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Item Perfil epidemiologico das neoplasias do colo uterino (in situ e invasoras) diagnosticadas na cidade de goiânia: análise de 17 anos (1988-2004)(Universidade Federal de Goiás, 2010-10-28) ALMEIDA, Fábio Marques de; MOREIRA, Marise Amaral Rebouças; http://lattes.cnpq.br/6390358577348486Determine the epidemiological profile of in situ and invasive neoplasias of the uterus cervix in Goiânia during the period from 1988 to 2004. Methodology: The cases were identified in the Population Base Register of Cancer database of Goiânia. The studied variables were: age, histological type, extension of the disease and mortality. Analysis was done by central tendency in which the incidence rates were calculated by age, extension of the disease using Census population data and the standard population of Segi; for the mortality analysis the data were extracted from Mortality Information System. Results: We identified 4446 cases of in situ and invasive neoplasias of the uterus from the period of 1988 to 2004. Histopathology was used in 91,9% of the cases; average age was 40 years old for the in situ neoplasias and 52 years for the invasive ones (DP ± 13 and 14 years old, respectively). There were 2213 (58,28%) in situ cases, 1603 invasives (41,8%) and, in 633 cases (14,2%), it was not possible to verify their extension. The annual rate of percentage change (AAPC) for the in situ incidence was 13.08% (IC 95% 9.75 16.50; p<0.0000) per year and1.27% (IC95% -1.74 4.37; p<0.3862) for the invasive cases. The standard mortality rate was 12.2 and 8.2 per 100,000 in 1988 and 2004 respectively, with an AAPC of -3.02 (IC95% -5,36 -0,62; p<0,0172). Squamous cell carcinoma was found to be the predominant histologic type. A reduction of the Adenocarcinoma incidence in situ was not found nor was found a significant change of the Adenocarcinoma invasive; the squamous invasive cancer did present a considerable reduction of 2,85 per year. Conclusion: It was observed that the most frequent invasive tumors were the squamous cell carcinomas and Adenocarcinomas. Data did not demonstrate a rise in the diagnosis of invasive neoplasia, although there occurred an increase of diagnoses of in situ neoplasias. Mortality has demonstrated a tendency of reduction, suggesting that improvements of the tracking programs have changed the incidence or uterine cancer, though it has not yet accomplished all its objectives. Keywords: cervical cancer, uterus, epidemiology, frequency, extension, incidence, Goiânia, Brazil.Item Capacidade funcional de idosos com vertigem posicional parxística benigna(Universidade Federal de Goiás, 2010-10-18) ALVARENGA, Gabriella Assumpção; BARBOSA, Maria Alves; http://lattes.cnpq.br/5025797873585225; PORTO, Celmo Celeno; http://lattes.cnpq.br/9673684282497548Dissertation built modality scientific article. In the first article submitted to "Journal of Otolaryngology" with the title benign paroxysmal positional vertigo without nystagmus: diagnosis and treatment, there was a literature review, using the following keywords: "dizziness / vertigo, diagnosis / diagnosis, therapeutic / therapeutical approaches. " Scientific publications are included in the period 2001-2009 in Portuguese, English and German. We found nine papers dealt with BPPV without nystagmus, whose diagnosis was based exclusively on clinical history and physical examination. The treatment of BPPV without nystagmus was made by Epley maneuvers, Semont, discharge modified for posterior semicircular canal and Brandt-Daroff exercises. All show that 50% to 97.1% of patients with BPPV without nystagmus, had remission of symptoms, while patients with BPPV nystagmus with remission of symptoms ranged from 76% to 100%. Hence one can conclude that the differences may not be significant, which demonstrates the need for further studies on BPPV without nystagmus. In the second paper, Functional Capacity of Elderly with benign paroxysmal positional vertigo, compared the functional capacity among elderly patients with BPPV and elderly without clinical diagnosis of BPPV and that / or dizziness or vertigo, identifying the physical activities of daily living and instrumental activities of daily living in elderly people in both the Group of Elderly with BPPV (EBPPVG) and Control Group (CG). This is a cross-sectional study, case-control study in Hospital Geral de Goiânia (HGG), with the participation of 14 elderly patients with a diagnosis of BPPV and the Programa de Gerontologia Social / Universidade Aberta à Terceira Idade (UNATI) from the Pontificia Universidade Católica de Goiás (PUC-GO), with the participation of 13 subjects without dizziness or vertigo and / or clinical diagnosis was of BPPV. Functional capacity was assessed by the subscale of the Functional Assessment Questionnaire Brazilian Multidimensional Functional Capacity / Operating Older American Resources and Services Multidimensional Functional Assessment Questionnaire (BOMFAQ/OARS), verifying that the difficulty in performing 15 activities of daily living (ADL), eight physical activities of daily living (AFVD): throw / out of bed, eating, combing hair, walk on the plane, bathing, dressing, going to the bathroom in time and trimming toenails, and seven instrumental activities of living daily living (IADL): climbing stairs (one flight), doctor-on time, walk close to home, shopping, preparing meals, driving out and do house cleaning. Arrived at the following conclusions: a) elderly people with BPPV showed a statistically significant lower functional capacity than subjects without this diagnosis, b) in EBPPVG, the average number of daily activities (physical and instrumental), those with difficulty was 6.53 with a maximum of 11 activities committed while in the CG, the average impairment was 0.86 with a maximum of 4 activities referred with difficulty in performing c) EBPPVG affected performance in 13 activities of daily living, including physical seventh floor in the plan, bathing, dressing, combing hair, going to the bathroom in time, bedtime and getting up from bed or chair and cut nails feet, and 6 which are instrumental, climbing stairs, walking around the house, shopping, preparing meals, driving out and do house cleaning in the comparison between groups, d) Activities that were cited as the most difficult among the elderly were similar in both groups. However, the degree of impairment, characterized in: without commitment (when the elderly did not report any difficulty in any of the 15 evaluated ADL), mild (1 to 3 activities impaired), moderate (4-6 impaired activities) and severe (for seven or more impaired activities) was significantly higher in EBPPVG, where 7 (50%) showed severe impairment in ADL performance.Item Avaliação da inicialização da marcha na gestante de baixo risco nos três trimestres gestacionais(Universidade Federal de Goiás, 2012-02-17) ANDRADE, Sara Rosa de Sousa; VIEIRA, Marcus Fraga; http://lattes.cnpq.br/4153462617460766; AMARAL, Waldemar Naves do; http://lattes.cnpq.br/4092560599116579Introduction: The pregnant woman's body promotes many changes, including their biomechanics. The hormonal action which increases the laxity causes structural changes in the static and dynamic skeleton. Other factors, such as weight gain, growth of the uterus and the breasts, will help changing the gravitational forces of the pregnant woman and cause large static and dynamic postural adjustments in pregnant women. The startup of gait position is the transition from quasi-static to the first step. It is a task that challenges the postural control, because the demands on the neuromuscular system are increased at the beginning of the march, since it is required a complex integration of neural mechanisms, muscle activity and biomechanical forces. Objective: describe the oscillation amplitude and mean velocity of center of pressure during startup of gait, to compare the behavior of the center of pressure between the three groups at different gestational periods, verify that the changes in the behavior of the center of pressure along the pregnancy is at risk dynamic stability for pregnant women. Methods: A total of oscillation amplitude and velocity of displacement of center of pressure during startup of gait in 57 low-risk pregnancies in three trimesters. Results: Significant differences were found when comparing the groups 1º trimester and 3º trimester for the variable amplitude of oscillation mediolateral and mediolateral displacement speed. Discussion: Pregnant women tend to decrease the amplitude of oscillation mediolateral and mediolateral displacement speed during gestation. Conclusions: The amplitude of oscillation anteroposterior and mediolateral displacement speeds and respective of the first quarter from the third there was, on average, a gradual decrease to a platform and to the platform 2. There were significant differences in the oscillation amplitude variables mediolateral and mediolateral displacement speed when comparing the groups 1° trimester and 3° trimester, being higher in 1º trimester for both variables. The variables analyzed showed minor differences and do not constitute an imminent risk to the dynamic stability of the pregnant woman.Item BEVACIZUMABE INTRA-VÍTREO: ANÁLISE DA TOXICIDADE RETINIANA APÓS 3 MESES EM OLHOS DE COELHOS NÃO ALBINOS(Universidade Federal de Goiás, 2009-06-19) ARRAES, João Carlos Diniz; ÁVILA, Marcos Pereira de; http://lattes.cnpq.br/3335187297522447Antiangiogenesis therapy has become a first-line treatment for neovascular age-related macular degeneration (AMD). Bevacizumab has proven to be efficient and cost effective, however its use in AMD is still off-label. PURPOSES: Evaluating the histological toxicity of bevacizumab on the neurosensorial retina (NSR) and the retinal pigmented epithelium (RPE) in pigmented rabbit eyes; evaluating if a fast increase in vitreous volume after a 0.1 ml balanced saline solution (BSS) intravitreal injection (IVI) in a rabbit eye will lead to histological damages in the NSR and RPE; and evaluating postoperative clinical complications after an IVI in rabbits eyes. METHODS: Eighteen pigmented rabbits (36 eyes) were divided into 4 groups a Control Group (3 rabbits - 6 eyes), which did not receive any IVI; the rabbits were sacrificed at the beginning of the study. Thirty eyes of the fifteen remaining rabbits were distributed to three groups: a sham group (S), that received a 0.1 ml balanced saline solution (BSS) IVI (ten eyes); group 1, that received a 1.25 mg (0.1 ml) bevacizumab IVI (ten eyes); and group 2, that received a 2.5 mg (0.1 ml) bevacizumab IVI (ten eyes). Postoperative clinical evaluation included inspection of the anterior segment and indirect binocular ophthalmoscopy. The rabbits were sacrificed 90 days after the procedure and both eyes of all the rabbits were enucleated. Histological examination of the NSR and RPE were performed and their morphological features and layer thickness were analyzed. RESULTS: No significant postoperative clinical complications were observed either in the neurossensorial retina or in the RPE. Histological morphology and thickness of the NSR and RPE layers did not differ significantly between BBS-injected eyes and bevacizumab-injected eyes. CONCLUSIONS: A rapid increase in vitreous volume, after 0.1 ml BSS IVI did not lead to any histological damage in the NSR and RPE in rabbit eyes. After a 90-day follow-up period, a single Bevacizumab 1.25 and 2.5 mg intravitreal injection did not lead any toxic damage in the NSR and RPE. No important postoperative complications in pigmented rabbit eyes were observed and it appears to be a safe procedure for the treatment of retinal neovascular diseasesItem Efeitos de um programa individualizado e supervisionado de exercícios para os músculos do assoalho pélvico em multíparas de parto vaginal(Universidade Federal de Goiás, 2012-04-16) ASSIS, Thaís Rocha; AMARAL, Waldemar Naves do; http://lattes.cnpq.br/4092560599116579This study consists of two scientific papers. The first aimed at investigating the effects of an individualized and supervised exercise program to strengthen pelvic floor muscles (PFM) in the postpartum period of multiparous women, and verify the correlation between two methods used to assess muscle strength. The second paper aimed at verifying the perception that puerperal women have regarding the alterations to their vaginal area and sex life after childbirth and after a PFM exercise program. To achieve these goals, an open clinical trial was performed on the first study, while the second conducted an exploratory and descriptive study. The final sample consisted of 23 puerperal women divided into two groups: intervention group (IG, n=11) and control group (CG, n=12). In IG, the puerperal women participated in an eight-week PFM exercise program, twice a week. In CG, the puerperal women did not receive any recommendations regarding exercises. PFM strength was assessed by digital vaginal palpation using the modified Oxford Scale and perineometer. The statistical analysis of the first article was performed using the following tests: Fisher s Exact Test, Chi-squared Test, Student s t-test, Kolmogorov Smirnov test for the two samples, and Pearson s Correlation Coefficient. Significance was defined as p < 0.05. On the second paper, categories were established and content analysis was performed. The participants mean age in IG was 24 ± 4.56 years, and 25.33 ± 4.03 years in CG (p=0.465). By completing the PFM exercise program, a significant difference was observed between the groups in the two muscle strength assessments (p0.001). The two methods used to assess muscular strength showed significant correlation in both assessments (1st assessment: r = 0.889 with p <0.001; 2nd assessment: r = 0.925 with p <0.001). In terms of the participants perception regarding any vaginal alteration in the late postpartum period, the most frequent reports in both groups were those related to the category perception of low vaginal tonus . Fourteen weeks into the postpartum period, at the end of the exercise program, the participants in IG presented more reports in the category perception of increased vaginal tonus and greater control over the PFM and those in the CG, in the category feels that the vagina is back in the same condition as before pregnancy . Finally, the exercise program resulted in a significant increase in PFM strength in puerperal women and showed positive effects on the perineal area and in the sex life of the participants. Good correlation was observed between digital vaginal palpation and perineometer, which indicates that vaginal palpation can be used in clinical practice, considering it is an inexpensive method that demonstrated significant correlation with an objective method, i.e. perineometer.Item Avaliação dos resultados dos exames citopatológicos do colo do útero dos laboratórios credenciados pelo Sistema Único de Saúde de acordo com o diagnóstico da Unidade de Monitoramento Externo da Qualidade(Universidade Federal de Goiás, 2010-03-03) ÁZARA, Cinara Zago Silveira; GUIMARÃES, Janaína Valadares; http://lattes.cnpq.br/0986934969522024; AMARAL, Rita Goreti; http://lattes.cnpq.br/3665611660713029Introduction: The External Quality Monitoring (MEQ) was developed from recommendations of the National Cancer Institute, in order to evaluate the performance of cytopathology diagnostic of the cervix and provide subsidies for continuing education to professionals in laboratories that provide services to public health. Objectives: To evaluate the results of Pap cervical smear between the laboratories accredited by the Single Health System (SUS) according to the diagnostic of the Unit of External Quality Monitoring (UMEQ), checking the frequency of the results of Pap cervical smear, the discordant cases, false positives (FP), false negative (FN) and diagnostic agreement. Methods: A total of 14 laboratories accredited by the SUS indicated by the Municipal Secretary of Health in Goiânia-GO participated in this study. It was reviewed the period from January 2007 to December 2008, Pap cervical smear tests selected by the Information System of Cancer of the cervix including all positive cases, all unsatisfactory ones and at least 5% of negative test results which should achieve at least 10% of the monthly routine of each laboratory, totaling 10,053 tests. These were reviewed by professionals from UMEQ / Faculty of Pharmacy from Federal University of Goiás. It was considered discordant cases in which there was a change in clinical management in accordance with the criteria established by the Ministry of Health. To place the cytological cervical results the Bethesda System was used. The magnitude of agreement was evaluated between the diagnoses using the kappa coefficient. The level of agreement considering its respective confidence intervals of 95% depending on the need to assign different weights to the disagreements were classified as follows: less than 0 - very bad agreement, 0 to 0.2, bad agreement; from 0.2 to 0.4 - reasonable agreement, from 0.4 to 0.6 - good agreement, from 0.6 to 0.8 - very good agreement and from 0.8 to 1.0 excellent. Results: There was disagreement between the UMEQ and laboratories of origin in 763 (7,59%) cases, of these 110 (1,1%) were FN distributed in: 37 (0,37%) atypical squamous cells of undetermined significance (ASC-US), 22 (0,22%) intraepithelial low-grade squamous lesions (LSIL), 30 (0,30%) atypical squamous cells cannot exclude a high-grade lesion (ASC-H), 12 (0,13%) squamous intraepithelial lesions of high grade (HSIL), an (0,01%) intraepithelial lesion of high-grade with suspicious features for invasion, six (0,07%) atypical glandular cells and two (0,02%) adenocarcinomas in situ. There was a delay in clinical management in 245 (2,44%) cases, of these 85 (0,84%) were initially classified as ASC-US and 160 (1,50%) as LSIL.The cases of ASC-US were distributed in: 53 (0,53%) ASC-H, 31 (0,31%) HSIL and an (0,01%) atypical glandular. The cases of LSIL were distributed in: 19 (0,19%) ASC-H, 139 (1,38%) HSIL and two (0,02%) atypical glandular cells. It was considered 283 (2,82%) FP cases and 125 (1,24%) initially negative cases that were reclassified as unsatisfactory. The agreement between the laboratories of origin and the UMEQ was excellent (Kappa = 0.81). It was found that for the evaluation of agreement of each laboratory, the majority showed very good agreement. The agreement of the sample adequacy was considered reasonable (Kappa = 0.30). Conclusion: Most laboratories showed very good agreement, however, it is worth mentioning that MEQ is an exercise of improvement needed to establish the standardization of diagnostic criteria and improve the accuracy of cervical smear.Item Prevalência de problemas de saúde mental em populações de crianças e adolescentes indígenas Karajá da Amazônia brasileira(Universidade Federal de Goiás, 2012-03-14) AZEVÊDO, Paulo Verlaine Borges e; CAIXETA, Leonardo Ferreira; http://lattes.cnpq.br/9536747113677509Objective: To determine the prevalence of mental disorders in children and adolescents from an indigenous population living in isolated tribes in the Brazilian Amazon. Methods: This is an analytical prevalence study in a sample of 192 indigenous children and adolescents from Karajá ethnicity, aged between 7 and 14 years old. The prevalence were determined using the syndrome scales of mental health problems according to the ASEBA questionnaires. The Child Behavior Checklist 6-18 (CBCL) and the Teacher Report Form 6-18 (TRF) were used for the screening of these problems. The difference among the prevalence found in the two questionnaires as well as the risk association between gender and schooling and mental health problems were evaluated. Results: A total prevalence of problems of 34.38% with the CBCL and of 23.44% with the TRF was found (p < 0.00). There was an association between the occurrence of these problems in the subjects attending the second phase of fundamental school (6th to 9th year of formal education). Conclusion: The prevalence of mental health problems found was high when compared to studies with other cultures around the world. It was observed that even in human populations who preserve the primordial cultural aspects of their ancestors who lived 10.000 years ago, psychiatric problems exist and have clinical presentations that are similar to those found in modern civilized societies, in which the cultural context may influence the manifestations of such problems.Item Composição corporal e antropometria de idosos:concordância entre métodos, desenvolvimento e validação de equações preditivas e pontos de corte(Universidade Federal de Goiás, 2011-05-09) BARBOSA, Larissa Silva; SILVEIRA, Erika Aparecida da; http://lattes.cnpq.br/3801865783333828The aim of this study was to assess body composition and anthropometry of the elderly with regard to agreement between methods, development and validation of predictive equations and cutoffs. We evaluated 132 elderly patients (52 men and 80 women) aged between 60 and 91 years, users of primary health care, not institutionalized and drawn at random in proportion to the nine health districts of Goiânia, GO. For collection of anthropometric measurements, bioelectrical impedance (BIA) and dual energy x-ray absorptiometry (DEXA), standardized procedures were used by trained examiners and equipment was calibrated regularly. Analyses were performed using STATA/SE. Descriptive analysis, tests for comparison of means, equation validation according to criteria suggested by Lohman, Bland-Altman and Lin graphic analysis and ROC (receiver operator characteristic curve) analysis were carried out. The project was approved by the Ethics Committee of the Federal University of Goias. The Durnin and Womersley equation showed the highest concordance correlation coefficient (CCC = 0.846) and the lowest mean differences (MD = - 2.335) for males. The equations of Lean et al. (for men) and Deurenberg et al. (for women) showed the highest correlation with and lowest mean differences from DEXA. Equations were proposed to estimate body fat percentage (BF%): (males: BF% = - 16.868 + 0.571TSF + 0.409WC and females: BF% = 8.634 + 0.601BMI + 0.321SISF + 0.234SSSF + 0.398TSF 0.467BSF). In both sexes, the equations are similar to DEXA in estimating BF% with high precision and accuracy. In males, the proposed body mass index (BMI) cutoff point was ≥ 25 kg/m2; the waist circumference (WC) cutoff point was ≥ 98.9 cm. In women, the BMI and WC values with the most sensitivity, specificity and accuracy were ≥ 26.6 kg/m2 and ≥ 90.5 cm. Since the currently available equations for predicting body composition of elderly have certain limitations, these newly developed and validated equations for the two sexes can be recommended for wide use. Accurate BMI and WC cutoff points for predicting BF% in older adults were also identified.Item Qualidade de vida de mulheres com dor pélvica crônica(Universidade Federal de Goiás, 2010-06-16) BARCELOS, Priscilla Rodrigues; CONDE, Délio Marques; http://lattes.cnpq.br/8628571386803692OBJECTIVES: to compare the quality of life (QOL) of women who have or do not have chronic pelvic pain (CPP) and to investigate the factors associated with QOL in women with CPP. METHODS: a cross-sectional study was performed, in which 30 women with CPP and 20 women without CPP were included. They were premenopausal women aged 18 to 50 years attending the gynecologic outpatient department of a tertiary care university hospital (Hospital das Clínicas, Universidade Federal de Goiás, Brazil). A CPP case was considered when presenting with recurrent or constant pelvic pain of at least six months` duration, unrelated to periods. Women who had been pregnant in the previous year or who had a history of malignant disease were excluded. Sociodemographic and clinical features were assessed. The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) questionnaire was used to investigate QOL. It provides an eight-scale profile of scores: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health. These eight domains can be summed up in two summary measures: physical component summary (PCS) and mental component summary (MCS). Pain intensity was evaluated using a mechanical visual analogue scale (VAS). Multiple regression analyses was used to compare QOL scores between women with and without CPP and to identify the factors associated with QOL in women with CPP. RESULTS: the mean age of women with and without CPP was 35.2±7.5 and 36±9.3 years, respectively (p=0.77). Women with CPP had a lower monthly family income (p=0.04) and a higher prevalence of dysmenorrhea (87% versus 40%; p<0.01) and depression (30% versus 5%; p=0.04) compared to those without CPP. After adjusting the analyses using potential confounding variables, women with CPP had lower QOL scores in two domains: bodily pain (31 versus 72; p<0.01) and social functioning (56.3 versus 100; p<0.01). Depression was negatively associated with the role-emotional domain (coefficient: -65.185; CI 95% -130.25 to -0.12; p=0.05) and the MCS (coefficient: -23.271; CI 95% -43.8 to -2.74; p=0.03), whereas pain intensity was negatively associated with the bodily pain domain (coefficient: -8.826; CI 95% -13.98 to -3.66; p<0.01) of the QOL of women with CPP. CONCLUSIONS: women with CPP had poorer QOL compared to those without CPP. Depression in women with CPP was associated with lower QOL. Greater pain intensity, as assessed by the mechanical VAS, was also associated with lower QOL among women with CPP. These factors should be considered when managing CPP patients in an attempt to minimize the negative effects they may exert on QOL.Item Monitoração terapêutica das concentrações plásmaticas da digoxina em pacientes com insuficiência cardíaca(Universidade Federal de Goiás, 2008-10-27) BARROS, Isabel Cristina Medeiros; RASSI, Salvador; http://lattes.cnpq.br/7236834842677715; CUNHA, Luiz Carlos da; http://lattes.cnpq.br/6349547031976679It was investigated the clinical, lab and plasma digoxin concentration profiles in 15 cardiac heart failure (CHF) outpatients of the Cardiac Heart Service of the Goias Federal University Clinical Hospital. It was aimed to know plasma digoxin concentration profile in 15 cardiac heart failure (CHF) outpatients by two analytical methods, taking account clinical, laboratorial, habits, anthropometric data and drug usage. Digoxin dosage was developed by LC/MS/MS and immunoassay methods; questionnaire and consults handbooks were performed. Results and Conclusions: 87% of the patients who over 46 years of age (33% above 61), the masculine majority; the IC of Chagas disease origin presented greater occurrence, followed of the hipertensive and idiopatic (59%); IC functional classroom II (53.33%); hypertension and diabetes had been distinguished as co-morbidities (26.67% and 20%); tobaccoism, overweight and obesity degree I had presented low occurrence. No patients presented relevant clinical data suggestive of digitalis intoxication. No observed changes in biochemical and hematological exams. The ejection fractions were good by means 41.7 ± 9%. Some drugs with interaction potential had been associated to the treatment, apparently without alterations. Statistical significative difference between both methods was observed (P < 0.05, ANOVA, Tukey Test). In the immunoassay method, all the patients were inside of the therapeutical range (0, 5-2, 0 ng/mL), whereas for the LC-MS/MS method, 8 patients they would be in subtherapeutical concentrations. However, no patient presented signals or symptoms of poisoning or inefficacy of the digoxin, demonstrating biological variability. The two methods are useful, since that it has a correlation with the clinical and laboratorial state of the patients.Item Força muscular do assoalho pélvico em mulheres submetidas ao parto vaginal, à cesárea e nulíparas(Universidade Federal de Goiás, 2010-11-17) BATISTA, Elicéia Marcia; AMARAL, Waldemar Naves do; http://lattes.cnpq.br/4092560599116579; CONDE, Délio Marques; http://lattes.cnpq.br/8628571386803692Childbirth may determine pelvic floor modifications that may cause dysfunctions such as urinary/fecal incontinence and pelvic organ prolapse. Furthermore, delivery may be associated with a decrease in pelvic floor muscle (PFM) strength. Objectives: to compare PFM strength in women who delivered vaginally or by cesarean section and nulliparae, investigate the factors associated with PFM strength and demonstrate a correlation between measurements of PFM strength obtained by vaginal digital examination and by perineometer. Methods: a cross-sectional study was conducted, including 31 women following vaginal delivery, 30 following cesarean section and 30 nulliparae. PFM strength was investigated by vaginal digital examination (modified Oxford grading system) and by perineometer. Multiple linear regression analysis with adjustment for covariables was used to compare the mean PFM strength and identify factors associated with PFM strength. The Kendall test was applied to investigate the correlation between vaginal digital examination and a perineometer. Results: the mean age of the participants who delivered vaginally, underwent cesarean section and those who were nulliparous was 32.3±5.8 years, 30.5±5.4 years and 27.2±5.9 years (p<0.01), respectively. The mean PFM strength of women undergoing vaginal delivery and cesarean section was 25.6±14.5cmH2O and 39.6±22.0cmH2O (p<0.01, adjusted for covariables), respectively. A correlation between measurements of PFM strength obtained by vaginal digital examination and perineometer device was observed (tau=0.82; p<0.01). Non-white race/ethnicity was negatively associated with PFM strength (coefficient: -10.2424; p=0.02). Conclusions: women with a history of vaginal delivery had a lower PFM strength than those delivering by cesarean section. Non-white race/ethnicity negatively affected PFM strength. Our data suggest that vaginal digital examination may be applied in clinical practice because of its expressive correlation with a perineometer.Item Ingestão de nutrientes e anemia em crianças de creches municipais em Goiânia(Universidade Federal de Goiás, 2008-02-14) BERALDO, Fernanda Carneiro; HADLER, Maria Claret Costa Monteiro; http://lattes.cnpq.br/6754793957094104; FORNÉS, Nélida Schmid; http://lattes.cnpq.br/0630711826568302Introduction: The high prevalence of anemia, which is a serious public health problem, together with an early and in appropriate introduction of food for children, shows a close relationship between feeding practices and the presence of anemia. Objectives: To compare anemia among anemic and non-anemic children enrolled in municipal day nurseries of Goiânia, the socioeconomic and demographic characteristics, nutritional status, distribution of the consumption of macronutrients and the intake of micronutrients (calcium, iron and vitamin C), for Dietary Reference Intakes; evaluate and compare the ingestion of total iron, heme and non-heme iron and the bioavailable iron in the diets of anemic and non-anemic children from 12 to 24 months and compare the bioavailable iron according to algorithms developed by Monsen et al. and FAO / WHO. Methods: Observational study of cross-sectional analysis with children from 6 to 24 months in Goiânia-Goiás, in the years of 2005 and 2006. Investigations of socioeconomic, demographic and food (direct food weighing and 24 hour dietary recall) were applied for 2 days and the anthropometric evaluation and the dosage of hemoglobin were done. The diagnosis of anemia was determined by the level of hemoglobin less than 11 g / dL. Results: 89 children were studied. The prevalence of anemia was 53.9%. It was observed an statistically significant difference between anemic and non-anemic children as for per capita income. The proportion of macronutrients in the diets of the evaluated groups was appropriate and there was no difference statistically significant. Among the anemic children (n = 47), the prevalence of inadequacy was 12.8% for iron and 8.5% for vitamin C, whereas in the non-anemic ones (n = 41), the prevalence of inadequacy for iron and vitamin C was: 14.6% and 7.3%, respectively. The average intake of calcium was 50% above the recommendations in both groups. By the criterion of the World Health Organization, it was realized an anthropometric evaluation in three moments and the anemic had greater z-score according to the weight / length than non-anemic in the 2 and 3 moments (p = 0.015 p = 0.006) respectively . The average consumption of total iron, non-heme and bioavailable iron were low in the groups studied, showing no statistically significant difference. There was an intense positive correlation between the methodologies used to evaluate the iron bioavailable (r = 0.91 r = 0.84) for nonanemic and anemic children, respectively. Conclusion: There was a statistically difference between per capita income and anemia. It was observed a greater z-score for the index weight / length in the anemic children. There was no statistically difference between the two groups in relation to the consumption of calcium, iron and vitamin C, however there was a significant prevalence of inadequacy of iron and vitamin C, besides a high intake of calcium in the diet. There was a low total consumption of iron, heme and non-heme and bioavailable iron that reinforces the importance of the knowledge of food consumption of children, as well as the adoption of measures that ensure the supply of food sources of iron and food promoters of bioavailability of this micronutrient.Item Estudo da Relação entre Hiperatividade dos Músculos Esfenomandibulares e dor ocular(Universidade Federal de Goiás, 2010-07-13) BORGES, Raulino Naves; ÁVILA, Marcos; http://lattes.cnpq.br/3335187297522447study was based on the hypothesis that a TMD can be the etiological factor in ocular pain and to test it the authors performed a clinical evaluation in TMD patients presenting with sphenomandibular muscle hyperactivity. The hypothesis is based on the fact that the muscle originates in the lateral aspect of the orbit, with a point of insertion in the mandible. It is an observational and descriptive study, characterized by: 1) an anatomical investigation performed in cadavers and 2) a clinical interpretation of the physiological relationship between sphenomandibular muscle functions and symptoms involving temporomandibular disorders presenting with ocular pain. Ten anatomical specimens (five cadavers) from the Anatomy Department of the School of Medicine of the Catholic University of Goiás were examined. One hundred three patients with temporomandibular disorders (TMD) were treated and followed in the Outpatient Clinic of the School of Dentistry of the Federal University of Goiás for the purpose of studying the interrelationship between cervical and craniofacial pain symptoms and craniomandibular disorders. The work was carried out in the Outpatient Clinic of the School of Dentistry of the Federal University of Goiás, between April 2006 and December 2008. Inclusion criteria, used to form Group I, totaling 58 patients, included temporomandibular disorders, referred ocular pain and sphenomandibular muscle hyperactivity. Group II comprised 45 patients who did not present with sphenomandibular muscle hyperactivity. All the patients received treatment for Temporomandibular Disorder (Groups I and II) and were followed for two years, with biannual evaluation visits. Response to treatment was evaluated by means of an opinion-based questionnaire that served to stratify the level of ocular pain, which was reported as eliminated in 46 of the 58 patients in Group I (79.3%) and in eight Group II patients (17.8%). This evaluation has made it possible for the authors to affirm that the sphenomandibular muscle is independent from the temporal muscle and is closely related to the orbit; the clinical examinations conducted along the study enabled the evaluation of sphenomandibular muscle hyperactivity in temporomandibular disorder episodes; and this hyperactivity is significantly associated to the presence of referred ocular pain.Item Adesão de pessoas adoecidas de AIDS (Síndrome da Imunodeficiência Adquirida) à terapia antiretroviral: estudo clínico e laboratorial à partir da orientação de Enfermagem(Universidade Federal de Goiás, 2011-02-21) BRASILEIRO, Marislei de Sousa Espíndula; CUNHA, Luiz Carlos da; http://lattes.cnpq.br/6349547031976679Adherence to antiretroviral therapy reduces the risk of treatment failure, toxicity and resistance, so the therapeutic monitoring is necessary in the treatment of infection by human immunodeficiency virus. The aim of this study was to determine, through clinical and laboratory studies, the compliance of individuals sickened by HIV / AIDS with antiretroviral therapy before and after three nursing interventions. The study design was analytical, descriptive, prospective and quantitative, using data from medical records, interviews and blood sampling for plasma levels of efavirenz by HPLC analysis, including subjects with a diagnosis of HIV / AIDS, attended at the Hospital for Diseases Tropical Goiânia - Goiás and treated with zidovudine/ lamivudine and efavirenz. The results of analysis of data from 15 subjects indicate a socio-demographic profile, predominantly male, young, heterosexual. After nursing intervention, there was a change in 48% of the diagnoses. We also noticed a positive change in the rates of CD4, corresponding to 14%. As viral count, an increase of subjects with undetectable loads of 1 st to 2 nd nursing intervention (20%, or 73.3% to 93.3%). Chromatographic analysis of plasma of the subjects indicated that 60% of them had adequate medication adherence, and 40% increased adhesion between the 1st and 2nd visits by nurses, 10% between the 1st and 3rd and 10% between the 2nd and 3rd queries. The factor that was associated with high concentration rate after adjustment in nursing diagnoses and prescriptions was having difficulty using the antiretroviral in the same time. It was also demonstrated significant difference between mean plasma concentrations of efavirenz from the 1st, 2nd and 3rd interventions. Considering the reference measurement of plasma concentrations of efavirenz, the method of accession had a sensitivity and specificity, with high proportion of agreement between the rate of CD4, nursing diagnosis and analysis of the plasma of subjects. Conclusions: the systematization of nursing care and determination of plasma concentrations should be incorporated into the routine outpatient care, for better monitoring of adherence to antiretroviral therapy of individuals sickened by HIV / AIDS.Item Aspectos Inflamatórios e Imunológicos de Pulpites Dentárias Humanas(Universidade Federal de Goiás, 2009-09-18) BRUNO, Kely Firmino; ESTRELA, Carlos; http://lattes.cnpq.br/3611967334176683Immune and inflammatory cells may contribute to host defense and microenvironmental changes during the pathogenesis of dental pulpitis. This study evaluated the microscopic characteristics and densities (per mm2) of tryptase+ mast cells, CD4+ T helper lymphocytes, CD45RO+ memory T lymphocytes, foxp3+ T regulatory lymphocytes, CD20+ B lymphocytes, CD68+ macrophages, and CD31+ blood vessels in human dental pulpitis (n = 38). Methods: Tryptase, CD4, CD45RO, foxp3, CD20, CD68, and CD31 expressions were analyzed using immunohistochemistry; other microscopic features, such as intensity of inflammatory infiltrate and collagen deposition, were evaluated after staining with hematoxylin and eosin. Results: Two microscopic patterns of dental pulpitis were found: group 1 (G1) (n = 15) showed intense inflammatory infiltrate and mild collagen deposition; conversely, group 2 (G2) (n = 23) showed scarce inflammatory infiltrate and intense collagen deposition. The numbers of CD68+ and CD20+ cells and the density of blood vessels were higher in G1 than in G2. However, there were no differences in CD4+ and CD45RO+ cell densities between groups. When present, mast cells were equally distributed in G1 and G2, whereas foxp3+ cells were detected in 58.82% and 14.28% of the samples of G1 and G2. Conclusions: Immune and inflammatory cell infiltration have different patterns in human dental pulpitis, which might reflect distinct microscopic characteristics and particular local defense capabilities.Item Avaliação de citocinas na secreção endocervico-vaginal de pacientes com vaginose bacteriana e papilomavírus humano(Universidade Federal de Goiás, 2011-03-09) CAMPOS, Ana Claudia Camargo; REIS, Cleomenes; http://lattes.cnpq.br/5103786277121402The vagina and the cervix are the first immune and physical line of defense against sexually transmitted pathogens. However infectious process in the vagina, caused by potentially pathogenic microorganism such as bacterial vaginosis (BV), are very often. This may be associated with a morbid entity as Human Papillomavirus (HPV). It was evaluated the association between the presence of BV and HPV in the lower female genital tract, identifying the clinical and lab aspects in women who received medical attention at emergency rooms in the city of Goiânia-GO and observed the production of cytokines in endocervical secretions in cases with VB associated with HPV. This study included 173 sexually active women, between 16 and 48 years old, divided into groups: control, with BV and with high and low risk of HPV. A survey was conducted to collect the intrinsic and extrinsic factors associated with the patients. Microbial cultures, vaginal pH, identification of high and low risk of HPV by PCR, and the concentration of cytokines were performed. The result of the research data was submitted to a statistical analysis, calculating the oods ratio, confidence intervals and p of 0,05. Forty seven cases of BV were diagnosed. Besides, the presence of a vaginal pH > 4.5, showed a result statistically significant for the presence of HPV, p = 0.001 was also observed. When analyzing the multivariate logistic regression, the independent risk factors for the presence of VB were: having more than one sexual partner in the last 5 years p<0,001 and have more than 3 sexual intercourses per week p=0,002. But in HPV infection the independent risk factors were: being married p=0,029 and pH ≤ 4.5 p<0,001 and in the case of high-risk HPV the only independent factor considered was the pH ≤ 4.5 p= 0,006. Relating HPV infections with high and low risk and the presence of VB with some immune factors by the strength of local cytokines, it was found that, IL-2 and IL-12 were significantly elevated in cases of BV and HPV. The IL-6 was high only for HPV, followed by IFN-gamma and IL-10 although the last two showed a trend towards statistical significance in HPV cases. It was concluded through the univariate analysis that the factors, having more than one sexual partner in the last 5 years, a failure in the use of condoms and the presence of leucorrhoea and dyspaurenia were related to the presence of BV and level of alkaline in the vagina which could possibly predispose to infections HPV, and the immune response Th1-type cytokines in vaginal secretions in the presence of BV and/or HPV may also be similar.Item Efeito da aplicação de cinesioterapia e eletroestimulação no trabalho de parto(Universidade Federal de Goiás, 2010-02-21) CANESIN, Kariny Fleury; AMARAL, Waldemar Naves do; http://lattes.cnpq.br/4092560599116579Aiming to evaluate the techniques described in the literature to decrease the time of labor birth and the application of techniques of exercise, massage and transcutaneous electrical nerve stimulation on the active phase of labor and intensity of pain in primiparas. The habit of women to keep moving during labor in an upright position (standing, sitting and / or walking) was a practice more common in some cultures. Historically, the postures and the vertical position change and ambulation have been reported to evolve as efficient dilation, relieve pain during contraction and facilitate the descent of the fetus through the birth canal. We conducted a randomized clinical trial, prospective which was attended by 60 women at the beginning of the active phase with 5 cm of cervical dilation, a public hospital in Goiania in the period July 2009 to July 2010. The women were divided into three groups: control (n = 20), exercise (n =20) and electrical stimulation (n = 20), and monitored during the active phase of labor. During this period, data were collected: Template for recording data (age, weight, height and maternal BMI, race, education), visual analog scale pain, and partograph (gestational age, duration of labor, weight and height of the newborn). In the study, comparing the group of exercise with electrical stimulation and control groups there was a significant difference in the time of labor (p = 0.003). However, in relation to pain intensity difference was not statistically significant (p> 0.05). It is concluded according to the literature there is no way to define a specific technique to encourage labor birth and techniques of exercise, electrical stimulation used in the active phase of labor, the motherspromote progression of labor, but not interfere in its intensity pain.Item A saúde mental em cursos de graduação na área da saúde em Goiânia/GO interfaces com a Reforma Psiquiátrica e as Diretrizes Curriculares Nacionais(Universidade Federal de Goiás, 2010-06-15) CARNEIRO, Larissa Arbués; BARBOSA, Maria Alves; http://lattes.cnpq.br/5025797873585225; PORTO, Celmo Celeno; http://lattes.cnpq.br/9673684282497548Dissertation Thesis consisting of two steps each article format. The first, a bibliographic search, sought to understand the scientific literature in national periodicals on the teaching of mental health in undergraduate in health courses. The consultation was held in the Virtual Health Library (VHL) for publications between April 2001 to December 2009, twenty-six articles were the corpus of the study and their data were identified through a protocol. The results indicate that were more frequent papers published in 2005, authorship of nursing and studies of reporting experience type. The reports have revealed a trend of changes in educational practices. Despite the strong influence of biomedical model focusing psychopathologic, currently converge the theoretical framework of Collective Health and Psychiatric Reform, as well as the diversification of practice scenarios and development of communication and relationship skills in students, themes been underwritten by axis of interdisciplinarity and by humanizing, de-institutionalisation and subjectivity and rights of citizenship. Before this movement for change, the second step of the search sought to describe the insertion of the theme in local context, for both were investigated mental health disciplines in Nursing, Medicine, Psychology and Occupational Therapy courses in two universities of Goiânia/GO/Brazil. The data sources were: curricular matrix, programs of nine disciplines/thematic areas and questionnaires applied to teachers. Survey data shows characteristics of disciplines in relation to the matrix curricular, practice scenarios, methods and contents adopted. The results indicated that in the general context of disciplines there is a nascent but important rapprochement with Psychiatric Reform and National Curriculum Guidelines principles. Shows the coexistence of messages from biomedical and biopsychossocial models, with greater emphasis on the first model. It is expected that the results of this dissertation can bring subsidies for understanding the mental health teaching-learning process, extending discussions on the theme that forward-looking building knowledge and practice in the context of mental health education. Some of these paths have already been flagged as factors that drive changes the magnification of theoretical, intra and interpersonal skills learning, diversification of scenarios and teaching-learning practices and the strengthening of integration education-service. Suggested further studies in mental health education with the goal of better understanding of local and national realities and investigate how undergraduate come operationalizing making changes from National Curriculum Guidelines and Psychiatric Reform.Item Encontro clínico no modelo biopsicossocial: autopercepção dos acadêmicos de medicina da Pontifícia Universidade Católica de Goiás(Universidade Federal de Goiás, 2010-11-30) CARVALHO, Gélcio Sisteroli de; CHAVES, Sandramara Matias; http://lattes.cnpq.br/8215617614854729; PORTO, Celmo Celeno; http://lattes.cnpq.br/9673684282497548Introduction: The Pontifical Catholic University of Goiás pedagogical project for its medical course has stemmed from a thirty year long dream. It came into existence in 2005 following the authorization granted by the National Council of Education after the homologation of the National Curricular Guidelines. The present study shows the need to further investigate the development of assessment processes which are used to identify, follow and materialize changes in medical training. The theory used lies on the possibility of quantifying the medical performance in the patient-physician encounter. Objective: to evaluate some components of the patient-physician encounter based on biopsychosocial model; to create an assessment tool to measure the self-perception of this encounter; to test the effectiveness of this tool in this scenario; and to quantify the category variables of the research in a Pontifical Catholic University of Goiás medical course. Materials and Methods: This was a quantitative, longitudinal and cohort study. The study group presented 39 medical students from 5th Class of the Pontifical Catholic University of Goiás Medical School Course and the investigation was divided into two stages with a year interval between the application of the required academic protocols preceded by a medical semiological conclusion. The dimensions under observation were the following: biomedical, cognitive, ecosystemic, psychological and bioethical. The assessment tool was designed to present 5 dimensions,18 facets and 72 indicators, divided into groups of four alternatives per facet, scaled in degrees 0,1,2 or 3. The higher the degree, the higher the complexity of the biopsychosocial model represented by the software program developed by the researcher called Project 2. Introduction: The Pontifical Catholic University of Goiás pedagogical project for its medical course has stemmed from a thirty year long dream. It came into existence in 2005 following the authorization granted by the National Council of Education after the homologation of the National Curricular Guidelines. The present study shows the need to further investigate the development of assessment processes which are used to identify, follow and materialize changes in medical training. The theory used lies on the possibility of quantifying the medical performance in the patient-physician encounter. Objective: to evaluate some components of the patient-physician encounter based on biopsychosocial model; to create an assessment tool to measure the self-perception of this encounter; to test the effectiveness of this tool in this scenario; and to quantify the category variables of the research in a Pontifical Catholic University of Goiás medical course. Materials and Methods: This was a quantitative, longitudinal and cohort study. The study group presented 39 medical students from 5th Class of the Pontifical Catholic University of Goiás Medical School Course and the investigation was divided into two stages with a year interval between the application of the required academic protocols preceded by a medical semiological conclusion. The dimensions under observation were the following: biomedical, cognitive, ecosystemic, psychological and bioethical. The assessment tool was designed to present 5 dimensions,18 facets and 72 indicators, divided into groups of four alternatives per facet, scaled in degrees 0,1,2 or 3. The higher the degree, the higher the complexity of the biopsychosocial model represented by the software program developed by the researcher called Project 2.Results: Through a circular radial profile with a central point and three areas with crescent spirals graded by differing shades of colors, we have been able to represent the clinical encounter, using the individuals self-perception. The results showed the effectiveness of the software, following a quality control process across all responses. We have used descriptive statistics to mathematically analyze the increase in the study group performance, and compare the responses in percentages in the two stages of the study. We have found a weak association between the category variables (facets) using the Chi-square ratio with the Cramer s-V Coefficient, except for the following facets: Critical Analysis(p 2 = 0,002); Social Health Indicators (p 2 = 0,007); e Health Promotion (p 2 = 0,049). As for individual self-perception, having the facet responses as a reference, 26 subjects (66,7%) showed growth in the formation process; 6 (15,4%) showed decrease and 7 (17,9%) remained unaltered. Conclusion: Through the use of the academic protocol and the biopsychosociallybased patient-physician self-perception assessment tool we have been able to quantitatively assess the academic performance as to knowledge, skills and medical attitudes displayed in the interaction of the physician with the patient. The selfperception assessment tool designed to graphically represent such encounters was put to test and has fulfilled all its objectives. The evaluation of the study group evidentiated some biopsychosocially practices in the pedagogical process used by the Pontifical Catholic University of Goiás Medical School. After a year interval between the stages of the study, an increase was observed in the self-perception of the individuals performance 2,9 times as high as the decrease responses. A long-term application of our findings include opportunities to use this methodology for an on-going self-evaluation of the medical students, provide insights about individual performance in the different stages of the medical training, create a new scenario in the academic portfolios as an evaluation and curricular history resource, and finally adjust the assessment tool so that it could be used by other courses and professionals in the health area working in clinical settings.Item Prevalência de sinais e sintomas do transtorno de déficit de atenção e hiperatividade em crianças e adolescentes da cidade de Cavalcante-GO que se identificam como Kalunga(Universidade Federal de Goiás, 2011-03-16) CARVALHO, Karla Cristina Naves de; CAIXETA, Leonardo Ferreira; http://lattes.cnpq.br/9536747113677509Few studies have been conducted worldwide on Attention Deficit Disorder and Hyperactivity Disorder (ADHD) in rural communities and none in Brazil so far. This is the first prevalence research on the signs and symptoms of ADHD in children and adolescents who identify themselves as Kalunga, as well as one of the pioneers on this field specifically with African descendants in Brazil. Its overall objective was the investigation of the presence of signs and symptoms of ADHD in children and adolescents (from 6 to 18 years) who identify themselves as Kalunga, in Cavalcante- GO, Brazil. A total of 204 children and adolescents were assessed through the responses provided by their parents or guardians and their teacher during interviews using the Child Behavior Checklist for Ages 6-18 (CBCL/6-18) and the Teacher s Report Form for Ages 6-18 (TRF/6-18), respectively. Using the CBCL/6-18 and TRF/6-18, the signs and symptoms of ADHD were detected in 5.9% and 5,4% of the individuals assessed, whereas those of ADD were observed in 16.2% and 15.2% of them, respectively. Also, we detected that the prevalence of ADD in this study was higher than the national average, while the ADHD presented median prevalence compared with that of the world population. According to the evaluations of parents or guardians and teachers, the following estimated prevalences of comorbidities with signs and symptoms of ADHD were observed, respectively: 83% and 90% with oppositional defiant disorder; 41.6% and 45.4% with conduct disorder; 58.3% and 63.6% with anxiety disorders; 33.3% and 36.3% with affective disorders. In accordance with the evaluations of parents or guardians and teachers, the following estimated prevalences of comorbidities with signs and symptoms of ADHD were registered, respectively: 60.6% and 64% with oppositional defiant disorder; 54.5% and 58% with conduct disorder; 75.7% and 80.6% with anxiety disorders; 57.5% and 61.2% with affective disorders. We concluded that ADD exists in a culturally diverse population, the children and adolescents who identify themselves as Kalunga and who live in Cavalcante-GO, Brazil, presenting a high prevalence rate, with comorbidities commonly found in other populations of children from various cultures around the world. On the other hand, the signs and symptoms of ADHD in the present sample presented a prevalence that can be compared with that of the world population, also with comorbidities commonly found in studies performed in several parts of the world and some carried out in Brazil.