Evuloção cognitiva e funcional de pacientes pós-acidente vascular cerebral - AVC

PURPOSE: Stroke is a high-incidence cerebrovascular disease with elevated morbidity that results in impairments such as functional disabilities. This study aimed to investigate the functional evolution of individuals in the first six months post-stroke. METHOD: Longitudinal study with 42 stroke patients. The functional independence measure (FIM) and The National Institutes of Health Stroke Scale (NIHSS) were used by multidisciplinary staff 3 times in each participant; the first application was at admission to rehabilitation and the others three and six months later. RESULTS: Sample predominantly female (57%), married (52%), mean age 65.26 ±10.72 years, elementary schooling level (43%), ischemic stroke (91%), and right cerebral hemisphere (74%). Motor FIM scores and NIHSS scale showed improvement in the 3 evaluations, with significant p-value (<0.001). There was a strong relation between motor FIM evolution and NIHSS evolution (r = - 0.69 p-value< 0.001). CONCLUSIONS: It was observed that functional evolution at 6 months post-stroke was significant and the smaller the evolution of clinical impairment in these patients, the larger the evolution of their functional independence. The study is important because it allows a more appropriate therapeutic planning according with functional evolution in stroke rehabilitation

Intervenção dietoterápica em portadores de lipodistrofia generalizada congênita do Rio Grande do Norte

Congenital generalized lipodystrophy is a rare genetic disease with autosomal recessive inheritance characterized by the generalized absence of subcutaneous adipose tissue and insulin resistance. The aim of our study was to determine the profile of patients with congenital generalized lipodystrophy (Berardinelli-Seip syndrome) through their clinical history, eating habits, and socioeconomic and cultural aspects; assess food consumption and nutritional status of the study group; propose and evaluate a diet therapy model associated to oral supplementation with zinc to help in the control and prevention of metabolic complications associated to the pathology. Initial assessment of food consumption indicated a voracious appetite in all the patients studied. The introduction of zinc reduced appetite, contributing to patient adherence to the food plan proposed. It was also observed that the proposed diet contributed mainly to glycidic control, specifically with respect to HbA1c. The nutritional status of the patients investigated was adequate in terms of body mass index (BMI), arm muscle circumference (AMC), arm muscle area AMA, but triceps skinfold (TSF) indicated serious malnutrition. Our study is unique in the literature and provides important information to the field of nutrition and to individuals with this pathology. Furthermore, it contemplates the interdisciplinary and multidisciplinary requirements of the Postgraduate Program in Health Sciences of the Federal University of Rio Grande do Norte (UFRN), Natal, Brazil

Aspectos clínicos e imunológicos da infecção por Leishmania Infantum Chagasi em cães do Rio Grande do Norte / Paula Vivianne Souza de Queiroz. Natal/RN

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Avaliação do conhecimento e de habilidades clínicas em saúde sexual e reprodutiva na graduação de medicina

No Brasil, a despeito das conquistas obtidas a partir da implantação do Sistema Único de Saúde e dos avanços legais e institucionais na atenção a diversos problemas relacionados ao gênero, a incorporação de temas relacionados aos direitos humanos, sexuais e reprodutivos no contexto da formação profissional em saúde permanece deficiente. Este trabalho teve como objetivos avaliar a inserção da temática saúde sexual e reprodutiva no currículo do curso de graduação em Medicina, por meio do emprego de avaliações de conteúdo cognitivo, procedimental e atitudinal. Trata-se de estudo de intervenção educacional envolvendo alunos do internato do curso de Medicina da UFRN. Foram utilizados os seguintes métodos avaliativos: prova escrita, exame clínico objetivo estruturado (OSCE) e Mini-CEX. Como variáveis explicativas foram consideradas o sexo, idade e participação prévia no componente curricular optativo Saúde Reprodutiva . A avaliação do processo constou da aplicação de questionários de satisfação e entrevistas acerca dos métodos avaliativos utilizados. Considerando os três métodos avaliativos empregados, 183 estudantes participaram do estudo, com média de idade de 24,5 ± 2,2 anos, sendo 52,5% do sexo masculino e 47,5% do sexo feminino. No contexto geral, observamos concordância entre os desempenhos dos estudantes nas avaliações de conteúdo cognitivo, procedimental e atitudinal. A participação dos estudantes no componente curricular eletivo Saúde Reprodutiva mostrou-se associada com melhor desempenho em algumas dimensões da avaliação cognitiva e na avaliação com o Mini-CEX, em relação às competências de anamnese, profissionalismo e qualidades humanísticas, relação médico paciente e desempenho global. A análise da fidedignidade entre os avaliadores na avaliação com o método OSCE mostrou-se adequada (alfa de Cronbach superior a 70%) em relação ao desempenho global e aos aspectos técnicos das competências avaliadas, observando-se baixa confiabilidade na avaliação da comunicação médico-paciente. O presente trabalho constitui-se numa experiência educacional inovadora e pioneira no âmbito da educação médica brasileira no que tange à inserção da temática de saúde sexual e reprodutiva na graduação, sugerindo-se um impacto positivo da iniciativa na formação do médico generalista na UFRN. A avaliação de conhecimentos, habilidades e atitudes em saúde sexual e reprodutiva na graduação de Medicina mostrou-se factível, com alta concordância entre os diferentes métodos empregados. Os métodos OSCE e Mini-CEX podem ser aplicados ao contexto da saúde sexual e reprodutiva, possibilitando a avaliação de competências clínicas relevantes para a formação do médico generalista e que habitualmente não são contempladas nas avaliações rotineiramente realizadas na graduação

Aspectos ambientais e sociais envolvidos na transmissão da L. chagasi no município de Parnamirim/RN

Visceral leishmaniasis hás adapted in the past 20 years to periurban and urban areas, and in Natal, Rio Grande do Norte, it became endemic. Thid study aimed to evaluate the environmental and social aspectsof Leishmania chagasi infection and its epidemiologic transmission chain in an urban, periurban and rural area of Parnamirim-RN. A study with three sections was conducted: Section 1: Sectional study of the human and canine infection by L. chagasi and its environmental and social determinants. Section 2: Observational longitudinal cohort to evaluate the dynamics of the canine infection. Section 3: Longitudinal study to evaluate the behavior of Lu. Longipalpis vector and the seasonal factors related to its dynamics. To include in the study the hauses were randomly selected and georreferenciated. Montenegro skin test was done in the human population and blood samples were collected for anti-Leishmania antibody detection. The canine population was examinated for L. chagasi infection by RIFI, ELISA and ELISA for rK39. An entomologic surveillance was monthly done with CDC light trapsin 10 houses of each locality. Quantitative and qualitative analyses was done using STATISC 6.0. Probality and prediction maps were done using ArcGis 9.0 model. In the human population L. chagasi infection was associated with the area of the hause, age, sex, population densyti, vegetation, kind of the floor of thr hause, water and resides destiny. In the canine population L. chagasi infection was associated with the breed, size, time of living in the hause, presence of dogs in the neighborhood, presence of horses and donkeys in the neighborhood, vegetation, kind of the floor and walls of the hause. The human infection was associated with canine infction only when analyzed taking into account the locality. In the prospective study, serum conversion and antibody lost observed in 30,8% and 22% of the animals examined, respectively. The human infection rate by L. chagasi was 24,6%, by the presence of anti-Leishmania antibody and 38,6% by the Montenegro skin test. The canine infection rate 32,5% by the presence of anti-Leishmania antibody. The vector Lu longipalpis showed an atypical behavior. These results indicate that environmental and social factors are important variables associated with L. chagasi infection in humans and canines, with punctual association of thr last two. Control measures of the infection on the studied points are necessary, in the aim to reduce the endemic focus of the disease in the study area. This research was carried out in a multidisciplinary involving the categories of: doctor, biologist, veterinarian, statistical, pharmaceutical and biochemical

Aspectos socioeconômicos e demográficos relacionados ao estresse e a síndrome de Burnout em fisioterapeutas no Brasil

Dos problemas de saúde existentes no ambiente de trabalho, 18% afetam o aparelho psíquico, a exemplo do estresse, atingindo cerca de 30% dos trabalhadores em geral. A persistência e intensidade do estresse, associada às sucessivas tentativas de lidar com os mesmos, tornam os indivíduos vulneráveis ao surgimento da Síndrome deBurnout. O objetivo deste trabalho foi identificar a relação dos aspectos socioeconômicos e demográficos com o estresse e a Síndrome de Burnout em fisioterapeutas do Brasil. Para isso, este estudo teve uma abordagem do tipo transversal, com 1040 fisioterapeutas do Brasil, através de uma amostragem do tipo snowbolle não probabilística. Utilizou-se um questionário socioeconômico, demográfico e profissional, a Escala de Estresse no Trabalho (EET) e a adaptação do Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo (CESQT). Na análise dos dados, foram utilizadas a estatística descritiva e inferencial. Dentre os principais resultados obtidos, percebeu-se uma maior representatividade da região Nordeste (48,7%), com idade média de 31anos, sexo feminino (75,7%), carga horária semanal de 35,4 horas, com 3-5 anos de atuação profissional. Observou-se que 37,0% apresentavam estresse relacionado estatisticamente com a idade (p=0,008),atividade física (p=0,039) e satisfação com a saúde (r=-0,322; p<0,001). Não foi observado nenhum caso de Burnout, porém houve uma média elevada nas dimensões, desgaste psíquico, indolência e culpa, totalizando 49,0% comtendência ao desenvolvimento da síndrome. Portanto, as variáveis, idade, prática da atividade física e satisfação com a saúde obtiveramrelação com o estresse. Para o Burnout, destacaram-se a região de moradia (centro-oeste), satisfação com a saúde, local de trabalho (clínicas e hospitais), além do maior número de locais de trabalho. Diante desse contexto, os estudos sobre o estresse e a Síndrome de Burnout se apresentam como elementos derelevância dentro do contexto da prevenção dos riscos laborais e da análise das condições de trabalho

Influência dos aspectos clínicos e assistenciais na qualidade de vida das pessoas com doença venosa crônica com e sem úlcera venosa

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Abordagem dos aspectos psicológicos da mulher infértil :um estudo quali-quantitativo

Purpose: assess the frequency of stress and anxiety levels in infertile women, correlate these aspects with risk factors and qualitatively analyze feelings resultant from the inability to conceive, in order to obtain data for specific psychological guidance. Methods: the case-control study included a total of 302 women, 152 being infertile (case group: 30.3 ± 5.4 years), and 150 non-fertile (control group: 25.7 ± 7.9 years). The quantitative approach involved the application of Lipp s Stress Symptoms Inventory (LSSI) and State-Trait Anxiety Inventory (STAI), whereas the qualitative approach consisted of a semi-structured interview. Response variables considered were: stress frequency and anxiety scores (State and Trait). Statistical analysis compared frequencies and medians between groups, by means of qui-squared and Mann-Whitney tests, respectively, and constructed logistical regression models to test associations between response variables and risk factors considered. Qualitative data were analyzed descriptively and categorized in order to perform correspondence analysis. The level of significance was 5%. Results: in the study sample, stress frequency was higher in the case group than in the control(61.8 and 36.0%, respectively), however, significant differences were not observed between groups in relation to stress phases and predominant symptomology type. With respect to anxiety, there were no significant differences between case and control groups as to median state scores [39.5 (35.0 46.0) and 41.0 (35.7 47.0 ); respectively) and anxiety trait scores [44.0 (34.0 51.0) and 42.0 (36.0 49.2); respectively). Risk factors significantly associated with greater risk for high anxiety scores in the case group were: primary infertility, unawareness of the causal factor, diagnostic phase investigation, religion, lack of children from other marriages and the fact that the woman was previously married. The qualitative approach demonstrated that infertility provokes emotional responses, such as sadness, anxiety, anger, fear and guilt. Conclusions: it can be concluded that infertile women are more vulnerable to stress; however, they are capable of adapting to stressful events without serious physical or psychological compromising

FERRITINA: intervalos de referência para adultos no Estado do Rio Grande do Norte

Ferritin is a protein composed of heavy and light chains, non-covalently linked and which accommodates, in its core, thousands of atoms of iron. Furthermore, this protein represents the stock of iron in the body and it is characterized as an acute marker and predictor of diseases, such as iron deficiency anemia, hereditary hemochromatosis and others. Considering the variability of reference values and the analytical methods currently available, the aim of this work was to propose 95% confidence intervals for adults in the State of Rio Grande do Norte, Brazil, after determining the average concentration of serum ferritin for both sexes, beyond its correlation with the age. We analyzed 385 blood samples, collected by venipuncture from individuals residing in the State, after 12-14 hours of fast. The populational sample had 169 men and 216 women between 18-59 years old, which filled a questionnaire on socioeconomic, food habits and accounts about previous and current diseases. The sample collections were itinerant and the results of erythrogram, fasting glucose, alanine aminotransferase, aspartate aminotransferase, &#947;-glutamyl transferase, urea, creatinine, leukocyte count and platelets, beyond C-reactive protein, were issued to each participant, so that, after selection of the apparently healthy individuals, the dosage of serum ferritin was carried out. Statistical analysis was performed using the softwares SPSS 11.0 Windows version, Epi Info 3.3.2 and Graf instant pad (version 3.02), and the random population sample was single (finite population), for which the test of linear correlation and diagram of dispersion were also made. After selection of individuals and determination of serum ferritin, the most discrepant outliers were disregarded (N = 358, Men = 154/Women = 207) and the average value determined for the masculine sex individuals was 167,18 ng / dL; for the feminine sex individuals, the average value obtained was 81,55 ng / dL. Moreover, we found that 25% of men had values < 90,30 ng / dL; 50% &#8804; 156,25 ng / dL and 75% &#8804; 229,00 ng / dL. In the group of women, 25% had values < 38,80 ng / dL; 50% &#8804; 65,00 ng / dL and 75% &#8804; 119,00 ng / dL. Through the correlation coefficient (r = 0,23 with p = 0,003), it is possible to suggest the existence of positive linear correlation between age and serum ferritin for men. The correlation coefficient for women (r = 0,16 with p = 0,025) also confirms the existence of positive linear correlation between serum ferritin and age. Considering the analysis carried out and specific methods corroborating with the proposed benchmarks, we concluded that the average value found for men is higher than that found for women. Furthermore, this scenario rises with age for both sexes, and the 95% confidence intervals obtained were 74 ng/dL &#8804; &#956; &#8804; 89 ng/dL and 152ng/dL &#8804; &#956; &#8804;183ng/dL for the feminine and masculine sex individuals respectively

Aspectos de patogenicidade e relacionamento genético de isolados clínicos vaginas e anais de Candida albicans oriundos de pacientes com candidíase vulvovaginal

Vulvovaginal candidiasis (VVC) is one of the most common causes of vaginitis and affects about 75% of women of reproductive age. The majority of cases (80 to 90%) are due to C. albicans, the most virulent species of the genus Candida. Virulence attributes are scarcely investigated and the source of infection remains uncertain. Objective: This study aimed to evaluate the virulence factors and genotypes of clinical isolates of C. albicans sequentially obtained from the anus and vagina of patients with sporadic and recurrent VVC. Materials and methods: We analyzed 62 clinical isolates of C. albicans (36 vaginal and 26 anal strains). Direct examination of vaginal and anal samples and colony forming units (CFU) counts were performed. Yeasts were identified using the chromogenic media CHROMagar Candida® and by classical methodology, and phenotypically characterized regarding to virulence factors, including the ability to adhere to epithelial cells, proteinase activity, morphogenesis and biofilm formation. The genotypes of the strains were investigated with ABC genotyping, microsatellite genotyping with primer M13 and RAPD. Results: We found 100% agreement between direct examination and culture of vaginal samples. Filamentous forms were present in most of the samples of vaginal secretion, which presented CFU counts significantly higher than the samples of anal secretion. There was no statistically significant difference between virulence factors of infecting vaginal isolates and those presented by colonizing anal isolates; as well as for the comparison of the vaginal isolates from patients with different clinical conditions (sporadic or recurrent VVC). There was a decrease in the ability to adhere to HBEC, morphogenesis and biofilm formation of the vaginal isolates during the progress of infection. There was an association between the ability to express different virulence factors and the clinical manifestations presented by the patients. Genotype A was the most prevalent (93.6%), followed by genotype C (6.4%). We found maintenance of the same ABC genotype and greater prevalence of microevolution for the vaginal strains of C. albicans sequentially obtained. Vaginal and anal isolates of C. albicans obtained simultaneously from the same patient presented the same ABC genotype and high genetic relatedness. Conclusion: It is noteworthy that the proliferation of yeast and bud-to-hypha transition are important for the establishment of CVV. The expression of virulence factors is important for the pathogenesis of VVC, although it does not seem to be determinant in the transition from colonization to infection or to the installation of recurrent condition. Genotype A seems to be dominant over the others in both vaginal and anal isolates of patients with VVC. The most common scenario was microevolution of the strains of C. albicans in the vaginal environment. It is suggested that the anal reservoir constituted a possible source of vaginal infection, in most cases assessed

Do lixo à solidariedade : avanços e perspectivas na busca de uma nova realidade

The dissertating study about the solidarity economy has the objective to analyze the four unions responsible for the selective municipal garbage collection in Natal. It aims at verifying the consolidation of these unions as solidarity economic undertakings, revealing which progresses they have made, as well as the social and economic insertion of the garbage collectors and their process of conquering citizenship. The referred four unions had been founded and are constituted, in their majority, by collectors coming from the Cidade Nova lixão (big garbage). As it was closed in August 2004, they decided to make a union in order to collecting garbage. As what concerns the methodic and theoretic proceedings, our research has been developed with a critical perspective and a qualitative approach without discarding and quantitative one. The central analytical categories of this paper are: association, work, social exclusion and citizenship. Our research has had three articulated axis which aim was to apprehend the subject, disclosing it. The exposition of the investigative results is subdivided in four chapters. The first one approaches the main aspects of the crisis of the capital and its reflexes in the world of work. Here we deal with the question the structural unemployment coming as a result of the present economic model, the mains changes verified in the Brazilian work market, as well as levels of unemployment affecting the work market in Natal s metropolitan region. The second chapter treats of the origin, concept and revival in Brazil concerning the tradition of thought and cooperative economic organization, which has recovered the central elements of the associative thought and is nowadays studied in Latin America under the name of solidarity economy. The third chapter deals with embodiment of the collectors unions, its history, appearing and development of each union. The fourth chapter presents the relative dimensions of the analysis categories supported in the reports of institutional actors as well as the perception collectors have about the recyclable stuffs, the way they face the daily life and so on, what brings about the contradictions present in their reality. The final comments sum up the main trends and particularities of the unions researched under the light of the solidarity economy and disclose the real perspectives of social and economic insertion of these collectors and the process they follow to conquest social recognition

Histórias e relatos sobre Pipa: a praia internacional do Rio Grande do Norte

The overwhelming gear that boosted tourism as the main economic activity of Pipa a district formerly agricultural and fishery, that belongs to the municipality of Tibau do Sul/RN produced significant changes in the social, economic and cultural rights of the native population of the place where social relations were narrow and justified in some cases, the line of kinship in an environment where all residents knew each other. However, we can not observe the emergence of this activity just as voracious disarticulator of old local forms of sociability that in a linear process, destroys the old, replacing it with the new. New compositions are generated by merging elements of past and present. Overcoming opposition to simplistic positive or negative impacts of tourism sought especially in this dissertation, review the history of Pipa (told in narrative form), showing how slowly this district has become a major international tourist destination and how its residents were being swallowed by the "whirlwind" that led to this reality. The research used qualitative methodology and was based on photographic, literature and survey, observation, experience, oral and written reports acquired in the field. We conducted in-depth interviews (oral history) with subjects that are the living memory of the place local residents (mostly natives). We found that before the process of "modernization" resulting from the pressure of globalization itself and the capital investment in tourism resulting from the native population is not passive. On the contrary, natives resist, creating mechanisms of material and symbolic reformulations. The present moment is always dynamic. Because of that, the identity of a place is not the crystallization of its past. Many landscapes still reveal materialities of yesteryear, such as registration of social practices in the construction of the place

Responsabilidade social empresarial: percepções e práticas do empresariado salineiro do Rio Grande do Norte.

The debate around the thematic of Corporate Social Responsibility - CSR involves economic, social, cultural and symbolic aspects in the relations established between company and society. In Brazilian reality, the CSR, understood as enterprise actions, external and/or internal, that contributes to social and ambient improvement, gains greater visibility in 1990 decade. Although the significant increase of theoretical productions about CSR pertinent elements, it is still scarce the studies that treats about the relation company/society in the northeastern reality, and singularly, in Rio Grande do Norte. It was in this perspective, that, in being the salt industry one of most important in the potiguar economic history formation , the present work investigated practicies and perceptions of salt entrepreneurship about CSR. Considering all the Rio Grande do Norte salt industry history phases, since the period of the Brazil s settling, as well as the characteristics of the study object, was opted to the qualitative research, objectified in interviews half-structuralized realized with the salt segment entrepreneurs, as well as professionals of ambient management and human resources working in potiguar salt segment. The research main results indicated a coexistence between the mechanisms of management seated on personal and paternalists relations, typical of traditional salt industry, and the emergency of innovative elements typical of the modern management, like the CSR. In this context, a tension between continuity and rupture with the traditional mechanisms of management in salt entrepreneurship actions

Alguns aspectos sobre o processo da democratização dos sistemas políticos no mundo árabe :Egito e Líbano como modelos de estudo

The World has tried diverse democratic waves at distinct moments. Some nations have adopted the idea of the democracy for years; others have not yet and other ones are still in a slow process of transition. The field of studies on the Arabian political systems has testified since the last quarter of 20th century a notorious development. This advance disclosed in the existence of a set of trends that has turned around a number of concepts and main theoretical frames such as the political pluralism and the democratic transition and the civil society and its relation with the State. The speech on the process of democratic transition consists in part in the capture and the analysis of the role of the forces and the organizations of the civil society in this process. The peculiarities of the Arab World excite questions concerning the establishment of one governmental system in this universe in the mold of that one that develops with hegemony in the Occident, which has become an interesting field of inquiries for the Political Science. This study comprises the analysis of some aspects of the political situation in the Arab World towards the process of democratization in which Egypt and Lebanon are models of study. Thus the theoretical basis of the term democracy is introduced, presenting different considerations about this expression, since the sprouting of the term until its current conception; later the civil society is analyzed as well as the systems of the political parties and the electoral systems of both countries in attempt to identify the level of democratization existing there and also to find the possible ways to magnify the democratic horizons

Rodando a bolsinha: dinheiro e relações de prostituição

In this work a series of discussions is made on the relationship between money and prostitution in a way of overcoming its merely economic aspects, in the perception of both being social, cultural and historical phenomena, and taking them as symbols, whose study aids to unveil the reality. In this context it is looked for revealing its forms and contents to make it possible to understand them beyond the rationality, calculability and mathematical elements presents in them; beyond apparentness, taking them in their complexity. The discussions encompass theoretical elements, based especially on Georg Simmel s theoretical analyses, allied to a specific empirical frame that regards the life experience of the women of Praia do Meio, pedaço of the city of Natal-RN-Brazil, where the data were collected from. Fundamentally, prostitution is perceived as an exchange activity, which is not depleted in the economic elements, but, contrarily, starts on them and surpasses them in diverse aspects. It deals about a money-mediated relationship between human beings that possesses in itself a full complexity, which demands an accurate and keen attention to be comprehended. Since money has transformed the world and the men and women in it, the discussions in the text are conducted in a direction to attempt to encircle and understand the relationship between money and prostitution. Prostitution, in turn, aids to understand such a transformation as it is also a symbol of our times and it makes us to face the true essence of our society: the transformation of human beings into merchandise, into negotiable objects. In the money-based society it is possible to picture the phenomenon of double prostitution: negotiation of the human being, through labor, and negotiation of sex, the last being dramatically stigmatized and the former strongly encouraged. This may be demonstrating that the paid sex is, in the money-ruled society, a limit of commercialization, widely accepted provided it is camouflaged and surrounded by an aura of sensuality and legitimacy