18 resultados para contextos clínicos

em Universidade Federal do Rio Grande do Norte(UFRN)


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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

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This study has as general object: to verify as the health professionals that work in different hospitals evaluate the hospital services; and specific objectives: identify how health professionals evaluate the work conditions in different hospitals and verify the central nucleus and the peripheral elements of the social representations elaborated by these professionals about these institution. This is a descriptive study realized in Natal, capital of Rio Grande do Norte. Were collected 213 questionnaires. Concerning the evaluation of the health services, high averages had been verified in the philanthropic hospital, for example, quality of the customer service. At the state hospital was observed lowest ones: respect to the privacy of the patients. Similar results were found about work conditions. It was observed as central nucleus the categories Overcrowded and Humanized care, in the state and philanthropic hospital respectively, and as peripheral elements Low wages and Overcrowded. Being thus the conflicts in this scene are inevitable because of the poor structure of some public hospitals, however, these problems can be foresee and solvable if the hospital has a free expression channel accessible to all agents. The evaluation has to become integrant part of the culture of the organization, a time that this will guide the steps in direction to the best quality in the hospital assistance

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Conselho Nacional de Desenvolvimento Científico e Tecnológico

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Vulvovaginal candidiasis (VVC) is one of the most common causes of vaginitis and affects about 75% of women of reproductive age. The majority of cases (80 to 90%) are due to C. albicans, the most virulent species of the genus Candida. Virulence attributes are scarcely investigated and the source of infection remains uncertain. Objective: This study aimed to evaluate the virulence factors and genotypes of clinical isolates of C. albicans sequentially obtained from the anus and vagina of patients with sporadic and recurrent VVC. Materials and methods: We analyzed 62 clinical isolates of C. albicans (36 vaginal and 26 anal strains). Direct examination of vaginal and anal samples and colony forming units (CFU) counts were performed. Yeasts were identified using the chromogenic media CHROMagar Candida® and by classical methodology, and phenotypically characterized regarding to virulence factors, including the ability to adhere to epithelial cells, proteinase activity, morphogenesis and biofilm formation. The genotypes of the strains were investigated with ABC genotyping, microsatellite genotyping with primer M13 and RAPD. Results: We found 100% agreement between direct examination and culture of vaginal samples. Filamentous forms were present in most of the samples of vaginal secretion, which presented CFU counts significantly higher than the samples of anal secretion. There was no statistically significant difference between virulence factors of infecting vaginal isolates and those presented by colonizing anal isolates; as well as for the comparison of the vaginal isolates from patients with different clinical conditions (sporadic or recurrent VVC). There was a decrease in the ability to adhere to HBEC, morphogenesis and biofilm formation of the vaginal isolates during the progress of infection. There was an association between the ability to express different virulence factors and the clinical manifestations presented by the patients. Genotype A was the most prevalent (93.6%), followed by genotype C (6.4%). We found maintenance of the same ABC genotype and greater prevalence of microevolution for the vaginal strains of C. albicans sequentially obtained. Vaginal and anal isolates of C. albicans obtained simultaneously from the same patient presented the same ABC genotype and high genetic relatedness. Conclusion: It is noteworthy that the proliferation of yeast and bud-to-hypha transition are important for the establishment of CVV. The expression of virulence factors is important for the pathogenesis of VVC, although it does not seem to be determinant in the transition from colonization to infection or to the installation of recurrent condition. Genotype A seems to be dominant over the others in both vaginal and anal isolates of patients with VVC. The most common scenario was microevolution of the strains of C. albicans in the vaginal environment. It is suggested that the anal reservoir constituted a possible source of vaginal infection, in most cases assessed

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Shows up the memory of the elderly, as a consistent experience in the in the construction of the social memory of Janduís, Rio Grande do Norte, where the research takes place. Through an autobiographic narrative, in a qualitative approaching, the intent is to stand up aspects about the individual history and collective memories, starting in a simple question: what did they remember? A question that turns into many others, as how the remember and under which circumstances. So, the lived and remembered moments are the subject of this paper, as these testimonials shows and reveals the citizens typical aspects, intending to telling (again) the city s history by the memories of this people. By oral statements and the analysis that followed, subjective aspects that made a social memory, highlight in violent episodes, that, now remembered, occurred in the historical sediment, which connects several social times, establishing a narrative standard. In Janduís, this standard is about the memory that sticks out their individual ways, and the collective life, in the past, standing out the fair and the events that occurred on it, as the most remembered place, where the memories go stronger. When they narrate are incorporated others facts, the story is reinvented, connecting the past to the future. The paper also revels builders subjects aspects of a social memory, as historical sediment that joins the social times. At the present moment, the fair, to them, is a place that doesn t exist anymore; for the city, is a place of enlargement of women s presence at the trending spaces, which means a place of social transformation. That being said, the fair, in both times, present and past, turns into a analysis object, with important elements to reference narrative s time and place. And how the narrative update the past recorded in the old citizen s memory. What was intended to do was articulate the memory and the history form temporal and special etching that define the place and the narrative context: the lived and the remembered at the group s day by day. In that way, were identify the collective memory s common elements, enunciating the memory and the narratives that update that history, influencing and being influenced, forming in memories in a collective phenomenon fueling the local imaginary

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From the investigation, analysis, discussion and pondering about the activities developed by the lndians from the Porteira hamlet, members of the Xerente community, in the Tocantins state, we developed an investigative and descriptive study about the reality of this people with the aim of helping in the conceptual formation and in the reorientation of the pedagogical practice of the local teachers. In this sense, the undertaken research involved the teachers, the main representatives and experts in that cultural tradition, in order to investigate how the everyday activities (agriculture, food handling, assets distribution among the community members, etc.) and the cultural tradition (log race, body painting, clan division, Xerente numeration, Indian myths and histories, etc.), may enable the contextualization of the mathematics teaching in the lndian School Srêmtôwê of this hamlet, under a more transversal and globalizing perspective of the local and school knowledge. We based this research in the sociocultural conceptions of knowledge generation proposed by D Ambrosio (1990; 2002); Vergani (2007); Oliveras (1996); Gerdes (1991; 2002); Bishop (1999) e Sebastiani Ferreira (1997; 2004). ln the process of this study we propose some viable ways so that the Indian teachers may reorganize their classroom knowledge and actions, based in the strengthening of their history and culture. The observation of some social practices and knowledge as well as of the Xerente traditions helped us to point some possibilities of projection of a didacticalpedagogical dimension of these activities and practices, in the development of the school mathematical knowledge in this community

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O presente trabalho tem origem em nossas vivências como professora alfabetizadora na escola pública em contextos de periferias urbanas, o que nos levou ao envolvimento com questões relativas à (não)aprendizagem das crianças em seu processo de alfabetização. Por outro lado, a inserção na vida acadêmica nos aproximou de perspectivas de compreensão dos processos de aprendizagem e desenvolvimento das crianças, bem como do papel que o meio sociocultural tem nesses processos. Dessas experiências, emergiram os questionamentos que guiaram nossa investigação: em que contextos/situações crianças que vivem em um meio socialmente adverso se apropriam de conhecimentos acerca da linguagem escrita? Onde, com quem, como e o que aprendem as crianças de tal meio sobre a escrita como prática cultural? Tendo como objeto de estudo os contextos/situações em que crianças que vivem em contextos sociais marcados por condições adversas de extrema pobreza se apropriam de conhecimentos pertinentes à linguagem escrita, definimos, como objetivo, Analisar contextos/situações (intra e extra-escolares) em que crianças que vivem em um meio social adverso interagem e se apropriam de conhecimentos pertinentes à linguagem escrita. O campo de estudo foi a comunidade Frei Damião, localizada na periferia do município de Caicó, RN, originária de um lixão e reconhecida na região por ser economicamente carente, com alto índice de analfabetismo e baixíssimo nível de qualidade de vida (escassez de condições sanitárias, serviços públicos de saúde, saneamento e segurança, dentre outros próprios de meios urbanos). Assumindo os princípios da pesquisa qualitativa e as características de um estudo de caso, tomamos como sujeitos do estudo, nove crianças, com idades entre sete e oito anos, residentes na comunidade e estudantes da escola no segundo ano do Ensino Fundamental. Além das crianças, foram também considerados como sujeitos, suas mães, a diretora e duas funcionárias da escola. Os dados foram construídos a partir de entrevistas semi-estruturadas, questionários e anotações em diário de campo. Da sistematização desenvolvida com base nos princípios da análise de conteúdo emergiram evidências de que, mesmo vivendo em um ambiente marcado pela escassez de bens materiais, como de práticas e materiais escritos, as crianças constroem conhecimentos significativos sobre a escrita, apresentando níveis avançados de conceitualizações sobre o funcionamento do sistema alfabético. Tais construções resultam de interações em que se envolvem em diversos contextos intra e extra-escolares em sua comunidade nos quais são mediados, tanto por seus pais, em suas casas, como pela professora, na escola. Mesmo analfabetos ou com pouca instrução escolar, verificou-se que os pais inserem as crianças em processos de letramento e alfabetização ao valorizarem a escrita e seu aprendizado. Enquanto contexto de interação e apropriação de conhecimentos destaca-se, na comunidade, a escola e suas práticas. Mediante parcos recursos e limites, a professora cria situações de aprendizado do funcionamento do sistema de escrita e de habilidades textuais, aproximando as crianças da escrita como linguagem. Esses resultados apontam para a necessidade de reflexões e reformulações acerca das possibilidades da escola pública na promoção de educação de qualidade para as crianças de meios populares

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

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Venous ulcer (VU) is a lower limbs injury resulting from inadequate return of venous blood in feet or legs. Although it is not a deadly disease, it causes chronic wounds, which seriously undermine patients´ quality of life (QOL) and sometimes leads to drastic family, social, economic and psychological changes. In this sense, there are several aspects that may influence the venous ulcers patients´ QOL. The study´s objective aimed on the association of socio-demographic and health, health care and clinical injury on UV patients‟ QOL. Analytical studies, which consider the complexity of factors involved in changes in UV patients‟ QOL has a cross-sectional and quantitative approach. The HUOL Ethics Committee approved this project (n.279/09). The collection of data lasted a period of 3 months in 2010 and it took place at the clinic of Angiology at Hospital Universitário Onofre Lopes (HUOL). The data sample consisted of 60 patients treated by UV angiologists in the HUOL Surgical Clinic. The results were analyzed with SPSS 15.0 by descriptive and inferential statistics. The study was based on UV patients that were predominantly female, average age of 61.4 years, that had low education level and low family income, with occupations requiring long periods of standing or sitting, but mostly retired, unemployed or laid off due to the disease and/or due to chronic diseases associated with the UV. The study took also into consideration patients that used inappropriate products, that were improperly treated by a professional caregiver, that lacked of adequate guidance and compression therapy, that performed no lifting of the lower limbs and regular exercise, that the time of injury were greater than or equal to six months, that were missing specific laboratory tests. The study‟s reference were on recurrent lesions, medium to large lesions area, bed of the lesion (injuries) with fibrin and/or necrosis, with amount of exudate with medium to large, odorless and no signs of infection, with tissue loss between 1st and 2nd degree, without collecting swab or biopsy and with pain. In general, QOL of researched individuals were considered low, the maximum score was 69 points, which the areas that were mostly influenced were the total scores of QOL functional capacity (0.021), emotional (0.000) and social functioning (0.080). Of the 60 individuals, 53.3% had scores between 40 and 69 points in SF-36, and they had the best scores in sociodemographic and health variables (ρ = 0.049). In respect to the assistance and injury characteristics, patients who scored between 40 and 69 points in SF-36 had better scores on these characteristics. By combining the socio-demographic variables, health, and handling characteristics of the injury, we observed a significant difference (ρ = 0.032) when linking them with the QOL total scores. When analyzing separately the domains of the SF-36 scores on the quality of life, we find that the areas that showed statistical significance were functional ability (ρ = 0.035), appearance (ρ = 0.019), emotional (ρ = 0.000), and mental health (ρ = 0.050). Among the socio-demographic characteristics studied, gender and marital status contributed more to the reduction of QOL and among the variables of assistance and the injury, orientation, reference and area of UV contributed the most. By analyzing these five variables all together in accordance with the overall score obtained in the quality of life, we found a significant correlation (ρ = 0.002); with 6.23 times more chances of patients have better QOL in the presence of these five positive factors. By conducting the Mann Whitney U test between all the five demographic variables, health, and clinical care, we found that this combination also proved to be significant (ρ = 0.006). Therefore, patients with these five variables positive tend to have a better QOL. Based on these results, we reject the null hypothesis (H0) and accept the alternative hypothesis (H1) proposed in this study because we noted that the QOL of patients with UV is associated with sociodemographic and health, health care and clinical aspects of the injury

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Trasnversal study, with the objective of evaluating the accuracy of clinical indicators of nursing diagnosis excessive fluid volume in patients undergoing hemodialysis. The study occurred in two stages, the first consisted of the evaluation of the diagnostic indicators in study; and the second, the diagnostic inference conducted by nurse diagnosticians. The first stage occurred from december 2012 to april 2013, in a University Hospital and a Hemodialysis Clinic in Northeastern of Brazil, with a sample of 100 chronic renal failure patients on hemodialysis. The data were selected through an interview form and a physical examination, organized into spreadsheets and analyzed as to the presence or absence of the indicators of diagnosis excessive fluid volume. In the second step, the spreadsheets were sent to three nurses diagnosticians, who judged the presence or absence of diagnosis in the clientele searched. This step was conducted from july to september 2013. For analysis of the data, we used descriptive and inferential statistics. In the descriptive analysis, we used measures of central tendency and dispersion. In inferential analysis, we used the tests Chi- square, Fisher and prevalence ratios. The accuracy of the clinical indicators pertaining to the diagnosis were measured as to the specificity, sensitivity, predictive values, likelihood ratios and Diagnostic Odds Ratio. Also developed a logistic regression. The results were organized in tables and discussed with literature. This study was approved by the Ethics Committee in Research of the Federal University of Rio Grande do Norte, with Presentation Certificate for Ethics Appreciation nº 08696212.7.0000.5537. The results revealed that the diagnosis studied was present in 82% of patients. The characteristics with prevalence above 50 % that stood out were: azotemia, decreased hematocrit, electrolyte imbalance, intake exceeds output, anxiety, edema, decreased hemoglobin, oliguria and blood pressure changes. Eight defining characteristics were presented statistically significant association with the nursing diagnosis investigated: pulmonary congestion, intake exceeds output, electrolytes imbalance, jugular vein distension, edema, weight gain over short period of time, agitation and adventitious breath sounds. Among these, the 10 characteristics which showed higher prevalence ratios were: edema and weight gain over short period of time. The features with the highest sensitivity were edema, electrolytes imbalance and intake exceeds output and the standing out with greater specificity were: anasarca, weight gain over short period of time, change in respiratory pattern, adventitious breath sounds, pulmonary congestion, agitation and jugular vein distension. The indicators jugular vein distension, electrolytes imbalance, intake exceeds output, increased central venous pressure and edema, together, were identified in the logistic regression model as the most significant predictors. It is concluded that the identification of accurate clinical indicators allow a good prediction of the nursing diagnosis of excessive fluid volume in patients undergoing hemodialysis in order to assist the nurse in the inference process, which will contribute to the success of patient care. In addition, nurses will consider for diagnostic inference not only his clinical experience, but also scientific evidence of the occurrence of excessive fluid volume, contributing to the control of volemia in these patients

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The popularization of the Internet has stimulated the appearance of Search Engines that have as their objective aid the users in the Web information research process. However, it s common for users to make queries and receive results which do not satisfy their initial needs. The Information Retrieval in Context (IRiX) technique allows for the information related to a specific theme to be related to the initial user query, enabling, in this way, better results. This study presents a prototype of a search engine based on contexts built from linguistic gatherings and on relationships defined by the user. The context information can be shared with softwares and other tool users with the objective of promoting a socialization of contexts

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Introduction: Actually the obesity is a public health problem throughout the world. Bariatric surgery has been an efficient method of weight reduction body in severe obesity, reducing its associated effects and presenting low levels of immediate and late postoperative complications. In Brazil, bariatric surgery asa recent therapeutic that has been growing recently. Being Brazil a country with continental dimensions and with a huge diversity socioeconomic and cultural, it is essential to understand the reality of patients undergoing bariatric surgery in less economically privileged regions of Brazil. Objectives: To evaluate the epidemiological, clinical outcomes and mortality of patients undergoing videolaparoscopic bariatric surgery through the public health system in the Brazilian state of Rio Grande do Norte- Brazil. Methods: Observational descriptive study of a prospective, carried out from February 2009 to February 2011, the Clinic Obesity and Bariatric Surgery at Universitary Hospital Onofre Lopes - Federal University of Rio Grande do Norte (HUOL-UFRN). Anthropometric measures, comorbidity and deaths register were made in the postoperative period. Results: Seventy patients (54 women) with low income aged 22 to 63 years completed the study. We recorded the death of three patients during the study period. The results show significant decrease anthropometric parameters, especially in relation to body weight, waist circumference and hipin both sexes. Only Waist / Hip ratio showed no difference after intervention in male patients It had a resolution of comorbidities. No significant differences in reports of daily sleepiness and the snoring male patients. Conclusion: Our findings attest laparoscopic bariatric surgery as an effective method reducing weight and comorbidities in morbidly obese patients

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Venous wounds cause physical, psychological and financial problems that impact the quality of life of patients. Treatment alternatives are investigated in order to reduce healthcare costs and improve quality of life of people affected by this problem. Physical resources, such as therapeutic ultrasound (US), are being considered in the treatment of ulcers as a potential healing agent. This study aimed to investigate the application of US as a treatment for venous ulcers. Subjects were divided into two groups: US group, where treatment consisted of 5 sessions of pulsed US (3 MHz, 1W/cm²) associated with compression and kinesiotherapy; and sham group, where individuals went through the same procedures, but with sham US therapy. Subjects were evaluated for wound size by planimetry and digital photography, visual analogue scale for pain, quality of life by the questionnaires SF- 36 and VEINES-QoL/Sym and enzymatic activity of metalloproteinases 2 and 9 by zymography. It was observed mean reduction in wound area of 41.58±53.8% for the US group and 63.47±37.2% for the placebo group, maintenance of quality of life scores in the US group and significant improvement (p<0.05) in the placebo group by VEINES questionnaire. It was observed decreased perception of pain in the placebo group. Sample feasibility for analysis of the protein activity of metalloproteinases 2 and 9 by zymography collected by swab method was also confirmed. Our data did not give us evidence to support the theory that the US accelerates healing of venous ulcers in a short-term analysis. However, we observed that standard care associated with compression therapy and kinesiotherapy were able to significantly shorten the progression of chronic venous ulcers

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Fundação de Amparo a Pesquisa do Estado de São Paulo