A auto-estima e o não-verbal dos pacientes com queimaduras

Esta pesquisa teve como objetivos identificar o grau de auto-estima dos pacientes do Ambulatório de Seqüelas de Queimaduras do HC-FMUSP e identificar os sinais não-verbais emitidos pelos pacientes, quando questionados sobre sua auto-estima. Realizado com 80 pacientes (54 mulheres e 26 homens) atendidos na unidade durante o mês de fevereiro de 2002, o projeto foi aprovado pelas Comissões de Ética em Pesquisa da EEUSP e do HC-FMUSP e as entrevistas individuais com os pacientes baseadas em uma escala para avaliação de auto-estima validada no Brasil e na classificação de sinais não-verbais proposta por Silva. Dentre os resultados, verificamos que 18,75% pacientes apresentam baixa auto-estima, 32,50% média auto-estima e 48,75% pacientes alta auto-estima. O complemento foi a função dos sinais não-verbais mais freqüente entre os pacientes.

A comunicação não-verbal enquanto fator iatrogênico

O estudo teve como objetivo verificar se os enfermeiros identificam situações nas quais os aspectos não-verbais da comunicação interpessoal entre profissionais de saúde e pacientes constituem fator iatrogênico. Os dados foram coletados por meio de entrevista semi-estruturada com oito enfermeiros e analisados segundo a metodologia de análise de conteúdo. Do discurso dos profissionais emergiram três categorias, que evidenciam a percepção da iatrogenia, suas conseqüências e características e a interrelação entre a linguagem não-verbal e o cuidado.

Pain intensity among institutionalized elderly: a comparison between numerical scales and verbal descriptors

AbstractOBJECTIVECorrelating two unidimensional scales for measurement of self-reported pain intensity for elderly and identifying a preference for one of the scales.METHODA study conducted with 101 elderly people living in Nursing Home who reported any pain and reached ( 13 the scores on the Mini-Mental State Examination. A Numeric Rating Scale - (NRS) of 11 points and a Verbal Descriptor Scale (VDS) of five points were compared in three evaluations: overall, at rest and during movement.RESULTSWomen were more representative (61.4%) and the average age was 77.0±9.1 years. NRS was completed by 94.8% of the elderly while VDS by 100%. The association between the mean scores of NRS with the categories of VDS was significant, indicating convergent validity and a similar metric between the scales.CONCLUSIONPain measurements among institutionalized elderly can be made by NRS and VDS; however, the preferred scale for the elderly was the VDS, regardless of gender.

Memory as acquaintance with the past: some Lessons from Russell, 1912-1914

Russell's theory of memory as acquaintance with the past seems to square uneasily with his definition of acquaintance as the converse of the relation of presentation of an object to a subject. We show how the two views can be made to cohere under a suitable construal of 'presentation', which has the additional appeal of bringing Russell's theory of memory closer to contemporary views on direct reference and object-dependent thinking than is usually acknowledged. The drawback is that memory as acquaintance with the past falls short of fulfilling Russell's requirement that knowledge by acquaintance be discriminating knowledge - a shortcoming shared by contemporary externalist accounts of knowledge from memory.

A percepção de pacientes sobre a comunicação não verbal na assistência médica

A confiança no médico e o sucesso terapêutico dependem, além de outros fatores, de uma boa comunicação entre profissional de saúde e paciente. O presente estudo buscou conhecer a percepção dos pacientes sobre aspectos da comunicação não verbal que influenciam a consolidação da confiança no médico. Trata-se de um estudo transversal, descritivo e analítico, com amostra aleatória de pacientes alocada em locais públicos da cidade. Foram realizadas 182 entrevistas com pessoas de idades entre 18 e 88 anos, registrando-se preferência pelo perfil mais tradicionalista do profissional, com roupas brancas, cabelos aparados e sem acessórios. O uso de maquiagem e acessórios (brincos, pulseiras, etc.) para mulheres é aceito com moderação. Existe restrição ao uso de piercings, tatuagens e brincos em homens, especialmente pela população idosa. Confirmando a importância da aparência na comunicação médico-paciente, o estudo destaca a necessidade da inserção do tema nos currículos médicos, uma vez que esses aspectos são pouco discutidos na formação do profissional médico, o que permitirá reflexões sobre aspectos não verbais da comunicação na relação médico-paciente e poderá influenciar positivamente as atitudes dos novos profissionais.

Mastalgias cíclicas: tratamento não-medicamentoso (orientação verbal)

Objetivos: avaliar o tratamento não-medicamentoso (orientação verbal) como primeira opção terapêutica para mulheres com mastalgia cíclica e observar se o tempo de existência da sintomatologia dolorosa altera os resultados. Métodos: conduzimos um estudo do tipo experimental não-controlado com uma amostra de 128 mulheres com história clara de mastalgia cíclica, tratadas com orientação verbal. Uma escala analógica visual da dor foi usada antes e após o tratamento, a fim de avaliar a severidade, e classificamos as mastalgias em graus I (leve), II (moderado) e III (severo), de acordo com a intensidade da dor. Usamos também o "Cardiff Breast Score" (CBS) modificado para avaliar a resposta clínica ao tratamento. A análise dos dados foi feita com o teste do chi² (Epi-Info 6.04). Resultados: verificou-se um índice de sucesso de 59,4% com a orientação verbal, mas não houve resposta com diferença estatisticamente significante entre os grupos (p = 0,16) com diferentes graus de mastalgia. A resposta menos satisfatória ao tratamento não-medicamentoso nas pacientes que apresentavam um período de tempo mais longo de sintomatologia foi apenas aparente, pois não houve diferença estatisticamente significante (p = 0.14). Conclusão: a orientação verbal deve ser tentada sempre como a primeira escolha terapêutica para mulheres com mastalgia cíclica, independentemente do grau de intensidade da dor. O curso prolongado da dor não interferiu nos resultados.

Discrepâncias entre o informe verbal e os registros no cartão da gestante, um instrumento negligenciado

OBJETIVO: Comparar o preenchimento do cartão da gestante em serviço-escola e em outros serviços, assim como verificar a concordância entre esses registros e as informações verbais das puérperas. MÉTODOS: Realizou-se estudo epidemiológico, transversal, misto, com duas etapas, adotando amostragem estratificada proporcional ao número de partos. Na primeira, os registros no cartão da gestante de um serviço-escola foram comparados aos de unidades não vinculadas ao ensino superior na área de saúde, em Recife (PE). Na segunda etapa, foram coletadas informações sobre o pré-natal de puérperas, por meio de questionário semiestruturado. Foram incluídas 262 puérperas com mais de 19 anos de idade, que portavam o cartão da gestante quando do parto, ocorrido entre maio e julho de 2008. Foram empregados testes estatísticos do χ², t de Student ou de Mann-Whitney, todos unicaudais à direita, com nível de significância de 5%. RESULTADOS: As informações mais frequentemente registradas no cartão da gestante, no serviço-escola, foram escolaridade (86,5 contra 70,3%; p=0,002), estado civil (83,7 contra 70,9%; p=0,01), peso anterior à gestação (72,1 contra 46,8%; p<0,001), estatura (62,5 contra 45,6%; p=0,007) e práticas educativas (76,9 contra 11,4%; p<0,001) e, nos outros serviços, apenas a informação de nascidos vivos com peso <2.500 g (27,2% contra 15,4% no serviço-escola; p=0,02). Houve discrepâncias significantes entre os dados obtidos por informe verbal e os registros no cartão da gestante. No serviço-escola, receberam assistência pré-natal adequada 40,3% das gestantes, contra 20,3%, nas outras unidades. CONCLUSÕES: Predominou maior percentual de registros, em todos os serviços, nas informações diretamente relacionadas ao parto, em detrimento das ações de caráter preventivo na assistência pré-natal.

Involvement of the hippocampus, amygdala, entorhinal cortex and posterior parietal cortex in memory consolidation

A total of 182 young adult male Wistar rats were bilaterally implanted with cannulae into the CA1 region of the dorsal hippocampus and into the amygdaloid nucleus, the entorhinal cortex, and the posterior parietal cortex. After recovery, the animals were trained in a step-down inhibitory avoidance task. At various times after training (0, 30, 60 or 90 min) the animals received a 0.5-µl microinfusion of vehicle (saline) or 0.5 µg of muscimol dissolved in the vehicle. A retention test was carried out 24 h after training. Retention test performance was hindered by muscimol administered into both the hippocampus and amygdala at 0 but not at 30 min posttraining. The drug was amnestic when given into the entorhinal cortex 30, 60 or 90 min after training, or into the parietal cortex 60 or 90 min after training, but not before. These findings suggest a sequential entry operation, during the posttraining period, of the hippocampus and amygdala, the entorhinal cortex, and the posterior parietal cortex in memory processing

Effects of entorhinal cortex lesions on memory in different tasks

Lesions of the entorhinal cortex produce retrograde memory impairment in both animals and humans. Here we report the effects of bilateral entorhinal cortex lesions caused by the stereotaxic infusion of N-methyl-D-aspartate (NMDA) in rats at two different moments, before or after the training session, on memory of different tasks: two-way shuttle avoidance, inhibitory avoidance and habituation to an open field. Pre- or post-training entorhinal cortex lesions caused an impairment of performance in the shuttle avoidance task, which agrees with the previously described role of this area in the processing of memories acquired in successive sessions. In the inhibitory avoidance task, only the post-training lesions had an effect (amnesia). No effect was observed on the open field task. The findings suggest that the role of the entorhinal cortex in memory processing is task-dependent, perhaps related to the complexity of each task

Long-term habituation (LTH) in the crab Chasmagnathus: a model for behavioral and mechanistic studies of memory

A decade of studies on long-term habituation (LTH) in the crab Chasmagnathus is reviewed. Upon sudden presentation of a passing object overhead, the crab reacts with an escape response that habituates promptly and for at least five days. LTH proved to be an instance of associative memory and showed context, stimulus frequency and circadian phase specificity. A strong training protocol (STP) (³15 trials, intertrial interval (ITI) of 171 s) invariably yielded LTH, while a weak training protocol (WTP) (£10 trials, ITI = 171 s) invariably failed. STP was used with a presumably amnestic agent and WTP with a presumably hypermnestic agent. Remarkably, systemic administration of low doses was effective, which is likely to be due to the lack of an endothelial blood-brain barrier. LTH was blocked by inhibitors of protein and RNA synthesis, enhanced by protein kinase A (PKA) activators and reduced by PKA inhibitors, facilitated by angiotensin II and IV and disrupted by saralasin. The presence of angiotensins and related compounds in the crab brain was demonstrated. Diverse results suggest that LTH includes two components: an initial memory produced by spaced training and mainly expressed at an initial phase of testing, and a retraining memory produced by massed training and expressed at a later phase of testing (retraining). The initial memory would be associative, context specific and sensitive to cycloheximide, while the retraining memory would be nonassociative, context independent and insensitive to cycloheximide

Involvement of hippocampal AMPA glutamate receptor changes and the cAMP/protein kinase A/CREB-P signalling pathway in memory consolidation of an avoidance task in rats

Training in step-down inhibitory avoidance (0.3-mA footshock) is followed by biochemical changes in rat hippocampus that strongly suggest an involvement of quantitative changes in glutamate AMPA receptors, followed by changes in the dopamine D1 receptor/cAMP/protein kinase A (PKA)/CREB-P signalling pathway in memory consolidation. AMPA binding to its receptor and levels of the AMPA receptor-specific subunit GluR1 increase in the hippocampus within the first 3 h after training (20-70%). Binding of the specific D1 receptor ligand, SCH23390, and cAMP levels increase within 3 or 6 h after training (30-100%). PKA activity and CREB-P levels show two peaks: a 35-40% increase 0 h after training, and a second increase 3-6 h later (35-60%). The results correlate with pharmacological findings showing an early post-training involvement of AMPA receptors, and a late involvement of the D1/cAMP/PKA/CREB-P pathway in memory consolidation of this task

Agents that affect cAMP levels or protein kinase A activity modulate memory consolidation when injected into rat hippocampus but not amygdala

Male Wistar rats were trained in one-trial step-down inhibitory avoidance using a 0.4-mA footshock. At various times after training (0, 1.5, 3, 6 and 9 h for the animals implanted into the CA1 region of the hippocampus; 0 and 3 h for those implanted into the amygdala), these animals received microinfusions of SKF38393 (7.5 µg/side), SCH23390 (0.5 µg/side), norepinephrine (0.3 µg/side), timolol (0.3 µg/side), 8-OH-DPAT (2.5 µg/side), NAN-190 (2.5 µg/side), forskolin (0.5 µg/side), KT5720 (0.5 µg/side) or 8-Br-cAMP (1.25 µg/side). Rats were tested for retention 24 h after training. When given into the hippocampus 0 h post-training, norepinephrine enhanced memory whereas KT5720 was amnestic. When given 1.5 h after training, all treatments were ineffective. When given 3 or 6 h post-training, 8-Br-cAMP, forskolin, SKF38393, norepinephrine and NAN-190 caused memory facilitation, while KT5720, SCH23390, timolol and 8-OH-DPAT caused retrograde amnesia. Again, at 9 h after training, all treatments were ineffective. When given into the amygdala, norepinephrine caused retrograde facilitation at 0 h after training. The other drugs infused into the amygdala did not cause any significant effect. These data suggest that in the hippocampus, but not in the amygdala, a cAMP/protein kinase A pathway is involved in memory consolidation at 3 and 6 h after training, which is regulated by D1, ß, and 5HT1A receptors. This correlates with data on increased post-training cAMP levels and a dual peak of protein kinase A activity and CREB-P levels (at 0 and 3-6 h) in rat hippocampus after training in this task. These results suggest that the hippocampus, but not the amygdala, is involved in long-term storage of step-down inhibitory avoidance in the rat.

Memory-impairing effects of local anesthetics in an elevated plus-maze test in mice

Post-training intracerebroventricular administration of procaine (20 µg/µl) and dimethocaine (10 or 20 µg/µl), local anesthetics of the ester class, prolonged the latency (s) in the retention test of male and female 3-month-old Swiss albino mice (25-35 g body weight; N = 140) in the elevated plus-maze (mean ± SEM for 10 male mice: control = 41.2 ± 8.1; procaine = 78.5 ± 10.3; 10 µg/µl dimethocaine = 58.7 ± 12.3; 20 µg/µl dimethocaine = 109.6 ± 5.73; for 10 female mice: control = 34.8 ± 5.8; procaine = 55.3 ± 13.4; 10 µg/µl dimethocaine = 59.9 ± 12.3 and 20 µg/µl dimethocaine = 61.3 ± 11.1). However, lidocaine (10 or 20 µg/µl), an amide class type of local anesthetic, failed to influence this parameter. Local anesthetics at the dose range used did not affect the motor coordination of mice exposed to the rota-rod test. These results suggest that procaine and dimethocaine impair some memory process(es) in the plus-maze test. These findings are interpreted in terms of non-anesthetic mechanisms of action of these drugs on memory impairment and also confirm the validity of the elevated plus-maze for the evaluation of drugs affecting learning and memory in mice

Effect of repeated restraint stress on memory in different tasks

The present study investigated the effect of repeated stress applied to female rats on memory evaluated by three behavioral tasks: two-way shuttle avoidance, inhibitory avoidance and habituation to an open field. Repeated stress had different effects on rat behavior when different tasks were considered. In the two-way active avoidance test the stressed animals presented memory of the task, but their memory scores were impaired when compared to all other groups. In the habituation to the open field, only the control group showed a significant difference in the number of rearings between training and testing sessions, which is interpreted as an adequate memory of the task. In the handled and chronically stressed animals, on the other hand, no memory was observed, suggesting that even a very mild repeated stress would be enough to alter habituation to this task. The performance in the inhibitory avoidance task presented no significant differences between groups. The findings suggest that repeated restraint stress might induce cognitive impairments that are dependent on the task and on stress intensity.