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

Atividade biológica de células-tronco da polpa de dentes decíduos humanos submetidas à criopreservação

Dental pulp stem cells have been widely investigated because of their ability to differentiate into both dental and non-dental cells, with potential use in therapies involving tissue engineering. The technique of cell cryopreservation represents a viable alternative for the conservation of these cells, since it stops reversibly, in a controlled manner, all of cell biological functions in an ultra low temperature. The present study aimed to evaluate, using in vitro experiments, the influence of a cryopreservation protocol on the biologic acti vity of stem cells from human exfoliated deciduous teeth (SHED). Cells obtained from the pulp of three deciduous teeth on end-stage exfoliation or with indicated extraction were expanded in α-MEM culture medium supplemented with antibiotics and 15% fetal bovine serum. At second subculture (P2), a group of cells were submitted to cryopreservation for 30 days in 10% DMSO diluted in fetal bovine serum, at -80º C, while the remind cells continued under normal conditions of cell culture. Cell proliferation was evaluated in both groups (not cryopreserved or cryopreserved) by Trypan blue stain essay at intervals of 24, 48 and 72h after plating. Cell cycle analysis of SHEDs submitted or not to the cryopreservation protocol was performed in the same intervals. Events related to cell death were studied by Annexyn V and PI expression under flow cytometry at the intervals of 24 and 72h. The presence of nuclear morphological changes was evaluated by DAPI staining at 72h interval. It was observed that both groups exhibited an upward cell proliferation curve, without considerable changes in cell viability throughout the experiment. The distribution of cell in the cell cycle phasis was consistent with cell proliferation in both groups. There were no nuclear morphological damages in the end range of the experiment. therefore, it is concluded that the proposed cryopreservation protocol is efficient for storing the studied cell type, allowing its use in future experimental studies

Algoritmos de agrupamentos fuzzy intervalares e índice de validação para agrupamento de dados simbólicos do tipo intervalo

Symbolic Data Analysis (SDA) main aims to provide tools for reducing large databases to extract knowledge and provide techniques to describe the unit of such data in complex units, as such, interval or histogram. The objective of this work is to extend classical clustering methods for symbolic interval data based on interval-based distance. The main advantage of using an interval-based distance for interval-based data lies on the fact that it preserves the underlying imprecision on intervals which is usually lost when real-valued distances are applied. This work includes an approach allow existing indices to be adapted to interval context. The proposed methods with interval-based distances are compared with distances punctual existing literature through experiments with simulated data and real data interval

Estratigrafia de sequências do intervalo aptiano ao albino na Bacia do Araripe, NE do Brasil

This study has as a main objective to make a detailed stratigraphic analysis of the Aptian-Albian interval in the east part of Araripe Basin, NE of Brazil which correspond, litostratigraphically, to Rio Da Batateira, Crato, Ipubi and Romualdo formations. The stratigraphic analysis was based on three different stages, the 1D, 2D and 3D analysis; these ones were adapted to the sequence stratigraphy concepts in order to create a chronostratigraphic framework for the study area within the basin. The database used in the present study contains field and well information, wells that belong to Santana Project, carried out by the Ministério de Minas e Energia- DNPM- CPRM from 1977 to 1978. The analysis 1D, which was done separately for each well and outcrop allowed the recognition of 13 sedimentary facies, mainly divided based on predominant litologies and sedimentary structures. Such facies are lithologically represented by pebble, sandstones, claystones, margas and evaporates; these facies are associated in order to characterize different depositional systems, that integrate from the continental environment (fluvial system and lacustre), paralic system (delta system and lagunar) to the marine environment (shelfenvironment). The first one, the fluvial system was divided into two subtypes: meandering fluvial system, characterized by fill channel and floodplain deposits; the facies of this system are associated vertically according to the textural thinning upward cycles (dirting-up trend pattern in well logs). Lacustrine environment is mainly related with the lithotypes of the Crato Formation, it shows a good distribution within the basin, been composed by green claystone deposits and calcareous laminated. Deltaic System represented by prodelta and delta front deposits which coarsening upward tendency. Lagunar system is characterised by the presence of anhydrite and gypsum deposits besides the black claystone deposits with vegetal fragments which do not contain a fauna typically marine. The marine platform system is composed by successions of black and gray claystone with fossiliferous fauna of Dinoflagellates (Spiniferites Mantell, Subtilisphaera Jain e Subtilisphaera Millipied genre) typical of this kind of depositional system. The sedimentary facies described are vertically arranged in cycles with progradational patterns which form textural coersening upward cycles and retrogradational, represented by textural thinning dowward cycles. Based in these cycles, in their stack pattern and the vertical change between these patterns, the systems tracks and the depositional sequences were recognized. The Low System Track (LST) and High System Track (HST) are composed by cycles with progradational stack pattern, whereas the Trangessive System Track (TST) is composed by retrogradational stack pattern cycles. The 2D stratigraphic analysis was done through the carrying out of two stratigraphic sections. For the selection of the datum the deepest maximum flooding surface was chosen, inside the Sequence 1, the execution of these sections allowed to understand the behaviour of six depositional systems along the study area, which were interpreted as cycles of second order or supercycles (cycles between 3 and 10 Ma), according to the Vail, et al (1977) classification. The Sequence 1, the oldest of the six identified is composed by the low, transgressive and high systems tracks. The first two system tracks are formed exclusively by fluvial deposits of the Rio da Batateira Formation whereas the third one includes deltaic and lacustrine deposits of the Crato Formation. The sequences 2 and 3 are formed by the transgressive systems tracks (lake spreading phase) and the highstand system track (lake backward phase). The TST of these sequences are formed by lacustrine deposits whereas HST contains deltaic deposits, indicating high rates of sedimentary supply at the time of it s deposition. The sequence 4 is composed by LST, TST and HST, The TST4 shows a significant fall of the lake base level, this track was developed in conditions of low relation between the creation rate of space of accommodation and the sedimentary influx. The TST4 marks the third phase of expansion of the lacustrine system in the section after the basin´s rift, the lacustrine system established in the previous track starts a backward phase in conditions that the sedimentary supply rate exceeds the creation rate of space accommodation. The sequence 5 was developed in two different phases, the first one is related with the latest expansion stage of the lake, (TST5), the basal track of this sequence. In this phase the base level of the lake rose considerably. The second phase (related to the TST5) indicates the end of the lacustrine domain in the Araripe Basin and the change to lagunar system ant tidal flat, with great portions in the supratidal. These systems were formed by restricted lagoons, with shallow level of water and with intermittent connections with the sea. This, was the phase when the Araripe Basin recorded the most several arid conditions of the whole interval studied, Aptian Albian, conditions that allow the formation of evaporitic deposits. The sequence 6 began its deposition after a significant fall of the sea (LST6). The sequence 6 is without any doubtlessly, the sequence that has deposits that prove the effective entrance of the sea into the Araripe Basin. The TST6, end of this sequence, represents the moment which the sea reaches its maximum level during the Aptian Albian time. The stratigraphic analysis of the Aptian Albian interval made possible the understanding that the main control in the development of the depositional sequences recognized in the Araripe Basin were the variations of the local base level, which are controlled itself by the climate changes

Características das Curvas de Regressão da Gonadotrofina Coriônica Pós-mola Hidatiforme Completa

Objetivos: construir a curva de regressão do b-hCG pós-mola hidatiforme completa (MHC) com remissão espontânea e comparar com a curva de regressão pós-MHC com tumor trofoblástico gestacional (TTG). Análise comparativa da curva de regressão do b-hCG das portadoras de MHC, acompanhadas no Serviço, com a curva de regressão observada por outros autores1-3. Métodos: foi realizada avaliação clínica e laboratorial (dosagem sérica de b-hCG), na admissão e no segmento pós-molar, de todas as pacientes com MHC, atendidas entre 1990 e 1998 no Hospital das Clínicas de Botucatu - Unesp. O resultado da determinação seriada do b-hCG foi analisado em curvas log de regressão. A evolução da curva de regressão do b-hCG foi analisada e comparada em MHC com remissão espontânea e MHC com TTG numa curva log de regressão, com intervalo de confiança de 95%. A curva log de regressão do grupo de remissão espontânea foi comparada com curvas consideradas padrão1,2. Foram construídas curvas log individuais de todas as pacientes e classificadas de acordo com os quatro tipos de curva (I, II, III e IV), propostos para o seguimento pós-molar³. Resultados: 61 pacientes com MHC tiveram seguimento pós-molar completo, 50 (82%) apresentaram remissão espontânea e 11 (18%) desenvolveram TTG. No grupo de pacientes com MHC e remissão espontânea, o tempo para alcançar a normalização dos níveis do b-hCG, após o esvaziamento molar, foi até 20 semanas. As pacientes que desenvolveram TTG apresentaram desvio precoce da curva de regressão normal do b-hCG, 4 a 6 semanas após o esvaziamento molar. Nestas pacientes, a quimioterapia foi introduzida em média na 9ª semana pós-esvaziamento molar. Conclusões: a curva de regressão do b-hCG pós-MHC com remissão espontânea apresentou declínio log exponencial, semelhante ao observado por outros autores1,2, e diferente das MHC com TTG. Foram identificados três tipos de curvas de regressão do b-hCG, semelhantes aos de Goldstein³, I, II e IV, e outros dois tipos diferentes de regressão do b-hCG: V (regressão normal) e VI (regressão anormal).

Síndrome pós-laqueadura: repercussões clínicas e psíquicas da pós-laqueadura

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Desempenho produtivo de vacas de quatro grupos genéticos submetidas a diferentes manejos alimentares desmamadas aos 42 ou 63 dias pós-parto

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Comparação dos testes de escada, caminhada e espirometria preditos com os obtidos no pós-operatório de ressecções pulmonares

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Variabilidade da freqüência cardíaca como ferramenta de análise da função autonômica: revisão de literatura e comparação do comportamento autonômico e metabólico em recuperação pós-exercício

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeito da duração do intervalo em saltos verticais: relações entre trabalho realizado e duração até a exaustão

Pós-graduação em Ciências da Motricidade - IBRC

Análises moleculares das formigas lava-pés (Solenopsis spp.) (Hymenoptera : Formicidae) e da presença da endobactéria Wolbachia

Pós-graduação em Ciências Biológicas (Biologia Celular e Molecular) - IBRC

Efeito da cafeína e do cádmio na próstata do rato wistar púbere: proliferação e morte de células epiteliais e alterações estromais

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

Algumas distribuições de probalidade para idosos grupados e censurados

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)