Importancia de las Cuidadoras en la Constitución Psíquica de Niños Abrigados

Attachment is a means of showing affection and allows for a healthier psychological development. This research aimed to understand the importance of caring and welcoming by carers in attachment building, targeting the reduction of institutionalized children’s suffering. A semi structured interview was conducted with nine carers of an Association located in a country town in São Paulo. Results showed that carers develop attachment to the children and help in lowering the impacts of institutionalization, as they perform maternal roles. On the other hand, carers were displeased with the institution due to the reduced number of employees, especially the rota system, as a factor that interferes with children’s care. Besides, they showed difficulties in understanding the limits of attachment with the children, for the relationship to be healthy for both parts. It is hoped that this research’s results provide knowledge to carers, concerning the importance of caring and the role of attachment in psychological development during institutionalization. Keywords: psychological development; carers; attachment.La vinculación es una manera de demonstrar afectividad y permite un desarrollo psíquico saludable. Esta pesquisa tuvo el objetivo de comprender la importancia del cuidado y acogida de las cuidadoras en la construcción de la vinculación, para reducir el sufrimiento de niños abrigados. Fue efectuada una entrevista semiestructurada con nueve cuidadoras de una Asociación localizada en una ciudad del interior de São Paulo. Resultados muestrearan que las cuidadoras desarrollan vinculaciones afectivas con los niños y contribuyen en la diminución de los impactos de la institucionalización, porque realizan el papel de figura maternal. En contrapartida, las cuidadoras retrataran una insatisfacción con la institución, relacionada a el número reducido de empleados, especialmente la rotatividad como un factor prejudicial a los cuidados con los niños. También presentaran dificultad em comprender el límite de envolvimiento afectivo con los niños, para que sea una relación saludable para ambos. Se espera que los resultados de esta pesquisa traigan conocimiento a las cuidadoras, referente a la importancia del proceso de cuidar y el papel de la vinculación en el desarrollo psíquico en el proceso de abrigamento. Descriptores: desarrollo psíquico; cuidadoras; vinculación.O vínculo é uma das formas de se demonstrar a afetividade e permite um desenvolvimento psíquico mais saudável. Esta pesquisa teve o objetivo compreender a importância do cuidado e acolhimento realizado por parte das cuidadoras na construção do vínculo, visando reduzir o sofrimento de crianças institucionalizadas. Foi realizada uma entrevista semiestruturada com nove cuidadoras de uma Associação localizada numa cidade do interior do estado de São Paulo. Os resultados mostraram que as cuidadoras desenvolvem vínculo afetivo com as crianças, e contribuem na amenização dos impactos da institucionalização, uma vez que realizam o papel de figura materna. Em contrapartida, as cuidadoras demonstraram um descontentamento com a instituição referente ao número reduzido de funcionárias, destacando a alta rotatividade como um fator que prejudica o cuidado das crianças. Além disso, apresentaram dificuldades em compreender o limite de envolvimento afetivo com as crianças, para que seja uma relação saudável para ambas as partes. Espera-se que os resultados desta pesquisa forneçam conhecimento às cuidadoras, referente à importância no processo de cuidar, e o papel do vínculo no desenvolvimento psíquico ao longo do processo de abrigamento. Palavras-chave: desenvolvimento psíquico; cuidadoras; vínculo

Long-term efficacy and safety of a treatment strategy for HIV infection using protease inhibitor monotherapy: 8-year routine clinical care follow-up from a randomised, controlled, open-label pragmatic trial (PIVOT)Research in context

Summary: Background: Treatment-simplification strategies are important tools for patient-centred management. We evaluated long-term outcomes from a PI monotherapy switch strategy. Methods: Eligible participants attending 43 UK treatment centres had a viral load (VL) below 50 copies/ml for at least 24 weeks on combination ART. Participants were randomised to maintain ongoing triple therapy (OT) or switch to a strategy of physician-selected PI monotherapy (PI-mono) with prompt return to combination therapy if VL rebounded. The primary outcome, previously reported, was loss of future drug options after 3 years, defined as new intermediate/high level resistance to at least one drug to which the participant's virus was considered sensitive at trial entry. Here we report resistance and disease outcomes after further extended follow-up in routine care. The study was registered as ISRCTN04857074. Findings: We randomised 587 participants to OT (291) or PI-mono (296) between Nov 4, 2008, and July 28, 2010 and followed them for a median of more than 8 years (100 months) until 2018. At the end of this follow-up time, one or more future drug options had been lost in 7 participants in the OT group and 6 in the PI-mono group; estimated cumulative risk by 8 years of 2.7% and 2.1% respectively (difference −0.6%, 95% CI −3.2% to 2.0%). Only one PI-mono participant developed resistance to the protease inhibitor they were taking (atazanavir). Serious clinical events (death, serious AIDS, and serious non-AIDS) were infrequent; reported in a total of 12 (4.1%) participants in the OT group and 23 (7.8%) in the PI-mono group (P = 0.08) over the entire follow-up period. Interpretation: A strategy of PI monotherapy, with regular VL monitoring and prompt reintroduction of combination treatment following rebound, preserved future treatment options. Findings confirm the high genetic barrier to resistance of the PI drug class that makes them well suited for creative, patient-centred, treatment-simplification approaches. The possibility of a small excess risk of serious clinical events with the PI monotherapy strategy cannot be excluded. Funding: The National Institute for Health Research Health Technology Assessment programme