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Världshälsoorganisationens (WHO) checklista för säker kirurgi utvecklades för att minska risken för kirurgiska komplikationer och dödsfall i samband med kirurgi. Kommunikationen i operationssalen behöver förbättras mellan alla personalkategorier så att säkerhetsåtgärder blir konsekventa och rätt utförda. Målet med sjukvården är att främja en hög patientsäkerhet för att minimera andelen vårdrelaterade skador. Trots att WHO´s checklista visat positiva resultat finns indikationer på att följsamheten minskar samt att den möts av motstånd från personalen. Syftet med studien var att belysa operationssjuksköterskans upplevelse vid användningen av WHO´s checklista. Fyra operationssjuksköterskor intervjuades och resultaten analyserades med kvalitativ innehållsanalys. Analysprocessen resulterade i tre kategorier: säkerhet i vårdprocessen, vidareutveckling och följsamhet. I resultatet framkom hur användningen av WHO´s checklista främjar patientens säkerhet både i det patientnära arbetet samt i operationssjuksköterskans självständiga arbete. Behovet av vidareutveckling för att möta verksamhetens individuella krav var en annan synpunkt som lyftes fram. Vikten av följsamhet betonades av operationssjuksköterskorna för att uppnå avsikten med WHO´s checklista för säker kirurgi. Konklusionen är att konsekvent tillämpning av WHO´s checklista för säker kirurgi resulterar i ökad patientsäkerhet. / The surgical safety checklist was developed by the World health organization (WHO) to reduce the risk of surgical complications and death. The communication in the operating room needs to be improved between all categories of the staff so that the safety measures will be consistently and correctly performed. The target with hospital care is to promote a high patient safety to minimize the share of care related injuries. In the spite of WHO´s checklist has shown positive result there are indications that compliance decreases and it is also met with resistance from the hospital staff. The purpose of this study would like to illustrate the theater nurses experience about the application of WHO´s checklist. Four theater nurses where interviewed and the result was analyzed by qualitative content analysis. The process of the analysis resulted in three categories: safety of the care process, development and compliance. The result showed how the application of WHO´s checklist promotes safety for the patient in the close contact and in the theatre nurse independent occupation. The need of development to meet the changing surgical field was another aspect. The importance of compliance where described by the theatre nurse to achieve the best outcome of WHO´s checklist for safe surgery. A consistent implementation of WHO´s surgical safety checklist lead to increased patient safety.

1 ABSTRACT PHARMACY STUDENTS' QUALITY OF LIFE Student: Karolína Horáková Tutor: PharmDr. Jitka Pokladníková, Ph.D. Dept. of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Czech Republic Introduction: The quality of life of pharmacy students may change throughout their university life and differ from the quality of life of the general population. In the Czech Republic, quality of life of pharmacy students was not yet examined. Aim: The aim was to determine the quality of life of second year students at the Faculty of Pharmacy at Charles University in Hradec Králové. Secondary aim was to compare results of the Bern Subjective Well-Being Questionnaire with the short version of World Health Organization Quality of Life questionnaire and the Subjective quality of life analysis questionnaire. Methods: The data were collected during 2011. Questionnaires were filled in by second-year students of Faculty of Pharmacy in Hradec Králové. The Bern Subjective Well-Being Questionnaire, the short version of World Health Organization Quality of Life questionnaire and the Subjective quality of life analysis questionnaire were used. The data were analyzed using the MS Excel computer program. Results: The results of the questionnaires showed that most of the students rated their...

A doença cerebrovascular é a maior causa de morte e uma grande causa de incapacidades no Brasil. A taxa de mortalidade no Brasil é uma das mais altas do mundo, principalmente entre os indivíduos com menor condição socioeconômica. A coleta de dados confiáveis e com qualidade sobre as características do acidente vascular cerebral (AVC) é essencial para sua prevenção. Entretanto, existem poucos estudos brasileiros sobre a prevalência da doença. A Organização Mundial de Saúde propõe uma estratégia de vigilância para o acidente vascular cerebral (The WHO STEPwise Approach to Stroke Surveillance) em 3 etapas. A etapa 1 analisa os eventos hospitalizados, a etapa 2, os eventos fatais na comunidade e a etapa 3, os casos de AVC na comunidade que não foram admitidos em hospitais. Por meio de padronização de instrumentos para coleta de dados nas três etapas, esta estratégia permite a comparação de dados sobre a epidemiologia do AVC ao longo do tempo e entre países. Este estudo transversal tem como objetivo avaliar a prevalência de acidente vascular cerebral na área de abrangência do Programa Saúde da Família no Jardim São Jorge, zona oeste do município de São Paulo, por meio da implantação do terceiro passo do WHO STEPS Stroke. Validou-se questionário sobre sintomas de AVC (fraqueza de membros em um dos lados do corpo, paralisia facial, problemas na articulação da fala, alterações de sensibilidade em um dos lados do corpo e alterações visuais) e história prévia da doença. O padrão-ouro utilizado para validação do instrumento foi avaliação por neurologista e revisão de prontuário. Após validação, foram considerados casos de AVC indivíduos com duas ou mais respostas positivas ao questionário com procura a serviços de saúde ou mais de 3, mesmo sem procura a serviços de saúde. Utilizando-se os critérios de positividade acima expostos, a sensibilidade do questionário comparada ao padrão-ouro foi de 72,2%, a especificidade 94,4%, a razão de verossimilhança positiva 12,9 e a razão de verossimilhança negativa 0,29. O questionário validado foi aplicado pelos agentes comunitários de saúde em suas visitas mensais às residências, a todos os moradores maiores de 35 anos da área de abrangência da unidade. Dos 4.496 moradores, aceitaram participar da pesquisa 3.661 pessoas (81,4%). Destes, 577 (15,8%) apresentaram rastreamento positivo e foram submetidos à entrevista mais detalhada para confirmação de AVC. Foram considerados como casos de acidente vascular cerebral 243 indivíduos (6,6%). A prevalência de AVC ajustada por idade nos indivíduos maiores de 35 anos foi de 6,5% (IC95% 3,5 - 5,7) entre as mulheres e 4,6% (IC95% 3,9 - 5,7) entre os homens. Hipertensão, doença cardíaca e dislipidemia foram as condições auto-referidas associadas ao AVC. 11,9% dos casos de AVC apresentavam incapacidade grave segundo a escala de Rankin modificada. A taxa de prevalência foi elevada em comparação com outras pesquisas, principalmente entre as mulheres. / Stroke is the leading cause of death and a major cause of disability in Brazil. Mortality rates are higher compared to other countries mainly among individuals with lower socio-economic status. The search of reliable and good quality data on characteristics of stroke -is essential for stroke prevention. However, there are few Brazilian studies about the prevalence of stroke. The World Health Organization proposes a surveillance strategy to stroke (The WHO STEPwise approach to stroke surveillance). Using standardized questionnaires, it is possible to collect data and compare them over time and among countries. Step 1 aims to collect information on stroke patients admitted to hospitals, Step 2 identifies fatal stroke events in the community and Step 3 estimates community based non fatal stroke events. This crosssectional study aims to evaluate the prevalence of stroke in a poor neighborhood \"Jardim São Jorge\" assisted by the Family Health Program. A validated questionnaire about stroke symptoms (limb weakness, facial weakness, speech articulation problems, sensibility disturbances and impaired vision) and past diagnosis of stroke were applied to all residents older than 35 years in the area. The gold-standard method was a neurological evaluation and a review of patient medical records. After validation, questionnaire were considered positive when a participant answered positive to two or more questions about stroke symptoms and/or the presence of stroke being confirmed by a physician, or at least three positive questions not confirmed by a physician. The questionnaire presented a sensitivity of 72.2%, a specificity of 94.4%, a positive likelihood ratio of 12.9 and a negative likelihood ratio of 0.29. Of 4,496 individuals with 35 years or more, 3,661 people were screened (81.4%) by the community health workers in their monthly visits to the residences and 577 (15.8%) presented a positive screening and underwent more detailed interview for confirmation of stroke. 243 individuals (6.6%) were considered as cases of stroke. The prevalence of stroke adjusted by age in individuals over 35 years was 6.5% (CI95% 3.5 - 5.7) among women and 4.6% (CI95% 3.9 - 5.7) among men. Hypertension, heart disease and dyslipidemia were self- reported conditions associated with stroke. 11.9% of stroke cases had serious disability according to the modified Rankin scale. The prevalence rate was higher compared to other surveys especially among women

Background. Swaziland adopted the World Health Organization’s (WHO) guidelines for the inpatient treatment of severely malnourished children in 2007 to reduce case -fatality rates for childhood malnutrition. However, no follow-up studies have been conducted to determine the reduction in the case -fatality rate post-implementation of the guidelines. Objectives. To determine the case -fatality rate for childhood malnutrition post-implementation of the WHO treatment guidelines and determine the level of adherence to the guidelines at Mbabane Government Hospital. Methods. A retrospective observational study was undertaken. All children under 5 years admitted for inpatient treatment of malnutrition between January 2010 and December 2011 had their demographic-, anthropometric- and clinical characteristics recorded and analysed, as well as the outcome of admission. Results. Of the 227 children admitted during the study period, 179 (64.6%) were severely malnourished and 98 (35.4%) had moderate malnutrition. One-hundred-and-eleven children died during admission, an overall case -fatality rate of 40.1%. Mortality was significantly higher among severely malnourished children compared to those with moderate malnutrition, (46.9% vs 27.6%, OR 3.0 (95% CI 1.7 to 5.3)). Comorbid pneumonia and gastroenteritis were significant predictors of mortality – , OR 2.0 (95% CI 1.2 to 3.4) and 1.9 (95% CI 1.1 to 3.2) respectively. Conclusion. Case -fatality rates for childhood malnutrition remain high, despite adoption of the WHO treatment guidelines. A need exists for improved adherence to the WHO guidelines and periodic clinical audits to reduce deaths from childhood malnutrition to meet the WHO mortality target of less than 5% and improve child survival. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Clinical Epidemiology / unrestricted

Our understanding of humoral immune response to human papillomavirus (HPV) infection has been mainly derived from studies in women. Very little is known about humoral immune response to HPV in men. There is also a growing interest in understanding the burden of HPV exposure in the subgroups of the male population, including men who have sex with women (MSW), men who have sex with men (MSM) and men who have sex with both men and women (MSMW). This dissertation was undertaken to understand and characterize humoral immune response, measured by detectable serum antibody IgG, to HPV 6, 11, 16 and 18 infection, to estimates seroprevalence of HPV 6, 11, 16 and 18, to determine the associations of sociodemographic and sexual behavioral factors with seroprevalence of individual HPV types, and to evaluate the role of serum antibodies in the subsequent acquisition of infection with the same HPV type, genetically related and un-related HPV types. Three studies that compose of this dissertation were conducted within the framework of two longitudinal studies of HPV infection in men: a single-site natural history study of male residents of Tucson, Arizona (the 1st study: N=285); and a multinational natural history study of healthy men residing in São Paulo, Brazil, Cuernavaca, Mexico, and Tampa, Florida (the 2nd study: N=1477; the 3rd study: N=2187). Men were recruited using similar eligibility criteria in both natural history studies and followed every 6 months for a maximum of 18 months in the single-site study and 48 months in the multi-national study. HPV DNA status was assessed using the PGMY09/11 L1 consensus primer system and the Linear Array HPV Genotyping Protocol. Testing of serum antibodies to HPV 6, 11, 16 and 18 was performed with virus-like particle-based ELISA assays. Data from our studies indicate that exposure to HPV 6, 11, 16 and 18, the four HPV types targeted in the currently license HPV vaccines, is common. Of 285 male residents of Tucson, Arizona, 28.8% of them were seropositive to HPV 16 and/or 18 at study entry. Similarly, approximately one third of 1477 participants of the multi-national male HPV natural history study were seropositive to at least one vaccine HPV type, with the percentage of 21.8% in U.S. site, 33.4% in Mexico site, and 49.1% in Brazil site. It is also noted that seroprevalence of individual vaccine HPV types is greatly elevated among men of different sexual practices. Seroprevalence of HPV 6, 11, 16 and/or 18 was twice as high among MSM and MSMW compared to MSW. Likewise, seroprevalence of individual HPV types was two fold or higher among MSW and MSMW. Our findings suggest that the predominant predictors of seropositivity to HPV 6, 11, 16 and 18 are age and same-sex sexual behaviors. Seroprevalence increased with age among young-to-middle-aged men with significant upward age trends observed for HPV 11, 16 and 18. MSM, compared to MSW, more likely to be seropositive to HPV 16 or 18. Similarly, men who practiced same-sex anal sex, compared to those who did not, were significantly more likely to be seropositive to HPV 6, 11, 16 and 18, respectively. Among 276 men free of HPV 16 at enrollment in Tucson, We did not detect statistically significant associations between the baseline serum antibodies to HPV 16 and/or 18 and subsequent risk of infection with homogeneous HPV types or related-HPV types. Of 2187 men residing in three countries who tested HPV 16 negative at enrollment, the risk of subsequent HPV 16 infection was not associated with enrollment HPV 16 serum antibodies status. Our data provide important estimates of population exposure to vaccine HPV types for future studies modeling potential vaccine impact and vaccine cost effectiveness in men. Our findings also support strategic vaccination of males as an effective preventive measure for HPV-related diseases and cancers in men and their sex partners, men and women alike.

In this paper I have studied the two new religious phenomena, Temple of the Jedi Order and Whovianism, based on the cognitive concept of man dominated by schemas that characterize the outcome of adequate response to new situations. This principle is about how man faces new situations through old knowledge and experience of similar events. For this study, I analyzed selected stories in which individuals describe their religious interest and involvement in the Star Wars movies, and the related religious community Temple of the Jedi Order, as well as the television series Doctor Who, with the associated religious community Whovianism. This study was inspired by phenomenographic method by which researchers focus on the perceived and how it is conveyed in the respective story. The results of this study show that new religious phenomena, such as the Temple of the Jedi Order and Whovianism, can be explained using the theory of cognitive schemas.  The study shows that the individuals, whose stories have been examined, use ancient knowledge and experiences on the different aspects conveyed by Star Wars and Doctor Who and through this a new religious community is born.

This investigation of failure in the first two grades and the effectiveness of group counseling upon the failing children seeks first to determine whether students who have failed hold a different self-concept or attitude toward school from those of students who have not. The second aim is to determine the effect of group counseling on self-concept and attitude toward school of failing students. The third purpose is to analyze the implications of these findings for elementary school counselors and teachers. The investigation's two phases include a survey study and an experimental study. The ninety-six subjects for the survey phase were selected by identifying forty-eight first and second grade students who failed their grade level in the 1972-1973 school year, and by randomly selecting a control group of forty-eight second and third grade students who had not failed a grade. For the experimental phase of the study, the forty-eight failing students were divided into an experimental group and a control group. Twenty-four were randomly placed in the counseling groups, with the remaining twenty-four as a control group.

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Världshälsoorganisationen (WHO) introducerade 2008 checklistan för säker kirurgi, som ett led i att minska vårdskador i samband med kirurgiska ingrepp och stärka kommunikationen mellan de olika professionerna på operationssalen. Denna checklista är uppdelad i tre delar; kontroll inför anestesistart, kontroll inför operationsstart (time-out), samt avslutning. Eftersom vår profession är operationssjuksköterskor, valde vi att fokusera på time-out, för att beskriva operationssjuksköterskors upplevelser av kommunikationen och följsamheten i samband med time-out. Uppsatsen är en litteraturstudie baserad på tio kvalitativa vetenskapliga artiklar, vilka granskades och analyserades. I artiklarna sökte vi efter gemensamma nämnare, de kategoriserades till huvudteman och underteman. Under huvudtemat kommunikation återfinns hierarki, som var en starkt bidragande faktor till bristfällig kommunikation inom det interprofessionella operationsteamet och till en låg följsamhet till WHO´s checklista för säker kirurgi. I huvudtemat utbildning framkom problem i samband med implementeringen av WHO´s checklista för säker kirurgi, där det saknas adekvat utbildning och handledning för hela teamet. Resultatet för uppsatsen kan ligga till grund för vidare forskning inom ämnet och bidraga till utbildning i interprofessionell kommunikation och utveckling, samt hantering av de olika hierarkierna på en operationsavdelning. / In 2008, the World Health Organization (WHO) introduced the Surgical Safety Checklist as a means to reduce surgical complications and improve communication among healthcare professionals in the operating room. The checklist is divided into three parts: pre-anesthesia check, time-out before incision, and closing check. As operating room nurses, we chose to focus on the time-out component to describe operating room nurses' experiences with communication and compliance during time-out.   This literature review is based on ten qualitative scientific articles, which were reviewed and analyzed. We searched for common themes in the articles, which were categorized into main themes and sub-themes. Under the main theme of communication, we found that hierarchy was a strong contributing factor to poor communication within the interprofessional operating team and low compliance with the WHO's Surgical Safety Checklist.   Under the main theme of education, we found problems with the implementation of the WHO's Surgical Safety Checklist, including inadequate education and training for the entire team. The results of this study can form the basis for further research on interprofessional communication and development, as well as the management of different hierarchies in the operating room.