Compreensão da espiritualidade para os portadores de transtorno mental: contribuições para o cuidado de enfermagem

Objetivo: Compreender os significados da espiritualidade para o paciente portador de transtorno mental.Método: Pesquisa qualitativa, fenomenológica com nove usuários do Centro de Atenção Psicossocial em um município do interior de Minas Gerais, em fevereiro de 2014.Resultados: Da análise compreensiva, emergiram duas unidades de significado: A espiritualidade é um suporte terapêutico para a saúde mental; O templo religioso é o local de manifestação da espiritualidade. Verificou-se o suporte oferecido pela religião para o enfrentamento dos problemas de saúde dos usuários e que estes expressam sua crença através de orações, além de frequentarem templos religiosos e apresentarem comportamentos que revelam a fé em Deus e nos santos.Conclusão: Há a necessidade de capacitar os profissionais de saúde, em especial o enfermeiro, para que ofereçam novas práticas assistenciais que contemplem o cuidado espiritual/religioso no conjunto de ações integrais que deve ser oferecido nos serviços de Saúde Mental.Palavras-chave: Espiritualidade. Saúde mental. Enfermagem

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Promoção da saúde no cenário religioso: possibilidades para o cuidado de enfermagem Promoción de la salud en un ambiente religioso: posibilidades para el cuidado de enfermería Health promotion in the religious scenario: opportunities for nursing care

Estudo qualitativo, do tipo documental, desenvolvido no primeiro semestre de 2008, objetivando descrever as práticas de promoção da saúde desenvolvidas no cenário religioso católico em município do interior do Ceará. As informações foram coletadas por meio de entrevistas áudio-gravadas, junto ao sacerdote responsável pela paróquia e a três coordenadores de projetos vinculados à Igreja Católica, selecionados a partir da identificação dos projetos com o pároco. Os resultados apontam que a promoção e educação em saúde estão presentes nas atividades desenvolvidas por voluntários no cenário religioso. A Igreja busca a mudança de atitude e adoção de comportamento saudável dos indivíduos, por meio de ações individuais e coletivas. Urge necessidade da inserção de profissionais de saúde para atuar neste cenário, fortalecendo-o como rede social de apoio, reduzindo gradativamente atividades assistenciais e intensificando aquelas voltadas à promoção da saúde, com apoio da Enfermagem, com vistas a aprimorar o cuidado à saúde neste cenário.<br>Estudio cualitativo, de tipo documental, desarrollado en el primer semestre de 2008, con el objetivo de describir las prácticas de promoción de la salud desarrolladas en un ambiente religioso en municipio del interior de Ceará, Brasil. Las informaciones fueron colectadas por medio de entrevistas audio-grabadas, junto al sacerdote de la parroquia y tres coordinadores de proyectos. Los resultados indican que la promoción y educación en salud están presentes en las actividades desarrolladas por voluntarios en un ambiente religioso. La iglesia busca un cambio de actitud y la adopción de comportamientos saludables de los individuos, por medio de acciones individuales y colectivas. Urge la necesidad de inserción de profesionales de salud para actuar en este ambiente fortaleciéndolo como red social de apoyo, reduciendo actividades asistenciales e intensificando la promoción de la salud, con apoyo de la Enfermería, buscando perfeccionar el cuidado en este ambiente.<br>This was a qualitative study of the documentary type carried out in the first half of 2008, and it aimed to describe the practices of health promotion developed in the religious scenario in a city in the countryside of Ceará, Brazil. Information were collected through audio-taped interviews with the priest in charge of the parish and the three coordinators of projects linked to the Catholic Church, selected by the identification of projects with the priest. The results show that promotion and health education are present in the activities developed by volunteers in the religious scenario. The church seeks to change attitudes and to promote the adoption of healthy behavior by individuals, through individual and collective actions. There is an urgent need to insert healthcare professionals in this scenario, strengthening it as a social support, gradually reducing the assistential activities and intensifying those aimed at health promotion with the support of nursing, in order to improve healthcare in this scenario

Loss of brainstem white matter predicts onset and motor neuron symptoms in C9orf72 expansion carriers : a GENFI study

BACKGROUND AND OBJECTIVES: The C9orf72 expansion is the most common genetic cause of frontotemporal dementia (FTD) and/or motor neuron disease (MND). Corticospinal degeneration has been described in post-mortem neuropathological studies in these patients, especially in those with MND. We used MRI to analyze white matter (WM) volumes in presymptomatic and symptomatic C9orf72 expansion carriers and investigated whether its measure may be helpful in predicting the onset of symptoms. METHODS: We studied 102 presymptomatic C9orf72 mutation carriers, 52 symptomatic carriers: 42 suffering from FTD and 11 from MND, and 75 non-carriers from the Genetic Frontotemporal dementia Initiative (GENFI). All subjects underwent T1-MRI acquisition. We used FreeSurfer to estimate the volume proportion of WM in the brainstem regions (midbrain, pons, and medulla oblongata). We calculated group differences with ANOVA tests and performed linear and non-linear regressions to assess group-by-age interactions. RESULTS: A reduced WM ratio was found in all brainstem subregions in symptomatic carriers compared to both noncarriers and pre-symptomatic carriers. Within symptomatic carriers, MND patients presented a lower ratio in pons and medulla oblongata compared with FTD patients. No differences were found between presymptomatic carriers and non-carriers. Clinical severity was negatively associated with the WM ratio. C9orf72 carriers presented greater age-related WM loss than non-carriers, with MND patients showing significantly more atrophy in pons and medulla oblongata. DISCUSSION: We find consistent brainstem WM loss in C9orf72 symptomatic carriers with differences related to the clinical phenotype supporting the use of brainstem measures as neuroimaging biomarkers for disease tracking