External jugular vein hemangioma: case report.

Hemangioma is a common tumor, normally diagnosed in children, and accounting for almost 10% of benign neoplasms. A hemangioma arising from the wall of a vessel is rare, and must be differentiated from other vascular malformations of the same origin. We report a rare case of a hemangioma arising from the wall of an external jugular vein and discuss diagnostic work-up and management.

Nonparametric intensity bounds for the delineation of spatial clusters.

BACKGROUND: There is considerable uncertainty in the disease rate estimation for aggregated area maps, especially for small population areas. As a consequence the delineation of local clustering is subject to substantial variation. Consider the most likely disease cluster produced by any given method, like SaTScan, for the detection and inference of spatial clusters in a map divided into areas; if this cluster is found to be statistically significant, what could be said of the external areas adjacent to the cluster? Do we have enough information to exclude them from a health program of prevention? Do all the areas inside the cluster have the same importance from a practitioner perspective? RESULTS: We propose a method to measure the plausibility of each area being part of a possible localized anomaly in the map. In this work we assess the problem of finding error bounds for the delineation of spatial clusters in maps of areas with known populations and observed number of cases. A given map with the vector of real data (the number of observed cases for each area) shall be considered as just one of the possible realizations of the random variable vector with an unknown expected number of cases. The method is tested in numerical simulations and applied for three different real data maps for sharply and diffusely delineated clusters. The intensity bounds found by the method reflect the degree of geographic focus of the detected clusters. CONCLUSIONS: Our technique is able to delineate irregularly shaped and multiple clusters, making use of simple tools like the circular scan. Intensity bounds for the delineation of spatial clusters are obtained and indicate the plausibility of each area belonging to the real cluster. This tool employs simple mathematical concepts and interpreting the intensity function is very intuitive in terms of the importance of each area in delineating the possible anomalies of the map of rates. The Monte Carlo simulation requires an effort similar to the circular scan algorithm, and therefore it is quite fast. We hope that this tool should be useful in public health decision making of which areas should be prioritized.

O caminho do desenvolvimento de um aplicativo móvel para enfermeiros intensivistas sobre drogas cardioativas / The way to develop a mobile application for intensive care nurses about cardioactive drugs / La forma de desarrollar una aplicación móvil para enfermeras de cuidados intensivos sobre fármacos cardioactivos

Objetivo: Evidenciar as etapas do desenvolvimento de um aplicativo móvel para enfermeiros intensivistas sobre drogas cardioativas. Métodos: Trata-se de um estudo de desenvolvimento experimental de um aplicativo, realizado no período de setembro de 2019 a março de 2020. Para tal, foi constituído por duas etapas, a saber: metodológica, composta pela seleção e construção do conteúdo por dois pesquisadores, com posterior validação do conteúdo do aplicativo por 16 especialistas das áreas de enfermagem e farmácia; e tecnológica, realizada por um docente e quatro graduandos da área de computação, por meio da Plataforma Google Flutter, resultando no protótipo Cardio Help. Resultados: O aplicativo foi elaborado com 62 telas, sendo 02 (duas) telas principais (identificação do aplicativo; e apresentação dos cardioativos e o ícone de informações); 10(dez) telas secundárias (nome do cardiotônico e menu específico por cardiotônico (classificação/efeitos; uso terapêutico; eventos adversos; detalhes; interações medicamentosas e cuidados). Conclusão: Foram evidenciadas as etapas de desenvolvimento do aplicativo móvel sobre drogas cardioativas para enfermeiros intensivistas, que se apresenta como uma proposta promissora para a tomada de decisão e sobretudo com a finalidade de promover a segurança do paciente. (AU)

Objective: Show the stages of development of a mobile application for intensive care nurses about cardioactive drugs. Methods: This is an experimental development study of an application, carried out from September 2019 to March 2020. For this purpose, it consisted of two stages, namely: methodological, consisting of the selection and construction of the content by two researchers, with subsequent validation of the application's content by 16 specialists from the fields of nursing and pharmacy; and technological, carried out by a professor and four undergraduate students in the field of computing, through the Google Flutter Platform, resulting in the Cardio Help prototype. Results: The application was developed with 62 screens, being 02 (two) main screens (application identification; and presentation of cardioactive drugs and the information icon); 10 (ten) secondary screens (name of the cardiotonic and specific menu by cardiotonic (classification/effects; therapeutic use; adverse events; details; drug interactions and care). Conclusion: The stages of development of the mobile application on cardioactive drugs for nurses were highlighted intensivists, which presents itself as a promising proposal for decision-making and, above all, with the purpose of promoting patient safety. (AU)

Objetivo: Demostrar las etapas de desarrollo de una aplicación móvil para enfermeras de cuidados intensivos sobre fármacos cardioactivos. Métodos: Se trata de un estudio de desarrollo experimental de una aplicación, realizado entre septiembre de 2019 y marzo de 2020. Para ello, consta de dos etapas, a saber: metodológica, consistente en la selección y construcción de contenido por dos investigadores, con posterior validación del contenido de la aplicación por 16 especialistas de los campos de enfermería y farmacia; y tecnológico, realizado por un profesor y cuatro estudiantes de pregrado en el área de informática, a través de la plataforma Google Flutter, dando como resultado el prototipo Cardio Help. Resultados: La aplicación se desarrolló con 62 pantallas, siendo 02 (dos) pantallas principales (identificación de la aplicación; presentación de fármacos cardioactivos y el icono de información); 10 (diez) pantallas secundarias (nombre del cardiotónico y menú específico por cardiotónico (clasificación / efectos; uso terapéutico; eventos adversos; detalles; interacciones farmacológicas y cuidados). Conclusión: Las etapas de desarrollo de la aplicación móvil sobre fármacos cardioactivos para enfermeiras. Se destacaron los intensivistas, que se presenta como una propuesta prometedora para la toma de decisiones y, sobre todo, con el propósito de promover la seguridad del paciente. (AU)

Cell-permeant NAADP: a novel chemical tool enabling the study of Ca2+ signalling in intact cells.

NAADP (nicotinic acid adenine dinucleotide phosphate) is a recently discovered second messenger, and as such, we have much yet to learn about its functions in health and disease. A bottleneck in this basic research is due to NAADP, like all second messengers, being charged to prevent it from leaking out of cells. This makes for effective biology, but imposes difficulties in experiments, as it must be injected, loaded via liposomes, or electroporated, techniques that are highly technically demanding and are possible only in certain single cell preparations. For the better understood second messenger inositol 1,4,5-trisphosphate, great success has been obtained with cell-permeant derivatives where the charged groups are masked through esterification. We now report NAADP-AM as a cell-permeant analogue of NAADP that is taken up into cells and induces NAADP-mediated Ca(2+) signalling. NAADP-AM is a powerful chemical tool that will be of enormous biological utility in a wide range of systems and will greatly facilitate research into the role of NAADP in health and disease.

Fiscal Responsibility Law and expenditure on health personnel: an analysis of the condition of Brazilian municipalities from 2004 to 2009. / Lei de Responsabilidade Fiscal e as despesas com pessoal da saúde: uma análise da condição dos municípios brasileiros no período de 2004 a 2009.

The limits for expenditure on personnel that were imposed by the Fiscal Responsibility Act (FRA) have been considered by local health managers as an obstacle to health sector policies. This paper analyzes the linear trend for the personnel expenses indicators and the correlation of this with the profile of spending on health care personnel in 5,356 Brazilian municipalities from 2004 to 2009. The study of the time series used data from the 'Finanças do Brasil' (Finbra) and data from the Information System on Public Health Budgets (SIOPS). There was a trend towards an increase of 1.3% in the annual average of total personnel expenditure in the municipalities, but the cost of health care staff did not follow that growth. There were no correlations between the indicators, and this result is contrary to the arguments given by the health managers. They attribute the problems with hiring workers and the expansion of health systems to the FRA. The availability of data from the Finbra and the Siops system is associated with a lack of knowledge on these issues. This makes it an opportune time for conducting new research.

HbA1c levels in individuals heterozygous for hemoglobin variants.

OBJECTIVE:: To evaluate the levels of glycated hemoglobin (HbA1c) in patients heterozygous for hemoglobin variants and compare the results of this test with those of a control group. METHOD:: This was an experimental study based on the comparison of HbA1c tests in two different populations, with a test group represented by individuals heterozygous for hemoglobin variants (AS and AC) and a control group consisting of people with electrophoretic profile AA. The two populations were required to meet the following inclusion criteria: Normal levels of fasting glucose, hemoglobin, urea and triglycerides, bilirubin > 20 mg/dL and non-use of acetylsalicylic acid. 50 heterozygous subjects and 50 controls were evaluated between August 2013 and May 2014. The comparison of HbA1c levels between heterozygous individuals and control subjects was performed based on standard deviation, mean and G-Test. RESULTS:: The study assessed a test group and a control group, both with 39 adults and 11 children. The mean among heterozygous adults for HbA1c was 5.0%, while the control group showed a rate of 5.74%. Heterozygous children presented mean HbA1c at 5.11%, while the controls were at 5.78%. G-Test yielded p=0.93 for children and p=0.89 for adults. CONCLUSION:: Our study evaluated HbA1c using ion exchange chromatography resins, and the patients heterozygous for hemoglobin variants showed no significant difference from the control group.

[Homicides and social vulnerability]. / Homicídios e vulnerabilidade social.

UNLABELLED: The goal of this study was to analyze the spatial distribution of homicide rates (H) according to the social vulnerability index (SVI) and the quality of urban life index (QUL) in Betim, State of Minas Gerais, from 2006 to 2011. Descriptive analysis was performed using Moran's spatial correlation analysis, and the H, SVI and QUL spatial analyses. During this period there were 1,383 deaths, mostly of males (91.9%), aged 15-24 years (46.9%), brown/black (76.9%), with secondary education (51.1%), and single (83.9%). No spatial autocorrelation was revealed, indicating that the distribution of homicide rates is random; the same occurred with the SVI and the QUL index. Taken together, however, the H, SVI and QUL index overlapped, which was analyzed using different theories of crime, such as those addressing socioeconomic issues, arms of drugs dealing and Durkheim's and Habermas' theories, namely anomie and colonization of the lifeworld. CONCLUSION: social vulnerability and homicide are associated from both empirical and theoretical perspectives.

Inequalities in the spatial concentration of agricultural crops among the micro- and mesoregions of Minas Gerais, Brazil / Desigualdades na concentração espacial de culturas agrícolas entre as micro e mesorregiões de Minas Gerais, Brasil

ABSTRACT: The present research aimed to map and estimate the spatial autocorrelation of agricultural crops of coffee, corn, soybeans, sugarcane and beans in the state of Minas Gerais and analyzed in the period from 2011 to 2015. The planted area data were obtained of the Systematic Survey of Agricultural Production - IBGE. The Exploratory Spatial Data Analysis model was used to calculate spatial autocorrelation using the Global and Local Moran Index. Significant spatial self-correction was reported in all studied cultures (P-value <0.05). The regions with the highest concentration of planted area are located in the western portion of the state. The least significant planting regions were the municipalities located in the Jequitinhonha and Vale do Mucuri regions. The results pointed to a micro and mesoregional inequality in the distribution of agricultural activities in the mining territory that seems to reflect the incomplete agricultural modernization process that occurred in the state in the 70 s and 80 s.

RESUMO: O presente trabalho tem por objetivo mapear e estimar a autocorrelação espacial das culturas agrícolas de café, milho, soja, cana-de-açúcar e feijão no estado de Minas Gerais e analisadas no período de 2011 a 2015. Os dados de área plantada foram obtidos do Levantamento Sistemático da Produção Agrícola - IBGE. Empregou-se o modelo de Análise Exploratória de Dados Espacial com cálculo da autocorrelação espacial por meio do Índice de Moran Global e Local. Constatou-se autocorreção espacial significativa em todas as culturas estudadas (p-valor < 0,05). As regiões com maior concentração de área plantada estão localizadas na porção oeste do estado. As regiões de plantio menos expressivas foram dos municípios localizados na região do Jequitinhonha e Vale do Mucuri. Os resultados apontam para uma desigualdade micro e mesorregional da distribuição das atividades agrícolas no território mineiro, que parece refletir o processo de modernização agrícola incompleta que ocorreu no estado nas décadas de 70 e 80.

Efficacy of the superoxide dismutase mimetic tempol in animal hypertension models: a meta-analysis.

OBJECTIVE: Considering the growing body of evidence that indicates the contribution of superoxide anions (O2) and other reactive oxygen species (ROS) to the development of hypertension, we assessed whether animal models of hypertension have a benefic effect with tempol, a superoxide dismutase mimetic, to help augment the design of future studies. METHODS: Studies published between July 1998 and December 2012 on blood pressure (BP) in different hypertensive models were obtained after an electronic and manual search of PubMed. In-depth analyses of the methodological quality of the studies and the mean arterial pressure (MAP) changes after treatment with tempol were performed, as well as the subgroup analyses on the route of tempol delivery. RESULTS: Out of the 144 identified studies, 28 were included after screening. The data showed that tempol reduced MAP by computing the standardized mean difference with the value of 4.622 (95% confidence interval 3.24-5.99). The quality of studies included in the meta-analysis was category II; however, omission of details in the trials might have biased the results. There was substantial heterogeneity in the results with an I of 94.45%, which persisted after stratifying for the route of tempol delivery. CONCLUSION: In conclusion, this analysis shows that antioxidant treatment with tempol can reduce BP, suggesting that ROS plays a role in the pathogenesis of increased BP in the hypertension models used in the current research practice.

Updates in biological therapies for knee injuries: bone.

Bone is a unique tissue because of its mechanical properties, ability for self-repair, and enrollment in different metabolic processes such as calcium homeostasis and hematopoietic cell production. Bone barely tolerates deformation and tends to fail when overloaded. Fracture healing is a complex process that in particular cases is impaired. Osteoprogenitor cells proliferation, growth factors, and a sound tridimensional scaffold at fracture site are key elements for new bone formation and deposition. Mechanical stability and ample vascularity are also of great importance on providing a proper environment for bone healing. From mesenchymal stem cells delivery to custom-made synthetic scaffolds, many are the biological attempts to enhance bone healing. Impaired fracture healing represents a real burden to contemporary society. Sound basic science knowledge has contributed to newer approaches aimed to accelerate and improve the quality of bone healing.

Hemangioma de veia jugular externa: relato de caso / External jugular vein hemangioma: case report

Hemangioma é um tumor frequente, geralmente diagnosticado em crianças, constituindo quase 10% das neoplasias benignas. Um hemangioma com crescimento na parede de um vaso é extremamente raro, e deve ser diferenciado de outras malformações vasculares de mesma origem. Apresentamos um caso raro de hemangioma de veia jugular externa e discutimos sua propedêutica e manejo

Hemangioma is a common tumor, normally diagnosed in children, and accounting for almost 10% of benign neoplasms. A hemangioma arising from the wall of a vessel is rare, and must be differentiated from other vascular malformations of the same origin. We report a rare case of a hemangioma arising from the wall of an external jugular vein and discuss diagnostic work-up and management

Percepções dos adolescentes sobre a violência em um assentamento rural: uma análise qualitativa / Adolescents' perceptions of violence in a rural settlement: a qualitative analysis

RESUMO O objetivo deste artigo foi analisar as percepções de adolescentes de uma escola localizada em um assentamento rural, no município de Alto Paraíso de Goiás, em relação à violência. Realizou-se estudo qualitativo, utilizando-se entrevistas semiestruturadas. A sistematização e a interpretação dos dados foram realizadas pela análise de conteúdo definida por Bardin. Os adolescentes pesquisados relataram variadas formas de violência, por diversas causas, exercidas por diferentes atores, em diversos locais e acometendo todas as faixas etárias. Conclui-se que a escola e a família são fontes privilegiadas de mediações de conflitos, possibilitando uma atuação ampla no campo da prevenção da violência.

ABSTRACT The aim of this article was to analyse the perceptions of the adolescents, in a school located in a rural settlement, in the municipality of Alto Paraíso de Goiás, regarding violence. A qualitative study was carried out, using a semi-structured interview. The systematization and interpretation of the data were performed by the content analysis defined by Bardin. The adolescents surveyed identified several forms of violence, carried out by different actors, in different places, that affects all age groups, and has several causes. It is concluded that school and family are privileged sources of conflict mediation, making possible a broad action in the field of violence prevention.

Orientações sobre transferências na redução da intensidade da dor lombar crônica de cuidadores familiares em um ambulatório de cuidados paliativos: estudo piloto / Guidelines on transfers in the reduction of chronic low back pain intensity of family caregivers in a palliative care ambulatory: pilot study

Objetivo: Avaliar a eficácia de uma estratégia de orientações verbal e escrita sobre transferências na redução da dor lombar em cuidador familiar de pacientes em cuidados paliativos; o impacto no desempenho das tarefas diárias do cuidador antes e após a intervenção e se a adesão às orientações resultou em melhora clínica significativa da dor e do desempenho nas atividades. Método: Trata-se de ensaio clínico piloto, realizado no ambulatório de cuidados paliativos do HCFMUSP. Foram avaliados 4 cuidadores familiares divididos em dois grupos. O grupo intervenção recebeu orientação verbal e escrita e o grupo controle apenas orientação verbal. A análise dos dados foi realizada através de medida de proporção e análise de significância estatística pelo teste exato de Fisher. A correlação entre as variáveis será realizada através de regressão logística. Resultados: Houve dificuldade no recrutamento com influência direta no tamanho reduzido da amostra. Os resultados preliminares sobre a eficácia da intervenção para redução de dor e aumento de desempenho em cuidadores familiares não demonstraram significância estatística. A análise descritiva de aderência às recomendações aponta para uma tendência promissora quanto à viabilidade da intervenção educativa. Conclusão: A relevância deste ensaio piloto deve-se a avaliação preliminar do tempo necessário para se recrutar um número adequado de participantes e a tendência de boa aderência à intervenção. A dificuldade de recrutamento de pacientes em final de vida é previsível devido ao tempo reduzido de sobrevida e a complexidade do cuidado. A eficácia da intervenção somente poderá ser demonstrada com o ajuste do tamanho da amostra.

Objective: To evaluate the efficacy of strategy of verbal and written guidance on transference in the reduction of low back pain in the family caregiver of patients in palliative care; the impact on the performance of the daily tasks of the caregiver before and after the intervention and whether adherence to the guidelines resulted in a significant clinical improvement of pain and performance in the activities. Method: This is a pilot clinical trial, performed at the HCFMUSP palliative care outpatient. Four family caregivers were divided into two groups. The intervention group received verbal and written guidance and the group controlled verbal guidance. The analysis of the data was performed by measurement of proportion and analysis of statistical significance by the Fisher exact test. The correlation between the variables will be performed through logistic regression. Results: Due to the small sample size, preliminary results on the efficacy of the intervention to reduce pain and increase performance in family caregivers did not demonstrate statistical significance. The descriptive analysis of adherence to the recommendations points to a promising tendency towards the feasibility of the educational intervention. Conclusion: The relevance of this pilot test is due to the preliminary evaluation of the time needed to recruit an adequate number of participants and the tendency of good adherence to the intervention. The difficulty of recruiting end-of-life patients is predictable due to reduced survival time and the complexity of care. The effectiveness of the intervention can only be demonstrated by adjusting the sample size.

Violência e Atenção Primária à Saúde: percepções e vivências de profissionais e usuários / Violence and Primary Health Care: perceptions and experiences of professionals and users

RESUMO O presente estudo teve por objetivo comparar vivências e percepções de usuários e profissionais de saúde relativas à violência no âmbito da Atenção Primária à Saúde. Trata-se de um estudo transversal qualiquantitativo realizado em Ribeirão das Neves (Minas Gerais), no qual foram realizadas entrevistas semiestruturadas utilizando questionários aplicáveis a usuários (n=628), e autoaplicáveis a profissionais (n=300). Foi realizada análise descritiva- distribuição de frequência simples, cruzada e bivariada - e análise de correspondência, comparando as respostas de usuários e profissionais, armazenadas em 2 diferentes bancos de dados. A Análise de Conteúdo Categorial Temática possibilitou a construção de três categorias de análise - a partir das quais foram discutidos, de forma entrelaçada, os resultados quantitativos e qualitativos: 1) A violência como um problema de saúde; 2) Integralidade da Atenção; 3) Participação social. Nota-se que a violência permeia o cotidiano de vida e atuação de usuários e profissionais, comportando-se como um evento que merece aprofundamento por parte de quem sofre, convive e lida com o problema. Os espaços de participação social foram reconhecidos como estratégia importante de inserção da comunidade na discussão dos seus problemas. No entanto, usuários e profissionais diferem quanto ao papel da assistência à saúde na abordagem e no enfrentamento da violência. A atenção primária tem grande potencial de produzir atenção de qualidade, mas, ao que parece, não o realiza quando se trata da abordagem da violência.

ABSTRACT This study aimed to compare experiences and perceptions of users and health professionals on violence in the context of Primary Health Care. It is a cross-sectional study of qualitative and quantitative nature conducted in Ribeirão das Neves (Minas Gerais), in which semi-structured interviews were carried out using questionnaires applicable to users (n= 628) and self-administered to professionals (n=300). Descriptive analysis was performed - distribution of simple frequency, cross and bivariate - and correspondence analysis comparing the responses of users and professionals, stored in two different databases. The Thematic Categorical Content Analysis enabled the construction of three categories of analysis - from which were discussed and jointly, the quantitative and qualitative results: 1) Violence as a health problem; 2) Completeness of Care; 3) Social Participation. It is noted that violence permeates everyday life and activity of users and professionals, behaving as an event that deserves deepening by who is suffering, living and dealing with the problem. The social participation spaces were recognized as an important strategy of community inclusion in the discussion of their problems. However, users and professionals differ on the role of health care in addressing and violence. Primary care has great potential to produce quality of care but apparently does not accomplish it when deals with the violence approach.

Promoção de saúde, participação em ações coletivas e situação de violência entre usuários da Atenção Primária à Saúde / Health promotion, participation in collective actions and situation of violence among users of Primary Health Care

RESUMO Este artigo visa a analisar a relação entre a promoção de saúde, mensurada por meio da participação em ações coletivas, e a violência entre usuários das unidades de saúde da atenção primária, no município de Ribeirão das Neves (MG). Trata-se de estudo de abordagem quantitativa, cuja metodologia consiste de entrevistas semiestruturadas com usuários da atenção primária do município de Ribeirão das Neves (MG). A análise estatística foi baseada em tabelas de frequências absolutas e percentuais para as distribuições uni e bivariada, destacando-se o perfil sociodemográfico. As associações e suas significâncias estatísticas foram avaliadas por meio do teste Qui-quadrado e da análise de correspondência. Foram entrevistados 628 usuários de 58 Unidades Básicas de Saúde; as violências mais frequentes foram: verbal, psicológica e tentativa de suicídio. A participação em ações coletivas está predominantemente ligada a cultos religiosos. O desenvolvimento de ações de prevenção à violência na atenção primaria é baixo. Na análise de correspondência, a baixa frequência de ações coletivas se associou fortemente à presença de violência e à tentativa de suicídio. A presença de ações ligadas a atividades esportivas/artísticas se associa à ausência de violência verbal e sexual; a participação em associações/sindicatos se associa à ausência de violência psicológica, física e tentativa de suicídio; por fim, ações de trabalho voluntário se associam à ausência de violência sexual, ter parente assassinado e conhecer alguém que foi assassinado. Concluiu-se que a participação e a não participação em ações coletivas se associam, respectivamente, com menor e maior prevalência de violência.

ABSTRACT This article aims to analyze the relationship between health promotion, measured by means of participation in collective actions, and violence among users of primary health units, in the municipality of Ribeirão das Neves (MG). This is a quantitative approach study, whose methodology consists of semi-structured interviews with users of primary care of the municipality of Ribeirão das Neves (MG). The statistical analysis was based on absolute and frequency tables for univariate and bivariate distributions, highlighting the sociodemographic profile. The associations and their statistical significance were evaluated through Chi-square test and correspondence analysis. A total of 628 users from 58 Basic Health Units were interviewed; the most frequent violences were: verbal, psychological and attempted suicide. Participation in collective actions is predominantly linked to religious services. The development of actions to prevent violence in primary care is low. In the correspondence analysis, the low frequency of collective action was strongly associated to the presence of violence and suicide attempt. The presence of actions related to sports/art activities is associated with the absence of verbal and sexual violence; participation in associations/unions is associated with absence of psychological, physical and attempted suicide; finally, voluntary work actions are associated with lack of sexual violence, having a relative murdered and knowing someone who was murdered. It was concluded that participation and non-participation in collective actions are associated, respectively, with lower and higher prevalence of violence.

Atitudes e opiniões de profissionais envolvidos na atenção à mulher em situação de violência em 10 municípios brasileiros / Attitudes and opinions of professionals involved in the care to women in violence situation in 10 Brazilian cities

RESUMO Esta pesquisa objetivou analisar opiniões e atitudes de profissionais da rede de atenção às mulheres em situação de violência em 10 municípios brasileiros. Estudo transversal quantitativo, realizado mediante entrevistas semiestruturadas com os participantes de oficinas realizadas nos municípios em estudo, totalizando 438 sujeitos. Realizou-se análise descritiva com distribuição de frequências, análise bivariada e análise de correspondência. O número de profissionais que atenderam casos suspeitos é maior do que o número dos que atenderam casos confirmados de violência contra a mulher. Menos da metade dos profissionais que atenderam casos suspeitos adotou alguma atitude frente a eles. A adoção de alguma atitude pelos profissionais foi mais comum - embora também abaixo da metade para a maioria das ações - diante dos casos confirmados. Subnotificação ocorre nos casos suspeitos e nos casos confirmados. A maioria dos entrevistados considera ser papel do setor saúde desenvolver ações de prevenção da violência contra a mulher, com elevada proporção de respostas deixadas em branco. Conclui-se que falta muito para que a atenção à mulher em situação de violência seja devidamente ofertada; os profissionais rotineiramente encaminham mais do que abordam os casos, notificam pouco, não se sentem capacitados e, às vezes, sequer se veem como responsáveis por essa atenção.

ABSTRACT This research aimed to analyze opinions and attitudes of professionals of the network of care to women in violence situation in 10 Brazilian cities. It is a quantitative cross-sectional study, carried out through semi-structured interviews with the participants of the workshops in these cities, totaling 438 individuals. A descriptive analysis was performed with frequency distributions, bivariate analysis and correspondence analysis. The number of professionals working on the suspected cases is higher than the number of those working on the confirmed cases of violence against women. Less than half of the professionals who attended the suspected cases has taken action on the matter of the fact. The adoption of some attitudes by the professionals was more common - even also being less than half of the majority of actions - in the face of the confirmed cases. Underreporting occurs in suspected cases and confirmed cases. Most of the interviewed people consider to be responsibility of the public health sector to develop preventing actions toward violence against women, with a high rate of unanswered cases. It is concluded that there is a long way for care to women in violence situation to be properly offered; professionals routinely refer more than address the cases, they poorly report them, they do not feel qualified, and sometimes do not even see themselves as the responsible for this care.

Percepção dos Professores de Medicina de uma Escola Pública Brasileira em relação ao Sofrimento Psíquico de Seus Alunos / The Psychological Distress Suffered by Medical Students at a Brazilian Public University from the Viewpoint of their Teachers

RESUMO O sofrimento psíquico do estudante de Medicina é conhecido e já estudado. O papel do professor em detectar dificuldades geradoras de sofrimento psíquico em seus alunos e saber como lidar com elas é fundamental para a prevenção desse sofrimento. Entretanto, nem sempre os professores estão preparados para esses desafios. Objetivo: Estudar a percepção dos docentes do curso de Medicina da Universidade Federal de Minas Gerais (UFMG) em relação ao sofrimento psíquico de seus alunos. Método: Estudo transversal quantitativo realizado com os docentes do ciclo profissional do curso de Medicina da UFMG. A amostra de 102 docentes foi obtida por sorteio aleatório e dividida em quatro estratos: masculino até dez anos de docência, masculino com mais de dez anos, feminino com até dez anos de docência e feminino com mais de dez anos. Foi elaborado um questionário autoaplicativo de 28 itens com cinco opções da escala de Likert. Para análise dos dados foram construídos quatro indicadores: indicador de percepção de sofrimento psíquico (IPSP), indicador de compromisso do professor com as dificuldades emocionais do estudante (ICDE), indicador de atuação frente ao sofrimento psíquico (IAPS) e indicador geral (IG). Realizou-se análise dos quartis e calculou-se a diferença entre os grupos utilizando testes não paramétricos. Cinco questões não incluídas nos indicadores foram analisadas separadamente. Resultados: Dos 102 sorteados, 79 docentes responderam e sete se negaram a participar da pesquisa. Foi constatada preocupação com o sofrimento psíquico dos estudantes, variável entre os estratos. Para o IG, as professoras com mais tempo de docência obtiveram a mediana mais elevada em relação aos homens com menos tempo (p<0,05). Para os demais indicadores, apesar da diferença entre os quartis, a comparação das medianas não mostrou diferenças estatisticamente significativas. Para as perguntas não incluídas nos indicadores, do total de professores, 85% já tiveram alunos com dificuldades emocionais. Os homens, com maior frequência, afirmaram desconhecer a existência de problemas emocionais entre os estudantes. Houve desconhecimento das instâncias de acolhimento psicólogico aos estudantes por 16,5% dos professores. A ocorrência de bullying na FMUFMG não foi percebida por mais de 50% dos professores. Apenas 28% admitiram que seus atos ou atitudes teriam desencadeado sofrimento psíquico no estudante. Ao se perguntar sobre apoio ao professor, 75,9% desejavam uma instância de apoio emocional ao professor. Conclusão: Este estudo, apesar das limitações, é inédito ao avaliar a percepção do docente do curso de Medicina em relação ao sofrimento psíquico dos estudantes. Tempo de docência e sexo feminino parecem exercer um papel importante na percepção do docente sobre o sofrimento psíquico do estudante. Parcela significativa de professores desconhece a existência das instâncias de apoio psicológico aos estudantes. Situações de assédio e bullying na escola médica permanecem negadas por muitos docentes.

ABSTRACT The psychological distress suffered by medical students is well-known. The role of the teaching staff in detecting difficulties causing students psychological distress and their knowledge of how to handle them is fundamental for preventing such problems. However, medical teachers are not always prepared to deal with these challenges. Objective: To study the perception of the teaching staff of the medical school at the Universidade Federal de Minas Gerais (FMUFMG) concerning the psychological distress of the students. Method: A cross-sectional quantitative study carried out with the faculty of the UFMG medical school. The sample of 102 teachers was obtained by random draw and divided into four groups: males with up to ten (10) years of teaching, males with more than ten (10) years, females with up to ten (10) years of teaching, and females with more than ten (10)years. A self-applied 28-item questionnaire with a 5-point Likert scale from strongly agree to strongly disagree was prepared. For the data analysis four indicators were elaborated: psychological distress perception indicator (IPSP), commitment of the teacher to the student emotional difficulties indicator (ICDE), performance in the face of psychological distress indicator (IAPS) and a general indicator (IG). Quartile analysis was carried out and the difference among the groups was calculated using nonparametric tests. Five questions that were not included in the indicators were independently analyzed. Results: Seven teachers refused to participate and 79 answers were collected. The results showed varying degrees of concern among the groups in relation to the psychological distress of students. For the IG, the female teachers with longer teaching experience obtained a higher median in relation to the men with less teaching experience (p<0.05). For the other indicators, despite the difference between the quartiles, the comparison of the medians showed no statistically significant differences. For questions not included in the indicators, it was shown that 85% of the sample had perceived psychological distress among their students. Male teachers more frequently deny psychological distress among students. 16.5% of the teachers did not know of any instances of institutional psychological care. The occurrence of bullying failed to be noted by more than 50% of the teachers. Only 28% of the teachers admitted that their actions or attitudes could precipitate a student's psychological distress. When questioned about emotional support for teachers, 75.9% would appreciate some institutional support. Conclusion: The present study, despite its limitations, is unique in assessing the perception of the medical teaching staff in relation to the psychological distress of the students. Teaching experience and being female seem to play an important role in the teacher's perception of psychological distress among students. A significant portion of the teaching staff ignores the existence of psychological support programs for students.

[ARTIGO RETRATADO] Percepção dos Professores de Medicina de uma Escola Pública Brasileira em relação ao Sofrimento Psíquico de Seus Alunos / [RETRACTED ARTICLE] The Psychological Distress Suffered by Medical Students at a Brazilian Public university from the Viewpoint of their Teachers

RESUMO O sofrimento psíquico do estudante de Medicina é conhecido e já estudado. O papel do professor em detectar dificuldades geradoras de sofrimento psíquico em seus alunos e saber como lidar com elas é fundamental para a prevenção desse sofrimento. Entretanto, nem sempre os professores estão preparados para esses desafios. Objetivo: Estudar a percepção dos docentes do curso de Medicina da Universidade Federal de Minas Gerais (UFMG) em relação ao sofrimento psíquico de seus alunos. Método: Estudo transversal quantitativo realizado com os docentes do ciclo profissional do curso de Medicina da UFMG. A amostra de 102 docentes foi obtida por sorteio aleatório e dividida em quatro estratos: masculino até dez anos de docência, masculino com mais de dez anos, feminino com até dez anos de docência e feminino com mais de dez anos. Foi elaborado um questionário autoaplicativo de 28 itens com cinco opções da escala de Likert. Para análise dos dados foram construídos quatro indicadores: indicador de percepção de sofrimento psíquico (IPSP), indicador de compromisso do professor com as dificuldades emocionais do estudante (ICDE), indicador de atuação frente ao sofrimento psíquico (IAPS) e indicador geral (IG). Realizou-se análise dos quartis e calculou-se a diferença entre os grupos utilizando testes não paramétricos. Cinco questões não incluídas nos indicadores foram analisadas separadamente. Resultados: Dos 102 sorteados, 79 docentes responderam e sete se negaram a participar da pesquisa. Foi constatada preocupação com o sofrimento psíquico dos estudantes, variável entre os estratos. Para o IG, as professoras com mais tempo de docência obtiveram a mediana mais elevada em relação aos homens com menos tempo (p < 0,05). Para os demais indicadores, apesar da diferença entre os quartis, a comparação das medianas não mostrou diferenças estatisticamente significativas. Para as perguntas não incluídas nos indicadores, do total de professores, 85% já tiveram alunos com dificuldades emocionais. Os homens, com maior frequência, afirmaram desconhecer a existência de problemas emocionais entre os estudantes. Houve desconhecimento das instâncias de acolhimento psicólogico aos estudantes por 16,5% dos professores. A ocorrência de bullying na FMUFMG não foi percebida por mais de 50% dos professores. Apenas 28% admitiram que seus atos ou atitudes teriam desencadeado sofrimento psíquico no estudante. Ao se perguntar sobre apoio ao professor, 75,9%desejavam uma instância de apoio emocional ao professor. Conclusão: Este estudo, apesar das limitações, é inédito ao avaliar a percepção do docente do curso de Medicina em relação ao sofrimento psíquico dos estudantes. Tempo de docência e sexo feminino parecem exercer um papel importante na percepção do docente sobre o sofrimento psíquico do estudante. Parcela significativa de professores desconhece a existência das instâncias de apoio psicológico aos estudantes. Situações de assédio e bullying na escola médica permanecem negadas por muitos docentes.

ABSTRACT The psychological distress suffered by medical students is well-known. The role of the teaching staff in detecting difficulties causing students psychological distress and their knowledge of how to handle them is fundamental for preventing such problems. However, medical teachers are not always prepared to deal with these challenges. Objective: To study the perception of the teaching staff of the medical school at the Universidade Federal de Minas Gerais (FMUFMG) concerning the psychological distress of the students. Method: A cross-sectional quantitative study carried out with the faculty of the UFMG medical school. The sample of 102 teachers was obtained by random draw and divided into four groups: males with up to ten (10) years of teaching, males with more than ten (10) years, females with up to ten (10) years of teaching, and females with more than ten (10)years. A self-applied 28-item questionnaire with a 5-point Likert scale from strongly agree to strongly disagree was prepared. For the data analysis four indicators were elaborated: psychological distress perception indicator (IPSP), commitment of the teacher to the student emotional difficulties indicator (ICDE), performance in the face of psychological distress indicator (IAPS) and a general indicator (IG). Quartile analysis was carried out and the difference among the groups was calculated using nonparametric tests. Five questions that were not included in the indicators were independently analyzed. Results: Seven teachers refused to participate and 79 answers were collected.The results showed varying degrees of concern among the groups in relation to the psychological distress of students. For the IG, the female teachers with longer teaching experience obtained a higher median in relation to the men with less teaching experience (p<0.05). For the other indicators, despite the difference between the quartiles, the comparison of the medians showed no statistically significant differences. For questions not included in the indicators, it was shown that 85% of the sample had perceived psychological distress among their students. Male teachers more frequently deny psychological distress among students. 16.5% of the teachers did not know of any instances of institutional psychological care. The occurrence of bullying failed to be noted by more than 50% of the teachers. Only 28% of the teachers admitted that their actions or attitudes could precipitate a student's psychological distress. When questioned about emotional support for teachers, 75.9% would appreciate some institutional support. Conclusion: The present study, despite its limitations, is unique in assessing the perception of the medical teaching staff in relation to the psychological distress of the students. Teaching experience and being female seem to play an important role in the teacher's perception of psychological distress among students. A significant portion of the teaching staff ignores the existence of psychological support programs for students.

[The public healthcare system in the context of Brazil's demographic transition: current and future demands]. / Assistência pública de saúde no contexto da transição demográfica brasileira: exigências atuais e futuras.

This paper assesses inpatient and outpatient care and their capacity to respond to changing demands in the context of the demographic transition in Brazil. The data were obtained from studies by the Brazilian Institute of Geography and Statistics (IBGE) and databases in the National Health System (CNES, SIH, and SIA). The reduction in birth, fertility, and infant mortality rates and the increase in life expectancy at birth are still driving population growth, while decreasing the dependency rate, thereby providing the opportunity to make necessary adjustments. The population increased by more than 27.5 million from 1999 to 2009, with a 26.7% reduction in hospital beds and 947,000 hospitalizations, with distortions in the distribution by specialty, but with increases in high-complexity outpatient and inpatient care. The results show that Brazil is undergoing a transition in the healthcare model, requiring greater capacity for future planning of a more complex system and revising the model to prepare for a larger elderly population in the coming decades.

Lei de Responsabilidade Fiscal e as despesas com pessoal da saúde: uma análise da condição dos municípios brasileiros no período de 2004 a 2009 / Fiscal Responsibility Law and expenditure on health personnel: an analysis of the condition of Brazilian municipalities from 2004 to 2009

Resumo Os limites para as despesas com pessoal impostos pela Lei de Responsabilidade Fiscal (LRF) têm sido apontados pelos gestores municipais de saúde como obstáculo à política do setor. O artigo analisa a tendência linear dos indicadores de despesas com pessoal e a correlação deste com o perfil de gastos com pessoal da saúde de 5.356 municípios brasileiros, entre 2004 e 2009. O estudo, de série temporal, recorreu aos dados do Finanças do Brasil (Finbra) e do Sistema de Informações sobre Orçamentos Públicos em Saúde (Siops). Observou-se uma tendência de aumento de 1,3% nas médias anuais da despesa total com pessoal dos municípios, porém as despesas com pessoal da saúde não acompanharam esse crescimento. Não houve correlação entre os indicadores, portanto, esse resultado se opõe aos argumentos dos gestores de saúde, que atribuem à LRF os problemas para contratação de trabalhadores e expansão dos sistemas de saúde. A disponibilidade de dados dos sistemas Finbra e Siops associado à carência de conhecimento sobre o assunto tornam oportunas novas pesquisas.

Abstract The limits for expenditure on personnel that were imposed by the Fiscal Responsibility Act (FRA) have been considered by local health managers as an obstacle to health sector policies. This paper analyzes the linear trend for the personnel expenses indicators and the correlation of this with the profile of spending on health care personnel in 5,356 Brazilian municipalities from 2004 to 2009. The study of the time series used data from the ‘Finanças do Brasil’ (Finbra) and data from the Information System on Public Health Budgets (SIOPS). There was a trend towards an increase of 1.3% in the annual average of total personnel expenditure in the municipalities, but the cost of health care staff did not follow that growth. There were no correlations between the indicators, and this result is contrary to the arguments given by the health managers. They attribute the problems with hiring workers and the expansion of health systems to the FRA. The availability of data from the Finbra and the Siops system is associated with a lack of knowledge on these issues. This makes it an opportune time for conducting new research.