ABSTRACT
Os autores descrevem as experiências de integração ensino-serviço-gestão entre a Universidade Federal de Santa Maria, a Prefeitura Municipal de Santa Maria e a 4ª Coordenadoria Regional de Saúde do Rio Grande do Sul. O objetivo é apontar as principais ações planejadas e executadas por docentes, gestores, residentes e estudantes de graduação destas três instâncias. O envolvimento dos estudantes de graduação nas atividades de estágio obrigatório é avaliado por meio da análise dos relatórios e as experiências de formação em serviço dos residentes da Residência Multiprofissional por meio de registro das atividades realizados nos serviços públicos de saúde do município. Aborda-se os avanços alcançados na implementação das ações, as dificuldades e as potencialidades encontradas na sua articulação, além da importância dos espaços de integração destas instâncias como ambientes privilegiados na formação dos cirurgiões-dentistas e dos estagiários da Odontologia. O estreitamento das relações entre a Residência Multiprofissional em Saúde e a gestão municipal e regional permitiu a concretização de espaços de interlocução entre profissionais em formação, docentes, gestores e usuários do serviço, proporcionando a reflexão sobre o processo de produção do cuidado, bem como a corresponsabilização pela formação profissional e pela qualidade do serviço de saúde (AU).
The authors describe the experiences of teachingservice-management integration between the Federal University of Santa Maria, the Municipality of Santa Maria and the 4th Regional Health Coordination of Rio Grande do Sul. The objective is to report the central actions planned and executed by teachers, managers, residents and undergraduate students of these three instances. The involvement of undergraduate students in compulsory traineeship activities is evaluated through the analysis of the reports and the in-service training experiences of residents of the Multiprofessional Residency, by recording the activities performed in the public health services of the municipality. We address the advances achieved in the implementation of the actions, the difficulties and potentialities found in their articulation, and emphasize the importance of integration spaces as privileged environments in the continuing training of dental surgeons and trainees. The close relationship between the Multiprofessional Residency in Health and the municipal and regional management allowed for the creation of spaces for dialogue between professionals in training, teachers, managers and users of the service, providing reflection on the process of production of care, co-responsibility for the professional training and the quality of the health service (AU).
Subject(s)
Humans , Male , Primary Health Care , Health Services Administration , Teaching Care Integration Services , Education, Dental , Health Services , Internship and Residency , Brazil , Oral Health , Problem-Based Learning/methods , Curriculum/standardsABSTRACT
BACKGROUND: Mixed cryoglobulinemia is a multisystem disorder associated strongly with hepatitis C virus (HCV) infection. The kidney frequently is involved, and glomerulonephritis represents the key factor affecting prognosis. METHODS: Clinical, serological, immunogenetic, and morphological data were collected retrospectively from medical records of 146 patients with cryoglobulinemic glomerulonephritis who underwent biopsies in 25 Italian centers and 34 cryoglobulinemic controls without renal involvement. RESULTS: Eighty-seven percent of patients were infected with HCV; genotype 1b was more frequent than genotype 2 (55% versus 43%). Diffuse membranoproliferative glomerulonephritis was the most prevalent histological pattern (83%). Type II cryoglobulin (immunoglobulin Mkappa [IgMkappa]/IgG) was detected in 74.4% of cases. The remainder had type III (polyclonal IgM/IgG) cryoglobulins. A multivariate Cox proportional hazard model showed that age, serum creatinine level, and proteinuria at the onset of renal disease were associated independently with risk for developing severe renal failure at follow-up. Overall survival at 10 years was about 80%. Kaplan-Meier survival curves were worsened by a basal creatinine value greater than 1.5 mg/dL (>133 mumol/L), but were unaffected by sex and HCV infection. Cardiovascular disease was the cause of death in more than 60% of patients. CONCLUSION: Data confirm the close association between mixed cryoglobulinemia and HCV infection and between glomerulonephritis and type II cryoglobulin. Survival profiles are better than previously reported in the literature, probably because of improvement in therapeutic regimens. Causes of death reflect this improvement in survival, with an increased prevalence of cardiovascular events compared with infectious complications and hepatic failure, which were predominant in the past.
