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OBJECTIVES: Coronavirus disease 2019 (COVID-19) may be associated with prolonged symptoms and post-recovery health impairment. This study aimed to evaluate the persistence of symptoms, lung function, and pulmonary diffusion for carbon monoxide (DLCO) in patients between 15 and 30 days after hospital discharge after admission for severe COVID-19. METHODS: The evaluation consisted of 1) comparative analysis between the initial symptoms and symptoms still present at the post-discharge evaluation 2) analysis of the chest images obtained during hospitalization, and 3) conducting spirometry, plethysmography, and DLCO assessment. RESULTS: Forty-one patients who were hospitalized for 16±8 days with severe COVID-19 were included. Patients were predominantly men (73%) and had a mean age of 51±14 years. The most frequent comorbidities were arterial hypertension (51%) and diabetes mellitus (37%). Pulmonary evaluation was performed a mean of 36 days after the onset of symptoms, with the most frequent persistent symptoms being dyspnea (83%) and coughing (54%). Approximately 93% of patients still had at least one symptom, and 20% had more than five symptoms. Chest imaging revealed a typical pattern of COVID-19 on X-ray (93%) and computer tomography (95%). Lung function test results showed a restrictive pattern with a reduction in forced vital capacity (FVC) in 54% of individuals, with an average FVC of 78±14%. A reduction in DLCO was observed in 79% of patients. CONCLUSIONS: We observed a high prevalence of symptoms, in addition to a significant change in lung function and DLCO, in the post-discharge assessment of patients requiring hospitalization after admission for COVID-19.

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OBJECTIVES: Coronavirus disease 2019 (COVID-19) may be associated with prolonged symptoms and post-recovery health impairment. This study aimed to evaluate the persistence of symptoms, lung function, and pulmonary diffusion for carbon monoxide (DLCO) in patients between 15 and 30 days after hospital discharge after admission for severe COVID-19. METHODS: The evaluation consisted of 1) comparative analysis between the initial symptoms and symptoms still present at the post-discharge evaluation 2) analysis of the chest images obtained during hospitalization, and 3) conducting spirometry, plethysmography, and DLCO assessment. RESULTS: Forty-one patients who were hospitalized for 16±8 days with severe COVID-19 were included. Patients were predominantly men (73%) and had a mean age of 51±14 years. The most frequent comorbidities were arterial hypertension (51%) and diabetes mellitus (37%). Pulmonary evaluation was performed a mean of 36 days after the onset of symptoms, with the most frequent persistent symptoms being dyspnea (83%) and coughing (54%). Approximately 93% of patients still had at least one symptom, and 20% had more than five symptoms. Chest imaging revealed a typical pattern of COVID-19 on X-ray (93%) and computer tomography (95%). Lung function test results showed a restrictive pattern with a reduction in forced vital capacity (FVC) in 54% of individuals, with an average FVC of 78±14%. A reduction in DLCO was observed in 79% of patients. CONCLUSIONS: We observed a high prevalence of symptoms, in addition to a significant change in lung function and DLCO, in the post-discharge assessment of patients requiring hospitalization after admission for COVID-19.

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Peripheral blood mononuclear cells (PBMC) from patients with ocular toxoplasmosis were challenged with total antigens from Toxoplasma gondii lysate (TATL) in a cytokine release assay (CRA), run during the inactive period of the disease. Increased interferon gamma (IFN-γ) levels were detected after PBMC stimulation with either ME49 reference strain (P = 0.0015) or local TgCkAr-11-9 isolate (P = 0.0012), as compared with those recorded under basal conditions. TATL from TgCkAr11-9 isolate induced a higher release of IFN-γ than ME49 strain in CRA from all tested patients (P = 0.02). The median value of IFN-γ release on TgCkAr-11-9 stimulation (26.03 pg/mL) allowed the classification of patients into high- or low-/non-IFN-γ releasers. Clinical correlations were established with both groups. The results obtained in this study suggest the need to include local strains when performing CRA with TATL.

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OBJECTIVES: To describe the experience of an outpatient clinic with the multidisciplinary evaluation of intensive care unit survivors and to analyze their social, psychological, and physical characteristics in a low-income population and a developing country. METHODS: Retrospective cohort study. Adult survivors from a general intensive care unit were evaluated three months after discharge in a post-intensive care unit outpatient multidisciplinary clinic over a period of 6 years (2008-2014) in a University Hospital in southern Brazil. RESULTS: A total of 688 out of 1945 intensive care unit survivors received care at the clinic. Of these, 45.2% had psychological disorders (particularly depression), 49.0% had respiratory impairments (abnormal spirometry), and 24.6% had moderate to intense dyspnea during daily life activities. Patients experienced weight loss during hospitalization (mean=11.7%) but good recovery after discharge (mean gain=9.1%), and 94.6% were receiving nutrition orally. One-third of patients showed a reduction of peripheral muscular strength, and 5.7% had moderate to severe tetraparesis or tetraplegia. There was a significant impairment in quality of life (SF-36), particularly in the physical and emotional aspects and in functional capacity. The economic impacts on the affected families, which were mostly low-income families, were considerable. Most patients did not have full access to rehabilitation services, even though half of the families were receiving financial support from the government. CONCLUSIONS: A significant number of intensive care unit survivors evaluated 3 months after discharge had psychological, respiratory, motor, and socioeconomic problems; these findings highlight that strategies aimed to assist critically ill patients should be extended to the post-hospitalization period and that this problem is particularly important in low-income populations.

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OBJECTIVES: To describe the experience of an outpatient clinic with the multidisciplinary evaluation of intensive care unit survivors and to analyze their social, psychological, and physical characteristics in a low-income population and a developing country. METHODS: Retrospective cohort study. Adult survivors from a general intensive care unit were evaluated three months after discharge in a post-intensive care unit outpatient multidisciplinary clinic over a period of 6 years (2008-2014) in a University Hospital in southern Brazil. RESULTS: A total of 688 out of 1945 intensive care unit survivors received care at the clinic. Of these, 45.2% had psychological disorders (particularly depression), 49.0% had respiratory impairments (abnormal spirometry), and 24.6% had moderate to intense dyspnea during daily life activities. Patients experienced weight loss during hospitalization (mean=11.7%) but good recovery after discharge (mean gain=9.1%), and 94.6% were receiving nutrition orally. One-third of patients showed a reduction of peripheral muscular strength, and 5.7% had moderate to severe tetraparesis or tetraplegia. There was a significant impairment in quality of life (SF-36), particularly in the physical and emotional aspects and in functional capacity. The economic impacts on the affected families, which were mostly low-income families, were considerable. Most patients did not have full access to rehabilitation services, even though half of the families were receiving financial support from the government. CONCLUSIONS: A significant number of intensive care unit survivors evaluated 3 months after discharge had psychological, respiratory, motor, and socioeconomic problems; these findings highlight that strategies aimed to assist critically ill patients should be extended to the post-hospitalization period and that this problem is particularly important in low-income populations.

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Enzymatic activities for digestion of proteins and carbohydrates were compared among three organs of the digestive system of Pimelodus maculatus in two reservoirs with different trophic conditions during the winter of 2006. The aim was to test the hypothesis that enzymatic activity for the digestion of proteins and carbohydrates differed among organs and that such activities differ between the trophic state of the environment. Enzymatic activities were determined through the assays of specificity for trypsin, chymotrypsin and β-glucosidase enzymes. The intestine had higher trypsin-like enzymatic activities compared to the stomach and liver. The highest β-glucosidase activity was found in the liver compared to the stomach and intestine in the oligotrophic reservoir only. Overall, enzymatic activity did not differ between the eutrophic and oligotrophic reservoirs, although the intestinal chymotrypsin was comparatively higher in the eutrophic reservoir and the hepatic β-glucosidase was higher in the oligotrophic reservoir. These findings indicated that most digestive activity occurred in the intestine for P. maculatus, which was probably related to its omnivorous/carnivorous feeding habits. The highest proteolytic activity in the intestine was expected for most fishes, but the high hepatic β-glucosidase in the oligotrophic reservoir was unexpected. The hepatic β-glucosidase as well as the intestinal chymotrypsin-like activity could be considered as the candidates for biomarkers of environmental quality.

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The Gram-negative intestinal microbiota of Hypostomus auroguttatus and Pimelodus maculatus, a detritivorous and an omnivorous fish species, respectively, were compared between fishes from the reservoir and the stretch of the river below the dam of the Funil hydroelectric plant, Rio de Janeiro, Brazil. Four selective culture media were used under aerobic and two under anaerobic conditions. The omnivorous species had microbiota with higher population levels compared to the detritivorous species. The number of morphotypes and population levels of total bacteria, vibrio and Bacteroides tended to be higher in summer and autumn in the reservoir, and not different in the river. The number of morphotypes of enterobacteria and total bacteria were higher in the lotic environment compared with the lentic one. The bacteria Aeromonas hydrophila and Plesiomonas shigelloides and the obligate anaerobic Fusobacterium mortiferum were the most frequently identified microorganisms in the intestine of both H. auroguttatus and P. maculatus. Both season and habitat influenced the Gram-negative intestinal microbiota of H. auroguttatus and P. maculatus. Environmental factors influenced the Gram-negative intestinal microbiota of both species with possible impact on the interrelationship between the fishes and their digestive ecosystem, although the gut microbiota composition of fishes may result from host-specific selective pressures within the gut.

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The Gram-negative intestinal microbiota of Hypostomus auroguttatus and Pimelodus maculatus, a detritivorous and an omnivorous fish species, respectively, were compared between fishes from the reservoir and the stretch of the river below the dam of the Funil hydroelectric plant, Rio de Janeiro, Brazil. Four selective culture media were used under aerobic and two under anaerobic conditions. The omnivorous species had microbiota with higher population levels compared to the detritivorous species. The number of morphotypes and population levels of total bacteria, vibrio and Bacteroides tended to be higher in summer and autumn in the reservoir, and not different in the river. The number of morphotypes of enterobacteria and total bacteria were higher in the lotic environment compared with the lentic one. The bacteria Aeromonas hydrophila and Plesiomonas shigelloides and the obligate anaerobic Fusobacterium mortiferum were the most frequently identified microorganisms in the intestine of both H. auroguttatus and P. maculatus. Both season and habitat influenced the Gram-negative intestinal microbiota of H. auroguttatus and P. maculatus. Environmental factors influenced the Gram-negative intestinal microbiota of both species with possible impact on the interrelationship between the fishes and their digestive ecosystem, although the gut microbiota composition of fishes may result from host-specific selective pressures within the gut.

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The Gram-negative intestinal microbiota of Hypostomus auroguttatus and Pimelodus maculatus, a detritivorous and an omnivorous fish species, respectively, were compared between fishes from the reservoir and the stretch of the river below the dam of the Funil hydroelectric plant, Rio de Janeiro, Brazil. Four selective culture media were used under aerobic and two under anaerobic conditions. The omnivorous species had microbiota with higher population levels compared to the detritivorous species. The number of morphotypes and population levels of total bacteria, vibrio and Bacteroides tended to be higher in summer and autumn in the reservoir, and not different in the river. The number of morphotypes of enterobacteria and total bacteria were higher in the lotic environment compared with the lentic one. The bacteria Aeromonas hydrophila and Plesiomonas shigelloides and the obligate anaerobic Fusobacterium mortiferum were the most frequently identified microorganisms in the intestine of both H. auroguttatus and P. maculatus. Both season and habitat influenced the Gram-negative intestinal microbiota of H. auroguttatus and P. maculatus. Environmental factors influenced the Gram-negative intestinal microbiota of both species with possible impact on the interrelationship between the fishes and their digestive ecosystem, although the gut microbiota composition of fishes may result from host-specific selective pressures within the gut.

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The enzymatic activities involved in the digestion of proteins and carbohydrates were compared among three organs of the digestive track of two Siluriformes fish species, and between two areas: a reservoir, and an area downriver of it. Our aim was to test the hypothesis that the digestive organs of species with varied feeding habits have different enzymatic activities, and that the enzymatic activity differs among seasons and environmental conditions. The iliophagous/herbivorous species Hypostomus auroguttatus Kner, 1854 had higher trypsin-like, chymotrypsin-like peptidase and -glucosidase activity in the intestine when compared with the omnivorous species Pimelodus maculatus Lacepède, 1803, whereas the latter had more hepatic trypsin-like activity than the former. The peak of activity of the three enzymes in H. auroguttatus was recorded in the winter and spring. On the other hand, P. maculatus tended to have the more prominent peptidase and -glucosidase activity in the summer, and the smallest in the winter. The intestine of H. auroguttatus had higher enzymatic (trypsin, chymotrypsin and -glucosidase) activity than the stomach and the liver. For P. maculatus, the highest -glucosidase activity was found in the liver. The enzymatic activity of H. aurogutattus did not differ between lotic and lentic systems, whereas P. maculatus had comparatively higher stomach and hepatic trypsin levels and hepatic chymotrypsin-like activities in the reservoir than down in the river. These findings indicate that, in H. auroguttatus, most digestive activity occurs in the intestine, which is long and adapted for the digestion of bottom-river vegetable matter and detritus. The seasons and the type of the system (lentic vs. lotic) seem to affect the enzymatic activity for these two species differently, a likely consequence of their different lifestyles.

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The enzymatic activities involved in the digestion of proteins and carbohydrates were compared among three organs of the digestive track of two Siluriformes fish species, and between two areas: a reservoir, and an area downriver of it. Our aim was to test the hypothesis that the digestive organs of species with varied feeding habits have different enzymatic activities, and that the enzymatic activity differs among seasons and environmental conditions. The iliophagous/herbivorous species Hypostomus auroguttatus Kner, 1854 had higher trypsin-like, chymotrypsin-like peptidase and -glucosidase activity in the intestine when compared with the omnivorous species Pimelodus maculatus Lacepède, 1803, whereas the latter had more hepatic trypsin-like activity than the former. The peak of activity of the three enzymes in H. auroguttatus was recorded in the winter and spring. On the other hand, P. maculatus tended to have the more prominent peptidase and -glucosidase activity in the summer, and the smallest in the winter. The intestine of H. auroguttatus had higher enzymatic (trypsin, chymotrypsin and -glucosidase) activity than the stomach and the liver. For P. maculatus, the highest -glucosidase activity was found in the liver. The enzymatic activity of H. aurogutattus did not differ between lotic and lentic systems, whereas P. maculatus had comparatively higher stomach and hepatic trypsin levels and hepatic chymotrypsin-like activities in the reservoir than down in the river. These findings indicate that, in H. auroguttatus, most digestive activity occurs in the intestine, which is long and adapted for the digestion of bottom-river vegetable matter and detritus. The seasons and the type of the system (lentic vs. lotic) seem to affect the enzymatic activity for these two species differently, a likely consequence of their different lifestyles.

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The enzymatic activities involved in the digestion of proteins and carbohydrates were compared among three organs of the digestive track of two Siluriformes fish species, and between two areas: a reservoir, and an area downriver of it. Our aim was to test the hypothesis that the digestive organs of species with varied feeding habits have different enzymatic activities, and that the enzymatic activity differs among seasons and environmental conditions. The iliophagous/herbivorous species Hypostomus auroguttatus Kner, 1854 had higher trypsin-like, chymotrypsin-like peptidase and -glucosidase activity in the intestine when compared with the omnivorous species Pimelodus maculatus Lacepède, 1803, whereas the latter had more hepatic trypsin-like activity than the former. The peak of activity of the three enzymes in H. auroguttatus was recorded in the winter and spring. On the other hand, P. maculatus tended to have the more prominent peptidase and -glucosidase activity in the summer, and the smallest in the winter. The intestine of H. auroguttatus had higher enzymatic (trypsin, chymotrypsin and -glucosidase) activity than the stomach and the liver. For P. maculatus, the highest -glucosidase activity was found in the liver. The enzymatic activity of H. aurogutattus did not differ between lotic and lentic systems, whereas P. maculatus had comparatively higher stomach and hepatic trypsin levels and hepatic chymotrypsin-like activities in the reservoir than down in the river. These findings indicate that, in H. auroguttatus, most digestive activity occurs in the intestine, which is long and adapted for the digestion of bottom-river vegetable matter and detritus. The seasons and the type of the system (lentic vs. lotic) seem to affect the enzymatic activity for these two species differently, a likely consequence of their different lifestyles.

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The objective of this study was to evaluate whether the sound pressure levels are decreased in the ICU after an educational intervention with the multidisciplinary team. Noise levels were measured inside the ICU (using a decibelimeter installed near the bedside of a patient) for seven days, and repeated the procedure after an educational intervention, which consisted of lectures, posters and dramatizations, among others. There was a large reduction in noise level between the pre and postintervention period, at all times evaluated. The main sources of noise in the ICU were the own team. The noise levels were higher than recommended. The study showed that with an educational intervention with the ICU staff and their awareness of the mechanisms and effects, it is possible to have reduced levels of noise and consequent estresse environment.

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O objetivo deste estudo foi avaliar se os níveis de pressão sonora dentro da UTI são diminuídos após intervenção educativa com a equipe multiprofissional. Foram mensurados os níveis de ruído no interior da UTI (através de um decibelímetro instalado próximo à cabeceira de um paciente) durante sete dias, sendo repetido o procedimento após uma intervenção educativa, a qual consistiu de palestras, cartazes e dramatizações, entre outros. Houve grande redução do nível de ruído entre o período pré e pós-intervenção, em todos os horários avaliados. As principais fontes de ruídos dentro da UTI foram da própria equipe. Os níveis de ruído encontrados estiveram acima do recomendado. O estudo mostrou que, com uma intervenção educacional junto à equipe da UTI e sua conscientização sobre os mecanismos e efeitos, é possível haver redução dos níveis de ruído e consequente eestressee do ambiente.

The objective of this study was to evaluate whether the sound pressure levels are decreased in the ICU after an educational intervention with the multidisciplinary team. Noise levels were measured inside the ICU (using a decibelimeter installed near the bedside of a patient) for seven days, and repeated the procedure after an educational intervention, which consisted of lectures, posters and dramatizations, among others. There was a large reduction in noise level between the pre and postintervention period, at all times evaluated. The main sources of noise in the ICU were the own team. The noise levels were higher than recommended. The study showed that with an educational intervention with the ICU staff and their awareness of the mechanisms and effects, it is possible to have reduced levels of noise and consequent estresse environment.

El objetivo de este estudio fue evaluar si los niveles de presión sonora se redujeron en la UCI después de una intervención educativa con el equipo multidisciplinario. Se midieron los niveles de ruido en la UCI (utilizando un decibelímetro instalado cerca de la cabecera de un paciente) durante siete días, y se repite el procedimiento después de una intervención educativa con el equipo, que consistió en conferencias, carteles y dramatizaciones, entre otros. Hubo una gran reducción en el nivel de ruido entre el período pre y post-intervención, en todos los tiempos evaluados. Las principales fuentes de ruido en la UCI fueron del proprio equipo. Los niveles de ruidos encontrados eran más altos que los recomendados. Este estudio mostró que con una intervención educativa y de sensibilización acerca de los mecanismos y los efectos del ruido con el personal de la UCI, es posible lograr la reducción de los niveles de ruido y el estrés ambiental consecuente.

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UNLABELLED: Currently studying the speech voice therapy effectiveness in cases of oropharyngeal dysphagia has been deepened and included the variables that prevent the patient develops treatment. OBJECTIVE: To study the possible risk factors for progression of food intake by mouth during the speech accompanying dysphagia in patients hospitalized with degenerative neurological diseases. METHOD: Retrospective study conducted at the Department of Speech Therapy in a General Hospital from January 2007 to May 2008. Were collected 117 records of patients with oropharyngeal dysphagia, and only 15 (12.8%) were diagnosed with degenerative neurological disease, evolved with complaints of dysphagia and underwent speech therapy. We used myofunctional orofacial and vocal exercises for rehabilitation. We applied Fisher's exact test and nonparametric test Mann-statistical analysis of possible relationship with risk factors, namely clinical events during therapy and respiratory conditions of patients. RESULTS: Study participants were 11 (73.3%) female patients and four (26.7%) males. Ten (66.7%) patients who progressed on the ability of oral intake and had less time in therapy, 11 (73.4%) did not present any problem, two (13.3%) had worsening of symptoms and two (13.3%) had a lowered level of consciousness during the therapeutic process. Ten of 15 patients (66.7%) showed progression in the ability of oral intake according to clinical assessment (range FOIS®), five (33.3%) remained the same conditions prior to therapy and no patient had worsening oral intake. CONCLUSION: The level of consciousness and respiratory complications in this study were associated with poor prognosis for the progression of oral in speech therapy.

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In this work we describe the gonad morphology and spawning season of Hypostomus affinis (Steindachner, 1877) in a tropical reservoir based on 55 males and 125 females. Our aim was to assess eventual adaptations in reproductive tactics developed by this riverine species inhabiting an oligotrophic reservoir with low habitat complexity, few rocks and few other preferred consolidated substrata. We described the stages of cells of reproductive lineage, gonadal development and some reproductive traits which were compared with information in the available literature. Cells from the spermatogenic lineage were spermatogonia, spermatocytes, spermatids and spermatozoa, and cells from the oocytarian lineage were primary oocytes, previtelogenic oocytes, cortical vesicle oocytes and yolk globules or vitellogenic. Five stages were described for the males/females according to the distribution of oocytes and spermatogenic lineage cells: resting; initial maturation; advanced maturation; partially spent/spawned; totally spent/spawn. Females outnumbered males and reached larger size. Synchronic ovary development in two groups was found with diameter of mature oocytes ranging from 2 to 3.35 mm. Indication of early maturation, a longer reproductive period and the production of smaller eggs in small clutches seems to be features of the reservoir population not found in riverine systems. Such changes in tactics may indicate a shift to an opportunistic strategy, helping the population to withstand environmental constraints and to succeed in this oligotrophic and poorly structured reservoir.

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In this work we describe the gonad morphology and spawning season of Hypostomus affinis (Steindachner, 1877) in a tropical reservoir based on 55 males and 125 females. Our aim was to assess eventual adaptations in reproductive tactics developed by this riverine species inhabiting an oligotrophic reservoir with low habitat complexity, few rocks and few other preferred consolidated substrata. We described the stages of cells of reproductive lineage, gonadal development and some reproductive traits which were compared with information in the available literature. Cells from the spermatogenic lineage were spermatogonia, spermatocytes, spermatids and spermatozoa, and cells from the oocytarian lineage were primary oocytes, previtelogenic oocytes, cortical vesicle oocytes and yolk globules or vitellogenic. Five stages were described for the males/females according to the distribution of oocytes and spermatogenic lineage cells: resting; initial maturation; advanced maturation; partially spent/spawned; totally spent/spawn. Females outnumbered males and reached larger size. Synchronic ovary development in two groups was found with diameter of mature oocytes ranging from 2 to 3.35 mm. Indication of early maturation, a longer reproductive period and the production of smaller eggs in small clutches seems to be features of the reservoir population not found in riverine systems. Such changes in tactics may indicate a shift to an opportunistic strategy, helping the population to withstand environmental constraints and to succeed in this oligotrophic and poorly structured reservoir.

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In this work we describe the gonad morphology and spawning season of Hypostomus affinis (Steindachner, 1877) in a tropical reservoir based on 55 males and 125 females. Our aim was to assess eventual adaptations in reproductive tactics developed by this riverine species inhabiting an oligotrophic reservoir with low habitat complexity, few rocks and few other preferred consolidated substrata. We described the stages of cells of reproductive lineage, gonadal development and some reproductive traits which were compared with information in the available literature. Cells from the spermatogenic lineage were spermatogonia, spermatocytes, spermatids and spermatozoa, and cells from the oocytarian lineage were primary oocytes, previtelogenic oocytes, cortical vesicle oocytes and yolk globules or vitellogenic. Five stages were described for the males/females according to the distribution of oocytes and spermatogenic lineage cells: resting; initial maturation; advanced maturation; partially spent/spawned; totally spent/spawn. Females outnumbered males and reached larger size. Synchronic ovary development in two groups was found with diameter of mature oocytes ranging from 2 to 3.35 mm. Indication of early maturation, a longer reproductive period and the production of smaller eggs in small clutches seems to be features of the reservoir population not found in riverine systems. Such changes in tactics may indicate a shift to an opportunistic strategy, helping the population to withstand environmental constraints and to succeed in this oligotrophic and poorly structured reservoir.

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OBJETIVO: verificar se as condições referentes à estrutura geral dos asilos, recursos humanos e rotinas diárias de alimentação em instituições asilares, podem potencializar alterações da dinâmica da deglutição em idosos. MÉTODOS: foi aplicado questionário aos dirigentes de cinco instituições asilares do município do Rio de Janeiro, no qual constavam perguntas em relação aos recursos materiais, humanos e rotina alimentar. RESULTADOS: o asilo do sistema privado foi o único a aproximar-se das condições ideais da estrutura geral para o atendimento do idoso. Em relação aos recursos humanos existentes, nenhum dos asilos possuía todos os profissionais exigidos pela portaria nº810/89. Em relação às rotinas diárias de alimentação, em uma das instituições pesquisadas, cuja maioria dos residentes não faziam uso de próteses dentárias, não havia restrição na consistência alimentar oferecida. Outro fator significativo diz respeito à negligência referente à higiene bucal, favorecendo a colonização de bactérias na cavidade oral, podendo agravar infecções pulmonares no caso de microaspirações. O fato dos idosos deitarem para dormir logo após o término das refeições, como ocorrido em três das instituições pesquisadas, tem grande importância na medida em que favorece a ocorrência de episódios de refluxo gastroesofágico. CONCLUSÃO: foram observados que em todas as instituições pesquisadas há fatores que podem potencializar um distúrbio de deglutição, como problemas em relação à estrutura geral e ou aos recursos humanos e ou relativos à rotina alimentar estabelecida.

PURPOSE: to check if the conditions related to general structure, human resources and daily routine of feeding in asylums can increase the chances for an alteration in the deglutition process of the elderlies. METHODS: a questionnaire was elaborated to be applied to the directors of five institutions in the city of Rio de Janeiro. RESULTS: it can be observed that the sole factor related to the structure of the place that had relevance in the obtained results was the nature of the institution, as the private system was the only one that was considered near the ideal conditions. Regarding the existing human resources, none of the institutions had all the professionals demanded by the Ordinance nº810/89. In relation to the daily feeding routines, in one of the investigated institutions, where the majority of the residents did not use denture, there was no restriction as for the offered food consistency. Another significant factor was the carelessness in terms of oral hygiene, favoring the settling of bacteria in the mouth, which can cause serious consequences in case of microaspirations. In three of the investigated institutions, it was observed that the elderlies lay down to sleep soon after the meals, fact that also had great importance, as this favors the incidence of gastroesophageal reflux episodes that can lead to gradual dysphagia. CONCLUSION: despite the fact that the asylum directors did not mention any referring problem in the process of deglutition of the elderlies, they show proper characteristics that can increase the possibilities for occurrence of alterations in the deglutition of these elderlies.

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OBJETIVO: Identificar os principais estressores ambientais, conforme a percepção de familiares de pacientes internados em uma UTI-G de adultos de um hospital público universitário. MÉTODO: Estudo transversal descritivo com familiares de pacientes gravemente enfermos internados na UTI de um hospital escola. Para a coleta de dados, utilizou-se uma escala contendo 25 itens relacionados a eventos da referida UTI. Para análise dos resultados, as respostas foram classificadas como estressores ambientais, referentes à equipe, ao paciente e à visita. RESULTADOS: Participaram 53 familiares, 67,9 por cento mulheres, com média de idade de 39,7 anos. Os fatores relacionados ao paciente foram mais estressantes do que aqueles referentes à equipe e ao ambiente (p < 0,005). Os eventos mais estressantes para os familiares estiveram relacionados à insegurança e ao medo quanto ao estado clínico do paciente, dentre esses, o motivo e o tempo de internação e ver o paciente em coma. CONCLUSÃO: A internação de um parente próximo na UTI foi considerada pelos familiares que efetivamente participaram desse processo um evento estressante. Todos os participantes indicaram pelo menos um evento causador de estresse capaz de provocar diferentes reações emocionais. Conhecer tais eventos pode facilitar as estratégias de humanização hospitalar, propiciando alternativas para reduzir os níveis de estresse e alterações psiquiátricas subsequentes.

OBJECTIVE:To identify main environment stressors according to the perception of relatives of patients hospitalized in an adult ICU in a university public hospital. METHOD: It is a transversal descriptive study involving family members of critically ill patients hospitalized in an ICU of a school hospital. To collect data we used a 25-item scale related to the referred ICU. For result analysis, answers were classified as environmental stressors concerning the team, patients, and visits. RESULTS: There were 53 family-member participants where 67.9 percent were women averaging 39.7 years of age. Factors related to patients were more stressing than those concerning the hospital team and the environment (p < 0.005). The most stressed events for the family members were related to uncertainty and fear of the clinical state of the patient, among them reason and length of hospital stay, and witness the patients in a coma. CONCLUSION: Hospital ICU stay of a relative was considered by the close to kin, who actually participated in the process, a stressful event. All participants indicated at least one event that causes stress as capable of provoking diverse emotional reactions. Knowing such events can favor hospital humanization strategies thus providing alternatives to reduce stress levels and subsequent psychiatrical disorder.