Distender o tempo e alinhavar o cuidado: o bordado inventado e a tecnologia da palavra / Stretching time and basting care: the invented embroidery and the word technology / Estirar el tiempo y hilvanar el cuidado: elbordado inventado y la tecnología de palabra

O projeto de pesquisa-intervenção As narrativas ficcionais e o cuidado à dor crônica atuou no Setor de Dor e Cuidados Paliativos de um hospital público, oferecendo-se como coadjuvante do cuidado em saúde. O Ateliê Jardim de Histórias foi um de seus dispositivos e propôs o bordado inventado como linhas de sustentação para um fazer compartilhado. No contexto latinoamericano, o bordar remete à transmissão transgeracional e a práticas políticas e processos de luta e luto no laço social. Este artigo propõe recuperar a história do bordado para além da perspectiva colonial e, a partir disso, a-bordar essa experiência da pesquisa-intervenção no hospital e suas possibilidades. Entende-se que o bordado inventado ressalta a dimensão de improviso e de criatividade dessa prática enquanto um suporte afetivo para a tessitura de narrativas, a partir da disposição de estar com o outro em torno de um fazer sem prescrições. (AU)

The research-intervention project Fictional narratives and chronic pain careacted in the Sector of Pain and Palliative Care of a public hospital, offering an adjunct to health care. The Garden of Stories Atelierwas one of its devices, which proposed the invented embroidery as threads of support for a shared work. In Latin America, embroidery refers to transgenerational transmission, and to political practices and processes of struggle and mourning in the social bond. This article aims to retrieve the history of embroidery beyond the colonial perspective and, from there, to approach this experience of research-intervention in the hospital and its possibilities. The invented embroidery is thought to emphasize the dimension of improvisation and creativity of this practice, as an affective support for the weaving of narratives, from the willingness to be together around an activity without prescriptions. (AU)

El proyecto de investigación-intervención Narrativas ficcionales y el cuidado al dolor crónicofuncionó en el Sector de Dolor y Cuidados Paliativos de un hospital público, ofreciéndose como complemento al cuidado en salud. El Taller Jardín de Historiasfue uno de sus dispositivos y propuso el bordado inventado como líneas de apoyo para una acción compartida. En latinoamerica, el bordado remite a la transmisión transgeneracional y a prácticas políticas y procesos de lucha y luto en el lazo social. Este artículo se propone recuperar la historia del bordado más allá de la perspectiva colonial y, desde allí, abordar esta experiencia de investigación-intervención en el hospital y sus posibilidades. Se entiende que el bordado inventado enfatiza la dimensión deimprovisación y creatividad de esta práctica como soporte afectivo para el tejido de narrativas, desde la voluntad de estar con el otro en torno a un hacer sin recetas. (AU)

O papel dos RNAs longos não codificantes na insuficiência cardíaca: uma revisão de literatura / The role of non-coding long RNAs in heart failure: a literature review / El papel de las RNAs largas no codificantes en la insuficiencia cardiaca: una revisión de la literatura

A Insuficiência Cardíaca (IC) é uma das principais causas de internação hospitalar no mundo e tem um elevado grau de morbidade e mortalidade, sendo um grave problema de saúde pública. Os lncRNAs (RNAs longo não codificantes), têm funções regulatórias transcricionais e/ou pós transcricionais bem complexas e que ainda não são totalmente claras, mas que podem exercer influência sobre as doenças cardiovasculares, dentre elas a IC. Assim o estudo teve como objetivo identificar na literatura o papel dos lncRNAs na patogênese da IC por meio de uma revisão integrativa com busca sistemática. Foram considerados elegíveis para leitura e composição do estudo 33 artigos e os principais papéis dos lncRNA na IC foram relatados como possíveis marcadores biológicos para diagnóstico e prognóstico da doença devido a sua expressividade na corrente sanguínea. Além disso, os lncRNAs podem estar relacionados à capacidade funcional uma vez que o aumento ou diminuição de sua expressão promove redução da apoptose de células endoteliais, melhora a disfunção cardíaca, distúrbios de contratilidade e dos canais de cálcio em pacientes com IC. Portanto, os lncRNAs parecem estar envolvidos na patogênese e/ou fisiopatologia da IC, podendo ser utilizados como biomarcadores genéticos com sensibilidade e especificidade semelhantes ou superiores aos empregados atualmente no diagnóstico e prognóstico da IC.

Heart Failure (HF) is one of the main causes of hospitalization worldwide and has a high degree of morbidity and mortality being considered a public health pro- blem. lncRNAs (non-coding long RNAs) have very complex transcriptional and/or post- transcriptional regulatory functions that are still not entirely clear but may influence car- diovascular diseases, including HF. Thus, the study aimed to identify in the literature the role of lncRNAs in the pathogenesis of HF through an integrative review with a systema- tic search. A total of 33 articles were considered eligible for reading and composition of the study. The roles of lncRNA in HF were reported as possible biological markers for the diagnosis and prognosis of the disease due to its expressiveness in the bloodstream. In addition, lncRNAs may be related to functional capacity since the increase or decrease in their expression promotes a reduction in endothelial cell apoptosis, and improves car- diac dysfunction, contractility, and calcium channel disorders in patients with HF. The- refore, lncRNAs seem to be involved in the pathogenesis and/or pathophysiology of HF and can be used as genetic biomarkers with sensitivity and specificity similar or superior to those currently employed in the diagnosis and prognosis of HF.

La Insuficiencia Cardiaca (IC) es una de las principales causas de hospita- lización en el mundo y tiene un alto grado de morbimortalidad considerándose un pro- blema de salud pública. Los lncRNAs (ARN largos no codificantes) tienen funciones re- guladoras transcripcionales y/o post-transcripcionales muy complejas que aún no están del todo claras pero que pueden influir en las enfermedades cardiovasculares, incluida la IC. Así pues, el estudio se propuso identificar en la literatura el papel de los lncRNAs en la patogénesis de la IC mediante una revisión integradora con una búsqueda sistemática. Un total de 33 artículos fueron considerados elegibles para su lectura y composición del estudio. Las funciones de los lncRNA en la IC se señalaron como posibles marcadores biológicos para el diagnóstico y pronóstico de la enfermedad debido a su expresividad en el torrente sanguíneo. Además, los lncRNAs pueden estar relacionados con la capacidad funcional, ya que el aumento o disminución de su expresión promueve una reducción de la apoptosis de las células endoteliales y mejora la disfunción cardiaca, la contractilidad y los trastornos de los canales de calcio en pacientes con IC. Por tanto, los lncRNAs parecen estar implicados en la patogénesis y/o fisiopatología de la IC y pueden ser utili- zados como biomarcadores genéticos con sensibilidad y spe-cificidad similares o superi- ores a los empleados actualmente en el diagnóstico y pronóstico de la IC.

Dor total em pacientes oncológicos: uma revisão integrativa da literatura / Dolor total en pacientes con cancer: revisión integradora de la literatura / Total pain in cancer patients: the integrative literature review

RESUMO A dor é um dos sintomas mais temidos por pacientes oncológicos e precisa ser considerada em sua integralidade. Com o objetivo de atender esse desafio, os cuidados paliativos previnem e aliviam o sofrimento de pacientes que enfrentam doenças que ameaçam a vida, pela identificação precoce, avaliação e intervenção correta da dor, considerando a integralidade do ser, por meio de quatro componentes da dor total: física, psíquica, social e espiritual. Para entender essa complexidade, a presente pesquisa objetiva analisar a produção científica nacional e internacional sobre dor total em pacientes oncológicos. Realizou-se uma revisão integrativa da literatura, selecionando artigos publicados em português e inglês entre 2014 e 2019, nas bases de dados da Scientific Electronic Library Online e do portal PubMed, por meio de quatro combinações de descritores e booleanos, encontrando-se 21.548 arquivos. Após a aplicação dos critérios de exclusão, foram selecionados 25 artigos. Prevaleceram os estudos em inglês, quantitativos e realizados por médicos. Eles sinalizaram que, dentre os sintomas, a dor é o mais prevalente na doença oncológica e o maior responsável por influenciar negativamente a qualidade de vida dos pacientes. Sinalizaram a dificuldade dos profissionais de saúde em diagnosticar e tratar a dor de forma multidimensional e a ausência de instrumentos e protocolos que norteiam essa avaliação. Conclui-se que, para a identificação e tratamento eficaz da dor de paciente em cuidados paliativos, ela deve ser considerada em sua integralidade. Para tal, fazem-se necessárias a capacitação de profissionais de saúde e a criação de instrumentos que os auxiliem no manejo dessa dor que se expressa de forma total.

RESUMEN El dolor es uno de los sintomas más temidos por los pacientes con cancer y debe considerarse em su totalidad. Para hacer frente a este desafio, los cuidados paliativos previenen y alivian el sufrimiento de pacientes que enfrentan enfermedades potencialmente mortales, a través de la identificación prematura, evaluación e intervención correcta del dolor, considerando la integralidad del ser, por medio de cuatro componentes del dolor total: física, psíquica, social y espiritual. La presente investigación objetiva examinar la producción científica nacional e internacional sobre dolor total en pacientes oncológicos. Se llevó a cabo una revisión integrativa de la literatura, seleccionando artículos publicados en portugués e inglés, entre 2014 y 2019, en las bases de datos de Scielo y del portal PubMed, encontrándose 21.548 archivos. Tras la aplicación de los criterios de exclusión, fueron seleccionado 25 artículos. Han prevalecido los estudios en inglés, cuantitativos y realizados por médicos. Ellos señalaron que, de entre los síntomas, el dolor es lo más prevalente en lo cancer y el mayor responsable por influenciar negativamente la calidad de vida de los pacientes. Han señalado la dificultad de los profesionales de salud en diagnosticar y tratar el dolor de forma multidimensional y la ausencia de instrumentos y protocolos que guían esa evaluación. Se concluyó que, para la identificación y tratamiento eficaz del dolor de paciente en cuidados paliativos, ella debe ser considerada en su grado completo. Se hacen necesarias la capacitación de profesionales de salud y la creación de instrumentos que los auxilien en el manejo de ese dolor que se expresa de manera total.

ABSTRACT Pain is one of the most feared symptoms by cancer patients and needs to be considered in its entirety. In order to meet this challenge, palliative care, it prevents and alleviates suffering of patients facing life-threatening illnesses, through early identification, assessment and correct intervention in pain that should be considered from the perspective of the whole being, through four components of total pain: physical, psychic, social and spiritual. To understand this complexity, this research aims to investigate the national and international scientific production about total pain in cancer patients. An integrative literature review was peformed, selecting articles published in Portuguese and English, between 2014 and 2019 in the Scientific Electronic Library Online and Pubmed portal databases, using four combinations of descriptors and booleans, with 21,548 files. After applying the exclusion criteria, 25 articles were selected. Studies in English, quantitative and performed by doctors, prevailed. They pointed that among the symptoms, pain is the most prevalent in cancer disease and the major responsible for influencing patients' quality of life negatively. They pointed out the difficulty of health professionals in diagnosing and treating pain in a multidimensional way, with few instruments and protocols that guide the assessment. The conclusion is that for the identification and effective treatment of pain in palliative care patients, the treatment must be considered in its entirety. For this, it is necessary the qualification of health professionals and the creation of instruments that help them to manage pain in its full expression.

Percepción en la recuperación de la salud y los cuidados de enfermería / Perception of health recovery and nursing care

INTRODUCCIÓN: El trato humanizado es cuando un profesional aborda el cuidado y la familia, compartiendo experiencias, apreciando valores y reconociendo la individualidad de la otra persona. OBJETIVO: Determinar la percepción en la recuperación de la salud de la persona hospitalizada respecto a la calidad de los cuidados de enfermería en el hospital regional de San Gil. MATERIALES Y MÉTODOS: Estudio descriptivo-transversal, la muestra estuvo conformada por 101 personas hospitalizadas que cumplieron con los criterios de inclusión, se aplicó el Instrumento sobre la Percepción en la recuperación de la salud de la persona hospitalizada respecto a la calidad de los cuidados de enfermería en el hospital regional de San Gil, los resultados se analizaron en el programa estadístico SPSS. RESULTADOS: El 97,0% (n=98) de los encuestados dicen que la buena relación de enfermera persona si mejora su estado de salud. CONCLUSIÓN: El profesional de enfermería brinda un cuidado al aspecto o necesidad emocional del paciente creando un entorno confortable siendo este el motivo por el cual se sienta más a gusto con la atención recibida.

INTRODUCTION: Humanized treatment is when a professional approaches care and family, sharing experiences, appreciating values and recognizing the individuality of the other person. OBJECTIVE: To determine the perception in the recovery of health of the hospitalized person regarding the quality of nursing care in the regional hospital of San Gil. METHODS: Descriptive-cross-sectional study, the sample consisted of 101 hospitalized persons who met the inclusion criteria, the Instrument on the Perception on the recovery of health of the hospitalized person with respect to the quality of nursing care in the regional hospital of San Gil was applied, the results were analyzed in the statistical program SPSS. RESULTS: 97.0% (n=98) of the respondents say that the good nurse-person relationship does improve their state of health. CONCLUSION: The nursing professional provides care to the emotional aspect or need of the patient by creating a comfortable environment, which is the reason why the patient feels more comfortable with the care received.

Atención de las necesidades espirituales y religiosas de pacientes por personal de salud: un modelo basado en el acompañamiento espiritual / Attention to the spiritual and religious needs of patients by health personnel: a model based on spiritual accompaniment

Resumen Los aspectos espirituales y religiosos han retomado su importancia en la atención de salud, en la búsqueda de una atención integral, digna y más humana, teniendo en cuenta además, los múltiples beneficios clínicos asociados. Sin embargo, el cuidado de las necesidades espirituales y religiosas, históricamente asumidas por capellanes religiosos y guías espirituales, actualmente, en forma paulatina, son considerados parte de las obligaciones de los equipos de salud, no sin la reticencia de los mismos y sin una manera clara de cómo hacerlo. El objetivo del presente trabajo es presentar la importancia de la atención de las necesidades espirituales y religiosas en el cuidado de salud y un modelo de atención basado en el acompañamiento espiritual.

In the search for comprehensive, dignified and more humane care, the spiritual and religious aspects have regained their importance in health care. Furthermore, the múltiple associated clinical benefits must also be taken into account. However, the care of spiritual and religious needs, historically undertaken by religious chaplains and spiritual guides, have gradually become considered part of the obligations of the health teams, in spite of their reluctance and without a clear way on how to do it. The objective of this work is to present the importance of attending to the spiritual and religious needs in health care and a care model based on spiritual accompaniment.

Acompañamiento de un paciente con cáncer avanzado desde un enfoque psicosomático e integrativo: una propuesta de mirada integradora / Psychosomatic and integrative accompaniment to a patient with advanced cancer: an integrated sight proposal

RESUMEN: Los avances de la medicina moderna nos han permitido la subespecialización de diversas áreas, con gran ganancia en múltiples ámbitos, pero adoleciendo a veces de perder la perspectiva del ser humano completo. La salud como la enfermedad suceden a un sujeto que es más que la suma de sus partes. La psiquiatría, especialmente la de enlace, busca integrar las miradas y superar la "falsa escisión" del ser. Logra hacerlo cuando el síntoma inicia en la psiquis. La medicina psicosomática emerge como oportunidad de hacerlo cuando el síntoma/enfermedad se origina en el cuerpo. Se presenta la historia de una persona, que presenta una enfermedad orgánica muy frecuente en nuestros días, abordando lo convencional y clásico, sumando además la mirada psicosomática. Para ello usa las herramientas de la medicina integrativa, específicamente las de la medicina antroposófica y terapia artística de dicha corriente. El objeto de su presentación es mostrar esta mirada de como enfocar a estos paciente y su acompañamiento terapéutico, que intenta reunificar psique-soma como una forma de sanación del Ser. Este enfoque propone un camino concreto, con una mirada y un lenguaje común, entre diversas especialidades, que permita recuperar el lugar de centro de la identidad del ser humano, como ser sujeto a acompañar en salud y enfermedad. Pienso que esto puede tener beneficios en la morbi- mortalidad de los pacientes.

ABSTRACT The advances of modern medicine have allowed us to subspecialize in various areas, with great gain in multiple areas, but sometimes suffering from losing the perspective of the complete human being. Health and illness happen to a subject who is more than the sum of its parts. Liaison Psychiatry seeks to integrate the looks and overcome the "false split" of being. It manages to do it when the symptom starts in the psyche. Psychosomatic medicine emerges as an opportunity to do so when the symptom / illness originates in the body. I present the story of a pathient, who has a very frequent organic disease in our days, addressing the conventional view, and also adding the psychosomatic perspective. For this we use the tools of integrative medicine, specifically those of anthroposophic medicine and artistic therapy. The purpose of his presentation is to show this sight of how to approach these patients and their therapeutic accompaniment, which tries to reunify psyche-somatism as a form of healing of the Being. This approach proposes a concrete path, with a common sight and language, between various specialties, that allows to recover the place of center of the identity of the human being, as being subject to accompany in health and illness. I think this may have benefits in the morbidity and mortality of patients.

Patient experience and non-surgical periodontal therapy in a postgraduate periodontal training program: A qualitative study

ABSTRACT: Objective: To explore patient experience for non-surgical periodontal therapy using phenomenography. Methods: This qualitative study was performed in a postgraduate specialist training program in periodontics. Patients reported their experiences through in-depth interviews in order to recognize the impact of non-surgical periodontal therapy on their quality of life and their satisfaction. A homogeneous sampling procedure was used, establishing redundancy after the fifteenth interview. Interviews were audio recorded, transcribed and analyzed by three researchers who codified the answers into categories to determine the emerging topics. Results: The core emerging themes were: (i) lack of information about periodontal disease; (ii) experience during treatment; (iii) treatment implications; and (iv) clinician-patient relationship. Conclusions: Patients seem to have limited knowledge about periodontal diseases. Reasons for attendance mainly include bleeding gums, tooth mobility, and aesthetic problems. Therapy can generate pain, fear, and is considered invasive, whereas dentine hypersensitivity may occur post-operatively. Despite this, patients would be willing to undergo treatment again and were generally satisfied with the level of care and treatment received.

Perception and performance of the nursing team in caring for patients with suicide behavior

Objective: to understand the perception and performance of the Nursing team in a hospital emergency service in the care of patients after attempting suicide. Methods: exploratorystudy, with a qualitative approach, carried out through semi-structured interviews with Nursing professionals who work in an Emergency Service. The interviews were transcribed and analyzed as to their content following Bardin's thematic model. Results: seven nurses and four Nursing technicians participated in the study, with an average age of 36 years, most of them female. Suicide attempts are often associated with 'psychic pain' that is opposed to the principles of life preservation; such an attitude has caused suicidal behavior to be misinterpreted by health professionals. Conclusion: most professionals demonstrated a stereotyped 'pre-concept' and full of taboos about patients who attempted suicide, which triggered a service more directed to physical needs and protocol formalities. Few professionals reported carrying out holistic and empathic care, which is so necessary for these people. In this sense, the importance and urgency of training the team in the identification of suicide risks and in the continuity of treatment of surviving individuals is emphasized.

Psychological well-being in patients undergoing stem cell transplantation

The aim of the study is to determine the psychological well-being of patients who underwent stem cell transplantation. This cross-sectional study was conducted with 100 patients. Data were collected face-to-face using an introductory information form and the Brief Symptom Inventory.When the results of the patients were examined, the interpersonal sensitivity of the sub-dimensions of the scale was found to be 5.0 ± 4.06, depression 7.60 ± 5.37, and anxiety disorder 7.90 ± 5.34. There was a significant difference between the diagnosistime of the patients and all sub-factors of the scale, except phobic anxiety. It was found that the psychological state of the patients was directly related to the time of first diagnosis. As a result, the importance of following the psychological processof the patients during the treatment process was revealed when planning nursing care.

Perceptions of patients in the waiting line for bariatric surgery: contributions from the experience of an educational process / Percepções de pacientes na fila de espera para cirurgia bariátrica: contribuições a partir da experiência de um processo educativo / Percepciones de pacientes en la fila de espera para cirugía bariátrica: contribuciones a partir de la experiencia de un proceso educativo

The present study is a qualitative research with the objective of analyzing the perceptions of patients in the face of the challenges in the bariatric surgery line through focal groups. All patients were treated with an outpatient protocol, however, they were divided into two groups, one participated in the educational process and the other did not. Four categories of analysis were drawn up and discussed in the light of the current literature. Patients from the educational process were able to express themselves with greater positivity in view of the challenges and they showed better resources for going through the emotional suffering, the worsening of comorbidities and the risk of death. The results show the potential of education in health and of group work in the promotion of self-care and well-being.(AU)

O presente estudo trata-se de uma pesquisa qualitativa com o objetivo de analisar as percepções dos pacientes diante dos desafios na fila da cirurgia bariátrica por meio de grupos focais. Todos os pacientes foram atendidos com protocolo ambulatorial, porém, foram divididos em dois grupos, um participou do processo educativo e o outro não. Quatro categorias de análise foram elaboradas e discutidas à luz da literatura atual. Os pacientes do processo educativo conseguiram se expressar com maior positividade diante dos desafios e apresentaram melhores recursos para atravessar o sofrimento emocional, o agravamento das comorbidades e o risco de morte. Os resultados mostram o potencial da educação em saúde e do trabalho em grupo na promoção do autocuidado e do bem-estar.(AU)

El presente estudio se trata de una investigación cualitativa con el objetivo de analizar las percepciones de los pacientes ante los desafíos en la fila de la cirugía bariátrica por medio de grupos focales. Todos los pacientes fueron atendidos con protocolo ambulatorio, pero se dividieron en dos grupos, uno participó en el proceso educativo y el otro no. Se elaboraron y discutieron cuatro categorías de análisis a la luz de la literatura actual. Los pacientes del proceso educativo consiguieron expresarse con mayor positividad antes los desafíos y presentaron mejores recursos para pasar por el sufrimiento emocional, el agravamiento de las comorbilidades y el riesgo de muerte. Los resultados muestran el potencial de la educación en salud y del trabajo en grupo de la promoción del autocuidado y del bienestar.(AU)

Psychometric properties of the Chinese version of the Positive Thinking Scale in individuals after hip fracture surgery

Positive thinking is a form of positive cognition and a coping strategy. The Positive Thinking Scale (PTS) is used to measure positive thinking, but the reliability and validity of the PTS-Chinese have yet to be tested. This study aims to examine the psychometric properties of the PTS-Chinese. A total of 154 patients post-hip fracture surgery completed the questionnaire in a hospital in Taiwan between April 2020 and December 2020. The scales in the questionnaire included the PTS, Automatic Thoughts Questionnaire-Positive, Automatic Thoughts Questionnaire-Negative, Barthel Index, and items related to happiness, demographics, and disease treatment. The results of the confirmatory factor analysis and average variance extracted show that the PTS-Chinese version exhibits construct validity. Scores on the PTS-Chinese version are positively related to scores on the Automatic Thoughts Questionnaire-Positive and happiness items and negatively related to scores on the Automatic Thoughts Questionnaire-Negative. This finding indicates that the PTS-Chinese demonstrates concurrent, predictive, and discriminant validity. The scale also presents acceptable reliability and test-retest reliability. Overall, the PTS-Chinese can be used to evaluate and track the positive thinking of patients. Further studies are needed to assess the psychometric properties of the PTS-Chinese in different cultures and ethnic groups. (AU)

Perfil dos pacientes com crise hipertensiva atendidos em uma unidade de pronto atendimento / Perfil de los pacientes con crisis hipertensiva atendidos en una unidad de pronta atención / Profile of patients with hypertensive crisis seen in an emergency care unit

RESUMO Objetivo: descrever o perfil dos pacientes com crise hipertensiva atendidos em uma Unidade de Pronto Atendimento. Método: estudo transversal descritivo, realizado por meio da análise de 80 prontuários de pacientes com quadro de crise hipertensiva, atendidos em uma unidade de pronto atendimento, entre o período de março de 2018 a fevereiro de 2019. Os dados foram coletados por meio de roteiro estruturado e receberam tratamento estatístico descritivo. Resultados: Após a análise dos 80 prontuários, constatou-se que a média de idade entre os pacientes atendidos foi de 58,03, sendo a faixa etária adulta a mais prevalente (53,8%). Constatou-se que a média da pressão arterial sistólica foi significativamente maior em homens em relação às mulheres (p=0,013). Quanto à sintomatologia, a cefaleia foi a mais prevalente, com 35,0%. Verificou-se que durante o atendimento da crise hipertensiva, a maioria dos pacientes fez uso de apenas uma droga para redução da PA, sendo o inibidor adrenérgico de ação central o mais citado. Quanto ao desfecho, grande parte dos pacientes recebeu alta (93,8%) logo após o atendimento, porém, 6,3% permaneceram em internamento de curta permanência até a estabilização do quadro. Considerações finais: Este estudo possibilitou a caracterização da população com crise hipertensiva atendida em um pronto atendimento, a qual evidencia uma possível fragilidade existente entre a articulação dos níveis de atenção à saúde.

RESUMEN Objetivo: describir el perfil de los pacientes con crisis hipertensiva atendidos en una Unidad de Pronta Atención. Método: estudio transversal descriptivo, realizado por medio del análisis de 80 registros médicos de pacientes con cuadro de crisis hipertensiva, atendidos en una unidad de pronta atención, entre el período de marzo de 2018 a febrero de 2019. Los datos fueron recogidos por medio de guion estructurado y recibieron tratamiento estadístico descriptivo. Resultados: después del análisis de los 80 registros médicos, se constató que el promedio de edad entre los pacientes atendidos fue de 58,03, siendo la franja etaria adulta la más prevalente (53,8%). Se constató que el promedio de la presión arterial sistólica fue significativamente mayor en hombres que en las mujeres (p=0,013). En cuanto a la sintomatología, la cefalea fue la más prevalente, con 35,0%. Se verificó que, durante la atención de la crisis hipertensiva, la mayoría de los pacientes hizo uso de solo una droga para reducción de la PA, siendo el inhibidor adrenérgico de acción central el más relatado. Respecto al resultado, gran parte de los pacientes recibió el alta (93,8%) inmediatamente después de la atención, sin embargo, el 6,3% permaneció en internamiento de corta estancia hasta la estabilización del cuadro. Consideraciones finales: este estudio posibilitó la caracterización de la población con crisis hipertensiva atendida en una pronta atención, la cual evidencia una posible fragilidad existente entre la articulación de los niveles de atención a la salud.

ABSTRACT Objective: to describe the profile of patients with hypertensive crisis treated at an Emergency Care Unit. Method: descriptive cross-sectional study carried out through the analysis of 80 medical records of patients with hypertensive crisis, treated at an emergency care unit, between March 2018 and February 2019. Data were collected using a structured script and were subjected to descriptive statistical treatment. Results: after analyzing the 80 medical records, it was found that the mean age of the treated patients was 58.03, with the adult age group being the most prevalent (53.8%). It was found that the mean systolic blood pressure was significantly higher in men than in women (p=0.013). As for symptoms, headache was the most prevalent, with 35.0%. It was found that during the treatment of the hypertensive crisis, most patients used only one drug to reduce BP, with centrally acting antiadrenergic drugs being the most cited. Regarding the outcome, most of the patients were discharged (93.8%) soon after treatment; however, 6.3% remained in short-term hospitalization until their condition stabilized. Final considerations: this study made it possible to characterize the population with hypertensive crisis treated in an emergency room, showing a possible fragility in the articulation between health care levell

Estudio del miedo en pacientes frente a la extracción del tercer molar / Study of fear in patients facing third molar extraction

El tratamiento odontológico sigue siendo percibido en la actualidad como una experiencia atemorizadora para muchas personas. Se han establecido diversos métodos para tratar de evaluar el temor y ansiedad que refieren las personas cuando deben recibir tra-tamientos bucales. Sin embargo, estos no han sido aplicados adecuadamente como parte de la atención clínica cotidiana. Considerando esto, podría suponer-se que el miedo es uno de los factores desencadenan-tes en la deserción de los tratamientos odontológicos, y las personas asistirían solo en el momento de una urgencia. El objetivo del presente estudio fue analizar el afrontamiento de emociones (miedo) en los pacien-tes que concurren a la consulta para la extracción de un tercer molar en la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA). La metodología que se utilizó fue cuantitativa y cualitativa. El diseño fue exploratorio-descriptivo (AU)

Dental treatment is still perceived today as a frightening experience for many people. Various methods have been established to try to assess the fear and anxiety that people report when they must receive oral treatments, however, these have not been adequately applied as part of daily clinical care. Considering this, it could be assumed that fear is one of the triggering factors in desertion of dental treatments and people would attend only at the time of an emergency. The objective of this study was to analyze the coping with emotions (fear) in patients who attend the consultation for the extraction of a third molar at the Faculty of Dentistry of the University of Buenos Aires (FOUBA). The methodology used was quantitative and qualitative. The design was exploratory-descriptive (AU)

Experiencias luego del diagnóstico de demencia: aportes desde la perspectiva de los pacientes / Experiences following the diagnosis of dementia: contributions from the patients' perspective

INTRODUCCIÓN: Comunicar el diagnóstico de demencia es un importante desafío médico, por lo que tiende a ser una práctica poco frecuente no obstante el derecho de los pacientes a ser informados de sus diagnósticos. En Chile, existe investigación que describe las implicancias del diagnóstico de demencia en el sistema familiar y cuidadores informales, pero no se ha abordado esta experiencia desde la perspectiva de los pacientes, por lo que sus implicancias son también desconocidas. OBJETIVO: Describir las experiencias luego del diagnóstico de demencia desde la perspectiva de los pacientes. MATERIAL Y MÉTODO: Estudio cualitativo. Se realizó entrevistas a 11 personas, 6 hombres y 5 mujeres, con edad promedio 70 años (64-82), quienes recibieron el diagnóstico de demencia tipo Alzheimer en etapa leve y fueron informados de su diagnóstico por Neuróloga tratante. Las entrevistas transcritas fueron analizadas mediante análisis de contenido con codificación abierta, usando software NVivo 11.0 Pro. RESULTADOS: Las siguientes cinco categorías temáticas genéricas fueron producidas a partir del análisis de las entrevistas, describiendo la experiencia de los pacientes luego de recibir el diagnóstico: rol capacitante de la familia, ser informado/a sobre la demencia, autoestigma, ambivalencia en contar el diagnóstico, y estrategias de adaptación al diagnóstico. CONCLUSIONES: Los resultados de este estudio informan de necesidades específicas de los pacientes luego de ser informados del diagnóstico de demencia tipo Alzheimer. Se presentan consideraciones para el abordaje local del diagnóstico por equipos de salud y apoyo social que enfrentan el desafío de planificar la atención de personas con trastornos cognitivos y sus familias.

INTRODUCTION: Communicating the diagnosis of dementia is a medical challenge. Despite the the patients' right to be informed of their diagnosis, diagnostic disclosure is globally underperformed. In Chile, previous research has addressed the implications of diagnosis from the perspectives of families and family caregivers, but the perspectives and implications from the patients' perspectives remain unknown. OBJECTIVE: To describe the experiences of patients following the diagnosis of dementia. MATERIAL AND METHODS: Qualitative study. Interviews were performed to 11 individuals who had received the diagnosis of early-stage dementia of the Alzheimer's type, 5 women and 6 men, average age 70 years old (64-82). Interviews transcripts were analyzed using content analysis with open coding, using software NVivo 11.0 Pro. RESULTS: The following five generic categories were produced from the interpretation of interviews to describe the experience of patients after being informed of a diagnosis of dementia: the enabling role of families, being informed about dementia, self-stigma, ambivalence on sharing the diagnosis, and coping strategies. CONCLUSIONS: Findings report specific unmet needs of patients who have been communicated of the diagnosis of dementia of the Alzheimer's type. Suggestions are presented to inform local health care and social support teams that face the challenge of developing interventions to support people with dementia and their families.

Efectividad de la hipnoterapia en pacientes deprimidos / Effectiveness of hypnotherapy in depressed patients

RESUMEN Introducción: la depresión es uno de los problemas de salud que más afecta a los seres humanos a nivel mundial. En Cuba, un elevado número de personas padece este flagelo, sin distinción de razas, sexos u otras categorías. Objetivo: evaluar la efectividad de la hipnosis como modalidad terapéutica en pacientes deprimidos. Materiales y métodos: se realizó un estudio explicativo de tipo experimental de comparación de grupo pre-post prueba en 30 pacientes con trastornos depresivos; 15 de ellos se atendieron con hipnoterapia (grupo estudio) y otros 15 mediante terapia racional emotiva conductual (grupo control). Por la importancia para enriquecer la investigación, se definió como variable independiente el tratamiento empleado según el grupo, y como variables dependientes la respuesta psicológica antidepresiva y ansiolítica. Los datos se procesaron cuantitativa y cualitativamente. Se empleó la prueba de las probabilidades exactas de Fisher y la t de Student para validar la significación del cambio. Resultados: en términos de evolución clínica, la hipnoterapia fue efectiva, ya que el 93,3 % de los pacientes mejoraron significativamente en comparación con los resultados obtenidos con la terapia conductual racional emotiva, dados en un 73,33 %. Conclusión: la hipnoterapia es tan efectiva como la terapia racional emotiva conductual, y si bien no hubo diferencias significativas por los resultados del estadígrafo matemático empleado, sí las hubo desde el punto de vista práctico y clínico, pues evolucionaron más rápido los pacientes del grupo estudio que los del grupo control (AU).

ABSTRACT Introduction: depression is one of the health problems more affecting the human being around the world. A high number of persons suffers this scourge, without distinction of race, sex or any other category. Objective: to assess hypnosis effectiveness as a therapeutic modality in depressed patients. Materials and methods: an experimental-kind explanatory study was carried out comparing a group of 30 patients with depressive disorders before and after test; 15 of them were treated with hypnotherapy (study group) and 15 with rational emotive behavioral therapy (control group). For the importance of enriching the research the treatment used according to each group was defined as independent variable and the anxiolytic and anti-depressive psychological answer. Data were quantitative and qualitatively processed. Fisher's exact test and T student test were used to validate the change significance. Results: in terms of clinical evolution, hypnotherapy was effective, since 93.3% of patients significantly improved in comparison to the results achieved with the rational emotive behavioral therapy, reaching 73.33%. Conclusions: hypnotherapy is as effective as rational emotive behavioral therapy, and although there were not significant differences due to the results of the used mathematical statistic, there they were from the practical and clinical point of view, because the patients from the study group improved faster than the ones in the control group AU).

Mental-physical multimorbidity treatment adherence challenges in Brazilian primary care: A qualitative study with patients and their healthcare providers.

Improved understanding of multimorbidity (MM) treatment adherence in primary health care (PHC) in Brazil is needed to achieve better healthcare and service outcomes. This study explored experiences of healthcare providers (HCP) and primary care patients (PCP) with mental-physical MM treatment adherence. Adults PCP with mental-physical MM and their primary care and community mental health care providers were recruited through maximum variation sampling from nine cities in São Paulo State, Southeast of Brazil. Experiences across quality domains of the Primary Care Assessment Tool-Brazil were explored through semi-structured in-depth interviews with 19 PCP and 62 HCP, conducted between April 2016 and April 2017. Through thematic conent analysis ten meta-themes concerning treatment adherence were developed: 1) variability and accessibility of treatment options available through PHC; 2) importance of coming to terms with a disease for treatment initation; 3) importance of person-centred communication for treatment initiation and maintenance; 4) information sources about received medication; 5) monitoring medication adherence; 6) taking medication unsafely; 7) perceived reasons for medication non-adherence; 8) most challenging health behavior change goals; 9) main motives for initiation or maintenance of treatment; 10) methods deployed to improve treatment adherence. Our analysis has advanced the understanding of complexity inherent to treatment adherence in mental-physical MM and revealed opportunities for improvement and specific solutions to effect adherence in Brazil. Our findings can inform research efforts to transform MM care through optimization.

Improving treatment outcomes for leprosy in Pernambuco, Brazil: a qualitative study exploring the experiences and perceptions of retreatment patients and their carers.

BACKGROUND: Brazil has a high leprosy burden and poor treatment outcomes (TOs), manifesting in high relapse rates. Pernambuco, an impoverished Brazilian state suffering notable geographical health inequalities, has 'hyperendemic' leprosy. Although current literature identifies barriers and facilitators influencing leprosy treatment compliance, inadequate investigation exists on other factors influencing TOs, including carers' roles and psycho-dermatological impact. This qualitative study explores experiences and perceptions of leprosy patients and their carers in Pernambuco, Brazil; to identify location-specific factors influencing TOs, and consequently inform future management. METHODS: 27, semi-structured, in-depth interviews were conducted with 14 patients and 13 carers. Participants were recruited using maximum variation and snowball sampling from three clinics in Petrolina, Pernambuco. Transcripts and field notes from both participant groups were separately analysed using conventional thematic and deviant case analysis. The University of Birmingham Internal Research Ethics Committee and Instituto Lauro de Souza Lima provided ethical approval. RESULTS: Two homologous sets of four, primary, interdependent themes influencing leprosy TOs emerged: 'personal factors'; 'external factors'; 'clinical factors'; and 'the healthcare professional (HCP)-patient-carer relationship'. Poor participant knowledge and lack of symptomatic relief caused patients to distrust treatment. However, because participants thought HCP-led interventions were vital for optimal TOs, patients were effectively persuaded to adhere to pharmaceutical treatments. High standard patient and population education facilitated treatment engagement by encouraging evidence-based medicine belief, and dispelling health myths and stigma. Healthcare, on occasions, was perceived as disorganised, particularly in resource-scarce rural areas, and for those with mental health needs. Participants additionally experienced incorrect/delayed diagnoses and poor contact tracing. Leprosy's negative socio-economic impact on employment - together with stigma, dependency and changing relationships - caused altered senses of identity, negatively impacting TOs. Better dialogue between patients, HCPs and carers facilitated individualised patient support. CONCLUSION: This study highlights the importance of: effective evidence-based leprosy education; communication between HCPs, patients and carers; state-funded support; and healthcare resource distribution. These findings, if prioritised on governmental scales, provide the valuable insight needed to inform location-specific management strategies, and consequently improve TOs. Future research should evaluate the effectiveness of these implementations. Failure to address these findings will hinder regional elimination efforts.

Young people in oncological treatment during COVID-19: indicators of the social representation of the coronavírus / Jovens em tratamento oncológico durante o COVID-19: indicadores da representação social do coronavírus

Abstract Objectives: to understand indicators of the social representation of the coronavirus in adolescents undergoing cancer treatment during the COVID -19pandemic. Methods: the theory of social representations was used as theoretical and methodological support in its procedural approach in an exploratory study of a qualitative nature. The free word association technique was used in the application of virtual forms using guidelines of the snowball method. The terms 'Coronavirus', 'Going to the hospital' and 'Cancer treatment' were applied. After that moment, the participants were asked for a hierarchy and justification of the evoked words. Data analysis was based on content analysis and frequency distribution of the content produced. Results: articulations were made on the impacts that the pandemic situation had on the treatment experience of that population. It was identified a character endowed with fear and tension about the elaboration of the reality of these subjects in the current period in face of the inevitability of a hospital scenario that facilitates contamination and facing the immunological vulnerability characteristic of their treatments. Conclusions: the participants constructed different contents of psychological suffering aimed at expressions of fear and insecurity experienced during the pandemic period in the face of assistance in the hospital setting. This study is understood as a contribution to more effective actions in order to adapt the care plan of this population, aiming at future professional interventions.

Resumo Objetivos: compreender indicadores da representação social do coronavírus em jovens em tratamento oncológico durante a pandemia do COVID-19. Métodos: utilizou-se como apoio teórico-metodológico a teoria das representações sociais na sua abordagem processual em estudo exploratório de natureza qualitativa. Empregou-se a técnica de associação livre de palavras na aplicação de formulários virtuais utilizando diretrizes do método bola de neve. Foram aplicados os termos indutores 'Coronavírus', 'Ir ao hospital' e 'Tratamento contra o câncer'. Após esse momento foi solicitado aos participantes uma hierarquização e justificativa das palavras evocadas. A análise dos dados foi pautada na análise de conteúdo e distribuição de frequência dos conteúdos produzidos. Resultados: realizou-se articulações sobre os impactos que a conjuntura pandêmica gerou na experiência de tratamento da referida população. Identificou-se um carácter dotado de receio e tensão sobre a elaboração da realidade desses sujeitos no período atual diante da inevitabilidade de um cenário hospitalar facilitador da contaminação e frente a vulnerabilidade imunológica característica de seus tratamentos. Conclusões: os participantes construíram diferentes conteúdos de sofrimento psicológico voltados para expressões de medo e insegurança vivenciadas no período da pandemia diante da assistência em cenário hospitalar. Entende-se este estudo como uma contribuição para ações mais efetivas no intuito de adequar o plano de cuidado dessa população, visando futuras intervenções profissionais.

An Assessment of Patient, Caregiver, and Clinician Perspectives on the Post-discharge Phase of Care.

OBJECTIVE: We sought to elicit patients', caregivers', and health care providers' perceptions of home recovery to inform care personalization in the learning health system. SUMMARY BACKGROUND DATA: Postsurgical care has shifted from the hospital into the home. Daily care responsibilities fall to patients and their caregivers, yet stakeholder concerns in these heterogeneous environments, especially as they relate to racial inequities, are poorly understood. METHODS: Surgical oncology patients, caregivers, and clinicians participated in freelisting; an open-ended interviewing technique used to identify essential elements of a domain. Within 2 weeks after discharge, participants were queried on 5 domains: home independence, social support, pain control, immediate, and overall surgical impact. Salience indices, measures of the most important words of interest, were calculated using Anthropac by domain and group. RESULTS: Forty patients [20 whites and 20 African-Americans (AAs)], 30 caregivers (17 whites and 13 AAs), and 20 providers (8 residents, 4 nurses, 4 nurse practitioners, and 4 attending surgeons) were interviewed. Patients and caregivers attended to the personal recovery experience, whereas providers described activities and individuals associated with recovery. All groups defined surgery as life-changing, with providers and caregivers discussing financial and mortality concerns. Patients shared similar thoughts about social support and self-care ability by race, whereas AA patients described heterogeneous pain management and more hopeful recovery perceptions. AA caregivers expressed more positive responses than white caregivers. CONCLUSIONS: Patients live the day-to-day of recovery, whereas caregivers and clinicians also contemplate more expansive concerns. Incorporating relevant perceptions into traditional clinical outcomes and concepts could enhance the surgical experience for all stakeholders.