Identificação de crianças e adolescentes com suspeita de câncer: uma proposta de intervenção

Unlike adult cancer, where cells usually originate from epithelial tissue and is linked to environmental factors, malignant tumors in childhood are mostly of embryonic origin and have a phase of rapid proliferation. When not started chemotherapy at this stage, the tumor increases in size, reducing their growth rate, thus reducing the response to chemotherapy. Childhood cancer is in Brazil, the second cause of mortality among children and adolescents from one to nineteen. His impact on the ranking of diseases becomes significantly important to public health since the first issue is related to accidents and violence. Many children are still sent to the centers of high complexity for cancer treatment with advanced stage disease. The delay in referral to diagnosis can be family, or the difficulty of access to the health sector, or the characteristics of the disease and lack of health staff regarding theme of childhood cancer. Before this problem, we aimed to assess the performance of health teams in the identification of child and adolescent symptoms of cancer in primary care, through the action research methodology, which includes the teaching-learning, seminars, describing the actions of the group and discussing the activities after the training. This study involved thirty-seven health professionals who provide care for children and adolescents in the USF Felipe Shrimp II, the Support Center for Children with Cancer and the pediatric hospital UFRN during the period from March to December 2010. The data were analyzed simultaneously to evaluate actions, following the direction of the analysis of ideas Freires, having as theoretical reference the primary health care. The diagnosis of current reality, as knowledge of the health team targeted for early identification of signs and symptoms raised through questioning, presented as generative themes: resistance to change, awareness of the need for apprehension of knowledge; prior knowledge through the media, fragmentation of the healthcare network, interfering with the operation of the reference and counter, the stigma of death, among others. The selected themes enabled the choice of content for the preparation of four seminars, such as implementation of collective action for discussion problematical. The teaching-learning process has allowed the study participants awareness of the problem and work through the knowledge acquired by interfering in decreasing the time interval between the identification of signs and symptoms of cancer and early specialist treatment. Their difficulties we are faced with a diagnosis of terminal cancer and associated with delayed access to laboratory tests and imaging necessary for the diagnosis of neoplasms. Thus, we find that when the team is consciously involved in the education process from identification of the problem situation, there may be significant changes in daily activities through awareness of being. However, we also realize that acquisition of knowledge and interest of the team are not enough, since to be efficiency of our service, we need an organization of cancer care network operating in the state of Rio Grande do Norte

Redução de danos e o saber-fazer de profissionais de um CAPS ad em Natal-RN

The present study had as a main objective to analyze how the professionals at a CAPS ad unit in Natal-RN conceive the knowledge-practice process with regard to the Harm Reduction Policy (HRP) towards alcohol and other drugs. For the accomplishment of this proposal, it was intended: 1) Verifying the possibilities and limits of the HRP implementation at a CAPS ad unit in Natal-RN; 2) Relating the professionals knowledge at a CAPS ad unit in Natal in regard to the Harm Reduction Policy; 3) Enumerating the HRP programmatic actions at the institution. The research had exploratory, descriptive and qualitative approach aspects, guided by the concepts of biopower and self care proposed by Michel Foucault. Data collection occurred in June and July 2011, in which the focal group technique was used. After that, collect field material was analyzed through the content analysis method proposed by Minayo. The results showed some conceptual and practical approach between the harm reduction strategy and the knowledge-practice of the professionals at this CAPS ad unit. The discursive models about drug usage, especially the moral-legal model, still have a significant role in the daily lives of these professionals, being amplified by some demands of their jobs or even through the instituted discourse. The individuals recognize the need for less prohibited practices and more socializing ones, identifying them with the Harm Reduction (HR) logic, when there is a coherent and well-founded understanding about HR among the professionals. Distorted and reductionist views about HR as considering the simple instrumental function of this strategy (distribution of basic supplies) among the professionals, represent one of the main barriers for its implementation. There are few programmatic activities that are related to the RD strategy at this CAPS ad unit which makes a more effective appropriation by the working team difficult to reach. The working processes and the postures adopted by this CAP ad unit professionals have been showing that many of their practices and conceptions were modified to the detriment of new necessities emerged from the demands. Consequently, the self care notion is revealed which brings the need for the valorization of these care agents roles, that is, their collective and individual contribution.

Desempenho dos serviços de atenção primária do município de Natal/RN para o diagnóstico e controle da tuberculose

Tuberculosis (TB) is one of the most important health problems being faced worldwide. In Brazil, the responsibility for the actions of to diagnosis and control of this disease was transferred to the municipalities within the Primary Health Care (PHC), aiming at improvement in epidemiological indicators, requiring reorientation of the practice of family health teams and requiring methodologies to analyze the extent to which components of the PHC are being achieved. Thus, this study aims to analyze the performance of primary care services in the city of Natal-RN for the diagnosis and control of TB, from the perspective of health professionals (doctors and nurses). The study is descriptive, cross-sectional and quantitative. Data collection was conducted from March to July 2011 and involved 121 health professionals working in 52 health units (family health unit, basic health unit and mixed units). The instrument is structured based on the Primary Care Assessment Tool (PCAT), validated and adapted to assess attention to TB in Brazil, and includes questions regarding the Structure and Process components of health services. For quantitative analysis, it was constructed indicators, whose response patterns are followed according to the Likert scale between one and five, which meant the degree of preference relation (or agreement) of the claims. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. With regard to inputs and equipment, the units had satisfactory condition for form (  = 4.26), consultation (  = 4.02) and basic basket (  = 4.24); regular condition to pot (  = 3.56) and unsatisfactory conditions for transportation tickets (  = 1.50) and sputum smear microscopy (  = 2.42) and X-rays (  = 1.07). In relation to actions, there was satisfactory development for those focused on the individual patient. Actions aimed at the collective level, as the search for respiratory symptoms (RS), monitoring of contacts and guidelines for the community ranged from regular to unsatisfactory (  = 3.16 -  = 1.34). With regard to training, 94,2% received training to identify RS. As regards the time for diagnosis, the median time elapsed between the identification of RS and the beginning of treatment it was 22 days. In relation to the difficulties faced by professionals in the diagnosis of TB, 56,2% reported that they are related only to health services, especially for the failure in the rearguard laboratory and in the specialized services reference, the lack of human and material resources and low performing an active search. The professionals perceive the performance of diagnosis and control of TB, permeated with limitations and barriers to organizational and operational character of various sizes, emerging the need for effective coordination of various sectors and key stakeholders of TB care, to adoption of a new intersectoral strategies that aim to increase the responsiveness of the PHC, providing the best performance in service delivery to the user, family and community, and ensuring effective action and resolving the needs of this population group.

Cardiovascular actions of rattlesnake bradykinin ([Val(1), Thr(6)] bradykinin) in the anesthetized South American rattlesnake Crotalus durissus terrificus

Incubation of heat-denatured plasma from the rattlesnake Crotalus atrox with trypsin generated a bradykinin (BK) that contained two amino acid substitutions (Arg(1) --> Val and Ser(6) --> Thr) compared with mammalian BK. Bolus intra-arterial injections of synthetic rattlesnake BK (0.01-10 nmol/kg) into the anesthetized rattlesnake, Crotalus durissus terrificus, produced a pronounced and concentration-dependent increase in systemic vascular conductance (Gsys). This caused a fall in systemic arterial blood pressure (Psys) and an increase in blood flow. Heart rate and stroke volume also increased. This primary response was followed by a significant rise in Psys and pronounced tachycardia (secondary response). Pretreatment with N-G-nitro-L-arginine methyl ester reduced the NK-induced systemic vasodilatation, indicating that the effect is mediated through increased NO synthesis. The tachycardia associated with the late primary and secondary response to BK was abolished with propranolol and the systemic vasodilatation produced in the primary phase was also significantly attenuated by pretreatment, indicating that the responses are caused, at least in part, by release of cathecholamines and subsequent stimulation of beta-adrenergic receptors. In contrast, the pulmonary circulation was relatively unresponsive to BK.

Rendeiras da Vila de Ponta Negra Natal/RN: o ensino da renda de bilro e do desenho como alternativa de continuidade da produção artesanal tradicional

This paper analyzes the development of Bobbin Lace and Design workshops, in the neighborhood of Vila de Ponta Negra (in Natal - RN, Brazil), which proposed contents and practices for its learning and teaching that would compose a possible model for a hybrid Workshop of Bobbin Lace and Lace Design. This research was based on Ergonomic Work Analysis, a methodology used by Ergonomics to analyze work in a wide approach, considering cognitive, social, organizational, as well as other aspects which are relevant to the study of the working situation, in terms of learning/teaching, as addressed on this paper. Some steps of the above mentioned methodology were followed in order to understand the activity of Bobbin Lace craftswomen, by means of bibliographical research centered on this activity. The instruments used for collecting data comprise of conversational actions, analysis of collective work, and spontaneous as well as provoked verbalizations. The adaptations performed in the process of learning/teaching Bobbin Lace for the achievement of Bobbin Lace and Design workshops became instrumental for the continuity of that tradition, attracting new apprentices to this art/craft causing to revitalize a network of handicraft economical activities linked to the Bobbin Lace production, such as the making of cushion, bobbins and trestles

Aprendizado por Reforço com Valores deInfluência em Sistemas Multi-Agente

We propose a new paradigm for collective learning in multi-agent systems (MAS) as a solution to the problem in which several agents acting over the same environment must learn how to perform tasks, simultaneously, based on feedbacks given by each one of the other agents. We introduce the proposed paradigm in the form of a reinforcement learning algorithm, nominating it as reinforcement learning with influence values. While learning by rewards, each agent evaluates the relation between the current state and/or action executed at this state (actual believe) together with the reward obtained after all agents that are interacting perform their actions. The reward is a result of the interference of others. The agent considers the opinions of all its colleagues in order to attempt to change the values of its states and/or actions. The idea is that the system, as a whole, must reach an equilibrium, where all agents get satisfied with the obtained results. This means that the values of the state/actions pairs match the reward obtained by each agent. This dynamical way of setting the values for states and/or actions makes this new reinforcement learning paradigm the first to include, naturally, the fact that the presence of other agents in the environment turns it a dynamical model. As a direct result, we implicitly include the internal state, the actions and the rewards obtained by all the other agents in the internal state of each agent. This makes our proposal the first complete solution to the conceptual problem that rises when applying reinforcement learning in multi-agent systems, which is caused by the difference existent between the environment and agent models. With basis on the proposed model, we create the IVQ-learning algorithm that is exhaustive tested in repetitive games with two, three and four agents and in stochastic games that need cooperation and in games that need collaboration. This algorithm shows to be a good option for obtaining solutions that guarantee convergence to the Nash optimum equilibrium in cooperative problems. Experiments performed clear shows that the proposed paradigm is theoretical and experimentally superior to the traditional approaches. Yet, with the creation of this new paradigm the set of reinforcement learning applications in MAS grows up. That is, besides the possibility of applying the algorithm in traditional learning problems in MAS, as for example coordination of tasks in multi-robot systems, it is possible to apply reinforcement learning in problems that are essentially collaborative