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Esta pesquisa identificou a compreensão do cuidado na perspectiva da integralidade pela fisioterapia da Atenção Primária à Saúde (APS) por meio de Revisão Integrativa da Literatura, desenvolvida em seis etapas. Realizada em setembro de 2018, nas respectivas bases de dados, SciELO e LILACS, por meio das seguintes palavras-chave: Fisioterapia, Atenção Primária à Saúde e Integralidade e suas conexões. Critérios de inclusão: artigos primários, disponíveis na íntegra em português pela integralidade se tratar de um príncipio do sitema de saúde brasileiro, relacionados ao trabalho da fisioterapia na APS, publicados entre 2014 e 2018 e que respondessem à pergunta de pesquisa. Critérios de exclusão: teses, dissertações, editoriais, estudos de reflexão teórica e revisões de literatura. Dos quinze artigos selecionados emergiram três categorias: deficiência na formação do fisioterapeuta na APS, comunicação inadequada e necessidade de melhoria do papel do fisioterapeuta na APS. Os resultados indicaram pontos que requerem ajustes: práticas comunicativas, melhoria do papel do fisioterapeuta e preparação acadêmica com base no preconizado nas DCN e no SUS.

A compreensão e o desenvolvimento da integralidade do cuidado que representa uma das diretrizes do Sistema Único de Saúde, devido ao seu caráter polissêmico, tem despertado interesses das diferentes categorias profissionais, em especial pela enfermagem. Essa pesquisa teve como objetivo identificar evidências literárias da visão do enfermeiro sobre o cuidado na perspectiva da integralidade. Foi desenvolvida por meio de revisão integrativa da literatura, constituída por seis etapas: questão norteadora; seleção da amostra; categorização dos dados; análise crítica dos estudos; discussão e interpretação dos resultados e síntese do conhecimento analisado. Foram identificados 129 artigos nas bases de dados BDENF e LILACS, selecionados seis artigos, que constituíram a amostra. As informações analisadas foram agrupadas em três categorias: concepção de integralidade, formação para integralidade e, integralidade e o trabalho interdisciplinar. Nesse sentido, considera-se que, a compreensão da integralidade e o seu desenvolvimento percorrem os mesmos caminhos: assistir o indivíduo considerando-o um ser indivisível; realizar abordagens fundamentadas no acolhimento e no vinculo; e valorizar a assistência interdisciplinar.

O objetivo desse estudo foi analisar as concepções e percepções dos estudantes de medicina, sobre cuidar de si integralmente. Trata-se de um estudo qualitativo, não experimental, transversal, exploratório, descritivo e de campo. O cenário da pesquisa foi uma faculdade de medicina do interior do estado de São Paulo que utiliza a Aprendizagem Baseada em Problemas e a Problematização como estratégia para o ensino com participação ativa do estudante. Os dados coletados através de vinte e cinco entrevistas semiestruturadas foram analisados à luz da Análise de Conteúdo, modalidade temática. Os resultados apontam que os estudantes percebem que necessitam estar mais atentos aos aspectos como: escassez de sono, excesso de estudo, automedicação e alimentação inadequada. Compreendem o cuidado integral como inerente a formação, porém as concepções e a percepção de suas práticas nem sempre estão em harmonia. Considera-se que a melhoria dos serviços sob a óptica da integralidade passa necessariamente pelo cuidado integral do estudante de medicina ao longo da sua formação.

Objetivos: Analisar o processo saúde doença das mulheres com câncer cérvico uterino, o acesso às redes de atenção à saúde e caracterizar o perfil dessas mulheres atendidas na atenção terciária. Método: Estudo epidemiológico do tipo transversal quanti-qualitativo. Para análise quantitativa, foram utilizados prontuários para o preenchimento de 183 questionários de mulheres com câncer de colo uterino no período de 2010 a 2013, atendidas pelo SUS em um hospital do interior do Estado de São Paulo. Os dados foram analisados e apresentados em porcentagens, seguida de análise descritiva. Para análise qualitativa, foram realizadas 11 entrevistas e utilizada a técnica de análise de conteúdo, modalidade temática. Resultados e conclusões: A média de idade das mulheres com câncer cérvico uterino foi de 53 anos, sendo a maioria casada (47,5%), com ensino fundamental completo (29%), branca (78,8%) e do lar (42,6%) e esperaram até três meses para o início do tratamento. A notícia do diagnóstico é impactante, devido ao estigma negativo do câncer e de seu tratamento. A descoberta da doença desencadeia um processo complexo de reações psicossociais, tanto para a mulher, como para aqueles que constituem suas redes sociais, principalmente familiares e amigos mais próximos. As redes de apoio são fundamentais para o enfrentamento e superação de todo o processo. É necessário melhorar a educação em saúde quanto à importância da realização anual de Papanicolaou e também os aspectos de humanização e empatia na relação profissional de saúde-paciente.

O objetivo deste estudo é analisar as percepções dos estudantes de fisioterapia e dos usuários ou acompanhantes quanto ao atendimento prestado com abordagem na humanização. Pesquisa qualitativa. Os participantes foram estudantes de fisioterapia que faziam estágio em um hospital público, os usuários internados que recebiam cuidados de fisioterapia ou seus acompanhantes. Para a coleta de dados, foram realizadas entrevistas, com roteiros de perguntas semiestruturadas. Os dados coletados foram compilados, analisados e categorizados em três categorias: 1) Expectativas dos estudantes frente ao relacionamento com o paciente hospitalizado; 2) Atendimento humanizado; 3) Humanização na graduação. É possível concluir que o estudo da humanização é um assunto amplo; que os usuários e acompanhantes veem o atendimento recebido com satisfação; que o estudante apesar de ter carência de conhecimentos científicos sobre o tema, demonstra interesse pelo assunto e que, na graduação, pode-se enraizar valores de respeito à vida humana. Enfim a instituição formadora é responsável também por preparar esses futuros profissionais em uma nova cultura de atendimento à saúde.

RESUMO: Atualmente no Brasil há uma grande demanda por profissionais de saúde capazes de realizar um atendimento integral, que envolva o contexto biopsicossocial do paciente. Sua formação é grande desafio e requer esforços das instituições de ensino superior (IES). Este estudo teve como objetivo avaliar a contribuição de um curso de graduação medicina para a inserção do estudante no processo de trabalho das equipes da Atenção Básica. Estudo exploratório, descritivo, transversal, com abordagem quanti-qualitativa. Entrevistas semiestruturadas foram realizadas com 323 estudantes matriculados em uma IES pública no centro-oeste paulista, 79,87% disseram que não pretendem atuar na Atenção Básica. Os estudantes consideraram-se preparados para atuar com a população de um território definido; desenvolver ações de saúde com os diferentes grupos de pessoas, considerando suas necessidades e os fatores de risco, por meio de atendimento individual e/ou coletivo; realizar o acolhimento com vínculo e responsabilização pelo usuário e trabalhar em equipe, integrando áreas técnicas e profissionais de diferentes formações. No entanto, referiram não se sentir preparados para atender de maneira resolutiva a demanda espontânea e realizar o primeiro atendimento às urgências e emergências; trabalhar com ações educativas nos diferentes; desenvolver ações de gestão, atuar no contexto do território e estimular a participação social. a. A identificação de potencialidades e fragilidades na formação do futuro médico para atuar na Atenção Básica pode subsidiar mudanças em outras IES do país que enfrentam dificuldades semelhantes no que tange o atual ensino em saúde.

Revisão integrativa da literatura para compreender a experiência de profissionais da saúde com a educação permanente (EP) como estratégia de formação de recursos humanos. Para seleção dos artigos utilizou-se as bases Medical Literature Analysis and Retrieval System on-line (MEDLINE) e Literatura latino-Americana e do Caribe em Ciências da Saúde (LILACS). Segundo os critérios de inclusão e exclusão oito publicações foram selecionadas e analisadas por meio da análise de conteúdo. Dois temas emergiram: EP como espaço de escuta, diálogo e integração dos trabalhadores; vivenciando mudanças na prática a partir dos movimentos de EP contribuindo para a autonomia e segurança nas tomadas de decisões. Conclui-se que a decisão de utilizar da educação permanente para a formação dos trabalhadores de saúde ainda se configura em uma atitude ousada, pois é necessário romper com os modelos de gestão autoritários e os processos de cuidar centralizados no profissional de saúde e não no usuário.

Background: Epidemiological investigations have indicated that Helicobacter pylori induces inflammation in the gastric mucosa regulated by several interleukins. The genes IL1B and IL8 are suggested as key factors in determining the risk of gastritis. The aim of this paper was to evaluate the association of gene polymorphism of interleukin-1 and interleukin-8 with chronic gastrits in H. pylori infected patients. A total of 60 patients underwent endoscopic procedure. Biopsy samples were collected for urease test, histopathological and molecular exams. The DNA of theses samples was extracted for detection of H. pylori and analysis of the genes mentioned above. Patients with gastritis had a higher frequency of H. pylori-positive samples. Result: H. pylori was detected in 30/60 patients (50%) by PCR. As for polymorphism of interleukin 8 (-251) gene we observed a statistical difference when analyzed TA (p = 0.039) and TT (p = 0.047) genotypes. In the IL1B31 there was a statistical difference in TT (p = 0.01) genotype and in theIL1B-511 there wasn’t any statistical difference. Conclusion: Our results suggest a strong correlation between the presence of chronic gastritis and infection byH. pylori and that IL1B-31TT and IL8-251TT genotypes appear to act as protective factors againstH. pylori infection while IL8-251TA genotype may comprise a risk factor for infection with this bacterium. Marília Medical School FAMEMA Blood Center Department of Genetics Sacred Heart University Marília Medical School Department of Digestive System Surgery Federal University of São Paulo Department of Morphology Marília Medical School Department of Radiotherapy and Oncology FAMEMA Hemocentro Laboratório de Genética UNIFESP, Department of Morphology SciELO

Made available in DSpace on 2015-03-19T16:20:26Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-09-01Bitstream added on 2015-03-19T16:29:24Z : No. of bitstreams: 1 S1413-65382012000300006.pdf: 759166 bytes, checksum: 1fae04d2bea3ae92330dd74eb68f4d17 (MD5) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) É um desafio atender aos alunos, em suas diversas necessidades especiais. Diferentemente das deficiências, há poucas pesquisas no Brasil sobre estudantes com doenças crônicas e suas especificidades, na escola. O objetivo do presente estudo foi identificar as necessidades especiais de escolares com diabetes mellitus tipo 1. Participaram 37 familiares de escolares em tratamento ambulatorial de uma faculdade paulista, por meio de entrevista semiestruturada, gravada em áudio e transcrita para análise. Os resultados mostraram que todos comunicaram a escola a respeito da doença do filho, mas, mesmo assim, 29,7% relatam dificuldade de inclusão ou acesso à escola, como desconhecimento do professor para o controle do diabetes, merenda escolar inadequada, preconceito dos colegas e da diretora ou vergonha por parte do aluno. As faltas ocorrem com 70,3% dos alunos, principalmente devido às consultas médicas. Necessidades especiais foram identificadas por 32,4%, incluindo a alimentação, o desempenho escolar e a necessidade de profissionais da escola mais bem informados sobre a doença. Além disso, 72,9% referem algum tipo de apoio para enfrentar o diabetes, principalmente de profissionais de saúde. Dos familiares, 51,3% apresentam sugestões para um melhor desenvolvimento do filho na escola, incluindo alimentação escolar adequada e melhor preparo da escola para lidar com o diabetes, como palestras e treinamento aos professores. Sugerimos a aproximação entre a escola e a área da saúde, porém, o primeiro passo para a integração intersetorial é identificar as necessidades desses alunos com doenças crônicas, como foi possível com este trabalho, ao enfocar o diabetes mellitus e suas repercussões escolares. Catering to students according to their various special needs is a challenge. As opposed to the field of disability, there is little research in Brazil on students with chronic diseases and their specific needs at school. The purpose of this study was to identify the special needs of children with diabetes mellitus type 1. The participants were 37 family members of students in treatment in an outpatient center at a state of São Paulo medical school. A semi-structured interview was carried, which was audio recorded and transcribed for analysis. The results showed that all participants informed the school informed about their child's condition, however 29,7% reported that inclusion or access to school was difficult, due to the teacher being uninformed about diabetes control, inadequate school lunches, and preconceptions of peers and school supervisor, or the student's embarrassment. Absenteeism occurred among 70,3% of the students, mainly due to doctor appointments. Special needs were identified by 32,4%, including meals, performance in school tasks and the need to better inform school professionals about the condition. Furthermore, 72,9% reported some kind of support to cope with diabetes had been provided, mainly by health professionals. In order to improve their child's development at school 51,3% presented suggestions such as including appropriate school meals, better preparation of school for dealing with diabetes, i.e. lectures and training for teachers. Our suggestion is that there should be a closer relationship between the school and health services, but the first step towards intersector integration is to identify the needs of students with chronic diseases, such as this study showed, by focusing on diabetes mellitus and its impact on the school. Universidade Estadual Paulista (UNESP) Departamento de Educação Especial Faculdade de Medicina de Marília (Famema) Universidade Estadual Paulista (UNESP) Departamento de Educação Especial

Objective: To understand the structure, development, and functionality of the family of the elderly victim of violence. Method: Descriptive research with a qualitative approach, based on the Calgary Family Assessment Model. Four elderly people who suffered violence and their family members were assessed at home, from October to November 2019. Data analysis was based on the genogram and ecomap, as proposed in the model. Results: It was found that the members of the four families had low schooling and financial difficulties. As for the social support network, the neighbors, the health unit and the Church stood out. The members of each family nucleus expressed feelings of fear, insecurity, anger, nervousness, sadness and impotence, resulting from the conflict between the couple. Final considerations: In the assessed families, weaknesses and potentialities in the structure, development and functioning are highlighted, which must be considered in the elaboration of the care plan. RESUMEN Objetivo: Comprender la estructura, desarrollo y funcionalidad de la familia del anciano víctima de violencia. Método: Investigación descriptiva con enfoque cualitativo, basada en el Modelo de Evaluación de la Familia de Calgary. Cuatro ancianos que sufrieron violencia y sus familiares fueron evaluados en su domicilio, de octubre a noviembre de 2019. El análisis de los datos se basó en el genograma y ecomapa, como se propone en el modelo. Resultados: Se encontró que los miembros de las cuatro familias tenían baja escolaridad y dificultades económicas. En cuanto a la red de apoyo social, destacaron los vecinos, la unidad de salud y la Iglesia. Los miembros de cada núcleo familiar expresaron sentimientos de miedo, inseguridad, enfado, nerviosismo, tristeza e impotencia, resultado del conflicto entre la pareja. Consideraciones finales: En las familias evaluadas se destacan debilidades y potencialidades en la estructura, desarrollo y funcionamiento, que deben ser consideradas en la elaboración del plan de cuidados. RESUMO Objetivo: Compreender a estrutura, o desenvolvimento e a funcionalidade da família da pessoa idosa vítima de violência. Método: Pesquisa descritiva e de abordagem qualitativa, pautada no Modelo Calgary de Avaliação Familiar. Avaliaram-se, no próprio domicílio, quatro idosos que sofreram violência e os respectivos familiares, no período de outubro a novembro de 2019. A análise dos dados ocorreu com base no genograma e ecomapa, conforme proposto no modelo. Resultados: Verificou-se que os integrantes das quatro famílias apresentaram baixa escolaridade e dificuldades financeiras. Quanto à rede de suporte social, destacaram-se os vizinhos, a unidade de saúde e a Igreja. Os membros de cada núcleo familiar manifestaram sentimentos de medo, insegurança, raiva, nervosismo, tristeza e impotência, decorrentes do conflito entre o casal. Considerações finais: Destaca-se, nas famílias avaliadas, fragilidades e potencialidades na estrutura, no desenvolvimento e no funcionamento, que devem ser consideradas na elaboração do plano de cuidados.

Made available in DSpace on 2020-12-12T02:23:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-11-01 BACKGROUND Toll-like receptors (TLRs) are the first line of host defense, and are involved in Helicobacter pylori (H. pylori) recognition and activation of both inflammatory and carcinogenic processes. The presence of single nucleotide polymorphisms (SNPs) in genes that activate the immune response may modulate the risk of precancerous lesions and gastric cancer (GC). Among them, Toll-like receptor 9 (TLR9) polymorphisms have emerged with a risk factor of infectious diseases and cancer, however the studies are still inconclusive. AIM To evaluate whether TLR9 rs5743836 and rs187084 SNPs contribute to the risk of gastric carcinogenesis, and its influence on mRNA expression. METHODS A case-control study was conducted to evaluate two TLR9 SNPs (TLR9-1237 TCrs5743836 and TLR9-1486 CT-rs187084) in chronic gastritis (CG) and GC patients. A total of 609 DNA samples of peripheral blood [248 CG, 161 GC, and 200 samples from healthy individuals (C)] were genotyped by polymerase chain reaction-restriction fragment length polymorphism. All samples were tested for the H. pylori infection using Hpx1 and Hpx2 primers. Quantitative polymerase chain reaction by TaqMan® assay was used to quantify TLR9 mRNA from fresh gastric tissues (48 GC, 26 CG, and 14 C). RESULTS For TLR9-1237, the TC + CC or CC genotypes were associated with a higher risk of GC than C [recessive model odds ratio (OR) = 5.01, 95% confidence interval (CI): 2.52-9.94, P < 0.0001], and the CG (recessive model OR =4.63; 95%CI: 2.44- 8.79, P < 0.0001) groups. For TLR9-1486, an association between the CT + TT genotypes and increased risk of both GC (dominant model OR = 2.72, 95%CI: 1.57-4.72, P < 0.0001) and CG (dominant model OR = 1.79, 95%CI: 1.15-2.79, P = 0.0094) was observed when compared to the C group. Moreover, the presence of TLR9-1237 TC/CC + TLR9-1486 CC genotypes potentiate the risk for this neoplasm (OR = 18.57; 95%CI: 5.06-68.15, P < 0.0001). The TLR9 mRNA level was significantly higher in the GC group (RQ = 9.24, P < 0.0001) in relation to the CG group (RQ = 1.55, P = 0.0010) and normal mucosa (RQ = 1.0). When the samples were grouped according to the polymorphic genotypes and the presence of H. pylori infection, an influence of TLR9-1237 TC + CC polymorphic genotypes (P = 0.0083) and H. pylori infection (P < 0.0001) was observed on the upregulation of mRNA expression. CONCLUSION Our findings show that TLR9 rs5743836 and rs187084 polymorphisms are associated with a higher risk of carcinogenesis gastric, and that TLR9 mRNA levels can be modulated by TLR9-1237 TC + CC variant genotypes and H. pylori infection. Department of Graduate-Level Research USCSacred Heart University Department of Genetics and Molecular Biology FAMEMA-Marilia Medical School Department of Biology São Paulo State University-UNESP Department of Molecular Biological and Genetics and Molecular Biology Research Unit - UPGEM Faculty of Medicine of São José do Rio Preto - FAMERP Department of Biology São Paulo State University-UNESP

Made available in DSpace on 2022-04-29T08:46:42Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-12-01 Background: Rheumatoid Arthritis (RA) is a chronic disabling systemic disease characterized by joint inflammation, and extra-articular manifestations, including peripheral neuropathy, a condition that can be associated with changes in muscle strength, proprioception and postural balance contributing for the risk of falls. The objective of this study is to analyze the incidence of peripheral neuropathy in patients with RA and its association with the occurrence of falls. Methods: Patients were assessed by an electroneuromyography (ENMG) exam and by a questionnaire on accidental falls occurrence in the previous 12 months. They were also assessed on balance by the Short Physical Performance Battery (SPPB), functionality by the Health Assessment Questionnaire (HAQ), disease activity by the Disease Activity Score (DAS-28), neuropathic pain by the Questionnaire for the Diagnosis of Neuropathic Pain (DN4), and cutaneous sensitivity of the feet by the monofilament testing of Semmes–Weinstein. Monthly calls on falls were made in the subsequent six months. Data analysis was performed using the Shapiro–Wilk test for normality and Spearman, Chi-square, and T-student correlation tests, with a significant P level ≤ 0.05. Results: A sample of 33 patients were evaluated. The incidence of peripheral neuropathy was 48.5%, of which 68.7% were axonal and 31.3% myelinic. The sensorimotor type was present in 64.7%, motor in 17.6%, and sensorial in 11.7% of the cases. Neuropathy was associated to balance (P = 0.026), neuropathic pain (P = 0.016), deep tendon reflexes absence (P = 0,049), altered skin sensitivity of the feet (P = 0.029) and fear of falling (P = 0.001). No association was found between peripheral neuropathy and age, gender, disease activity, or functionality. No significant association was found between peripheral neuropathy and occurrence of falls, in a 12-month retrospective and 6-month prospective evaluation. Conclusion: Peripheral neuropathy has a high incidence in patients with RA, and is related to neuropathic pain, altered postural balance, but not to the occurrence of falls. Neurology Department Marilia Medical School (FAMEMA), 800 Monte Carmelo Avenue, SP Physiotheraphy Departament São Paulo State University (UNESP), 737 Hygino Muzzi Filho Avenue, SP Rheumathology Department Marilia Medical School (FAMEMA), 800 Monte Carmelo Avenue, SP Physiotheraphy Departament São Paulo State University (UNESP), 737 Hygino Muzzi Filho Avenue, SP

Made available in DSpace on 2021-06-25T10:47:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-02-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Objective: To compare the parameters of gait kinematics of older adults with cognitive impairment who live in community dwellings or those living or spending most of the time in non-family environment settings. Methods: The sample was composed of 33 older adults of both sexes with cognitive impairment. Participants were separated into three groups: a community-dwelling older adult group comprised of 11 subjects; a semi-institutionalized older adult group comprised of 10 older adults attended in a geriatric daycare institution; and an institutionalized older adult group comprised of 12 older adults living in long-term institutions. Gait kinematics were recorded by pressure sensors (footswitches). Fifty gait cycles at self-selected pace were analyzed to obtain: gait speed, stride length, stance, swing, and stride time. The variability of these parameters was also analyzed. Results: MANCOVA identified the main effect of groups (p < 0.001). Gait speed of older adults living in long-term institutions and older adults attended in geriatric daycare institutions was slower than community-living older adults (p < 0.001 and p = 0.04, respectively). Swing and stride time variability was higher in older adults living in long-term institutions (p = 0.003 and p = 0.001) and in older adults attended in geriatric daycare institutions (p = 0.02 and p = 0.001) than in community-dwelling older adults. Conclusion: The most important finding was that older adults with cognitive impairment who need non-family residential setting care had higher gait kinematics abnormalities, which may increase the risk of falls, compared to those who live in the community. Health Science Center Sacred Heart University USC Department of Physical Therapy and Occupational Therapy São Paulo State University UNESP Marilia Medical School FAMEMA Department of Health Science Ribeirão Preto Medical School University of São Paulo USP Department of Physical Therapy and Occupational Therapy São Paulo State University UNESP FAPESP: 2014/07722-3 FAPESP: 2016/02727-3 FAPESP: 2016/02728-0

Made available in DSpace on 2021-06-25T10:53:09Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Aim: To describe the transcultural adaptation process of the Children's Anxiety Questionnaire (CAQ) for the Brazilian culture. Design: This is a methodological study of cross-cultural adaptation. Methods: Study conducted in Brazil and Sweden involved the following steps: preparation, translation, synthesis of translations, back-translation and review, and harmonization of the translations by a committee of 13 healthcare professionals using the content validity index (CVI). Cognitive debriefing, using children between 4–10 years old, was completed by 15 children to determine if the images corresponded with their meanings and 17 children to determine if they could understand the Global CAQ after listening. Results: Convergences and discrepancies between the original instrument in Swedish, the English version and the Brazilian translation were compared. The process of culturally adapting the CAQ to Brazilian Portuguese was validated, as demonstrated by a satisfactory S-CVI (0.94) among professionals and an agreement of 95% and above by children. Nursing Department Botucatu Medical School - UNESP Nursing Department Marilia Medical School - FAMEMA School of Architecture Arts and Communication – UNESP Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care Sahlgrenska Academy University of Gothenburg Nursing Department Botucatu Medical School - UNESP School of Architecture Arts and Communication – UNESP

Made available in DSpace on 2020-12-12T02:03:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01. Added 1 bitstream(s) on 2021-07-15T15:07:27Z : No. of bitstreams: 1 S1516-31802020000100033.pdf: 282334 bytes, checksum: 552c9f1aafb1779541bb019ff77e08d1 (MD5) BACKGROUND: Progress tests are longitudinal assessments of students’ knowledge based on successive tests. Calibration of the test difficulty is challenging, especially because of the tendency of item-writers to overestimate students’ performance. The relationships between the levels of Bloom’s taxonomy, the ability of test judges to predict the difficulty of test items and the real psychometric properties of test items have been insufficiently studied. OBJECTIVE: To investigate the psychometric properties of items according to their classification in Bloom’s taxonomy and judges’ estimates, through an adaptation of the Angoff method. DESIGN AND SETTING: Prospective observational study using secondary data from students’ performance in a progress test applied to ten medical schools, mainly in the state of São Paulo, Brazil. METHODS: We compared the expected and real difficulty of items used in a progress test. The items were classified according to Bloom’s taxonomy. Psychometric properties were assessed based on their taxonomy and fields of knowledge. RESULTS: There was a 54% match between the panel of experts’ expectations and the real difficulty of items. Items that were expected to be easy had mean difficulty that was significantly lower than that of items that were expected to be medium (P < 0.05) or difficult (P < 0.01). Items with high-level taxonomy had higher discrimination indices than low-level items (P = 0.026). We did not find any significant differences between the fields in terms of difficulty and discrimination. CONCLUSIONS: Our study demonstrated that items with high-level taxonomy performed better in discrimination indices and that a panel of experts may develop coherent reasoning regarding the difficulty of items. Department of Neurology Psychology and Psychiatry Universidade Estadual Paulista (UNESP) Edudata Informática Faculdade de Medicina de Marília (FAMEMA) Department of Medical Psychology and Psychiatry Universidade Estadual de Campinas (UNICAMP) Department of Pediatrics Universidade Estadual de Campinas (UNICAMP) Department of Neurology Psychology and Psychiatry Universidade Estadual Paulista (UNESP)

Made available in DSpace on 2018-12-11T17:12:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-01. Added 1 bitstream(s) on 2019-10-09T18:31:01Z : No. of bitstreams: 1 S1809-48642018000100060.pdf: 2059332 bytes, checksum: 77f3430de00387928ee13ad745d5a62d (MD5) Introduction Cleft lip and cleft palate can result in impairments in communication, specifically in hearing, making the use of technological resources such as blogs a fundamental guideline for health professionals. Objective The aim of this study was to prepare and analyze the access to a blog about cleft lip and cleft palate and hearing as a pedagogical tool for health professionals. Methods The first stage for the development of the blogwas the selection of the content that would be addressed and the respective illustrations. The second stage was making the blog available through theWordPress platform, and the third stage included the evaluation of the blog, of the access to theWordPress statistical features, and of the quality of the blog through the Emory questionnaire, which was answered by 75 professionals. Results The blog, titled Fissure and Hearing, was developed with the architecture of a digital information environment containing a system of organization, navigation, labeling and search (first stage). The address hosting the blog was: Http://fissuraeaudicao. wordpress.com (second stage). The result of the third stage included 56,269 views of the blog from different countries, and Brazil was the country with the highest viewing. Regarding the assessment by the Emory questionnaire, we found that for most of the major issues, the percentages obtained were or equal to 90%, while the analysis of the scales, navigation and structure presented the lowest scores. Conclusion The blog was developed and enabled greater access to information available on the web about cleft lip and cleft palate and hearing. Hospital for Rehabilitation of Craniofacial Anomalies Universidade de São Paulo Department of Speech-Language Pathology and Audiology Faculdade de Odontologia de Bauru Universidade de São Paulo (FOB-USP), Al. Dr. Octávio Pinheiro Brisola, 9-75 Centro de Reabilitação Lucy Montoro Faculdade de Medicina de Marília - FAMEMA Department of Ophthalmology Otolaryngology and Head and Neck Surgery Botucatu Medical School Universidade Estadual Paulista (FMB-UNESP) Department of Ophthalmology Otolaryngology and Head and Neck Surgery Botucatu Medical School Universidade Estadual Paulista (FMB-UNESP)

Made available in DSpace on 2019-10-06T16:26:50Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-05-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background: Cognitive impairments reduce adaptive responses and may increase the risk of falls. Objectives: To compare gait kinematics in older adults with cognitive impairments living in long term institutions and to identify the ability of gait kinematics to predict falls in older adults with cognitive impairments living in long term institutions. Methods: Data of 23 older adults with cognitive impairments living in long term institutions were considered for this study. Fifty gait cycles were recorded during walking at a self-selected pace using footswitches sensors. The variables considered for the analysis were: speed; stride length; stance, swing and stride time; and the variability of these parameters. Fall status was recorded for a 6 month-period. Findings: MANOVA found group effect (p = 0.025) for gait kinematics comparisons. Variability of stance (p = 0.01) and swing (p = 0.012) and stride time (p < 0.001) were higher in older fallers. Speed of older fallers was 31.8% slower than those of the non-fallers (p < 0.001). The kinematic variables that were able to predict falls were: stride time variability (p < 0.001), threshold of 0.4 s, sensitivity of 50% and specificity of 100%; and gait speed (p < 0.001), threshold of 0.65 m·s −1 , sensibility and specificity of 50%. Interpretation: Older adults living in an assisted living facility with a history of falls demonstrate increased kinematic variability while walking. However, the ability of gait kinematic parameters to predict falls was found to be weak. The results suggested that gait kinematic parameters are weak predictors of falls in older adults with cognitive impairments living in long term institutions. Center of Health Sciences Sacred Heart University USC Department of Physiotherapy and Occupational Therapy University of São Paulo State UNESP Marilia Medical School FAMEMA Department of Health Sciences University of São Paulo (USP) School of Medicine Department of Physiotherapy and Occupational Therapy University of São Paulo State UNESP FAPESP: 2016/02727-3 FAPESP: 2016/02728-0

Made available in DSpace on 2018-11-12T17:29:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-08-01. Added 1 bitstream(s) on 2018-11-12T17:37:12Z : No. of bitstreams: 1 S0102-36162018000400460.pdf: 1761369 bytes, checksum: 18f854d0f08975ede3236d7a1dd2f14a (MD5) RESUMOObjetivo: Este estudo tem o objetivo de analisar, retrospectivamente, os resultados clínico- funcionais e radiográficos do tratamento cirúrgico da tríade terrível do cotovelo, com no mínimo doze meses de acompanhamento pós-operatório, avaliando a função do cotovelo.Métodos: Definimos um grupo de pacientes para avaliação retrospectiva no período de 2004 a 2015, no qual foram estudados 12 pacientes, submetidos a procedimento cirúrgico devido a fratura da cabeça do rádio, fratura do processo coronoide e luxação do cotovelo; sendo avaliados pelo escore Disabilities of the Arm, Shoulder and Hand (DASH), grau de satisfação do paciente, grau de energia do trauma, radiografias, arco de movimento e complicações.Resultados: Observou-se maior incidência de fraturas do processo coronoide do tipo II de Regan e Morrey; em relação às lesões, nove pacientes apresentaram desinserção do músculo braquial. Metade dos pacientes apresentou queda da própria altura como mecanismo de trauma. Os graus de flexão e extensão do cotovelo tiveram respectivamente as médias: 126,6 e 24,1 graus; e as médias em graus de pronação e supinação foram respectivamente: 64,1 e 62,0 graus. Todos os pacientes apresentaram grau de força muscular IV ou V. Obtivemos escore DASH médio de 14,3, a escala de dor teve média de 2,5, e a maioria dos pacientes se disse satisfeita com o tratamento.Conclusão: Apesar da perda de amplitude total de movimento do cotovelo, principalmente em extensão, o tratamento mostrou-se satisfatório para a maioria dos pacientes. ABSTRACTObjective: This study aims at analyzing retrospectively the clinical-functional and radiographic results of surgical treatment of the terrible elbow triad, with at least 12 months of postoperative follow-up evaluating elbow function.Methods: A group of patients for retrospective analysis from 2004 to 2015 was defined, in which 12 patients were studied. They underwent surgery due to fracture of the radial head, coronoid fracture, and elbow dislocation; they were evaluated by the Disabilities of the Arm, Shoulder and Hand (DASH) score, the degree of patient satisfaction, the degree of trauma energy, radiographic images, range of motion, and complications.Results: There was a higher incidence of Regan and Morrey type II coronoid process fractures; in relation to the injuries, nine patients had deinsertion of the brachialis. Half of the patients suffered a fall from their own height as the mechanism of trauma. The extent of elbow flexion and extension averaged 126.6 and 24.1 degrees, respectively; the averages for pronation and supination were 64.1 and 62.0 degrees, respectively. All patients presented muscle strength of grade IV or V. The mean DASH score was 14.3, the mean pain score was 2.5, and a majority of the patients were satisfied with the treatment.Conclusion: Despite the total loss of range of motion of the elbow, especially in extension, the treatment was satisfactory for most patients. Faculdade de Medicina de Marília Santa Casa de Misericórdia de Marília Departamento de Ortopedia e Traumatologia Universidade Estadual Paulista Faculdade de Medicina Universidade Estadual Paulista Faculdade de Medicina

Made available in DSpace on 2018-12-11T17:03:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-06-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background: The clinical assessment of gait variability may be a particularly powerful tool in the screening of older adults at risk of falling. Measurement of gait variability is important in the assessment of fall risk, but the variability metrics used to evaluate gait timing have not yet been adequately studied. Objectives: The aims of this study were (1) to identify the best mathematical method of gait variability analysis to discriminate older fallers and non-fallers and (2) to identify the best temporal, kinematic parameter of gait to discriminate between older fallers and non-fallers. Methods: Thirty-five physically active volunteers participated in this study including 16 older women fallers (69.6 ± 8.1 years) and 19 older women non-fallers (66.1 ± 6.2 years). Volunteers were instructed to walk for 3 min on the treadmill to record the temporal kinematic gait parameters including stance time, swing time and stride time by four footswitches sensors placed under the volunteers’ feet. Data analysis used 40 consecutive gait cycles. Six statistical methods were used to determine the variability of the stance time, swing time and stride time. These included: (1) standard deviation of all the time intervals; (2) standard deviation of the means of these intervals taken every five strides; (3) mean of the standard deviations of the intervals determined every five strides; (4) root-mean-square of the differences between intervals; (5) coefficient of variation calculated as the standard deviation of the intervals divided by the mean of the intervals; and (6) a geometric method calculated based on the construction of a histogram of the intervals. Results: The standard deviation of 40 consecutive gait cycles was the most sensitive (100 %) and specificity (100 %) parameter to discriminate older fallers and non-fallers. Conclusion: The standard deviation of stance time is the kinematic gait variability parameter that demonstrated the best ability to discriminate older fallers from non-fallers. Protocol number of Brazilian Registry of Clinical Trials Department of Physical Therapy and Occupational Therapy São Paulo State University UNESP Department of Physical Education and Physical Therapy Uberlândia Federal University UFU Faculty of Medicine of Marilia FAMEMA Department of Physical Education São Paulo State University UNESP Departamento de Fisioterapia e Terapia Ocupacional UNESP, Avenida Hygino Muzzi Filho, 737 Department of Physical Therapy and Occupational Therapy São Paulo State University UNESP Department of Physical Education São Paulo State University UNESP Departamento de Fisioterapia e Terapia Ocupacional UNESP, Avenida Hygino Muzzi Filho, 737 FAPESP: 11/11639-7

Made available in DSpace on 2018-11-26T17:54:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-08-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Head and neck cancers are common in several regions of the world and the treatment usually includes radiotherapy. This treatment can generate adverse effects to the salivary flow, with a relationship between the dose and the damage caused. Salivary gland cells are highly permeable to water and therefore, they express aquaporins (AQPs). This study analyzed changes in the expression and location of these proteins and identified morphological changes induced by low radiation in rat submandibular gland. Female rats were divided into control and irradiated groups. Immunohistochemistry analysis allowed confirming the presence of AQP1 in the blood vessel endothelium. Intense and steady labelling granules were also observed in the cytoplasm of submandibular gland ductal cells. In addition, there was AQP5 positive labelling in ductal cells delimiting the lumen of intercalated duct, in the cytoplasm and membrane of acinar cells. Finally, the decrease of AQP labelling in irradiated animal glands validated their radiosensitivity. Thus, the decrease in AQP1 protein levels in the endothelium and AQP5 in gland ductal cells of irradiated animals may have hindered the removal of water from the lumen of ductal cells, inducing a delay in water absorption and triggering a slight lumen increase. Fac Med Marilia FAMEMA, Marilia, SP, Brazil Univ Estadual Paulista, Inst Biosci, Dept Anat, Botucatu, SP, Brazil Univ Estadual Paulista, Inst Biosci, Dept Anat, Botucatu, SP, Brazil FAPESP: 2013/07203-4

Objective: To evaluate the occurrence of falls reported by rheumatoid arthritis patients and its relation to disease activity, functional capacity and physical fitness. Materials and methods: A cross-sectional study constituted by a sample of 97 rheumatoid arthritis patients from the city of Marília (SP) from 2012 to 2013, were assessed for disease activity. Instruments validated for Brazilian population in order to evaluate physical and functional capacity were used. Data analysis was carried out with descriptive statistics, Spearman correlation and Chi-squared test, considering p < 0.05. Results: 88.7% were female subjects with a mean age of 56 (±11.7) years. The median duration of rheumatoid arthritis was 10 years (P25 = 6 and P75 = 17) and the mean of disease activity was 3.6 (±1.3), what was considered a moderate activity. In the last 12 months 37.1% of patients experienced at least one fall, with a total of 52 episodes, and fear of falling was reported by 74.2% of them, but this was not associated to the occurrence of a fall (χ 2 = 1.19, p = 0.27). Gender, number of medications, age, disease activity, duration of rheumatoid arthritis, functional capacity, and physical tests showed no associations with history of falls in the past year. Conclusion: It was observed that the occurrence of falls and the fear of falling are quite common in this population. The occurrence of falls in this sample of rheumatoid arthritis patients bears no relation to disease activity, functional capacity, or physical fitness tests. RESUMO Objetivo: Avaliar a ocorrência de quedas reportadas por pacientes com artrite reumatoide (AR) e sua associação com a atividade da doença, capacidade funcional e aptidão física. Material e métodos: Estudo transversal com uma amostra de 97 pacientes com AR em Marília (SP), entre 2012 e 2013. Foram usados instrumentos validados na população brasileira para avaliar capacidade física e funcional. Análise dos dados com estatística descritiva, correlações de Spearman e qui-quadrado, considerado p < 0,05. Resultados: Dos pacientes, 88% eram mulheres, média de 56, anos (± 11,7), duração mediana da AR de 10 anos (P25 = 6 e P75 = 17) e média da atividade da doença 3,6 (± 1,3). Nos últimos 12 meses, 37,1% tiveram pelo menos uma queda (total 52 episódios), 74,2% relataram medo de cair, porém sem associação com a ocorrência de quedas (χ2 = 1,19, p = 0,27). Sexo, quantidade de medicamentos, idade, atividade da doença, duração da AR, capacidade funcional e testes físicos não estão associados com história de queda no último ano. Conclusões: Observou-se que a ocorrência de quedas e o medo de cair é frequente nessa população. A ocorrência de quedas nessa amostra de pacientes com AR não está relacionada à atividade da doença, à capacidade funcional e a testes de aptidão física.

Made available in DSpace on 2015-11-03T18:23:55Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-01-01. Added 1 bitstream(s) on 2015-11-04T10:13:18Z : No. of bitstreams: 1 S0104-12902014000100313.pdf: 131758 bytes, checksum: 28181ef8a0f1f12a72991a18827ef6df (MD5) A prática assistencial tem suscitado inquietações relacionadas ao cuidado dispensado às mulheres, com a atenção para questões que se revestem de extrema importância na Saúde Materna na Saúde Pública. Propõe-se disparar neste estudo a discussão sobre os alcances e desafios da integralidade do cuidado à saúde materna, a partir da experiência de uma das autoras em cenários de saúde do Brasil e Portugal. Será apresentada a análise comparada do formato de grupos de gestantes enquanto estratégia frequente, principalmente na Atenção Primária dos dois países. Para isso, foi utilizada a observação participante de dois grupos de gestantes, um em cada país. A organização dos grupos foi apresentada e analisada em suas configurações metodológicas e práticas. A análise das experiências indica que os dois grupos podem ser considerados informativos ou educativos, com metodologia e estruturação sob a forma de palestras com temas pré-definidos, com reduzida possibilidade de reflexão e empoderamento, devido à forma fragmentada de apresentação, o que pode também denotar diminuída reflexão acerca das mudanças no papel feminino. Conclui-se que a necessidade do cuidado às mulheres, em distintos momentos de suas vidas, pressupõe a contínua luta por uma abordagem ampliada e integral, enfatizando a rede de cuidados e o enfoque na promoção de saúde. Care practices have raised some questions concerning the attention given to women, specifically when it comes to issues of extreme importance in Public Health's approach of pre-natal care. The present study intends to discuss the scope and challenges of the integral care in maternal health, taking into consideration the experiences of one of the authors in the health scenarios from both Brazil and Portugal. A comparative analysis was conducted on the format of the pre-natal classes offered to groups of pregnant women, a frequent practice of Primary Care in both countries. The method of participant observation of two groups of pregnant women, one in each country was used. The organization of each group is presented and evaluated regarding its methodological and practical settings. The analysis of the experiences indicates that both groups can be considered as informative or educative, since the chosen methodology and structure was formed by lectures with predefined themes; there was reduced reflection and empowerment possibilities, due to the fragmented presentation form, and this could also mean diminished reflection on the changes of the feminine role. It is thus concluded that the need for offering care for women in different periods of their lives should include a continuous fight for an amplified and integral approach, with emphasis in the care network and in health promotion. Universidade Estadual Paulista (UNESP), Programa de Pós-Graduação em Saúde Coletiva, Marília BR-17514000, SP, Brasil Faculdade de Medicina de Marília (FAMEMA), Marília BR-17514000, SP, Brasil Universidade Estadual de Campinas (UNICAMP), Programa de Pós-Graduação em Saúde Coletiva, Campinas BR-13041317, SP, Brasil Universidade Estadual Paulista (UNESP), Programa de Pós-Graduação em Saúde Coletiva, Marília BR-17514000, SP, Brasil

Made available in DSpace on 2014-10-01T13:08:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-03-01Bitstream added on 2014-10-01T14:03:07Z : No. of bitstreams: 1 S1677-54492014000100018.pdf: 299322 bytes, checksum: 648c645742548d3999490d11d29d5cb5 (MD5) OBJECTIVE:The purpose of this study was to evaluate the long term clinical and ultrasonographic outcomes of thrombophilic patients with deep venous thrombosis (DVT).METHOD:Cohort study, retrospective case-control with cross-sectional analysis. Thirty-nine thrombophilic patients and 25 non-thrombophilic patients were assessed 76.3 ± 45.8 months after diagnosis. Demographic and family data were collected, as well as data from clinical and therapeutic progress, and physical and ultrasound examinations of the limbs were performed. Groups were matched for age and gender and the variables studied were compared across groups.RESULTS:Deep venous thrombosis was more frequent in women. The most common thrombophilias were antiphospholipid syndrome and factor V Leiden mutation. There was no difference between groups in terms of the number of pregnancies or miscarriages and the majority of women did not become pregnant after DVT. Non-spontaneous DVT prevailed. Proximal DVT and DVT of the left lower limb were more frequent, and the main risk factor was use of oral contraceptives. All patients were treated with anticoagulation. There was a higher frequency of pulmonary embolism in non-thrombophilic patients. Most patients considered themselves to have a normal life after DVT and reported wearing elastic stockings over at least 2 years. Seventy-one percent of patients had CEAP > 3, with no difference between groups. Deep venous reflux was more frequent in thrombophilic patients.CONCLUSION:There were no significant differences between groups with respect to most of the variables studied, except for a higher frequency of pulmonary embolism in non-thrombophilic patients and greater frequency of deep venous reflux in thrombophilic patients. Universidade de Marília - UNIMAR Faculdade de Medicina de Marília - FAMEMA Departamento de Clínica Médica Universidade Estadual Paulista - UNESP Departamento de Cirurgia e Ortopedia Universidade Estadual Paulista - UNESP Departamento de Bioestatística Universidade Estadual Paulista - UNESP Universidade Estadual Paulista - UNESP Departamento de Cirurgia e Ortopedia Universidade Estadual Paulista - UNESP Departamento de Bioestatística Universidade Estadual Paulista - UNESP

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:41:34Z No. of bitstreams: 1 S0066-782X2013000100012.pdf: 420323 bytes, checksum: 35398b33be8a494958203a9d4c08f3b0 (MD5) Made available in DSpace on 2013-08-22T18:41:34Z (GMT). No. of bitstreams: 1 S0066-782X2013000100012.pdf: 420323 bytes, checksum: 35398b33be8a494958203a9d4c08f3b0 (MD5) Previous issue date: 2013-01-01 Made available in DSpace on 2013-09-30T18:17:49Z (GMT). No. of bitstreams: 2 S0066-782X2013000100012.pdf: 420323 bytes, checksum: 35398b33be8a494958203a9d4c08f3b0 (MD5) S0066-782X2013000100012.pdf.txt: 32513 bytes, checksum: 0a6ff82b68de87d648b4b6979c276a5d (MD5) Previous issue date: 2013-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:33:42Z No. of bitstreams: 2 S0066-782X2013000100012.pdf: 420323 bytes, checksum: 35398b33be8a494958203a9d4c08f3b0 (MD5) S0066-782X2013000100012.pdf.txt: 32513 bytes, checksum: 0a6ff82b68de87d648b4b6979c276a5d (MD5) Made available in DSpace on 2014-05-20T13:33:42Z (GMT). No. of bitstreams: 2 S0066-782X2013000100012.pdf: 420323 bytes, checksum: 35398b33be8a494958203a9d4c08f3b0 (MD5) S0066-782X2013000100012.pdf.txt: 32513 bytes, checksum: 0a6ff82b68de87d648b4b6979c276a5d (MD5) Previous issue date: 2013-01-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) FUNDAMENTO: Pacientes com talassemia major (TM) apresentam hemólise crônica e necessitam de transfusões sanguíneas egularmente que podem causar cardiomiopatia por sobrecarga de ferro e insuficiência cardíaca crônica. A hemocromatose é caracterizada por acúmulo excessivo de ferro nos tecidos; acometimento do coração é a principal causa de óbito em pacientes com talassemia. OBJETIVO: Avaliar as estruturas e a função cardíaca por meio de ecocardiografia com Doppler convencional e Doppler tecidual em pacientes com TM, sem evidência clínica de insuficiência cardíaca. MÉTODOS: Trata-se de estudo observacional prospectivo de 18 pacientes com TM que recebem transfusão sanguínea regularmente. Para avaliar, separadamente, os efeitos da anemia e da transfusão sanguínea, dois grupos controles pareados por gênero, idade, peso e altura foram incluídos: um com indivíduos saudáveis (Saudável, n = 18) e outro com pacientes com anemia por deficiência de ferro (Anemia, n = 18). Análise estatística foi realizada utilizando ANOVA seguida pelo teste de Tukey ou Kruskal-Wallis e teste de Dunn. RESULTADOS: As seguintes variáveis ecocardiográficas apresentaram valores significativamente mais elevados no grupo TM do que nos grupos Anemia e Saudável: índice de volume do átrio esquerdo (Saudável: 16,4 ± 6,08; Anemia: 17,9 ± 7,02; TM: 24,1 ± 8,30 cm/m); razão E/Em septal mitral (Saudável: 6,55 ± 1,60; Anemia: 6,74 ± 0,74; TM: 8,10 ± 1,31) e duração do fluxo reverso em veias pulmonares [Saudável: 74,0 (59,0-74,0); Anemia: 70,5 (67,0-74,0); TM: 111 (87,0-120) ms]. Arazão E/A mitral foi maior no grupo TM do que no grupo Anemia (Saudável: 1,80 ± 0,40; Anemia: 1,80 ± 0,24; TM: 2,03 ± 0,34). Não foram encontradas diferenças entre os grupos em variáveis estruturais do ventrículo esquerdo e em índices de função sistólica. CONCLUSÃO: A ecocardiografia com Doppler convencional e o Doppler tecidual permite que alterações na função diastólica do ventrículo esquerdo sejam identificadas em pacientes assintomáticos com talassemia major. BACKGROUND: Patients with thalassemia major present chronic hemolysis and require regular blood transfusions which may cause iron overload cardiomyopathy and chronic heart failure. Hemochromatosis is characterized by excessive iron accumulation in tissues, and heart involvement is the main cause of death in patients with thalassemia. OBJECTIVE: The aim of this study was to evaluate cardiac structure and function by conventional Doppler echocardiography and tissue Doppler imaging in patients with TM and no clinical evidence of heart failure. METHODS: This is a prospective observational study including 18 patients with thalassemia major (TM) receiving regular blood transfusion. To separately evaluate anemia and blood transfusion effects, two gender, age, weight, and height-matched control groups were included: one with healthy individuals (Healthy, n=18) and one with iron deficient anemia patients (Anemia, n=18). Statistical analysis was performed using ANOVA followed by Tukey's test or Kruskal-Wallis's and Dunn's test. RESULTS: The following echocardiographic variables presented significantly higher values in TM than the Anemia and Healthy groups: left atrium volume index (Healthy: 16.4±6.08; Anemia: 17.9±7.02; TM: 24.1±8.30 cm³/m²); mitral septal E/Em ratio (Healthy: 6.55±1.60; Anemia: 6.74±0.74; TM: 8.10±1.31); and duration of reverse pulmonary vein flow [Healthy: 74.0 (59.0-74.0); Anemia: 70.5 (67.0-74.0); TM: 111 (87.0-120) ms]. The mitral E/A ratio was higher in TM than Anemia (Healthy: 1.80±0.40; Anemia: 1.80±0.24; TM: 2.03±0.34). No differences were found in left ventricular structures and systolic function indexes. CONCLUSION: Conventional Doppler echocardiography and tissue Doppler allow changes in left ventricular diastolic function to be identified in asymptomatic patients with thalassemia major. Faculdade de Medicina de Marília Departamento de Clínica Médica UNESP Faculdade de Medicina de Botucatu Departamento de Clínica Médica UNESP Faculdade de Medicina de Botucatu Departamento de Clínica Médica CNPq: 304998/2009-5 CNPq: 305013/2009-0

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Universidade do Sagrado Coracao de Bauru Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Faculdade de Medicina de Marilia (FAMEMA) Our study aimed to associate IL-1 beta and IL-1RN polyrnorphisms with AD disease in comparison with elderly control group from São Paulo - Brazil. We genotyped 199 Alzheimer's disease (AD) patients, 165 elderly control and 122 young control samples, concerning VNTR (IL-1RN) and -511C>T and -31T>C (IL-1 beta) polymorphisms. Our findings revealed that -511C/-31T/2-repetitions VNTR haplotype had a protective effect for AD when compared to EC (p=0.005), whereas -511C/-31C/1-repetition VNTR haplotype was associated as a risk factor for AD (p=0.021). Taken together, we may suggest that there is a relevant role of IL-1 genes cluster in AD pathogenesis in this Brazilian population. (c) 2012 Elsevier B.V. All rights reserved. USC, São Paulo, Brazil Universidade Federal de São Paulo, Escola Paulista Med UNIFESP EPM, Dept Morfol, Disciplina Genet, São Paulo, Brazil Universidade Federal de São Paulo, Escola Paulista Med UNIFESP EPM, Disciplina Neurol Ambulatorio Neurol Comportament, São Paulo, Brazil Fac Med Marilia FAMEMA, Hemoctr, Disciplina Genet, São Paulo, Brazil Fac Med Sao Jose do Rio Preto, Nucleo Pesquisa Bioquim & Biol Mol, São Paulo, Brazil Univ Marilia UNIMAR, Fac Med, São Paulo, Brazil Universidade Federal de São Paulo, Escola Paulista Med UNIFESP EPM, Dept Morfol, Disciplina Genet, São Paulo, Brazil Universidade Federal de São Paulo, Escola Paulista Med UNIFESP EPM, Disciplina Neurol Ambulatorio Neurol Comportament, São Paulo, Brazil FAPESP: 06/07240-3 FAPESP: 09/15857-9 FAPESP: 04/15273-3 Web of Science

INTRODUÇÃO: Na urticária crônica (UC), o teste cutâneo do soro autólogo (TCSA) pode sugerir a etiologia autoimune. Recentemente, uma nova técnica laboratorial denominada teste de ativação de basófilos (TAB) vem sendo utilizada para esse diagnóstico. OBJETIVOS: Analisar o TCSA em relação ao TAB, assim como avaliar os receptores da interleucina 3 (IL3) (CD123) e a presença de autoanticorpos da classe de imunoglobulina G (IgG) inespecíficos ligados aos basófilos de pacientes com UC. MÉTODOS: Estudamos 33 adultos com UC espontânea com idade média de 42,5 + 14 anos. Por meio da citometria de fluxo foi feita a análise da expressão das moléculas CD63 em basófilos de um doador atópico após o estímulo pelo soro dos pacientes com UC. Também realizamos a pesquisa da expressão da molécula CD123 e de autoanticorpos IgG inespecíficos. RESULTADOS: O odds ratio (OR) entre o TCSA e o TAB foi de 1 (intervalo de confiança [IC] 95%: 0,22-4,5). O TCSA para o diagnóstico da UC autoimune mostrou acurácia de 54,5%, sensibilidade de 66%, especificidade de 33%, valor preditivo positivo de 63% e valor preditivo negativo de 36%. Não houve diferença estatística entre os grupos estudados quanto à média de expressão dos anticorpos IgG inespecíficos e das moléculas CD123 (para um p < 0,05). DISCUSSÃO: Este estudo demonstrou baixa precisão do TCSA no diagnóstico da UC autoimune; o grupo de pacientes com TCSA positivo não mostrou diferença estatística em relação ao grupo com TCSA negativo nos demais aspectos analisados. CONCLUSÃO: Pelos poucos estudos existentes e pela relevância do assunto, acreditamos na necessidade de mais estudos abordando esses aspectos. INTRODUCTION: The autologous serum skin test (ASST) may suggest an autoimmune etiology in chronic urticaria (CU). A new laboratory technique called basophil activation test (BAT) has been currently employed for its diagnosis. OBJECTIVE: To analyze ASST in relation to BAT as well as to evaluate interleukin 3 (IL3) receptors (CD123) and non-specific immunoglobulin G (IgG) autoantibodies bound to basophils in patients with chronic urticaria. METHODS: We studied 33 adults with CU and mean age of 42.5 + 14 years. After stimulation by serum from patients with CU, CD63 expression on basophils from one atopic donor was analyzed by flow cytometry. Furthermore, we investigated CD123 and IgG autoantibody expressions. RESULTS: The odds ratio (OR) between ASST and BAT was 1.00 (95% confidence interval [CI]: 0.22 to 4.5). The ASST for autoimmune CU diagnosis showed an accuracy of 54.5%, sensitivity of 66%, specificity of 33%, positive predictive value of 63%, and negative predictive value of 36%. There was no statistical difference between the studied groups as to mean non-specific IgG and CD123 expressions (for a p < 0.05). DISCUSSION: This study demonstrated that ASST has low accuracy in the diagnosis of autoimmune CU. Concerning other analyzed aspects, there was no statistical difference between positive ASST and negative ASST. CONCLUSIONS: Due to insufficient studies in this area and the relevance of this issue, further investigation is required.

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:25:50Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:36:13Z : No. of bitstreams: 1 2-s2.0-84455170390.pdf: 135974 bytes, checksum: 0a4cddb5cd628d479ac6a66924797265 (MD5) Made available in DSpace on 2014-05-27T11:25:50Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-04-01 Objective: evaluating the adequacy, prescription and energy supply of enteral nutrition therapy in hospitalized patients. Methods: was performed a retrospective survey of the evolution of TNE protocol of 59 patients hospitalized in a general hospital in Marília / SP / BR. Data collected included gender, age, clinical diagnosis, anthropometric and dietary data related to the prescribed dietary formula, route and method of administration of the enteral nutrition, the daily volume prescribed and administered, the daily amount of energy required and offered in the diet, as well as possible complications. Body mass index (BMI), triceps skinfold (TSF) and arm muscle circumference (AMC) were used to establish the nutritional status of the patients. The adequacy of ENT was done according to the daily energy requirement compared to the average energy received during the daily use of ENT. Results: The average found to the BMI was 21.4 kg/m 2, and no differences were found comparing male and female. The data for TSF and AMC were different between genders (p0.05) in energy supply, volume of enteral nutrition prescribed and administered among eutrophic, underweight or overweight patients. Conclusion: The results of this study indicate that the prescription and energy supply were not based on the needs of these patients, causing a significant energy deficit, which can lead to worsening of the nutritional status of the same. In hospitalized patients in use of ENT, the energy requirement must be made by a qualified professional within the multidisciplinary team, based on the needs of each patient. Universidade Estadual Paulista - Unesp, Botucatu Universidade de Marília - UNIMAR Universidade Paulista - Unip, Assis Universidade Estadual Paulista - Unesp, Araraquara Aprimoranda de Nutrição Clínica Faculdade de Medicina de Marília - FAMEMA, Marília Universidade Estadual Paulista - Unesp, Botucatu Universidade Estadual Paulista - Unesp, Araraquara

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:57:54Z No. of bitstreams: 1 S0102-76382010000200008.pdf: 56932 bytes, checksum: a257630b8910bfd423a51ef964cb6d97 (MD5) Made available in DSpace on 2013-08-22T18:57:54Z (GMT). No. of bitstreams: 1 S0102-76382010000200008.pdf: 56932 bytes, checksum: a257630b8910bfd423a51ef964cb6d97 (MD5) Previous issue date: 2010-06-01 Made available in DSpace on 2013-09-30T19:53:04Z (GMT). No. of bitstreams: 2 S0102-76382010000200008.pdf: 56932 bytes, checksum: a257630b8910bfd423a51ef964cb6d97 (MD5) S0102-76382010000200008.pdf.txt: 45846 bytes, checksum: 6998dc825cc55ed4641a4094dbba54af (MD5) Previous issue date: 2010-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:31:46Z No. of bitstreams: 2 S0102-76382010000200008.pdf: 56932 bytes, checksum: a257630b8910bfd423a51ef964cb6d97 (MD5) S0102-76382010000200008.pdf.txt: 45846 bytes, checksum: 6998dc825cc55ed4641a4094dbba54af (MD5) Made available in DSpace on 2014-05-20T13:31:46Z (GMT). No. of bitstreams: 2 S0102-76382010000200008.pdf: 56932 bytes, checksum: a257630b8910bfd423a51ef964cb6d97 (MD5) S0102-76382010000200008.pdf.txt: 45846 bytes, checksum: 6998dc825cc55ed4641a4094dbba54af (MD5) Previous issue date: 2010-06-01 OBJETIVO: Avaliar qualidade do serviço prestado aos pacientes de cirurgia cardíaca no período hospitalar, em serviço do SUS, identificando as expectativas e percepções dos pacientes. Relacionar qualidade de serviço com gênero, faixa etária e circulação extracorpórea. MÉTODOS: Estudaram-se 82 pacientes (52,4% do sexo feminino e 47,6% do masculino) submetidos a cirurgia cardíaca eletiva, operados por toracotomia médio-esternal, idade: 31 a 83 anos (média 60,4 ± 13,2 anos), período: março a setembro de 2006. Avaliou-se a qualidade do serviço em dois momentos: expectativas no pré-operatório e percepções do atendimento recebido no 6º dia de pós-operatório; mediante aplicação da escala SERVQUAL modificada (SERVQUAL-Card). O resultado foi obtido pela diferença da somatória das notas das percepções e expectativas por meio de análise estatística. RESULTADOS: A escala SERVQUAL-Card foi validada estatisticamente, apresentando adequado índice de consistência interna. Encontrou-se maior frequência de revascularização do miocárdio 55 (67,0%); primeira cirurgia cardíaca 72 (87,8%) e utilização de CEC 69 (84,1%). Verificaram-se altos valores para expectativas e percepções, com resultados significantes (P

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:57:30Z No. of bitstreams: 1 S0102-36162009000100010.pdf: 1345914 bytes, checksum: b5da59200c852756483a375da2b2db17 (MD5) Made available in DSpace on 2013-08-22T18:57:30Z (GMT). No. of bitstreams: 1 S0102-36162009000100010.pdf: 1345914 bytes, checksum: b5da59200c852756483a375da2b2db17 (MD5) Previous issue date: 2009-02-01 Made available in DSpace on 2013-09-30T18:16:27Z (GMT). No. of bitstreams: 2 S0102-36162009000100010.pdf: 1345914 bytes, checksum: b5da59200c852756483a375da2b2db17 (MD5) S0102-36162009000100010.pdf.txt: 31645 bytes, checksum: 810f17dddf024b36a7ff163af415b943 (MD5) Previous issue date: 2009-02-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:45Z No. of bitstreams: 2 S0102-36162009000100010.pdf: 1345914 bytes, checksum: b5da59200c852756483a375da2b2db17 (MD5) S0102-36162009000100010.pdf.txt: 31645 bytes, checksum: 810f17dddf024b36a7ff163af415b943 (MD5) Made available in DSpace on 2014-05-20T13:32:45Z (GMT). No. of bitstreams: 2 S0102-36162009000100010.pdf: 1345914 bytes, checksum: b5da59200c852756483a375da2b2db17 (MD5) S0102-36162009000100010.pdf.txt: 31645 bytes, checksum: 810f17dddf024b36a7ff163af415b943 (MD5) Previous issue date: 2009-02-01 OBJETIVO: Investigar as repercussões clínicas, biomecânicas e histomorfométricas do ácido zoledrônico em tíbias de ratas osteoporóticas, após ooforectomia bilateral. MÉTODOS: Foram estudadas, prospectivamente, 40 ratas da linhagem Wistar (Rattus novergicus albinus). Com 60 dias de vida, os animais foram aleatorizados em dois grupos de acordo com o procedimento cirúrgico: ooforectomia bilateral (O) (n=20) e pseudo-cirurgia (sham) (P) (n=20). Após 30 dias, os animais foram divididos em quatro subgrupos, de acordo com a administração de 0,1mg/kg de ácido zoledrônico (AZ) ou água destilada (AD): OAZ (n=10), OAD (n=10), PAZ (n=10) e PAD (n=10). Após 12 meses, os animais foram eutanasiados e suas tíbias analisadas. No estudo clínico foi considerado o peso dos animais; no estudo biomecânico foram realizados ensaios compressivos e na análise histomorfométrica foi determinada a área trabecular óssea. RESULTADOS: Os grupos O tiveram aumento de peso significativamente maior que os grupos P (p=0,005). Os grupos OAZ e PAZ tiveram aumento, não significativo, de peso quando comparados aos grupos OAD (p=0,47) e PAD (p=0,68). Os grupos com ácido zoledrônico e com água destilada suportaram carga máxima, semelhante (p=0,2), no momento em que ocorreu fratura. Nos grupos com ácido zoledrônico verificou-se o aumento não significante da área trabecular óssea quando comparados aos grupos com água destilada (p=0,21). Houve correlação positiva entre a área trabecular e a carga máxima (p=0,04; r=0,95). CONCLUSÃO: O ácido zoledrônico não influiu significativamente no peso dos animais. Os resultados mostraram aumento, não significante, tanto da resistência óssea diafisária tibial, como da área trabecular óssea. OBJECTIVE: To investigate clinical, biomechanic and histomorphometric effects of zoledronic acid on osteoporotic rats'tibiae after bilateral ooforectomy. METHODS: 40 female Wistar (Rattus novergicus albinus) rats were prospectively studied. on the 60th day of life, the animals were randomized into two groups according to the surgical procedure: bilateral ooforectomy (O) (n=20) and sham surgery (sham) (P) (n=20). After 30 days, the animals were divided into four groups, according to the administration of zoledronic acid (ZA) 0.1mg/kg or distilled water (DW): OZA (n=10), ODW (n=10), PZA (n=10) and PDW (n=10). After 12 months, the animals were sacrificed, and had their tibiae assessed. In the clinical study, animals'weight was considered; in the biomechanical study, compressive assays were applied and, in the histomorphometric analysis, the bone trabecular area was determined. RESULTS: O groups showed a significantly greater weight gain than P groups (p=0.005). Groups OZA and PZA showed an insignificant weight gain when compared to ODW (p=0.47) and PDW (p=0.68). The groups receiving zoledronic acid and distilled water were able to bear maximum load, similar (p=0.2), at the moment of fracture. In the groups receiving zoledronic acid, an insignificant increase of the bone trabecular area was found when compared to the groups receiving distilled water (p=0.21). There was a positive correlation between trabecular area and maximum load (p=0.04; r=0.95). CONCLUSION: Zoledronic acid did not significantly influence animals' weight. The results showed an insignificant increase both of the tibial shaft bone resistance and the bone trabecular area. Faculdade de Medicina de Marília Programa de Ortopedia e Traumatologia Unesp Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia Faculdade de Medicina de Marília Departamento de Ortopedia e Traumatologia Unesp Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:40:42Z No. of bitstreams: 1 S0066-782X2007000200015.pdf: 230914 bytes, checksum: a4209176b0398f78cd163439d47b7e04 (MD5) Made available in DSpace on 2013-08-22T18:40:42Z (GMT). No. of bitstreams: 1 S0066-782X2007000200015.pdf: 230914 bytes, checksum: a4209176b0398f78cd163439d47b7e04 (MD5) Previous issue date: 2007-02-01 Made available in DSpace on 2013-09-30T19:26:41Z (GMT). No. of bitstreams: 2 S0066-782X2007000200015.pdf: 230914 bytes, checksum: a4209176b0398f78cd163439d47b7e04 (MD5) S0066-782X2007000200015.pdf.txt: 43960 bytes, checksum: 61a8187ccb4632ab49e50ccaa4820bd1 (MD5) Previous issue date: 2007-02-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:07:27Z No. of bitstreams: 2 S0066-782X2007000200015.pdf: 230914 bytes, checksum: a4209176b0398f78cd163439d47b7e04 (MD5) S0066-782X2007000200015.pdf.txt: 43960 bytes, checksum: 61a8187ccb4632ab49e50ccaa4820bd1 (MD5) Made available in DSpace on 2014-05-20T15:07:27Z (GMT). No. of bitstreams: 2 S0066-782X2007000200015.pdf: 230914 bytes, checksum: a4209176b0398f78cd163439d47b7e04 (MD5) S0066-782X2007000200015.pdf.txt: 43960 bytes, checksum: 61a8187ccb4632ab49e50ccaa4820bd1 (MD5) Previous issue date: 2007-02-01 OBJETIVO: Avaliar a contribuição relativa da remodelação geométrica do ventrículo esquerdo (VE) e das alterações morfológicas e funcionais do miocárdio, em ratos com estenose aórtica supravalvar (EAS), na fase de transição da hipertrofia compensada para a insuficiência cardíaca congestiva (ICC). MÉTODOS: Vinte e uma semanas após a indução da EAS os ratos foram classificados como controles (GC,n=13), não portadores (GE,n=11) ou portadores de insuficiência cardíaca congestiva (GE-IC,n=12).Todos os grupos foram avaliados com estudo ecocardiográfico, hemodinâmico e morfológico do miocárdio. RESULTADOS: Vinte e uma semanas após EAS: índice de massa (GE-IC>GE>GC,pGC, pGE>GC, pGE>GC,pGE>GC, pGE>GC, pSG>CG, pCG, pSG>CG, pSG>CG, pSG>CG, pSG>CG, p

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:45:19Z No. of bitstreams: 1 S2179-83972007000400018.pdf: 903831 bytes, checksum: e438603045c97eeb7b55b0aa593dca7f (MD5) Made available in DSpace on 2013-08-22T18:45:19Z (GMT). No. of bitstreams: 1 S2179-83972007000400018.pdf: 903831 bytes, checksum: e438603045c97eeb7b55b0aa593dca7f (MD5) Previous issue date: 2007-01-01 Made available in DSpace on 2013-09-30T18:17:27Z (GMT). No. of bitstreams: 2 S2179-83972007000400018.pdf: 903831 bytes, checksum: e438603045c97eeb7b55b0aa593dca7f (MD5) S2179-83972007000400018.pdf.txt: 48515 bytes, checksum: b47107160a7ddb48d1fe68916e6ba344 (MD5) Previous issue date: 2007-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:33:33Z No. of bitstreams: 2 S2179-83972007000400018.pdf: 903831 bytes, checksum: e438603045c97eeb7b55b0aa593dca7f (MD5) S2179-83972007000400018.pdf.txt: 48515 bytes, checksum: b47107160a7ddb48d1fe68916e6ba344 (MD5) Made available in DSpace on 2014-05-20T13:33:33Z (GMT). No. of bitstreams: 2 S2179-83972007000400018.pdf: 903831 bytes, checksum: e438603045c97eeb7b55b0aa593dca7f (MD5) S2179-83972007000400018.pdf.txt: 48515 bytes, checksum: b47107160a7ddb48d1fe68916e6ba344 (MD5) Previous issue date: 2007-01-01 Atualmente, diante das técnicas atuais, a manometria tem sido relegada a plano secundário durante a cateterização cardíaca. No entanto, ainda fornece importantes informações para identificação e avaliação das doenças cardiovasculares. Os dados coletados durante os exames possibilitam a obtenção de variáveis quantitativas e qualitativas, as quais podem ser comparadas aos padrões normais. Os sistemas manométricos são compostos por transdutor, amplificador e registrador, que, em conjunto, devem espelhar com fidelidade a morfologia e os valores das variáveis analisadas. Para atingir esse objetivo, é necessário desempenho adequado de todos os componentes. Se uma determinada informação é de extrema relevância, o operador deve gastar tempo suficiente para obtê-la de maneira inequívoca. Assim, o operador deve estar familiarizado com os sistemas manométricos e com as fontes de erro relacionadas com as técnicas de registro, cateteres, conectores e fluidos. Com os fundamentos analisados neste manuscrito, salientamos que deve ser dispensada atenção às ondas de pressão usadas nas interpretações da fisiopatologia das doenças cardiovasculares. Cardiac catheterization and ancillary procedures provide invaluable information for the detection of heart disease and the assessment of cardiac function. Raw data are collected in the course of the investigation and then processed, yielding hemodynamic and mechanical variables which can be evaluated qualitatively and quantitatively against the known standards. Precise recordings are clearly indispensable for a reliable hemodynamic evaluation: to accomplish this objective, the use of an appropriate instrument system must be made. A modern instrument system for physiologic recording consists of three main components, namely, transducer, amplifier, and indicator. The adequacy of an instrument system depends on the performance of its components: stability, sensitivity, linearity and an adequate frequency response. If the information is considered important enough to perform hemodynamic measurements, the operators should take the time to obtain pressure waveforms that are reliable and unequivocal, separating artifact from pathology. With the fundamentals analyzed in this paper, we would like to point out that, all due attention should be paid to the pressure waves used in the interpretation of the physiopathology of cardiovascular illness. UNESP Faculdade de Medicina de Botucatu Hospital das Clínicas Faculdade de Medicina de Marília UNESP Faculdade de Medicina de Botucatu Hospital das Clínicas

Made available in DSpace on 2016-07-07T12:34:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2015. Added 1 bitstream(s) on 2016-07-07T12:43:15Z : No. of bitstreams: 1 S0102-76382015000200017.pdf: 791651 bytes, checksum: d6759adbd76607875ad5a62337aef499 (MD5) A bibliometria é uma técnica quantitativa estatística para medir índices de produção e disseminação do conhecimento, assim como ferramenta útil para acompanhar o próprio desenvolvimento de uma determinada área científica. A avaliação da produção necessá- ria para reconhecimento de investigadores e de revistas é realizada com o uso de ferramentas chamadas índices bibliométricos, divididos em indicadores de qualidade e de impacto científico. Inicialmente desenvolvida para medidas estatísticas de monografias, especialmente em bibliotecas, hoje a bibliometria é utilizada principalmente para avaliar produtividade de autores e estudos de citações. Contudo, tais ferramentas por vezes têm limitações e controvérsias surgem acerca da aplicação indiscriminada das mesmas, levando ao desenvolvimento de índices mais recentes. É importante para o pesquisador conhecer os índices mais comuns, utilizá-los adequadamente e reconhecer suas limitações, pois sua utilização correta tem impacto direto na prática diária, reputação e obtenção de recursos. Bibliometry is a quantitative statistical technique to measure levels of production and dissemination of knowledge, as well as a useful tool to track the development of an scientific area. The valuation of production required for recognition of researchers and magazines is accomplished through tools called bibliometricindexes, divided into quality indicators and scientific impact. Initially developed for monographs of statistical measures especially in libraries, today bibliometrics is mainly used to evaluate productivity of authors and citation repercussion. However, these tools have limitations and sometimes provoke controversies about indiscriminate application, leading to the development of newer indexes. It is important to know the most common search indexes and use it properly even acknowledging its limitations as it has a direct impact in their daily practice, reputation and funds achievement. Faculdade de Medicina de Marília (FAMEMA), Marília, SP, Brasil Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Clínica Médica, Botucatu, SP, Brasil Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Clínica Médica, Botucatu, SP, Brasil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Helicobacter pylori is a spiral-shaped Gram-negative bacterium. It colonizes the gastric mucosa of humans and persists for decades if not treated. Helicobacter pylori infection affects more than half of the world's population and invariably results in chronic gastritis. The cagA gene is present in about 60 to 70% of H. pylori strains; it encodes a high-molecular-weight protein (120 to 140 kDa) and several investigators have noted a correlation between strains that possess cagA and the severity of gastric mucosal inflammation. We examined the relation between cagA status in H. pylori strains and chronic gastritis with inflammatory processes in children from Marília, São Paulo, Brazil. One-hundred-twenty-one children were analyzed histopathologically and by polymerase chain reaction (PCR) to detect H. pylori and cagA. We then looked for an association between cagA presence and inflammatory infiltration. Using histology and PCR, we found 47% H. pylori positive infection; 29 children were diagnosed with chronic gastritis, while 28 showed normal mucosa by histopathological analysis. CagA presence was genotyped in both groups, and an inflammatory infiltrate was studied in all infected children with chronic gastritis. We found cagA strains in 20 of 29 (69%) children with chronic gastritis and 18 of 28 (64%) with normal mucosa, demonstrating a strong relationship between the strains and the inflammatory process. We found a positive association between an inflammatory process associated with H. pylori of cagA+ strains and chronic gastritis development. School of Medicine of Marília Department of Genetic and Molecular Biology Hemocentro UNIFESP-EPM Department of Genetic FAMEMA Department of Pathology UNIFESP, EPM, Department of Genetic SciELO

Made available in DSpace on 2015-10-21T13:10:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-01-15 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Aims: The present study aimed to investigate the effects of the interaction between the abusive use of nandrolone decanoate (ND) and physical activity on the prostate structure of adult and older rats. We evaluated whether the use of ND, associated or not with physical exercise during the post-pubertal stage, interferes with the morphophysiology of the prostate.Main methods: Fifty-six male Sprague-Dawley rats were divided into eight groups. The animals were treated for eight weeks and divided into sedentary and trained groups, with or without ND use. Four groups were sacrificed 48 h after the end of the eight week experiment (adult groups), and four other groups were sacrificed at 300 days of age (older groups). The prostate was collected and processed for stereological and histopathological analysis and for the expression of AQP1 and VEGF by the Western blotting technique.Key findings: Both ND and physical activity altered the ventral prostate structure of the rats; the AQP1 and VEGF expression increased in young animals subjected to physical exercise.Significance: Thus, it was concluded that the use of ND, associated or not with exercise during the post-pubertal stage, interferes with the morphophysiology of the prostate. (c) 2014 Elsevier Inc All rights reserved. Fac Med Marilia FAMEMA, Marilia, SP, Brazil Univ Estadual Paulista UNESP, Dept Anat, Inst Biosci, Botucatu, SP, Brazil Univ Estadual Paulista UNESP, Sch Sci, Dept Biol Sci, Bauru, SP, Brazil Univ Estadual Paulista UNESP, Inst Biosci, Dept Morphol, Bauru, SP, Brazil Univ Campinas UNICAMP, Inst Biol, Dept Struct &Funct Biol, Campinas, SP, Brazil Univ Estadual Paulista UNESP, Dept Anat, Inst Biosci, Botucatu, SP, Brazil Univ Estadual Paulista UNESP, Sch Sci, Dept Biol Sci, Bauru, SP, Brazil Univ Estadual Paulista UNESP, Inst Biosci, Dept Morphol, Bauru, SP, Brazil FAPESP: 2013/07203-4

Made available in DSpace on 2014-09-30T18:18:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-04-01Bitstream added on 2014-10-01T14:04:15Z : No. of bitstreams: 1 S0066-782X2014000300002.pdf: 438856 bytes, checksum: bc0d7717ad1a108cca1737821d935962 (MD5) Fundamento: Estresse e etanol são ambos, independentemente, importantes fatores de risco cardiovascular. Objetivo: avaliar o risco cardiovascular do consumo de etanol e exposição ao estresse, isolados e em associação, em ratos machos adultos. Métodos: Os ratos foram separados em quatro grupos: controle, etanol (20% na água de beber durante seis semanas), estresse (imobilização 1h dia/5 dias por semana/ 6 semanas) e estresse/etanol. As curvas de concentração-resposta à noradrenalina - na ausência e na presença de ioimbina, L-NAME ou indometacina - ou fenilefrina foram determinadas em aortas torácicas com e sem endotélio. EC50 e resposta máxima (n = 8-12) foram comparadas através de ANOVA de dois fatores (two-way) / método de Bonferroni. Resultados: Estresse ou estresse em associação com o consumo de etanol aumentaram as respostas máximas de noradrenalina em aortas intactas. Essa hiper-reatividade foi eliminada pela remoção do endotélio, ou pela presença da indometacina ou ioimbina, mas não foi alterada pela presença de L-NAME. Enquanto isso, o consumo de etanol não alterou a reatividade à noradrenalina. As respostas da fenilefrina em aortas com e sem endotélio também permaneceram inalteradas independentemente do protocolo. Conclusão: O estresse crônico aumentou as respostas aórticas dos ratos à noradrenalina. Esse efeito é dependente do endotélio vascular e envolve a liberação de prostanóides vasoconstritores através da estimulação de α-2 adrenoceptores endoteliais. Além disso, o consumo crônico de etanol pareceu não influenciar as respostas de noradrenalina em aorta de rato, nem modificar o aumento de tais respostas observadas em consequência da exposição ao estresse. Background: Stress and ethanol are both, independently, important cardiovascular risk factors. Objective: To evaluate the cardiovascular risk of ethanol consumption and stress exposure, isolated and in association, in male adult rats. Methods: Rats were separated into 4 groups: Control, ethanol (20% in drinking water for 6 weeks), stress (immobilization 1h day/5 days a week for 6 weeks) and stress/ethanol. Concentration-responses curves to noradrenaline - in the absence and presence of yohimbine, L-NAME or indomethacin - or to phenylephrine were determined in thoracic aortas with and without endothelium. EC50 and maximum response (n=8-12) were compared using two-way ANOVA/Bonferroni method. Results: Either stress or stress in association with ethanol consumption increased the noradrenaline maximum responses in intact aortas. This hyper-reactivity was eliminated by endothelium removal or by the presence of either indomethacin or yohimbine, but was not altered by the presence of L-NAME. Meanwhile, ethanol consumption did not alter the reactivity to noradrenaline. The phenylephrine responses in aortas both with and without endothelium also remained unaffected regardless of protocol. Conclusion: Chronic stress increased rat aortic responses to noradrenaline. This effect is dependent upon the vascular endothelium and involves the release of vasoconstrictor prostanoids via stimulation of endothelial alpha-2 adrenoceptors. Moreover, chronic ethanol consumption appeared to neither influence noradrenaline responses in rat thoracic aorta, nor did it modify the increase of such responses observed as a consequence of stress exposure. Universidade Estadual Paulista Instituto de Biociências Departamento de Farmacologia Faculdade de Medicina de Marília Laboratório de Farmacologia USP Faculdade de Ciências Farmacêuticas Departamento de Análise Clínica - Toxicológica e Ciência de Alimentos Universidade Estadual Paulista Instituto de Biociências Departamento de Farmacologia

Made available in DSpace on 2016-07-07T12:35:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2014. Added 1 bitstream(s) on 2016-07-07T12:44:39Z : No. of bitstreams: 1 ISSN0916-8737-2014-50-85-92.pdf: 661759 bytes, checksum: 2905633727aa7cd1392433fca6c9b840 (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Functional studies have shown that orchidectomy increases the effects of phenylephrine on rat portal veins, but that it is completely prevented in the presence of both ETA and ETB receptor antagonists. Although it suggests the involvement of endothelin-1 (ET-1), the local production of this vasoactive peptide has not been directly quantified in portal veins. Therefore, the aim of the present study was to verify if orchidectomy increases the local expression of ET-1 as well as ETA and ETB receptors in the rat portal vein. Indeed, the genic expression of ET-1, ETA and ETB receptors in rat portal veins taken from control (CONT), orchidectomized (ORX) and ORX plus testosterone-replacement therapy (ORX + T) animals were determined by Real Time RT-PCR. The results showed that orchidectomy induced a significant increment in genic expression of ET-1and ETB receptors in the rat portal veins, which was completely reversed by testosterone replacement treatment. In conclusion, the results suggest that orchidectomy increases the production of ET-1 in the rat portal vein and that, at least partially, it may be related to the previously reported elevation of responses to phenylephrine. Universidade Estadual Paulista, Departamento de Fisioterapia e Terapia Ocupacional, Faculdade de Filosofia e Ciências de Marília Universidade Estadual Paulista, Departamento de Farmacologia, Instituto de Biociências de Botucatu FAPESP: 2009/08012-2

Made available in DSpace on 2016-07-07T12:34:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2014. Added 1 bitstream(s) on 2016-07-07T12:43:58Z : No. of bitstreams: 1 ISSN1981-8963-2014-08-08-2770-2780-en.pdf: 620805 bytes, checksum: 5525327d5c83a8753b5c80ec88ecb139 (MD5). Added 1 bitstream(s) on 2016-07-07T12:43:58Z : No. of bitstreams: 2 ISSN1981-8963-2014-08-08-2770-2780-en.pdf: 620805 bytes, checksum: 5525327d5c83a8753b5c80ec88ecb139 (MD5) ISSN1981-8963-2014-08-08-2770-2780-pt.pdf: 566352 bytes, checksum: 1cd854dceda58799676b43080e81e93d (MD5) Objetivos: descrever, desde sua implantação, o projeto Saúde e Prevenção nas Escolas, em Marília (SP), e analisar os aspectos organizacionais, estruturais, operacionais e de dinâmica do trabalho realizado, com vistas a obter subsídios para sua gestão intersetorial. Método: estudo qualitativo, com dados produzidos por observação direta, análise documental e entrevistas semiestruturadas com 31 profissionais da saúde e educação e estudantes. Empregou-se a técnica de análise de conteúdo, na modalidade temática. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina de Botucatu, da Universidade Estadual Paulista (Unesp), sob o Protocolo n. 4.041/2011. Resultados: apesar das dificuldades, o projeto em foco tem cumprido seus objetivos, consolidando-se como profícua iniciativa intersetorial, porém, sem avaliação sistemática de suas ações. Conclusão: para consolidar e ampliar ações intersetoriais, especialmente as avaliativas, faz-se necessário estreitar as relações entre os setores envolvidos, pais e comunidade, bem como maior participação dos estudantes nos diferentes momentos e espaços de sua ocorrência. Objectives: to describe, from its implementation, the project Health and Prevention at Schools, in Marília, São Paulo, Brazil, and to analyze the organizational, structural, operational, and dynamic aspects of the work done, with a view to obtaining grants for its intersectoral management. Method: qualitative study, with data produced through direct observation, documentary analysis, and semi-structured interviews with 31 health and education professionals and students. We applied the content analysis technique, in its thematic modality. The study was approved by the Research Ethics Committee of the School of Medicine of Botucatu, of the São Paulo State University (UNESP), under the Protocol 4,041/2011. Results: despite the difficulties, the project in focus has complied with its objectives, establishing itself as a fruitful intersectoral initiative, however, there is no systematic evaluation of its actions. Conclusion: to consolidate and expand intersectoral actions, especially those with an evaluative design, there is a need to strengthen relations between the sectors involved, parents and the community, as well as greater participation of students at the various times and spaces where they take place. Objetivos: describir, desde su implementación, el proyecto Salud y Prevención en las Escuelas, en Marília, São Paulo, Brasil, y analizar los aspectos organizativos, estructurales, operacionales y de dinámica del trabajo realizado, con miras a la obtención de subvenciones para su gestión intersectorial. Método: estudio cualitativo, con datos producidos a través de observación directa, análisis documental y entrevistas semiestructuradas con 31 profesionales de salud y educación y estudiantes. Se empleó la técnica de análisis de contenido, en su modalidad temática. El estudio fue aprobado por el Comité de Ética en Investigación de la Facultad de Medicina de Botucatu, de la Universidad Estadual Paulista (Unesp), bajo el Protocolo 4.041/2011. Resultados: a pesar de las dificultades, el proyecto en foco ha cumplido con sus objetivos, estableciéndose como una iniciativa intersectorial fructífera, sin embargo, no hay una evaluación sistemática de sus acciones. Conclusión: para consolidar y ampliar acciones intersectoriales, especialmente aquellas evaluativas, hay una necesidad de fortalecer las relaciones entre los sectores involucrados, padres y comunidad, así como una mayor participación de los estudiantes en los distintos momentos y espacios donde se llevan a cabo. Universidade Estadual Paulista, Departamento de Enfermagem, Faculdade de Medicina de Botucatu

Made available in DSpace on 2015-11-03T15:27:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-01-01. Added 1 bitstream(s) on 2015-11-04T10:15:36Z : No. of bitstreams: 1 S0103-21002014000600579-pt.pdf: 128931 bytes, checksum: ee886d9c5d7d8480f2d00de19d4c1179 (MD5). Added 1 bitstream(s) on 2015-11-04T10:15:36Z : No. of bitstreams: 2 S0103-21002014000600579-pt.pdf: 128931 bytes, checksum: ee886d9c5d7d8480f2d00de19d4c1179 (MD5) S0103-21002014000600579-en.pdf: 138291 bytes, checksum: 730564180b139eba9566bec3e89b324f (MD5) Objetivo: Compreender o significado da intervenção de massagem com aromaterapia em saúde mental para o usuário durante a internação psiquiátrica. Métodos: Pesquisa qualitativa que incluiu 22 participantes com diagnóstico de Transtornos de Personalidade internados em unidade psiquiátrica de um hospital geral. Foram realizadas entrevistas semiestruturadas, com uma questão norteadora aos participantes, os quais se submeteram a intervenções de massagem com aromaterapia. O conteúdo das entrevistas foi avaliado segundo a Análise de Conteúdo. Resultados: Entre os sujeitos de pesquisa, houve predominância do sexo feminino e do diagnóstico de Transtornos de Personalidade Emocionalmente Instável. Dos dados qualitativos, emergiram duas categorias: “identificando os benefícios da aromaterapia” e “possibilitando o autoconhecimento”. Conclusão: O significado da intervenção de massagem com aromaterapia foi representado por melhorias no cuidado de enfermagem e no tratamento durante a internação psiquiátrica, ao auxiliar na diminuição dos sintomas ansiosos e no enfrentamento do transtorno mental. Objective: To understand the meaning of the aromatherapy massage intervention in mental health for the patient during psychiatric hospitalization.Methods: A qualitative study including 22 participants with a diagnosis of personality disorder hospitalized in a psychiatric unit of a general hospital. We used semi-structured interviews with a guiding question for participants, for whom the aromatherapy massage intervention was performed. The content of the interviews was assessed according to content analysis.Results: Among the study subjects, there was a predominance of females and the majority presented a diagnosis of Emotionally Unstable Personality Disorder. Two categories that emerged were identified from qualitative data: "Identifying the benefits of aromatherapy" and "Enabling self-knowledge."Conclusion: The meaning of the aromatherapy massage intervention was represented by improvements in nursing care and treatment during psychiatric hospitalization, while assisting in the reduction of anxiety symptoms and coping with mental illness. Faculdade de Medicina de Marília, Hospital das Clínicas Universidade Estadual Paulista, Departamento de Enfermagem, Faculdade de Medicina de Botucatu

Made available in DSpace on 2015-02-24T13:57:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2014Bitstream added on 2015-02-24T14:08:20Z : No. of bitstreams: 1 ISSN18084281-2014-14-03-877-892.pdf: 570249 bytes, checksum: 84c9ac450026cd46868f767d5a07751b (MD5) Este estudo teve como objetivo identificar a presença de indicadores de estresse, os níveis de estresse e sobrecarga junto a cuidadores formais e informais de pacientes oncológicos. Participaram da pesquisa 33 cuidadores de pacientes com câncer no total, sendo 17 informais e 16 formais. Para a coleta de dados utilizou-se: 1) Roteiro para caracterização dos participantes; 2) O Inventário de Sintomas de Estresse de Lipp - ISSL e 3) Protocolo Zarit Burden Interview – ZBT. Os resultados revelaram que 43% dos cuidadores informais encontravam-se na fase de resistência, 29% na fase de exaustão, 14% na fase de quase exaustão e 14% na fase de alerta. Os cuidadores formais 25% encontram-se na fase de exaustão e 75% na fase de resistência. A sobrecarga também apresentou-se em maior escala em cuidadores informais do que formais, sendo 47% para 18,7% repectivamente. Contudo, os resultados não revelaram diferença estatística significativa entre os grupos para incidência de estresse, mas indicou diferença em relação à sobrecarga apontando que em cuidadores profissionais a incidência é menor. Os resultados sugerem a necessidade de implantar programas de suporte para cuidadores informais e formais, desenvolver estratégias de enfrentamento, manejo com as situações de sobrecarga e estresse, objetivando melhor qualidade de vida para o cuidador e, consequentemente, para o paciente que está recebendo os cuidados. The present study aimed to identify the presence of indicators of stress, levels of stress and overload with the formal and informal caregivers of cancer patients. Participated in the survey 33 caregivers of cancer patients in total, 16 formal and 17 informal. To collect data, we used: 1) Roadmap for characterization of participants; 2) Inventory of Stress Symptoms Lipp - ISSL and 3) Protocol Zarit Burden Interview - ZBT. The results revealed that 43 % of informal carers were in the resistance phase, 29 % in the burnout stage, 14 % at the stage of exhaustion and almost 14 % in the alert phase. Formal caregivers 25 % are in the exhaustion phase and 75 % in the resistance. The overload has also performed on a larger scale in informal than formal caregivers, 47 % to 18,7 % charge respectively. However, the results revealed no statistically significant difference between groups for the incidence of stress but indicated a difference against overloading pointing out that professional caregivers in the incidence is lower. The results suggest the need to implement support for informal and formal caregivers programs, develop coping strategies, handling the situations of overload and stress, aiming to better quality of life for the caregiver, and consequently for the patient who is receiving care. El presente estudio tuvo como objetivo identificar la presencia de indicadores de estrés, los niveles de estrés y sobrecarga de los cuidadores formales e informales de pacientes con cáncer. En la encuesta participaron 33 cuidadores de pacientes con cáncer en total, 16 formal e informal 17. Para recopilar los datos, se utilizaron: 1) Plan de trabajo para la caracterización de los participantes; 2) Inventario de Síntomas de Estrés Lipp - ISSL y 3) Protocolo de Zarit Carga Entrevista - ZBT. Los resultados revelaron que el 43 % de los cuidadores no profesionales se encontraban en la fase de resistencia, 29 % en la fase de agotamiento, 14 % en la fase de agotamiento y casi el 14 % en la fase de alerta. Cuidadores formales el 25% están en la fase de agotamiento y el 75 % en la resistencia. La sobrecarga también se ha realizado a una escala mayor en el sector informal que los cuidadores formales, el 47 % a cargo del 18,7% respectivamente. Sin embargo, los resultados no revelaron diferencias estadísticamente significativas entre los grupos de la incidencia de estrés, pero indicaron una diferencia contra sobrecarga señalando que los cuidadores profesionales en la incidencia es menor. Los resultados sugieren la necesidad de implementar programas de apoyo a los cuidadores informales y formales, desarrollar estrategias de afrontamiento, el manejo de las situaciones de sobrecarga y el estrés, con el objetivo de una mejor calidad de vida para el cuidador, y en consecuencia para el paciente que está recibiendo atención. Universidade Estadual Paulista Júlio de Mesquita Filho, Departamento de Educação Especial, Faculdade de Filosofia e Ciências - Campus de Marília, Marilia, Av. Hygino Muzzi Filho, 737, CEP 17525-900, SP, Brasil Universidade Estadual Paulista Júlio de Mesquita Filho, Departamento de Educação Especial, Faculdade de Filosofia e Ciências - Campus de Marília, Marilia, Av. Hygino Muzzi Filho, 737, CEP 17525-900, SP, Brasil

Made available in DSpace on 2015-02-24T13:57:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2014Bitstream added on 2015-02-24T14:08:23Z : No. of bitstreams: 1 ISSN1981-8963-2014-08-04-1064-1071-pt.pdf: 528639 bytes, checksum: 665633dbe68ef2474036e92622077a01 (MD5)Bitstream added on 2015-02-24T14:08:23Z : No. of bitstreams: 2 ISSN1981-8963-2014-08-04-1064-1071-pt.pdf: 528639 bytes, checksum: 665633dbe68ef2474036e92622077a01 (MD5) ISSN1981-8963-2014-08-04-1064-1071-en.pdf: 537139 bytes, checksum: b761504a09b655f4a7728a379c82a90a (MD5) Objetivo: analisar os cuidados prestados à mulher acometida por câncer de mama e que tenha realizado linfadenectomia axilar. Método: revisão integrativa realizada nas bases de dados LILACS e PubMed, entre 2000 e 2012, partindo da questão <> resultando em 18 artigos, analisados sob as variáveis: autor, título, metodologia, ano, revista, objetivo, prevenção e controle do linfedema, terapias e adesão à reabilitação. Resultados: identificou-se três categorias para a reabilitação da paciente: prevenção e controle, terapias e adesão. Conclusão: o pré-operatório é pouco abordado pela equipe; ressalta-se a importância da visita domiciliar como parte da reabilitação, sendo esta efetiva com a adesão da paciente, que necessita de informações para seu seguimento; há necessidade de um guideline para este tipo de tratamento. Objective: to examine the care provided to women affected by breast cancer and who has performed axillary lymphadenectomy. Method: integrative review conducted in the databases LILACS and PubMed between 2000 and 2012, leaving the question << What care is provided to prevent lymphedema in women who underwent lymphadenectomy? >> Resulting in 18 articles, analyzed under the following variables: author, title, methodology, year, journal, goal, prevention and control of lymphedema therapies and adherence to rehabilitation. Results: three categories are identified for rehabilitation of patient: prevention and control, therapies and adherence. Conclusion: preoperative is poorly addressed by; emphasizes the importance of home visits as part of rehabilitation, which is effective with the accession of the patient who needs information for its follow-up, no need for a guideline for this type treatment. Objetivo: analizar la atención a las mujeres afectadas por cáncer de mama y que ha realizado la linfadenectomía axilar. Método: revisión integradora realizada en las bases de datos LILACS y PubMed entre 2000 y 2012, dejando la pregunta << ¿Qué atención se proporciona para prevenir el linfedema en mujeres que se sometieron a la linfadenectomía >> resultando en 18 artículos, analizados en las siguientes variables: Autor, el título, la metodología, el año, la revista, el objetivo, la prevención y el control de las terapias linfedema y la adherencia a la rehabilitación. Resultados: tres categorías se identifican para la rehabilitación del paciente: prevención y control, tratamientos y adherencia. Conclusión: preoperatorio es poco abordado por, hace hincapié en la importancia de las visitas domiciliarias como parte de la rehabilitación, que es eficaz con la adhesión del paciente que necesita la información para su seguimiento, sin necesidad de una guía para este tipo tratamiento. Department of Speech Pathology/FFC-UNESP∕Marília

Made available in DSpace on 2018-11-28T01:49:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-10-01 Fundacao de Apoio ao Ensino, Pesquisa e Assistencia do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo Background: Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are alternative strategies for stroke prevention in patients with atherosclerotic carotid disease. CEA has been considered the first-line treatment for carotid stenosis worldwide, and the safety and efficacy of CAS compared to CEA remains in question. Objective: The purpose of this study is to compare the practice and outcomes of CAS and CEA in a real-world setting within public university hospitals in Brazil. Methods: This study will be a prospective 5-year analysis of treatment for atherosclerotic carotid stenosis with CEA and CAS performed at 5 centers affiliated with the Vascular Study Group at public university hospitals in Brazil. The indications for the procedures will be determined by each surgeon's individual discretion, in accordance with preoperative risk evaluation. The primary outcome measures will be (1) any in-hospital stroke or death, and (2) any per-procedural stroke, death, or myocardial infarction (MI). Patients undergoing CEA in conjunction with cardiac surgery will be excluded from the study. Multivariate logistic regression will be performed to identify predictors of stroke or death in patients undergoing CEA and CAS. All tests of significance will be performed at the .05 level. This study was approved by the Committee of Ethics in Research at the University Hospital of Ribeirao Preto Medical School, and in all other participating institutions linked to National Research System and National Board of Health in Brazil (Process 15695/2011). Results: This study is currently in the recruitment phase, and the final patient is expected to be enrolled by the end of 2018. We hope to recruit approximately 800 patients to the study. Analyses will focus on primary end points for patients that are allocated to each treatment group. During the per-procedural period, the occurrence of the primary end point components (stroke, MI, or death) for CAS and CEA will be analyzed for symptomatic or asymptomatic subjects. Conclusions: The analyses of the primary endpoints (and all others variables of the study) are expected to be published in 2019 in a peer reviewed journal, and results will be presented at scientific meetings, with summary results published online. This study will obtain new data related to the quality of treatment for carotid disease in Brazil at the primary training centers of future vascular surgeons, but the initial data that will be obtained and published (with the outcomes and complications) are restricted to the first 30 days postprocedure. This time restriction limits the comparison of the results that relate to the main goal of treatment, which is to decrease the risk of stroke over 5 years. The purpose of the study group is to continue the monitoring of patient records, and evaluate the follow-up data in the 5 years following the initial evaluation. This study protocol will contribute very significantly to improving the care of patients with carotid disease, in addition to qualifying the level of assistance provided in public university hospitals in the state of Sao Paulo, Brazil. Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Surg & Anat, Ave Bandeirantes 3900, BR-14048900 Ribeirao Preto, Brazil Univ Julio de Mesquita Filho UNESP, Botucatu Med Sch, Dept Surg, Botucatu, SP, Brazil Univ Estadual Campinas, Sch Med Sci, Dept Surg, Campinas, SP, Brazil Sao Jose do Rio Preto Med Sch FAMERP, Dept Surg, Sao Jose Do Rio Preto, Brazil Marilia Med Sch FAMEMA, Dept Surg, Marilia, Brazil Univ Julio de Mesquita Filho UNESP, Botucatu Med Sch, Dept Surg, Botucatu, SP, Brazil

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:06:07Z No. of bitstreams: 1 S0037-86822000000600007.pdf: 38778 bytes, checksum: c638935d7a48297b256c9445128b1166 (MD5) Made available in DSpace on 2013-08-22T19:06:07Z (GMT). No. of bitstreams: 1 S0037-86822000000600007.pdf: 38778 bytes, checksum: c638935d7a48297b256c9445128b1166 (MD5) Previous issue date: 2000-12-01 Made available in DSpace on 2013-09-30T18:07:20Z (GMT). No. of bitstreams: 2 S0037-86822000000600007.pdf: 38778 bytes, checksum: c638935d7a48297b256c9445128b1166 (MD5) S0037-86822000000600007.pdf.txt: 18330 bytes, checksum: 06744e2cebaa8e9161fd7a5a2b04d36d (MD5) Previous issue date: 2000-12-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:25:15Z No. of bitstreams: 2 S0037-86822000000600007.pdf: 38778 bytes, checksum: c638935d7a48297b256c9445128b1166 (MD5) S0037-86822000000600007.pdf.txt: 18330 bytes, checksum: 06744e2cebaa8e9161fd7a5a2b04d36d (MD5) Made available in DSpace on 2014-05-20T13:25:15Z (GMT). No. of bitstreams: 2 S0037-86822000000600007.pdf: 38778 bytes, checksum: c638935d7a48297b256c9445128b1166 (MD5) S0037-86822000000600007.pdf.txt: 18330 bytes, checksum: 06744e2cebaa8e9161fd7a5a2b04d36d (MD5) Previous issue date: 2000-12-01 A susceptibilidade de ninfas de 3º estádio de Rhodnius neglectus, R. robustus e Triatoma infestans às cepas Y e AMJM de Trypanosoma cruzi foi verificada utilizando xenodiagnóstico artificial. Para a leitura do xenodiagnóstico, as fezes dos triatomíneos foram examinadas a cada dois dias, a partir do 5º até o 31º dia pós infecção, pela técnica de compressão abdominal. Os resultados mostraram diferenças na susceptibilidade dos triatomíneos para as duas cepas estudadas e o período ótimo de leitura variou do 11º ao 19º dias para a cepa Y e do 11º ao 15º dias para a cepa AMJM. Também, pôde-se concluir que para a cepa Y, as três espécies de triatomíneos demonstraram boa susceptibilidade, enquanto para a cepa AMJM, a melhor susceptibilidade foi observada com R. neglectus, seguida pelo T. infestans e R. robustus. The susceptibility of 3rd instar nymph of Triatominae Rhodnius neglectus, R. robustus and Triatoma infestans to Trypanosoma cruzi Y and AMJM strains was verified using artificial xenodiagnosis. After the accomplishment of the xenodiagnosis, the faeces of the Triatominae were analyzed on two-day intervals from day 5 until day 31 post infection, using the abdominal compression technique. The results showed differences in the susceptibility of the Triatominae for the two strains studied, and the optimal period reading differed from day 11 to day 19 for the Y strain and from day 11 to day 15 for the AMJM strain. For the Y strain, all three Triatominae species showed good susceptibility, whereas in the AMJM strain, the highest susceptibility was observed with R. neglectus, followed by T. infestans and R. robustus. Faculdade de Medicina de Marília Disciplina de Parasitologia UNESP Faculdade de Ciências Farmacêuticas Departamento de Ciências Biológicas UNESP Faculdade de Ciências Farmacêuticas Departamento de Ciências Biológicas

Made available in DSpace on 2015-02-24T13:57:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2013Bitstream added on 2015-02-24T14:07:19Z : No. of bitstreams: 1 ISSN2175-3946-2013-15-04-48-56.pdf: 279543 bytes, checksum: e7b0c7968a82ecaf8226e4a12aecb221 (MD5) Made available in DSpace on 2015-02-24T13:57:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2013Bitstream added on 2015-02-24T14:07:19Z : No. of bitstreams: 1 ISSN2175-3946-2013-15-04-48-56.pdf: 279543 bytes, checksum: e7b0c7968a82ecaf8226e4a12aecb221 (MD5) Made available in DSpace on 2015-02-24T13:57:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2013Bitstream added on 2015-02-24T14:07:19Z : No. of bitstreams: 1 ISSN2175-3946-2013-15-04-48-56.pdf: 279543 bytes, checksum: e7b0c7968a82ecaf8226e4a12aecb221 (MD5) Introdução: Evidências científicas indicam que a exposição neonatal a drogas ototóxicas causam perda auditiva em recém-nascidos. Objetivo: Caracterizar o uso de antibióticos ototóxicos em recém-nascidos (RN), atendidos em UTI neonatal e avaliar possíveis alterações auditivas. Métodos: Estudo descritivo transversal, com abordagem quantitativa, utilizando dados de prontuários de RN, que estiveram em algum momento na UTI neonatal e utilizaram antibióticos, inclusive os ototóxicos, nos meses de janeiro a junho, tanto de 2004 quanto de 2010, sendo os dados comparados e analisados. Os pais/responsáveis dos RN nascidos em 2004 foram contactados e aplicou-se-lhes um questionário contendo questões sobre a audição. Estas crianças foram submetidas a avaliação audiológica. Resultados: Observou-se redução significativa no tempo de uso, na quantidade de antibióticos prescritos aos RN e na prescrição de Vancomicina, em 2010, quando comparado a 2004. Os exames auditivos dos 13 nascidos em 2004 mostraram: perda auditiva do tipo neurossensorial em apenas 2 (perda auditiva de grau moderado e configuração descendente na audiometria tonal liminar em um e comprometimento coclear bilateral no outro); limiares audiométricos dentro dos padrões da normalidade em 11 pacientes; e presença de emissões otoacústicas evocadas em 9. No Potencial Evocado Auditivo de Tronco Encefálico (PEATE), não foram observadas alterações. Conclusão: A redução no tempo de uso, na quantidade e nos tipos de antibióticos observada pode estar relacionada à adoção de protocolo, em 2008, por parte do serviço. Em contrapartida, as alterações auditivas encontradas podem estar relacionas à exposição neonatal aos antibióticos, em 2004. Introduction: Scientific evidence indicates that neonatal exposure to ototoxic drugs cause hearing loss in newborns. Objective: To characterize the use of ototoxic antibiotics in newborns (NB), treated in the Neonatal Intensive Care Unit (NICU) and evaluate possible hearing modifications. Methods: A descriptive cross-sectional quantitative approach, using data from medical records of infants who were at some time in the NICU and used antibiotics, including ototoxic, from January to June 2004 as much as 2010, and the data were compared and analyzed. Parents/guardians of infants born in 2004 were contacted and applied a questionnaire containing questions about the children’s hearing. These children were submitted to audiological evaluation. Results: There was significant reduction in the time of use, the amount of antibiotics prescribed to newborns and Vancomycin prescription in 2010 compared to 2004. The hearing tests of 13 born in 2004 showed: sensorineural hearing loss in only 2 (one with moderate hearing loss and descending configuration in pure tone audiometry and the other with bilateral cochlear impairment); audiometric thresholds within the normal range in 11 patients, and the presence of otoacoustic emissions in 9. In Evoked Auditory Brainstem Response (ABR) no changes were observed. Conclusion: The reduction in the time of use, the amount and types of antibiotics observed may be related to the adoption of a Protocol in 2008, by the service. In contrast, auditory alterations may be related to a neonatal exposure to antibiotics in 2004. Universidade Estadual Paulista Júlio de Mesquita Filho, Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências - Campus de Marília, Marilia, Av. Hygino Muzzi Filho,737, Vila Universitária, CEP 17500-000, SP, Brasil Universidade Estadual Paulista Júlio de Mesquita Filho, Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências - Campus de Marília, Marilia, Av. Hygino Muzzi Filho,737, Vila Universitária, CEP 17500-000, SP, Brasil

Made available in DSpace on 2014-09-30T18:18:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-09-01Bitstream added on 2014-10-01T14:04:13Z : No. of bitstreams: 1 S0100-55022013000300006.pdf: 2873181 bytes, checksum: 235025945a535c7cf0cbe68870303176 (MD5) O presente estudo avaliou o ganho de conhecimentos de estudantes do curso médico que participaram de uma atividade integradora básico-clínica de Farmacologia e Psiquiatria no quinto ano, bem como verificou a opinião deles quanto à relevância em participar dessa atividade. Foi realizado estudo quali-quantitativo, utilizando avaliação pré e pós-teste, e a técnica do Discurso do Sujeito Coletivo (DSC) para a análise do conteúdo linguístico. Observou-se aumento significativo na porcentagem de acertos no pós-teste em relação ao pré-teste (p < 0,001). As ideias centrais obtidas na análise do DSC foram: atividade muito pertinente; ampliação desta atividade para outros estágios; dificuldade nas disciplinas básicas; aplicação de avaliação cognitiva; e participação ativa do professor nas discussões. Estes resultados sugerem que a integração entre a Farmacologia e as atividades práticas do internato em Psiquiatria possibilitou ampliar conceitos de Farmacologia, tornando o aprendizado significativo. Embora os estudantes tenham apontado a necessidade de melhor ajuste da atividade, o seu nível de aceitação foi verbalizado por meio da sugestão de que ela se estenda aos demais estágios do quinto ano. This study quantifies fifth year medical students' knowledge after their participation in a basic clinical integration activity of psychiatry and pharmacology and investigates their opinions on the importance of the activity. A quali-quantitative study was performed using pre- and post-test assessment (multiple choice) and linguistic content analysis using the Discourse of the Collective Subject (DCS) technique. A significant increase in the percentage of correct answers in the post-test assessment was found compared to pre-test (p

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:04:05Z No. of bitstreams: 1 S0004-27302013000300003.pdf: 174729 bytes, checksum: 7306ee4425bad456035431ee48e4d3ae (MD5) Made available in DSpace on 2013-08-22T19:04:05Z (GMT). No. of bitstreams: 1 S0004-27302013000300003.pdf: 174729 bytes, checksum: 7306ee4425bad456035431ee48e4d3ae (MD5) Previous issue date: 2013-04-01 Made available in DSpace on 2013-09-30T20:06:41Z (GMT). No. of bitstreams: 2 S0004-27302013000300003.pdf: 174729 bytes, checksum: 7306ee4425bad456035431ee48e4d3ae (MD5) S0004-27302013000300003.pdf.txt: 89847 bytes, checksum: ba81a61af2dcb02cd4b1c4ea24bd4fc5 (MD5) Previous issue date: 2013-04-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:17:02Z No. of bitstreams: 2 S0004-27302013000300003.pdf: 174729 bytes, checksum: 7306ee4425bad456035431ee48e4d3ae (MD5) S0004-27302013000300003.pdf.txt: 89847 bytes, checksum: ba81a61af2dcb02cd4b1c4ea24bd4fc5 (MD5) Made available in DSpace on 2014-05-20T15:17:02Z (GMT). No. of bitstreams: 2 S0004-27302013000300003.pdf: 174729 bytes, checksum: 7306ee4425bad456035431ee48e4d3ae (MD5) S0004-27302013000300003.pdf.txt: 89847 bytes, checksum: ba81a61af2dcb02cd4b1c4ea24bd4fc5 (MD5) Previous issue date: 2013-04-01 INTRODUÇÃO: O hipotireoidismo subclínico (HSC), definido por concentrações elevadas do TSH em face de níveis normais dos hormônios tireoidianos, tem elevada prevalência no Brasil, particularmente entre mulheres e idosos. Embora um número crescente de estudos venha associando o HSC com maior risco de doença arterial coronariana e de mortalidade, não há ensaio clínico randomizado sobre o benefício do tratamento com levotiroxina na redução dos riscos e o tratamento permanece controverso. OBJETIVO: Este consenso, patrocinado pelo Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia e desenvolvido por especialistas brasileiros com vasta experiência clínica em tireoide, apresenta recomendações baseadas em evidências para uma abordagem clínica do paciente com HSC no Brasil. MATERIAIS E MÉTODOS: Após estruturação das questões clínicas, a busca das evidências disponíveis na literatura foi realizada inicialmente na base de dados do MedLine-PubMed e posteriormente nas bases Embase e SciELO - Lilacs. A força da evidência, avaliada pelo sistema de classificação de Oxford, foi estabelecida a partir do desenho de estudo utilizado, considerando-se a melhor evidência disponível para cada questão e a experiência brasileira. RESULTADOS: Os temas abordados foram definição e diagnóstico, história natural, significado clínico, tratamento e gestação, que resultaram em 29 recomendações para a abordagem clínica do paciente adulto com HSC. CONCLUSÃO: O tratamento com levotiroxina foi recomendado para todos os pacientes com HSC persistente com níveis séricos do TSH > 10 mU/L e para alguns subgrupos especiais de pacientes. INTRODUCTION: Subclinical hypothyroidism (SCH), defined as elevated concentrations of thyroid stimulating hormone (TSH) despite normal levels of thyroid hormones, is highly prevalent in Brazil, especially among women and the elderly. Although an increasing number of studies have related SCH to an increased risk of coronary artery disease and mortality, there have been no randomized clinical trials verifying the benefit of levothyroxine treatment in reducing these risks, and the treatment remains controversial. OBJECTIVE: This consensus, sponsored by the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism and developed by Brazilian experts with extensive clinical experience with thyroid diseases, presents these recommendations based on evidence for the clinical management of SCH patients in Brazil. MATERIALS and METHODS: After structuring the clinical questions, the search for evidence in the literature was initially performed in the MedLine-PubMed database and later in the Embase and SciELO - Lilacs databases. The strength of evidence was evaluated according to the Oxford classification system and established based on the experimental design used, considering the best available evidence for each question and the Brazilian experience. RESULTS: The topics covered included SCH definition and diagnosis, natural history, clinical significance, treatment and pregnancy, and the consensus issued 29 recommendations for the clinical management of adult patients with SCH. CONCLUSION: Treatment with levothyroxine was recommended for all patients with persistent SCH with serum TSH values > 10 mU/L and for certain patient subgroups. Faculdade de Medicina de Marília Universidade Federal do Rio de Janeiro (UFRJ) Departamento de Clínica Médica Serviço de Endocrinologia Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Departamento de Clínica Médica Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Clínica Médica Universidade Federal do Ceará (UFC) Universidade Estadual de Campinas Faculdade de Ciências Médicas Laboratório de Genética Molecular do Câncer Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Clínica Médica

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:01:33Z No. of bitstreams: 1 S0104-07072013000100012.pdf: 256042 bytes, checksum: 1505692ff8e2770b8739b69da819ee82 (MD5) Made available in DSpace on 2013-08-22T19:01:33Z (GMT). No. of bitstreams: 1 S0104-07072013000100012.pdf: 256042 bytes, checksum: 1505692ff8e2770b8739b69da819ee82 (MD5) Previous issue date: 2013-03-01 Made available in DSpace on 2013-09-30T20:01:40Z (GMT). No. of bitstreams: 2 S0104-07072013000100012.pdf: 256042 bytes, checksum: 1505692ff8e2770b8739b69da819ee82 (MD5) S0104-07072013000100012.pdf.txt: 38340 bytes, checksum: 09c81d038c3bb0755df1dd509416b2ca (MD5) Previous issue date: 2013-03-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:15:50Z No. of bitstreams: 2 S0104-07072013000100012.pdf: 256042 bytes, checksum: 1505692ff8e2770b8739b69da819ee82 (MD5) S0104-07072013000100012.pdf.txt: 38340 bytes, checksum: 09c81d038c3bb0755df1dd509416b2ca (MD5) Made available in DSpace on 2014-05-20T15:15:50Z (GMT). No. of bitstreams: 2 S0104-07072013000100012.pdf: 256042 bytes, checksum: 1505692ff8e2770b8739b69da819ee82 (MD5) S0104-07072013000100012.pdf.txt: 38340 bytes, checksum: 09c81d038c3bb0755df1dd509416b2ca (MD5) Previous issue date: 2013-03-01 O estudo avaliou a formação em enfermagem ancorada na problematização e na aprendizagem baseada em problemas a partir da percepção dos egressos. Trata-se de estudo transversal de natureza ex-post-facto. Os resultados foram analisados na triangulação das abordagens quantitativa e qualitativa e na perspectiva hermenêutica dialética. Na abordagem quantitativa 180 egressos responderam um questionário. Na qualitativa, 14 participaram das entrevistas, que buscaram sentidos relacionados ao cuidado ideal, para construção dos indicadores que revelassem a lógica da avaliação. Esses indicadores nortearam a escolha das questões para triangulação. Os resultados apontaram que 85,1% dos egressos estão inseridos no mercado de trabalho, 92,1% cursaram pós-graduação e 99,1% acreditam apresentar formação necessária ao cuidado ético, humanizado e fundamentado. A análise dos dados aponta para formação comprometida com a construção da autonomia e do conhecimento, bem como articulada aos princípios do Sistema Único de Saúde e do mundo do trabalho em enfermagem. This present study evaluated nursing education based on problem-solving and learning based on problems originating from alumni's perceptions. This is an ex-post-facto cross-sectional study. Results were analyzed using both quantitative and qualitative approaches triangulation and through dialectical hermeneutics. In the quantitative approach 180 alumni answered a questionnaire. The qualitative approach involved 14 interviews that searched for meanings related to the notion of ideal care, in order to build indicators that would reveal this evaluation logic. These indicators guided the choice of triangulation questions. Results demonstrated that 85.1% of alumni are working in the nursing market, 92.1% have taken a post-graduate course and 99.1% believe they have the education required to deliver ethical, humanized and founded care. Data analysis demonstrates a compromised education as autonomy and knowledge are being built, and articulated to the Single Health System and the world nursing principles. El estudio objetivó evaluar los resultados de la formación en enfermería anclada en la problematización y en el aprendizaje basado en problemas desde la percepción de los propios egresados. Estudio transversal y de naturaleza ex-post-facto. Los resultados fueron analizados en por la triangulación de métodos cuantitativos y cualitativos y la perspectiva hermenéutica dialéctica. En el abordaje cuantitativo 180 egresados respondieron un cuestionario. En el cualitativo, 14 participaron de entrevistas, relatando sus pensamientos relacionados al cuidado ideal, para la construcción de indicadores que revelasen la lógica de la evaluación. Esos indicaron nortearon las cuestiones para la triangulación. Los resultados mostraron: 85,1% de los graduados están en el mercado laboral, 92,1% asistieron al posgrado y 99,1% creen presentar una formación necesaria al cuidado ético, humanizado y fundamentado. Los datos resaltan una formación comprometida con la construcción de autonomía y conocimiento y articulada a los principios del Sistema Único de Salud y del mundo laboral en enfermería. Faculdade de Medicina de Marília Famema Universidade Estadual Paulista Universidade Estadual Paulista