A familia, o adolescente e suas rela����es com a pratica de atividades fisicas em regi��o metropolitana e interiorana do Estado de S��o Paulo

Universidade Estadual de Campinas . Faculdade de Educa����o F��sica

Lei n.�� 11.889/2008: avan��o ou retrocesso nas compet��ncias do t��cnico em sa��de bucal?

O objetivo deste estudo foi analisar as compet��ncias que, desde a aprova����o da lei n.�� 11.889/08, incumbem ao t��cnico em sa��de bucal (TSB) no Brasil, incluindo os termos definidos para sua supervis��o. Foi realizada an��lise documental, comparando-se as compet��ncias definidas no referido instrumento legal com as previstas no parecer n.�� 460/75 do Conselho Federal de Educa����o e na resolu����o n.�� 63/2005 do Conselho Federal de Odontologia. Foram empregadas t��cnicas de an��lise tem��tica considerando-se as habilidades em termos de a����es diretas e indiretas distribu��das em quatro ��reas de compet��ncia: planejamento e administra����o em sa��de, promo����o da sa��de, preven����o de doen��as e de assist��ncia individual. Embora as compet��ncias aprovadas na lei tenham sido distribu��das em um n��mero menor de itens, comparado aos dois outros documentos, do ponto de vista qualitativo, os resultados da an��lise permitiram concluir que v��rios avan��os foram obtidos com a regulamenta����o da profiss��o, nos termos aprovados, em todas as ��reas de compet��ncia. Houve impacto positivo para o processo de trabalho em sa��de, tanto com rela����o �� coopera����o interprofissional quanto �� supervis��o t��cnica das atividades, representando uma conquista relevante dos trabalhadores da ��rea e tamb��m uma contribui����o significativa para avan��ar na amplia����o do acesso aos servi��os odontol��gicos

A qualidade das refei����es de empresas cadastradas no Programa de Alimenta����o do Trabalhador na cidade de S��o Paulo

OBJETIVO: Avaliar a qualidade global das refei����es oferecidas por Unidades de Alimenta����o e Nutri����o de empresas benefici��rias do Programa de Alimenta����o do Trabalhador, na cidade de S��o Paulo. M��TODOS: Estudo transversal realizado com 72 empresas cadastradas no programa. Foram coletadas informa����es de tr��s dias consecutivos das refei����es oferecidas no almo��o, no jantar e na ceia. A qualidade das refei����es oferecidas foi avalia pelo ��ndice de Qualidade da Refei����o, e sua an��lise foi feita de forma estratificada segundo o perfil da empresa obtido pela an��lise de cluster. RESULTADOS: A m��dia do ��ndice de Qualidade da Refei����o para as grandes refei����es foi de 66,25. Foram obtidos dois grupos de empresas na an��lise de cluster. As empresas do primeiro, composto em sua maioria por empresas do setor de com��rcio de micro e pequeno porte, cadastradas na modalidade de autogest��o e sem supervis��o de nutricionista, obtiveram pior qualidade da refei����o (��ndice=56,23). As empresas do segundo cluster, constitu��do principalmente por empresas de m��dio e grande porte do setor industrial, com gest��o terceirizada e supervis��o de nutricionista, obtiveram pontua����o m��dia do ��ndice de 82,95. CONCLUS��O: As refei����es oferecidas pelas empresas participantes do Programa de Alimenta����o do Trabalhador n��o estavam adequadas, segundo o ��ndice de Qualidade da Refei����o. As empresas de menor porte e estrutura tiveram refei����es de pior qualidade quando comparadas com as demais, demonstrando que empresas deste perfil s��o priorit��rias para interven����es dentro do Programa de Alimenta����o do Trabalhador.

Efetividade de programa de agentes comunit��rios na promo����o da sa��de bucal

OBJETIVO:Avaliar mudan��as em conhecimentos, atitudes e acesso/utiliza����o de servi��os odontol��gicos decorrentes de um programa de promo����o da sa��de bucal com agentes comunit��rios de sa��de. M��TODOS:Um projeto de capacita����o combinando ensino-aprendizagem, apoio e supervis��o, foi desenvolvido entre os meses de julho de 2003 a agosto de 2004. As mudan��as foram avaliadas por meio de entrevistas estruturadas em que participaram 36 agentes comunit��rios de sa��de e uma amostra de 91 mulheres e m��es, representativa de donas de casa com 25 a 39 anos de idade, alfabetizadas e residentes em domic��lios de tr��s a seis c��modos no munic��pio de Rio Grande da Serra (SP). Foram colhidos dados sobre conhecimentos de sa��de-doen��a bucal, pr��ticas e capacidades auto-referidas em rela����o ao auto-exame, higiene bucal, n��mero de residentes e de escovas dentais individuais e coletivas em cada domic��lio e acesso e uso de servi��os odontol��gicos. Por meio do teste t de Student pareado, foram comparadas as m��dias dos valores obtidos antes e depois do programa para cada um dos grupos estudados. As respostas foram analisadas adotando-se um n��vel de signific��ncia de 5%. RESULTADOS: Foram observadas diferen��as estatisticamente significativas para quest��es relativas ao conhecimento de sa��de bucal entre os agentes e entre as mulheres antes e depois da capacita����o (p<0,05). Desequil��brio entre o n��mero de escovas e de indiv��duos em cada fam��lia diminuiu. A freq����ncia da escova����o e do uso do fio dental se elevou depois da atua����o dos agentes. Os valores de auto-avalia����o da higiene bucal aumentaram. Modifica����o nas pr��ticas e capacidades auto-referidas mostrou significativa eleva����o da auto-confian��a. O acesso ao servi��o foi mais f��cil (p<0,000) e seu uso mais regular (p<0,000) entre mulheres. CONCLUS��ES: Houve mudan��as positivas na percep����o em rela����o a aspectos de sa��de bucal, na auto-confian��a e no acesso e uso de servi��os odontol��gicos. Tais mudan��as po

Evaluation of the Incidence of Bladder Perforation After Transurethral Bladder Tumor Resection in a Residency Setting

Purpose: To evaluate prospectively the actual bladder perforation incidence during transurethral resection of bladder tumor (TURB) performed by residents and to identify possible predisposing factors to such condition. Patients and Methods: Thirty-four patients with bladder tumor were submitted to TURB in our academic institution in April 2006, and were prospectively studied. Procedures were all done by senior residents under an attending direct supervision. All patients had a cystograms performed after the procedure by the injection of 400 mL of saline-diluted contrast solution with low-pressure infusion through the Foley catheter. The cystograms were evaluated blindly by a single radiologist. All patients were examined by cystoscopy and/or CT every 3 months for the first 2 years postoperatively. Results: The cystogram showed contrast leaking compatible with bladder perforation in 17 (50%) cases. None of the perforations were recognized intraoperatively by the surgeon. All perforations were extraperitoneal and managed conservatively. There was no significant correlation between the incidence of bladder perforation and the patient age (p = 0.508), the tumor stage (p = 0.998), the tumor grade (p = 0.833), the number of lesions (p = 0.394), and the tumor size (p = 0.651). The only factor that had impact on the development of bladder perforation was tumor localization at the bottom of the bladder (p = 0.035; OR, 6750; 95% CI, 1.14, 39.8). Conclusion: Asymptomatic perforations of the bladder wall occur very frequently after a TURB procedure performed by residents in training and, most of the time, are not noticed by the surgeon. Localization of the tumor at bladder dome was the only factor that negatively influenced perforation rates.

Remote control of CNC machines using the CyberOPC communication system over public networks

During the last few years, the evolution of fieldbus and computers networks allowed the integration of different communication systems involving both production single cells and production cells, as well as other systems for business intelligence, supervision and control. Several well-adopted communication technologies exist today for public and non-public networks. Since most of the industrial applications are time-critical, the requirements of communication systems for remote control differ from common applications for computer networks accessing the Internet, such as Web, e-mail and file transfer. The solution proposed and outlined in this work is called CyberOPC. It includes the study and the implementation of a new open communication system for remote control of industrial CNC machines, making the transmission delay for time-critical control data shorter than other OPC-based solutions, and fulfilling cyber security requirements.

Avalia����o do desempenho ambiental de obras de recupera����o de rodovias

This paper features a tool to carry out environmental performance evaluation in highway rehabilitation works, as a component of environmental supervision activities. The procedure involves (i) evidence gathering by conducting technical inspections and reviewing environmental compliance reports, (ii) ranking nonconformities according to a proposed weighting framework, and (iii) calculation of an environmental conformity index. For the sake of testing and calibration, the procedure was applied to five road segments that were submitted to rehabilitation works in Sao Paulo State and the results were treated qualitatively.

Thesis summary: Standardized dried extracts of Brazilian medicinal plants: Assessment of technical and economic feasibility of spouted bed drying

This study is an integral part of a research project which seeks the establishment of protocols for the production of standardized herbal dried extracts emphasizing the spouted bed drying. This thesis was conducted at faculty of Pharmaceutical Science of Ribeiro Preto/University of So Paulo, Brazil, under supervision of Prof. Dr. Wanderley Pereira Oliveira*, defended on September 28, 2007.

Challenge or opportunity: can regional training hospitals capitalise on the impending influx of interns?

To the Editor: The increase in medical graduates expected over the next decade presents a huge challenge to the many stakeholders involved in providing their prevocational and vocational medical training. 1 Increased numbers will add significantly to the teaching and supervision workload for registrars and consultants, while specialist training and access to advanced training positions may be compromised. However, this predicament may also provide opportunities for innovation in the way internships are delivered. Although facing these same challenges, regional and rural hospitals could use this situation to enhance their workforce by creating opportunities for interns and junior doctors to acquire valuable experience in non-metropolitan settings. We surveyed a representative sample (n = 147; 52% of total cohort) of Year 3 Bachelor of Medicine and Bachelor of Surgery students at the University of Queensland about their perceptions and expectations of their impending internship and the importance of its location (ie, urban/metropolitan versus regional/rural teaching hospitals) to their future training and career plans. Most students (n = 127; 86%) reported a high degree of contemplation about their internship choice. Issues relating to career progression and support ranked highest in their expectations. Most perceived internships in urban/metropolitan hospitals as more beneficial to their future career prospects compared with regional/rural hospitals, but, interestingly, felt that they would have more patient responsibility and greater contact with and supervision by senior staff in a regional setting (Box). Regional and rural hospitals should try to harness these positive perceptions and act to address any real or perceived shortcomings in order to enhance their future workforce.2 They could look to establish partnerships with rural clinical schools3 to enhance recruitment of interns as early as Year 3. To maximise competitiveness with their urban counterparts, regional and rural hospitals need to offer innovative training and career progression pathways to junior doctors, to combat the perception that internships in urban hospitals are more beneficial to future career prospects. Partnerships between hospitals, medical schools and vocational colleges, with input from postgraduate medical councils, should provide vertical integration4 in the important period between student and doctor. Work is underway to more closely evaluate and compare the intern experience across regional/rural and urban/metropolitan hospitals, and track student experiences and career choices longitudinally. This information may benefit teaching hospitals and help identify the optimal combination of resources necessary to provide quality teaching and a clear career pathway for the expected influx of new interns.

The nurse lecturer role in clinical practice conceptualized: helping clinical teachers provide optimal student learning

Despite the fairly wide reporting in the literature of the ma ny roles of clinical supervision by the nursing teacher, little attention has been given to conceptualizing the relative priorities these roles take during the process of supervising nursing students in clinical practice. The purpose of this paper is to consider the manifestations and implications of conflicting roles when nurse lecturers undertake clinical supervision. Previously published research will provide working examples of issues in a conceptual framework for clinical teaching.

Traditional healers as tuberculosis treatment supervisors: precedent and potential

SETTING: Hlabisa, South Africa. OBJECTIVE: To determine precedent and potential for traditional healers to act as tuberculosis (TB) treatment supervisors. METHODS: Literature review to describe precedent for the involvement of traditional healers in TB treatment supervision. Interviews with 100 TB patients to determine use of healers and their acceptability as supervisors. Interviews with 24 healers in the project sub-district to determine willingness to act as supervisors. RESULTS: Despite extensive literature on the interaction between traditional healers and conventional health services, including descriptions of traditional understandings of TB, no published work was identified that reported supervision of TB patients by traditional healers. Of 100 patients interviewed, only 10% had used a healer as the first health provider for their illness, but 40% had attended a healer at some time prior to diagnosis. Although only 4% believe healers can cure TB, 84% would consider choosing a healer as a treatment supervisor. Of the 24 healers, 15 (63%) distinguished between two types of diagnosis made among patients with. symptoms suggestive of TB: TB and idliso. Idliso is poisoning or bewitching, and is said to be best cured by healers, while TB is infectious and cannot be cured by healers. Most healers (88%) reported having referred patients with possible TB to hospital in the past; all were keen to negotiate collaboration with health services, and 92% were willing to act as treatment supervisors. CONCLUSIONS: While there is little reported precedent for traditional healers to interact formally with tuberculosis treatment services, the potential for collaboration seems to be high, at least in our setting.

The case for a new system for oversight of research on human subjects

The increasing emphasis on evidence-based clinical practice has thrown into sharp focus multiple deficiencies in current systems of ethical review. This paper argues that a complete overhaul of systems for ethical oversight of studies involving human subjects is now required as developments in medical, epidemiological and genetic research have outstripped existing structures for ethical supervision. It shows that many problems are now evident and concludes that sequential and piecemeal amendments to present arrangements an inadequate to address these. Ar their core present systems of ethical review still rely on the integrity and judgement of individual investigators. One possible alternative is to train and license research investigators, make explicit their responsibilities and have ethics committees devote much more of their time to monitoring research activity in order to detect those infringing the rules.

Long-Term Prospective, Randomized, Controlled Study Using Repetitive Education at Six-Month Intervals and Monitoring for Adherence in Heart Failure Outpatients The REMADHE Trial

Background-The effectiveness of heart failure disease management proarams in patients under cardiologists` care over long-term follow-up is not established. Methods and Results-We investigated the effects of a disease management program with repetitive education and telephone monitoring on primary (combined death or unplanned first hospitalization and quality-of-life changes) and secondary end points (hospitalization, death, and adherence). The REMADHE [Repetitive Education and Monitoring for ADherence for Heart Failure] trial is a long-term randomized, prospective, parallel trial designed to compare intervention with control. One hundred seventeen patients were randomized to usual care, and 233 to additional intervention. The mean follow-up was 2.47 +/- 1.75 years, with 54% adherence to the program. In the intervention group, the primary end point composite of death or unplanned hospitalization was reduced (hazard ratio, 0.64; confidence interval, 0.43 to 0.88; P=0.008), driven by reduction in hospitalization. The quality-of-life questionnaire score improved only in the intervention group (P<0.003). Mortality was similar in both groups. Number of hospitalizations (1.3 +/- 1.7 versus 0.8 +/- 1.3, P<0.0001), total hospital days during the follow-up (19.9 +/- 51 versus 11.1 +/- 24 days, P<0.0001), and the need for emergency visits (4.5 +/- 10.6 versus 1.6 +/- 2.4, P<0.0001) were lower in the intervention group. Beneficial effects were homogeneous for sex, race, diabetes and no diabetes, age, functional class, and etiology. Conclusions-For a longer follow-up period than in previous studies, this heart failure disease management program model of patients under the supervision of a cardiologist is associated with a reduction in unplanned hospitalization, a reduction of total hospital days, and a reduced need for emergency care, as well as improved quality of life, despite modest program adherence over time. (Circ Heart Fail. 2008;1:115-124.)

Outcomes and safety of drug provocation tests

Drug provocation tests (DPTs) are considered the gold standard for identifying adverse drug reactions (ADRs). The aim of this study was to analyze DPT results and discuss severe systemic reactions associated with them. This was a retrospective analysis of 500 patients with ADRs who sought treatment and were submitted to DPTs when indicated between 2006 and 2010. We performed DPTs according to the European Network for Drug Allergy recommendations. Single-blind, placebo-controlled DPTs were performed with antibiotics, local anesthetics, and nonsteroidal anti-inflammatory drugs, as well as with other drugs. Patient characteristics, DPT results, and reactions were analyzed. The sample comprised 198 patients (80.8% of whom were female patients) submitted to 243 DPTs. Ages ranged from 9 to 84 years (mean, 39.9 years). The 243 DPTs were performed with local anesthetics (n = 93), antibiotics (n = 19), acetaminophen (n = 44), benzydamine (n = 33), COX-2 inhibitors (n = 26), dipyrone (n = 7), aspirin (n = 4), or other drugs (n = 17). The results of 4 tests (1.6%) were inconclusive, whereas those of 10 (4.1%) revealed positive reactions to antibiotics (2/19), COX-2 inhibitors (2/26), acetaminophen (3/44), and local anesthetics (3/93). Two severe reactions were observed: cephalexin-induced anaphylactic shock and bupivacaine-induced anaphylaxis without shock. Four patients (2.0%) reacted to the placebo before administration of the drug. Drug provocation tests are safe for use in clinical practice but they should be placebo-controlled and should be performed under the supervision of an allergist. To confirm a presumptive diagnosis and to manage allergies appropriately, it is crucial to perform DPTs. (Allergy Asthma Proc 32:301-306, 2011; doi: 10.2500/aap.2011.32.3450)

Child psychiatry takes to the streets: A developmental partnership between a university institute and children and adolescents from the streets of Sao Paulo, Brazil

Objective: High levels of domestic violence, mental illness, and alienation from authorities are associated with high incidence of children/adolescents living on the streets in low and middle income countries. The Equilibrium Project (Programa Equilibrio) was created to facilitate social reintegration through a virtual partnership between an academic psychiatric institute and highly vulnerable children and adolescents living on the streets, in group shelter with supervision, and in other high risk situations. Methods: Descriptive presentation of qualitative data and analysis of preliminary empirical data collected over a 24-month period. Results: Dialogue between academic professionals, street children, and city officials shaped The Equilibrium Project over the last 2 years. The program has progressively moved from a professional clinic setting to a community-based but protected activity center with recreational and professional services and an emphasis on linkage with social service agencies, city government and law enforcement officials in an academic research context. A total of 351 patients have been served of whom virtually all were neglected by their parents, 58.4% report physical or sexual abuse, 88.89% have been diagnosed with a psychiatric disorder, 40.4% drug use. After 2 years of operation, 63.5% (n = 223) successfully completed or continue in treatment and 34.8% (n = 122) were reunited with their families. Conclusions and Practice implications: Program development guided by consumer input led to a successful program offering professional services in a protected community setting that facilitates social reintegration by providing ""go between"" services integrating relationships between alienated consumers and formal psychiatric, pediatric, social service, and criminal justice systems. (C) 2011 Elsevier Ltd. All rights reserved.