Lessons learned from stakeholders in a facilitation intervention targeting neonatal health in Quang Ninh province, Vietnam

BACKGROUND: In northern Vietnam the Neonatal health - Knowledge Into Practice (NeoKIP, Current Controlled Trials ISRCTN44599712) trial has evaluated facilitation as a knowledge translation intervention to improve neonatal survival. The results demonstrated that intervention sites, each having an assigned group including local stakeholders supported by a facilitator, lowered the neonatal mortality rate by 50% during the last intervention year compared with control sites. This process evaluation was conducted to identify and describe mechanisms of the NeoKIP intervention based on experiences of facilitators and intervention group members. METHODS: Four focus group discussions (FGDs) were conducted with all facilitators at different occasions and 12 FGDs with 6 intervention groups at 2 occasions. Fifteen FGDs were audio recorded, transcribed verbatim, translated into English, and analysed using thematic analysis. RESULTS: Four themes and 17 sub-themes emerged from the 3 FGDs with facilitators, and 5 themes and 18 sub-themes were identified from the 12 FGDs with the intervention groups mirroring the process of, and the barriers to, the intervention. Facilitators and intervention group members concurred that having groups representing various organisations was beneficial. Facilitators were considered important in assembling the groups. The facilitators functioned best if coming from the same geographical area as the groups and if they were able to come to terms with the chair of the groups. However, the facilitators' lack of health knowledge was regarded as a deficit for assisting the groups' assignments. FGD participants experienced the NeoKIP intervention to have impact on the knowledge and behaviour of both intervention group members and the general public, however, they found that the intervention was a slow and time-consuming process. Perceived facilitation barriers were lack of money, inadequate support, and the function of the intervention groups. CONCLUSIONS: This qualitative process evaluation contributes to explain the improved neonatal survival and why this occurred after a latent period in the NeoKIP project. The used knowledge translation intervention, where facilitators supported multi-stakeholder coalitions with the mandate to impact upon attitudes and behaviour in the communes, has low costs and potential for being scaled-up within existing healthcare systems.

O professor do magistério de primeiro grau: sua origem social, visão de mundo e prática docente

o tema deste trabalho - o professor do magistério de Primeiro Grau - foi analisado em um estudo de caso, realizado em urna escola da rede pública do município do Rio de Janeiro. Optamos por um quadro de referências dentro da concepção dialética da educação, o que possibilitou articular o ambiente pedagógico à totalidade social mais ampla. Isto nos pareceu fundamental uma vez que pretendíamos estudar o assunto em torno de categorias gerais - a origem social, a visão de mundo e a prática docente, entendidas em conexão e interdependência. A análise do desenvolvimento histórico da educação elementar no Brasil serviu de base para que se pudesse distinguir o contexto no qual se deu a elaboração de teorias e pesquisas pedagógicas sobre o terna em questão. Na investigação foi utilizada a observação participante, questionário e entrevistas gravadas com os professores da escola. O núcleo em torno do qual se deu a pesquisa foi: - a origem do professor de Primeiro Grau, entendida em sua dimensão de classe social e envolvendo a especificidade de suas frações; - a forma de conceber a sociedade, a educação e o trabalho escolar, enquanto consciência do professor, permeada por suas limitações e avanços, e enquanto ideologia deste grupo; - a prática docente, entendida de forma mais ampla que o mero aspecto didático-pedagógico. No texto, observou-se a forma imbricada em que se apresentam estas três categorias e as contradições que se interpõem à prática docente. Esta se realiza em um ambiente onde o conflito entre as classes, a tensão entre os diferentes valores culturais e,em especial, a estratégia política do Estado de oferecer escolas sem realizar a real democratização do ensino acabam por estabelecer a cisão entre professores e alunos. A percepção, em termos do processo de conscientização, da identidade de interesses entre professores, alunos e pais, intermediados por intelectuais orgânicos e por movimentos sociais, é a forma de romper esta cadeia de impasses e forçar a saída das promessas de democratização do ensino básico do discurso vazio do poder dominante para a realidade da relação político - pedagógica.

Os movimentos de educação popular no Brasil, 1961-64

O presente estudo propõe uma análise crítica dos objetivos e estratégias dos três movimentos de educação popular mais expressivos no Brasil, no periodo de 1961-64, as quais tinham como objetivo último transformações qualitativas na estrutura social: o Movimento de Educação de Base (MEB), o Movimento de Cultura Popular de Recife (MCP) e o Centro Popular de Cultura (CPC) da União Nacional dos Estudantes(UNE). A análise crítica foi feita a partir de referencial teórico elaborado com base na teoria de Gramsci, com elementos para explicar a dinâmica das forças sociais em Estado capitalista, levando em consideração o contexto econômico, social e politico da época como pressuposto necessãrio à análise de um fato social. Interessou, sobremodo, no referencial, identificar os espaços de ação que escaparam ao controle da classe dominante, permitindo a formação de uma contra-hegemonia. A ação dos intelectuais, fundamental nesta dimensão, uma vez que se trata de criar nova concepção de história, foi analisada enquanto se propôs despertar o dinamismo residente na camada popular e canalizá-lo para fins político-sociais de transformação qualitativa da ordem vigente. Sem conclusões definitivas - os movimentos só atuaram três anos, até serem supressos em abril de 1964 - o estudo reconhece uma expressiva atuação do MEB e MCP na conscientização e treinamento da camada popular em sentido da formação de contra-hegemonia, destacando-se o surgimento e formação de lideranças nesta camada. O CPC, com maior caráter de mobilização, teve ação menos significativa com a camada popular, no entanto ele se distinguiu pela elaboração artistica e cultural. Não apareceu, nos três movimentos, uma visão teórica suficientemente clara sobre as possibilidades de transformação qualitativa em Estado capitalista e não houve a canalização e orientação política que era de se esperar no dinamismo despertado na camada popular.

Egresso da FUNABEM: sua reintegração na sociedade

Este trabalho partiu da questão do menor institucionalizado e da constatação de que grande parte da população brasileira está à margem do processo econômico e cultural. Também a margem desse processo está o egresso da Fundação Nacional do Bem Estar do Menor - FUNABEM, que se encontrava numa situação de menor carente, abandonado ou de conduta irreguIar, foi interno em instituição de amparo ao bem-estar e agora, após a institucionalização, encontra-se na mesma situação: abandonado à sua sorte. Desse modo, viu-se a necessidade de investigação das causas de existência de urna "população marginal" de egressos da FUNABEM, vivendo em condições de notória miserabilidade, uma vez que foram institucionalizados por estarem abandonados e sem recursos mínimos de subsistência, estando novamente abandonados ao atingirem a maioridade. Para entender o surgimento do menor abandonado e sua "carreira", dentro do contexto das populações carentes, buscou-se literatura pertinente, formando um conjunto teórico capaz de orientar a identificação e a compreensão do significado de sua existência. A unidade metodológica do trabalho realizado, visando melhor compreensão do tema abordado, teve o seguinte seguimento: -Na primeira parte, a visão global sobre o egresso, processo de marginalização, institucionalização e o processo de desligamento. -Na segunda parte, a pesquisa e seus resultados. Na pesquisa, o estudo centralizou-se na Associação dos Ex-alunos de FUNABEM - ASSEAF - como principal campo de investigação, muito embora outras fontes fossem utilizadas com o objetivo de colher dados necessários. A análise e interpretações dos resultados permitiram concluir que a situação dos egressos pode ser subdividida em tópicos que destacam visões específicas - visão dos que cuidam do menor abandonado e do ex-aluno, visão do ex-aluno, visão que é veiculada pela imprensa. A análise de conteúdo foi o procedimento usado para extrair essas diferentes visões. O resultado da pesquisa conclui que, após o desligamento da instituição, crescem os riscos de não integração do egresso, porque se repete o processo de marginalização acrescentando-se exigências e pressões sociais mais críticas, dado o fato de serem "maiores", do ponto de vista jurídico. Do mesmo modo, demonstra que as soluções, adotadas para fazer frente à problemática do menor abandonado - no âmbito policial e assistencial - têm sido ineficazes, o que se explica principalmente pelo fato de essas soluções não serem nem planejadas, nem executadas com base no conhecimento já existente sobre as causas econômicas e sociais desta problemática. Mais do que soluções de controle jurídico-policial e de assistência governamental, são necessárias mudanças radicais e efetivas a nível de estrutura econômica e dos seus reflexos político-sociais em benefício das classes menos favorecidas.

A educação na Baixada Maranhense: 1822/1889

o presente trabalho visou acompanhar o processo educacional da Baixada Maranhense, na época imp~ rial, ressaltando as relações existentes entre a educaçã~ tanto sistematizada quanto assistematizada e os sistemas político e econômico vigorantes. o estudo procurou compreender a influência da educação no crescimento e posterior declínio da re gião. Os dados econômicos foram analisados,co~ siderada a função exportadora da região que, como conseqUência do próprio sistema, dividiu a atividade rural em grande lavoura e lavoura de subsistência, ambas dependentes dos interesses maiores do mercado externo. Os fatos históricos demonstraram a relaçao existente entre o enriquecimento dos fazendeiros e as lideranças políticas, locais e provinciais. Mostraram ta~ bém que essas lideranças atuaram especialmente na conservação do status social daquela nobreza rural e não no di- - recionamento da política econômica a ponto de alterarem o curso do processo, uma vez que o mesmo foi determinado de fora para dentro. Foi demonstrada como a influência externa, principalmente nas relações econômicas, se estendeu à educação, tornando-a um ensino estático e sem criatividade. Observou-se que as soluções emanadas pelo Governo se localizaram a nível dos fenômenos,sem nunca terem atingido as raízes dos problemas educacionais e,por isso, não permitiram que a educação tivesse maior influên cia no destino da sociedade estudada.

Uso e disponibilidade da vegetação lenhosa em comunidades rurais no Rio Grande do Norte

The aim of this study was to test the Ecological Apparency Hypothesis comparing two rural communities in João Câmara (RN) and Remigio (PB), in the Northeast of Brazil. This hypothesis assumes that plants are perceived, known and used by human populations according to their local availability. The most used species would be the ones that are more available in the forest (apparent), and apparently suffer greater pressure of use. Communities were consulted through semi-structured interviews. In Remigio 42 people were interviewed, and 50 in João Câmara. The importance of each species was evaluated considering the distinction between citations from current and potential uses. The ethnobotanical information was associated with phytosociological parameters collected by the point-centered quarter method in forested areas, where 50 transects were distributed in each community, and 4,000 individuals sampled in total. Based on the interviews, 58 useful species were recorded, 42 genera and18 families. In the phytosociological study 30 species, 22 genera and 12 families in João Câmara, In Remígio were identified 34 species, 22 genera and nine families.The species were grouped into 11 categories of use. The ecological appearance was confirmed only in the João Câmara, which best explained the relationship between local availability and use of timber resources. Positive correlations were observed also between the technology category VUpotential and dominance. The point-centered quarter was efficient to test appearance, however, further studies through the point-centered quarter method are recommended

O jornal televisivo e o ensino/aprendizagem integrado de português língua materna e francês língua estrangeira

Pour beaucoup de chercheurs, il y a une crise à l école et dans l enseignement/apprentissage des langues qui est provoquée par un enseignement cloisonné et décontextualisé de la réalité. Dans ce type d enseignement/apprentissage, le livre scolaire a une présence si hégémonique qu il est la source quasi exclusive du discours pédagogique et on ne fait que très rarement usage des langages du quotidien des apprenants. Le langage télévisuel est un de ces langages qui pourraient être utilisé pour ciliter enseignement/apprentissage d une langue vivante, variée et en situation, car il permet l exploration de tous les composants de la compétence de communication. En même temps, ce langage pourrait servir à sensibiliser les apprenants à une éducation aux médias. Le journal télévisé peut favoriser un enseignement/apprentissage intégré de la langue maternelle et de la langue étrangère, grâce à son format, similaire dans plusieurs cultures, et à son importance en tant que reflet des valeurs socioculturels des sociétés. Ces qualités sont très favorables pour stimuler le transfert des compétences entre la langue maternelle et la langue étrangère, pour qu on puisse enseigner et apprendre une langue, et connaître une culture. Le journal télévisé est vu comme une source d information et son analyse en classe peut contribuer à la formation d un apprenent/citoyen actualisé, critique et conscient des problèmes et des répresentations des sociétés

Retratos da dignidade: negros do riacho: identidade educação fotografia (2005-2007)

Portraits de la Dignité: Noirs du Riacho (2005-2006) analyse le Projet Dignité, comme un produit publicitaire du gouverne du Rio Grande do Norte, à travers de trois voie: l éducation; l identité; la propagande publicitaire. Notre regard a été dirigé vers les images écrites, parlés et photografiées pour meilleur comprendre comme la communauté des Noirs du Riacho, a été incorporer a polítique d égalité de races proposé par les gouvernes Municipal, de l État, et Fédéral, tout em transformant la communauté en produit publicitaire du gouverne. Entre une partie et l outre on a enregistrés des questions sur l identité, plus particulierment la (des)constrution identitaire tout en s appuyant dans le rôle de la langage publicitaire, que em utilisand les richeses de ses techniques, montre le Riacho et le peuple dans la exposition etno-photogaphique Portraits de la Dignité. Ainsi, c est important comprendre la divulgation du Projet Dignité, appuyer dans la propragande de l image des personnages du Riacho divulguées dans la presse locale. Cette problematique, nos conduit a controverser des questions três anciennes par rapports aux discriminations contre les négres, ainsi comme la façon que le gouvernement en la période analysé, s engage en la problematique des communautés restantes de quilombolas dans l État du Rio Grande do Norte. Au choisir la communauté du Riacho pour développer sa politique d action affirmative l État place le Riacho comme laboratoire sociale , en cette contexte nous cherchons à travers des analyses des documents officiels, thèses, recherches bibliografiques et de champs, bien comme de matériel journalistique et publicitaire, révéler les messages véhiculés dans la presse locale sur des questions proposés par cette étude. Pour développer l étude nous appuyons metodologicament en la recherche qualitative, sans perdre de vue l analyse critique des contenus, vu que les sujets en étude ne doive pas être analyser basé en un unique point de vue. Ainsi, nous pensons ne pas fermer la question, mas ouvrir l outres pour permettre meilleur débattre la liason chaque jour plus fort entre la publicité e l action gouvernamentale, en ce qui est relatif aux usages de l image photografique

Cidade e sociabilidades (Principe, Rio Grande do Norte seculo XIX)

Dans ce travail qui a comme thématique ville et éducabilité et comme objet les pédagogies de la ville de Príncipe au XIXème siècle, nous avons pour objectif de problématiser comment la relation entre la ville et les sociabilités constituent les éducabilités dans cette ville de Príncipe au XIXème siècle, à partir d'espaces de propagation d énoncés pédagogiques. Ainsi, nous proposons la thèse qu il existe une pédagogie de la ville de Príncipe au XIXème siècle, vu que le modus vivendi de celle-ci est lié à des sociabilités de diverses instances, la constituant comme investie d'une orientation pédagogique et l'habitant de la cité comme formé dans et par des sociabilités. Le corpus de documents de l'étude de la pédagogie de la ville se compose de sources distinctes et suffisantes. Elles sont: ecclésiastiques, politico-administratives, notariales et judiciaires. Pour l'analyse et l'interprétation de ces sources, l'étude s'est basée sur la méthode indiciaire, permettant de considérer les détails et la conciliation entre la rationalité et la sensibilité. Ce travail s'inscrit dans la dimension de l'histoire culturelle ici entreprise, de conformité avec Roger Chartier et Peter Burke en tant qu étude des processus avec lesquels se construisent des sens, il faut donc la rapprocher à des configurations sociales et conceptuelles d'un temps et d'un espace propres. De cette manière, nous localisons et focalisons le modus vivendi de Príncipe à partir de pratiques sociales et de valeurs de la vie matérielle et des élaborations symboliques qui constituent un ensemble d'apprentissages liés à la relation entre les espaces et les sociabilités, celles-ci étant constituées et constituantes de pédagogies à la ville. Visant les espaces et ses écrits, sociabilités et éducabilités nous comprenons que nous constituons une histoire d éducabilités dans la ville de Principe au XIXème siècle, celle-ci a comme plus grand constructeur la ville et ses composants d'éducation socialisatrice et instructive. En termes conclusifs, penser à la ville et l éducabilité met en valeur que la pédagogie de et dans la ville se laisse lire par les pratiques et les actions propagées aux sociabilités qui, dans l'intersection de la pédagogie de la ville et des éducabilités, se sont (con)figurées comme formatives

Reproductive and behavioral aspects of red-winged tinamous (Rhynchotus rufescens) in groups with different sex ratios

The aim of this research study was to evaluate the reproductive performance of tinamous submitted to five different male:female ratios. The study was carried out with 72 birds in a randomized experimental design with 4 replications. Tinamous were housed in cages, using the ratios of one (1:1), two (2:1), three (3:1) and four (4:1) females per male, and also one male was housed with three females individually (3R:1), in a rotational system. Reproductive records of the breeding season from September 2004 to March 2005 were used. The reproductive traits studied were: number of eggs laid, fertility, and percentage of eggs damaged and cracked by pecking. Nonparametric analyses of these traits were performed using Kruskal-Wallis test. Two replications of treatments 1:1 and 4:1, and one of treatment 2:1 were video-taped for three days, 12 hours/day. The videotapes were sampled according to the scan method to fit an ethogram. Birds were also watched for one hour per day to study dominance and agonistic behavior. None of the reproductive traits was affected by mating sex ratio (p<0.05). Female dominance could be related to displacement behavior (r=1.00), and male sitting in immobility plus sitting in activity behaviors were related to lower number of damaged eggs (r=-0.90). Social dominance was indirectly determined by displacement behavior in the study situation. A large number of damaged eggs occurred in all treatments, thereby not allowing a clear conclusion on the best male:female ratio.

Custo-efetividade da terapia compressiva no processo de cicatrização de úlceras venosas

Analytical study of therapeutic nonrandomized intervention type, intra-group controlled, with the aim of analyzing the cost-effectiveness of compression therapy with manipulated Unna boot in relation to conventional therapy in the healing of venous ulcers (VU) of patients treated in ambulatory clinic. The study population was composed by patients with VU treated by angiologists in Surgical Clinic Ambulatory of the Onofre Lopes University Hospital (HUOL) with a sample of 18 patients. It obtained the assent of the HUOL Ethics in Research Committee (Protocol 276/09). Data collection was performed over a period of four months by the own master's student and 34 nursing students, through the application of the research instrument in the admission of patients to the study and in the ten subsequent evaluations, performed at the time of changing Unna boot, weekly, for a maximum period of 10 weeks. The data were analyzed with SPSS 15.0 software, using descriptive and inferential statistics, and presented as tables, charts and graphs. Among those surveyed, prevailed: females, mean age 57.6 years, low education and income levels, most retired, unemployed or off work, with the standing position more than six hours per day and up to eight hours daily of domestic or occupational activities. In health status profile of respondents there were predominantly sleep, rest and inadequate elevation of the lower limbs, no smoking and/or alcohol use, presence of hypertension and no use of drugs. Most presented the first VU for over 10 years, recurrences, present VU for more than five years, involvement of left leg, in malleolar and / or distal leg region, mild edema, hyperpigmentation, lipodermatosclerosis, telangiectasies, reticular and varicose veins, mild pain, serous exudate in moderate quantity, small lesions (up to 50cm2), with predominance of granulation tissue and / or epithelialization and demarcated, elevated and irregular borders, with crusts and macerated. Most patients reported that in the 10 weeks prior to admission, made bandages at home and / or Basic Health Unit and / or ambulatory, with nursing aides or technicians, daily, and on weekends or holidays, performed by patients themselves, using healing ointment on the lesion, being observed granulation / epithelialization and increase in VU prevalent in the 10 weeks of traditional treatment. After follow up with manipulated Unna boot, was observed a decrease of lesions in all study patients, with complete healing in 27.8% of those between 1 and 5 weeks of treatment, with satisfactory evolution of the lesions, pain and ankle and calf circumferences, and unsatisfactory development of the borders of ulcers, edema, sleep, rest and elevation of the lower limbs, especially in more chronic patients. Furthermore, patients who achieved total healing and exhibited the greatest percentage reduction of lesions had a higher number of wound healing factors (ρ = 0.01 and ρ = 0.027, respectively). The manipulated Unna boot showed better results in those patients with shorter duration of injury, leading them to a satisfactory outcome within a short period of treatment. After the cost-effectiveness analysis, we conclude that the manipulated Unna boot is more effective than conventional therapy in the healing process of VU and is more cost-effective in patients with shorter lesions (ρ = 0.001), shorter treatment (ρ = 0.000) and greater number of wound healing factors (ρ = 0.005).

Assistência aos portadores de úlceras venosas: proposta de protocolo

Venous ulcers (VU), recurrent chronic wounds resulting from Chronic Venous Insufficiency (CVI), affect different age groups and would severely affect ambulation of patients. The lesions require treatment lasting and complex and are responsible for significant morbidity and mortality. Thus, this study aims to identify the important aspects covered in the scientific literature protocol for assisting patients with venous ulcers, identifying the issues to be proposed by the judges of the study (nurses, doctors and physiotherapists) to the protocol of care provided to patients venous ulcers and present the structure of protocol proposed by the judges of the study to assist patients with venous ulcers treated at a referral hospital of Rio Grande do Norte. This is a descriptive study using a quantitative approach, carried out at the dressings, located in the outpatient surgical clinic of the Hospital University Onofre Lopes (HUOL), located in East Sanitary District, Natal-RN. The sample consisted of 39 professionals, 30 nurses, seven doctors and two physical therapists, team members HUOL surgical clinic and other public and private institutions of Rio Grande do Norte and Jequié/Bahia. These professionals were the judges responsible for selecting the guidelines already proposed in the literature on VU protocols. Approved by the Ethics in Research HUOL (Report n.o 081/07), began the first stage of the study which consisted of reviewing the scientific literature about the relevant aspects to be included in a protocol for assisting patients with VU. These aspects were organized into a proposed questionnaire to the judges of the study. Following examination, held on the content validation with application of the Kappa (K), accepting a score higher than 0.80 and the Likert Scale, whereas rates from 4.0 to 5.0. The data collected were organized in Microsoft Excel and exported into Statistical Package for Social Sciences (SPSS) 15.0. The literature review included national and international scientific articles, thesis, dissertation and institutional protocols. Regarding the characterization of professional nurses predominated (76.1%), between 34 and 45 years (41.0%), female (79.5%), married/consensual union (46.2%), with specialization in VU care (61.5%), working in the hospital network (46.1%), with up to 5 years experience in VU (69.2%) and claiming to feel prepared to care for these injuries (92.3 %). With regard to aspects that had very good agreement (K ≥ 0.81), remained the items found in the literature with some modifications. In the analysis of the proposed evaluation items had very important, ranging from 4.1 (drug treatment) to 4.9 (patient assessment and care of the injury and the injured and perilesional skin). The proposition of the protocol is arranged in eleven items: A) Evaluation of patient and lesion, B) Registration and documentation, C) the wound and perilesional skin, D) an indication of coverage, E) Use of antibiotic and pain treatment, F) Surgical treatment of CVI, G) Drug treatment, H) Improving venous return and prevetion of recurrence, I) Referral of patients, J) Training and K) Reference and counter reference

Qualidade de vida de pessoas com úlcera venosa: associação dos aspectos sociodemográficos, de saúde, assistência e clínicos da lesão

Venous ulcer (VU) is a lower limbs injury resulting from inadequate return of venous blood in feet or legs. Although it is not a deadly disease, it causes chronic wounds, which seriously undermine patients´ quality of life (QOL) and sometimes leads to drastic family, social, economic and psychological changes. In this sense, there are several aspects that may influence the venous ulcers patients´ QOL. The study´s objective aimed on the association of socio-demographic and health, health care and clinical injury on UV patients‟ QOL. Analytical studies, which consider the complexity of factors involved in changes in UV patients‟ QOL has a cross-sectional and quantitative approach. The HUOL Ethics Committee approved this project (n.279/09). The collection of data lasted a period of 3 months in 2010 and it took place at the clinic of Angiology at Hospital Universitário Onofre Lopes (HUOL). The data sample consisted of 60 patients treated by UV angiologists in the HUOL Surgical Clinic. The results were analyzed with SPSS 15.0 by descriptive and inferential statistics. The study was based on UV patients that were predominantly female, average age of 61.4 years, that had low education level and low family income, with occupations requiring long periods of standing or sitting, but mostly retired, unemployed or laid off due to the disease and/or due to chronic diseases associated with the UV. The study took also into consideration patients that used inappropriate products, that were improperly treated by a professional caregiver, that lacked of adequate guidance and compression therapy, that performed no lifting of the lower limbs and regular exercise, that the time of injury were greater than or equal to six months, that were missing specific laboratory tests. The study‟s reference were on recurrent lesions, medium to large lesions area, bed of the lesion (injuries) with fibrin and/or necrosis, with amount of exudate with medium to large, odorless and no signs of infection, with tissue loss between 1st and 2nd degree, without collecting swab or biopsy and with pain. In general, QOL of researched individuals were considered low, the maximum score was 69 points, which the areas that were mostly influenced were the total scores of QOL functional capacity (0.021), emotional (0.000) and social functioning (0.080). Of the 60 individuals, 53.3% had scores between 40 and 69 points in SF-36, and they had the best scores in sociodemographic and health variables (ρ = 0.049). In respect to the assistance and injury characteristics, patients who scored between 40 and 69 points in SF-36 had better scores on these characteristics. By combining the socio-demographic variables, health, and handling characteristics of the injury, we observed a significant difference (ρ = 0.032) when linking them with the QOL total scores. When analyzing separately the domains of the SF-36 scores on the quality of life, we find that the areas that showed statistical significance were functional ability (ρ = 0.035), appearance (ρ = 0.019), emotional (ρ = 0.000), and mental health (ρ = 0.050). Among the socio-demographic characteristics studied, gender and marital status contributed more to the reduction of QOL and among the variables of assistance and the injury, orientation, reference and area of UV contributed the most. By analyzing these five variables all together in accordance with the overall score obtained in the quality of life, we found a significant correlation (ρ = 0.002); with 6.23 times more chances of patients have better QOL in the presence of these five positive factors. By conducting the Mann Whitney U test between all the five demographic variables, health, and clinical care, we found that this combination also proved to be significant (ρ = 0.006). Therefore, patients with these five variables positive tend to have a better QOL. Based on these results, we reject the null hypothesis (H0) and accept the alternative hypothesis (H1) proposed in this study because we noted that the QOL of patients with UV is associated with sociodemographic and health, health care and clinical aspects of the injury

Validação de protocolo de assistência para pessoas com úlcera venosa na atenção primária

People with venous ulcers constitute as an important public health problem, its treatment is onerous and require assistance provided by trained professionals, systematized through protocols, however what lies in the assistance is that the management of this group of people differs from that preconized in the scientific literature, interfering with wound healing and quality of life of affected. In this sense, the construction of a assistance protocol specific to people with venous ulcers (VU) can help professionals of the Family Health Strategy both in patient assessment as and in establishment of quality assistance. Thus, this study aimed to analyse the validity of a multiprofessional assistance protocol for people with venous ulcers in primary care by health professionals using Delphi technique. This is a quantitative study, the methodological type conducted in two steps: first step related to integrative literature review to subsidize the development of the protocol, then these aspects were organized and proposed to the judges of the study through the Delphi technique. The study was initiated after approval by the Research Ethics Committee. The first step was performed between August and September 2012, in the virtual library of health, in the page of the Coordination of Improvement of Higher Education Personnel, of Municipal Health Secretariat and international guidelines of associations and in the subsequent step carried out between September 2012 to January 2013, was performed search by Lattes platform of the National Council of Technological and Scientific Development, in order to identify health professionals in Brazil who act as judges of the instrument and then, via online, the form was submitted to them.The sample for the second step was 51 judges in the first round and 35 for the second round Delphi. The analysis was done by adopting Kappa index ≥ 0.81 and Content Validity Index (CVI)> 0.80. In the first submission for the judges, items that did not reach Kappa and CVI established were: request / realization / test results, demographic data, medical history, risk factors, verification of pain / vital signs / pulse / infection signs / lesion location/ edema and pain treatment. After removal of items which have not obtained Kappa or CVI index established, it was found achieving optimal levels of these index for the categories. In the next step was the ressubmissão of protocol to judges through the Delphi technique in it was found that, of the 15 categories of the protocol, 12 presented higher scores in Delphi 2 phase and the other three categories remained the same Kappa and IVC of the previous phase. As for the average of evaluation requirements of the protocol was found that the scores assigned by the judges were higher in the second phase in nine of the 10 items, remaining the same in only one of the items indicating validity of the instrument before the consensus of the judges. Thus, we accepted the alternative hypothesis in this study, as they were obtained in the second Delphi phase the validity index greater than or equal to the Delphi 1 phase. The formulation of this assistance protocol valid and reproducible will enable a reorganization and redesign of assistance, with standardization of actions and continuity of care for persons with venous ulcers in primary health care

Qualidade da assistência e o conhecimento sobre o direito à saúde das pessoas com úlcera venosa crônica

The study aimed to identify the quality of care and knowledge of health rights of people with chronic venous ulcers (VU) in Brasilian National Health Care System (SUS). It is a cross-sectional study, with quantitative approach, performed at the University Hospital Onofre Lopes (HUOL). The study was approved by the Ethics Committee of HUOL (CAAE nº 0148.0.051.000-10). The sample by accessibility was composed for 30 people with VU treated at the outpatient surgical clinic of HUOL. For data collection we used a structured questionnaire composed of two parts: sociodemographic characteristics and of health, of care and the clinical course of VU; and knowledge of people with VU about the rights of health. The results were processed using SPSS 15.0 and analyzed by descriptive statistics. Given the characterizations sociodemographic and health presented, we identified a clientele of users with VU predominantly female (76,7%), aged from 60 years (66,7%), married/ stable union (60,0%), low education level (83,3%), family income lower than a minimum wage (73,3%), unemployeds and with chronic diseases (53,3%), sleep greater than or equal to 6 hours (76,7%) and were not alcoholics or smokers (93,3%). In relation to clinical conditions, were shown the presence of one or more relapses of VU (73,3%), predominance of granulation tissue/epithelialization in the bed of VU (60,0%), exudate serosanguineous (43,3%), in quantity medium/large (60,0%), with no predominance of presence or absence of odor (50,0%), all patients with tissue loss in grade III / IV, no signs of infection (73,3%) and presence of intense pain (50,0%). In the last 30 days the main venue of achievement of dressing was the HUOL (100,0%), the main compression therapy used was the Unna boot (60,0%) and on inability to perform the dressing on the unit were the own patients who made the exchange at home (40,0%). The majority of respondents listed out more positive factors associated with quality of care (56,7%) were satisfied with the care of SUS (76,7%), claimed to have knowledge about their rights (70,0%), but at the same time did not know the meaning of the acronym SUS (90,0%) and classified their level of information as inappropriate (70,0%). We realize that people with VU identified as good the quality of care and demonstrated inadequate knowledge about their rights to health in the SUS, but showed interest in acquiring more information. The basic rights to entry in the SUS are constitutionally guaranteed and need to be disseminated in order to make them known to the population, so it can be implemented and ensured a greater resolution assistance in treating this type of injury