Estudo representacional da participação familiar nas atividades dos centros de atenção psicossocial no município de Natal-RN

Comprehending social representations of users relatives of Psychosocial Care Centers (CAPS) from Natal-RN, about their participation in the activities of these services, was the purpose of this study. The research instrument used was a semi-structured interview, led to 28 relatives of users of East and West CAPS II, East and North CAPS-ad, involved in the Relative Therapeutic Group, in Relative Meeting, in the Assembly of Users, Technicians and Relatives, according to the therapeutic schedule of each health services, between August to November 2007. Data obtained in family and users identification were characterized with the aid of charts and boards in absolute and/or percentage values. The discursive material from the guide from interviews was submitted to the informational resource ALCESTE (Analyse Lexicale par Contexte d'un Ensemble of Segments of Texte), and analyzed on the basis of the Theory of Social Representations and Central Nucleus Theory. Most of the relatives were women, married, aged over 50 years, who participated for more than two years in CAPS activities, and a coexistence of more than 11 years with the user. From the classification system of ALCESTE were selected categories, identified by: Category 1, Treatment Improvements and Expectations; Category 2, Living User Before and After; Category 3, Activities Relevance, Contradictions and Suggestions; Category 4, Guidelines -- Psychopharmacology and Medicalization; Category 5, Family Participation and Activities; and Category 6, Therapeutic Conditions Thanks, Tips and Vulnerability. The social representation of the family exists in the desire for change, identifying that we need to promote change by the continuity of therapeutic activities and overcome the detected inconsistencies, targeted by strengthening and by the stability of improvements in living and health conditions of users, experienced in CAPS treatment. The central nucleus had corresponded to positive changes in health and living conditions of users, and the peripheral elements were constituted by family conducts before and during treatment, and the expectations of changes in activities, especially in workshops. Despite this family participation be considered important, it still does not meet conditions to promote the inclusion of family, under an emancipating point of view, capable of causing in subject the hope for autonomy, initiative, individual and collective growths, a closer and active involvement in therapeutic activities, in workshops and discussions

As ações de controle da tuberculose na atenção primária à saúde: a visão do doente

Tuberculosis is a disease of great impact on the world context today. In Brazil, the disease management was directed to the Primary Health Care, due to the determination of the Ministry of Health to decentralize health actions for primary care. Thus, since the actions of diagnosis, treatment and control of the disease should happen in this context, however, there are still many barriers that may hinder the realization of these determinations. This study aims to analyze the development of tuberculosis control activities conducted in the services of primary health care from the patient's vision. This is a descriptive, cross-sectional and quantitative study. The population consists of 517 tuberculosis patients treated in units of Primary Health Care in the city of Natal-RN; the sample consists of 93 TB patients. The collect instrument is structured, based in The Primary Care Assessment Tool (PCAT), validated in Brazil and adapted to assess attention to TB in Brazil, with modifications. This instrument was divided into blocks: the first one describes the socio-demographic information of patients with TB and the second one describes the health services working in control, diagnosis and treatment of TB, and includes issues related to the dimensions of primary care: access, bond, services, coordination of care, guidance to the community and family focus. For quantitative analysis, were built indicators for each item of the instrument. The response patterns are followed according to the Likert scale, which was assigned a value between one and five meant that the degree of preference relation (or agreement) of the statements. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. The results indicate that 62.37% of patients are male, 27.96% aged 41 to 50 years old, and 34.41% unemployed, with low education and low family income. It was found that the reference hospital services are the front door to the patient (59.14%), and are also the local diagnosis of the disease (72.04%). On access, the conditions satisfactory found are: the number of times the patients need to pick up the health care issue, the marking and the facility to get a consultancy in the HS, assistance provided without harm to the individual's attendance labor and facilities related to the proximity between the residence and services; were considered unsatisfactory conditions related to travel to the HS, and on hours and days of operation of services. As for the cast of services were satisfactory and regular actions related to the request for examination to become viable in the first HS, the availability of pot to perform smear and medicines for the treatment, as well as consultations control and receiving information about the disease and the treatment performed; it is considered unsatisfactory the performance of the home care for patients with TB by the HS that acts as a front door, for implementation of the Directly Observed Treatment (DOT), home visits during treatment, the provision of transportation allowance to the patient and the existence of groups for TB patients. Regarding the coordination of care, resulted in regular the action of referring the patient to other HS to obtain examinations, and as unsatisfactory referral to obtain medications. The relationship bond between patient and health team were considered satisfactory in the majority or regular. As for the family and community focus, is satisfactory only the indicator relating to questions from professionals to the patient about the existence of respiratory symptoms in the family. It is considered that there is need for greater commitment from government entities to the incentives required to TB control, as well as the availability of necessary inputs and training of human resources working in the PHC in the ongoing quest to strengthen primary care, as a place of broader host needs to contact the user with the actions and health professionals. It is recommended the adoption of management mechanisms possible to expand the capacity of the health PHC, promoting the service delivery to the user and ensuring attention to population health.

Estágio menopausal e níveis hormonais no desenvolvimento muscular e funcional em mulheres de meia idade: um estudo transversal

Introduction: Hypoestrogenism is the main characteristic of female aging. It promotes significant changes in body composition, both in fat mass as in lean body mass, leading to a decrease in muscle strength and physical performance. Objective: The aim of this study was to test whether menopausal status and hormone levels are associated with muscular strength and physical performance in middle-aged women. Methods: In a cross-sectional study it was collected sociodemographic data, gynecological history, anthropometric and biochemical measures in women aged 40 to 65 years in Parnamirim-RN. The menopause status (pre, peri and post menopause) was determined by menstrual history. All women underwent three dimensions of physical performance assessment: handgrip dynamometry, gait speed and chair stands test - Short Physical Performance Battery (SPPB). Categorical data were presented as absolute and relative frequencies. Quantitative data were showed as mean and standard deviation and the normality of distribution was verified with Kolmogorov-Smirnov (KS) test. Biochemical measures of estradiol and follicle-stimulating hormone (FSH) were transformed to log10. ANOVA with Tukey post-test for comparison of variables between the groups pre, peri and post-menopausal was performed and then multiple linear regression analyzes. Results: Two hundred and seventy eight women aged 50.2 (±5.58) years composed this study, being 50 women in premenopausal status (18%), 122 in perimenopausal (43.9%), and 106 postmenopausal stage (38.1%). The groups were different in age (p=0.001), marital relationship duration (p <0.001), number of pregnancies (p=0.001) and parity (p=0.001). Differences in biochemical measures were observed among the groups: estradiol (p<0.001), FSH (p<0.001), total cholesterol (p=0.001). There were no differences in gait velocity between menopausal status. Values in mean of grip strength decreased by postmenopausal women to perimenopausal and premenopausal ones (24.5 ± 5.1, 25.6 ± 5.4, 26.9 ± 4.9 for post-stage, pre and peri menopausas, respectively, p = 0.02) and the performance of chair stands test was better in premenopausal women compared with that in peri and postmenopausal status (p = 0.02). In multiple linear regression for muscle strength, the variables that remained were: age, estradiol and somatic symptoms measured by Menopause Rating Scale-MRS (R2=0.15). While for the xiv chair-stands test the predictors were number of births and FSH values (R2=0.04). Conclusion: There is a relationship between the stages of menopause and muscle performance in measures of grip strength and sit-up test and these are influenced by the fall of estrogens levels. Data suggest that the decrease in muscle strength and physical performance already appear in the transition to menopause stage, pointing to the need for more research in this area and appropriate preventive interventions

Centros de especialidades odontológicas: avaliação da atenção de média complexidade na rede pública da Grande Natal

The Specialized Dental Care Centers (CEO) were developed to provide specialized dental care to the population, given the accumulated needs of health since the past. They must operate as units of reference for the Oral Health Team of the Primary Care, complementing the dental procedures performed at this level of attention. This study aims to assess the performance of CEOs of the Grande Natal Health Region as a strategy of Secondary Care consolidation in oral health through users, dentists and managers. For this to try to identify factors about access, hosting and satisfaction with the service, the actions developed in these centers, integration between the CEOs and the Basic Health Units (UBS), considering the reference and counter reference. Data were collected through semi-structured interview, conducted in four CEOs, among 253 users, 31 dentists and 4 managers. It was submitted to descriptive statistical analysis and to content analysis by software ALCESTE 4.5. The results revealed that the specialties of prosthesis, endodontics and surgery were the most sought by 38.2%, 23.7% and 21.7% of respondents, respectively. It was noticed that among users aged 18 to 30 years-old the greatest demand is for the specialty of endodontics (44.4%) and over 50 years for prosthesis (76.4%). There is a weakness in the reference and counter reference between UBS and CEO, because part of users goes directly to the centers without going before to the Primary Care and the majority does not want to return to the dentist of Health Unit. Satisfaction with care was reported by 90.9% of users, because they resolved the problems needed and were welcomed by the team. But the delay in care was the main factor for not satisfaction. For most dentists, some users could solve their problems completely in Primary Care, which shows the existence of unnecessary referrals to the CEOs, however they consider the existence of limiting factors in UBS that compromise the service. Most dentists revealed that some users do not get to CEOs with the basic dental treatment done, and some of them do not counter reference users. It can be concluded that the studied CEOs are being resolutive for those who access them, offering necessary care for the population, and if they don t account with this service, will encounter obstacles to resolution of problems, ranging seek care service in particular, in another public sector, or even giving up treatment. However, it is perceived the need of professionals training to understand the importance of the reference and counter reference, to that they can better serve and guide users. It is also important that cities offer better conditions to UBS and CEOs, so they can work together, with complementary actions of oral health, seeking full care, aiming for better resolution to the users' health problems

Disfunção sexual feminina e níveis dos hormônios esteroidais em mulheres obesas atendidas no ambulatório de cirurgia bariátrica do hospital universitário Onofre Lopes em Natal/RN

A disfunção sexual corresponde a alterações em uma ou mais fases da resposta sexual humana e apresenta maior prevalência na população feminina. Ademais, a participação de alguns fatores como obesidade e níveis dos hormônios esteroidais na disfunção sexual feminina (DSF) permanece incerta. O presente estudo deteve-se na análise da ocorrência de DSF numa população de mulheres portadoras de obesidade, cadastradas no Ambulatório de Cirurgia Bariátrica do Hospital Universitário Onofre Lopes, da Universidade Federal do Rio Grande do Norte, no município de Natal, RN. O estudo foi realizado em uma amostra composta por trinta e uma mulheres, com idade entre 20 e 50 anos, com índice de massa corpórea (IMC) > 30 Kg/m2. A todas as pacientes foi aplicado um questionário composto por uma seção com dados socio-econômicos, e outra abordando a saúde sexual feminina, sendo esta última correspondente ao Female Sexual Function Index (FSFI), para diagnóstico de DSF. A partir dessa caracterização, as pacientes foram reunidas nos grupos CD (pacientes com disfunção, n= 9) e SD (sem disfunção, n= 22). Para a análise do efeito da obesidade na DSF, as pacientes foram reunidas nos grupos 1 (6 pacientes com IMC grau I e II: entre 30 e 40 Kg/m2) e 2 (25 com IMC grau III: acima de 40). Para o estudo da participação dos hormônios esteroidais foram determinadas as concentrações séricas de cortisol, estradiol e dehidroepiandrosterona (DHEA) pelo método de quimiluminescência. A análise estatística dos dados foi realizada usando os testes ANOVA, MANOVA (Pillai), além de análise de Cluster. Para identificar as diferenças entre os domínios do FSFI, foi usado o teste T de Student. A significância considerada para todos os testes foi para p< 0,01. Das pacientes estudadas, 25,8% apresentaram DSF de acordo com o escore total do FSFI. A análise estatística posterior evidenciou que as diferenças ocorreram para os domínios desejo, excitação e orgasmo. Não foi encontrada relação da presença de DSF com os diferentes graus de obesidade ou com os níveis hormonais dos esteróides cortisol, estradiol ou DHEA. Contudo, foi encontrado aumento significativo nos níveis séricos de estradiol para o grupo 1, que corresponde ao de menor índice de IMC. Estes resultados mostram que a prevalência de DSF não diferiu entre os graus I,II e III de obesidade das pacientes deste estudo mas, quando presente, a disfunção ocorre nos domínios desejo, excitação e orgasmo. A maior concentração de estradiol encontrada nas pacientes de menor índice de IMC sugere uma possível relação entre as duas variáveis que precisa ser investigada em estudos futuros.

Perfis e práticas dos profissionais de saúde mental em dois hospitais psiquiátricos de grande porte

In the Brazilian network of psychosocial care, health professionals are important actors in the process of transformation of mental health public policies among various services. In the reality of psychiatric hospitals, one should understand the need to expand the debate about the current context of practices developed. This study aimed at analyzing the process of psychiatric reform and the mental health policy in the State of Rio Grande do Norte (RN) from the profiles and practices of higher-level professionals in two psychiatric hospitals. This is a cross-sectional and descriptive research, with quantitative and qualitative data, conducted in two psychiatric hospitals of RN. The universe of the target population was 95 professionals, taking into account the margin of error of 8%, non-response rate and the inclusion criteria: holding effective link with the institution by means of approval in public examination for, at least, six months, being state or municipal servant; having a minimum weekly workload of 20 hours in service; participating in care and/or activities with patients and families in a direct way. The final sample consisted of 60 professionals. The tool for data collection was a questionnaire with closed and semi-open questions about socioeconomic profile, and mental health policies, practices and training. Quantitative data were tabulated in the statistical software SPSS, and simple and bivariate statistics, chi-square type, was used for analysis by adopting the significance level with the value p<0,05. In order to analyze data, the content analysis of Bardin was used. The qualitative findings obtained with the semi-open questions in Analyse Lexicale par Context d'un Ensemble de Segments de Texte (ALCESTE) were grouped into four thematic axes: Professional action in mental health; Mental health training; Scenarios of psychiatric reform and psychiatric hospitals; Mental health policies and practices: challenges for professionals in hospitals. The profile of professionals has revealed the majority of women (89,7%), nurses (36,7%), aged 50-59 years (42,9%), weekly workload of 40 hours (52,4% ), time of completion of graduation from six to 15 years (57%), and 21,4% reported to have specialization in mental health. Regarding the practices developed in individual care, it was found an association between those who do not build or partially conducts the therapeutic project and those who conduct care related to observation and annotation. In family care, it was obtained care consultation during crisis; and, in group care, recreational activities. In the analysis of thematic axes, it was noted that, despite changes identified in the profiles and practices of higher-level professionals in care services for mental health, with the implementation of new public policies for this field, the findings indicate the confluence of asymmetries and divergences in the actions of the teams in psychiatric hospitals, difficulties in managing services, frequent readmissions, reduced quantitative of available services and equipment, high demand of users, disarticulation of the network of psychosocial care, and the very shortage of skilled human resources to compose these services. Accordingly, the evidenced scenarios partially outline the current political and ideological mismatch of the national process of psychiatric reform that denies the role of care actions conducted within hospitals, although it has not gone far enough with the creation of new services that justify the total extinction of this institution

Transplantes de córneas no estado do Rio Grande do Norte: aspectos epidemiológicos e clínicos

This study aimed to characterize in a clinical and epidemiological way the patients who are on a waiting list for transplantation and the patients transplanted with corneal tissue in a corneal transplants reference service in the state of Rio Grande do Norte. It is an epidemiological study of a quantitative approach, with cross-sectional, descriptive and analytical cut including all patients on the waiting list for transplantation (population A) and the patients already transplanted with a corneal tissue (population B) in a reference service. In population A, there was a census conducted of patients on the waiting list for corneal transplantation (n=62 patients). In population B, the sample was non-probabilistic and corresponded to all corneal transplants performed in the service in the period from 2010 to 2014 (n=258). This study is approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte, in Opinion 876 177 and CAAE 37533014.8.0000.5537. Data were collected in full in the period from January to April 2015, by two instruments built to systematize the necessary data collection. After being coded and tabulated, data were analyzed using the Statistical Package for Social Sciences software, version 20.0. The definition of variables and their distribution patterns were presented as frequencies and measures of central tendency while, for multivariate analysis, the effect of magnitude measures were applied (prevalence ratio) and measures of association (chi-square test or Fisher's exact test) for a 0.05 significance level. The results are shown in two scientific articles coming from the field survey data. It was found that the epidemiological profile of patients on the waiting list (n=62) showed a prevalence of individuals aged over 50 years old, female (54.84%) and residents of the middle region of East Rio Grande do Norte (66.13%). The clinical profile of patients with corneal transplantation (n=258) was characterized by being male (51.16%) with an average age of 49.33 years old and 57.75% were coming from East Rio Grande do Norte. The average time on the waiting list was 172.63 days in elective transplants and 9.03 days in urgent transplants. Keratoconus was the main indicator condition to perform the transplant. For patients on the waiting list, the variable “type of disorder of the cornea” showed statistically significant association with gender and age. For patients with corneal transplants, the variable "type of disorder of the cornea" was associated with the variables gender, age, previous surgery, failure of previous graft, classification of the eye and glaucoma. By characterizing the clinical and epidemiological profile of corneal transplants, it is possible to question the reality, pointing about the care that should be offered and develop targeted interventions to collective and individual needs intrinsic to patients who need this surgery as a treatment option.

Expressão imuno-histoquímica das proteínas E-Caderina e BCL2 e nevos melanociticos orais e cutâneos

Melanocytic nevi (MNs) are benign melanocytic proliferations of cells, which can be found in the skin and mucous coat, including the oral mucosa. However, skin NMs are more common when compared to those that affect the oral mucosa. The molecular mechanisms involved in the development of nevi and the factors that can influence the migration pattern of the nevus cells are little explored. The aim of this study was to analyze the immunohistochemical expression of E-cadherin protein and Bcl-2 in oral / skin NMs and relate them to the clinical characteristics (gender, age, location, exposure to solar radiation) and histopathological types. 36 cases of oral NMs and 34 Skin NMs were analyzed. The immunohistochemistry was used of the protein E-cadherin and bcl-2, which were analyzed the intensity (weak, moderate and strong) and distribution marking (diffuse and focal). The immunoreactivity also analyzed as to the types of nevus cells (epithelioid cells -A, -B lymphocyte and fibroblast-like -C). Statistical analysis was performed using the chi-square tests of Pearson and Spearman correlation with significance level set at 5%. Of the 70 cases of NMs, 82.9% were female, 48.6% aged 26-50 years, 51.4% were diagnosed histologically as intradermal / intramucosal nevi and 80% were NMs acquired. Immunohistochemical expression of BCL2 and E-cadherin were variables in the sample and showed no association with clinical parameters. The expression of bcl-2 and E-cadherin were variable according to the types of nevus cells (A, B and C) (P = 0.001). The expression of bcl-2 was more diffuse in congenital MNs (p = 0.002). E-cadherin was positive in 83.3% of MNs <1cm (p = 0.001) and exhibited weak staining in 73.9% of MNs that were in exposed areas (p = 0.010). Based on these results, it is suggested that the E-cadherin has a modulating effect on the migratory properties of NMs, and bcl-2 is a marker of MNs with increased proliferative capacity.

Aids em idosos no Brasil no período de 2000 a 2012: uma análise de série temporal e dos fatores contextuais associados

The characteristics profile of individuals who develop AIDS in Brazil has changed over time. Among these modifications, a worrying finding is the increased incidence of AIDS in the elderly across the country. But, however, is not yet clear whether the increase in AIDS cases is sufficient to produce a change in the trend of measures in recent years in the Brazilian states, and this increase has an effect from the socioeconomic and demographic indicators. In this sense, the objective of this study is to analyze the AIDS incidence rates among the elderly in Brazil and its effect on socioeconomic and demographic inequalities in the period 2000 to 2012. This is an ecological time-series study to meet behavior of the time series of the incidence rates of AIDS in the elderly from 2000 to 2012. the rates were calculated using the secondary data from Diseases Information System Notification and the Brazilian Institute of Geography and Statistics. Data were analyzed statistically to know the trends in incidence rates, by polynomial regression model and joinpoint log-linear regression model, but also the simple linear regression analysis to find the relationship of trends with variables socioeconomic and demographic. SPSS 20.0® and Joinpoint 4.1.1 programs were used. All tests were carried out considering a significance of 5%. After the analysis, in Brazil were reported 62,052 new cases of AIDS in the elderly from 2000 to 2012. During this period, a significant increase was found for males, both aged 50-59 years (APPC: 3.46 %, p <0.001), such as above 59 years (AAPC: 4.38%; p <0.001). For females, the increase was significant and has the largest increments in the time series, when compared to males in both age groups (AAPC: 4.62%, p <0.001 and AAPC: 6.53%; p <0.001) respectively. The largest increases are observed in women and in the states of North and Northeast. In the Southeast Region is observed stabilization of rates throughout the series. The reason of trends between the sexes had a significant reduction, but also an approach in both age groups of the study, reaching a ratio of 1.7 males for every female in the youngest age group. The trends were related to illiteracy rates, with increasing social inequality and the lowest human development in the Brazilian states. We conclude that in Brazil the incidence of AIDS in the elderly follows an increasing trend in individuals over 50 years. Noteworthy are the highest rates of study in women and in the states of North and Northeast. In this sense, the country needs to enhance policies towards older people with STD / AIDS, training health professionals and developing effective measures for the prevention and early diagnosis of infected people, especially in places with limited resources and high social inequality. In the long term, it is developing new studies to understand whether the measures taken were effective in reducing the trends identified in this study.