Validação de protocolo de assistência para pessoas com úlcera venosa na atenção primária

People with venous ulcers constitute as an important public health problem, its treatment is onerous and require assistance provided by trained professionals, systematized through protocols, however what lies in the assistance is that the management of this group of people differs from that preconized in the scientific literature, interfering with wound healing and quality of life of affected. In this sense, the construction of a assistance protocol specific to people with venous ulcers (VU) can help professionals of the Family Health Strategy both in patient assessment as and in establishment of quality assistance. Thus, this study aimed to analyse the validity of a multiprofessional assistance protocol for people with venous ulcers in primary care by health professionals using Delphi technique. This is a quantitative study, the methodological type conducted in two steps: first step related to integrative literature review to subsidize the development of the protocol, then these aspects were organized and proposed to the judges of the study through the Delphi technique. The study was initiated after approval by the Research Ethics Committee. The first step was performed between August and September 2012, in the virtual library of health, in the page of the Coordination of Improvement of Higher Education Personnel, of Municipal Health Secretariat and international guidelines of associations and in the subsequent step carried out between September 2012 to January 2013, was performed search by Lattes platform of the National Council of Technological and Scientific Development, in order to identify health professionals in Brazil who act as judges of the instrument and then, via online, the form was submitted to them.The sample for the second step was 51 judges in the first round and 35 for the second round Delphi. The analysis was done by adopting Kappa index ≥ 0.81 and Content Validity Index (CVI)> 0.80. In the first submission for the judges, items that did not reach Kappa and CVI established were: request / realization / test results, demographic data, medical history, risk factors, verification of pain / vital signs / pulse / infection signs / lesion location/ edema and pain treatment. After removal of items which have not obtained Kappa or CVI index established, it was found achieving optimal levels of these index for the categories. In the next step was the ressubmissão of protocol to judges through the Delphi technique in it was found that, of the 15 categories of the protocol, 12 presented higher scores in Delphi 2 phase and the other three categories remained the same Kappa and IVC of the previous phase. As for the average of evaluation requirements of the protocol was found that the scores assigned by the judges were higher in the second phase in nine of the 10 items, remaining the same in only one of the items indicating validity of the instrument before the consensus of the judges. Thus, we accepted the alternative hypothesis in this study, as they were obtained in the second Delphi phase the validity index greater than or equal to the Delphi 1 phase. The formulation of this assistance protocol valid and reproducible will enable a reorganization and redesign of assistance, with standardization of actions and continuity of care for persons with venous ulcers in primary health care

Qualidade da assistência e o conhecimento sobre o direito à saúde das pessoas com úlcera venosa crônica

The study aimed to identify the quality of care and knowledge of health rights of people with chronic venous ulcers (VU) in Brasilian National Health Care System (SUS). It is a cross-sectional study, with quantitative approach, performed at the University Hospital Onofre Lopes (HUOL). The study was approved by the Ethics Committee of HUOL (CAAE nº 0148.0.051.000-10). The sample by accessibility was composed for 30 people with VU treated at the outpatient surgical clinic of HUOL. For data collection we used a structured questionnaire composed of two parts: sociodemographic characteristics and of health, of care and the clinical course of VU; and knowledge of people with VU about the rights of health. The results were processed using SPSS 15.0 and analyzed by descriptive statistics. Given the characterizations sociodemographic and health presented, we identified a clientele of users with VU predominantly female (76,7%), aged from 60 years (66,7%), married/ stable union (60,0%), low education level (83,3%), family income lower than a minimum wage (73,3%), unemployeds and with chronic diseases (53,3%), sleep greater than or equal to 6 hours (76,7%) and were not alcoholics or smokers (93,3%). In relation to clinical conditions, were shown the presence of one or more relapses of VU (73,3%), predominance of granulation tissue/epithelialization in the bed of VU (60,0%), exudate serosanguineous (43,3%), in quantity medium/large (60,0%), with no predominance of presence or absence of odor (50,0%), all patients with tissue loss in grade III / IV, no signs of infection (73,3%) and presence of intense pain (50,0%). In the last 30 days the main venue of achievement of dressing was the HUOL (100,0%), the main compression therapy used was the Unna boot (60,0%) and on inability to perform the dressing on the unit were the own patients who made the exchange at home (40,0%). The majority of respondents listed out more positive factors associated with quality of care (56,7%) were satisfied with the care of SUS (76,7%), claimed to have knowledge about their rights (70,0%), but at the same time did not know the meaning of the acronym SUS (90,0%) and classified their level of information as inappropriate (70,0%). We realize that people with VU identified as good the quality of care and demonstrated inadequate knowledge about their rights to health in the SUS, but showed interest in acquiring more information. The basic rights to entry in the SUS are constitutionally guaranteed and need to be disseminated in order to make them known to the population, so it can be implemented and ensured a greater resolution assistance in treating this type of injury

Controle da neoplasia maligna do colo de útero: a resolutividade na atenção básica

A quantitative, descriptive, cross-sectional and retrospective study, using technical procedures of document consultation from secondary sources and health household survey with application form for face to face inter views, with the assent nº.039/2011 from the Ethics Committee of the Federal University of Rio Grande do Norte. The aim of this study was to analyze the cervix cancer control in the area47 of the Health Family Centre Nova Natal II. The cancer cervix is the second most common cancer among women worldwide. In Brazil screening for early detection and treatment of disease has been poorly done and follow-up to reduce mortality has not been executed. From a total of1170women belonging to area 47, who under went screening by the Pap test in the period from 2005 to 2010,was elected a sample of 38 women with positive cervical changes, over 18 years old. The calculation of frequency analysis of socio demographic and clinical and epidemiological selected variables with the results of cervical changes, using the X2 test and taking as significance level of p<0.05 was not statistically significant. The predominant age range was 25 to 64 years (68.9%), most no white women (60.5%), predominantly with primary education (57.9%), most married (68.4%) and housewives (68.4%) with early age of sexual activity (86.8%), the minority smokers (13.2%), with a sexual partner (36.8%). At the time of interview, 42.1% of the women voiced complaint of discharge, while only 2.6% reported bleeding. In relation to the occurrence of STDs (including HPV), 10.5% of women reported being a carrier. The use of oral contraceptives was 32.3% of women, from 2 to 4 years (44.4%). The result of the last screening test performed, showed prevalence of immature squamous metaplasia (55.3%), followed by intraepithelial low- grade lesion (including the cytopathologic HPV effect and cervical intra epithelial neoplasia grade I) (31.6%); intraepithelial high-grade lesion (including cervical intraepithelial neoplasia grade II and III) (7.9%), atypical squamous non neoplastic cells (5.3%). There was no squamous cell carcinoma and adenocarcinoma. Most women received information about the action that should be done after the last screening test result (55.3%), but how to perform follow, most women did not report having done so (55.3%). The follow-up group of women studied, with varying degrees of cervical abnormalities, should only be completed with the discharge by cure, established inconsecutive negative cytology, a goal that is not being achieved in the area 47 of the Health Family Centre of Nova Natal II

Avaliação da assistência à saúde dos portadores de úlceras venosas atendidos no programa saúde da família do município de Natal/RN

Descriptive research aimed at evaluating the assistance offered to patients with venous ulcers, on lower limbs, attended by the Family Health Program (FHP) team, from the municipality of Natal/RN. The target population was composed of 74 patients with venous ulcers (VU), attended by the FHP teams in the 31 FHUs. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (protocol n.55/05). The data collection was performed in patients homes and in the FHUs, through structured interviews and physical examinations of patients with VU and non-participant observation during the changing of wound dressings in these Units and in users homes. The data was organized into an Excel electronic table and transported into the SPSS 14.0 program, for descriptive analysis on 2x2 contingency tables and inferential (Qui-Square χ2, Spearman Correlation, Binomial Proportion Test and p-value <0.05). The prevalence of VU (0.36/1000) in the target population (over 20 years of age) was greater than in the population registered in FHP (0.25/1000). We detected a greater prevalence in the age area of over 60 years (2.22/1000), with 2.98/1000 for females and 1.3/1000 for males (p-value=0.008). The sociodemographical and health characteristics of patients with VU revealed predominance of females (74.5%), elders over 60 years of age (67.6%), with fundamental education (74.3%), family earnings of up to 2 minimum wages (68.9%), retired (90.5%), ortostatic position (23.0%), inadequate sleep (59,9%), presence of CVI (100.0%), hypertension (44.6%) and diabetes (25.7%). As for the time of existence of the VU, 64.9% had over 1 year, and 35.1% less than 1 year), with predominance of one wound (67.6%). The changing of wound dressings is performed mostly at home, in and inadequate way, especially with incorrect cleaning techniques, likewise incorrect use of products and substances, and reduced participation of the FHP team on the evaluation and application of the dressing and choosing of products and substances. The compressive therapy is not part of therapeutic conducts for treatment in the FHUs. As for the evaluation of assistance to patients with VU, 90.5% were inadequate and only 9.5% adequate. The main inadequacy factors were the absence of: diagnosis (47.3%), consultation with and angiologist (63.5%), compressive treatment (100.0%), adequate optical therapy (98.62%), adequate dressing kit (70.3%), training for the changing of dressings (67.6%), following by the FHP team (51.4%) and performed exams (55.4%). We ve concluded that patients with VU mostly present now socioeconomical level and associated chronic diseases. Considering that assistance offered by FHP is non-systematic, fragmented, with no diagnosis planning, continual evaluation and evolution, we qualify the assistance as inadequate and with low level of solution, directly interfering on the maintenance of the VUs chronic state

Nível crítico de fósforo no solo paraPanicum maximum Jacq. cv. Tanzânia

Foram avaliados os efeitos da aplicação de fósforo (P) em solo argiloso, de textura média e arenoso, sobre a produção de matéria seca de Panicum maximum Jacq. cv. Tanzânia. O ensaio foi conduzido em casa de vegetação, em vasos de plástico contendo 10 dm³ de solo, em esquema fatorial e delineamento inteiramente ao acaso. Após calagem para V = 70% e aplicação de 0, 35, 70, 105 e 140 mg/dm³ de P, o solo foi umedecido, e depois de 30 dias, secado e amostrado. O ensaio foi conduzido por 76 dias, a partir da emergência das plântulas, com o primeiro corte aos 48 dias, a 10 cm do solo, e o segundo, aos 76,rente ao solo. Com a aplicação de P houve aumento de produção de matéria seca, e o maior acréscimo ocorreu com a aplicação de 35 mg/dm³. A maior produção foi obtida no solo de textura média. O teor de P nas plantas estava adequado nos solos arenoso e argiloso. No de textura média, ele diminuiu com o aumento da produção,caracterizando efeito de diluição. Com aprodução relativa e o teor de P de cada solo, foi determinado o nível crítico de 38 mg/dm³ de P extraído por resina.

Influência do Nível de Energia da Dieta sobre a Expressão Hepática de Hsp70-kDa em Frangos Submetidos ao Estresse Calórico Agudo

Este trabalho foi desenvolvido com o objetivo de pesquisar o efeito da energia da dieta sobre a temperatura do cólon e concentração de proteína de choque térmico (Hsp70) de frangos à temperatura ambiente, bem como durante o estresse calórico agudo. Os frangos foram criados até 51 dias de idade e alimentados com dietas contendo nível de energia alto (13.186 kJ EM/kg) ou baixo (12.139 kJ EM/kg). No 21º e 51º dias de idade, a temperatura do cólon foi medida e amostras de fígado foram obtidas para quantificação da Hsp70 através da análise por Western Blotting.. Nessas mesmas idades, a resposta das aves ao estresse calórico agudo (37º C/5 h) foi avaliada (temperatura colón e Hsp70 no fígado). Os resultados mostraram que aos 21 dias de idade, à temperatura ambiente, a temperatura do cólon e a concentração de Hsp70 hepática não foram afetadas pela energia da dieta, mas, aos 51 dias de idade, os frangos alimentados com baixos teores de energia apresentaram menores concentrações de Hsp70 no fígado. As respostas ao estresse calórico agudo mostraram que as aves alimentadas com dietas de alta energia tiveram menor incremento na temperatura do cólon, bem como no conteúdo de Hsp70 hepático. Os resultados desse estudo sugerem que a síntese de Hsp70 no fígado pode ser afetada pela energia da dieta e que frangos alimentados com altos níveis de energia podem ter a termotolerância alterada em condições de estresse agudo pelo calor.

Características anatômicas da lâmina foliar e do colmo de gramíneas forrageiras tropicais, em função do nível de inserção no perfilho, da idade e da estação de crescimento

Foram avaliados os efeitos da idade, do nível de inserção da folha no perfilho e da estação de crescimento (verão ou outono), sobre a proporção de tecidos e a espessura da parede celular em lâminas foliares e segmentos de colmo de capim-braquiária (Brachiaria decumbens), capim-gordura (Melinis minutiflora) e capim-tifton 85 (Cynodon sp). Lâminas foliares das posições inferior e superior do perfilho foram colhidas no dia da exposição da lígula e 20 dias após. Foram determinadas as proporções relativas de epiderme, xilema, floema, bainha parenquimática dos feixes, esclerênquima, parênquima no colmo e mesofilo na lâmina foliar. Foram medidas as espessuras das paredes dos vasos de metaxilema e do esclerênquima da lâmina e do colmo. A proporção de tecidos em lâminas foliares não foi alterada pela idade nem pela estação de crescimento, sendo a espessura da parede de células do esclerênquima da lâmina a única característica modificada pela idade. Lâminas do nível de inserção superior apresentaram mais elevadas proporções de esclerênquima, bainha parenquimática dos feixes e xilema e células do esclerênquima e do metaxilema com paredes mais espessas, enquanto as lâminas do nível de inserção inferior se destacaram por apresentar mais elevada proporção de mesofilo e paredes celulares mais delgadas. Enquanto a proporção de parênquima decresceu, a área relativa de esclerênquima e as espessuras das paredes celulares variaram diretamente com a idade do colmo e foram maiores, em geral, no verão.

Redução do nível protéico da dieta, através da formulação baseada em aminoácidos digestíveis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Abordagem da ergonomia para a análise da acessibilidade de uma instituição de longa permanência para idosos da cidade de Natal-RN

This dissertation presents and discusses the results of an applied research on the accessibility of residents in a Long Term Care Institution (LTCIs) in the city of Natal- RN. The main objective of this research is to suggest projectual improvements that maximize the accessibility in a LTCIs of Natal-RN, considering the aspects of mobility, safety, comfort and independence of elderly residents. Moreover, one should consider the specific characteristics of the user population, capabilities and limitations of the biological process of aging, which causes damage to the neurological system, musculoskeletal and cardiovascular and progressively affects on visual acuity, balance and locomotion of elderly people. This research has a qualitative approach and divided into four phases: exploratory, bibliographical and documentary research, mapping of the LTCIs of Natal-RN, case study. The phase of the mapping presented an overview of accessibility on LTCIs of Natal-RN. The institution of the case study was defined based on the overall assessment of accessibility and ergonomics criteria, preceded by an application of an Ergonomic Work Analysis to understand the accessibility of the elderly people. Interactional and observational methods were used to collect field data. To this end, an intense process of social construction was conducted, involving the elderly residents, caregivers, health professionals and general servants and LTCIs´ managers. It was found that the NBR 9050 is not comprehensive to solve the diversity of accessibility problems found in LTCIs. All LTCIs investigated were in disconformity to the NBR 9050. In the case study, it was found that the inappropriate design hinders the daily activities of the elderly people and is a source of risk of accidents. The environment, facilities and lack of assistive technologies hinder the autonomy of the elderly people, and this LTCI requires ergonomic intervention to improve the accessibility, autonomy and security of the elderly people

Semeadura direta de milho com dois tipos de sulcadores de adubo, em nível e no sentido do declive do terreno

O presente estudo teve como objetivo avaliar parâmetros operacionais de um conjunto mecanizado envolvendo trator e semeadora, assim como o rendimento da cultura do milho semeada nas diferentes configurações das máquinas e combinações com o ambiente de produção. Os tratamentos consistiram de tipos de sulcadores (discos duplos e hastes), os quais foram avaliados em experimentos em que a operação de semeadura direta do milho foi efetuada transversalmente ao declive (em nível) e em aclive e declive. A semeadura contra o declive e o uso de haste sulcadora implicaram maior demanda de esforço de tração, patinagem do trator e consumo de combustível por área trabalhada e não influenciaram o volume de solo mobilizado, a população de plantas e a produtividade de grãos do milho, em relação à operação realizada em declive e uso de sulcador de discos duplos, respectivamente. A utilização de sulcador do tipo haste resultou em menor número de plantas acamadas e quebradas, em relação ao uso de discos duplos, independentemente do sentido da operação. A principal diferença entre semear em nível ou em declive é a formação de sulcos orientados no sentido do terreno, pela ação de sulcadores do tipo haste e elevada patinagem dos rodados do trator, já que o consumo de combustível por área trabalhada e capacidade operacional não foram afetados por aquelas variáveis.

Modelagem e controle adaptativo de uma planta didática de nível com instrumentação industrial

The control, automation and optimization areas help to improve the processes used by industry. They contribute to a fast production line, improving the products quality and reducing the manufacturing costs. Didatic plants are good tools for research in these areas, providing a direct contact with some industrial equipaments. Given these capabilities, the main goal of this work is to model and control a didactic plant, which is a level and flow process control system with an industrial instrumentation. With a model it is possible to build a simulator for the plant that allows studies about its behaviour, without any of the real processes operational costs, like experiments with controllers. They can be tested several times before its application in a real process. Among the several types of controllers, it was used adaptive controllers, mainly the Direct Self-Tuning Regulators (DSTR) with Integral Action and the Gain Scheduling (GS). The DSTR was based on Pole-Placement design and use the Recursive Least Square to calculate the controller parameters. The characteristics of an adaptive system was very worth to guarantee a good performance when the controller was applied to the plant

Acelerando algoritmos de baixo nível em visão robótica com hardware reconfigurável

A challenge that remains in the robotics field is how to make a robot to react in real time to visual stimulus. Traditional computer vision algorithms used to overcome this problem are still very expensive taking too long when using common computer processors. Very simple algorithms like image filtering or even mathematical morphology operations may take too long. Researchers have implemented image processing algorithms in high parallelism hardware devices in order to cut down the time spent in the algorithms processing, with good results. By using hardware implemented image processing techniques and a platform oriented system that uses the Nios II Processor we propose an approach that uses the hardware processing and event based programming to simplify the vision based systems while at the same time accelerating some parts of the used algorithms

Plantas aquáticas e nível de infestação das espécies presentes no reservatório de Bariri, no Rio Tietê

O monitoramento da vegetação aquática permite avaliar a evolução das comunidades e determinar o potencial de danos associados a essas populações. O objetivo do trabalho foi identificar as plantas aquáticas e os níveis de infestação de cada espécie, presentes no reservatório de Bariri. Foram avaliados todos os focos de vegetação aquática presente na represa (194 pontos), e os pontos foram demarcados com um aparelho de GPS. As plantas foram identificadas e realizou-se uma estimativa visual do valor geográfico do ponto (tamanho da área) e a distribuição proporcional das plantas no foco de infestação. Foram encontradas 15 espécies de plantas aquáticas vegetando na represa de Bariri. Considerando que as principais espécies ocorreram com níveis de infestação acima de 10%, as mais importantes foram: Brachiaria mutica (27,0% da área e 97,4% de freqüência), B. subquadripara (22,7% da área e 96,9% de freqüência), Eichhornia crassipes (13,8% da área e 85,6% de freqüência) e Typha angustifolia (16,7% da área e 72,7% de freqüência). Outra espécie que pode ser destacada e que apresentou um bom potencial de infestação foi Enidra sessilis, que ocorreu em 8,9% de ocupação na área vegetada e com 76,3% de freqüência.

Net melon resistance to Didymella bryoniae according to grafting and potassium levels

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Lesão na base e concentrações de ácido indolbutírico no enraizamento de estacas apicais de figueira ‘Roxo de Valinhos’

This work aimed to increase the rhizogenic potential of cuttings collected from the apical portion of the branches of fig trees, performing injuries and treating the cuttings with indolbutyric acid (IBA). Apical cuttings of 'Roxo de Valinhos' fig tree were collected in July. The cuttings were standardized with 20 cm in length and basal diameter of 10 mm. The cuttings received or not incisions at the basis (parallel cuts of 2 cm) and immersed in IBA at 0, 1000, 2000 and 3000 mg L(-1) for 10 seconds. The cuttings were buried (3/4 of the length) in moistened sand, inside a screen house (50% of light). After 60 days it was found that treatment with IBA benefits in the development of apical cuttings, and the concentration that achieved the best results was 2000 mg L(-1); the use of injury at the base of the cuttings helps rooting.