Seleção de categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde para avaliação do paciente com acidente vascular cerebral em reabilitação

Stroke represents the first cause of disabilities among adults. Although different professions work together in treatment of stroke patients, all they use different terminologies for the description of the patients problems and it can constitute an impediment in the communication between the staff members. Thus, the multidisciplinary and interdisciplinary work would be facilitated if using a reference common tool, as the new International Classification of Functioning, Disability and Health (ICF). However, the ICF is very extensive and complex and due to its complexity, it has been evidenced the necessity to select its categories to become it more practical. The aim of the study was to investigate which categories of the ICF are more suitable to evaluate and to describe the stroke patient in the view of teachers and municipal public health professionals. It was a descriptive research, which involved 5 professors and 11 professionals of Physiotherapy that have worked at the health public area in Natal / RN. It was used the Delphi Technique in 3 rounds and the Likert Scale to select the categories among the ICF components. As result, from the 362 IFC categories, 94 were selected. The selected categories correspond to rehabilitative characteristics of Stroke patients in the universe of the Physiotherapy performance. The methodology applied was suitable to the studied object emphasizing the necessity of future studies for validation of the chosen categories

Proteção constitucional do trabalhador portador de incapacidade laboral

Social security has constitutional protection and encompasses health policies, social security and welfare, which are explicitly recognized as a fundamental social right. When workers suffering from work disability are unable to earn income with your work force to support themselves and their families. The State, through the public welfare, contributory and compulsory, has a duty to protect workers in times of misfortune, replacing these income through the provision of social security benefits. Disability the employee has a higher degree of vulnerability, and the granting of disability claims a right sensitive, which can‟t suffer postponements, lest cause legal uncertainty and violating the dignity of the human person. There isn‟t legal definition of disability. The main purpose of the study is the constitutional protection of the worker carrying work disability, seeking to highlight the factors affecting work disability and proposing the use of objective criteria for the grant of social security benefits, because the criteria used are purely medical, based the subjectivity and agency of medical assessor, which hinders the judicial and administrative control of the State. At the time of preparing the expert report, the expert should not consider only tangible aspects, but also social and environmental issues, which contribute to the inability to work and therefore should be considered in granting social security benefits. The granting of social security benefits for incapacity for work is intended to prevent or lessen the impact of individual and social risks in relation to the worker incapacitated, ensuring that the constitutional protection to be effective. The presumed inability, the institute reversing the burden of proof and free conviction motivated are important tools for resolving conflicts between the insured and welfare, finding basis in the insured`s vulnerability, sensitivity and little reliance right at issue in relation to the employee social pension

Proposição e aplicação de um core set da classificação internacional de funcionalidade, incapacidade e saúde (CIF) para saúde física de idosos

Para aumentar a viabilidade do uso da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), core sets começaram a ser desenvolvidos, e objetivam estabelecer uma seleção de categorias adaptada para representar os padrões de avaliação multiprofissional de grupos específicos de pacientes. Com o objetivo de propor um core set da CIF para classificar a saúde física de idosos, formou-se uma comissão de especialistas para julgar o instrumento por meio da técnica Delphi, o que mostra a interface multidisciplinar do projeto. Finalizada a participação da comissão, o core set foi proposto contendo 30 categorias. Após aplicação em uma amostra com 340 idosos dos municípios de Natal/RN e Santa Cruz/RN, o core set foi submetido à análise fatorial, tendo ficado com 19 categorias. A análise ainda proporcionou gerar uma pontuação para cada idoso por meio do escore fatorial, tendo provado ser uma forma fidedigna e confiável de se pontuar um core set.

Influência de fatores biopsicossociais sobre a mortalidade de idosos no município de Santa Cruz/RN: um estudo prospectivo

The aging process if characterizes for a complex events network, from multidimensional nature, that encloses biological, social, psychic and functional aspects. The alteration of one or more aspects can speed up the aging process, anticipating limitations and until the death in the aged. For an adjusted confrontation of this question is necessary an interdisciplinary vision, in which the some areas of the knowledge can interact and with this to intervenes of the best possible form. Then, information derived from studies of aspects related to incidence, morbidity-mortality and transition patterns, involved in the health-illness process can more accurately identify risk groups thereby establishing links between social factors, illness, incapacity and death. Thus, this study aimed to identify, by a multidimensional vision, the risk factors of mortality in a coorth of elderly in a city in the interior of the state of Rio Grande do Norte (RN), Brazil. A prospective study carried out in Santa Cruz RN, where 310 elderly were randomly selected to form a baseline. The follow-up was 53 months. The predictive variables were divided into sociodemographic, physical health, neuropsychiatric and functional capacity. The statistical analysis carried out by bivariate analysis, survival analysis, followed by binary logistic regression and Cox regression, in the multivariate analysis, considering significant levels p < 0.05 and confidence interval (CI) of 95%. A total of 60 (19.3%) elderly died during the follow-up, where cardiovascular disease was the main cause. The survival was approximately 24.8 months. The study of general survival showed, at 12, 24, 36, and 48 months of observation, a survival rate of 97%, 54%, 31%, and 5% respectively, with a statistical difference in survival only observed for the variables of cognitive function and Basic Activities of Daily Living. In the logistic regression analysis, the risk factors identified were cognitive deficits (OR = 8.74), poor perception of health (OR = 3.89) and dependence for Basic Activities of Daily Living (OR = 3.96). In the Cox analysis, as well as dependence for Basic Activities of Daily Living (HR = 3.17), cognitive deficit (HR = 4.30) and stroke (CVA) (HR = 3.49) continued as independent risk factors for death. The risk factors found in the study can be interpreted as the primary predictors for death among elderly members of the community. Therefore, improvements in health conditions, with actions towards sustaining an autonomous life with special attention for elderly with cognitive impairment, could mean additional healthy quality of life, resulting in the reduction of premature mortality in this population

Evuloção cognitiva e funcional de pacientes pós-acidente vascular cerebral - AVC

PURPOSE: Stroke is a high-incidence cerebrovascular disease with elevated morbidity that results in impairments such as functional disabilities. This study aimed to investigate the functional evolution of individuals in the first six months post-stroke. METHOD: Longitudinal study with 42 stroke patients. The functional independence measure (FIM) and The National Institutes of Health Stroke Scale (NIHSS) were used by multidisciplinary staff 3 times in each participant; the first application was at admission to rehabilitation and the others three and six months later. RESULTS: Sample predominantly female (57%), married (52%), mean age 65.26 ±10.72 years, elementary schooling level (43%), ischemic stroke (91%), and right cerebral hemisphere (74%). Motor FIM scores and NIHSS scale showed improvement in the 3 evaluations, with significant p-value (<0.001). There was a strong relation between motor FIM evolution and NIHSS evolution (r = - 0.69 p-value< 0.001). CONCLUSIONS: It was observed that functional evolution at 6 months post-stroke was significant and the smaller the evolution of clinical impairment in these patients, the larger the evolution of their functional independence. The study is important because it allows a more appropriate therapeutic planning according with functional evolution in stroke rehabilitation

Impacto do déficit cognitivo na saúde e capacidade funcional da populção idosa do distrito oeste da cidade do Natal-RN

A incapacidade funcional e o déficit cognitivo são condições relacionadas com o processo de envelhecimento humano. O déficit cognitivo é considerado um importante fator preditor de prejuízos funcionais em populações idosas. Este estudo teve um caráter multidisciplinar na sua elaboração e execução, contando com profissionais de distintas áreas da saúde. Trata-se de um estudo transversal que analisou a associação do desempenho cognitivo na capacidade funcional de uma amostra populacional idosa residente em Natal-RN. Foram avaliados 213 idosos pelo Questionário Multidimensional BOAS e pelo Mini-Exame do Estado Mental (MEEM). Através de análise multivariada, mediante regressão linear, os resultados apontam a idade e o nível de escolaridade como fatores associados ao desempenho cognitivo nos idosos do estudo. O modelo explicativo final elaborado através de regressão logística apresentou o desempenho cognitivo como a única variável associada à incapacidade funcional para as atividades da vida diária, mesmo quando ajustado por variáveis sócio-demográficas. A identificação dos fatores, associados ao declínio do estado funcional dos idosos que vivem na comunidade, poderá reduzir o impacto dessas condições na capacidade funcional através da aplicação de medidas preventivas voltadas para este fim

Avaliação dos efeitos da reeducação postural global (rpg) em pacientes com espondilite anquilosante

The Ankylosing Spondylitis (AS) is a chronic inflammatory disease that primarily affects the axial skeleton, leading to limitation of spine mobility and functional disability. Physical therapy, especially exercise, is an important part in your treatment. The Global Postural Reeducation(GPR),a method that uses stretching based on evaluation of muscular chains, with significant interference in postural changes may be a complementary alternative for the treatment of this disease. The aim was to evaluate the effects of Global Postural Reeducation (GPR) in patients with Ankylosing Spondylitis (AS) and compare GPR with group conventional segmental self-stretching and breathing exercises. This is a controlled interventional study of 38 patients divided into 2 groups: a GPR group (n = 22) and a control group (n = 16). Both groups were treated over four months. With the GPR group patients, positions that stretched the shortened muscle chains were used. With the control group patients, conventional segmental self-stretching and breathing exercises were performed. The variables analyzed were: pain intensity, morning stiffness, spine mobility, chest expansion, functional capacity (Health Assessment Questionnaire - Spondyloarthropathies - HAQ-S), quality of life (Medical Outcome Study Short Form 36 Healthy Survey-SF-36), and disease activity (Bath Ankylosing Spondylitis Disease Activity Index - BASDAI). Statistical analysis was used with a significance level of p < 0.05. There was a statistically significant difference for all the parameters analyzed between pre and post-treatment in both groups. In the inter-group comparison the GPR group showed a statistically significant improvement in morning stiffness (p = 0.01), spine mobility parameters, except finger-floor distance (p = 0.11), in chest expansion (p = 0.02), and in the physical aspect component of the SF-36 (p = 0.00).Finally, we observed that this sample of patients with AS ,treatment with RPG 60 seems to have a better response in some clinical measures, than the conventional self stretching performed in groups. Further studies are needed to further evaluate this therapeutic alternative in the EA

Efeitos da sintomatologia depressiva na mobilidade de idosos de um centro urbano do nordeste brasileiro

O processo de envelhecimento da humanidade é um fenômeno mundial e nas últimas décadas a população brasileira tem acompanhado essa tendência. No entanto, este fenômeno somente pode ser considerado como uma real conquista em termos sócios demográficos na medida em que se agregue qualidade aos anos adicionais de vida para a população. Em populações idosas, a incapacidade funcional e os sintomas depressivos tornaram-se importantes conceitos tanto por suas consequências para a saúde pública, quanto pelo impacto na qualidade de vida dessas populações. Este estudo tem como objetivo verificar se há associação entre os sintomas depressivos e o desempenho funcional de idosos comunitários. Foram avaliados 313 idosos de um centro urbano do nordeste brasileiro através das baterias de testes; Center for Epidemiologic Studies Depression CES-D e Short Physical Performance Battery - SPPB; além de variáveis relacionadas ao estado físico, condições crônicas, função cognitiva e características sócio demográficas. Foram utilizadas medidas de correlação e aplicado método de análise multivariada para construir um modelo explicativo da influência da sintomatologia depressiva no desempenho funcional. Os resultados revelaram que as mulheres apresentaram mais sintomas depressivos (p< 0.01) e pior desempenho funcional (p< 0.01) que os homens. Os indivíduos com sintomatologia depressiva apresentaram pior desempenho funcional, especialmente as mulheres. A idade, o sexo feminino, o estado de saúde percebido, o nível de função cognitiva e o Índice de massa corporal foram identificados como fatores associados ao desempenho funcional na amostra estudada. Os resultados deste estudo permitem inferir a relação de associação entre sintomas depressivos e desempenho funcional em uma população de idosos de um centro urbano no nordeste do Brasil. Estes resultados fornecem informações úteis para intervenções terapêuticas adequadas voltadas para a prevenção do declínio na mobilidade em idosos

Avaliação da eficácia de um programa de "Escola de Coluna" para lombalgia crônica inespecífica

The Back School has been used to prevent and to treat back pain since 1969, however its effectiveness still is controversy in literature. The objective of this study was to evaluate the effectiveness of a program of "Back School" in patients with nonspecific chronic low back pain, directed by rheumatologists and orthopedic doctors to Physiotherapy School Clinic of Universidade Potiguar (UnP) Natal/RN- Brazil, in period of May/2002 to December/2003. Seventy patients, with age varying from 18 to 60 years, were randomized in two groups: Experimental group (group A) with 34 patients, which was subdivided in groups with 6 to 8 components. This group participated of a theoretician and practical program of Back School with 4 lessons, one day per week, with 60 minutes of duration; to the Control group (group B), with 36 patients, was explained that the group should stay four months in a waiting list . Both groups, had been carried through three evaluations, by a blind, to patient group, independent observer: initial evaluation, after four and sixteen weeks. The following variables were analyzed: pain intensity, measured by analog visual scale (AVS), functional disability, measured by disability questionnaire of Roland and Morris and the spinal mobility measured by Schöber s method. In statistical analysis it was used variance analysis ANOVA, the test of Newman-Keuls multiple comparations, and the Pearson correlation coefficient, with significance level p<0.05. Thirteen patients (18,6%) didn t complete the evaluations, (5 from experimental group and 8 from control group). At last, 57 patients were studied, (29 from Experimental group and 28 from Control group), it was observed a significant statistical improve just for Experimental group in variables pain intensity (p=0,0001), functional disability

Abordagem dos aspectos psicológicos da mulher infértil :um estudo quali-quantitativo

Purpose: assess the frequency of stress and anxiety levels in infertile women, correlate these aspects with risk factors and qualitatively analyze feelings resultant from the inability to conceive, in order to obtain data for specific psychological guidance. Methods: the case-control study included a total of 302 women, 152 being infertile (case group: 30.3 ± 5.4 years), and 150 non-fertile (control group: 25.7 ± 7.9 years). The quantitative approach involved the application of Lipp s Stress Symptoms Inventory (LSSI) and State-Trait Anxiety Inventory (STAI), whereas the qualitative approach consisted of a semi-structured interview. Response variables considered were: stress frequency and anxiety scores (State and Trait). Statistical analysis compared frequencies and medians between groups, by means of qui-squared and Mann-Whitney tests, respectively, and constructed logistical regression models to test associations between response variables and risk factors considered. Qualitative data were analyzed descriptively and categorized in order to perform correspondence analysis. The level of significance was 5%. Results: in the study sample, stress frequency was higher in the case group than in the control(61.8 and 36.0%, respectively), however, significant differences were not observed between groups in relation to stress phases and predominant symptomology type. With respect to anxiety, there were no significant differences between case and control groups as to median state scores [39.5 (35.0 46.0) and 41.0 (35.7 47.0 ); respectively) and anxiety trait scores [44.0 (34.0 51.0) and 42.0 (36.0 49.2); respectively). Risk factors significantly associated with greater risk for high anxiety scores in the case group were: primary infertility, unawareness of the causal factor, diagnostic phase investigation, religion, lack of children from other marriages and the fact that the woman was previously married. The qualitative approach demonstrated that infertility provokes emotional responses, such as sadness, anxiety, anger, fear and guilt. Conclusions: it can be concluded that infertile women are more vulnerable to stress; however, they are capable of adapting to stressful events without serious physical or psychological compromising

Concentração da posse da terra e o programa nacional de crédito fundiário - uma análise para o estado do Rio Grande do Norte, 2006 - 2012

O objetivo do trabalho é propor um estudo sobre a relação do Programa Nacional de Crédito Fundiário - PNCF, no estado do Rio Grande do Norte, e sua concentração fundiária. Ou seja, se o PNCF está sendo direcionado, para as microrregiões que apresentam maior índice de concentração, de acordo com o índice de Gini, e se as áreas adquiridas através do crédito fundiário estão emergindo nestas microrregiões. Para isto, o estudo levantou a hipótese de que o PNCF no estado do Rio Grande do Norte não está sendo conduzida, de modo a reduzir a concentração fundiária, dentre as microrregiões do estado. Ou seja, não existe correlação entre o índice de Gini, da concentração fundiária, e as áreas adquiridas através do programa. Além disso, o trabalho buscou realizar uma discussão da literatura sobre os programas de reforma agrária assistida pelo mercado. Apresentando os autores que são exaltadores do modelo e das suas potencialidades, atrelando as causas dos problemas levantados como sendo de ordem técnica e operacional, onde os principais autores desta linha são: Van Zyl, Kirsten & Binswanger, (1996), Deininger & Binswanger, (1999). Têm-se também a apresentação da posição dos autores adeptos as políticas fundiárias pautadas na dinâmica e liberação dos mercados de terras, mas que visam contribuir com estudos que permitam uma redução para o custo elevado e a sua incapacidade de abarcar a esfera social, em decorrência do pagamento á vista e a preço de mercado aos donos das terras, são eles: De Janvry & Sadoulet (2002), Gordillo (2002), Banerjee (1999), Jaramillo (1998) e Burki & Perry (1997). Todavia, apresentou-se a corrente de autores que ressalta a natureza socialmente agressiva da Reforma Agrária Assistida pelo Mercado (RAAM), sendo os seus principais contribuidores: El-Ghonemy (2001); Barros, Schwartzman & Sauer (2003); Borras Jr. (2006, 2003 e 2003a); Garoz et al. (2005); Sauer & Pereira (2006); Pereira (2005, 2006 e 2010); Sauer (2010); Lahiff, Borras Jr. & Kay (2007). Em sequência, o trabalho apresentou a transição e características dos programas de acesso à terra, no Brasil, a partir da década de 1990, bem como, alguns indicadores do PNCF, no Brasil e o estado do Rio Grande do Norte. Apresentou-se também os indicadores da concentração fundiária, no Brasil e no estado. Através dos dados do Censo Agropecuário de 2006 foi possível calcular o índice de Gini da distribuição fundiária nas microrregiões no estado do Rio Grande do Norte. Com os dados fornecidos pela Secretaria de Estado de Assuntos Fundiários e de Apoio à Reforma Agrária - SEARA mostrou-se a distribuição das linhas de crédito do PNCF e as áreas adquiridas, entre os anos de 2006 e 2012. Por fim, o valor do coeficiente de correlação simples (r) igual a (0,2865), que com base no teste bilateral da distribuição de t de Student chegou-se no resultado para T calculado no valor de (1,2333), que ao ser comparado com o valor de T crítico igual a (2,898), com 17 graus de liberdade, a um nível de significância de 1%, pode aceitar a hipótese de partida, ou seja, que o PNCF não estava sendo direcionado para diminuir a concentração fundiária no estado

O Fundef e o Fundeb como política de financiamento para a valorização do magistério: efeitos na carreira e na remuneração dos professores da rede pública estadual de ensino do RN

Le présent étude analyse les effets de la politique de financement de l éducation de base, par les Fonds contables, Fundef et Fundeb, et sa proposition de valorisation de l enseignement, en considerant les dimensions de la carrière et de la rémunération des professeurs de l éducation publique de l état du Rio Grande do Norte, entre les années de 1996 et 2000. Pour comprendre les contraintes de l évaluation des politiques publiques, en cherchant aussi les contribution en Marx (1996) selon qui « le concret est concret » et que la dialétique du concret peut appuyer pour la tentative de capter le fenomène étudié. On a utilisé encore le référentiel bibliographique relatif au financement de l éducation et la valorisation de l enseignement à partir de la littérature reférente aux dimensions de l objet (Fundef et Fundeb) et (carrière et rémuneration). Dans la recherche documental, au-delà des législations, directrices nationales et locales pertinentes, se sont utilisés des donnés référents aux ressources, disponibles à la Finbra, Trésor National, SIOPE/RN, INEP/MEC, des informations du résumé de la feuille et feuille de payement du Secrétariat d État, de l Éducation et de la Culture (SEEC) et 289 bulletins de salaire de 21 professeurs. On a réalisé interview semi structurée avec une quantité de 9 professeurs, reférent à la carrière, et un questionaire appliqué à 12 professeurs relatif à la remuneration. On considère que sur les résultats reférents aux indicateurs éducationnel, dans la période Fundef il y a eu une réduction des inscriptions aux écoles de l état comme aussi aux fonctions des professeurs de l Enseignement Fondamental, et cela correspond à 37%. À partir de la vigence du Fondebe (2007 - 2010) ces indicateurs ont équalisé. Pendant toute la période, 1996 et 2010 il y a eu une augmentation des inscriptions de 119,03%, et aussi aux fonctions des professeurs de 77,44%. Par rapport aux informations de financement, on a constaté que, du minimum exigé (60%) sur l aplication des fonds à la rémuneration de l enseignant, on applique pour la période des deux fonds, plus que le minimum exigé, c est-à-dire de 83,29% à 98,89% des fonds. Les effets des fonds sur la carrière des 9 professeurs n ont pas été satisfactoires, si l on considère la promotion et la progression. Au cas de la promotion des 9 de ces professeurs, un seul a évolué son niveau (les titres) mais a, au même temps, rétroagit dans sa progression. Pour la progression des 9 professeurs, 8 d entre eux ont sa progression retardée, ce qui correspond à entre 2 et 5 classes, et ce qui provoque un préjudice qui varie entre 10% à 45% sur sa remunération. La différence d une classe à l autre correspond à 5% de son salaire. On évalue que les avantages financières contribuent pour la remunération avec un pourcentage plus élevé que son salaire, ce qui diminuent pendant lo Fundeb. Par rapport à la remunération un professeur de 24 ans de service avec formation, n arrive même pas à gagner 2 salaires minimums. Le professeur de 30 ans de service, maître, reçoit un salaire, en 2010, qui correspond a moins de 3 salaires minimums, c est-à-dire, une proportion de 2,82 et une remuneration qui correspond à un peu plus que 3 salaires minimums, c est-à-dire, une proportion de 3,66. L enseignement n est pas très favorisé si on le met face à d autres profession qui ont aussi l exigence de formation supérieure, ce qui provoque un effet négatif pour voir l enseignement comme profession. À propos des effets sur la rémuneration, on conclue qu il y a eu une amélioration mais encore insufisante, surtout si l on compare au Salaire Minimum annuel. On évalue que les fonds Fundef et Fundeb n ont pas été capables de promouvoir la valorisation de l enseignement dans le contexte de carrière et rémuneration. On observe quelques résultats négatif dans la politique de fonds, une fois qu il y aurait en avoir avec l incapacité de tel politique en promouvoir la dite valorisation de l enseignement, ce qui est une des causes, le financement avec des restriction budgétaire

Inclusão e deficiência: em busca das representações sociais na mídia impressa em Natal/RN

This thesis is the result of an extensive research on print media discourse on the inclusion of disabled people in society. Articles published in the newspapers Diário de Natal/O Poti and Tribuna do Norte from 1992 to 2002 have been analyzed. Beginning with the very same questions that moved Moscovici (1978) in his classic study La Psychalyse son image et son public , according to which the media play a predominant role in the formation and propagation of social representations as well as in the construction of human behaviors, we have chosen this mass media as our investigation field. Understanding the importance of the communication theory, we intend to associate it to the social representation theory, since communication, as an aspiration, relates to the fundamentals of all humanity (WOLTON, 2004, p. 56). Moreover, means of communication represent an important space for symbolic production and representational process, allowing the analysis of the circulating discourses on social inclusion and disability. Based on these questions, we have determined social representations present in print media on the subject to be our study object. This objective was elected due to the fact that the thematic of disability and inclusion is scarcely and sporadically found in journalistic speech. The research questions have been: which is the representation of disabled people s condition in print media? What changes have occurred during the analyzed period and which was the role played by print media in this process? The research corpus was composed of newspaper articles about various aspects concerning disability and of free word association by reporters. We have analysed: 1) graphical language promoted by the picture of the substances propagated in the period from 1992 a 2002; 2) free word association experiments carried out with reporters of both newspapers; and 3) texts published from 1996 to 1997 using the high-tech program ALCESTE (Contextual Lexical Analysis of a Set of Segments of Texts). The results revealed that the print media in Natal/RN refer to the topic in a discontinuous way, and depend on specific events to highlight disabled people s fight for their rights. Social inclusion is still a great challenge for these people in all levels. We believe that this incapacity to overcome all kinds of obstacles is established in a dialectic relation between society and the media: society remains silent (the manifestation of interest for the cause only attracts some people s or groups attention) and the media, which selects which information is to be broadcasted, gives no evidence to the issue. This representation may be noticed in the infrequency in which articles about the subject are published, as well as in the emphasis to sports, a more important issue for the media. An implication of this study is that a new perspective is opened for analysis and reflection: the Paralympics games as both an inclusive and a segregating social phenomenon. It would be beautiful to have all of us together!

Da negatividade a positividade: possível trânsito de saberes, práticas e representações sociais sobre o estigma da hanseníase

Leprosy is a chronic infectious-contagious disease, caused by Mycobacterium leprae, manifested by dermatological and neurological signs and symptoms and has great disabling power. It was marked by a strong stigma throughout its history, since its bearers represented a threat, target of fear and social contempt. Currently, leprosy has treatment and cure, and the need to separate the diseased from family and social environment is no more necessary. However, patients still suffer prejudice and discrimination. This study aimed to understand the social representations of leprosy that interfere modifying mental health of the patient with leprosy in relation to stigma and prejudice. This is a descriptive and exploratory study, with qualitative approach, which involved 22 users of the Special Care Clinic in Infectious Diseases at the Hospital Giselda Trigueiro, located in Natal / RN. They were in use of multidrug therapy in the period of data collection, were of both sexes, aged between 16 and 80 years of age and classified as paucibacillary or multibacillary. The study was approved by the UFRN Ethics in Research Committee. Data collection was performed by filling the questionnaire identification and then for conducting the semi-structured interview, which was recorded. After the end of data collection, there was the construction of tables and graphs, using the Microsoft Excel Start 2010 for proper characterization of the research subjects; and for the treatment of the data obtained from the interviews, was used the Content Analysis and based on the Theory of Social Representations. The subjects studied were mostly male (64%), married or in a stable relationship (68%), concentrated in the age group 50-60 years (36%) and 28-38 years (23%), had at most elementary education (65%) and were low-income (59%). Of the total respondents, 64% were classified as multibacillary, with predominantly dimorfous form, and 50% had disability grade I or II, with different periods of diagnosis. The reports originate two categories: 1. The negative meanings of illness and leprosy; and 2. The positive meanings of illness in leprosy, which were subsequently subdivided into subcategories. Thus, it was found that in the group studied, the social representation of leprosy experiences a moment of transition, as regards the understanding of the disease and its way of experiencing the disease process. Such representation is anchored in the quality of information on the disease of its bearers and aimed at an attempt to face the illness of leprosy as a "normal process". It was found in this study that the transition is due to the work of combating stigma and consequences of leprosy, which is able to gradually transform reality, both regarding the team work of reference, and in relation to a broader character, of actions of health education, which favors overcoming of psychosocial disabilities

Integridade tissular de pacientes com úlceras venosas: um estudo baseado na Classificação dos Resultados de Enfermagem

The venous ulcer is an epidemiological problem of high prevalence, causing disability and dependence. Assess the tissue impairment level of patients with venous lesions, within a nursing referential, is relevant for the implementation of a directed assistance to specific clientele. Thus, this work aims to characterize the health status regarding the integrity the lower limbs skin of patients with venous ulcers, according to the of tissue integrity outcome indicators from the Nursing Outcomes Classification. A cross-sectional study conducted in a university hospital in Natal - Rio Grande do Norte. The sample consisted of 50 participants, selected through consecutive sampling. Data collection occurred through a interview and physical examination form and a operational definitions tool for indicators of the nursing Tissue Integrity outcome directed to patients with venous ulcer, applied from February to June 2012. Data analysis was done by descriptive statistics and nonparametric tests (Spearman, Kruskal-Wallis and Mann-Whitney tests). The project was approved by the Research Ethics Committee with protocol 608/11 and Presentation Certificate to Ethical Consideration No. 0038.0.294.000-11. The results were presented using three scientific articles derivatives of research. It was found that the indicators show moderate impairment, light and not impaired, as the median. The respondents had an average of 59.72 years, 66% female, 50% were retired, 60% with a partner, 44% had arterial hypertension, 26% allergies, 20% diabetes mellitus, 96% were sedentary, 14% drank alcohol and 6% were smokers. There was a statistically significant correlation of low intensity between age and hydration (p=0.032; rs=-0.304) and skin desquamation (p=0.026; rs=-0.316), family income and necrosis (p=0.012; rs=-0.353); Ankle Brachial Index and tissue perfusion (p=0,044; rs=-0,329); Diabetes Mellitus and texture (p=0.015) and tissue perfusion (p=0.026); allergy and texture (p=0.034), physical activity and hydration (p=0.034), smoking and thickness (p=0.018), and alcohol consumption and exudate (p=0.045). We conclude that the patients had light to moderate impairment, indicating a good state of health on the integrity of the skin of the lower limbs, according to the indicators of the outcome of tissue integrity Classification Nursing Outcomes valued in the present study. It is believed that the evaluation of impairment tissue using a self-nursing system and its relation with socioeconomic, clinical and risk factors are unique tools in the care planning and in the wound healing