Representações de enfermeiras sobre o cuidado com mulheres em situação de aborto inseguro

O aborto, realidade presente em nossa sociedade, é um desafio complexo para os profissionais da saúde. Este artigo objetiva relatar as representações de enfermeiras da Atenção Básica à Saúde do município de Chapecó (SC) sobre o cuidado com mulheres em situação de abortamento/aborto inseguro. Trata-se de estudo qualitativo, exploratório-descritivo. Os dados foram coletados por meio de Grupo Focal, constituído por oito enfermeiras, e depois analisados com a utilização do método do Discurso do Sujeito Coletivo. Os discursos indicam que o cuidado vem permeado de conflitos entre posicionar-se contra o aborto, apoiar as mulheres ou manter-se na imparcialidade. A representação da preservação da vida, princípio almejado pela formação profissional e tradição cristã, desencadeia tentativas de se evitar o aborto. Quando não há sucesso, mesmo desejando-se ajudar a mulher a encontrar uma saída segura, as enfermeiras apenas a orientam a ir para casa pensar, deixando claro que não é com ela a prática do aborto. Ficando a mulher abandonada...

Projeções e expectativas de ingressantes no curso de formação docente em educação profissional técnica na saúde

O presente estudo propõe analisar as projeções e expectativas dos ingressantes em um curso de formação docente, que visa superar a fragmentação disciplinar e criar maior aproximação com o mundo do trabalho. Trata-se de estudo qualitativo realizado a partir de entrevistas com 33 ingressantes do curso. Para a análise dos dados, pautou-se na técnica de análise de conteúdo, modalidade temática. Os resultados do estudo permitiram elencar as seguintes categorias temáticas: possibilidade de ensinar-aprender; necessidade de capacitação pedagógica e de constante busca de aprendizagem; possibilidade de mudança da realidade. Conclui-se que os ingressantes vislumbram a transformação da realidade social na qual estão inseridos, considerando a necessidade de aquisição de novas habilidades e competências profissionais, com intuito de exercer eficazmente o trabalho e ocupar um espaço competitivo no mercado.

The Paediatric Rheumatology International Trials Organisation provisional criteria for the evaluation of response to therapy in juvenile dermatomyositis.

OBJECTIVE: To develop a provisional definition for the evaluation of response to therapy in juvenile dermatomyositis (DM) based on the Paediatric Rheumatology International Trials Organisation juvenile DM core set of variables. METHODS: Thirty-seven experienced pediatric rheumatologists from 27 countries achieved consensus on 128 difficult patient profiles as clinically improved or not improved using a stepwise approach (patient's rating, statistical analysis, definition selection). Using the physicians' consensus ratings as the "gold standard measure," chi-square, sensitivity, specificity, false-positive and-negative rates, area under the receiver operating characteristic curve, and kappa agreement for candidate definitions of improvement were calculated. Definitions with kappa values >0.8 were multiplied by the face validity score to select the top definitions. RESULTS: The top definition of improvement was at least 20% improvement from baseline in 3 of 6 core set variables with no more than 1 of the remaining worsening by more than 30%, which cannot be muscle strength. The second-highest scoring definition was at least 20% improvement from baseline in 3 of 6 core set variables with no more than 2 of the remaining worsening by more than 25%, which cannot be muscle strength (definition P1 selected by the International Myositis Assessment and Clinical Studies group). The third is similar to the second with the maximum amount of worsening set to 30%. This indicates convergent validity of the process. CONCLUSION: We propose a provisional data-driven definition of improvement that reflects well the consensus rating of experienced clinicians, which incorporates clinically meaningful change in core set variables in a composite end point for the evaluation of global response to therapy in juvenile DM.

Virtual Environment: assistance in nursing care for the deaf based on the protocol of Primary Care

Objective: Presenting a Virtual Environment (VE) based on the Protocol of Treatment of Hypertension and Diabetes Mellitus type 2, used in Primary Care for evaluation of dietary habits in nursing consultations. Method: An experimental study applied by two nurses and a nurse manager, in a sample of 30 deaf patients aged between 30 and 60 years. The environment was built in Visual Basic NET and offered eight screens about feeding containing food pictures, videos in Libras (Brazilian sign language) and audio. The analysis of the VE was done through questionnaires applied to patients and professionals by the Poisson statistical test. Results: The VE shows the possible diagnostics in red, yellow, green and blue colors, depending on the degree of patients’ need. Conclusion: The environment obtained excellent acceptance by patients and nurses, allowing great interaction between them, even without an interpreter. The time in consultation was reduced to 15 minutes, with the preservation of patient privacy.

Geology and correlation of the Mersin mélanges, southern Turkey

Our paper aims to give a thorough description of the infra-ophiolitic melanges associated with the Mersin ophiolite. We propose new regional correlations of the Mersin melanges with other melange-like units or similar series, located both in southern Turkey and adjacent regions. The palaeotectonic implications of the correlations are also discussed. The main results may be summarized as follows: the infra-ophiolitic melange is subdivided into two units, the Upper Cretaceous Sorgun ophiolitic melange and the Ladinian-Carnian Hacialani melange. The Mersin melanges, together with the Antalya and Mamonia domains, are represented by a series of exotic units now found south of the main Taurus range, and are characteristic of the South-Taurides Exotic Units. These melanges clearly show the mixed origin of the different blocks and broken formations. Some components have a Palaeotethyan origin and are characterized by Pennsylvanian and Lower to Middle Permian pelagic and slope deposits. These Palaeotethyan remnants, found exclusively in the Hacialani melange, were reworked as major olistostromes in the Neotethys basin during the Eo-Cimmerian orogenic event. Neotethyan elements are represented by Middle Triassic seamounts and by broken formations containing typical Neotethyan conodont faunas such as Metapolygnathus mersinensis Kozur & Moix and M. primitius s. s., both present in the latest Carnian interval, as well as the occurrence of the middle Norian Epigondolella praeslovakensis Kozur, Masset & Moix. Other elements are clearly derived from the former north Anatolian passive margin and are represented by Huglu-type series including the Upper Triassic syn-rift volcanic event. These sequences attributed to the Huglu-Pindos back-arc ocean were displaced southward during the Late Cretaceous obduction event. The Tauric elements are represented by Eo-Cimmerian flysch-like and molasse sequences intercalated in Neotethyan series. Additionally, some shallow-water blocks might be derived from the Bolkardag para-autochthonous and the Taurus-Beydaglari marginal sequences.

Genetic diversity in widespread species is not congruent with species richness in alpine plant communities.

The Convention on Biological Diversity (CBD) aims at the conservation of all three levels of biodiversity, that is, ecosystems, species and genes. Genetic diversity represents evolutionary potential and is important for ecosystem functioning. Unfortunately, genetic diversity in natural populations is hardly considered in conservation strategies because it is difficult to measure and has been hypothesised to co-vary with species richness. This means that species richness is taken as a surrogate of genetic diversity in conservation planning, though their relationship has not been properly evaluated. We tested whether the genetic and species levels of biodiversity co-vary, using a large-scale and multi-species approach. We chose the high-mountain flora of the Alps and the Carpathians as study systems and demonstrate that species richness and genetic diversity are not correlated. Species richness thus cannot act as a surrogate for genetic diversity. Our results have important consequences for implementing the CBD when designing conservation strategies.

Heidelberg Retina Tomograph in Glaucoma Case-finding

Purpose: To compare the disease classification using optic nerve head imaging against clinical examination combined with perimetry in the case-finding environment.Methods: During a glaucoma screening event at the University Hospital in Lausanne 148 attendees opted to undergo an extended screening exam consisting of perimetry with Octopus (Haag-Streit, Koeniz, Switzerland), tonometry, gonioscopy, slit-lamp optic nerve head examination and Heidelberg Retinal Tomorgraph (HRT, Heidelberg engineering). Classification criteria of an abnormal clinical exam consisted of a cup to disc ratio > 0.6, other disc abnormality (e.g. notching), closed angles, Van Herrick < ¼ and intraocular pressure >21mmHg. In perimetry a square root loss variance (sLV) >3.0 dB was considered abnormal. Those cases with both an abnormal clinical exam and abnormal perimetric results were considered to be glaucoma suspects. An abnormal HRT exam was a global Moorfields Regression Analysis (MRA) result of "outside normal limits". The results from the worse eye for each instrument are reported.Results: The mean age of the patients was 59.9 years (SD ±14.8years). 46 subjects failed the clinical exam. 55 subjects had sLV>3.0dB. 86 subjects failed one or more of the testing components, 21 subjects failed both the clinical exam and perimetry. Two cases of advanced glaucoma were diagnosed on the day of the event. 20 subjects were referred due to other ocular pathology (10 cataract; 2 AMD; 8 other). 16 subjects were outside normal limits with the HRT, of which 11 failed the clinical exam, 9 failed the perimetric exam and 7 failed all three. HRT had a sensitivity of 33% CI [15%,57%] with a specificity of 93% CI [87%,97%].Conclusions: HRT shows good specificity, however the low sensitivity makes it of limited use in the proposed case finding scenario.

Bahía de Coishco, Chimbote, Perú: una visión integral de sus recursos vivos y su ambiente. 2001 - 2005

Se ha recorrido la Bahía de Coishco a fin de conocer las actividades artesanal e industrial que se desarrollan en esta área, y se han revisado los informes sobre las actividades y proyectos que ejecuta el Laboratorio Costero de Chimbote como parte del Plan Anual de Trabajo Institucional. Se presenta una descripción de la morfología, topografía y sedimentología de la Bahía de Coishco, así como de las características físicas, químicas y biológicas de sus masas de agua. Se hace una descripción de las fuentes y niveles de contaminación, producto del vertimiento de aguas de diferentes tipo de uso: industrial, pesquero, doméstico; de escorrentía y producto de actividades de las embarcaciones que operan en esta bahía. Se mencionan las especies que sustentan la pesca artesanal e industrial, los instrumentos y áreas de pesca, los bancos naturales de invertebrados marinos, los tonelajes de extracción a nivel artesanal y de procesamiento a nivel industrial por cada una de las fábricas que operan en esta bahía. La bahía de Coishco, con un área aproximada de 11.655 km2 es una bahía abierta, rodeada por las islas Santa y Moñaque; en sus profundidades predominan las isóbatas desde 12 a 16 m y en el centro de la bahía existe alta concentración de materia orgánica. Las masas de agua son generalmente Aguas Costeras Frias, de 15 a 20 ºC; la salinidad cerca de la línea litoral es menor a 35 ups, en cambio en el sur de la balúa las salinidades son en promedio del orden de 35,1ups. El vertimiento de aguas de uso industrial pesquero y doméstico influye en el contenido de oxígeno tanto superficial como de fondo, habiéndose detectado situaciones de anoxia; igualmente se afectan los nutrientes, tal es así que los niveles de fosfatos se incrementan durante la época de intensa actividad pesquera y disminuyen durante la época de veda. Se ha identificado 60 especies de organismos planctónicos, destacando las diatomeas de afloramiento Chaetoceros decipiens, Thalassiosira rotula y Skeletonema costatum. Los peces constituyen la principal fuente de pesca artesanal (82% de las capturas), destacando: "lorna" Sciaena deliciosa, "pejerrey" Odonthestes regia regia, "machete" Etmidium maculatum, "cachema" Cynoscion analis, "cabinza" Isacia conceptionís. La anchoveta es la principal materia prima para la elaboración de harina y aceite de pescado. Entre los invertebrados, destacaron "caracol" Stramoníta chocolata, "almeja" Semele spp., "concha de abanico" Argopecten purpu­ratus, "pulpo" Octopus mimus.

The cost of inappropriateness of coagulation testing [I costi dell'inappropriatezza in coagulazione]

Background. Laboratory utilization has steadily increased with a corresponding increase in overall costs; several authors have attempted to measure the impact of inappropriateness on clinical outcomes but data are insufficient. The aim of the study is to assess the cost of inappropriateness of test-ordering behaviour for second-level coagulation tests (hemorrhagic diathesisand thrombophilia). Methods. We reviewed all second-level coagulation testrequests received by our department during a six months period. Clinicians must fill out a specific order form for these kind of tests, containing all informations deemed necessary for the laboratory specialist to evaluatethe appropriateness of the request. We identified all inappropriate requests and counted the numbers and types of all coagulation tests that were not performed during the period. An analysis of the laboratory activity costs was done in order to calculate the global costof each test in our department and to estimate the savings achieved. Results. On a total of 1664 second-level coagulationtest requests, we estimated 150 as completely inappropriate. We found an overall of 295 inappropriate testswhich were not performed. This resulted in an economic saving of 20.000 euro in 6 months. Conclusions. The analysis of cost of our intervention shows the urgent need for a definite and sustained reduction in inappropriate requests of second-level coagulation tests. Even though we estimated only the economic aspect of inappropriate testing, this is also associated with the overuse of diagnostic tests which entailsthe risk of generating erroneous results with potentialnegative consequences on patients' health.

Experiencias en sistema controlado para la obtención de semillas de concha de abanico Argopecten purpuratus (Lamarck, 1819) . Ilo, Moquegua

IMARPE Ilo obtuvo financiamiento del Gobierno Regional de Moquegua en base al proyecto "Mejoramiento de infraestructura e implementació n de laboratorio de investigació n de molusc"os, para construir un laboratorio experimental con el objetivo de desarrollar técnicas de reproducción artificial de moluscos nativos de la Región, para la obtención de semillas principalmente de macha Mesodesma donacium, chanque Concholepas concholepas y pulpo Octopus mimus. Este informe contiene el resultado de las actividades realizadas el 2007,en relación a la aplicación de técnicas de cultivo de microalgas (alimento vivo) y obtención de semillas de concha de abanico.

Bancos naturales entre Punta Herradura y Playa Chica, Huacho. Junio 2002

En junio del 2002 se realizó el estudio de bancos naturales entre Punta Herradura-Playa Chica (11°15’17,6”S a 11°11’10,7”S) dentro de una franja costera de 1mn. Se encontraron aguas costeras frías (ACF), con salinidad entre 35,1 y 34,8 ups y TSM entre 14,8 °C y 15,4 °C; substratos mayormente de arena fina compacta, fondos algosos y duros de roca volcánica. Entre 3,5 y 22 m de profundidad, la fauna bentónica estuvo compuesta por crustáceos: Platyxanthus orbignyi, Romaleon polyodon, Hepatus chiliensis y Pleuroncodes monodon; moluscos: Loligo gahi y Octopus mimus; peces: Odontesthes regia regia y equinodermos.

La Pesca artesanal marina en la Región La Libertad, Perú

En la Región La Libertad se encuentran asentadas 11 comunidades pesqueras artesanales y 21 organizaciones de pescadores artesanales legalmente registradas, con un total de 1191 integrantes además de un número semejante de pescadores artesanales informales. Se reconocieron 9 artes y aparejos de pesca, así como la extracción manual y por buceo. El arte de pesca más utilizado es la red cortina, con tamaños de malla que varían de 4 - 36 cm. El aparejo más utilizado es el espinel de superficie con tamaños de anzuelo desde el número 1 al 5. La flota artesanal está compuesta por 4 tipos de embarcaciones: lancha, bote, chalana y caballito de totora. La capacidad de bodega varía de 0,5 t a 20 t, mientras que los caballitos de totora su capacidad de carga es de 100 k. Se identificaron 31 especies de macroalgas marinas siendo Chondracanthus chamissoi (yuyo) y Gracilariopsis lemanaeformis (pelillo) de importancia económica. En invertebrados marinos se identificaron 69 especies, de las cuales 68 especies son costeras y 1 es oceánica Dosidicus gigas (pota). De las especies costeras, 9 son de importancia comercial: Platyxanthus orbignyi (cangrejo violáceo), Stramonita chocolata (caracol negro), Octopus mimus (pulpo), Argopecten purpuratus (concha de abanico), Semele solida y S.corrugata (almeja), Emerita analoga (muy muy), Pattalus mollis (pepino de mar), Donax sp. (palabritas). Se identificaron 112 especies de peces, 89 de ellas corresponden a peces óseos y 23 a cartilaginosos.

Treatment of autoinflammatory diseases: results from the Eurofever Registry and a literature review.

OBJECTIVE: To evaluate the response to treatment of autoinflammatory diseases from an international registry and an up-to-date literature review. METHODS: The response to treatment was studied in a web-based registry in which clinical information on anonymised patients with autoinflammatory diseases was collected retrospectively as part of the Eurofever initiative. Participating hospitals included paediatric rheumatology centres of the Paediatric Rheumatology International Trial Organisation network and adult centres with a specific interest in autoinflammatory diseases. The following diseases were included: familial Mediterranean fever (FMF), cryopyrin-associated periodic syndromes (CAPS), tumour necrosis factor (TNF)-receptor associated periodic syndrome (TRAPS), mevalonate kinase deficiency (MKD), pyogenic arthritis pustulosis acne (PAPA) syndrome, deficiency of interleukin-1 receptor antagonist (DIRA), NLRP12-related periodic fever and periodic fever aphthosis pharyngitis adenitis (PFAPA) syndrome. Cases were independently validated by experts for each disease. A literature search regarding treatment of the abovementioned diseases was also performed using Medline and Embase. RESULTS: 22 months from the beginning of the enrolment, complete information on 496 validated patients was available. Data from the registry in combination with evidence from the literature confirmed that colchicine is the treatment of choice for FMF and IL-1 blockade for DIRA and CAPS. Corticosteroids on demand probably represent a valid therapeutic strategy for PFAPA, but also for MKD and TRAPS. Patients with poorly controlled MKD, TRAPS, PAPA or FMF may benefit from IL-1 blockade; anti-TNF treatment may represent a possible valuable alternative. CONCLUSIONS: In the absence of high-grade evidence, these results could serve as a basis for therapeutic guidelines and to identify candidate drugs for future therapeutic trials.

Estudio Línea Base – ELBA Callao, primavera 2011

Estudio Línea Base – ELBA Callao, primavera 2011. Inf Inst Mar Perú. 39(3-4): 149-198.- El ELBA se efectuó en el área delimitada por las islas San Lorenzo y El Frontón y la Península de La Punta, del 21 al 30 de noviembre 2011, para a) caracterizar biológica y oceanográficamente el área de estudio y b) obtener bases técnicas para el ordenamiento pesquero y acuícola. En el área predominaron sedimentos arenosos y grava de origen terrígeno. Presentó características térmicas frías al interior y cálidas al sur, con influencia de aguas costeras. La comunidad fitoplanctónica presentó abundancia de diatomeas. Se identificó zonas con alta biomasa de bentos y con altos valores de stress. Los sólidos suspendidos totales, cadmio y coliformes totales y termotolerantes sobrepasaron los límites de los estándares de calidad acuática en el Perú. Las comunidades de invertebrados más importantes fueron: concha de abanico Argopecten purpuratus, cangrejos Cancer setosus (ahora Romaleon polyodon) y C. porteri, almeja Semele spp., pulpo Octopus mimus y macroalga Macrocystis sp.; el calamar Loligo gahi usa el área para desovar.

Monitoreo de invertebrados marinos en estaciones fijas del Callao, 2008-2012

Se presentan resultados de investigaciones sobre reclutamiento, estructura por tallas y abundancia de Stramonita chocolata, Argopecten purpuratus, Cancer setosus (= Romaleon polyodon) y Glycymeris ovata efectuados en los bancos naturales de Callao durante el 2008-2012, así como del experimento de marcación - recaptura de A. purpuratus en la bahía del Callao el 2011-2012. Con los resultados del monitoreo de invertebrados marinos en estaciones fijas del 2008 al 2012 se establecieron patrones temporales y espaciales del reclutamiento y abundancia que tendrían fuerte impacto en la determinación de medidas alternativas de manejo en la regulación pesquera. Con los resultados de marcación – recaptura de A. purpuratus se determinaron parámetros de crecimiento von Bertalanffy: 100 mm para longitud infinita, 0,891 y 0,931 año-1 para k para los años 2011 y 2012 respectivamente, y -0.04 para t0. También se presentan resultados del monitoreo de Octopus mimus en las islas de la región Lima (Ancón- Asia) los cuales muestran por primera vez índices de abundancia, distribución y aspectos biológicos.