Gestação após gastroplastia para tratamento de obesidade mórbida: série de casos e revisão da literatura

Objetivo: relatar a evolução de uma série de casos de gestação em mulheres previamente submetidas à cirurgia de bypass gástrico para tratamento de obesidade grave. Métodos: cinco casos consecutivos de gravidez após gastroplastia ocorridos entre 2001 e 2004 foram avaliados. As pacientes tinham idade entre 30 e 34 anos e todas haviam sido submetidas à cirurgia de Capella. Aspectos clínicos, laboratoriais e do acompanhamento materno e fetal foram considerados, durante o período gestacional e após o parto. Foi realizada revisão da literatura internacional, por meio das bases de dados MEDLINE e Web of Science, utilizando os seguintes unitermos: gastroplasty, gastric bypass surgery, bariatric surgery e pregnancy. Resultados: todas as gestações observadas foram únicas e não ocorreram complicações obstétricas, durante o seguimento pré-natal e parto. Também não houve registro de recém-nascidos prematuros ou de baixo peso ao nascimento. Conclusão: nossos dados sugerem que a gravidez após gastroplastia é segura para a mãe e feto. Entretanto, em virtude do limitado volume de informação disponível sobre o tema, investigações adicionais são necessárias para estabelecer recomendações apropriadas com relação ao seguimento dessas gestações _________________________________________________ABSTRACT Purpose: we report a small series of pregnant women who underwent gastric bypass surgery for severe obesity, with a review of the literature on this topic. Methods: five consecutive cases of pregnancy after gastroplasty between 2001 and 2004 were evaluated, and clinical, laboratory and therapeutic features were considered. Patients were 30 to 34 years old and all had been submitted to gastroplasty by the Capella technique. The outcomes for both the pregnant woman and the fetus were evaluated. A search of the English language literature was done through MEDLINE and Web of Science databases with the following terms: gastroplasty, gastric bypass surgery, bariatric surgery, and pregnancy. Results: all 5 pregnancies were singleton. No major obstetric complications were observed and there were no premature or lowbirth weight infants. Conclusion: our data suggest that pregnancy following gastroplasty is safe for mother and fetus. However, since information about this topic is limited, further investigations are required to establish appropriate recommendations concerning the follow-up of these pregnancies

Gestação após gastroplastia para tratamento de obesidade mórbida: série de casos e revisão da literatura

relatar a evolução de uma série de casos de gestação em mulheres previamente submetidas à cirurgia de bypass gástrico para tratamento de obesidade grave. Métodos: cinco casos consecutivos de gravidez após gastroplastia ocorridos entre 2001 e 2004 foram avaliados. As pacientes tinham idade entre 30 e 34 anos e todas haviam sido submetidas à cirurgia de Capella. Aspectos clínicos, laboratoriais e do acompanhamento materno e fetal foram considerados, durante o período gestacional e após o parto. Foi realizada revisão da literatura internacional, por meio das bases de dados MEDLINE e Web of Science, utilizando os seguintes unitermos: gastroplasty, gastric bypass surgery, bariatric surgery e pregnancy. Resultados: todas as gestações observadas foram únicas e não ocorreram complicações obstétricas, durante o seguimento pré-natal e parto. Também não houve registro de recém-nascidos prematuros ou de baixo peso ao nascimento. Conclusão: nossos dados sugerem que a gravidez após gastroplastia é segura para a mãe e feto. Entretanto, em virtude do limitado volume de informação disponível sobre o tema, investigações adicionais são necessárias para estabelecer recomendações apropriadas com relação ao seguimento dessas gestações

Definições para o resultado de enfermagem comportamento de prevenção de quedas: uma revisão integrativa

Devido à necessidade de mensurar o risco de quedas em concordância à linguagem padronizada de enfermagem, foi selecionado o resultado de enfermagem Comportamento para Prevenção de Quedas da Nursing Outcomes Classification (NOC), com objetivo de identificar evidências sobre seus elementos, mensuração, comparação com indicadores existentes e construir definições constitutivas. Foi efetuada revisão integrativa entre abril e novembro de 2009, mediante identificação da questão, estabelecimento de critérios de inclusão/exclusão, extração das informações, avaliação, interpretação e síntese. Destacaram-se pesquisas transversais e perspectivas de especialistas. Os indicadores Uso de recursos de correção da visão e Uso de sapatos amarrados e do tamanho adequado foram considerados insuficientes para avaliar fatores de risco como déficits sensoriais e roupas/calçados inadequados. Percebe-se que algumas definições precisam ser melhor desenvolvidas e que esse resultado de enfermagem merece refinamento sobretudo referente aos indicadores. Foram identificados 22 indicadores e definições foram propostas baseadas nas evidências da literatura

Cuidados de enfermagem ao paciente em pós-operatório de prostatectomia: revisão integrativa

Este estudo trata-se de revisão integrativa da literatura com objetivo de sintetizar o conhecimento produzido em artigos sobre os cuidados de enfermagem aos pacientes em pós-operatório de prostatectomia. Para seleção dos artigos foram consultadas cinco bases de dados – SCOPUS, CINAHL, PUBMED, LILACS e Cochrane – sendo incluídos dezenove artigos. Os resultados mostram estudos que se enquadram nos níveis II, IV, V, VI e VII de evidência, a maioria realizada nos Estados Unidos durante os anos de 1999 a 2011. Os cuidados de enfermagem identificados foram agrupados em seis categorias: acompanhamento psicológico, orientações pós-operatórias, tratamento da disfunção erétil, tratamento da incontinência urinária, tratamento da dor e tratamento da hiponatremia. Conclui-se que os estudos com maior nível de evidência identificado recomendam cuidados de enfermagem centrados no acompanhamento psicológico, nas orientações do período pós-operatório e no tratamento da disfunção erétil. Destaca-se ainda que tais recomendações concentram-se, sobretudo, nas ações de apoio emocional e educativo

Integridade da pele em idosos: revisão da literatura segundo as cartas de promoção da saúde

Trata-se de uma revisão bibliográfica que objetivou relacionar as medidas educativas para a promoção da integridade da pele em idosos com as Cartas de Promoção da Saúde. Realizou-se a busca nas bases de dados CINAHL, SCOPUS, LILACS e COCHRANE, nos portais CAPES e BVS e na biblioteca PUBMED, mediante a aplicação dos descritores Health Education; Skin e Aged. Os resultados dos 7 artigos analisados apontaram como principais medidas educativas: inspeção diária da pele, cuidados com calçados e com os pés, uso regular de protetor solar e mudanças de decúbito. Essas medidas estavam relacionadas com as seguintes Cartas de Promoção da Saúde: Ottawa, Declaração de Santafé de Bogotá e Declaração de Jacarta. Conclui-se que as medidas educativas, baseadas nas Cartas, são de grande relevância para a criação de uma cultura de saúde, com enfoque na população e no indivíduo como agentes executores imprescindíveis para o alcance da promoção da saúde

Revitalização urbana de centros históricos: uma revisão de contextos e propostas: a Ribeira como estudo de caso

This dissertation focuses on the theme of urban revitalization in historical centers. It starts from a survey of international and national concepts and experiences about the subject, in special, the historical center of Ribeira, in Natal, Brazil. It gives more attention to local management and it is dedicated to the study of objectives and actions developed, basically, by two segments that manage works in the district. Companhia Docas do Rio Grande do Norte aims at the economical development of the state and it implies the enlargement of capacity of loading and unloading of the harbor of Natal and the Natal city counsil aims at urban preservation and revitalization. It was analysed speeches ans projects related to Ribeira and it was discovered that Natal has done very little to revitalize its historical center in the last two dacades. It analyses what seemed, or at least, should be a conflict of interests between incompatible projects, revealing both conciliatory proceedings and connivance between the participants in decision making. The conclusion directs attentions to the threat to historical building in the city and the importance of enhancing discussion about the future of our historical sites

Morbimortalidade perinatal associada à infecção clamidiana: uma revisão sistemática

Universidade Federal do Rio Grande do Norte

Programas de exercícios físicos e níveis de biomarcadores inflamatórios em mulheres com distúrbios metabólicos: uma revisão sistemática

Uma grande quantidade de informações dá suporte à relação existente entre inatividade física e processos inflamatórios latentes em distúrbios metabólicos. O objetivo deste trabalho foi acessar criticamente o corpo de evidências existentes na literatura sobre a associação entre programas de exercícios físicos e os níveis de biomarcadores inflamatórios em mulheres entre 18 e 82 anos de idade. Foram realizadas buscas bibliográficas sistemáticas usando as bases de dados PubMed Medline, Cochrane Central Register of Controlled Trials, Web of Science, LILACS e SciELO de publicações entre janeiro de 1993 e janeiro de 2012 usando os seguintes termos: inflamação, citocinas, exercícios, treinamento físico, treinamento aeróbico, treinamento cardiovascular, treinamento de força, treinamento contra resistência, treinamento intervalado, reabilitação cardíaca e gerenciamento/modificação terapêutica de estilo de vida. Do total de estudos incluídos na revisão, três deles reportaram mudanças não significativas nos níveis de biomarcadores inflamatórios, um estudo documentou um aumento nos biomarcadores e 12 estudos reportaram decréscimos nos níveis de biomarcadores inflamatórios associados com exercício. Características secundárias do estilo de vida, como trabalho físico extenuante e fumo, afetaram os níveis de biomarcadores inflamatórios. Intervenções integrativas incluindo dieta, exercício aeróbico moderado (60% a 80% da frequência cardíaca máxima ou 50% a 60% do VO2Máx), treinamento contra resistência em circuito (8 a 10 exercícios, 8 a 12 repetições), aconselhamento e educação voltados para a saúde, usados conjuntamente, se apresentaram como possíveis estratégias efetivas na melhoria nos níveis de biomarcadores inflamatórios em mulheres

Do controle de constitucionalidade dos atos jurisdicionais transitados em julgado

The following study aims to verify in which hypothesis res judicata, when it comes of an unconstitutional decision, shall not prevail over Constitution. It displayed the characteristics of formal and material constitutional systems. It debated the concepts of existence, validity and efficacy of juridical rules and acts. It dissertated about the idea of Constitution s superiority and about the birth of the judicial review of constitutionality. It focused some contemporary models of this judicial review and its historical evolution in Brazil, showing its effects towards the current Constitution. It sustained that the decision given by Supremo Tribunal Federal during abstract control of rules must bind even legislative bodies, preventing them to produce the same rules previously declared unconstitutional. It held up that all parts of the decision of Supremo Tribunal Federal oblige, even the juridical arguments employed, in both diffused and concentrated reviews. It showed that, despite these models of review live together in Brazil, our constitutional system preferred the concentrated one, considering one only court over the other constitutional organs. It discussed about res judicata with the purpose of clarifying its juridical nature, its objective and subjective limits and its regulation in collective demands. It explained that the material res judicata is an effect of a decision which cannot be reviewed, which makes the law s will free of discussion, binding the contendants and avoiding that other courts, judging future demands about the same object, may decide differently. It showed how the regulation of res judicata in collective demands, in respect oh their subjective limits, is useful to demonstrate that it is not the material law who must adapt itself to res judicata as traditionally thought, but res judicata, as a warranty of juridical certainty and security, who must be shaped from the debated rule. It presented to view the main doctrinal conceptions about res judicata s review in the hypothesis of unconstitutional judgement. It concluded that the decisions forged by unconstitutional rules or interpretations reputed not compatible to the Constitution by Supremo Tribunal Federal, in spite of it can make res judicata, may be reviewed beyond the term to file a recissory claim, since while the debated law is still valid, no matter if its decision was before or after the res judicata. At the end, it asserted that, when it is not legally authorized, the judicial review of res judicata is not admissible, after the term to file a recissory claim, under the argument that there was no direct violation to the constitutional principle or rule

Direito fundamental ao tempo razoável do processo judicial: limites e possibilidades de concretização no ordenamento jurídico pátrio

This dissertation aims to address the limits and possibilities of realizing the fundamental right to reasonable time of the Brazilian legal system process. From this perspective, we analyze a reasonable time concept for the process, consistent with the civil homeland process; the relationship between efficiency, effectiveness, legal security and reasonable time of adjudication; a formal recognition of the fundamental right to reasonable time of the procedure in the Constitution of 1988; and the immediate applicability of this fundamental right. As indicated, the crisis of the Judiciary and procedural delay are problems directly related to the limits and possibilities of realization of the fundamental right under study. Moreover, we also present some mechanisms that can be used to overcome these problems. The subject was developed based on constitutional interpretation of fundamental rights, an approach that will always have this concern to be based on a methodology which includes the normative and empirical-dogmatic fields, realizing the fundamental right to reasonable time of the process. We adopted as methodological approach the study of this issue in judicial aspect, more specifically in the field of civil procedure. Finally, we weave through a critical and analytical view, our conclusions, which demonstrate the possibilities of overcoming the limits imposed to immediate implementation of the fundamental right to reasonable time of the process in our legal system

Ativismo judicial e materialização das políticas públicas infanto-juvenis na constituição da república: Fixação de planos ideais de atuação para os atores do Sistema de Garantia de Direitos (SGD)

The research arose from the necessity of showing ways to be followed by the actors of the System Guaranteeing Rights of the Child and Adolescent (SGD), regarding the implementation of rights for young people, because the legislation in force in Brazil is currently considered a model around the world and, paradoxically, the fundamental rights of children and adolescents are not met, even with the constitutionally guaranteed priority. Thus, the study investigates the fundamentality rights for young people, enshrined in the Constitution of the Republic, as well as the ways of effectiveness of these rights through the actions of actors of the System Guaranteeing Rights, especially the judiciary. Focusing realized, studying theories of fundamental rights, especially Structuring a Theory of Law (Strukturiende Rechtslehre), Friedrich Müller, who emphasizes the need for analysis of social reality in the application of the rule of law. Study also the public budget and public policies concerning children and adolescents, with emphasis on preparation of budget laws and the process of discussion, deliberation, choice and implementation of public policies for children and teenagers. It then presents the typical functions of the members of System Guaranteeing Rights, as well as prepare a plan for optimum performance for each of the actors, with emphasis on analysis of the implementation of public policies at the municipal level. Finally, it analyzes the theory of separation of three powers, and discusses the positive and negative factors for judicial intervention, concluding that the Courts can consider the action activist, from finding the omission of the Executive and legislative branches, as regards the implementation of the rights of children and adolescents, as well as the rights of children and young people are not realized in most cases, due to the omission of actors of the System Guaranteeing Rights

Intervenção judicial nas sociedades limitadas em face da liberdade de iniciativa

The judicial intervention in limited liability company goes through several issues of legislative and hermeneutics origin, based considerably on the small importance given to freedom of economic initiative by the participants in the process of formation and application of the law. In addition, Brazilian law, due to incompleteness, inconsistency or lack of valid grounds, put the judge in a procedural delicate situation. Being forced to judge, the judiciary faces severe uncomfortable interpretive situations, of which derive solutions of dubious constitutionality and affecting, significantly, the dynamics of business activity. In this context, and considering the limited liability company as an expression of free enterprise, corresponding to a lawful association of people in order to undertake economically, in exercise of his freedom of contracting and professional action, intended to be offered safe parameters of constitutionality for judicial intervention in limited liability company in the hypothesis of (i) transfer of corporate shares, (ii) attachment of corporate shares, (iii) dismissal of directors, (iv) appointment of judicial stakeholders, (v) exclusion of shareholders and (vi ) trespass. The hypothetical-deductive approach was adopted, building hypotheses to overcome the gaps and unconstitutionality of the law and subjecting them to tests, reviews, and comparisons with hypothetical facts and case law in order to determine the constitutional validity of the proposed solutions. The procedure aimed to reconcile the historical, comparative, dialectical and scientific methods. The roots of temporal institutes were researched as well as current solutions provided by national and compared law. From problematizations point, addressed by the constitutional interpretation of the law and jurisprudence, responses that bring out the unconstitutionality of certain conceptions were headed

Parâmetros de concretização judicial do direito fundamental à saúde no fornecimento de medicamentos

In Brazil, social rights have always been considered secondary legal categories, whose implementation could wait for the pending of political decisions. At the end of the Second World War, International Law emphasizes the protection of human beings, raising his dignity as a legal pillar of the legal orders and one of the main foundations of Constitutions. At the post-positivism Constitutionalism, the realization of social rights receives special attention with the assumption of supremacy and normativity of the Constitutions, while the judiciary participates in the realization of democracy, not only as applicator of laws, but also as the guardian of constitutionality of the acts and administrative omissions, creatively contributing to the constitutional achievement, filling gaps and normative state omissions. In this aspect, the supply of medicines, whose costs can not be supported by the individual, keep a close connection with the right to life, health and dignity of the human being, as the subject of numerous lawsuits directed against the Public Administration. Such phenomenon has caused intense debate regarding judicial activism and legitimacy of these decisions, particularly on the need to define what are the limits and possibilities considering the principle of separation of powers and the principle of reserve of the possible; bieng this the problematic developed in this research. Thus, this research aims to verify the legitimacy of judicial decisions that determines to the Public Administration the compulsory providing of medicine to those who can not afford the cost of their treatment, as well as, contribute to the dogmatic constructions of parameters to be observed by judicial interference. Regarding the methodology, this research has an investigative and descriptive caracter and an theoretical approach based on bibliographical data collection (judicial and doutrine decisions) that received qualitative treatment and dialectical approach. As a result, it is known that the judicial decision that determines the supply of medicines to those individuals who can not afford them with their own resources is legitimate and complies with the democratic principle, not violating the principle of separation of powers and the reserve of the possible, since the judicial decison is not stripped with an uniform and reasonable criteria, failing to contain high burden of subjectivism and witch signifies a possible exacerbation of functions by the judiciary, suffering, in this case, of requirement of legal certainty. It is concluded that the Court decision that determines the government the providing of medicine to those who can not afford the cost of treatment should be based on parameters such as: the protection of human dignity and the minimum existencial principle, the inafastable jurisdiction principle; compliance critique of the possible reserve principle; subsidiarity of judicial intervention; proportionality (quantitative and qualitative) in the content of the decision; the questioning about the reasons for non-delivery of the drug through administrative via; and, finally, the attention not to turn the judiciary into a mere production factor of the pharmaceutical industry, contributing to the cartelization of the right to health

Análise do processo judicial eletrônico (PJe) sob os parâmetros da discursividade processual e do acesso democrático à justiça

The conceptions of the judicial function, the process and the factors of legitimacy of the norm of decision are changed according to the model of State (liberal, social democratic and constitutional). The right of access to justice, likewise, follows the ideals present in constitutional movements experienced in different historical moments. The deficit of legitimacy of the judiciary is recurring subject of study in the doctrine, especially in the face of democratic standards that permeate the current paradigm of state. Under the process law, the essential element for the distinction of the states based on the rule of law (formal and material) and the democratic constitutional state lies in the democratic guarantee of participation to the litigants in the process of elaborating the norm of decision. The concern about the participatory democracy and the concretion of fundamental rights has as presupposition the conception of popular sovereignty. Keeping this effort in mind, the civil procedure cannot be oblivious to such considerations, especially when it justifies its constitutional conformation from the institutionalization of discourse within the procedural field (democratic principle) and of the democratization of access to justice, leading to the necessary contestation of the theory of instrumentality of the process. The democratic prospects of civil procedure and the concern about the legitimacy of the rule of decision cannot be moved away from the analysis of the judicial function and the elements that influence the legal suit s progress. The computerization of the judicial process entails extensive modification in the way the judicial function is developed, in view of automation of activities held, of the eliminating of bureaucratic tasks, manual and repetitive, and of streamlining the procedure. The objective of this study is to analyze the dogmatic changes and resulting practices from the implementation of the Judicial Electronic Process (JEP), prepared by the National Council of Justice, under the parameters of procedural discourse and democratic access to justice. Two hypotheses are raised, which, based on a bibliographic-documentary, applied and exploratory research, are contested dialectically. The expansion of publicity of procedural acts and the facilitating of communication and practice of such acts are elements that contribute to the effective participation of the recipients of the norm of decision in its making process and, therefore, the democratic principle in the procedural field. Ensuring access (to the parts) to the case files and reasonable duration of the process along with the preservation of its founding principles (contradictory, legal defense and isonomy) are essential to ensure democratic access to justice within the virtual system

Vivência de mulheres no puerpério : significado atribuído à revisão pósparto

The consultation for women during the postpartum period should occur between the seventh and tenth days, and 42 days after childbirth, to decrease the incidence of maternal and neonatal morbidity and mortality. However, the effectiveness of such assistance in primary health care has not been achieved, especially in the forty-second day of puerperium. Facing this reality, the research aimed to understand the views of women about postpartum consultation. This is an exploratory and descriptive research with qualitative approach, developed in the municipality of Lajes/RN, Brazil, with women inscribed on the four teams that make up the Family Health Strategy. Data were collected through semistructured interviews with 15 women who met the following criteria: be enrolled in ESF; have health mental preserved, have been entered in the Humanization Program of Prenatal and Birth, and that was, at maximum, 60 days postpartum. The data were organized according to the precepts of content analysis according to Bardin, generating three categories: prevention of puerperal complications, feelings related to life changes after childbirth, and postpartum care. This process of coding and categorizing a central theme emerged: the experience of women in the postpartum period. The data were analyzed according to the principles of symbolic interactionism, according to Blumer. The study revealed that the meanings attributed to the postpartum period for prevention of complications were directly related to home, to the consultation and postpartum care provided by family members and health professionals. The interviewees strictly complied with the rest under the influence of the context in which they were entered. But that has not happened with the postpartum revision because few mothers underwent this procedure. Therefore, the interaction of the interviewed people in their living standard as well as the feelings that permeated the post-partum were crucial to consider whether or not the post-partum visit as significant. According to the results, it was noted that disability guidelines and counter-references has impaired the access of women to postpartum review. Thus, further studies are needed on the subject, as well as a reorientation of health care activities in view of the consolidation of postpartum consultation in primary care