Altered expression of COX-2 and TNF-α in patients with hepatocellular carcinoma.

BACKGROUND AND AIM: hepatocellular carcinoma is a type of cancer related with inflammation, as 90% of cases develop in a chronic inflammation condition. Excess inflammation can affect tissue homeostasis. Cytokines and inflammatory mediators are immunological components that can influence the functioning of cells and tissues. In addition, the estrogen receptor appears to play an important role in hepatocarcinogenesis. The aim of the study was to evaluate the expression of inflammatory markers and ER in patients with hepatocellular carcinoma. METHODS: data from 143 patients of ISCMPA were analyzed. Immunohistochemistry was performed of cyclooxygenase-2 enzyme (COX-2), nuclear factor kappa B (NF-κB), tumor necrosis factor alpha (TNF-α) and ER in paraffin-embedded hepatic tissue. The percentage of the stained area, intensity of staining and of the number of ER positive nuclei were evaluated using the ImageJ 1.50 software. RESULTS AND CONCLUSION: there was a significant difference between the groups in terms of the percentage of marked area (p = 0.040) for COX-2 and the intensity of staining of TNF-α (p = 0.030). No significant differences were observed in any of other parameters evaluated. In conclusion, COX-2 and TNF-α are possible markers that should be further studied to determine their immunohistochemical profile and role in HCC development.

Portraits of interprofessional collaborative practice in the primary health care teams. / Retratos da prática interprofissional colaborativa nas equipes da atenção primária à saúde.

OBJECTIVE: To analyze the Interprofessional Collaborative Practice in Health from the perspective of professionals of the Primary Health Care teams. METHODOLOGY: Participatory, qualitative, exploratory-descriptive study, performed in Basic Health Units of a municipality in the northwest of the Paraná, with 88 professionals of thw Primary Health Care teams. The data collection took place from February to April 2017, through the "Photovoice" data collection and analysis technique. RESULTS: Two categories of analysis emerged: A picture of the process of constructing concepts of the Collaborative Interprofessional Health Practice; A picture of the configurations of the Collaborative Interprofessional Health Practice in the work process among the Primary Health Care teams. FINAL CONSIDERATIONS: It was pointed out that Collaborative Interprofessional Practice is a new term and little explored in the Primary Health Care scenario, but the reflections about the photos allowed the assimilation, the thematic approximation and the collective construction of knowledge validated by the practice.

Educational action research on Facebook®: combining leisure and learning. / Pesquisa-ação educativa no Facebook®: aliando lazer e aprendizado.

OBJECTIVE: To analyse the path of dialogical education in leisure and mental health in social media. METHOD: Action research based on the theoretical-methodological framework of Paulo Freire, conducted with 11 nursing students of a public university in the state of Paraná, Brazil, during seven days of June 2015, in a closed group on Facebook®. The dialogues were called, 'Virtual Culture Circles' and preceded by self-administered questionnaires that addressed the relationship between leisure and mental health. The data were analysed in an interpretive way, using the encoding and decoding proposed by Freire. RESULTS: The students related leisure to pleasurable activities and quality of life; however, it is not widely or critically practiced in their personal lives or education. CONCLUSIONS: The Virtual Culture Circles provided emancipatory dialogues and a critical analysis of the subject matter, with possible repercussions on the personal and professional lives of the subjects.

Home intervention as a tool for nursing care: evaluation of the satisfaction of the elderly. / Intervenção domiciliar como ferramenta para o cuidado de enfermagem: avaliação da satisfação de idosos.

OBJECTIVE: To evaluate the results of home nursing interventions according to the satisfaction of the elderly users. METHODS: Ex-post facto evaluative, qualitative and descriptive research, conducted from November 2015 to January 2016 with 12 dependent elderly individuals accompanied by an extension project in the city of Maringá, PR, Brazil. Data were collected after home interventions based on the Single-User Treatment Project, by means of semi-structured interviews subjected to content analysis and the theoretical framework of Donabedian. RESULTS: The following thematic categories emerged: "home nursing intervention: synonymous with joy, distraction and bonding" and" home nursing intervention: health and lifestyle transformations". CONCLUSION: The home nursing interventions had positive results that signal the quality of the provided care.

Giving meaning to internalized violence throughout life by older adults living in rural areas.

OBJECTIVES: to understand the meanings of violence internalized throughout life by older adults living in rural areas. METHODS: a qualitative study, anchored in the Symbolic Interactionism theoretical framework and the Grounded Theory methodological framework in the constructivist aspect. Data collection occurred through individual interviews. Data were coded using the Atlas.ti software. RESULTS: it was possible to identify that the context of rural areas strengthens patriarchy culture as well as contributing to violence silence and naturalization. It was also found that violence is a product of social inequality and gender inequality. FINAL CONSIDERATIONS: older adults living in rural areas internalized the violence suffered in a unique way, and this scenario's specific aspects can increase intra-family abuse, as there is a patriarchal culture that promotes social and gender inequality.

The self-care process of community-dwelling older adults during the COVID-19 pandemic.

OBJECTIVES: to understand the self-care process of community-dwelling older adults during the COVID-19 pandemic. METHODS: this is an explanatory study with a qualitative approach based on the constructivist Grounded Theory, carried out with 18 community-dwelling older adults. Data collection took place through interviews and content was analyzed through initial and focused coding. RESULTS: two categories were obtained: "Building connections to support self-care practices" and "Living with the risk group stigma". From their interaction, the phenomenon "Performing self-care in old age during the COVID-19 pandemic" emerged. FINAL CONSIDERATIONS: it was possible to identify how older adults' experiences curing the COVID-19 pandemic had repercussions on their self-care process, being influenced by factors such as information about the disease and the impacts of risk group stigmas.

The Institutionalisation of Brazilian Older Abused Adults: A Qualitative Study among Victims and Formal Carers.

Abuse against elders is acknowledged as a severe and pervasive problem in society. If support services are not tailored to the victims' knowledge or perceived needs, the intervention is likely to be unsuccessful. This study aimed to explore the experience of institutionalisation of abused older people from the perspective of the victims and their formal carers in a Brazilian social shelter. A qualitative descriptive study was performed with 18 participants, including formal carers and older abused persons admitted to a long-term care institution in the south of Brazil. Qualitative thematic analysis was used to analyse the transcripts of semi-structured qualitative interviews. Three themes were identified: (1) personal, relational, and social bonds: broken or weakened; (2) denial of the violence suffered; and (3) from imposed protection to compassionate care. Our findings provide insights for effective prevention and intervention measures in elder abuse. From a socio-ecological standpoint, vulnerability and abuse might be averted at the community and societal levels (e.g., education and awareness of elder abuse) by creating a minimum standard for the care of older individuals (e.g., law or economic incentives). Further study is needed to facilitate recognition and raise awareness among individuals in need and those offering assistance and support.

Matrix support in specialized care backed by the care model for chronic conditions: evaluative research.

OBJECTIVE: To analyze the matrix support for health teams in Specialized Outpatient Care, according to the Chronic Conditions Care Model. METHOD: Qualitative evaluative research, conducted by the Chronic Conditions Care Model, carried out from February to July 2020. For data collection, interviews were carried out with 21 health professionals, assistance observation and document analysis of the service. Data were analyzed by data triangulation, with the aid of the MAXQDA software, respecting all ethical aspects. RESULTS: The matrix support provided approximation between Primary and Secondary Care; implemented case management and qualified comprehensive care for people with chronic conditions. Weaknesses in communication and understanding of the theoretical bases of matrix support were obstacles to the proper implementation of matrix strategies. FINAL CONSIDERATION: Matrix support for specialized health teams qualified the professional care given to people with chronic conditions treated at the service.

Meanings and Experiences of Prisoners and Family Members Affected by the COVID-19 Pandemic in a Brazilian Prison Unit: A Grounded Theory Analysis.

Worldwide, the COVID-19 pandemic represented a health emergency for prisons. This study sought to understand the meanings and experiences through the narratives of prisoners and family members affected by the COVID-19 pandemic in the context of a maximum-security state penitentiary complex in southern Brazil. For this purpose, a qualitative study was developed based on the methodological framework of constructivist grounded theory. Data were collected between February and August 2022 through individual in-depth interviews and field notes. The sample consisted of 41 participants: 28 male prisoners, and 13 family members. Guided by the Charmaz method of grounded theory analysis, the study afforded the core category "Feeling trapped in prison during the COVID-19 pandemic" with three interrelated phases: "Triggering", "Escalating", and "Readjustment". The "Triggering" phase refers to COVID-19-related elements or events that triggered certain reactions, processes, or changes in prison. During the "Escalating" phase, participants became overwhelmed by the suffering caused by incarceration and the pandemic crisis. The "Readjustment" phase involved adapting, reorienting, or reformulating previous approaches or strategies for dealing with a specific situation. Prisons faced complex challenges during the pandemic and were forced to prioritize protecting public health. However, the measures adopted must be carefully evaluated, ensuring their needs and that they are based on scientific evidence. The punitive approach can undermine inmate trust in prison authorities, making it difficult to report symptoms and adhere to preventive measures.

Illness Experiences of Brazilian People Who Were Hospitalized Due to COVID-19 and Faced Long COVID Repercussions in Their Daily Life: A Constructivist Grounded Theory Study.

Long COVID is a multisystem condition that has multiple consequences for the physical, mental, and social health of COVID-19 survivors. The impact of the long COVID condition remains unclear, particularly among middle-aged and older adults, who are at greater risk than younger people of persisting symptoms associated with COVID-19. Therefore, we aimed to understand the experiences of middle-aged and older people who had been hospitalized for COVID-19 and the repercussions of long-term COVID symptoms in their daily lives. A qualitative study was carried out, adopting the framework of the constructivist grounded theory (CGT) proposed by Kathy Charmaz. Fifty-six middle-aged and older adult participants from the southern region of Brazil were recruited. Data were gathered from semi-structured telephone interviews. Concomitantly a comparative analysis was performed to identify categories and codes using the MaxQDA® software (version 2022). Three subcategories were identified: (1) experiencing COVID-19 in the acute phase; (2) oscillating between 'good days' and 'bad days' in long COVID; and (3) (re)constructing identity. These concepts interact with each other and converge upon the central category of this study: recasting oneself to the uniqueness of the illness experience of long COVID. Our findings provided insights related to the disruption in the lives of long COVID-19 sufferers who still live with persistent symptoms of the disease, including physical, social, family, emotional and spiritual repercussions. Likewise, this study may aid in developing friendly and welcoming social environments, lowering stigma and prejudice towards patients with long COVID, and fostering prompt and suitable policy support and mental health care for these individuals.

Evaluation of the C3435T polymorphism in the MDR1 gene in patients with hepatocellular carcinoma.

INTRODUCTION: Considering the high prevalence of liver tumors and the impact on patient survival, a greater understanding of the biological behavior of those tumors if of great importance. The multidrug resistance gene (MDR1) may present as single nucleotide polymorphism (SNP) which can affect the expression and activity of P-glycoprotein (Pgp), and high expression of Pgp has been associated with a worse prognosis in affected patients. OBJECTIVE: To correlate the C3435T polymorphism in the MDR1 gene with the immunohistochemical expression of Pgp. MATERIAL AND METHODS: A total of 67 samples from patients with diagnosis of hepatocellular carcinoma (HCC), collected in the period from 2000 to 2009, were analyzed. The polymorphism in the MDR1 gene was determined by the technique of allele-specific real time PCR using TaqMan assay, and the expression of protein Pgp was evaluated by immunohistochemistry. RESULTS: Among the samples evaluated, 56 (83.6%) were from male patients and 11 (16.4%) from females. Mean age was 60.6 years (± 8.8), ranging from 37 to 85 years. The etiology of the HCC was related to hepatitis C virus infection (HCV) in 31 (46.3%) of cases, followed by hepatitis C virus infection + alcohol in 24 cases (35.8%), alcohol in 4 cases (6)%, hepatitis B virus (HBV) in 4 cases (6%) and other factors in 4 cases (6%). Liver transplantation was performed in 48 cases (71.6%) and hepatectomia in 19 cases (28.4%). The genotypes CC, CT and TT showed frequencies of 25.4%, 41.8% and 32.8%, respectively, and the allele frequencies were 46.3% for allele C and 53.7% for allele T. The expression of Pgp in over 75% of the cells was significantly more frequent in tumor tissue. On the other hand, a low expression of Pgp, in less than 25% of the cells, was significantly more frequent in non-tumor tissue. The Pgp expression in more than 50% of tumor cells of individuals with genotypes CC, CT and TT was 15.7%, 51.0% and 33.3%, respectively, and was significantly higher when in the presence of allele T (p = 0.002). CONCLUSION: The presence of the polymorphic allele T is related to increased expression of Pgp protein in patients with HCC.

Improvement of older women's sexuality through emancipatory education.

The purpose of this action research (AR) was to explore the ways in which sexuality is experienced daily and to improve the expression of older women's sexuality. The pedagogy of autonomy as proposed by the Brazilian educator Paulo Freire theoretically supported this AR, with the participation of six older adult women living in a rural setting in southwest Brazil. The older women's experiences regarding sexuality, their concerns, and their educational demands could be summarized through five phrases: the improvement of self-esteem as a way to promote sexuality; sexuality impaired by loneliness and lack of affection; men's sexual satisfaction seen as a woman's obligation; women's sexuality controlled by the society; and relinquishment of the companion to attend to the expectations of family members. Dialogical and participative educational approaches and continuous observation-participation strategies were performed to support the women's care and educational requirements.

[Leisure and mental health in people with hypertension: convergence in health education]. / O lazer e a saúde mental das pessoas hipertensas: convergência na educação para a saúde.

People with hypertension constantly deal with issues related to mental health due to the psychosocial determinants of this illness, and leisure is an important control strategy. The objective of this study was to promote health education to a group of hypertensive patients, through research-action, based on critical-social pedagogy, and taking into consideration the participants' perception of leisure. Educational activities were conducted and, following, an evaluation was performed regarding the subjects' opinion about the impact of leisure on their lives and mental health. The group perceived leisure as a coping strategy for loneliness and also as a late development of independence; it was also regarded as a means of socialization and as a promotion of mental health. These perceptions revealed two themes: aging, leisure, and chronic disease; and knowledge and leisure experiences. Educational actions, such as group dynamics and discussions, were planned considering these themes with the purpose of providing the necessary conditions for socializing and exchanging experiences.

Knowledge and practices of elderly women about fall prevention.

OBJECTIVE: Unveil the knowledge and practices of elderly women about the prevention of falls. Methods: Qualitative, exploratory-descriptive research, developed with eight elderly women from a community group at a Basic Health Unit in the state of Paraná. Data were obtained through individual interviews, submitted to lexicographical analysis through the Descending Hierarchical Classification using the IRaMuTeQ® software, and discussed with the theoretical-analytical framework of Paulo Freire's Praxis. RESULTS: Six classes emerged: 1. Experiences, background, and practices of Health Education; 2. Advancing age as a factor for the occurrence of falls; 3. Fall prevention practices; 4. Falls and their consequences; 5. Importance of preventive practices; and 6. Environmental and behavioral risk factors in the elderly's home. CONCLUSION: Knowledge and practices were learned from experiences, background, and educational practices in Primary Health Care, implemented in praxis and mediated by concrete reality and emancipatory dialogue.

Adolescent health in the Covid-19 pandemic: a construction through Nola Pender's model.

OBJECTIVE: To construct perspectives of adolescent health in the face of the Covid-19 pandemic, through emancipatory dialogues guided by Nola Pender's Model. METHOD: This is a participatory research based on the methodology of Psychodramatic Pedagogy of María Alicia Romaña. The action was carried out with 17 school-aged adolescents from a city in the Center-West Region of Brazil. The theoretical-analytical framework used was Nola Pender's Health Promotion Model, and the data collected were discussed based on Paulo Freire's dialogical framework. RESULTS: The workshop allowed the sharing of individual characteristics and experiences of adolescents regarding the reality experienced in the pandemic, highlighting mental health as a main theme for health promotion. FINAL CONSIDERATIONS: It was construct, along with the adolescents, important knowledge about health in the pandemic, supporting the thematic reflection and the elaboration of timely health promotion interventions.

The Chronic Care Model and its implications for Specialized Outpatient Care.

OBJECTIVE: to assess the Chronic Care Model implementation in Specialized Outpatient Care and its repercussions for health care. METHODS: qualitative evaluative research, conducted by the Chronic Care Model. We used observation techniques, document analysis and interviews with 21 health professionals from specialized care. Analysis was conducted by triangulation, with the aid of MAXQDA software for initial and focused coding. All ethical aspects were respected. RESULTS: professionals recognized that the model reorganized service care and administrative practices, presenting positive repercussions for the health of people assisted. The absence of continuing education for service professionals compromised the complete model implementation. FINAL CONSIDERATIONS: the implementation, even if partial, of the model brings contributions to service improvement. The weaknesses that are still present are compatible with professionals' difficulty in distancing themselves from the biomedical model.

Lethal violence against women in southern Brazil: Spatial analysis and associated factors.

OBJECTIVE: estimate the risk for the occurrence of lethal violence against women and to identify the associated factors in the state of Paraná. METHOD: ecological study of deaths of women aged between 15 and 59 years, victims of aggression. The units of analysis were the cities of Paraná. Latent Bayesian Gaussian models with negative binomial probability distribution were used. The modeling considered intercept, spatial random effects and covariates, performed with the deterministic Integrated Nested Laplace Approximations approach. RESULTS: There was a positive association between lethal violence against women and the percentage of mothers who were heads of households. Finally, male homicide rates, rates of non-lethal violence against women and the cities with women mayors and councilors were also associated. CONCLUSION: This type of violence was associated with low education, structural violence and the participation of women in politics.

Vulnerability, family violence and institutionalization: narratives for elderly and professionals in social welcome center.

OBJECTIVE: To know the institutionalization process and the functional clinical condition of elderly people who suffered family violence, from the perspective of the elderly and professionals. METHODS: Qualitative, which used oral history as a data collection technique. Held in a long-term institution for the elderly, using a semi-structured interview script. The participants were three nursing technicians, two nursing assistants, five caregivers for the elderly and eight elderly. Thematic analysis was performed with the aid of the MAXQDA® software. RESULTS: Three categories were identified: The condition of vulnerability and the care needs of the elderly, indicating welcoming as an intervention; Suffering and denial of conditions of vulnerability; and Situations of family violence and the positive aspects of reception. CONCLUSIONS: Long-term institutions are considered important spaces for comprehensive and humanized care, as well as essential for the protection of elderly victims of family violence.

Professional competency for elder care: perception among professors, nursing students, and nurses.

OBJECTIVE: to know the perception of nurses, undergraduate students, and professors about the competencies for professional nurses in elder care. METHODS: this is a qualitative analytical study developed with six professors, four nurses, and 12 nursing students. Data were collected through semi-structured interviews and analyzed using Fiorin's Discourse technique, with support from the MAXQDA software. RESULTS: the competencies identified included knowledge of theories and general concepts of gerontology, communication, listening, leadership, teamwork, proactivity, respect, and empathy. FINAL CONSIDERATIONS: knowing the competencies contributes to understanding the aging process and qualifying nurses for elder care.

Dialogic educational practices in the context of child intoxication: an approach based on Paulo Freire.

OBJECTIVE: To analyze the knowledge and practices of education of Family Health Strategy professionals regarding child intoxication for the autonomy and empowering of the families. METHODS: Qualitative research, carried out through semistructured interviews with 50 professionals from the Family Health Strategy of a city in the Northwest of Paraná. Data was problematized using Paulo Freire's sociocultural approach and its concepts of dialogism and autonomy. RESULTS: The statements showed the many ways in which the care for child intoxication is perceived and their relations with educational action, but these were traditional educational practices, with elements focused on the dissemination of information about health-disease, probably because the dialogic approach is still abstract and has no interface with the concrete practices. FINAL CONSIDERATIONS: The education knowledge and practices of the professionals for the autonomy and empowering of families suggested that there is a transition stage between the biomedical model, focused on a cure, and the dialogical one.