A Ten-Year Comparative Study on Ethical Cognition of Experimental Animals among Medical Students in a University / 中国医学伦理学

The study was carried out to understand the changes in the ethical cognition status of laboratory animals and the effectiveness of laboratory animal ethics education among medical students in Xiangya School of Medicine of Central South University (CSU), and provide new enlightenment for further strengthening the ethical education of laboratory animals. In the study, the same self-compiled questionnaire was used to investigate the ethical cognition of experimental animals among medical students in Xiangya School of Medicine of CSU in 2011 and 2021, and 359 and 363 questionnaires were collected respectively. Through comparative analysis of the questionnaire results before and after ten years, it was found that medical students’ animal experiment operation and attitudes towards laboratory animals, cognition of experimental animal ethics knowledge and their attitude to animal experiment ethics education were significantly improved. It showed that the state of experimental animal ethics cognition among medical students in Xiangya School of Medicine of CSU had improved significantly in recent 10 years, but the cognition of experimental animal ethics knowledge was higher than the actual behavior of caring for experimental animals, and there was the phenomenon of "separation of knowledge and action". The ethics education of experimental animals needs to pay more attention to the development of students’ behavior of caring for experimental animals.

I, too, need care: Narratives of caregivers raising a child with HIV – An input for life coaching approaches

Objectives@#The present study explored the experiences of caregivers raising a child with perinatal HIV infection through a narrative inquiry approach. It uncovered how caregivers learned about their children’s diagnosis, the challenges that they experience in raising their children, and how they cope with the ordeal caused by HIV infection. @*Methods@#A total of ten participants joined the study – five caregivers participated in the key informant interviews (KIIs), with their respective child diagnosed to have perinatal HIV infection joining the focus group discussion (FGD) (n=5). Semi-structured individual interviews were carried out to examine in-depth narratives from the caregivers. We thoroughly analyzed the verbatim interview transcripts using reflexive thematic analysis (RTA) by the six-phase process outlined by Braun and Clarke (2019). NVivo 12 was utilized in the process of data analysis. The transcribed data were uploaded, coded, and analyzed individually. The software helped the organization and expression of the codes and themes.@*Result@#In this study, three major themes and four sub-themes in each theme were generated: a) becoming known: the journey towards testing and treatment, which includes reasons for testing, cause of acquiring HIV, reactions, and treatment, b) passing through challenging times, which cover preparing the child to understand illness, child's awareness and understanding of illness, physical health, and discrimination, and c) receiving essential support which includes an understanding of illness, building hope, needs received, and sources of support.@*Conclusions@#Caregivers with children living with HIV face challenges such as preparing the illness to be known and understood by their child, managing the child’s physical health, and discriminating against others. However, they can live healthy and meaningful lives if they are given comprehensive support from the government, access to quality healthcare and education, and psychosocial interventions. The government and private sectors must make efforts to promote physical, emotional, and mental health care underpinning the well-being of caregivers and children with HIV. The retention of the programs offered by certain organizations (e.g., testing and treatment needs, nutritional and basic needs support, educational supply, and livelihood program for caregivers) and the increase in the number of psychoeducational and support group activities were suggested to significantly help in addressing the concerns of both caregivers and their child with perinatal HIV infection.

Autogestão do diabetes na adolescência: experiência de jovens adultos e pais portugueses / Autogestión de la diabetes en la adolescencia: experiencias de jóvenes adultos y padres portugueses / Self-management of diabetes in adolescence: experience of Portuguese young adults and their parents

Resumo Objetivo Identificar os fatores que facilitam ou dificultam a construção da autonomia na adolescência através da experiência de jovens adultos com diabetes tipo 1 e seus pais. Métodos Estudo de natureza qualitativa, descritiva e exploratória. Foram realizadas duas entrevistas de grupo focal, uma com nove jovens adultos peritos na gestão de sua doença e outra com sete pais. Para análise dos dados, foram usados análise de conteúdo temática e categorial, com particularidades de entrevista de grupo focal, e recurso ao software NVIVO 12. Resultados Emergiram duas grandes categorias e dez subcategorias relativas aos fatores que facilitaram (sistemas de suporte, conhecimentos, alimentação, bomba de insulina, responsabilização precoce pela gestão da terapêutica, características dos jovens), e dificultaram (regime terapêutico, estigma, atitude dos profissionais de saúde, características dos jovens, conhecimento) o desenvolvimento da autonomia na gestão da doença. Conclusão A autonomia na gestão do diabetes envolve vários desafios aos adolescentes, o que requer adequação de atitudes e intervenções de profissionais. Além da gestão tradicional da condição de saúde, é essencial abordar temas relacionados com a socialização dos adolescentes, procurando estratégias inovadoras que promovam o coping e a qualidade de vida. Os resultados deste estudo possibilitam refletir sobre a relação terapêutica com os adolescentes, salientando a importância de individualizar cuidados e respostas inovadoras às suas necessidades específicas.

Resumen Objetivo Identificar los factores que facilitan o dificultan la construcción de la autonomía en la adolescencia a través de la experiencia de jóvenes adultos con diabetes tipo 1 y sus padres. Métodos: Estudio de naturaleza cualitativa, descriptiva y exploratoria. Se realizaron dos entrevistas de grupo focal, una con nueve jóvenes adultos expertos en la gestión de su enfermedad y otra con siete padres. Para el análisis de datos se utilizó el análisis de contenido temático y categorial, con particularidades de entrevista de grupo focal y recurso del software NVIVO 12. Resultados Surgieron dos grandes categorías y diez subcategorías relativas a los factores que facilitaron el desarrollo de la autonomía en la gestión de la enfermedad (sistemas de apoyo, conocimientos, alimentación, bomba de insulina, responsabilización temprana de la gestión de la terapéutica, características de los jóvenes) y los que la dificultaron (régimen terapéutico, estigma, actitudes de los profesionales de la salud, características de los jóvenes, conocimientos). Conclusión La autonomía en la gestión de la diabetes incluye muchos desafíos para los adolescentes, lo que requiere adaptación de actitudes e intervenciones de profesionales. Además de la gestión tradicional del estado de salud, es esencial abordar temas relacionados con la socialización de los adolescentes y buscar estrategias innovadoras que promuevan el coping y la calidad de vida. Los resultados de este estudio permiten reflexionar sobre la relación terapéutica con los adolescentes y destacar la importancia de individualizar los cuidados y las respuestas innovadoras para sus necesidades específicas.

Abstract Objective To identify the factors that facilitate or hinder the construction of autonomy in adolescence through the experience of young adults with type-1 diabetes and their parents. Methods This was a qualitative, descriptive, and exploratory study. Two focus group interviews were conducted: one with nine young adults who were experts in managing their illness and the other with seven parents. Thematic and categorical content analysis was used for data analysis, with particularities of a focus group interview and the use of the NVIVO 12 software. Results Two major categories and ten subcategories related to factors that facilitated (support systems, knowledge, diet, insulin pump, early responsibility for managing therapy, and characteristics of young people) and hindered (therapeutic regimen, stigma, attitude of health professionals, characteristics of young people, and knowledge) the development of autonomy in disease management emerged. Conclusion Autonomy in the management of diabetes involves several challenges for adolescents, which requires adaptation of attitudes and interventions by professionals. In addition to the traditional management of the health condition, addressing issues related to the socialization of adolescents is essential, looking for innovative strategies that promote coping and quality of life. The results of this study make it possible to reflect on the therapeutic relationship with adolescents, emphasizing the importance of individualizing care and innovative responses to their specific needs.

Violência doméstica e seu impacto emocional sobre o adolescente: um estudo de revisão / Domestic violence and its emotional impact on adolescents: a review study / La violencia doméstica y su impacto emocional en los adolescentes: un estudio de revisión

Considerando a violência doméstica contra crianças e adolescentes como um problema social e de saúde pública que atinge milhares de famílias de todas as partes do mundo, o objetivo desta revisão de literatura é compreender o impacto emocional da violência doméstica na vida de adolescentes. Foram sele-cionados artigos científicos delimitados pelos descritores "domestic violence", "adolescent" e "emotional impact", nos idiomas português, inglês e espanhol, nas bases de dados Scielo, PsycINFO (APA) e Pubmed. Incluímos artigos empíricos avaliados por pares publicados nos últimos dez anos (2010- 2020). A partir da análise crítica dos 14 estudos selecionados identificamos que o impacto emocional da violência doméstica é resultado de uma complexa inte-ração entre fatores culturais, sociais, familiares e emocionais. De modo geral, o jovem vitimado apresenta sintomas depressivos, ansiedade e autoestima diminuída, a qual se revela por crenças negativas sobre si e sobre o mundo. Compreendemos a sintomatologia dos jovens como uma estratégia de sobre-vivência psíquica em ambientes familiares invasivos e negligentes quanto às suas necessidades físicas e emocionais. Concluímos pela necessidade de inter-venções preventivas e interventivas que objetivem tanto o bem estar de crianças e adolescentes quanto a oferta de um cuidado parental suficientemente bom. (AU)

Considering domestic violence against children and adolescents as a social and public health problem affecting thousands of families all over the world, the objective of this literature review is to understand the emotional impact of domestic violence on the lives of adolescents. Scientific articles delimited by the descriptors "domestic violence", "adolescent" and "emotional impact" were selected, in Portuguese, English and Spanish, in the Scielo, PsycINFO (APA) and Pubmed databases. We include peer- reviewed empirical articles published in the last ten years (2010-2020). Based on a critical analysis of 14 selected studies, we identified that the emotional impact of domestic violence is the result of a complex interaction between cultural, social, family and emotional factors. In general, the victimized youth presents depressive symptoms, anxiety and reduced self-esteem, which is revealed in negative beliefs about themselves and about the world. We understand the symptoms of young people as a psychic survival strategy in invasive family environments that neglect their physical and emotional needs. We conclude that there is a need for preventive and interventive actions aiming both at the well-being of children and adolescents and at offering a sufficiently good parental care.(AU)

Considerando la violencia intrafamiliar contra la niñez y adolescencia como un problema social y de salud pública afectando a miles de familias del mundo, el objetivo de esta revisión de literatura es comprender su impacto emocional en la vida de los adolescentes. Se seleccionaron artículos científicos delimitados por los descriptores "violencia doméstica", "adolescente" y "impacto emocional", en portugués, inglés y español, en las bases de datos Scielo, PsycINFO (APA) y Pubmed. Incluimos artículos empíricos revisados por pares publicados en los últimos diez años (2010-2020). A partir de un análisis crítico de 14 estudios seleccionados, identificamos que el impacto emocional de la violencia doméstica es el resultado de una interacción compleja entre factores culturales, sociales, familiares y emocionales. En general, el joven victimizado presenta síntomas depresivos, ansiedad y disminución de la autoestima, lo que se manifiesta en creencias negativas sobre sí mismos y el mundo. Entendemos los síntomas de los jóvenes como una estrategia de supervivencia psíquica en entornos familiares invasivos que descuidan sus necesidades físicas y emocionales. Concluimos que existe necesidad de intervenciones preventivas y intervencio-nistas apuntando tanto al bienestar de los niños y adolescentes como a ofrecer un cuidado parental suficientemente bueno. (AU)

Desmistificando a coleta citopatológica: uma forma de prevenir o câncer de colo do útero / Demystifying cytopathological collection: a way to prevent cervical cancer

Objetivo: Relatar uma ação de Educação em Saúde sobre a prevenção do câncer de colo uterino por meio da citologia. Método: Trata-se de um relato de experiência vivenciado por uma enfermeira durante uma ação a dez mulheres sobre a importância da coleta citopatológica para prevenção desse câncer. Foi realizada em maio de 2023, em uma unidade básica de saúde e dividida em três momentos: no primeiro, foi realizado um Brainstorm, no segundo um pré-teste utilizando uma dinâmica e o terceiro momento foi o pós-teste. Resultado: Foi evidenciado que as mulheres não tinham entendimento correto sobre a coleta citopatológica, as etapas do exame, ou seja, o conhecimento era insuficiente e não se sentiam preparadas para falar sobre o assunto. Conclusão: A ação permitiu um maior conhecimento das usuárias e das suas necessidades de entendimento e esclarecimentos sobre a coleta citopatológica, levando em consideração a sua importância no rastreio precoce de câncer de colo do útero.(AU)

Objective: To report a Health Education action on the prevention of cervical cancer through cytology. Method: This is an experience report lived by a nurse during an action with ten women on the importance of cytopathological collection for the prevention of this cancer. It was carried out in May 2023, in a basic health unit and divided into three moments: in the first, a Brainstorm was performed, in the second, a pre-test using a dynamic and the third moment was the post-test. Result: It was evidenced that the women did not have a correct understanding of the cytopathological collection, the examination steps, that is, the knowledge was insufficient and they did not feel prepared to talk about the subject. Conclusion: The action allowed for a greater knowledge of the users and their needs for understanding and clarification about the cytopathological collection, taking into account its importance in the early screening of cervical cancer.(AU)

Objetivo: Relatar un programa de educación sanitaria sobre la prevención del cáncer de cuello de útero mediante la citología. Método: Este es un informe de la experiencia de una enfermera durante una acción con diez mujeres sobre la importancia de la recolección citopatológica para prevenir este cáncer. Tuvo lugar en mayo de 2023 en una unidad básica de salud y se dividió en tres etapas: la primera fue una lluvia de ideas, la segunda fue un pre-test mediante dinámicas y la tercera fue el post-test. Resultados: Quedó claro que las mujeres no tenían una comprensión correcta de la colecta citopatológica y de las etapas del examen, o sea, sus conocimientos eran insuficientes y no se sentían preparadas para hablar del tema. Conclusión: La acción permitió una mayor concienciación de las usuarias y su necesidad de comprensión y aclaración sobre la colecta citopatológica, teniendo en cuenta su importancia en el cribado precoz del cáncer de cuello uterino.(AU)

Experiencias de personas adultas con discapacidad intelectual sobre el derecho a la vida independiente: Un estudio de caso / Experiences of adults with intellectual disabilities on the right to independent living: A case study

Resumen En el ámbito de la discapacidad intelectual, el desarrollo de una vida independiente se ha configurado como un derecho humano y civil que permite a estas personas articular planes de vida deseados. Esta investigación analiza, mediante un estudio de caso, los significados que un grupo asesor compuesto por ocho personas adultas con discapacidad intelectual tiene sobre el concepto de vida independiente en el contexto chileno. Para la recopilación de los datos se diseñó una entrevista grupal semiestructurada acompañada de moodboards que facilitaron la verbalización de las respuestas. Sobre los relatos obtenidos a partir de las entrevistas se realizó un análisis de contenido temático. Los resultados muestran cómo el desempeño de una actividad laboral remunerada o el establecimiento de relaciones afectivas sólidas se conforman como elementos imprescindibles para la independencia personal. La dificultad para ser económicamente independientes o la falta de accesibilidad en el entorno laboral se identifican también como principales barreras para la concreción de este derecho. Igualmente, se destaca el rol que desempeñan la pareja y las amistades como figuras de apoyo constante a la independencia y al empoderamiento personal. Estos resultados sugieren algunas orientaciones para la planificación de intervenciones sobre este constructo, las cuales deben procurar la adquisición de habilidades que fortalezcan la capacidad de autocuidado de este colectivo, promover el incremento de oportunidades para la realización de elecciones significativas en el ámbito laboral, personal y comunitario, y adaptarse a los espacios en los que se desenvuelven las personas con discapacidad intelectual en la edad adulta.

Abstract In the field of intellectual disability, the development of an independent life has been configured as a human and civil right that allows these people to articulate desired life plans. Despite the advances, at the international level, research on aspects related to independent living in people with intellectual disabilities continues to be very scarce. Generally, the approaches to the study of this construct are based on broader investigations dedicated to evaluating the levels of quality of life or self-determination of this population in residential services or sheltered housing. Precisely, this study analyzes, through a case study, the meanings that an advisory group made up of eight adults with intellectual disabilities has on the concept of independent living in the Chilean context in order, on the one hand, to identify relevant elements for the definition of the construct from the perceptions and experiences of this population; and on the other, to propose guidelines at various levels that allow progress in the realization of this right. To collect the data, a semi-structured group interview was designed whose questions were grouped around four themes: previous conceptions of the participants about the construct of independent life, satisfaction with life and possibilities of the context for the development of personal independence, role of family, friendship and partner in independent life, and opportunities of the work context for the achievement of personal independence. During the interview, another strategy was incorporated in which visual language gained more relevance. Specifically, a set of ten moodboards were used that allowed participants to delve into the different topics addressed. The results of the code validation process were calculated using Krippendorff's alpha statistics (.954) and Cohen's kappa (.953), which showed a high level of inter-judge agreement. As a result of this process, categories (N = 6) and subcategories (N = 17) were established. The results show how various needs, barriers and facilitators for the development of independent life are identified from the interviews of the interviewees. Among the main needs is the performance of a paid work activity or the establishment of solid affective relationships. With regard to the barriers that hinder personal independence, the most notorious are related to the difficulty of being financially independent or to the lack of accessibility in the work environment. Regarding the elements that facilitate the development of an independent life, the role of the couple stands out as a constant figure of support for independence and personal empowerment. These results suggest some guidelines for planning interventions on this construct. Among others, they should seek the acquisition of skills that strengthen the self-care capacity of this group; should promote increased opportunities for making meaningful choices in the workplace, personal and community; and they must adapt to the spaces in which people with intellectual disabilities operate in adulthood. On the other hand, it is assumed that one of the main limitations of this research is that the results are not generalizable. However, this study has some strengths. Among others, it contributes to enriching the bulk of research on independent living, this being an aspect barely addressed in the literature. It also complements the results of other research regarding the elements that can condition the development of skills for personal independence. This allows for the design of interventions that provide opportunities for independent living based on the felt needs of these people. In addition, it raises future lines of research related, for example, to the importance of the informed choice of the residential environment or to the study of the possibilities of the digital world as an incident phenomenon in the acquisition of skills for personal independence.

Necesidades de formación de las personas editoras de la Universidad de Costa Rica

El crecimiento de la necesidad de información veraz ha llevado a que las revistas científicas se posicionen como medios de información confiables; lo cual hace que se requiera una necesidad de la profesionalización de esta labor que garantice la confiablidad y rigurosidad de las mismas. El objetivo de este manuscrito fue identificar las necesidades de formación de profesionales a cargo de la gestión editorial de las revistas científicas de la Universidad de Costa Rica. La investigación se realizó desde enero del 2019 hasta junio del 2020, por medio de un enfoque cualitativo de tipo descriptivo, con técnicas de recolección de este mismo enfoque. Se entrevistaron a las personas editoras y directoras de las principales revistas posicionadas en los primeros diez lugares del ranking UCR índex (a la fecha 4 de noviembre del 2019), se utilizó una entrevista semiestructurada con preguntas relacionadas a la identificación de actitudes, habilidades, conocimientos, necesidades de formación y el contexto en el que se desarrollan, estas representan las categorías de análisis utilizadas para el procesamiento de información. Entre los resultados se destacaron necesidades de formación en temáticas afines a los procesos administrativos relacionados con revistas, fundamentos de la gestión editorial, herramientas tecnológicas y el posicionamiento de las revistas; además se evidenciaron las cortas jornadas laborales que poseen los editores de revistas UCR. Se concluye que es imperativo que la UCR atienda estas necesidades de formación, además de fortalecer estos medios de divulgación del conocimiento y que se analice la oportunidad de ofrecer un programa de formación continua o bien una especialidad en gestión editorial.

The growth of the need for reliable information has led scientific journals to position themselves as reliable information media, which entails a need for the professionalization of this work that guarantees the reliability and rigor of this. The objective of this manuscript was to identify the training needs of the professionals in charge of the editorial management of the scientific journals of the University of Costa Rica. The research was carried out from January 2019 to June 2020, through a descriptive qualitative approach, with qualitative collection techniques. The editors and directors of the main journals positioned in the first ten places of the UCR index ranking (November 4th, 2019) were interviewed, a semi-structured interview was used with questions related to the identification of attitudes, skills, knowledge, training needs and the context in which they are developed, these represent the categories of analysis used for the processing of information. The main results shows that, training needs in topics related to the processes were highlighted, administrative issues related to journals, fundamentals of editorial management, technological tools and the positioning of journals; in addition, the short working hours that the editors of UCR magazines have were evidenced. It is concluded that it is imperative that the UCR meets these training needs, in addition to strengthening these means of disseminating knowledge and that the opportunity to offer a continuous training program or a specialty in editorial management be analyzed.

Educación Meditativa, una metodología para el autocuidado de académicos universitarios / Meditative Education, a Methodology for Self-care of University Scholars

Introducción: Dentro de la cultura organizacional, el profesor universitario es un agente clave para el logro de los aprendizajes, coordinando diariamente las solicitudes de las asignaturas y carrera, junto a las necesidades estudiantiles. Por esto, la docencia es una de las profesiones con mayor riesgo de padecer estrés, así como ansiedad y depresión. Con el objetivo de disminuir dichos factores se han creado programas para docentes con diversas actividades que promueven el autocuidado. Objetivo: Demostrar la efectividad del Programa de Educación Meditativa del Sistema Isha Judd en la disminución de los niveles de estrés, depresión y ansiedad de docentes de la Facultad de Ciencias de la Salud de la Universidad Autónoma de Chile. Métodos: Se desarrollaron 10 talleres presenciales dirigidos por facilitadores del Sistema ISHA Judd. Los inscritos se dividieron en tres grupos que sesionaron los lunes, en horarios diferidos (n = 22). Las reuniones fueron cada 15 días, cada sesión se dividió en seis momentos. En la primera y última sesión se realizaron Test Depresión y Ansiedad de Beck, Escala de Autoestima de Rossemberg, Escala de Estrés Percibido y encuesta de bienestar del Sistema Isha Judd. Resultados: El nivel de estrés del grupo bajó en 7,2 puntos pasando de moderado a bajo, el nivel de depresión bajó significativamente, al igual que los valores de ansiedad, llegando a leve y mínimo. El nivel de autoestima inicialmente estaba en el rango alto y al finalizar se mantuvo en el mismo rango, pero mejorando el puntaje promedio en 1,88. Conclusión: En aquellos docentes que cumplieron con los requerimientos mínimos del programa, esta metodología impactó positivamente en su satisfacción, mejorando en promedio sus niveles de estrés, ansiedad, depresión y autoestima. Este estudio presenta limitaciones por el número y tipo de muestra por lo que se sugiere realizar una segunda etapa(AU)

Introduction: Within the organizational culture, the university professor is a key agent for the achievement of learning, coordinating daily the requests of the subjects and majors, together with the students' needs. For this reason, teaching is one of the professions with the highest risk of experiencing stress, as well as anxiety and depression. In order to reduce these factors, programs have been created for teachers with various activities that promote self-care. Objective: To demonstrate the effectiveness of the Meditative Education Program of the Isha Judd System in reducing the levels of stress, depression and anxiety in teachers of the School of Health Sciences of the Universidad Autónoma de Chile. Methods: Ten face-to-face workshops were conducted by facilitators of the Isha Judd System. The participants were divided into three groups that met on Mondays, at different times (n = 22). The meetings were held every 15 days, each session was divided into six moments. In the first and last session, Beck's Depression and Anxiety Test, Rossemberg's Self-Esteem Scale, Perceived Stress Scale and the Isha Judd System wellbeing survey were applied. Results: The stress level of the group decreased by 7.2 points, going from moderate to low, the depression level decreased significantly, as did the anxiety values, reaching mild and minimal. The level of self-esteem was initially in the high range and at the end it remained in the same range, but the average score improved by 1.88 points. Conclusion: In those teachers who met the minimum requirements of the program, this methodology had a positive impact on their satisfaction, improving on average their levels of stress, anxiety, depression and self-esteem. This study has limitations due to the number and type of sample, so a second stage is suggested(AU)

Características Cognitivas e Comportamentais Associadas à Distrofia Muscular de Duchenne: Revisão Integrativa / Cognitive and Behavioral Characteristics Associated with Duchenne Muscular Dystrophy: Integrative Review / Características Cognitivas y de Comportamiento Asociadas con la Distrofia Muscular de Duchenne: Revisión Integrativa

A Distrofia Muscular de Duchenne (DMD) é uma doença neuromuscular progressiva recessiva causada por mutações genéticas ligadas ao cromossomo X. Além do enfraquecimento muscular progressivo, a condição é associada a alterações neuropsicológicas. O objetivo deste estudo foi realizar uma revisão sistematizada da temática, para investigar os aspectos cognitivos e comportamentais associados à DMD pela literatura, nos últimos dez anos (2011-2021). Realizou-se uma revisão integrativa da literatura, com o propósito de sintetizar e analisar o conhecimento sobre o tema no campo científico, sendo efetuada busca nas bases de dados e motores de busca Science Direct, SciELO, PubMed e BVS. Após consideração dos critérios de inclusão e exclusão, foram selecionados 29 artigos para análise. Os resultados endossaram que alterações cognitivas e do neurodesenvolvimento, bem como de problemas comportamentais parecem ser mais prováveis na DMD, em comparação com a população geral. Verificou-se escassez de estudos empíricos brasileiros e a necessidade de avaliar e intervir nos âmbitos neuropsicológico e psicossocial, de forma precoce, contínua e multidisciplinar, no intuito de atender às necessidades desse grupo.

Duchenne Muscular Dystrophy (DMD) is a recessive progressive neuromuscular disease caused by X-linked genetic mutations. In addition to progressive muscle weakness, the condition is associated with neuropsychological alterations. The aim of this study was to perform a systematic review about the theme, to investigate the cognitive and behavioral aspects associated with DMD in the literature, over the last ten years (2011-2021). An integrative literature review was carried out, with the purpose of synthesizing and analyzing the knowledge on the subject in the scientific field, with a search in the databases and search engines Science Direct, SciELO, PubMed and BVS. After considering the inclusion and exclusion criteria, 29 articles were selected for analysis. The results endorsed that cognitive and neurodevelopmental alterations and behavioral problems seem to be more likely in DMD, when compared to the general population. There was a lack of brazilian empirical studies and the need to assess and intervene in the neuropsychological and psychosocial spheres was observed, in an early, continuous and multidisciplinary way, in order to meet the needs of this group.

La distrofia muscular de Duchenne (DMD) es una enfermedad neuromuscular progresiva recesiva causada por mutaciones genéticas ligadas al cromosoma X. Además de la debilidad muscular progresiva, la afección se asocia con cambios neuropsicológicos. El objetivo de este estudio fue realizar una revisión sistemática del tema, para investigar los aspectos cognitivos y conductuales asociados a la DMD en la literatura, en los últimos diez años (2011-2021). Se realizó una revisión integradora de la literatura, con el propósito de sintetizar y analizar el conocimiento sobre el tema en el campo científico, mediante una búsqueda en las bases de datos y motores de búsqueda Science Direct, SciELO, PubMed y BVS. Después de considerar los criterios de inclusión y exclusión, se seleccionaron 29 artículos para su análisis. Los resultados respaldaron que alteraciones cognitivas y del neurodesarrollo, así como problemas del comportamiento parecen ser más probables en la DMD en comparación con la población general. Se observó la escasez de estudios empíricos brasileños, así como la necesidad de evaluar e intervenir en los ámbitos neuropsicológico y psicosocial, de forma precoz, continua y multidisciplinar, para atender las necesidades de esta población.

Impacto de los ejercicios físicos en la rehabilitación de pacientes con lesiones medulares cervical incompleta, en Guinea-Bissau

Las personas con lesiones de la médula espinal cervical tienen de dos a cinco veces más probabilidades de morir prematuramente, estas lesiones son una de las causas de muerte más frecuente en la población mundial independientemente de la religión, edad, raza, sexo, nacionalidad o clase social; las tasas de supervivencia más bajas, se encuentran en los países de ingresos bajos y medianos. En Guinea-Bissau, los pacientes desconocen su enfermedad y los beneficios de la actividad física para su tratamiento; por ello, se realizó un estudio con diez pacientes que asisten al área de Neuro-rehabilitación motora, Bissau, donde el objetivo fue: determinar el impacto de los ejercicios físicos en la rehabilitación de los pacientes con lesión medular cervical incompleta. Se utilizaron métodos de orden cualitativo (revisión documental) y cuantitativos (medición) y criterio de expertos que permitieron el estudio del objeto y la evaluación teórica y práctica de los ejercicios físicos, los que fueron validados por 17 expertos, entre los cuales el 95 % evaluaron los indicadores en adecuados y muy adecuados y se aplicó en la práctica a diez pacientes con resultados muy satisfactorios, lo que confirmó la pertinencia del estudio realizado. El 100 % de los participantes alcanzaron un nivel significativo en las actividades de la vida diaria, capacidades físicas y funcionales. Este estudio respondió a necesidades investigativas de la Universidad de Ciencias de la Cultura Física y el Deporte "Manuel Fajardo", de Cuba y al Centro de Neuro-Rehabilitación Físico Motor Sanca, de Guinea-Bissau.

SÍNTESE Pessoas com lesões da medula cervical têm duas a cinco vezes mais probabilidade de morrer prematuramente, essas lesões são uma das causas de morte mais freqüentes na população mundial, independentemente da religião, idade, raça, sexo, nacionalidade ou classe social; as mais baixas taxas de sobrevivência são encontradas em países de baixa e média renda. Na Guiné-Bissau, os pacientes desconhecem sua doença e os benefícios da atividade física para seu tratamento; portanto, foi realizado um estudo com dez pacientes que freqüentavam a área de neuro-reabilitação motora, Bissau, onde o objetivo era: determinar o impacto dos exercícios físicos na reabilitação de pacientes com lesão incompleta da medula cervical. Foram utilizados métodos qualitativos (revisão documental) e quantitativos (medição) e julgamento de especialistas para estudar o objeto e a avaliação teórica e prática dos exercícios físicos, que foram validados por 17 especialistas, 95% dos quais avaliaram os indicadores como adequados e muito adequados, e foram aplicados na prática a dez pacientes com resultados muito satisfatórios, confirmando a relevância do estudo realizado. 100% dos participantes atingiram um nível significativo nas atividades de vida diária, nas habilidades físicas e funcionais. Este estudo respondeu às necessidades de pesquisa da Universidade de Cultura Física e Ciências do Esporte "Manuel Fajardo", Cuba e do Centro de Reabilitação Neuro-Motora Sanca, Guiné-Bissau.

People with cervical spinal cord injuries are two to five times more likely to die prematurely, these injuries are one of the most frequent causes of death in the world population regardless of religion, age, race, sex, nationality or social class; the lowest survival rates are found in low- and middle-income countries. In Guinea-Bissau, patients are unaware of their illness and the benefits of physical activity for their treatment; for this reason, a study was carried out with ten patients who attend the area of Motor Neuro-rehabilitation, Bissau, where the objective was: to determine the impact of physical exercises on the rehabilitation of patients with incomplete cervical spinal cord injury. Qualitative (documentary review) and quantitative (measurement) and expert criteria methods were used, which allowed the study of the object and the theoretical and practical evaluation of the physical exercises, which were validated by 17 experts, among whom 95% they evaluated the indicators as adequate and very adequate and it was applied in practice to ten patients with very satisfactory results, which confirmed the relevance of the study carried out. 100% of the participants reached a significant level in activities of daily living, physical and functional capacities. This study responded to the research needs of the "Manuel Fajardo" University of Physical Culture and Sports Sciences, of Cuba and the Sanca Neuro - Physical Motor Rehabilitation Center, of Guinea-Bissau.

Developing Ice Cream for Mucositis Management and Improving the Nutritional Support for Pediatric Cancer Patients / Desenvolvimento de um Sorvete para Prevenção e Tratamento da Mucosite e Suporte Nutricional a Pacientes Pediátricos com Câncer / Desarrollo de Helados para el Manejo de la Mucositis y del Soporte Nutricional a Pacientes Pediátricos con Cáncer

Introduction: Mucositis is one of the main complications of cancer treatment, associated with several nutritional limitations and the ability to cause secondary infections. Cryotherapy is a low-cost treatment consistent with clinical practice guidelines for treating patients with mucositis. Objective: To develop and evaluate the acceptance of ice cream for the prevention and treatment of mucositis and nutritional support of pediatric cancer patients. Method: Based on knowledge about the side effects of chemotherapy (especially in oral and gastrointestinal mucositis) and the nutritional needs of pediatric cancer patients, a literature search for ingredients that could meet the study's objectives was undertaken. Food Technology Laboratory of the São Paulo State University (Unesp), Botucatu campus, and in partnership with Sorvetes Naturais ice cream shop in the municipality of Botucatu-SP, produced the ice cream. An acceptance test was applied in ten patients undergoing cancer treatment and 30 individuals in the control group using the 5-point mixed facial hedonic scale. Results: The final formula consisted of semi-skimmed lactose-free milk, extra virgin coconut oil, oat flour, honey, chamomile, Fortini food supplement, demerara sugar, and stabilizer/emulsifier. 90% of patients undergoing cancer treatment rated the final product as "liked" or "loved it," compared to 63% of the control group. Conclusion: Development of an ice cream that met the objectives of the study was possible through the choice of its composition. Honey and chamomile can favor the prevention of mucositis, and other ingredients offer the caloric density and protein supply.

Introdução: A mucosite é uma das principais complicações do tratamento oncológico, está associada a várias limitações nutricionais e é capaz de causar infecções secundárias. A crioterapia é uma forma de tratamento de baixo custo, consistente com as diretrizes de prática clínica para o cuidado de pacientes com mucosite. Objetivo: Desenvolver e avaliar a aceitação de um sorvete para prevenção e tratamento da mucosite e para suporte nutricional de pacientes pediátricos com câncer. Método: Baseado no conhecimento sobre os efeitos colaterais da quimioterapia (especialmente na mucosite oral e gastrointestinal) e nas necessidades nutricionais do paciente oncológico pediátrico, buscou-se, na literatura, por ingredientes que pudessem alcançar os objetivos do estudo. O sorvete foi produzido no Laboratório de Tecnologia de Alimentos da Universidade Estadual Paulista (Unesp), campus de Botucatu, e em parceria com a sorveteria Sorvetes Naturais no município de Botucatu-SP. Foi realizado teste de aceitação com dez pacientes em tratamento oncológico e com 30 indivíduos do grupo controle usando a escala hedônica facial mista de 5 pontos. Resultados: A fórmula final consistiu em leite sem lactose semidesnatado, óleo de coco extravirgem, farinha de aveia, mel, camomila, suplemento alimentar Fortini, açúcar demerara e estabilizante/emulsificante. Dos pacientes em tratamento oncológico, 90% classificaram o produto final em "gostei" ou "adorei", comparado com 63% do grupo controle. Conclusão: O desenvolvimento de um sorvete que alcançasse os objetivos do estudo foi possível por meio da escolha da sua composição. O mel e a camomila podem favorecer a prevenção da mucosite, e outros ingredientes oferecem densidade calórica e oferta proteica.

Introducción: La mucositis es una de las principales complicaciones del tratamiento del cáncer, asociada a varias limitaciones nutricionales y la capacidad de causar infecciones secundarias. La crioterapia es una forma de tratamiento de bajo costo consistente con las guías de práctica clínica para el cuidado de pacientes con mucositis. Objetivo: Desarrollar y evaluar la aceptación de un helado para la prevención y tratamiento de la mucositis y para el apoyo nutricional de pacientes pediátricos con cáncer. Método: Con base en el conocimiento sobre los efectos secundarios de la quimioterapia (especialmente en la mucositis oral y gastrointestinal) y las necesidades nutricionales de los pacientes con cáncer pediátrico, buscamos en la literatura ingredientes que pudieran lograr los objetivos del estudio. El helado fue producido en el Laboratorio de Tecnología de Alimentos de la Universidad Estatal de São Paulo (Unesp), campus de Botucatu y en sociedad con la heladería Sorvetes Naturais del municipio de Botucatu-SP. Se realizó una prueba de aceptación con diez pacientes en tratamiento oncológico y 30 individuos del grupo control utilizando la escala hedónica facial mixta de 5 puntos. Resultados: La fórmula final estuvo compuesta por leche semidesnatada sin lactosa, aceite de coco virgen extra, harina de avena, miel, manzanilla, complemento alimenticio Fortini, azúcar demerara y estabilizante/emulsionante. El 90% de los pacientes en tratamiento contra el cáncer calificaron el producto final como "me gustó" o "me encantó", en comparación con el 63% del grupo de control. Conclusión: El desarrollo de un helado que cumpliera con los objetivos del estudio fue posible a través de la elección de su composición. La miel y la manzanilla pueden favorecer la prevención de la mucositis y otros ingredientes ofrecen densidad calórica y aporte proteico.

Clinical efficacy and toxic effects of prophylactic cranial irradiation in non-small cell lung cancer: a meta-analysis / 中华放射肿瘤学杂志

Objective:To investigate the role of prophylactic cranial irradiation (PCI) in non-small cell lung cancer (NSCLC) by meta-analysis.Methods:Studies published from January 1, 1980 to August 30, 2021 were searched systematically in PubMed, Embase, Cochrane Systematic Review database and China National Knowledge Infrastructure Database. The searching keywords included "non-small cell lung cancer", "randomized controlled trial", "prophylactic cranial irradiation" and "clinical trial". The data extracted from the above studies were analyzed using Review Manager 5.3 and Stata 12.0 software. Outcomes included the development of brain metastases (BM), overall survival (OS), disease-free survival (DFS), toxicity, and quality of life (QoL).Results:Ten trials, including 2005 NSCLC patients, met the inclusion criteria. Patients who underwent PCI had a significantly lower risk of BM than those who did not ( OR=0.29, 95% CI: 0.22-0.40, P<0.001). Compared with non-PCI group, DFS in PCI group was significantly increased ( HR=0.75, 95% CI: 0.63-0.89, P=0.001). However, there was no significant difference in OS ( OR=0.90, 95% CI: 0.69-1.18, P=0.45). In addition, the incidence of fatigue was significantly increased in the PCI group ( OR=2.64, 95% CI: 1.58-4.40, P<0.001). There was no significant difference in cognitive impairment between the PCI and non-PCI groups ( OR=3.60, 95% CI: 0.97-13.32, P=0.06). Conclusions:PCI is the standard treatment for NSCLC. Compared with non-PCI, PCI significantly reduces the incidence of BM and prolongs the DFS of NSCLC patients. The effect of PCI-related toxicity on the QoL and long-term OS needs further study.

Pilot implementation of a community-based, eHealth-enabled service delivery model for newborn hearing screening and intervention in the Philippines

Objectives@#This study explores the potential of the HeLe Service Delivery Model, a community-based newborn hearing screening (NHS) program supported by a web-based referral system, in improving provision of hearing care services. @*Methods@#This prospective observational study evaluated the HeLe Service Delivery Model based on records review and user perspectives. We collected system usage logs from July to October 2018 and data on patient outcomes. Semi-structured interviews and review of field reports were conducted to identify implementation challenges and facilitating factors. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data, respectively. @*Results@#Six hundred ninety-two (692) babies were screened: 110 in the RHUs and 582 in the Category A NHS hospital. Mean age at screening was 1.4±1.05 months for those screened in the RHU and 0.46±0.74 month for those in the Category A site. 47.3% of babies screened at the RHU were ≤1 month old in contrast to 86.6% in the Category A hospital. A total of 10 babies (1.4%) received a positive NHS result. Eight of these ten patients were referred via the NHS Appointment and Referral System; seven were confirmed to have bilateral profound hearing loss, while one patient missed his confirmatory testing appointment. The average wait time between screening and confirmatory testing was 17.1±14.5 days. Facilitating factors for NHS implementation include the presence of champions, early technology adopters, legislations, and capacity-building programs. Challenges identified include perceived inconvenience in using information systems, cost concerns for the patients, costly hearing screening equipment, and unstable internet connectivity. The lack of nearby facilities providing NHS diagnostic and intervention services remains a major block in ensuring early diagnosis and management of hearing loss in the community. @*Conclusion@#The eHealth-enabled HeLe Service Delivery Model for NHS is promising. It addresses the challenges and needs of community-based NHS by establishing a healthcare provider network for NHS in the locale, providing a capacity-building program to train NHS screeners, and deploying health information systems that allows for documentation, web-based referral and tracking of NHS patients. The model has the potential to be implemented on a larger scale — a deliberate step towards universal hearing health for all Filipinos.

Characteristics of Early Onset Dementia and Caring Experiences and Service Needs of Family Caregivers: A Mixed Methods Study / 정신간호학회지

Purpose@#The purpose of this mixed methods study was to explore the caring experiences of the family caregivers of patients with early-onset dementia, and identify the characteristics of early-onset dementia. @*Methods@#A qualitative study was conducted using Colaizzi‘s phenomenological method to explore the caring experiences and service needs of ten family caregivers. A quantitative study was carried out by secondary data analysis to compare the differences in disease characteristics and comorbidities between early and late-onset dementia. @*Results@#The experiences of the family caregivers of patients with early-onset dementia were ‘Learning about dementia’, ‘Away from everyday life’, ‘Facing dementia’, and ‘Barely managing’. The study also revealed that one out of five dementia patients had early-onset dementia. However, most dementia services are concentrated on late-onset dementia. Thus, the family and caregivers of early-onset dementia patients experience relatively inadequate services. @*Conclusion@#This study’s findings identified the characteristics of early-onset dementia, as well as the caring experiences and service needs of family caregivers from a more holistic perspective, and will contribute to the development of adequate nursing intervention programs and policies in the future.

Advances in research on mechanism of lactate dehydrogenase B in tumors / 中国药科大学学报

@#Increased glycolysis is a major feature of metabolic reprogramming in cancer.Glycolysis provides not only energy for cancer cells but also necessary precursors for biosynthesis, which is important for promoting tumor growth.Cancer cells meet their own needs by regulating glycolytic enzymes, which play an active role in promoting cancer survival, metastasis, and invasion.Lactate dehydrogenase (LDH), as a key enzyme in glycolysis, consists of two subunits: lactate dehydrogenase A (LDHA) and lactate dehydrogenase B (LDHB).LDHA is known to play a key role in aerobic glycolysis and has been extensively studied, whereas less has been done on LDHB.However, at present, more and more reports have revealed the important effects of LDHB on the progression of various cancers.A large number of studies have shown that LDHB is abnormally expressed in a variety of cancers, which is related to the malignant progression of tumors.The article reviews the research progress of LDHB in recent ten years, including its regulatory mechanism in tumor, its relationship with cancer development and its role as a biomarker in clinical diagnosis of cancer, which provides some insight for further investigation of the mechanism of LDHB in cancer research.

Memoirs of yesterday: The lived experience of individuals with separated parents

@#Separation issues have been rampant, and a significant rise in union dissolution cases in the Philippines has been observed. This certain occurrence should be given particular attention because it may alter the individual's way of living, particularly in perceiving and dealing with relationships. This study explores the lived experience of individuals who have undergone parental separation. The study utilized a Hermeneutic Phenomenological Design, which involved ten (10) respondents using a semi-structured key informant interview guide. The respondents were selected based on criteria as follows: (1) Have parents who have decided on the dissolution of marriage (annulled or informal) living separately; (2) 18 years of age and above; (3) Residents of Central Visayas; permanent or transient in Cebu City and; (4) Able to understand and express ideas in Cebuano dialect or English language. An Interpretative Phenomenological Analysis anchored on van Manen's six-step interpretive phenomenological approach with management and analysis done manually created a poem titled “Memoirs of Yesterday,” which incorporates three (3) major themes: (1) Into the Tunnel: Etiology of Separation, (2) The Darkness in the Tunnel: effects of the dissolution of marriage to children- emotional, psychological and academic status and (3) The Light After the Tunnel: attitude of the child and parent towards relationships and separation. The study implies that nurses should recognize the importance of assessing family concerns in rendering holistic and individualized client care. Thus, nurses should use assessed needs in advocating for the creation of more programs on awareness and counseling to families and, most especially, children.

Needs assessment for establishment of telepathology in the Philippines

Objective@#The Philippines has more than a hundred ten million population with a very limited number of general pathologists and subspecialist pathologists. Consultation of pathologists with other pathologists is important to ensure accurate results for difficult cases. However, pathologists are not always accessible to review slides. Telepathology can provide access to other pathologists by sending microscopic images through the internet. This study explores the needs of pathologists for consultation in their practice that may be aided by telepathology. The status of current pathology practice and subspecialty consultations across the different regions in the Philippines were determined and the readiness of pathologists for telepathology was identified.@*Methodology@# This is a cross-sectional descriptive study using an 18-item online survey questionnaire based on the World Health Organization guidelines on needs assessment for medical devices. The survey was distributed among anatomic pathologists practicing in the Philippines.@*Results@#One hundred forty (140) pathologists responded and were included in this study. 5-10% of cases of respondents required subspecialty referral. Diagnostically challenging cases and confirmation of malignancy are the most common reasons for consultation. Respondents practicing outside the National Capital Region (NCR) have fewer subspecialist pathologists available for referrals within their region. Turnaround times for signing out challenging cases are longer outside NCR (>7 days) compared to NCR (4-7 days). Most respondents have access to the basic equipment to perform telepathology, which includes, an internet link, a smartphone with high-resolution camera and a computer. Almost all respondents will use telepathology if it is available.@*Conclusion@#A hub-and-spoke telepathology network can provide access to subspecialty consultation to reduce the diagnostic turnaround time and to increase the accuracy of results for challenging cases. The availability of the minimum telepathology infrastructure and the positive attitude of the pathologists towards telepathology may be indicators of readiness for a local telepathology system in the Philippines.

Brain-computer interface technology for stroke in the past decade: a visualized analysis / 中国康复理论与实践

ObjectiveTo conduct a visualized analysis of the research related to the use of brain-computer interface technology for stroke rehabilitation in the past ten years, and identify and predict the hot spots and hot trends in order to promote the further development of this field. MethodsThe Web of Science Core Collection database was searched for literature related to brain-computer interface technology for stroke rehabilitation from January, 2011 to October, 2022. CiteSpace 5.8.R3 was used to analyze the number of publications, countries, institutions, authors, keywords, co-citations, and grant support. Results and ConclusionA total of 592 papers were included, and the annual number of publications in this field of research showed a rapid growth trend, and the research enthusiasm continued to increase. The United States was in the leading position in this field, with the highest number of cooperative publications and the highest intermediary centrality; China had certain advantages in this field, but still needed to strengthen the exchange and cooperation with other countries/regions. Foreign institutions and authors had formed a network of close cooperative relationships, and formed a high-impact team represented by Niels Birbaumer, Cuntai Guan, Kai Keng Ang, etc.; there were poor cooperative relationships among domestic authors and institutions, and there were geographical restrictions and lack of high-impact academic groups. The keywords "motor imagery" and "recovery" formed ten major clusters and 15 prominent words with high variation rates, showing a trend of diversification in research directions. The study of the efficacy of upper limb motor rehabilitation and central mechanisms has been the hot topics in this field and will continue for some time in the future; the use of lower limb brain-computer interface systems for improving foot drop, gait and balance in stroke patients and the application of multimodal brain-computer interfaces will probably become a hot topic in the future. Finally, the use of brain-computer interface-guided neurofeedback training for cognitive and language rehabilitation in stroke also needs attention.

Local muscle load and fatigue of simulated high-voltage cable climbing task of operation inspection personnel by surface electromyography / 环境与职业医学

Background Climbing pylons during high-voltage cable maintenance is not only a labor-intensive task, but also a challenge bringing about heat stress and mental pressure from working at height, which may lead to accumulation of muscle fatigue and work-related musculoskeletal disorders. Objective To record the local muscle fatigue during a simulated climbing task by high-voltage cable electricians based on surface electromyography (sEMG) signals, explore the characteristic changes in sEMG signals and their relationship with subjective fatigue evaluation of the task, and provide data support for developing task specific objective assessment tools for local muscle fatigue and prevention of work-related musculoskeletal disorders. Methods Ten male college students were recruited to conduct a test of a simulated pylon climbing task. The climbing distance was 60 m, and a task segment was set for every 20 m (about 100 s), recorded as T1, T2, and T3, respectively. After completing each task segment, the subjects were required to rate their subjective fatigue using the Borg's RPE Scale. Fatigue was defined by rating of perceived exertion (RPE) score ≥ 14 in this study. The sEMG signals of trapezius, erector spinae, rectus femoris, and gastrocnemius muscles were recorded wirelessly. The standardized maximal voluntary electrical activation (MVE) obtained by standardizing the root mean square (RMS) of the time domain index and the median frequency (MF) of the frequency domain index were estimated for the recorded sEMG signals, and joint amplitude and spectrum analysis (JASA) was used to evaluate local muscle fatigue of target muscles involving in the climbing task. Results The RPE scores of T1, T2, and T3 were 11.9, 15.3, and 17.4, respectively. Subjective fatigue was found in T2 and T3 but not in T1. With the extension of climbing time, the MVE values of left and right erector spinae muscles, left and right rectus femoris, and right gastrocnemius muscle increased gradually, while the MVE values of left and right trapezius muscles and left gastrocnemius muscle increased first and then decreased. The MF values of left and right rectus femoris increased at first, then remained unchanged, while the MF values of the other muscles remained basically unchanged. In T1, three muscles, including left trapezius muscle and both side of erector spinae muscles, showed fatigue; in T2, five muscles, including both sides of erector spina muscles, right trapezius muscle, and both sides of gastrocnemius muscle appeared fatigue; in T3 , except for left rectus femoris, the other seven muscles were fatigue. Conclusion The characteristic changes of electromyography signals in the simulated climbing task are not completely consistent with the typical amplitude increase and left shift of the frequency spectrum of sEMG signals in static tasks, indicating that the application of time-domain and frequency-domain analysis methods in the evaluation of muscle fatigue in climbing tasks needs further discussion. Trapezius muscles and erector spinae muscles are the first to show fatigue in the simulation, and may be the sensitive muscle groups of muscle fatigue associated with climbing movement. Compared with subjective evaluation, surface electromyography is more sensitive in the assessment of body fatigue. Fatigue is reported about 100 s of climbing (the climbing length is about 20 m).

Crianças hospitalizadas com necessidades de saúde especiais complexas: estudo de casos múltiplos / Infantes hospitalizados con necesidades de salud especiales complejas: estudio de casos múltiples / Hospitalized children with complex special healthcare needs: multiple case studies

Resumo Objetivo Descrever os casos clinicamente complexos de crianças com necessidades de saúde especiais em hospitalização contínua e analisar a natureza das demandas de cuidados clinicamente complexos durante a hospitalização. Métodos Estudo de casos múltiplos de três crianças clinicamente complexas hospitalizadas. A coleta de dados ocorreu, entre janeiro e março de 2020, em prontuário, na observação de cuidados e interação espontânea registrada em diário de campo e entrevista. Participaram sete pessoas, sendo dois familiares, três técnicos de enfermagem e duas enfermeiras. Aplicou-se a análise temática, orientando-se pela tipologia de demandas de cuidados de crianças com necessidades de saúde especiais e classificação de Collière. Resultados Os casos de meninas e menino, com três, dez e 11 anos de idade, e tempo de internação de 4 meses a 6 anos, geraram linhas de convergências com as demandas de cuidados de crianças com necessidades de saúde especiais, proporcionando sobrevivência, bem-estar e conforto. Desses casos extraíram-se demandas contínuas e complexas de cuidados de estimulação, apaziguamento, confortação e parecer convergentes com o de desenvolvimento e habituais modificados (banho, arrumar-se, alimentação e mobilidade); os cuidados de compensação, no manejo de tecnologias corporais e a administração de medicamentos de uso contínuo, convergiram para demandas de cuidados tecnológicos e medicamentosos Conclusão A necessidade de sobrevivência, determinada pela natureza clinicamente complexa da criança, direciona a prioridade dos cuidados no uso contínuo de múltiplos medicamentos e manejo de tecnologias, na segurança do ambiente hospitalar. Embora essenciais, precisa-se contemplar as outras demandas de cuidados de desenvolvimento e social integrando-as às clinicamente complexas.

Resumen Objetivo Describir los casos clínicamente complejos de infantes con necesidades de salud especiales en hospitalización continua y analizar la naturaleza de las demandas de cuidados clínicamente complejos durante la hospitalización. Métodos Estudio de casos múltiples de tres infantes hospitalizados clínicamente complejos. La recopilación de datos se realizó de enero a marzo de 2020, en la historia clínica, en la observación de cuidados e interacción espontánea registrada en un diario de campo y en entrevista. Participaron siete personas, de las cuales dos eran familiares, tres técnicos de enfermería y dos enfermeras. Se aplicó el análisis temático, orientándose por la tipología de demandas de cuidados de infantes con necesidades de salud especiales y clasificación de Collière. Resultados Los casos de las niñas y el niño, de 3, 10 y 11 años, entre 4 meses y 6 años de tiempo de internación, generaron líneas convergentes con las demandas de cuidados de infantes con necesidades de salud especiales, donde se proporciona supervivencia, bienestar y consuelo. De estos casos se observaron demandas continuas y complejas de cuidados de estimulación, apaciguamiento, consuelo y opinión convergentes con los del desarrollo y los habituales modificados (baño, arreglarse, alimentación y movilidad); los cuidados de compensación, con el manejo de tecnologías corporales y la administración de medicamentos de uso continuo, convergieron en las demandas de cuidados tecnológicos y medicamentosos. Conclusión La necesidad de supervivencia, determinada por la naturaleza clínicamente compleja del infante, direcciona la prioridad de los cuidados en el uso continuo de múltiples medicamentos y en el manejo de tecnologías para la seguridad del ambiente hospitalario. Aunque sean esenciales, es necesario contemplar otras demandas de cuidados de desarrollo y sociales e integrarlas a las clínicamente complejas.

Abstract Objective To describe the medically complex cases of children with special healthcare needs in continuous hospitalization and to analyze the nature of medically complex care demands during hospitalization. Methods This is a multiple case study of three hospitalized medically complex children. Data collection occurred between January and March 2020 in the medical records in the observation of care and spontaneous interaction documented in a fieldwork note and interview. Seven people participated, two family members, three nursing technicians, and two nurses. Thematic analysis was applied, guided by the typologies of Collière's care and the demands of children with special healthcare needs. Results The cases included girls and a boy aged three, ten, and 11 years, and hospitalization time from 4 months to 6 years. They all generated lines of convergence with the care demands of children with special healthcare needs, providing survival, well-being, and comfort. These cases extracted continuous and complex care demands of stimulation, pacification, and comfort; and seemed convergent with developmental and modified daily life activities (bath, grooming, feed, and mobility) care. Compensating care in managing bodily technologies and administering continuous-use medication converged with demands for technological and medication care. Conclusion The need for survival, determined by children's medically complex nature, directs the priority of care to the continuous use of multiple medications, the management of technologies, and the safety of hospital environments. Although essential, it is necessary to consider the other developmental and social care demands, integrating them with the medically complex ones.