CONTEXTO: Esta revisión busca dar respuesta a cómo la enfermería ha abordado la espiritualidad en el proceso de cuidado en la Unidad de Cuidados Intensivos (UCI), contribuyendo a la comprensión de las dificultades y factores que pueden mejorar el desempeño de estos profesionales en este ambiente ambivalente entre la vida y la muerte de los pacientes. OBJETIVO: Verificar los artículos existentes en la literatura sobre el cuidado espiritual proporcionado por el equipo de enfermería en las UCI. METODOLOGÍA: Se utilizó el método de revisión integradora con las búsquedas realizadas entre 2008 y 2018 en las bases de datos LILACS, MEDLINE, PubMed y Cinahl. Las claves de búsqueda se utilizaron con los descriptores Spirituality, Nursing, Team, Intensive Care Units, Systematization of Nursing Care y sus variaciones en portugués e español, com los operadores booleanos Y y/o OR. RESULTADOS: En la literatura, se encontraron 381 artículos y, al final del proceso, se incluyeron cuatro artículos que incluían el cuidado espiritual proporcionado por el equipo de enfermería de la UCI. Se enumeraron tres categorías que abordan el tema: a) Proceso de enfermería y el cuidado espiritual; b) Bienestar espiritual; c) Retos en la asistencia del cuidado espiritual. CONCLUSIONES: La espiritualidad dentro del proceso de atención se ha informado en pocos estudios y de forma fragmentada. Resulta importante cuidarse a sí mismo para cuidar de los demás, así como los aspectos relacionados con los desafíos que enfrenta. La enfermería necesita tener una visión más amplia del cuidado espiritual, de modo que pueda ofrecer un cuidado sistematizado y con base científica.

CONTEXTO: Esta revisão busca responder como a enfermagem tem abordado a espiritualidade no processo de cuidar na Unidade de Terapia Intensiva (UTI), contribuindo na compreensão das dificuldades e fatores que possam melhorar a atuação destes profissionais neste ambiente de ambivalência entre a vida e a morte dos pacientes. OBJETIVO: Verificar os artigos existentes na literatura sobre os cuidados espirituais prestados pela equipa de enfermagem em UTI. MÉTODOS: Foi utilizado o método de revisão integrativa, sendo as buscas realizadas entre 2008 a 2018 nas bases de dados Medline, Lilacs, Cinahl e no portal PubMed. Foram utilizados chaves de busca com os descritores Spirituality, Nursing, Team, Intensive Care Units, Systematization of Nursing Care e suas variações em português e espanhol, com os operadores booleanos AND e/ou OR. RESULTADOS: Foram encontrados na literatura 381 artigos, sendo que ao final do processo foram incluídos quatro artigos que descreviam os cuidados espirituais prestados pela equipa de enfermagem em UTI. Foram elencadas três categorias que tratam da temática: Processo de Enfermagem e os cuidados espirituais; b) Bem-estar espiritual; c) Desafios na assistência aos cuidados espirituais. CONCLUSÕES: A espiritualidade dentro do processo de cuidar foi relatada em poucos estudos e de forma fragmentada. Mostrou-se importante o cuidar de si para cuidar do outro, além de aspectos relacionados ao enfrentamento de desafios. A enfermagem necessita ter um olhar mais amplo do cuidado espiritual, para que possa ofertar o cuidado sistematizado e com embasamento científico.

BACKGROUND: This review seeks to answer how nursing has addressed spirituality in the care process in the Intensive Care Unit (ICU), contributing to the understanding of the difficulties and factors that can improve the performance of these professionals in this ambivalent environment between patients' lives and deaths. AIM: Verify the existing studies in the literature on spiritual care provided by the nursing team in the ICU. METHODS: The integrative review method was used, and the searches performed between 2008 and 2018 in the databases Medline, Lilacs, Cinahl and the PubMed portal. The search keys were used with the descriptors Spirituality, Nursing, Team, Intensive Care Units, Systematization of Nursing Care and its variations in Spanish and Portuguese, using Boolean operators AND and/or OR. RESULTS: In the literature, 381 articles were found and, at the end of the process, four articles were included that presented the spiritual care provided by the ICU nursing team. Three categories that address the issue were listed: a) Nursing process and spiritual care; b) Spiritual well-being; c) Challenges in assisting spiritual care. CONCLUSIONS: Spirituality within the attention process has been reported in few studies and of fragmented way. It was important to take care of yourself to take care of others, as well as aspects related to the facing challenges. Nursing needs to have a broader vision of spiritual care, so that it can offer systematized care scientific basis.

ABSTRACT PURPOSE: To evaluate the contamination index of metals and pesticides in pregnant women, and to relate this to perinatal outcomes. METHODS: Descriptive, retrospective, exploratory study, developed from existing secondary data analyses at Level III maternity center. A total of 40 mothers with their newborns (NB), living in a rural area in Botucatu- Brazil and surrounding region. Blood samples from mothers and newborn were collected to determine the total contamination index for metals and pesticides. The concentrations of each metal and each pesticide were determined in blood samples of mothers and their newborns by Rudge's results. After obtaining these concentrations, the total contamination index in mother and NB was calculated, along with its correlation with clinical parameters of NB. RESULTS: There was no correlation (p> 0.05) between maternal contamination index with NB clinical parameters, and NB contamination index versus NB clinical parameters. CONCLUSION: The maternal contamination index of metals and pesticides was not related to perinatal outcomes, but it could be used as baseline parameter in future toxicological studies, regarding to long-term toxic characteristics as persistent organic pollutants, its long half-lives, bioacumulative, and expected to impose serious health effects on humans.

PURPOSE: To analyze the physiological and biochemical measurements before, during and after pregnancy of healthy rats. METHODS: Wistar adult females rats (n=8) were weighed and blood samples were obtained before, during and after pregnancy for biochemical determinations, chow intake, water consumption and milk production were evaluated. At day 10 postpartum, the rats were killed for weighing of organs and adipose tissues. RESULTS : The results showed increase in body weight, serum insulin and ingestion of water and chow. At day 17 pregnancy, presented normal values in the OGTT. At days 7, 14 and 20 of pregnancy, there was increase in triglyceride levels. At term pregnancy, there was weight gain due to fetal growth. In the postpartum period presented reduced blood glucose levels. The glycemic means were reduced during and after pregnancy compared to after pregnancy. The triglyceride concentrations were increased before and during pregnancy in relation to after pregnancy. The total cholesterol levels presented no changes. CONCLUSION: The use of experimental animals is suitable for evaluation of metabolic changes because the profile of answers found in this study was similar to human profile, showing the relevance of translational research to better understand the pathophysiological mechanisms and possible treatment for diseases.

PURPOSE:To evaluate the effect of exercise (swimming) on pregnancy in spontaneously hypertensive rats (SHR).METHODS: Thirty three pregnant female SHR were distributed into three groups (n=11 animals/group): SHR Control=non-exercised (sedentary); SHR Ex0 = exercised from day zero to day 20 of pregnancy; and SHR Ex7 = exercised from day 7 to 20 of pregnancy. Body weight and systolic blood pressure were indirectly measured during pregnancy. On gestational day 21, the rats were anaesthetized and uterine content was withdrawn for analysis of maternal reproductive outcome parameters and fetal development.RESULTS:The reduced blood pressure percentage was higher in SHR Ex0 and SHR Ex7 compared to SHR Control group. Weight gain was present in all pregnancy periods, but it was lower in SHR Ex7 than in SHR Control dams. The exercise increased the pre-implantation loss rate. The post-implantation loss rate was lower in SHR Ex0 group. SHR Ex7 group showed a significantly higher percentage of fetuses classified as small for gestational age as compared to others groups.CONCLUSION:The exercise contributed to lowering gestational blood pressure in SHR rats, but had a negative impact on the developing embryo.

The aim of this work was to evaluate the direct protective action of oral fatty acid supplementation against the deleterious effect of hyperglycemia on maternal reproductive outcomes; fetal growth and development on female Wistar rats. The animals were distributed into four experimental groups: G1= non-diabetic without supplementation (Control group); G2= non-diabetic treated with linoleic (LA) and gammalinolenic acid (GLA) (1 mL of Gamaline-V/day); G3= diabetic without supplementation and G4= diabetic treated with LA and GLA. Diabetes was induced by streptozotocin (40 mg/kg). At day 21 of pregnancy, the gravid uterus was weighed and dissected to count the dead and live fetuses, resorption, implantation, and corpora lutea numbers. The fetuses were analyzed for external and internal anomalies. The treatment with Gamaline-V supplementation to diabetic rats interfered in the maternal reproductive outcome (reduced number of live fetuses and embryonic implantation); however, it protected the deleterious on the incidence of congenital anomalies caused by hyperglycemia.

O objetivo deste trabalho foi avaliar a performance reprodutiva, estudo morfológico do fígado e características " post mortem" de ratas Wistar prenhes tratadas com indometacina, um inibidor geral de COX. Indometacina foi administrada oralmente, nas doses de 0 (controle), 0,32, 1,68 e 8,40 mg/kg/dia (n=10/grupo), nos dias 3 e 4 de prenhez (dia 0 = primeiro dia de prenhez = esperma positivo). Os animais foram eutanasiados sob anestesia no 11º dia de prenhez, e foram realizadas necropsia e cultura de microorganismos. Os resultados mostraram que as doses de 0,32 e 1,68 mg/kg de peso corpóreo (dose terapêutica para humanos) de indometacina não causaram efeitos embriotóxicos ou letais. A maior dose (8,40 mg/kg) de indometacina prejudicou o processo de implantação e, portanto, interferiu no desenvolvimento fetal. A peritonite foi detectada na necropsia e nos estudos bacteriológicos dos animais tratados com 8,4 mg/kg e considerada a causa-morte destes animais. Portanto, este estudo analisou um agente farmacológico na prenhez de roedores e evidenciou que a indometacina apresentou efeitos embriotóxicos e letais na maior dose empregada, mas foi segura na dose terapêutica usada pelo homem.

The objective of this study was to evaluate the reproductive performance, liver morphological study and post mortem characteristics of the pregnant Wistar rats treated with indomethacin, a general COX inhibitor. Indomethacin at doses of 0 (control), 0.32, 1.68 and 8.40 mg/kg/day were orally given once daily to each group (n=10) on days 3 and 4 of pregnancy (day 0 = first day of pregnancy = positive vaginal sperm). The animals were euthanized under anesthesia on day 11 of pregnancy, and were carried out necropsy and microorganism culture study. The results showed that the doses of 0.32 and 1.68 mg/kg body weight (the therapeutic dose for humans) of indomethacin caused no embryotoxic or lethal effects. The highest dose (8.40 mg/kg) of indomethacin disturbed implantation process and, thus, interrupted major development in some fetuses. The peritonitis was detected in the necropsy and in the bacteriological study of the animals treated with 8.4 mg/kg. It was considered death cause of these animals. Thus, this study analyzed a pharmacological agent on pregnancy in rodents and it provided some evidences that indomethacin presented embryotoxic and lethal effects at a high dose, but it was safe in the therapeutic dose used for humans.

O objetivo deste estudo foi verificar se a prática do exercício físico (natação), iniciada em diferentes momentos da prenhez de ratas diabéticas, promove alterações no metabolismo materno. Após confirmação do diabete, induzido por Streptozotocin, ratas Wistar foram acasaladas e randomizadas em três grupos (n = 13 ratas/grupo): não-praticante (G1) ou praticante de exercício desde o dia zero (G2) ou sétimo dia (G3) de prenhez. O exercício consistiu de um programa de natação com intensidade moderada. Durante a prenhez, glicemia e peso corpóreo foram avaliados semanalmente. No final da prenhez, as ratas foram anestesiadas e dessangradas para obtenção de amostras de sangue para determinação de proteínas totais, triglicérides, colesterol total e VLDL-colesterol. Fígado e músculo foram coletados para dosagem de glicogênio hepático e muscular, respectivamente. Independente do momento em que foi iniciado, o exercício não alterou os níveis glicêmicos, a evolução do peso corpóreo e as concentrações de proteínas totais e glicogênio hepático e muscular. Porém, a natação iniciada no sétimo dia de prenhez diminuiu as taxas de triglicérides (G1 = 369,10 ± 31,91mg/dL; G2 = 343,32 ± 162,12mg/dL; G3 = 212,35 ± 70,32mg/dL), colesterol total (G1 = 176,48 ± 28,25mg/dL; G2 = 141,33 ± 19,77mg/dL; G3 = 129,86 ± 33,16mg/dL) e VLDL (G1 = 64,92 ± 24,41mg/dL; G2 = 63,54 ± 28,31mg/dL; G3 = 42,53 ± 14,12mg/dL) comparando com o grupo G1. Apesar de não se comprovar a influência do exercício físico sobre os níveis glicêmicos maternos, a prática diária de natação a partir do sétimo dia de prenhez mostrou-se benéfica para o perfil lipídico de ratas diabéticas. Esse resultado reforça a validade da associação da atividade física regular à dieta e insulina na gestação complicada pelo diabete.

The aim of the present study was to evaluate if physical exercise (swimming program), begun in different periods of pregnancy of diabetic rats, promotes changes in the maternal metabolism. Severe diabetes was induced in female rats using Streptozotocin. The rats were mated and randomly assigned to three groups (n = 13 rats/group): sedentary (G1) or exercised from day zero (G2) or day seven (G3) to day 21 of pregnancy. The exercise consisted of a moderate swimming program. During pregnancy, the body weight and glycemic level were weekly evaluated. All the female rats were killed on day 21 of pregnancy to carry out laparotomy. The blood samples were collected to determine total protein, triglycerides, total cholesterol and VLDL-cholesterol. Liver and muscle samples were collected to determine hepatic and muscular glycogen, respectively. Regardless the initial moment, the exercise did not alter glycemic level, body weight evolution and total protein, hepatic and muscular glycogen concentrations. However, the swimming program begun on the 7th day of the pregnancy decreased the triglyceride rate (G1 = 369.10 ± 31.91 mg/dL; G2 = 343.32 ± 162.12 mg/dL; G3 = 212.35 ± 70.32 mg/dL), total (G1 = 176.48 ± 28.25 mg/dL; G2 = 141.33 ± 19.77 mg/dL; G3 = 129.86 ± 33.16 mg/dL), and VLDL (G1 = 64.92 ± 24.41 mg/dL; G2 = 63.54 ± 28.31 mg/dL; G3 = 42.53 ± 14.12 mg/dL) cholesterol concentrations compared to G1 group. Physical exercise did not interfere on the maternal glycemic levels. Thus, the swimming program began on the day seven of the pregnancy was a beneficial treatment for the lipidic profile of the diabetic rats. This result validates an association of regular physical activity to diet and insulin treatment in pregnancy complicated by diabetes.

El objetivo de este estudio ha sido el de verificar si la práctica de ejercicio físico (natación), iniciada en diferentes momentos de preñez de ratas diabéticas, promueve alteraciones en el metabolismo materno. Después de la confirmación de la diabetes, inducido por Streptozotocin, ratonas Wistar fueron acasaladas y randomizadas en tres grupos (n = 13 ratonas/grupo): no practicante (G1) o practicante de ejercicio desde el día cero (G2) o séptimo día (G3) de preñez. El ejercicio se constituyó de un programa de natación con intensidad moderada. Durante la preñez, glicemia y peso corpóreo fueron evaluados semanalmente. Al final de la preñez, las ratonas fueron anestesiadas y desangradas para la obtención de muestras de sangre para la determinación de proteínas totales, triglicéridos, colesterol total y VLDL-colesterol. Hígado y músculo se colectaron para dosaje de glicógeno hepático y muscular, respectivamente. Independiente del momento en que fue iniciado, el ejercicio no alteró los niveles glicéricos, la evolución del peso corpóreo y las concentraciones de proteínas totales y glicógeno hepático y muscular. Sin embargo, la natación iniciada en el séptimo día de preñez disminuyó las tasas de triglicéridos (G1 = 369,10 ± 31,91 mg/dL; G2 = 343,32 ± 162,12 mg/dL; G3 = 212,35 ± 70,32 mg/dL), colesterol total (G1 = 176,48 ± 28,25 mg/dL; G2 = 141,33 ± 19,77 mg/dL; G3 = 129,86 ± 33,16 mg/dL) y VLDL (G1 = 64,92 ± 24,41 mg/dL; G2 = 63,54 ± 28,31 mg/dL; G3 = 42,53 ± 14,12 mg/dL) comparado al grupo G1. A pesar de no comprobarse la influencia del ejercicio físico sobre los niveles glicéricos maternos, la práctica diaria de natación a partir del séptimo día de preñez se mostró benéfica para el perfil lipídico de ratonas diabéticas. Este resultado refuerza la validez de la asociación de la actividad física regular a la dieta e insulina en los embarazos complicados por diabetes.

Para avaliar a performance reprodutiva de ratas e o desenvolvimento de seus filhotes, ratas Wistar prenhes foram tratadas por gavage com 0 mg/kg peso corpóreo/dia (grupo controle, n = 20) e 166,5 mg/kg/dia de mistura de vitamina C, hesperidina e piperidol (grupo experimental, n= 20) durante o período organogênico (do 5º ao 14º dia de prenhez, considerando esfregaço vaginal positivo = dia 1). As ratas foram mortas no 21º dia de prenhez. O número de implantações, reabsorções (morte embrionária) e os fetos vivos e mortos foram contados para avaliação da taxa de perda pós-implantação. Não houve alteração na performance reprodutiva materna, mas foi verificado aumento no número de fetos com uretér dilatado, hidronefrose e ossificação reduzida do crânio devido ao tratamento das ratas com a mistura de vitamina C, hesperidina e piperidol. Essas anormalidades foram consideradas transitórias e não interfeririam no desenvolvimento dos filhotes. Não foram observados outros tipos de malformações amiores e os fetos também apresentaram atrofia dos membros superiores que pudesse estar relacionado ao uso desta mistura.

To evaluate the reproductive performance and the development of their offspring on rat pregnancy, Wistar pregnant rats were gavaged with 0 mg/kg wb/day (control group, n = 20) and 166.5 mg/kg/day of a mixture of vitamin C, hesperidin and piperidol (experimental group, n= 20) during the organogenic period (from day 5 to 14 of pregnancy; positive vaginal smear = day 0). The female rats were killed on day 21 of pregnancy. The number of implantations, resorptions (dead embryos), and live/dead fetuses were counted for the analysis of the postimplantation loss rates. There was neither alteration in maternal reproductive performance, but it was verified an increase of the number of fetuses presenting dilated urether, hydronephrosis, and reduced ossification of skull due to the treatment of female rats with a mixture of vitamin C, hesperidin and piperidol, these abnormalities were considered transitory and may not interfere on offspring development. It was not verified other type of major malformation neither the appearance of fetuses presenting atrophy of upper limbs that it could be associated to use of this drug.

O objetivo deste trabalho foi realizar um estudo randomizado, controlado e "cego" para investigar se a dose terapêutica de ácido acetilsalicílico (AAS), usado por mulheres grávidas, pode causar efeito tóxico ao embrião ou anormalidades congênitas nos animais de experimentação. MÉTODOS: Foi confirmada a prenhez das fêmeas através da observação da presença de espermatozóides no esfregaço vaginal (1º dia de prenhez - GD1). As ratas acasaladas foram colocadas em gaiolas individualizadas e divididas aleatoriamente para compor os grupos experimentais. Os animais receberam 50 mg/kg/dia de AAS, por via oral (gavage), durante dois períodos diferentes de prenhez. Um grupo de ratas (n=11) recebeu aspirina do 1º ao 4º dia de prenhez (antes de implantação embrionária) para avaliação dos blastocistos, e outro grupo recebeu aspirina do 6º ao 15º dia (período de organogênese) para avaliação fetal. Os grupos controle (n=12) receberam água destilada com mesmo volume e durante os mesmos períodos, semelhante aos respectivos grupos experimentais. RESULTADOS E CONCLUSÃO: O tratamento de ratas prenhes com AAS, de acordo com dose terapêutica mínima usada por mulheres, não causou efeitos embriotóxicos ou malformações maiores, mas foi responsável pelo aumento das taxas de fetos com dilatação de ureter. Pode ser verificada uma divergência muito grande entre os dados obtidos experimentalmente e em humano, mas não há ainda uma evidência conclusiva dos efeitos adversos em humanos. Existe uma dose de perigo potencial, portanto o uso indiscriminado de ácido de acetilsalicílico (aspirina) é contra-indicado.

The aim of this paper was to perform a randomized, controlled and blinded study to investigate if a therapeutic dose of acetylsalicylic acid (ASA), taken by pregnant women, may also cause embryotoxic or congenital abnormalities on experimental animal. METHODS: Females were confirmed to have mated by observations of sperm in a vaginal smear. The day on which spermatozoa were found in the vaginal smear was considered as day 1 of gestation (GD1). After randomization, mated females were assigned to experimental groups and individually caged, were given 50 mg/kg/day of acetylsalicylic acid, by needle gavage once daily, during two different periods of pregnancy. One group of dams (n=11) received aspirin from day 1 to 4 of pregnancy (before embryonic implantation) for evaluation of the blastocysts, and another group received aspirin from day 6 to 15 of pregnancy (organogenic period) for fetal evaluation. Control groups (n=12) received distilled water in same volume and during same periods as their respective experimental groups. RESULTS AND CONCLUSION: The treatment of the dams with ASA, according to minimal therapeutic dose used for humans, did not cause embryotoxic or major malformations on experimental animal but was responsible for rate increased of fetuses presenting ureteric dilatation. After analysis of the data, it appears that, although direct conclusive evidence of adverse effects in humans is lacking, a potential hazard dose exists and thus the indiscriminate use of acetylsalicylic acid (aspirin) is contraindicated.