Psicologia na atenção primária à saúde: reflexões e implicações práticas

The inclusion of Psychology in the primary health care has been a subject under discussion with proposals of change in the recent decades. This study aimed to characterize psychological practices in the primary health care in Ribeirão Preto-SP, Brazil and verify whether proposals to change practices were incorporated. Five psychologists working in this context were interviewed. Collected data were analyzed through the Social Health Psychology perspective. Results revealed that the professionals did not have specific undergraduate or graduate education in public health. The psychological practices were restricted to consultations at a secondary care level focused on children and adolescents with emotional and behavioral problems. We consider mandatory the inclusion of public health topics in undergraduate programs as well as the promotion of continuous education as a strategy to reorganize psychological services.La inclusión de la Psicología en la atención primaria de salud ha sido objeto de debates y propuestas de cambios en las últimas dos décadas. Este estudio tuvo el objetivo de caracterizar las prácticas psicológicas desarrolladas en Ribeirão Preto-SP, Brasil e identificar si las medidas de actuación propuestas fueron incorporadas al área de atención primaria. Cinco psicólogas que trabajaban en este contexto fueron entrevistadas. Los datos obtenidos fueron analizados bajo la perspectiva de la Psicología Social de la Salud. Los resultados mostraron que los profesionales no tuvieron formación específica en salud pública, durante los estudios de grado o de postgrado. Las prácticas psicológicas se limitaban a cuidados en el nivel secundario, dirigidos a niños y adolescentes con problemas emocionales y comportamentales. Consideramos urgente incluir contenidos referentes a salud pública en la formación de grado así como la efectiva educación permanente como estrategia de reorganización de la asistencia psicológicas.A inserção da Psicologia na atenção primária à saúde tem sido alvo de discussões com propostas de mudanças, nas últimas duas décadas. Esta pesquisa teve como objetivo caracterizar as práticas psicológicas desenvolvidas neste contexto em Ribeirão Preto-SP e identificar se as propostas de atuação nesta área foram incorporadas. Cinco psicólogas que trabalhavam neste contexto foram entrevistadas. Os dados obtidos foram analisados sob a perspectiva da Psicologia Social da Saúde. Os resultados mostraram que as profissionais não tiveram formação específica em saúde pública, seja na graduação ou na pós-graduação. As práticas psicológicas se restringiram aos atendimentos em nível secundário dirigidos às crianças e aos adolescentes com problemas emocionais e comportamentais. Consideramos premente a incorporação de conteúdos de saúde pública nos currículos de graduação e a efetivação da educação permanente nos serviços, como estratégia de reorganização dos serviços de psicologia

Facial paralysis associated with acute otitis media

Acute otitis media with facial paralysis is not a very frequent association. AIM: the goal of the present investigation was to asses the evolution of facial paralysis caused by acute otitis media. STUDY FORMAT: clinical-retrospective. MATERIALS AND METHODS: we studied 40 patients with this association, from a total of 2758 cases of facial paralysis seen during this time in the department of facial nerve disorders. All the patients were clinically assessed and had epidemiological data, prognostics and evolution. RESULTS AND CONCLUSION: the paralysis was of sudden onset in 95% of the cases. Recovery was of 85% for grade I (House-Brackman) and 15% for grade II (House-Brackman). Treatment was clinical, with antibiotics and steroids - yielding good results. In those patients with electrical bad prognosis, facial nerve decompression turned their evolution into a favorable one.A otite média aguda com paralisia facial não é uma associação muito freqüente. OBJETIVO: O objetivo deste trabalho foi avaliar a evolução da paralisia facial decorrente de otite média aguda. FORMA DE ESTUDO: Clínico retrospectivo. MATERIAL E MÉTODO: Foram estudados 40 pacientes com esta associação de patologias, num total de 2758 casos de paralisa facial atendidos neste período no setor de distúrbios do nervo facial. Todos os pacientes foram avaliados clinicamente com dados epidemiológicos, prognósticos e evolutivos. RESULTADOS E CONCLUSÃO: A paralisia foi súbita em 95% dos casos. A recuperação foi de 85% para o grau I (House-Brackman) e 15% para o grau II (House-Brackman). O tratamento foi clínico com antibiótico e corticoterapia com bons resultados. Nos pacientes com mau prognóstico elétrico a descompressão do nervo facial fez com que a evolução fosse favorável.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESP, EPM, Depto. de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoSciEL

Tuberculose no Brasil - peritonite tuberculosa, contextualização, propedêutica e tratamentos

A tuberculose é uma doença grave que cresce no Brasil. A peritonite tuberculosa é uma manifestação infrequente que afeta o peritônio, a membrana que reveste a cavidade abdominal e, ou, os órgãos abdominais. O diagnóstico muitas vezes inconclusivo, pede propedêutica minuciosa para um tratamento assertivo. Objetivou-se realizar abordagem da ocorrência da Tuberculose no Brasil, pelo Datasus, dos indivíduos diagnosticados nas diferentes Regiões brasileira e realizar uma Revisão, nas bases de dados do PubMed, Medline, Lillacs e Scielo, sobre a peritonite tuberculosa abordando a propedêutica e tratamento utilizados. Muitos são os fatores que contribuem para que no Brasil, ainda haja alta incidência de casos de tuberculose e grande diferença de ocorrência entre as regiões brasileiras. Entre elas as diferenças geográficas, sociais e ecológicas, colocam a população em diferentes níveis de perigo pois, muitas vezes, isso pode determinar os diferentes tipos de contato que elas terão com o microorganismo causador da doença. A Região Sudeste, teve o maior número de notificações para tuberculose, em seguida vieram as regiões: Nordeste, Norte, Sul e Centro-Oeste. Quanto a revisão dos artigos, tem-se que o uso dos medicamentos para controle da Mycobacteriun sp empregada no Brasil e no mundo inteiro: Rifampacina, Isoniazida; Pirazinamida; Etambutol, chamada de terapia combinada. Novos estudos devem ser realizados para que se possa cada vez mais, ampliar a condição de rapidez na condução do diagnóstico para peritonite utilizando uma propedêutica que conduza ao tratamento cada vez mais, assertivo

Histopathological evaluation of coronary thrombi in patients with ST-segment elevation myocardial infarction

ABSTRACTBackgroundPrimary percutaneous coronary intervention (primary PCI) is the preferred reperfusion method in patients with ST-segment elevation myocardial infarction (STEMI). Manual aspiration thrombectomy has been increasingly used and enables the analysis of thrombus aspirates.MethodsConsecutive patients undergoing primary PCI were enrolled from December 2009 to June 2011. Clinical, laboratory and angiographic data were prospectively collected and entered in a dedicated database. The decision to perform thromboaspiration was left to the discretion of the operators. One hundred and twelve samples of thrombi were collected, stored in 10% formalin-fixed paraffin, stained with hematoxylin-eosin and analyzed by light microscopy. On histopathological evaluation, the thrombi were classified as recent thrombi or lysed/organized thrombi.ResultsRecent thrombi were identified in 68 patients (61%) and lysed/organized thrombi in 44 patients (39%). Patients with recent thrombi had higher red blood cell infiltration (P=0.03). There were no other statistically significant differences identified for clinical, angiographic, laboratory or clinical outcomes between the two study groups.ConclusionsIn patients with STEMI undergoing primary PCI, two-thirds of thrombus aspirates showed histopathological features of recent thrombi. There were no significant associations between these characteristics and clinical, laboratory and angiographic data in this contemporary sample representative of the real world

Effect of propolis gel on the in vitro reduction of dentin permeability

OBJECTIVE: The aim of this study was to evaluate the capacity of potassium oxalate, fluoride gel and two kinds of propolis gel to reduce the hydraulic conductance of dentin, in vitro. MATERIAL AND METHODS: The methodology used for the measurement of hydraulic conductance of dentin in the present study was based on a model proposed in literature. Thirty-six 1-mm-thick dentin discs, obtained from extracted human third molars were divided into 4 groups (n=9). The groups corresponded to the following experimental materials: GI-10% propolis gel, pH 4.1; GII-30% propolis gel; GIII-3% potassium oxalate gel, pH 4,1; and GIV-1.23% fluoride gel, pH 4.1, applied to the dentin under the following surface conditions: after 37% phosphoric acid and before 6% citric acid application. The occluding capacity of the dentin tubules was evaluated using scanning electron microscopy (SEM) at ×500, ×1,000 and ×2,000 magnifications. Data were analyzed statistically by two-way ANOVA and Tukey's test at 5% significance level. RESULTS: Groups I, II, III, IV did not differ significantly from the others in any conditions by reducing in hydraulic conductance. The active agents reduced dentin permeability; however they produced the smallest reduction in hydraulic conductance when compared to the presence of smear layer (P<0.05). The effectiveness in reducing dentin permeability did not differ significantly from 10% or 30% propolis gels. SEM micrographs revealed that dentin tubules were partially occluded after treatment with propolis. CONCLUSIONS: Under the conditions of this study, the application of 10% and 30% propolis gels did not seem to reduce the hydraulic conductance of dentin in vitro, but it showed capacity of partially obliterating the dentin tubules. Propolis is used in the treatment of different oral problems without causing significant great collateral effects, and can be a good option in the treatment of patients with dentin sensitivity

Establishing an online resource to facilitate global collaboration and inclusion of underrepresented populations:Experience from the MJFF Global Genetic Parkinson's Disease Project

Parkinson's disease (PD) is the fastest-growing neurodegenerative disorder, currently affecting ~7 million people worldwide. PD is clinically and genetically heterogeneous, with at least 10% of all cases explained by a monogenic cause or strong genetic risk factor. However, the vast majority of our present data on monogenic PD is based on the investigation of patients of European White ancestry, leaving a large knowledge gap on monogenic PD in underrepresented populations. Gene-targeted therapies are being developed at a fast pace and have started entering clinical trials. In light of these developments, building a global network of centers working on monogenic PD, fostering collaborative research, and establishing a clinical trial-ready cohort is imperative. Based on a systematic review of the English literature on monogenic PD and a successful team science approach, we have built up a network of 59 sites worldwide and have collected information on the availability of data, biomaterials, and facilities. To enable access to this resource and to foster collaboration across centers, as well as between academia and industry, we have developed an interactive map and online tool allowing for a quick overview of available resources, along with an option to filter for specific items of interest. This initiative is currently being merged with the Global Parkinson's Genetics Program (GP2), which will attract additional centers with a focus on underrepresented sites. This growing resource and tool will facilitate collaborative research and impact the development and testing of new therapies for monogenic and potentially for idiopathic PD patients.</p

The IASLC Early Lung Imaging Confederation (ELIC) Open-Source Deep Learning and Quantitative Measurement Initiative.

BackgroundWith global adoption of CT lung cancer screening, there is increasing interest to use artificial intelligence (AI) deep learning methods to improve the clinical management process. To enable AI research using an open source, cloud-based, globally distributed, screening CT imaging dataset and computational environment that are compliant with the most stringent international privacy regulations that also protects the intellectual properties of researchers, the International Association of the Study of Lung Cancer (IASLC) sponsored development of the Early Lung Imaging Confederation (ELIC) resource in 2018. The objective of this report is to describe the updated capabilities of ELIC and illustrate how this resource can be utilized for clinically relevant AI research.MethodsIn this second Phase of the initiative, metadata and screening CT scans from two time points were collected from 100 screening participants in seven countries. An automated deep learning AI lung segmentation algorithm, automated quantitative emphysema metrics, and a quantitative lung nodule volume measurement algorithm were run on these scans.ResultsA total of 1,394 CTs were collected from 697 participants. The LAV950 quantitative emphysema metric was found to be potentially useful in distinguishing lung cancer from benign cases using a combined slice thickness ≥ 2.5 mm. Lung nodule volume change measurements had better sensitivity and specificity for classifying malignant from benign lung nodules when applied to solid lung nodules from high quality CT scans.ConclusionThese initial experiments demonstrated that ELIC can support deep learning AI and quantitative imaging analyses on diverse and globally distributed cloud-based datasets