Saúde Mental e Morte: subsídios para implantação dos Cuidados Paliativos na Atenção Básica

The objective of this work was, from a bibliographical survey, to discuss the relationship between the subjects “Mental Health” and “Death”, in order to analyze possible contributions of the Psychiatric Reformation tied with the sphere of Palliative Cares. The characterization of madness as a social problem is related to the development of the capitalist mode of production. Unable to fulfill the requirements imposed by capital, insane persons are excluded from society and locked in psychiatric hospitals in order to be treated. In the same way, death is incompatible with the capitalist principles of accumulation of goods. Dying people are then transferred to the hospital in order to hide their invalidity, non-production and felt inexistence of wealth. Some principles for care in mental health that could be shared in the palliative cares are: deinstitutionalization; organization of assistance in a network; psychosocial assistance; interdisciplinarity and construction of the autonomy of family members and users. In this sense, some challenges are distinguished, between them, professional training.

Vigilância à saúde de recém-nascidos de risco: elaboração de protocolo de organização de serviços para redução do óbito infantil

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Lamb Bright Saviors [Excerpt: Noon Song & Mady]

Lamb Bright Saviors begins as an apocalyptically inclined itinerant preacher staggers across the Nebraska prairie. With his young assistant, Mady, in tow hauling a wagon stacked with bibles, it’s not long before the preacher finds he’s come to the final fulfillment of his self-proclaimed life’s work: to die in front of a group of strangers. Odd as his own end-of-days might be, the lives and struggles of the strangers attending this deathbed scene are even odder. As the dying preacher unleashes a barrage of hallucinatory ramblings and rantings in the hope of imparting wisdom, each ragtag member of this unlikely congregation must reckon with his or her own dark past. And, through it all, the irrepressible Mady lends the preacher’s strange performance a surprising and unforgettable dignity and humor.

An Estuarine Low Temperature Fish Kill in Mississippi, with Remarks on Restricted Necropsies

In January 1973, large numbers of Mugil cephalus (striped mullet), weighing approximately 250 gm each, died in two freshwater localities in tidewater bayous of Jackson County, Mississippi. Fish identified as Mugil curema, M. cephalus, Megalops atlantica, Dormitator maculatus, and Fundulus grandis were found dead in other low saline estuarine areas. Fish-kills during cold periods are less commonly encountered in Mississippi than in Texas or Florida. This particular incident is attributed to conditions of stress for fishes incompletely acclimated to the encountered low temperatures. The most deleterious stress was the low saline water which probably allowed a breakdown in the fishes' ion-osmoregulatory mechanisms. Striped mullet and other euryhaline fishes in salinities greater than 6 ppt survived, as did freshwater centrarchids and ictalurids in areas with dying mullet. Other stresses thought to contribute to the weakening of striped mullet in Paige Bayou during the period of rapidly decreasing temperatures include starvation and high levels of pesticide residues. In examined fish, the alimentary tracts were devoid of food, the gall bladders were distended and leaking bile, the livers contained excess lipid material and were often stained throughout with bile pigments, and the levels of DDT metabolites and endrin residues in the liver were higher than in control fish. Stress caused by low levels of dissolved oxygen, toxic substances in the water, or disease was discounted as a cause of death.

HAWAIIAN SUGAR CANE RAT CONTROL METHODS AND PROBLEMS

The problem of rats in our Hawaiian sugar cane fields has been with us for a long time. Early records tell of heavy damage at various times on all the islands where sugar cane is grown. Many methods were tried to control these rats. Trapping was once used as a control measure, a bounty was used for a time, gangs of dogs were trained to catch the rats as the cane was harvested. Many kinds of baits and poisons were used. All of these methods were of some value as long as labor was cheap. Our present day problem started when the labor costs started up and the sugar industry shifted to long cropping. Until World War II cane was an annual crop. After the war it was shifted to a two year crop, three years in some places. Depending on variety, location, and soil we raise 90 to 130 tons of sugar cane per acre, which produces 7 to 15 tons of sugar per acre for a two year crop. This sugar brings about $135 dollars per ton. This tonnage of cane is a thick tangle of vegetation. The cane grows erect for almost a year, as it continues to grow it bends over at the base. This allows the stalk to rest on the ground or on other stalks of cane as it continues to grow. These stalks form a tangled mat of stalks and dead leaves that may be two feet thick at the time of harvest. At the same time the leafy growing portion of the stalk will be sticking up out of the mat of cane ten feet in the air. Some of these individual stalks may be 30 feet long and still growing at the time of harvest. All this makes it very hard to get through a cane field as it is one long, prolonged stumble over and through the cane. It is in this mat of cane that our three species of rats live. Two species are familiar to most people in the pest control field. Rattus norvegicus and Rattus rattus. In the latter species we include both the black rat and the alexandrine rats, their habits seem to be the same in Hawaii. Our third rat is the Polynesian rat, Rattus exlans, locally called the Hawaiian rat. This is a small rat, the average length head to tip of tail is nine inches and the average body weight is 65 grams. It has dark brownish fur like the alexandrine rats, and a grey belly. It is found in Indonesia, on most of the islands of Oceania and in New Zealand. All three rats live in our cane fields and the brushy and forested portions of our islands. The norway and alexandrine rats are found in and around the villages and farms, the Polynesian rat is only found in the fields and waste areas. The actual amount of damage done by rats is small, but destruction they cause is large. The rats gnaw through the rind of the cane stalk and eat the soft juicy and sweet tissues inside. They will hollow out one to several nodes per stalk attacked. The effect to the cane stalk is like ringing a tree. After this attack the stalk above the chewed portion usually dies, and sometimes the lower portion too. If the rat does not eat through the stalk the cane stalk could go on living and producing sugar at a reduced rate. Generally an injured stalk does not last long. Disease and souring organisms get in the injury and kill the stalk. And if this isn't enough, some insects are attracted to the injured stalk and will sometimes bore in and kill it. An injured stalk of cane doesn't have much of a chance. A rat may only gnaw out six inches of a 30 foot stalk and the whole stalk will die. If the rat only destroyed what he ate we could ignore them but they cause the death of too much cane. This dead, dying, and souring cane cause several direct and indirect tosses. First we lose the sugar that the cane would have produced. We harvest all of our cane mechanically so we haul the dead and souring cane to the mill where we have to grind it with our good cane and the bad cane reduces the purity of the sugar juices we squeeze from the cane. Rats reduce our income and run up our overhead.

CONTROLLING YELLOW-BILLED MAGPIES (Pica nuttalli)

The yellow-billed magpie is a little smaller than the American or black-billed magpie, but the difference in size is very slight. The birds look exactly alike, except one has a black beak and the other has a yellow bill and a bit of yellow skin back of the eye.There are concentrated populations in the Los Banos area, Gustine area, and along the course of the Merced River comprising about 19,100 acres. They are occasionally seen in other areas of the County, but only infrequently observed in the southwestern portion of the County. The heaviest populations are in walnut orchards, dairy farms, almond orchards, turkey ranches and areas adjacent to river bottoms.The yellow-billed magpie may represent a dying ancient race. Since scientific interest has been directed toward its habits and distribution, its range has become more restricted. There are reports that 50 or 60 years ago it was common in many places close to the Coast, where the observer would now look for it in vain. It inhabits only the interior of California west of the Sierra Nevada, chiefly in the Sacramento and San Joaquin Valleys. It haunts stock ranches, because food to its liking is usually plentiful in such places. When cattle and sheep are butchered the refuse attracts magpies. They gather about any dead animal. They feed on grasshoppers, worms and grubs, and of course always look for a reasonable supply of eggs.

Extremely slow feeding in a tropical drilling ectoparasite, Vitularia salebrosa (King and Broderip, 1832) (Gastropoda: Muricidae), on molluscan hosts from Pacific Panama

This study documents one of the slowest feeding behaviors ever recorded for a muricid gastropod in one of the most biotically rigorous regions on the planet. In Pacific Panama, Vitularia salebrosa attacks mollusks by drilling through their shells. The duration of attacks estimated by isotope sclerochronology of oyster shells collected during attacks in progress range from 90 to 230 days, while experimental observation of interactions documented one attack greater than 103 days. The prolonged nature of attacks suggests that V. salebrosa is best characterized as an ectoparasite than as a predator, which is the ancestral condition in the Muricidae. An ectoparasitic lifestyle is also evident in the unusual interaction traces of this species, which include foot scars, feeding tunnels and feeding tubes, specialized soft anatomy, and in the formation of male-female Pairs, which is consistent with protandrous hermaphroditism, as is typical in sedentary gastropods. To delay death of its host, V. salebrosa targets renewable resources when feeding, such as blood and digestive glands. A congener, Vitularia miliaris from the Indo-Pacific, has an identical feeding biology The origin and persistence of extremely slow feeding in the tropics challenges our present understanding of selective pressures influencing the evolution of muricid feeding behaviors and morphological adaptations. Previously, it has been suggested that faster feeding is advantageous because it permits predators to spend a greater proportion of time hiding in enemy-free refugia or to take additional prey, the energetic benefits of which could be translated into increased fecundity or defenses. The benefits of exceptionally slow feeding have received little consideration. In the microhabitat preferred by V. salebrosa (beneath boulders), it is possible that prolonged interactions with hosts decrease vulnerability to enemies by reducing the frequency of risky foraging events between feedings . Ectoparasitic feeding through tunnels by V. salebrosa may also reduce competitive interactions with kleptoparasites (e.g., crabs, snails) that steal food through the gaped valves of dead or dying hosts.

Blocking of Connexin-Mediated Communication Promotes Neuroprotection during Acute Degeneration Induced by Mechanical Trauma

Accruing evidence indicates that connexin (Cx) channels in the gap junctions (GJ) are involved in neurodegeneration after injury. However, studies using KO animal models endowed apparently contradictory results in relation to the role of coupling in neuroprotection. We analyzed the role of Cx-mediated communication in a focal lesion induced by mechanical trauma of the retina, a model that allows spatial and temporal definition of the lesion with high reproducibility, permitting visualization of the focus, penumbra and adjacent areas. Cx36 and Cx43 exhibited distinct gene expression and protein levels throughout the neurodegeneration progress. Cx36 was observed close to TUNEL-positive nuclei, revealing the presence of this protein surrounding apoptotic cells. The functional role of cell coupling was assessed employing GJ blockers and openers combined with lactate dehydrogenase (LDH) assay, a direct method for evaluating cell death/viability. Carbenoxolone (CBX), a broad-spectrum GJ blocker, reduced LDH release after 4 hours, whereas quinine, a Cx36-channel specific blocker, decreased LDH release as early as 1 hour after lesion. Furthermore, analysis of dying cell distribution confirmed that the use of GJ blockers reduced apoptosis spread. Accordingly, blockade of GJ communication during neurodegeneration with quinine, but not CBX, caused downregulation of initial and effector caspases. To summarize, we observed specific changes in Cx gene expression and protein distribution during the progress of retinal degeneration, indicating the participation of these elements in acute neurodegeneration processes. More importantly, our results revealed that direct control of GJ channels permeability may take part in reliable neuroprotection strategies aimed to rapid, fast treatment of mechanical trauma in the retina.

Identification of a new translocation that disrupts the RUNX1 gene in a patient with de novo acute myeloid leukemia

Translocation (8;21)(q22;q22)/RUNX1-RUNX1T1 is a molecular marker that is usually associated with a favorable outcome in both pediatric and adult patients with acute myeloid leukemia (AML). The present report describes the results of hematologic, cytogenetic, and fluorescence in situ hybridization analysis of a case of AML with maturation in a 23-year-old woman. Cytogenetic analysis revealed a balanced translocation involving chromosomal band 21q22, which disrupts the RUNX1 gene, and 10q22, with the following karyotype: 45,X,-X,t(10;21)(q24;q22)[cp16]/46,XX [4]. Interphase FISH showed, in 67% of the 300 interphase nuclei analyzed, three signals for RUNX1 and two RUNX1T1, but no signals corresponding to RUNX1-RUNX1T1 fusion gene. These results were corroborated by RT-PCR, which revealed negative results for the amplification of RUNX1-RUNX1T1 fusion gene. The patient was refractory to conventional and salvage chemotherapy regimens and early relapsed after unrelated donor bone marrow transplantation (BMT), dying of pneumonia, acute respiratory failure, and sepsis on day +80 after BMT, 1 year after diagnosis.

ROLAND BARTHES AND THE STRUGGLE BETWEEN GOOD AND EVIL

This article begins at Barthes lecture of Tolstoy's War and Peace, to understand some writing moves observed at the manuscript of his novel "Vita Nova". To reach this purpose, we find an element in Tolstoy's book he intended to develop in his novel: the fight of Good and Evil, developed in the last text by written Barthes before dying.

Cost-effectiveness of conventional and modified supervised toothbrushing in preventing caries in permanent molars among 5-year-old children

The cost-effectiveness of a modified supervised toothbrushing program was compared to a conventional program. A total of 284 five-year-old children presenting at least one permanent molar with emerged/sound occlusal surface participated. In the control group, oral health education and dental plaque dying followed by toothbrushing with fluoride dentifrice was carried outfour times per year. With the test group, children also underwent professional cross-brushing on surfaces of first permanent molar rendered by a dental assistant five times per year. Enamel/dentin caries were recorded on buccal, occlusal and lingual surfaces of permanent molars for a period of 18 months. The incidence density (ID) ratio was estimated using Poisson's regression model. The ID was 50% lower among boys in the test group (p = 0.016). The cost of the modified program was US$ 1.79 per capita. The marginal cost-effectiveness ratio among boys was US$ 6.30 per avoided carie. The modified supervised toothbrushing program was shown to be cost-effective in the case of boys.

Survival Analysis of Patients with Heart Failure: Implications of Time-Varying Regression Effects in Modeling Mortality

Background: Several models have been designed to predict survival of patients with heart failure. These, while available and widely used for both stratifying and deciding upon different treatment options on the individual level, have several limitations. Specifically, some clinical variables that may influence prognosis may have an influence that change over time. Statistical models that include such characteristic may help in evaluating prognosis. The aim of the present study was to analyze and quantify the impact of modeling heart failure survival allowing for covariates with time-varying effects known to be independent predictors of overall mortality in this clinical setting. Methodology: Survival data from an inception cohort of five hundred patients diagnosed with heart failure functional class III and IV between 2002 and 2004 and followed-up to 2006 were analyzed by using the proportional hazards Cox model and variations of the Cox's model and also of the Aalen's additive model. Principal Findings: One-hundred and eighty eight (188) patients died during follow-up. For patients under study, age, serum sodium, hemoglobin, serum creatinine, and left ventricular ejection fraction were significantly associated with mortality. Evidence of time-varying effect was suggested for the last three. Both high hemoglobin and high LV ejection fraction were associated with a reduced risk of dying with a stronger initial effect. High creatinine, associated with an increased risk of dying, also presented an initial stronger effect. The impact of age and sodium were constant over time. Conclusions: The current study points to the importance of evaluating covariates with time-varying effects in heart failure models. The analysis performed suggests that variations of Cox and Aalen models constitute a valuable tool for identifying these variables. The implementation of covariates with time-varying effects into heart failure prognostication models may reduce bias and increase the specificity of such models.

Caspase-mediated cleavage of the exosome subunit PM/Scl-75 during apoptosis

Recent studies have implicated the dying cell as a potential reservoir of modified autoantigens that might initiate and drive systemic autoimmunity in susceptible hosts. A number of subunits of the exosome, a complex of 3'→5' exoribonucleases that functions in a variety of cellular processes, are recognized by the so-called anti-PM/Scl autoantibodies, found predominantly in patients suffering from an overlap syndrome of myositis and scleroderma. Here we show that one of these subunits, PM/Scl-75, is cleaved during apoptosis. PM/Scl-75 cleavage is inhibited by several different caspase inhibitors. The analysis of PM/Scl-75 cleavage by recombinant caspase proteins shows that PM/Scl-75 is efficiently cleaved by caspase-1, to a smaller extent by caspase-8, and relatively inefficiently by caspase-3 and caspase-7. Cleavage of the PM/Scl-75 protein occurs in the C-terminal part of the protein at Asp369 (IILD369↓G), and at least a fraction of the resulting N-terminal fragments of PM/Scl-75 remains associated with the exosome. Finally, the implications of PM/Scl-75 cleavage for exosome function and the generation of anti-PM/Scl-75 autoantibodies are discussed.

Educadores e a morte

A morte interdita e a escancarada convivem no século XXI. Crianças e jovens podem ter a morte no seu cotidiano, pela perda de pessoas significativas, pela violência e pelos meios de comunicação. A morte invade também o contexto escolar, com crianças e jovens enlutados ou mortes que ocorrem nas instituições de educação. O artigo discute como a instituição escolar e os educadores veem a morte e sua implicação neste processo, suas necessidades e dificuldades. São apresentadas propostas para inclusão do tema da morte nas atividades pedagógicas regulares ou em instituições especiais e na formação de educadores.

The design of a syllabus for translation students: learning outcomes in the subjects of spanish language

[EN]In the new design of educational programs in European Higher Education Area (EHEA), what defines a subject it is Learning Outcomes (LO). These LO, as explicit and precise declarations, turn into the center of teaching and learning process. Keeping this change is mind, our research examines the Educational Guides (EG) of Spanish Language (SL) through a list of verbs, according to the graduation of educacionational objectives of Bllom's Taxonomy (2014-2015)