Práticas de enfermagem na atenção primária em saúde durante a pandemia de covid-19, Maranhão, Brasil / Nursing practices in primary health care during the covid-19 pandemic, Maranhão, Brazil / Prácticas de enfermería en la atención primaria de salud durante la pandemia de covid-19, Maranhão, Brasil

Objetivo: Este estudo analisou vivências e práticas de enfermagem, de enfermeiros da APS em seis municípios do Maranhão, durante a pandemia da covid-19. Métodos: Trata-se de estudo qualitativo, do qual participaram 23 profissionais vinculados à estratégia Saúde da Família, entrevistados de novembro a agosto de 2021. Os dados foram exportados para o software IRaMuTeQ, extraindo-se padrões de associação, e a partir do dendograma das classes obtido, as categorias foram nomeadas e exploradas por análise temática. Foram identificadas quatro categorias: Dificuldades vivenciadas para o atendimento; Interrupções e adaptações na oferta regular das ações; Enfrentamentos para atendimento da covid-19 e O retorno das atividades e os impactos deixados pela pandemia. Resultados: Observou-se desafiante cenário para as práticas de enfermagem nos atendimentos de pacientes com e sem covid-19, fragilidade institucional e falta de organização da estrutura e dos processos de trabalho, com impactos para a vida e assistência dos entrevistados. Conclusões: Os resultados demonstram a necessidade de diferentes investimentos na APS, que embora tenham sido apontados durante a pandemia, extrapolam este cenário, precisam ser inseridos no cotidiano do trabalho destes profissionais. (AU)

Objective: This study analyzed the experiences and nursing practices of PHC nurses in 6 municipalities in Maranhão, during the covid-19 pandemic. Methods: This is a qualitative study, in which 23 professionals linked to the Family Health Strategy participated, interviewed from November to August 2021. The data were exported to the IRaMuTeQ software, extracting association patterns, and from the dendrogram of the classes obtained, the categories were named and explored by thematic analysis. Four categories were identified: Difficulties experienced in providing care; Interruptions and adaptations in the regular offer of shares; Coping with covid-19 and The return of activities and the impacts left by the pandemic. Results: A challenging scenario was observed for nursing practices in the care of patients with and without covid-19, institutional weakness and lack of organization of structure and work processes, with impacts on the life and care of the interviewees. Conclusion: The results demonstrate the need for different investments in PHC, which, although they were pointed out during the pandemic, go beyond this scenario, it need be inserted in the daily work of these professionals. (AU)

Objetivo: Este estudio analizó las experiencias y prácticas de enfermeros de la APS en 6 municipios de Maranhão, durante la pandemia de COVID-19. Métodos: Se trata de un estudio cualitativo, con 23 profesionales vinculados a la Estrategia Salud de la Familia, entrevistados de noviembre a agosto de 2021. Los datos fueron exportados al software IRaMuTeQ, extrayendo del dendrograma de las clases obtenidas, las categorías fueron nombrados y explorados por el análisis temático, en cuatro categorías: Dificultades experimentadas en la atención; Interrupciones y adaptaciones en la oferta regular de acciones; Enfrentando el COVID-19 y El retorno de las actividades y los impactos que dejó la pandemia. Resultados: Se observó un escenario desafiante para las prácticas de enfermería en el cuidado de pacientes con y sin COVID-19, debilidad institucional y falta de organización de la estructura y procesos de trabajo, con impactos en la vida y cuidado de los entrevistados. Conclusión: Los resultados demuestran la necesidad de diferentes inversiones en la APS, que, aunque fueron señaladas durante la pandemia, van más allá de ese escenario y se insertan en el cotidiano de su trabajo. (AU)

Determinantes do comportamento sedentário de idosos que residem em Portugal: análise temática qualitativa a partir da SOS-framework / Determinantes del comportamiento sedentario entre las personas mayores que viven en Portugal: un análisis temático cualitativo basado en el marco SOS / Determinants of sedentary behavior in elderly people living in Portugal: qualitative thematic analysis from the SOS-framework

O processo de envelhecimento resulta num declínio geral das capacidades do indivíduo. Associado ao comportamento sedentário (CS), que traz inúmeras consequências para a saúde, torna-se importante perceber e criar estratégias que modifiquem este comportamento, no sentido depromover uma melhor qualidade de vida. Assim, o objetivo deste estudo foi identificar e compreender quais os determinantes do CS de idosos que residem em Portugal. Participaram no estudo 12 idosos, com idades entre os 71 e os 86 anos (M = 78,92 anos; DP =6,52), que responderam a uma entrevista semiestruturada. Os dados recolhidos foram analisados tendo como base uma perspetiva interpretativa, assumindo uma ontologia relativista e uma epistemologia subjetivista. Os resultados revelaram determinantes que foram reunidos em seis grupos: Saúde e Bem-Estar, Contexto Social e Cultural, Comportamento e Psicologia, Ambiente Construído e Natural, Configurações institucionais/domiciliares e, Política e Economia. Os determinantes mais mencionados pelos participantes para se manterem em CS foram as limitações físicas, as atividades organizadas em grupo (sentados), a solidão, a falta de motivação e de instalações para saírem de casa, as políticas institucionais, o conforto do quarto e, por último, as autoridades locais que não realizam atividades, por vezes, por falta de recursos financeiros. Desta forma, percebemos que o CS é determinado por diversos fatores e todos eles estão relacionados entre si, contudo, não podemos generalizar, sendo necessária uma análise individual e contextual específica, para se ajustarem as estratégias ao indivíduo/grupo. (AU)

El proceso de envejecimiento provoca una disminución general de las capacidades del individuo. Asociado al comportamiento sedentario, que tiene numerosas consecuencias para la salud, es importante entender y crear estrategias para modificar este comportamiento, con el fin de promover una mejor calidad de vida. Por lo tanto, el objetivo de este estudio fue identificar y comprender los determinantes del comportamiento sedentario entre las personas mayores que viven en Portugal. Participaron en el estudio 12 personas mayores de entre 71 y 86 años (M = 78,92 años; DT = 6,52), que completaron una entrevista semiestructurada. Los datos recogidos se analizaron desde una perspectiva interpretativa, asumiendo una ontología relativista y una epistemología subjetivista. Los resultados revelaron determinantes que se agruparon en seis grupos: Salud y bienestar, Contexto social y cultural, Comportamiento y psicología, Entorno construido y natural, Entorno institucional/doméstico y, Política y economía. Los determinantes más mencionados por los participantes para permanecer en el CS fueron las limitaciones físicas, las actividades organizadas en grupo (sentarse), la soledad, la falta de motivación y de facilidades para salir de casa, las políticas institucionales, la comodidad de la habitación y, por último, las autoridades locales que no realizan actividades, a veces por falta de recursos económicos. Así, nos damos cuenta de que el comportamiento sedentario está determinado por varios factores y todos ellos están relacionados entre sí; sin embargo, no podemos generalizar, y se requiere un análisis contextual individual y específico para ajustar las estrategias al individuo/grupo. (AU)

The aging process results in a general decline in the individual's abilities. Associated with sedentary behavior, which has numerous health consequences, it is important to understand and create strategies to modify this behavior in order to promote a better quality of life. Thus, the aim of this study was to identify and understand the determinants of sedentary behavior among the elderly living in Portugal. Twelve elderly aged between 71 and 86 years (M = 78.92 years; SD = 6.52) participated in the study and answered a semi-structured interview. The data collected were analyzed based on an interpretive perspective, assuming a relativistic ontology and a subjectivist epistemology. The results revealed determinants that were gathered into six groups: Health and Well-Being, Social and Cultural Context, Behavior and Psychology, Built and NaturalEnvironment, Institutional/Household Settings, and, Politics and Economy. The determinants most mentioned by participants for staying in sedentary behavior were physical limitations, organized group activities (sitting), loneliness, lack of motivation andfacilities to leave home, institutional policies, room comfort, and lastly, local authorities that do not carry out activities sometimes due to lack of financial resources. Thus, we realize that sedentary behavior is determined by several factors andtheyare all related to each other; however, we cannot generalize, and an individual and specific contextual analysis is necessary to adjust strategies to the individual/group. (AU)

Dificuldades no enfrentamento da hanseníase no tratamento e pós-alta / Difficulties coping with leprosy during treatment and post-discharge

Objetivo: Identificar as principais dificuldades durante o tratamento e pós-alta de pacientes com hanseníase atendidos na Atenção Secundária em Teresina-Piauí e seu perfil epidemiológico. Métodos: Trata-se de um estudo transversal, quantitativo, que identificou necessidades e levantou dados de pacientes em tratamento de hanseníase em um serviço de referência localizado em Teresina-Piauí. Resultados: Na amostra, observou-se predomínio de pacientes do sexo masculino (58,5%), casados ou em união estável (54,7%), com ensino fundamental completo (62,3%), renda de 1 a 2 salários mínimos (66,0%) e residentes em Teresina-Piauí (90,6%). A idade média dos pacientes foi 53 anos. 9,4% abandonaram o tratamento. No pós-alta, 90,6% dos pacientes apresentaram algum tipo de sequela. Notou-se que a ausência de conhecimento sobre a hanseníase retardou o acesso ao sistema de saúde. Verificou-se associação significativa entre a variável presença de sequela e alteração de sensibilidade (p=0,014). Os relatos de preconceito foram mais frequentes durante o tratamento (41,5%), em relação ao pós-alta (15,1%). Conclusão: A hanseníase ainda é uma doença negligenciada, estigmatizada e de difícil diagnóstico, sendo necessário maiores investimentos em políticas públicas para a difusão de conhecimentos sobre a doença. Descritores: Hanseníase; Terapêutica; Perfil de Saúde; Conhecimento; Estigma Social.

Objective: To identify the main difficulties and the epidemiological profile during treatment and post-discharge in patients with leprosy treated at the Secondary Care level in Teresina-Piauí.Methods: This is a cross-sectional and quantitative study that identified needs and surveyed data from patients undergoing leprosy treatment in a reference service located in Teresina-Piauí.Results: In the sample, there was predominance of male patients (58.5%), married or in a stable union (54.7%), with complete Elementary School (62.3%), incomes of 1 to 2 minimum wages (66.0%) and residents of Teresina-Piauí (90.6%). The mean age of the patients was 53years old. 9.4% abandoned the treatment. 90.6% of the patients presented some type of sequelae post-discharge. It was noticed that lack of knowledge about leprosy delayed access to the health system. A significant association was verified between the "presence of sequelae" variable and change in sensitivity (p = 0.014). The reports about prejudice were more frequent during the treatment (41.5%) than in the post-discharge period(15.1%). Conclusion: Leprosy is still a neglected, stigmatized and difficult to diagnose disease, with a need for greater investments in public policies to disseminate knowledge about the disease. Descriptors: Leprosy; Therapy; Health Profile; Knowledge; Social Stigma.

Percepções e conhecimentos médicos sobre limitação de suporte de vida / Physician perceptions and knowledge about limiting life support / Percepciones y conocimientos médicos sobre la limitación del soporte vital

Resumo Este estudo descritivo e qualitativo identificou percepções e conhecimentos de médicos de unidades de terapia intensiva sobre a limitação do suporte de vida. Os resultados revelaram diferentes compreensões e estímulos acerca do uso da limitação do suporte de vida: tomadas de decisão isoladas e compartilhadas; empecilhos como família, profissionais, questões jurídicas e imprevisibilidade da morte; e relatos de casos específicos com benefícios, dilemas e especificidades por quadro e faixa etária. Existe consenso quanto à necessidade de limitação do suporte de vida, mas falta preparo na formação e persistem divergências de compreensão. Os diferentes estímulos para seu uso e as dificuldades para tomada de decisão e definição de condutas são permeados por conflitos éticos, culturais e pessoais e demonstram a necessidade de educar sobre o tema em diferentes níveis de formação de profissionais de saúde.

Abstract This qualitative, descriptive study identified perceptions and knowledge of intensive care unit physicians about limiting life support. Results revealed different understandings and reasons for limiting life support: shared and isolated decision-making; obstacles such as family, professionals, legal issues and unpredictability of death; and specific case reports with benefits, dilemmas, and specificities by clinical picture and age group. Physicians agree on the need to limit life support but lack training on the topic and differences in understanding remain. The multiple reasons for its use and difficulties in decision-making and definition of conduct are permeated by ethical, cultural and personal conflicts, demonstrating the need for better education on the theme at different levels of health professional training.

Resumen Este estudio descriptivo y cualitativo identificó las percepciones y el conocimiento de los médicos en las unidades de cuidados intensivos sobre la limitación del soporte vital. Los resultados revelaron diferentes comprensiones y estímulos sobre el uso de la limitación del soporte vital: toma de decisiones aislada y compartida; obstáculos como la familia, los profesionales, las cuestiones legales y la imprevisibilidad de la muerte; e informes de casos específicos con beneficios, dilemas y especificidades por condición y grupo de edad. Existe consenso sobre la necesidad de limitar el soporte vital, pero carece de preparación y persisten las diferencias de comprensión. Los diferentes estímulos para su uso y las dificultades para la toma de decisiones y la definición de conductas están impregnados de conflictos éticos, culturales y personales, además de que demuestran la necesidad de discutir sobre el tema en los diferentes niveles de formación de los profesionales de la salud.

Simulação in situ e suas diferentes aplicações na área da saúde: uma revisão integrativa / In situ simulation and its different applications in healthcare: an integrative review

Resumo Introdução: A simulação in situ (SIS) consiste em técnica de capacitação que ocorre no local real de trabalho como um método relevante para promover a fidelidade ambiental no cenário simulado. Objetivo: Este estudo teve como objetivo verificar o uso da SIS no mundo para compreender sua aplicabilidade na área de saúde. Método: Trata-se de uma revisão integrativa que adotou a seguinte questão norteadora: "Como tem sido utilizada a simulação in situ por profissionais da área da saúde?". Foram realizadas buscas nas bases PubMed, SciELO, LILACS e Web of Science, com as diferentes combinações dos descritores "simulação in situ", "saúde" e "medicina" (em português, inglês e espanhol) e os operadores booleanos AND e OR, com utilização de filtro temporal de 2012 a 2021. Encontraram-se 358 artigos, nos quais se aplicaram os critérios de inclusão e exclusão, seguindo as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Após revisão independente realizada por pares, com o uso do Rayyan, restaram 190 para esta revisão. Resultado: Os resultados mostraram que os Estados Unidos detêm a maioria absoluta das produções (97/51%), seguidos do Canadá, porém com grande diferença numérica (18/9,5%). A maior parte dos trabalhos está escrita em inglês (184/96,8%), é quase experimental (97/51%) e tem equipes multiprofissionais como público-alvo (155/81,6%). Os artigos têm 11.315 participantes e 2.268 intervenções de simulação. Os principais cenários de SIS foram os setores de urgência e emergência (114/60%), seguidos de UTI (17/9%), sala de parto (16/8,42%) e centro cirúrgico (13/6,84%). Os temas mais estudados foram RCP (27/14,21%), Covid-19 (21/11%), complicações do parto (13/6,8%) e trauma (11/5,8%). As vantagens apontadas incluem: atualização profissional e aquisição de habilidades e competências em ambiente próximo do real e de baixo custo por não depender de dispendiosos centros de simulação. Conclusão: Em todo o mundo, a SIS tem sido utilizada por profissionais da saúde como estratégia de educação na área de saúde, com bons resultados para aprendizagem e capacitações de diferentes momentos da formação profissional e com melhora da assistência. Ainda há muito o que expandir em relação ao uso da SIS, sobretudo no Brasil, na publicação de estudos sobre essa abordagem.

Abstract Introduction: The in situ simulation (ISS) consists of a training technique that takes place in the real workplace as a relevant method to promote environmental fidelity in the simulated scenario. Objective: To verify the use of the ISS in the world, to understand its applicability in healthcare. Method: This is an integrative review, which used the following guiding question: How has in situ simulation been used by health professionals? Searches were carried out in the PubMed, SciELO, LILACS and Web of Science databases, with different combinations of the following descriptors: in situ simulation, health and medicine (in Portuguese, English and Spanish) and the Boolean operators AND and OR using a temporal filter from 2012 to 2021. A total of 358 articles were found and the inclusion and exclusion criteria were applied, following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and also with an independent peer review, using Rayyan, leaving 190 articles for this review. Results: The results showed that the United States has the absolute majority of productions (97/51%), followed by Canada, but with a large numerical difference (18/9.5%). Most of the works are written in English (184/96.8%), are quasi-experimental studies (97/51%), and have multidisciplinary teams as the target audience (155/81.6%). The articles have 11,315 participants and 2,268 simulation interventions. The main ISS scenarios were the urgent and emergency sectors (114/60%), followed by the ICU (17/9%), delivery room (16/8.42%) and surgical center (13/6.84%). The most frequently studied topics were CPR (27/14.21%), COVID-19 (21/11%), childbirth complications (13/6.8%) and trauma (11/5.8%). Discussion: The pointed-out advantages include the opportunity for professional updating with the acquisition of knowledge, skills and competencies, in an environment close to the real thing and at low cost, as it does not depend on expensive simulation centers. Conclusion: In situ simulation has been used by health professionals worldwide, as a health education strategy, with good results for learning and training at different moments of professional training, with improved care and low cost. There is still much to expand in relation to the use of ISS, especially in Brazil, in the publication of studies and experience reports on this approach.

Perfil epidemiológico dos casos de hanseníase em um estado do nordeste brasileiro de 2018 a 2022 / Epidemiological profile of the cases of leprosy in a state in the northeast of brazil from 2018 to 2022 / Perfil epidemiológico de los casos de hanseniasis en un estado del noreste de brasil de 2018 a 2022

A hanseníase é uma doença crônica, infectocontagiosa, de notificação compulsória e investigação obrigatória no Brasil, de evolução lenta, causada pelo bacilo Mycobacterium leprae que acomete predominantemente pele e nervos periféricos causando incapacidades funcionais permanentes de diversos graus, além de ser uma patologia ainda cercada por estigma e discriminação social. O objetivo do artigo consiste em avaliar o perfil epidemiológico da hanseníase no Estado do Rio Grande do Norte entre 2018 a 2022, estado que ocupa, atualmente, o 3° lugar a nível nacional de registro geral de casos de hanseníase. Trata-se de um estudo epidemiológico, descritivo, retrospectivo e de abordagem quantitativa, com base em dados obtidos no Departamento de Informática do Sistema Único de Saúde (DATASUS) e analisados com auxílio do software livre Jamovi 2.3.21 solid. O perfil epidemiológico da hanseníase no período de 2018 a 2022, no Estado do Rio Grande do Norte, apresentou predomínio pelo sexo feminino, acometendo adultos entre 50 a 69 anos de idade, com registro ignorado ou em branco no grau de escolaridade, predominando a forma multibacilar do tipo Virchowiana, causando grau 0 de incapacidade e a grande parte dos casos evoluindo para a cura. Portanto, faz-se relevante conhecer melhor o perfil epidemiológico e a realidade de cada município, visto que é uma patologia fortemente relacionada a condições econômicas, sociais e ambientais desfavoráveis passíveis de intervenção.

Leprosy is a chronic, contagious infectious disease, compulsorily notifiable and compulsory research in Brazil, of slow evolution, caused by the bacillus Mycobacterium leprae that predominantly affects skin and peripheral nerves causing permanent functional impairments of various degrees, besides being a pathology still surrounded by stigma and social discrimination. The objective of the article is to evaluate the epidemiological profile of leprosy in the State of Rio Grande do Norte between 2018 and 2022, which currently occupies the 3rd place at the national level of general registration of cases of leprosy. This is an epidemiological, descriptive, retrospective and quantitative approach study, based on data obtained in the Department of Information Technology of the Unified Health System (DATASUS) and analyzed with the help of free software Jamovi 2.3.21 solid. The epidemiological profile of leprosy in the period from 2018 to 2022, in the state of Rio Grande do Norte, showed predominance by the female sex, affecting adults between 50 and 69 years of age, with ignored or blank registration in the level of schooling, predominating the multibacillary form of the Virchowiana type, causing grade 0 disability and the great majority of cases evolving to cure. Therefore, it is important to know better the epidemiological profile and reality of each municipality, since it is a pathology strongly related to unfavorable economic, social and environmental conditions that can intervene.

La Hanseniasis es una enfermedad crónica, una enfermedad contagiosa, una notificación obligatoria e investigación obligatoria en Brasil, de evolución lenta, causada por el bacilo Mycobacterium leprae, que ataca predominantemente la piel y los nervios periféricos, causando discapacidades funcionales permanentes de diversos grados, además de ser una enfermedad aún rodeada de estigma y discriminación social. El propósito del artículo es evaluar el perfil epidemiológico de la lepra en el estado de Río Grande del Norte entre 2018 y 2022, un estado que actualmente ocupa el tercer lugar en el registro general nacional de casos de lepra. Se trata de un estudio de enfoque epidemiológico, descriptivo, retrospectivo y cuantitativo basado en datos obtenidos del Departamento de Datos del Sistema de Salud Pública (DATASUS) y analizado con la ayuda del software sólido Jamovi 2.3.21 libre. El perfil epidemiológico de la lepra en el período 2018-2022, en el estado de Rio Grande do Norte, mostró predominio del sexo femenino, atacando a adultos de 50 a 69 años, con un registro desconocido o en blanco en el grado de escolaridad, predominando en la forma multibacible del tipo Virchowiana, causando un grado de discapacidad y el gran número de casos. evolucionando hacia la curación. Por lo tanto, es importante conocer mejor el perfil epidemiológico y la realidad de cada municipio, ya que se trata de una enfermedad que está fuertemente relacionada con condiciones económicas, sociales y ambientales desfavorables que pueden ser intervenidas.

Fatores associados à infecção pelo papilomavírus humano na gestação: Uma revisão integrativa / Factores asociados a la infección por el virus del papiloma humano durante el embarazo: Una revisión integradora / Factors associated with human papillomavirus infection during pregnancy: An integrative review

Objetivo: Identificar os fatores associados à infecção pelo papilomavírus humano em gestantes. Método: Revisão integrativa realizada nas seguintes bases de dados: BDENF, LILACS, MEDLINE e IBECS. Foram utilizados os seguintes descritores: "Papilomavirus Humano", "HPV", "Gravidez", "Infecções Sexualmente Transmissíveis" e "IST" (com respectivas traduções para o inglês). Resultados: Seis artigos compuseram a amostra final deste estudo. O design de pesquisa mais prevalente foi o estudo transversal (n: 03). Verificou-se que os fatores associados à infecção pelo HPV estavam relacionados a características sociodemográficas (menor idade, baixa escolaridade, estado civil solteira e consumo de álcool na gestação) e maternas (multiparidade). Conclusão: Verificou-se que alguns fatores podem estar associados à presença de infecção pelo HPV em gestantes, como características sociodemográficas e maternas. Faz-se necessário que os profissionais de saúde tenham um olhar mais atento a este público, afim de contribuir para disseminação da informação e consequente prevenção.(AU)

Objective: To identify factors associated with human papillomavirus infection in pregnant women. Method: Integrative review carried out in the following databases: BDENF, LILACS, MEDLINE and IBECS. The following descriptors were used: "Papilomavirus Humano", "HPV", "Gravidez", "Infecções Sexualmente Transmissíveis" and "IST" (with respective translations into English). Results: Six articles made up the final sample of this study. The most prevalent research design was the cross-sectional study (n: 03). It was found that the factors associated with HPV infection were related to sociodemographic (younger age, low education, single marital status and alcohol consumption during pregnancy) and maternal (multiparity) characteristics. Conclusion: It was found that some factors may be associated with the presence of HPV infection in pregnant women, such as sociodemographic and maternal characteristics. It is necessary that health professionals have a closer look at this public, in order to contribute to the dissemination of information and consequent prevention.(AU)

Objetivo: Identificar los factores asociados a la infección por el virus del papiloma humano en mujeres embarazadas. Método: Revisión integrativa realizada en las siguientes bases de datos: BDENF, LILACS, MEDLINE e IBECS. Se utilizaron los siguientes descriptores: "Papilomavirus Humano", "HPV", "Gravidez", "Infecções Sexualmente Transmissíveis" y "IST" (con sus respectivas traducciones al inglés). Resultados: Seis artículos constituyeron la muestra final de este estudio. El diseño de investigación más prevalente fue el estudio transversal (n: 03). Se encontró que los factores asociados a la infección por VPH se relacionaron con características sociodemográficas (menor edad, baja escolaridad, estado civil soltero y consumo de alcohol durante el embarazo) y maternas (multiparidad). Conclusión: Se encontró que algunos factores pueden estar asociados a la presencia de infección por VPH en gestantes, como las características sociodemográficas y maternas. Es necesario que los profesionales de la salud tengan una mirada más cercana a este público, a fin de contribuir a la difusión de información y consecuente prevención.(AU)

The industrial versatility of Gluconobacter oxydans: current applications and future perspectives.

Gluconobacter oxydans is a well-known acetic acid bacterium that has long been applied in the biotechnological industry. Its extraordinary capacity to oxidize a variety of sugars, polyols, and alcohols into acids, aldehydes, and ketones is advantageous for the production of valuable compounds. Relevant G. oxydans industrial applications are in the manufacture of L-ascorbic acid (vitamin C), miglitol, gluconic acid and its derivatives, and dihydroxyacetone. Increasing efforts on improving these processes have been made in the last few years, especially by applying metabolic engineering. Thereby, a series of genes have been targeted to construct powerful recombinant strains to be used in optimized fermentation. Furthermore, low-cost feedstocks, mostly agro-industrial wastes or byproducts, have been investigated, to reduce processing costs and improve the sustainability of G. oxydans bioprocess. Nonetheless, further research is required mainly to make these raw materials feasible at the industrial scale. The current shortage of suitable genetic tools for metabolic engineering modifications in G. oxydans is another challenge to be overcome. This paper aims to give an overview of the most relevant industrial G. oxydans processes and the current strategies developed for their improvement.

Rupture and chemical accumulation in contact lenses with dexamethasone eye drop administration after congenital cataract surgery.

PURPOSE: To investigate whether contact lenses used after surgery for congenital cataracts act as a depot for dexamethasone, which would allow the prescribed amount of drops to be reduced, and to examine whether the preservative benzalkonium chloride accumulates in the contact lens matrix, which would suggest a need for more frequent replacements. METHODS: Contact lenses (n = 10) worn by infants treated with dexamethasone eye drops after congenital cataract surgery were analysed with scanning electron microscopy, UV-vis, 1 H-NMR and LDI-MS for chemical deposits and for changes on the contact lens surface. Unused lenses (n = 5) and lenses (n = 4) from patients with no eye drop treatment were analysed as reference. RESULTS: The treated contact lenses displayed ruptured surfaces in comparison with unused and reference lenses. Dexamethasone and BAK were not detected in any of the lenses. A polyethylene oxide component was found in the treated lenses, likely originating from the dexamethasone eye drops or the contact lens solution. CONCLUSION: Dexamethasone and BAK do not accumulate in the contact lenses, and a depot effect of any clinical significance is unlikely. Therefore, the number of drops given after surgery should remain the same regardless of whether the child has contact lenses. The ruptured surface may both decrease the child's comfort and increase the risk of microbial adhesion, and so it is recommended that contact lenses should be replaced once a month throughout the course of anti-inflammatory eye drop treatment after surgery for congenital cataract.

Evaluation of Chlamydia trachomatis and HR-HPV infection in women living with HIV: a cross-sectional study / Avaliação da infecção por Chlamydia trachomatis e HR-HPV em mulheres vivendo com HIV: um estudo transversal

Introduction: Infections caused by Chlamydia trachomatis (CT) and Human Papilloma Virus (HPV) are among the most prevalent sexually transmitted infections (STIs) worldwide. CT infection in women living with the human immunodeficiency virus (HIV) can facilitate HIV transmission by increasing HIV shedding in cervicovaginal secretions. The prevalence of Human papillomavirus (HPV) infection is higher in women living with HIV when compared to HIVnegative women, even when comparing those with the same sociodemographic characteristics. Generally, they have a high viral load and a higher persistence of viral infection, which increases the risk of developing premalignant and malignant lesions in the lower genital tract. Objective: To evaluate the frequency of CT and High-Risk HPV (HR-HPV) infection among women living with HIV and the association with sociodemographic, behavioral and clinical characteristics. Methods: Cross-sectional study carried out with a population of 66 non-pregnant women aged between 18 and 70 years living with HIV and/or acquired immunodeficiency syndrome (AIDS) at the Hospital Universitário Antônio Pedro, Universidade Federal Fluminense (UFF), Niterói (RJ), Brazil, between the period of March 1, 2018 and October 31, 2018. A standardized questionnaire was applied including sociodemographic and behavioral characteristics, and clinical information (use of oral contraceptives, Antiretroviral Therapy (ART), cluster of differentiation 4 (CD4) cell count, and viral load). Endocervical samples were collected for CT (COBAS 4800® system, Roche) and HPV (COBAS® HPV test, Roche) detection. Fisher's Exact Test was used to assess the association between variables. Regression analyses were performed using the logistic model in order to identify the factors associated with the outcomes of interest. Results: A frequency of 1.5% for CT and 21.2% for HR-HPV was found. Age was the single factor that presented statistical significance associated with HR-HPV infection. Conclusion: Our study showed that some women living with HIV promote risky behavior which could facilitate the acquisition of other STIs, such as HPV and CT infection. Some of them, with detected viral load, were not using condoms even with HIV-negative partners. These results may suggest that in addition to treatment and follow-up of women living with HIV, STIs counseling and guidance may play an important role in the control of STIs in this population

Introdução: As infecções causadas por Chlamydia trachomatis e por papilomavírus humano (HPV) estão entre as infecções sexualmente transmissíveis (IST) mais prevalentes em todo o mundo. A infecção por Chlamydia trachomatis em mulheres que vivem com HIV pode facilitar a transmissão do HIV, aumentando a disseminação do HIV cérvico-vaginal. A prevalência da infecção pelo HPV é maior em mulheres vivendo com HIV quando comparadas às mulheres HIV negativas, mesmo quando comparadas àquelas com as mesmas características sociodemográficas. Geralmente apresentam carga viral elevada e maior persistência de infecção viral, o que aumenta o risco de desenvolver lesões pré-malignas e malignas no trato genital inferior. Objetivo: Avaliar a frequência de infecção por Chlamydia trachomatis e HPV de alto risco (HR-HPV) em mulheres vivendo com HIV e sua associação com características sociodemográficas, comportamentais e clínicas. Métodos: Estudo transversal realizado com uma população de 66 mulheres não gestantes de 18 a 70 anos vivendo com HIV e/ou AIDS no Hospital Universitário Antônio Pedro, Universidade Federal Fluminense ­ Niterói (RJ), Brasil, entre 1º de março e 31 de outubro de 2018. Aplicou-se um questionário padronizado incluindo características sociodemográficas e comportamentais e informações clínicas (uso de anticoncepcionais orais, terapia antirretroviral, contagem de células CD4 e carga viral). Amostras endocervicais foram coletadas para detectar Chlamydia trachomatis (COBAS 4800® Roche) e HPV (COBAS ® HPV Roche). O teste exato de Fisher avaliou a associação entre as variáveis. As análises de regressão foram realizadas por meio do modelo logístico, a fim de identificar os fatores associados aos desfechos de interesse. Resultados: Encontrou-se frequência de 1,5% para Chlamydia trachomatis e 21,2% para HR-HPV. A idade foi o único fator que apresentou significância estatística associada à infecção por HR-HPV. Conclusão: Nosso estudo mostra que algumas mulheres vivendo com HIV praticam comportamentos de risco que podem facilitar a aquisição de outras IST, como a infecção por HPV e Chlamydia trachomatis. Algumas delas com carga viral detectada não usavam preservativo, mesmo com parceiros HIV negativos. Esses resultados podem sugerir que, além do tratamento e acompanhamento de mulheres vivendo com HIV, o aconselhamento e a orientação para IST podem desempenhar um papel importante no controle das IST nessa população.

Swedish Parents' Experiences and Their Need for Support When Having a Child with Congenital Cataract: A Qualitative Study.

PURPOSE: To explore parents' experiences of living with a child with congenital cataract, with the intention of identifying how to improve the parental support. DESIGN AND METHOD: A qualitative descriptive design using semi-structured interviews. The parents were interviewed when the children were aged 12-24 months. All children were operated on for congenital cataract before three months of age. The interviews were transcribed and analysed using qualitative content analysis with an inductive approach. Findings were reported following the Standard for Reporting Qualitative Research (SRQR) checklist. RESULTS: Three categories emerged from the data: trying to survive during a chaotic time; adapting to a different normal; being in need of support. When receiving the preliminary diagnosis, most of the parents were upset but managed well once the initial shock had subsided. However, some described feelings of despair, difficulties in accepting the situation and in connecting with the child. All parents stated that, to be valuable, a counsellor needed to have insights in how the eye works and the function of visual development. CONCLUSION: The parents' need for psychosocial support in the early post-diagnostic stage varied greatly. Early identification of those in need of specialized counselling is therefore of importance, preferably at the maternity ward or by the regional ophthalmologist when the referral is made. CLINICAL IMPLICATIONS: The study provides understanding of the importance to take the parents' well-being beyond the medical issues into consideration. This knowledge can be used to provide support at an earlier stage in the treatment programme than is currently the case.

Contributors and Moderators of Quality of Life in Caregivers of Alzheimer´s Disease Patients.

Aim and objective: This study aimed to identify the variables that contributed to Quality of Life (QoL) of Alzheimer's Disease (AD) caregivers, taking into consideration the caregiving context, stressors, role strains, and resources.Methods: The sample included 102 caregivers of AD patients who answered the following instruments: Depression, Anxiety and Stress Scale-21; Satisfaction with Social Support Scale; Revised Memory and Behavioral Problems Checklist; Family Communication and Satisfaction Scales; Spiritual and Religious Attitudes in Dealing with Illness; and Quality of Life in Alzheimer's Disease - Caregiver Version.Results: Caregivers who were employed, chose the caregiving role, and received help in caring showed better QoL. Also, being younger, less caregiving daily hours, caring for patients with less memory and behavior problems, lower distress, and family satisfaction predicted better QoL. Finally, spirituality was a moderator between family communication and QoL but not between family satisfaction and QoL.Conclusion: Caregiving-context variables (age, professional status, choosing to care, receiving help in the caregiving role and duration of daily care); role strains (family dissatisfaction); stressors (caregivers' distress and patients' memory and behavioral problems); and resources (spirituality) had an impact on caregivers' QoL emphasizing the adequacy of the Stress Process Model. Intervention should also focus on spirituality given its moderating role.

Social participation and self-assessment of health status among older people in Brazil.

To estimate the prevalence of social participation (exposure) and its association with positive self-assessment of overall health status (SAH) (outcome) among 7,712 Brazilian elderly interviewed in the National Health Survey 2013. A cross-sectional study that used Propensity Score (PS) to improve comparability between the group exposed and no exposed to social participation. Poisson regression was performed to determine the prevalence and association of interest using crude and adjusted by inverse probability of selection of PS. Social participation was reported by 25.1% (CI95%: 23.4-26.9) and was lower among poor older people, who depend on public transportation and live in more precarious contexts. Most did not SAH positively, but the proportion was higher when they had social participation (48.0%; CI95%: 46.0-51.0). There was a positive association of social participation with SAH positive. The association using the adjusted model (PR: 1.15; CI95%: 1.08-1.22) attenuated the estimated in the crude model. Elderly exposed were 15% more likely to provide a positive SAH. Despite low levels in Brazil, there was a positive association between of social participation and SAH, confirming that engagement in such activities provides important gains for the health and quality of life.

Behavioral profile, lifestyle and social skills in Portuguese adolescents.

BACKGROUND: Seventy percent of premature deaths in adults are due to behaviors initiated during adolescence. Therefore, it is essential to promote individual and social behaviors that educate adolescents in the ability to make healthy choices. Accordingly, the main goals of this study were to characterize Lifestyles and Social Skills, as well as identify homogeneous subgroups, in a sample of Portuguese adolescents. METHODS: A cross-sectional study was conducted, including 1008 adolescents attending the 7th to the 9th grades of five middle schools from the Tâmega and Sousa regions of Portugal, and using the My Lifestyle Questionnaire and the Social Skills Inventory. To establish a profile of the participants, a Cluster Analysis (K-means) was performed, and the Jaccard coefficient was used to assess the stability of the solution found. RESULTS: From the total sample, 556 adolescents with a mean age of 13.43 years (SD = 1.1) were included in the analysis. The majority of the sample presented a healthy lifestyle (72.26%) and 50.7% of the adolescents had a highly elaborated repertoire of Social Skills. Moreover, three clusters were found. Cluster 1 (n = 92) showed a less elaborate repertoire of Social Skills and was designated as the "Adjusted". Cluster 2 (n = 115) comprised adolescents with a good repertoire of Social Skills and was named the "Sociable". Cluster 3 (n = 258) was composed of adolescents with a highly elaborate repertoire of Social Skills and the best Lifestyle indicators and was named the "Healthy". CONCLUSIONS: The group of adolescents in the cluster called the "Sociable" needs to be included in health education and Social Skills programs. Nutrition and Monitored Safety behaviors reveal low values and, therefore, present a greater need for awareness, sensitization, and intervention in the school context. For this reason, the promotion of a healthy lifestyle should be part of the academic curriculum and transversal to all academic disciplines.

Association of Salt Iodization and Urine Iodine Concentration in Schoolchildren from Public Schools in Northeast of Brazil.

Iodine deficiency (ID) is recognized as a leading risk factor for child development. Universal salt iodization (USI) is an effective and well-established intervention strategy for the prevention of iodine deficiency disorders (IDD). To evaluate the levels of iodine in household salt samples and the urinary iodine concentration (UIC) in schoolchildren aged 6 to 14 years in public schools in Bahia, Brazil. A cross-sectional study was conducted with 1231 students (6 to 14 years old) from 17 public schools in Bahia. The iodine concentration was evaluated in salt and UIC samples. The adapted Sandell-Kolthoff reaction was used to determine urinary iodine levels. A spectrophotometer (UV-Vis) was used to examine the reduction of ceric ammonium sulfate. A standard iodine solution using a potassium iodate was used to extrapolate the iodine concentrations. The total of 665 salt samples had a median iodine concentration of 24 mg/kg (25th-75th percentile 17.0 to 28.5 mg/kg). The largest proportion (79.6%) of salt samples had iodine concentration in the recommended range, 17.6% of the samples presented iodine at a salt concentration below the established level (<15 mg/kg) and a small proportion was above it (2.8%). The general mean urinary iodine concentration (MUIC) was 217.53 ± 28.30 µg/L and median was 205.50 µg/L. The students evaluated and the salt samples analyzed showed satisfactory results, as recommended by Brazilian legislation and nutritional recommendations of the World Health Organization (WHO).

Social participation and self-assessment of health status among older people in Brazil / Participação social e autoavaliação do estado de saúde entre idosos no Brasil

Abstract To estimate the prevalence of social participation (exposure) and its association with positive self-assessment of overall health status (SAH) (outcome) among 7,712 Brazilian elderly interviewed in the National Health Survey 2013. A cross-sectional study that used Propensity Score (PS) to improve comparability between the group exposed and no exposed to social participation. Poisson regression was performed to determine the prevalence and association of interest using crude and adjusted by inverse probability of selection of PS. Social participation was reported by 25.1% (CI95%: 23.4-26.9) and was lower among poor older people, who depend on public transportation and live in more precarious contexts. Most did not SAH positively, but the proportion was higher when they had social participation (48.0%; CI95%: 46.0-51.0). There was a positive association of social participation with SAH positive. The association using the adjusted model (PR: 1.15; CI95%: 1.08-1.22) attenuated the estimated in the crude model. Elderly exposed were 15% more likely to provide a positive SAH. Despite low levels in Brazil, there was a positive association between of social participation and SAH, confirming that engagement in such activities provides important gains for the health and quality of life.

Resumo Estimar a prevalência da participação social (exposição) e sua associação com a autoavaliação positiva do estado de saúde (AAS) (desfecho) de 7.712 idosos entrevistados na Pesquisa Nacional de Saúde 2013. Trata-se de estudo transversal que usou o Escore de Propensão (EP) para melhorar a comparação entre o grupo exposto e não exposto a participação social. Realizou-se regressão de Poisson para determinar a prevalência e associação em estudo com o modelo bruto e ajustado pelo inverso da probabilidade de seleção do EP. A participação social foi referida por 25,1% (IC:95%: 23,4-26,9) e foi menor entre os idosos pobres, que dependem de transporte público e vivem em contextos mais precários. A maioria não avaliou positivamente sua saúde, mas a proporção foi maior quando tem participação social (48,0%; IC95%: 46,0-51,0). Houve associação positiva da participação social com a AAS positiva. A magnitude de associação usando o modelo ajustado (RP: 1,15; IC95%: 1,08-1,22) atenuou a estimada no modelo bruto. Idosos expostos tiveram 15% a mais de chance de referir AAS positiva. Apesar de baixa prevalência no Brasil, houve positiva influência da participação social na avaliação de saúde, confirmando que o engajamento social permite ganhos importantes para a saúde e qualidade de vida.

Letramento em saúde a idosos: uma abordagem da comunicação na atenção básica em saúde / Health literacy and socioeconomic characteristics of elderly people: a communication approach in the unified health system / Nivel de alfabetización y características socioeconómicas de las personas mayores: un enfoque de comunicación en el sistema único de salud

Objetivo: Analisar a associação de características socioeconômicas com o nível de letramento de pessoas idosas atendidas no Sistema Único de Saúde do município de Pinheiro, Maranhão, Brasil. Método: Foram selecionados 121 pessoas idosas aptas a participarem do estudo. Resultados: A maioria era do sexo feminino, com idade entre 60 e 64 anos, escolaridade básica, e sem ocupação após a aposentadoria. 60,3% possuem letramento baixo. Há uma diferença estatisticamente significante no baixo letramento com as variáveis sexo, faixa etária, escolaridade, e o tipo de ocupação. As mulheres possuem maior nível de letramento, e quanto mais avançada a idade, menor o letramento. A população idosa aposentada demonstrou maior nível de letramento. O tipo de material para leitura mais citado foi a bíblia. Destaca-se um número alto de pessoas idosas que relatou não gostar de ler, influenciando a alta prevalência do baixo nível de letramento. Conclusões: Propõe-se aqui, que intervenções que visem garantir a promoção da saúde, devem verificar o nível de letramento dos indivíduos (Au).

Objective: To analyze the association of socioeconomic characteristics with the level of literacy of elderly people assisted in the Unified Health System in the municipality of Pinheiro, Maranhão, Brazil. Method: 121 aged people qualified to participate in the study were selected. Results: Most were female, aged between 60 and 64 years old, with basic education, and without occupation after retirement. 60.3% have low literacy. There is a statistically significant difference in low literacy with the variables sex, age, education, and type of occupation. Women have a higher level of literacy, and the more advanced their age, the lower their literacy. The retired elderly population showed a higher level of literacy. The most cited type of reading material was the bible. There is a high number of aged people who reported not enjoying reading, influencing the high prevalence of low literacy. Conclusions: It is proposed here that interventions aimed at guaranteeing health promotion should check the literacy level of individuals (Au).

Objetivo: Analizar la asociación entre las características socioeconómicas y el nivel de alfabetización de los adultos mayores atendidos en el Sistema Único de Salud en el municipio de Pinheiro, Maranhão, Brasil. Método: se seleccionaron 121 adultos mayores aptos para participar en el estudio. Resultados: la mayoría era de sexo femenino, tenía entre 60 y 64 años, educación básica y no tenía ocupación después de jubilarse. El 60,3% tiene baja alfabetización. Hay una diferencia estadísticamente significativa entre la baja alfabetización y las variables sexo, edad, educación y tipo de ocupación. Las mujeres tienen mayor nivel de alfabetización, y cuanto más avanzada es su edad, menor es su alfabetización. La población de adultos mayores jubilados mostró un mayor nivel de alfabetización. El tipo de material de lectura más citado fue la Biblia. Hay un gran número de personas mayores que informaron no disfrutar de la lectura, lo que influye en la alta prevalencia de baja alfabetización. Conclusiones: se propone que las intervenciones dirigidas a garantizar la promoción de la salud verifiquen el nivel de alfabetización de las personas (Au).

Development and validation of a clinical instrument to predict risk of an adverse drug reactions in hospitalized patients.

OBJECTIVE: Development and internal validation of a clinical tool for assessment of the risk of adverse drug reactions (ADR) in hospitalized patients. METHODOLOGY: Nested case-control study in an open cohort of all patients admitted to a general hospital. Cases of ADR were matched to two controls. Eighty four patient variables collected at the time of the ADR were analyzed by conditional logistic regression. Multivariate logistic regression with clustering of cases in a random sample of 2/3 of the cases and respective controls, with baseline odds-ratio corrected with an estimate of ADR incidence, was used to obtain regression coefficients for each risk factor and to develop a risk score. The clinical tool was validated in the remaining 1/3 observations. The study was approved by the institution's research ethics committee. RESULTS: In the 8060 hospitalized patients, ADR occurred in 343 (5.31%), who were matched to 686 controls. Fourteen variables were identified as independent risk factors of ADR: female, past history of ADR, heart rate ≥72 bpm, systolic blood pressure≥148 mmHg, diastolic blood pressure <79 mmHg, diabetes mellitus, serum urea ≥ 67 mg/dL, serum sodium ≥141 mmol/L, serum potassium ≥4.9 mmol/L, main diagnosis of neoplasia, prescription of ≥3 ATC class B drugs, prescription of ATC class R drugs, prescription of intravenous drugs and ≥ 6 oral drugs. In the validation sample, the ADR risk tool based on those variables showed sensitivity 61%, specificity 73% and area under the ROC curve 0.73. CONCLUSION: We report a clinical tool for ADR risk stratification in patients hospitalized in general wards based on 14 variables.

[The dynamic of the supply of pediatric palliative care: a multiple case study]. / Dinâmica da oferta de cuidados paliativos pediátricos: estudo de casos múltiplos.

The objective was to analyze the dynamic involving the supply of palliative care for eligible children from the perspective of health professionals and families. A qualitative exploratory multiple case study was performed. This was a cross-section of data from a thesis that evaluated care for hospitalized children who were eligible for palliative care. The data were collected in a teaching hospital serving as the reference for high-complexity care in São Luís, Maranhão State, Brazil, from October 2016 to July 2017, interpreted with thematic analysis. The participants were 18 family members and 30 health professionals. Cases were nine children from one to eight years of age, five of whom were eligible for exclusive care and four for integrated care. Three categories emerged from the interviews: (1) a mistaken understanding of the concept of palliative care; (2) delivering the news; and (3) comprehensiveness and fragmentation in the context of palliative care. The mistaken understanding of pediatric palliative care interfered in the approach to the child and family and delayed the start of care. Feelings of insecurity, fear, resistance, and guilt were present among those involved in this care. The communication process and relations displayed weaknesses. The care involved both comprehensiveness and fragmentation. The care shows weaknesses and lack of knowledge and requires investments in training and preparing the health professionals, shared decisions, and receptiveness to the families. Palliative care mobilizes life-and-death cultural and religious values, and education in this direction proves to be a path full of challenges.

O objetivo foi analisar a dinâmica que envolve a oferta de cuidados paliativos para crianças elegíveis, na perspectiva de profissionais e familiares. Foi realizado estudo exploratório qualitativo do tipo de casos múltiplos. Trata-se de um recorte dos dados de tese que avaliou o cuidado oferecido a crianças internadas, elegíveis para cuidados paliativos. Os dados foram coletados em hospital de ensino, referência para atendimento de alta complexidade, em São Luís, Maranhão, Brasil, entre outubro de 2016 e julho de 2017, interpretados por análise temática. Os participantes foram 18 familiares e 30 profissionais. As unidades de caso envolveram nove crianças, entre um e oito anos de idade, sendo cinco casos elegíveis para cuidados exclusivos e quatro para cuidados integrados. Três categorias emergiram das falas: (1) compreensão equivocada do conceito de cuidados paliativos; (2) comunicação da notícia; (3) integralidade e fragmentação no contexto dos cuidados paliativos. A compreensão equivocada dos cuidados paliativos pediátricos interferiu na abordagem criança/familiar e postergou o início dos cuidados. Sentimentos de insegurança, medo, resistência e culpa estiveram presentes entre os envolvidos nesse cuidado. O processo de comunicação e as relações apresentaram fragilidades. O cuidado perpassou por integralidade e fragmentação. O cuidado apresenta fragilidades e falta de conhecimento, demanda investimentos na formação e no preparo dos profissionais, no compartilhamento de decisões e no acolhimento dos familiares. Os cuidados paliativos mexem com valores culturais-religiosos de vida e morte, e a educação nesse sentido mostra-se como um caminho cheio de desafios, dentre vários outros necessários.

El objetivo fue analizar la dinámica que implica la oferta de cuidados paliativos para niños elegibles, desde la perspectiva de profesionales y familiares. Se realizó un estudio exploratorio cualitativo del tipo de estudio de casos múltiples. Se trata de un fragmento de los datos procedentes de una tesis que evaluó el cuidado ofrecido a niños internados elegibles para cuidados paliativos. Los datos se recogieron en un hospital universitario de referencia para la atención de alta complejidad, en São Luís, Maranhão, Brasil, desde octubre de 2016 hasta julio de 2017, interpretados mediante análisis temático. Los participantes fueron 18 familiares y 30 profesionales. Las unidades de caso implicaron a 9 niños, entre uno y ocho años de edad, siendo 5 casos elegibles para cuidados exclusivos y 4 para cuidados integrados. Emergieron de las charlas tres categorías: (1) comprensión equivocada del concepto de cuidados paliativos; (2) comunicación de la noticia; (3) integralidad y fragmentación en el contexto de los cuidados paliativos. La comprensión equivocada de los cuidados paliativos pediátricos interfirió en el abordaje niño/familiar y postergó el inicio de los cuidados. Estuvieron presentes sentimientos de inseguridad, miedo, resistencia y culpa entre los implicados en este cuidado. El proceso de comunicación y las relaciones presentaron fragilidades. El cuidado atravesó integralidad y fragmentación. El cuidado presenta fragilidades y falta de conocimiento, y demanda inversiones en la formación y preparación de los profesionales, así como compartir decisiones, y acoger familiares. Los cuidados paliativos impulsan valores culturales-religiosos de vida y muerte y la educación, en ese sentido, se muestra como un camino lleno de desafíos, entre otros tantos necesarios.

Spirituality and quality of life in older adults: a path analysis model.

BACKGROUND: Study older adults' quality of life is becoming increasingly important in the assessment, quality improvement and allocation of health and social care service. The purpose of this study was to enhance knowledge on the relationship between modifiable (psychological variables) and non-modifiable variables (sociodemographic), and quality of life in elderly, regarding psychological and social variables in Portuguese context. METHODS: This is a cross-sectional study, including 604 older adults from general community. 63.6% of the sample was composed by female gender with a mean age of 71.6(SD = 4.81). Participants completed the following instruments: Barthel Index to assess functionality; Satisfaction with Social Support Scale to assess social support; The Spiritual and Religious Attitudes in Dealing with Illness to assess spirituality and Short Form Health Survey 36, to assess mental and physical quality of life. RESULTS: A path analysis model was performed where the presence of a chronic disease, age and functionality has a direct effect on physical quality of life and spirituality had a direct effect on mental quality of life. Social support mediated the relationship between functionality and mental quality of life, and in turn, functionality mediated the relationship between age and physical quality of life. CONCLUSIONS: Results reinforce the effect of age and chronic disease as non-modifiable variables as well as functionality, spirituality and satisfaction with social support as modifiable variables, in the quality of life of older people. Social support, health and education programs in the community should be promoted in order to improve quality of life in this population. Strategies to promote functionality and enhance the social support network, especially in the elder with chronic illness, should be a priority.