Impacto do contexto de trabalho e da resiliência sobre o bem-estar no trabalho de profissionais dos Centros de Atenção Psicossocial

Este estudo teve como intuito investigar o impacto do contexto de trabalho e da resiliência sobre o bem-estar no trabalho em profissionais dos Centros de Atenção Psicossocial (CAPS). Os CAPS são serviços públicos substitutivos ao modelo asilar para tratamento de pessoas em sofrimento psíquico, preconizado e fundamentado na Política Nacional de Saúde Mental (PNSM). Para medir o contexto de trabalho utilizou-se a Escala de Avaliação do Contexto de Trabalho (EACT) que investiga as condições de trabalho, a organização do trabalho e as relações sócio profissionais. Já o instrumento utilizado para medir a capacidade dos trabalhadores em manter o nível de desempenho no trabalho mesmo em situações complexas e desgastantes foi a Escala de Avaliação de Resiliência no Trabalho (EART). Por último, investigou-se o nível de bem-estar do público pesquisado através do Inventário de Bem- Estar no Trabalho (IBET-13). O bem-estar no trabalho tem sido considerado como um construto psicológico resultado de vínculos positivos com o trabalho e com a organização. Participaram 81 profissionais dos CAPS das cidades de Petrolina PE e São Bernardo do Campo SP, com idade média de 37 anos (DP= 10,45), em sua maioria do sexo feminino (65,4%), com níveis de escolaridade acima do ensino superior e pós-graduação completa (ambos com 29%), que se declararam casados ou em união estável (39%). Neste estudo, considerou-se bem-estar no trabalho como variável critério e resiliência no trabalho e contexto de trabalho como preditores. Foram realizadas análises estatísticas exploratórias e descritivas, análises de regressão e análises de variância (ANOVA) para descrever participantes, variáveis e testar o modelo. Os resultados apoiaram parcialmente o modelo de predição, pois apenas o fator relações sócio profissionais se confirmou como preditor significativo de Bem-estar no Trabalho, e não houve predição significativa com as demais variáveis (Condições de Trabalho, Organização do Trabalho e Resiliência no Trabalho). Estes dados podem revelar que boas relações sócio profissionais tendem a aumentar o nível de satisfação e comprometimento organizacional afetivo com a instituição, bem como o aumento do nível de envolvimento desses profissionais com seu trabalho.

PERCEPÇÃO DE SUCESSO NA CARREIRA E RESILIÊNCIA: UM ESTUDO COM ADMINISTRADORES

Sucesso profissional está relacionado à satisfação do indivíduo com a sua carreira em longo prazo. Essa satisfação deriva de aspectos intrínsecos e extrínsecos, referentes a uma dimensão objetiva - aspectos mais visíveis do sucesso na carreira - que inclui: salários, progressão profissional, status e oportunidades de desenvolvimento de carreira, como promoção; e outra subjetiva, que se refere à interpretação pessoal do que seja sucesso, em especial na carreira: satisfação com o trabalho, orgulho, sentimentos de autorrealização, dentre outros. A percepção do sucesso com a carreira pode estar associada a características individuais como, por exemplo, a resiliência, que representa o processo dinâmico de adaptação positiva frente às adversidades. Na literatura, não foram localizados estudos que relacionem ambas as variáveis, isto é, sobre o quanto a resiliência pessoal pode contribuir para a percepção de sucesso na carreira. A fim de investigar essa influência, esta pesquisa tem como objetivo principal identificar se resiliência pessoal de administradores prediz sua percepção de sucesso na carreira. Participaram 137 administradores, formados em diversas instituições, sendo 56,1% do sexo feminino e 43,7% do sexo masculino, com idade média de 33 anos, divididos entre casados ou solteiros (44,5% para ambos). Os dados foram coletados por meio de um questionário sociodemográfico, baseado na Escala de Percepção de Sucesso na Carreira e da Connor-Davidson Resilience Scale (CD-RISC). As respostas compuseram um banco eletrônico de dados e foram analisados por meio do Statistical Package for the Social Sciences (SPSS). Resultados de análises de regressão hierárquica revelaram que resiliência prediz 5,5% da percepção do sucesso na carreira objetiva e 9% da percepção de sucesso na carreira subjetiva. Ao acrescentar a interação entre idade e tempo de trabalho, o poder de predição de ambos os modelos, tanto para sucesso objetivo, quanto para o subjetivo, elevou-se substancialmente, chegando ao dobro. Resiliência contribui para que os participantes percebam sucesso na carreira em ambas as dimensões, objetiva e subjetiva, e a predição é potencializada pela interação entre idade e tempo de trabalho. Os achados deste estudo confirmaram a hipótese levantada. O estudo trouxe contribuições para a área, mas também foram reconhecidas limitações, em função das quais foi proposta uma agenda de pesquisa para estudos futuros.

OS IMPACTOS DO BALANÇO EMOCIONAL, OTIMISMO E PERCEPÇÕES DE SUPORTES SOBRE BEM-ESTAR NO TRABALHO DE AGENTES COMUNITÁRIOS DE SAÚDE

Nas décadas de 60 e 70, os olhares de muitos estudiosos se voltaram para os aspectos positivos da vida. Diversos autores ofereceram sustentação para fortalecer uma nova perspectiva de campo científico, a Psicologia Positiva. Tendo como base teórica o conhecimento de Psicologia Positiva e Psicologia da Saúde, pesquisas estão sendo desenvolvidas para investigar simultaneamente variáveis oriundas destes domínios. Um dos temas colocado sob analise são as emoções, investigadas em diferentes contextos e no ambiente organizacional. Importante salientar a existência de outras variáveis no contexto organizacional que têm sido investigadas à luz da Psicologia Positiva, tais como otimismo, percepções de suporte social no trabalho e percepções de suporte organizacional, algumas delas reunidas para compor modelos preditivos de bem-estar no trabalho (BET), construto multidimensional composto por dois vínculos afetivos positivos com o trabalho (satisfação no trabalho e envolvimento com o trabalho) e um com a organização (comprometimento organizacional afetivo). O presente estudo teve como objetivo analisar a capacidade de predição do balanço emocional (afetos positivos/negativos), do otimismo e de percepções de suporte (social no trabalho e organizacional) sobre as três dimensões de BET. Participaram do estudo 110 agentes comunitários de saúde (ACS), prestadores de serviço de uma prefeitura municipal paulista, com idade média de 38,84 anos, sendo o grupo constituído, em sua maioria, por mulheres e por pessoas casadas. Para a coleta de dados, foi aplicado um questionário contendo sete escalas autoaplicáveis que aferiram as variáveis do estudo. A análise dos dados, todos de natureza numérica, foi desenvolvida utilizando-se subprogramas do SPSS, versão 17.0 para Windows, para cálculos de estatísticas descritivas (médias, desvios padrão e correlações) e estatísticas multivariadas (análises de regressão linear múltipla stepwise). Os resultados do estudo, no que concerne ao seu objetivo principal, que consistiu em submeter a análise um modelo preditivo para BET, demonstraram que os níveis das três dimensões de BET poderiam variar sob o impacto de três preditores: percepção de suporte organizacional, afetos positivos e percepção de suporte instrumental. Como análise geral dos três modelos de regressão calculados, seria possível afirmar que o estado geral de bem-estar dos ACS no contexto de trabalho pode ser fortalecido ou enfraquecido pela atuação de fatores cognitivos que se desenvolvem a partir de percepções da dinâmica social presente no ambiente de trabalho (percepções de suporte social e organizacional) e de um fator de cunho estritamente pessoal contido na estrutura emocional do indivíduo sob a forma de experiências afetivas e aqui referidas com afetos positivos.(AU)

IMPACTO DO CONFLITO INTRAGRUPAL, DO SUPORTE SOCIAL NO TRABALHO E DO AUTOCONCEITO PROFISSIONAL SOBRE A RESILIÊNCIA: UM ESTUDO COM POLICIAIS MILITARES.

A resiliência é um construto que remete à habilidade do ser humano de ter êxito frente às adversidades da vida, superá-las e inclusive, ser fortalecido ou transformado por elas. Campos de investigações da psicologia, como Psicologia da Saúde, Psicologia Positiva e Comportamento Organizacional Positivo, têm considerado a resiliência como uma importante via para a compreensão dos aspectos positivos e saudáveis dos indivíduos. Este trabalho pretendeu ampliar o conhecimento acerca da resiliência e suas relações com outros construtos no contexto organizacional. Para isto, definiu-se como objetivo geral deste estudo verificar a capacidade preditiva do conflito intragrupal (tarefa e relacionamento), do suporte social no trabalho (emocional, informacional e instrumental) e do autoconceito profissional (saúde, realização, autoconfiança e competência) sobre a resiliência (adaptação ou aceitação positiva de mudanças, espiritualidade, resignação diante da vida, competência pessoal e persistência diante das dificuldades) de policiais militares. Participaram do estudo 133 policiais militares de um batalhão do interior do estado de São Paulo, prevalecendo indivíduos do sexo masculino (97,7%), com idade média de 30 anos (DP= 5,7). Para a medida das variáveis foram utilizadas as seguintes escalas validadas: Escala de Avaliação de Resiliência reduzida, Escala de Conflitos Intragrupais, Escala de Percepção de Suporte Social no Trabalho e a Escala de Autoconceito Profissional. Os dados foram submetidos a cálculos descritivos e a análises de regressão linear múltipla padrão. Os resultados indicaram que o modelo que reunia as variáveis antecedentes (conflito intragrupal, suporte social no trabalho e autoconceito profissional) explicou significativamente a variância das dimensões da resiliência: 30% da persistência diante das dificuldades, 29% da adaptação ou aceitação positiva de mudanças, 28% da competência pessoal e 11% da espiritualidade. As variáveis que tiveram impacto estatisticamente importante sobre a persistência diante das dificuldades foram o suporte emocional no trabalho, cuja direção da predição foi inversa, e autoconfiança, cuja direção da predição foi direta. A adaptação ou aceitação positiva de mudanças teve como preditor inverso a variável saúde e como preditor direto a autoconfiança. A competência pessoal teve impacto significativo da variável autoconfiança, que se mostrou um preditor direto. A espiritualidade, por sua vez, teve um único preditor significante, a variável realização, cuja direção da predição foi direta. Os resultados sugerem que dentre as variáveis antecedentes, o autoconceito profissional evidenciou maior poder de explicação da variância da resiliência. À luz da literatura da área foram discutidos estes achados. Por fim, foram apresentadas as limitações e a proposta de uma agenda de pesquisa que contribua para confirmação e ampliação dos resultados desta investigação.

Filogenia molecular das enzimas isocitrato liase e malato sintase e sua evolução em Viridiplanta

The plant metabolism consists of a complex network of physical and chemical events resulting in photosynthesis, respiration, synthesis and degradation of organic compounds. This is only possible due to the different kinds of responses to many environmental variations that a plant could be subject through evolution, leading also to conquering new surroundings. The glyoxylate cycle is a metabolic pathway found in glyoxysomes plant, which has unique role in the seedling establishment. Considered as a variation of the citric acid cycle, it uses an acetyl coenzyme A molecule, derived from lipids beta-oxidation to synthesize compounds which are used in carbohydrate synthesis. The Malate synthase (MLS) and Isocitrate lyase (ICL) enzyme of this cycle are unique and essential in regulating the biosynthesis of carbohydrates. Because of the absence of decarboxylation steps as rate-limiting steps, detailed studies of molecular phylogeny and evolution of these proteins enables the elucidation of the effects of this route presence in the evolutionary processes involved in their distribution across the genome from different plant species. Therefore, the aim of this study was to establish a relationship between the molecular evolution of the characteristics of enzymes from the glyoxylate cycle (isocitrate lyase and malate synthase) and their molecular phylogeny, among green plants (Viridiplantae). For this, amino acid and nucleotide sequences were used, from online repositories as UniProt and Genbank. Sequences were aligned and then subjected to an analysis of the best-fit substitution models. The phylogeny was rebuilt by distance methods (neighbor-joining) and discrete methods (maximum likelihood, maximum parsimony and Bayesian analysis). The identification of structural patterns in the evolution of the enzymes was made through homology modeling and structure prediction from protein sequences. Based on comparative analyzes of in silico models and from the results of phylogenetic inferences, both enzymes show significant structure conservation and their topologies in agreement with two processes of selection and specialization of the genes. Thus, confirming the relevance of new studies to elucidate the plant metabolism from an evolutionary perspective

Integração da simulação termoenergética com o processo de projeto: a análise de 6 casos

This work consists of the integrated design process analyses with thermal energetic simulation during the early design stages, based on six practical cases. It aims to schematize the integration process, identifying the thermal energetic analyses contributions at each design phase and identifying the highest impact parameters on building performance. The simulations were run in the DesignBuilder energy tool, which has the same EnergyPlus engine, validated. This tool was chosen due to the flexible and user friendly graphic interface for modeling and output assessment, including the parametric simulation to compare design alternatives. The six case studies energy tools are three architectural and three retrofit projects, and the author the simulations as a consultant or as a designer. The case studies were selected based on the commitment of the designers in order to achieve performance goals, and their availability to share the process since the early pre-design analyses, allowing schematizing the whole process, and supporting the design decisions with quantifications, including energy targets. The thermoenergetic performance analyses integration is feasible since the early stages, except when only a short time is available to run the simulations. The simulation contributions are more important during the sketch and detail phases. The predesign phase can be assisted by means of reliable bioclimatic guidelines. It was verified that every case study had two dominant design variables on the general performance. These variables differ according the building characteristics and always coincide with the local bioclimatic strategies. The adaptation of alternatives to the design increases as earlier it occurs. The use of simulation is very useful: to prove and convince the architects; to quantify the cost benefits and payback period to the retrofit designer; and to the simulator confirm the desirable result and report the performance to the client

Utilização da espectroscopia no infravermelho próximo para o controle de qualidade do camarão (Litopenaeus vannamei)

This work was developed with the objective of proposing a simple, fast and versatile methodological routine using near-infrared spectroscopy (NIR) combined with multivariate analysis for the determination of ash content, moisture, protein and total lipids present in the gray shrimp (Litopenaeus vannamei ) which is conventionally performed gravimetrically after ashing at 550 ° C gravimetrically after drying at 105 ° C for the determination of moisture gravimetrically after a Soxhlet extraction using volumetric and after digestion and distillation Kjedhal respectively. Was first collected the spectra of 63 samples processed boiled shrimp Litopenaeus vannamei species. Then, the determinations by conventional standard methods were carried out. The spectra centered average underwent multiplicative scattering correction of light, smoothing Saviztky-Golay 15 points and first derivative, eliminated the noisy region, the working range was from 1100,36 to 2502,37 nm. Thus, the PLS models for predicting ash showed R 0,9471; 0,1017 and RMSEP RMSEC 0,1548; Moisture R was 0,9241; 2,5483 and RMSEP RMSEC 4,1979; R protein to 0,9201; 1,9391 and RMSEP RMSEC 2,7066; for lipids R 0,8801; 0,2827 and RMSEP RMSEC 0,2329 So that the results showed that the relative errors found between the reference method and the NIR were small and satisfactory. These results are an excellent indication that you can use the NIR to these analyzes, which is quite advantageous, since conventional techniques are time consuming, they spend a lot of reagents and involve a number of professionals, which requires a reasonable runtime while after the validation of the methodology execution using NIR reduces all this time to a few minutes, saving reagents, time and without waste generation, and that this is a non-destructive technique.

Critério de correntropia no treinamento de redes fuzzy wavelet neural networks para identificação de sistemas dinâmicos não lineares

The great interest in nonlinear system identification is mainly due to the fact that a large amount of real systems are complex and need to have their nonlinearities considered so that their models can be successfully used in applications of control, prediction, inference, among others. This work evaluates the application of Fuzzy Wavelet Neural Networks (FWNN) to identify nonlinear dynamical systems subjected to noise and outliers. Generally, these elements cause negative effects on the identification procedure, resulting in erroneous interpretations regarding the dynamical behavior of the system. The FWNN combines in a single structure the ability to deal with uncertainties of fuzzy logic, the multiresolution characteristics of wavelet theory and learning and generalization abilities of the artificial neural networks. Usually, the learning procedure of these neural networks is realized by a gradient based method, which uses the mean squared error as its cost function. This work proposes the replacement of this traditional function by an Information Theoretic Learning similarity measure, called correntropy. With the use of this similarity measure, higher order statistics can be considered during the FWNN training process. For this reason, this measure is more suitable for non-Gaussian error distributions and makes the training less sensitive to the presence of outliers. In order to evaluate this replacement, FWNN models are obtained in two identification case studies: a real nonlinear system, consisting of a multisection tank, and a simulated system based on a model of the human knee joint. The results demonstrate that the application of correntropy as the error backpropagation algorithm cost function makes the identification procedure using FWNN models more robust to outliers. However, this is only achieved if the gaussian kernel width of correntropy is properly adjusted.

Indicadores e fatores preditivos de uso abusivo de álcool em adultos jovens

The abusive use of alcohol is closely related to dependence and to social and work damages. The main focus of this thesis is to create an instrument about alcohol abuse, in order to differentiate the degree of commitment of the symptomatology, considering its psychosocial factors of prediction. As specific goals: I) characterize the state of the art about assessment related to the abuse and dependence to alcohol; II) investigate and systematize aspects related to the predictive psychosocial factors for alcohol dependence; III) build an instrument for the assessment of alcohol abuse and protection and risk factors for the development of an alcohol dependence; and IV) verify validity evidence of the instrument built for the Brazilian population. In Study I, it was possible to observe the prevalence of articles related to the use of alcohol in a problematic way, without a classification dependence, it is lower than the one of articles that investigate the disease when it is already manifested, not to mention a few systematic studies about the theme of alcohol abuse in the scientific environment. In Study II, focus groups (FGs) were conducted, the analysis about the discourses of the focus groups were made through the ALCESTE software and it was possible to observe a response pattern that existed among the participants in different groups, with the generation of five classes. In Study III, we developed an instrument that contemplated aspects of the Alcohol Dependence Syndrome of the Millon Clinical Multiaxial Inventory-III, in addition to the characteristics defined in Study I and in Study II. The final version of the instrument had 59 items assessed through the likert scale of five points. In Study IV, the administration of the instrument was performed in an online format with university students ranging from 18 to 24 years old, residents in Brazilian metropolitan cities. The results evidenced that the internal consistency of the instrument is considered satisfactory (α = 0,882) and in what it refers to classes, the most significant data was the one related to financial loss and criteria for the diagnosis of alcohol abuse. It is important to consider the evaluative potential of risk and protective factors for the development of alcohol dependence of the instrument as a whole. Once the indicators of abuse and the profile of the abusers has been modified, the patient may have his/her treatment/intervention focused on the trouble and/or specific syndrome, thus having a clear and fast improvement.

Estudo experimental sobre o comportamento do escoamento bifásico água - ar para a medição de vazão em placa de orifício

The measurement of flow through the prediction of differential pressure is widely used in industrial day-to-day, this happens mainly due to the fact that it is used for various types of fluids, such as gas flow and liquid with viscosity distinct even flow of fluids with particles in suspension. The suitability of this equipment for measuring mass flow in two-phase flow is of paramount importance for technological development and reliability of results. When it comes to two-phase flow the relationship between the fluids and their interactions are of paramount importance in predicting the flow. In this paper, we propose the use of concentric orifice plate used in small diameter pipes of 25.4 mm order where a two-phase flow flows between water-air. The measurement of single-phase flow was made with the use of data in NBR 5167-1 which was used to Stolz equation for measuring discharge coefficient. In the two-phase flow was used two correlations widely used in the prognosis of mass flow, the pattern of Zhang (1992) and the model of Chisholm (1967), to the homogeneous flow model. It was observed that the behavior found in Zhang model are consistent more realistic way the mass flow of two-phase flow, since the model Chisholm extrapolate the parameters for the downstream pressure P2, the orifice plate, and the rated discharge coefficient. The use of the change in pressure drop P1-P2 and discharge coefficient, led to a better convergence of the values obtained for the two-phase air-water stream.

Controle de mobilidade infraestruturado e orientado à qualidade para maximização de admissões em sistemas WiNeMO: uma abordagem definida por software

The spread of wireless networks and growing proliferation of mobile devices require the development of mobility control mechanisms to support the different demands of traffic in different network conditions. A major obstacle to developing this kind of technology is the complexity involved in handling all the information about the large number of Moving Objects (MO), as well as the entire signaling overhead required to manage these procedures in the network. Despite several initiatives have been proposed by the scientific community to address this issue they have not proved to be effective since they depend on the particular request of the MO that is responsible for triggering the mobility process. Moreover, they are often only guided by wireless medium statistics, such as Received Signal Strength Indicator (RSSI) of the candidate Point of Attachment (PoA). Thus, this work seeks to develop, evaluate and validate a sophisticated communication infrastructure for Wireless Networking for Moving Objects (WiNeMO) systems by making use of the flexibility provided by the Software-Defined Networking (SDN) paradigm, where network functions are easily and efficiently deployed by integrating OpenFlow and IEEE 802.21 standards. For purposes of benchmarking, the analysis was conducted in the control and data planes aspects, which demonstrate that the proposal significantly outperforms typical IPbased SDN and QoS-enabled capabilities, by allowing the network to handle the multimedia traffic with optimal Quality of Service (QoS) transport and acceptable Quality of Experience (QoE) over time.

Acurácia dos indicadores clínicos do diagnóstico de enfermagem falta de adesão em pessoas vivendo com AIDS

In the early 1990s, a major milestone in the treatment of Acquired Immune Deficiency Syndrome was the development of highly active combination antiretroviral therapy. The great benefit generated by the use of this therapy was prolonging the survival of the people who got this disease, since it is no longer considered fatal, becoming a chronic condition. Despite improvements generated by this therapy, there are still many difficulties to be overcome. One is the patient adherence to their treatment, bringing challenges to services and health professionals. Hence the need for early identification of nursing diagnosis Lack of Accession so that solutions are sought by the nurse with the patient and his family. With this problem, adds to the difficulty of hospital nurses in inferring that diagnosis, especially in identifying their defining characteristics. In this context, the objective was to evaluate the accuracy of clinical indicators of nursing diagnosis Lack of Adherence to antiretroviral treatment for people living with the Acquired Immunodeficiency Syndrome. The research took place in two stages. The first consists of the evaluation of the diagnostic indicators in the study; and second, the diagnostic inference performed by specialist nurses. The first step took place in a referral hospital in the treatment of infectious diseases in the Northeast of Brazil, and data were collected through an instrument for carrying out history and physical examination and analyzed for the presence or absence of the diagnostic indicators. In the second stage, the data were sent to experts, who judged the presence or absence of the diagnosis in the studied clientele. The project was submitted to the Ethics Committee of the Federal University of Rio Grande do Norte, obtaining approval with the General Certificate for Ethics Assessment (CAAE) No 46206215.3.0000.5537. Data were analyzed using descriptive and inferential statistics. Test were used Fisher's exact, chi-square test of Pearson and logistic regression. Since the accuracy of clinical indicators was measured by sensitivity, specificity, predictive values, likelihood ratios. As a result, we identified the presence of diagnosis Lack of Accession on 69% (n = 78) of the study patients. The defining characteristics that showed statistically significant association with the diagnosis studied were: lack of adherence behavior, complications related to development, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. The characteristic with greater sensitivity was missing scheduled appointments and the highest specificity behavior of noncompliance. The logistic regression showed as predictors for the diagnosis Lack of Accession: lack of adherence behavior, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. It was concluded that the identification of clinical indicators accurately enabled a good prediction of the nursing diagnosis Lack of Accession on people living with the Acquired Immune Deficiency Syndrome, helping nurses develop early on strategies for promoting adherence to the use of antiretrovirals.

Acurácia dos indicadores clínicos do diagnóstico de enfermagem falta de adesão em pessoas vivendo com AIDS

In the early 1990s, a major milestone in the treatment of Acquired Immune Deficiency Syndrome was the development of highly active combination antiretroviral therapy. The great benefit generated by the use of this therapy was prolonging the survival of the people who got this disease, since it is no longer considered fatal, becoming a chronic condition. Despite improvements generated by this therapy, there are still many difficulties to be overcome. One is the patient adherence to their treatment, bringing challenges to services and health professionals. Hence the need for early identification of nursing diagnosis Lack of Accession so that solutions are sought by the nurse with the patient and his family. With this problem, adds to the difficulty of hospital nurses in inferring that diagnosis, especially in identifying their defining characteristics. In this context, the objective was to evaluate the accuracy of clinical indicators of nursing diagnosis Lack of Adherence to antiretroviral treatment for people living with the Acquired Immunodeficiency Syndrome. The research took place in two stages. The first consists of the evaluation of the diagnostic indicators in the study; and second, the diagnostic inference performed by specialist nurses. The first step took place in a referral hospital in the treatment of infectious diseases in the Northeast of Brazil, and data were collected through an instrument for carrying out history and physical examination and analyzed for the presence or absence of the diagnostic indicators. In the second stage, the data were sent to experts, who judged the presence or absence of the diagnosis in the studied clientele. The project was submitted to the Ethics Committee of the Federal University of Rio Grande do Norte, obtaining approval with the General Certificate for Ethics Assessment (CAAE) No 46206215.3.0000.5537. Data were analyzed using descriptive and inferential statistics. Test were used Fisher's exact, chi-square test of Pearson and logistic regression. Since the accuracy of clinical indicators was measured by sensitivity, specificity, predictive values, likelihood ratios. As a result, we identified the presence of diagnosis Lack of Accession on 69% (n = 78) of the study patients. The defining characteristics that showed statistically significant association with the diagnosis studied were: lack of adherence behavior, complications related to development, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. The characteristic with greater sensitivity was missing scheduled appointments and the highest specificity behavior of noncompliance. The logistic regression showed as predictors for the diagnosis Lack of Accession: lack of adherence behavior, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. It was concluded that the identification of clinical indicators accurately enabled a good prediction of the nursing diagnosis Lack of Accession on people living with the Acquired Immune Deficiency Syndrome, helping nurses develop early on strategies for promoting adherence to the use of antiretrovirals.

Efeitos da internacionalização no desvio da estrutura de capital alvo e na velocidade de ajuste

This dissertation investigates the effects of internationalization in two gaps related to the capital structure that have not been discussed by the Brazilian literature yet. To this, were developed two independent sections. The first examined what the effects of internationalization on the deviation from the target capital structure. The second examined what the effects of internationalization on speed of adjustment (SOA) of the capital structure. It used data from Brazil, multinational and domestic companies, from 2006 to 2014. The results of the first analysis indicate that internationalization helps reduce the difference between the target and the current debt. That is, to the extent that the level of internationalization increases; whether only export or a combination of export, assets and employees abroad, the gap between the current structure and the target structure decreases. This reduction is given as a function of internationalization as a consequence of the upstream effect of the upstream-downstream hypothesis. Thus, as the Market Timing theory, it can be seen as an opportunity for adjustment of the capital structure, and with the reduction of deviation, there is also a reduction in the cost of capital of the firm. The result of the second analysis indicates that internationalization is able to significantly increase the speed adjustment, ensuring for the multinational a faster adjustment of its capital structure. Exports increase the SOA in 9 to 23%. And when also kept active assets and employees abroad the increase is 8 to 20%. In terms of time, while domestic company takes more than three years to reduce half of the deviation that has, while multinacional companies take on average one and a half year to reduce the same proportion of the deviation. The validity of the upstream-downstream hypothesis for the effect of internationalization in SOA was confirmed by comparing the results for US companies. Thus, the phenomenon of internationalization increases SOA when companies are from less stable markets, such as Brazil; and it has a less significcative effect when companies are derived from more stable markets, because they already have a high speed of adjustmennt. In addition, the adequacy analysis of the estimators also showed the model pooled OLS (Ordinary Least Squares) presents the highest quality in predicting the SOA than the system GMM (Generalized Method of Moments). For future studies it is suggested to analyze the effect of international event, by itself, and to validate the hypothesis using samples of different markets and the use of other estimators.

Índices de obesidade central e fatores de risco cardiovascular na síndrome dos ovários policísticos

Fundamento: A obesidade abdominal apresenta elevada prevalência em mulheres com síndrome dos ovários policísticos (SOP) e está associada a um aumento do risco cardiovascular. Objetivo: Verificar a acurácia da circunferência da cintura (CC), da relação cintura-quadril (RCQ), da relação cinturaestatura (RCEST) e do índice de conicidade (índice C), no que se refere à detecção de fatores de risco cardiovascular (FRCV) em mulheres com SOP. Métodos: Por meio de estudo transversal, foram alocadas 102 mulheres (26,5 ± 5 anos) com diagnóstico de SOP, de acordo com o consenso de Rotterdam. O colesterol total (CT), os triglicerídeos (TG), o LDL-colesterol (LDL-C), o HDLcolesterol (HDL-C), a glicemia de jejum, a glicemia após teste oral de tolerância à glicose (TOTG) e a pressão arterial (PA) foram avaliados em todas as pacientes, além das variáveis antropométricas. Resultados: A relação cintura-estatura foi o marcador que apresentou correlações positivas significativas com o maior número de FRCV (PA, TG e glicemia após TOTG), destacando-se ainda a correlação negativa com HDL-C. Todos os marcadores antropométricos avaliados se correlacionaram positivamente com PA, enquanto CC e RCQ apresentaram correlação positiva também com TG. No tocante à acurácia para detecção de FRCV, os indicadores antropométricos considerados apresentaram taxas de sensibilidade superiores a 60%, com destaque para a RCEST, que apresentou sensibilidade superior a 70%. Conclusão: A RCEST demonstrou ser o indicador antropométrico com a melhor acurácia para a predição de FRCV. Nesse sentido, propõe-se a inclusão desse parâmetro de fácil mensuração na avaliação clínica para o rastreamento de mulheres com SOP e FRCV----------------------ABSTRACT Background: Women with polycystic ovary syndrome (PCOS) present a high prevalence of abdominal obesity, which is associated with an increased cardiovascular risk. Objective: To verify the accuracy of the waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and the conicity index (CI) in the detection of cardiovascular risk factors (CVRF) in women with PCOS. Methods: The present transversal study allocated 102 women (26.5 ± 5 years) with a diagnosis of PCOS, according to the Rotterdam criteria. Total cholesterol (TC), triglycerides (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), fasting glucose, glucose after the oral glucose tolerance test (OGTT) and blood pressure (BP) were evaluated in all patients, in addition to the anthropometric variables. Results: The WHtR was the marker that presented significant positive correlations with the highest number of CVRF (BP, TG and post-OGTT glucose), whereas there was a negative correlation with HDL-C. All the evaluated anthropometric markers were positively correlated with BP, whereas WC and WHR also presented a positive correlation with TG. Regarding the accuracy for the detection of CVRF, the anthropometric markers presented a sensibility > 60%, especially the WHtR, which had a sensibility > 70%. Conclusion: The WHtR showed to be the most accurate anthropometric indicator for the prediction of CVRF. In this sense, we propose the inclusion of this easily-measured parameter in the clinical assessment for the screening of women with PCOS and CVRF