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      Ser adolescente apesar das restrições e da discriminação impostas pela doença falciforme Translated title: Being an adolescent despite the restrictions and discrimination imposed by sickle cell disease Translated title: Ser adolescente pese a las restricciones y a la discriminación impuestas por la enfermedad de células falciformes

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          Abstract

          Resumo Objetivo Compreender as experiências de ser adolescente com a doença falciforme. Métodos Estudo qualitativo, realizado em unidade de referência no estado da Bahia entre março e junho de 2018. Participaram dez adolescentes com doença falciforme, os dados foram obtidos mediante desenhos-estória com tema e entrevistas semiestruturadas e submetidos à análise embasada na Teoria Fundamentada nos Dados. Resultados A experiência do adolescente com doença falciforme é representada pela categoria central “Buscando ser um adolescente normal, apesar das restrições e da discriminação impostas pela doença falciforme” e mais cinco categorias: “Sentindo-se diferente dos outros adolescentes”, ao perceberem seu crescimento alterado, vivenciarem problemas clínicos e se compararem aos demais adolescentes; “Vivendo com restrições em sua rotina diária”, de ordem física e alimentar demandadas no autocuidado e manejo da doença para o alcance de qualidade de vida; “Vivenciando situações ruins”, na experiência de dor, constantes hospitalizações, medo da morte e incerteza quanto ao futuro; “Sentindo-se um adolescente normal”, quando podiam manter suas atividades sociais com escola, amigos e família; e “Percebendo o estigma”, ao temerem a discriminação e adotarem modos de ocultar que possuíam a doença. Conclusão Ao buscar ser um adolescente normal os participantes aspiraram assumir o controle sobre a própria vida, evitar rupturas na rotina e atender às expectativas sociais, protegendo sua identidade de rótulos e discriminação.

          Translated abstract

          Abstract Objective Understand the experiences of being an adolescent with sickle cell disease. Methods Qualitative study, conducted at a reference service in the state of Bahia, Brazil between March and June 2018. Ten adolescents with sickle cell disease participated. The data were obtained through drawings-and-stories with a theme and semi-structured interviews and analyzed based on Grounded Theory. Results The experience of adolescents with sickle cell disease is represented by the core category of “trying to be a normal adolescent, despite the restrictions and discrimination the sickle cell disease imposes”, and five other categories: “Feeling different from other adolescents”, when they see that their growth has altered, that they experience medical problems and compare themselves to other adolescents, “Living with restrictions in their daily routine”, of physical and food-related restrictions, required in self-care and disease management to achieve quality of life, “Living in bad situations”, in the experience of pain, constant hospital visits, fear of death and uncertainty about the future, “Feeling like a normal adolescent”, when they were able to maintain their social activities, including school, friends, and family, and “Realizing the stigma”, when they fear the discrimination and adopt ways to hide that they have the disease. Conclusion By seeking to be a normal adolescent, the participants aspired to take control over their own lives, avoid breaks from the routine and meet social expectations, protecting their identity from labels and discrimination.

          Translated abstract

          Resumen Objetivo Entender las experiencias de ser adolescente con la enfermedad de células falciformes. Métodos Estudio cualitativo, realizado en una unidad de referencia en el estado de Bahia entre marzo y junio de 2018. Participaron diez adolescentes con la enfermedad de células falciformes, se obtuvieron los datos por medio de dibujos-historia con tema y entrevistas semiestructuradas y sometidos a análisis con base a la Teoría Fundamentada en Datos. Resultados La experiencia del adolescente con enfermedad de células falciformes está representada por la categoría central “Busca ser un adolescente normal, pese a las restricciones y a la discriminación impuestas por la enfermedad de células falciformes” y otras cinco categorías: “Se sienten diferentes de los demás adolescentes”, cuando se dan cuenta de su crecimiento alterado, vivencian problemas clínicos y se comparan a los demás adolescentes; “Viven con restricciones en su rutina diaria”, de orden físico y alimentario que se demandan en el autocuidado y en la gestión de la enfermedad para lograr la calidad de vida; “Vivenciando malas situaciones”, en la experiencia del dolor, constantes ingresos a hospitales, miedo a la muerte e incertidumbre con relación al futuro; “Sentirse un adolescente normal”, cuando podían mantener sus actividades sociales en la escuela, amigos y familia; y “Percatándose del estigma”, al sentir temor de la discriminación y adoptar formas de ocultar que padecen la enfermedad. Conclusión Al intentar ser un adolescente normal, los participantes aspiraron a asumir el control sobre sus propias vidas, evitar rupturas en la rutina y atender a las expectaciones sociales, protegiendo su identidad de clasificaciones y de discriminación.

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          Friendships and Family Support Reduce Subsequent Depressive Symptoms in At-Risk Adolescents

          Background Early life stress (ELS) consists of child family adversities (CFA: negative experiences that happened within the family environment) and/or peer bullying. ELS plays an important role in the development of adolescent depressive symptoms and clinical disorders. Identifying factors that may reduce depressive symptoms in adolescents with ELS may have important public mental health implications. Methods We used structural equation modelling and examined the impact of adolescent friendships and/or family support at age 14 on depressive symptoms at age 17 in adolescents exposed to ELS before age 11. To this end, we used structural equation modelling in a community sample of 771 adolescents (322 boys and 477 girls) from a 3 year longitudinal study. Significant paths in the model were followed-up to test whether social support mediated or moderated the association between ELS and depressive symptoms at age 17. Results We found that adolescent social support in adolescence is negatively associated with subsequent depressive symptoms in boys and girls exposed to ELS. Specifically, we found evidence for two mediational pathways: In the first pathway family support mediated the link between CFA and depressive symptoms at age 17. Specifically, CFA was negatively associated with adolescent family support at age 14, which in turn was negatively associated with depressive symptoms at age 17. In the second pathway we found that adolescent friendships mediated the path between peer bullying and depressive symptoms. Specifically, relational bullying was negatively associated with adolescent friendships at age 14, which in turn were negatively associated with depressive symptoms at age 17. In contrast, we did not find a moderating effect of friendships and family support on the association between CFA and depressive symptoms. Conclusions Friendships and/or family support in adolescence mediate the relationship between ELS and late adolescent depressive symptoms in boys and girls. Therefore, enhancing affiliate relationships and positive family environments may benefit the mental health of vulnerable youth that have experienced CFA and/or primary school bullying.
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            Insight into the complex pathophysiology of sickle cell anaemia and possible treatment.

            Sickle cell anaemia (SCA) is the consequence of abnormal haemoglobin production due to an inherited point mutation in the β-globin gene. The resulting haemoglobin tetramer is poorly soluble when deoxygenated, and when this is prolonged, intracellular gelation of sickle haemoglobin occurs, followed by haemoglobin polymerisation. If many cycles of sickling and unsickling occur, the red cell membrane will be disrupted leading to haemolysis and vaso-occlusive events. Recent studies have also shown that leucocyte adhesion molecules and nitric oxide (NO) depletion are involved in endothelial damage. New insights in SCA pathophysiology and vascular biology have shown that cell-derived microparticle (MP) generation is also involved in the vaso-occlusion. Endothelial damage is perpetuated by impaired production or increased consumption of protective modulators such as protein C, protein S and NO. New therapeutic interventions should address these aspects of SCA pathogenesis. To date, the only US-FDA-approved therapy to prevent painful vaso-occulsive episodes is hydroxyurea that reduces haemoglobin polymerisation in sickle cells by increasing the production of foetal haemoglobin and L-glutamine. However, several new drugs have been tested in the last years in randomised clinical trials. We here report an update on the current status of knowledge on SCA.
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              How sickle cell disease patients experience, understand and explain their pain: An Interpretative Phenomenological Analysis study.

              Sickle cell disease (SCD) is the UK's most common blood disorder causing sickle shaped red blood cells to block small blood vessels inducing both acute and chronic pain. A crucial factor in determining quality of life for those with SCD is the severity, timing and number of painful sickling episodes. However, little research focuses on the nature of pain and so it is poorly understood. The aim of this study is to provide an in-depth and meaning led account of the experience of SCD pain.
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                Author and article information

                Journal
                ape
                Acta Paulista de Enfermagem
                Acta paul. enferm.
                Escola Paulista de Enfermagem, Universidade Federal de São Paulo (São Paulo, SP, Brazil )
                0103-2100
                1982-0194
                2022
                : 35
                : eAPE0243345
                Affiliations
                [1] Feira de Santana Bahia orgnameUniversidade Estadual de Feira de Santana Brazil
                [2] South Carolina orgnameUniversity of South Carolina orgdiv1College of Nursing United States
                Article
                S0103-21002022000100345 S0103-2100(22)03500000345
                10.37689/acta-ape/2022ao0243345
                163031a2-db8d-49e0-8ce1-9de1f9e0afcd

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 16 June 2021
                : 02 September 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 31, Pages: 0
                Product

                SciELO Brazil

                Categories
                Artigo Original

                Social stigma,Anemia, sickle cell,Chronic disease,Adolescente,Comportamento do adolescente,Estigma social,Discriminação social,Autocuidado,Anemia falciforme,Doença crônica,Conducta del adolescente,Discriminación social,Anemia de células falciformes,Enfermedad crónica,Social discrimination,Self Care

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