O cotidiano familiar da pessoa com esquizofrenia: cuidando no domicílio / The everyday family life of people with schizophrenia: caring at home / El cotidiano familiar de la persona con esquizofrenia: cuidando en el domicilio

Estudo exploratório-descritivo de abordagem qualitativa que teve como objetivo conhecer o cotidiano do familiar quanto às suas vivências em relação ao cuidado para com o indivíduo esquizofrênico em seu domicílio. Realizado no CAPS III, em Cascavel-PR, onde foram entrevistados oito familiares, no período de maio a junho de 2009, tendo em vista a questão norteadora: "O que é isto, a esquizofrenia em seu lar?". Os depoimentos foram submetidos à análise temática de conteúdo, da qual emergiu o tema "Vivenciando a esquizofrenia no lar" e os subtemas "Sentindo necessidade de compartilhar seu pesar", "Compartilhando o preconceito" e "Sentimento de desesperança". A análise demonstrou que a vivência da esquizofrenia no lar transcende os aspectos físicos, espirituais e sociais, sobrecarregando a família. Recomenda-se a ampliação da atenção a essas pessoas no que se refere às suas necessidades de cuidado, para que juntos, doente, familiar e equipe de saúde, vislumbrem caminhos para uma assistência integral.

This exploratory-descriptive study was performed using a qualitative approach with the objective of understanding the everyday family life regarding the experiences of taking care of schizophrenic individuals at home. The study was performed at the Psychosocial Care Center (CAPS III), located in Cascavel - PR, where we interviewed eight family members in the period from May to June 2009, using the following guiding question: "What does schizophrenia in your home mean?" The statements were subjected to thematic content analysis, which advanced the theme "Experiencing schizophrenia at home" and the subthemes "Feeling the need to share your burden", "Sharing the prejudice" and "Feeling hopeless". The analysis demonstrated that dealing with schizophrenia at home transcends the physical, spiritual, and social aspects, causing an overload on the family. We recommend broadening the care that is provided to these people in terms of their health care needs, so that the patient, family members and health team can, together, find the path towards comprehensive health care.

Estudio exploratorio-descriptivo, de abordaje cualitativo, que objetivó conocer el cotidiano del familiar respecto a sus experiencias relativas al cuidado del individuo esquizofrénico en su domicilio. Realizado en el CAPS III, en Cascavel-PR, donde entrevistamos ocho familiares entre marzo y junio 2009, mediante la pregunta orientadora: "¿Qué es esto, la esquizofrenia en su hogar?" Los testimonios fueron sometidos a análisis temático de contenido, emergiendo el tema "Experimentando la esquizofrenia en el hogar" y los subtemas "Sintiendo necesidad de compartir su pesar", "Compartiendo el prejuicio" y "Sentimiento de desesperanza". El análisis demostró que la experiencia de la esquizofrenia en el hogar trasciende aspectos físicos, espirituales y sociales, sobrecargando a la familia. Recomendamos la ampliación de la atención de dichas personas en lo referente a sus necesidades de cuidado, para que juntos, enfermo, familiar y equipo de salud, vislumbren caminos para una atención integral.

Epidemiology and prognostic factors in acute superior mesenteric artery occlusion.

BACKGROUND: Reports on trends in incidence and mortality of acute superior mesenteric artery (SMA) occlusion and evaluation of prognostic factors in recent years are lacking. METHODS: Patients with acute SMA occlusion were identified through the in-patient and autopsy registry between 1970 and 1982 (n = 270), 1987 to 1996 (n = 135), and 2000 and 2006 (n = 100) in Malmö, Sweden. RESULTS: The overall incidence rate decreased from 8.6 to 5.4/100,000 person years and the autopsy rate from 87% to 25% over time. A higher serum creatinine level was associated with a lower probability of undergoing multi-detector row computed tomography with intravenous contrast (MDCTiv) (p = 0.006). Not performing a MDCTiv (odds ratio 4.0; 95% confidence interval [1.0-16.0]) remained as independent prognostic factor for in-hospital mortality. General and vascular surgeons collaborated in 25 out of 61 patients that underwent an intervention, of which 21 (84%) (p < 0.001) survived. CONCLUSIONS: A close collaboration between radiologists and general and vascular surgeons seems to be most important to lower the mortality in patients with acute SMA occlusion.

Impact of MDCT with intravenous contrast on the survival in patients with acute superior mesenteric artery occlusion.

Acute thromboembolic occlusion in the superior mesenteric artery (SMA) is a condition with high mortality and morbidity. Multi-detector computerised tomography with intravenous contrast enhancement (MDCTiv) may improve diagnostic accuracy and survival. Patients with acute SMA occlusion were identified between 2004 and 2008 at Malmö University Hospital, Sweden. Medical records were analysed. Each MDCTiv was re-evaluated. A total of 67 patients were identified with SMA occlusion, of which 36 were examined with MDCTiv and ten with plain MDCT without intravenous contrast. In all, 24 (67%) of the 36 patients were correctly diagnosed by MDCTiv at first evaluation. Clinical suspicion of intestinal ischemia followed by a distinct inquiry for intestinal ischemia was associated with trend for a higher rate of correct radiological diagnosis, 18 of 23 (78%), at first evaluation (0.06) but without affecting in-hospital survival (p = 0.27). At re-evaluation, SMA occlusion was found in all cases with MDCTiv, whereas intestinal findings were present in half. In-hospital mortality rate was 42% for patients who underwent MDCTiv, which was significantly lower compared to 90% for the ten patients examined with plain MDCT (p = 0.007) and 71% for patients not examined with MDCTiv or plain MDCT (p = 0.031). Patients that underwent plain MDCT had higher levels of creatinine compared to those examined with MDCTiv (p = 0.005). Patients who underwent intestinal revascularisation, endovascular or open, had higher survival rate (p = 0.001). Examination with MDCTiv in patients with acute SMA occlusion was associated with survival benefit. Hence, MDCTiv seems to be the method of choice in the workup phase. Radiologists should routinely describe the mesenteric vessels in patients with acute abdomen even when the diagnosis is not asked for. Patients with high creatinine levels are at risk to be examined without intravenous contrast, and survival in these patients is poor.

Unspecific clinical presentation of bowel ischemia in the very old. Digitalis treatment--a reason for higher mortality?

BACKGROUND AND AIMS: Ischemic bowel disease predominantly affects the elderly (>65 years). Early diagnosis and treatment are of vital importance for the outcome. The vague symptoms of ischemic bowel disease entail a risk of delayed diagnosis, with a subsequent risk of increased mortality. The aims of this retrospective study were to identify symptoms and prodromes, to study factors associated with mortality in ischemic bowel disease, and to describe the influence of age, by comparing patients <80 and > or = 80 years. METHODS: The subjects of the study were 135 patients, mean age 77 years, admitted to Malmö University Hospital, Sweden, between 1987 and 1996, with a ICD-9 diagnosis of acute or chronic splanchnic ischemia. RESULTS: Patients aged 80 years or more presented with a significantly higher prevalence of confusion (29% vs 12%), hematemesis (57% vs 14%), vomiting (82% vs 65%) and dehydration (58% vs 36%) at admission compared with patients aged under 80 years, and presented a higher mortality (87% compared with 65%, p=0.003). The prevalence of digitalis treatment was 34%, which was high compared with other Swedish cohort studies. Digitalis, adjusted for age, congestive heart failure and atrial fibrillation, was associated with increased mortality (odds ratio 4.6, 95% CI 1.3-16.1). Prodromal signs predicted poor outcome, and were found in one out of 4 patients, without any age differences. CONCLUSIONS: Bowel ischemia in the very old is associated with a different clinical presentation and a higher mortality compared with younger patients. Digitalis treatment seems to be associated with increased mortality in ischemic bowel disease. Prodromal signs are prognostically unfavorable.