Mara Lisiane de Moraes dos Santos

Conhecimento e prática sobre os fatores de risco para o câncer de mama entre mulheres de 40 a 69 anos

OBJECTIVES: to investigate knowledge of and practices regarding risk factors for breast cancer among users of the Family Health Strategy (FHS). METHODS: a cross-sectional study was carried out among 393 women aged between 40 and 69 years using the FHS in the city of Dourados, in the Brazilian State of Mato Grosso do Sul. An interview was conducted using a semi-structured questionnaire to investigate socio-demographic variables, family history and awareness/practices regarding the risk factors for breast cancer. The variables were described using simple frequency and a percentage. The association between awareness of the risk factors and the variables was confirmed using Fishers exact test and the chi-square with a level of significance of 5%. RESULTS: the mean age was 52.5 ± 8.1 years, the mean years of schooling was 4.4±3.6 years, 52.4% of the women were black/colored and 66.6% had a partner. Of the women, 86.5% had received some information on breast cancer. The risk factors for the disease are known by 54.2% of the women. Awareness of the risk factors was associated with family history (p=0.004) and years of schooling (p=0.01). Where the risk factors were known, 52.2% of the women took preventive measures. CONCLUSION: the identification of variables related to greater awareness of the disease may facilitate the adoption of strategies aimed at the most vulnerable groups.

Terapia de reposição enzimática para as mucopolissacaridoses I, II e VI: recomendações de um grupo de especialistas brasileiros

Mucopolysaccharidoses (MPS) are rare genetic diseases caused by deficiency of specific lysosomal enzymes that affect catabolism of glycosaminoglycans (GAG). Accumulation of GAG in various organs and tissues in MPS patients results in a series of signs and symptoms, producing a multisystemic condition affecting bones and joints, the respiratory and cardiovascular systems and many other organs and tissues, including in some cases, cognitive performance. So far, eleven enzyme defects that cause seven different types of MPS have been identified. Before introduction of therapies to restore deficient enzyme activity, treatment of MPS focused primarily on prevention and care of complications, still a very important aspect in the management of these patients. In the 80s treatment of MPS with bone marrow transplantation/hematopoietic stem cells transplantation (BMT/HSCT) was proposed and in the 90s, enzyme replacement therapy (ERT),began to be developed and was approved for clinical use in MPS I, II and VI in the first decade of the 21st century. The authors of this paper are convinced that a better future for patients affected by mucopolysaccharidoses depends upon identifying, understanding and appropriately managing the multisystemic manifestations of these diseases. This includes the provision of support measures (which should be part of regular multidisciplinary care of these patients) and of specific therapies. Although inhibition of synthesis of GAG and the recovery of enzyme activity with small molecules also may play a role in the management of MPS, the breakthrough is the currently available intravenous ERT. ERT radically changed the setting for treatment of mucopolysaccharidosis I, II and VI in the last decade., Benefits can even be extended soon to MPS IV A (ERT for this condition is already in clinical development), with prediction for treatment of MPS III A and the cognitive deficit in MPS II by administration of the enzyme directly into the central nervous system (CNS). A large number of Brazilian services, from all regions of the country, already have experience with ERT for MPS I, II and VI. This experience was gained not only by treating patients but also with the participation of some groups in clinical trials involving ERT for these conditions. Summing up the three types of MPS, more than 250 patients have already been treated with ERT in Brazil. The experience of professionals coupled to the data available in international literature, allowed us to elaborate this document, produced with the goal of bringing together and harmonize the information available for the treatment of these severe and progressive diseases, which, fortunately, are now treatable, a situation which bring new perspectives for Brazilian patients, affected by these conditions.As mucopolissacaridoses (MPS) sao doencas geneticas raras causadas pela deficiencia de enzimas lisossomicas especificas que afetam o catabolismo de glicosaminoglicanos (GAG). O acumulo de GAG em varios orgaos e tecidos nos pacientes afetados pelas MPS resulta em uma serie de sinais e sintomas, integrantes de um quadro clinico multissistemico que compromete ossos e articulacoes, vias respiratorias, sistema cardiovascular e muitos outros orgaos e tecidos, incluindo, em alguns casos, as funcoes cognitivas. Ja foram identificados 11 defeitos enzimaticos que causam sete tipos diferentes de MPS. Antes do advento de terapias dirigidas para a restauracao da atividade da enzima deficiente, o tratamento das MPS tinha como principal foco a prevencao e o cuidado das complicacoes, aspecto ainda bastante importante no manejo desses pacientes. Na decada de 80 foi proposto o tratamento das MPS com transplante de medula ossea/transplante de celulas tronco hematopoieticas (TMO/TCTH) e na decada de 90 comecou o desenvolvimento da Terapia de Reposicao Enzimatica (TRE), que se tornou uma realidade aprovada para uso clinico nas MPS I, II e VI na primeira decada do seculo 21. Os autores deste trabalho tem a conviccao de que um melhor futuro para os pacientes afetados pelas MPS depende da identificacao, compreensao e manejo adequado das manifestacoes multissistemicas dessas doencas, incluindo medidas de suporte (que devem fazer parte da assistencia multidisciplinar regular destes pacientes) e terapias especificas. Embora a inibicao da sintese de GAG e o resgate da atividade enzimatica com moleculas pequenas tambem possam vir a ter um papel no manejo das MPS, o grande avanco disponivel no momento e a TRE intravenosa. A TRE permitiu modificar radicalmente o panorama do tratamento das mucopolissacaridoses I, II e VI na ultima decada, sendo que ainda pode estender seus beneficios em breve para a MPS IV A (cuja TRE ja esta em desenvolvimento clinico), com perspectivas para o tratamento da MPS III A e do deficit cognitivo na MPS II atraves de administracao da enzima diretamente no sistema nervoso central (SNC). Um grande numero de centros brasileiros, incluindo servicos de todas as regioes do pais, ja tem experiencia com TRE para MPS I, II e VI. Essa experiencia foi adquirida nao so com o tratamento de pacientes como tambem com a participacao de alguns grupos em ensaios clinicos envolvendo TRE para essas condicoes. Somados os tres tipos de MPS, mais de 250 pacientes ja foram tratados com TRE em nosso pais. A experiencia dos profissionais brasileiros, somada aos dados disponiveis na literatura internacional, permitiu elaborar este documento, produzido com o objetivo de reunir e harmonizar as informacoes disponiveis sobre o tratamento destas doencas graves e progressivas, mas que, felizmente, sao hoje trataveis, uma realidade que traz novas perspectivas para os pacientes brasileiros afetados por essas condicoes.

Efeitos de técnicas de desobstrução brônquica na mecânica respiratória de neonatos prematuros em ventilação pulmonar mecânica

OBJECTIVES: This research aimed to evaluate the repercussions of specific chest physiotherapy procedures in mean airway resistance and in dynamic compliance in preterm infants in mechanical ventilation. METHODS: Eighteen preterm infants in conventional mechanical ventilation were submitted to one session of chest physiotherapy (manual chest compression during expiration + intermittent aspiration of intratracheal cannula). Mean airway resistance and dynamic compliance measurements were taken prior to, 10, 40 and 70 minutes after intervention using a pneumotachograph with graphic display (Newport Navigator GM-250®), coupled to a flow transducer (Varfley-Bicore®). For analysis of results the infants were divided into 2 groups; less than 5 days (group mechanical ventilation 5) on mechanical ventilation. Values were analyzed by Friedman Test, with Dunns Multiple Comparisons Test (p 5 mean airway resistance had a significant reduction at the 10th (p 5 improved mean airway resistance and dynamic compliance, with best results for the mean airway resistance.

Educação Permanente no cotidiano da Atenção Básica no Mato Grosso do Sul

O artigo analisou as acoes de Educacao Permanente em Saude na Atencao Basica em Mato Grosso do Sul, Brasil, na perspectiva de 184 equipes participantes da primeira fase do Programa de Melhoria do Acesso e da Qualidade (PMAQ), de junho de 2012 a fevereiro de 2013. Entre as acoes de Educacao Permanente, os cursos presenciais foram mais prevalentes, seguidos por troca de experiencia, teleducacao, ensino a distância e tutoria/preceptoria, tanto na capital quanto no interior. As acoes de planejamento e apoio a gestao foram mais prevalentes na capital. As acoes de apoio da gestao estavam diretamente relacionadas com o planejamento e a organizacao do processo de trabalho.

Contextual and Individual Factors Influencing Periodontal Treatment Needs by Elderly Brazilians: A Multilevel Analysis.

Objective To assess the relationship between periodontal treatment needs by elderly Brazilians and contextual as well as individual variables. Methods A cross-sectional study was carried out to assess the need for clinical periodontal treatment, based on National Oral Health Survey (SB Brasil 2010) data on the presence of dental calculus, shallow (3–5 mm) and deep (≥ 6 mm) periodontal pockets, and gingival bleeding in elderly people (n = 7,619). The contextual variables included the Municipal Human Development Index (MHDI), income inequality (Gini Index) and coverage of the municipal population by the Family Health Strategy (FHS) program oral health teams.<0} The individual variables were sex, income, education level and self-reported skin color. Multilevel logistic regression models were used to calculate the odds ratio (OR) and 95% confidence intervals (CI95%) between periodontal treatment needs and the contextual as well as individual variables. Results Gingival bleeding was found in 20.7% of the elderly analyzed (n = 1,577), dental calculus in 34% (n = 2,590), shallow periodontal pockets in 15.6% (n = 1,189), and deep periodontal pockets in 4.2% (n = 320). Individual factors were correlated with all the outcomes assessed. Sex was a protective factor in regard to gingival bleeding (OR = 0.87; CI95% 0.76–1.00), dental calculus (OR = 0.86; CI95% 0.75–0.99), shallow periodontal pockets (OR = 0.69; CI95% 0.60–0.80) and deep periodontal pockets (OR = 0.58; CI95% 0.45–0.74). It was found that fewer women needed treatment. Elderly people who self-reported having nonwhite skin had higher chances of needing periodontal treatment. Skin color was a risk factor for gingival bleeding (OR = 1.32; CI95% 1.14–1.53), dental calculus (OR = 1.32; CI95%1.14–1.54) and shallow periodontal pockets (OR = 1.27; CI95% 1.09–1.49). Education level was associated with the presence of dental calculus (OR = 0.77; CI95% 0.66–0.89), shallow periodontal pockets (OR = 0.86; CI95% 0.73–1.00) and deep periodontal pockets (OR = 0.74; CI95% 0.57–0.97), thus acting as a risk factor for undereducated elderly people. There was a correlation between population coverage by the Family Health Strategy (FHS) program oral health teams and the presence of gingival bleeding (OR = 0.67; CI95% 0.52–0.88), shallow periodontal pockets (OR = 0.76; CI95% 0.58–0.98) and deep periodontal pockets (OR = 0.62; CI95% 0.44–0.89), making these teams act as a protective factor. Conclusions This study showed evidence of the sociocontextual as well as individual sociodemographic characteristics influencing periodontal treatment needed by elderly Brazilians, based on the clinical features of periodontal disease. The results suggest the existence of inequality related to periodontal treatment needs among elderly Brazilians, especially in regard to sex and ethnicity, in addition to a potentially positive impact from the expansion of the Family Health Strategy (FHS) program oral health teams.

Acolhimento na Atenção Primária à Saúde: revisão integrativa

ABSTRACT The present study aims to analyze the knowledge produced about the reception in the Primary Health Care, in the last eight years. It is about an integrative review, also related to the reception within the Family Health Strategy. It can be stated that the reception process is not yet fully systematized in the models of health care, and this may be a justification for the difficulties presented by both professionals and users. There are necessary studies with new approaches or strategies for the systematizing of the reception in units of Primary Health Care, and verify if these actually have an impact on the quality of services and in the users satisfaction. ERDS User embracement; Health care (Public Health); Primary Health Care; Family Health Strategy. SAUDE DEBATE | rio de Janeiro, v. 39, n. 105, p.514-524, aBr-JUn 2015 514 Acolhimento na Atencao Primaria Sade reisao interatia reception in primar Health Care: an integrative revie Larissa Rachel Palhares Coutinho 1 , Ana Rita Barbieri

Respostas fisiológicas de recém-nascidos pré-termo submetidos ao Metódo Mãe-Canguru e a posição prona

O Ministerio da Saude recomenda e incentiva a Atencao Humanizada ao recem-nascido de baixo peso utilizando-se o Metodo Mae-Canguru (MMC) nas unidades integrantes do Sistema Unico de Saude (SUS). O objetivo deste estudo foi avaliar e comparar as respostas fisiologicas entre o MMC e a posicao prona (PP), em recem-nascidos pre-termo (RNPT). Foi feito um estudo de intervencao, realizado entre setembro e outubro de 2009, composto por 20 RNPT, de ambos os sexos, com idade gestacional entre 24 a 36 semanas, estaveis hemodinamicamente, sendo classificados como grupo I (MMC) e grupo II (PP). Foram consideradas as variaveis: frequencia cardiaca (FC), frequencia respiratoria (FR), saturacao periferica de oxigenio (SatO2) e temperatura corporal (T). As mensuracoes foram realizadas por tres dias consecutivos, antes e 60 min apos a aplicacao das tecnicas. No grupo PP, a FR aferida antes foi significativamente maior do que a aferida apos a intervencao, nos 1o e 3o dias (p<0,0001; p<0,006); enquanto que, no MMC, a FR apresentou diferenca significativa somente no 3o dia (p<0,006). A FC apresentou reducao entre os momentos no 3o dia, nos grupos PP (p<0,02) e no MMC (p<0,04). No grupo PP, a variavel SatO2 apresentou significativo aumento nos 1o (p<0,02) e 3o dias (p<0,02), entre os momentos de coleta, e no 3o dia do MMC (p<0,04). Nao foram observadas alteracoes na FR, FC, T e SatO2 com a aplicacao do MMC e PP, nao havendo melhor desempenho em relacao aos grupos. Observamos diminuicao da FR apos a aplicacao do MMC e PP em momentos isolados e aumento da SatO2 no 3o dia apos o MMC.

Fisioterapia ambulatorial na rede pública de saúde de Campo Grande (MS, Brasil) na percepção dos usuários: resolutividade e barreiras

Este artigo trata de um ensaio empirico embasado na analise critica da experiencia das rodas de conversas com adolescentes do sexo feminino de quatro comunidades do sertao pernambucano. Com ele, busca-se contribuir com a qualificacao metodologica e pedagogica das rodas de conversa, haja vista o seu desenvolvimento cada vez mais comum em diversos contextos no campo da promocao da saude. Advoga-se por um lado que a roda de conversa e mais que disposicoes circulares de cadeiras e, por outro, que e um modo critico de pensar os papeis socialmente construidos transversalizados pelas historicas e desiguais relacoes de classe, genero e etnia. Por fim, com ele, busca-se reafirmar o compromisso com espacos que possibilitem o inesperado das vozes divergentes. Apontando tal fertilidade discursiva, e possivel produzir um olhar sobre as rodas de conversa como estrategia metodologica, engajada na acao pedagogica-transformadora.Este estudo teve como objetivo conhecer a percepcao de usuarios dos servicos de fisioterapia ambulatorial do Sistema Unico de Saude (SUS), no municipio de Campo Grande-MS, sobre a resolutividade da atencao e barreiras enfrentadas. Foi realizada pesquisa descritivo-exploratoria com entrevistas e os dados organizados pela tecnica do Discurso do Sujeito Coletivo. Foram entrevistados 45 usuarios, em sete clinicas de fisioterapia conveniadas ao SUS. Os motivos de procura pela fisioterapia foram disturbios osteomioarticulares (93,3%) e neurologicos (6,7%). Foram identificadas as Ideias Centrais (IC): ICA – A Fisioterapia nao e totalmente resolutiva; ICB – A Fisioterapia pelo SUS e resolutiva e funciona bem; ICC – A distância dificulta o acesso a Fisioterapia; ICD – A burocracia dificulta a continuidade do tratamento. A maioria dos entrevistados considerou a fisioterapia resolutiva (86,6%). As dificuldades foram relacionadas ao acesso, sendo limitantes as questoes fisico-financeiras e burocraticas.Este estudo teve como objetivo conhecer a percepcao de usuarios dos servicos de fisioterapia ambulatorial do Sistema Unico de Saude (SUS), no municipio de Campo Grande-MS, sobre a resolutividade da atencao e barreiras enfrentadas. Foi realizada pesquisa descritivo-exploratoria com entrevistas e os dados organizados pela tecnica do Discurso do Sujeito Coletivo. Foram entrevistados 45 usuarios, em sete clinicas de fisioterapia conveniadas ao SUS. Os motivos de procura pela fisioterapia foram disturbios osteomioarticulares (93,3%) e neurologicos (6,7%). Foram identificadas as Ideias Centrais (IC): ICA – A Fisioterapia nao e totalmente resolutiva; ICB – A Fisioterapia pelo SUS e resolutiva e funciona bem; ICC – A distância dificulta o acesso a Fisioterapia; ICD – A burocracia dificulta a continuidade do tratamento. A maioria dos entrevistados considerou a fisioterapia resolutiva (86,6%). As dificuldades foram relacionadas ao acesso, sendo limitantes as questoes fisico-financeiras e burocraticas.This article attend an empirically experiment grounded in critical analysis of the experience of the wheels conversations with female adolescents in four communities of the interior of Pernambuco. Seeks to contribute to the methodological and pedagogical skills of conversation circles, given the development increasingly common in various contexts in the field of health promotion. The argument is, on the one hand that the conversation wheel is more that circular arrangements of chairs, and on the other, which is a critical way of thinking about the socially constructed roles mainstreamed by historical and unequal relations of class, gender and ethnicity. Finally, reaffirms commitment to spaces that allow the unexpected divergent voices. Pointing this discursive fertility, it is possible to produce a look on the conversation circles as a methodological strategy, engaged in pedagogical action-transforming.

Visita domiciliar e cuidado domiciliar na Atenção Básica: um olhar sobre a saúde bucal

ABSTRACT The objective of the present work was to analyze the process of home care within the primary care teams that joined the National Program for Access and Quality Improvement. A study was conducted from the database of the program related to the dimension that has evalua -ted the accomplishment of home visit and home care, with emphasis on the practices of the oral health team. Almost 100% of the evaluated family health teams perform home visits. The home care is performed by more than 90% of the professionals of the minimum team, and by appro-ximately 50% of professionals of the oral health team. The oral health team has challenges to overcome towards the new practices in primary care. ERDS Home visit; Oral health; Primary Health Care. SAUDE DEBATE | rio de Janeiro, v. 39, n. 105, p.441-450, aBr-JUn 2015 441 Visita domiciliar e cuidado domiciliar na Atenao Basica um olar sobre a saude bucal Home visit and home care in the primar Care: a loo on oral health Alessandro Diogo De-Carli

Maximal respiratory pressures in healthy boys who practice swimming or indoor soccer and in healthy sedentary boys

The purpose of this study was to investigate respiratory muscle strength in boys who practice swimming or indoor soccer and in their sedentary counterparts. Seventy-five 7- and 8-year-old boys were included; 25 were swimmers (group 1), 25 played indoor soccer (group 2), and 25 were sedentary (group 3). All subjects underwent anthropometric evaluation. Maximal respiratory pressures were measured by manometry. Data were analyzed by using ANOVA and the Tukey–Kramer post hoc test (significance level: p < 0.05). Mean maximal inspiratory pressures in groups 1, 2, and 3 were –109.67 ± 11.06, –90.74 ± 16.06, and –90.67 ± 19.93 cm H2O, respectively (p < 0.001 by ANOVA; group 1 × group 2: p < 0.001; group 1 × group 3: p < 0.001; group 2 × group 3: p > 0.05 by Tukey–Kramer). Mean maximal expiratory pressures in groups 1, 2, and 3 were 108.17 ± 9.90, 92.32 ±11.67, and 91.33 ±15.17 cm H2O, respectively (p < 0.0001 by ANOVA; group 1 × group 2: p < 0.001; group 1 × group 3: p < 0.001; group 2 × group 3: p > 0.05 by Tukey–Kramer). Swimmers showed better maximal respiratory pressures than indoor soccer players and sedentary subjects. No significant difference was observed between the results for soccer players and sedentary subjects.