Avaliação do conhecimento e de habilidades clínicas em saúde sexual e reprodutiva na graduação de medicina

No Brasil, a despeito das conquistas obtidas a partir da implantação do Sistema Único de Saúde e dos avanços legais e institucionais na atenção a diversos problemas relacionados ao gênero, a incorporação de temas relacionados aos direitos humanos, sexuais e reprodutivos no contexto da formação profissional em saúde permanece deficiente. Este trabalho teve como objetivos avaliar a inserção da temática saúde sexual e reprodutiva no currículo do curso de graduação em Medicina, por meio do emprego de avaliações de conteúdo cognitivo, procedimental e atitudinal. Trata-se de estudo de intervenção educacional envolvendo alunos do internato do curso de Medicina da UFRN. Foram utilizados os seguintes métodos avaliativos: prova escrita, exame clínico objetivo estruturado (OSCE) e Mini-CEX. Como variáveis explicativas foram consideradas o sexo, idade e participação prévia no componente curricular optativo Saúde Reprodutiva . A avaliação do processo constou da aplicação de questionários de satisfação e entrevistas acerca dos métodos avaliativos utilizados. Considerando os três métodos avaliativos empregados, 183 estudantes participaram do estudo, com média de idade de 24,5 ± 2,2 anos, sendo 52,5% do sexo masculino e 47,5% do sexo feminino. No contexto geral, observamos concordância entre os desempenhos dos estudantes nas avaliações de conteúdo cognitivo, procedimental e atitudinal. A participação dos estudantes no componente curricular eletivo Saúde Reprodutiva mostrou-se associada com melhor desempenho em algumas dimensões da avaliação cognitiva e na avaliação com o Mini-CEX, em relação às competências de anamnese, profissionalismo e qualidades humanísticas, relação médico paciente e desempenho global. A análise da fidedignidade entre os avaliadores na avaliação com o método OSCE mostrou-se adequada (alfa de Cronbach superior a 70%) em relação ao desempenho global e aos aspectos técnicos das competências avaliadas, observando-se baixa confiabilidade na avaliação da comunicação médico-paciente. O presente trabalho constitui-se numa experiência educacional inovadora e pioneira no âmbito da educação médica brasileira no que tange à inserção da temática de saúde sexual e reprodutiva na graduação, sugerindo-se um impacto positivo da iniciativa na formação do médico generalista na UFRN. A avaliação de conhecimentos, habilidades e atitudes em saúde sexual e reprodutiva na graduação de Medicina mostrou-se factível, com alta concordância entre os diferentes métodos empregados. Os métodos OSCE e Mini-CEX podem ser aplicados ao contexto da saúde sexual e reprodutiva, possibilitando a avaliação de competências clínicas relevantes para a formação do médico generalista e que habitualmente não são contempladas nas avaliações rotineiramente realizadas na graduação

Avaliação gerontológica multidimensional das condições de saúde de idosos residentes em instituições de longa permanência

Introdução/objetivos: A avaliação do estado de saúde de idosos institucionalizados é considerada prática essencial à promoção e recuperação da sua saúde, a qual deve incluir a investigação de aspectos multidimensionais e multidisciplinares relacionados ao envelhecimento saudável. O estudo objetivou avaliar as condições de saúde dos idosos residentes em instituições de longa permanência (ILPI) do município de Natal RN. Métodos: Trata-se de um estudo descritivo, longitudinal, envolvendo seis ILPI filantrópicas, com uma população de 243 idosos. A coleta de dados se deu por meio de entrevistas com os idosos nas instituições mediante a aplicação de um questionário com informações sócio demográficas, saúde e institucionalização, além de várias facetas multidisciplinares que envolvem a escala de avaliação cognitiva (Mini Exame do Estado Mental); o índex de KATZ, para avaliação das atividades da vida diária e uma análise do estado nutricional com questões antropométricas (peso, estatura, circunferência abdominal) e Índice de Massa Corpórea. Participaram do estudo todos os idosos com idade igual ou superior a 60 anos, que aceitaram responder a entrevista e assinaram o Termo de Consentimento Livre e Esclarecido e/ou a impressão datiloscópica. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal do Rio Grande do Norte, sob parecer n° 164/2011. Resultados: Os participantes do estudo incluem 243 idosos, sendo a maioria mulheres (172 = 70,7%), com média de idade de 79 ± 9,44 anos. 124 idosos são solteiros (51,0%) e 66 viúvos (27,0%). A prática de atividades físicas não é rotina nas instituições, onde a maioria dos idosos (82,7%; n = 201) não realiza nenhum tipo de atividade. 78% dos idosos (n = 192) chegou a instituição sendo levados por familiares, enquanto que apenas 18% (n = 44 idosos) por vontade própria e 4% (n = 7 idosos) não souberam responder. Quanto aos aspectos cognitivos, identificou-se que 64,2% dos idosos (n = 156) apresentaram alterações significativas dentro da pontuação dos escores com restrições em responder aos demais questionamentos durante a entrevista por apresentarem limitações cognitivas e/ou dificuldades senso perceptivas.Conclusão: O presente estudo evidenciou alterações cognitivas na maioria dos idosos institucionalizados impossibilitando-os a continuidade da realização da avaliação global da saúde. A identificação correta da perda cognitiva em idosos é de suma importância para a equipe de saúde a fim de promover a detecção precoce de alterações cognitivas e a adoção de tratamento adequado, no sentido de contribuir para uma melhor qualidade de vida desta população

Tecnologia para banho no leito de idosos e usuários acamados: uma contribuição para o cuidar humanizado

This study aimed to validate the technology at Bed Bath System, in view of bedridden elderly and their caregivers, with a view to transforming the conventional paradigm regarding the practice of bodily hygiene held in bath chairs adapted in long-stay institutions for the elderly. This is an experimental study involving 51 (fifty one) elderly and 17 (seventeen) caregivers of three long-stay institutions for the elderly of the city of João Pessoa. For data collection, applied initially to cognitive assessment scale Mini Mental State Examination, with the aim of tracking the subject group of elderly cognitively able to participate in the study. In the second phase, to measure the percentage of agreement and disagreement about the attributes of the subjects of the shower chair and adapted the system for bed bath, used a questionnaire with closed questions, Likert scale model of four (4) points, with a good reliability index (0.728), estimated by alpha conbrach, evidenced by the Wilcoxon test a significant difference (P<0.05) between the responses of seniors and caregivers about the attributes involving technology system in bath bed and bath chair adapted, confirming the perspective of the subjects that the two systems differ significantly. However, the system bed bath got greater degree of agreement for their use, characterizing this system is a technology that makes the differential bed bath pleasurable action, quality and humanized

Diagnóstico molecular da talassemia ALFA em indivíduos com microcitose e/ou hipocromia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Composição da fauna de formigas (Hymenoptera: Formicidae) de serapilheira em florestas semidecídua e de Eucalyptus spp., na região sudeste do Brasil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Caracterização molecular e laboratorial da talassemia beta e da interação hemoglobina s/talassemia beta

Beta thalassemia arises as a consequence of the reduction (β+, β++, βsilent) or absence (β0) of beta globin chain synthesis and results from a number of mechanisms that lead to genetic defects. The inheritance of beta thalassemia is characterized by the existence of heterozygous individuals, compound heterozygotes, homozygotes and those with coinheritance of beta thalassemia allele and other thalassemias and/or hemoglobin variants. The aim of this study was to perform molecular and laboratory characterization of beta thalassemia in heterozygous and homozygous individuals and in those with coinheritance of S beta thalassemia. A total of 48 individuals were included (35 heterozygotes, 4 homozygotes and 9 S beta thalessemia carriers) referred to the Integrated Laboratory of Clinical Analyses of the Federal University of Rio Grande do Norte (UFRN) and the Hematology Ambulatory Facility of the Dalton Barbosa Cunha Hemocenter (Hemonorte Natal, Brazil). Peripheral blood samples form each patient underwent the following laboratory examinations: erythrogram, hemoglobin electrophoresis at alkaline pH, measurements of Hb A2, Fetal Hb and serum ferritin. DNA was extracted using the illustra blood genomicPrep Mini Spin Kit and molecular characterization was performed by the PCR/RFLP technique, which involves digestion with specific restriction enzymes for IVS-1 nt 1 (G®A), IVS-1 nt 6 (T®C) and codon 39 (CAG®TAG) mutations. Of the 35 heterozygotes, 37.1% showed IVS-1 nt 6 mutation, 42.9% IVS-1 nt 1 and 20% were carriers of other mutations not identified by the technique used. The four homozygous patients presented with the IVS-1 nt 6 mutation, while 66.7% of the individuals with S beta thalassemia had the IVS-1 nt 1 mutation. Codon 39 was not detected in any of the patients investigated. Of the thallasemic alleles found, 40.4% were IVS- 1 nt 1, 40.4% IVS-1 nt 6 and 19.2% were not identified. Laboratory data showed that the heterozygotes exhibited microcytosis and hypochromia, evidenced by MCV ranging from 57 to 75fL and MCH from 15.9 to 23.6 pg. Hemoglobin A2 varied between 3.7 and 7.2%. The homogygotes also showed reduced MCV and MCH and elevated HbA2.. Comparison of laboratory data between heterozygous individuals with IVS-1 nt 1 and IVS-1 nt 6 mutations showed that heterozygotes for the IVS1-1 mutation had significantly lower mean MCV and MCH (p = 0.023 and 0.007, respectively) and significantly higher hemoglobin A2 (p < 0.001) when compared to heterozygotes for the IVS-1 nt 6 mutation. PCR/RFLP was useful in identifying the presence or absence of IVS-1 nt 6, IVS-1 nt 1 and codon 39 mutations in most of the patients investigated here. This is the first study conducted in the state of Rio Grande do Norte, Brazil aimed at identifying beta thalassemia mutations and represents an important contribution to the knowledge regarding the molecular profile of beta thalassemia in our country

Serosurvey for antibodies against Brucella abortus and Leptospira interrogans in pampas deer from Brazil

A survey for antibodies against Brucella abortus, and Leptospira interrogans was conducted on 17 pampas deer (Ozotocerus bezoarticus) from Pantanal Matogrossense (State of Mato Grosso do Sul, Brazil) and on 24 pampas deer from Parque Nacional de Emas (State of Goias, Brazil). Antibodies against B. abortus were detected by plate ag glutination, rose Bengal, and complement fixation tests, antibodies against Leptospira interrogans were detected by the microscopic agglutination test. All sera were negative for B. abortus antibodies and all deer sera from Parque Nacional de Emas were negative for L. interrogans antibodies. Four (24%) of 17 sera from Pantanal Matogrossense were positive for L. interrogans serovar (n = 2) hardjo, wolffi (n = 1) and mini (n = 1). While these diseases do not appear to be of major importance to the health status of Pampas deer, it appears that deer are reservoir for leptospirosis in one of the study areas.

Um olhar estético sobre o telespetáculo esportivo :contribuições para o ensino do esporte na escola

The sportive television spectacle shows up like a media phenomenon which evidence performances and techniques that further on the community realized in the quotidian sportive practices into a show and play mixer, that more and more, sensibility the viewers. In this scenery , this research is about the relation between sportive television spectacle and viewer by the aesthetics perspective, and discussed the sport in the Physical Education context with the focus in the contributions to teaching in the school. The research, to the methodological view, uses the discuss analysis and realizes a qualitative study in two interdependent moments. In the first, analysis the dada collated in the Education, sport and television workshop. In the second, turns about TV images of sportive television spectacle to appreciated, to support a discuss of these phenomenon s aesthetics elements, looking for the relation established between the sportive television spectacle and viewer. The analysis s emphasis is in the sensations by sportive television spectacle, as well in the aesthetic elements problems promoted by this experience, from the two basics concepts, to know: the aesthetic and the synaesthetic perception. The analysis s corpus is composed by Esporte Espetacular TV program. Identify, in the sportive television spectacle appreciation, four big discuss axis of great importance between sportive television spectacle and viewer understanding: the relation space and time, the belonging feeling, the language interlacing, and beauty models. Understand in the analysis that, in the sportive TV scenery, occurs a construction image that seduces and involves the viewer through the aesthetics elements. From that discuss axis reflect about teaching sport in the school, main concern to the materialization a sport model only. Aims unfolding about space and time construction yet, and about the multiplicity language for to work in the school. Positions that no absolute rules, but that check the TV sport by the seduction promoted in the viewers through the aesthetics elements transmit

Planejamento cooperativo de tarefas em um ambiente de futebol de robôs

Este trabalho apresenta o desenvolvimento de um método de coordenação e cooperação para uma frota de mini-robôs móveis. O escopo do desenvolvimento é o futebol de robôs. Trata-se de uma plataforma bem estruturada, dinâmica e desenvolvida no mundo inteiro. O futebol de robôs envolve diversos campos do conhecimento incluindo: visão computacional, teoria de controle, desenvolvimento de circuitos microcontrolados, planejamento cooperativo, entre outros. A título de organização os sistema foi dividido em cinco módulos: robô, visão, localização, planejamento e controle. O foco do trabalho se limita ao módulo de planejamento. Para auxiliar seu desenvolvimento um simulador do sistema foi implementado. O simulador funciona em tempo real e substitui os robôs reais. Dessa forma os outros módulos permanecem praticamente inalterados durante uma simulação ou execução com robôs reais. Para organizar o comportamento dos robôs e produzir a cooperação entre eles foi adotada uma arquitetura hierarquizada: no mais alto nível está a escolha do estilo de jogo do time; logo abaixo decide-se o papel que cada jogador deve assumir; associado ao papel temos uma ação específica e finalmente calcula-se a referência de movimento do robô. O papel de um robô dita o comportamento do robô na dada ocasião. Os papéis são alocados dinamicamente durante o jogo de forma que um mesmo robô pode assumir diferentes papéis no decorrer da partida

Controle biológico da podridão radicular e promoção de crescimento em pepino hidropônico com microrganismos de manguezais

O objetivo deste trabalho foi avaliar a capacidade de microrganismos de manguezais para controlar a podridão radicular causada por Pythium aphanidermatum e para promover o crescimento em pepino hidropônico (Cucumis sativus). Avaliaram-se 19 microrganismos quanto ao controle da doença em mini-hidroponia. Os microrganismos mais promissores para esse fim - Gordonia rubripertincta SO-3B-2 e a mistura dos isolados G. rubripertincta SO-3B-2, MB-P3A-49, MB-P3-C68 e SO-3L-3, de Pseudomonas stutzeri, e Bacillus cereus AVIC-3-6 - foram, posteriormente, testados quanto à promoção de crescimento do pepineiro, em casa de vegetação. Microrganismos de manguezais podem ter importância funcional no controle biológico da podridão radicular causada por P. aphanidermatum e na promoção do crescimento do pepineiro cultivado em hidroponia. Os microrganismos G. rubripertincta SO-3B-2 e P. stutzeri MB-P3A-49 são promissores na promoção do crescimento das plantas não infestadas com o patógeno.

Implementação da técnica de difração de elétrons de baixa energia

The purpose of this study is to describe the implementation of the Low Energy Electron Diffaction (LEED) technique in the Laboratory of Magnetic Nanostructures and Semiconductors of the Department of Theoretical and Experimental Physics of the Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil. During this work experimental apparatus were implemented for a complete LEED set-up. A new vacuum system was also set up. This was composed of a mechanical pump, turbomolecular pump and ionic pump for ultra-high vacuum and their respective pressure measurement sensors (Pirani gauge for low vacuum measures and the wide range gauge -WRG); ion cannon maintenance, which is basically mini-sputtering, whose function is sample cleaning; and set-up, maintenance and handling of the quadrupole mass spectrometer, whose main purpose is to investigate gas contamination inside the ultra-high vacuum chamber. It should be pointed out that the main contribution of this Master's thesis was the set-up of the sample heating system; that is, a new sample holder. In addition to the function of sample holder and heater, it was necessary to implement the function of sustaining the ultra-high vacuum environment. This set of actions is essential for the complete functioning of the LEED technique

Filmes nanométricos de FeN e ALN crescidos por sputtering e aplicações do efeito peltier

This study will show the capability of the reactive/nonreactive sputtering (dc/rf) technique at low power for the growth of nanometric thin films from magnetic materials (FeN) and widegap semiconductors (AlN), as well as the technological application of the Peltier effect using commercial modules of bismuth telluride (Bi2Te3). Of great technological interest to the high-density magnetic recording industry, the FeN system represents one of the most important magnetic achievements; however, diversity of the phases formed makes it difficult to control its magnetic properties during production of devices. We investigated the variation in these properties using ferromagnetic resonance, MOKE and atomic force microscopy (AFM), as a function of nitrogen concentration in the reactive gas mixture. Aluminum nitride, a component of widegap semiconductors and of considerable interest to the electronic and optoelectronic industry, was grown on nanometric thin film for the first time, with good structural quality by non-reactive rf sputtering of a pure AlN target at low power (≈ 50W). Another finding in this study is that a long deposition time for this material may lead to film contamination by materials adsorbed into deposition chamber walls. Energy-dispersive X-ray (EDX) analysis shows that the presence of magnetic contaminants from previous depositions results in grown AlN semiconductor films exhibiting magnetoresistance with high resistivity. The Peltier effect applied to commercially available compact refrigeration cells, which are efficient for cooling small volumes, was used to manufacture a technologically innovative refrigerated mini wine cooler, for which a patent was duly registered

Funcionalidade em pacientes após acidente vascular encefálico: relação com o sono e ritmo de atividade-repouso

It is known that sleep plays an important role in the process of motor learning. Recent studies have shown that the presence of sleep between training a motor task and retention test promotes a learning task so than the presence of only awake between training and testing. These findings also have been reported in stroke patients, however, there are few studies that investigate the results of this relationship on the functionality itself in this population. The objective of this study was to evaluate the relationship between functionality and sleep in patients in the chronic stage of stroke. A cross-sectional observational study was conducted. The sample was composed of 30 stroke individuals in chronic phase, between 6 and 60 months after injury and aged between 55 and 75 years. The volunteers were initially evaluated for clinical data of disease and personal history, severity of stroke, through the National Institute of Health Stroke Scale, and mental status, the Mini-Mental State Examination. Sleep assessment tools were Pittsburgh Sleep Quality Index, the Questionnaire of Horne and Ostberg, Epworth Sleepiness Scale, the Berlin questionnaire and actigraphy, which measures were: real time of sleep, waking after sleep onset, percentage of waking after sleep onset, sleep efficiency, sleep latency, sleep fragmentation index, mean activity score. Other actigraphy measures were intraday variability, stability interdiária, a 5-hour period with minimum level of activity (L5) and 10-hour period with maximum activity (M10), obtained to evaluate the activity-rest rhythm. The Functional Independence Measure (FIM) and the Berg Balance Scale (BBS) were the instruments used to evaluate the functional status of participants. The Spearman correlation coefficient and comparison tests (Student's t and Mann-Whitney) were used to analyze the relationship of sleep assessment tools and rest-activity rhythm to measures of functional assessment. The SPSS 16.0 was used for analysis, adopting a significance level of 5%. The main results observed were a negative correlation between sleepiness and balance and a negative correlation between the level of activity (M10) and sleep fragmentation. No measurement of sleep or rhythm was associated with functional independence measure. These findings suggest that there may be an association between sleepiness and xii balance in patients in the chronic stage of stroke, and that obtaining a higher level of activity may be associated with a better sleep pattern and rhythm more stable and less fragmented. Future studies should evaluate the cause-effect relationship between these parameters

Tradução, adaptação cultural e avaliação psicométrica da prova cognitiva de leganés em uma população idosa brasileira com baixo nível de escolaridade

Introdução: The scales of cognitive screening are important tools for early detection of dementia, creating the possibility of developing measures to slow this process and assist in the management of the disease. Objective: To validate the Leganés Cognitive Test (Prueba Cognitive de Leganés) (PCL) for cognitive screening in low educated elderly Brazilians. Methods: The study sample was composed of 59 elderly residents from the city of Santa Cruz, Brazil with low schooling levels. Reliability was analyzed with a 2-day interval between assessments, and concurrent validity was assessed using the Mini Mental State Examination (MMSE). Results: According to the PCL, the prevalence of dementia was 11.8%. The scale items showed a moderate to strong correlation between domains (p <0.01), and inter-rater reliability exhibited ICC = 0.81, 95% CI (0.72-0.88). Factor analysis resulted in two factors: memory and orientation. Interscale agreement was considered poor (k = - 0.02), supporting the hypothesis of an educational impact on final MMSE scores. Conclusion: The results suggest that PCL has acceptable levels of reliability for use in low educated elderly Brazilians

Efeitos da adição de carga no treino de marcha na esteira em indivíduos com Doença de Parkinson: ensaio clínico controlado randomizado

Introduction: The intrinsic gait disorders in individuals with Parkinson's disease (PD) are one of the most disabling motor symptoms. Among the therapeutic approaches used in attempts to improve the motor function, especially the gait pattern of individuals, stands out the treadmill gait training associated with the addition of load. However, there are few findings that elucidate the benefits arising from such practice. Objective: To assess the effects of adding load on the treadmill gait training in individuals with PD. Material and Methods: A controlled, randomized and blinded clinical trial, was performed with a sample of 27 individuals (18 men and 9 women) with PD, randomly assigned to three experimental conditions, namely: treadmill gait training (n=9), treadmill gait training associated with addition of 5% load (n=9) and treadmill gait training associated with addition of 10% load (n=9). All volunteers were assessed, during phase on of Parkinson's medication, regarding to demographic, clinical and anthropometric (identification form) data, level of disability (Hoehn and Yahr Modified Scale), cognitive function (Mini Mental State Examination), clinical functional - in those areas activity of daily living and motor examination (Unified Parkinson's Disease Rating Scale - UPDRS) and gait cinematic analysis was performed through Qualisys Motion Capture System®. The intervention protocol consisted of gait training in a period of 4 consecutive weeks, with three weekly sessions, lasting 30 minutes each. The post-intervention assessment occurred the next day after the last training session, which was performed cinematic analysis of gait and the UPDRS. Data analysis was performed using the software Statistical Package for Social Sciences® (SPSS) 17.0. Results: The age of volunteers ranged from 41 to 75 years old (62,26 ± 9,07) and the time of clinical diagnosis of PD between 2 to 9 years (4,56 ± 2,42). There was a reduction regarding the score from motor exam domain (p=0,005), only when training with the addition of a 5% load. As for the space-time variables there was no significant difference between groups (p>0,120); however, the training with addition of 5% load presented the following changes: increase in stride length (p=0,028), in step length (p=0,006), in time balance of the most affected member (p=0,006) and reduction in support time of the referred member (p=0,007). Regarding angular variables significant differences between groups submitted to treadmill gait training without addition load and with 5% of load were observed in angle of the ankle at initial contact (p=0,019), in plantar flexion at toe-off (p=0,003) and in the maximum dorsiflexion in swing (p=0,005). While within groups, there was a reduction in amplitude of motion of the ankle (p=0,048), the only workout on the treadmill. Conclusion: The treadmill gait training with addition of 5% load proved to be a better experimental condition than the others because it provided greater gains in a number of variables (space-time and angular gait) and in the motion function, becoming a therapy capable of effectively improving the progress of individuals with PD