Marcadores nutricionais e inflamatórios e sua associação com a morbimortalidade em hemodiálise

Background: Malnutrition, inflammation and comorbidities are frequent in patients with chronic renal failure in hemodialysis (HD), contributing for morbidity and mortality. Aims: To evaluate the correlation between anthropometric, laboratory parameters, bioelectrical impedance (BIA) and inflammatory markers with the morbidity and mortality of patients in HD, as well as the impact of its alterations throughout 12 months. Methods: 143 patients of a dialysis facility in Northeast Brazil were evaluated throughout 18 months. Patients with more than 3 months on dialysis, older than 18 years, without amputation of hands and feet, were included in the study. We performed a clinical (subjective global assessment - SGA), anthropometric (BMI, percent of ideal weight, MAC, MAMC, MAMA, percent of fat mass and TSF), laboratory (albumin, creatinine, lymphocyte count as nutritional markers and CRP, IL-6 and TNF- as inflammatory markers) evaluation and BIA (reactance, phase angle and percent of body cell mass) at the beginning of study and after 3, 6 and 12 months of follow-up. The association between study variables and deaths and hospitalizations in 6 and 12 months was investigated. The variable with significance < 10% in the univariate analysis had been enclosed in a multivariate logistic regression analysis. We also investigated the risk of mortality and hospitalization associated with differences in measurements of the variables at baseline and six months later. Results: Patients were aged 52.2 ± 16.6 years on the average, 58% were male, and mean dialysis vintage was 5.27 ± 5.12 years. The prevalence of malnutrition varied from 7.7-63.6%, according to the nutritional marker. The variables associated with morbidity and mortality in 6 and 12 months had been creatinine ≤ 9.45 mg/dl, phase angle ≤ 4.57 degrees, BMI ≤ 23 kg/m2, age ≤ 64.9 years, reactance ≤ 51.7 ohms; Charlson´s index ≥ 4 and socioeconomic status ≤ 7. During six months of follow up, decrease in albumin was associated with significantly higher mortality risk. Conclusions: This study detected that the best predictors of morbidity and mortality between nutritional and inflammatory markers are phase angle, reactance, creatinine and BMI and that changes in albumin values over six 107 months provide additional prognostic information. The authors believe that parameters of BIA may detect early changes in nutritional status and emphasize that longitudinal studies with larger number of patients are necessary to confirm these data and to recommend BIA as a routine nutritional evaluation in HD patients

O corpo como matriz pedagógica

The contemporary conjuncture based on the capitalistic knowledge converges to the corporal consciousness that makes us see, feel, taste and hear, be in/to pieces. Disembodied reason legitimate and legislate ways of being and living socially and its development is the dehumanization of human relations causing pain and suffering. The objective of this work is to discuss the body as pedagogical matrix through imagistic/artistic elements: music, painting and literature. Metaphors lead to self knowledge of human subjectivity and approach us to the kaleidoscope of sensitive knowledge and enables learning to learn with the infinite combinations of images, knowledge, feelings and worldviews. The song Memória da Pele comes in the voice of Maria Betânia speak of the memories that are not mine, but are tattooed in me in the memory of skin, singing the memories of a love lived by who tries to forget rationally, but the body insists on remembering. It is password to think about what we are. The short story by Clarice Lispector, entitled Miss Algarve, narrates the life story of an unmarried and virgin woman, and her encounter with an alien called Ixtlan. Until then, she who lived as if every day were a Monday, found herself seduced by the pleasure of having a body in contact with another body, which also allowed her to give visibility to the bodies of others. She had repudiation by the immorality that her body and the other s perspired. The discovery of the body brings important lessons for nursing, involving our body and the others'. The painting the flying bed or Henry Ford Hospital, by Frida Kahlo, is our final metaphor. The traumatic experience of abortion is shown in this painting trough the picture of the artist naked in a hospital bed. This painting invites us to reflect on our work process. We need to think in multiple dimensions of the being and accept the invitation of art, so that the lightness confronts us with the weight imposed by the hegemonic ideology. I believe it is not a single view, but the many views that should justify the knowledge and practices of nursing; what matters is that they are woven into the dialogue, democracy, provided that protagonism of those individuals involved in this process, in the wandering and uncertainty, in the rewiring, solidarity, plurality. To this end, the body must be the great pedagogue that is able to be viewed not as a tapestry seen by the right view, as the logical knowledge sees, but seen by the opposite side in its singular, irregular, discontinuous weavings

Trajetória de profissionais da saúde de um hospital colônia para hanseníase

Leprosy as a public health problem , there is still quite some time , even with treatment for decades . Your health-disease process is marked by a historical backdrop of stigma , prejudice, social exclusion and authoritarian decisionducts , in order to extinguish the disease milieu under the regime of compulsory confinement of the patient. In this perspective , the Brazilian public health twentieth century adopted policies of compulsory isolation , which meant that those who receive a diagnosis of leprosy were isolated from society and their families in hospitals colonies . Objective is, to the study, rescue the trajectory of health professionals in the Colony Hospital St. Francis of Assisi , in Natal / RN ; Identify the policy was perceived as compulsory institutionalization imposed for leprosy patients by health professionals ; describe the behaviors Professional Hospital adopted in Cologne ; Retrieve information about the existence and functioning of the Hospital and Create a documentary of historical fragments of leprosy from the point of view of professionals from a former colony. Exploratory - descriptive method with a qualitative approach , using the methodological framework thematic oral history was used . Obtained approval by the IRB of the Federal University of Rio Grande do Norte, under Protocol No 461 403 and CAAE 19476913.9.0000.5537 . Be interviewed during the period of November and December 2013 , five health professionals who worked in the hospital colony , using audio recorder and images to capture and record the statements. The interviews were transcribed , textualized, transcriadas and sent to reviewers to step conference of the reports. Subsequently , analysis of the stories was made from the proposed content analysis of Bardin . The results and discussion are presented in the form of article: Opinion of nursing professionals who worked in a hospital for leprosy colony , which aimed to : identify the opinion of nurses who worked in hospital colony on the lives of patients . In this article, three main themes were highlighted and discussed from the reports of colaboradoes : I - The socialization process of internal II - 16 Prejudice , stigma and discrimination III - Social exclusion versus inclusion . We conclude that , in the context of the colony hospital, the performance of health professionals contributed significantly to that stigma , prejudice and social exclusion would be minimized and that the experience of asylum seekers in the colony were not seen more traumatic

CAD e engenharia reversa como ferramentas de auxílio na fabricação de cartuchos para próteses ortopédicas

The manufacturing of above and below-knee prosthesis starts by taking surfac measurements of the patient s residual limb. This demands the making of a cartridg with appropriate fitting and customized to the profile of each patient. The traditiona process in public hospitals in Brazil begins with the completion of a record file (according to law nº388, of July 28, 1999 by the ministry of the health) for obtaining o the prosthesis, where it is identified the amputation level, equipment type, fitting type material, measures etc. Nowadays, that work is covered by the Brazilian Nationa Health Service (SUS) and is accomplished in a manual way being used commo measuring tapes characterizing a quite rudimentary, handmade work and without an accuracy.In this dissertation it is presented the development of a computer integrate tool that it include CAD theory, for visualization of both above and below-knee prosthesis in 3D (i.e. OrtoCAD), as well as, the design and the construction a low cos electro-mechanic 3D scanner (EMS). This apparatus is capable to automatically obtain geometric information of the stump or of the healthy leg while ensuring smalle uncertainty degree for all measurements. The methodology is based on reverse engineering concepts so that the EMS output is fed into the above mentioned academi CAD software in charge of the 3D computer graphics reconstruction of the residualimb s negative plaster cast or even the healthy leg s mirror image. The obtained results demonstrate that the proposed model is valid, because it allows the structura analysis to be performed based on the requested loads, boundary conditions, material chosen and wall thickness. Furthermore it allows the manufacturing of a prosthesis cartridge meeting high accuracy engineering patterns with consequent improvement in the quality of the overall production process

Desenvolvimento de métodos construtivos e de novos materiais empregados na confecção de cartuchos de próteses de membros inferiores

The manufacture of prostheses for lower limb amputees (transfemural and transtibial) requires the preparation of a cartridge with appropriate and custom fit to the profile of each patient. The traditional process to the patients, mainly in public hospitals in Brazil, begins with the completion of a form where types of equipment, plugins, measures, levels of amputation etc. are identified. Currently, such work is carried out manually using a common metric tape and caliper of wood to take the measures of the stump, featuring a very rudimentary, and with a high degree of uncertainty geometry of the final product. To address this problem, it was necessary to act in two simultaneously and correlated directions. Originally, it was developed an integrated tool for viewing 3D CAD for transfemoral types of prostheses and transtibial called OrtoCAD I. At the same time, it was necessary to design and build a reader Mechanical equipment (sort of three-dimensional scanner simplified) able to obtain, automatically and with accuracy, the geometric information of either of the stump or the healthy leg. The methodology includes the application of concepts of reverse engineering to computationally generate the representation of the stump and/or the reverse image of the healthy member. The materials used in the manufacturing of prostheses nor always obey to a technical scientific criteria, because, if by one way it meets the criteria of resistance, by the other, it brings serious problems mainly due to excess of weight. This causes to the user various disorders due to lack of conformity. That problem was addressed with the creation of a hybrid composite material for the manufacture of cartridges of prostheses. Using the Reader Fitter and OrtoCAD, the new composite material, which aggregates the mechanical properties of strength and rigidity on important parameters such as low weight and low cost, it can be defined in its better way. Besides, it brings a reduction of up steps in the current processes of manufacturing or even the feasibility of using new processes, in the industries, in order to obtain the prostheses. In this sense, the hybridization of the composite with the combination of natural and synthetic fibers can be a viable solution to the challenges offered above

Atividade do professor na educação a distância: interações com o gênero profissional docente

This research aimed to analyze the dynamics established between the activity of the teacher in Distance Education (DE) and professional gender of teaching, in terms of impact of DE in teacher s usual professional activity. Previous studies showed that one of the central discussions concerning DE refers to the role that the teacher is called to perform. The present research, based on theoretical and methodological assumptions issued from Clinic of Activity, analyzed the impact referred above. This central aim was operationally executed along three main stages: 1) survey study for description of socio-professional profile of teachers working in DE in two universities from Natal (RN-Brazil), 2) clinical analysis of professional activity of teachers working in DE, taking into account four simultaneous levels of psychological constitution and development of human activity: personal, interpersonal, transpersonal and impersonal; 3) analytical focus on transpersonal context in order to understand the influence of pedagogical practice in DE on professional gender of teaching. Documental research, audio recorded voice data and a multiple choice Likert scale questionnaire concerning socio-professional information were used as procedural tools. The qualitative-clinical procedural tool of instruction to the double , firstly proposed by Clinic of Activity research group, was used in order to obtain oral productions concerning professional activity. Data issued from stage 1 (n=70, 28 men and 41 women) was submitted to descriptive and inferential statistical analyzes. 65.7% of the sample worked in a public institution, 30% in a private institution, and 4.3% in public and private institutions. 31.4% of the sample of participants was formed by teachers having a master degree, 28.6% were doctors and 26.3% had degrees of specialists. 54.3% of participants acted as remote tutor, and 44.3% were regents teachers. After descriptive multidimensional cluster analysis, two groups emerged (remote tutors and regents teachers), the most important variables in terms of contributions to this distinction being: professional function, level of graduate formation, level of income, activities and forms of entry in DE. Clinical analysis of data produced by two participant-teachers of each group, issued from instruction to the double technique, was performed. This analysis indicated the existence of different models of distance education. A general concern referring to the need of both taking into account information technology and pedagogical attitudes was detected. On the other hand, participant-teachers considered that participation in DE activities could bring relevant contributions to general professional gender of teaching. . Finally, teachers warned against certain formats of organization of teachers professional activity, as found in the domain of DE, since these activities could promote the intensification and individualization of teachers` work activity, and even the worsening of relations, rather than exchanges and shares through collective bargaining. This process could compromise the renew of the professional gender, by losing its historical roots and diminishing activity possibilities of teachers in their labor context