Analysis of the behavior of children victims of burnings during surgical dressing without anesthetical drugs in infirmary

O caráter aversivo de muitos procedimentos médicos é amplamente divulgado na literatura. Tais procedimentos são considerados como estressores em potencial, principalmente no caso de pacientes pediátricos vítimas de queimaduras. O acidente por queimadura é responsável por uma experiência extremamente aversiva para a criança. Associados a ele estão os efeitos negativos ao desenvolvimento adequado dessa criança, decorrentes da hospitalização e de procedimentos médicos invasivos utilizados no tratamento. As crianças vítimas de queimaduras são constantemente submetidas à realização de procedimentos, como curativos, fisioterapia, que são tidos como extremamente aversivos e inerentes ao tratamento. Este estudo teve como objetivo principal analisar os comportamentos emitidos por crianças vítimas de queimaduras durante procedimento de curativo sem sedação realizado em enfermaria. Participaram seis crianças com idades entre seis e doze anos. Utilizou-se: (a) roteiro de entrevista semi-estruturado com perguntas sobre dados sociodemográficos e questões referentes ao acidente que ocasionou a queimadura, e (b) escala de observação de distresse comportamental (Observation Scale of Distress Behavior [OSDB]). Os resultados apontam que todas as crianças apresentaram uma freqüência de comportamentos concorrentes superior a 80%, em comparação aos comportamentos não-concorrentes. Houve um maior predomínio das categorias comportamentais: protestar (43%), comportar-se de modo nervoso (24%) e chorar (20%). Dentre as categorias de comportamentos não concorrentes, as que tiveram a maior freqüência foram: falar (37,5%) e responder verbalmente (25%). Dessa forma, ressalta-se que procedimentos médicos invasivos necessitam de intervenções que visem à diminuição do sofrimento comportamental da criança.The aversive nature of many medical procedures is widely available in the literature. These procedures are considered as potential stressors, especially in pediatric patients affected by burns. Burning is a highly aversive experience for the child. Associated with it are the negative effects to the proper development of children resulting from hospitalization and invasive medical procedures used in treatment. Child victims of burns are constantly exposed to procedures such as dressings, physiotherapy, which are regarded as extremely aversive and related to treatment. This study aimed to analyse behaviors of children suffering burns during dressing procedure performed without sedation in the ward. Attended six children aged between six and twelve years. Used: (a) roadmap for semi-structured questions on sociodemographic data and questions relating to the accident which caused the burn, and (b) scale of behavioral observation (Observation Scale of Behavioral Distress [OSDB]). The results indicate that all children had a higher frequency of behaviors competitors to 80%, as opposed to non-competitive behavior. There was a higher prevalence of behavioral categories: protesting (43%), behave nervously (24%) and crying (20%). Among the categories of not competitor behavior, those which had the greatest frequency were: talking (37.5%) and answering (25%). Thus, invasive medical procedures require interventions aimed at reducing the suffering of children.

Vasorelaxant activity and acute toxicity of the ethanolic extract of Zanthoxylum rhoifolium Lam leaves

The study evaluated the vasorelaxant effect induced by the ethanolic extract of the leaves of Zanthoxylum rhoifolium Lam (EEtOH-Zr/leaves). Wistar rats were treated with the leaf extract containing a single dose of 2,000 mg / kg, v.o. After 14 days, the animals were anesthetized for blood collection and subsequent analysis of the biochemical parameters; they were then euthanized (sodium pentobarbital-100 mg/kg, i.p.) for the removal and morphological analysis of the heart, lung, liver and kidney. The vasorelaxation activity the and vascular reactivity of EEtOH-Zr/leaves were evaluated on artery mesenteric rings isolated from rats. The extract showed no signs of toxicity and no significant difference in the values of the biochemical parameters between the control group and the group of treated animals. In the evaluation of pharmacological activity in the smooth muscle, the EEtOH-Zr/leaves caused vasorelaxant effect on the tonic contraction induced by phenylephrine in mesenteric artery preparations in the presence (pD2=2.17±0.05 µg/mL; Emax=99.8±5.2%) and absence (pD2=2.14±0.05 µg/mL; Emax=95.3±6.4%) of the vascular endothelium. Oral administration of EEtOH-Zr/leaves reduced the contraction induced by the cumulative addition of PHE. It is concluded that the EEtOH-Zr/leaves promote vasorelaxation and reduce vascular reactivity of adrenergic alpha-1 agonist in the mesenteric artery. The results did not show toxic effects of the extract

Importation and early local transmission of COVID-19 in Brazil, 2020

We conducted the genome sequencing and analysis of the first confirmed COVID-19 infections in Brazil. Rapid sequencing coupled with phylogenetic analyses in the context of travel history corroborate multiple independent importations from Italy and local spread during the initial stage of COVID-19 transmission in Brazil

Instruction as a coping strategy for the realization of dressing in a ward with child burn victim

One may define “burn” as the resulting picture or the outcome of a direct or indirect action of heat, chemical compounds or electricity over the human organic structure. Some studies point out children as the majority of victims. Procedures, inherent to the process of recovery, are known to be particularly painful. The frequency of invasive medical procedures on burn-victims, favors the production of concurrent behaviors from the child and can lead to the generalization of the aversive feature of the invasive procedure to stimuli existing in the environment, thus justifying studies over the effectiveness of such invasive interventions. The research was divided into two studies with specific objectives. Study 1 (n = 5): to characterize behaviors of children which are burn-victims, produced during curative procedures without sedation in wards and to compare the frequency of concurrent and non-concurrent behaviors generated by these children in two consecutive sessions of this procedure. Study 2 (n = 2): to analyze the effects of the use of instruction on the frequency of concurrent and non-concurrent behaviors in children which are burn-victims during the curative procedure without sedation in wards. Seven children (four boys and three girls, ages 7-12) victims of burns on body lower areas inferior to 70% and their companions, selected from a Burn Treatment Center (BTC) participated. The following were used as instruments: (a) Health Care Team Consultation Protocol, (b) Child Behavioral Check List (CBCL 6-18 years), (c) Guide Book for interviewing the child, (d) Observation scale of behavioral distress OSBD, (e) Scale to evaluate the child’s facial pain perception and (f) Instruction Manual on curative procedures. In Study 1, it was noticed a higher frequency of concurrent behavior over the non- concurrent one in two sessions of curative procedures. In Study 2, upon using the Instruction Manual, it was noticed a statistically significant reduction in the frequency of the concurrent behavior Whimpering (p-value = 0.0447) and a significant increase (p-value = 0.0324) in the frequency of non-concurrent behavior Assistant in the implementation of the procedure. There was a significant correlation (p-value = 0.0066) between the frequency of non-concurrent behaviors among children in Study 1 and those who participated in Study 2, therefore suggesting that the intervention was effective in increasing the frequency of non-concurrent behaviors in children participating in Study 2.CNPq - Conselho Nacional de Desenvolvimento Científico e TecnológicoA queimadura corresponde ao quadro resultante da ação direta ou indireta do calor do fogo, de substâncias químicas ou da eletricidade sobre o organismo humano. Alguns estudos apontam as crianças como as maiores vítimas. Procedimentos inerentes ao processo de recuperação são reconhecidos como particularmente dolorosos. A frequência de procedimentos médicos invasivos, situação constante ao paciente vítima de queimadura, favorece a emissão de comportamentos concorrentes pela criança, bem como pode ocasionar a generalização do caráter aversivo do procedimento invasivo para estímulos presentes no ambiente, justificando estudos sobre a eficácia de intervenções neste contexto. A pesquisa foi dividida em dois estudos com objetivos específicos. Estudo 1 (n=5): caracterizar comportamentos de crianças vítimas de queimadura emitidos durante procedimento de curativo sem sedação em enfermaria e comparar a frequência de comportamentos concorrentes e não concorrentes emitidos por estas crianças em duas sessões consecutivas deste procedimento. Estudo 2 (n=2): analisar os efeitos do uso de instrução sobre a frequência de comportamentos concorrentes e não concorrentes em crianças vítimas de queimadura durante procedimento de curativo sem sedação em enfermaria. Participaram sete crianças (4 meninos e 3 meninas; 7 a 12 anos) vítimas de queimadura em área corporal inferior a 70% e seus acompanhantes, selecionados em um Centro de Tratamento de Queimados (CTQ). Como instrumentos, foram utilizados: (a) Protocolo de consulta à equipe de saúde; (b) Lista de Verificação Comportamental para crianças/adolescentes (CBCL 6-18anos); (c) Roteiro de entrevista com a criança; (d) Escala de observação comportamental OSBD (Observation Scale of Behavioral Distress); (e) Escala facial para avaliar a percepção de dor da criança (FACES); e (f) Manual de instrução sobre o procedimento de curativo. No Estudo 1, observou-se maior frequência de comportamentos concorrentes sobre os não concorrentes nas duas sessões de curativo. No Estudo 2, após o uso do Manual de instrução, observou-se redução estatisticamente significante na frequência do comportamento concorrente Choramingar (= 0,0447) e aumento significativo (= 0,0324) na frequência do comportamento não concorrente Auxiliar na execução do procedimento. Houve correlação significativa (p-valor = 0,0066) entre a frequência de comportamentos não concorrentes entre as crianças do Estudo 1 e as que participaram do Estudo 2, sugerindo que a intervenção, por meio de instruções, foi eficaz para aumentar a frequência de comportamentos não concorrentes nas crianças participantes do Estudo 2

Adherence to the treatment by caregivers of children with congenital hypothvroidism

Chronic diseases which require attention and continuous evaluations and have called for attention ofhealth professionals, specially those who devote themselves to the area ofPediatric Psychology, who devote themselves to the study of child development, as well as to the relationship between health and sickness and the interferences in the life quality of children and their relatives. This study aims accomplishing a descriptive study to identify variables making easier or more difficult, the adherence to the treatment of caregivers of children with Congenital Hypothyroidism, attended by the Center of Reference in Pará State. Fifty main caregivers ranging between 17 to 55 years of age. Forty mothers, four grandmothers, four fathers and two aunts took part in this study. Variables related to the adherence were identified by means of structured interviews. Program characteristics were analyzed through structured interviews carried out by the team professionals. The analyses of caregivers reports showed that some of the demands to the treatment adherence are not being supplied. Informations about the illness characteristics, etiology, diagnostics, treatment and prognostics are not part of the repertory of most caregivers, independently of age, school degree, degree of relationship with reiatives and time of participation in the Neonatal Selection Programo Significant differences were found regarding the adequate time for the exam accomplishment, which showed the delay of the treatment start. The difficulties described by the professionals as to the adherence to the treatment by the caregivers were attributed not only to the problems showed by the Program structure itselfbut also by the lack of interest to it. The study brings relevant implications to the implantation of more effective and efficacious prevention programs to attend the needs of caregivers and promote the adequate child development.As doenças crônicas requerem atenção e avaliações continuas e têm despertado a atenção de profissionais da área da saúde, especialmente aqueles que se dedicam à Psicologia Pediátrica, campo de aplicação que se dedica ao estudo do desenvolvimento da criança, bem como das relações entre saúde e doença e as interferências na qualidade de vida da criança e de seus familiares. Esta pesquisa teve como objetivo principal realizar um estudo descritivo, a fim de identificar variáveis que estivessem facilitando ou dificultando a adesão ao tratamento por cuidadores de crianças com Hipotireoidismo Congênito atendidas em um centro de referência no Estado do Pará. Participaram deste estudo 50 cuidadores principais, com idade entre 17 a 55 anos, com diferentes graus de parentesco com a criança. As variáveis relacionadas à adesão foram identificadas por meio de entrevistas estruturadas com os cuidadores. Características do Programa foram analisadas por meio de entrevistas realizadas com os profissionais da equipe. A análise dos relatos dos cuidadores mostrou que algumas exigências para a adesão ao tratamento não estão sendo fornecidas. Informações sobre características da doença, etiologia, diagnóstico, tratamento e prognóstico não fazem parte do repertório da maioria dos cuidadores, independente da idade, escolaridade, grau de parentesco e tempo em que a criança está no Programa de Triagem Neonatal. Diferenças significativas foram encontradas quanto ao tempo adequado para a realização do exame, o que demonstrou atraso no inicio do tratamento, As dificuldades descritas pelos profissionais quanto à adesão ao tratamento pelo cuidador foram atribuídas tanto a problemas apresentados pela própria estrutura do Programa como por falta de interesse do cuidador. O estudo traz implicações relevantes para a implantação de programas de prevenção mais efetivos e eficazes que atendam os cuidadores e promovam o adequado desenvolvimento da criança

Entry into the treatment of the congenital hypothyroidism according to reports of their caregivers / Adesão ao tratamento do hipotireoidismo congênito segundo relato de cuidadores

This study aims at identifying variables which interfere on the entry into the treatment according to reports of caregivers of children suffering from Congenital Hypothyroidism seen at the Center of Reference in Pará State. Fifty main caregivers, with different degrees of kinship to the children and ranging from 17 to 55 years old, took part in this study. The variables related to the treatment entry were identified by means of interviews with the caregivers following structured pilot instructions. Results showed that most of the caregivers are not aware of the characteristics of the disease, its etiology, diagnosis, treatment and prognostic, regardless the age, school degree, kinship and amount of time the child is on the Program, which makes the treatment entry more difficult. In most children, the Newborn Screening Test was not done in the right time, fact that brought damage to the treatment

Entry into the treatment of the congenital hypothyroidism according to reports of their caregivers

This study aims at identifying variables which interfere on the entry into the treatment according to reports of caregivers of children suffering from Congenital Hypothyroidism seen at the Center of Reference in Pará State. Fifty main caregivers, with different degrees of kinship to the children and ranging from 17 to 55 years old, took part in this study. The variables related to the treatment entry were identified by means of interviews with the caregivers following structured pilot instructions. Results showed that most of the caregivers are not aware of the characteristics of the disease, its etiology, diagnosis, treatment and prognostic, regardless the age, school degree, kinship and amount of time the child is on the Program, which makes the treatment entry more difficult. In most children, the Newborn Screening Test was not done in the right time, fact that brought damage to the treatment.Esta pesquisa procurou identificar variáveis que interferem na adesão ao tratamento segundo relato de cuidadores de crianças com Hipotireoidismo Congênito atendidas em um centro de referência no Estado do Pará. Participaram 50 cuidadores primários, com idade entre 17 e 55 anos, com diferentes graus de parentesco com a criança. As variáveis relacionadas à adesão foram identificadas por meio de entrevistas com os cuidadores, seguindo roteiro estruturado. Os resultados indicaram que a maioria dos cuidadores desconhece sobre características da doença, etiologia, diagnóstico, tratamento e prognóstico, independentemente da idade, escolaridade, grau de parentesco e tempo em que a criança está no Programa, dificultando a adesão ao tratamento. Para a maioria das crianças, o Teste do Pezinho foi realizado com atraso, indicando prejuízos ao tratamento

Importation and early local transmission of COVID-19 in Brazil, 2020

ABSTRACT We conducted the genome sequencing and analysis of the first confirmed COVID-19 infections in Brazil. Rapid sequencing coupled with phylogenetic analyses in the context of travel history corroborate multiple independent importations from Italy and local spread during the initial stage of COVID-19 transmission in Brazil