A primeira dor e a última dor / First pain and last pain

No decorrer do texto a autora se propõe a uma reflexão sobre a questão da dor. Qual seria a primeira dor que o homem sentiria ao longo de sua vida? E a última dor? Nesse percurso entre o nascimento e a morte, passando por momentos anteriores e posteriores a esses dois marcos da vida humana, a autora lança um olhar sobre a angústia originária, do ponto de vista freudiano e levando em consideração uma separação mais arcaica, liga essa vivência com o real lacaniano, porque sem experiência, sem verbo, sem linguagem. Faz ainda referência à importância dos significantes desses marcos para os sujeitos envolvidos no evento com seus próprios desfechos, suas alegrias e suas lágrimas, conforme a situação inerente a cada acontecimento, não esquecendo o sujeito que chega e o sujeito que parte, objetos diretos do estudo em questão(AU)

Throughout the text the author proposes a reflection about the question of pain. What would be the first pain man fells in his life? And which would be the last pain? In the comes and goes from birth to death passing by moments that are anterior and posterior to those milestones of human life, giving a look on the worry originated from the Freudian standpoint, going to a more archaic separation, liking this experience with the Lacanian concept of "the Real", because without experience, without voice, without language. The author also makes reference to birth and death moments and their meaning for subjects involved in the event, with their own outcomes, happiness, tears, according to the situation inherent to each occurrence. Not forgetting the subject that arrives and the one that goes as direct objects of this study’s discussion(AU)

Transtornos de comportamento em crianças e adolescentes - experiência em um Serviço de Atenção Primária / Behavior disorders in children and adolescent - experience in Health Primary Attention Service

A partir do referencial da Pediatria Holística, que engloba questões orgânicas, do campo relacional familiar, odesempenho cognitivo e o social, pretende-se com este estudo analisar os pacientes atendidos em serviço de atençãoprimária, voltado às questões psicossociais. Trata-se de estudo descritivo, transversal, de abordagem quantitativa,considerando o perfil sócio-demográfico e a prevalência de transtornos de comportamento supostos na primeira consulta.Os dados serão obtidos a partir dos prontuários, considerando variáveis sócio-demográficas, estrutura e dinâmica familiar,motivos da consulta, hipóteses diagnósticas e condutas adotadas. Os resultados serão analisados com os estudosestatísticos apresentado em tabelas e figuras, com discussão que contemplará a literatura pertinente. O projeto foiaprovado pelo Comitê de Ética do Centro de Saúde da Universidade Federal de Pernambuco, Recife, Brasil.

[BCG vaccine against tuberculosis: its protective effect and vaccination policies]. / Vacina BCG contra tuberculose: efeito protetor e políticas de vacinação.

OBJECTIVE: The BCG vaccine has been in use since 1921, but still arouses controversy and uncertainties. The objective was to analyze the protective effect of the BCG vaccine in its first and second doses and the accompanying vaccination policies. METHODS: A systematic review of the literature in both English and Spanish was carried out, covering the period 1948 to 2006, using the PubMed database. The main search terms used included BCG vaccine, BCG efficacy, BCG and tuberculosis. The studies were grouped by design, with the main results from the clinic tests, case-control studies and meta-analyses presented separately. RESULTS: The protective effect of the first dose of the BCG vaccine against tuberculosis in its miliary and meningeal forms is high. However, the results vary in relation to the pulmonary form of the disease, with some indicating zero effect and others levels of nearly 80%. Research is being carried out to develop new vaccines that could substitute the BCG or be used as a booster. CONCLUSIONS: There are evidences that the protective effect of the BCG vaccine does not increase with a second dose. In spite of its limitations and the expectation that a new tuberculosis vaccine will be developed in the future, the BCG vaccine remains an important tool in controlling the harmful effects of tuberculosis, particularly in countries with medium or high incidence levels of the disease.

Vacina BCG contra tuberculose: efeito protetor e políticas de vacinação / BCG vaccine against tuberculosis: its protective effect and vaccination policies

OBJETIVO: A vacina BCG é utilizada desde 1921, embora ainda apresente controvérsias e aspectos não esclarecidos. O objetivo do artigo foi analisar aspectos relacionados ao efeito protetor da primeira e segunda doses da vacina BCG e as políticas de vacinação adotadas. MÉTODOS: Foi realizada revisão sistemática da literatura publicada em inglês e espanhol, abrangendo o período compreendido entre 1948 e 2006, na base PubMed. Os principais descritores utilizados foram BCG vaccine, BCG efficacy, BCG e tuberculosis. Os estudos foram agrupados por tipo de desenho, apresentando-se separadamente os principais resultados de ensaios clínicos, estudos de caso-controle e metanálises. RESULTADOS: O efeito protetor da primeira dose da vacina BCG contra a tuberculose na forma miliar ou na meningite é elevado. No entanto, os resultados são discordantes em relação à forma pulmonar, variando de ausência de efeito a níveis próximos a 80 por cento. Estão sendo conduzidas pesquisas sobre novas vacinas candidatas a substituir a BCG ou serem utilizadas como reforço. CONCLUSÕES: Há evidências de que a segunda dose da BCG não aumenta o seu efeito protetor. Apesar de seus limites e da expectativa futura de nova vacina para tuberculose, a vacina BCG mantém-se como importante instrumento no controle dos efeitos danosos da doença, sobretudo em países com taxas de incidência médias e elevadas.

OBJECTIVE: The BCG vaccine has been in use since 1921, but still arouses controversy and uncertainties. The objective was to analyze the protective effect of the BCG vaccine in its first and second doses and the accompanying vaccination policies. METHODS: A systematic review of the literature in both English and Spanish was carried out, covering the period 1948 to 2006, using the PubMed database. The main search terms used included BCG vaccine, BCG efficacy, BCG and tuberculosis. The studies were grouped by design, with the main results from the clinic tests, case-control studies and meta-analyses presented separately. RESULTS: The protective effect of the first dose of the BCG vaccine against tuberculosis in its miliary and meningeal forms is high. However, the results vary in relation to the pulmonary form of the disease, with some indicating zero effect and others levels of nearly 80 percent. Research is being carried out to develop new vaccines that could substitute the BCG or be used as a booster. CONCLUSIONS: There are evidences that the protective effect of the BCG vaccine does not increase with a second dose. In spite of its limitations and the expectation that a new tuberculosis vaccine will be developed in the future, the BCG vaccine remains an important tool in controlling the harmful effects of tuberculosis, particularly in countries with medium or high incidence levels of the disease.

Factors associated with treatment failure, dropout, and death in a cohort of tuberculosis patients in Recife, Pernambuco State, Brazil

A cohort of cases initiating tuberculosis treatment from May 2001 to July 2003 was followed in Recife, Pernambuco State, Brazil, to investigate biological, clinical, social, lifestyle, and healthcare access factors associated with three negative tuberculosis treatment outcomes (treatment failure, dropout, and death) separately and as a group. Treatment failure was associated with treatment delay, illiteracy, and alcohol consumption. Factors associated with dropout were age, prior TB treatment, and illiteracy. Death was associated with age, treatment delay, HIV co-infection, and head of family's income. Main factors associated with negative treatment outcomes as a whole were age, HIV co-infection, illiteracy, alcoholism, and prior TB treatment. We suggest the following strategies to increase cure rates: further training of the Family Health Program personnel in TB control, awareness-raising on the need to tailor their activities to special care for cases (e.g., literacy training); targeting use of directly observed therapy for higher risk groups; establishment of a flexible referral scheme to handle technical and psychosocial problems, including alcoholism; and increased collaboration with the HIV/AIDS program.

Acompanhou-se uma coorte de casos de tuberculose que iniciou o tratamento entre maio de 2001 e julho de 2003, em Recife, Pernambuco, Brasil, com o objetivo de investigar a associação de fatores biológicos, clínicos, sociais, de hábitos de vida e acesso aos serviços de saúde com falência terapêutica, abandono e óbito, separadamente e de forma agregada. Falência do tratamento esteve associada com demora para o início do tratamento, analfabetismo e consumo de álcool. Associação com o óbito foi encontrada com grupo etário, demora para o início do tratamento, co-infecção pelo HIV e renda do chefe da família. Fatores associados ao abandono foram grupo etário, tratamento prévio para tuberculose e analfabetismo. Os fatores associados aos desfechos de forma agregada foram grupo etário, co-infecção pelo HIV, analfabetismo, consumo de álcool e tratamento prévio para tuberculose. Sugere-se, para aumentar os percentuais de cura, a capacitação continuada das equipes do Programa Saúde da Família para o controle da tuberculose, adaptação das atividades de controle para situações especiais como analfabetismo, alcoolismo e co-infecção pelo HIV, direcionando o uso da terapia diretamente observada para estes grupos de risco.

Factors associated with treatment failure, dropout, and death in a cohort of tuberculosis patients in Recife, Pernambuco State, Brazil.

A cohort of cases initiating tuberculosis treatment from May 2001 to July 2003 was followed in Recife, Pernambuco State, Brazil, to investigate biological, clinical, social, lifestyle, and healthcare access factors associated with three negative tuberculosis treatment outcomes (treatment failure, dropout, and death) separately and as a group. Treatment failure was associated with treatment delay, illiteracy, and alcohol consumption. Factors associated with dropout were age, prior TB treatment, and illiteracy. Death was associated with age, treatment delay, HIV co-infection, and head of family's income. Main factors associated with negative treatment outcomes as a whole were age, HIV co-infection, illiteracy, alcoholism, and prior TB treatment. We suggest the following strategies to increase cure rates: further training of the Family Health Program personnel in TB control, awareness-raising on the need to tailor their activities to special care for cases (e.g., literacy training); targeting use of directly observed therapy for higher risk groups; establishment of a flexible referral scheme to handle technical and psychosocial problems, including alcoholism; and increased collaboration with the HIV/AIDS program.