Aquisição e desenvolvimento de competência relacionais do estudante de licenciatura em enfermagem – Um estudo qualitativo.

Introdução: Ao longo dos tempos,verificou-se que dos cuidados centrados na doença, passaram a valorizar-se os cuidados centrados na área afectiva e relacional.As competências afectivas e relacionais dos alunos de enfermagem durante o processo de cuidar os utentes convocam determinados factores associados à intimidade. Este conceito tão presente no cuidado de enfermagem não tem sido muito estudado, mas surge em documentos emanados por entidades com responsabilidade na área da saúde, nomeadamente direitos dos doentes, constituição portuguesa e código deontológico dos enfermeiros. Objectivos: - Identificar como ocorre a aquisição e desenvolvimento de competências relacionais do estudante de licenciatura em enfermagem durante o processo de cuidar;- Identificar a presença (e operacionalização) das competências relacionais nos estudantes de licenciatura em enfermagem, durante o processo de cuidados aos utentes;- Verificar se os estudantes de enfermagem, durante a sua formação clínica, preservam da intimidade/privacidades dos utentes durante o processo de cuidar. Metodologia: Trata-se de um estudo descritivo de abordagem quantitativa e qualitativa.A população estudada foram os estudantes de uma Escola Superior de Saúde do litoral da região centro e a amostra foi constituída pelos estudantes de enfermagem da referida escola, que se encontravam a realizar ensino clínico em contexto hospitalar.Os instrumentos de recolha de dados foram um questionário(caracterização dos estudantes e do contexto clínico)e uma Grelha de Observação aplicada durante o ensino clínico.Análise dos dados foi realizada através de técnicas estatísticas consideradas adequadas para organizar, avaliar, interpretar e comunicar a informação. Resultados: Dos estudantes observados, 87% eram do sexo feminino, com distribuição por todos os anos do CLE, enquanto 13% eram do sexo masculino, que frequentam o 2º e o 3º ano do CLE.A análise geral das observações revelou que os estudantes do 1º ano demonstram algumas competências relacionais durante o processo de cuidar, mas ainda pouco desenvolvidas o que é compatível com a aquisição e desenvolvimento de conhecimentos que tiverem. Nos estudantes do 2º ano, observámos que se preocupam na execução correcta das técnicas, mas a parte relacional fica um pouco aquém dos conhecimentos e experiência que já desenvolveram no 1º ano. Relativamente aos estudantes do 3º ano observados verificámos que demonstram competências relacionais tanto com a equipa como com os utentes. Na observação realizada aos estudantes do 4º ano, verificámos que possuem competências relacionais e tem a noção de preservação da intimidade/privacidade durante todo o processo de cuidar e não só em algumas situações. Conclusões: Em conclusão, podemos dizer que as competências relacionais se vão adquirindo desde o 1º ano até ao 4º ano de forma progressiva. Relativamente à preservação da intimidade no processo de cuidar, verificou-se que esta é preservada em determinados procedimentos relacionados com o processo de cuidar nomeadamente nos que requerem exposição corporal. Nos procedimentos em que não exista exposição de zonas corporais mais íntimas dos utentes, como a realização de uma punção venosa periférica, os estudantes não preservam a sua exposição. Só no final do curso (4ºano) esta competência é dominada e aplicada a todos os procedimentos do processo de cuidar

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Childhood trauma in substance use disorder and depression: An analysis by gender among a Brazilian Clinical sample

Objective: in this study, we compared the frequency and intensity of childhood traumas in alcohol- or other drug-dependent patients, in patients with depression, and in a control group without psychiatric diagnoses.Methods: the study had a retrospective design of a clinical sample of men and women from the groups listed above. They were evaluated by the same standardized instrument: the Childhood Trauma Questionnaire.Results: A higher frequency and intensity of emotional, physical, and sexual abuse were found in alcohol- and other drug-dependent patients than in patients with depression, who, in turn, presented significantly higher proportions than the control group. in all of the cases, the frequency was higher among women than men.Conclusion: Because of the high frequency and intensity of childhood traumas among alcohol- or other drug-dependent patients and depressed patients, the assessment of problems due to childhood traumas among these patients is essential to a better understanding of the etiology of those disorders and to their treatment. (C) 2010 Elsevier B.V. All rights reserved.Universidade Federal de São Paulo, Dept Psicobiol, BR-04023062 São Paulo, BrazilUniv Estadual São Paulo, Fac Med Botucatu, Dept Neurol & Psiquiatria, Botucatu, SP, BrazilUniversidade Federal de São Paulo, Dept Ciencias Saude, Santos, SP, BrazilUniversidade Federal de São Paulo, Dept Psicobiol, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Ciencias Saude, Santos, SP, BrazilWeb of Scienc

Ancylostoma duodenale em estrangeiros radicados em Botucatu, SP, Brasil

Utilizando-se a técnica de Harada & Mori foi efetuada verificação das espécies de Ancylostomidae prevalentes entre imigrantes europeus, asiáticos e brasileiros residentes no município de Botucatu, Estado de São Paulo, Brasil. Ancylostoma duodenale foi encontrado em 8,5% dos imigrantes asiáticos e Necator americanus em 3,5% dos europeus e em 18% dos brasileiros examinados.A survey of the species of Ancylostomidae causing infection among European inmigrants and Brazilian residents in Botucatu, São Paulo State, Brazil was performed using Harada & Mori's technique. Ancylostoma duodenale was found in 8.5% of the asiatic inmigrants and Necator americanus in 3.5% of the European and 18.0% of the Brazilians examined

Atividades psiquiátricas no campo dos transtornos devidos ao uso de substâncias psicoativas

There are a large number of institutions, proposals and publications in the field of disorders resulting from the use of psychoactive substances. There is no corresponding progress in results obtained in clinical treatments. Concepts and appropriate points of view are indispensable. The vision of the world drug addicts is not only determined by the biochemical effects of intoxication, but also by the experience they go through, by their own way of living. By accepting such postulate, we may conceptualize the problem, thus benefiting research studies and more efficient treatments. Preventing intoxication, upon the onset of dependence, depends on educational, social, legal and other measures, which can neither be studied nor practiced by medicine

Sexual abuse and alcohol use among women in metropolitan Sao Paulo, Brazil: a general population study

OBJECTIVE:The present study aimed at estimating the prevalence of lifetime sexual abuse among women and at investigating its association with alcohol consumption.METHOD:Population-based survey conducted through a representative and stratified cluster sample of metropolitan São Paulo. GENACIS questionnaire was used. Sample unit was the home, and all residents aged 18 years and over were interviewed. The outcome was lifetime sexual abuse. The univariate statistical analysis used the Rao-Scott test. Logistic regression was used for the multivariate analysis.RESULTS:The final sample totalized 1,216 women aged 18 years and over; the response rate was 75.0%. Most women were married (56.6%) and had less than 12 years of formal education (59.0%); 46.2% were aged between 25 and 44 years, and 44.4% had a low income. Of the respondents, 7.5% reported having suffered lifetime sexual abuse. Multiple logistic regression model showed an association between lifetime sexual abuse and being a heavy drinker (OR = 4.97) and being a former drinker (OR = 2.04).CONCLUSIONS:There are few population studies in Brazil investigating sexual abuse and its relation to alcohol use. Although the prevalence of lifetime sexual abuse in the present study was smaller than that observed in other studies, it is a highly expressive percentage on account of its social and economic impact, as well as its potential effect on the health system

Violence between intimate partners and alcohol use: prevalence and associated factors

Objective. To estimate physical violence between intimate partners and to examine the association between violence and sociodemographic variables, use of alcohol, and other related factors. Method. This epidemiologic survey included a stratified probabilistic sample representative of the population from the city of Sao Paulo in economic and educational terms. The Gender, Alcohol and Culture: An International Study (GENACIS) questionnaire was employed. The sampling unit was the home, where all individuals older than 18 years were candidates for interview. The final sample included 1 631 people. Statistical analysis employed the Rao Scott test and logistic regression. Results. The response rate was 74.5%. Most participants were female (58.8%), younger than 40 years of age (52%), or had 5 to 12 years of schooling. Of the overall group, 5.4% reported having been victims of physical violence by an intimate partner and 5.4% declared having been aggressors of intimate partners in the past 2 years. Most men declared that none of those involved had ingested alcohol at the moment of aggression. Most women reported that nobody or only the man had drunk. Being a victim or an aggressor was associated with younger age and having a heavy-drinking partner. Women suffered more serious aggression, requiring medical care, and expressed more anger and disgust at aggression than men. Conclusions. The results underscore the importance of the association between alcohol use and risk of aggression between intimate partners, and may contribute to the design of public policies aimed to control this situation

Alcohol use and falls among the elderly in Metropolitan São Paulo, Brazil Consumo de álcool e ocorrência de quedas entre idosos na Região Metropolitana de São Paulo, Brasil

The objectives of this study are to identify the pattern of alcohol use among the elderly and to analyze its association with falls. A population-based survey was conducted in a sample of Metropolitan São Paulo, Brazil, using the GENACIS questionnaire, Gender, Alcohol and Culture: An International Study. Adjusted prevalence ratios were calculated using Poisson Regression with robust variance, and the dependent variable was the occurrence of falls. Interviews were carried out with 432 subjects whose average age was 69.5 years. Regarding alcohol use 50.9% were lifetime abstainers, 25.5% had not drunk in the previous year and 23.6% were current drinkers. Among the latter, 14 (13.7%) were heavy drinkers. In the previous year 24.5% people had falls, which were associated with being a heavy drinker and being older. Although a relationship between being a heavy drinker and falls found in this survey does not allow for inferences on causality, this association supports the hypothesis that alcohol abuse in later life might be related with health problems.<br>Este estudo se propõe a identificar o padrão de uso de álcool entre idosos e analisar sua associação com quedas. Foi conduzido um estudo transversal, de base populacional, com amostra estratificada da Região Metropolitana de São Paulo, Brasil, utilizando-se o questionário Gênero, Álcool e Cultura: Um Estudo Internacional (GENACIS). A análise estatística utilizou o teste de qui-quadrado e a regressão de Poisson, com variância robusta. A ocorrência de quedas foi considerada a variável dependente. Entrevistas foram conduzidas com 432 sujeitos, com idade média de 69,5 anos. Em relação ao uso de álcool, 50,9% nunca haviam feito uso, 25,5% não bebeu no último ano e 23,6% fizeram uso de álcool no último ano. Entre os bebedores, 14 (13,7%) relataram uso de risco de álcool. No ano anterior, 24,5% relataram quedas, que se associou a uso de risco de álcool e a ser mais velho. Embora a relação entre uso de risco de álcool e quedas encontrada neste estudo não permita inferir causalidade, tal associação sustenta a hipótese de que abuso de álcool entre idosos pode estar relacionado a problemas de saúde