Validação de conteúdo do instrumento para consulta de enfermagem na visita domiciliar às pessoas com lesão medular: um enfoque no autocuidado

This study aimed to validate the contents of an Instrument for Nursing Consultation in the Home Visit of people with Spinal Cord Injury (INCEVDOP-LM), based on the Self-Care Deficit Theory. The methodological development study was conducted with spinal cord injured (SCI) people ascribed in the Family Health Units the city of Natal/RN/Brazil, and with the nurses of these institutions. The study was conducted from Januray 2012 to January 2013 in two phases: the first aimed to identify the need for self-care of persons with SCI, and the second to develop and validate the INCEVDOP-LM. The first phase consisted of a census study of people with SCI living in Natal/RN. In the second phase, a non-probabilistic convencience sample of subjects was selected to form two groups: First stage - Group 1 of the first stage was comprised by 73 adults with SCI diagnosed with paraplegia or tetraplegia, with cognitive function preserved and that were registered to some family health unit; Group 2 of the Second phase was composed of six experts that were nurses with doctoral formation, scientific experience in the area of technology development or assistance to persons with SCI, and with publications in periodicals Qualis A2. Data collection of the first phase was conducted through home visits of people with SCI that responded three instruments: Questionnaire I (comprised of demographic and socioeconomic variables), The Competency Rating Scale for Self-care (ASA) and the Barthel Index (an instrument for evaluation of functional capacity). The research for the second phase was conducted in two stages: I-construction of the INCEVDOP LM; II-validation of the INCEVDOP-LM. The instrument and an evaluation form were forwarded to the experts for the validation. The correlations between the responses were analyzed by the Kappa test, with accepting values of>0.75. The evaluation criteria were: organization, clarity, simplicity, readability, appropriateness of vocabulary, objectivity, accuracy, reliability and suitability and the positive responses with frequency values of≥90% were considered excellent. The chi-square test was used to investigate the differences between proportions. The study attended to the principles of Human Rights CNS Resolution 196/96. Results were reported by means of four articles derived from the study. The findings indicate that the items that showed disagreement among experts (k=0.02) were diagnoses, interventions and evaluation of the nursing features pertaining to the domains of Nutrition, Hygiene, Elimination, Physical, Social and Psychological, and of the Ability to perform work activities feature. Agreement among the experts were reported for the other items, with kappa ranging from 0.72 to 1. After removing items with disagreement, all criteria achieved excellent rates and no significant differences were observed between the proportions of responses of evaluation of experts (p>0.05). We conclude that the instrument shows validity to serve as a guide for nurses to conduct a systematic consultation during the home visit to people with spinal cord injury, with emphasis on self-care. The instrument must go through other levels of validation when applied in the clinical setting

Desempenho auditivo ao longo do tempo e satisfação dos usuários de implante coclear com perda auditiva pós-lingual

Most cochlear implant (CI) users, who suffer from post lingual hearing loss, are able to perceive sounds and comprehend speech after the implant. The prediction of maximal benefit over time, with the use of CI, can be useful for counseling patients about their expectations in using the new device. The measurement of satisfaction should be of primary interest in medical intervention, as the results may be used for intervention feedback. The purpose of this study is to analyze auditory performance of CI over time, as well as to evaluate users‟ satisfaction. Therefore two types of study designs were employed: a) retrospective cohort study with the analysis of medical records from 59 subjects about auditory performance before and after surgery. Results were submitted to the Kaplan -Meier estimator of cumulative probability and compared to prognostic factors of auditory performance using the logrank test. b) A sectional study design was conducted to evaluate the satisfaction of 51 subjects. The instrument consists of two specific questionnaires: Satisfaction with Amplification in Daily Life SADL and International Outcome Inventory Cochlear Implant IOI- CI. Results show statistical significant differences (p<0,001) in auditory performance before and after CI. The majority obtained satisfactory results of CI use during the first six months. Logrank tests does not indicate significant correlation between the analyzed covariates and the time in which adequate speech perception occurs. SADL e IOI-CI questionnaires indicate that most of the CI users are satisfied with their devices. The SADL detected a 27, 5% insatisfaction amongst CI users in relation to services and costs involved with the CI. The results of the IOI show 4% of insatisfaction with the use of CI and the social environment. In conclusion CI is capable to rehabilitate social auditory function in a short period of time and CI users demonstrate satisfaction with auditory, social and psychological gain offered through CI device

Trajetória de vida dos pescadores vítimas de lesão medular por mergulho: experiências, representações sociais e estresse

Spinal cord injury causes permanent disabling manifestations, affecting the anatomic integrity, bodily changes and functional limitations related to the disability state. It was aimed to analyze the social representation, stress level and experiences of fishermen victims of spinal cord injury caused by diving accident in the Northern beaches of Brazil. It is a descriptive - exploratory study with quantitative, qualitative and representational data developed i n fishermen’s villages in nine beaches of Northern shore/RN, between October 2013 to August 2014, after the approval of the Ethics Committee in Research of the Universidade Federal do Rio Grande do Norte, under the number 431.891/2013, CAAE 20818913.0.0000 .5537. The sample was composed by 44 fishermen with spinal cord injury, defined from inclusion and exclusion criteria of the participants. It was used as instrument to collect the data a semi structured interview. Quantitative data was analyzed by descrip tive statistics, showing the data through table, boxes and graphics by Microsoft Excel. Data from interviews were submitted to the software called Analyse Lexicale par Contexte d’un Ensemble de Segments de Texte (ALCESTE) using the analysis of the Social R epresentation Theory and Center Core Theory. It is shown the outcomes of the research through four articles, following the normative recommendations of the journals. Participants of the study were all male, age mean 49,6 years, elementary school (68,2%), m arried (77,3%); paraplegia sequel (50,0%). Most of them showed stress (75,0%), almost in the exhaustion stage (33,3%), prevalent insomnia symptoms (95,5%) in the last hours; hypertension (97,7%) in the last week and sexual troubles (95,5%) in the last mont h). Decompressive illness caused spinal cord injury (57,1%), occurred prevalently in low summer (75,0%), northern shore (96,4%), having as main consequences the paresthesia and pain in the upper and lower limbs (67,9%), followed by death (25,0%). Interview analysis under the understanding of Social Representation of spinal cord injury allowed the appearance of seven categories: Treatment: limitation and expectative; Spinal Cord injury: before and after; Retirement: reality yet to come; Disability: dependenc y, incapacity, vulnerability; Overcoming and autonomy; Self feelings: physics losses and new start; Life and labor: impediments, plans and changes. The center core of the representation is found in the first category by the expectative and limitation on th e treatment, meanwhile the outskirt elements are in seventh and third categories. Physics limitation for fishing activities and retirement expectative is the most outstanding of the structure. Social representation concerning spinal cord injury is found in a transaction moment between before and after with the prevented fishing activity, coping of the situation with the potential remaining. The anchoring is established in the desire for changes related to the improvements of life and health conditions exper ienced day by day through faith. This study finishes pointing out the range of the objectives, which topic is relevant for public health of fishermen. It is suggested prevention measures, promotion and health recovery of fishermen, besides safe, healthy an d worthy conditions as a compromise of social and health politics.

Associação da imunoexpressão das proteínas XRCC1, TFIIH E XPF com características clinicopatológicas e sobrevida em carcinoma epidermoide de língua oral

DNA repair systems, genes and proteins are essential for genome integrity maintenance, avoiding serious diseases such as cancer. Deregulation in the expression of those proteins has been associated with both the risk of development and evolution of various human cancers, including oral squamous cell carcinoma. The purpose of this study was to analyze the immunoreactivity of the DNA repair proteins XRCC1, THIIF and XPF in oral tongue squamous cell carcinoma (OTSCC) and to investigate its association with clinical and histopathological parameters, outcome and 5-year survival rate. Seventy-four cases of OTSCC were analyzed semi-quantitatively through immunohistochemistry. We observed that DNA repair proteins were highly expressed in parenchymal cells; however, we only observed a significant association between XRCC1 high expression and better clinical staging (p=0,02). Cox regression showed that tumor size (p<0,01), lymph node involvement (p=0,04), tumor stage (p=0,02) and depth of invasion> 4mm (p=0,05) were prognostic factors. The results of this experiment suggest that XRCC1, TFIIH and XPF participate in the tumorigenic process, however, their immunoexpression may not be used as an independent prognostic indicator for OTSCC.

Associação da imunoexpressão das proteínas XRCC1, TFIIH E XPF com características clinicopatológicas e sobrevida em carcinoma epidermoide de língua oral

DNA repair systems, genes and proteins are essential for genome integrity maintenance, avoiding serious diseases such as cancer. Deregulation in the expression of those proteins has been associated with both the risk of development and evolution of various human cancers, including oral squamous cell carcinoma. The purpose of this study was to analyze the immunoreactivity of the DNA repair proteins XRCC1, THIIF and XPF in oral tongue squamous cell carcinoma (OTSCC) and to investigate its association with clinical and histopathological parameters, outcome and 5-year survival rate. Seventy-four cases of OTSCC were analyzed semi-quantitatively through immunohistochemistry. We observed that DNA repair proteins were highly expressed in parenchymal cells; however, we only observed a significant association between XRCC1 high expression and better clinical staging (p=0,02). Cox regression showed that tumor size (p<0,01), lymph node involvement (p=0,04), tumor stage (p=0,02) and depth of invasion> 4mm (p=0,05) were prognostic factors. The results of this experiment suggest that XRCC1, TFIIH and XPF participate in the tumorigenic process, however, their immunoexpression may not be used as an independent prognostic indicator for OTSCC.