rESUMo Este artigo analisa a determinação social da hanseníase, a partir do reconhecimento da vulnerabilidade social dos usuários em tratamento irregular, no Programa de Controle da Hanseníase do município de Campos dos Goytacazes (RJ). Para isso, apresenta uma pesquisa documental, com base nas Fichas de Cadastro Social dos usuários mencionados, destacando aspectos como trabalho, renda, formação familiar e acesso a políticas públicas. Seus resultados registram significativa presença de trabalho precarizado associado a baixos níveis de renda e de escolaridade, sendo a maioria considerada pobre ou indigente (51,5%) e não usuária de benefícios assistenciais (66,7%).
Resumo Este artigo revisa os fatores limitadores e facilitadores do acesso aos serviços públicos de saúde no Brasil na área da atenção ao câncer de colo de útero (CCU). Nesta revisão, foram utilizadas a base de dados bibliográficos Medline (interface com Biblioteca Virtual de Saúde/BVS e PubMed) e os portais Lilacs e SciELO. Buscou-se publicações referentes ao período 2011-2016, a partir do uso de termos específicos das fontes consultadas, relativos a ‘neoplasias do colo do útero’ e ‘acesso aos serviços de saúde’. Foram inicialmente encontrados 704 artigos, mas, considerando os critérios adotados, foram selecionados 31 artigos, dos quais foram incluídos 19. Foram mencionados aspectos facilitadores do acesso como ampla cobertura do exame Papanicolaou e de biopsias equivalente ao número de preventivos alterados. Entretanto, aspectos limitadores de acesso como periodicidade inadequada do Papanicolau, dificuldades para agendamento de consultas e exames, alto índice de estadiamento avançado e atrasos no diagnóstico e no início de tratamento, também foram apresentados.
A region of approximately 22 kb of DNA defines the large hrp gene cluster of strain GMI1000 of Pseudomonas solanacearum. The majority of mutants that map to this region have lost the ability to induce disease symptoms on tomato plants and are no longer able to elicit a hypersensitive reaction (HR) on tobacco, a non-host plant. In this study we present the complementation analysis and nucleotide sequence of a 4772 bp region of this hrp gene cluster. Three complete open reading frames (ORFs) are predicted within this region. The corresponding putative proteins, HrpN, HrpO and HpaP, have predicted sizes of 357, 690 and 197 amino acids, respectively, and predicted molecular weights of 38,607, 73,990 and 21,959 dalton, respectively. HrpN and HrpO are both predicted to be hydrophobic proteins with potential membrane-spanning domains and HpaP is rich in proline residues. A mutation in hpaP (for hrp associated) does not affect the HR on tobacco or the disease on tomato plants. None of the proteins is predicted to have an N-terminal signal sequence, which would have indicated that the proteins are exported. Considerable sequence similarities were found between HrpO and eight known or predicted prokaryotic proteins: LcrD of Yersinia pestis and Y. enterocolitica, FlbF of Caulobacter crescentus, FlhA of Bacillus subtilis, MxiA and VirH of Shigella flexneri, InvA of Salmonella typhimurium and HrpC2 of Xanthomonas campestris pv. vesicatoria. These homologies suggest that certain hrp genes of phytopathogenic bacteria code for components of a secretory system, which is related to the systems for secretion of flagellar proteins, Ipa proteins of Shigella flexneri and the Yersinia Yop proteins. Furthermore, these homologous proteins have the common feature of being implicated in a distinct secretory mechanism, which does not require the cleavage of a signal peptide. The sequence similarity between HrpO and HrpC2 is particularly high (66% identity and 81% similarity) and the amino acid sequence comparison between these two proteins presented here reveals the first such sequence similarity to be shown between Hrp proteins of P. solanacearum and X. campestris. An efflux of plant electrolytes was found to be associated with the interactions between P. solanacearum and both tomato and tobacco leaves. This phenomenon may be part of the mechanism by which hrp gene products control and determine plant-bacterial interactions, since hrpO mutants induced levels of leakage which were significantly lower than those induced by the wild type on each plant.
Objectives: The Assessment of Burden of COPD (ABC) tool evaluates and visualizes the health status of patients with chronic obstructive pulmonary disease (COPD). This tool may be used during consultations to monitor the burden of COPD and to adjust treatment. The ABC tool has items in 5 dimensions: symptoms, limitations, mental status, exacerbations, and fatigue. The aim of our study was to determine the burden of each of 15 elements in the ABC questionnaire. MethOds: A discrete choice experiment (DCE) was conducted using telephone-assisted personal interviews with 279 COPD patients. They were presented 13 sets of two patients, and decided which patient was in the worst health state. In order to make the choice task feasible despite the large number of 15 attributes, we generated an efficient partial profile design, that kept attributes in some dimensions constant and all at the same level (fold in), while varying the attributes in other dimensions (fold out). This reduced the burden on respondents by having them assess some attributes combined in categories, instead of as separate attributes. Multinomial logit was used to analyze the data. Results: Patients were considered to be in worst health if they had high levels of fatigue, exacerbations, anxiety, breathlessness at rest and limitations in moderate physical activities. These factors had three to five times as much impact on the burden of disease as lower levels of these attributes and other limitations. Coefficients were very small and/or statistically insignificant for breathlessness during physical activity, limitations on strenuous activity, coughing, small numbers of exacerbations, and most mental attributes. cOnclusiOns: It is possible to administer cognitively complicated DCE questionnaires using a fold-infold-out design. COPD-patients seem to accept being unable to perform strenuous activities. Gains in well-being can primarily be achieved by focusing on patients' ability to lead a relatively normal everyday life.
Este artigo analisa limites e perspectivas de acesso aos serviços de saúde para investigação diagnóstica e tratamento de Papanicolaou alterado. Apresenta pesquisa realizada com usuárias do Centro de Referência e Tratamento da Mulher/CRTM, no município de Campos dos Goytacazes/RJ. Seus resultados apresentam marcação de consulta, em prazo não superior a 30 dias, e seguimento segundo diretrizes nacionais de controle do câncer do colo do útero (CCU). No entanto, houve dificuldades relativas a defeito em aparelho de exame e extravio de exames, bem como relacionadas à articulação com a rede hospitalar, para fins de procedimentos e/ou tratamentos, inclusive oncológico.
Este artigo apresenta uma avaliação das ações desenvolvidas por um projeto de extensão universitária, realizado pelo Curso de Serviço Social da Universidade Federal Fluminense, em parceria com a Secretaria de Saúde/ Programa DST-HIV-Aids do município de Campos dos Goytacazes/RJ, intitulado "Banco de Preservativos da UFF-Campos". A avaliação é realizada em uma dimensão quanti-qualitativa, sendo analisado o número de atividades educativas e de plantões do projeto realizados, o número de universitários presentes nas ações educativas, o número de cadastros para recebimento mensal de kit de preservativos, a média de efetivação da busca mensal; e também, consideradas as opiniões dos universitários sobre o projeto, a partir da aplicação de questionários. Os resultados expressam um bom desempenho do projeto, quando seus objetivos, em modo geral, são alcançados e quando é expresso o reconhecimento de sua importância, pelos universitários.
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