A concepção de família e religiosidade presente nos discursos produzidos por profissionais médicos acerca de crianças com doenças genéticas

O estudo explora a influência de tradições culturais arraigadas na construção do discurso que médicos do Instituto Fernandes Figueira/Fundação Oswaldo Cruz produzem acerca das crianças com doenças genéticas associadas a malformações congênitas e ao retardo mental, assim como, as reflexões provocadas pelo convívio profissional com tais crianças. Os dados foram coletados através de entrevistas orais do tipo narrativa conversada e do material analisado semioticamente. Os resultados apontaram para quatro tradições culturais muito presentes no discurso médico: a norma, a razão, a família e a religiosidade judaico-cristã. Este artigo, contudo, centra-se nas duas últimas, enfatizando como a concepção da família, principalmente a mitificação da mãe, pode 'tornar invisível' a criança com uma doença genética, como também contribui para que a condição de mulher da mãe fique subestimada diante de sua maternidade. Tais noções imbricam-se com aquelas trazidas pelas tradições religiosas e influenciam as percepções médicas a respeito do paciente e de sua família.This study explores the influences of cultural traditions rooted in the tone of medical discourse at the Instituto Fernandes Figueira/ Fundação Oswaldo Cruz by physicians regarding children with genetic diseases involving malformations and mental retardation, as well as reflections upon the professional care for these children. Data were collected using oral interviews (in the form of conversational narratives) and were submitted to semiotic analysis. The results pointed to four main cultural traditions present in medical discourse: the norm, the reason, the family and the Jewish-Christian religiosity. This article, however, focuses on the latter two, emphasizing how the notion of the family, mainly the mythification of the mother, can make the child with a genetic disease 'invisible,' in addition to contributing towards womanhood being underestimated when contrasted with motherhood. Such concepts overlap with those brought by the religious traditions and directly influence the medical perceptions towards patients and their families

Occurrence of insertion sequences within the genomes and Tn1546-like elements of glycopeptide-resistant enterococci isolated in Brazil, and identification of a novel element, ISEfa5

Insertion sequences (IS) occur widely within the Tn1546-like elements responsible for VanA glycopeptide resistance in enterococci from several countries. As such insertions can be used as epidemiological markers and for studying horizontal transfer of gene clusters, we investigated the distribution of IS6770, IS1542, IS1216V, IS1476, and IS1251 elements in 26 VanA Enterococcus faecium and 21 VanA Enterococcus faecalis from Brazil. PCR, using genomic DNA as a template, indicated that most of the isolates contained IS6770 (97%), IS1216V (87%) and IS1476 (72%) elements. IS1251 was also detected, but at a higher frequency in E faecium (80%) than in E faecalis (14%). None of the isolates harboured IS1542. Only two of 47 isolates had IS elements within their Tn1546-like elements; one possessed IS1251 between vanS and vanH, as reported in the United States; another possessed a novel IS element, designated ISEfa5, located between vanX and van Y. This novel element was found in the genomic DNA of 25 (96%) E faecium and 11 (52%) E faecalis. in stability studies, no IS-mediated changes were detected in the Tn.1546-like elements of 25 vancomycin-resistant enterococci (VRE) monitored over 11 months. These results suggest that the occurrence of IS in Brazilian isolates is similar to that reported in American isolates, but that these elements occur rarely within the vanA gene clusters. As patterns of IS carriage did not correlate with the PFGE type of the VRE, the prevalence of IS elements in genomic DNA of VRE is not a useful epidemiological marker. However, the presence of IS-modified Tn1546-like elements, which appear to be rare in Brazil, could be a useful molecular marker in local epidemiological studies to monitor the evolution and horizontal transmission of VanA elements. (c) 2004 Published by Elsevier GmbH.Univ São Paulo, Fac Ciencias Farmaceut, BR-14040903 Ribeirao Preto, BrazilInst Adolfo Lutz Registro, São Paulo, BrazilUNIFESP, Dept Doencas Infecciosas & Parasitarias, São Paulo, BrazilHlth Protect Agcy, Specialist & Reference Microbiol Div, Antibiot Rsistance Monitoring & Reference Lab, London, EnglandUNIFESP, Dept Doencas Infecciosas & Parasitarias, São Paulo, BrazilWeb of Scienc