Clinical Implications of the Interdisciplinary Psychosocial Approach and Integrative Care for Patients with Advanced Cancer and Family Members in the Nutritional Support and Cancer Cachexia Clinic

Food and eating are of great significance to humans, as we are the only creatures that establish relationships and sustain a social network through food and eating. Recent studies revealed that patients with advanced cancer and their family members often experience complicated eating-related distress due to tumors themselves, side effects of cancer treatments, and negative impacts of cancer cachexia. Therefore, we suggested the importance of the integration of palliative, supportive, and nutritional care to alleviate eating-related distress among patients and family members, and the significance of the development of tools to measure their distress in supportive and palliative care settings. No care strategies for eating-related distress experienced by patients and family members have been established, and the development of an interdisciplinary psychosocial approach and integrative care is required. As such, we are planning to start a nutritional support and cancer cachexia clinic in the National Cancer Center, and disseminate a newly developed care program across Japan.

Specificity of HTLV screening tests and its impact on health care program costs: The perspective of antenatal screening in Brazil

Abstract INTRODUCTION: Brazil ranks first in the number of HTLV-1/-2-infected individuals worldwide. The high morbidity and mortality of HTLV-1-associated diseases, especially following infection in infancy, requires strong action to reduce vertical transmission. METHODS: To facilitate the appraisal of the implementation of the HTLV antenatal screening program by the Brazilian Ministry of Health, we determined the costs in distinct scenarios according to HTLV seroprevalence, specificity of the screening test, and type of confirmatory test. RESULTS: HTLV antenatal screening would cost R$ 55,777,012-R$ 77,082,123/year. Screening assays with high specificity reduce the need and cost of confirmatory assays by up to 25%. CONCLUSIONS: Careful selection of the screening assay is required to optimize the program.

Sistema Automatizado para seguimiento y control de la embarazada / Automated system for the follow-up and control of the pregnant woman

Introducción: La más elevada organización del trabajo, imprescindible para el desarrollo, solo es posible lograrla con la introducción de técnicas de ordenamiento automatizado que permitan la eficiencia necesaria en el manejo de grandes volúmenes de información. Objetivo: Realizar una propuesta de sistema automatizado para el control y seguimiento de la embarazada del Programa de Atención Materno Infantil. Material y Métodos: Se realizó una investigación de innovación tecnológica, consistente en el diseño de un sistema automatizado para el control y seguimiento de la embarazada. Se realizó además un análisis de las herramientas computacionales disponibles para la realización del sistema y determinar cuál o cuáles eran las más apropiadas de acuerdo con el objetivo del sistema y las características del personal encargado de su implementación y uso. Se utilizaron las herramientas para tabulación de información y fórmulas que ofrece el programa Excel del paquete Microsoft Office 2013. Para el diseño se utilizó una interface muy simple, de fácil manejo por el posible usuario. Resultados: Se propone el presente sistema cuya característica principal es la simplicidad de su uso. El mismo contribuye a organizar y facilitar el procesamiento de la información para el control y seguimiento de la embarazada a nivel del área de salud. Conclusiones: Se realiza la propuesta del sistema automatizado, el cual facilita el control y seguimiento de la embarazada a nivel del área de salud(AU)

Introduction: The highest work organization, which is indispensable for development, is only achieved with the introduction of automated techniques that allow the necessary efficiency in the management of high volumes of information. Objective: To make a proposal of an automated system for the control and follow-up of the pregnant woman of the Maternal-Infantile Care Program. Material and Methods: A technological innovation research, which consisted on the design of an automated system for the control and follow-up of the pregnant woman was conducted. Also, an analysis of the computing tools available for the implementation of the system was carried out, as well as a study of the appropriate ones in accordance with the system objective, and the characteristics of the staff in charge of its implementation and use. Information and tabulation tools and formulas that the Microsoft Excel 2013 offers, were used. A very simple interphase, quite user-friendly and easy handling, was used for the design. Results: The present system is proposed; whose main characteristic is the simplicity of its use. It contributes to organize and facilitate the information processing for the control and follow-up of the pregnant woman in the health care area. Conclusions: The proposal of the automated system that facilitates the control and follow-up of the pregnant woman in the health care area is analyzed(AU)

The effect of aspirin and clopidogrel combined antiplatelet therapy combined with emergency rescue nursing program in patients with acute myocardial infarction / 中国生化药物杂志

Objective To observe and explore the pre hospital dual antiplatelet therapy combined with emergency rescue nursing application effect in patients with acute myocardial infarction. Methods 70 cases of patients with acute myocardial infarction in our hospital and treated from April 2014 to April 2017 as the research object, randomly divided into control group and observation group, 35 cases in each group. the control group of patients first aid given aspirin 300mg, clopidogrel 600mg chewing and routine emergency care procedures for emergency patients in the observation group were given aspirin 300mg and clopidogrel 600 mg chawing simultaneously gives the optimization of emergency nursing procedure, and comparative analysis of two groups of patients. Results There were statistically significant differences of the duration of rescue, the time of emergency balloon dilatation, the time of access to the emergency room and the number of hospital stay between the observation group and control group (P<0.05); the success rate of rescue (97.14％) in the observation group was statistically significant (P <0.05) compared with the control group (80.00％, P<0.05); there was a significant difference in the recurrence rate (2.86％) between the observation group and the control group (17.14％, P<0.05); there was significant difference in nursing satisfaction (97.14％) between the observation group and the control group (77.14％, P<0.05). Conclusion The better implementation of hospital patients with acute myocardial infarction before dual antiplatelet therapy combined with emergency care program.

Atendimento psicológico domiciliar no contexto do envelhecimento: um olhar sob a perspectiva sistêmica / Residential psychological treatment in the context of the elderly: a look from a systemic perspective

O número de pessoas idosas, na população brasileira, tem apresentado crescimento expressivo, demandando a criação e expansão de serviços em saúde que contemplem as mudanças deste momento de vida. Este estudo objetiva descrever o processo de atendimento psicológico domiciliar no contexto do envelhecimento sob a perspectiva sistêmica. Para tanto, foi realizada uma descrição do Programa de Atendimento Domiciliar de um plano de saúde. Os resultados contemplam o processo de atendimento psicológico, o encaminhamento para a psicoterapia, a construção da demanda e identificação dos personagens envolvidos no processo psicoterapêutico. Dentre os envolvidos no atendimento psicológico no contexto do envelhecimento, destaca-se o paciente e aqueles presentes nos seus cuidados, como os familiares e cuidadores-domésticos. Elementos do ambiente domiciliar também integram o atendimento psicológico, discutidos nas suas especificidades e significados para os sujeitos envolvidos. Desafios quanto ao setting e ética do profissional podem ser melhor desenvolvidos, adequando a tal modelo de assistência. Por fim, destaca-se a profícua relevância da expansão da atuação do psicólogo para a esfera domiciliar, de modo a integrar as diferentes esferas de relações do paciente, promovendo uma assistência em saúde ainda mais concisa e abrangente.

The number of elderly people in Brazil has been increasing, requiring the creation and expansion of health services that address the changes happening on this moment of life. The aim of this study is to describe the process of a residential psychological treatment in the context of the elderly from a systemic perspective. To that end, it is provideda description of a Home Care Program from a Health Service. The results include the description of the processof the residential psychological treatment, the referral to psychotherapy, the construction of the demand, and the identification of the characters involved in the psychotherapeutic process. Among those involved in the psychological treatment in the context of the elderly, it is highlighted the patient and those responsible for their care, such as family and home carers. Elements of the residential environment are also a part of the psychological treatment, discussedin its specificities and significance to the subjects involved. Challenges regarding the settings and the ethics of the professional can be better developed, adapting to the home care program. Finally, it highlights the important relevance of the expansion of the function of the psychologist to the home care program, in order to integrate differents pheres of patients’ relationships, promoting a concise and comprehensive assistance.

El riesgo preconcepcional y su vínculo con la salud materna / The preconception risk and its link with maternal health

Introducción: la prevención de la enfermedad y la muerte durante el proceso de reproducción es uno de los pilares fundamentales para el desarrollo de la salud reproductiva, donde el riesgo preconcepcional tiene importancia medular por su relación con la mortalidad materna e infantil. Objetivo: mostrar los principales hallazgos sobre la relación entre el riego preconcepcional y la mortalidad materna e infantil. Métodos: se realizó una revisión bibliográfica entre los años 2010 - 2015 a publicaciones relacionadas con el tema objeto de estudio en las siguientes bases de datos: Medline, EMBASE, Current Contents, Science Citation Index, todas en español. Conclusiones: un adecuado control y manejo del riesgo preconcepcional permite determinar y evaluar la morbilidad de cada paciente y su estado de salud para asumir un embarazo con resultados satisfactorios. Se evidencia la relación existente entre el riesgo preconcepcional en mujeres en edad fértil y la presencia de complicaciones de diferente tipo en la madre y el niño, muchas de las cuales ocasionan la pérdida de uno de los dos. Se enfatiza en la necesidad de fortalecer todas las acciones de salud de carácter preventivo que ayuden a la mujer a enfrentar la maternidad en mejores condiciones(AU)

Introduction: Prevention of illness and death during reproduction is one of the fundamental pillars for the development of reproductive health, where the preconception risk has central importance due to its relation to maternal and infant mortality. Objective: Show the main findings on the relationship between preconception risk and maternal and infant mortality. Methods: A literature review was conducted between the years 2010 - 2015 to publications related to the topic under study in the following databases: Medline, EMBASE, Current Contents, Science Citation Index, all in Spanish. Conclusions: Proper preconceptional control and risk management allow to determine and evaluate the morbidity of each patient and their health to take a pregnancy with satisfactory results. The relationship between preconception risks in women of childbearing age and the presence of different types of complications in mother and child is evidenced, many of which cause the loss of one of them. The need to strengthen all actions of preventive health to help women cope with motherhood in better condition is emphasized(AU)

O envelhecimento e a qualidade de vida: a influência das experiências individuais / Aging and quality of life: the influence of individual experiences / El envejecimiento y la calidad de vida: la influencia de las experiencias individuales

O objetivo do estudo foi compreender o significado do envelhecimento com qualidade de vida (QV), a partir das vivências e experiências de idosos. Trata-se de um estudo exploratório, quanti-qualitativo, que permitiu compreender o significado do envelhecimento e da QV dos idosos. Foram aplicados 173 questionários com idosos que recebem visitas domiciliares dos líderes da Pastoral da Pessoa Idosa, sendo 79% do sexo feminino (n=138). O estudo evidenciou o envelhecimento e a qualidade de vida como algo subjetivo, o modo de andar a vida que determina as experiências individuais de cada ser, para um viver saudável. Cabe à sociedade valorizar o idoso e incentivar a sua participação social, uma vez que, quando o idoso é ativo e co-partícipe do seu processo saúde/doença, ele é visto como um idoso sábio, um exemplo para a sociedade.

The objective of the study was to understand the meaning of aging with quality of life (QOL), from the experiences and experiences of older people. This is an exploratory study, quantitative and qualitative that allows us to understand the meaning of aging and QOL of the elderly. 173 questionnaires were administered to elderly people receiving home visits from leaders of the Pastoral Care of the Elderly, 79% female (n = 138). The study showed the aging and quality of life as something subjective, the way of living life that determines the individual experiences of each being for a healthy living. It is up to society to value the aged and to promote their social participation, since, when the elderly are active and co-sharer of your health / disease process, it is seen as a wise old, an example for society.

El objetivo del estudio fue comprender el significado de envejecimiento con calidad de vida (QOL), a partir de las vivencias y experiencias de las personas mayores. Se trata de un estudio exploratorio, cuantitativo y cualitativo, que nos permite entender el significado de la vejez y la calidad de vida de las personas mayores. 173 cuestionarios fueron administrados a las personas mayores que reciben visitas a domicilio de los líderes de la Pastoral de las Personas de Edad, 79% mujeres (n = 138). El estudio mostró que el envejecimiento y la calidad de vida como algo subjetivo, la manera de vivir la vida que determina las experiencias individuales de cada ser para una vida saludable. Corresponde a la sociedad a valorar la edad y promover su participación social, ya que, cuando los mayores son activos y co-partícipe de su proceso de salud / enfermedad, que es visto como un viejo sabio, un ejemplo para la sociedad.

Experience of nurses in combined care program of traditional Chinese medicine:a qualitative research / 中国实用护理杂志

Objective To describe the experience of nurses in combined care program of traditional Chinese medicine (TCM) and provide references for nursing managers. Methods The phenomenology research method was adopted in this study. Fourteen nurses who had achieved the combined care program of TCM participated in an in-depth interview. Data were analyzed by using phenomenological analysis. Results All nurses approved nursing program of TCM: finding sense of belonging in nursing work;demonstration of self-value;standardization of nursing tednnique;harmonious environmont of nursing work. But some defect still existed: too subjective evaluation item of nursing program of TCM;inappropriate evaluation table;lact of hospital characteristics of TCM nursing;deficiency of TCM knowledge. Conclusion Nursing managers should pay more attention to nurses' emotional experience, grasp the implementation of the problems during the program and improve the program, optimize the skills, provide trainings.

Población infanto-juvenil alojada en hogares de la Ciudad Autónoma de Buenos Aires que transitó por un programa de atención comunitaria durante 2010 / Children and youth population living in institutions in Buenos Aires City and covered by a community care program in 2010

INTRODUCCIÓN: los niños y adolescentes institucionalizados representan un grupo vulnerable. Es importante conocer su situación y necesidades específicas, así como losrecursos requeridos para su adecuada atención. OBJETIVOS: Explorar las características y la trayectoria institucional de los niños y adolescentes institucionalizados en hogares convivenciales, terapéuticos y maternales de la Ciudad Autónoma de Buenos Aires (CABA). Explorar el abordaje que recibieron desde el campode la salud mental, en particular en el Programa de Atención Comunitaria (PAC) durante 2010. MÉTODOS: Se utilizó un diseño descriptivo-exploratorio de tipo cualitativo. Se analizaron variables vinculadas a la trayectoria institucional y al abordaje recibido desde el campo de la salud mental, a partir de la exploración de lashistorias clínicas y de entrevistas semiestructuradas a trabajadores de hogares. RESULTADOS: Se analizaron 29 casos de niños y adolescentes alojados en hogares de CABA. El estudio evidenció prolongados períodos de permanencia, insuficiencia de recursos para la adecuada atención, obstáculos para la inserción social/comunitaria, dificultades en el trabajo de vinculación familiar y en el logro del egreso, situaciones de tensión y conflicto entre las diversas instituciones intervinientes y barreras de accesibilidad a los servicios de salud mental, pero un abordaje eficaz en el PAC. CONCLUSIONES: La restitución de los derechos vulnerados es una cuenta pendiente. Es indispensable adecuar las prácticas a la legislación local y a los postulados de la Convención sobre los Derechos del Niño. También resulta prioritario capacitar al recurso humano que asiste a esta población.

INTRODUCTION: children and adolescents living in institutions represent a vulnerable group. It is important to know their situation and specific needs, as well as theresources required for a proper care. OBJECTIVES: To explore the characteristics and institutional path of children and adolescents living in cohabiting, therapeutic and maternalhomes in Buenos Aires city. To explore the approach they received from the field of mental health particularly in theCommunity Care Program (CCP) in 2010. METHODS: A qualitative, descriptive and exploratory design was used, with an intentional non-probabilistic sample. The institutionaltrajectory and the approach received from the field of mental health were analyzed by exploring medical records and conducting semi-structured interviews to workers homes. RESULTS: A total of 29 cases of children and adolescents living in Buenos Aires Dwelling Homes were analyzed. The study showed long periods of institutionalization, insufficient resources for the proper care, obstacles for social/communityintegration, difficulties regarding family bonds and exit from the institution, tension and conflicts between institutions involved, and barriers to mental health services, but an efficient approach in the CCP. CONCLUSIONS: The restitution of violated rights is still an ongoing issue. Practices should be established according to local law and to the principles set forth by the Convention on the Rights of the Child. Thetraining of human resources devoted to this population is also a priority.

One-year outcomes and reasons for dropout in participants of the continuous dental care program of the Community Child Center in Gangnueng city / 대한구강보건학회지

OBJECTIVES: This study aimed to determine the effectiveness of the continuous dental care program of the Community Child Center in Gangneung city by evaluating one-year outcomes and determining the reasons for dropout. METHODS: A total of 180 children in the study group were provided with continuous dental care in 2008. The control group consisted of 131 children whose 2009 dental records from Gangneung-Wonju National University Dental Hospital were retrospectively reviewed. The outcome of dental caries prevention was evaluated by prevalence rates and number of decayed teeth. The evaluation of dental care outcome was based on cost and frequency of dental care. A chi-square test and Mann-Whitney U test were used to assess differences between the study group and the control group. In addition, the dropout rate and the reasons for dropout by the time of dental service supply were investigated for 427 children who participated in this program in 2010. RESULTS: Dental caries prevention results of the study group were better than those of the control group, but significant differences were found only in the dt rates of girls (P<0.001). The average frequency of dental care per child in the study group was lower than that of the control group. The average cost of dental care per child was 56,910 won per boy in the study group, 124,893 won per boy in the control group, 71,657 won per girl in the study group, and 127,296 won per girl in the control group. Significant differences in dental care results were found for both boys and girls (P<0.05). The reasons for dropout were leaving the center, absence, use of another dental clinic, parents' or child's rejection of the program, and disability. CONCLUSIONS: On the basis of these results, we could logically assume that promoting oral health and reducing the cost of dental care might be achieved through the introduction of a continuous dental care program for vulnerable children and adolescents in the community.

Comprehensive dental health care program at an orphanage in Nellore district of Andhra Pradesh.

Background: Provision of oral health care in India, especially for the underprivileged is limited due to inadequate finances and manpower. Resources of dental colleges in such a scenario can be utilized to provide prevention oriented oral health care. Aim: To improve the oral health status of children at an institute in Nellore district of Andhra Pradesh, India, through prevention based comprehensive dental health care program (CDHP). Design and Setting: A longitudinal institution based interventional study conducted among the primary grade children (n=162). Materials and Methods: Baseline data collection included (i) basic demographic data (ii) body mass index (BMI) (iii) assessment of the dentition status and treatment needs according to WHO 1997 criteria. The CDHP included group based dental health education, professional oral prophylaxis, weekly (0.2%) sodium fluoride mouth rinse program, biannual application of topical fluoride (1.23% APF), pit and fissure sealants for all first permanent molars and provision of all necessary curative services. Results: Mean treatment requirements per child decreased at 18 months. New caries lesions developed among four children. BMI of children with decay was seen to improve significantly after instituting the CDHP. Conclusion: CDHP is effective in overall improvement of general and oral health. In resource limited countries like India, such programs organized by dental schools can improve oral health.

Grupo com agentes comunitárias: a construção de novas possibilidades do cuidar / Groups with health community agents: from helplessness to the construction of new healthcare possibilities / Grupo con agentes comunitarias: la construcción de nuevas posibilidades del cuidar

O Programa de Saúde da Família (PSF) é uma estratégia política adotada pelo Ministério da Saúde para promover a transformação do modelo tradicional de cuidados com a saúde na atenção básica. A figura do agente comunitário de saúde (ACS) tem papel fundamental no PSF por ser o principal elo entre a unidade de saúde e a comunidade. A partir do estágio supervisionado em Psicologia Comunitária do Curso de Psicologia da Universidade São Francisco, foi realizado um grupo com os ACSs de uma unidade de PSF de um Município do interior de São Paulo. A proposta do grupo era discutir o trabalho realizado na unidade de saúde, buscando fomentar uma postura protagonista no enfrentamento das dificuldades cotidianas. Para tanto, utilizou-se o referencial dos grupos operativos tal como postulado por Enrique Pichon-Rivière, tendo sido observada, ao longo do processo, uma vivência de grande desamparo por parte das agentes. Essa questão foi abordada a partir de diversas atividades e estratégias de modo a fortalecer os vínculos grupais. Ao final deste trabalho, os ACSs podiam ocupar um lugar de maior propriedade com relação ao trabalho realizado no território...

The Family Health Program (FHP), is a political strategy adopted by the Health Ministry to promote the transformation of the traditional basic healthcare. The health community agent (HCA) has a key role in the FHP being the main link between the healthcare unit and the community. With a supervised internship in Community Psychology from the Psychology Course at São Francisco University, a group was formed with HCAs from the FHP unit of a city in the state of São Paulo. The objective of the group was to debate the work done at the health unit, seeking to establish a leading posture in facing daily difficulties. For such, the operative groups postulated by Enrique Pichon-Rivière were used as reference, and it was observed, throughout the process, great helplessness on most of the agents. This issue was approached using several activities and strategies to strengthen group bonding. At the end of this research, the HCA could fulfill a role with greater responsibility in relation to the work done in the area...

El programa de Salud de la Familia (PSF) es una estrategia política adoptada por el Ministerio de Salud para promover la transformación del modelo tradicional de cuidados con la salud en la atención básica. La figura del agente comunitario de salud (ACS) tiene papel fundamental en el PSF por ser el principal enlace entre la unidad de salud y la comunidad. A partir de la pasantía supervisada en Psicología Comunitaria del Curso de Psicología de la Universidad de San Francisco, se ha conformado un grupo con los ACSs de una unidad de PSF de un municipio del interior de San Pablo. La propuesta del grupo era la de discutir el trabajo llevado a cabo en la unidad de salud, objetivando fomentar una postura protagonista en el enfrentamiento de las dificultades cotidianas. Para tanto, se ha utilizado el referencial de los grupos operativos con arreglo a lo postulado por Enrique Pichon-Rivière, habiendo sido observada, a lo largo del proceso, una vivencia de gran desamparo por parte de las agentes. Esa cuestión ha sido abordada a partir de diversas actividades y estrategias de modo a fortalecer los vínculos grupales. Al final de este trabajo, los ACSs podían ocupar un lugar de mayor propiedad con relación al trabajo llevado a cabo en el territorio...

Comparación de los costos reales anuales asociados al manejo ambulatorio de pacientes hipertensos del programa cardiovascular en el Hospital Comunitario de Bulnes con el pago de prestaciones de Fonasa / Cost of ambulatory care of hypertensive subjects in a community hospital (bulnes): comparison of activity associated costs to the national health fund (fonasa) estimated payments in the setting of a national cardiovascular care program

Antecedentes: El financiamiento de las prestaciones entregadas a los usuarios de atención primaria portadores de Hipertensión Arterial, esta determinado por un arancel definido por el Fondo Nacional de Salud (FONASA), el cual ha estimado montos a pagar a la institución prestadora, basados en estudios realizados a nivel nacional, los cuales difieren de las estimaciones de gasto real de cada prestación, para lo cual se hace necesario objetivar dicha diferencia de estimación a nivel local. Objetivo: Determinar los costos directos e indirectos reales de las prestaciones entregadas a los usuarios hipertensos de control ambulatorio en atención primaria de salud mediante la metodología de costos asociados a actividades (ABC), para compararlos con los valores asignados por FONASA. Diseño: Estudio Analítico no experimental de enfoque cuantitativo de corte transversal, en que se revisaron 290 tarjetas de control de usuarios hipertensos bajo control en el Hospital Comunitario de Salud Familiar de Bul-nes. Se analizaron específicamente los valores del control Médico, control Enfermera, control Nutricionista, y valores de exámenes: hematocrito, perfil lipídico, glicemia, creatinina plasmática, orina completa, potasio plasmático, electrocardiograma, atención farmacéutica. Resultados: Los costos reales de las prestaciones incluidas en la Guía Clínica GES para el manejo ambulatorio de la Hipertensión Arterial, obtenidos mediante el uso de la metodología ABC fueron significativamente mayores a los establecidos por el FONASA (promedio miles de pesos: Fonasa 21.370; Costo real 39.991,7 +/- 11.999,4; p <0,001). Conclusión: Estos resultados sugieren que existe una diferencia entre lo que FONASA cancela por estas prestaciones y el gasto real en que se incurre por su atención. Si estos valores se acercan, podría obtenerse un mejor financiamiento del programa.

Background: Payments for ambulatory care of hypertensive patients in the national cardiovascular program is defined by FONASA based on national studies. Considerable differences are observed upon confrontation with the real costs involved in a given place. Aim: to determine direct and indirect costs of health care actions in the ambulatory care of hypertensive patients through an activity based cost (ABC) methodology and to compare these with the corresponding payments defined by FONASA Method: In a cross sectional design, 290 records of hypertensive subjects under control at the Community Hospital in Bulnes were analyzed. Costs of doctor, nurse and nutritionist controls were determined along with those related to laboratory tests including hematocrit, lipid profile, glycemia, plasma creatinine, urine analysis, plasma K level and electrocardiogram. Cost of pharmacy was also included. Results: a monthly mean of $ 39 992 +/- 12 000 per hypertensive patient cared was determined through ABC based costs. This is considerable greater than de $ 21 370 determined by FONASA (p<0.001). Conclusion: Payments considered by FONASA are insufficient to cover real costs involved in ambulatory care of hypertensive patients. A better financing of the cardiovascular care program requires these costs and payments to converge.

A atenção domiciliar em saúde mental realizada por estagiários de Psicologia no Programa de Intensificação de Cuidados / Home care in mental health held by Psychology trainees in the Care Intensification Program / La atención domiciliaria en salud mental realizada por practicantes de Psicología dentro del Programa de Intensificación de Cuidados

Este estudo investiga a atenção domiciliar, tomando o domicílio como lócus de cuidado de pessoas com transtorno mental, na perspectiva dos familiares acompanhados por estagiários de Psicologia do Programa de Intensificação de Cuidados (PIC). Trata‑se de pesquisa qualitativa com desenho de estudo de caso, que ainda considera o domicílio como encontro dos saberes técnico‑científicos e familiares, centro de tensões e dinâmicas vinculares. Realizaram‑se entrevistas semi estruturadas com familiares assistidos em 2010, para avaliar o PIC, e análise do prontuário do paciente para contextualizar o atendimento entre 2004 e 2008. Conclui‑se que os entrevistados reconheceram o PIC como uma possibilidade exitosa de cuidado em saúde mental, no processo de desinstitucionalização da loucura, por apontar diversos ganhos para o paciente e para sua família. A atenção domiciliar e as tecnologias empregadas pelo PIC são reconhecidas como promotoras da autonomia do usuário, o que resulta na ampliação da sua rede de cuidado ao ser inserido no Centro de Atenção Psicossocial (Caps).

This study investigates home care, taking the household as the locus of care for people with a mental disorder, in the perspective of the family members followed by Psychology trainees of the Care Intensification Program (PIC). It is a qualitative research with a case study design which also considers home as a meeting of the technical‑scientific knowledge with the family knowledge, a center of tensions and bonding dynamics. Semi‑structured interviews were held with the family members assisted in 2010, in order to assess PIC, and the analysis of the patient's medical records to contextualize the assistance service between 2004 and 2008. One concludes the interviewees acknowledge PIC as a successful possibility of care in mental health, in the process of deinstitutionalization of madness, because as it points out many benefits, both for the patients and their families. The home care and the technologies employed by PIC are acknowledged as providers of client's autonomy, resulting in an expansion of their care network, when they get into the Psychosocial Care Center (Caps).

Este estudio investiga la atención domiciliaria, tomando el domicilio como lugar de atención de personas con trastorno mental, según perspectiva de los familiares acompañados por practicantes de Psicología del Programa de Intensificación de Cuidados (PIC). Es una investigación cualitativa con diseño de estudio de caso, que también considera el domicilio como encuentro de saberes técnico‑científicos y familiares, centro de tensiones y dinámicas vinculares. Se efectuaron entrevistas semi‑estructuradas con familiares asistidos en 2010, para evaluar el PIC y el análisis del prontuario del paciente para contextualizar el atendimiento entre 2004‑2008. Se concluye que los entrevistados reconocieron el PIC como una posibilidad exitosa del cuidado de la salud mental en el proceso de desinstitucionalización de la locura, señalando muchos beneficios para el paciente y su familia. La atención domiciliaria y las tecnologías empleadas por el PIC son reconocidas como promotoras de la autonomía del paciente, lo que resulta en la expansión de su red de atención al inserirse en el Centro de Atención Psicosocial (Caps).

A construção do cuidado pela equipe de saúde e o cuidador em um programa de atenção domiciliar ao acamado em Porto Alegre (RS, Brasil) / The construction of care by the health team and the caretaker within a home-care program for bedridden patients in Porto Alegre (RS, Brazil)

Este artigo é um estudo de caso cujo objetivo principal foi compreender a construção do cuidado no Programa de Atendimento Domiciliar ao Acamado (PADA) de uma unidade básica de saúde (UBS) em Porto Alegre, RS. Os dados foram obtidos em 13 grupos de cuidadores na UBS e em observação participante registrada em diário de campo nos domicílios. Foi realizada análise das práticas discursivas, inspirada nos conceitos de discurso de Foucault e nos estudos sobre ética e cuidado de si. No transcurso dos grupos, os cuidadores ocuparam um espaço que chamamos metaforicamente de Oráculo de Delfos, lócus de acolhimento, escuta e de suporte. Escutar os diálogos travados entre equipe e cuidadores defrontou-nos com a contradição presente no discurso institucional que ao mesmo tempo que estimula o cuidado de si impõe normas, deveres e fazeres. O cuidado como direito de cidadania em contraposição ao cuidado como submissão e assujeitamento tensionou o grupo em vários momentos. A noção foucaultiana de cuidado compreende uma síntese entre o exercício de uma pessoa sobre ela mesma, tornando-a melhor como ser humano e, ao mesmo tempo, capacitando-a a se tornar melhor como cidadão.

The main objective of this case study was to understand the construction of care in the Homecare Program for Bedridden Patients (PADA) of a basic health unit (UBS) in Porto Alegre, RS. Data were obtained from 13 caretaker groups in the UBS, and participating observation recorded in field diary in the patient's homes. An analysis of the discourse practices was performed inspired in Foucault's discourse concepts speeches and in studies on ethics and self-care. In the groups, the caretaker occupied a space that we metaphorically called the Delphic Oracle, a place for acceptance, listening and support. Hearing the dialogues that took place between the team and the caretakers made us face the contradiction present in the institutional discourse, which both stimulates self-care, and imposes rules, duties, tasks. Care as a citizenship right opposite to care as submission and subjugation created tension inside the group several times. Foucault's notion of care comprises a synthesis of the exercise of a person over his- or herself, making him or her better as a human being and, at the same time, capacitating him or her to become a better citizen.

Prevention and Education for Diabetic Foot / 임상당뇨병

Diabetic foot ulceration, which can result in amputations of the lower extremities and death, is a major complication for people with diabetes mellitus. Comprehensive foot care programs based on the International Consensus on the Diabetic Foot 2007, including regular inspections and examination of the foot at risk, identification of the foot at risk, education of patient, family and healthcare provider, recommendations of appropriate footwear, and treatment of non-ulcerative pathologies, can reduce the occurrence of foot lesions in up to 50% of patients. The objective of this overview is to discuss how to prevent diabetic foot, and educate patients with diabetic foot.

Informações em saúde: o uso do SIAB pelos profissionais das Equipes de Saúde da Família / Información en salud: el uso del SIAB por los profesionales de los Equipos de Salud de la Familia / Information in health care: the use of SIAB by the professional teams of family health

A expansão acentuada das equipes da Estratégia Saúde da Família e a discussão das questões relacionadas ao montante de dados coletados impulsionaram a necessidade da criação de um sistema de informação que contemplasse a complexidade da organização da atenção básica. Para isto, em 1998 foi criado o Sistema de Informação da Atenção Básica (SIAB). Esta pesquisa teve como objetivo investigar o uso do SIAB pelos profissionais de Equipes de Saúde da Família. Foi aplicado um questionário a 75 profissionais de 10 equipes que foram observadas por uma semana de março a junho de 2008. Constatou-se que as Equipes de Saúde da Família que participaram do estudo não têm utilizado as informações obtidas com o SIAB para planejamento e avaliação das ações desenvolvidas, perdendo desta forma a oportunidade de utilizar as informações para intervenção baseada nas necessidades locais.

La expansión acentuada del Programa Salud de la Familia, la discusión de las cuestiones relacionadas al montante de datos recogidos impulsaron la necesidad de la creación de un sistema de información que obsequiase la complejidad de la organización de la atención básica. Para esto, en 1998 fue creado el Sistema de Información de la Atención Básica (SIAB). Esta investigación tuvo como objetivo averiguar el uso del SIAB por los profesionales de los Equipos de Salud de la Familia. Fue aplicado un cuestionario a 75 profesionales de 10 equipos, además de eso, estos equipos fueron observados por el período de cinco semanas. Se constata que los equipos que participaron del estudio no han utilizado tales informaciones, perdiendo de esta forma la oportunidad de utilización de las informaciones para una atención vuelta para las necesidades locales.

The remarkable expansion of Family Health Care Program and the discussion of issues related to the amount of the collected data stimulated the need for designing an information system that embraced the complex organization of basic health care. So, in 1998, the Basic Health Care Information System (SIAB) was founded. This research aimed at investigating the use of SIAB by the professional teams of the Family Health Care. A questionnaire was applied to 75 professionals belonging to 10 teams. Besides, of these teams were observed, one week each. It showed as evidence that the Family Health Care teams that participated in this research have not used the available information for planning or assessing their health care services, and so, they have missed the opportunity of using the available information for health care local needs.

Atendimento às pessoas em situação de violência o lugar e as práticas do psicólogo em programas da região metropolitana de Vitória/ES / Assistance to people in violence situation: the position and practices of psychologists in programs of the metropolitan region of Vitoria/ES

A violência torna-se crescente foco de políticas públicas. Diversos programas no país buscam criar medidas preventivas e atender às pessoas em situação de violência. Entrevistamos individualmente 15 profissionais de 12 programas da Região Metropolitana de Vitória/ES, objetivando conhecer o funcionamento destes e compreender o papel e a atuação do psicólogo. Realizamos Análise de Conteúdo, com apoio do software QRS-N6, e discutimos aqui duas das três categorias identificadas: Características dos programas e Atuação do Psicólogo. Percebemos a prevalência do atendimento a vítimas de violência e a existência de uma rede de atuação em crescente organização, carente de investimento financeiro, pessoal e treinamento específico. Observou-se uma conquista gradual e valorização de espaço do psicólogo. Os relatos das psicólogas são discutidos considerando-se a formação em Psicologia, dado que revela a necessidade de uma capacitação teórico-técnica possível de ser adequada a práticas profissionais voltadas às demandas sociais e que permita a inserção de fato dessas profissionais nesse campo de atuação.

Violence has become a growing focus of public politics. Various services in the country try to create preventive measures and assist people in situation of violence. In this research we individually interviewed 15 professionals of 12 services of the Metropolitan Region of Vitória/ES, having as a goal to get to know how these services work as well as to understand the psychologists’ role and practice. A Content Analysis of the data was made by using software QRS-N6 and two out of the three identified categories are here discussed: Characteristics of the services; and Psychologist’s practice. We noticed the prevalence of the assistance to victims of violence and the existence of an increasing action network, in need of financial, personnel and specific training investments. A gradual achievement and valorization of the psychologist’s role were observed. Psychologists' reports are discussed considering the formation in psychology, which reveals the need for theoretical-technical training capable of being suited to professional practices focused on social needs and that allows genuine insertion of these professionals in this field of action.

Utilização de medicamentos e risco de interações medicamentosas em idosos atendidos pelo Programa de Atenção ao Idoso da Unijuí / Use of medications and risk of drug interactions in the elderly population at the Elderly Care Program in Unijuí

Idosos utilizam elevado número de medicamentos, apresentando alto potencial para desenvolver interações medicamentosas. Objetivou-se verificar o perfil de utilização de medicamentos e conhecer possíveis interações medicamentosas em idosos acompanhados pelo Programa de Atenção ao Idoso (PAI) da Unijuí. Os dados foram coletados em julho de 2009. Classificaramse os medicamentos no sistema Anatomical Therapeutic Chemical e possibilidades de interações segundo Drug Interaction Facts. De março/2008 até julho/2009 o PAI atendeu 31 idosos, estando 16 em acompanhamento, os quais apresentaram média de 78,4 ± 6,8 anos e utilizaram 83 medicamentos, com média de 5,2 ± 3,7/ idoso. Os fármacos mais prevalentes foram os que atuam no aparelho cardiovascular, no sistema nervoso e para o trato alimentar e metabolismo. Verificaram-se 36 possíveis interações entre 9 pacientes, com média de 4/idoso. O fármaco mais envolvido foi digoxina. Quanto a classificação, 4 apresentaram nível de significância 1, dez nível 2, cinco nível 3, sete nível 4 e dez nível 5. O número de possíveis interações verificadas foi expressivo, entretanto nem todos os idosos apresentarão reações relacionadas às interações, mas apresentaram o risco. Portanto, é importante que prescritores conheçam a influência de um fármaco sobre outro. Seria necessário treinamento intensivo para intervenção farmacêutica, sendo o relacionamento com o médico indispensável.

Elderly people take a large number of medicines, entailing a high risk of developing drug interactions. The aim was to study the profile of medicines prescribed and the possible drug interactions in the public Elderly Care Program (PAI) run at Unijuí, a university in south Brazil. The data were collected in July 2009. The Anatomical Therapeutic Chemical (ATC) Classification System was used to classify medicines, while the potential interactions were classified with the aid of Drug Interaction Facts. Between March 2008 and July 2008, the PAI attended 31 elderly patients, of whom 16 were monitored, with a mean age of 78.4 ± 6.8 years. This group received 83 medicines, making an average of 5.2 ± 3.7 medicines/patient. The most prevalent drugs were those acting on the cardiovascular system, nervous system, digestive tract and metabolism. There were 36 possible interactions in 9 patients, an average of 4 interactions per patient. The drug most frequently involved was digoxin. The interactions were classified as follows: 4 at level 1, 10 at level 2, 5 at level 3, 7 at level 4 and 10 at level 5. This number of possible interactions is considerable; although not all elderly patients show the effects of the drug interactions, they do run the risk. Therefore, it is highly important that prescribers are familiar with the drug interactions. For the pharmacist to help the patient, intensive training for pharmaceutical intervention and a good relationship with the doctor are indispensable.

Pertenecer a algo mayor: experiencias de pacientes y cuidadores durante el cuidado paliativo en Chile / Belonging to something greater: experiences of patients and caregivers enrolled in palliative care services in Chile

Estudio cualitativo realizado a fin de comprender el significado de las experiencias de los pacientes y los que les brindan cuidados durante el período que permanecen en el Programa de Cuidados Paliativos, así como las diferentes maneras de enfrentar su enfermedad terminal en Chile. Los resultados de este estudio señalan la importancia de encontrar un refugio, de lo contrario es o será difícil enfrentar las cosas; tal situación fue denominada "pertenecer a algo mayor". Estos resultados tienen implicancias hacia las áreas de investigación, práctica y para la elaboración de políticas públicas. Este estudio puede servir como motivación para futuras investigaciones que puedan enfocarse en áreas relacionadas con el tratamiento paliativo y el aspecto psicosocial del paciente y/o familia.

The goal of this qualitative study was to understand the meaning of the experiences of patients and their caregivers enrolled in palliative care and facing a terminal illness in Chile. Two focus groups were conducted to understand the patients' experiences and the caregivers' experiences. Results point to the importance of finding a sense of refuge in order to cope with a terminal illness. The overarching theme of this study "belonging to something greater" emerged from the participants' experiences. The findings provide guidance to focus on further research, practice, and policy efforts in the area of palliative care in Chile. This study may serve as motivation to enhance research studies focusing on different bio-psychosocial aspects of palliative care and how these factors influence patients and/or families.