Cancer-Related Neuropathic Pain, Chemotherapy-Induced Peripheral Neuropathy and Cognitive Decline in a 5-Year Prospective Study of Patients with Breast Cancer-NEON-BC.

This study aims to estimate the prevalence and to identify the determinants of cancer-related neuropathic pain (CRNP), chemotherapy-induced peripheral neuropathy (CIPN) and cognitive decline among patients with breast cancer over five years after diagnosis. Women with an incident breast cancer (n = 462) and proposed for surgery were recruited at the Portuguese Institute of Oncology-Porto in 2012 and underwent systematic neurological examinations and evaluations with the Montreal Cognitive Assessment (MoCA) before treatment and after one, three, and five years. Multivariate logistic regression was used to assess the determinants of CRNP and CIPN, and multivariate linear regression for the variation in MoCA scores. Prevalence of CRNP and CIPN decreased from the first to the fifth year after diagnosis (CRNP: from 21.1% to 16.2%, p = 0.018; CIPN: from 22.0% to 16.0% among those undergoing chemotherapy, p = 0.007). Cognitive impairment was observed in at least one assessment in 17.7% of the women. Statistically significant associations were observed between: cancer stage III and both CRNP and CIPN; triple negative breast cancer, chemotherapy, axillary node dissection, older age, higher education, and being single and CRNP; taxanes and fruit and vegetable consumption and CIPN. Anxiety, depression and poor sleep quality at baseline were associated with decreases in MoCA values from pre- to post-treatment and with CRNP. Follow-up protocols should consider the persistence of CRNP, CIPN, and cognitive impairment for several years following diagnosis.

Ensino e pesquisa em saúde mental na atenção básica: Portfólio de Práticas Inspiradoras em Atenção Psicossocial / Mental Health teaching and research in primary care: Portfolio of Inspiring Practices in Psychosocial Care / Enseñanza e investigación en salud mental en atención primaria: Portafolio de Prácticas Inspiradoras en Atención Psicosocial

Resumo Neste artigo, discutimos o processo de trabalho da pesquisa, a metodologia participativa e colaborativa para a construção do site para uso ampliado na Atenção, Ensino e Pesquisa nos campos da Saúde Mental Atenção Básica, o qual intitulamos 'Portfólio de Práticas Inspiradoras em Atenção Psicossocial', bem como as ações em curso para sua gestão compartilhada. O conjunto da pesquisa analisou, sistematizou e categorizou práticas na atenção básica e espaços comunitários, construindo mecanismos de busca e disseminação científica para experiências inovadoras e inspiradoras em todo o país, no período de 2015 a 2020. O site dá visibilidade e relevância às abordagens psicossociais de acolhimento, cuidado e potencialização da vida presentes no Sistema Único de Saúde. Experiências alternativas ao modelo biomédico, base para uma perspectiva interdisciplinar e desinstitucionalizante de Saúde Mental na Atenção Básica.

Abstract In this article, we discuss the working process of the research, the participatory and collaborative methodology for the construction of the website for expanded use in Care, Teaching and Research in the fields of Mental Health Primary Care, which we titled 'Portfolio of Inspiring Practices in Psychosocial care', as well as the ongoing actions for its shared management. The whole research analyzed, systematized and categorized practices in primary care and community spaces, building search engines and scientific dissemination for innovative and inspiring experiences throughout the country, in the period from 2015 to 2020. The website gives visibility and relevance to the psychosocial approaches of reception, care and enhancement of life present in the Unified Health System. Alternative experiences to the biomedical model, the basis for an interdisciplinary and deinstitutionalizing perspective of Mental Health in Primary Care.

Resumen En este artículo discutimos el proceso de trabajo de la investigación, la metodología participativa y colaborativa para la construcción del site de uso ampliado en la Atención, Enseñanza e Investigación en los campos de la Atención Primaria de Salud Mental, que denominamos 'Portafolio de Prácticas Inspiradoras en Atención Psicosocial', así como las acciones en curso para su gestión compartida. El conjunto de investigación analizó, sistematizó y categorizó prácticas en la atención primaria y en los espacios comunitarios, construyendo mecanismos de búsqueda y divulgación científica de experiencias innovadoras e inspiradoras en todo el país, de 2015 a 2020. El site confere visibilidad y relevancia a los enfoques psicosociales de acogida, cuidado y potenciación de vida presentes en el Sistema Único de Salud. Experiencias alternativas al modelo biomédico, base para una perspectiva interdisciplinar y desinstitucionalizadora de la Salud Mental en Atención Primaria.

Anxiety and Depression in Patients with Prostate Cancer, at Cancer Diagnosis and after a One-Year Follow-Up.

Prostate cancer (PCa) is the most prevalent among men, and psychological symptoms may affect many patients. This study aims to describe the prevalence of probable anxiety and depression before PCa treatments and after one year and to identify sociodemographic and clinical factors associated with these outcomes. Between February 2018 and March 2020, 292 patients recently diagnosed with PCa were recruited at the Instituto Português de Oncologia-Porto. The Hospital Anxiety and Depression Scale (HADS) was used to define probable anxiety and depression (cutoff = 11). The prevalence of probable anxiety remained stable from baseline to one year (7.8% vs. 8.5%, p = 0.866) while there was an increase in probable depression (3.1% vs. 6.8%, p = 0.012). After one year, probable depression persisted in 55.6% of patients with probable depression at baseline and 47.8% of those with probable anxiety at the first assessment had normal anxiety scores. At baseline, anxiety was more frequent among dwellers in rural areas (adjusted odds ratio-aOR, 95%CI: 2.80, 0.91-8.58) and less frequent in patients with body mass index 25-29.9 kg/m2 (aOR, 95%CI: 0.33, 0.12-0.91) compared to 18.5-24.9 Kg/m2, while those living alone had higher odds of depression (aOR, 95%CI: 6.35, 1.43-28.30). The frequency of anxiety and depression fluctuated during the course of treatment. Monitoring these symptoms would identify the most affected patients, contributing for a better use of mental health services.

Trajectories of Anxiety and Depression Symptoms over Five Years since Breast Cancer Diagnosis: Results of the NEON-BC Prospective Study.

Anxiety and depression symptoms are frequent among patients with breast cancer (BCa) and may last after initial treatments. We aimed to identify five-year trajectories of anxiety and depression symptoms among women with BCa. Neuro-oncological complications of BCa (NEON-BC) cohort included 506 patients admitted at the Portuguese Institute of Oncology of Porto in 2012, who were evaluated with the Hospital Anxiety and Depression Scale before cancer treatment and after one, three, and five years (7.9% attrition rate). Mixed-effect models were used to model anxiety and depression scores over time and model-based clustering to identify the different trajectories. Three trajectories of anxiety symptoms were identified: (1) high scores at baseline and increasing over time (21.7%); (2) consistently low scores over time (63.6%); (3) mid-range scores at baseline, decreasing over time (14.6%). Three trajectories were identified for depression symptoms: (1) high scores at baseline and increasing over time (21.1%); (2) mid-range scores at baseline, which decreased afterward (58.7%); (3) consistently low levels over time (20.2%). Age, education, baseline, and one-year anxiety/depression status predicted the worst five-year trajectories. These results show that assessing anxiety and depression symptoms before treatment and after one year may contribute to identifying the patients who could benefit the most from psychological support.

Prevalence of Cognitive Impairment before Prostate Cancer Treatment.

Cognitive impairment is common among patients with different types of cancer, even before cancer treatment, but no data were reported among patients with prostate cancer (PCa), who may be at high risk due to advanced age. This study aims to estimate the prevalence of cognitive impairment before PCa treatment. Between February 2018 and April 2021, the NEON-PC cohort recruited 605 patients with PCa proposed for treatment at the Portuguese Institute of Oncology of Porto. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive performance. Participants with a MoCA < 1.5 standard deviations (SD) of age- and education-specific normative values were considered to have probable cognitive impairment (PCI) and were referred for a comprehensive neuropsychological assessment. Data from the population-based cohort EPIPorto (n = 351 men aged ≥40 years, evaluated in 2013−2015) were used for comparison. The prevalence of PCI was 17.4% in EPIPorto and 14.7% in NEON-PC (age- and education-adjusted odds ratio: 0.82, 95%CI: 0.58,1.18). Neuropsychological assessment was performed in 63 patients with PCa: 54.0% had cognitive impairment. These results suggest that the impact of PCa on cognitive performance could be negligible in the short term, contrary to what other studies have reported regarding other types of cancer.

Prevalence and Persistence of Anxiety and Depression over Five Years since Breast Cancer Diagnosis-The NEON-BC Prospective Study.

Anxiety and depression are frequent among patients with breast cancer (BCa). Evidence of the persistence and recovery from these conditions and their determinants is scarce. We describe the occurrence of clinically significant anxiety and depression symptoms and their associated factors among BCa patients. A total of 506 women admitted in 2012 at the Portuguese Institute of Oncology of Porto were evaluated before treatment and after one, three, and five years (7.9% attrition rate). The five-year prevalence of anxiety and/or depression (Hospital Anxiety and Depression Scale, subscores ≥ 11) was 55.4%. The peak prevalence for anxiety was before treatment (38.0%), and after one year for depression (13.1%). One in five patients with anxiety/depression at baseline had persistent anxiety/depression over time, while only 11% and 22% recovered permanently from anxiety and depression, respectively, during the first year. Higher education, higher income, practicing physical activity, and adequate fruit and vegetable intake were protective factors against anxiety and/or depression. Loss of job and income, anxiolytics and antidepressants, cancer-related neuropathic pain, and mastectomy were associated with higher odds of anxiety and/or depression. These results highlight the importance of monitoring anxiety/depression during the first five years after cancer diagnosis and identify factors associated with these conditions.

Horticultural performance of 'Fuji Suprema' and 'Maxi Gala' apple trees trained at Tall Spindle and Bi-Axis systems grafted on different rootstocks in Southern Brazil / Comportamento agronômico de macieiras 'Fuji Suprema' e 'Maxi Gala' conduzidas em Tall Spindle e Bi-Axis enxertadas em diferentes porta-enxertos no Sul do Brasil

The use of new rootstocks combined with different training systems have been studied to increase productivity, fruit quality, and reduce costs. Another important factor is the validation of studies under replanting conditions, due to the growing limitation of new areas for planting commercial apple orchards in Brazil. The present study aimed to evaluate the behavior of 'Fuji Suprema' and 'Maxi Gala' apple trees in two training systems grafted on two rootstocks. The study occurred during the seasons 2016/17, 2017/18 and 2018/19, in an orchard located in southern Brazil in an area previously cultivated with apple trees. A randomized block design consisting of a 2x2 factorial was used, with Tall Spindle and Bi-Axis as the training system and 'M.9' and 'G.213' as rootstocks of Fuji Suprema and Maxi Gala cultivars. Variables were evaluated to determine tree vigor, as well as yield and fruit quality characteristics. It was observed that 'G.213' promoted higher vigor for both cultivars as well as the Bi-Axis training system in the Maxi Gala cultivar. The highest yield was observed in Tall Spindle as well as the rootstock 'G.213' in both cultivars. The most significant changes on fruit quality occurred in the Bi-Axis training system, presenting higher intensity of red color as well as 'Maxi Gala' grafted on 'G.213' rootstock.

A utilização de novos porta-enxertos e diferentes sistemas de condução tem sido estudado para aumentar a produtividade, qualidade dos frutos e reduzir custos. Outro fator importante é a validação de estudos em condições de replantio, devido à crescente limitação de novas áreas para o plantio comercial de pomares de macieiras no Brasil. O presente estudo teve como objetivo avaliar o comportamento de macieiras 'Fuji Suprema' e 'Maxi Gala' em dois sistemas de condução enxertados sobre dois porta-enxertos. O estudo ocorreu durante as safras 2016/17, 2017/18 e 2018/19, em um pomar localizado no sul do Brasil, em área previamente cultivada com macieiras. Utilizou-se delineamento de blocos casualizados, consistindo em um fatorial 2x2, sendo Tall Spindle e Bi-Axis como sistemas de condução e 'M.9' e 'G.213' como porta-enxertos das cultivares Fuji Suprema e Maxi Gala. Foram avaliadas variáveis para determinar o comportamento vegetativo, bem como as características de produtividade e qualidade dos frutos. Observou-se que 'G.213' promoveu maior vigor para ambas cultivares, assim como o sistema de condução Bi-Axis na cultivar Maxi Gala. O maior rendimento foi observado nas macieiras conduzidas em Tall Spindle e enxertadas sobre 'G.213' em ambas cultivares. As mudanças mais significativas na qualidade dos frutos ocorreram nas macieiras conduzidas em Bi-Axis, apresentando maior intensidade de coloração vermelha, assim como na macieira 'Maxi Gala' enxertada sobre 'G.213'.

Percepciones sobre envejecimiento satisfactorio desde la vivencia de las personas mayores que viven en comunidad / Perceptions of successful aging from the experience of the elderly living in community

OBJETIVO: Conocer e interpretar las experiencias y los significados que las personas mayores que viven en comunidad atribuyen al envejecimiento satisfactorio. MÉTODO: Investigación cualitativa, con enfoque hermenéutico dialéctico de George Gadamer, realizada en zona metropolitana de Uruguay, años 2015-2016; participaron 23 personas mayores. RESULTADOS: se identificaron las categorías conciencia histórica con tres subcategorías: familia, sociedad y estado en el que vivimos, y categoría carga de la tradición con dos subcategorías: juicios y límites. CONCLUSIONES: se logró conocer las percepciones sobre envejecimiento satisfactorio desde las vivencias de personas mayores, enfatizando en las relaciones familiares como pilar fundamental de sostén para mantenerse activos y saludables. Es importante la promoción de la salud. Las personas mayores tienen un cuerpo que sufre dolencias; manteniéndose en actividad, son personas con salud mental, ya que ellos manifiestan que mientras la mente anda, todo puede salir bien. La expectativa se centra en ser resiliente, siendo este el punto principal de seguir día a día en el camino

OBJECTIVE: To know and interpret the experiences and meanings attributed by elderly people living in community to satisfactory aging. METHOD: qualitative research, with a dialectical hermeneutic approach by George Gadamer, carried out in the metropolitan area of Uruguay, 2015-2016; 23 elderly people participated. RESULTS: categories were identified: historical awareness with three subcategories: family, society and state in which we live; another category carries the tradition with two subcategories: judgments and limits. CONCLUSIONS: it was possible to know the perceptions of successful aging from the experiences of older people, emphasizing family relationships as a fundamental pillar of support to stay active and healthy; health promotion is important, older people have a body that suffers ailments, staying active, they are people with mental health, since they referenced that while the mind walks everything can go well. The expectation is focused on being resilient, this being the main point to follow day by day along the way

BIRTH WEIGHT, WEIGHT GAIN, AND OBESITY AMONG CHILDREN IN URUGUAY: A PROSPECTIVE STUDY SINCE BIRTH.

OBJECTIVE: To examine the effect of birth weight and subsequent weight gain on children being overweight and obese in serial assessments of Uruguayan children living at urban areas. METHODS: We used secondary data of pediatric anthropometric measurements and health and socioeconomic characteristics of families that were included in a longitudinal and prospective nationally representative survey ("Encuesta de Nutrición, Desarrollo Infantil y Salud"). The associations of conditional weight gain, being overweight and obesity were tested through correlation coefficients. Multivariate binary logistic regression models were performed to calculate the effect of birth weight on childhood obesity and were adjusted for covariates. RESULTS: For macrosomic babies, there was an increase in the prevalence of overweight and obesity in 70% compared with non-macrosomic babies, when we adjusted for sex, exclusive breastfeeding duration, and household income. The correlation between weight gain and the body mass index for age indicated that the greatest (positive) difference in Z score between measurements increased the obesity levels. CONCLUSIONS: Our findings suggest that ensuring optimal birth weight and monitoring and controlling posterior weight gain represent the first steps toward primary prevention of childhood obesity.

Birth weight, weight gain, and obesity among children in uruguay: a prospective study since birth / Peso ao nascer, ganho ponderal e obesidade em crianças no uruguai: estudo prospectivo desde

ABSTRACT Objective: To examine the effect of birth weight and subsequent weight gain on children being overweight and obese in serial assessments of Uruguayan children living at urban areas. Methods: We used secondary data of pediatric anthropometric measurements and health and socioeconomic characteristics of families that were included in a longitudinal and prospective nationally representative survey ("Encuesta de Nutrición, Desarrollo Infantil y Salud"). The associations of conditional weight gain, being overweight and obesity were tested through correlation coefficients. Multivariate binary logistic regression models were performed to calculate the effect of birth weight on childhood obesity and were adjusted for covariates. Results: For macrosomic babies, there was an increase in the prevalence of overweight and obesity in 70% compared with non-macrosomic babies, when we adjusted for sex, exclusive breastfeeding duration, and household income. The correlation between weight gain and the body mass index for age indicated that the greatest (positive) difference in Z score between measurements increased the obesity levels. Conclusions: Our findings suggest that ensuring optimal birth weight and monitoring and controlling posterior weight gain represent the first steps toward primary prevention of childhood obesity.

RESUMO Objetivo: Analisar o efeito do peso ao nascer e do ganho ponderal subsequente em crianças com sobrepeso e obesidade com base em avaliações consecutivas de crianças uruguaias vivendo em áreas urbanas. Métodos: Foram utilizados dados secundários de medidas antropométricas pediátricas, além de características de saúde e socioeconômicas de famílias incluídas em um inquérito prospectivo e longitudinal de representatividade nacional ("Encuesta de Nutrición, Desarrollo Infantil y Salud"). As associações entre ganho ponderal condicional, sobrepeso e obesidade foram testadas por meio de coeficientes de correlação. Modelos de regressão logística binária multivariada foram construídos para calcular o efeito do peso ao nascer sobre a obesidade infantil e ajustados por covariáveis. Resultados: Bebês macrossômicos tiveram um aumento de 70% na prevalência de sobrepeso e obesidade em comparação a bebês não-macrossômicos, quando ajustado por sexo, duração do aleitamento materno exclusivo e renda familiar. A correlação entre ganho ponderal e índice de massa corporal para idade mostrou que a maior diferença (positiva) de escore z entre as medições aumentou os níveis de obesidade. Conclusões: Os achados deste estudo sugerem que garantir o peso ideal ao nascer e monitorar e controlar o ganho ponderal subsequente são os primeiros passos para a prevenção primária da obesidade infantil.

La situación de la enfermería en el mundo y la Región de las Américas en tiempos de la pandemia de COVID-19

[Extract]. El informe Situación de la enfermería en el mundo 2020: invertir en educación, empleo y liderazgo (1), lanzado por la Organización Mundial de la Salud (OMS) el 7 de abril de 2020 proporciona una visión y una agenda prospectivas para las políticas relacionadas con esta profesión, al tiempo que el mundo celebra en 2020 el Año Internacional de los Profesionales de Enfermería y Partería y enfrenta la pandemia de enfermedad por coronavirus 2019 (COVID-19). En el mundo hay aproximadamente 28 millones de profesionales de enfermería, 30% de los cuales, o unos 8,4 millones, trabajan en la Región de las Américas. Estos profesionales representan el 56% de la fuerza laboral de salud total (constituida por dentistas, enfermeros, farmacéuticos, médicos y parteras), un porcentaje inferior al promedio mundial, estimado en 59%. Más del 80% de los profesionales de enfermería se encuentra en países cuyas poblaciones, en conjunto, representan la mitad de la población mundial. A nivel mundial se estima una escasez de 5,9 millones de profesionales, y se calcula que el 89% (5,3 millones) de este déficit se concentra en los países de ingresos bajos y medianos-bajos.

Incidence and identification of microfibers in ocean waters in Admiralty Bay, Antarctica.

Antarctic pristine environment is threatened by the presence of microplastics that occur in a variety of shapes and sizes, from fibers to irregular fragments. The aim of this study is to assess the abundance, distribution, and the characterization of the microfibers in zooplankton samples found in ocean waters in Admiralty Bay, Antarctica. The samples were collected at five points in Admiralty Bay during the XXIX Brazilian Antarctic Expedition in the austral summer of 2010-2011. A total of 603 microfibers were collected in 60 samples, with an average abundance of 2.40 (± 4.57) microfibers 100 m-3. Microfiber size ranging from ca. 10 to 22 µm in diameter of various lengths and colors (blue, red, black, and clear) was collected and characterized by scanning electron microscopy (SEM) and Raman spectroscopy. Most of these microfibers were entangled in various different zooplankton species and were identified as polymers composed mostly by polyethyleneglycols, polyurethanes, polyethylene terephthalates, and polyamides. The presence of such microfibers may cause the loss of biodiversity in the Antarctic continent, and the results presented herein can contribute to a better understanding of the impact caused by them within the food chain and human health. Graphical Abstract ᅟ.

Calidad de la medida de la presión arterial en la asistencia habitual / Quality of blood pressure measurement in routine care

Fundamento y objetivos: la medida de la presión arterial es uno de los procedimientos más utilizados en la asistencia, lo que se relaciona con la elevada prevalencia de la hipertensión arterial. Una medición inexacta genera un problema importante, pues pocos mmHg de error sistemático aumentan o disminuyen artificialmente más de un 50% su diagnóstico y más de un 40% su grado de control. Asimismo, la medición correcta habitualmente muestra más hipertensos con presión arterial dentro del rango objetivo. El presente estudio se realizó para evaluar la calidad de la medida en la práctica habitual. Método: estudio observacional transversal en instituciones asistenciales mientras el personal realizaba el cuidado habitual. Lo observado se contrastó con los requisitos para una buena medida analizando 36 variables agrupadas en tres dimensiones: estructura (ambiente, equipamiento), proceso (interrogatorio, paciente, observador) y resultado. Se consideró correcta cada dimensión cuando tenía ³75% de variables apropiadas en cada medida. Resultados: en las 302 medidas analizadas hubo porcentaje correcto de 100% en estructura, 5% en proceso y 47% en resultado. El hecho de redondear a 0 (llevar a la decena entera más próxima el valor de la medida en mmHg) y el interrogatorio insuficiente fueron los errores más frecuentes, seguidos de colocar el estetoscopio debajo del brazalete y la realización de una única medida cuando el valor inicial fue ³140/90 mmHg. Conclusiones: se detectaron frecuentes fallas en la medida de la presión arterial en la práctica habitual relacionadas a mala técnica de medición, lo que tiene gran trascendencia en el manejo crónico de la HA, ya que la precisión de la medida es esencial, pues tanto su diagnóstico como su tratamiento requieren disponer de cifras apropiadas.

Background and objective: the measurement of blood pressure is one of the most used procedures in clinical practice, what is related to the high prevalence of arterial hypertension. An inaccurate measurement generates a significant problem, because few mmHg of systematic error artificially increase or decrease 50% its diagnosis and 40% its degree of control. Also, correct measurement usually shows more hypertensives with blood pressure within the target range. The present study was carried out to evaluate the quality of the blood pressure measure in the usual practice. Method: observational cross-sectional study in health institutions while the staff performed the usual care. The observations were contrasted with the requirements for a correct measure, by analyzing 36 variables grouped in three dimensions: structure (environment, equipment), process (interview, patient, observer) and result. The dimension was considered correct when it had ³75% of appropriate variables in each measure. Results: in the 302 measures analyzed there was a correct percentage of 100% in structure, 5% in process and 47% in result. Rounding to zero and insufficient patient interview were the most frequent errors, followed by placing the stethoscope under the cuff and performing a single measurement when the initial value was ³140/90 mmHg. Conclusions: failures were detected in the measurement of blood pressure in the usual practice related to poor measurement technique. In chronic treatment of arterial hypertension, the accuracy of the measurement is essential since both its diagnosis and its management require adequate blood pressure values.

Significados que le atribuyen al envejecimiento activo y saludable un grupo de personas mayores que viven en comunidad / Significados atribuídos ao envelhecimento ativo e saudável em um grupo de pessoas vivendo em comunidade idosos / Meanings attributed to active and healthy aging to a group of elderly people living in community

RESUMEN Objetivo: conocer e interpretar las experiencias y los significados que le atribuyen al envejecimiento activo y saludable un grupo de personas mayores de 64 años que viven en comunidad en la ciudad de Montevideo, Uruguay. Método: se optó por el método cualitativo con enfoque hermenéutico dialéctico. La recolección de datos se realizó a través de entrevistas en profundidad a 11 personas mayores de 64 años de la ciudad de Montevideo, Uruguay. Resultados: el análisis de los datos permitió construir las categorías de: desarrollo personal, alteración del estado físico, pérdidas, cambios del rol social, falta de reconocimiento, actividades de recreación. Conclusión: se identificaron aspectos relevantes sobre las necesidades de sentirse útiles para la sociedad y familia, reconocen que su capacidad funcional ha disminuido, sienten limitaciones físicas. Se devela el sentimiento de las pérdidas, tanto económicas, como físicas y laborales. Manifiestan que una fortaleza es su salud mental la que los mantiene vivos y activos.

RESUMO Objetivo: compreender e interpretar as experiências e significados atribuídos ao envelhecimento ativo e saudável de um grupo de pessoas com mais de 64 anos que vivem em comunidade, na cidade de Montevidéu, Uruguai. Método: qualitativo com abordagem hermenêutico dialético. A coleta de dados foi realizada através de entrevistas em profundidade com 11 pessoas com mais de 64 anos da cidade de Montevidéu, Uruguai. Resultados: análise dos dados permitiu categorias: desenvolvimento pessoal, condição física prejudicada, perdas, mudanças no papel social, a falta de reconhecimento, atividades recreativas. Conclusão: aspectos relevantes da necessidade de se sentir útil foram identificados sociedade e família, reconhecem que a sua capacidade funcional diminuiu, eles se sentem limitações físicas. O sentimento de perda, tanto econômica e física e de trabalho é revelado. Eles dizem que a força é sua saúde mental, que os mantém vivos e ativos.

ABSTRACT Objective: to find out and interpret the experiences and meanings attributed to the active and healthy aging of a group of elderly people over 64 living in community in the city of Montevideo, Uruguay. Method: we chose the qualitative method with dialectical hermeneutic approach. Data collection occurred through in-depth interviews with 11 elderly people aged 64 or more in the city of Montevideo, Uruguay. Results: data analysis allowed us to construct the categories personal development, physical state changing, losses, social role changes, lack of recognition, recreation activities. Conclusion: we identified relevant aspects on the need to feel useful for society and family; they recognize that their functional capacity has decreased; they feel physical limitations. Feelings of economic, physical and labor losses showed up in the study. They point out that their mental health is their strength that keeps them alive and active.

Redes internacionales de enfermería de las Américas: Reporte 2015 / International networks nursing in the Americas: Report 2015

Introducción: las Redes Internacionales de Enfermería de las Américas son una organización que une a profesionales de enfermería y afines al cuidado de los más diversos países. La integración creciente de los países a las Redes, así como el desarrollo de estas, son clave. Objetivo: identificar el estado actual de las Redes Internacionales de Enfermería de las Américas Organización Panamericana de la Salud/Organización Mundial de la Salud, describir fortalezas y debilidades y ofrecer recomendaciones para el desarrollo de su trabajo en el Acceso y la Cobertura Universal en Salud. Métodos: estudio descriptivo transversal, con una población de 24 redes, se alcanzó una muestra de 21 redes. Se utilizó encuesta semiestructurada a través del sitio web del Observatorio de Recursos Humanos de Salud. La recolección de datos se realizó en los meses de junio y julio de 2015. Resultados: la mitad de las redes cuentan con 3 coordinadores; la red con mayor cantidad de países integrados tiene un total de 45 países, una amplia mayoría cumple con los parámetros de misión, visión, objetivos, estrategias y logo establecidos; sólo 5 cuentan con estrategias de comunicación e intercambio a través de correos y listas de distribución; el posicionamiento en Internet a través de redes sociales y otros medios es aún escaso; a pesar de dificultades en la comunicación y respuesta de los integrantes y en la falta de recursos, las redes cuentan con una importante producción de actividades. Conclusiones: se obtuvo información general acerca de la misión y visión de las redes, sus objetivos, actividades, estrategias, entre otros(AU)

Introduction: The International Network of Nursing in the Americas is an organization that unites professional nursing and related care most diverse countries. The increasing integration of countries into the networks, and the development of these are the key. Objective: To identify the current status of International Nursing Network of the Americas PAHO/WHO, describe strengths and weaknesses, and provide recommendations for the development of their work in Access and Universal Health Coverage. Methods: A cross-sectional descriptive study, with a population of 24 networks, a sample of 21 networks is reached. A semistructured questionnaire was used through the website of the Observatory of Human Resources for Health. Data collection was conducted in June and July 2015. Results: Half of the networks have 3 coordinators; the network with the most integrated countries has a total of 45 countries, a large majority have the parameters of mission, vision, objectives, strategies and logo; only 5 have strategies for communication and exchange through postal and distribution lists; positioning on the Internet through social networks and other media is still scarce; despite difficulties in communication and response of the members and the lack of resources, networks have an important production activities. Conclusions: General information about the mission and vision of networks, their objectives, activities, and strategies, among others was obtained(AU)

Epidemiology of myasthenia gravis in Northern Portugal: Frequency estimates and clinical epidemiological distribution of cases.

INTRODUCTION: In this study we estimated the prevalence, incidence, and mortality of myasthenia gravis (MG) in northern Portugal and characterized the clinical features of the patients identified. METHODS: We used 2 data sources: clinical records from the hospitals and pyridostigmine prescription registers. RESULTS: On December 31, 2013, we estimated a point prevalence of 111.7 patients per million population. The highest prevalence was observed in the group >65 years of age, especially in men (288.1 per million). During 2013, we estimated an incidence rate of 6.3 per million per year. Among women, the incidence rate was highest in the 15-49-year age group; in men, incidence increased with age up to 22.1 per million in those >65 years old. The MG-related mortality rate was 0.5 per million. CONCLUSIONS: These figures are in keeping with similar studies and emphasize the importance of diagnosis and management of MG in elderly populations. Muscle Nerve 54: 413-421, 2016.