Efeitos do tratamento com Hidrogel na cicatrização de úlceras venosas de membros inferiores: revisão sistemática

Chronic venous disease (CVD) is evident among the chronic diseases and affects the elderly population and primarily is responsible for leg ulcers in this population. The use of dressings in the care of a venous ulcer is a fundamental part of the treatment for healing, however, evidence to assist in choosing the best dressing is scarce. The main objective of this study was to evaluate the effectiveness of treatment with hydrogel in the healing of venous ulcers using search methods, synthesis of information and statistical research through a systematic review and meta-analysis. Randomized controlled trials were selected in the following databases: CENTRAL; DARE; NHS EED; MEDLINE; EMBASE; CINAHL. Beyond these databases three websites were consulted to identify ongoing studies: ClinicalTrials.gov, OMS ICTRP e ISRCTN. The primary outcomes were analyzed: complete wound healing, incidence of wound infection and the secondary were: changes in ulcer size, time to ulcer healing, recurrence of ulcer, quality of life of participants, pain and costs of treatment. Four studies are currently included in the review with a total of 250 participants. The use of hydrogel appears to be superior to conventional dressing, gauze soaked in saline, for the healing of venous leg ulcers; 16/30 patients showed complete healing of ulcers (RR 5,33, 95%CI [1,73,16,42]). The alginate gel was shown to be more effective when compared to the hydrogel dressing in reduction of the wound area; 61,2% (± 26,2%) with alginate e 19,4% (± 24,3%) with hydrogel at the end of four weeks of treatment. Manuka honey has shown to be similar to the hydrogel dressings in percentage of area reduction. This review demonstrated that there is no evidence available about the effectiveness of the hydrogel compared to other types of dressings on the healing of venous leg ulcers of the lower limbs, thus demonstrating the need of future studies to assist health professionals in choosing the correct dressing.

Revisitando o eletrocorticograma intra-operatório na epilepsia mesial do lobo temporal: relevância das oscilações de alta frequência

Epilepsies are neurological disorders characterized by recurrent and spontaneous seizures due to an abnormal electric activity in a brain network. The mesial temporal lobe epilepsy (MTLE) is the most prevalent type of epilepsy in adulthood, and it occurs frequently in association with hippocampal sclerosis. Unfortunately, not all patients benefit from pharmacological treatment (drug-resistant patients), and therefore become candidates for surgery, a procedure of high complexity and cost. Nowadays, the most common surgery is the anterior temporal lobectomy with selective amygdalohippocampectomy, a procedure standardized by anatomical markers. However, part of patients still present seizure after the procedure. Then, to increase the efficiency of this kind of procedure, it is fundamental to know the epileptic human brain in order to create new tools for auxiliary an individualized surgery procedure. The aim of this work was to identify and quantify the occurrence of epilepticform activity -such as interictal spikes (IS) and high frequency oscillations (HFO) - in electrocorticographic (ECoG) signals acutely recorded during the surgery procedure in drug-resistant patients with MTLE. The ECoG recording (32 channels at sample rate of 1 kHz) was performed in the surface of temporal lobe in three moments: without any cortical resection, after anterior temporal lobectomy and after amygdalohippocampectomy (mean duration of each record: 10 min; N = 17 patients; ethic approval #1038/03 in Research Ethic Committee of Federal University of São Paulo). The occurrence of IS and HFO was quantified automatically by MATLAB routines and validated manually. The events rate (number of events/channels) in each recording time was correlated with seizure control outcome. In 8 hours and 40 minutes of record, we identified 36,858 IS and 1.756 HFO. We observed that seizure-free outcome patients had more HFO rate before the resection than non-seizure free, however do not differentiate in relation of frequency, morphology and distribution of IS. The HFO rate in the first record was better than IS rate on prediction of seizure-free patients (IS: AUC = 57%, Sens = 70%, Spec = 71% vs HFO: AUC = 77%, Sens = 100%, Spec = 70%). We observed the same for the difference of the rate of pre and post-resection (IS: AUC = 54%, Sens = 60%, Spec = 71%; vs HFO: AUC = 84%, Sens = 100%, Spec = 80%). In this case, the algorithm identifies all seizure-free patients (N = 7) with two false positives. To conclude, we observed that the IS and HFO can be found in intra-operative ECoG record, despite the anesthesia and the short time of record. The possibility to classify the patients before any cortical resection suggest that ECoG can be important to decide the use of adjuvant pharmacological treatment or to change for tailored resection procedure. The mechanism responsible for this effect is still unknown, thus more studies are necessary to clarify the processes related to it

O tratamento odontológico sob o olhar da criança :um estudo de representações sociais

Oral health measures directed to children are characterized by the lack of policies that consider the individual and his biopsychosocial aspects. As a consequence, it can be observed that a child´s dental experience has normally been prejudged as unpleasant and threatening. Thus, this study is aimed at investigating dental treatment from the child´s viewpoint using the theory of social representations for theoretical/methodological support. This theory was selected for being able to build practical knowledge surrounding the interrelations between social actors, the phenomenon and the world around them. The investigation was performed at the Professor José Fernandes Machado State School, located in the Ponta Negra district of Natal-RN-Brazil. The participants consisted of 30 children from the public elementary school system in the 6-10 year age group, who had undergone dental treatment within the previous year or were being treated at the time of data collection. An in-depth interview and story drawing within a theme were used as collection instruments. Thematic Content Analysis (Bardin, 2002) was used to analyze the material collected in the interviews, whereas for story drawing within a theme, in addition to content analysis, the data were also analyzed by the Coutinho model (2001). The two instruments demonstrated similarity of content as well as complementarity and contained categories associated to the model for dental treatment in children, the description of the dental office environment., the perception of the image of the dentist, as well as psychological and behavioral manifestations. The results enable us to understand determinate reactions of the children in relation to dental treatment, which has been characterized by its technical-curative approach, where the motive for seeking treatment, the manner in which it is performed and the relation of the dentist with the child are all in evidence. Thus, this study intends not only to reveal the viewpoint of children faced with dental treatment, but also to contribute to a dental practice directed towards them, in this way instilling in the professionals who attend them a more concrete awareness of the needs, anxieties and feelings of these young patients

Impacto sócio-dentário das oclusopatias e suas respectivas necessidades de tratamento na qualidade de vida de adolescentes

Nas últimas décadas, com a significativa redução da cárie dentária em crianças e adolescentes, uma maior atenção tem sido dada a outros problemas bucais como as oclusopatias. Em termos epidemiológicos no Brasil, esta tem ocupado o terceiro lugar dentre os problemas de saúde oral na população e, portanto, a inclusão destas como um problema de saúde pública se deve não apenas à sua alta prevalência, mas também ao impacto social, que interfere diretamente na qualidade de vida das pessoas. Diante do exposto é que este estudo objetiva buscar o impacto da presença e severidade das oclusopatias e suas respectivas necessidades de tratamento na qualidade de vida de adolescentes escolares de um município. Sendo assim, foram examinados 356 escolares na faixa etária de 15 -19 anos e determinadas a prevalência, severidade e necessidade de tratamento de oclusopatias através dos índices DAI, IOTN e ICON. O impacto sócio dentário das oclusopatias na qualidade de vida dos adolescentes foi analisado através do índice CS-OIDP. A fim de se verificar possíveis influências de variáveis estudadas na determinaçao do impacto na qualidade de vida das oclusopatias, estas serão coletadas através do estatus sócio-econômico, gênero, idade e tipo escola. Nos resultados parciais, relacionado a 50% da amostra, se observou uma maior prevalência do escolares de escola pública(68,1%), idade entre 15-16 anos(74,7%), gênero feminino(52,7%) e maior prevalência do SES baixo(77,5%). A análise estatística usando o teste qui-quadrado mostrou uma associação significativa do impacto da oclusopatia na qualidade de vida apenas quando avaliada com o índice ICON e o A-IOTN do examinado, comprovando uma associação da necessidade de tratamento com a presença do impacto na qualidade de vida. Com isso, busca-se comprovar e enfatizar a necessidade de se estabelecer políticas públicas que trabalhem na prevenção e interceptação dessas oclusopatias na população, melhorando, portanto, a qualidade de vida e saúde oral dos adolescentes.

Impacto sócio-dentário das ocusopatias e suas respectivas necessidades de tratamento na qualidade de vida de adolescentes

Nas últimas décadas, com a significativa redução da cárie dentária em crianças e adolescentes, uma maior atenção tem sido dada a outros problemas bucais como as oclusopatias. Em termos epidemiológicos no Brasil, esta tem ocupado o terceiro lugar dentre os problemas de saúde oral na população e, portanto, a inclusão destas como um problema de saúde pública se deve não apenas à sua alta prevalência, mas também ao impacto social, que interfere diretamente na qualidade de vida das pessoas. Diante do exposto é que este estudo objetiva buscar o impacto da presença e severidade das oclusopatias e suas respectivas necessidades de tratamento na qualidade de vida de adolescentes escolares de um município. Sendo assim, foram examinados 356 escolares na faixa etária de 15 -19 anos e determinadas a prevalência, severidade e necessidade de tratamento de oclusopatias através dos índices DAI, IOTN e ICON. O impacto sócio dentário das oclusopatias na qualidade de vida dos adolescentes foi analisado através do índice CS-OIDP. A fim de se verificar possíveis influências de variáveis estudadas na determinaçao do impacto na qualidade de vida das oclusopatias, estas serão coletadas através do estatus sócio-econômico, gênero, idade e tipo escola. Nos resultados parciais, relacionado a 50% da amostra, se observou uma maior prevalência do escolares de escola pública(68,1%), idade entre 15-16 anos(74,7%), gênero feminino(52,7%) e maior prevalência do SES baixo(77,5%). A análise estatística usando o teste qui-quadrado mostrou uma associação significativa do impacto da oclusopatia na qualidade de vida apenas quando avaliada com o índice ICON e o A-IOTN do examinado, comprovando uma associação da necessidade de tratamento com a presença do impacto na qualidade de vida. Com isso, busca-se comprovar e enfatizar a necessidade de se estabelecer políticas públicas que trabalhem na prevenção e interceptação dessas oclusopatias na população, melhorando, portanto, a qualidade de vida e saúde oral dos adolescentes.

Influência do tratamento periodontal sobre os níveis da proteína c-reativa ultrassensível em pacientes com insuficiência renal crônica em fase de prétransplante

The present study evaluated the influence of non-surgical periodontal treatment on the levels of C- reactive protein (hsCRP) in patients with chronic renal failure (CRF) in pretransplant. We conducted a controlled and randomized trial to evaluate the periodontal condition and plasma concentrations of hsCRP, albumin and transferrin in 56 dialysis patients divided into two groups: experimental and control. The study was conducted at the dental clinic of Family and Community Health s Unit (USFC), located in Onofre Lopes University Hospital (HUOL), Federal University of Rio Grande do Norte (UFRN), from December 2010 to November 2011. Severe periodontitis was the type of periodontal disease more common, affecting 78.6% of patients. Periodontal conditions, evaluated through the means of probing depth, clinical attachment level, bleeding index and plaque index, proved to be uniform for both groups at the initial examination. There were no differences in levels of inflammatory markers between the two groups. The analysis of the concentrations of hsCRP allowed classifying study participants as at high risk of developing cardiovascular disease. After completion of periodontal treatment in the experimental group, there was a statistically significant reduction of the mean of all periodontal parameters assessed; however this improvement of periodontal health was not accompanied by changes in the levels of hsCRP, albumin and transferrin in the evaluation time. Given this, the periodontal treatment did not promote the reduction of systemic inflammatory burden and risk of cardiovascular complications in patients with CRF

Relação entre padrão comportamental, estágios do ciclo de muda e atividade de enzimas digestivas proteolíticas em juvenis do camarão marinho Litopenaeus vannamei (Crustacea: Penaeidae)

Shrimp farming in Brazil is a consolidated activity, having brought economical and social gains to several states with the largest production concentrated in the northeast. This fact is also reflected in higher feed intake, necessitating a more efficient feed management. Currently, management techniques already foresee food loss due to molting. In this sense, studies relating shrimp s digestive physiology, molting physiology and behavioral response of shrimp feed can optimize the feed management. Thus, our study aimed to evaluate the behavioral response of the marine shrimp L. vannamei (Crustacea: Penaeidae) in accordance with the stages of moulting cycle and feeding schedules based on higher or lower activity of proteolytic digestive enzymes; also, to investigate the influence of feeding schedule on hepatosomatic index and non-specific and specific protease activity (trypsin). Experiments were carried out at the Laboratory of Shrimp Behavioral Studies at UFRN in partnership with the Laboratory of Enzimology UFPE. Juveniles of L. vannamei weighting 5.25 g (+ 0.25 g) were kept in aquaria at a density of 33 shrimp m -2. In the first experiment, shrimp were fed in the light phase or in the dark phase for 8 days; in the ninth day, the animals were observed for 15 minutes every hour during the 12 hours of each phase of the photoperiod. We recorded the frequency of inactivity, exploration, food intake, burrowing, swimming and crawling behavior. At the end of the 12th observation session, the shrimp were sacrified and classified by the method of setogenesis in the molt cycle stages A, B, C, D0, D1, D2 or D3. We found that the shrimp in A stage show high levels of inactivity. Moreover, the frequency of food intake was very low. The shrimp in D3 stage also had low food intake and high inactivity associated with elevated frequencies of burrowing. In the second experiment, shrimp were kept in physiological acclimation to experimental conditions for 28 days, distributed in 12 treatments in the light phase and 12 treatments in the dark phase. In the end, the animals were sacrified and dissected to assess non-specific and specific protease activity (trypsin) activity. In general, these parameters did not vary among animals fed in the light phase and those fed in the dark phase. However, significant differences were found in the activity of specific and nonspecific proteases in relation to food treatment. In the light phase, the major proteolytic activities converged to 10 hours after the start of the light phase, while the lowest activities converged to 6 hours after the beginning of this phase. In the dark phase, the highest enzyme activity converged to 12 hours after the onset of phase, while the lowest activities converged to 3 hours after the onset of phase. In the third experiment, we sought to evaluate the behavioral responses of shrimp in relation to dietary treatments based on higher or lower activity of proteolytic enzymes, considering the results of the second experiment. The behavioral categories observed were the same as the ones in the first experiment, with observations of 30 minutes (15min before and 15min after food supply). We found variation in behavioral responses as a function of the treatments, with greater intake of food in shrimp fed during the period of greatest activity of proteolytic enzymes, in the light phase. Thus we see that periodic events associated with the shrimp s physiology interfere in their behavioral responses, revealing situations that are more adjustable to the provision of food, and consequently optimizing feeding management

Avaliação da estimulação da medula espinhal como modelo de tratamento da doença de parkinson no primata Callithrix jacchus

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Efeito do tratamento com as drogas antipsicóticas haloperidol e clozapina sobre a infecção de toxoplasma gondii em cultura de células retinianas embrionárias

T. gondii is an obligate intracellular protozoan and the main cause of retinochoroiditis in humans. The aim of this study was to evaluate the effect of the antipsychotic drugs haloperidol and clozapine on the course of infection by T. gondii of cultured embryonic retinal cells. Embryo retinas of Gallus gallus domesticus (E12) were used for the preparation of mixed monolayer cultures of retinal cells. Cultures were maintained on plates of 96 and 24 wells by 37°C in DMEM medium supplemented with 5% fetal bovine serum for 2 days. After this period, cultures were simultaneously infected with tachyzoites of T. gondii and treated with the antipsychotics haloperidol and clozapine for 48 hours. Treatment effects were determined by both assessing cell viability with the MTT method and evaluating infection outcomes in slides stained with Giemsa. The treatment with haloperidol and clozapine cells infected with T. gondii resulted in higher viability of these cells, suggesting a possible prevention of neuronal degeneration induced by T. gondii. Additionally, intracellular replication of this protozoan in cells treated with haloperidol and clozapine were significantly reduced, possibly by modulation of the parasite s intracellular calcium concentration

O Tratamento com a fluoxetina (mas não com outros farmacos antidepressivo e ansioíiticos) reverte o déficit de memória aversiva causado por estresse agudo de contenção em camundongos

The physiologist H. Selye defined stress as the nonspecific response of the body to any factors that endanger homeostasis (balance of internal environment) of the individual. These factors, agents stressors, are able to activate the Hypothalamic-Pituitary-Adrenal (HPA) axis, thus resulting in the physiological responses to stress by the release of glucocorticoids that leads to psychophysiological changes, including effects on cognitive functions such as learning and memory. When this axis is acutely stimulated occurs a repertoire of behavioral and physiological changes can be adaptive to the individual. Notwithstanding, when the HPA axis is chronically stimulated, changes may favor the development of, such as anxiety disorders. Some drugs used in the clinic for the treatment of anxiety disorders these can exert effects on cognitive function, on the HPA axis and on the anxiety. In this context, the aim of our study was to investigate the effects of administration i.p. acute of diazepam (DZP, 2 mg/kg), buspirone (BUS, 3 mg/kg), mirtazapine (MIR, 10 mg/kg) and fluoxetine (FLU, 10 mg/kg) in male mice submitted to acute restraint stress, and evaluated using plus-maze discriminative avoidance task (PMDAT), which simultaneously evaluates parameters such as learning, memory and anxiety. Our results demonstrated that (1) the administration of DZP and BUS, but not FLU, promoted anxiolytic effects in animals; (2) administration mirtazapine caused sedative effect to animals; (3) in the training session, the animals treated with BUS, MIR and FLU learned the task, on the other hand DZP group showed impairment in learning; (4) in the test session, animals treated with DZP, BUS, and MIR showed deficits in relation to discrimination between the enclosed arms, aversive versus non-aversive arm, demonstrating an impairment in memory, however, animals treated with FLU showed no interference in the retrieval of this memory; (5) acute stress did not interfere in locomotor activity, anxiety, or learning on the learning task, but induced impairment in retrieval memory, and the group treated with FLU did not demonstrated this deficit of memory . These results suggest that acute administration of drugs with anxiolytic and antidepressant activity does not interfere with the learning process this aversive task, but impair its retrieval, as well as the acute restraint stress. However, the antidepressant fluoxetine was able to reverse memory deficits promoted by acute stress, which may suggest that modulation, even acutely serotonergic neurotransmission, by selectively inhibiting the reuptake of this neurotransmitter, interferes on the process of retrieval of an aversive memory

Elaboração e avaliação de indicadores comportamentais de aderência ao tratamento hemodialítico

Introduction: This work intents to characterize behavioral indicators of tack to the hemodialysis treatment in a sample of carrying patients of chronic kidney failure (CKF) in the great Natal/RN. The therapeutical adherence represents the agreement degree between the patient behavior and the health team lapsings. The CKF is the gradual and irreversible loss of the renal function, being the hemodialysis treatment an important alternative to assist or to substitute the kidneys. Method: The sample consisted in 80 chronic kidney patients in hemodialysis treatment in two located clinical centers in the region of the great Natal, RN. It was used as instruments (a) a protocol of clinical data collection, (b) the Millon Index of Personality Styles (MIPS) and (c) a script of halfstructuralized interview. Results: The results show a balance between the genders (51% of female and 48.8% of the male sex), average age and equal average time of dialysis respectively to the 43,4 years (±13,25 years) and 22,04 years (±4,24 years). The marital status of half of the sample is married, predominating basic education (43.6%) and a familiar income until a minimum wage (43.8%). It had been defined six physicianlaboratorial indicators to evaluate the therapeutical adherence, further the use of the evaluation of the health team and the patient themselves. Thus, there was an average adherence around 55.97% of the sample ±18.37%). However only between selfassessment of the patients about the adherence and the assessment made by blood pressure post-dialysis indicated a significant association (p=0,029, qui-square test). On the other hand, there was a significant association (p <0.05, chi-square test) among the criteria for treatment adherence and issues investigated in the interview - the perception on the quality of the health services provided to patients, the difficulties following the prescribed diet, the characterization of the days between dialysis sessions and the perception of patients about the dialysis sessions. It was also noted a significant association (p <0.05, Levene test) between adherence to therapy and scales that constitute the MIPS. The health team characterized the patients more adherent behavior as an attitude of acceptance of the treatment, looking actively for their implementation, for more information and knowledge, and establishing a positive communication with the team and with other patients. Similar results were confirmed by the MIPS evaluation. According to that assessment the more compliant patients adopt a more optimistic attitude, trying to act or adapt themselves to their environment, processing cognitively both concrete and objective information, such as more speculative and symbolic information. In addition they establish a gregarious, cooperative, submissive and flexibly pattern of interpersonal relationships to social demands. These characteristics managed to explain 55.7% of the adherence variation according the health team and 23.3% of the variation according the CaxP laboratory indicator. Conclusions: The MIPS shown to be able to identify the most and least adherent to therapy patients. The use of different adherence indicators is important for an evaluation covering the different facets of this process. The adhesion levels are observed within registered by the relevant literature. There is need for further studies with a larger sample to deepen the data findings in this work

Avaliação da floco-decantação de manta de lodo associada à decantação de alta taxa no tratamento de águas de consumo humano

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Validade e confiabilidade da versão informatizada do inventário Million de estilos de personalidade

Currently, several psychological and non-psychological tests can be found in publishes without standardization on procedures set in different psychological areas, like intelligence, emotional states, attitudes, social skills, vocation, preferences and others. The computerized psychological testing is a extension of traditional testing psychological practices. However, it has own psychometrics qualities, either by its matching in a computerized environment or by the extension that can be developed in it. The current research, developed from a necessity to study process of validity and reliability on a computerized test, drew a methodological structure to provide parallel applications in numerous kinds of operational groups, evaluating the influences of the time and approach in the computerization process. This validity refers to normative values groups, reproducibility in computerized applications process and data processing. Not every psychological test can be computerized. Therefore, our need to find a good test, with quality and plausible properties to transform in computerized application, leaded us to use The Millon Personality Inventory, created by Theodore Millon. This Inventory assesses personality according to 12 bipolarities distributed in 24 factors, distributed in categories motivational styles, cognitive targets and interpersonal relations. This instrument doesn t diagnose pathological features, but test normal and non adaptive aspects in human personality, comparing with Theodore Millon theory of personality. In oder to support this research in a Brazilian context in psychological testing, we discuss the theme, evaluating the advantages and disadvantages of such practices. Also we discuss the current forms in computerization of psychological testing and the main specific criteria in this psychometric specialized area of knowledge. The test was on-line, hosted in the site http://www.planetapsi.com, during the years of 2007 and 2008, which was available a questionnaire to describe social characteristics before test. A report was generated from the data entry of each user. An application of this test was conducted in a linear way through a national coverage in all Brazil regions, getting 1508 applications. Were organized nine groups, reaching 180 applications in test and retest subject, where three periods of time and three forms of retests for studies of on-line tests were separated. Parallel to this, we organized multi-application session offline group, 20 subjects who received tests by email. The subjects of this study were generally distributed by the five Brazilian regions, and were noticed about the test via the Internet. The performance application in traditional and on-line tested groups subsidies us to conclude that on-line application provides significantly consistency in all criteria for validity studied and justifies its use. The on-line test results were related not only among themselves but were similar to those data of tests done on pencil and paper (0,82). The retests results demonstrated correlation, between 0,92 and, 1 while multisessions had a good correlation in these comparisons. Moreover, were assessed the adequacy of operational criteria used, such as security, the performance of users, the environmental characteristics, the organization of the database, operational costs and limitations in this on-line inventory. In all these five items, there were excellent performances, concluding, also, that it s possible a self-applied psychometric test. The results of this work are a guide to question and establish of methodologies studies for computerization psychological testing software in the country

As especificidades da clínica psicanalítica com crianças na neurose e na psicose: conseqüências para a direção do tratamento

This dissertation aims to answer the question: What are the specifics of psychoanalytical clinic with children in neurosis and psychosis and its consequences for the treatment direction? It constitutes a theoretical study based on Freud, Lacan and the current productions of Lacanian psychoanalysts about the clinic with children. It presents some clinical vignettes. To answer this question, were constructed four chapters. The chapter The subject constitution treats the psychoanalysis subjectivity, based on a structure from the relationship with the Other. Key concepts of Lacanian psychoanalysis are shown, necessary to understand what becomes present in clinic with children. The second chapter, The clinic of neurosis, reveals the structure of the subject in its oedipal mooring held by the Name-of the-Father, that separates the mother-child dual relationship. The child neurosis is the effect of psyche constitution and the symptoms are an interpretation of what child picks up from parents and helps him/her on the passage through the Oedipus. The analyst is there to help him/her through this path. The next chapter is entitled The clinic of psychosis. In psychosis the non-occurrence of the Name-of-the-Father is concerned. The subject is stuck in duality with the mother, and becomes what fills the Other s gap. To protect themselves, they have to be in incessant work. The analyst will be a child s partner in daily work already carried out by him/her. The last chapter, The consequences for the treatment direction, shows that the standard analytic treatment works well to the clinic of neurosis. To psychosis it s not true. Psychoanalysts thought about a different way of psychotic children treatment: the practice held in a multiprofessional team work. The practice shared by many has been a team strategy applied to the institutional practice that aims to attenuate the invasive character of the Other, facilitating the partnership between the analyst and the child in treatment and the Other contention

Caminhos e descaminhos da adesão ao tratamento anti-hipertensivo :um estudo com usuários do Pacha (Programa de Assistência e Cuidado da Hipertensão Arterial) do Hospital Universitário Onofre Lopes

The high blood pressure is a multifactorial chronic disease which possesses emotional and social features in the illness appearance and evolution and in the adherence to the treatment which involves a decision-making through patient so that he or she process the necessary changes on harmful living habits. Adhesion, traditionally, it is referred to the patient to answer to the doctor orientations or of other health professional, about the appearance to the appointment with a doctor, about the use of medicine or lifestyle changes and maintaining this adhesion is the main problem to be overcame. It is expected the adhesion will ever be a continual, stable and satisfactory action, disregarding the complexity of subjectivity processes which permeate the sicken. This research aimed to investigate the difficulties which the person with high blood pressure has to adhere to the treatment, from the signification processes which give sense to the actions dealing with the adhesion. The study was carried out with 48 users of assistance program to the high blood pressure patient from Hospital Universitário from Natal RN, between 40-65 age. The answers were submitted to a double analysis process: 1) answer systematization in categories and codes and admission in statistical program SPSS (Statistical Package of Social Science), for generation of descriptive statistics; 2) Sense and signification analysis which permeated the deepener statement and interpretatively. The greater difficulties found are present on low-salt and law-calorie diets, in the dealing with everyday feeling and stress, being these factors cited as direct motive to the high blood pressure, regardless of interviewee s sex. It is observed there is not adhesion, but adhering, as an experienced everyday process. This work contributes with its results, assessing the used strategies by program with the aim of increasing the adhesion rates