Challenges and possibilities of health professionals in the care of dependent older adults

This study investigates the challenges and possibilities of health professionals in managing care for dependent older adults in PHC. We employed a qualitative approach based on dialectical hermeneutic fusion. Interviews were carried out with 38 health professionals, from June to December 2019, in eight cities in the five Brazilian regions, which resulted in themes about the challenges of professionals in the management of care for older adults, the strategies used, and their suggestions for improving the quality of care for dependent older adults. Management failures, structural factors, access barriers, scarce supplies, disrupted network, and lack of security, were pointed out as hardships in directing health protection, prevention, and promotion actions. The applied strategies are diverse and conflicting and aim to articulate the multiprofessional teams, which involve the Family Health Strategy and specialists to implement care. Strengthening reception, encouraging home consultation, mobilizing support groups, and carrying out health education were among the participants' integrative practices. Due to the complex study object, it was evidenced that professionals recognize the shortcomings in the health services and face undesirable situations due to the lack of qualified personnel in the teams and the defective materials and transportation.

Effect of Ni content in PdNi/C anode catalysts on power and methanol co-generation in alkaline direct methane fuel cell type

PdNi electrocatalysts supported on carbon were used as anode materials for methane oxidation in alkaline direct methane fuel cells (ADMEFCs). The electrocatalysts were successfully synthesized by the NaBH₄ reduction method. X-ray diffraction measurements showed the formation of non-alloyed Pd in the face- centered cubic (FCC) structure for all materials and formation of NiO and Ni(OH)₂ species. TEM images showed that the metal particles are well dispersed on the support with small agglomeration regions. Information about the surface structure of the catalyst were obtained by Raman spectra, mainly confirming the presence of Ni(OH)₂. The species observed by DEMS, that is, methanol (m/z = 32), CO₂ (m/z = 44) and potassium formate (m/z = 84) were confirmed by FTIR, which also showed the presence of a high amount of carbonate in the methane oxidation products of the ADMEFC with Pd₅₀Ni₅₀/C as the anode catalyst. Tests in ADMEFCs showed that the dependence of the maximum power density on nickel content in the catalysts goes through a maximum value of 13.5 μW cm^-2 at 50 at% Ni. Moreover, the amount of produced methanol decreases with increasing Ni content in the PdNi/C catalysts. Both these results can be explained by the enhanced methanol oxidation in the presence of nickel.

Clinical profile of home-based care patients in a Brazilian cohort

Background

The concern with increasing healthcare expenditures and the quality of life of chronically dependent of invasive mechanical ventilation (IMV) patients, led to the emergence of home-based care services (HBCS), which aims the humanization of health services and the reduction of hospital length of stay. Knowledge about the models used in HBCS and the results achieved is essential to identify, plan and execute actions that minimize obstacles to the adequate provision of this service.

Methods

Descriptive, longitudinal and retrospective study, in a HBCS provided by a private hospital in Fortaleza, Brazil. The medical records of 98 adult patients from the HBCS in need of IMV were analyzed.

Results

In 2019, 156 patients went through the HBCS. Of these, 58 were under 18 years-old and not included in the sample. Of the adult patients, 42 (42,8%) were male and 56 (57,1%) female. The age range varied from 28 to 102 years-old and the median age was 85 years. 57 (58,2%) patients were admitted throughout 2019, and 16 (28,1%) of them had, at least, 1 hospital readmission in 2019. 41 (41,8%) patients had been admitted before 2019, and 6 (14,6%) of them had, at least, 1 readmission in 2019. These facts may suggest that the need of hospitalization tend to happen more at the beginning of home-based care. In 2019, 13 (13,3%) patients died. 8 (61,5%) of these were admitted in 2019, and 5 (38,4%) were already in the HBCS before that year. The main diagnosis were: Dementia (21,4%), Chronic Encephalopathy (9,1%) and Multiple Sclerosis (8,2%).

Conclusions

The study shows that, even in an elderly and dependent cohort, the need of re-hospitalization and mortality rates are low, which points to the need of further studies of HBCS in order to reduce hospital stay and expenditures.

Key messages

It is important to deepen studies related to home-based care models, in association with payment expenses inquiries, as this type of assistance seems to develop humanized and safe care. The mortality rate of the HBCS studied was 13% and the overall re-hospitalization rate was 22,4%, which points this as a promising model for IMV dependent patients.

Association of estrogen receptor β polymorphisms with posterior tibial tendon dysfunction

Posterior tibial tendon (PTT) dysfunction is three times more common in females, and some patients may have a predisposition without a clinically evident cause, suggesting that individual characteristics play an important role in tendinopathy. The present study investigated the association of rs4986938 (+ 1730G > A; AluI RFLP) and rs1256049 (- 1082G > A; RsaI RFLP) single nucleotide polymorphisms (SNPs) of estrogen receptor-beta (ER-β) gene with PTT dysfunction. A total of 400 participants were recruited. The PTT dysfunction group: these patients underwent surgery, with PTT tendinopathy confirmed by histopathology and magnetic resonance image (MRI). The control group was composed of participants with no clinical or MRI evidence of PTT dysfunction. Each group was composed of 100 postmenopausal women, 50 premenopausal women, and 50 men. Genomic DNA was extracted from saliva samples, and genotypes were obtained by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). Concerning the ER-β SNP rs4986938, there were significant differences in the frequencies of alleles between test and control groups of all the cases, only postmenopausal women and only men (p < 0.0001, p = 0.0016 and p = 0.0001). Considering the PTT dysfunction group and comparing postmenopausal women versus premenopausal women adding men, the analysis showed significant differences in the allelic distribution (p = 0.0450): the allele A in postmenopausal women is a risk factor. The ER-β SNP rs1256049 did not show differences in the frequencies of alleles and genotypes between groups. The ER-β SNP rs4986938, but not ER -β SNPs rs1256049, may contribute to PTT insufficiency in the Brazilian population, with additional risk in postmenopausal women. Addition, in men the genetic factor could be more determinant.

ERα PvuII and XbaI polymorphisms in postmenopausal women with posterior tibial tendon dysfunction: a case control study

Background

Posterior tibial tendon (PTT) insufficiency is considered as the main cause of adult acquired flat foot and is three times more frequent in females. High estrogen levels exert a positive effect on the overall collagen synthesis in tendons. We have previously demonstrated the association between some genetic single-nucleotide polymorphism (SNP) and tendinopathy. In the present study, we investigated the association of PvuII c454-397T>C (NCBI ID: rs2234693) and XbaI c454-351A>G (NCBI ID: rs9340799) SNPs in estrogen receptor alfa (ER-α) gene with PPT dysfunction.

Methods

A total of 92 female subjects with PTT dysfunction, with histopathological examination of the tendon and magnetic resonance image (MRI) evidence of tendinopathy, were compared to 92 asymptomatic females who presented an intact PPT at MRI for PvuII and XbaI SNPs in the ER-α gene. Genomic DNA was extracted from saliva and genotypes were obtained by polymerase chain reaction restriction fragment length polymorphism.

Results

The analysis of PvuII SNPs showed no significant differences in the frequency of alleles and genotypes between control and PTT dysfunction groups. The XbaI SNPs in the ER-α gene showed significant differences in the frequency of genotypes between control and test groups (p = 0.01; OR 95% 1.14 (0.55–2.33).

Conclusions

The XbaI SNP in the ERα gene may contribute to tendinopathy, and the A/A genotype could be a risk factor for PTT tendinopathy in this population. The PvuII SNP studied was not associated with PTT tendinopathy.

Detection of Breast Cancer: Knowledge, Attitude, and Practice of Family Health Strategy Women

In rural area, control of breast cancer is related to health promotion and early diagnosis, which includes knowledge, awareness, and stimulating behavioral change, emphasizing screening for disease. The present study was developed to assess the knowledge, attitude, and practice of rural women about early detection of breast cancer in the Primary Health Care Centre. This is a cross-sectional study in a Primary Health Care Centre with 243 rural women participating in the public health service. Data collection was made by a self-administered questionnaire which included sociodemographic characteristics, questions on breast cancer risk factors, screening, and diagnostic methods. Marks were attributed to each question and calculated for each section. Participants fell in three categories of knowledge, attitude, and practice: appropriate, regular and inappropriate. Knowledge, attitude, and practice of early detection methods were considered especially appropriate for those rural women with education and higher economic level, but inadequate responses to such methods were still significant. It is noted that there is still a significant number of rural women who do not have basic knowledge regarding early detection methods of breast cancer, contributing to the non-realization of these methods, as its advocates.

Accuracy of the defining characteristics of the nursing diagnosis for fatigue in women under radiotherapy

ABSTRACT Objective: To evaluate the accuracy of the defining characteristics of the nursing diagnosis for “fatigue in women with breast cancer under radiotherapy”. Method: Study of diagnostic accuracy, with cross-sectional design, performed in 130 women with breast cancer under radiation treatment. A data collection instrument was used to evaluate clinical socio-demographics and to investigate the presence or absence of defining characteristics for fatigue. The latent class analysis model was applied to assess accuracy measurements of the characteristics identified. Results: Fatigue diagnosis was present in 21.9% of the women. The characteristic which showed the highest sensitivity was “Impaired capacity in maintaining the usual level of physical activity”, while “Impaired capacity in maintaining usual routines” and “Lack of interest about the surrounding environment” presented greater specificity. Conclusion: Accurate diagnostics allow devising an action plan directed to the patients' real needs.

Uso de tecnologia leve-dura nas práticas de enfermagem: análise de conceito

Objetivo: establecer el concepto de tecnología blanda-dura en las prácticas de enfermería. Materiales y métodos: estudio reflexivo, con aplicación del método de análisis conceptual de Walker e Avant, que utiliza los siguientes pasos: selección de un concepto; determinación de los objetivos de análisis, de los atributos definidores; identificación de un caso modelo y contrario, e identificación de los antecedentes y las consecuencias. El estudio se llevó a cabo desde la búsqueda en bases de datos de las producciones científicas disponibles en ambiente virtual, en el periodo de abril y mayo de 2014. Resultados y discusión: inicialmente, el concepto de tecnología estaba relacionado al de técnica; con el del tiempo, sufrió cambios y pasó a relacionarse con los aspectos subjetivos y objetivos del cuidador. La tecnología blanda-dura sobrepasa los conocimientos tecnológicos estructurados y presenta libertad que les permite a los profesionales diversas posibilidades de acción. El uso de tecnologías en el cuidado de la enfermería es capaz de promover la salud e intensificar el vínculo entre profesional y cliente. Conclusión: el método de Walker e Avant posibilita demarcar los aspectos y la formación de un concepto desde atributos, antecedentes y consecuentes, además de analizar la utilización de los términos en la práctica.

Evaluation of an educational handbook as a knowledge-acquisition strategy for mastectomized women

This descriptive, cross-sectional and quantitative study presents an analysis of knowledge acquired by mastectomized women concerning breast cancer after reading an educational handbook. The sample was composed of 125 women. Data were collected in a specialized cancer facility in three phases: preparatory, operational I and operational II. As to the knowledge acquired, the posttest showed an 11% increase in the number of correct answers compared to the pretest. The most frequent correct answer regarded a question asking the name of the surgery (97.60%) while the question concerning breast reconstruction obtained the lowest number of correct answers (58.40%). Answers to all the questions significantly improved in the posttest, with the exception of a question addressing breast reconstruction (p=0.754). The assessment of knowledge showed positive results after reading, suggesting that cognition is essential to understanding and adhering to guidance, thus the handbook is a favorable resource to be used in the rehabilitation of mastectomized women.

Construção de um Vídeo Educativo sobre Detecção Precoce do Câncer de Mama

Introdução: As atividades de educação em saúde estimulam a prevenção de doenças, a promoção da saúde e o engajamento da população em assuntos relacionados a saúde e à qualidade de vida, através da construção do conhecimento. Objetivo: Descrever a construção de um vídeo educativo sobre o câncer de mama em uma oficina virtual. Método: Estudo do tipo de desenvolvimento de tecnologia educativa. A construção do material educativo ocorreu em junho de 2012, em quatro etapas: revisão narrativa da literatura, análise dos dados coletados, seleção dos dados e construção do material. Resultados: Obteve-se um vídeo educativo que abordava a definição do câncer de mama, as alterações na mamas sugestivas de câncer e os métodos de detecção da doença: mamografia, exame clínico das mamas, ultrassonografia mamaria e autoexame das mamas. Conclusão: A enfermeira como profissional da saúde e responsável pela promoção da saúde da comunidade, devendo desenvolver avanços na enfermagem que assegurem o compromisso social, a luta e o combate as doenças, como a elaboração de materiais que auxiliem a educação em saúde. A oficina virtual como uma tecnologia educativa pode facilitar a construção do conhecimento de forma a promover saúde.  

Prognosis of breast cancer during pregnancy: evidence for nursing care

This integrative review analyzed evidence available in the literature concerning the prognosis of breast cancer during pregnancy. The following databases were used for selecting studies: PubMed, CINAHL and LILACS. A total of 240 primary studies were identified; 13 papers were included in the integrative review's sample after reading the titles and abstracts and according to the established inclusion and exclusion criteria. There is evidence indicating that pregnancy does not worsen the evolution of breast cancer and a poor prognosis is related to late stage tumors. Among the gaps identified in the studied theme, the need for further studies addressing nursing care provided to pregnant women with breast cancer is highlighted in order to promote improved care in the context of health care.

Significado do cuidado familiar à mulher mastectomizada

Objetivou-se compreender o significado do cuidado familiar prestado à mulher mastectomizada. Estudo qualitativo, cujo referencial teórico utilizado foi o Interacionismo Simbólico, e o metodológico, a Teoria Fundamentada nos Dados. Entrevistaram-se 11 familiares entre julho e agosto de 2008. Os resultados evidenciaram os seguintes fenômenos: enfrentamento das dificuldades da família para cuidar, diagnóstico de câncer de mama defrontado pela família e cuidado familiar percebido após a cirurgia. Concluiuse que, apesar de os participantes valorizarem o cuidado familiar, alguns se sentiam despreparados para assumi-lo efetivamente. Considera-se a relação familiar consistente uma estratégia fundamental para a reabilitação da mulher mastectomizada.

[Knowledge and expectations of women in the preoperative mastectomy]

The objective of this study was to understand the knowledge, concerns and expectations of patients suffering from breast cancer in relation to mastectomy. Interviews were performed with 11 women before their being submitted to surgery at the Hospital das Clinicas in Fortaleza (Ceará state) on December 2008. The hermeneutic-dialectical method was used for discourse analysis, and three theme categories were defined: Knowledge about the surgery, Feelings and expectations surrounding mastectomy, and Removing the breast. It was found that women go through a stressful preoperative period, lack knowledge about the surgery, experience anxiety and fear of what they should expect, as well as feelings of panic and shock before their breast is removed. It is, therefore, observed that the health team caring for those patients has an important role in education and in providing emotional support so as to minimize the tragedy those women are experiencing.

Association between stress and breast cancer in women: a meta-analysis

The objective of the current meta-analysis was to verify the association between stressful life events and primary breast cancer incidence in women. A total of 618 studies from 1982-2007 were found in the PubMed, LILACS, and Cochrane Library databases. Methodological quality was evaluated according to the Downs & Black criteria. Eight studies were selected (six case-controls and two cohorts). The studies were grouped in three analyses, two of which based on the categories widowhood and divorce and the other based on self-rated intensity and frequency of stressful events. Relative risks were: widowhood 1.04 (95%CI: 0.75-1.44; p = 0.800); divorce 1.03 (95%: 0.72-1.48; p = 0.850); and intensity/frequency of stress 1.73 (95%CI: 0.98-3.05; p = 0.059). We conclude that stressful life events as a whole are not associated with risk of breast cancer in women. However, it is not possible to rule out high-intensity stress as a risk factor for breast cancer.

Percepção dos cônjuges de mulheres mastectomizadas com relação à convivência pós-cirurgia

Esta pesquisa teve como objetivo compreender a percepção dos cônjuges de mulheres mastectomizadas em relação à convivência pós-cirúrgica. Estudo qualitativo, realizado em 2006, no domicílio de cinco homens que viviam maritalmente com mulheres mastectomizadas, em Fortaleza-CE. Utilizamos a entrevista semi-estruturada. Os resultados foram agrupados em três categorias de análise. Identificamos um nível de desinformação quanto à doença, tranquilidade atribuída à fé em Deus, e a forte convicção de que câncer e morte são sinônimos. Cabe aos profissionais de enfermagem/saúde favorecer o conhecimento sobre câncer de mama, e abrir um painel de integração marido/esposa, priorizando uma convivência saudável.

Palliative care to the cancer patient: reflections according to Paterson and Zderad's view

This reflective study presents the approach of the Nursing Palliative Care to the cancer patient without therapeutic possibility according to the Paterson and Zderad's Humanistic Nursing Theory. The palliative care aims to provide the patient without therapeutic possibility and his family better quality of life. When the nurse, in addition to delivering palliative care to the cancer patient, uses the Humanistic Theory, (s)he starts to recognize each person as a singular existence. This recognition permits one to understand the person's meaning in the process of his(er) disease.