bluuebunny/crossref_metadata_2025 huggingface dataset:
Training for Fitness: Reconsidering the 80-Hour Work Week
Authors: Caldicott Catherine V , Holsapple James W
Published: January 2008

The medical literature is replete with articles about the Accreditation Council for Graduate Medical Education's 2003 resident duty hour restrictions. Most of these papers describe creative and thoughtful responses to the new system. However, others express concern that the "80-hour work week" could hamper continuity of care and educational activities. Nevertheless, if fatigue impairs resident learning and medical care quality, then work hour restrictions seem worthwhile. We add our voices to the critics' for additional reasons. Data support that fatigue occurs even with reasonable work schedules, and residents do not reliably use time off from work to rest. Regulated work schedules can interfere with adequate rehearsal of the physical and mental stamina required in certain specialties, yet patients have a right to expect their physicians to be trained in the particular demands of those specialties. Similarly, residents have a right to a realistic understanding of authentic clinical practice. Further, while self-sacrifice need not be routine, trainees should feel that occasional self-sacrifice is appropriate and acceptable for a physician. We reject uniform, arbitrary duty hour limits for all specialties. Rather, we propose that a subspecialty-based system can foster the development of the endurance, skills, and reasoning that patients and colleagues expect.
Survival Advantage of the Hemochromatosis C282Y Mutation
Authors: Weinberg Eugene D
Published: January 2008

The hemochromatosis C282Y mutation is present in up to 12.5% of people in populations of northern and central European origin. The prevalence of this mutation suggests that it may confer some type of epidemiologic advantage. One hypothesis has proposed that female heterozygotes have enhanced dietary iron absorption during their reproductive years, but evidence in support of this concept is not available. A second hypothesis is based on the observation that macrophages in iron-loaded C282Y homozygotes are very low in iron. These persons would be predicted to have increased resistance to pathogens that require iron for growth in macrophages. Notable examples of such pathogens are S. typhi and M. tuberculosis, the bacteria that cause typhoid fever and tuberculosis. Several cellular models that provide evidence for the low-iron macrophage hypothesis have recently been described.
Improving the Quality of Care via Maintenance of Certification and the Web: An Early Status Report
Authors: Holmboe Eric S , Lynn Lorna , Duffy F. Daniel
Published: January 2008

Few question the need for continuous professional development throughout a physician's career, but rapid changes in health care are creating demand for physicians to acquire new knowledge, skills, and attitudes to implement quality improvement in clinical practice. The Internet and World Wide Web are technologies that have the potential to facilitate deep change in physician practice and lifelong learning. This paper describes how the American Board of Internal Medicine (ABIM) has utilized the Web and the Internet to engage physicians in the competencies of practice-based learning and improvement and systems-based practice. Specifically, we describe how the ABIM developed and implemented Web-based practice improvement modules (PIMs) to help physicians measure and improve their clinical practice.
Medical Simulation: The New Tool for Training and Skill Assessment
Authors: Carroll John D , Messenger John C
Published: January 2008

Medical simulation is a new method to facilitate skill training and assessment. Simulation has achieved a high degree of sophistication in aviation and other fields. However, the complexity of health care, the numerous stakeholders, and the lack of central control of medical education have been barriers to the development and broad implementation of medical simulation. Acceptance by the medical community is growing, with the publication of scientific validation studies, the development of economic models and funding, and the integration of simulation into existing curricula and training programs. The major forces for implementing simulation will most likely come from the medical device industry and from institutions with mandates to improve the quality of health care and enhance patient safety. Certification boards are expected to increase their utilization of simulation technology to objectively assess proficiency of skills relevant to physicians and the health care system. Medical simulation has made the transition from an experimental technology to the clinical world, and the next five to 10 years may be viewed as the golden age of medical simulation.
Simulation in Health Care Education
Authors: Issenberg S. Barry , Scalese Ross J
Published: January 2008

During the past 15 years there has been widespread adoption of simulation in health care education as a method to train and assess learners. Multiple factors have contributed to this movement, including reduced patient availability, limited faculty teaching time, technological advances in diagnosis and treatment that require a new skills set, greater attention to patient safety with the need to reduce medical errors, and a focus on outcomes-based education. In this discussion, simulation refers broadly to any device or set of conditions that attempts to present the patient authentically. While simulation offers many advantages over traditional methods of teaching, there are several challenges that must be addressed to ensure its effective use. This article presents the range of available simulation technologies, explores the challenges that health care educators face when using this method, provides an example of a successful program that has integrated simulation into the culture of learning at its institution, and discusses an approach to maximizing the effectiveness of simulation as a means to learning and practicing skills in a safe, interactive environment.
Two Faces of Death: Fatalities from Disease and Combat in America's Principal Wars, 1775 to Present
Authors: Cirillo Vincent J
Published: January 2008

Throughout America's first 145 years of war, far more of the country's military personnel perished from infectious diseases than from enemy action. This enduring feature of war was finally reversed in World War II, chiefly as a result of major medical advances in prevention (vaccines) and treatment (antibiotics). Safeguarding the health of a command is indispensable for the success of any campaign. Wars are lost by disease, which causes an enormous drain on the military's resources and affects both strategy and tactics. Disease and combat mortality data from America's principal wars (1775–present) fall into two clearly defined time periods: the Disease Era (1775–1918), during which infectious diseases were the major killer of America's armed forces, and the Trauma Era (1941–present), in which combat-related fatalities predominated. The trend established in World War II continues to the present day. Although there are currently more than 3,400 U.S. military fatalities in Iraq, the disease-death toll is so low that it is exceeded by the number of suicides.
Computer-Assisted Medical Education: Current and Potential Roles
Authors: Stern Scott D. C
Published: January 2008

Medical education remains a time-consuming and complex task whose goals are to provide students with sufficient factual information and the clinical reasoning tools to ensure the competency of its graduates. Today, this task is especially challenging because of the exponential growth in biomedical information and the ever-increasing time pressure placed upon medical educators. Electronic tools have the capacity to facilitate medical education, as well as to fundamentally improve our ability to ensure the competency of our graduates. This article reviews some of the approaches to electronic education developed at the University of Chicago.
Moderation or the Middle Way: Two Approaches to Anger
Authors: Vernezze Peter
Published: January 2008

Most of us tend to be Aristotelians when it comes to anger. While admitting that uncontrolled anger is harmful and ought to be avoided, we reject as undesirable a state of being that would not allow us to express legitimate outrage. Hence, we seem to find a compelling moral attitude in Aristotle's belief that we should get angry at the right time and for the right reasons and in the right way. Buddhism and Stoicism, however, carve out a position on the issue of anger that stands in marked contrast to the Aristotelian conception. This article considers the similarities between these two views of anger, contrasts the Buddhist with the much more common (at least in the West) Aristotelian one, and, finally, considers the objections of a prominent Western scholar to this shared Buddhist/Stoic conception.
Cosmogony as Political Philosophy
Authors: Kim Youngmin
Published: January 2008

This essay examines the Diagram of the Supreme Ultimate and its shifting interpretations—those of Zhu Xi (1130–1200) and Wang Tingxiang (1474–1544) in particular—and by doing so explores the significance of ''cosmogony'' in the Confucian tradition and its significance for the change of political philosophy from the Song dynasty through the Ming. First, through a close reading of Zhu Xi's commentaries on the Diagram, it is argued that they should be interpreted primarily as a statement of political philosophy rather than a mere textual study of Zhou Dunyi's metaphysics. Wang Tingxiang's reworking of the Diagram is examined in order to explore the transformation of its worldview through the shifted focus from li to qi. Then, by connecting the fundamental structures of the two cosmogonies to other aspects of their systems of thought, the moral and political implications that develop from the cosmogonies are unraveled. This examination of shifting interpretations of the Diagram will shed light on the cosmogonies as crucial expressions of political philosophy in the Confucian tradition without losing sight of their historical contexts.
On Dōgen and Derrida
Authors: Bredeson Garrett Zantow
Published: January 2008

Are Derrida's critique of presence and Dōgen's emphasis on presence incompatible? I argue that they are not—and, in fact, that there is a deep connection between the projects of the two thinkers. In showing this I hope to combat some serious misconceptions about essential aspects of both Zen Buddhism and deconstruction.
Activity and Communal Authority: Localist Lessons from Puritan and Confucian Communities
Authors: Fox Russell Arben
Published: January 2008

Puritanism and Confucianism have little in common in terms of their substantive teachings, but they do share an emphasis on bounded, authoritative, localized human arrangements, and this profoundly challenges the dominant presumptions of contemporary globalization. It is not enough to say that these worldviews are ''communitarian'' alternatives to globalism, for that defines away what needs to be explained. This article compares the ontology of certain elements of the Puritan and Confucian worldviews, and, by focusing on the role of both authority and activity in these systems, assesses (with the assistance of Max Weber) the theories of harmony that each invoke. It concludes by identifying the distinct options that these two modes of human existence suggest for those who wish to defend the relevance of boundedness and authority, and thus the very possibility of a human-scaled politics, in today's world.
The Role of Iconicity in International Sign
Authors: Rosenstock Rachel
Published: January 2008

This article investigates the role of iconicity in International Sign Language (ISL), as used by interpreters for Deaf people at international conferences. In analyses of ISL, specific issues of iconicity (e.g., degree of abstractness, levels of application, competing motivations, and universality) are considered and applied to ISL data. The data used in this article were recorded at Deaf Way II, an international conference held in Washington, D.C., and exemplify iconic structures on the lexical, syntactic, and discourse-pragmatic levels.
Breaking the Molds: Signed Languages and the Nature of Human Language
Authors: Slobin Dan Isaac
Published: January 2008

Grammars of signed languages tend to be based on grammars established for written languages, particularly the written language in use in the surrounding hearing community of a sign language. Such grammars presuppose categories of discrete elements which are combined into various sorts of structures. Recent analyses of signed languages go beyond this tradition, attending to gradient elements of signs and to the communicative and physical settings in which signs are produced. Important new insights are gained when sign language linguists consider such factors, making use of new tools of cognitive linguistics. A typological approach to signed languages suggests that they are of the opposite type to the surrounding spoken/written languages of Europe, North America, and East Asia. Those languages are dependent-marked, whereas signed languages are head-marked.
Passive and Assertive Secularism: Historical Conditions, Ideological Struggles, and State Policies toward Religion
Authors: Kuru Ahmet T.
Published: January 2008

Why do secular states pursue substantially different policies toward religion? The United States, France, and Turkey are secular states that lack any official religion and have legal systems free from religious control. The French and Turkish states have banned students' headscarves in public schools, whereas the U.S. has allowed students to wear religious symbols and attire. Using the method of process tracing, the author argues that state policies toward religion are the result of ideological struggles. In France and Turkey the dominant ideology is “assertive secularism,” which aims to exclude religion from the public sphere, while in the U.S., it is “passive secularism,” which tolerates public visibility of religion. Whether assertive or passive secularism became dominant in a particular case was the result of the particular historical conditions during the secular state-building period, especially the presence or absence of an ancien regime based on a marriage of monarchy and hegemonic religion.
Proximate Outcomes of Gatekeeper Training for Suicide Prevention in the Workplace
Authors: Cross Wendi , Matthieu Monica M. , Cerel Julie , Knox Kerry L.
Published: January 2008

In this pilot study we report on proximate outcomes of a 1‐hour community gatekeeper training in‐service for 76 nonclinical employees in a university hospital workplace setting. Pre‐post analyses resulted in positive changes in participants' knowledge about suicide and attitudes (self‐efficacy) about intervening with suicidal individuals. A subset of participants engaged in role play practice of gatekeeper skills following training and rated the experience positively. Fifty‐five observations were rated using an observational measure developed for this study and approximately half of these demonstrated satisfactory skills post training. Participants in this workplace gatekeeper training reported sharing new knowledge and skills with family, friends, and coworkers.
Health Status and Health Care Expenditures in a Nationally Representative Sample: How Do Overweight and Healthy-Weight Children Compare?
Authors: Skinner Asheley Cockrell , Mayer Michelle L. , Flower Kori , Weinberger Morris
Published: January 2008

OBJECTIVE. Childhood overweight is epidemic in the United States. Although limited, previous studies suggest that overweight children have chronic health problems. A more complete understanding of the effect of overweight on children's health requires a nationally representative, population-based sample. Our objective was to examine whether overweight children have (1) more chronic conditions, (2) poorer health, and (3) greater health care expenditures than healthy-weight children.

PATIENTS AND METHODS. This was a cross-sectional study of children aged 6 to 17 years participating in 1 of 2 nationally representative surveys of civilian, noninstitutionalized Americans, the 2001–2002 National Health and Nutrition Examination Survey and 2002 Medical Expenditure Panel Survey. The main outcome measures were prevalence of dyslipidemia, hyperglycemia, and hypertension; self-reported health status; and health care expenditures.

RESULTS. Overweight children, compared with healthy-weight children, have significantly increased risk for high total cholesterol levels (15.7% vs 7.2%), high low-density lipoprotein (11.4% vs 7.7%) or borderline low-density lipoprotein cholesterol levels (20.2% vs 12.5%), low high-density lipoprotein cholesterol levels (15.5% vs 3.0%), high triglyceride levels (6.7% vs 2.1%), high fasting glucose levels (2.9% vs 0.0%), high glycohemoglobin levels (3.7% vs 0.5%), and high systolic blood pressure (9.0% vs 1.6%). Overweight children, compared with healthy-weight children, demonstrate significantly lower prevalence of excellent health (National Health and Nutrition Examination Survey: 36.5% vs 53.3%; Medical Expenditure Panel Survey: 42.8% vs 55.6%). These differences persist in multiple regression models that control for potential confounders. In adjusted analyses, expenditures were comparable between overweight and healthy-weight children.

CONCLUSIONS. Our data demonstrate that overweight children have more chronic conditions and poorer health but have health care expenditures that are no greater than those for healthy-weight children. Addressing the health care needs of overweight children may prevent the development of chronic conditions and improve health status. These findings demonstrate the need to more thoroughly consider whether (1) overweight children have appropriate access to care, (2) physicians fully recognize the impact of overweight, and (3) physicians have resources to address overweight.
Racial and Ethnic Disparities in Medical and Dental Health, Access to Care, and Use of Services in US Children
Authors: Flores Glenn , Tomany-Korman Sandra C.
Published: January 2008

BACKGROUND. Not enough is known about the national prevalence of racial/ethnic disparities in children's medical and dental care.

OBJECTIVE. The purpose of this work was to examine racial/ethnic disparities in medical and oral health, access to care, and use of services in a national sample.

METHODS. The National Survey of Children's Health was a telephone survey in 2003–2004 of a national random sample of parents and guardians of 102353 children 0 to 17 years old. Disparities in selected medical and oral health and health care measures were examined for white, African American, Latino, Asian/Pacific Islander, Native American, and multiracial children. Multivariate analyses were performed to adjust for primary language at home, age, insurance coverage, income, parental education and employment, and number of children and adults in the household. Forty measures of medical and oral health status, access to care, and use of services were analyzed.

RESULTS. Many significant disparities were noted; for example, uninsurance rates were 6% for whites, 21% for Latinos, 15% for Native Americans, 7% for African Americans, and 4% for Asians or Pacific Islanders, and the proportions with a usual source of care were as follows: whites, 90%; Native Americans, 61%; Latinos, 68%; African Americans, 77%; and Asians or Pacific Islanders, 87%. Many disparities persisted for ≥1 minority group in multivariate analyses, including increased odds of suboptimal health status, overweight, asthma, activity limitations, behavioral and speech problems, emotional difficulties, uninsurance, suboptimal dental health, no usual source of care, unmet medical and dental needs, transportation barriers to care, problems getting specialty care, no medical or dental visit in the past year, emergency department visits, not receiving mental health care, and not receiving prescription medications. Certain disparities were particularly marked for specific racial/ethnic groups: for Latinos, suboptimal health status and teeth condition, uninsurance, and problems getting specialty care; for African Americans, asthma, behavior problems, skin allergies, speech problems, and unmet prescription needs; for Native Americans, hearing or vision problems, no usual source of care, emergency department visits, and unmet medical and dental needs; and for Asians or Pacific Islanders, problems getting specialty care and not seeing a doctor in the past year. Multiracial children also experienced many disparities.

CONCLUSIONS. Minority children experience multiple disparities in medical and oral health, access to care, and use of services. Certain disparities are particularly marked for specific racial/ethnic groups, and multiracial children experience many disparities.
Implicit Religion
Authors: Bailey Edward
Published: January 2008

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Amostragem por saturação em pesquisas qualitativas em saúde: contribuições teóricas
Authors: Fontanella Bruno José Barcellos , Ricas Janete , Turato Egberto Ribeiro
Published: January 2008

A transparência e a clareza dos relatórios de pesquisa, destacando a etapa de coleta de dados, são consideradas parâmetros importantes de avaliação do rigor científico dos estudos qualitativos. Este texto visa a refletir sobre o emprego do conceito metodológico de amostragem por saturação teórica, empregado freqüentemente nas descrições de pesquisas qualitativas nas diversas áreas do conhecimento, relevantemente, no campo da atenção à saúde. Discutimos e problematizamos os seguintes tópicos: definição de fechamento amostral por saturação teórica; dificuldades de aceitação e operacionalização de amostras intencionais (exemplificando-as), o tamanho adequado da amostra intencional, o significado de valorizar o que se repete ou as diferenças contidas nos relatos da amostra, os usos inadequados de expressões que empregam o termo saturação e, finalmente, possíveis metáforas para compreender o conceito.
Análise de indicadores de avaliação do atendimento a crianças e adolescentes em situação de violência
Authors: Ferreira Ana Lúcia , Souza Edinilsa Ramos de
Published: January 2008

A avaliação do atendimento a crianças vítimas de violência, baseada em indicadores, ainda é pouco realizada em nosso país. Este trabalho tem como objetivo analisar criticamente indicadores empregados em pesquisas sobre serviços que atendem a crianças/adolescentes em situação de violência. Para tal, foi realizado estudo exploratório para o qual foram selecionados cinco trabalhos realizados em quatro serviços: duas organizações não-governamentais de duas cidades do interior do Estado de São Paulo e duas da cidade do Rio de Janeiro: uma não-governamental e outra governamental. A análise buscou identificar os indicadores utilizados (de estrutura, processo ou resultado) e a que aspecto da atenção eles se propunham mensurar (dinâmica do atendimento, adesão ao tratamento, resolutividade e integração com a rede). Foram identificados e discutidos 18 indicadores de processo e nove de resultado. Sugere-se um conjunto mínimo de indicadores considerados essenciais para a realização de uma avaliação do atendimento a crianças/adolescentes e suas famílias.
Atividade física em adultos e idosos residentes em áreas de abrangência de unidades básicas de saúde de municípios das regiões Sul e Nordeste do Brasil
Authors: Siqueira Fernando V. , Facchini Luiz Augusto , Piccini Roberto X. , Tomasi Elaine , Thumé Elaine , Silveira Denise S. , Hallal Pedro C.
Published: January 2008

As mudanças na pirâmide demográfica brasileira e conseqüente envelhecimento populacional têm promovido aumento de doenças crônicas. Nesta realidade, as unidades básicas de saúde e a atividade física ganham importância. Em um estudo com delineamento transversal, avaliou-se a prevalência de sedentarismo e fatores associados em 4.060 adultos e 4.003 idosos, residentes em áreas de unidades básicas de saúde de 41 municípios com mais de 100 mil habitantes, em sete estados do Brasil. A prevalência de sedentarismo foi de 31,8% (IC95%: 30,4-33,2) e 58% (IC95%: 56,4-59,5) para adultos e idosos respectivamente, sendo sempre maior na Região Nordeste e nos homens. Baixa renda familiar foi fator de risco para sedentarismo nos adultos e idosos, enquanto a baixa escolaridade apresentou um efeito somente entre os idosos. Houve relação inversa entre autopercepção de saúde e sedentarismo para adultos e idosos. A prevalência média de sedentarismo foi maior na área de abrangência das unidades básicas de saúde Pré-PROESF em comparação aos outros modelos de atenção básica. Conclui-se que a prevalência de sedentarismo é muito elevada e que os grupos sócio-econômicos mais desfavorecidos apresentam nível menor de atividade física.
Doenças respiratórias agudas: um estudo das desigualdades em saúde
Authors: Chiesa Anna M. , Westphal Marcia F. , Akerman Marco
Published: January 2008

Apresentam-se as desigualdades em saúde valendo-se das doenças respiratórias agudas na infância na área de abrangência de um centro de saúde na cidade de São Paulo, Brasil, para subsidiar o planejamento local de ações de promoção da saúde. O trabalho se fundamentou em estudos ecológicos que utilizam a área geográfica como unidade de análise, permitindo a comparação de indicadores de saúde e sócio-econômicos mediante dados censitários. Foram construídos indicadores de "inserção social" e de "qualidade do domicílio", gerando o "índice potencial de exposição" que reflete as condições de risco para o adoecimento por agravos respiratórios. O tratamento estatístico incluiu o agrupamento pela técnica de cluster. Foram identificados quatro grupos sociais homogêneos nas condições de risco para as doenças respiratórias agudas. Os grupos III e IV - com as piores condições sócio-econômicas - mostraram diferenciais importantes em relação aos grupos I e II. Os diferenciais de mortes por pneumonia encontrados, sugerem iniqüidades em saúde. Os resultados permitiram a localização geográfica de maior e menor concentração das carências relativas às condições de vida e a comparação entre os setores censitários para o reconhecimento de necessidades distintas, que subsidiem propostas para a articulação intersetorial.
Perfil epidemiológico da coqueluche no Rio Grande do Sul, Brasil: estudo da correlação entre incidência e cobertura vacinal
Authors: Trevizan Sarina , Coutinho Simone Elizabeth Duarte
Published: January 2008

No Estado do Rio Grande do Sul, Brasil, foi constatado que a coqueluche apresentou uma tendência crescente desde o ano 2000, levando à deflagração de alerta epidêmico em 2004, conforme boletins epidemiológicos emitidos pelos órgãos governamentais de saúde. Nosso objetivo neste estudo foi identificar o perfil epidemiológico da coqueluche nesse estado; para tanto, utilizamos a incidência da notificação da doença entre janeiro de 1995 e dezembro de 2004, a porcentagem de cobertura vacinal e a caracterização da população afetada. Construiu-se um diagrama de controle para determinar a magnitude da doença em 2004; para a análise da correlação entre incidência e cobertura vacinal foi estabelecida a oscilação entre as curvas de cobertura vacinal e de notificação de casos nos últimos dez anos. No Rio Grande do Sul, a coqueluche esteve em nível epidêmico em 2004, representando importante causa de morbimortalidade em crianças menores de um ano, apesar da disponibilidade de vacinas eficazes e de altas taxas de cobertura vacinal informadas nos últimos anos. Portanto, serão necessários estudos sobre o comportamento da doença nos próximos anos e determinação de possíveis fatores envolvidos nesse ressurgimento.
A dinâmica do cuidado em saúde mental: signos, significados e práticas de profissionais em um Centro de Assistência Psicossocial em Salvador, Bahia, Brasil
Authors: Nunes Mônica , Torrenté Maurice de , Ottoni Vitória , Moraes Neto Valfrido , Santana Mônica
Published: January 2008

O presente artigo analisa o sistema de signos, significados e práticas em saúde mental utilizado por profissionais de um Centro de Atenção Psicossocial (CAPS) situado em Salvador, Bahia, Brasil, com oito anos de implantação na época da pesquisa. Para tanto se realizou, durante nove meses, uma etnografia do serviço, complementada por entrevistas e grupos focais com todos os profissionais de nível universitário e de nível médio. Entre os principais resultados, identifica-se a coexistência de três modelos de cuidado nesse CAPS: o modelo biomédico humanizado, o psicossocial com ênfase na instituição e o psicossocial com ênfase no território, revelando pontos de conflito entre os profissionais na forma de vislumbrar a Reforma Psiquiátrica desejada e o alcance das práticas nesta perspectiva. A despeito das diferenças, há uma evidência inquestionável de transformação do cuidado quando comparado ao modelo asilar fundado principalmente em uma "clínica do encontro", alicerçada no questionamento, na reflexão e, sobretudo, na experimentação de relações interpessoais mais dialógicas e na escuta do outro, o que justifica o impacto clínico-social desta clínica.
The Brazilian version of the effort-reward imbalance questionnaire to assess job stress
Authors: Chor Dóra , Werneck Guilherme Loureiro , Faerstein Eduardo , Alves Márcia Guimarães de Mello , Rotenberg Lúcia
Published: January 2008

The effort-reward imbalance (ERI) model has been used to assess the health impact of job stress. We aimed at describing the cross-cultural adaptation of the ERI questionnaire into Portuguese and some psychometric properties, in particular internal consistency, test-retest reliability, and factorial structure. We developed a Brazilian version of the ERI using a back-translation method and tested its reliability. The test-retest reliability study was conducted with 111 health workers and University staff. The current analyses are based on 89 participants, after exclusion of those with missing data. Reproducibility (interclass correlation coefficients) for the "effort", "'reward", and "'overcommitment"' dimensions of the scale was estimated at 0.76, 0.86, and 0.78, respectively. Internal consistency (Cronbach's alpha) estimates for these same dimensions were 0.68, 0.78, and 0.78, respectively. The exploratory factorial structure was fairly consistent with the model's theoretical components. We conclude that the results of this study represent the first evidence in favor of the application of the Brazilian Portuguese version of the ERI scale in health research in populations with similar socioeconomic characteristics.
A importância do uso das células tronco para a saúde pública
Authors: Pereira Lygia da Veiga
Published: January 2008

Em 1999, as células-tronco foram eleitas "Scientific Breakthrough of the Year" (avanço científico do ano) pela revista Science¹. Naquele ano, foi demonstrado que células-tronco de tecidos adultos mantinham a capacidade de se diferenciar em outros tipos de tecidos. No ano anterior, as primeiras linhagens de células-tronco embrionárias humanas foram estabelecidas. Desde então, o número de artigos científicos sobre células-tronco vem crescendo exponencialmente, onde novos paradigmas são estabelecidos. Neste artigo, farei uma revisão da área de células-tronco com um foco especial em seu uso como agente terapêutico em doenças comuns como diabetes e cardiopatias. As células-tronco serão tratadas em dois grupos distintos: as embrionárias e as adultas. Enquanto o potencial de diferenciação das primeiras está bem caracterizado em camundongos e em humanos, seu uso em terapia celular e em pesquisa tem sido dificultado por questões de histocompatibilidade, segurança e ética. Em contraste, células-tronco adultas não apresentam estes empecilhos, apesar da extensão de sua plasticidade ainda estar sob investigação. Mesmo assim, diversos testes clínicos em humanos estão em andamento utilizando células-tronco adultas, principalmente derivadas da medula óssea. Discutirei ainda a importância de se trabalhar com as duas classes de células-tronco humanas de forma a se cumprir suas promessas terapêuticas.
Satisfação com o atendimento odontológico: estudo qualitativo com mães de crianças atendidas na Universidade Federal de Santa Catarina
Authors: Robles Ana Carolina Couto , Grosseman Suely , Bosco Vera Lúcia
Published: January 2008

Esta pesquisa objetivou conhecer a percepção de mães em relação ao atendimento odontológico prestado em clínicas de odontopediatria da Universidade Federal de Santa Catarina (UFSC), bem como sua concepção sobre como seria o dentista "ideal". O método utilizado foi o qualitativo, tipo estudo de caso. A coleta de dados foi feita através de entrevista semi-estruturada e a população estudada constituiu-se de sete mães de crianças atendidas em clínicas de odontopediatria da UFSC. Observou-se que, para as mães entrevistadas, o dentista ideal deveria reunir habilidades afetivas, psicomotoras e cognitivas, tais como: gostar do que faz, ser atencioso e amigável, fornecer informações claras sobre saúde bucal, resolver os problemas bucais do paciente e manter-se atualizado. Os aspectos interpessoais foram fundamentais para a satisfação com o atendimento na universidade, além da capacidade técnica dos alunos e a facilidade para conseguir uma vaga no serviço de odontopediatria. Sugere-se maior entendimento, por parte dos profissionais, dos aspectos que envolvem a relação dentista-paciente, de maneira a associar fatores afetivos aos cognitivos e psicomotores no dia-a dia da prática odontológica.
Integral healthcare model for treating problems caused by alcohol and other drugs: perceptions of users, their companions and practitioners
Authors: Moraes Maristela
Published: January 2008

Based on an integral healthcare model for the users of alcohol and other drugs, the expansion of Brazil's Psycho-Social Care Centers - Alcohol and Drugs (CAPS-AD) is guided by the acknowledgement of users as citizens rather than patients, aiming at social reinsertion through an intersectoral approach and damage control, as well as other principles designed to build up integral healthcare services that are fair and egalitarian. This paper examines alcohol and drug users, their companions and healthcare practitioners in terms of the existing healthcare model, through a study conducted at two Psycho-Social Care Centers - Alcohol and Drugs in Recife, Pernambuco State. Focus groups, participative observation and documentary surveys were used to analyze the daily work routines at these Centers, exploring player perceptions and therapeutic projects. The findings indicate that users are still perceived as being ill, with medicalization and other traces of care models not used since the Psychiatric Reform. Social reinsertion was perceived as the main obstacle in integral healthcare. Restructuring this practice seems necessary, in order to break away from a culture of prejudice, exclusion and illness, as well as control models based on hospital-centric psychiatry.
Vague and diffuse symptoms in biomedicine: a review of the literature
Authors: Guedes Carla Ribeiro , Nogueira Maria Inês , Camargo Jr. Kenneth Rochel de
Published: January 2008

The purpose of this study is to chart academic output on vague and diffuse symptoms in biomedicine. As methodological tool, we conducted a bibliographic study through the Internet ranging from 1990 to 2005. Forty papers were selected and five major theme areas were established for the survey: the nomenclatures assigned to vague and diffuse symptoms; their definitions; the relevance of the theme being addressed; the criteria used to diagnose vague and diffuse symptoms; and the therapeutic actions adopted. The discussion of the findings identifies many biomedical difficulties in dealing with sufferers from undefined complaints, including: diversity and lack of conceptual precision in the use of the nomenclature; physicians who are poorly prepared to deal with these patients; demand considered as a psychic disorder; difficulties in establishing diagnostic criteria and poor use of treatment resources. This leads to the conclusion that the biomedical model behind these difficulties has few tools for dealing with the singularities of human suffering and its experiential phenomenological dimension.
Representações do trabalho informal e dos riscos à saúde entre trabalhadoras domésticas e trabalhadores da construção civil
Authors: Iriart Jorge Alberto Bernstein , Oliveira Roberval Passos de , Xavier Shirlei da Silva , Costa Alane Mendara da Silva , Araújo Gustavo Ribeiro de , Santana Vilma Sousa
Published: January 2008

Nas últimas décadas, o mercado de trabalho no Brasil tem apresentado um aumento de trabalhadores não registrados. Trabalhadores informais, além de remunerações abaixo do mínimo legal, não contam com seguridade social, e medidas de prevenção de riscos. Este estudo teve por objetivo a análise das representações e percepções sobre a informalidade do contrato de trabalho e dos riscos à saúde entre trabalhadores informais acidentados. A pesquisa foi qualitativa, baseada em entrevistas em profundidade realizadas com dezessete trabalhadores, nove trabalhadoras domésticas e oito operários da construção civil. Observou-se que os trabalhadores reconhecem a importância do trabalho formal, principalmente pela garantia dos direitos trabalhistas, apontando a desvalorização simbólica do trabalho informal com repercussão em sua auto-estima. Ambos os grupos tenderam a minimizar os riscos de acidentes de trabalho, e não associaram o trabalho informal a maior risco de acidentes ou doenças. Identificou-se a necessidade sentida de formalização dos vínculos de trabalho pelos trabalhadores. Os resultados do estudo demonstram a necessidade de maior divulgação e discussão dos direitos trabalhistas e da construção de políticas públicas que contemplem a segurança e saúde destes trabalhadores.
Jovens portadores de deficiência: sexualidade e estigma
Authors: Soares Ana Helena Rotta , Moreira Martha Cristina Nunes , Monteiro Lúcia Maria Costa
Published: January 2008

O presente artigo pretende ampliar a discussão sobre deficiência e sexualidade valorizando as expectativas, crenças, desejos e experiências de jovens com deficiência física. Refere-se a um recorte parcial dos dados da pesquisa de doutorado "Vocês riem porque eu sou diferente, eu rio porque vocês são todos iguais: as dimensões da qualidade de vida em jovens portadores de espinha bífida", que objetivou discutir a qualidade da vida de jovens portadores de espinha bífida em duas culturas: brasileira e norte-americana. A percepção, interesse e problematização dos participantes em relação à sua sexualidade e seus desdobramentos na sua família, serviço de saúde e círculo de amizades motivaram um maior aprofundamento da temática e apontaram para a necessidade de abordar o conceito sexualidade de maneira englobante. Os discursos dos jovens priorizam quatro aspectos relacionados à vivência da sexualidade: (1) sexualidade e cuidado; (2) sexualidade, imagem corporal e as características desacreditáveis; (3) a sexualidade do portador de deficiência física através do olhar da violência, e finalmente; (4) a sexualidade e interrogação das informações médicas.
A prevenção do câncer de próstata: uma revisão da literatura
Authors: Gomes Romeu , Rebello Lúcia Emilia Figueiredo de Sousa , Araújo Fábio Carvalho de , Nascimento Elaine Ferreira do
Published: January 2008

O presente estudo tem como objetivo analisar as recomendações voltadas para a prevenção do câncer de próstata presentes na literatura específica sobre o assunto. O método consistiu numa revisão da literatura sobre o assunto, realizada a partir de uma abordagem qualitativa. O material revisado foi estudado a partir da técnica de análise de conteúdo temática. A discussão dos resultados do estudo se desenvolve a partir das seguintes categorias de análise: (1) prevenção primária; (2) prevenção secundária; (3) masculinidade-prevenção. Concluiu-se que: (a) as recomendações apresentam tanto uma diversidade quanto certa polêmica entre os diferentes posicionamentos; (b) a produção de artigos científicos da área da saúde coletiva sobre o assunto é escassa; (c) faz-se necessário o desenvolvimento de uma abordagem mais interdisciplinar no trato da temática e (d) poucas fontes levam em conta as especificidades de ser homem nas recomendações da prevenção do câncer de próstata.
Concepts involved in the training and work processes of community healthcare agents: a bibliographical review
Authors: Bornstein Vera Joana , Stotz Eduardo Navarro
Published: January 2008

This paper is the outcome of a bibliographical review that aims at systemizing references in the literature to concepts involved in the training and work processes of community health agents under the Community Health Agent Program (PACS) and the Family Health Program. Published in scientific journals, manuals and official documents through to October 2004, 504 articles were consulted, of which 49 were selected and examined in full. The findings were systematically arranged under four themes, reviewing controversial aspects raised by authors, outstanding among which are: the 'discourse of change' statements in official documents, defining the Family Health Program as a reorientation strategy for the Primary Healthcare Model; the scope and ambiguity of understandings of the role of mediator and definitions of the duties and responsibilities of Community Healthcare Agents, as well as the gaps in their training.
Efeitos das queimadas na Amazônia: método de seleção dos municípios segundo indicadores de saúde
Authors: Ignotti Eliane , Hacon Sandra de Souza , Silva Ageo Mario Cândido , Junger Washington Leite , Castro Hermano
Published: January 2008

INTRODUÇÃO: Na Amazônia é intensa a queima de biomassa decorrente do desmatamento nos meses de seca. No entanto, os efeitos à saúde humana decorrentes da poluição atmosférica derivada das queimadas são pouco estudados. OBJETIVOS: Descrever o método de seleção dos municípios prioritários, orientado pelos indicadores de morbidade e mortalidade por doenças respiratórias para o estudo da "avaliação do efeito das queimadas do desmatamento à saúde humana" na região da Amazônia. MATERIAL E MÉTODOS: Estudo ecológico dos indicadores de morbidade hospitalar e mortalidade por doenças do aparelho respiratório em menores de cinco de idade no período de 2000 a 2004. Análise de: proporção de óbitos; taxa de internação e proporção de internações por doença do aparelho respiratório em menores de 5 anos para o cálculo dos escores e definição do ranking dos municípios. Foi considerada a localização geográfica dos municípios, tipo de bioma, estrutura da rede de serviços de saúde, número de habitantes, registros de dados ambientais prévios sobre poluentes atmosféricos e de dados meteorológicos. RESULTADOS: Foram selecionados os municípios de Alta Floresta e de Tangará da Serra no Estado de Mato Grosso para o desenvolvimento da pesquisa em razão destes alcançarem as piores classificações em termos de morbimortalidade. CONCLUSÃO: Os indicadores de saúde mostram consistência e orientam a análise integrada de saúde e ambiente.
Prevalence of multiple sclerosis in the city of Santos, SP
Authors: Fragoso Yara Dadalti , Peres Maristela
Published: January 2008

OBJECTIVE: To assess the prevalence of multiple sclerosis (MS) in the city of Santos, SP. METHOD: Evaluation of data from the Reference Center for MS of the coastal region of the State of São Paulo, from the Regional Association of Patients with MS (APEMBS), with active participation of all neurologists and neurosurgeons of the city, data from IBGE, from the city council, and from EMPLASA. The protocol proposed by the BCTRIMS (already used in other similar studies) was used for data collection and analysis, June 30th 2005 being established as the prevalence day. RESULTS: Santos has an area of 280.3 km², with 418,316 inhabitants (1.49 inhabitant per km²). A total of 65 patients were identified, attaining the prevalence of 15.54/100.000. The most frequent initial symptom of the disease was optical neuritis (28.8%). CONCLUSION: data from the city of Santos are similar to those already observed, but as yet not published, in other cities of the State of São Paulo and of Brazil.
Hepatitis B among female sex workers in Ribeirão Preto - São Paulo, Brazil
Authors: Passos Afonso Dinis Costa , Figueiredo José Fernando de Castro , Martinelli Ana de Lourdes Candolo , Villanova Márcia Guimarães , Nascimento Margarida Pásseri do , Gaspar Ana Maria Coimbra , Yoshida Clara Fumiko Tachibana
Published: January 2008

OBJECTIVE: To estimate the prevalence of hepatitis B markers and to study the risk factors for this disease among female sex workers in the city of Ribeirão Preto, Brazil. METHODS: A questionnaire was given to 449 female sex workers in order to obtain information about demographic, socioeconomic and behavioral variables. Blood samples were collected and analyzed by immunoenzymatic techniques for detection of HBsAg, anti-HBs, anti-HBc and anti-HCV markers. RESULTS: The mean age of participants was 23 years, varying from 13 to 64 years. A high spatial mobility was observed, with 47.9% of participants residing in places out of the region of Ribeirão Preto or in other Brazilian states. Complete absence of previous vaccine against hepatitis B was referred by 98.2%. Overall, the presence of any hepatitis B marker was observed in 106 participants (prevalence of 23.6%; 95% CI: 19.7 27.5), with 84 positive for anti-HBs (18.7%), 100 for anti-HBc (22.3%), and only 3 for HBsAg (0.7%). The logistic regression analysis showed association between hepatitis B markers and the following co-variables: residence in Ribeirão Preto, age, low socioeconomic level, consumption of crack, intercourse with HIV-infected individuals, history of previous hepatitis, intercourse with a case of hepatitis, and positivity for hepatitis C. CONCLUSIONS: Ribeirão Preto's female sex workers present several risk factors for hepatitis B and almost absence of previous specific vaccination, making it necessary to emphasize this low-cost preventive measure, preferably through the use of a mobile team, taking the vaccine to their places of work.
Aderência a medidas de proteção individual contra a hepatite B entre cirurgiões-dentistas e auxiliares de consultório dentário
Authors: Garcia Leila Posenato , Blank Vera Lúcia Guimarães , Blank Nelson
Published: January 2008

OBJETIVO: O vírus da hepatite B é um risco ocupacional reconhecido na odontologia. Além de aderir às precauções padrão, todos os profissionais da odontologia devem se proteger através da vacinação contra a hepatite B e confirmação da imunidade. Este estudo verificou a aderência às medidas de proteção individual contra a hepatite B, incluindo a vacinação e o uso de equipamentos de proteção individual, entre cirurgiões-dentistas e auxiliares de consultório dentário do município de Florianópolis, localizado no sul do Brasil. MÉTODOS: Neste estudo transversal, os dados foram coletados através de questionários auto-aplicáveis. Foram obtidas respostas de 289 cirurgiões-dentistas e 104 auxiliares. RESULTADOS: A prevalência da vacinação completa contra a hepatite B foi 73,4% entre os dentistas e 39,4% entre os auxiliares. Apenas 32,1% e 21,9% deles, respectivamente, monitoraram a resposta vacinal. A vacinação completa foi positivamente associada com o ano de formatura a partir de 1997 (RP = 1,16; IC95% = 1,01-1,33) e atuação predominantemente em especialidade cirúrgica (RP = 1,24; IC95% = 1,02-1,51) entre os dentistas e com a realização de curso de formação entre os auxiliares (RP = 1,96; IC95% = 1,23-3,14). O uso constante de luvas, máscara e óculos de proteção foi mais elevado entre os dentistas do que entre os auxiliares. CONCLUSÃO: São indicadas campanhas visando a vacinação daqueles que não o fizeram ou não completaram o esquema vacinal e informações sobre a necessidade do monitoramento da resposta vacinal. Medidas educativas são recomendadas para elevar a aderência às medidas de proteção pessoal, voltadas especialmente aos auxiliares.