The aim of this research programme was to explore ehealth technology in pharmacy practice in Scotland and, by doing so, contribute original knowledge to this area. Strategists worldwide believe technology has the potential to promote quality, safety and efficiency in healthcare. This has been reflected in national ehealth policies designed to support collaborative working between medical and non-medical healthcare practitioners and, more recently, the whole health and social care team. A meta-narrative systematic review was conducted to explore and contextualise research related to healthcare professionals’ views of the adoption of ehealth technologies to support shared care. Findings indicate the importance of organisational development and training for core and optional ehealth services with pharmacists particularly under-represented in ehealth research. Socio-technical systems theory and the computer supported cooperative working framework were adopted to explore healthcare practitioners’ perceptions of ehealth in relation to integrated care. Findings from the review indicate ehealth research continues to focus on doctors and nurses. No ehealth application was perceived to be an unqualified success with the socio-technical gap still evident. Multiple case studies were conducted to develop explanatory theory around the digital literacy experiences, education and training related needs of pharmacy staff in the NHS Grampian area. Digital literacy levels were self-reported as basic with mixed views on the need for formal education and training. Findings indicate organisational and social factors may act as restraining forces against implementation of technology in pharmacy and associated digital literacy training. A final theory testing, systematic review was conducted into digital literacy training experiences of pharmacy staff applying Kirkpatrick’s four level model. It found a lack of evidence of specific, measurable digital literacy levels but indications that suggest digital literacy should be included in pharmacy education at all levels and career stages. This research provides novel insight into ehealth and digital literacy in pharmacy practice. Combined ehealth, education and pharmacy research has been demonstrated to be an under-researched area therefore these findings contribute original knowledge.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / To systematically review all studies examining HPV vaccination acceptability among immigrant and ethnic minority parents and eligible individuals for cervical cancer prevention in the Unites states. MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane database searches were conducted searching for English language, US‐based studies to examine immigrant and ethnic minority population’s acceptability of HPV vaccination. Thirteen of more than 3,098 potentially relevant articles were included in the final analysis. Results. Latinos were statistically more likely to accept vaccination for both their daughters and sons. Foreign‐born adult Latinas were more accepting of the vaccine than U.S.‐born Latinas after controlling for other variables. Overall African American and Asian American parents were less likely to accept HPV vaccination for their daughters than Hispanic and White parents. Of the African American parents who intended to vaccinate their children the majority were significantly non‐Baptist and had higher levels of education. The majority of Haitian immigrants intended to vaccinate daughters and the rest agreed that they would most likely have their daughters vaccinated if their daughters’ physicians recommended it. More research is needed, particularly in the context of health care provider HPV vaccination recommendation to immigrant and ethnic‐minority populations. Acceptance figures so far suggest that the vaccine is generally well received among Hispanic/Latin and Haitian immigrants, but details of ethnic variations among these groups and a qualitative understanding of lower rates of acceptability among African American and Asian American communities are still being awaited. Despite advances in cervical cancer screening rates in the US, cervical cancer remains disproportionately high among low‐income immigrant and minority women, making this subgroup particularly vulnerable to disparities in screening and its detection. The purpose of this study is to examine the qualitative aspects of institutional and community level interventions of Cervical Intraepithelial Neoplasia (CIN) within the immigrant and refugee populations and the use of HPV vaccination as a prevention method. Combinations of the following keywords/phrases will be used: CIN‐ Cervical Intraepithelial Neoplasia, Cervical diseases, Cervical dysplasia, Refugees, Pap smear, Cervical Cancer Screening, HPV‐ Human Papillomavirus, HPV vaccination, Ethnic minorities, Immigrants. Independent reviews of each article will be conducted to assess the study quality and confirm the accuracy, completeness, and consistency of the abstracted data.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The rate of technology expansion is rapidly covering even the most remote parts of the globe and in the lowest resource settings. With globalization however, low and middle income areas are facing emerging health issues such as injuries and chronic medical conditions. With these illnesses, there are inevitable demands on emergency services. It has been thought that technology be utilized to augment emergency medical care in such settings where formal Emergency Medical Services. To aggregate and analyze the existing literature on the topic a systematic literature review was conducted. This study analyzed the existing literature on prehospital emergency care in settings in which no formal EMS services were utilized. Four databases were searched with inclusion and exclusion criteria, yielding 1782 results. The initial screening excluded all but 21 articles. Of the 21 articles in full review, 15 were included in the final review. Studies included in the final review were grouped into those reporting outcomes from five categories: Feasibility, Quality of Care, Response Time, Patient Outcomes, and Cost Effectiveness. Only one study was identified to be of high quality. There was a lack of studies with adequate statistical analysis to conduct statistical aggregation. Most studies however reported prehospital telemedicine in settings without EMS to be feasible, provide quality care, are be cost effective. However, the lack of statistical analysis makes it difficult to make conclusions. Also, several studies did show response time of a trained basic life support volunteer to be faster than EMS in many of the settings. But no positive health outcomes were observed in patients treated with projects utilizing technology in the prehospital setting. The prehospital emergency medicine setting is a young field of study that may have significant hurdles in application. The studies conducted have shown promise in the use of technology in prehospital settings without formal EMS services, but are not robust enough to make strong conclusions or recommendations that could be put into practice. Thus, more robust, statistically oriented research is imperative in the field so that we can fully explore the potential of technology in the prehospital setting, especially in low resource and rural settings without formal EMS services. With more robust studies, we can hope to integrate new technologies into practice and better serve the populations without adequate EMS coverage to provide more timely emergency care.

Les érymides sont des crustacés décapodes marins ayant une morphologie comparable à celle des homards actuels. Ils sont regroupés au sein d’une unique famille, les Erymidae Van Straelen, 1925, caractérisée par la présence d’une plaque intercalaire dorsale. Ces crustacés sont présents dès la fin du Permien. Ils se sont diversifiés et répandus dans le monde entier au Jurassique et ont perduré jusqu’au Paléocène. Ils sont particulièrement abondants au Jurassique, fossilisés dans des dépôts issus d’environnements variés : de faible profondeur – comme les calcaires lithographiques de Solnhofen (Allemagne) –, très profonds – comme La Voulte (France) –, ou encore dans différents milieux de plate-forme – comme le Terrain à Chailles (France). Depuis les premières descriptions d’érymides, au début du XIXe siècle, de nombreux auteurs se sont attachés à décrire de nouvelles formes et à tenter d’élucider les affinités phylogénétiques de ces crustacés éteints. Ces nombreux travaux ont abouti à l’installation et à la propagation de confusions rendant douteuse la systématique des érymides tant au niveau des genres que des espèces. Ces problèmes taxinomiques particulièrement marqués chez les érymides — on parle d’ailleurs de « problème érymidien » — sont accompagnés d’un débat sur leur classification au sein des Pleocyemata. Jusqu’au début du XXIe siècle, la majorité des auteurs les classaient dans l’infraordre des Astacidea mais de récentes analyses phylogénétiques suggèrent l’intégration des érymides au sein des Glypheidea. Une autre étude a même abouti à la remise en cause du statut éteint des érymides. En effet, Schram & Dixon (2004) ont observé la plaque intercalaire sur l’actuel Enoplometopus A. Milne Edwards, 1862. Leur analyse a ensuite conduit au regroupement de cette forme actuelle avec les érymides au sein d’un même clade nommé Erymida. Les objectifs de cette thèse sont donc de remédier aux problèmes taxinomiques des érymides, d’élucider leurs affinités phylogénétiques et d’apporter des éléments permettant de mieux comprendre leur mode de vie et leur succès évolutif. Pour ce faire, une révision systématique aussi exhaustive que possible, appuyée sur l’étude de plus d’un millier de spécimens, a été réalisée. Elle a permis d’homogénéiser la description des 6 genres et des 75 espèces reconnues et d’identifier les caractères nécessaires à l’étude phylogénétique. L’arbre obtenu montre clairement que les érymides constituent un groupe particulier d’Astacidea auquel Enoplometopus n’appartient pas. De plus, la topologie de l’arbre de strict consensus soutient une refondation complète de la systématique du groupe. D’une unique famille, les érymides se retrouvent désormais répartis dans deux familles, distinguées par la présence/absence de la zone post-orbitaire : les Enoploclytidae n. fam. et les Erymidae. Cette dernière est d’ailleurs elle-même divisée en sous-familles, Eryminae Van Straelen, 1925 et Tethysastacinae n. s.–fam., en raison de l’architecture très simple des sillons de la carapace de Tethysastacus Devillez et al., 2016 comparée à celle des autres genres. Cette étude a aussi été l’occasion de formuler des hypothèses paléobiogéographiques qui demeurent, hélas, en grande partie spéculatives et incomplètes du fait des importantes discontinuités géographiques et stratigraphiques du registre fossile. Les observations de stades larvaires, des yeux, de la morphologie des pinces, de pores cuticulaires et de la variabilité intraspécifique chez certains spécimens ont également permis, en s’appuyant sur les formes actuelles, d’émettre des hypothèses sur le mode de vie de ces crustacés disparus. Enfin, la grande tolérance environnementale déduite des différentes formations géologiques ayant livré des érymides fossiles est probablement une des clés de leur succès au Mésozoïque et soulève la question des raisons de leur extinction. / Erymids are marine decapod crustaceans with a morphology close to that of extant lobsters. They are grouped within an unique family, Erymidae Van Straelen, 1925, based on the presence of a characteristic intercalated plate. These crustaceans were already present in the Permian, have become diversified and widespread during the Jurassic and have lasted until the Paleocene. The erymids are abundant during the Jurassic. They fossilized in deposits from various paleoenvironments: shallow water environments – like lithographic limestones from Solnhofen (Germany) –, from deep environments – like in La Voulte (France) –, and also from different platform environments – like the Terrain à Chailles (France). Since the first descriptions of erymids in the first part of the XIXth century, numerous authors have described new species and have attempted to establish the phylogenetic affinities of these extinct crustaceans. This high number of studies resulted with the apparition and propagation of confusions. So, the systematics of the erymids has become doubtful at both generic and specific levels. These taxonomic problems strongly affecting the erymids — the so called « erymidian problem » — are increased by their uncertain phylogenetic relationships among the Pleocyemata. Until the XXIst century, most of the authors classified the erymids within the infraorder Astacidea but recent phylogenetic analyses suggest an integration within Glypheidea. Moreover, a study has led to question the extinct status of the erymids. Indeed, Schram & Dixon (2004) have observed an intercalated plate in the extant Enoplometopus A. Milne Edwards, 1862. Their analysis has resulted with the clustering of this extant lobster together with the erymids within a same clade named Erymida. So, the purposes of this thesis are to rectify the taxonomic problems of the erymids, to elucidate their phylogenetic affinities and to provide observations which enable a better comprehension of their lifestyles and their evolutionary success. To reach these goals, a systematic review, supported by the examination of more than a thousand specimens, has been done. It has resulted in a homogenisation of the descriptions of the 6 genera and 75 species herein recognized and in the identification of useful characters for the phylogenetic study. The phylogenetic tree obtained clearly shows that erymids form a particular group of Astacidea and that Enoplometopus does not belong to this group. Moreover, the topology of the strict consensus tree supports a new systematic building of the group. From a unique family, the erymids are now spread into two families supported by the absence/presence of a post-orbital area: Enoploclytidae n. fam. and Erymidae. The last is also divided in subfamilies, Eryminae Van Straelen, 1925 and Tethysastacinae n. s.-fam., based on the very simple carapace groove pattern of Tethysastacus Devillez et al., 2016. This new study on the erymids was also an occasion to provide some paleobiogeographic hypotheses. But, unfortunately, they remain speculative and incomplete due to geographic and stratigraphic discontinuities of the fossil record. Observations of larval stages, of eyes, of P1 chela morphologies, of cuticular pores, and of intraspecific variability on some specimens have also enabled comparisons with extant forms. These observations led to provide hypotheses on the lifestyle of these extinct lobsters. Finally, the strong environmental tolerance was probably one of the keys of the success of the erymids during the Mesozoic but raised interrogations about the reasons of their extinction.

A crescente adoção do paradigma experimental na pesquisa em Engenharia de Software visa a obtenção de evidências experimentais sobre as tecnologias propostas para garantir sua correta avaliação e para a construção de um corpo de conhecimento sólido da disciplina. Uma das abordagens de pesquisa experimental é a revisão sistemática, um método rigoroso, planejado e auditável para a realização da coleta e análise crítica de dados experimentais disponíveis sobre um determinado tema de pesquisa. Apesar de produzir resultados confiáveis, a condução de uma revisão sistemática pode ser trabalhosa e muitas vezes demorada, principalmente quando existe um grande volume de estudos a serem considerados, selecionados e avaliados. Uma solução encontrada na literatura é a utilização de ferramentas de Mineração Visual de Textos (VTM) como a Projection Explorer (PEx) para apoiar a fase de seleção e análise de estudos primários no processo de revisão sistemática. Neste trabalho foi realizada uma reengenharia de software na ferramenta PEx com dois objetivos principais: apoiar, utilizando VTM, a fase de seleção e análise de estudos primários no processo de revisão sistemática e implementar novos requisitos não-funcionais relativos à melhoria da manutenibilidade e escalabilidade da ferramenta. Como resultado foi construída uma plataforma modular para a instanciação de ferramentas de visualização e, a partir da mesma, uma ferramenta de revisão sistemática apoiada por VTM. Os resultados de um estudo de caso executado com a ferramenta mostraram que a abordagem de aplicação de técnicas VTM usada nesse contexto é viável e promissora, melhorando tanto a performance quanto a efetividade da seleção / The increasing adoption of the experimental paradigm in Software Engineering research aims at obtaining experimental evidence of the proposed technologies to ensure their proper evaluation and to build a solid body of knowledge for the discipline. One approach of experimental research is the systematic review, a rigorous, auditable and planned method to carry out the collection and analysis of experimental data available on a particular research topic. Despite producing reliable results, conducting a systematic review can be a cumbersome and often lengthy process, especially when a large volume of studies is to be considered, selected and evaluated. One solution found in the literature is the use of Visual Text Mining (VTM) tools such as the Projection Explorer (PEx) to support the selection and analysis of primary studies in the systematic review process. In this work a software re-engineering was performed on PEx with two main goals: to support, using VTM, the stage of selection and analysis of primary studies in the systematic review process and to implement new non-functional requirements related to improving the maintainability and scalability of the tool. The results were the building of a modular platform for instantiating visualization tools and, from it, the instantiation of a systematic review tool supported by VTM. The results of a case study carried out with the tool showed that the VTM approach used in this context is feasible and promising, improving both performance and the effectiveness of selection

Introdução: O consumo de alimentos fontes de substâncias bioativas podem representar uma abordagem na inibição dos danos provocados pelo excesso de radicais livres, tornando-se uma alternativa na prevenção e controle das doenças cardiovasculares e suas complicações associadas, as quais apresentam significativas taxas de mortalidade e alocação de recursos públicos no Brasil. O guaraná (Paullinia cupana), planta nativa brasileira, apresenta em sua semente significativa concentração polifenóis atribuindo característica antioxidante, tornando-se objeto de interesse científico. Objetivo: Avaliar por meio de uma revisão sistemática os efeitos do guaraná (Paullinia cupana) na saúde cardiovascular em humanos. Metodologia: A revisão sistemática foi registrada no PROSPERO (CRD42018083312) e foram seguidas as propostas da Colaboração Cochrane e checklist PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Os estudos foram selecionados nas bases de dados: PubMed, Scopus, Web of Science, The Cochrane Library, Embase e Lilacs. Considerou-se o período de publicação de Dezembro de 2000 a Dezembro de 2017. Na estratégia de busca foram considerados os seguintes grupos de descritores: população (seres humanos), exposição (guaraná) e desfechos (indicadores de risco cardiovascular). Os critérios de elegibilidade foram: estudos realizados em humanos de qualquer faixa etária; nos idiomas Português, Inglês e Espanhol; descritores de acordo com os indicadores de risco cardiovascular. Artigos potencialmente elegíveis foram selecionados por dois revisores separadamente. Resultados: Foram identificados 142 artigos. Após a leitura dos títulos e resumos, 5 artigos preencheram os critérios de elegibilidade e foram analisados. Investigações experimentais sugeriram que o consumo ou suplementação do guaraná (Paullinia cupana) podem estar associados à efeitos positivos no metabolismo lipídico, principalmente nas concentrações de lipoproteína de baixa densidade (LDL) e desfecho para eventos ateroscleróticos, parâmetros pressóricos, enzimas e marcadores do estresse oxidativo. Essas implicações tendeciam ao guaraná um efeito cardioprotetor, imunomodulador, antiaterogênico, contribuintes de maneira geral, para redução de fatores de risco às doenças cardiovasculares. Discussão: Embora muitos benefícios provenientes do guaraná (Paullinia cupana) já tenham sido relatados, são escassos os estudos relacionando o consumo ou suplementação com desfechos cardiovasculares. Diversos compostos bioativos estão presentes em sua composição, sendo poucos os estudos que conseguiram definir qual o princípio ativo responsável diretamente por estas alegações à saúde cardiovascular, além de não haver consenso em relação a dosagem, além das suas diversificadas formas de administração e consumo. Porém diante dos estudos analisados, estes apresentam implicações as quais tendenciam ao consumo do guaraná o efeito cardioprotetor, imunomodulador, antiaterogênico, contribuintes de maneira geral, para redução de fatores de risco às doenças cardiovasculares. Conclusão: Este é o primeiro estudo de revisão sistemática com a temática abordada, porém são necessários mais estudos com elevada qualidade metodológica, favorecendo melhor compreensão dos benefícios do guaraná em detrimentos aos fatores de risco cardiovascular, possibilitando evidências mais consistente, agregando benefícios quanto aos desfechos e impactos a nível de saúde pública, principalmente por tratar-se de um fruto nativo brasileiro. / Introduction: The use of biological calorie sources may be a strategy to inhibit the damage caused by excess free radicals, becoming an alternative in the prevention and control of cardiovascular diseases and their associated complications, such as mortality rates, allocation of public resources in Brazil. Guaraná (Paullinia cupana), a native Brazilian plant, presents in its seed a high concentration of polyphenols attributing the antioxidant functionality, becoming an object of scientific interest. Objective: To evaluate for a systematic review of the effects of guarana (Paullinia cupana) on cardiovascular health in humans. Methodology: The systematic journal was registered in PROSPERO (CRD42018083312) and were followed as proposals of the Cochrane Collaboration and PRISMA checklist (Preferred Reports Items for Systematic Reviews and Meta-Analyzes). The authors were selected in the databases: PubMed, Scopus, Web of Science, Cochrane Library, Embase and Lilacs. The research strategy used was the following in the following indicators: cardiovascular risk indicators. The eligibility criteria were: studies in humans of any age group; in Portuguese, English and Spanish; Descriptors according to cardiovascular risk indicators. The eligible processes were selected by two reviewers separately. Results: 142 articles were identified. After reading the titles and abstracts, the five items selected were the eligibility criteria and were. Experimental experiments that can be consumed and guarana (Paullinia cupana) supplementation may be associated with positive effects for lipid metabolism, especially on low density lipoprotein (LDL) molecules and for atherosclerotic events, blood pressure parameters, enzymes and markers of oxidative stress. Keywords with the objective of protecting the cardioprotector, immunomodulator, antiatherogenic, general contributor, to reduce cardiovascular risk factors. Discussion: The scaly benefits of guarana (Paullinia cupana) have been related, there are few studies related to consumption or supplementation with cardiovascular outcomes. Several bioactive compounds are present in its composition, and few studies have been able to define what is the active factor for these cardiovascular claims, besides having no relation to the dosage, in addition to its diversified forms of administration and consumption. The role of immunomodulatory, antiatherogenic, and generally contributing contributors to reducing risk factors for cardiovascular disease. Conclusion: This is the first systematic review study with an approach approached, however, with the same cardiovascular risk indicators, making it possible to obtain the most consistent, adding benefit to outcomes and public health care, mainly because it is treated of a Brazilian native fruit.

Na atualidade, a questão dos eventos adversos a medicamentos nos idosos apresenta grande importância, dada a expansão populacional deste grupo e o impacto negativo destes eventos, que muitas vezes apresenta associação com o uso de medicamentos potencialmente inapropriados (MPI). Tendo em vista que os resultados dos estudos sobre o impacto do uso de MPI na mortalidade de idosos, ainda são inconclusivos, o objetivo foi identificar e analisar na literatura científica as evidências de que o uso de MPI em idosos, segundo critério de Beers, encontra-se associado a mortalidade. Trata-se de uma revisão sistemática finalizada em 20 de Julho de 2012, cujos procedimentos metodológicos seguiram as recomendações do Joanna Briggs Institutte e Systematic Reviews Centre for Reviews and Dissemination guidance for undertaking reviews in health care. Na busca das publicações foram utilizadas as bases de dados Pubmed/Medline, Lilacs, Scopus, Embase, International Pharmaceutical Abstracts, Web of science, Sciencedirect; CINAHL, Current contents connect, Proquest Dissertation and Theses, Banco de teses-CAPES. A seleção das publicações e extração das informações dos estudos foi realizada por dois investigadores de forma independente. A qualidade metodológica dos estudos foi avaliada pela lista de verificação Newcastle-Ottawa. A amostra da RS foi constituída por 17 estudos, sendo que destes, oito publicações compuseram a metanálise. Na síntese descritiva observou-se que a maioria dos estudos apresentou nível de evidência IV (94,1%), cujo delineamento foi coorte (94,1%), usou técnica de amostragem não probabilística (64,7%), coletou dados de modo prospectivo (64,7%), utilizou amostra superior a 1.000 idosos (64,7%), realizou seguimento de 12 a 24 meses (52,9%) e a obtenção do desfecho mortalidade ocorreu em bases de dados (64,7%). A metanálise que totalizou a participação de 90.611 participantes apontou que idosos que utilizaram MPI apresentaram maior risco relativo para o desfecho de mortalidade (RR=1,11; IC 95% 1,01 1,22; p = 0,023), de acordo com os critérios de Beers, independente do cenário do estudo, da existência de comorbidades, de polifarmácia ou do tipo de MPI usado. / Currently, the issue of adverse drug events in the elderly presents great importance, given the expansion of this population group and the negative impact of these events, which often presents association with the use of Potentially Inappropriate Medications (PIM). Having in mind that the results of studies on the impact of using MPI elderly mortality are still inconclusive, the aim was to identify and analyze the evidences in the scientific literature that the use of PIM in the elderly, according to the Beers criteria, is associated with mortality. This is a Systematic Review finalized in July 20, 2012, whose methodological procedures followed the recommendations of the Joanna Briggs Institutte and Systematic Reviews - Centre for Reviews and Dissemination Guidance for Undertaking Reviews in Health Care. In the search of the publications were used databases Pubmed / Medline, Lilacs, Scopus, Embase, International Pharmaceutical Abstracts, Web of science, Sciencedirect, CINAHL, Current Contents Connect, Proquest Dissertation and Theses database-CAPES. The selection of publications and extraction of the information of the studies was conducted by two researchers independently. The methodological quality of studies was assessed by checklist Newcastle-Ottawa. The sample was composed of RS 17 studies, of which eight publications were included in the meta-analysis. In the synthesis descriptive observed that most studies showed level of evidence IV (94.1%), whose design was cohort (94.1%) used non-probability sampling technique (64.7%), collected data from prospectively (64.7%) used sample of more than 1,000 elderly (64.7%), realized during 12 to 24 months (52.9%) and obtaining of outcome mortality occurred in databases (64.7% ). The meta-analysis which totaled the participation of 90,611 participants pointed out that the elderly who have used PIM had higher relative risk for the outcome of mortality (RR = 1.11, 95% CI 1.01 to 1.22, p = 0.023), according to Beers criteria, regardless of the setting of the study, the existence of co-morbidities, polypharmacy, or the type of PIM used.

Introdução: As mudanças nas relações entre pais e filhos decorrentes das transformações pelas quais a família vem passando têm levado a um crescente questionamento sobre o papel dos pais na educação de seus filhos. Objetivo: Realizar um levantamento sistemático e revisão crítica da literatura referente a estilos e práticas parentais, buscando apontar diretrizes que possam ser orientadores para pesquisadores, profissionais e pais. Metodologia: Revisão sistemática integrativa da literatura. Definimos como questão norteadora O que tem sido estudado e publicado sobre estilo e práticas parentais que pode orientar pesquisadores, profissionais e pais? Estabelecemos como descritores parenting style AND parenting practices e SciELO, PsycINFO, Science Direct e Web of Science como bancos de dados. Optamos por artigos publicados em periódicos, desde o início do ano 2006 até o final de 2010 e estudos voltados para as práticas com crianças de 02 aos 12 anos. Após a obtenção do corpo da pesquisa ficamos com um total de 67 artigos na integra para serem analisados. Utilizando o programa Access criamos um banco de dados que permitiu análises do conjunto do material a partir de várias tabelas construídas automaticamente de acordo com a determinação do pesquisador. Foi realizado posteriormente um trabalho exaustivo de leitura dos artigos voltada para a análise das contribuições trazidas na temática. Resultados: Percebemos uma grande maioria de artigos (61,8%) oriundos dos Estados Unidos, um aumento no número das publicações no decorrer dos anos e trabalhos predominantemente quantitativos e transversais. O número amostral utilizado variou bastante, com uma maioria de artigos (60,3%) com até 200 participantes; quanto às crianças focalizadas, meninas e meninos aparecem com porcentagens praticamente iguais. No maior número de trabalhos (39,7%), os participantes eram as crianças e seus pais (pais e mães) e as pesquisas são realizadas principalmente nas escolas (50%). Encontramos na maioria dos artigos a caracterização da sua amostra tanto com relação ao fator socioeconômico (69,1%) como dos grupos étnicos (89,7%). Dentre os instrumentos o Parenting Styles and Dimensions Questionnaire é o mais utilizado (16%) e os autores mais citados foram Baumrind (1966, 1971), seguido por Maccoby e Martin (1983) e Darling e Steinberg (1983). Após várias leituras do material completo definimos três temas: a) conjunto de práticas que afetam o desenvolvimento (34% dos artigos); b) práticas educativas e saúde (28% dos artigos); c) contexto afetando as práticas parentais (38% dos artigos). A descrição do corpo reunido por tema permite apontar: a) é comum o uso de práticas parentais coercitivas, inclusive a punição física, sendo associada com problemas de adaptação, comportamento, ajustamento emocional e baixa autoestima; b) o aumento da obesidade infantil é foco de várias pesquisas, que sugerem que o uso de práticas inadequadas, relacionadas aos estilos autoritário, negligente e indulgente propicia a obesidade infantil; c) os treinamentos para pais foram impulsionados por questões diversas - deficiência de desenvolvimento, ajustamento comportamental e emocional da criança talentosa e/ou superdotada, crianças diagnosticadas com obesidade, ansiedade, problemas de aprendizagem, de comportamento e de conduta - e foram unânimes em constatar ótimos resultados para pais e filhos; d) vários estudos correlacionais enfocam as questões das diferenças relativas à culturas e etnias, sendo sugerido que o estilo parental autoritativo de Baumrind (1966), considerado como o mais adequado a partir de estudos com norte americanos descendentes de europeus, não poderia ser considerado desta forma em outros contextos. Conclusão: através da revisão sistemática integrativa percebemos que os estudos com foco nas práticas que afetam o desenvolvimento investigam continuamente as práticas disciplinares coercitivas, que as práticas relacionadas à saúde voltam-se para problemáticas e demandas atuais e que a tipologia dos estilos parentais de Baumrind vem sendo questionada e investigada para melhor utilização em diversas culturas e etnias. / Introduction: Families have changed, and, therefore, so have parent-child relationships. This has raised constant questions regarding the parents role in their childrens education. Goal: Perform a systematic search and critical review of the literature on parenting styles and practices, aiming at pointing out guidelines to assist researchers, psychologists, and parents. Method: Integrative systematic literature review. We used the following guiding question What has been studied and published on parenting styles and practices that could guide researchers, psychologists, and parents? We chose parenting style AND parenting practices as keywords, and SciELO, PsycINFO, Science Direct and Web of Science as databases. We chose journal articles published between early 2006 and late 2010, and studies on practices with children aged 2 to 12 years. The complete body of research comprised 67 full-text articles to be analyzed. We used Microsoft Access to create a database that permitted to perform group analyses of the material from several tables created automatically and according to the researchers preference. Later, an exhaustive reading of the articles was performed aimed at analyzing their contributions. Results: We realized that the vast majority of the articles (61.8%) were originally from the United States, and that the number of publications has increased over the years, mostly quantitative and cross-sectional studies. The sample size ranged considerably, with most articles (60.3%) working with 200 participants or less; as to the children involved, boys and girls appear with virtually the same participation. The larger part of the studies (39.7%) had children and their parents for participants, and was usually (50%) performed at school. We observed that most articles characterized the sample regarding socioeconomic factors (69.1%) as well ethnic groups (89.7%). The Parenting Styles and Dimensions Questionnaire is the most often used (16%) instrument, and the most cited authors were Baumrind (1966, 1971), followed by Maccoby and Martin (1983), and Darling and Steinberg (1983). After reading the material several times, we defined three themes: a) set of practices that affect child development (34% of articles); b) educational practices and health (28% of articles); c) context affecting parenting practices (38% of articles). The description of the body of research grouped according to the theme shows that: a) coercive parenting practices are common, including physical punishment, and they are associated with problems involving adjustment, behavior, emotional adjustment, and low self-esteem; b) several focus on the increasing rates of childhood obesity, which suggest that inadequate practices, related with authoritarian, negligent and indulgent styles promote childhood obesity; c) parent training programs were motivated by several different issues impaired development, behavioral and emotional adjustment of talented and/or gifted children, children diagnosed with obesity, anxiety, and learning, behavior, and conduct disorders and were unanimous in reporting excellent results for parents and children; several correlational studies focus on issues regarding cultural and ethnical differences, suggesting that the authoritarian parenting style proposed by Baumrind (1966), considered the most appropriate according to studied with North-Americans of European descent, could not be considered as such in different contexts. Conclusion: through an integrative systematic review we realized that studies focused on practices affecting child development continuously investigate coercive disciplinary practices, that health practices aim at current issues and demands, and that the typology of Baumrinds parenting styles is being questioned and investigated to improve its use among different cultures and ethnicities.

Contexto: a eficácia dos inibidores da 3-hidróxi-3-metilglutaril-coenzima (HMG-CoA) redutase (estatinas) na prevenção primária e secundária na doença cardiovascular é bem estabelecida na literatura. Contudo os benefícios destes fármacos na prevenção secundária de mortalidade e eventos cardiovasculares no paciente com Síndrome Coronariana Aguda (SCA), ainda não foram completamente esclarecidos. Objetivo: analisar os benefícios do uso das estatinas comparadas a placebo ou cuidados usuais nos pacientes com SCA quanto a redução de mortalidade (por todas as causas), infarto agudo do miocárdio (fatal e não-fatal), intervenção coronária percutânea, revascularização cirúrgica do miocárdio e hospitalização. Base de Dados: trata-se de uma revisão sistemática finalizada em 29 de Janeiro de 2012, cuja seleção dos ensaios clínicos controlados e randomizados (ECCR) foi realizada nas bases de dados eletrônicas PubMed/MEDLINE, EMBASE, Cochrane Central, LILACS e Banco de Teses - CAPES. Coleta de Dados: a extração das informações sobre características basais dos estudos incluídos, avaliação da qualidade metodológica e desfechos não combinados foi realizada por dois investigadores de forma independente. Resultados: foram incluídos na metanálise 18 ECCR, que envolveram 15.370 pacientes com SCA. O uso das estatinas mostrou benefício na redução da mortalidade por todas as causas, diferença de risco (rd) = -0,0066 (IC 95% -0,0121 a -0,001; P=0,8459; I2=0%) e hospitalização rd = -0,0101 (IC 95% -0,0188 a -0,0014; P=2,1496; I2=76%). Quanto aos desfechos mortalidade cardiovascular, infarto agudo do miocárdio fatal e não fatal, intervenção coronária percutânea e revascularização cirúrgica do miocárdio não houve diferença estatisticamente significante entre os grupos estatinas versus placebo ou cuidados usuais. Conclusões: as evidências disponíveis apontam que as estatinas causam redução na mortalidade por todas as causas e na hospitalização, porém não demonstram diferença quando comparadas ao placebo ou cuidados usuais em outros eventos de importante magnitude clínica e econômica no âmbito dos serviços de saúde e da sociedade. / Context: the effectiveness of inhibitors of 3-Hydroxy-3-methylglutaryl-Coenzyme (HMG-CoA) reductase (statins) in primary and secondary prevention of cardiovascular disease is well established in the literature. However, the benefits of these drugs in secondary prevention of mortality and cardiovascular events in patients with Acute Coronary Syndrome (ACS) have still not been fully clarified. Objective: to analyze the benefits of using statins compared to placebo or usual care in patients with SCA on the reduction of mortality (from all causes), myocardial infarction (fatal and non-fatal), percutaneous coronary intervention, revascularization and hospitalization. Database: this is a systematic review completed on January 29, 2012, whose selection of randomized and controlled clinical trials (ECCR) was held in electronic databases MEDLINE, EMBASE, PubMed/Cochrane Central, LILACS and Theses database-CAPES. Data collection: two researchers performed the extraction of information about Basal characteristics of included studies, evaluation of methodological quality and outcomes not independently combined. Results: were included in the meta-analysis, involving 18 ECCR 15,370 patients with SCA. The use of statins has shown benefit in reducing mortality from all causes, risk difference (rd) = -0.0066 (CI 95% -0.0121 to -0.001; P = 0.8459; I2 = 0%) and hospitalization rd = -0.0101 (CI 95% -0.0188 to -0.0014; P = 2.1496; I2 = 76%). As to cardiovascular, myocardial infarction fatal and non-fatal coronary intervention, and percutaneous revascularization mortality outcomes, there was no statistically significant difference between the groups statins versus placebo or usual care. Conclusions: the available evidence suggests that statins cause a reduction in mortality from all causes and hospitalization, but do not demonstrate difference when compared to placebo or usual care in other important events within cost-effective clinic and economic magnitude of health services and society.

Os conectores sem agulhas foram introduzidos para redução de incidência de acidentes pérfuro-cortantes nos profissionais da área da saúde e a literatura apresenta evidências irrefutáveis sobre este aspecto. No entanto, não há evidências conclusivas sobre as vantagens do conector sem agulha para o paciente, no que se referem aos índices de infecção de corrente sanguínea relacionada ao cateter venoso central. Este estudo tem como objetivo evidenciar o impacto do uso de conectores sem agulhas para sistema fechado de infusão na ocorrência de infecção de corrente sanguínea relacionada ao cateter venoso central por meio de revisão sistemática, desenvolvida conforme as recomendações propostas pela Colaboração Cochrane. A estratégia de busca nas bases de dados eletrônicas utilizou os componentes do PICO: População (estudos com pacientes em uso de cateter venoso central, independente de idade, sexo, etnia e serviço de saúde vinculado); Intervenção (uso de conectores de sistema fechado sem agulhas, não-valvulados, valvulados, com pressão positiva ou não); Comparação (uso de oclusores, conectores de sistema fechado com ou sem agulhas, não-valvulados, valvulados, com pressão positiva ou não); Outcome-desfecho (infecção de corrente sanguínea, contaminação do canhão, contaminação microbiana, infecção de corrente sanguínea relacionada ao cateter). As bases eletrônicas investigadas foram: PubMEDLINE, OVID, EMBASE, LILACS, CINAHL. Também foram avaliadas as referências bibliográficas dos estudos incluídos. Os resultados estão apresentados em três etapas: caracterização do processo de seleção dos estudos encontrados na busca; caracterização dos estudos incluídos para a revisão sistemática (RS); avaliação de qualidade e força da evidência dos estudos incluídos segundo a Escala de Jadad e a Escala de avaliação de qualidade dos estudos na área de Controle e Prevenção de Infecção de Corrente Sanguínea Relacionada ao cateter Venoso Central. A amostra desta revisão sistemática constitui-se de 14 estudos, e quatro investigaram somente conectores sem agulhas. Foram encontrados 6 ensaios clínicos controlados randomizados, 4 coortes, 3 caso-controle e 1 resultado terapêutico. A infecção de corrente sanguínea relacionada ao cateter venoso central foi o desfecho de 9 estudos. Seis apresentaram diferenças a favor do conector valvulado; 04 a favor do conector puncionável com cânula; 01 a favor do conector puncionável com agulha; 01 a favor do conector valvulado com pressão positiva e 02 a favor do dispositivo usado antes da troca. A heterogeneidade dos estudos quanto aos desenhos de pesquisa, as características das populações e os fatores de riscos controlados e os resultados, não permitem a realização de meta-análise, contudo, é possível afirmar, com base nos quatro melhores estudos encontrados, que a implantação de conectores sem agulhas, quer valvulados ou com injetor pré-furado, com manutenção de sistema fechado de infusão, apresentam impacto positivo relacionado à menor contaminação do canhão do cateter ou na ocorrência de infecção de corrente sanguínea relacionada ao cateter venoso central / Needleless connectors were introduced to reduce the incidence of needlestick injuries in health professionals and according to the literature their effectiveness is irrefutable. However, there is no conclusive evidence on the advantages of needleless connectors for patients with regard to bloodstream infection rates from the use of central venous catheters. The objective of this study was to determine the impact of the use of needleless connectors in closed infusion systems on the occurrence of bloodstream infections related to the use of central venous catheters by conducting a Cochrane systematic review. The strategy for searching electronic databases employed the components of the PICO model: Population (studies of patients using central venous catheters, regardless of age, sex, race and associated health service); Intervention (use of closed needleless connector systems, with and without valves, with and without positive pressure); Comparison (use of plugs, closed system connectors with and without needles, with and without valves, with and without positive pressure); Outcome (bloodstream infection, cannula contamination, microbial contamination, bloodstream infection related to catheter). The electronic databases investigated were: PubMEDLINE, OVID, EMBASE, LILACS and CINAHL. Bibliographical references of the studies included were also evaluated. The results are presented in three stages: characterization of selection process for studies found in the search; characterization of studies included in the systematic revision; evaluation of quality and strength of evidence for studies included according to the Jadad Scale and the scale of quality of studies in the control and prevention of bloodstream infections related to central venous catheters. The sample of this systematic review was made up of 14 studies of which 4 investigated only needleless connectors. We found 6 randomized control clinical trials, 4 cohort, 3 case-control and 1 therapeutic result. Bloodstream infection related to central venous catheters was the outcome for 9 studies. Six presented differences regarding the valved connector; 04 in favor of the puncturable connector with cannula; 01 in favor of the puncturable connector with needle; 01 in favor of the valved connector with positive pressure and 02 in favor of the device used before the change. The heterogeneous nature of the studies with regard to design, population characteristics and controlled risk factors and results prevented a meta-analysis. However, it is possible to state, based on the four best studies found, that the introduction of needleless connectors, whether valved or puncturable with cannula, coupled with a closed infusion system, presented a positive impact on lowering contamination of catheter cannulae and on the occurrence of bloodstream infection related to central venous catheters