Screening approaches for cervical cancer in Mozambique in HIV positive and negative women.

OBJECTIVE: Cervical cancer (CC) is a global health issue, in Mozambique, 5300 new cases and 3800 deaths are reported each year. The WHO recommends the introduction of HPV molecular testing for CC screening, but Mozambique uses an approach based on visual inspection with acetic acid (VIA). This study aims to evaluate the feasibility of high-risk HPV (hrHPV) testing compared to actual approaches in Mozambique. METHODS: An observational study was carried out in the DREAM center in Zimpeto, Mozambique. Women aged 30-55 were included. HPV testing was performed with the Cobas HPV test. They were then screened with the current national recommendations based on VIA. Cryotherapy was performed on-site or referred for colposcopy if necessary. RESULTS: In the period, 1207 women were enrolled, 47.8% HIV+; 124 (10.3%) VIA+, and HPV DNA test was positive in 325 (26.9%) women. HPV positivity rates were higher in HIV-infected women. In the sample, 52.8% of the 124 VIA+ women were HPV uninfected and underwent unnecessary cryotherapy or colposcopy. Meanwhile, 24.7% of the 1083 VIA- women were actually HPV infected. In comparison, a screen, triage and treat approach based on hrHPV testing would only test and treat the 325 HPV-infected women. CONCLUSION: The study found high rates of hrHPV infection, particularly in HIV-positive women, with many concurrent or multiple infections. The current screening method misses important hrHPV infections and results in many unnecessary treatments. These results support the use of HPV molecular testing as the initial screening test for CC.

Is Protecting Older Adults from COVID-19 Ageism? A Comparative Cross-cultural Constructive Grounded Theory from the United Kingdom and Colombia.

The COVID-19 pandemic impacted people's lives all over the world, requiring health and safety measures intended to stop the virus from spreading. This study explores whether an unintended consequence of these measures is a new form of ageism. We explore, using qualitative methods, the experiences of older adults living through the pandemic in the United Kingdom and Colombia. Although there were some small differences between countries, for the most part, the experiences were similar. We found that older adults reported that they were seen as a homogenous group and experienced both benevolent and hostile ageism and a loss of autonomy as a consequence of COVID-19 protection measures. Participants from both countries expressed anger and frustration, and increased anxiety, and felt that their individuality was ignored. We recommend that policy-makers, the media, and wider society consider the impact of such health and safety measures on older adults in preparing for future pandemics and health challenges.

Perfil e capacidade funcional em sujeitos com Doença de Huntington / Profile and functional capacity in Huntington's disease subjects

Objetivo: traçar o perfil e a capacidade funcional de sujeitos com Doença de Huntington (DH) atendidos em um ambulatório de fisioterapia do Distrito Federal. Método: trata-se de um estudo transversal em que foram aplicados um questionário para coletar informações gerais para traçar o perfil, além do índice de Barthel, escala Lawton para medir grau de independência para as atividades de vida diária, força de preensão palmar por meio do dinamômetro JAMAR®, equilíbrio por meio da escala de equilíbrio de Berg, declínio cognitivo por meio da Montreal Cognitive Assessment (MoCA), e risco de disfagia utilizando a Eating assessment tool (EAT-10). Resultados: foram avaliados sete sujeitos, 58% homens e 42% mulheres com média de idade de 45,8±10,5 anos e tempo médio de diagnóstico de 7,5±4,2 anos. Todos apresentam redução da força de preensão palmar (21,1±7,3 Kg/F) e declínio cognitivo (13,1±4,2 pontos) no MoCA. Sobre o risco de cair, este se fez presente em todos os participantes com o risco de disfagia. Conclusão: os indivíduos com Doença de Huntington apresentaram déficit cognitivo, diminuição da força de preensão palmar e alterações de marcha; porém, ainda mantêm independência para as atividades básicas de vida diária , além de risco para a disfagia.

Objective: to outline the profile and functional capacity of subjects with Huntington's disease (HD) attended at a physiotherapy clinic in the Federal District. Methods: This is a cross-sectional study in which a questionnaire was used to collect general information to profile, besides Barthel index, Lawton scale to measure the degree of independence for the activities of daily life, palmar grip strength using the JAMAR® dynamometer, balance by means of Berg balance scale, cognitive decline by means of the Montreal Cognitive Assessment (MoCA), and risk of dysphagia using the Eating assessment tool (EAT-10). Results: Seven subjects were evaluated, 58% male and 42% female with mean age of 45.8 ± 10.5 years and mean diagnosis time of 7.5 ± 4.2 years. All presented reduced palmar grip strength (21.1 ± 7.3 Kg / F) and cognitive decline (13.1 ± 4.2 points) in MoCA. About the risk of falling this was present in all partcipants as well as the risk of dysphagia. Conclusion: The individuals with Huntington's disease presented cognitive deficit, decreased palmar grip strength and gait alterations, however still maintains independence for the basic activities of daily life, besides risk for dysphagia.

VAR2CSA Serology to Detect Plasmodium falciparum Transmission Patterns in Pregnancy.

Pregnant women constitute a promising sentinel group for continuous monitoring of malaria transmission. To identify antibody signatures of recent Plasmodium falciparum exposure during pregnancy, we dissected IgG responses against VAR2CSA, the parasite antigen that mediates placental sequestration. We used a multiplex peptide-based suspension array in 2,354 samples from pregnant women from Mozambique, Benin, Kenya, Gabon, Tanzania, and Spain. Two VAR2CSA peptides of limited polymorphism were immunogenic and targeted by IgG responses readily boosted during infection and with estimated half-lives of <2 years. Seroprevalence against these peptides reflected declines and rebounds of transmission in southern Mozambique during 2004-2012, reduced exposure associated with use of preventive measures during pregnancy, and local clusters of transmission that were missed by detection of P. falciparum infections. These data suggest that VAR2CSA serology can provide a useful adjunct for the fine-scale estimation of the malaria burden among pregnant women over time and space.

[Social protection in Latin America and the Caribbean: changes, contradictions, and limits]. / Proteção social na América Latina e Caribe: mudanças, contradições e limites.

Recent studies suggest that governments in the majority of Latin American and Caribbean countries were able to expand social investments and introduce innovations in social protection policies in the last two decades with positive results in the actions' coverage and impact. However, the restrictions imposed by the current fiscal crisis and the rise of governments more ideologically aligned with the neoliberal discourse in various countries in the region point to a new retreat of the state from the social area, thereby compromising recent advances. The article aims to discuss the changes, contradictions, and limits of recent social protection standards in Latin America and the Caribbean. The discussion includes three items: a description of the history of social protection in the region, seeking to identify its principal historical periods and characteristics (benefits, target public, and financing); the social protection models that have been implemented in the region; and the specific case of health. We argue that although countries have adopted different solutions in the field of social protection, the policies' hybrid nature (with extensive private sector participation in the financing, supply, and management of services) and the prevalence of segmented models (with differential access according to individuals' social status) have been predominant traits in social protection in Latin America and the Caribbean, thus limiting the possibilities for greater equity and social justice.

Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities.

BACKGROUND: Resistance and tolerance to Plasmodium falciparum can determine the progression of malaria disease. However, quantitative evidence of tolerance is still limited. We investigated variations in the adverse impact of P. falciparum infections among African pregnant women under different intensities of malaria transmission. METHODS: P. falciparum at delivery was assessed by microscopy, quantitative PCR (qPCR) and placental histology in 946 HIV-uninfected and 768 HIV-infected pregnant women from Benin, Gabon, Kenya and Mozambique. Resistance was defined by the proportion of submicroscopic infections and the levels of anti-parasite antibodies quantified by Luminex, and tolerance by the relationship of pregnancy outcomes with parasite densities at delivery. RESULTS: P. falciparum prevalence by qPCR in peripheral and/or placental blood of HIV-uninfected Mozambican, Gabonese and Beninese women at delivery was 6% (21/340), 11% (28/257) and 41% (143/349), respectively. The proportion of peripheral submicroscopic infections was higher in Benin (83%) than in Mozambique (60%) and Gabon (55%; P = 0.033). Past or chronic placental P. falciparum infection was associated with an increased risk of preterm birth in Mozambican newborns (OR = 7.05, 95% CI 1.79 to 27.82). Microscopic infections were associated with reductions in haemoglobin levels at delivery among Mozambican women (-1.17 g/dL, 95% CI -2.09 to -0.24) as well as with larger drops in haemoglobin levels from recruitment to delivery in Mozambican (-1.66 g/dL, 95% CI -2.68 to -0.64) and Gabonese (-0.91 g/dL, 95% CI -1.79 to -0.02) women. Doubling qPCR-peripheral parasite densities in Mozambican women were associated with decreases in haemoglobin levels at delivery (-0.16 g/dL, 95% CI -0.29 to -0.02) and increases in the drop of haemoglobin levels (-0.29 g/dL, 95% CI -0.44 to -0.14). Beninese women had higher anti-parasite IgGs than Mozambican women (P < 0.001). No difference was found in the proportion of submicroscopic infections nor in the adverse impact of P. falciparum infections in HIV-infected women from Kenya (P. falciparum prevalence by qPCR: 9%, 32/351) and Mozambique (4%, 15/417). CONCLUSIONS: The lowest levels of resistance and tolerance in pregnant women from areas of low malaria transmission were accompanied by the largest adverse impact of P. falciparum infections. Exposure-dependent mechanisms developed by pregnant women to resist the infection and minimise pathology can reduce malaria-related adverse outcomes. Distinguishing both types of defences is important to understand how reductions in transmission can affect malaria disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT00811421 . Registered 18 December 2008.

Multiplexing detection of IgG against Plasmodium falciparum pregnancy-specific antigens.

BACKGROUND: Pregnant women exposed to Plasmodium falciparum generate antibodies against VAR2CSA, the parasite protein that mediates adhesion of infected erythrocytes to the placenta. There is a need of high-throughput tools to determine the fine specificity of these antibodies that can be used to identify immune correlates of protection and exposure. Here we aimed at developing a multiplex-immunoassay to detect antibodies against VAR2CSA antigens. METHODS AND FINDINGS: We constructed two multiplex-bead arrays, one composed of 3 VAR2CSA recombinant-domains (DBL3X, DBL5Ɛ and DBL6Ɛ) and another composed of 46 new peptides covering VAR2CSA conserved and semi-conserved regions. IgG reactivity was similar in multiplexed and singleplexed determinations (Pearson correlation, protein array: R2 = 0.99 and peptide array: R2 = 0.87). IgG recognition of 25 out of 46 peptides and all recombinant-domains was higher in pregnant Mozambican women (n = 106) than in Mozambican men (n = 102) and Spanish individuals (n = 101; p<0.05). Agreement of IgG levels detected in cryopreserved plasma and in elutions from dried blood spots was good after exclusion of inappropriate filter papers. Under heterogeneous levels of exposure to malaria, similar seropositivity cutoffs were obtained using finite mixture models applied to antibodies measured on pregnant Mozambican women and average of antibodies measured on pregnant Spanish women never exposed to malaria. The application of the multiplex-bead array developed here, allowed the assessment of higher IgG levels and seroprevalences against VAR2CSA-derived antigens in women pregnant during 2003-2005 than during 2010-2012, in accordance with the levels of malaria transmission reported for these years in Mozambique. CONCLUSIONS: The multiplex bead-based immunoassay to detect antibodies against selected 25 VAR2CSA new-peptides and recombinant-domains was successfully implemented. Analysis of field samples showed that responses were specific among pregnant women and dependent on the level of exposure to malaria. This platform provides a high-throughput approach to investigating correlates of protection and identifying serological markers of exposure for malaria in pregnancy.

Proteção social na América Latina e Caribe: mudanças, contradições e limites / Social protection in Latin America and the Caribbean: changes, contradictions, and limits / Protección social en Latinoamérica y Caribe: cambios, contradicciones y límites

Resumo: Estudos recentes sugerem que os governos da maioria dos países da América Latina e Caribe foram capazes de ampliar os investimentos sociais e introduzir inovações nas políticas de proteção social nas duas últimas décadas, com resultados positivos em termos de cobertura e impacto das ações. Entretanto, as restrições impostas pelo atual cenário de crise fiscal, juntamente com a ascensão de governos ideologicamente mais alinhados com o discurso neoliberal em diversos países da região, apontam para um novo recuo do Estado na área social, comprometendo os avanços obtidos no período recente. O objetivo do texto é discutir as mudanças, contradições e limites dos padrões recentes da proteção social na América Latina e Caribe. A discussão é feita em três itens: descrição da trajetória da proteção social na região, buscando identificar os principais períodos e características da proteção social (benefícios, público-alvo e financiamento); os modelos de proteção social historicamente implantados; e o caso da saúde. Argumentamos que, embora os diferentes países tenham adotado soluções diferenciadas no campo da proteção social, o caráter híbrido das políticas (com grande participação do setor privado no financiamento, oferta e gestão dos serviços) e a prevalência de modelos segmentados (com acesso diferenciado em função da posição social dos indivíduos) têm sido os traços predominantes da proteção social na América Latina e Caribe, limitando as possiblidades de maior equidade e justiça social.

Abstract: Recent studies suggest that governments in the majority of Latin American and Caribbean countries were able to expand social investments and introduce innovations in social protection policies in the last two decades with positive results in the actions' coverage and impact. However, the restrictions imposed by the current fiscal crisis and the rise of governments more ideologically aligned with the neoliberal discourse in various countries in the region point to a new retreat of the state from the social area, thereby compromising recent advances. The article aims to discuss the changes, contradictions, and limits of recent social protection standards in Latin America and the Caribbean. The discussion includes three items: a description of the history of social protection in the region, seeking to identify its principal historical periods and characteristics (benefits, target public, and financing); the social protection models that have been implemented in the region; and the specific case of health. We argue that although countries have adopted different solutions in the field of social protection, the policies' hybrid nature (with extensive private sector participation in the financing, supply, and management of services) and the prevalence of segmented models (with differential access according to individuals' social status) have been predominant traits in social protection in Latin America and the Caribbean, thus limiting the possibilities for greater equity and social justice.

Resumen: Estudios recientes sugieren que los gobiernos de la mayoría de los países de Latinoamérica y Caribe fueron capaces de ampliar sus inversiones sociales e introducir innovaciones en las políticas de protección social durante las dos últimas décadas, con resultados positivos en términos de cobertura e impacto de las acciones. No obstante, las restricciones impuestas por el actual escenario de crisis fiscal, además de la ascensión de gobiernos ideológicamente más alienados con el discurso neoliberal en diversos países de la región, apuntan a una nueva retirada del Estado en el área social, comprometiendo los avances obtenidos recientemente. El objetivo de este trabajo es discutir los cambios, contradicciones y límites de los patrones recientes de protección social en Latinoamérica y Caribe. La discusión se realiza sobre tres ítems: descripción de la trayectoria de la protección social en la región, buscando identificar los principales períodos y características de la protección social (beneficios, público-objetivo y financiación); los modelos de protección social históricamente implantados; y el caso de la salud. Argumentamos que, aunque los diferentes países hayan adoptado soluciones diferenciadas en el campo de la protección social, el carácter híbrido de las políticas (con gran participación del sector privado en la financiación, oferta y gestión de los servicios) y la prevalencia de modelos segmentados (con acceso diferenciado, en función de la posición social de los individuos) han sido las características predominantes de la protección social en Latinoamérica y Caribe, limitando las posibilidades de una mayor equidad y justicia social.

Importance of rotary systems in dental care by undergraduate students in patients of a public health service of Belo Horizonte.

BACKGROUND: The aim of this study was to evaluate the fracture rates of ProTaper rotary files used in the endodontics extension clinic of the Undergraduate Dentistry Course of the Pontifical Catholic University of Minas Gerais during the prior eight years. MATERIAL AND METHODS: Control record data regarding file usage by students were collected and analyzed by semester. For each period, the total number of patient consultations, the frequency of file use, the occurrence of fractures and the file numbers for which fractures occurred were noted. Descriptive statistics, including frequency of file fractures were calculated for all file types. The chi-square test was used to evaluate differences in the frequency of file fractures between all file types. RESULTS: The study results revealed that during the examined period, there were 1006 consultations and 7993 uses of files. A total of 30 file fractures were recorded throughout this period; thus, fractures occurred in 0.37% of total file uses and 2.98% of all consultations. The most frequently used files were S1, S2 and F1, and these files also accounted for the most fractures. However, no differences in the frequency of file fractures were observed between the file types (p𰀎0.05). CONCLUSIONS: The low fracture rates observed in this study indicate that the examined instruments can be used to safely provide dental care to patients. KEY WORDS: Dental instruments, endodontics, public health.

Changing Trends in P. falciparum Burden, Immunity, and Disease in Pregnancy.

BACKGROUND: Prevention of reinfection and resurgence is an integral component of the goal to eradicate malaria. However, the adverse effects of malaria resurgences are not known. METHODS: We assessed the prevalence of Plasmodium falciparum infection among 1819 Mozambican women who delivered infants between 2003 and 2012. We used microscopic and histologic examination and a quantitative polymerase-chain-reaction (qPCR) assay, as well as flow-cytometric analysis of IgG antibody responses against two parasite lines. RESULTS: Positive qPCR tests for P. falciparum decreased from 33% in 2003 to 2% in 2010 and increased to 6% in 2012, with antimalarial IgG antibody responses mirroring these trends. Parasite densities in peripheral blood on qPCR assay were higher in 2010-2012 (geometric mean [±SD], 409±1569 genomes per microliter) than in 2003-2005 (44±169 genomes per microliter, P=0.02), as were parasite densities in placental blood on histologic assessment (50±39% of infected erythrocytes vs. 4±6%, P<0.001). The malaria-associated reduction in maternal hemoglobin levels was larger in 2010-2012 (10.1±1.8 g per deciliter in infected women vs. 10.9±1.7 g per deciliter in uninfected women; mean difference, -0.82 g per deciliter; 95% confidence interval [CI], -1.39 to -0.25) than in 2003-2005 (10.5±1.1 g per deciliter vs. 10.6±1.5 g per deciliter; difference, -0.12 g per deciliter; 95% CI, -0.67 to 0.43), as was the reduction in birth weight (2863±440 g in women with past or chronic infections vs. 3070±482 g in uninfected women in 2010-2012; mean difference, -164.5 g; 95% CI, -289.7 to -39.4; and 2994±487 g vs. 3117±455 g in 2003-2005; difference, -44.8 g; 95% CI, -139.1 to 49.5). CONCLUSIONS: Antimalarial antibodies were reduced and the adverse consequences of P. falciparum infections were increased in pregnant women after 5 years of a decline in the prevalence of malaria. (Funded by Malaria Eradication Scientific Alliance and others.).

Intestinal parasites in children hospitalized at the Central Hospital in Maputo, Mozambique.

INTRODUCTION: Intestinal parasites are important contributors to the global disease burden, especially in children of low-income countries. The present study determined the frequency of intestinal parasites in children hospitalized at the diarrhea section of the Infectious-Contagious Diseases ward and at the Malnutrition ward of the Department of Pediatrics of the Maputo Central Hospital in Mozambique. METHODOLOGY: This pilot study conducted between February and March 2009 enrolled a total of 93 children between 1.5 and 48.2 months of age; 87.1% were younger than 24 months. Parasite detection in stool samples was achieved using direct microscopic observation and Ritchie's concentration technique. RESULTS: Infection with pathogenic intestinal parasites was detected in 16.1% (15/93) of the children. Giardia duodenalis and Trichuris trichiura were the most common parasites (6.5%, 6/93 each), followed by Ascaris lumbricoides (2.2%, 2/93). One case of mixed infection with A. lumbricoides plus T. trichiura was also detected. CONCLUSION: This study reinforces the importance of routinely examining stool samples for the diagnosis of intestinal parasites (including protozoa) in children hospitalized in endemic areas.

Molecular and Clinical Characterization of Giardia duodenalis Infection in Preschool Children from Lisbon, Portugal.

Giardia duodenalis is the most prevalent intestinal protozoan infection especially in children. In Portugal scarce data are available relative to this infection in preschoolers. The present study was conducted from April to July 2009 in public preschools in Lisbon enrolling 316 children. Stool examination was performed through microscopy. Molecular analysis was conducted in all positive samples for G. duodenalis in order to determine the assemblage and subassemblage of this parasite. Eight of the preschoolers studied children (2.5%, 8/316) were infected with G. duodenalis. Additionally the brother of one of the infected children was also infected. Genotyping analysis targeting ssu-rRNA and ß -giardin loci revealed six infections with assemblage A and 3 with assemblage B. Sub-assemblage determination was possible in four of the samples, with three A2 and one A3. The limited number of cases precluded an association of a determined symptom with an assemblage. The data presented here show the relevance of considering G. duodenalis analysis in children with intestinal complaints even in developed countries.

Perfil de internações hospitalares por doenças respiratórias em crianças e adolescentes da cidade de São Paulo, 2000-2004 / Hospital admissions due to respiratory diseases in children and adolescents of São Paulo city, 2000-2004

OBJETIVO: Analisar o perfil das internações hospitalares por doenças respiratórias em crianças e adolescentes na cidade de São Paulo (SP). MÉTODOS: Estudo ecológico de séries temporais. Foram obtidas informações sobre internações hospitalares por doenças respiratórias (Código Internacional de Doenças, 10ª Revisão: J00-J99) em hospitais conveniados ao Sistema Único de Saúde, localizados na cidade de São Paulo, entre 2000 e 2004. Foram descritas as principais características de distribuição temporal, por faixa etária e por causa de morbidade respiratória na infância e na adolescência. RESULTADOS: As pneumonias e broncopneumonias (51 por cento), a asma (18 por cento) e as doenças agudas e crônicas das vias aéreas superiores (10 por cento) responderam pela maior parte das internações. As crianças até cinco anos são as mais internadas, independentemente da causa específica. Entre os adolescentes, observou-se que as principais causas de internações foram as doenças respiratórias que afetam o interstício pulmonar (0,1 por cento) e as afecções necróticas e supurativas das vias aéreas inferiores (0,2 por cento). Na faixa etária de seis a dez anos, predominam as internações por doenças agudas e crônicas das vias aéreas superiores (10 por cento). Houve tendência de aumento das internações por doenças respiratórias ao longo do período analisado, além da constatação de que o pico de morbidade se dá no começo do outono. CONCLUSÕES: As internações por doenças respiratórias de crianças e adolescentes apresentam padrão de distribuição dependente da faixa etária e da sazonalidade. Quanto menor a faixa etária maior o número de internações.

OBJECTIVE:To analyze the profile of children and adolescents' hospital admissions due to respiratory diseases in São Paulo (SP), Brazil. METHODS: This is an ecological time series study. Data was obtained on hospital admissions for respiratory diseases (International Classification of Diseases, 10th Revision: J00-J99) in hospitals under the Brazilian Unified Health System located in São Paulo between 2000 and 2004. Main characteristics of the temporal distribution of respiratory morbidity in childhood and adolescence by age and cause are described. RESULTS: Pneumonia and bronchopneumonia (51 percent), asthma (18 percent) and acute and chronical diseases from upper airways (10 percent) accounted for most of the admissions. Children up to five years are most frequently hospitalized, regardless of the specific cause. Among adolescents, the main causes of hospitalization were respiratory diseases that affects mainly the interstitial lung (0.1 percent) and the necrotic and suppurative diseases of lower airways (0.2 percent). From the age of six to ten years, admissions for acute and chronic diseases from upper airways (10 percent) were predominant. The peak of morbidity occurs in early autumn. There was a trend towards increasing hospital admissions for respiratory illnesses during the analyzed period. CONCLUSIONS: The distribution of hospital admissions for respiratory diseases in children and adolescents is dependent on age and season. The younger the age the greater the number of hospital admissions.

Percepções de pessoas com baixa visão sobre seu retorno ao mercado de trabalho / The perceptions of low vision people about their return to the labor market / Percepciones de personas con baja visión sobre el retorno al mercado de trabajo

Este estudo objetivou investigar as características de pessoas com baixa visão afastadas do trabalho e encaminhadas pelo Instituto Nacional de Seguro Social para programa de reabilitação bem como identificar suas expectativas quanto ao possível retorno ao mercado de trabalho. O estudo descritivo transversal contou com entrevistas semiestruturadas. A amostra contou com 12 sujeitos em idade produtiva, sendo 11 do sexo masculino. Quanto à escolaridade, 7 dos sujeitos não completaram o ensino fundamental. O material obtido foi submetido à análise qualitativa de conteúdo, agrupado nas seguintes categorias: conhecimento da deficiência, reabilitação e acesso aos direitos sociais, retorno ao mercado de trabalho, planos para o futuro. Os entrevistados detinham pouco conhecimento sobre a deficiência visual e os direitos sociais da pessoa deficiente. A despeito das políticas afirmativas para pessoas deficientes, a desvantagem social é significativa quando se observam a baixa escolaridade e a pouca qualificação profissional, dificultando sua inclusão no mercado de trabalho.(AU)

This study aims investigate the characteristics of people with low vision, unable to work and conducted by the Instituto Nacional de Seguro Social to a rehabilitation program, and identify their expectations about the return to the labor market. In this cross-section descriptive study were conducted semi-strutured interviews. The sample was formed of 12 low vision people, in productive age, 11 of which were male. Concerning to scholarship, 7 had not completed their basic education. The transcribed data underwent qualitative analysis by theme: knowledge of the visual disabilities, rehabilitation and the access of the social rights, return to the labor market and plans to the future. The interviewed showed a poor knowledge of the visual disabilities, the rehabilitation and the social rights. In spite of the affirmatives public policies to disable people in the labor market, the social disadvantage is very significant considering their low scholar level and poor professional qualification, bringing difficulties to his inclusion on the labor market.(AU)

El objetivo del presente estudio fue investigar las características de personas con baja visión, apartadas del trabajo y encaminadas para rehabilitación desde el Instituto Nacional de Seguro Social y identificar sus expectativas cuanto al regreso al mercado de trabajo. El estudio descriptivo trasversal contó con el aplicación de cuestionario por medio de entrevista. La muestra arrolló 12 sujetos en edad productiva, siendo 11 del sexo masculino. Cuanto a la escolaridad 7 de los sujetos no tenían el enseño fundamental. Para el análisis los datos fueran reunidos en temas: conocimiento de la discapacidad visual, rehabilitación y acceso a los derechos sociales, regreso al mercado de trabajo, planes para el futuro. Los entrevistados detenían poco conocimiento de la causa de sus discapacidades visuales y de los derechos sociales. Mientras las políticas afirmativas a los discapacitados visuales, el desventaja social es significativa cuando si observa la baja escolaridad y limitada calificación profesional, perjudicando la inclusión al mercado de trabajo.(AU)

Percepções de pessoas com baixa visão sobre seu retorno ao mercado de trabalho / The perceptions of low vision people about their return to the labor market / Percepciones de personas con baja visión sobre el retorno al mercado de trabajo

Este estudo objetivou investigar as características de pessoas com baixa visão afastadas do trabalho e encaminhadas pelo Instituto Nacional de Seguro Social para programa de reabilitação bem como identificar suas expectativas quanto ao possível retorno ao mercado de trabalho. O estudo descritivo transversal contou com entrevistas semiestruturadas. A amostra contou com 12 sujeitos em idade produtiva, sendo 11 do sexo masculino. Quanto à escolaridade, 7 dos sujeitos não completaram o ensino fundamental. O material obtido foi submetido à análise qualitativa de conteúdo, agrupado nas seguintes categorias: conhecimento da deficiência, reabilitação e acesso aos direitos sociais, retorno ao mercado de trabalho, planos para o futuro. Os entrevistados detinham pouco conhecimento sobre a deficiência visual e os direitos sociais da pessoa deficiente. A despeito das políticas afirmativas para pessoas deficientes, a desvantagem social é significativa quando se observam a baixa escolaridade e a pouca qualificação profissional, dificultando sua inclusão no mercado de trabalho.

This study aims investigate the characteristics of people with low vision, unable to work and conducted by the Instituto Nacional de Seguro Social to a rehabilitation program, and identify their expectations about the return to the labor market. In this cross-section descriptive study were conducted semi-strutured interviews. The sample was formed of 12 low vision people, in productive age, 11 of which were male. Concerning to scholarship, 7 had not completed their basic education. The transcribed data underwent qualitative analysis by theme: knowledge of the visual disabilities, rehabilitation and the access of the social rights, return to the labor market and plans to the future. The interviewed showed a poor knowledge of the visual disabilities, the rehabilitation and the social rights. In spite of the affirmatives public policies to disable people in the labor market, the social disadvantage is very significant considering their low scholar level and poor professional qualification, bringing difficulties to his inclusion on the labor market.

El objetivo del presente estudio fue investigar las características de personas con baja visión, apartadas del trabajo y encaminadas para rehabilitación desde el Instituto Nacional de Seguro Social y identificar sus expectativas cuanto al regreso al mercado de trabajo. El estudio descriptivo trasversal contó con el aplicación de cuestionario por medio de entrevista. La muestra arrolló 12 sujetos en edad productiva, siendo 11 del sexo masculino. Cuanto a la escolaridad 7 de los sujetos no tenían el enseño fundamental. Para el análisis los datos fueran reunidos en temas: conocimiento de la discapacidad visual, rehabilitación y acceso a los derechos sociales, regreso al mercado de trabajo, planes para el futuro. Los entrevistados detenían poco conocimiento de la causa de sus discapacidades visuales y de los derechos sociales. Mientras las políticas afirmativas a los discapacitados visuales, el desventaja social es significativa cuando si observa la baja escolaridad y limitada calificación profesional, perjudicando la inclusión al mercado de trabajo.

Experiência de cuidados à pessoa com cancro, na perspectiva de estudantes de formação inicial em enfermagem / Experience of care to people with cancer, a student's perspective of training in nursing / La experiencia de la atención a personas con cáncer, la perspectiva de los estudiantes de la formación en enfermería

Objetivo: analisar a experiência dos estudantes de enfermagem no cuidado à pessoa com cancro.Metodologia: estudo descritivo, exploratório, de abordagem qualitativa, com análise do discurso produzido pelos sujeitos,a partir da questão norteadora: Qual a experiência dos estudantes de enfermagem no cuidado à pessoa com cancro? A recolha de dados foi realizada através de narrativas elaboradas pelos estudantes, com prévia assinatura dos termos de consentimentos livre e esclarecido, realizadas em setembro 2007. Participaram doze estudantes com experiência de cuidados a pessoas com cancro. Resultados: a partir da análise das narrativas, emergiram três categorias: características dos cuidados, com sete sub-categorias ; Aspectos enriquecedores dos cuidados, com duas sub-categorias; Dificuldades no processo de cuidados, com duas sub-categorias. Conclusão: Carcterizou-se o cenário da experiência de cuidados, na qual se identificaram aspectos enriquecedores e dificuldades, surgindo alguns elementos caracterizadores em que a disponibilidade para o outro e a importância de promover a esperança foram realçadas.(AU)

Objective: to analyze the experience of nursing students in caring for the person with cancer. Methodology: this is about a descriptive, exploratory study from qualitative approach, analyzing the speech produced by subjects from the question: What is the experience of nursing students in caring for people with cancer? Data collection was done through narratives compiled by students with prior signing of terms of free and informed consent, conducted in September 2007. Twelve students were participants with experience of care for people with cancer. Results: from the narratives revealed three categories: characteristics of care, with seven sub-categories; enriching aspects of care, with two sub-categories; Difficulties in the process of care, with two sub-categories. Conclusion: spiced up the scene of the care experience, which identified enriching aspects and difficulties arise in which some elements that determine the availability to the other and the importance of promoting hope were highlighted.(AU)

Objetivo: analizar la experiencia de los estudiantes de enfermería en el cuidado de la persona con cáncer. Metodología: enfoque descriptivo, exploratorio y cualitativo, el análisis del discurso producido por los sujetos de la pregunta: ¿Cuál es la experiencia de los estudiantes de enfermería en el cuidado de las personas con cáncer? La recolección de datos se realiza a través de relatos compilados por los estudiantes con la firma previa de los términos del consentimiento libre e informado, realizado entre septiembre de 2007. Los participantes doce estudiantes con experiencia en atención a las personas con cáncer. Resultados: de los relatos reveló tres categorías: características de la atención, con siete subcategorías, enriqueciendo los aspectos del cuidado, con dos sub-categorías, las dificultades en el proceso de atención, con dos sub-categorías. Conclusión: aderezado el escenario de la experiencia del cuidado, que se identificaron los aspectos enriquecedores y dificultades que surgen en la que algunos de los elementos que determinan la disponibilidad para el otro y la importancia de la esperanza se puso de relieve la promoción.(AU)

Educação em enfermagem baseada em competências: revisão da literatura / Competency-based to nursing education: literature review / Educación en enfermería basada en competencias: revisión de la literatura

Objetivos: caracterizar produção científica sobre modelos e estratégias educacionais para educação em enfermagem baseada em competências; Identificar resultados da implementação de modelo/estratégias educacionais; Discutir aspectos convergentes e divergentes sobre uso dos modelos/estratégias educacionais. Metodologia: revisão de literatura em Novembro de 2010, nas bases da Biblioteca Virtual em Saúde (BVS) utilizando os seguintes descritores: Educação baseada em competências, Educação em enfermagem e Ensino Superior, sendo selecionado um. Na EBSCO, utilizando os mesmos descritores em língua inglesa (Competency-Based Education; Education, Nursing; Education, Higher), igual período de tempo, encontaram-se 36 artigos e foram seleccionados 9. Os critérios de inclusão foram: artigos de pesquisas publicados no período 2005 a 2010, estar disponível on-line como texto completo, estar nos idiomas português, inglês ou espanhole focalizar objecto de estudo. Excluíram-se artigos de opinião, editoriais e teses. Resultados: Foram caracterizados estudos sobre modelos e estratégias educacionais para uma aprendizagem baseada em competências nos quais as experiências enfatizam os métodos de ensino, o desenho curricular ou a avaliação. Conclusão: Ficou evidenciada vantagem na educação baseada em competências, sobretudo com a utilização de modelos pré definidos e uso de estratégias e modelos educacionais de carácter interativo.(AU)

Objectives: to characterize the scientific production of models and educational strategies for nursing education based on competencies; Identify results of model implementation/education strategies; discuss the commonalities and divergences on the use of models / educational strategies. Methodology: this is about a literature review study performed in November 2010, on the bases of the Virtual Health Library (VHL) using the following keywords: Competency-based Education, Nursing Education and Higher Education, being selected one. In EBSCO, using the same descriptors in English (Competency-Based Education, Education, Nursing, Education, Higher), same time period, are found on 36 articles and 9 were selected. The inclusion criteria were research papers published between 2005 to 2010, available online as full text, to be in Portuguese, English or Spanish and focus further study. Also excluded were review articles, editorials and theses. Results: we characterized studies of educational models and strategies for a competency-based learning experiences in which emphasize teaching methods, curriculum design or evaluation. Conclusion: It was evident advantage in competency-based education, especially with the use of predefined models and use of educational strategies and models of interactive nature. (AU)

Objetivos: caracterizar la producción científica de los modelos y estrategias educativas para la educación de enfermería basada en competencias; Identificar los resultados de la implementación del modelo y estrategias en la educación, discutir los puntos comunes y divergencias sobre el uso de modelos y estrategias educativas. Metodologia: revisión de la literatura en noviembre de 2010, sobre las bases de la Biblioteca Virtual en Salud (BVS) con las siguientes palabras: Educación Basada en Competencias, Educación en Enfermería y Educación Superior, siendo seleccionada uno. En EBSCO, utilizando los mismos descriptores en Inglés (Competency-Based Education; Education, Nursing; Education, Higher), mismo período de tiempo, se encuentran en 36 artículos y 9 fueron seleccionadas. Los criterios de inclusión fueron artículos de investigación publicados entre 2005 y 2010, disponible en línea en texto completo, para estar en Portugués, Inglés o Español y el foco mayor estudio. También se excluyeron los artículos de revisión, editoriales y tesis. Resultados: Se han caracterizado los estudios de los modelos educativos y estrategias de experiencias basadas en las competencias de aprendizaje que hacen hincapié en los métodos de enseñanza, diseño curricular o la evaluación. Conclusión: Es evidente ventaja en la educación basada en la competencia, especialmente con el uso de modelos predifinidos y el uso de estrategias educativas y modelos de carácter interactivo.(AU)

Direito à saúde, atenção básica e transferências condicionadas de renda na América Latina / Healthcare rights and conditional cash transfers in Latin America

Os programas de transferência de renda na América Latina foram acompanhados de condicionalidades - responsabilidades com o objetivo de melhorar os níveis educacionais, impedir a evasão escolar e o trabalho infantil e também para melhorar os indicadores de saúde e nutrição. Apesar da relativa uniformidade encontrada na condicionalidade vinculada à saúde, as estratégias utilizadas pelos governos para cumprir com as metas e os objetivos estabelecidos são diversas e configuram dificuldades adicionais para a melhoria das condições de vida das populações mais vulneráveis. Longe de essa iniciativa incentivar o direito à saúde, talvez o que promova seja expansão de um novo ciclo de programas de atenção básica focalizados e de natureza provisória.

Conditional cash transfer programs in Latin America impose specific requirements and responsibilities on beneficiary households, in order to upgrade education levels, improve drop-out rates and eliminate child labor, while enhancing health and nutrition indicators. Although counterpart healthcare conditions are common to all these programs, government strategies differ in terms of reaching their goals, at times even undermining improvements in the living conditions of more vulnerable segments of the population. Instead of upholding rights to healthcare, such initiatives may well trigger a new cycle of tightly-focused basic care through provisional programs.

[Healthcare rights and conditional cash transfers in Latin America]. / Direito à saúde, atenção básica e transferências condicionadas de renda na América Latina.

Conditional cash transfer programs in Latin America impose specific requirements and responsibilities on beneficiary households, in order to upgrade education levels, improve drop-out rates and eliminate child labor, while enhancing health and nutrition indicators. Although counterpart healthcare conditions are common to all these programs, government strategies differ in terms of reaching their goals, at times even undermining improvements in the living conditions of more vulnerable segments of the population. Instead of upholding rights to healthcare, such initiatives may well trigger a new cycle of tightly-focused basic care through provisional programs.

Desvio apical de canais radiculares com limas de níquel-titânio acionadas a motor e manuais de aço inoxidável / Lateral deviations in root canals using rotatory nickel-titanium instruments and hand stainless steel files

O propósito deste estudo foi investigar a manutençäo do trajeto original do canal, quando formatado com instrumentos de NiTi ProFile .04 Série 29 acionados a motor e limas tipo K de aço inoxidável. O tempo gasto também foi avaliado. Foram selecionadas as raízes mesiais de 32 molares inferiores humanos, com curvatura variando entre 26§ e 40§. Trinta e dois canais (16MV e 16ML) foram formatados com instrumentos de NiTi acionados a motor, a os 32 restantes (16MV e 16ML) com limas manuais de aço inoxidável. A manutençäo do trajeto original do canal foi determinada pela sobreposiçäo das radiograias de odontometria e pós-formataçäo (instrumento no CT) para examinar o desvio. A incidência de desvio, durante a instrumentaçäo, näo foi diferente estatisticamente entre os dois grupos. Entretanto, em relaçäo ao tempo, os instrumentos de NiTi acionados a motor foram significativamente mais rápidos que os de aço inoxidável. Ocorreram duas fraturas e uma deformaçäo de limas ProFile .04 Série 29