Academic literature on the topic 'Explication of Disease'

The article deals with the question of cancer myth representation in the popular science medical discourse. This study is carried out according to the linguocultural approach to the study of the cancer myth, which is based on the reconsideration of linguocultural phenomena. Myths about diseases are of linguistic and cultural significance and they are passed down from generation to generation. Those of phenomena that are incomprehensible and frightening are considered to cause additional associations. Cancer diseases refer to such linguocultural phenomena. Myths about diseases reflect the results of this or that form of reconsideration or experience of some phenomena by a particular linguocultural society. The work provides the definitions of the notions myth and disease. The methodology of the study is based on the research by foreign and Russian scientists in the field of study of the notions of myth and disease as semiotic systems. The popular science medical survey The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee served as a research background. It analyses the way the disease myth actualizes in the popular science medical discourse. It shows a mythological plot (or mythological information) to get actualized in a particular situation by means of reference, and the way it contributes to the explication of a particular disease myth. Neither the subject of the message nor the plot of the myth is of importance for the reader, only the influence of the myth on the patients representations of disorder and his emotional state and on the society as a whole makes sense. The study helps conclude that mythological information representing the disease myth is nationally and socially marked, and is characterized by a particular conceptual presentation and is expressed by different linguistic means.

The concept of periodontal medicine has been created by taking into consideration the strong connection between the development of the periodontal disease and other general conditions. The presence in blood, saliva and gingival fluid of certain inflammatory markers that are common for the two conditions � periodontitis and chronic hepatitis C, that can generate the appearance of the periodontal inflammation, can be an explication for the probable interconnection of the two conditions. The purpose of this pilot study is to investigate whether chronic hepatitis C can be a worsening factor for the development of the periodontal disease, by setting correlations between the periodontal pathology and some metabolic markers of both hepatitis C and periodontitis patients in comparison to periodontitis-only ones. Positive correlations would justify the expansion of the study for a larger group of patients and the dosage of inflammatory markers for biologic fluids such as blood, saliva and gingival fluid.

IntroductionIt is necessary to consider the religious worldview and spiritual needs of patients with mental illness in the course of psychotherapy and rehabilitation.ObjectivesThe explication of value-meaning formations (VMF) in mental patients with a religious worldview.MethodsG. Kelly’s methodology of personal constructs (Method of Triads, Hinkle’s laddering technique, the assessment repertory grid by F.Fransella&D.Bannister) and statistical analyses were applied.Results1. The structure of the value-meaning formations (VMF) of patients with religious worldview was characterized by its integrity, which is prerequisite for coping. 2. Opposite, patients with absence of religious belief had substantial destruction of integrity and plurality of relationships between VMF. 3. The content of the VMF of mental patients with religious worldview and healthy believers had similarities. 4. In the content of VMF meta-values were: 1. active aspiration to God and the realization of own existence; 2. material well-being in the earthly world; 3. “unselfish” ability to get along without causing harm; 4. feeling of inner confidence.ConclusionsMental disease affects VMF of believers and unbelievers in different way. In unbelievers, the structure of VMF in the course of disease significantly changes. In believers, the disease does not destroy the basis of VMF and allows to keep safe the key elements. The stability of VMF in the believers may be explained by the meaningfulness of life. The concepts of “health” and “disease” are included in the worldview of believers, in the general context of their spiritual, psychic and physical life.DisclosureNo significant relationships.

Whilst the cannabis-cancer link has been traditionally described as controversial recent whole nation and whole continent studies have demonstrated that well documented laboratory-based multimodal cannabinoid genotoxicity is indeed reflected in numerous cancer types in larger epidemiological series. A recent longitudinal human sperm epigenome-wide DNA methylation screen in both cannabis dependence and cannabis withdrawal has revealed remarkable insights into the manner in which widespread perturbations of DNA methylation may lead to cancerogenic changes in both the exposed and subsequent generations as a result of both cannabis exposure and withdrawal. These results therefore powerfully strengthen and further robustify the causal nature of the relationship between cannabinoid exposure and cancerous outcomes well beyond the previously published extensive mechanistic literature on cannabinoid genotoxicity. The reported epigenomic results are strongly hypothesis generating and call powerfully for further work to investigate oncogenic mechanisms in many tissues, organs and preclinical models. These epigenomic results provide an extraordinarily close predictive account for the epidemiologically observed pattern of cannabis-related malignant disease and indicate that malignant and multigenerational cannabinoid epigenotoxicity is potentially a significant and major public health concern.

AbstractCardiovascular illness is one the foremost causes of death in females. The goal of preventive medicine is to identify and target high-risk females belonging to the younger age group in order to prevent future onset of cardiovascular pathologies. Certain obstetric complications like idiopathic preterm birth, preeclampsia (PE), gestational diabetes and abruptio placentae mark their presence in the checklist of risk indicators for cardiovascular diseases (CVD) among the female population. Previous severe acute respiratory syndrome-1 (SARS-1) infections recorded a significant impact on maternal and fetal outcomes. In this article, we aim to focus on the incidence of cardiovascular risk indicators with the incessant novel Coronavirus disease-19 (COVID-19) pandemic in pregnant women and to provide recommendations for venous thromboembolism (VTE) prophylaxis in infected females. As the disease is novel and gradually unfolding to clinicians globally, the data and the publications are also evolving. Studies on COVID-19 in pregnancy has shown an increase in the number of preterm births, and PE with some reports on vertical transmission, but no significant increase in miscarriage, still births and teratogenicity. Preterm births appear more likely to be iatrogenic rather than idiopathic, owing to severity of infection or maternal/fetal safety. Causal association of virus with PE needs further analysis by large population studies, as both have common overlapping clinical and laboratory parameters. Direct placental involvement by virus leading on to PE or infection itself simulating PE needs further explication. Assessment of placental function, histopathological examination, and measurement of antiangiogenic factors are some of the suggested measures to differentiate further. Peripartum cardiomyopathy in COVID-19 positive pregnant females has not yet been actively explored, particularly in cases of clinical deterioration. Practical utilization of handheld point-of-care echocardiography machines stand in need for diagnosing myocardial dysfunction in this pandemic. COVID-19 infection and pregnancy together may impart a greater thromboembolism risk due to their inherent hypercoagulable states. All pregnant females with COVID-19 infection are candidates for VTE prophylaxis, both antepartum and postpartum depending on the severity of illness.

Contexte : L’existence du « Lyme chronique » est l’objet de controverses scientifiques depuis plus de 10 ans. Dans le cas du Lyme chronique, la maladie du malade-illness diffère de la maladie du médecin-disease. Un modèle explicatif sous-tend illness et disease. Il regroupe « l’étiologie, le moment et le mode d’apparition des symptômes, la physiopathologie, l’évolution du trouble et le traitement ». Les différences de modèles explicatifs compliquent les soins. Objectif : Recueillir les modèles explicatifs de patients pensant souffrir de maladie de Lyme chronique et des « Lyme doctors » afin de faciliter la mise en place de réseaux sémantiques support du soin. Méthode : Étude qualitative par entretiens semi-dirigés auprès de patients présentant des symptômes persistants après une borréliose de Lyme avec un guide d’entretien fondé sur la médecine narrative. Les entretiens ouverts pour les « Lymes doctors » ont recherché les interactions entre leurs modèles explicatifs et ceux des patients. Résultats : Borrelia burgdorferi (Bb) est perçue comme une bactérie intelligente, véritable poison, capable de se cacher et de s’enkyster. Le phénomène d’attribution exogène est autonome et souvent en conflit avec les médecins. Des études de faible niveau de preuve ont recherché la persistance de Bb après un traitement antibiotique conforme aux recommandations. La persistance de traces de la bactérie n’est pas le témoin de l’infection. Conclusion : Établir des ponts entre les modèles explicatifs des patients et des médecins demande de réfuter les théories sans fondement scientifique et de reconnaître la souffrance.

BACKGROUND: Relatives caring for an epilepsy patient play a significant role in the care system and maintaining the well-being of the chronically ill and often suffer from significant stress. AIM: The aim of the study was to reveal the relationship of psychological distress, basic beliefs and perceptions of family relationships in relatives taking care of children and adults with epilepsy. MATERIALS AND METHODS: The study involved 62 relatives caring for patients with epilepsy, 44 relatives of children (mean [SD] age, 34,64 6,73 years) and 18 relatives of adults (mean [SD] age, 48,72 10,99 years). The Symptom Checklist-90-Revised (SCL-90-R), the World Assumption Scale and the Family Environment Scale was used as an assessment tools. Also semi-structured interview for assessing socio-demographic and clinical characteristics was applied. RESULTS: The results of the study revealed significant similarities of the studied groups both in the explication of the psychopathological symptoms and in perception of their own personality, the surrounding world and intra-family interaction. Informal caregivers of such patients demonstrates significant variability and severity of psychopathological symptoms. And their perception of themselves and the surrounding world is characterized by the faade tendencies that act as psychological protection that prevents the catastrophizing of the subjective assessment of the situation associated with the chronic disease of a loved one. CONCLUSIONS: The study demonstrated the need to develop specialized psychotherapeutic interventions aimed at reducing the level of psychological distress in informal caregivers of patients with epilepsy. During the development and carrying out of such interventions, it is important to take into account the subjective assessment of caregivers available life situation, as well as his/her personal values and attitudes that largely determine the severity of psychopathological symptoms.

IntroductionIn the USA, African American men bear a disproportionate burden of prostate cancer (PCa) compared with all other groups, having a higher incidence and mortality, poorer quality of life and higher dissatisfaction with care. They are also less likely to receive guideline-concordant treatment (eg, undertreatment of aggressive disease). Inadequate patient–provider communication contributes to suboptimal care, which can be exacerbated by patients’ limited health literacy, providers’ lack of communication skills and time constraints in low-resource, safety net settings. This study is designed to examine the communication experiences of African American patients with PCa as they undertake treatment decision-making.Methods and analysisUsing an ethnographic approach, we will follow 25 African American men newly diagnosed with PCa at two public hospitals, from diagnosis through treatment decision. Data sources include: (1) audio-recorded clinic observations during urology, radiation oncology, medical oncology and primary care visits, (2) field notes from clinic observations, (3) patient surveys after clinic visits, (4) two in-depth patient interviews, (5) a provider survey, and (6) in-depth interviews with providers. We will explore patients’ understanding of their diagnoses and treatment options, sources of support in decision-making, patient–provider communication and treatment decision-making processes. Audio-recorded observations and interviews will be transcribed verbatim. An iterative process of coding and team discussions will be used to thematically analyse patients’ experiences and providers’ perspectives, and to refine codes and identify key themes. Descriptive statistics will summarise survey data.Ethics and disseminationTo our knowledge, this is the first study to examine in-depth patient–provider communication among African American patients with PCa. For a population as marginalised as African American men, an ethnographic approach allows for explication of complex sociocultural and contextual influences on healthcare processes and outcomes. Study findings will inform the development of interventions and initiatives that promote patient-centred communication, shared decision-making and guideline-concordant care. This study was approved by the University of California San Francisco and the Alameda Health System Institutional Review Boards.

Disease is ubiquitous. Disease afflicts humans. It afflicts animals. It afflicts plants. People refer to disease in their everyday conversation. Newspapers comment upon it. Parliaments enact legislation regarding it. Novelists write about it. Artists depict it. Physicians, veterinary surgeons and agriculturalists seek to combat it. Insurance companies offer reimbursement against it. Anthropologists study it. Philosophers debate its nature, and dictionaries define it. Disease looms large in human consciousness. One might presume that, since disease is so important in daily life, human beings would know exactly what they mean by it. Most people seem to believe instinctively that they understand the nature of disease, and that their ideas about it coincide with other people�s ideas. The definition of disease therefore arouses little controversy in everyday conversation. People use the word disease as readily as they use the words spade, or table or nose. They suggest, when they joke that somebody calls a spade a spade, that the nature of the implement used to dig the garden is so obvious that it requires no further definition. Similarly with a table or a nose. They might debate how many legs a table must have, but�regardless of the answer�rarely deny that it is a table; whilst every human must surely know what a nose is. This high level of agreement about so many commonly used terms perhaps creates an assumption that the meaning of disease is equally obvious and requires no further analysis. Is this, however, really the case? Disease is a somewhat less concrete phenomenon than is a spade or a table or a nose. Its existence, most would agree, is incontrovertible, but its nature is less clear. It is something that seems to befall people and animals and plants. It rarely serves any useful purpose. It often carries dire implications. It is something that most of us would prefer not to have, but rarely succeed in avoiding. It commonly comes unannounced and at inconvenient times. It usually causes distress, but not always. It can have a fatal outcome. Some people appear more prone to it that others. It sometimes sweeps through whole populations producing social devastation, but its manifestations vary. Some diseases affect a person�s whole body, others merely a part of the body; some affect some parts of the body, others other parts. Some diseases only affect humans, whereas others affect both humans and animals. Some spread from animals to humans, others from humans to humans, and others still do not appear to spread at all. Some diseases affect plants, and few that affect plants seem to affect humans, but some humans can acquire diseases when they come into contact with plants that appear to have no diseases. Any reasonable analysis of the nature of disease must account for all these aspects and many others also. The nature of disease is a topic that has attracted the attention of physicians, scientists and philosophers over millennia. The close association that existed between medicine and philosophy in the classical Egyptian, Palestinian and Greek eras ensured that scholars who flourished in those societies examined the nature of disease. Comparable developments occurred in classical Indian and Chinese civilizations. The natural philosophers of Renaissance and post-Renaissance Europe divided into competing schools of thought over the nature of disease. More recent years have witnessed an enormous flourishing of physicians, pathologists, and agriculturalists who study aspects of disease that relate to their individual disciplines. Most of these researchers have, however, examined ever-narrower aspects of specific diseases�such as manifestations, mechanisms and causes�rather than the generic nature of the phenomenon. Some contemporary philosophers, on the other hand, have become interested in general aspects of the topic. They have proposed a number of novel ideas and reached some stimulating conclusions, although they can hardly yet claim to have reached a consensus. This lack of unanimity presumably implies that the issues involved require closer analysis if a formulation is to emerge that most of them can accept. The object of the present thesis is to undertake such an analysis. It will start by outlining in this introduction the general background to the topic. It will then detail the more noteworthy of previously proposed theories about the nature of this phenomenon, classifying them according to their most prominent components, and assessing their several strengths and weaknesses. It will next discuss the specific philosophical issues of definition, causation, and explication in the biomedical context, before suggesting a comprehensive, but succinct, definition that acknowledges many older views about disease, encompasses current usage, and provides a theoretical base from which to work into the future. It will finally test the strengths and weaknesses of that definition to account for observed phenomena and to accommodate some former definitions.

A pessoa com distúrbios hematológicos demonstra desarranjos físicos, emocionais e sociais. Assim, atuar nesta área é estar disposta a cuidar do indivíduo, percebendo e intervindo precocemente nas alterações manifestadas. Os tratamentos para as patologias hematológicas podem ser feitos pela radioterapia, quimioterapia e o transplante de células tronco hematopoéticas (TCTH). Na maioria dos casos, a combinação destas modalidades terapêuticas faz-se necessária para o alcance do controle da doença. Após ser submetido à quimioterapia e/ou radioterapia o paciente é encaminhado para o TCTH almejando-se a cura. Estes tratamentos são altamente agressivos, acarretando prejuízos em todas as dimensões da vida do doente. A compreensão da trajetória da pessoa acometida por uma doença, desde o início dos sinais e sintomas até as perspectivas para o futuro, identificando suas idéias e condutas na luta pela sobrevivência, parte do entendimento do contexto sociocultural em que está inserida. Nessa perspectiva, o objetivo deste estudo foi identificar os modelos explicativos (MEs) para o TCTH alogênico aparentado, na visão de um grupo de pacientes. Para o seu alcance, estabelecemos como base teórica a antropologia médica, o método do estudo de caso qualitativo e a técnica de análise de conteúdo indutivo. Participaram deste estudo 11 pacientes, sendo três com leucemia mielóide aguda, quatro com leucemia mielóide crônica, dois com leucemia linfóide aguda e dois com anemia aplástica grave. As seis mulheres e os cinco homens formam um grupo de adultos em idade produtiva e suas características sociais mostram que são pessoas oriundas da classe social popular. Realizamos entrevistas semi-estruturadas, norteada por questões que integram a construção dos modelos explicativos. Posteriormente compilamos cada uma das entrevistas e seguimos para a análise de dados que se realizou em duas etapas. Reunimos as entrevistas e após várias leituras elencamos as categorias temáticas: da trajetória da doença ao tratamento especializado, os sentidos dados à doença e aos tratamentos, o lidar com a doença e os tratamentos e a vida após os tratamentos. Por estas categorias apreendemos os diversos elementos constitutivos dos modelos explicativos do adoecer e do submeter-se ao TCTH alogênico, onde evidenciamos a influência da cultura em que estão inseridos os participantes. Os entrevistados retrataram os sinais e sintomas da doença, a percepção do estar doente e suas causas, a difícil busca pela assistência à saúde, os tratamentos caseiros, a necessidade das terapêuticas, a existência de um doador compatível, as complicações e suas consequências, as dificuldades financeiras, os cuidados e as mudanças no modo de vida após os tratamentos e as perspectivas de futuro. Concluímos que a cultura é um sistema de referência para as pessoas de um grupo social, que fornece formas de pensar e agir sobre uma determinada situação ou evento. Evidenciamos exemplos da trajetória percorrida pelos participantes em busca da cura, almejando instigar os profissionais da saúde, em especial à equipe de enfermagem, que cuidam destes pacientes a olhá-los em todas as suas dimensões da vida, desejando um cuidado integral e diferenciado, integrando conhecimentos culturais ao modelo biomédico.
People with hematologic disorders face physical, emotional and social alterations. Thus, acting in this area means to be willing to care for the individual, precociously perceiving and intervening in the revealed changes. Hematologic pathologies can be treated by radiotherapy, chemotherapy and hematopoietic stem cell transplantation (HSCT). In most cases, the combination of these types of therapy is needed to control the disease. After undergoing chemotherapy and/or radiotherapy the patient is subject to HSCT, aiming the cure. These treatments are highly aggressive, causing damages in all dimensions of patients lives. Understanding patients sociocultural context is necessary to comprehend the trajectory of someone affected by a disease, since the beginning of the signs and symptoms up to the perspectives for the future, identifying their ideas and behaviors in the fight for survival. In this way, this study aimed to identify the explanatory models (EMs) for allogeneic HSCT of related donors, in the view of a group of patients. In order to achieve this, the medical anthropology, the qualitative case study method and the inductive content analysis technique were established as theoretical bases. Eleven patients participated in the study, three with acute myeloid leukemia, four with chronic myeloid leukemia, two with acute lymphoid leukemia and two with severe aplastic anemia. The six women and five men are adults at reproductive age and their social characteristics show they are from the lower social class. Semi-structured interviews guided by questions that are part of the construction of the explanatory models were carried. Afterwards the interviews were compiled and analyzed in a two-phase data analysis. Interviews were gathered and after several readings, the following thematic categories were listed: from the trajectory of the disease to specialized treatment, the meanings given to the disease and treatments, dealing with the disease and treatments, and life after treatments. Different elements of the explanatory models of becoming ill and undergoing allogeneic HSCT emerged from these categories. The influence of participants cultural context was evidenced. Interviewed subjects reported the signs and symptoms of the disease, the perception of being ill and its causes, the difficult search for health care, home treatments, the need of medications, the existence of a compatible donor, complications and their consequences, the financial difficulties, care and changes in the lifestyle after treatments and the perspectives of future. It is concluded culture is a reference system to people from a social group, which provides ways of thinking and acting about a certain situation or event. Examples of the trajectory followed by the participants in the search for care is evidenced, aiming to motivate health professionals, specially from the nursing team, who delivery care to these patients, to look them in all dimensions of their lives, to provide a comprehensive and differentiated care, integrating cultural knowledge to the biomedical model.

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This research aims to understand the explanatory model and the therapeutic itinerary of a group of patients affected by chronic diseases who are assisted by disease management programs carried out by operators of health plans and identify strategies of self-care that relate with the explanatory model. The thesis that moves this study is that the route that the patient uses for its treatment has deep roots in his own culture, being much larger than the model used by health professionals, also generated by the culture, but restricted by the biomedical vision. The meanings of terms such as health, cure, treatment, disability, dependence and others are not always equal in both models. If the meaning is too different, adherence to the treatment will be impaired, but the patient may still have obtained relief from their suffering. The methodology applied is qualitative, gathered through interviews with people with confirmed previous medical diagnosis of chronic disease who were already undergoing treatment, accompanied by chronic diseases management programs, which, according to the hegemonic healthy model, should know the diseases that affect them with a sufficient degree of information that would allow their full compliance. Because these are people linked to health plans, with a higher socioeconomic strata, they would fit the criteria of information, income, education and access to health care that would turn them into ideal patients and adherent to therapy. Reasons for non-adherence to treatment among these participants are what motivated this research and generated the hypothesis that the therapeutic itinerary of these patients, generated and engraved in their culture, originates from an explanatory model of the illness process much wider than the hegemonic model. So these diseased would present strategies of self-care, as part of this layman model, which allows them to carry on and manage their treatment both within and without the current prevailing model, strategies those that can be seen by health professionals as noncompliance. We believe that this study achieved its objectives, supporting the initial hypothesis of the research, showing that even in a theoretically disciplined group within criteria taken as ideal for joining the biomedical model of illness and treatment, people are immersed in their culture and find loopholes for the exercise of self-care. The work also showed that the crisis of the biomedical model, in this case, stems from the microphysics power relations and from the structural conditions of the health system and the people in the group are able to identify some of these flaws. We hope this research will contribute to this relevant nowadays debate as well as collaborate in the reflections on medicine and health education, broadening the discussion to incorporate the experiences and narratives of this group of patients
Esta pesquisa tem como objetivo perceber o modelo explicativo e o itinerário terapêutico de um grupo de doentes acometidos por afecções crônicas assistidos por programas de gerenciamento de doenças realizados por operadoras de planos de saúde e identificar estratégias de cuidar de si que se inter-relacionam com seu modelo explicativo. A tese que move este estudo é de que o itinerário que o doente utiliza para seu tratamento tem profundas raízes na cultura, sendo muito mais amplo do que o modelo dos profissionais de saúde, por sua vez também gerado na cultura, porém restringido pela visão da biomedicina. Os significados de termos como saúde, cura, tratamento, incapacidade, dependência, entre outros, nem sempre são correspondentes em ambos os modelos. Caso o significado seja muito diferente, a adesão ao tratamento ficará prejudicada, mas o doente pode ter obtido alívio para seu sofrimento. A metodologia empregada é qualitativa, realizada mediante entrevistas com pessoas com diagnóstico médico prévio confirmado de doença crônica e que já se encontravam em tratamento, acompanhadas por programas de gerenciamento de doenças crônicas, as quais, segundo o modelo de atenção à saúde hegemônico, deveriam conhecer as doenças que os acometem com um grau de informação suficiente que permitisse sua adesão plena ao tratamento. Por se tratarem de pessoas vinculadas a planos de saúde, portanto de estratos socioeconômicos mais elevados, preencheriam os quesitos de informação, renda, educação e acessibilidade ao sistema de saúde que os transformaria em pacientes ideais e aderentes à terapêutica. O porquê da não adesão ao tratamento entre estes participantes é que despertou esta pesquisa e gerou a hipótese de que o itinerário terapêutico destes enfermos, gerado e inscrito na cultura, origina-se de um modelo explicativo do processo de adoecer mais amplo do que o modelo hegemônico. Estes adoecidos apresentariam assim estratégias de cuidar de si próprios, como parte deste modelo dito leigo, que faz com que convivam e gerenciem seu tratamento tanto dentro quanto à revelia do modelo predominante, estratégias estas que podem ser vistas pelos profissionais de saúde como não adesão. Acreditamos que esta pesquisa atingiu seus objetivos, corroborando a hipótese inicial do trabalho, demonstrando que, mesmo em um grupo teoricamente disciplinado dentro de critérios tidos como ideais para a adesão ao modelo biomédico de adoecimento e tratamento, as pessoas estão imersas na cultura e encontram brechas para o exercício do cuidar de si. O trabalho mostrou ainda que a crise do modelo biomédico, neste caso, advém tanto das relações microfísicas de poder quanto das condições estruturais do sistema de saúde e que as pessoas do grupo conseguem identificar algumas destas falhas. Esperamos que esta pesquisa possa contribuir para este debate tão atual, além de colaborar nas reflexões sobre a medicina e sobre o ensino na saúde, ampliando a discussão ao incorporar as experiências e narrativas deste grupo de enfermos

In partial fulfilment of the requirements for the degree Masters of Arts in Clinical Psychology, 2006.
The purpose of this research was to describe the experience of working with patients with HIV/AIDS, in particular performing caesarean sections, from a medical practitioner's perspective. A phenomenological study method was employed in which each participant used in the research was interviewed in a single session. The original sample consisted of 9 participants. They were selected by means of criterion sampling from the gynaecology and obstetrics department of different public hospitals in Johannesburg, Pretoria and Cape Town. Six protocols were selected for phenomenological explication based on the interviews with the 9 original participants. The sample consisted of 3 females and 3 males, from different cultural backgrounds, who regularly perform surgical gynaecological procedures on patients with HIV/AIDS. The results were presented in the form of an integrative text, which accounted for all of the individual variations of the experience of working with patients with HIV/AIDS. Out of this text the researcher explicated natural meaning units, specific to each participant, which were used in formulating a specific description of experiencing the performance of a caesarean section on a patient with HIV/AIDS. This study concluded with a discussion of the results, as well as a formulation of a general description of experiencing the performance of caesarean sections on patients with HIV/AIDS for all 6 participants. Overall, this research explicated unique descriptions of individual experiences, and contributes to a general understanding of the experience of performing a caesarean section on a patient with HIV/AIDS. Operational definitions • Phenomenology - A department of the inductive sciences concerned with the facts that form the basis of its system. • Caesarean section - A mode of childbirth in which a surgical incision is made through a pregnant woman's abdomen and uterus to deliver a baby. • Human Immunodeficiency Vinis- A retrovirus that attacks and severely damages the body's immune system and for which there is presently no cure. • Life-wortd- The space occupied by any one person in the external, physical world, as well as the internal lived-in world, consisting of emotions and cognitions.

A doença crónica é hoje no mundo e, em particular na Europa, a responsável por grande parte da mortalidade e morbilidade, prevendo-se uma acentuação deste cenário nos próximos anos. Com frequência a doença crónica e suas co morbilidades representam a causa de episódios de internamento, por descompensação da doença e, ou, das suas consequências. Este é um fenómeno complexo e não se explica através de um único fator; no entanto, sabe-se que uma gestão inadequada da doença e do regime terapêutico recomendado é uma das causas apontada com maior frequência. O elevado número de episódios de repetição de internamento demonstra carências em cuidados que os evitem e diminuam os custos sociais e económicos que lhes estão inerentes para além da qualidade de vida perdida. Este estudo equaciona as questões da gestão da doença e do regime terapêutico enquanto atividades de autocuidado (autogestão), partindo do pressuposto que a forma como é vivida a transição saúde/doença influencia a forma como se desenvolverão os processos adaptativos, de desenvolvimento da mestria e de uma identidade fluída que incorpore a doença como parte integrante do “eu”. Finalidade: Criar um modelo explicativo sobre a gestão do regime terapêutico levada a cabo por pessoas com manifestação de ineficácia dessa gestão, tendo em vista inferir os elementos de uma intervenção em saúde promotora de uma gestão responsável do autocuidado. Participantes e métodos: Uma análise no número de internamentos de pessoas que, no ano de 2006 e/ou de Janeiro de 2007 até 30 de Setembro do mesmo ano, tenham tido “mais que um episódio de internamento”, na Unidade Local de Saúde de Matosinhos (Hospital Pedro Hispano), revela a existência de 8695 registos de episódios de internamento (englobando os que entretanto faleceram); destes, 3004 correspondem a clientes sobre os quais não existe assento de falecimento e que correspondem a 7027 episódios de internamento, com um máximo de onze durante o período considerado. Para o estudo foram selecionados os que apresentavam doença crónica, mais que cinco episódios de internamento e que pertenciam à área de abrangência dos Centros de Saúde da ULS Matosinhos. Após análise dos processos clínicos hospitalares, da tentativa de contato e de verificação de todos os critérios de inclusão foram selecionados vinte e dois participantes que aceitaram participar no estudo e que apresentavam reinternamentos relacionados direta ou indiretamente com a(s) mesma(s) doença(s), que se presumiu pudessem estar relacionadas com uma gestão ineficaz do regime terapêutico Estes vinte e dois participantes foram acompanhados, por um período máximo de cerca de um ano e meio, num estudo longitudinal, constituindo vinte e dois “casos” – estudo multicasos. Os dados foram obtidos pela análise de documentação, designadamente consulta de processos clínicos e por observação participante. Foram realizadas entrevistas aos participantes e acompanhados em contexto familiar e/ou institucional. Os dados foram analisados de acordo com o método proposto por Strauss e Corbin para gerar uma Grounded Theory. Iniciando-se por uma microanálise que se organizou numa codificação aberta, agrupando os conceitos e verificando as relações que mantinham entre si através de uma análise axial e, finamente, sintetizando os dados elaborando a sua redução teórica numa codificação seletiva, apresentando-se, finalmente, a teoria. Resultados: Neste estudo emergem duas condições face à autogestão: o padrão de complexidade do regime terapêutico e o padrão de vulnerabilidade. O padrão de vulnerabilidade e, por oposição, o padrão de resiliência, resultam de duas condições: a contextual e a pessoal. O contexto de maior vulnerabilidade que emerge no estudo é o socioeconómico e cultural – a pobreza, sendo o contexto familiar o fator discriminatório face ao anterior; enquanto o suporte familiar é o fator protetor que emerge com maior ênfase nos relatos dos participantes e na síntese da observação. Da análise das condições pessoais, pela atitude face à vida e à doença e aos atributos pessoais, resultou um agrupamento em quatro padrões, que denominamos como “estilos de gestão”: responsável; independente; formalmente guiado; negligente. Conclusões e implicações para a prática clínica: Deste estudo conclui-se que enquanto para os profissionais o foco se situa na preparação da pessoa para a mestria, as pessoas com doença crónica se focalizam na vivência da própria transição e no desejo de manter a continuidade na sua vida. A incorporação de necessidades de autogestão da doença e do regime terapêutico é realizada de acordo com as condições pessoais e contextuais, sendo que algumas destas condições são pouco propícias a uma transição saudável e constituem por isso verdadeiros desafios à prática de enfermagem
Chronic disease is responsible in the world, and particularly in Europe, for much of the mortality and morbidity, it is expected an increase of this scenario in the coming years. Often chronic disease and its comorbidities represent the cause of episodes of hospitalization for lack of disease control, or its consequences. Hospital readmissions is a complex phenomenon and cannot be explained by a single fator, however it is known that inadequate management of the disease and ineffectiveness of self-management are reasons pointed out more often in studies. The high number of episodes of hospital care, show deficiencies in primary care that should prevent and minimize the social and economic costs associated with them, and improve the quality of life of the persons with chronic illness. This study issues on disease management and treatment regimen, as a self-care activities (self-management), assuming that the way the health/disease transition is experienced influences the way the adaptive processes move on, the development of mastery and a fluid identity, that incorporates the disease as part of the "self". Purpose: Create an explanatory model on the management of therapeutic regimen carried out by people with demonstration of ineffectiveness of self-management, in order to infer the elements of a health intervention that promotes a responsible self-management. Methods and Participants: An analysis of the number of hospitalizations of people who, in 2006 and / or January 2007 to September 30 of that year, have had "more than one episode of internment" in the Local Health Unit Matosinhos (Hospital Pedro Hispano), reveals the existence of records of 8695 inpatient episodes (though covering those who died) and of these, 3004 represent clients on which there is no seat of death and which correspond to 7027 episodes of hospitalization, with a maximum of eleven during the period considered. Selected for study were those with chronic illness, more than five episodes of hospitalization and who belonged to the catchment area of the health centers of the ULS Matosinhos. After analysis of hospital medical records, the attempt to contact and check all the inclusion criteria were selected twenty-two participants who agreed to participate in the study and who had re-hospitalization related diretly or indiretly with chronic disease(s), which was assumed could be related to inefficient self-management. These twenty-two participants were followed for a maximum of a year and a half, in a longitudinal study, like twenty-two "cases" - multicases study. Data were obtained from the analysis of documentation, including clinical documentation and participant observation. Participants were interviewed and followed in family or institutional context. The data were analyzed according to the method proposed by Strauss and Corbin, to generate a Grounded Theory. Beginning with a microanalysis, which was organized in an open coding, than grouping the concepts and their relationships through an axial analysis, and summarizing the data, drawing up theoretical reduction in a selective coding, finally, presenting the theory. Results: In this study two conditions emerge face to self-management: the complexity of the treatment regimen and the pattern of vulnerability. The pattern of vulnerability and, in the opposite, the pattern of resilience, is the result of two conditions: a contextual and personal. The context of greater vulnerability that emerges in the study is the socio-economic and cultural - poverty, family background and the discriminatory fator compared to the previous, while family support is a protective fator that emerges with greater emphasis on participants' reports and the synthesis of observation. From the analysis of personal circumstances, attitude to life and illness, and personal attributes, participants grouped in four patterns, which we named to as "management styles": responsible, independent, formally guided, negligent.. Conclusions and implications for clinical practice: This study concludes that while the focus for professionals is situated in preparation for mastery, people with chronic disease focus on the experience of the transition itself, and in the desire to maintain continuity in his life. The incorporation of self-management needs of the disease and the treatment regimen is carried out according to the personal and contextual fators, and some of these conditions are hardly conducive to a healthy transition, and so are real challenges to the practice of nursing