Sofrimento psíquico dos trabalhadores de uma equipe do Programa Saúde da Família na organização do trabalho

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Trabalho flexível e capital social: um estudo de caso sobre a ação dos agentes comunitários de saúde em Araraquara

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Sofrimento, conhecimento de si e corpo em Schopenhauer

Esta pesquisa busca explicar em que consiste o fundamento do sofrimento para a filosofia de Schopenhauer, especialmente segundo sua obra magna O mundo como vontade e como representação, partindo de uma concepção de natureza que espelha a Vontade em sua contradição consigo mesma, percorrer seus graus de objetivação até chegar ao “ápice” que se apresenta na consciência humana, e, através dela, compreender que o conhecimento, produzido como um apêndice para servir de auxílio na complexidade inerente a esta consciência, na realidade se comporta como um “parasita” trazendo, assim, pela via da individualidade e do corpo, uma consciência de ansiedade e impotência. Busca-se explorar o porquê da limitação desse conhecimento teórico frente a vontade e, pelo sentido contrário, explicitar a sentimentalidade, enquanto via de acesso a essa vontade, no corpo, torna-se como uma saída possível para a percepção de si, a qual, se for trabalhada em conjunto com o conhecimento teórico, oferece uma “melhor consciência” frente ao inexorável sofrimento.

Retorno à atividade reprodutiva de touro angus após fimose traumática com obliteração parcial da luz prepucial: relato de caso

The main disturbs affecting the genital segment of bulls are balanitis, phimosis and preputial injuries, abscesses or prolapses, resulting in decreased libido or mating ability. One case of traumatic phimosis with partial obliteration of preputial lumen is reported in Aberdeen Angus bull. During anamnesis, it was reported that the animal was unable to expose the penis and presented increased penile and preputial volume of unknown etiology after being submitted to a libido test. During clinical examination, a firm preputial mass of 15 cm in diameter was observed in the middle third of the prepuce and stenosis of preputial lumen was detected approximately 17 cm from the preputial orifice. Reconstructive surgery was the chosen therapy, with amputation of the affected foreskin portion. A skin segment of about 12 cm and affected mucosal portion were removed. Postoperative therapy consisted of dressing with chlorhexidine digluconate based ointment, povidone iodine and topical insect repellent (cypermethrin and carbamyl), systemic antibiotic therapy with benzathine penicillin (30,000 IU / kg, repeated after 48 hours) and anti-inflammatory therapy with flunixin meglumine (2 , 0 mg / kg SID) for three days. After twenty days, semen was collected by massage of the accessory glands. The ejaculate volume was 3 mL, with 200x106 spermatozoa / mL, white color, "suis generis" odor, 88% of motile sperm, 64% of progressively motile sperm and 82% of rapid sperm. Thus, the chosen surgical treatment was effective to correct the pathology and reintroduce the animal into reproductive activity

The Effectiveness of Psychological Interventions for the Treatment of Erectile Dysfunction: Systematic Review and Meta-Analysis, Including Comparisons to Sildenafil Treatment, Intracavernosal Injection, and Vacuum Devices

In contrast to the impressive advances in somatic research of erectile dysfunction (ED), scientific literature shows contradictory reports on the results of psychotherapy for the treatment of ED. Authors conducted a meta-analysis to evaluate the effectiveness of psychological interventions for the treatment of ED compared to oral drugs, local injection, vacuum devices, or other psychological intervention. Distinct sources of randomized controlled trials (RCTs) were searched: electronic databases (between 1966 and 2007), cross checking of references, and contact with scientific societies. For dichotomous outcomes the pooled relative risks were calculated and for continuous outcomes mean differences between interventions. Statistical heterogeneity was addressed. Eleven RCTs involving 398 men met the inclusion criteria. There is evidence that group therapy improves ED. Focused sex group therapy showed greater efficacy than control group. Men randomized to receive psychotherapy plus sildenafil showed significant improvement of ED and were less likely than those receiving only sildenafil to drop out. Regarding to the effectiveness of psychological interventions for the treatment of ED compared to local injection and vacuum devices no difference was found. Melnik T, Soares BGO, and Nasello AG. The effectiveness of psychological interventions for the treatment of erectile dysfunction: Systematic review and meta-analysis, including comparisons to sildenafil treatment, intracavernosal injection, and vacuum devices. J Sex Med 2008;5:2562-2574.

Family Health Strategy Professionals Facing Medical Social Needs: difficulties and coping strategies

Professionals of Family Health Strategy (FHS) work in communities where there are complex medical social problems. These contexts may lead them to psychological suffering, jeopardizing their care for the users, and creating yet another obstacle to the consolidation of FHS as the primary health care model in Brazil. The study investigated the difficulties and coping strategies reported by health professionals of the FHS teams when they face medical social needs of the communities where they work. Focus groups and semi-structured interviews were carried out with 68 professionals of three primary care units in the city of Sao Paulo (Southeastern Brazil). Drug dealing and abuse, alcoholism, depression and domestic violence are the most relevant problems mentioned by the study group. Professionals reported lack of adequate training, work overload, poor working conditions with feelings of professional impotence and frustration. To overcome these difficulties, professionals reported collective strategies, particularly experience sharing during team meetings and matrix support groups. The results indicate that the difficulties may put the professionals in a vulnerable state, similar to the patients they care for. The promotion of specialized and long term support should be reinforced, as well as the interaction with the local network of services and communities leaders. That may help professionals to deal with occupational stress related to medical and social needs present in their routine work; in the end, it may as well contribute to the strengthening of FHS.

Moderate/severe erectile dysfunction in patients with antiphospholipid syndrome

Purpose: To evaluate sexual function of antiphospholipid syndrome (APS) patients using the Brazilian version of the validated International Index of Erectile Function (IIEF). Materials and methods: Eleven APS male patients (Sapporo criteria) were age and race-matched with 22 healthy controls. Demographic and clinical data, drug use and antiphospholipid antibodies were evaluated. The IIEF was also self-applied. Results: Mean age (p = 0.114), frequency of Caucasian race (p = 1.00) and married status (p = 0.438) were similar in APS and controls. Mean disease duration was 8.8 +/- 4.6 years. Erectile dysfunction (ED) was frequently observed in APS versus controls (45.5 vs. 4.5%, p = 0.0096), especially moderate/severe ED (p = 0.0081). The total IIEF score (49.6 vs. 67.1, p = 0.019), erectile function (19.6 vs. 28.1, p = 0.005) and intercourse satisfaction (7.8 vs. 11.9, p = 0.009) were lower in patients than in controls. No differences were seen in orgasmic function (p = 0.114), sexual desire (p = 0.123) or overall satisfaction (p = 0.097) between the groups. The comparison between APS patients with ED (n = 5) and without ED (n = 6) revealed more arterial events in APS with ED (100 vs. 16.7%, p = 0.0152), and also longer disease duration (12 [7-16] vs. 5.5 [2-13] years, p = 0.031). A trend towards lower venous events (20 vs. 83.3%, p = 0.0801) and higher renal thrombotic microangiopathy (60% vs. 0, p = 0.0606) was observed in APS patients with ED. Demographics, clinical manifestations, smoking and antiphospholipid antibodies positivity were similar in both groups. Conclusion: To our knowledge, this was the first study that demonstrated moderate/severe ED in almost 50% of cases of a rare autoimmune disease. This alteration was linked to arterial events and longer disease duration. Lupus (2012) 21, 319-323.

Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial

Erectile dysfunction (ED) and urinary incontinence are common complications following radical prostatectomy (RP). Although pelvic-floor biofeedback training (PFBT) may improve urinary continence following RP, its effects on the recovery of potency are unknown. Fifty-two patients selected for RP were prospectively randomized for a treatment group (n=26) receiving PFBT once a week for 3 months and home exercises or a control group (n=26), in which patients received verbal instructions to contract the pelvic floor. Erectile function (EF) was evaluated with the International Index of Erectile Function-5 (IIEF-5) before surgery and 1, 3, 6 and 12 months postoperatively. Patients were considered potent when they had a total IIEF-5 score >20. Continence status was assessed and defined as the use of no pads. Groups were comparable in terms of age, body mass index, diabetes, pathological tumor stage and neurovascular bundle preservation. A significant reduction in IIEF-5 scores was observed after surgery in both groups. In the treatment group, 8 (47.1%) patients recovered potency 12 months postoperatively, as opposed to 2 (12.5%) in the control group (P=0.032). The absolute risk reduction was 34.6% (95% confidence interval (CI): 3.8-64%) and the number needed to treat was 3 (95% CI: 1.5-17.2). A strong association between recovery of potency and urinary continence was observed, with continent patients having a 5.4 higher chance of being potent (P=0.04). Early PFBT appears to have a significant impact on the recovery of EF after RP. Urinary continence status was a good indicator of EF recovery, with continent patients having a higher chance of being potent.

Circulating matrix metalloproteinases and their endogenous inhibitors in patients with erectile dysfunction

Erectile dysfunction (ED) may reflect vascular alterations associated with imbalanced matrix metalloproteinases (MMPs) activities. However, no previous study has compared MMPs levels in ED patients with those found in healthy subjects. We measured the circulating MMP-2, MMP-9, TIMP-1 and TIMP-2 levels in ED patients, with or without diabetes mellitus (DM), and in healthy controls. We studied 28 healthy men (control group), 35 men with ED (ED group), and 33 men with ED and DM (ED/DM group). MMP-2, MMP-9, TIMP-1 and TIMP-2 plasma levels were measured by enzyme-linked immunosorbent assay and zymography. We found no differences in MMP-9 levels (P>0.05) among groups. However, while patients in the ED group had similar TIMP-1 levels compared with those found in the control group, we found higher TIMP-1 levels and lower MMP-9/TIMP-1 ratios in the ED/DM group compared with controls (P<0.05). While both groups of patients (ED and ED/DM) had slightly lower MMP-2 levels compared with controls (P<0.05), we found no differences in TIMP-2 levels among the study groups (P>0.05), and no differences in MMP-2/TIMP-2 ratios (P>0.05). We found evidence indicating lack of significant alterations in circulating net MMP-9 and MMP-2 activities in patients with ED, and lower net MMP-9 activity in diabetic patients with ED. International Journal of Impotence Research (2012) 24, 38-43; doi:10.1038/ijir.2011.44; published online 15 September 2011

Satisfaction with the treatment, confidence and 'naturalness' in engaging in sexual activity in men with psychogenic erectile dysfunction: preliminary results of a randomized controlled trial of three therapeutic approaches

OBJECTIVE To assess the efficacy of group psychotherapy (GTP) and/or sildenafil for psychogenic erectile dysfunction (ED). PATIENTS AND METHODS A randomized controlled single-blind trial was performed at the Institute of Psychiatry of the Medical School of at Universidade de Sao Paulo, Sao Paulo, Brazil. In all, 30 men with mild and moderate psychogenic ED were randomized to receive for 6 months: GPT plus 50 mg sildenafil on-demand, or 50 mg sildenafil on-demand exclusively, or GPT exclusively. Changes in score from baseline for three questions of the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) were evaluated at endpoint and after 3-months follow-up. RESULTS Satisfaction with the treatment, confidence and 'naturalness' increased in the GPT plus sildenafil and GPT exclusively groups (P = 0.001) from baseline to endpoint. The treatment-by-time comparison was not significant at endpoint vs the 3-month follow-up, in the three groups. There was no difference in the sildenafil group in the three study periods (P > 0.05) CONCLUSION Men with mild and moderate psychogenic ED had higher treatment satisfaction, confidence and naturalness in engaging in sexual activity when receiving GPT plus sildenafil or GP exclusively, when compared with sildenafil exclusively, as assessed by these three EDITS questions after 6-months treatment.

Role of adenosine signaling in penile erection and erectile disorders.

INTRODUCTION: Penile erection is a hemodynamic process, which results from increased flow and retention of blood in the penile organ due to the relaxation of smooth muscle cells. Adenosine, a physiological vasorelaxant, has been shown to be a modulator of penile erection. AIM: To summarize the research on the role of adenosine signaling in normal penile erection and erectile disorders. MAIN OUTCOME MEASURES: Evidence in the literature on the association between adenosine signaling and normal and abnormal penile erection, i.e., erectile dysfunction (ED) and priapism. METHODS: The article reviews the literature on the role of endogenous and exogenous adenosine in normal penile erection, as well as in erectile disorders namely, ED and priapism. RESULTS: Adenosine has been shown to relax corpus cavernosum from various species including human in both in vivo and in vitro studies. Neuromodulatory role of adenosine in corpus cavernosum has also been demonstrated. Impaired adenosine signaling through A(2B) receptor causes partial resistance of corpus cavernosum, from men with organic ED, to adenosine-mediated relaxation. Increased level of adenosine has been shown to be a causative factor for priapism. CONCLUSION: Overall, the research reviewed here suggests a general role of exogenous and endogenous adenosine signaling in normal penile erection. From this perspective, it is not surprising that impaired adenosine signaling is associated with ED, and excessive adenosine signaling is associated with priapism. Adenosine signaling represents a potentially important diagnostic and therapeutic target for the treatment of ED and priapism.

Trazo de un encuentro : los límites de la teoría frente a la práctica política en la lectura althusseriana de Maquiavelo

La producción teórica de Louis Althusser forja una alianza entre materialismo y política que asedia los espacios comunes de la tradición teórica marxista. Para Althusser, las posibilidades de actualizar la teoría, de transformarla en una herramienta útil para el análisis y la formulación de estrategias acordes a los problemas planteados por la coyuntura, implica un trabajo sobre los conceptos tal como se encontraban en la teoría marxista clásica. En la crisis manifiesta del movimiento comunista internacional se expresa el correlato entre impotencia teórica y fracaso político. Por esta razón, y aun considerando los cambios de acento que se registran a lo largo de sus escritos, su discurso insiste en señalar los bloqueos e insuficiencias conceptuales de la teoría, los “límites absolutos" que anidan en la adherencia idealista de parte de las formulaciones de Marx. En los límites que traza sobre la teoría marxista y llevando la alianza entre materialismo y política más allá de Marx, Althusser encuentra a Maquiavelo. Nos proponemos indagar cómo este rodeo permite a Althusser replantear, no sin desplazamientos, la relación entre teoría y práctica política, en el horizonte de volver a la primera permeable a los matices que la coyuntura imprime sobre la segunda.

DIRETOR DE ESCOLA: GERENTE OU EDUCADOR? POSSIBILIDADES E LIMITAÇÕES DO DESENVOLVIMENTO DA FUNÇÃO PEDAGÓGICA EM UMA ESCOLA PÚBLICA ESTADUAL PAULISTA

Há tempo, as dificuldades enfrentadas pelos diretores de escola da rede pública estadual de São Paulo constituem motivo de inquietação e impotência, pois estes têm seu trabalho engessado pela rotina burocrático-administrativa, a qual dificulta o desempenho das atividades pedagógicas. Este trabalho centra-se no estudo das possibilidades e limites no desenvolvimento da função pedagógica do Diretor de Escola, aliás, Gerente ou Educador? Nesta pesquisa utiliza-se dos documentos da Unidade Escolar, desde sua fundação em 1985 até 2007, para se entender o desenvolvimento da função de diretor de escola, neste duplo aspecto burocráticoadministrativo e pedagógico. Desta forma, foram abordadas as seguintes questões: quais são as solicitações e exigências da Secretaria de Estado da Educação de São Paulo (SEE-SP) e dos órgãos a ela subordinados em relação às atividades desenvolvidas cotidianamente pelo diretor de escola? Quais as incumbências objetivas que o diretor de escola tem que responder para a SEE-SP? A partir disso, quais são as possibilidades e os limites do diretor para desenvolver a função pedagógica no ambiente escolar? A hipótese aventada é que, o diretor de escola não consegue centrar-se no desenvolvimento das atividades pedagógicas em face do atendimento às exigências burocrático-administrativas da SEE-SP e dos órgãos a ela subordinados, os quais condicionam sua atividade profissional. Pretende-se com este estudo contribuir para o debate acerca da prática da gestão escolar e da reflexão da função e do papel do diretor de escola no processo de transformação econômico-político-social. A apresentação desta pesquisa está estruturada em três capítulos. As considerações finais apontam que o diretor de escola, devido ao grande número de solicitações e exigências de tarefas burocrático-administrativas, emanadas do poder central e de seus órgãos subordinados, vê comprometido o desempenho das funções pedagógicas.(AU)

DIRETOR DE ESCOLA: GERENTE OU EDUCADOR? POSSIBILIDADES E LIMITAÇÕES DO DESENVOLVIMENTO DA FUNÇÃO PEDAGÓGICA EM UMA ESCOLA PÚBLICA ESTADUAL PAULISTA

Há tempo, as dificuldades enfrentadas pelos diretores de escola da rede pública estadual de São Paulo constituem motivo de inquietação e impotência, pois estes têm seu trabalho engessado pela rotina burocrático-administrativa, a qual dificulta o desempenho das atividades pedagógicas. Este trabalho centra-se no estudo das possibilidades e limites no desenvolvimento da função pedagógica do Diretor de Escola, aliás, Gerente ou Educador? Nesta pesquisa utiliza-se dos documentos da Unidade Escolar, desde sua fundação em 1985 até 2007, para se entender o desenvolvimento da função de diretor de escola, neste duplo aspecto burocráticoadministrativo e pedagógico. Desta forma, foram abordadas as seguintes questões: quais são as solicitações e exigências da Secretaria de Estado da Educação de São Paulo (SEE-SP) e dos órgãos a ela subordinados em relação às atividades desenvolvidas cotidianamente pelo diretor de escola? Quais as incumbências objetivas que o diretor de escola tem que responder para a SEE-SP? A partir disso, quais são as possibilidades e os limites do diretor para desenvolver a função pedagógica no ambiente escolar? A hipótese aventada é que, o diretor de escola não consegue centrar-se no desenvolvimento das atividades pedagógicas em face do atendimento às exigências burocrático-administrativas da SEE-SP e dos órgãos a ela subordinados, os quais condicionam sua atividade profissional. Pretende-se com este estudo contribuir para o debate acerca da prática da gestão escolar e da reflexão da função e do papel do diretor de escola no processo de transformação econômico-político-social. A apresentação desta pesquisa está estruturada em três capítulos. As considerações finais apontam que o diretor de escola, devido ao grande número de solicitações e exigências de tarefas burocrático-administrativas, emanadas do poder central e de seus órgãos subordinados, vê comprometido o desempenho das funções pedagógicas.(AU)

Cases of divorce for several causes : viz. I. Memoirs of the life of Robert Feilding esq; containing an account of his amours ... and a true copy of his last will and testament. II. The case of Barbara late Dutchess of Cleaveland, with the whole proceedings between Her Grace, and Major-General Feilding in Doctors-Commons ... III. The case of John Dormer, esq. IV. The case of Sir George Downing, bart. and Mrs. Mary Forester. V. Depositions taken in the Lady Howard's case : also the judgment of the most eminent divines, &c. concerning the dissolution of marriage.

ESTC