Possibilities of the nurse's action in front of the effects of social isolation on the patient with chronic pain: integrative review / Possibilidades de atuação do enfermeiro frente aos efeitos do isolamento social no paciente com dor crônica: revisão integrativa

ABSTRACT BACKGROUND AND OBJECTIVES: Social isolation, as experienced in the context of the COVID-19 pandemic, has triggered psychological and neuropsychiatric problems; these conditions can aggravate chronic pain crises. It is also known that social relationships play an important role in pain and emotions. Chronic pain (CP) is a challenging disease, especially in terms of its multifaceted mechanisms and treatment. Thus, the aim of this study was to provide a better understanding of nurses' work with patients with CP and the impact of social isolation resulting from the COVID-19 pandemic. CONTENTS: This is an integrative review, carried out in the Virtual Health Library (Biblioteca Virtual em Saúde - BVS) and Medline via Pubmed databases of the National Library of Medicine. To select the articles, the following descriptors in health sciences and Medical Subject Headings (DeCS/MeSh) were considered: "Social isolation", "Chronic pain", "COVID-19", "Nursing care" and "Patient care planning", with their synonyms/alternative terms. A total of 45,703 articles were found; based on the inclusion and exclusion criteria, 27 articles were selected. This study hoped to answer the following guiding questions: "how do nurses work with individuals with CP during the social isolation caused by COVID-19?", and "what are the consequences of social isolation for this population due to the COVID-19 pandemic?". Of the 27 articles, most were published in North America and Europe, and three in Brazil. The population most affected by CP are seniors, women and people on low incomes. In terms of profession, only three of the 27 articles were published by nurses. The data was discussed considering the work of nurses with individuals with CP, especially through telehealth, as well as the impacts that people with CP have suffered from social isolation during the coronavirus pandemic. CONCLUSION: There is a significant gap in the literature regarding the role of nurses with individuals with CP in social isolation, suggesting the need for further studies in this area, mainly at the national level. From the studies found, it was evidenced that individuals who live with CP have the multiple dimensions of the human being affected, but that in this moment of social isolation due to the COVID-19 pandemic, the worst commitment was the emotional one. Thus, with the continued rise of telehealth and the possibility of future pandemics, it is recommended to move the existing guidelines for the formal development of telehealth competencies towards relevant curricular content and clinical experience for all nursing programs.

RESUMO JUSTIFICATIVA E OBJETIVOS: O isolamento social, como vivenciado no contexto da pandemia da COVID-19, desencadeou problemas psicológicos e neuropsiquiátricos; essas condições podem agravar as crises de dor crônicas. Além disso, é sabido que as relações sociais têm um papel importante na dor e nas emoções. A dor crônica (DC) apresenta-se como uma doença desafiadora, sobretudo quanto aos seus mecanismos multifacetados e ao seu tratamento. Assim, o objetivo do presente estudo foi trazer uma maior compreensão da atuação do enfermeiro nos pacientes com DC e do impacto do isolamento social decorrente da pandemia da COVID-19. CONTEÚDO: Trata-se de uma revisão integrativa, realizada nas bases de dados Biblioteca Virtual em Saúde (BVS) e Medline via Pubmed da National Library of Medicine. Para a seleção dos artigos foram considerados os descritores em ciências da saúde e Medical Subject Headings (DeCS/MeSh): "Isolamento social", "Dor crônica", "COVID-19", "Cuidados de enfermagem" e "Planejamento de assistência ao paciente", com os seus sinônimos/termos alternativos. Foram encontrados 45.703 artigos; a partir dos critérios de inclusão e exclusão, foram selecionados 27 artigos. Este estudo esperou responder às seguintes perguntas norteadoras: "qual a atuação do enfermeiro com o indivíduo com DC durante o isolamento social da COVID-19?", e "quais as consequências do isolamento social devido à pandemia da COVID-19 para essa população?". Dos 27 artigos, a maior parte foi publicada na América do Norte e Europa, e três no Brasil. A população mais afetada pela DC são idosos, mulheres e pessoas de baixa renda. Em relação à profissão, dos 27 artigos somente três foram publicados por enfermeiros. Os dados foram discutidos considerando a atuação do enfermeiro para com o indivíduo com DC, em especial por meio da telessaúde, bem como os impactos que as pessoas com DC sofreram com o isolamento social durante a pandemia do novo coronavírus. CONCLUSÃO: Há uma significativa lacuna na literatura no que tange à atuação do enfermeiro com indivíduos com DC em isolamento social, sugerindo a necessidade de maiores estudos nessa área, principalmente a nível nacional. Nos estudos encontrados, foi evidenciado que indivíduos que vivem com DC possuem as múltiplas dimensões humanas afetadas, mas nesse momento de isolamento social devido à pandemia da COVID-19 a dimensão de pior comprometimento foi a emocional. Assim, com o aumento contínuo da telessaúde e a possibilidade de futuras pandemias, recomenda-se mover as diretrizes existentes para o desenvolvimento formal de competências da telessaúde por conteúdo curricular relevante e experiência clínica para todos os programas de enfermagem.

Modelos neuropsicobiológicos para estudo da dor e das emoções / Neuropsychobiological models for the study of pain and emotions / Modelos neuropsicológicos para el estudio del dolor y las emociones

Dor é uma experiência pessoal e subjetiva que pode apenas ser sentida pelo sofredor. A dor aguda tem a finalidade de avisar o indivíduo que algo está errado. Contudo, a dor crônica (DC) é um problema global de saúde, que afeta a qualidade de vida e torna o indivíduo parcial ou totalmente incapacitado. A pesquisa básica utiliza diversos modelos animais para o estudo da dor aguda ou crônica, bem como para o estudo das principais comorbidades oriundas de sua cronificação como a ansiedade e a depressão. Esta revisão aborda os modelos animais mais comumente utilizados neste contexto.

Pain is a personal and subjective experience that can only be felt by the sufferer. Acute pain is intended to warn the individual that something is wrong. However, chronic pain (CP) is a global health problem, affecting the quality of life and making the individual parts or disabled. Basic research uses several animal models for the study of acute or chronic pain, as well as for the study of the main comorbidities arising from their chronicity, such as anxiety and depression. This review focuses on the animal models most commonly used in this context.

El dolor es una experiencia personal y subjetiva que solo puede sentir la víctima. El dolor agudo está destinado a advertir al individuo que algo está mal. Sin embargo, el dolor crónico (EC) es un problema de salud global, que afecta la calidad de vida y hace que el individuo esté parcial o totalmente discapacitado. La investigación básica utiliza varios modelos animales para el estudio del dolor agudo o crónico, así como para el estudio de las principales comorbilidades resultantes de su cronicidad, como la ansiedad y la depresión. Esta revisión se centra en los modelos animales más utilizados en este contexto.

Resistance to temephos and deltamethrin in Aedes aegypti from Brazil between 1985 and 2017

BACKGROUND Aedes aegypti populations in Brazil have been subjected to insecticide selection pressures with variable levels and sources since 1967. Therefore, the Brazilian Ministry of Health (MoH) coordinated the activities of an Ae. aegypti insecticide resistance monitoring network (MoReNAa) from 1999 to 2012. OBJECTIVES The objective of this study was to consolidate all information available from between 1985 and 2017 regarding the resistance status and mechanisms of Brazilian Ae. aegypti populations against the main insecticide compounds used at the national level, including the larvicide temephos (an organophosphate) and the adulticide deltamethrin (a pyrethroid). METHODS Data were gathered from two sources: a bibliographic review of studies published from 1985 to 2017, and unpublished data produced by our team within the MoReNAa between 1998 and 2012. A total of 146 municipalities were included, many of which were evaluated several times, totalling 457 evaluations for temephos and 274 for deltamethrin. Insecticide resistance data from the five Brazilian regions were examined separately using annual records of both the MoH supply of insecticides to each state and the dengue incidence in each evaluated municipality. FINDINGS Ae. aegypti resistance to temephos and deltamethrin, the main larvicide and adulticide, respectively, employed against mosquitoes in Brazil for a long time, was found to be widespread in the country, although with some regional variations. Comparisons between metabolic and target-site resistance mechanisms showed that one or another of these was the main component of pesticide resistance in each studied population. MAIN CONCLUSIONS (i) A robust dataset on the assessments of the insecticide resistance of Brazilian Ae. aegypti populations performed since 1985 was made available through our study. (ii) Our findings call into question the efficacy of chemical control as the sole methodology of vector control. (iii) It is necessary to ensure that sustainable insecticide resistance monitoring is maintained as a key component of integrated vector management. (iv) Consideration of additional parameters, beyond the supply of insecticides distributed by the MoH or the diverse local dynamics of dengue incidence, is necessary to find consistent correlations with heterogeneous vector resistance profiles.

Polymorphisms in the TGFB1 and IL2RA genes are associated with clinical forms of leprosy in Brazilian population

BACKGROUND Leprosy is a chronic infectious disease caused by Mycobacterium leprae, and compromises the skin and peripheral nerves. This disease has been classified as multibacillary (MB) or paucibacillary (PB) depending on the host immune response. Genetic epidemiology studies in leprosy have shown the influence of human genetic components on the disease outcomes. OBJECTIVES We conducted an association study for IL2RA and TGFB1 genes with clinical forms of leprosy based on two case-control samples. These genes encode important molecules for the immunosuppressive activity of Treg cells and present differential expressions according to the clinical forms of leprosy. Furthermore, IL2RA is a positional candidate gene because it is located near the 10p13 chromosome region, presenting a linkage peak for PB leprosy. METHODS A total of 885 leprosy cases were included in the study; 406 cases from Rondonópolis County (start population), a hyperendemic region for leprosy in Brazil, and 479 cases from São Paulo state (replication population), which has lower epidemiological indexes for the disease. We tested 11 polymorphisms in the IL2RA gene and the missense variant rs1800470 in the TGFB1 gene. FINDINGS The AA genotype of rs2386841 in IL2RA was associated with the PB form in the start population. The AA genotype of rs1800470 in TGFB1 was associated with the MB form in the start population, and this association was confirmed for the replication population. MAIN CONCLUSIONS We demonstrated, for the first time, an association data with the PB form for a gene located on chromosome 10. In addition, we reported the association of TGFB1 gene with the MB form. Our results place these genes as candidates for validation and replication studies in leprosy polarisation.

Esgotamento entre profissionais da Atenção Primária à Saúde / Burnout Syndrome in Primary Health Care Professionals

O esgotamento profissional (EP) caracteriza-se por exaustão emocional, despersonalização, e baixa realização profissional, podendo ocorrer entre profissionais da saúde. Este artigo avalia o EP entre trabalhadores da Atenção Primária à Saúde (APS) em três municípios de pequeno porte da Zona da Mata Mineira. O estudo analisa a associação por regressão logística entre EP, aspectos socioeconômicos, demográficos e aspectos do trabalho. Um total de 149 profissionais foi selecionado, destes, 107 responderam a todos os questionários. Para mensurar o EP, foi utilizado o Maslach Burnout Inventory (MBI) e, para a caracterização dos profissionais, foi utilizado outro questionário segundo três diferentes questões: aspectos individuais, sociodemográficos e área de cobertura da equipe. Foram classificados 101 profissionais com indicação positiva para EP. As variáveis presentes no modelo de regressão logística backward stepwise, associadas positivamente com indicativo de esgotamento profissional foram: possuir idade inferior à mediana da população (> 29,5 anos) e fazer uso de medicamentos "calmantes, tranquilizantes e remédios para dormir". Os resultados contribuem para identificar fatores associados com o esgotamento profissional e apontam, neste sentido, para a necessidade de investigações mais detalhadas.

Burnout is characterized by emotional exhaustion, depersonalization and low occupational performance, which may occur among health professionals. This article evaluates burnout among workers in Primary Health Care (PHC) in three small towns in the Zona da Mata Mineira. The study analyzes associations by logistic regression between burnout, socioeconomic, and demographic aspects of work. A total of 149 professionals were selected, 107 of these responded to all questionnaires. To measure burnout, the Maslach Burnout Inventory (MBI) was used and to characterize the professional, a questionnaire assessing three different issues - namely individual and sociodemographic aspects and team area coverage - was used. 101 professionals were classified with positive indication for burnout. The variables present in the backward stepwise logistic regression model positively associated with indicative of burnout were: being younger than the population average (> 29.5 years) and use of drugs, including sedatives, tranquilizers and sleeping pills. The results contribute to the identification of factors associated with burnout and therefore highlight the need for more detailed investigation.

Descrição do comportamento de superfície do boto cinza, Sotalia guianensis, na Praia de Pipa - RN / Description of the surface behaviour of marine tucuxi, Sotalia guianensis, at Pipa Beach - RN

O estudo do comportamento animal é uma área de pesquisa consolidada, que cresceu e se diversificou em vários países e que deu origem a disciplinas e abordagens de investigação, como a Etologia, a Ecologia Comportamental, a Neuroecologia, a Psicologia e a Psicologia evolucionista. No estudo do comportamento animal, o etograma é a base para estudos comportamentais de espécies pouco conhecidas, como também para comparar comportamentos de populações distintas de uma mesma espécie. Tradicionalmente, um etograma descreve de forma detalhada eventos comportamentais realizados por indivíduos de uma espécie. O presente estudo apresenta um etograma dos eventos comportamentais realizados na superfície por uma espécie de golfinho costeiro, boto cinza, na praia de Pipa - RN.

Research in animal behavior is a consolidated area whose development and diversification in several countries have originated some subjects and investigation approaches, such as Ethology, Behavior Ecology, Neuroecology, Psychology and Evolutionist Psychology. In the study of animal behavior, the ethogram is the foundation for studies on behavior patterns of distinct populations of the same species. An ethogram traditionally describes behavioral events performed by individuals of the same species in detail. This study presents an ethogram of behavioral events performed on surface by a costal dolphin known as the gray dolphin (Marine Tucuxi Dolphin), at Pipa Beach, RN.