Honneth: Contribuições para o cuidar em enfermagem à luz do amor, direito e solidariedade / Honneth: Contribuciones para cuidar en enfermería a la luz del amor, la ley y la solidaridad / Honneth: Contributions to Nursing Care in Light of Love, Rights and Solidarity

Introdução: Compreender a relação intersubjetiva que permeia o cuidado de enfermagem requer reconhecimento recíproco enfermeiro e paciente e/ou familiar. Para tanto, é necessário refletir sobre a construção do próprio ser humano consolidado no amor, no direito e na solidariedade. Objetivo: Refletir sobre o saber e fazer do cuidado de enfermagem a partir do respeito aos três padrões de reconhecimento conforme Honneth: amor, direito e solidariedade. Materiais e Métodos: Revisão integrativa da literatura, com busca nas bases de dados eletrônicas, nacionais e internacionais, a partir de descritores controlados e palavras relacionadas. Utilizou-se também a obra "Luta por Reconhecimento: a gramática moral dos conflitos sociais". Resultados: Foram incluídos 16 artigos na revisão. Os resultados apontaram a práxis da enfermagem frente à escolha/recusa do cuidado respaldado no respeito mútuo, nas legalidades e nas reflexões frente à complexidade subjetiva do paciente e sua autonomia. Discussão: O amor, direito e solidariedade, compreendidos no processo de cuidado em enfermagem são vistos na literatura como uma construção história e social de reconhecimento mútuo, assim como relação intersubjetiva entre o profissional e o indivíduo, buscando estabelecer respeito à dignidade humana e à sua autonomia. Desrespeitar tais relações resultam em desumanização e desmoralização do sujeito. Conclusões: O respeito às dimensões do amor, direito e solidariedade contribuem para o reconhecimento do cuidado de enfermagem e autonomia do paciente.

Introduction: Understanding the intersubjective relationship that permeates nursing care requires mutual recognition between nurses and patients and/or families. Therefore, a reflection on the construction of the human being based on love, rights and solidarity is required. Objective: To reflect on knowledge and practice of nursing care based on respect for the three forms of recognition, love, rights and solidarity, defined by Honneth. Materials and Methods: A comprehensive literature review and search in electronic national and international databases were carried out using controlled descriptors and related terms. The Struggle for Recognition: The Moral Grammar of Social Conflicts was also used for this study. Results: 16 articles were selected to be included in this review. The results addressed nursing practice in the face of choice/rejection of care based on mutual respect, legalities and reflections on subjective complexity and patient autonomy. Discussion: From a nursing care perspective, love, rights and solidarity are considered in the literature as a historical and social construction mutually recognized as well as an intersubjective relationship between nursing professionals and patients, thus seeking to establish respect for human dignity and autonomy. The lack of respect for such relationships leads to subject dehumanization and demoralization. Conclusion: Respect for love, rights and solidarity dimensions contribute to recognizing nursing care and patient autonomy.

Introducción: La comprensión de la relación intersubjetiva que impregna el cuidado de enfermería requiere un reconocimiento mutuo entre la enfermera y el paciente y / o la familia. Por lo tanto, es necesario reflexionar sobre la construcción del ser humano consolidado en amor, derecho y solidaridad. Objetivo: Reflexionar sobre el conocimiento y la práctica de los cuidados de enfermería basados en el respeto a los tres estándares de reconocimiento según Honneth: amor, derecho y solidaridad. Materiales y métodos: Revisión integral de literatura, búsqueda en bases de datos electrónicas, nacionales e internacionales, utilizando descriptores controlados y palabras relacionadas. También se utilizó el trabajo "Luta por Reconhecimento: a gramática moral dos conflitos sociais". Resultados: se incluyeron 16 artículos en la revisión. Los resultados apuntaron a la praxis de enfermería frente a la elección / rechazo de la atención basada en el respeto mutuo, las legalidades y las reflexiones sobre la complejidad subjetiva y la autonomía del paciente. Discusión: El amor, el derecho y la solidaridad, entendidos en el proceso de cuidados de enfermería, se ven en la literatura como una construcción histórica y social de reconocimiento mutuo, así como una relación intersubjetiva entre el profesional y el individuo, buscando establecer el respeto por la dignidad humana y su autonomía. La falta de respeto a tales relaciones da como resultado la deshumanización y la desmoralización del sujeto. Conclusiones: El respeto por las dimensiones del amor, el derecho y la solidaridad contribuyen al reconocimiento del cuidado de enfermería y la autonomía del paciente.

Older adult sexuality in the practice and training of geriatricians: a qualitative study / Sexualidade do idoso na prática e formação de geriatras: estudo qualitativo

OBJECTIVE: To understand the academic training of geriatrics residents and their supervisors regarding the sexuality of older adults, as well as practical approaches to the subject in their work routines. METHODS: This qualitative study was conducted with geriatrics residents and their supervisors at a public hospital in Recife, PE, Brazil in 2019 and 2020. RESULTS: A partial understanding of the respondents' concept of sexuality was identified through statements that expressed confusion between sexual intercourse and sexuality, as well as a lack of knowledge about sexuality on an individual level. Although the respondents affirmed the importance of discussing the subject, they reported that they do not, except passively. The respondents discuss this issue depending on the patient's questions, despite acknowledging their difficulty in seeking a health service to talk about sexuality-related issues. Finally, the lack of an approach to sexuality in geriatric consultations was linked with gaps in undergraduate and specialization programs about general care for older adults, resulting in a feeling of unpreparedness to face the taboos and prejudices associated with sexuality. CONCLUSION: Although professionals consider it important to address sexuality with patients, most of them do not do so in medical consultations due to a number of difficulties, including the lack of a protocol to follow, which leads to a passive approach. Therefore, professionals acknowledge the difficulty of addressing the subject and associate it with deficiencies in their academic training.

Compreender a formação acadêmica de preceptores e residentes de geriatria acerca do conteúdo sobre sexualidade em idosos, bem como a abordagem prática do assunto nas suas rotinas médicas. MÉTODOS: Trata-se de um estudo qualitativo realizado entre 2019 e 2020, com preceptores e residentes de geriatria em um hospital público de Recife (PE), Brasil. RESULTADOS: Foi identificada compreensão parcial do conceito de sexualidade, observando-se falas que denotam confusão dos conceitos de relação sexual e sexualidade, além do desconhecimento da sexualidade no âmbito individual. Verificou-se, ainda, que, apesar de os profissionais de saúde afirmarem a importância de se discutir o tema, eles relatam que não o fazem e que, quando o fazem, utilizam a abordagem passiva, dependendo dos questionamentos do paciente, embora percebam a dificuldade dos idosos em buscar o serviço de saúde para falar sobre questões relacionadas à sexualidade. Por fim, a ausência de abordagem sobre sexualidade nas consultas geriátricas foi relacionada às lacunas deixadas pelos cursos de graduação e de especialização na preparação para um atendimento adequado aos idosos de maneira geral, resultando em uma sensação de despreparo para enfrentar seus tabus e preconceitos ao falar sobre sexualidade. CONCLUSÃO: Apesar de os profissionais considerarem importante abordar o tema com os pacientes, a maioria não o faz nas consultas médicas por diversas dificuldades, entre elas a ausência de um protocolo a seguir, o que os leva a uma abordagem passiva do tema. Portanto, os profissionais entendem a dificuldade de abordagem do assunto e a associam à deficiência em sua formação acadêmica.

Tyrosol May Prevent Obesity by Inhibiting Adipogenesis in 3T3-L1 Preadipocytes.

Tyrosol (TR), a major polyphenol found in extra virgin olive oil (EVOO), exerts several antioxidant effects. However, only scarce evidences are present regarding its activity on adipocytes and obesity. This study evaluated the role of TR in adipogenesis. Murine 3T3-L1 preadipocytes were incubated with TR (300 and 500 µM), and TR administration inhibited adipogenesis by downregulation of several adipogenic factors (leptin and aP2) and transcription factors (C/EBPα, PPARγ, SREBP1c, and Glut4) and by modulation of the histone deacetylase sirtuin 1. After complete differentiation, adipocytes treated with 300 and 500 µM TR showed a reduction of 20% and 30% in lipid droplets, respectively. Intracellular triglycerides were significantly reduced after TR treatment (p < 0.05). Mature adipocytes treated with TR at 300 and 500 µM showed a marked decrease in the inflammatory state and oxidative stress as shown by the modulation of specific biomarkers (TNF, IL6, ROS, and SOD2). TR treatment also acted on the early stage of differentiation by reducing cell proliferation (~40%) and inducing cell cycle arrest during Mitotic Expansion Clonal (first 48 h of differentiation), as shown by the increase in both S1 phase and p21 protein expression. We also showed that TR induced lipolysis by activating the AMPK-ATGL-HSL pathway. In conclusion, we provided evidence that TR reduces 3T3-L1 differentiation through downregulation of adipogenic proteins, inflammation, and oxidative stress. Moreover, TR may trigger adipose tissue browning throughout the induction of the AMPK-ATGL-UCP1 pathway and, subsequently, may have promise as a potential therapeutic agent for the treatment and prevention of obesity.

Infecções relacionadas à assistência à saúde em pacientes internados em unidade de terapia intensiva cardiológica / Healthcare-associated infections in patients admitted to a cardiological intensive care unit / Infecciones relacionadas con la atención sanitaria en pacientes ingresados en unidad de cuidados intensivos cardiológicos

Justificativa e Objetivos: As Infecções Relacionadas à Assistência à Saúde (IRAS) acometem milhares de pessoas em todo o mundo e são uma das principais causas de complicações em indivíduos hospitalizados. O objetivo deste estudo foi conhecer as características das IRAS em pacientes internados em uma Unidade de Terapia Intensiva Cardiológica em um hospital de referência em Santa Catarina, no período de janeiro a dezembro de 2017. Métodos: Estudo descritivo, realizado de forma transversal na Comissão de Controle de Infecção Hospitalar (CCIH) e Unidade de Terapia Intensiva (UTI) da instituição. Os dados foram coletados em 86 fichas de notificação de IRAS. Fizeram parte deste estudo todos os pacientes internados na UTI Cardiológica que tiveram notificação de IRAS registrada pela CCIH em 2017, sendo coletadas nos prontuários as variáveis demográficas e clínicas. Os dados foram organizados no Excel e analisados por meio do Statistical Package for the Social Sciences (SPSS) versão 18.0. Resultados: O percentual de IRAS em 2017 foi de 58,6% e o índice de mortalidade foi de 44,8%. Verificou-se maior ocorrência de infecção em indivíduos com idade entre 71 e 80 anos (39,6%), principalmente infecção do trato respiratório (ITR) (58,1%), seguida de infecção do trato urinário (43%) e infecção da corrente sanguínea (30,2%). Os principais agentes etiológicos foram: Pseudomonas aeruginosa (27,9%), Klebsiella pneumoniae (26,7%) e Acinetobacter baumannii (19,8%). Quanto à patologia de base, a mais frequente foi a insuficiência cardíaca congestiva (19,8%). Conclusão: O levantamento dos dados acerca das IRAS em UTI Cardiológica evidenciou incidência semelhante aos achados com a literatura. Ações de educação permanente, elaboração de protocolos (bundles) de prevenção e controle, e técnicas de higienização correta das mãos têm se mostrado efetivos para reduzir as infecções.(AU)

Justification and Objectives: Healthcare-associated infections (HAI) affect thousands of people worldwide and are a major cause of complications among hospitalized patients. This study aimed to identify HAI characteristics among patients hospitalized at a cardiac intensive care unit (CICU) in a reference hospital in Santa Catarina from January to December 2017. Methods: This is a descriptive cross-sectional study conducted in the hospital infection control committee (HICC) and intensive care unit (ICU) of the institution. Data were collected from 86 HAI notification forms. All patients admitted to the CICU notified with HAI by the HICC in 2017 were included in the study. Demographic and clinical data were collected from patients' medical records. Data were tabulated in Microsoft Excel and analyzed by the Statistical Package for the Social Sciences (SPSS) version 18.0. Results: In 2017, HAI incidence was 58.6% and mortality rate 44.8%. The infection was more prevalent among individuals aged between 71 and 80 years (39.6%), and mainly affected the respiratory tract (RTI) (58.1%), the urinary tract (43%), and the bloodstream (30.2%). Pseudomonas aeruginosa (27.9%), Klebsiella pneumoniae (26.7%) and Acinetobacter baumannii (19.8%) were the main etiological agents. Regarding the base pathology, congestive heart failure was the most frequent (19.8%). Conclusion: This study found similar results on the incidence of HAI in CICU to those reported in the literature. Studies have showed permanent education, prevention and control protocols (bundles), and appropriate hand hygiene to be effective actions in reducing infections.(AU)

Justificación y Objetivos: Las infecciones relacionadas con la atención sanitaria (IRAS) afectan a miles de personas en todo el mundo y son una de las principales causas de complicaciones en individuos hospitalizados. El objetivo de este estudio fue conocer las características de las IRAS en pacientes ingresados en una Unidad de Cuidados Intensivos Cardiológicos, en un hospital de referencia de Santa Catarina, de enero a diciembre de 2017. Métodos: Estudio descriptivo realizado de forma transversal en la Comisión de Control de Infecciones Hospitalarias (CCIH) y la Unidad de Cuidados Intensivos (UCI) de la institución. Los datos se recopilaron en 86 formularios de notificación de IRAS. El estudio incluyó a todos los pacientes ingresados en la UCI de Cardiología que recibieron notificación de IRAS registrada por el CCIH en 2017, y se recogieron variables demográficas y clínicas de los registros médicos. Los datos se organizaron en Excel y se analizaron utilizando el Paquete Estadístico para las Ciencias Sociales (SPSS), versión 18.0. Resultados: El porcentaje de IRAS en 2017 fue del 58,6%, y la tasa de mortalidad resultó el 44,8%. Hubo una mayor ocurrencia de infección en individuos entre 71 y 80 años (39,6%), principalmente infección del tracto respiratorio (ITR) (58,1%), seguida de infección del tracto urinario (43%) e infección del torrente sanguíneo (30,2%). Los principales agentes etiológicos fueron: Pseudomonas aeruginosa (27,9%), Klebsiella pneumoniae (26,7%) y Acinetobacter baumannii (19,8%). En cuanto a la patología de base, la más frecuente fue la insuficiencia cardíaca congestiva (19,8%). Conclusión: La recogida de datos sobre las IRAS en UCI de Cardiología mostró una incidencia similar a los hallazgos de la literatura. Se ha demostrado que las acciones por la educación continua, la preparación de protocolos de prevención y control (bundles) y técnicas adecuadas de higiene de manos son eficaces para reducir las infecciones.(AU)

Cytotoxicity of xyloglucan from Copaifera langsdorffii and its complex with oxovanadium (IV/V) on B16F10 cells.

The aim of this study was to investigate the effects of xyloglucan extracted from Copaifera langsdorffii seeds (XGC) and its complex with oxovanadium (XGC:VO) in murine melanoma B16F10 cells. The formation of complexes was followed by potentiometric titration and further demonstrated by 51V RMN. The viability and proliferation of B16F10 cells were reduced up 50% by the xyloglucan and its complex, both at 200 µg/mL, from 24 to 72 h. Cytotoxic effects of XGC and XGC:VO do not involve changes in cell cycle progression. Only XGC:VO (200 µg/mL) promoted the cell death evidenced by annexin V stain. XGC increased the respiration and lactate levels in melanoma cells, while XGC:VO reduced about 50% the respiration and levels of pyruvate, without alter the lactate levels, indicating that both xyloglucan preparations interfere with the metabolism of B16F10 cells. No change in activity of the enzyme hexokinase and expression of pyruvate kinase M2 was observed. XGC:VO (200 µg/mL) negatively modulated the expression of the ß subunit of ATP synthase. The results demonstrate that the cytotoxicity of XGC and XGC:VO on murine melanoma B16F10 cells can be related to the impairment of the mitochondrial functions linked to energy provision.

Risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery / Fatores de risco associados a delírio no despertar da anestesia em crianças submetidas à cirurgia ambulatorial

Abstract Introduction: Anesthesia emergence delirium is a self-limiting clinical phenomenon very common in children. Although pathophysiology is still uncertain, some factors seem to be involved, such as rapid awakening in an unknown environment, agitation during anesthetic induction, preoperative anxiety, environmental disorders, use of preanesthetic medication, use of inhalational anesthetics, and postoperative pain. Objective: To determine the prevalence and risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery. Methods: A prospective observational study was carried out with 100 children aged 2-10 years, who underwent surgery on an outpatient basis. The study variables were: anesthesia emergence delirium and the associated risk factors (preoperative anxiety, child impulsive behavior, use of pre-anesthetic medication, traumatic induction, type of anesthesia, and postoperative pain). Multivariate Poisson's logistic regression was used to analyze the possible explanatory variables, where the prevalence ratios were estimated with the respective 95% confidence intervals, considering a significance level of 5%. Results: Delirium and pain were observed in 27% and 20% of children, respectively. Only postoperative pain after Poisson's regression, was shown to be associated with anesthesia emergence delirium, with a prevalence ratio of 3.91 (p < 0.000). Conclusion: The present study showed 27% prevalence of anesthesia emergence delirium in the study population. The incidence of anesthesia emergence delirium was higher in children who had postoperative pain.

Resumo Introdução Delírio ao despertar anestésico é um fenômeno clínico autolimitado muito comum em crianças. Apesar de fisiopatologia ainda incerta, alguns fatores parecem estar envolvidos, como despertar rápido em um ambiente desconhecido, agitação durante a indução anestésica, ansiedade pré-operatória, perturbações ambientais, uso de medicação pré-anestésica, uso de anestésicos inalatórios e dor pós-operatória. Objetivo Determinar a prevalência e os fatores de risco associados ao delírio ao despertar anestésico em crianças submetidas à cirurgia ambulatorial. Métodos Estudo observacional prospectivo, envolveu 100 crianças entre dois e 10 anos, submetidos à cirurgia em caráter ambulatorial. As variáveis de estudo foram: delírio ao despertar anestésico e os fatores de risco associados (ansiedade pré-operatória, comportamento impulsivo da criança, uso de medicação pré-anestésica, indução traumática, tipo de anestesia e dor pós-operatória). Foi feita a regressão multivariada de Poisson para análise das possíveis variáveis explanatórias, na qual foram estimadas as razões de prevalência com os respectivos intervalos de confiança de 95%, considerou-se o nível de significância de 5%. Resultados Delírio e dor foram observados em 27% e 20% das crianças respectivamente. Apenas a dor no pós-operatório, após a regressão de Poisson, mostrou ter uma associação com o delírio ao despertar anestésico, cuja razão de prevalência foi 3,91 (p < 0,000). Conclusão O presente estudo evidenciou uma prevalência de delírio ao despertar anestésico de 27% na população estudada. A incidência de delírio ao despertar anestésico foi maior em crianças que apresentaram dor no pós-operatório.

Efeito da rutina em modelo de depressão crônico induzido por corticosterona em camundongos / Effect of rutin on a model of chronic corticosterone-induced depression in mice

Introdução: a depressão é uma doença altamente prevalente na população mundial e apesar de não ter sua causa estabelecida, algumas teorias tentam esclarecer sua etiologia. A rutina é um flavonoide pertencente à classe dos flavonóis, que tem propriedades anti-inflamatória e antioxidante. Objetivo: avaliar os efeitos antidepressivos da rutina em um modelo crônico induzido por corticosterona em camundongos. Metodologia: foram utilizados camundongos Swiss fêmeas (25-30g) que receberam corticosterona 20mg/kg ou tween 3% por 21dias. Outros grupos receberam corticosterona por 14 dias e entre 15o ao 21o dia de tratamento, rutina (0,2, 2,0 e 10mg/kg) ou fluoxetina10mg/kg ou diazepam 1mg/Kg. Uma hora após a última administração, os animais passaram pelos testes de campo aberto, labirinto em cruz elevada e nado forçado. Após os testes, os animais foram sacrificados por decapitação e as áreas cerebrais córtex pré-frontal, hipocampo e corpo estriado dissecados. Para análise entre os grupos foi usado o teste "t" de Student e para comparação múltipla dos parâmetros utilizará a Análise de Variância (ANOVA). Resultados: a corticosterona foi capaz de induzir a depressão nos animais. No teste de campo aberto, a rutina 0,2, 2,0 e 10mg/kg reduziram a locomoção. A menor dose da rutina apresentou melhor resposta, aumentando o número de entrada e tempo de permanência no braço aberto no teste de labirinto em cruz elevada. Também reduziu significativamente o tempo de imobilização no teste de nado forçado. Conclusão: a substância apresentou atividades ansiolítica e antidepressiva.

Introduction: Depression is a highly prevalent disease in the world population, and, although its cause is not established, several theories try to clarify its etiology. Rutin is a flavonoid belonging to the subclass of flavonoids, which has anti-inflammatory and antioxidant properties. Objective: to evaluate the antidepressant effects of rutin in a chronic model induced by corticosterone in mice. Methods: Female Swiss mice (25-30g) receiving 20mg / kg corticosterone or 3% tween for 21 days were used. Other groups received corticosterone for 14 days and between 15 and 21 days of treatment, rutin (0.2, 2.0 and 10mg / kg) or fluoxetine 10mg / kg or diazepam 1mg / kg. One hour after the last administration, the animals underwent open field tests, elevated cross labyrinth and forced swimming. After the tests, the animals were sacrificed by decapitation and the cerebral areas, prefrontal cortex, hippocampus and striatum dissected. Student's t-test was used for the analysis between the groups, and Variance Analysis (ANOVA) was used for multiple comparison of the parameters. Results: Corticosterone was able to induce depression in animals. In the open field test, routine 0.2, 2.0 and 10mg / kg reduced the locomotion. The lower dose of rutin presented better response, increasing the number of entry and length of stay in the open arm in the high cross maze test. It also significantly reduced stall time in the forced swim test. Conclusion: the substance presented anxiolytic and antidepressant activities.

[Women's experience with cesareans in Uruguay: the woman's right to be accompanied by a person of her choice and difficulties with enforcement]. / Experiencia de mujeres con cesárea en Uruguay: el derecho a estar acompañada por una persona de su elección y las dificultades en su cumplimiento.

The article aims to analyze how women are accompanied by a trusted person during cesareans, as guaranteed under Law 17,386 on "accompanying persons during labor and childbirth", enacted in Uruguay in 2001. The findings are part of a larger study on the experience and meaning of cesareans for Uruguayan women. An exploratory, descriptive qualitative methodology was used for this purpose. The technique involved in-depth interviews with 31 women whose cesareans were performed in their first pregnancy in the city and greater metropolitan area of Montevideo. Based on the findings, the conclusion is that having a trusted accompanying person during labor and childbirth is experienced by women as a factor for emotional protection given the anxieties generated by a major surgery like a cesarean. Nevertheless, for the women interviewed in the study, "being accompanied" was not a continuous process, but characterized by a series of separations, both from the accompanying persons and from their children, causing anxiety, anguish, ambivalent feelings towards the newborn infant, and difficulties in mother-infant bonding, especially in the immediate postpartum.

El objetivo de este artículo es analizar el acompañamiento durante la cesárea, por parte de una persona de confianza de la mujer, consagrado por la Ley nº 17.386 de "acompañamiento en el parto", aprobada en Uruguay en el año 2001. Los resultados forman parte de una investigación mayor sobre la vivencia y el significado de la cesárea para las mujeres que pasaron por esta experiencia. Para ello se optó por una metodología cualitativa de carácter exploratorio y descriptivo. La técnica utilizada fue la entrevista en profundidad, realizada a un total de 31 mujeres, cuyas cesáreas tuvieron lugar en su primera gestación, en Montevideo y área metropolitana (Uruguay). De los resultados obtenidos, se concluye que el acompañamiento en el proceso de trabajo de parto y nacimiento es vivido por las mujeres como un factor de protección emocional ante las ansiedades que genera la experiencia de una cirugía mayor como es la cesárea. Sin embargo, para las mujeres entrevistadas, el "acompañamiento" más que continuo se caracterizó por una serie de separaciones, tanto de sus acompañantes, como de sus hijos/as, lo cual provocó ansiedad, angustia, sentimientos de ambivalencia ante el recién nacido, dificultades en el establecimiento del vínculo materno-filial, sobre todo en el puerperio inmediato.

O objetivo deste artigo é analisar o acompanhamento durante a cesariana, por parte de uma pessoa de confiança da mulher, consignado pela Lei nº 17.386 de "parto assistido", adotada no Uruguai no ano de 2001. Os resultados fazem parte de uma pesquisa maior sobre a experiência e o significado da cesariana para as mulheres que passaram por esta experiência. Para esse fim, foi escolhida uma metodologia qualitativa de caráter exploratório e descritivo. A técnica utilizada foi a entrevista en profundidade, realizada em um total de 31 mulheres, cujas cesarianas tiveram lugar na sua primeira gestação, em Montevidéu e área metropolitana (Uruguai). A partir dos resultados obtidos, concluiu-se que o acompanhamento no processo de trabalho de parto e nascimento é experimentado pelas mulheres como um fator de proteção emocional ante as ansiedades que geram a experiência de uma cirurgia maior como a cesariana. No entanto, para as mulheres entrevistadas, o "acompanhamento" ao invés de continuo foi caracterizado por uma série de separações, tanto de seus acompanhantes, como de seus filhos/as, o qual provocou ansiedade, aflição, sentimentos de ambivalência em relação ao recém-nascido, dificuldades no estabelecimento do vínculo materno, especialmente no puerpério imediato.

[Risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery]. / Fatores de risco associados a delírio no despertar da anestesia em crianças submetidas à cirurgia ambulatorial.

INTRODUCTION: Anesthesia emergence delirium is a self-limiting clinical phenomenon very common in children. Although pathophysiology is still uncertain, some factors seem to be involved, such as rapid awakening in an unknown environment, agitation during anesthetic induction, preoperative anxiety, environmental disorders, use of preanesthetic medication, use of inhalational anesthetics, and postoperative pain. OBJECTIVE: To determine the prevalence and risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery. METHODS: A prospective observational study was carried out with 100 children aged 2 to 10 years, who underwent surgery on an outpatient basis. The study variables were: anesthesia emergence delirium and the associated risk factors (preoperative anxiety, child impulsive behavior, use of pre-anesthetic medication, traumatic induction, type of anesthesia, and postoperative pain). Multivariate Poisson's logistic regression was used to analyze the possible explanatory variables, where the prevalence ratios were estimated with the respective 95% confidence intervals, considering a significance level of 5%. RESULTS: Delirium and pain were observed in 27% and 20% of children, respectively. Only postoperative pain after Poisson's regression, was shown to be associated with anesthesia emergence delirium, with a prevalence ratio of 3.91 (p<0.000). CONCLUSION: The present study showed 27% prevalence of anesthesia emergence delirium in the study population. The incidence of anesthesia emergence delirium was higher in children who had postoperative pain.

Experiencia de mujeres con cesárea en Uruguay: el derecho a estar acompañada por una persona de su elección y las dificultades en su cumplimiento / Women's experience with cesareans in Uruguay: the woman's right to be accompanied by a person of her choice and difficulties with enforcement / Experiência de mulheres com cesariana no Uruguai: o direito a estar acompanhada por uma pessoa de sua confiança e as dificuldades no seu cumprimento

El objetivo de este artículo es analizar el acompañamiento durante la cesárea, por parte de una persona de confianza de la mujer, consagrado por la Ley nº 17.386 de "acompañamiento en el parto", aprobada en Uruguay en el año 2001. Los resultados forman parte de una investigación mayor sobre la vivencia y el significado de la cesárea para las mujeres que pasaron por esta experiencia. Para ello se optó por una metodología cualitativa de carácter exploratorio y descriptivo. La técnica utilizada fue la entrevista en profundidad, realizada a un total de 31 mujeres, cuyas cesáreas tuvieron lugar en su primera gestación, en Montevideo y área metropolitana (Uruguay). De los resultados obtenidos, se concluye que el acompañamiento en el proceso de trabajo de parto y nacimiento es vivido por las mujeres como un factor de protección emocional ante las ansiedades que genera la experiencia de una cirugía mayor como es la cesárea. Sin embargo, para las mujeres entrevistadas, el "acompañamiento" más que continuo se caracterizó por una serie de separaciones, tanto de sus acompañantes, como de sus hijos/as, lo cual provocó ansiedad, angustia, sentimientos de ambivalencia ante el recién nacido, dificultades en el establecimiento del vínculo materno-filial, sobre todo en el puerperio inmediato.

The article aims to analyze how women are accompanied by a trusted person during cesareans, as guaranteed under Law 17,386 on "accompanying persons during labor and childbirth", enacted in Uruguay in 2001. The findings are part of a larger study on the experience and meaning of cesareans for Uruguayan women. An exploratory, descriptive qualitative methodology was used for this purpose. The technique involved in-depth interviews with 31 women whose cesareans were performed in their first pregnancy in the city and greater metropolitan area of Montevideo. Based on the findings, the conclusion is that having a trusted accompanying person during labor and childbirth is experienced by women as a factor for emotional protection given the anxieties generated by a major surgery like a cesarean. Nevertheless, for the women interviewed in the study, "being accompanied" was not a continuous process, but characterized by a series of separations, both from the accompanying persons and from their children, causing anxiety, anguish, ambivalent feelings towards the newborn infant, and difficulties in mother-infant bonding, especially in the immediate postpartum.

O objetivo deste artigo é analisar o acompanhamento durante a cesariana, por parte de uma pessoa de confiança da mulher, consignado pela Lei nº 17.386 de "parto assistido", adotada no Uruguai no ano de 2001. Os resultados fazem parte de uma pesquisa maior sobre a experiência e o significado da cesariana para as mulheres que passaram por esta experiência. Para esse fim, foi escolhida uma metodologia qualitativa de caráter exploratório e descritivo. A técnica utilizada foi a entrevista en profundidade, realizada em um total de 31 mulheres, cujas cesarianas tiveram lugar na sua primeira gestação, em Montevidéu e área metropolitana (Uruguai). A partir dos resultados obtidos, concluiu-se que o acompanhamento no processo de trabalho de parto e nascimento é experimentado pelas mulheres como um fator de proteção emocional ante as ansiedades que geram a experiência de uma cirurgia maior como a cesariana. No entanto, para as mulheres entrevistadas, o "acompanhamento" ao invés de continuo foi caracterizado por uma série de separações, tanto de seus acompanhantes, como de seus filhos/as, o qual provocou ansiedade, aflição, sentimentos de ambivalência em relação ao recém-nascido, dificuldades no estabelecimento do vínculo materno, especialmente no puerpério imediato.

Sintomas que afetam a ingestãoalimentar de pacientes com linfoma emquimioterapia ambulatorial / Symptoms affecting patient’s intake of food with lymphoma inoutpatient chemotherapy

Os linfomas são uma neoplasia maligna, os quais se originam nos linfonodos, que estão envolvidos no combate às infecções.Essa neoplasia teve o maior crescimento na incidência entre as doenças oncohematológicas. O objetivo do estudofoi avaliar os possíveis sintomas gastrointestinais apresentados pelo paciente durante o tratamento e relacioná-los com aingestão alimentar e estado nutricional. Foi realizada a avaliação subjetiva global, índice de massa corporal, área musculardo braço e avaliada o consumo alimentar, assim como presença de sintomas gastrointestinais em portadores de linfoma,submetidos à quimioterapia ambulatorial. A amostra foi composta por 30 pacientes do Serviço de Oncologia Clínica doHospital Erasto Gaertner do Paraná, entre os meses de maio a junho de 2014, sendo 33,3% com linfoma de Hodgkin e66,7% com linfoma não Hodgkin. Segundo a ASG 100% dos pacientes foram considerados como nutridos, porém 46,7%dos pacientes apresentaram perda ponderal. Segundo a AMB, 57% dos pacientes apresentaram algum grau de desnutrição.Em relação ao IMC, 26,7% dos adultos estavam eutróficos, 30% com sobrepeso, 13,3% obesidade e nenhum com desnutrição,já nos idosos 6,7% estavam abaixo do peso, 6,7% eutróficos e 16,7% com excesso de peso. Houve diminuição naingestão alimentar por parte dos pacientes após início da quimioterapia, sendo náuseas, disgeusia, xerostomia e obstipaçãoos sintomas mais frequentes. Considerando os sintomas gastrointestinais que interferem diretamente no padrão alimentare a perda ponderal ocasionados pelo tratamento quimioterápico, os pacientes oncohematológicos devem ser consideradospacientes em risco nutricional e receber acompanhamento nutricional especializado, visando minimizar seus efeitoscolaterais adversos e melhorar sua qualidade de vida.

Lymphomas are a malignant neoplasm which arises in the lymph nodes, which are involved in fighting infection. This cancerhad the highest increase in incidence among oncohematological diseases. The objective of the study was evaluate the possiblegastrointestinal symptoms presented by the patient during treatment and relates them to food intake and nutritionalstatus. The subjective global assessment was performed; body mass index, arm muscle area and assessed food intake, aswell as presence of gastrointestinal symptoms in patients with lymphoma undergoing outpatient chemotherapy. The sampleconsisted of 30 patients of the Oncology Clinic Erasto Gaertner Hospital of Paraná service, between the months of Mayand June 2014, 33.3% with Hodgkin’s lymphoma and 66.7% with non-Hodgkin lymphoma. According to ASG 100% ofpatients were considered nourished, but 46.7% of patients had weight loss. According to the AMB, 57% of patients hadsome degree of malnutrition. In the BMI, 26.7% of adults were eutrophic, 30% were overweight, 13.3% were obese andnone with malnutrition, in relation to the elderly 6.7% were underweight, 6.7% were eutrophic and 16.7 % overweight.There was a decrease in food intake by some patients after chemotherapy initiation, being nausea, dysgeusia, dry mouthand constipation the most frequent symptoms. Considering the gastrointestinal symptoms that interfere directly in the dietarypattern and weight loss caused by chemotherapy, the onco hematological patients should be considered at nutritional riskand receiving specialized nutritional monitoring to minimize its adverse side effects and improve their life quality.

[Reaction time of a health care team to monitoring alarms in the intensive care unit: implications for the safety of seriously ill patients]. / Tempo estímulo-resposta da equipe de saúde aos alarmes de monitorização na terapia intensiva: implicações para a segurança do paciente grave.

OBJECTIVE: To define the characteristics and measure the reaction time of a health care team monitoring alarms in the intensive care unit. METHODS: A quantitative, observational, and descriptive study developed at the coronary care unit of a cardiology public hospital in Rio de Janeiro state (RJ). Data were obtained from the information collected on the patients, the monitoring used, and the measurement of the team's reaction time to the alarms of multi-parameter monitors during a non-participatory field observation. RESULTS: Eighty-eight patients were followed (49 during the day shift and 39 during the night shift). During the 40 hours of observation (20 hours during the day shift and 20 hours during the night shift), the total number of monitoring alarms was 227, with 106 alarms during the day shift and 121 during the night shift, an average of 5.7 alarms/hour. In total, 145 alarms unanswered by the team were observed, with 68 occurring during the day shift (64.15%) and 77 during the night shift (63.64%). This study demonstrated that the reaction time was longer than 10 minutes in more than 60% of the alarms, which were considered as unanswered alarms. The median reaction time of the answered alarms was 4 minutes and 54 seconds during the day shift and 4 minutes and 55 seconds during the night shift. The respiration monitoring was activated in only nine patients (23.07%) during the night shift. Regarding the alarm quality of these variables, the arrhythmia alarm was qualified in only 10 (20.40%) of the day-shift patients and the respiration alarm in four night-shift patients (44.44%). CONCLUSION: The programming and configuration of the physiological variables monitored and the parameters of alarms in the intensive care unit were inadequate; there was a delay and lack of response to the alarms, suggesting that relevant alarms may have been ignored by the health care team, thus compromising the patient safety.

Tempo estímulo-resposta da equipe de saúde aos alarmes de monitorização na terapia intensiva: implicações para a segurança do paciente grave / Reaction time of a health care team to monitoring alarms in the intensive care unit: implications for the safety of seriously ill patients

Objetivo: Definir as características e mensurar o tempo estímulo-resposta da equipe de saúde aos alarmes de monitorização na terapia intensiva. Métodos: Estudo de abordagem quantitativa, observacional, descritivo, desenvolvido na unidade coronariana de um hospital público de cardiologia no Rio de Janeiro (RJ). Os dados foram extraídos de informações referentes aos pacientes, monitorização utilizada e da medição do tempo estímulo-resposta da equipe aos alarmes dos monitores multiparamétricos por observação de campo não participativa. Resultados: Acompanhamos 88 pacientes (49 no serviço diurno e 39 no serviço noturno). O número total de alarmes de monitorização foi de 227 nas 40 horas de observação (20 horas no serviço diurno e 20 horas no serviço noturno), 106 alarmes no serviço diurno e 121 no serviço noturno, numa média de 5,7 alarmes/hora. Foram observados 145 alarmes sem resposta da equipe, 68 (64,15%) alarmes no serviço diurno e 77 (63,64%) no serviço noturno. Demonstramos que mais de 60% dos alarmes excederam o tempo-resposta de 10 minutos, considerados alarmes sem resposta. Obtivemos uma mediana de temporesposta dos alarmes atendidos de 4 minutos e 54 segundos no serviço diurno e 4 minutos e 55 segundos no serviço noturno. A monitorização da respiração encontrava-se ativada em apenas 9 pacientes (23,07%) no serviço noturno. Em relação à habilitação dos alarmes dessas variáveis, o alarme de arritmia estava habilitado em somente 10 (20,40%) dos pacientes no serviço diurno e o alarme da respiração em 4 pacientes (44,44%) no serviço noturno. Conclusão: A programação e configuração de variáveis fisiológicas monitorizadas e parâmetros de ...

Objective: To define the characteristics and measure the reaction time of a health care team monitoring alarms in the intensive care unit. Methods: A quantitative, observational, and descriptive study developed at the coronary care unit of a cardiology public hospital in Rio de Janeiro state (RJ). Data were obtained from the information collected on the patients, the monitoring used, and the measurement of the team's reaction time to the alarms of multi-parameter monitors during a non-participatory field observation. Results: Eighty-eight patients were followed (49 during the day shift and 39 during the night shift). During the 40 hours of observation (20 hours during the day shift and 20 hours during the night shift), the total number of monitoring alarms was 227, with 106 alarms during the day shift and 121 during the night shift, an average of 5.7 alarms/hour. In total, 145 alarms unanswered by the team were observed, with 68 occurring during the day shift (64.15%) and 77 during the night shift (63.64%). This study demonstrated that the reaction time was longer than 10 minutes in more than 60% of the alarms, which were considered as unanswered alarms. The median reaction time of the answered alarms was 4 minutes and 54 seconds during the day shift and 4 minutes and 55 seconds during the night shift. The respiration monitoring was activated in only nine patients (23.07%) during the night shift. Regarding the alarm quality of these variables, the arrhythmia alarm was qualified in only 10 (20.40%) of the day-shift patients and the respiration alarm in four night-shift patients (44.44%). Conclusion: The programming and configuration of the physiological variables monitored and the parameters of alarms in the intensive care unit were inadequate; there was a delay and lack of response to the alarms, suggesting that relevant alarms may have been ignored by the health care team, thus compromising the patient safety. .

Alkyl caffeates as anti-Helicobacter pylori and scavenger of oxidants produced by neutrophils.

Helicobacter pylori pathogenic action involves the colonization of the gastrointestinal tract and a large production of reactive oxygen species (ROS) by the neutrophils attracted to the site of infection. The aim of this study was to evaluate caffeic acid and its alkyl esters as inhibitors of the release of ROS by Helicobacter pylori activated neutrophils and their bactericidal effect. The increased hydrophobicity caused by esterification had direct consequence in their efficiency as bactericidal agents against H. pylori and inhibitors of the production of ROS by neutrophils. The minimum inhibitory concentration (MIC) decreased from higher than 1000 µg/mL (caffeic acid) to 250 µg/mL to butyl and heptyl caffeate. The release of total ROS, superoxide anion and hypochlorous acid by activated neutrophils was also significantly decreased and the esters were more efficient than the acid precursor. In conclusion, the alkyl esters of caffeic acid have two properties that are complementary for the treatment of H. pylori infections: bactericidal activity and inhibitory effect upon generation of ROS by neutrophils. Hence, we propose that these easily synthesized and non-expensive substances should be applied to in vivo experimental models of H. pylori induced gastric infections.

Eficácia do uso de um software para estimulação de habilidades de consciência fonológica em crianças / Effectiveness of using software for stimulation of phonological awareness abilities in children

OBJETIVO: Verificar a eficácia do uso do software "Pedro no Parque de Diversões" no desenvolvimento da consciência fonológica e na construção da escrita alfabética. MÉTODOS: Participaram do estudo 12 crianças, com idades entre 4 e 5 anos, de uma escola particular de educação infantil da cidade de Porto Alegre. Cada criança foi avaliada individualmente quanto à consciência fonológica e hipótese de escrita. Por meio de sorteio, as crianças com hipótese de escrita pré-silábica foram divididas em dois grupos: o grupo estudo (GE) e o grupo controle (GC). As crianças do GE foram estimuladas com o uso do software e as do GC receberam, unicamente, a estimulação de linguagem e de consciência fonológica padrão da escola. Ao término da estimulação (dez encontros) as crianças foram reavaliadas. RESULTADOS: Os resultados evidenciaram diferença significativa no que se refere à consciência fonológica, no nível da sílaba e do fonema, e à mudança da hipótese de escrita dos participantes do GE, em relação ao desempenho dos participantes do GC. CONCLUSÃO: O estudo verificou que o software, tendo o fonoaudiólogo como mediador, foi eficaz para desenvolver a consciência fonológica e facilitou a mudança da hipótese de escrita pré-silábica para a silábica. Dessa forma, programas de estimulação usados na educação infantil devem ser cuidadosamente selecionados, para garantir maiores resultados.

PURPOSE: To investigate whether the software called Peter in the Amusement Park is effective in both developing phonological awareness and building alphabetical writing. METHODS: Twelve children, aged 4-5 years, from a nursery school in Porto Alegre, participated in this study. Each child was individually assessed in terms of phonological awareness and had his/her writing hypothesis analyzed. Children whose writing hypothesis was considered pre-syllabic were randomly assigned to two groups: study group (SG) and control group (CG). Children belonging to SG were stimulated through the use of the software, while those from CG were given only standardized school stimulation. At the end of 10 stimulation meetings, children were reassessed. RESULTS: The results have shown a statistically significant difference in phonological awareness at the level of syllable and phonemes, as well as change in the writing hypothesis among SG children in comparison to the CG participants' performance. CONCLUSION: The study evidenced that the software, by having a speech and language pathologist as a mediator, was effective to develop phonological awareness and facilitated the change in the spelling hypothesis from pre-syllabic writing to syllabic writing. Therefore, stimulation programs used in children education should be carefully selected in order to guarantee better results.

Phase angle from BIA as a prognostic and nutritional status tool for children and adolescents undergoing hematopoietic stem cell transplantation.

BACKGROUND & AIMS: The phase angle (PA) has been considered a prognostic and nutritional status indicator in several clinical situations considering its use as a body cell mass estimate value. The aim of this study was to evaluate the association between PA and other methods of nutritional assessment, as well as its prognostic value for children and adolescents undergoing hematopoietic stem cell transplantation (HSCT). METHODS: The nutritional status of 67 patients and 35 controls was assessed by bioelectric impedance analysis and anthropometric measurements. The phase angle was calculated and expressed in degrees and standardized (SPA) according to reference values. The Kaplan-Meier method was used to calculate survival and Kappa coefficient to determine the concordance between the SPA and other parameters of nutritional assessment. The correlation was established by using Pearson's correlation analysis. RESULTS: SPA progressively decreased during the treatment. The agreement between SPA and the diagnosis of malnutrition was moderate to %ideal weight, %TSF and %AMC and weak for BMI and weight/age z-score. Patients who had severe weight loss after transplantation had lower levels of SPA as compared to the group that did not lose weight (p < 0.001). Patients who developed chronic graft-versus-host disease had lower levels of SPA (p = 0.02), as well as patients who had been using corticosteroids during the post-transplant phase (p = 0.03). In this case, there was an inverse correlation between drug dose and SPA (p = 0.01). Patients with SPA ≤ 0 SD had a lower survival time as compared to the group of patients with SPA > 0 SD (p = 0.02) and showed an increased risk of death of 5.1as compared to the other group (95% CI: 1.41-18.94). CONCLUSION: The present study suggests that SPA could be useful as an indicator of survival and nutritional status for patients undergoing HSCT.

Dietary supplementation with soybean lecithin increases pulmonary PAF bioactivity in asthmatic rats.

The prevalence of asthma has risen over the last few decades, and some studies correlate this with the greater consumption of polyunsaturated fatty acids (PUFAs). Dietary PUFAs are known to increase the susceptibility of biological structures to lipid peroxidation, a process by which platelet-activating factor (PAF)-like lipids can be generated. These lipids functionally mimic the bioactivity of PAF, a potent proinflammatory mediator that exerts several deleterious effects on asthma. Thus, this work aimed to investigate if dietary supplementation with soybean lecithin (SL), a source of PUFAs, increases lipid peroxidation and PAF bioactivity in lungs of asthmatic Wistar rats. Animals were separated into groups: control, supplemented, asthmatic, asthmatic supplemented with SL (2 g/kg body weight), asthmatic supplemented with SL (2 g/kg body weight) and DL-alpha-tocopheryl acetate (100 mg/kg body weight). Asthmatic inflammation increased pulmonary lipid peroxidation, PAF bioactivity, alveolar-capillary barrier permeability and production of nitric oxide. In asthmatics, dietary supplementation with SL promoted an increase in pulmonary lipid peroxidation and PAF bioactivity, and an increase in the permeability of the alveolar-capillary barrier. Moreover, the treatment of asthmatic rats with DL-alpha-tocopheryl acetate inhibited the lipid peroxidation and decreased the PAF bioactivity. Therefore, the increase in pulmonary PAF bioactivity in asthmatic individuals elicited by the dietary supplementation with SL probably involves the generation of PAF-like lipids. This finding suggests that PAF-like lipids may account for the deleterious effects of dietary PUFAs on asthma.