A IMPORTÂNCIA DO FLUXOGRAMA PARA O TRABALHO DA SAÚDE DA FAMÍLIA NA VISÃO DO PROJETO PET-SAÚDE

O projeto Rede Cegonha, aderido por Santa Cruz do Sul no ano de 2012, visa auxiliar na integralidade do cuidado no âmbito da assistência no pré-natal, parto, puerpério e puericultura. Através do PET-Saúde, as bolsistas do curso de Enfermagem e Medicina estiveram inseridas na dinâmica da Estratégia de Saúde da Família (ESF) e puderam conhecer os fluxogramas de atendimento às gestantes e às crianças da unidade. O objetivo é conhecer os fluxogramas de acolhimento, de pré-natal e de puericultura preconizados pela Rede Cegonha e confeccionar os utilizados na ESF Menino Deus do município de Santa Cruz do Sul para analisar a sua importância na unidade como ferramenta que articula as ações da equipe. O estudo é descritivo de abordagem qualitativa e exploratória através da confecção e análise dos fluxogramas de atendimento no período de janeiro a setembro de 2013. Os fluxogramas de acolhimento, pré-natal e puericultura foram confeccionados a partir da rotina da ESF e, então, percebeu-se a sua importância para identificação dos nós-críticos da unidade. Os fluxogramas foram apresentados e discutidos em reunião multidisciplinar junto aos tutores, preceptores e bolsistas do PET com a busca de benefícios, melhorias e resolutividade, integrando o acadêmico como futuro profissional dentro do serviço

IMPACTO DAS ATIVIDADES DO PET-REDE CEGONHA NO ÍNDICE DE GESTAÇÕES DE UMA UNIDADE DE SAÚDE

Introducción: El planeamiento familiar representa un conjunto de acciones que auxilian la pareja que pretende tener hijos y también a quien prefiera adiar el crecimiento de la familia con anticoncepción. Objetivo: Evaluar el impacto de las actividades de planeamiento familiar del PET-Red Cigüeña en visitas domiciliarias y salas de espera. Metodología: Estudio transversal de naturaleza cuantitativa a través del análisis retrospectivo de las actividades del PET-Red Cigüeña en el periodo de enero de 2013 a enero de 2014, y contabilización del número de gestaciones de la unidad antes y después de las actividades del proyecto. Resultados/Conclusión: Había 47 gestantes en el comienzo de las actividades del PET-Red Cigüeña. Tras las actividades de visitas domiciliares a las mujeres y salas de espera con orientaciones sobre asuntos referentes a la gestación y planeamiento familiar, ese número cayó para 30 gestantes. Eso significa una reducción de 38% en el índice de gestaciones de la ESF Menino Deus.Introdução: O planejamento familiar representa um conjunto de ações que auxiliam o casal que pretende ter filhos e também quem prefere adiar o crescimento da família com anticoncepção. Objetivo: Avaliar o impacto das atividades de planejamento familiar do PET-Rede Cegonha em visitas domiciliares e salas de espera. Metodologia: Estudo transversal de natureza quantitativa através da análise retrospectiva das atividades do PET-Rede Cegonha, no período de janeiro de 2013 a janeiro de 2014, e contabilização do número de gestações da unidade antes e depois das atividades do projeto. Resultados/Conclusão: Havia 47 gestantes no início das atividades do PET-Rede Cegonha. Após as atividades de visitas domiciliares às mulheres e salas de espera com orientações sobre assuntos referentes à gestação e planejamento familiar esse número caiu para 30 gestantes. Isso significa uma redução de 38% no índice de gestações da ESF Menino Deus

Genetic Predictors of Antiretroviral Response and Toxicity

Since the emergence of the HIV epidemic it has been recognized that complications to HIV infection and variations in drug response and toxicity are influenced by patient genetics. Identification of genetic predictors of HIV infection complications and variation in drug response and toxicity will lead to better treatment options for patients and reduce HIV-related mortality and morbidity. This dissertation contains research that uses candidate gene and genome-wide approaches to identify and characterize novel genetic predictors of nevirapine pharmacokinetics, nucleoside reverse transcriptase inhibitor-induced peripheral neuropathy and HIV-induced peripheral neuropathy. This research demonstrates that nevirapine pharmacokinetic properties are heritable in European and African patients and characterizes the significant effects of CYP2B6 516G>T, CYP2B6 983T>C and ABCC10 rs2125739 on nevirapine Cmin concentrations in a Ugandan HIV+ population. It also highlights the importance of considering all three polymorphisms for prediction of nevirapine Cmin. This dissertation also explores the genetic predictors of NRTI-SN using whole genome and candidate gene approaches in a Ugandan HIV+ population. A polymorphism in VAMP4, rs188298690, was identified in the whole genome study and bioinformatic analyses found that this marker is in an active regulatory region and also a population specific eQTL locus. The candidate gene analysis found that polymorphisms in SLC28A1 and ABCC4 are predictive of the development of NRTI-SN. Finally, this dissertation describes research to identify genetic predictors of HIV-SN. Several polymorphisms in the FOLH1 region were identified in a whole genome study and bioinformatic analyses support a role for these polymorphisms in determining FOLH1 expression. Analysis of the top FOLH1 polymorphism in additional samples showed a trend towards significance and a meta-analysis of the discovery and replication cohorts had improved statistical significance. The research obtained in this dissertation increases the understanding of the role of genetic variation in determining antiviral pharmacokinetics and toxicity and in complications to HIV infection

Measuring the overall genetic component of nevirapine pharmacokinetics and the role of selected polymorphisms

ObjectiveNevirapine is an important component of highly active antiretroviral therapy used in the treatment of HIV infection. There is a considerable variation in the pharmacokinetics of nevirapine and this variation can impact the efficacy and toxicity of nevirapine. Although some of this variation can be attributed to environmental factors, the degree to which heritability influences nevirapine pharmacokinetics is unknown. This study aims to estimate how much variation in nevirapine pharmacokinetics is due to genetic factors and to investigate the contribution of selected polymorphisms to this variability.MethodsTwo doses of immediate-release nevirapine were administered to European (n=11) and African American (n=6) participants recruited from the Research in Access to Care in the Homeless cohort. A repeated drug administration method was then used to determine the relative genetic contribution (r(GC)) to variability in nevirapine AUC(0-6 h). Nevirapine plasma levels were quantified using LC/MS/MS. Patients were also genotyped for selected polymorphisms in candidate genes that may influence nevirapine pharmacokinetics.ResultsA significant r(GC) for nevirapine AUC(0-6 h) was found in Europeans (P=0.02) and African Americans (P=0.01). A trend toward higher nevirapine AUC(0-6 h) for the CYP2B6 516TT (rs3745274; Q172H) genotype was observed in European Americans (P=0.19).ConclusionThis study demonstrates that there is a significant genetic component to variability in nevirapine pharmacokinetics. Although genetic variants such as CYP2B6 polymorphisms attributed to some of this variation, these data suggest that there may be additional genetic factors that influence nevirapine pharmacokinetics

Measuring the overall genetic component of nevirapine pharmacokinetics and the role of selected polymorphisms: towards addressing the missing heritability in pharmacogenetic phenotypes?

ObjectiveNevirapine is an important component of highly active antiretroviral therapy used in the treatment of HIV infection. There is a considerable variation in the pharmacokinetics of nevirapine and this variation can impact the efficacy and toxicity of nevirapine. Although some of this variation can be attributed to environmental factors, the degree to which heritability influences nevirapine pharmacokinetics is unknown. This study aims to estimate how much variation in nevirapine pharmacokinetics is due to genetic factors and to investigate the contribution of selected polymorphisms to this variability.MethodsTwo doses of immediate-release nevirapine were administered to European (n=11) and African American (n=6) participants recruited from the Research in Access to Care in the Homeless cohort. A repeated drug administration method was then used to determine the relative genetic contribution (r(GC)) to variability in nevirapine AUC(0-6 h). Nevirapine plasma levels were quantified using LC/MS/MS. Patients were also genotyped for selected polymorphisms in candidate genes that may influence nevirapine pharmacokinetics.ResultsA significant r(GC) for nevirapine AUC(0-6 h) was found in Europeans (P=0.02) and African Americans (P=0.01). A trend toward higher nevirapine AUC(0-6 h) for the CYP2B6 516TT (rs3745274; Q172H) genotype was observed in European Americans (P=0.19).ConclusionThis study demonstrates that there is a significant genetic component to variability in nevirapine pharmacokinetics. Although genetic variants such as CYP2B6 polymorphisms attributed to some of this variation, these data suggest that there may be additional genetic factors that influence nevirapine pharmacokinetics