Maria Lúcia Ivo

Characterization of tuberculosis among HIV/AIDS patients at a referral center in Mato Grosso do Sul.

Tuberculosis was investigated regarding its clinical presentation, treatment outcome and sociodemographic profile among HIV patients attended at a referral center in Mato Grosso do Sul, in 2003-2005. Sixty-six medical files on patients over 14 years of age and data from the Brazilian National Information System for Notifiable Diseases relating to tuberculosis and from the Mortality Information System were analyzed. Most of the patients were male, white, of low schooling level and from urban areas. Increased extrapulmonary clinical presentation was found and it correlated with the degree of immunological competence. The main reasons for ceasing treatment were cure (reached after longer-than-expected follow-up) and death (of six patients at the beginning of the tuberculosis treatment). Information gaps were found in the tuberculosis notification records and medical files. The study revealed the need for early diagnosis of tuberculosis among HIV-positive patients, improvements in medical records and follow-up beyond the recommended duration, because of changes to the clinical evolution of tuberculosis in cases of comorbidity with HIV.

Obesidade em pacientes candidatos a cirurgia bariátrica

Objective: To identify the demographic and clinical profile of individuals with severe obesity who were candidates for bariatric surgery. Methods: This was a descriptive study. Data were extracted from 252 medical records of candidates for bariatric surgery in the Hospital of the Federal University of Mato Grosso do Sul from 2004 through 2007. Results: The prevalence of obesity was associated with other chronic diseases related to the eating habits. The majority of candidates for bariatric surgery were whites (86.53%) and female (80.15%). The mean age of the candidates was 36.07±10.16 years. The most common commorbidities included high blood pressure (63.49%), dyspnea (55.56%), varicose veins (45.63%), and depression (36.51%). Conclusion: The major comorbidity associated with obesity is high blood pressure; individuals need be followed by a multidisciplinary team of health care providers.OBJECTIVE: To identify the demographic and clinical profile of individuals with severe obesity who were candidates for bariatric surgery. METHODS: This was a descriptive study. Data were extracted from 252 medical records of candidates for bariatric surgery in the Hospital of the Federal University of Mato Grosso do Sul from 2004 through 2007. RESULTS: The prevalence of obesity was associated with other chronic diseases related to the eating habits. The majority of candidates for bariatric surgery were whites (86.53%) and female (80.15%). The mean age of the candidates was 36.07±10.16 years. The most common commorbidities included high blood pressure (63.49%), dyspnea (55.56%), varicose veins (45.63%), and depression (36.51%). CONCLUSION: The major comorbidity associated with obesity is high blood pressure; individuals need be followed by a multidisciplinary team of health care providers.

Assistência de enfermagem a portadores de anemia falciforme, à luz do referencial de Roy

Este estudio busca aplicar los conceptos del modelo de adaptacion de Roy para identificar los comportamientos (adaptativos e inefectivos) de pacientes portadores de anemia falciforme, asi como tambien como los estimulos focales, contextuales y residuales responsables por estos comportamientos. La recoleccion de datos fue realizada en la consulta externa de Hemoglobinopatias del HCFMRP-USP. Fueron sujetos 9 pacientes (8 mujeres y 1 hombre). Los resultados evidenciaron, en el modo fisiologico, el comportamiento inefectivo de baja oxigenacion y sus consecuencias (desarrollo fisico comprometido, retardo sexual, ictericia por hemolisis, alteraciones respiratorias). En el modo psicosocial y considerando el autoconcepto, fue observada la disminucion de la auto estima como el comportamiento mas destacado; el desempeno del rol fue caracterizado por cambios de ocupacion; cuanto a la interdependencia, la madre fue referida como el otro significante mas frecuente. Se identifico la oclusion de vasos sanguineos como estimulo causador de comportamientos inefectivos y se verifico que la funcion fisiologica afectada altera otros modos de adaptacion.O presente estudo busca aplicar os conceitos do modelo de Adaptacao de Roy para identificar os comportamentos (adaptativos e inefetivos) de pacientes portadores de anemia falciforme, bem como os estimulos focais, contextuais e residuais responsaveis por tais comportamentos. A coleta de dados foi realizada no Ambulatorio de Hemoglobinopatias do HCFMRP-USP. Foram sujeitos 9 pacientes (8 mulheres e 1 homem). Evidenciou-se, no modo fisiologico, o comportamento inefetivo de baixa oxigenacao e suas consequencias (desenvolvimento fisico comprometido, retardo sexual, ictericia por hemolise, alteracoes respiratorias). No modo psicossocial, o autoconceito teve a diminuicao da auto-estima como o comportamento mais destacado; o desempenho de papel foi caracterizado por mudancas de ocupacao; quanto a interdependencia, a mae foi referida como o outro significante mais frequente. Identificou-se, predominantemente, como estimulo causador dos comportamentos inefetivos, a vaso-oclusao. Verificou-se que a funcao fisiologica afetada altera os outros modos adaptativos.

O contexto da formação dos agentes comunitários de saúde no Brasil

Este estudio tuvo como objetivo identificar y describir el proceso historico de la formacion profesional de los agentes comunitarios de salud, mediante el analisis de documentos relativos a la formacion tecnica en salud. Es una investigacion documental realizada en documentos normativos e instrumentales en los registros administrativos y de gestion del Departamento de Atencion Primaria, con investigacion bibliografica en las bases de datos Medline y LILACS, de publicaciones orientadas a la politica de formacion profesional, en el periodo de 1986 a 2006, y de lectura con analisis tematico. En respuesta a las demandas politicas y economicas, el agente comunitario de salud se convirtio en profesion en 2002. Sus funciones fueron ampliadas, motivo por el cual, en 2006 ya habia en Brasil mas de 200 mil profesionales trabajando segun el nuevo reglamento: la Ley 11.350, que revoco la ley anterior. El agente comunitario se convirtio en un elemento importante para la promocion de cambios en el modelo asistencial y el fortalecimiento de la atencion primaria en salud.The purpose of this study was to investigate and describe the historical development of the professional education of community health agents by analyzing documents related to technical education in the health area. Documental investigation of normative and instrumental documents within the managerial and administrative records of the Primary Care Department was carried out with a literature survey in the Medline and Lilacs databases of sources that guided educational policies between 1986 and 2006, as well as theme analysis reading. In response to political and economic demands, the profession of community health agent was established in 2002, with subsequent increases in attributions. In 2006, over 200 000 professionals were active in Brazil with their role regulated by Federal Law 11,350, which superseded previous legislation. In conclusion, community health agents have become an important element in promoting changes to the care model and strengthening primary care services. DESCRIPTORS: Professional education. Health professionals. Educational measurement. EL CONTEXTO DE LA FORMACION PROFESIONAL DE LOS AGENTES COMUNITARIOS DE SALUD EN BRASIL RESUMEN: Este estudio tuvo como objetivo identificar y describir el proceso historico de la formacion profesional de los agentes comunitarios de salud, mediante el analisis de documentos relativos a la formacion tecnica en salud. Es una investigacion documental realizada en documentos normativos e instrumentales en los registros administrativos y de gestion del Departamento de Atencion Primaria, con investigacion bibliografica en las bases de datos Medline y LILACS, de publicaciones orientadas a la politica de formacion profesional, en el periodo de 1986 a 2006, y de lectura con analisis tematico. En respuesta a las demandas politicas y economicas, el agente comunitario de salud se convirtio en profesion en 2002. Sus funciones fueron ampliadas, motivo por el cual, en 2006 ya habia en Brasil mas de 200 mil profesionales trabajando segun el nuevo reglamento: la Ley 11.350, que revoco la ley anterior. El agente comunitario se convirtio en un elemento importante para la promocion de cambios en el modelo asistencial y el fortalecimiento de la atencion primaria en salud. DESCRIPTORES: Educacion profesional. Profesional de salud. Evaluacion educacional.

Obesidad en pacientes candidatos a cirugía bariátrica

Objective: To identify the demographic and clinical profile of individuals with severe obesity who were candidates for bariatric surgery. Methods: This was a descriptive study. Data were extracted from 252 medical records of candidates for bariatric surgery in the Hospital of the Federal University of Mato Grosso do Sul from 2004 through 2007. Results: The prevalence of obesity was associated with other chronic diseases related to the eating habits. The majority of candidates for bariatric surgery were whites (86.53%) and female (80.15%). The mean age of the candidates was 36.07±10.16 years. The most common commorbidities included high blood pressure (63.49%), dyspnea (55.56%), varicose veins (45.63%), and depression (36.51%). Conclusion: The major comorbidity associated with obesity is high blood pressure; individuals need be followed by a multidisciplinary team of health care providers.OBJECTIVE: To identify the demographic and clinical profile of individuals with severe obesity who were candidates for bariatric surgery. METHODS: This was a descriptive study. Data were extracted from 252 medical records of candidates for bariatric surgery in the Hospital of the Federal University of Mato Grosso do Sul from 2004 through 2007. RESULTS: The prevalence of obesity was associated with other chronic diseases related to the eating habits. The majority of candidates for bariatric surgery were whites (86.53%) and female (80.15%). The mean age of the candidates was 36.07±10.16 years. The most common commorbidities included high blood pressure (63.49%), dyspnea (55.56%), varicose veins (45.63%), and depression (36.51%). CONCLUSION: The major comorbidity associated with obesity is high blood pressure; individuals need be followed by a multidisciplinary team of health care providers.

Obesity in candidates for bariatric surgery

Objective: To identify the demographic and clinical profile of individuals with severe obesity who were candidates for bariatric surgery. Methods: This was a descriptive study. Data were extracted from 252 medical records of candidates for bariatric surgery in the Hospital of the Federal University of Mato Grosso do Sul from 2004 through 2007. Results: The prevalence of obesity was associated with other chronic diseases related to the eating habits. The majority of candidates for bariatric surgery were whites (86.53%) and female (80.15%). The mean age of the candidates was 36.07±10.16 years. The most common commorbidities included high blood pressure (63.49%), dyspnea (55.56%), varicose veins (45.63%), and depression (36.51%). Conclusion: The major comorbidity associated with obesity is high blood pressure; individuals need be followed by a multidisciplinary team of health care providers.OBJECTIVE: To identify the demographic and clinical profile of individuals with severe obesity who were candidates for bariatric surgery. METHODS: This was a descriptive study. Data were extracted from 252 medical records of candidates for bariatric surgery in the Hospital of the Federal University of Mato Grosso do Sul from 2004 through 2007. RESULTS: The prevalence of obesity was associated with other chronic diseases related to the eating habits. The majority of candidates for bariatric surgery were whites (86.53%) and female (80.15%). The mean age of the candidates was 36.07±10.16 years. The most common commorbidities included high blood pressure (63.49%), dyspnea (55.56%), varicose veins (45.63%), and depression (36.51%). CONCLUSION: The major comorbidity associated with obesity is high blood pressure; individuals need be followed by a multidisciplinary team of health care providers.

Ocorrência de hemoglobina S no estado de Mato Grosso do Sul, Brasil

BACKGROUND: Hemoglobinopathies are the most common genetic disorders in humans and Hb S is the most frequent among them. Its occurrence in the state of Mato Grosso do Sul has not been systematically analyzed yet. OBJECTIVES: To describe the occurrence of hemoglobin S according to genotypes, gender, age at the moment of diagnosis, cover index and prevalence in the state of Mato Grosso do Sul. MATERIAL AND METHOD: Retrospective, transversal and descriptive study of the results of neonatal screening for hemoglobinopathies performed with high pressure liquid chromatography technique at Instituto de Pesquisa, Ensino e Diagnosticos da Associacao dos Pais e Amigos dos Excepcionais (IPED/APAE) in the state of Mato Grosso do Sul (2000-2005). RESULTS: Among 190,809 screened individuals, 2,624 (1.38%) showed alterations, 2,385 were neonates and 239 were children aged 28 days or more. There was no difference in gender (1,335 females and 1,289 males). The altered genotypes were FAS (99.16%), FS (0.61%) and FSC (0.23%). CONCLUSION: This first study of neonatal screening in the state of Mato Grosso do Sul revealed that the state program developed by IPED/APAE has been consolidating and advancing as to cover index and early diagnosis. These indicators may be the basis for preventive (genetic counseling and family studies) and assistance measures (continuous ambulatory treatment), which aim at the reduction of morbimortality in individuals with these hemoglobinopathies in the state.resumo Background: Hemoglobinopathies are the most common genetic disorders in humans and Hb S is the most frequent among them. Its occurrence in the state of Mato Grosso do Sul has not been systematically analyzed yet. Objectives: To describe the occurrence of hemoglobin S according to genotypes, gender, age at the moment of diagnosis, cover index and prevalence in the state of Mato Grosso do Sul. Material and method: Retrospective, transversal and descriptive study of the results of neonatal screening for hemoglobinopathies performed with high pressure liquid chromatography technique at Instituto de Pesquisa, Ensino e Diagnosticos da Associacao dos Pais e Amigos dos Excepcionais (IPED/APAE) in the state of Mato Grosso do Sul (20002005). Results: Among 190,809 screened individuals, 2,624 (1.38%) showed alterations, 2,385 were neonates and 239 were children aged 28 days or more. There was no difference in gender (1,335 females and 1,289 males). The altered genotypes were FAS (99.16%), FS (0.61%) and FSC (0.23%). Conclusion: This first study of neonatal screening in the state of Mato Grosso do Sul revealed that the state program developed by IPED/APAE has been consolidating and advancing as to cover index and early diagnosis. These indicators may be the basis for preventive (genetic counseling and family studies) and assistance measures (continuous ambulatory treatment), which aim at the reduction of morbimortality in individuals with these hemoglobinopathies in the state. unitermos key words Triagem neonatal

The burden and quality of life of caregivers of sickle cell anemia patients taking hydroxyurea versus those not taking hydroxyurea

OBJECTIVE: To assess the burden and quality of life of caregivers of patients with sickle cell anemia taking hydroxyurea versus those of patients not taking hydroxyurea. METHODS: A cross-sectional study was performed of caregivers of outpatients with sickle cell anemia in two public hospitals in Campo Grande, MS, from January through June 2010. The World Health Organization Quality of Life-BREF Scale and the Caregiver Burden Scale were used. RESULTS: Of the 37 caregivers in this study, 81.1% were women, 73.0% were mothers, 59.5% were married, 54.1%were mulattos, 48.6% were housewives, 54.1% had family incomes of up to one minimum wage and 75.7% had onlycompleted elementary education. The mean duration of care provided (time after diagnosis) was 16.08 ± 9.88 yearsand 89.2% reported that they provided 24-hour care. Regarding health, 27.0% of study participants reported having physical and 13.5% emotional problems. There were no significant relationships between these variables either with the different domains or the total score of the WHOQOL-BREF comparing caregivers of patients taking hydroxyurea versusthose of patients not taking hydroxyurea. There was a moderate negative linear correlation between the WHOQOL-BREF and the Caregiver Burden Scale scores (linear correlation test of Pearson: p-value = 0.003, r = -0.477). The burden of caregivers of patients who did not take hydroxyurea was significantly higher than those of patients who took the medication in terms of general tension, disappointment, environment and total score (student t-test: p-value < 0.05). CONCLUSION: In the perception of the caregiver, looking after sickle cell anemia patients represents a moderate negative burden.Objective To assess the burden and quality of life of caregivers of patients with sickle cell anemia taking hydroxyurea versus those of patients not taking hydroxyurea. Methods A cross-sectional study was performed of caregivers of outpatients with sickle cell anemia in two public hospitals in Campo Grande, MS, from January through June 2010. The World Health Organization Quality of Life-BREF Scale and the Caregiver Burden Scale were used. Results Of the 37 caregivers in this study, 81.1% were women, 73.0% were mothers, 59.5% were married, 54.1%were mulattos, 48.6% were housewives, 54.1% had family incomes of up to one minimum wage and 75.7% had onlycompleted elementary education. The mean duration of care provided (time after diagnosis) was 16.08 ± 9.88 yearsand 89.2% reported that they provided 24-hour care. Regarding health, 27.0% of study participants reported having physical and 13.5% emotional problems. There were no significant relationships between these variables either with the different domains or the total score of the WHOQOL-BREF comparing caregivers of patients taking hydroxyurea versusthose of patients not taking hydroxyurea. There was a moderate negative linear correlation between the WHOQOL-BREF and the Caregiver Burden Scale scores (linear correlation test of Pearson: p-value = 0.003, r = -0.477). The burden of caregivers of patients who did not take hydroxyurea was significantly higher than those of patients who took the medication in terms of general tension, disappointment, environment and total score (student t-test: p-value < 0.05). Conclusion In the perception of the caregiver, looking after sickle cell anemia patients represents a moderate negative burden.

Scope and efficiency of the newborn screening program in identifying hemoglobin S

Background In 2001, the Brazilian Ministry of Health added hemoglobinopathies to the National Neonatal Screening Program to be implemented in three steps. In order to meet the proposed goals, it is crucial to establish periodic assessments of this program with the aim of monitoring its implementation. Objective To assess the scope and the efficiency of the stages of the National Newborn Screening Program in identifying hemoglobin S. Methods A cross-sectional study was developed with the results of the heel prick test using the high performance liquid chromatography method for babies born in Mato Grosso do Sul from 2006 to 2010. The following variables were investigated: year, number of live births, total screening, coverage ratio, prevalence, time between the child birth and the blood collection; age at diagnosis; age at the time of the first consultation; and time between the diagnosis and the first appointment. Results Over the five years of the study, the mean coverage rate was 91.77%. The prevalences of hemoglobin FAS and hemoglobin FS were 1.65% and 0.011%, respectively. Blood samples from 43.48% of children were collected from the second to the seventh day. The age at diagnosis was within the first 28 days in 87.80% of the screened children. The lowest mean indices for the first consultation and the time between the diagnosis and the first appointment (58.8 and 46.4 days, respectively) occurred in 2010. Conclusions The scope of the National Neonatal Screening Program for hemoglobinopathies is good, with a large number of individuals being tested. Efficiency is a suitable indicator to assess the program steps. Three points are recommended: the training of the individuals involved, studies to assess the assistance provided to the affected child, and genetic counseling to the mothers.

Situação do pênfigo foliáceo endêmico em Mato Grosso do Sul, Brasil, 1990-1999

307 cases were examined to characterize epidemiological aspects of endemic pemphigus foliaceus. The disease was predominantly identified in rural workers between 10 and 42 years old. Incidence was higher in the December, January, February, March and May (average: 30.7 cases/year). Our findings identified a corridor, coinciding with the state watershed.