Tecnología apropiada en obstetricia: definición y evaluación desde las perspectivas de la población y del personal de salud

Se parte de la hipótesis de que para lograr satisfacer las necesidades de salud de la población, es preciso, entre otras cosas, que los servicios de salud utilicen tecnologías apropiadas. El problema que surge es el de definir lo que se considera "adecuado" y quiénes lo definen. Para ello se ha efectuado una investigación que permite detectar y analizar comparativamente la definición que, desde las perspectivas de la población y de los profesionales, se hace de la tecnología apropiada en obstetricia, como así también la tecnología utilizada en los distintos sectores de atención (público, de obras sociales y privado). Se presentan algunos datos referidos a dos aspectos de la atención: Utilización de técnicas y procedimientos biomédicos (pujar, jadear, episiotomía, anestesia, etc.) y consideración de las relaciones interpersonales en el proceso de atención (continuidad de la atención, rol del padre, favorecimiento del vínculo madre-hijo, etc.). Se observa que se utilizan modalidades de atención diferenciales según sectores de atención: son más tecnologizadas y medicalizadas en el sector privado. A la vez en éste se consideran más las relaciones interpersonales que favorecen la atención. Además, las opiniones de los profesionales, en cuanto a lo que cosideran adecuado, concuerdan más con las de las madres de dicho sector, siendo sus necesidades satisfechas en mayor medida que las de las demás. Resulta así que las necesidades de las mayorías - las que se atienden en servicios privados y de obras sociales - son cubiertas en menor medida, no qual se opone a un enfoque de riesgo que vuelca sus recursos en los grupos considerados vulnerables.

Relación del personal de salud con los pacientes en la Ciudad de México

OBJETIVO: Analizar la calidad de la relación del personal de salud con los pacientes hospitalizados. MÉTODOS: Estudio cualitativo realizado de febrero a julio del 2005, en la Ciudad de México. Se aplicaron 40 entrevistas a profundidad a pacientes internados en un hospital de tercer nivel. Las categorías de análisis para explorar la percepción del trato entre los informantes fueron las siguientes: actitudes y acciones del personal médico y de enfermería, comunicación efectiva, grado de conocimiento del paciente y/o familiares sobre el diagnóstico, tratamiento clínico, evolución del agravo. RESULTADOS: En general, se encontró un alto grado de satisfacción con la atención médica. No obstante, los pacientes hospitalizados percibieron como inadecuado el trato cotidiano (no clínico) del personal médico y de enfermería del hospital, relacionado con la falta de confianza para solicitar información acerca de su padecimiento. El uso excesivo de tecnicismos por parte del prestador de servicios reforzó esta percepción de trato inadecuado. CONCLUSIONES: La percepción del trato inadecuado por el personal de salud fuera del ámbito técnico, mostró que la efectividad clínica no significa una plena calidad de la atención y que es necesario incorporar las necesidades y expectativas de trato no clínico de los pacientes a la eficiencia técnica y científica.

Rapid Characterization of S. mansoni Expression Library Clones of Potential Interest

A S. mansoni adult worm cDNA expression library was screened with sera from baboons in a early phase after infection. The clones that were positive with the early infection sera were examined for reactivity with pre-infection sera and heterologous infection sera. In order to discriminate a positive antibody reaction from the reactivity due to residual anti-E. coli antibodies, an unrelated cDNA clone was plated with the positive clone. The unrelated clone provided the negative background and the contrast necessary to discern a positive antibody reaction. In this way, we were able to eliminate selected clones that were positive with the pre-infection sera or heterologous infection sera. This characterization of the expression library clones enabled us to quickly target only clones with the desired pattern of antibody reactivity for sequencing, subcloning, and expressing

Characterization of a clone from an adult worm cDNA library selected with anti-Schistosoma mansoni human antibodies dissociated from immune complexes: a preliminary report

Considering the scarcity of defined antigens, actually useful and reliable for use in the field studies, we propose an alternative method for selection of cDNA clones with potential use in the diagnosis of schistosomiasis. Human antibodies specific to a protein fraction of 31/32 kDa (Sm31/32), dissociated from immune complexes, are used for screening of clones from an adult worm cDNA library. Partial sequencing of five clones, selected through this strategy, showed to be related to Schistosoma mansoni: two were identified as homologous to heat shock protein 70, one to glutathione S-transferase, one to homeodomain protein, and one to a previously described EST (expressed sequence tag) of S. mansoni. This last clone was the most consistently reactive during the screening process with the anti-Sm31/32 antibodies dissociated from the immune complexes. The complete sequence of this clone was obtained and the translation data yielded only one ORF (open reading frame) that code for a protein with 57 amino acids. Based on this amino acid sequence two peptides were chemically synthesized and evaluated separately against a pool of serum samples from schistosomiasis patients and non-schistosomiasis individuals. Both peptides showed strong reactivity only against the positive pool, suggesting that these peptides may be useful as antigens for the diagnosis of schistosomiasis mansoni.

Personal and Social Performance (PSP) scale for patients with schizophrenia: translation to Portuguese, cross-cultural adaptation and interrater reliability

INTRODUCTION: Schizophrenia is a chronic mental disorder associated with impairment in social functioning. The most widely used scale to measure social functioning is the GAF (Global Assessment of Functioning), but it has the disadvantage of measuring at the same time symptoms and functioning, as described in its anchors. OBJECTIVES:Translation and cultural adaptation of the PSP, proposing a final version in Portuguese for use in Brazil. METHODS: We performed five steps: 1) translation; 2) back translation; 3) formal assessment of semantic equivalence; 4) debriefing; 5) analysis by experts. Interrater reliability (Intraclass correlation, ICC) between two raters was also measured. RESULTS: The final version was applied by two independent investigators in 18 adults with schizophrenia (DSM-IV-TR). The interrater reliability (ICC) was 0.812 (p < 0.001). CONCLUSION: The translation and adaptation of the PSP had an adequate level of semantic equivalence between the Portuguese version and the original English version. There were no difficulties related to understanding the content expressed in the translated texts and terms. Its application was easy and it showed a good interrater reliability. The PSP is a valid instrument for the measurement of personal and social functioning in schizophrenia.

Some personal views on the control of schistosomiasis mansoni

Our views are based, on a recent study of a district of Uniao dos Palmares (Alagoas). Although being a very compact community (32 city blocks holding two thousand families), transmission is very uneven, the geometric mean egg counts in the various blocks ranging between extremes of 96 and 1920. (Results do not correlate with the availability of domestic water supply). We thus are led to conclude that: (a) transmission is primarily peridomestic, resulting from pollution of open ditches and other collections of water; (b) control of transmission can be done on a selective basis, requiring quite medest investments. Given the inefficacy of population-based chemotherapy, when used alone, the author insists that this alternative cannot any longer be overlooked. He also regrets the emphasis placed upon vaccine development; allegations that this would, at any rate, prevent severe morbidity can be dismissed, since-whatever the cause-morbidity due to schistosomiasis has been rapidly declining in Northeast Brazil.

Personal experience with diagnostic and therapeutic aspects of human Leishmania (Viannia) braziliensis in Três Braços

Diagnostic and therapeutic aspects of human infection with Leishmania (Viannia) braziliensis found in the littoral forest of the state of Bahia are reviewed. There is pressing need for alternative cheap oral drug therapy.

Sequencing and identification of expressed Schistosoma mansoni genes by random selection of cDNA clones from a directional library

We have initiated a gene discovery program in Schistosoma mansoni based on the technique of Expressed Sequence Tags (ESTs), i.e. partial sequences of cDNAs obtained from single passes in automatic DNA sequencers. ESTs can be used to identify genese onf the basis of their homology whith sequences from other species deposited in DNA or protein databases. Trasncripts with sequences without matches in teh databases may represent novel parasite-specific genes. This approach has shown to be very efficient and in less than two years a broad range of novel genes has already been ascertained, more than doubling the number of known S. mansoni genes.

A bacterial artificial chromosome library for Biomphalaria glabrata, intermediate snail host of Schistosoma mansoni

To provide a novel resource for analysis of the genome of Biomphalaria glabrata, members of the international Biomphalaria glabrata Genome Initiative (biology.unm.edu/biomphalaria-genome.html), working with the Arizona Genomics Institute (AGI) and supported by the National Human Genome Research Institute (NHGRI), produced a high quality bacterial artificial chromosome (BAC) library. The BB02 strain B. glabrata, a field isolate (Belo Horizonte, Minas Gerais, Brasil) that is susceptible to several strains of Schistosoma mansoni, was selfed for two generations to reduce haplotype diversity in the offspring. High molecular weight DNA was isolated from ovotestes of 40 snails, partially digested with HindIII, and ligated into pAGIBAC1 vector. The resulting B. glabrata BAC library (BG_BBa) consists of 61824 clones (136.3 kb average insert size) and provides 9.05 × coverage of the 931 Mb genome. Probing with single/low copy number genes from B. glabrata and fingerprinting of selected BAC clones indicated that the BAC library sufficiently represents the gene complement. BAC end sequence data (514 reads, 299860 nt) indicated that the genome of B. glabrata contains ~ 63% AT, and disclosed several novel genes, transposable elements, and groups of high frequency sequence elements. This BG_BBa BAC library, available from AGI at cost to the research community, gains in relevance because BB02 strain B. glabrata is targeted whole genome sequencing by NHGRI.

Conocimiento de la ley y preparación del personal sanitario sobre el proceso asistencial de la muerte

Este estudio apunta a conocer la percepción que los profesionales de la salud (médicos, enfermeras y auxiliares de enfermería) tienen acerca de su preparación en el cuidado de los enfermos terminales y determinar sus conocimientos sobre la legislación de cuidados paliativos. Se ha realizado un estudio transversal, en un hospital de Granada (España), mediante la aplicación de un cuestionario ad hoc. Los resultados muestran que la mayoría del personal ha trabajado con pacientes en el final de su vida, pero sólo la mitad cree tener la formación adecuada para cuidarlos. Una parte considerable dice no conocer la legislación actual en cuidados paliativos. La mayoría de los profesionales plantearía la retirada de terapias para el mantenimiento de la vida y desconocen el mecanismo para informar sobre la cumplimentación del Testamento Vital, como indica el Plan de Cuidados Paliativos de Andalucía (España).

Soil spectral library and its use in soil classification

Soil science has sought to develop better techniques for the classification of soils, one of which is the use of remote sensing applications. The use of ground sensors to obtain soil spectral data has enabled the characterization of these data and the advancement of techniques for the quantification of soil attributes. In order to do this, the creation of a soil spectral library is necessary. A spectral library should be representative of the variability of the soils in a region. The objective of this study was to create a spectral library of distinct soils from several agricultural regions of Brazil. Spectral data were collected (using a Fieldspec sensor, 350-2,500 nm) for the horizons of 223 soil profiles from the regions of Matão, Paraguaçu Paulista, Andradina, Ipaussu, Mirandópolis, Piracicaba, São Carlos, Araraquara, Guararapes, Valparaíso (SP); Naviraí, Maracajú, Rio Brilhante, Três Lagoas (MS); Goianésia (GO); and Uberaba and Lagoa da Prata (MG). A Principal Component Analysis (PCA) of the data was then performed and a graphic representation of the spectral curve was created for each profile. The reflectance intensity of the curves was principally influenced by the levels of Fe2O3, clay, organic matter and the presence of opaque minerals. There was no change in the spectral curves in the horizons of the Latossolos, Nitossolos, and Neossolos Quartzarênicos. Argissolos had superficial horizon curves with the greatest intensity of reflection above 2,200 nm. Cambissolos and Neossolos Litólicos had curves with greater reflectance intensity in poorly developed horizons. Gleisols showed a convex curve in the region of 350-400 nm. The PCA was able to separate different data collection areas according to the region of source material. Principal component one (PC1) was correlated with the intensity of reflectance samples and PC2 with the slope between the visible and infrared samples. The use of the Spectral Library as an indicator of possible soil classes proved to be an important tool in profile classification.

Identidad personal y subjetividad social: educación y constitución subjetiva

La constitución subjetiva en nuestra sociedad contemporánea debe ser abordada dentro de la compleja trama de relaciones intersubjetivas y desde diferentes formulaciones teóricas. La construcción del sujeto involucra la existencia de un "otro", que le da sentido a su existencia y a la constitución/adquisición de identidades sociales/colectivas. Ese proceso se aborda en términos de representaciones sociales, como expresión del sentido común, que se desarrollan en complejos procesos que involucran estabilidad de largo alcance y antinomias -themata- que definen las situaciones de tensión, inherentes y propias, del devenir del sentido común. Se considerarán cuatro procesos psicosociales: 1) La Identidad como producto intersubjetivo. 2) La Representación social como expresión de la identidad. 3) Los themata como constitutivos de la Representación social. 4) La interdependencia simbólica Yo/Otros. Se ilustrará con ejemplos de dos investigaciones, en Ciers-ed y en Universidad de Buenos Aires sobre educación

Building the future: the Brazilian university library in 2010

Information technology will affect academic activities as well as the nature of the high education sector. This sector besides the need to assimilate these technologies will need to attend the requisites of market globalization and, as consequence, all theses changes will be reflected in the university library. Prospectives impacts will affect the structure (emphasis in user services, outsourcing of several services), in the financing aspect (growing of consortia in order to reduce costs), in services (electronic reference, support to long distance education programs, intelligent agents) and in the clientele (attending the great demand por high education which implies a diversity of people).

Technology and research in a global Networked University Digital Library (NUDL)

Digital Libraries (DLs) are extremely complex information systems that support the creation, management, distribution, and preservation of complex information resources, while allowing effective and efficient interaction among the several societies that benefit from DL content and services. In this paper, we focus on our experience facing challenges of building, maintaining, and developing the Networked University Digital Library (www.nudl.org), an extension of the Networked Digital Library of Theses and Dissertations (www.ndltd.org). NUDL is a worldwide initiative that addresses making the intellectual property produced in universities more accessible, stimulating international collaboration across all disciplines. We detail technological aspects of our solutions and research activities carried out to provide powerful and enriched services for the communities served by this initiative.