Women's perception about the discovery of breast cancer amid the covid-19 pandemic.

BACKGROUND: Breast cancer is considered a health problem at a worldwide level. In Brazil, the South and Southeast regions have the highest mortality rates. Understanding how they dealt with the diagnostic of a stigmatized disease amid the COVID-19 pandemic and its potential repercussions, may enable healthcare professionals to of life. Thus, this study is aimed at understanding the perception of women about the discovery of breast cancer and the impact of the disease on their lives. METHODS: A qualitative study, with the participation of forty women with breast cancer, under chemotherapy treatment. It was performed in a hospital specialized in oncology, in Juiz de Fora, Brazil, in 2020 and 2021. Data collection was carried out with semi-structured interviews, which were analyzed with Bardin Content Analysis. RESULTS: Based on the central theme "Discovery of the disease", these categories were developed: "Discovery" and "Impact of the disease". A large part of women noticed a change in the breast, even before routine checks. Upon the impact of cancer diagnosis, negative feelings arise, then going through a process of acceptance and coping. Some barriers were faced due to the COVID-19 pandemic, which caused delays in the diagnostic and impact caused by social isolation. Family, friends, and healthcare professionals integrated an important supporting network in order to help coping with the disease. CONCLUSION: The consequences of a breast cancer diagnosis can be devastating. It is necessary that healthcare professionals know and embrace the feelings, beliefs, and values as a part of the aspects related to health. Valuing the supporting network of women suffering from the disease may favor the process of accepting and coping with the neoplasm. The COVID-19 pandemic is highlighted as an obstacle to be overcome specially when it comes to diagnostic assistance and availability of a support network. In that sense, it is worth mentioning the importance of a healthcare team able to offer full assistance, with quality. The need of further studies to determine the impact of the pandemic in the long run.

Technologies Applied to the Mental Health Care of Pregnant Women: A Systematic Literature Review.

OBJECTIVE: This article aims to review the literature regarding the use of technologies to promote mental health for pregnant women. We seek to: understand the strategies that pregnant women use for mental health care. Also, we investigate the existence of scientific evidence that validates such practices. METHODS: This study follows the PRISMA guidelines for systematic reviews. We analyze 27 studies published between 2012 and 2019. We include publications in Portuguese, English, and Spanish. RESULTS: The results revealed several different possibilities to use technology, including the use of text messages and mobile applications on smartphones. Mobile applications are the most commonly used approaches (22.5%). Regarding the strategies used, cognitive-behavioral approaches, including mood checks, relaxation exercises, and psychoeducation comprised 44.12% of the content. CONCLUSION: There is a need for further investigation and research and development efforts in this field to better understand the possibilities of intervention in mental health in the digital age.

OBJETIVO: Este artigo objetiva revisar a literatura quanto ao uso das tecnologias como promotoras de saúde mental de gestantes. Desta forma, compreender quais são as estratégias utilizadas no cuidado da saúde mental dessas mulheres, assim como verificar se há evidências científicas que justifiquem a implementação dessas práticas. MéTODOS:: Este estudo segue o protocolo PRISMA para revisões sistemáticas de 27 estudos publicados em 2012-2019, incluindo publicações em português, inglês e espanhol. RESULTADOS: Os resultados revelaram diferentes possibilidades de utilização da tecnologia, sendo o uso de mensagens de texto e de aplicativos em smartphones mais os utilizados (22,5%). No que se refere às ferramentas utilizadas, estratégias cognitivo-comportamentais, tais como verificação do humor, exercícios de relaxamento e psicoeducação compreenderam 44,12% do conteúdo. CONCLUSãO:: Verifica-se a necessidade de mais investimentos nessa área para que se possa compreender as possibilidades de intervenção em saúde mental na era digital.

Technologies Applied to the Mental Health Care of Pregnant Women: A Systematic Literature Review / Tecnologias aplicadas aos cuidados em saúde mental de grávidas: revisão sistemática da literatura

Abstract Objective: This article aims to review the literature regarding the use of technologies to promote mental health for pregnant women. We seek to: understand the strategies that pregnant women use for mental health care. Also, we investigate the existence of scientific evidence that validates such practices. Methods: This study follows the PRISMA guidelines for systematic reviews. We analyze 27 studies published between 2012 and 2019. We include publications in Portuguese, English, and Spanish. Results: The results revealed several different possibilities to use technology, including the use of text messages and mobile applications on smartphones. Mobile applications are the most commonly used approaches (22.5%). Regarding the strategies used, cognitive-behavioral approaches, including mood checks, relaxation exercises, and psychoeducation comprised 44.12% of the content. Conclusion: There is a need for further investigation and research and development efforts in this field to better understand the possibilities of intervention in mental health in the digital age.

Resumo Objetivo: Este artigo objetiva revisar a literatura quanto ao uso das tecnologias como promotoras de saúde mental de gestantes. Desta forma, compreender quais são as estratégias utilizadas no cuidado da saúde mental dessas mulheres, assim como verificar se há evidências científicas que justifiquem a implementação dessas práticas. Métodos: Este estudo segue o protocolo PRISMA para revisões sistemáticas de 27 estudos publicados em 2012-2019, incluindo publicações em português, inglês e espanhol. Resultados: Os resultados revelaram diferentes possibilidades de utilização da tecnologia, sendo o uso de mensagens de texto e de aplicativos em smartphones mais os utilizados (22,5%). No que se refere às ferramentas utilizadas, estratégias cognitivo-comportamentais, tais como verificação do humor, exercícios de relaxamento e psicoeducação compreenderam 44,12% do conteúdo. Conclusão: Verifica-se a necessidade de mais investimentos nessa área para que se possa compreender as possibilidades de intervenção em saúde mental na era digital.

Atitudes de profissionais sobre o uso de drogas por gestantes / Health professional attitudes towards drug use for pregnant women / Actitudes de profesionales sobre el consumo de drogas en mujeres embarazadas

O uso de drogas é um dos fatores associados a gestações de alto risco. As crenças e atitudes dos profissionais configuram possíveis dificultadores dos cuidados em saúde. O presente estudo buscou verificar as atitudes profissionais em relação a gestantes usuárias de drogas. Realizou-se a busca bibliográfica de publicações entre 2000 e junho de 2022, nas bases de dados Scielo, Lilacs, Medline/Pubmed, Scopus e PsycINFO. Ao final foram analisados 27 artigos, todos de língua inglesa. Foram identificadas atitudes negativas em 33,3% dos artigos, e atitudes positivas em 44,5%; também foram encontradas atitudes ambivalentes (22,2%). Além disso, alguns dos estudos apontaram algumas barreiras quanto às intervenções. Atitudes negativas e moralizantes denotam um cunho individualizante. Em relação às atitudes positivas, essas podem ter um papel fundamental na atuação profissional e na saúde materna e do feto.

Drug use is one of the factors related to high-risk pregnancy. The health professional beliefs and attitudes regarding this issue constitute possible difficulties in the health care. The present study sought to verify the health professional attitudes towards pregnant women who use drugs. A literature review for studies published between 2000 and june 2022 was carried out in the Scielo, Lilacs, Medline/Pubmed, Scopus, and PsycINFO databases. In the end, 27 articles were analyzed, all of them written in English. Negative attitudes were identified in 33,3% of the articles, and positive attitudes in 44,5%; ambivalent attitudes were also found in 22,2% of the studies. Additionally, some studies pointed out barriers to interventions. The negative and moralizing attitudes denote an individualizing nature. Concerning the positive attitudes, they can play a fundamental role on professional performance and, consequently, on the maternal and fetal health.

El uso de drogas es uno de los factores asociados a los embarazos de alto riesgo. Las creencias y actitudes de los profesionales se configuran como posibles obstáculos al cuidado en salud. El presente estudio buscó verificar las actitudes de los profesionales en relación a embarazadas usuarias de drogas. Se realizó una búsqueda bibliográfica de publicaciones entre 2000 y junio de 2022, en las bases de datos Scielo, Lilacs, Medline/Pubmed, Scopus y PsycINFO. Finalmente, fueron analizados 27 artículos, todos en idioma inglés. Se identificaron actitudes negativas en el 33,3% de los artículos, y actitudes positivas en el 44,5%; así también se encontraron actitudes ambivalentes (22,2%). Además, algunos de los estudios señalaron algunas barreras con respecto a las intervenciones. Las actitudes negativas y moralizantes denotan una impronta individualizadora. En relación con las actitudes positivas, estas pueden tener un papel fundamental en la actuación profesional y en la salud materna y del feto.

Vulnerabilidade ao HIV entre usuários de CAPSad: crenças e comportamentos em saúde / HIV vulnerability among CAPSad users: relationship between beliefs and health behaviors / Vulnerabilidad al VIH entre usuarios de CAPSad: creencias y comportamientos en salud

O abuso de álcool e outras drogas é uma importante questão de saúde mental para a população adulta e adolescente. Entre os eventos associados a esse abuso, encontra-se elevada vulnerabilidade ao HIV. O presente estudo buscou avaliar, em usuários de substâncias, a relação entre: gravidade percebida do HIV, autoeficácia para uso de preservativo e vulnerabilidade ao HIV. Trata-se de um estudo transversal, quanti-qualitativo, com usuários de um Centro de Atenção Psicossocial para Álcool e Outras Drogas (CAPSad) no Brasil. Os resultados indicam não haver associação significativa entre gravidade percebida do HIV e vulnerabilidade ao HIV (ρ de Spearman de -0,109 e valor-p de 0,507). Contudo, foi identifi-cada uma associação negativa marginalmente significativa entre autoeficácia para uso de preservativo e vulnerabilidade ao HIV (ρ de Spearman de -0,302 and valor-p de 0,061). Neste artigo, discutimos o estigma relacionado ao HIV/aids e realizamos uma crítica a intervenções baseadas no medo, recomen-dando contra seu uso. Em contrapartida, são propostas estratégias para o desenvolvimento da autoe-ficácia, de modo a fortalecer a autonomia dos usuários de CAPSad.

The abuse of alcohol and other drugs is an important mental health issue in the adult and adolescent population. Along with other concerns, substance use can be associated with a higher vulnerability to HIV infection. This study aimed to assess the relationship between three variables in substance users: HIV perceived severity, condom use self-efficacy, and HIV vulnerability. This was a cross-sectional, quanti-qualitative study on outpatients from a Psychosocial Care Center for Alcohol and Other Drugs (CAPSad) in Brazil. Our findings indicate no significant association between HIV perceived severity and HIV vulnerability (Spearman's ρ of -0.109 and p-value of 0.507), and a marginally significant negative association between condom use self-efficacy and HIV vulnerability (Spearman's ρ of -0.302 and p-value of 0.061). In this paper, we discuss the stigma related to HIV/aids and criticize fear-based preventive interventions, recommending against them. On the other hand, we propose strategies for self-efficacy development, aiming to strengthen the autonomy of CAPSad users.

El abuso de alcohol y otras drogas es un importante problema de salud mental para la población adulta y adolescente. Entre los eventos de salud a ele asociados, se encuentra elevada vulnerabilidad a infección por VIH. El estudio buscó evaluar la relación entre: gravedad percibida del VIH, autoeficacia para el uso del condón y vulnerabilidad a el VIH. Este es un estudio transversal, cuanti-cualitative, con usuarios de un Centro de Atención Psicosocial para el Alcohol y Otras Drogas (CAPSad) en Brasil. Los hallazgos indican ausencia de asociación entre gravedad percibida del VIH y vulnerabilidad a el VIH (ρ de Spearman de -0,109 y valor-p de 0,507); y una asociación negativa marginalmente significativa entre esta última variable y autoeficacia para el uso de condón (ρ de Spearman de -0,302 y valor-p de 0,061). En este trabajo discutimos el estigma relacionado con el VIH/sida y criticamos las intervenciones basadas en el miedo, recomendando contra su uso. Por otro lado, se proponen estrategias para el desarrollo de la autoeficacia, con el fin de fortalecer la autonomía de los usuarios del CAPSad.

Educação e colaboração interprofissional: resultados qualitativos de uma intervenção com residentes / Interprofessional education and collaboration: qualitative results from an intervention with residents

Apresentar resultados qualitativos de uma intervenção grupal voltada ao aprimoramento da educação e da colaboração interprofissional em residentes multiprofissionais e residentes médicos, com ênfase no contexto da atenção hospitalar. Trata-se de um estudo qualitativo, do qual participaram nove residentes. A intervenção desenvolvida com os participantes desmembrou-se em quatro encontros de duas horas de duração cada e promoveu atividades voltadas ao fomento de competências interprofissionais. Os encontros foram gravados em áudio e posteriormente transcritos, sendo que as transcrições foram submetidas à análise de conteúdo temática. Foram configuradas duas categorias básicas, cujos relatos correspondentes indicam que, de acordo com os participantes, a intervenção foi proveitosa já que, dialogicamente, lhes possibilitou tanto reconhecer obstáculos ao trabalho em equipe no campo da saúde quanto delinear expedientes capazes de superá-los. A intervenção gerou contribuições ao aprimoramento da educação e da colaboração interprofissional para com os participantes.

To present qualitative results from a group intervention aimed at improving education and interprofessional collaboration in multidisciplinary residents and medical residents, with emphasis on the context of hospital care. This is a qualitative study, in which nine residents participated. The intervention developed with the participants was divided into four meetings lasting two hours each and promoting activities aimed at fostering interprofessional competences. The meetings were audio recorded and later transcribed, and the transcripts were subjected to thematic content analysis. Two basic categories were configured, whose corresponding reports indicate that, according to the participants, the intervention was beneficial in the sense that, dialogically, it enabled them both to recognize obstacles to teamwork in the health field and to outline expedients capable of overcoming them. The intervention generated contributions to the improvement of education and interprofessional collaboration with the participants.

Estudo das Crenças de Receptores acerca do Transplante Renal - Estudo Qualitativo / Study of Receptor Beliefs About Kidney Transplantation - Qualitative Study

Resumo Objetivo: investigar crenças sobre o transplante renal em pacientes submetidos a esse procedimento cirúrgico. Método: pesquisa qualitativa, realizada com 34 pacientes. A elaboração da entrevista e a discussão dos resultados foram realizadas a partir do Modelo de Crenças em Saúde e os dados organizados de acordo com a Análise de Conteúdo. Resultados: amostra com média de idade de 45,94 (±10,67) anos, mediana de tempo de transplante de 13 anos, sendo 55,9% masculina. Discussão: observou-se predominância das crenças relacionadas aos benefícios percebidos na realização do transplante renal em comparação às dificuldades percebidas; as crenças sobre motivação pela escolha do transplante e motivação para o tratamento estavam associadas às crenças sobre o transplante renal e às crenças relativas aos benefícios percebidos.

Abstract Objective: to investigate beliefs about kidney transplantation in transplanted patients. Method: qualitative research with 34 participants. The elaboration of the interview and discussion of the results were based on the theory of the Health Belief Model and the data was organized according to the Content Analysis. Results: A mean age of 45.94 (± 10.67) years, median transplant time of 13 years, being 55.9% of men. Discussion: we observed a predominance of beliefs related to perceived benefits in renal transplantation compared to perceived difficulties; and beliefs about motivation for choosing a transplant and motivation for treatment were associated with beliefs about kidney transplantation and beliefs perceived benefits.

Interdisciplinarity and interprofessionality in teamwork: perceptions of multiprofessional residents in Hospital Care

Multiprofessional Health Residency Programs were created to further align health training with the needs of the population and, through an emphasis on teamwork, have been contributing to the consolidation of the Brazilian Unified Health System. The present study sought to understand the perceptions of a group of multiprofessional residents in Hospital Care about interdisciplinarity and interprofessionality within the scope of teamwork. This is a qualitative study that had the participation of 29 multiprofessional residents in the 'Hospital Care' area of concentration, all female (six psychologists, six social workers, six nurses, six physiotherapists and five nutritionists). Data were collected by means of a semi-structured interview script. The corpuswas subjected to thematic content analysis. Most of the participants: (1) reported that their first contact with the notion of interdisciplinarity occurred when they were in college, which led to them assimilating it as a synonym for joint action, and (2) claimed to have no knowledge of the notion of interprofessionality, but valued the horizontalization of relations between health professionals. Additionally, important conditions concerning both interdisciplinarity and interprofessionality were not emphasized by the participants. Further studies on the subject are needed, due to its importance for public health.

Aspectos psicossociais da gestação de alto risco: análise de mulheres grávidas hospitalizadas / Psychosocial aspects of high-risk pregnancy: analysis of hospitalized pregnant women / Aspectos psicosociales de la gestación de alto riesgo: análisis de mujeres embarazadas hospitalizadas

A gestação de alto risco é caracterizada por ser um momento em que a vida ou a saúde da mãe e/ou do feto e/ou do recém-nascido está submetida a maiores chances de morte que a média da população considerada. O estudo objetivou apresentar dados sobre o perfil de gestantes de alto risco e identificar os aspectos psicossociais ligados à gravidez. A amostra foi composta por 74 mulheres grávidas em um hospital no município de Juiz de Fora, MG. Elas responderam ao PHQ-2, a EPSS, ao IDATE, ao ASSIST e a um questionário sociodemográfico e clínico. Foi possível observar a prevalência de sintomas de depressão, ansiedade, baixo suporte social e uso de substâncias na população avaliada. As análises confirmaram correlações entre características sociodemográficas, clínicas e aspetos psicossociais. Os resultados demonstram a relevância de se conhecer o perfil dessas mulheres para a melhora na elaboração de estratégias de suporte direcionadas ao enfrentamento de possíveis fatores que possam interferir no bom andamento da gestação.

The high-risk pregnancy is characterized for being a moment that the life or health of the mother and/or fetus and/or newborn is subjected to higher risks of death compared to the average population. The study aimed to present data concerning the profile of high risks pregnancy and determine psychosocial aspects about high-risk. The sample was composed by 74 pregnant women in a hospital located in Juiz de Fora/MG, Brazil. The instruments applied were: PHQ-2, PSSS, STAI, ASSIST and a sociodemographic and clinical survey. It was possible to identify the prevalence of depressive symptoms, anxiety, reduced social support and inappropriate substance use in this population. The analyzes confirmed correlations between sociodemographic, clinical, and psychosocial aspects. The results demonstrate the relevance of knowing the profile of these women to improve the formulation of supportive strategies, directing to confront possible factors that may interfere the good progress of the gestation.

La gestación de alto riesgo se caracteriza por ser un momento que la vida o la salud de la madre y/o del feto está sometida a mayores riesgos de la muerte que la media de la población considerada. El estudio objetivó presentar datos sobre el perfil de gestantes de alto riesgo e identificar los aspectos psicosociales ligados al embarazo de riesgo. Se realizó con 74 mujeres clasificadas en el perfil de gestación de alto riesgo en un hospital en el municipio de Juiz de Fora / MG. Ellas respondieron al PHQ-2, a la EPSS, al IDATE, al ASSIST y a un cuestionario sociodemográfico y clínico. Los análisis confirmaron correlaciones entre características sociodemográficas, clínicas y aspectos psicosociales. Los resultados demuestran la relevancia de conocer el perfil de esas mujeres para mejorar en la elaboración de estrategias de soporte dirigidas al enfrentamiento de factores que puedan interferir en el buen andamiento de la gestación.

Educação interprofissional em saúde: revisão integrativa da literatura brasileira (2008-2018) / Interprofessional education in healthcare: integrative review of brazilian literature (2008-2018) / Educación interprofesional en salud

Este estudo teve como objetivo estabelecer um panorama da produção científica nacional relativa à Educação Interprofissional em Saúde (EIP), com ênfase nas pesquisas desenvolvidas junto a pós-graduandos ou profissionais de saúde ao longo de uma década (2008-2018). Trata-se de uma revisão integrativa realizada mediante consultas às bases de dados MEDLINE, LILACS, SciELO-Brasil e Scopus. Compuseram o corpus de análise 31 referências, as quais foram examinadas segundo um conjunto de dimensões analíticas. Evidenciou-se que as referências se concentram nos últimos cinco anos e, predominantemente, foram assinadas por pesquisadores vinculados a universidades públicas, derivam de pesquisas qualitativas voltadas à prática interprofissional e tiveram como participantes profissionais de saúde inseridos em serviços de atenção primária. Conclui-se que o fortalecimento da EIP no país se afigura como um importante caminho a ser percorrido no sentido da integralidade das ações e dos serviços de saúde, e que novas pesquisas são necessárias para tanto.

This study aimed to establish an overview of the Brazilian scientific production related to Interprofessional Education in Healthcare (IPE), emphasizing researches developed with graduate students or healthcare personnel participation along a decade (2008-2018). This is an integrative review carried out in MEDLINE, LILACS, SciELO-Brasil and Scopus databases. The corpus of analysis consisted of 31 references, which were examined according to a set of analytical dimensions. It was evidenced that the references are concentrated in the last five years, and, predominantly, were signed by researchers from public universities, derive from qualitative research focused on interprofessional practice, and had as participants professionals inserted in primary healthcare services. It can be concluded that the strengthening of IPE in Brazil is an important way towards the integrality of health actions and services, and that new research is needed for this purpose.

Este estudio tuvo como objetivo establecer una visión general de la producción científica brasileña relacionada con la Educación Interprofesional en Salud (EIP), con énfasis en investigaciones realizadas con la participación de estudiantes de posgrado o profesionales de salud a lo largo de una década. Esta es una revisión integradora realizada a través de consultas a las bases de datos MEDLINE, LILACS, SciELO-Brasil y Scopus. El corpus de análisis comprendió 31 referencias, que fueron examinadas de acuerdo con un conjunto de dimensiones analíticas. Se evidenció que las referencias se concentraron en los últimos cinco años, y, predominantemente, fueron firmadas por investigadores vinculados a universidades públicas, son derivadas de investigaciones cualitativas centradas en la práctica interprofesional y tuvieran como participantes profesionales de salud de servicios de atención primaria. Se puede concluir que el fortalecimiento de la IPE en Brasil es una forma importante de avanzar hacia la integralidad de las acciones y servicios de salud, y que se necesita más investigaciones para este fin.

Câncer de mama e imagem corporal: impacto dos tratamentos no olhar de mulheres mastectomizadas / Breast cancer and body image: impact of treatments from the point of view of mastectomized females

Esta pesquisa avaliou a percepção da imagem corporal de mulheres mastectomizadas, com ou sem reconstrução mamária, investigando como o adoecimento e os tratamentos impactaram suas vidas. Trata-se de um estudo descritivo, transversal, com abordagem qualitativa. Participaram dez mulheres com diagnóstico de câncer mamário, mastectomizadas, com ou sem reconstrução mamária, atendidas no HU/UFJF, de janeiro a novembro de 2015, por meio de uma entrevista semiestruturada. Para análise qualitativa, aplicou-se a Análise de Conteúdo de Bardin, de onde emergiram as categorias: "Diagnóstico e Enfrentamento", "Rede de Apoio", "Tratamentos e seus Anseios", "Imagem Corporal", e "Papel na Sociedade". Concluiu-se que o cuidado com a saúde das mulheres acometidas pela doença demanda assistência multiprofissional, que auxilie no processo de enfrentamento do câncer e na reabilitação para além das limitações físicas, com o intuito de reconexão do corpo físico, psíquico e espiritual, visando facilitar a adaptação ao "novo corpo" e permitir incremento na autoestima, a reinserção social e melhoria da qualidade de vida.

The perception of body image by mastectomized females, with or without breast reconstruction, is evaluated. Current descriptive, transversal and qualitative research analyzes how illness and treatments impacted their lives. Ten mastectomized females, diagnosed with breast cancer, attended at the University Hospital of UFJF, between January and November 2015, participated through a half-structured interview. Qualitative analysis comprised Bardin´s Content Analysis, from which were derived the categories: "Diagnosis and Coping", "Support Network", "Treatments and Anxiety", "Body Image", and "Role in Society". Results show that health care of ill females require multiprofessional assistance that helps them to cope with cancer and to rehabilitate them beyond physical limitations. The target is the reconnection of the physical, psychic and spiritual body, to facilitate the adaptation to the 'new body' and allow an increase in self-esteem, social reinsertion and improvement in life quality.

Percepções de residentes multiprofissionais de saúde sobre a interdisciplinaridade / Perceptions of health multi-professional interns on interdisciplinarity

O estudo objetiva compreender as percepções de residentes multiprofissionais acerca: (1) das diferentes formas de atuação em equipe no campo da saúde; (2) da interdisciplinaridade nos Programas de Residência Multiprofissional em Saúde (PRMSs) aos quais se encontram vinculados; e (3) dos fatores que favoreceriam e dificultariam a sua efetivação. Trata-se de um estudo qualitativo, com 29 residentes multiprofissionais de duas universidades federais. Os resultados demonstram que há, entre os participantes, dificuldades significativas na distinção entre as diferentes modalidades de trabalho em equipe. Além disso, observou-se que, para a maioria dos participantes, os PRMSs aos quais se encontram vinculados propiciavam a interdisciplinaridade apenas parcialmente, sendo a iniciativa pessoal dos residentes um dos fatores favorecedores, e problemas no diálogo com os profissionais de Medicina um dos fatores dificultadores. O presente estudo, assim, colabora com o debate científico acerca de uma temática essencial para a consolidação e fortalecimento do Sistema Único de Saúde.

Current study analyzes the perceptions of multi-professional interns on (1) the different working manners with teams in the health area; (2) interdisciplinarity in the Multi-professional Intern Programs (PRMSs) in health to which they are subordinated; (3) factors study involved 29 multi-professional interns of two Brazilian federal universities. Results show that among the participants there are significant difficulties in distinguishing between different team-work modes. In the case of most participants, PRMSs to which they are subordinated favor only partial interdisciplinarity. Personal initiative of interns is one of the favored factors and lack of dialogue between medical professionals is an impeding factor. Current analysis tries to corroborate with the scientific debate on a theme that is essential for the consolidation and strengthening of the Brazilian health System.

Variáveis psicológicas associadas ao crescimento pós-traumático após a vivência do câncer de mama: uma revisão sistemática / Psychological variables associated with posttraumatic growth after breast cancer experience: a systematic review

Introdução: O câncer de mama é considerado um dos tipos de câncer mais comuns entre as mulheres, representando 25% e 29% dos casos novos a cada ano no mundo e no Brasil, respectivamente. A vivência de seu diagnóstico, bem como de seus tratamentos pode acarretar impactos importantes na saúde física e mental, porém esta experiência pode também ser fonte de ressignificações positivas. Objetivo: O presente estudo revisou a literatura sobre as publicações científicas em relação ao crescimento pós-traumático em mulheres com câncer de mama. Material e Métodos:A busca da literatura foi realizada entre os meses de setembro e outubro de 2019, nas bases de dados Medline, Scielo, PsycINFO e Web of Science com base no Protocolo PRISMA, através do cruzamento dos descritores breast neoplasms e posttraumatic growth. Resultados: De um total de 56 referências finais analisadas observou-se que os EUA, China e Portugal são os países com maior número de publicações sobre o tema, sendo a maioria dos estudos de caráter transversal e quantitativo. O crescimento pós-traumático é fenômeno observado em diversas mulheres que sobreviveram ao câncer de mama, sofrendo a influência de fatores como suporte social, estratégias de coping, estresse psicológico, depressão, processamento cognitivo, qualidade de vida, percepção sobre a doença, religiosidade/espiritualidade, ansiedade, estressores específicos do câncer, otimismo, afeto positivo e saúde mental. Conclusão: Através deste estudo foi possível mapear, na literatura, algumas das principais variáveis psicológicas relacionadas ao crescimento observado após a vivência do câncer de mama, podendo esta experiência estar associada não somente a impactos negativos, mas também a ressignificações importantes sobre a vida.

Introduction: Breast cancer is considered one of the most common cancers among women, representing 25% and 29% of the new cases each year in the world and in Brazil. The experience of its diagnosis, as well as its treatments can have important impact on physical and mental health, but this experience can also be a source of positive reframing. Objective: This study revised the literature about the scientific publications concerning the posttraumatic growth in women with breast cancer. Materials and methods: The search of literature was carried out between September and October 2019 in the databases Medline, Scielo, PsycINFO and Web of Science using the PRISMA protocol, through the crossing of the descriptors breast neoplasms and posttraumatic growth. Results: From a total of 56 final references, it was observed that the USA, China and Portugal are the countries with the largest number of publications on the subject, with the majority of cross-sectional and quantitative studies. Posttraumatic growth is a phenomenon observed in several women who have survived breast cancer, being influenced by factors such as social support, coping strategies, psychological stress, depression, cognitive processing, quality of life, perception about the disease, religiosity/spirituality, anxiety, specific cancer stressors, positive affect, mental health, among others. Conclusion: Through this study it was possible to map in the literature some of the main psychological variables related to the growth observed after the experience of breast cancer, and this experience may be associated not only with negative impact, but also with important resignifications concerning life.

Beyond quality of life: a cross sectional study on the mental health of patients with chronic kidney disease undergoing dialysis and their caregivers.

BACKGROUND: Patients with terminal chronic kidney disease (CKDT) requiring renal replacement therapies (RRT) undergo important changes in living habits and frequently need caregiving. These patients and their caregivers are risk groups for the development of physical and psychological symptoms. This study aimed to evaluate the prevalence of anxiety, depression, stress, fatigue, social support, and quality of life in patients with CKD and their caregivers. METHOD: This cross sectional study was conducted with 21 patients and their caregivers, from January to September 2015. We included patients aged over 18 years, with at least 6 months on dialysis treatment, and caregivers who were family members. The participants' social, demographic, clinical, laboratory, and psychological variables were evaluated. A descriptive analysis and an examination of the association between patients and caregivers were performed. RESULTS: Among patients, we observed that 38.1% had symptoms that indicated anxiety and depression. The average score for practical social support was 3.15 ± 0.769 and that for emotional social support was 3.16 ± 0.79. As for fatigue, 14.3% of patients reported being 'extremely tired' and 14.3% reported that they engaged in all the activities they usually performed before the illness. Further, 57.1% presented stress, and of these, 66.7% were at the resistance stage, with predominance of psychological symptoms in 60.0%. The quality of life domain in terms of functional capacity (FC) presented a correlation with haemoglobin level (r = 0.581, p = 0.006) and non-anaemic patients presented better FC. Among caregivers, we observed symptoms that indicated anxiety and depression in 33.3% of the sample. Caregivers exhibited an average score of 2.88 ± 0.77 for practical social support and 3.0 ± 0.72 for emotional social support. Further, 14.3% reported being 'extremely tired' and 28.8% reported that they engaged in all activities that they usually performed before the patient's illness. When comparing the two groups (patients vs. caregivers), we observed that they presented similar results for the presence of anxiety, depression, and fatigue. Caregivers received less social support than patients did. Both groups presented similar predominance of stress levels; however, patients presented more predominance of psychological symptoms. With reference to quality of life, patients and caregivers presented similar results on the social aspects, vitality, mental health, and mental domains. CONCLUSION: The mental health characteristics of patients and caregivers were similar, and within the context of dialysis for renal disease, both must undergo specific interventions.

Stress, coping and adherence to immunosuppressive medications in kidney transplantation: a comparative study / Estresse, coping e aderência a medicamentos imunossupressores em transplante renal: um estudo comparativo

ABSTRACT CONTEXT AND OBJECTIVE : Adherence to medication is a key issue relating to outcomes from transplantation and it is influenced by several factors, such as stress and coping strategies. However, these factors have been poorly explored. We aimed to compare stress and coping strategies between adherent and nonadherent renal transplant recipients who were receiving immunosuppression. DESIGN AND SETTING : We conducted a comparative, cross-sectional and observational study at a university-based transplantation clinic in Juiz de Fora, Brazil. METHODS :Fifty patients were recruited and classified as adherent or nonadherent following administration of the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Stress was evaluated using the Lipp Stress Symptom Inventory for Adults and coping strategies were assessed using the Ways of Coping Scale. RESULTS : The study included 25 nonadherent patients and 25 controls with a mean age of 44.1 ± 12.8 years and median post-transplantation time of 71.8 months. Stress was present in 50% of the patients. Through simple logistic regression, nonadherence was correlated with palliative coping (OR 3.4; CI: 1.02-11.47; P < 0.05) and had a marginal trend toward significance with more advanced phases of stress (OR 4.7; CI: 0.99-22.51; P = 0.053). CONCLUSION :Stress and coping strategies may have implications for understanding and managing nonadherent behavior among transplantation patients and should be considered among the strategies for reducing nonadherence.

RESUMO CONTEXTO E OBJETIVO :Aderência à medicação é uma questão chave para o resultado do transplante e é influenciada por diversos fatores, tais como o estresse e estratégias de enfrentamento ou coping . Entretanto, esses aspectos têm sido pouco explorados. Compararmos o estresse e as estratégias de coping em paciente transplantados renais, aderentes e não aderentes, em uso de imunossupressores. TIPO DE ESTUDOE LOCAL : Realizamos estudo comparativo, transversal e observacional em uma clínica universitária de transplantes em Juiz de Fora, Brasil. MÉTODO :Cinquenta pacientes foram selecionados e classificados como aderentes e não aderentes a partir da escala Basel Assessment of Adherence to Immunosuppressive Medications Scale. O estresse foi avaliado pelo Inventário de Sintomas de Estresse para Adulto de Lipp e as estratégias de coping foram avaliadas pela escala Escala de Modos de Enfrentamento de Problemas. RESULTADOS : O estudo inclui 25 pacientes não aderentes e 25 controles com idade média de 44,1 ± 12,8 anos e mediana de tempo de transplante de 71,8 meses. Estresse esteve presente em 50% dos pacientes. Por regressão linear simples, a não aderência foi associada com o coping paliativo (OR 3,4, CI: 1,02-11,47; P < 0,05) e teve uma tendência marginal a significância com as fases mais avançadas do estresse (OR 4,7, CI: 0,99-22,51; P = 0,053). CONCLUSÃO : Estresse e estratégias de coping podem trazer implicações na compreensão e manejo do comportamento de não aderência dos pacientes transplantados e deveriam ser considerados nas estratégias na redução da não aderência.

Stress, coping and adherence to immunosuppressive medications in kidney transplantation: a comparative study.

CONTEXT AND OBJECTIVE: : Adherence to medication is a key issue relating to outcomes from transplantation and it is influenced by several factors, such as stress and coping strategies. However, these factors have been poorly explored. We aimed to compare stress and coping strategies between adherent and nonadherent renal transplant recipients who were receiving immunosuppression. DESIGN AND SETTING: : We conducted a comparative, cross-sectional and observational study at a university-based transplantation clinic in Juiz de Fora, Brazil. METHODS: :Fifty patients were recruited and classified as adherent or nonadherent following administration of the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Stress was evaluated using the Lipp Stress Symptom Inventory for Adults and coping strategies were assessed using the Ways of Coping Scale. RESULTS: : The study included 25 nonadherent patients and 25 controls with a mean age of 44.1 ± 12.8 years and median post-transplantation time of 71.8 months. Stress was present in 50% of the patients. Through simple logistic regression, nonadherence was correlated with palliative coping (OR 3.4; CI: 1.02-11.47; P < 0.05) and had a marginal trend toward significance with more advanced phases of stress (OR 4.7; CI: 0.99-22.51; P = 0.053). CONCLUSION: :Stress and coping strategies may have implications for understanding and managing nonadherent behavior among transplantation patients and should be considered among the strategies for reducing nonadherence.

Analysis of the changes and difficulties arising from kidney transplantation: a qualitative study.

OBJECTIVE: to identify the main gains and stressors perceived by the patient, one year subsequent to kidney transplantation. METHOD: a qualitative study, in which the data were obtained and analyzed through the Discourse of the Collective Subject and frequency counting, with the participation of 50 patients who had received kidney transplantation. RESULTS: the sample presented a mean age of 44±12.8 years old, and a predominance of males (62%). The principal positive changes provided by the transplant were: return to activities; freedom/independence; well-being and health; strengthening of the I; and closening of interpersonal relationships. The most-cited stressors were: fear; medication; excess of care/control; specific characteristics of the treatment; and failure to return to the social roles. CONCLUSION: kidney transplantation caused various positive changes in the patient's routine, with the return to activities of daily living being the most important gain, in the participants' opinion. In relation to the stressors, fear related to loss of the graft, and questions relating to the immunosuppressive medication were the main challenges to be faced following transplantation.

Analysis of the changes and difficulties arising from kidney transplantation: a qualitative study / Análise das mudanças e dificuldades advindas após o transplante renal: uma pesquisa qualitativa / Análisis de los cambios y dificultades surgidas después del trasplante renal: una investigación cualitativa

to identify the main gains and stressors perceived by the patient, one year subsequent to kidney transplantation.

identificar os principais ganhos e estressores percebidos pelo paciente, após um ano de transplante renal.

identificar las principales ganancias y estresores percibidos por el paciente, después de un año de trasplante renal.

Impact of social vulnerability on the outcomes of predialysis chronic kidney disease patients in an interdisciplinary center.

INTRODUCTION: Numerous studies examined the associations between socio-demographic, economic and individual factors and chronic kidney disease (CKD) outcomes and observed that the associations were complex and multifactorial. Socioeconomic factors can be evaluated by a model of social vulnerability (SV). OBJECTIVE: To analyze the impact of SV on the outcomes of predialysis patients. METHODS: Demographic, clinical and laboratory data were collected from a cohort of patients with predialysis stage 3 to 5 who were treated by an interdisciplinary team (January 2002 and December 2009) in Minas Gerais, Brazil. Factor, cluster and discriminant analysis were performed in sequence to identify the most important variables and develop a model of SV that allowed for classification of the patients as vulnerable or non-vulnerable. Cox regression was performed to examine the impact of SV on the outcomes of mortality and need for renal replacement therapy (RRT). RESULTS: Of the 209 patients examined, 29.4% were classified as vulnerable. No significance difference was found between the vulnerable and non-vulnerable groups regarding either mortality (log rank: 0.23) or need for RRT (log rank: 0.17). In the Cox regression model, the hazard ratios (HRs) for the unadjusted and adjusted impact of SV on mortality were found to be 1.87 (confidence interval [CI]: 0.64-5.41) and 1.47 (CI: 0.35-6.0), respectively, and the unadjusted and adjusted impact of need for RRT to be 1.85 (CI: 0.71-4.8) and 2.19 (CI: 0.50-9.6), respectively. CONCLUSION: These findings indicate that SV did not influence the outcomes of patients with predialysis CKD treated in an interdisciplinary center.

Impact of social vulnerability on the outcomes of predialysis chronic kidney disease patients in an interdisciplinary center / Impacto da vulnerabilidade social nos desfechos de pacientes com doença renal crônica pré-dialítica em um centro interdisciplinar

Introduction: Numerous studies examined the associations between socio-demographic, economic and individual factors and chronic kidney disease (CKD) outcomes and observed that the associations were complex and multifactorial. Socioeconomic factors can be evaluated by a model of social vulnerability (SV). Objective: To analyze the impact of SV on the outcomes of predialysis patients. Methods: Demographic, clinical and laboratory data were collected from a cohort of patients with predialysis stage 3 to 5 who were treated by an interdisciplinary team (January 2002 and December 2009) in Minas Gerais, Brazil. Factor, cluster and discriminant analysis were performed in sequence to identify the most important variables and develop a model of SV that allowed for classification of the patients as vulnerable or non-vulnerable. Cox regression was performed to examine the impact of SV on the outcomes of mortality and need for renal replacement therapy (RRT). Results: Of the 209 patients examined, 29.4% were classified as vulnerable. No significance difference was found between the vulnerable and non-vulnerable groups regarding either mortality (log rank: 0.23) or need for RRT (log rank: 0.17). In the Cox regression model, the hazard ratios (HRs) for the unadjusted and adjusted impact of SV on mortality were found to be 1.87 (confidence interval [CI]: 0.64-5.41) and 1.47 (CI: 0.35-6.0), respectively, and the unadjusted and adjusted impact of need for RRT to be 1.85 (CI: 0.71-4.8) and 2.19 (CI: 0.50-9.6), respectively. Conclusion: These findings indicate that SV did not influence the outcomes of patients with predialysis CKD treated in an interdisciplinary center. .

Introdução: Inúmeros estudos avaliaram as associações entre fatores sociodemográficos, econômicos e doença renal crônica (DRC) e demonstraram que essas associações foram complexas e multifatoriais. Um método para avaliar os fatores socioeconômicos é construir um modelo de vulnerabilidade social (VS). Objetivo: Identificar a influência de vulnerabilidade social (VS) sobre os desfechos de uma coorte de pacientes com doença renal crônica (DRC) pré-dialítica. Métodos: Foram coletados dados demográficos, clínicos e laboratoriais, em uma coorte retrospectiva com pacientes nos estágios 3 a 5, que foram acompanhados por uma equipe interdisciplinar, no período compreendido entre janeiro de 2002 e dezembro de 2009, em Minas Gerais, Brasil. Para calcular a VS, foram utilizadas três técnicas estatísticas em sequência, análise fatorial, análise de agrupamento e análise discriminante. A sobrevida foi analisada com as curvas de Kaplan-Meier. O desfecho foi mortalidade ou iniciar a terapia renal substitutiva (TRS), analisadas por uma regressão de Cox. Resultados: Foram avaliados 209 pacientes, 29,4% eram vulneráveis. Não observamos diferença na mortalidade entre os grupos VS pela Kaplan Meier. Na regressão de Cox, hazard ratio (HR) e intervalo de confiança (CI) para o impacto da VS sobre a mortalidade, não ajustado foi HR: 1.87 (CI: 0.64-5 0,41) e HR ajustado:1,47 (C1: 0.35-60,0). O impacto da VS em TRS mostrou o HR e CI HR não ajustado: 1,85 (CI: 0.7140,8) e HR ajustado: 2,19 (CI: 0.50-90,6). Conclusão: Estes resultados indicam que a VS não influenciou os resultados de pacientes com DRC na pré-diálise tratados em um centro interdisciplinar. .