Análisis de los cambios y dificultades surgidas después del trasplante renal: una investigación cualitativa

;;OBJECTIVE:;; to identify the main gains and stressors perceived by the patient, one year subsequent to kidney transplantation.;;;;METHOD:;; a qualitative study, in which the data were obtained and analyzed through the Discourse of the Collective Subject and frequency counting, with the participation of 50 patients who had received kidney transplantation.;;;;RESULTS:;; the sample presented a mean age of 44±12.8 years old, and a predominance of males (62%). The principal positive changes provided by the transplant were: return to activities; freedom/independence; well-being and health; strengthening of the I; and closening of interpersonal relationships. The most-cited stressors were: fear; medication; excess of care/control; specific characteristics of the treatment; and failure to return to the social roles.;;;;CONCLUSION:;; kidney transplantation caused various positive changes in the patient's routine, with the return to activities of daily living being the most important gain, in the participants' opinion. In relation to the stressors, fear related to loss of the graft, and questions relating to the immunosuppressive medication were the main challenges to be faced following transplantation.;;;;OBJETIVO:;; identificar os principais ganhos e estressores percebidos pelo paciente, após um ano de transplante renal.;;;;MÉTODO:;; trata-se de um estudo qualitativo, em que os dados foram obtidos e analisados através do Discurso do Sujeito Coletivo e contagem de frequência, com a participação de 50 pacientes transplantados renais.;;;;RESULTADOS:;; a amostra apresentou média de idade de 44±12,8 anos e predominância do sexo masculino (62%). As principais mudanças positivas proporcionadas pelo transplante foram: retorno às atividades; liberdade/independência; bem-estar e saúde; fortalecimento do eu; e estreitamento das relações interpessoais. Os estressores mais citados foram: medo; medicação; excesso de cuidado/controle; particularidades do tratamento; e não retorno aos papéis sociais.;;;;CONCLUSÃO:;; o transplante renal proporcionou várias mudanças positivas à rotina do paciente, sendo o retorno às atividades de vida diária o ganho mais importante, na opinião dos participantes. Quanto aos estressores, o medo relacionado à perda do enxerto e questões relativas ao medicamento imunossupressor foram os principais desafios a serem enfrentados após o transplante.;;;;OBJETIVO:;; identificar las principales ganancias y estresores percibidos por el paciente, después de un año de trasplante renal.;;;;MÉTODO:;; se trata de un estudio cualitativo, en que los datos fueron obtenidos y analizados a través del Discurso del Sujeto Colectivo y conteo de frecuencia, con la participación de 50 pacientes trasplantados renales.;;;;RESULTADOS:;; la muestra presentó promedio de edad de 44±12,8 años y predominancia del sexo masculino (62%). Los principales cambios positivos proporcionadas por el trasplante fueron: retorno a las actividades; libertad/independencia; bienestar y salud; fortalecimiento del yo; y estrechamiento de las relaciones interpersonales. Los estresores más citados fueron: miedo; medicación; exceso de cuidado/control; particularidades del tratamiento; y no retorno a los papeles sociales.;;;;CONCLUSIÓN:;; el trasplante renal proporcionó varios cambios positivos en la rutina del paciente, siendo el retorno a las actividades de la vida diaria la ganancia más importante, en la opinión de los participantes. En cuanto a los estresores, el miedo relacionado a la pérdida del injerto y las cuestiones relativas al medicamento inmunosupresor fueron los principales desafíos a ser enfrentados después del trasplante.;

Depression and anxiety among patients undergoing dialysis and kidney transplantation : a cross-sectional study.

BACKGROUND: Depression and anxiety are the most prevalent psychological disorders among end-stage renal disease patients and are associated with various conditions that result in poorer health outcomes, e.g. reduced quality of life and survival. We aimed to investigate the prevalences of depression and anxiety among patients undergoing renal replacement therapy. DESIGN AND SETTING: Cross-sectional study in Belo Horizonte, Brazil. METHODS: Patients? depression and anxiety levels were assessed using the Beck Inventory. The independent variables were the 36-Item Short-Form Health Survey (SF-36), Charlson Comorbidity Index and Global Subjective Assessment, along with sociodemographic and clinical characteristics. RESULTS: 205 patients were included. Depression and anxiety symptoms were detected in 41.7% and 32.3% of dialysis patients and 13.3% and 20.3% of transplantation patients, respectively. Lower SF-36 mental summary scores were associated with depression among transplantation patients (odds ratio, OR: 0.923; 95% confidence interval, CI: 0.85-0.99; P = 0.03) and dialysis patients (OR: 0.882; 95% CI: 0.83-0.93; P ? 0.001). Physical component summary was associated with depression among dialysis patients (OR: 0.906; 95% CI: 0.85-0.96; P = 0.001). Loss of vascular access (OR: 3.672; 95% CI: 1.05-12.78; P = 0.04), comorbidities (OR: 1.578; 95% CI: 1.09-2.27; P = 0.01) and poorer SF-36 mental (OR: 0.928; 95% CI: 0.88-0.97; P = 0.002) and physical (OR: 0.943; 95% CI: 0.89-0.99; P = 0.03) summary scores were associated with anxiety among dialysis patients. CONCLUSIONS: Depression and anxiety symptoms occurred more frequently among patients undergoing dialysis. Quality of life, comorbidities and loss of vascular access were associated factors

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil

Background: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D).Methods: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups.Results: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). the majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001).Conclusions: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.Farmanguinhos/Fundacao Oswaldo Cruz/National Health MinistryBrazilian Diabetes SocietyFundacao do Amparo a Pesquisa do Estado do Rio de JaneiroConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Estado Rio de Janeiro, Unit Diabet, BR-20551030 Rio de Janeiro, BrazilBaurus Diabet Assoc, São Paulo, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilFed Univ Hosp Porto Alegre, Porto Alegre, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilSanta Casa Misericordia, Belo Horizonte, MG, BrazilSanta Casa Misericordia São Paulo, São Paulo, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilHosp Geral de Bonsucesso, Rio de Janeiro, BrazilHosp Univ Clementino Fraga Filho IPPMG, Rio de Janeiro, BrazilUniv Hosp São Paulo, São Paulo, BrazilFac Ciencias Med Santa Casa São Paulo, São Paulo, BrazilUniv São Paulo, Inst Crianca, Hosp Clin, São Paulo, BrazilUniv São Paulo, Fac Med Ribeirao Preto, Hosp Clin, Ribeirao Preto, BrazilAmbulatorio Fac Estadual Med Sao Jose Rio Preto, Ribeirao Preto, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilClin Endocrinol Santa Casa Belo Horizonte, Belo Horizonte, MG, BrazilUniv Estadual Londrina, Londrina, BrazilUniv Fed Parana, Hosp Clin, Porto Alegre, RS, BrazilInst Crianca Com Diabet Rio Grande Sul, Rio Grande Do Sul, RS, BrazilGrp Hosp Conceicao, Inst Crianca Com Diabet, Porto Alegre, RS, BrazilHosp Univ Santa Catarina, Florianopolis, SC, BrazilInst Diabet Endocrinol Joinville, Joinville, BrazilHosp Reg Taguatinga, Brasilia, DF, BrazilHosp Geral Goiania, Goiania, Go, BrazilCtr Diabet & Endocrinol Estado Bahia, Goiania, Go, BrazilUniv Fed Maranhao, Sao Luis, BrazilCtr Integrado Diabet & Hipertensao Ceara, Fortaleza, Ceara, BrazilUniv Fed Sergipe, Aracaju, BrazilHosp Univ Alcides Carneiro, Campina Grande, BrazilHosp Univ Joao de Barros Barreto, Belem, Para, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, São Paulo, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilWeb of Scienc

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Relação entre estresse e padrões de “coping” e aderência medicamentosa no transplante renal

Chronic Renal Failure is a serious public health problem. The available treatments are not curative, but rather substitutes and renal transplantation is the modality that brings better quality of life and longer survival. Adherence to immunosuppressant therapy constitutes a fundamental issue for the results of transplantation. Adherence can be defined as the degree of agreement between the patient's behavior and the health professionals’ recommendations. It is influenced by many factors, including those related to the patient's behaviors that are very poorly studied. Stress and coping patterns are part of this group. It is believed that the transplantation, even being the best therapeutic option, results in different kinds of stress to the patient. The term coping is used to identify the cognitive and behavioral responses issued by the individual to deal with the situation precipitating stress, aiming to reduce, mitigate or avoid it. Effective responses result a positive adjustment to stress, minimizing the impact of the mental and physical health of the patient. Intreventions on the most stressful situations and on coping patterns may contribute to the maintenance of general mental health of transplant recipients, leading consequently to an appropriate process of adherence to immunosuppressive treatment. This study aimed to evaluate the relationship between stress and the types of stress coping responses, with adherence to immunosuppressive treatment after the kidney transplantation. We also identified the benefits/challenges perceived by transplant patients and sociodemographic/clinical data associated with stress. We conducted a cross-sectional case-control study, involving 25 previously classified as adherent and 25 non adherent transplant patients, treated as outpatients from Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia. As inclusion criteria, were considered a minimum age of 18 years and have more than one year of functioning graft. The degree of adherence to treatment was measured by adapted and validated instrument The Basel Assessment of Adherence with Immunosuppressive Medication Scale. The stress and stress coping response were assessed by the Lipp Stress Symptom Inventory for Adults and the Ways of Coping Scale, respectively. A semi structured interview was conducted in order to detect major stressful events related to the transplantation. Frequency analysis was used to evaluate the qualitative and categories variables. T Test, Mann-Whitney, Chi-square or Fisher's Test and logistic regression were used to compare adherent and nonadherent groups. Differences are considered significant when p ≤ 0.05. The mean age of our population was 44 ± 12.8ys and the median of post-transplant time was 71.8 (12-230) months. Stress was prevalent in 50%. The categories of “Fear” and “Medication” were the most stressful concerns. Non-adherence was significantly associated with more advanced stress phases (OR 4.7, IC: 0.99-22.51, p < 0.05) and palliative coping (OR 3.4, IC: 1.02-11.47, p < 0.05). The stress was significantly associated with female gender (p = 0.04), presence of comorbidities (p = 0.04) and responses not directed to problem solving coping (p < 0.0001). We conclude that the presence of stress and the non active coping patterns are associated with non adherence of immunosuppressive after renal transplantation. These results highlight the psychological events have implications for the understanding and management of non-adherent transplant patients.A Doença Renal Crônica é um grave problema de saúde pública. Os tratamentos disponíveis não são curativos, mas sim substitutivos, sendo o transplante renal a modalidade que traz melhor qualidade de vida e maior sobrevida ao paciente. A aderência à terapia imunossupressora constitui-se ponto fundamental para os resultados do transplante. Aderência pode ser definida como o nível de coincidência entre o comportamento do paciente e as orientações dos profissionais de saúde. É influenciada por vários fatores, dentre eles os relacionados com o comportamento do paciente que são muito pouco estudados. O estresse e os padrões de enfrentamento ou coping fazem parte desse grupo. Acredita-se que o transplante, mesmo constituindo-se como a melhor terapêutica, acarreta diferentes fontes de estresse ao paciente. Coping é definido como as respostas cognitivas e comportamentais emitidas pelo indivíduo, para lidar com a situação desencadeadora do estresse, com o objetivo de reduzi-lo, amenizá-lo ou evitá-lo. Respostas eficazes resultam um ajustamento positivo ao estresse e minimizam o impacto deste na saúde mental e física do paciente. Intervenções sobre os estressores mais frequentes, assim como nos padrões de coping, podem contribuir para a manutenção da saúde mental geral do paciente transplantado, levando, consequentemente, a um processo adequado de aderência ao tratamento imunossupressor. Este estudo teve como objetivo geral avaliar a relação entre o estresse e os padrões de coping com a aderência ao tratamento imunossupressor após o transplante. Procuramos ainda identificar os principais ganhos/desafios percebidos pelos pacientes transplantados e as variáveis sociodemográficas/clínicas associadas ao estresse. Foi desenvolvido estudo transversal de caso controle, em que foram avaliados 25 pacientes transplantados renais previamente classificados como aderentes e 25 não aderentes, acompanhados no ambulatório do Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia. Como critérios de inclusão foram considerados: aceitação prévia em participar do estudo, idade mínima de 18 anos e ter mais de um ano de enxerto funcionante. O grau de aderência ao tratamento foi medido pelo instrumento adaptado e validado The Basel Assessment of Adherence with Immunosuppressive Medication Scale. O estresse e os padrões de coping foram avaliados pelo Inventário de Sintomas de Stress para Adultos de Lipp e Escala de Modos de Enfrentamento de Problemas, respectivamente. Uma entrevista semiestruturada foi conduzida com o objetivo de detectar os principais ganhos e situações estressoras relacionados ao transplante renal. A análise de frequência foi utilizada para avaliar as variáveis qualitativas e categóricas. As fases do estresse foram agrupadas em menos avançadas (alerta e resistência) e mais avançadas (quase exaustão e exaustão). Também agrupamos as categorias de coping em ativo e paliativo para análise. Os testes t de Student, Mann-Whitney, Qui-quadrado ou Teste de Fisher e regressão logística foram usados para comparar os grupos aderentes e não aderentes. As diferenças foram consideradas significativas quando p≤0,05. A média de idade da nossa população foi de 44 ± 12,8 anos e a mediana de tempo de pós transplante de 71,8 (12-230) meses. O estresse foi prevalente em 50% da amostra. As categorias “Medo” e “Medicação” foram as questões mais estressantes. A não aderência foi associada às fases mais avançadas do estresse (OR 4,7, IC: 0,99-22,51, p < 0,05) e ao coping paliativo (OR 3,4, IC: 1,02-11,47, p < 0,05). O estresse foi significativamente associado ao sexo feminino (p=0,04), presença de comorbidades (p = 0,04) e coping não focalizado no problema (p < 0,0001). Concluímos que a presença de estresse, especialmente nas suas fases mais avançadas e os padrões de coping paliativo são associados com a não aderência à medicação imunossupressora após o transplante renal. Estes resultados reforçam que os aspectos psicológicos têm implicação na compreensão e manuseio de pacientes não aderentes após transplante

Cuidando de quem cuida: estudo de caso sobre o cuidador principal de um portador de insuficiência renal crônica Cuidando de quien cuida: estudio del caso del cuidador principal de un portador de insuficeicia renal crónica Caring for those who care: case study of the primary caregiver of a chronic renal failure bearer

As doenças crônicas e adquiridas vêm predominando no cenário de saúde pública de vários países, inclusive do Brasil. A partir desse quadro surge a necessidade de mudanças nos hábitos e no estilo de vida do indivíduo doente crônico, a fim de limitar os possíveis riscos e complicações. A família, representada pela figura do cuidador principal, tem um papel fundamental no cuidado do doente, por influenciá-lo positivamente na adesão ao tratamento; porém o ato de cuidar acarreta desgastes em sua saúde física e mental que, se não tratados, representam fatores de risco para o desenvolvimento de enfermidades crônicas. O estudo de caso vem ilustrar a importância de se apoiar o cuidador de um portador de insuficiência renal crônica, para assim minimizar os fatores de risco que podem levá-lo à cronicidade.Las enfermedades crónicas y adquiridas están predominando en el escenario de la salud pública de varios países, inclusive en Brasil. A partir de este cuadro, surge la necesidad de modificaciones en los hábitos y los estilos de vida de los individuos con enfermedades crónicas con el fin de limitar los posibles riesgos y complicaciones. La familia, representada como la figura que otorga los cuidados principales, tiene un papel fundamental en el cuidado del enfermo, influenciándolo positivamente en su decisión por tratarse. De esta forma, el acto de cuidar acarrea desgastes en la salud física y mental que si no son tratados, representan factores de riesgo para el desenvolvimiento de enfermedades crónicas. El estudio del caso ilustra la importancia de considerarse el cuidador de un portador de insuficiencia renal crónica, minimizando los factores de riesgo que puedan convertirlo en crónico.The chronic and acquired diseases are predominantly in the scenario of public health in several countries, including Brazil. From that circumstance, there is the need for changes in habits and lifestyle of the chronic patients in order to limit the possible risks and complications. The family, represented by the figure of the main carer, has a key role in caring for the patient by positively influence in his adherence to treatment. However, the act of caring brings wear on his physical and mental health, if untreated, represent risk factors for the development of chronic disease. The case study is to demonstrate the importance of supporting a caregiver of a chronic renal failure bearer, thus minimizing the risk factors that can lead him to chronicity