Diferencias en costo efectividad del cuidado paliativo domiciliario frente a la atención convencional hospitalaria para el manejo de enfermedades crónicas en fase terminal

En Colombia la dinámica poblacional ha experimentado cambios a través de los años; lo cual modifica las características epidemiológicas y los perfiles de morbimortalidad de la población, aumentando la incidencia y prevalencia de enfermedades crónicas de difícil pronóstico dentro de la población; siendo estos grupos etarios hacía quienes deben destinarse nuevas modalidades de atención y soporte paliativo. Se realizó una revisión sistemática de diversos artículos, clasificados con niveles de evidencia I y II; cuyas variables de análisis fueron: El lugar de fallecimiento del paciente, alivio de la sintomatología, nivel de satisfacción del paciente y sus cuidadores con los servicios recibidos, número de ingresos hospitalarios independientemente de la causa y días promedio de estancia hospitalaria. El 88% de los pacientes que fueron vinculados a la atención domiciliaria falleció en su hogar; el 68% refirió haber experimentado disminución en la intensidad de al menos 2 síntomas como resultado de la atención en casa. El nivel de satisfacción para el cuidado en casa puntuó 19 puntos porcentuales por encima de la calificación que obtuvo el manejo hospitalario. El 23% de los pacientes tratados en su hogar, requirió al menos una hospitalización durante el manejo; mostrando una disminución en el tiempo de estancia hospitalaria de 3.4 días promedio. El manejo paliativo domiciliario de pacientes crónicos en fase terminal, no sólo es una alternativa en la reducción de costos para el sistema de salud, sino que es un factor protector de tipo emocional que refleja también una importante disminución de los riesgos de la hospitalización.

A comunicação da equipe de enfermagem com o paciente em cuidados paliativos

The article consists of a contextualized reflection on the communication in palliative care with the purpose of explaining strategies used for effective communication among the nursing, terminally ill and his family. In that sense, it was observed that for the nurse to assist the terminally ill is a difficult task, which raises sensation of sadness, frustration, impotence and even failure in the rendered attendance. This way, many professionals use denial, escaping, and the apparent coldness as defense mechanisms to cope with situation. Throughout this discussion are exposed some aspects that enable developing empathic communication skills, perceived as a task that requires nursing staff a shift in focus and attitude. Apart from careful listening, truthfulness, good humor and therapeutic touch, forming strategies for effective communication in the terminally ill life.

The role of satellite image-processing for national-scale estimates of gene flow from genetically modified crops: rapeseed in the UK as a model.

1. There is concern over the possibility of unwanted environmental change following transgene movement from genetically modified (GM) rapeseed Brassica napus to its wild and weedy relatives. 2. The aim of this research was to develop a remote sensing-assisted methodology to help quantify gene flow from crops to their wild relatives over wide areas. Emphasis was placed on locating sites of sympatry, where the frequency of gene flow is likely to be highest, and on measuring the size of rapeseed fields to allow spatially explicit modelling of wind-mediated pollen-dispersal patterns. 3. Remote sensing was used as a tool to locate rapeseed fields, and a variety of image-processing techniques was adopted to facilitate the compilation of a spatially explicit profile of sympatry between the crop and Brassica rapa. 4. Classified satellite images containing rapeseed fields were first used to infer the spatial relationship between donor rapeseed fields and recipient riverside B. rapa populations. Such images also have utility for improving the efficiency of ground surveys by identifying probable sites of sympatry. The same data were then also used for the calculation of mean field size. 5. This paper forms a companion paper to Wilkinson et al. (2003), in which these elements were combined to produce a spatially explicit profile of hybrid formation over the UK. The current paper demonstrates the value of remote sensing and image processing for large-scale studies of gene flow, and describes a generic method that could be applied to a variety of crops in many countries. 6. Synthesis and applications. The decision to approve or prevent the release of a GM cultivar is made at a national rather than regional level. It is highly desirable that data relating to the decision-making process are collected at the same scale, rather than relying on extrapolation from smaller experiments designed at the plot, field or even regional scale. It would be extremely difficult and labour intensive to attempt to carry out such large-scale investigations without the use of remote-sensing technology. This study used rapeseed in the UK as a model to demonstrate the value of remote sensing in assembling empirical information at a national level.

Rapeseed cytoplasm gives advantage in wild relatives and complicates genetically modified crop biocontainment

Biocontainment methods for genetically modified crops closest to commercial reality (chloroplast transformation, male sterility) would be compromised (in absolute terms) by seed-mediated gene flow leading to chloroplast capture. Even in these circumstances, however, it can be argued that biocontainment still represses transgene movement, with the efficacy depending on the relative frequency of seed-and pollen-mediated gene flow. In this study, we screened for crop-specific chloroplast markers from rapeseed (Brassica napus) amongst sympatric and allopatric populations of wild B. oleracea in natural cliff-top populations and B. rapa in riverside and weedy populations. We found only modest crop chloroplast presence in wild B. oleracea and in weedy B. rapa, but a surprisingly high incidence in sympatric (but not in allopatric) riverside B. rapa populations. Chloroplast inheritance models indicate that elevated crop chloroplast acquisition is best explained if crop cytoplasm confers selective advantage in riverside B. rapa populations. Our results therefore imply that chloroplast transformation may slow transgene recruitment in two settings, but actually accelerate transgene spread in a third. This finding suggests that the appropriateness of chloroplast transformation for biocontainment policy depends on both context and geographical location.

The role of satellite image-processing for national-scale estimates of gene flow from genetically modified crops: rapeseed in the UK as a model

1.There is concern over the possibility of unwanted environmental change following transgene movement from genetically modified (GM) rapeseed Brassica napus to its wild and weedy relatives. 2. The aim of this research was to develop a remote sensing-assisted methodology to help quantify gene flow from crops to their wild relatives over wide areas. Emphasis was placed on locating sites of sympatry, where the frequency of gene flow is likely to be highest, and on measuring the size of rapeseed fields to allow spatially explicit modelling of wind-mediated pollen-dispersal patterns. 3. Remote sensing was used as a tool to locate rapeseed fields, and a variety of image-processing techniques was adopted to facilitate the compilation of a spatially explicit profile of sympatry between the crop and Brassica rapa. 4. Classified satellite images containing rapeseed fields were first used to infer the spatial relationship between donor rapeseed fields and recipient riverside B. rapa populations. Such images also have utility for improving the efficiency of ground surveys by identifying probable sites of sympatry. The same data were then also used for the calculation of mean field size. 5. This paper forms a companion paper to Wilkinson et al. (2003), in which these elements were combined to produce a spatially explicit profile of hybrid formation over the UK. The current paper demonstrates the value of remote sensing and image processing for large-scale studies of gene flow, and describes a generic method that could be applied to a variety of crops in many countries. 6.Synthesis and applications. The decision to approve or prevent the release of a GM cultivar is made at a national rather than regional level. It is highly desirable that data relating to the decision-making process are collected at the same scale, rather than relying on extrapolation from smaller experiments designed at the plot, field or even regional scale. It would be extremely difficult and labour intensive to attempt to carry out such large-scale investigations without the use of remote-sensing technology. This study used rapeseed in the UK as a model to demonstrate the value of remote sensing in assembling empirical information at a national level.

Another Proof of the Preceding Theory

Another Proof of the Preceding Theory was produced as part of a residency run by Artists in Archeology in conjunction with the Stonehenge Riverside project. The film explores the relationship between science, work and ritual, imagining archaeology as a future cult. As two robed disciples stray off from the dig, they are drawn to the drone of the stones and proceed to play the henge like a gigantic Theremin. Just as a Theremin is played with the hand interfering in an electric circuit and producing sound without contact, so the stones respond to the choreographed bodily proximity. Finally, one of the two continues alone to the avenue at Avebury, where the magnetic pull of the stones reaches its climax. Shot on VHS, the film features a score by Zuzushi Monkey, with percussion and theremin sounds mirroring the action. The performers are mostly artists and archeologists from the art and archaeology teams. The archeologists were encouraged to perform their normal work in the robes, in an attempt to explore the meeting points of science and ritual and interrogate our relationship to an ultimately unknowable prehistoric past where activities we do not understand are relegated to the realm of religion. Stonehenge has unique acoustic properties, it’s large sarsen stones are finely worked on the inside, left rough on the outside, intensifying sound waves within the inner horseshoe, but since their real use, having been built over centuries, remains ambiguous, the film proposes that our attempts to decode them may themselves become encoded in their cumulative meaning for future researchers.

Traditional medicine use by cancer patients in Thailand

Ethnobotanical relevance Cancer patients commonly use traditional medicines (TM) and in Thailand these are popular for both self-medication and as prescribed by TM practitioners, and are rarely monitored. A study was conducted at Wat Khampramong, a Thai Buddhist temple herbal medicine hospice, to document some of these practices as well as the hospice regime. Materials and methods Cancer patients (n=286) were surveyed shortly after admission as to which TMs they had previously taken and perceptions of effects experienced. They were also asked to describe their current symptoms. Treatment at the hospice is built upon an 11-herb anti-cancer formula, yod-ya-mareng, prescribed for all patients, and ideally, its effects would have been evaluated. However other herbal medicines and holistic practices are integral to the regime, so instead we attempted to assess the value of the patients׳ stay at the hospice by measuring any change in symptom burden, as they perceived it. Surviving patients (n=270) were therefore asked to describe their symptoms again just before leaving. Results 42% of patients (120/286; 95% CI 36.4%, 47.8%) had used herbal medicines before their arrival, with 31.7% (38/120; 95% CI 24%, 40.4%) using several at once. Mixed effects were reported for these products. After taking the herbal regime at Khampramong, 77% (208/270 95% CI; 71.7%, 81.7%) reported benefit, and a comparison of the incidence of the most common (pain, dyspepsia, abdominal or visceral pain, insomnia, fatigue) showed statistical significance (χ2 57.1, df 7, p<0.001). Conclusions A wide range of TMs is taken by cancer patients in Thailand and considered to provide more benefit than harm, and this perception extends to the temple regime. Patients reported a significant reduction in symptoms after staying at Khampramong, indicating an improvement in quality of life, the aim of hospices everywhere. Based on this evidence, it is not possible to justify the use of TM for cancer in general, but this study suggests that further research is warranted. The uncontrolled use of TMs, many of which are uncharacterised, raises concerns, and this work also highlights the fact that validated, robust methods of assessing holistic medical regimes are urgently needed.

Bemötande av patienter med cancer inom palliativ vård : en systematisk litteraturstudie

Studien hade till syfte att beskriva faktorer som var av vikt i bemötandet av patienter inom palliativ vård och genomfördes som en systematisk litteraturstudie. Artiklar har sökts i olika databaser samt via manuell sökning. Sökorden som har använts var palliative care, caring, patients, end-of-life, hospice, cancer, needs, support och experience. Antal granskade artiklar var 11. Granskningen resulterade i fyra faktorer; information, kommunikation, känslomässig dimension och delaktighet i vården. Faktorerna omformulerades till teman enligt följande: Vikten av kunskap för att kunna ge information, Kommunikation mellan vårdpersonal och patient, Känslor som kan uppstå i livets slutskede och Patienternas delaktighet i vården. Informationen var viktig för att patienten skulle veta vad sjukdomen innebar och vad som kom att hända i framtiden. Vårdpersonalen fick känna av hur mycket information patienten kunde ta emot och hur mycket de ville veta om sjukdomen. Upprepning av informationen fick ges för att patienterna inte tidigare kunde smälta all information som de fått. Kommunikationen var grunden för att ett bemötande skulle kunna uppstå. Med kommunikationens hjälp byggdes relationer och förtroende upp mellan vårdpersonal och patienter, vilket var en förutsättning för att ge en god omvårdnad. Det var svårt för vårdpersonal som inte var specialiserade inom palliativ vård att kunna bemöta patienterna på ett tillfredsställande sätt. Patienterna upplevde att de fick en bättre vård av den specialiserade vårdpersonalen. Patienterna upplevde många olika känslor under sjukdomstiden. Frustration och maktlöshet för sjukdomen var vanliga upplevelser. Det var svårt för patienterna att släppa kontrollen över sin situation. Frustrationen upplevdes på grund av att de fick be vårdpersonalen om hjälp med de saker som de själva hade klarat av tidigare. Delaktighet i vården var en annan faktor som patienterna upplevde som viktig. De fick då vara med och bestämma över sin situation och sitt eget liv så långt det var möjligt.

Conselhos municipais como canal de participaçãp pública: desafios para populações rurais na Amazônia: um estudo de caso sobre Juruti-PA.

Parte do processo de descentralização iniciado no Brasil no fim da década de 1980, o movimento por uma maior permeabilidade do Estado resultou na definição de Conselhos Gestores de Políticas como peças centrais para as políticas sociais em todo o país. No entanto, a heterogeneidade brasileira de proporções continentais solicita a adequação e o ajuste de políticas públicas e instituições para responderem àsdiversas realidades locais. Este trabalho foi realizado a partir de um estudo de caso exploratório que busca responder sobre o alcance dos Conselhos como arena para discussão, encaminhamento de demandas e solução de problemas da população que habita o espaço considerado “rural” de Juruti, município amazônico repleto de especificidades e desafios comuns à região. Assim, apesar de observarmos a existência de grupos, associações e espaços similares nas comunidades para discutir necessidades e endereçar as demandas por meio da atuação engajada de lideranças locais de diversos perfis, o que se percebe é que muitos desconhecem caminhos já institucionalizados (como os Conselhos Municipais) para encaminhar suas demandas. Com um movimento alheio aos espaços legalmente constituídos, as comunidades perdem a oportunidade de participar mais ativamente da formação de agenda do município, além de ficarem de fora dos mecanismos de controle social e acesso a recursos públicos. A realização de suas demandas se transforma em moeda de troca em vez de direitos reivindicados satisfeitos, se transforma em conquistas que perdem o papel simbólico no fortalecimento organizativo das comunidades.Em uma realidade rural amazônica como Juruti, parece fundamental discutir o chamado “trabalho de base”, o que implica em considerar variáveis de extrema relevância de custo e tempo de deslocamento, além da necessária regionalização dos interesses e demandas. Percebe-se imprescindível também a rediscussão sobre os parâmetros para a definição do “rural” no país, de forma a incluir os diversos Brasis e viabilizar diagnósticos que possibilitem que particularidades como as amazônicas se reflitam em políticas públicas, em modelos de gestão municipal e em espaços participativos adequados, que dialoguem com o local.

O papel da tecnologia da informação e comunicação na inclusão financeira da população ribeirinha da Ilha de Marajó: o caso Agência Barco

O desafio de ofertar infraestrutura de serviços públicos nas regiões menos desenvolvidas do Brasil, geralmente mais afastadas dos grandes centros urbanos, mobiliza setores da sociedade na busca de abordagens novas e criativas que possam diminuir as grandes disparidades inter-regionais. Uma das carências vivenciadas por parte da população brasileira é a falta de acesso ao sistema financeiro, comprometendo a capacidade de plena participação dessas pessoas na economia, dificultando a geração e acúmulo de riqueza, situação essa presente na Ilha de Marajó, no estado do Pará, cuja maioria de seus dezesseis municípios apresenta Índice de Desenvolvimento Humano (IDH) baixo ou muito baixo. Para mudar essa realidade, uma iniciativa inovadora é a agência bancária itinerante instalada em barco, para atendimento a populações ribeirinhas de regiões com vasta extensão territorial, baixa densidade demográfica, dificuldades de transporte e limitações na oferta de tecnologia da informação e comunicação (TIC). Assim, essa pesquisa, com propósito exploratório e descritivo, tem como objetivo principal identificar, sob o ponto de vista das TIC, como os indicadores de inclusão financeira são influenciados pela atuação da Agência Barco na Ilha de Marajó. Além do estudo teórico, foi realizada investigação empírica, por meio de observação direta e entrevistas semiestruturadas com clientes e funcionários da Agência Barco, realizadas ao longo de quatro dias, em duas cidades da Ilha de Marajó. Para análise dos dados, foram aplicadas técnicas de análise de conteúdo às entrevistas, com objetivo de identificar a presença de elementos de inclusão financeira, transpondo os resultados para um modelo heurístico de infoinclusão dinâmica (2iD), o qual foi adaptado para contemplar constructos de inclusão financeira. O resultado da pesquisa demonstra que a Agência Barco consegue suprir as necessidades de acesso a serviços e produtos financeiros pela população da Ilha de Marajó, ao mesmo tempo em que se identifica oportunidades para ampliação de aspectos relacionados à educação financeira, possibilitando fortalecer os componentes dinâmicos do processo de inclusão financeira, com aumento da conscientização e consequente aumento da demanda por serviços e produtos financeiros.

Visões da cidade : da cidade histórica aos bairros da Cidade Alta e Ribeira em Natal-RN

The present work is an initiative of undertaking a perspective that values the aspects of the city in its diversity. The one that t intends is to discuss the urbanity starting from the aspect of the image, of the history, and about main point, to value the point of the individual's view that lives the urban space in its more several configurations: the house, the street, the neighborhood, and the city in wider scale. The described historical research defines the city as space of the human accomplishments. When analyzing the moments of the most recent history of the urban life the modernity/post-modernity notions they are explored in the sense of illuminating the wealth, continuity and it breaks of patterns of behavior, and on the other hand, to describe a I overfly in the several times of the city. The prominences of aspects of the archaeology and of the descriptive resource they are related, for its time, the most punctual perspective of the practical research, the instance of the neighborhood, specifically High City and Riverside, configuring an immersion in the daily more punctual of the city, valuing forms of being, aiming the perspective of the personal computer as point-of-view. The images of the city assume the paper of representing the documental about the current features of the urbanity. It is without a doubt that at the present time the photographic image already possesses a paper of prominence it is as research instrument, be as main source for a work on files of photos. The photographic images in the present work possess a prominence place, focusing specific places of the city in the time. Finally, the individual's voice valued under the perspective on as the person's knowledge that inhabits and live the urbanity he/she understands the knowledge of the life in the city and, more than in any other place, a middle where the loss of action models is pointed very easily tends in view the dynamic movement of the practices and renewal of new indications; in the same space in that becomes urgent to build marks starting from which the individual can shimmer the future. And in that space the individual's voice is valued as rich source of information on living the scenery of conflicts of the present time