Representações sobre a doença mental por parte dos cuidadores formais, em instituições de apoio e acolhimento a pessoas idosas: a realidade transfronteiriça entre Portugal e Espanha

Segundo (Lage; 2005) o cuidador informal sempre existiu ao longo da história da humanidade, ao séc. XX a família tinha um papel muito importante, após o sec. XX a família e o cuidar informal foi substituído pela medicina e pelo cuidador formal. O aumento do envelhecimento populacional, o aumento da esperança média de vida e a desertificação trouxeram um conjunto de preocupações e responsabilidades, às famílias e às entidades sociais e da saúde, devido aos cuidados que são necessários prestar às pessoas idosas dependentes e com doença mental, devido à crise dos sistemas sociais, de saúde e financeiro das entidades governamentais, a maioria dos casos de doença mental e idosos foram como que obrigados a recorrer aos cuidos informais para fazer face as despesas. Com o presente estudo, de caráter qualitativo, procuramos conhecer os estigmas que existem face a doença mental em dois países transfronteiriços, Portugal e Espanha. A amostra da população selecionada é constituída por quarenta cuidadores formais em instituição de acolhimento e apoio a pessoas idosas, em que quarto instituições distintas, duas em Portugal e duas em Espanha. Os cuidadores inquiridos referiram que há pouca procura por parte dos doentes mentais a estas instituições, uma vez que requerem mais cuidados presenciais e equipas direcionadas aos problemas específicos, embora todos tenham uma formação abrangente, mas é mais difícil cuidar deste tipo de clientes.

O doente diabético com doença coronária crónica. Como revascularizar?

A doença diabética representa uma das mais importantes preocupações para todos quantos têm de abordar e tratar a doença coronária, aguda ou crónica. A presença da diabetes coloca problemas particulares relacionados com o agravamento do prognóstico que nestes doentes se verifica, bem como as dificuldades inerentes à terapêutica, que nesta população levanta problemas especiais. O lugar da revascularização miocárdica no tratamento da doença coronária crónica tem sido matéria de controvérsia, muito por culpa de alguns estudos clínicos que falharam na demonstração da sua superioridade. Após o estudo BARI-2D a cirurgia de bypass aorto-coronário ganhou alguma vantagem sobre a angioplastia coronária, em doentes diabéticos com doença multivasos, vantagem esta que veio a ser recentemente consolidada no estudo FREEDOM, no qual se demonstra uma significa redução de eventos ao fim de cinco anos.

Doença cardiovascular: contribuição do Vascepa®, medicamento de origem marinha, no combate à hipertrigliceridemia

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

O homem medico de si mesmo, ou sciencia, e arte nova de conservar cada hum a si proprio a saude, e destruir a sua doença ... /

Mode of access: Internet.

O FISIOTERAPEUTA, O PACIENTE E A DOENÇA

A visão biopsicossocial de homem é de fundamental importância para que os fisioterapeutas sejam capazes de atuar com seus pacientes, de forma global, sem focar a atenção apenas à doença, mas sim à pessoa doente. A compreensão acerca da profissão e dos conceitos de saúde-doença e paciente, também se faz necessária para que esses profissionais possam considerar sua intervenção num âmbito mais amplo do que a reabilitação. O objetivo deste trabalho é investigar a compreensão que os alunos do último ano de Fisioterapia de uma Universidade privada de São Paulo têm sobre saúde-doença, paciente, Fisioterapia e relacionamento fisioterapeuta-paciente e como associam estas compreensões aos modelos de saúde existentes. Para isso toma por base autores da Psicologia da Saúde que defendem uma visão biopsicossocial de homem, assim como autores da Fisioterapia e Medicina que escrevem sobre os modelos adotados nos currículos de formação dos profissionais da saúde. Foram realizadas 10 entrevistas semi-dirigidas com os alunos, apresentando questões a respeito dos temas em questão. Os resultados foram analisados de forma qualitativa através da construção de categorias de análise visando responder aos objetivos da pesquisa. Conclui-se que os alunos percebem alguns aspectos psicológicos e sociais do paciente, mas não de forma clara e, na maioria dos casos, este conhecimento se dá através de conhecimentos que não foram adquiridos na Universidade. Esta, apesar de fornecer os conteúdos para a formação mais humana do fisioterapeuta, não alcança os objetivos ao final do curso, já que os alunos oscilam entre os modelos biomédico e biopsicossocial

Sofrimento e Adaptação: Aspectos Sociais e Psico-afetivos de Pacientes com Doença Periodontal Crônica

OS OBJETIVOS DESTE ESTUDO FORAM: CARACTERIZAR A POPULAÇÃO DE PACIENTES DE UMA CLÍNICA-ESCOLA; INVESTIGAR OS ASPECTOS PSICO-AFETIVOS ASSOCIADOS ÀS DOENÇAS PERIODONTAIS DESSES PACIENTES, ALÉM DOS RECURSOS DEFENSIVOS UTILIZADOS POR ELES. MÉTODO: LEVANTOU-SE DADOS SÓCIO-DEMOGRÁFICOS, DE SAÚDE GERAL E PERIODONTAL DE 789 PACIENTES ATENDIDOS NUM DEPARTAMENTO DE PERIODONTIA DE UMA CLÍNICA-ESCOLA DE ODONTOLOGIA, DADOS ESTES QUE CONSTITUÍRAM A ETAPA QUANTITATIVA DO ESTUDO. ESSA CARACTERIZAÇÃO FOI FEITA ATRAVÉS DE PLANILHAS ESPECIALMENTE ELABORADAS PARA A PESQUISA. A PARTIR DESSAS PLANILHAS, FOI SELECIONADA UMA SUB-AMOSTRA DE 273 PACIENTES QUE APRESENTARAM QUEIXAS EM TRÊS OU MAIS SISTEMAS ORGÂNICOS, ALÉM DA QUEIXA PERIODONTAL, OS QUAIS FORAM DENOMINADOS DE PACIENTES POLI-QUEIXOSOS. UMA TERCEIRA SUB-AMOSTRA INTEGROU 59 PACIENTES POLI-QUEIXOSOS, DIAGNOSTICADOS COM DOENÇA LEVE A MODERADA OU LEVE A SEVERA. DESSES PACIENTES, TRÊS FORAM ENTREVISTADOS E INTEGRARAM A AMOSTRA DA ETAPA QUALITATIVA DA PESQUISA. OS RESULTADOS INDICARAM QUE ENTRE PACIENTES POLI-QUEIXOSOS NÃO FOI ENCONTRADA CORRELAÇÃO SIGNIFICATIVA ENTRE DOENÇA PERIODONTAL LEVE A MODERADA OU LEVE A SEVERA COM GÊNERO, IDADE, ESTADO CIVIL, GRAU DE INSTRUÇÃO OU ATIVIDADE LABORAL. TAMBÉM NÃO HOUVE RELAÇÃO SIGNIFICATIVA QUANTO À PRESENÇA DE TABAGISMO, BRUXISMO, ONICOFAGIA E XEROSTOMIA. VERIFICAMOS QUE A DOENÇA PERIODONTAL CRÔNICA TEM SUAS ORIGENS NAS RELAÇÕES OBJETAIS DA MAIS TENRA INFÂNCIA E QUE AS ANSIEDADES ESQUIZO-PARANÓIDES QUE CARACTERIZAM ESSAS PRIMEIRAS RELAÇÕES, CONTINUAM PERMEANDO AS RELAÇÕES DURANTE TODA A VIDA DAS PACIENTES. COMO OS RECURSOS DEFENSIVOS UTILIZADOS SÃO PSIQUICAMENTE POUCO EVOLUÍDOS, O EQUILÍBRIO, A HOMEOSTASE É ENCONTRADA NA DOENÇA. CONCLUÍMOS QUE A DINÂMICA INTRA-PSÍQUICA PODE ESTAR ASSOCIADA NÃO SÓ À DOENÇA PERIODONTAL, MAS TAMBÉM AO ESTADO DE SAÚDE GERAL DESSES PACIENTES.

Relação entre desempenho funcional e indicadores de doença arterial obstrutiva periférica em idosas

The presence of peripheral arterial disease (PAD) increases the risk and vulnerability to adverse clinical outcomes in the elderly. Like this, we investigated the relationship between functional performance and indicators of PAD in elderly women. METHODS: Cross-sectional study in which 54 elderly were assessed by questionnaire mini mental state examination, Short Phisical Performance Battery (SPPB), ankle-brachial index (ABI), human activity profile (HAP) and Edinburgh questionnaire. Statistical analysis was performed using ANOVA, t test and Pearson correlation. We considered p <0.05 as significance level. RESULTS: The mean age SPPB and ABI were 69.2 (± 6.9) years, SPPB 9.42 (± 2.55) and ABI 1.04 (± 0.14). The prevalence of PAD was 16.3%. There was a significant correlation between ABI and gait speed (r = 0.75, p = 0.001) and between PAH with SPPB (p = 0.001). CONCLUSIONS: It is suggested that the decline in functional performance in older, expressed in gait velocity component of the SPPB, is related to the presence of PAD

Modelo animal da Doença de Parkinson baseado na expressão de alfa - sinucleína: caracterização comportamental, eletrofisiológica e avaliação dos efei tos da estimulação da medula espinhal

Parkinson disease (PD) is associated with motor symptoms and dopaminergic cell loss in the nigrostriatal pathway. Alpha-synuclein is the major component of the Lewy bodies, the biological hallmarks of disease, and has been associated with familial cases of PD. Recently, the spinal cord stimulation (SCS) showed to be effective to alleviate the Parkinson symptoms in animal models and human patients. In this project, we characterized the motor and electrophysiological effects of alpha-synuclein overexpression in the substantia nigra of rats. We further investigated the effects of spinal electrical stimulation, AMPT and L-dopa administration in this model. Method: Sprague-Dawley rats were injected with empty viral vector or the vector carrying the gene for alpha-synuclein in the substantia nigra, and were tested weekly for 10 weeks in the open field and cylinder tests. A separated group of animals implanted with bilateral electrode arrays in the motor cortex and the striatum were recorded in the open field, during the SCS sessions and the pharmacological experiments. Results: Alpha-synuclein expression resulted in motor asymmetry, observed as the reduction in use of contralateral forepaw in the cylinder test. Animals showed an increase of local field potential activity in beta band three and four weeks after the virus injection, that was not evident after the 5th week. AMPT resulted in a sever parkinsonian state, with reduction in the locomotor activity and significant peak of oscillatory activity in cortex and striatum. SCS was effective to alleviate the motor asymmetry at long term, but did not reduce the corticostriatal low frequency oscillations observed 24 hs after the AMPT administration. These oscillations were attenuated by L-dopa that, even as SCS, was not effective to restore the locomotor activity during the severe dopaminergic depletion period. Discussion: The alpha-synuclein model reproduces the motor impairment and the progressive neurodegenerative process of PD. We demonstrated, by the first time, that this model also presents the increase in low frequency oscillatory activity in the corticostriatal circuit, compatible with parkinsonian condition; and that SCS has a therapeutic effect on motor symptom of this model.

Estratégias de enfrentamento de pessoas vivendo com AIDS frente à situação da doença

The Acquired Immune Deficiency Syndrome (AIDS), considered today one chronic nature of the disease due to the advent of antiretroviral therapy (TARV), brings to individuals living with this disease, difficulties related to social interaction and adaptation to new physical condition and the routines imposed by the treatment. This reality has a strong impact on the lives of these people in order of overcoming them use coping strategies, Coping. In this context, the aim of this study was to characterize the epidemiological, clinical and life habits of people living with AIDS and analyze the coping strategies used with the situation of the disease, according to sociodemographic, clinical and life habits. This is a cross-sectional study with a quantitative approach. The sample consisted of 331 people registered at the clinic of the Hospital Giselda Trigueiro (HGT), located in Natal / RN, who had scheduling for outpatient medical consultation from January to August 2014. The study was approved by the Ethics Committee the Federal University of Rio Grande do Norte with the Presentation of Certificate for Ethics Assessment (CAAE), paragraph 16578613.0.0000.5537. The data of social characterization showed predominance of men (52%), young people (42%) coming from the capital (58%), mulatto (53%), single (56%), heterosexual (79%), poor (68 %). With regard to clinical aspects it has been found that most held the first HIV testing for less than five years (60%) had signs and symptoms of AIDS before the examination (90%) were hospitalized (90%) started ART for less than five years (60%) believe they have good knowledge of the disease (75%) and believe that their health has improved (92%). For lifestyle, it became clear that most do not consume alcohol (71%), do not smoke (88%) and do not use illicit drugs (92%) and never used condoms before diagnosis (62%) and only 192 (58%) use the currently codon. With regard to the reference was higher coping focused modes of emotion, although the problem solving has been the second most common. The mean scores of women, workers, religious and never abandoned the treatment were higher for all factors. Having a partner, living with family members and support in the treatment had higher average scores for various factors, coinciding in the confrontation, withdrawal and social support. As for the leisure and physical exercise also dominated the modes focused on emotion as was seen in the correlation between the time of treatment, education and family income and IEEFL factors, although with low intensity. The profile of the study population confers with national characteristics, suggesting feminization, internalization, pauperization, heterosexual, increased CD4 cell count and viral load reduction during treatment and maintaining healthy lifestyle habits. Coping strategies used were more focused on emotion. In this context, it is understood that the identification of these strategies can facilitate care planning, encouraging such persons to adapt to stressors with the situation of the disease

Quintosana e seus derivados conjugados com ácido gálico: avaliação de seu potencial antioxidante e de interferência na formação de cristais de oxalato de cálcio

Chitin is the second most abundant polysaccharide in nature and its derivative chitosan has been widely studied due to its unique chemical and pharmacological properties. However, studies show that when this molecule is used as food, drug, etc. it tends to accumulate in renal tissue and promotes an increase in calcium excretion. Nevertheless, the effect of chitosan on the formation of calcium oxalate (OxCa) crystals has never been evaluated. The formation of kidney stones (urolithiasis) is the disease that most often affects the kidneys and the urinary system. In addition, this is a disease with high prevalence and recurrence. Many molecules with antioxidant activity have been shown to decrease the potential for in vitro OxCa crystals formation. Thus, the aim of this study was to evaluate the effect of low molecular weight chitosan and its derivatives conjugated to gallic acid (AG) as antioxidant and inhibitor of OxCa crystals formation. The physico-chemical analysis confirmed the identity of chitosan. This molecule was subjected to five antioxidant tests and showed an excellent copper chelating activity. However, chitosan did not show other significant antioxidant activity. When chitosan was subjected to in vitro crystal formation tests, it increased the number of OxCa monohydrate crystals, modified the morphology of the crystals, modified the proportions between populations of crystals in solution and increased the zeta potential of these crystals formed. Four molecules of chitosan conjugated with GA were obtained. The physico-chemical analysis confirmed that chitosan and AG were covalently bonded. However, the amount of GA liked to chitosan did not increase even when 10 times more GA was used in experiment. When these derivatives were subjected to antioxidant tests, all chitosan conjugates showed higher antioxidant potential than their precursors. However, they showed different activity between them, which indicating that the position where AG is conjugated is an important factor for chitosan-GA activity. When conjugated chitosans were submitted to in vitro crystal formation tests, a reduction in the crystals number was observed when compared with those formed in the presence of unconjugated chitosan. Chitosan has a strong capacity for inducing OxCa monohydrate crystal formation, as well as modify their morphology and zeta potential. Over all, the process of conjugating AG to chitosan led to an increase in antioxidant potential of this molecule and was also able to decrease its capacity of inducing in vitro crystal formation

Efeitos da azilsartana sobre a doença periodontal em um modelo experimental com ratos wistar

Periodontal diseases, highly prevalent disease in worldwide population, manifest primarily in two distinct entities: plaque-induced gingivitis and periodontitis. Periodontitis is a chronic inflammatory disease characterized of different levels of collagen, cementum, and alveolar bone destruction. Recent experimental studies demonstrated anti-inflammatory and antirreabsortive effect of antihypertensive agents of the angiotensin II receptor blockers class on periodontal disease. The aim of this study was to evaluate the effects of azilsartan (AZT), a potent inhibitor of the angiotensin II receptor which has minimal adverse effects on bone loss, inflammation, and the expression of matrix metallo proteinases (MMPs), receptor activator of nuclear factor kB ligand (RANKL), receptor activator of nuclear factor kB (RANK), osteoprotegerin (OPG), cyclooxygenase-2 (COX-2), and cathepsin K in periodontal tissue in a rat model of ligature-induced periodontitis. Male Wistar albino rats were randomly divided into 5 groups of 20 rats each: (1) nonligated, water; (2) ligated, water; (3) ligated, 1 mg/kg AZT; (4) ligated, 5 mg/kg AZT; and (5) ligated, 10 mg/kg AZT. All groups were treated with water or AZT for 10 days. Periodontal tissues were analyzed by morphometric exam, histopathology and immunohistochemical detection of MMP-2, MMP-9, COX-2, RANKL, RANK, OPG, and cathepsin K. Levels of IL-1b, IL-10, TNF-a, myeloperoxidase (MPO), and glutathione (GSH) were determined by ELISA. Treatment with 5 mg/kg AZT resulted in reduced MPO (p˂0.05) and IL-1b (p˂0.05) levels and increased in Il-10 levels (p˂0.05). It was observed a reduced expression of MMP-2, MMP-9, COX-2, RANK, RANKL, cathepsin K, and a increased expression of OPG in the animals subjected to experimental periodontitis and threated with AZT (5 mg/kg). Conclusions: These findings suggest an anti-inflammatory and anti-reabsortive effects of AZT on ligature-induced periodontitis in rats.

Análise da imuno expressão das proteínas IL-17, IL-23 E RORγt na patogenia da doença periodontal

Periodontal disease is a chronic inflammatory condition primarily caused by bacteria in dental biofilm, which interact with the host, thus determining the nature of the resulting disease. Despite the wide knowledge about the pathogenesis of these diseases, the exact composition of the T cell profile during the active phase of the disease (Th1, Th2 or Th17) remains unknown. This study aimed to evaluate by immunohistochemical expression, the presence of the markers (IL-17, IL-23 and RORγt), involved in Th17 response in clinically healthy gingiva cases (n = 32), biofilm-induced gingivitis (n = 30), chronic periodontitis (n = 32) and aggressive periodontitis (n = 25), in order to analyze if the expression and/or distribution of these molecules in lymphocytes and macrophages, present in the inflammatory infiltrate of periodontal tissue, influences the tissue destruction observed in these diseases. The morphological analysis of cases was performed which assessed the intensity of the inflammatory infiltrate in mild, moderate and intense. For each case, in the area with the most representative immunostaining, 5 fields were chosen and analyzed, both for the intensity of the inflammatory infiltrate as for the quantity of immunostained cells, based on predetermined scores: score 0 (absence of inflammatory infiltrate/immunostaining), score 1 (the infiltrate/immunostaining covered less than 25% of the field area), score 2 (the infiltrate/immunostaining occupied between 25 and 50%) and score 3 (infiltrate/immunostaining present in over 50% of the field area). From this, a median was generated representing each case. The intensity of the inflammatory infiltrate correlated with the disease progression, in other words, it was crescent from clinically healthy gingiva to aggressive periodontitis (P <0.001). It was detected the presence of IL-17, IL-23 and RORγt in most of the evaluated cases and the number of immunostained cells correlated with the intensity of the inflammatory infiltrate (P <0.001) and with the clinical parameters analyzed (P <0.001), showing a positive correlation, mainly moderate. Aggressive periodontitis showed a higher percentage of immunostaining for all markers in relation to other clinical conditions assessed, suggesting a possible association of these markers with the progression of this disease, in which the higher the loss of periodontal support, the greater the amount of inflammatory infiltrate and larger the number of immunostained cells.

Relação do polimorfismo BDNF val66met e níveis periféricos de BDNF com a doença de Parkinson e sua sintomatologia

Neurodegenerative diseases are frequently studied due to the increasing number of cases associated with the populational ageing and to the impact on the conditions on the quality of life. Parkinson’s disease (DP) is the second most frequent neurodegenerative disease. Despite the fact that its etiology is not completely understood, it is known that DP is caused by environmental and genetic factors. Thus, the investigation of etiologic factors and mechanisms responsible for the changes that lead to DP may help early diagnostic and prevention. A possible association between DP and the common polymorphism of Brain Derived Neurotrophic Factor (BDNF) G196A (Val66Met) has been suggested by different studies with contrasting results. For this reason, the aim of this study is to investigate if the BDNF Val66Met polymorphism is related to susceptibility to DP in a cohort of Brazilian patients. Additionaly, we verify if the presence of the polymorphism implies in alterations in the BDNF whole blood concentrations, as well as variations in symptomatology. The sample comprised Brazilian patients accompanied by the neurology service of the Onofre Lopes University Hospital (HUOL) and healthy controls (CTRL). The motor aspects of DP were evaluated by Hoehn e Yahr Scale (HY), Unified Parkinson’s Disease Rating Scale (UPDRS) and Schwab & England Scale (SE). For the evaluation of non-motor symptoms were used the following instruments: Frontal Assessment Battery (BAF), Mini-Mental State Examination (MEEM), Beck Depression Inventory (IDB) and the Beck Anxiety Inventory (IAB). Blood samples were collected for BDNF Val66Met polymorphism genotyping and BDNF whole blood measurement. As expected, DP patients performed worse in motor, cognitive and emotional battery of questionnaires. Alleles distribution between DP and CTRL was not significantly different, but the A/G genotype was significantly associated with a protector factor for DP. In contrast, the G/G genotype was significantly associated with depression and anxiety development in DP patients. However, BDNF concentrations were not different between genotypes or groups. This is the first study of genetic association of this polymorphism with DP in Brazilian subjects and the first one that associate A/G genotype with protection against DP.