Perfil das condições de seguimento terapêutico em portadores de hipertensão arterial

A proposta foi investigar os aspectos comportamentais referentes ao seguimento da terapêutica farmacológica e não farmacológica e o grau de adesão ao tratamento anti-hipertensivo de um grupo específico. Estudo observacional descritivo com análise quantitativa, realizado no Centro de Referência da Assistência Social em Fortaleza-CE, de agosto/2008 a maio/2009. Dados obtidos de 49 indivíduos por entrevista e exame físico. Mais de 50% dos participantes seguiam as terapêuticas não farmacológicas. Prevaleceram a terapia combinada (53%) e as classes medicamentosas de diuréticos (72%) e inibidores da enzima conversora de angiotensina (55%). Muitos participantes (49%) referiram reações adversas. Destas, as mais citadas foram poliúria e tontura (29%). Quanto ao grau de adesão, a média correspondeu ao conceito não adesão leve. A avaliação dos comportamentos de seguimento terapêutico e a caracterização clínico-epidemiológica são necessárias para o enfermeiro planejar estratégias educativas. Ambas possibilitam ajustes no planejamento das intervenções, contribuindo para a melhor adesão terapêutica dos indivíduos

Atenção ao usuário em um centro de referência HIV/Aids: perspectiva de profissionais e usuários

We study the health care focused on care in an intercessor and dialogical relationship with the User, which involves the construction of therapeutic projects essential to the quality of the treatment of the user in health services, and it is necessary individual and collective actions. It is intended to acknowledge and analyze the perception of social subjects, users and professionals on the treatment given to a user of a Specialized Outpatient Service (Serviço Ambulatorial Especializado SAE) in STD/HIV/AIDS state reference in Natal, RN. The study is structured in a transdisciplinary vision of science and knowledge, theoretical and methodological principles that give meaning to the expression of the institutional features of care and health care reconnecting them to the social context. As a research strategy we seek the expressions of 56 subjects of social research, which agreed to participate in the sample, from a symbolic map of the attention, coupled with the techniques of observation and semi-structured interview. For the analysis of the results, five categories of analysis were established: the meaning of the service, care perception, process of communication and interaction, treatment perception and organization and evaluation of the service. It is argued that the attention and care are developed in a technical health care assistance to the disease, focusing on attention based on treatment, on diagnostic and drug therapy of antiretroviral drugs, reflecting the traditional biomedical paradigm of attention to the disease. This is also the mode of organization of practical actions in daily SAE: the therapy proves to be fragmented in several specialties, vertical and feeds the same model, generating tension and overload for professionals; showing impersonal care focused on structured and informative technology, unrelated to an interactive dialogic. From the speech of the subjects, the SAE is understood as the place of confrontation with the disease, but also enables greater elaboration of the illness by meeting their peers. Living with HIV and AIDS is living with concern, apprehension and fear, but mainly with the stigma, prejudice and exclusion, which require that the disease is kept in secret. There is a movement of forces and power, expressed in the knowledge-power of those who dominate the technical and administrative capabilities, devices that concentrate the maintenance of the medicalization of care, rapid consultations and with little attention, making it difficult to interact with and listen to, combined with structural failures, organizational and inadequate management of the service. We conclude that there are dimensions that are not considered in the internal dynamics of the care service multiple forms, characterized by care conflicting models, marked by individual interventions related to the disease. The subject is not considered together with his speech as technical discourse is imposed and care production based on material technology is observed

Hipertensão arterial e fatores de risco em servidores atendidos pelo departamento de assistência da Universidade Federal do Rio Grande do Norte

Systemic arterial hypertension is a multifactorial disease that contributes to the country´s high cardiovascular morbi-mortality rates. Considering that hypertension affects individuals in their most productive age while facing work and living risk factors, it is important to investigate its occurrence and predisposing factors in different occupational segments. The objective of this study was to identify the prevalence of hypertension among workers attended to in a medical service of a public university, their hypertension levels, the risk factors present, and their knowledge of the factors that influence the arterial pressure. The epidemiologic study was conducted in the Health Department of the Federal University of Rio Grande do Norte with 102 workers that sought care in the medical clinic during the months of March to May 2009. Data were collected by means of a questionnaire and measurements of systolic and diastolic arterial pressure (SAP and DAP) that were classified in stages according to the Brazilian Society of Hypertension and the degree of risk for cardiovascular events according to the criteria of the Brazilian Society for Cardiology. Data were analyzed using descriptive statistics. The workers were, on average, 54 years of age; the majority (67%) was male and had primary or middle educational level; they worked mainly in supplemental units and deanship offices conducting different functions such as security guards, administrative assistants, health auxiliaries and constructions workers; 48 (47%) of the workers identified themselves as hypertensive for 8 years on average, with the majority executing hard labor and administrative functions. Among the workers with hypertension, the number of the pressure levels classified as pre-hypertensive, stage I and II were: (12% in the SAP and 20% in the DAP); (16% in the SAP and 9% in the DAP); and (15% in the SAP and 5% in the DAP), respectively. The workers that did not identify themselves as hypertensive presented classifications with greater frequencies were: normal (16% in the SAP and 30% in the DAP); and pre-hypertensive (21% in the SAP and 16% in the DAP). The risk factors identified in more than 50% of the workers were: tobacco smoking, alcohol consumption and indices of being overweight, although physical activities are also present. Of the 48 workers diagnosed as hypertensive, those that had 5 risk factors present and limitrophic pressure levels (12%), in stage I hypertension (16%) and stage II hypertension (15¨%) were categorized as being in high risk for vascular events. The number of workers that indicated they had knowledge of the factors that influence their hypertension was less than 39% for each factor. It is concluded that there is a high prevalence of systemic arterial hypertension in the university workers, even amongst those already under treatment. They constitute a population at risk considering their age group, their work functions, and their inadequate life habits. Health care of these hypertensive workers that seek attention in the Health Department is an important aspect of the internal workers health policy in the institution. Educational interventions are recommended for the improvement of quality of life and of work in these workers

Realidade virtual na atividade cerebral: um estudo comparativo entre estados emocionais de adultos jovens e idosos

The association of Virtual Reality (VR) to clinical practice has become common in the recent years, showing to be an additional tool on health care, especially for elderly. Its use has been related to higher therapeutic adhesion levels and well being sensation. Such emotional based aspects are often observed by subjective tools of relative validity. This study analyzed the immediate effects of varied VR contexts balance training over emotional behavior, which was observed under peaks of maximum expression of EEG waves. Methodology: 40 individuals, divided in two groups, both gender, 20 young and 20 elderly, were submitted to a 60 minutes intervention, including balance training under VR. The first 25 minutes referred to initial evaluation, general orientation and cognitive assessment by the use of Mini Mental. The next ten minutes were designated to the avatar creation and tutorial video presentation. Through the following 20 minutes, the individuals from both groups were exposed to the exact same sequence of games under virtual contexts, while submitted to electroencephalography by Emotiv EPOC® focusing Adhesion, Frustration and Meditation states. The virtual interface was provided by the Nintendo® game, Wii Fit Plus, with the scenarios Balance Bubble (1), Penguin (2), Soccer (3), Tight Rope (4) and Table Tilt (5). Finally, a questionnaire of personal impressions was applied on the 5 minutes left. Results: data collected showed 64,7% of individuals from both groups presented higher concentration of adhesion peaks on Balance Bubble game. Both groups also presented similar behavior regarding meditation state, with marks close to 40%, each, on the same game, Table Tilt. There was divergence related to the frustration state, being the maximum concentration for the young group on the Soccer game (29,3%), whilst the elderly group referred highest marks to Tight Rope game (35,2%). Conclusion: Findings suggest virtual contexts can be favorable to adhesion and meditation emotional patterns induction, regardless age and for both sexes, whilst frustration seems to be more related to cognitive motor affordance, likely to be influenced by age. This information is relevant and contributes to the orientation for the best choice of games applied in clinical practice, as for other studies regarding this topic

Análise dos procedimentos empregados por 100 cirurgiões-dentistas nos casos de avulsão dentária

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Acompanhamento farmacoterapêutico de usuários portadores de dislipidemia: um projeto piloto

As Doenças Cardiovasculares (DCV) são a principal causa de morte no mundo e no Brasil. A dislipidemia é um dos principais fatores de risco associados a DCV, o descontrole no perfil lipídico impacta na aterosclerose e na diminuição da sobrevida. A dislipidemia pode ser tratada farmacologicamente ou através de medidas para mudanças do estilo de vida. O farmacêutico, como profissional da saúde especializado em medicamentos, está habilitado para solucionar Resultados Negativos associados a Medicação (RNMs), trabalhar na melhoria da adesão e na educação em saúde. Este estudo tem o objetivo de implementar um projeto piloto de acompanhamento farmacêutico em usuários com dislipidemia diagnosticada. Método: Foram selecionados 20 indivíduos com idade entre 40 e 64 anos, atendidos na unidade básica de saúde Parque São Paulo, do município de Araraquara- SP (Brasil) que eram diagnosticados com dislipidemia há pelo menos 3 meses e eram usuários de pelo menos um medicamento para tratamento da dislipidemia. Os pacientes foram divididos em dois grupos: o grupo controle, que não receberá intervenção farmacêutica e o grupo intervenção que receberá acompanhamento farmacêutico através do método Dáder, durante o período de 4 meses de estudo. Foram investigadas as variáveis sócio-demográficas, as relacionadas aos hábitos alimentares, as terapêuticas (uso de medicamentos, adesão terapêutica); Escala de auto-relato de adesão desenvolvida por Morisky. Os parâmetros bioquímicos/fisiológicos foram mensurados através do aparelho portátil Accutrend Plus(Roche) de medida do colesterol e triglicérides. Resultados: O presente estudo demonstrou que as intervenções farmacêuticas relacionadas ...

Prática supervisionada de exercícios físicos durante o tratamento regular com estatinas de pacientes da atenção básica: caracterização, aderência e delimitação das respostas musculares

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Assistência cirúrgico-odontológica a pacientes com história de infarto do miocárdio

The execution of a appropriate odontological surgical treatment for patients with Myocardial Infarction has been based in established protocols for important works in world wide literature during the sixty’s and seventy’s decade, established with a minimum of six months before the noncardiac surgery. The recent advancements in the medical assessment of surgical risk based on the individual analysis of each case with availability of new therapeutic tools in reference to medical or dental treatment, allowing for new procedures that can be used in the execution of safer odontological surgery for each patients. This review of the literature shows the actual tendencies of the treatment of patients with Myocardial Infarction concerning specific care before, during and after surgery based on laboratory evaluation and drug therapy as well as the possibility of surgical treatment before six months post-infarction.

Resultados da atenção farmacêutica no Brasil: uma revisão

The practice of pharmaceutical care (PC) is recent in Brazil and little is known about its impact on the health system or patients. The aim of this review was thus to identify the clinical, humanistic and economic outcomes achieved by the practice of PC in Brazil. In order to assess those outcomes, data published in studies from 1997 to 2011 were collected from Lilacs and MEDLINE databases, using the technique of content analysis. Original studies on PC that included pharmacotherapeutic follow-up were considered eligible for this descriptive review. A total of 306 articles were identified through the chosen descriptors. Of those, ten studies were eligible for this review and only two did not report significant results. The others reported increased adherence to pharmacotherapy, resolution of pharmacotherapeutic issues and control of clinical parameters of diseases (such as maintenance or reduction of blood pressure, reduction in HIV viral load and increase in lymphocyte count), promoting improvements in the general state of health and behavioral changes. However, economic impact was not assessed in any article analyzed, nor was a direct measurement of life quality performed. Although there are few studies on the outcomes of pharmaceutical care services in Brazil, it is demonstrated in this review that positive results were obtained when the pharmacist acted as a provider of optimized pharmacotherapy. This may be considered a result of the actions that followed the Brazilian Pharmaceutical Care Consensus of 2002, such as the restructuring of the curricular basis of pharmacy courses. From this point on, Brazilian researchers and pharmacists should think of a strategy to expand the offer of pharmaceutical care beyond academia and reach people in general who need this type of health care.

Autocuidado na percepção de pessoas com hanseníase sob a ótica da complexidade

Objective: This study aimed to understand how patients with Hansen's Disease perceive self-care from the complexity perspective. Methods: Qualitative, descriptive and exploratory study based on the Collective Subject Discourse. Results: Sample composed of 15 subjects, most of whom were married males (66.6%) with a mean age of 52.3 years and were classified in the polarized forms of the disease. The following themes emerged from the DCS synthesis: having Hansen's Disease, drug therapy, self-care and lifestyle. The study provided visibility to the vertical model, which is largely hegemonic in the tradition of public health care policies, showing concern about only treating the disease, disregarding the complex relationships involved. Conclusion: Acknowledging these limitations and setting strategies to change them in favor of the dialogue among interprofessional team members are challenges to further develop self-care practices and to empower patients in relation to treatment and disease.

Summary of the II Brazilian Guideline Update on Acute Heart Failure 2009/2011

In the past two years we observed several changes in the diagnostic and therapeutic approach of patients with acute heart failure (acute HF), which led us to the need of performing a summary update of the II Brazilian Guidelines on Acute Heart Failure 2009. In the diagnostic evaluation, the diagnostic flowchart was simplified and the role of clinical assessment and echocardiography was enhanced. In the clinical-hemodynamic evaluation on admission, the hemodynamic echocardiography gained prominence as an aid to define this condition in patients with acute HF in the emergency room. In the prognostic evaluation, the role of biomarkers was better established and the criteria and prognostic value of the cardiorenal syndrome was better defined. The therapeutic approach flowcharts were revised, and are now simpler and more objective. Among the advances in drug therapy, the safety and importance of the maintenance or introduction of beta-blockers in the admission treatment are highlighted. Anticoagulation, according to new evidence, gained a wider range of indications. The presentation hemodynamic models of acute pulmonary edema were well established, with their different therapeutic approaches, as well as new levels of indication and evidence. In the surgical treatment of acute HF, CABG, the approach to mechanical lesions and heart transplantation were reviewed and updated. This update strengthens the II Brazilian Guidelines on Acute Heart Failure to keep it updated and refreshed. All clinical cardiologists who deal with patients with acute HF will find, in the guidelines and its summary, important tools to help them with the clinical practice for better diagnosis and treatment of their patients.

Efavirenz versus Nevirapina : comparação da efectividade e do perfil de segurança, a longo prazo, no tratamento da infecção por vírus da imunodeficiência humana tipo 1

Tese de mestrado, Doenças Infecciosas Emergentes, Universidade de Lisboa, Faculdade de Medicina, 2016

Doenças neurológicas

As convulsões são o problema neurológico mais comum nos animais de companhia. Convulsão é o quadro clínico gerado por descargas elétricas paroxísticas, descontroladas e transitórias nos neurónios do encéfalo, levando a alterações da consciência, atividade motora, funções viscerais, perceção sensorial, conduta e memória. A anamnese é muito importante para o diagnóstico, pois é o proprietário quem na maioria das vezes presencia o evento e, os dados obtidos podem auxiliar no plano de diagnóstico e terapêutico. É importante reconhecer, no entanto, que esta informação é coadjuvante ao exame neurológico. As convulsões podem ter causas extracranianas (ex: metabólicas e toxicas), intracranianas (ex: traumatismos, enfermidades infeciosas, malformações congénitas) e idiopáticas (epilepsia idiopática). É fundamental tentar identificar a causa das convulsões através da realização do exame clínico e neurológico, com atenção especial aos sistemas cardio-circulatório, respiratório, digestivo e urinário. Devem ser realizados exames complementares adequados (hemograma, urianálise, enzimas hepáticas, ureia, creatinina, glicemia, sorologias, reação em cadeia de polimerase, radiografias torácicas, ultrassonografia, tomografia computorizada e ressonância magnética quando disponíveis). O objetivo do tratamento antiepilético é controlar as convulsões sem efeitos adversos, no entanto, o clínico apenas pode tentar reduzir a frequência e severidade das convulsões a um nível que não comprometa substancialmente a qualidade de vida do animal e dos proprietários, evitando efeitos secundários.

Cessação Tabágica e Ganho Ponderal: Linhas de Orientação

Fumar é a primeira causa evitável de doença, incapacidade e morte prematura nos países desenvolvidos, estando associada a seis das oito primeiras causas de morte a nível mundial. Em 2010, o consumo de tabaco foi responsável, em Portugal, pela morte de cerca de 11 000 pessoas fumadoras ou ex-fumadoras, causadas por doenças respiratórias, cancro ou doenças do aparelho cardiovascular. Os indivíduos que cessam os hábitos tabágicos antes dos 50 anos têm metade do risco de morrer nos 15 anos seguintes. Deixar de fumar diminui o risco de desenvolver doenças cardiovasculares e doenças respiratórias, bem como inúmeros tipos de cancro. Ao longo do processo da cessação tabágica, cujo sucesso passa pelo acompanhamento de uma equipa multidisciplinar, a vontade de comer e de ingerir alimentos particularmente ricos em energia é frequente, bem como o aumento de peso. Este último é citado frequentemente como o principal motivo para a relutância em parar de fumar e recaída depois da cessação, especialmente nos fumadores que apresentam preocupações com o seu peso. Contudo, é hoje consensual que os benefícios da cessação do consumo de tabaco superam eventuais riscos que esta possa apresentar. De forma a promover um consumo alimentar adequado durante a cessação tabágica, fazem-se diversas recomendações, baseadas na evidência científica mais recente, facilitando a adesão terapêutica e a continuação do processo e reduzindo o risco do aumento de peso corporal.

Profilaxia de pré-exposição da infeção por HIV

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz