Problemas interpessoais em comunidade terapêutica: um estudo exploratório

Este estudo investigou problemas interpessoais em comunidades terapêuticas para dependentes químicos. Quatro residentes e dois monitores foram entrevistados individualmente. A análise de conteúdo foi utilizada para tratamento dos dados. Segundo os participantes, os desentendimentos nas comunidades onde estiveram ocorrem em circunstâncias banais do dia a dia e envolvem pequenas discussões e bate-bocas. Em alguns casos, tornam-se mais intensos, podendo ocorrer ameaça e agressão física. A conduta dos monitores diante desses casos é bem diversificada. Há divergências em relação às crenças a respeito dos efeitos dos problemas interpessoais sobre o tratamento: a) atrapalham o tratamento; b) podem atrapalhar, mas podem também servir como oportunidade de desenvolvimento; c) atrapalham apenas quem está pouco interessado no tratamento, sendo utilizados como desculpas para desistir do tratamento. Conclui-se que monitores e demais profissionais devem implementar estratégias para reduzir e administrar problemas interpessoais, sendo cautelosos em relação às manipulações dos residentes.Palavras-chave: Comunidade Terapêutica. Transtornos relacionados ao uso de substâncias. Relações interpessoais

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Crenças de gestores de saúde em relação à violência doméstica

Understanding the processes involved in the inclusion of domestic violence on the agenda of the health sector is important for the formulation and implementation of policies and intervention projects. Therefore, this paper sought to investigate the beliefs of health managers on domestic violence. Two studies were conducted in the municipalities of a micro region of Minas Gerais, one with 16 municipal health managers and another with 19 municipal coordinators of the “Family Health Strategy”. Data was collected through semi structured individual interviews and processed through the content analysis. According to managers of both groups, alcohol consumption, illicit drug use, lack of structure and of family planning, lack of dialogue and the manner and pace of current life/day-by-day stress are the main factors leading to various types of domestic violence. Municipal coordinators of the “Family Health Strategy” also highlighted the low income factor. Besides these, managers of both groups highlighted other factors related to specific situations: how parents were raised and the culture of violence as a mean of education (domestic violence against children); adolescent rebelliousness and lack of parenting skills in order to deal with them (domestic violence against teenagers); lack of patience from family/caregivers and interest in taking care of the elderly only for the money (domestic violence against the elderly); betrayal and jealousy (intimate partner violence). The prevention of violence as one of the roles of the health sector was more highlighted in the group of municipal health managers. The difficulties for further intervention were highlighted as: victims do not report the violence, little community involvement, insufficient financial resources, poor intersectoral coordination and absence of a specific policy. The workload was further emphasized by the coordinators of the “Family Health Strategy”. Managers were concerned and sensitized about the issue of domestic violence, but the actions to prevent it are still sporadic. The results indicate the presence of the biomedical model permeating the health sector. It is concluded that the approach to domestic violence is presented as a challenge for the health sector. It is recommended a greater focus on this issue when training and continuing education of professionals as well as the formulation of a more specific policy.Compreender os processos implicados na inclusão da violência doméstica na agenda do setor saúde é importante para a formulação e implementação de políticas e projetos de intervenção. Sendo assim, buscou-se investigar crenças de gestores de saúde sobre violência doméstica. Foram realizados dois estudos em municípios de uma microrregião de Minas Gerais: um com 16 secretários municipais de saúde e outro com 19 coordenadores municipais da Estratégia Saúde da Família. Os dados foram coletados por meio de entrevista individual semiestruturada e tratados através da análise de conteúdo. Segundo os gestores, consumo de álcool, consumo de drogas ilícitas, falta de estrutura e de planejamento familiar, falta de diálogo e o modo e ritmo de vida atual / estresse cotidiano são os principais fatores geradores dos vários tipos de violência doméstica. Os coordenadores municipais da Estratégia Saúde da Família ressaltaram também o fator baixa renda. Além desses, os gestores de ambos os grupos destacaram outros fatores relacionados a situações mais específicas: forma como os pais foram criados e cultura da violência como forma de educar (violência doméstica contra crianças); rebeldia dos adolescentes e falta de habilidades dos pais para lidar com eles (violência doméstica contra adolescentes); falta de paciência de familiares / cuidadores e interesse em cuidar do idoso apenas pelo dinheiro dele (violência doméstica contra idosos); traição e ciúmes (violência entre parceiros íntimos). A prevenção da violência como papel do setor saúde foi mais destacada pelo grupo de secretários municipais de saúde. As dificuldades para intervenção mais ressaltadas foram: vítimas não relatam a violência, pouca participação da comunidade, recurso financeiro insuficiente, pouca articulação intersetorial e ausência de política específica. A sobrecarga de trabalho foi mais enfatizada pelos coordenadores da Estratégia Saúde da Família. Os gestores se mostraram preocupados e sensibilizados com a questão da violência doméstica, mas as ações ainda são pontuais. Os resultados assinalam a presença do modelo biomédico permeando o setor saúde. Conclui-se que a abordagem da violência doméstica apresenta-se como um desafio para o setor saúde. Recomenda-se maior enfoque desse assunto na formação e educação continuada dos profissionais, bem como formulação de políticas mais específicas.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superio

Gene expression patterns in the alveolar bone healing after tooth extraction.

<p>Molecular analysis of the gene expression patterns in the bone healing in the socket was comprised of an initial exploratory analysis by RealTimePCR array a pool comprised of samples from all the experimental time periods (0h, 7d, 14d, 21d). RealTimePCR array analysis was performed with the VIA7 system (Applied Biosystems, Warrington, UK) using a customized qPCRarray comprised of the major targets from the Osteogenesis, Inflammatory Cytokines & Receptors and Wound Healing panels of the PCRarrayRT² Profiler (SABiosciences/QIAGEN). Results are depicted as the fold increase change (and the standard deviation) in mRNA expression from triplicate measurements in relation to the control samples and normalized by internal housekeeping genes (GAPDH, HPRT, β-actin). * indicate a statistically significant difference (p<0.05) between the experimental sample and the control.</p

Kinetics of gene expression in the alveolar bone healing process after tooth extraction.

<p>After the initial RealTimePCR array pooled from of all the experimental time periods, targets whose expression variation presented a significant variation were analyzed regarding their kinetics expressions in the bone healing process (0h, 7d, 14d, 21d time periods). RealTimePCRarray analysis was performed with the VIA7 system (Applied Biosystems, Warrington, UK) using a customized qPCRarray comprised of the major targets from the Osteogenesis, Inflammatory Cytokines & Receptors and Wound Healing panels of the PCRarrayRT² Profiler (SABiosciences/QIAGEN). Results are depicted as the fold increase change (and the standard deviation) in mRNA expression from triplicate measurements in relation to the control samples and normalized by internal housekeeping genes (GAPDH, HPRT, β-actin). Different letters indicate statistically significant differences (p 0.05) between time periods.</p

Histological aspects of the coronal, medial and apical thirds from tooth sockets in the bone healing process.

<p>Representative sections of the alveolar bone healing kinetics at 0, 7, 14 and 21 days post-extraction of the upper right incisor. HE staining, original magnification 10x and 40x. Bar = 100 μm.</p

Micro-computed tomography (μCT) analysis of bone healing process kinetics in mice.

<p>Samples from 8-week-old male wild-type (WT) C57BL/6 mice were scanned with the μCT System (Skyscan 1174; Skyscan, Kontich, Belgium): control (maxilla without extraction) and at 0, 7, 14 and 21 days post tooth to evaluate the kinetics of the bone healing process. Images were reconstructed using the NRecon software and three-dimensional images obtained with the CT-Vox software. From top to bottom, the sectioned maxilla are represented at the transverse (horizontal); sagittal; sagittal with inclination and transaxial planes.</p

Intramembranous Bone Healing Process Subsequent to Tooth Extraction in Mice: Micro-Computed Tomography, Histomorphometric and Molecular Characterization

<div><p>Bone tissue has a significant potential for healing, which involves a significant the interplay between bone and immune cells. While fracture healing represents a useful model to investigate endochondral bone healing, intramembranous bone healing models are yet to be developed and characterized. In this study, a micro-computed tomography, histomorphometric and molecular (RealTimePCRarray) characterization of post tooth-extraction alveolar bone healing was performed on C57Bl/6 WT mice. After the initial clot dominance (0h), the development of a provisional immature granulation tissue is evident (7d), characterized by marked cell proliferation, angiogenesis and inflammatory cells infiltration; associated with peaks of growth factors (BMP-2-4-7,TGFβ1,VEGFa), cytokines (TNFα, IL-10), chemokines & receptors (CXCL12, CCL25, CCR5, CXCR4), matrix (Col1a1-2, ITGA4, VTN, MMP1a) and MSCs (CD105, CD106, OCT4, NANOG, CD34, CD146) markers expression. Granulation tissue is sequentially replaced by more mature connective tissue (14d), characterized by inflammatory infiltrate reduction along the increased bone formation, marked expression of matrix remodeling enzymes (MMP-2-9), bone formation/maturation (RUNX2, ALP, DMP1, PHEX, SOST) markers, and chemokines & receptors associated with healing (CCL2, CCL17, CCR2). No evidences of cartilage cells or tissue were observed, strengthening the intramembranous nature of bone healing. Bone microarchitecture analysis supports the evolving healing, with total tissue and bone volumes as trabecular number and thickness showing a progressive increase over time. The extraction socket healing process is considered complete (21d) when the dental socket is filled by trabeculae bone with well-defined medullary canals; it being the expression of mature bone markers prevalent at this period. Our data confirms the intramembranous bone healing nature of the model used, revealing parallels between the gene expression profile and the histomorphometric events and the potential participation of MCSs and immune cells in the healing process, supporting the forthcoming application of the model for the better understanding of the bone healing process.</p></div