Configurações familiares e implicações para o trabalho em saúde da criança em nível hospitalar / Family arrangements and implications for the health work with children in a hospital

Resumo A família tem passado por diversas transformações ao longo do tempo. Hoje, é possível ver diferentes configurações familiares, incluindo, além da família nuclear, tios, avós, padrinhos e mesmo amigos. Esses grupos caracterizam-se por relações de influência recíproca, direta, intensa e duradoura, interiorizadas por seus membros. No trabalho em saúde, especialmente na área de Saúde da Criança, encontram-se trabalhadores, pacientes e famílias. Este estudo buscou, portanto, investigar se os profissionais de saúde identificam implicações das diferentes configurações familiares em seu trabalho. A pesquisa, qualitativa de cunho exploratório, foi realizada na internação pediátrica de um hospital universitário. Os participantes, selecionados por conveniência, foram profissionais das oito formações de nível superior atuantes na unidade: médico, psicólogo, fisioterapeuta, assistente social, farmacêutico, educador físico, nutricionista e enfermeiro. Os dados foram coletados por meio de entrevistas semiestruturadas e interpretados através da análise de conteúdo. Os resultados foram agregados em quatro categorias: "O conceito de família", "A função da família", "A configuração familiar mais frequente" e "Implicações para o trabalho em saúde". Identificou-se que os trabalhadores reconhecem a presença de diferentes arranjos familiares e sofrem quando identificam demandas que vão além do trabalho prescrito, como exercer as funções materna e paterna.

Abstract The family has gone through several transformations over time. Today one can see different family configurations, including uncles, grandparents, godparents. These groups are characterized by relations of mutual, direct, intense and lasting influence, which are internalized by its members. In healthcare, especially in the area of child health, there is an encounter of workers, patients and families. This study aimed, therefore, to investigate whether health professionals identify effects of different family configurations on their work. The research, qualitative and of exploratory nature, was conducted in the pediatric unit of a university hospital. The participants, selected by convenience, were professionals of the eight formations active in the higher level unit: physician, psychologist, physiotherapist, social worker, pharmacist, physical educator, dietitian and nurse. Data were collected through semistructured interviews and interpreted through content analysis. The results were aggregated into four categories: "The concept of family", "The role of the family", "Most frequent Family configuration" and "Implications for health work". We noticed that workers recognize the presence of different family arrangements and suffer when identify demands that go beyond the prescribed work, such as exercising the maternal and paternal functions.

WHOQOL-100 Before and After Sex Reassignment Surgery in Brazilian Male-to-Female Transsexual Individuals.

INTRODUCTION: The 100-item World Health Organization Quality of Life Assessment (WHOQOL-100) evaluates quality of life as a subjective and multidimensional construct. Currently, particularly in Brazil, there are controversies concerning quality of life after sex reassignment surgery (SRS). AIM: To assess the impact of surgical interventions on quality of life of 47 Brazilian male-to-female transsexual individuals using the WHOQOL-100. METHODS: This was a prospective cohort study using the WHOQOL-100 and sociodemographic questions for individuals diagnosed with gender identity disorder according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The protocol was used when a transsexual person entered the ambulatory clinic and at least 12 months after SRS. MAIN OUTCOME MEASURES: Initially, improvement or worsening of quality of life was assessed using 6 domains and 24 facets. Subsequently, quality of life was assessed for individuals who underwent new surgical interventions and those who did not undergo these procedures 1 year after SRS. RESULTS: The participants showed significant improvement after SRS in domains II (psychological) and IV (social relationships) of the WHOQOL-100. In contrast, domains I (physical health) and III (level of independence) were significantly worse after SRS. Individuals who underwent additional surgery had a decrease in quality of life reflected in domains II and IV. During statistical analysis, all results were controlled for variations in demographic characteristics, without significant results. CONCLUSION: The WHOQOL-100 is an important instrument to evaluate the quality of life of male-to-female transsexuals during different stages of treatment. SRS promotes the improvement of psychological aspects and social relationships. However, even 1 year after SRS, male-to-female transsexuals continue to report problems in physical health and difficulty in recovering their independence.

A presença de idosos num serviço de emergência: campo de saúde ou campo de guerra? / The presence of elderly in the emergency department: the health field or battlefield?

Este estudo buscou conhecer as necessidades em saúde dos idosos e a configuração dos processos de trabalho para responder a tais requisitos, num serviço de emergência. Foi uma pesquisa qualitativa, descritiva, utilizando entrevistas semi-estruturadas e grupo focal - estratégia do mapa-falante. Familiares e trabalhadores destacaram as necessidades de cuidado, privacidade, afeto e acesso aos serviços de saúde, e que as condições de trabalho, ainda que adversas, assim como o maior tempo de permanência, procuram responder às necessidades em saúde dos idosos.(AU)

This study aimed to investigate the health needs of older people and the configuration of work process in order to provide them, in an emergency service. A qualitative, descriptive research was conducted, with semi-structured interviews and focus groups (applying the talking-map strategy). Relatives and health care providers highlighted the needs for: care, privacy, affection and access to health services, and that their work conditions, though adverse, and a greater time of stay, seek to respond to the health needs of older people.(AU)

A presença de idosos num serviço de emergência: campo de saúde ou campo de guerra? / The presence of elderly in the emergency department: the health field or battlefield?

Este estudo buscou conhecer as necessidades em saúde dos idosos e a configuração dos processos de trabalho para responder a tais requisitos, num serviço de emergência. Foi uma pesquisa qualitativa, descritiva, utilizando entrevistas semi-estruturadas e grupo focal - estratégia do mapa-falante. Familiares e trabalhadores destacaram as necessidades de cuidado, privacidade, afeto e acesso aos serviços de saúde, e que as condições de trabalho, ainda que adversas, assim como o maior tempo de permanência, procuram responder às necessidades em saúde dos idosos.

This study aimed to investigate the health needs of older people and the configuration of work process in order to provide them, in an emergency service. A qualitative, descriptive research was conducted, with semi-structured interviews and focus groups (applying the talking-map strategy). Relatives and health care providers highlighted the needs for: care, privacy, affection and access to health services, and that their work conditions, though adverse, and a greater time of stay, seek to respond to the health needs of older people.

Discordant transsexualism in male monozygotic twins: neuroanatomical and psychological differences.

One monozygotic male twin pair discordant for transsexualism is described. Both twins were interviewed and tested with the Wechsler Adult Intelligence Scale battery for cognitive functions and they underwent magnetic resonance imaging to measure the volumes of specific cerebral structures. Interviews with the twins and their mother indicated no unusual medical or life history events that could have had a causal role in the emergence of the disorder. Both cognitive function testing and neuroimaging detected differences between the twins that could be related to unexplained epigenetic effects and exogenous hormone usage.

Desvelando a concepção de saúde em um grupo de crianças inseridas em atividades de promoção da saúde / Unveiling the notion of health in a group of children included in health promotion activities'

Com o objetivo de conhecer como se expressa a concepção de saúde no cotidiano de crianças que participam de ações de educação em saúde na escola, realizou-se esta pesquisa, de abordagem qualitativa, utilizando-se o Método Criativo Sensível por meio da Dinâmica do Mapa Falante. Participaram 12 crianças, com idade entre 9 e 10 anos, divididas em dois grupos, pertencentes a uma escola do município de Porto Alegre/RS. Os dados evidenciaram o entrelaçamento entre a promoção da saúde, a determinação social da saúde e o território em que se expressam na concepção ampliada de saúde. As práticas educativas contribuem para a efetivação das ações de promoção da saúde.

With the aim of understanding how the notion of health is expressed in the everyday life of children who participate in health education activities at school, this qualitative study employed the Sensitive and Creative Method through a Speaking Map role-play exercise. Twelve children aged 9 to 10 years old from a municipal school in Porto Alegre/RS, split into two groups, participated in the study. The data revealed the intertwined relationship between health promotion, the social determination of health and the territory in which they are expressed in a broader notion of health. Educational practices contribute toward rendering health promotion actions effective.

Solo e raízes das dimensões individual, social e programática da vulnerabilidade e as sementes no processo de saúde da criança / Solo and roots of individual, social and programmatic vulnerability’s dimensions and the seeds in the child’s health process

O trabalho buscou conhecer a relação das dimensões da vulnerabilidade com o processo de saúde e doença da criança, através de uma pesquisa qualitativa do tipo descritivo, tendo como referencia o materialismo histórico. Considera-se a vulnerabilidade uma categoria teórica, que analisa a chance de exposição para o adoecimento e para a saúde, pelo conjunto de aspectos individuais, sociais e programáticos. Os resultados indicam que a vulnerabilidade é um fenômeno que se refrata na vida das famílias através do não reconhecimento dos direitos e dos impasses da organização do setor saúde, ao mesmo tempo em que identifica os condicionantes que são os propulsores de resistência. As famílias se mostraram como as protagonistas nas mediações necessárias ao processo de saúde e doença das crianças, destacando-se elementos como a indignação, a resiliência, o afeto como força política e a apropriação do conceito de saúde ampliado para a defesa dos seus direitos. A vulnerabilidade revela-se também apropriada para explorar as questões da eficácia e da autonomia das práticas em saúde...

The paper tried to know the relationship of the dimensions of vulnerability to the child’s disease and health process. It was a descriptive kind of a qualitative research, with reference to historical materialism. It is considered the vulnerability as a theoretical category, which analyzes the chance of exposure to the illness and to the health, by all individual, social and programmatic aspects. The results indicate that the vulnerability is a phenomenon that is refracted on lives of the families thought of non-recognition of the rights and the impasses of the organization of the health sector, at the same time that it identifies the conditions of engines of resistance. The families were shown like the protagonists in necessary mediations to the process health and disease of children, highlighting elements such as anger, resilience, affection as a political force and the appropriation of the concept of extended health for the defense of their rights. The vulnerability revealed also appropriate to explore the issues of efficiency and autonomy of our health practices...

Serum concentrations of brain-derived neurotrophic factor in patients with gender identity disorder.

Gender Identity Disorder (GID) is characterized by a strong and persistent cross-gender identification that affects different aspects of behavior. Brain-derived neurotrophic factor (BDNF) plays a critical role in neurodevelopment and neuroplasticity. Altered BDNF-signaling is thought to contribute to the pathogenesis of psychiatric disordersand is related to traumatic life events. To examine serum BDNF levels, we compared one group of DSM-IV GID patients (n = 45) and one healthy control group (n = 66). Serum BDNF levels were significantly decreased in GID patients (p = 0.013). This data support the hypothesis that the reduction found in serum BDNF levels in GID patients may be related to the psychological abuse that transsexuals are exposed during their life.

[Promotion in mental health, nursing creating and intervening with children's stories]. / Promoção em saúde mental: a enfermagem criando e intervindo com histórias infantis.

This paper refers to the importance of the childish stories as an instrument for the nursing action and the mental health promotion in childhood. The objective was to veriyj the recognition of the children's emotions, through stories specific to health. This is a descriptive-exploratory study of a qualitative nature, conducted in seven groups meetings with six children aged seven to ten years in an outpatient childish mental health. In the data collection the following were used as instruments: six fairy tales, the play of emotions, emotional faces, drawings, paintings and clay sculptures. Thematic analysis was used in which the following emerged, the recognition of emotions. The children recognized four basics emotions: sadness, joy, fear and anger. It was found in the study that the creation of contextualized stories and the strategy of storytelling group may be useful as a tool for research and qualification of nursing actions, to promote children's mental health.

Promoção em saúde mental: a enfermagem criando e intervindo com histórias infantis / Promoción de la salud mental: la enfermería la creación e la intervención con los cuentos infantiles / Promotion in mental health: nursing creating and intervening with children's stories

Este trabalho refere-se à importância das histórias infantis enquanto instrumento, para a ação de enfermagem e a promoção da saúde mental na infância. Objetivou-se verificar o (re)conhecimento das emoções de crianças, através de histórias específicas para a saúde. Trata-se de um estudo descritivo-exploratório de natureza qualitativa, realizado em sete encontros de grupo com seis crianças de sete a dez anos, em um ambulatório de saúde mental infantil. Na coleta de dados utilizaram-se como instrumentos: seis histórias infantis, o jogo das emoções, as carinhas emotivas, desenhos, pinturas e esculturas em argila. Utilizou-se a análise temática, na qual emergiu o tema: o (re)conhecimento das emoções. As crianças reconheceram quatro emoções básicas: tristeza, alegria, medo e raiva. Constatou-se no estudo que a criação de histórias contextualizadas e a estratégia do grupo de contação podem ser úteis como ferramenta para a pesquisa e qualificação das ações de enfermagem na promoção de saúde mental infantil.

Este artículo se refiere a la importancia de los cuentos infantiles como una herramienta para la acción de enfermería y la promoción de la salud mental en la infancia. Se buscó verificar el reconocimiento de las emociones, a través de historias específicas para la salud. Es un estudio cualitativo y descriptivo-exploratorio, fueron realizados siete encuentros con seis niños, entre siete y diez años, de un servicio de salud mental infantil. En la recogida de datos se utilizaron: seis historias infantiles, el juego de emociones, caras emotivas, diseños, pinturas y esculturas en arcilla. Se utilizó el análisis temático, en el que surgió: el reconocimiento de las emociones. Ellos reconocen cuatro emociones: tristeza, alegría, miedo y rabia. La creación de historias contextualizadas y la estrategia del grupo de narración de cuentos, puede ser útil como herramienta para la investigación y cualificación de las acciones de enfermería en la promoción de salud mental.

This paper refers to the importance of the childish stories as an instrument, for the nursing action and the mental health promotion in childhood. The objective was to verify the recognition of the emotions of children, through stories specific to health. This is a descriptive-exploratory study by qualitative nature, conducted in seven groups meetings with six children aged seven to ten years in an outpatient childish mental health. In the data collection were used as instruments: six fairy tales, the play of emotions, emotional faces, drawings, paintings and clay sculptures. It was used thematic analysis, in which emerged: the recognition of emotions. The children recognized four basics emotions: sadness, joy, fear and anger. It was found in the study that the creation of contextualized stories and the strategy of storytelling group may be useful as a tool for research and qualification of nursing actions, to promote children's mental health.

Using the Defensive Style Questionnaire to evaluate the impact of sex reassignment surgery on defensive mechanisms in transsexual patients / Aplicação do Defensive Style Questionnaire para avaliar o impacto da cirurgia de redesignação sexual nos mecanismos de defesa de pacientes transexuais

Objective: To evaluate the impact of sex reassignment surgery on the defense mechanisms of 32 transsexual patients at two different points in time using the Defensive Style Questionnaire. Method: The Defensive Style Questionnaire was applied to 32 patients upon their admission to the Gender Identity Disorder Program, and 12 months after they had undergone sex reassignment surgery. Results: There were changes in two defense mechanisms: anticipation and idealization. However, no significant differences were observed in terms of the mature, neurotic and immature categories. Discussion: One possible explanation for this result is the fact that the procedure does not resolve gender dysphoria, which is a core symptom in such patients. Another aspect is related to the early onset of the gender identity disorder, which determines a more regressive defensive structure in these patients. Conclusion: Sex reassignment surgery did not improve the defensive profile as measured by the Defensive Style Questionnaire.

Objetivo: Avaliar o efeito da cirurgia de redesignação sexual nos mecanismos de defesa de 32 pacientes transexuais em dois momentos do estudo usando o Defensive Style Questionnaire. Método: O Defensive Style Questionnaire foi aplicado a 32 pacientes quando ingressaram no Programa de Transtorno de Identidade de Gênero e 12 meses após a cirurgia de redesignação sexual. Resultados: Houve modificações em dois mecanismos de defesa: antecipação e idealização; porém, sem mudanças significativas nos fatores maduro, neurótico e imaturo. Discussão: Uma possibilidade para esse resultado é o fato de a intervenção cirúrgica não resolver a disforia de gênero (principal sintoma desses pacientes). Outro aspecto está relacionado com o fato de o transtorno de identidade de gênero ser instalado precocemente, o que determina uma estrutura defensiva mais regressiva para esses pacientes. Conclusão: A cirurgia de redesignação sexual não foi capaz de modificar o padrão dos mecanismos de defesa medidos pelo Defensive Style Questionnaire.

Using the Defensive Style Questionnaire to evaluate the impact of sex reassignment surgery on defensive mechanisms in transsexual patients.

OBJECTIVE: To evaluate the impact of sex reassignment surgery on the defense mechanisms of 32 transsexual patients at two different points in time using the Defensive Style Questionnaire. METHOD: The Defensive Style Questionnaire was applied to 32 patients upon their admission to the Gender Identity Disorder Program, and 12 months after they had undergone sex reassignment surgery. RESULTS: There were changes in two defense mechanisms: anticipation and idealization. However, no significant differences were observed in terms of the mature, neurotic and immature categories. DISCUSSION: One possible explanation for this result is the fact that the procedure does not resolve gender dysphoria, which is a core symptom in such patients. Another aspect is related to the early onset of the gender identity disorder, which determines a more regressive defensive structure in these patients. CONCLUSION: Sex reassignment surgery did not improve the defensive profile as measured by the Defensive Style Questionnaire.

Follow-up of sex reassignment surgery in transsexuals: a Brazilian cohort.

This study examined the impact of sex reassignment surgery on the satisfaction with sexual experience, partnerships, and relationship with family members in a cohort of Brazilian transsexual patients. A group of 19 patients who received sex reassignment between 2000 and 2004 (18 male-to-female, 1 female-to-male) after a two-year evaluation by a multidisciplinary team, and who agreed to participate in the study, completed a written questionnaire. Mean age at entry into the program was 31.21+/-8.57 years and mean schooling was 9.2+/-1.4 years. None of the patients reported regret for having undergone the surgery. Sexual experience was considered to have improved by 83.3% of the patients, and became more frequent for 64.7% of the patients. For 83.3% of the patients, sex was considered to be pleasurable with the neovagina/neopenis. In addition, 64.7% reported that initiating and maintaining a relationship had become easier. The number of patients with a partner increased from 52.6% to 73.7%. Family relationships improved in 26.3% of the cases, whereas 73.7% of the patients did not report a difference. None of the patients reported worse relationships with family members after sex reassignment. In conclusion, the overall impact of sex reassignment surgery on this cohort of patients was positive.

Estudo da inteligência em esquizofrênicos, medida pela escala Weschler / Study of the intelligence of schizophrenic patients based on the Weschler Scale

O desempenho cognitivo (DC) de 25 esquizofrênicos ambulatoriais diagnosticados pelos critérios da DSM-III-R é comparado com o de 28 controles sadios, balanceados por idade e educaçäo. O desempenho cognitivo foi medido pela Escala de Inteligência para adultos de Weschler, em sua versäo portuguesa (WAIS), aplicado fora da fase aguda. Os resultados do WAIS apontam para um déficit cognitivo nos esquizofrênicos, comparados com os controles. A diferença foi mais acentuada nos aspectos de inteligência associados à atençäo, concentraçäo, percepçäo e uso de conceitos. Estes achados säo reforçados por achados prévios, de um padräo de déficit neuropsicológico de inteligência em esquizofrenia. Estes déficits, devidamente quantificados, podem servir de auxílio no planejamento de tratamento, treinamento de habilidades sociais e reduçäo de stress em esquizofrênicos

Estudo da inteligencia em esquizofrenicos, medida pela escala Weschler

O desempenho cognitivo (DC) de 25 esquizofrenicos ambulatoriais diagnosticados pelos criterios da DSM-III-R e comparado com o de 28 controles sadios, balanceados por idade e educacao. O desempenho cognitivo foi medido pela Escala de Inteligencia para Adultos de Weschler, em sua versao portuguesa (WAIS), aplicado fora da fase aguda. Os resultados do WAIS apontam para um deficit cognitivo nos esquizofrenicos, comparados com os controles. A diferenca foi mais acentuada nos aspectos de inteligencia associados a atencao, concentracao, percepcao e uso de conceitos. Estes achados sao reforcados por achados previos, de um padrao de deficit neuropsicologico de inteligencia em esquizofrenia. Estes deficits, devidamente quantificados, podem servir de auxilio no planejamento de tratamento, treinamento de habilidades sociais e reducao de stress em esquizofrenicos.