Education and care in nursing: passport to the learning, education, and care in health

This is an essay about care and education in nursing from integrative and converging approaches, elucidating that the dialogical process between the subject who cares and the citizen-subject who is cared must occur in a problem-maker perspective, contextualized and transversalized between the two conceptual worlds that involve the human relations. It shows furthermore that, to the professional exert the care and education, he must use a "passport" that conducts him to different "scales" of knowledge in a creative, aesthetical, ethical, political and technical approach. In which the education empowers the capacity of care and the use of it, capacitates him to intervent in a constructive/reflexive, singular/plural, dynamic/flexible way, in a given historical cultural context of relationships between subjects.     

Education, care and management technologies: a reflection based on nursing teachers' conception

This study involved the teachers of sixteen Nursing Courses at Higher Education Institutions in the State of Rio Grande do Sul and aimed to identify the care, education and management technologies that are used and/or produced in their professional praxis in professionalizing subjects. This text presents a research extract and focuses on the conceptions about the different types of technologies the teachers approached. Data were collected through a questionnaire with closed and open questions and later analyzed according to the methodological framework of content analysis. The study revealed that most teachers presented a restricted concept of the theme, manifesting difficulties for technology use and production and suggesting ways of support to overcome these difficulties, with a view to improving professional praxis.     

An in vivo OCT study of human natural accommodation in a 19-year-old albino

Modifications of the anterior segment during accommodation of the eye under examination cannot be studied in a simple and direct way with anterior segment imaging techniques such as Scheimpflug photography, A Scan, B Scan, and UBM. With this equipment, it is necessary to stimulate the fellow eye in order to observe the variations of the analyzed eye. The techniques using ultrasound equipment can only be used with contact systems or with water baths that will modify the anatomical dimensions or the pressure of the anterior segment. With the Scheimpflug photographic technique, geometrical reconstructions are necessary and cannot be used in certain axes. Optical coherence tomography provides the advantage of producing non-contact images of the anterior segment in static and dynamic conditions that are then easy to use. The target of the optical system can be focused and unfocused with negative or positive lenses, thus reproducing the conditions of natural accommodation. With a normal subject, the morphological modifications of the crystalline lens behind the iris screen cannot be studied because the infrared light source used is blocked by the pigment epithelium. The absence of this pigment in an albino subject allowed us to study the modifications of the crystalline lens and the ciliary body during accommodation. In this study, we were able to definitely confirm all the modifications of the anterior segment as described by von Helmholtz in 1855, who, at the time, used very rudimentary optical procedures based on the reflections of a flame on the surface of the crystalline lens.     

Lack of impact of hepatitis C virus coinfection in end-stage renal disease patients with hepatitis B virus infection

INTRODUCTION: Hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection results in more severe forms of liver disease in nonuremic patients; however, the impact of HCV coinfection is not clearly known in end-stage renal disease (ESRD) patients with HBV infection. We sought to determine the impact of HCV coinfection in HBV-infected ESRD patients. PATIENTS AND METHODS: The HBsAg-positive ESRD patients evaluated between March 1999 and May 2003 were divided into two groups: group B, HBV infection alone, and group BC, HBV-HCV coinfection (anti-HCV-positive). Both groups were compared regarding epidemiological, laboratory, and histological findings. A liver biopsy was obtained in cases with evidence of viral replication and/or elevated alanine aminotransferase. RESULTS: One hundred patients (73% men) with mean age of 42 +/- 11 years (55 patients in group B and 45 in group BC) were studied. Comparison between groups showed a difference in time on hemodialysis and duration of infection, which were higher in group BC (P < .001 and P = .001, respectively) and in history of blood transfusion, which was also more frequent in group BC (P = .04). Liver biopsies, obtained from 15 patients in group B and 28 patients in group BC, showed no difference in frequency of septal fibrosis (60% in group B vs 48% in group BC, P = .46) or interface hepatitis (73% vs 71%, P = .99). CONCLUSIONS: HBV-HCV coinfection was related to a longer time on hemodialysis, longer duration of infection, and history of blood transfusion. Contrary to nonuremic patients, HCV coinfection was not associated with more severe forms of liver disease in ESRD patients.     

Resource utilization in postmenopausal osteoporosis without incident fractures

OBJECTIVE: To evaluate the annual utilization and cost incurred by postmenopausal women with osteoporosis in a public tertiary healthcare facility. METHODS: One hundred consecutive patients with postmenopausal osteoporosis were selected from the Universidade Federal de S?o Paulo (UNIFESP), Brazil. The socioeconomic and clinical characteristics, quality of life, and resource utilization and costs in the last year were assessed using 3 questionnaires. Each resource used had its unitary cost based on the Public Healthcare System Table of Fees (1998). RESULTS: The mean age was 66 years and the monthly family income was 456 US dollars (1998). There was a mean of 7 visits/patient/year. Seventy-seven percent of the patients used calcium and 38% used estrogens. There were no incident fractures during the study. The mean total annual cost for osteoporosis treatment, considering the societal perspective, was 775 US dollars (1998) per patient/year. CONCLUSION: The costs of all treatment drugs related and not related to osteoporosis represented 9% of the monthly household income. Among some drugs used, many are lacking evidence of effectiveness, such as shark cartilage. The costs related to transportation were significant, representing 21% of the total directly spent by the patients. Further studies are necessary to rationally drive treatment, based on the best cost-effectiveness strategies of osteoporosis management.     

Angiogenesis and skin carcinomas with skull base invasion: a case-control study

BACKGROUND: Some skin carcinomas may be very aggressive. Intensity of angiogenesis, measured by intratumoral vessel density using expression of CD34, has been associated with tumor aggressiveness. In this study, the expression of CD34 in basal cell carcinomas ( BCCs) and squamous cell carcinomas (SCCs) with skull base invasion was compared with that in tumors with good outcome. METHODS: Expression of CD34 was graded as mild, moderate, and intense, in 24 BCCs and 11 SCCs with skull base invasion. The control group included 23 BCCs and 10 SCCs. RESULTS: Intense expression of CD34 was noted in 25.00% of BCCs with skull base invasion, compared with 4.35% in the control group (p =.058). Regarding SCCs, intense expression of CD34 was found in 54.55% of aggressive tumors, compared with 10.00% in the control group (p =.133). CONCLUSIONS: A trend toward denser microvascular angiogenesis was observed in both BCCs and SCCs with skull base invasion compared with less aggressive controls.