ABSTRACT
INTRODUCCIÓN: La institucionalización de niños, niñas y adolescentes (NNA) es una medida frecuente en el país, pese a que la evidencia es contundente en señalar las graves consecuencias a nivel global en NNA bajo este régimen de cuidado, destacando el rezago en el desarrollo y problemas de salud mental. En este escenario, los enfermeros(as) de los equipos de Salud Mental comunitaria participan en su tratamiento y rehabilitación. OBJETIVO: Develar la gestión del cuidado en el trabajo con NNA pertenecientes a residencias Mejor Niñez, adscritos a Centros de Salud Mental, con enfoque comunitario. METODOLOGÍA: Se trabaja bajo el paradigma cualitativo, con análisis de contenido, en una población de enfermeros(as) adscritos a centros de Salud Mental, seleccionados por muestreo deliberado. Investigación autorizada por el Comité Ético-Científico de Valdivia (Chile). RESULTADOS: Se obtuvieron dos metacategorías: La gestión del cuidado de enfermeros(as) de Salud Mental en NNA institucionalizados(as), que engloba el actuar de enfermería según las realidades locales, y las brechas y nodos de las residencias Mejor Niñez: Crisis de reparación, que incluye narrativas de dilemas éticos y de coordinación. CONCLUSIONES: Existen falencias respecto del bienestar y seguridad de los niños(as) institucionalizados(as), lo cual puede generar consecuencias nocivas en el proceso de reparación. Se sugiere la incorporación de enfermeros(as) al staff de hogares institucionales, así como el empleo de protocolos de acción para el abordaje de enfermería en salud mental dirigido a esta población.
INTRODUCTION: Institutionalization of children and adolescents (NNA) is a frequent measure in the country, though the evidence is conclusive identifying the serious consequences at a general level in children and adolescents under this care regime, especially in evelopmental problems and terms of mental health conditions. In this scenario, nurses from community mental health teams participate in the treatment and rehabilitation of these users. The purpose is to generate knowledge about care management and the challenges related to this context. METHODOLOGY: The population consisted of nurses from Mental Health centers in the South of Chile, selected by means of a non-probabilistic deliberate sampling and snowball technique. This research was authorized by the Valdivia's Ethical-Scientific Committee(Chile). RESULTS: Two meta-categories were obtained: The care management of Mental Health nurses for institutionalized children and adolescents, which includes nursing actions according to the realities of each locality; and the second meta-category is called "Mejor Niñez" residencies Gaps and nodes: Crisis of reparation, which includes accounts of ethical and coordination dilemmas. CONCLUSIONES: There are still flaws regarding the safety and well-being of institutionalized children, which may generate harmful consequences in the reparation process. The incorporation of nurses to the staff of institutional homes is suggested, as well as the use of action protocols for the mental healthnursingapproach aimed at this population.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Psychiatric Nursing , Public Health , Community Mental Health Services , Primary Health Care , Chile , Human RightsABSTRACT
OBJECTIVE: The aim of this study was to determine the association between previously documented risk factors such as recurrent pyelonephritis with the incidence of renal scarring after acute pyelonephritis in children. MATERIAL AND METHODS: Children with acute pyelonephritis who were admitted to the Department of Pediatrics of a teaching hospital during 2007-2009 were enrolled in this study. DMSA scans were obtained 4-6 months after the last episode of pyelonephritis in all patients. RESULTS: A total of 80 children with acute pyelonephritis were enrolled in this study. Most of them were girls (77.5 percent), with a median age of 12 months. Nearly half of the children (n = 44; 55 percent) had one or more renal scars. The distribution of gender, CRP level and leukocytosis did not differ significantly regardingthe absence or presence of renal scars (p > 0.05). Most of the scars occurred in children who had presented with bilateral pyelonephritis (69.4 percent vs. 18.2 percent, p = 0.001). Most of the patients with renal scars had a positive history of vesicoureteral reflux (VUR) (75 percent vs.13.6 percent, p = 0.001). The significant roles of recurrent pyelonephritis and presence of VUR were further confirmed by multivariate analysis. CONCLUSIONS: According to our findings, presence of VUR and recurrent pyelonephritis are independently associated with a higher incidence of renal scarring.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Cicatrix/etiology , Kidney , Pyelonephritis/complications , Acute Disease , Cicatrix , Kidney , Prospective Studies , Pyelonephritis , Recurrence , Risk Factors , RadiopharmaceuticalsABSTRACT
OBJETIVO: Descrever as características clínicas e oftalmológicas encontrados em indivíduos institucionalizados, com necessidades especiais no estado de Pernambuco. MÉTODOS: Realizou-se projeto multidisciplinar em 37 pacientes, com necessidades especiais, institucionalizados na Comunidade Rodolfo Aureliano (CRAUR), unidade da Fundação da Criança e do Adolescente (FUNDAC) em Recife-PE. A faixa etária dos indivíduos institucionalizados variou de seis a 30 anos, média de 18,8 ± 5,1 anos. O sexo masculino foi mais prevalente com 35 indivíduos (94,5 por cento). Consideraram-se como indivíduos institucionalizados, aqueles que vivem abrigados em instituições mantidas pelo Estado. Foi feito estudo de corte transversal, verificando-se os principais achados clínicos e oftalmológicos destes indivíduos. Realizou-se o exame oftalmológico completo nos casos, com boa colaboração e de acordo com protocolo pré-estabelecido. RESULTADOS: Uso de álcool na gravidez foi relatado por nove mães (24,3 por cento). Verificou-se a presença de retardo mental grave em 22 casos (59,4 por cento), paralisia cerebral e epilepsia em sete (18,9 por cento) indivíduos cada. Foi possível a realização do exame oftalmológico completo em 24 indivíduos (64,8 por cento). Detectou-se cegueira legal em dez casos (41,6 por cento). Os diagnósticos oftalmológicos mais encontrados foram ambliopia, erro refracional e phthisis bulbi em três casos (12,5 por cento) cada. Estrabismo foi encontrado em dois casos (8,3 por cento). CONCLUSÃO: Os achados oftalmológicos revelaram a importância do exame oftalmológico em indivíduos com necessidades especiais institucionalizados. A associação com múltiplas deficiências, tais como: doenças neuropsiquiátricas, contribuiu para o maior grau de dificuldade na avaliação e condução dos casos.
PURPOSE: To describe the main clinical and visual findings in special needs subjects institutionalized in Pernambuco State. METHODS: Thirty seven subjects with special needs, institutionalized in Rodolfo Aureliano Community (CRAUR), from Children and Adolescent Foundation (FUNDAC), in Recife PE, were evaluated by a multidiscipline team. The subjects aged 6 to 30 years, with mean of 18.8±5.1 years. Most of them were boys (94.5 percent). Institutionalized individuals were considered when they lived in institutions maintained by the State. It was made a cross-sectional study, verifying the main clinical and ophthalmic findings of these individuals. It was performed a complete ophthalmic examination in cases with good cooperation in accordance with pre-established protocol. RESULTS: Alcohol use in pregnancy was reported by nine mothers (24.3 percent). Severe mental retardation was seen in 22 subjects (59.4 percent), cerebral palsy and epilepsy in 7 (18.9 percent) subjects each. It was possible to perform the complete ophthalmic examination in 24 subjects (64.8 percent). Legal blindness was detected in 10 cases (41.6 percent). Main ophthalmologic findings found were amblyopia, refractive error and phthisis bulbi in 3 cases (12.5 percent) each. Strabismus was seen in two cases (8.3 percent). CONCLUSION: The ophthalmological findings detected revealed the importance of ophthalmic examination in institutionalized individuals with special needs. The association with multiple disabilities such as neuropsychiatric diseases contributed to the greatest degree of difficulty in the evaluation and conduct of cases.