Melhoria da Atenção à Saúde dos Usuários com HAS e/ou DM da UBS Samira Barroso, Ipixuna/ AM

O acompanhamento dos usuários com Hipertensão Arterial Sistêmica e/ou Diabetes Mellitus são fundamentais para um ótimo controle das doenças, proporcionando um índice menor de complicações. O trabalho de conclusão de curso (TCC) mostra a experiência vivenciada mediante intervenção realizada na Unidade Básica de Saúde Samira Barroso Araújo no município Ipixuna, estado Amazonas, no período de setembro de 2014 a fevereiro de 2015. O foco da atuação foi na qualificação da atenção e assistência aos usuários hipertensos e/ou diabéticos, tendo como guias os Cadernos de Atenção Básica produzidos pelo Ministério da Saúde. Mediante Análise situacional criteriosa, constatou-se que havia necessidades de melhoria da cobertura, pois eram acompanhados 23 (16,4%) usuários com hipertensão e apenas 3 (9,37%) com diabetes. Após a intervenção, houve melhorias importantes, como a implantação da ficha espelho, ampliação da cobertura de atenção a usuários com Hipertensão Arterial e/ou Diabetes Mellitus, alcançando 100% de cobertura para ambas as doenças, com 140 hipertensos e 32 diabéticos acompanhados. Além disso, o desenvolvimento dessa intervenção proporcionou melhoria nos indicadores de qualidade relativos à coleta de exames laboratoriais, atendimento de saúde bucal, realização de busca ativa, avaliação de risco, dentre outras. Acreditamos que a intervenção possibilitou a formação de um vínculo maior com a comunidade e melhoria da qualidade e acessibilidade do serviço de saúde. Conclui-se que há ainda necessidade de melhorias no serviço e maior envolvimento e comprometimento da equipe, gestão e usuários, promovendo a incorporação e continuidade da intervenção no serviço, alcançando um excelente trabalho na Atenção Primaria à Saúde.

Atendimento aos trabalhadores rurais da colheita de café na Unidade de Saúde Cachoeirinha em Córrego Danta - MG

A dificuldade em oferecer assistência médica gratuita e de qualidade a todos os brasileiros, conforme prevê a Constituição Federal é um dos desafios da saúde pública no Brasil. Na unidade de saúde Cachoeirinha, localizada em Córrego Danta/Minas Gerais, o atendimento aos trabalhadores diminui consideravelmente no período da colheita de café, o que ilustra essa dificuldade. Em razão disso, este artigo pretende investigar a viabilidade de se implantar um projeto para intervenção neste cenário. Nesse sentido, foi realizada uma pesquisa bibliográfica sobre o assunto e elaborado um plano de ação, seguindo o modelo PES - Planejamento Estratégico Situacional proposto pela Universidade Federal de Minas Gerais, para execução na unidade supracitada. Em um primeiro momento, foi realizado um breve estudo sobre as garantias e os direitos dos trabalhadores, mais especificamente sobre os trabalhadores rurais. Para tanto foram utilizados livros, artigos científicos obtidos em bancos de dados como SCIELO e LILACS, além de manuais de inquéritos do Ministério da Saúde, testes e dissertações. Os descritores utilizados foram: saúde do trabalhador, saúde da população rural, direito à saúde. Foi utilizada literatura em língua portuguesa, compreendendo, principalmente, o período de 1998 a 2013. Em seguida foi caracterizada a comunidade em que está situada a unidade de saúde e por fim, foram analisadas as estratégias para a ação proposta. Concluiu-se que a garantia constitucional de acesso aos serviços de saúde para todos os brasileiros ainda não se verificou na prática e que o atendimento aos trabalhadores rurais da comunidade estudada está aquém do esperado; portanto, é preciso conscientizar a população sobre a importância da adoção de hábitos mais saudáveis e de se cuidar preventivamente da saúde e, principalmente, deve-se criar um horário alternativo para o atendimento dos trabalhadores que atuam na colheita de café, a fim de ampliar o atendimento a essa população

Ausência de contrarreferência na Estratégia Saúde da Família Córrego das Calçadas, município de Santa Luzia/MG

A Atenção Primária é a porta de entrada para o Sistema Único de Saúde e é, também, responsável pela coordenação do cuidado dos pacientes. Entretanto, para que a Atenção Primária possa exercer sua função de modo eficaz, é necessária uma contrarreferência adequada da Atenção Secundária e Terciária. A ausência de contrarreferência é um problema na Atenção Primária e resolvê-lo é um desafio para o sistema de saúde, porque depende da conscientização de profissionais especialistas e de uma rede integrada de prontuários eletrônicos. O objetivo deste estudo é elaborar um Projeto de Intervenção para aumentar, significativamente, o preenchimento de relatório de contrarreferência pelos profissionais especializados no município de Santa Luzia, Minas Gerais. Foi realizada uma revisão de literatura, contendo as informações nas bases de dados do SCIELO, Núcleo de Educação Em Saúde Coletiva (NESCON) - biblioteca virtual da Faculdade de Medicina da UFMG e site do Instituto Brasileiro de Geografia e Estatística (IBGE), utilizando como palavras-chaves: Contrarreferência, Atenção Primária, Unidade Básica de Saúde, Estratégia Saúde da Família e Atenção Especializada, com a finalidade de delimitar o objeto de estudo e o campo de investigação para a realidade que se pretende apreender. Optou-se por selecionar apenas as produções na forma de artigos publicados em periódicos nacionais nos últimos cinco anos. Para elaboração do Plano de Intervenção foram utilizados os passos do Planejamento Estratégico Situacional (PES), descrito no Módulo de Planejamento Estratégico Situacional (PES), descrito no módulo de Planejamento e Avaliação das Ações de Saúde do Curso de Especialização em Estratégia Saúde da Família/NESCON.

Plano de intervenção para melhorar a assistência aos usuários crônicos de medicações psicoativas da UAPs Córrego do Ouro II - Santos Dumont/Minas Gerais

O Córrego do Ouro é o maior bairro da cidade de Santos Dumont e nele está situada a UAPS Córrego do Ouro II, com equipe única da ESF, que atende 2808 pessoas, com 909 famílias divididas em seis micro áreas. Um grande problema enfrentado pela Unidade de Saúde Córrego do Ouro II é o elevado número de pessoas que fazem uso de medicações psicoativas. Das 382 pessoas que procuram a unidade com interesse em renovação de alguma prescrição de psicotrópicos, apenas 41 possuem diagnóstico de transtorno mental ou epilepsia, os demais utilizam remédios psicoativos sem uma causa bem documentada. Objetivo deste trabalho é elaborar um plano de intervenção visando o melhor acompanhamento dos usuários da Unidade de Atenção Primária de Córrego do Ouro II em relação ao uso crônico de medicações psicoativas. Na elaboração desta intervenção foram utilizados trabalhos científicos disponíveis nas seguintes Bases de dados:Biblioteca Virtual em Saúde, PUBMED, Biblioteca Virtual da Universidade Federal de Minas Gerais, SCIELO, incluindo artigos, publicações em livros e revistas médicas (descritores: Psicotrópicos, Medicamentos, Intoxicação, Saúde Mental). Outras fontes de pesquisa foram: a Secretaria Municipal de Saúde de Santos Dumont, dados do Ministério da Saúde e arquivos da própria unidade de saúde. A ação está voltada para oferta de informação por meio de intervenções breves, implantação de linha guia em saúde mental e estreitamento da relação UAPS-CAPS para melhora na referência e contra referência dos pacientes

Synaptic Rearrangement Following Axonal Injury: Old And New Players.

Following axotomy, the contact between motoneurons and muscle fibers is disrupted, triggering a retrograde reaction at the neuron cell body within the spinal cord. Together with chromatolysis, a hallmark of such response to injury is the elimination of presynaptic terminals apposing to the soma and proximal dendrites of the injured neuron. Excitatory inputs are preferentially eliminated, leaving the cells under an inhibitory influence during the repair process. This is particularly important to avoid glutamate excitotoxicity. Such shift from transmission to a regeneration state is also reflected by deep metabolic changes, seen by the regulation of several genes related to cell survival and axonal growth. It is unclear, however, how exactly synaptic stripping occurs, but there is substantial evidence that glial cells play an active role in this process. In one hand, immune molecules, such as the major histocompatibility complex (MHC) class I, members of the complement family and Toll-like receptors are actively involved in the elimination/reapposition of presynaptic boutons. On the other hand, plastic changes that involve sprouting might be negatively regulated by extracellular matrix proteins such as Nogo-A, MAG and scar-related chondroitin sulfate proteoglycans. Also, neurotrophins, stem cells, physical exercise and several drugs seem to improve synaptic stability, leading to functional recovery after lesion.

Long-term Decline Of The Amazon Carbon Sink.

Atmospheric carbon dioxide records indicate that the land surface has acted as a strong global carbon sink over recent decades, with a substantial fraction of this sink probably located in the tropics, particularly in the Amazon. Nevertheless, it is unclear how the terrestrial carbon sink will evolve as climate and atmospheric composition continue to change. Here we analyse the historical evolution of the biomass dynamics of the Amazon rainforest over three decades using a distributed network of 321 plots. While this analysis confirms that Amazon forests have acted as a long-term net biomass sink, we find a long-term decreasing trend of carbon accumulation. Rates of net increase in above-ground biomass declined by one-third during the past decade compared to the 1990s. This is a consequence of growth rate increases levelling off recently, while biomass mortality persistently increased throughout, leading to a shortening of carbon residence times. Potential drivers for the mortality increase include greater climate variability, and feedbacks of faster growth on mortality, resulting in shortened tree longevity. The observed decline of the Amazon sink diverges markedly from the recent increase in terrestrial carbon uptake at the global scale, and is contrary to expectations based on models.

Prevalence of refractive errors and ocular disorders in preschool and school children of Ibiporã - PR, Brazil (1989 to 1996)

Purpose: To establish the prevalence of refractive errors and ocular disorders in preschool and schoolchildren of Ibiporã, Brazil. Methods: A survey of 6 to 12-year-old children from public and private elementary schools was carried out in Ibiporã between 1989 and 1996. Visual acuity measurements were performed by trained teachers using Snellen's chart. Children with visual acuity <0.7 in at least one eye were referred to a complete ophthalmologic examination. Results: 35,936 visual acuity measurements were performed in 13,471 children. 1.966 children (14.59%) were referred to an ophthalmologic examination. Amblyopia was diagnosed in 237 children (1.76%), whereas strabismus was observed in 114 cases (0.84%). Cataract (n=17) (0.12%), chorioretinitis (n=38) (0.28%) and eyelid ptosis (n=6) (0.04%) were also diagnosed. Among the 614 (4.55%) children who were found to have refractive errors, 284 (46.25%) had hyperopia (hyperopia or hyperopic astigmatism), 206 (33.55%) had myopia (myopia or myopic astigmatism) and 124 (20.19%) showed mixed astigmatism. Conclusions: The study determined the local prevalence of amblyopia, refractive errors and eye disorders among preschool and schoolchildren.

Efeitos da constrição pupilar na perimetria de freqüência dupla em olhos normais

Purpose: To study the effects of pupillary constriction on frequency doubling perimetry in a group of normal subjects. Methods: Eighteen healthy volunteers participated in the study. Only one eye per patient (right eye) underwent frequency doubling perimetry (Full Threshold C-20 strategy). For the second session, one drop of 2% pilocarpine was administered to the volunteers' right eye and the examination was repeated after 60 minutes. Results: Sixty minutes after administration of 2% pilocarpine, there was a significant reduction of the pupillary diameter from 4.22 ± 0.17 mm to 1.55 ± 0.51 mm (p<0.05). There was a significant reduction of the mean retinal sensibility after pupillary constriction. The threshold sensitivity of the central 5º worsened by 5.67 ± 2.49 dB; the area between 2.5º and 10º worsened by 4.49 ± 2.73 dB; and the area between 10º and 20º worsened by 5.10 ± 3.55 dB (p<0.01). A reduction of 4.06 ± 2.67 dB was observed in the mean deviation, as well as an increase of 0.64 ± 0.94 dB in the pattern standard deviation (p<0.01). No differences were observed regarding the number of fixation losses, false-positive and false-negatives responses, and duration of the examination. Conclusion: Changes in pupillary diameter may produce significant declines in threshold sensitivities of the 20º visual field tested by frequency doubling perimetry. These results suggest that is important to maintain a constant pupillary diameter in seriate examinations.

Full threshold vs. Swedish interactive threshold algorithm (SITA) em pacientes glaucomatosos submetidos à perimetria computadorizada pela primeira vez

PURPOSE: To compare the Full Threshold (FT) and SITA Standard (SS) strategies in glaucomatous patients undergoing automated perimetry for the first time. METHODS: Thirty-one glaucomatous patients who had never undergone perimetry underwent automated perimetry (Humphrey, program 30-2) with both FT and SS on the same day, with an interval of at least 15 minutes. The order of the examination was randomized, and only one eye per patient was analyzed. Three analyses were performed: a) all the examinations, regardless of the order of application; b) only the first examinations; c) only the second examinations. In order to calculate the sensitivity of both strategies, the following criteria were used to define abnormality: glaucoma hemifield test (GHT) outside normal limits, pattern standard deviation (PSD) <5%, or a cluster of 3 adjacent points with p<5% at the pattern deviation probability plot. RESULTS: When the results of all examinations were analyzed regardless of the order in which they were performed, the number of depressed points with p<0.5% in the pattern deviation probability map was significantly greater with SS (p=0.037), and the sensitivities were 87.1% for SS and 77.4% for FT (p=0.506). When only the first examinations were compared, there were no statistically significant differences regarding the number of depressed points, but the sensitivity of SS (100%) was significantly greater than that obtained with FT (70.6%) (p=0.048). When only the second examinations were compared, there were no statistically significant differences regarding the number of depressed points, and the sensitivities of SS (76.5%) and FT (85.7%) (p=0.664). CONCLUSION: SS may have a higher sensitivity than FT in glaucomatous patients undergoing automated perimetry for the first time. However, this difference tends to disappear in subsequent examinations.

Curva de aprendizado e flutuações a curto e longo prazos com perimetria de freqüência dupla (FDT)

OBJECTIVE: To evaluate the learning effect, short-term fluctuation and long-term fluctuation in healthy subjects undergoing frequency doubling perimetry (FDP). METHODS: Twenty healthy young subjects underwent FDT (program N30, full threshold) in one eye (right). Each subject was tested once in the first three sessions and three times in the fourth session. Both short- and long-term fluctuations were studied as the average fluctuation of all the tested points or as a point-to-point fluctuation. To study the learning effect, the MDs values of the first session were compared to the second, third and fourth sessions. RESULTS: In the short-term analysis (3 examination done in the last session), the total mean sensitivity was 31.91 ± 1.20 dB and the mean MD and PSD were 0.84 ± 1.85 and 3.73 ± 1.55 dB, respectively. The average short-term fluctuation was 1.72 ± 0.38 dB. When the four examination, performed at different visits, were compared, the average mean sensitivity of all sessions and the average long-term fluctuation were 31.75 ± 1.11 and 2.16 ± 0.26 dB, respectively. The MD averages of the first, second, third and fourth tests were 0.11 ± 2.14 dB, 0.47 ± 1.64 dB, 1.16 ± 1.62 dB and 0.98 ± 1.92 dB respectively. The MD difference between the first and the third and between the first and the fourth examinations were statistically significant (p<0.05). CONCLUSION: The threshold sensitivity detected by FDP is influenced by both short- and long-term fluctuations. We observed a mild learning effect that shoud be taken into account whenever a patient undergoes this test for the first time.

Atividade diaria e (in)atividade fisica na sociedade indigena Terena : Aldeias Buriti e Corrego do Meio

Universidade Estadual de Campinas . Faculdade de Educação Física

Drug consumption among medical students in São Paulo, Brazil: influences of gender and academic year

OBJECTIVE: To analyze alcohol, tobacco and other drug use among medical students. METHOD: Over a five-year period (1996-2001), we evaluated 457 students at the Universidade de São Paulo School of Medicine, located in São Paulo, Brazil. The students participated by filling out an anonymous questionnaire on drug use (lifetime, previous 12 months and previous 30 days). The influence that gender and academic year have on drug use was also analyzed. RESULTS: During the study period, there was an increase in the use of illicit drugs, especially inhalants and amphetamines, among the medical students evaluated. Drug use (except that of marijuana and inhalants) was comparable between the genders, and academic year was an important influencing factor. DISCUSSION: Increased inhalant use was observed among the medical students, especially among males and students in the early undergraduate years. This is suggestive of a specific behavioral pattern among medical students. Our findings corroborate those of previous studies. CONCLUSION: Inhalant use is on the rise among medical students at the Universidade de São Paulo School of Medicine. Because of the negative health effects of illicit drug use, further studies are needed in order to deepen the understanding of this phenomenon and to facilitate the development of preventive measures.

Anthropogenic influences in a lagoonal environment: a multiproxy approach at the valo grande mouth, Cananéia-Iguape system (SE Brazil)

The Cananéia-Iguape system, SE Brazil, consists of a complex of lagoonal channels, located in a United Nations Educational, Scientific and Cultural Organization (UNESCO) Biosphere Reserve. Nevertheless, important environmental changes have occurred in approximately the last 150 yrs due to the opening of an artificial channel, the Valo Grande, connecting the Ribeira de Iguape River to the lagoonal system. Our objective is to assess the historical record of the uppermost layers of the sedimentary column of the lagoonal system in order to determine the history of environmental changes caused by the opening of the artificial channel. In this sense, an integrated geochemical-faunal approach is used. The environmental changes led significant modifications in salinity, in changes of the depositional patterns of sediments and foraminiferal assemblages (including periods of defaunation), and, more drastically, in the input of heavy metals to the coastal environment. The concentrations Pb in the core analyzed here were up to two times higher than the values measured in contaminated sediments from the Santos estuary, the most industrialized coastal zone in Brazil.

Association between neuromuscular tests and kumite performance on the Brazilian Karate National Team

The aim of this study was to verify the relationship of strength and power with performance on an international level karate team during official kumite simulations. Fourteen male black belt karate athletes were submitted to anthropometric data collection and then performed the following tests on two different days: vertical jump test, bench press and squat maximum dynamic strength (1RM) tests. We also tested power production for both exercises at 30 and 60% 1RM and performed a kumite match simulation. Blood samples were obtained at rest and immediately after the kumite matches to measure blood lactate concentration. Karate players were separated by performance (winners vs. defeated) on the kumite matches. We found no significant differences between winners and defeated for strength, vertical jump height, anthropometric data and blood lactate concentration. Interestingly, winners were more powerful in the bench press and squat exercises at 30% 1RM. Maximum strength was correlated with absolute (30% 1RM r = 0.92; 60% 1RM r = 0.63) and relative power (30% 1RM r = 0.74; 60% 1RM r = 0.11, p > 0.05) for the bench press exercise. We concluded that international level karate players' kumite match performance are influenced by higher levels of upper and lower limbs power production.

Polyelectrolyte-protein complexation driven by charge regulation

The interplay between the biocolloidal characteristics (especially size and charge), pH, salt concentration and the thermal energy results in a unique collection of mesoscopic forces of importance to the molecular organization and function in biological systems. By means of Monte Carlo simulations and semi-quantitative analysis in terms of perturbation theory, we describe a general electrostatic mechanism that gives attraction at low electrolyte concentrations. This charge regulation mechanism due to titrating amino acid residues is discussed in a purely electrostatic framework. The complexation data reported here for interaction between a polyelectrolyte chain and the proteins albumin, goat and bovine alpha-lactalbumin, beta-lactoglobulin, insulin, k-casein, lysozyme and pectin methylesterase illustrate the importance of the charge regulation mechanism. Special attention is given to pH congruent to pI where ion-dipole and charge regulation interactions could overcome the repulsive ion-ion interaction. By means of protein mutations, we confirm the importance of the charge regulation mechanism, and quantify when the complexation is dominated either by charge regulation or by the ion-dipole term.