A relação de ajuda ao doente em fim de vida e família: o enfermeiro e o cuidar em fim de vida

Os cuidados ao doente em fim de vida tornam-se difíceis de suportar pelas pessoas envolvidas, pois, para além da sobrecarga física, existe um grande desgaste psicológico e emocional, pelo que se torna importante um acompanhamento e apoio por parte dos profissionais de saúde. A relação de ajuda é um elemento decisivo na atividade dos enfermeiros, desempenhando um papel central na resposta às necessidades concretas do doente em fim de vida e sua família. O objectivo do estudo foi identificar necessidades e dificuldades que os enfermeiros enfrentam no contexto da relação de ajuda ao doente em fim de vida e família. A metodologia utilizada foi a Revisão Sistemática da Literatura sendo aplicada a metodologia PICO. Recorreu-se às bases de dados B-on, LILACS e Scielo, tendo sido reunidos 14 artigos e analisados 7. Os resultados mostraram que muitos enfermeiros sentem dificuldade em comunicar com doentes terminais, apesar de valorizarem as relações interpessoais relacionadas com a comunicação, o conforto, o apoio e acompanhamento e as técnicas de alívio do sofrimento do doente e família, direcionadas para a gestão da dor e sofrimento. A falta de formação em cuidados paliativos é evidente, sendo que o desempenho das competências relacionais de ajuda está correlacionado com a formação que os enfermeiros desenvolvem acerca da relação de ajuda. As principais conclusões a que o estudo chegou foram que apesar da dedicação dos enfermeiros a relação de ajuda ao doente terminal e família nem sempre é conseguida. O desenvolvimento pessoal e profissional, o modo como gerem as dificuldades pessoais e relacionais com o doente e família no contexto de fim de vida, são considerados como os ingredientes major ao nível do cuidar e da relação de ajuda profissional.info:eu-repo/semantics/publishedVersio

Developing Conceptual and Methodological Foundations in Community Engagement

We describe the efforts of two related undergraduate projects to promote lasting social change in marginalized communities in the Dominican Republic and Nicaragua. The projects represent a test of the premise that undergraduate projects can engage academically based strategies and transcend good intentions to achieve effective community partnerships to improve health and health care. The projects proceed from a perspective and theory of marginalization and its consequences. Specifically, marginalization undermines individual and collective capacity to meet basic needs and efforts to thrive. Through strengthening social infrastructure, communities can overcome the effects of marginalization. Project work begins with annual medical clinics and, with the permission of community residents, team members conduct ethnographic descriptions of the communities and their health and health care concerns and resources. We use social network analysis (SNA) and geographic information system (GIS) techniques to describe social infrastructure. Working from those foundations, both projects have enabled increased social infrastructure. To date, we have observed increased communication among community residents, facilitated the development of community-endorsed five-year plans, and established partnerships with regional and international groups

Lysophosphatidic acid enhances survival of human CD34(+) cells in ischemic conditions

Several clinical trials are exploring therapeutic effect of human CD34(+) cells in ischemic diseases, including myocardial infarction. Unfortunately, most of the cells die few days after delivery. Herein we show that lysophosphatidic acid (LPA)-treated human umbilical cord blood-derived CD34(+) cells cultured under hypoxic and serum-deprived conditions present 2.2-fold and 1.3-fold higher survival relatively to non-treated cells and prostaglandin E2-treated cells, respectively. The pro-survival effect of LPA is concentration- and time-dependent and it is mediated by the activation of peroxisome proliferator-activator receptor γ (PPARγ) and downstream, by the activation of pro-survival ERK and Akt signaling pathways and the inhibition of mitochondrial apoptotic pathway. In hypoxia and serum-deprived culture conditions, LPA induces CD34(+) cell proliferation without maintaining the their undifferentiating state, and enhances IL-8, IL-6 and G-CSF secretion during the first 12 h compared to non-treated cells. LPA-treated CD34(+) cells delivered in fibrin gels have enhanced survival and improved cardiac fractional shortening at 2 weeks on rat infarcted hearts as compared to hearts treated with placebo. We have developed a new platform to enhance the survival of CD34(+) cells using a natural and cost-effective ligand and demonstrated its utility in the preservation of the functionality of the heart after infarction.info:eu-repo/semantics/publishedVersio

Endothelial Progenitor Cells influence acute and subacute stroke hemodynamics

BACKGROUND: Endothelial Progenitor Cells (EPCs) are a circulating stem cell population with in vivo capacity of promoting angiogenesis after ischemic events. Despite the promising preclinical data, their potential integration with reperfusion therapies and hemodynamic evolution of stroke patients is still unknown. Our aim was to determine the association of EPCs with acute, subacute and chronic hemodynamic features. METHODS: In this prospective study, we included consecutive patients with ages between 18 and 80years and non-lacunar ischemic stroke within the territory of a middle cerebral artery. All patients were subject to hemodynamic evaluation by ultrasound at baseline, seven days and three months. We quantified cerebral blood flow (CBF) and assessed early recanalization and collateral flow. Hemorrhagic transformation was graded in Magnetic Resonance imaging performed at seven days. EPCs were isolated from peripheral venous blood collected in the first 24h and seven days, counted and submitted to functional in vitro tests. RESULTS: We included 45 patients with a median age of 70±10years. The angiogenic and migratory capacities of EPCs were associated with increased collateral flow in the acute stage and day seven CBF, without statistically significant associations with recanalization nor haemorrhagic transformation. The number of EPCs was not associated with any hemodynamic variable. CONCLUSIONS: The functional properties of EPCs are associated with acute and subacute stroke hemodynamics, with no effect on haemorrhagic transformation.info:eu-repo/semantics/publishedVersio

What do you do for a living? Toward a more succinct definition of health services research

This commentary discusses the need for, and the advantages of, a more concise, revised definition of the field of health services research. It argues for a definition that includes not only the topics on which health services research focuses but also the goals of health services research. A number of condensed definitions are provided for consideration

Partisan Asymmetries in Online Political Activity

We examine partisan differences in the behavior, communication patterns and social interactions of more than 18,000 politically-active Twitter users to produce evidence that points to changing levels of partisan engagement with the American online political landscape. Analysis of a network defined by the communication activity of these users in proximity to the 2010 midterm congressional elections reveals a highly segregated, well clustered partisan community structure. Using cluster membership as a high-fidelity (87% accuracy) proxy for political affiliation, we characterize a wide range of differences in the behavior, communication and social connectivity of left- and right-leaning Twitter users. We find that in contrast to the online political dynamics of the 2008 campaign, right-leaning Twitter users exhibit greater levels of political activity, a more tightly interconnected social structure, and a communication network topology that facilitates the rapid and broad dissemination of political information.Comment: 17 pages, 10 figures, 6 table

Assessing the context of health care utilization in Ecuador: A spatial and multilevel analysis

<p>Abstract</p> <p>Background</p> <p>There are few studies that have analyzed the context of health care utilization, particularly in Latin America. This study examines the context of utilization of health services in Ecuador; focusing on the relationship between provision of services and use of both preventive and curative services.</p> <p>Methods</p> <p>This study is cross-sectional and analyzes data from the 2004 National Demographic and Maternal & Child Health dataset. Provider variables come from the Ecuadorian System of Social Indicators (SIISE). Global Moran's I statistic is used to assess spatial autocorrelation of the provider variables. Multilevel modeling is used for the simultaneous analysis of provision of services at the province-level with use of services at the individual level.</p> <p>Results</p> <p>Spatial analysis indicates no significant differences in the density of health care providers among Ecuadorian provinces. After adjusting for various predisposing, enabling, need factors and interaction terms, density of public practice health personnel was positively associated with use of preventive care, particularly among rural households. On the other hand, density of private practice physicians was positively associated with use of curative care, particularly among urban households.</p> <p>Conclusions</p> <p>There are significant public/private, urban/rural gaps in provision of services in Ecuador; which in turn affect people's use of services. It is necessary to strengthen the public health care delivery system (which includes addressing distribution of health workers) and national health information systems. These efforts could improve access to health care, and inform the civil society and policymakers on the advances of health care reform.</p

Veterans Affairs Health System and Mental Health Treatment Retention among Patients with Serious Mental Illness: Evaluating Accessibility and Availability Barriers

We examine the impact of two dimensions of access—geographic accessibility and availability—on VA health system and mental health treatment retention among patients with serious mental illness (SMI). Methods . Among 156,631 patients in the Veterans Affairs (VA) health care system with schizophrenia or bipolar disorder in fiscal year 1998 (FY98), we used Cox proportional hazards regression to model time to first 12-month gap in health system utilization, and in mental health services utilization, by the end of FY02. Geographic accessibility was operationalized as straight-line distance to nearest VA service site or VA psychiatric service site, respectively. Service availability was assessed using county-level VA hospital beds and non-VA beds per 1,000 county residents. Patients who died without a prior gap in care were censored. Results . There were 32, 943 patients (21 percent) with a 12-month gap in health system utilization; 65,386 (42 percent) had a 12-month gap in mental health services utilization. Gaps in VA health system utilization were more likely if patients were younger, nonwhite, unmarried, homeless, nonservice-connected, if they had bipolar disorder, less medical morbidity, an inpatient stay in FY98, or if they lived farther from care or in a county with fewer VA inpatient beds. Similar relationships were observed for mental health, however being older, female, and having greater morbidity were associated with increased risks of gaps, and number of VA beds was not significant. Conclusions . Geographic accessibility and resource availability measures were associated with long-term continuity of care among patients with SMI. Increased distance from providers was associated with greater risks of 12-month gaps in health system and mental health services utilization. Lower VA inpatient bed availability was associated with increased risks of gaps in health system utilization. Study findings may inform efforts to improve treatment retention.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73433/1/j.1475-6773.2006.00642.x.pd