Robust multiferroicity and magnetic modulation of the ferroelectric imprint field in heterostructures comprising epitaxial Hf0.5Zr0.5O2 and Co.

Magnetoelectric multiferroics, either single-phase or composites comprising ferroelectric/ferromagnetic coupled films, are promising candidates for energy efficient memory computing. However, most of the multiferroic magnetoelectric systems studied so far are based on materials that are not compatible with industrial processes. Doped hafnia is emerging as one of the few CMOS-compatible ferroelectric materials. Thus, it is highly relevant to study the integration of ferroelectric hafnia into multiferroic systems. In particular, ferroelectricity in hafnia, and the eventual magnetoelectric coupling when ferromagnetic layers are grown atop of it, are very much dependent on quality of interfaces. Since magnetic metals frequently exhibit noticeable reactivity when grown onto oxides, it is expected that ferroelectricity and magnetoelectricity might be reduced in multiferroic hafnia-based structures. In this article, we present excellent ferroelectric endurance and retention in epitaxial Hf0.5Zr0.5O2 films grown on buffered silicon using Co as the top electrode. The crucial influence of a thin Pt capping layer grown on top of Co on the ferroelectric functional characteristics is revealed by contrasting the utilization of Pt-capped Co, non-capped Co and Pt. Magnetic control of the imprint electric field (up to 40% modulation) is achieved in Pt-capped Co/Hf0.5Zr0.5O2 structures, although this does not lead to appreciable tuning of the ferroelectric polarization, as a result of its high stability. Computation of piezoelectric and flexoelectric strain-mediated mechanisms of the observed magnetoelectric coupling reveal that flexoelectric contributions are likely to be at the origin of the large imprint electric field variation.

Robust Antiferromagnetic FeRh Films on Mica.

FeRh shows an antiferromagnetic to ferromagnetic phase transition above room temperature, which permits its use as an antiferromagnetic memory element. However, its antiferromagnetic order is sensitive to small variations in crystallinity and composition, challenging its integration into flexible devices. Here, we show that flexible FeRh films of high crystalline quality can be synthesized by using mica as a substrate, followed by a mechanical exfoliation of the mica. The magnetic and transport data indicate that the FeRh films display a sharp antiferromagnetic to ferromagnetic phase transition. Magnetotransport data allow for the observation of two distinguishable resistance states, which are written after a field-cooling procedure. It is shown that the memory states are robust under the application of magnetic fields of up to 10 kOe.

Nitrogen-Based Magneto-ionic Manipulation of Exchange Bias in CoFe/MnN Heterostructures.

Electric field control of the exchange bias effect across ferromagnet/antiferromagnet (FM/AF) interfaces has offered exciting potentials for low-energy-dissipation spintronics. In particular, the solid-state magneto-ionic means is highly appealing as it may allow reconfigurable electronics by transforming the all-important FM/AF interfaces through ionic migration. In this work, we demonstrate an approach that combines the chemically induced magneto-ionic effect with the electric field driving of nitrogen in the Ta/Co0.7Fe0.3/MnN/Ta structure to electrically manipulate exchange bias. Upon field-cooling the heterostructure, ionic diffusion of nitrogen from MnN into the Ta layers occurs. A significant exchange bias of 618 Oe at 300 K and 1484 Oe at 10 K is observed, which can be further enhanced after a voltage conditioning by 5 and 19%, respectively. This enhancement can be reversed by voltage conditioning with an opposite polarity. Nitrogen migration within the MnN layer and into the Ta capping layer cause the enhancement in exchange bias, which is observed in polarized neutron reflectometry studies. These results demonstrate an effective nitrogen-ion based magneto-ionic manipulation of exchange bias in solid-state devices.

Frequency-dependent stimulated and post-stimulated voltage control of magnetism in transition metal nitrides: towards brain-inspired magneto-ionics.

Magneto-ionics, which deals with the change of magnetic properties through voltage-driven ion migration, is expected to be one of the emerging technologies to develop energy-efficient spintronics. While a precise modulation of magnetism is achieved when voltage is applied, much more uncontrolled is the spontaneous evolution of magneto-ionic systems upon removing the electric stimuli (i.e., post-stimulated behavior). Here, we demonstrate a voltage-controllable N ion accumulation effect at the outer surface of CoN films adjacent to a liquid electrolyte, which allows for the control of magneto-ionic properties both during and after voltage pulse actuation (i.e., stimulated and post-stimulated behavior, respectively). This effect, which takes place when the CoN film thickness is below 50 nm and the voltage pulse frequency is at least 100 Hz, is based on the trade-off between generation (voltage ON) and partial depletion (voltage OFF) of ferromagnetism in CoN by magneto-ionics. This novel effect may open opportunities for new neuromorphic computing functions, such as post-stimulated neural learning under deep sleep.

O velho e o outro: identificação e reconstrução de si / The old and the other: identification and reconstruction of you

Este artigo se propõe a abordar as significações atribuídas à velhice e a sua identidade em sujeitos com idade igual ou superior a 70 anos. Utilizou-se o método clínico-qualitativo, de caráter exploratório e descritivo. Foram realizadas entrevistas semiestruturadas, com quatro homens e seis mulheres, com idade média de 76,3 anos, observadas pela análise de conteúdo. Os participantes da pesquisa relatam não se identificarem enquanto "velhos", entretanto apropriam-se do "ser idoso" a partir das marcas corporais que advêm do envelhecer, bem como por meio do olhar da sociedade. Ainda retratam o vínculo com o passado e a memória como um fator de sustentação da identidade e do pertencimento a um lugar reconhecido por eles, de modo a destacar um mundo e um presente no qual não se reconhecem e um futuro de difíceis projeções de si. Todavia, evidencia-se, nesta fase, a reestruturação do sujeito de forma a atribuir ganhos e novas relações.

From Binary to Ternary Transition-Metal Nitrides: A Boost toward Nitrogen Magneto-Ionics.

Magneto-ionics is an emerging actuation mechanism to control the magnetic properties of materials via voltage-driven ion motion. This effect largely relies on the strength and penetration of the induced electric field into the target material, the amount of generated ion transport pathways, and the ionic mobility inside the magnetic media. Optimizing all these factors in a simple way is a huge challenge, although highly desirable for technological applications. Here, we demonstrate that the introduction of suitable transition-metal elements to binary nitride compounds can drastically boost magneto-ionics. More specifically, we show that the attained magneto-ionic effects in CoN films (i.e., saturation magnetization, toggling speeds, and cyclability) can be drastically enhanced through 10% substitution of Co by Mn in the thin-film composition. Incorporation of Mn leads to transformation from nanocrystalline into amorphous-like structures, as well as from metallic to semiconducting behaviors, resulting in an increase of N-ion transport channels. Ab initio calculations reveal a lower energy barrier for CoMn-N compared to Co-N that provides a fundamental understanding of the crucial role of Mn addition in the voltage-driven magnetic effects. These results constitute an important step forward toward enhanced voltage control of magnetism via electric field-driven ion motion.

Magnetic structure and internal field nuclear magnetic resonance of cobalt nanowires.

The magnetic properties of cobalt metal nanowires grown by electrodeposition in porous membranes depend largely on the synthesis conditions. Here, we focus on the role of electrolyte additives on the magnetic anisotropy of the electrodeposited nanowires. Through magnetometry and internal field nuclear magnetic resonance (IF NMR) studies, we compared both the magnetic and crystalline structures of 50 and 200 nm diameter Co nanowires synthesized in the presence or absence of organic additives. The spectral characteristics of IF NMR were compared structurally to X-ray diffraction patterns, and the anisotropy of the NMR enhancement factor in ferromagnetic multidomain structures to magnetometry results. While the magnetic behavior of the 50 nm nanowires was dominated, as expected, by shape anisotropy with magnetic domains oriented on axis, the analysis of the 200 nm proved to be more complex. 59Co IF NMR revealed that the determining difference between the samples electrodeposited in the presence or in absence of organic additives was not the dominant crystalline system (fcc or hcp) but the coherent domain sizes and boundaries. In the presence of organic additives, the cobalt crystal domains are smaller and with defective grain boundaries, as revealed by resonances below 210 MHz. This prevented the development in the Co hcp part of the sample of the strong magnetocrystalline anisotropy that was observed in the absence of organic additives. In the presence of organic additives, even in nanowires as wide as 200 nm, the magnetic behavior remained determined by the shape anisotropy with a positive effective magnetic anisotropy and strong anisotropy of the NMR enhancement factor.

Estratégias de Enfrentamento Utilizadas por Profissionais do SAMU Frente à Iminência de Morte de Pacientes / Coping Strategies Used by SAMU Professionals Face to Imminence of Patient Death / Estrategias de Enfrentamiento Utilizadas por los Profesionales de SAMU Ante la Inminencia de Muerte de Pacientes

O presente trabalho teve por objetivo verificar as estratégias de enfrentamento utilizadas pelos profissionais de uma equipe do SAMU (Serviço de Atendimento Móvel de Urgência) frente situações de iminência de morte de pacientes, além de avaliar a correlação entre coping e ansiedade, depressão e estresse. Para tanto, realizou-se uma pesquisa quantitativa, da qual participaram 43 profissionais do SAMU de um município no interior do estado do Rio Grande do Sul, entre médicos, enfermeiros, técnicos em enfermagem e condutores. Os instrumentos utilizados foram o DASS-21 e o Inventário de Estratégias de Coping. A análise dos dados foi feita a partir de estatística descritiva e inferencial, utilizando o software SPSS. Os resultados indicam que as estratégias mais utilizadas pelos profissionais são resolução de problemas, autocontrole e reavaliação positiva. Já as menos utilizadas são fuga-esquiva e confronto. Ademais, obteve-se um baixo índice de estresse, ansiedade e depressão na amostra. A correlação dos instrumentos permitiu compreender esses dados, visto que as estratégias menos utilizadas apresentaram maior correlação com estresse, ansiedade e depressão. Considera-se que os profissionais do SAMU utilizam estratégias de enfrentamento que permitem a elaboração das situações vivenciadas, o que indica a importância da valorização de potencialidades a serem desenvolvidas no serviço.

This paper aims to verify the coping strategies used by a SAMU (Emergency Mobile Care Service) team professionals face to patients' imminent death situations, as well as to evaluate the correlation between coping and anxiety, depression and stress. To this end, a quantitative research was carried out, involving 43 SAMU professionals from a city in the interior of Rio Grande do Sul State, including doctors, nurses, nursing technicians and drivers. Instruments used were the DASS-21 and the Coping Strategies Inventory. Data analysis was performed using descriptive and inferential statistics using the SPSS software. Results indicate that strategies most used by professionals are problem solving, self-control and positive reevaluation. The least used are escape-avoidance and confrontation. In addition, a low rate of stress, anxiety and depression was obtained in the sample. The instruments correlation allowed us to understand these data, since the less used strategies presented a higher correlation with stress, anxiety and depression. It is considered that SAMU professionals use coping strategies that allow the elaboration of situations experienced, which indicates the importance of valuing potentialities to be developed in the service.

Este estudio tuvo por finalidad verificar las estrategias de afrontamiento utilizadas por profesionales de un equipo de SAMU (Servicio de Atendimiento Móvil de Urgencia) ante situaciones de muerte inminente de pacientes, además de evaluar correlaciones entre coping, ansiedad, depresión y estrés. Se realizó una investigación cuantitativa, con la participación de 43 profesionales del SAMU de un municipio en el interior del estado del Rio Grande del Sur, con médicos, enfermeros, técnicos de enfermería y choferes. Los instrumentos utilizados fueron el DASS-21 y el Inventario de Estrategias de Coping. El análisis de los datos se realizó con estadística descriptiva e inferencial, utilizando el software SPSS. Los resultados indican que las estrategias más utilizadas por los profesionales son Resolución de Problemas, Autocontrol y Reevaluación Positiva. Las menos utilizadas son Fuga-esquiva y Enfrentamiento. Además, se obtuvo un bajo índice de estrés, ansiedad y depresión. La correlación de los instrumentos permitió comprender esos datos, visto que las estrategias menos utilizadas presentaron mayor correlación con estrés, ansiedad y depresión. Se considera que los profesionales del SAMU utilizan estrategias de enfrentamiento que permiten la elaboración de situaciones vividas, indicando la importancia de la valorización de potencialidades a ser desarrolladas en el servicio.

Reversible writing/deleting of magnetic skyrmions through hydrogen adsorption/desorption.

Magnetic skyrmions are topologically nontrivial spin textures with envisioned applications in energy-efficient magnetic information storage. Toggling the presence of magnetic skyrmions via writing/deleting processes is essential for spintronics applications, which usually require the application of a magnetic field, a gate voltage or an electric current. Here we demonstrate the reversible field-free writing/deleting of skyrmions at room temperature, via hydrogen chemisorption/desorption on the surface of Ni and Co films. Supported by Monte-Carlo simulations, the skyrmion creation/annihilation is attributed to the hydrogen-induced magnetic anisotropy change on ferromagnetic surfaces. We also demonstrate the role of hydrogen and oxygen on magnetic anisotropy and skyrmion deletion on other magnetic surfaces. Our results open up new possibilities for designing skyrmionic and magneto-ionic devices.

Bendable Polycrystalline and Magnetic CoFe2O4 Membranes by Chemical Methods.

The preparation and manipulation of crystalline yet bendable functional complex oxide membranes has been a long-standing issue for a myriad of applications, in particular, for flexible electronics. Here, we investigate the viability to prepare magnetic and crystalline CoFe2O4 (CFO) membranes by means of the Sr3Al2O6 (SAO) sacrificial layer approach using chemical deposition techniques. Meticulous chemical and structural study of the SAO surface and SAO/CFO interface properties have allowed us to identify the formation of an amorphous SAO capping layer and carbonates upon air exposure, which dictate the crystalline quality of the subsequent CFO film growth. Vacuum annealing at 800 °C of SAO films promotes the elimination of the surface carbonates and the reconstruction of the SAO surface crystallinity. Ex-situ atomic layer deposition of CFO films at 250 °C on air-exposed SAO offers the opportunity to avoid high-temperature growth while achieving polycrystalline CFO films that can be successfully transferred to a polymer support preserving the magnetic properties under bending. Float on and transfer provides an alternative route to prepare freestanding and wrinkle-free CFO membrane films. The advances and challenges presented in this work are expected to help increase the capabilities to grow different oxide compositions and heterostructures of freestanding films and their range of functional properties.

The Accessibility of the Cell Wall in Scots Pine (Pinus sylvestris L.) Sapwood to Colloidal Fe3O4 Nanoparticles.

This work presents a rapid and facile way to access the cell wall of wood with magnetic nanoparticles (NPs), providing insights into a method of wood modification to prepare hybrid bio-based functional materials. Diffusion-driven infiltration into Scots pine (Pinus sylvestris L.) sapwood was achieved using colloidal Fe3O4 nanoparticles. Optical microscopy, scanning electron microscopy/energy-dispersive X-ray spectroscopy, transmission electron microscopy, and X-ray powder diffraction analyses were used to detect and assess the accessibility of the cell wall to Fe3O4. The structural changes, filling of tracheids (cell lumina), and NP infiltration depth were further evaluated by performing X-ray microcomputed tomography analysis. Fourier transform infrared spectroscopy was used to assess the chemical changes in Scots pine induced by the interaction of the wood with the solvent. The thermal stability of Fe3O4-modified wood was studied by thermogravimetric analysis. Successful infiltration of the Fe3O4 NPs was confirmed by measuring the magnetic properties of cross-sectioned layers of the modified wood. The results indicate the feasibility of creating multiple functionalities that may lead to many future applications, including structural nanomaterials with desirable thermal properties, magnetic devices, and sensors.

Electrically Enhanced Exchange Bias via Solid-State Magneto-ionics.

Electrically induced ionic motion offers a new way to realize voltage-controlled magnetism, opening the door to a new generation of logic, sensor, and data storage technologies. Here, we demonstrate an effective approach to magneto-ionically and electrically tune the exchange bias in Gd/Ni1-xCoxO thin films (x = 0.50 and 0.67), where neither of the layers alone is ferromagnetic at room temperature. The Gd capping layer deposited onto antiferromagnetic Ni1-xCoxO initiates a solid-state redox reaction that reduces an interfacial region of the oxide to ferromagnetic NiCo. An exchange bias is established after field cooling (FC), which can be enhanced by up to 35% after a voltage conditioning and subsequently reset with a second FC. These effects are caused by the presence of an interfacial ferromagnetic NiCo layer, which further alloys with the Gd layer upon FC and voltage application, as confirmed by electron microscopy and polarized neutron reflectometry studies. These results highlight the viability of the solid-state magneto-ionic approach to achieve electric control of exchange bias, with potential for energy-efficient magneto-ionic devices.

Magneto-Ionics in Single-Layer Transition Metal Nitrides.

Magneto-ionics allows for tunable control of magnetism by voltage-driven transport of ions, traditionally oxygen or lithium and, more recently, hydrogen, fluorine, or nitrogen. Here, magneto-ionic effects in single-layer iron nitride films are demonstrated, and their performance is evaluated at room temperature and compared with previously studied cobalt nitrides. Iron nitrides require increased activation energy and, under high bias, exhibit more modest rates of magneto-ionic motion than cobalt nitrides. Ab initio calculations reveal that, based on the atomic bonding strength, the critical field required to induce nitrogen-ion motion is higher in iron nitrides (≈6.6 V nm-1) than in cobalt nitrides (≈5.3 V nm-1). Nonetheless, under large bias (i.e., well above the magneto-ionic onset and, thus, when magneto-ionics is fully activated), iron nitride films exhibit enhanced coercivity and larger generated saturation magnetization, surpassing many of the features of cobalt nitrides. The microstructural effects responsible for these enhanced magneto-ionic effects are discussed. These results open up the potential integration of magneto-ionics in existing nitride semiconductor materials in view of advanced memory system architectures.

Religiosidade e Espiritualidade no Processo de Luto de Pais cujos Filhos Morreram Crianças / Religiosity and Spirituality in the Process of Grief of Parents whose Children have Died / Religiosidad y Espiritualidad en el Proceso de Duelo de Padres cuyos Hijos Murieron

Diante da complexidade dos fatores que envolvem a perda de um filho, o objetivo deste artigo foi compreender o papel da religiosidade e da espiritualidade no processo de luto de pais cujos filhos morreram crianças. Para tanto, foram realizadas 11 entrevistas com pais que haviam perdido os filhos crianças dentro de um intervalo de 4 meses a 1 ano e 4 meses. Os dados, coletados entre maio e outubro de 2015, foram analisados sob a perspectiva da análise de conteúdo temática. Os resultados mostraram que os pais atribuíram a causa da morte à vontade de Deus, o que permitiu conferir uma razão à perda. A partir da crença da vida após a morte, acreditaram que seus filhos poderiam estar vivos em outra dimensão, o que favoreceu o sentimento de esperança no reencontro. As relações com a fé variaram, de modo que alguns pais se direcionaram em busca da religiosidade, outros questionaram suas crenças prévias e outros se revoltaram contra Deus. Assim, destaca-se a necessidade de considerar os aspectos subjetivos em conjunto com as ferramentas que podem auxiliar na elaboração da perda, a fim de que haja um manejo adequado do luto parental. (AU)

Towards the complexity of factors involving the loss of a child, this article aimed to comprehend the role of religiosity and spirituality in the process of grief of parents whose children have died. Therefore, 11 interviews were conducted with parents who had lost their children in a range of 4 months to 1 year and 4 months. Data ­ which were collected from May to October of 2015 ­ were analyzed from the perspective of the thematic content analysis. The results showed that parents would attribute the cause of death to God's will, which would give them a reason for the loss. Based on the belief of life after death, they would believe that their children could be alive in another dimension, which stimulated the hope for meeting again. The relationship with faith was varying so that some parents had driven into religiosity, while others had questioned their previous beliefs and others had risen against God. Thus, it is emphasized the necessity of considering subjective aspects with tools that might help in the elaboration of the loss, in order to promote an adequate handling of parental grief. (AU)

Frente a la complejidad de los factores que implican perder un hijo, el objetivo del artículo fue comprender el papel de la religiosidad y la espiritualidad en el proceso de duelo de padres cuyos hijos murieron niños. Fueron realizadas 11 entrevistas con padres que habían perdido los hijos niños en un intervalo de 4 meses a 1 año y 4 meses. Los datos, recolectados entre mayo y octubre de 2015, fueron analizados desde la perspectiva del análisis de contenido temático. Los resultados mostraron que los padres atribuyeron la causa de la muerte a la voluntad de Dios, permitiendo dar una razón a la pérdida. Partiendo de la aceptación de la vida después de la muerte, creían que sus hijos podrían estar vivos en otra dimensión, favoreciendo el sentimiento de esperanza en el reencuentro. Las relaciones con la fe variaron, así que algunos padres se direccionaron en busca de la religiosidad, otros cuestionaron sus creencias previas y otros se rebelaron contra Dios. Así, se destaca la necesidad de considerar los aspectos subjetivos junto con las herramientas que puedan auxiliar en la elaboración de la pérdida para realizar un manejo adecuado del duelo parental. (AU)

Efficient and Robust Metallic Nanowire Foams for Deep Submicrometer Particulate Filtration.

The ongoing COVID-19 pandemic highlights the severe health risks posed by deep submicrometer-sized airborne viruses and particulates in the spread of infectious diseases. There is an urgent need for the development of efficient, durable, and reusable filters for this size range. Here we report the realization of efficient particulate filters using nanowire-based low-density metal foams which combine extremely large surface areas with excellent mechanical properties. The metal foams exhibit outstanding filtration efficiencies (>96.6%) in the PM0.3 regime, with the potential for further improvement. Their mechanical stability, light weight, chemical and radiation resistance, ease of cleaning and reuse, and recyclability further make such metal foams promising filters for combating COVID-19 and other types of airborne particulates.

Manifestaciones cardiovasculares en pacientes hospitalizados con dengue / Cardiovascular disorders in hospitalized patients with dengue infection

Introducción: Las complicaciones cardiacas en pacientes con dengue no son infrecuentes y no son diagnosticadas, ya que usualmente son leves y autolimitadas. Objetivos: Caracterizar las manifestaciones cardiovasculares en pacientes hospitalizados con infección por dengue. Métodos: Se realizó un estudio epidemiológico observacional, analítico, de corte longitudinal, prospectivo, que incluyó 427 pacientes atendidos en el Hospital Docente Clínico-Quirúrgico Comandante Manuel Fajardo con diagnóstico de infección por dengue durante el periodo comprendido desde abril de 2017 hasta abril de 2018. Resultados: Las manifestaciones cardiovasculares (19,7%), principalmente los trastornos del ritmo (bradicardia sinusal [13,8%], extrasístoles auriculares [4,9%] y ventriculares [4,0%]) fueron frecuentes en pacientes con infección por dengue. La pericarditis y miocarditis se identificó en el 1,6% y 0,2%, respectivamente. Estas manifestaciones fueron autolimitadas en el 83,3% y se presentaron en los primeros días de inicio del cuadro febril en el 75,0%. La edad avanzada (OR=1,70), el sexo masculino (OR=1,94), el recuento de plaquetas disminuido (OR=1,13) y el dengue con signos de alarma (OR=3,29) se relacionaron con una mayor probabilidad de presentar manifestaciones cardiovasculares en el curso de una infección por dengue. Conclusiones: Las manifestaciones cardiovasculares en pacientes con dengue son frecuentes, y se relacionan con la edad avanzada, el sexo masculino, así como las formas severas de la enfermedad.(AU)

Introduction: Cardiac complications in dengue patients are not uncommon and are not diagnosed, since they are usually mild and self-limiting. Objectives: To characterize the cardiovascular manifestations in hospitalized patients with dengue infection. Methods: We conducted an observational, analytical, longitudinal, prospective epidemiological study, which included 427 patients treated at Manuel Fajardo Clinical-Surgical Teaching Hospital with diagnosis of dengue infection since April 2017 to April 2018. Results: Cardiovascular manifestations (19.7%), mainly heart rate disorders (sinus bradycardia [13.8%], atrial [4.9%] and ventricular [4.0%] extrasystoles) were frequent in dengue infection patients. Pericarditis and myocarditis were diagnosed in 1.6% and 0.2% respectively. These disorders were self-limiting in 83.3% of cases and occurred in the first days of the onset of fever in 75.0%. Advanced age (OR=1.70), male sex (OR=1.94), decreased platelet count (OR=1.13) and dengue with warning signs (OR=3.29) were related to a higher probability of presenting cardiovascular disorders in the course of a dengue infection. Conclusions: Cardiovascular manifestations in dengue patients are frequent, and are related to advanced age, male sex, as well as severe forms of the disease.(AU)

Cardiovascular disorders in hospitalized patients with dengue infection. / Manifestaciones cardiovasculares en pacientes hospitalizados con dengue.

INTRODUCTION: Cardiac complications in dengue patients are not uncommon and are not diagnosed, since they are usually mild and self-limiting. OBJECTIVES: To characterize the cardiovascular manifestations in hospitalized patients with dengue infection. METHODS: We conducted an observational, analytical, longitudinal, prospective epidemiological study, which included 427 patients treated at Manuel Fajardo Clinical-Surgical Teaching Hospital with diagnosis of dengue infection since April 2017 to April 2018. RESULTS: Cardiovascular manifestations (19.7%), mainly heart rate disorders (sinus bradycardia [13.8%], atrial [4.9%] and ventricular [4.0%] extrasystoles) were frequent in dengue infection patients. Pericarditis and myocarditis were diagnosed in 1.6% and 0.2% respectively. These disorders were self-limiting in 83.3% of cases and occurred in the first days of the onset of fever in 75.0%. Advanced age (OR=1.70), male sex (OR=1.94), decreased platelet count (OR=1.13) and dengue with warning signs (OR=3.29) were related to a higher probability of presenting cardiovascular disorders in the course of a dengue infection. CONCLUSIONS: Cardiovascular manifestations in dengue patients are frequent, and are related to advanced age, male sex, as well as severe forms of the disease.

O luto de pais: considerações sobre a perda de um filho criança / Parents' grief: thoughts on the loss of a child / El duelo de los padres: consideraciones Sobre la pérdida de un hijo todavía niño

A morte fora de lugar, a perda dos projetos futuros, das idealizações depositadas no filho e o lugar insubstituível que ele ocupa no imaginário dos pais dificultam o processo de elaboração do luto. Neste trabalho, buscou-se compreender como os pais vivenciam a perda de um filho ainda criança e discutir aspectos característicos desses casos. Foi realizada uma pesquisa qualitativa, em que se entrevistou 11 pais que perderam os filhos crianças, cujas mortes ocorreram em um intervalo que varia entre quatro meses e um ano e quatro meses em relação à entrevista. As entrevistas foram semiestruturadas com eixos norteadores que direcionaram os temas a serem abordados, e os dados foram trabalhados por meio da análise temática, revelando os núcleos de sentido da comunicação. Entre os principais elementos constituintes das narrativas, destacam-se: a dor incomparável, culpa, as experiências diferentes entre pais e mães, os outros filhos, o sentimento de perda de uma parte de si, a perda do objeto narcísico e a vivência do luto diante do funcionamento social contemporâneo. O estudo demonstrou a importância de considerar a singularidade do luto parental e não o confundir com a melancolia. Esses aspectos precisam ser reconhecidos, junto às diferenças que marcam as experiências distintas entre pai e mãe, o narcisismo dos pais e o contexto contemporâneo, a fim de auxiliar na construção de intervenções adequadas nesses casos. Sublinha-se a importância da fala na organização de uma narrativa que permita a construção de um sentido para a perda e a elaboração do luto. (AU)

The sudden death; the interruption of future projects, of the idealizations set upon a child; and its irreplaceable role within parents' imagination hamper the grief resolution process due to the loss of a child. Thus, this study aimed to understand how parents experience the loss of a child, discussing particular aspects related to this situation. Through a qualitative approach, semi-structured interviews guided by thematic axes were conducted with 11 parents who had lost their children between four months and one year and four months before the interview. Collected data underwent thematic analysis, revealing the communication cores. Incomparable pain, guilt, different experiences between fathers and mothers, other children, the feeling of losing a part of themselves, the loss of a narcissistic object, and the experience of grief towards the contemporary social functioning were the main elements present in parents' narratives. This study demonstrates the importance of considering the singularity of the parental grief without misinterpreting it as melancholy. To help developing appropriate interventions aimed at these cases, one must recognize the aforementioned aspects, as well as the differences marking paternal and maternal experiences, parents' narcissism, and the contemporary context. The findings also point to the relevance of speech in organizing a narrative that enables the construction of a meaning for the loss and grief resolution.(AU)

La muerte fuera de lugar, la pérdida de proyectos futuros, de idealizaciones para el hijo y el lugar insustituible que este ocupa en lo imaginario de los padres hace que el proceso del duelo sea difícil. En este trabajo, se pretendió comprender cómo los padres vivencian la pérdida de un hijo aún niño y discutir los aspectos característicos de este caso. Para tanto, se realizó una investigación cualitativa, en que se entrevistaron 11 padres que perdieron hijos aún niños, cuyas muertes ocurrieron entre los cuatro meses y un año y cuatro meses antes de la entrevista. Las entrevistas semiestructuradas incluían ejes que direccionaron hacia temas predefinidos, y para el análisis de los datos se aplicó el análisis temático revelando los núcleos de sentido de la comunicación. Entre los principales elementos constituyentes de las narrativas se destacan: el dolor incomparable, la culpa, las experiencias diferentes entre el padre y la madre, los otros hijos, el sentimiento de perder una parte de sí, la pérdida del objeto narcisista y la vivencia del duelo por el funcionamiento social contemporáneo. El estudio demostró la importancia de considerar la singularidad del duelo parental y no confundirlo con la melancolía. Es necesario reconocer estos aspectos junto con las diferencias que marcan las experiencias distintas entre el padre y la madre, el narcisismo de los padres y el contexto contemporáneo, con la finalidad de contribuir con intervenciones adecuadas a esos casos. Se destaca la importancia del habla en la organización de una narrativa que permita la construcción de un significado para la pérdida y la elaboración del duelo.(AU)

Significados atribuídos por pais enlutados às suas experiências e aos cuidados da equipe de saúde / Meanings attributed by bereaved parents to their experiences and to the care of the healthcare team / Significados atribuidos por los padres en duelo a sus experiencias y a los cuidados del equipo de salud

O adoecimento e a morte de uma criança repercutem diretamente na vida dos pais. Diante disso, este artigo, de abordagem qualitativa, objetivou compreender os significados atribuídos por pais enlutados às suas experiências diante da perda do filho e aos cuidados desempenhados pela equipe de saúde. Realizaram-se 11 entrevistas semiestruturadas com pais que perderam filhos crianças em virtude de doença, cujos dados foram tratados conforme análise de conteúdo temática. Os resultados mostraram: a importância da participação no cuidado da criança adoecida e do contato com o filho morto; e as percepções ambivalentes em relação à equipe de saúde, que evidenciaram atenção e comunicação compreensiva e despreparo para a atuação, comunicação inadequada e falta de seguimento na assistência. Destaca-se a importância da comunicação clara e do reconhecimento da perda, além de capacitações aos profissionais para atuarem com situações de morte e luto.

The illness and death of a child reverberate directly on parents' lives. Therefore, this qualitative approach paper aimed to comprehend the meanings attributed by bereaved parents to their experiences in front of the loss of their child and to the care performed by the healthcare team. There were conducted 11 semi-structured interviews with parents who had lost their children because of an illness. Data were analyzed according to thematic content analysis. The results demonstrated: the importance of participating on the care of the sick child and the contact with the dead child; ambivalent perceptions towards the healthcare team, which evidences attention and comprehensive communication and shows unpreparedness for the performance, inadequate communication and lack of follow-up on care. It is emphasized the importance of an honest communication and the recognition of the loss, as well as training professionals to work with situations of death and grief.

La enfermedad y la muerte de un niño repercuten directamente en la vida de los padres. Asi, este artículo, de abordaje cualitativa, objetivó comprender los significados atribuidos por los padres en duelo a sus experiencias ante la pérdida de su hijo y a los cuidados desempeñados por el equipo de salud. Se realizaron 11 entrevistas semiestructuradas con padres que perdieron su niño en virtud de una enfermedad, cuyos datos fueron tratados conforme análisis de contenido temático. Los resultados mostraron: la importancia de la participación en el cuidado del niño enfermo y del contacto con el niño muerto; percepciones ambivalentes frente al equipo de salud, evidenciaron atención y comunicación comprensiva y despreparo para la actuación, comunicación inadecuada y falta de asistencia continuada. Se destaca la importancia de comunicación clara y del reconocimiento de la pérdida, así como la formación de profesionales para trabajar con situaciones de muerte y luto.

Significações dos cuidados paliativos para profissionais de um serviço de atenção domiciliar / The meanings of palliative care for professionals in a home care service / Significados de los cuidados paliativos para los profesionales de un servicio de atención domiciliaria

Os cuidados paliativos são promovidos por uma equipe interdisciplinar que visa oferecer melhor qualidade de vida tanto aos pacientes que enfrentam doenças que ameaçam a vida quanto a seus familiares. Este trabalho objetivou compreender as significações dos cuidados paliativos para os profissionais de uma equipe de atenção domiciliar, que configura uma das modalidades de assistência em que esses cuidados podem ocorrer. Para tanto, adotou-se a pesquisa descritiva e exploratória, de cunho qualitativo. Participaram da pesquisa 9 profissionais de diferentes áreas de um Serviço de Atenção Domiciliar (SAD) vinculado a um hospital-escola do interior do Rio Grande do Sul. Os dados foram coletados por meio de entrevistas semiestruturadas e submetidos à análise de conteúdo. Os resultados demonstraram que os cuidados paliativos são compreendidos pela equipe investigada como uma prática de natureza interdisciplinar que gera benefícios para os pacientes e profissionais envolvidos nessa área de atuação. Além disso, os participantes consideram que atuar em cuidados paliativos exige que os profissionais tenham um bom gerenciamento das emoções e preparo para trabalhar com situações complexas. Também acreditam que essa atividade pode proporcionar desenvolvimento pessoal e profissional. Assim, é notória a importância de uma formação que contemple os princípios dos cuidados paliativos e um suporte emocional aos profissionais, para que possam converter as experiências de convívio com o sofrimento e com a finitude humana em aprendizados.(AU)

Palliative care is the care provided by an interdisciplinary team to improve the quality of life of patients facing life-threatening diseases and that of their families; home care is among the types of support that offer this assistance. This study aimed to understand the meanings of palliative care for professionals of a home care team. It consists of a descriptive exploratory research of qualitative nature conducted with nine professionals from different areas of a Home Care Service (HCS) linked to a School Hospital in the countryside of Rio Grande do Sul. Data were collected by semi-structured interviews and analyzed using content analysis. The results show that the investigated professionals understand palliative care as an interdisciplinary practice that provides benefits for patients and professionals involved. The participants also consider that professionals working in palliative care must manage their emotions well and be prepared to face complex situations. At the same time, they believe that this activity can provide personal and professional development. Thus, the results highlight the importance of a formation that contemplates the principles of palliative care and an emotional support for the professionals, who, from the conviviality with suffering and human finitude, should transform these experiences into learnings.(AU)

Los cuidados paliativos son promovidos por un equipo interdisciplinario que trata de ofrecer una mejor calidad de vida tanto a los pacientes que enfrentan enfermedades que amenazan la vida como a sus familiares. Este estudio se propone comprender los significados de los cuidados paliativos para los profesionales de un equipo de atención domiciliaria, una de las modalidades de asistencia a esos cuidados. Para ello, se adoptó la investigación descriptiva y exploratoria, de tipo cualitativo. Participaron en la investigación 9 profesionales de diferentes áreas de un Servicio de Atención Domiciliaria (SAD) vinculado a un Hospital Escuela del interior del Rio Grande do Sul (Brasil). Los datos se recopilaron de entrevistas semiestructuradas y se aplicó el análisis de contenido. Los resultados demostraron que el equipo investigado comprende los cuidados paliativos como una práctica de naturaleza interdisciplinaria, la cual genera beneficios para pacientes y los profesionales involucrados en esta área. Además, los participantes consideran que el trabajo con cuidados paliativos requiere de los profesionales una buena gestión de las emociones y preparación para manejar situaciones complejas. Al mismo tiempo, creen que esta actividad puede proporcionar desarrollo personal y profesional. Por lo tanto, es notoria la importancia de una formación que contemple los principios de los cuidados paliativos y dé soporte emocional a los profesionales, los cuales, a partir de la convivencia con el sufrimiento y la finitud humana, pueden convertir estas experiencias en aprendizajes.(AU)