Following Darwin's footsteps: Evaluating the impact of an activity designed for elementary school students to link historically important evolution key concepts on their understanding of natural selection.

While several researchers have suggested that evolution should be explored from the initial years of schooling, little information is available on effective resources to enhance elementary school students' level of understanding of evolution by natural selection (LUENS). For the present study, we designed, implemented, and evaluated an educational activity planned for fourth graders (9 to 10 years old) to explore concepts and conceptual fields that were historically important for the discovery of natural selection. Observation field notes and students' productions were used to analyze how the students explored the proposed activity. Additionally, an evaluation framework consisting of a test, the evaluation criteria, and the scoring process was applied in two fourth-grade classes (N = 44) to estimate elementary school students' LUENS before and after engaging in the activity. Our results show that our activity allowed students to link the key concepts, resulting in a significant increase of their understanding of natural selection. They also reveal that additional activities and minor fine-tuning of the present activity are required to further support students' learning about the concept of differential reproduction.

Propriedades psicométricas do Questionário Geral de Saúde 28 itens em enfermeiros: proposta com 24 itens / Psychometric properties of the 28-Item General Health Questionnaire in nurses: a proposal with 24 items / Propiedades psicométricas del Cuestionario de Salud General de 28 ítems en enfermeros: propuesta con 24 ítems

Resumo Enquadramento: A avaliação das propriedades psicométricas dos instrumentos de medida, quando aplicados em diferentes populações, é essencial. Objetivo: Analisar as propriedades psicométricas do Questionário de Saúde Geral 28 itens (GHQ28) em enfermeiros. Metodologia: Estudo metodológico de validação de instrumentos de medida. Análise das propriedades psicométricas, análise fatorial exploratória (AFE) pelo método dos componentes principais, e curva Receiver Operating Characteristic (ROC), com uma amostra não probabilística de 1.264 enfermeiros. Resultados: A AFE propõe a manutenção de 4 fatores e eliminação de 4 itens em 3 dimensões (item 3,16, 21,26). A variância explicada pelos 4 fatores foi 61,5% e o alfa de Cronbach 0,93. Os resultados de saúde geral não sofreram variabilidade significativa após se retirarem os 4 itens. A curva ROC, comparando a versão 24 itens com a de 28, revelou uma área sob a curva (AUC) de 0,996 (p < 0,001) e ponto de corte 20,5, com uma sensibilidade de 96,3% e especificidade de 98,4%. Conclusão: A reavaliação das propriedades psicométricas do GHQ28 em enfermeiros, sugere redução para 24 itens.

Abstract Background: The psychometric properties of measurement instruments should be assessed in different populations. Objective: To analyze the psychometric properties of the 28-Item General Health Questionnaire (GHQ-28) in nurses. Methodology: Methodological validation study of measurement instruments. Analysis of psychometric properties, exploratory factor analysis (EFA) by the principal component analysis method, and Receiver Operating Characteristic (ROC) curve, with a nonprobability sample of 1,264 nurses. Results: EFA suggests keeping four factors and deleting four items in three dimensions (items 3, 16, 21, and 26). The variance explained by the four factors was 61.5%, and Cronbach's alpha was 0.93. The general health scores did not change significantly after deleting the four items. The comparison between the 24-item version and the 28-item version revealed an area under the curve (AUC) of 0.996 (p <0.001) and a cutoff point of 20.5, with a 96.3% sensitivity and a 98.4 specificity. Conclusion: The reassessment of the psychometric properties of GHQ-28 in nurses suggests a reduction to 24 items.

Resumen Marco contextual: La evaluación de las propiedades psicométricas de los instrumentos de medición, cuando se aplican en diferentes poblaciones, es esencial. Objetivo: Analizar las propiedades psicométricas del Cuestionario de Salud General de 28 ítems (GHQ28) en enfermeros. Metodología: Estudio metodológico sobre la validación de instrumentos de medida. Análisis de las propiedades psicométricas, análisis factorial exploratorio (AFE) mediante el método de componentes principales y curva Receiver Operating Characteristic (ROC), con una muestra no probabilística de 1264 enfermeros. Resultados: La AFE propuso el mantenimiento de 4 factores y la eliminación de 4 ítems en 3 dimensiones (ítem 3, 16, 21, 26). La varianza explicada por los 4 factores fue del 61,5% y el alfa de Cronbach del 0,93. Los resultados de salud general no experimentaron una variabilidad significativa tras eliminar los 4 ítems. La curva ROC, que compara la versión de 24 ítems con la de 28, mostró un área bajo la curva (AUC) de 0,996 (p < 0,001) y un punto de corte de 20,5, con una sensibilidad del 96,3% y una especificidad del 98,4%. Conclusión: La reevaluación de las propiedades psicométricas del GHQ28 en enfermeros sugiere una reducción a 24 ítems.

Relationship between age and blastocyst chromosomal ploidy analyzed by noninvasive preimplantation genetic testing for aneuploidies (niPGT-A).

OBJECTIVE: To assess the relationship between human blastocyst chromosomal ploidy established by niPGT-A and increasing age. METHODS: This is a prospective multicenter study carried out by ten assisted reproduction centers after their embryologists acquired training and validated their results with the previous use of niPGT-A. A total of 94 couples with indication for niPGT-A due to increase maternal age, male factor, repeated implantation failures, recurrent abortion or because they requested niPGT-A were included in this study. The couples had no karyotype abnormalities. After ICSI, the embryos were cultured until blastocyst stage using one or two step culture systems, single or sequential media respectively, at 37°C in an atmosphere of 6-7% CO2 and 5-20% O2 incubators. On day 3, we re-evaluated cleavage embryos to complete cumulus cells removal. The embryos were then cultured in individual well, with 20µl of medium under oil until they reached blastocyst stage. The blastocysts were vitrified and stored in liquid nitrogen. After that, the spent blastocyst culture medium (20µl) was transferred to a PCR tube and sent for analysis in the genetic laboratory, where it was stored at -80°C until sequencing. A total of 243 samples of spent blastocyst culture medium were collected on the 5th/6th day. Cell-free DNA secreted on culture medium was amplified using NICS Sample Preparation Kit (Yikon Genomics), based on the MALBAC technology. After whole genome amplification, the DNA was measured using a Qubit 2.0 fluorometer and subjected to next generation sequencing (NGS) using Illumina MiSeq® platform. The data were analyzed using the ChromGo® software (Yikon Genomics). RESULTS: The mean age of the patients was 38±4.08 years with an interval of 20-44 years. The euploid was diagnosed in 36.4% (80/220) of cases, aneuploidy in 31.3% (69/220), and mosaicism in 32.3% (71/220; with ≥60% aneuploidy) of blastocysts. Mosaic values ranged from 29.8% to 33.8% in different age groups. Individually, the most frequent chromosomal abnormality was XXY (Klinefelter Syndrome) occurring in 18 cases, followed by chromosome 21 (trisomy/monosomy) in 8 cases. The niPGT-A data showed a ≥60% incidence of aneuploid cells in all cases of chromosomal mosaicism (n=71). CONCLUSION: A high degree of mosaicism with aneuploidy cells was detected, and some hypotheses were suggested for this data (niPGT-A sensitivity in detecting the self-correction of chromosomal abnormalities phenomenon). However, it did not vary remarkably with age. On the other hand, euploidy levels had a negative correlation with age and aneuploidy levels had a positive relationship. This is the first report in the literature to relate chromosomal ploidy in blastocysts using niPGT-A and increasing patient age.

A national survey of the nurses' mental health - The case of Portugal.

AIM: To understand Portuguese nurses' perceptions of their mental health. BACKGROUND: The impact of nurses' health and well-being on the quality and safety of the care they provide is well known. In Portugal, there are no representative studies regarding nurses' mental health. MATERIALS AND METHODS: Transversal, analytical, and observational methods were used, with a quantitative approach. Participants answered questions through an online form. We collected data concerning social-professional characterization, general health status, and mental health. The General Health Questionnaire-28 (GHQ-28) was used. RESULTS: A total of 1264 nurses participated in a nonrandomized sample. Two-thirds revealed a negative perception of their mental health. Of these, 22.2% reported severe depression symptoms, 71.6% indicated significant somatic symptoms, 76% showed significant anxiety, and 94.1% presented some kind of social dysfunction. CONCLUSION: Better mental health is associated with being part of a larger household, enjoying more hours of sleep, having more free weekends, being male, working as a specialist, and engaging in leisure activities. Worse mental health is associated with being older, having a longer career, working more hours, and practicing in the hospital context. IMPLICATIONS FOR NURSING PRACTICE: The professionals' living and working conditions must be addressed by their managers.

Assessing Tumor Mechanics by MR Elastography at Different Strain Levels.

BACKGROUND: Malignant tumors are associated with increased tissue rigidity, which can be an indicator of tumor progression. MR elastography (MRE) has the potential to study the variations of tumor mechanical properties. ex vivo studies have shown the ability of MRE to assess increase of mechanical properties; nevertheless, it has not yet been observed in vivo. PURPOSE: To propose a method to assess the increase in mechanical properties of tumors in vivo under static external compression using MRE. STUDY TYPE: Prospective, experimental study. ANIMAL MODEL: Forty-six SCID mice with subcutaneous tumor implantation (patient-derived hepatocellular carcinoma xenografts, Model 1, n = 13, and Model 2, n = 33). FIELD STRENGTH/SEQUENCE: 7.0T; a spin echo sequence was used for anatomical images and a modified spin echo sequence for elastography acquisitions with a vibration frequency of 600 Hz. ASSESSMENT: An inflatable balloon was placed on the abdomen to apply a load to the tumor. MRE acquisitions were performed at the basal state and at increasing compression levels. Anatomical images were used to calculate the octahedral shear strain between the tumor at the basal strain state and each strain level. For six mice (Model 2), each static preloading scan was acquired twice consecutively without moving the mouse to evaluate repeatability. Statistical Tests: The Bland-Altman method was used to assess repeatability. Correlations between tumor stiffness and deformation were evaluated with Pearson correlation coefficients. RESULTS: For stiffness (G*), a good repeatability was obtained between the acquisitions; the limits of agreement of the Bland-Altman test were [-10.17%; 11.49%] with an absolute bias of 0.66%. A significant correlation between tumor stiffness and deformation was observed for both models (Model 1: r = 0.57, P < 0.0001 and Model 2: r = 0.31, P < 0.0001). DATA CONCLUSION: We establish that tumor mechanical properties can increase under mechanical compression. This increase can effectively be monitored using a proposed MRE setup. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1982-1989.

Produção científica sobre as contribuições fenomenológicas para o estudo da tanatologia na enfermagem / Producción científica sobre las contribuciones fenomenológicas para el estudio de la tanatología en enfermería / Scientific Production about Phenomenological Contributions for the Study of Thanatology in Nursing

RESUMO Introdução: A intervenção do cuidado passa diretamente pela compreensão, reflexão, analise de como o profissional da enfermagem percebe o fenômeno do processo de morte/morrer. Objetivo: Analisar as produções científicas desenvolvidas pela enfermagem que abordam a temática tanatologia. Métodos: Estudo de revisão integrativa, de característica crítica e retrospectiva. Estratégia de busca: utilização da palavra-chave "fenomenologia" e descritores "enfermagem", "cuidados paliativos" e "tanatologia". A busca ocorreu nas bases: MEDLINE; LILACS; BDENF e SCOPUS. Critérios de inclusão: artigos disponibilizados na íntegra nos portais de dados selecionados que apresentavam aderência à temática em Português, Inglês e Espanhol, publicados entre os anos de 2011 a 2015 e que apresentassem na metodologia o referencial filosófico adotado. Critérios de exclusão: pesquisas que se encontravam repetidas nas bases de dados. Conclusões: Abordam o processo morte/morrer por acadêmicos ingressantes no curso de enfermagem; a vivencia da terminalidade por intermédio da arte; o cuidado paliativo na terminalidade e a doação de órgãos após a finitude da vida. A preocupação pela temática permeia o cenário acadêmico e hospitalar, mas em ambos a preocupação mais latente está ligada a humanização assistencial. As produções científicas desenvolvidas pela enfermagem que abordam a temática tanatologia presam pelo cuidado não apenas durante o processo morte/morrer, mas estende-se ao pós-morte por meio da doação de órgãos, o que demonstra um olhar holístico ao exercer o cuidar, tornando este efetivo e com repercussões positivas sobre a memória dos que recebem os cuidados(AU)

RESUMEN Introducción: La intervención de cuidado pasa directamente por la comprensión, la reflexión, el análisis de la forma en que el profesional de enfermería percibe el fenómeno del proceso de la muerte / morir. Objetivo: Analizar las publicaciones científicas que abordan el tema de la Tanatología desarrolladas por la enfermería. Métodos: Estudio de revisión integradora de la función crítica y retrospectiva, con fuentes de datos primarios. Estrategia de búsqueda: el uso de palabras clave "fenomenología" y descriptores "enfermería" y "cuidados paliativos". La búsqueda se produjo en: MEDLINE; LILACS; BDENF y SCOPUS. Criterios de inclusión: los artículos disponibles en su totalidad en los portales de datos seleccionados que presentan la adherencia al tema en portugués, inglés y español, publicados entre los años 2011 la 2015 y para proporcionar el marco filosófico metodología adoptada. Criterios de exclusión: investigaciones que se repitieron en las bases de datos. Conclusiones: Se acercan a la muerte / proceso de morir por los estudiantes de primer año en el programa de enfermería; las experiencias de enfermedad terminal a través del arte; cuidados paliativos de la enfermedad terminal y la donación de órganos después de la finitud de la vida. La preocupación por el tema impregna el entorno académico y el hospital, pero en tanto la preocupación más latente está vinculada a la humanización del cuidado. Producciones científicas desarrolladas por la enfermería abordan la cuestión de la Tanatología fundamentalmente la atención no solo durante el proceso de la muerte, sino que se extiende a la otra vida con el tema de la donación de órganos, lo que demuestra una mirada integral al cuidado de ejercicio haciendo este eficaz y positivo en la memoria de los que reciben atención(AU)

ABSTRACT Introduction: Health care passes directly through understanding, reflection, and analysis of the way the nursing professional perceives the phenomenon of death or dying. Objective: To analyze the scientific publications addressing the topic of thanatology as developed by nursing. Methods: Integrative review study of the critical and retrospective function, with primary data sources. The search strategy consisted in the use of the keywords and descriptors fenomenología [phenomenology],enfermería [nursing] and cuidados paliativos [palliative care]. The search was performed MEDLINE, LILACS, BDENF and SCOPUS. The inclusion criteria permitted to choose the articles totally available in the selected sites and presenting relation to the topic in Portuguese, English and Spanish, published between 2011 and 2015 and those providing the philosophical framework adopted. The exclusion permitted not to use the investigations that were repeated in the databases. Conclusions: First-year students of the nursing program approach death or the dying process, the experiences associated with terminal illness through art, palliative care for terminal illness and organ donation after the finiteness of life. Concern about the topic permeates the academic environment and the hospital, but the most representative concern is associated with the care humanization. Scientific productions developed by nurses address the topic of thanatology, mainly the attention not only during the process of death, but extended to the next life with the focus of organ donation, which demonstrates a comprehensive approach to healthcare, being this effective and positive in the memory of those who receive attention(AU)

Produção do conhecimento sobre o cuidado fenomenológico na enfermagem / Producción de conocimiento sobre el cuidado de enfermería fenomenológica / Production of knowledge about the phenomenological care in nursing

RESUMO Introdução: na fenomenologia o cuidado é consolidado no modo de ser, atuante em todo e qualquer comportamento humano. Logo, sendo o cuidado a essência da enfermagem, ao pensarmos este em seu sentido fenomenológico, nos atemos à essência e ao sentido do cuidar. Objetivo: realizar o levantamento das produções do conhecimento que objetivaram o cuidado por intermédio da enfermagem em fenomenologia e apresentar suas contribuições para o cuidado. Métodos: estudo de revisão integrativa, de característica crítica e retrospectiva. Estratégia de busca: utilização da palavra-chave "phenomenology" e descritores "nursing care" e "health". A busca ocorreu nas bases: MEDLINE; LILACS; BDENF e SCOPUS. Critérios de inclusão: artigos publicados entre os anos de 2010 a 2015, nos idiomas Português, Inglês e Espanhol, que apresentavam aderência à temática, e que constassem o referencial filosófico adotado. Critérios de exclusão: artigos de revisão, teóricos ou de reflexão, e também os que não apresentaram aderência às questões do cuidado na enfermagem com enfoque fenomenológico. Foram analisados 26 artigos. Conclusões: o cuidado fenomenológico encontra seu desenvolvimento mais significativo sob a dimensão social, se apropriando e compreendendo o sujeito permeado por suas vivências, experiências e significados, sem esquecer-se dos familiares envolvidos no processo de cuidar e dos profissionais de saúde, o que demonstra a importância destes terem suas esferas biopsicossociais cuidadas para que o cuidado se faça substancial e efetivo(AU)

RESUMEN Introducción: el cuidado de la fenomenología se consolida con el fin de estar activo en cada comportamiento humano. Por lo tanto, teniendo cuidado de la esencia de la enfermería, a pensar de esta en su sentido fenomenológico, nos ceñimos a la esencia y el sentido de cuidado. Objetivo: realizar el levantamiento de las producciones del conocimiento dirigidas a la atención a través de la enfermería en la fenomenología y presentar sus contribuciones a la atención. Métodos: estudio de revisión integradora de la función crítica y retrospectiva. Estrategia de búsqueda: el uso de palabras clave "fenomenología" y descriptores "cuidados de enfermería" y "salud". La búsqueda se produjo en: MEDLINE; LILACS; BDENF y SCOPUS. Criterios de inclusión: los artículos publicados entre los años 2010 a 2015 en los idiomas portugués, inglés y español, que presentan la adherencia al tema, y que se trataran en el marco filosófico adoptado. Criterios de exclusión: los artículos de revisión, teóricos o de reflexión, y aquellos que no muestran la adhesión a la atención de enfermería en temas con enfoque fenomenológico. Fueron analizados 26 artículos. Conclusiones: el cuidado fenomenológico encuentra su desarrollo más significativo en la dimensión social, la apropiación y la comprensión de la materia permeada por sus experiencias, experiencias y significados, sin olvidar las familias que participan en los profesionales de procesos de atención y de salud, lo que demuestra la importancia que tienen sus esferas biopsicosociales cuidadas para que la atención se realiza sustancial y efectiva(AU)

ABSTRACT Introduction: in phenomenology care is consolidated in order to be active in every human behavior. Therefore, being careful the essence of nursing, to think of this in its phenomenological sense, we stick to the essence and sense of caring. Objective: to carry out the survey the knowledge productions aimed care through nursing in phenomenology and present their contributions to care. Methods: study of integrative review of critical feature and retrospective. Search strategy: keyword use "phenomenology" and descriptors "nursing care" and "health". The search occurred in: MEDLINE; LILACS; BDENF and SCOPUS. Inclusion criteria: articles published between the years 2010 - 2015 in the languages Portuguese, English and Spanish, presenting adherence to the theme, and to see covered in the philosophical referential adopted. Exclusion criteria: review articles, theoretical or reflection, and those who did not show adherence to care issues in nursing with phenomenological approach. 26 articles were analyzed. Conclusions: the phenomenological care finds its most significant development on the social dimension, appropriating and understanding the subject permeated by their experiences, experiences and meanings, without forgetting families involved in the care process and health professionals, which demonstrates the importance these have their biopsychosocial cared spheres so that care is done substantial and effective(AU)

Produção científica sobre as contribuições fenomenológicas para o estudo da Tanatologia na enfermagem / Producción científica sobre las contribuciones fenomenológicas de enfermería para el estudio de la Tanatología / Scientific production on the contributions infirmary fenomenológicas for the study of the Tanatología

RESUMO Introdução: a intervenção do cuidado passa diretamente pela compreensão, reflexão, analise de como o profissional da enfermagem percebe o fenômeno do processo de morte/morrer. Objetivo: analisar as produções científicas desenvolvidas pela enfermagem que abordam a temática tanatologia. Métodos: estudo de revisão integrativa, de característica crítica e retrospectiva. Estratégia de busca: utilização da palavra-chave "fenomenologia" e descritores "enfermagem", "cuidados paliativos" e "tanatologia". A busca ocorreu nas bases: MEDLINE; LILACS; BDENF e SCOPUS. Critérios de inclusão: artigos disponibilizados na íntegra nos portais de dados selecionados que apresentavam aderência à temática em Português, Inglês e Espanhol, publicados entre os anos de 2011 a 2015 e que apresentassem na metodologia o referencial filosófico adotado. Critérios de exclusão: pesquisas que se encontravam repetidas nas bases de dados. Conclusões: abordam o processo morte/morrer por acadêmicos ingressantes no curso de enfermagem; a vivencia da terminalidade por intermédio da arte; o cuidado paliativo na terminalidade e a doação de órgãos após a finitude da vida. A preocupação pela temática permeia o cenário acadêmico e hospitalar, mas em ambos a preocupação mais latente está ligada a humanização assistencial. As produções científicas desenvolvidas pela enfermagem que abordam a temática tanatologia presam pelo cuidado não apenas durante o processo morte/morrer, mas estende-se ao pós-morte por meio da doação de órgãos, o que demonstra um olhar holístico ao exercer o cuidar, tornando este efetivo e com repercussões positivas sobre a memória dos que recebem os cuidados(AU)

RESUMEN Introducción: la intervención de cuidado pasa directamente por la comprensión, la reflexión, el análisis de la forma en que el profesional de enfermería percibe el fenómeno del proceso de la muerte / morir. Objetivo: analizar las publicaciones científicas que abordan el tema de la Tanatología desarrolladas por la enfermería. Métodos: estudio de revisión integradora de la función crítica y retrospectiva, con fuentes de datos primarios. Estrategia de búsqueda: el uso de palabras clave "fenomenología" y descriptores "enfermería" y "cuidados paliativos". La búsqueda se produjo en: MEDLINE; LILACS; BDENF y SCOPUS. Criterios de inclusión: los artículos disponibles en su totalidad en los portales de datos seleccionados que presentan la adherencia al tema en portugués, inglés y español, publicados entre los años 2011 la 2015 y para proporcionar el marco filosófico metodología adoptada. Criterios de exclusión: investigaciones que se repitieron en las bases de datos. Conclusiones: se acercan a la muerte / proceso de morir por los estudiantes de primer año en el programa de enfermería; las experiencias de enfermedad terminal a través del arte; cuidados paliativos de la enfermedad terminal y la donación de órganos después de la finitud de la vida. La preocupación por el tema impregna el entorno académico y el hospital, pero en tanto la preocupación más latente está vinculada a la humanización del cuidado. Producciones científicas desarrolladas por la enfermería abordan la cuestión de la Tanatología fundamentalmente la atención no solo durante el proceso de la muerte, sino que se extiende a la otra vida con el tema de la donación de órganos, lo que demuestra una mirada integral al cuidado de ejercicio haciendo este eficaz y positivo en la memoria de los que reciben atención(AU)

ABSTRACT Introduction: care intervention passes directly by the understanding, reflection, analysis of how the nursing professional perceives the phenomenon of the process of death / die. Objective: analyze the scientific publications that address the issue of thanatology developed by nursing. Methods: study of integrative review of critical feature and retrospective, with primary data sources. Search strategy: keyword use "phenomenology" and descriptors "nursing" and "palliative care". The search occurred in: MEDLINE; LILACS; BDENF and SCOPUS. Inclusion criteria: articles available in full on the selected data portals presenting adherence to the theme in Portuguese, English and Spanish, published between the years 2011-2015 and to provide the methodology philosophical framework adopted. Exclusion criteria: researches which were repeated in the databases. Conclusion: approach the process death / die for entering students in the nursing program; the experiences of terminality through art; palliative care in terminality and organ donation after the finiteness of life. Concern for the thematic permeates the academic and hospital setting, but in both the most latent concern is linked to care humanization. Scientific productions developed by nursing addressing the issue of Thanatology presam the care not only during the process death / die, but extend to the afterlife with the issue of organ donation, which demonstrates a holistic look at exercise care making this effective and positive effect on the memory of those who receive care(AU)

An overview of the results of hysterosonography prior to in vitro fertilization.

OBJECTIVE: This study aimed to analyze the results of hysterosonography performed prior to in vitro fertilization (IVF) and to correlate anomalous findings with hysteroscopy. METHODS: Findings from 197 hysterosonograms of patients examined in an assisted reproduction clinic between January 2012 and August 2014 were included. Enrollment criteria: patients in preparation for IVF not recently submitted to uterine examination through hysterosalpingography or hysteroscopy referred to hysterosonography. Uterine cavity evaluation was considered anomalous when one or more of the following were found: polyps, submucous myomas, uterine synechiae, Müllerian duct anomalies. Individuals with cavity abnormalities that might interfere with IVF results were referred to hysteroscopy. RESULTS: Normal test results were seen in 170/197 of the cases (86.3%). Eighteen of the 197 cases (9.1%) were suspected for polyps, two (1%) for submucous myoma, six (3.5%) for synechiae, and one (0.5%) for Müllerian duct anomalies. Sixteen of the patients diagnosed with abnormalities underwent hysteroscopy to confirm or treat the suspected pathology. In only two cases there was no agreement between tests: one patient suspected for synechiae and another for polyps were not confirmed; another individual suspected for polyps was found to have focal endometrial thickening in hysteroscopy. The positive predictive value (PPV) in our study was 93.7%. CONCLUSION: In most cases, the diagnoses obtained by hysterosonography showed normal uterine cavities. The most common anomalous findings were polyps, followed by synechiae, submucous myoma, and Müllerian duct anomalies. Hysterosonography is a good option for evaluating the uterus and offers a high positive predictive value, while hysteroscopy stands as the gold standard.

Efeito das orientações em saúde na capacidade funcional de pessoas com úlceras venosas / Efecto de las orientaciones en salud en la capacidad funcional de las personas con úlcera varicosa / Health-related orientation effects on the functional capability of people with varicose ulcer

Introdução: a avaliação da capacidade funcional em pacientes com úlceras venosas crônicas permite realizar a seleção da melhor intervenção e consequentemente controle do estado clínico-funcional. Objetivo: descrever a influência das orientações em saúde realizadas pelo enfermeiro durante a visita domiciliar na capacidade funcional de pacientes adultos e idosos com úlceras venosas. Métodos: pesquisa descritiva, de abordagem quantitativa, desenvolvida no Ambulatório de Reparo de Feridas do Hospital Universitário Antônio Pedro (HUAP) localizado em Niterói/RJ e na residência dos pacientes atendidos no referido ambulatório. A coleta de dados ocorreu de Fevereiro a Junho de 2014, através do instrumento da unidade de saúde, do índice de TINETTI e do instrumento de Orientações a serem prestadas aos sujeitos da pesquisa e contou com 16 participantes. Resultados: evidenciam que os participantes do estudo apresentaram melhora significativa nos domínios/ itens avaliados pelo Índice de TINETTI. Conclusão: as orientações em saúde no contexto domiciliar foram benéficas aos participantes do estudo, repercutindo positivamente sobre a capacidade funcional destes(AU)

Introducción: la evaluación de la capacidad funcional en pacientes con úlceras venosas crónicas permite seleccionar la mejor intervención y por lo tanto el control de la situación clínica y funcional. Objetivo: describir la influencia de las instrucciones de salud dados por la enfermera durante la visita a la casa de la capacidad funcional de los pacientes adultos y ancianos con úlceras venosas. Métodos: estudio descriptivo, con abordaje cuantitativo, desarrollado en la Clínica de la curación de heridas en el Hospital Universitario Antônio Pedro (HUAP) situado en Niterói / RJ y la residencia de los pacientes atendidos en la clínica. La recolección de datos ocurrió entre febrero y junio de 2014, a través del instrumento de la unidad de salud, el índice de TINETTI e instrumento de orientación que se deben proporcionar para investigar temas y tuvo 16 participantes. Resultados: los participantes del estudio mostraron una mejoría significativa en las áreas / artículos por un valor de TINETTI Índice. Conclusión: la orientación de la Salud en el entorno del hogar era beneficiosa para los participantes del estudio, lo que refleja positivamente en la capacidad funcional de estos(AU)

Introduction: Evaluating the functional capability of patients with chronic venous ulcers allows choosing the best intervention and thus controlling the clinical and functional situation. Objective: To describe the influence of health-related orientations given by the nurse during the home visits in the functional capability of adult and elderly patients with venous ulcers. Methods: Descriptive study, with a quantitative approach, developed at the Wound Healing Clinic at Antônio Pedro University Hospital (HUAP) located in Niterói, RJ, and the residence of the patients treated at the clinic. Data collection occurred between February and June 2014, through the health unit instrument, the TINETTI index, a guiding instrument that should to be provided to search about issues, and had 16 participants. Results: The study participants showed significant improvement in areas or articles for a value of the TINETTI index. Conclusion: Health-related orientation in the home environment was beneficial for the study participants, which is positively reflected on their functional capability(AU)

Highly prevalence of vitamin D deficiency among Brazilian women of reproductive age

ABSTRACT Objective Vitamin D has several metabolic functions and possible reproductive functions. This study aimed to determine the prevalence of vitamin D deficiency among Brazilian women of reproductive age, and to evaluate the relationship between serum 25-hydroxyvitamin D [25(OH)D] concentrations and infertility causes. Subjects and methods This retrospective cross-sectional study evaluated data from a private Brazilian assisted reproduction center that were collected between January 1 and May 5, 2012. Serum 25(OH)D concentrations were measured and compared for infertile and fertile women. Concentrations of 25(OH)D that were < 20 ng/mL were defined as deficiency and concentrations of 21-30 ng/mL were defined as hypovitaminosis D. Results Among the 369 evaluated women, 81.1% exhibited hypovitaminosis D and 32.0% exhibited deficiency. The infertile and control patients did not exhibit any significant differences in the prevalence of vitamin D deficiency (30.2% vs. 35%, respectively; p = 0.33) or in the mean 25(OH)D concentrations (24.3 ± 7.9 ng/mL vs. 23.8 ± 8.7 ng/mL, respectively; p = 0.51). Furthermore, there were no significant differences in the mean 25(OH)D concentrations among subgroups of patients with single infertility factors, or between these subgroups and the control group. Conclusions A high proportion of Brazilian women of reproductive age exhibited vitamin D deficiency, regardless of their fertility status. Thus, it may be useful to evaluate this population for vitamin D deficiency, although future studies are needed to determine whether this deficiency might affect the outcomes of treatments for infertility.

Highly prevalence of vitamin D deficiency among Brazilian women of reproductive age.

OBJECTIVE: Vitamin D has several metabolic functions and possible reproductive functions. This study aimed to determine the prevalence of vitamin D deficiency among Brazilian women of reproductive age, and to evaluate the relationship between serum 25-hydroxyvitamin D [25(OH)D] concentrations and infertility causes. SUBJECTS AND METHODS: This retrospective cross-sectional study evaluated data from a private Brazilian assisted reproduction center that were collected between January 1 and May 5, 2012. Serum 25(OH)D concentrations were measured and compared for infertile and fertile women. Concentrations of 25(OH)D that were < 20 ng/mL were defined as deficiency and concentrations of 21-30 ng/mL were defined as hypovitaminosis D. RESULTS: Among the 369 evaluated women, 81.1% exhibited hypovitaminosis D and 32.0% exhibited deficiency. The infertile and control patients did not exhibit any significant differences in the prevalence of vitamin D deficiency (30.2% vs. 35%, respectively; p = 0.33) or in the mean 25(OH)D concentrations (24.3 ± 7.9 ng/mL vs. 23.8 ± 8.7 ng/mL, respectively; p = 0.51). Furthermore, there were no significant differences in the mean 25(OH)D concentrations among subgroups of patients with single infertility factors, or between these subgroups and the control group. CONCLUSIONS: A high proportion of Brazilian women of reproductive age exhibited vitamin D deficiency, regardless of their fertility status. Thus, it may be useful to evaluate this population for vitamin D deficiency, although future studies are needed to determine whether this deficiency might affect the outcomes of treatments for infertility.

Reproductive planning in times of Zika: getting pregnant or delaying plans? The opinion of the Brazilian Society of Assisted Reproduction Committee - a basis for a bioethical discussion.

Although the causality between Zika virus, microcephaly, and other central nervous system disorders has been taken for granted by the scientific community, many uncertainties remain. The gap of knowledge at the moment is large enough to remove part of the confidence physicians have on the advice given to patients - and infertile women in particular - on their reproductive plans. Pretreatment serologic screening is a possible strategy to offer more confidence for individuals choosing to bear children regardless of the Zika virus, but the tests currently available do not seem to be sufficiently adequate. Until now, there is no formal recommendation to avoid pregnancy solely because of the Zika virus outbreak, and the choice of becoming pregnant has been regarded as a personal decision to be made by each woman and her family.

Major complications following total en bloc spondylectomy for giant-cell tumor.

The authors present the case of a 32-year-old Caucasian female with a giant-cell tumor of the eighth thoracic vertebra, causing unremitting pain, segmental kyphosis and imminent local instability. A total en bloc spondylectomy by a posterior-only approach was performed, complemented with anterior-column reconstruction with a titanium mesh and structural allograft, as well as pedicle screw fixation. Despite the surgery being uneventful, several complications developed over the ensuing weeks: bilateral hemothorax, empyema and sepsis, requiring numerous revision surgeries for postoperative infection. The same pathogen was identified in different samples collected, including a sample from the allograft used. Only the aggressive therapeutic measures adopted allowed improvement in clinical and analytic parameters. The present report alerts to the possible complications following major spine surgery, and raises concerns on the safety of the bone allografts provided, renewing the interest in the development of alternative bone substitutes.

Minirressectoscópio de Gubbini / Miniresectoscope of Gubbini

Os instrumentos empregados na histeroscopia cirúrgica experimentaram grandes avanços nos últimos 30 anos e permitiram escolher desde ressectoscópios de 26 e 21 Fr. acoplados a corrente mono ou bipolar até a office hysteroscopy, que contempla o uso de sistemas operatórios de diâmetros semelhantes àqueles empregados na histeroscopia diagnóstica. Essas opções ampliaram e fortaleceram as possibilidades de indicação cirúrgicas, minimizaram riscos e reduziram acentuadamente as contra indicações. A introdução do minirressectoscópio de Gubbini de 16 Fr. na prática histeroscópica permitiu, graças ao seu diâmetro reduzido, a execução de procedimentos ambulatoriais com a técnica de slicing, que aumenta e facilita as possibilidades do see and treat ambulatorial. A funcionalidade do instrumento tem se revelado satisfatória, já que permite a passagem da corrente de mono para bipolar no mesmo ressectoscópio em uso e nas mesmas alças multiuso. A nossa casuística, que compreende 1.350 pacientes e inclui variadas patologias intrauterinas e endocervicais, demonstra uma eficácia de 100% do instrumento, cuja limitação, não categórica, subordina-se aos miomas com diâmetro superior a 3 cm.

The instruments employed in surgical hysteroscopy experienced great advances in the last 30 years, allowing operators to choose from resectoscopes of 26 and 21 fr. coupled with mono or bipolar current, to the use of “office hysteroscopy”, which contemplates the use of operating systems of diameters similar to those employed in diagnostic hysteroscopy. All these options have broadened and strengthened the possibilities of surgical indications, minimizing risk and reducing sharply the contraindications. The introduction of the miniresectoscope of Gubbini of 16 fr. thanks to its reduced diameter, enabled the implementation of outpatient procedures with the technique of “slicing”, increasing andfacilitating the possibilities of “see and treat” outpatient. The functionality of the instrument has proved to be satisfactory as it allows the passage of current from mono to bipolar in the same resectoscope in use and under the same multipurpose handles. Our series,comprising 1,350 patients and including various intrauterine and endocervical pathology, demonstrates an effectiveness of 100% of the instrument, whose limitation, not categorical, is subordinated to the fibroids with diameter greater than 3 cm.

La relación de bioseguridad con el costo-efectividad en las hospitalizaciones: nexos con la formación continua / The relation of biosafety at the cost-effectiveness in hospitalizations: nexus with the permanent instruction

Objetivos: Determinar si la bioseguridad puede ayudar a reducir el costo-efectividad de las hospitalizaciones, conocer el grado de impacto de la educación permanente en materia de bioseguridad para reducir los costos relacionados con la hospitalización y demostrar los efectos de la bioseguridad en la reducción de costos hospitalario basándose en la literatura existente. Método: Estudio descriptivo exploratorio cualitativo, mediante la revisión sistemática de la literatura sobre la base de Enfermería de la base de datos (BDENF), América Latina y el Caribe en Ciencias de la Salud (LILACS) y Scientific Electronic Library Online (SCIELO). Resultados: Se identificó la formación continua como un agente contribuyente a la concienciación de las enfermeras acerca de la seguridad necesaria en la profesión. Conclusión: La bioseguridad asociada a la formación continua contribuye a la reducción del costo- rentabilidad(AU)

Aim: To identify whether the biosecurity can help to reduce the cost-effectiveness in hospitalizations; to know the degree of impact of permanent education for biosecurity in reducing costs related to hospitalization and to demonstrate the effects of biosecurity on reducing costs hospital-based literature. Method: It is a descriptive exploratory study, qualitative, through systematic review of literature on the basis of Nursing Database (BDENF), Latin American and Caribbean Center on Health Sciences (LILACS) and Scientific Electronic Library Online (SCIELO). Results: It was identified permanent education as an agent in contributing awareness of nurses about the security needed in the profession. Conclusion: The biosafety related to permanent education contributes to the reduction of the cost-effectiveness(AU)