Atendimento psicológico a estudantes universitários: considerações acerca de uma experiência em clínica-escola

O presente estudo tem como objetivo descrever o Programa de Pronto-Atendimento Psicológico ao Aluno (PPAPA). Trata-se de um serviço de atendimento psicológico oferecido gratuitamente junto à clínica-escola da Faculdade de Ciências e Letras de Assis (UNESP) e voltado exclusivamente à comunidade discente interna. Apresentaremos ao longo do artigo uma breve caracterização do serviço, algumas considerações acerca das modalidades de atendimento e estratégias de intervenção empregadas e uma sucinta problematização do manejo de questões técnicas e éticas. Por fim, alinhavaremos algumas propostas para a reestruturação do serviço.

Uma experiência de pronto atendimento em saúde mental coletiva

Este artigo apresenta a reflexão sobre uma experiência de atendimento em grupo na porta de um serviço de Saúde Mental Coletiva de um município do Estado de São Paulo com 30 mil habitantes. Com a análise de dados referentes ao atendimento inicial desta instituição denominado Pronto Atendimento (PA), em especial as filas de espera em psiquiatria e em psicoterapia, considerou-se que o PA pode operar como um analisador, uma vez que é nesse atendimento que os usuários que procuram ajuda na instituição apresentam suas queixas e os seus pedidos de ajuda. É também a partir desse atendimento que a instituição, por meio de seus profissionais, oferece as possibilidades terapêuticas. A análise efetuada permitiu apontar que esse atendimento pode constituir ações que reforçam o paradigma psiquiátrico dominante ou ações que podem contribuir na construção do modelo psicossocial, partindo de mudanças da própria representação social da instituição, do sofrimento psíquico e dos recursos terapêuticos de cura.

Encontrando-se em casa: uma proposta de atendimento domiciliar para famílias de idosos dependentes

OBJETIVO: Este estudo qualitativo teve por objetivo descrever como um sistema familiar reage perante a situação de dependência em um membro idoso, quais recursos utiliza para manter sua estabilidade e a assistência de enfermagem disponibilizada neste contexto. MÉTODOS: Utilizou-se como referencial teórico a abordagem dos sistemas familiares e como método a pesquisa-ação. Os dados foram colhidos de novembro de 2004 a janeiro de 2005, utilizando-se o genograma, o ecomapa e o levantamento de problemas. RESULTADOS: Principais demandas familiares: luto antecipado, sobrecarga do papel de cuidador, falta de conhecimento sobre a doença e desajustamento familiar perante a crise. Principais intervenções: incentivar a narrativa da enfermidade, oferecer sugestões e informações, elogiar as forças familiares e assegurar pronto atendimento. CONCLUSÕES: Com o atendimento à família sob o enfoque sistêmico foi possível propor as intervenções de ajuda para a melhoria da qualidade de vida familiar, de maneira que ela também vislumbrasse suas próprias soluções para o enfrentamento das adversidades.

A importância da rapidez de atendimento em supermercados: um estudo de caso

Neste trabalho, analisam-se algumas causas pelas quais clientes frequentam um supermercado, tais como: preço de produtos, localização do estabelecimento, rapidez de atendimento, qualidade de atendimento, variedade de produtos, estacionamento e outras. Por meio de análise estatística multivariada, foi verificada a relevância de cada causa em contraste com as outras, ou seja, a importância relativa de cada uma. Assim, pôde-se observar que a rapidez de atendimento desempenha um papel importante em relação às demais para o nível de serviço dos clientes. Utilizando-se análise de agrupamentos hierárquicos de variáveis e análise de correspondência, associaram-se causas em grupos e relacionaram-se causas a alguns fatores, como, por exemplo, escolaridade dos clientes, sendo esta uma observação interessante por existir, no Brasil, uma relação significativa entre renda e escolaridade. A coleta de dados foi realizada em um supermercado no interior de São Paulo e, desta forma, os resultados baseiam-se em um estudo de caso, tendo limitações inferenciais.

Perfil da clientela de um programa de pronto-atendimento psicológico a estudantes universitários

Pesquisas indicam que a caracterização da clientela de clínicas-escola de Psicologia fornece elementos para o aprimoramento dos serviços oferecidos. O presente estudo propõe-se a traçar o perfil sociodemográfico e clínico dos usuários do Programa de Pronto-Atendimento Psicológico ao Aluno da UNESP/Assis. Os dados indicam que a maioria dos usuários era ingressante na universidade, oriunda do curso de Psicologia, com idade entre 19 e 22 anos, do gênero feminino, não exercia atividade profissional remunerada, apresentava dificuldades psicológicas moderadas e foi encaminhada para psicoterapia. Tal caracterização subsidiou a implementação de mudanças nos serviços já existentes e a criação de novas modalidades de atendimento.

O grupo psicoterapêutico e a interpretação na abordagem lacaniana: reflexão e redefinição de possibilidades e modos de atendimento na Saúde Coletiva

Cet article propose, à travers une expérience pratique, présenter et discuter le groupe psychothérapeutique dans le référentiel psychanalytique théorique et éthique de Jacques Lacan en mettant l'accent sur la question de l'interprétation. Nous proposons une réflexion et la redéfinition des possibilités et des modes d'accueil dans le contexte de la Santé Collective. Le groupe psychothérapeutique proposé ici, qui applique la psychanalyse, correspond à une possibilité parmi les dispositifs de production de sens pour les impasses de subjectivation de la clinique contemporaine, surtout dans la Santé Publique. La pratique présentée et analysée dans cet article est une petite contribution à une proposition de psychothérapie de groupe fondée sur la théorie de Jacques Lacan, dont le but est de repenser et redéfinir les formes d'accueil de groupe en Santé Collective.

Allelic imbalance studies of chromosome 9 suggest major differences in chromosomal instability among nonmelanoma skin carcinomas

CONTEXTO: Vários estudos de perda de heterozigozidade na região 9p21-p22, que abriga os genes supressores tumorais CDKN2a/p16INK4a, p19ARF e p15INK4b, têm sido realizados em uma ampla série de tumores humanos, incluindo os melanomas familiares. Perdas e ganhos em outras regiões do cromossomo 9 também têm sido observados com freqüência e podem indicar mecanismos adicionais no processo de tumorigênese dos carcinomas basocelulares da pele. OBJETIVO: Investigar o equilíbrio alélico existente na região 9p21-p22 em carcinomas basocelulares. TIPO DE ESTUDO: Análise molecular de marcadores de microssatélites em tumores e controles. LOCAL: Dois serviços de dermatologia de atendimento terciário em universidades públicas de São Paulo e o Laboratório de Genética Molecular do Câncer da Universidade Estadual de Campinas (UNICAMP), Brasil. PARTICIPANTES: Examinamos 13 casos benignos, incluindo 4 queratoses solares, 3 queratoacantomas, 3 nevos melanocíticos, 2 doenças de Bowen e 1 neurofibroma cutâneo, além de 58 tumores malignos da pele: 14 de células escamosas, 40 carcinomas basocelulares e 4 melanomas; em pacientes consecutivamente encaminhados à clínica de Dermatologia da Unicamp e que concordaram em participar do estudo. VARIÁVEIS ESTUDADAS: O tumor principal e uma porção normal de pele não-adjacente foram removidos cirurgicamente de pacientes que consecutivamente procuraram os ambulatórios de dermatologia da Universidade Estadual de Campinas (UNICAMP) e da Universidade Estadual de São Paulo (Unesp), São Paulo, por causa de lesões cutâneas. Extraímos DNA tanto de tecido tumoral como do correspondente tecido normal de cada paciente. Para amplificar regiões de repetição polimórfica de microssatélites do cromossomo 9, foram utilizados quatro pares de primers, sendo dois deles destinados à região 9p21-p22. RESULTADOS: Identificamos oito casos (20%) de desequilíbrio alélico entre os carcinomas basocelulares, sendo dois casos de perda de heterozigozidade e seis casos de instabilidade de microssatélite na região 9p21-p22. Outros marcadores também mostravam anormalidades em três destes tumores, enquanto nenhuma alteração foi detectada entre os casos benignos e nos outros tumores malignos. CONCLUSÃO: Esta dependência fenotípica sugere que existem diferenças importantes no comportamento das formas mais comuns de tumores cutâneos não-melanocíticos em relação à sua tendência para instabilidade de microssatélite no cromossomo 9. Considerando-se que os genes CDKN2a/p16INK4a, p19ARF e p15INK4b não parecem responsáveis pelas anormalidades observadas, outros genes em 9p21-p22 podem estar envolvidos na etiopatogenia e na progressão dos carcinomas basocelulares.

Evaluation of a double-setting alpha-tricalcium phosphate cement in eviscerated rabbit eyes

Purpose: To evaluate the macroscopy, microstructure, and tissue reaction of a double-setting a-tricalcium phosphate bone cement used as an intraocular implant in rabbits.Methods: the internal and external surface of the double-setting a-tricalcium phosphate implant was analyzed macroscopically and by scanning electron microscopy. Twelve New Zealand rabbits received 12-mm implants made of double-setting alpha-tricalcium phosphate cement after unilateral evisceration. Clinical evaluation was performed daily for the first 15 days after surgery and at 15-day intervals until the end of the study period. For histopathologic analysis, 3 animals per experimental period were submitted to enucleation at 15, 45, 90, and 180 days.Results: on gross inspection, the external surface of the implant was solid, smooth, and compact. The microarchitecture was characterized by the formation of columns of hexagonal crystals with interconnecting channels forming micropores. No wound dehiscence, signs of infection, or implant extrusion were observed in any animal throughout the study period. Histologic examination revealed the formation of fibrovascular tissue surrounding the implants, and there were signs of minimal integration of the surface limiting the fibrocellular cap with the space previously occupied by the implant.Conclusions: the double-setting alpha-tricalcium phosphate implant behaved as an inert and nonintegratable material. The lack of incorporation of this material by fibrovascular tissue is related to its characteristics of compactness and high resistance.

Evaluation of the thermal shrinkage of titanium and the setting and thermal expansion of phosphate-boded investments

Statement of problem. There are few studies on titanium casting shrinkage, and phosphate-bonded investments for titanium casting have not produced appropriate marginal fit.Purpose. The purpose of this study was to determine the thermal shrinkage of titanium and the setting and thermal expansion of 3 phosphate-bonded investments.Material and methods. The thermal shrinkage between the melting temperature and room temperature was calculated using a titanium thermal expansion coefficient. The thermal and setting expansion were measured for 3 phosphate bonded investments: Rematitan Plus (RP) specific for titanium, Rema Exakt (RE), and Castorit Super C (CA), using different special liquid concentrations (100%, 75%, and 50%). Setting expansion was measured for cylindrical specimens 50 mm long x 8 mm in diameter with a transducer. The heating and cooling curves were obtained with a dilatometer (DIL 402 PC). The total expansion curve was drawn using software, and temperatures to obtain expansion equivalent to titanium casting shrinkage were determined (n=5). In addition, the total expansion of the control group (RP at 430 degrees C) was measured, as well as the temperatures at which the other groups achieved equivalent total expansion (n=5). Data were analyzed by 1-way ANOVA and the Tukey HSD test (alpha=.05).Results. Titanium casting shrinkage was estimated as 1.55%. RP did not achieve this expansion. RE achieved expansion of 1.55% only with a special liquid concentration of 100% at 594 degrees C. CA with all special liquid concentrations attained this expansion (351 degrees C to 572 degrees C). Total expansion of the control group was 0.86%, and the other groups reached that expansion within the range of 70 degrees C to 360 degrees C.Conclusions. Only RE and CA demonstrated sufficient expansion to compensate for titanium casting shrinkage. All groups reached total expansion equivalent to that of the control group at significantly lower temperatures.

Utilization of peritoneal dialysis in the acute setting

Peritoneal dialysis (PD), although classically described and utilized in the treatment of patients with end-stage renal disease, can also be utilized in the acute setting in different clinical situations. Recent studies showed that, in patients with acute renal failure, it is possible to obtain reasonable dialysis doses with adequate metabolic and etectrolytic control and tow incidence of complications by utilizing continuous PD through a cycler at high volume. In patients with congestive heart failure without end-stage renal disease, PD is capable of promoting clinical improvement with slow removal of liquids, becoming an attractive alternative for situations of rapidly or slowly worsening cardiac function. In patients submitted to chronic hemodialysis but who have vascular access difficulties, PD can also be utilized as a bridge, thereby avoiding the use of central venous catheters, which can be associated with infectious complications such as bacterial endocarditis. New studies must be realized showing other indications for PD.

Emplacement setting of the granite sheeted pluton of Esperanca (Brasiliano orogen, Northeastern Brazil)

Anisotropy of magnetic susceptibility (AMS) and isotopic (U-Pb, Sm-Nd) data were combined to study the emplacement setting of the granite sheets that constitute the Esperanca pluton in the Borborema Province (Northeastern Brazil). The sheets dip moderately to the SE along the contact zone between the Paleoproterozoic basement rocks and Early Neoproterozoic orthogneisses and metasediments. Granite fabrics were determined mainly using AMS in 136 sites distributed within the central and western part of the pluton. The sheets normally have susceptibility lower than 0.35 mSI but, locally, where a Ti-poor magnetite appears with titanite, the susceptibility increases up to 5 mSI. Comparison between the silicate fabric and AMS showed inconsistencies between the shape of mineral and magnetic ellipsoids despite of their orientations that fit fairly well to each other. AMS indicated the deformation was partitioned between the lower (tonalite, syenogranite) and upper (leucogranite and coarse porphyritic granite) sheets. In the lower sheets the curvilinear lineation trajectory is attributed to a dominant heterogeneous pure shear event that flattened laterally the still molten tonalite and syenogranite into the regional foliation. ne associated microstructures are typically magmatic. Zircon U/Pb data of the syenogranite yielded a crystallization age of 592 +/- 5 Ma. In the upper sheets the fabric recorded a component of simple shear deformation that displaced the coarse porphyritic granite and the top gneissic host rocks to the southwest. Microstructures are mostly of post-full crystallization type. T(DM) model ages and epsilon(Nd) (t = 0) values indicate that the magma contaminated by partial melting of the regional host rocks. Sheet propagation at the emplacement level would have exploited the contact zone between crustal blocks of different rheologies when the melt pressures would be able to tensionally fail the anisotropy of the host rocks. (C) 2004 Elsevier B.V. All rights reserved.

Application of impedance spectroscopy to evaluate the effect of different setting accelerators on the developed microstructures of calcium phosphate cements

The main goal of the present study was to evaluate the effect of different setting accelerator agents on the developed microstructures of calcium phosphate cements (CPCs) by employing the impedance spectroscopy (IS) technique. Six compositions of CPCs were prepared from mixtures of commercial dicalcium phosphate anhydrous (DCPA) and synthesized tetracalcium phosphate (TTCP) as the solid phases. Two TTCP/DCPA molar ratios (1/1 and 1/2) and three liquid phases (aqueous solutions of Na(2)HPO(4), tartaric acid (TA) and oxalic acid (OA), 5% volume fraction) were employed. Initial (I) and final (F) setting times of the cement pastes were determined with Gillmore needles (ASTM standard C266-99). The hardened samples were characterized by X-ray powder diffraction (XRD), Fourier transformed infrared (FTIR) spectroscopy, scanning electron microscopy (SEM), and apparent density measurements. The IS technique was employed as a non-destructive tool to obtain information related to porosity, tortuosity and homogeneity of the cement microstructures. The formulation prepared from a TTCP/DCPA equimolar mixture and OA as the liquid phase presented the shortest I and F (12 and 20 min, respectively) in comparison to the other studied systems. XRD analyses revealed the formation of low-crystallinity hydroxyapatite (HA) (as the main phase) as well as the presence of little amounts of unreacted DCPA and TTCP after 24 h hardening in 100% relative humidity. This was related to the proposed mechanisms of dissolution of the reactants. The bands observed by FTIR allowed identifying the presence of calcium tartrate and calcium oxalate in the samples prepared from TA and OA, in addition to the characteristic bands of HA. High degree of entanglement of the formed crystals was observed by SEM in samples containing OA. SEM images were also correlated to the apparent densities of the hardened cements. Changes in porosity, tortuosity and microstructural homogeneity were determined in all samples, from IS results, when the TTCP/DCPA ratio was changed from 1/1 to 1/2. The cement formulated from an equimolar mixture of TTCP/DCPA and OA as the liquid phase presented setting times, degree of conversion to low-crystallinity HA and microstructural features suitable to be used as potential bone cement in clinical applications. The IS technique was shown to be a very sensitive and non-destructive tool to relate the paste composition to the developed microstructures. This approach could be very useful to develop calcium phosphate bone cements for specific clinical demands.

Tectonic setting and U/Pb zircon dating of the plutonic Socorro Complex in the Transpressive Rio Paraíba do Sul Shear Belt, SE Brazil

The Precambrian Rio Paraíba do Sul Shear Belt comprises a 200-km-wide anastomosing network of NE-SW trending ductile shear zones extending over 1000 km of the southeastern coast of Brazil. Granulitic, gneissic-migmatitic, and granitoid terrains as well as low- to medium-grade metavolcanosedimentary sequences are included within it. These rocks were affected by strong contractional, tangential tectonics, due to west-northwestward oblique convergence of continental blocks. Subsequent transpressional tectonics accomodated large dextral, orogen-parallel movements and shortening. The plutonic Socorro Complex is one of many deformed granites with a foliation subparallel to that of the shear belt and exposes crosscutting relationships between its tectonic, magmatic, and metamorphic structures. These relationships point to a continuous magmatic evolution related to regional thrusts and strike slip, ductile shear zones. The tectonic and magmatic structural features of the Serra do Lopo Granite provide a model of emplacement by sheeting along shear zones during coeval strike-slip and cross shortening of country rocks. Geochronological data indicate that the main igneous activity of Socorro Complex spanned at least 55 million years, from the late stage of the northwestward ductile thrusting (650 Ma), through right-lateral strike slip (595 Ma) deformation. The country rocks yield discordant age data, which reflect a strong imprint of the Transamazonian tectono-metamorphic event (1.9 to 2.0 Ma). We propose a model for the origin of calcalkaline granites of the Ribeira Belt by partial melting of the lower crust with small contributions of the lithospheric mantle during transpressional thickening of plate margins, which were bounded by deep shear zones. The transpressional regime also seems to have focused granite migration from deeper into higher crustal levels along these shear zones.

Atendimento extra-hospitalar a alcoolistas em um municipio do interior Paulista

The purpose of this work is to know the forms of minding to the alcoholics in extra-hospitable services of mental health in Botucatu municipality. This places are: Mental Health Ambulatory and School Health Center both of the Medicine College of the Paulista State University and Mental Health Ambulatory of the NGA-11. For the development of this work was realized a bibliographic raising, presented in the introduction. Four professionals that work in this assistance were interviewed. The data that was collected in the interviews were reported with the literature of the area allowing the knowledge of the main characteristics of the minding to the alcoholist in the three services that were consulted. For example: groupal minding, minding to the family and the kind of therapeutic contract.

Genetic control of fruit-setting percentage of tomatoes tolerant to high temperatures

The aim of present work was to study, through means and variances of generations, the genetic control of fruit-set percentage in tomatoes, in a biparental cross between line Jab-95 (resistant to fruit-set) and 'Caribe' cultivar (susceptible to fruit-set) after being subjected to high temperatures. F1, F2, and backcross generations for both parents (P 1, P2) were produced in a greenhouse at FCAVUNESP, Jaboticabal-SP, Brazil. A randomized complete block experimental design with four replications was used to evaluate the different generations. Estimates of genetic parameters were obtained according to Mather and Jinks (1982). An additive-dominant model was fitted to explain the variation observed. The mean degree of dominance (0.54), indicated incomplete dominance in the direction of increasing fruit-set percentage at high temperatures. The genetic control of fruit-set percentage, at high temperatures, for tomato was found to be oligogenic or polygenic (3.54 genes). The heritability in a limited sense was 83.91%, suggesting that the selection of individuals based on the characteristic evaluated can be efficient.