O médico diante da morte na urgência e emergência:reflexões sobre o ser médico

The literature pointed that the way which people deal with death have been changing along centuries, and nowadays what is realized it is that, each time more, the human being have difficulties to deal with death. Due to the fact that the main function of the physician is to save their patients lives; responsibility that is aggravated by the necessity of to take decisions quickly, once he need to deal with the unexpected situations of the urgency and emergency, many times these professional have to face of impotency and fail situations, when he lose a patient. The main goal of this study was to understand the experience of physicians that work in the urgency and emergency, in front of death. These questioning it justified by the fact of the physicians do not have, many times, a space to express their suffering and anguish about the issues related to death in their work routine, despite lifedeath question to be often present their everyday. It is still possible to verify in the literature, an appointment of the necessity of to include in the curriculum of Medicine courses, subjects that approach such questions. The method used was based on the existential-phenomenological perspective, using as instrument the participant observation, to the intent of understand the routine in the urgency and emergency context, and semi-structured interview. It was interviewed six physicians that work in the urgency and emergency of the most important hospital of public health system of Natal-RN. The results showed that the physicians reported pleasure in work in the urgency and emergency, despite of they presented stress and the difficulties that they deal with in the public system. Despite of the fact that the death to be considered as a phenomenon that make part of the physician s routine, sometimes, deals with these one is more difficult. Many times losses generate an impotency and guilty feeling, as well as questionings about their performance during the attempts to save lives. We verified, from this study, the importance of the existence of some kind of intervention in the emergency, in order to the physicians can elaborate the questions about death and die emerged in their work. We consider yet that this study corroborates and reiterates the discussions concerning the importance of this thematic to be approached in a more effective way, during the academic formation of these professionals, as well as, the importance of a larger investment from the part of Government in the urgency and emergency sector, in order to propitiate to these professionals a work that brings less harmful for their health

O oncologista clínico diante da morte: implicações para a produção do cuidado

It is undeniable that all the extraordinary technological advances in contemporary society have increased the severe patients expectation and quality of life, especially cancer patients. On the other hand, it is easily verifiable by many researches that it was not possible to advance in the same proportion in caring for the human experience of death. Much is said about the anguish of a man facing death, of cancer patients in terminal stage, about their families, and very little about the feelings, anxieties and ways of coping with the medical professional who deals with this situation, specifically the clinical oncologist. Little is known about the experience of the doctor who has learned to take death as an enemy to be defeated, and increasingly is compelled to live at length with his advertisement. However, we started to watch in recent years a growing interest of researchers in this issue. This study seeks to add to this interest in order to understand the experience of clinical oncologists that accompany dying patients, the meanings they attach to death, ways of coping and the implications for providing care. This is a qualitative study in which was used as a tool for data collection an in-depth interview with the projective using script and scenes. Gadameriana Hermeneutics was used for analysis and interpretation of narratives. The subjects were 10 clinical oncologists who work at two institutions from cancer treatments in the state of Rio Grande do Norte, chosen from a variation in the time working in the specialty (minimum of one year, even old ones). However, you can bring some initial results for the dialogue. It was found that the death is still a topic that causes many difficulties in the daily lives of these professionals, the choice for oncology involves dealing with death without preparation in medical education; being close to the patient in the final moment, supporting the family, coping with own pain of loss and the inability to heal. These are central elements of the narratives. We also have investment in medical training and continuing education in setting up a demand that permeates the discourse of participants. Being able to listen to the subjective world of clinical oncologists will support the work not only for them as other professionals who deal with patients with advanced cancer, providing evidence to understand to what extent the meanings attributed to its know-how before patients on the verge of death interfere with the production of care and allow identify coping strategies in everyday life of these professionals that hinder or facilitate coping with death, promote or preclude the care with others and with themselves. It is hoped that research can contribute to the field of knowledge about the know-how in clinical oncology and their terminal-care-death oncologist-patient relationships, bringing runways capable of promoting a better quality of care in the production of all involved in this process: professionals, patients and families

Os agentes funerários e a morte: o cuidado presente diante da vida ausente

The present time is marked by the art of escape from death, which has become synonymous with failure, its exposure has become intolerable and the care of the dead body were assigned to third parties who market this practice through services and products that shape the market undertaker. In this context, in which death is an object of study, has arisen funeral officers, as professionals dealing with a dead body, with the pain of relatives and their reactions, often being the first to have contact with the death scene. As professionals in the health area, the morticians also deal with death. The first attempt to prevent the arrival of death, funeral officers already has begun their work routine from there. Death and its surrounding part of their profession. What about those professionals whose work demands as a feared and denied by society? This study aims to understand the intents, meanings and implications for the mortician to deal with death in their daily work in order to focus renewed attention to the care of these professionals. To this end, it was carried out a qualitative research grounded in the theoretical framework of Gadamerian hermeneutics for production and interpretation of narratives. It was used two methodological strategies for data collection: in-depth interview with script and workshop with the use of "scenes". Research participants were nine morticians funeral of two funeral agencies of the city of Natal. It was possible to detect the presence of the social imaginary of interdiction on the theme of death from living with feelings of his presence daily, from the need of respondents to naturalize their contacts with death, a requirement of their office to deal with the difficulties of manipulating body fluids and odors, sometimes in a state of decomposition; allied to wishes to achieve the goal of delivering to family-customers a "embellished" body for the final farewell. Being a mortician, in addition to not being a professional motivation, involves facing difficulties related to heavy routine work, low salaries, unprofitable work materials and equipments, besides having to deal with the social gaze that devalues the profession. In turn, they also deal with the pain coming especially from contact with family members, either when they are targets of these feelings of anger, whether they identify with the pain of the bereaved ones. On the other hand, when the recognition and gratitude of the families occur, they find meaning and beauty in their profession of caring for the dead body. The present study by giving voice to morticians has become possible to understand better their profession, the pain that surrounds and care needs of these workers. Finally, it has argued that the mortician may be recognized as a care professional for the way exercising caution with the dead body and their families.

Cuidados paliativos e ser-para-morte: reflexões sobre um atendimento psicológico

Death is a theme that fascinates, though at the same time, frightens and uneasy the human being, despite the finitude being present at our daily lives. In each historical time, death has been represented in a peculiar way, from familiar death (at Middle Ages), to interdicted death (at contemporary times). Through this path it‟s possible to recognize several attitudes and stages front of death and the process of dying as possibilities of coping and the understanding of these occurrences. In other hand, the palliative care proposal came as a humanized attention, front of the human finitude, recognizing death as a part of the vital cycle. The Brazilian reality, in this context, still faces a lot of political, economic and social barriers that makes difficult the consolidation of palliative care at the death process in the Brazilian Health Care policies. Currently, according to the Brazilian Palliative Care Association, Brazil presents an average of 40 services with this proposal. Such data portray our inexpressive condition in relation to these cares when considering the territorial extension and population of our country. Considering this scenario is relevant think about death and the process of dying at contemporary times, at a health context in which palliative care, when trying to humanize the process of dying, bring to light the issue of human finitude and the beingtowards- death, as thought by the philosopher Martin Heidegger. According to him, the human being (Dasein) is constituted as a being-towards-death, once death is its most own potentiality-for-bein and its last possibility to be lived. In view of the ideas presented, the proposed study appears as a qualitative research of existential-phenomenological inspiration and aims to understand the experience of being-toward-death from the psychological care to a person out of possibilities of cure living on palliative cares. The psychological care happened at the patient‟s home, understanding the clinical process of being-with-the-other from the written reports of the psychology/researcher, by the accompanying sessions, configured as an experience report. These reports are focused on the experiences lived by the patient, as well as apprehended by the psychologist at the intersubjectivity relation and its own experience with Dasein and, therefore, being-toward-death. The reports were hermeneutically interpreted, from the senses that emerged in this process, considering the notion of being-toward-death proposed by Heidegger. Furthermore, it was important to dialogue with other authors that approached the studied theme. It is perceived, through brief and meaningful reflections about the clinical treatments started, that the experience of illness with no possibilities of cure makes the Dasein revises feelings and experiences that were marked at the temporality and historicity of existence. It is a stage of life in which the cultural dimension and the common sense of finitude, often gains ground in the human condition, taken in its ordinary sense, unlike the way it has been thought from an ontological and existential perspective of death. Thus, there are singulars and revealing paths in the palliative care scenery as possible ways for authenticity of being-toward-death

Morte e filosofia: sobre o desejo de imortalidade entre os gregos

Enfoca-se aqui a vinculação íntima entre a exaustiva busca empreendida pelo espírito grego para edificar em terreno sólido as colossais fundações de uma ciência dos primeiros princípios, e o que supõe-se ser sua motivação secreta e última, a aspiração pela eternidade, o mais universal e genuíno desejo presente em todo ser humano, não ser obliterado pelo tempo.

Genética e biologia reprodutiva de vriesea minarum (Bromeliaceae): em busca de estratégias de conservação no quadrilátero ferrífero, minas gerais

Vriesea minarum is a rupiculous bromeliad species, with naturally fragmented populations, restricted to the Iron Quadrangle, Minas Gerais, Brazil. It is a threatened species, which is suffering from habitat loss due to the growth of cities and mining activities. The knowledge of genetic variability in plant populations is one of the main branches of conservation genetics, linking genetic data to conservation strategies while the knowledge about plant reproductive biology can aid in understanding key aspects of their life story, as well as in the comprehension of their distribution and survival strategies. Thus, the study of diversity, richness, and genetic structure, as well as the reproductive biology of populations of V. minarum can contribute to the development of conservation actions. Chapter 1 presents the transferability of 14 microsatellite loci for V. minarum. Among the results of this chapter, we highlight the successful transferability of 10 microsatellite loci described for other species of Bromeliaceae, all of which are polymorphic. In Chapter 2, we present the genetic analyses of 12 populations of V. minarum that are distributed throughout the Iron Quadrangle. We used the 10 microsatellite loci tested in Chapter 1. The results show a low population structuring (Fst = 0.088), but with different values of genetic richness (mean = 2.566) and gene diversity (mean = 0.635) for all populations; and a high inbreeding coefficient (Gis = 0.376). These may be the result of pollinators action and/or efficient seed dispersal, thus allowing a high connectivity among populations of naturally fragmented outcrops. The reproductive biology and floral morphology of a population of V. minarum, located in the Parque Estadual da Serra do Rola-Moça, are studied in Chapter 3. This reserve is the only public environmental protection area where the species occurs. As a result of field experiments and observations, we found that the species has its flowering period from January to March, with flowers that last for two days and that it has a mixed pollination syndrome. It is primarily alogamous, but also has the capacity to be self-ferilized. It is expected that data obtained in chapters 1, 2 and 3 serve as basis for other studies with species from the ferruginous rocky fields, since until now, to our knowledge, there are no other survey of endemic species from the Iron Quadrangle, seeking to merge the genetic knowledge, with the data of the reproductive biology, with the ultimate aim of biodiversity conservation. Considering the great habitat loss for the species by mining, it becomes crucial to analyze the creation of new protected areas for its conservation

Monitorização da pressão intracraniana como exame complementar no diagnóstico de morte encefálica: observação preliminar através do registro de dois casos

Estudou-se retrospectivamente a evolução clínica de dois pacientes, até sua falência cardíaca irreversível (FCI), submetidos à monitorização contínua da pressão intracraniana (PIC). O estudo detalhado desses traçados mostrou que, nos dois casos a PIC atingiu valores máximos 5 e 12 h antes de ocorrer diminuição na amplitude das ondas, observada 47 e 60 h pré-FCI. Essa diminução foi progressiva e tornou-se linear cerca de 30 h antes da FCI, em ambos os casos. O diagnóstico clínico de morte encefálica (ME) foi obtido 3 e 28 hs após a linearidade do traçado. Os autores sugerem que o diagnóstico de ME pode ser definido mais precocemente com o uso da monitorização da PIC desde que o paciente não esteja sob sedação, e salientam a necessidade de mais observações, em número maior de pacientes.

Biologia reprodutiva de populações de Ocimum selloi Benth

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Biologia da reprodução de Mimosa bimucronata: uma espécie ruderal

Com o objetivo de estudar a biologia reprodutiva de Mimosa bimucronata, o presente estudo foi realizado em Botucatu e Cachoeira Paulista, SP, no período de novembro de 2003 a junho de 2005. Determinou-se o número de flores por glomérulo, sua duração, os eventos da antese e outras características florais, como tamanho, formato, coloração, odor, presença de néctar e localização de osmóforos. A receptividade do estigma e a viabilidade do pólen foram avaliadas. Flores foram examinadas e documentadas em microscópio eletrônico de varredura, após tratamento adequado. Foram feitos testes para a determinação do sistema reprodutivo, visando avaliar a dependência dos polinizadores. A presença de visitantes florais foi observada no campo, sendo registrada a quantidade de visitas e o comportamento dos visitantes, além do tempo médio de permanência dos visitantes junto às flores. O padrão de floração de M. bimucronata é anual. Os grãos de pólen encontram-se reunidos em políades compostas por oito células, o que pode ser interpretado como uma adaptação para minimizar o efeito da mistura das cargas de pólen depositadas sobre o diminuto estigma. A formação de frutos em condições naturais foi baixa e não ocorreu agamospermia. A morfologia das flores e das inflorescências permite o acesso aos recursos florais para uma ampla variedade de visitantes (Hymenoptera, Diptera e Coleoptera). A maioria das visitas foi realizada por abelhas (56,4%). Os resultados permitem considerar que, embora M. bimucronata seja dependente de vetores de pólen para sua reprodução, é espécie entomófila generalista e, portanto, bastante adaptada aos ambientes ruderais, onde sua ocorrência é predominante.

Comparação dos padrões de atratividade de Hermetia illucens (Diptera, Stratiomyidae) associada a carcaças de Rattus norvergicus enterradas e tratadas com hormônios esteróides

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Registro de ocorrência de duas espécies de potamotrigonídeos na região do Alto Rio Paraná e algumas considerações sobre sua biologia

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Contribuição para o conhecimento da biologia de Cynoscion jamaicensis (Vaillant & Bocourt, 1883), na área entre Cabo de São Tomé (22º04's) e Torres (29º21'S), Brasil

Este trabalho baseia-se na análise de dados obtidos de 1891 exemplares de Cynoscion jamaicensis coletados durante quatro cruzeiros oceanográficos realizados por intermédio do N/Oc. Prof. W. Besnard, na área entre Cabo de Sao Tomé (22º04'S) e Torres (29º30'S), até a isóbata de 200 m, dentro do programa FAUNEC. A espécie distribui-se ao longo da plataforma continental, preferencialmente na região banhada pela agua costeira, com temperaturas entre 27ºC e 18ºC. Ocorrem concentrações de jovens e adultos, indiscriminadamente da distância da costa; os jovens ocorreram, em fevereiro-março, entre 22ºS e 27ºS e, nos demais períodos, entre 23º20'S e 27º30'S, enquanto os adultos distribulram-se, em fevereiro-março e maio, entre 26ºS e 27º30'S e, em setembro e novembro, entre 23ºS e 29º30'S. A desova ocorre entre as latitudes 24º30'S e 26º30'S, durante o fim do inverno-primavera (setembro-novembro). Concordando com o ciclo reprodutivo, o fator de condição mostrou variações cíclicas, com valor mais baixo durante setembro, período de desova. O pico de recrutamento verificou-se em maio, quando ocorreram indivíduos com comprimento total entre 70 e 90 mm, provenientes da desova do ano anterior, que ainda nao completaram um ano de idade. 0 comprimento médio de início da primeira maturação sexual é de 154 mm, sendo que aos 200 mm todos os indivíduos estão aptos para a reprodução. A relação peso total/comprimento total apresentou diferenças estatisticamente significativas entre sexos, com α = 3,25 para machos e 3,10 para fêmeas.

Biologia populacional de Cyphocarax modestus (Osteichthyes, Curimatidae) no córrego Ribeirão Claro, município de Rio Claro (SP)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Biologia populacional de Corydoras flaveolus (Siluriformes, Callichthyidae) no Rio Passa Cinco, sub-bacia do Rio Corumbataí, São Paulo, Brasil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The opportunistic feeding and reproduction strategies of the annual fish Cynopoecilus melanotaenia (Cyprinodontiformes: Rivulidae) inhabiting ephemeral habitats on southern Brazil

A maioria dos peixes da família Rivulidae são popularmente conhecidos como anuais por completarem todo seu ciclo biológico em pequenos corpos de água temporários que secam obrigatoriamente em determinados períodos do ano causando a morte dos indivíduos adultos. Possuem características biológicas peculiares como pequeno porte, maturação sexual precoce, reprodução contínua, um elaborado padrão de corte e uma grande capacidade reprodutiva entre os peixes. Os rivulídeos se encontram amplamente distribuídos nas Américas do Norte, Central e Sul. Este trabalho analisou a dieta e a biologia reprodutiva de Cynopoecilus melanotaenia. Foram coletados 263 exemplares e a análise de 233 conteúdos gastrointestinais revelou uma dieta invertívora composta principalmente por microcrustáceos (Cladocera, Amphipoda e Ostracoda) e insetos imaturos (Chaoboridae, Culicidae, Syrphidae, mas principalmente larvas de Chironomidae). Foi registrada a lepidofagia na dieta dos machos. A fecundidade foi estimada pela análise de 59 pares de ovários maduros e variou entre 2 a 157 ovócitos (média, 19 ± 26[DP]). A espécie apresentou desova parcelada, uma estratégia para aumentar a chance de sobrevivência a depleções prolongadas. Este trabalho apresenta a primeira investigação sobre a biologia reprodutiva de C. melanotaenia. Os resultados encontrados sugerem a estratégia reprodutiva oportunista de C. melanotaenia e fornecem novas informações biológicas que podem contribuir para pesquisas de conservação e manutenção da espécie em seu ambiente natural.