Influências dos canais de comunicação, sistema social e tempo na difusão do prontuário eletrônico do cidadão no Brasil / Influence of the elements communication channels, social system and time on the diffusion of the Electronic Health Record

O objetivo do artigo é analisar as influências dos elementos (canais de comunicação, sistema social e tempo) sobre a difusão do Prontuário Eletrônico do Cidadão. Foi realizado um estudo de caso, de abordagem qualitativa, fundamentado na Teoria da Difusão da Inovação, contendo 17 entrevistas e observações do cotidiano de trabalho de 8 equipes de saúde da família envolvidas na utilização da tecnologia em um Município do oeste de Minas Gerais. Os dados foram analisados por meio da Análise de Conteúdo, modalidade Temático-Categorial, e sistematizados com o software Atlas Ti. Observou-se que os canais de comunicação de massa de mídia e interpessoais potencializaram a difusão da tecnologia. Além disso, destacou-se a aceitação da inovação, fomentada pelo enfermeiro, que motivou e mobilizou a equipe para essa aderência. Foi possível compreender que alguns fatores contribuíram para resistência, como por exemplo, médicos e outros profissionais, com maior tempo de trabalho, consideravam a tecnologia complexa e o tempo insuficiente. A difusão da tecnologia também foi influenciada por estratégias no contexto do sistema social: criação de escalas de digitação, revezamentos, acordos, dentre outras. Alguns desafios emergiram: coexistência entre as tecnologias referentes ao Prontuário Eletrônico do Cidadão e o prontuário em ofício, conflitos, deficiências estruturais e de capacitação, e subutilização da tecnologia. Constatou-se que os elementos (canais de comunicação, tempo e sistema social), influenciam a difusão da inovação, predominantemente, colaborando para sua adoção no contexto estudado(AU)

El propósito del artículo fue analizar la influencia de los elementos canales de comunicación, sistema social y tiempo en la difusión del Registro Ciudadano Electrónico en Brasil. Se realizó un estudio de caso, con enfoque cualitativo, basado en la Teoría de Difusión de la Innovación, que contiene 17 entrevistas y observaciones del trabajo diario de 8 equipos de salud familiar involucrados en el uso de la tecnología en una ciudad del occidente de Minas Gerais. Los datos fueron analizados mediante análisis de contenido y la modalidad temático-categorial, sistematizados con el software Atlas Ti. Se observó que los medios de comunicación y los canales de comunicación interpersonal potenciaron la difusión de la tecnología. Además, se destacó la aceptación de la innovación, impulsada por la enfermera, que motivó y movilizó al equipo para esta adherencia. Se pudo comprender que algunos factores contribuían a la resistencia, por ejemplo, los médicos y otros profesionales, con mayor jornada laboral, consideraban el complejo tecnológico y el tiempo insuficiente. La difusión de la tecnología también estuvo influenciada por estrategias en el contexto del sistema social: creación de escalas de mecanografía, relevos, acuerdos, entre otros. Han surgido algunos desafíos: convivencia entre tecnologías relacionadas con la Historia Clínica Electrónica del Ciudadano y la historia clínica, conflictos, deficiencias estructurales y formativas y subutilización de la tecnología. Se encontró que los elementos (canales de comunicación, tiempo y sistema social), influyen en la difusión de la innovación, predominantemente, colaborando para su adopción en el contexto estudiado(AU)

The purpose of the study was to analyze the influence of the elements communication channels, social system and time on the diffusion of the Electronic Health Record in Brasil. A qualitative case study was conducted based on innovation diffusion theory, which contains 17 interviews and observations of the daily work of eight family health teams involved in the use of technology in a city of western Minas Gerais. The data were processed by thematic-categorial content analysis and systematized with the software Atlas Ti. Communication means and interpersonal communication channels were found to strengthen technology diffusion. Acceptance of the innovation was fostered by the nurse, who encouraged and mobilized the team in this direction. It was observed that some factors contributed to resistance. For example, doctors and other professionals with longer work hours considered that the technology was complex and the time available insufficient. Diffusion of technology was also affected by strategies deriving from the social system context: creation of typing scales, reliefs and agreements, among others. Some challenges have emerged: coexistence of technologies related to the Electronic Health Record and the clinical record, conflicts, structural and training deficiencies, and underused technology. It was found that the elements communication channels, time and social system influence innovation diffusion, mainly by fostering its adoption in the context studied(AU)

Transwomen and bone mineral density: a cross-sectional study in Brazilian population.

OBJECTIVES: Transgender individuals submitted to hormone or surgical treatment may have alterations in their bone metabolism as these elements are important players in bone remodeling. We aimed to study bone mineral density (BMD) and body composition in transwomen undergoing cross-sex hormonal treatment (CSHT) from Brazil for over 3 years, comparing them with female and male controls. METHODS: 93 individuals (31 transwomen, 31 females and 31 males paired for age and body mass index) were studied for bone mass, and body composition by densitometry (by DXA). Epidemiological and clinical data were collected through direct questioning. RESULTS: Low bone mass (T score ≤2) was found in 12.9% of transwomen; in 3.2% of females and 3.3% of males. Transwomen individuals had lower spine Z score (0.26 ± 1.42 vs 0.50 ± 1.19) and femur Z score (-0.41 ± 0.95 vs 0.29 ± 1.04) than females. They had lower total femur Z score than males (-0.41 ± 0.95 vs 0.20 ± 0.83). Lean mass values correlated positively with total femur BMD (ρ = 0.40; 95% confidence interval = 0.009-0.68; p = 0.04) and BMD in femoral neck (ρ = 0.48; 95% confidence interval = 0.11-0.74; p = 0.01) but neither the type of therapy received nor the time that they were used, impacted bone mass. CONCLUSION: Low BMD is found frequently in transwomen and it is correlated with lean body mass. ADVANCES IN KNOWLEDGE: There are few studies of the effects of hormone therapy on the bones and muscles of transwomen. This study demonstrated that significant changes occur, and that the population studied needs greater care in musculoskeletal health.

MECHANISMS IN ENDOCRINOLOGY: Clinical and pharmacogenetic aspects of the growth hormone receptor polymorphism.

Pharmacogenetics aims to maximize the beneficial effects of a medical therapy by identifying genetic finger prints from responders and non-responders and, thereby improving safety and efficacy profile of the drug. Most subjects who are deficient in growth hormone (GHD) are candidates for recombinant human GH (rhGH) therapy. To date, it is well established that even after adjustments for several clinical variables, such as age, gender, body composition and the age at onset of the GHD, response to rhGH treatment is highly variable among individuals, part of which is believed to be due to genetic factors within the GH system. As the first genetic variant to potentially influence the individual response to rhGH therapy in children with growth disorders, polymorphism in the GH receptor (GHR) has attracted a great interest as a target for pharmacogenetics. Studies have been conducted to compare the functional and molecular effects of the full-length GHR (fl-GHR) isoform with the exon 3 deleted (d3-GHR) isoform in children and adults treated with rhGH therapy. Additionally, the impact of the GHR polymorphism has been investigated in relation to the clinical status and response to medical treatment in acromegaly, especially to the GHR antagonist drug pegvisomant. We have performed a narrative review of the studies performed to date on the association of GHR polymorphism with rhGH response in children and adults, and its potential influence in the medical management of acromegaly. In addition, data from studies on the general population and in other chronic diseases examining a role of this genetic variant in the regulation of growth and metabolism are summarized.

Extracellular water and blood pressure in adults with growth hormone (GH) deficiency: a genotype-phenotype association study.

OBJECTIVES: Growth hormone deficiency (GHD) in adults is associated with decreased extracellular water volume (ECW). In response to GH replacement therapy (GHRT), ECW increases and blood pressure (BP) reduces or remains unchanged. Our primary aim was to study the association between polymorphisms in genes related to renal tubular function with ECW and BP before and 1 year after GHRT. The ECW measures using bioimpedance analysis (BIA) and bioimpedance spectroscopy (BIS) were validated against a reference method, the sodium bromide dilution method (Br(-)). DESIGN AND METHODS: Using a candidate gene approach, fifteen single-nucleotide polymorphisms (SNPs) in nine genes with known impact on renal tubular function (AGT, SCNN1A, SCNN1G, SLC12A1, SLC12A3, KCNJ1, STK39, WNK1 and CASR) were genotyped and analyzed for associations with ECW and BP at baseline and with their changes after 1 year of GHRT in 311 adult GHD patients. ECW was measured with the Br(-), BIA, and BIS. RESULTS: Both BIA and BIS measurements demonstrated similar ECW results as the reference method. At baseline, after adjustment for sex and BMI, SNP rs2291340 in the SLC12A1 gene was associated with ECW volume in GHD patients (p = 0.039). None of the SNPs influenced the ECW response to GHRT. One SNP in the SLC12A3 gene (rs11643718; p = 0.024) and three SNPs in the SCNN1G gene [rs5723 (p = 0.02), rs5729 (p = 0.016) and rs13331086 (p = 0.035)] were associated with the inter-individual differences in BP levels at baseline. A polymorphism in the calcium-sensing receptor (CASR) gene (rs1965357) was associated with changes in systolic BP after GHRT (p = 0.036). None of these associations remained statistically significant when corrected for multiple testing. CONCLUSION: The BIA and BIS are as accurate as Br(-) to measure ECW in GHD adults before and during GHRT. Our study provides the first evidence that individual polymorphisms may have clinically relevant effects on ECW and BP in GHD adults.

SNPs within the GH-signaling pathway are associated with the early IGF1 response to GH replacement therapy in GHD adults.

OBJECTIVE: GH-deficient (GHD) adults have reduced serum concentrations of IGF1. GH replacement therapy increases serum IGF1 concentrations, but the interindividual variation in treatment response is large and likely influenced by genetic factors. This study was designed to test the hypothesis that single-nucleotide polymorphisms (SNPs) in genes within the GH signaling pathway influence the serum IGF1 response to GH replacement. DESIGN AND METHODS: A total of 313 consecutive GHD adults (58.1% men; mean age 49.7 years) were studied before and after 1 week, 6 months, and 1 year of GH treatment. GH dose was individually titrated to normalize serum IGF1 levels. Six SNPs in the GH receptor (GHR) and the GH signaling pathway (JAK2, STAT5B, SOCS2, and PIK3CB) genes were selected for genotyping. The GHR exon 3-deleted/full-length (d3/fl) polymorphism was analyzed using tagSNP rs6873545. RESULTS: After 1 week of GH replacement, homozygotes of the fl-GHR showed a better IGF1 response to GH than carriers of the d3-GHR (P=0.016). Conversely, homozygotes of the minor allele of PIK3CB SNP rs361072 responded better than carriers of the major allele (P=0.025). Compared with baseline, both SNPs were associated with the IGF1 response at 6 months (P=0.041 and P=0.047 respectively), and SNP rs6873545 was further associated with the IGF1 response at 1 year (P=0.041). CONCLUSIONS: Our results indicate that common genetic variants in the GH signaling pathway may be of functional relevance to the response to GH replacement in GHD adults.

Discontinuing long-term GH replacement therapy--a randomized, placebo-controlled crossover trial in adult GH deficiency.

CONTEXT: Adult GH deficiency (GHD) is associated with impaired quality of life (QoL) and increased cardiovascular risk. Continued long-term efficacy in terms of QoL and cardiovascular risk factors has been indicated in open surveillance studies. OBJECTIVES: The aim was to study the impact of discontinuation of long-term GH replacement on QoL, body composition, and metabolism. DESIGN AND SETTING: We conducted a randomized, double-blind, placebo-controlled 4-month crossover trial in a referral center. PATIENTS: Sixty adult hypopituitary patients with GHD and more than 3 yr of continuous GH replacement therapy (mean treatment duration, 10 yr) participated in the study. INTERVENTION: Patients received GH or placebo. MAIN OUTCOME MEASUREMENTS: We measured QoL using validated questionnaires; body composition using computer tomography, dual-energy x-ray absorptiometry, and bioelectrical impedance spectroscopy; and insulin sensitivity using the short insulin tolerance test. RESULTS: Mean serum IGF-I decreased from 168 ± 52 to 98 ± 47 µg/liter during the placebo period (P < 0.001). Two QoL domains (emotional reactions and positive well-being) in the Nottingham Health Profile and Psychological General Well-Being questionnaires deteriorated during placebo, compared with GH treatment (P < 0.05). Waist circumference and sc and visceral fat mass increased, and extracellular water and muscle area decreased during the placebo period (all P < 0.05). C-reactive protein and total-, low-density lipoprotein-, and high-density lipoprotein-cholesterol increased, and insulin sensitivity improved during placebo, compared to GH treatment (P < 0.05). CONCLUSION: After more than 3 yr of GH replacement therapy, a 4-month period of placebo treatment caused self-perceived deterioration in QoL and increased abdominal fat accumulation. Moreover, markers of systemic inflammation and lipid status deteriorated, whereas insulin sensitivity improved. Long-term continuous GH replacement is needed to maintain therapeutic effects of GH on QoL and cardiovascular risk factors.

Genotypes associated with lipid metabolism contribute to differences in serum lipid profile of GH-deficient adults before and after GH replacement therapy.

OBJECTIVE: GH deficiency (GHD) in adults is associated with an altered serum lipid profile that responds to GH replacement therapy (GHRT). This study evaluated the influence of polymorphisms in genes related to lipid metabolism on serum lipid profile before and after 1 year of GHRT in adults. DESIGN AND METHODS: In 318 GHD patients, total cholesterol (TC) serum concentrations, LDL-C, HDL-C, and triglycerides (TG) were assessed. Using a candidate gene approach, 20 single nucleotide polymorphisms (SNPs) were genotyped. GH dose was individually titrated to obtain normal serum IGF1 concentrations. RESULTS: At baseline, the minor alleles of cholesteryl ester transfer protein (CETP) gene SNPs rs708272 and rs1800775 were associated with higher serum TC and apolipoprotein E (APOE) gene SNP rs7412 with lower TC concentrations; CETP SNPs rs708272, rs1800775, and rs3764261 and apolipoprotein B (APOB) gene SNP rs693 with higher serum HDL-C; APOE SNP rs7412, peroxisome proliferator-activated receptor gamma (PPARG) gene SNP rs10865710 with lower LDL-C, and CETP SNP rs1800775 with higher LDL-C; and APOE/C1/C4/C2 cluster SNP rs35136575 with lower serum TG. After treatment, APOB SNP rs676210 GG genotype was associated with larger reductions in TC and LDL-C and PPARG SNP rs10865710 CC genotype with greater TC reduction. All associations remained significant when adjusted for age, sex, and BMI. CONCLUSIONS: In GHD adults, multiple SNPs in genes related to lipid metabolism contributed to individual differences in baseline serum lipid profile. The GH treatment response in TC and LDL-C was influenced by polymorphisms in the APOB and PPARG genes.

Detection of genetic hypopituitarism in an adult population of idiopathic pituitary insufficiency patients with growth hormone deficiency.

Idiopathic pituitary insufficiency (IPI) is diagnosed in 10% of all hypopituitary patients. There are several known and unknown aetiologies within the IPI group. The aim of this study was to investigate an adult IPI population for genetic cause according a screening schedule. From files of 373 GH deficient (GHD) patients on GH replacement 50 cases with IPI were identified. Of the 39 patients that approved to the study, 25 patients were selected for genetic investigation according to phenotype and 14 patients were not further tested, as sporadic isolated GHD (n = 9) and GHD with diabetes insipidus (n = 5) have low probability for a known genetic cause. Genotyping of all coding exons of HESX1, LHX4, PROP1, POU1F1 and GH1 genes were performed according to a diagnostic algorithm based on clinical, hormonal and neuroradiological phenotype. Among the 25 patients, an overall rate of 8% of mutations was found, and a 50% rate in familial cases. Among two sibling pairs, one pair that presented with complete anterior pituitary insufficiency, had a compound heterozygous PROP1 gene mutation (codons 117 and 120: exon 3 p Phe 117 Ile (c349 T>A) and p Arg 120 Cys (c358 C>T)) with a phenotype of very late onset ACTH-insufficiency. In the other sibling pair and in the sporadic cases no mutation was identified. This study suggests that currently known genetic causes are rare in sporadic adult IPI patients, and that systematic genetic screening is not needed in adult-onset sporadic cases of IPI. Conversely, familial cases are highly suspect for genetic causes.

Models to predict changes in serum IGF1 and body composition in response to GH replacement therapy in GH-deficient adults.

OBJECTIVE: Clinical response to GH therapy in GH-deficient (GHD) adults varies widely. Good predictors of treatment response are lacking. The aim of the study was to develop mathematical models to predict changes in serum IGF1 and body composition (BC) in response to GH therapy in GHD adults. DESIGN AND METHODS: One hundred and sixty-seven GHD patients (103 men, median age 50 years) were studied before and after 12 months of GH treatment. GH dose was tailored according to serum IGF1 concentrations. Good responders (GR) and poor responders (PR) to GH therapy were defined as patients with a response >60th and <40th percentile respectively, for changes in serum IGF1 levels (adjusted for GH cumulative dose) and in BC (lean body mass (LBM) and body fat determined using dual-energy X-ray absorptiometry). A logistic regression model was used to predict the probability of being a GR or PR. RESULTS: In the IGF1 prediction model, men (odds ratio (OR) 5.62: 95% confidence interval 2.59-12.18) and patients with higher insulin levels (OR 1.06: 1.00-1.12) were more likely to be GR. The accuracy of the prediction model was 70%. In the BC model, men (OR 10.72: 1.36-84.18) and GHD patients with lower LBM (OR 0.82: 0.73-0.92) and greater height (OR 1.23: 1.08-1.40) at baseline were more likely to be GR. The accuracy of the prediction model was 80%. CONCLUSION: Accurate mathematical models to predict GH responsiveness in GHD adults were developed using gender, body height, baseline LBM, and serum insulin levels as the major clinical predictors.

Influence of the exon 3-deleted/full-length growth hormone (GH) receptor polymorphism on the response to GH replacement therapy in adults with severe GH deficiency.

CONTEXT: There is considerable individual variation in the clinical response to GH replacement therapy in GH deficient (GHD) adults. Useful predictors of treatment response are lacking. OBJECTIVE: The aim of the study was to assess the influence of the exon 3-deleted (d3-GHR) and full-length (fl-GHR) GH receptor isoforms on the response to GH replacement therapy in adults with severe GHD. DESIGN AND PATIENTS: A total of 124 adult GHD patients (79 men; median age, 50 yr) were studied before and after 12 months of GH therapy. GHD patients were divided into those bearing fl/fl alleles (group 1) and those bearing at least one d3-GHR allele (group 2), and the genotype was related to the effects of GH therapy on IGF-I levels and total body fat (BF). INTERVENTION: GH dose was individually titrated to obtain normal serum IGF-I levels. MAIN OUTCOME MEASURES: GHR genotype was determined by PCR amplification, IGF-I levels by immunoassay, and BF by a four-compartment model. RESULTS: Seventy-two (58%) patients had fl/fl genotype and were classified as group 1, whereas 52 (42%) had at least one d3-GHR allele and were classified as group 2 (40 were heterozygous and 12 were homozygous). At baseline, there were no significant differences in the study groups. Changes in IGF-I and BF after 12 months of GH treatment did not differ significantly between the two genotype groups. CONCLUSION: The presence of d3-GHR allele did not influence the response to GH replacement therapy in our cohort of adults with severe GHD.

Boletim Informativo em UTI: percepção de familiares e profissionais de saúde / Informative Bulletin in the ICU: perception of family members and health professionals / Boletín Informativo en UTI: percepción de familiares y profesionales de salud

No cotidiano da Unidade de Terapia Intensiva (UTI) a família mostra-se ansiosa, tem medo da perda e do desconhecido. Essa situação é mais crítica quando se depara com uma unidade de acesso limitado por horários rígidos e curto tempo de visita por paciente. Dentre as normas e rotinas das Unidades de Terapia Intensiva (UTI), encontra-se aquela relativa às informações clínicas sobre os pacientes internados, que geralmente são fornecidas por meio de um Boletim Informativo (BI), contendo termos como: grave, estável, regular, que não esclarecem satisfatoriamente o estado do familiar internado. É comum a família ter acesso ao Informativo e buscar informações adicionais por meio de telefonemas ou pessoalmente na UTI. Estudo descritivo exploratório que objetivou identificar semelhanças e diferenças entre Boletins Informativos (BI) de Unidades de Terapia Intensiva (UTI); descrever a percepção de familiares e profissionais sobre os BI como instrumento de comunicação do estado do paciente nas UTI; identificar os aspectos comunicacionais envolvidos na compreensão dos BI das UTI; identificar sugestões que possibilitem elaborar um informativo adequado às necessidades dos familiares. Foram realizadas entrevistas semi-estruturadas com 41 familiares e profissionais, e as respostas analisadas conforme propõe Bardin (2004). Evidenciou-se que os BI são semelhantes na forma, conteúdo e maneira de transmitir as informações. A maioria dos informantes caracterizou o BI como pouco compreensível e de linguagem técnica, que não esclarece a situação do paciente, gerando confusão e dúvidas sobre a confiabilidade das informações. Consideraram-no subjetivo e controverso pela falta de critérios usados na sua elaboração, mas que ainda é uma forma eficaz de transmitir informações. Sugeriram inclusão de itens menos técnicos e um glossário anexo, transmitido por profissional capacitado. Identificou-se similaridade nos discursos dos profissionais e familiares, e uma prática profissional não condizente com o exposto. É fundamental mudar os BI tanto na forma quanto no conteúdo, bem como a revisão de alguns modos cotidianos de pensar e agir. Pressupõe a compreensão de que a excelência da qualidade assistencial, baseada na comunicação efetiva, envolve reorganização do processo de trabalho em dimensões teóricas, práticas, políticas, organizacionais e interpessoais. Porém, este processo de mudança está mais na dependência de mudanças pessoais do que externas, pois a qualidade do cuidar envolve não apenas o agir técnico, mas, sobretudo a dimensão humana, que certamente decorre da interação, do diálogo efetivo, do respeito à diversidade de percepções, da mudança de comportamentos. Significa transformar em ações o discurso do ?atender com qualidade?.

In the daily routine of the intensive therapy, the patient?s family is anxious, afraid of their loss, of the unknown. This situation is more critical when they have to face a health unit with limited access due to strict schedule. Among the guidelines of most Intensive Care Units (ICU), there is the clinical information about the patients, provided to the family through an Informative Bulletin (IB) containing terms such as severe, stable, regular, which do not satisfactorily enlighten them as to the condition of their relative. It is common for the family to receive the IB and still search for additional information by telephone or personally. It is a descriptive exploratory study with the purpose of to identify similarities and differences among various Informative Bulletins (IBs) of Intensive Care Unity (ICU) and the routine of information to the family members in the ICUs; to describe the family members and health professionals? perception about the IB as an instrument to communicate the clinical state of the ICU patient; to identify the communication aspects involved in the comprehension of the ICU Informative Bulletin by the professionals and family members; to identify suggestions given by the professionals and family members in order to create suitable IBs to the family members? needs. The participants were 41 professionals and people with a family member under treatment in an ICU. Data were collected through semi structured interviews followed by answer content analysis in accordance with Bardin (2004). Comparison between information routine of each ICU and the various IBs indicated that they are similar both in form and content. Most participants characterized the IB as not clear and containing technical terms, not elucidative about the condition of the patient, generating confusion and doubts about the information reliability. They also considered it subjective and controversial due to lack of consensus criteria on the terms used. Some participants mentioned that the IB is an effective way to transmit information and reach the family member perception because it is simple and there are ethical aspects that limit its content. They also emphasized the importance of the inclusion of other not technical items with a glossary. It was possible to identify similarities in the discourses of the professionals and family members and a professional practice that did not correspond to the discourse. This leads to the reflection that a change is vital both in form and content used in the IBs, and that it is necessary to revise some routine ways of thinking and acting. This presumes the understanding that the assistance service excellence, based on effective communication, involves reorganizing the process of work in the theoretical, practical, political, organizational, and interpersonal dimensions. Nevertheless, this process of change is more dependent on personal changes than on external ones, because the quality of the assistance involves not only the technical act, but mainly the human dimension, which certainly derives from the interaction, the effective dialogue, the respect to the diversity of perceptions, the changes in behavior. It means to transform the discourse of ?attention with quality? into action.

En la rutina diaria de la terapia intensiva, la familia del paciente está ansiosa, asustada de su pérdida, del desconocido. Esta situación es más crítica cuando ellos tienen que enfrentar una unidad de salud con el acceso limitado debido al horario estricto. Entre las pautas de más Unidades del Cuidado Intensivas (UTI), hay la información clínica sobre los pacientes, con tal de que a la familia a través de un Boletín Informativo (BIRF) conteniendo las condiciones como severo, estable, regular, qué no los ilumina satisfactoriamente acerca de la condición de su pariente. Es común para la familia recibir el BIRF y todavía buscar la información adicional por el teléfono o personalmente. Estudio desctriptivo explorador que intentó identificar semejanzas y diferencias entre Boletines Informativos (BI) de Unidades de Terapia Intensiva (UTI); describir la percepción de familiares y profesionales sobre los BI como instrumento de comunicación del estado del paciente en las UTI; identificar sugerencias que posibiliten elaborar un informe adecuado a las necesidades de los familiares. Fueron realizadas entrevistas semi estructuradas con 41 familiares y profesionales, y las respuestas analisadas según propone Bardin (2004). Se comprobó que los BI son semejantes en la forma, contenido y manera de transmitir las informaciones. La mayoría de los informantes definió al BI como poco comprensible y de lenguaje técnico, que no aclara la situación del paciente, generando confusión y dudas sobre la confiabilidad de las informaciones. Lo consideran subjetivo y contradictorio por la falta de criterios usados en su elaboración, pero que aún es una forma eficaz de transmitir informaciones. Sugirieron que se incluyeran los puntos menos técnicos y un glosario anexo, transmitido por un profesional capacitado. Se concluye que hay semejanza en los discursos de los profesionales y familiares y una práctica profesional que no condice con el discurso. Es fundamental cambiar los BI tanto en la forma como en el contenido, así como revisar algunos modos cotidianos profesionales de pensar y actuar, transformando en acciones el discurso del ``atender con calidad´´.

Boletim Informativo em UTI: percepção de familiares e profissionais de saúde / Informative Bulletin in the ICU: perception of family members and health professionals / Boletín Informativo en UTI: percepción de familiares y profesionales de salu

Estudo descritivo exploratório que objetivou identificar semelhanças e diferenças entre Boletins Informativos (BI) de Unidades de Terapia Intensiva (UTI); descrever a percepção de familiares e profissionais sobre os BI como instrumento de comunicação do estado do paciente nas UTI; identificar os aspectos comunicacionais envolvidos na compreensão dos BI das UTI; identificar sugestões para elaborar um informativo adequado às necessidades dos familiares. Realizadas entrevistas semi-estruturadas com 41 familiares e profissionais, entre fevereiro - abril de 2006 e analisadas respostas conforme propõe Bardin (2004). Evidenciou-se que os BI são semelhantes na forma, conteúdo e transmissão das informações. O BI foi considerado pouco compreensível, com linguagem técnica, que não esclarece a situação do paciente, gerando confusão e dúvidas sobre a confiabilidade das informações. Consideraram-no subjetivo e controverso pela falta de critérios na sua elaboração, mas ainda é uma forma eficaz de transmitir informações. Sugeriram incluir itens menos técnicos com glossário anexo e ser transmitido por profissional capacitado. Conclui-se que existe similaridade nos discursos dos profissionais e familiares e prática profissional não condizente com o discurso. É fundamental mudar os BI na forma, no conteúdo, bem como revisar modos cotidianos profissionais de pensar e agir, transformando em ações o discurso do ?atender com qualidade?.

It is a descriptive exploratory study with the purpose to identify similarities and differences among various Informative Bulletins (IBs) of Intensive Care Unity (ICU) and the information routine to the family members in the ICUs; to describe the family members and health professionals? perception about the IB as an instrument to communicate the ICU patient clinical state ; to identify the communication aspects involved in the comprehension of the ICU Informative Bulletin by professionals and family members; to identify suggestions given by professionals and family members in order to create suitable IBs to the family members? needs. The participants were 41 professionals and people with a family member under treatment in an ICU. Data were collected between February and April 2006, through semi-structured interviews followed by answer content analysis in accordance with Bardin (2004). Comparison between information routine of each ICU and the various IBs indicated that they are both similar in form and content. Most of the participants characterized the IB as not clear and containing technical terms, not elucidative about the condition of the patient, generating confusion and doubts about the information reliability. They also considered it subjective and controversial due to lack of consensus criteria on the used terms. Some participants mentioned that the IB is an effective way to transmit information and reach the family member perception because it is simple and there are ethical aspects that limit its content. They also emphasized the importance of the inclusion of other not technical items with a glossary. It was possible to identify similarities in the professional?s discourses and family members and a professional practice that didn?t correspond to the discourse.

Estudio desctriptivo explorador que pretendió identificar semejanzas y diferencias entre Boletines Informativos (BI) de Unidades de Terapia Intensiva (UTI); describir la percepción de familiares y profesionales sobre los BI como instrumento de comunicación del estado del paciente en las UTI; identificar sugerencias que posibiliten elaborar un informe adecuado a las necesidades de los familiares. Fueron realizadas entrevistas semi estructuradas con 41 familiares y profesionales entre febrero - abril de 2006, y las respuestas analizadas según propone Bardin (2004). Se comprobó que los BI son semejantes en la forma, contenido y manera de transmitir las informaciones. El BI fue considerado como poco comprensible, de lenguaje técnico, que no aclara la situación del paciente, generando confusión y dudas sobre la confiabilidad de las informaciones. Lo consideran subjetivo y contradictorio por la falta de criterios usados en su elaboración, sin embargo, es una forma eficaz de transmitir informaciones. Sugirieron que se incluyeran los puntos menos técnicos y un glosario anexo, que será transmitido por un profesional capacitado. Se concluye que hay semejanza en los discursos de los profesionales y familiares y una práctica profesional que no condice con el discurso. Es fundamental cambiar los BI tanto en la forma como en el contenido, así como revisar modos cotidianos profesionales de pensar y actuar, transformando en acciones el discurso del ?atender con calidad?.

A filariose bancroftiana no muicípio de Moreno - Pernambuco, Brasil / Lymphatic filariosis in Moreno, Northeast Brazil

No Brasil estima-se que 49 mil pessoas estejam infectadas pela Wuchereria bancrofti, residindo em três áreas consideradas endêmicas: Maceió-AL, Belém-PA e Região Metropolitana do Recife-PE; esta última apresenta a maior casuística no país. Este estudo tem como objetivo identificar o limite entre municípios com e sem transmissão ativa, em Pernambuco. Para tal foi realizado um estudo seccional no município de Moreno, localizado na Região Metropolitana do Recife. O inquérito epdemiológico foi constituído de entrevistas utilizando questionários fechados contendo informações relacionadas à filariose e à pesquisa parasitológica. Dentre os 2.513 exames realizados, dois casos foram detectados, ambos provenientes do Recife-PE. Quanto à manifestação clínica, 65 (2,6 por cento) indivíduos relataram queixas correlatas com filariose. Em relação ao tratamento prévio para Filariose, 24 pessoas (0,9 por cento) afirmaram já terem tomado a dietilcarbamazina. A importância deste trabalho decorre do desconhecimento da extensão da endemia na Região Metropolitana do Recife e da constatação de que Moreno apresenta os componentes para manter o ciclo parasitário. Desta forma, a vigilância epidemiológica municipal deverá identificar as áreas com maior risco de transmissão e assim criar estratégias para evitar sua fixação.