Biological and Molecular Docking Evaluation of a Benzylisothiocyanate Semisynthetic Derivative From Moringa oleifera in a Pre-clinical Study of Temporomandibular Joint Pain.

Objective: Moringa oleifera possesses multiple biological effects and the 4-[(4'-O-acetyl-α-L- rhamnosyloxy) benzyl] isothiocyanate accounts for them. Based on the original isothiocyanate molecule we obtained a semisynthetic derivative, named 4-[(2',3',4'-O-triacetyl-α-L-rhamnosyloxy) N-benzyl] hydrazine carbothioamide (MC-H) which was safe and effective in a temporomandibular joint (TMJ) inflammatory hypernociception in rats. Therefore, considering that there is still a gap in the knowledge concerning the mechanisms of action through which the MC-H effects are mediated, this study aimed to investigate the involvement of the adhesion molecules (ICAM-1, CD55), the pathways heme oxygenase-1 (HO-1) and NO/cGMP/PKG/K+ ATP, and the central opioid receptors in the efficacy of the MC-H in a pre-clinical study of TMJ pain. Methods: Molecular docking studies were performed to test the binding performance of MC-H against the ten targets of interest (ICAM-1, CD55, HO-1, iNOS, soluble cGMP, cGMP-dependent protein kinase (PKG), K+ ATP channel, mu (µ), kappa (κ), and delta (δ) opioid receptors). In in vivo studies, male Wistar rats were treated with MC-H 1 µg/kg before TMJ formalin injection and nociception was evaluated. Periarticular tissues were removed to assess ICAM-1 and CD55 protein levels by Western blotting. To investigate the role of HO-1 and NO/cGMP/PKG/K+ ATP pathways, the inhibitors ZnPP-IX, aminoguanidine, ODQ, KT5823, or glibenclamide were used. To study the involvement of opioid receptors, rats were pre-treated (15 min) with an intrathecal injection of non-selective inhibitor naloxone or with CTOP, naltrindole, or norbinaltorphimine. Results: All interactions presented acceptable binding energy values (below -6.0 kcal/mol) which suggest MC-H might strongly bind to its molecular targets. MC-H reduced the protein levels of ICAM-1 and CD55 in periarticular tissues. ZnPP-IX, naloxone, CTOP, and naltrindole reversed the antinociceptive effect of MC-H. Conclusion: MC-H demonstrated antinociceptive and anti-inflammatory effects peripherally by the activation of the HO-1 pathway, as well as through inhibition of the protein levels of adhesion molecules, and centrally by µ and δ opioid receptors.

Factor VIII prophylactic therapy reduces neurological complications in patients with Hemophilia A.

BACKGROUND: Bleeding in hemophiliacs can cause complications in the central and peripheral nervous system (CNS and PNS). The incidence of intracranial hemorrhage has reduced after the introduction of prophylactic treatment with factor VIII or IX, but the benefits of this therapy have not yet been evaluated on PNS complications. OBJECTIVE: The aim of this study was to determine the prevalence of neurological complications in hemophiliacs and verify the effect of prophylactic therapy in these patients, including PNS disorders. METHODS: We retrospectively evaluated the prevalence of CNS and PNS disorders caused by bleeding in hemophiliacs seen at the Hemocentro Regional Norte, Ceará, Brazil, from 1992 to 2018, and we compared the incidence in different periods (before and after the introduction of prophylactic treatment in 2011). RESULTS: Of 75 hemophilia A patients evaluated (4.61/100.000 population), 13.3% (n=10) had either CNS (n=5) or PNS (n=5) disorders secondary to bleeding. Patients submitted to factor VIII replacement prophylactic therapy were less likely to have CNS events: from 1992 to 2011, 5 of 63 patients had CNS disease, while from 2011 to 2018, there were no new cases (p=0.0181). From 2011 to 2018, 5 PNS events occurred in patients without prophylactic therapy, whereas none occurred in those covered by prophylactic therapy (5/20 versus 0/29, p=0.0081). CONCLUSIONS: The prevalence of neurological complications in hemophiliacs in our cohort is similar to other studies. Similar to CNS, prophylactic therapy also reduces the risk of PNS complications. This is the first report in the literature showing this benefit.

Factor VIII prophylactic therapy reduces neurological complications in patients with Hemophilia A / Terapia profilática com Fator VIII reduz complicações neurológicas em paciente com Hemofilia A

ABSTRACT Background: Bleeding in hemophiliacs can cause complications in the central and peripheral nervous system (CNS and PNS). The incidence of intracranial hemorrhage has reduced after the introduction of prophylactic treatment with factor VIII or IX, but the benefits of this therapy have not yet been evaluated on PNS complications. Objective: The aim of this study was to determine the prevalence of neurological complications in hemophiliacs and verify the effect of prophylactic therapy in these patients, including PNS disorders. Methods: We retrospectively evaluated the prevalence of CNS and PNS disorders caused by bleeding in hemophiliacs seen at the Hemocentro Regional Norte, Ceará, Brazil, from 1992 to 2018, and we compared the incidence in different periods (before and after the introduction of prophylactic treatment in 2011). Results: Of 75 hemophilia A patients evaluated (4.61/100.000 population), 13.3% (n=10) had either CNS (n=5) or PNS (n=5) disorders secondary to bleeding. Patients submitted to factor VIII replacement prophylactic therapy were less likely to have CNS events: from 1992 to 2011, 5 of 63 patients had CNS disease, while from 2011 to 2018, there were no new cases (p=0.0181). From 2011 to 2018, 5 PNS events occurred in patients without prophylactic therapy, whereas none occurred in those covered by prophylactic therapy (5/20 versus 0/29, p=0.0081). Conclusions: The prevalence of neurological complications in hemophiliacs in our cohort is similar to other studies. Similar to CNS, prophylactic therapy also reduces the risk of PNS complications. This is the first report in the literature showing this benefit.

RESUMO Antecedentes: O sangramento em hemofílicos causa complicações no sistema nervoso central e periférico (SNC e SNP). A incidência de hemorragia intracraniana diminuiu após a introdução da profilaxia com fator VIII ou IX, entretanto esse benefício ainda não foi avaliado no SNP. Objetivo: O objetivo deste estudo foi determinar a prevalência de complicações neurológicas em hemofílicos, verificando o efeito da terapia profilática também no SNP. Métodos: Avaliamos retrospectivamente a prevalência de complicações neurológicas causadas ​​por sangramentos em hemofílicos atendidos no Hemocentro Regional Norte, Ceará, Brasil, de 1992 a 2018, comparando a incidência em diferentes períodos (antes e depois da introdução do tratamento profilático em 2011). Resultados: Foram avaliados 75 pacientes com hemofilia A (4,61/100 mil habitantes). Deles, 13,3% (n=10) tinham distúrbios do SNC (n=5) ou do SNP (n=5) secundários a hemorragias. Os pacientes submetidos à terapia profilática com fator VIII apresentaram menor probabilidade de eventos do SNC: de 1992 a 2011, cinco de 63 pacientes apresentaram hemorragia no SNC, enquanto de 2011 a 2018 não ocorreram novos casos (p=0,0181). De 2011 a 2018, cinco eventos no SNP ocorreram entre pacientes sem terapia profilática, e nenhum ocorreu entre aqueles cobertos pela profilaxia (5/20 × 0/29, p=0,0081). Conclusões: A prevalência de complicações neurológicas em hemofílicos em nossa coorte é similar à de outros estudos. Assim como no SNC, a terapia profilática também reduz o risco de complicações no SNP. Este é o primeiro relato na literatura a mostrar esse benefício.

High Frequency of Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae Nosocomial Strains Isolated from a Teaching Hospital in Brazil.

The aim of this study was to investigate the frequency, antimicrobial sensitivity profile, and genetic characteristics of nosocomial strains of extended-spectrum ß-lactamase (ESBL)-producing Klebsiella pneumoniae isolated from inpatients at a teaching hospital in Brazil. The bacterial identification, phenotypic detection of ESBL, and antimicrobial susceptibility profile were performed by the VITEK 2 automated system. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) mass spectrometry was used to confirm the identity of the species and genotyping of ESBL-producing K. pneumoniae was performed by pulsed-field gel electrophoresis (PFGE). Thirty-six ESBL-producing K. pneumoniae nosocomial strains isolated from November 2013 to August 2014 were analyzed. High resistance rates were observed for ceftriaxone, ceftazidime, cefepime, gentamicin, and ciprofloxacin. However, all isolates were susceptible to amikacin and meropenem. All strains harbored blaCTX-M-like and blaSHV-like genes. Molecular typing by PFGE showed a diversity of genotypes distributed among 25 clusters, but two isolates collected in different wards had the same genotypic profile and carried the same bla genes, so they were considered clones. The data showed that there was a high frequency of ESBL-producing K. pneumoniae multidrug-resistant among patients in the studied hospital. Furthermore, the detection of blaCTX-M-like genes in all isolates suggests that these enzymes are the major ESBL responsible for the beta-lactam resistance phenotypes among the analyzed strains.

Tocoyena sellowiana extract decreases bone loss in an experimental model of periodontitis in rats: Putative role for cyclooxygenase-2 and IL-1? inhibition.

Tocoyena sellowiana (Cham. & Schltdl.) K.Schum is one of the most important families of Brazilian medicinal plants. This study aimed to evaluate the effect of Tocoyena sellowiana (Cham. & Schltdl.) K.Schum ethanolic extract in a pre-clinical trial of periodontitis and to investigate possible mechanisms underlying such effects. Periodontitis was induced in Wistar rats by placing a nylon thread ligature around second upper left molars for 11 days. Rats received (per os) Tocoyena sellowiana (0.1, 1 or 10?mg?kg) or vehicle 1?h before ligature and daily until day 11. Macroscopic, histopathological, and COX-2 immunohistochemical analyses were performed to evaluate the periodontium. The gingival tissue was used to quantify the myeloperoxidase (MPO) activity and interleukin (IL)-1? levels by ELISA. Blood samples were collected to evaluate bone-specific alkaline phosphatase (BALP), the dosage of creatinine, aspartate and alanine transaminases. The liver, kidneys, spleen, and body mass variations were also evaluated. Tocoyena sellowiana decreased bone loss, reduced MPO, IL-1? levels as well as COX-2 immunostaining, and increased BALP activity. Moreover, Tocoyena sellowiana did not alter organs nor body weight. Tocoyena sellowiana reduced bone loss in rats and its efficacy was at least partially dependent upon both IL-1? and cyclooxygenase-2 inhibition.

The efficacy of a lectin from Abelmoschus Esculentus depends on central opioid receptor activation to reduce temporomandibular joint hypernociception in rats.

Abelmoschus esculentus is largely cultivated in Northeastern Brazil for medicinal purposes, e.g. inflammatory conditions. This study aimed to evaluate the efficacy of Abelmoschus esculentus lectin (AEL) in reducing formalin-induced temporomandibular joint inflammatory hypernociception in rats. The behavioral experiments were performed in male Wistar rats (180-240 g). Rats were pre-treated (i.v.) with AEL (0.001, 0.01 or 0.1 mg/kg) 30 min before formalin injection (i.art.). To analyze the possible effect of opioid pathways on AEL efficacy, animals were pre-treated with naloxone or CTOP (µ opioid receptor antagonist), naltrindole (δ opioid receptor antagonist) or nor-binaltorphimine (κ opioid receptor antagonist) (i.t.) 15 min before AEL administration followed by intra-TMJ injection of 1.5% formalin. Animals were monitored for a 45-min observation period. TMJ tissue, trigeminal ganglion, and subnucleus caudalis were collected for TNF-α dosage (ELISA). In addition, the vascular permeability was evaluated by Evans Blue extravasation. AEL significantly reduced formalin-induced TMJ inflammatory hypernociception and decreased Evans blue extravasation. It decreased TNF-α levels in the TMJ tissue, trigeminal ganglion, and subnucleus caudalis. AEL antinociceptive effects were not observed in the presence of naltrindole or nor-binaltorphimine, suggesting that AEL efficacy depends on TNF-α inhibition and the activation of δ and κ opioid receptors. AEL has provided prominent analgesic and anti-inflammatory effects in this pre-clinical model of TMJ, supporting its possible use as a pharmacological tool for the management of painful conditions.

Antinociceptive, anti-inflammatory and toxicological evaluation of semi-synthetic molecules obtained from a benzyl-isothiocyanate isolated from Moringa oleifera Lam. in a temporomandibular joint inflammatory hypernociception model in rats.

Inflammation is a key component of many clinical conditions that affect the temporomandibular joint (TMJ) and Moringa oleifera Lam. has been used to treat inflammatory diseases. Here, we evaluated the toxicological effects on mice of a naturally-occurring isothiocyanate from M. oleifera and its seven analogue molecules. Further, the anti-nociceptive and anti-inflammatory effects on a rat model of TMJ inflammatory hypernociception were assessed. The systemic toxicological profile was determined in mice over a 14-day period: MC-1 1 µg/kg; MC-D1 1 µg/kg, MC-D3 100 µg/kg, MC-D6 1 µg/kg, MC-D7 1 µg/kg, MC-D8 1 µg/kg, MC-D9 10 µg/kg, and MC-H 1 µg/kg. The safest molecules were assayed for anti-nociceptive efficacy in the formalin (1.5%, 50 µL) and serotonin (255 mg) induced TMJ inflammatory hypernociception tests. The anti-inflammatory effect was evaluated through the vascular permeability assay using Evans blue. Further, the rota-rod test evaluated any motor impairment. Among the tested molecules, MC-D7, MC-D9, and MC-H were not toxic at the survival rate test, biochemical, and hystological analysis. They reduced the formalin-induced TMJ inflammatory hypernociception, but only MC-H decreased the serotonin-induced TMJ inflammation, suggesting an adrenergic receptor-dependent effect. They diminished the plasmatic extravasation, showing anti-inflammatory activity. At the rota-rod test, no difference was observed in comparison with control groups, reinforcing the hypothesis of anti-nociceptive effetc without motor impairment in animals. The analogues MC-D7, MC-D9, and MC-H were safe at the tested doses and efficient in reducing the formalin-induced TMJ hypernociception in rats. Our next steps include determining their mechanisms of anti-nociceptive action.

Proposta e validação de um protocolo de triagem para identificar as manifestações fonoaudiológicas na hanseníase / Proposal and validation of a screening Protocol for Identifying Speech, Language and Hearing Manifestations in Leprosy / Propuesta y validación de un Protocolo de Selección para la Identificación de Manifestaciones Fonoaudiológicas de la Lepra

Objetivo: Propor e validar o conteúdo do protocolo de triagem para identificação das manifestações fonoaudiológicas na hanseníase. Métodos: Este estudo foi organizado em duas fases: pesquisa bibliográfica para subsidiar a construção do instrumento de triagem e posterior avaliação da adequação do conteúdo por um painel de especialistas. Para avaliar a relevância/ representatividade das respostas, utilizou-se o Índice de Validade de Conteúdo (IVC) com concordância mínima de 90%. Resultados: A leitura do material resultou na construção de um instrumento de 18 itens, abrangendo quatro seções: audiologia, voz, deglutição e fala/motricidade orofacial. A etapa seguinte constou da análise da representatividade dos itens do protocolo pelos juízes. Após a primeira análise, a validação do conteúdo resultou na permanência de dez com IVC total de 100%. Conclusão: O protocolo de triagem foi considerado um instrumento válido para identificar as manifestações fonoaudiológicas na hanseníase.

Objective: To propose and validate the content of a screening protocol for identifying speech, language and hearing manifestations in leprosy. Methods: This study was organized into two phases: bibliographic research to support the development of the screening instrument and subsequent evaluation of the adequacy of the content by a panel of experts. The relevance/representativeness of the responses was evaluated using the Content Validity Index (CVI) with a minimum agreement of 90%. Results: The reading of the material resulted in the development of an instrument with 18 items covering four sections: audiology, voice, swallowing and speech/orofacial motricity. The next phase consisted of the analysis of the representativeness of the protocol items by the judges. After the first analysis, the content validation resulted in ten items with CVI of 100%. Conclusion: The screening protocol was considered a valid instrument for the identification of speech, language and hearing manifestations in leprosy.

Objetivo: Proponer y validar el contenido del protocolo de selección para la identificación de las manifestaciones fonoaudiológicas de la lepra. Métodos: Este estudio fue organizado en dos fases: la investigación bibliográfica para subsidiar la construcción del instrumento de selección seguida de la evaluación de la adecuación del contenido a través de un panel de especialistas. Para valorar la relevancia/representatividad de las respuestas se utilizó el Índice de Validad de Contenido (IVC) con concordancia mínima del 90%. Resultados: La lectura del material ha resultado en la construcción de un instrumento de 18 ítems involucrando cuatro secciones: audiología, voz, deglución y habla/motricidad orofacial. La etapa siguiente fue el análisis de la representatividad de los ítems del protocolo de parte de los jueces. Tras el primer análisis la validación del contenido ha resultado em la permanencia de diez con IVC totalizando el 100%. Conclusión: El protocolo de selección fue considerado un instrumento válido para la identificación de las manifestaciones fonoaudiológicas de la lepra.

Atendimento à Lei Arouca no Ensino de Farmacologia no Curso de Medicina, UFC, Sobral / Compliance with Arouca’s Law in Teaching Pharmacology at the UFC Medical School, Sobral

RESUMO De acordo com a Lei Arouca (Lei n° 11.794 – 2008), que estabelece critérios para “a criação e a utilização de animais em atividades de ensino e pesquisa científica, em todo o território nacional”, tem-se que, “sempre que possível, as práticas de ensino deverão ser fotografadas, filmadas ou gravadas, de forma a permitir sua reprodução para ilustração de práticas futuras, evitando-se a repetição desnecessária de procedimentos didáticos com animais”. O objetivo deste estudo foi relatar o desenvolvimento de um software (Pharmasoftware®) como método alternativo de ensino em Farmacologia no curso de Medicina da Universidade Federal do Ceará (UFC), Campus Sobral. Para a certificação, foram utilizados dois grupos de alunos, um em aula prática convencional e outro com o Pharmasoftware®. A análise dos resultados revelou que ambas as atividades foram igualmente eficazes em auxiliar na consolidação do tema Vias de Administração dos Fármacos, evidenciando, assim, o Pharmasoftware® como uma ferramenta capaz de auxiliar no ensino da Farmacologia e, ainda, de fomentar a implantação de outros métodos alternativos de ensino de Farmacologia nas Instituições de Ensino Superior.

ABSTRACT The Brazilian Law on scientific and teaching use of animals, Arouca’s Law (n° 11.794 – 2008), clearly states that animals should not be used if an alternative method is available. The aim of this study was to describe the development of a software (Pharmasoftware®) as an alternative method of teaching in pharmacology at a Medical School (Federal University of Ceara, Campus Sobral). To support the development and validation of the Pharmasoftware® as an alternative method, students were allocated into two groups: one attending a conventional practical class and the other employing Pharmasoftware®. The results showed that two activities were equally effective in improving the students’ knowledge of drug administration. Pharmasoftware® may therefore represent a tool capable of supporting pharmacology teaching and it also fostering the establishment of alternative methods for teaching Pharmacology in the undergraduate courses.

[Evaluation of the accessibility to the Specialized Dental Care Center within the scope of the macro region of Sobral, in the state of Ceará, Brazil]. / Avaliação da acessibilidade ao Centro de Especialidades Odontológicas de abrangência macrorregional de Sobral, Ceará, Brasil.

The Specialized Dental Care Center for the region of Sobral in the state of Ceará (CEO-R) has characteristics that render it unique, as it has regional coverage and is managed by a Local Health Consortium (which comprises 24 cities). It also works in conjunction with the School of Dentistry of the Federal University of Ceará - Sobral Campus, combining care and academic study in the same location. The scope of this article was to evaluate the accessibility to specialized care in this region with the implementation of this CEO-R. A descriptive-exploratory study with a quantitative approach was conducted by means of the collection and analysis of secondary data regarding the availability and usage of this service in addition to the application of semi-structured interviews with Oral Health Coordinators of the 24 municipalities in the consortium. The results showed that the CEO-R is equipped to meet the demand. However, geographic, financial and organizational barriers were detected, which explains the low rates of appointments scheduled and use of the services and the high rate of missed appointments, causing a significant financial impact on the cities included in the consortium.

Avaliação da acessibilidade ao Centro de Especialidades Odontológicas de abrangência macrorregional de Sobral, Ceará, Brasil / Evaluation of the accessibility to the Specialized Dental Care Center within the scope of the macro region of Sobral, in the state of Ceará, Brazil

O Centro de Especialidades Odontológicas Regional de Sobral (CEO-R), no Ceará, possui características que o tornam único: tem abrangência regional, é administrado por um Consórcio intermunicipal de Saúde (totalizando 24 municípios) e funciona juntamente com o Curso de Odontologia da Universidade Federal do Ceará - Campus Sobral, congregando no mesmo espaço serviço e academia. O objetivo desta pesquisa foi avaliar a acessibilidade à atenção especializada nesta região após a implantação do CEO-R Sobral. Foi realizado um estudo exploratoìrio-descritivo, com abordagem quantitativa, por meio da coleta e análise de dados secundários de oferta e utilização desse serviço, além da aplicação de entrevista semiestruturada aos Coordenadores de Saúde Bucal dos 24 municiìpios consorciados. Os resultados evidenciaram que o CEO-R está preparado para atender à demanda. Contudo, foram encontradas barreiras geográficas, financeiras e organizacionais que explicam as baixas taxas de aproveitamento de marcação de consultas e de utilização do serviço e a alta taxa de faltosos, causando um importante impacto financeiro para os municípios consorciados.

The Specialized Dental Care Center for the region of Sobral in the state of Ceará (CEO-R) has characteristics that render it unique, as it has regional coverage and is managed by a Local Health Consortium (which comprises 24 cities). It also works in conjunction with the School of Dentistry of the Federal University of Ceará - Sobral Campus, combining care and academic study in the same location. The scope of this article was to evaluate the accessibility to specialized care in this region with the implementation of this CEO-R. A descriptive-exploratory study with a quantitative approach was conducted by means of the collection and analysis of secondary data regarding the availability and usage of this service in addition to the application of semi-structured interviews with Oral Health Coordinators of the 24 municipalities in the consortium. The results showed that the CEO-R is equipped to meet the demand. However, geographic, financial and organizational barriers were detected, which explains the low rates of appointments scheduled and use of the services and the high rate of missed appointments, causing a significant financial impact on the cities included in the consortium.

Investigação domiciliar sobre incontinência urinária em mulheres / Domiciliary survey on urinary incontinence in women / Estudio domiciliario acerca de la incontinencia urinaria en mujeres

Objetivo: identificar prevalência de mulheres com incontinência urinária e verificar a presença de fatores desencadeadores da incontinência urinária de esforço. Método: trata-se de um estudo quantitativo, descritivo e transversal, desenvolvido com 94 mulheres de 30 a 80 anos, residentes em um bairro de Sobral-CE. O instrumento foi aplicado por meio de uma investigação domiciliar realizada entre novembro de 2009 e janeiro de 2010. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Estadual Vale do Acaraú, sob o Parecer n. 804. Resultados: das 94 entrevistadas, 35 tinham polaciúria, 39 urgência urinária, 39 bexiga hiperativa, 40 noctúria, 35 perda de urina ao esforço e 13 infecção urinária. A faixa etária mais prevalente para incontinência urinária foi de mulheres jovens. A via departo, número de gestações e a episiotomia têm influência direta na perda urinária involuntária e ao esforço. Conclusão: muitas são as queixas urinárias e a prevalência da perda urinária na amostra estudada foi de 37%. A incontinência urinária requer adequado cuidado por parte dos profissionais da atenção básica e dos fisioterapeutas da Residência Multiprofissional em Saúde da Família, com vistas ao diagnóstico, orientação da terapêutica adequada e encaminhamento para o serviço de referência, a fim de que essas mulheres possam receber cuidados e obter melhor qualidade de vida.(AU)

Objective: to identify the prevalence of women with urinary incontinence and verify the presence of factors triggering stress urinary incontinence. Method: this is a quantitative, descriptive, and transversal study developed with 94 women ranging from 30 to 80 years of age, living in a neighborhood of Sobral, Ceará, Brazil. The instrument was applied through a domiciliary survey carried out between November 2009 and January 2010. The project was approved by the Research Ethics Committee of Universidade Estadual Vale do Acaraú, under the Opinion 804. Results: out of the 94 women interviewed, 35 had pollakiuria, 39 urinary urgency, 39 overactive bladder, 40 nocturia, 35 urine loss on effort, and 13 urinary infection. The most prevalent age group for urinary incontinence was young women. The route of delivery, number of pregnancies, and episiotomy have a direct influence on involuntary urine loss and urine loss on efforts. Conclusion: there are many urinary complaints and the prevalence of urine loss in the sample under study was of 37%. Urinary incontinence requires an adequate care from the basic health professionals and the physical therapists of the Multiprofessional Residence in Family Health, aiming at the diagnosis, adequate therapeutic method, referral to the reference service, so that these women can receive appropriate care and achieve a better quality of life.(AU)

Objetivo: identificar la prevalencia de mujeres con incontinencia urinaria y verificar la presencia de factores desencadenantes de la incontinencia urinaria de esfuerzo. Método: esto es un estudio cuantitativo, descriptivo y transversal, desarrollado con 94 mujeres de 30 a 80 años, residentes en un barrio de Sobral, Ceará, Brasil. El instrumento fue aplicado por medio de un estudio domiciliario, entre noviembre de 2009 y enero de 2010. el proyecto fue aprobado por el Comité de Ética en Investigación de la Universidade Estadual Vale do Acaraú, con la Opinión 804. Resultados: de las 94 entrevistadas, 35 tenían la polaciuria, 39 tenían urgencia urinaria, 39 tenían la vejiga hiperactiva, 40 nicturia, 35 pérdida de orina al esfuerzo y 13 infección urinaria. El grupo etario más frecuente fue lo de las mujeres jóvenes. La via de parto, el número de embarazos y la episiotomía tienen influencia directa en la pérdida de orina involuntaria y al esfuerzo. Conclusión: hay muchas quejas urinarias y la prevalencia de la pérdida urinaria en la muestra estudiada fue de 37%. La incontinencia urinaria requiere cuidado adecuado de los profesionales de la atención básica y de los fisioterapeutas de la Residencia Multiprofesional en Salud de la Familia, visando al diagnóstico, a la orientación de la terapéutica adecuada y el encaminamiento al servicio de referencia, para que esas mujeres puedan recibir cuidados y obtener una mejor calidad de vida.(AU)

Educação permanente com os auxiliares de enfermagem da estratégia saúde da família em Sobral, Ceará / Continuing education with nursing assistants from the family health strategy in Sobral, Ceará

A proposta da Política Nacional de Educação Permanente em Saúde (PNEPS) é a formação e o desenvolvimento dos trabalhadores para o Sistema Único de Saúde (SUS). A partir desse pressuposto, o objetivo deste estudo foi analisar a percepção dos auxiliares de enfermagem sobre o processo de Educação Permanente(EP) que vem sendo realizado pela Escola de Formação em Saúde da Família Visconde de Sabóia (EFSFVS) em Sobral, Ceará, Brasil. Desenvolveu-se um estudo exploratório-descritivo de natureza qualitativa com dez auxiliares de enfermagem que participaram pelo menos uma vez das atividades de EP desenvolvidas pela Coordenação de EP de Sobral. Os dados foram coletados por meio da técnica de grupo focal, e os resultados, analisados a partir do discurso do sujeito coletivo. Os resultados evidenciaram que houve mudanças na prática dos auxiliares de enfermagem após a inserção destes nas atividades de EP através do apoderamento e aperfeiçoamento de competências(habilidades, atitudes e conhecimentos). Destarte, faz-se necessária a permanência desses trabalhadores no processo de EP, assim como de avaliação sistemática nesse processo, para que se alcance uma prática profissional eficiente e transformadora, pelo aprender constante, qualificando a atenção à saúde.

The proposal set forth by the National Policy on Continuing Education in Health (PNEPS) is to train and develop workers for the Unified Health System (SUS). Based on this assumption, the purpose of this study was to analyze the perceptions nursing assistants have about the Continuing Education (CE) process being carried out by the Visconde de Sabóia School for Education in Family Health (EFSFVS), in Sobral, state of Ceará, Brazil. A qualitative descriptive exploratory study was undertaken involving ten nursing assistants who participated at least once in the CE activities undertaken by the Sobral CE Coordination. Data were collected through focus group techniques, and results were analyzed from the collective subject discourse. The results showed that there were changes in the nursing assistants' practice after their insertion inthe CE activities by means of the empowerment and the improvement of competencies (skills, attitudes, and knowledge). Thus, it is necessary for these workers to remain in the CE process, as well as for their systematic assessment in it in order to reach an efficient, transforming professional practice based on constant learning and aiming to qualifying health care.

A fisioterapia no programa de saúde da família de Sobral CE / The physical therapy in the Family Health Program of Sobral CE

O Programa Saúde da Família (PSF) é uma estratégia que tem como objetivo principal contribuir para a reorientação do modelo assistencial à saúde a partir da atenção básica, em conformidade com os princípios do Sistema Único de Saúde. O município de Sobral, localizado na região norte do Estado do Ceará, vem adotando esta estratégia desde 1997 e, a partir de 1999, o fisioterapeuta foi inserido no Programa. O objetivo deste trabalho foi conhecer opiniões de usuários do sistema sobre a atuação do fisioterapeuta dentro do PSF. A pesquisa foi realizada através do método qualitativo com abordagem descritiva do tipo exploratória. Foram realizadas entrevistas semi-estruturadas com os usuários dos serviços de fisioterapia no PSF. A partir da análise das entrevistas, observamos que os profissionais vêm atuando principalmente na realização de atividades referentes à promoção da saúde e prevenção de doenças. Apesar do pouco tempo de atuação do fisioterapeuta na Estratégia Saúde da Família, o resultado tem se mostrado bastante promissor, pois revela uma mudança paradigmática na atuação deste profissional, que antes desempenhava suas ações principalmente no campo da reabilitação, e que agora passa a intervir significativamente na prevenção de doenças e na promoção da saúde.

The Family Health Program (PSF) it is a strategy that has as main objective to contribute for the reorientation of the care to the health starting from the basic attention, in accordance with the beginnings of the Unique System of Health. In Sobral city, placed in the north of the State of Ceará, this strategy has been used since 1997 and after 1999 the physical therapist was inserted in the Program. The objective of this study was to know opinions of the users about the physical therapist performance inside the PSF. The research was accomplished through the qualitative method with descriptive approach of exploratory type and through semi-structured interviews applied to the users of physical therapy in PSF. From the interviews analysis, we observed that the professionals are acting mainly in the accomplishment of activities regarding the health promotion and prevention of illness. In spite of the short performance time of the physical therapist in the Family Health Strategy, the result has shown to be quite promising, and reveals a paradigmatic shift in the performance of this professional, who previously carried out actions principally in the rehabilitation field, and now goes on to intervene significantly in the prevention of illness and the promotion of health.