MEDICAL STUDENT IN THE FAMILY HEALTH STRATEGY ON THE FIRST YEARS OF COLLEGE: PERCEPTION OF GRADUATES

There is a lack of knowledge about the effective value of the experience gained by medical students who participate in the Family Health Strategy (Estratégia Saúde da Família (ESF)) during the early stages of their medical training. This teaching strategy is based on learning by experiencing the problems that exist in real life. This study proposed to understand the value of this teaching strategy from the viewpoint of the students who had participated, after their graduation. The method adopted was a qualitative study conducted through interviews with students who graduated in the years 2009, 2010 and 2011. The data analysis used the hermeneutic dialectic technique as its model. The graduates considered that this experience enabled them to understand the organization and functioning of the health service and the context of the daily life of the users. This experience facilitated the doctor patient relationship, the development of clinical reasoning and the bond with the user. However the students emphasized that a lack of maturity prevented them gaining a higher level of benefit from the experience. Therefore, although the structure of the course is permeated by advances and challenges, it was concluded that this experience contributed to the student's learning of certain essential elements of medical training.

Chemotherapy-induced peripheral neuropathies: an integrative review of the literature

OBJECTIVE: To identify scientific studies and to deepen the knowledge of peripheral neuropathies induced by chemotherapy antineoplastic, seeking evidence for assistance to cancer patients. METHOD: Integrative review of the literature conducted in the databases Latin American and Caribbean Health Sciences (LILACS), Scientific Electronic Library Online (SciELO), Medical Literature Analysis (PubMed/MEDLINE), the Cochrane Library and the Spanish Bibliographic Index Health Sciences (IBECS). RESULTS: The sample consisted of 15 studies published between 2005-2014 that met the inclusion criteria. Studies showed aspects related to advanced age, main symptoms of neuropathy and chemotherapy agents as important adverse effect of neuropathy. CONCLUSION: We identified a small number of studies that addressed the topic, as well as low production of evidence related to interventions with positive results. It is considered important to develop new studies proposed for the prevention and/or treatment, enabling adjustment of the patient's cancer chemotherapy and consequently better service.

Managers' perspective on continuous health education in a region of São Paulo State

OBJECTIVEAnalysing the concepts of Continuous Health Education - CHE (EPS - in Portuguese), operated by municipal managers and translated into official documents.METHODQualitative research with the use of official documents and semi-structured interviews with the Municipal Health Secretaries or Coordinators of Primary Health Care in the Northeast Region of São Paulo State, and thematic analysis of empirical material.RESULTSResults indicate difficulties in the municipalities problematizing their management practices, services and health care; EPS tools presented are insufficient and unsatisfactory for amending the array of problems raised and are still far from the routine of Primary Care services.CONCLUSIONDespite efforts to implement EPS actions for the strengthening of primary care, the process appears to be incipient.

Participation of nurses in the execution of clinical research protocol about technological innovation

AbstractOBJECTIVETo report the nurse's experience of inclusion in interdisciplinary clinical study about technological innovation, involving people with spinal cord injury.METHODDescriptive experience report. The empirical support was based on notes about perspectives and practice of clinical research, with a multi-professional nursing, physical education, physiotherapy and engineering staff.RESULTThe qualification includes the elaboration of the document for the Ethics Committee, familiarization among the members of staff and with the studied topic, and also an immersion into English. The nurse's knowledge gave support to the uptake of participants and time adequacy for data collection, preparation and assistance of the participants during the intervention and after collection. Nursing theories and processes have contributed to reveal risky diagnoses and the plan of care. It was the nurse's role to monitor the risk of overlapping methodological strictness to the human aspect. The skills for the clinical research must be the object of learning, including students in multidisciplinary researches.CONCLUSIONTo qualify the nurse for clinical research and to potentialize its caregiver essence, some changes are needed in the educational system, professional behavior, attitude and educational assistance.

Padrão de intervenções de enfermagem realizadas em vítimas de trauma segundo o Nursing Activities Score

RESUMO Objetivo Identificar o padrão de intervenções de enfermagem realizadas em vítimas de trauma nas primeiras 24 horas de internação na Unidade de Terapia Intensiva (UTI). Método Estudo prospectivo, realizado na UTI de um hospital em São Paulo, Brasil. O instrumento Nursing Activities Score (NAS) foi utilizado para identificar as intervenções de enfermagem. Resultados A casuística foi composta por 200 pacientes, a maioria homens, com idade média de 40,7 anos, vítimas de acidentes de transporte. A média do NAS foi de 71,3% e o padrão de intervenções de enfermagem identificado incluiu as atividades de monitorização e controles; investigações laboratoriais; medicação, exceto drogas vasoativas; procedimentos de higiene; cuidados com drenos; mobilização e posicionamento; suporte e cuidado aos familiares e pacientes; tarefas administrativas e gerenciais; suporte respiratório; cuidado com vias aéreas artificiais; e tratamento para melhora da função pulmonar. Nas intervenções de monitorização e mobilização, houve a necessidade de cuidados além do normalmente requerido por pacientes de UTI. Conclusão Os resultados desta pesquisa trazem importantes contribuições para o planejamento de ações que visem a capacitação e o dimensionamento da equipe de enfermagem na unidade crítica.

Desempenho dos ajustes do Trauma and Injury Severity Score (TRISS): revisão integrativa

RESUMO Objetivo identificar estudos que realizaram ajustes na equação do Trauma and InjurySeverity Score (TRISS) e compararam a capacidade discriminatória da equação modificada com a original. Método Revisão integrativa de pesquisas publicadas entre 1990 e 2014 nas bases de dados LILACS, MEDLINE, PubMed e SciELO utilizando-se a palavra TRISS. Resultados foram incluídos 32 estudos na revisão. Dos 67 ajustes de equações do TRISS identificados, 35 (52,2%) resultaram em melhora na acurácia do índice para predizer a probabilidade de sobrevida de vítimas de trauma. Ajustes dos coeficientes do TRISS à população de estudo foram frequentes, mas nem sempre melhoraram a capacidade preditiva dos modelos analisados. A substituição de variáveis fisiológicas do Revised Trauma Score (RTS) e modificações do Injury Severity Score (ISS) na equação original tiveram desempenho variado. A mudança na forma de inclusão da idade na equação, assim como a inserção do gênero, comorbidades e mecanismo do trauma apresentaram tendência de melhora do desempenho do TRISS. Conclusão Diferentes propostas de ajustes no TRISS foram identificadas nesta revisão e indicaram, principalmente, fragilidades do RTS no modelo original e necessidade de alteração da forma de inclusão da idade na equação para melhora da capacidade preditiva do índice.

Cost of nursing turnover in a Teaching Hospital

Abstract OBJECTIVE To map the sub processes related to turnover of nursing staff and to investigate and measure the nursing turnover cost. METHOD This is a descriptive-exploratory study, classified as case study, conducted in a teaching hospital in the southeastern, Brazil, in the period from May to November 2013. The population was composed by the nursing staff, using Nursing Turnover Cost Calculation Methodology. RESULTS The total cost of turnover was R$314.605,62, and ranged from R$2.221,42 to R$3.073,23 per employee. The costs of pre-hire totaled R$101.004,60 (32,1%), and the hiring process consumed R$92.743,60 (91.8%) The costs of post-hire totaled R$213.601,02 (67,9%), for the sub process decreased productivity, R$199.982,40 (93.6%). CONCLUSION The study identified the importance of managing the cost of staff turnover and the financial impact of the cost of the employee termination, which represented three times the average salary of the nursing staff.

New record of Pterotaenia fasciata (Wiedemann) (Diptera, Ulidiidae) in Brazil, a probably mechanical vector of enteric bacteria

Pterotaenia fasciata is commonly recorded in rural areas in Argentina, but during a Diptera survey study developed in a reservoir which retains storm water from polluted canals in an urban area of Taboão da Serra municipality, SP, Brazil, we could capture P. fasciata adults. Enteric bacteria Escherichia coli T. Escherich, 1885 and Proteus sp. were isolated from P. fasciata collected in traps inside the reservoir and around it. Fecal coliforms and E. coli were found in the water of the reservoir. These records suggest that a high abundance of this species at urban areas with inadequate sewage canals should reveal these muscoid dipterans as mechanical vectors of enteric bacteria.

Diversity of Ephemeroptera (Insecta) of the Serra da Mantiqueira and Serra do Mar, southeastern Brazil

The aim of this study was to inventory the mayfly fauna, based on nymphal and alate stages, in Serra da Mantiqueira and in Serra do Mar, São Paulo State, as well as to present information about habitats used by the genera. Nymphs were collected in several streams and mesohabitats with a Surber sampler and the winged stages with light attraction methods, entomological nets, and Malaise traps. In all, eight families and 33 genera were recorded, representing a very significant portion of the Brazilian fauna (80% of families and 49% of genera). Furthermore, it was possible to identify 11 species, of which two are new records for the state: Tricorythodes santarita Traver and Caenis reissi Malzacher. Despite the high diversity recorded, the accumulation curves presented an ascending form, indicating an increase in the number of genera with additional sampling effort. The high richness found in these areas are in agreement with the high biodiversity of the Atlantic Forest biome and the sampling effort employed, which included the use of different methods, the collection of both nymphs and winged stages, and the sampling of a large area with diverse streams and habitats.

Effects of forest conversion on the assemblages' structure of aquatic insects in subtropical regions

The effects of forest conversion to agricultural land uses on assemblages of aquatic insects were analyzed in subtropical streams. Organisms and environmental variables were collected in six low-order streams: three streams located in a forested area, and three in areas converted to agricultural land uses. We expected that the aquatic insects' assemblage attributes would be significantly affected by forest conversion, as well as by environmental variables. Streams in converted areas presented lower species richness, abundance and proportion of sensitive insect taxa. The ANOSIM test evidenced strong difference in EPT assemblage structure between streams of forested and converted areas. The ISA test evidenced several EPT genera with high specificity to streams in forested areas and only one genus related to streams in converted areas. Thus, the impacts of the conversion of forested area to agricultural land uses have significantly affected the EPT assemblages, while environmental variables were not affected. We suggest that the effects detected can be influenced by two processes related to vegetation cover: i) lower input of allochthonous material, and ii) increased input of fine sediments in streams draining converted areas.

Desempenho do tensiômetro, TDR e sonda de nêutrons na determinação da umidade e condutividade hidráulica do solo

Técnicas que envolvem a utilização da instrumentação agronômica com vistas em determinar o conteúdo de água no solo são de grande importância para a pesquisa científica. Independentemente da técnica utilizada, é importante que, na determinação da função K(teta), por exemplo, a umidade volumétrica seja determinada de forma precisa e, de preferência, que haja facilidade na sua obtenção. Com o objetivo de comparar a performance da sonda de nêutrons e do TDR com o tensiômetro, buscando verificar a sensibilidade destes equipamentos na obtenção da umidade do solo e da função condutividade hidráulica K(teta), a partir dos dados da curva de retenção de água no solo, foi instalado um experimento no município de Piracicaba (SP), em um Nitossolo Vermelho distrófico latossólico. Para tanto, foram instalados numa área de 7,07 m², 30 tensiômetros, três tubos de acesso para sonda de nêutrons e 15 sensores de TDR. Foi utilizado o procedimento do perfil instantâneo, analisando as profundidades de 0,70 e 1,00 m e considerando, no presente estudo, o tensiômetro como equipamento-padrão. Os resultados de umidade e de condutividade hidráulica não saturada obtidos na profundidade de 0,70 m mostraram que o TDR apresentou um comportamento mais próximo ao obtido pelo tensiômetro, quando comparado à sonda de nêutrons e, na profundidade de 1,00 m, a sonda de nêutrons mostrou-se mais eficiente na determinação da umidade e da condutividade hidráulica não saturada.

Hidrólise da uréia em latossolos: efeito da concentração de uréia, temperatura, pH, armazenamento e tempo de incubação

Este trabalho objetivou estudar a velocidade de hidrólise da uréia em dois diferentes solos brasileiros (Latossolo Vermelho Aluminoférrico típico e Latossolo Vermelho distrófico típico) onde foram realizados ensaios sobre o efeito do tempo e condições de armazenamento, concentração do substrato (uréia), temperatura, pH e tempo de incubação sobre a atividade da urease. As melhores condições de armazenamento foram em temperatura ambiente ou 5 ºC, após secagem ao ar, por um período de até 7 dias; para as condições estudadas, o melhor tempo de incubação foi de uma hora a 25-30 ºC, sem a utilização de tampão para acertar o pH, e a concentração de uréia suficiente foi de 3,30 g L-1, para o Latossolo Vermelho Aluminoférrico típico, e de 2,5 g L-1, para o Latossolo Vermelho distrófico típico para obter a velocidade máxima da enzima.

Desafios técnicos e barreiras sociais,econômicas e regulatórias na fitorremediação de solos contaminados

A fitorremediação - uso de plantas e comunidades microbianas associadas à rizosfera para degradar, isolar ou imobilizar contaminantes do solo e água - é uma técnica de custo relativamente baixo, vantagens estéticas e que não gera impactos adicionais. A maioria dos estudos com plantas na recuperação de áreas contaminadas tem sido desenvolvida em países de clima temperado, onde o potencial da fitorremediação é limitado por fatores climáticos. No Brasil, o conhecimento acerca do potencial fitorremediador das várias espécies de plantas e comunidades microbianas em solos tropicais é ainda muito escasso, o que, associado à falta de instrumentos de aferição e de apoio à decisão, dificulta a recomendação por parte das agências ambientais e empresas. A presente revisão descreve brevemente os mecanismos de fitorremediação e discute aspectos sociais, econômicos e reguladores que representam entraves ao amplo desenvolvimento da técnica, em comparação com técnicas convencionais, mais conhecidas e aceitas pelas agências e empresas. Finalmente, o mercado brasileiro presente e futuro é discutido, sendo sugerida a criação de protocolos experimentais e instrumentos de apoio à decisão que estimulem a aplicação da fitorremediação nos casos em que ela se apresente como a opção mais adequada.

Growth, nodulation and nitrogen fixation of cowpea in soils amended with composted tannery sludge

Tannery wastes generation is increasing every year and a suitable method for tannery sludge management is necessary in order to decrease this environmental problem. The composting is recognized as a suitable method for sludge recycling.. The effect of tannery sludge compost (TSC) rates on growth, nodulation and N fixation of cowpea was investigated. Sandy and clayey soils were amended with TSC at rates of 0, 7.5, 15, 30, and 60 t ha-1. The shoot dry weight of cowpea plants 45 days after emergence (DAE) was greater in the TSC-amended than in the unamended soil. In the sandy soil, nodule dry weight increased with TSC application 45 DAE. In the clayey soil, 45 DAE, nodule dry weight decreased with TSC amendment levels greater than 7.5 t ha-1 compared to the unamended control. The application of TSC increased N accumulation in the cowpea plants. The results suggest that cowpea responds differently to TSC depending on the amendment rate and initial soil type.