Planejamento e gestão na responsabilidade social: desafios para o Serviço Social

Pós-graduação em Serviço Social - FCHS

O Serviço Social contracenando com a arte para desvelar a realidade

Pós-graduação em Serviço Social - FCHS

Fatores ergonômicos críticos de mochos odontológicos e sua relação com a produtividade e satisfação de cirurgiões dentistas

The purpose of the ergonomics is to generate adequate working conditions, by the correct use of equipment and appropriate anatomic positions. Ergonomics has become essential in the dentist's life while in the dental practice. The misuse of equipment in performing tasks or the wrong choice of equipment can initiate various problems like back pain, bursitis, repetitive strain injury (RSI), limitation of movement, and stress. Using a survey that was implemented with professional dentists linked to Paulista Association of Dental Surgeons (APCD) and graduate students at the Universidade Estadual Paulista (UNESP) in the São José dos Campos (SP) region, this study intends to propose an adequate research instrument to identify ergonomic critical factors of dental stools and their relation to productivity and satisfaction of dentists. The survey was developed with Google Docs Forms tool and was designed by analysis of other studies, existing surveys and other papers in this area. Relevant content were discussed and developed questions about the stool used by dentists in their activities, the occurrence of any problems arising from the exercise of their profession and the views of respondents about the influence of using the dental stool in these cited problems as well as their productivity. Due to obstacles encountered during the project, particularly bureaucratic issues, the survey cannot be implemented as needed, resulting in a test with reduced number of answers. The users' opinion varies according to the stool used, bringing some difficulty to generalizing the answers, but if treated properly, it is possible to obtain relevant conclusions about the main aspects perceived by users in relation to the stool and the needs pointed as most important

Fatores ergonômicos críticos de mochos odontológicos e sua relação com a produtividade e satisfação de cirurgiões dentistas

The purpose of the ergonomics is to generate adequate working conditions, by the correct use of equipment and appropriate anatomic positions. Ergonomics has become essential in the dentist's life while in the dental practice. The misuse of equipment in performing tasks or the wrong choice of equipment can initiate various problems like back pain, bursitis, repetitive strain injury (RSI), limitation of movement, and stress. Using a survey that was implemented with professional dentists linked to Paulista Association of Dental Surgeons (APCD) and graduate students at the Universidade Estadual Paulista (UNESP) in the São José dos Campos (SP) region, this study intends to propose an adequate research instrument to identify ergonomic critical factors of dental stools and their relation to productivity and satisfaction of dentists. The survey was developed with Google Docs Forms tool and was designed by analysis of other studies, existing surveys and other papers in this area. Relevant content were discussed and developed questions about the stool used by dentists in their activities, the occurrence of any problems arising from the exercise of their profession and the views of respondents about the influence of using the dental stool in these cited problems as well as their productivity. Due to obstacles encountered during the project, particularly bureaucratic issues, the survey cannot be implemented as needed, resulting in a test with reduced number of answers. The users' opinion varies according to the stool used, bringing some difficulty to generalizing the answers, but if treated properly, it is possible to obtain relevant conclusions about the main aspects perceived by users in relation to the stool and the needs pointed as most important

Weight gain in relation to night work among nurses

Objective: To investigate the relationship between working at night and increased body weight in nursing. In addition, we evaluated the differences in the proportion of variables sociodemographic, work and health, according to the work shift and their association with body mass index. Methods: Based on questionnaires, we obtained data from 446 nursing professionals about aspects of their job, health and lifestyle. We performed linear and logistic regression analysis. Results: Working at night is associated with a weight gain greater than (beta=0.24 kg/m(2)) working during the day (beta=0.15 kg/m(2)), as well as with aging (beta=0.16 kg/m(2)) and duration of working in nursing (beta=0.18 kg/m(2)). Night workers have a higher educational level, have been working for more years in nursing and also in the current shift, do not have diabetes and have reported longer sleep than day workers. There are also a higher number of smokers among the night workers than day workers. Logistic regression analysis also showed the more time to work in nursing and as an assistant was more likely to develop overweight/obesity. Conclusion: Working at the night contributes to more weight gain than the day shift, aging and duration of working in nursing.

Cardiovascular risk factors in patients with first-episode psychosis in Sao Paulo, Brazil

Objective: The objective was to evaluate the cardiovascular profile of first-episode psychosis patients in Sao Paulo, Brazil, an issue that has not been sufficiently explored in low-/middle-income countries. Method: A cross-sectional study was performed 1 to 3 years after an initial, larger survey that assessed first-episode psychosis in sao Paulo. We evaluated cardiovascular risk factors and lifestyle habits using standard clinical examination and laboratory evaluation. Results: Of 151 contacted patients, 82 agreed to participate (mean age=35 years; 54% female). The following diagnoses were found: 20.7% were obese, 29.3% had hypertension, 39.0% had dyslipidemia, 19.5% had metabolic syndrome, and 1.2% had a >20% 10-year risk of coronary heart disease based on Framingham score. Also, 72% were sedentary, 25.6% were current smokers, and 7.3% reported a heavy alcohol intake. Conclusion: Compared to other samples, ours presented a distinct profile of higher rates of hypertension and diabetes (possibly due to dietary habits) and lower rates of smoking and alcohol intake (possibly due to higher dependence on social support). Indirect comparison vs. healthy, age-matched Brazilians revealed that our sample had higher frequencies of hypertension, diabetes and metabolic syndrome. Therefore, we confirmed a high cardiovascular risk in first-episode psychosis in Brazil. Transcultural studies are needed to investigate to which extent lifestyle contributes to such increased risk. (C) 2012 Elsevier Inc. All rights reserved.

Understanding the correlates of adolescents' dietary intake patterns. A multivariate analysis

We investigated dietary intake patterns (DIP) in adolescents (14-18 year-olds) and the association with demographic and socioeconomic characteristics and lifestyle variables. This school-based survey was carried out among high school students from the city of Maringa in the state of Parana (PR), Brazil (2007). The sample included 991 students (54.5% girls) from high schools. DIPs were investigated by the frequency of weekly consumption of each food group: vegetables, fruit, rice, beans, fried food, sweet food, milk, soda, meat, eggs, alcoholic drinks. Independent variables were: demographic and socioeconomic characteristics and lifestyle variables. DIPS were identified using principal component analysis with orthogonal rotation (varimax). Three components were extracted. Component 1 (fried foods, sweets and soft drinks) was positively associated with not having breakfast for girls and dinner for boys. Moreover, component 2 (consumption of fruit and vegetables) was positively associated with having breakfast at home for boys and number of meals for girls. Component 3 (beans, eggs and meat) was positively associated with having lunch, employment and sedentary behavior level for girls. However, it was negatively associated with having lunch and dinner for boys. Adolescents who have healthier eating patterns also had other healthier behaviors regardless of gender. However, factors associated with dietary patterns differ between boys and girls. (C) 2012 Elsevier Ltd. All rights reserved.

Insulin analogues in the treatment of diabetes in pregnancy

Pregnancy affects both maternal and fetal metabolism, and even in non-diabetic women, it exerts a diabetogenic effect. Among pregnant women, 2% to 14% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, which may predispose the fetus to many alterations in organogenesis, restrict growth, and the mother, to some diabetes-related complications, such as retinopathy and nephropathy, or to acceleration of the course of these complications, if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle changes; when these changes are not enough for optimal glycemic control, insulin therapy must then be considered. Women with type 2 diabetes using oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes should start intensive glycemic control. As basal insulin analogues have frequently been used off-label in pregnant women, there is a need to evaluate their safety and efficacy. The aim of this review is to report the use of both short- and long-acting insulin analogues during pregnancy and to enable clinicians, obstetricians, and endocrinologists to choose the best insulin treatment for their patients.

Densidade energética da dieta e fatores associados: como está a população de São Paulo?

OBJETIVO: Avaliar a densidade energética da dieta de adultos do município de São Paulo e fatores associados. SUJEITOS E MÉTODOS: Participantes do estudo ISA-Capital, com amostragem probabilística (n = 710 adultos). O consumo alimentar foi avaliado pelo R24h. As correlações foram investigadas pelo coeficiente de correlação de Pearson. As associações com dados demográficos, socioeconômicos e de estilo de vida foram investigadas por modelos de regressão multivariados. RESULTADOS: A densidade energética média foi 1,98 kcal/g (IC95% [1,94; 2,01]) e correlacionou-se positivamente com a ingestão de energia, gordura, carboidrato, colesterol, gordura saturada, sacarose, gordura trans e açúcar adicionado e negativamente com fibras. Apenas idade e hábito de fumar apresentaram associação com a densidade energética. CONCLUSÕES: Os valores elevados da densidade energética da dieta e a relação demonstrada com outros constituintes nutricionais denotam má qualidade da dieta nessa população, o que pode estar contribuindo para crescentes taxas de excesso de peso. Arq Bras Endocrinol Metab. 2012;56(9):638-45

Valutazione della relazione tra composizione corporea e stili di vita in soggetti di età scolare

Il lavoro svolto in questa tesi si propone di valutare la variabilità della composizione corporea nell’infanzia e nell’adolescenza, con particolare attenzione alla transizione dalla prima alla seconda, in relazione allo stato nutrizionale ed agli stili di vita. Lo studio è stato condotto eseguendo misure antropometriche presso scuole primarie e secondarie di Bologna. Sono stati analizzati inoltre dati acquisiti a partire dal 2004. Il campione analizzato comprende 3546 soggetti di età compresa tra 6 anni e 14 anni. In particolare sono state analizzate le principali misurazioni utili per il calcolo della composizione corporea, evidenziando i parametri antropometrici principali quali BMI, circonferenza vita, WHR, %F e FFM. Questi caratteri sono stati quindi messi in relazione con le informazioni inerenti l’attività sportiva extrascolastica e gli stili di vita dei soggetti esaminati. L’analisi trasversale delle principali caratteristiche antropometriche ha fornito un interessante panorama della situazione italiana e del nord Italia; lo studio longitudinale delle variabili antropometriche permette di ottenere un quadro aggiornato dei principali incrementi delle misure corporee. La valutazione della variabilità della composizione corporea in relazione all’attività sportiva e allo stile di vita durante il processo di accrescimento ha indicato come abitudini sane e propensione all’attività motoria sono sicuramente in grado di apportare miglioramenti nella modificazione della composizione corporea nel processo evolutivo specialmente se somministrate con modalità adeguate all’età e alle esigenze individuali. Questi aspetti sono certamente rilevanti e complessi, sarebbe infatti interessante in prospettiva futura riuscire ad indagare ancora più dettagliatamente sull’interazione tra i fattori che determinano e modificano la composizione corporea in un periodo della vita così particolare come la transizione dall’infanzia all’adolescenza.

Lo spreco alimentare domestico in Italia: stime, cause ed impatti

Non esiste una definizione standard di spreco alimentare, così come non esistono metodologie uniformi per calcolarlo. Gli studi finora realizzati sullo spreco sono carenti, i dati raccolti spesso insufficienti. Il cibo viene sprecato ad ogni stadio della filiera alimentare, dal campo alla tavola. Nei Paesi Membri dell’Unione Europea, le famiglie – secondo dati elaborati da Eurostat- sono le principali responsabili dello spreco. Secondo la FAO, ogni europeo spreca ogni anno 179 chili di alimenti. Last Minute Market, spin off accademico che si occupa di ridurre e recuperare lo spreco, ha stimato che a livello domestico in Italia si sprecano mediamente il 17% dei prodotti ortofrutticoli acquistati, il 15% di pesce, il 28% di pasta e pane, il 29% di uova, il 30% di carne e il 32% di latticini. Da un punto di vista economico, lo sperpero alimentare significa una perdita di 1.693 euro l’anno per famiglia. Per inquadrare lo spreco alimentare domestico in Italia e gettare luce su dati contrastanti emersi da diversi studi finora realizzati, la tesi – dopo aver presentato stime a livello globale, europeo e italiano – si concentra sull’analisi dei dati emersi da un questionario sullo spreco domestico, compilato da 3.087 italiani tra il mese di novembre e quello di dicembre 2012. L’indagine socio-economica è stata realizzata in collaborazione con la Commissione Europea (DG JCR, Istituto per la Tutela della Salute dei Consumatori) e il Karlsruhe Institut für Technologie. Il questionario è stato posto sulla piattaforma online surveymonkey. La tesi ha avuto come obiettivi l’identificazione di dati quantitativi circa “quanto si spreca” , “cosa si spreca”, l’individuazione delle cause sociali, valoriali, comportamentali e di stile di vita, dello spreco alimentare delle famiglie italiane, l’impatto economico dello spreco sul budget domestico e l’elaborazione di profili di consumatori attraverso la cluster analysis.

Metagenomic trajectory of gut microbiome in the human lifespan

Co-evolving with the human host, gut microbiota establishes configurations, which vary under the pressure of inflammation, disease, ageing, diet and lifestyle. In order to describe the multi-stability of the microbiome-host relationship, we studied specific tracts of the bacterial trajectory during the human lifespan and we characterized peculiar deviations from the hypothetical development, caused by disease, using molecular techniques, such as phylogenetic microarray and next-generation sequencing. Firstly, we characterized the enterocyte-associated microbiota in breast-fed infants and adults, describing remarkable differences between the two groups of subjects. Successively, we investigated the impact of atopy on the development of the microbiome in Italian childrens, highlithing conspicuous deviations from the child-type microbiota of the Italian controls. To explore variation in the gut microbiota depending on geographical origins, which reflect different lifestyles, we compared the phylogenetic diversity of the intestinal microbiota of the Hadza hunter-gatherers of Tanzania and Italian adults. Additionally, we characterized the aged-type microbiome, describing the changes occurred in the metabolic potential of the gut microbiota of centenarians with respect to younger individuals, as a part of the pathophysiolology of the ageing process. Finally, we evaluated the impact of a probiotics intervention on the intestinal microbiota of elderly people, showing the repair of some age-related dysbioses. These studies contribute to elucidate several aspects of the intestinal microbiome development during the human lifespan, depicting the microbiota as an extremely plastic entity, capable of being reconfigured in response to different environmental factors and/or stressors of endogenous origin.

La sanità mediata: il rapporto medico-paziente dentro e fuori lo schermo televisivo

L’obiettivo di questa tesi è rilevare se e quanto i medical dramas abbiano contribuito a ridefinire conoscenze, aspettative e pratiche dei telespettatori/pazienti rispetto a questioni concernenti la salute e il loro ruolo all’interno della relazione medico-paziente. Grazie ad un lavoro di campo, fatto di questionari e interviste con utenti, operatori della sanità di Centro e Nord Italia e studenti di Medicina, sono state poi registrate le modalità di interazione che i protagonisti della scena della cura dichiarano di sperimentare quotidianamente. Ciò ha permesso di rendere conto delle trasformazioni più recenti della professione medica e di come viene elaborato oggi il sapere sulla malattia da parte dei soggetti implicati, fra tecnicismi, atteggiamenti difensivi, sfiducia e affidamento. La tesi restituisce anche alcune modalità sperimentali di interazione fra pazienti e medici, messe in atto in contesti locali, che testimoniano l’esigenza di approdare a un sapere partecipato delle relazioni di cura. Infine, raccogliendo la sfida posta dalle medical humanities, immagina un utilizzo del medical drama nella formazione degli studenti di medicina per l’apprendimento di competenze narrative necessarie ad una pratica medica più umana e efficace.

Das Biobankgeheimnis : Schutz der Persönlichkeitsrechte in der biomedizinischen Forschung

Biobanken sind Sammlungen von Körpersubstanzen, die mit umfangreichen gesundheits- und lebensstilbezogenen sowie geneologischen Daten ihrer Spender verknüpft sind. Sie dienen der Erforschung weit verbreiteter Krankheiten. Diese sog. Volkskrankheiten sind multifaktoriell bedingte Krankheiten. Dies bedeutet, dass diese Krankheiten das Ergebnis eines komplizierten Zusammenspiels von umwelt- und verhaltensrelevanten Faktoren mit individuellen genetischen Prädispositionen sind. Forschungen im Bereich von Pharmakogenomik und Pharmakogenetik untersuchen den Einfluss von Genen und Genexpressionen auf die individuelle Wirksamkeit von Medikamenten sowie auf die Entstehung ungewollter Nebenwirkungen und könnten so den Weg zu einer individualisierten Medizin ebnen. Menschliches Material ist ein wichtiger Bestandteil dieser Forschungen und die Nachfrage nach Sammlungen, die Proben mit Daten verknüpfen, steigt. Einerseits sehen Mediziner in Biobanken eine Chance für die Weiterentwicklung der medizinischen Forschung und des Gesundheitswesens. Andererseits lösen Biobanken auch Ängste und Misstrauen aus. Insbesondere wird befürchtet, dass Proben und Daten unkontrolliert verwendet werden und sensible Bereiche des Persönlichkeitsrechts und der persönlichen Identität betroffen sind. Diese Gefahren und Befürchtungen sind nicht neu, sondern bestanden schon in der Vergangenheit bei jeglicher Form der Spende von Körpersubstanzen. Neu ist aber der Umfang an Informationen, der durch die Genanalyse entsteht und den Spender in ganz besonderer Weise betreffen kann. Bei der Speicherung und Nutzung der medizinischen und genetischen Daten ergibt sich somit ein Spannungsfeld insbesondere zwischen dem Recht der betroffenen Datenspender auf informationelle Selbstbestimmung und den Forschungsinteressen der Datennutzer. Im Kern dreht sich die ethisch-rechtliche Bewertung der Biobanken um die Frage, ob diese Forschung zusätzliche Regeln braucht, und falls ja, wie umfassend diese sein müssten. Im Zentrum dieser Diskussion stehen dabei v.a. ethische Fragen im Zusammenhang mit der informierten Einwilligung, dem Datenschutz, der Wiederverwendung von Proben und Daten, der Information der Spender über Forschungsergebnisse und der Nutzungsrechte an den Daten. Ziel dieser Arbeit ist es, vor dem Hintergrund des Verfassungsrechts, insbesondere dem Recht auf informationelle Selbstbestimmung, das Datenschutzrecht im Hinblick auf die Risiken zu untersuchen, die sich aus der Speicherung, Verarbeitung und Kommunikation von persönlichen genetischen Informationen beim Aufbau von Biobanken ergeben. Daraus ergibt sich die weitere Untersuchung, ob und unter welchen Voraussetzungen die sich entgegenstehenden Interessen und Rechte aus verfassungsrechtlichem Blickwinkel in Einklang zu bringen sind. Eine wesentliche Frage lautet, ob die bisherigen rechtlichen Rahmenbedingungen ausreichen, um den Schutz der gespeicherten höchstpersönlichen Daten und zugleich ihre angemessene Nutzung zu gewährleisten. Das Thema ist interdisziplinär im Schnittfeld von Datenschutz, Verfassungsrecht sowie Rechts- und Medizinethik angelegt. Aus dem Inhalt: Naturwissenschaftliche und empirische Grundlagen von Biobanken – Überblick über Biobankprojekte in Europa und im außereuropäischen Ausland – Rechtsgrundlagen für Biobanken - Recht auf informationelle Selbstbestimmung - Recht auf Nichtwissen - Forschungsfreiheit - Qualitätssicherung und Verfahren – informierte Einwilligung – globale Einwilligung - Datenschutzkonzepte - Forschungsgeheimnis –– Biobankgeheimnis - Biobankgesetz

Verlauf und Determinanten der Lebensqualität bei Langzeitüberlebenden nach Prostatakarzinom in Schleswig-Holstein : Ergebnisse einer registerbasierten Kohortenstudie

Durch die ansteigende Inzidenz und niedrige Mortalität steigt die Anzahl der überlebenden Männer nach Prostatakarzinom. Mit einer 5-Jahresprävalenz von 279.000 Männern stellte das Prostatakarzinom im Jahr 2010 den größten Anteil der Krebspatienten. Die absolute 5-Jahres-Überlebensrate liegt bei 78 %. Studien zur Lebensqualität dieser Langzeitüberlebenden (> 5 Jahre nach Diagnosestellung) beschränken sich meist auf bestimmte Therapien, schließen höhere Tumorstadien aus oder untersuchen nur die Wirkung von klinischen Einflussfaktoren. In Schleswig-Holstein wurde im Rahmen der populationsbezogenen OVIS- und CAESAR-Studie die Lebensqualität bei Männern mit bzw. nach Prostatakrebs zu drei Zeitpunkten erhoben (15 Monate, 3 ½ und 7 Jahre nach initialer Diagnose). Für die allgemeine krebsspezifische Lebensqualität (EORTC QLQ-C30) erfolgt eine Beschreibung des Verlaufs sowie ein Vergleich mit Referenzdaten aus der deutschen Allgemeinbevölkerung. Aus der dritten Befragung liegen auch Daten zur prostataspezifischen Lebensqualität (EORTC QLQ-PR25) vor. Mittels multipler linearer Regressionen werden für elf ausgewählte Lebensqualitätsskalen (mögliche Werte 0 bis 100) potenzielle Einflussfaktoren (klinisch, soziodemographisch, Lifestyle) untersucht. Die Lebensqualität der 911 Männer (medianes Alter bei Drittbefragung: 72 Jahre) nimmt im zeitlichen Verlauf nur gering, aber nicht klinisch relevant ab. Es zeigen sich nur geringe Unterschiede zur Lebensqualität der Referenzbevölkerung. Im absoluten Vergleich aller Skalen werden zum Zeitpunkt der Drittbefragung auf den prostataspezifischen Skalen die größten Einschränkungen berichtet. In den berechneten multiplen Regressionen war sieben Jahre nach Diagnose eine Krankheitsprogression auf allen untersuchten Skalen signifikant mit einer geringeren Lebensqualität assoziiert (niedrigster Regressionskoeffizient βadj -13,8, 95 %-CI -18,8; -8,8). Eine Strahlentherapie zeigte auf zehn, eine Hormontherapie auf fünf Skalen einen negativen Einfluss. Ebenfalls auf fünf Skalen war ein höherer Body-Mass-Index ein Prädiktor für eine geringere Lebensqualität. Auf allen Funktionsskalen war ein höherer Sozialstatus mit einer besseren Lebensqualität assoziiert und zeigte tendenziell einen größeren Einfluss als die initiale Therapie. Alleinstehende Männer berichteten eine geringere sexuelle Aktivität (βadj -7,5, 95 %-CI -13,8; -1,2) als Männer in einer Partnerschaft. Neben klinischen Faktoren beeinflussen auch soziodemographische Variablen die Lebensqualität von langzeitüberlebenden Männern nach bzw. mit Prostatakarzinom signifikant. Daher sollten in nicht-randomisierten Studien zum Adjustieren die entsprechenden Variablen (wie z. B. Body-Mass-Index, Sozialstatus, Partnerschaft) mit erhoben werden. Klinisch relevante Veränderungen der allgemeinen krebsspezifischen Lebensqualität finden – wenn überhaupt – innerhalb der ersten 15 Monate nach Diagnosestellung statt. Referenzdaten für die prostataspezifische Lebensqualität der Allgemeinbevölkerung liegen nicht vor. Eine Erhebung dieser scheint sinnvoll, da hier größere Unterschiede im Vergleich beider Gruppen erwartet werden.