Usual clinical practice for early supported discharge after stroke with continued rehabilitation at home : an observational comparative study

Introduction: Based on randomised controlled trials, evidence exists that early supported discharge (ESD) from the hospital with continued rehabilitation at home has beneficial effects after stroke; however, the effects of ESD service in regular clinical practice have not been investigated. The purpose of the current study was to compare ESD service with conventional rehabilitation in terms of patient outcomes, caregiver burden at 3 and 12 months and the use and costs of healthcare during the first year after stroke. Material and methods: This study was a subgroup analysis of a longitudinal observational study of patients who received care in the stroke unit at Karolinska University Hospital in Sweden. Patients who met the inclusion criteria for ESD in previous experimental studies were included. The patients were referred to available rehabilitation services at discharge, and comparisons between those who received ESD service (the ESD group, n = 40) and those who received conventional rehabilitation (the NoESD group, n = 110) were performed with regard to independence in activities of daily living (ADL), the frequency of social activities, life satisfaction, and caregiver burden and the use and costs of healthcare during the first year after stroke. Results: At 3 and 12 months, no differences were observed with regard to patient outcomes; however, ESD was associated with a lower caregiver burden (p = 0.01) at 12 months. The initial length of stay (LOS) at the hospital was 8 days for the ESD group and 15 days for the NoESD group (p = 0.02). The median number of outpatient rehabilitation contacts was 20.5 for the ESD group (81% constituting ESD service) and 3 for the NoESD group (p<0.001). There was no difference between the groups with regard to overall healthcare costs. Conclusions: ESD service in usual clinical practice renders similar health benefits as conventional rehabilitation but a different pattern of resource use and with released capacity in acute stroke care.

What determines the use of capital budgeting methods? : Evidence from Swedish listed companies

Purpose: This paper aims to extend and contribute to prior research on the association between company characteristics and choice of capital budgeting methods (CBMs). Design/methodology/approach: A multivariate regression analysis on questionnaire data from 2005 and 2008 is used to study which factors determine the choice of CBMs in Swedish listed companies. Findings: Our results supported hypotheses that Swedish listed companies have become more sophisticated over the years (or at least less unsophisticated) which indicates a closing of the theory-practice gap; that companies with greater leverage used payback more often; and that companies with stricter debt targets and less management ownership employed accounting rate of return more frequent. Moreover, larger companies used CBMs more often. Originality/value: The paper contributes to prior research within this field by being the first Swedish study to examine the association between use of CBMs and as many as twelve independent variables, including changes over time, by using multivariate regression analysis. The results are compared to a US and a continental European study.

Medical treatment and the good death: an ethical analysis of euthanasia, physician assisted suicide, and the right to die

Frequent advances in medical technologies have brought fonh many innovative treatments that allow medical teams to treal many patients with grave illness and serious trauma who would have died only a few years earlier. These changes have given some patients a second chance at life, but for others. these new treatments have merely prolonged their dying. Instead of dying relatively painlessly, these unfortunate patients often suffer from painful tenninal illnesses or exist in a comatose state that robs them of their dignity, since they cannot survive without advanced and often dehumanizing forms of treatment. Due to many of these concerns, euthanasia has become a central issue in medical ethics. Additionally, the debate is impacted by those who believe that patients have the right make choices about the method and timing of their deaths. Euthanasia is defined as a deliberate act by a physician to hasten the death of a patient, whether through active methods such as an injection of morphine, or through the withdrawal of advanced forms of medical care, for reasons of mercy because of a medical condition that they have. This study explores the question of whether euthanasia is an ethical practice and, as determined by ethical theories and professional codes of ethics, whether the physician is allowed to provide the means to give the patient a path to a "good death," rather than one filled with physical and mental suffering. The paper also asks if there is a relevant moral difference between the active and passive forms of euthanasia and seeks to define requirements to ensure fully voluntary decision making through an evaluation of the factors necessary to produce fully informed consent. Additionally, the proper treatments for patients who suffer from painful terminal illnesses, those who exist in persistent vegetative states and infants born with many diverse medical problems are examined. The ultimate conclusions that are reached in the paper are that euthanasia is an ethical practice in certain specific circumstances for patients who have a very low quality of life due to pain, illness or serious mental deficits as a result of irreversible coma, persistent vegetative state or end-stage clinical dementia. This is defended by the fact that the rights of the patient to determine his or her own fate and to autonomously decide the way that he or she dies are paramount to all other factors in decisions of life and death. There are also circumstances where decisions can be made by health care teams in conjunction with the family to hasten the deaths of incompetent patients when continued existence is clearly not in their best interest, as is the case of infants who are born with serious physical anomalies, who are either 'born dying' or have no prospect for a life that is of a reasonable quality. I have rejected the distinction between active and passive methods of euthanasia and have instead chosen to focus on the intentions of the treating physician and the voluntary nature of the patient's request. When applied in equivalent circumstances, active and passive methods of euthanasia produce the same effects, and if the choice to hasten the death of the patient is ethical, then the use of either method can be accepted. The use of active methods of euthanasia and active forms of withdrawal of life support, such as the removal of a respirator are both conscious decisions to end the life of the patient and both bring death within a short period of time. It is false to maintain a distinction that believes that one is active killing. whereas the other form only allows nature to take it's course. Both are conscious choices to hasten the patient's death and should be evaluated as such. Additionally, through an examination of the Hippocratic Oath, and statements made by the American Medical Association and the American College of physicians, it can be shown that the ideals that the medical profession maintains and the respect for the interests of the patient that it holds allows the physician to give aid to patients who wish to choose death as an alternative to continued suffering. The physician is also allowed to and in some circumstances, is morally required, to help dying patients whether through active or passive forms of euthanasia or through assisted suicide. Euthanasia is a difficult topic to think about, but in the end, we should support the choice that respects the patient's autonomous choice or clear best interest and the respect that we have for their dignity and personal worth.

Princípio republicano, cargo em comissão e clientelismo político nos municípios do estado do Rio de Janeiro: reflexões sobre a profissionalização da função pública no Brasil

A origem do comportamento orientado para a conquista de cargos públicos no Brasil remonta à formação dos primeiros povoados e vilas durante o período colonial. O nepotismo e o clientelismo político perpassam toda a história do País. Tendo como fio condutor o princípio republicano, buscou-se verificar até que ponto são os cargos em comissão utilizados no âmbito dos Municípios do Estado do Rio de Janeiro como estratégia para manter e atualizar práticas clientelísticas como o empreguismo e o nepotismo. A utilização de métodos e técnicas de análise documental e de conteúdo, em dispositivos legais produzidos pelos municípios estudados e em Relatórios de Inspeções Ordinárias neles realizadas pelo Tribunal de Contas do Estado do Rio de Janeiro, permitiu não só o proceder de uma análise qualitativa como o uso de técnicas quantitativas e representações gráficas dos achados, possibilitando uma leitura mais amena àqueles que têm pouco contato com a matéria. Essa complementaridade de métodos permitiu depreender que as ações empreendidas pelos gestores públicos, no que tange à utilização da livre nomeação, encontram-se na contramão da prática da cidadania, do igualitarismo, do respeito ao servir público. A pesquisa atestou que a quase totalidade dos municípios estudados se utiliza dos cargos em comissão de forma totalmente avessa à prevista constitucionalmente, servindo tais cargos, na verdade, para dar ingresso no serviço público a pessoas das relações do administrador, não para assessorá-lo, mas para aumentar renda familiar, cumprir compromissos de campanha e, até mesmo, para, em troca de votos, exercerem funções que por suas características deveriam ser oferecidas em concurso a toda sociedade. O estudo sugere, ao fim, um conjunto de medidas, baseadas em critérios fundamentados em princípios científicos de gestão, visando à valorização do servidor público, à redução do grau de politização da direção da administração pública e da apropriação patrimonialista dos postos de trabalho, à aceleração da profissionalização das funções públicas e a restringir o livre provimento de cargos em comissão, bem como a impingir sanções, por improbidade administrativa, aos que as desrespeitarem. Em que pese à importância de medidas preventivas, orientadas para o desenvolvimento de uma postura no sentido de um autêntico servir público, a tendência à permissividade precisa ser urgentemente afastada.

The art of being together: a social constructionist perspective on dialogic methods in the organizational context

The purpose of this project is to understand, under a social constructionist approach, what are the meanings that external facilitators and organizational members (sponsors) working with dialogic methods place on themselves and their work. Dialogic methods, with the objective of engaging groups in flows of conversations to envisage and co-create their own future, are growing fast within organizations as a means to achieve collective change. Sharing constructionist ideas about the possibility of multiple realities and language as constitutive of such realities, dialogue has turned into a promising way for transformation, especially in a macro context of constant change and increasing complexity, where traditional structures, relationships and forms of work are questioned. Research on the topic has mostly focused on specific methods or applications, with few attempts to study it in a broader sense. Also, despite the fact that dialogic methods work on the assumption that realities are socially constructed, few studies approach the topic from a social constructionist perspective, as a research methodology per se. Thus, while most existing research aims at explaining whether or how particular methods meet particular results, my intention is to explore the meanings sustaining these new forms of organizational practice. Data was collected through semi-structured interviews with 25 people working with dialogic methods: 11 facilitators and 14 sponsors, from 8 different organizations in Brazil. Firstly, the research findings indicate several contextual elements that seem to sustain the choices for dialogic methods. Within this context, there does not seem to be a clear or specific demand for dialogic methods, but a set of different motivations, objectives and focuses, bringing about several contrasts in the way participants name, describe and explain their experiences with such methods, including tensions on power relations, knowledge creation, identity and communication. Secondly, some central ideas or images were identified within such contrasts, pointing at both directions: dialogic methods as opportunities for the creation of new organizational realities (with images of a ‘door’ or a ‘flow’, for instance, which suggest that dialogic methods may open up the access to other perspectives and the creation of new realities); and dialogic methods as new instrumental mechanisms that seem to reproduce the traditional and non-dialogical forms of work and relationship. The individualistic tradition and its tendency for rational schematism - pointed out by social constructionist scholars as strong traditions in our Western Culture - could be observed in some participants’ accounts with the image of dialogic methods as a ‘gym’, for instance, in which dialogical – and idealized –‘abilities’ could be taught and trained, turning dialogue into a tool, rather than a means for transformation. As a conclusion, I discuss what the implications of such taken-for-granted assumptions may be, and offer some insights into dialogue (and dialogic methods) as ‘the art of being together’.

Avaliação do cuidado na estratégia saúde da família em metrópoles do nordeste brasileiro

Objective: To evaluate the implementation of the Family Health Strategy (FHS) in Brazilian cities of the Northeast, expanding coverage, analyzing the progress, challenges and innovations. Methods: Multicentric Evaluation Research, Studies Baselines in urban centers, using as a case study method. Selected cases of Aracaju, being capital, advanced coverage with extended team, and Fortaleza, capital coverage incipient and minimal staff. In Fortaleza, purposive sample of 11 Units Primary (APS), 03 managers, 53 professionals and 109 users. In Aracaju, 09 units of APS, 02 managers, 36 professionals, and 90 users. Structured interviews for managers, and structured to professionals and users. Descriptive analysis focusing on the political and institutional dimensions, organization and comprehensive care. Results: There was consensus that the ESF is the preferred port users and acts as inducing changes in care. In the case of Fortaleza, the specificities were: care protocols and community activities aimed at chronic conditions (100%) , with greater participation of doctors and nurses (93%) ; conjunction with more complex services, but the teams reported difficulties with the examination center and experts, the long waits and poor access to local services were the main difficulties reported by users., As innovative practice, the therapeutic group of elderly caregivers mentioned by respondents; There was intersectoral initiatives and teams 87 % of users have participated in meetings about health problems. In the case of Aracaju, care protocols were directed to the lines of care and formulated locally, 85 % coverage of the population with FHS counterpart local financing; employees hired by public tender; 70 % of teams with expertise in public health center for continuing education acting; democratization in management; access technologies, welcoming and computerization in different integrated networks, and evaluation matrix. Conclusions: The ESF has promoted access to health care and inclusion of disadvantaged populations. Different perceptions and practices in the organization of care, with distinct trajectories of reorganization. In the case of Fortaleza, predominance of model programs valuing older, with evidence of advances in care practices and teamwork, but restricted to primary care practices and incipient in public policy perspective. In Aracaju, had network integration with technologies related to the family, in which the ESF is consolidated as public policy. It can be argued that the XII APS expanding coverage, exhibited efficacy, despite the challenges inherent to the different degrees of implementation

Praxiologia, representação social de menopausa e práticas educativas de enfermeiras na estratégia saúde da família

This research, whose theme is related to climacteric, aims to know the social representation of menopause developed by the nurses working for Estratégia Saúde da Família (Family Health Strategy) in João Pessoa PB, as well as identifying its structure and verifying the way it interferes with the assistance and educational practices to the climacterial user. In the theoretical level, it is based on a model that articulates the social representations theory, the central nucleus complementary theory and the central concepts of Pierre Bourdieu s praxiology: habitus, cultural capital, social field and symbolic power. A hundred and forty-seven female nurses who work for Estratégia Saúde da Família (Family Health Strategy) in João Pessoa (PB) took part in this research, and the data collection period was from February 2008 to March 2009. As to the methods and techniques, we used the method to determine the central nucleus based on the free association of words, a questionnaire to identify certain regularities that constitute the nurses habitus, and the semi-structured interview to explore opinions and attitudes when facing assistance situations and educational practices and to collect other relevant information. The data analysis was developed, when referring to the free associations, with the help of the EVOC software, which is a group of articulated programs which carry out the statistical analysis of the evocations and the identification of the possible elements of both the central nucleus and the peripheral system of the social representation. As to the questionnaire, we used the descriptive statistical analysis and the analysis of correlation between the variables. The interviews were submitted to a categorical analysis of the content. The EVOC result indicated that the cognition hormone was the only element of the central nucleus of the social representation of menopause. Due to its symbolic value and structuring power, this central nucleus ensures the strict and, at the same time, flexible character of the representational content. The analysis of the social advancement, of some fundamental features of the group habitus, as well as the analysis of its insertion in the health field and of the attitudinal opinions and dispositions concerning the assistance given to the climacterial user, and the analysis of the pedagogical dimension of this assistance, all these analyses lead to the conclusion that the nurses who took part in this research share a social representation of the menopause resulting from the association of different technical and scientific knowledge. These derive from the biomedical pattern as well as from hegemonic values which disqualify old age and overvalue youth, from pedagogical conceptions arising from patterns that are presently regarded as authoritative and old-fashioned and from cultural references (responsible for the semantic variations concerning the central nucleus) which are specific to the subgroups the nurses belong to. This research enables the creation of opportunities for discussion between active nurses working for Estratégia Saúde da Família, and the nurses who are teachers at institutions of higher education, aiming at linking theory to practice, so that they can find ways of thinking about the climacteric and working, in a more comprehensive way, with users who are experiencing this stage of life

Análise de qualidade da atenção à criança na estratégia saúde da família: o óbito infantil evitável como referência

Alma-Ata declaration bring the Primary Attention to the Health (PAH) as first level of health attention for individuals, family and community, which considers infant group as priority. Several initiatives that gave bases to integral attention to the children health formalized in the principles of Unique Health System. Family Health Strategy (FHS) comes to strengthen this attention, instituting new ways of work organization and professional practices that gave impact in their quality indicators. One of them is children mortality, showing decline in their values. Though, studies indicates persistence of avoidable infant deaths. In Natal RN, this reality is also perceptible leading to inquietudes, mainly at the space of services production, it means, which motivated the accomplishment of the present study intending to analyse the way that the organizational and structural processes as long as the professional practices in FHS interfered in the quality of children s health attention who died by avoidable death in the year of 2007 in municipal district of Natal-RN. It treats, therefore, to an exploratory and descriptive survey of cases study type, thar had as primary sources the oficial documents of MH, the family prontuary, pregnant card, child card and testimony obt ined from instrument of research elaborated based in investigation form of infant death by MH, applied to 10 mothers of children who had avoidable death. In analysis it was appealed silmultaneous triangulation of methods and sources, allowing a bigger aproximation from obtained informations. To elucidate the cases, the aspects studied were analyzed to the light of explicative model of Social Determinants of Health. Among individual and family aspects were highlighted the related to age, schooling, family habits and customs and mother s economic condition, besides of pregnancy age, newborn weight and associated diseases, which don t differ from literature about the theme. Reffering to the factors organizational and structural processes and professionals practice, highlihgted, the treatment given by the professionals, the territorialization and adscription of areas, the difficulty of having access to the services or sleepers and the reference and counterreference. But also, the ausence or few greet, the lack of communication, few assiduity and ponctuality by professionals in service, among others. In a general way mothers considers the attendance received in the hospital good and very good , opnions that in the Basic Attention weren t so favorable, in spite of many of predictible actions in this level have been performed in the studied cases. It is observed, therefore, that the social determinants of health has a strong influence in ocurrence of infant deaths, what implicates in a large actuation by Infant Mortality Committee from municipal district. This way, it becomes fundamental the reflection and evaluation about the effectiveness and execution by the processes of vigilance to health in FHUs; the rethink about the social determinants of health in a wide and articulate way to the services quality, to permanent education, to management in service, to the given attention and to the way how it is installed the popular participation and social control. To the professionals it is presented the great challenge to review their daily practice, their values, behaviors and commitment, which ones must be guided by logical of sharing, work in team, humanescence and alterity, not only by the accomplishment of a professional duty

Vivências de docentes de enfermagem no ensino do cuidar

Care, in a global perspective, appears in the main quarrels as the necessary phenomenon that will have to permeate the thoughts, the perception and values for the change that will lead to the overcoming of a paradigmatic crisis. The professional care was attributed, in elapsing of history, to the Nursing. Its historical evolution and articulation with the social processes, political and scientific in prominence place, in what it says respect to human well-being, not objectifying to cure, but to comfort, to complement the weak capacities and to the establishment the present capacities, alleviating pain, in other words, caring. The Teaching of care in Nursing, suffered great influences of the biomedical model, being like this, the education in Nursing has been criticized for if being valid pedagogical models incapable to promote the growth of the subjects, keeping it passive before your life processes, showing fragilities, attitudes and questionable behaviors, dissonances, appearing the imminence of an act of to care and to educate that needs to be considered as dialectical and intersubjective act. The objective of this research is to understand the lived experience of the nursing teachers in the Teaching of Care, in order to reflect about the insert of Nursing in the current world context, watching the dialetics of the Teaching of care and the paradigm changes in the section health. It is a phenomenological research that used the analysis of the located phenomenon, to obtain the units of meaning of the speech Nursing teachers about your experience lived in the Teaching of care. This study allowed the Nursing teachers could share your existences, senses and information on the interior of your pedagogic action exalting the interpretation, which appears intentionally in the conscience, emphasizing the pure experience of the be-professor, including emotions and affectivities in the teaching of care. In the construction of the results, three moments were devoted for discussion: Multidimensional Care; Care as Professional Practice; and the Teaching of care. The speeches had revealed rich, complex and for paradoxical times. The understanding of a sensitive teaching, that sometimes, arrives if to worry in rescuing the tenderness and the humanity, it is running into the other permeated speeches of fragilities, inconstancies, technifying, that showed lacks of pedagogic preparation. The Teaching of care needs to adopt a conception of education/learning and to use methodologies that can lead to an action liberating, capable to breach with traditional mooring cables and preconceptions or little healthful habits of life, favoring the use of methods that promote educating for the way of the sensitive, detaching aspects that they contribute for this end, as the intuition, the emotion, the creation, the perception and the sensibility. In this direction, it is considered important to deepen subjects that make possible the creation of care strategies and educational with the human being vision in your totality, therefore if it perceives that the necessary therapeutical boarding to be ampler, passing for the social individual, family and its relations

A busca de sintomáticos respiratórios de tuberculose na prática e perspectiva do agente comunitário de saúde nos distritos sanitários de Natal

The objective of this work - which is characterized analyze the search for symptomatic tuberculosis in practice and perspective of the Community Health Agent (ACS) in the districts of Natal. Methods: This is a cross-sectional study. The study population was 646 professionals, and conducted a probabilistic random sampling, stratified by districts. The data were collected from one instrument to collect data based on Primary Care Assesment Toll (PCAT) and analyzed by descriptive statistics. The sample consisted of ACS was 87% female. Among the study participants 58% completed high school and 120 months of exercise training (95% CI 111.9 to 129.5) on average. 90% were USF. The average follow-up of cases found were 2 cases of TB since the beginning of the career of the ACS and the last three years the average is presented in a case accompanied. The ACS received satisfactory ratings on the bond of trust with the user, so as access to homes in the community. The ACS reported for denying the fear of being positive result was the biggest reason for not performing the sputum. All units have a professional that responds to the Tuberculosis Control Program. Regarding the structural capacity of primary care settings for the diagnosis of TB, we observed satisfactory levels in different districts of pots for sputum collection, however, a point that deserves attention from managers is lack of materials for packaging sputum. Fear of positive result was one of the reasons for the refusal of sputum collection, followed by alcoholism. With regard to TB suspects, all responded that ACS always suspect when the user has TB coughs, but in all districts were noticed at low delivery of requests for applications for smear. BSR in TB control, is characterized in practice as a complex action goes beyond technical expertise and contact with the family that breaks with the Cartesian. The BSR is part of the ACS can perform them from the daily visits. We conclude that the ACS is difficult to achieve. This practice should not be the privilege of this actor, but the entire team of primary care. We must rethink the practices of TB care, seeing the health surveillance while aegis of the working process of primary care teams for early diagnosis and thereby reduce TB in communities

A comparison of statistical methods for genomic selection in a mice population

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

Muscle lesion treatment in Brazilian soccer players: Theory vs. Practice

Background: In this study we evaluated the rehabilitation profile of Brazilian soccer players which underwent lower limb muscle lesions.Methods: This is a descriptive investigation. We evaluated 139 professional soccer players (1724 years old). We evaluated the following variables: muscle lesion diagnosis, symptoms, non steroidal anti-inflammatory used, physiotherapy treatment, which physiotherapy recourses was used if treated and train adaptation.Results: In great part of the athletes muscle lesion remained between 2 weeks and 1 month. Around 54% were diagnosed by a physician; the other part was diagnosed by a physical therapist. Non steroidal anti-inflammatory were prescribed by physicians in 42% of the cases; in 7% the physical therapist prescribed the medication while in 49% of the cases the masseur prescribed the drug. More than 1/4 of the athletes received physiotherapy treatement between 48 hours and 5 days. Isometric exercise therapy was applied in 15% of the cases. 63% were not accompanied by the physiotherapist on their return to the field. 48% received massages immediately after injury.Conclusion: We presented discrepancy between the recommended theory described by several researches and the practice. We indicate the necessity of recycling in a general context the rehabilitation of muscle injuries.

O psicólogo e os serviços de acolhimento institucional para crianças e adolescentes

The Shelters are responsible for caring for children and adolescents whose families or guardians are temporarily unable to fulfill his role as care and protection. The activities to be developed by psychologists in these services are greatly important for the elaboration and development of political- pedagogical project of the same, and for reasons pertaining to the present and future of children and adolescents received judgments. The psychologist puts up the challenge of contributing to a better care of children, also cooperating with the implementation of the new care standards of childcare. The aim of this study was to investigate the role of the professional psychologist in assistance to children and adolescents in 13 Shelters in the Metropolitan Region of Natal/RN. For both set out to make visits to the institutions to know how it is organized the field work of the psychologist, his routine work and activities developed. Nine psychologists interviewed according to a semi-structured interview script. The data analysis is supported by the theoretical aspects of dialectical materialism historical and theme content analysis was used. Results were presented from three angles: psychologists and institutional framework; activities, resources and methods of work; psychologists and legal frameworks of the Institutional Hospitality. The study points out the recent entry of the psychologist in Shelters, combined with considerable turnover of these professionals. This work has been organized through the Individualized Service Plan, prioritizing the return to family of origin. Moreover, in general, perform joints with the service network, reporting, individual consultations and follow-adoption processes . Staff members, however, feel a lack of specific and continuing training on special protection, including due to the distance between the proposed theory and practice. It was thus observed a movement of psychologists distance themselves from welfare or repressive practices, however the structural difficulties of services and lack of continuing education appear to limit the development of a performance focused on the transformation of the reality of children and adolescents treated and their families

Vivências maternas associadas ao aleitamento materno exclusivo mais duradouro: um estudo etnográfico

Objective: To describe the experiences of breastfeeding mothers using the Unified Health System who were seeking to obtain knowledge, expectations, perceptions and feelings involved with identifying aspects relevant for more prolonged, exclusive breastfeeding Methods: A qualitative ethnographic study conducted with eight primiparas and family references, through observation and household interviews during the first semester of the infants' lives. The data were summarized in three categories: starting breastfeeding; experiencing the process of early weaning maintaining exclusive breastfeeding Results: Breastfeeding appeared as a particular event in different contexts of occurrence, however, it was possible to identify that exclusive breastfeeding was linked to maternal determination, despite the difficulties experienced. Longer Lasting exclusive breastfeeding was related to the mothers who were highly motivated to practice, those who were aware of its benefits and were supported by their family, even in the face of interference contrary to their culture. Conclusion: The lack of determination for exclusive maternal breastfeeding should be investigated and, when present, receive special consideration by health professionals.

Dimensional analysis of burden in family caregivers of patients with obsessive-compulsive disorder

Aims: Obsessivecompulsive disorder (OCD) also generates emotional burden in the patient's family members, but no study has evaluated the specific dimensions of burden. The objectives were to evaluate the dimensions of the Zarit Burden Interview (ZBI) and possible correlates. Methods: This was a cross-sectional study involving 47 patients and 47 caregivers, using a sociodemographic questionnaire; the ZBI; the Self Reporting Questionnaire; the Family Accommodation Scale; and the YaleBrown ObsessiveCompulsive Scale. The ZBI factor analysis was conducted using Varimax Rotation. Results: Six factors were identified, explaining 74.2% of the total variance: factor 1, interference in the caregiver's personal life (36.6% of the variance); factor 2, perception of patient's dependence (10.8%); factor 3, feelings of irritation or intolerance (9.2%); factor 4, guilt (7.2%); factor 5, insecurity (5.6%); and factor 6, embarrassment (4.8%). The six ZBI factors were associated with greater OCD severity and with greater accommodation to the patient's symptoms, and factors 1, 2, 5 and 6 with caregiver's psychological morbidity. Caregiver's sex (female) was associated with factors 5 and 6, relationship with the patient (being a parent or son/daughter) with factor 5, higher educational level with factor 6, living with the patient with factor 3, worse self-evaluation of health with factors 1, 5 and 6, and occupational status (not working) with factors 1, 2, 5 and 6. Conclusion: The dimensions of burden identified indicate the most affected aspects of a caregiver's life and could guide the planning of more specific interventions. Thus, the caregiver could participate more effectively in the OCD patient's treatment, with a lower impact on his/her life.