O PACIENTE COM TRANSTORNO MENTAL: A PERCEPÇÃO DE FAMILIARES CUIDADORES ACERCA DESSA CONDIÇÃO

This is a qualitative and descriptive study, whose objective was to verify the perception of caregivers about patients with mental disorders treated in the public health network in the city of Montes Claros-MG. The work was developed at the Psychosocial Care Center (CAPS). The data were obtained through a focal group and analyzed through the discourse analysis technique. After data collection, categories related to the difficulties and challenges encountered by caregivers, patient behavior and caregiver overload emerged. It was concluded that the family caregiver of the mentally ill person presents suffering and lack of information. This demonstrates the need to bring the health team closer to the caregiver, since this interaction may contribute to the process of mitigating the responsibility of caring.Trata-se de um estudo qualitativo e descritivo, cujo o objetivo foi verificar a percepção de cuidadores acerca de pacientes com transtornos mentais atendidos na rede pública de saúde na cidade de Montes Claros-MG. O trabalho foi desenvolvido no centro de atenção psicossocial (CAPS). Os dados foram obtidos através da realização de um grupo focal e analisados através da técnica de análise do discurso. Após a coleta de dados surgiram categorias relacionadas as dificuldades e desafios encontrados pelos cuidadores, comportamento do paciente e sobrecarga dos cuidadores. Concluiu-se que o familiar cuidador do portador de transtorno mental apresenta sofrimento e carência de informação. Isso demonstra a necessidade da aproximar a equipe de saúde ao cuidador, pois essa interação poderá contribuir no processo de amenização da responsabilidade do ato de cuida

Repercussões Respiratórias no Pós – Operatório de Câncer de Mama

Introduction: Cancer is defined as a disorderly proliferation of cells that can spread and invade tissues and/or organs throughout the body, when a genetic mutation occurs, the deoxyribonucleic acid (DNA) undergoes an erroneous change of orders on how to multiply, classified as cancer cells, named according to their multiplication speed and ability to spread to other tissues. Objective: Check the respiratory repercussions in the postoperative period of breast câncer. Method: This is a descriptive, cross-sectional study with quantitative analysis, carried out with 20 female individuals in the postoperative period of breast cancer who were undergoing treatment at a Specialty Outpatient Clinic in Montes Claros - Minas Gerais. The instruments used were the MRC scale, which assesses the level of dyspnea during physical activity, cirtometry, which assesses chest expansion, and a manovacuometer, which measures respiratory muscle strength. Results: The average age of the participants was 50.40 ± 5.50, it was observed that 90.0% of the participants feel short of breath only during intense exercises, according to the MRC scale, in the cirtometry all the subjects showed a reduction in expandability thoracic. A significant decrease in respiratory muscle strength was observed, the average percentage achieved in forced inspiration was 86.77% and in forced expiration its average percentage was 71.75%. Conclusion: It is concluded that patients with breast cancer who underwent a surgical procedure may have respiratory changes, that is, the population studied showed changes in muscle strength and changes in expansion, but there was no association between the level of chest expansion and type of surgery.Introdução: O câncer é definido como uma proliferação de células desordenadas que pode se espalhar e invadir tecidos e/ou órgãos por todo o corpo, quando ocorre uma mutação genética. Objetivo: Verificar as repercussões respiratórias no pós-operatório do câncer de mama. Método: Trata-se de um estudo de caráter descritivo, corte transversal e análise quantitativa, realizado com 20 indivíduos do sexo feminino no pós-operatório do câncer de mama que estavam em tratamento em um Ambulatório de Especialidade em Montes Claros - Minas Gerais. Os instrumentos utilizados foram a escala de MRC que avalia o nível de dispneia durante atividade física, cirtometria que avalia a expansibilidade torácica e manovacuômetro que mensura a força muscular respiratória. Resultados: A idade média das participantes foi de 50,40 ± 5,50, observou-se que 90,0% das participantes sente falta de ar só durante exercícios intensos, segundo a escala de MRC, na cirtometria todos os sujeitos apresentaram redução da expansibilidade torácica. Foi observado uma diminuição significativa na força muscular respiratória, a média percentual alcançada na inspiração forçada foi de 86,77% e na expiração forçada sua média percentual foi de 71,75%. Conclusão: Conclui-se que pacientes portadoras de CA de mama que foram submetidas a um procedimento cirúrgico podem apresentar alterações respiratórias, ou seja, a população estudada apresentou alteração de força muscular e alteração da expansibilidade, porém não houve associação entre nível de expansibilidade torácica e tipo de cirurgia. &nbsp

O câncer e a criança: um impacto familiar

The aim of this work is a bibliographic review concerning the children living with cancer and their family, in order to identify the themes that have been already studied and to understand the impact on the family during the phases of childhood cancer. The information acquisition was based on documents from the Ministry of Health and on scientific studies available on the following databases: the Google Scholar, the Health virtual Library, the Scielo, the CAPES Journals, the MEDLINE, the LILACS and the Cochrane. The choice of the documents and journals was mainly justified by its link with the childhood health theme. The systematic of the studies research covered the period from 1999 to 2015. The keywords used for the research’s strategy were: childhood health, childhood cancer, family caregivers and grief. The results were presented in three themes: childhood cancer impact on the family, adaptation process of the family facing the sickness and the mourning regarding the death of the sick child. The review enabled to identify the need for special follow-up of the person, which is in direct contact with the child, usually the mother, since the moment of the diagnostic, until after the death.O objetivo desse estudo é revisar a literatura relativa à criança com câncer e sua família, a fim de identificar temas que têm sido pesquisados, e compreender o impacto causado na família durante as fases do câncer infantil. O levantamento de dados foi embasado em documentos do Ministério da Saúde e em trabalhos científicos disponibilizados no Google Acadêmico, Biblioteca virtual da Saúde, Scielo, Periodicos Capes, MEDLINE, LILACS e Cochrane. A escolha dos documentos e periódicos se deu pela sua relação com os temas Saúde da criança. A busca sistematizada de trabalhos abrangeram o período de 1999 a 2015. A estratégia de busca desse referencial utilizou as seguintes palavras-chave: Saúde da Criança, Câncer Infantil, Cuidadores Familiares e Luto. Os resultados foram apresentados em três temas: impacto do câncer infantil na familiar; processo de adaptação da família diante da doença e o luto diante da morte da criança. A revisão demonstrou que uma necessidade de acompanhamento especial a pessoa em contato direto com a criança, geralmente a mãe, desde o momento do diagnostico, e até após a morte

Acesso a Tratamento Endovascular para Acidente Vascular Cerebral Isquémico em Portugal

Introduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts. Material and Methods: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture. Results: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity. Conclusion: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitals.Introdução: A aprovação do tratamento endovascular para o acidente vascular cerebral isquémico obrigou à reorganização dos cuidados de saúde em Portugal. Os nove centros que realizam tratamento endovascular não estão distribuídos equitativamente pelo território, o que poderá causar acesso diferencial a tratamento. O principal objetivo deste estudo é realizar uma análise descritiva da frequência e métricas temporais do tratamento endovascular em Portugal continental e seus distritos. Material e Métodos: Estudo de coorte nacional multicêntrico, incluindo todos os doentes com acidente vascular cerebral isquémico submetidos a tratamento endovascular em Portugal continental durante um período de dois anos (julho 2015 a junho 2017). Foram colhidos dados demográficos, relacionados com o acidente vascular cerebral e variáveis do procedimento. Taxas de tratamento endovascular brutas e ajustadas (ajuste indireto a idade e sexo) foram calculadas por 100 000 habitantes/ano para Portugal continental e cada distrito. Métricas de procedimento como tempo entre instalação, primeira porta e punção foram também analisadas. Resultados: Foram registados 1625 tratamentos endovasculares, indicando uma taxa bruta nacional de tratamento endovascular de 8,27/100 000 habitantes/ano. As taxas de tratamento endovascular entre distritos variaram entre 1,58 e 16,53/100 000/ano, com taxas mais elevadas nos distritos próximos a hospitais com tratamento endovascular. O tempo entre sintomas e punção femural entre distritos variou entre 212 e 432 minutos. Conclusão: Portugal continental apresenta uma taxa nacional de tratamento endovascular elevada, apresentando, contudo, assimetrias regionais no acesso. As métricas temporais foram comparáveis com as observadas nos ensaios clínicos piloto

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Neotropical freshwater fisheries : A dataset of occurrence and abundance of freshwater fishes in the Neotropics

The Neotropical region hosts 4225 freshwater fish species, ranking first among the world's most diverse regions for freshwater fishes. Our NEOTROPICAL FRESHWATER FISHES data set is the first to produce a large-scale Neotropical freshwater fish inventory, covering the entire Neotropical region from Mexico and the Caribbean in the north to the southern limits in Argentina, Paraguay, Chile, and Uruguay. We compiled 185,787 distribution records, with unique georeferenced coordinates, for the 4225 species, represented by occurrence and abundance data. The number of species for the most numerous orders are as follows: Characiformes (1289), Siluriformes (1384), Cichliformes (354), Cyprinodontiformes (245), and Gymnotiformes (135). The most recorded species was the characid Astyanax fasciatus (4696 records). We registered 116,802 distribution records for native species, compared to 1802 distribution records for nonnative species. The main aim of the NEOTROPICAL FRESHWATER FISHES data set was to make these occurrence and abundance data accessible for international researchers to develop ecological and macroecological studies, from local to regional scales, with focal fish species, families, or orders. We anticipate that the NEOTROPICAL FRESHWATER FISHES data set will be valuable for studies on a wide range of ecological processes, such as trophic cascades, fishery pressure, the effects of habitat loss and fragmentation, and the impacts of species invasion and climate change. There are no copyright restrictions on the data, and please cite this data paper when using the data in publications

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt