A gravidez na adolescência sob a perspectiva dos familiares: compartilhando projetos de vida e cuidado

Estudo qualitativo, que objetivou apreender o significado da gravidez da adolescente para seus familiares. Empregou-se a entrevista semi-estruturada e discurso do sujeito coletivo. A gravidez da adolescente é representada como problema a ser enfrentado com o suporte familiar. As famílias preocupam-se e se mobilizam para resolver as adversidades. Além do choque pela notícia, impotência quanto à prevenção da gravidez, conformismo, alegria e melhora no relacionamento familiar pela chegada do bebê, evidenciou-se a frustração devido à interrupção/mudança no projeto de vida familiar em relação à adolescente sem um relacionamento estável com o pai da criança. Considera-se que, ao se valorizar a perspectiva dos familiares sobre a gestação na adolescência, o cuidado profissional à adolescente grávida e à família pode se dar em parceria e sintonia com o contexto familiar e social, facilitando o enfrentamento de conflitos e reconhecendo a família como sujeito ativo nesse processo.

O conceito de Educação em Hegel

A educação sempre mereceu atenção por parte dos filósofos. Basta citar o exemplo de Sócrates ensinando em praça pública. Sua atividade era um convite ao saber. O filósofo alemão G. W. F. Hegel ( 1770 - 1834 ) também não ficou indiferente a essa questão muito embora não tenha se manifestado detidamente sobre ela em sua obra. No entanto, Hegel sempre ocupou cargos ou desempenhou funções relacionadas à educação. Por isso é possível apontar essa preocupação em sua filosofia e sugerir as possíveis contribuições. Para Hegel não há sociedade que se sustente sem a educação, pois ela é expressão da razão que busca estabelecer a liberdade e implantá-la enquanto prática corrente. Disso deriva a concepção hegeliana de homem que se caracteriza pela construção de si com seus semelhantes através da história. Esse homem é responsável pelo seu destino e por sua felicidade que não se identifica de forma absoluta com qualquer estrutura material. Nesse sentido Hegel atribui centralidade ao conteúdo e não aos métodos e técnicas. O conteúdo deve ser ministrado enquanto direito e também necessidade, pois é por ele que o homem aprende a ser livre, isto é, racional. A liberdade como fim da educação somente se realiza na totalidade da comunidade o que implica a superação de posicionamentos individualistas.

REVERSIBILITY OF ADENOMATOUS HYPERPLASIA IN THE GASTRIC STUMP AFTER DIVERSION OF BILE REFLUX IN RATS

Morphological and phenotypical patterns of proliferative epithelial lesions induced in the gastric stump mucosa by duodenal content reflux after Billroth II partial gastrectomy (BII) were evaluated in rats. Control animals were either sham-operated or submitted at different times after BII to Roux-en-Y (RY) surgical procedure which prevents duodenal reflux. The lesions were analysed using routine haematoxylin and eosin staining, immunohistochemical staining for pepsinogen isoenzyme 1 and histochemical procedures for mucins (paradoxical Concanavalin A, galactose oxidase Schiff and sialidase galactose oxidase Schiff reactions). Mucosal hyperplasia (H) was observed in the group submitted to BII procedure 6 weeks after surgery. Adenomatous hyperplasia (AH) also appeared 6 weeks after induction of the reflux and its incidence and size increased until the 54th week of the experiment. RY procedure performed in the normal animals at the beginning of the experiment or at the 24th week after BII gastrectomy led to a significantly lower incidence of AH which was related to the moment of surgery. Most of H was due to pyloric mucosal hyperplasia. AH consisted mainly of gastric type glands but in some animals glands of the intestinal type Were present probably originating from the intestinal mucosa. Six mucinous adenocarcinomas were observed, all of them of intestinal type. This study demonstrates that AH induced by BII procedure is a reversible lesion and that the anomalous epithelial proliferation in the stoma may lead to adenocarcinomas.

DEVELOPMENT OF BLOOD-PRESSURE AND CARDIAC REFLEXES IN THE FROG PSEUDIS-PARADOXSUS

Systemic arterial blood pressure and heart rate (f(H)) were measured in unanesthetized, unrestrained larvae and adults of the paradoxical frog, Pseudis paradoxus from São Paulo State in Brazil. Four developmental groups were used, representing the complete transition from aquatic larvae to primarily air-breathing adults. f(H) (49-66 beats/min) was not significantly affected by development, whereas mean arterial blood pressure was strongly affected, being lowest in the stage 37-39 larvae (10 mmHg), intermediate in the stage 44-45 larvae (18 mmHg), and highest in the juveniles and adults (31 and 30 mmHg, respectively). Blood pressure was not significantly correlated with body mass, which was greatest in the youngest larvae and smallest in the juveniles. In the youngest larvae studied (stages 37-39), lung ventilation was infrequent, causing a slight decrease in arterial blood pressure but no change in heart rate. Lung ventilation was more frequent in stages 44-45 larvae and nearly continuous in juveniles and adults floating at the surface. Bradycardia during both forced and voluntary diving was observed in almost every advanced larva, juvenile, and adult but in only one of four young larvae. Developmentally related changes in blood pressure were not complete until metamorphosis, whereas diving bradycardia was present at an earlier stage.

Condições associadas ao grau de satisfação com a vida entre a população de idosos

OBJECTIVE: As a result of overall growing population's life expectancy, it has become increasingly important to ensure not only that the elderly have greater longevity but also happiness and life satisfaction. The objective of the study was to describe factors associated with life satisfaction among elderly people.METHODS: Three hundred and sixty-five older persons, selected by means of random stratified proportional sampling, were interviewed in 2003. The instrument used was a combination of Flanagan and Nahas questionnaires and WHOQOL-100. There were added questions concerning physical activity extracted from International Physical Activity Questionnaire, questions regarding reported morbidity and emotional assessment, sociodemographic condition and an open question. The level of life satisfaction was measured using a scale from one to seven by means of visual recognition. Hierarchical logistic regression analysis was performed including life satisfaction as a dependent variable and those included the final questionnaire, in blocks, as independent variables.RESULTS: Most elderly were generally rather satisfied with life as well as with specific aspects. The level of life satisfaction was associated with: comfort at home (OR=11.82; 95% Cl: 3.27; 42.63); appraising leisure as quality of life (OR=3.82; 95% Cl: 2.28; 6.39); waking up feeling well in the morning (OR=2.80; 95% Cl: 1.47; 5.36); not reporting loneliness (OR=2.68; 95% Cl: 1.54; 4.65); having three or more daily meals (OR=2.63; 95% Cl: 1.75; 5.90) and not reporting Diabetes Mellitus (OR-2.63; 95% Cl: 1.3 1; 5.27).CONCLUSIONS: Most elderly in the study were satisfied with life and their satisfaction was associated with situations related to being well and not being diabetic.

REDUCTION OF CELL PROLIFERATIVE ACTIVITIES OF GASTRIC STUMP ADENOMATOUS HYPERPLASIAS AFTER BILE REFLUX DIVERSION IN RATS

Previously we reported the majority of lesions induced hy bile reflux, in the absence of chemical carcinogens, in the rat remnant stomach to consist primarily of gastric type and secondarily of intestinal type cells, and that they are reversible after diversion of bile reflux. The present study was designed to evaluate changes in proliferative activities in cells of each type under these conditions. The frequency of adenomatous hyperplasia (AH) induced in the gastric stump mucosa by duodenal content reflux after Billroth II partial gastrectomy (BII) increased until the 54th week of the experiment. Roux-en-Y (RY) surgical procedure which prevents duodenal reflux performed at the 24th or 36th week after BII led to a decrease in AH. Cell content of the lesions was analyzed using routine H&E staining, immunohistochemical staining for pepsinogen isoenzyme 1 and histochemical procedures for mucins (paradoxical concanavalin A, galactose oxidase Schiff and sialidase galactose oxidase Schiff reactions) and proliferation in each compartment evaluated by an immunohistochemical method using bromodeoxyuridine (BrdU) and a monoclonal antibody against BrdU. At the 54th week the number of BrdU-labeled cells per normal pyloric column was significantly (P < 0.05) increased to 10.63/pit after the BII operation, while it diminished to 5.23/pit after RY diversion, this being the same level as with the RY procedure alone. AH maintained a high rate of BrdU incorporation at 12.7% after BII operation, which was also significantly reduced (P < 0.01) to 7.0% by the RY surgery. The intestinal type cell showed highest (22.2%), the surface mucous type cell showed the next (16.5%) and the pyloric gland type cell showed lowest (5.2%) BrdU labeling indices after BII operation. All the cell types in AH showed similar proportional decreases in BrdU incorporation after RY diversion. Thus surgical intervention reverses the cell proliferation caused by bile reflux in the gastric stump.

Response to Treatment in a Prospective Cohort of Patients with Large Ulcerated Lesions Suspected to Be Buruli Ulcer (Mycobacterium ulcerans Disease)

Background: The World Health Organization (WHO) advises treatment of Mycobacterium ulcerans disease, also called Buruli ulcer'' (BU), with a combination of the antibiotics rifampicin and streptomycin (R+S), whether followed by surgery or not. In endemic areas, a clinical case definition is recommended. We evaluated the effectiveness of this strategy in a series of patients with large ulcers of >= 10 cm in longest diameter in a rural health zone of the Democratic Republic of Congo (DRC).Methods: A cohort of 92 patients with large ulcerated lesions suspected to be BU was enrolled between October 2006 and September 2007 and treated according to WHO recommendations. The following microbiologic data were obtained: Ziehl-Neelsen (ZN) stained smear, culture and PCR. Histopathology was performed on a sub-sample. Directly observed treatment with R+S was administered daily for 12 weeks and surgery was performed after 4 weeks. Patients were followed up for two years after treatment.Findings: Out of 92 treated patients, 61 tested positive for M. ulcerans by PCR. PCR negative patients had better clinical improvement than PCR positive patients after 4 weeks of antibiotics (54.8% versus 14.8%). For PCR positive patients, the outcome after 4 weeks of antibiotic treatment was related to the ZN positivity at the start. Deterioration of the ulcers was observed in 87.8% (36/41) of the ZN positive and in 12.2% (5/41) of the ZN negative patients. Deterioration due to paradoxical reaction seemed unlikely. After surgery and an additional 8 weeks of antibiotics, 98.4% of PCR positive patients and 83.3% of PCR negative patients were considered cured. The overall recurrence rate was very low (1.1%).Interpretation: Positive predictive value of the WHO clinical case definition was low. Low relapse rate confirms the efficacy of antibiotics. However, the need for and the best time for surgery for large Buruli ulcers requires clarification. We recommend confirmation by ZN stain at the rural health centers, since surgical intervention without delay may be necessary on the ZN positive cases to avoid progression of the disease. PCR negative patients were most likely not BU cases. Correct diagnosis and specific management of these non-BU ulcers cases are urgently needed.

Anormalidade pupilar rara na sinusopatia maxilar

Sinusitis can affect adjacent tissues, including those of the nervous system. In this report we describe a case of maxillary sinusopathy causing a rare pupillary abnormality with paradoxical reaction to light. As far as we know, this is the first time that this association has been described.

Compreendendo o significado da gestação para grávidas diabéticas.

This qualitative study intends to understand the meaning of pregnancy for diabetic women. Semi-structured interviews were carried out and data were analyzed by means of the Collective Subject Discourse, identifying the following central ideas: happiness about a desired pregnancy, preoccupation with pregnancy and renouncement, my pregnancy was planned, I had other plans, I feel what pregnant women feel, I had many problems during pregnancy, a child was everything that he wanted, he didn't feel the same emotions as a woman, I am controlling, doing everything the doctor says, I am trying to follow a diet, but it is hard. These central ideas demonstrate that, among the diabetic pregnant women, planning and wanting the pregnancy and counting on the support of the family and/or companion were also essential for the treatment to be faced naturally and for the pregnancy to be experienced in a pleasant way.

Prosthetic rehabilitation of a bone defect with a teeth-implant supported, removable partial denture

The use of teeth-implant, mucosa-supported removable dentures for rehabilitation of partially edentulous patients involves highly complex biomechanical aspects. This type of prosthesis associates 3 kinds of support that react differently to the functional and parafunctional forces developed in the oral cavity. Although the construction of removable partial dentures may seem paradoxical when osseointegrated implants are placed, in some cases, this option is an excellent alternative to solve difficulties related to the anatomic, biologic, psychomotor, and financial conditions of the patient. This article reports on a case in which a teeth-implant, mucosa-supported removable partial denture was the option of choice for a patient with financial and anatomic limitations, having a large structural loss of the residual alveolar ridge caused by trauma by a gunshot injury at the mandible. The 5-year follow-up did not reveal any type of biomechanical or functional problem. Copyright © 2006 by Lippincott Williams and Wilkins.

From hard-peg to hard landing?: recent experiences of Argentina and Ecuador

Includes bibliography

Aparecimento de psoríase durante o tratamento das doenças inflamatórias intestinais com infliximabe: A terapia biológica deve ser suspensa?

Context - Several paradoxical cases of infliximab-induced or-exacerbated psoriatic lesions have been described in the recent years. There is disagreement regarding the need to discontinue infliximab in order to achieve the resolution of these adverse cutaneous reactions specifically in inflammatory bowel disease (IBD) patients. Objective - To systematically review the literature to collect information on IBD patients that showed this adverse cutaneous reaction, focusing mainly on the therapeutic approach. Methods - A systematic literature review was performed utilizing Medline, Embase, SciELO and Lilacs databases. Published studies were identified, reviewed and the data were extracted. Results - Thirty-four studies (69 IBD patients) met inclusion criteria for review. There was inconsistency in reporting of some clinical and therapeutic aspects. Most patients included had Crohn's disease (89.86%), was female (47.83%), had an average age of 27.11 years, and no reported history of psoriasis (84.05%). The patients developed primarily plaque-type psoriasis (40.58%). There was complete remission of psoriatic lesions in 86.96% of IBD patients, existing differences in the therapeutic approaches; cessation of infliximab therapy led to resolution in 47.83% of cases and 43.48% of patients were able to continue infliximab therapy. Conclusion - As increasing numbers of IBD patients with psoriasis induced or exacerbated by infliximab, physicians should be aware of its clinical manifestations so that appropriate diagnosis and treatment are properly established. The decision whether to continue or discontinue infliximab should be individualized.

Induction or exacerbation of psoriatic lesions during anti-TNF-α therapy for inflammatory bowel disease: A systematic literature review based on 222 cases

Background: Paradoxical cases of psoriatic lesions induced or exacerbated by anti-tumor necrosis factor (TNF)-α therapy have been reported more frequently in recent years, but data related to inflammatory bowel disease (IBD) are rare. A systematic literature review was performed to provide information about this adverse effect in patients with IBD who receive anti-TNF therapy. Methods: Published studies were identified by a search of Medline, Embase, Cochrane, SciELO, and LILACS databases. Results: A total of 47 studies (222 patients) fulfilled the inclusion criteria and were selected for analysis. Clinical and therapeutic aspects varied considerably among these reports. Of the 222 patients, 78.38% were diagnosed with Crohn's disease, and 48.20% were female. The mean patient age was 26.50. years, and 70.72% of patients had no history of psoriasis. Patients developed psoriasiform lesions (55.86%) more often than other types of psoriatic lesions, and infliximab was the anti-TNF-α therapy that caused the cutaneous reaction in most patients (69.37%). Complete remission of cutaneous lesions was observed in 63.96% of the cases. Conclusions: We found that psoriatic lesions occurred predominantly in adult patients with Crohn's disease who received infliximab and had no previous history of psoriasis. Most patients can be managed conservatively without discontinuing anti-TNF-α therapy. © 2012 European Crohn's and Colitis Organisation.

Qualidade de vida em gestantes com cardiopatia

The objective of this cross-sectional, descriptive and exploratory study was to describe the perceptions of pregnant women with heart disease concerning their quality of life. Ferrans and Powers Quality of Life Index was applied to 42 patients from the second trimester of pregnancy on, between January 2008 and March 2009. Descriptive statistics, analysis of variance and Student's t test were used. The Quality of Life Index median total score was relatively high (23.9), while the socioeconomic domain was the most compromised (22.9). An association between unplanned pregnancies and the socioeconomic domain was observed (p=0.065). These patients' quality of life can be regarded as good, but unplanned pregnancies contributed to worsening scores in the socioeconomic domain. High-risk pregnancies did not affect quality of life because a pregnancy is linked to meanings such as happiness, satisfaction and personal fulfillment.

Análise funcional dos evidenciais e modalizadores no discurso da autoajuda da saúde

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)