“Você é um dos reprovados?”: cotas, tensões e processos de subjetivação entre universitários negros de medicina

Resumo Este artigo contribui para as reflexões sobre as relações entre cotas, identificação racial, bancas de heteroidentificação e disputas epistêmicas que emergem a partir do ingresso de um maior contingente de universitários pretos e pardos no ensino superior público brasileiro. O material analisado é fruto de etnografia realizada em um coletivo de estudantes negros do curso de Medicina da Universidade Estadual de Campinas (Unicamp), chamado Quilombo Ubuntu. A análise focaliza a chegada dos estudantes cotistas, os conflitos, os estereótipos e os processos de agenciamento; os dilemas envolvidos na opção pela modalidade de cotas para o ingresso, a heteroidentificação racial e sua relação com processos de tornar-se negro; e o modo como esse processo se articula com a produção de conhecimento, incluindo mudanças epistêmicas, nos temas de pesquisas, nos eventos da área, e na maneira como olham para a própria prática médica.

Building Nursing and Midwifery Capacity Through Rwanda's Human Resources for Health Program

Global disparities in the quantity, distribution, and skills of health workers worldwide pose a threat to attainment of the Sustainable Development Goals by 2030 and deepens already existing global health inequities. Rwanda and other low-resource countries face a critical shortage of health professionals, particularly nurses and midwives. This article describes the Human Resources for Health (HRH) Program in Rwanda, a collaboration between the Ministry of Health of Rwanda and a U.S. consortium of academic institutions. The ultimate goal of the HRH Program is to strengthen health service delivery and to achieve health equity for the poor. The aim of this article is to highlight the HRH nursing and midwifery contributions to capacity building in academic and clinical educational programs throughout Rwanda. International academic partnerships need to align with the priorities of the host country, integrate the strengths of available resources, and encourage a collaborative environment of cultural humility and self-awareness for all participants.

Assessing the Readiness of Nursing Sectors in Low- and Middle-Income Countries to Adopt Holistic Practice: Rwanda as Exemplar

Over the past several years, holistic nursing education has become more readily available to nurses working in high-income nations, and holistic practice has become better defined and promoted through countless organizational and governmental initiatives. However, global nursing community members, particularly those serving in low- and middle-income countries (LMICs) within resource-constrained health care systems, may not find holistic nursing easily accessible or applicable to practice. The purpose of this article is to assess the readiness of nursing sectors within these resource-constrained settings to access, understand, and apply holistic nursing principles and practices within the context of cultural norms, diverse definitions of the nursing role, and the current status of health care in these countries. The history, current status, and projected national goals of professional nursing in Rwanda is used as an exemplar to forward the discussion regarding the readiness of nurses to adopt holistic education into practice in LMICs. A background of holistic nursing practice in the United States is provided to illustrate the multifaceted aspects of support necessary in order that such a specialty continues to evolve and thrive within health care arenas and the communities it cares for.

A Globally-Conscious Nonlocal Nursing Community: From Caritas to Communitas

The purpose of this article is to describe the creative process and nursing implications of the website, Holding Heartspace: A Nonphysical Ashram for the Like-hearted to Honor Story, Process, and Sacred Intentions of Caring-Healing-Loving in the World. Holding Heartspace is an example of a virtual community that links the experiences of nurses from around the world to a centralized forum. This site is the culminating project of the author's participation in and graduation from the Caritas Coach Education Program (CCEP). Human caring science is a theory of nursing maintaining several relevant components and definitions that have fostered the creation of Holding Heartspace. It is within the contextual realm of caring science that facilitation from caritas (compassionate, generous love) to the more universal communitas (recognition of our collective humanity) is realized and experienced (Watson, 2008).

Caring Science Conscious Dying

Caring science is an extant theory of human relationship, guiding the profession of nursing with the understanding and application of a moral-ethical praxis that promotes, protects, and provides human dignity throughout the life continuum. Over the past 30 or more years, caring science has transformed nursing by calling for a heightened ethical perspective of human dignity in how nurses practice, educate, research, and evolve the profession. Conscious dying is a framework rooted in a human caring ontology, which strives to deepen the nurse healer’s awareness in tending to a patient’s dying and death, returning death to its sacred place in the cycle of life. Reflective inventories are self-reflection tools that have been used to encourage nurses’ personal growth and development and may be utilized in individual or group settings. The purpose herein is to introduce an emerging metaparadigm that links self to system, interweaving and integrating the teachings of caring science and conscious dying through the use of reflective inventories for both the individual nurse and collective of nursing.

Nephrology Nursing in Rwanda: Creating the Future Through Education and Organizational Partnership

The Human Resources for Health Program was launched in Rwanda in 2012 as a sevenyear initiative to improve healthcare services and decrease overall dependence on foreign aid. In partnership between U.S. academic institutions and Rwandan education affiliates, nursing resources have become primarily centered on the design and implementation of Rwanda's first Masters of Science in Nursing (MScN) Program at the School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali. The nephrology track consists of seven students with a wealth of clinical and educational experience who will receive the training needed to become advanced, ethical, and capable leaders in the nephrology nursing field. Faculty member William Rosa collaborated with the American Nephrology Nurses Association (ANNA) to provide these students with the online community, continuing education, practice standards, and journal access required to be proficient as graduate nurses through the donations of virtual memberships and copies of necessary texts. This is the University of Rwanda's MScN Nephrology Track story.

Soluble Fas ligand (sFasL) as a predictor of reduction of general psychopathology in schizophrenia after antipsychotic treatment

Introduction

Dysregulation of the apoptotic process is associated with the etiopathogenesis of schizophrenia, which is observed at the brain and peripheral blood levels. A significant negative correlation between the duration of the disease and serum sFasL concentration was demonstrated by other authors. It was shown that an increased rate of apoptosis is more pronounced in neuroleptic-free patients with the first-episode of schizophrenia than in patients with chronic disease.

Aim

Search for a predictor of good response to antipsychotic treatment based on the analysis of the sFasL plasma level and its relationship with clinical symptoms.

Methods

Fifty-three patients with chronic schizophrenia and 46 healthy individuals were enrolled in the study. The concentration of sFasL was measured by ELISA. Clinical assessments (PANSS, SANS, SAPS) and blood analyses were conducted three times: during the active phase of disease (at admission), after 4 weeks of pharmacotherapy, and after reaching remission.

Results

In the schizophrenia group, non-altered levels of sFasL (P = 0.1; U Mann-Whitney test), compared to the control, were detected at admission. The initial level of sFasL correlated negatively (r = −0.33; P = 0.04; Spearman's rank) with blood leukocyte count. Despite clinical improvement, no significant changes in the level of sFasL were observed. However, the sFasL level correlated negatively with the PANSS general psychopathology reduction after 4 weeks of pharmacotherapy (r = −0.7; P = 0.04) and after remission (r = −0.39; P = 0.026).

Conclusions

The results indicate a possible role of sFasL in apoptosis of blood leukocytes and suggest that the reduction of sFasL level can predict level of PANSS general psychopathology after antipsychotic treatment in schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Selected metabolites of kynurenine pathway and response to antipsychotic treatment in schizophrenia

Introduction

Deficit of glutamatergic transmission and aberrant function of kynurenine pathway, with disturbed synthesis of glutamate receptors antagonist, kynurenic acid (KYNA) and neurotoxic metabolite of kynurenine, 3-hydroxykynurenine (3-OH-KYN) have been implicated in the pathogenesis of schizophrenia.

Objectives

Demonstrated by others higher level of KYNA in the brain may cause relative deficiency of glutamate-mediate transmission with resulting behavioural and cognitive changes.

Aims

Search for predictors of satisfactory response to antipsychotic treatment based on the analysis of KYNA and 3-OH-KYN serum levels.

Methods

Fifty-three patients with chronic schizophrenia and 46 healthy individuals were enrolled in the study. Quantitative analyses of KYNA and 3-OH-KYN were performed using high-pressure liquid chromatography (HPLC) and electrochemical detection, respectively. Clinical assessments (PANSS, SANS, SAPS) and blood analyses were conducted at 3 time-points: during the active phase of disease, after 4 weeks of modified pharmacotherapy, and after reaching remission.

Results

In schizophrenia group, lower levels of KYNA (P = 0.002) and non-altered levels of 3-OH-KYN (p = 0.195), as compared to control, were detected during active phase of disease. Despite clinical improvement, no significant changes in the level of studied metabolites were observed later on. The initial level of 3-OH-KYN correlated negatively (r = –0.368; Spearman's rank) with clinical improvement (negative symptoms) (P < 0.05).

Conclusions

1. The peripheral dysregulation of kynurenine pathway metabolites in chronic schizophrenia manifests as relative increase in the ratio between neurotoxic 3-OH-KYN and neuroprotective KYNA. 2. The higher serum level of 3-OH-KYN during relapse of schizophrenia seems to predict poor response to antipsychotic treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Reflections on Self in Relation to Other: Core Community Values of a Moral/Ethical Foundation

One of the first steps toward reaffirming the core community values of nursing as we see, feel, hear, and acknowledge them is the awareness of a moral/ethical foundation that preserves, promotes, and protects human dignity. This foundation serves as a starting point and evolutionary path for education, research, and practice (Watson, 2008). Nursing-specific malignancies of compassion fatigue, burnout, moral distress, and nurse-to-nurse bullying can metastasize throughout nursing communities in which caring environments are not nourished as priorities and starting points for being, doing, knowing, and belonging. An understanding that we all participate in holographic membership results in an ethical display of moral empathy, so that the complexities of nursing can be articulated and validated in safe environments. In addition, preparing for our deaths in a way that celebrates and honors life may potentially lead to peaceful relationships with self, other, and the community as a whole. The nature of such a community implies that nurses are invested in ensuring the integrity of the human experience, will serve as advocates of ethical/moral engagement, and are the embodiment of the sacred, if we so choose to honor it.

Intertwined Narratives of the Human Caring Story

The story of human caring is universal; built on a foundation of caring-healing-loving and comprising intersubjective shared intimacy, authenticity, and presence. Each person’s relationship with story is worthy of telling as it connects the individual to the collective, the personal to the global. The story of human caring is the result of intertwined narratives; the love, light, and prayer we hold for ourselves and each other in the world.