Maria Amélia de Campos Oliveira

Direct Vital Microscopic Study of Defective Leukocyte-Endothelial Interaction in Diabetes Mellitus

The number of leukocytes rolling along the venular endothelium of the vascular network of the internal spermatic fascia was determined in nondiabetic control rats and diabetic rats with television microscopy. A marked decrease in the number of rolling cells was observed in animals rendered diabetic by the injection of alloxan 10, 30, or 180 days before relative to matching controls. Blood leukocyte counts, however, were equivalent in both control and diabetic rats. Under the influence of a local inflammatory stimulus, cells emerged into the perivascular tissue in control animals, and this was accompanied by a reduction in the number of rolling leukocytes. In diabetic rats, the number of rolling leukocytes remained unaltered, and only a few cells accumulated in the connective tissue adjacent to the vessel. Reversal of the defective leukocyte-endothelial interaction was attained by treatment of diabetic animals with insulin. Inhibitors of arachidonic acid metabolism were ineffective to improve leukocyte-endothelial interactions in diabetic animals. Control rats injected intravenously with lyophilized plasma constituents, obtained after dialysis of diabetic rat plasma with 12,000-M retention dialysis tubing, behaved as diabetic animals in that they exhibited a reduced number of leukocytes rolling along the venular endothelium. In contrast, material obtained from control rat plasma produced no effect. Heating of active samples for 1 h at 56°C degrees C resulted in the complete loss of the inhibitory effect. We conclude that a substance or substances present in diabetic plasma induce a defective leukocyte-endothelial interaction that further impairs resistance to infection.

Qualidade de vida dos cuidadores de pacientes dependentes no programa de saúde da família

La investigacion tuvo como objetivo evaluar la asociacion entre la calidad de vida de los cuidadores familiares de enfermos dependientes atendidos por el Programa Salud de la Familia y las caracteristicas sociales, demograficas, y de salud, asi como el grado de sobrecarga percibido y el grado de independencia funcional del enfermo. Fueron entrevistados 66 cuidadores, en el periodo de diciembre 2006 a marzo 2007, utilizando un cuestionario de caracterizacion WHOQOL-bref, Zarit Burden Interview y la Medida de Independencia Funcional para los enfermos. Hubo el predominio de mujeres cuidadoras, amas de casa, con un promedio de 50,5 anos de edad. La media de la medida de independencia funcional fue 57,82, clasificando los enfermos en dependencia modificada. La escala Zarit se correlaciono negativamente con todos los dominios del WHOQOL-bref. Las variables independientes estadisticamente relacionadas a la calidad de vida general, en el modelo multiple, fueron: escala de sobrecarga, la presencia del companero y la presencia de enfermedad en el cuidador.The objective of this study was to evaluate the association between the quality of life of family caregivers of dependent patients served by the Brazilian Family Health Program healthcare teams and socio-demographic characteristics, health condition, level of perceived burden, and degree of functional independence of the patient. Interviews were administered to 66 caregivers between December, 2006 and March, 2007, and utilizing the WHOQOL-bref; Zarit Burden Interview, and Functional Independence Measure of the patients as instruments. The caregivers were predominantly women, housewives, with an average age of 50.5 years. The average functional independence measure was 57.82, classifying the sample of patients in modified dependence. The Zarit was negatively correlated with all domains of the WHOQOL-bref. The statistically independent variables related to overall quality of life in the multiple model were: burden scale, the presence of a companion, and the presence of disease in the caregiver.

Atributos essenciais da Atenção Primária e a Estratégia Saúde da Família

The essential attributes of Primary Health Care are attention at first contact, longitudinality, completeness and coordination, and the derived attributes are family and community orientation and cultural competence. This paper discusses the presence of such attributes in Family Health Strategy, a political and governmental proposal to change the health care model in the context of the Unified Health System in Brazil.The essential attributes of Primary Health Care are attention at first contact, longitudinality, completeness and coordination, and the derived attributes are family and community orientation and cultural competence. This paper discusses the presence of such attributes in Family Health Strategy, a political and governmental proposal to change the health care model in the context of the Unified Health System in Brazil. descriptors: Health Policy; Primary Health Care; Family Health.

Validação, no Brasil, do Índice de Barthel em idosos atendidos em ambulatórios

Objective: To validate the Barthel Index for elderly patients being attended in outpatient clinics in Brazil through analysis of reliability and validity. Methods: To prove the reliability, it was used the internal consistency and to verify its validity was used the factor analysis and the validity criterions of convergence and discriminancy. Results: The reliability calculated with the alpha of Cronbach presented the value of 0.90 for the total scale. The validity analysis of convergent criterion, using the Functional Independence Measure, identified a satisfactory correlation for most areas. In the factor analysis, which retained only one domain and the 10 items of the original scale, the variance explained was 63.8%. Conclusion: The results recommend its use for evaluating the functional ability of elderly patients being treated in outpatient care in Brazil.

Aminoguanidine and the prevention of leukocyte dysfunction in diabetes mellitus: a direct vital microscopic study

1 Defective leukocyte‐endothelial interactions are observed in experimental diabetes mellitus. The present study investigated the effect of aminoguanidine, an inhibitor of advanced glycation end products formation, on leukocyte‐endothelial interactions in alloxan‐induced diabetic rats. 2 In rats anaesthetized with sodium pentobarbitone, the internal spermatic fascia was exteriorized and the microcirculation was observed by a closed‐circuit TV coupled to a microscope. The number of leukocytes rolling along the venular endothelium and sticking to the vascular wall was determined after topical application of zymosan‐activated plasma (1 mg ml−1), as well as the number of adherent and migrated cells after an irritative stimulus (carrageenan 100 μg). 3 The diabetic state decreased the number of rolling, sticking and migrated leukocytes. Pretreatment of diabetic animals with aminoguanidine (250 mg kg−1 day−1, for 18 days) normalized these values. To be effective, aminoguanidine had to be administered chronically, starting treatment before induction of the diabetic state. 4 The preventive effect was unrelated to the number of circulating leukocytes, or to the hyperglycaemia or to the hyperosmolality secondary to hyperglycaemia. 5 A non‐dialyzed (>12,000‐Mr) material in plasma from diabetic, but not normal animals, decreased the number of rolling, sticking and migrated leukocytes in recipient rats. This effect was completely abolished by chronic treatment of diabetic plasma donors with aminoguanidine. 6 The results suggest that a protein modified by glycosylation (>12 kDa) is associated with leukocyte dysfunction in diabetes mellitus and that the ability of aminoguanidine to prevent such dysfunction is related to an inhibitory effect on advanced glycation end products formation.

Rede de suporte social do idoso atendido por equipes de Saúde da Família

The aging process has specific aspects marked by the class of individuals and social groups as well as cultural, political, socio-economic and sanitary conditions of the collective groups. Social support systems are essential for meeting the specific needs of the elderly. The aim of this paper is to describe the socio-demographic profile and the social support networks of elderly patients served by the Family Health Strategy. Its a cross-sectional study with elderly patients living in Dourados, in the state of Mato Grosso do Sul (Brazil). Data were collected using a socio-demographic questionnaire and a Minimum Relationships Map for the Elderly (MMRI). Of the 503 elderly patients interviewed, 69% were female, 53.1% were illiterate, 58.3% earned less than one minimum salary and 82.9% lived with others. The MMRI showed that the family was the most important provider of care in all the dimensions assessed, but the elderly have their own small social networks. Elderly patients attended by the Family Health teams have low incomes and little formal education, and social support networks that are too small to meet their needs.

Influence of social support on the quality of life of family caregivers while caring for people with dependence

O objetivo deste estudo foi avaliar a qualidade de vida de cuidadores familiares de pessoas dependentes atendidas por equipes de Saude da Familia e a relacao com o apoio social. Foram entrevistados 66 cuidadores, utilizando o WHOQOL-bref para avaliacao da qualidade de vida, e Zarit Burden Interview para a sobrecarga. O dominio Relacoes Sociais do WHOQOL-bref obteve o segundo melhor escore. Na analise de regressao linear multipla, cuidadores do sexo feminino com menores escores de sobrecarga e aqueles que recebiam ajuda de alguem para realizar o cuidado alcancaram os maiores escores. Da mesma forma, cuidadoras com companheiros apresentaram maior escore medio na avaliacao global da qualidade de vida e saude do que as sem companheiros. Os resultados fornecem indicios da influencia da rede de apoio social na qualidade de vida e sobrecarga dos cuidadores familiares.The objective of this study was to evaluate the Quality of Life (QOL) of family caregivers of handicapped people attended at home by Family Health Teams and the relationship with their social support. Sixty-six family caregivers were interviewed using the WHOQOL-bref for a QOL evaluation and Zarit Burden Interview for the burden. The Social Relations domain of the WHOQOL-bref received the second best score within the domains of the instrument. During multiple linear regressions analysis, female caregivers, with low burden scores and who had received help from someone to perform the care, obtained the highest scores. Similarly, caregivers with partners had higher mean scores in the overall global assessment for QOL and health than those without partners. The results provide evidence of the influence of social support regarding Quality of Life and the burden perceived by family caregivers.

A historicidade das teorias interpretativas do processo saúde-doença

The interpretative theories of the health-illness process that can be identified through History have as consequence intervention projects upon the reality, in response to social needs. Until the 19 century, they could be synthesized in two main streams: ontologic and dynamic. In the ontologic conception, illness assumes the character of a natural or supernatural entity, external to the human body, that shows itself when invading it. The dynamic conception sees illness as a product of the disharmony among vital forces, and the re-establishment of the health comes of the restoration of this balance. At the end of the 18 century, the social-environmental paradigms prevailed in Europe as forms of explanation for human illness, linked to the dynamic conception, and the first evidences of the social determination of the health-illness process were formulated. The onset of the Bacteriologic Era made the ontologic conception victorious and its conquests led to the abandon of the social approaches to face the populations health problems. At the present time, one can identify the prevalence of the multicausal theory, with emphasis in the individual conditionings. This paper proposes the articulation of the individual and collective dimensions of the health-illness process, in consonance with the Theory of Nursing Praxical Intervention in Collective Health.The interpretative theories of the health-illness process that can be identified through History have as consequence intervention projects upon the reality, in response to social needs. Until the 19 century, they could be synthesized in two main streams: ontologic and dynamic. In the ontologic conception, illness assumes the character of a natural or supernatural entity, external to the human body, that shows itself when invading it. The dynamic conception sees illness as a product of the disharmony among vital forces, and the re-establishment of the health comes of the restoration of this balance. At the end of the 18 century, the social-environmental paradigms prevailed in Europe as forms of explanation for human illness, linked to the dynamic conception, and the first evidences of the social determination of the health-illness process were formulated. The onset of the Bacteriologic Era made the ontologic conception victorious and its conquests led to the abandon of the social approaches to face the populations health problems. At the present time, one can identify the prevalence of the multicausal theory, with emphasis in the individual conditionings. This paper proposes the articulation of the individual and collective dimensions of the health-illness process, in consonance with the Theory of Nursing Praxical Intervention in Collective Health.The interpretative theories of the health-illness process that can be identified through History have as consequence intervention projects upon the reality, in response to social needs. Until the 19 century, they could be synthesized in two main streams: ontologic and dynamic. In the ontologic conception, illness assumes the character of a natural or supernatural entity, external to the human body, that shows itself when invading it. The dynamic conception sees illness as a product of the disharmony among vital forces, and the re-establishment of the health comes of the restoration of this balance. At the end of the 18 century, the social-environmental paradigms prevailed in Europe as forms of explanation for human illness, linked to the dynamic conception, and the first evidences of the social determination of the health-illness process were formulated. The onset of the Bacteriologic Era made the ontologic conception victorious and its conquests led to the abandon of the social approaches to face the populations health problems. At the present time, one can identify the prevalence of the multicausal theory, with emphasis in the individual conditionings. This paper proposes the articulation of the individual and collective dimensions of the health-illness process, in consonance with the Theory of Nursing Praxical Intervention in Collective Health.

Competências para ação educativa da enfermeira

UNLABELLED The focus of this study is the interface between nursing education and nursing care in its educative dimension. OBJECTIVE To develop a profile of competencies for nursing care education from the perspective of the subjects involved. METHOD Historical and dialectical materialism was used as the theoretical and methodological framework. Competence was addressed as the conceptual category, as defined by Perrenoud, based on healthcare concepts and on instrumental knowledge as advocated by Mendes-Gonçalves. RESULTS the analysis of empirical material resulted in the creation of 10 core competencies for nursing education activities. CONCLUSION The need to give a new meaning to education action from the perspective of Popular Education implies the development of pedagogical opportunities during their undergraduate studies in order to enable students to use their knowledge and skills to develop a dialogical attitude of recognition of the subjects of nursing care.Este estudo tem como objeto a interface entre o ensino e a assistencia de enfermagem, em sua dimensao educativa. OBJETIVO: Construir perfil de competencias para acao educativa da enfermeira, a partir da perspectiva dos sujeitos envolvidos. METODO: No referencial teorico metodologico o materialismo historico e dialetico, e utilizou-se como categoria conceitual a nocao de competencia definida por Perrenoud, ancorada nas concepcoes de trabalho em saude e no saber operante de Mendes-Goncalves. RESULTADOS: A analise do material empirico, resultou a construcao de dez competencias para acao educativa da enfermeira. CONCLUSAO: A necessidade de ressignificar a acao educativa, na perspectiva da Educacao Popular, implicando o desenvolvimento de competencias mediante oportunidades pedagogicas que, durante a formacao inicial, permitam aos estudantes utilizar seus conhecimentos e habilidades em prol de atitude dialogica e de reconhecimento das necessidades dos sujeitos assistidos.

Competencies for educational activities in nursing

UNLABELLED The focus of this study is the interface between nursing education and nursing care in its educative dimension. OBJECTIVE To develop a profile of competencies for nursing care education from the perspective of the subjects involved. METHOD Historical and dialectical materialism was used as the theoretical and methodological framework. Competence was addressed as the conceptual category, as defined by Perrenoud, based on healthcare concepts and on instrumental knowledge as advocated by Mendes-Gonçalves. RESULTS the analysis of empirical material resulted in the creation of 10 core competencies for nursing education activities. CONCLUSION The need to give a new meaning to education action from the perspective of Popular Education implies the development of pedagogical opportunities during their undergraduate studies in order to enable students to use their knowledge and skills to develop a dialogical attitude of recognition of the subjects of nursing care.Este estudo tem como objeto a interface entre o ensino e a assistencia de enfermagem, em sua dimensao educativa. OBJETIVO: Construir perfil de competencias para acao educativa da enfermeira, a partir da perspectiva dos sujeitos envolvidos. METODO: No referencial teorico metodologico o materialismo historico e dialetico, e utilizou-se como categoria conceitual a nocao de competencia definida por Perrenoud, ancorada nas concepcoes de trabalho em saude e no saber operante de Mendes-Goncalves. RESULTADOS: A analise do material empirico, resultou a construcao de dez competencias para acao educativa da enfermeira. CONCLUSAO: A necessidade de ressignificar a acao educativa, na perspectiva da Educacao Popular, implicando o desenvolvimento de competencias mediante oportunidades pedagogicas que, durante a formacao inicial, permitam aos estudantes utilizar seus conhecimentos e habilidades em prol de atitude dialogica e de reconhecimento das necessidades dos sujeitos assistidos.