Educação permanente ou intermitente? explorando a realidade dos médicos da Atenção Primária de Campina Grande/PB

The objective of this work was to analyze the implementation of the National Policy on Permanent Education in Health (PNEPS) in Primary Health Care (APS) in the city of Campina Grande, Paraíba (PB). Therefore, the study was developed using two strategies. The first one was accomplished through an integrative review in the literature through researches in the SciELO databases, using the following Descriptors in Health Sciences (DeCS): Permanent education; Primary Health Care; Telehealth. In order to select the articles, the following criteria were established: articles in Portuguese, English or Spanish, with a restriction on national production, with a title related to PNEPS in APS, as of 2010 because in Brazil, PNEPS was started in 2004, updated in 2007 and revised in 2009. The second policy analysis strategy was based on the evaluation of its implementation in Campina Grande / PB through a questionnaire applied to the Family Health Strategy (ESF) physicians. Two articles were drafted and submitted to the Pan American Health Organization (PAHO) Journal. The first one followed the rules of an opinion article that concluded that the PNEPS implemented would be able to produce dialogue and cooperation between professionals, between services and between management, attention, training and social control, so that these areas could be strengthened and expanded the ability of everyone to tackle and solve problems with quality. It would also contribute to the team's analysis of their own relationships and their work process, which is traversed by diverse institutions. The second article showed that only 31% of the physicians in Campina Grande who work in the Family Health Strategy (ESF) knew the PNEPS, and only one had actually read the ordinance in question, although it presented difficulties for its use as all others . Similar to the national scenario, there is no support from local management, which may correspond to micropolitical issues, as well as questions related to the training of these professionals that are not exposed to the daily life of the PHC satisfactorily during graduation, which impairs the practice of a critical-reflexive attitude needed when acting in health.NenhumaO trabalho em questão teve como objetivo analisar a implementação da Política Nacional de Educação Permanente em Saúde (PNEPS) na Atenção Primária à Saúde (APS) na cidade de Campina Grande, na Paraíba (PB). Para tanto, o estudo foi desenvolvido utilizando-se duas estratégias. A primeira foi realizada por meio de uma revisão integrativa na literatura através de pesquisas nas bases de dados SciELO, utilizando os seguintes Descritores em Ciências da Saúde (DeCS): Educação permanente; Atenção Primária à Saúde; Telessaúde. Para seleção dos artigos foram estabelecidos os seguintes critérios: artigos em português, inglês ou espanhol, com restrição à produção nacional, com título relacionado à PNEPS na APS, a partir de 2010 porque, no Brasil, a PNEPS foi iniciada em 2004, atualizada em 2007 e revisada em 2009. A segunda estratégia de análise da política se deu por meio da avaliação de sua implementação em Campina Grande/PB através de um questionário aplicado aos médicos da Estratégia de Saúde da Família (ESF). Como resultados obtidos, foram redigidos dois artigos que foram submetidos à Revista da Organização Pan-Americana de Saúde (OPAS). O primeiro seguiu as regras de um artigo de opinião que concluiu que a PNEPS implementada seria capaz de produzir diálogo e cooperação entre os profissionais, entre os serviços e entre a gestão, atenção, formação e controle social, para que essas áreas se potencializassem e ampliassem a capacidade de todos para enfrentar e resolver problemas com qualidade. Também contribuiria para a análise da equipe a respeito de suas próprias relações e de seu processo de trabalho, que é atravessado por instituições diversas. O segundo artigo mostrou que apenas 31% dos médicos de Campina Grande que trabalham na Estratégia de Saúde da Família (ESF) conheciam a PNEPS, e apenas um tinha lido realmente a portaria em questão, apesar de apresentar dificuldades para sua utilização como todos os outros. Semelhante ao cenário nacional, não há apoio da gestão local, o que pode corresponder a questões micropolíticas, além de questões relacionadas à formação destes profissionais que não são expostos ao cotidiano da APS de modo satisfatório durante a graduação, o que prejudica a prática de uma atitude crítico-reflexiva necessária ao agir em saúde

Estudo da prevalência de doença autoimune da tireóide em portadoras de câncer de mama

Breast cancer is a hormone-dependent neoplasia. In addition to the fact that breast cancer and thyroid disease are more prevalent in the fifth and sixth decades of life, several studies also suggest an association between these two disorders. The aim of this study was to analyze the prevalence of thyroid disorders in patients with a positive biopsy for breast cancer prior to specific antitumor treatment. The frequency and pattern of thyroid disorders were evaluated in 112 patients with breast cancer (G1) and 125 control patients (G2) by analyzing serum thyroidstimulating hormone (TSH), anti-thyroid peroxidase (anti-TPO) antibodies and antithyroglobulin (anti-Tg) antibodies. In addition, the expression of estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptor 2 (HER2) was assessed in the breast biopsies by immunohistochemistry. The frequency of thyroid disorders, such as changes in TSH levels and/or the presence of positive thyroid antibodies, was not different between the two groups examined (30.4% in G1 and 28.0% in G2) (p=0.69). However, a family history of thyroid disease was more frequent in patients with breast cancer (50.5% in G1 and 28.2% in G2) (p=0.001). Regarding the clinical stage of breast cancer, there was no difference between women with autoimmune thyroiditis and those without thyroid dysfunction (p=0.316). Similarly, there were no differences in hormone receptor (estrogen and progesterone) and HER2 expression between patients who tested positive and negative for antithyroid antibodies (p=0.052 and p=0.549). The data obtained in this study did not reveal a higher frequency of autoimmune thyroid disease in patients with breast cancer compared to controls, and the prevalence of thyroid disorders was similarly elevated in both groups. However, a family history of thyroid disease was higher in those with cancer.Dissertação (Mestrado)Câncer de mama é uma neoplasia hormônio-dependente. Além do fato de existir uma maior prevalência de câncer de mama e doença tireoidiana na quinta e sexta décadas de vida, vários estudos sugerem uma associação entre estas duas desordens. O objetivo do presente estudo foi analisar a prevalência de desordens tireoidianas em pacientes com biópsia positiva para câncer de mama antes de qualquer tratamento antitumoral específico. Foram avaliadas, as frequências e o padrão das desordens tireoidianas em 112 pacientes portadoras de câncer de mama (G1) e 125 pacientes controles (G2), por meio da dosagem sérica de TSH, anticorpos anti-peroxidase (anti-TPO) e anticorpos anti-tireoglobulina (anti-Tg). Foram realizados ainda estudos da presença de receptores de estrógeno (ER) e progesterona (RP) e expressão do receptor HER2 através de imunohistoquímica nas biópsias de mama. A frequência de desordens tireoidianas como alteração dos níveis de TSH e/ou presença de anticorpos tireoidianos positivos não foi diferente nos dois grupos (30,4% no G1 e 28,0% no G2) (p=0,69). No entanto, a história familiar de doenças tireoidianas foi mais frequente nas pacientes portadoras de câncer de mama (50,5% no G1 e 28,2% no G2) (p=0,001). Quanto ao estadio clínico do câncer de mama, não houve diferença entre as portadoras de tireoidite autoimune e aquelas sem alteração tireoidiana (p=0,316). Também não houve diferença quanto à presença de receptores hormonais (estrógeno e progesterona) e expressão de HER2 entre aquelas que apresentavam anticorpos antitireoidianos positivos e negativos (p= 0,052 e p=0,549). Não foi possível demonstrar a maior frequência de Doença Autoimune de Tireóide em pacientes portadoras de câncer de mama comparadas aos controles embora a história familiar de doença tireoidiana tenha sido maior naquelas com câncer. A prevalência de desordens tireoidianas foi elevada nos dois grupos

Determination of amatoxins and phallotoxins in Amanita phalloides mushrooms from northeastern Portugal by HPLC-DAD-MS

Amanita phalloides is a toxic mushroom responsible for the majority of deaths occurring after mushrooms ingestion, mainly due to amatoxins. In the present study the contents and distribution of the major amatoxins and phallotoxins in different tissues of A. phalloides from two different sites of Portugal were analyzed by liquid chromatography (LC) coupled to diode array (DAD) and mass spectrometry (MS) detection. The main toxins were separated by LC and its chemical structures confirmed by MS. a-Amanitin contents in caps, stipe and volva tissues were quantified by RP-HPLC. The results show that caps have the highest content of amatoxins, whereas the volva was richest in phallotoxins. Moreover variability in the toxins composition from different geographic sites was also observed. This study provides for the first time the content of toxins in A. phalloides from Portugal.Authors are grateful to Dr Zélia dos Santos Azevedo, Faculty of Sciences, University of Porto, who loaned LC/DAD-ESI/MS and for all technical assistance. The authors also are grateful for the help of the Foundation for the Science and Technology (FCT, Portugal) for financial support and also thank FCT for doctoral grant SFRH/BD/74979/2010.info:eu-repo/semantics/publishedVersio

The efficacy of etodolac and ibuprofen, regarding gender, on pain, edema and trismus after impacted lower third molar surgery:a randomized prospective clinical split-mouth study

This study aimed to conduct a randomized prospective study about the efficacy of etodolac and ibuprofen on trismus, pain and edema regarding gender of patients submitted to impacted lower third molar teeth extraction. Thirty patients aging between 16 and 35 year-old were submitted to the exodontia of impacted lower third molars. During the postoperative period, patients received nine ibuprofen (600 mg) or etodolac (300 mg) pills via oral administration immediately after surgery and repeated doses every eight hours during three days. Patients were evaluated regarding pain, trismus and edema. Sixteen men and fourteen women participated of the study. No statistical difference was established regarding gender according to the evaluated parameters. However, etodolac use showed better results regarding pain, trismus and edema. Pain, edema and trismus after impacted third molars extraction were not influenced by gender

RAÇA/COR E INDICADORES DE SAÚDE SEXUAL E REPRODUTIVA: IDENTIFICANDO POSSÍVEIS DIFERENÇAS DE COMPORTAMENTO DAS MULHERES NO BRASIL EM 2006

Os diferenciais entre brancos e negros são perceptíveis em várias esferas da vida social, tais como a inclusão no sistema formal de educação, mercado de trabalho, até o acesso aos serviços de saúde. Esses diferenciais também estão presentes no acesso à saúde sexual e reprodutiva, com grande desvantagem para o grupo de mulheres negras. Este trabalho tem a finalidade descrever e analisar os diferenciais por raça/cor no acesso à saúde sexual e reprodutiva no Brasil em 2006. Foram utilizados os dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher do ano de 2006. Utilizou-se a análise descritiva, teste Qui-quadrado e modelagem estatística para averiguar associação entre as variáveis. Pode-se concluir que ainda hoje a variável raça/cor influencia o acesso à saúde sexual e reprodutiva. Em alguns indicadores esse efeito é atenuado quando controlado pela escolaridade das mulheres

Sexual health of adolescents according to the National Survey of School Health

O objetivo deste estudo foi descrever as situações relacionadas à saúde sexual dos adolescentes, segundo a Pesquisa Nacional de Saúde do Escolar (PeNSE). Trata-se de um estudo transversal, realizado pelo Instituto Brasileiro de Geografia e Estatística (IBGE) em parceria com o Ministério da Saúde, que envolveu 60.973 escolares e 1.453 escolas públicas e privadas. A análise dos dados aponta que 30,5% (IC95% 29,9-31,2) dos adolescentes já tiveram relação sexual alguma vez na vida, sendo mais frequente em meninos (43,7%; IC95% 42,7-44,7) do que em meninas (18,7%; IC95% 18,0-19,4), naqueles que estudam em escola pública (33,1%; IC95% 32,4-33,9), com idade acima de 15 anos (47,3%; IC95% 45,7-48,9) e aos 16 anos (63,5%; IC95% 61,5-65,4). A idade de iniciação sexual foi precoce e 40,1% dos adolescentes (IC95% 38,8-41,4) relataram ter tido um único parceiro na vida. O uso do preservativo na ultima relação sexual foi elevado tanto para proteção (75,9%; IC95% 74,8-76,9), como também para método contraceptivo na última relação sexual (74,7%; IC95% 73,6-75,7). Torna-se necessário enfatizar ações de promoção à saúde sexual voltadas aos adolescentes, visando minimizar vulnerabilidades.The objective of this study was to describe situations related to sexual health of adolescents, according to the National Survey of School Health (PeNSE). It is a cross-sectional study performed by the Brazilian Institute of Geography and Statistics (IBGE), in partnership with the Ministry of Health that involved 60,973 students and 1,453 public and private schools. Data analysis points out that 30.5% (95%CI 29.9-31.2) of the adolescents had already had sexual relations sometime in their lives, being more frequent for males (43.7%; 95%CI 42.7-44.7) than females (18.7%; 95%CI 18.0-19.4), especially those who go to public schools (33.1%; 95%CI 32.4-33.9), aged 15 years or older (47.3%; 95%CI 45.7-48.9) and 16 years (63.5%; 95%CI 61,5-65.4). The sexual initiation age was early and 40.1% (95%CI 38.8-41.4) reported having had only one partner in life. The use of condoms in the last sexual relation was high both for protective (75.9%; CI95% 74.8-76.9) and contraceptive methods (74.7%; 95%CI 73.6-75.7). It is necessary to emphasize actions for promoting sexual health towards adolescents in order to minimize vulnerabilities

Determination of the rotary fatigue life of NiTi alloy wires

Nickel-Titanium (NiTi) alloys with superelastic properties have been increasingly introduced as a substitute to more conventional alloys, such as stainless steel, in a variety of applications. In Dentistry, NiTi alloys are used in tools such as Endodontic rotary files, allowing the file to follow teeth root canals more easily than their stainless steel counterparts. Nevertheless, during surgery, the file is subjected to cyclic bending loading, since it is rotating while being deformed inside the curved canals and is prone to fracture due to fatigue, without showing any visible signals of degradation. Following a systematic approach, this work presents the results of rotary fatigue tests for several NiTi wires from different manufacturers (Memry and Euroflex). The formulation is presented, where the material strength reduction can be quantified from the determination of the strain and the number of cycles until failure. Experimental tests as well as numerical Finite Element Analysis (FEA) simulations are presented to better understand the fatigue fracture mechanisms present in NiTi alloys, showing that there is good agreement between the predicted strains (difficult to measure in such small wires) and the cycles to failure

Preemptive analgesia with ibuprofen increases anesthetic efficacy in children with severe molar hypomineralization: a triple-blind randomized clinical trial

Molar incisor hypomineralization (MIH) is often accompanied by dental hypersensitivity and difficulty in achieving effective analgesia. Objective:This study evaluated the effectiveness of preemptive analgesia in children with severe MIH, post-eruptive enamel breakdown, and hypersensitivity. Methodology: Ibuprofen (10 mg/kg child weight) or placebo was administered, followed by infiltrative anesthesia and restoration with resin composite. Hypersensitivity was evaluated in five moments. The data were analyzed using the chi-square test, Fisher’s exact test, and t-test. Results: Preemptive analgesia provided benefits for the treatment of severe cases of MIH, with an increase in the effectiveness of infiltrative anesthesia and improved patient comfort during the restorative procedure. Conclusion: Preemptive analgesia has shown efficacy in reducing hypersensitivity during restorative dental procedures, evidencing the significance of this study for patients with MIH and hypersensitivity

Preemptive analgesia with ibuprofen increases anesthetic efficacy in children with severe molar:a triple-blind randomized clinical trial

Molar incisor hypomineralization (MIH) is often accompanied by dental hypersensitivity and difficulty in achieving effective analgesia. OBJECTIVE: This study evaluated the effectiveness of preemptive analgesia in children with severe MIH, post-eruptive enamel breakdown, and hypersensitivity. METHODOLOGY: Ibuprofen (10 mg/kg child weight) or placebo was administered, followed by infiltrative anesthesia and restoration with resin composite. Hypersensitivity was evaluated in five moments. The data were analyzed using the chi-square test, Fisher’s exact test, and t-test. RESULTS: Preemptive analgesia provided benefits for the treatment of severe cases of MIH, with an increase in the effectiveness of infiltrative anesthesia and improved patient comfort during the restorative procedure. CONCLUSION: Preemptive analgesia has shown efficacy in reducing hypersensitivity during restorative dental procedures, evidencing the significance of this study for patients with MIH and hypersensitivity