The current thesis tests empirically the relationship of the dimensional trait model proposed for the fifth edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders with five-factor models (FFM) of personality disorder (PD). The DSM-5 Personality and Personality Disorders Work Group proposes to diagnose the disorders largely in terms of a 25 trait dimensional model organized within five broad domains (i.e., negative affectivity, detachment, antagonism, disinhibition, and psychoticism). Consistent with the authors of DSM-5, it was predicted that negative affectivity would align with FFM neuroticism, detachment with FFM introversion, antagonism with FFM antagonism, disinhibition with low FFM conscientiousness and, contrary to the authors of DSM-5, psychoticism would align with FFM openness. Suggested changes in trait placements according to FFM of PD research were also tested. Four measures of five factor models of general personality were administered to 445 undergraduates along with the Personality Inventory for DSM-5. The results of the present study provided support for the hypothesis that all five domains of the DSM-5 dimensional trait model are maladaptive variants of general personality structure, including the domain of psychoticism; however, the findings provided mixed support for suggested trait placement changes in the DSM-5 model.

Introduction Primary health care in South Africa is predominantly provided by clinics and Community Health Centres (CHC). These primary care facilities are situated in the community to ensure accessibility to care. 1 As part of ensuring quality planning, implementation and transformation of the health system, good knowledge of which cases are prevalent at our primary health facilities is important. Thus the rationale for this study as to know what are the reasons our patients come to our facilities and which diagnoses are made by the attending health care workers based on these reasons. Aim The aim of this study was to describe the spectrum of clinical and non-clinical problems encountered and the diagnoses made at our primary care facilities in the North West province of South Africa. Methods A prospective, cross-sectional survey at 19 Clinics and 5 Community Health Centres in 4 sub-districts of the Ngaka Modiri Molemma District of NW Province, South Africa. The International Classification of Primary Care-Version 2 (ICPC-2) was used to code data on selected days over a 10-month period from patients presenting at the participating clinics and community health centres. Results In total, 5082 patient encounters were recorded of which 3438 (67.7%) were females while 1644 ( 32.3%) were males. The category with highest reasons for encounter (RFE) was the general and unspecific component with 16.5% (n = 1202), followed by the respiratory component at 14.7% (n= 1066) and the cardiovascular component at 12.1% (n=882). The most common diagnoses were in the general component at 16.5% (n= 981) followed by cardiovascular at 16.0% (n= 951) and the respiratory component at 14.5% (n= 865). The average numbers of RFE was 1.4 per encounter among females and 1.5 amongst males. Diagnoses per encounter averaged 1.2 among females and males. Younger people under 40 years of age 67% (n = 3409) and females 68% (n = 3438) made up the majority of encounters. Conclusion Of all the health care facilities surveyed, there were mixtures of RFEs and various diagnoses of mixture of disease components. There were very few patients that came to the facilities for administrative purposes. Majority of the attendees were women. Collection of hypertension medication was the most common reason for encounter (RFE) with uncomplicated hypertension being the commonest diagnoses while psychosocial and problems related to male genitals were the least RFEs. There were more RFEs presented by patients than the diagnoses made by the attending HCWs. The ICPC-2 is a very user friendly tool that can be successfully utilised to monitor encounters and diagnoses at any health care facilities.

A acurácia de uma variável consiste na capacidade de a mesma representar realmente o que ela deveria representar. A definição conceitual de acurácia diagnóstica é baseada no pressuposto de que há uma ampla variedade de diagnósticos possíveis nas situações clínicas além dos diagnósticos que são altamente acurados. O objetivo desta pesquisa foi desenvolver um instrumento para estimar a acurácia de diagnósticos de enfermagem a partir de dados escritos da avaliação de paciente. Tratou-se de estudo quantitativo de desenvolvimento metodológico, realizado em 3 fases: teórica, empírica e analítica. Na fase teórica elaborou-se a definição de acurácia do diagnóstico de enfermagem e os itens do instrumento, submetendo-os a validação de conteúdo e teste piloto; na fase empírica, o instrumento definido na etapa anterior foi aplicado por enfermeiros especialistas em diagnóstico de enfermagem com a finalidade de estimar a validade e a confiabilidade do instrumento na fase analítica. O instrumento elaborado foi denominado de Escala de Acurácia de Diagnóstico de Enfermagem – EADE, e foi estruturado com base no conceito de que a acurácia de um diagnóstico de enfermagem é o julgamento de um avaliador quanto ao grau de relevância, especificidade e coerência das pistas existentes para o diagnóstico. O instrumento ficou composto por 4 itens: Presença de pistas (manifestações dos pacientes que representam indícios, vestígios, sinais, indicações ou características de um diagnóstico de enfermagem - item graduado em “sim”ou “não”); Relevância da pista (propriedade de uma pista de ser importante como indicador de um diagnóstico de enfermagem - item graduado em “alta/moderada” ou “baixa”); Especificidade da pista (propriedade de uma pista de ser própria e distintiva de um diagnóstico de enfermagem - item graduado em “alta/moderada” ou “baixa/nula”); Coerência da pista (propriedade de uma pista de ser consistente com o conjunto das informações disponíveis - item graduado em “alta/moderada” ou “baixa/nula”). Como indicativo de validade da EADE, os dados estatísticos mostram que os 4 itens do instrumento foram importantes para predizer diagnósticos de enfermagem acurados: Pista (OR 1,95 /IC 95% [1,78 ? 2,14], p = 0,000); Relevância (OR 1,73 /IC 95% [1,52 ? 1,98], p = 0,000); Especificidade (OR 2,41 IC 95% [2,11 ? 2,76], p = 0,000); Coerência (OR 3,92 /IC 95% [3,40 ? 4,53], p =0,000). A EADE obteve coeficiente de confiabilidade de Kuder-Richardson de 0,92 e de Hoyt de 0,92, indicando alta confiabilidade. A EADE mostrou boa sensibilidade e especificidade: área sob a curva ROC = 0,79, p = 0,000 e IC 95% [0,78?0,79]. O estudo atual permitiu desenvolver um instrumento para avaliar a acurácia de diagnósticos de enfermagem a partir de dados escritos. A EADE será refinada em estudos futuros / The accuracy of a variable consists of its capacity to actually represent what it was meant to represent. The conceptual definition of diagnosis accuracy is based on the presupposition that there is a wide variety of possible diagnosis in clinical situations, besides those diagnoses that are highly accurate. This research has set out to develop an instrument to estimate the accuracy of nursing diagnoses from the written data of patient evaluation. A quantitative study of methodological development was carried out, in 3 phases: a theoretical, an empirical and an analytical one. In the theoretical phase, the definition of accuracy of nursing diagnosis and the items of the instrument were shaped and subjected to content validation and pilot testing; in the empirical phase, the instrument defined previously was applied by nurses who are specialists in nursing diagnosis, aiming at estimating the validity and reliability of the instrument in the analytical phase. The instrument was named Escala de Acurácia de Diagnóstico de Enfermagem - EADE, and was structured according to the concept that the accuracy of a nursing diagnosis is the judgment of a rater in relation to the degree of relevance, specificity and coherence of the existing cues for the diagnosis. The instrument was made of 4 items: Presence of cues (manifestations of those patients who represent evidences, vestiges, signals, indications or characteristics of a nursing diagnosis - item graded as “yes” or “no”); Relevance of the cue (the property of a cue being important as an indicator of a nursing diagnosis - item graded as “high/moderate” or “low”); Specificity of the cue (the property of a cue being proper and distinctive of a nursing diagnosis - item graded as “high/moderate” or “low/nil”); Coherence of the cue (the property of a clue being consistent with the amount of information available - item graded as “high/moderate” or “low/nil”). As an indicator of the validity of the EADE, the statistic data showed that the 4 items of the instrument were important to predict accurate nursing diagnoses: Cue (OR 1,95 /IC 95% [1,78 ? 2,14], p = 0,000) Relevance (OR 1,73 /IC 95% [1,52 ? 1,98], p = 0,000); Specificity (OR 2,41 IC 95% [2,11 ? 2,76], p = 0,000); Coherence (OR 3,92 /IC 95% [3,40 ? 4,53], p = 0,000). The EADE had the Kuder-Richardson coefficient of reliability of 0.92 and the Hoyt coefficient of 0,92, which indicates high reliability. The EADE showed good sensitivity and specificity: area under curve ROC = 0,79, p = 0.000 and IC 95% [0,78 ? 0,79]. This study has led to the development of an instrument to assess the accuracy of nursing diagnoses from written data. The EADE shall be refined in future studies

Submitted by EPAMINONDAS RODRIGUES SOARES null (soaresep@ig.com.br) on 2016-09-15T12:24:24Z No. of bitstreams: 1 Tese_Epa_15092016.pdf: 3559715 bytes, checksum: f9c8d9306fde4e031595ddab51bed217 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-09-15T18:40:37Z (GMT) No. of bitstreams: 1 soares_erj_dr_guara.pdf: 3559715 bytes, checksum: f9c8d9306fde4e031595ddab51bed217 (MD5) / Made available in DSpace on 2016-09-15T18:40:37Z (GMT). No. of bitstreams: 1 soares_erj_dr_guara.pdf: 3559715 bytes, checksum: f9c8d9306fde4e031595ddab51bed217 (MD5) Previous issue date: 2016-08-26 / Esta pesquisa teve o objetivo de diagnosticar o nível de maturidade de diversas unidades produtivas de uma empresa do ramo químico e se elas poderiam ser consideradas Classe Mundial, identificando os pontos fortes e fracos da gestão de cada uma das fábricas analisadas, visando buscar oportunidades de melhoria em seu Sistema de Gestão. O método científico utilizado, as limitações da pesquisa e implicações, os resultados de investigação e pesquisa são exploratórios. O estudo foi feito por meio de uma pesquisa tipo Survey por análise combinada inicialmente qualitativa e em seguida quantitativa, referente ao grau de maturidade das empresas analisadas, utilizando-se do método de Análise de Correlação Grey. Referente ao método de pesquisa, foi utilizado o questionário combinado do LAI Enterprise Self-assessment Tool (Lesat) do Massaussuchets Institute of Technology (MIT) e Baldrige Performance Excellence Program do National Institute of of Standards and Techonology (NIST) do United States Department of Commerce, aplicados ao Método de Diagnóstico de Empresas (MDE). Pesquisas futuras podem ser realizadas em estudos de correlação entre um número maior de empresas de manufatura de outros segmentos. Este estudo amplo e com diversidade de organizações proporcionará um melhor entendimento do nível maturidade das organizações. A contribuição do estudo está na capacidade de diagnosticar o nível de maturidade da organização pesquisada. Avaliar se a aplicação das ferramentas do MDE, Lesat, Baldrige e Grey System entre as diversas fábricas de uma empresa do ramo químico pesquisadas têm sido capazes de identificar os pontos fortes e fracos desta organização. O estudo resultou na identificação de uma forma sistêmica de orientar a necessidade de novos projetos e ações para apoiar e elaborar o planejamento estratégico da empresa química pesquisada. / This research had the purpose to diagnose the level of maturity of the several production plants in a chemical industry and evaluate if they could be consider World Class, in order to identify the strengths and weaknesses of the management of each of the analyzed factories, to identify opportunities for improvement in its Management System. The scientific method used, research limitations and implications, the results of investigation and research are exploratory. This study done through a survey type Survey combined qualitative analysis initially and then quantitative, concerning the degree of maturity of the factories analyzed, using Grey Correlation analysis method. Concerning the study method was the combined questionnaire LAI Enterprise Self-assessment Tool (Lesat) of Massachusetts Institute of Technology (MIT) and Baldrige Performance Excellence Program of the National Institute of Standards and Technology (NIST) of the United States Department of Commerce, using the Business Diagnostic Method (BDM). Future research can be carry out and correlation studies among a larger number of other branches manufacturing companies can be perform. A larger study with a diversity of organizations will provide a better understanding of the maturity level of the organizations. The contribution of this study is in the ability to diagnose the organization's maturity level. Evaluate if the application of BDM, Lesat & Baldrige and Grey System tools between the different factories inside a chemical company surveyed have been able to identify the strengths and weaknesses of this organization. The study resulted in the identification of a systemic way to guide the need for new projects and initiatives to support and develop the strategic planning of the chemical company researched.

Os fitoplasmas são procariotos sem parede celular pertencentes à classe Mollicutes. Um grande número de doenças de plantas cultivadas estão associadas aos fitoplasmas, incluindo tanto aquelas que afetam grandes culturas como aquelas ocorrentes em diversas espécies de ornamentais. Em cana-de-açúcar, uma doença conhecida como síndrome do amarelecimento foliar ou amarelinho causou danos expressivos à cultura e provocou a substituição de uma cultivar muito produtiva e extensivamente plantada no estado de São Paulo. A doença também foi registrada em outros países e investigações sobre a etiologia evidenciaram a ocorrência de vírus e fitoplasma como agentes. Em primavera (Bougainvillea spectabilis), uma espécie de origem brasileira bastante apreciada como ornamental, foram observados sintomas de clorose foliar, superbrotamento de ramos, deformações foliares e florais e declínio, sintomas característicos de infecção causada por fitoplasmas. O presente trabalho teve como finalidade investigar a etiologia desta nova doença encontrada em primavera, denominada de superbrotamento, e identificar molecularmente o fitoplasma envolvido com a síndrome do amarelecimento foliar da cana-de-açúcar. Para isso, amostras de plantas sintomática e assintomáticas de cana-de-açúcar e primavera foram submetidas à extração do DNA total. A partir deste DNA, a detecção molecular foi conduzida com PCR duplo usando-se os iniciadores P1/Tint na primeira reação e R16 F2n/R2 na segunda reação. Posteriormente à detecção, foi realizada a identificação através de PCR duplo com iniciadores específicos e análises de RFLP com as enzimas de restrição AluI, RsaI, KpnI, MseI, HhaI, HpaII, e MboI. Análises filogenéticas foram baseadas nas sequências nucleotídicas do 16S rDNA dos fitoplasmas detectados na cana e na primavera, bem como nas sequências de outros fitoplasmas disponíveis em banco de dados. O teste de transmissão usou plantas infectadas de primavera e plantas sadias de vinca, interligados por filamentos de cuscuta. Os resultados mostraram que fragmentos genômicos de aproximadamente 1.2kb foram amplificados em 33% e 60% das amostras de DNA extraído de plantas sintomáticas de cana-de-açúcar e de primavera, respectivamente. O uso de iniciadores específicos demonstrou a presença de fitoplasmas dos grupos 16SrI e 16SrIII associados ao superbrotamento da primavera e de um fitoplasma do grupo 16SrI associado à síndrome do amarelecimento foliar. Análises de RFLP, confirmaram a ocorrência de fitoplasmas membros dos grupos 16SrI e 16SrIII em plantas de primavera, e revelaram que estes fitoplasmas poderiam ser classificados nos subgrupos 16SrI-B e 16SrIII-B. A identificação evidenciou que o fitoplasma encontrado em cana-de-açúcar é um representante do grupo 16SrI, sub-grupo B. Análises filogenéticas e de mapas de sítios putativos de restrição, confirmaram os resultados obtidos com os testes de PCR e com as análises de RFLP para os fitoplasmas relacionados às duas doenças estudadas. A transmissão dos fitoplasmas presentes em primavera para plantas de vinca através da cuscuta demonstrou, biologicamente, que ambos são agentes causais do superbrotamento. Em quase todas as amostras de cana-de-açúcar positivas para fitoplasma também foi detectada a presença de um luteovírus, através do uso de RT-PCR, demonstrando que o amarelecimento foliar da cana-de-açúcar no estado de São Paulo está associado a um complexo formado por fitoplasma e vírus. No caso da primavera, este trabalho se constituiu no primeiro relato da ocorrência de fitoplasmas como agente de doença nessa espécie. / Phytoplasmas are wall-less prokaryote belonging to class Mollicutes. Several hundred plant species, including food crops and ornamental species have been reported as hosts of phytoplasmas, which are associated with important diseases. In sugarcane, a disease known as yellow leaf syndrome caused serious damage and led to replacement of a cultivar with high yield and widely distributed in the São Paulo State. The syndrome has also been described in other countries and studies about etiology evidenced the occurrence of virus and phytoplasmas as causal agents. In bougainvillea (Bougainvillea spectabilis), a native specie from Brazilian territory, were observed typical symptoms of phytoplasmas, characterized by leaf chorosis, proliferation of branches, deformation of leaves and flowers, decline, and death. The aim of this study was to investigate the etiology of the disease observed in bougainvillea and to identify molecularly the phytoplasma associated with sugarcane yellow leaf. Thus, DNA was extracted from samples collected of naturally symptomatic plants of sugarcane and bougainvillea. Nested PCR primed by P1/Tint-R16F2n/R2 was used for detection, while specific primers were used for identification. RFLP with restriction enzymes AluI, RsaI, KpnI, MseI, HhaI, HpaII, MboI and phylogenetic analysis based on nucleotide sequences of 16S rDNA were also used to identify the phytoplasmas detected in sugarcane and boungainvillea. Transmission of phytoplasmas from bougainvillea to periwinkle by dodder was conducted to demonstrate the pathogenecity of this agents. Results showed that genomic fragments of 1.2kb were amplified, evidencing the presence of phytoplasmas in 33% and 60% of symptomatic sugarcane and bougainvillea plants, respectively. PCR with specific primer pairs demonstrated that phytoplasmas affiliated to groups 16SrI and 16SrIII were associated with bougainvillea proliferation, while a phytoplasma belonging to group 16SrI was present in sugarcane plants exhibiting symptoms of yellow leaf. RFLP and phylogenetic analysis revealed that phytoplasmas found in bougainvillea could be classified within subgroups 16SrI-B and 16SrIII-B, and that phytoplasma detected in sugarcane is a representative of subgroup 16SrI-B. Almost the totality of symptomatic sugarcane plants showed the presence of virus, by using RT-PCR, indicating that a coinfection of virus and phytoplasma could be responsible by inducing the disease. Positive results for transmission revealed that both phytoplasmas found in boungainvillea are causal agents of the disease. This is the first report of phytoplasma as agent of disease in that species.

Background The International Council of Nurses (ICN) states in it’s ethical code that the nurse practitioner is responsible for giving each patient correct and culturally adapted care. Military culture is unique and comes with its own challenges and needs of nursing care. Aim The aim is to find the prominent nursing diagnoses in military personnel in relation to the military ethos. Method A literature review of twenty articles found through searches in PubMed, Cinhal and Summon. Results The prominent nursing diagnoses were risk-prone health behavior together with pain issues and sleep disturbances. Two thirds of military personnel consumed high amounts of alcohol, pain issues was the most prevalent, up to half of all personnel experienced sleep disturbances and willingness to seek care was low. Stress, depression, consequences of pain and effects on the family process was also found. Result of military duty could also be infections, wounds, dermatological problems, hearing impairment and diarrhea. Conclusion Military culture is unique and reports health differently than the civilian population. Because of this it is important to know the prominent diagnoses to be able to give this patient group appropriate nursing interventions and competent care. / Bakgrund I enlighet med International Council of Nurses (ICN) etiska kod har sjuksköterskan ett ansvar för att varje person ska få en korrekt, tillfredsställande och kulturellt anpassad information som grund till sin vård och behandling. Militärkulturen ger upphov till en patientgrupp med unika behov och detta skall styra vården. Syfte Syftet är att genom en litteraturstudie förstå vilka omvårdnadsdiagnoser som är framträdande hos militärpersonal med relation till militärt etos. Metod En litteraturstudie av artiklar (n=20) genom sökningar i PubMed, Cinhal och Summon. Resultat Riskfyllt hälsobeteende var största temat följt av smärta och sömnproblematik. Hos militärpersonal var alkoholkonsumtion hög hos två tredjedelar, smärta hade högst prevalens, påverkan på sömnen återfanns i upp till hälften av personalen och viljan att söka vård var nedsatt. Stress, depression, smärtkonsekvenser samt påverkade familjerelationer och processer återfanns. Följder av tjänstgöringen var infektioner, hudskada, hudåkommor, hörselnedsättning och diarré. Slutsats Militärkulturen är unik och underrapporterar ohälsa, därför behövs det en förståelse för de framträdande omvårdnadsdiagnoserna för att kunna ge denna patientgrupp god vård.

This study examined the effectiveness of a training program on the ability of registered nurse students to write complete nursing diagnoses. A comparison group was used as a control. There were 47 participants in the training group and 51 participants in the comparison group who received no training. Five hypotheses were used to examine the (1) complete nursing diagnoses, (2) labels, (3) clarifiers, (4) etiologies, and (5) mislabeled medical diagnoses or clinical problems as nursing diagnoses. As a pretest and posttest, participants in both groups viewed a video tape of a nursing situation and were asked to write nursing diagnoses. The training group received nine clock hours of classroom instruction on the nursing process of which three hours were on nursing diagnosis with a focus on the inclusion of label, clarifier, and etiology necessary for a complete nursing diagnosis. In the clinical component of the educational program the training group wrote nursing diagnoses as part of the nursing process. It was assumed that the comparison group did not receive comparable education. The mean difference of proportions between the pretest and posttest was computed for each group on the item tested by the hypotheses and for the difference between the two groups. Three of the five hypotheses tested in the study were accepted. The training group did have a significant increase in the average (mean) difference of proportions in the number of complete nursing diagnoses and etiologies and a significant decrease in the number of mislabeled nursing diagnoses. There was no significant difference in the number of labels and clarifiers. The training group did show a percentage increase in the number of labels and clarifiers written. There was little or no change in the comparison group over the time period of the study.

This study examined the clinical utility of the recently released National Institute of Mental Health's (NIMH) research domain criteria (RDoC) by replicating and extending earlier work by using a demographically novel sample. Information retrieval and natural language processing of archival clinical records was used to achieve two main objectives: (1) estimate how well the RDoC domains match language used by clinicians by creating domain scores and (2) examine the differences between the DSM's and RDoC's ability to predict treatment outcome using these domain scores and DSM diagnoses. The social systems RDoC category was found to be the strongest predictor of treatment outcome across all diagnostic measures.

No description available.

It is increasingly important to understand the factors associated with individuals struggling with addiction and their quality of life, especially with those struggling with co-occurring diagnoses (CODs). The purpose of this study was to explore the extent to which meaning, and CODs of anxiety and depression predict an individual's attitudes and beliefs about addiction among persons receiving treatment for substance use disorders (SUDs). The theoretical foundation used to guide this study was logotherapy, which emphasizes the importance of increasing meaning in life through choices, while also centering on being able to find meaning in all situations. A cross-sectional correlation design was employed, using a sample of patient admission records from a dual diagnosis treatment center in the western United States. The responses on 4 assessments related to meaning, symptoms of anxiety and depression, and attitudes about substances were analyzed using a multiple linear regression. There was no statistically significant relationship between an individual's attitudes and beliefs about addiction as predicted by that individual's meaning and CODs symptoms of anxiety and depression. A significant negative correlation existed between depression and meaning (p < .01), while a significant positive correlation existed between the depression and anxiety (p < .05) as well as the anxiety and attitudes about substances (p < .01). The findings from this study can assist counselor educators in understanding the correlation between SUD, increased depressive symptoms, and low personal meaning.