Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2016-12-16T09:36:11Z No. of bitstreams: 2 Dissertação - Thais Yoshida - 2016.pdf: 2049015 bytes, checksum: 4c0db77258728ea13cbc289c1d269fc0 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2016-12-16T13:53:27Z (GMT) No. of bitstreams: 2 Dissertação - Thais Yoshida - 2016.pdf: 2049015 bytes, checksum: 4c0db77258728ea13cbc289c1d269fc0 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-12-16T13:53:27Z (GMT). No. of bitstreams: 2 Dissertação - Thais Yoshida - 2016.pdf: 2049015 bytes, checksum: 4c0db77258728ea13cbc289c1d269fc0 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-04-15 / INTRODUCTION: Primary bloodstream infections related to central venous access(CVA) are among the most frequent infections related to the health assistance and are associated to a longer hospitalization time, high mortality risk and higher costs to health services. Preventive measurements as bundles can reduce the recurring cases of hospitalization and other complications. OBJECTIVES: To analyze the use of a prevention bundle on primary laboratory bloodstream infection related to central venous access on Intensive Care Units in a public hospital in Goiás, from 2012 to 2015. METHODOLOGY: Retrospective study performed on adult and kids intensive care units(ICU) through the analyses of secondary data of the physical and electronic data archives from the Medical Infection Control Service. The following tests were used: Shapiro-Wilk test to check the normal quantitative variables; test of U-Mann-Whitney and Fisher to compare the median differences and proportions of the ICU’s. Two models were used to achieve the objectives. To evaluate the effect of the bundle implementation two periods were compared, these periods were determined as pre intervention period ( prior to bundle implementation) and post intervention. In the adult ICU the pre intervention period corresponds from January 2012 until October 2014 and at the kids ICU, from January 2012 to August 2014. The post intervention phase corresponded of data between November 2014 to December 2015 on the adult’s ICU and from September 2014 to December 2015 on the kids ICU. To evaluate the bundle process indicators, two periods were taken in comparison (2014 and 2015), 2014 being the year that the bundle was implemented. Indicators and variables found on the pre and post intervention period were compared using the regression models of Poisson. <0,05 p rates were considered statistically significant. Confidence intervals of 95% were calculated to the indicators. The analyses were performed on the STATA software, 12.0 version and the graphics were built on the Graph Pad Prism software, 6.07 version. The project was approved by the Ethic Committee, 011/2012 protocol number. RESULTS: A non significant reduction on the IPCSL/CVC in adults ICU’s (RR:0,75; IC 95%: 0,15-3,60; p = 0,723), even though there was high bundle use on the post intervention period. On the other hand, there was a non significant increase on the kids ICU’s(RR: 1,17; IC 95%: 0,26-5,27; p = 0,834). Low bundle total conformity on the kids ICU’’s . Insertion and removal of the catheter were the two least adhered methods adopted on both ICU’s. CONCLUSION: This study did not find significant reduction on the IPCSL/CVC density after bundle implementation, which suggests the need of reviewing the use process, just as the need of continuous professional training to apply bundle and ways to measure the use of the processes with the assistance team. / INTRODUÇÃO: As Infecções Primárias da Corrente Sanguínea associadas ao Cateter Venoso Central (IPCSL/CVC) estão entre as Infecções Relacionadas à Assistência à Saúde frequentes e associadas a maior tempo de internação, elevada morbimortalidade e custos para serviços de saúde. Medidas de prevenção como a adoção de bundles podem diminuir a sua incidência. OBJETIVO: Analisar a utilização de bundle de prevenção de Infecção Primária de Corrente Sanguínea Laboratorial relacionada a Cateter Venoso Central em Unidades de Terapia Intensiva de um hospital público de Goiás, durante o período de 2012 a 2015. METODOLOGIA: Estudo de coorte retrospectivo realizado em unidades de terapia intensiva (UTI) adulto e pediátrica, por meio de análise de dados secundários dos arquivos físicos e eletrônicos do Serviço de Controle de Infecção Hospitalar. Foram utilizados os seguintes testes: Teste Shapiro-Wilk para verificar a normalidade das variáveis quantitativas; testes de U-Mann-Whitney ou exato de Fisher para comparar as diferenças nas medianas e proporções das variáveis entre as UTI, respectivamente. Para avaliar o efeito da implementação do bundle foram comparados dois períodos, denominados pré-intervenção (anterior à aplicação do bundle) em pós-intervenção. Na UTI adulto o período de pré-intervenção correspondeu aos meses de janeiro de 2012 a outubro de 2014 e na UTI pediátrica, de janeiro de 2012 a agosto de 2014. A fase de pós-intervenção correspondeu ao período de novembro de 2014 a dezembro de 2015 na UTI adulto e de setembro de 2014 a dezembro de 2015 na UTI pediátrica. Para avaliar os indicadores de processo do bundle foram comparados os anos de 2014 e 2015, sendo 2014 o ano da implantação da bundle. Variáveis e indicadores encontrados nos períodos de pré e pós-intervenção do bundle foram comparados usando modelos de regressão de Poisson. Valores de p < 0,05 foram considerados estatisticamente significantes. Foram calculados intervalos de confiança de 95% para os indicadores. Análises foram realizadas no STATA software, versão 12.0 e gráficos construídos no Graph Pad Prism software, versão 6.07. RESULTADOS: Verificou-se uma redução não-significativa na incidência de IPCSL/CVC na UTI adulto (RR: 0,75; IC 95%: 0,15-3,60; p = 0,723), apesar da alta taxa de aplicação do bundle no período pós-intervenção. Por outro lado, houve aumento não significativo na densidade de incidência na UTI pediátrica (RR: 1,17; IC 95%: 0,26-5,27; p = 0,834). Observou-se baixa conformidade total dos bundles na UTI pediátrica. Inserção e retirada do cateter foram as etapas com menor adesão nas UTI. CONCLUSÃO: Este estudo não encontrou redução significativa na densidade de IPCSL/CVC após implantação do bundle, sugerindo a necessidade de revisão do processo de utilização, assim como capacitação contínua para a aplicação do bundle e mensuração da adesão com discussão dos indicadores do processo junto à equipe assistencial.

Evaluating the psychofortology of adults recovering from a substance-use disorder has been identified as a research priority in South Africa. This is in line with calls from researchers in diverse fields of psychology for more attention to the resilience, strengths, resources and capacities of people. This study therefore aimed to explore and describe the coping resources, sense of coherence, happiness and satisfaction with life of adults recovering from a substance-use disorder within the Nelson Mandela Metropole. The sample consisted of 99 voluntary participants from various managed recovery centres within the Nelson Mandela Metropole. Participants were given a package of questionnaires to complete under the supervision of the researcher. The assessment consisted of a biographical questionnaire and four standardized paper and pencil measures namely; the Coping Resources Inventory (CRI), the Sense of Coherence Scale (SOC-29), the Affectometer 2 (AFM-2) and the Satisfaction with Life Scale (SWLS). A quantitative, non-experimental exploratory-descriptive research method was used. Data was analysed using descriptive statistics and the Pearson product-moment correlation coefficient. Key findings include the following: Results on the CRI revealed low average mean scores on both the Coping Resources Inventory and within all the five subscales. Results of the SOC-29 revealed a high average mean score for sense of coherence. Results of the AFM-2 revealed that more positive affect than negative affect is present, resulting in happiness. Results of the SWLS revealed an average level of satisfaction with life, with most participants’ reporting neutral levels of satisfaction with life. There were significant positive correlations between the coping resources, sense of coherence, happiness and satisfaction with life of the sample. This implies that these constructs can be categorized under the subdiscipline of psychofortology. Overall, these findings emphasized the need for more research into adults recovering from a substance-use disorder.

This study demonstrates how to make and use a three dimensional model in GSI3D, based on well data from the Geological Survey of Sweden’s well archive. The objective is to determine if it is possible to show a supposed fault scarp, the Bollnäs fault, in the bedrock and the valley morphology in a 3D model based on the data available. During the last ice age, the land surface under the ice was depressed by several hundred meters. As the last ice sheet retreated, land uplift began and faulting occurred. These glacially-induced faults are dated to late or post glacial times since they are cutting post glacial sediments. The same goes for the Bollnäs fault. The scarp is seen through airborne light detecting and ranging, LiDAR, cutting surficial sediments but never outcrops in the bedrock. After examining and validating the well data in the mapped area, 430 of 478 wells were used to build the model, giving a 3D model of the surficial deposits and the bedrock surface. In the model, the scarp cannot be seen in the bedrock, nor in the deposits nor in the valley morphology. Exporting the model to Arc GIS as a digital terrain model, a DTM, as a raster, shows that with the amount of data available a fair pixel resolution would be 150 m2. With that resolution detailed landforms like fault scarps would not appear. The conclusion is that the amount of data is to low to accurately model small-scale features.  These findings aligning with earlier research on 3D models.

Cette thèse examine la littérature du sida en France et la présence des écritures intimes au sein de cette production littéraire qui apparaît au cours des années 1980 parallèlement à l’émergence globale de la pandémie. La rencontre entre l’écriture de l’intime et l’écriture autofictionnelle donne lieu à des formes hybrides, qui sont l’expression d’un micro-pouvoir, essentiel à la parole, le seul dont le malade dispose pour dire la condition inédite qui est la sienne. Le corpus principal analyse l’œuvre de Cyril Collard, de Hervé Guibert et de Jean-Luc Lagarce. / The thesis examines AIDS-related literature in France with a particular focus on the writing of the self'. The meeting between diary an autofictional writing generates hybrid forms, which are the expression of a micropower, essential to language, that is the only way for the writes to express their condition of dying young men. Our main corpus includes texts by Cyril Collard, Hervé Guibert and Jean-Luc Lagarce.

This thesis explores structures of melancholy in five of Kurt Vonnegut's early novels, Player Piano, The Sirens of Titan, Mother Night, Slaughterhouse-Five and Breakfast of Champions. The thesis attempts to give new readings to each of the novels by drawing on critical approaches to melancholy and by viewing each text as being subject to contemporary cultural influences. In particular, the thesis maps how each of the novels comments on human progress through a combination of historical, scientific, cultural, social and political paradigms. In the chapters on The Sirens of Titan and Mother Night the protagonist is seen as suffering from a number of melancholic complaints that are closely related to schizophrenia, while the narratives as a whole exploit this splintering of the self to suggest a variety of allegorical readings. The chapters on Player Piano, Slaughterhouse-Five and Breakfast of Champions discuss how the Puritan foundations of American culture play a major part in the construction of the self through the establishment of the Protestant work ethic. These chapters also attempt to expose how many of the ideological concepts that adhere to work, progress and capitalism have melancholic consequences for all involved. Throughout the thesis the relationship between reality and representation, language and authority is seen as being crucial to understanding the depth of Vonnegut's early novels and the way in which each novel deconstructs established values and subverts readers' expectations. Occasionally, the thesis discusses the novels' poststructural concerns as appearing to precipitate melancholy within both readers and characters. However, the thesis also explores how melancholy has been seen historically to galvanise the soul and build up, from the depths of depression, a renewal of spirit. Overall, the thesis shows how melancholy is a constituent part of Vonnegut's novels, connecting his work to the tradition in American melancholic writing created by the founders of the nation. This thesis traces the persistence of this melancholic note within selected Vonnegut novels and its connections with other themes identified within his work.

No description available.

Abstract Dental diseases such as dental caries and periodontal disease could well be seen as being behaviour-related. The high prevalence of periodontal disease in the Finnish adult population mirrors the need for improving oral health behaviours in a comprehensive manner. Thus far, scant attention has been drawn to the underlying psycho-social factors that could, in part, explain oral health and oral health behaviours. Deficiencies in oral health behaviour may also be indicative of an individual's poor health behaviour in general. The aim of this study was to introduce the salutogenic approach, called sense of coherence, into the domain of oral health and health behaviour. The present study uses data from the nationally representative Health 2000 survey carried out in 2000–2001 by the National Public Health Institute of Finland. The subjects of this study numbered 4175 in article I, 4131 in article II, 4039 in article III, and 4096 in article IV, and were 30- to 64-year-old dentate men and women. The cross-sectional data was collected via home interviews, self-administered questionnaires, or clinical examinations. Sense of coherence was positively associated with oral health behaviours, such as dental attendance and tooth-brushing frequency. In addition to tooth-brushing frequency, sense of coherence was also positively associated with the level of oral hygiene. The association between sense of coherence and level of oral hygiene weakened only marginally after controlling for tooth-brushing frequency. A strong sense of coherence was strongly associated with a positive oral health-related quality of life (OHIP). Sense of coherence was also associated with all of the OHIP sub-scales, and the association was most evident in the psychological discomfort, psychological disability and handicap sub-scales. Among males, health behaviours seemed multidimensional, whereas they tended to be unidimensional among females. A strong sense of coherence was a common determinant of healthy behaviours in general, as well as of a good subjective health status. The present study recognizes the sense of coherence as a common health-promoting determinant of oral and general health behaviours, good oral health, and a good oral health-related quality of life. The results thus suggest that the role of psycho-social factors should not be underestimated in health promotion.

Abstract Manganese superoxide dismutase (MnSOD) is an important intracellular antioxidant enzyme, which has been suggested to play a role in tumour biology. In the present study, the expression and possible role of MnSOD in malignant pleural mesothelioma was investigated. Mesothelial cells in healthy visceral pleural tissue showed no MnSOD immunoreactivity in five out of six cases, whereas moderate or high immunoreactivity for MnSOD was detected in 30 out of 42 (71%) cases of mesothelioma. Only two of the 21 cases with metastatic adenocarcinoma of the pleura showed moderate MnSOD immunoreactivity, the remaining 19 (90.5%) showing negative or weak reactivity (p &lt; 0.001, by Fisher's exact test compared to mesothelioma). The immunostaining of catalase, a hydrogen peroxide scavenging antioxidant enzyme, was detectable in 27 of the 35 (77%) mesothelioma cases studied, whereas all the five samples of healthy pleural mesothelium were negative. Reactive mesothelium showed positive immunoreactivity for MnSOD and catalase, suggesting that induction of these enzymes is not specific for mesothelioma. Two continuous human mesothelioma cell lines showed higher MnSOD activity, immunoreactive protein and mRNA levels than non-malignant mesothelial cells. In addition, mesothelioma cells expressing the highest MnSOD levels had the highest levels of catalase and copper-zinc superoxide dismutase. The mitochondria of these cells expressed higher MnSOD and lower superoxide levels than non-malignant mesothelial cells. The mesothelioma cells with the highest antioxidant enzyme levels were most resistant to oxidant- and drug-induced injury and to drug-induced apoptosis compared to non-malignant mesothelial cells and mesothelioma cells with lower MnSOD and catalase levels. The extent of cell proliferation and apoptosis of mesothelioma tissue were 14.1±13.2% and 1.1±1.2%, respectively. MnSOD expression was inversely associated with cell proliferation (p = 0.02 by t-test), and a tendency for a better prognosis among patients with moderate or strong MnSOD expression was demonstrated. Patients displaying a tumour with enhanced proliferation or apoptosis had a poorer prognosis (p &lt; 0.001 by Log Rank test). In conclusion, the MnSOD level is usually high in pleural mesothelioma, which may affect the proliferation and drug-resistance of mesothelioma cells. MnSOD immunostaining can thus possibly be used to distinguish mesothelioma from metastatic adenocarcinoma but not from reactive mesothelium.

This longitudinal investigation examined motives for alcohol use, alcohol consumption, and alcohol-related consequences in a Vancouver, British Columbia youth sample (n = 405). Secondary analyses were performed on data that were collected at two time points (1995-1996 and 2003-2004). Sociodemographic variables included age, gender, adoption status, parent education, household moves, and family net worth. Bivariate correlations and structural equation modeling were used to examine associations between social, enhancement, and coping motives, alcohol consumption and alcohol-related consequences. The social motives included drinking to be sociable and drinking to add to the enjoyment of meals. Enhancement motives included drinking to feel good. Coping motives included: drinking to help you relax, drinking to forget worries, and drinking to feel less shy and inhibited. In the final longitudinal structural equation model combining T1 motives and both T1 and T2 alcohol consumption and alcohol-related consequences, results showed endorsement at T1 of drinking to forget worries was predictive of the alcohol-related consequences latent factor at T1. Moreover, T1 consequences were predictive of alcohol-related consequences at T2. The data show a positive relationship between T1 endorsement of drinking to feel good and the alcohol consumption latent variables at both T1 and T2, but no relationship between drinking to feel good and the alcohol-related consequences emerged. Additionally, the data yielded a negative relationship between the variable, “drink to be sociable” and the alcohol-related consequences latent factor at T1. Certain self-identified motives for drinking may be risk factors for continued alcohol use and subsequent misuse. Therefore, differentiating between specific motives for alcohol use may be a helpful marker for Child and Youth Care workers and other professionals to initiate conversations about alcohol use and consequences. / Graduate

Background: Alcohol Related Brain Damage (ARBD) is an umbrella term used to describe the range of effects that long-term consumption of alcohol can have on the structure and function of the brain. Despite the increasing prevalence of ARBD, there is a lack of research in this area, and as a result, there are no current guidelines and few services available for the treatment of this condition. There is therefore a need to increase the evidence base in this area, which will assist in the understanding, and ultimately treatment, of ARBD. Aims: This thesis consists of two parts. The first is a systematic review journal article which asks the question: “What is the impact of alcohol-abuse on memory function within the first three weeks of alcohol withdrawal?” The second part is a qualitative research project which aims to develop a grounded theory regarding the patient experience of ARBD, identifying and highlighting themes and concepts that are central to the experience. Methods: For the systematic review, four databases were searched. Studies that were included in the review had to have participants with alcohol-dependence; abstinence of less than or equal to three weeks; and to have undergone some form of neuropsychological assessment of memory function. Data from 15 articles were extracted and assessed for quality. For the qualitative study, participants (n=10) were interviewed regarding their experiences of ARBD and the data was then analysed using grounded theory methodology. Results: The results of the systematic review were somewhat ambiguous with some studies reporting impairments in verbal and visual memory, while other studies found no impairments. Episodic memory deficits were present in all studies reviewed. The results of the qualitative study propose a tentative model which describes “transformation through adaptation”. This model hypothesises that successful negotiation of the journey through ARBD hinges on the adaptations that need to be made in order to progress towards transformation. The model is understood in the framework of a number of phases, “Being diagnosed with ARBD, “Focusing on abstinence”, “Taking ownership of life with ARBD” and “Creating a valuable life”, all of which exist within a framework of being supported by specialist services. Conclusions and implications: The systematic review demonstrated some support for deficits in visual and episodic memory within the first three weeks of abstinence, while it appeared that verbal memory was relatively preserved. The heterogeneity of the studies, coupled with the methodological variability, meant that all conclusions need to be considered as tentative, and be interpreted with caution. The main difficulties with interpretation were to do with the confounding factors often found within this client group. The results reinforce the concept of tailored treatment programmes for individuals due to the large variability of the effect of alcohol (and other factors). The qualitative study proposes a model that shows how adaptation appears to play a key role in the successful negotiation of a diagnosis of ARBD. The study describes a series of categories that can be used as a framework to identify and support the changes that are necessary for recovery and reintegration. The value in this study is that the results are directly attributable to individuals who have been diagnosed, and are now successfully living, with ARBD.