O consumo de drogas e álcool constitui cada vez mais um problema social e de saúde pública, pelas consequências negativas que provocam no desenvolvimento emocional e físico dos indivíduos. Existem poucas referências na literatura avaliando o uso destas substâncias por portadores de doença falciforme (DF). Estes pacientes apresentam crises álgicas severas, recorrentes, frequentemente controladas por opióides. O comprometimento da qualidade de vida predispõe a ocorrência de transtornos psiquiátricos não-psicóticos, como depressão por exemplo, tornando o grupo vulnerável ao uso abusivo de substâncias. Objetivos: avaliar o consumo de álcool e drogas em pacientes portadores de DF acompanhados pelo Centro de Referência de Doença Falciforme (CRAF) do Hospital de Clínicas de Porto Alegre (HCPA), estimar o percentual de pacientes em tratamento da doença falciforme que fazem uso abusivo de álcool e drogas, e colaborar com o estudo que avaliará a efetividade de um centro de referência multidisciplinar para esta população. Métodos: estudo transversal, de uma amostra de conveniência, com 139 pacientes portadores de DF acompanhados no CRAF do HCPA. Resultados: a prevalência do uso abusivo foi de 1,5% para o álcool e 3,0% para o tabaco, e não se identificou o uso abusivo de outras substâncias, inclusive opióides. O padrão para o uso de substâncias não foi influenciado pela exposição ou por transtornos psiquiátricos não-psicóticos. Conclusão: São necessários mais estudos para reforçar estes achados, mas demonstra-se a segurança do uso de analgésicos opióides para o manejo das crises dolorosas apresentadas pelos portadores de DF. / Drug abuse is increasingly becoming a social and public health problem, because of the negative consequences that such abuse causes on the emotional and physical development of individuals. There are few references in the literature evaluating the use of these substances by individuals with sickle cell disease (SCD). These patients have severe and recurrent pain crises, frequently needing opioids drugs to control it. The compromised quality of life can predispose this population to the occurrence of non-psychotic psychiatric disorders such as depression, making them vulnerable to substance abuse. Objectives: To evaluate the level of consumption of alcohol and drugs in patients with SCD followed by Sickle Cell Disease Reference Center (CRAF) at Hospital de Clínicas de Porto Alegre; to estimate the percentage of patients in treatment of SCD who abuse alcohol and drugs, and to collaborate with the study evaluating the effectiveness of the CRAF. Methods: cross-sectional study of a convenience sample of 139 patients with SCD treated at CRAF. Results: the prevalence of abusive use of the studied population was 1.5% for alcohol and 3.0% for tobacco, and no abusive use of any other substance, including opioids, was identified. It was verified that the pattern for substance use was not influenced by exposure to substances or the presence of non-psychotic psychiatric disorders. Conclusion: More studies are needed to reinforce these findings, but they suggested that the use of opioid analgesics for the management of SCD painful crises is safe and do not induces substance abuse.

nÃo hà / Esta pesquisa trata da anÃlise da trajetÃria acadÃmica de bolsistas do Programa Institucional de Bolsas de IniciaÃÃo CientÃfica (PIBIC) do Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico (CNPq) no contexto da Universidade Federal do CearÃ, no perÃodo de 2010 a 2013. O nosso objetivo foi investigar a contribuiÃÃo do PIBIC/CNPq da UFC para a continuidade dos estudos acadÃmicos de seus egressos. No tocante ao mÃtodo, a pesquisa caracteriza-se como um estudo de caso. Os resultados alcanÃados foram: a descriÃÃo de caracterÃsticas gerais dos bolsistas PIBIC/CNPq da UFC; a averiguaÃÃo do encaminhamento dos egressos do Programa para a pÃs-graduaÃÃo em nÃvel de mestrado e a aferiÃÃo do tempo de permanÃncia desses estudantes no mestrado. Pretende-se que os resultados aqui apresentados possam contribuir para o melhoramento do PIBIC, de um modo geral, almejando-se que resultados mais expressivos sejam alcanÃados em relaÃÃo nÃo sà ao investimento feito pelo CNPq, mas tambÃm pelo que à feito pela prÃpria UFC e pela FundaÃÃo Cearense de Apoio ao Desenvolvimento CientÃfico e TecnolÃgico (FUNCAP). / This research is an analysis of the academic trajectory of research fellows on Programa Institucional de Bolsas de IniciaÃÃo CientÃfica (PIBIC), specifically those with scholarships sponsored by Conselho Nacional de Desenvolvimento TecnolÃgico (CNPq), in the context of Universidade Federal do Cearà during the period of time between 2010 and 2012. It aims to investigate the contribution of PIBIC/CNPq â UFC to furthering the academic studies of its former fellows in the form of a case study as its methodology. Results achieved include: a general profile of the fellows from PIBIC/CNPq â UFC; observing whether or not former fellows continue their academic studies on post-graduate programs at the master level and measuring how much time they spend on these programs. Results shown here are intended to improve PIBIC as a whole, while also aiming for more expressive results not only in relation to the investment made by CNPq, but also by the UFC itself and by FundaÃÃo Cearense de Apoio ao Desenvolvimento CientÃfico e TecnolÃgico (FUNCAP), both of which also sponsor fellowships on the program.

Dados oficiais do censo escolar, produzidos e divulgados pelo Instituto de estudos e pesquisas educacionais Anísio Teixeira em 2009, confirmam a prevalência de 2/3 de meninos entre as matrículas da educação especial registradas no Brasil e no município de São Paulo, com uma ligeira predominância dos alunos brancos no Brasil e mais de 40% no município de São Paulo. No entanto, chama atenção o fato de mais de 38% dos alunos matriculados nessa modalidade não terem declarado sua cor/raça em nível nacional e pouco mais de 22% no município estudado. Estudos localizados sobre o tema diferenças de sexo, e de gênero e escolarização não são conclusivos e constatou-se número restrito de produções nacionais sobre esse assunto. A literatura estrangeira indica uma super-representação de meninos negros em serviços de educação especial encaminhados, principalmente, por questões culturais e socioeconômicas. Nesta pesquisa, de natureza qualitativa, pretendeu-se averiguar e analisar os motivos que embasam o encaminhamento dos alunos para Salas de recursos da rede municipal de São Paulo, com recorte de gênero e cor/raça, cotejando-os com orientações e/ou critérios oficiais para o seu encaminhamento. Para alcançar os objetivos desta tese, foi solicitado à Secretaria Municipal de Educação dados sobre a matrícula e o atendimento dos alunos atendidos nesse serviço. A análise das informações indicou-nos que a maioria dos alunos atendidos nas Salas de recursos em 2011 era composta por aqueles com deficiência intelectual sendo que havia mais estudantes do sexo masculino (60,52%) e que, em quase todos os tipos de deficiência e Transtorno global de desenvolvimento, registrou-se mais meninos atendidos do que meninas. A respeito da cor/raça dos alunos com deficiência intelectual, em 2011 a Rede municipal de ensino registrou supremacia no atendimento de alunos classificados como brancos, cerca de 84%, seguidos pelos pardos (57%), os não declarados (45%) e os pretos (11%). Para a segunda fase deste estudo, escolheu-se como delineamento de pesquisa o estudo de caso. A coleta de dados foi realizada em uma escola municipal paulistana de ensino fundamental, na qual foram entrevistadas a coordenadora pedagógica e a professora da sala de recursos, e também foram analisados os prontuários dos alunos que estavam em atendimento pela referida sala. Foram encaminhados questionários de caracterização socioeconômica para os alunos da Sala de recursos e para os seus colegas das classes comuns. A análise dos dados mostrou-nos que nessa escola a maioria dos alunos atendidos nessa sala possuía laudo clínico e não havia predominância de alunos negros, todavia, pode-se considerar, tal como em outros estudos brasileiros, que a professora tendeu a embranquecer alguns alunos. Em relação a situação socioeconômica, verificou-se que os alunos atendidos na Sala de recursos, tal como a amostra de estudantes das classes comuns da escola na qual realizamos a pesquisa, estavam inseridos na classe C. Desse modo, as condições de gestão e de trabalho pedagógico encontradas na escola pesquisada podem justificar os dados que não confirmam os estudos sobre gênero, cor/raça e educação especial. / Official data from the school census, produced and released by Instituto de estudos e pesquisas educacionais Anísio Teixeira in 2009, confirm the prevalence of 2/3 of boys between the enrollment of special education registered in Brazil and in São Paulo municipality, with a slight predominance of white students in Brazil and over 40% in São Paulo. However, it draw attention that more than 38% of the students enrolled in this modality have not declared their color/race nationally and just over 22% in the municipality. Studies located about gender differences and gender and schooling topic are not conclusive and it was found limited number of national productions on this subject. Foreign literature indicates an overrepresentation of black children in special education services directed mainly by socioeconomic and cultural issues. In this qualitative research, it was intended to assess and analyze the reasons for the referral of students to resource rooms in the municipality of São Paulo, looking at gender and race/color information, comparing them with guidelines and/or official criteria for their referral. To achieve the objectives of this thesis it was solicited to the Municipal Department of Education data about enrollment and attendance of students serve on this service. Analysis of the data indicated us that the majority of students served in resource rooms in 2011 was composed of those with intellectual disabilities and that there were more male students (60.52%) and that in almost all types of deficiency disorder and global development, there were more boys than girls attended. Regarding the color/race of students with intellectual disabilities, in 2011 the municipal school network recorded supremacy in serving students classified as white, about 84%, followed by brown (57%), the unreported (45%) and blacks (11%). For the second phase of this study, it was chosen as the research design case study. Data was collected in a municipal elementary school, where we interviewed the educational coordinator and the resource room teacher, and also analyzed the records of students who were in attendance by that room. Questionnaires were sent for the socioeconomic characterization of the students Resource room and their colleagues from common classes. Data analysis showed us that in this school most of the students served in the resource room had a clinical report and there was no predominance of black students, however, can be considered, as in other Brazilian studies, that the teacher tended to \"whiten\" some students. Regarding socioeconomic status, it was found that the students served in the resource room, such as the sample of students in regular classes in school which the survey was conducted, were classified in Class C. Thus, the conditions of management and pedagogical work found in the school where the study was carried on can justify the data that not confirm the studies on gender, color / race and special education.

Although less than half of all patients with mental disorders seek mental health treatment per se, approximately 80% of all people will visit their primary care physician (PCPs) within a year (Strosahl, 1998). However, it is not well understood how to best handle patients presenting with mental health issues in primary care practices. The purpose of this project was to implement an intervention involving a screening measure for anxiety and mood disorders in a primary care setting to increase the volume of anxiety and mood disorder screening, to increase the accuracy of disorder detection, and to also enhance PCPs patterns of referral to mental health professionals (MHPs). Though starting with a quantitative design, difficulties encountered throughout the project eventually led to a largely qualitative analysis, which did yield useful information. A pilot project demonstrated anxiety and mood disorders were commonly noted in patients’ medical charts (46%), but also found referrals were rarely made for mental health services (7%), despite colocation of a licensed psychologist and licensed clinical social worker within the practice. This indicated that services available to provide comprehensive integrated total health care may not be have been used to their full potential. In the main project, 59 participants from a family medicine clinic and 20 PCPs from that clinic participated. The My Mood Monitor (M3) was administered to the patients and became part of their Electronic Medical Records (EMR). The M3 screens for anxiety, depression, and bipolar disorders within primary care settings. In 2 separate noon conferences, PCPs were trained on diagnostic criteria for anxiety disorders and mood disorders, interpretation of M3 results, and the internal Mental Health Professional referral process. The project was hampered by a full-scale switch from paper-based medical records to an EMR and accompanying lack of user experience with EMR functions, lack of efficient transfer of M3 results into the EMR, and an unforeseen switch of psychologists mid-way through the study. However, results were obtained that showed relatively low levels of PCP review of M3 results, potentially high rates of anxiety disorders and mood disorders within the setting, relatively high levels of PCP knowledge of diagnostic criteria for anxiety and mood disorders, and that patients may not prefer a ‘warm handoff’ model of mental health referral. These findings are couched within a number of important caveats, but future directions for research were clearly implied.

No description available.

Orientador: Nemre Adas Saliba / Banca: Doris Hissako Sumida / Banca: Symone Cristina Teixeira / Resumo: Introdução: A rede de atenção à saúde maternoinfantil foi instituída em 2011 com a finalidade de promover melhorias na eficiência da gestão dos serviços, porém ainda se apresenta como um grande desafio para os gestores. Objetivo: Analisar a rede regional de atenção à saúde da gestante no SUS. Método: Trata-se de pesquisa de caráter transversal, quanti-qualitativa, tipo inquérito. Foram realizadas entrevistas com gestores de 28 municípios, do Ambulatório de Especialidades Médicas (AME) e do Departamento Regional de Saúde (DRS) II do estado de SP, totalizando 86 entrevistados. As variáveis pesquisadas foram: realização de atividade educativa no pré-natal, existência de protocolo de atendimento e encaminhamento, organização da atenção à saúde bucal e geral à gestante, pactuação das referências e funcionalidade do sistema de referência e contrarreferência. Realizou-se análise de conteúdo para as questões discursivas e triangulação entre as respostas obtidas nos municípios, AME e DRS. Resultado: Observou-se que 78,57% dos municípios realizam atividade educativa com gestantes; 42,86% não possuíam protocolo de atendimento implantado e em 57,14% não havia critérios de encaminhamento estabelecidos. Do total de gestores municipais, 53,57% afirmaram realizar testes rápidos para detecção de HIV, Sífilis e Hepatite B e C; 46,43% teste rápido de gravidez e 39,28% relataram avaliar a situação vacinal. Quanto à atenção odontológica primária, não havia protocolo instituído em 71,43% dos munic... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The maternal and child health care network was established in 2011 with the purpose of promoting improvements in the efficiency of service management, but still presents a great challenge for managers. Objective: To analyze the regional health care network of pregnant women in SUS. Method: This is a cross-sectional, quantitative-qualitative research type survey. Interviews were carried out with managers from 28 municipalities, from the Ambulatory of Medical Specialties (AME) and from the Regional Department of Health (DRS) II of the state of São Paulo, totaling 86 interviewees. The variables studied were: performance of prenatal educational activity, existence of a referral protocol, organization of oral and general health care for the pregnant woman, agreement of references and functionality of the referral and counter-referral system. Content analysis was performed for the discursive questions and triangulation between the responses obtained in the municipalities, AME and DRS. Result: It was observed that 78.57% of the municipalities carry out educational activities with pregnant women; 42.86% did not have an implanted care protocol and in 57.14% there were no established referral criteria. Of the total of municipal managers, 53.57% affirmed to carry out rapid tests for the detection of HIV, Syphilis and Hepatitis B and C; 46.43% rapid pregnancy test and 39.28% reported evaluating the vaccine situation. Regarding primary dental care, there was no protocol esta... (Complete abstract click electronic access below) / Mestre

Thesis (M. Cur.) --University of Limpopo, 2015 / The purpose of this study was to determine the factors that were contributing to selfreferrals of antenatal women at the Dilokong Hospital in the Tubatse Local Municipality. By employing a quantitative, non-experimental research method, 360 women completed and submitted a structured questionnaire. Validity and reliability were insured by pre-testing the data collection instrument on respondents who were not part of the main study. Data was analysed by using the SPSS and Excel computer programs with the assistance of a statistician. The age group between 21 and 30 years 197 (54.7%) was larger than the other age groups. Primigravida women represented less than half 147 (40.3%) of the respondents. These women were also supposed to be referred to the hospital for delivery; however, only 23.3% of the women were referred to the hospital for delivery. The choice of the delivery site was influenced by a lack of women’s knowledge about the referral system and of services offered at the clinics, as well as the unavailability of doctors, midwives, food, equipment, enough space for delivery at the clinics, and the perceptions that nurses and midwives were rude. The government should ensure that the clinics are provided with adequate human resources and other resources that are needed for providing these health services. Pregnant women should be given referral letters and information with regard to where they are supposed to deliver. Key concepts: Antenatal women, self-referral, referral system, and Primary Health Care (PHC).

The purpose of this study was to investigate the determinants of high neonatal mortality rates in Migori County, Kenya. The neonatal mortality cases were utilised as the target population to the study. A quantitative, descriptive, cross-sectional, non-experimental research design was used. A systematic sampling technique was employed to draw a sample of 201 archived neonatal cases out of 420 neonatal mortality medical records, which constituted the study population. Data were collected by means of a developed questionnaire. The Statistical Package for Social Sciences (SPSS) Version 21 was used to analyse data. The main findings revealed the leading determinants of neonatal mortality were early neonatal period, prematurity, poor 1st Apgar score, low birth weight and neonates with intrapartum complications. Obstetrical haemorrhage and HIV were the main maternal complications associated to neonatal mortalities, while the leading direct causes of death in this study were birth asphyxia and sepsis. Other determinants were gender, rural residence, lowly educated and informally employed mothers. To reduce mortalities, a multifaceted approach is needed to establish quality improvement in neonatal intensive care, reduce preterm birth incidences, and empower mothers socio-economically. / Health Studies / M.A. (Nursing Science)

Vocal Cord Dysfunction (VCD) is characterized by paradoxical vocal cord movement during inspiration or expiration, and generally affects adolescents and predominantly women. Previous studies have shown a large inconsistency concerning terminology, definitions, etiology, assessment, differential diagnosis, co-morbidity and treatment. The purpose of this study was to map knowledge on and management of VCD in Sweden. The study was conducted as a written survey addressed to speech-language pathologists and physicians, and attained an answer percentage of 79 percent. The results showed that several professions were involved in the management of these patients, but no clear pattern of referral could be observed. The majority of the respondents considered intense physical exertion and psychological stress as triggering factors for VCD. Despite this, referral to a psychologist or psychiatrist seldom occurred. Asthma was the most frequent diagnosis regarding co-morbidity, and also the most frequent misdiagnosis. Respiratory exercises, relaxation and information about the diagnosis generally form the basis of VCD treatment. Physicians rated their knowledge on VCD greater compared to the speech-language pathologists. Several of the respondents stated that an increase in knowledge and awareness among nursing staff had contributed to an increase of patients with suspected or confirmed VCD. This study showed that there was no consensus regarding assessment, co-morbidity, misdiagnosis and treatment of VCD among speech-language pathologists and physicians in Sweden. / Vocal Cord Dysfunction (VCD) karakteriseras av paradoxala stämbandsrörelser vid in- eller utandning och drabbar vanligtvis ungdomar och huvudsakligen kvinnor. I tidigare studier framkom ingen konsensus kring terminologi, definition, etiologi, utredning, differentialdiagnostik, komorbiditet eller behandling. Syftet med föreliggande studie var att kartlägga kännedom om och handhavande av VCD i Sverige. Studien genomfördes i form av en enkätundersökning bland logopeder och läkare och svarsfrekvensen var 79 %. Ur resultatet framkom att flera professioner hade träffat dessa patienter men ingen tydlig remitteringsgång observerades. Majoriteten av respondenterna ansåg att intensiv fysisk ansträngning och psykologisk stress var utlösande faktorer till VCD. Däremot förekom sällan remittering till psykolog eller psykiater. Astma var den mest frekventa diagnosen gällande komorbiditet och feldiagnostisering. Andningsövningar, avspänning/avslappning samt information kring diagnosen inkluderades i behandlingen i hög grad. Läkarna skattade sin kunskapsnivå om VCD högre än logopederna. Flera av respondenterna angav att ökad kunskap och medvetenhet bland vårdpersonal hade bidragit till en ökning av diagnostisering av patienter med misstänkt eller konstaterad VCD. Föreliggande studie visade att det inte fanns någon enighet gällande utredning, komorbiditet, feldiagnostisering och behandling av VCD bland logopeder och läkare i Sverige.

<p>Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens &amp / Zupan, 2005). Early&nbsp / detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing&nbsp / countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking&nbsp / behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home&nbsp / visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit,&nbsp / community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing&nbsp / community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured&nbsp / questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers&rsquo / home or at the study&nbsp / offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis.&nbsp / Descriptive analysis was&nbsp / conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant&nbsp / associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were&nbsp / enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the&nbsp / highest number of which occurred within&nbsp / the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking&nbsp / their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW.&nbsp / Conclusion: This study found&nbsp / high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South&nbsp / African National Department of Health (SANDOH) which will involve the establishment of family health worker teams&nbsp / including community health workers. A key function of these workers will&nbsp / be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with&nbsp / non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by&nbsp / community health workers. Most of the referrals in this study were&nbsp / neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal&nbsp / and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater&nbsp / realization of a team approach to PHC.</p>