Avaliação da deglutição: intervenção do enfermeiro de reabilitação / Swallowing assessment: intervention of the rehabilitation nurse

A disfagia é um problema com elevada prevalência e comum a nível mundial, podendo afetar a pessoa ao longo do seu ciclo de vida. Fatores como a idade avançada, institucionalização, deficiências neuromusculares, acidente vascular cerebral e intubação endotraqueal representam alguns dos fatores de risco associados à disfagia. A presença de disfagia está associada a maiores taxas de mortalidade e morbilidade, pelo risco acrescido de desnutrição e desidratação, risco de aspiração e consequente pneumonia de aspiração, aumentando o tempo de hospitalização e custo de internamento por doente. Em cuidados intensivos, a intubação endotraqueal e ventilação mecânica são procedimentos comuns, porém interferem com o normal processo de deglutição, originando frequentemente disfagias pós-extubação. Assim, neste contexto o enfermeiro assume um papel fulcral na avaliação precoce da deglutição e identificação de disfagia no doente internado em cuidados intensivos. Objetivos: contribuir para a uniformização das intervenções de enfermagem na avaliação da deglutição. Metodologia: o trabalho de investigação centra-se na metodologia de projeto. Na fase de diagnóstico de situação realizamos um estudo qualitativo de carácter exploratório- descritivo. Os dados foram obtidos através da realização de entrevistas semi-estruturadas a 10 enfermeiros e da observação das práticas na avaliação da deglutição a 12 enfermeiros de uma Unidade de Cuidados Intensivos, de um Hospital da região Norte. Resultados: as práticas descritas pelos enfermeiros aquando da avaliação de deglutição, e na abordagem à pessoa com disfagia estão de acordo com a literatura, porém as intervenções mencionadas não foram uniformes e sistemáticas. Foi possível mostrar que os enfermeiros manifestam necessidades formativas, o que se torna num fator dificultador das práticas. Por outro lado, a presença do Enfermeiro de Reabilitação assume-se como um fator facilitador na avaliação da deglutição, bem como a existência de protocolo. De acordo com estes resultados, foram definidos os objetivos do projeto e planeadas duas atividades: Ação de formação: Avaliação da Deglutição - O papel do enfermeiro na avaliação e intervenção precoce; e elaboração da proposta de procedimento de avaliação da Deglutição com recurso à escala de rastreio de disfagia: Escala de GUSS. Conclusão: A ação de formação: Avaliação da Deglutição - O papel do enfermeiro na avaliação e intervenção precoce, foi realizada em abril de 2019, sendo os resultados do seu impacto imediato positivos, quando avaliado o nível de satisfação dos participantes com a ação, relativamente à importância dos conhecimentos na melhoria do desempenho profissional. A atividade "elaboração da proposta de procedimento de avaliação da Deglutição com recurso à escala de rastreio de disfagia: Escala de GUSS" será apresentada no sentido de ser aprovada pela comissão científica do Hospital e figurar como protocolo do serviço

Dysphagia is a high prevalence problem, frequent all over the world, and can affect people through the life cycle. Factors such as old age, institutionalization, neuromuscular deficiencies, stroke and tracheal intubation represent some of the risk factors associated with dysphagia. The presence of dysphagia is associated with higher mortality and morbidity rates by the increased risk of malnutrition and dehydration, risk of aspiration and consequent aspiration pneumonia, increasing hospitalization time and cost of hospitalization per patient. In intensive care, tracheal intubation and mechanical ventilation are common procedures, but they interfere with the normal swallowing process, frequently leading to post-extubation dysphagia. In this context, the nurses assume a key role as professionals in the early assessment of swallowing and identification the patient in intensive care with dysphagia. Objectives: contribute to the uniformity of nursing interventions in the assessment of swallowing. Methodology: the investigation work is based on the project methodology. In the stage of situation diagnosis we realize a qualitative study, exploratory-descriptive character. The results have been obtained through semi-structured interviews with 10 nurses and observation of practices in the assessment of swallowing with 12 nurses in the Intensive Care Unit of a North Region Hospital. Results: the practices described by nurses in the swallowing assessment and in the treatment of the person with dysphagia are in agreement with the literature, but the interventions mentioned were not uniform and systematic. It was possible to demonstrate that the nurses expressed formative needs, which becomes one of the factors identified. On the other side, the presence of the Rehabilitation Nurse is a facilitating factor in the assessment of swallowing, and also the existence of protocol. According to these results, the objectives of the project were defined and it was planned two activities: Formation action: Assessment of Deglutition - The role of the nurse in the assessment and early intervention; and the elaboration of the proposal protocol for assessment of the Deglutition using the Dysphagia Screening Scale: GUSS Scale. Conclusion: The formation action: Assessmenof the Deglutition - The role of the nurse in the assessment and early intervention, was realized in April of 2019, and the results of its immediate impact were positive, when the level of satisfaction of the participants with the action was evaluated, in relation to the importance of the knowledge in the improvement of the professional performance.The activity "Elaboration of the proposed protocol for assessment of Deglutition using the Dysphagia Screening Scale: GUSS Scale" will be presented in order to be approved by the scientific committee of the Hospital and to be included as protocol of the service.

Assessment of Beneficial and Possible Toxic Effects of Two New Alfalfa-Derived Shelf Products.

Aerial parts of Medicago sativa L. have been used as food and its consumption has been associated with health benefits, one among the most important being menopausal symptoms control. This work was aimed to explore possible pharmacological effects of two new alfalfa-derived products that have recently emerged as daily beverage preparations. In exploring their potential estrogenic effects, they produced no relevant alteration in the uterus. However, lowering glucose levels until normal values without causing further hypoglycemic effect were observed, when rats were treated with 1.5 g/kg/day samples. In vivo acute toxicity was not found when the alfalfa products were tested up to 3 g/kg rat weight. Furthermore, in vitro studies were conducted to assess their possible toxic effects. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and lactate dehydrogenase tests were carried out on the Caco-2 cell model to determine cell viability and membrane integrity. A concentration-dependent effect was observed, with a significant decrease in cell viability after exposure to concentrations of alfalfa product up to 100 mg/mL (after 3 h of incubation) and 50 mg/mL (after 24 h of treatment). Although in vitro level, the decrease in cell viability at these still low doses may underlie some toxicity, making necessary additional studies before any recommendation of a sustained consumption of these products by humans.

Geno- and immunotoxic effects on populations living near a mine: a case study of Panasqueira mine in Portugal.

Mining industry is a vital economic sector for many countries but it is also one of the most hazardous activities, both occupationally and environmentally. Existing studies point to several adverse effects on communities' health living near mines, effects such as mesothelioma and respiratory illnesses. Results achieved in a geochemical sampling campaign undertaken in the vicinity of São Francisco de Assis village showed an anomalous distribution of some heavy metals in soils and waters. To evaluate the effects of mining activities on human health produced by these conditions, a group of 28 individuals from São Francisco de Assis village was examined for some biological endpoints. A nonexposed group (30 individuals) with the same demographic characteristics without exposure to genotoxic compounds was also studied and data obtained from both groups compared. Results of the T-cell receptor mutation assay and micronucleus (MN) test showed significant increases in the frequencies of both mutations and MN in exposed subjects compared to controls. Data obtained in the analysis of the different lymphocyte subsets demonstrated significant decreases in percentages of CD3+ and CD4+ cells, and a significant increase in percentage of CD16/56+ cells, in exposed individuals. The results of the present study indicate an elevated risk of human environmental contamination resulting from mining activities, emphasizing the need to implement preventive measures, remediation, and rehabilitation plans. This would lead to a reduction in cancer risk not only for this particular population but for all populations exposed under similar conditions.