[Health promoted by social and community networks of low-income women]. / A saúde promovida por redes sociais e comunitárias de mulheres de baixa renda.

Social and community networks constitute an important social determinant of health, especially in the poorer segments of civil society and in their struggles to guarantee the right to health care. This study sought to understand the social and community networks created by women living in a low-income community and their relationship with the development of health care in this social group. Semi-structured interviews were conducted with 11 women participating in a nongovernmental organization in the community, and the data were subjected to content analysis. The analysis highlighted four categories: the community as a large network, formed by multiple interconnected dynamic networks; the network of "aunts", women with an important role in the care of the community, treated as part of the family; the conversation circles, such as the rite of periodic meeting on the sidewalks, indicated as an important space that guarantees emotional stability and quality of life; and the benzedeiras with the use of medicinal plants, they are reference care within the community, providing disease prevention, health treatment, and referral to the health care unit when necessary. We concluded that the social and community networks created by the participants are important social determinants, and health facilities registered in the territory should value such networks.

As redes sociais e comunitárias constituem um importante determinante social de saúde, especialmente nos segmentos populares da sociedade civil e em suas lutas para garantir o direito à saúde. Esta pesquisa buscou compreender quais são as redes sociais e comunitárias constituídas por mulheres residentes em uma comunidade de baixa renda e sua relação com a produção da saúde nesse grupo social. Foram realizadas entrevistas semiestruturadas com 11 mulheres participantes de uma organização não governamental (ONG) da comunidade, e os dados foram submetidos à análise de conteúdo. A análise destacou quatro categorias: a comunidade como uma grande rede - formada por múltiplas redes dinâmicas interligadas; a rede das "tias" - mulheres com papel importante no cuidado da comunidade, tratadas como parte da família; as rodas de conversa - como o rito de encontro periódico nas calçadas, apontado como importante espaço garantidor de estabilidade emocional e qualidade de vida; e as benzedeiras e o uso de plantas medicinais - referências de cuidado na comunidade, que proporcionam prevenção/tratamento à saúde e encaminhamento para a unidade de saúde quando necessário. Conclui-se que as redes sociais e comunitárias formadas pelas participantes são determinantes sociais importantes. Assim, é necessária a valorização de tais redes pelos equipamentos de saúde inscritos no território.

Las redes sociales y comunitarias constituyen un importante determinante social de salud, especialmente en los segmentos populares de la sociedad civil y en sus luchas para garantizar el derecho a la salud. La presente investigación buscó comprender cuáles son las redes sociales y comunitarias tejidas por las mujeres residentes en una comunidad de bajos ingresos y su relación con la producción de la salud en este grupo social. Se realizaron entrevistas semiestructuradas con 11 mujeres participantes de una organización no gubernamental de la comunidad, y los datos se sometieron a análisis de contenido. El análisis destacó cuatro categorías: la comunidad como una gran red - formada por múltiples redes dinámicas interconectadas; la red de las "tías" - mujeres con papel importante en el cuidado de la comunidad, tratadas como parte de la familia; las ruedas de conversación - como el rito de encuentro periódico en las aceras, señalado como un espacio importante que garantiza la estabilidad emocional y la calidad de vida, y las curanderas y el uso de plantas medicinales - referencias de cuidado en la comunidad; que proporcionan prevención/tratamiento a la salud y el encaminamiento para la unidad de salud cuando sea necesario. Se concluye que las redes sociales y comunitarias tejidas por las participantes son determinantes sociales importantes, siendo necesaria la valorización de tales redes por los equipos de salud inscritos en el territorio.

Conservative management following patellar dislocation: a level I systematic review.

BACKGROUND: Patellar instability is a common and disabling clinical condition. Treatment of acute primary patellar dislocation aims to reduce the risk of recurrence or painful subluxation and improve function. However, the actual clinical efficacy of any management modality following an acute dislocation has never been demonstrated in prospective or retrospective studies, and the optimal way in which the various management modalities should be used is at best unclear. METHODS: A search was conducted in PubMed, Bireme and Embase databases. Inclusion criteria followed the acronym PICOS, (P) subjects with patellar instability, (I) therapeutic interventions, (C) placebo or control or surgical treatments, (O) rate of dislocations and function, and (S) clinical trials. The Medical Subject Headings (MeSH) terms used were: (("patellar instability") OR ("patellar dislocation")) AND ((physiotherapy) OR (rehabilitation) OR ("conservative treatment") OR (therapy) OR (therapeutic)). The risk of bias was analysed using the PeDRO scale. RESULTS: Seven randomized controlled trials including 282 patients were considered. The quality of studies detailing the results of conservative treatment was higher than that of surgical procedures, but all studies have relatively low methodological quality. Four studies compared physiotherapeutic interventions with surgical procedures, and three studies compared conservative intervention techniques. CONCLUSION: An unstructured lower limb physical therapy programme evidences similar outcomes to specific exercises. Surgical management is associated with a lower rate of re-dislocation; however, whether surgery produces greater functional outcomes than conservative management is still unclear. The use of a knee brace with a limited range of motion, stretching and neuromuscular exercises are the most commonly recommended physiotherapy methodologies.

A saúde promovida por redes sociais e comunitárias de mulheres de baixa renda / Health promoted by social and community networks of low-income women / La salud promovida por las redes sociales y comunitarias de mujeres de bajos ingresos

Resumo: As redes sociais e comunitárias constituem um importante determinante social de saúde, especialmente nos segmentos populares da sociedade civil e em suas lutas para garantir o direito à saúde. Esta pesquisa buscou compreender quais são as redes sociais e comunitárias constituídas por mulheres residentes em uma comunidade de baixa renda e sua relação com a produção da saúde nesse grupo social. Foram realizadas entrevistas semiestruturadas com 11 mulheres participantes de uma organização não governamental (ONG) da comunidade, e os dados foram submetidos à análise de conteúdo. A análise destacou quatro categorias: a comunidade como uma grande rede - formada por múltiplas redes dinâmicas interligadas; a rede das "tias" - mulheres com papel importante no cuidado da comunidade, tratadas como parte da família; as rodas de conversa - como o rito de encontro periódico nas calçadas, apontado como importante espaço garantidor de estabilidade emocional e qualidade de vida; e as benzedeiras e o uso de plantas medicinais - referências de cuidado na comunidade, que proporcionam prevenção/tratamento à saúde e encaminhamento para a unidade de saúde quando necessário. Conclui-se que as redes sociais e comunitárias formadas pelas participantes são determinantes sociais importantes. Assim, é necessária a valorização de tais redes pelos equipamentos de saúde inscritos no território.

Abstract: Social and community networks constitute an important social determinant of health, especially in the poorer segments of civil society and in their struggles to guarantee the right to health care. This study sought to understand the social and community networks created by women living in a low-income community and their relationship with the development of health care in this social group. Semi-structured interviews were conducted with 11 women participating in a nongovernmental organization in the community, and the data were subjected to content analysis. The analysis highlighted four categories: the community as a large network, formed by multiple interconnected dynamic networks; the network of "aunts", women with an important role in the care of the community, treated as part of the family; the conversation circles, such as the rite of periodic meeting on the sidewalks, indicated as an important space that guarantees emotional stability and quality of life; and the benzedeiras with the use of medicinal plants, they are reference care within the community, providing disease prevention, health treatment, and referral to the health care unit when necessary. We concluded that the social and community networks created by the participants are important social determinants, and health facilities registered in the territory should value such networks.

Resumen: Las redes sociales y comunitarias constituyen un importante determinante social de salud, especialmente en los segmentos populares de la sociedad civil y en sus luchas para garantizar el derecho a la salud. La presente investigación buscó comprender cuáles son las redes sociales y comunitarias tejidas por las mujeres residentes en una comunidad de bajos ingresos y su relación con la producción de la salud en este grupo social. Se realizaron entrevistas semiestructuradas con 11 mujeres participantes de una organización no gubernamental de la comunidad, y los datos se sometieron a análisis de contenido. El análisis destacó cuatro categorías: la comunidad como una gran red - formada por múltiples redes dinámicas interconectadas; la red de las "tías" - mujeres con papel importante en el cuidado de la comunidad, tratadas como parte de la familia; las ruedas de conversación - como el rito de encuentro periódico en las aceras, señalado como un espacio importante que garantiza la estabilidad emocional y la calidad de vida, y las curanderas y el uso de plantas medicinales - referencias de cuidado en la comunidad; que proporcionan prevención/tratamiento a la salud y el encaminamiento para la unidad de salud cuando sea necesario. Se concluye que las redes sociales y comunitarias tejidas por las participantes son determinantes sociales importantes, siendo necesaria la valorización de tales redes por los equipos de salud inscritos en el territorio.

Low-grade albuminuria and its relationship with cardiovascular disease risk in hypertensive and diabetic patients in primary health care.

OBJECTIVE: To evaluate the presence of LGA and the relationship with the 10-year risk of a cardiovascular event in hypertensive and diabetic patients in Primary Health Care. STUDY DESIGN: The study design used is cross-sectional. METHODS: This study was based on the application of questionnaires, anthropometric measurements, and laboratory tests carried out from August 2017 to April 2018. Logistic regression was used to evaluate the odds ratio of the explanatory variables in relation to the highest tercile of LGA. The Framingham risk score was used to assess the 10-year risk of cardiovascular event. The comparison of this score with the LGA terciles was analyzed using ANOVA. RESULTS: An increase in the 10-year risk of cardiovascular event score was observed with an increasing LGA tercile, and this pattern prevailed after adjusting for confounding variables. CONCLUSION: An association between LGA and the 10-year risk of cardiovascular event was observed in a representative sample of hypertensive and diabetic patients.

Spirituality in Daily Healthcare Provided in Brazil: Meanings and Practices of the Nursing Team.

OBJECTIVE: to understand the meanings and practices related to spirituality experienced by Nursing teams in the daily care provided in Oncology. METHODS: qualitative research, guided by the theory of Holistic Nursing by Myra Levine, conducted with members of the Nursing team at an Oncology hospital in Brazil. Data collection was carried out in 2018, through an interview guided by a semi-structured script. Data analysis was performed using Lawrence Bardin's Content Analysis technique. RESULTS: two categories emerged: the first brought to light the meanings attributed to spirituality by the Nursing team and the second category presented the practices of spiritual care by Nursing personnel in their daily routine in Oncology, highlighting that professionals address spirituality with patients in different ways. CONCLUSION: the approach to spirituality in Oncology care and in the professional training of Nursing personnel is essential, as a way of providing holistic and humanized care, thus strengthening the psycho-spiritual dimension in daily care.

Repercussões da infodemia associada ao COVID-19 na saúde mental do idoso no Brasil / Repercusiones de la infodemia asociada al COVID-19 en la salud mental de los ancianos en Brasil / Repercussions of infodemia associated with COVID-19 on the mental health of the elderly in Brazil

O fenômeno denominado infodemia refere-se ao aumento do volume informacional sobre um tema em específico, que se multiplica rapidamente em um curto período de tempo, e tem-se destacado frente ao contexto da crise sanitária desencadeada pela pandemia de COVID-19. O excesso de informações pode suscitar sentimentos de medo, ansiedade, estresse e outras condições de sofrimento mental. O estudo tem como objetivo descrever o perfil de exposição a informações sobre COVID-19 e suas repercussões na saúde mental de idosos brasileiros. Trata-se de um estudo transversal realizado com 1924 idosos brasileiros. Coletaram-se dados por meio de web-based survey enviada aos idosos por redes sociais e e-mail, no período de julho a outubro de 2020. Os resultados da análise descritiva dos dados demonstram que a maioria dos idosos apresentou idade entre 60 e 69 anos (69,02por cento), é do sexo feminino (71,26por cento), casados (53,79 por cento) e de cor branca (75,57por cento). Cerca de 21,67por cento (n = 417) concluíram a graduação, 19,75por cento (380) concluíram especialização e 16,63por cento (320) concluíram mestrado ou doutorado. Foram reportados como fontes frequentes de exposição às notícias ou informações sobre a COVID-19, a televisão 862 (44,80por cento) e as redes sociais 651 (33,84por cento). Os participantes assinalaram que a televisão (46,47por cento; n = 872), as redes sociais (30,81por cento; n = 575) e o rádio (14,48por cento; 251) os afetavam psicológica e/ou fisicamente. Receber notícias falsas sobre a COVID-19 pela televisão (n = 482; 19,8por cento) e pelas redes sociais (n = 415; 21,5por cento) repercutiu, principalmente, estresse e medo. As informações disseminadas contribuem para conscientização, mas, também, afetam física e/ou psicologicamente muitos idosos, principalmente gerando medo e estresse(AU)

El fenómeno denominado infodemia hace referencia al aumento del volumen de información sobre un tema específico, que se multiplica rápidamente en un corto período, y ha destacado en el contexto de la crisis sanitaria desencadenada por la pandemia de la COVID-19. Demasiada información puede desencadenar sentimientos de miedo, ansiedad, estrés y otras condiciones de angustia mental. El estudio tiene como objetivo describir el perfil de exposición a la información sobre la COVID-19 y sus repercusiones en la salud mental de los ancianos brasileños. Se trata de un estudio transversal realizado con 1924 ancianos brasileños. Los datos fueron recolectados a través de una encuesta web enviada a los ancianos a través de redes sociales y correo electrónico, de julio a octubre de 2020. Los resultados del análisis descriptivo de los datos muestran que la mayoría de los ancianos tenían entre 60 y 69 años (69,02 por ciento), mujer (71,26 por ciento), casada (53,79 por ciento) y blanca (75,57 por ciento). El 21,67 por ciento (n = 417) concluyó su graduación, el 19,75 por ciento (380) concluyó especialización y el 16,63 por ciento (320) concluyó maestría o doctorado. La televisión 862 (44,80 por ciento) y las redes sociales 651 (33,84 por ciento) se reportaron como fuentes frecuentes de exposición a noticias o información sobre el COVID-19. Los participantes indicaron que la televisión (46,47 por ciento; n = 872), las redes sociales (30,81 por ciento; n = 575) y la radio (14,48 por ciento; 251) les afectaban psicológica y/o físicamente. Recibir noticias falsas sobre el COVID-19 en la televisión (n = 482; 19,8 por ciento) y en las redes sociales (n = 415; 21,5 por ciento) resultó principalmente en estrés y miedo. La información difundida contribuye a la sensibilización, pero también afecta física y/o psicológicamente a muchas personas mayores, generando principalmente miedo y estrés(AU)

The phenomenon called infodemia refers to the increase in the volume of information on a specific topic, which multiplies rapidly in a short period of time, and has stood out in the context of the health crisis triggered by the COVID-19 pandemic. Too much information can trigger feelings of fear, anxiety, stress, and other conditions of mental distress. The study aims to describe the profile of exposure to information about COVID-19 and its repercussions on the mental health of elderly Brazilians. This is a cross-sectional study carried out with 1924 elderly Brazilians. Data were collected through a web-based survey sent to the elderly via social networks and email, from July to October 2020. The results of the descriptive analysis of the data show that most of the elderly were aged between 60 and 69 years (69.02percent), female (71.26percent), married (53.79percent) and white (75.57percent). About 21.67percent (n = 417) concluded their graduation, 19.75percent (380) concluded their specialization and 16.63percent (320) concluded their master's or doctoral degrees. Television 862 (44.80percent) and social networks 651 (33.84percent) were reported as frequent sources of exposure to news or information about COVID-19. Participants indicated that television (46.47percent; n = 872), social networks (30.81percent; n = 575) and radio (14.48percent; 251) affected them psychologically and/or physically. Receiving fake news about COVID-19 on television (n = 482; 19.8percent) and on social media (n = 415; 21.5percent) mainly resulted in stress and fear. The disseminated information contributes to awareness, but also affects physically and/or psychologically many elderly people, mainly generating fear and stress(AU)

Optimal Cutoff of the TG/HDL-c ratio for Cardiovascular Risk in Hypertensive and Diabetic Patients Monitored by Primary Health Care in a city in Minas Gerais

Abstract Background The analysis of the atherogenic potential of the lipid profile for biomarkers, such as the TG/HDL-c ratio, predicts cardiovascular risk better than isolated lipids. Objective To identify the TG/HDL-c cutoff points for multiple risks (hypertension, Diabetes Mellitus, obesity) and to evaluate the association between sociodemographic, clinical, laboratory, anthropometric, and life habit variables and the TG/HDL-c ratio in hypertensive and/or diabetic individuals in the context of Primary Health Care. Methods This was a cross-sectional study with 833 hypertensive and/or diabetic patients, conducted between August 2017 and April 2018. The cutoff point of the TG/HDL-c were obtained by the ROC curve. Cardiovascular risk was discriminated by TG/HDL-c, categorized by the cutoff and evaluated in relation to multiple risks. The magnitude of the association between TG/HDL-c and independent variables was estimated by logistic regression. The significance level of p<0.05 was adopted for all tests. Results The cutoff values of TG/HDL-c (3.26 for men and 2.72 for women) were more sensitive and less specific than those in the literature. Women (OR=1.90 and 95% CI 1.13-3.20) and men (OR=4.58 and 95% CI 1.78-11.76) with multiple risks, and white men, alcohol users, with a history of stroke, had a higher chance of altered GT/HDL-c. Increases in glycosylated hemoglobin, glycemia, and phosphorus in women, and cholesterol, glycemia, and microalbuminuria in men increased the chances of altered TG/HDL-c. Being a former smoker and black reduced the chance of altered TG/HDL-c in women. Conclusions TG/HDL-c proved to be a good indicator for habitual use in Primary Care.

Analysis of the service telessaúde-COVID in a municipality of Minas Gerais. / Análise dos atendimentos realizados pelo telessaúde-COVID em um município de Minas Gerais.

OBJECTIVE: to analyze the sociodemographic and clinical profile of patients treated by the remote care service "Telessaúde-COVID" and the factors associated with positive results for COVID-19. METHODS: an exploratory and analytical study, carried out based on the analysis of patient records treated by a remote care service called "Telessaúde-COVID". Characteristics of the patients treated and variables related to the service's functioning were evaluated. A descriptive, inferential analysis was performed by logistic regression. RESULTS: 1,854 new patients were evaluated and an estimate of 8,630 visits. Female patients were predominant (60.9%), aged between 20 and 59 years (75.9%). The most frequent signs and symptoms were: headache (41.8%), cough (33.3%) and runny nose (30.0%). Of the total number of patients, 66.4% were reported as suspected case of COVID-19 and 14.5% tested positive for COVID-19. The age of 60 years or more was more common among confirmed cases (26.6%). Most patients (80.4%) did not require face-to-face assistance. Confirmed cases of COVID-19 were associated with the age of the patients (OR 1,020; IC95% 1,007 - 1,032); home contact with a confirmed/suspected case (OR 1,902; IC95% 1,178 - 3,070); presence of nausea/vomiting (OR 2,403; IC95% 1,148 - 5,029) and changes in smell (OR 2,827; IC95% 1,294 - 6,176). CONCLUSION: "Telessaúde-COVID" was relevant in the management and notification of cases, avoiding the search for face-to-face consultations without clinical indication. Among the suspected cases, positivity for COVID-19 was associated with aging, history of home contact, gastrointestinal and olfactory symptoms.

OBJETIVOS: Analisar o perfil sociodemográfico e clínico dos pacientes atendidos pelo serviço de atendimento remoto "Telessaúde-COVID" e os fatores associados aos resultados positivos para COVID-19. MÉTODOS: Estudo exploratório e analítico, realizado com base na análise dos registros de pacientes atendidos por um serviço de atendimento remoto intitulado "Telessaúde-COVID". Foram avaliadas características dos pacientes atendidos e variáveis relacionadas ao funcionamento do serviço. Realizou-se análise descritiva e inferencial, com utilização da regressão logística. RESULTADOS: Foram avaliados 1.854 novos pacientes e estimados 8.630 atendimentos. Houve predomínio de pacientes do sexo feminino (60,9%) e da faixa etária de 20 a 59 anos (75,9%). Os sinais e sintomas mais frequentes foram: cefaleia (41,8%), tosse (33,3%) e coriza (30,0%). Do total de pacientes, 66,4% foram notificados como casos suspeitos de COVID-19 e 14,5% apresentaram resultado positivo para COVID-19. A idade igual ou superior a 60 anos foi mais frequente entre os casos confirmados (26,6%). A maioria dos pacientes (80,4%) não necessitou de atendimento presencial. Os resultados positivos para COVID-19 estiveram associados à idade dos pacientes (Odds Ratio - OR 1.020; intervalo de confiança - IC95% 1.007 - 1.032); contato domiciliar com caso positivo ou suspeito (OR 1.902; IC95% 1.178 - 3.070); presença de náuseas/vômitos (OR 2.403; IC95% 1.148 - 5.029) e alterações no olfato (OR 2.827; IC95% 1.294 - 6.176). CONCLUSÕES: O Telessaúde-COVID foi relevante na condução e notificação dos casos atendidos, evitando a procura por consultas presenciais sem indicação clínica. Entre os casos suspeitos, a positividade para COVID-19 associou-se a idosos, história de contato domiciliar, sintomas gastrointestinais e olfatórios.

Sobrevida e funcionalidade em idosos na atenção domiciliar / Survival and functionality in elderly in home care

Com o envelhecimento ocorrem complicações que afetam a funcionalidade e a independência dos indivíduos, muitas vezes sendo necessário o acompanhamento contínuo por profissionais da saúde, entre eles o fisioterapeuta. Diante disso, objetivou-se verificar a sobrevida, a funcionalidade e a ocorrência de comorbidades em indivíduos idosos acompanhados pelo serviço de Fisioterapia domiciliar. Um estudo com delineamento transversal foi realizado com 121participantes de um Serviço de Atenção Domiciliar, utilizando a Karnofsky Performance Scale para verificar a funcionalidade, e o Índice de Comorbidades de Charlson para avaliar as multimorbidades. Constatou-se que aproximadamente metade dos participantes apresentou cronicidade funcional, com condição potencialmente incapacitante, com piora dos índices de funcionalidade em indivíduos que sofreram alguma intercorrência. Os resultados demonstraram também que o acesso à Fisioterapia aumentou a taxa de sobrevida dos idosos e que o acompanhamento fisioterapêutico mais frequente possibilitou que a funcionalidade se mantivesse.

With aging, there are complications affecting the functionality and independence of individuals, often requiring continuous monitoring by health professionals, including the physical therapist. The objective was to analyze survival, functionality and the occurrence of comorbidities in elderly individuals monitored by the home physical therapy service. A cross-sectional study was carried out with 121 participants from a home care service, using the Karnofsky Performance Scale to check functionality, and the Charlson Comorbidity Index to assess multimorbidity. It was found that approximately half of the participants evaluated had functional chronicity, with potentially disabling condition, with worsening of functionality indices in individuals who have suffered some complication. The results also demonstrated that access to physical therapy increased the survival rate of the elderly and that the more frequent physical therapy follow-up enabled the functionality to be maintained.

Sleep quality and its association with menopausal and climacteric symptoms.

OBJECTIVE: to assess sleep quality in menopausal women and its association with symptoms related to this period. METHOD: this is a cross-sectional, analytical and correlational study. Sleep was assessed using the Pittsburgh Sleep Quality Index; and climacteric symptoms, according to the Menopause Rating Scale. To compare the total score and each Menopause Rating Scale domain with the PSQI classification, the Mann-Whitney U non-parametric test was used. P<0.05 was considered significant. RESULTS: 261 women (67.8%) were classified as bad sleepers. There was a positive and significant correlation between the sleep scale scores and the total menopause score and its domains. Women categorized as poor sleepers had worse scores on the menopause symptom scale. CONCLUSION: women with worse sleep quality revealed greater severity of symptoms related to menopause.

In vitro Streptococcus mutans adhesion and biofilm formation on different esthetic orthodontic archwires.

OBJECTIVES: To evaluate the ability of different esthetic archwires to retain oral biofilms in vitro. MATERIALS AND METHODS: Seven different brands of coated orthodontic archwires were tested: two epoxy coated, two polytetrafluoroethylene coated, two rhodium coated, and one silver plus polymer coated. Conventional uncoated metallic archwires were used as controls. Streptococus mutans adherence to archwires was quantified by colony count following 24 hours of biolfilm growth, and total wire-associated biofilm was measured using a crystal violet staining assay. For both tests, two conditions were used: 0% sucrose and 3% sucrose. For statistical analysis, P < .05 was considered as statistically significant. RESULTS: For S. mutans colony forming units per biofilm, there were no statistically significant differences among the various archwires (P = .795 for 0% sucrose; P = .905 for 3% sucrose). Regarding total biofilm formed on archwires in the 3% sucrose condition, there were statistically significant differences in crystal violet staining only for the comparison between Niti Micro Dental White and Copper Ni-Ti wires (P < .05). CONCLUSIONS: The clinical use of esthetic-coated orthodontic wires may be considered to have similar risks as uncoated archwires for biofilm retention.

Impactos del cuidado de personas con cáncer en la vida del cuidador y la dinámica familiar / Impacts of Caring for Persons with Cancer on the Caregiver and Family Dynamics

Introducción: La existencia de un paciente con cáncer en el seno de la familia implica varios retos y conduce a una necesidad de reorganización de toda la familia para la prestación de cuidados a este individuo, dejando, a veces, de cuidar de sí mismo, generando nuevas demandas a menudo descuidadas. Objetivo: Comprender, desde la perspectiva de los familiares cuidadores, cómo el proceso de cuidar de la persona con cáncer impacta en la vida del cuidador y la dinámica familiar. Métodos: Estudio descriptivo y exploratorio, con enfoque cualitativo realizado con los familiares cuidadores de personas con cáncer de la ciudad de Viçosa, Minas Gerais, Brasil, desde diciembre de 2016 hasta enero de 2017. La recopilación de datos se realizó con 7 cuidadores familiares, por medio de una guía con preguntas abiertas, estructurada sobre la base de la escala de Zarit, que se interrumpió cuando hubo la saturación de los datos. El análisis se realizó mediante la técnica de análisis de contenido. Resultados: Los familiares cuidadores mostraron alteraciones en las necesidades humanas básicas relacionadas con los dominios: psicobiológico, psicosocial y psicoespiritual. Tales aspectos orientan las acciones de los profesionales de salud y validan la importancia de una asistencia holística y humanitaria para el cuidador, que también necesita de cuidados. Conclusiones: Los profesionales de enfermería deben actuar en la planificación de acciones que se centran en el apoyo educativo, psicológico, humanizado, empático e integral y en la promoción de la salud, agregados al plan de atención el núcleo familiar, a fin de minimizar el desgaste físico, psicológico y social del cuidador(AU)

Introduction: The existence of a cancer patient within any family implies several challenges and leads to a necessity for reorganization of the whole family in order to provide care for this individual, sometimes ceasing to take care of themselves and generating new demands, often neglected. Objective: To understand, from the perspective of family caregivers, how the process of caring for the person with cancer impacts the caregiver's life and family dynamics. Methods: Descriptive and exploratory study, with a qualitative approach, carried out, from December 2016 to January 2017, with family caregivers of people with cancer, in Viçosa City, Minas Gerais, Brazil. Data collection was carried out with seven family caregivers, using a guide with open questions and structured on the basis of the Zarit scale, which was interrupted when the data was saturated. The analysis was carried out using the content analysis technique. Results: Family caregivers showed alterations in basic human needs related to the psychobiological, psychosocial and psychospiritual domains. Such aspects guide the actions of health professionals and validate the importance of holistic and humanitarian assistance for the caregiver, who also needs care. Conclusions: Nursing professionals must act in planning actions that focus on educational, psychological, humanized, empathic and comprehensive support and health promotion, added to the family nucleus care plan, in order to minimize the physical, psychological and social exhaustion of the caregiver(AU)

ANALYSIS OF THE SERVICE PERFORMED BY TELESAÚDE-COVID IN A MUNICIPALITY OF MINAS GERAIS / ANÁLISE DOS ATENDIMENTOS REALIZADOS PELO TELESSAÚDE-COVID EM UM MUNICÍPIO DE MINAS GERAIS

Objective: to analyze the sociodemographic and clinical profile of patients treated by the remote care service "Telessaúde-COVID" and the factors associated with positive results for COVID-19. Methods: an exploratory and analytical study, carried out based on the analysis of patient records treated by a remote care service called "Telessaúde-COVID". Characteristics of the patients treated and variables related to the service's functioning were evaluated. Descriptive and inferential analysis was performed, using logistic regression. Results: 1,854 new patients were evaluated and an estimated 8,630 visits. There was a predominance of female patients (60.9%) and aged 20 to 59 years (75.9%). The most frequent signs and symptoms were: headache (41.8%), cough (33.3%) and runny nose (30.0%). Of the total number of patients, 66.4% were reported as suspected cases of COVID-19 and 14.5% had a positive result for COVID-19. The age of 60 years or more was more frequent among confirmed cases (26.6%). Most patients (80.4%) did not require face-to-face assistance. The positive results for COVID-19 were associated with the age of the patients (OR 1,020; I.C.95% 1,007-1,032); home contact with a positive/suspected case (OR 1,902; I.C95% 1,178 - 3,070); presence of nausea/vomiting (OR 2,403; I.C.95% 1,148 - 5,029) and changes in smell (OR 2,827; I.C.95% 1,294-6,176). Conclusion:  Telehealth-COVID was relevant in the management and notification of cases attended, avoiding the search for face-to-face consultations without clinical indication. Among the suspected cases, positivity for COVID-19 was associated with the elderly, history of home contact, gastrointestinal and olfactory symptoms.

Objetivos: analisar o perfil sociodemográfico e clínico dos pacientes atendidos pelo serviço de atendimento remoto "Telessaúde-COVID" e os fatores associados aos resultados positivos para COVID-19. Métodos: estudo exploratório e analítico, realizado a partir da análise dos registros de pacientes atendidos por um serviço de atendimento remoto intitulado "Telessaúde-COVID". Foram avaliadas características dos pacientes atendidos e variáveis relacionadas ao funcionamento do serviço. Realizou-se análise descritiva e inferencial, com utilização da regressão logística. Resultados: foram avaliados 1.854 novos pacientes e estimados 8.630 atendimentos. Houve predomínio de pacientes do sexo feminino (60,9%) e da faixa etária de 20 a 59 anos (75,9%).  Os sinais e sintomas mais frequentes foram: cefaleia (41,8%), tosse (33,3%) e coriza (30,0%). Do total de pacientes, 66,4% foram notificados como casos suspeitos de COVID-19 e 14,5% apresentaram resultado positivo para COVID-19. A idade igual ou superior a 60 anos foi mais frequente entre os casos confirmados (26,6%). A maioria dos pacientes (80,4%) não necessitou de atendimento presencial. Os resultados positivos para COVID-19 estiveram associados à idade dos pacientes (OR 1.020; I.C.95% 1.007-1.032); contato domiciliar com caso positivo ou suspeito (OR 1.902; I.C95% 1.178 ­ 3.070); presença de náuseas/vômitos (OR 2.403; I.C.95% 1.148 ­ 5.029) e alterações no olfato (OR 2.827; I.C.95% 1.294-6.176). Conclusões: o Telessaúde-COVID foi relevante na condução e notificação dos casos atendidos, evitando a procura por consultas presenciais sem indicação clínica. Dentre os casos suspeitos, a positividade para COVID-19 associou-se aos idosos, história de contato domiciliar, sintomas gastrointestinais e olfatórios.

Os nós críticos do processo de trabalho na Atenção Primária à Saúde: uma pesquisa-ação / The critical nodes of the work process in Primary Health Care: an action research

Resumo Pesquisa qualitativa com abordagem da pesquisa-ação cujo objetivo foi identificar os nós críticos inscritos no processo de trabalho da Atenção Primária à Saúde (APS). Participaram 44 profissionais/gestores da APS de um município do interior de Minas Gerais. A coleta de dados ocorreu de junho a dezembro de 2019, por meio da técnica de observação participante e, posteriormente, de oficinas. Os dados foram analisados a partir da técnica de Análise de Conteúdo de Bardin e sob a perspectiva dos referenciais teóricos de Rudimar Baldissera e Paulo Freire. Na análise, emergiram cinco categorias, que expressaram os nós críticos identificados na observação participante e validados pelos profissionais nas oficinas: ambiência, comunicação, educação permanente, planejamento e identidade profissional. Esta pesquisa sinaliza a importância do diálogo e da reflexão crítica das práticas de saúde como instrumentos de transformação do processo de trabalho em saúde.

Abstract Qualitative research with an action research approach whose objective was to identify the critical nodes enrolled in the Primary Health Care (PHC) work process. Forty-four PHC professionals / managers from a municipality in the interior of Minas Gerais participated. Data collection took place from June to December 2019, using the participant observation technique and later through workshops with the participants. The data were analyzed using Bardin's Content Analysis technique and from the perspective of the theoretical frameworks of Rudimar Baldissera and Paulo Freire. The analysis allowed the emergence of five categories, which expressed the critical nodes identified in the participant observation and validated by the professionals in the workshops: ambience, communication, continuing education, planning and professional identity. This research signals the importance of dialogue as an instrument of transformation within the health work process.

Ultrasonic therapy modulates the expression of genes related to neovascularization and inflammation in fibroblasts / Terapia ultrassônica modula a expressão de genes relacionados à neovascularização e inflamação em fibroblastos

Abstract Introduction: In the rehabilitation of musculoskeletal injuries, ultrasound is widely used in clinical practice. Objective: To evaluate the effects of pulsed ultrasonic therapy on the viability and modulation of genes involved in inflammation (IL-6) and neovascularization (VEGF) processes of L929 fibroblast cells. Methods: For irradiation with ultrasound the cells were subdivided into groups: G1 (without irradiation), G2 (0.3 W/cm2-20%) and G3 (0.6 W/cm2-20%), with periods of treatment at 24, 48 and 72 hours. The cell viability assay was analyzed by the MTT method and gene modulation was analyzed by RT-qPCR method. Results: After the comparative analysis between groups, only G2 and G3 (48-hour) presented statistically significant differences in relation to the control. In relation to the gene expression, the selection of the groups analyzed was delimited according to the comparative analysis of the values obtained by the MTT test. After the achievement of RT-qPCR, it could be observed that in G2 the amount of VEGF gene transcripts increased by 1.125-fold compared to endogenous controls, and increased 1.388-fold in G3. The IL-6 gene, on the other hand, had its transcripts reduced in both G2 (5.64x10-9) and G3 (1.91x10-6). Conclusion: Pulsed ultrasound in L929 fibroblasts showed a significant biostimulatory effect in the 48-hour period, with increased cell viability, and the same effect in the modulation of gene expression related the neovascularization and inflammation, mediating the acceleration of the tissue repair cascade.

Resumo Introdução: Na reabilitação de lesões musculoesqueléticas, o ultrassom é amplamente utilizado na prática clínica. Objetivo: Avaliar os efeitos da terapia ultrassônica pulsada sobre a viabilidade e modulação de genes envolvidos nos processos de inflamação (IL-6) e neovascularização (VEGF) de fibroblastos L929. Métodos: Para irradiação com ultrassom, as células foram subdivididas em grupos: G1 (sem irradiação), G2 (0,3 W/cm2-20%) e G3 (0,6 W/cm2-20%), com períodos de tratamento de 24, 48 e 72 horas. O ensaio de viabilidade celular foi analisado pelo método MTT e a modulação gênica pelo método RT-qPCR. Resultados: Após a análise comparativa entre os grupos, apenas G2 e G3 (48 horas) apresentaram diferenças estatisticamente significantes em relação ao controle. Em relação à expressão gênica, a seleção dos grupos analisados ​​foi delimitada de acordo com a análise comparativa dos valores obtidos pelo teste MTT. Após a obtenção do RT-qPCR, pôde-se observar que no G2 a quantidade de transcritos do gene VEGF aumentou 1,125 vezes em relação aos controles endógenos e 1,388 vezes no G3. O gene IL-6, por outro lado, teve seus transcritos reduzidos tanto no G2 (5,64x10-9) quanto no G3 (1,91x10-6). Conclusão: O ultrassom pulsado em fibroblastos L929 apresentou efeito bioestimulador significativo no período de 48 horas, com aumento da viabilidade celular, e o mesmo efeito na modulação da expressão gênica relacionou neovascularização e inflamação, mediando a aceleração da cascata de reparação de tecidos.

Sleep quality and its association with menopausal and climacteric symptoms / Calidad del sueño y su asociación con síntomas menopáusicos y climatéricos / Qualidade do sono e sua associação com os sintomas de menopausa e climatério

ABSTRACT Objective: to assess sleep quality in menopausal women and its association with symptoms related to this period. Method: this is a cross-sectional, analytical and correlational study. Sleep was assessed using the Pittsburgh Sleep Quality Index; and climacteric symptoms, according to the Menopause Rating Scale. To compare the total score and each Menopause Rating Scale domain with the PSQI classification, the Mann-Whitney U non-parametric test was used. P<0.05 was considered significant. Results: 261 women (67.8%) were classified as bad sleepers. There was a positive and significant correlation between the sleep scale scores and the total menopause score and its domains. Women categorized as poor sleepers had worse scores on the menopause symptom scale. Conclusion: women with worse sleep quality revealed greater severity of symptoms related to menopause.

RESUMEN Objetivo: evaluar la calidad del sueño en mujeres menopáusicas y su asociación con síntomas relacionados con este período. Método: estudio transversal, analítico y correlacional. El sueño se evaluó mediante el índice de calidad del sueño de Pittsburgh; y síntomas climatéricos, según la escala de calificación de la menopausia. Para comparar la puntuación total y cada dominio Menopause Rating Scale con la clasificación PSQI, se utilizó la prueba no paramétrica U de Mann-Whitnney. P <0,05 se consideró significativo. Resultados: 261 mujeres (67,8%) fueron clasificadas como mal durmientes. Hubo una correlación positiva y significativa entre las puntuaciones de la escala de sueño y la puntuación total de la menopausia y sus dominios. Las mujeres clasificadas como personas que duermen mal tuvieron peores puntuaciones en la escala de síntomas de la menopausia. Conclusión: las mujeres con peor calidad del sueño revelaron una mayor gravedad de los síntomas relacionados con la menopausia.

RESUMO Objetivo: Avaliar a qualidade do sono em mulheres menopausadas e sua associação com os sintomas relacionados a esse período. Método: Estudo transversal, analítico e correlacional. O sono foi avaliado por meio do Índice de Qualidade do Sono de Pittsburgh; e os sintomas do climatério, pelo Menopause Rating Scale. Para a comparação do escore total e de cada domínio do Menopause Rating Scale com a classificação do Índice de Qualidade do Sono de Pittsburgh (PSQI), foi utilizado o teste não paramétrico U de Mann-Whitney. Considerou-se valor p<0,05 como significante. Resultados: Foram classificadas 261 mulheres (67,8%) como más dormidoras. Houve correlação positiva e significativa dos escores da escala do sono com o escore total da menopausa e seus domínios. As mulheres categorizadas como más dormidoras apresentaram piores escores na escala de sintomas de menopausa. Conclusão: Mulheres com pior qualidade do sono revelaram maior severidade dos sintomas relacionados à menopausa.

Análise dos atendimentos realizados pelo telessaúde-COVID em um município de Minas Gerais / Analysis of the service telessaúde-COVID in a municipality of Minas Gerais

RESUMO: Objetivos: Analisar o perfil sociodemográfico e clínico dos pacientes atendidos pelo serviço de atendimento remoto "Telessaúde-COVID" e os fatores associados aos resultados positivos para COVID-19. Métodos: Estudo exploratório e analítico, realizado com base na análise dos registros de pacientes atendidos por um serviço de atendimento remoto intitulado "Telessaúde-COVID". Foram avaliadas características dos pacientes atendidos e variáveis relacionadas ao funcionamento do serviço. Realizou-se análise descritiva e inferencial, com utilização da regressão logística. Resultados: Foram avaliados 1.854 novos pacientes e estimados 8.630 atendimentos. Houve predomínio de pacientes do sexo feminino (60,9%) e da faixa etária de 20 a 59 anos (75,9%). Os sinais e sintomas mais frequentes foram: cefaleia (41,8%), tosse (33,3%) e coriza (30,0%). Do total de pacientes, 66,4% foram notificados como casos suspeitos de COVID-19 e 14,5% apresentaram resultado positivo para COVID-19. A idade igual ou superior a 60 anos foi mais frequente entre os casos confirmados (26,6%). A maioria dos pacientes (80,4%) não necessitou de atendimento presencial. Os resultados positivos para COVID-19 estiveram associados à idade dos pacientes (Odds Ratio - OR 1.020; intervalo de confiança - IC95% 1.007 - 1.032); contato domiciliar com caso positivo ou suspeito (OR 1.902; IC95% 1.178 - 3.070); presença de náuseas/vômitos (OR 2.403; IC95% 1.148 - 5.029) e alterações no olfato (OR 2.827; IC95% 1.294 - 6.176). Conclusões: O Telessaúde-COVID foi relevante na condução e notificação dos casos atendidos, evitando a procura por consultas presenciais sem indicação clínica. Entre os casos suspeitos, a positividade para COVID-19 associou-se a idosos, história de contato domiciliar, sintomas gastrointestinais e olfatórios.

ABSTRACT: Objective: to analyze the sociodemographic and clinical profile of patients treated by the remote care service "Telessaúde-COVID" and the factors associated with positive results for COVID-19. Methods: an exploratory and analytical study, carried out based on the analysis of patient records treated by a remote care service called "Telessaúde-COVID". Characteristics of the patients treated and variables related to the service's functioning were evaluated. A descriptive, inferential analysis was performed by logistic regression. Results: 1,854 new patients were evaluated and an estimate of 8,630 visits. Female patients were predominant (60.9%), aged between 20 and 59 years (75.9%). The most frequent signs and symptoms were: headache (41.8%), cough (33.3%) and runny nose (30.0%). Of the total number of patients, 66.4% were reported as suspected case of COVID-19 and 14.5% tested positive for COVID-19. The age of 60 years or more was more common among confirmed cases (26.6%). Most patients (80.4%) did not require face-to-face assistance. Confirmed cases of COVID-19 were associated with the age of the patients (OR 1,020; IC95% 1,007 - 1,032); home contact with a confirmed/suspected case (OR 1,902; IC95% 1,178 - 3,070); presence of nausea/vomiting (OR 2,403; IC95% 1,148 - 5,029) and changes in smell (OR 2,827; IC95% 1,294 - 6,176). Conclusion: "Telessaúde-COVID" was relevant in the management and notification of cases, avoiding the search for face-to-face consultations without clinical indication. Among the suspected cases, positivity for COVID-19 was associated with aging, history of home contact, gastrointestinal and olfactory symptoms.

Acute Changes in Interleukin-6 Level During Four Days of Long-Distance Walking.

BACKGROUND: Interleukin 6 (IL-6) has an inflammatory effect, and its concentration in serum increases during exercise. However, no studies have assessed acute changes in IL-6 concentration after consecutive days of extreme and long-term exercise. OBJECTIVE: This study aimed to assess acute changes in serum IL-6 concentration during four days of long-distance walking. METHODS: This prospective observational study assessed 25 athletes (aged 44.8 ± 9.1 years), who covered a total of 251 km in four days. Blood samples were collected daily to assess serum IL-6 concentrations. Repeated-measures analysis of variance (with Bonferroni's post hoc test) and the Kruskal-Wallis H-test (with Dunn's post hoc test) were used to investigate the differences between the measures. RESULTS: The serum IL-6 concentrations were higher on the four days of walking (1st day: 26.8 ± 14.8; 2nd day: 14 ± 7.4; 3rd day: 9.4 ± 10.8; 4th day: 4.5 ± 0.2 pg/mL) when compared to pre-walk values (pre-walk: 2.2 ± 2.1 pg/mL; p < 0.001). On the first day, there was a tenfold increase compared to the pre-walk value. CONCLUSION: The inflammatory response increased the serum concentration of IL-6 after four days of exercise. With the passing of days, there were reductions but not to baseline values.

Experiences and expectations of obese older people on the care received in the primary health care network.

OBJECTIVE: to understand the experiences and expectations of obese elderly people on the care they received in the primary health care network. METHODS: phenomenological study, in which 16 obese elderly people living in a municipality in the state of Minas Gerais, Brazil, were interviewed. Their statements were organized into categories and analyzed according to Alfred Schütz's social phenomenology and thematic literature. RESULTS: the following categories emerged: "Care neglected to obese elderly people in the primary health care network", "Group activities as a way to provide primary health care to obese elderly people: a present past", and "Qualified longitudinal care, centered in the needs of obese elderly people". FINAL CONSIDERATIONS: offering comprehensive and longitudinal primary health care to obese older people was difficult, and there was instability in the consolidation of public policies, which pointed out the need for effective bonds between different healthcare network services and between professionals and users.

The health care experience of individuals with morbid obesity assisted in public healthcare services.

OBJECTIVE: To understand the health care experience of individuals with morbid obesity assisted in public healthcare services. METHOD: This was a qualitative study based on Alfred Schütz's social phenomenology, carried out in the medical-surgical clinic of a public hospital in São Paulo, Brazil. Interviews with open questions were conducted between January and April 2017. RESULTS: Seventeen individuals with morbid obesity participated in the study. The findings revealed care(lessness) experiences of obese individuals in the Brazilian Healthcare System in terms of structure/logistics and human resources. Study participants shared care expectations about health care management and staff, and further considered the Primary Health Care service as a scenario of power to have their obesity-related care needs met. CONCLUSION: The findings need to be carefully (re)examined by the healthcare system's micro- and macro management, as well as by health teaching and research personnel, in order to integrate, follow up and qualify care actions towards the prevention and control of obesity in public healthcare services.