Objetivos dos sistemas de atenção à saúde

Este material compõe o Curso de Especialização em Nefrologia Multidisciplinar (Módulo 4, Unidade 3), produzido pela UNA-SUS/UFMA. Trata-se de um recurso educacional interativo que apresenta os objetivos dos sistemas de atenção à saúde, definidos pela Organização Mundial da Saúde (OMS), com o objetivo de promover, restaurar e manter a saúde da população.

Desmoid tumor in patients with familial adenomatous polyposis

CONTEXT: Desmoid tumors constitute one of the most important extraintestinal manifestations of familial adenomatous polyposis. The development of desmoids is responsible for increasing morbidity and mortality rates in cases of familial adenomatous polyposis. OBJECTIVES: To evaluate the occurrence of desmoid tumors in familial adenomatous polyposis cases following prophylactic colectomy and to present patient outcome. METHODS: Between 1984 and 2008, 68 patients underwent colectomy for familial adenomatous polyposis at the School of Medical Sciences Teaching Hospital, University of Campinas, SP, Brazil. Desmoid tumors were found in nine (13.2%) of these patients, who were studied retrospectively by consulting their medical charts with respect to clinical and surgical data. RESULTS: Of nine patients, seven (77.8%) were submitted to laparotomy for tumor resection. Median age at the time of surgery was 33.9 years (range 22-51 years). Desmoid tumors were found in the abdominal wall in 3/9 cases (33.3%) and in an intra-abdominal site in the remaining six cases (66.7%). Median time elapsed between ileal pouch-anal anastomosis and diagnosis of desmoid tumor was 37.5 months (range 14-60 months), while the median time between colectomy with ileorectal anastomosis and diagnosis was 63.7 months (range 25-116 months). In 6/9 (66.7%) patients with desmoid tumors, the disease was either under control or there was no evidence of tumor recurrence at a follow-up visit made a mean of 63.1 months later (range 12-240 months). CONCLUSIONS: Desmoid tumors were found in 13.2% of cases of familial adenomatous polyposis following colectomy; therefore, familial adenomatous polyposis patients should be followed-up and surveillance should include abdominal examination to detect signs and symptoms. Treatment options include surgery and clinical management with antiestrogens, antiinflammatory drugs or chemotherapy.

Questionário de qualidade de vida na epilepsia: resultados preliminares

Seizures happen for brief periods of time, but the feelings of anxiety and helplessness, adaptation to the restrictions impose by the life-style and variety of other problems affect more the quality of life in epilepsy. This study proposes a protocol that regards the objectives of a quality of life assessment in health and is applied to a population that attends a university hospital. It contains 65 items and assesses the psychosocial performance, physical limitation, cognitive aspects, perception of control, self-concept, as well as perception of health and quality of life. The results of reliability and validity are discussed.

Amostragem e variabilidade espacial de atributos químicos do solo em área de vegetação natural em regeneração

The objectives of this work was to estimate the number of soil subsamples considering the classical statistics and geostatistics and determine the spatial variability of soil fertility attributes of an Ultisol, with clay texture, in an area of regenerating natural vegetation in Alegre - ES. Soil samples were collected in a depth of 0.0-0.2 m, at the crossing points of a regular grid, comprising a total of 64 points located at 10 m-intervals. The area presented low fertility soil. Considering a variation of 5% around the mean in the classic statistics, it is necessary a larger number of samples in relation to geostatistics. All the chemical attributes showed moderate to high spatial dependence, except for the effective cation exchange capacity (CECe), which showed pure nugget effect. The spherical semivariogram model gave the best fit to the data. Isoline maps allowed visualizing the differentiated spatial distribution of the contents of soil chemical attributes.

Variação na cobertura vegetal nativa em São Paulo: um panorama do conhecimento atual

Studies in several countries have shown the occurrence of forest transition, when forest cover increase overcomes the loss by deforestation. In Brazil, although deforestation is still higher than afforestation, this relationship may be inverse in some regions. Recent assessments suggest the tendency of the state of São Paulo towards forest transition. Aiming to analyze forest transition evidence and facilitate the use of existing information, we review data on native vegetation cover variation in São Paulo from four data sources (Instituto Florestal, SOS MataAtlântica/INPE, IBGE and CATI/IEA). Our results indicate that discrepancies among these assessments may be accounted by differences in methodologies and objectives. We highlight their common grounds and discuss possibilities to harmonize their information.

Gases e ruídos em edificações para suínos: aplicação das normas NR-15, CIGR e ACGIH

Swine production represents an important segment of Brazilian economy, and the possibility of increasing production is eminent mainly if considered the low pork consumption when compared to other meat and the consumption of other countries. The increasing need in the international market demands show that in a near future the commercial barriers will be based on welfare, in the protection of the environment as well as in the worker's legislation. Little knowledge is available in the subject of worker's standards in the environmental agents in rural activities as well as the air quality under Brazilian conditions. The objectives of this research were to apply the main used standards related to noise and gases and to estimate occupational risk using measurements of noise level, hydrogen sulfide, methane and oxygen in swine housing, in piglet's nursery and finishing. The results showed that the continuous noise level were below the one found in the standards, however there were observed differences (P < 0.05) in relation to the noise level measured in piglet's nursing cages and in semi-slatted floor. The respective concentrations of hydrogen sulfide and methane were less than 1 ppm and less than 0,1% by volume, which was lower than the recommended limits in NR-15, CIGR and ACGIH. The oxygen level was 21% in average.

Factors associated with low life life satisfaction in community-dwelling elderly: FIBRA Study

The objectives were to identify factors associated with decreased life satisfaction in community-dwelling elderly and describe such factors according to gender and age bracket. The study interviewed 2,472 elderly individuals 65 years or older without cognitive deficits suggestive of dementia, in probabilistic samples from seven Brazilian cities. All measures were self-reported except for functional performance, indicated by handgrip and gait speed. Women had more chronic diseases, worse functional performance, and greater social involvement when compared to men. The oldest participants showed worse functional performance and less social involvement when compared to the youngest. Low satisfaction was associated with three or more diseases, memory problems, low social involvement, low handgrip strength, and urinary incontinence. The authors conclude that health, functional performance, and social involvement interact with well-being, so interventions targeting these areas can favor quality of life for the elderly.

Ontogenia e estrutura do pericarpo de Prestonia riedelii (Müll. Arg.) Markgr. (Apocynaceae)

The aim of this work was to describe the morphology and ontogeny of P. riedelii fruits to aid in taxonomic, ecological and phylogenetic studies in Apocynaceae. Fruits were fixed in FAA, embedded in plastic resin, sectioned at 10 ìm and stained with toluidine blue, for structural analysis. The fruit of P. riedelii is a follicarium, with two follicular fruitlets. The epicarp is one-cell-layered, with trichomes and thick cuticle. The mesocarp, originating from fundamental ovary tissue, is parenchymatous with laticifers, non-lignified fibers and vascular bundles. The endocarp sensu lato is two-celllayered of crossed sclereids, originating from the inner ovary epidermis and from a single layer of parenchyma cells of fundamental ovary tissue. Follicle dehiscence is lateral and the dehiscence process involves anatomical characteristics such as a dehiscence zone with thin-walled cells, non-lignified fibers in the mesocarp and crossed sclereids in the endocarp.

A construção de uma escala de estratégias de aprendizagem para alunos do ensino fundamental

Although learning strategies are important tools for schooling process, there is a lack of national instruments to evaluate their knowledge by brazilian students. Therefore, the objectives of this paper are to describe the steps necessary for the construction of a scale to evaluate the learning strategies for basic education students and to present the preliminary study of its psychometric properties. It is also discussed the utility of this instrument for diagnosis, intervention and prevention in school and educational psychology.

Estratégias de aprendizagem e desempenho acadêmico: evidências de validade

The purpose of the present study was to verify the factorial validity of a learning strategy scale as well as to explore the concurrent validity of the instrument in regard to students´ academic achievement. The sample was composed of 815 basic education children from both public and private schools of São Paulo and Minas Gerais. The Learning Strategy Scale was collectively applied. Exploratory factorial analyses were conducted to achieve the purposes of the study. The alphas of Cronbach of the instrument and of its three subscales showed good reliability. Variance analyses showed significant differences between school achievement and punctuation in the scale. The data were discussed in terms of their possible implications for the psycho-educational evaluation area.

Sistema Nacional de Educação articulado ao Plano Nacional de Educação

This text which discusses the central theme of the National Conference on Education (CONAE), held in Brasília from 28th March to 1st April 2010, deals with the concept of a National System of Education in articulation with the National Plan of Education. To that end, after pointing to the basic uses of the concept of system, it discusses the question of the National System of Education exploring the federative question in order to reveal the complete compatibility of the organization of the National System of Education with the federative regime. Thereafter, it deals with the historical meaning of the National Plan of Education demonstrating that the plan is a demand of the system, since planned action is implicit in systematized education. Thus the National Plan of Education is fulfilling those goals and objectives for which it is responsible.

Escola, democracia e a construção de personalidades morais

This article intends to discuss the relationship between morality, democracy and education within the perspective of the complex thinking, pointing to paths and proposals for its effective implementation in the educational routine, under the conviction that this is an imperative of the new social demands presented to the contemporary schooling. Understanding that one of the purposes of education is the ethical development, the author proposes intentional actions such that through them the school practices can offer to the subjects of education the necessary tools to build their cognitive, affective, cultural, and organic competence, thereby enabling them to act morally in the world. To that effect, seven aspects of school reality that hamper or contribute to school democratization are identified and discussed, which must be understood from the paradigm of complexity: school contents, classroom methodology, the nature of interpersonal relationships, the values, self-esteem and self-knowledge of the school community, as well as the school management processes.

A moradia estudantil universitária como tema na produção científica nacional

This study analyses the national scientific production about college students' residence halls. The country's main data bases and electronic sites of several Brazilian higher education institutions were checked and 23 studies, published between 2000 and 2009, were found. The results of our analysis point to different focuses, which can be grouped into three categories: students who live in residence halls, residence halls themselves and actions for student assistance. Although there is large foreign scientific production about college student housing, the national production on this theme is still scarce, and the idea of student residence halls as educational spaces is still very incipient. The study points out to the need for investigating the living conditions in these places, and the impacts of this kind of habitation on students. Considering that student housing is an institutional responsibility, these studies potentially subsidize measures for proper educational conditions for college students.

Comparative analysis of adverse events between infliximab and adalimumab in Crohn's disease management: a Brazilian single-centre experience

INTRODUCTION: Data is scarce regarding adverse events (AE) of biological therapy used in the management of Crohn's Disease (CD) among Brazilian patients. OBJECTIVES: To analyse AE prevalence and profile in patients with CD treated with Infliximab (IFX) or Adalimumab (ADA) and to verify whether there are differences between the two drugs. METHOD: Retrospective observational single-centre study of CD patients on biological therapy. Variables analysed: Demographic data, Montreal classification, biological agent administered, treatment duration, presence and type of AE and the need for treatment interruption. RESULTS: Forty-nine patients were analysed, 25 treated with ADA and 24 with IFX. The groups were homogeneous in relation to the variables studied. The average follow-up period for the group treated with ADA was 19.3 months and 21.8 months for the IFX group (p = 0.585). Overall, 40% (n = 10) of patients taking ADA had AE compared with 50% (n = 12) of IFX users (p = 0.571). There was a tendency towards higher incidence of cutaneous and infusion reactions in the IFX group and higher incidence of infections in the ADA treated group, although without significant difference. CONCLUSIONS: No difference was found in the AE prevalence and profile between ADA and IFX CD patients in the population studied.

Terapia oclusiva em ambliopia: fatores prognósticos

Purpose: Amblyopia is the most common form of visual problem in children and for more than 250 years occlusion therapy is the standard treatment. Thus our purpose is to identify the factors that influence the outcome of amblyopia treatment with occlusion therapy. Methods: We reviewed 169 amblyopic children seen in the outpatient clinic of amblyopia of the Campinas State University, between January 1996 and May 1998. Patients were analyzed regar-ding sex, age at start of treatment (3 groups), affected eye, type of amblyopia (strabismic, anisometropic, visual depri-vation, associated), follow-up, initial visual acuity (light, moderate, severe), compliance with treatment (good, poor) and outcome (fully treated, partially treated, not treated). Results: Compliance was not seen to be significantly related to age at start of treatment (p=0.68) or initial visual acuity (p=0.82). 52.67% of the patients were fully treated while 19.52% were partially treated and 27.81% were not treated. Children recorded as showing good compliance had a significantly better outcome than those with poor complian-ce (p=0.0009). Neither the age at start of treatment (p=0.39) nor the initial visual acuity (p=0.30) were significantly corre-lated with the final outcome. Conclusions: We concluded that the main factor affecting the final outcome of amblyopia treatment is compliance.