As disfunções urinárias ou sexuais do idoso são subnotificadas. Porém, são de alta prevalência e associadas a diversos prejuízos psicossociais. O presente estudo visa à identificação da prevalência dessas condições por meio de questionários. Utilizou-se o Androgen Deficiency in Aging Male (ADAM) para avaliação de função sexual do homem, questões sobre função sexual feminina e masculina e, o International Prostate Symptom Score (IPSS) para avaliação de função urinária masculina e feminina. Temos o objetivo de realizar uma investigação nos indivíduos não institucionalizados, acima de 60 anos de idade, para obtermos dados referentes à sua saúde sexual e urinária nas cidades: São Paulo, Campinas, Santo André, São Bernardo do Campo, São Caetano e Londrina. Foram distribuídos cerca de 6000 questionários, sendo utilizados para estudo 3425, com 1575 homens e 1850 mulheres. Em relação ao ADAM, obtivemos 92,49% dos 1385 avaliados com suspeita de apresentarem distúrbio androgênico do envelhecimento masculino (DAEM). Quanto à função sexual masculina, evidenciamos que 383 (32,19%) apresentavam queixas eretivas, 458 (37,54%) de ejaculação precoce e 790 (59,13%) admitiram a necessidade de tratamento para melhorar o desempenho sexual. Quanto à função sexual feminina, 1300 (74,07%) não praticam relação sexual e os principais motivos foram: falta de parceiro, falta de desejo sexual e problema de saúde do parceiro. Além disso, 988 (78,41%) das mulheres que não têm relação sexual admitem estar bem assim e não querem sexo e mais importante: aproximadamente 21% dessas gostariam de ter relação sexual. Quanto à qualidade da relação sexual feminina, 272 (64,92%) acham a relação boa para ambos, 105 (25,06%) boa só para o parceiro e 33 (7,88%) ruim para ambos. Em relação ao IPSS masculino, observamos piora gradual no padrão miccional com o aumento da idade, dos sintomas moderados e graves, principalmente após os 75 anos, sendo os mais prevalentes: nictúria, urgência miccional e aumento da frequência urinária. Quanto ao IPSS feminino, notamos que, mesmo após os 80 anos, a maioria das mulheres (53,37%) apresenta sintomas leves relacionados à disfunção miccional; com o aumento da idade, ocorre um aumento gradual do resultado do IPSS, relacionado com os sintomas moderados e graves, sendo que o pico ocorre após os oitenta anos. Sendo assim, devido ao grande número de distúrbios sexuais e urinários encontrados, deixamos um alerta para que um maior número de medidas de Saúde Pública sejam implantadas, melhorando promover uma melhor qualidade de vida nessa população idosa / Urinary or sexual dysfunction in the elderly are underreported. However, are highly prevalent and associated with various psychosocial damage. This study aims to identify the prevalence of these conditions. We used the Androgen Deficiency in Aging Male (ADAM) to assess sexual function of men, questions of male and female sexual function, and the International Prostate Symptom Score (IPSS) for evaluation the urinary function. The aim is to carry out an investigation in non-institutionalized individuals over 60 years of age, to obtain data on its sexual and urinary health in: São Paulo, Campinas, Santo André, São Bernardo do Campo, São Caetano and Londrina. They were distributed about 6,000 questionnaires being used to study 3425, with 1575 men and 1850 women. Compared to ADAM, obtained 92.49% of the 1385 evaluated suspected of presenting androgen disorder of aging male (ADAM). As for the male sexual function, we showed that 383 (32.19%) had erective complaints, 458 (37.54%) of premature ejaculation and 790 (59.13%) admitted the need for treatment to improve sexual performance. As for the female sexual function, 1300 (74.07%) did not practice sexual intercourse and the main reasons were: lack of partner, lack of sexual desire and partner health problem. In addition, 988 (78.41%) of women who haven\'t sexual intercourse admit to being like that and not want sex and, more importantly, about 21% of them would like to have sexual intercourse. As for the quality of the female sex, 272 (64.92%) think the relation is good for both, 105 (25.06%) only good for the partner and 33 (7.88%) bad for both. IPSS when compared to males, we see gradual worsening of urinary pattern with increasing age, related with the moderate and severe symptoms, especially after 75 years, being the most prevalents: nocturia, urinary urgency and urinary frequency. As for the female IPSS, we note that even after 80 years, the majority of women (53.37%) have mild symptoms related to voiding dysfunction; with increasing age there is a gradual increase in the result of the IPSS, associated with moderate and severe symptoms, where the peak occurs after the age of eighty. Thus, due to the large number of sexual and urinary disorders found, left a warning to a greater number of public health measures are implemented, improving promote a better quality of life in this elderly population

Submitted by Ubirajara Cruz (ubirajara.cruz@gmail.com) on 2017-06-26T15:49:03Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Carolina_Sapin.pdf: 1243520 bytes, checksum: e9ae4587ba4ba0e8a1905c812da97edf (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2017-06-27T19:05:07Z (GMT) No. of bitstreams: 2 Carolina_Sapin.pdf: 1243520 bytes, checksum: e9ae4587ba4ba0e8a1905c812da97edf (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-06-27T19:05:07Z (GMT). No. of bitstreams: 2 Carolina_Sapin.pdf: 1243520 bytes, checksum: e9ae4587ba4ba0e8a1905c812da97edf (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-02-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Nesta dissertação, abordam-se as patologias do sistema urinário. Os dados referentes a estas enfermidades são relacionados aos casos diagnosticados na região sul do Rio Grande do Sul em um período de 36 anos. Com base nesses achados foram elaborados dois artigos científicos. No primeiro trabalho avaliaram-se todas as lesões do sistema urinário de cães, constantes nos protocolos de necropsia e exames histopatológicos do Laboratório Regional de Diagnóstico da Faculdade de Veterinária da Universidade Federal de Pelotas, no período de 1978 a 2014. Foram encontrados diagnósticos de afecções do sistema estudado em 363 cães, correspondente a 4,04% do total de 8980 diagnósticos realizados no período para a espécie. As lesões renais representaram 93,1%, sendo 309 primárias do rim; dentre as principais lesões estavam a nefrite túbulo-intersticial (142 casos), geralmente associada à 47 casos de Leptospirose. O trato urinário inferior (TUI) representou 6,9% dos casos destacando-se a cistite aguda com 19 casos de um total de 60 lesões do TUI. Neste estudo a insuficiência renal, aguda ou crônica, representou importante causa mortis em cães. No segundo artigo descreve-se um diagnóstico anatomo-patológico de metaplasia disontogênica uretral em um felino fêmea, de um mês de idade e sem raça definida. Havia histórico de aumento de volume abdominal desde o nascimento. Ainda apresentava disúria, eliminando a urina apenas por cistocentese, sondagem vesical ou gotejamento. Foi eutanasiado e na necropsia observou-se bexiga aumentada e dilatada, rins diminuídos e ureteres dilatados e tortuosos. Histologicamente havia metaplasia disontogênica da uretra e displasia renal bilateral. Conclui-se nesta dissertação que as principais lesões renais foram a necrose tubular aguda, nefrite túbulo-intersticial, fibroplasia e glomeruloesclerose; e quanto ao TUI sobressaíram-se a cistite aguda, urolitíase, ruptura de bexiga e neoplasias primárias. / This thesis addresses the pathologies of the urinary system. The data concerning disorders of the urinary tract are related to cases diagnosed in southern Rio Grande do Sul in a period of 36 years. Based on these findings two papers were written. The first article assessed all the urinary tract lesions of canine, described in the necropsy reports and histopahtological tests from the Regional Laboratory of Diagnosis of the College of Veterinary in the Federal University of Pelotas in the period from 1978 to 2014. From a total of 8980 diagnosis, 363 dogs were found to have affections of the urinary system, which represents 4,04% of diagnosis performed for that period and species. Renal injury accounted for 93.1% of the cases, with 309 being primary kidney lesions; from which the main lesions were the tubulointerstitial nephritis (142 cases) often associated with Leptospirosis (47). Injuries of the lower urinary tract (LUT) accounted for 6.9% of the cases where acute cystitis stands out with 19 cases of a total of 60 LUT injuries. In this study, renal failure, acute or chronic, represented an important cause of death in dogs. The second article describes an anatomopathological diagnosis of dysontogenic urethral metaplasia in a female, one monthold, mongrel cat. The animal had history of abdominal enlargement since birth and dysuria, eliminating urine only cystocentesis, urinary catheterization or drip. It was euthanized and in the necropsy was observed enlarged and distended bladder, reduced kidneys and dilated and tortuous ureters. Histologically, it had dysontogenic metaplasia of the urethra and bilateral renal dysplasia. It is concluded in this thesis that the main renal lesions were acute tubular necrosis, tubulointerstitial nephritis, fibroplasia and glomerulosclerosis; and when the LUT is concerned, acute cystitis, urolithiasis, bladder rupture and primary neoplasms stood out.

Instead of planktonic growth in nature, many species of bacteria form biofilm to survive in harsh conditions. Although many chronic bacterial infections are caused by bacterial species in a biofilm lifestyle, previous research has focused on studying antibiotic resistance in planktonic growth. Here we used a modified MBEC assay, i.e. biofilm growth on pegs, to determine Escherichia coli biofilm inhibitory concentrations (BIC) of ciprofloxacin, streptomycin and rifampicin and to study the minimal selective concentration (MSC) for ciprofloxacin in E. coli biofilm. We could observe high inhibitory concentrations for all antibiotics in the biofilm pre-formed in media without antibiotics compared to the biofilm formed in antibiotics. We also show preliminary result indicating that sublethal concentrations of ciprofloxacin lead to the selection of ciprofloxacin resistant mutants in biofilm and that the selection level is lower than what was observed in planktonic growing E. coli. With more knowledge in how the biofilm formation precedes in different antibiotic settings, the treatment for chronic biofilm infections used today could be evaluated and changed so that the infections could be eradicated.

<p>This thesis deals with problem solving of general practitioners (GPs), which is explored with different methods and from different perspectives. The general aim was to explore and describe rules of thumb and to analyse the management of respiratory and urinary tract infections (RTI and UTI) in general practice in Sweden. The results are based upon focus group interviews concerning rules of thumb and a prospective diagnosis-prescription study concerning the management of patients allocated a diagnosis of RTI or UTI. In addition unpublished data are given from structured telephone interviews concerning specific rules of thumb in acute sinusitis and prevailing cough.</p><p>GPs were able to verbalize their rules of thumb, which could be called tacit knowledge. A specific set of rules of thumb was used for rapid assessment when emergency and psychosocial problems were identified. Somatic problems seemed to be the expected, normal state. In the further consultation the rules of thumb seemed to be used in an act of balance between the individual and the general perspective. There was considerable variation between the rules of thumb of different GPs for patients with acute sinusitis and prevailing cough. In their rules of thumb the GPs seemed to integrate their medical knowledge and practical experience of the consultation. A high number of near-patient antigen tests to probe Streptococcus pyogenes (Strep A tests) and C-reactive protein (CRP) tests were performed in patients, where testing was not recommended. There was only a slight decrease in antibiotic prescribing in patients allocated a diagnosis of RTI examined with CRP in comparison with patients not tested. In general, the GPs in Sweden adhered to current guidelines for antibiotic prescribing. Phenoxymethylpenicillin (PcV) was the preferred antibiotic for most patients allocated a diagnosis of respiratory tract infection.</p><p>In conclusion, the use of rules of thumb might explain why current practices prevail in spite of educational efforts. One way to change practice could be to identify and evaluate rules of thumb used by GPs and disseminate well adapted rules. The use of diagnostic tests in patients with infectious illnesses in general practice needs critical appraisal before introduction as well as continuing surveillance. The use of rules of thumb by GPs might be one explanation for variation in practice and irrational prescribing of antibiotics in patients with infectious conditions.</p> / On the day of the public defence the status of the articles IV and V was: Accepted.

This thesis deals with problem solving of general practitioners (GPs), which is explored with different methods and from different perspectives. The general aim was to explore and describe rules of thumb and to analyse the management of respiratory and urinary tract infections (RTI and UTI) in general practice in Sweden. The results are based upon focus group interviews concerning rules of thumb and a prospective diagnosis-prescription study concerning the management of patients allocated a diagnosis of RTI or UTI. In addition unpublished data are given from structured telephone interviews concerning specific rules of thumb in acute sinusitis and prevailing cough. GPs were able to verbalize their rules of thumb, which could be called tacit knowledge. A specific set of rules of thumb was used for rapid assessment when emergency and psychosocial problems were identified. Somatic problems seemed to be the expected, normal state. In the further consultation the rules of thumb seemed to be used in an act of balance between the individual and the general perspective. There was considerable variation between the rules of thumb of different GPs for patients with acute sinusitis and prevailing cough. In their rules of thumb the GPs seemed to integrate their medical knowledge and practical experience of the consultation. A high number of near-patient antigen tests to probe Streptococcus pyogenes (Strep A tests) and C-reactive protein (CRP) tests were performed in patients, where testing was not recommended. There was only a slight decrease in antibiotic prescribing in patients allocated a diagnosis of RTI examined with CRP in comparison with patients not tested. In general, the GPs in Sweden adhered to current guidelines for antibiotic prescribing. Phenoxymethylpenicillin (PcV) was the preferred antibiotic for most patients allocated a diagnosis of respiratory tract infection. In conclusion, the use of rules of thumb might explain why current practices prevail in spite of educational efforts. One way to change practice could be to identify and evaluate rules of thumb used by GPs and disseminate well adapted rules. The use of diagnostic tests in patients with infectious illnesses in general practice needs critical appraisal before introduction as well as continuing surveillance. The use of rules of thumb by GPs might be one explanation for variation in practice and irrational prescribing of antibiotics in patients with infectious conditions. / On the day of the public defence the status of the articles IV and V was: Accepted.

In the last decades NMR spectroscopy has become an invaluable tool both in academic research and in the pharmaceutical industry. This thesis describes applications of NMR spectroscopy in biomedicinal research for structure elucidation of biologically active peptides and peptidomimetics as well as in studies of ligand-protein interactions. The first part of this thesis describes the theory and methodology of structure calculations of peptides using experimental restraints derived from NMR spectroscopy. This methodology has been applied to novel mimetics of the peptide hormones desmopressin and Leu-enkephalin. The results of these studies highlight the complicating issue of conformational exchange often encountered in structural determination of peptides and how careful analysis of experimental data as well as optimization of experimental conditions can enable structure determinations in such instances. Although the mimetics of both desmopressin and Leu-enkephalin were found to adopt the wanted conformations, they exhibited no or very poor biological activity. These results demonstrate the difficulties in designing peptidomimetics without detailed structural information of the receptors. A stereoselective synthetic route towards XxxΨ[CH2O]Ala pseudodipeptides is also presented. Such pseudodipeptides can be used as isosteric amide bond replacements in peptides in order to increase their resistance towards proteolytic degradation. The second part of this thesis describes the study of the interaction between compounds that inhibit pilius assembly, pilicides, and periplasmic chaperones from uropathogenic Escherichia coli. Periplasmic chaperones are key components in assembly of pili, i.e. hair-like protein complexes located on the surface of Escherichia coli that cause urinary tract infections. Detailed knowledge about this interaction is important in understanding how pilicides can inhibit pilus assembly by binding to chaperones. Relaxation-edited NMR experiments were used to confirm the affinity of the pilicides for the chaperones and chemical shift mapping was used to study the pilicide-chaperone interaction surface. These studies show that at least two interaction sites are present on the chaperone surface and consequently that two different mechanisms resulting in inhibition of pilus assembly may exist.

Urinary tract infection (UTIs) is an extremely common disease. Proteus mirabilis is a common cause of UTI in individuals with functional or structural abnormalities or with long-term catheterization, it forms bladder and kidney stones as a consequence of urease-mediated urea hydrolysis. Known virulence factors, besides urease, are flagella, fimbriae, outer membrane proteins, hemolysins, amino acid deaminase, protease, capsule and lipopolysaccharide (LPS). Study of LPS core is particularly relevant for several reasons: it is a conserved region, although it is increasingly clear that there is some variability at the genus or groups of similar genera, its chemical structure modulates the endotoxic activity of lipid A, alteration of the LPS core, which generates less virulent bacteria, encourages the search of substances that interfere with the biosynthesis of this region, and conserved regions of the core LPS could be useful as antigens in preventing diseases caused by pathogens that contain these conserved regions. The specific aims of this project have been to identify and functionally characterize genes involved in core LPS biosynthesis in P. mirabilis, to elucidate the mechanism of incorporation of galactosamine (GalN) to the core LPS, to identify genes coding for phosphoethanolamine (PEtN) modifications, and to characterize and to study the biological effects of the gene encoding the PEtN transferase involved in the modification of the second heptose residue (L,D-HepII). We found that P. mirabilis has most of the genes for the biosynthesis of LPS core grouped in the waa cluster in the chromosome. Despite this, additional genes required for core LPS biosynthesis are found outside the waa cluster. The pentasaccharide of the inner core, shared by all Enterobacteriaceae, is biosynthesized in P. mirabilis, by the sequential activity of a bifunctional transferase (WaaA) and three heptosyltransferases (WaaC, WaaF, and WaaQ). These enzymes are transcribed from genes located inside the waa cluster, and are conserved in P. mirabilis strains analyzed; for more, they show a high identity and similarity level to homologues proteins of Escherichia coli, Klebsiella penumoniae and Serratia marcescens. The waaL gene, coding for the O-antigen polymerase ligase, is found adjacent to the classic waa cluster. Downstream this gene, four genes encoding enzymes belonging to the 4 (walM, walN, and WalR), and 9 (walO) glycosyltransferase family were found. Even if members of these families were related to LPS core biosynthesis in several Gram-negative bacteria, in P. mirabilis they do not appear to be involved in the biosynthesis of the reported core LPS structures. The presence of the disaccharide hexosamine (HexN)-1,4-galacturonic acid (GalA) is a feature of P. mirabilis LPS outer core. Depending on the nature of the HexN outer core residue, two different homologues for N-acetyl-hexosamine transferases are present in the waa cluster: wabH or wabP. Altought the incorporation of glucosamine into LPS core requires an acetylglucosaminyltransferase (WabH) and a deacetilase (WabN), the incorporation of GalN requires three enzymes: an acetylgalactosaminyltransferase (WabP), a deacetilase (WabN) and an epimerase (gne). An amplification test with specific primers for this two different homologues can be used to predict the HexN nature in P. mirabilis LPS cores. The strain-specific genes wamB and wamC code for a galactosyltransferase and a heptosyltransferase respectively in strain R110 of P. mirabilis. The enzyme encoded by gene wamD is a N-acetylglucosaminyltransferase, and it is found in strain 51/57 of P. mirabilis. WamA, coded by wamA gene in the waa cluster of strains R110, 50/57, TG83 and HI4320, is a heptosyltransferase responsible for the incorporation of a quarter residue of heptose (Hep), in DD configuration, to the GalA II of the outer core. In P. mirabilis strain 51/57, a gene coding a protein of the Mig-14 family was identified inside the waa cluster, this localization appears to be an exception in the Enterobacteriaceae family. Inspection of the whole genome of P. mirabilis HI4320 did not allow the identification of a mig-14 similar gene. There are three putative PEtN transferases in the genome of P. mirabilis: PMI3040, PMI3576, and PMI3104. The gene identified as eptC (PMI3104) transfers the moiety of PEtN to the O-6 position of L,D-Hep II (HepII6PEtN). The absence of the positive charge due to PEtN residue doesn't affect the bacterial growth kinetics in lab conditions in rich or defined media, but causes a moderate destabilization of the outer-membrane. Despite the lack of the PEtN residue on the Hep II in P. mirabilis LPS core, has no statistically effects during urinary tract infection assays in mouse model, the absence of this modification causes an increase sensitivity to complement in non-immune human sera. / P. mirabilis no es una causa frecuente de infecciones urinarias en el huésped normal, más bien infecta el tracto urinario con alteraciones funcionales o anatómicas, o instrumentación crónica como el cateterismo. P. mirabilis está a menudo asociado con cálculos urinarios e incrustaciones de los catéteres y es, particularmente importante, en pacientes con cateterización prolongada. Las infecciones del tracto urinario asociadas a cateterización son mundialmente reconocidas como la causa más común de infección asociada a tratamientos en ambiente hospitalario. El LPS es un factor de virulencia importante en bacterias Gram negativas patógenas. También conocido como endotoxina, es una molécula glicolipídica que constituye la estructura mayoritaria de la cara externa de la membrana externa (OM). En Proteus mirabilis la mayoría de los genes responsables de la biosíntesis de núcleo de LPS están localizados en el cromosoma, en el agrupamiento génico waa. A pesar de esto, algunos genes adicionales, necesarios para la biosíntesis del núcleo de LPS, se encuentran ubicados fuera del agrupamiento génico waa. El pentasacárido del núcleo interno, común a todas las Enterobacteriáceae, se biosintetiza en P. mirabilis, por la actividad secuencial de una transferasa bifunciona (WaaA) y tres heptosiltransferasas (WaaC, WaaF, y WaaQ). La presencia del disacárido HexN‐1,4‐GalA es característica del núcleo externo de LPS en P. mirabilis. Dependiendo de la naturaleza del residuo de HexN, se encuentran, en el agrupamiento génico waa, dos HexNAc transferasas diferentes: wabH o wabP. El gen eptC (PMI3104) codifica para la enzima que transfiere el residuo de fosfoetanolamina a la posición O-6 de la L,D-Hep II (HepII6PEtN), en el núcleo de LPS de P. mirabilis. La ausencia de la carga positiva del residuo de fosfoetanolamina no afecta a la cinética de crecimiento de las bacterias en condiciones standard de laboratorio sea en medios ricos o definidos. La ausencia del residuo fosfoetanolamina provoca una desestabilización moderada de la membrana externa que se traduce en una disminución de la MIC para SDS.

Made available in DSpace on 2014-12-17T14:46:39Z (GMT). No. of bitstreams: 1 ParticiaCBF_DISSERT.pdf: 926078 bytes, checksum: 9ea88765b5e731681c2629ed4e7288ec (MD5) Previous issue date: 2009-09-29 / A descriptive, quantitative approach and non-participant observation study, which was aimed at analyzing the association between knowledge and practice of inclusion and maintenance of urinary catheter by nursing professionals in the occurrence of urinary tract infection, performed in the ICU of Onofre Lopes University Hospital in Natal / RN. The original sample was composed of 42 nursing staff professional, five (5) nurses and 37 nursing technicians, 27 of them were outsourced (FUNPEC and IEL fellows) and 10 servers UFRN. Data collection was performed using two instruments, the first observation procedures used in the insertion and manipulation of indwelling urinary catheter (IUC) and the second with a questionnaire that addressed the characterization data of respondents, knowledge and conduct the insertion and manipulation of the IUC. The results were tabulated in Microsoft Excel and analyzed using SPSS software, version 15.0. We found the prevalence of institutional staff members on outsourcing - IEL and FUNPEC - (64.3%) were female (69.0%), aged 21 to 35 years (59.5%) and with mid-level education (88.1%). As to knowledge, we found that the nurses had levels of good to excellent and the nursing technicians, to regulate the poor. The nurses made a mistake when choosing IUC (40.0%) and washing hands (30.0%) and technicians on hand washing (74.4%) and the contents of the tray (34.7%). In relation to the conduct of insertion of IUC, the nurses made a mistake when choosing SVD (66.7%) and washing hands (57.1%). Regarding the handling of IUC/drainage system, the technicians were wrong more about washing their hands (56.0%). Analyzing the misconduct to the categorization of knowledge, we saw that the nursing staff who had missed more had inadequate knowledge (&#961; = 0.001). At the end we found the risk of a patient to acquire UTI is higher in two and a half times when there is a large number of mismatches, patient spends more time using the IUC and hospitalized in the ICU. As regards the study hypotheses, we accept the alternative hypothesis and reject the null hypothesis proposed at the start of this research, where the number of gaps in knowledge and behavior increases the incidence of urinary tract infection. / Estudo descritivo, de abordagem quantitativa e observacional n?o participante, que teve como objetivo geral analisar a associa??o do conhecimento e conduta de inser??o e manuten??o da sonda vesical de demora pelos profissionais de enfermagem na ocorr?ncia de infec??o do trato urin?rio, realizado na UTI do Hospital Universit?rio Onofre Lopes em Natal/RN. A amostra pesquisada foi composta por 42 profissionais da equipe de enfermagem, sendo cinco (5) enfermeiros e 37 t?cnicos de enfermagem, deles 27 eram terceirizados (FUNPEC e bolsistas do IEL) e 10 servidores da UFRN. A coleta de dados foi realizada atrav?s de dois instrumentos, o primeiro utilizado na observa??o procedimentos de inser??o e de manipula??o da Sonda Vesical de Demora (SVD) e o segundo, com a aplica??o de um question?rio que abordou dados de caracteriza??o dos pesquisados, conhecimentos e conduta na inser??o e manipula??o da SVD. Os resultados foram tabulados no Excel e analisados atrav?s do programa estat?stico SPSS, vers?o 15.0. Encontramos a predomin?ncia de funcion?rios com v?nculo institucional terceirizado IEL e FUNPEC - (64,3%), do sexo feminino (69,0%), na faixa et?ria de 21 a 35 anos (59,5%) e com n?vel m?dio de escolaridade (88,1%). Quanto aos conhecimentos, verificamos que os enfermeiros apresentaram n?vel de bom a ?timo e os t?cnicos de enfermagem, de regular a ruim. Os enfermeiros erraram mais na escolha da SVD (40,0%) e na lavagem das m?os (30,0%) e os t?cnicos, na lavagem das m?os (74,4%) e no conte?do da bandeja (34,7%). Em rela??o ?s condutas de inser??o da SVD, os enfermeiros erraram mais na escolha da SVD (66,7%) e na lavagem das m?os (57,1%). Em rela??o ? manipula??o da SVD/sistema de drenagem, os t?cnicos erraram mais ao lavar as m?os (56,0%). Ao analisarmos as condutas inadequadas com a categoriza??o do conhecimento, vimos que os t?cnicos de enfermagem que erraram mais apresentaram conhecimentos inadequados (&#961; = 0,001). Ao final, vimos que o risco de um paciente adquirir ITU est? maior em duas vezes e meia quando ocorre um n?mero grande de inadequa??es, paciente passa mais tempo usando a SVD e internado na UTI. Quanto ?s hip?teses do estudo, aceitamos a Hip?tese alternativa e rejeitamos a hip?tese nula proposta no in?cio desta pesquisa, onde a quantidade de inadequa??es no conhecimento e conduta aumenta a ocorr?ncia de infec??o do trato urin?rio.

Bakgrund:Kvarliggande kateter [KAD] är en behandling för akut eller kronisk urinretention och används vid sjukdomar eller vissa operationer. Samtidigt ökar KAD risk för urinvägsinfektion, vilket minskar patientsäkerheten, förlänger återhämtningstid och ökar behandlingskostnad. Förebyggande åtgärder för att minska kateterassocierad urinvägsinfektion [UVI] blir därför allt viktigare. Flera länder i Europa, Nord- och Sydamerika har gjort flertalet studier och hittat effektiva evidensbaserade förebyggande åtgärder mot kateterassocierad UVI. Utifrån säker och evidensbaserad vård skulle evidensbaserade förebyggande åtgärder tas reda på och användas för att minska kateterassocierad UVI.  Syfte:Att beskriva förebyggande åtgärder inom omvårdnad mot kateterassocierad UVI. Metod:Litteraturöversiktutifrån Polit och Becks niostegsmodell användes i urval och datainsamling till att 12 artiklar gick igenom kvalitetsgranskningen och analyserades till resultatet med induktiv ansats.  Resultat:Förebyggande åtgärder sammanställdes i tre huvudkategorier. Första huvudkategorin följ riktlinjer med underkategorierna kateterisering endast utifrån läkarordination och lämpliga indikationer, aseptisk teknik med rätt utrustning, fixering av KAD och uppsamlingspåsen samt borttagning av KAD om inga behov föreligger. Andra huvudkategorin utför kontrollrutiner med underkategorierna utför kateteriserings checklista samt kontrollera, rapportera    och dokumentera kateter dagligen. Tredje huvudkategorin etablera ett systematiskt förbättringsarbete med underkategorierna utse en eller två ansvariga personer, erbjud föreläsning och träning om kateterisering samt arrangera workshop. Slutsatser:Kateterassocierad UVI kan förebyggas om sjuksköterska uppfyller sin kompetens med hjälp av workshop, utför kateterisering enligt riktlinjer, samt hanterar och kontrollerar urinkateter enligt kontrollrutiner såsom kateteriserings checklista. / Background:An indwelling catheter is used as a treatment for acute or chronic urinary retention and is commonly used for diseases or some surgeries. At the same time, indwelling catheters increases the risk of urinary tract infections, which reduces patient safety, prolongs patient’s recovery and increases treatment costs. Several countries in Europe, North- and South America have conducted several studies that found evidence-based, effective preventive measures against catheter associated urinary tract infections. Evidence-based preventative measures should be found out and be used to decrease catheter associated urinary tract infections. Aim: To describe preventive measures in nursing against catheter-associated urinary tract infections. Method:Literature overview with Polit and Beck's nine-way model is used in selection and data collection to ensure that the 12 articles selected to the quality review were analyzed for results with an inductive approach. Results:Prevention measures were compiled into three main categories. First main category follows guidelines with subcategories catheterization only based on medical ordinance and appropriate indications, aseptic technique with proper equipment, fixation of catheter and collection bag and removal of catheter if no needs exists. Second main category performs check routines with subcategories perform catheterization checklist as well as check, report and document catheters daily. Third main category establish a systematic improvement work with subcategories appoint one or two responsible persons, offer lecture and training on catheterization and arrange workshop. Conclusions:Catheter associated urinary tract infections can be prevented if the nurse fulfills her/his competency with help of workshop, performs catheterization according to guidelines, manages and controls the urinary catheter according to control routines such as catheterization checklist.

Made available in DSpace on 2015-12-06T23:47:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2008 / Objetivos: 0 estudo procurou determinar os fatores de risco associados a infeccao de sitio cirurgico e do trato urinario pos-transplante simultaneo de rim-pancreas. Foi tambem estudada a incidencia de infeccao de sitio cirurgico e infeccao do trato urinario nesta coorte de pacientes e os principais patogenos causadores destas infeccoes. Metodo: 0 estudo foi realizado no Hospital São Paulo, hospital terciario de ensino da Universidade Federal de São Paulo. 0 estudo utilizou uma coorte de pacientes que incluiu todos os pacientes que realizaram transplante simultaneo de rim-pancreas no periodo de 01 de dezembro de 2000 a 31 de dezembro de 2006 (119 receptores). Estes pacientes foram acompanhados atraves do prontuario, por um periodo de um mes pos-transplante, para desenvolvimento de infeccao de sitio cirurgico, e durante todo 0 periodo de internacao apos 0 transplante para 0 desenvolvimento de infeccao do trato urinario hospitalar. Os criterios usados para 0 diagnostico de infeccao hospitalar foram definidos pelo Centers for Disease Control and Prevention (CDC). E foram realizados dois estudos tipo caso-controle aninhado (do ingles Nested Case Control), onde foram avaliados os fatores de risco para infeccao de sitio cirurgico e infeccao do trato urinario nesta coorte de pacientes. A analise multivariada foi realizada pela tecnica de regressao logistica multipla, utilizando as variaveis com p&#8804; 0,05 na analise univariada. 0 metodo utilizado foi 0 Stepwise forward. Resultados: A mortalidade nos primeiros 30 dias apos 0 transplante foi 11,8%. A infeccao de sitio cirurgico ocorreu em 55 (46,2%) pacientes submetidos ao transplante. Os principais microrganismos foram: Klebsiella pneumoniae, 10 (28%); Staphylococcus aureus, 8 (22%); Pseudomonas aeruginosa, 8 (22%); Acinetobacter baumannii, 4 (11 %). Ap6s a regressao logistica multivariada, as variaveis independentemente associadas a ISC foram: necrose tubular aguda (OR=4,4; IC95%= 1,77 - 10,99; p=0,001); fistula renal ou pancreatica pos-­transplante (OR=7,25; IC95%= 1,35 - 38,99; p=0,02) e rejeicao do enxerto (OR=4,28; IC95%= 1,59 - 11,48; p=0,004). A infeccao do trato urinario ocorreu em 29 (24,4%) pacientes submetidos ao transplante. Os principais microrganismos foram: Klebsiella pneumoniae 13 (43,5%), Acinetobacter baumannii 7 (23,5%), Enterobacter spp 2(7%), Pseudomonas aeruginosa 2 (7%).Apos a regressao logistica multivariada, as variaveis independentemente associadas a ITU foram: tempo de hipertensao arterial (OR=1, 1; IC95%= 1,00 - 1,02; p=0,01); uso de alcool pelo doador (OR=7,49; IC95%= 1,01 - 55,66; p=0,04) e uso de drogas vasoativas no doador (OR=0,08; IC95%= 0,01 - 0,84; p=0,03) e, como fator protetor: diurese residual pre-transplante (OR=0,16; IC95%= 0,04 - 0,59; p=0,006). Conclusao: Nosso estudo demonstrou que variaveis relacionadas ao procedimento cirurgico estao mais relacionadas ao desenvolvimento de infeccao de sitio cirurgico e que variaveis relacionadas ao receptor e doador estao mais relacionadas ao surgimento de infeccao do trato urinario em pacientes submetidos a transplante simultaneo rim­-pancreas. Nosso estudo e um dos primeiros a avaliar fatores de risco para essas duas importantes infeccoes nosocomiais nessa coorte de pacientes. / BV UNIFESP: Teses e dissertações