La enfermedad respiratoria crónica: reflexiones en el contexto del sistema de salud colombiano

La enfermedad respiratoria crónica (ERC) es un problema de salud pública en Colombia, cuya gravedad va en aumento por la presencia de factores de riesgo, como el tabaquismo, que tienden a imponerse en poblaciones cada vez más jóvenes y que con el tiempo generan consecuencias a nivel físico, social y mental. La ERC comprende una serie de entidades clínicas con características propias, dadas por el sufrimiento, el aislamiento social, el deterioro fisiológico y la morbilidad asociada, que contribuyen a la limitación funcional, a la pérdida de la calidad de vida y, en definitiva, pueden convertir al individuo que la padece en un ser dependiente y sin futuro. Lo anterior lleva a un mayor consumo de recursos en salud sin que esto signifique una mejor atención, ya que en muchas oportunidades los esfuerzos aislados, la falta de normatividad, de propuestas sustentadas y el no uso de guías clínicas, entre otras causas, consienten que la intervención realizada esté destinada a paliar los síntomas presentes, pero lejos de abarcar un manejo integral, efectivo y que responda a necesidades individuales. En este artículo se pretende analizar las normas y políticas públicas que cobijan a los pacientes con ERC, los aspectos relacionados con los derechos a un tratamiento integral, seguro y real en el individuo afectado, así como los obstáculos para su realización.

Educació i integració en el cas de la comunitat marroquina a Girona. Una anàlisi entre el país d'origen i el d'assentament

La recerca s'ha desenvolupat a través d'un estudi que ha interrelacionat el procés d'integració social i cultural de la comunitat marroquina en la societat d'assentament amb la integració escolar dels infants i joves en els centres d'educació obligatòria. El que suposa una anàlisi del paper integrador que l'escola desenvolupa i pot desenvolupar, i també una reflexió sobre la interculturalitat i l' educació intercultural com a posicionament que afavoreix la integració plural. Tot aquest treball s'ha desenvolupat des d' una perspectiva articulada, ja que permet una major comprensió del fet migratori que es viu a una i altra banda de la Mediterrània. La investigació s 'ha desenvolupat en un paradigma sociocrític i a través d'un procés etnogràfic (observació, relats de vida, entrevistes ... ) al llarg de quasi tres anys, que ha estudiat i ha analitzat des d' una perspectiva comprensiva i transformadora, com la comunitat marroquina valora l'escolarització dels infants i joves des de les concepcions d'educació i d'escola que ha construït a través: 1. El procés migratori, entenent-lo mitjançant l' emigració i la immigració, en una perspectiva articulada. 2. El procés d'integració sociocultural en la societat d'arribada. El treball realitzat ha plantejat un marc teòric de tipus interdisciplinar -que s'ha estès al llarg de la investigació- per tal de situar el procés migratori, el concepte d'integració en la societat d'avui, des d'una perspectiva habermasiana i el paper de l'educació i de l'escola des d'una posicionament comunicatiu. Un cop presentat el marc teòric s'ha estudiat el procés migratori situant-se primer en el context de partida, el Marroc, realitzant una anàlisi que s'ha desenvolupat mitjançant factors socioculturals i educatius que en aquest darrer cas s'han ubicat sobre: l'educació en l'islam i en l'actual sistema d'ensenyament nacional. Posteriorment s'ha estudiat el context d'immigració a través d'aspectes demogràfics, jurídics, socioculturals i educatius. Presentant en aquest darrers un perfil socioformatiu de l'alumnat d'origen marroquí a través d'un estudi realitzat a la província de Girona. En els últims capítols s'exposen, primer situant-se en el Rif Oriental (Marroc), la ciutat de Nador i el seu entorn, de forma mes breu, i després amb extensió sobre l'espai de les comunitats marroquines d'Angles i Palafrugell a Catalunya, localitats de les comarques gironines, les característiques del context sociocutural i escolar, com a elements sobre el quals analitzar el procés d'integració sociocultural i escolar en el context d'assentament. La recerca també ha recollit l'opinió i l'experiència dels treballadors i famílies d'origen marroquí sobre l'escolarització dels infants i joves de la comunitat marroquina i sobre les expectatives que els pares i adults tenen de l'escola corn a institució formativa i integradora. Finalment es presenta una anàlisi, partint de la inforrnació obtinguda, que interrelaciona el procés d'integració sociocultural i escolar en el país d' assentament que ha aportat els següents referents i orientacions: 1. El procés d'integració de la comunitat marroquina mostra que es dóna un replegament sobre si mateixa que dificulta la integració plural. Aquest replegament es dóna mitjançant els valors de la tradició i de l'islam que són simultàniament, elements de cultura i de control. 2. Cal analitzar la integració en funció del model d' integració dominant en la societat d'arribada que es basa sobretot en aspectes funcionals: econòmics, jurídics i productius. 3. La integració en els àmbits morals: drets i deures, i en els aspectes simbòlics: identitats i identificacions són dominats en el primer cas per l'assimilació en els aspectes socials, culturals i productius, i pels estereotips en els aspectes identitaris i d'identificació. Aquesta situació comporta la necessitat de desenvolupar un model d'integració escolar que ha de tenir corn a referent que l'escola no pot integrar ni l'alumnat pot integrar-se si viu un procés de marginació o exclusió fora del centre i si el centre educatiu no és conscient d'allò que succeeix al seu entorn i a l'alumnat més enllà del context escolar. 1- Ha de procurar la integració de l'alumnat en la xarxa relacional i formativa del centre. 2- Ha d'aconseguir la integració de l'alumnat a l'aula. 3- Ha de tenir present que les accions integradores, abans esmentades, han d'afavorir la integració de l'alumnat fora de l'espai escolar i en una perspectiva de futur, ha d' afavorir la integració sociolaboral. Per tant, l'escola ha de plantejar-se que és necessari establir un diàleg amb totes les famílies a través d'un nou model de participació en el qual l'escola passi de ser un lloc de pas a un lloc de trobada. Aquesta dinàmica també replanteja ara les actuals fronteres entre allò públic i privat, entre l'escola i la família, amb l' objectiu de descobrir les coincidències entre els projectes social, cultural i educatiu d'ambdues institucions.

Perceptions of informal safety nets: a case study from a South African informal settlement

The relevance and importance of informal safety nets that buffer poor households from livelihood hardships have been given little attention in South Africa’s development programmes to date. This article contributes to the understanding of informal safety nets by investigating local perceptions in a South African informal settlement. The main findings of the study are that families perform an important safety net function, but that these sources of assistance can be susceptible to social isolation. Immediate neighbours and friends also play an important safety net role, but these reciprocal-based sources of assistance may be difficult to secure. Community-wide threats can have a severe impact on people’s ability to engage in safety net transfers. Many of these difficulties stem from South Africa’s structural unemployment crisis. This factor is the greatest danger to the future of the informal safety net system in the informal settlement.

The experience of friendship, victimization and bullying in children with an autism spectrum disorder: associations with child characteristics and school placement

Children with an autism spectrum disorder (ASD) may be vulnerable to social isolation and bullying. We measured the friendship, fighting/bullying and victimization experiences of 10–12-year-old children with an ASD (N = 100) using parent, teacher and child self-report. Parent and teacher reports were compared to an IQ-matched group of children with special educational needs (SEN) without ASD (N = 80) and UK population data. Parents and teachers reported a lower prevalence of friendships compared to population norms and to children with SEN without an ASD. Parents but not teachers reported higher levels of victimization than the SEN group. Half of the children with an ASD reported having friendships that involved mutuality. By teacher report children with an ASD who were less socially impaired in mainstream school experienced higher levels of victimization than more socially impaired children; whereas for more socially impaired children victimization did not vary by school placement. Strategies are required to support and improve the social interaction skills of children with an ASD, to enable them to develop and maintain meaningful peer friendships and avoid victimization.

The experience of the hidden curriculum for autistic girls at mainstream primary schools

This article presents the findings of ethnographic case studies of three girls on the autistic spectrum attending mainstream primary schools and illustrates the difficulties they experience and the ways in which these are often unrecognised. The observations of the girls and subsequent individual interviews with their mothers, class teachers, SENCO’s and ultimately themselves, reveal the personal adjustments the girls make in response to the hidden curriculum and the ways in which these go unnoticed, effectively masking their need for support, and contributing to their underachievement in school. The research also identifies a misunderstanding of autism in girls by some teachers that contributes to a lack of support for their needs, despite their diagnosis. Teachers need to understand how autistic girls present, and how they learn, if they are to recognise the need to illuminate the hidden curriculum. The implications of these findings are that without this awareness autistic girls in mainstream settings are also at risk of limited access to the known curriculum and of social isolation.

Eag 1, Eag 2 and Kcnn3 gene brain expression of isolated reared rats

The Eag1 and Eag2, voltage-dependent potassium channels, and the small-conductance calcium-activated potassium channel (Kcnn3) are highly expressed in limbic regions of the brain, where their function is still unknown. Eag1 co-localizes with tyrosine hydroxilase enzyme in the substantia nigra and ventral tegmental area. Kcnn3 deficiency leads to enhanced serotonergic and dopaminergic neurotransmission accompanied by distinct alterations in emotional behaviors. As exposure to stress is able to change the expression and function of several ion channels, suggesting that they might be involved in the consequences of stress, we aimed at investigating Eag 1, Eag2 and Kcnn3 mRNA expression in the brains of rats submitted to isolation rearing. As the long-lasting alterations in emotional and behavioral regulation after stress have been related to changes in serotonergic neurotransmission, expressions of serotonin Htr1a and Htr2a receptors in male Wistar rats` brain were also investigated. Rats were reared in isolation or in groups of five for nine weeks after weaning. Isolated and socially reared rats were tested for exploratory activity in the open field test for 5 min and brains were processed for reverse-transcription coupled to quantitative polymerase chain reaction (qRT-PCR). Isolated reared rats showed decreased exploratory activity in the open field. Compared to socially reared rats, isolated rats showed reduced Htr2a mRNA expression in the striatum and brainstem and reduced Eag2 mRNA expression in all examined regions except cerebellum. To our knowledge, this is the first work to show that isolation rearing can change Eag2 gene expression in the brain. The involvement of this channel in stress-related behaviors is discussed.

Elitidrottsproblem? : En kvalitativ studie om elitidrottares karriäravslutning

This paper used a qualitative technique from a social scientific perspective, a model based on Hewitt and his theory of the self-concept. The purpose of this study was to investigate why some elite athletes experience troublesome periods after their career ending. Interviews were performed with five elite athletes with varying experiences after career ending. The length of the elite athlete careers vary between 7 to 17 years. Two groups were made based upon experiences after career ending. Group 1 had experienced problems, for example suicide tendency, and group 2 had not. The result shows that a troublesome period can come up independently of career ending. The self-concept was investigated during the career and further different kind of variables which could affect the self as training and competition, social relations both before and after termination from sport. Result indicates that an individual in group 2 who has a high complexity in the self-concept based upon significant others outside the elite sport during the career copes with the new situation after career ending much better than group 1 who have not. To build up the self based only upon significant others in the elite sport seems to give expression in a strengthen self. Intensity in training and competition did not have a connection with a troublesome period after retirement from sport but it could prevent establishing contact with others outside the elite sport and reduce a high complexity in the self-concept. The result further shows that elite athletes who practise an individual sport trains in to a greater extent than elite athletes in a seasonal sport. Result also shows that practising a sport with one day off a week, contributes to better opportunities for developing a higher complexity in the self-concept. Suspicions has also rouse that practising an elite sport on the highest level can lead to extensive focusing that further leads to social isolation from individuals outside elite sport. To build up the self upon significant others outside elite sport during the career and keep in touch with significant others from elite sport after the career seems to be the key to avoid problems after the career ending. Suggestions about further investigations are made to see if medial exposure and status can affect the self.

Uma análise empírico-exploratória acerca do impacto do teletrabalho na carreira do teletrabalhador

This dissertation aims at understanding the impacts of telework in the teleworker's career by means of an empiric-exploratory analysis. To this end, we have analyzed the speech of teleworkers of an American multinational company in order to achieve an interpretation capable of identifying common aspects of said speeches. In this process, we have also dealt with issues such as infrastructure, social isolation, productivity, familiar environment, contact with other co-workers, allocation of private and work hours, and elements which motivated the choosing of work option. These factors were highly important for providing a better understanding of the work environment, and for completely covering the impacts of telework in the teleworker¿s career.

Jardins periféricos: estudo comparativo de dois loteamentos populares no município de Taboão da Serra

A presente monografia tem por foco de estudo os loteamentos populares que são a forma mais usual de produção produção de habitação para a população-de-baixa renda nas grandes cidades brasileiras. A margem dos programas habitacionais empreendidos por organismos estatais, por demais burocratizados e ínfimos se comparados à demanda que deveriam suprir, os loteamentos periféricos empreendidos por particulares sempre existiram nos arredores das grandes cidades.

Fenômeno vivido por familiares de pacientes internados em unidade de terapia intensiva

COMASSETTO, Isabel, ENDERS, Bertha Cruz. Fenômeno vivido por familiares de pacientes internados em Unidade de Terapia Intensiva. Revista Gaúcha de Enfermagem., Porto Alegre(RS), v.30,n., p.46-53. Mar. 2009. Disponivel em: < http://www.seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/search/results>.

Vivências de familiares do paciente internado em unidade de terapia intensiva: estudo fenomenológico

This study originated from my concerns as critical care nurse, regarding the lived experience of the family member of the patient that is hospitalized in the intensive care unit - ICU. The purpose of the study was to comprehend the experience of the family members while having a loved one interned in an ICU, and to identify the common elements of the phenomenon, based on the descriptions of their experiences. Considering that the object of study involves subjective and social questions, the study was conducted using some fundamental ideas of descriptive phenomenology as a referential and the situated phenomenon as suggested by Martins and Bicudo (1989). Ten (10) family members of patients that were interned in the ICU of private hospital in Natal, RN were interviewed using the following leading question: What is it like to have a member of your family interned in the ICU? Five thematic structural categories emerged from the comprehensive analysis of the interviews: Fear of the family member s death; Lack of humanization; Social isolation; Confidence in the ICU; and Overload to the personal life. The description of the phenomenon enabled a new look at how the care team relates to the family members of the patients interned in the ICU, providing some guidance on how to construct a humanized care that involves the family and that is based on affective human relations. This involves a rethinking of the care provided by team to the family and stimulates the reformulation of personal and social attitudes, and of hospital organizational norms

O processo de cuidar do enfermeiro em unidade de terapia intensiva: uma análise dos conhecimentos utilizados

Care has always been present in the history of humanity and in contemporary nursing it is considered to be a fundamental characteristic. In the Intensive Care Unit (ICU), care occurs within an environment that is known for its stressful factors, technological equipment, social isolation and discomfort. Whilst the reality of nursing practice in ICU demonstrates the lack of planned and systematized care, there is an indication that the professionals working in this setting utilize some type of knowledge. Based on that premise, in this study we aim to identify the knowledge that the nurses use in providing care in the ICU. We believe that the identification and characterization of this knowledge, and how it presents itself in practice, requires a reflective analysis process. Therefore, we utilized a qualitative perspective and Kim´s (1999) investigative methodology of reflective inquiry that is based on the precepts of Action Science proposed by Argyris et al. (1985). The study was conducted with 8 intensive care nurses of a public hospital. Data were collected by means of non-participative observation of the nursing care actions and a semi-structured interview conducted within the reflective mode that focused on the nurses practice in the ICU. The results enabled us no only to detect that the nurses utilized knowledge and patterns of knowledge acquired or constructed, but to identify them as: scientific, philosophic, religious, empirical, personal, ethical, and esthetic knowledge. The predominance of the scientific knowledge in the care process suggests that these nurses hold an acquired scientific substance that they utilize to provide specialized care directed toward critical treatment. The conception of this reality surpasses the theoretical limits, the techniques, and the known facts, and denotes the need for a reflective process in action to aide in the comprehension of the knowledge involved in the construction of excellent care

Avaliação comportamental e neuroquímica de ratos em dessincronização forçada: possíveis implicações para um modelo animal de oscilações no humor

Bipolar disorder has been growing in several countries. It is a disease with high mortality and has been responsible by the social isolation of the patients. Bipolar patients have alterations in circadian timing system, showing a phase shift in various physiological variables. There are several arguments demonstrating alterations in circadian rhythms may be part of the bipolar disorder pathophysiology. Given the necessity for further elucidation, the goal of this study was to validate the forced desynchronization protocol as an animal model for bipolar disorder. To do this, Wistar rats were submitted to a forced desynchronization protocol which consists in a symmetrical light dark cycle with 22h. Under this protocol, rats dissociate the locomotor activity rhythm into two components: one synchronized to the light / dark cycle with 22h, and another component with period longer than 24 hours following the animal endogenous period. These rhythms with different periods sometimes there is coincidence, which we named CAP (Coincidence Active Phase) and the opposite phase, non-coincidence, called NCAP (Non-Concidence Active Phase). The hypothesis is that in CAP animals present a mania-like behavior and animals in NCAP depressive-like behavior. We found some evidence described in detail throughout this thesis. In sum, the animals under forced desynchronization protocol were more stressed, showed an increase in stereotypic behaviors such as grooming and reduction in other behaviors such as risk assessment and vertical exploration when compared to the control group. The CAP animals showed increased locomotor activity, especially during the dark phase when compared to controls (rats under T24) and less depressive behavior in the forced swim test. The animals in NCAP showed a higher anxiety in elevated plus maze, but they don t have ahnedonia. The animals under dissociation have more labeled 5HT1A cells at the amygdala area, which appoint that they have more amygdala inhibition. Taking these data together, we could partially validated the forced desynchronization protocol as an animal model for mood oscillations

Efeitos de diferentes tipos estressores sobre a memória e aprendizagem de ratas

The exposure to stressors produces physiological changes of the organism in order to adapt the individual to the environment. Depending on the type, intensity and duration, stress can affect some cognitive functions, particularly processes of learning and memory. Several studies have also proposed that some level of anxiety would be necessary for memory formation. In this context, memories of previously aversive experiences may determine the manner and intensity with which are expressed fear responses, which explains the great interest in analyzing both anxiety and memory in animals. In addition, males and females demonstrate different reactions in relation to stressful stimuli, showing different levels of anxiety and differences in processing of the acquisition, retention and recall of information. Based on this information, the present study aimed to verify the effect of stress on learning, memory and anxiety behavioral parameters in rats exposed at different types of stressors of long duration (seven consecutive days): restraint (4h/day), overcrowding (18h/day) and social isolation (18h/day) in the different phases of the estrous cycle. Our results showed that the stress induced by restraint and social isolation did not cause changes in the acquisition process, but impaired the recall of memory in rats. Furthermore, it is suggested a protective effect of sex hormones on retrieval of aversive memory, since female rats in proestrus or estrus phase, characterized by high estrogen concentrations, showed no aversive memory deficits. Furthermore, despite the increased plasma levels of corticosterone observed in female rats subjected to restraint stress and social isolation, anxiety levels were unaltered, compared to those various stress conditions. Animal models based on psychological and social stress have been extensively discussed in the literature. Correlate behavioral responses, physiological and psychological have contributed in increasing the understanding of stress-induced psychophysiological disorders

Vivenciando a sobrecarga ao vir-a-ser um cuidador familiar de pessoa com acidente vascular cerebral (AVC): análise do conhecimento

Trata-se de trabalho do tipo bibliográfico com a finalidade de fazer uma análise temática da produção do conhecimento em periódicos, acerca da sobrecarga em cuidadores familiares de pessoas com Acidente Vascular Cerebral (AVC). O corpus de análise reuniu artigos localizados nas décadas de 80 e 90, a partir das bases de dados Medline, Lilacs e Cinahl. A análise de conteúdo foi o referencial metodológico que permitiu organizar todo o conhecimento, em um corpo de categorias e subcategorias, denominadas: Categoria 1 - As seqüelas do AVC gerando sobrecarga; Categoria 2 - Aspectos gerando sobrecarga, congregando as subcategorias: o isolamento social, as mudanças e as insatisfações conjugais, as dificuldades financeiras e os déficits na saúde física e no autocuidado do cuidador; Categoria 3 - Outras análises relacionadas à sobrecarga em cuidadores familiares.