Qualidade de vida do cuidador de enfermagem e sua relação com o cuidar; Quality of life of the nursing caregiver and its relationship with care

Objective:To identify aspects that affect the quality of life of nursing caregivers and their relationship with care in an Intensive Care Unit for Adults (A-ICU). Methods:This was a descriptive study with qualitative approach, taking as subjects 21 professionals who constitute the nursing staff of the A-ICU of a school hospital in Maringá-PR. Unstructured interview was used as a strategy to collect data, conducted between May and June 2009. Data analysis was based on the method of content analysis. The categories identified were: overlooking improvement in quality of life related to the resources in an A-ICU; the quality of life influencing the form of care; interpersonal relationships into the health team reflecting on the quality of life and care. Results:The analysis of caregivers’ speech and the results of the observation showed that there is correlation between the aspects they consider influential in their quality of life and the way of caring for patients in an A-ICU.Conclusion: The findings indicate that, among the influential aspects, the stressful factors overlap the enhancing ones. From this perspective, dealing with caregiver’s suffering might be the starting point for the improvement in quality of care in an A-ICU.

Dor crónica : percepções, limitações e implicações. Uma perpectiva social

A dor crónica (DC) é um fenómeno complexo que interfere na vida dos indivíduos ao nível do bem-estar, nas relações familiares e sociais, e na vida profissional, provocando alterações biológicas, psicossociais e, na maioria das vezes, sofrimento. Associada às limitações físicas, profissionais e sociais, a DC compromete a qualidade de vida (QDV) e promove a insegurança, resultando em perdas materiais e sociais consideráveis. Neste contexto é fundamental uma abordagem multidimensional na avaliação da dor, de modo a encontrar uma resposta célere e adequada às necessidades de cada indivíduo. A avaliação deve ter em conta, além dos factores físicos, os factores psicológicos e os sociais. Os autores, neste artigo, reforçam a ideia que, qualquer avaliação e/ou intervenção que seja feita em pessoas com DC, deve ter sempre em conta os factores internos e externos do meio em que o indivíduo está inserido e que influenciam o modo como este percepciona e avalia a sua dor.

Nanotecnologia e a sua aplicação à terapêutica oncológica

A nanotecnologia, e a sua aplicação na área da biomedicina, em particular na terapêutica e diagnóstico oncológico, tem sido alvo de um desenvolvimento exponencial, com impacto profundo no que respeita a cuidados de saúde. O cancro é uma das doenças que afecta mais pessoas a nível mundial, com elevados índices de mortalidade, níveis de sofrimento físico e emocional e, encargos para o doente, família e sociedade. É uma doença complexa, e a prática clínica convencional constitui um paradigma, na medida em que se revela insuficiente e extremamente agressiva, expondo o doente a medicamentos citotóxicos, não específicos, com elevada toxicidade sistémica e efeitos adversos. A Nanomedicina, e a exploração das propriedades únicas das nanopartículas, apresenta a potencialidade de melhorar a capacidade de detecção e diagnóstico do cancro e, aumentar a especificidade e efectividade no tratamento das células tumorais. No entanto, o recurso a nanotecnologias continua a ser alvo de alguma controvérsia e cepticismo por parte de alguns elementos das comunidades científicas e académica. Com nanoprodutos já aprovados e utilizados em prática clínica e muitos outros em desenvolvimento e investigação em ensaios clínicos, a realização deste trabalho tem como objectivo compreender os conceitos de nanotecnologia e Nanomedicina, perceber o estado da arte, ponderando as vantagens e desvantagens da abordagem “nano” e a sua real aplicação à terapêutica oncológica.

As Relações entre Filhos/as de Santo e Espíritos no Cosmo Religioso Umbandista : uma abordagem a partir do contexto de Viçosa/AL

Contundentemente, espíritos do cosmo religioso umbandista estão e interferem na vida dos filhos/as de santo ou como proclama a religiosidade umbandista, nos seus ‘cavalos’. Este trabalho pesquisa oito terreiros de Umbanda inseridos no município de Viçosa/Alagoas, por meio das relações existentes entre filhos/as de santo e espíritos neste cosmo religioso ímpar e multifacetado. Para o desenvolvimento desta pesquisa, fez-se uso de um aparato metodológico que possibilitou compreender fenomenologicamente este processo análogo circunscrito em discursos sobre ‘marcas’ ou ‘sofrimentos’ resultantes das atitudes negligenciais dos filhos/as de santo que constituem a memória umbandista viçosense. Pretendeu-se mostrar também que o imbricamento dos aspectos relacionais como: reverência, temor, devoção, respeito, esperança, fidelidade, dedicação e obediência às entidades cultuadas, configuram-se nessa dinâmica relacional. Este cosmo religioso traz em seu arcabouço existencial discursos e situações vivenciadas em todas as esferas da vida desses filhos/as de santo, principalmente religiosa. O presente trabalho apontou, portanto, a relação de interdependência existente como fruto dessa religiosidade marcada por fé e mistérios.

Baldomera: el instinto y la irrupción del cuerpo (Del Fabulador)

La autora parte de la concepción de Alfredo Pareja sobre el acto de escribir (sostiene que a través de sus personajes logró dar vida a sus ideas y proyectos políticos), y afirma que un ejemplo cabal de ella es la construcción de la mulata Baldomera. Reflexiona entonces sobre el autor, a partir de su biografía y de la creación de sus personajes. Baldomera sería una metáfora de la mujer de la época, ubicada entre la sujeción y la búsqueda de una autonomía, en este proceso ella se rebela, no contra los hombres, sino fundamentalmente contra su cuerpo, contra sí misma, evidenciando la doble moral de la mentalidad patriarcal, que persigue la sumisión de la mujer por medio de la violencia. Entonces, "¿qué representa Baldomera? Es un cuerpo roto, escindido, marcado y sufriente. Una muestra de la obscenidad de la miseria".

Destierro y redención: el «síndrome de Adán y Eva» en La belleza del mundo de Héctor Tizón (Crítica)

En este ensayo, el autor plantea un diálogo entre la novela La belleza del mundo, de Héctor Tizón, y los arquetipos bíblicos de Adán y Eva, la pérdida del paraíso y el destierro, y el retorno al Edén. A partir de la traición primigenia de la esposa del protagonista, se inicia la integración a un tiempo cíclico e infinito –el del exilio. En el destierro, el protagonista está marcado por su afán de anular la temporalidad real y, a la vez, su propia identidad, intenta forzosamente olvidar la propia historia, lo cual lo conduce a una crisis de identidad. Al cabo de un largo recorrido, se plantea la necesidad de incorporar los acontecimientos de la vida a un tiempo mítico que regenere y perpetúe todas las acciones, y en el cual se busque el sufrimiento para alcanzar la salvación. El autor evidencia paralelismos diversos del texto con la doctrina cristiana: el protagonista comprende que para regresar a su propio centro debe perdonar. Y eso solo es posible regresando, enfrentando su pasado: el tiempo de redención es un regreso, pero el mismo-nuevo sitio no vuelve a ser jamás el paraíso.

Jorge Velasco Mackenzie: tatuaje de náufragos es la única novela en la que me he divertido escribiendo (De la Escena Contemporánea)

El autor entrevista al narrador guayaquileño Jorge Velasco Mackenzie, quien responde sobre su oficio de escritor. Velasco sostiene que sufre con sus personajes y agoniza cuando estos mueren. Mira a Tatuaje de náufragos como un homenaje a un bar generacional, a una época y una forma de ser artista que ya no existen más, sería la autopsia de una generación y de la ciudad. Velasco sostiene que el poeta Fernando Nieto no solo fue un animador de la bohemia del Montreal, el fundador de Sicoseo, sino un hombre que sabía mucho, y un hombre generoso en lo personal, admira la posición de Nieto frente al mundo, frente a la literatura. En los escritos de Velasco siempre está Guayaquil, porque es el lugar donde nació y es el único donde puede vivir. Podría decirse que escribir sobre Guayaquil es su proyecto estético. Considera al Montreal como un lugar vivo, abierto, con sus personajes y su rocola antigua, lo evocó así toda su vida y a lo largo del libro intentó devolverle ese esplendor.

"Ella", de Juan Carlos Onetti. Necrofilia y ficción (Homenaje)

La autora reflexiona sobre el relato “Ella”, del uruguayo Juan Carlos Onetti, y sobre otras representaciones de la muerte de Eva Perón, escritas por Jorge Luis Borges, David Viñas y Néstor Perlongher. Afirma que en la Argentina de Perón ya confluían realidad y ficción, y que las múltiples biografías de Eva serían “un duelo de versiones narrativas entre la ficción y la historia o, si se prefiere, una metáfora de la historia”. Rosano plantea que, en los textos revisados, es la realidad la que adopta contornos fantasmagóricos, disparados por motivos diversos: la descomposición y el tópico del mal olor, la impostura del cuerpo embalsamado y del mandatario, el entrelazamiento entre lo político y lo sexual en la escena del velorio, la imagen de Eva, “una diosa que muestra sus encajes de novia de suburbio” pero también una siniestra y doliente “zombi escarlata”. Señala, finalmente, que los textos muestran a los fieles, esos “miles de necrófilos murmurantes y enlutados”, sometidos a la potencia del mito.

EU global peace diplomacy. CEPS Commentary, 15 October 2012

Steven Blockmans characterises the award of the Nobel Peace Prize to the EU as “a marvellous honour and a much-needed boost" for an integration project that is suffering grave economic difficulties and considerable social unrest, but he regrets that the growing role of the EU to act as a peacemaker beyond its geographical borders was not acknowledged in the award announcement.

The social impacts of heat waves

The effects of the 2003 European heat wave have highlighted the need for society to prepare itself for and cope more effectively with heat waves. This is particularly important in the context of predicted climate change and the likelihood of more frequent extreme climate events; to date, heat as a natural hazard has been largely ignored. In order to develop better coping strategies, this report explores the factors that shape the social impacts of heat waves, and sets out a programme of research to address the considerable knowledge gaps in this area. Heat waves, or periods of anomalous warmth, do not affect everyone; it is the vulnerable individuals or sectors of society who will most experience their effects. The main factors of vulnerability are being elderly, living alone, having a pre-existing disease, being immobile or suffering from mental illness and being economically disadvantaged. The synergistic effects of such factors may prove fatal for some. Heat waves have discernible impacts on society including a rise in mortality, an increased strain on infrastructure (power, water and transport) and a possible rise in social disturbance. Wider impacts may include effects on the retail industry, ecosystem services and tourism. Adapting to more frequent heat waves should include soft engineering options and, where possible, avoid the widespread use of air conditioning which could prove unsustainable in energy terms. Strategies for coping with heat include changing the way in which urban areas are developed or re-developed, and setting up heat watch warning systems based around weather and seasonal climate forecasting and intervention strategies. Although heat waves have discernible effects on society, much remains unknown about their wider social impacts, diffuse health issues and how to manage them.

Unravelling the rationale of 'overgrazing' and stocking rates in the beef production systems of Central Brazil using a bi-criteria compromise programming model

In Central Brazil, the long-term sustainability of beef cattle systems is under threat over vast tracts of farming areas, as more than half of the 50 million hectares of sown pastures are suffering from degradation. Overgrazing practised to maintain high stocking rates is regarded as one of the main causes. High stocking rates are deliberate and crucial decisions taken by the farmers, which appear paradoxical, even irrational given the state of knowledge regarding the consequences of overgrazing. The phenomenon however appears inextricably linked with the objectives that farmers hold. In this research those objectives were elicited first and from their ranking two, ‘asset value of cattle (representing cattle ownership)' and ‘present value of economic returns', were chosen to develop an original bi-criteria Compromise Programming model to test various hypotheses postulated to explain the overgrazing behaviour. As part of the model a pasture productivity index is derived to estimate the pasture recovery cost. Different scenarios based on farmers' attitudes towards overgrazing, pasture costs and capital availability were analysed. The results of the model runs show that benefits from holding more cattle can outweigh the increased pasture recovery and maintenance costs. This result undermines the hypothesis that farmers practise overgrazing because they are unaware or uncaring about overgrazing costs. An appropriate approach to the problem of pasture degradation requires information on the economics, and its interplay with farmers' objectives, for a wide range of pasture recovery and maintenance methods. Seen within the context of farmers' objectives, some level of overgrazing appears rational. Advocacy of the simple ‘no overgrazing' rule is an insufficient strategy to maintain the long-term sustainability of the beef production systems in Central Brazil.

Unravelling the rationale of 'overgrazing' and stocking rates in the beef production systems of Central Brazil using a bi-criteria compromise programming model

In Central Brazil, the long-term, sustainability of beef cattle systems is under threat over vast tracts of farming areas, as more than half of the 50 million hectares of sown pastures are suffering from. degradation. Overgrazing practised to maintain high stocking rates is regarded as one of the main causes. High stocking rates are deliberate and crucial decisions taken by the farmers, which appear paradoxical, even irrational given the state of knowledge regarding the consequences of overgrazing. The phenomenon however appears inextricably linked with the objectives that farmers hold. In this research those objectives were elicited first and from their ranking two, 'asset value of cattle (representing cattle ownership and 'present value of economic returns', were chosen to develop an original bi-criteria Compromise Programming model to test various hypotheses postulated to explain the overgrazing behaviour. As part of the model a pasture productivity index is derived to estimate the pasture recovery cost. Different scenarios based on farmers' attitudes towards overgrazing, pasture costs and capital availability were analysed. The results of the model runs show that benefits from holding more cattle can outweigh the increased pasture recovery and maintenance costs. This result undermines the hypothesis that farmers practise overgrazing because they are unaware or uncaring caring about overgrazing costs. An appropriate approach to the problem of pasture degradation requires information on the economics,and its interplay with farmers' objectives, for a wide range of pasture recovery and maintenance methods. Seen within the context of farmers' objectives, some level of overgrazing appears rational. Advocacy of the simple 'no overgrazing' rule is an insufficient strategy to maintain the long-term sustainability of the beef production systems in Central Brazil. (C) 2004 Elsevier Ltd. All rights reserved.

Evaluating the role of environmental quality in the sustainable rural economic development of England

The issue of the sustainable development of rural economies in England has recently received considerable attention. This is because many of the poorest areas in the country are rural, often of high environmental quality, but suffering from high unemployment and a lack of services and facilities. The rapid decline in agricultural incomes and in-migration of affluent urban workers since 1990 has exacerbated economic inequality in such areas. A number of factors have the potential to drive rural development and this paper applies, and considers, the feasibility of a method from the USA for combining economic and environmental variables in a regional growth model to examine the hypothesis that environmental quality is an important determinant of sustainable rural development in England. The model output suggests that, although environmental quality does play a role in sustainable rural development in England there are other, more important, factors driving development. These include business and communications infra-structure, the degree and opportunities for commuting and underlying employment prospects. The robustness and limitations of the method for combining economic and environmental variables is discussed in relation to the spatial interrelatedness of Local Authority Districts in England, and conclusions are drawn about areas for refinement and improvement of the method.

An evaluation of a Bayesian method of dose escalation based on bivariate binary responses

Recently, various approaches have been suggested for dose escalation studies based on observations of both undesirable events and evidence of therapeutic benefit. This article concerns a Bayesian approach to dose escalation that requires the user to make numerous design decisions relating to the number of doses to make available, the choice of the prior distribution, the imposition of safety constraints and stopping rules, and the criteria by which the design is to be optimized. Results are presented of a substantial simulation study conducted to investigate the influence of some of these factors on the safety and the accuracy of the procedure with a view toward providing general guidance for investigators conducting such studies. The Bayesian procedures evaluated use logistic regression to model the two responses, which are both assumed to be binary. The simulation study is based on features of a recently completed study of a compound with potential benefit to patients suffering from inflammatory diseases of the lung.

Opportunities for reduction in acute toxicity testing via improved design

The conventional method for assessing acute oral toxicity (OECD Test Guideline 401) was designed to identify the median lethal dose (LD50), using the death of animals as an endpoint. Introduced as an alternative method (OECD Test Guideline 420), the Fixed Dose Procedure (FDP) relies on the observation of clear signs of toxicity, uses fewer animals and causes less suffering. More recently, the Acute Toxic Class method and the Up-and-Down Procedure have also been adopted as OECD test guidelines. Both of these methods also use fewer animals than the conventional method, although they still use death as an endpoint. Each of the three new methods incorporates a sequential dosing procedure, which results in increased efficiency. In 1999, with a view to replacing OECD Test Guideline 401, the OECD requested that the three new test guidelines be updated. This was to bring them in line with the regulatory needs of all OECD Member Countries, provide further reductions in the number of animals used, and introduce refinements to reduce the pain and distress experienced by the animals. This paper describes a statistical modelling approach for the evaluation of acute oral toxicity tests, by using the revised FDP for illustration. Opportunities for further design improvements are discussed.