Therapeutic Itineraries Research Articles

Therapeutic itinerary of elderly people with diabetes mellitus: implications for nursing care.

to describe the therapeutic itinerary of elderly people with diabetes mellitus registered at Family Health Strategy units. qualitative and descriptive study carried out with 15 elderly people with diabetes mellitus between February and April 2019 by applying semi-structured interviews with the participants. Data were submitted to analysis of Minayo's operational proposal. in the folk care subsystem, the use of medicinal herbs, healers, and faith was emphasized by the participants. In the professional care subsystem, Family Health Strategy units were the services with the strongest bond to elderly people, but these patients still had to resort to the private healthcare network. Family proved to be the main source of support in the popular care subsystem. nursing must acknowledge the different types of knowledge, coping strategies, beliefs, and the culture of elderly people with diabetes mellitus to guarantee the delivery of comprehensive care.

Evaluation of the profile and therapeutic itinerary of men with breast cancer in Pernambuco

Evaluation of the profile and therapeutic itinerary of men with breast cancer in Pernambuco

Therapeutic itinerary of families of children with chronic diseases

Abstract Objective: to understand the Therapeutic Itineraries of families of children with chronic diseases. Method: phenomenological study conducted at a university hospital, with ten families of children with chronic diseases who participated in a phenomenological interview with the guiding question - 'Tell me about the path you (and your family) traveled in search of health care for your child before arriving at this hospital'. Results: four thematic categories emerged: Walking in search of health care for their child - the beginning of the saga; Perceiving themselves as vulnerable in front of the Unified Health System; From the difficulty to get access to health care to unexpected help and Arriving at the reference service - from the relief of care to the perception of the existence of new problems. Discussion: some families were referred by bonds of friendship, transfer through zero vacancy and spontaneous demand in other health services. After the diagnosis and beginning of treatment, the family showed hope for a cure, reporting a sense of relief when they saw the child being cared for. Conclusion: it was evidenced that children with chronic diseases and their families experience a long process of seeking access to health care, mainly due to the need for referral to referral hospitals.

Meia lua Falciforme: poesia, dor e luta

O documentário Meia lua Falciforme retrata diversas faces e enfrentamentos no cotidiano dos pacientes e familiares que convivem com a doença falciforme no cenário brasileiro. A dor, o racismo e a resistência são pontos-chave discutidos no relevante curta-metragem, de Débora Evellyn Olimpo e Denise Kelm, que traz uma perspectiva para além do adoecimento físico e, com leveza, apresenta produções artísticas dos conviventes com a temática. No tocante à resistência e à luta, o documentário cita a grande conquista no que diz respeito ao reconhecimento e à normatização da doença no Brasil, os confltos enfrentados rotineiramente em busca de acesso aos serviços de saúde, bem como a luta por um SUS que garanta os princípios da universalidade e equidade. A presente resenha traz algumas notas sobre o documentário e os temas que perpassam a vida dos pacientes desde o momento do diagnóstico até os itinerários e decisões terapêuticos.

Therapeutic itinerary of transsexual people in light of human rights.

The therapeutic itinerary is not limited to the identification and availability of health services offered, but relates to the different individual searches and sociocultural and economic possibilities of each patient. In this study, we discuss the therapeutic itinerary of transsexual people seeking healthcare, from the user's perspective. The aim of this study was to discuss the therapeutic itinerary of transsexual people seeking healthcare, from the user's perspective. Individual interviews were performed with 10 transsexuals at the Trans Space of a University Hospital of Pernambuco, using the Universal Declaration of Human Rights as the theoretical reference and the Bardin's thematic content analysis as the reference methodological framework. This study was approved by the Human Research Ethics Committee at the Federal University of Pernambuco under protocol no. 91284218.5.0000.5208. The comprehensive care for transsexual people was evidenced through four categories analyzed: low demand of transsexuals in health services; use of social name in health services; care permeated by prejudiced and discriminatory attitudes; and health system and professionals who are not able to meet transgender health issues. Transsexual people are stigmatized and experience prejudice in their daily health, in a way they do not enjoy fundamental rights, as if they had fewer rights, or infringe the principle of universality of access to health. Thus, for effective and comprehensive care, the health team must keep up to date on the public policies existing in the healthcare of transsexual people and reconstruct what they understand by gender. Knowledge about the therapeutic itinerary of transgender people may support evaluation processes of health service networks to ensure the access to and reorganization of these services. Understanding this dynamic allows fostering discussions about the structure of health services at all care levels for the care of this population.

Compreendendo os motivos que levam os usuários a buscarem as Unidades de Pronto atendimento

Objetivo: compreender os aspectos individuais e socioculturais do itinerário terapêutico de usuários da Unidade de Pronto Atendimento. Método: trata-se de um estudo transversal, com abordagem qualitativa, realizado em uma Unidade de Pronto Atendimento. Para elucidar o desenvolvimento do trabalho de campo e a análise dos dados, utilizou-se como método a Teoria Fundamentada nos Dados. Resultados: notou-se que a motivação estabelecida pelos pacientes, para justificar sua busca aos serviços emergenciais variou de acordo com as atividades ofertadas pela Rede de Atenção í Saúde, a rápida resolução dos problemas, doenças crônicas agudizadas devido ao cuidado fragmentado e pelo baixo conhecimento em saúde pelos usuários e/ou profissionais. Conclusão: Fatores sociais, financeiros, barreiras geográficas e falhas na operacionalização dos serviços ofertados pelo Sistema Único de Saúde acabam por favorecer na gênese do fenômeno, necessitando desse modo, do fortalecimento de toda Rede de Atenção í Saúde, bem como das polí­ticas públicas existentes.

Itinerários terapêuticos de pessoas com doenças respiratórias crônicas

Objetivo: Compreender os Itinerários Terapêuticos de pacientes com doenças respiratórias crônicas nos diversos níveis de atenção à saúde. Métodos: O estudo trata-se de uma abordagem qualitativa e exploratória, realizada em um distrito sanitário de uma capital na região nordeste do Brasil. A técnica para a produção dos dados foi a entrevista semiestruturada com trabalhadores de saúde e pacientes com doenças respiratórias crônicas, o qual utilizou a análise de conteúdo para a interpretação do material coletado. Resultados: Os principais achados produzidos na pesquisa identificadas foram as consequências de uma comunicação ineficiente nas redes de atenção à saúde, o deslocamento excessivo do usuário no processo do cuidado, ocorrida principalmente pela dificuldade de acesso aos serviços no sistema de saúde local. Conclusão: Há um déficit na comunicação entre as redes de atenção à saúde, o que dificulta a resolutividade do cuidar com um olhar integral, o que produz uma rede fragmentada nos seus diferentes níveis.

Diabetic polyneuropathy with/out neuropathic pain in Mali: A cross-sectional study in two reference diabetes treatment centers in Bamako (Mali), Western Africa.

Diabetic polyneuropathy (DPN) with or without neuropathic pain is a frequent complication of diabetes. This work aimed to determine the prevalence of diabetic polyneuropathy, to describe its epidemiological aspects, and to analyze the therapeutic itinerary of patients with DPN. This was a cross-sectional, descriptive study performed synchronously over six months at two major follow-up sites for patients with diabetes in Mali. DPN was diagnosed based on the Michigan Neuropathy Screening Instrument (MNSI). The neuropathic nature of the pain and the quality of life of patients were evaluated by the DN4 and the ED-5D scale, respectively. We used three (3) different questionnaires to collect data from patients (one at inclusion and another during the follow-up consultation) and from the caregivers of patients with DPN. We included 252 patients with diabetes, and DPN was found to have a healthcare facility-based prevalence of 69.8% (176/252). The sex ratio was approximately three females for every male patient. The patients were mostly 31 to 60 years of age, 83% had type 2 diabetes, and 86.9% had neuropathic pain Approximately half of the patients (48.3%) had autonomic neuropathy and they reported moderate to intense pain, which was mainly described as a burning sensation. The patients exhibited impaired exteroceptive and proprioceptive sensations in 51.7% of cases. The patients smoked tobacco in 3.4% of cases, while 36.6% of the patients were obese and had dyslipidemia. The caregivers clearly indicated that appropriate medications were not readily accessible or available for their patients with DPN. The healthcare facility-based prevalence of DPN with or without neuropathic pain was high in our cohort. These inexpensive and easy-to-use tools (MNSI, DN4) can be used to adequately diagnose DPN in the African context. In Mali, screening and early treatment of patients at risk of DPN should allow for a reduction of the burden of the disease, while caregivers need to be adequately trained to manage DPN.

Weaving networks: therapeutic itineraries of people with ostomy

Objective: To describe the therapeutic itinerary of people with an ostomy in search of specialized care. Method: exploratory, descriptive study with a qualitative approach, with ten people with ostomy treated at the Ostomy Care Service (Serviço de Atenção à Saúde da Pessoa Ostomizada), from August to November 2017. Reconstitution took place through semi-structured interviews, registration in a field diary and consultation with records of specialized health services, and processed by the software Interface de R pour les Analyses Multidimensionnelles de Texte et de Questionnaires. Results: the therapeutic itinerary begins with the discovery of signs and symptoms, when there is access to the nearest health services and later in search of specialized services. Marked by formal connections and supported by interrelated subsystems. The trajectories of search, production, health transport and health care management undertaken by individuals, families and informal groups express different paths and movements in the phase that precedes specialized care. Conclusion: the knowledge apprehended by the speeches enables the identification of basic needs presented by this clientele, facilities and barriers encountered in the course undertaken to obtain an adequate therapeutic plan.

Role of Flavonoids in The Interactions among Obesity, Inflammation, and Autophagy.

Nowadays, obesity is considered as one of the main concerns for public health worldwide, since it encompasses up to 39% of overweight and 13% obese (WHO) adults. It develops because of the imbalance in the energy intake/expenditure ratio, which leads to excess nutrients and results in dysfunction of adipose tissue. The hypertrophy of adipocytes and the nutrients excess trigger the induction of inflammatory signaling through various pathways, among others, an increase in the expression of pro-inflammatory adipocytokines, and stress of the endoplasmic reticulum (ER). A better understanding of obesity and preventing its complications are beneficial for obese patients on two facets: treating obesity, and treating and preventing the pathologies associated with it. Hitherto, therapeutic itineraries in most cases are based on lifestyle modifications, bariatric surgery, and pharmacotherapy despite none of them have achieved optimal results. Therefore, diet can play an important role in the prevention of adiposity, as well as the associated disorders. Recent results have shown that flavonoids intake have an essential role in protecting against oxidative damage phenomena, and presents biochemical and pharmacological functions beneficial to human health. This review summarizes the current knowledge of the anti-inflammatory actions and autophagic flux of natural flavonoids, and their molecular mechanisms for preventing and/or treating obesity.

Gestão do cuidado à criança/adolescente com doença crônica: (des)articulação da rede e fragmentação das ações

Objetivo: analisar a gestão do cuidado à criança/adolescente com doença crônica na rede de atenção à saúde, tendo como alicerce as experiências de famílias na busca pelo cuidado do(a) filho(a). Método: pesquisa qualitativa, realizada com dez familiares de crianças/adolescentes com doença crônica, residentes do município de João Pessoa, Paraíba, Brasil. Os dados foram coletados de novembro de 2017 a junho de 2018 por meio de entrevistas semiestruturadas e submetidos à análise temática indutiva. Resultados: a rede de atenção à saúde de crianças/adolescentes com doença crônica está desarticulada e as ações de cuidado fragmentadas; as famílias traçam seus próprios itinerários terapêuticos e não recebem apoio dos profissionais/serviços no manejo do cuidado. Conclusão: a desarticulação no planejamento das ações de cuidado nas redes de atenção à saúde, aliado ao atendimento pontual e descontínuo à criança/adolescente com doença crônica e sua família fragilizam e empobrecem a gestão do cuidado.

Therapeutic itineraries of Qom mothers in a peri-urban community of Formosa.

Indigenous peoples are undergoing profound Lifestyle changes that affect their health and the way they manage their diseases. The objective of this study was to determine the therapeutic itineraries followed by Qom mothers whenever they perceive their children are sick. The study was done in the Namqom peri-urban community, in the province of Formosa, with a group of mothers with young children interviewed at their houses until achieving saturation. The study followed an exploratory, qualitative design based on a conceptual health belief model. The therapeutic itineraries selected by 16 Qom mothers included using home remedies, biblical/faith healing, healers, and visiting the provincial health center. In general, the itinerary depends on how the mother characterizes disease symptoms: natural (biological cause) or unnatural (sorcery-related). The different methods are not necessarily incompatible and, many times, are used as complementary. Both reliability on effectiveness and fear of consequences play an important role on treatment selection. These results are extremely helpful to improve the dialog between the community and the health center. It is necessary to promote an improved coordination among the different health care agents working in transitioning indigenous communities. The results of this study described selected therapeutic itineraries and, as a consequence, evidenced the strong presence of pluralistic medical systems in this community.

Barriers to access and organization of primary health care services for rural riverside populations in the Amazon

BackgroundThe ways of life in the Amazon are diverse and not widely known. In addition, social inequities, large geographic distances and inadequate health care network noticeably limit access to health services in rural areas. Over the last decades, Brazilian health authorities have implemented fluvial mobile units (FMU) as an alternative to increase access and healthcare coverage. The aim of the study was to identify the strategies of access and utilization of primary health care (PHC) services by assessing the strengths and limitations of the healthcare model offered by the FMU to reduce barriers to services and ensure the right to healthcare.MethodsQualitative and ethnographic research involving participant observation and semi-structured interviews. Data collection consisted of interviews with users and health professionals and the observation of service organization and healthcare delivered by the FMU, in addition to the therapeutic itineraries that determine demand, access and interaction of users with healthcare services.ResultsPrimary care is offered by the monthly locomotion of the FMU that serves approximately 20 rural riverside communities. The effectiveness of the actions of the FMU proved to be adequate for conditions such as antenatal care for low-risk pregnancy, which require periodic consultations. However, conditions that require continued attention are not adequately met through the organization of care established in the FMU. The underutilization of the workforce of community health workers and disarrangement between their tasks and those of the rest of the multi-professional team are some of the reasons pointed out, making the healthcare continuity unfeasible within the intervals between the trips of the FMU. From the users’ perspective, although the presence of the FMU provides healthcare coverage, the financial burden generated by the pursuit for services persists, since the dispersed housing pattern requires the locomotion of users to reach the mobile unit services as well as for specialized care in the urban centers.ConclusionsThe implementation of the FMU represents an advance in terms of accessibility to PHC. However, the organization of their activity uncritically replicates the routines adopted in the daily routine of health services located in urban spaces, proving to be inadequate for providing healthcare strategies capable of mitigating social and health inequalities faced by the users.

Implications of institutional racism in the therapeutic itinerary of people with chronic renal failure.

Objective. To understand the implications of institutional racism in the therapeutic itinerary of patients with chronic renal failure (CRF) in the search for diagnosis and treatment of the disease. Methods. Descriptive, qualitative study developed with 23 people with CRF in a regional reference hospital for hemodialysis treatment in Northeast Brazil. Two techniques of data collection were used: semi-structured interview and consultation to the NEFRODATA electronic medical record. For systematization and analysis, the technique of content analysis was used. Results. Black and white people with CRF showed significant divergences and differences in their therapeutic itineraries: while white people had access to diagnosis during outpatient care in other medical specialties, black people were only diagnosed during hospitalization. In addition, white people had more access to private health plans when compared to black people, which doubles the possibility of access to health services. Moreover, even when the characteristics in the itinerary of black and white people were convergent, access to diagnosis and treatment proved to be more difficult for black people. Conclusion. The study showed the presence of institutional racism in the therapeutic itinerary of people with kidney disease in which black people have greater difficulty in accessing health services. In this sense, there is a need to create strategies to face institutional racism and to consolidate the National Policy for Comprehensive Health Care of the Black Population.

Fatores de vulnerabilidades em itinerários terapêuticos de doenças raras: uma revisão integrativa

Objetivo: O artigo preocupa-se em ampliar a compreensão sobre conflitos éticos vivenciados por pacientes de doenças raras, identificandoos principais fatores de vulnerabilidades em itinerários terapêuticos de pessoas que vivem nessa condição.Método: Para tanto, realizou-se uma revisão integrativa da literatura desenvolvida nas bases de dados internacionais, publicada entre os anos de 2000 a 2016, compreendendo os idiomas português, inglês e espanhol. Resultados e discussão: Os resultados, a partir da análise qualitativa dos estudos selecionados, possibilitaram identificar os seguintes fatores de vulnerabilidades: falta de informações; despreparo profissional; dificuldade de se chegar a um diagnóstico; longos caminhos percorridos/ diversos serviços de saúde; faltam privacidade e autonomia na participação em pesquisas dedoenças raras; dificuldades de tratamentos e/ ou tratamentos de auto custo; dificuldades financeiras/empobrecimento; falta de organização e estrutura dos serviços de saúde; acolhimento diferenciado seja por discriminação, privações e/ou estigmatização, e sofrimento emocional.Conclusão: Ao discutir essas diferentes dimensões da vulnerabilidade a partir do campo da bioética, o artigo concluí pela necessidade de abordar os itinerários terapêuticos a partir de novas perspectivas interdisciplinares, buscando garantir o respeito ao direito à vida, à saúde e à proteção da dignidade das pessoas que vivem com doenças raras.

Espera, paciência e resistência: reflexões antropológicas sobre transexualidades, curso da vida e itinerários de acesso à saúde

Este trabalho parte de duas investigações realizadas na cidade de Goiânia (Brasil), sobre o tema do acesso à saúde nos marcos do Processo Transexualizador do Sistema Único de Saúde (SUS), com foco na questão da espera. A primeira delas centrou-se nas narrativas de homens trans e a segunda nas de mulheres trans, acerca de suas trajetórias e dos itinerários terapêuticos implicados na chamada transição de gênero. Nosso argumento é que a espera é uma chave antropológica importante para interpretar tais narrativas. Nosso interesse, assim, é colocar em diálogo elementos etnográficos produzidos nessas investigações, tendo como eixo principal uma discussão em torno das ambivalências e tensões que tais sujeitos estabelecem em relação à espera. Nesse sentido, interessa-nos trazer também elementos de campo a fim de discutir antropologicamente os efeitos que expectativas heteronormativas e cisnormativas acerca do gênero e do curso da vida produzem em seus corpos e em suas vidas.

Characterization of deaths and therapeutic itineraries investigated by the Porto Alegre AIDS Mortality Committee, Brazil, in 2015.

to characterize AIDS deaths eligible for Porto Alegre AIDS Mortality Committee (AIDSMC) investigation, Brazil, in 2015, and their therapeutic itineraries. this was a descriptive study using secondary data from surveillance information systems and AIDSMC investigation forms. out of 336 deaths from AIDS-related causes, 113 (33.6%) were considered avoidable, of which 52 were analyzed by AIDSMC; there was predominance of males (30/52), low schooling level (29/52 incomplete elementary education), and less than 2 years between HIV infection diagnosis and death (28/52); tuberculosis was the most frequent cause of death (17/52); and in 50/52 cases at least one therapeutic itinerary inadequacy was identified. avoidable deaths of people with AIDS occurred mostly in men, those with low education level, those with recent HIV diagnosis and most deaths were due to tuberculosis.

Health demands and care of children with congenital Zika syndrome and their mothers in a Brazilian state

BackgroundA Zika virus (ZIKV) infection outbreak occurred in Brazil in 2015, accompanied by a marked increase in the number of newborns presenting with microcephaly and other neurological disorders. This characteristic set of birth defects was later termed congenital Zika syndrome (CZS). The therapeutic itinerary of mothers and children infected by ZIKV can be determined by several factors, including the relationship established with existing healthcare services. Here, we aimed to describe and analyze the extent to which children with CZS, born from 2015 to 2018 in the state of Mato Grosso do Sul, Brazil, and their mothers were treated according to the guidelines established by the Brazilian Ministry of Health.MethodsThis was a descriptive cross-sectional study that considered all children (and respective mothers) with confirmed or suspected CZS born in Mato Grosso do Sul. Children and their mothers were identified based on all suspected or confirmed cases of congenital anomalies in Mato Grosso do Sul that were reported to the Registry of Public Health Events. We analyzed data on the epidemiological profile of mother-child pairs and the care received by them. Data were summarized using statistical descriptive analysis.ResultsWe showed that most mothers were white women (57%) with low income. Among pregnant women, 73% had a diagnosis of fever caused by ZIKV infection at a primary health care institution (PHCI), but only 36% received the necessary information regarding the risk of CZS. Over a third (36%) of the mothers did not receive guidance about childcare follow-up and 73% did not receive guidance regarding the availability of social support after childbirth. Gaps in medical care were observed mainly in pregnant women treated at a PHCI. Specialized assistance for children was adequate in most cases. Psychosocial support was not made available to women throughout their therapeutic itineraries.ConclusionsHere, we identified gaps in the care of families and children with disabilities, which can have an important impact on their quality of life. Beyond protocols, practical interventions must cover all the needs that arise throughout the therapeutic itineraries not only of children but also of pregnant women and mothers.

Conceptual model for pluralistic healthcare behaviour: results from a qualitative study in southwestern Uganda

IntroductionMedical pluralism, or concurrent utilisation of multiple therapeutic modalities, is common in various international contexts, and has been characterised as a factor contributing to poor health outcomes in low-resource settings....

Interpretation systems, therapeutic itineraries and repertoires of leprosy patients in a low prevalence country.

In Peru, despite the small number of cases, there is evidence of late diagnosis and hidden prevalence of leprosy. In this context the objective of the study was to know the interpretation systems on leprosy, itineraries and therapeutic repertoires of patients diagnosed with leprosy who are in treatment or who have finished treatment. A qualitative study was carried out, applying se mi-structured interviews to patients diagnosed with leprosy from the Loreto and Ucayali regions. 30 patients were interviewed. Most did not know the mechanism of leprosy transmission. In relation to therapeutic itineraries, patients generally went to health facilities on the recommendation of third parties who knew the disease. In some cases, health personnel made a bad diagnosis. The importance of the treatment indicated by the "Ministerio de Salud" (Ministry of Health) is recognized; however, economic factors and the distance to health facilities negatively affect adherence to treatment. In addition, it was evidenced that stigma persists towards the disease. Patients recognize the importance of treatment; however, they express misconceptions about the pathogenesis of leprosy, and weaknesses in the health system are also identified. These problems would lead to delay in diagnosis and treatment. It is recommended to strengthen control strategies and decentralize the care of leprosy with the participa tion of the community, patients, health personnel and healers, considering the identified barriers and a probable underdiagnosis in women.