Infecções por enterobacteriaceae resistente aos carbapenêmicos em hospital de ensino: epidemiologia e caracterização molecular

Introduction: The production of KPC (Klebsiella pneumoniae carbapenemase) has become an important mechanism of carbapenem-resistance among Enterobacteriaceae strains. In Brazil, KPC is already widespread and its incidence has increased significantly, reducing treatment options. The “perfect storm” combination of the absence of new drug developmentand the emergence of multidrug-resistant strains resulted in the need for the use of older drugs, with greater toxicity, such as polymyxins. Aims: To determine the occurrence of carbapenemase-producing strains in carbapenem-resistant Enterobacteriaceae isolated from patients with nosocomial infection/colonization during September/2014 to August/2015, to determine the risk factors associated with 30-day- mortality and the impact of inappropriate therapy. Materials and Methods: We performed a case control study to assess the risk factors (comorbidities, invasive procedures and inappropriate antimicrobial therapy) associated with 30-day-mortality, considering the first episode of infection in 111 patients. The resistance genes blaKPC, blaIMP, blaVIM and blaNDM-1 were detected by polymerase chain reaction technique. Molecular typing of the strains involved in the outbreak was performed by pulsed field gel electrophoresis technique. The polymyxin resistance was confirmed by the microdilution broth method. Results: 188 episodes of carbapenem-resistant Enterobacteriaceae infections/colonizations were detected; of these, 122 strains were recovered from the hospital laboratory. The presence of blaKPC gene were confirmed in the majority (74.59%) of these isolates. It was not found the presence of blaIMP , blaVIM and blaNDM-1 genes. K. pneumoniae was the most frequent microorganism (77,13%), primarily responsible for urinary tract infections (21,38%) and infections from patients of the Intensive Care Unit (ICU) (61,38%). Multivariate statistical analysis showed as predictors independently associated with mortality: dialysis and bloodstream infection. The Kaplan-Meier curve showed a lower probability of survival in the group of patients receiving antibiotic therapy inappropriately. Antimicrobial use in adult ICU varied during the study period, but positive correlation between increased incidence of strains and the consumption was not observed. In May and July 2015, the occurrence rates of carbapenem-resistant Enterobacteriaceae KPC-producing per 1000 patient-days were higher than the control limit established, confirming two outbreaks, the first caused by colistin-susceptible KPC-producing K. pneumoniae isolates, with a polyclonal profile and the second by a dominant clone of colistin-resistant (≥ 32 μg/mL) KPC-producing K. pneumoniae. The cross transmission between patients became clear by the temporal and spatial relationships observed in the second outbreak, since some patients occupied the same bed, showing problems in hand hygiene adherence among healthcare workers and inadequate terminal disinfection of environment. The outbreak was contained when the ICU was closed to new admissions. Conclusions: The study showed an endemicity of K. pneumoniae KPC-producing in adult ICU, progressing to an epidemic monoclonal expansion, resulted by a very high antibiotic consumption of carbapenems and polymyxins and facilitated by failures in control measures the unit.

Estratégias de promoção da saúde a partir da escola e da Unidade Básica de Saúde da Família, em Uberlândia (MG)

Health promotion is opposed directly to the biomedical model and established by intersectoral action, with collective and interdisciplinary approaches, considering the subject in their life contexts. Build healthy territories is to promote health, which necessarily includes intersectoral coordination and community mobilization. The health and education sectors can work together to promote health, developing so articulate actions and practices involving the subject in its territory of life and work. This study aimed to design and experience of health promotion strategies in school and Basic Health Units Family in Uberlândia - MG, from intersectoral relationship and community mobilization. The methodological research route was action research, or research intervention, because while researching already applied the ideas to solve problems through collective action. The research began in the Municipal School of Basic Education Prof. Eurico Silva, with the Health Centre's deployment to carry out surveillance and health promotion with active participation of students, involving all subjects of the school, students, teachers and other staff in the context of everyday life, which extrapolates the school walls, reaching the family and social groups in the community to which they belong. The health observatory has the objective existence with the establishment of the working groups, which at first were "healthy eating" and "drug-free world" and later, "dengue". The themes were chosen by the participants of the Health Centre, in which each is involved preferably. The second part of the research started with the approach between the Centre for Health and the health units (UBS and BFHU). The proposal was that the schools and the health nurse unit together should undertake prevention and health promotion, combating Aedes aegypti with intersectoral coordination and community mobilization. For it was crucial the involvement of ACS, ACE, ASE and the nurse coordinator of the Health Unit in creating community networks in the territory. home visits, community mobilization and intersectoral coordination: a training course in all BFHU and UBS teams with the following subjects was conducted. At this stage, were the Health Units that should approach the schools, in order to provide community networks to fight Aedes aegypti in each territory. The results and the scope of this experiment could only be brought to fruition because the Board of Health Surveillance and Care Coordination council of Basic embraced the proposal and helped in its implementation. It remains to continue consolidating this process of work in health units of primary care and the elementary schools, replicate the Health Centre's experience at school. The conclusion of this work is that schools and care facilities to health together with intersectoral coordination and community mobilization supported by community networks, can carry out prevention and health promotion, from a health model that considers the social determinants of health and overcoming hygienist model / sanitarian.

Território, Criminalidade e tráfico de drogas ilícitas em Montes Claros/MG

Urban violence, manifestly public and free, has changed the standard of sociability of townspeople. The city is an increasingly private space of hopes of reducing the risk of victimization, due to the fear of violence that separates and distances the classes in expectation of concealing this behavior. However, violence has many facets and, in one way or another, will always be present as a product of social friction. It is in the urban context and using drug trafficking as a backdrop that this work raises questions about the territorial violence in Montes Claros - MG. The objective was to analyze the dynamics of illicit drug trafficking from the concepts of territory, observing to what extent the appropriation of space contributes to the use of violence, especially in interpersonal disputes. Methodologically, it seeks from quantitative and qualitative techniques make the spatial distribution of criminal indicators, defining and creating hierarchy territories of violence in urban areas. From the qualitative approach seeks to organize and analyze data together to the Civil and Military Police, Brazilian Institute of Geography and Statistics -IBGE, João Pinheiro Foundation and the System of the Ministry of Health Mortality Information - SIM. The opportunity of miscegenation between the knowledge of the survey respondents and the official data has introduced qualitative part. The city of Montes Claros has been taken as an object of observation due to a set of conditions, which stood its medium size, your importance in the regional context and their socioeconomic disparities. The results point to the existence of multiple territoriality of violence involving the trafficking of illicit drugs in urban space. Territorial disputes by the traffickers have victimized people with socioeconomic characteristics and urban spatial origin similar. The dynamism of the established boundaries from the cohesion and / or rupture of the interests of those involved creates and destroys territories in the power struggle.

Quando fé e gestão se encontram: compreendendo uma ONG de filosofia protestante sob as lentes da prática e do Sensemaking

We find in Brazil the reality of religious pluralism. From the end of XIX century until now, the religious scenario became more diversified in a process of acceptance and legitimation of different religions. In the same period, the Third Sector was largely developed up until its current form: complex, broad and plural as well. In this context, we find non profitable organizations that provide services under a religious phylosophy. One in particular, placed in Uberlândia-MG, protestant, has the fearures of a big company and is the largest one among the ones that provide social services and receive public funds in the city: Missão Luz. Thinking about the organization, some questions came to mind: is there a noticeable influence of the religious orientation on practices? How do managers understand and make sense of their practices? Adopting Chanlat’s (1996) concept of management mode, the perspective proposed by the Practice Based Studies (GHERARDI, 2013) and the sensemaking studies (WEICK, 1995), I developed a research that intended to understand Missão Luz’ management practices. Three sources of data were used – documents, shadowing and interviews – to understand, in the most complete way, organization’s management practices, using managers’ perspective. Results pointed to a noticeable relation between faith and management. Ten practices were identified among managers: council decisions, appreciation for excellence, respect for authority figures, giving second chances to employees, desire to be a reference, results quantification, search for professionalization, organization, formalization and standardization. The first five practices were heavily influenced by religious principles, and the five last were influenced by instrumental rationality, usually found in the Second Sector. It was noticed that faith was also related to those last practices, justifying them for their contribution for achieving excellence e consequent action of glorifying God. Practices are maintained e passed by the cultivation of the Mission’s DNA, an organization’s way of doing things, and by the belief of the role of the leader maintaining this DNA. Associated to practices, sensemaking moments were analyzed, situations where there order was disrupted and managers had to make sense e act on this understanding. These situations were divided in three themes: “fly the flag of the company”, changes in schools’ management and God’s purpose and sovereignty. The paper is finished with some suggestions for future researches.

A escola do urbano no campo do município de Catalão/GO : ensino de geografia nas especificidades do lugar

This study makes an approach to the Morro Agudo Community (Cisterna) located in Catalão city(GO) rural area where stands the Maria Bárbara Sucena Municipal School. This school center is a result of getting together several small and isolated schools, which worked, scattered in many rural communities in the region. After this centralization in a single school, many students had to move along inconvenient distance to get their classes. Morro Agudo Community (Cisterna) was outstanding at garlic cultivation throughout the 1990`s when eventually this activity came to a decline. The region is constituted by properties of small tract of land. The landowners come from a Portuguese background and there are, in addit ion, migrant workers from the northeast region of Brazil. These northeasterners work for these local landowners, and that brings an additional meaning to the social relations in the region and to the rural schooling. The social and cultural diversity of the region has a feedback at the school arising tensions in many ways. In the teaching and learning process the school deals with this diversity, combined with rules and goals that, in the end, delivers a geography teaching not able to value the local knowledge accumulated in the region by its own inhabitants. New methodological approaches to rural school communities emerged out of the analysis of these unmet expectations. Furthermore, this study takes into consideration some “residues”, that means not all events are fit into programs; there are unintended consequences in an open process. All these are object of deep review in this doctoral dissertation. In this community, an analysis of the public policies implemented by Federal and municipal governments to rural schools communities in Brazil was conducted. The way in which public policies toward rural communities are implemented at the schools was reviewed; the goals they pursue and the role played by textbooks are also object of analysis. This study questions the relevance of this tools, mainly if they meet the real needs of the local people. The social representations of teachers and students are considered carefully based on their everyday lives and experiences.

A noção de sistema na fundação da linguística moderna

This work is intended to investigate the saussurian notion of system. Such a notion is fundamental to Ferdinand de Saussure's theorization, since it composes the definition of "langue", as he thought it. This definition was crucial to the delimitation of linguistics' specific object of study, which granted its place among modern sciences. However, the notion of system was not created by Saussure. Not only in Linguistics, but also in other areas, this notion appeared in very ancient studies, mingling with the establishment of man in society and the development of their economic and organizational activities. Specifically, in the context of language studies, the system consists in a notion that composed the work of the first grammarians in the West, in ancient Greece. Moreover, this notion was also used afterwards, in the synonymy studies and in the comparative analysis of languages, developed by scholars of the nineteenth century. Nevertheless, although Saussure had had his formation in Leipzig and Berlim, amid comparatists studies, his notion of system is an innovation, while is also continuing. In light of this, we aim to highlight the aspects of the saussurian notion of system that allow the establishment of a relationship of continuity and rupture with other conceptions of system. For that, we will investigate four Saussure authored documents: the « Cours de linguistique générale », the « Mémoire sur le système primitif des voyelles dans les langues indo-européennes », and the two sets of manuscripts « De l'essence double du langage » and « Notes pour le cours III ».