Associação entre diferentes marcadores antropométricos com variáveis espirométricas e de força muscular respiratória em obesos mórbidos

A obesidade é uma epidemia global em alarmante ascensão. Caracterizada pelo excesso de gordura corporal subcutânea, de caráter multifatorial, está relacionada ao surgimento de diversas co-morbidades, entre elas, várias alterações respiratórias, estas se tornam mais intensas quanto maior o grau de obesidade. Não há consenso na relação entre os marcadores de adiposidade geral ou específicos e suas repercussões sobre a função ventilatória, especialmente em relação à sobrecarga muscular respiratória. Objetivo: Analisar a relação entre marcadores antropométricos e variáveis espirométricas e de força muscular respiratória em indivíduos com obesidade mórbida. Métodos: Estudo transversal entre setembro de 2007 e outubro de 2012. Participaram da pesquisa 163 obesos mórbidos (37.1±9.8 anos e IMC=49.0±5.88 Kg/m2) sem alterações espirométricas. Foram observadas as associações entre Índice de Massa Corporal-IMC, adiposidade localizada (Circunferências de Pescoço-CP, Cintura-CC e Quadril-CQ), percentual de gordura corporal através do Índice de Adiposidade Corporal-IAC, volumes e capacidades pulmonares (CVF, VEF1 e VRE) e pressões respiratória estática (PIM e PEM) e dinâmica (VVM). Resultados: O VRE foi o volume mais afetado pela obesidade (apenas 41%predito) e mostrou associação negativa nas relações com todos os marcadores de adiposidade (IMC: r=-0.52; IAC: r=-0.21; CC: r=-0.44; CP: r=-0.25 e CQ: r=-0.28). Há relação inversa entre o percentual de gordura corporal (IAC) com a CVF (r=-0.59), o VEF1(r=-0.56) e o VVM (r=-0.43). As pressões respiratórias são justificadas principalmente pela adiposidade ao redor do pescoço e o IAC. Nossos dados de força muscular respiratória foram melhores associados aos valores de referências sugeridos pelas equações de Harik-Klan et al (1998) para PIM (R²=0.72) e com a equação proposta por Neder et al (1999) para PEM (R²=0.52). Em um modelo de regressão linear, as variáveis de adiposidade não justificam a VVM, já o VEF1 explica 62% da variância da VVM em obesos mórbidos. Conclusão: O percentual da adiposidade corporal e a circunferência do pescoço estão associados com a força muscular e capacidade de gerar fluxo respiratório de obesos mórbidos. Sugerimos a equação elaborada por Harik-Klan et al (1998) para obtenção de valores preditos de PIM e a equação proposta por Neder et al (1999) para valores de normalidade da PEM em sujeitos com obesidade mórbida. Foi possível fornecer uma equação de referência específica para VVM em obesos mórbidos

Estimativas de mortalidade para a região nordeste do Brasil em 2010: uma associação do método demográfico equação geral de balanceamento, com o estimador bayesiano empírico

One of the greatest challenges of demography, nowadays, is to obtain estimates of mortality, in a consistent manner, mainly in small areas. The lack of this information, hinders public health actions and leads to impairment of quality of classification of deaths, generating concern on the part of demographers and epidemiologists in obtaining reliable statistics of mortality in the country. In this context, the objective of this work is to obtain estimates of deaths adjustment factors for correction of adult mortality, by States, meso-regions and age groups in the northeastern region, in 2010. The proposal is based on two lines of observation: a demographic one and a statistical one, considering also two areas of coverage in the States of the Northeast region, the meso-regions, as larger areas and counties, as small areas. The methodological principle is to use the General Equation and Balancing demographic method or General Growth Balance to correct the observed deaths, in larger areas (meso-regions) of the states, since they are less prone to breakage of methodological assumptions. In the sequence, it will be applied the statistical empirical Bayesian estimator method, considering as sum of deaths in the meso-regions, the death value corrected by the demographic method, and as reference of observation of smaller area, the observed deaths in small areas (counties). As results of this combination, a smoothing effect on the degree of coverage of deaths is obtained, due to the association with the empirical Bayesian Estimator, and the possibility of evaluating the degree of coverage of deaths by age groups at counties, meso-regions and states levels, with the advantage of estimete adjustment factors, according to the desired level of aggregation. The results grouped by State, point to a significant improvement of the degree of coverage of deaths, according to the combination of the methods with values above 80%. Alagoas (0.88), Bahia (0.90), Ceará (0.90), Maranhão (0.84), Paraíba (0.88), Pernambuco (0.93), Piauí (0.85), Rio Grande do Norte (0.89) and Sergipe (0.92). Advances in the control of the registry information in the health system, linked to improvements in socioeconomic conditions and urbanization of the counties, in the last decade, provided a better quality of information registry of deaths in small areas

Determinação da energia de ativação e pureza de medicamentos de referência, genérico e similar utilizando técnicas termoanalíticas

In this work, the reference drugs, generic and similar to the active ingredients acetylsalicylic acid, paracetamol, captopril, hydrochlorothiazide and mebendazole were purchased from local pharmacies and studied by thermogravimetry (TG) and Differential Scanning Calorimetry (DSC). Thermal decomposition was assessed to obtain from the Ozawa method the activation energy in inert atmosphere (nitrogen), using three different heating ratios (5, 10 and 20 o C min-1). The pharmaceutical formulation of the AAS reference was the one who presented different from the others (generic and similar) Thermogravimetric profile indicating likely interaction between the active ingredient and excipients. Was observed at the heating rate of the inverse temperature that no linearity of the data, ie, there was no correlation between the percentage of mass loss and the activation energy involved in the thermal decomposition of the pharmaceutical formulation of the AAS reference log graph. The analysis by differential scanning calorimetry was performed in nitrogen atmosphere with a heating rate of 10 ° C min-1. In the analysis of these same drugs, the data curves found on the melting point were, except for hydrochlorothiazide, are consistent with the literature. Hydrochlorothiazide presented a melting point well below that found in the literature, which may be justified due to the interaction of the active ingredient with the excipient lactose. In the study of purity, using the Van't Hoff equation, the reference drugs hydrochlorothiazide and mebendazole reference generic and showed similar impurity content below the limit established that this equation must be greater than 2.5 mol%

Biblioteca digital de teses e dissertaçoes: uma referência fundamental

OLIVEIRA, Raimundo Muniz de. Biblioteca digital de teses e dissertaçoes: uma referencia fundamental. In: CINFORM ENCONTRO NACIONAL DE ENSINO E PESQUISA DA INFORMAÇAO,HUMANISMO E DESENVOLVIMENTO CIENTIFICO E TECNOLOGICO,7.,2007,Salvador. Anais...Salvador:UFBA, 2007.Disponivel em:www.cinform.ufba.br>. Acesso em: 27 set. 2007. Acesso em: 27 set. 2010.

Avaliação das pressões respiratórias máximas em crianças e adolescentes da grande Natal: elaboração de uma equação preditiva

The human respiratory system was so designed that would allow efficient ventilation, regardless of variations in the external environment that may hinder the act of breathing, such an act involves dozens of variables, among them we find the respiratory depression, which is nothing more than respiratory muscle strength. The pressures are widely used in several cases: Neuro-muscular; evolution of pulmonary dysfunction and a predictor for discontinuation of mechanical ventilation. Therefore it was proposed to carry out evaluations of these respiratory pressures for children and adolescents aged 10 to 16 years and propose a predictive equation that involves the anthropometric variables age (A, years), body mass (BM, kilograms) and height (H, meters) with maximal respiratory pressures (maximum inspiratory and expiratory pressure). Evaluations were performed in this age group of students in public and private schools of the Grande Natal , measurements were performed using the analogue manometer, were children and adolescents and their parents gave informed consent. 517 samples were taken, and 250 for males (M), 255 for females (F) and 12 were excluded according to our exclusion criteria. The sample was subdivided into three age groups (10-11, 12-13 and 14 to 16 years old). It was found through the student s t test (p ≤ 0.05) for all variables studied, children and male adolescents had higher means than females, except for the MC. For the correlation between the variables found significant correlation (p <0.05) among all the variables when analyzed as pairs except between MIP and height for females. The development of predictive equations (for p ≤ 0.05) based on three types of strategies adopted were restricted to two association between anthropometric variables isolated, resulting in: for males: MIP = -32.29 + (-2.11*A) + (-0.52*BM), MIP = 9.99 + (-0.36*BM) + (-49.40*H); MEP = 18.54 + 3.53*A + 0, 42*BM, MEP = -33.37 + 2.78*A + 52.18* H, MEP = -17.39 + 0.33*BM + 55.04*H; and, for females we find: MEP = 24.32 + 2.59 * A + 0.24*BM

Avaliação da atenção à saúde de portadores de HIV no centro de referência para o tratamento da Aids em Natal/RN por profissionais e usuários do serviço

Objective: The aim of this study was to evaluate the health care of HIV/AIDS Reference Center for treatment of AIDS in Natal/RN for professionals and service users. Methods: This is an evaluative study with a quantitative approach, performed in the outpatient Giselda Trigueiro Hospital, in Natal (RN). The target population consisted of 313 patients with HIV and 34 professionals of the center. Data collection occurred from august 2007 to july 2008, with a structured form of interview, validated through a pilot study. The data were analyzed by descriptive and inferential statistics. Results: The evaluation of the service was considered unsatisfactory by 85.6% users. However, 58.8% of professionals considered it satisfactory. There was difference in the evaluation of the following indicators: the relationship professional users, offering support, timeliness of professional guidelines on the treatment. There was similarity in the following indicators: physical structure, respect for privacy, opportunity to make complaints, hospitality, convenience of schedules, availability of ARVs and laboratory tests, and ease of access. Conclusion: The results point to dissatisfaction of the users and professional satisfaction with the health care of people with HIV / AIDS in the service searched. It was found that the indicators used in this study may be considered relevant to evaluate the service in question, as well as monitoringparameters provide acceptable quality of health care by the National STD/AIDS

Estado nutricional antropométrico, composição corporal e pressão arterial em adolescentes

Os objetivos deste trabalho foram: (1) estimar as prevalências de excesso de peso e de gordura corporal, obesidade central e pressão arterial elevada (PAE) em adolescentes beneficiários do Programa Nacional de Alimentação Escolar (PNAE) da rede municipal de ensino de Natal-RN; (2) verificar a associação entre variáveis antropométricas e de composição corporal com a pressão arterial, a maturação sexual e a história familiar positiva de fatores de risco para doença cardiovascular (FRDCV); (3) comparar dois padrões de referência para classificação do excesso de peso em adolescentes; e (4) propor equações preditivas de massa gorda (MG) e massa livre de gordura (MLG) baseadas nos perímetros corporais. Trata-se de um estudo transversal, com 526 adolescentes beneficiários do PNAE, em Natal, Brasil. O tamanho da população de estudo foi definido por amostragem aleatória, em dois estágios, e ponderada segundo número de alunos de cada escola. No primeiro estudo, o excesso de peso foi determinado por Índice de Massa Corporal (IMC), a gordura corporal estimada por dobras cutâneas e a obesidade central por perímetro abdominal. A pressão arterial elevada foi classificada conforme a American Academy of Pediatrics. As prevalências foram apresentadas em valores relativos e efeito do desenho. Realizou-se uma análise fatorial para sintetizar o conjunto de variáveis antropométricas visando identificar fatores comuns. Extraíram-se dois fatores: (1) padrão excesso de adiposidade e (2) padrão adiposidade central elevada. Para avaliar a associação entre os padrões de adiposidade corporal com pressão arterial elevada, faixa etária, maturação sexual e história familiar de FRDCV utilizou-se a Razão de Chances e respectivo intervalo de confiança de 95% e regressão logística. No segundo estudo, calculou-se a sensibilidade e a especificidade do excesso de peso classificado segundo o IOTF e a World Health Organization WHO em relação ao excesso de adiposidade corporal; e a estatística Kappa para medir a concordância entre os dois padrões de referência. No terceiro estudo, foram elaborados modelos preditivos de MG e MLG com base em nove perímetros corporais, utilizando a bioimpedância Byodinamics 450 como padrão de referência. Para tanto foram selecionados 218 adolescentes eutróficos, segundo o IMC a partir do estudo transversal. As equações foram estimadas por regressão linear múltipla, considerando a idade e os perímetros corporais. Os resultados apontaram que 14,1% dos meninos e 15,7% das meninas tinham excesso de peso; 15,3% dos meninos e 11,6% das meninas tinham excesso de gordura corporal e dentre os meninos 14,3% tinham pressão arterial elevada e as meninas, 21,4%. Todos os efeitos do desenho foram inferiores a 2,5%. Nos meninos, o padrão excesso de adiposidade foi associado à história familiar positiva de FRDCV (ORajust=2,60; 1,09-6,22), maturação sexual (ORajust=2,92; 1,04-8,22) e PAE (ORajust=3,66; 1,34-9,94). Os meninos com 12 anos e mais apresentaram 6,1 vezes mais chance de apresentar padrão adiposidade central elevada do que os adolescentes com 10 a 11 anos (IC95% 2,32-16,04), assim como os púberes apresentaram 3,2 vezes este mesmo padrão em relação aos pré-púberes (IC95%1,14-8,85). A partir da comparação entre os dois padrões de referencia de classificação do excesso de peso por meio do IMC, observou-se que a sensibilidade foi de 79,3% para o critério IOTF e de 88,9% para WHO e a especificidade foi de 94,7% e 89,9%, respectivamente. O nível de concordância foi maior para o critério IOTF (Kappa=0,70 x Kappa=0,64). Em relação à construção das equações preditivas de gordura corporal, do total de 106 meninos e 112 meninas, foram desenvolvidas duas equações para estimar MG e duas para MLG, considerando o sexo. No sexo masculino, a equação para estimar a MG incluiu as variáveis idade, punho, quadril e perímetro abdominal (R2=0,552; AIC=416,04) e MLG, idade, punho e antebraço (R2=0,869; AIC=578,24). Enquanto que no feminino, MG foi estimada pelas variáveis punho, perímetro do abdômen, do quadril, da coxa proximal e da panturrilha (R2=0,838; AIC=415,36); e a MLG por idade, punho, perímetro do abdômen, do quadril e da panturrilha (R2=0,878; AIC=512,48). Conclui-se que os adolescentes tinham elevada prevalência de excesso de adiposidade corporal e de pressão arterial elevada. Tanto o padrão excesso de adiposidade quanto adiposidade central elevada constituem-se em padrões de risco. O padrão excesso de adiposidade foi associado à pressão arterial, história familiar positiva de FRDCV e maturação sexual em meninos. O critério IOTF mostrou-se menos sensível, mais específico, com maior nível de concordância e maior probabilidade de identificar corretamente o excesso de gordura corporal nos adolescentes avaliados. Quatro equações foram desenvolvidas para a estimativa da MG e MLG em adolescentes. As equações desenvolvidas para estimar a MG no sexo feminino e MLG para ambos os sexos apresentaram valores elevados de coeficiente de determinação ajustados e, portanto, são as preferenciais. Este estudo foi realizado com a participação de equipe multidisciplinar composta por professores da área de Nutrição, Endocrinologia Pediátrica, Estatística, Educação Física, discentes do Curso de Graduação em Nutrição e residentes em Pediatria

Valores de referência para cobre e zinco no plasma e no eritrócito em adultos universitários na cidade de Natal-RN

This study aimed builds reference values for copper and zinc, of healthy adults in Natal-RN, and to identify the influence of the gender, age, body mass index (BMI) and diet, on those values. They were assessed 123 healthy students of the Universidade Federal do Rio Grande do Norte (UFRN), both genders, with age between 19 and 41 years. The project was approved by the Ethics Committee in Research of UFRN. BMI was determined and the food consume was accomplished through a 24h recordatory. Dietary was evaluated as the energy, macronutrients, copper and zinc, according to the recommendations of National Academy of Sciences (2001; 2002). Analyses of the copper and zinc concentrations in the plasma and erythrocytes were accomplished by flame atomic absorption spectrometry. The casuistic came quite homogeneous as for the distribution for gender and age, being the largest number of individuals between the 19 and 24 years old. Most of the volunteers presented anthropometric nutritional state inside of the normality patterns. Chronic diseases family antecedents and sedentarysm were observed. Diet was characterized with low consumption of zinc, appropriate of copper and of lipids. Average concentrations of plasma copper (p=0,002), erythrocyte copper (μg/dL, p=0,036; μg/gHb, p=0,038), and plasma zinc (p=0,022) were different among the genders, what was demonstrated by the largest values of copper in the female gender and larger of zinc in the masculine. Plasma copper values still suffered interference of the variables: energy, carbohydrate and copper consumption, all classified in agreement with the median, besides the protein classified according to the percentage contribution for the dietary total energy. The study allowed to establish reference values for erythrocyte zinc (1.261,6-1.344,0 μg/dL e 51,0-54,3 μg/gHb) and to suggest "indicative" of reference values for plasma (108,4 130,2 μg/dL) and erythrocyte (female = 85,0 91,4 μg/dL; masculine = 80,2 86,5 μg/dL) copper and plasma zinc (female = 98,8 105,8 μg/dL; masculine = 104,6 111,6 μg/dL)

FERRITINA: intervalos de referência para adultos no Estado do Rio Grande do Norte

Ferritin is a protein composed of heavy and light chains, non-covalently linked and which accommodates, in its core, thousands of atoms of iron. Furthermore, this protein represents the stock of iron in the body and it is characterized as an acute marker and predictor of diseases, such as iron deficiency anemia, hereditary hemochromatosis and others. Considering the variability of reference values and the analytical methods currently available, the aim of this work was to propose 95% confidence intervals for adults in the State of Rio Grande do Norte, Brazil, after determining the average concentration of serum ferritin for both sexes, beyond its correlation with the age. We analyzed 385 blood samples, collected by venipuncture from individuals residing in the State, after 12-14 hours of fast. The populational sample had 169 men and 216 women between 18-59 years old, which filled a questionnaire on socioeconomic, food habits and accounts about previous and current diseases. The sample collections were itinerant and the results of erythrogram, fasting glucose, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, urea, creatinine, leukocyte count and platelets, beyond C-reactive protein, were issued to each participant, so that, after selection of the apparently healthy individuals, the dosage of serum ferritin was carried out. Statistical analysis was performed using the softwares SPSS 11.0 Windows version, Epi Info 3.3.2 and Graf instant pad (version 3.02), and the random population sample was single (finite population), for which the test of linear correlation and diagram of dispersion were also made. After selection of individuals and determination of serum ferritin, the most discrepant outliers were disregarded (N = 358, Men = 154/Women = 207) and the average value determined for the masculine sex individuals was 167,18 ng / dL; for the feminine sex individuals, the average value obtained was 81,55 ng / dL. Moreover, we found that 25% of men had values < 90,30 ng / dL; 50% ≤ 156,25 ng / dL and 75% ≤ 229,00 ng / dL. In the group of women, 25% had values < 38,80 ng / dL; 50% ≤ 65,00 ng / dL and 75% ≤ 119,00 ng / dL. Through the correlation coefficient (r = 0,23 with p = 0,003), it is possible to suggest the existence of positive linear correlation between age and serum ferritin for men. The correlation coefficient for women (r = 0,16 with p = 0,025) also confirms the existence of positive linear correlation between serum ferritin and age. Considering the analysis carried out and specific methods corroborating with the proposed benchmarks, we concluded that the average value found for men is higher than that found for women. Furthermore, this scenario rises with age for both sexes, and the 95% confidence intervals obtained were 74 ng/dL ≤ μ ≤ 89 ng/dL and 152ng/dL ≤ μ ≤183ng/dL for the feminine and masculine sex individuals respectively

Determinação dos intervalos de referência para lipídios, lipoproteínas e apolipoproteínas no estado do Rio Grande do Norte

The lipid profile is a group of lab tests that include triglycerides, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). However, serum non-HDL-C, Apo A-I and Apo B levels, as well as the lipids ratios (TC/HDL-C, LDL-C/HDL-C and Apo B/Apo A-I), have been described as better predictors of cardiovascular diseases. Reference intervals are tools often used to help the evaluation of the people s health state. These days, Brazilian studies still use the reference intervals of lipids and lipoproteins from other countries, ignoring differences between the populations. Therefore, this study aimed to establish reference intervals for lipids, lipoproteins and apolipoproteins in adults of Rio Grande do Norte/Brazil. Healthy individuals (96 men and 283 women) between 18 and 59years old formed the reference sample group. The samples were collected after fasting 12 to 14 hours. Information on lifestyle and dietary habits of the participants were obtained through questionnaire. The serum glucose level and renal and liver activity were evaluated by laboratory testing. The results of lipid profile were analyzed according to sex, age and mesoregion of Rio Grande do Norte, with significance level of 5% (p < 0,05). The lower and upper reference limits were identified by the 2.5 percentile and 97.5 percentile, respectively, and assurance intervals of 90% was calculated for each of these limits. Among the determinants of lipid profile analyzed, only a few significant differences were observed according to sex, but in terms of age, the groups of smaller and older ages were most likely different. When evaluated by region, the means of West region shown the most significant variations. Not many studies were useful to compare the reference intervals determined in this study. Thus, it becomes necessary to carry out similar studies in other regions of Brazil and of the world given the clinical importance of reference intervals

Implementação da política de assistência social em Mossoró/RN : uma avaliação a partir dos centros de referência da assistência social

The current National Policy for Social Assistance (PNAS) is the instrument that regulates the organization and procedures of social-welfare actions. Developed and approved in 2004 since the Unified Social Assistance System (ITS) was crated in 2003, it reaffirms the democratic principles of the Social Assistance Organic Law (LOAS) focusing on the universalization of social rights and equality of rights when accessing the social-welfare system. In the SUAS point of view, the PNAS highlights the information, monitoring and evaluation fields for being the best way to assure the regulation, organization and control by the Federal Government paying attention to the principles of decentralization and participation. This political-institutional rearrangement occurs through the pact among all the three federal entities. The pact deals with the implementation of the task. It says that it has to be shared between the federal autonomous entities, established by dividing responsibilities. To the cities, considered as the smallest territorial unit of the federation and closer to the population, was given the primary responsibility, which is to feed and maintain the database of SUAS NETWORK and identify families living in situations of social vulnerability. In addition to these responsibilities, the cities that have full autonomy in the management of their actions, have the responsibility to organize the basic social protection and the special social protection, that using the Center of Social Assistance Reference (CRAS) and the Center of Specialized Social Assistance Reference (CREAS), are responsible for the provision of programs, projects and services that strengthen the family and community; that promote people who are able to enjoy the benefits of the Continuing benefit of Provisions (BPC) and transfer of incomes; that hold the infringed rights on its territory; that maximize the protective role of families and strengthen its users organization. In Mossoró/RN, city classified as autonomous in the social assistance management, has five units of CRAS that, for being public utilities, are considered the main units of basic social protection, since they are responsible for the connection between the other institutions that compose the network of local social protection. Also known as Family House, the CRAS, among other programs and services, offers the Integral Attention to Families Program (PAIF), Juvenile ProJovem Program, socio-educational coexistence services programs, as well as sending people to other public policies and social-welfare services network, provides information, among others. In this large field, social workers are highlighted as keys to implement the policy of social assistance within the city, followed by psychologists and educators. They should be effective public employees, as a solution to ensure that the provision of the services are to be continued, provided to the population living around the units. However, what we can find here is inattention to the standard rules of social assistance, which not only undermines the quality of programs and services, but also the consolidation of policy on welfare as public policy of social rights

Atenção ao usuário em um centro de referência HIV/Aids: perspectiva de profissionais e usuários

We study the health care focused on care in an intercessor and dialogical relationship with the User, which involves the construction of therapeutic projects essential to the quality of the treatment of the user in health services, and it is necessary individual and collective actions. It is intended to acknowledge and analyze the perception of social subjects, users and professionals on the treatment given to a user of a Specialized Outpatient Service (Serviço Ambulatorial Especializado SAE) in STD/HIV/AIDS state reference in Natal, RN. The study is structured in a transdisciplinary vision of science and knowledge, theoretical and methodological principles that give meaning to the expression of the institutional features of care and health care reconnecting them to the social context. As a research strategy we seek the expressions of 56 subjects of social research, which agreed to participate in the sample, from a symbolic map of the attention, coupled with the techniques of observation and semi-structured interview. For the analysis of the results, five categories of analysis were established: the meaning of the service, care perception, process of communication and interaction, treatment perception and organization and evaluation of the service. It is argued that the attention and care are developed in a technical health care assistance to the disease, focusing on attention based on treatment, on diagnostic and drug therapy of antiretroviral drugs, reflecting the traditional biomedical paradigm of attention to the disease. This is also the mode of organization of practical actions in daily SAE: the therapy proves to be fragmented in several specialties, vertical and feeds the same model, generating tension and overload for professionals; showing impersonal care focused on structured and informative technology, unrelated to an interactive dialogic. From the speech of the subjects, the SAE is understood as the place of confrontation with the disease, but also enables greater elaboration of the illness by meeting their peers. Living with HIV and AIDS is living with concern, apprehension and fear, but mainly with the stigma, prejudice and exclusion, which require that the disease is kept in secret. There is a movement of forces and power, expressed in the knowledge-power of those who dominate the technical and administrative capabilities, devices that concentrate the maintenance of the medicalization of care, rapid consultations and with little attention, making it difficult to interact with and listen to, combined with structural failures, organizational and inadequate management of the service. We conclude that there are dimensions that are not considered in the internal dynamics of the care service multiple forms, characterized by care conflicting models, marked by individual interventions related to the disease. The subject is not considered together with his speech as technical discourse is imposed and care production based on material technology is observed

Assistência a mulher com câncer de mama em um cenro de referência no Estado da Paraíba

The assistance to women who have breast cancer is studied in a Reference Center in Paraiba and also the way this assistance is performed in a School Hospital maintained by SUS (Single Health System) is questioned. Breast cancer demands institutional organization, provision of financial, material and human resources, requiring, from the health system, effective assistance with new technologies which make it possible for the population their access to specialized medical services although it not always is able to guarantee those services nor the rights which the legislation granted them, inhibiting a proper relationship between the health professional and the patient. The theme is discussed through a transdisciplinary knowledge view and has as its theoretical referential the contribution of classical and contemporary authors from the human and social sciences and, as an empirical research strategy, the structured interview. The objectives of the research were: identify how the assistance to women with breast cancer is carried on at a Reference Center on Oncology in Campina Grande, Paraiba, identifying their difficulties and their satisfaction with the received assistance; draw up a profile of the women with breast cancer who were assisted in this Reference Center; understand their gynecological and obstetric antecedents, life styles, age group and stage of the disease when the treatment started; check their knowledge about their rights and which benefits they had received. Most women ranged between 40 and 59 years old (63%), which corresponds to the risk range of developing breast cancer. As to their occupations, 38.3% were housewives and 30.1% retired, whose family income was among those who received between less than a minimum salary and one minimum salary (58.2%). This population was mainly constituted of married women (60.2%), whose most frequent schooling was an incomplete elementary school (27.6%) and complete elementary school (24.1%), which added up to 51.6%. It was observed that the majority of the women seemed to be satisfied with the assistance received, noting that a minimum care was enough to define this satisfaction, although it is perceived that the access to the health system does not ensure the ideal attention conditions they need; it was verified that the availability of the services and the assistance itself are seen (in the local culture) as a favor and not as a right. It is also observed that only 30% of the women mentioned that they knew about their rights and the most mentioned ones were the disease assistance (13%), the medicines (13%) and the treatment (12%), which represent the most important triad to face the disease and around which the oncologic assistance most focus on. It is concluded that the condition of the users´ minimum existential of a public health unit and the condition of belonging to a lower social stratum were variables that influenced the respondents´ satisfaction in relation to the assistance received but the importance of the Reference Center for the women with breast cancer´s assistance for the whole region cannot be denied as well as the need to broaden the way the policy of the oncologic assistance in Brazil in the local realm is seen

Narrativa autobiográfica como prática de formação e de atualização de si : os grupos referência e o grupo reflexivo na mediação da constituição identitária docente

The thesis: "autobiographical narrative as practical continuous training and updating of itself: the groups-reference and the reflexive group in the mediation of identity construction of teaching" begins in the founder matter: "What are the implications of groups-reference in the process of identity formation and the teaching role of teachers which is participating of the research? This object of study deals with the continuing education of teachers of Basic Education and the role of the reflective group as space-time of (re) construction of educational knowledge, for the recognition of yourself. The thesis defends that the autobiographical narrative, as a pedagogical tool and research, for the initial and continuous training, is presented as theoretical and methodological foundation necessary for identity formation of the teacher. The research is limited to the qualitative approach with a focus on the autobiographical narrative. The participants are six teachers, three teachers and three students-teachers. The corpus comprises six autobiographical narratives, six reports of successful experiences, two studies on the biographical work, and six individual testimonials about the impact in personal and professional life. The data analysis was to reference Dausien and Alheit (2006), Bruner (1997), Contreras (2002), Delory-Momberger (2007), Freire (2005), Giddens (2002), Josso (2004), new (1988, 2002), Passeggi (2001, 2002), Pineau (2004), Ricoeur (2004), Souza (2006), Tardif (2002) and Vygotsky (2005). The research revealed that the formation of identity as a teachers of the educators occurred in the reference group, involving the formal, non-formal and informal of the processes of knowledge , in a movement of alternation training that includes yourself, the other and the ambient. Also revealed that the pedagogical choices of the teachers studied aimed at minimizing educational gaps that were lived in both field personal and social; that the personal identity is configured as an identity narrative and the methodology of the biographical work, through the mimesis of continuing education, provided the passage from the group reflective to the group of reference

Construindo um modelo de referência ao despertar do interesse dos sujeitos em projetos educativos em ambiente on-line

This dissertation was written for the making of a model to be used as reference to the construction and diagnoses of educational projects in on-line environments. The model approaches a series of characteristics, technical and humans, which if considered can increase the potential of awake the interests to the active use of these projects for the students and build conditions to the development of an active posture by the students, fundamental factor to the educational advances. Focused in the students, not in the technology in use, we propose this model as a guide, reference to be used in a critical way in relation with every educational context. This research was made from the qualitative category, trough the method of study of case, using as reference to the analysis the use of the website guanabara.info - website outside of the school context - by it users, heard through the internet, by the use of semi-opened interview, in a data taken of the primary type. We follow as theoretical references Paulo Freire´s work, considering his vision of education and the building of knowledge as a process which occurs between man, and Celestín Freinet, in his pedagogy of humanized and critical insertion of the technologies in the school. At the end, we show the practical utilization of the model constructed using it for the diagnostics of an educational project in the on-line educational environmental moodle