Apoyo social a drogodependientes en programa de mantenimiento con metadona en una prisión

Goal: To learn more about the social support available to patients participating in a prison methadone maintenance program (PMM). Methodology: Descriptive, with controls. Setting: A penitentiary in Albolote (Granada) Population Sample: The total prison population was 1,579; 364 patients were included in the PMM; 35 were female and 329 were male. 60 patients, 7 women and 53 men, were used as cases. 30 non-drug dependent prisoners, 3 women and 27 men, were the control group. They had no antecedents of problems with drug addiction. Interventions: Interviews with cases and controls to learn about their addictive antecedents, family structure, socio-economic level, and a hetero-applied MOS questionnaire was completed. Percentages of each social support variable were obtained and compared using the chi-squared technique. Results: The overall support received is low in 38 cases (74.5%) and in 9 controls (30%): p = 0.0001. OR 0.1466, confidence interval at 95% (0.0538-0.3989). Support received is normal in 13 cases (25%) and 21 controls (70%): p = 0.0007. OR 0.69, confidence interval at 95% (0.44-0.93). All of the variables were statistically significant for non-drug addicts, except for emotional support, which was the same for both groups. Conclusion: The perception of inmates participating in the methadone maintenance program was that they received less social support than the non-drug dependent inmates.

Brote de brucelosis interprovincial por ingesta de queso fresco sin higienizar

Goal: To study an August 2004 outbreak of brucellosis notified in Velez-Rubio (Almeria) and to determine the source of that infection as well as its transmission mechanisms, in addition to proposing preventive measures. Methodology: Descriptive study and paired case controls (three controls were selected for each case). Setting: Health Centers in de Vélez-Rubio (Almeria) and Alcalá de Guadaira (Seville). Population: Suspected/probable case: a person with compatible clinical symptoms and positive brusella agglutination diagnosed between July 2005 and March 2005. Confirmed case: in addition to identifying the causal agent, laboratory test results resulted in a confirmation. Interventions: Report forms, epidemiological surveys, clinical histories, and laboratory tests were used as sources of data. Odds ratios (OR) and confidence intervals were calculated to study the relationship among cases, sources of infection, and transmission mechanisms. The Chi Square test and Yates correction were employed. Results: 10 cases were identified (9 in Almeria and 1 in Seville), 8 of them pobable and 2 confirmed, in persons between the ages of 45 and 81. The symptoms first appeared between the months of May and September 2005. Fever was the most frequent symptom (100%). The OR for the consumption of fresh, non.-pasteurized cheese was 112 (CI 4,48-16968,94), p< 0,001. Infected animals were intervened. Conclusions: The inter-provincial outbreak of brucellosis was confirmed as stemming from the consumption of non-pasteurized cheese sold on the street. The source of infection was identified and the Department of Agriculture carried out the necessary actions.

Identification of factors associated with diagnostic error in primary care.

BACKGROUND Missed, delayed or incorrect diagnoses are considered to be diagnostic errors. The aim of this paper is to describe the methodology of a study to analyse cognitive aspects of the process by which primary care (PC) physicians diagnose dyspnoea. It examines the possible links between the use of heuristics, suboptimal cognitive acts and diagnostic errors, using Reason's taxonomy of human error (slips, lapses, mistakes and violations). The influence of situational factors (professional experience, perceived overwork and fatigue) is also analysed. METHODS Cohort study of new episodes of dyspnoea in patients receiving care from family physicians and residents at PC centres in Granada (Spain). With an initial expected diagnostic error rate of 20%, and a sampling error of 3%, 384 episodes of dyspnoea are calculated to be required. In addition to filling out the electronic medical record of the patients attended, each physician fills out 2 specially designed questionnaires about the diagnostic process performed in each case of dyspnoea. The first questionnaire includes questions on the physician's initial diagnostic impression, the 3 most likely diagnoses (in order of likelihood), and the diagnosis reached after the initial medical history and physical examination. It also includes items on the physicians' perceived overwork and fatigue during patient care. The second questionnaire records the confirmed diagnosis once it is reached. The complete diagnostic process is peer-reviewed to identify and classify the diagnostic errors. The possible use of heuristics of representativeness, availability, and anchoring and adjustment in each diagnostic process is also analysed. Each audit is reviewed with the physician responsible for the diagnostic process. Finally, logistic regression models are used to determine if there are differences in the diagnostic error variables based on the heuristics identified. DISCUSSION This work sets out a new approach to studying the diagnostic decision-making process in PC, taking advantage of new technologies which allow immediate recording of the decision-making process.

Verificação da ocorrência do efeito índice no Ibovespa – 2004-2013

RESUMONo artigo, analisa-se a ocorrência de retornos e volumes anormais para as ações adicionadas ao Ibovespa entre 2004 e 2013, no contexto do efeito índice, uma das anomalias de mercado mais antigas relatadas em finanças, empregando-se a metodologia de estudo de evento. Diferentemente de outros estudos, encontram-se retornos anormais positivos próximos aos dias que antecedem a data de efetivação do índice à nova carteira. Os resultados são invertidos para períodos de estimação superiores àquele de apuração do índice. Os volumes são anormalmente altos. A não persistência dos retornos anormais ao longo da janela de entrada é coerente com a hipótese de pressão de preços e pode ser considerada coerente com a forma de eficiência semiforte de mercado.

Meropenem versus imipenem-cilastatin in intraabdominal infections requiring surgery

In a multicentre, open, randomised study, the efficacy and tolerability of intravenous meropenem (1 g every 8 h, infusion or bolus) was compared with that of intravenous imipenem/cilastatin (1 g every 8 h, infusion) in 232 hospitalised patients with moderate to severe intra-abdominal infections. At the end of therapy, a satisfactory clinical response (cure or improvement) was seen in 79/82 (96%) evaluable meropenem patients and 83/88 (94%) imipenem/cilastatin patients; this was still seen at follow-up (57/63; 90% and 58/66; 88%, respectively). A satisfactory bacteriological response (elimination or presumed elimination) was seen in 69/82 (84%) meropenem patients and 71/88 (81%) imipenem/cilastatin patients at the end of therapy and in 52/62 (84%) and 55/70 (79%), respectively, at follow-up, There was a high level of clinical cure or improvement(95% for both treatment groups) in the 120 patients (60 in each group) who had polymicrobial infections. <p>A similar incidence of adverse events was seen in each group: 45/116 patients in the meropenem group (72 events) and 42/116 patients in the imipenem/cilastatin group (65 events); the adverse event profiles were also similar, with injection site inflammation and elevated transaminases the most frequent in both groups. The results of this study indicate that monotherapy with meropenem was as effective and as well tolerated as the combination of imipenem/cilastatin in the treatment of moderate to severe intra-abdominal infections.

Early intracellular trafficking of Waddlia chondrophila in human macrophages.

Waddlia chondrophila is an obligate intracellular bacterium considered as a potential agent of abortion in both humans and bovines. This member of the order Chlamydiales multiplies rapidly within human macrophages and induces lysis of the infected cells. To understand how this Chlamydia-like micro-organism invades and proliferates within host cells, we investigated its trafficking within monocyte-derived human macrophages. Vacuoles containing W. chondrophila acquired the early endosomal marker EEA1 during the first 30 min following uptake. However, the live W. chondrophila-containing vacuoles never co-localized with late endosome and lysosome markers. Instead of interacting with the endosomal pathway, W. chondrophila immediately co-localized with mitochondria and, shortly after, with endoplasmic reticulum- (ER-) resident proteins such as calnexin and protein disulfide isomerase. The acquisition of mitochondria and ER markers corresponds to the beginning of bacterial replication. It is noteworthy that mitochondrion recruitment to W. chondrophila inclusions is prevented only by simultaneous treatment with the microtubule and actin cytoskeleton-disrupting agents nocodazole and cytochalasin D. In addition, brefeldin A inhibits the replication of W. chondrophila, supporting a role for COPI-dependent trafficking in the biogenesis of the bacterial replicating vacuole. W. chondrophila probably survives within human macrophages by evading the endocytic pathway and by associating with mitochondria and the ER. The intracellular trafficking of W. chondrophila in human macrophages represents a novel route that differs strongly from that used by other members of the order Chlamydiales.

Controle pressórico e adesão/vínculo em hipertensos usuários da Atenção Primária à Saúde

Estudo descritivo e analítico, de base populacional, realizado com uma amostra aleatória e probabilística de 340 hipertensos, representativa da Estratégia Saúde da Fam&#237;lia (ESF) de João Pessoa, PB. O estudo compõe a primeira parte de uma coorte iniciada em 2008. O instrumento utilizado foi adaptado do Primary Care Assessment Tool, revalidado no Brasil. A regressão logística avaliou a associação entre o controle pressórico, as variáveis sócio-demográficas e o indicador de adesão/vínculo. Dentre os 340 hipertensos, 32,6% era acompanhado pela ESF e 89,1% apresentou adesão/vínculo satisfatória. Os idosos apresentaram maior chance de controlar a pressão, o que sugere uma percepção melhor do autocuidado e maior adesão ao tratamento. O estudo permitiu dar visibilidade à problemática do controle da hipertensão por meio da avaliação do serviço. Espera-se que esse modelo possa ser adotado em outras localidades, gerando parâmetros para comparações entre municípios distintos.

Acompanhamento de familias de criancas com doenca cronica: percepcao da equipe de Saude da Familia

Este estudo objetivou caracterizar como a equipe da Estratégia Saúde da Fam&#237;lia percebe sua din&#226;mica de acompanhamento de fam&#237;lias que convivem com a doen&#231;a crônica da crian&#231;a. Trata-se de uma pesquisa qualitativa que teve como referencial teórico o Interacionismo Simbólico e como método a An&#225;lise de Conteúdo, técnica de an&#225;lise categorial temática. Para a coleta de dados utilizou-se o grupo focal, que foi desenvolvido com três equipes de Saúde da Fam&#237;lia, totalizando 32 sujeitos. Os resultados foram organizados em três categorias temáticas: Peculiaridades das fam&#237;lias que convivem com a doen&#231;a crônica da crian&#231;a; Equipe, fam&#237;lia e Estratégia Saúde da Fam&#237;lia e Limitações para cuidar. A percepção da equipe é que o desenho da Estratégia Saúde da Fam&#237;lia favorece o acesso à experiência familiar, permitindo o reconhecimento de suas especificidades. Os dados revelam ainda as limitações da equipe em sua capacidade de resolução e a necessidade de investimentos na articulação entre os distintos serviços, setores e equipamentos sociais.

Vulnerabilidade da crian&#231;a diante de situações adversas ao seu desenvolvimento: proposta de matriz analítica

Estudo teórico que teve como objetivo elaborar uma matriz conceitual para analisar a vulnerabilidade da crian&#231;a diante de situações adversas para seu desenvolvimento. Propõe-se que vulnerabilidade da crian&#231;a seja analisada por meio dos aspectos das dimensões individual, relativa a relações sustentadoras contínuas e proteção física e seguran&#231;a; social , concernente à inserção social da fam&#237;lia e ao acesso a direitos à proteção e promoção social, e programática , cen&#225;rio político-programático, de diretrizes e implementação político-programáticas. A aplicação prática desta matriz permite a captação do processo saúde-doen&#231;a para além da dimensão individual, possibilitando a articulação das políticas públicas e das ações dos profissionais, a fim de obter eficácia no atendimento às necessidades das crian&#231;as. O uso desse instrumento conceitual pode propiciar às equipes de saúde a apreensão, de forma específica, das situações adversas ao desenvolvimento infantil, bem como subsidiar a construção de planos de interven&#231;ão a partir das dimensões analíticas da vulnerabilidade.

Enfermeiro Clinico Especialista: um modelo de pratica avancada de enfermagem em oncologia pediatrica no Brasil

O objetivo deste artigo é relatar a experiência de implantação do modelo de prática avan&#231;ada de enfermagem por meio da incorporação do enfermeiro clínico especialista na composição do quadro de enfermagem. As autoras apresentam o conceito desse modelo e descrevem seu processo de implantação em uma instituição de referência no cuidado à crian&#231;a e ao adolescente com câncer da cidade de São Paulo, Brasil. Na avaliação das enfermeiras clínicas especialistas, o principal resultado obtido com a adoção do modelo refere-se ao fortalecimento do papel do enfermeiro como profissional de referência para a articulação das diferentes demandas de cuidado à crian&#231;a, ao adolescente e ao adulto jovem com câncer e sua fam&#237;lia. Também destacam a satisfação dos usuários com o estreitamento da relação paciente, fam&#237;lia e enfermeira clínica, em todas as etapas do processo de cuidar.

Programa de Educacao pelo Trabalho para Saude: experiencia de transformacao do ensino e pratica de enfermagem

Trata-se de um relato de experiência de tutoras de enfermagem do Programa de Educação pelo Trabalho na Saúde (PET-Saúde) da Universidade Federal de Alagoas, entre maio de 2009 a abril de 2010. O objetivo do PET-Saúde enfermagem foi desenvolver ações de educação em saúde voltadas para as necessidades das comunidades atendidas pelas Unidades de Saúde da Fam&#237;lia em Maceió, Alagoas. Para isso, foi realizado o planejamento em saúde orientado pela metodologia da problematização. As atividades resultaram em mudan&#231;a na aprendizagem dos estudantes e na prática das enfermeiras do PET-Saúde, indicando a importância deste programa para o ensino e prática de enfermagem.

Supervision of Community Health Agents in the Family Health Strategy: the perspective of nurses

Objective Analyzing the conceptions of supervision of nurses in the Family Health Strategy (ESF - Estratégia Saúde da Fam&#237;lia) in relation to community health workers (ACS – Agente Comunitário de Saúde), taking for reference the work process and the power relations. Method A qualitative study, in which 18 interviews were carried out with nurses from the ESF in the countryside of the state of Goiás. Following transcription, the data were subjected to thematic content analysis and the following categories were identified: Supervision with that sees it all and Supervision is participating and working together. Results Among the findings, it is clear the character of control and monitoring that is carried out primarily through printed instruments and home visits, which constitute vertical and impositive relations, and suffer influence of the local health management. Another finding is the supervision as acting together and with the educational perspective. Conclusion The supervision carried out does not provide the changes intended by the ESF.

MEDICAL STUDENT IN THE FAMILY HEALTH STRATEGY ON THE FIRST YEARS OF COLLEGE: PERCEPTION OF GRADUATES

There is a lack of knowledge about the effective value of the experience gained by medical students who participate in the Family Health Strategy (Estratégia Saúde da Fam&#237;lia (ESF)) during the early stages of their medical training. This teaching strategy is based on learning by experiencing the problems that exist in real life. This study proposed to understand the value of this teaching strategy from the viewpoint of the students who had participated, after their graduation. The method adopted was a qualitative study conducted through interviews with students who graduated in the years 2009, 2010 and 2011. The data analysis used the hermeneutic dialectic technique as its model. The graduates considered that this experience enabled them to understand the organization and functioning of the health service and the context of the daily life of the users. This experience facilitated the doctor patient relationship, the development of clinical reasoning and the bond with the user. However the students emphasized that a lack of maturity prevented them gaining a higher level of benefit from the experience. Therefore, although the structure of the course is permeated by advances and challenges, it was concluded that this experience contributed to the student's learning of certain essential elements of medical training.

Evaluation of professional knowledge and attitudes on dementia patient care: a trans-cultural adaptation of an evaluation instrument

Objective To describe the trans-cultural adaptation of the evaluation instrument entitled Atenció Sanitària de Les Demències: la visió de L' Atenció Primarià from Catalan into versions in Portuguese for doctors and nurses. This study evaluates the knowledge and perspectives of these professionals in their treatment of patients diagnosed with dementia in cases of primary care. Method The adaptation followed internationally accepted rules, which include the following steps: translation, synthesis, back-translation, revision by a committee of specialists, and a test run with 35 practicing doctors and 35 practicing nurses in Brazil's Family Health Strategy (Estratégia Saúde da Fam&#237;lia, or ESF in Portuguese). Results The translation, synthesis, and back-translation steps were performed satisfactorily; only small adjustments were required. The committee of specialists verified the face validity in the version translated into Portuguese, and all of the items that received an agreement score lower than 80% during the initial evaluation were revised. In the test run, the difficulties presented by the health care professionals did not reach 15% of the sample, and therefore, no changes were made. Conclusion The Portuguese translation of the instrument can be considered semantically, idiomatically, culturally, and conceptually equivalent to the original Catalan version and is, therefore, appropriate for use in Brazil.