Background and objectives: Stress-related illness is a growing public health problem in Sweden and it is the most common reason for sick leave today. Stress-related illness causes suffering on a number of levels and affects the patient’s health and life in the long term. The stress-related ill health also leads to consequences for society, causing high costs for sick leave and health care as well as lost workforce since people partially or entirely lose their capacity to work. Research on stress-related ill health and rehabilitation often underline work-related conditions as crucial in dealing with the problem. There is also research that points out psychosocial factors in understanding stress-related ill health. What we know little about is the existential perspective of clinical burn-out. Therefore, it is of importance to investigate people’s existential experiences of clinical burn-out and the significance of an existential perspective in rehabilitation. Aim: The overall aim of this thesis is to gain insight into the existential experience of clinical burn-out as well as to highlight the significance of an existential perspective in rehabilitation. In addition, the thesis aims to reach a deeper understanding of clinical burn-out from an existential point of view and contribute to the field with knowledge of the existential dimension of health. Methods: The study, conducted in 2011, is based on qualitative interviews made with an inductive hermeneutic approach. Five patients and seven care givers were interviewed, focusing their existential experiences of clinical burn-out as well as their experiences of rehabilitation with an existential approach. A strategic selection was made of informants in the context of a rehabilitation program with an existential approach for people diagnosed with clinical burn-out. The data was analysed in two steps. In the first step the data was interpreted with an inductive hermeneutic approach. In step two of the analysis, the data was interpreted with a deductive hermeneutic approach, using Karl Jasper’s concept of limit situation as a way of interpreting the existential experience. Aaron Antonovsky’s concept sense of coherence was used as a tool for understanding components that can contribute to restoring health. Results: In this study, the patients describe clinical burn-out as a comprehensive existential experience that can be perceived as being in between life and death, in a shadow world, trapped in a dead end. It’s a situation characterized by being powerless. It creates a need to comprehend one’s situation in order to be able to regain control and manage it. It’s a struggle to make sense of the life situation. When not being met with understanding, the patients lose hope. Existential issues in terms of meaning, existence and life choices become urgent. Working with the existential perspective requires trust, openness from both caregiver and patient, distinctness, a way to communicate it and courage to take on the challenge of dealing with existential issues. The perspective also requires that the existential suffering can be contained. Dealing with existential questions leads to self-knowledge and insights that enables a possibility to make different choices and leave negative behavioural patterns. Also, it can lead to a discovery of spirituality and religion as a resource in life. Besides their personal struggle for meaning, the patients see an existential void in society, leaving people without tools to handle existential needs. This is understood as something that affects people’s ability to handle stressful times in life. The care providers understand burn-out as a manifestation of a way of living that is not sustainable. It is an existential experience embodied in body and mind that can be experienced as being drained of life. It’s an existential challenge, causing grief when realizing one’s limitations as a human being. Also, loss of meaning and sense of existential vulnerability due to an experience of being annihilated is crucial for understanding the deep existential crisis that clinical burn-out can induce. This situation makes the patient ask existential questions about identity, meaning, values and direction. In the burnout-process the patients have distanced themselves from their own self and therefore need to reconnect with themselves. This makes the existential questions central in the rehabilitation as a way to reconnect to inner strength and resources, which are prerequisites for starting a health promoting, sustainable process which is empowering, making it possible to see oneself as a human being who experience meaning, not only as a patient with a diagnosis. Instead of finding meaning in the diagnosis, the patient’s existential questions and the existential experience is a key to moving forward, out of the situation. Meaning-making is therefore important in the rehabilitation. A holistic-existential approach and view of man makes it possible to work with the complexity of the situation. The holistic-existential approach creates synergies and offers an extra tool both for the caregiver and the patient. Focusing on the patient’s resources and competence makes it possible to see the crisis as a way to learn from it. The existential perspective in health care and rehabilitation is enabled by competence, openness, reliance, empathy and respect when meeting the patient. It also requires courage to take on the challenge of dealing with existential issues. It can be hard for both the patient and the care giver to confront existential suffering. It is the responsibility of the care giver to enable the existential perspective by acknowledging and making the existential perspective possible to communicate and work it through. The care providers understands values in modern society as contributing to people’s experience of feeling alone with existential needs, which intensifies their existential aloneness. The care providers’ experience is that the biomedical paradigm aggravates an existential perspective. The perspective is not associated with the care situation. There is a lack of knowledge about and understanding of the value of the existential perspective, all the way from the decision-making level to the clinical meeting with the patient. In addition, the paradigm affects how the patients express their illness. Also, the perspective requires time. Existential perspectives, therefore, tend to be concealed in the health care context. Applying Karl Jasper’s concept of limit situation, clinical burn-out can be interpreted as a defining existential experience. It can be understood as a limit situation when humans realize their limitations and at the same time get insights that are crucial for their lives. It’s an experience they wish they had not gone through, but on the other hand, it has led to insights they do not want to be without. The meaning-making process is health promoting by recreating meaning, the fundamental part of sense of coherence, which is crucial for a salutogenic direction. Conclusion: The existential state that the clinical burnout patients go through can, using Karl Jasper’s concept, be understood as a limit situation. According to Jasper’s reasoning, the limit situation can be perceived as facing an abyss, making it clear one has limitations as a human being. At the same time, the experience can be perceived as reaching a limit where humans can get insights about human life that can enhance life. Clinical burn-out, using Aaron Antonovsky’s concept, can be understood as a loss of the components that create sense of coherence. Loss of meaning is particularly central for understanding burn-out. Consequently, it is crucial to acknowledge the existential challenge that the patient is facing, as well as the importance of the meaning-making process for facilitating a movement in a health promoting manner. It gives a deeper understanding of the challenges and needs of patients suffering from clinical burn-out. The existential dimension of health has been highlighted in health promotion, but gets little attention in practice. This is especially significant in the health care context. This points out the need for a discussion about how the existential health dimension can be used as a resource in health care and rehabilitation and how this resource for health can be applied in a better way in health promotion and public health.

O meropenem é um carbapenêmico de amplo espectro e alta potência, largamente prescrito para tratamento de infecções graves causadas por bactérias sensíveis gram-negativas em pacientes críticos internados em Unidades de Terapia Intensiva. O objetivo do presente estudo foi avaliar a efetividade do antimicrobiano em pacientes grandes queimados, recebendo a dose recomendada 1 g q8h através da infusão intermitente de 0,5 hora que ocorreu até 2014 (grupo 1) comparada a infusão estendida de 3 horas que ocorreu após esse período (grupo 2). Investigaram-se 25 pacientes sépticos de ambos os sexos (6F/19M), 26 (21-34) anos, medianas (interquartil), 70 (60-75) kg, superfície corporal total queimada (SCTQ) 35 (16-42)%, SAPS 3: 55 (45-59) e Clcr 129 (95-152) ml/min que foram distribuídos em dois grupos. Registrou-se trauma térmico pelo fogo em 19/25 e trauma elétrico no restante dos pacientes (6/25), lesão inalatória (17/25), intubação orotraqueal e a necessidade de vasopressores em 18/25 pacientes. Duas amostras de sangue foram coletadas (3ª e 5ª horas) para dosagem sérica do meropenem por cromatografia líquida no período precoce do choque séptico. A farmacocinética foi investigada pela aplicação do modelo aberto de um compartimento e a abordagem PK/PD foi realizada com base no novo índice recomendado 100%f&#916;T>CIM. Evidenciou-se aumento do PCR 224 (179-286) versus 300 (264-339) mg/L, p=0,0411 e neutrofilia: 12 (8-17) versus 8 (2-15) células/mm3, p=0,1404, respectivamente nos grupos de infusão estendida versus infusão intermitente. Os níveis séricos obtidos mostraram diferença significativa entre grupos (p<0,0001) tanto para o pico 21 (21-22) mg/L versus 44 (42-45) mg/L, como para o vale 7,8 (7,3-9,5) mg/L versus 3,0 (2,6-3,7) mg/L. A farmacocinética mostrou-se alterada nos dois grupos frente aos dados de referência reportados em voluntários sadios. Significativa alteração ocorreu em diferentes proporções pela comparação entre os grupos relativamente à constante de eliminação 0,190 (0,157-0,211) versus 0,349 (0,334-0,382) h-1; meia-vida biológica 3,6 (3,3-4,4) versus 2,0 (1,8-2,1) h; depuração total corporal 8,6 (8,2-8,9) versus 5,3 (5,2-5,4) L/h; volume de distribuição 41,8 (39,9-44,5) versus 15,4 (14,1-16,2) L (p<0,0001). A infecção de ferida foi a mais prevalente nos dois grupos com 47% versus 38% dos isolados, sendo a Klebsiella pneumoniae, a principal enterobactéria. A abordagem PK/PD para patógenos CIM 1 a 4 mg/L mostrou cobertura até CIM 4 mg/L para a infusão estendida e até CIM 2 mg/L para infusão intermitente. Em conclusão, demonstrou-se a superioridade da infusão estendida decorrente de alterações na farmacocinética do meropenem em pacientes grandes queimados. O aumento do volume de distribuição contribuiu para o prolongamento da meia-vida e dos altos níveis de vale registrados, o justifica o impacto na cobertura antimicrobiana após infusão estendida e controle das infecções com cura desses pacientes. / Meropenem is a broad-spectrum agent widely prescribed for the treatment of septic shock caused by gram-negative susceptible strains in critically ill patients from the Intensive Care Units. Subject of the present study was to evaluate the drug effectiveness in critically ill septic burn patients in SIRS at the early period of septic shock receiving the recommended dose of Meropenem 1 g q8h by intermittent 0.5 hour infusion or the extended 3 hour infusion. Twenty-five septic patients were: (6F/19M), 26 (21-34) years, medians (quartiles), 70 (60-75) kg, total burn body surface (SCTQ) 35 (16-42) %, SAPS 3: 55 (45-59) and Clcr 129 (95-152) ml/min. Thermal trauma was registered in 19/25 and electrical trauma in the remaining patients (6/25), inhalation injury (17/25), orotracheal intubation and vasopressor requirement in 18/25 patients. Patients were distributed in two groups on the basis of the duration of drug infusion that occurred for the patients of group 1 (1g q8h 0.5 hr) until 2014, December in the hospital. In addition, the extended 3 hours infusion occurred after that period for patients enrolled afterwards (group 2). Pharmacokinetics was investigated after blood sampling at the third (3rd) hour and the fifth (5th) hour of starting the meropenem infusion. Serum drug measurement was done by liquid chromatography. A one compartment open model was applied and kinetic parameters were estimated. PK/PD approach based on the new recommended index of drug effectiveness 100% f&#916;T>MIC was performed, on the basis on PK parameters and the minimum inhibitory concentration, PD parameter. It was demonstrated a significant difference between groups (p <0.0001) related to the trough levels 7.8 (7.3-9.5) mg/L versus 3.0 (2.6-3.7) mg/L, respectively after extended infusion or intermittent infusion. Concerning the pharmacokinetics, it was shown profound changes on meropenem kinetic parameters in both groups of burn patients by comparison with the reference data reported in healthy volunteers. In addition, it is important to highlight that significant changes occurred also by comparison of PK data between groups of patients related to the parameters: elimination constant 0.190 (0.157-0.211) versus 0.349 (0.334-0.382) h-1; biological half-life 3.6 (3.3-4.4) versus 2.0 (1.8-2.1) hr; total body clearance 8.6 (8.2-8.9) versus 5.3 (5.2-5.4) L/hr; volume of distribution 41.8 (39.9-44.5) versus 15.4 (14.1-16.2) L. Concerning the inflammatory biomarker an increase of C-reactive protein was registered in both groups of septic patients in SIRS: 224 versus 300 mg/L, p = 0.0411, after the extended infusion versus intermittent infusion, respectively. Wound and bone were the most prevalent sites of infection in those patients of both groups. It was shown in the isolates the prevalence of Gram-negative strains 54/83 (65%) that were distributed in Enterobacteriaceae, K. pneumoniae 7/30 (23%), and Non-Enterobacteriaceae, P. aeruginosa 13/54 (24%) followed by Acinetobacter baumannii 11/54 (20%). Drug effectiveness against susceptible strains was demonstrated by PK/PD approach up to 4 mg/L over 2 mg/L, after the extended infusion or after intermittent infusion, respectively. In conclusion, the superiority of the extended infusion in septic burn patients at the earlier period of septic shock was demonstrated, once considerable increases on volume of distribution impacted the drug effectiveness of these patients. Cure was obtained by meropenem monotherapy in 22/25 patients; only three patients (3/25) received meropenem - colistine combined therapy due to Acinetobacter baumannii isolated.

In today's era of high stakes testing and accountability, school principals are confronted with many difficult challenges in addition to those traditionally experienced by principals given the advent of No Child Left Behind (NCLB) and the many mandates each school principal must report on annually. With mandated curriculum standards and widespread demand to improve student achievement, principals face a multitude of administrative tasks. As the school accountability deadline to meet the 2014 federal objective of the No Child Left Behind Act of 2001 rapidly draws closer for the majority of states, this federal legislation has created increasingly high stress levels, potentially the highest ever, for principals across the country. ... The proposed study is significant to the field of education because this study provides the most current research regarding the mental and physical effects of work-related stress on elementary school principals in an era of increased accountability and the impact stress has on the school climate. Further, this study offers school principals a repertoire of effective coping mechanisms that can be utilized to help reduce their perceived stress levels. Over the time of the study, it was repeatedly reported by the principal participants that their work stress had increased, which was found to have impacted their health as well as the school climate. / by Joyce Krzemienski. / Thesis (Ph.D.)--Florida Atlantic University, 2012. / Includes bibliography. / Mode of access: World Wide Web. / System requirements: Adobe Reader.

Introdução: O uso de matrizes dérmicas é uma opção no tratamento de vários tipos de sequelas de queimaduras. O objetivo deste estudo foi avaliar e comparar a contração tardia dos enxertos de pele de espessura parcial autólogos utilizados para o tratamento de sequelas de queimaduras associado com as matrizes dérmicas Integra®, Matriderm® e Pelnac®. Métodos: Este é um ensaio clínico prospectivo, randomizado e controlado, e foi aprovado pelo Comitê de Ética em Pesquisa da instituição. O estudo comparou a contração da área do enxerto de pele de espessura parcial autólogo associado ou não com a matriz dérmica após 1, 3, 6 e 12 meses da cirurgia para tratamento de sequelas de queimaduras em pacientes da Unidade de Queimados de um hospital universitário. Os critérios de inclusão foram pacientes acima de 18 anos de idade, com uma ou mais sequelas de queimadura causando prejuízo funcional, com seguimento pós-queimadura de no mínimo 1 ano, e com indicação de tratamento cirúrgico usando enxerto de pele de espessura parcial. Os critérios de exclusão foram a perda do seguimento clínico, perda da matriz dérmica e falha na integração de mais de 10% do enxerto de pele parcial. As sequelas dos pacientes foram submetidas a randomização permutada em bloco por sorteio (de acordo com as normas do CONSORT) para um de quatro grupos: Grupo Integra® (n=10), Grupo Pelnac® (n=10), Grupo Matriderm® (n=9), e Grupo Controle (n=10), cujo tratamento envolveu apenas o enxerto de pele sem uso de matriz dérmica. Utilizamos este tipo de randomização para garantir um número balanceado de participantes nos diferentes grupos. As cirurgias foram realizadas pelo mesmo cirurgião e consistiu na ressecção da sequela da queimadura, gerando um defeito de cobertura cutânea. As cirurgias foram em dois tempos para os grupos Integra® e Pelnac® (primeiro a ressecção da sequela e colocação da matriz dérmica, e 21 dias depois remoção da lâmina de silicone e aplicação do enxerto de pele de espessura parcial autólogo sobre a matriz), ou em tempo único para os grupos Matriderm® e Controle (ressecção da sequela, colocação da matriz e do enxerto de pele de espessura parcial, ou apenas do enxerto de pele de espessura parcial). A obtenção dos enxertos de pele foi realizada por meio de dermátomo elétrico com regulagem de 0,2mm de espessura em todos os grupos. No intraoperatório, o contorno do defeito tridimensional (que corresponde ao contorno da matriz ou do enxerto de pele) foi marcado com azul de metileno e transferido para um anteparo maleável estéril de superfície plana, sempre em posição de extensão máxima para membros e pescoço. A obtenção das medidas no pós-operatório foi realizada da mesma forma com 1, 3, 6 e 12 meses. Essas medidas foram posteriormente transferidas para uma folha de papel com escala de centímetros, e submetidas a fotografias com máquina fotográfica com plano focal paralelo ao da folha de papel e com distância fixa de 40 cm. O cálculo das dimensões foi realizado por meio do software de planimetria digital \"Image J\" e comparados entre os grupos. Dessa forma, foi possível calcular a porcentagem de contração do enxerto de pele de espessura parcial em relação ao defeito original. A análise estatística foi realizada pelo software SAS® 9.2 utilizando o modelo de regressão linear com efeitos mistos (efeitos aleatórios e fixos), e o nível designificância adotado foi 5%. Resultados: Foram operadas 39 sequelas de queimaduras em 30 pacientes, sendo 19 do sexo masculino e 21 do sexo feminino. Após 12 meses, os resultados mostraram que o Grupo Controle apresentou menores taxas de contração do enxerto comparado aos grupos das matrizes dérmicas Integra® (p<0,01), Matriderm® (p=0,01), e Pelnac® (p<0,01); o Grupo Pelnac® mostrou uma contração do enxerto de pele estatisticamente maior comparado ao Grupo Matriderm® (p<0,01) e ao Grupo Integra® (p=0,02); a contração do enxerto de pele do Grupo Integra® não apresentou diferença significativa comparado ao Grupo Matriderm® (p=0,16). A contração variou bastante entre as diversas áreas do corpo, e a região cervical apresentou uma elevada taxa de contração em todos os grupos, sendo estatisticamente maior comparado com as outras regiões do corpo (p<0,01). Conclusão: No tratamento de sequelas de queimaduras, a contração tardia dos enxertos de pele de espessura parcial foi maior quando associados com matrizes dérmicas, em comparação ao enxerto de pele sem uso de matriz. A contração dos enxertos teve grande variabilidade de acordo com o local da sequela, sendo que a região cervical apresentou os maiores índices de contração. / Purpose: The use of dermal matrices is an option in the treatment of burn sequelae. The objective of this study was to evaluate and compare the contraction of autologous split-thickness skin grafts used for the treatment of burn sequelae associated with dermal matrices. Methods: This is a prospective, randomized, controlled clinical trial, comparing the contraction of the autologous split-thickness skin graft associated or not with dermal matrix after 1, 3, 6 and 12 months postoperatively for the treatment of burn sequelae. Patients were selected from the Burns Unit of an university hospital, and our Institutional Review Board approved this study. Inclusion criteria were patients with one or more burn sequelae causing functional impairment, with post-burn follow-up of at least one year, and with an indication of surgical treatment using split-thickness skin graft. Exclusion criteria were the loss of follow-up, loss of the dermal matrix, and failure to integrate more than 10% of the split-thickness skin graft. Patients\' sequelae were randomly assigned to a randomized block design (according to the CONSORT standards) for one of four groups: Integra® Group (n = 10), Pelnac® Group (n = 10), Matriderm® Group (n = 9), and Control Group (n = 10), whose treatment involved only the skin graft without dermal matrix. Surgeries were performed by the same surgeon and consisted of resection of the burn sequelae, leading to a tegument defect. Surgeries were performed in two stages for the Integra® and Pelnac® groups (first resection of the sequela and placement of the dermal matrix, and 21 days later removal of the silicon sheet and application of the skin graft on the matrix), or in single stage for the Matriderm® and Control groups (resection of the sequelae, placement of the matrix and skin graft, or only the skin graft). The skin grafts were obtained using an electric dermatome with the regulation of 0.2 mm thickness in all groups. During the surgery, the contour of the three-dimensional defect (corresponding to the contour of the matrix or the skin graft) was marked with methylene blue and transferred to a sterile, flat surface, always in the position of maximum extension for limbs and neck. This procedure was also performed after 1, 3, 6 and 12 months postoperatively. Then, it was transferred to a sheet of paper with a centimeters scale and submitted to pictures using a camera with a fixed distance of 40 cm. The measures of the dimensions were carried out using the digital planimetry software \"Image J\" and compared among the four groups. Thus, we calculate the percentage of contraction of the split-thickness skin graft comparing it to the original defect. Statistical analysis was carried out using the linear regression model with mixed effects (random and fixed effects), and the significance level adopted was 5%. Results: Thirty-nine burn sequels were performed in 30 patients, 19 male and 21 female. Twelve months postoperatively, the results showed that the Control Group presented lower rates of skin graft contraction compared to the Integra® (p < 0.01), Matriderm® (p = 0.01) and Pelnac® (p < 0.01); the Pelnac Group showed a statistically larger contraction of the skin graft compared to the Matriderm® Group (p < 0.01) and the Integra® Group (p = 0.02); the contraction of the skin grafts from the Integra® Group did not present a significant difference compared to the Matriderm® Group (p = 0.16). The contraction varied widely among the treated areas, and the cervical region showed a high rate of contraction in allgroups, being statistically higher compared to the other body regions (p < 0.01). Conclusion: In the treatment of burn sequelae, the late contraction of split-thickness skin grafts was greater when associated with dermal matrices, in comparison to the skin graft without dermal matrix. The contraction of the skin grafts had great variability according to the location of the sequelae, and the cervical region had the highest rates of contraction.

This study investigates the relationship between mobbing, burnout, and religious coping styles among Protestant clergy. Mobbing is an emotionally abusive workplace behavior and is defined as the prolonged malacious harassment of a coworker by a group of other members of an organization to secure the removal from the organization of the one who is targeted. Mobbing has only recently become a focus of attention in the US. To date, there are no known studies investigating mobbing in the workplace setting of the church. The broad purpose of this study is to determine if Protestant pastors experience mobbing, how they are affected by it, and how they cope with it. Four religious coping styles - Self-directing, Collaborative, Deferring, and Surrender to God - are investigated to determine how coping styles of religious individuals function in mediating the effect of mobbing or burnout. Burnout is assessed throught he Maslach Burnout Inventory and measures emotional exhaustion, depersonalization, and reduced personal accomplishment. This study utilizes Structural Equation Modeling (SEM) and presents two models of mediational analysis.... The results of analysis indicate that Protestant clergy do experience being mobbed which results in emotional exhaustion and depersonalization. Clergy with a self-directing coping style experience more burnout than do those who utilize a surrender to God style. Differences in indirect effects between models were noted. The implications to theory and practice are discussed. / by Steven R. Vensel. / Thesis (Ph.D.)--Florida Atlantic University, 2012. / Includes bibliography. / Mode of access: World Wide Web. / System requirements: Adobe Reader.

Made available in DSpace on 2016-07-27T14:22:10Z (GMT). No. of bitstreams: 1 Priscilla Maria Pires Frota.pdf: 4466873 bytes, checksum: 737dd748e5c812cead9713d22cb32acb (MD5) Previous issue date: 2010-12-01 / Previous studies have demonstrated that both the experience of stressing events and the strategies chosen to deal with them greatly influence people s adaptation and welfare. Taking this into consideration, the main goal of the present study was to examine the existence of correlation among the use of coping strategies, personality, and social support in a group of burn survivors. Initially, a theoretical review on the aforementioned themes was carried out, and, posteriorly, an empirical study was developed. In order to perform the empirical study, the participants answered questions regarding their sociodemographics. For the extraction and evaluation of data such as the coping strategies adopted, social support received and perceived from the social network of each participant, as well as the personality traits, the following instruments were used: Coping Strategy Indicator, Personality Markers, and MOS Social Support Survey. The results obtained evidenced that the sample analyzed presented correlation among the variables coping, personality markers, and social support, demonstrating that socialization correlated positively with reported social support whereas neuroticism correlated negatively with reported social support. It is important to emphasize that, differently from other studies, no significant relationships were found between social support and coping in the sample analyzed. These data are useful to a better planning of the types of intervention that should be implemented in the treatment of burn survivors, based on their peculiarities, so that their results and consequent adaptation to the new routine can be optimized. / Estudos anteriores demonstraram que não apenas a vivência de eventos estressantes como também as maneiras escolhidas para enfrentar estas situações muito influenciam na adaptação e bem-estar das pessoas. Em função disso, o presente estudo teve como objetivo principal investigar a existência de correlação entre o uso de estratégias de coping, personalidade e apoio social para um grupo formado por sobreviventes de queimaduras graves. Em um primeiro momento, foi realizada revisão teórica sobre os temas acima citados e, posteriormente, foi desenvolvido um estudo empírico. Para a realização do estudo empírico, os participantes responderam a perguntas relativas aos seus dados sociodemográficos. Também foram submetidos à aplicação dos instrumentos Coping Strategy Indicator, Marcadores de Personalidade e Questionário de Apoio Social (Escala de MOS) para a extração e a avaliação de dados como as estratégias de coping adotadas, o apoio social recebido e percebido da rede social de cada sujeito, além de características de personalidade. Os resultados obtidos evidenciaram que, na amostra pesquisada, houve correlação entre as variáveis coping, marcadores de personalidade e apoio social, demonstrando que quanto maior a pontuação em socialização, maior o relato de apoio social, assim como quanto maior a pontuação em neuroticismo, menor o relato de apoio social. Ressalta-se que, diferentemente de outros estudos, não foram encontradas relações significativas entre apoio social e coping na amostra avaliada. Esses dados são úteis para melhor planejar os tipos de intervenção que devem ser implementados no tratamento de sobreviventes de queimaduras graves, com base em suas particularidades, de modo a otimizar seus resultados e a consequente adaptação ao novo cotidiano.

Submitted by Elba Lopes (elba.lopes@fecap.br) on 2016-02-10T14:57:11Z No. of bitstreams: 2 Alexandre_Luis_Gonzaga.pdf: 709405 bytes, checksum: 4d482624a35ea9c5fee2573da0231a90 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2016-02-10T14:57:11Z (GMT). No. of bitstreams: 2 Alexandre_Luis_Gonzaga.pdf: 709405 bytes, checksum: 4d482624a35ea9c5fee2573da0231a90 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2003-11-24 / Burnout, a widely studied phenomenon, has been defined as having a three dimension structure. In this study, the instrument was translated to Portuguese and afterwards the survey was applied in a financial institution. The instrument was submitted to a statistic validation with the use of factorial analysis - Equamax rotation and tests KMO and Barlett - opening the way to the comparison with Barnet works et al. (1999), Gil-Monte (2002), Jimenez (2002) and Maslach & Jackson (1986). It was identified a structure with five factors in the process of validation of Maslach Burnout Inventory opening new perspectives of analysis of this syndrome in the working place. The octagonal rotation did not confirm the factors predicted by Maslach and Jackson. This way the factors were called: 1 - Street in the workplace; 2 - Interpersonal relationship; 3 - Satisfaction in the workplace; 4 - Interest in the customer service; 5 - Apathy in the workplace. / Burnout, um fen??meno amplamente estudado, tem sido definido como tendo uma estrutura fatorial de tr??s dimens??es. Neste estudo efetuou-se a tradu????o do instrumento para a l??ngua portuguesa, e o submetemos a valida????o segundo m??todos quantitativos, abrindo caminho para compara????o com os trabalhos de Barnet et. al. (1999), Gil-Monte (2002), Grajales (2000), Jimenez (2002) Schutte (2000) e Maslach & Jackson (1986). N??s identificamos uma estrutura de cinco fatores no processo de valida????o do instrumento de medida Maslach Burnout Inventory abrindo novas perspectivas de an??lise desta s??ndrome no ambiente de trabalho. A rota????o ortogonal n??o confirmou os fatores previstos por Maslach & Jackson. Assim, os fatores foram denominados: 1- Stress no local de trabalho; 2- Relacionamento interpessoal; 3- Satisfa????o no trabalho; 4- Atendimento ao cliente; 5- Apatia no trabalho.

Introdução: A assistência hospitalar a pacientes portadores de queimaduras é altamente dispendiosa devido aos recursos humanos, materiais e estruturais necessários à sua viabilização. O conhecimento financeiro relativo a essa temática ainda é escasso, especialmente no que tange aos custos dos procedimentos executados por profissionais de enfermagem a pacientes, grandes queimados, em condições críticas. Objetivo: Identificar o custo direto médio (CDM) dos procedimentos realizados, com maior frequência, por profissionais de enfermagem, a pacientes grandes queimados internados em uma Unidade de Terapia Intensiva de Queimaduras (UTIQ). Método: Esta pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso único, foi conduzida na UTIQ da Unidade de Queimaduras do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. O CDM foi calculado multiplicando-se o tempo (cronometrado) despendido por profissionais de enfermagem na execução dos procedimentos, objeto de estudo, pelo custo unitário da mão de obra direta, somando-se ao custo dos materiais e soluções/medicamentos. Para a realização dos cálculos utilizou-se a moeda brasileira (R$). Resultados: A partir de 1354 observações, relativas a 12 procedimentos frequentemente realizados na UTIQ, obteve-se o CDM de R$ 1,88 (DP=1,04) para controle dos sinais vitais; R$ 28,78 (DP=69,74) para administração de medicamentos via intravenosa; R$ 16,97 (DP=7,92) para mensuração de diurese; R$ 2,68 (DP=1,20) para verificação de glicemia capilar; R$ 6,71(DP=2,20) para administração de medicamentos via sonda nasoenteral; R$ 50,07 (DP=11,89) para higiene íntima no leito; R$ 3,64 (DP=2,01) para auxílio alimentação; R$ 55,88 (DP=18,98) para banho no leito/arrumação da cama; R$ 287,11 (DP=372,87) para curativo; R$ 6,65 (DP=2,09) para higiene oral; R$ 3,13 (DP=1,08) para administração de medicamentos via oral e R$ 8,51 (DP=1,79) para administração de medicamentos via subcutânea. Conclusão: A apuração dos custos dos recursos consumidos nos procedimentos requeridos pelos pacientes, grandes queimados, em UTI, pode fundamentar as tomadas de decisão gerenciais subsidiando a sua eficiência alocativa, evitando a ocorrência de desperdícios e, quando possível, indicando estratégias de contenção/minimização de custos sem prejuízos à qualidade da assistência de enfermagem. / Introduction: Hospital care for critical burn patients is highly costly due to human, material and structural resources required for its viability. The financial knowledge concerning this subject is still scarce, especially in regard to the cost of procedures performed by nurses in critical burn patients. Objective: To identify the average direct cost (ADC) of the nursing procedures carried out with greater frequency for burn patients admitted into the burn intensive care unit (BICU). Methodology: This quantitative exploratory and descriptive single case study was conducted in BICU at the Burn Unit of the Hospital das Clinicas of the Faculty of Medicine, Universidade de Sao Paulo. The ADC was calculated by multiplying the time (chronometering) spent by nursing professionals in procedures, object of this study, by the unit cost of direct labor adding to the cost of materials and solutions/drugs. For the purposes of the calculation, the Brazilian currency (R$) was used. Results: Based on 1354 observations related to 12 procedures often performed in BICU, it was obtained the ADC of R$ 1.88 (SD=1.04) for \"control the vital signs\"; R$ 28.78 (SD=69.74) for \"administering medication intravenously\"; R$ 16.97 (SD=7.92) for \"measurement of diuresis\"; R$ 2.68 (SD=1.20) to \"check Capillary Blood Glucose\"; R$ 6.71 (SD=2.20) for \"drug administration via nasogastric tube\"; R$ 50.07 (SD=11.89) for \"patient intimate hygiene; R$ 3.64 (SD=2.01) for \"food aid\"; R$ 55.88 (SD=18.98) for \"bed bathing/make the bed\"; R$ 287.11 (SD=372.87) for \"dressing\"; R$ 6.65 (SD=2.09) for \"oral hygiene\"; R$ 3.13 (SD=1.08) for \"oral drug administration\" and R$ 8.51 (SD=1.79) for \"drug administration subcutaneously\". Conclusion: The calculation of the resource costs spent in the procedures required by critical burn patients, in ICU, justify the decision making of subsidizing its allocative efficiency, avoiding the occurrence of waste and, when possible, indicating control strategies/minimizing strategy costs without impairing the quality of nursing care

Ngai Sek-yum, Steven. / Bibliography: leaves 187-193 / Thesis (M.S.W.)--Chinese University of Hong Kong, 1986

Introdução: O uso de matrizes dérmicas é uma opção no tratamento de vários tipos de sequelas de queimaduras. O objetivo deste estudo foi avaliar e comparar a contração tardia dos enxertos de pele de espessura parcial autólogos utilizados para o tratamento de sequelas de queimaduras associado com as matrizes dérmicas Integra®, Matriderm® e Pelnac®. Métodos: Este é um ensaio clínico prospectivo, randomizado e controlado, e foi aprovado pelo Comitê de Ética em Pesquisa da instituição. O estudo comparou a contração da área do enxerto de pele de espessura parcial autólogo associado ou não com a matriz dérmica após 1, 3, 6 e 12 meses da cirurgia para tratamento de sequelas de queimaduras em pacientes da Unidade de Queimados de um hospital universitário. Os critérios de inclusão foram pacientes acima de 18 anos de idade, com uma ou mais sequelas de queimadura causando prejuízo funcional, com seguimento pós-queimadura de no mínimo 1 ano, e com indicação de tratamento cirúrgico usando enxerto de pele de espessura parcial. Os critérios de exclusão foram a perda do seguimento clínico, perda da matriz dérmica e falha na integração de mais de 10% do enxerto de pele parcial. As sequelas dos pacientes foram submetidas a randomização permutada em bloco por sorteio (de acordo com as normas do CONSORT) para um de quatro grupos: Grupo Integra® (n=10), Grupo Pelnac® (n=10), Grupo Matriderm® (n=9), e Grupo Controle (n=10), cujo tratamento envolveu apenas o enxerto de pele sem uso de matriz dérmica. Utilizamos este tipo de randomização para garantir um número balanceado de participantes nos diferentes grupos. As cirurgias foram realizadas pelo mesmo cirurgião e consistiu na ressecção da sequela da queimadura, gerando um defeito de cobertura cutânea. As cirurgias foram em dois tempos para os grupos Integra® e Pelnac® (primeiro a ressecção da sequela e colocação da matriz dérmica, e 21 dias depois remoção da lâmina de silicone e aplicação do enxerto de pele de espessura parcial autólogo sobre a matriz), ou em tempo único para os grupos Matriderm® e Controle (ressecção da sequela, colocação da matriz e do enxerto de pele de espessura parcial, ou apenas do enxerto de pele de espessura parcial). A obtenção dos enxertos de pele foi realizada por meio de dermátomo elétrico com regulagem de 0,2mm de espessura em todos os grupos. No intraoperatório, o contorno do defeito tridimensional (que corresponde ao contorno da matriz ou do enxerto de pele) foi marcado com azul de metileno e transferido para um anteparo maleável estéril de superfície plana, sempre em posição de extensão máxima para membros e pescoço. A obtenção das medidas no pós-operatório foi realizada da mesma forma com 1, 3, 6 e 12 meses. Essas medidas foram posteriormente transferidas para uma folha de papel com escala de centímetros, e submetidas a fotografias com máquina fotográfica com plano focal paralelo ao da folha de papel e com distância fixa de 40 cm. O cálculo das dimensões foi realizado por meio do software de planimetria digital \"Image J\" e comparados entre os grupos. Dessa forma, foi possível calcular a porcentagem de contração do enxerto de pele de espessura parcial em relação ao defeito original. A análise estatística foi realizada pelo software SAS® 9.2 utilizando o modelo de regressão linear com efeitos mistos (efeitos aleatórios e fixos), e o nível designificância adotado foi 5%. Resultados: Foram operadas 39 sequelas de queimaduras em 30 pacientes, sendo 19 do sexo masculino e 21 do sexo feminino. Após 12 meses, os resultados mostraram que o Grupo Controle apresentou menores taxas de contração do enxerto comparado aos grupos das matrizes dérmicas Integra® (p<0,01), Matriderm® (p=0,01), e Pelnac® (p<0,01); o Grupo Pelnac® mostrou uma contração do enxerto de pele estatisticamente maior comparado ao Grupo Matriderm® (p<0,01) e ao Grupo Integra® (p=0,02); a contração do enxerto de pele do Grupo Integra® não apresentou diferença significativa comparado ao Grupo Matriderm® (p=0,16). A contração variou bastante entre as diversas áreas do corpo, e a região cervical apresentou uma elevada taxa de contração em todos os grupos, sendo estatisticamente maior comparado com as outras regiões do corpo (p<0,01). Conclusão: No tratamento de sequelas de queimaduras, a contração tardia dos enxertos de pele de espessura parcial foi maior quando associados com matrizes dérmicas, em comparação ao enxerto de pele sem uso de matriz. A contração dos enxertos teve grande variabilidade de acordo com o local da sequela, sendo que a região cervical apresentou os maiores índices de contração. / Purpose: The use of dermal matrices is an option in the treatment of burn sequelae. The objective of this study was to evaluate and compare the contraction of autologous split-thickness skin grafts used for the treatment of burn sequelae associated with dermal matrices. Methods: This is a prospective, randomized, controlled clinical trial, comparing the contraction of the autologous split-thickness skin graft associated or not with dermal matrix after 1, 3, 6 and 12 months postoperatively for the treatment of burn sequelae. Patients were selected from the Burns Unit of an university hospital, and our Institutional Review Board approved this study. Inclusion criteria were patients with one or more burn sequelae causing functional impairment, with post-burn follow-up of at least one year, and with an indication of surgical treatment using split-thickness skin graft. Exclusion criteria were the loss of follow-up, loss of the dermal matrix, and failure to integrate more than 10% of the split-thickness skin graft. Patients\' sequelae were randomly assigned to a randomized block design (according to the CONSORT standards) for one of four groups: Integra® Group (n = 10), Pelnac® Group (n = 10), Matriderm® Group (n = 9), and Control Group (n = 10), whose treatment involved only the skin graft without dermal matrix. Surgeries were performed by the same surgeon and consisted of resection of the burn sequelae, leading to a tegument defect. Surgeries were performed in two stages for the Integra® and Pelnac® groups (first resection of the sequela and placement of the dermal matrix, and 21 days later removal of the silicon sheet and application of the skin graft on the matrix), or in single stage for the Matriderm® and Control groups (resection of the sequelae, placement of the matrix and skin graft, or only the skin graft). The skin grafts were obtained using an electric dermatome with the regulation of 0.2 mm thickness in all groups. During the surgery, the contour of the three-dimensional defect (corresponding to the contour of the matrix or the skin graft) was marked with methylene blue and transferred to a sterile, flat surface, always in the position of maximum extension for limbs and neck. This procedure was also performed after 1, 3, 6 and 12 months postoperatively. Then, it was transferred to a sheet of paper with a centimeters scale and submitted to pictures using a camera with a fixed distance of 40 cm. The measures of the dimensions were carried out using the digital planimetry software \"Image J\" and compared among the four groups. Thus, we calculate the percentage of contraction of the split-thickness skin graft comparing it to the original defect. Statistical analysis was carried out using the linear regression model with mixed effects (random and fixed effects), and the significance level adopted was 5%. Results: Thirty-nine burn sequels were performed in 30 patients, 19 male and 21 female. Twelve months postoperatively, the results showed that the Control Group presented lower rates of skin graft contraction compared to the Integra® (p < 0.01), Matriderm® (p = 0.01) and Pelnac® (p < 0.01); the Pelnac Group showed a statistically larger contraction of the skin graft compared to the Matriderm® Group (p < 0.01) and the Integra® Group (p = 0.02); the contraction of the skin grafts from the Integra® Group did not present a significant difference compared to the Matriderm® Group (p = 0.16). The contraction varied widely among the treated areas, and the cervical region showed a high rate of contraction in allgroups, being statistically higher compared to the other body regions (p < 0.01). Conclusion: In the treatment of burn sequelae, the late contraction of split-thickness skin grafts was greater when associated with dermal matrices, in comparison to the skin graft without dermal matrix. The contraction of the skin grafts had great variability according to the location of the sequelae, and the cervical region had the highest rates of contraction.