Resiliência e adesão ao tratamento em pacientes com lúpus eritematoso sistêmico

Universidade Federal do Rio Grande do Norte

Ensaio clínico duplo-cego controlado e randômico, comparando a eficácia da Clofazimina com a Cloroquina, no tratamento das lesões cutâneas do Lúpus Eritematoso Sistêmico

PURPOSE: To evaluate the capacity of clofazimine (CFZ) to control cutaneous activity of systemic lupus erythematosus (SLE), compared with chloroquine diphosphate (CDP). METHODS: A prospective, randomized, controlled, double blind clinical trial was carried out in thirty-three patients with SLE and cutaneous lesions (malar rash and/or discoid lupus and/or subacute cutaneous lupus), after approval by the respective Ethics Committee. Sixteen patients received clofazimine - 100mg/day (CFZ group) and 17 received chloroquine diphosphate - 250mg/day (CDP group), during six months. Both groups applied broad-spectrum sunscreens twice a day. The dose of prednisone was kept stable during the study. Cutaneous lesions were evaluated by 2 blinded observers and photographed at baseline and at months 1, 2, 4 and 6. RESULTS: Thirty-three patients began and 27 completed the 6 months of treatment. The groups were homogeneous and comparable in terms of demographic and clinical characteristics. Five CFZ-patients and one CDP-patients dropped out due to severe flare of disease requiring other treatment. At the end of the study, 12 CFZ-patients (75%) and 14 CDP-patients (82,4%) presented complete or near-complete remission of skin lesions; intention-to-treat analysis showed no significant difference in the response rates between groups. Side effects in both groups were frequent, but patients didn t have to discontinue the drugs. CONCLUSIONS: Clofazimine and chloroquine were effective in controlling cutaneous lesions in SLE patients

A doença como ponto de mutação :os processos de significação em mulheres portadores de lúpus eritematoso sistêmico

Systemic lupus erythematous (SLE) is a chronic and auto-immune disease that can affect several systems of one´s body, including the nervous system, causing several clinical evidences, which can put in risk the person´s life. Although the illness could manifest itself at any age or sex, studies indicate higher incidence among women. Its etiology points to the combination of genetic, hormonal and environmental factors. Due to the disease´s complexity, it is evident that it affects all the person´s life as a whole and not only its organic dimension. It is believed that the signification attributed to all the process of sickening influences its treatment, as well as the person´s capacity to cope with the difficulties and implicit profits involved in the process.In this study, eight women who were affected by SLE were interviewed, with the aim of examining carefully the processes of signification as well as the generation of meanings which permeate these women´s sickening processes. The analysis of their speeches evidences distinct forms of giving meaning to the process, regardless of the time of the diagnosis. The fact that the disease is incurable was shocking to all the participants, and it demanded changes in their lives, in order to detain a relative control of their condition. The majority of the participants were able to deal with these modifications, since strategies have been created to face the difficulties and thus to preserve their social life, without damaging their health. However, some of the participants did not obtain strenght to cope with the disease, eventually developing a depressive state. It is observed that not only SLE has innumerable ways of manifestation, but the experience of the illness is very subjective and dynamic. There are also several ways of expressing this experience, according to the implications in the social, cultural and economic context where the participants are inserted. This ratifies the necessity of a interdisciplinary approach to embrace SLE complexity. (310 words, 1.610 characters)

Eosinófilos e proteína catiônica eosinofílica na urina: uma nova abordagem para o diagnóstico da inflamação renal no lúpus eritematoso sistêmico

Universidade Estadual do Rio Grande do Norte

Mulheres com lúpus eritematoso sistêmico: sintomas depressivos e apoio social percebido

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease, rare, multisystem, with a very heterogeneous clinical and serological manifestations standard. The patient, in addition to suffering injuries on his physical and physiological functioning, may also face a number of psychosocial problems. Research indicates that SLE can cause significant damage to the psychological realm, especially with the presence of anxiety and depression. In 1999, the American College of Rheumatology (ACR), proposed the establishment of 19 neuropsychiatric clinical syndromes attributed to SLE. Depression lies between mood disorders and is one of the most common psychiatric manifestations in this group, being found more frequently in these patients than in the general population. Studies also suggest that social support plays an important role in the development of coping strategies, in SLE management and depression. This study has as main objective verify the association between depressive symptoms and perceived social support in patients with SLE. The specific objectives turned to: investigte the prevalence of depressive symptoms; investigate the perceived social support and verify if there is an association between depression, social support and sociodemographic variables. We used a sociodemographic questionnaire, the Beck Depression Scale, and the Perceived Social Support Scale. The analysis was performed through descriptive and inferential statistics. The final sample could count with 79 SLE women, with an average age of 35.7 years. 44 (55.7%) of the participants were married. Only 6 (7.59%) had completed higher education and 32 (40.51%) have not finished high school. Seventy-one (89.87%) had an income below three minimum salaries and 71 (89.87) practiced a religion, and the Catholic (67.71%) was the most mentioned by them. Of the total sample, 37 (46.74%) had been diagnosed SLE more than 7 years before, and 25 (31.65%) had the disease for more than 10 years. Only 19 (24.05%) had some work activity. Forty-two of them (53.17%) had depressive symptoms levels from mild to severe, and 51 (64.46%) reported pain levels of 5, or above. The study found a significant association between depressive symptoms and pain (p = 0.013) and depressive symptoms and work activity (p = 0.02). When we examined the perception of social support, the results showed high levels among participants. Using the Spearman correlation test we found a strong correlation between depressive symptoms and social support (p= 0,000037). It means that the higher the frequency of support, the lower the score of depression. These findings are relevant because depressive symptoms in patients with SLE have a multicausal and multifactorial character and may remain unnoticed, since many of them are confused with the manifestations of the disease. This fact requires a careful assessment from professionals, not only in the clinical setting, but also considering other psychosocial reasons, that may be influencing the emergence or worsening of symptoms. These results also corroborate other studies, which not only confirm the predictive role of social support in the physical wellbeing, but also in the psychological.

Mulheres com lúpus eritematoso sistêmico: sintomas depressivos e apoio social percebido

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease, rare, multisystem, with a very heterogeneous clinical and serological manifestations standard. The patient, in addition to suffering injuries on his physical and physiological functioning, may also face a number of psychosocial problems. Research indicates that SLE can cause significant damage to the psychological realm, especially with the presence of anxiety and depression. In 1999, the American College of Rheumatology (ACR), proposed the establishment of 19 neuropsychiatric clinical syndromes attributed to SLE. Depression lies between mood disorders and is one of the most common psychiatric manifestations in this group, being found more frequently in these patients than in the general population. Studies also suggest that social support plays an important role in the development of coping strategies, in SLE management and depression. This study has as main objective verify the association between depressive symptoms and perceived social support in patients with SLE. The specific objectives turned to: investigte the prevalence of depressive symptoms; investigate the perceived social support and verify if there is an association between depression, social support and sociodemographic variables. We used a sociodemographic questionnaire, the Beck Depression Scale, and the Perceived Social Support Scale. The analysis was performed through descriptive and inferential statistics. The final sample could count with 79 SLE women, with an average age of 35.7 years. 44 (55.7%) of the participants were married. Only 6 (7.59%) had completed higher education and 32 (40.51%) have not finished high school. Seventy-one (89.87%) had an income below three minimum salaries and 71 (89.87) practiced a religion, and the Catholic (67.71%) was the most mentioned by them. Of the total sample, 37 (46.74%) had been diagnosed SLE more than 7 years before, and 25 (31.65%) had the disease for more than 10 years. Only 19 (24.05%) had some work activity. Forty-two of them (53.17%) had depressive symptoms levels from mild to severe, and 51 (64.46%) reported pain levels of 5, or above. The study found a significant association between depressive symptoms and pain (p = 0.013) and depressive symptoms and work activity (p = 0.02). When we examined the perception of social support, the results showed high levels among participants. Using the Spearman correlation test we found a strong correlation between depressive symptoms and social support (p= 0,000037). It means that the higher the frequency of support, the lower the score of depression. These findings are relevant because depressive symptoms in patients with SLE have a multicausal and multifactorial character and may remain unnoticed, since many of them are confused with the manifestations of the disease. This fact requires a careful assessment from professionals, not only in the clinical setting, but also considering other psychosocial reasons, that may be influencing the emergence or worsening of symptoms. These results also corroborate other studies, which not only confirm the predictive role of social support in the physical wellbeing, but also in the psychological.

Avaliação dos parâmetros de estresse oxidativo no lúpus eritematoso

OBJECTIVE: The aim of this work was to analyse some oxidative stress parameters in patients of Systemic Lúpus Erythematosus. PATIENTS AND METHODS: Determinations of reduced glutathione content in whole blood were carried out. The activity of superoxide dismutase, gluthatione peroxidase and catalase in erythrocytes and the concentration of reactive substances of acid thiobarbituric in plasma of patients female (n =19) with SLE no activity of disease (Mex-SLEDAI < 2), with average ages of 32 ± 11 years, through the spectrophotometrical methods and from healthy individuals (n =30). Statistical data were analyzed by student t-test, p<0,05. RESULTS: Our data indicated a significant decrease on the activity of catalase and significant increase on the concentration of reactive substances of acid thiobarbituric in patients with SLE comparing with healthy individuals. There was no significant difference in other parameters. CONCLUSION: The results showed that oxidative stress has a role in the pathogenesis of the disease in SLE, even in patients without active disease.

Avaliação demográfica, clinico-laboratorial e genética de indivíduos com lupus eritematoso sistêmico e artrite reumatóide residentes em região tropical

The aetiology of autoimmunes disease is multifactorial and involves interactions among environmental, hormonal and genetic factors. Many different genes may contribute to autoimmunes disease susceptibility. The major histocompatibility complex (MHC) genes have been extensively studied, however many non-polymorphic MHC genes have also been reported to contribute to autoimmune diseases susceptibility. The aim of the present study was to evaluate the influence of SLC11A1 gene in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Ninety-six patients with SLE, 37 with RA and 202 controls enrolled in this case-control study, were evaluated with regard to demographic, genetic, laboratorial and clinical data. SLE mainly affects females in the ratio of 18 women for each man, 88,3% of the patients aged from 15 to 45 years old and it occurs with similar frequency in whites and mulattos. The rate of RA between women and men was 11:1, with 77,1% of the cases occurring from 31 to 60 years. The genetic analysis of the point mutation -236 of the SLC11A1 gene by SSCP did not show significant differences between alleles/genotypes in patients with SLE or RA when compared to controls. The most frequent clinical manifestations in patients with SLE were cutaneous (87%) and joint (84.9%). In patients with RA, the most frequent out-joint clinical manifestation were rheumatoid nodules (13,5%). Antinuclear antibodies were present in 100% of the patients with SLE. There was no significant relation between activity of disease and presence of rheumatoid factor in patients with RA, however 55,6% of patients with active disease presented positive rheumatoid factor. Significant association between alleles/genotypes of point mutation -236 and clinical manifestations was not found

Avaliação demográfica, clinico-laboratorial e genética de indivíduos com lupus eritematoso sistêmico e artrite reumatóide residentes em região tropical

The aetiology of autoimmunes disease is multifactorial and involves interactions among environmental, hormonal and genetic factors. Many different genes may contribute to autoimmunes disease susceptibility. The major histocompatibility complex (MHC) genes have been extensively studied, however many non-polymorphic MHC genes have also been reported to contribute to autoimmune diseases susceptibility. The aim of the present study was to evaluate the influence of SLC11A1 gene in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Ninety-six patients with SLE, 37 with RA and 202 controls enrolled in this case-control study, were evaluated with regard to demographic, genetic, laboratorial and clinical data. SLE mainly affects females in the ratio of 18 women for each man, 88,3% of the patients aged from 15 to 45 years old and it occurs with similar frequency in whites and mulattos. The rate of RA between women and men was 11:1, with 77,1% of the cases occurring from 31 to 60 years. The genetic analysis of the point mutation -236 of the SLC11A1 gene by SSCP did not show significant differences between alleles/genotypes in patients with SLE or RA when compared to controls. The most frequent clinical manifestations in patients with SLE were cutaneous (87%) and joint (84.9%). In patients with RA, the most frequent out-joint clinical manifestation were rheumatoid nodules (13,5%). Antinuclear antibodies were present in 100% of the patients with SLE. There was no significant relation between activity of disease and presence of rheumatoid factor in patients with RA, however 55,6% of patients with active disease presented positive rheumatoid factor. Significant association between alleles/genotypes of point mutation -236 and clinical manifestations was not found

Representações de professores de língua inglesa de Natal-RN: um estudo sistêmico-funcional

Teaching and learning representations have been more and more investigated in the Brazilian applied linguistics field, as it allows the understanding of the teachers representations and how they conceive the learning process. This practice facilitates the planning of actions to improve the educational system. This study aims at identifying, interpreting and discussing some representations related to the identity and professional view of English as a foreign language teachers in different school contexts of Natal-RN. The theoretical and methodological foundation for this research is Halliday s Systemic- Functional Linguistics (1994; HALLIDAY; MATHIESSEN, 2004; EGGINS, 1994, among others). Our goal was to reveal the teachers representations embedded in their language, mainly through the ideational metafunction, as language is the tool we use to express ourselves about the external world (events, qualities, things, etc) and the internal world (thoughts, beliefs, feelings, etc). The research corpus is made of 21 teacher narratives, generated from a questionnaire sent to the teachers, who were divided in two groups: Group 1 (public schools teachers) and Group 2 (private schools and English course teachers). Most of the participants seemed to be satisfied with their professional choice. Many of them see the job as a challenge and an opportunity to transmit knowledge. All of them affirmed that the English teacher is a professional, for different reasons; however, the low professional appreciation was a recurrent aspect among the studied narratives. When asked about where they work, the private school teachers seemed to be more satisfied with the teaching-learning process than the ones from the public schools. We believe that the data analyzed in this study is important to show how some English teachers from Natal-RN see their profession. The results might be used in continuing education courses as food-for-thought in group discussions, as it is extremely important to emphasize and stimulate this practice

O portfólio na formação inicial do professor reflexivo de inglês como língua estrangeira: uma análise sistêmico-funcional

This research deals with the insertion of the portfolio as a resource to the development of the reflective action in training teachers of English as a Foreign Language (EFL). Its goal is to characterize linguistic marks that show the reflective process in learning narratives collected in portfolios following the considerations of the ideational metafunction of the Systemic-Functional Grammar (SFG) by Halliday (1994). Within the scope of analysis offered by SFG, the system of transitivity was chosen attempting to observe and study the lexicogrammatical choices made by participants to produce their learning narratives. The corpus was composed of twenty-six learning narratives produced by thirteen participants into two distinct modules, designated here as "First Assessment" and "Final Assessment. The analysis were performed using procedures related to Corpus Linguistics, with the aid of the computer resource WordSmith Tools 5.0 (Scott, 1999). The results seems to indicate that preservice teachers, when asked to reflect on activities written on the classroom, use in their narratives a significant majority of mental processes instead of material processes that are common in narratives from other nature. Meanwhile, the use of a portfolio in teacher training in EFL, can be considered as a trigger reflection tool, which allows future teachers' effective monitoring of all their learning process

"Eu pensei que ia sair daqui falando inglês": um estudo sistêmico-funcional sobre papéis sociais atribuídos por alunos de um curso de Letras/Inglês

Research in the area of teacher training in English as a Foreign Language (CELANI, 2003, 2004, 2010; PAIVA, 2000, 2003, 2005; VIEIRA-ABRAHÃO, 2010) articulates the complexity of beginning teachers classroom contexts aligned with teaching language as a social and professional practice of the teacher in training. To better understand this relationship, the present study is based on a corpus of transcribed interviews and questionnaires applied to 28 undergraduate students majoring in Letters/English emphasis, at a public university located in the interior of the Western Amazon region, soliciting their opinions about the reforms made in the curriculum of this Major. Interviews and questionnaires were used as data collection instruments to trace a profile of the students organized in Group 1, with freshmen and sophomore undergraduates who are following the 2009 curriculum, and Group 2, with junior and senior undergraduates who are following the 2006 curriculum. The objectives are to identify, to characterize and to analyze the types of pronouns, roles and social actors represented in the opinions of these students in relation to their teacher training curriculum. The theoretical support focuses on the challenge of historical and contemporary routes from English teachers initial education programs (MAGALHÃES; LIBERALLI, 2009; PAVAN; SILVA, 2010; ALVAREZ, 2010; VIANA, 2011; PAVAN, 2012). Our theoretical perspective is based on the Systemic Functional Grammar of Halliday (1994), Halliday and Hasan (1989), Halliday and Matthiessen (2004), Eggins (1994; 2004) and Thompson (2004). We focus on the concept of the Interpersonal meaning, specifically regarding the roles articulated in the studies by Delu (1991), Thompson and Thetela (1995), and in the Portuguese language such as Ramos (1997), Silva (2006) and Cabral (2009). Moreover, we ascribe van Leeuwen s (1997; 2003) theory of Representation of Social Actors as a theoretical framework in order to identify the sociological aspect of social actors represented in the students discourse. Within this scenario, the analysis unfolds on three levels: grammatical (pronouns), semantic (roles), and discursive (social actors). For the analysis of interpersonal realizations present in the students opinions, we use the computational program WordSmith Tools (SCOTT, 2010) and its applications Wordlist and Concord to quantify the occurrences of the pronouns I, You and They, which characterize the roles and social actors of the corpus. The results show that the students assigned the following roles to themselves: (i) apprentice to express their initial process of English language learning; (ii) freshman to reveal their choice of Major in Letters/English emphasis; (iii) future teacher to relate their expectations towards a practicing professional. To assign the roles to professors in the major, the students used the metaphor of modality (I think) to indicate the relationship of teacher training, while they are in the role of a student and as a future teacher. From these evidences the representation of the students as social actors emerges in roles such as: (i) active roles; (ii) passive roles and (iii) personalized roles. The social actors represented in the opinions of the students reflect the inclusion of these roles assigned to the actions expressed about their experiences and expectations derived from their teacher training classroom

O Macrogênero drama Norte-Riograndense: uma análise de gênero e de discurso sob a perspectiva da linguística sistêmico-funcional

The focus of this qualiquantitative research is the phenomenon we are denominating Drama-of-Rio-Grande-do-Norte, which contemplates short verse texts from the oral tradition, sung and presented on stage by women in communities on the south coast of the northeastern Brazilian State, Rio Grande do Norte. This tradition harkens to the medieval romance of the Iberian Peninsula (CASCUDO, 2001; GURGEL, 1999; GALVÃO, 1993; MAGALHÃES, 1973; ROMERO,1977). The objective of this research is to: identify what characterizes the genre Drama of Rio Grande do Norte; situate this genre within a systemization of genres from the oral tradition in Rio Grande do Norte; investigate the interpersonal relationships of power and solidarity through the role of the women in the discourse, how they see themselves and others, pointing out which elements of the world they evaluate and to identify representations of the feminine in the discourse. The theory of Genre and Register of Martin and Rose (2008) and Generic Structure Potential of Hasan (1989, 1996), which has as a base the Systemic Functional Linguistics of Halliday and Matthiessen (2004), Eggins (1994) among others, offers a theoretical framework for the characterization of the genre through the identification of stages and phases configuring its typology the individual schematic structure and its topology its relation to other phenomena in the oral tradition. Other groupings were mapped of the ‗Macrogenre , from the model of Martin and Rose (2008) as a continuum on two axis: between the poles of how the genre circulates orally x in writing, and recited/individually x staged/collectively; as well as mapping the samples with relation to power using the same model, but with the poles of individual voice x collective voice on an axis between increased power and diminished power. Eleven texts described as Narratives and one Anecdote were selected for the analysis of Attitudes, and Negotiations of power. Through the quantification of semantic discursive resources in the discourse systems of Appraisal (MARTIN; WHITE, 2005) and of Negotiation (MARTIN; ROSE, 2007), as well as reflections about humor (EGGINS; SLADE, 1997) we identified the Attitudes and the Negotiations of interpersonal roles. The quantification is based on the theories of Corpus Linguistics (BERBER SARDINHA, 2010), using WordSmith Tools 5.0 (SCOTT, 2010). Our results show that the Drama-of-Rio-Grande-do-Norte is characterized as a Macrogenre in the Community of Oral Stories, in the Family of Street Theatre/Games, composed of five genre types: Narratives, Praise, Complaints, Anecdotes, and Exemplum. The Macrogenre is characterized by its being circulated orally, staged collectively and the texts analyzed configure in differing degrees of power between men and woman. In synthesis we observe that through humor, the Drama-of-Rio-Grande-do-Norte functions to offer a space for women to voice, comment, judge and orient about social conditions in their communities, such as alcoholism, domestic violence, inequalities before the law etc., as well as circulating positive appreciations of rural/coastal culture and judgments about the behavior of members of the speech community, the role of women being to establish and reinforce norms. We anticipate possible benefits of the addition of the genre analyzed in literacy projects in the schools of Rio Grande do Norte

Avaliação e monitoramento de políticas públicas: criação de um modelo sistêmico aplicado ao Instituto de Assistência Técnica e Extensão Rural do Rio Grande do Norte (EMATER-RN)

The nature of this thesis is interventionist and aims to create an alternative on how to control and evaluate the public policies implementation developed at the Institute for Technical Assistance and Rural Extension of Rio Grande do Norte State. The cenarium takes place in a public institution , classified as a municipality that belongs to the Rio Grande do Norte government and adopts the design science research methodology , where it generates a set of artifacts that guide the development of a computerized information system . To ensure the decisions, the literature was reviewed aiming to bring and highlight concepts that will be used as base to build the intervention. The use of an effective methodology called Iconix systems analysis , provides a software development process in a short time . As a result of many artifacts created by the methodology there is a software computer able of running on the Internet environment with G2C behavior, it is suggested as a management tool for monitoring artifacts generated by the various methods. Moreover, it reveals barriers faced in the public companies environment such as lack of infrastructure , the strength of the workforce and the executives behavior

Sobre (vivência) e mortalidade de pequenos negócios: o caso de mercados varejistas potiguares

This paper‟s starting point was the objective of understanding the relation between the reasons pointed out by small businesses owners for the continuity or shutdown of their businesses, and the reasons presented by the Environmental Theories. The paper discusses the Environmental Theories understand that it is supported by a systemic metaphor speech, discussing the theme in terms of organizational survival and mortality . The text reviews the literature showing the changes in the administrative thinking regarding the organization versus environment relation, and presenting general ideas about the micro and small businesses. In methodological terms, the qualitative approach was used in the research. Regarding the data collection technique, an in-depth thematic interview was used. It was carried out considering the elements of the techniques of life history and oral history, always giving priority to real world related narratives told by the interviewed subjects. The empirical corpus of the research was made up of seven owners of small retail businesses in two Potiguar cities: Natal and Mossoró. The interpretative and analytical process focused, at first, on the reflexive dialogue with each one of the owners‟ professional life history and business management experience, constituting the first level of analysis: reflections on individual narratives; and, afterwards, the interpretative process was developed through the analysis of all the subjects‟ statements, identifying the recurring themes and constituting the second level of analysis: reflection on the totalizing narrative. The themes identified in the totalizing narrative, that refer to the continuity of the businesses are: evolution, control, fidelity, liking what one does for a living. The themes that came up as reasons for shutdown are: lack of empathy with the business, lack of evolution, competition problems, suppliers and the government. The text synthesizes its comprehensions affirming that the reasons associated with continuity and shutdown of small markets, for this group of owners specifically, come up as a permanent tension between the volunteerism (quite human) and the determinism (systemic). The tension is shown in testimonies that at the same time evoke the organicist systemic logic through the themes evolution/no evolution, and also counterpoints with themes related to the interested human action, based on desires, feelings and personal convictions such as: liking what one does/ lack of empathy. As for the reflexive dialogue between the postulates of the Environmental Theories and the narratives, the results make it possible to affirm that, differently from the tension expressed by the subjects while talking about their reasons, the reasons associated with survival and mortality of businesses according to the Environmental Theories are theoretically polarized, seeming to preach options that are stagnated and shaping towards the subjects involved in the organization-environment relation