Estigmatização do HIV nas relações de trabalho em Imperatriz, Maranhão, Brasil: barreiras, perdas e silêncio / HIV stigmatization in work relations in Imperatriz, Maranhão, Brazil: barriers, losses, and silence

Objetivos: compreender as problemáticas decorrentes da estigmatização do HIV sobre a vida profissional de trabalhadores soropositivos. Métodos: estudo de abordagem qualitativa com realização de entrevistas semiestruturadas, cujos dados foram categorizados utilizando a técnica de análise de conteúdo na modalidade temática. Os sujeitos da pesquisa foram 15 participantes do grupo de adesão do Centro de Testagem e Aconselhamento de Imperatriz, Maranhão, Brasil. Os discursos foram tratados à luz da teoria do estigma proposta por Erving Goffman. Resultados: a partir da análise, emergiram três categorias: barreiras ­ "[…] porque nunca vão me querer"; perdas ­ "[…] umas me deram amizade, outros me deram preconceito"; e silêncio ­ "[…] ficar… em silêncio todo o tempo". Discussão: as barreiras interpostas aos interlocutores contribuem para uma percepção negativa da possibilidade de reinserção no mercado de trabalho. A prática de demissões discriminatórias leva os trabalhadores a manterem silêncio constante sobre a situação soropositiva, para que o estigma do HIV não os torne alvo de discriminação no ambiente de trabalho

Objectives: to understand the issues from HIV stigmatization over the professional life of seropositive workers. Methods: qualitative study with semistructured interviews, whose data were categorized by using the technique of content analysis in the thematic modality. The subjects of the research are 15 participants of the Group of Adhesion of the Testing and Counseling Center of Imperatriz, Maranhão, Brazil. The discourses were treated in the light of the Theory of Stigma proposed by Erving Goffman. Results: from the analysis, three categories emerged: barriers ­ "[…] because they will never want me;" losses ­ "[…] some showed me friendship, some showed me prejudice;" and silence ­ "[…] keep… silent all the time." Discussion: the barriers imposed to the interlocutors contribute to a negative perception of the possibility of reinsertion in the job market. The practice of discriminatory lay-offs leads workers to keep constant silence about the seropositive situation so that the HIV stigma does not turn them into targets of discrimination at the work environment

Por debaixo do arco-íris: perspectivas de mulheres lésbicas e bissexuais sobre saúde e doença / From beneath the rainbow: lesbian and bisexual women's perspectives on health and disease

Resumo Este estudo teve como objetivo compreender os sentidos que mulheres homossexuais e bissexuais dão ao estado de saúde e doença e a forma como avaliam o seu próprio quadro de bem-estar. Tratou-se de uma pesquisa qualitativa constituída pelos relatos de 14 mulheres do município de Imperatriz, Maranhão, Brasil. A antropologia médica e os estudos sobre gênero contribuíram para analisar as categorias "Dimensões da saúde e da doença" e "O olhar sobre a própria saúde". Nessas seções, são discutidas as perspectivas dualistas mente-corpo que caracterizavam etiologicamente o processo saúde-doença na visão dessas interlocutoras. Ademais, o contexto sociocultural foi compreendido como formatador da maneira como traduziam e avaliavam a sua própria condição de saúde, contexto esse atravessado pela vivência bissexual e lésbica. Portanto, as identidades e os comportamentos sexuais das entrevistadas friccionam a rigidez como o processo saúde-doença é interpretado pelo saber biomédico, questionando práticas que marginalizam essas mulheres nos serviços de assistência à saúde.

Abstract This study aimed to understand the meanings that homosexual and bisexual women give to the state of health and illness and the way they evaluate their own state of well-being. It is a qualitative research study consisting of the accounts of 14 women from the municipality of Imperatriz, Maranhão, Brazil. Medical anthropology and gender studies contributed to analyzing the categories "Dimensions of health and disease" and "Looking at one's own health". These sections discuss the dualistic mind-body perspectives that etiologically characterized the health-disease process in these interlocutors' view. In addition, the sociocultural context was understood as shaping the way they translated and evaluated their own health condition, a context crossed by their bisexual and lesbian experience. Therefore, the interviewees' sexual identities and behaviors challenge the rigid way the health-disease process is interpreted by biomedical knowledge, questioning practices that marginalize these women in health care services.

Management of early-stage triple-negative breast cancer: recommendations of a panel of experts from the Brazilian Society of Mastology.

BACKGROUND: Triple-negative breast cancer (TNBC) is a heterogenous subtype involving different patterns of behavior and clinical course, demanding a complex, individualized sequence of treatment. The knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology regarding TNBC were evaluated and a consensus regarding management and treatment was reached. METHODS: Affiliates completed a survey involving 44 objective questions. In addition, a specialist meeting was held with 27 experts and 3 ad hoc consultants. The panelists completed the survey before and after brainstorming. Answers achieving 70% of agreement were considered consensual. The chi-square test was used to compare answers between panelists and affiliates and the Kappa coefficient to calculate agreement. RESULTS: Consensus among the panelists increased from 26 (59.1%) to 32 questions (72.7%) following brainstorming (p = 0.17), including 7/10 questions on systemic treatment. Among the affiliates, consensus was achieved for 24 questions (54.5%), resulting in moderate agreement (κ = 0.445). Neoadjuvant chemotherapy should be indicated for almost all cases (except cT1a-b N0) and should include platinum agents. When indicated, immunotherapy is part of the standard of care. The panel reaffirmed the concept of no ink on tumor as indicative of adequate margins and the possibility of sentinel lymph node biopsy for cN1 patients who become cN0 following neoadjuvant therapy. Controversies remain on combining immunotherapy with capecitabine/olaparib in pertinent cases. CONCLUSION: Expert consensus was achieved for > 70% of the questions, with moderate agreement between panelists and affiliates. Educational interventions on systemic breast cancer treatment affected decision-making in 60% of the questions.

Management of the positive sentinel lymph node following neoadjuvant chemotherapy: results of a survey conducted with breast surgeons.

Introduction: Despite the lack of randomised evidence, there is a current trend towards omitting axillary surgery in cases of positive sentinel lymph node (SLN) following neoadjuvant chemotherapy (NACT). This study evaluated practice patterns of Brazilian breast surgeons when managing positive SLN following NACT. Methods: This was a nationwide electronic survey of breast surgeons affiliated with the Brazilian Society of Mastology. Management approaches for positive SLN after NACT (axillary dissection (AD), regional nodal irradiation (RNI) or no additional treatment) were evaluated as a function of residual disease volume in the SLN (macro-metastasis, micro-metastasis or isolated tumour cells (ITC)). Results: Survey response rate was 49%, with 799/1,627 questionnaires returned. Most respondents were <50 years old (61%), lived in south-eastern Brazil (50%), in a major city (67%), worked in an academic institute (80%) and were board-certified (80%). AD recommendation rate decreased according to residual nodal disease volume: 91% of respondents recommended AD for cases of macro-metastasis, 64% for micro-metastasis and 38% for ITC (p < 0.00001). Furthermore, 35% would recommend no additional surgery for micro-metastasis, while 27% would recommend no treatment at all for ITC (p < 0.00001). Not working in an academic institute was associated with RNI for micro-metastasis (p = 0.02), but not for macro-metastasis or ITC. Being board-certified did not affect axillary management. Conclusion: Most respondents would recommend AD and/or RNI in residual nodal disease following NACT irrespective of disease volume. Nevertheless, a trend towards surgical de-escalation was found with low-volume disease (micro-metastasis and ITC). Ongoing randomised trials will clarify the impact of this trend.

Chemical composition and larvicidal activity of the essential oil of Pimenta dioica leaves / Composición química y actividad larvicida del aceite esencial de hojas de Pimenta dioica

In this study, we investigated the main constituent, the predominant class and biological activity of the essential oil extracted from the leaves of Pimenta dioica and the pattern of the major constituent against larvae in the third stage of Aedes aegypti. For this reason, we extracted the oil by hydrodistillation, identified its components by gas chromatography coupled with mass spectrometry (GC/MS) and calculated the lethal concentration (LC50) of the larvicidal activity using the Reed-Muench method. The results show that the oil consists mainly of eugenol, in which the phenylpropanoid class predominated and the lethal concentration, LC50, was 38.86 µg mL-1at a confidence level of 2.25 µg mL-1, while the eugenol standard presented LC5079.75 µg mL-1at a confidence level of 2.10 µg mL-1. Given the facts, we conclude that the oil is more active than the standard and that it has the potential to replace chemical larvicides.

En este estudio, investigamos el constituyente principal, la clase predominante y la actividad biológica del aceite esencial extraído de las hojas de Pimenta dioica y el patrón del constituyente principal contra las larvas en la tercera etapa de Aedes aegypti. Por este motivo, extrajimos el aceite por hidrodestilación, identificamos sus componentes mediante cromatografía de gases acoplada a espectrometría de masas (GC/MS) y calculamos la concentración letal (CL50) de la actividad larvicida mediante el método Reed-Muench. Los resultados muestran que el aceite está constituido principalmente por eugenol, en el que predominó la clase fenilpropanoide y la concentración letal, CL50, fue de 38,86 µg.mL-1 a un nivel de confianza de 2,25 µg.mL-1, mientras que el estándar de eugenol presentó CL50 79,75 µg.mL -1 a un nivel de confianza de 2,10 µg.mL-1. Dados los hechos, concluimos que el aceite es más activo que el estándar y que tiene el potencial de reemplazar los larvicidas químicos.

The Attitudes of Brazilian Breast Surgeons on Axillary Management in Early Breast Cancer-10 Years after the ACOSOG Z0011 Trial First Publication.

PURPOSE: To evaluate the impact of the ACOSOG Z0011 trial on axillary breast cancer surgery management in Brazil following publication of that study (2010) and again in 2020. PATIENTS AND METHODS: A survey of members of the Brazilian Society of Mastology. RESULTS: Of 1627 breast surgeons, 799 (49.1%) completed and returned the questionnaire. For patients with the Z11 inclusion criteria, following detection of a positive sentinel lymph node (SLN), axillary dissection (AD) was recommended by 99.2% of respondents before publication of the study, 47.5% in 2010 and 18.5% in 2020 (p < 0.001). In breast-conserving surgery, if there were micro-metastases, 2.6% would perform AD, 30.3% axillary radiotherapy, and 67.1% no additional axillary treatment, while with macro-metastases, these proportions were 21.3%, 52.2%, and 26.5%, respectively. In cases of mastectomy and of nodal extracapsular extension, 43.4% and 36% of surgeons, respectively, recommended AD. For clinically negative axilla and suspicious findings at ultrasonography, 69% of the surgeons would apply the Z11 approach. Most applied the Z11 criteria in cases of younger patients (83.6%) and triple-negative and/or HER2 positive tumors (74%). AD was significantly more likely to be recommended by surgeons who did not work in academic institutes, who worked in locations other than capital cities, who were not board-certified, and who were ≥ 50 years old. CONCLUSIONS: This survey revealed substantial changes in axillary surgery management in cN0/pathologically positive SLN, particularly following publication of the updated Z11 results and other similar studies. A better education environment and long-term follow-up were factors associated with the incorporation of Z11-related changes in practice.

Germline genetic mutations in high-risk patients for breast cancer: profile of a group in the city of Florianopolis, Santa Catarina

To analyze the occurrence of genetic mutations in a sample of patients with high risk of breast cancer in Florianopolis/ SC from December 1st, 2021, to January 31, 2022. Methods: An observational, descriptive and retrospective study carried out through data collection of a preexisting database. A total of 194 tests were analyzed. Of these, 192 met the inclusion criteria and composed the final sample of 205 genes. Data were classified and reported the frequency and percentage of the variables: gene and presence or absence of mutation. Results: Mean age of the analyzed patients was 52.3 years, and most underwent the test due to personal history of breast cancer (80%). Clinical significance classification showed that, of the 192 gene panels, 62% were variants of uncertain significance; 14% were pathogenic; and 24%, negative. Of the 205 mutations, the most prevalent genes were: ATM 8.7%, MUTYH 5.8%, POLE 5.8%, BRCA2 4.8%, MSH6 4.8% and RECQL4 4.8%. Of the pathogenic tests regarding genetic predisposition to cancer (n=38/14.1%), the most common mutations were MUTYH (23%) and BRCA1 (15%), with mean age of 52 years (±14.3). In variants of uncertain significance panels (n=168/62%) the frequency rates were ATM (7.7%), POLE (7.1%) and MSH6 (5.9%) genes. The high penetrance genes were present in 18% of the genetic predisposition to cancer panels. Of those with positive family history (n=40), 19% of the genes were pathogenic, 53% were variants of uncertain significance; and 26% were negative. Furthermore, in patients with pathogenic mutations and positive family history (n=11), the most common mutations were in BRCA1 (27%) and BRCA2 (27%). Of the patients who tested due to personal history (n=152), 64% of the genes presented variants of uncertain significance, 13% were pathogenic and 22% were negative.

Repercussions of social isolation of elderly people during the covid-19 pandemic / Repercusiones del aislamiento social de las personas mayores durante la pandemia de covid-19 / Repercussões do isolamento social de pessoas idosas durante a pandemia da covid-19

Objective: reflecting on the repercussions of social isolation of elderly people during the COVID-19 pandemic according to Wanda Horta's Theory. Method: theoretical reflection study, developed through the search of articles in periodicals and official documents which deal with the disease, based on Wanda Horta's Theory of Basic Human Needs. Results: the study reflected on the psychobiological, psychosocial and psycho-spiritual repercussions of the social isolation of elderly people in the context of the pandemic and the performance of nursing professionals. Final considerations: The psychobiological, psychosocial and psycho-spiritual repercussions of social isolation on the elderly person during the pandemic may bring changes to their health situation and interfere with their well-being and quality of life. Health professionals should pay attention to these repercussions, in order to avoid illness and its complications in the life of the elderly person.

Objetivo: reflexionar sobre las repercusiones del aislamiento social de las personas mayores durante la pandemia del COVID-19 a la luz de la Teoría de Wanda Horta. Método: estudio de reflexión teórica, desarrollado a través de la búsqueda de artículos en publicaciones periódicas y documentos oficiales que tratan de la enfermedad, con base en la Teoría de las Necesidades Humanas Básicas de Wanda Horta. Resultados: el estudio reflexionó sobre las repercusiones psicobiológicas, psicosociales y psicoespirituales del aislamiento social de las personas mayores en el contexto de la pandemia y la actuación de los profesionales de enfermería. Consideraciones finales: las repercusiones psicobiológicas, psicosociales y psicoespirituales del aislamiento social en la persona mayor durante la pandemia pueden provocar cambios en su situación de salud e interferir en su bienestar y calidad de vida. Los profesionales de la salud deben prestar atención a estas repercusiones para evitar la enfermedad y sus complicaciones en la vida de la persona mayor.

Objetivo: refletir sobre as repercussões do isolamento social de pessoas idosas durante a pandemia da COVID-19 à luz da Teoria de Wanda Horta. Método: estudo de reflexão teórica, desenvolvido mediante a busca de artigos em periódicos e documentos oficiais que tratam sobre a doença, embasados pela Teoria das Necessidades Humanas Básicas, de Wanda Horta. Resultados: o estudo refletiu acerca das repercussões psicobiológicas, psicossociais e psicoespirituais do isolamento social de pessoas idosas no contexto da pandemia e a atuação dos profissionais de Enfermagem. Considerações finais: as repercussões psicobiológicas, psicossociais e psicoespirituais do isolamento social na pessoa idosa durante a pandemia podem trazer alterações à sua situação de saúde e interferir em seu bem-estar e qualidade de vida. Os profissionais de saúde devem prestar atenção a essas repercussões, para evitar o adoecimento e suas complicações no viver do idoso.

Elderly people's experiences in emergencies through access to other levels of health care.

OBJECTIVE: to understand elderly people's experiences in emergencies through access to other levels of health care. METHODS: a phenomenological study in the light of Heidegger, conducted with 19 elderly patients admitted to an Emergency Care Unit of the city of Salvador, between April and October 2019. RESULTS: ontic primacy: Disposition of the experience of elderly people waiting for regulation; Constitutional anguish and fear in the willingness to be an elderly person waiting for regulation in an Emergency Care Unit; Inappropriate elderly being suppressed while waiting for regulation; Being an elderly person unveiled in the existential modality of being for death. Ontological primacy: Heal how to be the presence of elderly people waiting for regulation. FINAL CONSIDERATIONS: elderly people being anguished and afraid, feelings that allow the questioning of their own being, who want a healing and seeks ways that allows an active and proper participation in care.

Validation of the WHOQOL-Bref instrument in Brazilian sign language (Libras).

PURPOSE: The recognition of the Brazilian Sign Language (Libras) as the official language of the Brazilian deaf, in 2002, reaffirms the linguistic and cultural particularities of the deaf population. Therefore, there is a lack of a validated instrument for assessing the Quality of Life of deaf people using Libras. With authorization from the World Health Organization (WHO), a version of the WHOQOL-Bref in Libras was developed, called WHOQOL-Bref/Libras. However, its psychometric properties have not been examined as yet. Therefore, the purpose of this work is to perform the psychometric validation of the WHOQOL-Bref/Libras. METHODS: WHOQOL-Bref/Libras and a sociodemographic questionnaire were applied to 311 deaf people from the five Brazilian regions. To assess temporal stability, the questionnaire was readministered to 52 deaf people, over an interval of 2 weeks. RESULTS: WHOQOL-Bref/Libras demonstrated satisfactory psychometric values for reliability, discriminant and construct validity, temporal stability, and internal consistency. Cronbach's alpha coefficient showed satisfactory values for each of the WHOQOL-Bref domains: Physical health (0.641), Psychological (0.705), Environment (0.710), and Overall-Bref domains (0.873). The WHOQOL-Bref/Libras is the appropriate option to assess the quality of life of deaf people who communicate through Libras. CONCLUSION: WHOQOL-Bref/Libras had a satisfactory psychometric performance; therefore, it is a valid option that will provide autonomous participation for the deaf in quality of life investigations.

Comunicação organizacional, microcefalia e estéticas da diferença: análise de 2 (dois) anos de discursos do governo federal frente à epidemia do vírus Zika, / Organizational communication, microcephaly and aesthetics of difference: analysis of 2 (two) years of the Federal Government's discourses in face of the Zika virus' epidemic

Resumo Este artigo objetiva analisar formas de afetação da diferença presentes na comunicação organizacional do governo federal em meio ao contexto do aumento do número de nascimentos de crianças com microcefalia no Brasil, durante a epidemia do vírus Zika, entre novembro de 2015 e novembro de 2017. Suas bases conceituais discutem a comunicação e o regime estético das/nas organizações, diante da aparição pública da microcefalia, que afeta discursos oficiais a partir de estéticas da diferença, reveladoras de cenários de vulnerabilidade. A metodologia pautou-se por uma análise interpretativa do discurso organizacional, tendo como suporte empírico publicações sobre a microcefalia no Blog da Saúde, do Ministério da Saúde. Como resultados, os tratamentos discursivos sinalizam, progressivamente, posturas de: impassibilidade (em relação a mulheres/crianças); erradicação do vetor (prioridade da ação pública); confissão (admissão circunscrita de um desafio de saúde pública); admissão expandida; atribuição de aparência (naturalidade); e atrofiamento (microcefalia associada unicamente à erradicação do vetor). Conclui-se que, à exceção dos tratamentos de admissão expandida e atribuição de aparência, todos os outros revelam abordagens que podem colaborar com o apagamento da existência de seres humanos, com visíveis marcas sociais de vulnerabilidade, por apostas discursivas que, ironicamente, reforçam uma personificação do vetor transmissor do Zika.

Abstract This article aims to analyze ways of difference's affecting present in the Federal Government's organizational communication in the context of the increase in the number of births of children with microcephaly in Brazil, during the Zika virus epidemic, between November 2015 and November 2017. Its conceptual bases discuss communication and the aesthetic regime of / in organizations, in the face of the public appearance of microcephaly, which affects official discourses based on aesthetics of difference, revealing vulnerability scenarios. The methodology was based on an interpretative analysis of the organizational discourse, having as empirical support publications on microcephaly in the Health Blog, from the Ministry of Health. As a result, the discursive treatments progressively signal positions of: impassibility (in relation to women/children); vector eradication (priority of public action); confession (circumscribed admission of a public health challenge); expanded admission; appearance attribution (naturalness); and atrophy (microcephaly associated only with vector eradication). It is concluded that, with the exception of the treatments of expanded admission and appearance attribution, all the others reveal approaches that can collaborate with the erasure of the existence of human beings, with visible social marks of vulnerability, by discursive bets that, ironically, reinforce a personification of the Zika transmitting vector.

Elderly people's experiences in emergencies through access to other levels of health care / Experimentado por los ancianos en situaciones de emergencia debido al acceso a otros niveles de satención de la salud / Vivido pelo idoso nas emergências pelo acesso para outros níveis de atenção à saúde

ABSTRACT Objective: to understand elderly people's experiences in emergencies through access to other levels of health care. Methods: a phenomenological study in the light of Heidegger, conducted with 19 elderly patients admitted to an Emergency Care Unit of the city of Salvador, between April and October 2019. Results: ontic primacy: Disposition of the experience of elderly people waiting for regulation; Constitutional anguish and fear in the willingness to be an elderly person waiting for regulation in an Emergency Care Unit; Inappropriate elderly being suppressed while waiting for regulation; Being an elderly person unveiled in the existential modality of being for death. Ontological primacy: Heal how to be the presence of elderly people waiting for regulation. Final considerations: elderly people being anguished and afraid, feelings that allow the questioning of their own being, who want a healing and seeks ways that allows an active and proper participation in care.

RESUMEN Objetivo: comprender lo que viven los ancianos en situaciones de emergencia a través del acceso a otros niveles de atención de la salud. Métodos: estudio fenomenológico a la luz de Heidegger, realizado con 19 pacientes ancianos ingresados en la Unidad de Urgencias de la ciudad de Salvador, entre los meses de abril y octubre de 2019. Resultados: primacía óntica: disposición de la experiencia del anciano en espera de regulación; Angustia constitucional y miedo ante la voluntad de ser un anciano en espera de regulación en una unidad de emergencia; Ancianos inapropiados reprimidos mientras esperan la regulación; Ser un anciano desvelado en la modalidad existencial del ser para la muerte. Primacía ontológica: Cura cómo ser la presencia del anciano esperando la regulación. Consideraciones finales: el anciano está angustiado y asustado, sentimientos que permiten el cuestionamiento de su propio ser, que quiere una cura y busca caminos que le permitan una participación activa y adecuada en el cuidado.

RESUMO Objetivo: compreender o vivido pelo idoso nas emergências pelo acesso para outros níveis de atenção à saúde. Métodos: estudo fenomenológico à luz de Heidegger, realizado com 19 idosos internados em Unidade de Pronto Atendimento do município de Salvador, entre os meses de abril e outubro de 2019. Resultados: primado ôntico: Disposição do vivido da pessoa idosa à espera pela regulação; Angústia e medo constitutivos na disposição de ser idoso à espera pela regulação em Unidade de Pronto Atendimento; Ser idoso impróprio suprimido na espera pela regulação; Ser idoso próprio desvelado na modalidade existenciária de ser para a morte. Primado ontológico: Cura como ser da presença da pessoa idosa à espera pela regulação. Considerações finais: o ser idoso se angustia e tem medo, sentimentos que permitem o questionamento do próprio ser, que deseja a cura e busca caminhos que permite uma participação ativa e própria no cuidado.

Telemonitoring of Brazilian Nursing homes before Coronavirus and COVID-19 Infections.

OBJECTIVE: to report the experience of telemonitoring Brazilian nursing homes before coronavirus and COVID-19 infections. METHODS: a descriptive experience report that occurred between March 18 and April 25, 2020 through telemonitoring nursing homes in Salvador, Bahia, following a script previously prepared for first contact and follow-up. The telemonitoring was carried out by professors from the School of Nursing of Universidade Federal da Bahia and Graduate Program students for four weeks. RESULTS: thirty-two institutions were followed for four weeks. Some facilities and difficulties appeared during the monitoring. FINAL CONSIDERATIOS: as nursing homes are collective households, their residents are vulnerable to transmission of infections. In addition, the diversity of structures and economic, social and human resources needs of these locations reveal their fragility and urgency of public policies that address such diversities.

Improving a Web-Based Tool to Support Older Adults to Stay Independent at Home: Qualitative Study.

BACKGROUND: Older adults desire to stay independent at home for as long as possible. We developed an interactive website to inform older adults and caregivers about ways to achieve this. OBJECTIVE: This study aimed to perform an in-depth exploration among potential end users about how to improve the interactive website to better inform older adults and caregivers about ways to stay independent at home. METHODS: To complement the results of a quantitative survey on the usability and acceptability of the website before implementation, we conducted a qualitative descriptive study. Using multiple recruitment strategies, we recruited a purposeful sample of older adults (aged ≥65 years) and caregivers of older adults struggling to stay independent at home. We conducted face-to-face or telephonic interviews in either English or French. In addition, we collected sociodemographic characteristics, other characteristics of participants (eg, health, digital profile, and perception of retirement homes), and experiences with using the website (factors facilitating the use of the website, barriers to its use, and suggestions for improvement). Interviews were audio recorded, transcribed verbatim, and thematically analyzed by two researchers. RESULTS: We recruited 15 participants, including 5 older adults (mean age 75 years, SD 6) and 10 caregivers (mean age 57 years, SD 14). The mean interview time was 32 min (SD 14). Most older adults had either mobility or health problems or both, and many of them were receiving home care services (eg, blood pressure measurement and body care). Overall, participants found the website easy to navigate using a computer, reassuring, and useful for obtaining information. Barriers were related to navigation (eg, difficult to navigate with a cellphone), relevance (eg, no specific section for caregivers), realism (eg, some resources presented are not state funded), understandability (eg, the actors' accents were difficult to understand), and accessibility (eg, not adapted for low digital literacy). Suggestions for improvement included a needs assessment section to direct users to the support appropriate to their needs, addition of information about moving into residential care, a section for caregivers, distinction between state-provided and private support services, simpler language, expansion of content to be relevant to all of Canada, and video subtitles for the hearing impaired. CONCLUSIONS: Users provided a wealth of information about the needs of older adults who were facing a loss of autonomy and about what such a website could usefully provide. The request for less generic and more personalized information reflects the wide range of needs that electronic health innovations, such as our interactive website, need to address. After integrating the changes suggested, the new website-Support for Older Adults to Stay Independent at Home (SUSTAIN)-will be implemented and made available to better assist older adults and caregivers in staying independent at home.

Estudo da composição química, toxicidade e atividade moluscicida do óleo essencial Citrus sinensis (L.) Osbeck / Study of the chemical composition, toxicity and molluscicidal activity of the essential oil Citrus sinensis (L.) Osbeck

RESUMO Determinamos a composição química e testamos a toxicidade e a atividade moluscicida do óleo essencial extraído das cascas do Citrus sinensis (L.) Osbeck. Para isso, o óleo essencial foi extraído quantitativamente por hidrodestilação. Em seguida, as quantificações de seus componentes foram realizadas por cromatografía gasosa acoplada à espectrometria de massas (CG-MS) e a toxicidade e atividade moluscicida foram testadas, respectivamente, contra Artemia salina e caramujos Biomphalaria glabrata. Os resultados mostraram que o óleo contém 81,50% de D-limoneno (constituinte principal) e 0,06% de citronelal (componente menor) e este possui atividade moluscicida com concentração letal (CL50) de 100,08 mg.L-1 e atoxicidade, com CL50 de 321,84 mg.L-1 a um nível de confiança de 95%. Portanto, o óleo é ativo contra o caramujo Biomphalariaglabrata e atóxico para outros seres vivos.

SUMMARY In this present study, we determined the chemical composition and we tested the toxicity and the molluscicidal activity of the essential oil extracted from the barks of Citrus sinensis (L.) Osbeck. For this, the essential oil was extracted quantitatively by hydrodistillation. Then, quantifications of its components were performed by gas chromatography coupled to mass spectrometry (CG-MS) and the toxicity and molluscicidal activity were tested, respectively, against Artemia salina and snails Biomphalaria glabrata. The results showed that the oil contains 81.50% of D-limonene (main constituent) and 0.06% of citronellal (minor component) and it has lethal activity (LC50) of 100.08 mg.L-1 and a toxicity, with LC50 of321.84 mg.L -1 at a 95% confidence level. Therefore, the oil is active against the snail Biomphalaria glabrata and non-toxic to other living bein.

Chemical composition and biological activity of the essential oil of the fruits Pimenta dioica against formae speciales of fungus Fusarium oxysporum / Composición química y actividad biológica del aceite esencial de los frutos Pimenta dioica contraformae speciales del hongo Fusarium oxysporum

SUMMARY We determined the chemical composition and explored the hypothesis that the essential oil of the fruits of Pimenta dioica inhibits the mycelial development of fungi Fusarium oxysporum f. sp. lycopersici, F. oxysporum f. sp. passiflorae, F. subglutinans f. sp. ananas, F. oxysporum f. sp. vasinfectum e F. oxysporum f. sp. Cubense. To do this, we extracted the oil by hydrodistillation, identified its components by gas chromatography coupled to mass spectrometry (GC-MS) and determined the fungal activity against five special forms of Fusarium species. The results showed that the oil had 76.88% of eugenol and inhibited the mycelial development of fungi up to 97.78% in an average of 7.2 days. Therefore, oil is a potential natural fungicide.

RESUMEN Determinamos la composición química y exploramos la hipótesis de que el aceite esencial de los frutos de Pimenta dioica inhibe el desarrollo micelial de los hongos Fusarium oxysporum f. sp. lycopersici, F. oxysporum f. sp. passiflorae, F. subglutinans f. sp. ananas, F. oxysporum f. sp. vasinfectum e F. oxysporum f. sp. Cubense. Para hacer esto, extrajimos el aceite por hidrodestilación, identificamos sus componentes por cromatografía de gases acoplada a espectrometría de masas (GC-EM) y determinamos la actividad fúngica contra cinco formas especiales de especies de Fusarium. Los resultados mostraron que el aceite tenía 76,88% de eugenol e inhibió el desarrollo micelial de hongos hasta 97,78% en un promedio de 7,2 días. Por lo tanto, el aceite es un potencial fungicida natural.

Variations in factors associated with healthcare providers' intention to engage in interprofessional shared decision making in home care: results of two cross-sectional surveys.

BACKGROUND: DOLCE (Improving Decision making On Location of Care with the frail Elderly and their caregivers) was a post-intervention clustered randomised trial (cRT) to assess the effect of training home care teams on interprofessional shared decision-making (IP-SDM). Alongside the cRT, we sought to monitor healthcare providers' level of behavioural intention to engage in an IP-SDM approach and to identify factors associated with this intention. METHODS: We conducted two cross-sectional surveys in the province of Quebec, Canada, one each at cRT entry and exit. Healthcare providers (e.g. nurses, occupational therapists and social workers) in the 16 participating intervention and control sites self-completed an identical paper-based questionnaire at entry and exit. Informed by the Integrated model for explaining healthcare professionals' clinical behaviour by Godin et al. (2008), we assessed their behavioural intention to engage in IP-SDM to support older adults and caregivers of older adults with cognitive impairment to make health-related housing decisions. We also assessed psychosocial variables underlying their behavioural intention and collected sociodemographic data. We used descriptive statistics and linear mixed models to account for clustering. RESULTS: Between 2014 and 2016, 271 healthcare providers participated at study entry and 171 at exit. At entry, median intention level was 6 in a range of 1 (low) to 7 (high) (Interquartile range (IQR): 5-6.5) and factors associated with intention were social influence (ß = 0.27, P <  0.0001), beliefs about one's capabilities (ß = 0.43, P <  0.0001), moral norm (ß = 0.31, P <  0.0001) and beliefs about consequences (ß = 0.21, P <  0.0001). At exit, median intention level was 5.5 (IQR: 4.5-6.5). Factors associated with intention were the same but did not include moral norm. However, at exit new factors were kept in the model: working in rehabilitation (ß = - 0.39, P = 0.018) and working as a technician (ß = - 0.41, P = 0.069) (compared to as a social worker). CONCLUSION: Intention levels were high but decreased from entry to exit. Factors associated with intention also changed from study entry to study exit. These findings may be explained by the major restructuring of the health and social care system that took place during the 2 years of the study, leading to rapid staff turnover and organisational disturbance in home care teams. Future research should give more attention to contextual factors and design implementation interventions to withstand the disruption of system- and organisational-level disturbances. TRIAL REGISTRATION: Clinicaltrials.gov (NCT02244359). Registered on September 19th, 2014.

Correction to: Time to move? Factors associated with burden of care among informal caregivers of cognitively impaired older people facing housing decisions: secondary analysis of a cluster randomized trial.

Following publication of the original article [1], we have been notified that one of the authors' given name and last names are reversed and misspelled and thus not reflected correctly (given name now is Painchaud-Guérard and it should be Geneviève and last name now is Geneviève and it should be Painchaud Guérard).

Acolhimento e cuidado da enfermeira na estratégia saúde da família: percepções da pessoa idosa / Acogida del paciente y atención deenfermería en la estrategia salud familiar: percepción de los adultos mayores / Nursing reception and care in the family health strategy: perceptions of the elderly person

RESUMO Objetivo: analisar a percepção da pessoa idosa sobre o acolhimento e cuidado da enfermeira na Estratégia Saúde da Família. Métodos: estudo descritivo, com abordagem qualitativa, desenvolvido com 21 idosos, cadastrados em sete unidades de saúde da família, em um município da Bahia, Brasil. Os dados foram coletados por meio da entrevista semiestruturada, ocorridas entre janeiro e março de 2016. Os dados foram analisados com base na análise categorial temática de Bardin, sob a luz da teoria transpessoal de Watson. Resultados: as percepções de pessoas idosas sobre o acolhimento e cuidado da enfermeira no contexto atenção básica foram: 1. empatia com ênfase na escuta qualificada; 2. cuidado com acolhimento e afeto; 3. cuidado com ênfase no aspecto biológico; 4. o cuidado direcionado para a prevenção de doenças e promoção da saúde. Conclusão: o acolhimento e o cuidado da enfermeira têm repercussões positivas para a saúde da pessoa idosa assistida nas unidades de saúde da família. Entretanto, apesar do cuidado empático, acolhedor e com afeto, poucos depoimentos referiram a atenção multidimensional em seus aspectos direcionados, o que remete à necessidade de a enfermeira direcionar o cuidado que atenda a todas as dimensões propostas por Jean Watson no Processo Clinical Caritas.

RESUMEN Objetivo: analizar la percepción de las personas mayores sobre la acogiday la atención de las enfermeras en la estrategia de salud familiar. Métodos: estudio descriptivo con enfoque cualitativo, realizado con 21 personas mayores inscritas en siete unidades de salud familiar de un municipio del estado de Bahía, Brazil. Los datos se recogieron a través de la entrevista semiestructurada, entre enero y marzo de 2016 y se analizaron en base al análisis de contenido propuesto por Bardin, a la luz de la teoría del cuidado transpersonal de Watson. Resultados: la percepción de los adultos mayores sobre la acogida y la atención de las enfermeras en el contexto de la atención primaria fueron: 1. empatía con énfasis en la escucha calificada; 2. atención acogedora y afectuosa; 3. cuidados con énfasis en el aspecto biológico; 4. atención con foco en la prevención de las enfermedades y la promoción de la salud. Conclusión: la bienvenida y la atención de las enfermeras tienen repercusiones positivas para la salud de las personas mayores atendidas en las unidades de salud familiar. Sin embargo, a pesar deconsiderar la atención como empática, acogedora y afectuosa, pocas declaraciones se refirieron a la ella como multidimensional en los aspectosenfocados , lo cual indica la necesidad de que las enfermeras se concentren en los cuidados que atiendan a todas las dimensiones propuestas por Jean Watson en el Proceso de Clinical Caritas.

ABSTRACT Objective: to analyze the perceptions of the elderly person on the reception and care of nurses in the Family Health Strategy. Methods: a descriptive study with a qualitative approach, developed with 21 elderly people, registered in seven family health units, in a municipality in Bahia, Brazil. A semi-structured interview collected the data between January and March 2016. The data were analyzed based on Bardin's thematic categorical analysis, based on Watson's transpersonal theory. Results: the perceptions of elderly people about the reception and care of nurses in the context of primary care were: 1. The empathy with an emphasis on qualified listening; 2. The care assistance with welcoming and affection; 3. The care with an emphasis on the biological aspect; 4. The care aimed at disease prevention and health promotion. Conclusion: the reception and care of the nurse have positive repercussions for the health of the elderly person assisted in family health units. However, despite the empathic, welcoming and affectionate care, few statements showed multidimensional attention in its directed aspects, such as the need for the nurse to direct care that meets all dimensions proposed by Jean Watson in the Clinical Caritas Process.

Enhancing interprofessionalism in shared decision-making training within homecare settings: a short report.

Training in shared decision-making (SDM) often focuses solely on dyadic relationships between one healthcare provider and one patient. However, many healthcare decisions often involve two or more health professionals. These decisions warrant utilizing an interprofessional shared decision-making (IP-SDM) approach which enables patients and their caregivers to face difficult decisions around care together. Most existing SDM training programs fall short when building interprofessional (IP) competencies and require an approach that integrates IP with SDM. This short report discusses the creation and trial implementation of three enhanced education tools (a video, role-play exercise with decision aid, and an IP observation aid) for an IP-SDM workshop focused on helping homecare teams collaborate with seniors and their caregivers throughout the decision-making process. We developed and implemented these tools in eight study sites of a larger randomized control trial to test the training workshop for homecare teams. The workshop and tools helped participants overcome interprofessional challenges in their work. Participants evaluated the tools and workshop, which offered guidance to better translate teachable IP collaboration competencies within SDM.