Politicas públicas em oncologia: refletindo sobre a atuação da Terapia Ocupacional

A Política Nacional de Atenção Oncológica almeja o acesso e atendimento integral além de uma maior efetividade e efi ciência no controle do câncer. Assim, diversas ações, serviços e profi ssionais são exigidos para dar a assistência necessária. A respeito da atuação da Terapia Ocupacional, nota-se que a profi ssão não é especifi cada, e não tem a atuação regulamentada. Sendo assim, o objetivo principal do presente estudo foi identifi car a inserção, atuação e ampliação do campo de trabalho da Terapia Ocupacional no Estado de São Paulo para a área oncológica em contexto hospitalar, tomando por base as Políticas Públicas de Atenção Oncológica. Visou também identifi car os Centros de Assistência de Alta Complexidade em Oncologia do Estado de São Paulo que possuem o terapeuta ocupacional como parte da equipe. Para tanto, foi realizada: identifi cação dos Centros de Alta Complexidade em Oncologia do Estado de São Paulo cadastrados no Cadastro Nacional de Estabelecimentos de Saúde, por meio de dados fornecidos pelo INCA e do site ofi cial do Ministério da Saúde; mapeamento da inserção do terapeuta ocupacional nesses locais e aplicação de questionário aos profi ssionais, para caracterizar os serviços e ações desenvolvidas pela Terapia Ocupacional em oncologia. O estudo do tipo qualitativo descritivo constatou a existência de diferentes possibilidades assistenciais em oncologia, tendo em vista as demandas e organização dos hospitais. Quanto à inserção e ampliação do campo de trabalho, verifi cou-se que nem todos os CACONs contam com os serviços e ações da Terapia Ocupacional, o que sugere que ainda não há efetivamente a incorporação desse profi ssional nas equipes multiprofi ssionais desses centros.

Avaliação Postural em Sujeitos com Disfunção Temporomandibular Submetidos a Tratamento de Terapia Manual

Individuals with temporomandibular disorders (TMD) often have signs and symptoms such as intra-articular pain, muscle spasm, neck pain radiating from others who interfere with this balance. Over time can lead to postural changes and correction of the cervical spine, anterior head and shoulder asymmetry. The aim was to verify the effects of manual therapy on posture in subjects with TMD. Materials and methods: 30 volunteers (mean: 21.43± SD:1.43) of both sexes who had TMD classified according to axis I of the Research Diagnostic Criteria participated in this study. These were photographed in the anterior frontal and sagittal planes for analysis of the following angles (acromion clavicular joint, sternoclavicular joint, orbicular external, corners of the mouthand and protruding head). After, the volunteers were divided into groups ATM (manual therapy in the treatment of temporomandibular joint), Cervical (manual therapy in the treatment of cervical joint) and Control. The Kolmogokov-Smirnov test, followed by ANOVA, considering a significance level of 5% was used. Results: Groups ATM, Cervical and Control were considered homogeneous with respect to the values of the angles measured. These also showed no significant difference between the 1st, 5th and 10th sessions, so the manual therapy techniques applied to the TMJ and Cervical groups were not sufficient to change postural alignment. Conclusion: The postural alignment, the TMD patients evaluated in this study did not change after attending the sessions proposals with manual therapy techniques in the cervical and TMJ.

Efeitos da terapia manual de Maitland em pacientes com lombalgia crônica

Introduction: The low back pain are a problema of health. Objective: to evaluate the effects of the Maitland´s manipulation in pain, fl exibility, functional capacity and quality of life of the patients with chronic low back pain. Method: Sxteen subjects, of both genders, with the age from 23-68 years old (48.69,± 11.61 years old) were evaluated by test sit and reach (TSA), Visual Analogue Scale (VAS) and answered the questionnaires of the quality of life Medical Outcomes Study 36- Item Short-Form Health Survey (SF-36) and the Roland-Morris Disability functional incapacity (RMDQ). The treatment was carried out twice a week, totaling 10 sessions. Each session lasted 30 minutes and consisted by Maitland´s techniques, applied as the symptoms evaluated at the beginning of each session. After 10 session, the subjects were re-evaluated. The data obtained in the assessments concerning the TSA and VAS were analyzed by Student t test, the data relating to the questionnaire were analyzed using the Wilcoxon non-parametric statistics test. For the interpretation was used signifi cance level of 5% (p≤0,05). Results: A signifi cant improvement was in the intensity of pain, disability, fl exibility and quality of life. Conclusion: The Maitland´s therapy showed effective, which suggests be an appropriate strategy for intervention for patients with chronic low back pain.

Efeitos de um Protocolo Modificado da Terapia Por Contensão Induzida em Criança com Paralisia Cerebral Hemiparética

Evaluate the effects of a modifi ed ConstraintInduced Therapy intervention protocol regarding movement quality and frequency of use of the affected upper extremity on children with hemiplegic cerebral palsy. Longitudinal study of a single case, performed with a four year old submitted to intervention during three hours daily, for ten days, restricting the non-affected upper extremity for eight hours daily. Data were collected using the Pediatric Upper Extremity Motor Activity Log and analyzed using the arithmetic mean. Signifi cant improvement in quality of movement and frequency of use of the upper limb from pre to post-intervention were noted, maintaining the result in later data collection, besides the acquisition of functional motor skills. The modifi ed constraint-induced movement therapy protocol of this study was effective in treating the child with hemiplegic cerebral palsy, the results may be useful for professionals working with this clientele, assisting them in the intervention process.

Influência da terapia de contensão induzida na funcionalidade do membro superior de indivíduos hemiparéticos

Introduction: The Constraint-induced Movement Therapy (CIMT) is a therapeutic program which main goal is the functional recuperation of paretic upper extremity of stroke patients with motor deficits by an intensive treatment, practice of functional repetition and wear of restriction in non-paretic during 90% of the daily hours. Objective: The aim of this study was evaluate the CIMT influence on upper extremity function of hemiparetic individuals. Method: The CIMT was provided for 3 daily hours for 10 consecutive days. Besides, patients were asked to wear a restraint dispositive on the unaffected hand during 90% of their activities daily living hours. Before and after the intervention period, 2 tests were administered to evaluate motor function, the Motor Activity Log (MAL) and the Wolf Motor Function Test (WMFT). Results: The results of MAL showed significant difference in quantity (p=0,011) and quality (p=0,016) of paretic upper extremity movements. Analysis of WMFT indicated a significant reduction of time that patients performed the tasks (p= 0,042) and a difference for quality of movement (p<0,0001). Conclusion: The present results showed that CIMT improves upper extremity function in hemiparetic individuals.

Avaliação das atividades realizadas em uma instituição de atendimento de crianças e jovens com autismo: contribuições com a implantação de um serviço de terapia ocupacional

O Autismo Infantil é um Transtorno Global do Desenvolvimento que se caracteriza pela presença de comprometimentos severos nas áreas de comunicação, interação social recíproca, interesses e comportamentos. Este trabalho teve como objetivos analisar o atendimento realizado com indivíduos autistas em uma instituição e verificar como a Terapia Ocupacional pode contribuir na atenção voltada aos alunos. A pesquisa foi realizada através da observação e registro em diário de campo das atividades realizadas por cinco indivíduos com Autismo em uma associação específica de Autismo e Transtornos no Desenvolvimento. Também foi realizada entrevista com os profissionais que atuam na instituição. No diário de campo, nota-se a prevalência das atividades pedagógicas. Por outro lado, observa-se escassez de atividades funcionais, de atividades básicas e instrumentais de vida diária, e de atividades direcionadas à comunicação e interação. Nas entrevistas, foi possível constatar que existe interesse dos profissionais na implantação do serviço de Terapia Ocupacional. Considerando as possibilidades de atuação da Terapia Ocupacional junto às crianças e jovens com autismo, conclui-se que a implantação desse setor nessa associação poderia trazer inúmeros benefícios para os usuários e equipe de profissionais da instituição.

Avaliação dos efeitos da terapia fotodinâmica antimicrobiana com o fotossensibilizador ftalocianina-glucamina como terapia adjunta no tratamento da doença periodontal induzida em ratos

Pós-graduação em Odontologia - FOAR

Gerenciamento dos resíduos de serviços de saúde da Unidade de Terapia Intensiva do Pronto Socorro do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP

Health care waste (HCW) is the type of waste that results from activities performed in health care services during care provision to humans or animals. Presently, according to RDC 306/04, issued in 2004 by Anvisa, and Resolution no. 358/05, by CONAMA, waste groups have the following classification: Group A (biological waste), Group B (chemical waste), Group C (waste containing radionucleotides), Group D (common waste) and Group E (piercing and cutting waste). In Brazil, 149 tons of wastes are collected every day, and HCW corresponds to approximately 1% to 3 % of that total. An efficient way to adequately manage HCW is through the Health Care Waste Management Plan (HCWMP), and it is possible to reduce the risk posed by certain materials in addition to ensuring disposal in an ecologically correct and economical fashion. According to the Pan-American Health Organization (PAHO), the management process enables health care establishments to adequately manage waste. Hence, there is greater control and reduction in the health risks caused by infectious or special waste, in addition to facilitated recycling, treatment, storage, transport and final disposal of solid hospital waste in an environmentally safe fashion. To evaluate the management of HCW of Groups A and D from the Intensive Care Unit of the University Emergency Hospital - FMB - UNESP in the city of Botucatu according to the guidelines presently in force. The waste flow was followed up, and during four random days in the month of September 2011, waste was quantified by estimating daily and monthly values, according to its classification. : In 2011, the University hospital has produced an average of 57,676.8 kg/month of biological and common waste. By adding Groups A and D, during the four days, approximately 209.8 Kg of waste (202.2 Kg of Group A and 7.6 Kg of Group D) were produced in the establishment under study, which... (Complete abstract click electronic access below)

Qualidade de vida em mulheres com ausência ou presença de terapia de reposição hormonal

The objective of this study was to evaluate the quality of life (QL) of a group of menopausal women in the presence or absence of hormone replacement therapy (HRT). It consists of a cross-sectional analytical study involving women from the School Health Center - Unity Village Farmers' and Town Railway on the city of Botucatu. Participants were divided into two related groups of studies: run HRT and do not realize. We used the SF 36 and QRS, and a questionnaire to characterize the study population. No differences were seen when comparing the groups with regard to age, age at menarche and menopause. It was observed that 92% were white women and who have studied up to primary education (p = 0.0209), and those who had a partner (p = 0.0055), were the most reported changes in QL. The most frequent comorbidities were hypertension and diabetes, which is significantly more important in women without HRT. The account of the lower of QL was expressed by 28% of the sample, and the population obtained in MRS score more negative (p, 0.05). The correlation of the eight components of the SF36 and the MRS, with the presence or absence of TRH showed no significant differences. The concept of quality of life and evaluation of it is subjective and individual. However they can notice changes in QL, evidenced by instruments. One can see that menopause is not necessarily accompanied by changes in QL, however, when expressed, tend to be perceived more negatively. Despite the lower level of social and low education and women interviewed have QL as good. There is a need for studies to improve a more real relationship between HRT and QL

Revista Nise: revista customizada para a o projeto Terapia e Arte (Tear)

O objetivo deste Trabalho de Conclusão de Curso é divulgar experiências bem sucedidas no campo de atenção psicossocial através de uma revista customizada desenvolvida para o Projeto Tear “Terapia e Arte”, da cidade de Guarulhos, segunda cidade mais populosa do estado de São Paulo. Mais do que levar credibilidade e, consequentemente, visibilidade às práticas desenvolvidas por eles, o produto tem a intenção de colocar em reflexão a questão da inclusão social pelo trabalho e pela arte, as principais atividades do organismo, e explanar a respeito dos avanços das diretrizes da Reforma Psiquiátrica às quais o Projeto Tear está alinhado. Por meio de entrevistas, pesquisas e vivência in loco, buscou-se por em prática as técnicas jornalísticas aprendidas ao longo do curso de graduação e levar ao leitor série de reportagens de forma clara e diversificada, que contribuam para a propagação do tema e para o exercício de um jornalismo com compromisso ético e cidadão

Eventos adversos em terapia medicamentosa em Unidade de Terapia Intensiva - UTI

Due to the complexity and instability of clinical conditions of ICU patients, the drug therapy applied in this type of environment requires a combination of several prescribed drugs, which is a favorable condition for drug interaction, toxic synergism and possible iatrogenia. In the possible universe of ICU occurrences, this study aimed at identifying and evaluating the incidence of adverse events in drug therapy at the Intensive Care Therapy Service (SETI) in wards I and II. It is a cross-sectional, descriptive, prospective and quantitative study conducted from August to September, 2011 in the Intensive Care Service of the Botucatu School of Medicine University Hospital - UNESP. The population consisted of fifteen clinical nurses, including those in the Improvement and Volunteer Internship Programs, who contributed to the investigation after signing an informed consent form and according to approval by the Research Ethics Committee number 10711/CE - FMB. The data were entered on a form and analyzed. Results showed that, on average, 8.9% of events/day occurred, and the highest frequency was observed on August 04, 2011. 63% and 22% were respectively observed in the morning and afternoon shifts, and 15% in the night shift. 48% of these were due to administration time errors, followed by drug prescription and dispensation errors, with percentages of 22% and 18%, respectively. Antibiotics showed the highest frequency of adverse events - 18%, which was followed by 13% for anticoagulant, 11% for antiemetic and 10% for antiulcerative drugs. As regards the occurrence of adverse events related to hospitalization time, the highest frequency occurred in patients who were hospitalized for 10 days. Concerning the ratio between reported events and the number of items in the prescription, the highest frequency of events was related to prescriptions with 20 items... (Complete abstract click electronic access below)

Opinião de familiares sobre a internação de crianças em uma Unidade de Terapia Intensiva Pediátrica

A Pediatric Intensive care Unit (PICU) is an environment where care is provided to seriously ill children. Hospitalization is regarded as an unpleasant experience that requires adaptation and routine change. To assess the opinion of relatives of children hospitalized at a PICU concerning tie breakage and/or separation between children and their families. It is a descriptive, cross-sectional, quantitative study. A structured interview was conducted with the families of hospitalized children from July to September, 2010. The data were statistically analyzed. RESULTS: Twenty relatives were interviewed, 80% of whom believed that children’s behavior changes when they are present in the unit, and 85% considered the visitation time established to be sufficient. All the respondents reported to be satisfied about the care provided. The feelings prevailing in 50% of the relatives were fear and hope. Change in the family’s union after hospitalization occurred in 85% of the families. The most fearful aspect concerning the ICU is the equipment (25%), and the most worrisome, as regards personal life, is the separation from other children (65%). Health care professionals must pay more attention to relatives by including them in their health care plan so that the health care team and the family, who are essential in children’s recovery, can interact in a congenial fashion. It is also necessary to improve the knowledge related to that subject so that the health care team and families can work together towards children’s recovery

Caracterização de sistemas mucoadesivos para potencial administração de zidovudina

A zidovudina (AZT) é um antirretroviral que apresenta baixa biodisponibilidade devido seu intenso metabolismo pré2sistêmico. A via nasal tem sido estudada como alternativa para evitar este efeito, mas possui limitações, como os mecanismos de depuração mucociliar, que podem ser minimizadas através do desenvolvimento de sistemas de liberação mucoadesivos. O presente estudo tem por objetivo caracterizar sistemas tensoativos visando o desenvolvimento de uma formulação mucoadesiva para potencial administração nasal de AZT. Para isso, foi utilizada uma microemulsão (ME) composta por álcool cetílico etoxilado 20 OE e propoxilado 5 OP (PRO), ácido oleico (AO) e água. Foi testada a incorporação de polímeros mucoadesivos – policarbofil (PF), carbopol 971 (C971), 974 (C974) e quitosana (QS) na ME. Os sistemas foram caracterizados por microscopia de luz polarizada (MLP), quantificação do AZT, reologia de fluxo e oscilatória, análise do perfil de textura (TPA) e obtenção da força de mucoadesão. Os resultados mostraram que foi possível incorporar 0,1 % (p/v) dos polímeros e os sistemas incorporaram mais AZT do que a solução aquosa. Os sistemas apresentam fluxo newtoniano. Quando misturados ao muco artificial (MA), os sistemas tiveram G’ aumentado e houve mudança da ME para fase hexagonal. No teste TPA, a dureza da ME contendo PF foi a maior. Pode2se concluir que é possível obter uma formulação precursora de matriz com características de textura e reologia favoráveis à aplicação nasal. O sistema foi capaz de incorporar o AZT e apresentou grande potencial mucoadesivo. Esta estratégia se mostra promissora na melhora da terapia... (Resumo completo, clicar acesso eletrônico abaixo)

Susceptibilidade do Staphylococcus aureus à terapia fotodinâmica (PDT)

A terapia fotodinâmica (PDT), de maneira simplificada pode ser aplicada utilizando um fotossensibilizador (FS) e uma fonte de luz com comprimento de onda específico, que combinados na presença do oxigênio produzem espécies citotóxicas que causam o dano celular. O objetivo deste estudo piloto foi verificar a susceptibilidade de Staphylococcus aureus (ATCC 25923) à PDT, empregando diferentes concentrações de azul de metileno. As amostras desta bactéria foram sensibilizadas com azul de metileno nas concentrações de 6,25 μg/mL; 12,5 μg/mL; 25,0 μg/mL; 50,0 μg/mL; 100,0 μg/mL e 200,0 μg/mL e expostas à luz LED vermelha (660nm) por 20 minutos. Após o tratamento de todos os grupos estudados a fração de sobrevivência foi calculada pela contagem das unidades formadoras de colônia (UFC). O resultado deste estudo mostrou que o fotossensibilizador no escuro foi tóxico (dark toxicity) nas concentrações de 100 e 200 μg/mL. Já no grupo onde utilizamos apenas a luz, não houve redução bacteriana significativa. Entretanto, o uso combinado do AM e da luz LED (Grupo PDT) mostrou que todas as concentrações testadas causaram uma redução significativa de S aureus. Desta forma concluímos que a terapia fotodinâmica antimicrobiana pode ser um tratamento alternativo para redução de Staphylococcus aureus.

Redução bacteriana via terapia fotodinâmica

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)