Presença de 20% ou mais de clue cells como um criterio diagnostico de vaginose bacteriana em esfregaços de Papanicolaou

Orientador: Jose Antonio SimõesDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Objetivo: Avaliar a acurácia da presença de pelo menos 20% de clue cells nos esfregaços de Papanicolaou para o diagnóstico de vaginose bateriana (VB), avaliar a reprodutibilidade interobservador deste critério padronizado e comparar a acurácia das amostras cervicais e vaginais para este diagnóstico. Métodos: Foi realizado um estudo de validação de teste diagnóstico envolvendo 135 mulheres em idade reprodutiva atendidas no ambulatório de Planejamento Familiar da Universidade Estadual de Campinas. As mulheres foram submetidas a um exame ginecológico, no qual foram coletadas amostras cervicais e do fundo de saco vaginal para o exame de Papanicolaou, e também amostras do fundo de saco vaginal para realização do exame bacterioscópico corado pelo método de Gram e a para o exame a fresco. Avaliaram-se também os quatro critérios clínicos de Amsel para diagnóstico de VB. As lâminas de Gram foram analisadas utilizando os critérios bacterioscópicos de Nugent, método considerado padrão-ouro, no qual uma pontuação = 7 foi considerada positiva para VB. Nos esfregaços de Papanicolaou a presença de 20% ou mais de clue cells foi considerada positiva para VB, sendo este critério avaliado por dois observadores de laboratórios diferentes. Resultados: A freqüência de VB foi de 22% quando diagnosticada pelo método de Nugent, 24% pelo método de Papanicolaou e 29% pelos critérios de Amsel. O exame de Papanicolaou para o diagnóstico de VB utilizando como o critério a presença de pelo menos 20% de clue cells nos esfregaços, apresentou sensibilidade de 87%, especificidade de 94%, valor preditivo positivo de 81% e valor preditivo negativo de 96%. Este critério resultou em uma excelente concordância entre as amostras cervicais e vaginais (Kappa: 0,92) e também em uma excelente concordância entre os dois observadores (Kappa: 0,87). Conclusão: A presença de 20% ou mais de clue cells nos esfregaços de Papanicolaou é um critério acurado e reprodutível para o diagnóstico de VB, podendo ser utilizado para o diagnóstico presuntivo desta infecção sem a necessidade de coleta adicional de amostra vaginalAbstract: Objective: To evaluate the accuracy of the presence of at least 20 % of clue cells to diagnose bacterial vaginosis (BV) in Pap-smear, to asses the reproducibility of this criterion for the diagnosis of BV between different observers and to compare the accuracy of samples collected from cervical and vaginal sites to perform the diagnosis of BV. Methods: This is a diagnostic test validation study of 135 women of reproductive age attending at the Family Planning Out-patient Clinic of the Universidade Estadual de Campinas. A pelvic examination was performed to collect samples from cervical and vaginal sites for Pap-smear. Swabs were also collected for Gram¿s stain and wet mount. Amsel¿s criteria were also used for the presence of BV. The Gram stained slides were evaluated and graded for the presence of BV using Nugent¿s criteria. A score = 7 was defined as BV and considered as gold standard. The presence of = 20% of clue cells in Pap-smears was defined as positive for BV. These Pap-smears were analysed by two cytologists from different laboratories. Results: The frequency of BV was 22% by Nugent¿s criteria, 29% by Amsel¿s criteria and 24% by Pap-smear criterion. The use of the presence of at least 20% of clue cells in the Pap-smear for the diagnosis of BV showed a sensitivity of 87%, specificity of 94%, positive predictive value of 81% and negative predictive value of 96%. The concordance among the cervical and vaginal samples for the diagnosis of BV by Pap-smear was excellent (Kappa: 0.92). In addition, the concordance between the observers for diagnosis of BV by Pap-smear was also excellent (Kappa: 0.87). Conclusion: Our findings support the accuracy and reproducibility of Pap-smear for presumptive diagnosis of BV using the presence of 20% of clue cells as a diagnosis criterion. Furthermore, the results suggest that the screening of BV by Pap's can be made without an additional vaginal sample collectionMestradoCiencias BiomedicasMestre em Tocoginecologi

Proposta de protocolo assistencial de enfermagem para a abordagem motivacional de gestantes e puérperas usuárias de substâncias psicoativas em hospital geral

O uso de substâncias psicoativas por gestantes e puérperas é um grave problema de saúde pública global. O nascimento do bebê pode representar uma motivação para a cessação ou redução do consumo de substâncias psicoativas por mulheres no período gestacional e puerpério. Diante desta perspectiva, os profissionais de enfermagem exercem um papel fundamental na prevenção, promoção e tratamento do uso de substâncias psicoativas em sua prática clínica nos diversos níveis de atenção em saúde materno-infantil, incluindo unidades obstétricas. Frente a essa problemática, a Organização Mundial da Saúde recomenda diretrizes sobre rastreamento universal do uso de substâncias pautadas em um cuidado em saúde integral e individualizado. Neste sentido, o modelo de intervenção Triagem, Intervenção Breve e Encaminhamento para Tratamento (SBIRT) é uma proposta de baixo custo e implantado em alguns países. O objetivo desta pesquisa visa construir uma proposta de protocolo assistencial de enfermagem para a abordagem motivacional de gestantes e puérperas usuárias de substâncias psicoativas em hospital geral. Quanto ao método, trata-se de um estudo metodológico, desenvolvido em duas etapas: revisão integrativa da literatura e a elaboração do protocolo assistencial. A revisão integrativa objetivou identificar as evidências científicas sobre a aplicabilidade e eficácia do modelo de intervenção SBIRT em gestantes e puérperas, e foi realizado em 5 etapas: formulação do problema; coleta de dados; avaliação dos dados; análise e interpretação dos resultados e apresentação dos resultados. A produção textual do protocolo foi desenvolvida a partir da síntese das evidências científicas obtidas na RI, artigos científicos, livros didáticos e diretrizes governamentais nacionais e internacionais sobre triagem e intervenção breve. A formatação textual do protocolo foi adaptada de acordo com as normas institucionais de elaboração de protocolos do Hospital de Clínicas de Porto Alegre (HCPA). Para chegar até os resultados, utilizou-se as bases de dados LILAC, PubMed, Web of Science e Scopus para a busca dos dados e foram localizados 352 artigos. Após critérios de exclusão, totalizaram 5 artigos para integrar a RI. O produto gerado neste estudo foi a proposta de um Protocolo Assistencial de Enfermagem para a Abordagem Motivacional de gestantes e puérperas usuárias de substâncias psicoativas em hospital geral, pautado no modelo SBIRT. Apesar dos escassos estudos, os achados mostraram que os princípios básicos do modelo SBIRT podem ser utilizados na assistência a mulheres gestantes e puérperas usuárias de SPAs e possibilitou alcançar o objetivo principal deste trabalho. Assim, acredita-se que após validado, o instrumento elaborado possa colaborar na qualificação da prática de profissionais de enfermagem no cuidado integral dessa clientela, bem como contribuir com os objetivos do Programa Institucional de Álcool e Drogas do HCPA, no fortalecimento de pesquisas na área e na promoção de espaços de educação permanente.The use of psychoactive substances by pregnant and postpartum women is a serious global public health problem. The birth of the baby may represent a motivation to cease or reduce the consumption of psychoactive substances by women in the gestational and puerperal period. From this perspective, nursing professionals play a key role in the prevention, promotion, and treatment of substance use in their clinical practice at different levels of care in maternal and child health, including obstetric units. Faced with this problem, the World Health Organization recommends guidelines on universal screening for substance use based on comprehensive and individualized health care. In this sense, the Screening, Brief Intervention and Referral to Treatment (SBIRT) intervention model is a low-cost proposal implemented in some countries. The objective of this research aims to build a proposal for a nursing care protocol for the motivational approach of pregnant and postpartum women who are users of psychoactive substances in a general hospital. Quanto ao método, trata-se de um estudo metodológico, desenvolvido em duas etapas: revisão integrativa da literatura e a elaboração do protocolo assistencial. The integrative review aimed to identify the scientific evidence on the applicability and effectiveness of the SBIRT intervention model in pregnant and postpartum women and was conducted in five stages: problem formulation; data collection; data evaluation; analysis and interpretation of results and presentation of results. The textual production of the protocol was developed from the synthesis of scientific evidence obtained in the IR, scientific articles, textbooks, and national and international government guidelines on screening and brief intervention. The textual formatting of the protocol was adapted according to the institutional standards for protocol preparation of the Hospital de Clínicas de Porto Alegre (HCPA). To reach the results, the LILAC, PubMed, Web of Science and Scopus databases were used for data search and 352 articles were located. After exclusion criteria, they totalized 5 articles to integrate the IR. O produto gerado neste estudo foi a proposta de um Protocolo Assistencial de Enfermagem para a Abordagem Motivacional de gestantes e puérperas usuárias de substâncias psicoativas em hospital geral, pautado no modelo SBIRT. Despite the scarcity of studies, the findings showed that the basic principles of the SBIRT model can be used in assisting pregnant and postpartum women who use APS and made it possible to achieve the main objective of this study. Thus, it is believed that, once validated, the instrument may contribute to the qualification of nursing professionals' practice in the comprehensive care of this clientele, as well as contribute to the objectives of the HCPA's Institutional Alcohol and Drug Program, to the strengthening of research in the area and to the promotion of spaces for continuing education

Littlemonsters.com: análise da comunidade virtual de fãs da cantora Lady Gaga

Este trabalho tem como objetivo analisar o funcionamento da rede social voltada para fãs da cantora Lady Gaga, a partir de conceitos como Cultura da Convergência, Cibercultura e Comunidades Virtuais, relacionando tais conceitos com estudos sobre cultura de fãs, cultura participativa e fandoms. A escolha por um estudo de caso voltado à rede social da cantora Lady Gaga, littlemonsters.com, dá-se devido à popularidade da cantora, sua estreita relação com sua base de fãs, e, principalmente, pelo fato da sua rede social criada especialmente para sua fandom ser a primeira rede voltada para um único artista. Foram realizadas pesquisas com abordagens quantitativa e qualitativa a fim de se compreender a aceitação e a utilização dos usuários na rede, com a intenção de desvendar esse novo tipo de comunidade virtual. Os resultados deste trabalho, que consiste em uma pesquisa exploratória, poderão ser aplicados como base para futuros estudos sobre comunidades virtuais em âmbito de fãs, cultura de fãs na era digital e celebridades na cibercultura

A Region-Wide Field Placement Program Built on the Foundation of Mentorship and Professionalism

Background: The Region IV Public Health Training Center (R-IV PHTC) provides public health students from the eight states of HHS Region IV with essential practice experiences that demonstrate the value of working with underserved populations. The Pathways to Practice Scholars field placement program is built on a foundation of mentorship, professionalism, and community. Methods: Sixteen student scholars (13 graduate; 3 undergraduate) were selected to work during May-August 2015 in practiceoriented agencies serving underserved populations. Each scholar received a $1500 living allowance. Seven of 16 accepted an internship outside the state of their university. In conjunction with mentors, Scholars developed work plans based on Council on Linkages Core Competency domains. Requirements included a pre-, mid- and post-assessment, an executive summary/reflection, and a virtual webinar presentation. Results: Student Scholars worked at sites across eight states in state or local health departments, Area Health Education Centers (AHECs), and healthcare settings. Students identified Core Competency domains they developed most during the field placement: Communication, Analytical/Assessment, Leadership/Systems Thinking, and Community Engagement. The R-IV PHTC asked mentors to treat interns as valued employees and include them in activities beyond their specific project. Indicators of successful mentorship included expressed appreciation for student assistance and the desire to enrich the student experience while benefiting the agency mission. Mentors provided clearly defined projects for a short timeframe (10-12 weeks), adjusted to the students’ capacity and readiness, and offered opportunities to apply classroom skills to practice. They helped students develop immediately useful products in collaboration with community stakeholders. Conclusions: Mentors play a crucial role in the development and success of field placement students, but students and mentors share equal responsibility in fostering the relationship. Past case studies from this program demonstrate that some students find employment in these same agencies after graduation, and become mentors for future students, thus, creating a self-perpetuating learning community

Meeting the Public Health Workforce’s Training Priorities in Georgia and the Southeast

Background: The mission of the Region IV Public Health Training Center (R-IV PHTC) is to build knowledge and skills in the public health workforce in the eight states of HHS Region IV by providing competency-based training. Workforce training needs are changing quickly and dramatically in light of new developments in public health practice and science, emerging diseases, changes in the health care environment, and the growing emphasis on inter-professional practice. Additionally, a 2014 survey conducted by the Association of State and Territorial Health Officials (ASTHO) found that at least 38% of the current public health workforce plans to retire by 2020. Therefore, it is increasingly crucial to prepare upcoming managers for leadership positions and to train entry-level workers to assume more advanced roles. Methods: To address current and emerging training needs in Georgia and the southeast, the R-IV PHTC continually identifies emerging priorities and effective training approaches. It explores training needs through a review of formal needs assessments, key stakeholder interviews, surveys of targeted audiences, informal partner communications, and training evaluation data. An interactive component of the GPHA session allowed participants to identify and discuss their own professional training needs. Results: Workforce development needs assessments data across several southeastern states identified recurring training needs for professionals in Tiers 1, 2 and 3 of the Council on Linkages Core Competency domains for Analytical/Assessment Skills and Financial Planning/Management. In Georgia, top competency training needs gathered from a variety of assessment methods included Cultural Competency, Communication, Financial Planning/Management, Public Health Science, and Leadership/Systems Thinking. Participants in the workshop’s interactive component expressed highest personal need for training in Financial Planning/Management, Analytical/Assessment Skills, and Policy Development/Program Planning. However, for others in their organizations, they identified a priority need for leadership training. Conclusions: The R-IV PHTC assesses training needs and provides training resources to respond to current and emerging public health workforce development needs in Georgia and the southeast

Tree-Network Overrun Model Associated with Pilots’ Actions and Flight Operational Procedures

The runway excursions are defined as the exit of an aircraft from the surface of the runway. These excursions can take place at takeoff or at landing and consist of two types of events: veer off and overrun. This last one, which occurs when the aircraft exceeds the limits at the end of the runway, is the event of interest in the current study. This chapter aims to present an accident model with a new approach in aeronautical systems, based on the tasks of the pilots related to the operational procedures necessary for the approach and landing, in order to obtain the chain of events that lead to this type of accident. Thus, the tree-network overrun model (TNO model) was proposed, unlike most traditional models, which consider only the hardware failures or which do not satisfactorily explain the interrelationship between the factors influencing the operator. The proposed model is developed in a fault tree and transformed into a Bayesian network up to the level of the basic elements. The results showed the qualitative model of the main tasks performed by the pilots and their relation to the accident. It has also been suggested how to find and estimate the probability of factors that can impact on each of the tasks