In vitro test methods for evaluating high molecular weight polyethylene oxide polymer induced hemolytic and thrombotic potential.

To combat opioid abuse, the U.S. Food and Drug Administration (FDA) released a comprehensive action plan to address opioid addiction, abuse, and overdose that included increasing the prevalence of abuse-deterrent formulations (ADFs) in opioid tablets. Polyethylene oxide (PEO) has been widely used as an excipient to deter abuse via nasal insufflation. However, changes in abuse patterns have led to unexpected shifts in abuse from the nasal route to intravenous injection. Case reports identify adverse effects similar to thrombotic thrombocytopenic purpura (TTP) syndrome following the intravenous (IV) abuse of opioids containing PEO excipient. Increased risk of IV opioid ADF abuse compared to clinical benefit of the drug led to the removal of one opioid product from the market in 2017. Because many generic drugs containing PEO are still in development, there is interest in assessing safety consistent with generic drug regulation and unintended uses. Currently, there are no guidelines or in vitro assessment tools to characterize the safety of PEO excipients taken via intravenous injection. To create a more robust excipient safety evaluation tool and to study the mechanistic basis of HMW PEO-induced TMA, a dynamic in vitro test system involving blood flow through a needle model has been developed.

Asymmetrical Flow Field Flow Fractionation for Molar Mass Characterization of Polyethylene Oxide in Abuse-Deterrent Formulations.

High molar mass polyethylene oxide (HM-PEO) is commonly used to enhance the mechanical strength of solid oral opioid drug products to deter abuse. Because the properties of PEO depend on molar mass distribution, accurately determining the molar mass distribution is a necessary part of understanding PEO's role in abuse-deterrent formulations (ADF). In this study, an asymmetrical flow field-flow fractionation (AF4) analytical procedure was developed to characterize PEO polymers with nominal molar masses of 1, 4 or 7 MDa as well as those from in-house prepared placebo ADF. The placebo ADF were manufactured using direct compress or hot-melt-extrusion methods, and subjected to physical manipulation, such as heating and grinding before measurement by AF4 were performed. The molar mass distribution characterized by AF4 revealed that PEO was sensitive to thermal stress, exhibiting decreased molar mass with increased heat exposure. The optimized AF4 method was deemed suitable for characterizing HM-PEO, offering adequate dynamic separation range for PEO with molar mass from 100 kDa to approximately 10 MDa.

Auditory Brainstem response electrophysiological thresholds with narrow band chirps stimuli in hearing infants.

OBJECTIVES: to describe reference values for the electrophysiological thresholds obtained in the frequency-specific Auditory Brainstem Response (fsABR) with the NB CE-Chirp® LS and NB iChirp stimuli in hearing infants and to compare the variables: Minimum Levels of Response (MLR), latency, amplitude and examination time. METHODS: the sample consisted of 74 full-term infants, with a mean age of 23.11 days, 29 females and 45 males. The participants underwent fsABR at the frequencies of 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz, to measure the MLR with the NB CE-Chirp® LS stimulus in the Eclipse equipment, and with the NB iChirp stimulus in the SmartEP, all in natural sleep and performed in the same session. The waveforms were evaluated by judges and later, for the comparison of thresholds and examination time, analyzed with the Wilcoxon test. To compare latency and amplitude, the Student's T Test and ANOVA were used for the same variables, but with the same stimulus. The Kruskal-Wallis test was used to compare the examination time at the different frequencies. RESULTS: The MLR and latency at 500 Hz and 1000 Hz showed a statistically significant difference between the stimuli, with lower thresholds and higher latencies for the NB iChirp. Higher amplitudes were obtained with the NB iChirp stimulus. The average examination time for the threshold investigation in the four frequencies was 40 min for each ear. CONCLUSION: it was possible to present reference values for the MLR and latencies for the NB CE-Chirp® LS and NB iChirp stimuli for hearing infants. In addition, with the NB iChirp, the latency of the responses was influenced by the frequency, but it was the stimulus that provided greater amplitudes. With the NB CE-Chirp® LS, the frequency did not influence latency, except at 500 Hz, and the stimulus provided recordings that facilitated the visualization of wave V. There was no difference in the examination time between the stimuli, nor between the test frequencies.

Congenital toxoplasmosis and auditory disorders: a literature review.

Background: Congenital toxoplasmosis (CT) occurs mainly by primary maternal infection during pregnancy. It is estimated that the incidence of vertical transmission to the fetus is 20% and that infected women are more likely to have a premature birth or low birth weight neonate since there is an association between CT and the rate of premature birth and low birth weight. In addition to severe neurological and ophthalmic consequences, hearing disorders such as hearing loss are also among the clinical manifestations seen in children with CT. Given the above, the objective of this study is to verify what are the auditory disorders seen in children with CT. Methods: This literature review was structured according to the PRISMA statement and based on the terms of Study Target Population, Intervention, Comparison, Outcomes, and Study Types (PICOS). To obtain the studies, the following electronic databases were consulted: PubMed, Web of Science, Scopus, and Lilacs. The combined terms used for the search were: ("auditory evoked potentials" OR "hearing" OR "hearing loss") AND ("congenital toxoplasmosis"). The selection of articles was carried out independently, blindly, by two of the authors, to minimize risk of bias. Results: The search in the databases identified 172 articles, after excluding duplicate articles, 105 studies were identified. From the selection made by reading the titles and abstracts, 11 studies were selected for full-text reading. A total of 94 studies were excluded. An article was selected from the list of references. Therefore, 12 studies were included in the final analysis. It was observed that a significant percentage of studies sought to study the peripheral auditory pathway, verifying the occurrence or association between hearing loss and the presence of congenital infection. Only two studies evaluated the central auditory pathway, using the Brainstem Auditory Evoked Potential (BAEP) and the Frequency Following Response (FFR). Conclusion: Toxoplasmosis affects not only the peripheral areas but central areas as well. Most studies suggest this pathology as a risk factor for both peripheral and central impairment. Research has found a greater association between CT and mild to moderate hearing loss, in addition to alterations in exams such as BAEP and FFR. These data recommend that CT be reported as a global public health problem and can help assess complications and impacts of hearing disorders as a result of CT. There is a gap about studies that retract the co-occurrence between CT and other Risk Indicators for Hearing Loss (RIHL), such as prematurity, permanence in the intensive care unit, and use of ototoxic medications, lack of longitudinal studies, that accompany the development of hearing and language of children with CT, since the consequences of this infection may be late.

Hearing rehabilitation of children and adolescents with unilateral hearing loss / Reabilitação auditiva de crianças e adolescentes com perda auditiva unilateral

ABSTRACT Purpose To describe the audiological characteristics and the type of intervention chosen on unilateral hearing loss cases in children and adolescents as well as to analyze correlations between the degree of hearing loss, the indication and the use of electronic devices. Methods Observational, descriptive and retrospective study, carried out with information of 34 medical records from children and adolescents with unilateral hearing loss, assessed by two auditory rehabilitation services of medium complexity, throughout 2016 to 2019. Descriptive and Inferential statistical analysis were performed with the data. Results A predominance of profound sensorineural unilateral hearing loss in the right ear, of pre-lingual character, with 20.6% of malformations. The most adopted intervention was the hearing aid indication, although its use is low, regardless of the degree of the hearing loss. An association was found between the degree of the hearing loss and the healthcare professionals in indicating the use of the devices. Conclusion The indication of hearing aids is the most frequent and this decision is influenced by the degree of the hearing loss, in which the devices are mostly indicated for mild to severe losses, with bigger divergence of conduct for profound hearing losses.

RESUMO Objetivo Descrever as características audiológicas e o tipo de intervenção tomada em casos de perda auditiva unilateral em crianças e adolescentes e analisar correlações entre o grau da deficiência auditiva, a indicação e o uso de auxiliares de audição. Método Estudo observacional, descritivo e retrospectivo, realizado com informações dos prontuários de 34 crianças e adolescentes com perda auditiva unilateral, atendidos em dois serviços de reabilitação auditiva de média complexidade, no período de 2016 a 2019. Realizou-se a análise estatística descritiva e inferencial dos dados. Resultados Predomínio de perda auditiva unilateral do tipo neurossensorial, de grau profundo à direita, pré-lingual com 20,6% de malformações. A intervenção mais adotada foi a indicação de prótese auditiva, porém o uso é baixo, independente do grau da perda. Houve associação entre o grau da perda auditiva e a decisão dos profissionais em indicar o uso dos dispositivos. Conclusão A indicação de próteses auditivas é a mais frequente e esta decisão é influenciada pelo grau da perda auditiva, sendo os aparelhos auditivos indicados para as perdas leves a severas, com uma maior divergência de condutas para as perdas profundas.

Hearing rehabilitation of children and adolescents with unilateral hearing loss.

PURPOSE: To describe the audiological characteristics and the type of intervention chosen on unilateral hearing loss cases in children and adolescents as well as to analyze correlations between the degree of hearing loss, the indication and the use of electronic devices. METHODS: Observational, descriptive and retrospective study, carried out with information of 34 medical records from children and adolescents with unilateral hearing loss, assessed by two auditory rehabilitation services of medium complexity, throughout 2016 to 2019. Descriptive and Inferential statistical analysis were performed with the data. RESULTS: A predominance of profound sensorineural unilateral hearing loss in the right ear, of pre-lingual character, with 20.6% of malformations. The most adopted intervention was the hearing aid indication, although its use is low, regardless of the degree of the hearing loss. An association was found between the degree of the hearing loss and the healthcare professionals in indicating the use of the devices. CONCLUSION: The indication of hearing aids is the most frequent and this decision is influenced by the degree of the hearing loss, in which the devices are mostly indicated for mild to severe losses, with bigger divergence of conduct for profound hearing losses.

Is pilates better than other exercises at increasing muscle strength? A systematic review.

Our objective was to verify the effectiveness of Pilates method compared against other exercise modalities for muscle strength increase, balance and flexibility. Method: Databases used and its respective results were: CENTRAL (n = 456), CINAHL (n = 291), EMBASE (n = 313), PEDro (n = 176), PUBMED (n = 236), SCIELO (n = 98), SPORTDiscus (n = 197) e Web of Science (n = 150). It included randomized controlled studies using Pilates and others exercise modalities that measured muscle strength. Results: Eleven studies were included for analysis. The mean methodological quality score of these studies, evaluated by the PEDro scale, was 6 ± 1. For the primary outcome, not being observed this difference for dynamic force (SMD = -0.29; 95%IC -0.69; 0.10), isometric (SMD = 0.20; 95%IC -0.06; 0.47) or resistance (SMD = -0.19; 95%IC -0.46; 0.07). For secondary outcomes, there was no difference for balance and flexibility. Conclusion: In conclusion, there is very low to low evidence that there is no difference between Pilates and other exercise modalities for dynamic strength, isometric strength, resistance strength, balance and flexibility.

Long-Term Effects of a Kinematic Bikefitting Method on Pain, Comfort, and Fatigue: A Prospective Cohort Study.

The purpose of this study is to analyze the long-term riders' subjective responses to a standardized bikefitting method on their bicycles. Eighty-six amateur mountain bikers had their riding posture and bicycle components ergonomically adjusted through a 3D kinematic bikefitting method. Validated subjective scales (Feeling, OMNI, and Numerical Rating Pain Scale) were used to assess their overall riding comfort and fatigue along with localized pain for six body parts. Data were collected just before intervention (baseline or pre), immediately after (or post), and 30, 60, 90, and 120 days after the bikefit session. A Student's t-test comparing before bikefit and after 120 days showed significant (p < 0.05) reduction in localized pain for all six body parts and riding comfort along with a large effect size effect (d = 1.18) for riding comfort. Although initially reduced, fatigue scores gradually increased over the months, showing a high correlation (r = 0.946) with increased monthly training volume. In conclusion, overall riding discomfort and pain were significantly decreased after a standardized kinematic bikefit session even after 120 days post intervention. However, fatigue scores began to rise after 30 days, showing a high correlation with increasing monthly training volume.

The effect of child development on the components of the Frequency Following Response: Child development and the Frequency Following Response.

During childhood, neuronal modifications occur so that typical childhood communicative development occurs. This work aims to contribute to the understanding of differences in the speech encoding of infants and school-age children by assessing the effects of child development, in different phases of early childhood, on the encoding of speech sounds. There were 98 subjects of both sexes, aged from 1 day to 8 years and 9 months who participated in the study. All subjects underwent a Frequency Following Response (FFR) assessment. A regression and linear correlation showed the effects of age in the FFR components, i.e., significant decrease in the latency and increased amplitude of all FFR waves with age. An increase in the slope measure was also observed. Younger infants require more time and show less robust responses when encoding speech than their older counterparts, which were shown to have more stable and well-organized FFR responses.

Auditory Brainstem Response with the iChirp stimuli in the infant's audiological diagnosis.

OBJECTIVE: to investigate the use of the iChirp stimulus in the infant's audiological diagnosis compared to stimuli typically used in the ABR in infants, in addition to suggesting reference values for the assessment of this population. METHODS: 62 infants participated in the study, 29 females and 33 males. The subjects underwent the recording of the Auditory Brainstem Response in the Smart Ep equipment, with the stimuli click, iChirp-broadband, tone burst and iChirp-narrowband, which were presented at three levels of intensity (20 dB, 40 dB and 60 dB) and, for tone burst and iChirp-narrowband stimuli, at different frequencies (0.5, 1 k, 2 k and 4 KHz). The data were later analyzed using Student's t-test. RESULTS: In general, the iChirp-broadband and iChirp-narrowband stimuli showed higher latency values and greater amplitudes when compared to click and tone burst stimuli. Furthermore, better signal-to-noise ratios were observed when contrasting iChirp-narrowband with tone burst. Additionally, reference values were established for the assessment of ABR in infants with the iChirp-broadband and iChirp-narrowband in the Smart-Ep equipment. CONCLUSION: The iChirp stimulus appears to be promising in the infant's audiological diagnosis, as its use promoted greater amplitudes and better wave morphology, which facilitates to mark the waveforms and provides greater efficiency in the investigation of the auditory thresholds. The indication of normative data also enables the clinical use of these stimuli in the infant's audiological diagnosis.

What is the traditional method of resistance training: a systematic review.

INTRODUCTION: Many resistance studies state that they used the traditional method of resistance training in the intervention. However, there is a wide difference on the characteristics of the training protocols used even though they are labeled as "the traditional method." There is no clear definition and characteristics for the traditional method of resistance training. The aim of this study was to describe the most common definitions and references, and also the main characteristics of the training variables of the studies using the traditional training method for strengthening. EVIDENCE ACQUISITION: Searches were carried out in Pubmed, Embase, SPORTDiscus and Web of Science. We included randomized controlled trials that included a strengthening program using the "traditional method" and that evaluated hypertrophy and/or maximum strength in healthy individuals. EVIDENCE SYNTHESIS: The initial search resulted in 26,057 studies, but only 39 studies were eligible and included in this review. The common characteristics of the traditional training protocol were frequency of 3 sessions/week, 3 sets of 9 repetitions, with weight =75% 1RM. The movement time was 2±1 seconds for the concentric and for the eccentric phases. Resting time between sets was 2±1 minutes. The concepts used to define the method as traditional and the characteristics of the intervention protocols were different. The American College of Sports Medicine (ACSM) was the most cited reference. CONCLUSIONS: The "traditional method of resistance training" can be defined as: "Three (±1) sets of 9±6 repetitions of concentric and eccentric exercises using an external load of 75±20% of one maximum repetition, completed 3±1 times/week.

Mismatch Negativity in children with Phonological Disorders.

OBJECTIVE: to characterize the latency, amplitude and area variables of the Mismatch Negativity (MMN) elicited with verbal stimuli in children with PD, in addition to assessing whether this potential can be a useful tool in capturing auditory perception and discrimination deficits related to this disorder. METHODS: MMN was recorded using a combination of speech contrast consisting of acoustic syllables [da vs ta], as the standard and deviant stimuli, in 34 children aged between 5 and 8 years. 14 children of the sample were already diagnosed with Phonological Disorder (PD) while 19 were characterized with typical development. RESULTS: No statistically significant differences were observed for the MMN responses recorded between children with PD and their typically developed peers. CONCLUSION: The results suggest that the MMN may not be the most suitable procedure to assess auditory perception and discrimination deficits that could potentially be related to PD.

Polyethylene Oxide Molecular Size Determines the Severity of Atypical Thrombotic Microangiopathy in a Guinea Pig Model of Acute Intravenous Exposure.

In 2017, Opana ER was voluntarily removed from the U.S. market based on concerns that its risks outweighed its therapeutic benefits. The data that supported this conclusion were based on postmarketing evaluation that demonstrated increased intravenous abuse associated outbreaks of HIV, hepatitis C, and uniquely, a thrombotic thrombocytopenic purpura (TTP)-like syndrome. In 2017, the cause was mechanistically linked to intravenous exposure of the high-molecular weight polyethylene oxide (PEO), an excipient component of the drug product. However, it was unknown how differing PEO preparations might alter this response in vivo. Knowing the likelihood of a PEO driven atypical thrombotic microangiopathy with hemolytic uremic syndrome (TMA-HUS), this study was specifically designed with the primary objective focused on understanding the impact of PEO molecular weight on TMA-HUS in a guinea pig model of acute repeat PEO (1, 4, and 7 MDa) dosing. Results from this analysis suggest that repeated dosing with PEO 4 and 7 MDa, but not 1 MDa induced a marked intravascular hemolysis with schistocytes, mild anemia, thrombocytopenia, hemoglobinuria, and kidney injury, consistent with observations of a TMA-HUS-like syndrome. Nonetheless, observations of tissue microthrombi, complement or altered von Willebrand factor involvement were not observed, which would be consistent with a definitive TMA. Further, only 7 MDa PEO dosing was associated with marked renal hypoxia. Taken together, this study defines renal injury risk with PEO formulations >1 MDa that is driven by a robust intravascular hemolysis and potentially, tissue hypoxia.

Genetic differentiation and diversity of the Bolivian endemic titi monkeys, Plecturocebus modestus and Plecturocebus olallae.

The genetic variability of New World primates is still poorly documented. We present the first genetic study on two threatened endemic titi monkey species in northern Bolivia (Plecturocebus modestus and Plecturocebus olallae) using six microsatellite markers to investigate genetic structure and variability of 54 individuals from two wild populations. A low level of genetic diversity was found (34 alleles in the total sampled population). Locus 1118 presented the greatest number of alleles. The mean number of alleles per locus in the total population was 5.6 and the average heterozygosity was 0.38 (range 0.12-0.88). The FIS value for the total population using all microsatellite loci shows a statistically significant heterozygote deficit. The inbreeding coefficients (FIS) were positive and significantly different from zero (0.064 for P. olallae and 0.213 for P. modestus). The genetic differentiation between populations (FST) was moderate with a pair-wise FST estimate of 0.14. Population structure analyses assigned the two populations to two differentiated clusters (K = 2). These results suggest that these two species with very close distributional ranges arose from a single population, and that they remain in a process of genetic differentiation and speciation. This study further underlines the urgent need for conservation actions for both endemic primate species.

Evasion of Newborn Hearing Screening retest: relation with risk factors for hearing impairment / Evasão no reteste da Triagem Auditiva Neonatal: relação com indicadores de risco para deficiência auditiva

ABSTRACT Purpose: to analyze the evasion rate of the Newborn Hearing Screening program's retest, to verify whether the presence of risk indicators for hearing loss influences it, and to describe which risk indicators for hearing loss occur more frequently in these cases. Methods: 1,287 newborns/infants participated, who were screened between June 2015 and June 2018. All of them obtained "fail" as the Newborn Hearing Screening result, were referred to the retest and did not attend it. Information related to the occurrence of risk indicators for hearing loss was observed. Results: the study found that the evasion rate was of 15.23%. The presence of risk indicators for hearing loss did not show an association with non-attendance at this stage of the program (p-value = 0.087). The most frequent indicators in the cases of non-attendance at the retest were: ototoxic medication use and intensive care unit stay for more than five days. Conclusion: high evasion rate of the retest has been observed. It has been found that the presence of risk indicators did not influence the retest evasion rate. Use of ototoxic medication and stay at the intensive care unit were the most frequent indicators among those who did not attend the retest.

RESUMO Objetivo: analisar o índice de evasão no reteste do programa de Triagem Auditiva Neonatal, verificar se a presença de Indicadores de Risco para Deficiência Auditiva o influencia e descrever quais Indicadores de Risco para Deficiência Auditiva ocorrem com maior frequência nestes casos. Métodos: participaram 1287 neonatos/lactentes, triados no período de junho de 2015 a junho de 2018, que obtiveram resultado "falha" na Triagem Auditiva Neonatal, encaminhados para o reteste e não compareceram. Foram observadas informações relacionadas a ocorrência dos Indicadores de Risco para Deficiência Auditiva. Resultados: o estudo constatou que o índice de evasão foi de 15,23%. A presença de indicadores de risco para deficiência auditiva não demonstrou associação com o não comparecimento a essa etapa do programa (p-valor= 0,087). Os indicadores de maior ocorrência nos casos de não comparecimento no reteste foram: medicação ototóxica e permanência em Unidade de Tratamento Intensivo por período maior que cinco dias. Conclusão: observou-se elevado índice de evasão no reteste. Verificou-se que a presença dos indicadores de risco não influenciou no índice de evasão do reteste. O uso de medicação ototóxica e a permanência em Unidade de Terapia Intensiva foram os indicadores mais frequentes naqueles que não compareceram ao reteste.

Atuação estratégica em direitos humanos contra o afastamento arbitrário de bebês do convívio familiar: reflexões sobre a prática / Strategic action on human rights against the arbitrary withdrawal of infantis from the family: reflections on the practice

O presente artigo oferece um relato da experiência de trabalho da Clínica de Direitos Humanos da UFMG, a partir do método da advocacia estratégica em direitos humanos, frente ao problema do afastamento arbitrário de recém-nascidos do convívio familiar e a sistemática de violações de direitos humanos e estigmatização enfrentada por mães em situação de vulnerabilização social no contexto da cidade de Belo Horizonte.(AU)

This article offers an experience report of the work developed by the UFMG Human Rights Clinic through the use of the strategic advocacy method in human rights, in order to approach the problem of arbitrary State removals of newborn children from their familiar atmosphere and the systematic human rights violations and stigmatization suffered by their vulnerable mothers, in the context of the city of Belo Horizonte.(AU)

Interagindo com a família do paciente hospitalizado: vivência do técnico em enfermagem / interacting with family members of hospitalized patients: a nursing technician's experience / interactuando con la familia del paciente hospitalizado: experiencia del técnico en enfermería

Este estudo teve como objetivo compreender o significado atribuído pelo técnico em enfermagem à vivência de interagir com a família do paciente hospitalizado. Trata-se de uma pesquisa qualitativa, que utilizou como referencial teórico o Interacionismo Simbólico, e o metodológico, a Análise Qualitativa de Conteúdo. Participaram nove técnicos em enfermagem que atuavam nas unidades de clínica médica de dois hospitais públicos, sendo os dados coletados por entrevista semiestruturada e observação participante. Revelaram as dificuldades, ambiguidade e despreparo vivenciados pelos profissionais na interação com a família, embora reconheça sua importância, e a ausência de sua interação com conteúdo a respeito da temática, tanto no curso técnico como na vida profissional. Constatou-se que, na vivência com familiares, faltam-lhes conhecimento e habilidade para lidar com o cuidado da família, assim, necessitam de suporte teórico e prático para enfrentamento de tal situação.

This study aimed to understand the meaning attributed by nursing technicians to the experience of interacting with the family of hospitalized patients. It is a qualitative research supported by the Symbolic Interactionism theoretical framework, and the Qualitative Content Analysis methodological framework. It had the participation of nine nursing technicians that worked at the medical clinic units of two public hospitals. Data were collected through semi-structured interview and participant observation. They revealed the difficulties, ambiguities and unpreparedness experienced by the professionals in the interaction with the echnical course and in their professional lives. It was found that, in their experience with relatives, the nurse technicians lack knowledge and skills to deal with the care of the family; thus, they need theoretical and practical support to face such a situation.

Este estudio tuvo como objetivo comprender el significado atribuido por el técnico en enfermería a la experiencia de interactuar con la familia del paciente hospitalizado. Se trata de una investigación cualitativa, que utilizó como referencial teórico el Interaccionismo Simbólico, y para el metodológico, el Análisis Cualitativo de Contenido. Participaron nueve técnicos en enfermería que actuaban en las unidades de clínica médica de dos hospitales públicos, siendo los datos recolectados por entrevista semiestructurada y observación participante. Revelaron las dificultades, ambigüedad y falta de preparación vividas por los profesionales en la interacción con la familia, aunque reconozca su importancia, y la ausencia de su interacción con el contenido a respecto del tema, tanto en el curso técnico como en la vida profesional. Se constató que, en la experiencia con familiares, les faltan conocimiento y habilidad para lidiar con el cuidado de la familia, así, necesitan de soporte teórico y práctico para el enfrentamiento de tal situación.

The family living the child recovery process after hospital discharge.

OBJECTIVE: to understand the meaning attributed by the family to its experience in the recovery process of a child affected by an acute disease after discharge, and to develop a theoretical model of this experience. Symbolic interactionism was adopted as a theoretical reference, and grounded theory was adopted as a methodological reference. METHOD: data were collected through interviews and participant observation with 11 families, totaling 15 interviews. A theoretical model consisting of two interactive phenomena was formulated from the analysis: Mobilizing to restore functional balance and Suffering from the possibility of a child's readmission. RESULTS: the family remains alert to identify early changes in the child's health, in an attempt to avoid rehospitalization. CONCLUSION: the effects of the disease and hospitalization continue to manifest in family functioning, causing suffering even after the child's discharge and recovery.