Stela Maris de Jezus Castro

Teoria da resposta ao item aplicada ao Inventário de Depressão Beck

The Beck Depression Inventory (BDI), a scale that measures the latent trait intensity of depression symptoms, can be assessed by the Item Response Theory (IRT). This study used the Graded-Response model (GRM) to assess the intensity of depressive symptoms in 4,025 individuals who responded to the BDI, in order to efficiently use the information available on different aspects enabled by the use of this methodology. The fit of this model was done in PARSCALE software. We identified 13 items of the BDI in which at least one response category was not more likely than others to be chosen, so that these items had to be categorized again. The items with greater power of discrimination were sadness, pessimism, feeling of failure, dissatisfaction, self-hatred, indecision, and difficulty of work. The most serious items were weight loss, suicidal ideas, and social withdrawal. The group of 202 individuals with the highest levels of depressive symptoms was comprised by 74% of women and almost 84% had a diagnosis of a psychiatric disorder. The results show gains resulting from use of IRT in the analysis of latent traits.

Degree of Knowledge of Health Care Professionals About Pain Management and Use of Opioids in Pediatrics

OBJECTIVE To evaluate the degree of knowledge about pain management and opioids use by professionals working at three pediatric units. DESIGN This is a cross-sectional study. SETTING This study was carried out at three pediatric units (pediatrics, intensive care unit, and oncology) of Hospital de Clínicas de Porto Alegre, which is a university hospital located in southern Brazil. SUBJECT The subjects of this study include physicians, pharmacists, physiotherapists, nurses, nursing technicians, and nursing assistants. METHODS Cross-sectional study carried out in a university hospital in southern Brazil. A self-applicable semi-structured questionnaire was handed out to 182 professionals from December 2011 to March 2012. RESULTS The response rate was 67% (122); the average percentage of correct answers was 63.2 ± 1.4%. The most frequent errors were: an opioid must not be used if the cause of pain is unknown (47%; 54/115); patients often develop respiratory depression (42.3%; 22/52); and confusion about symptoms of withdrawal, tolerance, and dependency syndromes (81.9%; 95/116). Only 8.8% (10/114) reported the use of pain scales to identify pain in children. The most often cited hindrance to control pain was the difficulty to measure and spot pain in pediatric patients. Finally, 50.8% (62/122) of them did not have any previous training in pain management. CONCLUSIONS Problems in the processes of pain identification, measurement, and treatment have been found. Results suggest that there is a need for both an investment in continuing education of professionals and the development of protocols to optimize the analgesic therapy, thus preventing increased child suffering.

Validation of a New Method Developed to Measure the Height of Adult Patients in Bed

UNLABELLED We present the performance of a new instrument developed to measure the height of patients in bed (Luft Ruler). METHODS Standing height was the gold standard measured in 116 hospitalized adults with a stadiometer, compared with measurements from the Luft Ruler and calculated estimates. RESULTS Using the Luft Ruler in women, men, <60 years old, and >60 years old, the mean difference from the gold standard was, respectively, 1.5 cm (P= .02), 1.3 cm (P= .06), 1.2 cm (P= .07), and 1.6 cm (P= .02); total arm span: 6.7 cm, 7.7 cm, 5.4 cm, and 9.0 cm (P< .01 for all strata); 2x half arm span: 7.8 cm, 10.2 cm, 7.7 cm, and 10.3 cm (P< .01 for all); World Health Organization (WHO) equation: 5.5 cm, 6.2 cm, 4.7 cm, and 6.9 cm (P< .01 for all); and the Hospital de Clínicas de Porto Alegre equation: 1.9 cm (P< .01), 2.5 cm (P< .01), 1.1 cm (P= .12), and 3.3 cm (P< .01). The proportion of differences >5 cm was 0.9% (n=1) using the Luft Ruler, 62.9% using total arm span, 71.6% using 2x half arm span, 64.7% using the WHO equation, and 27.6% using the Hospital de Clínicas de Porto Alegre equation. CONCLUSIONS The Luft Ruler was the only method that presented minor mean differences in relation to the gold standard in both gender and age strata. The other estimates are not recommended because of high frequency of relevant errors.

Disponibilidade e valor nutritivo de forragem de leguminosas nativas (Adesmia DC.) e exóticas (Lotus L.)

RESUMO - O genero Adesmia DC. possui 17 especies nativas no Brasil, distribuidas nos Estados do Sul, cuja importância esta vinculada a sua adaptacao ao solo e clima regionais, alem de ser de crescimento hibernal (temperadas). Este trabalho teve o obj etivo comparar o padrao de acumulo de materia seca (MS) e valor nutritivo de forragem de A. latifolia, A. punctata e A. tristis, tendo como padrao Lotus corniculatus (cornichao) e L. uliginosus. O ensaio foi realizado em casa de vegetacao durante 210 dias (4000 graus-dia). A disponibilidade de forragem (DF) foi similar entre A. latifolia (276 g MS/m 2 ) e cornichao (275 g MS/m 2 ) e entre A. tristis (201g MS/m 2 ) e L. uliginosus (192 g MS/m 2 ), sendo que A. punctata apresentou a menor DF (155 g MS/m 2 ). A. latifolia caracterizou-se pela maior precocidade na DF, devido ao crescimento mais rapido em relacao as demais especies, sugerindo seu potencial para utilizacao dur ante a estacao fria. Em relacao as analises de qualidade, o teor de proteina bruta (PB) nas folhas de A. latifolia foi de ate 21,6% e a DIVMO atingiu 72,3%. Os maiores conteudos de PB e DIVMO foram encontrados nas folhas de cornichao, 30,3 e 75,8%, respectivamente. A. tristis apresentou DIVMO muito baixa nos caules (34,9 a 44,7%), o que poderia limitar seu consumo por bovinos. Concluiu-se que, entre as especies de Adesmia estudadas, A. latifolia detem o maior potencial forrageiro, sugerindo a continuidade de estudos com a especie.

Funcionamento Diferencial do Item no Inventário de Depressão Beck

INTRODUCTION There are several studies showing the presence of Differential Item Functioning (DIF) in some items of the Beck Depression Inventory (BDI), when comparing men and women. The presence of a large number of items with DIF in BDI is a severe threat to the validity of measurement of the intensity of depressive symptoms obtained by Item Response Theory (IRT) and to the conclusions based on the scores derived from the items with or without DIF. OBJECTIVE The objectives of this study were to identify these items from the BDI, adjust the IRT model for embarrassing items (model 2), which accommodates items with the presence of DIF, and compare these results with the fit of the traditional two-parameter logistic IRT model (model 1). METHODS The results obtained with the both models were compared. RESULTS Items with DIF were: sadness, feeling of failure, dissatisfaction, guilty, punishment, crying, fatigability and loss of libido. The results of the adjustment of the two models are similar in discrimination, gravity (except for items with DIF), and in the calculation of scores for individuals. Nevertheless, model 2 is beneficial because it shows the differences in gravity of depressive symptoms for groups evaluated, thus providing more information to the researcher on the study population. CONCLUSION This model, which has a broader scope in terms of target population, may be a good alternative to the identification and follow-up of individuals with potential depression.INTRODUCTION: There are several studies showing the presence of Differential Item Functioning (DIF) in some items of the Beck Depression Inventory (BDI), when comparing men and women. The presence of a large number of items with DIF in BDI is a severe threat to the validity of measurement of the intensity of depressive symptoms obtained by Item Response Theory (IRT) and to the conclusions based on the scores derived from the items with or without DIF. OBJECTIVE: The objectives of this study were to identify these items from the BDI, adjust the IRT model for embarrassing items (model 2), which accommodates items with the presence of DIF, and compare these results with the fit of the traditional two-parameter logistic IRT model (model 1). METHODS: The results obtained with the both models were compared. RESULTS: Items with DIF were: sadness, feeling of failure, dissatisfaction, guilty, punishment, crying, fatigability and loss of libido. The results of the adjustment of the two models are similar in discrimination, gravity (except for items with DIF), and in the calculation of scores for individuals. Nevertheless, model 2 is beneficial because it shows the differences in gravity of depressive symptoms for groups evaluated, thus providing more information to the researcher on the study population. CONCLUSION: This model, which has a broader scope in terms of target population, may be a good alternative to the identification and follow-up of individuals with potential depression.

Detection of ethanol in Brazilian gasoline station attendants

In Brazil, gasoline station attendants are regularly exposed to the ethanol contained in fuel, as well as the one used as the gasoline additive. This study aimed to assess the potential exposure of these workers to fuels, using breathalyzers and oral fluid (OF) analysis by headspace gas chromatography/mass spectrometry (HS-GC/MS). Attendants of 26 gasoline stations were invited to respond to a questionnaire covering the main features of the study population and the profile of drinking and driving behavior, followed by a breath test and OF collection with a Quantisal™ device. All OF samples were analyzed by HS-GC/MS. Ethanol was found in 100% of the OF samples whereas 72.83% had concentrations above the quantification limit of the method (0.00125 g dL−1). Regarding the breath tests, only one exhaled air sample (0.62%) showed a positive result (0.03 mg L−1). The positive results in OF samples and negative results in exhaled air may be explained by the higher sensitivity of OF analysis by HS-GC/MS, when compared to the breathalyzer.

Analysis of ineffective breathing pattern and impaired spontaneous ventilation of adults with oxygen therapy

ABSTRACT Objective: to analyze the manifestation of the defining characteristics of the nursing diagnoses of ineffective breathing pattern and impaired spontaneous ventilation, of the NANDA International and the defining characteristics identified in the literature for the concept of “ventilation” in adult patients hospitalized in an intensive care unit with use of oxygen therapy. Method: clinical diagnostic validation study, conducted with 626 patients in intensive care using oxygen therapy, in three different modalities. Multiple correspondence analysis was used to verify the discriminative capacity of the defining characteristics and latent class analysis to determine the diagnostic accuracy of them, based on the severity level defined by the ventilatory mode used. Results: in the multiple correspondence analysis, it was demonstrated that the majority of the defining characteristics presented low discriminative capacity and low percentage of explained variance for the two dimensions (diagnoses). Latent class models, separately adjusted for the two diagnoses, presented a worse fit, with sharing of some defining characteristics. Models adjusted by level of severity (ventilation mode) presented better fit and structure of the component defining characteristics. Conclusion: clinical evidence obtained in the present study seems to demonstrate that the set of defining characteristics of the two nursing diagnoses studied fit better in a single construct.

Multianalytical Method Validation for Qualitative and Quantitative Analysis of Solvents of Abuse in Oral Fluid by HS-GC/MS.

The use of oral fluid as a biological matrix to monitor the use of drugs of abuse is a global trend because it presents several advantages and good correlation to the blood level. Thus, the present work aimed to develop and validate an analytical method for quantification and detection of solvents used as inhalants of abuse in oral fluid (OF), using Quantisal™ as collector device by headspace and gas chromatography coupled with a mass detector (HS-GC/MS). Chromatographic separation was performed with a ZB-BAC1 column and the total time of analysis was 11.8 min. The method showed good linearity (correlation coefficient higher than 0.99 for all solvents). The limits of detection ranged from 0.05 to 5 mg/L, while the lower limits of quantification ranged from 2.5 to 12.5 mg/L. Accuracy, precision, matrix effect, and residual effect presented satisfactory results, meeting the criteria accepted for the validation of bioanalytical methods. The method showed good selectivity considering that, for solvents coeluting at the same retention time, resolution was performed by the mass detector. The method developed proved to be adequate when applied in OF samples from users of drugs and may be used to monitor the abuse of inhalants in routine forensic analyses.