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

Farmacêuticos e suas atividades em farmácias comunitárias: uma análise de perfil

The aim of this study was to establish the profile of the pharmacist technician responsible for community pharmacies in the city of Natal/RN, featuring personal elements, perceived their role and place of pharmaceutical care, levels of job satisfaction, type and quality of services provided in human and structural framework. To that end, we made an exploratory cross-sectional study applying a questionnaire containing open and closed questions, which was applied to pharmaceutical technicians responsible for community pharmacies in Natal/RN, from September 2010 to September 2011. The sample was established by calculating the simple random sample, with a confidence level of 95% and a significance level of 0.05. To evaluate the satisfaction level of the activities performed by pharmacists in community pharmacies was used Simple Satisfaction Scale (Likert, 1935). To assess the attitudes and perceptions of pharmacists in relation to aspects of pharmaceutical care, we used the Model Attitude toward the object (Fishbein, Ajzen, 1975). The answers were converted into data were analyzed statistically using Epi Info 3.5.2 The results showed that the strengths and weaknesses in relation to the profile of the pharmacist and their activities in community pharmacies in Natal/RN are not different in other cities in the country . The most important aspects were: 51% (n = 90) of the establishments visited, the pharmacist was absent; 46% (n = 80) did not have postgraduate and of those who are or have completed 33% (n = 51) are in the area of Clinical Analysis; 56% (n = 98) 08h for day work and 64% (n = 111) claim that this load influence its performance; 83% (n = 146) receive as salary, the floor pharmacist regarding the state of Rio Grande do Norte; 44% (n = 76) are unhappy about the salary, which is the main difficulty cited; 78% (n = 136) say they are always sought by users and the receptivity of these considered good (52%, n = 91). The activities of higher satisfaction are those related to pharmaceutical care and lower the administrative. As regards attitudes and perceptions, the score was more negative to the question 'if the pharmacist feels working as a team with the doctor', in which 59% (n = 103) responded 'never'. 49% (n = 86) reported being "able" to take questions from users and 39% (n = 68) are 'dissatisfied' with respect to the structure of the practice of pharmacy to pharmaceutical care. Action is needed on the obstacles to the exercise of the pharmacist in the solution and minimize the negative and positive stimulus to

Organizações comunitárias e movimentos sociais : conflitos e tensões nos espaços de participação do município de Natal

This study reflects on the conflicts that exist between the different forms of participation and the political representation manifested by community organizations and social movements in the city of Natal/RN. The objective is to better understand the process of political participation of the popular classes and how the different actors have represented collective demands in the struggle for rights. To this end, we mapped the organizations, social movements and participation spaces, through a type of participant research, in which we had the opportunity to experience and study different forms of collective action and events instigated by the community organizations and the Movement for the Struggle in the Neighborhoods, Villages and Slums (Movimento de Luta nos Bairros, Vilas e Favelas) MLB. From the theoretical contributions of authors such as Maria da Glória Gohn, Marco Aurélio Nogueira, Virginia Fontes, Vera da Silva Telles, Roberto Da Matta and Carlos Montaño, as well as the empirical data collected, the study revealed that on representing their segments and occupying different spaces of participation, some actors have formed partnerships with the State, putting collective demands on a second plane. Contrarily, other actors have articulated their struggle around collective demands and manifested through direct action, mobilizing and asserting themselves in defense of a project for society

A descentralização das políticas de desenvolvimento rural: uma análise da experiência do Rio Grande do Norte

MATOS FILHO, João. A descentralização das Políticas de desenvolvimento rural - uma análise da experiência do Rio Grande do Norte. 2002. 259f. Tese (Doutorado em Ciências Econômicas)– Instituto de Economia da Universidade Estadual de Campinas, Campinas, 2002.

Caracterização fenotípica e genotípica de Staphylococcus aureus resistentes à meticilina isolados na cidade do Natal/RN

Staphylococcus aureus resistente à meticilina (MRSA) é um dos principais agentes de infecções associadas a serviços de saúde em todo o mundo. No Brasil, há a predominância de um clone de MRSA multirresistente denominando clone epidêmico brasileiro (CEB). Entretanto, novos clones nãomultirresistentes com alta virulência têm sido descritos em infecções comunitárias e hospitalares. O objetivo desse estudo foi realizar a caracterização fenotípica e genotípica de cepas de MRSA isoladas na cidade do Natal/RN. Inicialmente avaliamos 60 amostras de S. aureus quanto a resistência à meticilina através de diferentes técnicas fenotípicas, utilizando a detecção do gene mecA por PCR como padrão. O antibiograma de todas as cepas foi realizado utilizando 12 antimicrobianos conforme descrito pelo CLSI. As cepas de MRSA foram caracterizadas geneticamente através da tipagem do cassete cromossômico estafilocócico mec (SCCmec) e da eletroforese em campo elétrico alternado (PFGE). Dos 60 S. aureus estudados, 45 foram resistentes à meticilina. Observamos que para algumas cepas de MRSA os testes de triagem em ágar com 6μg/mL de oxacilina e difusão em meio sólido com oxacilina-1μg apresentaram dificuldades na sua interpretação. No entanto, todas as 45 amostras de MRSA, foram facilmente detectadas pelos testes com o disco de cefoxitina-30μg e pesquisa da PBP2a. A análise molecular das cepas de MRSA mostrou 8 padrões distintos de PFGE (A-H), com predominância do padrão A (73%), relacionado ao CEB. Estas carreavam o SCCmec tipo IIIA, e apresentaram uma considerável variedade de subtipos (A1-A16). Cinco cepas de MRSA portando SCCmec IV também foram xiv identificadas, três delas relacionadas geneticamente ao clone USA800 (Padrão B). Destas cinco, três (2 padrão F e 1 padrão B) foram altamente susceptíveis as drogas testadas, entretanto, dois outros isolados, padrão B, apresentaram multirresistência. As amostras restantes pertenciam a padrões de PFGE distintos dos clones internacionais predominantes em nosso continente. Para realização deste projeto de pesquisa, a metodologia exigiu a interação com pesquisadores de áreas como: infectologia, microbiologia e biologia molecular. Portanto, esta dissertação apresentou um caráter de multidisciplinaridade e transdiciplinaridade no seu desenvolvimento

Investigação farmacoepidemiológica do uso do clonazepam no distrito sanitário leste em Natal-RN

Prescription errors are the most serious type of medication errors found in the health system. The main purpose of this study was to evaluate the quality of clonazepam prescriptions. A descriptive and observational study with retrospective data collection was conducted at 30 community pharmacies in Natal/RN, Brazil, after informed consent was obtained from the pharmacists. A sample of 313 prescription notifications was randomly collected in October 2009. They were analyzed for legible handwriting and completeness. During the study, one researcher, two pharmacists, and one pharmacy undergraduate student evaluated patient and purchaser identification, pharmaceutical form, dosing regimen, administration route, and prescription by generic name. This research was approved by the institutional Ethics Committee. Among the 313 collected notifications, only 44.1% were legible. A total of 55.91% (175/313) had at least one illegible item, 100% contained incomplete information, and 97.12% (304/313) contained one or more abbreviations. The proportion of illegible handwriting related to the patient s identification (p=0.0001) was statistically significantly greater than that related to the drug purchaser s identification (p=0.0004). Contrary to legal requirements, prescriptions with the generic name accounted for 13.42% (42/313) of the total. All the examined notifications were handwritten. Prescription errors, which potentially can have serious consequences, have been evaluated worldwide, although little is known about this subject as it relates to community pharmacies. This study showed high percentages of prescribing problems, which justifies the development of future research about medication errors in community pharmacies and education activities for prescribers

Avaliação do cuidado na estratégia saúde da família em metrópoles do nordeste brasileiro

Objective: To evaluate the implementation of the Family Health Strategy (FHS) in Brazilian cities of the Northeast, expanding coverage, analyzing the progress, challenges and innovations. Methods: Multicentric Evaluation Research, Studies Baselines in urban centers, using as a case study method. Selected cases of Aracaju, being capital, advanced coverage with extended team, and Fortaleza, capital coverage incipient and minimal staff. In Fortaleza, purposive sample of 11 Units Primary (APS), 03 managers, 53 professionals and 109 users. In Aracaju, 09 units of APS, 02 managers, 36 professionals, and 90 users. Structured interviews for managers, and structured to professionals and users. Descriptive analysis focusing on the political and institutional dimensions, organization and comprehensive care. Results: There was consensus that the ESF is the preferred port users and acts as inducing changes in care. In the case of Fortaleza, the specificities were: care protocols and community activities aimed at chronic conditions (100%) , with greater participation of doctors and nurses (93%) ; conjunction with more complex services, but the teams reported difficulties with the examination center and experts, the long waits and poor access to local services were the main difficulties reported by users., As innovative practice, the therapeutic group of elderly caregivers mentioned by respondents; There was intersectoral initiatives and teams 87 % of users have participated in meetings about health problems. In the case of Aracaju, care protocols were directed to the lines of care and formulated locally, 85 % coverage of the population with FHS counterpart local financing; employees hired by public tender; 70 % of teams with expertise in public health center for continuing education acting; democratization in management; access technologies, welcoming and computerization in different integrated networks, and evaluation matrix. Conclusions: The ESF has promoted access to health care and inclusion of disadvantaged populations. Different perceptions and practices in the organization of care, with distinct trajectories of reorganization. In the case of Fortaleza, predominance of model programs valuing older, with evidence of advances in care practices and teamwork, but restricted to primary care practices and incipient in public policy perspective. In Aracaju, had network integration with technologies related to the family, in which the ESF is consolidated as public policy. It can be argued that the XII APS expanding coverage, exhibited efficacy, despite the challenges inherent to the different degrees of implementation

Capital social e igreja católica :expressões e práticas no sertão do Seridó

It historizes and it analyzes the social capital in the area Seridó. The traditions associative seridoenses are reconstructed starting from the dimensions: economical, social, religious person and politics. In them it is possible to notice actions that form the social capital of the area. The country of Seridó present an associative tradition based on the mutual help, in the trust and reciprocity that she remount there are decades in your history. The relationship among the Catholic Church, that historically it is present in the area, and rural communities, through your community associations, it is the backdrop where you/they are the responsible associative elements for the tear of the regional social fabric: in him (the backdrop) he/she is the responsible social capital for the work of the rural community organizations. The Catholic Church, through your social action and the Program of Combat to the Rural Poverty, of Rio Grande do Norte is the league that sustains the actions collective seridoenses

Da Barra do Rio aos parrachos: duas realidades sociorganizacionais no litoral Norteriograndense

Observing that social capital is considered crucial for the consolidation of an association, this paper analyzes how different groups associative absorb the concept of membership and how to manage routing in their actions to the social interest. The research aimed to evaluate two central forms of association, based on the concept of Pierre Bourdieu (1980) on social capital, stressing that its distribution and perception are uneven and depends on the ability of ownership of different social groups. Accordingly, took up two organizations community based one in - Barra do Rio and another in Maracajaú - whose main activity is the exploitation in the coastal tourist norteriograndense. Once processed the data, it became clear that, despite the purpose for the association has been motivated by exploration in both organizations, each differently appropriates its capital. While one maintains a feelings of togetherness, trust and satisfaction of group work, the other one, feelings are stifled by individualism, mistrust among their members that although they see the association as something important for the growth and strengthening of the group, working individually

Desenvolvimento, sustentabilidade e conservação da biodiversidade na amazônia: a produção familiar agroextrativista em áreas protegidas no sul do amapá

The establishment of Extractivism and Sustainable Development Reserves comes from an amazon forestry people resistance initiative. It means an option of natural resources management as protected areas for agroextractivism purposes. According to the institutional point of view, these lands, called Conservation Unity for Sustainable Exploration, belong to the government which grants the usufruct rights to the agroextractivist families under a sharing territory administration agreement among government and rural communities. The main roles of these lands are both: to improve the dwellers wellbeing, and protecting the local biodiversity. Additionally, they also represent the start of this thesis theme entitled Development, sustainability, and biodiversity conservation in the Amazon region: the use of protected areas for agroextractivism domestic yield in south of Amapá state with the objective of analyzing the performance that each territory has been reaching in terms of the attributions proposed at the beginning, when they were created. Social, economics, and environment changes that occurred in the agroextractivist areas have been evaluated from two selected test sites, named Rio Cajari Extractivist Reserve and Rio Iratapuru Sustainable Reserve, both, localized in the south of Amapá state

Brincadeira do reisado na comunidade Cipó, Pedro II PI: mediação cultural, tradição e modernidade

This research studies the tradition of epiphany in the community of Cipó de Baixo, which belongs to the city of Pedro II, in the state of Piauí. Readings were made seeeking to emphasize the processivity of the play that navigates between permanence and change. The study starts with a social context of the community, in dialogue with the life history of the owner of the epiphany, Raimundo Milú: strong figure who, along with his family networks, as well as networks of patronage and friendship, struggles for the resistence of the play. The description of the ceremony of Kings, with its constituent parts, punctuates the remarkable character of Cipó community epiphany. This detailed understanding of the play favors the understanding of some of the social vines that serve as the basis for the warp of this cultural practice: modernization vine, where we explore the general motivation of Cipó community epiphany transformations - modernity; family and community exchange vine, which describes the scheme that holds the permanence of the play; masculinity vine, explains the strong gender system that crosses Cipó community epiphany; reinvented tradition vine, where we locate the uniqueness of Cipó community epiphany tradition and its dialogues with modern dynamism; conflict between generation vine, depicts the differences between generations and how they contribute to the dialogue between the traditional and the new; theatrical spectacle vine, describes the play as a performative activity. Thus, we build a social scheme that analyzes the play of Kings of Cipó community as a whole, where change and continuity plan a cultural plot on their own

História e educação de mulheres remanescentes indíginas de missão do Sahy.

El estudio Historia y educación de mujeres indígenas que quedan em Missão do Sahy pretende comprender, a través de recerdos y memorias, la transmisión de costumbres y prácticas educativas de un grupo de mujeres en sus relaciones con la familia, la escuela y la religión. El enfoque teórico-metodológico utilizado fue la Historia Oral, un enfoque que oferece la oportunidad de trabajar con la historia de mujeres y la memoria, tratando de reconstruir algunas de las experiencias de estas mujeres que tienen la custodia de las historias y los conocimientos transmitidos por los antepasados, como activistas en las actividades de la Comunidad, los partidos políticos, en la dirección de las asociaciones de la comunidad y los mantenedoras de la iglesia. La encuesta se realizó en el Distrito de Missão do Sahy, un asentamiento franciscano instalado en 1697 y abolida en 1863, em el territorio de Las Jacobinas, la ciudad de Senhor do Bonfim, en el norte de Bahia. El estudio demostró que todavía hay uma fuerte presencia de la práctica de los Padres Franciscanos, los creadores del pueblo, también mostró que las orientaciones religiosas han contribuido significativamente a fortalecer el papel de la mujer en Missão do Sahy como madre y esposa. Este estudio también mostró que el sesgo afecta a las más jóvenes remanescentes que - ni india ni negra - todavia son victimas de discriminación, un hecho que quizás tiene su origen el desconocimiento de la identidad de estas mujeres. Varios autores han contribuido en este estudio: Halbwachs (2006), Bosi (1994) y Pollak (1989) contribuyó a la construcción del estudio de la memoria, Perrot (1988, 2006, 2007) y Del Piore (2007) proporcionaron la base para la historia de la mujer; Machado y otros autores regionales (1993, 2007), Lourenço Pereira da Silva (1906, 1915), Adolfo Silva (1971), Edith Davis (1997), Joseph Davis (2001), Da Paz (2001, 2004), Oro (2008) , Santos (2007), Araujo (2002) y (2008 Vieira Filho) contribuyeron a la construcción de una historiografía de la zona de la investigación. Cronistas Frei Martinho de Nantes (1979) y Frei Venancio Willeke OFM (1994), además de teórico Norbert Elias (1993), de Michel de Certeau (1994) y Philippe Aries (1981), que presentan elementos importantes para el análisis de las pruebas.

Rituais de resistência: experiências pedagógicas tapeba

The work aims to investigate some of the educational actions developed in the differentiated Tapeba schools (CE), in their pedagogical practices. The reading of these practices as ritual of ethnic cultural resistance is accomplished by the approach of studies of experience and performance in the anthropology, as well as, the analytical perspective suggested by the dramaturgy ideas and social drama. So, taking a critical approach of the school, that conceives it, while time space privileged of possibilities of political social change, this work searches to notice the means of achievement of a differentiated education. I aim at, with that, to observe the ritual moments and performáticos of the pedagogic practices of Tapeba while important political-symbolic expressions of your collective experiences, looking at the process of construction of legitimacy of the school differentiated as scenery of creation of pedagogic rituals of resistance. Then, the Cultural Fair, Tapeba Indian Games, the Walking of Tapeba Indian`s Day and Carnauba Party by one side and the Cultural Classes, by another, promote a re-thinking on the experiences of Tapeba ethnicity, distinguishing also, in this process of identity affirmation, the political pedagogical role fulfilled by land re-taking. Finally, this work makes clear that Tapeba prove to be individuals with rights and at the same time they want to legitimate their differentiated school practices, Tapeba construct the meaning of their social actions in the educative and in other aspects of their communitarian living as well

Desempenho muscular e equilíbriu postural em idosas frágeis residentes na comunidade

Human aging is physiological process causes alterations in several systems of the organism. In the musculoskeletal system, a main change is the decreased muscle strength, that in the lower extremity, compromises the ability to respond quickly with enough strength to prevent falls, causing alterations in postural balance. Currently, many researchers have study the human frailty, defined as a multifactorial syndrome, with excess of vulnerability to stressors, reducing ability in maintaining or regulating homeostasis. Its characteristics are directly related to physical function. Aim: To analyze muscle performance and postural balance in frail and pre-frail elderly women, and to compare them according with the frailty phenotypes criteria proposed by Fried 2001. Method: 39 frail elderly women living in the community, aged 65 years and older, were assessed muscle performance of lower extremity using isokinetic dynamometer and postural balance using Berg s balance scale and computerized baropodometry. Results: There was significant difference in plantar flexor, knee flexor and knee extensor strength, in anteroposterior (AP) oscillation with eyes open and on Berg s scores between groups. A weak correlation was observed between strength and balance. Conclusion: The results suggest that the frail elderly present worse muscle performance in lower extremity and worse postural balance compared to the pre-frail elderly. There were correlations between muscle performance and balance impairments in these elderly, but several variables are also involved in maintaining postural balance

Comparação e mobilidade, equilíbrio corporal e desempenho muscular segundo a auto-eficácia para quedas em idosas

The aging process modifies various systems in the body, leading to changes in mobility, balance and muscle strength. This can cause a drop in the elderly, or not changing the perceived self-efficacy in preventing falls. Objective: To compare the mobility, body balance and muscle performance according to self-efficacy for falls in community-dwelling elderly. Methods: A cross-sectional comparative study with 63 older (65-80 years) community. Were evaluated for identification data and sociodemographic, cognitive screening using the Mini Mental State Examination (MMSE), effective for the fall of Falls Efficacy Scale International Brazil (FES-I-BRAZIL), Mobility through the Timed Up and Go Test , the balance Berg Balance Scale (BBS) and the Modified Clinical Test tests of Sensory Interaction on Balance (mCTSIB), tandem walk (TW) and Sit to Stand (STS) of the Balance Master® System. Finally, muscle performance by using isokinetic dynamometry. Statistical analysis was performed Student t test for comparison between groups, with p value ≤ 0.05. Results: Comparing the elderly with low-efficacy for falls with high-efficacy for falls, we found significant differences only for the variable Timed Up and Go Test (p = 0.04). With regard to data on balance tests were significant differences in the speed of oscillation firm surface eyes open modified Clinical Test of Sensory Interaction on Test of Balance (p = 0.01). Variables to isokinetic dynamometry were no significant differences in movement knee extension, as regards the variables peak torque (p = 0.04) and power (p = 0.03). Conclusion: The results suggest that, compared to older community with low-and high-efficacy for falls, we observed differences in variables related to mobility, balance and muscle function