Dificuldades no diagnóstico de fibrose quística : dois casos clínicos

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Medidas não farmacológicas no alívio da dor no trabalho de parto

Enquadramento: A dor do parto resulta de complexas interações, de caráter inibitório e excitatório e, apesar de os seus mecanismos serem análogos aos da dor aguda, há fatores próprios do trabalho de parto de natureza neurofisiológica, obstétrica, psicológica e sociológica que intervêm no seu limiar. Neste sentido, os métodos não farmacológicas podem auxiliar a parturiente no alívio da dor, reduzir os níveis de stresse e ansiedade e, consequentemente promover uma maior satisfação. Objetivos: Demonstrar evidência científica de se os métodos não farmacológicos usados no alívio da dor no trabalho de parto são mais eficazes quando comparados com a não utilização de nenhum método, placebo ou qualquer outro método; verificar o uso de medidas não farmacológicas no alívio da dor do parto; averiguar quais as variáveis sociodemográficas, variáveis contextuais da gravidez e contextuais do parto que interferem no recurso a medidas não farmacológicas no alívio da dor do parto. Métodos: No estudo empírico I seguiu-se a metodologia de revisão sistemática da literatura. Foi realizada uma pesquisa na EBSCO, PubMed, Scielo e RCAAP, de estudos publicados entre 1 janeiro de 2010 e 2 de janeiro de 2015. Os estudos encontrados foram avaliados de acordo com os critérios de inclusão previamente estabelecidos e, posteriormente, foi feita uma apreciação da qualidade dos estudos, por dois revisores, utilizando a “Grelha para avaliação crítica de um artigo descrevendo um ensaio clínico prospetivo, aleatorizado e controlado” (Bugalho & Carneiro, 2004). No final, foram incluídos no corpus do estudo 4 artigos. O estudo empírico II enquadra-se num estudo quantitativo, transversal, descritivo e retrospetivo, desenvolvido no serviço de Obstetrícia do Centro Hospitalar Cova da Beira, segundo um processo de amostragem não probabilística por conveniência (n = 382). A recolha de dados efetuou-se através da consulta de processos clínicos de mulheres com idade ≥ 18 anos, que tiveram um parto vaginal com feto vivo após as 37 semanas de gestação. Resultados: Os métodos não farmacológicos usados no alívio da dor no trabalho de parto são mais eficazes quando comparados com a não utilização de nenhum método, placebo ou qualquer outro método. Numa amostra constituída por 382 mulheres, com uma idade média de 30,95 anos (±5,451 anos), em 34,6% dos casos foram aplicadas as medidas não farmacológicas no alívio da dor no trabalho de parto, sobressaindo a respiração e o relaxamento (86,3%). Em alguns casos, ainda que em menor número, foi aplicada a hidroterapia isolada (6,9%) ou associada à respiração e ao relaxamento (5,3%), bem como a hipnose (0,8%) e a associação entre respiração e massagem (0,8%). Conclusão: De acordo com os resultados obtidos e com base na evidência científica disponível, importa referir que é essencial que os cuidados não farmacológicos de alívio da dor no parto sejam explorados, por serem mais seguros e acarretarem menos intervenções. Desta feita, os profissionais de saúde que prestam assistência às mulheres durante o trabalho de parto e parto têm de ter acesso ao conhecimento acerca desses métodos e os seus potenciais benefícios, a fim de os poderem aplicar com maior segurança, o que resultará indiscutivelmente numa maior humanização do parto, caminhando-se no sentido de uma maternidade mais segura. Palavras-chave: Trabalho de parto; dor de parto; terapias complementares; terapias alternativas

Mecanismos jurídicos en el tratamiento de los delitos de violación : Primeras aproximaciones al problema

Fil: Riva, Betina Clara. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

Mecanismos jurídicos en el tratamiento de los delitos de violación : Primeras aproximaciones al problema

Fil: Riva, Betina Clara. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

AS PRÁTICAS DE TREINAMENTO COMO MECANISMOS DISCIPLINARES E DE REGULAÇÃO EM ORGANIZAÇÃO DE DESENVOLVIMENTO E COMÉRCIO DE SOFTWARE DE RECURSOS HUMANOS

Este trabalho tem como objetivo investigar na prática organizacional as articulações e desarticulações entre as práticas de treinamento, vistas como mecanismo que disciplina o indivíduo (normas e padronização de procedimentos de trabalho), e as diretrizes de práticas de treinamento, vistas como mecanismo de regulação (normas, padrões de conduta), das relações entre a organização e os funcionários. A pesquisa permite trazer para o ambiente acadêmico científico um aprofundamento quanto aos mecanismos de poder disciplinar exercidos pela organização estudada sobre os funcionários e os mecanismos de regulação sobre o mesmo fenômeno práticas de treinamento , além de explorar a questão da distinção e complementaridade entre ambos. Foi utilizada pesquisa qualitativa e uma proposta teóricometodológica de análise de conteúdo e análise de discurso, a partir de uma amostra indicativa e intencional, sendo a empresa do ramo de desenvolvimento e comércio de software de recursos humanos. Utilizou-se de três instrumentos para a coleta de dados: a entrevista em profundidade, observações do pesquisador e pesquisa documental. As análises feitas entre a teoria e os dados empíricos comprovaram a existência de articulações e desarticulações entre os mecanismos, além de outros achados, confirmados através da norma de treinamento e dos depoimentos dos entrevistados.

Agrupamentos Complementares de Empresas

O tema escolhido para a minha tese de mestrado foram os Agrupamentos Complementares de Empresas (ACE). Na minha opinião, o tema dos ACE é um tema sempre atual, continuamos a verificar nos nossos dias o nascimento de diferentes ACE, por parte das empresas, e é por isso necessário percebermos o enquadramento dos ACE e como estes surgiram na nossa legislação. Os ACE surgiram no direito português pela lei nº 4/73, de 4 de Junho, e foi regulamentada pelo decreto-lei nº 430/73 de 25 de Agosto, tendo como objeto uma atividade auxiliar ou complementar daquelas que são exercidas por todos os que fazem parte do ACE. Ao referir-me aos ACE, não nos podemos esquecer de referir os AEIE – Agrupamentos Europeus de Interesses Económicos, uma figura similar aos ACE regulada pelo regulamento nº2137/85, do Conselho das Comunidades Europeias, de 25 de Junho e no DL nº 148/90 de 9 de Maio, este agrupamento é formado por membros de pelo menos dois estados diferentes da União Europeia. Estes dois agrupamentos estão devidamente regulados, possuem personalidade jurídica, são sujeitos de direitos e obrigações e têm como objetivo melhorar as condições de exploração ou os resultados das empresas agrupadas. Não posso falar de ACE nem AEIE sem me focar um pouco no regime que os sustem, o regime de transparência fiscal, este, consiste na imputação aos sócios da matéria coletável da sociedade determinada nos termos do CIRC, assim desconsidera-se o facto de existir uma sociedade coletiva e imputa-se a matéria coletável aos sócios. Os objetivos deste tipo de tributação são a neutralidade fiscal, o combate à evasão fiscal e evitar a dupla tributação.

Práticas integrativas e complementares em Currais Novos/RN: uso de plantas medicinais?

The objective of this study is to investigate how the team of health professionals of the Family Health Strategies program and clients in Currais Novos/RN deal with the use (or not) of medicinal plants as one of the complementary and holistic practices in the Individual Health System (SUS in Portuguese). The research is carried out using a qualitative approach, applying semi-structured interviews, related to the proposed objective, as the instruments of data collection. The interviews applied to professionals and clients were based on questionnaires and were recorded, with their permission, then transcribed in a field diary. The subjects of the study were doctors, nurses, dentists and community health agents of the Family Health Strategies team, totaling 24 (twenty four) health professionals, as well as ten volunteers identified in the research as people who use medicinal plants for health care purposes. From this study, we verify the great importance that health professionals and clients attribute to the use of medicinal plants, as well as evidence that family tradition is the main vehicle for the dissemination of knowledge regarding their use. Most medicinal plants had popular indications similar of those used scientifically, however, 70% of the clients reported never having had medical health advice or encouragement to use medicinal plants in their treatments. Half of the group of professionals interviewed reported not feeling safe in prescribing medicinal plants; approximately 25% reported having received information on the subject during their undergraduate program. Expected outcomes of this study include instigating the implementation of treatment protocols by the health professionals, and broadening holistic care practices, as well as access to alternative therapeutic options, client participation, ultimately strengthening the link between primary care and Family Health Strategies

Mecanismos de transmissão de preços e parcelas de mercado: uma análise sobre as exportações brasileiras de manga

Climate and environmental conditions allowed Brazil to become one of the largest producers of tropical fruits in the world. The São Francisco Valley, over the years, has emerged as the main fruit-producing region of the country, especially mangos and grapes. The mango, which is produced in this region, has reached a good international position, especially in European and American markets. However, the domestic price has absorbed more and more the impact of fluctuations in the international market expectations affecting the production and marketing of producers. The objective of the study is to analyze the transmission ratio of export prices of the mango, with the American market prices and the European Union in the period from 2003 to 2013. It is intended also to analyze the factors affecting the fluctuations of exports Brazilian mango for the main import markets. To achieve the proposed objectives, we used, in the methodology, the autoregressive vector model, in order to find the price transmission mechanism and the mechanisms of impacts through the impulse response function. We also used, the Constant Market Share model, in order to observe the importance of the effects competitiveness, destination, and growth in world trade on the changes of Brazilian mango exports in the period. The data used were obtained from the database of the Ministry of Development and Foreign Trade - MIDIC and FAOSTAT (Food and Agriculture Organization of the United Nations). Among the results, it was found that the Brazilian domestic prices are influenced by the US market price, and that price shocks promoted this market can impact on the growth of the internal prices for several months. It was noted also that the competitiveness effect accounted for the largest portion of the effective growth of Brazilian exports, in other word, the country has improved its competitiveness among the other exporting countries.

Direitos fundamentais sociais no Brasil: desafios e mecanismos para sua concretização

The work referred to above, in order to contribute to the legal issues, economic, political and social of the violation of social rights, performs even firmer approach to various implementation mechanisms of social rights in Brazil. Therefore, it begins the study dealing with aspects and important characters of the rights under discussion, as its normative forecast, concept, classifications; respect of social rights with the existential minimum; the principle of reservation of the possible and the need to use this principle as optimization commandment of state resources and the deficit of the realization of social rights in the country. This, in later chapters, in an interdisciplinary approach, challenges and proposals for the realization of social rights by bringing in each chapter, mechanisms for such implementation. That way, as a general objective, it has been to contribute to the discussed problems, when present proposals for the realization of social rights in the Brazilian context. As specific objectives, as well as record the key aspects of the rights in allusion, the one has to promote the perspective of economic development and taxation as posts instruments that the State must be focused on the promotion of social rights by registering in this context that nonexistent economic development without reducing poverty, misery and social inequality and adding that there should be a directly proportional relationship between the tax burden in the country and the human and social development index; analyze the achievement of budget control as essential and healthy measure for the realization of social rights; highlight the importance of society to the achievement of unavailable social interests, affirming the need for the implementation of participatory democracy and, in this line, brings knowledge of the Constitution and the constitutional sense as elements that provide the constitutional progress. Finally, it presents a study on public policies, considering that these are equivalent to the primary means of the promotion of social rights. That way it analyzes the stages that integrate public policies, ranging from the perception of social problems for evaluation and control of the policies implemented; debate about the administrative discretion in when it comes to public policies; brings the classification of essential public policies, the relationship of these with the existential minimum, control parameters and, finally, the legalization of public policy, regarded as legitimate to remedy the unconstitutional state failure and give normative effectiveness and strength to the defining constitutional rules for fundamental social rights. It uses to achieve the objectives outlined, the bibliographic and normative approach method and performs an analysis of jurisprudence related understandings to matter. In the conclusions, it rescues the most important aspects elucidated at work, with the aim of giving emphasis to the proposals and mechanisms that contribute to the solution of the discussed problems.

Mecanismos de sincronia social no ritmo circadiano de atividade durante a coabitação em casais de saguis (Callithrix jacchus)

In marmosets, it was observed that the synchrony among circadian activity profiles of animals that cohabite in family groups is stronger than those of the same sex and age of different families. Inside the group, it is stronger between the younger ones than between them and their parents. However, the mechanisms involved in the social synchrony are unknown. With the aim to investigate the synchronization mechanisms involved in the synchrony between the circadian activity profiles during cohabitation in pairs of marmosets, the motor activity was continuously registered by the use of actmeters on three dyads. The pairs were maintained in two different conditions of illumination: light-dark cycle LD 12:12 (LD cohabitation I – 21 days), and thereafter in LL (~350 lux). Under LL, the pairs were submitted to four experimental situations: 1. Cohabitation (LLJ I – 24 days), 2. Removal of one member of the pair to another room with similar conditions (LLS I – 20 days), 3. Reintroduction of the separated member in the cage of the first situation (LLJ II – 30 days) and 4. Removal of a member from each pair to another experimental room (LLS II – 7 days), to evaluate the mechanisms of synchronization. Ultimately, the members of each pair were reintroduced in the cage and were kept in LD cycle 12:12 (LDJ II – 11 days). The rhythms of pairs free-ran in LL, with identical periods between the members of each pair during the two stages of cohabitation. In the stages in which the animals were separated, only the rhythms of two females free-ran in the first stage and of three animals in the second one. In those conditions, the rhythms of animals of each pair showed different endogenous periods. Besides, during cohabitation in LD and LL, the members of each pair showed a stable phase relationship in the beginning of the active phase, while in the stages in which the animals were separated it was noticed a breaking in the stability in the phase relationships between the circadian activity profiles, with an increase in the difference in the phase angles between them. During cohabitation, at the transition between LD and LL, all animals showed free-running rhythms anticipating progressively the beginning and the end of the active phase in a phase similar to the previous condition, showing signs of entrainment to the previous LD. While in the posterior stages this was observed in only three animals between: LLT I and LLS I, and LLT II and LLS II, evidencing signs of entrainment to social cues between the members of each pair. On the other hand, one animal delayed progressively between LLT I and LLS I, three animals delayed between LLS I and LLT II, and three animals between LLT II and LLS II, perhaps by entrainment to the animals maintained outdoors in the colony. Similar process was observed in four animals between LLS II and LDT II, indicating entrainment to LD. In the transition between LLS I and LLT II, signs of masking was observed in the rhythm of a female in response to the male and in another pair in the rhythm of the male in regard to that of the female. The general and maximum correlations in the circadian activity profiles were stronger during cohabitation in LD and LL than in the absence of social contact in LL, evidencing the social effect. The cohabiting pairs had higher values of the maximum correlation in LD and LL than when the profiles were correlated to animals of different cages, with same or different sexes. Similar results were observed in the general correlation. Therefore, it is suggested that cohabitation induces a strong synchrony between circadian activity profiles in marmosets, which involves entrainment and masking. Nevertheless, additional studies are necessary to evaluate the effect of social cues on the synchronization of the circadian rhythm in pairs of marmosets in the absence of external social cues in order to confirm this hypothesis.

Caracterização do material particulado e avaliação do risco ocupacional e mecanismos moleculares associados à queima artesanal da castanha de caju

Brazil is among the largest cashew nut producers of the world. However, the roasting process is still carried out artisanally, especially in the Brazilian semiarid region. In face of this occupational problem, the aim of this study was to perform a physical-chemical characterization of the particulate matter (PM) emitted by the roasting of cashew nuts, as well as to determine the occupational risk and molecular mechanisms associated. The most evident PM characteristics were the prevalence of fine particles, typical biomass burning morphologies such as tar ball and the presence of the elements K, Cl, S, Ca and Fe. In addition, atmospheric modeling analyses suggest that these particles can reach neighboring regions of the emission source. Polycyclic aromatic hydrocarbons (PAHs) with carcinogenic potential, such as benzo[a]pyrene, dibenz[a,h]anthracene, benzo[a]anthracene, benzo[b]fluoranthene, chrysene, benzo[k]fluoranthene, indeno[1,2,3-c,d]pyrene and benzo[j]fluoranthene were the most abundant PAHs found in the two air monitoring campaigns. Among the identified oxy-PAH the benzanthrone (7H-benz[d,e]anthracen-7-one) had the highest concentration and the evaluation of lifetime cancer risk showed an increase of 12 to 37 cases of cancer for every 10,000 exposed people. Chemical analysis of roasted cashew nuts identified the PAHs: phenanthrene, benzo[g,h,i]perylene, pyrene and benzo[a]pyrene, besides the 3-pentadecilfenol allergen (urushiol analogue) as prevalent. Occupational exposure to PAHs was confirmed by the increase of urinary 1-hydroxypyrene levels and genotoxic effects were evidenced by the increase on micronuclei and nuclear bud frequency in exfoliated buccal mucosa cells among the exposed workers. Other biomarkers of effects such as karyorrhexis, pyknotic, karyolytic, condensed chromatin and binucleated cells also have their frequencies increased when compared to an unexposed control group. The investigation of the molecular mechanisms associated with the PM organic extract showed cytotoxicity in human lung cell lines (A549) at concentrations ≥ 4 nM BaPeq. Using non-cytotoxic doses the extract was able to activate proteins involved in the DNA damage response pathway (Chk1 and p53). Moreover, the specific contribution of the four most representative PAHs in the cashew nut roasting sample showed that benzo[a]pyrene was the most efficient to activate Chk1 and p53. Finally, the organic extract was able to increase persistently the mRNA expression involved in the PAHs metabolism (CYP1A1 and CYP1B1), inflammatory response (IL-8 and TNF-α) and cell cycle arrest (CDKN1A) for DNA repair (DDB2). The high PM concentrations and its biological effects associated warn of the serious harmful effects of artisanal cashew nut roasting and urgent actions should be taken to the sustainable development of this activity.

Caracterização do material particulado e avaliação do risco ocupacional e mecanismos moleculares associados à queima artesanal da castanha de caju

Brazil is among the largest cashew nut producers of the world. However, the roasting process is still carried out artisanally, especially in the Brazilian semiarid region. In face of this occupational problem, the aim of this study was to perform a physical-chemical characterization of the particulate matter (PM) emitted by the roasting of cashew nuts, as well as to determine the occupational risk and molecular mechanisms associated. The most evident PM characteristics were the prevalence of fine particles, typical biomass burning morphologies such as tar ball and the presence of the elements K, Cl, S, Ca and Fe. In addition, atmospheric modeling analyses suggest that these particles can reach neighboring regions of the emission source. Polycyclic aromatic hydrocarbons (PAHs) with carcinogenic potential, such as benzo[a]pyrene, dibenz[a,h]anthracene, benzo[a]anthracene, benzo[b]fluoranthene, chrysene, benzo[k]fluoranthene, indeno[1,2,3-c,d]pyrene and benzo[j]fluoranthene were the most abundant PAHs found in the two air monitoring campaigns. Among the identified oxy-PAH the benzanthrone (7H-benz[d,e]anthracen-7-one) had the highest concentration and the evaluation of lifetime cancer risk showed an increase of 12 to 37 cases of cancer for every 10,000 exposed people. Chemical analysis of roasted cashew nuts identified the PAHs: phenanthrene, benzo[g,h,i]perylene, pyrene and benzo[a]pyrene, besides the 3-pentadecilfenol allergen (urushiol analogue) as prevalent. Occupational exposure to PAHs was confirmed by the increase of urinary 1-hydroxypyrene levels and genotoxic effects were evidenced by the increase on micronuclei and nuclear bud frequency in exfoliated buccal mucosa cells among the exposed workers. Other biomarkers of effects such as karyorrhexis, pyknotic, karyolytic, condensed chromatin and binucleated cells also have their frequencies increased when compared to an unexposed control group. The investigation of the molecular mechanisms associated with the PM organic extract showed cytotoxicity in human lung cell lines (A549) at concentrations ≥ 4 nM BaPeq. Using non-cytotoxic doses the extract was able to activate proteins involved in the DNA damage response pathway (Chk1 and p53). Moreover, the specific contribution of the four most representative PAHs in the cashew nut roasting sample showed that benzo[a]pyrene was the most efficient to activate Chk1 and p53. Finally, the organic extract was able to increase persistently the mRNA expression involved in the PAHs metabolism (CYP1A1 and CYP1B1), inflammatory response (IL-8 and TNF-α) and cell cycle arrest (CDKN1A) for DNA repair (DDB2). The high PM concentrations and its biological effects associated warn of the serious harmful effects of artisanal cashew nut roasting and urgent actions should be taken to the sustainable development of this activity.