Gasto com a internação de idosos em unidades de terapia intensiva

Introduction: Population aging in Brazil underscores the need to discuss the proper management of the budget allocated in health field, especially in the sectors of high complexity, where coexist costly procedures, limited resources and the need for cost containment. In the other hand, demand is growing in a way directly proportional to the increase in the number of elderly in country. Objective: In this way, this research had as main objective to analyze the costs resulting from the admission of elderly in intensive care units (ICU) and its associated factors. Methods: This is a cross-sectional study with a quantitative approach and featured as a descriptive and exploratory research. Data were collected from medical records of elderly hospitalized in ICU from a brazilian city called Natal-RN, between november first, 2013 and january, 31 of 2014. The variables collected relate to the socio demographic profile, morbidity framework and characterization of hospitalization. The dependent variable was categorized by quartile 75 in high and low expense of hospitalization and submitted to chi-square test with the independent variables of the survey. Associations with p value <0.20 in the bivariate analysis were submitted to the technique of multiple logistic regression. We opted for the construction of three regression models from the above algorithm: general regression model, composed by all 493 hospitalizations in the study, other made with 181 individuals admitted in health public system (SUS) and a third one related to 312 cases from private service in health area. Results: In the general regression model, the variables respiratory diseases, hospitalizations in the private system, disoriented patient and previous stroke were associated with greater probability of high spending in the ICU. In the other hand, in SUS kind of hospitalizations, this probability was associated with disoriented patient, 80 years old or more, sepsis and admission for clinical reason. In the cases from the private network health, the high expenditure was associated with respiratory disease, mechanical ventilation, hospitalization for clinical reason and disoriented patients. Conclusion: The increased expenditure on hospitalization of elderly in intensive care depends on the clinical conditions of individuals. This highlights the importance of avoiding hospitalizations due to diseases sensitive to primary care by health preventive actions and providing comprehensive care to the elderly. In addition, obtaining different explanatory models, according to kind hospital funding, demonstrates the importance of the organization in health services related to composition of costs of hospitalization among the elderly. Another question founded was the need that to improve the funding, we must use rationally the available resources by avoiding unnecessary hospitalizations of elderly people in the extremes of severity. On this kind of precarious funding, ICU hospitalization of elderly non-critical or in a terminal state can compromise the quality of services provided to those who really need intensive care.

iSalud: uma arquitetura para publicação e distribuição de sistemas de informação para o SUS

The Brazil Telehealth Networks Program was established by the Ministry of Health in 2007. Its main objective is to support professionals in Primary Health Care (PHC) by offering educational qualification, resulting in more favorable conditions to fixate the professional in remote areas. The formulation and management of telehealth services are performed by scientific and technical centers that are operated by public institutions of higher education and responsible for providing tools and services in the context of the regions where they are. However, one of the problems generated by this decentralization is the development of various tools with different types of language, architecture and without any regulation and integration of information with the Ministry of Health. Aiming to solve the above problem, we propose the specification, implementation and validation of an architectural model in the development and distribution of the Unified Health System software tools. This proposed architecture enables tools developed in telehealth center to be shared among the other centers, thereby preventing the unnecessary use of resources.

Intervenção mediacional e hábitos alimentares: um estudo de crianças com síndrome de Down

The inadequacy about eating habits have been established as a serious problem nowadays. It is a multifactorial and difficult to handle, given their different nuances and causes. A population particularly exposed to the bad eating habits arising harm are individuals with Down syndrome, both with regard to the aspects inherent to the individual's own condition, regarding eating misfits, making it the weight control a necessary measure for a proper development. Thus, this study aimed to develop and evaluate a proposal based nutrition education from the assumptions of mediated learning, with children three to four years with Down syndrome. The participants were five children, four girls and a boy. Also included his parents and / or guardians. The data collection procedure involved the use of eight playful workshops with children and nutritional evaluation of those five meetings with parents and three home visits with each participating family. We tried to build with these children and their families a nutritional education to contribute to their daily choices of eating. Using listening, observation and questionnaire, besides playful interventions, it was observed that the first meaning of the act of eating is built in the family and reinforced by their social life. Overall, our sample characteristics seem to agree with the literature. During the intervention, the children showed attention, but little understanding of the content. With mothers, the results were different, with reflections on the inadequate power both the type of food offered, and quantity and so this offer is performed, conducted along the interventions changes in your lifestyle, such as perception of influence they had on their children in the formation of their eating habits, as well as less frequent intake of soft drinks and sweets. Nutritional interventions and mediations conducted with the mothers is that they seem to be effective strategies to combat obesity. Face of what was discussed, we see the importance of implementing intervention measures in combating and preventing overweight or obese since childhood, particularly with children with Down syndrome. One should prevent childhood obesity with educational and informative measures from birth, with family and with each child, through the primary health care and schools.

Saúde da população “trans”: uma revisão sistemática da produção teórica brasileira

This dissertation analyzed the existing work on travestility and transsexuality whose problematic research focused on issues related to health and / or health services. For this purpose, a Literature Review Systematized Descriptive in virtual databases was performed: Bank of Higher Education Personnel Improvement Coordination Thesis (CAPES), Brazilian Digital Library of Theses and Dissertations (BDTD), Scielo and PubMed, between the years 1997 and 2014 in Brazil. We used the search terms "transsexual," "transvestite" and "transgender", each associated with the search term "health", in Portuguese and English. Complementing this search, we used the Documentary Analysis methodology to assess pamphlets productions, institutional documents and non-governmental organizations (NGOs), which were incorporated into the discussion. 295 papers were identified, among theses, dissertations and scientific articles. Of these, 223 were excluded and 72 selected for analysis. Thus, it obtained five theses and dissertations 21 on the topic of travestility and 7 theses and dissertations 9 that deal with transsexuality. Among the selected papers, 16 deal with transsexuality and health, 5 address the issue of travestility and health and work, 9 refer to the term "transgender" and "health". Even though it is an emerging field of research, there is an apparent deviation of the speech, previously anchored in questions whose topics are related to confrontation, infection or illness by HIV / AIDS (level of specialized care) for discussions on the health care for transsexuals in the process (level of specialized care). Still, few papers have specific trans attention in primary care associated with a comprehensive health care, with the empowerment of individuals, respecting the power of life, which are configured as important issues for the Public Policy on Health today.

Visão dos profissionais de saúde frente à possibilidade de infecção de HIV/Aids em idosos

The HIV/Aids epidemic is today, in Brazil, a phenomenon of great magnitude and extent. The disease progresses over a physically weakened, and with more complex approach, portion of the population: the elderly. This study has the objective to know the vision of health professionals facing the possibility of HIV/Aids in the elderly. It is a cross-sectional observational study conducted in the city of Uberlandia, Minas Gerais, Brazil, from November 2013 to December 2015, with the participants Doctors, Dental Surgeons and nurses stationed in the Municipal Network of Primary Care, with a sample of 220. Using factor analysis, factors unrelated to the training of health professionals and others directly related; only the latter showed differences between the professions. The investigation of the professional view on the possibility of infection of HIV/Aids in the elderly should be crafted specifically for each type of professional, meeting the specific difficulties of training each degree course. It is crucial the need to update each professional in the health care field in order to be able to make an early diagnosis aimed at protecting the elderly patient's integrity affected by HIV/Aids.

Social representations of nursing students about hospital assistance and primary health care

Objective: To analyze how social representations of hospital and community care are structured in two groups of nursing students – 1st and 4th years. Method: Qualitative research oriented by the Theory of Social Representations. We used a questionnaire with Free Association of Words. Data were analyzed in the Software IRaMuTeQ 0.6 alpha 3. Results: We applied the method of Descending Hierarchical Classifi cation and obtained four classes. Class 4 has the largest social representation (30.41%) within the corpus. The two organizational axes are nurse and disease/patient in the central core. On the periphery are the care and help related to the nurse and the treatment and prevention associated with the disease. Conclusion: Social representations focus on disease/patient and on the role of nurses in the treatment, prevention, and care. Health promotion and the social determinants of health are absent from the social representations of students.

Programa Mais Médicos : uma avaliação dos resultados iniciais referentes ao eixo do provimento emergencial a partir da teoria da avaliação de programas

Dissertação (mestrado)—Universidade de Brasília, Centro de Estudos Avançados Multidisciplinares, Programa de Pós-Graduação em Desenvolvimento Sociedade e Cooperação Internacional, 2016.

La seguridad del paciente en atención primaria en salud ¿una actividad que podría quedar en el olvido?

Los eventos adversos (EA) están presentes en todos los niveles de atención en salud y deben ser evaluados de manera integral, tanto en los servicios hospitalarios como en el entorno de la Atención Primaria en Salud (APS). Los EA que se presentan en los servicios hospitalarios, son diferentes a los que se presentan en los servicios de Atención Primaria en Salud (APS) y por ello se debe dar un abordaje diferenciado. La seguridad del paciente debe ser una prioridad para todos los sistemas de salud. Desde esta perspectiva se deben identificar cuáles son las herramientas más adecuadas para el reporte, análisis, intervenciones y acciones de mejora, con las que deben contar los programas de seguridad del paciente y la apropiación de conceptos de gestión de riesgo, facilita la identificación y el manejo institucional de situaciones que ponen en peligro la integridad y la vida de los pacientes.

Ofício de aluno: o processo de socialização primária e a construção de uma identidade

Na última década dos anos 90, alguns estudos acadêmicos voltaram-se para a questão de se valorizar as investigações sobre o saber docente, o saber pedagógico e a prática pedagógica. Dentre os inúmeros temas abordados, o papel do aluno frente à escola, foi o que chamou nossa atenção. Com base nisso, estuda-se sobre o habitus do aluno, sobre seu papel enquanto ator social, sobre sua identidade de aluno, sobre seu ofício de aluno, entre outros. No âmbito desse processo e com base nas vivências da pesquisadora este estudo buscou como objetivo geral compreender o papel da socialização primária na constituição do ofício de aluno e na construção de sua identidade. Especificamente: (1) Levantar dados sobre o papel da socialização primária na construção da identidade de aluno e; (2) Identificar em estudantes do ensino fundamental como eles constituíram o seu ofício do aluno. Nosso trabalho se baseou em uma pesquisa de natureza qualitativa. Contou com 7 participantes, todos eles alunos de uma escola pública do munícipio de Rio Claro. Para coleta de dados foi utilizada a entrevista semi-estruturada. Na disposição dos resultados optou-se pela divisão em três eixos: (1) Infância, (2) Escola e (3) Ofício de aluno. Já para análise do conteúdo, a discussão, separou-se em dois eixos temáticos: o primeiro sobre a socialização primária na construção da identidade de aluno e o segundo sobre a construção do ofício de aluno. Com isso, pudemos concluir que o ofício de aluno é de ordem: temporal, social, plural, heterogêneo, personalizado, situado, biográfico e estrutural. E que papel que o aluno desenvolve na escola é influenciado pela socialização primária (família e escola) à qual o mesmo foi submetido. Porém, deixamos aqui uma contribuição singular, visando que futuros projetos possam ser desenvolvidos de forma a ampliar o entendimento desse tema

O cuidador de paciente com neoplasia cerebral maligna primária: os desafios do cuidado

Patients with primary malignant brain tumor endure several motor and cognitive dysfunctions, demanding the presence of a caregiver even more because the time necessary for their assistance increases considerably. Usually this task is performed by a family relative, whose activities include taking care of the patient’s personal hygiene, escorting them to medical appointments, managing their money and performing their housework. All of this overwhelms the caregiver both physical and psychologically. This bibliographic research intends to analyze the role in which a caregiver plays in the quality of life of those kinds of patients, the complications of such task, the caregivers’ needs and the daily life of those terminal patients. It was used CAPES, PubMed and Google Academic databases for researching articles related to family caregivers who assisted adult patients with primary malignant brain tumor. The study concluded that being a caregiver of patients in such conditions harms one’s quality of life, with consequences such as stress, insomnia, financial problems and lack of social support. Theirs needs include: having someone to talk to about the matter, attending programs for reducing stress and increasing their knowledge about the disease. In advanced phases of the condition, the patient shows great mobility problems, aphasia and regular seizures, which end up overwhelming the caregiver. The level of quality of life found was above other types of cancer’s caregivers. Therefore, they represent a group with special needs, which should be especially handled by health professionals.

Abordagem do câncer da boca: uma estratégia para os níveis primário e secundário de atenção em saúde

O avanço verificado no enfrentamento de neoplasias malignas por meio dos sistemas de saúde envolve melhorias nas áreas de vigilância, organização de redes de assistência, programas específicos voltados às prevenções primária e secundária e, obviamente, aos avanços técnico-científicos que caracterizam a abordagem diagnóstica e terapêutica. Embora seja notável o reconhecimento de avanços no manejo de neoplasias malignas em todas as áreas citadas, o câncer da boca permanece com indicadores de morbidade e mortalidade que parecem não acompanhar o acúmulo científico no conhecimento da doença. O presente manuscrito objetiva discutir os motivos desse descompasso, a necessidade de reorientação de prioridades na abordagem do câncer da boca e sua efetivação como política pública de saúde.

O envolvimento da atenção na codificação da informação visuoespacial integrada

O objetivo deste estudo foi investigar o envolvimento de recursos da atenção na codificação e manutenção da informação visual e espacial na memória de trabalho. Utilizou-se um paradigma de tarefas duplas em que uma tarefa primária de localização espacial foi realizada simultaneamente a uma tarefa atentiva secundária de discriminação de tons. O desempenho dos participantes (n = 20) na tarefa primária foi afetado pela presença e pela similaridade entre os tons da tarefa secundária, e também, pela instrução de priorizar uma ou outra tarefa. Os resultados indicam que recursos atentivos (do executivo central) estão envolvidos na codificação e na manutenção ativa da informação integrada na memória visuoespacial, assim como na manutenção dos objetivos das tarefas a serem realizadas simultaneamente.

A atuação do nutricionista na Atenção Básica à Saúde em um grande centro urbano

O nutricionista é um profissional importante na implementação de ações de promoção, tratamento e reabilitação da saúde. Porém, sua participação na Atenção Básica (AB) é reduzida. A cidade de São Paulo vem passando por um processo desigual de urbanização, produzindo novas situações de insegurança alimentar e nutricional. Este trabalho analisará a atuação do nutricionista na AB em um grande centro urbano. Trata-se de estudo de abordagem quantitativa no qual foram utilizados dados populacionais da Secretaria Municipal de Saúde e um questionário semiestruturado aplicado em entrevistas individuais. Encontraram-se 123 nutricionistas atuando na rede Básica de Saúde e 51 em Núcleos de Apoio à Saúde da Família (NASF). Todas as regiões do município apresentaram-se com menor número de nutricionistas quando comparada à recomendação do Conselho Federal de Nutricionistas. Em 57,3% dos NASF do município identificou-se a presença deste profissional. Cada nutricionista de NASF acompanha, em média, 7,1 equipes de saúde da família. As faixas etárias que correspondem à infância são as atendidas com menor frequência pelos nutricionistas das UBS e dos NASF. Comparando-se as atividades desenvolvidas, observa-se a transição de um modelo de assistência primária centrado no atendimento individual para um que prioriza o atendimento em grupo.

Trombocitopenia imune primária crónica : palavra-passe incompleta

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

Transtorno de déficit de atenção/hiperatividade

Define o transtorno de Déficit de Atenção/Hiperatividade (doravante mencionado pela sigla TDAH) Dispõe sobre a insuficiente disseminação de informações sobre o transtorno e a ainda incipiente conscientização dos portadores e pais/responsáveis sobre seus direitos. A Associação Brasileira do Déficit de Atenção (ABDA). Trata da provável aprovação do Projeto de Lei nº 7081 de 2010, que trata do assunto.