Prevalência da proporção dourada nos alunos de medicina dentária do ISCSEM

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Violência conjugal: dados sócio-demográficos, comportamentos e crenças associados: fragmentos de um amor menor

A violência doméstica tornou-se um fenómeno social de grande complexidade, que não pode ser tratado de forma superficial, seja por parte daqueles que intervêm tecnicamente, seja por parte das vítimas e agressores, pois trata-se da vida real de muitos indivíduos ou sujeitos. Deste modo, tornou-se necessário analisar a violência doméstica, procurando perceber o papel dos agentes, em especial dos técnicos, que acompanham as vítimas de violência doméstica na construção do seu projecto de vida. Para a realização deste estudo, fiz uma abordagem dos diferentes conceitos de violência doméstica, fundamental neste trabalho, em virtude da complexidade e controvérsia que a sua definição implica para diferentes autores e abordagens teóricas. Naturalmente que, se o tema da violência doméstica atravessa todo o trabalho, era indispensável ouvir as vítimas desta problemática quanto ao seu sofrimento, coragem e resiliência, ou abandono do lar e acompanhamento recebido. Assim sendo, e porque pretendi fazer uma análise à forma como é realizado o acompanhamento e intervenção por parte dos técnicos, este trabalho apresenta ainda uma investigação empírica realizada através da aplicação de inquéritos por questionário vítimas e não vítimas de violência doméstica, bem como a caracterização dos dados sociodemográficos do distrito de Portalegre. O tratamento e análise dos dados permitiram confirmar, em larga medida, a fundamentação teórica apresentada na primeira parte do estudo onde se verificou haver a divergência no conceito de violência doméstica, as vítimas serem predominantemente do sexo feminino e os agressores do sexo masculino, os vários motivos que levam as vítimas a permanecer na relação e a importância do papel dos técnicos de acompanhamento na definição de projectos de vida alternativos.

O benefício da transiluminação em estudos comunitários

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Giardiose: realidade em Portugal e no mundo

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

O vírus do papiloma humano e a vacinação contra o cancro do colo do útero

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Sistemas participativos online de monitorização de epidemias: avaliação do conhecimento e participação dos alunos finalistas dos cursos de ciências farmacêuticas da área de Lisboa

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

O Valor da Marca Banco BPI – Um Estudo de Caso

Este estudo teve como principal objetivo determinar o valor da marca Banco BPI na perspetiva dos clientes e financeira, recorrendo-se à distribuição de 250 inquéritos a clientes BPI para determinar o valor da marca na perspetiva dos clientes e à aplicação do método EVA para determinar o valor da marca na perspetiva financeira. Os inquiridos demonstraram uma perspetiva positiva nas várias dimensões do valor percebido da marca, no entanto a dimensão que apresentou a média mais elevada foi a notoriedade e a mais baixa foi a avaliação global da marca. De acordo com a análise fatorial exploratória efetuada, constatou-se que há duas componentes (fatores latentes) que parecem explicar o valor percecionado na perspetiva dos clientes. A primeira está relacionada com a confiança e fidelidade que os clientes possuem para com o Banco BPI e a segunda com o conhecimento das características do banco. Por sua vez, a qualidade percebida possui um peso semelhante em ambas as componentes. Ao longo do período temporal histórico considerado observaram-se EVA positivos para o Banco BPI. Através da comparação do EVA deste com o seu benchmark (Millennium BCP) verificou-se que o EVA do BPI é superior. O valor da marca na perspetiva financeira foi obtido através do método EVA usando diferentes cenários possíveis para o crescimento dos resultados e capitais investidos e por comparação com o valor da empresa, usando variáveis do benchmark. Desta forma, obtiveram-se resultados positivos em ambas as perspetivas, tal como era esperado, pelo que se concluiu que a marca Banco BPI possui um valor global positivo.

Os desafios da gestão das IPSS face aos serviços prestados: uma proposta de inovação

As IPSS são instituições particulares de solidariedade social. São instituições sem fins lucrativos que, embora não sendo instituições constituídas pelo Estado ou por outro organismo público, podem usufruir do seu apoio. Os seus objetivos visam responder às necessidades da sociedade de uma forma transversal, oferecendo apoio social às famílias, crianças, jovens e idosos e visando a integração e bem-estar da sociedade (Instituto da Segurança Social, 2013). O presente estudo focou-se no âmbito das respostas oferecidas à terceira idade, mais concretamente através do serviço prestado nos centros de convívio. Procurou-se analisar as práticas existentes, identificar as eventuais boas práticas e perceber qual a sua frequência. Em complemento, procurou-se ainda compreender se existe abertura para a mudança e para a inovação na gestão deste tipo de centros. Como metodologia de investigação recorreu-se à elaboração e tratamento de inquéritos feitos aos utentes e técnicos dos centros de convívio do concelho de Barcelos, presentes na Carta Social de Barcelos. Para identificar as boas práticas fez-se um exercício do Benchmarking, ferramenta de gestão que, enquanto instrumento de comparação das Boas Práticas, surge como recurso para comparar e procurar no seio destas instituições as boas práticas (Costa, 2009). O estudo permitiu concluir que existe comunicação entre as diferentes instituições, havendo entre algumas delas um efetivo trabalho em rede com vista a melhorar o desempenho e as respostas que podem ser oferecidas. A satisfação dos utentes dos centros permitiu ainda concluir que existem efetivamente boas práticas e que essas boas práticas são também reconhecidas no seio de outros centros, sendo adaptadas à realidade dos mesmos.

Avaliação das condicionalidades em saúde do Programa Bolsa Família

The programs of conditional cash transfer are widespread in developing countries in Latin America with emphasis on Brazil as a new paradigm in social p olicies for poverty eradication . Consist of transferring monetary funds from the government directly to poor families by fulfilling the condition alities on education and health . In health, even wi th variations between countries , conditionality targeting public pregnant women and children with a view to improving health indic ators maternoinfantil as growth , infant mortality and prenatal care. The objectives of this study are to compare the transfer progr am conditional Brazilian income , the Family and similar programs in Latin A merica in relation to it s effects on growth in children , and to evaluate the effect of Bolsa Família in the prevalence of use of services ( conditionalities ) of prenatal care in Brazilian health services whose teams joined the Programa de Acesso e Melhoria da Qualidade da Atenção Básica (PMAQ - AB) . For the first objective a systematic review , we selec ted ten articles between 1007 ( one thousand and seven ) found in the databases Embase , PubMed, Scopus , Scielo and Lilacs databases was performed . Articles are ob servational epidemiological studies of transverse descriptive and analytical types of cohort and case - co ntrol. For the second objective, for it is a prevalence study , a statistical analysis using Poisson regression with robust variance was performed to i nvestigate how the prevalence of compliance with conditionalities on health was influenced b y various explanatory variables . Ratios , crude and adjusted prevalence , with their respective confidence i ntervals of 95 % were estimated . The family joined the sch olarship program was considered as the main expo sure variable . Confounding variables were: maternal age , race / color, paid employment , marital status and region of residence . In d ata analysis software R 3.0.1 (RDevelopment Core Team 2013 ) was used . Rega rding the comparison of the Bolsa Família with other programs in Latin America , the review found similar results regarding the positive effect of income transfer in the nutritional status o f beneficiary children programs , and these effects are more evident in children under two years old and belonging to familie s of lower socioeconomic status . For the prevalence of conditionalities entres different groups of users of the Bolsa Família and nonusers results showed no statistically significant difference betwe en respondents (with children under two years ) registered and not registered in PBF on issues relating to: me et at least six prenatal visits , meet and participate in health education activities . It follows from side to increase minimum income for families in extreme poverty showed positive impact on children's health in Brazil and Latin America. The o ther is not confirmed in Brazil , an increase in conditionality expressed in use of primary care by the user s of the Bolsa Família services.

Epidemiologia e caracterização molecular dos vírus Dengue circulantes no Rio Grande do Norte, 2013-2014

Dengue is an acute infectious disease, usually transmitted by Aedes aegypti mosquitoes. The etiologic agents belong to the family Flaviviridae, genus Flavivirus, and occur as four antigenically related but distinct serotypes designated DENV-1, 2, 3, and 4. In Brazil, the disease represents a national public health problem. The purpose of the present study was to describe epidemiological aspects of dengue in the State of Rio Grande do Norte, from 2013 to 2014. A total of 483 blood or serum samples, collected from January 2013 to December 2014, were studied by RT-PCR for viral detection and typing. The infection was confirmed in 36.44% (176/483) of the cases studied. This study detected the circulation of three serotypes of dengue virus in Rio Grande do Norte, DENV-1, 2, and 4. The predominant serotype in 2013-2014 was the DENV-4, representing 83.51% (81/97) and 68.35% (54/79) of the positive cases, respectively. Regarding the spatial distribution, most of the cases occurred in Natal and Caicó, with 9.28% (9/97) and 18.99% (15/79), respectively. The months with the biggest viral circulation in RN were March 2013 and May 2014. The female gender was the most affected, representing 69.07% (67/97) in 2013 and 54.43% (43/79) in 2014. The most affected age groups were 21-30 years (2013) and 11-20 years (2014) with 25.77% (25/97) and 20.25% (16/79) positive cases, respectively. Phylogenetic analysis indicated that genotype V (DENV-1) and genotype II (DENV-4) circulated in the State. Our results provide information about the dynamics of DENV in the Rio Grande do Norte, important for the development of disease control strategies.

Mortalidade em idosos longevos e "mais jovens" no Brasil

The aim of the present study was to trace the mortality profile of the elderly in Brazil using two neighboring age groups: 60 to 69 years (young-old) and 80 years or more (oldest-old). To do this, we sought to characterize the trend and distinctions of different mortality profiles, as well as the quality of the data and associations with socioeconomic and sanitary conditions in the micro-regions of Brazil. Data was collected from the Mortality Information System (SIM) and the Brazilian Institute of Geography and Statistics (IBGE). Based on these data, the coefficients of mortality were calculated for the chapters of the International Disease Classification (ICD-10). A polynomial regression model was used to ascertain the trend of the main chapters. Non-hierarchical cluster analysis (K-Means) was used to obtain the profiles for different Brazilian micro-regions. Factorial analysis of the contextual variables was used to obtain the socio-economic and sanitary deprivation indices (IPSS). The trend of the CMId and of the ratio of its values in the two age groups confirmed a decrease in most of the indicators, particularly for badly-defined causes among the oldest-old. Among the young-old, the following profiles emerged: the Development Profile; the Modernity Profile; the Epidemiological Paradox Profile and the Ignorance Profile. Among the oldest-old, the latter three profiles were confirmed, in addition to the Low Mortality Rates Profile. When comparing the mean IPSS values in global terms, all of the groups were different in both of the age groups. The Ignorance Profile was compared with the other profiles using orthogonal contrasts. This profile differed from all of the others in isolation and in clusters. However, the mean IPSS was similar for the Low Mortality Rates Profile among the oldest-old. Furthermore, associations were found between the data quality indicators, the CMId for badly-defined causes, the general coefficient of mortality for each age group (CGMId) and the IPSS of the micro-regions. The worst rates were recorded in areas with the greatest socioeconomic and sanitary deprivation. The findings of the present study show that, despite the decrease in the mortality coefficients, there are notable differences in the profiles related to contextual conditions, including regional differences in data quality. These differences increase the vulnerability of the age groups studied and the health iniquities that are already present.

Síndrome de Guillain-Barré: epidemiologia, prognóstico e fatores de risco

Introduction. Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy and the principal cause of acute neuromuscular paralysis. The most prominent GBS subtypes are: acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor-sensory axonal neuropathy (AMSAN) and Fisher syndrome (FS). Differences in geographical distribution of variants have been reported. In Brazil, there are few studies describing the characteristics of GBS, but none on the frequency of GBS variants and their clinical manifestations. Infection-induced aberrant immune response resulting from molecular mimicry and formation of cross-reacting antibodies, contribute to complement activation. Functional biallelic polymorphism in immunoglobulin receptors that influence the affinity of IgG subclasses and the type of immune response have been described, suggesting genetic susceptibility to developing disease. It remains unclear whether individuals carrying different FCGR alleles have differential risk for GBS and⁄or disease severity. The goals of this study were: (1) To characterize GBS and describe the clinical findings in a cohort of patients with GBS from the state of Rio Grande do Norte, Brazil; (2) to determine whether polymorphism in FCGR were associated with development of GBS, and (3) to tease out whether the global gene expression studies could be a tool to identify pathways and transcriptional networks which could be regulated and decrease the time of disease. Methods. Clinical and laboratory data for 149 cases of GBS diagnosed from 1994 to 2013 were analyzed. Genomic DNA and total RNA were extracted from whole blood. Antigangliosides antibodies were determined in the sera. In addition, we also assessed whether FCGR polymorphism are present in GBS (n=141) and blood donors (n=364), and global gene expressions were determined for 12 participants with GBS. Blood samples were collected at the diagnosis and post-recovery. Results. AIDP was the most frequent variant (81.8%) of GBS, followed by AMAN (14.7%) and AMSAN (3.3%). The incidence of GBS was 0.3 ⁄ 100,000 people for the state of Rio Grande do Norte and cases occurred at a younger age. GBS was preceded by infections, with the axonal variant associated with episodes of diarrhea (P = 0.025). Proximal weakness was more frequent in AIDP, and distal weakness predominant in the axonal variant. Compared to 42.4% of cases with AIDP (P<0.0001), 84.6% of cases with the axonal variant had nadir in <10 days. Individuals with the axonal variant took longer to recover deambulation (P<0.0001). The mortality of GBS was 5.3%. A worse outcome was related to an axonal variant (OR17.063; P=0.03) and time required to improve one point in the Hughes functional scale (OR 1.028; P=0.03). The FCGR genotypes and allele frequencies did not differ significantly between the patients with GBS and the controls (FCGR2A p=0.367 and FCGR3A p=0.2430). Global gene expression using RNAseq showed variation in transcript coding for protein isoforms during acute phase of disease. Conclusions. The annual incidence of GBS was 0.3 per 100,00 and there was no seasonal pattern. A predominance of the AIDP variant was seen, and the incidence of the disease decreased with age. The distribution of weakness is a function of the clinical variants, and individuals with the axonal variant had a poorer prognosis. Early diagnosis and variant identification leads to proper intervention decreasing in long-term morbidity. FCGR polymorphisms do not seem to influence susceptibility to GBS in this population. This study found deregulated genes and signs of transcriptional network alterations during the acute and recovery phases in GBS. Identification of pathways altered during disease might be target for immune regulation and with potential to ameliorate symptoms.

Parasitos de importância para a caprinocultura e a ovinocultura potiguar

The goat and sheep industry shows up as an agricultural activity of great importance for the semiarid Northeast. However, the sheep and goats production is made with various difficulties. Among them, parasitic infections, particularly helminth infections of the gastrointestinal tract, the eimeriosis and toxoplasmosis; this one related to problems in reproduction. For this reason, the aim of this study is to to make a survey of the occurrence and some determinants of parasitic diseases that affect small ruminant flocks of the microregions Natal, Macaíba, Litoral Sul, Angicos, Vale do Açu and Borborema Potiguar. Thereunto, epidemiological tools were applied with producers, keepers or guardians of herds and also held collections of blood and feces of animals in eight properties located in seven municipalities of these microregions. The parasite load of the animals was determined through eggs and oocysts counting per gram of feces EPG and OPG, respectively. In addition, the recovery of infective larvae was made. Blood samples were used to measure the globular cell volume and the search for anti-Toxoplasma gondii IgG in sheep serum, by Enzyme Linked Immune Sorbent Assay (ELISA). For categorical variables, the statistical analysis was performed using Poisson regression, with significance level of 0.05. The analysis of the instruments showed that ivermectin is the anthelmintic used in 85,71% of properties. From the total of feces samples of the sheep (n = 179), 53,07% were positive for helminth eggs and 48,04% were positive for oocysts of Eimeria. From the samples of faeces of goats (n = 133), 72,18% were positive for helminth eggs and 96,99% for oocysts of Eimeria. The lowest EPG and OPG count was observed in the micro region of Angicos. Most of the EPG count was found in the micro region Litoral Sul and the OPG count in the micro-region Borborema Potiguar. Both cases the difference was statistically significant(p- value0,000)The most prevalent helminth genus found was Haemonchus, present in 49,87% of the sheep and 80,42% of goats. The average of hematocrit ranged from 22,91 to 33,25 in sheep and from 22,62 to 28,25 in goats. The prevalence of anti-Toxoplasma gondii IgG ranged from 63,33% to 100,00%. The goats showed to be more susceptible to infections by parasites of the gastrointestinal tract than the sheep. In all the properties was observed high prevalence of infection by T. gondii, with the lowest percentages recorded in the micro regions Angicos and Borborema Potiguar.

Condições de trabalho e saúde psíquica de servidores técnico-administrativos da UFRN

Unfavorable working conditions constitute one of the factors that may contribute to cause psychic suffering and behavioral disorders in workers. This research aimed to characterize the working conditions public servant technical- administrative , specifically the auxiliaries and assistants in administration of the Federal University of Rio Grande do Norte – UFRN, Natal, Brasil, as well to identify the incidence of psychic suffering in this group of public servants. As a strategy, we chose a case study of multi-method type, descriptive with quantitative and qualitative sequential steps. For this, it initially performed desk research by surveying epidemiological data for these public servants working in central campus, to identify the major diseases presented in the period from January 2011 to June 2014. Then, we proceeded to diagnostic step of the aspects related to work, by applying online and in loco of Working Conditions Survey (already validated by Borges et al., 2013a) in 11 sectors selected according to the following criteria: high number of workers public servants and major and minor percentage of absences for health care for ICD-F (according to records of Sector of Workers Health Care - DAS). In the treatment of the data the spreadsheet editor software Microsoft Office Excel and statistical SPSS Statistical Package for Social Sciences were used and made qualifying type of content analysis of open questions. Applied to this study 174 public servants and the results show a predominance of absenteeism due to mental or behavioral disorders (ICD F), musculoskeletal diseases (ICD M) and respiratory system (ICD J). Among the factors that were significant are the working hours (contractual and legal); Physical Effort (M = 2.59) and workspace (M = 2.58) - physical and material conditions; encouraging collaboration (M = 3.5) - processes and characteristics of the work; and participation (M = 1.78) - social-management environment. Therefore, it infers the existence of a relationship between these factors and some of the reasons for absenteeism reported by participants. It is suggested the expansion of this research with studies involving other professionals (including scholarship workers and contractors) and specific sectors.

Plano amostral, ponderação e efeitos do delineamento da Pesquisa Nacional de Saúde Bucal

OBJETIVO: Estimar la prevalencia y la extensión de la caries radicular en la población adulta y anciana de Brasil. MÉTODOS: A partir de los datos de la Investigación Nacional de Salud Bucal (SBBrasil 2010) se examinaron 9.564 adultos y 7.509 ancianos en domicilios de las 26 capitales y en el Distrito Federal y de 150 municipios del interior de cada macro región. Se implementaron criterios de diagnóstico establecidos por la Organización Mundial de la Salud. Para estudio de la prevalencia y de extensión se utilizó el índice de caries radicular y el índice de raíces cariadas y obturadas. RESULTADOS: La prevalencia de caries radicular fue de 16,7% en los adultos y 13,6% en los ancianos; el índice de raíces cariadas y obturadas fue de 0,42 y 0,32 respectivamente, siendo la mayor parte compuesta por caries no tratadas. Se observaron diferencias en la experiencia de caries radicular entre capitales y macro regiones, con valores mayores en capitales del Norte y Noreste. El índice de caries radicular en los adultos varió de 1,4% en Aracaju (SE) a 15,1% en Salvador (BA) y en los ancianos de 3,5% en Porto Velho (RO) a 29,9% en Palmas (TO). Se verificó incremento de caries radicular con la edad y mayor expresividad de la enfermedad en hombres de ambos grupos etarios. CONCLUSIONES: Se identificó una gran variación de la prevalencia y extensión de la caries radicular entre y dentro de las regiones de Brasil, tanto en adultos como en ancianos, y la mayor parte de la caries radicular se encuentra no tratada. Se recomienda la incorporación de este agravio al sistema de vigilancia en salud bucal, debido a su tendencia creciente.