Coffee consumption, obesity and type 2 diabetes: a mini-review.

PURPOSE: The effects of regular coffee intake on weight gain and development of diabetes are reviewed. The pathophysiology of obesity and type 2 diabetes as well as the necessity of preventive options based on the increasing prevalence of these two disorders worldwide is briefly discussed. The relationship between weight gain and development of diabetes is also presented. The two major constituents in the brewed coffee, chlorogenic acids and caffeine, are responsible for many of the beneficial effects suggested by numerous epidemiological studies of coffee consumption and the development of diabetes. METHODS: A wide search of various databases, such as PubMed and Google Scholar, preceded the writing of this manuscript, focusing on key words that are part of the title. It was selected mainly review papers from in vivo, ex vivo, in vitro experimental studies in animals and human tissues as well as wide population-based epidemiological studies in the last 10 years. CONCLUSION: As of today, there are mounting evidences of the reduced risk of developing type 2 diabetes by regular coffee drinkers of 3-4 cups a day. The effects are likely due to the presence of chlorogenic acids and caffeine, the two constituents of coffee in higher concentration after the roasting process.

[Preceptorship in the perspective of comprehensive care: conversations with nurses]. / Preceptoria na perspectiva da integralidade: conversando com enfermeiros.

The aim of this study was to understand preceptorship in nursing practice fields and its association with comprehensive care. This study was based on qualitative field research conducted in Fortaleza, Ceará, Brazil, from April to June 2012. A total of 20 preceptors were interviewed in the practice fields of three higher education institutions at three public state hospitals and one basic health unit Thematic analysis enabled apprehension of the theme 'preceptorship in the perspective of comprehensive care' and the empirical categories: (dis)articulation in teaching-service: distancing from academic institutions; welcoming students in the practice field. On the field, routine teaches: articulation in teaching-service from the preceptor's perspective. Results showed that teaching-service integration is at risk in light of biologicism and the gap between teaching institutions and health services, but that it is a way of constructing the necessary changes to consolidate the National Health Service.

Improving access to prosthetic limbs in Germany: An explorative review.

BACKGROUND: Meeting the needs of users when it comes to accessing prosthetic limbs is an important factor in the acceptance and use of a prosthesis; the cost of such prosthetics also constitutes a potential financial challenge. OBJECTIVES: The aim of this study was to investigate potential hurdles to accessing limb prosthetics in the German health care system, including organizational, social, economic, and regulatory issues, and to provide food for thought about ethical implications. METHODS: Sixteen German users of limb prosthetics with upper-limb and/or lower-limb amputation were recruited by means of purposive sampling. Semistructured interviews were performed, with the guiding question being as follows: "What were your experiences with the German prosthetic care and reimbursement system?" Ten stakeholders (insurance representatives, prosthetic technicians, medical service representatives, a law expert, and a lawyer) were asked about the issues they encounter in their work related to prosthetic care and reimbursement, and about ways to ameliorate these issues. A qualitative content analysis method was used to analyze the data. RESULTS: Half of the interviewed service users experienced hurdles to gaining a suitable prosthetic device, such as waiting times and pressure to negotiate their need for a certain prosthesis. Some of the views expressed about the issues relating to prosthetic reimbursement in Germany were common to all stakeholders, whereas some conflicted with the views of others. CONCLUSIONS: Equitable access to prostheses and the efficient distribution of prosthetic innovations could be improved by organizational and regulatory measures. Furthermore, a user-centered design of prostheses, a health technology assessment, monitoring of prosthetic care pathways, and a societal discussion about rationing in health care should be considered as parts of a broader approach to tackle this issue.

Cosmetic Formulations with Melaleuca alternifolia Essential Oil for the Improvement of Photoaged Skin: A Double-Blind, Randomized, Placebo-Controlled Clinical Study.

This aim of this study was to evaluate the penetration depth, antioxidant capacity and the clinical efficacy of Melaleuca alternifolia pure essential oil and in a nanoemulsion to prevent skin photoaging. For this, 2% of pure essential oil or 2% of this essential oil in a nanoemulsion were vehiculated in a formulation. The skin penetration was evaluated using confocal Raman microspectroscopy. The radical protection factor was evaluated using electron paramagnetic resonance spectroscopy. For a clinical study, 40 male participants, aged 18-28 years, were enrolled, being divided into three groups: vehicle formulation, M. alternifolia pure essential oil and M. alternifolia Nanoemulsion. All the participants also received a sunscreen SPF 50 to use during the day. Before and after 90 days of study, skin hydrolipidics and morphological characteristics were performed by skin imaging and biophysical techniques. The nanoemulsion presented a lower antioxidant capacity and a higher penetration through the stratum corneum, reaching the viable epidermis, improving the stratum granulosum morphology. The groups presented an increase in the papillary depth, improving in the dermis echogenicity and the collagen fibers. Melaleuca alternifolia essential provides the potential to improve photoaged skin, being the application of nanoemulsion able to reach deeper skin layers.

Aquatic physiotherapy: a vestibular rehabilitation option.

INTRODUCTION: Vestibular rehabilitation is a fundamental resource for vestibular symptom control. Its performance in the aquatic environment is considered safe for the physical activities of the elderly, because they act simultaneously on musculoskeletal disorders and balance improvement. OBJECTIVE: To evaluate the effects of an aquatic physiotherapy protocol in individuals with peripheral vestibular alterations. METHODS: This was an interventional case study with a paired intentional sample of four subjects, who were selected for convenience. The subjects, all of them diagnosed with peripheral vestibulopathy, were submitted to twelve sessions of aquatic physiotherapy for vestibular rehabilitation, being evaluated for dizziness in three moments: initial, after six sessions and at the end of the sessions. The tests applied were: unipodal support to measure static balance, the Fukuda stepping test, which estimates the dynamic balance and the dizziness handicap inventory protocol, aimed at verifying how dizziness influences daily life. RESULTS: When analyzing the static balance, initially the individuals were in the adaptive and abnormal dimensions, and all reached normality at the end of the protocol. Regarding the dynamic balance, the individuals initially showed marked impairment in the angular deviation, mainly to the side of pathology (75% to the left and 25% to the right), achieving improvement at the end of the study. However, it failed to reach statistical significance. The dizziness handicap inventory showed a statistically significant difference in its totality (p = 0.0414), which addresses the physical, functional and emotional factors. CONCLUSION: In conclusion, the aquatic physiotherapy protocol for vestibular rehabilitation of patients with peripheral impairment was positively assessed by the participants, considering the improvement in dizziness (static and dynamic) and its impact on daily activities.

[Prevalence of antidepressant use and associated factors among adults in Pelotas, Rio Grande do Sul State, Brazil, 2006]. / Prevalência e fatores associados ao uso de antidepressivos em adultos de área urbana de Pelotas, Rio Grande do Sul, Brasil, em 2006.

The objective of this study was to estimate the prevalence and determinants of antidepressant use among adults in a city in southern Brazil. The cross-sectional study was based on interviews with adults 40 years or older living in the urban area of Pelotas, Rio Grande do Sul State, Brazil, 2006. The chi-squared test was used for comparisons between proportions. Non-conditional logistic regression was used for multivariate analysis, with robust adjustment for variance. A total of 1,327 adults were interviewed, of whom 9.3% had used antidepressants. Use of antidepressants was significantly associated with female gender (OR: 2.45; 95%CI: 1.50-4.02), higher socioeconomic status (OR: 2.07; 95%CI: 1.28-3.34), and unemployment (OR: 1.65; 95%CI: 1.06-2.55). The prevalence of antidepressant use was higher than in other studies. Identification of individual determinants of use can serve as the basis for strategies to decrease the consumption of antidepressants in these groups.

Identidade indígena: olhares a partir da Psicologia Social / Indigenous identity: a view from social psychology

Este estudo consiste numa revisão integrativa cujo objetivo é identificar como a Psicologia Social tem abordado as questões relativas à identidade indígena. O levantamento foi feito a partir de artigos que tratam das questões indígenas na perspectiva da Psicologia Social nas bases eletrônicas: SciELO, Pepsic, LILACS, BVS- Psi e APA. Os descritores foram: identidade étnica, indígena, índio, identidade social e Psicologia social. Considerando os critérios de inclusão e exclusão, foram compilados 19 estudos nacionais e internacionais referentes à última década, publicados em revistas de psicologia, evidenciando o caráter recente de estudos que aproximem a Psicologia Social de estudos sobre identidade indígena. Por meio do levantamento realizado, verificou-se que as publicações sobreA o tema se organizaram em quatro eixos: (1) compreensão da identidade étnica a partir da Psicologia Social; (2) representações sociais, preconceito e discriminação contra indígenas; (3) efeitos da relação interétnica para indígenas; e (4) os desafios da relação pesquisador e indígenas. (AU)

This study consists in a integrative review whose aim is to identify how social psychology has abroached the questions relating to indigenous identity. The survey was done from articles that deal with indigenous questions in the perspective of social psychology in electronic bases: SciELO, Pepsic, LILACS, BVS-Psi e APA. The descriptors were: ethnic identity, indigenous, indian, social identity and social psychology. By considering the inclusion and exclusion criteria, 19 national and internacional studies were compiled, referring to the last decade, published Psychology magazines, by making evident the recent character of studies that may approximate Social Psychology and indigenous identity. By means of accomplished survey, it was found that the publications about the theme were organized in four axes: (1) comprehension of ethnic identity to arise from Social Psychology; (2) Social representations, preconception and discrimination against indigenous; (3) Effects of the interethnic relationship for indigenous and (4) The challenges of the relationship between the researcher and indigenous. (AU)

Este estudio consiste en una revisión integradora cuyo objetivo es identificar cómo la Psicología Social ha abordado cuestiones relacionadas con la identidad indígena. El relevamiento se realizó a partir de artículos que abordan la temática indígena desde la perspectiva de la Psicología Social en bases de datos electrónicas: SciELO, Pepsic, LILACS, BVS-Psi y APA. Los descriptores fueron: identidad étnica, indígena, indígena, identidad social y psicología social. Considerando los criterios de inclusión y exclusión, se compilaron 19 estudios nacionales e internacionales referentes a la última década, publicados en revistas de psicología, evidenciando el carácter reciente de los estudios que acercan la Psicología Social a los estudios sobre la identidad indígena. A través de la encuesta realizada, se encontró que las publicaciones sobre el tema estaban organizadas en cuatro ejes: (1) comprensión de la identidad étnica desde la Psicología Social; (2) representaciones sociales, prejuicios y discriminación contra los pueblos indígenas; (3) efectos de la relación interétnica para los pueblos indígenas; y (4) los desafíos de la relación investigador-indígena. (AU)

Necessidade de cuidador entre pessoas que vivem com transtorno mental: estudo ecológico / Necesidad de cuidador en personas que viven con trastorno mental: estudio ecológico / Need for caregivers among people living with mental disorders: an ecological study

Resumo Objetivo Identificar os usuários de um Centro de Atenção Psicossocial que apresentam dependência de cuidador e seus fatores associados. Métodos Estudo ecológico, com coleta de dados secundários de prontuários de pessoas que vivem com transtorno mental, ocorrida no ano de 2018 em um Centro de Atenção Psicossocial no Centro-Oeste brasileiro. Na análise, usou-se como variável dependente "necessidade de cuidador". Resultados Na amostra de 360 prontuários, houve prevalência do sexo feminino (220; 61,1%), idade entre 35 a 59 anos (190; 52,8%), tempo de tratamento ≤5 anos (164; 45,6%), cuidado exercido por família/amigos (162; 45,0%), diagnóstico principal de transtornos psicóticos (128; 35,6%) e em uso de antipsicóticos (275; 76,4%). Na análise múltipla, permaneceram associadas as variáveis ter escolaridade não letrado/fundamental (p=0,041), possuir transtorno psicótico (p=0,009) e usar antidepressivo (p=0,026). Conclusão O estudo apontou que fatores como ser do sexo masculino, possuir escolaridade não letrado/fundamental, ter transtorno psicótico e fazer uso de antidepressivo possuem maiores índices para dependência de cuidados e devem ser considerados e investigados pela equipe dos Centros de Atenção Psicossocial.

Resumen Objetivo Identificar los usuarios de un Centro de Atención Psicosocial que presentan dependencia de cuidador y los factores asociados. Métodos Estudio ecológico, con recopilación de datos secundarios de historias clínicas de personas que viven con trastorno mental, realizada en el año 2018 en un Centro de Atención Psicosocial en la región Centro-Oeste brasileña. En el análisis, se utilizó como variable dependiente "necesidad de cuidador". Resultados En la muestra de 360 historias clínicas, hubo prevalencia del sexo femenino (220; 61,1 %), edad entre 35 y 59 años (190; 52,8 %), tiempo de tratamiento ≤5 años (164; 45,6 %), cuidado ejercido por familia/amigos (162; 45,0 %), diagnóstico principal de trastornos psicóticos (128; 35,6 %) y en uso de antipsicóticos (275; 76,4 %). En el análisis múltiple, estuvieron asociadas las variables tener escolaridad no letrada/primaria (p=0,041), poseer trastorno psicótico (p=0,009) y tomar antidepresivos (p=0,026). Conclusión El estudio indicó que factores como ser de sexo masculino, tener escolaridad no letrada/primaria, tener trastorno psicótico y tomar antidepresivos poseen mayores índices para la dependencia de cuidados y deben ser considerados e investigados por el equipo de los Centros de Atención Psicosocial.

Abstract Objective To identify users of a Psychosocial Care Center who have caregiver dependence and their associated factors. Method This is an ecological study, with collection of secondary data from medical records of people living with mental disorders, which occurred in 2018 in a Psychosocial Care Center in the Brazilian Midwest. In the analysis, the dependent variable "need for caregiver" was used as a dependent variable. Results In the sample of 360 medical records, there was a prevalence of women (220; 61.1%), aged between 35 and 59 years (190; 52.8%), treatment time ≤5 years (164; 45.6%), care provided by family/friends (162; 45.0%), main diagnosis of psychotic disorders (128; 35.6%) and antipsychotic use (275; 76.4%). In the multiple analysis, the variables non-literacy/elementary school (p=0.041), having psychotic disorder (p=0.009) and antidepressant (p=0.026) remained associated. Conclusion The study pointed out that factors such as being men, non-literate/elementary school, having a psychotic disorder and using antidepressants have higher rates of dependence on care and should be considered and investigated by the Psychosocial Care Center team.

Comprometimento cognitivo e fatores associados em uma população de idosos / Cognitive impairment and associated factors in a population of aged people

Resumo Introdução: O envelhecimento populacional está entre as transformações globais mais importantes. Na população idosa, há prevalência aumentada de condições crônicas que comprometem a autonomia relacionadas ao comprometimento cognitivo. Objetivo: Este estudo buscou estimar a prevalência de comprometimento cognitivo e os fatores associados em uma população de idosos. Método: Trata-se de pesquisa transversal analítica envolvendo idosos com 60 anos ou mais, cadastrados na Estratégia Saúde da Família de Montes Claros, Minas Gerais, Brasil. Para caracterização dos fatores sociodemográficos, hábitos de vida e condições de saúde, utilizou-se o instrumento Brazilian Older Americans Researches and Service Multidimensional Function Assessment Questionnaire; para avaliação cognitiva, o Mini Exame do Estado Mental, e os resultados, ajustados por escolaridade na análise de regressão logística binária, com apresentação de odds ratio (OR) e intervalos de confiança (IC) de 95%. Resultados: Dos 1.746 idosos avaliados, 11,5% apresentaram comprometimento cognitivo. Os fatores de risco associados foram idosos acima de 80 anos (OR=4,463; IC95% 3,160-6,304); analfabetos (OR=3,996; IC95% 2,716-5,791); sem companheiro (OR=1,989; IC95% 1,388-2,850); sedentários (OR=1,777; IC95% 1,208-2,613) e com histórico de Acidente Vascular Cerebral (OR=3,635; IC95% 2,213-5,971). Conclusões: Comprometimento cognitivo foi associado a variáveis passíveis de ações preventivas, como o acesso à escolarização e hábitos de vida saudáveis.

Abstract Background: Population aging is among the most important global transformations. In the elderly population, there is an increased prevalence of chronic conditions that compromise autonomy, related to cognitive impairment. Objective: This study sought to estimate the prevalence of cognitive impairment and associated factors in an elderly population. Method: This is a cross-sectional and analytical survey involving elderly people aged 60 years old or older, registered with the Family Health Strategy of Montes Claros, Minas Gerais, Brazil. To characterize sociodemographic factors, life habits and health conditions, the Brazilian Older Americans Researches and Service Multidimensional Function Assessment Questionnaire was used; for cognitive evaluation, the Mini Mental State Examination, and the results adjusted for education in the binary logistic regression analysis, with the presentation of odds ratios (OR) and 95% confidence intervals (CI). Results: Of the 1,746 aged individuals evaluated, 11.5% presented cognitive impairment. The associated risk factors were elderly over 80 years old (OR=4.463; 95%CI 3.160-6.304); illiterate (OR=3.996; 95%CI 2.716-5.791); without companion (OR=1.989; 95%CI 1.388-2.850); sedentary (OR=1.777; 95%CI 1.208-2.613), and with a history of stroke (OR=3.635; 95%CI 2.213-5.971). Conclusions: Cognitive commitment was associated with variables susceptible to preventive actions, such as access to schooling and healthy living habits.

Involvement of cytochrome P450 in cisplatin treatment: implications for toxicity.

PURPOSE: The aim of this study is to evaluate the relationship between the CYP450 enzyme family and cisplatin toxicity. METHODS: This article examined a collection of studies suggesting that CYP450 enzymes may influence cisplatin toxicity. We performed a narrative mini-review. RESULTS: The studies review showed that CYP450 enzymes have an important role in drug-induced hepatotoxicity and nephrotoxicity, mainly CYP2E1 and CYP4A11. The studies also suggested that the cisplatin and CYP2E1 interaction leads to the generation of reactive oxygen species (ROS) and other oxidants resulting in renal injury; and that ROS generated by both the use of cisplatin and by the CYP2E1 increases tissue damage, induces apoptosis, and causes liver failure. CONCLUSIONS: We observed that there is an important relationship between CYP450 and cisplatin, involving increased toxicity. However, the possible mechanisms described for the involvement of CYP450 enzymes in nephrotoxicity and hepatotoxicity induced by cisplatin need to be confirmed by further studies. Therefore, there is a need for a deeper investigation focusing on cisplatin toxicity mediated by CYP450 enzymes, which would undoubtedly contribute to a better understanding of the mechanisms that have been implicated so far.

Aquatic physiotherapy: a vestibular rehabilitation option / Fisioterapia aquática: uma opção de reabilitação vestibular

Abstract Introduction: Vestibular rehabilitation is a fundamental resource for vestibular symptom control. Its performance in the aquatic environment is considered safe for the physical activities of the elderly, because they act simultaneously on musculoskeletal disorders and balance improvement. Objective: To evaluate the effects of an aquatic physiotherapy protocol in individuals with peripheral vestibular alterations. Methods: This was an interventional case study with a paired intentional sample of four subjects, who were selected for convenience. The subjects, all of them diagnosed with peripheral vestibulopathy, were submitted to twelve sessions of aquatic physiotherapy for vestibular rehabilitation, being evaluated for dizziness in three moments: initial, after six sessions and at the end of the sessions. The tests applied were: unipodal support to measure static balance, the Fukuda stepping test, which estimates the dynamic balance and the dizziness handicap inventory protocol, aimed at verifying how dizziness influences daily life. Results: When analyzing the static balance, initially the individuals were in the adaptive and abnormal dimensions, and all reached normality at the end of the protocol. Regarding the dynamic balance, the individuals initially showed marked impairment in the angular deviation, mainly to the side of pathology (75% to the left and 25% to the right), achieving improvement at the end of the study. However, it failed to reach statistical significance. The dizziness handicap inventory showed a statistically significant difference in its totality (p = 0.0414), which addresses the physical, functional and emotional factors. Conclusion: In conclusion, the aquatic physiotherapy protocol for vestibular rehabilitation of patients with peripheral impairment was positively assessed by the participants, considering the improvement in dizziness (static and dynamic) and its impact on daily activities.

Resumo Introdução: A reabilitação vestibular se consolida como um recurso fundamental para o controle de sintomas vestibulares e sua feitura no meio aquático é considerada segura para as atividades físicas dos idosos, atua simultaneamente nas desordens musculoesqueléticas e na melhoria do equilíbrio. Objetivo: Avaliar os efeitos de um protocolo de fisioterapia aquática em indivíduos com alterações vestibulares periféricas. Método: Estudo de caso intervencional com amostra intencional pareada de quatro sujeitos, selecionados por conveniência, diagnosticados com vestibulopatias periféricas. Os sujeitos foram submetidos a 12 sessões de fisioterapia aquática para reabilitação vestibular. Foram avaliados quanto à tontura em três momentos: inicial, após seis sessões e ao término dos atendimentos. Os testes aplicados foram: o apoio unipodal para mensurar o equilíbrio estático, a prova dos passos de Fukuda que estima o equilíbrio dinâmico e o protocolo dizziness handicap inventory com o objetivo de verificar o quanto a tontura influencia na vida cotidiana. Resultados: Ao analisar o equilíbrio estático, inicialmente os indivíduos se encontravam nas dimensões adaptativas e anormais e ao término do protocolo todos atingiram a normalidade. Em relação ao equilíbrio dinâmico, os indivíduos inicialmente apresentavam grande comprometimento no desvio angular principalmente para o lado da patologia (75% à esquerda e 25% à direita), conseguiram uma melhoria no fim do estudo. Todavia, não conseguiu atingir a significância estatística. O dizziness handicap inventory obteve diferença estatisticamente significante em sua totalidade (p = 0,0414), onde aborda os fatores físicos, funcionais e emocionais. Conclusão: O protocolo de fisioterapia aquática voltado para reabilitação vestibular de pacientes com comprometimento periférico foi avaliado de forma positiva pelos participantes, considerando-se a melhoria no quadro de tontura (estática e dinâmica) e do seu impacto nas atividades cotidianas.

RYP1 gene as a target for molecular diagnosis of histoplasmosis.

This study analyzed the RYP1 gene as a target for the molecular diagnosis of histoplasmosis. This assay detected fungal DNA in 13/13 blood samples from HIV/AIDS-patients with histoplasmosis. Therefore, the detection of RYP1 gene in whole blood sample is a quick and sensitive test to diagnose histoplasmosis.

Quantitative real-time PCR (q-PCR) for sputum smear diagnosis of pulmonary tuberculosis among people with HIV/AIDS.

OBJECTIVE: To assess quantitative real-time polymerase chain reaction (q-PCR) for the sputum smear diagnosis of pulmonary tuberculosis (PTB) in patients living with HIV/AIDS with a clinical suspicion of PTB. METHOD: This is a prospective study to assess the accuracy of a diagnostic test, conducted on 140 sputum specimens from 140 patients living with HIV/AIDS with a clinical suspicion of PTB, attended at two referral hospitals for people living with HIV/AIDS in the city of Recife, Pernambuco, Brazil. A Löwenstein-Jensen medium culture and 7H9 broth were used as gold standard. RESULTS: Of the 140 sputum samples, 47 (33.6%) were positive with the gold standard. q-PCR was positive in 42 (30%) of the 140 patients. Only one (0.71%) did not correspond to the culture. The sensitivity, specificity and accuracy of the q-PCR were 87.2%, 98.9% and 95% respectively. In 39 (93%) of the 42 q-PCR positive cases, the CT (threshold cycle) was equal to or less than 37. CONCLUSION: q-PCR performed on sputum smears from patients living with HIV/AIDS demonstrated satisfactory sensitivity, specificity and accuracy, and may therefore be recommended as a method for diagnosing PTB.

O suicídio como questão de saúde pública / Suicide as a public health issue

Em uma perspectiva global, o suicídio apresenta-se, atualmente, como uma grave questão de saúde pública.Segundo registros da Organização Mundial da Saúde(1), o suicídio vitimiza aproximadamente 800 mil pessoas por ano, o que significa uma morte a cada 35 segundos no mundo. O Brasil é o oitavo país em número absoluto de suicídios, registrando, em média, 11 mil casos por ano, isto é, 31 mortes por dia, sendo o número de homens quase quatro vezes maior que o de mulheres(2,3). Esses números podem ser ainda mais alarmantes quando se considera a subnotificação dos óbitos por suicídio. O número de casos de suicídio encontra-se camuflado entre registros de homicídios, acidentes e outras causas de morte. De qualquer forma, os registros oficiais disponíveis já permitem afirmar a gravidade desse fenômeno, que transcende a categoria de tragédia pessoal, configurando-se como um sério problema de saúde pública, especialmente em função da intensidade da dor, dos anos potenciais de vida perdidos e do seu caráter epidêmico(4,5). Mesmo diante desses dados e do reconhecimento da amplitude e da complexidade do fenômeno, o suicídio ainda é um tema tratado como tabu. De forma específica, é considerado como o ato humano de infligir a si próprio o fim da vida. Para sua delimitação, pode-se considerar como central a noção de intencionalidade de morte do indivíduo que tenta suicídio(5).Comportamentos suicidas não fatais se classificam, desde a ideação suicida - os diferentes níveis de pensamento que fomentam o suicídio, acompanhados de planejamento ou não - até a tentativa de suicídio, configurada como comportamento autolesivo em que há a intenção de pôr fim à vida(2). A fronteira entre a ideação suicida, a tentativa de suicídio e o suicídio propriamente dito é muito tênue. Em geral, angústias e sofrimentos que sustentam a ideia ou intenção de suicídio podem atingir um nível avassalador e impulsionar o ato. Essa estreita fronteira alerta que a morte autoinflingida quase sempre é pensada, planejada e precedida por tentativas, ampliando, assim, as chances de intervenções preventivas imediatas e efetivas. Tal afirmação não descarta os casos que não passam por um planejamento, em geral, decorrentes de um impulso desesperador(6). Assim, o suicídio caracteriza-se como um fenômeno marcado pela complexidade, que se configura como processo humano e universal. Trata-se de um processo cuja causa não deve ser reduzida a um acontecimento específico. Desse modo, para compreendê-lo é primordial que seja considerada a trajetória de vida do indivíduo, sua subjetividade, bem como variáveis ligadas ao contexto histórico, econômico e cultural. Nessa perspectiva, o suicídio exige uma análise da culminação dos fatores psicossociais e das experiências singulares do indivíduo. A complexidade do suicídio reside na maneira como esses fatores se entrelaçam e, sobretudo, se potencializam(7). A dinâmica de diversos fatores de risco em um indivíduo vulnerável ocasiona o surgimento de uma dor psíquica que pode atingir intensidade intolerável, impedindo-o de enxergar outra possibilidade de sua interrupção que não seja antecipar o próprio fim. Esse conjunto de fatores é uma questão essencial quando se estuda o fenômeno do suicídio, podendo ser discutido no resgate de histórias de vida de pessoas que efetivaram suicídios(8). Conhecer os fatores que predispõem uma pessoa a tentar tirar sua própria vida é o primeiro passo para que se criem programas eficazes e efetivos de prevenção, bem como para a estruturação de políticas públicas, ou seja, um levantamento de alternativas sobre o que fazer com esse problema de saúde pública através de instrumentos e estabelecer um curso de ação(9). Na análise dos fatores relacionados ao suicídio, a identificação de transtornos mentais é fundamental e pode ajudar o profissional da saúde a considerar clinicamente o risco e analisar as estratégias para reduzi-lo. Entre os transtornos mentais relacionados a casos de suicídio, tem-se transtornos do humor, sobretudo a depressão; transtornos mentais e de comportamento, resultantes do uso de substâncias psicoativas, como o alcoolismo; transtornos de personalidade, especialmente borderline, narcisista e antissocial; a esquizofrenia; e transtornos de ansiedade(10). Dentre os fatores de risco, destacam-se os de ordem psicológica, a exemplo de perdas recentes, má elaboração do luto de figuras parentais na infância, conflitos familiares, datas marcantes, reações de aniversário, personalidade impulsiva, agressividade marcante e humor lábil. Fatores sociodemográficos também podem ser influentes, como: sexo masculino; na faixa etária entre 15 e 35 anos e idosos acima de 75 anos; estratos econômicos extremos; residência em áreas urbanas; desemprego (principalmente perda recente do emprego); aposentadoria; isolamento social; ser solteiros ou separados. Algumas condições clínicas são consideradas pelo Ministério da Saúde como fatores de risco por serem, por vezes, incapacitantes, a exemplo de: doenças orgânicas intensas, dores crônicas, lesões desfigurantes, epilepsia, trauma medular, neoplasias malignas e presença do vírus HIV(4,5). Faz-se também necessário dedicar esforços à posvenção ao suicídio, a saber, o desenvolvimento de ações preventivas voltadas para amenizar os danos aos sobreviventes. A angústia daqueles que convivem com a lembrança de um suicídio deve ser vista com atenção pelos profissionais da saúde por representar um significante fator de risco para ocorrência de outros eventos da mesma natureza. Esse cuidado revela-se ainda mais necessário frente à ausência de redes e relações de apoio para a pessoa enlutada(11). Ademais, o impacto de um suicídio pode se estender para, pelo menos, seis pessoas próximas ao falecido, que comumente passam a ter suas vidas profundamente afetadas, emocional, social e economicamente(12,13). Destarte, entende-se que os esforços para promoção da saúde e a prevenção do comportamento suicida em todos os seus níveis de gravidade extrapolam os conhecimentos do campo da saúde. Tratando-se de fenômeno complexo e multideterminado, essas ações devem ser fundamentadas nos fatores de risco e proteção, bem como no conhecimento produzido por profissionais de diversas áreas do saber. Os conhecimentos gerados por esses profissionais podem contribuir para a redução dos índices de tentativa de suicídio e suicídio no Brasil e no mundo. Profissionais de saúde e assistência social, de todas as especialidades e níveis de atuação, devem estar qualificados para avaliar o risco de suicídio(1,3). Sendo assim, a Revista Brasileira em Promoção da Saúde (RBPS) busca colaborar significativamente com o desafio de evidenciar um problema emergente e multidimensional, visto que apresenta atenção sobre este tema, almejando a ampliação dos conhecimentos sobre os fatores e a sensibilização dos profissionais da saúde, assim como dos profissionais de Direitos Humanos e das demais áreas implicadas. Nesse sentido, considera-se a verificação do risco de suicídio uma estratégia desafiadora no contexto da saúde pública, fator primordial para a prevenção, o manejo adequado da crise suicida e a promoção da saúde. A colaboração da RBPS com a temática do suicídio ganha ainda mais relevância quando se constata uma lacuna nos estudos da suicidologia a respeito dos fatores e circunstâncias que promovem o desenvolvimento sadio e fortalecem recursos internos para o enfrentamento da crise suicida. Muito do que já se sabe envolve a questão do risco e suas implicações na vida da pessoa vulnerável. Para suprir essa lacuna, a RBPS almeja trazer à tona essas questões, que precisam ser discutidas por acadêmicos, profissionais e gestores de saúde, indicando como fundamental a ampliação do foco de investigação a partir de diferentes abordagens, perspectivas e campos do conhecimento. Conhecer os aspectos que possibilitam a superação da crise suicida pode constituir uma grande ferramenta para a construção de estratégias de prevenção mais precisas, às quais todos devem estar atentos. (AU)

Suicide is currently a serious public health issue worldwide. According to records from the World Health Organization(1), approximately 800,000 people commit suicide every year, which means one death every 35 seconds worldwide. Brazil ranks eighth in absolute number of suicides, with an average of 11 thousand cases a year, that is, 31 deaths per day, with the number of men being nearly four times higher than that of women(2,3). These figures may be even more alarming if we consider the underreporting of suicide deaths. The number of suicide cases is hidden between records of homicides, accidents and other causes of death. Despite that, official records available already allow us to confirm the seriousness of this phenomenon, which transcends the category of personal tragedy to become a serious public health problem, especially because of the intensity of pain, the years of potential life lost, and its epidemic character(4,5). Despite these data and the recognition of the depth and complexity of the phenomenon, suicide is an issue that is still a taboo. More specifically, it is defined as the human act of self-inflicted cessation of life. For its delimitation, the notion of the individual's intention to die should be considered in suicide attempts(5). The classification of nonfatal suicidal behaviors ranges from suicidal ideation ­ the different levels of suicidal thoughts accompanied or not by planning ­ to suicide attempt, which is defined as a self-injurious behavior in which there is the intent to end one's life(2). (AU) The line between suicidal ideation, attempted suicide and suicide itself is very thin. In general, anguish and suffering that underlie the idea or intent of suicide can reach an overwhelming level and boost the act. This thin line warns that self-inflicted death is almost always thought out, planned and preceded by attempts, thus increasing the chances of immediate and effective preventive interventions. This assertion does not rule out cases that do not go through planning and usually result from a desperate impulse(6). Thus, suicide is a complex human and universal phenomenon. It is a process whose cause must not be reduced to a specific event. Therefore, to understand it, it is essential to consider the individual's life trajectory, his/her subjectivity, and variables related to the historical, economic and cultural context. Given that, suicide requires an analysis of the culmination of psychosocial factors and individual experiences. The complexity of suicide lies in the way in which these factors intertwine and, above all, become potent(7). The dynamics of various risk factors in a vulnerable individual causes the onset of a psychic pain that can reach intolerable intensity, preventing the individual from seeing a possibility of its interruption other than anticipating his/her own end. This set of factors is an essential issue when studying suicide and can be discussed in the rescue of life histories of people who have committed suicides(8). Knowing the factors that predispose a person to try to take his own life is the first step to create efficient and effective prevention programs and structure public policies. That is, it is important to carry out a survey of alternatives on what to do with this public health problem through instruments and establish a course of action(9). In the analysis of factors related to suicide, the identification of mental disorders is fundamental and can help the health professional to clinically consider the risk and analyze the strategies to reduce it. Among the mental disorders related to cases of suicide, there are mood disorders, especially depression; mental and behavioral disorders resulting from the use of psychoactive substances, such as alcoholism; personality disorders, especially borderline, narcissistic and antisocial disorders; schizophrenia; and anxiety disorders(10). Among the risk factors, there are those of a psychological nature, such as recent losses, poorly elaborated childhood bereavement following parental death, family conflicts, important dates, birthday reactions, impulsive personality, striking aggressiveness, and labile humor. Sociodemographic factors may also be influential. They include: male gender; age between 15 and 35 years and older adults over 75 years old; extreme economic strata; residence in urban areas; unemployment (mainly recent job losses); retirement; social isolation; being single or separated. Some clinical conditions are considered by the Ministry of Health as risk factors because they are sometimes incapacitating, such as: intense organic diseases, chronic pain, disfiguring lesions, epilepsy, spinal cord trauma, malignant neoplasms, and presence of HIV virus(4,5). It is also necessary to put effort into suicide postvention, namely, the development of preventive actions aimed at mitigating the damage to the survivors. The anguish of those who live with the memory of a suicide must be seen with attention by health professionals because it represents a significant risk factor for the occurrence of other events of the same nature. This care is even more necessary in the absence of support networks and relationships for the bereaved person(11). In addition, suicide can have an impact on at least six people close to the deceased. These people commonly begin to have their lives deeply emotionally, socially and economically affected(12,13). Thus, it is understood that efforts to promote health and the prevention of suicidal behavior at all levels of severity go beyond health knowledge. As it is a complex and multi-determinate phenomenon, these actions must be based on risk and protective factors, as well as on the knowledge produced by professionals from different fields of knowledge. The knowledge generated by these professionals can contribute to the reduction of the rates of suicide and suicide attempt in Brazil and in the world. Health professionals and social workers from all fields of knowledge and levels of performance must be trained to assess the risk of suicide(1,3). Therefore, the Brazilian Journal in Health Promotion (Revista Brasileira em Promoção da Saúde ­ RBPS) seeks to collaborate significantly with the challenge of highlighting an emerging and multidimensional problem. By focusing on this theme, it aims to increase knowledge about factors and raise awareness among health professionals, Human Rights professionals and professionals from other areas involved. In this regard, suicide risk assessment is considered a challenging strategy in the context of public health and a key factor for prevention, appropriate management of the suicide crisis and health promotion. RBPS collaboration with the discussion about suicide is even more relevant because there is a lack of studies on suicide regarding factors and circumstances that promote healthy development and strengthen internal resources to cope with the suicidal crisis. Much of what is already known involves the risk and its implications in the life of the vulnerable person. To fill this gap, RBPS aims to bring up these issues, which need to be discussed by academics, practitioners and health managers, thus indicating the importance of expanding the focus of research from different approaches, perspectives and fields of knowledge. Knowing the aspects that make it possible to overcome the suicidal crisis can be a great tool for the construction of more precise prevention strategies, to which all must be attentive. (AU)

[The prevalence and factors associated with diabetic foot amputations]. / Prevalência e fatores associados a amputações por pé diabético.

The scope of this investigation was to establish the prevalence of diabetic foot amputations and analyze associations with factors related to the individual and to primary health care. It is a cross-sectional epidemiological study and the sample included 214 inpatients with diabetic feet in one of the four hospitals specialized in vascular surgery in the state of Pernambuco. Data were collected using semi-structured questionnaires. In the data analysis, chi-square association, Poisson regression (p < 0.05) and descriptive statistics procedures were applied. The prevalence of amputation ascertained was 50%. The following factors related to the individual were associated with its occurrence: low education (p = 0.027); two or more people living in the household (p = 0.046); and patient income below the minimum wage (p = 0.004). The following factors related to primary health care were associated with amputation: not having feet examined (PR = 1.17); not receiving guidance on foot care (PR = 2.24) in consultations in the past year; not using the drug for DM control as prescribed (PR = 1.60); and inadequate glycemic control (PR = 1.83). Understanding these factors helps to identify aspects of preventive care that require improvement.

Investigação sobre o uso do ácido retinoico a 3% e a 5% em soluções para peeling como agente para drug delivery após indução percutânea de colágeno com agulhas (IPCA®): perfil de segurança e protocolo de uso / Investigation on the use of 3% and 5% retinoic acid in peeling solutions as a drug delivery agent after percutaneous induction of collagen with needles (IPCA®): safety profile and application protocol

Introdução: O ácido retinoico em solução para peelings é amplamente usado no tratamento do fotoenvelhecimento. Até o presente momento não conhecemos o grau de esterilidade dessas soluções ou a segurança de seu uso em peles cuja integridade tenha sido perdida por intervenções com microagulhas. Objetivos: Avaliar o potencial bactericida do ácido retinoico 3% e 5% em soluções para peelings com e sem tonalizante, bem como a segurança e tolerância de sua administração imediatamente após o tratamento com microagulhas. Metódos: Amostras de solução de ácido retinoico 3% e 5%, com e sem tonalizante, oriundas de duas farmácias de manipulação (A e B) foram expostas a colônias de Pseudomonas aeruginosa e Staphylococcus aureus. Essas soluções foram usadas como drug delivery após indução percutânea de colágeno com agulhas. Resultados: As amostras avaliadas em D0, D30, D60 e D90 mostraram capacidade bactericida sobre os agentes testados. O uso das soluções após a intervenção com microagulhas foi bem tolerado e apresentou resultados satisfatórios. Conclusão: A solução de ácido retinoico para peelings pode ser utilizada com segurança após procedimentos que levem à perda da integridade da barreira cutânea. A ausência de efeitos adversos e os bons resultados do procedimento permite sugerir a associação de microagulhamento e peeling de ácido retinoico como uma proposta inovadora, reproduzível e segura.

Introduction: Retinoic acid in peeling solution is widely used in the treatment of photoaging. To date, the degree of sterility of these solutions or the safety of their use in skins whose integrity has been lost through microneedling interventions is unknown. Objectives: To evaluate the bactericidal potential of 3% and 5% retinoic acid in peeling solution, with and without a colored vehicle, as well as the safety and tolerance to its administration immediately after application with microneedles. Methods: Samples of 3% and 5% retinoic acid solution, with and without a colored vehicle, prepared by two dispensing pharmacies (A and B) were exposed to Pseudomonas aeruginosa and Staphylococcus aureus colonies. These solutions were used as drug delivery agents after percutaneous induction of collagen with needles. Results: The samples evaluated in D0, D30, D60 and D90 indicated the presence of bactericidal capacity of the tested agents. The use of the solutions following intervention with microneedles was well tolerated and yielded satisfactory results. Conclusion: The retinoic acid peeling solution can be safely used following procedures that lead to a loss of integrity of the skin barrier. The absence of adverse effects and good results yielded by the procedure suggest that the association of microneedling and retinoic acid peeling is an innovative, reproducible and safe proposal.

Chest radiographic findings in patients with HIV/AIDS and pulmonary tuberculosis.

The study describes the main chest radiographic changes in people living with HIV/AIDS and pulmonary tuberculosis, confirmed by sputum culture. This was a descriptive study involving a total of 42 sputum tests from 42 people living with HIV/AIDS and a clinical suspicion of pulmonary tuberculosis. All patients attended two referral hospitals in Recife-PE, Brazil, between August 2009 and January 2012. The most common isolated radiological change was parenchymal consolidation, encountered in six (14.3%) patients, followed by patterns of interstitial infiltrate, diffuse micronodular (miliary), and an association between interstitial infiltrate and parenchymal consolidation, each being encountered in five (11.9%) patients. No statistically significant difference was observed between the radiological findings and CD4 T-cell counts, p = 0.680.

Transplante hepático em hospital de referência: competências do enfermeiro no serviço ambulatorial / Liver transplant in reference hospital: nursing skills in outpatient service / Trasplante hepático en un hospital de referencia: competencias del enfermero en lo servicio de ambulatorio

Objetivo: descrever as competências do enfermeiro no serviço ambulatorial de transplante hepático.Método: estudo exploratório com abordagem qualitativa, com enfermeiros que atuam no ambulatório detransplante hepático de um hospital de referência, por meio de entrevista e observação não participante,com emprego da Técnica de Análise temática. Resultados: o período de espera envolve atividades relativasao acolhimento, triagem, consulta de enfermagem, procedimentos técnicos, educação em saúde, interaçãocom a equipe multiprofissional, ensino-pesquisa e gerenciamento de recursos humanos e materiais. Após otransplante, os cuidados estão direcionados para a prevenção de complicações e empoderamento para oautocuidado. Conclusão: é imprescindível a colaboração do enfermeiro na equipe multiprofissional, para umdesfecho positivo no processo do transplante hepático, pois precisa promover a assistência segura e efetiva,tanto aos clientes quanto aos seus familiares.(AU)

Objective: to describe the skills of nurses in outpatient liver transplant. Method: an exploratory study with a qualitative approach, with nurses working in liver transplantation clinic of a referral hospital through nonparticipant interviews and observation with use of thematic analysis technique. Results: the waiting period involves activities related to the reception, screening, nursing consultation, technical procedures, health education, interaction with the multidisciplinary team, teaching and research and management of human and material resources. After transplantation, care are directed to the prevention of complications and empowerment for self-care. Conclusion: the collaboration of the nurse in the multidisciplinary team is essential for a positive outcome in the process of liver transplantation, because they need to promote safe and effective care, both to clients and their families.(AU)

Objetivo: Describir las competencias del enfermero en lo servicio de ambulalorio de trasplante de hígado. Método: un estudio exploratorio con enfoque cualitativo, con las enfermeras que trabajan en el hígado clínica de trasplante de un hospital de referencia a través de entrevistas no participantes y la observación con el uso de la técnica de análisis temático. Resultados: el período de espera incluye actividades relacionadas con la recepción, selección, consulta de enfermería, procedimientos técnicos, la educación sanitaria, la interacción con el equipo multidisciplinario, la enseñanza y la investigación y la gestión de los recursos humanos y materiales. Después del trasplante, la atención se dirige a la prevención de las complicaciones y la habilitación para el autocuidado. Conclusión: la colaboración de la enfermera en el equipo multidisciplinario es esencial para un resultado positivo en el proceso de trasplante de hígado, debido a que necesita para promover una atención segura y eficaz, tanto a los clientes y sus familias.(AU)

Adaptação transcultural da Workplace Deviance Scale (WDS) para o contexto brasileiro / Cross-cultural adaptation of the Workplace Deviance Scale (WDS) for the brazilian context / Adaptación transcultural de la Workplace Deviance Scale (WDS) al contexto brasileño

Dentre o grupo de comportamentos organizacionais relacionados ao desempenho no trabalho existem aqueles denominados contraproducentes, ou seja, que causam danos ou prejuízos à organização e aos diferentes colaboradores (colegas, clientes, fornecedores, entre outros). Tendo em vista o crescente interesse social e científico pelo tema e a carência de pesquisas no contexto brasileiro, a proposta deste estudo é descrever o processo de adaptação transcultural e o estudo psicométrico de uma escala para avaliação de comportamentos contraproducentes no ambiente de trabalho denominada Workplace Deviance Scale (WDS). Para tanto, foram seguidas as recomendações preconizadas na literatura sobre adaptação de instrumentos de medida e levantadas as primeiras evidências de validade (semântica, estrutura interna e convergente). Para alcançar os objetivos propostos, foram realizados dois estudos. O primeiro contemplou a adaptação e o levantamento de validade semântica, e o segundo, a análise psicométrica da versão adaptada. Participaram do primeiro estudo três especialistas e uma amostra de trabalhadores (n = 20). Para o estudo psicométrico, foram coletados dados (n = 467) em meio eletrônico e presencial. Foi estabelecida equivalência entre as versões original e adaptada com evidências de validade semântica. Evidências de validade baseada na estrutura interna e convergente foram alcançadas. Dois, entre três índices de precisão estimados, foram satisfatórios. A versão brasileira da referida escala passou a ser intitulada WDS-BR.

Among the group of organizational behaviors related to job performance are those called counter-productive, i.e., that cause damage or harm to the organization and colleagues (co-workers, clients, suppliers, etc.). Considering the growing social and scientific interest in the subject and the lack of research in the Brazilian context, the aim of this study is to describe the process of cross-cultural adaptation and the psychometric study of a scale for assessment of counter productive behaviors in the workplace, called the Workplace Deviance Scale (WDS).To do so, the recommendations outlined in the literature on adaptation of measurement instruments were followed, and primary evidence of validity (semantic, internal and convergent structure) was investigated. To achieve the proposed objectives, two studies were conducted. The first one included the adaptation and semantic validity survey, and the second study, the psychometric analysis of the adapted version. The first study had three specialists and a sample of workers (n = 20). For the psychometric study, data were collected (n = 467) electronically and in-person. Equivalence was established between the original and adapted versions with evidence of semantic validity. Evidence of validity based on internal and convergent structure was found. Among three estimated precision indexes, two were satisfactory. The Brazilian version of the scale became entitled WDS-BR.

Entre los comportamientos organizacionales relacionados con el desempeño en el trabajo existen aquellos denominados contraproducentes, es decir, que causan daños o perjuicios a la organización y a los diferentes colaboradores (colegas, clientes, proveedores, etc.). Considerando el creciente interés social y científico por el tema y la carencia de investigaciones en el contexto brasileño, la propuesta de este estudio es describir el proceso de adaptación transcultural y el estudio psicométrico de una escala para la evaluación de comportamientos contraproducentes en el ambiente de trabajo denominada Workplace Deviance Scale (WDS). Para ello, se siguieron las recomendaciones preconizadas en la literatura sobre la adaptación de instrumentos de medida y se plantearon las primeras evidencias de validez (semántica, estructura interna y convergente). Para alcanzar los objetivos propuestos se realizaron dos estudios. El primero contempló la adaptación y la pesquisa de validez semántica, y el segundo estudió el análisis psicométrico de la versión adaptada. Participaron del primer estudio tres especialistas y una muestra de trabajadores (n=20). Para el estudio psicométrico se recopilaron datos (n=467) en soporte electrónico y manual. Se estableció una equivalencia entre las versiones original y adaptada con evidencias de validez semántica. Se alcanzaron evidencias de validez basadas en la estructura interna y convergente. Dos de los tres índices de precisión estimados fueron satisfactorios. La versión brasileña de la referida escala pasó a llamarse WDS-BR.

Preceptorship in the perspective of comprehensive care: conversations with nurses / Preceptoría en la perspectiva de la integridad: hablando con enfermeros / Preceptoria na perspectiva da integralidade: conversando com enfermeiros

The aim of this study was to understand preceptorship in nursing practice fields and its association with comprehensive care. This study was based on qualitative field research conducted in Fortaleza, Ceará, Brazil, from April to June 2012. A total of 20 preceptors were interviewed in the practice fields of three higher education institutions at three public state hospitals and one basic health unit. Thematic analysis enabled apprehension of the theme 'preceptorship in the perspective of comprehensive care', and the empirical categories: (dis)articulation in teaching-service: distancing from academic institutions; welcoming students in the practice field. On the field, routine teaches: articulation in teaching-service from the preceptor's perspective. Results showed that teaching-service integration is at risk in light of biologicism and the gap between teaching institutions and health services, but that it is a way of constructing the necessary changes to consolidate the National Health Service.

El objetivo fue comprender la preceptoría en Enfermería y en campos de prácticas y su articulación con la integralidad de la atención. Investigación de campo cualitativa llevada a cabo en Fortaleza-Ceará, Brasil, de abril a junio de 2012. Fueron entrevistados 20 preceptores en campos de práctica de tres Instituciones de Enseñanza Superior en tres hospitales públicos y una unidad básica de Salud. El análisis temático aprendió el tema Preceptoría en la perspectiva de la integralidad, y las categorías empíricas: (des)integración de la enseñanza-servicio: el distanciamiento de la academia; acogimiento del estudiante en campo de prácticas; en el campo, la rutina enseña; integración enseñanza-servicio bajo la perspectiva del preceptor. Los resultados señalaron la integración enseñanza-servicio en situación de riesgo delante del biologicismo y brecha entre las instituciones de enseñanza y los servicios de salud, pero una manera de construir cambios necesarios para consolidación del Sistema Único de Salud.

Objetivou-se compreender a preceptoria em Enfermagem nos campos de práticas e sua articulação com a integralidade do cuidado. Pesquisa de campo qualitativa, realizada em Fortaleza, Ceará, Brasil, de abril a junho de 2012. Foram entrevistados 20 preceptores nos campos de prática de três Instituições de Ensino Superior em três hospitais da rede pública estadual e uma unidade básica de saúde. A análise temática permitiu a apreensão do tema Preceptoria, na perspectiva da integralidade, e as categorias empíricas: (des)integração do ensino serviço: o distanciamento da academia; o acolhimento do estudante no campo de práticas; no campo, a rotina ensina; a integração ensino-serviço sob a ótica do preceptor. Os resultados apresentaram a integração ensino-serviço em situações de risco mediante o biologicismo e a lacuna entre instituições de ensino e os serviços de saúde, porém como, caminho de construção para as transformações necessárias, a consolidação do Sistema Único de Saúde. .