O cuidado em saúde mental e o agir em rede: como se agencia um caso de intensa complexidade?

Pós-graduação em Psicologia - FCLAS

Da autonomia da boca: práticas curriculares e identidade profissional na emergência do ensino brasileiro da odontologia

Analisa como ocorreu a separação entre o ensino da medicina e o da odontologia no Brasil. Privilegia a institucionalização das políticas de ensino da odontologia no país como vertente produtora de identidade profissional. Políticas de ensino e práticas profissionais são interrelacionadas para mostrar como suas relações e sentidos mudam historicamente. Propõe que a autonomia do ensino da odontologia emergiu da necessidade de conformação do sistema de regulação das práticas de cura no Brasil e seu processo de instituição desenvolveu-se sob inspiração das políticas positivistas acerca do ensino livre. Práticas curriculares foram produzindo a subjetividade do cirurgião-dentista moderno e também da clínica por ele desempenhada.

Major differences in organization and availability of health care and medicines for HIV/TB coinfected patients across Europe

OBJECTIVES The aim of the study was to investigate the organization and delivery of HIV and tuberculosis (TB) health care and to analyse potential differences between treatment centres in Eastern (EE) and Western Europe (WE). METHODS Thirty-eight European HIV and TB treatment centres participating in the TB:HIV study within EuroCoord completed a survey on health care management for coinfected patients in 2013 (EE: 17 respondents; WE:21; 76% of all TB:HIV centres). Descriptive statistics were obtained for regional comparisons. The reported data on health care strategies were compared with actual clinical practice at patient level via data derived from the TB:HIV study. RESULTS Respondent centres in EE comprised: Belarus (n = 3), Estonia (1), Georgia (1), Latvia (1), Lithuania (1), Poland (4), Romania (1), the Russian Federation (4) and Ukraine (1); those in WE comprised: Belgium (1), Denmark (1), France (1), Italy (7), Spain (2), Switzerland (1) and UK (8). Compared with WE, treatment of HIV and TB in EE are less often located at the same site (47% in EE versus 100% in WE; P < 0.001) and less often provided by the same doctors (41% versus 90%, respectively; P = 0.002), whereas regular screening of HIV-infected patients for TB (80% versus 40%, respectively; P = 0.037) and directly observed treatment (88% versus 20%, respectively; P < 0.001) were more common in EE. The reported availability of rifabutin and second- and third-line anti-TB drugs was lower, and opioid substitution therapy (OST) was available at fewer centres in EE compared with WE (53% versus 100%, respectively; P < 0.001). CONCLUSIONS Major differences exist between EE and WE in relation to the organization and delivery of health care for HIV/TB-coinfected patients and the availability of anti-TB drugs and OST. Significant discrepancies between reported and actual clinical practices were found in EE.

The population health performance of medical students at two medical schools

Public Health and medicine are complimentary disciplines dedicated to the health and well-being of humankind. Worldwide, medical school accreditation bodies require the inclusion of population health in medical education. In 2003, the Institutes of Medicine (IOM) recommended that all medical students receive basic public health training in population-based prevention. The purpose of this study was to (1) examine the public health clinical performance of third-year medical students at two independent medical schools, (2) compare the public health clinical practice performance of the schools, and (3) identify underlying predictors of high and low public health clinical performance at one of the medical schools. ^ This study is unique in its analysis and report of observed medical student public health clinical practices. The cohort consisted of 751 third-year medical students who completed a required clinical performance exam using trained standardized patients. Medical student performance scores on 24 consensus public health items derived from nine patient cases were analyzed.^ The analysis showed nearly identical results for both medical schools at the 60%, 65%, and 70% pass rate. Students performed poorly on items associated with prevention, behavioral science, and surveillance. Factors associated with high student performance included being from an underrepresented minority, matching to a primary care residency, and high class ranking. A review of medical school curriculum at both schools revealed a lack of training in four public health domains. Nationally, 32% of medical students reported inadequate training in public health in the year 2006.^ These findings suggest more dedicated teaching time for public health domains is needed at the medical schools represented in this study. Finally, more research is needed to assess attainment of public health knowledge and skills for medical students nationwide if we are to meet the recommendations of the IOM. ^

"Teens talk healthy weight": A video technology project

Purpose. The purpose of this study was to investigate the impact of a motivational weight management DVD on knowledge of obesity related diseases, readiness, motivation, and self-efficacy to lose weight, connectedness to their care provider, and patients return to clinic. Design. A randomized control trial was conducted in which 40 overweight/obese adolescents and their parents/caregivers were randomly assigned to standard care alone or standard care plus DVD. Subjects completed a set of pre- and post-questionnaire measures. A group of 22 patients was also formed as a historical control group in order to account for the potential effect of extra attention given to subjects prospectively enrolled. Methods. The adolescents and their parent/caregiver were placed into a patient room. Consent was obtained and a set of written pre-questionnaires were given to both the parent and the adolescent. Standard care was provided to all patients by the Registered Dietitian and physician; the DVD was shown in addition to standard care among the intervention group. A set of post-questionnaires were given and compensation was provided. Analysis. Groups were compared to determine equivalence at baseline. Analysis of covariance was used to evaluate changes over time, while controlling for pre-test scores and race/ethnicity. Results. Parents who viewed the DVD experienced greater changes in correct knowledge as compared to parents who did not view the DVD. Conclusion. Our study found only one substantial benefit of the DVD beyond standard clinical practices. This is an important area for change as it increased awareness of obesity as a serious disease and has future clinical implications.^

Provider perceptions of physical activity counseling: A systematic review

Background: Although the health benefits of physical activity are well-established, the evidence regarding the efficacy of physical activity counseling by primary care providers is inconclusive. Healthy People 2020 recommends that physicians provide counseling on physical activity to their patients; however, few providers adhere to these guidelines. The primary objective of this review is to systematically summarize and evaluate primary care providers' perceptions and attitudes about physical activity counseling. ^ Methods: A systematic literature search of relevant articles was conducted between January and May 2011 using four databases: MEDLINE (1948 to the present), PsycInfo (1806 to the present), CINAHL Plus with Full Text (1981 to the present), and the Cochrane Library. Studies were included if 1) the study population consisted of primary care providers and, 2) the study evaluated providers' attitudes and perceptions pertaining to physical activity counseling. Both quantitative and studies were considered. ^ Results: Most primary care providers agree that physical activity counseling is important and that they have a role in promoting physical activity to their patients. Providers are uncertain about the effectiveness of counseling, feel only marginally comfortable providing more than general advice about physical activity, and cite major barriers to counseling such as lack of time, lack of training, and lack of reimbursement for their counseling efforts. The evidence in this review suggests that beyond these barriers, providers are more likely to counsel their patients about physical activity if they are active themselves, or if they feel that their patients' condition, such as cardiovascular disease or obesity, would strongly benefit from a lifestyle change. ^ Conclusion: While major barriers to physical activity counseling, such as lack of time for counseling and lack of counseling knowledge still exist, primary care providers are receptive to the idea of acting as physical activity promoters in their clinical practices. However, the barriers encountered need to be addressed on multiple levels (e.g. individual, organizational), and additional training is needed in order for providers to effectively promote the physical activity of their patients.^

Historias de hormonas en Argentina : La obesidad de los niños y el diagnóstico precoz del embarazo en las décadas de 1930 y 1940

Este artículo aborda, desde una perspectiva de género, la producción de saberes sobre hormonas en Argentina, en las décadas de 1930 y 1940. Entendemos que un análisis histórico de las ideas científicas y las prácticas clínicas permite indagar en cómo éstas se entraman tanto con el escenario social del que forman parte como con los contextos institucionales donde se elaboran. Focalizaremos en las miradas de los endocrinólogos del Hospital de Niños de Buenos Aires sobre la obesidad en la infancia y el síndrome adiposo genital, y los debates en la Sociedad de Obstetricia y Ginecología de Buenos Aires sobre las técnicas de detección precoz del embarazo y la hormona gonadotropina coriónica

Historias de hormonas en Argentina : La obesidad de los niños y el diagnóstico precoz del embarazo en las décadas de 1930 y 1940

Este artículo aborda, desde una perspectiva de género, la producción de saberes sobre hormonas en Argentina, en las décadas de 1930 y 1940. Entendemos que un análisis histórico de las ideas científicas y las prácticas clínicas permite indagar en cómo éstas se entraman tanto con el escenario social del que forman parte como con los contextos institucionales donde se elaboran. Focalizaremos en las miradas de los endocrinólogos del Hospital de Niños de Buenos Aires sobre la obesidad en la infancia y el síndrome adiposo genital, y los debates en la Sociedad de Obstetricia y Ginecología de Buenos Aires sobre las técnicas de detección precoz del embarazo y la hormona gonadotropina coriónica

Historias de hormonas en Argentina : La obesidad de los niños y el diagnóstico precoz del embarazo en las décadas de 1930 y 1940

Este artículo aborda, desde una perspectiva de género, la producción de saberes sobre hormonas en Argentina, en las décadas de 1930 y 1940. Entendemos que un análisis histórico de las ideas científicas y las prácticas clínicas permite indagar en cómo éstas se entraman tanto con el escenario social del que forman parte como con los contextos institucionales donde se elaboran. Focalizaremos en las miradas de los endocrinólogos del Hospital de Niños de Buenos Aires sobre la obesidad en la infancia y el síndrome adiposo genital, y los debates en la Sociedad de Obstetricia y Ginecología de Buenos Aires sobre las técnicas de detección precoz del embarazo y la hormona gonadotropina coriónica

bioNMF: a versatile tool for non-negative matrix factorization in biology

Medical imaging has become an absolutely essential diagnostic tool for clinical practices; at present, pathologies can be detected with an earliness never before known. Its use has not only been relegated to the field of radiology but also, increasingly, to computer-based imaging processes prior to surgery. Motion analysis, in particular, plays an important role in analyzing activities or behaviors of live objects in medicine. This short paper presents several low-cost hardware implementation approaches for the new generation of tablets and/or smartphones for estimating motion compensation and segmentation in medical images. These systems have been optimized for breast cancer diagnosis using magnetic resonance imaging technology with several advantages over traditional X-ray mammography, for example, obtaining patient information during a short period. This paper also addresses the challenge of offering a medical tool that runs on widespread portable devices, both on tablets and/or smartphones to aid in patient diagnostics.

A Мodel for Assessment of Professional Competence in Physical Therapy Students

Report published in the Proceedings of the National Conference on "Education and Research in the Information Society", Plovdiv, May, 2015

Enhancing the Visualization of the Peripheral Retina with Wide Field-of-View Optical Coherence Tomography

The goal of my Ph.D. thesis is to enhance the visualization of the peripheral retina using wide-field optical coherence tomography (OCT) in a clinical setting.

OCT has gain widespread adoption in clinical ophthalmology due to its ability to visualize the diseases of the macula and central retina in three-dimensions, however, clinical OCT has a limited field-of-view of 300. There has been increasing interest to obtain high-resolution images outside of this narrow field-of-view, because three-dimensional imaging of the peripheral retina may prove to be important in the early detection of neurodegenerative diseases, such as Alzheimer's and dementia, and the monitoring of known ocular diseases, such as diabetic retinopathy, retinal vein occlusions, and choroid masses.

Before attempting to build a wide-field OCT system, we need to better understand the peripheral optics of the human eye. Shack-Hartmann wavefront sensors are commonly used tools for measuring the optical imperfections of the eye, but their acquisition speed is limited by their underlying camera hardware. The first aim of my thesis research is to create a fast method of ocular wavefront sensing such that we can measure the wavefront aberrations at numerous points across a wide visual field. In order to address aim one, we will develop a sparse Zernike reconstruction technique (SPARZER) that will enable Shack-Hartmann wavefront sensors to use as little as 1/10th of the data that would normally be required for an accurate wavefront reading. If less data needs to be acquired, then we can increase the speed at which wavefronts can be recorded.

For my second aim, we will create a sophisticated optical model that reproduces the measured aberrations of the human eye. If we know how the average eye's optics distort light, then we can engineer ophthalmic imaging systems that preemptively cancel inherent ocular aberrations. This invention will help the retinal imaging community to design systems that are capable of acquiring high resolution images across a wide visual field. The proposed model eye is also of interest to the field of vision science as it aids in the study of how anatomy affects visual performance in the peripheral retina.

Using the optical model from aim two, we will design and reduce to practice a clinical OCT system that is capable of imaging a large (800) field-of-view with enhanced visualization of the peripheral retina. A key aspect of this third and final aim is to make the imaging system compatible with standard clinical practices. To this end, we will incorporate sensorless adaptive optics in order to correct the inter- and intra- patient variability in ophthalmic aberrations. Sensorless adaptive optics will improve both the brightness (signal) and clarity (resolution) of features in the peripheral retina without affecting the size of the imaging system.

The proposed work should not only be a noteworthy contribution to the ophthalmic and engineering communities, but it should strengthen our existing collaborations with the Duke Eye Center by advancing their capability to diagnose pathologies of the peripheral retinal.

The impact of serum uric acid on the diagnostic of metabolic syndrome in apparently healthy Brazilian middle-aged men

Background: Hyperuricemia is related to Metabolic Syndrome (MetS) and cardiovascular diseases, but the use of serum uric acid (UA) to diagnose MetS is currently ignored in clinical practices. Objectives: To examine the impact of serum UA on the diagnostic of MetS and the relationship of serum UA with cardiometabolic risk factors in apparently healthy Brazilian middle-aged men residents in a city of Minas Gerais. Methods: In a cross-sectional analysis, 289 apparently healthy middle-aged men underwent anthropometric, clinical, sociodemographic and blood serum biochemical evaluation. By using receive operating curve the internal cutoff of serum UA was determined (5.25 mg/dL). Results: Subjects with two or more components of MetS exhibited higher serum UA as compared to those with one or none component. The inclusion of serum UA ≥ 5.25mg/dL as an additional component of MetS increased the occurrence of this syndrome by 13%. Subjects with UA ≥ 5.25mg/dL showed high prevalence for MetS and association with its components (central obesity, hypertriglyceridemia, dyslipidemia and hypertension) as well as atherogenic risk. Conclusions: Serum UA has an important impact on the diagnostic of MetS and is related to cardiometabolic risk factors in apparently healthy Brazilian middle-aged men. Its use in clinical practices could aggregate accuracy to diagnose MetS.

Discovery and validation of serologic biomarkers for the diagnosis and prognosis of invasive candidiasis by computational immunomics

Invasive candidiasis (IC) is an opportunistic systemic mycosis caused by Candida species (commonly Candida albicans) that continues to pose a significant public health problem worldwide. Despite great advances in antifungal therapy and changes in clinical practices, IC remains a major infectious cause of morbidity and mortality in severely immunocompromised or critically ill patients, and further accounts for substantial healthcare costs. Its impact on patient clinical outcome and economic burden could be ameliorated by timely initiation of appropriate antifungal therapy. However, early detection of IC is extremely difficult because of its unspecific clinical signs and symptoms, and the inadequate accuracy and time delay of the currently available diagnostic or risk stratification methods. In consequence, the diagnosis of IC is often attained in advanced stages of infection (leading to delayed therapeutic interventions and ensuing poor clinical outcomes) or, unfortunately, at autopsy. In addition to the difficulties encountered in diagnosing IC at an early stage, the initial therapeutic decision-making process is also hindered by the insufficient accuracy of the currently available tools for predicting clinical outcomes in individual IC patients at presentation. Therefore, it is not surprising that clinicians are generally unable to early detect IC, and identify those IC patients who are most likely to suffer fatal clinical outcomes and may benefit from more personalized therapeutic strategies at presentation. Better diagnostic and prognostic biomarkers for IC are thus needed to improve the clinical management of this life-threatening and costly opportunistic fungal infection...

Evaluation of the quality of the teaching-learning process in undergraduate courses in Nursing

Objective: to identify aspects of improvement of the quality of the teaching-learning process through the analysis of tools that evaluated the acquisition of skills by undergraduate students of Nursing. Method: prospective longitudinal study conducted in a population of 60 second-year Nursing students based on registration data, from which quality indicators that evaluate the acquisition of skills were obtained, with descriptive and inferential analysis. Results: nine items were identified and nine learning activities included in the assessment tools that did not reach the established quality indicators (p<0.05). There are statistically significant differences depending on the hospital and clinical practices unit (p<0.05). Conclusion: the analysis of the evaluation tools used in the article "Nursing Care in Welfare Processes" of the analyzed university undergraduate course enabled the detection of the areas for improvement in the teaching-learning process. The challenge of education in nursing is to reach the best clinical research and educational results, in order to provide improvements to the quality of education and health care.