Infections in Children with Cancer Admitted in an Oncology Reference Hospital: A Cross-sectional Study.

Pediatric oncology patients are usually immunosuppressed due to factors such as the neoplasm and its treatment, making them more susceptible to infections. This article aims to determine the infection profile of pediatric oncology patients admitted to an oncology reference hospital in Natal, Rio Grande do Norte, Brazil. A retrospective and cross-sectional study was conducted, collecting data from patients hospitalized due to infection in a pediatric oncology unit exclusively for the Brazilian public health system, spanning from 2018 to 2021. A total of 168 episodes of infections were identified in 96 patients, resulting in 157 hospitalizations. Among the patients with infections, 62.4% had hematological malignancies, and out of these cases, 74.6% specifically had Acute Lymphoid Leukemia. The Escherichia coli (31.9%) was the most prevalent microorganism isolated from the samples. Multidrug-resistant microorganisms accounted for 52% of all identified microorganisms. Fluoroquinolones and beta-lactam were the most prevalent antibiotic classes in the analyzed antibiograms. Factors such as Sex, type of cancer, chemotherapy in the last 30 days, were found to be associated with the occurrence of infection (p < 0.05). Conducting epidemiological studies regarding infections in pediatric oncology is crucial to development of empirical protocols, and the implementation of strategies to better control future infections.

Human tumor necrosis factor alpha affects the egg-laying dynamics and glucose metabolism of Schistosoma mansoni adult worms in vitro.

Several studies have described the effects of human tumor necrosis factor alpha (hTNF-α) on Schistosoma mansoni. hTNF-α affects the worm's development, metabolism, egg-laying, gene expression and protein phosphorylation. The available data on the influence of hTNF-α on egg-laying in S. mansoni are controversial, but understanding the mechanism of egg-laying regulation in this species is essential in combating schistosomiasis. We characterized the effects of in vitro treatment of S. mansoni adult worms with different doses of hTNF-α (5, 20 and 40 ng/ml) for 5 days. We explored the effects on egg-laying rate, glucose levels, ATP metabolism, and messenger RNA (mRNA) expression levels of lactate dehydrogenase, glucose transporters and the parasite gene which acts as an hTNF-α receptor, SmTNFR. hTNF-α influenced egg-laying in a time- and dose-dependent manner: at a dose of 40 ng/ml, egg-laying increased on day 2 and decreased on days 3 and 4; at 20 ng/ml, egg-laying decreased on day 3; while at 5 ng/ml, egg-laying decreased on day 4. The total number of eggs produced was not affected by the different treatments, but the egg-laying dynamics were: the median egg-laying time decreased significantly with treatment, and egg developmental stages and size were also affected. At 5 and 20 ng/ml hTNF-α, lactate production diminished on day 3 up to day 5, while glucose uptake increased on day 5. At 40 ng/ml, glucose uptake diminished on day 1 up to day 3, while ATP accumulation was detected on day 5. No significant changes in mRNA expression were detected in any of the treatments. We found that crosstalk involving hTNF-α and parasite signaling plays a role in the fine-scale regulation of the worm's metabolism and physiology, and points to new strategies for disease control.

In vitro antileishmanial activity of sustainable anacardic acid and cardol based silver nanoparticles on L. braziliensis.

The search for effective and less toxic drugs for the treatment of Cutaneous Leishmaniasis (CL) is desirable due to the emergence of resistant parasites. The present study shows the preparation, characterization and in vitro antileishmanial activity of green-based silver nanoparticles (AgNPs) with Cashew Nutshell Liquid (CNSL, main constituents: anacardic acid (AA) and cardol (CD). The synthesis of silver nanoparticles was achieved by reduction with sodium borohydride in the presence of anacardic acid or cardol under microwave irradiation (400 W, 60 °C, 5 min) resulting in AgAA and AgCD. In vitro assay showed opposite effects for AgAA and AgCD. While AgAA is highly toxic to macrophages (CC50 = 6.910 µg mL-1) and almost non-toxic for L.braziliensis (IC50 = 86.61 µg mL-1), AgCD results very selective toward killing the parasite (CC50 = 195.0 µg mL-1, IC50 = 11.54 µg mL-1). AA's higher polarity and conical shape easily promote cell lysis by increasing cell permeability, while CD has a protective effect: for that reason, AA and AgAA were not further used for tests. CD (EC50 = 2.906 µg mL-1) had higher ability to kill intracellular amastigotes than AgCD (EC50 = 16.00 µg mL-1), however, less intact cells were seen on isolated CD tests. In addition, considering that NO is one of the critical molecular species for the intracellular control of Leishmania, we used Griess colorimetric test to analyze the effect of treatment with AgCD and CD. Overall, the in vitro antileishmanial tests indicate that AgCD should be further explored as a promising non-toxic treatment for CL.

Photodynamic effect of palladium porphyrin derived from cashew nut shell liquid against promastigote forms of Leishmania braziliensis.

Cutaneous leishmaniasis (CL) is a neglected tropical disease (NTD), endemic mainly in low-income countries that lack adequate basic health care. The emergence of resistant parasites to pentavalent antimonials has led to the search for new treatments for CL. Photodynamic therapy (PDT) is a promising non-invasive and less toxic alternative for the treatment of CL. The present work describes the synthesis, characterization and photodynamic effect against CL of a new metalloporphyrin Pd (II) meso-tetra[4-(2-(3-n-pentadecylphenoxy)ethoxy]phenylporphyrin (PdP) derived from the cashew nut shell liquid (CNSL). The PdP complex presented a singlet oxygen quantum yield of 0.49, favoring a type II photochemical reaction. The results of the photodynamic experiment carried out with PdP on the promastigote forms of Leishmania braziliensis indicated a mortality percentage of 70 % of the cells when compared to the control after exposure to blue light (λ = 420 nm). Besides this, the metalloporphyrin PdP did not show considerable toxicity to macrophages, indicating the cell viability of the compound. Therefore, this metalloporphyrin derived from biomass represents an interesting alternative as a potential therapeutic drug for the treatment of CL through PDT, especially for patients with intolerance to the chemotherapeutic drugs currently available.

[Anesthesia for a cesarean section on a pregnant patient with Cockayne syndrome: case report]. / Anestesia para cesárea em gestante com síndrome de Cockayne: relato de caso.

Cockayne syndrome is an autosomal recessive multi-systemic disorder due to DNA repair failure. It was originally described in 1936 in children of small stature, retinal atrophy and deafness, characterized by dwarfism, cachexia, photosensitivity, premature aging and neurologic deficits. The most typical feature is described as birdlike facies: protruding maxilla, facial lipoatrophy, sunken eyes, large ears and thin nose. Difficult airway management with subglottic stenosis and risk of gastric content aspiration has been described. Although the clinical characteristics of Cockayne syndrome have been well described in pediatric publications, there is only one report in the literature on anesthesia for an obstetric patient. We report the case of a pregnant patient diagnosed with Cockayne syndrome, submitted successfully to spinal anesthesia for a cesarean section due to cephalopelvic disproportion. In view of the difficult decision between inducing general anesthesia in a patient with a likely difficult airway, or neuraxial anesthesia in a patient with cardiovascular, respiratory and neurocognitive limitations, we suggest tailored management to reach the best results for the mother and newborn.

Anesthesia for a cesarean section on a pregnant patient with Cockayne syndrome: case report / Anestesia para cesárea em gestante com síndrome de Cockayne: relato de caso

Abstract Cockayne syndrome is an autosomal recessive multi-systemic disorder due to DNA repair failure. It was originally described in 1936 in children of small stature, retinal atrophy and deafness, characterized by dwarfism, cachexia, photosensitivity, premature aging and neurologic deficits. The most typical feature is described as birdlike facies: protruding maxilla, facial lipoatrophy, sunken eyes, large ears and thin nose. Difficult airway management with subglottic stenosis and risk of gastric content aspiration has been described. Although the clinical characteristics of Cockayne syndrome have been well described in pediatric publications, there is only one report in the literature on anesthesia for an obstetric patient. We report the case of a pregnant patient diagnosed with Cockayne syndrome, submitted successfully to spinal anesthesia for a cesarean section due to cephalopelvic disproportion. In view of the difficult decision between inducing general anesthesia in a patient with a likely difficult airway, or neuraxial anesthesia in a patient with cardiovascular, respiratory and neurocognitive limitations, we suggest tailored management to reach the best results for the mother and newborn.

Resumo A síndrome de Cockayne é doença multissistêmica autossômica recessiva devido à falha no reparo do DNA. Originalmente descrita em 1936 em crianças com baixa estatura, atrofia retiniana e surdez, é caracterizada por nanismo, caquexia, fotossensibilidade, envelhecimento acelerado e déficits neurológicos. O mais típico é a fácies, descrita como similar à de um pássaro: maxila proeminente, atrofia do coxim adiposo bucal, olhos profundos, orelhas grandes e nariz fino. Tem sido descrita dificuldade no manejo da via aérea com estreitamento subglótico e risco de aspiração gástrica. Embora as características clínicas da síndrome de Cockayne sejam bem relatadas em publicações pediátricas, há apenas um relato de anestesia em paciente obstétrica na literatura. Relatamos o caso de gestante com diagnóstico de síndrome de Cockayne, submetida com sucesso a raquianestesia para parto cesariano por desproporção cefalopélvica. Diante da difícil decisão entre induzir anestesia geral em paciente com provável via aérea difícil ou anestesia neuroaxial, em meio a limitações cardiovasculares, respiratórias e neurocognitivas da paciente, conduta individualizada é sugerida para alcançar os melhores resultados para a gestante e o neonato.

Nanomaterials Based on Fe3O4 and Phthalocyanines Derived from Cashew Nut Shell Liquid.

In this work we report the synthesis of new hybrid nanomaterials in the core/shell/shell morphology, consisting of a magnetite core (Fe3O4) and two consecutive layers of oleic acid (OA) and phthalocyanine molecules, the latter derived from cashew nut shell liquid (CNSL). The synthesis of Fe3O4 nanoparticle was performed via co-precipitation procedure, followed by the nanoparticle coating with OA by hydrothermal method. The phthalocyanines anchorage on the Fe3O4/OA core/shell nanomaterial was performed by facile and effective sonication method. The as obtained Fe3O4/OA/phthalocyanine hybrids were investigated by Fourier transform infrared spectroscopy, X-ray diffraction, UV-visible spectroscopy, transmission electron microscopy (TEM), thermogravimetric analysis and magnetic measurements. TEM showed round-shaped nanomaterials with sizes in the range of 12-15 nm. Nanomaterials presented saturation magnetization (Ms) in the 1-16 emu/g and superparamagnetic behavior. Furthermore, it was observed that the thermal stability of the samples was directly affected by the insertion of different transition metals in the ring cavity of the phthalocyanine molecule.

Light-Emitting Porphyrin Derivative Obtained from a Subproduct of the Cashew Nut Shell Liquid: A Promising Material for OLED Applications.

In this work, the meso-tetra[4-(2-(3-n-pentadecylphenoxy)ethoxy]phenylporphyrin (H2P), obtained from the cashew nut shell liquid (CNSL), and its zinc (ZnP) and copper (CuP) metallic complexes, were applied as emitting layers in organic light emitting diodes (OLEDs). These compounds were characterized via optical and electrochemical analysis and the electroluminescent properties of the device have been studied. We performed a cyclic voltammetry analysis to determine the Highest Occupied Molecular Orbital (HOMO) and Lowest Unoccupied Molecular Orbital (LUMO) energy levels for the porphyrins, in order to select the proper materials to assemble the device. H2P and ZnP presented fluorescence emission band in the red region, from 601 nm to 718 nm. Moreover, we verified that the introduction of bulky substituents hinders the π⁻π stacking, favoring the emission in the film. In addition, the strongest emitter, ZnP, presented a threshold voltage of 4 V and the maximum irradiance of 10 µW cm-2 with a current density (J) of 15 mA cm-2 at 10 V. The CuP complex showed to be a favorable material for the design of OLEDs in the infrared. These results suggest that the porphyrins derived from a renewable source, such as CNSL, is a promising material to be used in organic optoelectronic devices such as OLEDs.

New ZnO@Cardanol Porphyrin Composite Nanomaterials with Enhanced Photocatalytic Capability under Solar Light Irradiation.

This work describes the synthesis, characterization, and photocatalytic activity of new composite nanomaterials based on ZnO nanostructures impregnated by lipophlilic porphyrins derived from cashew nut shell liquid (CNSL). The obtained nanomaterials were characterized by X-ray diffraction (XRD), UV-Vis diffuse reflectance spectroscopy (DRS), Fourier transform infrared spectroscopy (FT-IR), transmission electron microscopy (TEM), and steady-state photoluminescence spectra (PL). The results confirm nanostructures showing average diameter of 55 nm and an improved absorption in the visible region. Further, the FTIR analysis proved the existence of non-covalent interactions between the porphyrin molecules and ZnO. The photocatalytic activity of prepared photocatalysts was investigated by degradation of rhodamine B (RhB) in aqueous solution under visible light irradiation and natural sunlight. It was demonstrated that the photocatalytic activity increases in the presence of the porphyrins and, also, depends on the irradiation source. The development of composite photocatalysts based on porphyrins derived from CNSL provides an alternative approach to eliminate efficiently toxic wastes from water under ambient conditions.

Oxidative stress status and placental implications in diabetic rats undergoing swimming exercise after embryonic implantation.

The potential benefits and risks of physical exercise on fetal development during pregnancy remain unclear. The aim was to analyze maternal oxidative stress status and the placental morphometry to relate to intrauterine growth restriction (IUGR) from diabetic female rats submitted to swimming program after embryonic implantation. Pregnant Wistar rats were distributed into 4 groups (11 animals/group): control-nondiabetic sedentary rats, control exercised-nondiabetic exercised rats, diabetic-diabetic sedentary rats, and diabetic exercised-diabetic exercised rats. A swimming program was used as an exercise model. At the end of pregnancy, the maternal oxidative stress status, placental morphology, and fetal weight were analyzed. The swimming program was not efficient to reduce the hyperglycemia-induced oxidative stress. This fact impaired placental development, resulting in altered blood flow and energy reserves, which contributed to a deficient exchange of nutrients and oxygen for the fetal development, leading to IUGR.

Auditory stimulation with music influences the geometric indices of heart rate variability in response to the postural change maneuver.

It is poor in the literature the behavior of the geometric indices of heart rate variability (HRV) during the musical auditory stimulation. The objective is to investigate the acute effects of classic musical auditory stimulation on the geometric indexes of HRV in women in response to the postural change maneuver (PCM). We evaluated 11 healthy women between 18 and 25 years old. We analyzed the following indices: Triangular index, Triangular interpolation of RR intervals and Poincarι plot (standard deviation of the instantaneous variability of the beat-to beat heart rate [SD1], standard deviation of long-term continuous RR interval variability and Ratio between the short - and long-term variations of RR intervals [SD1/SD2] ratio). HRV was recorded at seated rest for 10 min. The women quickly stood up from a seated position in up to 3 s and remained standing still for 15 min. HRV was recorded at the following periods: Rest, 0-5 min, 5-10 min and 10-15 min during standing. In the second protocol, the subject was exposed to auditory musical stimulation (Pachelbel-Canon in D) for 10 min at seated position before standing position. Shapiro-Wilk to verify normality of data and ANOVA for repeated measures followed by the Bonferroni test for parametric variables and Friedman's followed by the Dunn's posttest for non-parametric distributions. In the first protocol, all indices were reduced at 10-15 min after the volunteers stood up. In the protocol musical auditory stimulation, the SD1 index was reduced at 5-10 min after the volunteers stood up compared with the music period. The SD1/SD2 ratio was decreased at control and music period compared with 5-10 min after the volunteers stood up. Musical auditory stimulation attenuates the cardiac autonomic responses to the PCM.

Estratégias de mediação do sofrimento estudo exploratório com professores em contexto escolar inclusivo

Este estudo investiga as vivências de prazer e de sofrimento entre professores do ensino médio de uma escola regular inclusiva da Secretaria de Estado de Educação do Distrito Federal (SEEDF). Buscamos identificar e analisar as estratégias de mediação do sofrimento do professor diante do contexto e do processo educacional inclusivo, analisar a organização de trabalho com base na discrepância entre o prescrito e o real, descrever as vivências de prazer e de sofrimento dos professores ao exercerem o magistério em turmas regulares inclusivas e analisar a articulação da educação especial inclusiva com o enfoque no prazer e no sofrimento dos professores. O aporte teórico foi a Psicodinâmica do Trabalho, na perspectiva de Dejours. Realizamos sessões coletivas, com roteiros semiestruturados, com um grupo de seis professores. Os conteúdos das falas foram avaliados pela Análise de Núcleos de Sentido (ANS). Os resultados reforçaram que o sofrimento do professor advém da falta de formação continuada ao ensino especial e da dificuldade em lidar com as especificidades dos alunos, além das salas de aula numerosas. Os sentimentos relatados pelos professores caracterizaram medo e ansiedade, pois estes lidam com o desconhecido. Mecanismos de negação e de rejeição do sofrimento do colega também foram relatados pelo grupo. Tais comportamentos denotaram a dificuldade de reconhecer o outro professor como personagem colaborativo para a formação coletiva das estratégias de enfrentamento do sofrimento. Com isso, reforça-se a ideia de incompetência do docente frente o contexto inclusivo. As estruturas de enfrentamento ao sofrimento denotaram uma conduta individualizada pelos professores, as quais puderam sustentar o sofrimento doentio desses profissionais. Porém, os reconhecimentos que os professores vivenciaram e o cumprimento do direito à educação favoreceram a transformação do sofrimento em prazer.

This study investigates the experiences of pleasure and suffering among high school teachers in a regular school inclusive of the State Department of Education of the Federal District. Seeks to analyze the strategies of mediation of suffering teacher before the inclusive educational context, analyzing the organization of work from the discrepancy between the prescribed and actual describe the experiences of pleasure / pain when exercising teachers teaching in regular classes inclusive and analyze the articulation of inclusive special education from the perspective of the pleasure / pain of teachers. The theoretical approach is psychodynamic work in perspective Dejours. Group sessions were held, with scripts semistructured, with a group of six teachers. The contents of the speech were evaluated using analysis of cores Sense. The results reinforce the suffering that stems from the lack of teacher training continued special education and the difficulty in dealing with the specifics of the students, and numerous classrooms. The feelings reported by teachers characterize fear and anxiety, because they deal with the unknown. The denial of the suffering and rejection of suffering colleague are also reported by the group. Such behaviors denote the difficulty of recognizing the other as teacher training and collaborative character of collective coping strategies. The structures of coping with suffering denote conduct individualized by teachers, which can sustain the suffering of the sick teacher. However, the recognition that teachers experience and the fulfillment of the right to education favor the transformation of the suffering in pleasure.

Estratégias de mediação do sofrimento estudo exploratório com professores em contexto escolar inclusivo

Este estudo investiga as vivências de prazer e de sofrimento entre professores do ensino médio de uma escola regular inclusiva da Secretaria de Estado de Educação do Distrito Federal (SEEDF). Buscamos identificar e analisar as estratégias de mediação do sofrimento do professor diante do contexto e do processo educacional inclusivo, analisar a organização de trabalho com base na discrepância entre o prescrito e o real, descrever as vivências de prazer e de sofrimento dos professores ao exercerem o magistério em turmas regulares inclusivas e analisar a articulação da educação especial inclusiva com o enfoque no prazer e no sofrimento dos professores. O aporte teórico foi a Psicodinâmica do Trabalho, na perspectiva de Dejours. Realizamos sessões coletivas, com roteiros semiestruturados, com um grupo de seis professores. Os conteúdos das falas foram avaliados pela Análise de Núcleos de Sentido (ANS). Os resultados reforçaram que o sofrimento do professor advém da falta de formação continuada ao ensino especial e da dificuldade em lidar com as especificidades dos alunos, além das salas de aula numerosas. Os sentimentos relatados pelos professores caracterizaram medo e ansiedade, pois estes lidam com o desconhecido. Mecanismos de negação e de rejeição do sofrimento do colega também foram relatados pelo grupo. Tais comportamentos denotaram a dificuldade de reconhecer o outro professor como personagem colaborativo para a formação coletiva das estratégias de enfrentamento do sofrimento. Com isso, reforça-se a ideia de incompetência do docente frente o contexto inclusivo. As estruturas de enfrentamento ao sofrimento denotaram uma conduta individualizada pelos professores, as quais puderam sustentar o sofrimento doentio desses profissionais. Porém, os reconhecimentos que os professores vivenciaram e o cumprimento do direito à educação favoreceram a transformação do sofrimento em prazer.

This study investigates the experiences of pleasure and suffering among high school teachers in a regular school inclusive of the State Department of Education of the Federal District. Seeks to analyze the strategies of mediation of suffering teacher before the inclusive educational context, analyzing the organization of work from the discrepancy between the prescribed and actual describe the experiences of pleasure / pain when exercising teachers teaching in regular classes inclusive and analyze the articulation of inclusive special education from the perspective of the pleasure / pain of teachers. The theoretical approach is psychodynamic work in perspective Dejours. Group sessions were held, with scripts semistructured, with a group of six teachers. The contents of the speech were evaluated using analysis of cores Sense. The results reinforce the suffering that stems from the lack of teacher training continued special education and the difficulty in dealing with the specifics of the students, and numerous classrooms. The feelings reported by teachers characterize fear and anxiety, because they deal with the unknown. The denial of the suffering and rejection of suffering colleague are also reported by the group. Such behaviors denote the difficulty of recognizing the other as teacher training and collaborative character of collective coping strategies. The structures of coping with suffering denote conduct individualized by teachers, which can sustain the suffering of the sick teacher. However, the recognition that teachers experience and the fulfillment of the right to education favor the transformation of the suffering in pleasure.

Intervenção grupal com enfoque no cuidado emocional: relato de uma experiência / Group intervention focusing on emotional care: a report of an experience

A atenção à saúde emocional do ser humano deve estar focalizada em qualquer circunstância do seu desenvolvimento, necessitando de enfoque especial no momento de adoecimento do indivíduo, pois, nessa circunstância, vemos surgir fragilidade, medo, desconforto e ansiedade, comuns na situação de hospitalização. Apresentamos uma experiência da utilização do grupo como estratégia na intervenção junto a pacientes internados em clínica médica, com vistas a implementação do cuidado emocional. Mostramos a trajetória do grupo, pontuando as características do trabalho com essa clientela, sinalizando suas peculiaridades. A experiência nos permite afirmar que o grupo é um instrumento de grande valia para o enfermeiro no planejamento de sua intervenção para esse tipo de paciente, oferecendo caminhos para o cuidado emocional. Requer, no entanto, preparo específico do profissional e domínio da dinâmica grupal como forma de melhor aproveitar os "fatores curativos" do grupo.

Conscienciologia na Finlândia / Conscientiology in Finland

Entrevista com o pesquisador da Conscienciologia Wagner Alegretti, engenheiro elétrico, projetor consciente, autor do livro Retrocognições - lembranças de vivências passadas e atual presidente da International Academy of Consciousness (IAC). As questões abordadas incluem as atividades da IAC na Finlândia e as peculiaridades deste local, a ressoma de Anaximandro de Mileto e da consciex amparadora EM na Finlândia, a relação de EM com este país, e algumas características do EM, de seu provável planeta de origem e do grupo de consciências a ele relacionadas (AU)

[Group intervention with a focus on emotional care: report of an experience]. / Intervenção grupal com enfoque no cuidado emocional: relato de uma experiência.

Attention to emotional health should be given at any circumstances of human beings development. It is especially necessary when an individual is ill and feels fragile, afraid, uncomfortable and anxious due to hospitalization. In this paper, we present an experience in which group work was used as a strategy of assistance to patients in the hospital, aiming at the implementation of an emotional assistance plan. The trajectory of the group, as well as the characteristics of the work done and its peculiarities are shown in this study. Results indicate that group work is a valuable tool for planning emotional care to these patients. However, it requires specific preparation and knowledge of group dynamics on the part of nursing professionals, so that the "healing" potential of group work can be better used.

Saúde mental em clientes cirúrgicos: o desenvolvimento de açöes de enfermagem através do grupo de suporte/apoio / Mental health in surgical clients: developing nursing care actions through support groups

A utilizaçäo de grupos como recurso para atender pacientes tem sido uma modalidade frequente na assistência de Enfermagem. O objetivo deste estudo foi utilizar o grupo de suporte/apoio para a abordagem do paciente cirúrgico internado, visando diminuir a ansiedade presente nessas situaçöes. A pesquisa foi desenvolvida na clínica cirúrgica do HCFM-UFG, com 41 pacientes. A coleta de dados foi realizada através de entrevistas individuais, material emergente dos grupos e diário de campo. De modo geral, observamos que os pacientes mostraram-se bastante envolvidos com o trabalho, demonstrando a eficiência do grupo como um recurso para trabalharmos ansiedade, medo e tensäo presentes durante a internaçäo. Destacamos a importância do enfermeiro treinar seu papel de coordenador de grupo, especialmente para lidar com situaçöes de manejo difícil. A supervisäo das reuniöes quanto ao seu conteúdo temático e funcionamento também säo imprescindíveis.