Estratégias de intervenção utilizadas por enfermeiros da ESF do município de Natal/RN no controle do câncer do colo de útero

Cancer of the cervix (cervical cancer) is the second most prevalent cancer among Brazilian women. The high rates of cervical cancer in Brazil justify the implementation of effective strategies to control this, which include actions to promote health, primary prevention, early detection, screening, treatment and palliative care. Despite the existence of the National Programme for Control of the CCU there was no reduction in the incidence and mortality of this disease in Brazil. The Family Health Strategy (FHS) has the potential to facilitate such control and, in this context, one should consider that nurses play a central role. The study aimed to know the general intervention strategies used by nurses FHS of Natal / RN in CCU control, and how specific: analyzing the knowledge of these nurses on the CCU, the actions developed in the ESF for the control of CCU and identify the difficulties faced by them to perform it. This is a descriptive exploratory quantitative developed through a structured interview guide with 106 nurses who have experience in controlling the CCU in FHS teams of Natal / RN. Data analysis was performed using descriptive statistic s. The results pointed to actions taken in the FHS to control the CCU, collection of cervical cancer screening, health education activities, nursing consultation, referral of suspected cases for medical monitoring and active women with abnormal test result . The actions that were not mentioned by the nurses included: forming groups of prevention and health promotion; expand coverage of exams and office hours of consultations, establishment of alternatives to end the pent-up demand in the health units, participation in treatment or rehabilitation process users with the CCU; interventions for pain management, alliances and partnerships with schools, in dustry and the use of protocols. This study can be seen that the practice nurses partially shares to the CCU in Natal / RN. The participants of this study, when asked about the CCU, specifically for signs and symptoms of disease and risk factors in general showed important gaps. Difficulties such as lack of materials for collection of Pap smear; inadequate physical space in the Health Units; pent-up demand in the service, delay in arrival of the test results; obstacles in the actions of referral and counter-referral and cultural factors make the CCU control is compromised. It is believed in this research contributed to a reflection on the importance of the role of nurses in the development of the ESF control actions CCU, pointing out the factors that affect these. It is important to involve all nurses who comprise the ESF as knowledgeable of the risk factors, signs and symptoms, and existing tools for the early detection of cervical cancer in the pursuit of quality improvement actions to promote women`s health, contributing in planning future interventions that may reduce mortality from this disease in Natal / RN.

Análise da presença de agentes mutagênicos nas águas do Rio Pitimbú/RN

The Pitimbu River is located at the oriental portion of the State of Rio Grande do Norte, including three importants cities named Macaíba, Parnamirim e Natal. Although its high importance as a water source, which supplys great part of the South Zone of the Natal city, this river receives a large quantity of domestic and industrial waste water without treatment. The Pitimbu River headhas its river-head located in the city of Macaiba, goes through Parnamirim, then it flowing into at the Jiqui Lake in Natal. The aim of this study was to evaluate, qualitatively and quantitatively, the environmental quality of the Pitimbu River by genotoxicity bio-assays, which are important tools for genetics toxicological evaluation. In this work, five samples sites, distributed along the river, were used to collect water samples. Another point site, located near Jiqui lake, was used to collect drinkable water, which was treated by CAERN, the water treatment entreprise of Rio Grande do Norte. The following assays where used to evaluate the quality of these samples: Allium cepa assay; Comet assay; Micronuclei (MN) assay; and Ames test. For the Allium cepa assay, sixteen specimes where used for each water sample from the sample sites. In this assay both microscopic, like cytogenetic damage, and macroscopic aspects, as morphological variation were evaluated. Red blood cells from periferical blood of the Crenicichla menezesi native specie were used not only for the MN assay, but also for the Comet assay. These fishes were collected at different points on the Pitimbu River and the negative control was developed using fishes of the same species that were bring to the laboratory and maintained for 100 days in the optimal experimental conditions. For the Ames test, TA100, YG1042, TA98 and YG1041 strains were used in the directed method without metabolic activation. The results found by the Allium cepa assay showed that two water sample sites induced increase of mitotic index (IM). Additionally, compared to the control, all the water samples increased the chromossomal aberrations frequency and/or micronucleus. Among the sample sites, two also showed an abnormal growth rate in its root and two samples induced morphological alteration. With the MN test in red blood cells, a high frequence of MN was observed in tree sample. By comparing all the results obtained on the water sample points and with the negative control, a significant variation on the MN frequency was observed. Positive results were also observed for the same sample to water test by the Comet assay. These results allow concluding that the proposed specie Crenicichla menezesi has a good profile as a bio-indicator for the evaluation of environmental water quality and the MN and comet test can be usuful for in situ evaluation. By the Ames test, it was possible to detect the mutagenic activity on the waters from the Pitimbu River in different levels of mutagenicity. This result suggests that this river has several substances that induced changes directly to the DNA. The mechanisms involved to this phenomenon could be by both processes, by changing of the reading frame and by nucleotide substitution. These data set indicate the presence of mutagenic agents, which can represent in risk to biot and human beens