Qualidade da assistência e o conhecimento sobre o direito à saúde das pessoas com úlcera venosa crônica

The study aimed to identify the quality of care and knowledge of health rights of people with chronic venous ulcers (VU) in Brasilian National Health Care System (SUS). It is a cross-sectional study, with quantitative approach, performed at the University Hospital Onofre Lopes (HUOL). The study was approved by the Ethics Committee of HUOL (CAAE nº 0148.0.051.000-10). The sample by accessibility was composed for 30 people with VU treated at the outpatient surgical clinic of HUOL. For data collection we used a structured questionnaire composed of two parts: sociodemographic characteristics and of health, of care and the clinical course of VU; and knowledge of people with VU about the rights of health. The results were processed using SPSS 15.0 and analyzed by descriptive statistics. Given the characterizations sociodemographic and health presented, we identified a clientele of users with VU predominantly female (76,7%), aged from 60 years (66,7%), married/ stable union (60,0%), low education level (83,3%), family income lower than a minimum wage (73,3%), unemployeds and with chronic diseases (53,3%), sleep greater than or equal to 6 hours (76,7%) and were not alcoholics or smokers (93,3%). In relation to clinical conditions, were shown the presence of one or more relapses of VU (73,3%), predominance of granulation tissue/epithelialization in the bed of VU (60,0%), exudate serosanguineous (43,3%), in quantity medium/large (60,0%), with no predominance of presence or absence of odor (50,0%), all patients with tissue loss in grade III / IV, no signs of infection (73,3%) and presence of intense pain (50,0%). In the last 30 days the main venue of achievement of dressing was the HUOL (100,0%), the main compression therapy used was the Unna boot (60,0%) and on inability to perform the dressing on the unit were the own patients who made the exchange at home (40,0%). The majority of respondents listed out more positive factors associated with quality of care (56,7%) were satisfied with the care of SUS (76,7%), claimed to have knowledge about their rights (70,0%), but at the same time did not know the meaning of the acronym SUS (90,0%) and classified their level of information as inappropriate (70,0%). We realize that people with VU identified as good the quality of care and demonstrated inadequate knowledge about their rights to health in the SUS, but showed interest in acquiring more information. The basic rights to entry in the SUS are constitutionally guaranteed and need to be disseminated in order to make them known to the population, so it can be implemented and ensured a greater resolution assistance in treating this type of injury

A pessoa idosa com doença crônica não transmissível atendida em serviços de média complexidade na cidade de Natal/RN

The demographic and epidemiological transition process caused by a declining in birth rates and in mortality, also changes occurred in morbidity and mortality is represented by the increasing of the aging population and the raising of chronic diseases. These diseases are characterized by multiple etiologies, risk factors, long latency period, a prolonged evolution, non-infectious origin and it has association with functional impairment and disability. Thus, elderly with chronic non-communicable disease has priority because they belong to a vulnerable group to get affection of comorbidities in aging, with increased demand and spending on health services. This study is aimed to analyse the understanding of elderly people with chronic non comunicable disease in the medium complexity service as a contribution to the improvement of health care in the city of Natal / RN. This is a descriptive and exploratory study with a quantitative approach, carried out at the Specialized Center for Elderly Health Care and at the Pescadores Hospital. The population was composed of 4,180 persons with a sample of 124 elderly aged above 60 years, attended in these medium complexity services. The instrument, a structured form, adapted from a questionnaire for monitoring risk and protective factors for chronic disease of the Ministry of Health. To collect data was was used the interview form containing demographic data, habits, health status and health care services. The results were processed using the Statistical Package for Social Science, version 18.0, analyzed by simple statistics. It was found that most seniors were female, predominantly between 70 and 74 years old, married, with a brown skin tone and Catholic religion, more than half had incomplete basic education, family income between one to two minimum wages and living with their families. Regarding the interviewers lifestyle, 94.4%, of them ate chicken and 97.6%, fruits, it was observed a reduction in smoking, alcoholism habits and physical activity according to the increasing age, 58.1 and 18.5% had insomnia18,5 % used sleeping pills. The elderly (51.6%) reported using services in times of sickness, seeking primary care at first (30.6%), 52% did not receive referral and was looking for free demand (38.7%). The most reported morbidity was hypertension, followed by musculoskeletal disorders. Regarding the difficulties in seeking health services, the delay in treatment and the waiting line were the most cited by the elderly. Almost all of them reported no activities to promote health in these services and those who received individual counseling on chronic diseases. Almost always, the health professionals who care of them, were mostly doctors followed by nurses. Based on the results presented, it is considered that the health services of medium complexity must undergone a more continuous dialogue with other attention level and focus on actions of health promotion and prevention. It is also recommended the necessity for qualified professionals to delivery health care to elderly and the implementation of protocols by a multidisciplinary health team, intending to provide better and continous care for the elderly with chronic diseases. The healthcare professionals who served them, were mostly physicians, followed by nurses. Through the results presented, it is considered that the medium complexity healthcare services need to perform a more continuous dialogue with the other levels of attention focusing attention to the health promotion and prevention actions. It is also recommended the necessity for qualified professionals to delivery healthcare for the elderly, in addition, a protocol implementation for the multidisciplinary health care team, to provide better care, and also the care continuity to elderly with chronic diseases

Integridade tissular de pacientes com úlceras venosas: um estudo baseado na Classificação dos Resultados de Enfermagem

The venous ulcer is an epidemiological problem of high prevalence, causing disability and dependence. Assess the tissue impairment level of patients with venous lesions, within a nursing referential, is relevant for the implementation of a directed assistance to specific clientele. Thus, this work aims to characterize the health status regarding the integrity the lower limbs skin of patients with venous ulcers, according to the of tissue integrity outcome indicators from the Nursing Outcomes Classification. A cross-sectional study conducted in a university hospital in Natal - Rio Grande do Norte. The sample consisted of 50 participants, selected through consecutive sampling. Data collection occurred through a interview and physical examination form and a operational definitions tool for indicators of the nursing Tissue Integrity outcome directed to patients with venous ulcer, applied from February to June 2012. Data analysis was done by descriptive statistics and nonparametric tests (Spearman, Kruskal-Wallis and Mann-Whitney tests). The project was approved by the Research Ethics Committee with protocol 608/11 and Presentation Certificate to Ethical Consideration No. 0038.0.294.000-11. The results were presented using three scientific articles derivatives of research. It was found that the indicators show moderate impairment, light and not impaired, as the median. The respondents had an average of 59.72 years, 66% female, 50% were retired, 60% with a partner, 44% had arterial hypertension, 26% allergies, 20% diabetes mellitus, 96% were sedentary, 14% drank alcohol and 6% were smokers. There was a statistically significant correlation of low intensity between age and hydration (p=0.032; rs=-0.304) and skin desquamation (p=0.026; rs=-0.316), family income and necrosis (p=0.012; rs=-0.353); Ankle Brachial Index and tissue perfusion (p=0,044; rs=-0,329); Diabetes Mellitus and texture (p=0.015) and tissue perfusion (p=0.026); allergy and texture (p=0.034), physical activity and hydration (p=0.034), smoking and thickness (p=0.018), and alcohol consumption and exudate (p=0.045). We conclude that the patients had light to moderate impairment, indicating a good state of health on the integrity of the skin of the lower limbs, according to the indicators of the outcome of tissue integrity Classification Nursing Outcomes valued in the present study. It is believed that the evaluation of impairment tissue using a self-nursing system and its relation with socioeconomic, clinical and risk factors are unique tools in the care planning and in the wound healing

Interferência de plantas daninhas no cultivo da melancia

A cultura da melancia é uma atividade explorada regionalmente, sendo uma das mais importantes fontes de renda familiar de pequenos municípios do médio Paranapanema, onde mudanças significativas no processo produtivo são atualmente constatadas, passando de mão-de-obra intensiva para uso de tecnologias promissoras, como é o caso do manejo de plantas daninhas. Um experimento foi conduzido no município de Oscar Bressani (SP), em área de produção comercial, com objetivo de estudar a interferência de plantas daninhas, no cultivo da melancia, na safra 2002/2003. O delineamento experimental utilizado foi de blocos ao acaso com dez tratamentos e quatro repetições, representadas por parcelas com área útil de 18 m², contendo quatro plantas de melancia e infestação prevalecente das espécies Sidaspp, Brachiaria humidicola, Commelina benghalensise Portulaca oleracea. A infestação das plantas daninhas foi estimada através de amostragens aleatórias das parcelas utilizando-se quadro vazado de ferro com 0,5 m de lado. Os tratamentos constaram de testemunhas capinadas e sem capina e diferentes épocas de controle da infestação, de forma que a cultura foi mantida na presença ou ausência das plantas daninhas até 7; 14; 28; 56 e 63 dias após a sua emergência (DAE). A ocorrência do período inicial de convivência possível maior que o período final estabeleceu o Período Crítico de Prevenção da Interferência do 9º ao 13º dias (PCPI= 9-13 DAE). A redução média da produtividade em função da interferência das plantas daninhas durante todo o ciclo da melancia foi de 41,4%. As características diâmetro e espessura da casca dos frutos também foram influenciadas pela convivência com a infestação durante todo o ciclo com decréscimos, de 7,9% e 23,3%, respectivamente, em média, ao contrário do comprimento e diâmetro de ramas e do ºBrix da polpa dos frutos, onde não foram constatadas diferenças significativas.

Violência doméstica contra adolescentes: o olhar dos educadores sociais

Domestic violence as a specific expression of violence against adolescents, is historically constructed from phenomenon of power relations that permeate the gender, ethnicity and social class, requiring differentiated attention. Sorting in A mass grave of what is understood by a child and teenager under the doctrines of the law of the minor and of irregular situation resulted, in General, in the preparation for the teenage audience, of policies and actions, fragile and inefficient with regard to domestic violence. Despite the status of children and adolescents clearly define what is meant by child and teenager, break with the menoristas doctrines and embrace the doctrine of integral protection, even if there is little guidance for the public actions and policies geared to the theme. Such deficiency contributes to characterize the current practice of social educators about domestic violence, marked by the absence of specific training; by inadequate working conditions; lack of preparation of the network of care. Thus, with the objective to start the discussion regarding the elements that make up the practice focused on this issue, the present study proposes to problematizing the design held by social educators working in public Social assistance of the city of Natal/RN, regarding the issue of domestic violence against adolescents, by paying attention to such things as their vocational integration, their training and their working conditions. Adopts norteadoras references as having its roots in the Pedagogia Problematizadora, Paulo Freire, and socio-historical perspective. The methodological procedure of nature quali-quantitative was lifting censitário and psychosocial characterization of educators together to State and local Departments of assistance; the application of questionnaire to educators, composed of open and closed issues; and observation and field journaling activities of their work. Of network professionals, 111 64 replied to the questionnaire, which represents more than 50% of the total. Psychosocial characterization exposes data as the predominance of low family income and female professionals; the note identified that do not have a professional technical parameter, and the activities carried out in accordance with the representations of each professional the respect of labour, problematic and adolescents involved, revealing an individual perspective of action. And a preliminary analysis of responses to the questionnaire pointed out that such professionals are subjected to precarious working conditions, as well as one realizes a relative ignorance about the network of care for adolescents at risk and ACE, all this resulting in restricted marginalizantes conceptions, and misleading information regarding domestic violence against teenagers.

Geographic and Educational Factors and Risk of the First Peritonitis Episode in Brazilian Peritoneal Dialysis Study (BRAZPD) Patients

Background and objectives Peritonitis remains as the most frequent cause of peritoneal dialysis (PD) failure, impairing patient's outcome. No large multicenter study has addressed socioeconomic, educational, and geographic issues as peritonitis risk factors in countries with a large geographic area and diverse socioeconomic conditions, such as Brazil.Design, setting, participants, & measurements Incident PD patients recruited from 114 dialysis centers and reporting to BRAZPD, a multicenter observational study, from December 2004 through October 2007 were included. Clinical, dialysis-related, demographic, and socioeconomic variables were analyzed. Patients were followed up until their first peritonitis. Cox proportional model was used to determine independent factors associated with peritonitis.Results In a cumulative follow-up of 2032 patients during 22.026 patient-months, 474 (23.3%) presented a first peritonitis episode. In contrast to earlier findings, PD modality, previous hemodialysis, diabetes, gender, age, and family income were not risk predictors. Factors independently associated with increased hazard risk were lower educational level, non-white race, region where patients live, shorter distance from dialysis center, and lower number of patients per center.Conclusions Educational level and geographic factors as well as race and center size are associated with risk for the first peritonitis, independent of socioeconomic status, PD modality, and comorbidities. Clin J Am Soc Nephrol 6: 1944-1951, 2011. doi: 10.2215/CJN.11431210

Armadillo meat intake was not associated with leprosy in a case control study, Curitiba (Brazil)

Leprosy's progression and its maintained endemic status, despite the availability of effective treatments, are not fully understood and recent studies have highlighted the possibility of involved Mycobacterium leprae ambient reservoirs. Wild armadillos can carry leprosy and, because their meat is eaten by humans, development of the disease among armadillo meat consumers has been investigated. This study evaluated the frequency of armadillo meat intake among leprosy patients as well as age and gender matched controls with other skin diseases from a dermatological unit. Armadillo meat consumption among both groups was adjusted by demographic and socioeconomic covariates based on a conditional multiple logistic regression model. One hundred twenty-one cases and 242 controls were evaluated; they differed in socioeconomic variables such as family income, hometown population and access to treated water. The multivariate analysis did not show an association between the intake of armadillo meat and leprosy (odds ratio = 1.07; CI 95% 0.56-2.04), even when only cases with no known contacts were analyzed. We conclude that leprosy is not associated with the intake of armadillo meat in these patients.

Occurrence of enteroparasites in day care centers in Botucatu (São Paulo State, Brazil) with emphasis on Cryptosporidium sp., Giardia duodenalis and Enterobius vermicularis

Verificou-se a prevalência dos enteroparasitas em 279 crianças (0 a 6 anos) de quatro creches municipais de Botucatu/SP. Foram coletadas três amostras de fezes de cada criança e processadas pelos métodos Hoffman, Faust e Ritchie e posterior coloração do esfregaço fecal pelos métodos de Auramina-O e Ziehl-Neelsen modificado para diagnóstico de Cryptosporidium sp. e método da fita gomada para diagnóstico de Enterobius vermicularis. Das crianças analisadas apresentaram-se parasitadas 53.40%, sendo que o parasita mais freqüente foi Giardia duodenalis (26.88%). Verificou-se associação significativa entre enteroparasitose, renda familiar, escolaridade materna e idade; quanto maior a renda e o grau escolar, menor a freqüência de enteroparasitas. Observou-se que G. duodenalis é mais prevalente em crianças de 0 a 4 anos e E. vermicularis em crianças entre três e quatro anos de idade. A elevada prevalência de enteroparasitas em creches sugere estrutura complexa em sua epidemiologia, onde fatores além do saneamento devem ser considerados.

Social support and infant malnutrition: a case-control study in an urban area of Southeastern Brazil

The relationship between malnutrition and social support was first suggested in the mid-1990s. Despite its plausibility, no empirical studies aimed at obtaining evidence of this association could be located. The goal of the present study was to investigate such evidence. A case-control study was carried out including 101 malnourished children (weight-for-age National Center for Health Statistics/WHO 5th percentile) aged 12-23 months, who were compared with 200 well-nourished children with regard to exposure to a series of factors related to their social support system. Univariate and multiple logistic regressions were carried out, odds ratios being adjusted for per capita family income, mother's schooling, and number of children. The presence of an interaction between income and social support variables was also tested. Absence of a partner living with the mother increased risk of malnutrition (odds ratio 2.4 (95 % CI 1.19, 4.89)), even after adjustment for per capita family income, mother's schooling, and number of children. The lack of economic support during adverse situations accounted for a very high risk of malnutrition (odds ratio 10.1 (95 % CI 3.48, 29.13)) among low-income children, but had no effect on children of higher-income families. Results indicate that receiving economic support is an efficient risk modulator for malnutrition among low-income children. In addition, it was shown that the absence of a partner living with the mother is an important risk factor for malnutrition, with an effect independent from per capita family income, mother's schooling, and number of children.

Economic valuation of the Emas waterfall, Mogi-Guaçu River, SP, Brazil

A Cachoeira de Emas, no Rio Mogi-Guaçu, é reconhecida regionalmente como um importante local para a pesca e o turismo. Os primeiros registros da pesca profissional e esportiva no local datam da década de 30, que é o mesmo período em que a atividade do turismo teve seu início. O presente artigo fornece uma valoração ambiental deste local e identifica as diferenças entre os principais grupos de pessoas que o frequentam. Durante o ano de 2006 nós entrevistamos 33 pescadores profissionais, 107 pescadores esportivos, 45 turistas e 103 excursionistas para estimar a Disposição a Pagar ( P) de cada categoria e para analisar a influência de fatores socioeconômicos através de regressões logísticas e ANCOVAs. A DAP dos pescadores profissionais foi significativamente influenciada pela idade e escolaridade e a DAP dos pescadores esportivos foi significativamente influenciada pela renda familiar. As variáveis que influenciaram a DAP dos turistas e excursionistas fora o sexo e a escolaridade. valor anual total agregado para manter a Cachoeira nas condições atuais foi estimado em US$ 81.080,00, e US$ 44.055.911,46 para recuperá-la.

Sport fishing in Cachoeira de Emas in Mogi-Guaçu River, State of São Paulo, Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Malnutrition in the second year of life and psychosocial care: a case-control study in an urban area of Southeast Brazil

O objetivo do estudo foi identificar e medir a presença de associação entre cuidado psicossocial e desnutrição. Realizou-se estudo caso-controle incluindo 101 crianças desnutridas (peso/idade < percentil 5 do padrão NCHS/OMS), com idades entre 12 e 23 meses, que foram comparadas a 200 controles eutróficos (peso/ idade > percentil 25) em termos de sua exposição a uma série de comportamentos maternos indicadores da qualidade de seu cuidado psicossocial. Criou-se um escore de cuidado psicossocial, variando de 0 a 14, de acordo com o número de comportamentos maternos desejáveis não observados: quanto maior o escore, pior a qualidade do cuidado psicossocial. Mediante análise de regressão logística verificou-se maior risco de desnutrição para as crianças no 2º e 3º tercis do escore de cuidado psicossocial. Esta associação foi modificada pela renda per capita. Após ajustes para possíveis confundidores, nas crianças dos estratos superiores de renda não houve associação entre cuidado psicossocial e desnutrição. Para as crianças com nível mais baixo de renda, pior cuidado psicossocial dobrou o risco de desnutrição (OR = 7,26; IC95%: 2,42-21,82) em relação àquele associado apenas à baixa renda (OR = 3,08; IC95%: 1,28-7,42).

Fatores associados a não realização da mamografia e do exame clínico das mamas: um estudo de base populacional em Campinas, São Paulo, Brasil

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

Diabetes auto-referido em idosos: prevalência, fatores associados e práticas de controle

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

Principais preocupações dos pacientes sobre as complicações mais frequentes na sala de recuperação pós-anestésica

JUSTIFICATIVA E OBJETIVOS: Eventos considerados menores têm assumido papel fundamental na determinação da qualidade do serviço prestado na área da Anestesiologia. O objetivo do presente estudo foi avaliar as principais preocupações dos pacientes em relação ao período pós-anestésico e testar a hipótese de que os efeitos mais indesejados podem ser influenciados por características demográficas. MÉTODO: Um questionário foi respondido por 440 pacientes imediatamente antes da avaliação pré-anestésica. Foram listados os possíveis efeitos indesejáveis no período pós-operatório imediato, baseados em levantamento a partir de dados disponíveis na literatura e considerando o critério de frequência, mas não o de gravidade. Foram avaliados os dados demográficos e pesquisadas as nove preocupações mais frequentemente citadas. As informações coletadas a partir da análise dos questionários preenchidos pelos entrevistados foram relacionadas com seus dados antropométricos, socioeconômicos e educacionais, com o objetivo de avaliar a influência dessas variáveis no perfil das respostas. RESULTADOS: Entre os efeitos indesejados, o temor de acordar intubado foi o mais frequentemente citado como o mais importante, seguido de dor forte no local da cirurgia e acordar durante a cirurgia. A análise dos três efeitos mais indesejados em relação aos dados demográficos não evidenciou diferença estatística significativa, com exceção do item dor no local da cirurgia (menos citada entre pacientes do sexo masculino). CONCLUSÕES: As principais preocupações dos pacientes em relação ao período pós-anestésico são: acordar com um tubo na garganta, dor forte no local da cirurgia e a lembrança de estar acordado durante a cirurgia. A idade, o grau de escolaridade e a renda familiar não determinaram diferenças nas preocupações dos pacientes.