organism and its internal environment.

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that causes motor, visual, and sensory symptoms. Patients also experience constipation, which is not yet understood, but could involve dysfunction of the enteric nervous system (ENS). Autoimmune targeting of the ENS occurs in other autoimmune diseases that exhibit gastrointestinal (GI) symptoms, and similar mechanisms could lead to GI dysfunction in MS. Here, we characterize GI dysmotility in the experimental autoimmune encephalomyelitis (EAE) model of MS and test whether autoantibodies targeting the ENS are present in the serum of MS patients. Male SJL or B6 mice were induced with EAE by immunization against PLP139-151, MOG35-55, or mouse spinal cord homogenate, and monitored daily for somatic motor symptoms. EAE mice developed GI symptoms consistent with those observed in MS. In vivo motility analysis demonstrated slower whole GI transit, and decreased colonic propulsive motility. EAE mice had faster rates of gastric emptying, with no changes in small intestinal motility. Consistent with these results, ex vivo evaluation of isolated colons demonstrated that EAE mice have slower colonic migrating myoelectric complexes and slow wave contractions. Immunohistochemistry of EAE colons exhibited a significant reduction in GFAP area of ENS ganglia, with no changes in HuD, S100, or neuron numbers. To test whether antibodies in MS bind to ENS structures, we collected serum samples from MS patients with constipation and without constipation, and healthy control patients without constipation. Immunoreactivity was tested using indirect immunofluorescence by applying serum samples to guinea pig ENS tissue. MS serum exhibited significantly higher immunoreactivity against guinea pig ENS than control patients, which was particularly evident in MS patients who did not experience constipation. There was no significant difference in immunoreactivity between MS patients with and without constipation. Targets of human MS and mouse EAE serum include enteric glia and neurons. Taken together, these data validate EAE as a model for constipation in MS, and support the concept that this symptom involves changes within the neuromuscular system of the colon. EAE mice develop symptoms consistent with constipation that affects functional ENS networks and may result in structural or phenotypic changes at the cellular level. Serum immunoreactivity suggests that autoantibodies could play a role in the development of constipation in MS by targeting the ENS itself.

Includes bibliographical references (leaves 159-213) Shows that IGF-I peptides are effective in diminishing post-surgical catabolism and enhancing adaptive gut hyperplasia in rats recovering from massive small bowel resection.

xxiii, 222 leaves : ill., plates ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Shows that IGF-I peptides are effective in diminishing post-surgical catabolism and enhancing adaptive gut hyperplasia in rats recovering from massive small bowel resection. / Thesis (Ph.D.)--University of Adelaide, Dept. of Animal Science, 1992

The continued existence of New Zealand’s critically endangered and endemic black stilt or kakï (Himantopus novaezelandiae) relies on an intensive captive management programme. While this is successful at rearing large numbers of birds for release to the wild, poor survivability of these birds is limiting significant increases in the wild population. Predation and starvation are suspected to be the most common causes of death in released birds, but underlying contributing factors to these mortalities have not been fully evaluated. This research investigates the possible contribution of gastrointestinal (GI) helminth burdens and suboptimal digestive organ development to the high mortality rates of released kakï. Emphasis is placed on evaluating the methods used to assess the importance of these factors and to make informed recommendations for future management. The efficacy of the anthelmintic regime used for kakï was assessed by dosing half of the 80 captive birds with praziquantel (PZQ) prior to release in 2007. Faecal samples were collected before and after anthelmintic treatment, and before and after release to the wild. Post mortem worm counts were conducted on 11 birds that died following release and historical worm count records dating back to 1997 were accessed. The main findings were: PZQ had high efficacy against trematodes; treatment did not prevent re-infection; birds were exposed to helminths at release site; and there was no advantage of treatment for survival. Overall, the results suggest that anthelmintic treatment is an unnecessary cost. Consequently, recommendations were made to cease anthelmintic treatment or reduce its intensity, continue health screening, and incorporate annual efficacy testing to monitor the emergence of anthelmintic resistance. The reliability of faecal screening for GI helminths was evaluated. Faecal egg counts (FECs) were found to be poor indicators of worm burden. The two modified sedimentation methods used to detect trematodes provided relatively low egg recovery rates. Trematode egg shedding varied between days but not by hour of the day or temperature. The collection and analysis of pooled faecal samples proved to be more cost and time-effective than samples from individual birds and the larger masses collected resulted in greater sensitivity. In conclusion, faecal analysis of pooled samples is a useful qualitative indicator of helminth presence or absence but is quantitatively unreliable. In order to assess the importance of digestive organ development to captive-reared and released kak?, the digestive organs of healthy and emaciated captive, released and wild Himantopus sp. were compared. Captive and released kak? had generally smaller digestive organs than wild birds, released birds did not increase digestive organ size to match the high fibre wild diet, and emaciated birds did not have atrophied organs. However, the greatest mortality rates occur soon after release, while the birds were still being supplementary fed. These results suggest that reduced digestive efficiency is probably not contributing significantly to mortality rates and the direct impacts of the translocation are probably greater risk factors. The continued provision of supplementary food to released birds and an increased focus on habitat enhancement and predator control at release sites were recommended. The reliability of comparing fresh and formalin fixed Himantopus sp. gut specimens was evaluated. Significant differences in fresh and formalin fixed organ dry masses and variation in preserved organ lengths indicate that this variation should be considered in future studies. In conclusion, current management practices appear to be successful in ensuring that GI helminths and reduced digestive efficiency do not significantly lower the survivorship of captive-reared and released kakï. There is a need for further research into developing a more direct physiological assessment of the impacts of GI helminths and gut morphology as well as considering the role that starvation may have on poor survivability.

The continued existence of New Zealand’s critically endangered and endemic black stilt or kakï (Himantopus novaezelandiae) relies on an intensive captive management programme. While this is successful at rearing large numbers of birds for release to the wild, poor survivability of these birds is limiting significant increases in the wild population. Predation and starvation are suspected to be the most common causes of death in released birds, but underlying contributing factors to these mortalities have not been fully evaluated. This research investigates the possible contribution of gastrointestinal (GI) helminth burdens and suboptimal digestive organ development to the high mortality rates of released kakï. Emphasis is placed on evaluating the methods used to assess the importance of these factors and to make informed recommendations for future management. The efficacy of the anthelmintic regime used for kakï was assessed by dosing half of the 80 captive birds with praziquantel (PZQ) prior to release in 2007. Faecal samples were collected before and after anthelmintic treatment, and before and after release to the wild. Post mortem worm counts were conducted on 11 birds that died following release and historical worm count records dating back to 1997 were accessed. The main findings were: PZQ had high efficacy against trematodes; treatment did not prevent re-infection; birds were exposed to helminths at release site; and there was no advantage of treatment for survival. Overall, the results suggest that anthelmintic treatment is an unnecessary cost. Consequently, recommendations were made to cease anthelmintic treatment or reduce its intensity, continue health screening, and incorporate annual efficacy testing to monitor the emergence of anthelmintic resistance. The reliability of faecal screening for GI helminths was evaluated. Faecal egg counts (FECs) were found to be poor indicators of worm burden. The two modified sedimentation methods used to detect trematodes provided relatively low egg recovery rates. Trematode egg shedding varied between days but not by hour of the day or temperature. The collection and analysis of pooled faecal samples proved to be more cost and time-effective than samples from individual birds and the larger masses collected resulted in greater sensitivity. In conclusion, faecal analysis of pooled samples is a useful qualitative indicator of helminth presence or absence but is quantitatively unreliable. In order to assess the importance of digestive organ development to captive-reared and released kak?, the digestive organs of healthy and emaciated captive, released and wild Himantopus sp. were compared. Captive and released kak? had generally smaller digestive organs than wild birds, released birds did not increase digestive organ size to match the high fibre wild diet, and emaciated birds did not have atrophied organs. However, the greatest mortality rates occur soon after release, while the birds were still being supplementary fed. These results suggest that reduced digestive efficiency is probably not contributing significantly to mortality rates and the direct impacts of the translocation are probably greater risk factors. The continued provision of supplementary food to released birds and an increased focus on habitat enhancement and predator control at release sites were recommended. The reliability of comparing fresh and formalin fixed Himantopus sp. gut specimens was evaluated. Significant differences in fresh and formalin fixed organ dry masses and variation in preserved organ lengths indicate that this variation should be considered in future studies. In conclusion, current management practices appear to be successful in ensuring that GI helminths and reduced digestive efficiency do not significantly lower the survivorship of captive-reared and released kakï. There is a need for further research into developing a more direct physiological assessment of the impacts of GI helminths and gut morphology as well as considering the role that starvation may have on poor survivability.

<p>The overall aim of this thesis is to investigate health-related quality of life (HRQoL), anxiety and depression in patients with endocrine gastrointestinal (GI) tumours. Patient as well as staff perceptions were assessed. HRQoL was studied with the EORTC QLQ-C30, and anxiety and depression with the Hospital Anxiety and Depression Scale. In addition, patient perceptions of the importance of and satisfaction with selected HRQoL aspects were investigated. Semi-structured interviews with open-ended questions were conducted to identify disease- and treatment-related distress, what constitutes a good quality of life and strategies to "keep a good mood" among these patients. Patients reported a relatively good HRQoL and low levels of anxiety and depression. However, they reported a lower HRQoL than could be expected for healthy people of similar age and gender. Staff gave a more pessimistic view of patient satisfaction with HRQoL aspects than did patients, and staff did not accurately judge individual patients' levels of anxiety and depression. Importance>satisfaction discrepancies for HRQoL aspects may identify patients with a low quality of life. HRQoL, anxiety and depression did not change substantially during the first year of treatment. Categories identified through content analysis of interview data concerning distress and quality of life were referred to physical, emotional or social dimensions. Identified strategies to "keep a good mood" were classified as Internal or External. Most categories of distress that were identified are covered by the EORTC QLQ-C30 and/or the HADS, but some additional emotional and social aspects of distress emerged from the interview data. Receiving good care was identified as a strategy to "keep a good mood". This result indicates a possible and potentially important relation between the quality of care and patient HRQoL.</p>

Gastrointestinal symptoms have a prevalence of 20-40% in the general adult population in the Western world. These symptoms are generally considered to be poor predictors of organic findings [e.g. peptic ulcer disease (PUD) or malignancy]. Approximately 50% of patients seeking care for such symptoms have no organic explanation for these upon investigation. When other organic or other functional conditions are excluded [e.g. PUD, gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS)] the remaining patients are labelled as having functional dyspepsia (persistent or recurrent pain and/or discomfort centred in the upper abdomen). Management of functional dyspepsia remains a challenge, reflecting the heterogeneity of the patients and the uncertain role of drug treatment. Also, prognostic factors for treatment success are largely unknown. I have therefore performed a series of studies to shed light on these issues: The first study (Paper I) was performed in a randomly selected adult population (n=1,001) assessing upper and lower gastrointestinal symptoms at two occasions with 1 to 6 month intervals. The results show that gastrointestinal symptoms are common (57%) and fluctuate to some extent in the shorter term. Troublesome dyspeptic symptoms remain in two out of three individuals. This proportion was similar whether or not organic findings were present. In the second study (Paper II) 799 patients with dyspeptic symptoms were evaluated with regard to whether gastrointestinal symptoms, identified by self-administered questionnaires, correlate with endoscopic diagnoses and discriminate organic from non-organic (functional) dyspepsia. The impact of dyspeptic symptoms on health-related well-being was also evaluated. Approximately 50% of these dyspeptic patients were found to have functional dyspepsia at upper endoscopy. A difference was discovered in the symptom profile between patients with organic and functional dyspepsia. Predicting factors for functional dyspepsia were found. This study shows that use of self-administered symptom questionnaires may aid in clinical decision making for patient management, e.g. by reducing the number of endoscopies, although probabilities of risks for organic dyspepsia are difficult to transfer to management of the individual patient. The results also indicate that the health-related well-being in patients with functional and organic dyspepsia is impaired to the same extent, illustrating the need for effective treatment of patients with functional dyspepsia, a group not well served by currently available treatment modalities. The aim of the third study (Paper III) was to develop and evaluate a selfadministered questionnaire focusing on upper abdominal and reflux complaints to allow for identification of patients with heartburn and factors that might predict symptom relief with omeprazole both in GERD and functional dyspepsia patients. The diagnostic validity of the questionnaire was tested against endoscopy and 24-hour pH monitoring. The questionnaire had a sensitivity of 92%, but a low specificity of 19%. Symptom relief by omeprazole was best predicted by the presence of predominant heartburn described as ‘a burning feeling rising from the stomach or lower chest up towards the neck’ and ‘relief from antacids’. These results indicate that this questionnaire which used descriptive language, appeared to be useful in identifying heartburn and predicting responses to omeprazole in patients with upper gastrointestinal symptoms. The fourth study (Paper IV) was a pilot study investigating the symptom response to omeprazole 20 mg twice daily or placebo for a duration of 14 days in 197 patients with functional dyspepsia. We concluded that a subset of patients with functional dyspepsia, with or without heartburn, would respond to therapy with omeprazole. In the final study (Paper V) the aim was to identify prognostic factors for the treatment success to a 4-week course of omeprazole 10 or 20 mg once daily in 826 patients with functional dyspepsia. The most highly discriminating predictor of treatment success was the number of days without dyspeptic symptoms during the first week of treatment. Fewer days with symptoms during the first week indicated higher response rates at four weeks. In addition, positive predictors of treatment response to omeprazole were identified as age &gt;40 years, bothersome heartburn, low scores of bloating and diarrhoea, history of symptoms for &lt;3 months and low impairment of vitality at baseline. The results indicate that early response during the first week to treatment with a proton pump inhibitor seems to predict treatment success after four weeks in patients with functional dyspepsia. Conclusion: These studies have shown that a large proportion of adult individuals in society, both those who seek and those who do not seek medical care, suffer from symptoms located in the upper part of the abdomen regardless of whether an organic cause is present. A subset of patients without organic findings and other functional conditions, i.e. functional dyspepsia, respond to therapy with omeprazole irrespective of the presence or absence of heartburn . An excellent way to predict the response to a full course of omeprazole in functional dyspepsia is to assess the early response (first week) to treatment. These findings allow for better and faster targeting of acid inhibitory therapy in functional dyspepsia, which potentially can result in more effective clinical management of these patients and savings of health care resources.