Analysis of the Coping Strategies of Primary Health Care Professionals: Cross-Sectional Study in a Large Brazilian Municipality.

Objective: To analyze the coping strategies used by primary healthcare (PHC) professionals. Methods: A cross-sectional, descriptive-analytical study realized with professionals working in primary healthcare units in São José do Rio Preto, a large city in the interior of São Paulo, Brazil. For data collection, we used an instrument developed by the researchers containing sociodemographic and professional variables, as well as the Problem Coping Modes Scale (EMEP). Results: We evaluated 333 PHC professionals. A difference was observed between the scores of the four coping strategies (p < 0.001), with the highest score for the problem-focused strategy (3.8) and the lowest score for the emotion-focused strategy (2.4). Physicians had the lowest scores in coping strategies focused on religious practices/fantastical thinking (p < 0.001) and pursuit of social support (p = 0.045), while community health agents had the highest scores in these coping strategies. Conclusions: Professionals working in PHC have different coping strategies for the problems and stressful situations experienced in the work environment. These strategies can involve more positive attitudes focused on confrontation and problem solving, and on emotional responses that involve attitudes of avoidance and denial of the problem.

Brief interventions for older adults (BIO) delivered by non-specialist community health workers to reduce at-risk drinking in primary care: a study protocol for a randomised controlled trial.

INTRODUCTION: Evidence suggests that brief interventions are effective in reducing alcohol consumption among older adults. However, the effectiveness of these interventions when delivered by community health workers (non-specialists) in a primary healthcare setting is unknown. To our knowledge, this will be the first randomised trial to examine this. METHODS AND ANALYSIS: Two hundred and forty-two individuals considered at-risk drinkers (Alcohol Use Disorders Identification Test-Consumption, AUDIT-C score ≥4) will be recruited and randomly allocated to usual care (waiting-list) or usual care plus an intervention delivered by trained community health workers (non-specialists). Seven primary care units (PCUs) in Sao José dos Campos, Brazil. PCUs are part of the Brazilian public healthcare system (Sistema Único de Saúde).Follow-up6 months.OutcomesThe primary outcome will be the proportion of participants considered at-risk drinkers (AUDIT-C score ≥4). Secondary outcomes will include alcohol consumption in a typical week in the last 30 days (in units per week) assessed by the AUDIT, service use questionnaire, cognitive performance-assessed by The Health and Retirement Study Harmonised Cognitive Assessment, physical activity-assessed by the International Physical Activity Questionnaire, depression-assessed by the Geriatric Depression Scale and quality of life-assessed by the Control, Autonomy, Self-realisation and Pleasure-16 instrument. The analysis will be based on intention-to-treat principle. ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of the Universidade Federal de São Paulo, CEP/UNIFESP Project n: 0690/2018; CAAE: 91648618.0.0000.5505. All eligible participants will provide informed consent prior to randomisation. The results of this study will be published in relevant peer-reviewed journals and in conference presentations. TRIAL REGISTRATION NUMBER: RBR-8rcxkk.

Adolescent Contraception Before and After Pregnancy-Choices and Challenges for the Future.

Objective To determine methods of contraception used by adolescents before and after pregnancy. Methods A cross-sectional study was performed, and data were collected from medical records of all teens in puerperal consultation at the Hospital da Mulher - José Aristodemo Pinotti (Caism), Universidade Estadual de Campinas (CAISM), São Paulo, Brazil, between July 2011 and September 2013. The inclusion criterion was being 10 to 19 years old, and the exclusion criterion was having a first consultation 90 days after childbirth. Statistical analyses were performed with averages, standard deviations, percentages, correlations and Fisher's exact tests using the SAS program, version 9.4. Results A total of 196 adolescents in postpartum consultation were included (44 days after childbirth on average). The majority was older than 14 years (89%), with an average age of 16.2 years, and the most were exclusively breast-feeding (70%). Before pregnancy, the use of any contraceptive methods was mentioned by 74% adolescents; the most frequent use was combined oral contraceptive followed by condom. The main reason for abandoning the use of contraception was the occurrence of an unintended pregnancy (41%), followed by reports of side effects (22%), behavior issues (18%) and desire for pregnancy (16%). A positive correlation was found between the age of the adolescent at the moment of childbirth, the age of menarche (r = 0.3), and the first sexual intercourse (r = 0.419). Vaginal delivery occurred in 76% of the cases. After birth, depot medroxyprogesterone acetate (DMPA) was the contraception method most frequently used (71%), followed by oral contraceptives (11.8%) and intrauterine devices (IUDs, 11.2%). Conclusions The most prescribed contraceptive method before pregnancy in adolescents who had childbirth was combined oral contraceptives. Many of the study participants had an unintended pregnancy. After childbirth, the most used contraceptive method was DMPA. To improve contraception and reduce the chance of unintended pregnancies among adolescents, we should promote the use of long-acting reversible contraceptives (LARCS).

Adolescent Contraception Before and After Pregnancy-Choices and Challenges for the Future / Contracepção em adolescentes antes e depois do parto: escolhas e desafios para o futuro

Abstract Objective To determine methods of contraception used by adolescents before and after pregnancy. Methods A cross-sectional study was performed, and data were collected from medical records of all teens in puerperal consultation at the Hospital da Mulher - José Aristodemo Pinotti (Caism), Universidade Estadual de Campinas (CAISM), São Paulo, Brazil, between July 2011 and September 2013. The inclusion criterionwas being 10 to 19 years old, and the exclusion criterion was having a first consultation 90 days after childbirth. Statistical analyseswere performed with averages, standard deviations, percentages, correlations and Fisher's exact tests using the SAS program, version 9.4. Results A total of 196 adolescents in postpartum consultation were included (44 days after childbirth on average). The majority was older than 14 years (89%), with an average age of 16.2 years, and the most were exclusively breast-feeding (70%). Before pregnancy, the use of any contraceptive methods was mentioned by 74% adolescents; the most frequent use was combined oral contraceptive followed by condom. The main reason for abandoning the use of contraception was the occurrence of an unintended pregnancy (41%), followed by reports of side effects (22%), behavior issues (18%) and desire for pregnancy (16%). A positive correlation was found between the age of the adolescent at the moment of childbirth, the age of menarche (r = 0.3), and the first sexual intercourse (r = 0.419). Vaginal delivery occurred in 76% of the cases. After birth, depot medroxyprogesterone acetate (DMPA) was the contraception method most frequently used (71%), followed by oral contraceptives (11.8%) and intrauterine devices (IUDs, 11.2%). Conclusions The most prescribed contraceptive method before pregnancy in adolescents who had childbirth was combined oral contraceptives. Many of the study participants had an unintended pregnancy. After childbirth, the most used contraceptive method was DMPA. To improve contraception and reduce the chance of unintended pregnancies among adolescents, we should promote the use of long-acting reversible contraceptives (LARCS).

Resumo Objetivo Conhecer os métodos contraceptivos utilizados por adolescentes antes e após a gravidez. Métodos Estudo transversal, os dados foram coletados de prontuários médicos de todas as adolescentes em consulta puerperal do Hospital da Mulher - José Aristodemo Pinotti (CAISM), Unicamp, São Paulo, Brasil, entre julho de 2011 e setembro de 2013. O critério de inclusão foi idade entre 10 e 19 anos, e o critério de exclusão foi primeira consulta com mais de 90 dias após o parto. As análises estatísticas foram realizadas com médias, desvios-padrão, porcentagens, correlações e teste exato de Fisher utilizando o pro grama SAS, versão 9.4. Resultados Um total de 196 adolescentes em consulta pós-parto foram incluídas (em média 44 dias após o parto). A maioria tinha mais do que 14 anos (89%), com idade média de 16,2 anos, e estava em aleitamento exclusivo (70%). Antes da gravidez, o uso de quaisquer métodos anticoncepcionais foi mencionado por 74% das adolescentes; o mais frequente foi contraceptivo oral combinado seguido de preservativo. A principal razão para abandonar o uso de contracepção foi a ocorrência de gravidez indesejada (41%), seguido por relatos de efeitos colaterais (22%), problemas comportamentais (18%) e desejo de gravidez (16%). Uma correlação positiva foi encontrada entre a idade da adolescente no momento do parto, a idade da menarca (r = 0,3), e a primeira relação sexual (r = 0,419). O parto vaginal ocorreu em 76% dos casos. Após o nascimento, acetato de medroxiprogesterona de depósito (DMPA) foi o método de contracepção mais utilizado (71%), seguido do contraceptivo oral (11,8%) e do dispositivo intrauterino (DIU) (11,2%). Conclusões O método anticoncepcional mais prescrito antes da gravidez em adolescentes que tiveram parto no serviço foi contraceptivo combinado oral. Muitas participantes do estudo tiveram uma gravidez indesejada. Após o parto, o método contraceptivomais utilizado foi DMPA. Paramelhor contracepção e reduzir a chance de gravidez indesejada entre adolescentes, devemos promover e estimular o uso de contraceptivos reversíveis longa ação.

Analysis of monotherapy prostate brachytherapy in patients with prostate cancer. Initial PSA and Gleason are important for recurrence?

PURPOSE: To evaluate the clinical outcome of a cohort of localized prostate cancer patients treated with 125-I permanent brachytherapy at the São José Hospital--CHLC, Lisbon. MATERIALS AND METHODS: A retrospective analysis was carried out on 429 patients with low and intermediate-risk of prostate adenocarcinoma, according to the recommendations of the EORTC, who underwent 125I brachytherapies in intraoperative dosimetry "real-time" system between September 2003 and September 2013. RESULTS: The mean follow-up was 71.98 months. Biochemical relapse of disease by rising PSA (Phoenix criterion) was observed in 18 patients (4.2%). Through the application of Kaplan-Meier survival curves in this sample, the rate of survival at 6 years without biochemical relapse was higher than 95%. By Iog rank test comparing biochemical relapse with initial PSA (15-10 and <10) and Gleason values (7 and <7), there was no statistical difference (P=0.830) of the initial PSA in the probability of developing biochemical relapse. In relation to Gleason score, it was noted a statistical difference (P <0.05), demonstrating that patients with Gleason 7 are more likely to develop biochemical relapse. CONCLUSIONS: Brachytherapy as monotherapy is at present an effective choice in the treatment of localized prostate adenocarcinoma. Biochemical relapses are minimal. The initial PSA showed no statistically difference in the rate of relapses, unlike the value Gleason, where it was demonstrated that patients with Gleason 7 have a higher probability of biochemical relapse. Cases with PSA bounce should be controlled before starting a salvage treatment.

Contributos da enfermagem de reabilitação no incremento da autonomia do utente em cuidados intensivos / Contributions of rehabilitation nursing to increasing the autonomy of intensive care patients

Este relatório teve como objetivo a análise reflexiva das competências adquiridas e desenvolvidas durante a unidade curricular Relatório/Estágio, inserida no curso de Mestrado em Enfermagem em Gestão de Unidades de Saúde. O estágio foi realizado na Unidade de Cuidados Intensivos (UCI) Dr. Emílio Moreira do Hospital Doutor José Maria Grande, em Portalegre. Um contexto economicamente recessivo implica uma alteração da gestão de unidades de saúde, que, no entanto, não diminua a qualidade dos cuidados prestados. As intervenções de enfermagem de reabilitação realizadas tiveram como objetivo responder às necessidades dos doentes, incrementando a autonomia dos utentes da UCI, apresentando-se um estudo de caso de uma doente com problemas respiratórios. Os ganhos em saúde, avaliados através do grau de funcionalidade, da mobilidade, da qualidade de vida, aumentam significativamente após as intervenções de enfermagem de reabilitação, conforme é demonstrado pela análise dos resultados do estudo de caso, que corroboram a importância das intervenções de enfermagem de reabilitação na redução do tempo de internamento dos utentes. A presença de um enfermeiro especialista em reabilitação é uma mais-valia numa Unidade de Cuidados Intensivos, devido à vasta área a que consegue dar resposta, contribuindo significativamente para uma maior eficácia na gestão de Unidades de Saúde.

The purpose of this report is the reflexive analysis of the skills acquired and developed during the clinical practice, inserted in Master course of Nursing in Health Services Management. The probation was conducted at the Intensive Care Unit (ICU) Dr. Emilio Moreira belonging to Hospital Dr. José Maria Grande, in Portalegre. An economically recessive context implies a change in health units management, which, however, does not diminish the quality of care. The rehabilitation nursing interventions, aimed to meet the needs of patients, increasing the autonomy of the ICU users, present a case study of a patient with respiratory problems. Health gains, assessed by the degree of functionality, mobility, quality of life, increase significantly after the rehabilitation nursing interventions, as demonstrated analyzing the results of the case study, which confirm the importance of nursing rehabilitation interventions in reducing the hospital stay of users. The presence of a rehabilitation specialist nurse is a benefit in an Intensive Care Unit due to the vast area that he can contribute to improve efficiency in Health Services Management.

Analysis of monotherapy prostate brachytherapy in patients with prostate cancer. Initial PSA and Gleason are important for recurrence?

Purpose To evaluate the clinical outcome of a cohort of localized prostate cancer patients treate with 125-I permanent brachytherapy at the São José Hospital – CHLC, Lisbon. Materials and Methods A retrospective analysis was carried out on 429 patients with low and intermediate-risk of prostate adenocarcinoma, according to the recommendations of the EORTC, who underwent 125I brachytherapies in intraoperative dosimetry “real-time” system between September 2003 and September 2013. Results The mean follow-up was 71.98 months. Biochemical relapse of disease by rising PSA (Phoenix criterion) was observed in 18 patients (4.2%). Through the application of Kaplan-Meier survival curves in this sample, the rate of survival at 6 years without biochemical relapse was higher than 95%. By Iog rank test comparing biochemical relapse with initial PSA (15-10 and <10) and Gleason values (7 and <7), there was no statistical difference (P=0.830) of the initial PSA in the probability of developing biochemical relapse. In relation to Gleason score, it was noted a statistical difference (P<0.05), demonstrating that patients with Gleason 7 are more likely to develop biochemical relapse. Conclusions Brachytherapy as monotherapy is at present an effective choice in the treatment of localized prostate adenocarcinoma. Biochemical relapses are minimal. The initial PSA showed no statistically difference in the rate of relapses, unlike the value Gleason, where it was demonstrated that patients with Gleason 7 have a higher probability of biochemical relapse. Cases with PSA bounce should be controlled before starting a salvage treatment. .

[Food security, income, and the Bolsa Família program: a cohort study of municipalities in Paraíba State, Brazil, 2005-2011]. / Segurança alimentar, renda e Programa Bolsa Família: estudo de coorte em municípios do interior da Paraíba, Brasil, 2005-2011.

This study aims to evaluate the impact of the conditional cash transfer program known as Bolsa Família in overcoming food insecurity. A cohort study was conducted in 2005 and 2011 in a sample of families in São José dos Ramos and Nova Floresta, Paraíba State, Brazil. In 2005, 609 households were interviewed, and in 2011 we located and re-interviewed 406 families. There had been an increase in food security and mild food insecurity and an improvement in socioeconomic indicators. A significant association was observed between higher income and improved food security. The program showed a positive impact by increasing income and providing improved levels of food security and mild food insecurity. Other socioeconomic variables may be contributing to this improvement. The fight against food insecurity and malnutrition thus requires additional policies and programs that act on other determinants.

Seguranca alimentar, renda e Programa Bolsa Familia: estudo de coorte em municipios do interior da Paraiba, Brasil, 2005-2011 / Food security, income, and the Bolsa Família program: a cohort study of municipalities in Paraíba State, Brazil, 2005-2011 / La seguridad alimentaria, los ingresos y Programa Bolsa Familia: estudio de cohorte de municipios en Paraiba, Brasil, 2005-2011

Este trabalho tem por objetivo avaliar o impacto do Programa Bolsa Família na superação da Insegurança Alimentar. Realizou-se um estudo de coorte em 2005 e 2011, em amostra de famílias residentes em São José dos Ramos e Nova Floresta, Paraíba, Brasil. Em 2005 foram avaliados 609 domicílios e em 2011 foram encontradas e entrevistadas 406 famílias. Houve aumento da segurança alimentar/insegurança alimentar leve e melhoria nos indicadores socioeconômicos. Percebeu-se uma relação significativa entre a elevação da renda e a melhoria dos níveis de Insegurança Alimentar. O programa impacta positivamente no aumento da renda, propiciando melhorias dos níveis de segurança alimentar/insegurança alimentar leve. Percebeu-se que outras variáveis socioeconômicas podem estar contribuindo na melhoria deste perfil. Diante disso, no combate à insegurança alimentar e nutricional, são necessárias outras políticas e programas que ajam nos demais determinantes.

This study aims to evaluate the impact of the conditional cash transfer program known as Bolsa Família in overcoming food insecurity. A cohort study was conducted in 2005 and 2011 in a sample of families in São José dos Ramos and Nova Floresta, Paraíba State, Brazil. In 2005, 609 households were interviewed, and in 2011 we located and re-interviewed 406 families. There had been an increase in food security and mild food insecurity and an improvement in socioeconomic indicators. A significant association was observed between higher income and improved food security. The program showed a positive impact by increasing income and providing improved levels of food security and mild food insecurity. Other socioeconomic variables may be contributing to this improvement. The fight against food insecurity and malnutrition thus requires additional policies and programs that act on other determinants.

Este estudio tiene como objetivo evaluar el impacto del Programa Bolsa Familia para superar la inseguridad alimentaria. Se realizó un estudio de cohorte en el año 2005 y 2011 en una muestra de familias que viven en São José dos Ramos y el Nova Floresta, Paraíba, Brasil. En 2005 se evaluaron 609 hogares y 2011 no se han encontrado y entrevistado a 406 familias. Hubo un aumento de seguridad alimentaria/inseguridad alimentaria. Así como una ligera mejora de los indicadores socioeconómicos. Se observó una relación significativa entre el aumento de los ingresos y la mejora de los niveles de inseguridad alimentaria. El programa tiene un impacto positivo en el aumento de los ingresos, proporcionar mejores niveles de seguridad alimentaria/inseguridad alimentaria. Se percibió que otras variables socioeconómicas pueden estar contribuyendo a la mejora de este perfil. Por lo tanto, en la lucha contra la inseguridad alimentaria y la nutrición, las políticas y los programas adicionales que actúan son determinantes.

Astrocitoma pilomixoide de fossa posterior em criança: relato de caso / Pilomyxoid astrocytoma of the posterior fossa in children: case report

Descrever um caso de astrocitoma pilomixoide, um tumor do sistema nervoso central raro, descrito e classificado recentemente diante de sintomatologia e achados pouco específicos. Análise e descrição de um caso de astrocitoma pilomixoide submetido a tratamento cirúrgico no Instituto José Frota, Fortaleza, Ceará. Paciente evolui com regressão importante dos sintomas, sem indícios de recidiva tumoral. O diagnóstico e a classificação correta dos tumores cerebrais são de extrema importância clínica, pois modificam de forma impactante o prognóstico, assim como a abordagem terapêutica.

To describe a pilomyxoid astrocytoma case, a tumor of the central nervous system rare recently described and classified in the face of a specific symptomatology and little found. Analysis and description of a case of pilomyxoid astrocytoma underwent surgical treatment at the José Frota Institute in Fortaleza, Ceará. Patient developed a significant decrease of symptoms without evidence of tumor relapse. The diagnosis and the correct classification of cerebral tumors are of extreme clinical importance, because it changes so as impacting the prognosis as well as therapeutic approach.

Proteína C reativa ultrassensível em indivíduos de 20 a 30 anos / High-Sensitive C-Reactive Protein in individuals aging from 20 to 30 years old

Introdução:a proteína C-reativa (PCR) é um marcador de fase aguda que se eleva em processos inflamatórios e infecciosos. Níveis elevados de proteína C ultrassensível (PCRus) têm sido associados a eventos cardiovasculares futuros. Objetivos: determinar a concentração plasmática de PCRus em indivíduos saudáveis de 20 a 30 anos e correlacioná-la com alguns fatores de risco para doenças cardiovasculares (DCV). Métodos: foi conduzido estudo observacional descritivo do tipo transversal. Participaram do estudo 50 indivíduos, sendo 74% do sexo feminino, com média de idade de 24,4 ± 3,9 anos, todos estudantes de graduação da Universidade José do Rosário Vellano. A determinação da PCRus foi realizada no soro, pelo método imunoturbidimétrico, utilizando-se o equipamento Cobas Mira Plus. Resultados: foram observados valores médios de PCRus de 4,9 ± 3,6 mg/L. Não foi apurada diferença significativa para os valores de PCRus nos dois sexos. Os homens apresentaram valores de índice de massa corporal e pressão arterial sistêmica sistólica significativamente mais altos quando comparados com estudantes do sexo feminino (p<0,05). Foram observadas correlações significativas entre alguns parâmetros estudados. Conclusões: os níveis de PCRus não foram associados a: idade, pressão arterial, tabagismo, IMC e história familiar para DCV nos indivíduos estudados. Os níveis de PCRus não se mostraram diferentes entre homens e mulheres. Estudos adicionais envolvendo maior número de estudantes são necessários para esclarecer, com fidedignidade, a relação entre os níveis plasmáticos de PCRus e os fatores de risco cardiovascular em indivíduos de 20 a 30 anos.

Introduction:C-reactive protein (CRP) is a marker of acute stage in inflammatory and infectious processes. High levels of high-sensitive C-reactive protein (HS-CRP) have been associated with future/potential cardiovascular events. Objectives: To determine the plasmatic concentration of HS-CRP in healthy individuals at age of 20-30 years and correlate it to some risk factors of cardiovascular diseases. Methods: An observational, descriptive, cross-sectional study was carried out with 50 individuals at average age of 24.4 ± 3.9 years old, 74% of them women and all of them undergraduates at Universidade José do Rosário Vellano. HS-CRP was detected by serological examination, more specifically using the immunoturbidimetric method and Cobas Mira Plus equipment. Results: Aver age HS-CRP concentration was 4.9 ± 3.6 mg/L. No significant difference in HS-CRP was found for sex. Men, however, had body mass indexes (BMI) and systolic blood pressures significantly higher than women (p < 0.05). Significant correlations were found for some of the parameters studied. Conclusions:HS-CRP levels were not associated with: age, blood pressure, smoking, BMI, and previous records of cardiovascular diseases in the family of the individuals examined. HS-CRP levels were not different for men and women. Further studies comprising a larger number of students are necessary to provide clearer and reliable understanding of the correlation of plasmatic levels of HS-CRP with risk factors of cardiovascular diseases in individuals at age of 20-30 years.

Sistema de Apoio a Decisão: a Segurança Alimentar e o Modelo em Rede Neural / Decision Support System: Food Security and Neural Network Model

Este artigo tem como objetivo criar um modelo deapoio à tomada de decisão baseado em rede neural parasegurança alimentar nutricional do município de São Josédos Ramos, no interior da Paraíba. Material e Métodos: Estatécnica foi usada a fim de criar um modelo, através dospadrões implícitos nas camadas de 10 variáveis sobrequantidade e variedade de alimentos de 181 famílias domunicípio em estudo, utilizando-se como classificador oPerceptron Multicamadas do software Weka. Resultados:Uma vez criado o modelo, observou-se um padrão declassificação excelente na distinção entre segurançaalimentar e insegurança alimentar, embora tenha apresentadoconfusão na classificação entre os níveis de insegurançaalimentar. A escolha das variáveis relevantes naimplementação das redes neurais deve ser realizadacuidadosamente, visto que a inclusão de variáveis nãorelevantes ao problema em estudo poderá prejudicar odesempenho da rede neural, assim como o erro declassificação. Conclusão: O modelo, aqui proposto, podeser conduzido como ferramenta de apoio para o diagnósticoda insegurança alimentar, visando respostas úteis aogerenciamento dos programas de combate à fome...

This article aims to create a model to supportdecision making based on neural network for food nutritionsecurity in São José dos Ramos, in the interior of Paraíba.Methods: This technique was used to create a model, throughimplicit patterns in layers of 10 variables on the quantity andvariety of foods from 181 families in the municipality understudy, using as classifier the Multilayer Perceptron Wekasoftware. Results: Once the model was developed, therewas an excellent standard classification in the distinctionbetween food security and food insecurity, althoughconfusion in the classification among food insecurity levelswas verified. The choice for relevant variables in theimplementation of neural networks must be performedcarefully, since the inclusion of variables non relevant to theproblem under study may affect the neural networkperformance, as well as the classification error. Conclusion:The model proposed here may be conducted as a supporttool for the diagnosis of food insecurity, providing usefulanswers to the management of programs to combat hunger...

[Extreme subcutaneous and intramuscular insulin resistance at type 1 diabetes mellitus]. / Extrema resistência à insulina subcutânea e intramuscular em diabetes melito tipo 1.

Insulin resistance signs reduced cellular response to this hormone and dysfunction of glucose transport to intracellular compartment. This phenomenon is associated to genetic factors and principally behavior factors correlating to obesity and its comorbidities, as type 2 diabetes mellitus, hypertension and dyslipidemia. However clinical factors of insulin resistance are still present at not obese type 1 diabetes in a known syndrome called type 1 diabetes mellitus with resistance to insulin administered subcutaneously and intramuscularly (DRIASM). This is a rare condition that consists into insulin resistance at subcutaneously and intramuscularly use and normal or near to normal sensitivity at intravenously way. Treatments until now proposed are ineffective and are related to frequent fails and complications. We report here two cases of DRIASM in 45 and 46 female patients that are different from others yet related because they have late diabetes type 1, sustained hyperglycemia associated to catabolic, microangiopathy and neuropathic complications without any ketoacidosis episode. The treatment vary from alternative ways for insulin infusion to inscription to a possible performance of pancreas transplantation like a experiment of definitive treatment. This report was approved by Research Ethic Committee from São José do Rio Preto medical school.

Extrema resistência à insulina subcutânea e intramuscular em diabetes melito tipo 1 / Extreme subcutaneous and intramuscular insulin resistence at type 1 diabetes mellitus

Resistência insulínica consiste em reduzida resposta celular a esse hormônio e, portanto, disfunção do transporte de glicose para o meio intracelular. Esse fenômeno associa-se a fatores genéticos e principalmente comportamentais relacionados a obesidade e comorbidades a ela associadas como diabetes melito tipo 2, hipertensão arterial e dislipidemia. Entretanto, fatores clínicos de resistência insulínica também estão presentes em diabéticos tipo 1 não obesos na conhecida síndrome de extrema resistência à insulina subcutânea e intramuscular (DRIASM). Condição rara que consiste em resistência à ação da insulina no tecido subcutâneo e muscular e sensibilidade normal, ou próxima do normal, quando administrada via intravenosa. Tratamentos propostos até o momento mostram-se pouco efetivos e se relacionam a complicações e falhas frequentes. Descrevemos dois casos de pacientes femininas de 45 e 46 anos com DRIASM que se diferenciam dos demais já descritos por apresentar diagnóstico de diabetes melito tipo 1 tardio, hiperglicemia constante associada a complicações catabólicas, microvasculares (retinopatia) e neuropáticas sem, no entanto, nenhum episódio de cetoacidose diabética. Os tratamentos propostos variaram desde aplicação de insulina intramuscular e intravenosa até listagem para possível realização de transplante de pâncreas como tentativa de tratamento definitivo. Este trabalho teve aprovação do Comitê de Ética em Pesquisa da Faculdade de Medicina de São José do Rio Preto.

Insulin resistance signs reduced cellular response to this hormone and dysfunction of glucose transport to intracellular compartment. This phenomenon is associated to genetic factors and principally behavior factors correlating to obesity and its comorbidities, as type 2 diabetes mellitus, hypertension and dyslipidemia. However clinical factors of insulin resistance are still present at not obese type 1 diabetes in a known syndrome called type 1 diabetes mellitus with resistance to insulin administered subcutaneously and intramuscularly (DRIASM). This is a rare condition that consists into insulin resistance at subcutaneously and intramuscularly use and normal or near to normal sensitivity at intravenously way. Treatments until now proposed are ineffective and are related to frequent fails and complications. We report here two cases of DRIASM in 45 and 46 female patients that are different from others yet related because they have late diabetes type 1, sustained hyperglycemia associated to catabolic, microangiopathy and neuropathic complications without any ketoacidosis episode. The treatment vary from alternative ways for insulin infusion to inscription to a possible performance of pancreas transplantation like a experiment of definitive treatment. This report was approved by Research Ethic Committee from São José do Rio Preto medical school.

Projeto de intervenção: acolhimento como diretriz operacional no centro de atenção psicossocial (CAPS) José Carlos Souto / Intervention project: reception as a guideline operating in psychosocial care center (PCC) Jose Carlos Souto

O tema Acolhimento tem sido abordado frequentemente nos encontros entre trabalhadores e gestores da saúde, como uma das diretrizes operacionais que favorece o acesso e cuidado integral do usuário nos serviços de saúde. Além de contribuir para a organização dos processos de trabalhos das equipes, permitindo uma reavaliação do Modelo Assistencial baseado na doença para uma mudança significativa na abordagem centrada no usuário e suas necessidades subjetivas. O presente trabalho pretende apresentar um projeto de intervenção sobre Acolhimento no Centro de Atenção Psicossocial José Carlos Souto, situado no Distrito Sanitário II, do Município do Recife, com o objetivo de qualificar os profissionais deste CAPS dentro da proposta da Política Nacional de Humanização (PNH), onde é enfatizada a importância da escuta para formação do vínculo e resolutividade dos problemas apresentados pelos usuários que buscam uma assistência especializada. Observam-se na revisão bibliográfica conceitos referentes às estratégias para Humanização dos Serviços de Saúde, urgentes para consolidação do Sistema Único de Saúde (SUS), com ênfase na facilitação da acessibilidade e integralidade, a partir do Acolhimento. Assim como atenção ao investimento no profissional, sua formação e Educação Permanente para melhor atuação junto aos usuários. Há também relatos positivos de experiências do Acolhimento em Centros de Atenção Psicossociais, consolidando as hipóteses que esta diretriz tem possibilitado a melhoria na qualidade da assistência e reorganização no processo de trabalho. A elaboração do plano operativo propõe oficinas para qualificação dos trabalhadores do CAPS José Carlos Souto e a continuidade do acompanhamento da qualificação, a partir da efetivação de um processo em Educação Permanente, garantindo a atualização nas práticas profissionais e melhores êxitos na assistência interdisciplinar. Espera-se contribuir para reflexão do tema e expansão da qualificação sobre Acolhimento em outros serviços de Saúde Mental do Município do Recife.

Estudo epidemiológico dos pacientes idosos queimados no Centro de Tratamento de Queimados do Hospital Instituto Doutor José Frota do município de Fortaleza-CE, no período de 2004 a 2008 / Epidemiological survey of elderly burned patients admitted on Centro de Tratamento de Queimados of Instituto Doutor José Frota Hospital in Fortaleza-CE, from 2004 to 2008

Objetivo: Analisar o perfil epidemiológico dos pacientes idosos internados no Centro de Tratamento de Queimados (CTQ) do Hospital Instituto Doutor José Frota (IJF), no período de 2004 a 2008. Método: Foram avaliados registros de 79 pacientes com idade igual ou superior a 60 anos que estiveram internados no CTQ do IJF durante o período de 2004 a 2008, por meio de um formulário específico. Resultados: Observou-se predominância das internações em indivíduos do sexo masculino (55,7%), com idade média de 72,7 ± 9,03 anos, provenientes de municípios do interior do estado Ceará (58,2%), tendo o fogo como principal agente causal (31,6%) e predominância para as queimaduras de 2º grau, sendo evidenciada taxa de 30% de superfície corporal queimada e 41,8% de mortalidade. Conclusão: Conclui-se que o perfil dos pacientes idosos vítimas de queimaduras internados no CTQ do Instituto Doutor José Frota, no período de 2004 a 2008, é constituído por indivíduos do sexo masculino, procedentes de cidades interioranas do estado do Ceará, tendo o fogo como principal agente causal e predominância para as queimaduras de 2º grau e 41,8% de mortalidade.

Objective: To analyze the elderly patients epidemiological profile in the Centro de Tratamento dos Queimados (CTQ) of Hospital Instituto Doutor José Frota (IJF), between 2004 and 2008. Methods: Records of 79 patients were evaluated, all of them 60 or older that had been hospitalized in the CTQ between 2004 and 2008, using a specific form. Results: The majority of patients were male (55.7%), aged 72.7 ± 9.03 years old, originated from the state's countryside (58.2%), fire was the main causal agent (31.6%), with second degree burns the most common, averaging 30% of burned surface area and 41.8% of mortality was observed. Conclusion: The conclusion was that the profile of burned elderly patients hospitalized in the CTQ of Hopital Instituto José Frota (IJF) between 2004 and 2008, are male patients, from the state's countryside, fire was the principal causal agent and second degree burns the most common with 41.8% of mortality.