RESUMO
Introducción: las competencias bioéticas permiten abordar colectiva y críticamente, aspectos éticos involucrados en la práctica clínica. Pero, la deliberación ética simultánea de médico/as con enfermero/as, en pacientes no críticos, es inhabitual. Objetivo: constatar la percepción de médico/as y enfermero/as de un hospital de alta complejidad, sobre sus competencias bioéticas y deliberación sincrónica, en hospitalizados pediátricos sin riesgo vital. Métodos: se realizó un estudio descriptivo y transversal mediante encuesta, a médico/as y enfermero/as del servicio médico-quirúrgico infantil, sobre presencia, modalidad de enseñanza de bioética en pregrado, percepción de tener conocimiento bioético suficiente para aplicarlo clínicamente y si hubo análisis ético-clínico conjunto, en pacientes hospitalizados. Resultados: la mayoría de los encuestados 47/54 (87%) recibió formación teórica obligatoria en bioética durante el pregrado. De ellos, 19/29 (65,5%) médico/as y 11/18 (61,1%) enfermero/as reconocieron que esta formación fue insuficiente para aplicarla en el trabajo. 25/35 (71,4%) médicos, afirmó participar en deliberación ética antes de enviar un caso al comité de ética asistencial, pero esta deliberación ocasionalmente incluyó a enfermero/as ya que, sólo 2/19 (10,5%) de los enfermero/as señalaron intervenir en este tipo de deliberación. Conclusiones: médico/as y enfermero/as que trabajan en pediatría y cirugía infantil, perciben insuficiencias de formación en pregrado en bioética e impericia para aplicar contenidos a la práctica cotidiana. La deliberación ética sobre casos clínicos pediátricos de enfermero/as es esporádica respecto de médico/as en hospitalización médico-quirúrgica básica.
Introduction: Bioethical skills are essential for addressing, both collectively and critically, ethical issues that arise in clinical practice. However, joint ethical deliberation between physicians and nurses with non-critical patients is uncommon Objective: To study the perception of physicians and nurses regarding their bioethical skills in a high-complexity hospital and whether they engage in collective deliberation in units of pediatric inpatients not at vital risk. Methods: A descriptive, cross-sectional study was conducted via a survey targeting physicians and nurses in the pediatric medical-surgical service. The survey inquired about the presence and modality of bioethics teaching during undergraduate education, the perception of having sufficient bioethical knowledge for clinical application, and whether joint ethical-clinical analysis was performed regarding hospitalized patients. Results: Most respondents, 47/54 (87%), had received mandatory theoretical training in bioethics during their undergraduate education. 19/29 (65.5%) physicians and 11/18 (61.1%) nurses acknowledged that this training was insufficient for application in their work. A high percentage of physicians, 19/29 (65.5%), claimed to carry out ethical analysis of cases before referring them to the healthcare ethics committee, occasionally including nurses since only 2/18 (11.1%) of the nurses indicated participation in such analysis. Conclusions: Medical and nursing professionals who work in pediatrics and children's surgery perceive insufficiencies in undergraduate training in bioethics issues and an inability to apply content to daily practice. Ethical deliberation on pediatric clinical cases by nurses is sporadic compared to doctors in basic medical-surgical hospitalization.
RESUMO
OBJECTIVE: The Latino/Hispanic community in the United States is at higher risk of developing Alzheimer's disease than other ethnic groups. Specifically, Caribbean Hispanics showed a more severe Alzheimer's disease symptomatology than any other ethnic group. In a previous study, we demonstrated that the mortality rate associated with Alzheimer's disease in Puerto Rico is higher than that reported in the United States. Moreover, the mortality rate associated with Alzheimer's disease was higher among Puerto Rican living in Puerto Rico than those in the mainland United States. There is also a differential geographical distribution of mortality rate associated with Alzheimer's disease in Puerto Rico, which may be associated with differential socioeconomic status and/or access to healthcare. However, there is no information regarding the clinical profile of Alzheimer's disease patients in Puerto Rico. METHODS: Here, we present the results of a retrospective study directed to profile Alzheimer's disease patients clustered into two groups based on areas previously determined with low (Metro Region) and high (Northwest-Central Region) mortality rate associated with Alzheimer's disease in Puerto Rico. RESULTS: Significant difference in the age-at-diagnosis and years of education was found among patients within the two studied regions. Despite these differences, both regions showed comparable levels of initial and last Mini Mental State Examination scores and rate of cognitive decline. Significant difference was also observed in the occurance of co-morbidities associated with Alzheimer's disease. CONCLUSIONS: The differential profile of Alzheimer's disease patients correlated with differences in socioeconomic status between these two regions, suggesting that covariant associated with social status may contribute to increased risk of developing Alzheimer's disease. Further studies should be conducted to determine the role of socioeconomic factors and healthy living practices as risk factors for Alzheimer's disease.
RESUMO
Electrophysiological and calcium mobilization experiments have suggested that the intracellular calcium release channel ryanodine receptors (RyRs) are involved in the circadian rhythmicity of the suprachiasmatic nucleus (SCN). In the present report the authors provide behavioral evidence that RyRs play a specific and major role in the output of the molecular circadian clock in SCN neurons. They measured the circadian rhythm of drinking and locomotor behaviors in dim red light before, during, and after administration of an activator (ryanodine 0.1 microM) or an inhibitor (ryanodine 100 microM) of the RyRs. Drugs were delivered directly into the SCN by cannulas connected to osmotic minipumps. Control treatments included administration of artificial cerebrospinal fluid, KCl (20 mM), tetrodotoxin (1 microM), and anysomicin (5 microg/microl). Activation of RyRs induced a significant shortening of the endogenous period, whereas inhibition of these Ca2+ release channels disrupted the circadian rhythmicity. After the pharmacological treatments the period of rhythmicity returned to basal values and the phase of activity onset was predicted from a line projected from the activity onset of basal recordings. These results indicate that changes in overt rhythms induced by both doses of ryanodine did not involve an alteration in the clock mechanism. The authors conclude that circadian modulation of RyRs is a key element of the output pathway from the molecular circadian clock in SCN neurons in rats.
Assuntos
Comportamento Animal/fisiologia , Relógios Biológicos/fisiologia , Ritmo Circadiano/fisiologia , Canal de Liberação de Cálcio do Receptor de Rianodina/metabolismo , Núcleo Supraquiasmático/citologia , Animais , Comportamento Animal/efeitos dos fármacos , Relógios Biológicos/efeitos dos fármacos , Ritmo Circadiano/efeitos dos fármacos , Masculino , Ratos , Ratos Wistar , Rianodina/farmacologia , Núcleo Supraquiasmático/efeitos dos fármacosRESUMO
Ryanodine-sensitive intracellular Ca2+ channels (RyRs) are present in suprachiasmatic nuclei (SCN) neurons, but the functions served by these channels are not known. Here we addressed whether mobilization of intracellular Ca2+ stores through the RyRs may be a link between the molecular clock and the firing rate in SCN neurons. Activation of the RyRs by administration of either 1 mM caffeine or 100 nM ryanodine increased the firing frequency, whereas inhibition of RyRs by 10 microM dantrolene or 80 microm ryanodine decreased firing rate. Similar results were obtained in experiments conducted at either midday or midnight. Furthermore, these effects were not mediated by synaptic transmission as blockade of GABA A, AMPA and NMDA receptors did not prevent the excitatory or inhibitory effects induced by either dose of ryanodine on SCN firing. We conclude that gating of RyRs is a key element of the intricate output pathway from the circadian clock within SCN neurons in rats.