Trauma em idosos atendidos pelo serviço pré-hospitalar móvel

O The aim of this study was to characterize the occurrence of trauma in the elderly population served by the mobile pre-hospital service, in Natal, Rio Grande do Norte. This is a descriptive, transversal and quantitative approach and whose population consisted of 2,080 trauma victims. The sample, of systematic random type, consisted of 400 elderly people, aged from 60 years old, assisted by the Office of Mobile Emergency in Natal / RN, between January 2011 and December 2012. Data collection began after consent and assent of the institution of a Research Ethics Committee under No. 309 505. It was proceeded to documentary retrospective analysis of records of this service through a form of self-development, validated by expert judges considered reliable (α> 0.75) and valid (CVI = 0.97) in their clarity and relevance. Data were tabulated by the Statistical Package for Social Sciences, version 20.0. The results show that older victims have an average age of 74.19 years old, with a prevalence of female involvement by chronic diseases, especially hypertension, average usage of 2.2 routine medications with vital signs within normal limits. The trauma prevailed during the daytime, in the residence of the victims, north of the city and on weekends. Among the mechanisms of trauma were falls, traffic accidents and physical aggression, whose most common type was brain-cerebral trauma and the main consequences were suture wounds and closed fractures. Basic Support Units were as more driven to pre-hospital care (87.8%) and the main destination place consisted of a referral hospital for emergency of the state (57.5%). Among the most commonly performed procedures by nursing staff immobilization with rigid board and neck collar and the peripheral venipuncture, and the main component used for volume replacement to saline were highlighted. There was a significant relationship between the deaths and the mechanism of injury, mechanism of injury and procedures, except medication administration procedures carried out, except immobilization and unit for service. It is highlighted the prevalence of trauma in the elderly, poor follow-up Pre-Hospital Trauma Life Support protocol and the paucity of records and nursing procedures performed. There is need for a protocol of care specific to elderly trauma victims and education strategies for the prevention of such events

Avaliação da assistência à saúde dos portadores de úlceras venosas atendidos no programa saúde da família do município de Natal/RN

Descriptive research aimed at evaluating the assistance offered to patients with venous ulcers, on lower limbs, attended by the Family Health Program (FHP) team, from the municipality of Natal/RN. The target population was composed of 74 patients with venous ulcers (VU), attended by the FHP teams in the 31 FHUs. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (protocol n.55/05). The data collection was performed in patients homes and in the FHUs, through structured interviews and physical examinations of patients with VU and non-participant observation during the changing of wound dressings in these Units and in users homes. The data was organized into an Excel electronic table and transported into the SPSS 14.0 program, for descriptive analysis on 2x2 contingency tables and inferential (Qui-Square χ2, Spearman Correlation, Binomial Proportion Test and p-value <0.05). The prevalence of VU (0.36/1000) in the target population (over 20 years of age) was greater than in the population registered in FHP (0.25/1000). We detected a greater prevalence in the age area of over 60 years (2.22/1000), with 2.98/1000 for females and 1.3/1000 for males (p-value=0.008). The sociodemographical and health characteristics of patients with VU revealed predominance of females (74.5%), elders over 60 years of age (67.6%), with fundamental education (74.3%), family earnings of up to 2 minimum wages (68.9%), retired (90.5%), ortostatic position (23.0%), inadequate sleep (59,9%), presence of CVI (100.0%), hypertension (44.6%) and diabetes (25.7%). As for the time of existence of the VU, 64.9% had over 1 year, and 35.1% less than 1 year), with predominance of one wound (67.6%). The changing of wound dressings is performed mostly at home, in and inadequate way, especially with incorrect cleaning techniques, likewise incorrect use of products and substances, and reduced participation of the FHP team on the evaluation and application of the dressing and choosing of products and substances. The compressive therapy is not part of therapeutic conducts for treatment in the FHUs. As for the evaluation of assistance to patients with VU, 90.5% were inadequate and only 9.5% adequate. The main inadequacy factors were the absence of: diagnosis (47.3%), consultation with and angiologist (63.5%), compressive treatment (100.0%), adequate optical therapy (98.62%), adequate dressing kit (70.3%), training for the changing of dressings (67.6%), following by the FHP team (51.4%) and performed exams (55.4%). We ve concluded that patients with VU mostly present now socioeconomical level and associated chronic diseases. Considering that assistance offered by FHP is non-systematic, fragmented, with no diagnosis planning, continual evaluation and evolution, we qualify the assistance as inadequate and with low level of solution, directly interfering on the maintenance of the VUs chronic state

Efeitos do tratamento com Hidrogel na cicatrização de úlceras venosas de membros inferiores: revisão sistemática

Chronic venous disease (CVD) is evident among the chronic diseases and affects the elderly population and primarily is responsible for leg ulcers in this population. The use of dressings in the care of a venous ulcer is a fundamental part of the treatment for healing, however, evidence to assist in choosing the best dressing is scarce. The main objective of this study was to evaluate the effectiveness of treatment with hydrogel in the healing of venous ulcers using search methods, synthesis of information and statistical research through a systematic review and meta-analysis. Randomized controlled trials were selected in the following databases: CENTRAL; DARE; NHS EED; MEDLINE; EMBASE; CINAHL. Beyond these databases three websites were consulted to identify ongoing studies: ClinicalTrials.gov, OMS ICTRP e ISRCTN. The primary outcomes were analyzed: complete wound healing, incidence of wound infection and the secondary were: changes in ulcer size, time to ulcer healing, recurrence of ulcer, quality of life of participants, pain and costs of treatment. Four studies are currently included in the review with a total of 250 participants. The use of hydrogel appears to be superior to conventional dressing, gauze soaked in saline, for the healing of venous leg ulcers; 16/30 patients showed complete healing of ulcers (RR 5,33, 95%CI [1,73,16,42]). The alginate gel was shown to be more effective when compared to the hydrogel dressing in reduction of the wound area; 61,2% (± 26,2%) with alginate e 19,4% (± 24,3%) with hydrogel at the end of four weeks of treatment. Manuka honey has shown to be similar to the hydrogel dressings in percentage of area reduction. This review demonstrated that there is no evidence available about the effectiveness of the hydrogel compared to other types of dressings on the healing of venous leg ulcers of the lower limbs, thus demonstrating the need of future studies to assist health professionals in choosing the correct dressing.

Avaliação da angiogênese em lesões de líquen plano oral e pênfigo vulgar

Oral lichen planus and pemphigus vulgaris are chronic diseases mucous membrane immune of unknown aetiology that can be observed affecting to the oral mucous. A relevant as regards neoplasies the role angiogenesis in the inflammatory chronic disease pathogenesis as it provides a substancial interest can be considered as being an activity diseases marker; besides being through specialised research of this angiogenic process to improve of understanding pathogenic mechanism. This research proposes to assess angiogenic active through of antibody immunohistochemistry expression antiCD34 antibody in 26 OLP of reticular cases, 14 OLP erosives cases, 18 of PV cases and 15 specimens of normal oral mucosa. The result was submitted non-parametric tests of 5% significance level. It is not statistically significant correlacion was seen regarding between average vessels. However, only be effectively observed the median of OLP cases was larger than pemphigus vulgaris in fact proved average larger than oral normal mucosa (p=0,280). Regarding the microvascular count of CD34 concerning clinic form oral lichen planus (reticular and erosion) increased emphasis is more cross-border average for the form erosion clinic. Despite of the statistic tests could not be more effective (p=0,720). Even though, the results of the research is not sufficient to enable to consider of angiogenic process in the pathogenesis and lesions progression of oral lichen planus and pemphigus vulgaris, we suggest this process is present in both forms lesion, however, more studies must be made in the near future in order to prepare a well-founded proposal

Estudo comportamental, hormonal e histopatológico de animais com perda de peso progressina (SEP) e da variável peso associada a uma nova classificação ontogenética em Callithrix jacchus

The use of non-human primates in scientific research has contributed significantly to the biomedical area and, in the case of Callithrix jacchus, has provided important evidence on physiological mechanisms that help explain its biology, making the species a valuable experimental model in different pathologies. However, raising non-human primates in captivity for long periods of time is accompanied by behavioral disorders and chronic diseases, as well as progressive weight loss in most of the animals. The Primatology Center of the Universidade Federal do Rio Grande do Norte (UFRN) has housed a colony of C. jacchus for nearly 30 years and during this period these animals have been weighed systematically to detect possible alterations in their clinical conditions. This procedure has generated a volume of data on the weight of animals at different age ranges. These data are of great importance in the study of this variable from different perspectives. Accordingly, this paper presents three studies using weight data collected over 15 years (1985-2000) as a way of verifying the health status and development of the animals. The first study produced the first article, which describes the histopathological findings of animals with probable diagnosis of permanent wasting marmoset syndrome (WMS). All the animals were carriers of trematode parasites (Platynosomum spp) and had obstruction in the hepatobiliary system; it is suggested that this agent is one of the etiological factors of the syndrome. In the second article, the analysis focused on comparing environmental profile and cortisol levels between the animals with normal weight curve evolution and those with WMS. We observed a marked decrease in locomotion, increased use of lower cage extracts and hypocortisolemia. The latter is likely associated to an adaptation of the mechanisms that make up the hypothalamus-hypophysis-adrenal axis, as observed in other mammals under conditions of chronic malnutrition. Finally, in the third study, the animals with weight alterations were excluded from the sample and, using computational tools (K-means and SOM) in a non-supervised way, we suggest found new ontogenetic development classes for C. jacchus. These were redimensioned from five to eight classes: infant I, infant II, infant III, juvenile I, juvenile II, sub-adult, young adult and elderly adult, in order to provide a more suitable classification for more detailed studies that require better control over the animal development

Mudanças climáticas globais e o compromisso pró-ecológico de adolescentes natalenses

In recent years, much has been discussed about global climate changes (GCCs), popularly known as global warming. The scientific evidences point out to the influence of human actions for its drastic intensification. Therefore, studies of the psychological aspects involved become relevant. This study aimed at the investigation of the views of adolescents concerning GCCs, and the possible relations between those views and their pro-ecological commitment. Such commitment is measured by willingness for engagement in pro-environmental behaviors; environmentalism attitudes, like ecocentric and anthropocentric; consideration of future consequences; and ecological worldviews. Participants were 348 adolescents who answered a questionnaire containing questions about socio-demographic data, open questions about the practice of environmental care, and about GCCs, and the scales of Ecocentric and Anthropocentric Environmentalism, the Consideration of Future Consequences and the Ecological Worldviews assessment scale. From the inter-relationships between variables, procedures carried out by means of descriptive and correlacional statistics, it was observed that 55% of teenagers said that they did not engage in actions of environmental care, which was associated with apathyanthropocentric, immediatism, and individualism. The consideration of future consequences joined the practice of environmental care, corroborating evidence from the literature. It was evident that views concerning GCCs were superficial; adolescents perceive it as a generic environmental problem, and are confused with other problems such as pollution. This study found no association between views about GCCs and the indicators of pro-ecological commitment, perhaps due to the conceptual confusion about the subject. However, the lack of environmental care actions and other indicators of non-commitment (apathy-anthropocentric, individualism and immediatism) were associated with conceptually poor or incomplete responses (with no indication of cause, consequence or responsibility for the problem), demonstrating diminished knowledge and the failure to consider these issues

Práticas institucionais/discursivas acerca dos cuidados com os bebês prematuros e/ou de baixo peso: o programa canguru

The Kangaroo Program was implemented in Brazil in 2000 through the Unified Health System (Sistema Único de Saúde SUS) sustained with a humanized rethoric of health care assistance. This program adopts the skin-to-skin contact contributing to the mother-infant bond, breastfeeding and promoting security in mother s care. The users of SUS are encouraged to live in the maternity ward to follow the baby health improvement. However, it was verified in previous observations that mothers participation in the Kangaroo Program has been done through an imposed practice. Therefore, this study intended to understand the texts that permeate the kangaroo practice. This research was developed through two studies: 1) an historic exploration of motherhood concept and an analysis of how the motherhood is presented in the official document that orients the program; 2) an analysis of institutional dynamic of Kangaroo Program, emphasizing the study about the health workers everyday practice, the mothers view about their life in the maternity wards, and the attendance practice. It is highlighted that the relation between this two studies allowed the comprehension abouthow the official discourses can influence the health workers behaviors and how their viewpoint and position can shape the everyday work in a public health program. This research, supported by Institutional Ethnography, considers that people s practices and experiences are socially organized and shaped by broad social forces. The discourse method was used in the documental analysis and in the analysis of qualitative data from empiric research. The research showed that the kangaroo program has been an excellent way to save resources and to improve some baby s biologic and psychological aspects. However, this program has failed to consider the social, economic and cultural complexity of mothers and the structural limitation of the health care system. The official document uses the economic and medical approach, following the hegemonic biomedical model and the life style of the people that don t use the public health system. Consequently, the program has not been successful because it is planned without people participation. On the other hand, it was verified that although some professionals are committed with their work, the mainly does not consider mothers participation as an active process, using the institutional power as a social control to keep mothers uninformed about the possibility to leave the maternity wards. As a result, the research also showed that mothers perceive the program as mandatory and not as option that can improve pleasure moments. It is, therefore, necessary to consider the complex social determinants of health that can increase mothers participation in the Kangaroo Program. Bringing these issues into debate can be a reflective exercise on citizenship and governance, allowing spaces for the improvement of public health programs