Distance learning in the nursing area: report of an experience

This study aims at reporting an experience of offering a course in the master program of the Universidad Nacional de Rosário. The purpose is to offer elements for a reflection on a conception of long-distance education, as an adequate and efficient modality of education, aiming at enabling a teaching with quality to a determined clientele. The course was developed in three moments: video-conference, long-distance didactic activities and a seminar. The tutoring was shared by establishing the challenge of having a dialogic relation with the students. Authors believe that long-distance education is an adequate pedagogical tool to qualify nurses who have no access to traditional graduate studies. Therefore it enables the qualification of a greater number of nurses, geographically dispersed, who are unable to scape from the routine of their personal and professional lives. Facing the need to form the country's nursing workers and qualify nurses to act as teachers, long-distance learning is an effective and possible pedagogical strategy.     

Effects of method and MRI slice thickness on entorhinal cortex volumetry

We assessed the effect of the method of analysis and the MRI slice thickness on entorhinal cortex volumetry. A T1 gradient echo 3D volumetric acquisition was reformatted into different slice thickness and analyzed by edge-tracing. We performed two different forms of analysis of images with 3 mm slice thickness: edge-tracing and pixel by pixel. There was difference among the volumes obtained from different slice thickness (p < 0.001), and also difference between the two different methods of analysis (p < 0.05). The use of thick slices is time saving, but volumes are linearly increased; different methods of segmentation also yields different values.The form of volumetric analysis of the entorhinal cortex should be evaluated in advance to prevent false estimates in longitudinal studies.     

Modeling the time dependence of the association between human papillomavirus infection and cervical cancer precursor lesions

The authors studied the time-dependent association between human papillomavirus (HPV) infection and squamous intraepithelial lesions (SIL) among women enrolled in a cohort study in Brazil (1993-2002), using repeated Papanicolaou cytologic examination and HPV testing by polymerase chain reaction. Through simulation with conceivable alternative cohort designs, they investigated different regression modeling approaches using time-varying covariates, time-varying hazard ratio functions, and repeated events to assess the effect of delay in lesion detection. Associations between HPV and early SIL were of high magnitude. The age-adjusted hazard ratios for the association between HPV at enrollment and low-grade SIL decreased gradually with time until 72 months for both oncogenic types of HPV (hazard ratio = 3.96, 95% confidence interval (CI): 2.5, 6.4) and nononcogenic types (hazard ratio = 2.37, 95% CI: 1.3, 4.3). The hazard ratio for incident high-grade SIL remained constant, ranging from 7.15 (95% CI: 2.0, 25.1) at 12 months to 6.26 (95% CI: 2.7, 14.5) at 72 months for oncogenic types of HPV. With oncogenic HPV as the time-dependent predictor variable, the hazard ratios for incident SIL and high-grade SIL events were 14.2 (95% CI: 8.7, 23.1) and 32.7 (95% CI: 8.4, 127.3), respectively. Investigators may underestimate the prognostic value of HPV detection using designs that rely on HPV ascertainment at a single time point. The waning in hazard ratios should be considered in the implementation of HPV testing-based screening programs.     

The use of human tissue in epidemiological research; ethical and legal considerations in two biobanks in Belgium

This paper discusses the legal implications of setting up two new biobanks in Belgium. The first is hospital-based and will archive tissue from patients with haematologic cancer, whereas the second is linked to a general practice based morbidity registry and will involve storage of blood samples. To date, Belgium has no specific legislation that regulates storage of human tissue and related databases. Several issues concerning the protection of individuals with regard to the processing of personal medical data are discussed from the existing privacy legislation. We will address the principle of consent (broad versus specific) and the type of data recorded (anonymous, encoded and identifiable) for both biobanks.     

Localization of oxytocin binding sites in the human brainstem and upper spinal cord: an autoradiographic study

Two different ligands, tritiated oxytocin and a newly synthesized and monoiodinated oxytocin antagonist, were used to reveal sites which bind oxytocin in the brainstem and upper spinal cord of 12 human subjects. Tissue sections were incubated with either ligand at a concentration close to their respective dissociation constants determined in human uterus and rat brain. Specificity of binding was assessed in presence of unlabelled oxytocin in excess. Comparable results were obtained using tritiated or iodinated ligand. Labelling was most intense in the substantia nigra pars compacta, the substantiae gelatinosae of the caudal spinal trigeminal nucleus and of the dorsal horn of the upper spinal cord, as well as in the medio-dorsal region of the nucleus of the solitary tract. Binding was also detected in the rest of the nucleus of the solitary tract and in other areas, including the oral and interpolar parts of the spinal trigeminal nucleus, the hypoglossal nucleus and the area postrema. Presence of oxytocin binding sites in regions concerned with sensory, autonomic and motor processing suggests that oxytocin could act as a neurotransmitter of neuromodulator in the human central nervous system.     

Sign language in Landau-Kleffner syndrome

This article reviews the history of sign language (SL) and the rationale for its use in children with profound auditory agnosia due to Landau-Kleffner syndrome (LKS), illustrated by studies of children and adults followed for many years and rare cases from the literature. The reasons that SL was successful and brought some children out of isolation while it could not be implemented in others are discussed. The nowadays earlier recognition and treatment of LKS and better awareness of the crucial need to maintain communication have certainly improved the outcome of affected children. Alternatives to oral language, even for less severe cases, are increasingly accepted. SL can be learned at different ages with a clear benefit, but the ambivalence of the patients and their families with the world and culture of the deaf may sometimes explain its refusal or limited acceptance. There are no data to support the fear that SL learning may delay or prevent oral language recovery in children with LKS. On the contrary, SL may even facilitate this recovery by stimulating functionally connected core language networks and by helping speech therapy and auditory training.     

The effects of Pilates method on pelvic floor muscle strength in patients with post‐prostatectomy urinary incontinence: A randomized clinical trial

Aims

To assess the effects of a Pilates exercise program compared to conventional pelvic floor muscle training (PFMT) protocol on pelvic floor muscle strength (PFMS) in patients with post‐prostatectomy urinary incontinence.

Methods

Patients were randomized into three treatment groups (G1: Pilates, G2: electrical stimulation combined with PFMT, and G3: control group). Duration of therapy was 10 weeks. Baseline assessment included the 24 h pad‐test and the ICI‐Q questionnaire. PFMS was measured using a manometric perineometry device at baseline and 4 months after radical prostatectomy (RP). The level of significance was P < 0.05.

Results

One hundred twenty three patients were randomized and 104 patients completed the study protocol (G1: n = 34; G2: n = 35; G3: n = 35). Post‐treatment assessment showed statistically significant improvements in maximum strength in G2, increased endurance in G1 and G2, and increment of muscle power in all three groups (P < 0.05). However, there were no significant differences in the mean changes of maximum strength, endurance, and muscle power between groups after treatment (P > 0.05). G1 and G2 achieved a higher number of fully continent patients than G3 (P < 0.05). At the end of treatment, 59% of patients in G1, 54% in G2, and 26% in G3 were continent (no pads/day).

Conclusions

Improvements in PFMS parameters were distinct among active treatment groups versus controls, but did not predict recovery of urinary continence at final assessment. The Pilates method promoted similar outcomes in the proportion of fully continent patients when compared to conventional PFMT 4 months after RP.     

Vulnerability and suffering in the work of a community health agent in the family health program

This qualitative research was aimed at investigating the representations and significations that a group of community health agents (CHAs) has concerning the vulnerabilities for suffering in their work to which they are exposed to, as well as the manifestations of this suffering as they perform their actions in the Family Health Program (PSF, in the Portuguese language acronym). The semistructured interview with the group of agents explored the meaning of being a CHA and their perception of their work organization; the analysis was based on the hermeneutics theoretical-methodology referential and on the theories related to labor psychodynamics. The findings show the existence of considerable suffering vulnerability, generated by an idealized ideation of the practice and by the scarce perspective for rearranging the constitutive ingredients of work organization, since these professionals depend on factors that are beyond their grasp, which include the limitations of the assistential model proposed by the PSF.