A PESQUISA EM ENFERMAGEM NO BRASIL: RETROSPECTIVA HISTÓRICA

O trabalho descreve os tipos e as linhas das pesquisas em enfermagem realizadas no Brasil entre as décadas de 50 a 80. Predominaram, nesse período, pesquisas sobre assistência, seguidas de pesquisas sobre educação. Conclui que as pesquisas estiveram voltadas, provavelmente, para as necessidades do momento histórico do País.Types and lines of nursing research in Brazil, from 1950 to 1980, are described. The majority of studies are on nursing care, followed by nursing education. The Author concludes that probably these studies were an answer to the needs of the country

A construção da identidade de diretores: discurso oficial e prática Construction of the identity of principals: official discourse and practice

Este estudo abordará a construção da identidade de diretores de escola sob dois enfoques: à luz do discurso oficial, por meio do estudo de documentos e legislações que definem seu "perfil", e por meio do discurso dos diretores, ao caracterizar sua atuação na prática cotidiana da escola. O pressuposto do estudo é o de que a identidade de diretores é o conjunto das representações colocadas em circulação tanto pelos discursos oficiais quanto pelos modos de ser e agir dos gestores de escola no exercício de suas funções. Um dos pontos de análise relaciona-se à contribuição da estrutura burocrática e centralizadora que permeia as instituições sociais no Brasil, na construção da identidade oficial estabelecida para os diretores de escola. A discussão da construção da identidade de diretores de escola tem importância na medida em que se insere nas expectativas sobre a atuação deles em diferentes momentos históricos.<br>This study discusses the identity construction of school's principals in two approaches: the public discourse present in the documents and laws that define their "profile" and the discourse of directors to characterize their performance in the every day schools practices. The assumption of the study is that the identity of principals is the set of representations put into circulation by both the official discourse about the ways of being and acting school managers in performing their duties. One aspect of analysis relates to the contribution of bureaucratic and centralized structure, which permeates the social institutions in Brazil in the construction of official identity established for school principals. The discussion of identity construction of school principals has its importance in that it falls in expectations about the performance of the same in different historical moments

10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1); a multicentre randomised trial

BACKGROUND: If carotid artery narrowing remains asymptomatic (ie, has caused no recent stroke or other neurological symptoms), successful carotid endarterectomy (CEA) reduces stroke incidence for some years. We assessed the long-term effects of successful CEA. METHODS: Between 1993 and 2003, 3120 asymptomatic patients from 126 centres in 30 countries were allocated equally, by blinded minimised randomisation, to immediate CEA (median delay 1 month, IQR 0·3-2·5) or to indefinite deferral of any carotid procedure, and were followed up until death or for a median among survivors of 9 years (IQR 6-11). The primary outcomes were perioperative mortality and morbidity (death or stroke within 30 days) and non-perioperative stroke. Kaplan-Meier percentages and logrank p values are from intention-to-treat analyses. This study is registered, number ISRCTN26156392. FINDINGS: 1560 patients were allocated immediate CEA versus 1560 allocated deferral of any carotid procedure. The proportions operated on while still asymptomatic were 89·7% versus 4·8% at 1 year (and 92·1%vs 16·5% at 5 years). Perioperative risk of stroke or death within 30 days was 3·0% (95% CI 2·4-3·9; 26 non-disabling strokes plus 34 disabling or fatal perioperative events in 1979 CEAs). Excluding perioperative events and non-stroke mortality, stroke risks (immediate vs deferred CEA) were 4·1% versus 10·0% at 5 years (gain 5·9%, 95% CI 4·0-7·8) and 10·8% versus 16·9% at 10 years (gain 6·1%, 2·7-9·4); ratio of stroke incidence rates 0·54, 95% CI 0·43-0·68, p<0·0001. 62 versus 104 had a disabling or fatal stroke, and 37 versus 84 others had a non-disabling stroke. Combining perioperative events and strokes, net risks were 6·9% versus 10·9% at 5 years (gain 4·1%, 2·0-6·2) and 13·4% versus 17·9% at 10 years (gain 4·6%, 1·2-7·9). Medication was similar in both groups; throughout the study, most were on antithrombotic and antihypertensive therapy. Net benefits were significant both for those on lipid-lowering therapy and for those not, and both for men and for women up to 75 years of age at entry (although not for older patients). INTERPRETATION: Successful CEA for asymptomatic patients younger than 75 years of age reduces 10-year stroke risks. Half this reduction is in disabling or fatal strokes. Net benefit in future patients will depend on their risks from unoperated carotid lesions (which will be reduced by medication), on future surgical risks (which might differ from those in trials), and on whether life expectancy exceeds 10 years. FUNDING: UK Medical Research Council, BUPA Foundation, Stroke Association