Evidências de validação de um protocolo para assistência às pessoas com úlceras venosas em serviços de alta complexidade

Venous ulcers are lesions resulting from chronic venous insufficiency, venous valvular abnormalities and venous thrombosis. Its occurrence has been growing with the increase in life expectancy of the world population. Considered as fundamental aspects in the approach to the person with venous ulcer care with the interdisciplinary approach, adoption of protocol-specific knowledge, technical skill, coordination between levels of care complexity of the Health System and active participation of patients and their families, a holistic perspective. The construction of a clinical protocol for people with venous ulcers can help professionals of high complexity services in patient assessment and the establishment of quality care in a systematic way and focused on the factors that interfere with wound healing. Thus, this study aimed to analyze the evidence of validation of a clinical protocol for people with venous ulcers treated at high-complexity services. This is a methodological study with a quantitative approach, developed in three stages: literature review, evidence of content validity and evidence of validation in the clinical context. Approved by the Federal University of Rio Grande do Norte Research Ethics Committee (Opinion: 147.452 and CAAE: 07556312.0.0000.5537). The literature review was conducted in August and September 2012, becoming the basis for the construction of the protocol. Then the evidence of content validity, which included 53 judges (experts) selected by the Lattes platform to evaluate the protocol items was performed. The judges were contacted by e-mail and rated the protocol via Google Docs . After analyzing the ratios obtained in this step, which reported kappa between 0.75 and 0.96 and between 0.80 and 0.98 IVC, and the suggestions of the judges, the protocol was adjusted and subjected to empirical evidence to validate the clinical setting at the University Hospital Onofre Lopes in Natal / RN. Evidence of validation in the clinical setting involved 4 judges who acted in pairs (paired) evaluated 32 patients with venous ulcers in the clinical context of high complexity. In both stages, we used the Kappa Index and Content Validity Index to analyze the responses of the judges. The parameters set as acceptable for these indices were: Kappa ≥ 0.61 and Content Validity Index > 0.80. Any evidence of content validity, as evidence of validation in the clinical context, the protocol items that have not reached Kappa and Content Validity Index established indices were excluded and some items were modified or added after suggestions. The process of content validation evidence and evidence of validation in the clinical setting allowed the improvement of the protocol for the care of people with venous ulcers initially proposed. The initial version of the protocol, built from the literature, contained 15 categories and 108 items; after evidence of content validity, remained the reduction to 15 categories with 91 items; the final version, clinically validated, is composed of the same 15 categories, 76 items. The protocol was validated in its content and in the clinical aspect, so we accepted the alternative hypothesis in the study. This protocol may contribute to the care system, allowing tailor behaviors and promote greater resolution in the treatment of people with venous ulcers in health services of high complexity

Atuação do enfermeiro na estratégia de atenção integrada às doenças prevalentes na infância

This study aimed to describe nurses' actions in the strategy of Integrated Management of Childhood Illness in the city of Natal, Rio Grande do Norte. This is a qualitative study with descriptive approach. The universe consisted of nurses from the Family Health Strategy, totaling 16 participants. For the research project was submitted for approval by the Ethics Committee of the Universidade Federal do Rio Grande do Norte, obtaining Opinion No. 187/2012. Data were obtained in two ways: a questionnaire survey to profile the training of nurses and an interview guided by a structured interview. Interviews were treated in the light of analysis of thematic category Bardin. The results showed the central thematic study "Integrated Management of Childhood Illness in the context of nursing activities" category and three analyzes: "Understanding the Integrated Management of Childhood Illness", "Difficulties invibializam use IMCI "and" Working conditions for nurses in the Integrated Management of Childhood Illness. " It is observed that nurses consider the Integrated Management of Childhood Illness useful, effective and important to keep sick children within the logic curative. However disregard the character of health promotion and disease prevention thereof. It was found that the participants still hold the attendance of crinaças within the biomedical model and that these same professionals are subjected to increasingly precarious working conditions and unhealthy due to lack of human and material resources. It was found that the interviewees do not follow the protocols of strategy because of barriers related to prescription medications by nurses, the medical, the lack of incentives, training and supervision by the municipal health and the Regional Nursing Council

Estratégias de intervenção utilizadas por enfermeiros da ESF do município de Natal/RN no controle do câncer do colo de útero

Cancer of the cervix (cervical cancer) is the second most prevalent cancer among Brazilian women. The high rates of cervical cancer in Brazil justify the implementation of effective strategies to control this, which include actions to promote health, primary prevention, early detection, screening, treatment and palliative care. Despite the existence of the National Programme for Control of the CCU there was no reduction in the incidence and mortality of this disease in Brazil. The Family Health Strategy (FHS) has the potential to facilitate such control and, in this context, one should consider that nurses play a central role. The study aimed to know the general intervention strategies used by nurses FHS of Natal / RN in CCU control, and how specific: analyzing the knowledge of these nurses on the CCU, the actions developed in the ESF for the control of CCU and identify the difficulties faced by them to perform it. This is a descriptive exploratory quantitative developed through a structured interview guide with 106 nurses who have experience in controlling the CCU in FHS teams of Natal / RN. Data analysis was performed using descriptive statistic s. The results pointed to actions taken in the FHS to control the CCU, collection of cervical cancer screening, health education activities, nursing consultation, referral of suspected cases for medical monitoring and active women with abnormal test result . The actions that were not mentioned by the nurses included: forming groups of prevention and health promotion; expand coverage of exams and office hours of consultations, establishment of alternatives to end the pent-up demand in the health units, participation in treatment or rehabilitation process users with the CCU; interventions for pain management, alliances and partnerships with schools, in dustry and the use of protocols. This study can be seen that the practice nurses partially shares to the CCU in Natal / RN. The participants of this study, when asked about the CCU, specifically for signs and symptoms of disease and risk factors in general showed important gaps. Difficulties such as lack of materials for collection of Pap smear; inadequate physical space in the Health Units; pent-up demand in the service, delay in arrival of the test results; obstacles in the actions of referral and counter-referral and cultural factors make the CCU control is compromised. It is believed in this research contributed to a reflection on the importance of the role of nurses in the development of the ESF control actions CCU, pointing out the factors that affect these. It is important to involve all nurses who comprise the ESF as knowledgeable of the risk factors, signs and symptoms, and existing tools for the early detection of cervical cancer in the pursuit of quality improvement actions to promote women`s health, contributing in planning future interventions that may reduce mortality from this disease in Natal / RN.

O cuidado compartilhado entre mães e educadoras de um centro municipal de educação infantil: uma pesquisa-ação

O cuidado à criança envolve a identificação e o atendimento às necessidades de modo a oferecer-lhe atenção como pessoa em contínuo processo de crescimento e desenvolvimento. Contudo, o cuidado oferecido à criança que convive em instituição escolar está permeado por conflitos que fragilizam a relação família-escola, não sendo estimulada a articulação desses atores no que refere ao cuidar da criança. Diante dessa problemática, objetivou-se analisar a construção de um pacto do cuidar entre mães e educadoras de crianças que frequentam um Centro Municipal de Educação Infantil. Trata-se de um estudo qualitativo, tendo como método a pesquisa-ação. Envolveu doze mães e oito educadoras de uma instituição de educação infantil de Cidade Nova, no município de Natal, no período de abril a novembro de 2013. Os dados foram coletados através de entrevista grupo focal, observação participante, seminários e diário de campo. Os resultados foram analisados seguindo o direcionamento da análise temática freireana. Na etapa do diagnóstico situacional, que investigou a realidade vivenciada pelas participantes do estudo, percebeu-se que as educadoras não se sentem preparadas para lidar com aspectos de saúde-doença da criança e recusam as ações de cuidado como desempenho de suas funções, interpretada como uma atitude que ultrapassa sua competência profissional. Os pais, por sua vez, apresentaram dificuldade de entendimento e clareza da sua função e relação com a instituição e executam as ações de saúde sem associá-lo à promoção e prevenção, além de realizarem com conhecimento empírico. Vista a necessidade de mudança das ações de saúde prestadas à criança, decidiu-se conjuntamente, através de uma roda de conversa, realizar capacitações sobre higiene e limpeza, medidas caseiras no cuidado à criança e primeiros socorros. Na etapa de implementação da ação coletiva as participantes consideraram as atividades úteis no cuidado prestado à criança e perceberam a importância do cuidado compartilhado para o desenvolvimento infantil. Com o desenvolvimento das capacitações, as participantes sentiram a necessidade de sistematizar as atividades prestadas à criança nos problemas de saúde e, para tanto, foram construídos, conjuntamente, protocolos e procedimentos operacionais padrão para a formalizar as ações. Na etapa de avaliação dos encontros, constatou-se que há expectativas positivas para a continuidade do cuidado em comunhão entre pais e educadores, pois foram construídas novas percepções em relação ao cuidado da criança. Percebeu-se mudança considerável nas mães assíduas ao estudo quanto ao cuidado e interesse, no entanto tornaram-se evidentes as fragilidades no processo de trabalho do CMEI, pois emergiram a dificuldade existente nos membros que compõe a instituição de educação infantil de articular o cuidado à educação. Como principal dificuldade, elenca-se o alto índice de mães faltosas e a dificuldade de articular com outros profissionais de saúde para as atividades. Considera-se que o pacto de cuidar não foi implantado integralmente, pois partilhar cuidados sugere o encontro de pais e educadores que podem ter aspectos divergentes sobre necessidades infantis e desenvolvimento, o que requer constante negociação entre as partes. Nesse sentido, constitui-se em um processo contínuo de aperfeiçoamento entre família e instituição de educação infantil

Produção pesqueira artesanal: diagnóstico ergonômico e bases para um planejamento nutricional situado e a promoção da saúde dos jangadeiros

The traditional fishing with rafts is characterized by unpredictability, high stakes and inadequate work conditions. The extensive working hours, physical wear, inadequate nutrition, unsanitary conditions, lack of salvage equipment and instruments suitable working, added by the presence of changes in the nutritional status of fisherman, that contribute to the picture of insecurity in high seas, injuries and health. This study aimed to analyze the activity of the fisherman s from Ponta Negra, Natal / RN, and check the conditions of supply of these fishermen and their implications on health and development of their work. To this finality, was used a methodology based on the ergonomic work analysis employing techniques such as observational and interactional conversational action, listening to the answers, observation protocols, photographic and video records. The script conversational dynamic action was developed from literature searches about the artisanal fisheries, culture and food habits of this population, and analyzes the overall situation of focus and two reference situations. To collect data on the usual diet of fisherman as well as quantitative and qualitative analysis that was used for data analysis and 24h recall the Food Frequency Questionnaire (FFQ). The impact of this power to the health of fisherman was evaluated performing a nutritional assessment. The results revealed that the fishermen carry out their activities with poor working conditions, health and nutrition. Feeding practices of these fishermen undertake development work, making it even more stressful, as well contributing to the emergence of Chronic Noncommunicable Diseases. The management of the activity, as well as the current structure of the vessel, also contributes to the adoption of inappropriate feeding practices during the shipment of catch. The results of this indicate the need for adequate interventions in order to assist in recovery and / or maintenance of health of fisherman minimizing reflections of nutritional disorders for the development activity by improving the quality of life in this population

Ergonomia, sustentabilidade sócio-ambiental e atividade de pesca artesanal com jangadas: estudo de caso na Praia de Ponta Negra, Natal-RN

The fishing is made possible by the handiwork of a fisherman, not using appliances that achieve the same levels of industrial fishing productivity and not causing environmental impacts on fish stocks with the same intensity. The adoption of sustainability practices in this type of fishing has been requested for the achievement of environmental and socioeconomic improvements, since its production has been decreasing over the years and overfishing has led to reduced stocks also stand out environmental aggressions such as pollution. Thus, this research aims to analyze the interference of environmental aspects/impacts that permeate the activity performed by fisherman on the beach of Ponta Negra, Natal-RN, in order to propose recommendations for environmental sustainability. We used a methodology based on the ergonomic work analysis (WISNER, 1987; GUERIN, 2001; VIDAL, 2008) using techniques such as observational and interactional observation protocols, photographs, videos, conversational action, and listening to verbalizations. To understand the vulnerability of the environment in which the activity is carried fisherman and the interferences that it suffers, we used the study of environmental aspects/impacts (SÁNCHEZ 2008). As a result, it appears that from the observations located and reports raftsmen, changes in the sea, the search for new fishing grounds farther from the coast, reducing fishery production, waste generation and pollution of the workplace, and the difficulty in docking rafts, factors arising from the pressures both for society as Seen by fisherman, denoting the necessity of drawing up recommendations and actions proposed by management activity by promoting discussion among raftsmen and accountable institutions, and training through workshops on environmental education, aiming to positive changes in the activity fisherman from Ponta Negra and the environment in which raftsmen are inserted in order to seek a sustainable activity, preserving its characteristics

Oportunidades de melhoria ergonômica das exigências físicas da atividade jangadeira em Ponta Negra Natal-RN

The fishing is an activity with rafts marked by unpredictability, poor tools, physical stress, awkward postures, risk of accidents and incidents, which contribute to insecurity in the context of activity. This study aimed to contribute to reducing of physical effort and the biomechanical impacts in jangadeiro activity of artisanal fishing using jangadas on the beach of Ponta Negra, Natal-RN. To achieve this purpose the methodology of the Work Ergonomic Analysis - WEA became a reference using techniques such as observational and interactional observation notes, photographs, videos, action conversational and listening verbalizations. The resulting activity in health jangadeiro, discussed in this research were: static postural assessment, flexibility of movement of shoulder flexion-extension, flexibility of the hamstrings and lower back, grip and musculoskeletal pain. It was found from observations, interactions and activity analysis, that in carrying out fishing rafts are frequent awkward postures associated with demand for power and many are already feeling the jangadeiros reflections of years of life dedicated to this work. These have already adopted some measures to manage the activity, such as job rotation during the expedition of capture. Therefore, there is a need to expand these measures of activity management, as well as design and capabilities of the raft, seeking positive changes in the activity and consequently the quality of life jangadeiro

Abordagem da ergonomia para análise da acessibilidade a hóspedes com deficiência visual em hotéis: soluções de inclusão de pessoas cegas e com baixa visão

This study evaluates the level of accessibility for people with visual impairment (blindness and low vision) hotels in the city of Natal-RN, Brazil, and provides principles, guidelines and means of projective make hotels accessible, to promote comfort, autonomy and security of these people. We used a qualitative research methodology and quantitative trait descriptive, analytical and interpretive. Was taken as a base for field studies Ergonomic Analysis of Work, beginning with a study of the demands of accessibility of hotels and analyzing the modeling activity in these establishments through the application of interactional and observational techniques, such as film, photographic records, conversational actions and observation protocols. A protocol was developed and applied to evaluate the compliance of accessibility of hotels in the face of Brazilian technical standard NBR 9050 (2004). We used methods of Cognitive Task Analysis (CTA) associated with simulated activities to identify the processes of decision making and analyzing the observables of the activities performed by people with visual impairment (POS). Interviews were conducted with people who are blind and low vision in various cities in order to meet accessibility difficulties they faced in hotels and recommendations for improvement that they indicate. The mapping results showed that of 16 hotels 4 and 5 star studied in Natal-RN, reached only 7% of the 50 items of the protocol, while none of them reached 70% of the items. About the results obtained in simulated activities and analyzed from the ATC, we saw that the hotel where it was performed this step shows a need to adequately address the guests with visual impairments

Desenvolvimento de metodologia para avaliação de desempenho ambiental em edifícios adaptada à realidade do Nordeste brasileiro

This research refers to the production of green buildings, defined, mainly, based on the use of sources of alternative energies, smaller emission of pollutant, use of recyclable materials, systems of recycling of the waters, maximization of the natural illumination, preservation of green areas or native, and appropriate quality of the internal air. From the conception of those buildings, it appears the needs of evaluating them, creating the methodologies for the evaluation of environmental performance of buildings. In that way, this work can be divided in two moments: the first one when it identifies the methodologies for the evaluation of environmental performance for buildings existents in the literature, defining their categories, criteria and sub-criteria to be appropriate to the reality of the Brazilian Northeast; and the second one when starting from the analysis of the systems of existent evaluation. It defines a methodological base and it generates a new evaluation system, denominated MEDACNE (Methodology of Evaluation of Environmental Acting for Construction in the Northeast). In that moment, the process of framing of the section of the building site is verified under the maintainable optics, stimulated mainly by the pressures of the society - conferences, protocols and agreements. Finally, the proposed methodology was applied in a case study, a residential building, called Maria José Gurgel , located in Natal-RN, Brazil, for its validation. This methodological proposition should increase the patterns environmental places for the production of new buildings, and it will be a reference guide for architects, engineers and planners to develop their constructions considering the criteria of the sustainability. This study made use of bibliographical research in books and specialized magazines and the analysis of the data was realized in an interpretative way

Um protocolo de comunicação multicast na camada de aplicação com Consciência de Localização

Internet applications such as media streaming, collaborative computing and massive multiplayer are on the rise,. This leads to the need for multicast communication, but unfortunately group communications support based on IP multicast has not been widely adopted due to a combination of technical and non-technical problems. Therefore, a number of different application-layer multicast schemes have been proposed in recent literature to overcome the drawbacks. In addition, these applications often behave as both providers and clients of services, being called peer-topeer applications, and where participants come and go very dynamically. Thus, servercentric architectures for membership management have well-known problems related to scalability and fault-tolerance, and even peer-to-peer traditional solutions need to have some mechanism that takes into account member's volatility. The idea of location awareness distributes the participants in the overlay network according to their proximity in the underlying network allowing a better performance. Given this context, this thesis proposes an application layer multicast protocol, called LAALM, which takes into account the actual network topology in the assembly process of the overlay network. The membership algorithm uses a new metric, IPXY, to provide location awareness through the processing of local information, and it was implemented using a distributed shared and bi-directional tree. The algorithm also has a sub-optimal heuristic to minimize the cost of membership process. The protocol has been evaluated in two ways. First, through an own simulator developed in this work, where we evaluated the quality of distribution tree by metrics such as outdegree and path length. Second, reallife scenarios were built in the ns-3 network simulator where we evaluated the network protocol performance by metrics such as stress, stretch, time to first packet and reconfiguration group time

GATE - Uma abordagem baseada em middleware para aplicações interperceptivas envolvendo múltiplos dispositivos

In this work, we present the GATE, an approach based on middleware for interperceptive applications. Through the services offered by the GATE, we extension we extend the concept of Interperception for integration with several devices, including set-top box, mobile devices (cell phones), among others. Through this extension ensures the implementation of virtual environments in these devices. Thus, users who access the version of the computer environment may interact with those who access the same environment by other devices. This extension is just a part of the services provided by the GATE, that remerges as a new proposal for multi-user virtual environments creation.

Valor nutritivo do resíduo do processamento do caroço de algodão suplementado com levedura e avaliado em bovinos

O objetivo neste trabalho foi avaliar o consumo, a digestibilidade total e parcial da matéria seca (MS) e dos nutrientes e os parâmetros ruminais de novilhos alimentados com rações à base de resíduo do processamento do caroço de algodão (RPCA) suplementado com levedura seca de cana-de-açúcar. Foram utilizados seis novilhos Nelore canulados no rúmen e duodeno, alimentados com rações compostas de 80% RPCA e 20% concentrado, composto de milho, ureia e levedura nos níveis de 0, 20 ou 40%. O delineamento experimental adotado para análise do consumo e da digestibilidade foi em blocos casualisados e a análise dos parâmetros ruminais foi em parcela subdividida. Os consumos e a digestibilidade de nutrientes não foram influenciados pela suplementação com levedura, fato que pode estar relacionado ao alto valor da fração C do resíduo do processamento do RPCA (44,51% MS) e à baixa fração proteica de lenta degradação da levedura, que impediu a sincronização energia/nitrogênio para maior degradação do resíduo. O pH do líquido ruminal decresceu linearmente nos animais mantidos com as dietas suplementadas com levedura. em todas as dietas, o pH e a concentração de N-NH3 foram adequados para o crescimento microbiano. As concentrações ruminais de acetato, propionato, butirato e ácidos graxos voláteis totais e a relação acetato:propionato não foram influenciadas pela suplementação com levedura. O resíduo do processamento do caroço de algodão é uma opção a ser utilizada no arraçoamento de bovinos.

Especificação e implementação de um modelo assíncrono para replicação, propagação e conciliação de bases de dados distribuídas

This graduate thesis proposes a model to asynchronously replicate heterogeneous databases. This model singularly combines -in a systematic way and in a single project -different concepts, techniques and paradigms related to the areas of database replication and management of heterogeneous databases. One of the main advantages of the replication is to allow applications to continue to process information, during time intervals when they are off the network and to trigger the database synchronization, as soon as the network connection is reestablished. Therefore, the model introduces a communication and update protocol that takes in consideration the environment of asynchronous characteristics used. As part of the work, a tool was developed in Java language, based on the model s premises in order to process, test, simulate and validate the proposed model

Especificação de uma rede MPLS fim-a-fim com diferenciação de serviços

New multimedia applications that use the Internet as a communication media are pressing for the development of new technologies, such as: MPLS (Multiprotocol Label Switching) and DiffServ. These technologies introduce new and powerful features to the Internet backbone, as the provision of QoS (Quality of Service) capabilities. However, to obtain a true end-to-end QoS, it is not enough to implement such technologies in the network core, it becomes indispensable to extend such improvements to the access networks, what is the aim of the several works presently under development. To contribute to this process, this Thesis presents the RSVP-SVC (Resource Reservation Protocol Switched Virtual Connection) that consists in an extension of RSVP-TE. The RSVP-SVC is presented herein as a mean to support a true end-to-end QoS, through the extension of MPLS scope. Thus, it is specified a Switched Virtual Connection (SVC) service to be used in the context of a MPLS User-to-Network Interface (MPLS UNI), that is able to efficiently establish and activate Label Switched Paths (LSP), starting from the access routers that satisfy the QoS requirements demanded by the applications. The RSVP-SVC was specified in Estelle, a Formal Description Technique (FDT) standardized by ISO. The edition, compilation, verification and simulation of RSVP-SVC were made by the EDT (Estelle Development Toolset) software. The benefits and most important issues to be considered when using the proposed protocol are also included

Uma arquitetura P2P baseada na hierarquia do endereçamento IP com roteamento unificado

There are some approaches that take advantage of unused computational resources in the Internet nodes - users´ machines. In the last years , the peer-to-peer networks (P2P) have gaining a momentum mainly due to its support for scalability and fault tolerance. However, current P2P architectures present some problems such as nodes overhead due to messages routing, a great amount of nodes reconfigurations when the network topology changes, routing traffic inside a specific network even when the traffic is not directed to a machine of this network, and the lack of a proximity relationship among the P2P nodes and the proximity of these nodes in the IP network. Although some architectures use the information about the nodes distance in the IP network, they use methods that require dynamic information. In this work we propose a P2P architecture to fix the problems afore mentioned. It is composed of three parts. The first part consists of a basic P2P architecture, called SGrid, which maintains a relationship of nodes in the P2P network with their position in the IP network. Its assigns adjacent key regions to nodes of a same organization. The second part is a protocol called NATal (Routing and NAT application layer) that extends the basic architecture in order to remove from the nodes the responsibility of routing messages. The third part consists of a special kind of node, called LSP (Lightware Super-Peer), which is responsible for maintaining the P2P routing table. In addition, this work also presents a simulator that validates the architecture and a module of the Natal protocol to be used in Linux routers