O atendimento por institui����o p��blica de sa��de: percep����o de fam��lias de doentes com c��ncer

This study aimed to analyze how the families of cancer patients perceived the treatment provided at a specialist public outpatient clinic, using Bardin's method of Content Analysis. Seven families consisting of fourteen family members were interviewed. They underlined doctor-patient relationship, judging it to be impersonal and superficial, resulting in a lack of security and trust. Families try to to participate but feel undervalued and excluded from the care. Necessary information that they are not given is sought in the media, while comfort is achieved through religious or spiritual practices. Health care training must encourage professionals to view the family as a unit of care, aligning training to different modes of health care.

Diverg��ncias entre hist��rico da consulta e diagn��stico m��dico de agress��es f��sicas registradas nos prontu��rios de uma unidade de urg��ncia e emerg��ncia

There can be several indicators of violence in society. However, in no other health unit such violence acquires visibility as in emergency. This study aimed to examine whether there is divergence between the history of medical consultation and diagnosis of physical aggressions in the emergency unit. A cross-sectional study was conducted in an emergency unit in the city of Ara��atuba, state of S��o Paulo, Brazil, based on medical records, considering data on patients, lesions, history, diagnosis and treatment. Out of 133,537 visits, only 153 were recorded as physical aggressions, and 161 informed violence in the history of the consultation; 59.6% were male, 60.6% were between 20 and 44 years old. Excoriations, pain and injury predominated. There were no associations between state violence in the diagnosis and the characteristics of patients and visits (schedule, routing, gender, age). The conclusion is that in most cases violence reported in the history of the consultation was not mentioned in the diagnosis of injuries. The characteristics of care and patients were not related to the fact that professionals diagnosed the case as violence.

Gross Motor Deficits in Children Prenatally Exposed to Alcohol: A Meta-analysis

BACKGROUND AND OBJECTIVES: Gross motor (GM) deficits are often reported in children with prenatal alcohol exposure (PAE), but their prevalence and the domains affected are not clear. The objective of this review was to characterize GM impairment in children with a diagnosis of fetal alcohol spectrum disorder (FASD) or moderate to heavy maternal alcohol intake.METHODS: A systematic review with meta-analysis was conducted. Medline, Embase, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PEDro, and Google Scholar databases were searched. Published observational studies including children aged 0 to <= 18 years with (1) an FASD diagnosis or moderate to heavy PAE, or a mother with confirmed alcohol dependency or binge drinking during pregnancy, and (2) GM outcomes obtained by using a standardized assessment tool. Data were extracted regarding participants, exposure, diagnosis, and outcomes by using a standardized protocol. Methodological quality was evaluated by using Strengthening the Reporting of Observational Studies in Epidemiology guidelines.RESULTS: The search recovered 2881 articles of which 14 met the systematic review inclusion criteria. The subjects' mean age ranged from 3 days to 13 years. Study limitations included failure to report cutoffs for impairment, nonstandardized reporting of PAE, and small sample sizes. The meta-analysis pooled results (n = 10) revealed a significant association between a diagnosis of FASD or moderate to heavy PAE and GM impairment (odds ratio: 2.9; 95% confidence interval: 2.1-4.0). GM deficits were found in balance, coordination, and ball skills. There was insufficient data to determine prevalence.CONCLUSIONS: The significant results suggest evaluation of GM proficiency should be a standard component of multidisciplinary FASD diagnostic services.

Percep����o de pacientes HIV-positivos de um centro de refer��ncia em rela����o a tratamento de sa��de

Introduction: health professionals, in many cases, have defensive and exclusionary practices, patterns of prejudice and discrimination in response to HIVpositive patients. Objective: to verify the perception of patients seropositives from a reference center for STD/HIV/aids in relation to health care. Methods: there were interviews with questions related to discriminatory attitudes suffered, access and health care. Results: 130 individuals participated in the survey, from which 30 (23.1%) reported events of discrimination suffered outside the center of reference, predominantly from surgeon-dentists and 112 (86.2%) believed to have the same access and health care as other citizens. 62 (47.7%) treated with the dental center of reference, of which 56 (90.3%) felt good being treated in a dental unit only for HIV positive and six (9.7%) were indifferent, believed to be more exposed, or have a bias to attend dental seropositive individuals. Conclusion: it is concluded that many patients have already been discriminated against outside the reference center. However, most of them have a positive feeling towards the treatment received at a specifi c place for treating HIV-positive patients, due to the feeling of being welcome at that place due to the humanization and access to health care.

Acesso aos n��veis de aten����o �� sa��de em um munic��pio do Estado de S��o Paulo: perspectivas de gestores, profissionais e usu��rios

P��s-gradua����o em Sa��de Coletiva - FMB

Redes de aten����o �� sa��de para gestantes usu��rias de ��lcool e/ou outras drogas

P��s-gradua����o em Sa��de Coletiva - FMB

Artes orientais de movimentos: alternativas ��s terapias do campo da sa��de. uma possibilidade de investiga����o para a psicologia do esporte. um exemplo de pesquisa fenomenol��gica

This research analyzes the discourse of teachers of ancient oriental arts, namely: Yoga, Tai Chi Chuan, Kung Fu, Lian Gong, Qwan Ki Do, reveals the meaning that subjects have about what are the benefits to health of those already considered practical alternatives conventional treatment of health. The research uses the phenomenological method specifically the method of the phenomenon. The method first provides a pre-reflection on the oriental arts, exposing not systematically, some curiosities changing between aspects of oriental arts: historical, main teaching methods, styles, the character of struggle, why are linked to health, the benefits of their practices, movements, philosophy, concepts, ways of acting, the roots, the basics. In this article the pre-reflection does not appear to meet the standards of Congress page limit. Rather concentrate on the next step of the research and present the phenomenon situated in the experience of those who have experienced it in the case of the five arts teachers mentioned above. The method performs individual analysis or ideographic analysis of the five discourses of teachers from each oriental art and then conducts the general or nomothetic. The result is presented an analysis of generalities, convergence, divergence and individuality of meanings expressed by the subject, to finally develop a discussion of these data and weave a synthesis. The analyzes reveal that Eastern practices currently as some of these five analyzed here, those involving aspects of struggle and concentration are excellent allied health development and well-being. Understanding the philosophical aspect is inherent in the practice of the movements, although the character of the struggle, which they transmit through knowledge of their origins and roots is the current thinking routine that generates a life philosophy of selfhelp, self-enabling and tranquility preparation to overcome the tensions, disputes, everyday challenges. The speeches also reveal that the psychophysical aspects of diseases are real, because the practices of movements and the physical drilling of these oriental arts have enabled visible improvements in health by working the mental and the physical in an integrated manner. Masters must have all the knowledge to better meet today's society, preserving these cultures, passing them through the generations.

As interfaces da conviv��ncia da fam��lia em uma unidade de pronto socorro

The aim was to describe the positive and negative aspects in a family communication at an emergency care unit. This is a descriptive research with a qualitative approach. The sample consisted of 20 family members / caregivers of patients admitted to the emergency room of a university hospital. Data collection was carried out through semi-structured interviews applied during the period of May-June 2011. Data analysis was performed using the methodological framework of the Collective Subject Discourse which resulted in four themes: Lack of information compromising the family/health professional ties; The ideal model of information provided by the professional regarding the condition of the hospitalized relative; Assessment of information provided about hospital routines; and The role of the relative/companion. Therefore, for the patient and his family, communication is presented as a tool on the care given with the function of transmitting safety, respect and guidance. However when it is incomplete, it becomes a potential form of stress and dissatisfaction.

Assist��ncia em sa��de: revis��o integrativa do conhecimento produzido �� luz da complexidade

This is part of an integrative review whose object of study was the production of knowledge in journals concerning nursing studies that have used the Theory of complexity as a theoretical framework. This study gathers seven articles collected from a literature review of 18 publications found on the databases: Medical Literature Analysis and Retrieval Sistem on-line (MEDLINE), Literatura Latino-Americana e do Caribe emCi��ncias da Sa��de (LILACS) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 1998 to 2008. In the two former databases, the following combination of key words was used: ���complexity theory��� and ���health��� and ���nursing���, and in the third: ���complexidade��� and ���sa��de��� and ���enfermagem. Content analysis was the methodological framework that allowed for organizing the knowledge aggregated in the theme: Health Care. It was observed that the Complexity Theory has based the comprehension of the health care process, pointing out the care provider with his practices and the environment.

A Reappraisal in Sao Paulo, Brazil (2008) of "The Ecology of Medical Care:" The "One Per Thousand's Rule"

BACKGROUND AND OBJECTIVES: Medical ecology is a conceptual framework introduced in 1961 to describe the relationship and utilization of health care services by a given population. We applied this conception to individuals enrolled in a private health maintenance organization (HMO) in Sao Paulo, Brazil, with the aim of describing the utilization of primary health care, verifying the frequency of various symptoms, and identifying the roles of different health care sources. METHODS: This was a cross-sectional telephone survey among a random sample of people enrolled in a private HMO. We interviewed a random sample of non-pregnant adults over age 18 using 10 questions about symptoms and health care use during the month prior to interview. RESULTS: The final sample consisted of 1,065 participants (mean age 68 years, 68% female). From this sample, 424 (39.8%) reported the presence of symptoms, 311 (29.2%) had a medical office consult, 104 (9.8%) went directly to an emergency medical department, 63 (5.9%) were hospitalized, 22 (2.1%) used complementary medicine resources, seven (0.7%) were referred to home care, and one (0.1%) was admitted to an academic hospital. CONCLUSIONS: The proportion of study participants referred to an academic care center was similar to that observed in previous "medical ecology" studies in different populations.

PCR colorimetric dot-blot assay and clinical pretest probability for diagnosis of Pulmonary Tuberculosis in Smear-Negative patients

Abstract Background Smear-negative pulmonary tuberculosis (SNPTB) accounts for 30% of Pulmonary Tuberculosis (PTB) cases reported annually in developing nations. Polymerase chain reaction (PCR) may provide an alternative for the rapid detection of Mycobacterium tuberculosis (MTB); however little data are available regarding the clinical utility of PCR in SNPTB, in a setting with a high burden of TB/HIV co-infection. Methods To evaluate the performance of the PCR dot-blot in parallel with pretest probability (Clinical Suspicion) in patients suspected of having SNPTB, a prospective study of 213 individuals with clinical and radiological suspicion of SNPTB was carried out from May 2003 to May 2004, in a TB/HIV reference hospital. Respiratory specialists estimated the pretest probability of active disease into high, intermediate, low categories. Expectorated sputum was examined by direct microscopy (Ziehl-Neelsen staining), culture (Lowenstein Jensen) and PCR dot-blot. Gold standard was based on culture positivity combined with the clinical definition of PTB. Results In smear-negative and HIV subjects, active PTB was diagnosed in 28.4% (43/151) and 42.2% (19/45), respectively. In the high, intermediate and low pretest probability categories active PTB was diagnosed in 67.4% (31/46), 24% (6/25), 7.5% (6/80), respectively. PCR had sensitivity of 65% (CI 95%: 50%���78%) and specificity of 83% (CI 95%: 75%���89%). There was no difference in the sensitivity of PCR in relation to HIV status. PCR sensitivity and specificity among non-previously TB treated and those treated in the past were, respectively: 69%, 43%, 85% and 80%. The high pretest probability, when used as a diagnostic test, had sensitivity of 72% (CI 95%:57%���84%) and specificity of 86% (CI 95%:78%���92%). Using the PCR dot-blot in parallel with high pretest probability as a diagnostic test, sensitivity, specificity, positive and negative predictive values were: 90%, 71%, 75%, and 88%, respectively. Among non-previously TB treated and HIV subjects, this approach had sensitivity, specificity, positive and negative predictive values of 91%, 79%, 81%, 90%, and 90%, 65%, 72%, 88%, respectively. Conclusion PCR dot-blot associated with a high clinical suspicion may provide an important contribution to the diagnosis of SNPTB mainly in patients that have not been previously treated attended at a TB/HIV reference hospital.

Comparison of two laboratory-developed PCR methods for the diagnosis of Pulmonary Tuberculosis in Brazilian patients with and without HIV infection

Abstract Background Direct smear examination with Ziehl-Neelsen (ZN) staining for the diagnosis of pulmonary tuberculosis (PTB) is cheap and easy to use, but its low sensitivity is a major drawback, particularly in HIV seropositive patients. As such, new tools for laboratory diagnosis are urgently needed to improve the case detection rate, especially in regions with a high prevalence of TB and HIV. Objective To evaluate the performance of two in house PCR (Polymerase Chain Reaction): PCR dot-blot methodology (PCR dot-blot) and PCR agarose gel electrophoresis (PCR-AG) for the diagnosis of Pulmonary Tuberculosis (PTB) in HIV seropositive and HIV seronegative patients. Methods A prospective study was conducted (from May 2003 to May 2004) in a TB/HIV reference hospital. Sputum specimens from 277 PTB suspects were tested by Acid Fast Bacilli (AFB) smear, Culture and in house PCR assays (PCR dot-blot and PCR-AG) and their performances evaluated. Positive cultures combined with the definition of clinical pulmonary TB were employed as the gold standard. Results The overall prevalence of PTB was 46% (128/277); in HIV+, prevalence was 54.0% (40/74). The sensitivity and specificity of PCR dot-blot were 74% (CI 95%; 66.1%-81.2%) and 85% (CI 95%; 78.8%-90.3%); and of PCR-AG were 43% (CI 95%; 34.5%-51.6%) and 76% (CI 95%; 69.2%-82.8%), respectively. For HIV seropositive and HIV seronegative samples, sensitivities of PCR dot-blot (72% vs 75%; p = 0.46) and PCR-AG (42% vs 43%; p = 0.54) were similar. Among HIV seronegative patients and PTB suspects, ROC analysis presented the following values for the AFB smear (0.837), Culture (0.926), PCR dot-blot (0.801) and PCR-AG (0.599). In HIV seropositive patients, these area values were (0.713), (0.900), (0.789) and (0.595), respectively. Conclusion Results of this study demonstrate that the in house PCR dot blot may be an improvement for ruling out PTB diagnosis in PTB suspects assisted at hospitals with a high prevalence of TB/HIV.

A humaniza����o do cuidado na forma����o dos profissionais de sa��de nos cursos de gradua����o

A proposta desta pesquisa bibliogr��fica �� conhecer e analisar a produ����o cient��fica do campo da sa��de, em peri��dicos nacionais, sobre o ensino da humaniza����o do cuidado nos cursos de gradua����o. Realizou-se um levantamento bibliogr��fico na base de dados LILACS, utilizando o termo humaniza����o, com textos publicados a partir do ano de 2000 at�� 2010, sendo analisados 42 artigos. Da an��lise dos artigos emergiram tem��ticas centrais: Humaniza����o: algumas considera����es sobre seus conceitos; Universidade e as Diretrizes Curriculares Nacionais para os Cursos de Gradua����o na ��rea da Sa��de: rela����es com o ensino da humaniza����o; Mudan��as curriculares, conte��dos e estrat��gias de ensino-aprendizagem no cuidado humanizado e Sujeitos do processo ensino-aprendizagem: alunos e professores na aprendizagem da humaniza����o do cuidado. Alguns elementos te��rico-pr��ticos v��m sendo constru��dos sobre o ensino da humaniza����o no contexto de sa��de, sendo imprescind��vel, todavia, maiores investimentos na constru����o efetiva de novos modos de cuidar.

Risco cardiovascular em profissionais de sa��de de servi��os de atendimento pr��-hospitalar

Avaliar os fatores de risco cardiovascular, com ��nfase na hipertens��o, e estratific��-los de acordo com o Escore de Risco de Framingham (ERF). Estudo com 154 profissionais que atuavam em aten-dimento pr��-hospitalar na cidade de S��o Paulo e rodovia Br-116. Foi considerado significante o valor de p<0,05. A preval��ncia de hipertens��o foi de 33%, sendo que 20,1% eram tabagistas, 47% ingeriam bebidas alco��licas, 64% eram sedent��rios, 66% apresentaram obesidade/sobrepeso e 70% cintura abdominal alterada, glicemia&gt;110mg/dL- 11%, colesterol total&gt;200mg/dL- 36%, LDL-c&gt;130mg/dL- 33%, HDL-c<60mg/dL- 89%, triglic��rides&gt;150mg/dL- 30% e prote��na C reativa&gt;0,5mg/dL- 16%. O ERF foi m��dio em 10,3% e alto em 1,3%. Na an��lise de regress��o log��stica verificou-se que a hipertens��o associou-se com as vari��veis: HDL-c (odds ratio: 0,257) e ERF (odds ratio: 23,159). Houve forte associa����o entre ERF e hipertens��o. Os dados chamam a aten����o, por se tratar principalmente de profissionais da ��rea da sa��de relativamente jovens.

Capacita����o em bio��tica para profissionais da Sa��de da Fam��lia do munic��pio de Santo Andr��, SP

Relato de experi��ncia da capacita����o em bio��tica para enfermeiros e m��dicos da Estrat��gia Sa��de da Fam��lia, Santo Andr��, SP. Trata-se de trabalho calcado na problematiza����o e bio��tica deliberativa, que objetivou apresentar o procedimento da delibera����o para subsidiar o manejo de problemas ��ticos. Trabalharam-se os conte��dos transversalmente em cinco sequ��ncias de atividades, em dois momentos de concentra����o, intercalados por um de dispers��o. Na primeira concentra����o, desenvolveram-se conceitos chaves e conte��dos da bio��tica deliberativa. Na segunda, houve sess��es de delibera����o para situa����es de conflito moral, selecionadas e preparadas durante a dispers��o. Os participantes avaliaram a delibera����o como um instrumental adequado para lidar com as quest��es ��ticas que vivem. A problematiza����o mostrou-se efetiva como estrat��gia educativa na forma����o cont��nua em bio��tica deliberativa.