Fisioterapia e sociedade: ações do Sistema Único de Saúde no Rio Grande do Norte

The work has objective to present actions of Physiotherapy, developed by SUS in the State of Rio Grande do Norte; discuss under the humanization point of view such actions of health; discuss the importance of physioterapy to the Norte-Riograndense, or maybe its role in the perpetuation of actions of health centered in the binomial cause/efect. The study was done in the State of Rio Grande do Norte. The data were obtained through public sources gathered in the health secretrary ship of this State. The collected data talks about physiotherapy sections developed by SUS in several areas of the State; such data was collected and analysed after the aproval of Ethic and Resarch Committee of Federal University of Rio Grande do Norte. Concerning the physiotherapy, along with the State Health Secretaryship of the State fo Rio Grande do Norte, there were only records of attending based on cure/rehabillitation, not being observed during the curse of study, any record or action of prevention, promotion and protection towards health. It s possible to notice that there is a highligth to the interventions focusing on the treatment of illness of rheumatic origin and general complaints related to the vertebral column. Such research evidenced that the Physiotherapy in the SUS in the State priorizes the individualized attending centered in the carteziano health/illness model, where the developde actions are turned to the curative and rehabilliting attention, with role fo some or no highligth in the primary attention

Entre cristo e o diabo:o ideário do Colégio Americano Batista do Recife (1902-1942)

Due to lack of work on the history of Baptist schools in the Northeast region of Brazil, it is important to understand through a historical reconstruction of the Baptist Protestant education. We embarked on this venture as a chance to understand the presence of Protestant schools, and his ideas on Brazilian soil. Our goal is to promote a reflection which has the axial dimension of the Baptists Protestant education, in time, we will place the debate between 1902-1942. The temporal boundaries of 1902-1942 was because 1902 was when he started the American Baptist College of Recife in 1942 and that ends the cycle of managing directors of Americans. Understand the functionality of time a school is justified when we realize that the history of education is the story of a work of self and formation within a framework that has the school as the main support that can enable a reading of reality. We also intend to examine the school culture brought to Brazil by American missionaries and their applicability in the Brazilian cultural-historical context. And just to demonstrate the hypothesis that the educational contribution of Baptists added to the participation of other Protestants promoted advances in Brazilian society. Possibly taking for granted that the Baptists were in possession of the democratic ideals of religious freedom, taken by many representatives and religious version of the republican regime. In addition to promoting a model in Brazil to make different methodological schools, based on the ideals of new school and ethics of the Bible. Our proposed research aims at understanding how North American missionaries settled in Brazil and what were the purposes of adding to the efforts of evangelization to formal education, binomial that justified the establishment of schools. A vision of saving men for evangelization and education of the Devil attack victims over the ethics of Christ

Avaliação da assistência à saúde dos portadores de úlceras venosas atendidos no programa saúde da família do município de Natal/RN

Descriptive research aimed at evaluating the assistance offered to patients with venous ulcers, on lower limbs, attended by the Family Health Program (FHP) team, from the municipality of Natal/RN. The target population was composed of 74 patients with venous ulcers (VU), attended by the FHP teams in the 31 FHUs. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (protocol n.55/05). The data collection was performed in patients homes and in the FHUs, through structured interviews and physical examinations of patients with VU and non-participant observation during the changing of wound dressings in these Units and in users homes. The data was organized into an Excel electronic table and transported into the SPSS 14.0 program, for descriptive analysis on 2x2 contingency tables and inferential (Qui-Square χ2, Spearman Correlation, Binomial Proportion Test and p-value <0.05). The prevalence of VU (0.36/1000) in the target population (over 20 years of age) was greater than in the population registered in FHP (0.25/1000). We detected a greater prevalence in the age area of over 60 years (2.22/1000), with 2.98/1000 for females and 1.3/1000 for males (p-value=0.008). The sociodemographical and health characteristics of patients with VU revealed predominance of females (74.5%), elders over 60 years of age (67.6%), with fundamental education (74.3%), family earnings of up to 2 minimum wages (68.9%), retired (90.5%), ortostatic position (23.0%), inadequate sleep (59,9%), presence of CVI (100.0%), hypertension (44.6%) and diabetes (25.7%). As for the time of existence of the VU, 64.9% had over 1 year, and 35.1% less than 1 year), with predominance of one wound (67.6%). The changing of wound dressings is performed mostly at home, in and inadequate way, especially with incorrect cleaning techniques, likewise incorrect use of products and substances, and reduced participation of the FHP team on the evaluation and application of the dressing and choosing of products and substances. The compressive therapy is not part of therapeutic conducts for treatment in the FHUs. As for the evaluation of assistance to patients with VU, 90.5% were inadequate and only 9.5% adequate. The main inadequacy factors were the absence of: diagnosis (47.3%), consultation with and angiologist (63.5%), compressive treatment (100.0%), adequate optical therapy (98.62%), adequate dressing kit (70.3%), training for the changing of dressings (67.6%), following by the FHP team (51.4%) and performed exams (55.4%). We ve concluded that patients with VU mostly present now socioeconomical level and associated chronic diseases. Considering that assistance offered by FHP is non-systematic, fragmented, with no diagnosis planning, continual evaluation and evolution, we qualify the assistance as inadequate and with low level of solution, directly interfering on the maintenance of the VUs chronic state

Atenção à criança no período neonatal: chamada neonatal, Rio Grande do Norte, 2010

The neonatal period, which includes the first 27 da ys postpartum, is a vulnerability phase in child health, making it necessary for a greater mon itoring by health professional through actions that add value to the binomial mother/child and comprehensive care to the newborn. To this end, this study aimed to evaluate the care actions the neonato from the strategies recommended by the Ministry of Health. This is a cr oss-sectional study carried out from the database of the national survey of population base entitled "Call Neonatal: evaluation of prenatal care and to children younger than one year old in the North and Northeast regions". It used as the sample unit the mothers and children yo unger than 1-year-old, costal residents of Rio Grande do Norte, Natal, Brazil, who attended th e vaccination campaign on June 12, 2010 in nine municipality’s priority for the Pact to Red uce Infant and Neonatal Mortality. To compose the study variables were selected issues/ac tions regarding the neonatal period and socio-demographic factors, followed by a descriptiv e and inferential analysis. A sample of 837 mother/child pairs was obtained, being 57.6% in capital and 42.4% in the whole from the interiors, which was weighted to represent the muni cipalities of the State. It was predominated by mothers aged between 20-29 years, complete high school, not entitled to income transfer program and male children (51.2%). The frequency of the actions of the hospital ranged from 35% to 96% and those performed at the Basic Health Unit (BHU) from 57% to 91.2%. Most actions had an association with hospitals and publi c nature of the state capital (p<0.05). The results for most of the actions are recommended in the care programs and policies for children, and reveal the regional inequities in hea lth and the need for the involvement of services and professionals in search of comprehensi ve care for enabling better care through humanized practices during this increased vulnerabi lity period.

Validação do conteúdo do diagnóstico de enfermagem proteção ineficaz para pacientes submetidos à hemodiálise

Methodological study, in order to validate the content of the nursing diagnosis protection ineffective in patients undergoing hemodialysis. The research took place in two stages, namely: concept analysis and content analysis of the instrument by experts. T he first step was operationalized through an integrative review of the databaes LILACS, CINAHL, PubMed, Scopus and Cochrane, with the key words protection and hemodialysis, in October and November 2013. The sample consisted of 32 articles, which were analyz ed by a c areful reading to identify the sections that correspond ed to the defining attributes , antecedents and consequences of protection in patients undergoing hemodialysis. T he interpretation for the diagnosis of effective protection was made by transpos ing the components of the diagnosis (definition, defining characteristics and related factors) to the denial form . In the second stage, we elaborated an instrument with the components of the nursing diagnostic s studied and proceeded to the analysis conduct ed in April 2014 by 22 specialists in nephrology and in the terminology of the NANDA International, selected by means of th e Lattes Platform . We used the binomial test to assess the proportion of experts who rated each item as appropriate, considering a si gnificance level of 5%. The project was approved by the Ethics Committee of the institution responsible for the research, an opinion on num b er 387 837 and CAAE 18486413.0.0000.5537. The results show that the proposal for the nursing diagnosis of ineffectiv e protection in patients undergoing hemodialysis is: definition - the same as that presented in the NANDA International Taxonomy II, location - domain safety / protection and class injury. Related factors are: Absence of routine vaccines; Non - adherence to care related to vascular access; Non - adherence to infection control measures; Non - adherence to prescribed diet; Non - adherence to drug therapy; Presence of comorbidities; Drug abuse; Immune disorders; Extremes of age; Abnormal blood profiles; Drugs that red uce immunity; and side effects and adverse treatment - related. The defining characteristics are: Presence of invading the bloodstream; Nutritional disorders; Increase in the number of hospitalizations; Uncontrolled dry weight; Infected vascular access; Vasc ular inadequate access; Increased blood pressure; fever; Bleeding disorder; Disability immunity; fatigue; weakness; itching; and maladaptive response to stress. It follows that the identification of the defining attributes, antecedents and consequences inc reased the wealth of vocabulary, allowing the construction of theoretical and empirical definitions for a broader understanding of the concept protection. Furthermore, the study contributed to the enrichment of nursing specific body of knowledge, as well a s in the direction of nursing care for patients undergoing hemodialysis.

Três alternativas estocásticas para modelar morbimortalidade por doenças respiratórias e cardiovasculares via variáveis atmosféricas

Climate and air pollution, among others, are responsible factors for increase of health vulnerability of the populations that live in urban centers. Climate changes combined with high concentrations of atmospheric pollutants are usually associated with respiratory and cardiovascular diseases. In this sense, the main objective of this research is to model in different ways the climate and health relation, specifically for the children and elderly population which live in São Paulo. Therefore, data of meteorological variables, air pollutants, hospitalizations and deaths from respiratory and cardiovascular diseases a in 11-year period (2000-2010) were used. By using modeling via generalized estimating equations, the relative risk was obtained. By dynamic regression, it was possible to predict the number of deaths through the atmospheric variables and the betabinomial-poisson model was able to estimate the number of deaths and simulate scenarios. The results showed that the risk of hospitalizations due to asthma increases approximately twice for children exposed to high concentrations of particulate matter than children who are not exposed. The risk of death by acute myocardial infarction in elderly increase in 3%, 6%, 4% and 9% due to high concentrations CO, SO2, O3 and PM10, respectively. Regarding the dynamic regression modeling, the results showed that deaths by respiratory diseases can be predicted consistently. The beta-binomial-poisson model was able to reproduce an average number of deaths by heart insufficiency. In the region of Santo Amaro the observed number was 2.462 and the simulated was 2.508, in the Sé region 4.308 were observed and 4.426 simulated, which allowed for the generation of scenarios that may be used as a parameter for decision. Making with these results, it is possible to contribute for methodologies that can improve the understanding of the relation between climate and health and proved support to managers in environmental planning and public health policies.

Quedas em idosos assistidos na estratégia saúde da família: frequência e fatores associados

The growth of the elderly population is a global phenomenon and, in Brazil, this transformation is happening in a very rapid rhythm. With the current population aging, this emerging age group will need more health care and attention. One of the characteristics of the population aging is the progressive accumulation of disabilities, which makes it more vulnerable to falls. This study was developed with the purpose of knowing the episode falls in the scope of an elderly population treated at a Family Health Unit. It is a research with cross-sectional nature, and its sample was composed by 121 elderly. The research was approved by the Ethics Committee of HUOL, with Opinion nº 816.022. We applied a questionnaire to the participants, and the results were statistically analyzed by using Chi-square test and Fisher’s exact test to verify the association between variables. In order to perform a multivariate analysis, we used the method of the Binomial Logistic Regression. For both tests, we accepted significance p<0,05 and CI of 95%. The results prove that the majority belongs to the female gender (76,9%); the age group of elderly reaches 88,4% and 11,6% is over-aged; regarding the marital status, 35,3% are married and 29,4% widowed; 92,1% with family income between one and two minimum wages; and 91,8% live with their partners and/or children. Regarding the frequency of falls, we found that 61,2% of the surveyed elderly suffered one or more falls in 2014. As associated factors, it became clear that 73,8% were due to extrinsic factors, 6,4% to intrinsic factors and 21,4% to both factors. As a consequence of the fall, we found that 89,2% have fear of falling again, 37,3% showed anxiety and 13,3% had their ambulation affected. Concerning the exposure to the risk factors, the most prevalent places were: street/avenue (31,0%), pavement (19,0%), living room (14,3%) and courtyard/backyard (10,7%). The study has proven a statistically significant association among female gender (p=0,001), rubble/objects in the backyard (p=0,015) and furniture that may cause accidents (p=0,005). It was evident among the elderly people surveyed, 72.7% receive little information about falls, being a risk factor for falls. We conclude that there is a high frequency of falls in the surveyed elderly, thereby constituting a worrisome data because this event in the elderly population is a serious matter, which raises the need to ensure them a safe environment in their homes and, above all, outside them. The information provided by the Family Health Strategy team are important to avoid these occurrences, which reinforces the need for developing health education activities together with the population as a way to prevent and reduce the occurrence of falls, thereby improving the quality of life of elderly.

Análise de conteúdo e validação clínica do diagnóstico de enfermagem autocontrole ineficaz da saúde

The study aims to analyze the content and measures of accuracy of the nursing diagnosis Ineffective Self Health in patients undergoing hemodialysis. Study of nursing diagnosis validation carried out in two stages, namely: content analysis by judges and accuracy of clinical indicators. In the first stage, 22 judges evaluated the setting and location of the diagnosis, clinical indicators and etiological factors and their conceptual and empirical definitions. We used the binomial test to determine the proportion of the judges of the relevance of the components of the nursing diagnosis. In the second stage, we used the Latent Class Analysis for the diagnostic accuracy by evaluating 200 patients in a hemodialysis clinic in northeastern Brazil. Research approved by the Ethics Committee, under the Opinion No 387 837 and CAAE 18486413.0.0000.5537. The results show that the judges evaluated as pertinent clinical indicators 12 and 22 etiological factors. Proposed amendment of the nomenclature of five indicators and six factors and the implementation of a clinical indicator for etiology and three etiological factors for clinical indicators. In conceptual and empirical definitions, judges judged as not relevant the conceptual and empirical definitions of a clinical indicator, the conceptual definitions of two etiological factors and empirical definitions four etiological factors. Still, changes were suggested in the conceptual and empirical definitions of two clinical indicators, the conceptual definitions of 12 etiological factors and empirical definitions of 11 etiological factors. Clinical indicators analyzed in the first stage were validated clinically in patients undergoing hemodialysis. The most frequent clinical indicators were Changes in laboratory tests (100%) and daily life choices ineffective to achieve health goals (81%); and three etiological factors had a higher frequency, they are: unfavorable demographic factors (94.5%), beliefs (79%) and comorbidities (77.5%). From Latent class analysis, diagnosis prevalence was estimated at 66.28%. Clinical indicators that showed the best sensitivity measures for the nursing diagnosis Ineffective Self Health were: daily life choices ineffective to achieve health goals and Expression of difficulty with prescribed regimens. In turn, the clinical indicators of inappropriate medication use, no expression of desire to control the disease, irregular attendance to the dialysis sessions and infection were more specific as to that diagnosis. Non-adherence to treatment was the only indicator that showed confidence intervals with values for sensitivity and specificity, statistically above 0.5, being the one who has better diagnostic accuracy as the inference of the nursing diagnosis Ineffective Self Health in hemodialysis clientele. Thus, it is believed that the improvement of the components of diagnosis in question will contribute to the development of more reliable nursing interventions to the health status of the individual in hemodialysis, providing a more scientifically qualified care.

Análise de conteúdo e validação clínica do diagnóstico de enfermagem autocontrole ineficaz da saúde

The study aims to analyze the content and measures of accuracy of the nursing diagnosis Ineffective Self Health in patients undergoing hemodialysis. Study of nursing diagnosis validation carried out in two stages, namely: content analysis by judges and accuracy of clinical indicators. In the first stage, 22 judges evaluated the setting and location of the diagnosis, clinical indicators and etiological factors and their conceptual and empirical definitions. We used the binomial test to determine the proportion of the judges of the relevance of the components of the nursing diagnosis. In the second stage, we used the Latent Class Analysis for the diagnostic accuracy by evaluating 200 patients in a hemodialysis clinic in northeastern Brazil. Research approved by the Ethics Committee, under the Opinion No 387 837 and CAAE 18486413.0.0000.5537. The results show that the judges evaluated as pertinent clinical indicators 12 and 22 etiological factors. Proposed amendment of the nomenclature of five indicators and six factors and the implementation of a clinical indicator for etiology and three etiological factors for clinical indicators. In conceptual and empirical definitions, judges judged as not relevant the conceptual and empirical definitions of a clinical indicator, the conceptual definitions of two etiological factors and empirical definitions four etiological factors. Still, changes were suggested in the conceptual and empirical definitions of two clinical indicators, the conceptual definitions of 12 etiological factors and empirical definitions of 11 etiological factors. Clinical indicators analyzed in the first stage were validated clinically in patients undergoing hemodialysis. The most frequent clinical indicators were Changes in laboratory tests (100%) and daily life choices ineffective to achieve health goals (81%); and three etiological factors had a higher frequency, they are: unfavorable demographic factors (94.5%), beliefs (79%) and comorbidities (77.5%). From Latent class analysis, diagnosis prevalence was estimated at 66.28%. Clinical indicators that showed the best sensitivity measures for the nursing diagnosis Ineffective Self Health were: daily life choices ineffective to achieve health goals and Expression of difficulty with prescribed regimens. In turn, the clinical indicators of inappropriate medication use, no expression of desire to control the disease, irregular attendance to the dialysis sessions and infection were more specific as to that diagnosis. Non-adherence to treatment was the only indicator that showed confidence intervals with values for sensitivity and specificity, statistically above 0.5, being the one who has better diagnostic accuracy as the inference of the nursing diagnosis Ineffective Self Health in hemodialysis clientele. Thus, it is believed that the improvement of the components of diagnosis in question will contribute to the development of more reliable nursing interventions to the health status of the individual in hemodialysis, providing a more scientifically qualified care.

Família e escola: memórias de letramento

The school has the social function of educating the individual, building knowledge, attitudes and values that make supportive, critical, ethical and participatory. It is understood, however, in this study, these functions will only be, in fact, met at school if the family engagement at school. As a result, the objective of this research is to rescue the stories of families literacies yesterday and today and their expectations forward to school literacy of children. Theoretically, this research is based on studies of literacy (STREET, 1984; KLEIMAN, 1995; TFOUNI, 1995; 2010; OLIVEIRA, 2008) and in research on family literacy (HEATH, 1982; 1983; DANTAS; MANYAK, 2010). Methodologically, it is a qualitative research which fall within the field of Applied Linguistics (MOITA LOPES, 2006), characterized as an approach of the kind interpretative (MAYRING, 2000; CRESWEL, 2010). It takes as research area Municipal School Councilman Jose Sotero - Igapó / Natal-RN, using data generation tools such as: interview, questionnaire, teaching sequence and conversation wheel, aiming to seek answers to the following questions: How important to recover the reading and writing practices of the parents? What are the relationships between the history of the parents and the reading practices prevalent in the family? Which way to articulate these two systems: family and school, giving new meaning to the literacy practices experienced in the family context and the implications of literacy in school literacy of children? From the analysis of the data generated is expected to understand the family-school binomial and its interference in the literacy process of the students.

Família e escola: memórias de letramento

The school has the social function of educating the individual, building knowledge, attitudes and values that make supportive, critical, ethical and participatory. It is understood, however, in this study, these functions will only be, in fact, met at school if the family engagement at school. As a result, the objective of this research is to rescue the stories of families literacies yesterday and today and their expectations forward to school literacy of children. Theoretically, this research is based on studies of literacy (STREET, 1984; KLEIMAN, 1995; TFOUNI, 1995; 2010; OLIVEIRA, 2008) and in research on family literacy (HEATH, 1982; 1983; DANTAS; MANYAK, 2010). Methodologically, it is a qualitative research which fall within the field of Applied Linguistics (MOITA LOPES, 2006), characterized as an approach of the kind interpretative (MAYRING, 2000; CRESWEL, 2010). It takes as research area Municipal School Councilman Jose Sotero - Igapó / Natal-RN, using data generation tools such as: interview, questionnaire, teaching sequence and conversation wheel, aiming to seek answers to the following questions: How important to recover the reading and writing practices of the parents? What are the relationships between the history of the parents and the reading practices prevalent in the family? Which way to articulate these two systems: family and school, giving new meaning to the literacy practices experienced in the family context and the implications of literacy in school literacy of children? From the analysis of the data generated is expected to understand the family-school binomial and its interference in the literacy process of the students.

Cenários de contra-hegemonia no protestantismo brasileiro no contexto da pós-modernidade

Since long ago that the religious manifestations are considered important items in various social media. In this sense, we are interested in understanding the strong denominational plurality, and the emergence of new movements / events and forms of Christianity in Brazil, which therefore is a reflection of what happens in the rest of the globalized world. Such interest is covered by the assumption that religiosity and social media are built on mutual and interconnected way, which allows us to understand that social cosmology presents itself as a fertile space privileged and to verify the interactions pertaining to the binomial: religion and society. The Protestantism is divided into three main streams: Historical, Pentecostal and Neo-Pentecostal. Each current of Protestantism emerged to adapt to social cosmology of historical ages, from the Reformation to the present day, forming institutions with certain ethical and moral stances. In this sense, it is necessary to research and understand how the historical Protestant, Pentecostal and neo-Pentecostal were implanted in Brazil. From this we believe to be interesting problematize accurately the following: How have the processes of formation of strands / evangelical movements in Brazil? These movements are still holding their "classic robes" or hybreeding their borders? What are the modulations in the religious transit demonstrate that this probable hybridization? If there is, indeed, a hybridization between the Evangelical means, we can put it is provoked only by a logic of "market of symbolic goods of religion" in the world today? Nowadays, we are experiencing a period of change cosmological, from Modern to Postmodern (caosmológic). This last is therefore characterized by secularization, the fracture, the mutilation, the diversity of subjectivities. And thinking about is this "spirit of the times" we take as the main its theoretical references of this study, the Italian philosopher and thinker of postmodernity Gianni Vattimo featuring postmodernity with the cosmology of fragile / pensiero debole Thought and post-metaphysical, that is which enhances the appearance of more plural institutions and non-absolute. To do so, he makes use of the philosophies of German, Nietzsche and Heidegger. Finally, it must be said that this grounded theoretical framework, raise the hypothesis that the Protestantism tends to "injure anymore" by the influence of postmodern social episteme, providing thereby the emergence of a new hybrid framework has not yet nominated and can move between the three major currents of world Protestantism, with features in converged aspects of the same.

Cenários de contra-hegemonia no protestantismo brasileiro no contexto da pós-modernidade

Since long ago that the religious manifestations are considered important items in various social media. In this sense, we are interested in understanding the strong denominational plurality, and the emergence of new movements / events and forms of Christianity in Brazil, which therefore is a reflection of what happens in the rest of the globalized world. Such interest is covered by the assumption that religiosity and social media are built on mutual and interconnected way, which allows us to understand that social cosmology presents itself as a fertile space privileged and to verify the interactions pertaining to the binomial: religion and society. The Protestantism is divided into three main streams: Historical, Pentecostal and Neo-Pentecostal. Each current of Protestantism emerged to adapt to social cosmology of historical ages, from the Reformation to the present day, forming institutions with certain ethical and moral stances. In this sense, it is necessary to research and understand how the historical Protestant, Pentecostal and neo-Pentecostal were implanted in Brazil. From this we believe to be interesting problematize accurately the following: How have the processes of formation of strands / evangelical movements in Brazil? These movements are still holding their "classic robes" or hybreeding their borders? What are the modulations in the religious transit demonstrate that this probable hybridization? If there is, indeed, a hybridization between the Evangelical means, we can put it is provoked only by a logic of "market of symbolic goods of religion" in the world today? Nowadays, we are experiencing a period of change cosmological, from Modern to Postmodern (caosmológic). This last is therefore characterized by secularization, the fracture, the mutilation, the diversity of subjectivities. And thinking about is this "spirit of the times" we take as the main its theoretical references of this study, the Italian philosopher and thinker of postmodernity Gianni Vattimo featuring postmodernity with the cosmology of fragile / pensiero debole Thought and post-metaphysical, that is which enhances the appearance of more plural institutions and non-absolute. To do so, he makes use of the philosophies of German, Nietzsche and Heidegger. Finally, it must be said that this grounded theoretical framework, raise the hypothesis that the Protestantism tends to "injure anymore" by the influence of postmodern social episteme, providing thereby the emergence of a new hybrid framework has not yet nominated and can move between the three major currents of world Protestantism, with features in converged aspects of the same.

Hepatite C crônica em serviço de referência no nordeste do Brasil: um estudo retrospectivo de dezoito anos de acompanhamento

Chronic Hepatitis C is the leading cause of chronic liver disease in advanced final stage of hepatocellular carcinoma (HCC) and of death related to liver disease. Evolves progressively in time 20-30 years. Evolutionary rates vary depending on factors virus, host and behavior. This study evaluated the impact of hepatitis C on the lives of patients treated at a referral service in Hepatology of the University Hospital Onofre Lopes - Liver Study Group - from May 1995 to December 2013. A retrospective evaluation was performed on 10,304 records, in order to build a cohort of patients with hepatitis C, in which all individuals had their diagnosis confirmed by gold standard molecular biological test. Data were obtained directly from patient charts and recorded in an Excel spreadsheet, previously built, following an elaborate encoding with the study variables, which constitute individual data and prognostic factors defined in the literature in the progression of chronic hepatitis C. The Research Ethics Committee approved the project. The results were statistically analyzed with the Chi-square test and Fisher's exact used to verify the association between variable for the multivariate analysis, we used the Binomial Logistic regression method. For both tests, it was assumed significance p < 0.05 and 95%. The results showed that the prevalence of chronic hepatitis C in NEF was 4.96 %. The prevalence of cirrhosis due to hepatitis C was 13.7%. The prevalence of diabetes in patients with Hepatitis C was 8.78 % and diabetes in cirrhotic patients with hepatitis C 38.0 %. The prevalence of HCC was 5.45%. The clinical follow-up discontinuation rates were 67.5 %. The mortality in confirmed cases without cirrhosis was 4.10% and 32.1% in cirrhotic patients. The factors associated with the development of cirrhosis were genotype 1 (p = 0.0015) and bilirubin > 1.3 mg % (p = 0.0017). Factors associated with mortality were age over 35 years, abandon treatment, diabetes, insulin use, AST> 60 IU, ALT> 60 IU, high total bilirubin, extended TAP, INR high, low albumin, treatment withdrawal, cirrhosis and hepatocarcinoma. The occurrence of diabetes mellitus increased mortality of patients with hepatitis C in 6 times. Variables associated with the diagnosis of cirrhosis by us were blood donor (odds ratio 0.24, p = 0.044) and professional athlete (odds ratio 0.18, p = 0.35). It is reasonable to consider a revaluation in screening models for CHC currently proposed. The condition of cirrhosis and diabetes modifies the clinical course of patients with chronical hepatitis C, making it a disease more mortality. However, being a blood donor or professional athlete is a protective factor that reduces the risk of cirrhosis, independent of alcohol consumption. Public policies to better efficient access, hosting and resolution are needed for this population.