Ensaio clínico randomizado sobre a prática da atenção farmacêutica nas farmácias comunitárias

Introdução: A criação de programas de equipe multiprofissional de saúde desponta como uma alternativa eficiente para controlar a evolução dos pacientes portadores de diabetes, e a inserção do farmacêutico em tais programas tem contribuído para melhorar o acompanhamento desses pacientes. Objetivo: Avaliar o impacto da intervenção do farmacêutico no acompanhamento dos pacientes diabéticos tipo 2, em farmácias comunitárias. Métodos: Ensaio clínico randomizado, uni-cego envolvendo 100 pacientes diabéticos tipo 2 de ambos os gêneros, usuários de farmácia comunitária, com idade igual ou superior a 30 anos, em uso de hipoglicemiantes orais com adição ou não de insulina e foram acompanhados por 6 meses. Os pacientes do grupo controle receberam o tratamento habitual existente em qualquer farmácia, e os de intervenção receberam o acompanhamento do farmacêutico incluindo intervenções aos problemas relacionados aos medicamentos. Os desfechos primários avaliados foram os valores da hemoglobina glicada (HbA1c), glicose basal e um questionário de qualidade de vida validado denominado de Diabetes Quality of Life Measure (DQOL) - Brasil; e como desfechos secundários as dosagens dos triglicérides, colesterol total, (HDL) colesterol, (LDL) colesterol, tensão arterial e a satisfação do usuário com o serviço prestado. Essa pesquisa contou com a colaboração de vários profissionais das diferentes áreas do conhecimento a seguir nominados: médico, farmacêutico bioquímico, enfermeiro, nutricionista e estatístico. Resultados: Finalizaram o estudo 89 pacientes. Durante o acompanhamento 95,7% (45/47) dos pacientes no grupo intervenção apresentaram problemas relacionados aos medicamentos (PRM), perfazendo um total de 141, com uma média de 3 eventos por paciente, ocorrendo uma resolutividade de 61,7% (87/141). A categoria que mais apresentou PRM foi a de efetividade com 34,1% (48/141) e a classe farmacológica mais utilizada foi a dos hipoglicemiantes orais com 35% (49/141). As variáveis de desfechos primários como hemoglobina glicada (HbA1c) e a glicose basal não apresentaram valores estatisticamente significantes quando comparadas o final com o inicial do acompanhamento nos grupos intervenção e controle considerando um p<0,05, mas o questionário de qualidade de vida DQOL Brasil apresentou resultados estatisticamente significante com um p=0,000. Os desfechos secundários, com exceção da satisfação do usuário, não apresentaram valores xi estatisticamente significantes quando comparados o final com o início do acompanhamento nos grupos de intervenção e controle. Conclusão: Os resultados indicam que as modificações das variáveis clínicas não apresentaram valores significativos no controle da enfermidade e comorbidades, enquanto que na avaliação da qualidade de vida os pacientes afirmaram que melhoraram; portanto, pode-se postular que a intervenção farmacêutica é uma atividade necessária, mas que a prática do Pharmaceutical Care trará benefícios com sustentabilidade para os pacientes se houver uma efetiva integração do farmacêutico numa equipe multiprofissional de saúde, o que está indisponível nas Farmácias Comunitárias

Crescimento inicial e morfologia foliar em plantas de Enterolobium contortisiliquum (Vell.) Morong. E Erythrina velutina Mart. ex Benth, sob estresse hídrico

The Caatinga is the predominant vegetation type in semi-arid region of Brazil, where many inhabitants depend on hunting and gathering for survival, obtaining resources for: food and feed, folk medicine, timber production, etc. It‟s the dry ecosystem with highest population density in the world. The early stages of development are the most critical during the life cycle of a flowering plant and they‟re primordial to its establishment in environments exposed to water stress. Information about adjustments to the growth of the species, correlated with their studies of distribution in Seridó oriental potiguar, are an important ecological and economic standpoint, because they provide subsidies for the development of cultivation techniques, to programs of sustainable use and recovery of degraded areas. This thesis aimed to study the initial growth and foliar morphology in plants like Enterolobium contortisiliquum (Vell.) Morong. (tamboril) and Erythrina velutina Mart. ex Benth (mulungu), species of occurrence in the Caatinga, under water stress. After sowing and emergency, the seedlings were exposed to three water regimes: 450 (control), 225 (moderate stress) and 112.5 (severe stress) mm of water slide for 40 days. Seeding occurred in bags of 5 kg and after the establishment of seedlings thinning was carried out leaving a plantlet per bag. At the beginning the waterings occurred daily with distilled water, passing to be on alternate days after thinning. Twenty and forty days after the thinning seedlings collections were held to be done analysis of growth and biomass partition. When compared to the control group, the treatments with water stress showed reduction in the growth of the aerial part, growth of the greater root, number of leaves and leaflets, dry leaf area and total phytomass in both species, but in general, this effect was most marked for E. velutina. Regarding the partition of biomass, there were few changes throughout the experiment. Morphological changes in the leaves as a function of stress were not significant, however, there was a trend, in both species, to produce narrower leaves, that facilitate heat loss to the environment. It has not been possible to establish a positive relationship between inhibition of growth and distribution of species, whereas E. velutina is a species of most common occurrence in Seridó oriental potiguar. In this way, other aspects should be taken into account when studying the adaptation of species the dry environments, such as salinity, presence of heavy metals, wind speed, etc

Prostitutas entendidas: o que entender?

In this research, we propose a discussion from that observed in our field of work that women are prostitutes and who self-define understood. We check these women have sex with men by means of work and with women from the relationship of affection. We analyzed the practice of sexual activity as another possible expression of sexuality. There are many studies that deal with issues around the theme of prostitution and homosexuality in regard to various aspects and disciplines. Our proposal for study with these women is a topic that is on the agenda, as today, the theme of prostitution and homosexuality is well discussed within the Humanities in general. These new studies indicate about sexuality in a privileged place discussing values associated with the intimacy of the modern person, but also suggest that permeate discussions elements underlying the identity of women who have sex with women and men, the latter being, sexual activity mediated through the employment relationship by the financial interest, because according to our informants, prostitution is a job. From the reports of our participants / informants your answers fit the various brands that define the social field of possibilities of the sexual practices of individuals, raising questions about the origin and social class, family history, stage of life they are set of gender relations in the universe in which they live. All these elements provide the beacons to the process of shaping of subjectivity, understood as the social and biographical circumstances that define the direction I face this new constitution of the subject, it is defined by many theorists of the humanities, such as post-modern or modernity, and the insurgency that we have with the liberation movements that gays and lesbians were in question and make the politicization of sexuality

O conceito de morte: significações de professoras dos anos iniciais do ensino fundamental

Cette étude appartient à l un des principaux défis de l éducation dans l actualité qui est la production de connaissances concernant la mort comme objet d investigation théorique et empirique dans le domaine éducationnel. Des recherches récentes signalent le besoin d une éducation contemplant des études sur la mort et montrent l école tel qu un lieu de débats et reflexions à propos de ce thème. Cette reflexion est relevante et fondamentale, étant donné que la mort fait partie du cycle de la vie et se trouve présente dans les contenus scolaires des différents domaines de la connaissance. Ce travail a, donc, l objectif d analyser les signification attribués à ce concept mort et la relation qui s établit entre eux et la pratique des professeurs de l enseignement fondamental. Il adopte en tant que référentiel les principes de la recherche qualitative du type étnographique (André, Chizzotti et Meksenas), dans une approche socio-historique et en ce qui concerne la formation et le développement des concepts (Vygotsky, Kopnin, Guetamanova et Ferreira). La participation des professeurs a été faite par l observation participante, registres en cahier de bord et application d un instrument de construction de données pour l appréhension des significations attribués aux concepts qui sont à la base de la pratique de cinq enseignantes des premières séries de l Enseignement Fondamental d une école publique du réseau d enseignement de l État du Rio Grande do Norte située dans la Zone Sud de Natal. De ce fait, les analyses et les interprétations des observations de la pratique dans la salle de classe et des réponses aux quinze questions liées au thème ont permis de construire les significations des concepts qui appuient les pratiques enseignantes de ces professeurs, tout en mettant en relief la fragmentation et la désarticulation entre les expressions décrites dans les questionnaires et les pratiques développées en salle de clase. Ces reflexions mettent en évidence la nécessité de re-penser l articulation entre l énnoncé et la pratique des professeurs à propos de cette thématique au cours d une formation initiale et continue

e-Resíduos: A influência da norma européia WEEE na estratégia da indústria de celulares no Brasil e no mundo e o impacto ambiental do descarte inadequado

This present Thesis, is explorer work and presents an analysis of e-wastes of the industry of cellular mobile telephony, evaluating the evolution of the telecommunications nets and as if it holds the global and Brazilian market of cellular telephony. It approaches the elements gifts in the cellular devices that can badly cause to the environment and the health, the discarding of the devices in end of life cycle is made. It analyzes the new European regulation of electric equipment residues and electronic, the WEEE, as it influenced the strategy of the companies manufacturers of mobile phone cellular and of that she forms is possible to create a Brazilian national industry for recycling of devices of cellular, with conditions to globally competition. For this some possible models of being implanted in Brazil are presented. The project of law 203/91 on solid residues is argued and as it would be interesting if to persist some proposals presented to the project, to create a Brazilian market of recycling with capacity of global competition for use to advantage of the European regulation if to get a competitive advantage

Análise de confiabilidade de uma bomba centrífuga: aplicação na injeção de água para recuperação de petróleo

The oil industry`s need to produce with maximum efficiency, not to mention the safety and the environment aspects, encourages the optimization of processes. It makes them look for a level of excellence in acquisition of equipment, ensuring the quality without prejudice security of facilities and peoples. Knowing the reliability of equipment and that this stands for a system is fundamental to the production strategy to seeks the maximum return on investment. The reliability analysis techniques have been increasingly applied in the industry as strategy for predicting failures likelihood ensuring the integrity of processes. Some reliability theories underlie the decisions to use stochastic calculations to estimate equipment failure. This dissertation proposes two techniques associating qualitative (through expertise opinion) and quantitative data (European North Sea oil companies fault database, Ored) applied on centrifugal pump to water injection system for secondary oil recovery on two scenarios. The data were processed in reliability commercial software. As a result of hybridization, it was possible to determine the pump life cycle and what impact on production if it fails. The technique guides the best maintenance policy - important tool for strategic decisions on asset management.

Estudo das propriedades psicométricas da escala WHOQOLold em idosos da região Nordeste

The population aging process increases the number of elderly people worldwide. In Brazil, a country of continental size, this process began in the 40s and happens with specific features in each of the different region s realities. This way, this thesis aimed to evaluate the psychometric properties of a elderly s quality of life (QOL) scale, the WHOQOL-old, in a population of the Northeast of Brazil. We sought to investigate the congruence between the content covered by the scale and the ones deemed as relevant by the participants. It aimed also study the validity evidences of the instrument s internal structure. To achieve the research objectives we adopted the design of multiple methods. The research was organized in two studies. For data collection, both studies used a sociodemographic questionnaire to obtain a profile of the participants and the Mini Mental State Exam (MMSE), used as exclusion criterion. A number of 18 elderly residents of the cities of Natal-RN and Campina Grande-PB, mean age of 73.3 years (SD = 5.9) took part od the study, They were organized into three focal groups (FG) in witch they discussed about the concept of QOL, what enhance and what hinders QOL. For Study II, a quantitative approach, 335 elderly from Campina Grande responded scale WHOQOL-old. They are between 65 and 99 years (M = 74.17, SD = 6.5). The FG data were analyzed by categorical thematic content. For the data analysis of the WHOQOL-old scale were used exploratory factor analysis and calculation of the Akaike and Bayesian information criteria. The results of both studies were triangulated. According to the discussions in the FG, health and social participation have central roles in quality of life. Social participation is related to all the other QOL s influences raised. The participants indicated the relevance of religiosity and were divided about the importance of sexual activity. Exploratory factor analysis (EFA) extracted a model of six factors. Two items (OLD_3 and OLD_9), not loaded on any factor and were excluded. The other items had factor loadings > 0.3. The response categories were reduced from five to three. After the scale changes, the empirical model showed better fit (-2loglikelihood = 8993.90, BIC and AIC = 9183.90 = 9546.24) than the theoretical model (-2loglikelihood = 18390.88, AIC = 18678.88 and BIC = 19228.11). Despite the best information criterion values, the RMESA remained above the ideal (0.06). We conclude that the WHOQOL-old presents psychometric parameters below the ideal when used with the Northeast population, but the improvements made the scale s use acceptable. The WHOQOL-old uses observable variables that matches with the participants' perceptions on quality of life. However, new strategies must be tested for a better sacale refinement

Influência das condições de saúde bucal no desempenho das atividades diárias de adolescentes escolares

Instruments are used in odontology to measure the Quality of Life Related to Oral Health (OHRQoL) to scale how the oral condition interferes with functional areas, of the people s psychological and social life. This cross-sectional study, held in Natal/RN, with 215 students from the Federal Institute of Education, Science and Technology of Rio Grande do Norte (IFRN) has investigated the association between the performance of daily activities and oral health status of school adolescents from 15 to 19 years of age, through the normative index DMFT (permanent teeth decayed, missing and filled), CPI (Community Periodontal Index) and DAI (dental Aesthetic Index) and subjective questionnaire assessment of quality of life related oral health OIDP index (oral impacts on daily performance). It was also carried out the socioeconomic characteristics of students through IFRN own data. Concerning the analysis of data was performed a descriptive analysis of the variables by their absolute and relative frequencies and measures of central tendency. The chi-square test was used to assess the association between the dependent variable and the independent categorical variables and the Student t test for quantitative. It was also conducted a further multiple analysis out using Poisson regression with robust variance between the outcome "presence of impact" and the independent variables that showed p <0.20. It was used for all the statistical tests a significance level of 5%. Among the adolescents surveyed, 51.16% reported that at least one activity assessed by OIDP had hampered its implementation due to some dental problem. The difficulties were more pronounced in the activities of eating (31.6%), oral hygiene (25.6%) and smile (25.1%).The tooth position, followed by toothache, were the causes of the impacts reported by most teenagers. There was a significant association between the presence and impact of the presence of one or more decayed teeth (p = 0.012), the presence of gum bleeding (p = 0.012) and for orthodontic treatment (p = 0.003), independently of other variables. There was no significant association between oral health status and socioeconomic and demographic characteristics of the adolescents. The survey results showed that there is an association between oral health status of the population studied and reports of difficulties in carrying out daily activities evaluated. The worse the oral health status, the greater the impact of this condition on the adolescents quality of life

Prova automática de satisfatibilidade módulo teoria aplicada ao método B

Este trabalho apresenta uma extensão do provador haRVey destinada à verificação de obrigações de prova originadas de acordo com o método B. O método B de desenvolvimento de software abrange as fases de especificação, projeto e implementação do ciclo de vida do software. No contexto da verificação, destacam-se as ferramentas de prova Prioni, Z/EVES e Atelier-B/Click n Prove. Elas descrevem formalismos com suporte à checagem satisfatibilidade de fórmulas da teoria axiomática dos conjuntos, ou seja, podem ser aplicadas ao método B. A checagem de SMT consiste na checagem de satisfatibilidade de fórmulas da lógica de primeira-ordem livre de quantificadores dada uma teoria decidível. A abordagem de checagem de SMT implementada pelo provador automático de teoremas haRVey é apresentada, adotando-se a teoria dos vetores que não permite expressar todas as construções necessárias às especificações baseadas em conjuntos. Assim, para estender a checagem de SMT para teorias dos conjuntos destacam-se as teorias dos conjuntos de Zermelo-Frankel (ZFC) e de von Neumann-Bernays-Gödel (NBG). Tendo em vista que a abordagem de checagem de SMT implementada no haRVey requer uma teoria finita e pode ser estendida para as teorias nãodecidíveis, a teoria NBG apresenta-se como uma opção adequada para a expansão da capacidade dedutiva do haRVey à teoria dos conjuntos. Assim, através do mapeamento dos operadores de conjunto fornecidos pela linguagem B a classes da teoria NBG, obtem-se uma abordagem alternativa para a checagem de SMT aplicada ao método B

GT4CCI: uma abordagem baseada em grounded theory para a identificação de interesses transversais em documentos de requisitos

When crosscutting concerns identification is performed from the beginning of development, on the activities involved in requirements engineering, there are many gains in terms of quality, cost and efficiency throughout the lifecycle of software development. This early identification supports the evolution of requirements, detects possible flaws in the requirements specification, improves traceability among requirements, provides better software modularity and prevents possible rework. However, despite these several advantages, the crosscutting concerns identification over requirements engineering faces several difficulties such as the lack of systematization and tools that support it. Furthermore, it is difficult to justify why some concerns are identified as crosscutting or not, since this identification is, most often, made without any methodology that systematizes and bases it. In this context, this paper proposes an approach based on Grounded Theory, called GT4CCI, for systematizing and basing the process of identifying crosscutting concerns in the initial stages of the software development process in the requirements document. Grounded Theory is a renowned methodology for qualitative analysis of data. Through the use of GT4CCI it is possible to better understand, track and document concerns, adding gains in terms of quality, reliability and modularity of the entire lifecycle of software

Influência do tamoxifeno associado ao diabete melito na densidade mineral óssea

Considering that osteopenia and osteoporosis are diabetes mellitus complications, and that tamoxifen (TAM) is an anti-estrogenic drug used in breast cancer treatment, this drug may have a beneficial action preventing accentuaded bone loss associated to diabetes. Female Wistar rats (n=60) weighting 180-250g were divided in four groups: Group C, control animals (n=5); Group T, animals treated with TAM (n=5); Group D, diabetic animals (n=5); and Group DT, diabetic animals treated with TAM (n=5). Oestrus cycle was evaluated before the beggining of experimental period to select the animals with regular cycle. This evaluation continued throughout the study period and for all studied groups. Diabetes was induced by a intra perithoneal injection of streptozotocin (STZ) in a concentration of 45 mg/Kg of body weight. Those animals with serum glicose levels 250 mg/dL were considered diabetics. Animals were sacrificed in the periods of 30, 60 and 90 days after diabetes onset. Left femur histomorphometric measurements and serum biochemical analysis (glycemia, alkaline phosphatase, tartaric-resistant acid phosphatase, calcium, phosphorous, magnesium, total proteins, albumin, globulins, urea and creatinine) were done. Histomorphometric results showed a progressive bone loss in Group D animals when compared to those from Group C all over the experimental period, becoming accentuaded in the 90 days period. In relation to Groups T and DT, values approcimated to those obtained for control group were found during the whole period of study. Those data may indicate a bone mass recovery or a diminished bone loss due to diabetes when animals were treated with TAM. During the whole experimental period animals of groups D and DT maintained glycemic levels above 250 mg/dL whereas animals of groups C and T maintained those levels below 150mg/dL. Alkaline phosphatase activity was increased in all study periods for groups D and DT when compared to group C animals over the 90 days period. Tartarate-resistant acid phosphatase activity was showed unaltered in all periods of study and for all groups. Calcium and magnesium results were also unaltered, maintaining reference levels for all groups in all experimental periods. Phosphorous levels were increased in groups D and DT when compared to groups C and T in the 30 days period. However no difference was found in the periods of 60 and 90 days for this test. No difference was found for total proteins levels for groups C, T, D and DT over the study period. Albumin levels were reduced in DT group in the 60 days period and in D and DT groups in the 90 days period. Urea levels were significantly increased in the 30, 60 and 90 days study periods in groups D and DT when compared to groups C and T. Creatinine results showed a significantly increase in the 90 days period for groups D and DT when compared to groups C and T, and maintaining unaltered in the 30 and 60 days periods. These results suggest that the treatment with TAM may reduce bone loss caused by diabetes mellitus