Atributos da atenção primária à sáude: a teoria e a prática em uma unidade de saúde da família na perspectiva de acadêmicos de medicina / Attributes of primary health care: theory and practice in a family health unit from the perspective of medical students / Atributos de la atención primaria de salud: teoría y práctica en una unidad de salud familiar desde la perspectiva de los estudiantes de medicina

A Atenção Primária à Saúde (APS), definida a partir da Declaração de Alma- Ata, e, identificada mundialmente como uma estratégia de organização dos serviços de saúde, caracteriza-se como o primeiro nível de contato dos indivíduos, da família e da comunidade com o sistema nacional de saúde. Este trabalho constitui um relato de experiência desenvolvido a partir de uma atividade teórico-prática, que se propôs a analisar os atributos e os processos de trabalho da Atenção Primária à Saúde no contexto de uma Unidade de Saúde da Família (USF), no município de Foz do Iguaçu-PR, com o objetivo de relacionar a teoria com a prática, por meio de questionários, elaborados com base na literatura e, aplicado aos profissionais e usuários do sistema de saúde. Ademais, contou com a observação da rotina do processo de trabalho na unidade. A vivência oportunizou a identificação dos desafios e fragilidades referentes aos atributos da APS e dos elementos constituintes do processo de trabalho em saúde. Por fim, conclui-se que, no cotidiano dos serviços, a APS enfrenta muitas dificuldades em se estabelecer como previsto na literatura e, por isso, faz-se premente a participação social para sua efetivação e consagração como primeiro nível de contato com o sistema de saúde.

Primary Health Care (PHC), defined from the Declaration of Alma-Ata, and identified worldwide as a strategy for organizing health services, is characterized as the first level of contact of individuals, family and community with the national health system. This paper is an experience report developed from a theoretical-practical activity, which proposed to analyze the attributes and work processes of Primary Health Care in the context of a Family Health Unit (USF) in the municipality of Foz do Iguaçu-PR, with the objective of relating theory to practice, through questionnaires, prepared based on the literature and applied to professionals and users of the health system. In addition, there was observation of the routine of the work process in the unit. The experience made it possible to identify the challenges and weaknesses related to the attributes of PHC and the constituent elements of the health work process. Finally, it is concluded that, in the daily life of services, PHC faces many difficulties in establishing itself as predicted in the literature and, therefore, social participation is necessary for its effectiveness and consecration as the first level of contact with the health system.

La Atención Primaria de Salud (APS), definida a partir de la Declaración de Alma-Ata, e identificada mundialmente como una estrategia de organización de los servicios de salud, se caracteriza por ser el primer nivel de contacto de los individuos, la familia y la comunidad con el sistema nacional de salud. Este trabajo es un relato de experiencia desarrollado a partir de una actividad teórico-práctica, que se propuso analizar los atributos y procesos de trabajo de la Atención Primaria de Salud en el contexto de una Unidad de Salud de la Familia (USF) en el municipio de Foz do Iguaçu- PR, con el objetivo de relacionar la teoría con la práctica, a través de cuestionarios, elaborados con base en la literatura y aplicados a profesionales y usuarios del sistema de salud. Además, hubo observación de la rutina del proceso de trabajo en la unidad. La experiencia permitió identificar los desafíos y debilidades relacionados con los atributos de la APS y los elementos constitutivos del proceso de trabajo en salud. Finalmente, se concluye que, en el día a día de los servicios, la APS enfrenta muchas dificultades para establecerse como predice la literatura y, por lo tanto, es necesaria la participación social para su eficacia y consagración como primer nivel de contacto con el sistema de salud. PALABRAS CLAVE: Atención Primaria de Salud; Sistema Único de Salud; Políticas de Salud.

Selecting tropical wheat genotypes through combining ability analysis.

The selection of parents to originate promising base populations, as well as the knowledge of the gene effects controlling agronomic traits by means of diallel, are useful to drive genetic gains in Brazilian tropical wheat breeding programs. The goals of this study were to select tropical wheat parents with a high frequency of favorable alleles and segregating populations with high potential to originate superior progenies through partial diallel analysis. Thus, 14 parents were divided in two groups and crossed in a 7 × 7 partial diallel scheme to originate 49 F1 combinations. After obtaining F2 generation, the populations and the parents were evaluated in the field in the summer of 2021. Days for heading, plant height, rust and yellow spot resistance, and grain yield were evaluated. The data were subjected to partial diallel analysis. There were significant effects of general combining ability for all traits. The specific combining ability effect was significant for days for heading and plant height. The additive gene effects were predominant over the non-additive ones. The parents with the highest frequency of favorable alleles for the traits evaluated were selected in each group. Four populations with high genetic potential to originate superior progenies were selected.

IMRT national audit in Portugal.

PURPOSE: The IAEA newly developed "end-to-end" audit methodology for on-site verification of IMRT dose delivery has been carried out in Portugal in 2018. The main goal was to evaluate the physical aspects of the head and neck (H&N) cancer IMRT treatments. This paper presents the national results. METHODS: All institutions performing IMRT treatments in Portugal, 20 out of 24, have voluntarily participated in this audit. Following the adopted methodology, a Shoulder, Head and Neck End-to-End phantom (SHANE) - that mimics an H&N region, underwent all steps of an IMRT treatment, according to the local practices. The measurements using an ionization chamber placed inside the SHANE phantom at four reference locations (three in PTVs and one in the spinal cord) and an EBT3 film positioned in a coronal plane were compared with calculated doses. FilmQA Pro software was used for film analysis. RESULTS: For ionization chamber measurements, the percent difference was within the specified tolerances of ±5% for PTVs and ±7% for the spinal cord in all participating institutions. Considering film analysis, gamma passing rates were on average 96.9%±2.9% for a criterion of 3%/3 mm, 20% threshold, all above the acceptance limit of 90%. CONCLUSIONS: The national results of the H&N IMRT audit showed a compliance between the planned and the delivered doses within the specified tolerances, confirming no major reasons for concern. At the same time the audit identified factors that contributed to increased uncertainties in the IMRT dose delivery in some institutions resulting in recommendations for quality improvement.

Observational evaluation of preoperative, intraoperative, and postoperative characteristics in 117 Brazilian women without uterine prolapse undergoing vaginal hysterectomy.

BACKGROUND: Despite the introduction of minimally invasive approaches for various benign uterine problems, hysterectomy is often still performed abdominally, but the vaginal route should be used whenever possible. The aim of this study was to identify the preoperative, intraoperative, and postoperative characteristics of women undergoing vaginal hysterectomy in the absence of uterine prolapse. METHODS: A prospective, descriptive, quantitative, noncomparative study was conducted in 117 women between August 2009 and February 2011 in Petropolis, Rio de Janeiro, Brazil. The women included had a uterine indication for hysterectomy, their surgeries were performed by the same team, and they were followed up for 12 months. An adapted Pelvic Organ Prolapse Quantification system was used to check for uterine prolapse. RESULTS: The age range of the women was 33-59 years, uterine volume was 300-900 mL, and 73.50% has undergone prior cesarean section. The main indication for hysterectomy was uterine myoma (64.95%), with a surgery time of 30-60 minutes in 55 (59.82%) and 19 (15.98%) cases, respectively. Uterine volume reduction was performed in 41 (35.05%) cases, salpingectomy was the most common associated surgery (81.19%), and anesthesia was subdural (68.37%). Common intraoperative complications included bladder lesions (8.54%), with conversion to the abdominal route being necessary in one case (1.28%), and the most common postoperative complication being vaginal cupola granuloma (32.47%). There was a statistically significant relationship between surgery time and uterine volume (χ(2) = 17.367; P = 0.002). CONCLUSION: This study suggests that vaginal hysterectomy is a safe surgical procedure in view of its good performance and low complication rate.

Mulheres Negras e HIV: determinantes de vulnerabilidade na região serrana do estado do Rio de Janeiro / Black Women and HIV: vulnerability determinants in highland region of Rio de Janeiro

Trata-se de estudo de base quantitativa que teve como objetivo central analisar componentes socioculturais e comportamentais relacionados ao processo de vulnerabilização ao HIV/aids a partir da percepção de mulheres negras na região serrana do estado do Rio de Janeiro. Para tal, foram entrevistadas 1.464 mulheres negras dos diferentes municípios que compõem essa região. Os principais determinantes que marcaram com maior intensidade a vulnerabilidade dessas mulheres associaram-se aos seguintes fatores: baixa escolaridade, renda e, consequentemente, acesso a bens e serviços, baixo índice de uso sistemático do preservativo e percepções de gênero, que reforçam a menor autonomia feminina na tomada de decisões protetoras.

This quantitative study aimed at analyzing social, cultural and behavioral components related to HIV vulnerability from perception of black women who live on a specific region of Rio de Janeiro - the highland area. For that, 1,464 black women from different towns of this region were interviewed. The main components that influenced vulnerability of these women could be associated to some factors, like: poor schooling, poverty, and consequently a difficulty to access property and services, low rates of using condom appropriately and some gender perceptions that reinforce women's autonomy on protection decisions is very short.

5-FU for genital warts in non-immunocompromised individuals.

BACKGROUND: Genital warts are common and usually are harmless but can be painful and psychologically burdensome. Several local treatments can be used, including topical 5-Fluorouracil (5-FU). OBJECTIVES: To determine the effectiveness and safety of 5-FU topical treatment for genital warts in nonimmunocompromised individuals. SEARCH STRATEGY: Databases searched were Cochrane Central Register of Controlled Trials (The Cochrane Library 2009 Issue 3), MEDLINE (1966 to August 2009), EMBASE (until August 2009), LILACS (1982 to August 2009). The search had no language or publication restrictions. SELECTION CRITERIA: The review included randomised controlled trials (RCTs) among women, men, or both sexes, aged 18 years and older, comparing: 5-FU versus placebo or no treatment; 5-FU in any dose versus other isolated treatment, topical or systemic; 5-FU in any dose associated with other treatment versus placebo; 5-FU in any dose associated with other treatment versus other isolated treatment, topical or systemic; 5-FU in any dose associated with other treatment versus other associated treatment, topical or systemic. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data from the original publications. MAIN RESULTS: Six trials involving 988 patients (645 women and 343 men) and reporting eight comparisons were found. Two studies reported withdrawals and dropouts, but none mentioned analysis by intention to treat (ITT). 5-FU presented better results for cure than placebo or no treatment (relative risk (RR) 0.39, 95% confidence interval (CI) 0.23 to 0.67), meta-cresol-sulfonic acid (MCSA) (RR 2.11, 95% CI 0.83 to 5.37), Podophylin 2%, 4% or 25% (RR 1.26, 95% CI 0.86 to 1.82). There were no statistical differences for treatment failure for 5-FU versus CO2 Laser (RR 0.69, 95% CI 0.43 to 1.11) versus 5-FU + INFalpha-2a (low dose) (RR 1.02, 95% CI 0.87 to 1.119). Worse results were found for 5-FU versus 5-FU + INFalpha-2a (high dose) (RR 10.78, 95% CI 1.50 to 77.36), and 5-FU + CO2 Laser INFalpha-2a (high dose) (RR 7.97, 95% CI 2.87 to 22.13). AUTHORS' CONCLUSIONS: The reviewed trials were highly variable in methods and quality, and the evidence provided by these studies was weak. Cure rates with several treatments were variable, and although 5-FU presents therapeutic results that are inferior to those seen with 5-FU + Inf alpha-2a (high dose) and 5-FU + CO2 Laser + Inf alpha-2a (high dose), the treatment should not be abandoned. Topical treatment with 5-FU has a therapeutic effect; however, the benefits and risks have not been determined clearly and further studies are needed.

Vulnerabilidade ao HIV em profissionais integrantes de um programa de promocao de saude na regiao serrana do estado do Rio de Janeiro / HIV vulnerability among professionals members of an health promotion program in highland region of Rio de Janeiro

O presente estudo buscou levantar os aspectos abordados nas atividades de promocao de saude e prevencao das DSTs/Aids por profissionais de saude, integrantes do Programa Saude na Escola, na regiao serrana do estado do Rio de Janeiro e os metodos didatico-pedagogicos por eles utilizados, alem de realizar o levantamento de riscos relacionados a exposicao sexual desses profissionais, identificar a auto-avaliacao de vulnerabilidade e realizacao de sorologia anti-HIV pelos profissionais em questao. Os dados foram coletados atraves de formulario individual durante o mes de janeiro de 2005. Pode-se observar que os profissionais participantes do estudo abordam com frequencia as formas de transmissao das DSTs/aids e a importancia do uso do preservativo, mas essa frequencia diminui quando se trata de ensinar e demonstrar como utiliza-lo. Questoes relacionadas a vulnerabilidade e diferencas de genero frente a infeccao pelo HIV tambem nao sao discutidas com tanta frequencia. Predominam as estrategias didatico-pedagogicas convencionais como palestras e projecao de videos. Observou-se que parte dos profissionais nunca utilizava o preservativo e as relacoes estaveis, o sentimento de confianca e a fidelidade apareceram como razoes para nao utilizacao da camisinha. Percebeu-se tambem que a autopercepcao de risco ao HIV e subestimada por parte dos profissionais entrevistados. Fica claro que a adocao de comportamentos protetores nao esteve associada ao nivel de informacao sobre prevencao , mas envolve uma diversidade de aspectos bio-psico-sociais e comportamentais, que devem ser constantemente trabalhados, inclusive entre os profissionais de saude

Progesterona e progestágenos: síntese, classificação e uso / Progesterone and progestogens: synthesis, classification and uses

A Progesterona, hormônio natural, e os progestágenos, compostos sintéticos, que mantêm sua atividade terapêutica mesmo quando administrados por via oral, antagonizam os efeitos induzidos pelos estrogênios por meio da redução das mitoses celulares. Seus efeitos biológicos se dão tanto por ação genômica, no interior da célula, acoplada a um receptor, quanto por ação não genômica, quando atua não acoplada a um receptor.Em virtude de seus efeitos, tanto a progesterona quanto os progestágenos, têm inúmeras aplicações em ginecologia, podendo ser usados isolados ou associados com estrógenos, em várias condições que vão desde o controle do ciclo menstrual, contracepção pós-parto e contracepção fora do período de lactação, prevenção de hiperplasias endometriais e terapêutica adjuvante do câncer de endométrio.Os efeitos colaterais são em geral dose-dependentes e se dão em nível psicológico, metabólico e físico

Síndrome das pernas inquietas na gestação / Restless legs syndrome in pregnancy

O Objetivo do presente estudo é determinar freqüência e características da síndrome das pernas inquietas em grávidas, e detectar possíveis fatores associados à sua ocorrência. Desenvolvemos estudo observacional em gestantes consecutivamente internadas em trabalho de parto durante 60 dias em maternidade conveniada com o SUS. Foi realizada no puerpério imediato entrevista utilizando questionário padronizado para diagnóstico da síndrome, e coletadas informações quanto às características dos sistemas e quanto a história obstétrica e patológica. Os dados foram tabulados e analisados com a utilização do programa Epi-Info 6.04b. Realizadas 262 entrevistas, 9,5 porcento (n=25) das entrevistadas haviam apresentado a síndrome durante a gestação; destas, 60 porcento queixaram-se de insônia. A síndrome foi mais comum no terceiro trimestre, e não houve relação entre a sua presença e qualquer variável obstétrica ou demográfica. Trata-se de síndrome relativamente comum na gestação, que pode levar a insônia e conseqüente diminuição na qualidade de vida. Possivelmente fatores genéticos e outros ligados a alterações do organismo materno, como por exemplo altos níveis séricos de estrogênio, participam da sua gênese neste contexto