Confidencialidade em medicina ocupacional: protegendo informações / Confidentiality in occupational medicine: protecting information / Confidencialidad en medicina del trabajo: protección de información

Resumo A confidencialidade é elemento central da relação médico-paciente e está associada à boa qualidade do atendimento. Contudo, pode ser rompida em conformidade com as normas éticas e legais estabelecidas no país. Este estudo objetiva mostrar os principais aspectos da confidencialidade em medicina ocupacional. Para isso, realizou-se revisão narrativa de literatura sobre o tema, utilizando bases de dados de livre acesso e embasando-se nos códigos de ética médica. A atuação do médico do trabalho envolve o trabalhador, outros profissionais não médicos e o empregador, situação capaz de desencadear conflitos, requerendo que o médico conheça suas obrigações e limites ético-legais. A proteção da confidencialidade respeita os direitos humanos, mas dilemas podem surgir, não bastando obedecer aos ditames éticos, mas sendo necessário essencialmente seguir as normas legais. Este estudo busca mostrar os principais aspectos éticos e legais atualizados referentes à saúde ocupacional.

Abstract Confidentiality is a central element of the physician-patient relationship and is associated with good quality of care. However, it may be broken in accordance with the ethical and legal standards established in the country. This study aims to show the main aspects of confidentiality in occupational medicine. For this, a narrative review of the literature on the subject was carried out, using free access databases and based on the codes of medical ethics. The occupational physician's performance involves the worker, other non-medical professionals and the employer, a situation that may trigger conflicts, requiring physicians to know their obligations and ethical-legal limits. The protection of confidentiality respects human rights, but dilemmas may arise, not only to obey ethical precepts, but to follow legal norms. This study seeks to show the main and updated ethical and legal aspects regarding occupational health.

Resumen La confidencialidad es clave en la relación médico-paciente y está asociada a buena calidad de la atención. Sin embargo, está sujeta a una quiebra de conformidad a lo establecido en las normas éticas y legales en el país. Este estudio pretende mostrar los principales aspectos de confidencialidad en la medicina del trabajo. Para ello, se realizó una revisión narrativa de la literatura en las bases de datos de acceso abierto basándose en códigos de ética médica. El actuar del médico del trabajo involucra al trabajador, a profesionales no médicos y al empleador, lo que puede desencadenar conflictos requiriendo que el médico conozca sus obligaciones y límites ético-legales. La protección de la confidencialidad respeta los derechos humanos, pero pueden surgir dilemas y no solo bastará atenerse a los dictámenes éticos, sino seguir fundamentalmente las normas legales. Los resultados mostraron los principales aspectos éticos y legales actualizados relacionados con la salud laboral.

Perfil de mulheres climatéricas em Estratégia de Saúde da Família no interior paulista / Health profile of climacteric women from the Family Health Strategy in the countryside of the state of São Paulo

Introdução: o climatério pode ser influenciado por mudanças psicossociais simultâneas, que associadas às alterações hormonais, como o hipoestrogenismo e a diminuição dos níveis de progesterona, podem intensificar os sintomas e agravos na mulher. Objetivo: identificar os perfis sociodemográficos, obstétricos, ginecológicos, de saúde e hábitos de vida das mulheres climatéricas atendidas na rede básica de saúde, por meio da aplicação de questionário, escalas de Hamilton de Ansiedade e Depressão, e Índice Menopausal de Kupperman e Blatt. Material e Método: estudo transversal descritivo exploratório de relato de experiência, desenvolvido por graduandas em Medicina e Enfermagem. As participantes apresentam idade entre 45 e 60 anos, atendidas em quatro unidades de Estratégia de Saúde da Família. Resultados: participaram 41 mulheres, com idade média de 52,3 anos. Prevaleceram brancas, casadas, com filhos, ensino médio completo, sem plano de saúde, escore de depressão leve, índice menopausal leve, ansiedade normal e uso regular de medicamentos. Conclusão: as mulheres climatéricas necessitam de um espaço para verbalizar seus sentimentos e dúvidas em relação ao climatério e ter acesso à escuta atenta por profissionais capacitados, visando o atendimento integral de saúde com resolutividade.

Introduction: climacteric can be influenced by simultaneous psychosocial changes, which associated with hormonal changes, such as hypoestrogenism and decreased progesterone levels, can intensify symptoms and health problems in women. Objective: to identify the health profile of climacteric women in primary care regarding their obstetrics, gynecological, social, and demographic aspects, and their lifestyle as well, through a questionnaire and the application of the Hamilton Anxiety Scale, Depression Scale, and the Blatt-Kupperman Menopausal Index. Materials and Methods: it is an exploratory-descriptive cross-sectional study presented as an experience report, developed by medical and nursing students. The participants had 45 to 60 years-old and visited four units of the Family Health Strategy. Results: 41 women participated in the research, with an average age of 52.3-year-old. The majority were white, married, high school graduates, with no health insurance; had children, normal anxiety levels, mild depression, mild menopausal index, and reported regular use of medication. Conclusion: the climacteric women need some time to verbalize their feelings and doubts about the climacteric to trained professionals, aiming for a resolutive and comprehensive health care.

A newly validated high-performance liquid chromatography method with diode array ultraviolet detection for analysis of the antimalarial drug primaquine in the blood plasma

Abstract INTRODUCTION: Primaquine (PQ) diphosphate is an 8-aminoquinoline antimalarial drug with unique therapeutic properties. It is the only drug that prevents relapses of Plasmodium vivax or Plasmodium ovale infections. In this study, a fast, sensitive, cost-effective, and robust method for the extraction and high-performance liquid chromatography with diode array ultraviolet detection (HPLC-DAD-UV ) analysis of PQ in the blood plasma was developed and validated. METHODS: After plasma protein precipitation, PQ was obtained by liquid-liquid extraction and analyzed by HPLC-DAD-UV with a modified-silica cyanopropyl column (250mm × 4.6mm i.d. × 5μm) as the stationary phase and a mixture of acetonitrile and 10mM ammonium acetate buffer (pH = 3.80) (45:55) as the mobile phase. The flow rate was 1.0mL·min-1, the oven temperature was 50OC, and absorbance was measured at 264nm. The method was validated for linearity, intra-day and inter-day precision, accuracy, recovery, and robustness. The detection (LOD) and quantification (LOQ) limits were 1.0 and 3.5ng·mL-1, respectively. The method was used to analyze the plasma of female DBA-2 mice treated with 20mg.kg-1 (oral) PQ diphosphate. RESULTS: By combining a simple, low-cost extraction procedure with a sensitive, precise, accurate, and robust method, it was possible to analyze PQ in small volumes of plasma. The new method presents lower LOD and LOQ limits and requires a shorter analysis time and smaller plasma volumes than those of previously reported HPLC methods with DAD-UV detection. CONCLUSIONS: The new validated method is suitable for kinetic studies of PQ in small rodents, including mouse models for the study of malaria.

Fatores associados à venda da Agricultura Familiar para o Programa Nacional de Alimentação Escolar nos municípios do estado de São Paulo / Associated factors with the sale of the Family Farming for the Brazilian School Feeding Program in the cities of São Paulo State

Introdução: A agricultura familiar (AF) e o PNAE após um processo de evolução política se vincularam em 2009 por meio da Lei n°11.947. O agricultor familiar a partir desse momento passou a dispor de um importante mercado institucional. Entretanto, esse ator apresenta dificuldades em atender à demanda do PNAE. Objetivo: Analisar os fatores associados à venda da AF para o PNAE nos municípios do estado de São Paulo em 2012. Metodologia: Trata-se de estudo transversal, envolvendo métodos de análise quantitativa. Os dados analisados foram coletados da pesquisa O encontro entre o Programa Nacional de Alimentação Escolar (PNAE) e a agricultura familiar: avaliação do processo de implementação e dos possíveis efeitos das compras locais, segundo a Lei n°11.947/2009, a qual avaliou 38 municípios do Estado de São Paulo. Foram coletados dados de 110 agricultores que venderam para o PNAE. Os eixos de variáveis estudadas foram: características socioeconômicas dos municípios, características do agricultor, apoio institucional e característica da venda. O percentual da compra da AF para o PNAE = 30 por cento foi a variável desfecho do estudo. A descrição e caracterização foram calculadas por meio de medidas de tendência central e dispersão e frequências absolutas e relativas. O teste de McNemar foi utilizado para verificar diferenças entre a comercialização antes e depois da Lei n° 11.947/09. Foi feita uma regressão simples bivariada com o intuito de verificar o incremento no percentual da compra da AF para o PNAE entre 2011 e 2015. E foi utilizada a análise de regressão logística múltipla para analisar os fatores associados à venda da AF para o PNAE. Resultados: Os municípios estudados apresentaram IDHM alto (87 por cento ); os alimentos produzidos pelos agricultores eram em sua quase totalidade in natura; os agricultores depois da Lei n°11.947/2009 aumentaram suas vendas para os mercados institucionais; a média no percentual da compra da agricultura familiar nos 16 municípios estudados subiu de 25,3 por cento para 36,3 por cento entre os anos de 2011 a 2015. Os municípios com PIB mais alto e que já apresentavam uma experiência com o Programa de Aquisição de Alimentos (PAA) se associaram significativamente com a venda da AF para o PNAE exigida pela Lei n°11.947/2009. No plano do agricultor, àqueles que obtiveram a Declaração de Aptidão ao PRONAF (DAP) depois da Lei n°11.947/2009 se associaram significativamente com o desfecho, OR 3,20 (1,19 8,63); os agricultores que vendiam para o PAA antes da Lei se associaram ao desfecho com OR 0,09 (0,03 0,33). O apoio da nutricionista se associou com o desfecho com OR 3,76 (1,18 12,03). Os agricultores não individuais (associados e cooperados) não se associaram com o desfecho percentual da compra = 30 por cento . Conclusão: Os municípios com PIB mais alto, em que já apresentavam uma experiência com o PAA, os agricultores que obtiveram a DAP após a Lei, o suporte técnico da nutricionista são fatores importantes associados à venda da AF para o PNAE

Introduction: The Family Farming (FF) and The Brazilian School Feeding Program (PNAE) after a process of political evolution were associated in 2009 by Brazilian act 11.947/2009. Since that time, the family farmer has an important institutional market available. However, this actor has difficulties to achieve the market demand. Objective: To analyze the factors associated to the sale of FF to the PNAE in the cities of the state of São Paulo in 2012. Methodology: The study is transverse, using quantitative analysis methods. The analyzed data were collected from the study \"The meeting of the National School Feeding Program and Family Farming: evaluation of the implementation process and the possible effects of local purchases, according to the act 11.947/2009, which evaluated 38 cities in the São Paulo state. Data were collected from 110 family farmers who sold to the PNAE. The main variables studied were: cities socioeconomic characteristics, farmer characteristics, institutional support and sale characteristics. The FF purchase percentage for the PNAE = 30 per cent was the outcome variable of the study. The description and characterization were calculated through measures of central tendency and dispersion and absolute and relative frequencies. McNemar´s test was used to verify differences between sales before and after the act 11.947/09. A simple bivariate linear regression was performed in order to verify the increase in the percentage of the FF purchases for the PNAE between 2011 and 2015. The multiple logistic regression analysis was used to analyze the factors associated to the FF sale to PNAE. Results: The studied cities had high Human Development Index (HDI) (87 per cent ); the produced food by family farmers was almost entirely in natura; the family farmers after the act 11.947/09 increased their sales to the institutional markets; the average percentage of FF purchases in the 16 studies cities increased from 25.3 per cent to 36.3 per cent between 2011 and 2015. The cities with the highest Gross Domestic Product (GDP) and previous experience with the Family Agriculture Food Acquisition Program (PAA) were significantly associated to the FF sale for the BSFP required by Brazilian Law. At the farmer\'s level, those who obtained Ability Declaration for National Program for the Strengthening of Family Farming (DAP) after the Brazilian act were significantly associated with the outcome, OR 3,20 (1,19 8,63); the family farmers who sold to the PAA before the act were associated with the outcome OR 0,09 (0,03 0,33). The nutritionist\'s support was associated with the outcome OR 3,76 (1,18 12,03). Non-individual farmers were not significantly associated with the outcome. Conclusion: Cities with: high GDP, previous experience with the PAA, family farmers with DAP experience, technical nutritionist support are important factors associated to the sale of FF for the PNAE

Sexually transmitted diseases: knowledge and perceived prevalence of symptoms in university students.

Background: Research addressing knowledge on sexual health, particularly of STDs risk and perceived symptoms’ prevalence, among university students around the world, and particularly in Portugal, is scarce. Aims: The aim of this study was to evaluate the levels of knowledge about the perceived prevalence of STD’s and their occurrence in Portuguese university students. Study Design: An internet based cross sectional and retrospective study was conducted. Methodology: A total 1018 students participated (68.57% women), with a mean age of 23.57 years (SD=5.82). The instruments used were a Sociodemographic Questionnaire, the "Sexually Transmitted Disease Knowledge Questionnaire" and "Sexual Risk Behaviours Questionnaire" (male and female versions), which were disseminated on the Internet, on a page specifically created for this research, after pretest was done and the necessary changes implemented. Results: The results indicated that students have inadequate knowledge about the STD's, the lifelong perceived prevalence of a STD was 9.9%, and the actual perceived prevalence of symptoms associated with a STD was 16.8%. Finally, a linear regression was performed, highlighting a significant effect between the degree of knowledge about STD’s and the occurrence of a STD or symptoms, which indicates that the symptoms depend on the knowledge. Conclusion: These results reinforce the need for investment in prevention programs, in order to increase the information and reduce infection by STDs in college students.

Meninas de luz: uma abordagem da enfermagem na gravidez na adolescência / Shining girls: a nursing's approach about adolescent pregnancy

Introdução - A gravidez na adolescência é um problema social, e vem aumentando consideravelmente entre a população brasileira. Este estudo teve como objetivo compreender o contexto social que tem favorecido o aumento nos índices de gestação na adolescência. Material e Métodos - Pesquisa quanti-qualitativa, através de entrevista com questionário com questões semi-estruturadas. Resultados - Foram entrevistadas 34 adolescentes entre 14 e 18 anos de idade atendidas no Centro Social Dona Gercina Teixeira no período de outubro de 2008. Das gestantes entrevistadas 38,2% estavam com 18 anos, 58,8% estão amasiadas com o pai da criança, 91,2% se encontram na primeira gestação, 38,2% residem em área urbana, 47,1% iniciaram a vida sexual entre 12-14 anos, 58,8% relataram possuir um bom relacionamento com os pais. Conclusões - O estudo demonstrou que a gravidez precoce acontece em um contexto social onde fatores como escolaridade, aspectos familiares e nível socioeconômico são menos favorecidos, revelando um problema que deve ser revisto por todos: família, escola, profissionais da área da saúde e os gestores públicos. Priorizando esta atenção para as adolescentes, estaremos orientando-as na parte preventiva, para que seu desenvolvimento, tanto físico, como mental e psico-espiritual, possa transcorrer sem intercorrências, propiciando assim uma melhor qualidade de vida.

Introduction - The adolescent pregnancy is considered a social problem that is having a fast growing between the Brazilian's population. The present study had the objective to comprehend the social context that had favored an increase in the report of adolescent pregnancy. Material and Methods - Quantitative and qualitative research through interview based on a questionnaire with semi-structured questions. Results - Were interviewed 34 adolescents between 14 and 18 years old attended in the Centro Social Dona Gercina Borges Teixeira during the period of October of 2008. The following results were found: 38,2% were 18 years old, 58,8% were leaving together with the baby's father, 91,2% were in the first pregnancy, 38,2% leave in a urban area, 47,1% began their sexual life between 12-14 years old, 58,8% reported to have a good relationship with their parents. Conclusions - Our study showed that adolescent pregnancy occurs in a social context where factors like scholarship, family aspect and social and economic level are unless favored, showing a problem that should be reviewed by all: family, school, health professionals and the government. By putting this attention on priority to those adolescents, we will be giving the preventive side directions, so that hers development, physical, mental and spiritual can elapse without intercurrence, propitiating a better quality of life.