Rodrigo Siqueira-Batista

Sepse: atualidades e perspectivas

This paper aims to provide an update on the main aspects of sepsis, a very relevant health care issue. A number of hypotheses have been proposed to explain its origin, involving interactions between microorganisms and the innate immune system, inflammation/immune mediation and the coagulation system. The clinical features of sepsis are variable and depend on the primary site of infection. The identification of early signs and symptoms is crucial for starting therapeutic measures fundamentally based on volume resuscitation, antibiotic therapy, use of steroids, anticoagulant therapy, biologic viability maintenance interventions and nutritional support.

Malária grave por Plasmodium falciparum

A malaria e uma das principais doencas parasitarias do mundo, acometendo importante contingente de pessoas. Por seu alcance epidemiologico e pela possibilidade de desenvolvimento de quadros graves - quase sempre devidos ao Plasmodium fqalciparum -, se faz necessario o conhecimento adequado de suas manifestacoes clinicas e da terapeutica, para otimizacao da conduta. Na malaria grave a internacao em unidade de terapia intensiva e mandatoria para reducao das complicacoes decorrentes da infeccao. O inicio do tratamento deve ser o mais precoce possivel, o qual tem impacto na sobrevida do paciente, e e baseado na combinacao de drogas antimalaricas e medidas de suporte. Neste âmbito, o presente artigo destina-se a discussao da forma grave da malaria por P. falciparum, com enfase no quadro clinico e no tratamento

Educação e competências para o SUS: é possível pensar alternativas à(s) lógica(s) do capitalismo tardio?

As transformacoes vividas no mundo do trabalho na sociedade contemporânea levam a necessidade de se repensar alternativas para a formacao dos profissionais de saude, permitindo, assim, a abordagem dos problemas de saude dos sujeitos e das coletividades. Com base nessas consideracoes, o presente trabalho pretende discutir a formacao em saude - em torno do conceito de competencia -, tendo como foco a educacao para o SUS, tomando como marco teorico a tentativa de analisar e propor uma alternativa aquelas entrincheiradas na logica do capitalismo tardio. Trata-se, pois, de uma reflexao sobre o assunto, correlacionando a teoria e a praxis, num movimento constante e incessante de construcao, desconstrucao e (re)construcao de proposicoes.

A influência da rede social da nutriz no aleitamento materno: o papel estratégico dos familiares e dos profissionais de saúde

The objective was to raise and classify scientific works on the influence of the social net of lactating mothers in the context of the breastfeeding. A bibliographical review was done in the main databases (MEDLINE, LILACS, SciELO), using as keywords: breastfeeding, weaning and family (and their versions in English and Spanish). Books, thesis, dissertations, and publications in international and national institutions were consulted (WHO, UNICEF, Ministry of Health). It could be observed that the actors that compose the social net of the lactating mothers can interfere in the decision of breastfeeding, through different extents, such as the encouragement/support to the initiative; reviewing the knowledge and cultural values; family tradition; and the cultivation of the indifference/discourage and the pressure exercised on the lactating mothers in relation to the form of feeding the child. In this way, it can infer on the need of the implementation of new health practices regarding to the care of this group. It is worth to highlight, the importance of the professionals to be qualified for the sensitive listening on the meaning of the nursing under the glance of the lactating mothers . Finally, it stands out the importance role of the social net of the lactating mothers, especially the family, for a successful breastfeeding.

Formação Médica na Estratégia de Saúde da Família: Percepções Discentes

Given current social demands, it has become essential for medical education to break from the traditional model of biological reductionist and training based only at hospitals and redefine itself towards a holistic care (integrality). The construction of new training practices in health with the use of new outdoor scenarios, in partnership with (Unified National Health System — SUS), assumed a key role. In 2005 the Centro Universitario Serra dos Orgaos (Unifeso) incorporated into its curriculum the Problem-Based Learning and the insertion of medical undergraduates into Basic Health Units Family. This paper describes the perception of medical students in this scenario. We conducted a qualitative research working from the application of interviews and the utilization of thematic analysis of responses with the creation of categories. The results show the combination of positive impressions — integration between theory and practice — and negative — problems in the organization of activities, as well as the necessity to identify a local preceptor. A plan is proposed, guided by the new Directives, for teaching in the primary health care in the context of the condition of integrality.

Evidências da contribuição dos programas de assistência ao idoso na promoção do envelhecimento saudável no Brasil

OBJETIVO: Buscar na literatura evidencias relativas a contribuicao dos programas de promocao da saude no processo de envelhecimento saudavel no Brasil. METODOS: Pesquisaram-se as bases de dados Science Direct, SciELO, LILACS, IBECS, Biblioteca Cochrane e MEDLINE em busca de artigos que enfocassem iniciativas voltadas para a populacao idosa e o envelhecimento saudavel, que avaliassem multidimensionalmente a qualidade de vida do idoso e que tratassem de aspectos relativos as praticas profissionais especificas em promocao da saude. Para definir a eficacia das iniciativas, adotaram-se os seguintes criterios: ter metas que incluissem a melhoria da saude e do bem-estar; ter foco na saude holistica; usar o empoderamento como mecanismo central; atender os pre-requisitos da saude e realizar acoes nas areas prioritarias da Carta de Ottawa. RESULTADOS: Foram identificados 10 artigos que se referiam a cinco programas de promocao da saude do idoso no Brasil. Pode-se afirmar que todos os programas apresentados demonstraram elementos que vao ao encontro da promocao da saude no envelhecimento por abranger caracteristicas que permitem a insercao dos idosos na sociedade por meio da criacao do ambiente de suporte para prevencao de agravos, aumento da capacidade funcional e melhoria da qualidade de vida, tendo sido atendidos os criterios de eficacia. CONCLUSOES: E preciso produzir evidencias cientificas acerca da efetividade, eficiencia e eficacia dos programas para a terceira idade para que se possa avaliar o valor dessas acoes na promocao da saude no envelhecimento.

Avaliação no Ensino Médico: o papel do portfólio nos currículos baseados em metodologias ativas

Current changes in medical education related to transformations in contemporary democratic societies have increasingly posed issues pertaining to the evaluation of teaching-learning processes. New methods and strategies are thus needed to supplant the prevailing summative grading approach. The current article thus discusses elements to construct such a new approach to evaluation, highlighting the portfolio as an evaluation tool.

A vida nos olhos, o coração nas mãos: concepções e representações femininas do processo saúde-doença

This social and historical investigation into the ways the health and sickness of mothers from Teixeiras municipality, Minas Gerais state, was represented is designed to comprehend behaviors in this sphere and help develop research in collective health. The semantics and indicators of a pluralistic view of disease and health, were built up from the most holistic to the most biomedical, from the most relational to the most individual. The quest for happiness was presented as a health concept by the mothers, which recalls Aristotelian and Spinozian philosophical concepts, but they put greater emphasis on the absence of illness. The prevailing welfare model still supplies useful references for interpreting such experiences. As the mothers status as care-taker helps one glean an understanding of other factors that affect the process of health and disease, it becomes possible to plan healthcare initiatives that are less alienating and more libertarian.

(Bio)ethics and Family Health Strategy: mapping problems

Este artigo apresenta os resultados de uma investigacao dirigida ao delineamento dos principais problemas (bio)eticos identificados pelos membros das equipes da Estrategia Saude da Familia (ESF) do municipio de Vicosa (MG). Trata-se de estudo com abordagem qualitativa, situando-se no campo da pesquisa social. A investigacao foi realizada por meio da aplicacao de questionario semiestruturado com perguntas abertas e fechadas aos profissionais - medicos, profissionais de enfermagem e agentes comunitarios de saude - que atuam na ESF. Realizouse a apreciacao das respostas pela tecnica de analise de conteudo - mais especificamente, sua modalidade tematica -, em razao de sua adequacao a investigacao qualitativa na area da saude. Participaram da investigacao 73 profissionais de 15 equipes da ESF. Observou-se que grande parte dos entrevistados tinha dificuldade para identificar problemas de cunho (bio)etico em seu processo de trabalho. Ainda assim, foi possivel categorizar cinco grandes grupos de problemas (bio)eticos vivenciados pelas equipes: os relacionados a desigualdade de acesso aos servicos de saude; os relacionados a relacao ensino-trabalho-comunidade; os relacionados ao sigilo e a confidencialidade; os relacionados aos conflitos entre equipe e usuarios; e os relacionados aos conflitos entre membros da equipe. Conclui-se que, mesmo que aparentemente mais sutis - se comparados as questoes (bio)eticas que se passam nas instituicoes hospitalares -, existem situacoes de conflitos morais atinentes ao âmbito da atencao primaria a saude que corroem o processo de trabalho e o alcance da promocao da integralidade do cuidado.

NICeSim: An open-source simulator based on machine learning techniques to support medical research on prenatal and perinatal care decision making

OBJECTIVE This paper describes NICeSim, an open-source simulator that uses machine learning (ML) techniques to aid health professionals to better understand the treatment and prognosis of premature newborns. METHODS The application was developed and tested using data collected in a Brazilian hospital. The available data were used to feed an ML pipeline that was designed to create a simulator capable of predicting the outcome (death probability) for newborns admitted to neonatal intensive care units. However, unlike previous scoring systems, our computational tool is not intended to be used at the patients bedside, although it is possible. Our primary goal is to deliver a computational system to aid medical research in understanding the correlation of key variables with the studied outcome so that new standards can be established for future clinical decisions. In the implemented simulation environment, the values of key attributes can be changed using a user-friendly interface, where the impact of each change on the outcome is immediately reported, allowing a quantitative analysis, in addition to a qualitative investigation, and delivering a totally interactive computational tool that facilitates hypothesis construction and testing. RESULTS Our statistical experiments showed that the resulting model for death prediction could achieve an accuracy of 86.7% and an area under the receiver operating characteristic curve of 0.84 for the positive class. Using this model, three physicians and a neonatal nutritionist performed simulations with key variables correlated with chance of death. The results indicated important tendencies for the effect of each variable and the combination of variables on prognosis. We could also observe values of gestational age and birth weight for which a low Apgar score and the occurrence of respiratory distress syndrome (RDS) could be less or more severe. For instance, we have noticed that for a newborn with 2000 g or more the occurrence of RDS is far less problematic than for neonates weighing less. CONCLUSIONS The significant accuracy demonstrated by our predictive model shows that NICeSim might be used for hypothesis testing to minimize in vivo experiments. We observed that the model delivers predictions that are in very good agreement with the literature, demonstrating that NICeSim might be an important tool for supporting decision making in medical practice. Other very important characteristics of NICeSim are its flexibility and dynamism. NICeSim is flexible because it allows the inclusion and deletion of variables according to the requirements of a particular study. It is also dynamic because it trains a just-in-time model. Therefore, the system is improved as data from new patients become available. Finally, NICeSim can be extended in a cooperative manner because it is an open-source system.