Melhoria da Atenção à Saúde de Pessoas Idosas na USF Walter Gomes Portela, Caroebe/RR

Resumo BARRETO CASTRO, YENIEL. Melhoria da atenção à saúde de pessoas idosas na Unidade de Saúde da Família Walter Gomes Portela, Caroebe/RR. Ano 2015. Trabalho de Conclusão de Curso (Curso de Especialização em Saúde da Família) - Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, Ano 2015. Para que mais pessoas alcancem o envelhecimento com melhor qualidade de vida a Atenção Primária à Saúde tem um papel fundamental, especialmente no que se refere a uma atenção contínua, integral e de qualidade à pessoa idosa. As especificidades deste ciclo de vida – tais como os transtornos na comunicação pela diminuição das capacidades sensório-perceptivas, aumento de necessidades pessoais e sociais demandam acompanhamento diferenciado. A Unidade de Saúde da Família Walter Gomes Portela, Caroebe, Roraima, lida com este desafio. Antes da intervenção, a unidade de saúde não fazia o acompanhamento a este público de forma organizada e sistematizada. Priorizava-se o atendimento aos hipertensos e diabéticos da área. Neste contexto, o trabalho relata a experiência de uma intervenção para melhoria da atenção à saúde da pessoa idosa na Unidade de Saúde, bem como os resultados desta intervenção. As ações deste projeto foram estruturadas em quatro eixos, quais sejam: monitoramento e avaliação; organização e gestão do serviço, engajamento público e qualificação da prática clínica. As atividades foram realizadas por todos os profissionais da equipe de Saúde da Família. Durante um período de dezesseis semanas. A partir da intervenção foi possível: ampliar a cobertura do Programa de Saúde do Idoso, melhorar a qualidade da atenção ao idoso na Unidade de Saúde, a adesão dos idosos às consultas programadas, o registro das informações sobre a atenção ao idoso na Unidade de Saúde utilizando ferramentas como planinha de coleta de dados e fichas-espelhos, mapear os riscos dos idosos e promover a saúde dos idosos na área de abrangência da Unidade de Saúde. Assim, cumpriram-se objetivos e metas propostos, tais como o alcance de 100% da população idosa da área cadastrada e avaliada (155) através da busca ativa dos agentes comunitários nas microareas e visitas domiciliares. A intervenção exigiu que a equipe se capacitasse para seguir as recomendações através do protocolo ou manual técnico (Cadernos de atenção básica, envelhecimento e saúde da pessoa idosa, Brasília, 2006). Além destes aspectos foi possível melhorar o processo de trabalho em equipe a partir da valorização da reunião de equipe, educação permanente e valorização das visitas domiciliares que já eram realizadas pelos agentes comunitários de saúde. Além disso, os usuários demonstram satisfação com o programa e foi possível contar uma boa aceitação pela população. A intervenção foi incorporada à rotina do serviço como continuidade desta ação programática no dia a dia de trabalho. Palavras-chave: Atenção Primária à Saúde; Saúde da Família; Saúde do Idoso; Assistência Domiciliar

Is there a relationship between age and side dominance of tubal ectopic pregnancies? – A preliminary report

Objectives: To determine whether there exists a relationship between age and side dominance of tubal ectopic pregnancies. Material and Methods: One hundred twenty patients were retrospectively analyzed. The sides of the tubal ectopic pregnancies were recorded on the basis of laparoscopy or laparotomy findings. Five age groups were created: 20-24, 25-29, 30-34, 35-39, and ≥40 years. Results: Of the patients who were ≥ 30 years of age, 46 (69%) and 21 (31%) had tubal ectopic pregnancies on the right and left sides, respectively (p=0.002). In the 35-39 years of age group, 17 of 20 patients (85%) had tubal ectopic pregnancies on the right, and 3 of 20 patients (15%) on the left side (p=0.002). In the 30-34 years of age group, 26 of 39 patients (67%) and 13 of 39 patients (33%) had tubal ectopic pregnancies on the right and left sides, respectively (p=0.037). In the ≥ 40 years of age group, 3 of 8 patients (37%) had tubal ectopic pregnancy on the right side, while 5 patients (63%) on the left side (p=0.48). Conclusions: Patients who are between the age of 30-40 years have a right-sided dominance of tubal ectopic pregnancy, however studies that involve larger numbers of subjects are needed to make definitive conclusions about women older than 40 years of age

Ocena łożyska całkowicie przodującego przy pomocy rezonansu magnetycznego i ultrasonografii w celu wykrycia łożyska wrośniętego i jego wariantów

Objective: To evaluate the importance of ultrasonography (US) and magnetic resonance imaging (MRI) in detecting placental adherence defects. Material and methods: Patients diagnozed with total placenta previa (n=40) in whom hysterectomy was performed due to placental adherence defects (n=20) or in whom the placenta detached spontaneously after a Cesarean delivery (n=20) were included into the study between June 2008 and January 2011, at the Department of Obstetrics and Gynecology, Ege University (Izmir, Turkey). Gray-scale US was used to check for any placental lacunae, sub-placental sonolucent spaces or a placental mass invading the vesicouterine plane and bladder. Intra-placental lacunar turbulent blood flow and an increase in vascularization in the vesicouterine plane were evaluated with color Doppler mode. Subsequently, all patients had MRI and the results were compared with the histopathologic examinations. Results: The sensitivity of MRI for diagnosis of placental adherence defects before the operation was 95%, with a specificity of 95%. In the presence of at least one diagnostic criterion, the sensitivity and specificity of US were 87.5% and 100% respectively, while the sensitivity of color Doppler US was 62.5% with a specificity of 100%. Conclusions: Currently, MRI appears to be the gold standard for the diagnosis of placenta accreta. None of the ultrasonographic criteria is solely sufficient to diagnose placental adherence defects, however, they assist in the diagnostic process.Cel pracy: Celem pracy była ocena przydatności ultrasonografii (US) i rezonansu magnetycznego (MRI) w wykrywaniu nieprawidłowości implantacji łożyska. Materiał i metoda: Do badania włączono pacjentki, które leczone były w Klinice Położnictwa i Ginekologii na Uniwersytecie Ege w Izmirze (Turcja), w okresie od czerwca 2008 do stycznia 2011, z powodu łożyska całkowicie przodującego (n=40). U 20 pacjentek wykonano histerektomię z powodu trudności w oddzieleniu łożyska a u 20 łożysko oddzieliło się samoistnie w trakcie cięcia cesarskiego. Zastosowano skalę Graya do oceny lakun w łożysku, wolnych przestrzeni pod płytą łożyska oraz masy łożyskowej naciekającej płaszczyznę pęcherzowo-maciczną oraz pęcherz moczowy. W badaniu USG z kolorowym Dopplerem oceniano turbulentny przepływ krwi w lakunach wewnątrzłożyskowych oraz wzrost unaczynienia w płaszczyźnie pęcherzowo-macicznej. Następnie wszystkie pacjentki miały wykonane badanie MRI a wyniki porównano z oceną histopatologiczną. Wyniki: Czułość badania MRI dla rozpoznania nieprawidłowości implantacji łożyska przed operacją wyniosła 95% a specyficzność również 95%. Przy obecnym przynajmniej jednym kryterium diagnostycznym, czułość i specyficzność badania USG wyniosły odpowiednio 87,5% i 100%, podczas gdy czułość kolorowego Dopplera wyniosła 62,5% a specyficzność 100%. Wnioski: Obecnie badanie MRI jest złotym standardem wykrywania łożyska wrośniętego. Żadne z ultrasonograficznych kryteriów nie jest wystarczające do rozpoznania nieprawidłowości implantacji łożyska, aczkolwiek pełnią funkcję pomocniczą w procesie diagnostycznym

Kombinacja wewnątrzczaszkowej przezierności i ultrasonografii 3D w diagnostyce wad cewy nerwowej w pierwszym trymestrze ciąży: opis przypadku i przegląd literatury

Neural tube defects are congenital defects of the central nervous system caused by lack of neural tube closure. First trimester screening for aneuploidy has become widespread in the recent years. Fetal intracranial translucency (IT) can be easily observed in normal fetuses in the mid-sagittal plane. The absence of IT should be an important factor taken into consideration in the early diagnosis of open spinal defects. 3D ultrasonography is especially useful in cases of spinal anomalies where the visualization of the fetal structure is insufficient due to fetal position. We present a combination of intracranial translucency and 3D sonography used in the first trimester diagnosis of a neural tube defect case.Wady cewy nerwowej są wrodzonymi defektami centralnego układu nerwowego spowodowanymi brakiem zamknięcia cewy nerwowej. Badania skriningowe w pierwszym trymestrze w kierunku aneuploidii stały się w ostatnich latach bardzo rozpowszechnione. Płodowa przezierność wewnątrzczaszkowa może być oceniona w prawidłowych płodach w płaszczyźnie pośrodkowej. Brak przezierności wewnątrzczaszkowej (IT) powinien być istotnym czynnikiem ryzyka branym pod uwagę we wczesnej diagnostyce otwartych wad cewy nerwowej. Ultrasonografia 3D jest szczególnie przydatna w przypadkach gdy uwidocznienie struktur płodu jest niewystarczające z uwagi na pozycję płodu. Przedstawiamy kombinację przezierności wewnątrzczaszkowej i ultrasonografii 3D w diagnostyce wad cewy nerwowej w pierwszym trymetrze ciąży

Comparative study between Latin America Geoparks and Sites of Geological Interest: a view from geotourism

El uso del patrimonio geológico está siendo utilizado para el desarrollo de modalidades turísticas amigables con el medio natural. Este trabajo tiene como objetivo comparar la situación de los geoparques latinoamericanos (Araripe, Grutas del Palacio, Mixteca Alta, Comarca Minera, Colca y Volcanes de Andagua, Kütralkura, Imbabura, así como, Río Coco) con algunos sitios de interés geológico relevantes (Cuevas de Nerja, Parque Nacional del Gran Cañón, Cueva Mammoth y Calzada de los Gigantes). La modalidad que se aborda es el geoturismo, definiendose seis variables para el estudio a través del Método de Expertos (año, extensión, país, tipologías de actividades, turistas anuales e ingresos por concepto de actividades turísticas). La investigación concluye que la situación de los geoparques de América Latina respecto a los sitios de interés geológico, desde la perspectiva del desarrollo del geoturismo, no resulta la más satisfactoria, por lo que se deben de aprovechar las experiencias positivas en esta vertiente y adecuarlas a las condiciones de cada país, en aras de contribuir a la conservación del patrimonio geológico, geomorfológico y cultural. El presente estudio forma parte de los resultados de un proyecto de investigación, por lo que se debe dar continuidad al mismo, presentado alternativas viables de desarrollo a la Junta Directiva del Geoparque Imbabura.The use of geological heritage is being used for the development of environmentally friendly tourism modalities. This work aims to compare the situation of Latin American geoparks (Araripe, Grutas del Palacio, Mixteca Alta, Comarca Minera, Colca and Volcanes de Andagua, Kütralkura, Imbabura, as well as Río Coco) with some relevant geological sites (Cuevas from Nerja, Grand Canyon National Park, Mammoth Cave and Giant's Causeway). The modality that is approached is geotourism. Six variables were defined for the study through the Expert Method (year, extension, country, types of activities, annual tourists and income from tourist activities). The research concludes that the situationof the geoparks of Latin America, with respect to the sites of geological interest, from geotourism, is not the most satisfactory, so positive experiences in this area should be taken advantage of and adapted to the conditions of each country, in order to contribute to the conservation of the geological, geomorphological and cultural heritage. This study is part of the results of a research project, so it should be continued, presenting viable development alternatives to the Imbabura Geopark Board of Directors

Dry selection and wet evaluation for the rational discovery of new anthelmintics

Helminths infections remain a major problem in medical and public health. In this report, atom-based 2D bilinear indices, a TOMOCOMD-CARDD (QuBiLs-MAS module) molecular descriptor family and linear discriminant analysis (LDA) were used to find models that differentiate among anthelmintic and non-anthelmintic compounds. Two classification models obtained by using non-stochastic and stochastic 2D bilinear indices, classified correctly 86.64% and 84.66%, respectively, in the training set. Equation 1(2) correctly classified 141(135) out of 165 [85.45%(81.82%)] compounds in external validation set. Another LDA models were performed in order to get the most likely mechanism of action of anthelmintics. The model shows an accuracy of 86.84% in the training set and 94.44% in the external prediction set. Finally, we carry out an experiment to predict the biological profile of our ‘in-house’ collections of indole, indazole, quinoxaline and cinnoline derivatives (∼200 compounds). Subsequently, we selected a group of nine of the theoretically most active structures. Then, these chemicals were tested in an invitro assay and one good candidate (VA5-5c) as fasciolicide compound (100% of reduction at concentrations of 50 and 10 mg/L) was discovered.Yovani Marrero-Ponce acknowledges the support from USFQ with partial finance of project ID5455Peer Reviewe

Sexuality throughout all the stages of pregnancy: experiences of expectant mothers

Objective: To explore and understand the sexual experiences of expectant mothers during their pregnancy. Methods: The study was carried out in two healthcare centers in the Almería Health District, in southern Spain. The participants included pregnant women who received prenatal care and/or maternity education. The inclusion criteria were being pregnant, maintaining sexual activity and agreeing to participate in the study. The exclusion criteria were having limitations on sexual activity by medical prescription. The sample consisted of 15 expectant women selected using a convenience sample, of which 5 took part in a focus group (FG) and 10 in in-depth interviews (IDI). Data was collected between the months of June and December 2016. Participants were contacted by the main researcher and an appointment was made to carry out the FGs or the IDIs. Results: Three main categories emerged: False beliefs and a holistic approach to sexuality during pregnancy, which is related to the concept of sexuality, false beliefs, and limited sexual counseling during pregnancy. Limitations: From fear at the beginning to physical diffi culty at the end, referring to the fluctuations in sexual desire as well as the physical changes that limit sexual activity. Adapting to changes: safe practices and satisfaction with one’s body image, which encompasses concerns about the risks and the relationship between body image and self-esteem. Conclusion: A lack of sexual counseling during pregnancy leads to the creation of false beliefs, which, together with physical changes, concerns about the risk, and fl uctuations in sexual desire and interest, bring about a decrease in sexual activity. But sexuality remains an important aspect of pregnancy, toward which the participants must adopt a broader approach, not limited to intercourse, and adopt sexual practices that are adapted to the physical and emotional changes that happen during this time

An investigation on the effect of elective math applications lessons on students' math literacy level and their math attitude and views of teachers

Bu araştırma, 2012-2013 eğitim öğretim yılında ortaokullarda seçmeli olarak okutulmaya başlanan matematik uygulamaları dersinin öğrencilerin matematik okuryazarlık düzeylerine ve matematiğe yönelik tutumlarına etkisini ölçmeyi ve dersin öğretmenlerinden görüş alınarak, dersin uygulama süreci hakkında bilgi almayı amaçlamıştır. Çalışmada ön test- son test tek grup deneysel desen ile nitel araştırma yöntemi kullanılmıştır. Bu bakımdan açıklayıcı yaklaşım işe koşulmuştur. 8 hafta süren çalışmada matematik okuryazarlık testi ve tutum ölçeği kullanılmıştır. Öğrencilere hazırlanan matematik okuryazarlık testi ve tutum ölçeği uygulamanın başında ön test olarak verilmiştir. Uygulama sonunda kullanılacak olan matematik okuryazarlık testiyle dersin öğrencilerin okuryazarlık seviyeleri üzerindeki etkisi, tutum ölçeğiyle de derse yönelik tutumları belirlenmiştir. Tutum ölçeğindeki ön test –son test puanları arasındaki farkla tutum puanları belirlenmiştir. Matematik okuryazarlık testinden öğrencilerin aldıkları ön test- son test puanları arasındaki farka bakılmıştır. Nitel kısımda ise matematik öğretmenlerinden görüş alınmıştır. Ön test-son test verileri arasında anlamlı bir fark olup olmadığına ilişkin bağımlı örneklemler t Testi kullanılmıştır. Karşılaştırma yaparken 0.05 anlamlılık düzeyi dikkate alınmıştır. Nitel verilerin analizinde ise betimsel analiz tekniği kullanılmıştır. Araştırmada elde edilen bulgulara göre, öğrencilerin matematik okuryazarlık testinden aldıkları ön test ve son test puanları arasında son test lehine anlamlı bir fark görülmüştür. Seçmeli matematik uygulamaları dersinin öğrencilerin matematik okuryazarlıklarını pozitif yönde etkilediği gözlemlenmiştir. Öğrencilerin matematiğe yönelik tutum ölçeğinden aldıkları ön test ve son test puanları arasında son test lehine anlamlı bir fark görülmüştür. Seçmeli matematik uygulamaları dersinin öğrencilerin matematiğe yönelik tutumları pozitif yönde etkilediği gözlemlenmiştir. Araştırma sonunda uygulamaya ve araştırmalara yönelik önerilerde bulunulmuştur.This study aims to evaluate effect of mathematics practice courses which were started to be taught in secondary school in 2012-2013 academic year on students' attitudes towards mathematics literacy levels and mathematics. It also aims to get information about course practice process by taking instructor's opinion. In this study, pre-test post-test, single-group experimental design and qualitative research method were used. Therefore, explanatory approach was put to use. In the 8-week study, mathematics literacy scale and attitude scale were used and mathematics literacy scale was given students as pre-test and post-test. The mathematics literacy scale to be used at the end of the practice and courses on the students' literacy levels and attitudes towards the courses with attitude scale were determined. Attitude scores were defined with the difference between the pre-test and post-test scores in the attitude scale. The difference between pre-test and post-test scores of students was examined from mathematics literacy scale. In the qualitative part, opinions were taken from the instructors. Paired student t-test was used to find out if there is a significant difference between pre-test and post-test. When comparing, the significance level of 0.05 was taken into consideration. In the analysis of qualitative data, descriptive analysis technique was used. According to the findings obtained in the study, there was a significant difference between the pre-test and post-test scores obtained from mathematics literacy scale. It has been observed that elective mathematics practice has a positive effect on students' mathematics literacy. There was a significant difference between the pre-test and post-test scores of the students. It has been observed that the elective mathematics practice course has a positive effect on students' attitudes towards mathematics. At the end of the research, suggestions were made for the application and researches

A CROSS-SECTION ANALYSIS OF THE RELATIONSHIP BETWEEN OUTPUT COMPOSITION AND COMPOSITION OF EDUCATION EXPENDITURE

In this thesis, a new theoretical framework is developed to study the relationship between human capital and economic development in a different perspective. The aim of this thesis is to examine the relationship between output composition and composition of education expenditure. Output composition is represented by the share of high value added sectors in total value added and composition of education expenditure is represented by share of higher education expenditure in total education expenditure. In this context, two hypotheses based on the possible positive relationship between the share of high value added production and share of tertiary education are established and the relationship examined for 20 OECD countries from 1995 to 2005 through cross section regression analyses. In contrast with our expectations we reject the existence of a possible positive relationship and our results suggest that the relationship between output composition and composition of education expenditure is negative and mainly depends on the structure of labor market and composition of population