Autoetnografía: el teatro como herramienta terapéutica para niños y niñas de una Escuela Hospitalaria / Autoetnografia: o teatro como ferramenta terapêutica para crianças da Escola do Hospital / Autoethnography: theater as a therapeutic tool for Hospital School children

Introducción: Este artículo versa sobre la experiencia de un taller de teatro realizado durante el año 2011 en una Escuela Hospitalaria, para niños y niñas con diversas condiciones de salud. El trabajo se convirtió en una posibilidad de difusión del arte como herramienta terapéutica y una invitación para reflexionar sobre la discapacidad y sus limitaciones reales y/o construidas simbólicamente. La problemática central se focalizó en la identificación de presencia de Factores de Riesgo Ocupacional y Apartheid Ocupacional, en el desempeño escolar de niños y niñas de la escuela Hospitalaria y de la autora. Se plantea que algunos de estos, eran provocados por elementos ambientales como también por construcciones simbólico-sociales generadas en torno a la idea de discapacidad. Objetivo: Describir el impacto que genera el uso de un taller de teatro como medio terapéutico en una escuela hospitalaria. Método: La metodología idónea fue autoetnográfica, que valida la experiencia de la investigadora como fuente de información. Desarrollo: Se analizan teóricamente las ideas sobre los Factores de Riesgo Ocupacional y Apartheid Ocupacional, además de los conceptos desarrollados a través del taller y utilizados para el combate de las condiciones adversas. Conclusion: Es necesario que todos experimentemos en nuestros diferentes contextos espacios de "no evaluación" y libertad para el uso, disfrute y despliegue de todas nuestras habilidades. Tener certeza que el cuerpo guarda las vivencias lo que potenciará esa alma resiliente que todos merecemos tener y abrirá camino a la posibilidad de destruir nuestras condiciones determinantes.

Introdução: Este artigo versa sobre a experiência de uma oficina de teatro realizada durante o ano de 2011, em um Hospital Escola, para crianças em diferentes condições de saúde. O trabalho converteu-se numa possibilidade de difusão da arte como ferramenta terapêutica e um convite para refletir sobre as pessoas em situação de deficiência e suas limitações reais e/ou construídas simbolicamente. A problemática central focaliza a identificação de Fatores de Risco Ocupacional e o Apartheid Ocupacional no desempenho escolar de crianças em um Hospital Escola e da autora. Observaram-se problemas provocados por elementos ambientais e também por construções simbólico-sociais geradas em torno da ideia de "deficientes". Objetivo: Descrever o impacto de uma oficina de teatro como meio terapêutico, em um Hospital Escola. Método: A metodologia aplicada foi a autoetnografia, que valida a experiência da pesquisadora como fonte de informação. Resultados: Analisaram-se teoricamente as ideias sobre os Fatores de Risco Ocupacional e o Apartheid Ocupacional, além dos conceitos desenvolvidos através da oficina e utilizados para o combate das condições adversas. Conclusão: É necessário que experimentemos, em nossos diferentes contextos, espaços que propiciem o "não avaliar" e a liberdade para o uso, o prazer e a manifestação de todas as nossas habilidades. Ter a certeza de que o corpo guarda as vivências que potenciarão a alma resiliente, que todos merecemos ter, e de que tais vivências abrirão caminho para a possibilidade de destruir nossas condições determinantes.

Introduction: This article recounts the experience of a theater workshop conducted in a hospital school with children under diverse health conditions in 2011. The work became a possibility of art diffusion as a therapeutic tool and an invitation to reflect on disability and its real and/or symbolically constructed limitations. The central problem focused on identifying the presence of Occupational Risk Factors and Occupational Apartheid in the school achievement of the hospital school children and the author. Problems caused by environmental elements as well as by symbolic-social constructions generated by the idea of disability were observed. Objective: To describe the impact generated by a theater workshop as a therapeutic means in a children's hospital school environment. Method: The autoethnographic methodology was chosen to validate the experience of the investigator as a source of information. Results: The ideas on Occupational Risk Factors, Occupational Apartheid, as well as the concepts developed in the workshop and those used to combat adverse conditions were theoretically analyzed. Conclusion: It is necessary that we experiment contexts that enable spaces free of evaluation and the freedom to use, enjoy and express all our abilities. We must be certain that the body keeps track of past experiences that potentialize the resilience of the soul, which we all deserve to have and which opens the path to the possibility of destroying our predetermined conditions.

Manejo del dolor por el personal de enfermería en paciente pediátrico post-quirúrgico de apendicectomía / Pain management by the nursing staff in pediatric patient post-surgical appendectomy

Introducción: El dolor es definido como una experiencia sensorial o emocional desagradable, asociada a daño real o potencial, es la experiencia humana más compleja y pese a la importancia de este síntoma es frecuentemente infravalorado. Objetivo: Describir como es el manejo del dolor que ofrece el personal de enfermería al paciente pediátrico postquirúrgico de apendicetomía Materiales y Métodos: Estudio descriptivo-transversal, exploratorio, con metodología cuantitativo, se utilizó un Instrumento semi-estructurado que se aplicó al personal de enfermeras que laboran en el área de pediatría en un hospital de segundo nivel en la ciudad de Durango, dicho instrumento consta de siete reactivos. Resultados: El 55% de la muestra solo utiliza la ministración de analgésicos como acción dependiente para manejar el dolor, mientras que el (45%) además realiza otras intervenciones independientes como parte del cuidado de enfermería. Del 45% de las enfermeras que realizan otras intervenciones se obtuvieron los siguientes resultados: apoyo emocional (56%), cambio de posición (22%), manejo ambiental (11%) y escala analgésica de la Organización Mundial de la Salud (11%). Discusión: En los resultados obtenidos no se reflejó de manera clara que entre mayor nivel académico más intervenciones propias de enfermería se realizarían para proporcionar alivio al dolor, para que este manejo sea más efectivo, algunos autores coinciden con nuestros resultados ya que a pesar de que se siguen algunas pautas para el manejo del dolor posquirúrgico, es necesario también cambiar de conductas. Conclusiones: Expuesto lo anterior se adjudica la necesidad de elaborar un modelo innovador en el cual las enfermeras en el servicio de pediatría apliquen intervenciones independientes propias de enfermería, con el objetivo de mejorar la calidad en la atención en el manejo del dolor en pacientes postquirúrgicos de apendicectomía.

Introduction: Pain is defined as an unpleasant sensory or emotional experience associated with actual or potential harm is more complex human experience, and despite the importance of this symptom is often underestimated. Objective: Describe how pain management is offered by the nursing staff of the pediatric patient after surgery appendectomy. Materials and Methods: Descriptive, no experimental, exploratory, quantitative approach, we used a semi-structured instrument that was applied to staff nurses working in the area of pediatrics at a second level hospital in the city of Durango, this instrument consists of seven items. Results: 55% of the sample only uses the ministry as dependent action of analgesics to manage pain, while (45%) also performed other independent operations as part of nursing care. 45% of nurses engaged in other interventions yielded the following results: emotional support (56%), position change (22%), environmental management (11%) and the OMS analgesic ladder (11%). Discussion: The results obtained are not clearly reflect that the higher academic level more typical of nursing interventions would be made to provide pain relief, so that more effective management, some authors are agree with our results because, although they are some guidelines for postoperative pain management is also necessary to change behavior. Conclusions: Exposed above the need to develop an innovative model in which nurses in the pediatric ward apply its own independent nursing interventions, in order to improve the quality of care in the management of postoperative pain in patient’s appendectomy.

Estrés oxidativo en los músculos soleo y extensor digitorum longus (EDL) de ratas espontáneamente hipertensas / Oxidative stress in soleus and extensor digitorum longus (EDL) muscles of spontaneously hypertensive rats

Las enfermedades sistémicas crónicas afectan el músculo esquelético, siendo la inflamación y el estrés oxidativo algunos de los mecanismos involucrados. El efecto de la hipertensión arterial esencial sobre el músculo esquelético no es bien conocido. Se estudiaron los músculos soleo y extensor digitorum longus (EDL) de ratas espontáneamente hipertensas (SHR), comparadas con las controles normotensas Wistar Kyoto (WKY). Se determinaron los niveles de nitritos y nitratos en µmoles/mg-proteína; las sintasas del óxido nítrico: endotelial (eNOS); neuronal (nNOS); e inducible (iNOS), nitrotirosina y el factor de necrosis tumoral-alfa (TNF-α) en ng/mg-proteína. En las SHR, en el soleo y el EDL respectivamente, se incrementó la nitrotirosina (24,4 ± 5,0 vs. 3,3 ± 0,3, p<0,001; 20,2 ± 4,3 vs. 4,5 ± 0,4, p<0,0037), iNOS (26,6 ± 3,7 vs. 8,3 ± 0,9; 21,3 ± 3,7 vs. 11,0 ± 0,8 ambos p<0,0001), y TNF-α (2,2 ± 0,5 vs. 0,6 ± 0,1, p<0,05; 1,9 ± 0,2 vs. 0,6 ± 0,1, p<0,02); hubo disminución de eNOS en el soleo (20,6 ± 1,4 vs. 30,3 ± 1,2, p<0,00001); de nNOS (soleo 16,8 ± 1,4 vs. 20,7 ± 1,8, p< 0,05; EDL 13,6 ± 1,3 vs. 21,9 ± 1,8, p<0,005) y de nitrito en el EDL (5,8 ± 0,3 vs. 7,1 ± 0,5, p<0,026). En las SHR se observó correlación positiva entre TNF-α vs. nitrotirosina: soleo (r=0,798; p<0,031) y tendencia en EDL (r=0,739; p<0,057); iNOS vs. nitrotirosina (soleo: r=0,908 p<0,0001; EDL: r=0,707; p=0,01), tendencia entre TNF-α vs. iNOS en EDL (r=0,736; p=0,059); y correlación negativa entre eNOS vs. nitrotirosina en soleo (r=-0,816; p=0,0012). En conclusión, las SHR presentan un proceso inflamatorio muscular, evidenciado por el incremento de TNF-α, nitrotirosina, e iNOS. La disminución de las sintasas constitutivas, con incremento de la iNOS es evidencia de la disfunción endotelial.

Systemic diseases affect skeletal muscle, and inflammation and oxidative stress are some of the involved mechanisms. There is scarce information about the effects of essential hypertension on skeletal muscle. The soleus and extensor digitorum longus (EDL) muscles of spontaneously hypertensive rats (SHR) were studied compared to control Wistar Kyoto (WKY) rats. The levels of nitrite and nitrate in µmol/mg-protein; endothelial (eNOS), neuronal (nNOS), and inducible (iNOS) nitric oxide synthases, nitrotyrosine and tumour necrosis factor alpha (TNF-α) in ng/mg-protein were determined. Compared with controls, the SHR showed increased levels of nitrotyrosine (soleus 24.4 ± 5.0 vs. 3.3±0.3, p<0.001; EDL 20.2 ± 4.3 vs. 4.5 ± 0.4, p<0.0037), iNOS (soleus 26.6 ± 3.7 vs. 8.3 ± 0.9; EDL 21.3 ± 3.7 vs. 11.0 ± 0.8, both p<0.0001) and TNF-α (soleus 2.2 ± 0.5 vs. 0.6 ± 0.1, p<0.05; EDL 1.9 ± 0.2 vs. 0.6 ± 0.1, p<0.02). A decrease of eNOS was found in soleus muscle (20.6 ± 1.4 vs. 30.3 ± 1.2, p<0.00001); of nNOS (soleus 16.8 ± 1.4 vs. 20.7 ± 1.8, p< 0.05; EDL 13.6 ± 1.3 vs. 21.9 ± 1.8, p<0.005) and nitrite in EDL (5.8 ± 0.3 vs. 7.1 ± 0.5, p<0.026).There was a positive correlation between TNF-α vs. nitrotyrosine in soleus (r=0.798; p<0.031) and a tendency in EDL (r=0.739; p=0.059); iNOS vs. nitrotyrosine (soleus: r=0.908; p<0.0001; EDL: r=0.707; p<0.01), a tendency between TNF-α and iNOS (EDL: r=0.736; p<0.059); and a negative correlation between eNOS vs. nitrotyrosine in soleus muscle (r=-0.816; p<0.0012). In conclusion, in skeletal muscles of SHR an inflammatory process was found evidenced by the increase in TNF-α, nitrotyrosine and iNOS. The decreased levels of constitutive synthases, together with the higher level of iNOS, are indicative of endothelial dysfunction.

Muscle damage and autoantibody fixation in an experimental model of autoimmune myopathy

An experimental model of autoimmune myopathy was designed using parental antigens (muscle mitochondrial fraction) inF1 hybrid rats (male Wistar female Sprague-Dawley). The immune response was modulated by spleen fragment transplant from either Wistar (W) or F1. Antibody fixation and inflammatory reaction were studied in Extensor digitorum longus and soleus muscles. Immunizationwithout spleen transplant resulted in antibody fixation mainly in capillaries and incompletely around muscle fibers; whorled fibers were found in 1/3 of F1 rats immunized with antigen from W rats. Spleen transplants from Sprague Dawley (SD) rats were usually accepted by F1;in some animals, antibodies surrounded completely muscle fibers and the percentage of animals showing soleus muscle lesions was increased. Spleen transplants from non immunized F1 were usually rejected by immunized F1; antibody reaction was found inside fibers of most of the rats, muscle damage was present in 40% of the animals immunized with W, but absent in those immunized with SD antigen. In conclusion, this model can be used to study immunological responses to alloantigens (parental to F1). Spleen fragment transplant modulates the immune response. There was discrepancy between antibody fixation and muscle damage. The immunological response was different according to muscle fiber type composition and/or microcirculatory characteristics.