Giants of the Amazon: How does environmental variation drive the diversity patterns of large trees?

For more than three decades, major efforts in sampling and analyzing tree diversity in South America have focused almost exclusively on trees with stems of at least 10 and 2.5 cm diameter, showing highest species diversity in the wetter western and northern Amazon forests. By contrast, little attention has been paid to patterns and drivers of diversity in the largest canopy and emergent trees, which is surprising given these have dominant ecological functions. Here, we use a machine learning approach to quantify the importance of environmental factors and apply it to generate spatial predictions of the species diversity of all trees (dbh ≥ 10 cm) and for very large trees (dbh ≥ 70 cm) using data from 243 forest plots (108,450 trees and 2832 species) distributed across different forest types and biogeographic regions of the Brazilian Amazon. The diversity of large trees and of all trees was significantly associated with three environmental factors, but in contrasting ways across regions and forest types. Environmental variables associated with disturbances, for example, the lightning flash rate and wind speed, as well as the fraction of photosynthetically active radiation, tend to govern the diversity of large trees. Upland rainforests in the Guiana Shield and Roraima regions had a high diversity of large trees. By contrast, variables associated with resources tend to govern tree diversity in general. Places such as the province of Imeri and the northern portion of the province of Madeira stand out for their high diversity of species in general. Climatic and topographic stability and functional adaptation mechanisms promote ideal conditions for species diversity. Finally, we mapped general patterns of tree species diversity in the Brazilian Amazon, which differ substantially depending on size class.

Modeling the evolution of deaths from infectious diseases with functional data models: The case of COVID-19 in Brazil.

In this paper, we apply statistical methods for functional data to explore the heterogeneity in the registered number of deaths of COVID-19, over time. The cumulative daily number of deaths in regions across Brazil is treated as continuous curves (functional data). The first stage of the analysis applies clustering methods for functional data to identify and describe potential heterogeneity in the curves and their functional derivatives. The estimated clusters are labeled with different "levels of alert" to identify cities in a possible critical situation. In the second stage of the analysis, we apply a functional quantile regression model for the death curves to explore the associations with functional rates of vaccination and stringency and also with several scalar geographical, socioeconomic and demographic covariates. The proposed model gave a better curve fit at different levels of the cumulative number of deaths when compared to a functional regression model based on ordinary least squares. Our results add to the understanding of the development of COVID-19 death counts.

Short-term Covid-19 forecast for latecomers.

The number of new Covid-19 cases is still high in several countries, despite vaccination efforts. A number of countries are experiencing new and severe waves of infection. Therefore, the availability of reliable forecasts for the number of cases and deaths in the coming days is of fundamental importance. We propose a simple statistical method for short-term real-time forecasting of the number of Covid-19 cases and fatalities in countries that are latecomers-i.e., countries where cases of the disease started to appear some time after others. In particular, we propose a penalized LASSO regression model with an error correction mechanism to construct a model of a latecomer country in terms of other countries that were at a similar stage of the pandemic some days before. By tracking the number of cases in those countries, we use an adaptive rolling-window scheme to forecast the number of cases and deaths in the latecomer. We apply this methodology to 45 countries and we provide detailed results for four of them: Brazil, Chile, Mexico, and Portugal. We show that the methodology performs very well when compared to alternative methods. These forecasts aim to foster better short-run management of the healthcare system and can be applied not only to countries but also to different regions within a country. Finally, the modeling framework derived in the paper can be applied to other infectious diseases.

[The view of teachers on bullying and implications for nursing]. / O olhar de professors sobre o bullying e implicações para a atuação da enfermagem.

OBJECTIVE: To understand school bullying from the perspective of teachers and reflect about the possible actions of the health area when coping with it. The guidelines of the School Health Program of the Ministries of Health and Education were used to reach that purpose. METHOD: A qualitative study carried out with teachers of a public school in Minas Gerais. Focus groups were used to collect data and the empirical material was decoded from thematic analysis of content, resulting in an analytical category: conceptions and experiences of teachers on bullying. RESULTS: Specific perceptions about the phenomenon and the use of ineffective intervention resources were identified. In the interpretive plan were problematized the health and nursing contributions with resizing the interventions and the continuing training process of teachers. CONCLUSION: The results point to the construction of intersectoral practices for coping with bullying.

Microbial community diversity in the gut of the South American termite Cornitermes cumulans (Isoptera: Termitidae).

Termites inhabit tropical and subtropical areas where they contribute to structure and composition of soils by efficiently degrading biomass with aid of resident gut microbiota. In this study, culture-independent molecular analysis was performed based on bacterial and archaeal 16S rRNA clone libraries to describe the gut microbial communities within Cornitermes cumulans, a South American litter-feeding termite. Our data reveal extensive bacterial diversity, mainly composed of organisms from the phyla Spirochaetes, Bacteroidetes, Firmicutes, Actinobacteria, and Fibrobacteres. In contrast, a low diversity of archaeal 16S rRNA sequences was found, comprising mainly members of the Crenarchaeota phylum. The diversity of archaeal methanogens was further analyzed by sequencing clones from a library for the mcrA gene, which encodes the enzyme methyl coenzyme reductase, responsible for catalyzing the last step in methane production, methane being an important greenhouse gas. The mcrA sequences were diverse and divided phylogenetically into three clades related to uncultured environmental archaea and methanogens found in different termite species. C. cumulans is a litter-feeding, mound-building termite considered a keystone species in natural ecosystems and also a pest in agriculture. Here, we describe the archaeal and bacterial communities within this termite, revealing for the first time its intriguing microbiota.

National Abortion Survey - Brazil, 2021.

The National Abortion Survey 2021 (PNA 2021) utilized face-to-face structured interviews and a self-administered questionnaire placed in a sealed box to collect data on abortions in Brazil. Interviews were held with a nationally representative sample of 2,000 women, randomly selected from among literate women ages 18 to 39 residing in urban areas. We compared some of the results with previous waves of the survey, PNA 2010 and PNA 2016. Findings show that abortion is in decline but remains a major public health issue. Around 10% of the women interviewed in 2021 said they had had at least one abortion in their lives (compared to 15% in 2010). We estimate that nearly one in every seven women (15%) have had an abortion by the age of 40. We identified a decline in the proportion of women who needed to be hospitalized to finalize their abortions (55% in 2010; 43% in 2021; p = 0.003) and in the proportion of women who used medication for the abortion (48% in 2010; 39% in 2021; p = 0.028). Abortion is an event that generally happens early on in women's reproductive lives: the PNA 2021 found that 52% of women were 19 years old or younger when they had their first abortion. Higher rates were detected among respondents with lower educational levels, Black and Indigenous women, and women residing in poorer regions.

Abortion and race in Brazil, National Abortion Surveys 2016 to 2021. / Aborto e raça no Brasil, Pesquisa Nacional de Aborto 2016 a 2021.

We examine racial differentials in abortion among women in Brazil using data from three editions of the Brazilian National Abortion Survey (PNA), 2016, 2019 and 2021. We test the difference in means in data from separate surveys, combined surveys without reweighting, and combined and reweighted surveys. We also use logistic models for the chance of having an abortion. The results indicate that there is a consistent racial differential in the three editions of PNA, with the percentage of abortions among Black women being higher than among white women. In the combined and reweighted surveys, among Black women of all ages the probability of having had an abortion is 11.03% while among white women it is 7.55%. This means a difference of 3.5 percentage points, which translates into a 46% higher probability for Black women, statistically significant values for a 5% interval. Logistic regressions produce similar results, with an average predicted probability of 12.61% for Black women and 8.90% for white women, also significant. Racial differences remain statistically significant for various combinations of PNA editions. However, in the separate surveys, the difference in means tests are only statistically significant in 2016. Black refers to the group formed by Black and Brown women (pretas and pardas). Due to the small sample size, it is not possible to say much about the differences with Asian and Indigenous women.

Examinamos a realização do aborto segundo cor ou raça das mulheres no Brasil usando dados de três edições da PNA, 2016, 2019 e 2021. Comparamos diferenciais raciais aplicando testes de diferenças de médias a dados de levantamentos separados, levantamentos combinados sem reponderação, e levantamentos combinados e reponderados. Na comparação usamos ainda modelos logísticos para a chance de realização de aborto. Os resultados indicam que há diferencial racial consistente nas três edições da PNA, com os percentuais de aborto entre as mulheres negras sendo mais elevados do que entre as mulheres brancas. Nos levantamentos combinados e reponderados, entre as mulheres negras de todas as idades a probabilidade de ter feito um aborto é de 11,03% enquanto entre as mulheres brancas é de 7,55%. Isso significa uma diferença de 3,5 pontos percentuais, que se traduz em uma probabilidade 46% maior para as negras, valores estatisticamente significantes para um intervalo de 5%. Regressões logísticas produzem resultados similares, com probabilidade média predita das mulheres negras de 12,61% e das mulheres brancas de 8,90%, também significantes. As diferenças raciais persistem estatisticamente significantes para várias combinações de edições da PNA. Porém, nos levantamentos isolados os testes de diferenças de média são estatisticamente significantes apenas em 2016.

[Sleep quality of obese workers of a teaching hospital: acupuncture as a complementary therapy]. / Qualidade de sono de trabalhadores obesos de um hospital universitário: acupuntura como terapia complementar.

The objective of this study was to verify the effect of acupuncture on the sleep quality of obese workers in a teaching hospital. Data were collected from July to October 2009, focusing on 37 workers who attended eight weekly acupuncture sessions. The Pittsburgh Sleep Quality Index was used to assess their sleep quality before and after the intervention. Results show that before the intervention, five (13.5%) people experienced good quality of sleep whereas at the end of the study 14 (37.8%) showed this condition. Statistic significance (p=0.0001) was found in comparing the mean scores obtained before and after acupuncture. Acupuncture had effects on the quality of sleep in the studied sample, presenting itself as a complementary technique for treating sleep disorders and consequently improving the quality of life in this population.

From Evidence Synthesis to Transfer: Results from a Qualitative Case Study with the Perspectives of Participants.

The increase in health research brings challenges to the production, synthesis, and use of research findings in clinical practice. In the case of undergraduate training in nursing, it is necessary to think about the curricular contents and create opportunities to develop skills for learning evidence-based practice. The objective of this study was to analyze nurses' perspectives regarding the effects of their participation in a project of translation of knowledge into clinical practice during undergraduate nursing education, specifically involving knowledge, attitudes, and competencies related to the use of evidence. This is a qualitative case study grounded in the knowledge-to-action theoretical framework. The participants were 13 nurses who were involved in a project about the translation of knowledge into clinical practice during the last term of their undergraduate course. The data were collected by applying interviews between December 2020 and April 2021. Content analysis was carried out by using the qualitative data analysis software tool webQDA®. The following categories emerged from the content analysis carried out on the material gathered during the interviews: understanding evidence; learning how to use evidence; transferring evidence; adjusting to the context; and observing the advantages of evidence-based practice. Extracurricular activities were perceived as an opportunity to understand what evidence is and observe in loco the advantages of health care for clients, teams, and services. During the project, the participants developed cross-sectional competencies and envisaged changes to their professional activity as a result of changes in their attitude regarding evidence and its use. We concluded that the opportunity to develop evidence-related activities allows for the development of skills and influences the attitude towards evidence-based practice and knowledge use.

Learning to use evidence at nursing undergraduation: a contribution to collective health. / Aprender a usar evidência na graduação em enfermagem: um contributo para a saúde coletiva.

There is universal agreement that health professionals have not implementing evidence-based practice as would be desirable and recommended by science and international institutions with responsibility for the guidelines issued for health contexts. This focus group with eight participants aimed to understand the perspective of students from the undergraduate nursing course on their involvement in a project of knowledge transfer to the clinic. Qualitative analysis followed the coding steps; storage/retrieval and interpretation of the findings and it was carried out by using a software for qualitative data analysis. This study is authorized by an Ethics Committee and respected the principles inherent to the investigation. The four categories that emerged from the content analysis were: Belonging, Using Evidence, Improving Care and Developing Competencies. The analysis of categories, subcategories and verbatim transcripts allowed us to conclude that participation in transference projects for clinics, according to the students, generates learning opportunities about the implementation and communication of evidence, facilitates integration in the service, participation, collaborative work and the development of transversal skills.

É consensual que os profissionais de saúde não estão a implementar a prática baseada na evidência como seria desejável e recomendado pela ciência e organismos internacionais com responsabilidade sobre as diretrizes emanadas para os contextos de saúde. Este focus group com oito participantes teve por objetivo compreender a perspetiva dos estudantes do curso de graduação em enfermagem sobre o seu envolvimento num projeto de transferência de conhecimento para a clínica. A análise qualitativa seguiu as etapas de codificação, armazenamento/recuperação e interpretação dos achados, e foi efetuada com um software de análise de dados qualitativos. Estudo autorizado por uma comissão de ética e que respeitou os princípios inerentes à investigação. As quatro categorias que emergiram da análise de conteúdo foram: "pertencer", "usar evidência", "melhorar cuidados" e "desenvolver competências". A análise das categorias, subcategorias e verbatins permite concluir que a participação em projetos de transferência para a clínica, na voz dos estudantes, gera oportunidades de aprendizagem sobre a implementação e comunicação de evidência, facilita a integração no serviço, a participação, o trabalho colaborativo e o desenvolvimento de competências transversais.

Participation of Nursing Students in Evidence-Based Practice Projects: Results of Two Focus Groups.

The development of true evidence-based practice requires that practitioners have the knowledge and skills to research, analyze, and use evidence. These skills must be acquired in pre-graduate training. The objective of the present study was to analyze the contributions of students' participation in knowledge translation projects to clinical practice for evidence-based learning. This was a qualitative, descriptive, and exploratory study that used focus groups. Scripted interviews were administered. The design of the study included five phases and took place in the partnering institutions of the Safety Transition Project, involving fifteen participants. The study was authorized by the Research Ethics Committee. The data were analyzed following the steps encoding the categories, storage and recovery, and (3) interpretation and using computer software (WebQDA®, Ludomédia, Aveiro, Portugal). Four categories were identified: learning evidence; communicating science; evidence-based practice; and developing skills. The successful implementation of evidence-based practice education resulted in students who understand its importance and use it competently. Further research should explore the skills developed by nurses involved in similar projects and their contribution to an EBP culture.

Prevalence and antimicrobial resistance of Salmonella in chicken carcasses at retail in 15 Brazilian cities.

OBJECTIVE: To describe the prevalence and antimicrobial resistance of Salmonella spp. in frozen chicken carcasses at retail from 15 Brazilian cities. METHODS: A descriptive study of data from the Brazilian National Program for Monitoring the Prevalence of Bacterial Resistance in Chicken (PREBAF) was conducted from September 2004 to July 2006. The program collected chicken carcasses in 15 state capitals of Brazil in the five geographic regions of the country. Standardized methodologies were used to isolate Salmonella-spp. and identify serotypes. The minimal inhibitory concentration method was used to test resistance to 18 antimicrobials. RESULTS: In 2 679 carcasses examined, the prevalence of Salmonella spp. was 2.7% (range 0.0%-8.9%). São Paulo State produced 50.6% of positive samples. Eighteen serotypes were identified. The most frequently occurring were Salmonella Enteritidis (48.8%), Salmonella Infantis (7.6%), Salmonella Typhimurium (7.2%), and Salmonella Heidelberg (6.4%). All 250 strains tested were resistant to one or more antibiotics, and 133 (53.2%) were multidrug resistant (≥ 3 classes). S. Heidelberg was resistant to ceftriaxone (75.0%) and to ceftiofur(43.8%). CONCLUSIONS: The prevalence of Salmonella spp. found in this study was relatively low. However, there were a high proportion of multidrug-resistant strains, including third-generation cephalosporins used to treat invasive salmonellosis. The results confirm the relevance of the PREBAF program. It is recommended that PREBAF be improved, including a timely data analysis. A review of permitted limits for Salmonella spp. in retail chicken in Brazil is also needed.

[Prevalence of respiratory symptoms in areas of the Federal District, Brazil]. / Prevalência de sintomáticos respiratórios em regiões do Distrito Federal, Brasil.

The identification of individuals with respiratory symptoms (RS) is important for the early detection of tuberculosis. The aim of this study was to estimate the prevalence of RS in three administrative regions of the Federal District, Brazil. For this, we used the 30 by 7 cluster sampling technique proposed by the World Health Organization. Individuals with RS were defined as those aged 15 years or older living in the administrative regions of Estrutural, Itapoã, or Varjão and reporting a cough lasting at least 3 weeks at the date of the interview. The prevalence of RS was 5.7% in Estrutural and Varjão (95% CI: 2.4-9.0) and 4.8% in Itapoã (95%CI: 1.6-7.9), with a design effect close to 1.0. In Estrutural and Itapoã, fewer years of schooling, and in Itapoã and Varjão, lower income, were associated with RS. Cigarette smoking was associated with the presence of RS in all regions. The prevalence of RS in the three administrative regions investigated is consistent with that of other areas with a similar socioeconomic profile.

Mega-dams and extreme rainfall: Disentangling the drivers of extensive impacts of a large flooding event on Amazon Forests.

Extreme weather events and the presence of mega-hydroelectric dams, when combined, present an emerging threat to natural habitats in the Amazon region. To understand the magnitude of these impacts, we used remote sensing data to assess forest loss in areas affected by the extreme 2014 flood in the entire Madeira River basin, the location of two mega-dams. In addition, forest plots (26 ha) were monitored between 2011 and 2015 (14,328 trees) in order to evaluate changes in tree mortality, aboveground biomass (AGB), species composition and community structure around the Jirau reservoir (distance between plots varies from 1 to 80 km). We showed that the mega-dams were the main driver of tree mortality in Madeira basin forests after the 2014 extreme flood. Forest loss in the areas surrounding the reservoirs was 56 km2 in Santo Antônio, 190 km2 in Jirau (7.4-9.2% of the forest cover before flooding), and 79.9% above that predicted in environmental impact assessments. We also show that climatic anomalies, albeit with much smaller impact than that created by the mega-dams, resulted in forest loss along different Madeira sub-basins not affected by dams (34-173 km2; 0.5-1.7%). The impact of flooding was greater in várzea and transitional forests, resulting in high rates of tree mortality (88-100%), AGB decrease (89-100%), and reduction of species richness (78-100%). Conversely, campinarana forests were more flood-tolerant with a slight decrease in species richness (6%) and similar AGB after flooding. Taking together satellite and field measurements, we estimate that the 2014 flood event in the Madeira basin resulted in 8.81-12.47 ∙ 106 tons of dead biomass. Environmental impact studies required for environmental licensing of mega-dams by governmental agencies should consider the increasing trend of climatic anomalies and the high vulnerability of different habitats to minimize the serious impacts of dams on Amazonian biodiversity and carbon stocks.

Chronic pain following inguinal herniorrhaphy: perceptions of children and adolescents.

OBJECTIVE: To analyze the perceptions of children and adolescents about chronic postsurgical pain, experienced for three years after outpatient inguinal herniorrhaphy. METHOD: Descriptive, exploratory study, with a qualitative approach. Children and adolescents who reported chronic postsurgical pain were invited from previous quantitative research. The interviews with a semi-structured script were recorded, transcribed, and coded according to content analysis, thematic modality. RESULTS: Twenty children and teenagers participated. They attributed different meanings to chronic persistent postsurgical pain, configuring a bad, uncomfortable, intermittent and limiting experience, which socially isolates, interferes with daily, school, and leisure activities. The report of pain was underestimated and neglected by the children's and adolescents' healthcare team, family members, teachers, and friends. CONCLUSION: Children and adolescents recognize postsurgical pain as persistent pain and seem to perceive that their report is underestimated and neglected by parents and teachers. Additionally, they feel responsible for the presence of pain that affects psychological and social dimensions and imposes damage and fear that leads to the return of the hernia and to death.

[Support group as embracement strategy for relatives of patients in intensive care unit]. / Grupo de suporte como estratégia para acolhimento de familiares de pacientes em unidade de terapia intensiva.

Admissions to the Intensive Care Unit (ICU) generate needs among relatives, which sometimes do not receive appropriate care. This study aimed at describing a support group (SG) that embraces the relatives of patients admitted to ICU and to evaluate its effectiveness in meeting their needs of information and emotional support. This descriptive study was performed in 2006 in a Hospital of Goiânia/GO, by means sessions of the Support Group for Families (SGF). The sessions were recorded and registered in a field-diary for further analysis of the group process. In addition, individual interviews were performed to evaluate if the needs for information and support were met. The SGF permitted to see to the needs of families, helping them cope with the hospitalization of their relative in the ICU. In conclusion, SGF helps to promote humanized care practice and to overcome care that is historically focused on patient and disease. Nurses should consider reorganizing their practice and the possibility of including the SGF as a strategy to meet the needs of the families.

Aspects of protection and social vulnerability of teenagers in public all-day schools.

OBJECTIVE: identify and analyze aspects related to social vulnerability of a group of teenagers of a public all-day school with regard to harmful and abusive use of psychoactive drugs. METHODS: a strategic social study, with a qualitative approach, was carried out with 49 teenagers of a public all-day secondary school. Focus groups were carried out between 2016 and 2017, and the resulting material was transcribed and analyzed by means of thematic content analysis, resulting in the following categories: The family I come from; Birds of a feather; If I'm studying, how can I work?; Drugs: a non-parallel universe. RESULTS: social vulnerability was associated with unequal income distribution, fragile social relations affected by the harmful use of drugs and vulnerability of public all-day schools. Final considerations: all-day schools did not appear as an effective tool to break away with the context of social vulnerability regarding the use of drugs.

Arrest of oogenesis in the bug Rhodnius prolixus challenged with the fungus Aspergillus niger is mediated by immune response-derived PGE2.

In this work we characterized the immune response of the insect Rhodnius prolixus to a direct injection into the hemocoel of the non-entomopathogenic fungus Aspergillus niger, and evaluated its consequences on host oogenesis. These animals were able to respond by mounting effective cellular and humoral responses to this fungus; these responses were shown, however, to have reproductive fitness costs, as the number of eggs laid per female was significantly reduced. The disturbance of egg formation during infectious process correlated with an elevation in the titer of hemolymph prostaglandin E2 48 h post-challenge. Administration of Zymosan A as an immunogenic non-infectious challenge produced similar effects on phenoloxidase and prophenoloxidase activities, oocyte development and prostaglandin E2 titer, precluding the hypothesis of an effect mediated by fungal metabolites in animals challenged with fungus. Ovaries at 48 h post-challenge showed absence of vitellogenic ovarian follicles, and the in vivo administration of prostaglandin E2 or its receptor agonist misoprostol, partially reproduced this phenotype. Together these data led us to hypothesize that immune-derived prostaglandin E2 raised from the insect response to the fungal challenge is involved in disturbing follicle development, contributing to a reduction in host reproductive output and acting as a host-derived adaptive effector to infection.

Judicialization 2.0: Understanding right-to-health litigation in real time.

Over the past two decades, debate over the whys, the hows, and the effects of the ever-expanding phenomenon of right-to-health litigation ('judicialization') throughout Latin America have been marked by polarised arguments and limited information. In contrast to claims of judicialization as a positive or negative trend, less attention has been paid to ways to better understand the phenomenon in real time. In this article, we propose a new approach-Judicialization 2.0-that recognises judicialization as an integral part of democratic life. This approach seeks to expand access to information about litigation on access to medicines (and health care generally) in order to better characterise the complexity of the phenomenon and thus inform new research and more robust public discussions. Drawing from our multi-disciplinary perspectives and field experiences in highly judicialized contexts, we thus describe a new multi-source, multi-stakeholder mixed-method approach designed to capture the patterns and heterogeneity of judicialization and understand its medical and socio-political impact in real time, along with its counterfactuals. By facilitating greater data availability and open access, we can drive advancements towards transparent and participatory priority setting, as well as accountability mechanisms that promote quality universal health coverage.

Engaging people with chronic kidney disease in their own care an integrative review. / Envolvimento da pessoa com doença renal crônica em seus cuidados: revisão integrativa.

The treatment of chronic kidney disease (CKD) places a major burden on patients and their families. Interventions such as nutritional management, medication regimen, and renal replacement therapies require active patient participation. An integrative literature review was carried out to identify articles on the engagement and participation of people with CKD in their care. The Medical Subject Headings (MeSH) "Kidney Failure, Chronic", "Self Care", and "Patient Participation" were used to conduct a search on the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), the U.S. National Library of Medicine® (Medline/PubMed), Biblioteca Virtual em Saúde (Bireme). A total of 21 articles published between 2012 and 2016 were selected. The most commonly used data collection and analysis techniques were semi-structured interviews and phenomenological thematic analysis, respectively. The articles were categorized into the following thematic groups: illness management and treatment; involvement in the decision-making process; advanced care plan; and home peritoneal dialysis. We found that there is a lack of qualitative research in certain areas, namely kidney transplant recipients and people with initial stages of CKD. People with CKD should be encouraged to actively engage in their own care, which in turn requires the knowledge, motivation and support of health professionals.

A doença renal crônica (DRC) acarreta ao indivíduo uma sobrecarga de cuidados indispensáveis ao alcance das metas terapêuticas e qualidade de vida. O controle nutricional, o regime medicamentoso e as terapias de substituição renal são exemplos que requerem participação ativa. Assim, foi realizada revisão integrativa de artigos científicos para identificar os que versam sobre envolvimento e participação do paciente em seus cuidados na DRC. Os descritores "Chronic kidney disease"; "Self-Care" and "Patient Participation" foram aplicados nas bases CINHAL, Bireme e Medline. Selecionamos 21 publicações entre 2012 e 2016. A entrevista semiestruturada destacou-se como método de coleta de dados, com a aplicação da análise temática fenomenológica. Conforme a predominância do assunto tratado, os manuscritos foram alocados em quatro eixos temáticos: Manejo da doença renal e seu tratamento; Envolvimento na tomada de decisão; Plano avançado de cuidados; e, Diálise peritoneal domiciliar. Verificamos que abordagens envolvendo pessoas transplantadas ou nos primeiros estágios da doença são pouco explorados com a aplicação do método qualitativo e, ainda, consideramos que pessoas com DRC devem ser instigadas no envolvimento ativo de seus próprios cuidados, necessitando de conhecimento, motivação e suporte dos profissionais de saúde.