Doença celíaca num doente com síndrome poliglandular autoimune tipo III : caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Benefícios e constrangimentos do envolvimento paterno no trabalho de parto e parto

Enquadramento - O envolvimento paterno no trabalho de parto tem suscitado o interesse de vários profissionais de saúde, nomeadamente dos enfermeiros obstetras, dado que os benefícios da presença paterna no contexto de parto ainda não são clara e totalmente assumidos por todos os profissionais. Por outro lado reconhece-se que o pai é o acompanhante ideal da grávida durante o trabalho de parto, pelo seu apoio e lugar que ocupa na tríade. Objetivos – Identificar os benefícios e constrangimentos do envolvimento paterno durante o trabalho de parto e parto. Método – Efetuada revisão integrativa da literatura sobre os “Benefícios e constrangimentos do envolvimento paterno durante o trabalho de parto e parto” nas bases de dados: PubMed, LILACS, SciELO, Repositórios Institucionais e Bibliotecas Digitais e EBSCO Host, elaborados entre 2000 e 2014. Selecionaram-se 19 artigos que obedeceram aos critérios de inclusão deste estudo. Dos 19 artigos selecionados, 4 são revisões sistemáticas da literatura, 13 são estudos qualitativos e 2 são estudos quantitativos. Resultados – Evidenciou-se um “novo” pai, que acompanha a grávida desde a gravidez, e que esteve presente no trabalho de parto. É dada grande relevância aos Enfermeiros Especialistas em Saúde Materna e Obstetrícia, pelo seu papel na inclusão do pai na sala de parto e desmitificação de tabus. Após esta pesquisa constatou-se que, ainda há lacunas relativamente à presença do pai parto. São muitos os benefícios do envolvimento paterno no parto, mas ainda são visíveis constrangimentos por parte do pai relativamente ao contexto de parto. Conclusões - A presença do pai na sala de parto permite estreitar os laços mais íntimos, consolidando a união familiar e proporcionando bem-estar à grávida. Realça-se o papel dos profissionais de saúde na integração do pai na maternidade. Caminhamos para um contexto de parto mais alargado e do qual já não faz parte apenas a grávida e o seu filho, mas no qual o pai é também elemento chave de todo o processo. Palavras- chave: “Pai”, “Nascimento”, “Envolvimento paterno” e “Recém - Nascido”.

Traité de la construction et des principaux usages des instrumens de mathématique : avec les figures nécessaires pour l'intelligence de ce traité.

Mode of access: Internet.

Abrégé de la grammaire grecque de Clénard, des accents, de la syntaxe et des dialectes : peu de préceptes, mais beaucoup de lecture, de réflexion, & d'exercise.

Mode of access: Internet.

Anthologia : ergo vraveumeno apo tē Gallikē Akadēmia /

Juvenilia - Silenti dissolutio - Tropaia stēn Trikymia - Hē Megalē aura - Ho gyros tōn hōron - Kalveia metra - Ho apethantos - Apollōnion asma - Aiolikē arpa.

Vus du dehors; essai de critique scientifique et philosophique sur quelques auteurs français contemporains,

Translation of Zeitgenössische Franzosen.

Traité de l'élevage et des maladies du porc.

Mode of access: Internet.

Traité complet de l'élevage et des maladies du mouton.

Mode of access: Internet.

Prevalência e fatores associados à morbidade materna: inquérito populacional em Natal/RN

INTRODUCTION: Severe maternal morbidity , also known as maternal near miss , has been used as an alternative to the study of maternal mortality , since being more frequent shares the same determinants and enables the implementati on of epidem iological surveillance of cases . Since then, hospital audits ha ve been carried out to determine the rates of maternal near miss, its mai n causes and associated factors . More recently, population surveys based on self - reported morbidity have als o been presented as vi able in identifying these cases . OBJECTIVE: The aim of this study was to determine the prevalence and associated factors of maternal near miss and complications during pregnancy and puerperal period in Natal/RN. METHODS: A cross - secti onal population - based study was conducted in Natal /RN , Brazil, which has as its target population women aged 15 to 49 years who were pregnant in the last five years. It was carried out a probabilistic sam pling design based on a multi - stage complex sample , in which 60 census tracts were selected from three strata (north , south - east and west). Afterwards, domiciles were visited in order to obtain a sample of the 908 eligible women in whom a questionnaire was applied. The descriptive analyzes and bivariate ass ociations were performed using the Chi - square test and the estimate of the prevalence ratio (PR ) with 95% confidence interval (CI) and considering the weights and design effects . The Poisson regression analysis , also with 5% significance and 95% CI, was us ed for analyzes of associated factors. RESULTS: 848 women were identified and interviewed after visits in 8.227 households corresponding to a response rate of 93 . 4 %. The prevalence of maternal near miss was 41 . 1 /1 000NV, being the Intensive Care Unity stay i ng (19 . 1 /1 000 LB ) and eclampsia (13 . 5/1000LB) the most important marker s . The prevalence of complications in the puerperal peri od was 21 . 2 %, and hemorrhage (10 . 7%) and urinary tract infection (10 . 7%) the most frequently reported clinical conditions and rema in ing in the hospital for over a week after delivery the mo st frequent intervention (5.4%) . Regarding associated factors , the bivariate analysis showed an association between the increased number of complications in women of black/brown race ( PR= 1 . 23; CI95 % : 1 . 04 - 1 . 46) and lower socioeconomic status ( PR= 1 . 33; CI95%: 1 . 12 - 1 . 58) in women who had pre natal care in public service ( PR= 1 . 42; CI95%: 1 . 16 to 1 . 72 ) and that were not advised during prenatal about where they should do the d elivery (PR= 1 . 24; CI95%: 1 . 05 - 1 . 46), made the del ivery in the public service (PR= 1 . 63; CI95%: 1 . 30 - 2 . 03), had to search for more than one hospital for delivery (PR=1 . 22; CI95%: 1 . 03 - 1 . 45) and had no companion during childbirth ( PR =1 . 19; CI95%: 1 . 01 - 1 . 41) or at all times of childbirth c are - before, during and after childbirth - ( PR= 1 . 25, CI95%: 1 . 05 - 1 . 48) . Moreover, the number of days postpartum hospitalization was higher in women who had more complications (P R= 1 . 59 ; CI95%: 1 . 36 - 1 . 86). In the final regression model for both birth place (P R= 1 . 21 ; CI 95% : 1 . 02 to 1 . 44 ) and socioeconomic status (PR = 1.54 ; CI95%: 1 . 25 - 1 . 90 ) the association remained. CONCLUSION : Conducting population surveys using the pragmatic definition of near miss is feasible and may add importa nt information about this ev ent . It was possible to find the expression of health inequalities related to maternal health in the analysis of both socioeconomic conditions and on the utilization of health services.

Processo de cuidar de um centro de tratamento oncológico

The objective was to understand the process of caring for a center for cancer treatment from the perspective of nurses and patients. This is a qualitative research, xploratory and descriptive, performed in a cancer treatment center in Natal / RN / Brazil. Data collection occurred between August 2013 and February 2014, being effected by means of two techniques: photographic record and projective interviews with nurses and patients. Social actors included in the study were ten professional nursing and ten patients admitted to the surgical department of the institution. The criteria used for inclusion of professionals were: be professional in the field of nursing, being an employee of the hospital, to be inserted in the scale of nurses of the institution at the time of data collection. For the patients were included who had preserved their cognitive abilities and who were hospitalized and at any stage of treatment. We used content analysis proposed by Bardin, for the analysis of material collected during projective interview. The research followed the ethical and legal principles that govern scientific research on human beings, being conducted by the project approval by the Research Ethics Committee of the Northern League Against Cancer Riograndense with 295 673 and look CAAE 16104313.0.0000.5293. Referring to nurses, they demonstrated different views about care, which sprouted from a holistic, multidisciplinary approach and welcoming, as well as linked to the performance of procedures and compliance with the requirements technicality. Furthermore, these subjects also showed that care unfolds through the actions of management in carrying out the records in the humanization of care by meeting the needs of the patient and ambience. Front of patients, it is noteworthy that, for them, care happens through attitudes of caring and professional approach, and by performing procedures, being mentioned as a careless lack of structure of the institution and the discomfort caused by this condition factors. It was evident also that the actors involved in the care, the perception of professionals and patients, are represented by nurses, doctors, psychologists, nutritionists, as well as kitchen assistants and cleaners; beyond family companion, the individual himself as responsible for their care and volunteer caregiver. In this opportunity, it is concluded 9 that an understanding of care from the perspective of nurses and patients involves broad issues ranging from perceptions of care that embraces a dynamic complex elements and attitudes imbued with meanings, in which those involved can assume both the role of carers as care beings, even a carefully tied to prescribed routines and performing procedures. Thus, the findings described refer to reflections on the care provided to cancer patients and whether this, in fact, translates principles of a humane practice

Processo de cuidar de crianças hospitalizadas com câncer

The objective was to understand the process of care in the perception of hospitalized children with cancer. This is a descriptive study of qualitative approach. Data were collected between the months of October 2013 and January 2014, through photographic records and semi-structured interview consisting of questions relating to the identification of age, sex, diagnosis and length of stay and a script of questions related to the recorded pictures. Eight children were included aged between six and twelve who were admitted to a pediatric oncology sector, located in the city of Natal / RN. The criteria used in the sample were: being hospitalized for cancer treatment; and present favorable physical conditions for carrying out the data collection. For the treatment of collected material was used content analysis, thematic modality. The study followed the ethical and legal principles governing scientific research with human beings and took place with the approval of the project by the Ethics and Research Committee of the Northern League Riograndense against Cancer, with opinion registered under number 329 015 and CAAE 16097613.9.0000.5293. According to the results it was found that, for the child, the care happens through technical activities, such as making procedures and the use of personal protective equipment, as well as through the dialogic relationship, which favors the establishment of confidence in care professional. Caring also means developing activities that promote well-being, the fun and the social and cognitive development, highlighting thus the playful, during hospitalization, as an auxiliary tool in the care process. During hospitalization, the child identifies two individuals responsible for their care, accompanying family and professional, and nursing professionals the most cited in moments of care. , Also of note, the promotion of care, in the perception of the child related to the infrastructure of the institution, environmental cleaning, personal hygiene, the medicalization and the food. It is concluded that care understood by the child, whilst still maintaining relations with the biomedical model, points to a new perspective that should consider the biological, social and psychological of acquiring cancer without unlink them of the development child. 9 Moreover, we see the child as an active social actor in this process, and therefore needs to be heard and answered their needs

Quem é o doente? Um estudo sobre as vivências dos acompanhantes de pacientes adultos em hospital público no Rio Grande do Norte

The aim of this research is to reveal how caregivers have lived the experiences from adult patients admitted in a Rio Grande do Norte’s state hospital. This is a study where the use of the participant observation, associated with the use of interviews and informal conversations handled categories such as the mismatch between the prerogatives of Brazilian Health Care Policies (HumanizaSUS) and practices performed in hospitals, the relationships established between the caregivers and the other subjects of the research field, family relationships, permanence of women as caregivers, therapeutic itineraries, dramas, religiosity and secrets. To sew up it appears the role of a caregiver is more than emotional support or help, it is a complex act in several directions.

Avaliação das condições de precipitação do azul da Prússia sobre pó de grafite visando o desenvolvimento de eletrodos de pasta de carbono para a quantificação de nitrito

An amperometric FIA method for nitrite quantification based on nitrite electroreduction and employing a carbon paste electrode (CPE) chemically modified with iron hexacyanoferrate (HCF) as an amperometric detector was developed. The influence of experimental conditions on the preparation of the electrode materials was evaluated and the materials obtained in each study were used for the development of modified electrodes. The electrochemical sensors were prepared by a fast, simple, and inexpensive procedure, and the long-term performance of the electrodes were quite satisfactory as the stability was maintained over one year. HCF was an effective redox mediator for nitrite electroreduction in acidic media, allowing nitrite detection at +0.2 V vs. Ag/AgClsat, which is a potential free of possible interfering species that are normally present in food and water samples. The electrochemical cell used in the FIA system was similar to a batch injection analysis cell, enabling recirculation of the carrier solution. This is an attractive feature because it allows the use of a high flow rate (6 mL min-1) leading to high sensitivity and analysis speed, while keeping reagent consumption low. The proposed method had a detection limit of 9 μmol L-1 and was successfully employed for nitrite quantification in spiked water and sausage samples. The obtained results were in good agreement with those provided by the spectrophotometric official method. At a 95 % confidence level it was not observed statistical differences neither in nitrite content nor in the precision provided by both methods. The experimental conditions for the synthesis of HCF were optimized and the best electrode material was prepared by mixing FeCl3, K4[Fe(CN)6] and carbon powder subjected to an acid and thermal treatment (400 ºC), followed by ultrasonic agitation at 4 °C. This material was used to construct an electrode with improved analytical performance to reduce nitrite, which presented greater stability compared to HCF film electrodeposited on the EPC, showing that the preparation procedure of the electrode material is an effective strategy for the development of HCF modified electrodes.

Tecendo vivências e sentidos do câncer infantil : família, doença e redes de apoio social em Natal-RN

This paper discusses the experiences related to the treatment of children´s cancer which had children, their mothers and families as their main characters. They were mainly originated from areas in the countryside and urban poor areas in the State of Rio Grande do Norte. The non-governmental organization Grupo de Apoio à Criança com Câncer (GACC) was the privileged ethnographic location. In this setting, the mother, which was called acompanhante (companion), and the children, defined as pacientes (patients), were often sheltered in reason of therapeutic practices and the treatment undertaken by children in a nearby hospital. This study aims to focus on the therapeutic itinerary, beyond the children´s suffering, dealing with the family as a whole, since the moral values from these popular families imply the complete involvement of the family in relation to the illness and its treatment. Therefore, it is experienced as a family problem. We also intend to understand the construction of meanings to the illness, dealing with the ideological continuity in the relationships between the families and the GACC. These meanings were built in the intersection of these two spheres, which refer particularly to medical, religious and emotional explanations. Ethnographic methods were applied in this research at the entity and another social contexts, such as the family households. I also tried to retrieve the process of treatment outside the GACC, visiting the family context, when doing dense interviews or just having conversations with informants. It was found that the GACC, as a non-governmental organization, generates a negotiation of identities, which develops, then, through the family as a whole, but also through the child and especially the mother, affecting, in some way, their internal organization. Furthermore, the meanings of the experience of illness appeared to be shaped by the family sphere as well as by the logic of public health structures

Vivências dos cuidadores de idosos durante a internação hospitalar

O estudo objetivou conhecer as vivências do cuidador principal no cuidado do idoso no hospital. Realizou-se uma pesquisa descritiva exploratória de cunho qualitativo. Foi executada nas unidades de clínica médica, cirúrgica e serviço de pronto atendimento de um hospital universitário do sul do país, entre os meses de novembro e dezembro de 2013, através de um roteiro de entrevista, respondido por 11 cuidadores de idosos com doenças crônicas. As entrevistas foram transcritas e analisadas com a técnica de análise temática de Minayo. Nesta pesquisa, os cuidadores se caracterizam por ser, na sua maioria, do sexo feminino, casadas, com filhos, sem emprego remunerado e serem filhas do idoso hospitalizado. Os cuidadores participantes entendem a atividade de cuidar como um dever moral, resultado das relações pessoais e familiares. A partir do momento em que necessitam desempenhar tal papel, o assumem como uma exigência decorrente do fato de viverem em família. Os motivos que levaram o cuidador a desempenhar este papel relacionam-se com fatores inerentes ao idoso, como estado de saúde e grau de parentesco. Ao cuidador, fazem alusão ao dever/obrigação, gratidão/retribuição, grau de parentesco, gênero, proximidade afetiva, estado civil, situação atual de emprego e ausência de outra pessoa para realizar o cuidado. Durante o processo de hospitalização do idoso, o cuidador desenvolve ações, tem facilidades e dificuldades e utiliza estratégias que o auxiliam a cuidar. Ao vivenciar o cuidado ao idoso no hospital é influenciado a tornar-se cuidador, apresenta diversas experiências ao cuidar e precisa promover mudanças, em relação ao cuidado, com a internação do idoso. Ao implementar estratégias de cuidado durante a hospitalização do idoso, o familiar cuidador se organiza para cuidar e faz uso de uma rede de apoio para o cuidado. Constatou-se que o idoso e seu cuidador centralizam as necessidades e as decisões, que a rede de apoio informal é a principal provedora de auxílio durante a hospitalização do idoso e que a rede de apoio formal extrahospitalar é existente, porém não apresenta participação ativa no suporte do cuidador familiar. Por outro lado, a equipe de enfermagem responsável pelo cuidado intra-hospitalar foi uma participante ativa na totalidade dos relatos, provendo tanto o cuidado técnico especializado quanto a ajuda nas situações cotidianas emergentes, bem como suporte emocional aos cuidadores e idosos. Outro aspecto relevante destacado foi a falta de ajuda de alguns familiares no amparo aos cuidadores ou até mesmo ao idoso hospitalizado. Esse fato é considerado, pelos cuidadores, uma situação inaceitável, pois a família é vista como o sustentáculo em momentos de crise. As implicações deste estudo nas intervenções da enfermagem no cuidado ao doente e sua família estão relacionadas às discussões e reflexões, a serem realizadas pela equipe de saúde, acerca da inclusão do familiar no espaço hospitalar, pois a sua presença auxilia na manutenção da estabilidade física e emocional do idoso. Desta forma, a enfermagem poderá oferecer apoio ao familiar acompanhante para que se mantenha estável e possa formar uma parceria de cuidados, contribuindo na reabilitação do idoso.