Family knowledge about the legal rights of children and adolescents with cancer.

OBJECTIVE: Identify the knowledge of family members of children and adolescents with cancer about their legal rights, difficulties, and concessions to ensure them. METHOD: Quantitative study, survey type, of intersectional design. A questionnaire drawn up by the researchers was applied in order to characterize the minor and their family and also to identify the family's knowledge about legal rights. Descriptive statistics were used to analyze data. RESULTS: 61 family members who participated know some more rights to the detriment of others and are especially motivated to search for information when negative impacts on the financial life increase, with repercussions beyond family health. CONCLUSION: the studied population requires more information and demands knowledge about some rights guaranteed by law. Guidance on rights empowers the family and guarantees the necessary care, searching to have an intersectoral action qualify care and assist in restructuring family dynamics to deal with chronic conditions.

Family knowledge about the legal rights of children and adolescents with cancer / Conocimiento familiar sobre los derechos legales de niños y adolescentes con cáncer / Conhecimento familiar sobre direitos legais de crianças e adolescentes com câncer

ABSTRACT Objective: Identify the knowledge of family members of children and adolescents with cancer about their legal rights, difficulties, and concessions to ensure them. Method: Quantitative study, survey type, of intersectional design. A questionnaire drawn up by the researchers was applied in order to characterize the minor and their family and also to identify the family's knowledge about legal rights. Descriptive statistics were used to analyze data. Results: 61 family members who participated know some more rights to the detriment of others and are especially motivated to search for information when negative impacts on the financial life increase, with repercussions beyond family health. Conclusion: the studied population requires more information and demands knowledge about some rights guaranteed by law. Guidance on rights empowers the family and guarantees the necessary care, searching to have an intersectoral action qualify care and assist in restructuring family dynamics to deal with chronic conditions.

RESUMEN Objetivo: Identificar el conocimiento de familiares de niños y adolescentes con cáncer sobre sus derechos legales, dificultades y facilidades para asegurarlos. Método: Estudio cuantitativo, del tipo survey, de delineamiento interseccional. Aplicó encuesta elaborada por las investigadoras para caracterización del menor y su familia, e identificación del conocimiento del familiar sobre derechos legales. Utilizó estadística descriptiva para analizar los datos. Resultados: Participaron 61 familiares. Los familiares conocen más algunos derechos que otros, siendo especialmente motivados a buscar por informaciones cuando aumentan los impactos negativos en la vida financiera, con repercusiones para además de la salud familiar. Conclusión: La población estudiada requiere más informaciones y demanda por conocimientos sobre algunos derechos asegurados por ley. La orientación cuanto a los derechos empodera las familias y garantiza los cuidados necesarios, siendo preciso actuación intersectorial para calificar el cuidado y auxiliar en la reestructuración de la dinámica familiar para lidiar con la condición crónica.

RESUMO Objetivo: identificar o conhecimento de familiares de crianças e adolescentes com câncer sobre os seus direitos legais, dificuldades e facilidades para assegurá-los. Método: Estudo quantitativo, do tipo survey, de delineamento interseccional. Aplicou-se questionário elaborado pelas pesquisadoras para caracterização do menor e de sua família, e identificação do conhecimento do familiar sobre os direitos legais. Utilizou-se estatística descritiva para analisar os dados. Resultados: Participaram 61 familiares. Os familiares conhecem mais alguns direitos em detrimento de outros, sendo especialmente motivados a buscar por informações quando aumentam os impactos negativos na vida financeira, com repercussões para além da saúde familiar. Conclusão: a população estudada requer mais informações e demanda por conhecimentos sobre alguns direitos assegurados por lei. A orientação quanto aos direitos empodera as famílias e possibilita a garantia dos cuidados necessários, sendo preciso atuação intersetorial para qualificar o cuidado e auxiliar na reestruturação da dinâmica familiar para lidar com a condição crônica.

Family knowledge about the legal rights of children and adolescents with cancer / Conocimiento familiar sobre los derechos legales de niños y adolescentes con cáncer / Conhecimento familiar sobre direitos legais de crianças e adolescentes com câncer

ABSTRACT Objective: Identify the knowledge of family members of children and adolescents with cancer about their legal rights, difficulties, and concessions to ensure them. Method: Quantitative study, survey type, of intersectional design. A questionnaire drawn up by the researchers was applied in order to characterize the minor and their family and also to identify the family's knowledge about legal rights. Descriptive statistics were used to analyze data. Results: 61 family members who participated know some more rights to the detriment of others and are especially motivated to search for information when negative impacts on the financial life increase, with repercussions beyond family health. Conclusion: the studied population requires more information and demands knowledge about some rights guaranteed by law. Guidance on rights empowers the family and guarantees the necessary care, searching to have an intersectoral action qualify care and assist in restructuring family dynamics to deal with chronic conditions.

RESUMEN Objetivo: Identificar el conocimiento de familiares de niños y adolescentes con cáncer sobre sus derechos legales, dificultades y facilidades para asegurarlos. Método: Estudio cuantitativo, del tipo survey, de delineamiento interseccional. Aplicó encuesta elaborada por las investigadoras para caracterización del menor y su familia, e identificación del conocimiento del familiar sobre derechos legales. Utilizó estadística descriptiva para analizar los datos. Resultados: Participaron 61 familiares. Los familiares conocen más algunos derechos que otros, siendo especialmente motivados a buscar por informaciones cuando aumentan los impactos negativos en la vida financiera, con repercusiones para además de la salud familiar. Conclusión: La población estudiada requiere más informaciones y demanda por conocimientos sobre algunos derechos asegurados por ley. La orientación cuanto a los derechos empodera las familias y garantiza los cuidados necesarios, siendo preciso actuación intersectorial para calificar el cuidado y auxiliar en la reestructuración de la dinámica familiar para lidiar con la condición crónica.

RESUMO Objetivo: identificar o conhecimento de familiares de crianças e adolescentes com câncer sobre os seus direitos legais, dificuldades e facilidades para assegurá-los. Método: Estudo quantitativo, do tipo survey, de delineamento interseccional. Aplicou-se questionário elaborado pelas pesquisadoras para caracterização do menor e de sua família, e identificação do conhecimento do familiar sobre os direitos legais. Utilizou-se estatística descritiva para analisar os dados. Resultados: Participaram 61 familiares. Os familiares conhecem mais alguns direitos em detrimento de outros, sendo especialmente motivados a buscar por informações quando aumentam os impactos negativos na vida financeira, com repercussões para além da saúde familiar. Conclusão: a população estudada requer mais informações e demanda por conhecimentos sobre alguns direitos assegurados por lei. A orientação quanto aos direitos empodera as famílias e possibilita a garantia dos cuidados necessários, sendo preciso atuação intersetorial para qualificar o cuidado e auxiliar na reestruturação da dinâmica familiar para lidar com a condição crônica.

Validation of a simplified score for predicting latent rheumatic heart disease progression using a prospective cohort of Brazilian schoolchildren.

OBJECTIVES: Echocardiographic (echo) screening is an important tool to estimate rheumatic heart disease (RHD) prevalence, but the natural history of screen-detected RHD remains unclear. The PROVAR+ (Programa de RastreamentO da VAlvopatia Reumática) study, which uses non-experts, telemedicine and portable echo, pioneered RHD screening in Brazil. We aimed to assess the mid-term evolution of Brazilian schoolchildren (5-18 years) with echocardiography-detected subclinical RHD and to assess the performance of a simplified score consisting of five components of the World Heart Federation criteria, as a predictor of unfavourable echo outcomes. SETTING: Public schools of underserved areas and private schools in Minas Gerais, southeast Brazil. PARTICIPANTS: A total of 197 patients (170 borderline and 27 definite RHD) with follow-up of 29±9 months were included. Median age was 14 (12-16) years, and 130 (66%) were woman. Only four patients in the definite group were regularly receiving penicillin. PRIMARY AND SECONDARY OUTCOME MEASURES: Unfavourable outcome was based on the 2-year follow-up echo, defined as worsening diagnostic category, remaining with mild definite RHD or development/worsening of valve regurgitation/stenosis. RESULTS: Among patients with borderline RHD, 29 (17.1%) progressed to definite, 49 (28.8%) remained stable, 86 (50.6%) regressed to normal and 6 (3.5%) were reclassified as other heart diseases. Among those with definite RHD, 13 (48.1%) remained in the category, while 5 (18.5%) regressed to borderline, 5 (18.5%) regressed to normal and 4 (14.8%) were reclassified as other heart diseases. The simplified echo score was a significant predictor of RHD unfavourable outcome (HR 1.197, 95% CI 1.098 to 1.305, p<0.001). CONCLUSION: The simple risk score provided an accurate prediction of RHD status at 2-year follow-up, showing a good performance in Brazilian schoolchildren, with a potential value for risk stratification and monitoring of echocardiography-detected RHD.

Meta-synthesis about man as a father and caregiver for a hospitalized child / Metassíntese sobre o homem como pai e cuidador de um filho hospitalizado / Metasíntesis sobre el hombre como padre y cuidador de un hijo hospitalizado

ABSTRACT Objective: to identify, analyze and synthesize the father's experience in care for a hospitalized child from results of primary qualitative studies. Method: this is a qualitative meta-synthesis through which 12 articles were analyzed, selected in the Cumulative Index to Nursing and Allied Health Literature databases, Latin American and Caribbean Literature in Health Sciences, Public Medline, Scopus, PsycINFO and Web of Science, published between 1995 and 2015. The methodological steps proposed by Sandelowski and Barroso were used to systematize the review, as well as concepts from the anthropology of masculinities to analyze and discuss the synthesis. Results: the synthesis was presented by means of two themes: 1) paternal dilemmas - what man feels and faces during the hospitalization of the child, highlighting the emotional involvement and change in the family and work relationship, and 2) paternal identities - masculinities readjusted in view of the child's illness, which reveals identity marks and repressed fatherhood in the hospital environment. Both themes illustrate the challenges and readjustment of parental identity. Final considerations: to get to know the experiences of the father during the hospitalization of the child and the way in which the challenges for the readjustment of roles related to masculinity could broaden the range of nursing and other health professionals, alerting to the importance of including the father as a protagonist or coadjuvant in the care for hospitalized children.

RESUMO Objetivo: identificar, analisar e sintetizar os resultados de estudos qualitativos primários que abordaram a experiência do pai no cuidado ao filho hospitalizado. Método: trata-se de metassíntese qualitativa por meio da qual analisaram-se 12 artigos, selecionados nas bases de dados Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Public Medline, Scopus, PsycINFO e Web of Science, publicados entre 1995 e 2015. As etapas metodológicas propostas por Sandelowski e Barroso foram utilizadas para sistematizar a revisão, bem como conceitos da antropologia das masculinidades, para análise e discussão da síntese. Resultados: a síntese foi apresentada por dois temas: 1) dilemas paternos - o que o homem sente e enfrenta durante a hospitalização do filho, destacando o envolvimento emocional e mudança na relação familiar e laboral, e 2) identidades paternas - masculinidades reajustadas diante do adoecimento do filho, que revela marcas identitárias e a paternidade reprimida, no ambiente hospitalar. Ambos os temas ilustram os desafios e o reajuste da identidade paterna. Considerações finais: conhecer as vivências do pai durante a hospitalização do filho e a maneira como os desafios para o reajuste de papéis relativos à masculinidade poderá ampliar o alcance da enfermagem, e dos demais profissionais de saúde, alertando para a importância de incluir o pai como protagonista ou coadjuvante no cuidado à criança hospitalizada.

RESUMEN Objetivo: identificar, analizar y sintetizar los resultados de estudios cualitativos primarios que discuten la experiencia del padre en el cuidado al hijo hospitalizado. Método: se trata de metasíntesis cualitativa por medio de la cual fueron analizados 12 artículos, seleccionados en las bases de datos Cumulative Index to Nursing and Allied Health Literature, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Public Medline, Scopus, PsycINFO y Web of Science, publicados entre 1995 y 2015. Las etapas metodológicas propuestas por Sandelowski y Barroso se utilizaron para sistematizar la revisión, así como conceptos de la antropología de las masculinidades, para análisis y discusión de la síntesis. Resultados: la síntesis fue presentada por dos temas: 1) dilemas paternos - lo que el hombre siente y enfrenta durante la hospitalización del hijo, destacando el involucramiento emocional y cambio en la relación familiar y laboral, y 2) identidades paternas - masculinidades reajustadas ante el adolecer del hijo, que revela marcas identitarias y la paternidad reprimida, en el ambiente hospitalario. Ambos temas ilustran los retos y el reajuste de la identidad paterna. Consideraciones finales: conocer las vivencias del padre durante la hospitalización del hijo y la manera como los desafíos para el reajuste de papeles relativos a la masculinidad puede ampliar el alcance de la enfermería, y de los demás profesionales de salud, alertando sobre la importancia de incluir al padre como protagonista o coadyuvante en el cuidado del niño hospitalizado.

Análise dos casos de endocardite infecciosa em um hospital terciário / Analysis of infectious endocarditis cases in a tertiary hospital

Introdução e objetivos: a endocardite infecciosa (EI) é uma doença com alta morbimortalidade, apesar do aprimoramento do diagnóstico e da terapia antimicrobiana. A identificação precoce de pacientes com alto risco de morte ou complicações pode melhorar o desfecho dessa doença. O objetivo foi analisar os casos de EI em um hospital terciário e seus desfechos intra-hospitalares. Pacientes e métodos: analisados retrospectivamente 93 episódios confirmados de EI, em 91 pct, no período de janeiro de 2001 a dezembro de 2008. As variáveis analisadas foram: dados clínicos, infecciosos, modalidade terapêutica e desfechos na evolução hospitalar. A análise estatística utilizou teste do qui-quadrado, Odds Ratio e teste de Mann-Whitney. Resultados: a mortalidade intra-hospitalar ocorreu em 35% (IC 95%; 26-41%), as próteses valvares foram acometidas em 60,23% dos casos, as hemoculturas sem isolamento ocorreram em 36,56%. Nas hemoculturas positivas, o principal agente etiológico isolado foi o Staphylococcus aureus (31,18%), o S. aureus multissensivel em 22,8% e o S. aureus MARSA em 8,6%. A intervenção cirúrgica foi realizada em 48,39% e o principal indicador cirúrgico foi a falha ao tratamento clínico (20,43%). Pacientes que tiveram a ICCcomo desfecho apresentaram mortalidade de 57,14% (p= 0,004 e OR de 3,76, IC 95% ; 1,41- 10,03) e aqueles com marca-passo como sítio de infecção, mortalidade de 66,67%. Conclusões: a EI permanece com elevada morbimortalidade. A mortalidade difere em relação aos agentes etiológicos, estado cardíaco prévio, sítio de infecção e aumento da idade.

Introduction and objective: infectious endocarditis (IE) is a disease with high morbidity and mortality despite improvements in diagnosis and antimicrobial therapy. The early identification of patients at high risk of death or complications can improve the outcome of this disease. The objective was to analyze IE cases in a tertiary hospital and their in-hospital outcomes. Patients and methods: 93 episodes of IE were retrospectively analyzed in 91 patients, between January of 2001 and December of 2008. The analyzed variables were: clinical and infectious data, therapeutic modality, and outcomes during hospital developments. The statisticalanalysis employed the Chi-square, odds ratio, and Mann-Whitney tests. Results: the in-hospital mortality occurred in 35% (IC 95%; 26-41%), valve prostheses were involved in 60.23% of cases, and blood cultures without isolation occurred in 36.56%. In positive blood cultures, the main etiological agent isolated was Staphylococcus aureus in 31.18%, multi sensitive S. aureus in 22.8%, and S. aureus MARSA in 8.6%. Surgical intervention was performed in 48.39% of the patients and the main surgical indicator was failure of clinical treatment (20.43%) Patients who have had ICC as outcome presented 57.14% mortality (p = 0.004 and OR of 3.76, IC 95%;1.41-10.03); mortality rate of 66.67% as observed in those with pacemakers as the site of infection. Conclusions: IE remains with high morbidity and mortality. Mortality rates vary according to the etiological agent, prior cardiac state, site of infection, and increased age.

Foraging habitat quality constrains effectiveness of artificial nest-site provisioning in reversing population declines in a colonial cavity nester.

Among birds, breeding numbers are mainly limited by two resources of major importance: food supply and nest-site availability. Here, we investigated how differences in land-use and nest-site availability affected the foraging behaviour, breeding success and population trends of the colonial cavity-dependent lesser kestrel Falco naumanni inhabiting two protected areas. Both areas were provided with artificial nests to increase nest-site availability. The first area is a pseudo-steppe characterized by traditional extensive cereal cultivation, whereas the second area is a previous agricultural zone now abandoned or replaced by forested areas. In both areas, lesser kestrels selected extensive agricultural habitats, such as fallows and cereal fields, and avoided scrubland and forests. In the second area, tracked birds from one colony travelled significantly farther distances (6.2 km ± 1.7 vs. 1.8 km ± 0.4 and 1.9 km ± 0.6) and had significant larger foraging-ranges (144 km(2) vs. 18.8 and 14.8 km(2)) when compared to the birds of two colonies in the extensive agricultural area. Longer foraging trips were reflected in lower chick feeding rates, lower fledging success and reduced chick fitness. Availability and occupation of artificial nests was high in both areas but population followed opposite trends, with a positive increment recorded exclusively in the first area with a large proportion of agricultural areas. Progressive habitat loss around the studied colony in the second area (suitable habitat decreased from 32% in 1990 to only 7% in 2002) is likely the main driver of the recorded population decline and suggests that the effectiveness of bird species conservation based on nest-site provisioning is highly constrained by habitat quality in the surrounding areas. Therefore, the conservation of cavity-dependent species may be enhanced firstly by finding the best areas of remaining habitat and secondly by increasing the carrying capacity of high-quality habitat areas through safe nest-site provisioning.