A epidemiologia da infeção por HIV-2

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Quincti Tyberii Angelerii Epidemiologia siue tractatus de peste ...

Mode of access: Internet.

O BANCO MUNDIAL E A EDUCAÇÃO NO BRASIL: ESTUDO REALIZADO A PARTIR DAS TESES DEFENDIDAS NA UNIVERSIDADE ESTADUAL DE CAMPINAS (UNICAMP), NO PERÍODO DE 1995 A 2007

Este estudo visa analisar as interferencias do Banco Mundial na Educacao Brasileira a partir do estudo de seis teses (aqui identificadas pelas iniciais A,B,C, D, E e F) de doutorado relativas ao tema, defendidas na Universidade Estadual de Campinas (Unicamp), sendo quatro delas (A, B, C, e D) voltadas a area de educacao e duas (E e F) a area de Ciencias Sociais e Economia. O estudo das teses parte dos objetivos de cada uma, que podem ser resumidos da seguinte forma: a Tese A - ¡ªA Mundializacao da Educacao: o Projeto Neoliberal de Sociedade e de Educacao no Brasil e na Venezuela. (MELO, 2003) -, sob a orientacao do Prof. Dr. Nilson Joseph Demange, teve como objetivo investigar o processo de mundializacao da educacao como elemento de uma nova fase de internacionalizacao e acumulacao capitalista, conduzida hegemonicamente pelos sujeitos politicos coletivos que assumem o projeto neoliberal de sociabilidade, especialmente o Fundo Monetario Internacional e o Banco Mundial, que buscam ser condutores das reformas estruturais para a America Latina e Caribe; a Tese B . ¡ªO Capital Financeiro e a Educacao no Brasil. (DEITOS, 2005) -, sob a orientacao da Profa. Dra. Maria Elizabete Sampaio Prado Xavier, teve como objetivo definir quais as consequencias da consolidacao do projeto, para a redefinicao das politicas educacionais na America Latina e Caribe; a Tese C . ¡ªGlobalizacao e Descentralizacao: o Processo de Desconstrucao do Sistema Educacional Brasileiro pela Via da Municipalizacao. (ROSAR, 1995) -, sob a orientacao do Prof. Dr. Demerval Saviani, teve como objetivo analisar as reformas educacionais empreendidas no Brasil, no periodo de 1995-2002, particularmente a politica educacional nacional para o ensino medio e profissional, com financiamento externo do Banco Internacional para Reforma e Desenvolvimento (BIRD); a Tese D . ¡ªAs Politicas Educacionais para o Desenvolvimento e o Trabalho Docente. (SOUZA, 1999) ., sob a orientacao da Profa. Dra. Liliana Rolisen Petrilli Segnini, trata da politica educacional para o ensino de 1¨¬ grau, tracada segundo a visao de seu autor no ambito de projetos federais, com o objetivo de induzir a municipalizacao do ensino, transferindo encargos para o municipio, sem a realizacao de investimentos financeiros satisfatorios nessa instancia; a Tese E . ¡ªEconomia, poder e influencias externa: O Grupo Banco Mundial e as Politicas de Ajustes Estruturais na America Latina, nas Decadas de Oitenta e Noventa. (COELHO, 2002) ., sob a orientacao do Prof. Dr. Sebastiao Carlos Velasco e Cruz, teve como objetivo analisar as relacoes entre o projeto educacional implementado pelo governo estadual, no periodo entre 1995 e 1998 e suas concepcoes de politicas educacionais; a Tese F - ¡ªA Questao Social e os Limites do Projeto Liberal no Brasil. (GIMENES, 2007) ., sob a orientacao do Prof. Dr. Carlos Alonso Barbosa de Oliveira, teve como objetivo analisar a relacao entre a economia, o poder politico e a influencia externa, focalizando o Grupo Banco Mundial e os programas de ajustamento estrutural na America Latina. Por fim este estudo mescla teses brasileiras advindas da area da Educacao e da Economia; foca o banco mundial e sua influencia no Brasil, oferecendo uma visao das conexoes logicas existentes entre elas. Como conclusao deste trabalho, apresentaremos as consideracoes finais de cada uma das teses, bem como as limitacoes e sugestoes para

Sofrimento e Adaptação: Aspectos Sociais e Psico-afetivos de Pacientes com Doença Periodontal Crônica

OS OBJETIVOS DESTE ESTUDO FORAM: CARACTERIZAR A POPULAÇÃO DE PACIENTES DE UMA CLÍNICA-ESCOLA; INVESTIGAR OS ASPECTOS PSICO-AFETIVOS ASSOCIADOS ÀS DOENÇAS PERIODONTAIS DESSES PACIENTES, ALÉM DOS RECURSOS DEFENSIVOS UTILIZADOS POR ELES. MÉTODO: LEVANTOU-SE DADOS SÓCIO-DEMOGRÁFICOS, DE SAÚDE GERAL E PERIODONTAL DE 789 PACIENTES ATENDIDOS NUM DEPARTAMENTO DE PERIODONTIA DE UMA CLÍNICA-ESCOLA DE ODONTOLOGIA, DADOS ESTES QUE CONSTITUÍRAM A ETAPA QUANTITATIVA DO ESTUDO. ESSA CARACTERIZAÇÃO FOI FEITA ATRAVÉS DE PLANILHAS ESPECIALMENTE ELABORADAS PARA A PESQUISA. A PARTIR DESSAS PLANILHAS, FOI SELECIONADA UMA SUB-AMOSTRA DE 273 PACIENTES QUE APRESENTARAM QUEIXAS EM TRÊS OU MAIS SISTEMAS ORGÂNICOS, ALÉM DA QUEIXA PERIODONTAL, OS QUAIS FORAM DENOMINADOS DE PACIENTES POLI-QUEIXOSOS. UMA TERCEIRA SUB-AMOSTRA INTEGROU 59 PACIENTES POLI-QUEIXOSOS, DIAGNOSTICADOS COM DOENÇA LEVE A MODERADA OU LEVE A SEVERA. DESSES PACIENTES, TRÊS FORAM ENTREVISTADOS E INTEGRARAM A AMOSTRA DA ETAPA QUALITATIVA DA PESQUISA. OS RESULTADOS INDICARAM QUE ENTRE PACIENTES POLI-QUEIXOSOS NÃO FOI ENCONTRADA CORRELAÇÃO SIGNIFICATIVA ENTRE DOENÇA PERIODONTAL LEVE A MODERADA OU LEVE A SEVERA COM GÊNERO, IDADE, ESTADO CIVIL, GRAU DE INSTRUÇÃO OU ATIVIDADE LABORAL. TAMBÉM NÃO HOUVE RELAÇÃO SIGNIFICATIVA QUANTO À PRESENÇA DE TABAGISMO, BRUXISMO, ONICOFAGIA E XEROSTOMIA. VERIFICAMOS QUE A DOENÇA PERIODONTAL CRÔNICA TEM SUAS ORIGENS NAS RELAÇÕES OBJETAIS DA MAIS TENRA INFÂNCIA E QUE AS ANSIEDADES ESQUIZO-PARANÓIDES QUE CARACTERIZAM ESSAS PRIMEIRAS RELAÇÕES, CONTINUAM PERMEANDO AS RELAÇÕES DURANTE TODA A VIDA DAS PACIENTES. COMO OS RECURSOS DEFENSIVOS UTILIZADOS SÃO PSIQUICAMENTE POUCO EVOLUÍDOS, O EQUILÍBRIO, A HOMEOSTASE É ENCONTRADA NA DOENÇA. CONCLUÍMOS QUE A DINÂMICA INTRA-PSÍQUICA PODE ESTAR ASSOCIADA NÃO SÓ À DOENÇA PERIODONTAL, MAS TAMBÉM AO ESTADO DE SAÚDE GERAL DESSES PACIENTES.

Gravidez na adolescência: estudo descritivo de variáveis psicológicas, sócio-demográficas e das relações objetais em adolescentes gestantes e sexualmente ativas

O presente estudo consta de uma etapa quantitativa e outra qualitativa; tem como objetivos descrever variáveis sócio-demográficas e psicológicas de adolescentes sexualmente ativas e primigestas de um Programa de Assistência Médica e Psicossocial à Adolescência (PAMPA) no período de 2000-2002. Descrever o conteúdo intrapsíquico de fantasias inconscientes em adolescentes. Identificar e correlacionar o conteúdo de fantasias inconscientes de adolescentes sexualmente ativas e primigestas em diferentes situações conjugais. Foram utilizadas as instalações do PAMPA na aplicação de uma entrevista semidiretiva e o Teste de Relações Objetais de Phillipson. Na análise sócio-demográfica verifico-se uma distribuição das adolescentes nas faixas etárias de 16 a 17 anos (31,1%), 14 a 15 anos (23,8%) e, 12 a 13 anos. 93,3%, das adolescentes são solteiras e, 6,7% é casada ou encontra-se em união consensual. Um terço das adolescentes encontra-se abaixo da escolaridade esperada para a faixa etária. A renda per capita de 48,6%, varia entre 0,5 e 1 salário mínimo. 40,2% das adolescentes tiveram a sexarca e destas 10,6% pertencem à faixa etária de 12 a 13 anos; e 48,5% de 16 a 17 anos. Metade das adolescentes sexualmente ativas estão grávidas. 57,6% das gestantes têm de 16 a 17 anos. Das adolescentes que iniciaram a vida sexual na faixa etária de 12 a 13 anos, 52,6% está grávida. 51% das adolescentes que tiveram a sexarca na faixa etária de 14 a 15 anos estão gestando e representam 45,5% do total de gestantes. Quanto à situação conjugal das primigestas, 54,5% é solteira e possui parceiro; já 30,3% encontra-se em união consensual ou é casada como conseqüência da gravidez. Não existem diferenças significativas da renda per capita das gestantes em relação à amostra em geral. 60,6% das gestantes buscaram assistência pré-natal a partir do segundo trimestre gestacional. 62,5% das adolescentes realizaram parto vaginal, 21,9% um parto por fórceps e 15,6% parto por cesariana. Observamos semelhanças no funcionamento psíquico em relação ao Sistema Tensional Inconsciente Dominante entre gestantes e adolescentes sexualmente ativas. Fatores como o não planejamento da gravidez e união conjugal em função da gravidez, são mais significativos, mostrando que o relacionamento conjugal e a maternidade não foram ainda elaborados e intensificam o processo de luto próprio da adolescência. No funcionamento psíquico, das gestantes, existem dificuldades em organizar a identidade sexual, negando modificações próprias da adolescência na tentativa de preservar relações vinculares infantilizadas. O conflito edípico permeia como principal nas relações triangulares, devido ao predomínio de objetos parciais persecutórios, incapacidade de conter o par combinado envolvendo sempre um terceiro excluído. Existe também a necessidade de manutenção de relações fusionais com exclusividade do vínculo não erotizado que levam a angústias intensas nas fantasias de separação, abandono e perda, sentimentos de fragmentação e medo de ataques destrutivo-vingativos. Quanto à período gravídico, as gestantes demonstram ambivalência na aceitação e necessidade de consentimento das figuras parentais, vinculadas à angústia surgida pelo medo de rejeição e abandono

Trajetos de exclusão e reclusão: oral temática de familiares atingidos pelo tratamento asilar da hanseníase

A história da hanseníase é marcada por preconceito, exclusão social, estigma, abandono e medo, por ter sido conhecida durante muito tempo como incurável e contagiosa. Além dos agravos inerentes às alterações dermatoneurológicas e consequentes incapacidades físicas, são ressaltadas as repercussão emocionais, alterações nos hábitos cotidianos e mudanças na configuração familiar. Atualmente a hanseníase é conhecida como doença negligenciada, com alta incidência e prevalência, considerada como um problema de saúde alvo de incentivos e mobilizações das políticas públicas. Ao estudar a história da hanseníase, parte-se do pressuposto de que pouco se sabe sobre as repercussões da doença do passado na vida dos familiares de ex-doentes tratados em regime asilar, assim como a visão e os sentimentos dos mesmos familiares diante da hanseníase na atualidade. Portanto, objetivou-se narrar a história de familiares de ex-doentes de hanseníase que foram tratados em hospital colônia. Os objetivos específicos são: Identificar se familiares de pacientes com hanseníase tratados em hospitais colônia eram atingidos pelo preconceito, estigma e exclusão que permeava a vida dos portadores da doença; Verificar se o tratamento de ex-doentes de hanseníase em hospitais colônia alterou a efetivação de laços familiares tais indivíduos e os membros de sua família; Averiguar qual a compreensão que familiares de ex-doentes de hanseníase tratados em hospitais colônia têm sobre a hanseníase; Promover, junto aos participantes da pesquisa, atividade de promoção da saúde sobre hanseníase. Adotou-se o estudo exploratório e descritivo, com abordagem qualitativa com suporte na História Oral de Temática como técnica e referencial metodológico. Os 52 familiares de ex-doentes de lepra que foram segregados no Hospital Colônia São Francisco de Assis, cadastrados no MORHAN-Potiguar, constituíram a colônia. A partir do ponto zero houve o recrutamento dos participantes que compuseram a rede, totalizando 10 colaboradores, de ambos os sexos e idade de 44 a 76 anos. Após aprovação pelo Comitê de Ética em Pesquisa - UFRN, sob o protocolo 650.654/2014 e CAAE 25922214.3.0000.5537, realizou-se a coleta de dados por meio de entrevista, utilizando instrumento de identificação da rede e questões abertas. As entrevistas foram gravadas, transcritas, conferidas pelos colaboradores e posteriormente transcriadas. Tratou-se as histórias, narradas pela técnica de Análise Temática de Conteúdo, segundo Bardin, emergindo três eixos temáticos: Impacto nas relações sociais (Estigma e preconceito; Exclusão social); Impacto nas relações familiares (Desagregação familiar; Restrições para visita; Compartilhamento e construção de uma nova família; Consequências familiar geradas pelo isolamento; Reconstrução do vínculo familiar); e Pensamentos frente a lepra e a hanseníase (A história no passado; A história no presente). O fato de ter um familiar doente de hanseníase segregado em hospital colônia gerou empecilhos nas relações sociais vivenciadas pelos colaboradores do estudo, que embora não tivessem a doença, foram vitimados pela exclusão social, estigma e preconceito. O internamento compulsório também gerou modificações na estrutura familiar, com distanciamento, alteração no vínculo e tentativa de reestruturação familiar. Os colaboradores também refletiram sobre política de controle da lepra no passado, assim como a adotada no presente frente à hanseníase.

Cenário da produção acadêmica em história da matemática no ensino de matemática: uma análise reflexiva das teses e dissertações (1990-2010)

This research aims to make a reflective analysis about the academic production originated in the stricto sensu post graduation programs in the country, produced in the period of 1990 to 2010, in the field of History of Mathematics, especifically on works about the History of Mathematics in Mathematics education and that present pedagogical proposals that make use of the History of Mathematics in order to teach Mathematics. Defending the thesis that the researches on mathematics education with goals turned to the use of didactic proposals related to the history of mathematic that take in consideration the coherency between epistemological aspects inherent to mathematics history and anthological elements materialized on the conceptions of mathematics and mathematics history and of apprenticeship (implicitly or explicitly exposed) may originate significant contribution to the field of history of mathematics on education. Among these, nine were Master’s Degree dissertations and five PHD’s theses. The reflective analysis was accomplished from two matrixes; one from theoretical nature and the other, ontologic nature, elaborated from the pretexts of Sanches Gamboa, about the epistemological analysis from academic production in the field of Mathematics Education and the following theoretical perspectives in the field of History of Mathematics Education, that are: linear evolutionary theory, structural construtivist operative, evolutionary discontinuous, historical and socialcultural investigation and the use of activities estimulating the usage of verbal and nonverbal expressions. These perspectives were based on the works of Miguel and Miorim, Mendes and Radford. As results, we have detected some established dissonances between the categories related to theoretical and ontologic levels and the pedagogical proposal presented in these researches. On the other hand, we have discovered works that are able to establish consonances between the theoretical and ontological elements and the presented pedagogical proposal. These works carry significative contributions to the field of History of Mathematics applied to Mathematics pedagogical practice, inclusively presenting significative theoretical elements to the production of knowledge recognized as scientific in the Mathematics field

Epidemiologia e caracterização molecular dos vírus Dengue circulantes no Rio Grande do Norte, 2013-2014

Dengue is an acute infectious disease, usually transmitted by Aedes aegypti mosquitoes. The etiologic agents belong to the family Flaviviridae, genus Flavivirus, and occur as four antigenically related but distinct serotypes designated DENV-1, 2, 3, and 4. In Brazil, the disease represents a national public health problem. The purpose of the present study was to describe epidemiological aspects of dengue in the State of Rio Grande do Norte, from 2013 to 2014. A total of 483 blood or serum samples, collected from January 2013 to December 2014, were studied by RT-PCR for viral detection and typing. The infection was confirmed in 36.44% (176/483) of the cases studied. This study detected the circulation of three serotypes of dengue virus in Rio Grande do Norte, DENV-1, 2, and 4. The predominant serotype in 2013-2014 was the DENV-4, representing 83.51% (81/97) and 68.35% (54/79) of the positive cases, respectively. Regarding the spatial distribution, most of the cases occurred in Natal and Caicó, with 9.28% (9/97) and 18.99% (15/79), respectively. The months with the biggest viral circulation in RN were March 2013 and May 2014. The female gender was the most affected, representing 69.07% (67/97) in 2013 and 54.43% (43/79) in 2014. The most affected age groups were 21-30 years (2013) and 11-20 years (2014) with 25.77% (25/97) and 20.25% (16/79) positive cases, respectively. Phylogenetic analysis indicated that genotype V (DENV-1) and genotype II (DENV-4) circulated in the State. Our results provide information about the dynamics of DENV in the Rio Grande do Norte, important for the development of disease control strategies.

Síndrome de Guillain-Barré: epidemiologia, prognóstico e fatores de risco

Introduction. Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy and the principal cause of acute neuromuscular paralysis. The most prominent GBS subtypes are: acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor-sensory axonal neuropathy (AMSAN) and Fisher syndrome (FS). Differences in geographical distribution of variants have been reported. In Brazil, there are few studies describing the characteristics of GBS, but none on the frequency of GBS variants and their clinical manifestations. Infection-induced aberrant immune response resulting from molecular mimicry and formation of cross-reacting antibodies, contribute to complement activation. Functional biallelic polymorphism in immunoglobulin receptors that influence the affinity of IgG subclasses and the type of immune response have been described, suggesting genetic susceptibility to developing disease. It remains unclear whether individuals carrying different FCGR alleles have differential risk for GBS and⁄or disease severity. The goals of this study were: (1) To characterize GBS and describe the clinical findings in a cohort of patients with GBS from the state of Rio Grande do Norte, Brazil; (2) to determine whether polymorphism in FCGR were associated with development of GBS, and (3) to tease out whether the global gene expression studies could be a tool to identify pathways and transcriptional networks which could be regulated and decrease the time of disease. Methods. Clinical and laboratory data for 149 cases of GBS diagnosed from 1994 to 2013 were analyzed. Genomic DNA and total RNA were extracted from whole blood. Antigangliosides antibodies were determined in the sera. In addition, we also assessed whether FCGR polymorphism are present in GBS (n=141) and blood donors (n=364), and global gene expressions were determined for 12 participants with GBS. Blood samples were collected at the diagnosis and post-recovery. Results. AIDP was the most frequent variant (81.8%) of GBS, followed by AMAN (14.7%) and AMSAN (3.3%). The incidence of GBS was 0.3 ⁄ 100,000 people for the state of Rio Grande do Norte and cases occurred at a younger age. GBS was preceded by infections, with the axonal variant associated with episodes of diarrhea (P = 0.025). Proximal weakness was more frequent in AIDP, and distal weakness predominant in the axonal variant. Compared to 42.4% of cases with AIDP (P<0.0001), 84.6% of cases with the axonal variant had nadir in <10 days. Individuals with the axonal variant took longer to recover deambulation (P<0.0001). The mortality of GBS was 5.3%. A worse outcome was related to an axonal variant (OR17.063; P=0.03) and time required to improve one point in the Hughes functional scale (OR 1.028; P=0.03). The FCGR genotypes and allele frequencies did not differ significantly between the patients with GBS and the controls (FCGR2A p=0.367 and FCGR3A p=0.2430). Global gene expression using RNAseq showed variation in transcript coding for protein isoforms during acute phase of disease. Conclusions. The annual incidence of GBS was 0.3 per 100,00 and there was no seasonal pattern. A predominance of the AIDP variant was seen, and the incidence of the disease decreased with age. The distribution of weakness is a function of the clinical variants, and individuals with the axonal variant had a poorer prognosis. Early diagnosis and variant identification leads to proper intervention decreasing in long-term morbidity. FCGR polymorphisms do not seem to influence susceptibility to GBS in this population. This study found deregulated genes and signs of transcriptional network alterations during the acute and recovery phases in GBS. Identification of pathways altered during disease might be target for immune regulation and with potential to ameliorate symptoms.

Resumo de dissertações e teses: a estrutura composicional à luz da Análise Textual dos Discursos

This doctoral dissertationproposes the description, interpretation and analysis of the compositional structure of thesis and dissertation abstracts, with regard to the linguistic mechanisms that evidence text zones of different typological sequences, such as those of the text plan. Along these lines, the research problem was developed from the notion of compositional structure (sequences and text plans), as one of the levels or plans of text analysis, according to the theoretical framework proposed by Jean-Michel Adam (2011a). The main objective of this study was to recognize how the compositional structure, of thesis and dissertation abstracts, is achieved, with respect to text units and the global organization of this text category. The hypothesis posed in this research posits that specific informational text composition categories of abstracts are necessary to process the representation of the original text and the way in which it makes its meaning. Subsequently, this study is based on the theoretical and methodological framework of Text Linguistics (TL) and, above all, Textual Discourse Analysis (TDA), as we endeavor to understand the organizational structure of abstracts from both a linguistic and textual perspective. This structure involves the text plan of abstracts, with respect to their communicative purpose, i.e, the sharing of scientific information in its standard textual form. Thus, the development of this study, from a theoretical and methodological perspective, is based on the theoretical and descriptive premises from TDA (ADAM, 2011a, 2012; PASSEGGI et al., 2010), and also from TL (BEAUGRANDE; DRESSLER, (2012 [1981]); COSERIU; LAMAS (2010); MARCUSCHI, 2009 [1983]; FÁVERO; KOCH, 1994;KOCH, 2006; BENTES, 2004; BENTES; LEITE, 2010), within the field of text studies. The methodology of this study relies on empirical, documental research, which is qualitative, and adopts a descriptive and interpretive approach. From the empirical perspective, our objective is to understand the problems pertaining to the textual composition of abstracts, aiming to elucidate them in light of the theoretical and methodological framework previously mentioned. The corpus of the analysis is comprised of seven abstracts designated for systematic data collection. These texts, written between 2004 and 2011,were selected from Master’s theses and Doctoral dissertations in their electronic version, from the graduate program at the Federal University of Rio Grande do Norte. A thorough review of the literature reveals a clear fluctuation in the terminology of the concept, ‘abstract’. The results of the analysis revealed that the abstracts, which comprise the corpus of analysis in this study, in general, present typological heterogeneity, while the text plan remains fixed. Finally, the new knowledge gained in this research contributes both to the understanding of the compositional structure of abstracts as well as their production.

Epidemiologia e saúde bucal coletiva: um caminhar compartilhado.

The public health dentistry is a way to bring oral health to Brazilian National Health System (SUS) and vice-versa. Thus, the epidemiology, in this context, it is one of the most important allies. In this article we intend to discuss the "shared walkway" between epidemiology and public health dentistry, through two views: first, we analyzed the efforts to establish methodological models for oral health sectional studies and the possibilities to construct a national data base. Second, we discussed how this knowledge has been transformed in a qualified scientific production presented in meetings and papers, which reflects, at the same time, about the contribution of this process in the consolidation of public health dentistry field. We concluded that this "shared walkway" was (and still is), influenced by political aspects, which, in different moments, leads to an improvement of public health dentistry. The oral health epidemiology has been established as a knowledge area, with regard to the scientific production in Brazil. At the same time, provide a tool that contributes to make oral health care models more appropriate to National Health System principles and, in other hand, make better the discussions about the social determinants of oral diseases.

Epidemiologia e saúde bucal coletiva: um caminhar compartilhado.

The public health dentistry is a way to bring oral health to Brazilian National Health System (SUS) and vice-versa. Thus, the epidemiology, in this context, it is one of the most important allies. In this article we intend to discuss the "shared walkway" between epidemiology and public health dentistry, through two views: first, we analyzed the efforts to establish methodological models for oral health sectional studies and the possibilities to construct a national data base. Second, we discussed how this knowledge has been transformed in a qualified scientific production presented in meetings and papers, which reflects, at the same time, about the contribution of this process in the consolidation of public health dentistry field. We concluded that this "shared walkway" was (and still is), influenced by political aspects, which, in different moments, leads to an improvement of public health dentistry. The oral health epidemiology has been established as a knowledge area, with regard to the scientific production in Brazil. At the same time, provide a tool that contributes to make oral health care models more appropriate to National Health System principles and, in other hand, make better the discussions about the social determinants of oral diseases.

Infecções por enterobacteriaceae resistente aos carbapenêmicos em hospital de ensino: epidemiologia e caracterização molecular

Introduction: The production of KPC (Klebsiella pneumoniae carbapenemase) has become an important mechanism of carbapenem-resistance among Enterobacteriaceae strains. In Brazil, KPC is already widespread and its incidence has increased significantly, reducing treatment options. The “perfect storm” combination of the absence of new drug developmentand the emergence of multidrug-resistant strains resulted in the need for the use of older drugs, with greater toxicity, such as polymyxins. Aims: To determine the occurrence of carbapenemase-producing strains in carbapenem-resistant Enterobacteriaceae isolated from patients with nosocomial infection/colonization during September/2014 to August/2015, to determine the risk factors associated with 30-day- mortality and the impact of inappropriate therapy. Materials and Methods: We performed a case control study to assess the risk factors (comorbidities, invasive procedures and inappropriate antimicrobial therapy) associated with 30-day-mortality, considering the first episode of infection in 111 patients. The resistance genes blaKPC, blaIMP, blaVIM and blaNDM-1 were detected by polymerase chain reaction technique. Molecular typing of the strains involved in the outbreak was performed by pulsed field gel electrophoresis technique. The polymyxin resistance was confirmed by the microdilution broth method. Results: 188 episodes of carbapenem-resistant Enterobacteriaceae infections/colonizations were detected; of these, 122 strains were recovered from the hospital laboratory. The presence of blaKPC gene were confirmed in the majority (74.59%) of these isolates. It was not found the presence of blaIMP , blaVIM and blaNDM-1 genes. K. pneumoniae was the most frequent microorganism (77,13%), primarily responsible for urinary tract infections (21,38%) and infections from patients of the Intensive Care Unit (ICU) (61,38%). Multivariate statistical analysis showed as predictors independently associated with mortality: dialysis and bloodstream infection. The Kaplan-Meier curve showed a lower probability of survival in the group of patients receiving antibiotic therapy inappropriately. Antimicrobial use in adult ICU varied during the study period, but positive correlation between increased incidence of strains and the consumption was not observed. In May and July 2015, the occurrence rates of carbapenem-resistant Enterobacteriaceae KPC-producing per 1000 patient-days were higher than the control limit established, confirming two outbreaks, the first caused by colistin-susceptible KPC-producing K. pneumoniae isolates, with a polyclonal profile and the second by a dominant clone of colistin-resistant (≥ 32 μg/mL) KPC-producing K. pneumoniae. The cross transmission between patients became clear by the temporal and spatial relationships observed in the second outbreak, since some patients occupied the same bed, showing problems in hand hygiene adherence among healthcare workers and inadequate terminal disinfection of environment. The outbreak was contained when the ICU was closed to new admissions. Conclusions: The study showed an endemicity of K. pneumoniae KPC-producing in adult ICU, progressing to an epidemic monoclonal expansion, resulted by a very high antibiotic consumption of carbapenems and polymyxins and facilitated by failures in control measures the unit.

Impacto na epidemiologia da sepse tardia após a mudança do protocolo de antimicrobianos em uma UTIN de um serviço universitário

Advances in neonatology resulted in reducing the mortality rate and the consequent increase in survival of newborn pre terms (PTN). On the other hand, there was also a considerable increase in the risk of developing health care-related infection (HAI) in its most invasive, especially for bloodstream. This situation is worrying, and prevent the occurrence of it is a challenge and becomes one of the priorities in the Neonatal Intensive Care Unit (NICU). Sepsis is the main cause of death in critical neonates and affects more than one million newborns each year, representing 40% of all deaths in neonates. The incidence of late sepsis can reach 50% in NICUs. Currently the major responsible for the occurrence of sepsis in developed countries is the coagulase negative Staphylococcus (CoNS), followed by S. aureus. The cases of HAIs caused by resistant isolates for major classes of antimicrobial agents have been increasingly frequent in the NICU. Therefore, vancomycin has to be prescribed more frequently, and, today, the first option in the treatment of bloodstream infections by resistant Staphylococcus. The objectives of this study were to assess the impact on late sepsis in epidemiology III NICU after the change of the use of antimicrobials protocol; check the frequency of multiresistant microorganisms; assess the number of neonates who came to death. This study was conducted in NICU Level III HC-UFU. three study groups were formed based on the use of the proposed late sepsis treatment protocol, with 216 belonging to the period A, 207 B and 209 to the C. The work was divided into three stages: Period A: data collected from neonates admitted to the unit between September 2010 to August 2011. was using treatment of late sepsis: with oxacillin and gentamicin, oxacillin and amikacin, oxacillin and cefotaxime. Period B: data were collected from March 2012 to February 2013. Data collection was started six months after protocol change. Due to the higher prevalence of CoNS, the initial protocol was changed to vancomycin and cefotaxime. Period C: data were collected from newborns inteerne in the unit from September 2013 to August 2014. Data collection was started six months after the protocol change, which occurred in March 2013. From the 632 neonates included in this study, 511 (80,8%) came from the gynecology and obstetrics department of the HC-UFU. The mean gestational age was 33 weeks and the prevailing sex was male (55,7%). Seventy-nine percent of the studied neonates were hospitalized at the NICU HC-UFU III because of complications related to the respiratory system. Suspicion of sepsis took to hospitalization in the unit of 1,9% of newborns. In general, the infection rate was 34,5%, and the most frequent infectious sepsis syndrome 81,2%. There was a tendency to reduce the number of neonates who died between periods A 11 and C (p = 0,053). From the 176 cases of late sepsis, 73 were clinical sepsis and 103 had laboratory confirmation, with greater representation of Gram positive bacteria, which corresponded to 67.2% of the isolates and CoNS the most frequent micro-organism (91,5%). There was a statistically significant difference in the reduction of isolation of Gram positive microorganisms between periods A and C (p = 0,0365) as well as in reducing multidrug-resistant CoNS (A and B period p = 0,0462 and A and C period, p = 0,158). This study concluded that: the CoNS was the main microorganism responsible for the occurrence of late sepsis in neonates in the NICU of HC-UFU; the main risk factors for the occurrence of late sepsis were: birth weight <1500 g, use of PICC and CUV, need for mechanical ventilation and parenteral nutrition, SNAPPE> 24 and length of stay more than seven days; the new empirical treatment protocol late sepsis, based on the use of vancomycin associated cefepime, it was effective, since promoted a reduction in insulation CoNS blood cultures between the pre and post implementation of the Protocol (A and C, respectively); just as there was a reduction in the number of newborns who evolved to death between periods A and C.

Classificação de atividade eletromiográfia facial de indivíduos saudáveis e com hanseníase por meio de máquina de vetores de suporte

A number of studies in the areas of Biomedical Engineering and Health Sciences have employed machine learning tools to develop methods capable of identifying patterns in different sets of data. Despite its extinction in many countries of the developed world, Hansen’s disease is still a disease that affects a huge part of the population in countries such as India and Brazil. In this context, this research proposes to develop a method that makes it possible to understand in the future how Hansen’s disease affects facial muscles. By using surface electromyography, a system was adapted so as to capture the signals from the largest possible number of facial muscles. We have first looked upon the literature to learn about the way researchers around the globe have been working with diseases that affect the peripheral neural system and how electromyography has acted to contribute to the understanding of these diseases. From these data, a protocol was proposed to collect facial surface electromyographic (sEMG) signals so that these signals presented a high signal to noise ratio. After collecting the signals, we looked for a method that would enable the visualization of this information in a way to make it possible to guarantee that the method used presented satisfactory results. After identifying the method's efficiency, we tried to understand which information could be extracted from the electromyographic signal representing the collected data. Once studies demonstrating which information could contribute to a better understanding of this pathology were not to be found in literature, parameters of amplitude, frequency and entropy were extracted from the signal and a feature selection was made in order to look for the features that better distinguish a healthy individual from a pathological one. After, we tried to identify the classifier that best discriminates distinct individuals from different groups, and also the set of parameters of this classifier that would bring the best outcome. It was identified that the protocol proposed in this study and the adaptation with disposable electrodes available in market proved their effectiveness and capability of being used in different studies whose intention is to collect data from facial electromyography. The feature selection algorithm also showed that not all of the features extracted from the signal are significant for data classification, with some more relevant than others. The classifier Support Vector Machine (SVM) proved itself efficient when the adequate Kernel function was used with the muscle from which information was to be extracted. Each investigated muscle presented different results when the classifier used linear, radial and polynomial kernel functions. Even though we have focused on Hansen’s disease, the method applied here can be used to study facial electromyography in other pathologies.