Cartographic notes on the work in the Family Health Strategy: relationships between workers and the population

The objective of this intervention study was to map instituted and instituting movements present in the work of the Family Health Strategy in the development of their care practices. The theoretical framework is based on institutional analysis, using the schizoanalytic approach. Group meetings were carried out with the staff to discuss how they provided collective care in continuing health education. The study subjects were professionals from the team and students who were engaged in academic activity in the service. The average attendance was twelve people per meeting, and there were a total of eight meetings from March to July 2010. Data were grouped into two immanent strata: the relationships of the team and the relationship with clients. The strata point to the intersection of education and legal institutions and the social and technical division of labor. Collective thinking in groups appeared to be effective in denaturalizing established processes and interrogating places, knowledge and practices.

Delay in the search for health services for the diagnosis of tuberculosis in Ribeirao Preto, Sao Paulo

The scope of this paper is to analyze delays in locating health services for the diagnosis of tuberculosis in Ribeirao Preto in 2009. An epidemiological and cross-sectional study was conducted with 94 TB patients undergoing treatment. A structured questionnaire, based on the Primary Care Assessment Tool adapted for TB care was used. A median (15 days or more) was established to characterize delay in health attendance. Using the Prevalence Ratio, the variables associated with longer delay were identified. The first healthcare services sought were the Emergency Services (ES) (57.5%). The longest period between seeking assistance occurred among males, aged between 50 and 59, who earned less than five minimum wages, had pulmonary TB, were new cases, were not co-infected with TB/HIV, did not consume alcohol, had satisfactory knowledge about TB before diagnosis (with a statistically significant association with delay) and who did not seek healthcare close to home before developing TB. There is a perceived need for training healthcare professionals about the signs and symptoms of the disease, reducing barriers of access to timely diagnosis of TB and widely disseminating it to the community in general.

FOLLOW-UP OF TREATED OSTEOSARCOMA PATIENT

Objective: To evaluate the value of post-treatment follow-up in osteosarcoma patients. Methods: Data were collected through a clinical record, with socio-demographic and clinical data, and information relating to the medical appointment. Descriptive analysis of the data was carried out. The Chi-squared test was used to associate the independent variables with attendance at scheduled follow-up appointments. Results: We found a recurrence in 59.6% of cases, of which 58% were lung related; 44% presented clinical complaints and arrived on the scheduled date of the appointment. There was no statistically significant association between the demographic characteristics and early attendance of follow-up visits. 81.3% of the cases who came for the appointment earlier than originally scheduled presented complaints compared to those who did not (p=0.005). Of the cases who presented recurrence, 12.9% attended an appointment late and those who did not present recurrence, 47.6% were late for the appointment (p=0.006). Conclusion: It is seen that the patients who came for an earlier appointment presented more complaints and were associated with the positive result of the exams carried out. The patients who had recurrence and came for an earlier appointment did not present a statistically significant difference in recurrence-free survival. It was observed that distance was not a predominant factor in late attendance at appointments. Level of Evidence II, Retrospective Study.

Sleep patterns and sleepiness of working college students

The double journey (work and study) may result or aggravate health problems, including sleep disturbances, as observed in previous studies with high school students. The aim of this study is to analyze the sleep-wake cycle and perceived sleepiness of working college students during weekdays. Twenty-three healthy college male students, 21-24 years old, working during the day and attending classes in the evening, participated in this study. During five consecutive days, the students filled out daily activities logs and wore actigraphs. Mean sleeping time was lower than 6 hours per night. No significant differences were observed in the sleep-wake cycle during the weekdays. The observed lack of changes in the sleep-wake cycle of these college students might occur as participants were not on a free schedule, but exposed to social constraints, as was the regular attendance to evening college and day work activities. Sleepiness worsened over the evening school hours. Those results show the burden carried by College students who perform double activities - work and study.

Psychosocial and clinical predictors of retention in outpatient alcoholism treatment

Objective: One of the factors associated with low rates of compliance in the treatment for alcoholism seems to be the intensity of craving for alcohol. This study aimed to evaluate the associations between alcohol craving and biopsychosocial addiction model-related variables and to verify whether these variables could predict treatment retention. Methods: The sample consisted of 257 male alcoholics who were enrolled in two different pharmacological trials conducted at the Universidade de Sao Paulo in Brazil. Based on four factors measured at baseline - biological (age, race, and family alcoholism), psychiatric (depression symptoms), social (financial and marital status), and addiction (craving intensity, severity of alcohol dependence, smoking status, drinking history, preferential beverage, daily intake of alcohol before treatment) - direct logistic regression was performed to analyze these factors' influence on treatment retention after controlling for medication groups and AA attendance. Results: Increasing age, participation in Alcoholics Anonymous groups, and beer preference among drinkers were independently associated with higher treatment retention. Conversely, higher scores for depression increased dropout rates. Conclusion: Health services should identify the treatment practices and therapists that improve retention. Information about patients' characteristics linked to dropouts should be studied to render treatment programs more responsive and attractive, combining pharmacological agents with more intensive and diversified psychosocial interventions.

Effects of Working Full-Time and Studying in the Evening Hours Among Young Apprentices and Trainees

Objective: This research aims to assess apprentices' and trainees' work conditions, psychosocial factors at work, as well as health symptoms after joining the labor force. Background: Despite the fact that there are over 3.5 million young working students in Brazil, this increasing rate brings with it difficult working conditions such as work pressure, heavy workloads, and lack of safety training. Method: This study was carried out in a nongovernmental organization (NGO) with 40 young members of a first job program in the city of Sao Paulo, Brazil. They filled out a comprehensive questionnaire focused on sociodemographic variables, working conditions, and health symptoms. Individual and collective semi-structured interviews were conducted. Empirical data analysis was performed using analysis of content. Results: The majority of participants mentioned difficulties in dealing with the pressure and their share of responsibilities at work. Body pains, headaches, sleep deprivation during the workweek, and frequent colds were mentioned. Lack of appropriate task and safety training contributed to the occurrence of work injuries. Conclusion: Having a full-time job during the day coupled with evening high school attendance may jeopardize these people's health and future. Application: This study can make a contribution to the revision and implementation of work training programs for adolescents. It can also help in the creation of more sensible policies regarding youth employment.

Acidentes e violência na infância: evidências do inquérito sobre atendimentos de emergência por causas externas - Brasil, 2009

Compreender as características e a magnitude das causas externas (acidentes e violência) em crianças de 0 a 9 anos de idade torna-se cada vez mais importante em Saúde Pública. O objetivo do presente artigo foi analisar os atendimentos de emergência por causas externas em crianças. Utilizaram-se dados do Sistema de Vigilância de Violências e Acidentes em Serviços Sentinelas de Urgência e Emergência (Inquérito VIVA), realizado em 74 serviços de urgência do Distrito Federal e 23 capitais no ano 2009. Analisaram-se dados de 7.123 crianças: 6.897 (96,7%) vítimas de acidentes e 226 (3,3%) de violência. Em comparação às vítimas de violência, os atendimentos por acidentes foram mais frequentes entre crianças de 2 a 5 anos, de pele branca e ocorridos no domicílio (p < 0,05). Dentre os acidentes, as quedas e queimaduras predominaram no grupo de 0 a 1 ano, enquanto os acidentes de transporte foram mais frequentes no grupo de 6 a 9 anos (p < 0,001). Quanto às violências, atendimentos por negligência e agressão física predominaram, respectivamente, nos grupos extremos de faixa etária, sendo um familiar identificado como agressor (p < 0,001). Informações sobre ocorrência de causas externas em crianças podem apoiar políticas de promoção da saúde, além de orientar profissionais de saúde, educadores e famílias na prevenção destas causas.

Ensino de anestesiologia durante a graduação por meio de uma liga acadêmica: qual o impacto no aprendizado dos alunos?

Justificativa e objetivos: As ligas acadêmicas vêm se firmando como instrumentos de ensino médico e inserção dos estudantes de medicina na prática das especialidades, inclusive na anestesiologia. Como o papel das ligas no processo de desenvolvimento de competências e aprendizado de seus alunos não é bem conhecido, avaliou-se o aprendizado dos integrantes de uma liga acadêmica de anestesiologia após um ano de participação nas suas atividades. MÉTODO: Os alunos de uma liga acadêmica de anestesiologia foram acompanhados de março a dezembro de 2010 e avaliados por meio de testes cognitivos objetivos de múltipla escolha aplicados antes do início das atividades e após sua conclusão. A frequência nas atividades e o perfil epidemiológico dos alunos foram correlacionados aos resultados dos testes. RESULTADOS: Foram analisados 20 acadêmicos do 3º ao 6º ano, com média de idade de 22,8 (21-26) anos. A frequência média nas atividades propostas foi 10,4/13 (80%). A média de acertos no primeiro teste foi 8,1/17 (47,6%), sendo que os alunos do 3º ano apresentam notas menores (p < 0,02) em relação aos demais. No teste pós-liga, a média de acertos foi 11,9/17 (70%), mostrando melhora no desempenho dos alunos (p < 0,05), e não houve diferença entre as notas dos diferentes anos da graduação. Foi encontrada relação forte entre frequência nas atividades e melhora nas notas (r = 0,719; p < 0,001). CONCLUSÕES: Os alunos que participaram da liga apresentaram melhora nos testes de avaliação de conhecimento, sugerindo que a liga é útil instrumento de ensino e promove ganho de aprendizado em anestesiologia. As atividades desenvolvidas nas ligas podem ter papel positivo na formação acadêmica dos graduandos, destacando-se, neste artigo, a anestesiologia.

Dual function of egg-covering in the Kentish plover Charadrius alexandrinus

Many bird species take recesses during incubation, and while the nests are unattended, the eggs may both be vulnerable to predation and reach suboptimal temperatures for embryo development. Perhaps to avoid these negative possibilities, some birds cover their eggs with materials when they depart from nests. We examined experimentally, using the ground-nesting Kentish plover as model species, whether egg-covering allows egg temperatures to remain within optimal limits for embryogenesis in unattended nests, thus reducing the requirements of contact incubation, and simultaneously maintain the eggs' camouflage. There was a negative relationship between nest attendance and ambient temperature, but only during mid-morning, the period of the day when egg-covering was most frequent. Indeed, during mid-morning egg-covering not only served to better camouflage the eggs, but also to maintain egg temperatures within optimal thermal thresholds for embryogenesis while the nests remained unattended. During other periods of the day, covered eggs in unattended nests overheated (e.g., afternoon) or did not reach the optimal temperature for embryogenesis (e.g., early morning). During periods in which eggs may be uncovered to alleviate overheating, unattended nests may be easier to locate by predators, because the eggs are less well camouflaged. Therefore, camouflage and appropriate thermal environment are inseparable functions of egg-covering in the ground-nesting Kentish plover.

Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil

Abstract Background The aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance of the care provided. The objective of the present study was to evaluate the adequacy of prenatal care use and the risk factors involved in inadequate prenatal care utilization in the metropolitan area of Aracaju, Northeast Brazil. Methods A survey was carried out with puerperal women who delivered singleton liveborns in all four maternity hospitals of Aracaju. A total of 4552 singleton liveborns were studied. The Adequacy of Prenatal Care Utilization Index, modified according to the guidelines of the Prenatal Care and Birth Humanization Programme, was applied. Socioeconomic, demographic, biological, life style and health service factors were evaluated by multiple logistic regression. Results: Prenatal care coverage in Aracaju was high (98.3%), with a mean number of 6.24 visits. Prenatal care was considered to be adequate or intensive in 66.1% of cases, while 33.9% were considered to have inadequate usage. Age < 18 to 34 years at delivery, low maternal schooling, low family income, two or more previous deliveries, maternal smoking during pregnancy, having no partner and prenatal care obtained outside Aracaju were associated with inadequate prenatal care use. In contrast, private service attendance protected from inadequate prenatal care use. Conclusion Prenatal care coverage was high. However, a significant number of women still had inadequate prenatal care use. Socioeconomic inequalities, demographic factors and behavioural risk factors are still important factors associated with inadequate prenatal care use.

Loss of interest, depressed mood and impact on the quality of life: Cross-sectional survey

Abstract Background Depressive symptoms and chronic disease have adverse effects on patients' health-related quality of life (H-RQOL). However, little is known about this effect on H-RQOL when only the two core depressive symptoms - loss of interest and depressed mood - are considered. The objective of this study is to investigate H-RQOL in the presence of loss of interest and depressed mood at a general medical outpatient unit. Methods We evaluated 553 patients at their first attendance at a general medical outpatient unit of a teaching hospital. H-RQOL was assessed with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Depressed mood and loss of interest were assessed by the Primary Care Evaluation of Mental Disorders (PRIME-MD)-Patient Questionnaire. A physician performed the diagnosis of chronic diseases by clinical judgment and classified them in 13 possible pre-defined categories. We used multiple linear regression to investigate associations between each domain of H-RQOL and our two core depression symptoms. The presence of chronic diseases and demographic variables were included in the models as covariates. Results Among the 553 patients, 70.5% were women with a mean age of 41.0 years (range 18-85, SD ± 15.4). Loss of interest was reported by 54.6%, and depressed mood by 59.7% of the patients. At least one chronic disease was diagnosed in 59.5% of patients; cardiovascular disease was the most prevalent, affecting 20.6% of our patients. Loss of interest and depressed mood was significantly associated with decreased scores in all domains of H-RQOL after adjustment for possible confounders. The presence of any chronic disease was associated with a decrease in the domain of vitality. The analysis of each individual chronic disease category revealed that no category was associated with a decrease in more than one domain of H-RQOL. Conclusion Loss of interest and depressed mood were associated with significant decreases in H-RQOL. We recommend these simple tests for screening in general practice.

ATENDIMENTO ONLINE POR CHAT: ADEQUANDO OS SERVIÇOS DE BIBLIOTECA A UM NOVO PÚBLICO

O trabalho relata a experiência da Biblioteca Virginie Buff D’Ápice da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo (FMVZ/USP) na implantação do sistema de atendimento online por chat e analisa estatística e qualitativamente os 527 atendimentos realizados entre Agosto de 2009 e Junho de 2010. Além disso, apresenta o impacto direto desse sistema na readequação do Serviço de Atendimento ao Usuário

Broschüren zur Früherkennung von Hautkrebs

In der vorliegenden Studie wurde überprüft, ob Broschüren, die negative Konsequenzen unzureichender Hautselbstuntersuchung (HSU) betonen (Verlustrahmung), besser geeignet sind, die Früherkennung von Hautkrebs zu fördern als Broschüren, die positive Konsequenzen bei richtig durchgeführter HSU schildern (Gewinnrahmung). Geschlecht und die Bewältigungsdispositionen Vigilanz und kognitive Vermeidung wurden als mögliche Moderatorvariablen untersucht. Nach Erfassung von Baseline- und Hintergrundvariablen lasen 180 Teilnehmer jeweils eine der Broschüren, die ihnen per Zufall zugeteilt wurde. Diese variierten in Rahmung (Gewinn/Verlust) und Bedrohungsgrad (gering/hoch), so dass vier unterschiedliche Versionen vorlagen. Rahmung und Bedrohungsgrad wirkten sich in Abhängigkeit von Vigilanz, d.h. der Disposition, bedrohungsbezogene Informationen systematisch zu verarbeiten, auf die Intention aus. Deutlicher war die Wirkung der Rahmung auf die berichtete Häufigkeit von HSU, die zwei Monate nach dem Lesen erneut erfragt worden war. In der Verlustbedingung stieg die berichtete Häufigkeit von HSU bei Personen mit hoher Vigilanz, bei Personen mit niedriger Vigilanz dagegen sank sie. In der Gewinnbedingung profitierten Personen mit niedriger Vigilanz, während Personen mit hoher Vigilanz weniger HSU berichteten als zuvor. Diese Effekte korrespondierten zwar mit Änderungen der eigenen Risikowahrnehmung, der Erinnerungsleistung und der Beschäftigung mit dem Studienthema, jedoch ließ sich für keine dieser Variablen eine vermittelnde Wirkung nachweisen. Einstellung und Anforderung von Informationsmaterialien blieben unbeeinflusst.

Untersuchung der zellulären Antwort von Tumor und Endothelium auf radioaktive Bestrahlung in vitro und in vivo

Tumore des Kopf-Hals Bereiches sprechen aufgrund schneller Resistenzbildung häufig schlecht auf die derzeit praktizierten Bestrahlungstherapien an. Der Erfolg dieser Behandlung wird dabei maßgeblich durch die Strahlenresistenz des malignen Gewebes limitiert. Das Verständnis der zugrunde liegenden zellulären und molekularen Mechanismen ist diesbezüglich unvollständig. Die Resistenzzunahme während der klinischen Behandlung könnte durch die Selektion strahlenresistenter Einzelzellen verursacht werden oder durch die Aktivierung von Resistenzmechanismen. Im Rahmen dieser Arbeit wurde die bestrahlungsvermittelte Freisetzung möglicherweise protektiv wirkender Faktoren durch Tumorzelllinien des Kopf-Hals Bereiches untersucht. Durch Bestrahlung erfolgte eine Induktion von VEGF (vascular endothelial growth factor) und FGF-2 (fibroblast growth factor 2), IL-8 (Interleukin-8) und PGE2 (Prostaglandin E2). Die Untersuchung von VEGF und FGF-2 zeigte weiterhin ein zytoprotektives Potential dieser Faktoren, d.h. die T

Mangia, bevi, ama. Cibo e rituali alimentari del matrimonio nell'Occidente altomedievale

La ricerca pone al centro dell’indagine lo studio dell’importanza del cibo nelle cerimonie nuziali dell’Europa occidentale nei secoli V-XI. Il corpus di fonti utilizzate comprende testi di genere diverso: cronache, annali, agiografie, testi legislativi, a cui si è aggiunta un’approfondita analisi delle antiche saghe islandesi. Dopo un'introduzione dedicata in particolare alla questione della pubblicità della celebrazione, la ricerca si muove verso lo studio del matrimonio come “processo” sulla base della ritualità alimentare: i brindisi e i banchetti con cui si sigla l’accordo di fidanzamento e i ripetuti convivi allestiti per celebrare le nozze. Si pone attenzione anche ad alcuni aspetti trasversali, come lo studio del caso della “letteratura del fidanzamento bevuto”, ossia una tradizione di testi letterari in cui il fidanzamento tra i protagonisti viene sempre ratificato con un brindisi; a questo si aggiunge un’analisi di stampo antropologico della "cultura dell’eccesso", tipica dei rituali alimentari nuziali nel Medioevo, in contrasto con la contemporanea "cultura del risparmio". L'analisi si concentra anche sulle reiterate proibizioni al clero, da parte della Chiesa, di partecipare a banchetti e feste nuziali, tratto comune di tutta l’epoca altomedievale. Infine, la parte conclusiva della ricerca è incentrata sulla ricezione altomedievale di due figure bibliche che pongono al centro della narrazione un banchetto nuziale: la parabola delle nozze e il banchetto di Cana. L’insistente presenza di questi due brani nelle parole dei commentatori biblici mostra la straordinaria efficacia del “linguaggio alimentare”, ossia di un codice linguistico basato sul cibo (e su contesti quali l’agricoltura, la pesca, ecc.) come strumento di comunicazione sociale di massa con una valenza antropologica essenzialmente universale.