Estratégias de intervenção utilizadas por enfermeiros da ESF do município de Natal/RN no controle do câncer do colo de útero

Cancer of the cervix (cervical cancer) is the second most prevalent cancer among Brazilian women. The high rates of cervical cancer in Brazil justify the implementation of effective strategies to control this, which include actions to promote health, primary prevention, early detection, screening, treatment and palliative care. Despite the existence of the National Programme for Control of the CCU there was no reduction in the incidence and mortality of this disease in Brazil. The Family Health Strategy (FHS) has the potential to facilitate such control and, in this context, one should consider that nurses play a central role. The study aimed to know the general intervention strategies used by nurses FHS of Natal / RN in CCU control, and how specific: analyzing the knowledge of these nurses on the CCU, the actions developed in the ESF for the control of CCU and identify the difficulties faced by them to perform it. This is a descriptive exploratory quantitative developed through a structured interview guide with 106 nurses who have experience in controlling the CCU in FHS teams of Natal / RN. Data analysis was performed using descriptive statistic s. The results pointed to actions taken in the FHS to control the CCU, collection of cervical cancer screening, health education activities, nursing consultation, referral of suspected cases for medical monitoring and active women with abnormal test result . The actions that were not mentioned by the nurses included: forming groups of prevention and health promotion; expand coverage of exams and office hours of consultations, establishment of alternatives to end the pent-up demand in the health units, participation in treatment or rehabilitation process users with the CCU; interventions for pain management, alliances and partnerships with schools, in dustry and the use of protocols. This study can be seen that the practice nurses partially shares to the CCU in Natal / RN. The participants of this study, when asked about the CCU, specifically for signs and symptoms of disease and risk factors in general showed important gaps. Difficulties such as lack of materials for collection of Pap smear; inadequate physical space in the Health Units; pent-up demand in the service, delay in arrival of the test results; obstacles in the actions of referral and counter-referral and cultural factors make the CCU control is compromised. It is believed in this research contributed to a reflection on the importance of the role of nurses in the development of the ESF control actions CCU, pointing out the factors that affect these. It is important to involve all nurses who comprise the ESF as knowledgeable of the risk factors, signs and symptoms, and existing tools for the early detection of cervical cancer in the pursuit of quality improvement actions to promote women`s health, contributing in planning future interventions that may reduce mortality from this disease in Natal / RN.

Acurácia dos indicadores clínicos do diagnóstico de enfermagem volume de líquidos excessivo em pacientes submetidos à hemodiálise

Trasnversal study, with the objective of evaluating the accuracy of clinical indicators of nursing diagnosis excessive fluid volume in patients undergoing hemodialysis. The study occurred in two stages, the first consisted of the evaluation of the diagnostic indicators in study; and the second, the diagnostic inference conducted by nurse diagnosticians. The first stage occurred from december 2012 to april 2013, in a University Hospital and a Hemodialysis Clinic in Northeastern of Brazil, with a sample of 100 chronic renal failure patients on hemodialysis. The data were selected through an interview form and a physical examination, organized into spreadsheets and analyzed as to the presence or absence of the indicators of diagnosis excessive fluid volume. In the second step, the spreadsheets were sent to three nurses diagnosticians, who judged the presence or absence of diagnosis in the clientele searched. This step was conducted from july to september 2013. For analysis of the data, we used descriptive and inferential statistics. In the descriptive analysis, we used measures of central tendency and dispersion. In inferential analysis, we used the tests Chi- square, Fisher and prevalence ratios. The accuracy of the clinical indicators pertaining to the diagnosis were measured as to the specificity, sensitivity, predictive values, likelihood ratios and Diagnostic Odds Ratio. Also developed a logistic regression. The results were organized in tables and discussed with literature. This study was approved by the Ethics Committee in Research of the Federal University of Rio Grande do Norte, with Presentation Certificate for Ethics Appreciation nº 08696212.7.0000.5537. The results revealed that the diagnosis studied was present in 82% of patients. The characteristics with prevalence above 50 % that stood out were: azotemia, decreased hematocrit, electrolyte imbalance, intake exceeds output, anxiety, edema, decreased hemoglobin, oliguria and blood pressure changes. Eight defining characteristics were presented statistically significant association with the nursing diagnosis investigated: pulmonary congestion, intake exceeds output, electrolytes imbalance, jugular vein distension, edema, weight gain over short period of time, agitation and adventitious breath sounds. Among these, the 10 characteristics which showed higher prevalence ratios were: edema and weight gain over short period of time. The features with the highest sensitivity were edema, electrolytes imbalance and intake exceeds output and the standing out with greater specificity were: anasarca, weight gain over short period of time, change in respiratory pattern, adventitious breath sounds, pulmonary congestion, agitation and jugular vein distension. The indicators jugular vein distension, electrolytes imbalance, intake exceeds output, increased central venous pressure and edema, together, were identified in the logistic regression model as the most significant predictors. It is concluded that the identification of accurate clinical indicators allow a good prediction of the nursing diagnosis of excessive fluid volume in patients undergoing hemodialysis in order to assist the nurse in the inference process, which will contribute to the success of patient care. In addition, nurses will consider for diagnostic inference not only his clinical experience, but also scientific evidence of the occurrence of excessive fluid volume, contributing to the control of volemia in these patients

Avaliação da assistência à saúde dos portadores de úlceras venosas atendidos no programa saúde da família do município de Natal/RN

Descriptive research aimed at evaluating the assistance offered to patients with venous ulcers, on lower limbs, attended by the Family Health Program (FHP) team, from the municipality of Natal/RN. The target population was composed of 74 patients with venous ulcers (VU), attended by the FHP teams in the 31 FHUs. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (protocol n.55/05). The data collection was performed in patients homes and in the FHUs, through structured interviews and physical examinations of patients with VU and non-participant observation during the changing of wound dressings in these Units and in users homes. The data was organized into an Excel electronic table and transported into the SPSS 14.0 program, for descriptive analysis on 2x2 contingency tables and inferential (Qui-Square χ2, Spearman Correlation, Binomial Proportion Test and p-value <0.05). The prevalence of VU (0.36/1000) in the target population (over 20 years of age) was greater than in the population registered in FHP (0.25/1000). We detected a greater prevalence in the age area of over 60 years (2.22/1000), with 2.98/1000 for females and 1.3/1000 for males (p-value=0.008). The sociodemographical and health characteristics of patients with VU revealed predominance of females (74.5%), elders over 60 years of age (67.6%), with fundamental education (74.3%), family earnings of up to 2 minimum wages (68.9%), retired (90.5%), ortostatic position (23.0%), inadequate sleep (59,9%), presence of CVI (100.0%), hypertension (44.6%) and diabetes (25.7%). As for the time of existence of the VU, 64.9% had over 1 year, and 35.1% less than 1 year), with predominance of one wound (67.6%). The changing of wound dressings is performed mostly at home, in and inadequate way, especially with incorrect cleaning techniques, likewise incorrect use of products and substances, and reduced participation of the FHP team on the evaluation and application of the dressing and choosing of products and substances. The compressive therapy is not part of therapeutic conducts for treatment in the FHUs. As for the evaluation of assistance to patients with VU, 90.5% were inadequate and only 9.5% adequate. The main inadequacy factors were the absence of: diagnosis (47.3%), consultation with and angiologist (63.5%), compressive treatment (100.0%), adequate optical therapy (98.62%), adequate dressing kit (70.3%), training for the changing of dressings (67.6%), following by the FHP team (51.4%) and performed exams (55.4%). We ve concluded that patients with VU mostly present now socioeconomical level and associated chronic diseases. Considering that assistance offered by FHP is non-systematic, fragmented, with no diagnosis planning, continual evaluation and evolution, we qualify the assistance as inadequate and with low level of solution, directly interfering on the maintenance of the VUs chronic state

Úlceras de pressão: um estudo com pacientes de unidade de terapia intensiva

To characterize patients according to gender, age category, internment time, diagnostical hypothesis and location of the pressure ulcer; to identify the susceptibility conditions, intrinsical and extrinsical factors present on ICU patients and to verify on the existence of association between the susceptibility conditions and the intrinsecal and extrinsecal factors on the occurrence of PU. Methods: It is a descriptive study, of longitudinal design of the panel type, with quantitative approach, performed on two ICU s of a private hospital located in Natal/RN, with 40 patients interned at these units. The data collection was performed on all three shifts through a structured observation and physical exam of the patients' skin form seeking to identify the presence of PU. Results: The greatest occurence of PU was on individuals of the male gender (70%) when compared to the female gender (30%), that difference being statistically significant (p=0,0267), with the male gender presenting 4,3 times greater chance of developing PU than the female; the predominant age category was from 60 years of age on (85%), 60,0% presented 1 to 2 PU s after 7 (seven) days of permanence in the ICU s, the predominant diagnostical hypothesis on the patients with PU were the respiratory diseases (42,3%) and the most frequent locations of PU were the sacral region (40,0%) and heels (36,0%). 25 PU s of stage I were diagnosed on 50,0% of the followed patients, with general incidence of 50,0% on both ICUs. from the 88 variables researched, 75 were identified on the patients from the study, being the predominant conditions (anemia, hypotension, leukocytosis, other diseases hypertension blood pressure, cardiac insuffience, pneumonia - and ansiolythic), the intrinsecal factors (diminished muscular strenght and/or mass, discrete edema, totally compromised mobile coordination and total inability for movement on the bed) and the extrinsecal factors (inadequate mattress type, permanence on a single position for >2 hours, shearing/friction force, bed clothes with folds that leave marks on the body, pressure force) predominated on patients with PU. The male gender variables (p=0,0267,OR=4,3), sedation (p=0,0006,OR=4,1), psychomotive agitation (p=0,0375,OR=5,8) and leukocytosis (p=0,0285,OR=5,0) presented a significant statistical diference when analyzed independently. We verified an association of 17,3%, statistically significant (p=0,0384), between the susceptibility conditions (anemia, leukocytosis and hypotension), the intrinsecal factors (age equal or above 60 years, diminished/absent pain sensibility and smooth, fine or delicate skin) and the extrinsecal factors (inadequate mattress, pressure forces, shearing/friction force, permanence on a single position for more than 2 hours, elevation between 30 to 45 degrees and inadequate bed clothes' conditions), with a chance ratio of 4,6 times the risk of occurrence of PU on the patients that presented the referred association. Conclusion: The incidence of PU detected on the ICU-interned patients was high and we made evident the existence of association between the susceptibility conditions, the intrinsecal and extrinsecal factors on the occurrence of PU s on the ICUinterned patients, and thus we accept the alternative hypothesis proposed on the study

Relação entre variáveis na regulação do consumo de vacas Holandês × Zebu em lactação sob pastejo em capim-elefante

A análise fatorial de componentes principais (CP) foi usada no exame do relacionamento entre variáveis de um banco de dados da Empresa Brasileira de Pesquisa Agropecuária (EMBRAPA) Gado de Leite. As variáveis disponíveis foram relacionadas às vacas (dias em lactação, teores lácteos de gordura e extrato seco total, produção de leite, ordem de lactação, peso vivo e grau de sangue), ao manejo (dia de pastejo, disponibilidade e períodos de descanso da pastagem), ao ambiente (estação do ano, precipitação pluviométrica) e ao alimento (consumo de nutrientes do concentrado e da cana × uréia, consumo de MS de pastagem de capim-elefante, composição química e digestibilidade in vitro da pastagem e concentração fecal de PB, FDN e FDA). O primeiro CP (33,7% da inércia dos dados) representou o uso da suplementação volumosa (cana × uréia) da pastagem em resposta à redução sazonal da disponibilidade e do consumo de capim-elefante. O segundo CP (15,3% da inércia) foi relacionado ao consumo de nutrientes do concentrado. O terceiro CP (8,5% da inércia) representou efeitos do manejo sobre a composição química da pastagem. A interpretação gráfica dos resultados favoreceu a percepção mais dinâmica da intensidade da associação e do antagonismo entre as variáveis contextualizadas no estudo.

Estratégias acadêmicas na avaliação de desempenho dos cursos de ciências contábeis no enade em NATAL - RN

O número de instituições de ensino superior no Brasil vem crescendo bastante nos últimos anos. Com isso a preocupação com a qualidade dos cursos ofertados também tem aumentado. Para avaliar essa qualidade do ensino o governo instituiu formas de avaliação e vem aperfeiçoando a cada ano. As instituições, por sua vez, buscam bons resultados nessas avaliações a fim de utilizar como item de vantagem competitiva, uma vez que as notas obtidas por elas chamam atenção de novos clientes. Dessa forma, o presente trabalho buscou analisar as principais estratégias acadêmicas utilizadas na avaliação de desempenho dos cursos de Ciências Contábeis, da região de Natal-RN, no ENADE. Trata-se de uma pesquisa de abordagem qualitativa e quantitativa, e foi aplicado um estudo de caso complementado por um survey. A parte qualitativa foi obtida através de entrevistas semiestruturadas realizadas com os coordenadores dos cursos e a quantitativa foi obtida através da aplicação de um questionário fechado aos alunos aptos a participarem do ENADE no ano de 2012. Foram estudadas todas as instituições em Natal que possuem o curso de Ciências Contábeis, modelo presencial, sendo ao todo 10 (dez) instituições identificadas. Os dados foram analisados por meio da análise de conteúdo (entrevistas) e do software SPSS® 18 (survey). Foram utilizados os métodos de análise fatorial, através da análise de componentes principais, com rotação Varimax e normalização Kaiser. Em relação à análise da importância do ENADE sob a perspectiva dos estudantes, foi utilizado o teste não paramétrico de Mann-Whitney. Como resultados da pesquisa, foi identificado que tanto os discentes como os coordenadores de curso entendem a importância do ENADE, também observou-se que a satisfação dos discentes com a instituição refletiu nos resultados obtidos por esta, bem como, o momento em que foi iniciada a preparação para o exame também refletiu nas notas recebidas pelas instituições

Sistema de teleoftalmologia para auxílio ao pré-diagnóstico de disfunções oculomotoras

The vision is one of the five senses of the human body and, in children is responsible for up to 80% of the perception of world around. Studies show that 50% of children with multiple disabilities have some visual impairment, and 4% of all children are diagnosed with strabismus. The strabismus is an eye disability associated with handling capacity of the eye, defined as any deviation from perfect ocular alignment. Besides of aesthetic aspect, the child may report blurred or double vision . Ophthalmological cases not diagnosed correctly are reasons for many school abandonments. The Ministry of Education of Brazil points to the visually impaired as a challenge to the educators of children, particularly in literacy process. The traditional eye examination for diagnosis of strabismus can be accomplished by inducing the eye movements through the doctor s instructions to the patient. This procedure can be played through the computer aided analysis of images captured on video. This paper presents a proposal for distributed system to assist health professionals in remote diagnosis of visual impairment associated with motor abilities of the eye, such as strabismus. It is hoped through this proposal to contribute improving the rates of school learning for children, allowing better diagnosis and, consequently, the student accompaniment

Levantamento epidemiológico das parasitoses intestinais: viés analítico decorrente do tratamento profilático

As parasitoses intestinais constituem um grave problema de saúde pública, especialmente nos países subdesenvolvidos, sendo esse problema associado e agravado por condições sanitárias precárias e falta de informação. Neste trabalho foram avaliados alguns parâmetros epidemiológicos vinculados às principais enteroparasitoses em diferentes regiões da cidade de Assis, Estado de São Paulo, Brasil. Os dados foram confrontados com aqueles obtidos em um levantamento anterior referente ao ano de 1991 e apresentam uma redução de três pontos percentuais. Há indícios de que, antiparasitários estariam sendo distribuídos profilaticamente, antes dos resultados do exame parasitológico de fezes. Este fato pode levar a importantes implicações epidemiológicas e distorções analíticas. Esta conduta terapêutica pode estar ocultando condições sanitárias e/ou educacionais desfavoráveis, de forma que haveria uma baixa prevalência de parasitoses em razão de reiterados tratamentos e não pela melhoria das condições de saneamento básico e educação sanitária da população.

Macroalgas de riachos da Floresta Nacional de Irati, região centro-sul do Estado do Paraná, Sul do Brasil

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

O complemento de lugar dos verbos de movimento: implicações para o ensino de língua materna

Conselho Nacional de Desenvolvimento Científico e Tecnológico

A complexidade do ser fictício: a construção da personagem Marcela no romance A ostra e o vento

It is possible to notice that the modern narrative increasingly seeks to invest its characters with a broad and complex nature, away from the well-defined beings of the traditional narrative. Through this work, we aim to make a study of Marcela, a character of the novel A ostra e o vento, by Moacir Costa Lopes, taking into account the way the complexity of the fictitious being is constituted through an analysis of structural, semantic, and thematic elements. We first will bring up a brief theoretical discussion about the character in a novel, and we also will carefully analyze the diagetic universe, presenting the complex path of the character further. Subsequently, we will focus on the structure of the narrative which creates a complex picture of the character, using the technique of crossed points of view as well as the technique of temporal fragmentation. Finally, we will investigate conflicting social relations that portray Marcela s disturbed inner side, as well as the metaphoric symbolic language, which furnishes a number of different representation of this character, impeding the creation of a well-structured coherent character. Studies of scholars such as Antonio Candido, Anatol Rosenfeld, Vitor Manuel de Aguiar e Silva, Fernando Segolin, Gerard Genette, Michel Zéraffa, among others, will guide our analysis

Analysis of cardiovascular system responses to forced vital capacity in COPD

CONTEXTUALIZAÇÃO: O teste de capacidade vital forçada (CVF) é rotineiramente realizado na avaliação da função pulmonar de pacientes com doença pulmonar obstrutiva crônica (DPOC). Entretanto, permanece pouco compreendida a influência do teste de CVF sobre o sistema cardiovascular de pacientes com DPOC. OBJETIVOS: Analisar o comportamento da frequência cardíaca (FC), pressão arterial (PA) e variabilidade da frequência cardíaca (VFC) no teste de CVF na DPOC. MÉTODOS: Dezenove homens com DPOC (72 ± 7 anos, no estágio de gravidade GOLD I=3, II=5, III=7 e IV=4 pacientes) realizaram a manobra de CVF e tiveram sua FC monitorada durante todo o exame, e a VFC analisada nos domínios do tempo (rMSSD) e da frequência (BF, AF e BF/AF) durante o repouso, antes e após a melhor manobra de CVF. A PA foi analisada no repouso, imediatamente ao final da manobra de CVF e 10 minutos após o término de todos os testes. RESULTADOS: Ao início da manobra de CVF, a FC reduziu (p<0,001) e, em seguida, aumentou progressivamente até o final do teste (p<0,001). Após término da manobra, a FC continuou a aumentar até atingir um pico (p<0,001) e depois caiu rapidamente a valores inferiores aos de repouso (p<0,001) e retornou ao seu valor basal. A PA e os índices da VFC não sofreram alterações nos períodos analisados. CONCLUSÃO: O teste de CVF influencia o comportamento da FC, sem alterar o seu controle autonômico, bem como a PA em pacientes com DPOC nos períodos analisados.

Alterações posturais em atletas brasileiros do sexo masculino que participaram de provas de potência muscular em competições internacionais

Os esportes de alto nível determinam padrões corporais que extrapolam barreiras geopolíticas, sociais e culturais. Estas peculiaridades resultam em alterações posturais que estão associadas à eficiência do gesto desportivo, porém, em longo prazo, podem evoluir para processos mórbidos que limitam a prática de atividades físicas regulares. O objetivo da pesquisa foi descrever o perfil postural dos atletas que participam de provas de potência muscular e identificar processos anátomo-cinesiológicos responsáveis pelas principais alterações corporais. A casuística foi composta por 15 atletas do sexo masculino, especializados em provas de potência muscular. O protocolo para coleta de dados foi elaborado com base na proposta de: i) Kendall, para o exame físico e observacional, utilizando simetrógrafo e fio de prumo; ii) Souchard, para a análise postural em cadeia. As informações foram organizadas sob a forma de distribuição de freqüência absoluta e relativa. Os resultados apontaram que: i) o tornozelo em valgo (67%) foi a situação mais comum; ii) a rotação interna da pelve à direita (60%), seguida do lado oposto mais elevado (47%), pode estar relacionada com a corrida em curva que sobrecarrega a estrutura da pelve para a manutenção da velocidade com simultânea mudança de direção em função da força gravitacional; iii) a anteversão de pelve (73%) decorre da retração observada nos músculos flexores do quadril e extensores do joelho; iv) a alteração expressa no item iii contribui para a formação de hiperlordose lombar (73%) e desencadeia mecanismo compensatório de retração da cadeia posterior causando cifose torácica (53%) e cabeça em protrusão (73%). O diagnóstico precoce e a adoção de medidas profiláticas efetivas podem contribuir para o aumento da performance, bem como prevenir a ocorrência de lesões desportivas. Estudos envolvendo intervenção fisioterápica deverão avaliar se há redução dos efeitos crônicos que as alterações posturais decorrentes do treinamento causam ao atleta de alto nível.

Essa marca de suor numa canção: o processo de redução estrutural na poesia de Zila Mamede

Die Beziehung zwischen Literatur und Gesellschaft wurden, im Laufe der Jahrhunderte, aus unterschiedlichen Perspektiven analysiert. Die Wissenschaftler analysieren manchmal die Aspekten der sozialen Realität, sie betonen manchmal die Natur der literarischen Werk. Wir glauben, dass Antonio Candido einen Gleichgewichtszustand erreicht, als er das Konzept der strukturellen Reduktion oder Formalisierung entwickelt. Nämlich, der Prozess, bei dem die menschliche und soziale Leben zu einem Bestandteil der literarischen Struktur wird. Der Autor tritt eine Einbahnstraße und er kann Daten aus der sozialen Ordnung aufholen, ohne dabei die Materialität des Textes den Augen verlieren. Und das sind die theoretische Annahmen, die die Entwicklung dieser Arbeit leiten. Wir wollen zu zeigen, dass die Struktur der mamediana Lyrik aufdeckt, signifikante Daten der Gesellschaft, in der der Autore eingefügt wurde enthüllt. Folglich, wir analysieren soziale Thema, das sein Werk durchzieht. Zuerst, wir untersuchen, wie Zila Mamede den Alltag der Gesellschaft vertreten. Von der strukturellen Organisation der Gedichte, wir erkennen, das die Episode aus kleiner Städte ein Akt des Widerstands gegen die fragmentierte Profil der kapitalistischen Gesellschaf sind. Das ist, warum sie doch eng mit der Idee der Tradition erscheinen. Die dichotome Beziehung zwischen den regionalen Daten und der Element der Modernisierung etabliert, sie wird durch die Organisation des Raumes verstärkt. Während die Stadt bei konkrete gesellschaftliche Ordnung Spitzenbeträge verweist, hat die Landschaft eine harmonische und warme Form. Allgemeinen, die moderne Stadt von Zila Mamede geformt, ist eine Abbild der Industriegesellschaft. Die Bilder die Landschaft sind ein Gegenmittel gegen die Feindseligkeiten Merkmale der neuen urbanen Zustand. So, die Landschaft hat die Funktion von Umstrukturierung der Persönlichkeit des Einzelnen durch die Erfahrung der großen Städte betroffen verdinglichenden. Der Konflikt, der durch das lyrische mamediana läuft, sind Reflexionen des Prozesses der Modernisierung der Stadt Natal, ihres eigenen Landes die politische Instabilität, sie durch verschiedene staatliche Programme ging, während Der Autor seine literarische Tätigkeit verfolgt

Os desdobramentos do feminino na poesia de Florbela Espanca

This work has the purpose to analyze the female images unrolled at the Florbela Espanca (1894 -1930) poetry of her three books published, Livro de Mágoas (1919), Livro de Sóror Saudade (1923) e Charneca em Flor (1931, posthumous), showing how the female mythic constituents Eve and Lilith advance among the books, delineating the female image which culminates to the female poet image, free of moral conventions and social principles in the beginning of 20th century. For this exam, we will apply the Imaginary criticism, and realize a short explanation about mythic archetypes theories from C.G. Jung, Mircea Eliade, E. Meletínki and Gilbert Durand, theories that will lead us to make the connection between the mythic constituents and Nietzsche tragic constituents, from which we will explain how these female mythic images associated to reason and unreason mythic constituents, unrolled at the Florbela poetry, also reveal the tragic esthetic at her work