Reganho de peso em mulheres após cirurgia metabólica e bariátrica: estudo qualitativo no Brasil

Introduction: Due to the increased number of bariatric surgeries over the years, aspects contributing or hindering the achievement of outcomes, among them weight regain, have acquired increased significance. Psychological factors directly influence on this unwanted situation, but there are few studies and controversies about the degree of participation of these factors. We propose a qualitative investigation to analyze the meanings of weight regain after surgery among women and how these factors influence this outcome. Method: This study uses the clinical-qualitative method, by means of a semi-structured interview with open questions in an intentional sample, closed by saturation, with eight women who underwent surgery at the Bariatric Surgery Outpatient Clinic of Hospital das Clínicas, Universidade Estadual de Campinas (UNICAMP), in the state of São Paulo, Brazil. Results: A feeling of defeat and failure emerges with weight regain, which contributes to social isolation; there is no regret, but gratitude for the surgery; among patients, there is a sense of feeling rejected greater than a rejection that actually exists. Conclusion: We found out the need for further qualitative studies that help the health team to better understand the dynamic psychological factors involved in the meaning of weight regain after bariatric surgery among women, in order to adopt appropriate conducts to deal with this problem.Due to the increased number of bariatric surgeries over the years, aspects contributing or hindering the achievement of outcomes, among them weight regain, have acquired increased significance. Psychological factors directly influence on this unwanted sit363140146sem informaçãosem informaçã

Transitioning Adolescents Living With Hiv/aids To Adult-oriented Health Care: An Emerging Challenge

Objective: To review the literature on transition from pediatric to adult-oriented health care and discuss this issue in the specific context of chronic conditions. Sources: MEDLINE and LILACS were searched for relevant English and French-language articles published between 1990 and 2010. Summary of the findings: The transition of adolescents with chronic diseases from pediatric care to adult-oriented services has been a growing concern among pediatric specialties. In recent years, young people living with HIV/AIDS have begun to reach adulthood, giving rise to several challenges. The studies reviewed herein discuss such relevant topics as: the difference between transfer, an isolated event, and transition, a gradual process; the transition models used in different services; the importance of transitioning in a planned and individualized manner; the need for comprehensive interaction between pediatric and adult-oriented care teams; the importance of joint participation of adolescents, their families, and health professionals in the process; barriers to and factors that promote successful transitions; and the special needs of adolescents with HIV/AIDS in this important period of life. Conclusions: Several authors agree that transitioning adolescents to adult-oriented health care should be a gradual process not determined by age alone. It requires a plan established with ample dialogue among adolescents, their families, and pediatric and adult care teams. However, there is little evidence to support any specific model of health care transition. This should prompt researchers to conduct more prospective studies on the theme, especially in more vulnerable groups such as adolescents living with HIV/AIDS. Copyright © 2010 by Sociedade Brasileira de Pediatria.866465472Brown, L.K., Lourie, K.J., Maryland, P., Children and adolescents living with HIV and AIDS: A review (2000) Journal of Child Psychology and Psychiatry and Allied Disciplines, 41 (1), pp. 81-96. , DOI 10.1017/S0021963099004977Gortmaker, S.L., Hughes, M., Cervia, J., Brady, M., Johnson, G.M., Seage III, G.R., Song, L.Y., Oleske, J.M., Effect of combination therapy including protease inhibitors on mortality among children and adolescents infected with HIV-1 (2001) New England Journal of Medicine, 345 (21), pp. 1522-1528. , DOI 10.1056/NEJMoa011157Matida, L.H., Marcopito, L.F., O aumento do tempo de sobrevida das crianças com AIDS - Brasil (2002) Boletim Epidemiológico AIDS, 15 (1), pp. 49-55Candiani, T.M., Pinto, J., Cardoso, C.A., Carvalho, I.R., Dias, A.C., Carneiro, M., Impact of highly active antiretroviral therapy (HAART) on the incidence of opportunistic infections, hospitalizations and mortality among children and adolescents living with HIV/AIDS in Belo Horizonte, Minas Gerais State, Brazil (2007) Cad Saude Publica, 23 (SUPPL. 3), pp. S414-23Miller, T., The next decade: Cardiovascular risks, outcomes, prevention, and treatment in pediatric HIV infection (2010) J Pediatr, 86, pp. 3-5. , Rio J(2008) Boletim Epidemiológico - AIDS e DST. Ano V - no 1 - 27a - 52a - Semanas Epidemiológicas - Julho a Dezembro de 2007. Ano V - No 1-01a - 26a - Semanas Epidemiológicas - Janeiro a Junho de 2008, , Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde - Programa Nacional de DST e Aids. Brasília: Ministério da SaúdeLandau, L.I., Cystic fibrosis: Transition from pediatric to adult physician's care (1995) Thorax, 50, pp. 1031-1032Scal, P., Blum, R.W., Transition for youth with chronic conditions: Primary care physicians' approaches (2002) Pediatrics, 110 (6 II), pp. 1315-1321Shaw, K.L., Southwood, T.R., McDonagh, J.E., User perspectives of transitional care for adolescents with juvenile idiopathic arthritis (2004) Rheumatology, 43, pp. 770-778. , British Paediatric Rheumatology Group. OxfordMcDonagh, J.E., Shaw, K.L., Southwood, T.R., Growing up and moving on in rheumatology: Development and preliminary evaluation of a transitional care programme for a multicentre cohort of adolescents with juvenile idiopathic arthritis (2006) J Child Health Care, 10, pp. 22-42Aberastury, A., Knobel, M., (2000) Adolescência Normal - Um Enfoque Psicanalítico, , Porto Alegre: ArtmedMeleis, A.I., Sawyer, L.M., Im, E.O., Hilfinger Messias, D.K., Schumacher, K., Experiencing transitions: An emerging middle-range theory (2000) ANS Adv Nurs Sci, 23, pp. 12-28Kralik, D., Visentin, K., Van Loon, A., Transition: A literature review (2006) J Adv Nurs, 55, pp. 320-329Rosen, D.S., Blum, R.W., Britto, M., Sawyer, S.M., Siegel, D.M., Transition to adult health care for adolescents and young adults with chronic conditions: Position paper of the Society for Adolescent Medicine (2003) J Adolesc Health, 33, pp. 309-311. , Society for Adolescent Medicine(2009) The World Bank Data & Statistics, , http://go.worldbank.org/K2CKM78CC0, Country ClassificationAccess: 03/01/2010Bell, L.E., Sawyer, S.M., Transition of care to adult services for pediatric solid-organ transplant recipients (2010) Pediatr Clin North Am, 57, pp. 593-610Kipps, S., Bahu, T., Ong, K., Ackland, F.M., Brown, R.S., Fox, C.T., Griffin, N.K., Dunger, D.B., Current methods of transfer of young people with Type 1 diabetes to adult services (2002) Diabetic Medicine, 19 (8), pp. 649-654. , DOI 10.1046/j.1464-5491.2002.00757.xLotstein, D.S., McPherson, M., Strickland, B., Newacheck, P.W., Transition planning for youth with special health care needs: Results from the national survey of children with special health care needs (2005) Pediatrics, 115 (6), pp. 1562-1568. , http://pediatrics.aappublications.org/cgi/reprint/115/6/1562, DOI 10.1542/peds.2004-1262Blum, R.W., Garell, D., Hodgman, C.H., Jorissen, T.W., Okinow, N.A., Orr, D.P., Slap, G.B., Transition from child-centered to adult health-care systems for adolescents with chronic conditions: A position paper of the Society for Adolescent Medicine (1993) Journal of Adolescent Health, 14 (7), pp. 570-576. , DOI 10.1016/1054-139X(93)90143-DSawyer, S.M., Blair, S., Bowes, G., Chronic illness in adolescents: Transfer or transition to adult services? (1997) J Paediatr Child Health, 33, pp. 88-90Forbes, A., While, A., Ullman, R., Lewis, S., Mathes, L., Griffiths, P., (2002) A Multimethod Review to Identify Components of Practice Which May Promote Continuity in the Transition from Child to Adult Care for Young People with Chronic Illness or Disability, , London: NCCSDOBoyle, M.P., Farukhi, Z., Nosky, M.L., Strategies for improving transition to adult cystic fibrosis care, based on patient and parent views (2001) Pediatric Pulmonology, 32 (6), pp. 428-436. , DOI 10.1002/ppul.1154Abdale, B., Kuhl, K., Tullis, D.E., Evaluation of patient satisfaction with the transition from a pediatric hospital to an adult centre (1994) Pediatr Pulmonol, 18 (SUPPL. 10), pp. 291-292Betz, C.L., Adolescent transitions: A nursing concern (1998) Pediatr Nurs, 24, pp. 23-28Dommergues, J.P., Alvin, P., Transition from pediatric to adult care in severe chronic diseases (2003) Archives de Pediatrie, 10 (4), pp. 295-299. , DOI 10.1016/S0929-693X(03)00041-1David, T.J., Transition from the paediatric clinic to the adult service (2001) Journal of the Royal Society of Medicine, 94 (8), pp. 373-374Geenen, S.J., Powers, L.E., Sells, W., Understanding the role of health care providers during the transition of adolescents with disabilities and special health care needs (2003) Journal of Adolescent Health, 32 (3), pp. 225-233. , DOI 10.1016/S1054-139X(02)00396-8, PII S1054139X02003968Tucker, L.B., Cabral, D.A., Transition of the Adolescent Patient with Rheumatic Disease: Issues to Consider (2007) Rheumatic Disease Clinics of North America, 33 (3), pp. 661-672. , DOI 10.1016/j.rdc.2007.07.005, PII S0889857X07000415, Pediatric RheumatologyFreed, G.L., Hudson, E.J., Transitioning children with chronic diseases to adult care: Current knowledge, practices, and directions (2006) Journal of Pediatrics, 148 (6), pp. 824-827. , DOI 10.1016/j.jpeds.2006.02.010, PII S0022347606001089Remorino, R., Taylor, J., Smoothing things over: The transition from pediatric to adult care for kidney transplant recipients (2006) Progress in Transplantation, 16 (4), pp. 303-308McCurdy, C., DiCenso, A., Boblin, S., Ludwin, D., Bryant-Lukosius, D., Bosompra, K., There to here: Young adult patients' perceptions of the process of transition from pediatric to adult transplant care (2006) Progress in Transplantation, 16 (4), pp. 309-316Reiss, J.G., Gibson, R.W., Walker, L.R., Health care transition: Youth, family, and provider perspectives (2005) Pediatrics, 115 (1), pp. 112-120. , http://pediatrics.aappublications.org/cgi/reprint/115/1/112, DOI 10.1542/peds.2004-1321Alpay, H., Transition of the adolescent patient to the adult clinic (2009) Perit Dial Int, 29 (SUPPL. 2), pp. S180-2Weissberg-Benchell, J., Wolpert, H., Anderson, B.J., Transitioning from pediatric to adult care: A new approach to the post-adolescent young person with type 1 diabetes (2007) Diabetes Care, 30 (10), pp. 2441-2446. , http://care.diabetesjournals.org/cgi/reprint/30/10/2441, DOI 10.2337/dc07-1249Arnett, J.J., Emerging adulthood. A theory of development from the late teens through the twenties (2000) Am Psychol, 55, pp. 469-480Arnett, J.J., (2004) Emerging Adulthood: The Winding Road from the Late Teens Through the Twenties, , New York: Oxford University PressWojciechowski, E.A., Hurtig, A., Dorn, L., A natural history study of adolescents and young adults with sickle cell disease as they transfer to adult care: A need for case management services (2002) Journal of Pediatric Nursing, 17 (1), pp. 18-27. , DOI 10.1053/jpdn.2002.30930Hauser, E.S., Dorn, L., Transitioning adolescents with sickle cell disease to adult-centered care (1999) Pediatr Nurs, 25, pp. 479-488Viner, R., Transition from paediatric to adult care. Bridging the gaps or passing the buck? (1999) Arch Dis Child, 81, pp. 271-275(2007) Lost in Transition: Moving Young People between Child and Adult Health Services, , Royal College of Nursing. London: RCNLewis-Gary, M.D., Transitioning to adult health care facilities for young adults with a chronic condition (2001) Pediatr Nurs, 27, pp. 521-524(2006) Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection, , The Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Bethesda, MD: Department of Health and Human Services(2009) Programa Nacional de DST e Aids. Recomendações para Terapia Antirretroviral Em Crianças e Adolescentes Infectados Pelo HIV, , Brasil. Secretaria de Vigilância Em Saúde. Ministério da Saúde. Brasília: Ministério da SaúdeWiener, L.S., Zobel, M., Battles, H., Ryder, C., Transition from a pediatric HIV intramural clinical research program to adolescent and adult community-based care services: Assessing transition readiness (2007) Soc Work Health Care, 46, pp. 1-19Vijayan, T., Benin, A.L., Wagner, K., Romano, S., Andiman, W.A., We never thought this would happen: Transitioning care of adolescents with perinatally acquired HIV infection from pediatrics to internal medicine (2009) AIDS Care, 21, pp. 1222-1229Hosek, S.G., Harper, G.W., Robinson, W.L., Identity development in adolescents living with HIV (2002) Journal of Adolescence, 25 (4), pp. 355-364. , DOI 10.1006/jado.2002.0480Gilliam, P.P., Ellen, J.M., Leonard, L., Kinsman, S., Jevitt, C.M., Straub, D.M., Transition of Adolescents with HIV to Adult Care: Characteristics and Current Practices of the Adolescent Trials Network for HIV/AIDS Interventions (2010) J Assoc Nurses AIDS Care, , Jun 9. Epub ahead of printSchidlow, D.V., Fiel, S.B., Life beyond pediatrics. Transition of chronically ill adolescents from pediatric to adult health care systems (1990) Med Clin North Am, 74, pp. 1113-1120Viner, R.M., Transition of care from paediatric to adult services: One part of improved health services for adolescents (2008) Archives of Disease in Childhood, 93 (2), pp. 160-163. , DOI 10.1136/adc.2006.103721Resnick, M.D., Bearman, P.S., Blum, R., Bauman, K.E., Harris, K.M., Jones, J., Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health (1997) JAMA, 278, pp. 823-832(2009) AIDS Epidemic Update: November 2009, , http://www.unaids.org/en/KnowledgeCentre/HIVData/EpiUpdate/EpiUpdArchive/ 2009/default.asp, Geneva: UNAIDSAccess: 11/08/201

Integrated Work Of Psychiatry In Ambulatory Internal Medicine: Relation Of An Experience [estagio Integrado De Residencia Psiquiatrica Em Ambulatorio De Clinica Medica. Relato De Uma Experiencia]

[No abstract available]32210911

Qualitative And Quantitative Methods In Health: Definitions, Differences And Research Subjects [métodos Qualitativos E Quantitativos Na área Da Saúde: Definições, Diferenças E Seus Objetos De Pesquisa]

The interest and accomplishments in qualitative research have been increasing in health. As a consequence, there is a greater demand for both institutional research programs and scientific journal publications. This article has the following purposes: (a) to present some definitions in qualitative methods used in Humanities and Health; (b) to compare them to the usual quantitative methods of health sciences; and, finally, (c) to illustrate the subject with the most important constructs in these methodological fields. Above all, the author's scope was to provide criteria to evaluate the pertinence of the path taken by qualitative researchers, from research plan elaboration to result interpretation.393507514Bogdan, R.C., Biklen, S.K., (1998) Qualitative Research for Education: An Introduction for Theory and Methods, , 3th ed. Boston: Allyn and BaconBritten, N., Making sense of qualitative research: A new series (2005) Med. Educ., 39 (1), pp. 5-6. , [editorials]Campos, C.J.G., Turato, E.R., The health professionals' team, the patient with renal disease in hemodialysis, and interpersonal relations (2003) Rev. Bras. Enferm., 56, pp. 508-512Chauí, M.S., (1995) Convite à Filosofia, , 3a ed. São Paulo: Áticade Figueiredo, R.M., Turato, E.R., Needs for assistance and emotional aspects of caregiving reported by AIDS patient caregivers in a day-care unit in Brazil (2001) Issues Ment. Health Nurs., 22 (6), pp. 633-643Denzin, N.K., Lincoln, Y.S., (1994) Handbook of Qualitative Research, , Thousand Oaks, SageFontanella, B.J.B., Turato, E.R., Doctor-patient relationship barriers to substance dependents seeking treatment (2002) Rev. Saúde Pública, 36, pp. 439-447Galilei, G., O ensaiador (2000), São Paulo: Nova CulturalJekel, J.F., Elmore, J.G., Katz, D.L., (2005) Epidemiologia, Bioestatística E Medicina Preventiva, , 2a ed. Porto Alegre: ARTMEDMalinowski, B.K., (1984) Argonautas Do Pacífico Ocidental: Um Relato Do Empreendimento E Da Aventura Dos Nativos Nos Arquipélagos Da Nova Guiné Melanésia, , 3a ed. São Paulo: Abril CulturalMinayo, M.C.S., (2004) O Desafio Do Conhecimento: Pesquisa Qualitativa Em Saúde, , 8a ed. São Paulo: Hucitec/Rio de Janeiro: AbrascoMorse, J.M., Field, P.A., (1995) Qualitative Research Methods for Health Professionals, , 2nd ed. Thousand Oaks, SageTurato, E.R., Introduction to the clinical-qualitative research methodology: Definition and main characteristics (2000) Rev. Portug. Psicossomática [Portug. J. Psychosomatics], 2 (1), pp. 93-108Turato, E.R., (2003) Tratado Da Metodologia Da Pesquisa Clínico-qualitativa: Construção Teórico-epistemológica, Discussão Comparada E Aplicação Nas áreas Da Saúde E Humanas, , 2a ed. Petrópolis: Vozes(2004) Medical Subject Headings, , http://www.nlm.nih.gov/mesh/2005/MBrowser.html, U.S. National Library of Medicine. Available from URL: [Nov 10