Discourse and manipulation: Nursing in question.

The history of Brazilian nurses is marked by several challenges, in part resulting from discontinuous and fragile activity boundaries among the health professions that share the same work objective in care services. A field of constant disputes, the Brazilian health system, was the target of a lawsuit filed by the Federal Council of Medicine that temporarily suspended nurses' activities in primary care. This study aimed to demonstrate the manipulative discourse present in the text of the injunction request by medical doctors against legislation by the Brazilian Federal Government in 2017. This is a qualitative and documental study that used the theoretical-methodological framework of critical discourse studies based on Teun Van Dijk's analytical categories. The results pointed to manipulative discourse through a polarization between manipulators' good qualities and intentions and the bad qualities of nurses and Brazilian primary care policies; episodic manipulation by the presentation of documental and historical evidence of the submission of nursing roles; and social manipulation marked by strong emotional appeal. The study demonstrated that manipulative discourse extrapolated linguistic categories in the form of ideology and history.

Quotidian of accompanying family members in an environment of care: the emergence of hospital tribes.

OBJETIVO: Compreender o relacionamento no quotidiano dos familiares acompanhantes nos cenários de cuidado que se aproximam da metáfora da tribo no ambiente hospitalar. MÉTODO: Estudo qualitativo com dados coletados a partir de entrevistas semiestruturadas e observação com 16 familiares acompanhantes de pessoas hospitalizadas com dependência para o autocuidado. Os dados foram submetidos à análise temática e analisados através da metáfora da tribo proposta pela sociologia compreensiva. RESULTADOS: Os familiares formam um agrupamento social em torno do cuidado onde encontramos as características das tribos: a ambiência emocional; a solidariedade baseada nos vínculos de simpatia e ajuda mútua; a nebulosa afetual no processo interacional; a lógica da fusão nas relações tácteis e a comunhão/religiosidade no processo de ligação numa identidade coletiva. CONCLUSÃO: Os familiares na presença do trágico criam agrupamentos sociais que se assemelham a tribos cujo totem é o cuidado. OBJECTIVE: Understand the quotidian relationships of accompanying family members in an environment of care, which are close to the metaphor of a tribe in hospital environment. METHODQualitative study with data gathered from semi-structured interviews and observations with 16 family members accompanying hospitalized individuals with dependence on self-care. Data were submitted to thematic analysis, and analyzed through the metaphor of "tribe" proposed by comprehensive sociology. RESULTS: Family members build up social clusters around caring, where we find traits typical of tribes: emotional ambience; solidarity based on links of sympathy and mutual assistance; an affectual nebula in the process of interaction; a logic of fusion in tactile relations; and communion/religiosity in the process of connecting in a collective identity. CONCLUSION: In the presence of tragedy, families build social clusters similar to tribes having care as a totem.

Prediction of the response to repetitive transcranial magnetic stimulation of the motor cortex in peripheral neuropathic pain and validation of a new algorithm.

CLINICAL TRIAL REGISTRATION: NCT02010281.

Extensively drug-resistant Pseudomonas aeruginosa: clinical features and treatment with ceftazidime/avibactam and ceftolozane/tazobactam in a tertiary care university hospital center in Portugal - A cross-sectional and retrospective observational study.

Introduction: Extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) is a growing concern due to its increasing incidence, limited therapeutic options, limited data on the optimal treatment, and high mortality rates. The study aimed to characterize the population, the outcome and the microbiological characteristics of XDR-PA identified in a Portuguese university hospital center. Methods: All XDR-PA isolates between January 2019 and December 2021 were identified. XDR-PA was defined as resistance to piperacillin-tazobactam, third and fourth generation cephalosporins, carbapenems, aminoglycosides and fluoroquinolones. A retrospective analysis of the medical records was performed. Results: One hundred seventy-eight individual episodes among 130 patients with XDR-PA detection were identified. The most common sources of infection were respiratory (32%) and urinary tracts (30%), although skin and soft tissue infections (18%) and primary bacteremia (14%) were also prevalent. Colonization was admitted in 64 cases. Several patients had risk factors for complicated infections, most notably immunosuppression, structural lung abnormalities, major surgery, hemodialysis or foreign intravascular or urinary devices. XDR-PA identification was more frequent in male patients with an average age of 64.3 ± 17.5 years. One non-susceptibility to colistin was reported. Only 12.4% were susceptible to aztreonam. Ceftazidime-avibactam (CZA) was susceptible in 71.5% of the tested isolates. Ceftolozane-tazobactam (C/T) was susceptible in 77.5% of the tested isolates. Antibiotic regimens with XDR-PA coverage were reserved for patients with declared infection, except to cystic fibrosis. The most frequently administered antibiotics were colistin (41 cases), CZA (39 cases), and C/T (16 cases). When combination therapy was used, CZA plus colistin was preferred. The global mortality rate among infected patients was 35.1%, significantly higher in those with hematologic malignancy (50.0%, p < 0.05), followed by the ones with bacteremia (44.4%, p < 0.05) and those medicated with colistin (39.0%, p < 0.05), especially the ones with respiratory infections (60.0%). Among patients treated with CZA or C/T, the mortality rate seemed to be lower. Discussion: XDR-PA infections can be severe and difficult to treat, with a high mortality rate. Even though colistin seems to be a viable option, it is likely less safe and efficient than CZA and C/T. To the best of the authors' knowledge, this is the first description of the clinical infection characteristics and treatment of XDR-PA in Portugal.

Report of similar placebo response in one internet versus onsite randomised controlled trials from the literature.

Objective: The aim of this study was to compare the magnitude and the predictors of the placebo response in an internet versus onsite randomised controlled trials (RCTs) in people with hand osteoarthritis (HOA). Method: This study is a post-hoc analysis based on one internet RCT (RADIANT) and previously published onsite RCTs for HOA identified through a rigorous searching and selection strategy. The magnitude of the placebo response in the two different types of RCTs were compared using heterogeneity statistics and forest plots visualisation. Classic placebo predictors as well as a combined model, defined with data from onsite RCTs, were tested to predict the placebo response. Results: We analysed the dataset from RADIANT and fourteen previously published onsite RCTs. None of the analyses showed a significant difference between the placebo response for the internet versus onsite RCTs. The "classic" placebo predictors combined in a multivariate predictive model correlated significantly with the placebo response measured in RADIANT study. Conclusion: Despite the absence of face-to-face interactions with the study personnel, there is no evidence that either the magnitude or the predictors of the placebo response of this internet RCT differ from those of onsite RCTs. This analysis is considered as a first step towards evaluating the difference between these designs and strengthens the argument that internet RCTs remain an acceptable alternative way to assess the efficacy of an active treatment in comparison to a placebo.

Exploring men's health in medium and high complexity care in Brazil: A deductive thematic analysis of social determinants.

Background: Men's health is influenced by a complex interplay of social, economic, and cultural determinants. Understanding how these aspects affect the health of adult cisgender men in medium and high-complexity healthcare settings is essential for improving healthcare services and promoting better health outcomes. Objective: This study aimed to analyze the health status of adult cisgender men in medium and high-complexity healthcare settings based on social determinants and conditioners. Methods: This study employed a qualitative design involving 45 adult cisgender men receiving care in medium/high complexity services in Bahia, Brazil. Semi-structured interviews were conducted from July 2019 to February 2020, and data were interpreted based on Dahlgren and Whitehead's Model of Social Determinants of Health using deductive thematic analysis. Results: Proximal determinants included biological aspects, preventive behaviors, lifestyle/social life, and aging processes. Intermediate factors included work conditions, access/utilization of healthcare services/medications, and psychosocial factors. Macro determinants involved income distribution, power dynamics, resource allocation, health inequalities/iniquities, morbidity, culture, political decisions, environmental factors, and structural elements. Conclusion: The health status of men in medium/high complexity care was profoundly influenced by structural social determinants. These determinants impacted healthcare attention, service organization, cultural influences, the reproduction of hegemonic masculinity patterns, lifestyle, social support, and socioeconomic conditions necessary to realize the right to health. Nursing practices should conduct comprehensive assessments that extend beyond physical health indicators.

Men's health care: concept analysis.

OBJECTIVES: To analyze the concept of men's health care and identify its essential, antecedent and consequent attributes in the health context. METHODS: This is a concept analysis structured in the theoretical-methodological framework of the Walker and Avant Model. An integrative review was carried out between May and July 2020, using keywords and descriptors: Men's Care and Health. RESULTS: The concept of men's health care is structured by 240 attributes, 14 categories, 82 antecedents and 159 consequents, from the selection of 26 published manuscripts. The design was evidenced from the dimensions: Intrapersonal, psychological and behavioral related to masculinities, interpersonal, organizational and structural, ecological, ethnoracial, cross-cultural and transpersonal. CONCLUSIONS: The concept of men's health care revealed the male specificities regarding the recognition of the place of health care and the daily exercise in the lived experience.

Propentofylline Improves Thiol-Based Antioxidant Defenses and Limits Lipid Peroxidation following Gliotoxic Injury in the Rat Brainstem.

Propentofylline (PROP) is a methylated xanthine compound that diminishes the activation of microglial cells and astrocytes, which are neuronal cells strongly associated with many neurodegenerative diseases. Based on previously observed remyelination and neuroprotective effects, PROP has also been proposed to increment antioxidant defenses and to prevent oxidative damage in neural tissues. Since most neurodegenerative processes have free radicals as molecular pathological agents, the aim of this study was to evaluate the antioxidant effects of 12.5 mg·kg-1·day-1 PROP in plasma and the brainstem of Wistar rats exposed to the gliotoxic agent 0.1% ethidium bromide (EB) for 7-31 days. The bulk of the data here demonstrates that, after 7 days of EB treatment, TBARS levels were 2-fold higher in the rat CNS than in control, reaching a maximum of 2.4-fold within 15 days. After 31 days of EB treatment, lipoperoxidation in CNS was still 65% higher than that in the control. Clearly, PROP treatment limited the progression of lipoperoxidation in EB-oxidized CNS: it was, for example, 76% lower than in the EB-treated group after 15 days. Most of these effects were associated with PROP-induced activity of glutathione reductase in the brainstem: the EB + PROP group showed 59% higher GR activity than that of the EB or control groups within 7 days. In summary, aligning with previous studies from our group and with literature about MTXs, we observed that propentofylline (PROP) improved the thiol-based antioxidant defenses in the rat brainstem by the induction of the enzymatic activity of glutathione reductase (GR), which diminished lipid oxidation progression and rebalanced the redox status in the CNS.

Analysis of the full-length genome sequence of papaya lethal yellowing virus (PLYV), determined by deep sequencing, confirms its classification in the genus Sobemovirus.

Papaya lethal yellowing virus (PLYV) causes an economically important disease in papayas in northeastern Brazil. Based on biological and molecular properties, PLYV has been tentatively assigned to the genus Sobemovirus. We report the sequence of the full-length genome of a PLYV isolate from Brazil, determined by deep sequencing. The PLYV genome is 4,145 nt long and contains four ORFs, with an arrangement identical to that of sobemoviruses. The polyprotein and CP display significant sequence identity with the corresponding proteins of other sobemoviruses. Pairwise comparisons and phylogenetic analysis based on complete nucleotide sequences confirm the classification of PLYV in the genus Sobemovirus.

Leveraging historical data to optimize the number of covariates and their explained variance in the analysis of randomized clinical trials.

The amount of data collected from patients involved in clinical trials is continuously growing. All baseline patient characteristics are potential covariates that could be used to improve clinical trial analysis and power. However, the limited number of patients in phases I and II studies restricts the possible number of covariates included in the analyses. In this paper, we investigate the cost/benefit ratio of including covariates in the analysis of clinical trials with a continuous outcome. Within this context, we address the long-running question "What is the optimum number of covariates to include in a clinical trial?" To further improve the benefit/cost ratio of covariates, historical data can be leveraged to pre-specify the covariate weights, which can be viewed as the definition of a new composite covariate. Here we analyze the use of a composite covariate to improve the estimated treatment effect in small clinical trials. A composite covariate limits the loss of degrees of freedom and the risk of overfitting.

NT-proBNP for heart failure diagnosis in Primary Care: Costs or savings? A budget impact study.

INTRODUCTION AND OBJECTIVES: Chronic heart failure (CHF) is a growing public health concern and diagnosis can be challenging, particularly in primary care. This study aims to estimate the budgetary impact of introducing N-terminal pro-B-type natriuretic peptide (NT-proBNP) for CHF diagnosis in a primary care setting from the perspective of the Portuguese health system. METHODS: A budget impact analysis was conducted over one-year from the patients' first presentation. The standard of care (SoC) was compared to NT-proBNP at the point-of-care (PoC) or laboratory (Lab). A decision tree model was used to estimate the downstream costs associated with each of the three pathways. RESULTS: An estimated 81 012 patients were expected to present to primary care with new onset CHF symptoms. The use of NT-proBNP as a primary diagnostic tool is estimated to generate annualized savings of EUR 935 657 and EUR 2 982 443 in the Lab and PoC setting, respectively. Estimated cost savings were due to the need for fewer medical visits, hospitalizations and echocardiograms (ECHO). The Lab and PoC settings led to similar reductions in hospitalizations (14.4%) and ECHO (27%), but the reduction in medical visits was higher in the PoC setting (38% compared to 2.5%), resulting in higher savings compared to Lab. CONCLUSIONS: Using NT-proBNP for CHF diagnosis in primary care could result in considerable costs savings for the public health system in Portugal. This evidence might support health policy makers to reconsider the resource management and define a new strategy to mitigate the impact of CHF.

[Constituent elements of masculinity taught/learned in childhood and adolescence of men who are being criminally prosecuted for violence against women/partners]. / Elementos constitutivos da masculinidade ensinados/apreendidos na infância e adolescência de homens que estão sendo processados criminalmente por violência contra a mulher/parceira.

The scope of this article was to understand the constituent elements of masculinity taught/learnt in childhood/adolescence and reproduced by men in criminal proceedings for conjugal violence. Oral Life History was used as a methodological reference. Interviews were conducted with 13 men in criminal proceedings for domestic violence. The data were organized according to thematic content analysis and interpreted in the light of the theoretical framework on masculinity. Based on male orality, the constitutive elements of masculinity that were taught/learnt in childhood and adolescence and reproduced by men in criminal proceedings for conjugal violence went through infidelity, overvaluation of work, family provisioning, imposition of family norms and dominance of power in relation to women. Considering that these elements are rooted in the hegemonic model, preventive actions with a focus on social, financial and health commitment are a pressing requirement.

O objetivo deste trabalho é compreender os elementos constitutivos da masculinidade ensinados/apreendidos na infância/adolescência e reproduzidos por homens em processo criminal por violência conjugal. Utilizou-se como referencial metodológico a história oral de vida. Foram realizadas entrevistas com 13 homens em processo criminal por violência conjugal. Os dados foram organizados segundo análise de conteúdo temática categorial e interpretados à luz do referencial teórico sobre masculinidade. Com base na oralidade masculina, os elementos constitutivos da masculinidade que foram ensinados/apreendidos na infância e adolescência e reproduzidos por homens em processo criminal por violência conjugal perpassaram pela infidelidade, supervalorização do trabalho, provisão familiar, imposição de normas familiares e detenção de poder em relação a mulher. Considerando que esses elementos se encontram arraigados no modelo hegemônico, urgem ações preventivas com enfoque no comprometimento social, financeiro e para a saúde.

Knowledge, attitudes and practices related to sexually transmitted infections of men in prison.

OBJECTIVES: to analyze the knowledge, attitudes, and practices related to sexually transmitted infections of men in prison. METHODS: qualitative study, based on the methodology Knowledge, Attitude and Practice, conducted with 30 men in prison. The study applied individual interviews submitted to the analyze of the discourse. RESULTS: the incipient knowledge of men was associated with: self-illness and the others', diagnosis, and perception of risk behavior, pervaded by distrust or lack of understanding of the rapid test for detection. The attitudes involved culpability of partnerships, non-adherence to prevention inputs, and resistance to look for health services. The practices are linked to health care after the identification of the disease, use of penile condoms, and attention to the partnership. CONCLUSIONS: the reduced knowledge about Sexually Transmitted Infections makes attitudes stereotyped, stigmatized, compromised by the level of education. The level of health care and the limits of deprivation of liberty weaken the practices.

Perception of men perpetrators of violence about paternity.

OBJECTIVES: to learn about the perception of men in the judicial process due to spousal violence about paternity. METHODS: a descriptive, qualitative study with nine men in the judicial process due to spousal violence. Data were collected through interviews; the men validated the data, which were systematized by the categorical thematic content analysis, and analyzed in light of scientific texts that discuss the subject. RESULTS: the study allowed the creation of three categories: the father is the example for the son; the father must provide for the son's needs; the father corrects the son. CONCLUSIONS: that context reveals the need to re-signify paternity to influence children's education positively.

Nursing interventions for people in palliative care, based on the Dignity Model.

BACKGROUND: The use of the standardised nursing language aims to accurately represent clinical practice, contributing to proper documentation and the creation of evidence-based practice. AIMS: To validate nursing interventions (NI) for patients in palliative care, structuring these using the Dignity-Conserving Care Model. METHODS: A methodological study was conducted, developed according to the recommendations of the International Council of Nurses (ICN) and anchored in the Dignity-Conserving Care Model. The NI were developed in four stages: 1) construction of NI, based in the International Standards Organisation's standard (18.104:2014); 2) content validation by 26 expert nurses; 3) cross-mapping with the NIs contained in the International Classification for Nursing Practice (ICNP®) catalogue, Palliative Care for Dignified Dying, to identify those already existing in the catalogue; and 4) structuring the NI based on the concepts of the Dignity-Conserving Care Model. FINDINGS: 209 NI were validated and grouped into categories, namely: illness-related concerns; dignity-conservation repertoire; social dignity inventory. Of these, 183 were new and 26 already existed in the ICNP® Catalogue. CONCLUSION: The study presents new insights into palliative care in Brazil and presents 183 new NI in addition to those already published by the ICN.

Sociohistorical Analysis of Normative Standards of Masculinity in the Pandemic of COVID-19: Impacts on Men's Health/Mental Health.

Objective: This study aims to analyze sociohistorically how the normative patterns of hegemonic masculinity produced impacts on men's health/mental health in the context of the COVID-19 pandemic. Methods: A qualitative study from a socio-historical perspective was conducted with 50 men based on an online survey. A semistructured form was applied. The data were analyzed by the Collective Subject Discourse method, interpreted in the light of the context of epidemic disease and hegemonic masculinity. Results: The experience of the pandemic exposed the normative patterns of masculinities from the consummation of acts representative of the pandemic context, which incited men to deny the existence of COVID-19 disease and to delay the understanding and adoption of measures to protect and control COVID-19. As a repercussion, men presented conflicts in the regulation of emotions; presented emotional suppression; were more reactive; felt threatened regarding the loss of the role of family provider, virility; and revealed a sense of invulnerability, added to the weakening of self-care. Conclusion: The discourse revealed that the men's behaviors are consistent with the characteristics of hegemonic masculinity, but express signs of recognition that this behavior causes harm to themselves and their health.

SARS-CoV-2 in Brazil and Psychosocial Repercussions on Men's Health: Health Literacy Is Important.

This study aimed at analyzing the psychosocial repercussions of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic on the health of men living in Brazil. For this, we carried out a socio-historical and qualitative study, with the participation of 200 men who answered an online questionnaire. The data collected were processed in the NVIVO12® software, structured by the Collective Subject Discourse method, and analyzed from the epidemic disease theoretical framework proposed by Charles Rosenberg. Our results showed that the SARS-CoV-2 pandemic brought about repercussions of different dimensions that compromised the health of men living in Brazil. The repercussions evidenced were behavioral changes and emergence of new habits due to the pandemic; uncomfortable family situations; impaired affective and sexual relationships; harms in marital relationships; and insecurity and psychological distress. It is important to implement strategies that maximize men's health literacy, promoting better communication in terms of health, and search for help and suitable information about health/mental health.

[Caring for the patient in the process of dying at the Intensive Care Unit]. / Cuidando do paciente no processo de morte na Unidade de Terapia Intensiva.

The objective of this study is to characterize how nursing care is performed at the ICU to patients with no possibility of cure. Ten nurses were interviewed. The field study was performed at the Intensive Care Unit of a public teaching hospital. For the nurses, there is no uniform pattern of care. Furthermore, according to their reports, it was observed that there is an overestimation of the technical care over the emotional, social and spiritual aspects. It was, however, observed that nurses are strongly with the suffering of the family in view of their loss. Results show that nurses must understand death as a part of the life cycle and review care as the essence of nursing, thus increasing the discussions on the issue in both the academic and daily practice environments.

An Unusual Cause of Knee Mass: Osseous Hydatidosis.

Hydatid disease (hydatidosis) is a zoonotic infection caused by the larval stage of the parasitic tapeworm Echinococcus granulosus endemic in some sheep-raising areas. The liver and lungs are most commonly affected. Bone involvement (osseous hydatidosis) is distinctly uncommon, and its diagnosis and treatment can be challenging. We report a case of a 54-year-old male with right knee pain and edema and an extensive lesion on the femur; he was diagnosed with knee hydatidosis and was successfully treated with surgery and albendazole. This case reinforces the importance of the rare osseous hydatidosis as part of the differential diagnosis of bone lesions.

Implementation of the National Policy for Comprehensive Attention to Men's Health: challenges experienced by nurses. / Implementação da Política Nacional de Atenção Integral à Saúde do Homem: desafios vivenciados por enfermeiras.

OBJECTIVE: To analyze the challenges experienced by nurses in the implementation of the National Policy for Comprehensive Attention to Men's Health. METHOD: Descriptive, qualitative study, carried out with nurses working in Primary Health Care in a city in the state of Bahia, Brazil. Individual interviews were carried out and then analyzed using the Discourse of the Collective Subject, in the light of the guidelines of the National Policy for Comprehensive Attention to Men's Health. RESULTS: A total of 40 nurses participated. The challenges for the implementation of the policy are related to the inoperability of government actions, weaknesses in municipal management, underfunding and discontinuity of actions. CONCLUSION: Nurses face complex macro-management challenges in the implementation of the National Policy for Comprehensive Attention to Men's Health in Primary Health Care.