Nurses' perception on social network of children with chronic illness: qualitative study, Brazil

Introduction

The high prevalence of chronic diseases in childhood is a serious public health problem in Brazil. The family life of children with chronic illness is marked by numerous determinant and conditioning factors, whether they are biological, psychological, cultural and social. Such factors are more relevant in the absence of a social support network for care. Therefore, the greater the support offered by health professionals, the greater the resources available for the family to face vulnerability.

Objectives

describing primary care nurses' perception of the social network approach for children with chronic diseases.

Methods

Qualitative research conducted in October 2019 through an interview with ten nurses from family health units in the city of Rio de Janeiro, Brazil. The project was approved by the Ethics and Research Committees of the participating institutions. Thematic content analysis was used.

Results

For nurses, social network meant support from family members and from secondary and tertiary level services. In their practice, these professionals are often unaware of the health situation of children with chronic diseases, and they perceive lack of articulation in referral those children to other services of the Health Care Network.

Conclusions

There are gaps between knowledge and practice of these professionals on the social network approach. It is important to highlight frailties in comprehensive care of children with chronic illness and the service counter-referral to the family health unit. It is necessary to carry out training courses for professionals, helping them to belong to the social network of the family of the child with chronic disease. This strategy could implement effective approach of support, surveillance and health promotion of children.

Key messages

There is a gap in the knowledge of social network approach among primary care nurses. The social network approach of children with chronic diseases favors comprehensive care and implementation of effective strategies focused on supporting, monitoring and promoting child health.

The family of a child with chronic illness and its social relationships

Introduction

The family life of a child with chronic illness is marked by several determinants and demands for care. Within that context, the greater the support received, the greater the resources available to face vulnerability, and to respond positively to guidance and care.

Objectives

describing the social network of families of children with chronic illness, and understanding the meaning of the relationship of the family caregiver with the members of his/her social network.

Methods

Qualitative research with nineteen relatives of children with chronic diseases at a rehabilitation center in the city of Rio de Janeiro, Brazil. The theoretical framework of Sanicola's social network was used. Data were collected in November 2019 by semi-structured interviews and analyzed using the content analysis technique. The research was approved by the Ethics and Research Committee of the participating institutions. The social network map showed the presence of few members and mothers as the main caregivers. The main problems among children were: autism, Down syndrome, cognitive disorders and cerebral palsy. Among the most involved people with the caregivers, friends, sisters and grandparents stood out as the ones who offered material, financial and emotional support. Rehabilitation unit support (secondary level) and dissatisfaction with the primary health unit were mentioned.

Conclusions

The social network of children with chronic illness is a small family network marked by social vulnerability and the female gender as responsible for care. It is noteworthy that the weakness in the relationship with health professionals at primary care level can compromise care continuity. Therefore, it is recommended to professionals to know the social network of the clientele served, as well as interacting and strengthening this network in order to provide more effective actions for health protection, rehabilitation and supported self-care strategies.

Key messages

Chronic childhood disease is a major public health problem. Being aware of social network favors the implementation of more actions toward health protection, rehabilitation and supported self-care strategies.

Emission of nanoparticles during friction stir welding (FSW) of aluminium alloys

Friction stir welding (FSW) is now well established as a welding process capable of joining some different types of metallic materials, as it was (1) found to be a reliable and economical way of producing high quality welds, and (2) considered a "clean" welding process that does not involve fusion of metal, as is the case with other traditional welding processes. The aim of this study was to determine whether the emission of particles during FSW in the nanorange of the most commonly used aluminum (Al) alloys, AA 5083 and AA 6082, originated from the Al alloy itself due to friction of the welding tool against the item that was being welded. Another goal was to measure Al alloys in the alveolar deposited surface area during FSW. Nanoparticles dimensions were predominantly in the 40- and 70-nm range. This study demonstrated that microparticles were also emitted during FSW but due to tool wear. However, the biological relevance and toxic manifestations of these microparticles remain to be determined.

HTLV-I negative tropical spastic paraparesis: a scientific challenge

We reviewed the historical, clinical and etiological aspects of the progressive chronic spastic myelopathies of unknown etiology, disserting on the clinical similarities between HTLV-I seropositive and seronegative tropical spastic paraparesis (TSP), as well as focusing on the PCR studies of the seronegative TSP.

Motor neuron diseases in the university hospital of Fortaleza (Northeastern Brazil): a clinico-demographic analysis of 87 cases

In this retrospective (1980-1998) study, we have analyzed clinico-demographically, from the records of the University Hospital of Fortaleza (Brazil), a group of 87 patients showing signs and symptoms of motor neuron diseases (MNDs). Their diagnosis was determined clinically and laboratorially. The WFN criteria were used for amyotrophic lateral sclerosis (ALS) diagnosis. The clinico-demographic analysis of the 87 cases of MNDs showed that 4 were diagnosed as spinal muscular atrophy (SMA), 5 cases as ALS subsets: 2 as progressive bulbar paralysis (PBP), 2 as progressive muscular atrophy (PMA) and 1 as monomelic amyotrophy (MA), and 78 cases of ALS. The latter comprised 51 males and 27 females, with a mean age of 42.02 years. They were sub-divided into 4 groups according to age: from 15 to 29 years (n= 17), 30 to 39 years (n= 18), 40 to 69 years (n= 39) and 70 to 78 years (n= 4). From the 78 ALS patients, 76 were of the classic sporadic form whilst only 2 were of the familial form. The analysis of the 87 patients with MNDs from the University Hospital of Fortaleza showed a predominance of ALS patients, with a high number of cases of juvenile and early onset adult sporadic ALS.

Amyotrophic lateral sclerosis. Clinical analysis of 78 cases from Fortaleza (northeastern Brazil)

We report on the clinical characteristics of amyotrophic lateral sclerosis (ALS) in Fortaleza (Northeastern Brazil). For this, we analyzed retrospectively (from 1980 to 1999) 78 cases of ALS from the Service of Neurology of the University Hospital of Fortaleza diagnosed clinically and laboratorially (EMG, muscle biopsy, myelography, blood biochemistry, muscle enzymes and cranio-cervical X-ray). The results showed that they were mostly sporadic ALS (76/78), and they were divided into definite (n = 36), probable (n = 20), possible (n = 15) and suspected (n = 7), according to the level of diagnostic certainty. They were also subdivided into juvenile (n = 17), early-onset adult (n = 18), age-specific (n = 39) and late-onset (n = 4) groups. Clinically, they presented as initials symptoms, principally, asymmetrical (30/78) and symmetrical (24/78) weakness of extremities, besides bulbar signs, fasciculations, and atrophy. Curiously, pain as first symptom occurred in an expressive fashion (17/78). The predominant initial anatomic site, in this series, was the spinal cord, and mainly affecting the arms. As to the symptom accrual from region to region, this occurs more quickly in contiguous areas, and fasciculations are predominant when bulbar region was associated.

Experimental HTLV-I infection and associated myelopathy

HTLV-I infection and associated myelopathy has been reproduced experimentally in vitro and in vivo and these studies have shown the possibility of creating several lines of infective cells and of detecting minor and major clinical expressions of HTLV-I associated myelopathy in rabbits and rats.

HTLV-negative and HTLV type I-positive tropical spastic paraparesis in northeastern Brazil

A type-specific serological survey among 1042 random nonneurological outpatients in two cities in the state of Ceara (northeastern Brazil) shows a low prevalence of HTLV-I (0.34% in Fortaleza; 0.44% in Crato) and of HTLV-II (0.34% in Fortaleza; 0% in Crato). Among 62 chronic myelopathic patients seen in Fortaleza 27 patients were found with clinical features of tropical spastic paraparesis (TSP); 10 of 27 were found HTLV-I seropositive (37%; 95% confidence limits, 19-58%). Proviral genome detection by polymerase chain reaction in 5 seropositive and 12 seronegative patients confirmed the serological findings. This excludes HTLV-I or -II infection as a cause in the seronegative TSP patients. The HTLV-positive and -negative patients did not differ clinically and by history, except that seropositives had a longer mean disease duration, a female predominance, and a higher proportion of white Caucasians. In this population with low HTLV-I and HTLV-II prevalences, HTLV-negative TSP is at least as frequent as the HTLV-I-associated TSP.