Autocuidado em hanseníase sob a ótica de grupos operativos: uma abordagem qualitativa / Self-care in leprosy from the perspective of operative groups: a qualitative approach / Autocuidado de la enfermedad de Hansen desde la perspectiva de los grupos operativos: abordaje cualitativo

OBJETIVOS: Analisar um grupo de apoio ao autocuidado para pessoas acometidas pela hanseníase sob a ótica de grupos operativos. MÉTODO: Estudo qualitativo do tipo explicativo, realizado em uma unidade de saúde em um município de Pernambuco. Foi realizada a análise de conteúdo, na modalidade análise temática proposta por Bardin. RESULTADOS: Os resultados apontaram características do grupo relacionadas aos seis vetores da teoria de Pichon-Rivière: afiliação e pertença, cooperação, pertinência, comunicação, aprendizagem e tele. DISCUSSÃO: O acompanhamento de um grupo de autocuidado em hanseníase proporciona uma abrangência de significados e reflexões. Estar inserido em um grupo aumenta as oportunidades de reconstrução da autoconfiança, autoestima e inserção na comunidade. CONCLUSÃO: O grupo de apoio ao autocuidado em hanseníase em foco se caracteriza como um grupo operativo. Estudos que investiguem os fatores implícitos dos GACs ainda são necessários, sobretudo no que diz respeito às características dos grupos nas diferentes unidades de saúde.

OBJECTIVES: To analyze a self-care support group for people affected by leprosy from the perspective of operative groups. METHOD: A qualitative study of the explanatory type, carried out in a health unit in a municipality of Pernambuco. Content analysis was carried out, in the thematic analysis proposed by Bardin. RESULTS: The results indicated characteristics of the group related to the six vectors of the Pichon-Rivière theory: affiliation and belonging, cooperation, pertinence, communication, learning and tele. DISCUSSION: The monitoring of a self-care group in leprosy provides a range of meanings and reflections. Being part of a group increases the opportunities for rebuilding self-confidence, self-esteem and insertion in the community. CONCLUSION: The leprosy self-care support group in focus is characterized as an operative group. Studies that investigate the implicit factors of the SCGs are still needed, especially with regard to the characteristics of the groups in the different health units.

OBJETIVO: Analizar un grupo de apoyo para el autocuidado de personas afectadas por la enfermedad de Hansen (lepra) desde la perspectiva de los grupos operativos. MÉTODO: Estudio cualitativo de tipo explicativo, realizado en una unidad de salud de un municipio de Pernambuco. El análisis de contenido se realizó según la modalidad de análisis temático propuesto por Bardin. RESULTADOS: Los resultados indicaron que el grupo tenía características relacionadas con los seis vectores de la teoría de Pichon-Rivière: afiliación y pertenencia, cooperación, pertinencia, comunicación, aprendizaje y telé. DISCUSIÓN: El seguimiento de un grupo para el autocuidado de la enfermedad de Hansen ofrece una cobertura de significados y reflexiones. Formar parte de un grupo aumenta las oportunidades de reconstruir la confianza en uno mismo, la autoestima y la inserción en la comunidad. CONCLUSIÓN: El grupo de apoyo para el autocuidado de la enfermedad de Hansen se caracteriza, principalmente, por ser un grupo operatorio. Aún se necesitan estudios que investiguen los factores implícitos de los GAC, especialmente en lo que respecta a las características de los grupos en las diferentes unidades de salud.

Protective effect of dapsone on cognitive impairment induced by propofol involves hippocampal autophagy.

Post-operative cognitive dysfunction (POCD) is a commonly seen postoperative complication in elderly patients and its underlying mechanisms are still unclear. Autophagy, a degradation mechanism of cellular components, is required for cell survival and many physiological processes. Although propofol is one of the most commonly used intravenous anesthetics, investigations into its mechanisms and effects on cognition in aged rodents are relatively scarce. In this study, we evaluate the influence of propofol on learning and memory, and identify the potential role of hippocampal autophagy in propofol-induced cognitive alterations in aged rats. The results demonstrate that 4h propofol exposure significantly impaired cognitive performance through the inhibition of hippocampal autophagy. Diaminodiphenyl sulfone (dapsone, DDS), which was used as an anti-leprosy drug, has been found to have neuroprotective effects. We have previously demonstrated that DDS can improve surgical stress induced depression- and anxiety-like behavior. We therefore aimed to investigate the effects of DDS on propofol-induced cognitive dysfunction and associated hippocampal autophagy responses. Pretreatment with 5mg/kg or 10mg/kg body weight DDS significantly improved the behavioral disorder and upregulated the inhibited autophagic response in aged rats. Our exploration is the first to establish an in vivo link between central autophagy and cognitive dysfunction in aged hippocampus after propofol anesthesia and demonstrate that the prophylactic effect of DDS on the cognitive impairment induced by propofol involves autophagy. These findings may imply a potential novel target for the treatment in patients with propofol anesthesia-induced cognitive impairment.

Does perceptual learning require consciousness or attention?

It has been proposed that visual attention and consciousness are separate [Koch, C., & Tsuchiya, N. Attention and consciousness: Two distinct brain processes. Trends in Cognitive Sciences, 11, 16-22, 2007] and possibly even orthogonal processes [Lamme, V. A. F. Why visual attention and awareness are different. Trends in Cognitive Sciences, 7, 12-18, 2003]. Attention and consciousness converge when conscious visual percepts are attended and hence become available for conscious report. In such a view, a lack of reportability can have two causes: the absence of attention or the absence of a conscious percept. This raises an important question in the field of perceptual learning. It is known that learning can occur in the absence of reportability [Gutnisky, D. A., Hansen, B. J., Iliescu, B. F., & Dragoi, V. Attention alters visual plasticity during exposure-based learning. Current Biology, 19, 555-560, 2009; Seitz, A. R., Kim, D., & Watanabe, T. Rewards evoke learning of unconsciously processed visual stimuli in adult humans. Neuron, 61, 700-707, 2009; Seitz, A. R., & Watanabe, T. Is subliminal learning really passive? Nature, 422, 36, 2003; Watanabe, T., Náñez, J. E., & Sasaki, Y. Perceptual learning without perception. Nature, 413, 844-848, 2001], but it is unclear which of the two ingredients-consciousness or attention-is not necessary for learning. We presented textured figure-ground stimuli and manipulated reportability either by masking (which only interferes with consciousness) or with an inattention paradigm (which only interferes with attention). During the second session (24 hr later), learning was assessed neurally and behaviorally, via differences in figure-ground ERPs and via a detection task. Behavioral and neural learning effects were found for stimuli presented in the inattention paradigm and not for masked stimuli. Interestingly, the behavioral learning effect only became apparent when performance feedback was given on the task to measure learning, suggesting that the memory trace that is formed during inattention is latent until accessed. The results suggest that learning requires consciousness, and not attention, and further strengthen the idea that consciousness is separate from attention.

Computer Assisted Objective Structured Clinical Examination: a useful tool for dermatology undergraduate assessment.

BACKGROUND: Dermatology is a minor subject in undergraduate medical curriculum in India. The dermatology clinical postings are generally poorly attended, and the clinical acumen of an average medical graduate in this specialty is quite low. AIMS: To develop and implement Computer Assisted Objective Structured Clinical Examination (CA-OSCE) as a means of end of dermatology posting evaluation. Also, to assess its effectiveness in improving the motivation, attendance and learning of undergraduate students with respect to their visual recognition skills and problem solving ability. METHODS: We designed and introduced CA-OSCE as a means of end of posting assessment. The average attendance and assessment scores of students undergoing CA-OSCE were compiled and compared using 'independent t test' with the scores of previous year's students who had undergone assessment with essay type questions. RESULTS: The average attendance and average assessment scores for the candidates undergoing CA-OSCE were found to 83.36% and 77.47%, respectively as compared to 64.09% and 52.07%, respectively for previous years' students. The difference between the two groups was found to be statistically significant. Student acceptability of the technique was also high, and their subjective feedback was encouraging. CONCLUSION: CA-OSCE is a useful tool for assessment of dermatology undergraduates. It has the potential to drive them to attend regularly as well as to test their higher cognitive skills of analysis and problem solving.

Conhecimentos e necessidades de aprendizagem de estudantes de fisioterapia sobre a hanseníase / Knowledge and necessities of learning of physioterapys students about leprosy

INTRODUÇÃO: A hanseníase se constitui importante problema de Saúde Pública no Brasil, tendo, no entanto, negligenciada sua importância e valorização na formação das profissões da saúde, mesmo nos países endêmicos. No caso específico do fisioterapeuta, faz-se necessário o ensino da hansenologia nos cursos de graduação no Brasil, para se atuar nas condições de saúde da população diante da problemática da Hanseníase.OBJETIVO: descrever e analisar conhecimentos de estudantes de fisioterapia sobre hanseníase, antes do contato formal na Universidade/Faculdade com a temática. METODOLOGIA: estudo qualitativo, realizado com 51 estudantes de graduação em fisioterapia do quarto ano de escola do interior do estado de São Paulo,em 2004. Na coleta dos dados, utilizou-se questionário auto-aplicado, com questões abertas. A partir da análise qualitativa das respostas realizou-se a categorização das mesmas. RESULTADOS: identificou-se que estudantes do último ano do curso de fisioterapia expressaram desconhecimento e/ou conceitos incompletos ou inadequados, frente a literatura, sobre hanseníase e os seguintes aspectos devem ser enfatizados no ensino da hansenologia: doença hanseníase; preconceito que os doentes vivenciam e como enfrentá-lo; educação em saúde e atuação do fisioterapeuta na hanseníase. Em relação à organização do ensino, identificou-se que Universidades/Faculdades devem construir estratégias para valorizar a hanseníase como um problema de Saúde Pública. CONCLUSÃO: evidenciou-se a necessidade de aprimoramento do ensino da hansenologia no curso de graduação em Fisioterapia, com abordagem do tema desde o início da formação, para que fisioterapeutas possam prestar o cuidado adequado frente a problemática da hanseníase e contribuir com o Programa de Controle da Hanseníase

INTRODUCTION: The Leprosy constitutes a significant problem of Public Health in Brazil, however its importance and valuation in the preparation of the health professions has been neglected, even in the endemic countries. In the specific case of the physiotherapist, the hansenology teaching in the graduation’s course in Brazil becomes necessary, to deal in the future with the health conditions of the population with the Leprosy’s problematic. OBJECTIVE: To describe and analyze the previous knowledge of physiotherapy’s students on leprosy during the professional preparation of the physiotherapist. METHODOLOGY: It is a qualitative study on leprosy knowledge among 51 students of physiotherapy in a Sao Paulo State school, in 2004. For the survey an auto-applied questionnaire with guided questions was used to collect the data. A qualitative analysis was done by categorization. RESULTS: It was identified unfamiliarity and/or inadequate concepts about leprosy and the following aspects must be emphasized in the hansenology teaching: the hansen’s disease; the preconception that the sick people live and how to face it; the health education and the performance of the physiotherapist in leprosy. In relation to the organization of education,it was identified that the Universities/Colleges must construct bigger strategies of motivation, valuing leprosy as a Public Health’s problem. CONCLUSION: It was proven the necessity of the hansenology’s education in the undergraduation courses of physiotherapy, so that the physiotherapists can give adequate assistance to the problematic of leprosy and contribute with the Program of Leprosy Control.