Motivation and adherence to psychosocial treatment for alcohol and drug use-related problems / Motivação e adesão ao tratamento psicossocial entre usuários de substâncias químicas

This is a prospective cohort study of 150 individuals attending a specialized health service for substance-related disorders. The study investigated the association between motivation to remain in treatment and treatment adherence. All service users were interviewed soon after admission to the treatment program and were followed-up during the first two months of treatment. A Cox Regression Model was used to estimate the hazard ratios for dropout during the two months following the admission interview. The results indicated that individuals with a primary-school education, lack of income, and low motivation toward treatment at the admission interview presented a higher risk of treatment dropout. This study showed the importance of motivation in changing addictive behavior and in adherence to treatment as essential factors for recovery.

A associação entre a motivação para manter-se em tratamento e a respectiva adesão foi estudada em uma coorte prospectiva de 150 usuários de um Centro de Atenção Psicossocial-Álcool e Drogas. Modelo de Regressão de Cox foi usado para estimar as razões de risco para o abandono do tratamento durante os dois primeiros meses após a entrevista de admissão. Os resultados sugerem que a pouca escolaridade (até a 9ª série), a ausência ou insuficiência de renda, bem como a baixa motivação no momento da entrevista de admissão são fatores de risco para o abandono do tratamento. As motivações para mudar o comportamento aditivo e para aderir ao tratamento foram identificadas como um dos fatores importantes para a recuperação de indivíduos com problemas relacionados ao uso de substâncias químicas.

Reencenação como experimento em política, ciência e psicologia: Bergson e Einsten sobre o tempo / Reenactment as an experiment in politics, science and psychology: Bergson and Einsten about time

Neste ensaio argumentamos que a adoção da reencenação como experimento metodológico permite uma dramática que articula efeitos inesperados para debates teóricos que, do ponto de vista da História das Ciências, estariam encerrados, produzindo rearticulações entre política, Ciência e Psicologia. Para abordar a reencenação como recurso metodológico, tomamos como fio condutor o debate sobre Bergson e Einstein a respeito do tempo. Pensar o debate entre Bergson e Einstein, ocorrido em 1922, a respeito do tempo, no qual o primeiro teria saído como o protagonista derrotado, sem se referir às soluções já instituídas sobre as controvérsias é uma pista metodológica importante para evitar polarizações e para conseguir percorrer os efeitos da noção de tempo no presente. A perspectiva da teoria ator-rede sobre o estudo de controvérsias permite recuperar o debate épico de 1922 e reinventá-lo por meio da reencenação, pois, ao trazer a concepção de rede como fluxos, circulações, alianças, movimentos, em vez de remeter a uma entidade cristalizada, dá lugar à reencenação como dispositivo de pensamento e de liberdade na criação de campos problemáticos inventivos. (AU)

In this essay we argue that the adoption of reenactment as a methodological experiment allows a dramatic one that articulates unexpected effects to theoretical debates that, from the point of view of the History of Sciences, would be closed, producing rearticulations between politics, Science and Psychology. In order to approach re-enactment as a methodological resource, we take as a thread the debate about Bergson and Einstein about time.. The debate between Bergson and Einstein in 1922 about time, in which the former would have emerged as the defeated protagonist, without referring to the solutions already instituted on the controversies is an important methodological clue to avoid polarization and to get through the effects of the notion of time in the present. The perspective of the actor-network theory on the study of controversies allows to recover the epic debate of 1922 and to reinvent it by means of the reenactment, therefore, in bringing the conception of network like flows, circulations, alliances, movements, instead of referring to A crystallized entity, gives way to reenactment as a thinking device. (AU)

En este ensayo argumentamos que la adopción de la reencenación como experimento metodológico permite una dramática que articula efectos inesperados para debates teóricos que, desde el punto de vista de la Historia de las Ciencias, estarían encerrados, produciendo rearticulaciones entre política, Ciencia y Psicología. Para abordar la reencenación como recurso metodológico, tomamos como hilo conductor el debate sobre Bergson y Einstein acerca del tiempo.. Argumentamos que pensar el debate entre Bergson y Einstein, ocurrido en 1922, con respecto al tiempo, en el que el primero habría salido como el protagonista derrotado, sin referirse a las soluciones ya instituidas sobre las controversias es una pista metodológica importante para evitar polarizaciones Y para lograr recorrer los efectos de la noción de tiempo en el presente. La perspectiva de la teoría actor-red sobre el estudio de controversias permite recuperar el debate épico de 1922 y reinventarlo por medio de la reencenación, pues, al traer la concepción de red como flujos, circulaciones, alianzas, movimientos, en lugar de remitir a la realidad una entidad cristalizada, presenta a la reencenación como dispositivo de pensamiento. (AU)

Construction and validation of content of one instrument to assess falls in the elderly.

OBJECTIVE: To develop and validate the content of the online Questionnaire for Fall Risk Assessment in the Elderly. METHODS: The instrument was developed based on the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization. Initially, the set of items was submitted to evaluation of judges (healthcare professionals with experience in elderly health), who could suggest inclusion or exclusion of questions from the instrument; they were also asked to rate each question according to the expected scope. At this stage, clarity and relevance levels for each item were evaluated, generating a total of Content Validity Coefficient (CtVC). RESULTS: Content Validity Coefficient values were satisfactory for both clarity (CtVC=0.76) and relevance (CtVC=0.82) of the questions. Next, a group of elderly volunteers participating in a socializing group evaluated the questionnaire for comprehension. The level of comprehension for each item was identified on a Likert scale, ranging from 0 to 5. The questionnaire was considered easy to understand by most participants (95%), with a mean of 4.75 (±0.11) points for each item. CONCLUSION: The instrument showed acceptable psychometric qualities for screening fall risk among the elderly population. Future studies shall investigate different validation aspects of construct for this measure.

Construction and validation of content of one instrument to assess falls in the elderly / Construção e validade de conteúdo de um instrumento para avaliação de quedas em idosos

ABSTRACT Objective To develop and validate the content of the online Questionnaire for Fall Risk Assessment in the Elderly. Methods The instrument was developed based on the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization. Initially, the set of items was submitted to evaluation of judges (healthcare professionals with experience in elderly health), who could suggest inclusion or exclusion of questions from the instrument; they were also asked to rate each question according to the expected scope. At this stage, clarity and relevance levels for each item were evaluated, generating a total of Content Validity Coefficient (CtVC). Results Content Validity Coefficient values were satisfactory for both clarity (CtVC=0.76) and relevance (CtVC=0.82) of the questions. Next, a group of elderly volunteers participating in a socializing group evaluated the questionnaire for comprehension. The level of comprehension for each item was identified on a Likert scale, ranging from 0 to 5. The questionnaire was considered easy to understand by most participants (95%), with a mean of 4.75 (±0.11) points for each item. Conclusion The instrument showed acceptable psychometric qualities for screening fall risk among the elderly population. Future studies shall investigate different validation aspects of construct for this measure.

RESUMO Objetivo Desenvolver e validar o conteúdo do Questionário on-line para Avaliação do Risco de Quedas em Idosos. Métodos A construção do instrumento foi baseada na Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) da Organização Mundial da Saúde. Inicialmente, o conjunto de itens foi submetido à avaliação de juízes (profissionais da saúde com experiência em saúde do idoso), que puderam sugerir questões a serem incluídas/excluídas do instrumento, além de verificarem cada questão do questionário, observando se as dimensões a serem avaliadas tinham sido abrangidas. Nesta etapa, os níveis de clareza e pertinência do conteúdo foram avaliados, gerando um total de Coeficiente de Validade de Conteúdo (CVCt). Resultados Os valores do Coeficiente de Validade de Conteúdo foram satisfatórios, tanto para a clareza (CVCt=0,76) quanto para a pertinência (CVCt=0,82) das questões. A seguir, a compreensão do questionário foi avaliada por idosos voluntários participantes de um grupo de convivência. O grau de compreensão para cada questão foi identificado em uma escala do tipo Likert, variando de 0 a 5. O questionário foi considerado de fácil compreensão pela maioria dos idosos (95%), com média de 4,75 (±0,11) pontos para cada questão. Conclusão O instrumento apresentou qualidades psicométricas aceitáveis para ser utilizado como ferramenta para rastrear o risco de quedas entre a população de idosos. Futuros estudos devem investigar diferentes aspectos da validade de construto desta medida.

Identifying frailty syndrome with tug test in home-dwelling elderly / Identificação da síndrome da fragilidade com o teste TUG em idosos residentes na comunidade

Introduction: Frailty is an important geriatric syndrome linked to increased mortality, morbidity and the risk of falls Detection of pre-frail and early frail individuals is essential to minimize adverse health outcomes, enabling effective interdisciplinary interventions. Objective: To identify frailty syndrome with Timed Up and Go (TUG) test in home-dwelling elderly. Methods: A home-based cross-sectional study was carried out with 322 elderly people living in a Southern city of Brazil. The Fried frailty criteria was used in order to assess the levels of frailty; the TUG score was investigated as a possible predictor of frailty. The diagnostic ability of different cut-off points for the TUG test was evaluated using the ROC curve. Results: ROC curve analysis for the TUG test, a value of eight seconds was identified as the good cut-off point for the screening of the frailty syndrome. The AUROC was 0.775, with a sensitivity of 85.0%, specificity of 59.5% and negative predictive value of 78.6%. Conclusions: Considering the limitations of a single test to accomplish the overall complexity of frailty syndrome, in the present study, TUG test was a good screening tool in home-dwelling elderly.

Introdução: A fragilidade é uma importante síndrome geriátrica associada ao aumento da mortalidade, morbidade e risco de quedas. A detecção de indivíduos pré-frágeis e frágeis precoces é essencial para minimizar os efeitos adversos à saúde, possibilitando intervenções interdisciplinares eficazes. Objetivo: Identificar a síndrome de fragilidade com o teste Timed Up and Go (TUG) em idosos domiciliares. Métodos: Estudo transversal de base domiciliar, com 322 idosos residentes em uma cidade do Sul do Brasil. O critério de fragilidade de Fried foi utilizado para avaliar os níveis de fragilidade; O teste TUG foi investigado como um possível preditor de fragilidade. A capacidade diagnóstica de diferentes pontos de corte para o teste TUG foi avaliada utilizando a curva ROC. Resultados: A análise da curva ROC para o teste TUG, identificou-se um valor de oito segundos como o bom ponto de corte para a triagem da síndrome de fragilidade. O AUROC foi de 0,775, com sensibilidade de 85,0%, especificidade de 59,5% e valor preditivo negativo de 78,6%. Conclusões: Considerando as limitações de um único teste para realizar a complexidade geral da síndrome de fragilidade, no presente estudo, o teste TUG foi uma boa ferramenta de rastreamento em idosos domiciliares.

Factors associated with post-diagnosis pregnancies in women living with HIV in the south of Brazil.

OBJECTIVES: To analyze the factors associated with the occurrence of pregnancies after the diagnosis of infection by HIV. METHODS: Cross-sectional study with women of a reproductive age living with HIV/AIDS cared for in the public services of the city of Porto Alegre, in southern Brazil. The data was analyzed from a comparison between two groups: women with and women without pregnancies after the diagnosis of HIV. Poisson regression models were used to estimate the reasons of prevalence (RP). RESULTS: The occurrence of pregnancies after the diagnosis of HIV is associated with a lower level of education (RP adjusted = 1.31; IC95%: 1.03-1.66), non-use of condoms in the first sexual intercourse (RP = 1.32; IC95%: 1.02-1.70), being 20 years old or less when diagnosed with HIV (RP = 3.48; IC95%: 2.02-6.01), and experience of violence related to the diagnosis of HIV (RP = 1.28; IC95%: 1.06-1.56). CONCLUSIONS: The occurrence of pregnancies after the diagnosis of infection by HIV does not indicate the exercise of the reproductive rights of the women living with HIV/AIDS because these pregnancies occurred in contexts of great vulnerability.

The Scale of Self-Efficacy Expectations of Adherence to Antiretroviral Treatment: A Tool for Identifying Risk for Non-Adherence to Treatment for HIV.

BACKGROUND: Identification of risk for non-adherence to treatment is a challenge for personalized care for people living with HIV. Standardized questionnaires of patients' expectations of their capability to overcome obstacles for treatment adherence may be used as a pre-screening for risk identification. A scale of self-efficacy expectations of adherence to antiretroviral treatment (SEA-ART scale) was previously developed. This study assesses the scale validity in predicting non-adherence to ART in adults living with HIV. METHODS AND FINDINGS: A prospective cohort study applied a 21-item SEA-ART scale to 275 adults in ART treatment at an outpatient public service for HIV in Southern Brazil. ART medications taken were assessed at one-month follow-up; ART adherence was devised as an intake of 95% and more of the prescribed medication. A SEA-ART score was calculated by adding up the scores of all items. Multivariable logistic regression and the Area Under the Receiver-Operating-Characteristic Curve (AUROC) were applied to examine the ability of the SEA-ART score to predict non-adherence at follow-up. The SEA-ART score varied from 21 to 105; mean 93.9; median 103.0. Non-adherence was 30.3% (n = 81/267). The odds of non-adherence was 8% lower for each unit increase of the SEA-ART score; after adjustment for age, sex, formal education and time in treatment (OR = 0.92; 95%CI 0.90-0.95; LRT for linear trend, p = 0.002). The AUROC was 0.80 (95%CI 0.73-0.87; p<0.001). The SEA-ART optimal cut-off value was 101, providing a sensitivity of 76.5%, a specificity of 73.1%, a positive predictive value of 55.4% and a negative predictive value of 87.7%. There was no evidence of difference in sensitivity, and specificity among groups organized by age, gender, formal education and time in treatment. CONCLUSIONS: The SEA-ART scale appears to have a good capacity to discriminate between adherents and non-adherents at one-month follow-up. Further studies should confirm these results in other populations.

Hans Gumbrecht: contribuições para pensar no exterior da clausura hermenêutica / Hans Gumbrecht: contributi ons to thinking outside the clausura hermeneutics

A pretensão maior da obra de Hans Ulrich Gumbrecht é virar a substancialidade do Ser contra a tese da universalidade da interpretação. O autor parte de uma crítica ao paradigma sujeito/objeto e concentra seus estudos no que ele nomeia de campo não hermenêutico, buscando pensar e alcançar a relação do homem com o mundo e com os outros homens, em uma dimensão que, não, exclusivamente, a do sentido. Os esforços de Gumbrecht se traduzem no que ele chama de sujar as mãos a sério, desenvolvendo uma série de conceitos para uma produção de presença, com base em uma leitura particular do conceito de ser no mundo, de Martin Heidegger. A partir dessa produção de presença, há desdobramentos, e outras noções emergem de suas argumentações– momentos de intensidade e Stimmung – com foco, sempre, em uma leitura da dimensão material, procurando restabelecer o contato do homem com as coisas do mundo (AU)

The biggest pretension of Hans UlrichGumbrecht with his work is to turn the substantiality of the Being against the thesis of the universality of interpretation. The author begins in a critical paradigm subject/object and concentrate your studies in what he calls “nonhermeneutic field”, trying to thinking and reach man’s relationship with the world and with other human beings, in a dimension which, is not exclusively, the dimension of the sense. Gumbrecht eff orts is translated in what he calls“get the hands dirty to heart”, developing a series of concepts for a “production of presence”, basedon a particular reading of the concept of “being in the world”, by Martin Heidegger. Based on this “production of presence”, exist consequences,and other notions emerge from the arguments - “Moments of intensity” and Stimmung - always focusing on a read of “physical dimension”, trying to restore contact between the man and “the things of theworld” (AU)

Hans Gumbrecht: contribuições para pensar no exterior da clausura hermenêutica / Hans Gumbrecht: contributions to thinking outside the clausura hermeneutics

A pretensão maior da obra de Hans Ulrich Gumbrecht é virar a substancialidade do Ser contra a tese da universalidade da interpretação. O autor parte de uma crítica ao paradigma sujeito/objeto e concentra seus estudos no que ele nomeia de campo não hermenêutico, buscando pensar e alcançar a relação do homem com o mundo e com os outros homens, em uma dimensão que, não, exclusivamente, a do sentido. Os esforços de Gumbrecht se traduzem no que ele chama de sujar as mãos a sério, desenvolvendo uma série de conceitos para uma produção de presença, com base em uma leitura particular do conceito de ser no mundo, de Martin Heidegger. A partir dessa produção de presença, há desdobramentos, e outras noções emergem de suas argumentações­ momentos de intensidade e Stimmung ­ com foco, sempre, em uma leitura da dimensão material, procurando restabelecer o contato do homem com as coisas do mundo

The biggest pretension of Hans UlrichGumbrecht with his work is to turn the substantiality of the Being against the thesis of the universality of interpretation. The author begins in a critical paradigm subject/object and concentrate your studies in what he calls "nonhermeneutic field", trying to thinking and reach man's relationship with the world and with other human beings, in a dimension which, is not exclusively, the dimension of the sense. Gumbrecht eff orts is translated in what he calls"get the hands dirty to heart", developing a series of concepts for a "production of presence", basedon a particular reading of the concept of "being in the world", by Martin Heidegger. Based on this "production of presence", exist consequences,and other notions emerge from the arguments - "Moments of intensity" and Stimmung - always focusing on a read of "physical dimension", trying to restore contact between the man and "the things of theworld"

[Development and validation of a social vulnerability index applied to public policies of the Unified Health System (SUS)]. / Desenvolvimento e validação de um índice de vulnerabilidade social aplicado a políticas públicas do SUS.

The article outlines the development and initial validation of a Social Vulnerability Index (SVI) including five social determinants of risk to health and demonstrates its application in the financing of primary care by the Unified Health System (SUS) in the State of Rio Grande do Sul. Municipal indicators of vulnerability relating to poverty and population dispersion were obtained from the 2010 population census of the Brazilian Institute of Geography and Statistics. Both exploratory and confirmatory factor analysis suggests that the five items can constitute a reliable and acceptable measurement scale. The SVI-5 was then generated based on the first main component, measuring municipal inequalities in social vulnerability relating to poverty and population in the territory in Z-scores. The external validity of SVI-5 was examined in relation to health outcomes using DATASUS 2007-2011 data, revealing that infant mortality and hospitalizations for conditions treatable by primary care are greater in more vulnerable municipalities The results suggest that the SVI-5 is a valid measure of inequalities in social vulnerability between municipalities, applicable to socially equitable policies in health.

Desenvolvimento e validação de um índice de vulnerabilidade social aplicado a políticas públicas do SUS / Development and validation of a social vulnerability index applied to public policies of the Unified Health System (SUS)

O artigo apresenta o desenvolvimento e a validação inicial de um Índice de Vulnerabilidade Social - IVS-5, incluindo cinco determinantes sociais de risco à saúde, e exemplifica sua aplicação no financiamento da atenção básica pelo Sistema Único de Saúde no Rio Grande do Sul. Indicadores municipais de vulnerabilidade relativa à pobreza e dispersão populacional foram obtidos do Censo do IBGE-2010. A análise fatorial exploratória e a análise fatorial confirmatória sugerem que os cinco itens podem constituir uma escala de medida cuja confiabilidade é aceitável. O IVS-5 foi então gerado a partir do primeiro componente principal, medindo, em escores Z, desigualdades municipais na vulnerabilidade social relativa à pobreza e dispersão populacional no território. A validade externa do IVS-5 foi examinada em relação a desfechos de saúde, usando dados do Datasus 2007-2011, mostrando que a mortalidade infantil e as hospitalizações por condições sensíveis à atenção básica são maiores em municípios mais vulneráveis. Os resultados sugerem que o IVS-5 é medida válida de desigualdades na vulnerabilidade social entre municípios, aplicável a políticas de equidade social e em saúde.

The article outlines the development and initial validation of a Social Vulnerability Index (SVI) including five social determinants of risk to health and demonstrates its application in the financing of primary care by the Unified Health System (SUS) in the State of Rio Grande do Sul. Municipal indicators of vulnerability relating to poverty and population dispersion were obtained from the 2010 population census of the Brazilian Institute of Geography and Statistics. Both exploratory and confirmatory factor analysis suggests that the five items can constitute a reliable and acceptable measurement scale. The SVI-5 was then generated based on the first main component, measuring municipal inequalities in social vulnerability relating to poverty and population in the territory in Z-scores. The external validity of SVI-5 was examined in relation to health outcomes using DATASUS 2007-2011 data, revealing that infant mortality and hospitalizations for conditions treatable by primary care are greater in more vulnerable municipalities The results suggest that the SVI-5 is a valid measure of inequalities in social vulnerability between municipalities, applicable to socially equitable policies in health.

Child maltreatment and later cognitive functioning: a systematic review / Maus-tratos na infância e funcionamento cognitivo tardio: uma revisão sistemática

This systematic review sought to assess the impact of child maltreatment on cognitive functioning. Seventeen papers from Medline, PsycINFO, Embase and Amed (1995-2011) databases were analyzed based on inclusion/exclusion criteria. The studies have shown that maltreatment during childhood has deleterious effects on cognitive functioning. Overall, adults or children/teenagers exposed to abuse during childhood performed poorly on tasks meant to assess verbal episodic memory, working memory, attention, and executive functions. We conclude that child maltreatment is a risk factor for short and long-term development due to potential adverse effects on cognitive functioning.(AU)

Este estudo buscou investigar os efeitos da exposição a maus-tratos sobre o funcionamento cognitivo através do método de revisão sistemática da literatura. Pelos bancos de dados Medline, PsycINFO, Embase e Amed (1995-2011), a partir de critérios de inclusão/exclusão, foram recuperados e analisados 17 trabalhos.Os estudos mostraram que há um efeito deletério de experiências de maus-tratos na infância no funcionamento cognitivo. De maneira geral, adultos ou crianças/adolescentes que sofreram maus-tratos na infância demonstraram um perfil cognitivo inferior em tarefas que examinaram memória verbal episódica, memória de trabalho, atenção e componentes das funções executivas. Conclui-se que maus-tratos sofridos na infância constituem fatores de risco para o desenvolvimento, tanto a curto quanto a longo-prazo, pois podem acarretar prejuízos cognitivos.(AU)

Child maltreatment and later cognitive functioning: a systematic review / Maus-tratos na infância e funcionamento cognitivo tardio: uma revisão sistemática

This systematic review sought to assess the impact of child maltreatment on cognitive functioning. Seventeen papers from Medline, PsycINFO, Embase and Amed (1995-2011) databases were analyzed based on inclusion/exclusion criteria. The studies have shown that maltreatment during childhood has deleterious effects on cognitive functioning. Overall, adults or children/teenagers exposed to abuse during childhood performed poorly on tasks meant to assess verbal episodic memory, working memory, attention, and executive functions. We conclude that child maltreatment is a risk factor for short and long-term development due to potential adverse effects on cognitive functioning...

Este estudo buscou investigar os efeitos da exposição a maus-tratos sobre o funcionamento cognitivo através do método de revisão sistemática da literatura. Pelos bancos de dados Medline, PsycINFO, Embase e Amed (1995-2011), a partir de critérios de inclusão/exclusão, foram recuperados e analisados 17 trabalhos.Os estudos mostraram que há um efeito deletério de experiências de maus-tratos na infância no funcionamento cognitivo. De maneira geral, adultos ou crianças/adolescentes que sofreram maus-tratos na infância demonstraram um perfil cognitivo inferior em tarefas que examinaram memória verbal episódica, memória de trabalho, atenção e componentes das funções executivas. Conclui-se que maus-tratos sofridos na infância constituem fatores de risco para o desenvolvimento, tanto a curto quanto a longo-prazo, pois podem acarretar prejuízos cognitivos...

Saber formal e saber local: convergências e assimetrias / Formal knowledge and local knowledge: similarities and asymmetries

O texto busca problematizar convergências e assimetrias relacionadas ao saber formal e aos saberes locais. Suspeita-se que a assimetria entre os saberes referidos ocorre no processo de difusão, e não no momento de sua criação. Aí haveria uma convergência entre o saber formal e os saberes locais. Outra suspeita é que o papel preponderante para a ocorrência de assimetrias ou de marcação de fronteiras seria propiciado pelo ambiente físico-social, por meio dos processos em deriva que marcam o espalhamento de toda criação.O que o texto apresenta de novo é que seus resultados surgem não apenas de uma revisão bibliográfica, ou de um discurso meramente especulativo a respeito da relação entre saber local e formal, mas também toma por base vivências dos autores, observações de campo e mesmo experimentações monitoradas e controladas.

Saber formal e saber local: convergências e assimetrias / Formal knowledge and local knowledge: similarities and asymmetries

O texto busca problematizar convergências e assimetrias relacionadas ao saber formal e aos saberes locais. Suspeita-se que a assimetria entre os saberes referidos ocorre no processo de difusão, e não no momento de sua criação. Aí haveria uma convergência entre o saber formal e os saberes locais. Outra suspeita é que o papel preponderante para a ocorrência de assimetrias ou de marcação de fronteiras seria propiciado pelo ambiente físico-social, por meio dos processos em deriva que marcam o espalhamento de toda criação.O que o texto apresenta de novo é que seus resultados surgem não apenas de uma revisão bibliográfica, ou de um discurso meramente especulativo a respeito da relação entre saber local e formal, mas também toma por base vivências dos autores, observações de campo e mesmo experimentações monitoradas e controladas

[Quality of life of women recovering from breast cancer after being subjected to mastectomies compared with those who had conservative surgery: a review of the literature]. / Qualidade de vida em mulheres submetidas à mastectomia comparada com aquelas que se submeteram à cirurgia conservadora: uma revisão de literatura.

This study reviews the literature on the quality of life (QoL) of women with breast cancer who have been subjected to mastectomy, compared with those who had conservative surgery. Eight random controlled trials were selected. The studies were compared with respect to the moment quality of life was assessed (whether during or after treatment for breast cancer), the measurement tools of quality of life used, and also the methodology and results achieved. The results of four studies suggest a stronger negative impact in the QoL of mastectomized women; the other four studies showed no difference between the groups in terms of QoL. Objective measurements of quality of life may help identify potentially critical situations of daily life and assist in planning actions to promote health among women who have been subjected to breast cancer surgery.

Qualidade de vida em mulheres submetidas à mastectomia comparada com aquelas que se submeteram à cirurgia conservadora: uma revisão de literatura / Quality of life of women recovering from breast cancer after being subjected to mastectomies compared with those who had conservative surgery: a review of the literature

Este estudo revisa a literatura sobre a qualidade de vida (QV) de mulheres com câncer de mama submetidas à mastectomia comparadas àquelas que realizaram cirurgia conservadora. A seleção final resultou em oito ensaios clínicos randomizados. Os estudos foram comparados quanto ao momento em que a QV foi avaliada, se durante ou após o tratamento, quanto aos instrumentos que mensuraram a QV, e quanto à metodologia e resultados. Os resultados de quatro estudos apontam para maior impacto negativo na QV em mulheres mastectomizadas; outros quatro estudos não evidenciam diferenças na QV entre os grupos que passaram pelos dois tipos de intervenção. Medidas objetivas de QV poderão ajudar a identificar situações potencialmente difíceis da vida diária e auxiliar no planejamento de ações de promoção da saúde de mulheres que passaram por cirurgia para câncer de mama.

This study reviews the literature on the quality of life (QoL) of women with breast cancer who have been subjected to mastectomy, compared with those who had conservative surgery. Eight random controlled trials were selected. The studies were compared with respect to the moment quality of life was assessed (whether during or after treatment for breast cancer), the measurement tools of quality of life used, and also the methodology and results achieved. The results of four studies suggest a stronger negative impact in the QoL of mastectomized women; the other four studies showed no difference between the groups in terms of QoL. Objective measurements of quality of life may help identify potentially critical situations of daily life and assist in planning actions to promote health among women who have been subjected to breast cancer surgery.

A Disease Register for ME/CFS: Report of a Pilot Study.

BACKGROUND: The ME/CFS Disease Register is one of six subprojects within the National ME/CFS Observatory, a research programme funded by the Big Lottery Fund and sponsored by Action for ME. A pilot study in East Anglia, East Yorkshire, and London aimed to address the problem of identifying representative groups of subjects for research, in order to be able to draw conclusions applicable to the whole ME/CFS population.While not aiming for comprehensive population coverage, this pilot register sought to recruit participants with ME/CFS in an unbiased way from a large population base. Those recruited are constituting a cohort for long-term follow-up to shed light on prognosis, and a sampling frame for other studies. FINDINGS: Patients with unidentified chronic fatigue were identified in GP databases using a READ-code based algorithm, and conformity to certain case definitions for ME/CFS determined. 29 practices, covering a population aged 18 to 64 of 143,153, participated.510 patients with unexplained chronic fatigue were identified. 265 of these conformed to one or more case definitions. 216 were invited to join the register; 160 agreed. 96.9% of participants conformed to the CDC 1994 (Fukuda) definition; the Canadian definition defined more precisely a subset of these. The addition of an epidemiological case definition increased case ascertainment by approximately 4%. A small-scale study in a specialist referral service in East Anglia was also undertaken.There was little difference in pattern of conformity to case definitions, age or sex among disease register participants compared with subjects in a parallel epidemiological study who declined to participate.One-year follow-up of 50 subjects showed little change in pain or fatigue scores. There were some changes in conformity to case definitions. CONCLUSIONS: Objective evaluation indicated that the aim of recruiting participants with ME/CFS to a Disease Register had been fulfilled, and confirmed the feasibility of our approach to case identification, data processing, transmission, storage, and analysis. Future developments should include expansion of the ME/CFS Register and its linkage to a tissue sample bank and post mortem tissue archive, to facilitate support for further research studies.

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in adults: a qualitative study of perspectives from professional practice.

BACKGROUND: Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) can cause profound and prolonged illness and disability, and poses significant problems of uncertainty for healthcare professionals in its diagnosis and management. The aim of this qualitative study was to explore the nature of professional 'best practice' in working with people with CFS/ME. METHODS: The views and experiences of health care practitioners (HCPs) were sought, who had been judged by people with CFS/ME themselves to have been particularly helpful and effective. Qualitative semi-structured interviews following a topic guide were carried out with six health care practitioners. Interviews were audio-recorded, transcribed and subject to thematic analysis. RESULTS: Five main themes were developed: 1) Diagnosis; 2) Professional perspectives on living with CFS/ME; 3) Interventions for treatment and management; 4) Professional values and support for people with CFS/ME and their families; 5) Health professional roles and working practices. Key findings related to: the diagnostic process, especially the degree of uncertainty which may be shared by primary care physicians and patients alike; the continued denial in some quarters of the existence of CFS/ME as a condition; the variability, complexity, and serious impact of the condition on life and living; the onus on the person with CFS/ME to manage their condition, supported by HCPs; the wealth of often conflicting and confusing information on the condition and options for treatment; and the vital role of extended listening and trustful relationships with patients. CONCLUSIONS: While professional frustrations were clearly expressed about the variability of services both in primary and specialist care and continuing equivocal attitudes to CFS/ME as a condition, there were also strong positive messages for people with CFS/ME where the right services are in place. Many of the findings from these practitioners seen by their patients as helping them more effectively, accord with the existing literature identifying the particular importance of listening skills, respect and trust for establishing a therapeutic relationship which recognises key features of the patient trajectory and promotes effective person-centred management of this complex condition. These findings indicate the need to build such skills and knowledge more systematically into professional training informed by the experience of specialist services and those living with the condition.

The expressed needs of people with chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review.

BACKGROUND: We aimed to review systematically the needs for support in managing illness and maintaining social inclusion expressed by people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) METHODS: We carried out a systematic review of primary research and personal ('own') stories expressing the needs of people with CFS/ME. Structured searches were carried out on Medline, AMED, CINAHL, EMBASE, ASSIA, CENTRAL, and other health, social and legal databases from inception to November 2007. Study inclusion, data extraction and risk of bias were assessed independently in duplicate. Expressed needs were tabulated and a conceptual framework developed through an iterative process. RESULTS: Thirty two quantitative and qualitative studies, including the views of over 2500 people with CFS/ME with mainly moderate or severe illness severity, met the inclusion criteria. The following major support needs emerged: 1) The need to make sense of symptoms and gain diagnosis, 2) for respect and empathy from service providers, 3) for positive attitudes and support from family and friends, 4) for information on CFS/ME, 5) to adjust views and priorities, 6) to develop strategies to manage impairments and activity limitations, and 7) to develop strategies to maintain/regain social participation. CONCLUSIONS: Although the studies were heterogeneous, there was consistent evidence that substantial support is needed to rebuild lives. Gaining support depends - most importantly - on the ability of providers of health and social care, colleagues, friends and relatives, and those providing educational and leisure services, to understand and respond to those needs.