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Zusammenfassung Wir berichten uber einen 28-jahrigen Hochleistungskampfsportler, der im Oktober 2018 unter einer zervikalen Radikulopathie nach einem retrospondylophytaren Bandscheibenvorfall der Halswirbelsaule litt. Die radikulare Symptomatik war durch Schmerzen, Sensibilitats- und Muskelfunktionsstorungen sowie eine Radialisparese charakterisiert. Die konservative Behandlung bestand aus einer angepassten Bewegungs- und Physiotherapie, einer hochumfanglichen zervikalen Traktionsmasnahme sowie einer temporaren oralen Einnahme von Schmerzmitteln und Muskelrelaxanzien. Die nicht-invasive Therapie ermoglichte nach elf Monaten ein Return-to-Competition auf vorherigem Leistungsniveau. Daruber hinaus legt der Beitrag verschiedene Moglichkeiten und Perspektiven von Traktionstherapien bei zervikaler Radikulopathie dar.

Testimony is a source of knowledge. A speaker asserts what a hearer may therefore come to know. Assertion has widely been treated as the exclusive or at least the paradigmatic vehicle for testimony. I argue that we testify not only by asserting something, but also by taking something for granted within some other utterance. In philosophy of language, this is called semantic presupposition. The very reasons leading theorists of testimony have for thinking that assertion can be testimony are equally reasons for thinking semantic presupposition can be testimony.

O avanço das políticas públicas, o progresso tecnológico e do conhecimento científico levaram à mudança do perfil epidemiológico de crianças e adolescentes brasileiros, aumentando a expectativa de vida desse grupo que antes não poderia sobreviver. Entre elas encontram-se as crianças com necessidades especiais de saúde que podem ser agrupadas de acordo com a demanda de necessidade e, neste estudo, destaca-se as crianças e os adolescentes assistidos por tecnologia. Esta pesquisa teve como objetivo geral compreender a vivência moral de famílias de crianças e adolescentes assistidos por tecnologia no domicílio. Foi realizado um estudo de abordagem qualitativa, com fundamentação teórico-metodológica no framework da vivência moral de Hunt e Carnevale e na fenomenologia interpretativa de Patricia Benner. Ambos têm base na hermenêutica, que propõe compreender o fenômeno pela interpretação. Foram utilizados como instrumentos de coleta de dados a entrevista e a observação, e como instrumentos facilitadores o desenho, o genograma e o ecomapa. O estudo foi conduzido em São Carlos, interior do Estado de São Paulo, com 15 participantes de quatro famílias de criança ou adolescente assistidos por tecnologia em cuidados domiciliares. Os participantes foram os familiares, incluindo pais, avós, tios, primos e um adolescente assistido por tecnologia. A análise de dados foi pautada na interpretação fenomenológica dos casos paradigmáticos, com análise temática, a qual apontou que a família dá o melhor na busca da manutenção da vida da criança ou do adolescente. Essa vivência é explicada em três temas: engajando-se para a manutenção da vida, impactando a vida da família e relacionando-se com profissionais e instituições de saúde. O primeiro tema, engajando-se para manutenção da vida, é fundamentado no forte vínculo, o que desperta o medo da morte da criança ou do adolescente e na dedicação aos seus cuidados. O segundo tema, impactando a vida da família, revela o impacto emocional, social e financeiro. Aponta para as diferentes emoções vivenciadas, o isolamento social, a importância de apoio, o enfrentamento do preconceito, a busca por normalidade, a dependência de assistência do governo e as dificuldades decorrentes da burocracia. O terceiro tema tem como foco o relacionamento com os profissionais de saúde, com as experiências da vivência moral com impacto positivo ou sofrimento moral, a depender da postura do profissional. Os resultados contribuem para o avanço na compreensão da vivência moral de famílias de crianças ou adolescentes brasileiros assistido por tecnologia em cuidados domiciliares. Os resultados destacam o potencial de oferta de cuidado humanizado e integral à essas famílias, quando acessada sua vivência moral, uma vez que a compreensão desse aspecto pode contribuir para uma convivência com a criança ou o adolescente assistido por tecnologia menos desafiadora para a família, pois, dessa maneira, ela é acolhida em sua integralidade e individualidade, sentindo-se fortalecida e apoiada. The advancement of public policy, technological progress, and scientific knowledge has led to changes in Brazilian children and adolescents\' epidemiological profile. Thus, increasing the life expectancy of a group that previously had no chance of survival. They are known as children with special health care needs that may be divided into groups according to their individual care needs, and in this study, we focus on a specific group: the technology-assisted children and adolescents. The aim is to understand families\' moral experience with technology-assisted child and adolescent cared for at home. This is a qualitative study, guided by the conceptual framework of moral experiences proposed by Hunt & Carnevale, and Patricia Benner\'s interpretative phenomenology as a methodological framework. Both have been drawn on the hermeneutic, which helps to understand the phenomena through interpretation. Interviews and observations were the primary data collection method. Field notes, genograms, and ecomaps were also used as facilitating instruments. The study took place in São Carlos, in the countryside of São Paulo, consisting of 15 participants from four families of the technology-assisted child or adolescent cared for at home, including parents, grandparents, uncle, cousins, and one technology-assisted adolescent himself. The data analysis was based on the interpretative phenomenology of the paradigmatic cases, using thematic analysis that showed that the family gives its best to maintain the child or adolescent\'s life. The results are explained on the following themes: engaging to maintain life, impacting family\'s lives and relations with healthcare professionals and health care organizations. The first theme, engaging to maintain life, is based on the strong bond that leads to fear of the child or adolescent\'s death, leading to a more significant dedication to the child or adolescent\'s care. The second theme, impacting family\'s lives, reveals the emotional, social, and financial impact. It encompasses the different lived experiences referring to the emotions, social isolation, the relevance of support, dealing with prejudice, seeking normality, the dependence on governmental assistance, and the difficulties with bureaucracy. The third theme addresses the relationship of the family with the health care professionals that may bring positive impact or moral distress, depending on how this relation is established. The results help advance the understanding of families\' moral experience with a child or adolescent technology-assisted, who is cared for at home. The results highlight that accessing these families\' moral experience may increase the potential of offering a humanized care. Understanding these families\' moral experience helps make this lived experience lighter, less challenging as a result of caring for them in its individuality, so they feel strengthened and supported.

There are at least three senses of sexual objectification: the moral sense of treating a person as if she were primarily a sexual object, the political sense in which women socially count as instruments for men’s sexual pleasure, and the epistemic sense of forming a belief that a person is as one sexually desires them to be. These different senses have been treated as rivals, competing about what the correct account of sexual objectification is, or they have been treated as entirely different projects. I argue for a third relation between them: each sense grasps an aspect of the existing social phenomenon of sexual objectification. Each further points out a wrong involved in sexual objectification. And the three aspects interact—we cannot fully explain any one sense of sexual objectification without the other two. To properly understand this interrelation I lean on an analogy: commodity fetishism as described by Marx helps make sense of the complex social reality of sexual objectification.

Este artigo tem como objetivo geral verificar se a Lei 10.639/2003 assegura uma educação comprometida com a diversidade étnico-racial e com a valorização da história e cultura afro-brasileira e africana. O problema do artigo consiste em verificar se é possível estabelecer uma educação anti-racista conforme preconiza a Lei 10.639 de 2003 no material didático fornecido pelo poder público aos alunos do 6º ao 9ª ano do ensino fundamental no município de Criciúma/SC. Este artigo está estruturado em três objetivos específicos: a) estudar as relações raciais no Brasil e o contexto histórico de exclusão da raça negra desde o período escravocrata; b) compreender a necessidade de construir-se uma sociedade livre de exclusões ou preconceitos vinculados a raça a partir da matriz intercultural dos direitos humanos; e, c) analisar o material didático fornecido pelo poder público para as escolas públicas do município de Criciúma. A pesquisa utiliza o método indutivo e procedimento monográfico envolvendo pesquisa bibliográfica e análise documental.

BackgroundIn acute respiratory distress syndrome (ARDS), pulmonary perfusion failure increases physiologic dead space ventilation (VD/VT), leading to a decline of the alveolar CO2 concentration [CO2]iA. Although it has been shown that alveolar hypocapnia contributes to formation of atelectasis and surfactant depletion, a typical complication in ARDS, the underlying mechanism has not been elucidated so far.MethodsIn isolated perfused rat lungs, cytosolic or mitochondrial Ca2+ concentrations ([Ca2+]cyt or [Ca2+]mito, respectively) of alveolar epithelial cells (AECs), surfactant secretion and the projected area of alveoli were quantified by real-time fluorescence or bright-field imaging (n=3–7 per group). In ventilated White New Zealand rabbits, the left pulmonary artery was ligated and the size of subpleural alveoli was measured by intravital microscopy (n=4 per group). Surfactant secretion was determined in the bronchoalveolar lavage (BAL) by western blot.ResultsLow [CO2]iA decreased [Ca2+]cyt and increased [Ca2+]mito in AECs, leading to reduction of Ca2+-dependent surfactant secretion, and alveolar ventilation in situ. Mitochondrial inhibition by ruthenium red or rotenone blocked these responses indicating that mitochondria are key players in CO2 sensing. Furthermore, ligature of the pulmonary artery of rabbits decreased alveolar ventilation, surfactant secretion and lung compliance in vivo. Addition of 5% CO2 to the inspiratory gas inhibited these responses.ConclusionsAccordingly, we provide evidence that alveolar hypocapnia leads to a Ca2+ shift from the cytosol into mitochondria. The subsequent decline of [Ca2+]cyt reduces surfactant secretion and thus regional ventilation in lung regions with high VD/VT. Additionally, the regional hypoventilation provoked by perfusion failure can be inhibited by inspiratory CO2 application.

Submitted by Raniere Barreto (raniere.barros@ufvjm.edu.br) on 2018-11-20T21:27:25Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) maria_paula_keller_pinheiro.pdf: 1317240 bytes, checksum: 47f8d062d99ad1447d8dda3d53fbf106 (MD5) Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2018-12-10T16:44:06Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) maria_paula_keller_pinheiro.pdf: 1317240 bytes, checksum: 47f8d062d99ad1447d8dda3d53fbf106 (MD5) Made available in DSpace on 2018-12-10T16:44:06Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) maria_paula_keller_pinheiro.pdf: 1317240 bytes, checksum: 47f8d062d99ad1447d8dda3d53fbf106 (MD5) Previous issue date: 2018 Findada a crise dos anos de 1970, o sistema capitalista deu entrada num processo de profundas transforma??es. Tais transforma??es n?o tiveram outro objetivo sen?o o restabelecimento do poder hegem?nico capitalista que durante certo per?odo hist?rico se viu amea?ado diante da amea?a socialista. Al?m de fortalecer o sistema do capital estas modifica??es deixaram intactas a estrutura que ? a base e fonte de toda a riqueza socialmente produzida: a for?a de trabalho. Na atual conjuntura, o modo de produ??o mercantil se configura pelaexponencia??o da esfera financeira que pelo uso sem controle das formas fict?cias de capital - que n?o possibilitam a gera??o de valor- a for?a de trabalho vem sofrendo o mais barbarizante ataque gra?as ao processo de reestrutura??o produtiva bem como a ado??o das pol?ticas neoliberais que munem o capital de todo arsenal para levar adiante o seu projeto societ?rio. Inseridos nesta din?mica salientamos os processos de superexplora??o do trabalho que se desenvolveram no pa?ses de economia subdesenvolvida como ? o caso do Brasil. Ap?s os anos 1990, quando ideologia neoliberal passou a nortear a din?mica socioecon?mica brasileira, a regress?o dos direito trabalhistas vem permitindo a legaliza??o da superexplora??o do trabalho. Isso sem falar do processo de desindustrializa??o no qual o Brasil vem submergindo o que o coloca num preocupante processo de revers?o neocolonial onde os produtos prim?rios s?o colocados enquanto principal pauta da exporta??o o que contribui para exponencia??o e aprofundamento do processo de superexplora??o do trabalho no pa?s. Disserta??o (Mestrado Profissional) ? Programa de P?s-Gradua??o em Tecnologia, Sa?de e Sociedade, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2018. After the crisis of the 1970s, the capitalist system entered into a process of profound changes. Such transformations had no other purpose than the reestablishment of the hegemonic capitalist power that during a certain historical period was threatened by the socialist threat. In addition to strengthening the capital system, these changes left intact the structure that is the basis and source of all socially produced wealth: the labor force. At the current juncture, the mode of mercantile production is shaped by the exponentiation of the financial sphere, which by the uncontrolled use of the fictitious forms of capital - which do not allow the generation of value - the labor force has been suffering the most barbaric attack thanks to the process of productive restructuring as well as the adoption of neo-liberal policies that provide the capital of every arsenal to carry out its corporate project. Inserted in this dynamic we emphasize the processes of superexploration of the work that have developed in countries of underdeveloped economy as is the case of Brazil. After the 1990s, when neoliberal ideology began to guide the Brazilian socioeconomic dynamics, the regression of labor law has allowed the legalization of overexploitation of labor. This does not holding process of nonindustrialization in the which the process may be important in the process of an error exponenciation and aprofundamento of process of superexploration of work in country.

Objetivo: identificar diagnosticos, intervencoes e resultados esperados de enfermagem a crianca com Doenca de Pompe, utilizando a Classificacao Internacional para a Pratica de Enfermagem® 2017. Metodo: estudo de caso realizado em dezembro de 2017, com uma mae de crianca com Doenca de Pompe. Resultados: elencaram-se dezessete diagnosticos de enfermagem, distribuidos entre as demandas de cuidados medicamentosos, tecnologicos, habituais modificados, de desenvolvimento e familiares. Discussao: os diagnosticos de enfermagem relacionaram-se ao tratamento e as complicacoes apresentadas pela crianca em decorrencia da Doenca de Pompe, acrescidas pelas necessidades familiares para desenvolver os cuidados no domicilio. Conclusao : verificou-se que a classificacao das praticas de enfermagem permitiu criar possibilidades mais especializadas para elaborar e executar um plano de cuidados com base nas reais necessidades desta crianca, podendo existir generalizacao para os portadores da mesma enfermidade. Descritores: Doenca de Deposito de Glicogenio Tipo II; Enfermagem Pediatrica; Atencao Primaria a Saude; Diagnostico de Enfermagem; Familia.

The risks and microbiology for peripherally inserted central catheters (PICCs) are less well described than those for traditional central catheters, particularly as they pertain to duration of catheterization. We compared patients with early- and late-onset PICC bloodstream infections at our institution and found significant differences in microbiologic etiologies.

A prevalência de doença crônica na infância tem aumentado, impondo à família contato contínuo com profissionais de saúde, ocasião em que a relação desempenha papel relevante. Raras explorações científicas abordam tal temática, apesar de ser apontada como núcleo fundamental para a interação efetiva. O objetivo desse estudo foi caracterizar como a família de criança doente crônica percebe sua relação com os profissionais de saúde. Foram entrevistados 20 cuidadores de criança com doença crônica. O referencial teórico e metodológico adotados foram, respectivamente, o Interacionismo Simbólico e a análise de conteúdo temática. O processo analítico revelou quatro categorias temáticas: papel do cuidador, relações angustiantes, serviços e profissionais e buscando relações acolhedoras. O resultado deste processo interacional que apresenta incongruência de expectativas e comportamentos entre profissional e família é falho e gera sentimento de desamparo, o qual é amenizado pela escuta e compreensão de outras famílias em situação similar. La prevalencia de la enfermedad crónica en la infancia ha aumentado, requiriendo la familia un contacto continuo con los profesionales de salud, momento donde esta relación juega un papel importante. Existen pocas exploraciones científicas que traten este tema, a pesar de ser identificado como núcleo fundamental para la interacción efectiva. El objetivo de este estudio fue caracterizar la percepción de la familia del niño con enfermedad crónica sobre la relación con los profesionales de la salud. Fueron entrevistados 20 cuidadores de niños con enfermedades crónicas. El referencial teórico y metodológico adoptados fueron el Interaccionismo Simbólico y el análisis del contenido temático, respectivamente. El proceso de análisis reveló cuatro categorías temáticas: rol del cuidador, relaciones angustiantes, servicios y profesionales y; buscando relaciones acogedoras. El resultado de este proceso de interacción que presenta incongruencia de las expectativas y comportamientos entre el profesional y la familia es deficiente, y genera un sentimiento de abandono, que es atenuado por la escucha y la comprensión de otras familias en situaciones similares. The prevalence of chronic disease in childhood has increased, placing families in constant contact with health professionals. In such situations the relationship with health professionals has an important role. Few scientific studies address this theme, in spite of its being highlighted as fundamental for effective interaction. The aim of this study was to characterize how the family of a child with a chronic disease perceives its relationship with health professionals. Twenty caregivers for children with chronic diseases were interviewed. The theoretical and methodological frameworks were, respectively, symbolic interactionism and thematic content analysis. The analytical process revealed four themes: role of the caregiver, stressful relationships, services and professionals, and seeking welcoming relationships. The outcomes of this interactional process, which show an incongruity of expectations and behaviors between professionals and families, are poor and generate feelings of abandonment. These can be eased through listening and understanding by other families in similar situations.

In adult respiratory distress syndrome (ARDS) pulmonary perfusion failure increases physiologic dead-space (VD/VT) correlating with mortality. High VD/VT results in alveolar hypocapnia, which has been demonstrated to cause edema formation, atelectasis, and surfactant depletion, evoked, at least in part, by apoptosis of alveolar epithelial cells (AEC). However, the mechanism underlying the hypocapnia-induced AEC apoptosis is unknown. Here, using fluorescent live-cell imaging of cultured AEC type 2 we could show that in terms of CO2 sensing the tricarboxylic acid cycle enzyme isocitrate dehydrogenase (IDH) 3 seems to be an important player because hypocapnia resulted independently from pH in an elevation of IDH3 activity and subsequently in an increase of NADH, the substrate of the respiratory chain. As a consequence, the mitochondrial transmembrane potential (ΔΨ) rose causing a Ca2+ shift from cytosol into mitochondria, whereas the IDH3 knockdown inhibited these responses. Furthermore, the hypocapnia-induced mitochondrial Ca2+ uptake resulted in reactive oxygen species (ROS) production, and both the mitochondrial Ca2+ uptake and ROS production induced apoptosis. Accordingly, we provide evidence that in AEC type 2 hypocapnia induces elevation of IDH3 activity leading to apoptosis. This finding might give new insight into the pathogenesis of ARDS and may help to develop novel strategies to reduce tissue injury in ARDS.

In adult respiratory distress syndrome (ARDS) pulmonary perfusion failure increases physiologic dead-space (VD/VT) correlating with mortality. High VD/VT results in alveolar hypocapnia, which has been demonstrated to cause edema formation, atelectasis, and surfactant depletion, evoked, at least in part, by apoptosis of alveolar epithelial cells (AEC). However, the mechanism underlying the hypocapnia-induced AEC apoptosis is unknown. Here, using fluorescent live-cell imaging of cultured AEC type 2 we could show that in terms of CO2 sensing the tricarboxylic acid cycle enzyme isocitrate dehydrogenase (IDH) 3 seems to be an important player because hypocapnia resulted independently from pH in an elevation of IDH3 activity and subsequently in an increase of NADH, the substrate of the respiratory chain. As a consequence, the mitochondrial transmembrane potential (ΔΨ) rose causing a Ca2+ shift from cytosol into mitochondria, whereas the IDH3 knockdown inhibited these responses. Furthermore, the hypocapnia-induced mitochondrial Ca2+ uptake resulted in reactive oxygen species (ROS) production, and both the mitochondrial Ca2+ uptake and ROS production induced apoptosis. Accordingly, we provide evidence that in AEC type 2 hypocapnia induces elevation of IDH3 activity leading to apoptosis. This finding might give new insight into the pathogenesis of ARDS and may help to develop novel strategies to reduce tissue injury in ARDS.

Affiliations: 1. Department of Epidemiology, Beaumont Health System, Royal Oak, Michigan; 2. Oakland University William Beaumont School of Medicine, Royal Oak, Michigan. Received April 26, 2012; accepted July 21, 2012; electronically published October 23, 2012. 2012 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2012/3312-0008$15.00. DOI: 10.1086/668430 Ultrasound transmission gel (USTG) is used in a variety of healthcare settings for both diagnostic and interventional procedures. Its potential role as a vehicle for spread of infections to patients is frequently overlooked. It has been shown on multiple occasions that USTG can become contaminated with bacteria, leading to significant outbreaks of infection among patients. It is incumbent upon all medical professionals to be aware of the potential risks these products pose to patients. Manufacturers of USTG should label products clearly as to their intended use. Producers of medical devices where USTG is likely to be used should provide explicit instructions on the type of USTG recommended and methods of use. Finally, standardized professional society guidelines would enhance patient safety and improve outcomes. On the basis of our recently described outbreak of infections associated with intrinsically contaminated ultrasound gel and a review of all other clusters, we would like to describe the differences between gels and propose guidelines for use of both nonsterile and sterile ultrasound gel. USTG is available from multiple manufacturers and comes in a variety of formulations and dispenser sizes, often without clearly defined differences between products or suggested uses. A review of one manufacturer’s website found 6 separate USTGs available for purchase, although it was not made clear what significant differences existed between products or if there were specific intended uses for them. Although these gels are often considered bacteriostatic because of components such as parabens or methyl benzoate, one study demonstrated that an ultrasound gel had no intrinsic antimicrobial properties and could function as a medium for bacterial growth. Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus were all demonstrated to survive in USTG in another in vitro study. The term “bacteriostatic” should not be used unless the product meets defined requirements to prove this. Contaminated USTG has been associated with outbreaks of infection due to a variety of procedures and microorganisms (Table 1). In all circumstances, the outbreaks were aborted after a switch to single-dose sterile gel. Our more recent report of cases of respiratory infections and colonizations with P. aeruginosa strongly suggested that gel contaminated at or around the time of manufacture was associated with infections. In this series, 16 patients were found to have P. aeruginosa in their respiratory tract after undergoing cardiovascular surgery. Laboratory isolates for 10 patients were saved, and all 10 proved to be more than 99% similar by molecular typing via repetitive extragenic palindromic polymerase chain reaction (rep-PCR). This surgery included the use of an intraoperative transesophageal echocardiogram (TEE) that utilized USTG as a conducting agent. The TEE probes were culture negative, but cultures of in-use multidose bottles of gel as well as sealed, unopened bottles of gel grew P. aeruginosa, which were also more than 99% similar to the outbreak strain by rep-PCR. Procedures utilizing USTG can range from noninvasive studies (such as transthoracic echocardiography, bladder scans, and vascular scans), to those with mucous membrane contact (such as TEE and transvaginal ultrasonography), to frankly invasive procedures (such as transrectal prostate biopsy [TRPB], thyroid biopsy, epiaortic ultrasonography [EAU], and stereotactic breast biopsies). As such, the Spaulding classification scheme can be applied to guide clinicians in making decisions regarding proper disinfection and sterilization of devices on the basis of the risk of infection involved with use of the item. By this scheme, scanning devices used for noninvasive procedures could be considered “noncritical devices” because of their contact with intact skin. Likewise, diagnostic studies using TEE or TRPB would require “semicritical” disinfection because of contact with mucous membranes. EAU transducers are required to be sterile, as they are introduced directly into the surgical field. On the basis of the Spaulding classification scheme, how does one define the appropriate use of USTG for procedures? Any procedure involving sterile skin preparation would likely also require sterile USTG. Sterility is not a necessary require

Objetivo: Identificar e caracterizar as revelações manifestas por crianças portadoras de doenças crônicas em tratamento ambulatorial. Métodos: Tratou-se de uma pesquisa qualitativa, norteada pelos referenciais do Interacionismo Simbólico e da análise de conteúdo temática de Bardin. A coleta dos dados foi desenvolvida por meio de sessões de brinquedo terapêutico com quatro crianças pré-escolares que convivem com a doença crônica. Resultados: Identificaram-se quatro categorias temáticas que marcam o cotidiano destas crianças: "Interações", "Luta", "Apoio" e "Dúvida". Conclusão: Estas crianças buscam transformar as interações de seu cotidiano com vistas a serem reconhecidas enquanto pessoas com voz, desejos, vontades, detentoras e formadoras de opinião. Objective: To identify and describe the revelations expressed by children with chronic diseases in outpatient treatment. Methods: This was a qualitative study guided by the theoretical framework of symbolic interactionism and Bardin's thematic content analysis. Data was collected through therapeutic play sessions with four preschool children who live with chronic illness. Results: Four thematic categories that characterize the daily life of these children were identified:"Interactions," "Fight," "Support" and "Doubt." Conclusion: The children in this study seek to transform their daily interactions with a view toward being recognized as individuals with voices, desires, wills and opinions.

Introducao: a asma e uma das doencas cronicas mais comuns no mundo, e a mais comum em criancas. no Brasil, estima-se que a prevalencia dela seja por volta de 10%. a literatura quando traz informacoes sobre a bronquite, a associa a asma, e muitas vezes bronquite e asma sao usados como termos sinonimos. a asma/bronquite exige demandas de cuidado que impactam a familia, com repercussoes a varios de seus membros, inclusive o irmao da crianca doente. Poucas pesquisas tem acessado a perspectiva do irmao da crianca com asma/ bronquite com vistas a compreender a experiencia fraterna na voz do proprio irmao, e no intuito de agregar conhecimento neste sentido, foi desenvolvida esta pesquisa. Objetivo: Compreender a experiencia de irmaos que convivem com criancas com asma ou bronquite. Metodo: Pesquisa exploratoria, qualitativa, pautada no referencial teorico e metodologico da hermeneutica filosofica de Gadamer. Oito criancas/adolescentes, irmas(aos) mais velhos de criancas com asma ou bronquite, com idades entre seis e 16 anos, integraram o estudo. a coleta dos dados deu-se por meio de entrevistas abertas integradas as estrategias de desenho, cartas ou fotografias. Foram seguidas as cinco etapas propostas por pesquisadores em Glasgow, que adotam a perspectiva gadameriana como estrutura para analisar dados. Resultados: a compreensao advinda da analise dos dialogos foi a de que o irmao valoriza a relacao fraterna e a sobrepoe as repercussoes da asma/bronquite da crianca em sua vida. a irmandade e marcada pela uniao, companheirismo, amizade e protecao, onde a simples presenca da crianca na vida do irmao e entendida como felicidade. em seu cotidiano, os irmaos exercem acoes de cuidado/protecao a crianca doente cronica determinadas pela dinâmica da familia. Nesta situacao, contam com escassas fontes de informacao sobre a doenca da crianca, e anseiam por poder obter mais conhecimento da mesma. Eles assumem responsabilidades de cuidado a crianca como medicar, vigiar, cuidado ambiental e prevencao de riscos de agudizacao da doenca. Sentem diferencas no tratamento ofertado pelos pais em relacao a ele e ao irmao. e apesar de terem suas proprias demandas, estas nao sao percebidas e o enfrentamento das mesmas e realizado de forma solitaria, sustentada por um movimento de ponderar sua situacao e encontrar acalento para aquilo que o faz sofrer. Tal processo permite a ele entender sua vida como “normal”. Conclusao: Os achados ressaltam a invisibilidade do irmao de criancas com asma/bronquite, o que implica em necessidade de transformacao de praticas profissionais, com vistas ao cuidado integral. Isso demanda transformacoes em cenarios de ensino, formacao e pesquisa. Nao ha como cuidar de forma humanizada percorrendo caminhos “retilineos”, “pre-determinados” e isentos de fusoes de horizontes, sem abertura para o encontro com o outro atraves do dialogo.

Financiadora de Estudos e Projetos Asthma is one of the most common chronic diseases and its prevalence is increasing, especially among children. The care demands from this situation impacts the entire family, with repercussions in several of its members, including the sibling. Therefore, this work aimed to understand the sibling s experience that lives with children with asthma or bronchitis on the voice of the sibling. It is an exploratory, qualitative research, based on the theoretical and methodological framework of Gadamer s philosophical hermeneutics. Philosophical hermeneutics seeks understanding, the apprehension of the senses through horizons that are mediated through dialogue with the purpose of understanding. And the understanding demands to face the fore-meanings and prejudices about the phenomenon that is about to be understood. This process involves language, which makes it possible to achieve understanding of the being. The language allows consciousness of being affected by history, where it is noted that the past is always present in human thoughts in order to be revealed through dialogue. It is the dialogue that there is the true birth of the truth. Eight children and teenagers, older siblings of children with asthma or bronchitis, ages six to 16 years old were the participants of this study. Data collection was done through open interviews integrated to the strategies of drawing, letter or photograph. Five steps proposed by researchers in Glasgow were followed, where is adopted the Gadamer's perspective as a framework for data analysis. The dialogue analysis allows understanding that siblings appreciates the fraternal relationship and overrides the effects of the child s asthma or bronchitis in his/her life. Union, fellowship, friendship and protection mark the relationship between siblings, where the mere presence of the child in the sibling s life is understood as happiness. In their daily lives, the siblings are engaged in actions of care and protection to the chronic ill child that is determined by the dynamics of the family. In this situation, they count on few sources of information about the child's illness and wish for having more information about it. They take responsibilities for the child s care such as give medicine, keep vigil, take care of the environmental and try to prevent possible risks that may exacerbate the disease. They feel that parents treat them and the sick child differently. And although they have their own demands, those are not perceived and coping is held in solitary way, sustained by the action to consider its own situation and find nurturing for what makes them suffer. This process allows the sibling to understand his/her life as "normal". The findings highlight the invisibility of the sibling of children with asthma or bronchitis, which implies a need for professional practice transformation aiming a comprehensive, meaningful and complete care. That requires changes in teaching, training and research scenarios. There is no way to care in a complete and humane way walking paths that are "straight" or " predetermined " and absents of fusions of horizons, without opening to the encounter with other through dialogue. A asma é uma das doenças crônicas mais comum, e sua prevalência está crescendo, especialmente entre crianças. As demandas de cuidado advindos desta patologia impacta toda a família, com repercussões a vários de seus membros, inclusive o irmão. Com vistas à compreender a experiência fraterna na voz do próprio irmão, e no intuito de agregar conhecimento neste sentido, foi desenvolvida esta pesquisa. Desta maneira, o objetivo deste trabalho foi compreender a experiência de irmãos que convivem com crianças com asma ou bronquite. É uma pesquisa exploratória, qualitativa, pautada no referencial teórico e metodológico da hermenêutica filosófica de Gadamer. A hermenêutica filosófica busca a compreensão, a apreensão dos sentidos por meio de horizontes que são mediados no diálogo com vista ao entendimento. E o compreender exige colocar o preconceito ou pré-compreensão em relação ao fenômeno que se deseja entender. Esse processo envolve a linguagem, sendo nela que se dá a compreensão do ser, e através dela retoma-se a historicidade, onde denota-se o passado estar sempre presente no pensamento humano de forma a ser retomado no diálogo. Pois é no diálogo que há o verdadeiro nascimento da verdade. Oito crianças e adolescentes, irmãs(ãos) mais velhos de crianças com asma ou bronquite, com idades entre seis e 16 anos, integraram o estudo. A coleta dos dados deu-se por meio de entrevistas abertas integradas às estratégias de desenho, carta ou fotografia. Foram seguidas as cinco etapas propostas por pesquisadores em Glasgow, que adotam a perspectiva gadameriana como estrutura para analisar dados. A análise dos diálogos permitiu compreender que o irmão valoriza a relação fraterna e a sobrepõe às repercussões da asma ou bronquite da criança em sua vida. A irmandade é marcada pela união, companheirismo, amizade e proteção, onde a simples presença da criança na vida do irmão é entendida como felicidade. Em seu cotidiano, os irmãos exercem ações de cuidado e proteção à criança doente crônica determinadas pela dinâmica da família. Nesta situação, contam com escassas fontes de informação sobre a doença da criança, e anseiam por poder obter mais conhecimento da mesma. Eles assumem responsabilidades de cuidado à criança como medicar, vigiar, cuidado ambiental e prevenção de riscos de agudização da doença. Sentem diferenças no tratamento ofertado pelos pais em relação a ele e ao irmão. E apesar de terem suas próprias demandas, estas não são percebidas e o enfrentamento das mesmas é realizado de forma solitária, sustentada por um movimento de ponderar sua situação e encontrar acalento para aquilo que o faz sofrer. Tal processo permite a ele entender sua vida como normal . Os achados ressaltam a invisibilidade do irmão de crianças com asma ou bronquite, o que implica em necessidade de transformação de práticas profissionais, com vistas ao cuidado integral. Isso demanda transformações em cenários de ensino, formação e pesquisa. Não há como cuidar de forma humanizada percorrendo caminhos retilíneos , pré-determinados e isentos de fusões de horizontes, sem abertura para o encontro com o outro através do diálogo.

The prevalence of chronic disease in childhood has increased, placing families in constant contact with health professionals. In such situations the relationship with health professionals has an important role. Few scientific studies address this theme, in spite of its being highlighted as fundamental for effective interaction. The aim of this study was to characterize how the family of a child with a chronic disease perceives its relationship with health professionals. Twenty caregivers for children with chronic diseases were interviewed. The theoretical and methodological frameworks were, respectively, symbolic interactionism and thematic content analysis. The analytical process revealed four themes: role of the caregiver, stressful relationships, services and professionals, and seeking welcoming relationships. The outcomes of this interactional process, which show an incongruity of expectations and behaviors between professionals and families, are poor and generate feelings of abandonment. These can be eased through listening and understanding by other families in similar situations.

Pulmonary perfusion disorders provoke atelectasis in order to minimize ventilation/perfusion mismatch. However, the underlying mechanisms remain unknown. Because intraalveolar CO2 concentration ([CO2]iA) declines as a consequence of poor pulmonary perfusion we postulated the existence a novel alveolar CO2-sensing mechanism which adapts the ventilation to perfusion. Real-time fluorescence imaging of rat lungs revealed that low [CO2]iA decreased cytosolic and increased mitochondrial Ca2+ in alveolar epithelial cells (AEC), leading to reduction of surfactant secretion and alveolar ventilation. Mitochondrial inhibition by ruthenium red or rotenone blocked the hypocapnia-induced responses. In cultured Type 2 AEC hypocapnia decreased cytosolic Ca2+ independently from pH and increased the NADH production, the mitochondrial transmembrane potential, and subsequently the mitochondrial Ca2+ uptake. All responses were completely blocked by the gene knockdown of the NADH producing Krebs cycle enzyme isocitrate dehydrogenase. Furthermore, ligature of the pulmonary artery of rabbits decreased alveolar ventilation, surfactant secretion, and lung compliance. Addition of 5% CO2 to the inspiratory gas inhibited all responses. Accordingly, we provide evidence for a novel CO2-sensing mechanism of AEC regulated by the Krebs cycle activity in terms of a negative feedback loop adapting surfactant secretion and thus regional ventilation to pulmonary perfusion.