Health professionals' subjectivation towards end of life and death in home care service

OBJECTIVES

to analyze the modes of subjectification of health professionals towards end of life and death in a home care service.

METHODS

this is qualitative research carried out in a home care service at a teaching hospital in southern Brazil, with 12 health professionals. Participant observation and semi-structured interviews were used for data collection, from April to September 2018. Data were analyzed based on Foucault's concept of power and subjectivation.

RESULTS

professionals are sensitized by moral, spiritual and palliative care discourses, as well as experiences that constitute them subjects who modify their ways of life and professional practice based on the relation with death.

FINAL CONSIDERATIONS

the discursive network of palliative care is internalized by professionals, who carry out their practices with behaviors aimed at promoting "a good death".

RODA DA VIDA E REPERCUSSÕES DO REIKI NA PROMOÇÃO DA SAÚDE DE PROFISSIONAIS DE ENFERMAGEM

RESUMO Objetivo: conhecer as repercussões de uma intervenção com Reiki no bem-estar e na saúde autorreferida de profissionais de enfermagem. Método: estudo com características de quase experimento, do tipo antes e depois, mediante intervenção com Reiki, realizado com 14 profissionais de enfermagem de um hospital escola do Sul do Brasil. Os dados foram coletados entre setembro de 2019 e março de 2020, mediante entrevista áudio-gravada, norteada pelo instrumento Roda da Vida, cuja representação gráfica é uma circunferência, dividida em 12 partes referentes a diferentes aspectos da vida, agrupados em quatro quadrantes: mental, emocional, prático e espiritual. Resultados: antes da intervenção, foi observado maior comprometimento no aspecto emocional, o que se manteve após, porém com aumento importante na pontuação atribuída, indicando melhora da satisfação. Apenas uma das participantes não apresentou aumento na pontuação. As reflexões mostraram que as profissionais estavam insatisfeitas e alheias à própria vida nos quatro aspectos avaliados e reconheciam que isso impactava sua condição de saúde. Após a intervenção, mostraram repercussões positivas e uma nova perspectiva de olhar a vida. Conclusão: a intervenção com Reiki promoveu melhoria na saúde autorreferida e no bem-estar geral das profissionais de enfermagem, caracterizada por contribuições nas questões mentais, práticas, emocionais e espirituais.

Reiki for promotion of health and sleep quality in hospital nursing professionals

ABSTRACT Objectives: to know the repercussions of a Reiki therapy intervention on the sleep quality of nursing professionals working in a general hospital. Methods: a qualitative-quantitative study conducted with 16 professionals from the nursing team of a hospital in northwest Paraná, who participated in an intervention consisting of six weekly Reiki sessions. Data collected from September, 2019 to March, 2020 through semi-structured interviews and application of the Pittsburgh Sleep Quality Index before and after the intervention. Results: better sleep quality, characterized by a reduction in the time to fall asleep and in nightmares, and an increase in sleeping hours. Conclusions: reiki intervention had a positive impact on the sleep quality of participants.

WHEEL OF LIFE AND REIKI REPERCUSSIONS ON HEALTH PROMOTION FOR NURSING PROFESSIONALS

ABSTRACT Objective: to know the repercussions of a Reiki intervention on the well-being and self-reported health of nursing professionals. Method: this is a study with quasi-experiment characteristics, of before and after type, through intervention with Reiki, carried out with 14 nursing professionals from a teaching hospital in southern Brazil. Data were collected between September 2019 and March 2020, through an audio-recorded interview, guided by the Roda da Vida instrument, whose graphic representation is a circumference, divided into 12 parts referring to different aspects of life, grouped into four quadrants: mental, emotional, practical and spiritual. Results: before intervention, there was a greater commitment in the emotional aspect, which remained after, but with a significant increase in the assigned score, indicating an improvement in satisfaction. Only one participant showed no increase in the score. The reflections showed that the professionals were dissatisfied and oblivious to their own lives in the four aspects evaluated and recognized that this impacted their health condition. After intervention, they showed positive repercussions and a new perspective of looking at life. Conclusion: the Reiki intervention promoted improvement in the self-reported health and general well-being of nursing professionals, characterized by contributions to mental, practical, emotional and spiritual issues.

Reiki para promoção da saúde e qualidade do sono em profissionais de enfermagem de hospital

RESUMO Objetivos: conhecer as repercussões de intervenção com sessões de reiki na qualidade do sono de profissionais de enfermagem atuantes em um hospital geral. Métodos: estudo de abordagem quali-quantitativa realizado com 16 profissionais da equipe de enfermagem de um hospital no noroeste do Paraná que participaram de uma intervenção constituída por seis sessões semanais de reiki. Dados coletados de setembro/2019 a março/2020, mediante entrevista semiestruturada e aplicação do Índice de Qualidade do Sono de Pittsburgh antes e após o término da intervenção. Resultados: melhora na qualidade do sono, caracterizada por redução do tempo para adormecer e dos pesadelos e aumento nas horas dormidas. Conclusões: a intervenção com reiki repercutiu de forma positiva sobre a qualidade do sono das participantes.

Knowledge of the self facing the experience of illness by cancer and palliative care

Introduction: The illness of an oncological disease provides experiences capable of modifying the body and the subjects' ways of life. Objective: To analyze how the knowledge of the self occurs facing the experience of illness by cancer and palliative care. Methods: This is a qualitative case study research based on post-critical theories, specifically in Foucault Studies. The participants were six patients who were experiencing cancer and palliative care, linked to a home hospitalization service. The data were collected from March to June 2018, based on open interviews, participant observation, and speech instigation through the use of occupational therapist therapeutic activities. The analysis occurred based on problematizations. Results: From the statements, different ways of getting sick were identified, from diagnosis to their approach to death, causing changes in the body, way of living, and in the perception of oneself from a life-threatening disease. Conclusion: Finally, we concluded that different ways of experiencing cancer and palliative care provided different modes of subjectivation. The lack of self-recognition was confronted by bodily changes and consequently by limitations, so the way this experience was lived reflected in the way they thought about the end of life.

Instrumentos para avaliar a sobrecarga e a qualidade de vida de cuidadores

Objetivo: identificar na literatura instrumentos para avaliar a qualidade de vida e a sobrecarga em cuidadores e sua aplicabilidade com essa população. Síntese de conteúdo: revisão integrativa da literatura em dois períodos de busca. Em setembro de 2017, foram selecionados 604 resumos na PubMed e 33 na LILACS, totalizando 637. Em seguida, para a atualização de dados, em setembro de 2020, foramescolhidos 137 resumos na PubMed e quatro na LILACS, totalizando 141. Após a leitura dos resumos, 106 artigos foram lidos na íntegra, dos quais 62 artigos atenderam os critérios de inclusão estabelecidos. Após a identificação de 80 instrumentos aplicados em cuidadores nessas publicações, buscou-se identificar a existência de validação brasileira, bem como sua aplicabilidade com cuidadores. Desses instrumentos, 39 não foramvalidados no Brasil, 13 eram elaborações próprias dos autores e 28 validações brasileiras. Desses 28 validados, sete são voltados para cuidadores e os demais, para populações gerais. Na análise de adequação da aplicação desses instrumentos gerais aessa população, verificou-se que os objetivos dos estudos foram atingidos, pois aspectos relativos à sobrecarga e à qualidade de vida também se aplicam ao cuidador que assume o cuidado do paciente em casa. Conclusões: os achados apontam que, para além da criação de novos instrumentos, é preciso identificar na literatura os já existentes.

Glycerol inoculation in eggs of young broiler breeders at different embryonic periods

Small eggs have lesser amounts of nutrients to be used by the embryo, and the yolk glycerol is the main substrate for glycogen production, which is the main energy source in the last days of incubation. Thus, the present study aimed to assess the effect of a glycerol injection in light weight eggs at 2 different days of incubation. To this end, 336 light eggs (55.6 to 58.6 g) from 32-wk-old broiler breeders were incubated. The eggs were divided into 3 treatment groups: 1 group inoculated with saline solution on the 17th d of embryonic development (E17) (control group), the second group injected with a 6 mg glycerol/mL solution at E17, and the third group injected with 6 mg glycerol/mL on the 18th d of incubation (E18). Incubation parameters, liver and muscle glycogen, and broilers performance at 7 d of age were evaluated. Glycerol administration in ovo did not influence hatchability, period of embryonic death or early hatching. Chicks exposed to glycerol in ovo feeding (IOF) used more yolk than birds inoculated with saline solution. Glycerol inoculation at E18 enhanced liver glycogen deposition (P = 0.001) and also improved broilers performance at 7 d, although this improvement in performance and glycogen reserves was not observed when eggs were inoculated at 17 d of incubation. Birds receiving glycerol IOF at E18 showed higher feed intake and body weight gain when compared to the control group and the group inoculated at E17. It was found that glycerol inoculation in light eggs at the 18th d of incubation contributed to raise liver glycerol levels and also to improve broilers performance at 7 d.

Profissionais de saúde e o processo de morte e morrer dos pacientes: uma revisão integrativa

Objetivo: conocer la producción científica sobre la relación entre los profesionales de salud y la muerte del paciente. Metodología: revisión integradora de la literatura mediante análisis de proximidad temática. Resultados: se elaboraron cuatro categorías: profesionales de salud no preparados para enfrentar la muerte; desafíos para lidiar con el proceso de muerte y morir en diferentes escenarios; tipos de muerte y sus interpretaciones, y profesionales de salud; y aspectos personales sobre cómo enfrentar la muerte. Concluciones: los profesionales de salud no están preparados para enfrentar el proceso del final de la vida; más allá de eso, sienten una falta de atención al tema, especialmente en relación con las estrategias de afrontamiento.

Manifestações e necessidades referentes ao processo de morte e morrer: perspectiva da pessoa com câncer Demonstrations and necessities on the death and dying process: perspective of the person with cancer

Objetivo: Conhecer manifestações e necessidades referentes ao processo de morte e morrer da pessoa com câncer no final de vida. Método: Estudo de caso, qualitativo, descritivo. O cenário foi no domicílio dos participantes vinculados ao Programa de Internação Domiciliar Interdisciplinar, em Pelotas/RS. Participaram cinco pessoas com câncer no final de vida, quatro do sexo masculino e uma do sexo feminino. A coleta de dados ocorreu por meio de entrevista semi-estruturada e observação participante, em agosto e setembro de 2015, com três ou quatro encontros em seus domicílios.Foi aplicada a Análise Temática. Resultados: Emergiram quatro categorias: Manifestações e Necessidades Emocionais; Manifestações e Necessidades Sociais; Manifestações e Necessidades. Físicas; Manifestações e Necessidades Espitituais. Conclusão: O câncer modifica a vida dos pacientes e familiares exigindo dos profissionais de saúde habilidade e olhar sensível para o atendimento de sua integralidade, considerando suas dimensões físicas, emocionais, sociais e espirituais.

Spirituality, religiosity and terminality: possible topics in homecare visits carried out with family caregivers / Espiritualidade, religiosidade e terminalidade: temas possíveis nas visitas domiciliares realizadas a cuidadores familiares /

OBJETIVO: relatar a experiência dos temas espiritualidade, religiosidade e terminalidade abordados em visitas domiciliares realizadas a cuidadores familiares. METODOLOGIA: trata-se de um relato de experiência; os dados foram coletados através do projeto de extensão “Um olhar sobre o cuidador: quem cuida merece ser cuidado”, de junho de 2015 até dezembro de 2016, com 52 cuidadores familiares em seus domicílios. Após análise dos registros, foram elaboradas duas categorias para apresentação dos dados: Propósito da espiritualidade e religiosidade; a morte no domicílio. RESULTADOS: As atribuições dadas para à fé foram diversas, como: suporte e força para superar a dor e o sofrimento, e auxílio para o controle emocional. Os cuidadores trouxeram em seus discursos a tristeza, que contrapõe à tranquilidade pelo alívio do sofrimento do paciente, sendo a espiritualidade e religião utilizadas como instrumento de compreensão. CONSIDERAÇÕES FINAIS: Abordar a espiritualidade, religiosidade e morte no contexto do cuidado domiciliar faz-se necessário e relevante nas demandas atuais, tanto de pacientes quanto de cuidadores familiares. Ambas foram vistas como essenciais na fortificação da fé, na promoção de coragem, força, e facilitadoras no processo de enfrentamento da morte, tanto antes quanto após o evento.

Meaning and Perceptions in Palliative Care: over view of patients on homecare / Significados e Percepções em cuidados paliativos: olhar de pacientes domiciliares / Significados y Percepciones en Cuidados Paliativos: punto de vista de pacientes

Objetivo: Conhecer os significados e percepções de cuidados paliativos pelos pacientes do Programa de Internação Domiciliar Interdisciplinar (PIDI). Metodologia: O estudo foi qualitativo-descritivo, realizado com pacientes oncológicos em cuidados paliativos, vinculados ao Programa de Internação Domiciliar Interdisciplinar (PIDI), situado em Pelotas, Rio Grande do Sul, Brasil. A coleta de dados se deu por meio de entrevistas semiestruturadas, realizadas no domicílio dos sujeitos do estudo, de agosto a outubro de 2015. Resultados e Discussão: a partir da análise foram elaboradas três categorias, as quais foram denominadas: Impressões acerca do diagnóstico, Benefícios do PIDI, e Cuidados Paliativos: (des)conhecimentos. Considerações Finais: pode-se conhecer os significados e percepções de cuidados paliativos pelos pacientes, pelo interesse da investigação que vai além das condições físicas e que interferem diretamente no processo de adoecimento, como também a busca por questões que possam contribuir para uma assistência paliativa efetiva, levando em consideração a singularidade do sujeito e a busca pela qualidade de vida.

BETTER OFF AT HOME: SAFETY DEVICE

ABSTRACT Objetive: to problematize the home care proposed by the Melhor em Casa Program as a safety device for understanding knowledge and conditions of possibility that support its discoursive network. Method: it is a study of genealogical inspiration about home care. The empirical material was constituted by legal documents about the theme, published in the Diário Oficial. The extracts that supposingly had the power to extract truth were organized in a spreadsheet. The analytic units were constructed, and instruments proposed by Foucault, such as power, biopolitics and device, were used for document analysis. Results: two analytic categories were elaborated: "From hospital to home", and "Home care: safety for the patient or for the State?". Conclusion: Home care, as a security device, proposes home as a safer and better place for the patient, who is close to the family, with no risk of hospital infection, cared by the health team, with the necessary technology.

Significados da Cirurgia Cardíaca para Pacientes Submetidos a Processo Cirúrgico

Este estudo teve por objetivo compreender os significados atribuídos à cirurgia cardíaca parapacientes submetidos a processo cirúrgico. Participaram 1 3 pacientes submetidos a cirurgia, sendoque os instrumentos de coleta de dados utilizados foram entrevistas semiestruturadas e aautofotografia. Os dados foram analisados qualitativamente com base na análise de conteúdo dasnarrativas, complementada pela análise das imagens, evidenciando que os significados atribuídos àcirurgia cardíaca giraram em torno da experiência cirúrgica como geradora de sofrimento,sentimentos de despersonalização e de desamparo, medo iminente de morte e estranhamento emrelação ao corpo. Destaca-se a necessidade de reconhecimento dos significados atribuídos pelospacientes ao processo cirúrgico, por parte dos profissionais de saúde que participam da atenção àsaúde desses pacientes.

A cirurgia cardíaca, o corpo e suas (im)possibilidades: significados atribuídos por pacientes pós-cirúrgicos

<p>Trata-se de um estudo clínico-qualitativo, de cunho exploratório e descritivo, cujo objetivo foi compreender os significados atribuídos à cirurgia cardíaca para pacientes submetidos a esse procedimento. Os participantes foram 12 usuários de um ambulatório de cardiologia de um hospital universitário do Sul do Brasil. Os dados foram coletados por meio de entrevistas semiestruturadas individuais e analisados mediante a análise de conteúdo. As categorias emergentes apontam estranhamento dos sujeitos com relação ao novo corpo, suas potencialidades e limitações, no período pós-cirúrgico. Os participantes referiram sentirem-se frágeis e vulneráveis, remetendo à incerteza com relação ao futuro, o que parece desencadear um movimento reflexivo. Discutem-se implicações desses significados e ressalta-se a necessidade de reflexão sobre os parâmetros de atenção à saúde para esses pacientes, de forma a subsidiar ações que se pautem pelo princípio da integralidade, visando ao protagonismo dos sujeitos em seus tratamentos.</p>

Representações sociais do cuidado de doentes terminais no domicílio: o olhar do cuidador familiar

Objetivo: conocer las representaciones sociales construidas por los cuidadores familiares de pacientes terminales sobre el cuidado en el domicilio. Método: estudio cualitativo con once cuidadores familiares de enfermos terminales, registrados en el servicio de internación domiciliaria de un hospital universitario del sur de Brasil. Realizaron entrevistas narrativas, analizadas por medio del análisis de contenido. Se definieron cuatro categorías: cuidadores hombres y mujeres, una visión diferente; la inversión de roles y los cambios en el cuidado; experiencias como fuente de conocimiento para el cuidado en el hogar; y desafíos del cuidado. Resultados: para los cuidadores hombres las representaciones difieren de las de las mujeres debido a que el cuidado incluye su entorno. Los hombres no atribuyen la angustia a la sobrecarga, pero si al temor de perder un ser. Otras representaciones remiten a la imposibilidad de elección para asumir el papel de cuidador y a la inversión de roles, lo que vuelve al paciente sometido al cuidador. Conclusión: esta investigación permitió conocer cómo los cuidadores familiares construyen los significados e interpretan el cuidado que realizan en el domicilio por medio del programa de hospitalización domiciliaria. Se destaca la función de los profesionales de la salud en orientar al cuidador familiar para realizar el cuidado.

Genesis of home care in Brazil at the start of the twentieth century

Objective to discuss the conditions that enabled home care at the beginning of the twentieth century. Method study of the genealogic inspiration on home care. The empirical material consisted of legal documents on the subject that were published in the Official Journal. The documents were studied using analytical tools, such as Power, Discipline and Biopolitics, which were inspired in Foucault. Results two analytical categories were established, "home inspection: visiting nurses and tuberculosis" and "records: political and economic apparatus". Final considerations tuberculosis, the new profession of visiting nurses, inspection records and the detailed analysis of the cities grant home care a nature of surveillance, inspection and control to conduct the behaviour of individuals.

[Care as a commitment of all: a study in a rural settlement]

This study aims to understand the perceptions of care of families living in a rural settlement in the northwestern area of Rio Grande do Sul. It is an ethnographical based qualitative field research, which has used the Observation-Participation-Reflection Model for data collection, performed between February and March, 2011. The data analysis went through four steps: raw data collection and documentation, describers and indexes identification, contextual and current patterns analysis, and identification of research themes and relevant findings. The study has shown that, for the settlers who participated in the study, care is bound to their vision of world, meaning a commitment of everybody, under the collective and individual premise of improvement of their lives. It is concluded that Nursing needs to understand cultural behaviors in order to enable a congruent and holistic care.

Vivências da família após infarto agudo do miocárdio

Objetivou-se descrever as vivências da família no pós-infarto. Pesquisa qualitativa, descritiva e exploratória, realizada com seis famílias de pacientes pós-infarto. A coleta de dados ocorreu no domicílio das famílias, no período de fevereiro a maio de 2012, por meio de observação e entrevista com a família. Foi utilizado o software Atlas Ti 6.2 na codificação das entrevistas e os dados foram explorados com a análise temática. Surgiram duas categorias: "Tempos difíceis": consequência imediata do infarto agudo do miocárdio para as famílias; e "Nos reeducamos - a gente se adapta", vivência atual das famílias. A vivência imediata pós-infarto é permeada por variados sentimentos, necessitando adaptação das famílias para adequação às necessidades. A vivência atual demonstra modificações nas famílias devido à enfermidade. A família é a principal responsável pelas práticas de cuidado, porém a Enfermagem deve atuar na troca e no compartilhamento de saberes.

Digestibility and metabolizable energy of raw soybeans manufactured with different processing treatments and fed to adult dogs and puppies

The objective of this study was to evaluate the apparent total tract digestibility (ATTD), ME, and fecal characteristics of adult dogs and puppies fed raw soybeans (RSB) and their by-products. Six treatments were evaluated: 1 reference diet (REF), based on a maize-poultry by-product meal, and 5 extruded diets containing 70% of the ingredients of the REF diet and 30% of a soybean processed product [defatted soybean meal (DSM), micronized soybeans (MSB), soybean meal (SBM), RSB, or toasted soybeans (TSB)]. Six adult dogs (5.8 yr old) and 6 puppies (5.1 mo old) were used in a study with a double Latin square design (6 × 6). Urease was reduced in all diets after extrusion, but trypsin inhibitor was reduced only in the diets containing SBM, DSM, and RSB. The ATTD of CP in DSM, SBM, MSB, TSB, and RSB were 85.1%, 85.2%, 88.4%, 84.7%, and 78.9%, respectively, for adult dogs. Soybean meal and DSM had the lowest ATTD of acid-hydrolyzed fat (AHF; 84.3% for both ingredients in adult dogs). The ATTD of DM and AHF in DSM and AHF in all soybean products were greater in puppies than adult dogs (P < 0.05). The ME content was greatest in MSB (21.39 MJ/kg) and least in DSM (15.23 MJ/kg). The feces of dogs fed soybean products were softer and had a lower pH (average of 5.91 vs. 6.05 for adult dogs fed soybean products and REF diets, respectively) and ammonia content (average of 3.82 vs. 4.32 g/kg for adult dogs fed soybean products and REF diets, respectively), except those fed RSB, which had similar fecal pH and ammonia values, compared with those fed the REF diet. Soybean products are good protein sources for both adult and growing dogs, provided they are heat treated before diet extrusion.

Effect of β-mannanase on the digestibility of diets with different protein sources in dogs determined by different methodologies

This experiment aimed at evaluating the effects of including the enzyme, β-mannanase, in dog (Canis lupus familiaris) diets based on either poultry (Gallus gallus domesticus) by-product meal (PBM) or soybean [Glycine max (L.) Merr.] Meal (SBM). The second objective was to evaluate 3 methods for determining energy and nutrient digestibility values in diets fed to dogs: total fecal collection (TFC) and use of aia or crude fiber (CF) as a marker. Eight dogs were allotted to a replicated latin square (4 by 4) design. There were 2 diets based on PBM as the major protein source and 2 diets based on SBM as the major protein source. Within each protein source, 1 diet contained no β-mannanase and 1 diet contained 0.01% β-mannanase. Diets were fed for an adaptation period of 5 d followed by 5 d of TFC. Fecal score (1 = watery feces to 5 = dry, hard pellets), pH, DM, and fecal volume were determined. The apparent total tract digestibility (ATTD) of DM, OM, CP, ether extract (EE), N-free extract (NFE), and GE, and ME content were calculated using the methods of TFC, AIA, and CF. Data were analyzed as a 2 by 2 by 3 split-split-plot design (β-mannanase, protein source, and digestibility calculation procedure). There were interactions between protein source and β-mannanase (P < 0.05). Supplementation of β-mannanase increased ATTD of nutrients and energy and ME (+ 195.3 kcal/kg) and also reduced fecal production in the diet with SBM, but not in the diet that contained PBM. There was an interaction between digestibility calculation procedure and protein source (P < 0.05). The use of AIA overestimated ATTD of the diets containing PBM, but digestibility values estimated based on TFC and CF were not different. Dogs fed diets containing SBM produced more feces with greater moisture content and lower pH compared with dogs fed the PBM diet (P < 0.05). Addition of 0.01% β-mannanase increased (P < 0.05) the digestibility and ME content of the diets containing SBM, but did not improve (P > 0.05) fecal texture. Results indicated that values for ATTD of energy and nutrients in diets containing sbm are not different if they are calculated based on TFC, AIA, or CF, but use of AIA may result in an overestimation of values for ATTD of energy and nutrients in diets containing PBM.

Internação domiciliar do paciente terminal: o olhar do cuidador familiar

O presente estudo buscou conhecer as relações entre paciente, cuidadores familiares e equipe de saúde, na internação domiciliar, sob o olhar do cuidador familiar. Trata-se de um estudo qualitativo com 11 cuidadores familiares de doentes terminais, cadastrados em um serviço de internação domiciliar de um hospital universitário do sul do Brasil. A coleta de dados se realizou através de entrevistas narrativas, que foram gravadas e transcritas para serem tratadas por meio de análise de conteúdo. A partir da análise dos dados, foram construídas três categorias: relações entre cuidador familiar, paciente e equipe de saúde; consciência da terminalidade do paciente: o olhar do cuidador; e situação de terminalidade ocultada ao paciente. Elas abordam como ocorrem as relações na internação domiciliar entre os seres que cuidam, como os profissionais de saúde e cuidadores familiares, e os seres cuidados, como os pacientes, explicitando o quanto a comunicação é importante nesse contexto de cuidado.

Internação domiciliar e internação hospitalar: semelhanças e diferenças no olhar do cuidador familiar

O objetivo deste estudo foi descrever como o cuidador familiar constrói as representações sociais da internação domiciliar na terminalidade, em relação à internação hospitalar. Tratou-se de um estudo qualitativo com 11 cuidadores familiares de doentes terminais, cadastrados no serviço de internação domiciliar de um hospital universitário do sul do Brasil. Para coleta de dados foram utilizadas entrevistas narrativas, analisadas por meio de análise de conteúdo com olhar nas representações sociais. Como a internação domiciliar é recente, os cuidadores a relacionam com a internação hospitalar, para poder assim representá-la. Ela significa acesso mais facilitado a recursos tecnológicos, e também à equipe de referência deste serviço. Além disso, a internação domiciliar representa mais liberdade e autonomia ao paciente, entretanto, para o cuidador, mais privação e responsabilização. A internação hospitalar representa privação para o paciente, e mais liberdade para o cuidador.

Health and Obesity: The Opinions of Nurses

Este estudio buscó conocer los discursos de las enfermeras sobre la obesidad publicados en las revistas brasileras de enfermería. Para ello, nos aproximamos al campo de los Estudios Culturales, en la línea pos-estructuralista, inspirada en Michel Foucault. El corpus de la investigación se basó en artículos encontrados en las bases de datos Periódicos de Enfermería de la Biblioteca Wanda de Aguiar Horta (PeriEnf) y Base de datos en Enfermería (BDENF). En los análisis utilizamos las herramientas de conocimiento, discurso y poder propuestos por Michel Foucault. El análisis de los artículos permitió la construcción de dos categorías: un cuerpo delgado y saludable: un juego de poder y saber, y un cuerpo deseable y sano: atravesando una red de discursos. Inicialmente, la obesidad es entendida como una condición que debe ser combatida poniendo el énfasis en la pérdida de peso de manera saludable. Con el correr de los años, pasó a ser considerada como un problema de la modernidad, trayendo consigo un modelo de belleza que privilegia el cuerpo delgado.

Setores de cuidado à saúde e sua inter-relação na assistência domiciliar ao doente crônico

Objetivou-se descrever a inter-relação e comunicação nos setores de cuidado à saúde sob a perspectiva de cuidadores familiares de adoecidos crônicos com doença incapacitante. Estudo qualitativo, descritivo e exploratório, realizado com 11 cuidadores familiares de pacientes adscritos em uma Estratégia de Saúde da Família localizada no município de Santa Maria, Rio Grande do Sul. Os cuidadores familiares foram indicados pela equipe de saúde da unidade. A coleta de dados ocorreu de julho a setembro de 2010 e desenvolveu-se com entrevistas narrativas, orientadas por eixos norteadores. Da análise de conteúdo temática surgiram categorias relacionadas à comunicação e às relações interpessoais entre profissionais, cuidadores familiares e doentes, além das interfaces entre os setores de cuidado à saúde. Há necessidade de uma comunicação efetiva entre os setores de cuidado, de maneira que atuem conjuntamente, permitindo troca de saberes que auxiliem no enfrentamento do processo de doença.

[Social networks and participation in a community referenced to a family health care unit]

The aim of this research is to describe factors that may influence the constitution of social networks and participation in a community referenced to a Family Health Care Unit, located in a medium-sized city in the South of Brazil. It is a qualitative research developed with key informants, community members, community health agents and other health team personnel. The method used was rapid participative assessment, through semi-structured interviews and field observation. Content analysis was used and two categories emerged: considerations about social networks and community participation. The first category presents factors related to social networks, such as family aggregation, socio-economic structure, alcoholism, among others. The second one presents community organization and the ways people participate in the community. Discussions and reflections presented in this paper enable to conclude that strategies to promote strengthening of bonds and greater mobilization for social participation may be developed.

[Reflections about death: a challenge for nursing]

This reflection proposes a reinsertion on the death theme, in a more present form, in the daily routine of the nurse and its similar, starting with a historic on death, focusing on the transfer of it, that occurred in the bedroom of the moribund, to the hospital bedroom. Soon after, some considerations about the reason to fear death and the need of discussing it, as well as a reflexion on the planning of actions looking as much as to care as to confort the dying patient. With that, it is easy to realize the relevance of the come back of the approach of the subject in the professional daily basis, considering the need to demystify it, to allow that nurses and its similars plan actions of confort to the dying patient.

A formação do enfermeiro frente às necessidades emergentes da terminalidade do indivíduo

Este artigo pretende realizar uma reflexão sobre a formação do enfermeiro, com vistas às necessidades decorrentes do enfrentamento da finitude humana. Essa discussão faz-se relevante, frente às necessidades que emergem com o processo de morte e morrer do paciente terminal. Para contemplar esta temática, foram desenvolvidos dois tópicos: o ensino fragmentado na enfermagem frente à morte, e a formação do enfermeiro à luz do paradigma dos cuidados paliativos. Desse modo, acredita-se ser necessário modificações curriculares, buscando integrar melhor as disciplinas básicas e profissionalizantes, além de criação de núcleos de estudos sobre morte, preparando, assim, o profissional de saúde para o planejamento de cuidados ao paciente terminal. Além disso, reforça-se a importância de se preparar os docentes para esta mudança.

DIGESTIBILITY OF NUTRIENTS WITH THE INCLUSION OF CONJUGATED LINOLEIC ACID IN THE DIET OF DOGS

The inclusion of the conjugated linoleic acid (CLA) in food for dogs has been displaying greatpotential, taking into account several benefits in regard to the use of this product. To determine the effect of CLAon the digestibility of the dry matter, nutrients and energy in dogs, two experiments were performed using dogs ofBeagle type, in the age of seven and 15 months, respectively. The experimental diets were isonutritive, justdiffering by the inclusion of CLA, watching for the addition to the control-diet, of an amount of lipids in the form ofchicken fat equivalent to the amount of CLAadded (0.3%), so that the diets were isoenergetic. The coefficients ofapparent digestibility of the dry matter, crude protein, ethereal extract and nitrogen-free extract were not affectedby the inclusion of conjugated linoleic acid, showing that the addition of the product did not interfere with theprocess of digestion of nutrients. In both digestibility experiments, higher values of metabolizable energy wereobserved for the diets with inclusion of CLA(P < 0.01) when compared with the control-diet.

Genetic divergence in the cacophony IVS6 intron among five Brazilian populations of Lutzomyia longipalpis

Genes involved in the reproductive isolation are particularly useful as molecular markers in speciation studies. Lutzomyia longipalpis (Diptera: Psychodidae: Phlebotominae), a putative species complex, is a vector of visceral leishmaniasis in Latin America. We isolated from this species a fragment homologous to cacophony, a Drosophila gene that encodes features of the lovesong, an acoustic signal that is important in the sexual isolation of closely related species and known to vary considerably among L. longipalpis putative siblings species. Using an intron of the sandfly cacophony as a marker, we analyzed the molecular variation and sequence divergence among five populations of L. longipalpis from Brazil, three allopatric (Jacobina, Lapinha and Natal) and two putative sympatric sibling species from the locality of Sobral. A high level of polymorphism was found and analysis of the data indicates that very little gene flow is occurring among the populations of Jacobina, Lapinha, and Natal. A high level of differentiation was also observed between the two putative sympatric species of Sobral, one of which seems to be the same sibling species found in Natal, while the other is somewhat more related to Jacobina and Lapinha. However, the amount of estimated gene flow among the Sobral siblings is about seven times higher than the previously estimated for period, another lovesong gene, perhaps indicating that introgression might be affecting cacophony more than period. The results suggest that L. longipalpis is not a single species in Brazil, but it is yet not clear whether the different populations studied deserve species status rather than representing an incipient speciation process.

Immunization of Saimiri sciureus monkeys with Plasmodium falciparum merozoite surface protein-3 and glutamate-rich protein suggests that protection is related to antibody levels

The immunogenicity and protective efficacy of various antigen-adjuvant formulations derived either from the merozoite-surface protein-3 (MSP-3) or the glutamate-rich protein (GLURP) of Plasmodium falciparum were evaluated in Saimiri sciureus monkeys. These proteins were selected for immunogenicity studies based primarily on their capacity of inducing an antibody-dependent cellular inhibition effect on parasite growth. Some of the S. sciureus monkeys immunized with MSP-3(212-380)-AS02 or GLURP(27-500)-alum were able to fully or partially control parasitaemia upon an experimental P. falciparum [Falciparum Uganda Palo Alto (FUP-SP) strain] blood-stage infection, and this protection was related to the prechallenge antibody titres induced. The data are indicative that MSP-3 and GLURP can induce protective immunity against an experimental P. falciparum infection using adjuvants that are acceptable for human use and this should trigger further studies with those new antigens.

Molecular evolution of the cacophony IVS6 region in sandflies

A number of insects produce acoustic signals during courtship. Genes involved in the control of the courtship song are particularly interesting from an evolutionary viewpoint because interspecific variation in this signal is potentially important as a reproductive isolation mechanism and, as a consequence, in the speciation process. The cacophony gene was identified by a mutation affecting the "lovesong" in Drosophila melanogaster. Phlebotomine sandflies (Diptera: Psychodidae) also produce acoustic stimuli during courtship and therefore cacophony can be used as an interesting molecular marker in evolutionary studies in these important disease vectors. In this paper we have studied the molecular evolution of the IVS6 region of cacophony in sandflies. We compared the level of divergence in the exon sequences encoding this conserved domain in Drosophila and Phlebotomines. We also analysed the high level of variation in an intron that is present in sandflies but that was lost in Drosophila during evolution. The available cacophony sequences were also used for a phylogenetic analysis of some species of the Neotropical genus Lutzomyia.

Aotus infulatus monkey is susceptible to Plasmodium falciparum infection and may constitute an alternative experimental model for malaria

Aotus is one of the WHO-recommended primate models for studies in malaria, and several species can be infected with Plasmodium falciparum or P. vivax. Here we describe the successful infection of the species A. infulatus from eastern Amazon with blood stages of P. falciparum. Both intact and splenectomized animals were susceptible to infection; the intact ones were able to keep parasitemias at lower levels for several days, but developed complications such as severe anemia; splenectomized monkeys developed higher parasitemias but no major complications. We conclude that A. infulatus is susceptible to P. falciparum infection and may represent an alternative model for studies in malaria.

Antibody response to the N and C-terminal regions of the Plasmodium vivax Merozoite Surface Protein 1 in individuals living in an area of exclusive transmission of P. vivax malaria in the north of Brazil

Recently, we found that a recombinant protein based on the 19 kDa C-terminal region of the Plasmodium vivax Merozoite Surface Protein 1 (PvMSP1(19)) was recognized by a large proportion of individuals naturally infected. The present study was designed to determine the prevalence of antibody to PvMSP1(19) in individuals from the village of Cotijuba, northern Brazil, where only P. vivax transmission occurs. Immuno-epidemiological studies on the prevalence of antibody to the C-terminus of PvMSP1 are of particular importance as this region of MSP1 is being intensively studied as a prime candidate for development of a vaccine against malaria. We evaluated the antibody response to PvMSP1(19), and compared it to the N-terminal region of PvMSP1 and to blood stage antigens. The total frequencies of individuals with IgG to blood stages, PvMSP1(19) or the N-terminal region of PvMSP1 were 76.6, 42.3 and 29.8%, respectively. The frequency of responders to PvMSP1(19) did not increase with age. However, the frequency of responders to this recombinant protein was significantly higher (77.4%) in individuals with a recent ( < 6 months) history of malaria, when compared to subjects whose last malaria attack occurred more than 6 months before (43.9%), or to individuals without a past history of symptomatic malaria (6.25%). These results confirm earlier studies by demonstrating that the PvMSP1(19) is highly immunogenic in individuals recently exposed to P. vivax malaria.

[Control of blood transfusion malaria in an endemic and in a non-endemic region in Brazil]

The aim of the present work was to establish appropriate criteria for screening of donor blood from regions with distinct Malaria epidemiological characteristics. Three locations with different screening criteria were studied: São Paulo, SP (with no vectorial transmission), Belém, PA (with low active transmission) and Matupá and Peixoto de Azevedo, MT (with high active transmission). The Malaria parasite--Plasmodium sp--was searched for by "thick film", QBC Test and antigen Immunofluorescence test, and was not detected in any of the samples. There was, however, a great variation in the positivity of anti-plasmodial antibodies, as determined by IIF-IgG anti-P. vivax and -P. falciparum, between accepted donors in the 3 studied locations and between rejected and accepted donors in São Paulo (1.98% accepted, 22.3% rejected--p < 0.01) and Belém (17.2% accepted, 58.3% rejected--p < 0.01). These data endorse the use of the applied clinical and epidemiological screening. In Matupá and Peixoto de Azevedo, where there was no rejected donor, the serological positivity was 80.6%. We, therefore, consider that the Malaria screening in blood banks should follow clinical and epidemiological criteria suitable to each region. The laboratorial screening techniques should then detect either the parasites (thick film/QBC Test or the parasite antigens.

Pfmdr1 Asn1042Asp and Asp1246Tyr polymorphisms, thought to be associated with chloroquine resistance, are present in chloroquine-resistant and -sensitive Brazilian field isolates of Plasmodium falciparum

Parasite resistance to antimalarial drugs, particularly chloroquine, is the most disturbing problem of malaria chemotherapy. There is evidence that the codon 86Tyr polymorphism of the Pfmdr1 gene is associated with chloroquine resistance in West African Plasmodium falciparum. The association of this and four other coding alterations of the Pfmdr1 gene with chloroquine resistance has not been extensively investigated in South American isolates. In this study, we examined 51 Brazilian P. falciparum isolates for the presence or absence of Asn86Tyr, Asn1042Asp, and Asp1246Tyr polymorphisms. While these isolates were all sensitive in vitro to mefloquine, amodiaquine, and quinine, only 2 (4%) were chloroquine-sensitive. The findings reported here provide the first observations of this kind on a large number of field parasite samples from South America. We show that in vitro chloroquine-resistant and -sensitive strains carry the Asn1042Asp and Asp1246Tyr polymorphisms and provide support for earlier suggestions that Asn86Tyr may be rare or absent in South American P. falciparum.

Plasmodium vivax: epitope mapping of monoclonal antibodies against the N-terminal region of the merozoite surface protein 1

Plasmodium vivax is the most widely distributed human malaria with an estimate of 35 million cases per year. The deduced amino acid sequence comparisons of the Merozoite Surface Protein 1 (MSP1) from several plasmodial species, including that of P. vivax (PvMSP1), revealed the existence of highly conserved blocks and polymorphic blocks. We had previously shown that sequences within conserved blocks from the N-terminal region of the PvMSP1 were poorly immunogenic in natural human infections. These results suggest that these regions code for important and unknown structural and/or functional features and thus they could potentially be tested as a sub-unit PvMSP1 vaccine. In the present study, a battery of monoclonal antibodies (Mabs) was produced against the N-terminal region of the PvMSP1 in an attempt to determine whether these N-terminal ICBs contained all the epitopes exposed on the native molecule. The results suggest that the most terminal ICB2 and ICB3 blocks are not exposed on the surface of the PvMSP1 native molecule and clearly eliminate the possibility of considering the N-terminal domains as unique components of a sub-unit PvMSP1 vaccine candidate.

Antibodies anti bloodstream and circumsporozoite antigens (Plasmodium vivax and Plasmodium malariae/P. brasilianum) in areas of very low malaria endemicity in Brazil

During 1992-1994, 33 malaria cases were reported in two regions in Brazil where few sporadic atypical cases occur, most of them in home owners, who are weekenders, while home caretakers live there permanently. Indirect Fluorescent Antibody Test (IFAT), with Plasmodium vivax, and Enzime Linked Immunosorbent Assay (ELISA) with repeat peptides of the circumsporozoite (CS) proteins of the 3 known P. vivax variants and P. malarie/P. brasilianum, were performed on 277 sera, obtained within a 5 to 10 km range of malaria cases. Very rarely did any of these donors recall typical malaria episodes. Blood smears of all but 5 were negative. One of the 5 malaria cases included in our serology was of a home owner, I of a permanent resident, 3 from Superintendência de Controle de Endemias employees who went there to capture mosquitoes. In Region 1 the prevalence of IFAT positive sera was 73% and 28% among caretakers, 18% and 9.6% among home owners. In Region 2 (3 localities) no distinction was possible between caretakers and home owners, IFAT positivity being 38%, 28% and 7%. The relative percentage of positive anti-CS repeats ELISA, differed for each of the peptides among localities. Dwellings are in the vicinity of woods, where monkeys are frequently seen. The origin of these malaria cases, geographical differences and high seropositivity is discussed.

[In vitro studies of the levels of resistance of Plasmodium falciparum to drugs from 1983 to 1986]

Foram realizados 171 testes de sensibilidade (microtécnica) com cepas de Plasmodium falciparum da Região Amazônica brasileira para cloroquina, mefloquina, amodiaquina e quinino. Os testes tiveram duração de 24 horas com as drogas preparadas na hora da realização de cada teste. Os resultados mostraram elevada resistência a cloroquina (83%) e sensibilidade em quase a totalidade das amostras testadas para mefloquina (97,7%). Para amodiaquina e quinino observou-se sensibilidade em 51,0% e 56,5% das cepas, respectivamente. Este estudo demonstra a emergência de um possível foco de resistência do Plasmodium falciparum a mefloquina, em Tucuruí.