Assessing Patients With Altered Level of Consciousness.

Patients with alterations in level of consciousness are among the most difficult to assess, so knowledge of how to assess these patients is important for tracking trends and identifying changes. This article discusses methods used to assess patients admitted with an altered level of consciousness and describes the neurological assessment of and potential causes for altered level of consciousness. Identifying and understanding certain examination findings enable faster recognition and intervention for life-threatening neurological events, directly impacting outcomes for neurologically compromised individuals.

Knowledge and actions for the control of the vector Aedes aegypti in a municipality in the Legal Amazon.

Infections caused by arboviruses that have mostly impacted the Brazilian morbidity and mortality are caused by the same vector, Aedes aegypti. Preventive actions related to the vector are the most effective strategies in the prevention and control of these diseases. This study aimed to associate the knowledge on the vector that transmits dengue, Zika and chikungunya with the sociodemographic and behavioral preventive practices towards Aedes aegypti in the municipality of Tangara da Serra, Mato Grosso State, in the Brazilian Legal Amazon. A probabilistic urban population sampling was obtained by clusters: census sectors and households. The sample size calculation considered 10% of loss and a 1.5 design effect. This is a cross-sectional research carried out through a household survey in February and March 2018. There were 583 participants. The study variables were knowledge on the vector, sociodemographic characteristics and preventive practices related to the vector. The statistical analysis was based on a bivariate analysis and Poisson multiple regressions. Inadequate or insufficient knowledge on the vector Aedes aegypti remained associated with education in the categories illiterate (p<0.001) and 8 years of study or less (p<0.001), in addition to not adopting practices of capping and cleaning the water tank (p=0.002) and not using insecticides at home (p=0.007). It is concluded that there is a need for health communication actions that consider characteristics the population, especially the level of education and previous knowledge on the vector, allowing a dialogical approach and enabling the community participation in preventive practices and control of the vector Aedes aegypti .

Assistência pré-natal realizada por enfermeiros: o olhar da puérpera / Prenatal care carried out by nurses: the view of the puerpera

Ao longo dos anos, as propostas voltadas para integralidade da atenção às necessidades do público feminino contribuíram para romper com os princípios norteadores do modelo materno-infantil desenvolvido, marcando de maneira histórica a vida da mulher. O estudo objetiva identificar as ações de enfermagem realizadas pelo enfermeiro durante a gestação sob o olhar da puérpera. A pesquisa possui abordagem qualitativa, de campo, exploratória e descritiva. Participaram do estudo nove puérperas. Foi realizada entrevista semiestruturada e coleta documental, entre agosto e dezembro de 2013, em duas Unidades de Saúde da Família do município de Rondonópolis. Os resultados demonstraram algumasparticularidades relacionadas à interação das mulheres diante das orientações em saúde (período gestacional, puerpério e cuidados com o recém-nascido) e às consultas de enfermagem (acolhimento, exame físico e conduta do enfermeiro). Concluiu-se que o enfermeiro é referência para assistência pré-natal, sendo suas condutas diretamente proporcionais à qualidade da assistência prestada...

Throughout the years, the proposals geared towards the comprehensiveness of attendance to the needs of the female public have contributed to overcome the guiding principles of the mother-child model that had been established, marking woman’s life historically. The objective of this study is to identify nursing actions performed by the nurses duringpregnancy from the point of view of the puerperae. The research has a qualitative, field, exploratory and descriptive approach. Nine puerperas participated in this study. Semi-structured interview and document collection were carried out between August and December 2013 in two Family Health Units at the municipality of Rondonópolis, Brazil. Results showed some peculiarities related to the interaction of women when facing health orientations (gestation period,puerperium and newborn care) and nursing visits (care, physical examination and nurse conduct). We conclude that the nurse is a reference for prenatal care, his conduct being directly proportional to the quality of the assistance provided...

A lo largo de los años, las propuestas vueltas hacia la integralidad de la atención a las necesidades del público femenino contribuyeron para romper con los principios que nortean el modelo materno-infantil desarrollado y marcaron de manera histórica la vida de las mujeres. El estudio tiene por objetivo identificar las acciones de enfermería realizadas por el enfermero durante la gestación bajo la mirada de la puérpera. La investigación tiene abordaje cualitativo, de campo,exploratorio y descriptivo. Participaron del estudio nueve puérperas. Se realizó entrevista semiestructurada y recolección documental, de agosto a diciembre de 2013, en dos Unidades de Salud de la Familia del municipio de Rondonópolis. Los resultados demostraron algunas particularidades relacionadas a la interacción de las mujeres frente a las orientaciones en salud (periodo gestacional, puerperio y cuidados con el recién nacido) y a las consultas de enfermería (acogimiento,exámenes físicos y conducta del enfermero). Se pudo concluir que el enfermero es referencia para la atención prenatal, al ser sus conductas directamente proporcionales a la calidad de la atención prestada...

As repercussões de viver com uma colostomia temporária nos corpos: individual, social e político / The repercussions of living with a temporary colostomy on the bodies: individual, social and political / Las repercusiones de vivir con una colostomía temporal en los cuerpos: individuales, sociales y políticos

O presente estudo abordou o tema colostomia temporária e teve como objetivo analisar suas repercussões na vida das pessoas com base nos corpos: individual, social e político. Estudo descritivo de abordagem qualitativa, com base na História de Vida Focal. Os sujeitos do estudo foram oito pessoas com colostomia temporária que frequentaram o ambulatório de estomias de um hospital universitário público de Cuiabá-MT. Os dados foram coletados por meio de entrevistas semiestruturadas, no período de outubro a novembro de 2008. As entrevistas foram gravadas e, após transcritas, procedeu-se a análise temática. Foram assim, identificadas duas categorias: as repercussões das informações sobre a necessidade da colostomia e seu cuidado; as repercussões de viver com uma colostomia temporária nos corpos individual, social e político. Ressaltamos a importância do papel da enfermagem em focalizar as particularidades das pessoas com colostomias temporárias, considerando o contexto sociocultural e a subjetividade de cada uma delas.

This study analyzed the repercussions of people with temporary colostomy based on the bodies: individual, social and political. It?s a descriptive study of qualitative approach, based on the Life History Focal. The subjects were eight people with temporary colostomy who attended the stomas ambulatory of a public university hospital from Cuiabá-MT. Data were collected by semi-structured interviews in the period from October to November 2008. The interviews were recorded and, after transcribed them, we proceeded to thematic analysis. Then, we identified two categories: the repercussions of information on the need of colostomy and its care; the repercussions of living with a temporary colostomy on the individuals bodies, social and political. We emphasize the importance of nursing role in focus the people?s particudlarities with temporary colostomy, considering the sociocultural context and the subjectivity of each one of them.

El presente estudio abordó el tema colostomía temporario teniendo como objetivo analizar sus repercusiones en la vida de las personas con base en sus cuerpos: individuales, sociales y políticos. Estudio descriptivo de abordaje cualitativo, con base en la historia de vida focal. Los participantes del estudio fueron ocho personas con colostomía temporaria que frecuentaran el ambulatorio de estomas de un hospital universitario público de Cuiabá-MT. Los datos fueron recogidos por medio de entrevista semi-estructuradas, en los meses de octubre a noviembre de 2008. Las entrevistas fueron grabadas, posteriormente transcritas y analizadas por temáticas. Las categorías identificadas fueron: las repercusiones de las informaciones sobre la necesidad de la colostomía y sus cuidados; las repercusiones de vivir con una colostomía temporaria en los cuerpos individuales, sociales y políticos. Resaltamos la importancia de la función de la enfermería en enfoque de las particularidades de las personas con colostomías temporarias, considerando el contexto socioculturales y la subjetividad de cada.

Early diagnosis and specialist care in the management of congenital hypothyroidism

Background. Newborn screening for congenital hypothyroidism (CH) in the Philippines was introduced in 1996. It is universally accepted that early detection through newborn screening and timely treatment can improve the physical and neuro-cognitive development of patients. As of December 2010, the prevalence of CH is 1 in 3,324 among 2,389,959 newborns screened. Objective. We sought to evaluate the role of timing of diagnosis, compliance with treatment, and specialist care on growth and development (mental and physical) of patients with congenital hypothyroidism detected through newborn screening. Methods. Of the 326 patients identified through newborn screening between July 1996-December 2008 at the Newborn Screening Center-National Institutes of Health, 86 patients participated in the study. With the parents' or guardians' consent, general physical examination and neuro-cognitive evaluation were done; FT4 and TSH were determined. Prevalence of poor control of disease (high TSH with normal or low FT4 or normal TSH with low FT4), stunting, and cognitive delay were each estimated at 95% confidence level and the associations of early diagnosis, initial and continuing specialist care with these conditions were determined by multiple logistic regression analyses. Results. The prevalences (95% confidence interval) were: poor control of disease 63% (52-73%), stunting 24% (15-34%) and neuro-developmental delay 17% (8-25%). Delay in one aspect of neuro-development was seen in 54% (43-66%). Early diagnosis was protective against poor control of disease (adjusted Odds Ratio, ORa=0.24 [CI: 0.08-0.77]). Trends towards protection were seen for initial and continuing specialist care. For delay in at least one cognetive aspect, early diagnosis was found to be protective (ORa=0.19 [CI 0.05-0.76]); results for specialist care were inconclusive. For stunting, low parent education was found to be a risk factor. (ORa of 5.45 [CI: 1.3-22.7]). Conclusion. Fifty-four percent of the study patients had delay in one aspect of neuro-development. While other factors play a role in the outcome of CH, early diagnosis and treatment were shown to be protective of patients from poor control of disease and cognitive delays. Observed trends of positive benefits of specialist care at onset and continuing medical management, and the association of low parent education with poor growth should be considered in drafting specific guidelines for the long term follow-up care and monitoring of CH patients detected through newborn screening. The low percentage of participation and incomplete retrieval of information are major limitations of this retrospective study. This stresses the need for better monitoring tools that will ensure proper tracking, medical care and evaluation of CH patients.

Auto-irrigação: estratégia facilitadora para a reinserção social de pessoas com colostomia / Self-irrigation: made easy strategy the social reinsertion of the people with definitive colostomy / Auto-irrigación: estrategia que puede facilitar la reinserción social de personas con colostomía

A auto-irrigação se constitui como um importante instrumento de apoio ao controle intestinal, possibilitando a pessoa com colostomia a sua reinserção social. Este estudo teve por objetivo compreender o processo de treinamento para técnica de auto-irrigação intestinal proposto a pessoas com colostomia definitiva, assim como as implicações desta técnica no que diz respeito à qualidade de vida, abordando aspectos sociais e culturais. Trata-se de um estudo exploratório com abordagem qualitativa, realizado em hospital universitário em Cuiabá-MT, no período de maio de 2005 a maio de 2006. Os sujeitos do estudo foram 10 pessoas com colostomia, selecionados conforme critérios estabelecidos previamente, e que aceitaram participar do treinamento da auto-irrigação. Os dados foram coletados através de entrevista semi-estruturada realizada em diferentes momentos do processo de treinamento: antes, durante e depois do mesmo. A análise desses dados resultou em duas categorias: a primeira denominada de ?Socializando a informação sobre a auto-irrigação? deu origem as subcategorias: Repercussões da aprendizagem da técnica de auto-irrigação e Realizando a técnica de auto-irrigação; e a segunda denominada ?As possibilidades após ensino-aprendizagem da auto-irrigação?. A irrigação se mostrou satisfatória como facilitadora da reinserção social dos indivíduos com colostomia definitiva, trazendo uma melhor qualidade de vida aos mesmos.

The self-irrigation constitutes an important instrument of support to intestinal control, allowing the colostomy?s carriers their social reintegration. The purpose of this study is to comprehend the process of training for technique of intestinal self-irrigation recommended to people with definitive colostomy, as well as the implications of this technique in respect to the quality of life, approaching social and cultural aspects. It means about an exploratory study with qualitative boarding, conducted at university hospital in Cuiabá ? MT, in the period from May 2005 to May 2006. The sample of the study constituted 10 colostomy?s carriers, selected conform criterions established previously, and who accepted to participate of the self-irrigation training. The data were collected through interviews half-structuralized occurred at different moments of the training process: before the training, during it and after it. The analysis of these data resulted in two categories: the first one called for ?Socializing the information about self-irrigation? originated the subcategories: Implications of learning the technique of self irrigation and accomplishing the technique of self-irrigation; and the second one called for "The possibilities after education-learning of the self-irrigation?. The irrigation presented to be satisfactory and facilitator to social reinsertion of individuals with definitive colostomy, bringing better quality of life to the same ones.

La auto irrigación se constituye en un importante instrumento de apoyo al control intestinal, posibilitando a la persona con colostomía su reinserción social. Este estudio tuvo como objetivo comprender el proceso de entrenamiento de la técnica de auto-irrigación intestinal propuesto para las personas con colostomía definitiva, así como las implicancias de esta técnica en su calidad de vida, investigando también aspectos sociales y culturales. Se trata de un estudio exploratorio de abordaje cualitativo, realizado en un hospital universitario en Cuiabá ? MT, en el periodo de mayo del 2005 a mayo del 2006. Los sujetos fueran diez colostomizados seleccionados por criterios establecidos previamente y que aceptaron participar del entrenamiento de auto-irrigación de su colostomía. Los datos fueran recolectados a través de entrevistas semi-estructuradas realizadas en diferentes momentos del entrenamiento: antes, durante y después del mismo. El análisis de los datos mostró dos categorías: la primera denominada de ?socializando la información sobre la auto-irrigación? que dio origen a las subcategorías: repercusiones del aprendizaje de la técnica de auto irrigación e realizando la técnica de auto irrigación; la segunda categoría denominada ?Las posibilidades después de la enseñanza ?aprendizaje de la auto irrigación?. La irrigación se mostró satisfactoria así como facilitadora de la reinserción social de los individuos con colostomía definitiva, aportando una mejor calidad de vida a los mismos.