FIBROCYSTIC CHANGES (FCC) are a group of alterations in the female breast ranging from harmless to those associated with an increased risk of breast c rcinoma. Some of these changes (stromal fibrosis a nd microcysts or macrocysts) produce palpable lumps. F CC are in essence an exaggeration and distortion of the cyclic breast changes that occur normally in the menstrual cycle. Traditionally, these breast alterations have been called fibrocystic disease. However, most of the changes included within this d iagnosis have little clinical significance except that they cause nodularity; onl y a small minority (epithelial hyperplasia) are cli nically important. Thus, the term FCC is preferred, since i t does not mark the subject with a disease. The lum ps produced by the various patterns of fibrocystic cha nge must be distinguished from cancer, and the dist inction between the unimportant variants and the more signi fica t ones can be made by examination of fine-need le aspiration material or more definitively by biopsy and histologic evaluation. The alterations encounte red within the FCC are subdivided into 1. Nonproliferative (simple FCC) that include cysts &/or fibrosis (the most common) 2. Proliferative that include a range of harmless to atypical epith lial cell hyperplasias of the ducts or ductules as well as sclerosing adenosis . All the entities within FCC tend to arise during re p oductive period of life but may persist after men opause. The various changes, particularly the nonproliferative ones, are so common, being found at autopsy in up to 80% of women, that they almost constitute physiologic variants. Cysts and Fibrosis : (Fig. 11-2) characterized by an increase in fibrous stroma asso ciated with dilation of ducts and formation of cysts of various sizes. Grossly, a single large cyst may form within one breast, b u the disorder is usually multifocal and often bilateral. The cyst s are up to 5 cm in diameter. Unopened, they are br own to blue (blue dome cysts) and are filled with serous, turbi d fluid. Microscopically, in smaller cysts, the epithelium is cuboidal to columnar. In larger cysts it may be fla ttened. Frequently, cysts are lined by large cells with abundant granular, eosinophilic cytoplasm, with small, round , deeply stained nuclei; this is called apocrine metaplasia, which is virtually always benign.  Proliferative Changes  1. Epithelial Hyperplasia comprises a range of proliferative lesions within the ductule s, the terminal ducts (ductal hyperplasia), and sometimes the lobules (lo bular hyperplasia) of the breast. Some of the epith lial hyperplasias are mild and carry little risk of carc inoma, but others are the more florid and atypical th t carry a significantly greater risk. Microscopically, the ducts, ductules, or lobules may be filled wit h cuboidal cells, within which small glands are disposed (fenestratio ns) (Fig. 11-3). The degree of hyperplasia can be mild, moderate, or severe. In some instances the hyperplastic cells show compl ex architectural patterns and approaching morphologically those of ductal carcino ma in situ, such hyperplasia is called atypical. The line separating the epithelial hyperplasias without atypia from atypical hyperplasia is difficult to define, just as it is difficult to clearly distinguish between atypical hyperplasia and carcinoma in situ. Atypical lobular hyperplasia (Fig. 11-4) describes hyperplasias that cytologically resembl lobular carcinoma in situ, but the cells do not fill or distend more than 50% of the acini within a lobule. Atypical lobular hyperplasia is associated with an increased risk of invasive carcinoma.

Pathology of the breast

Resumo: O ciclo da vida e constituido pelo nascimento, crescimento, reproducao e morte. Esses eventos sao naturais e proprios para a construcao da vida humana. Para algumas pessoas esses processos evolutivos nao seguem iguais para todos, existe uma especificidade de se colocar diante dos problemas e saber enfrenta-los e a questao primordial. A morte e vista sob diversos contextos cultural, social, familiar e vem para cada um de acordo com sua posicao frente ao mundo; o lidar pode estar definido ou causar outros comportamentos adversos. Lidar com a morte e um fenomeno sofrivel e algumas pessoas nao estao preparadas para esse enfrentamento em questoes nao definidas.Palavras-Chave: Morte, Doenca, Enfrentamento, Sofrimento Psiquico.

Sobre a Morte e o Morrer

Psychological resilience is comprised of an adaptive functioning standard before the current and accumulated risks of life. Furthermore, it has a comprehensive range of psychological resources which are essential to overcome adversities, such as personal competences, self-beliefs and interpersonal control which interact with the social networks support. The objectives are to show the concepts of psychological resilience in elderly, relative to dominant theoretical models and the main data about psychological resilience in aging, found in an international and Brazilian review from 2007 to 2013. The descriptors "resilience, psychological resilience and aging", "resiliencia e envelhecimento, velhice e velho", were used in PubMed, PsychInfo, SciELO and Pepsic databases. Fifty three international and eleven national articles were selected. The international articles were classified in four categories: psychological and social coping resources, emotional regulation before stressing experiences, successful resilience and aging and correlates, and resilience measures. The Brazilian articles were grouped in three: psychological and social resources, resilience in carers and theory review. Articles on psychological resources and on emotional regulation prevailed as key factors associated with psychological resilience in aging.

/pdf/resilience-in-aging-literature-review-59dd9fnkz8.pdf

Resilience in aging: literature review

Introduction Chronic kidney disease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT) Methods Systematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547 We included research published in English, Spanish and Portuguese, from 2000 to present, describing experience of illness and healthcare of people with CKD and caregivers Searches were conducted in MEDLINE, Embase, CINAHL Plus, PsycINFO, Scopus, Scientific Electronic Library Online and Red de Revistas Cientificas de America Latina y el Caribe, Espana y Portugal Content was analysed with theoretical framework using middle-range theories Results Searches resulted in 260 studies from 30 countries (5115 patients and 1071 carers) Socioeconomic status was central to the experience of CKD, especially in its advanced stages when renal replacement treatment is necessary Unfunded healthcare was fragmented and of indeterminate duration, with patients often depending on emergency care Treatment could lead to unemployment, and in turn, to uninsurance or underinsurance Patients feared catastrophic events because of diminished financial capacity and made strenuous efforts to prevent them Transportation to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources Additional work for those uninsured or underinsured included fund-raising Transplanted patients needed to manage finances and responsibilities in an uncertain context Information on the disease, treatment options and immunosuppressants side effects was a widespread problem Conclusions Being a person with end-stage kidney disease always implied high burden, time-consuming, invasive and exhausting tasks, impacting on all aspects of patients9 and caregivers’ lives Further research on BoT could inform healthcare professionals and policy makers about factors that shape patients’ trajectories and contribute towards a better illness experience for those living with CKD PROSPERO registration number CRD42014014547

https://bmjopen.bmj.com/content/bmjopen/8/9/e023507.full.pdf

Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies

https://periodicos.puc-campinas.edu.br/seer/index.php/reveducacao/article/download/180/163

Uma análise de pesquisa em ciências humanas e sociais

O objetivo deste estudo foi investigar o processo de transmissao do conhecimento relacionado as plantas medicinais entre as geracoes familiares, no contexto de agricultores de base ecologica da regiao sul do Rio Grande do Sul. Trata-se de um estudo qualitativo realizado com oito familias de agricultores, totalizando 19 entrevistados, residentes nos municipios de Pelotas, Morro Redondo, Cangucu e Arroio do Padre, entre janeiro e maio de 2009. A analise dos dados foi realizada atraves do metodo hermeneutico-dialetico. A familia foi referida como a principal fonte na transmissao do conhecimento em relacao as plantas medicinais. A maioria dos sujeitos informou primeiro realizar o tratamento com as plantas medicinais para em seguida buscar o servico formal de saude. A construcao do conhecimento relacionado as plantas medicinais pelas familias e predominantemente oral, realizada atraves do convivio diario entre seus membros e compartilhada com os demais membros da comunidade na qual estao inseridos.

https://www.scielo.br/pdf/reeusp/v45n1/en_07.pdf

Plantas medicinais: transmissão do conhecimento nas famílias de agricultores de base ecológica no Sul do RS

This study originates from a doctoral dissertation that aimed to better understand patients' oncological radiotherapy experience, given the theoretical and methodological reference of interpretative anthropology and the ethnographic method. The informants were 10 patients of both sexes, aged 34 to 80. The data was collected from March to August of 2007 through semi-structured interviews and participant observations. Through the interpretative analysis proposed by Hammersley and Atkinson, we constructed the clusters of meanings - Life alterations for the cancer and radiation survivor, and The survivor controlling their lives and weaving webs of the future. We understand nursing to go beyond the biological dimension of care when it includes the webs woven by cancer survivors to adjust to a new life, as they realize their existential limits, incorporate the disease and treatment, and insert them in a preliminary process which persists for the rest of their lives. DESCRIPTORS: Neoplasms. Survival. Culture. Nursing.

/pdf/as-teias-da-sobrevivencia-oncologica-com-a-vida-de-novo-1iqqkllo38.pdf

As teias da sobrevivência oncológica: com a vida de novo

The objective of this qualitative, descriptive and explanatory study was to identify the experience of a multidisciplinary team in providing hospice care in the hospital setting. The study included six members of a multidisciplinary health team providing palliative care in a university hospital in the South of Brazil. The results indicate that when professionals began providing care to terminal patients, they experienced frustration and a sense of helplessness. The experience, however, enabled them to find new meanings for care delivery, coming to understand death as a natural event of life, and realizing the importance of ensuring quality of life and providing comfort to patients. The participants reported the need to strengthen communication, teamwork, and to create opportunities to discuss terminality. Thus, hospital care should meet the needs of patients receiving hospice care and those of their families, connecting and promoting actions to ensure patients have their suffering relieved and can survive with dignity. DESCRIPTORS: Patient care team. Palliative care. Hospital care. Terminally Ill. Attitude to death.

/pdf/cuidados-paliativos-na-assistencia-hospitalar-a-vivencia-de-56a7gsqyly.pdf

Cuidados paliativos na assistência hospitalar: a vivência de uma equipe multiprofissional

Objetivou-se descrever o perfil dos hipertensos e diabeticos cadastrados no sistema HiperDia do Ministerio da Saude em tres unidades basicas do municipio de Pelotas, na regiao Sul do Rio Grande do Sul. Trata-se de um estudo transversal com abordagem quantitativa. Utilizou-se como instrumento de pesquisa um formulario baseado na ficha de cadastro do sistema HiperDia, que fornece informacoes importantes sobre a populacao atendida. Os dados coletados foram digitados no programa Epi-info 6.04 e analisados no software STATA 9.0. A populacao avaliada no estudo e predominantemente feminina, na faixa etaria acima dos 50 anos. Os fatores de risco mais presentes foram o sobrepeso, o habito de vida sedentario, a hereditariedade e como complicacoes cronicas as cardiovasculares. Concluiu-se que o perfil dos cadastrados e semelhante ao encontrado no banco de dados nacional do SisHiperDia.

/pdf/perfil-dos-usuarios-do-hiperdia-de-tres-unidades-basicas-de-4kwlfu25te.pdf

Perfil dos usuários do hiperdia de três unidades básicas de saúde do sul do Brasil

O estudo avaliou a completude das informacoes contidas nas fichas do Hiperdia de uma Unidade Basica de Saude (UBS) com Estrategia da Saude da Familia, em Pelotas, Rio Grande do Sul. Utilizou-se delineamento transversal atraves da coleta de dados secundarios. Foram analisadas as segundas vias de 567 fichas preenchidas de 2002 a 2008. Os dados foram registrados como “preenchidos” e “nao preenchidos”, em um questionario pre-codificado. Os de preenchimento obrigatorio, as maiores porcentagens de incompletude foram nos campos de identificacao, destacando-se o numero do cartao nacional de saude (95,6%), o codigo de enderecamento postal (47,2%) e a unidade federativa do nascimento (27,3%). Os de preenchimento opcional, maiores lacunas foram identificadas nos campos de tratamento nao medicamentoso (97,0%) e glicemia capilar (56,7%). Em relacao aos campos de dados clinicos todos tiveram incompletude baixa. Os resultados demonstram que o SisHiperdia em estudo, possui uma boa completude de preenchimento na maioria das variaveis analisadas.

/pdf/avaliacao-da-completude-das-informacoes-do-hiperdia-em-uma-ycxrl4hjmc.pdf

Rosani Manfrin Muniz

Papers

Plantas medicinais: transmissão do conhecimento nas famílias de agricultores de base ecológica no Sul do RS

As teias da sobrevivência oncológica: com a vida de novo

Cuidados paliativos na assistência hospitalar: a vivência de uma equipe multiprofissional

Perfil dos usuários do hiperdia de três unidades básicas de saúde do sul do Brasil

Avaliação da completude das informações do hiperdia em uma Unidade Básica do Sul do Brasil