Avaliação do conhecimento de enfermeiros da rede de atenção à saúde no município de Bauru (SP) sobre cuidado aos pacientes com feridas: um estudo transversal

Pós-graduação em Enfermagem - FMB

Projetos de lei sobre medicalização da educação: biopolítica, controle e resistência na contemporaneidade

At present, the processes of medicalization of childhood have reached the school spaces where diagnostic labeling accompanied of prescription of psychotropic drugs proliferate. The present work aims to study through the Foucauldian genealogical approach, the process of medicalization of education, with a special attention to analysis of Brazilian bills which serve to the medicalization logics and to the study of resistance movements which emerged with the purpose of denouncing psychopathology-causing strategies. It is considered that the school spaces, subject to the disciplining processes and standardization of bodies, have gained through bills, new devices of support to the psychiatric discourses. These, by appropriating of the childhood considered problem, have spawned diagnoses and psychopharmacological drugs, process that has been faced by resistance movements identified with proposals for enhancement of the plurality of life.

Medicalização em um serviço público de Saúde Mental: um estudo sobre a prescrição de psicofármacos

News of the fifth version of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) bringing an enlarged listing of diagnostic possibilities has fomented discussion concerning the tendency, recognizable in contemporary psychiatric practices, of including ordinary suffering of everyday life in psychiatric diagnosis and submit same to psychopharmacological treatment. The present paper brings to this discussion data obtained from field research about the prescription of psychopharmacs in the psychiatric care of a public mental health service. The results reveal that the psychiatry of the service keeps practically all of its users under prescription, and that medical discharge is extremely rare. The paper organizes elements critical to this practice and concludes that due to its inadequacy as to the objectives of promotion of personalized care concerned with autonomy and citizenship, present in the current national guidelines for public policies in mental health.

A psicopatologização da infância no contemporâneo: um estudo sobre a expansão do diagnóstico de transtorno de déficit de atenção e hiperatividade

The expansion of psychiatric labeling does not reach only the adult population, but also the problematic related to childhood have been captured by the speeches and practices of the medical-psychiatric knowledge and turned into psychopathologies which tend to be treated with the main resource made available by psychiatrics in the present times: the psychotropic drugs. This work presents a critical thinking on the expansion of the diagnoses of “attention deficit disorder and hyperactivity” (ADHD) both in children and teenagers and on the conduction of drug therapies. It follows that the processes of childhood psycho-pathologization and the trivializing of psychotropic drug prescription are related to the overvaluation of the biological conception of psychic suffering and to the economic interests of the great pharmaceutical laboratories which by means of several strategies influence the medical practices, factors that lead to exposure of these patients to possible side effects and the risks of stigmatization that must be considered.

O trabalho como dispositivo de atenção em saúde mental: trajetória histórica e reflexões sobre sua atual utilização

The partnership between Mental Health (MH) and work is present throughout the history of psychiatry. Capitalist society has used and uses the fitness or unfitness for work not only as one of the elements to the definition of "normality", but also as a treatment strategy. In this perspective, one can find a position healing and, more recently, a different proposal put forward by the psychiatric reform that considers also make / produce, the construction of meaning in the work as crucial for subjectivity. This sense is present in therapeutic workshops that seek to value the uniqueness, not to override the differences. The objective of this paper is to reflect on the relationship between Attention in SM / Work. Initially presents three theses, from which this relationship is built historically: 1 - Work as a means of avoiding idleness returning productively to society; 2 - Work as a healing practice, from the prescription, and 3 - Work as a strategy for care and social inclusion. Below, we discuss some questions about therapeutic workshops and income generation in the mental health care as a device for attention and social inclusion.

A banalização da prescrição de psicofármacos em um ambulatório de saúde mental

The development of modern psychiatric medications coupled with the wide range currently gained by preventive emphasis in mental health changed the practices of psychiatry, which is no longer focused on treating insanity but is also dedicated to treat any psychiatric suffering through the prescription of psychopharmacos. This study discusses the current process in which medication has been generalized, and presents the results of an exploratory study aimed to examine the patients' medical files, the trajectory of users since they enter the service to the prescription of psychiatric medication in the scope of a Mental Health Outpatient Clinic, in a town in the west of the São Paulo state, Brazil. Results revealed that most (65%) users already arrive at the service with previous prescription of psychiatric medications, and nearly all (99%) of them receive prescriptions of psychiatric medication once forwarded to psychiatric consultations.

Effects of omega-3 on metabolic markers in postmenopausal women with metabolic syndrome

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

Antibiotic prophylaxis for third molar extraction in healthy patients: current scientific evidence

Third molar extraction is one of the most frequently performed procedures in the dental clinic, and it is associated with innumerable trans- and postoperative complications, such as pain, trismus, edema, localized alveolar osteitis, and surgical site infection. Some authors advocate the use of local or systemic antibiotics to reduce the incidence of these postoperative complications. However, several studies have revealed an insignificant gain after using antibiotics. Despite the risks of allergic reactions, toxicity, and the development of resistant microorganisms, about 50% of dentists routinely prescribe the use of prophylactic antibiotics for this purpose. The goal of this paper is to evaluate the scientific evidence that justifies antibiotic prescription to healthy patients undergoing third molar extraction.

Rating of perceived exertion as a tool for prescribing and self regulating interval training: a pilot study

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

Analysis of mesiodistal angulations of preadjusted brackets

Manufacturers offer various prescriptions of preadjusted brackets for use in the "straight-wire" orthodontic technique. However, the need to incorporate bends in the rectangular wires during orthodontic finishing has led to concerns regarding the type of prescription chosen and the credibility of information provided by the manufacturer. The aim of this study was to compare the slot angulations of Roth prescription preadjusted metallic brackets for the maxillary left central incisor and maxillary left canine. For each tooth type, 10 brackets of three commercial brands (GAC, Forestadent and Morelli) were selected. Two individual metal matrices for brackets and tooth positioning were made for each group of teeth. Captured images were obtained by standardized ortho-radial photography with a digital camera. Images were exported and analyzed with the Image J software package. One-way ANOVA and Tukey statistical analyses were performed at the 5% significance level. For brackets of the maxillary left central incisor, differences in mean angulation were observed between the Morelli and GAC groups (p < 0.01) and between the Forestadent and GAC groups (p < 0.01). For brackets of the maxillary left canine, differences in mean angulation were found between the Morelli and GAC groups (p < 0.01) and between the Morelli and Forestadent groups (p < 0.05). In conclusion, despite their same prescription name, the different brands exhibited significantly different angulation measurements.

Safety assessment of essential medicines for elderly people: a bibliographic survey

Certain medicines are considered potentially inappropriate (PIM) for elderly people as they increase the risk of adverse drug events (ADE) and because safer alternative therapies are available on the market. In this context, in order to identify the instruments that assess the quality of medical prescriptions for elderly and to determine which drugs are considered PIM, a bibliographic survey was conducted in PUBMED, LILACS and PAHO databases, in February and March/2010. The search strategy included the use of health descriptors and a manual search in the references cited by selected papers. During the period of data collection, 15 instruments were identified. In 2012, with the publication of the update of Beers criteria, this instrument was included in the study. We identified 163 PIM of 25 therapeutic classes, of which 125 (76.7%) are marketed in Brazil. Of these, 31 (24.8%) are essential medicines (RENAME 2012), of which 13 have safer therapeutic equivalents and 19 (15.2%) are over-the-counter drugs. Data suggest the need for inclusion of safer alternatives for the elderly in the national list of essential medicines and the pharmaceutical care for early detection of ADE in this age group, in order to contribute to the safe use of medicines.

Short distance QCD contribution to the electroweak mass difference of pions

It is known that the short distance QCD contribution to the mass difference of pions is quadratic on the quark masses, and irrelevant with respect to the long distance part. It is also considered in the literature that its calculation contains infinities, which should be absorbed by the quark mass renormalization. Following a prescription by Craigie, Narison, and Riazuddin of a renormalization-group-improved perturbation theory to deal with the electromagnetic mass shift problem in QCD, we show that the short distance QCD contribution to the electroweak pion mass difference (with mu=md≠0) is finite and, of course, its value is negligible compared to other contributions.

Icodextrin reduces insulin resistance in non-diabetic patients undergoing automated peritoneal dialysis: results of a randomized controlled trial (STARCH)

Insulin resistance is a common risk factor in chronic kidney disease patients contributing to the high cardiovascular burden, even in the absence of diabetes. Glucose-based peritoneal dialysis (PD) solutions are thought to intensify insulin resistance due to the continuous glucose absorption from the peritoneal cavity. The aim of our study was to analyse the effect of the substitution of glucose for icodextrin on insulin resistance in non-diabetic PD patients in a multicentric randomized clinical trial. This was a multicenter, open-label study with balanced randomization (1:1) and two parallel-groups. Inclusion criteria were non-diabetic adult patients on automated peritoneal dialysis (APD) for at least 3 months on therapy prior to randomization. Patients assigned to the intervention group were treated with 2L of icodextrin 7.5%, and the control group with glucose 2.5% during the long dwell and, at night in the cycler, with a prescription of standard glucose-based PD solution only in both groups. The primary end-point was the change in insulin resistance measured by homeostatic model assessment (HOMA) index at 90 days. Sixty patients were included in the intervention (n = 33) or the control (n = 27) groups. There was no difference between groups at baseline. After adjustment for pre-intervention HOMA index levels, the group treated with icodextrin had the lower post-intervention levels at 90 days in both intention to treat [1.49 (95% CI: 1.23-1.74) versus 1.89 (95% CI: 1.62-2.17)], (F = 4.643, P = 0.03, partial η(2) = 0.078); and the treated analysis [1.47 (95% CI: 1.01-1.84) versus 2.18 (95% CI: 1.81-2.55)], (F = 7.488, P = 0.01, partial η(2) = 0.195). The substitution of glucose for icodextrin for the long dwell improved insulin resistance measured by HOMA index in non-diabetic APD patients.

Factors associated with red blood cell transfusions in very-low-birth-weight preterm infants in Brazilian neonatal units

Preterm infants in neonatal intensive care units frequently receive red blood cells (RBC) transfusions due to the anemia of prematurity. A number of variables related to gestational age, severity of illness and transfusion practices adopted in the neonatal unit where the neonate was born may contribute to the prescription of RBC transfusions. This study aimed to analyse the frequency and factors associated with RBC transfusions in very-low-birth-weight preterm infants. A prospective cohort of 4283 preterm infants (gestational age: 29.9 ± 2.9 weeks; birth weight: 1084 ± 275 g) carried out at 16 university hospitals in Brazil between January 2009 and December 2011 was analysed. Factors associated with RBC transfusions were evaluated using univariate and multiple logistic regression analysis. A total of 2208 (51.6%) infants received RBC transfusions (variation per neonatal unit: 34.1% to 66.4%). RBC transfusions were significantly associated with gestational age (OR: -1.098; 95%CI: -1.12 to -1.04), SNAPPE II score (1.01; 1.00-1.02), apnea (1.69; 1.34-2.14), pulmonary hemorrhage (2.65; 1.74-4.031), need for oxygen at 28 days of life (1.56; 1.17-2.08), clinical sepsis (3.22; 2.55-4.05), necrotising enterocolitis (3.80; 2.26-6.41), grades III/IV intraventricular hemorrhage (1.64; 1.05-2.58), mechanical ventilation (2.27; 1.74-2.97), use of umbilical catheter (1.86; 1.35-2.57), parenteral nutrition (2.06; 1.27-3.33), >60 days of hospitalization (5.29; 4.02-6.95) and the neonatal unit where the neonate was born. The frequency of RBC transfusions varied among neonatal intensive care units. Even after adjusting for adverse health conditions and therapeutic interventions, the neonatal unit continued to influence transfusion practices in very-low birth-weight infants.

Painful procedures and analgesia in the NICU: what has changed in the medical perception and practice in a ten-year period?

To compare the use of analgesia versus neonatologists' perception regarding analgesic use in painful procedures in the years 2001, 2006, and 2011. This was a prospective cohort study of all newborns admitted to four university neonatal intensive care units (NICUs) during one month in 2001, 2006, and 2011. The frequency of analgesic prescription for painful procedures was evaluated. Of the 202 neonatologists, 188 answered a questionnaire giving their opinion on the intensity of pain during lumbar puncture (LP), tracheal intubation, mechanical ventilation (MV), and postoperative period (PO) using a 10-cm visual analogic scale (VAS; pain >3cm). For LP, 12% (2001), 43% (2006), and 36% (2011) were performed using analgesia. Among the neonatologists, 40-50% reported VAS >3 for LP in all study periods. For intubation, 30% received analgesia in the study periods, and 35% (2001), 55% (2006), and 73% (2011) of the neonatologists reported VAS >3 and would prescribe analgesia for this procedure. As for MV, 45% (2001), 64% (2006), and 48% (2011) of patient-days were under analgesia; 56% (2001), 57% (2006), and 26% (2011) of neonatologists reported VAS >3 and said they would use analgesia during MV. For the first three PO days, 37% (2001), 78% (2006), and 89% (2011) of the patients received analgesia and more than 90% of neonatologists reported VAS >3 for major surgeries. Despite an increase in the medical perception of neonatal pain and in analgesic use during painful procedures, the gap between clinical practice and neonatologist perception of analgesia need did not change during the ten-year period.