Análise da atenção prestada aos pacientes portadores de hipertensão arterial no município de Piraí com bases nos registros dos prontuários ambulatoriais e hospitalares

O controle da Hipertensão Arterial é central para que seja alcançada maior eficiência na redução de eventos adversos secundários ao descontrole crônico da pressão arterial. Os resultados de uma atenção integral aos portadores não se esgotam no acesso e disponibilização de fármacos eficazes no controle da pressão arterial. Ela envolve a rede integrada de serviços, orientada pela atenção primária, com serviços especializados e hospitalares na atenção das intercorrências. O cuidado aos portadores destes agravos crônicos exige dos serviços e profissionais da atenção primária a implantação de estratégias de acolhimento, efetivação de vínculos e projetos terapêuticos e uma intervenção que abrange a promoção, prevenção, assistência e reabilitação. Com esta questão em mente é que este projeto buscou analisar a atenção prestada aos portadores de Hipertensão Arterial no município de Piraí com base nos registros dos prontuários ambulatoriais e hospitalares. Foram computados e analisados os prontuários de pacientes internados por agravos que, direta ou indiretamente, estão relacionados ao descontrole da pressão arterial. Identificaram-se um total de 61 pacientes internados com diagnóstico de internação de Crise Hipertensiva e Acidente Vascular Encefálico no ano de 2010, no Hospital Flávio Leal. A partir dos registros hospitalares foram selecionados 35 pacientes. Estes eram moradores do município de Piraí, adscritos a equipes básicas no município e tiveram seus diagnósticos de internação confirmados na alta hospitalar. A segunda etapa do estudo analisou, na Unidade de Saúde da Família, os prontuários familiares dos casos de internação. Foi observado que não havia uniformidade na forma de registro e de arquivamento dos prontuários entre as unidades básicas. Nos prontuários clínicos não havia campos destinados aos registros de aspectos psicossociais, mudança de comportamento ou adesão. As anotações eram centradas na doença e nos tratamentos farmacológicos. A participação de profissionais não médicos nos registros clínicos era escassa. A Ficha B do SIAB (Ficha de Acompanhamento do Paciente Hipertenso) que contém os dados sobre comportamento e risco cardiovascular foi encontrada apenas em 3 das 8 unidades visitadas. Segundo os dados dos prontuários analisados a distribuição de consultas e visitas domiciliares foi muito irregular. Com um total de 10 prontuários sem registros de consultas no ano em que o pacientes foi internado. A gravidade dos pacientes internados pode ser identificada pelo elevado número de óbitos entre os casos analisados. Muitos dos casos apresentavam sequelas neurológicas e comorbidades que provavelmente dificultava suas idas às unidades de saúde da família. Aspectos psicossociais, familiares e da comunidade estavam, em sua maioria, ausente dos prontuários familiares analisados dos pacientes internados. Também não foram encontrados anotações sobre projetos terapêuticos multidisciplinares que individualizassem e hierarquizassem os agravos e os riscos físicos e psicossociais dos pacientes. A análise evidencia que os registros nos prontuários não traduzem a abrangência de uma atenção integral aos portadores de Hipertensão Arterial no âmbito da Atenção Primária.

Vozes e caminhos do decrescimento: consequências humanas

O objetivo deste trabalho é apresentar o contemporâneo movimento sociopolítico do Decrescimento, partindo das ideias inaugurais de Serge Latouche, economista e filósofo francês responsável pela criação deste termo, sua historicidade, premissas de análise, e novas formas de subjetivação que propõe, cuja argumentação se sustenta e deriva também, dentre outros autores - como Castoriadis, Gorz e Mészáros - da tese de David Harvey que estabelece que desenvolvimento não é o mesmo que crescimento, e que é possível promover desenvolvimento nas dimensões das relações pessoais, sociais do cotidiano e das relações com o meio ambiente sem as orientações que favoreçam o capital e sua máxima de acumulação. Trata-se, segundo os autores, de um movimento anticapitalista que busca denunciar questões críticas contemporâneas e contradições e crises do capitalismo, apontando um conjunto de passos a serem dados para o lado de fora desta lógica que valoriza e incentiva o desejo e a necessidade do excesso. Em diálogo pleno com a Ética e seus mais recentes estudos, nos quais desponta a autora Victoria Camps, o Decrescimento se preocupa com as escolhas do indivíduo, com o que as mobiliza e com as maneiras pelas quais devemos viver. Segundo esta autora o reconhecimento em torno de nossa não autossuficiência faz com que nos percebamos vulneráveis e o espírito do que a maioria dos autores do Decrescimento chama de espírito do Dom do Decrescimento e de a Economia da Felicidade dialoga diretamente com a busca do homem por governar estas vulnerabilidades, compreender suas virtudes, desenvolvê-las e praticar o bem e seu senso coletivo. Sua contribuição por sua vez para a construção contínua e transformadora de uma Psicologia Social Crítica deve-se à busca por um novo sujeito, e cuja subjetividade possa ser ressignificada e emancipada, neste exercício alguns conceitos nos foram muito caros, como por exemplo, o conceito de liberdade. Discutiu-se o Decrescimento destacando suas viabilidades práticas, importância, dimensões planetárias e aquilo que particularmente mais me chamou atenção em relação ao movimento a partir de minha própria experiência na 3 Conferência Internacional do Decrescimento que ocorreu em Veneza em setembro de 2012. A espinha dorsal deste trabalho foi o próprio discurso do Decrescimento e o discurso construído em torno dele, e suas vozes que foram dispostas e organizadas em análise nesta pesquisa em forma de interlocução e diálogos abertos, interdisciplinares, teóricos e práticos. A interlocução foi exercício metodológico capaz de reunir as vozes do Decrescimento e transportá-las para dentro do texto desta pesquisa, sendo a própria pesquisa em si, pelo dar a conhecer deste sujeito e que pode ser outro e mediar sua existência com o mundo de outras maneiras, e pelo dar a conhecer em torno do próprio movimento, e sobre o qual não se pretende conclusões, pois não se trata de encerrar a discussão trata-se de valorizá-la por ela mesma e potencializar possibilidades dialéticas, críticas e reflexivas, ficando, portanto ao leitor o convite a problematizar-se diante das questões aqui destacadas, em busca de si, para si e pelas alternativas existenciais mais diversas, dentre elas, o Decrescimento.

O refúgio no direito internacional contemporâneo: entre a segurança nacional e a proteção do indivíduo

O direito internacional dos refugiados constitui um dos mais importantes mecanismos de proteção internacional do indivíduo, sendo objeto de Convenção com alto número de ratificações e de legislação nacional ainda mais protetiva. Não obstante o amplo acervo normativo disponível, desenvolvido para lidar com os desafios impostos pelos frequentes fluxos migracionais que marcaram a primeira metade do século XX, fenômenos recentes tornaram evidente a necessidade de revisão, ainda que parcial, de sua estrutura. Políticas de controle de fronteiras adotadas na Europa levaram ao incremento do fluxo de refugiados entre Estados do Sul. Paralelamente, a transferência de parte do controle para fora das águas territoriais europeias fenômeno observado também no sudeste asiático põe o direito internacional dos refugiados em confronto com a regulamentação do direito do mar. Enquanto isto, o Brasil, por não possuir histórico recente relevante de recebimento de migrantes, enfrenta grande dificuldade para garantir até mesmo o reconhecimento da condição de refugiado. Neste contexto, é imprescindível o enfrentamento de tais problemas, compatibilizando o instituto do refúgio com as necessidades das primeiras décadas do século XXI.

The fisheries resources of Lake Nakivali

Lake Nakivali is one of the four small lakes that form what is known as the koki lake sysyem. It is 14km long,6km wide.26km sqaured in area and has maximum depth of 3.5m at high water level. The lake is located in lake-swamp complex with river Rwizi as the principle inflow, and a number of peripheral lakes among which are four major ones,i.e Lake Nakivali, Mburo, Kachira and Kijanebalola. Lake Nakivali is a controlled lake with four official landing sites, namely: Kikusi, Kahirimbi, Kashojwa and Rukinga. The latter three are located within a Refugee settlement whereas Kikusi is outside. The Nakivali Refugee settlement initially established for Rwandese of Tutsi origin in 1963, now has at least seven nationalities which include people from Rwanda, Democratic Republic of Congo, Somalia, Sudan, Ethiopia, Kenya and Eritrea. By the end of 2006, the lake’s hinterland of about 378 km squared contained 43,448 people of whom 22,448 were refugees. This large population has had stressful impacts on both land and lake resources to the extent that now there is an apparent overfishing on the lake.

A comparative ecological study on internationally important wetlands of Khoor-e-Kolahy and Tiab

Ecological study on Kolahy and 'flab estuaries were carried out during 1996-1997. Water and sediment sampling was done seasonally. In order to study the physical and chemical characteristic of the water, various animal fauna from different material niches including planktons and fish from water, benthousi from the sediment , and surface living animal such as Arthropod (Crabs) and Waterbirds were identified. I he result shoved, that water salinity of both estuaries was the same as the general salinity existing its the Persian Gulf water, and its variation is same IN those waters Minimum water salinity in both estuaries are seen during Bahairdan or early winter mooth(Jaa.), which is about 31ppt and Maximum is during .rirldlun.) or summer mouth at about 19 ppt. Dissolved otygen and pH are slime as the general Persian Gulf waters., Dissolve Oxygen being directly associated to temperature and its fluctuation is between 7- Sing/I and pH between 7.5-LS. The animals of both estuaries are almost similar having a sal factory species diversity . The birds of the region are often seasonal migrants , the maximum population of which occurs in winter season and the minimum during summer month. Nam coverage is richer in Tiab than Kolahy estuary, where in Kolahy a signal Mangrove tree is in exigence. 'Ile total coverage of Mangrove forest in Tiab is estimated about -29 hec.Both estuaries are included with in the international Ramsar Convention sites in 1971. Due to national importance of these estuaries inproviding refugee for various birds species and also hinting grounds and access traffic for local fishing vehicles, Actiog as an important access for various inhabitancy living with these area of the Persian Gulf. Due to importance or prawn aquacultur for the economical well being of local inhabitance, these areas provide a suitable grandees for prawn production. I-test statistics show, there are no significant difference among various invertebrate and vertebrate animals. In over all out look 21) phytoplankton genera, 21) zeoplankton genera 17 miafauna and 32 roaerofauna genera , 11 different species Carcineacearions and 119 species of walerbirds were identified with in the Tiab and Kolahy estuariesregioos. The X statistic show that the animal density is directly associated to season. Where density of miofauna and maerofauna in both estuaries are in maiticrourn during summer and the minimums existing during the winter season. In addition the bentic invertebrate population density in closlly association to birds population density since , the later, feeds on the former animals. Where the increasing in bird population density during the winter season, the bentic invertebrate animal population density decreases. The over all trend of animal population density in winter tend to increased towards the summer seasons, which this is due to climatic conditions of the region. The bird population on the contrary to other animals of both estuaries tend to increase from summer towards the winter seasons and which this bird population density is in maximum in winter with in the region.

Lake Nasser fisheries: recommendations for management, including monitoring and stock assessment

This study sought to improve the baseline knowledge of the fisheries of Lake Nasser and to make recommendations for the improved management of the fisheries, including stock assessment. The study included the review of key literature, visits to fisheries infrastructure and fishing camps, and individual consultations with the key stakeholders by means of semi-structured interviews, as well as a collective stakeholder consultation workshop. A preliminary stock assessment was also undertaken using the most recent time series of catch and effort estimates.

Fishery methods and fish diversity in the Kilombero River in south-eastern Tanzania

Assessment of common fishery methods and of fish diversity was undertaken in two fishing camps on the Kilombero River in south-eastern Tanzania in surveys towards the end of the dry season, 1994. Fishermen identified 23 different types of fish that they caught on a regular basis. Only 19 species of fish, belonging to 17 genera and 11 families were, however, identified according to Linnean taxonomy. Hooks, nets, traps and spears were used to catch fish. Fish were either sold fresh. or preserved for storage and long-distance tranport by smoking or frying. based un frequency distributions of the numbers of fish landed over a 4 day period at one of the camps, a Shannon-diversity index of 1.95 was calculted. The fork (or total) length of 480 fish and the weight of 413 fish were measured and length frequency distributions as well as length-weight relationships determined for the six most common species. It is concluded that local fishing methods applied in the Kilombero River allow for sustainable fish production.

Exposed singularity

Edkins, J., Exposed singularity, Journal for Cultural Research, Volume 9, Issue 4 October 2005 , pages 359 - 386 RAE2008

Prawa człowieka w kontekstach kulturowych

The power of human rights idea and its expansion are connected with the experience of so far unprecedented pain and cruelty caused by man to man during the Second World War. Doctrine of legal positivism strenghtened totalitarian systems. One of the essential goals that were set by totalitarian systems was ethnic cleansing within both one’s and subjugated communities. To achieve this goal, concentration camps were established. This Second World War’s events gave raise to a question: does the common morality of the whole mankind exist? The Nuremberg Trials based on conviction that this common morality of the whole mankind exists. In this lawsuits Nazis were on trials for mass murder and crimes against humanity despite the fact that this crimes did not exist as a criminal offences in international law of that time. Lawyers of Nazis argued that their clients should not have been on trials for crimes against humanity because the rule “lex retro non agit” (“the law does not operate retroactively”) should have been in force. International Military Tribunal dismissed this argument – it was stated they tried Nazis are responsible for acts resulting from breach of the natural law. Therefore, the primacy of natural law over civil law (was approved and they admitted that morality and law are essential components of international reality. Since The Nuremberg Trials, the process of making international relations more ethical proceeded consistently through positivisationi.e. introducing human rights ideas to civil law (this issue is included in the Part I of the book: Positivisation of human rights idea). In this way, contemporary human rights as civil law arose, established on the basis of international agreement. Using them in order to legitimize and validate humanitarian interventions undertaken in various parts of the world became the common standard. However, positivisation of human rights idea did not mean that one common paradigm was accepted. Many interpretation of human rights arose and many new human rights formed in concrete cultures. It gives raise to a question about validity of interventions especially in the context of cultural differences in various parts of the world that influence perception, understanding and interpretation of human rights (this issues are discussed in Part II of this book). At present human rights are not only relativized to cultural contexts but undergo semantic changes as a result of globalisation process as well (Part II of the book: Human rights idea vs globalisation). Moreover, the propositions of establishing institutions and global structures that would strengthen human rights idea appear, interalia new propositions of citizenship defining (ujmowanie jako definiowanie)in response to a decreasing role and significance of nation states in the age of globalization. The idea of human rights dominated present-day law, culture and daily life both in local and global dimension. Human rights issue became essential for philosophy, especially political philosophy.

Konwencja dotycząca statusu uchodźców a praktyka turecka. Problem przybyszów zza wschodniej granicy

Celem publikacji jest podjęcie próby przeanalizowania polityki, jaką Turcja prowadzi wobec obcokrajowców poszukujących schronienia na jej terytorium. O ważkości zagadnienia zadecydowała w ostatnich latach przede wszystkim tocząca się w Syrii wojna domowa, w wyniku której na terytorium Turcji znalazło się ponad 700 tysięcy Syryjczyków. Szczególne w tym kontekście kontrowersje budzi fakt stosowania przez Turcję podwójnych standardów w przedmiocie nadawania imigrantom konwencyjnego statusu uchodźcy. Państwo to, jako jedno z czterech na świecie, w momencie przystępowania do Konwencji dotyczącej statusu uchodźców i Protokołu nowojorskiego zastrzegło sobie prawo do stosowania w tej materii tzw. kryterium geograficznego. W efekcie, o ile status uchodźcy nadany być może osobom przybywającym zza zachodnich granic Turcji, o tyle uciekinierzy z państw takich, jak Syria, Iran, czy Irak z formalnego punktu widzenia są „poszukującymi schronienia” (tur. sığınmacı). To zaś oznacza brak ich konwencyjnej ochrony. Celem artykułu jest jednak nie tylko przeanalizowanie prawnego i rzeczywistego położenia, w jakim znajdują się ofiary syryjskiej wojny domowej, przybywające na terytorium Turcji, a także próba przewidzenia scenariusza rozwoju tejże sytuacji. Celem uczynienia analizy możliwie najbardziej rzetelną, odwołano się zarówno do anglo, jak i tureckojęzycznych materiałów źródłowych.

Przywództwo Niemiec i Francji w Unii Europejskiej w XXI w. Problemy i wyzwania

Autor w pracy stawia tezę, że „francusko-niemiecki motor” odegrał pozytywną rolę w procesie integracji europejskiej w XX w. Dzięki bliskiej współpracy francusko-niemieckiej możliwa była realizacja unii walutowo-gospodarczej, Wspólna Polityka Zagraniczna i Bezpieczeństwa oraz stworzenie w UE „obszaru wolności, bezpieczeństwa i sprawiedliwości”. W XXI w. trudna sytuacja gospodarcza Francji i napięcia społeczne spowodowały spadek jej znaczenia w Unii Europejskiej. Kryzys finansowy strefy euro oraz problem uchodźców wykreowały Niemcy na samotnego lidera w Unii Europejskiej. Jednakże współpraca francusko-niemiecka nie załamała się, gdyż oba państwa wzajemnie się potrzebują i zapewniają równowagę w Europie. Zdaniem wielu ekspertów, ze względu na ogólne nastroje w Europie, w Berlinie i Paryżu brakuje nowych idei ukazujących perspektywy rozwojowe Unii Europejskiej na najbliższe lata.

The Barretstown experience

The thesis was prompted by a simple clinical observation. Seriously ill children returning from Barretstown Holiday Camp appeared changed. Barretstown ‘magic’ confuses the issue but indicates real and clinically evident transformations. The project sought to understand the experience and place it in a recognisable framework. The data was collected by interviews, observations as camp Paediatrician, memberships of the Child Advisory Committee and the Association’s criteria assessment team, participation in volunteer training and visits to international camps. The research presents evidence that the concepts of rite of passage, graceful mimesis and salutogenesis clarify operative social processes. The passage stages of separation, transition and reaggregation can be identified. Passage rites reorder personal and social upsets to fresh arrangements that facilitate change. Interviews confirm the reordering impact of achievements in play activities. These are challenging experiences closely guided by their Masters of Ceremonies – the Caras. The Cara/camper relationship is crucial and compatible with Girard’s theory of external mimesis. Visits to four camps confirm an inspirational process in contrast to a reported camp with a predetermined formative influence. Charismatic Caras/Councillors inspire playful mimesis and salutogenic transformations. Health is more than correction of pathogenic deficits and restoration of homeostasis. Salutogenic health promotes heterostasis – a desire for optimal experiences underpinned by a sense of coherence and adequate resources. Some evidence is presented that children have an improved sense of coherence after camp, which enables them to cope better with the demands of ill health. The camps enable sick children to up regulate risk taking towards more heterostatic experiences rather than down regulate their expectations. The heterostatic impulse can explain the disability paradox of good quality of life in the presence of severe disability. The salutogenic power of Barretstown can trump the pathogenic effects of childhood cancer and other serious illnesses.

Enforcing precariousness: a comparative analysis of the limitations placed on the legal status of refugees

This thesis focuses on the manner in which the EU, the UK, and Canada respond to and engage with the refugee’s movement from a temporary to a more permanent legal status in the state. It is noted that this transition is increasingly problematized. A trend is noted in response to this among the jurisdictions examined, to exceptionalise refugee status through acts of legal categorisation and separation. These categorisations represent an attempt to re-assert control over refugees who arrived to the state in a spontaneous manner. I argue that this categorisation and fragmentation of refugee status is another means of managing life in the state and ultimately excluding refugees within the state. Refugees therefore experience a contradictory response to their presence. While they are continually reminded of the temporary nature of their legal status in the state, they are still required to demonstrate a willingness to integrate in to the host society. Their behaviour in the state is something that is once again recalled by the decision makers who determine whether they should ultimately be able to access citizenship status. In this thesis, I argue that in order to navigate a route to citizenship, the refugee must respond to the constant re-framing and re-contextualisation of her status in the state of asylum. As the thesis observes, this raises broader questions about the nature of citizenship and belonging

Coupling of beta2-adrenoceptor to Gi proteins and its physiological relevance in murine cardiac myocytes.

-Transgenic mouse models have been developed to manipulate beta-adrenergic receptor (betaAR) signal transduction. Although several of these models have altered betaAR subtypes, the specific functional sequelae of betaAR stimulation in murine heart, particularly those of beta2-adrenergic receptor (beta2AR) stimulation, have not been characterized. In the present study, we investigated effects of beta2AR stimulation on contraction, [Ca2+]i transient, and L-type Ca2+ currents (ICa) in single ventricular myocytes isolated from transgenic mice overexpressing human beta2AR (TG4 mice) and wild-type (WT) littermates. Baseline contractility of TG4 heart cells was increased by 3-fold relative to WT controls as a result of the presence of spontaneous beta2AR activation. In contrast, beta2AR stimulation by zinterol or isoproterenol plus a selective beta1-adrenergic receptor (beta1AR) antagonist CGP 20712A failed to enhance the contractility in TG4 myocytes, and more surprisingly, beta2AR stimulation was also ineffective in increasing contractility in WT myocytes. Pertussis toxin (PTX) treatment fully rescued the ICa, [Ca2+]i, and contractile responses to beta2AR agonists in both WT and TG4 cells. The PTX-rescued murine cardiac beta2AR response is mediated by cAMP-dependent mechanisms, because it was totally blocked by the inhibitory cAMP analog Rp-cAMPS. These results suggest that PTX-sensitive G proteins are responsible for the unresponsiveness of mouse heart to agonist-induced beta2AR stimulation. This was further corroborated by an increased incorporation of the photoreactive GTP analog [gamma-32P]GTP azidoanilide into alpha subunits of Gi2 and Gi3 after beta2AR stimulation by zinterol or isoproterenol plus the beta1AR blocker CGP 20712A. This effect to activate Gi proteins was abolished by a selective beta2AR blocker ICI 118,551 or by PTX treatment. Thus, we conclude that (1) beta2ARs in murine cardiac myocytes couple to concurrent Gs and Gi signaling, resulting in null inotropic response, unless the Gi signaling is inhibited; (2) as a special case, the lack of cardiac contractile response to beta2AR agonists in TG4 mice is not due to a saturation of cell contractility or of the cAMP signaling cascade but rather to an activation of beta2AR-coupled Gi proteins; and (3) spontaneous beta2AR activation may differ from agonist-stimulated beta2AR signaling.

Las bibliotecas rurales en los medios de comunicación de la Región de Extremadura: un estudio de caso

El objetivo principal de este trabajo es, a través de las noticias publicadas en diversos medios de comunicación de la Región de Extremadura sobre bibliotecas rurales a lo largo de los últimos años, comprobar el impacto y la visibilidad de las bibliotecas en los medios. Para ello, se recopilan un total de 1196 noticias que, tras ser analizadas detalladamente, se reducen a 300 sobre las que versan los resultados del estudio. Esta disminución de noticias finales demuestra que el titular o los primeros párrafos no expresan exactamente el contenido de la noticia siendo necesario un análisis cualitativo de su contenido. Se concluye que: las noticias sobre bibliotecas rurales han decrecido en el periodo analizado (2007, 2008, 2012, 2013), siendo 2007 el año de mayor auge, si bien se ha observado un repunte en 2013 con respecto a 2012; las noticias sobre bibliotecas rurales de ámbito provincial (Badajoz y Cáceres) obtienen mayor porcentaje que las regionales y nacionales (sin representación); y el diario HOY es, con diferencia, el medio que acumula el mayor porcentaje de noticias sobre bibliotecas rurales.