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The European design rules for steel structures in EN1993 cover various failure modes that were developed using different methodologies in terms of accuracy and safety. Consequently, the safety level of these design rules is not homogeneous throughout their own field of application, as well as in comparison between different rules. Safety is regulated by partial factors for the various loads and resistances, respectively. EN 1990 - Annex D offers a procedure for the reliability assessment of resistance functions, based on a semi-probabilistic approach. However, its application is not straightforward in many cases concerning steel design rules and several additional assumptions are necessary to ensure that a target probability failure is achieved. Moreover, the design rules are calibrated using certain variability values for the relevant parameters, such as material properties, geometric properties and imperfections. It is therefore required to appropriately characterize the statistical distributions of these basic variables in order to comply with the safety assessment procedure. The present research work, carried out in the context of the European research project SAFEBRICTILE, had as a main objective the harmonization of the reliability level of design rules for steel structures covering modes driven by ductility, stability and fracture. This paper gives an overview of the reliability assessment of the Eurocode design rules carried out within the project for the studied failure modes; presents the adjustments in these design rules proposed whenever it was necessary; it also transmits the project recommendation on the statistical distributions of the relevant basic variables for steel structures, summarized in the "European database of steel properties" that was also developed within the project framework.

Objetivo : Apreender os saberes de mulheres sobre a prevencao do câncer de colo uterino por meio do exame de Papanicolaou. Metodologia: Estudo qualitativo realizado em Unidade Basica de Saude de um municipio do interior de Sao Paulo - Brasil, a partir de entrevista semiestruturada, audio gravadas com uma populacao de 20 mulheres. Os dados foram analisados pelo discurso do sujeito coletivo e fundamentado na teoria da representacao social. Resultados: As mulheres referiram sentimentos de desconforto, incomodo, vergonha e medo. Quanto ao conhecimento, apresentaram-se deficientes, em relacao a finalidade do exame e a propria doenca. Conclusao: Depreende-se que a falta de conhecimento pode intervir na adesao ao exame de Papanicolaou pelas mulheres, destacando-se a importância da pratica educativa como ferramenta nessa prevencao. Descritores : Mulheres, Teste Papanicolaou, Câncer de colo uterino. EARLY DETECTION AND PREVENTION OF UTERINE COLUMN CANCER: EDUCATIONAL PRACTICES AND KNOWLEDGE Objective : To apprehend the knowledge of women about cervical cancer prevention through a Pap smear. Methodology: A qualitative study carried out in a Basic Health Unit of a city in the interior of Sao Paulo, Brazil, from a semi - structured interview, recorded with a population of 20 women. The data were analyzed by the discourse of the collective subject and based on the theory of social representation. Results: Women reported feelings of discomfort, discomfort, shame and fear. As for knowledge, they were deficient in relation to the purpose of the examination and to the disease itself. Conclusion: It can be seen that the lack of knowledge can intervene in the adhesion to the Pap smear by women, highlighting the importance of the educational practice as a tool in this prevention. Keywords : Women, Papanicolaou test, Cervical cancer. DETECCION PRECOCE Y PREVENCION DEL CANCER DE COLUMNA UTERINA: PRACTICAS EDUCACIONALES Y CONOCIMIENTO Objetivo : Apreciar los saberes de mujeres sobre la prevencion del cancer de cuello uterino mediante el examen de Papanicolaou. Metodologia: Estudio cualitativo realizado en Unidad Basica de Salud de un municipio del interior de Sao Paulo - Brasil, a partir de entrevista semiestructurada, audio grabadas con una poblacion de 20 mujeres. Los datos fueron analizados por el discurso del sujeto colectivo y fundamentado en la teoria de la representacion social. Resultados: Las mujeres refirieron sentimientos de incomodidad, incomodidad, verguenza y miedo. En cuanto al conocimiento, se presentaron deficientes, en relacion a la finalidad del examen ya la propia enfermedad. Conclusion: Se desprende que la falta de conocimiento puede intervenir en la adhesion al examen de Papanicolaou por las mujeres, destacandose la importancia de la practica educativa como herramienta en esa prevencion. Descriptores : Mujeres, Prueba Papanicolaou, Cancer de cuello uterino.

The study aimed to comprehend the pain influence as a motive to search for hospital labor assistance. We used a social-existential phenomenological approach proposed by Schütz. Nine pregnant women conducted to the maternity participated in the study, from February to June of 2013. The interview was guided by the questions: Tell me how the pain influenced your decision of looking for a hospital. What is meaning of pain to you in this phase of your pregnancy? The speeches were submitted to ideographic and nomothetic analysis that resulted in the following categories: pain identification, pain with vaginal losses, pain permanence and progression, influence of family members to identify pain. The study allowed comprehending the influence of pain in the complexity of labor, considering its subjectivity and its multi-factors. It was also seen that it is not always possible to rationalize about pain considering the socio-cultural environment in where the pregnant women are. O estudo objetivou compreender a influência da dor como motivo de busca para assistência ao trabalho de parto hospitalar. Utilizou-se a abordagem fenomenológica socioexistencial, proposta por Schütz. Participaram do estudo nove gestantes conduzidas à maternidade, no período de fevereiro a junho de 2013. A entrevista norteou-se pelas questões: Conte-me como a dor influenciou sua decisão de procurar o hospital. Qual o significado da dor para você nesta fase da gestação? Os discursos foram submetidos à análise ideográfica e nomotética, em que emergiram as seguintes categorias: identificação da dor, dor com perdas vaginais, permanência e progressão da dor, influência de familiares para a identificação da dor. O estudo possibilitou compreender a influência da dor na complexidade do trabalho de parto, tendo em vista sua subjetividade e multifatoriedade. Evidenciou-se também que nem sempre é possível racionalizar acerca da dor em virtude do meio sociocultural no qual a gestante está inserida.

This article analyzed and discussed the offer of Environmental Education in courses of pedagogy of Federal University of Brazil and the implications for the education of the pedagogue in Environmental Education. This is a qualitative and quantitative research. Twenty-seven pedagogy courses were selected, one in each Brazilian capital. For analysis, data were collected in curricula, subjects' menus to verify the presence of Environmental Education in disciplines describing their insertion. It was observed that Environmental Education is not prioritized by these courses, 30% of the courses surveyed did not include it as a discipline, which can generate a problem in the formation of the environmental educator and, consequently, in society. With this problematic in the training, its performance in the classroom could be compromised, not favoring to the students the teaching of the knowledge of the Environmental Education ample and critical and that also make them capable subjects mediators of that consciousness, in the society. Investing in this training is the way for the teacher to have the skills and abilities to know this still in their undergraduate education.

Background: This is a quali- quantitative research and was conducted in a basic health unit aiming to investigate female adolescents’ knowledge, practices and attitudes concerning sexuality. Methodology: The action-research methodology was used to develop workshop activities because it is a participative methodology. The workshop was performed in two modules with the participation of 29 female adolescents, and data were collected by questionnaires addressing two groups of adolescents who had or had not begun sexual activity. Results: The representations about sexuality were related to sexual relationships and showed erroneous information concerning sexually transmitted infections, which makes the adolescents vulnerable. Many of them reported not to know anything about infections or contraceptive methods, to know about contraceptive pills and condoms and to have doubts about condom use, and when experiencing sexuality, gender manifestation was present in the adolescents’ descriptions. Conclusion: Strict gender roles and a patriarchal and a chauvinistic social structure determine adolescents’ behaviors that make them believe in two opposing worlds, the masculine and the feminine worlds. With this regard, identities are constructed in multiple institutions that produce and reproduce differences. Among such institutions, schools, families and the media are noteworthy, since, despite social and individual resistance movements, they impose behavioral models according to prevailing social practices and to the objectives of the consumer and producer market. It is important to reflect about the inclusion of sexual diversity in order to act in this reality by understanding sexuality in the perspective of human rights. Key words: Sexuality, Adolescent, Health.

Objetivo: analisar o conforto de cuidadores formais e informais de pacientes em cuidados paliativos, identificando as variáveis associadas às dificuldades de cuidado no domicílio.Métodos: estudo transversal, realizado com 50 cuidadores de pacientes em cuidados paliativos, atendidos pela Estratégia Saúde da Família, utilizando o General Comfort Questionnaire. Resultados: a maioria dos cuidadores era mulher (86,0%), idade média de 52 anos, com companheiros (68,0%) e praticantes de alguma religião (72,0%). Os escores de conforto oscilaram entre 202 e 263, com mediana de 235. Constatou-se relação inversa entre os escores do General Comfort Questionnaire e o cuidador relatar ter alguma dificuldade no cuidado prestado aos pacientes em cuidados paliativos (OR=0,90; IC 95,0% 0,81-1,01).Conclusão: o nível de conforto dos cuidadores de pacientes em cuidados paliativos foi relativamente bom e esteve associado às dificuldades de cuidado no domicílio.

Chemotherapy with oxazaphosphorines, such as ifosfamide, is often limited by unacceptable urotoxicity. Without uroprotection hemorrhagic cystitis becomes dose-limiting. Mesna, a thiol compound, is a drug able to bind the toxic metabolites, forming nontoxic compounds in the urine. A total of 122 patients were enrolled in this study and 228 chemotherapy cycles with an ifosfamide-containing regimen were performed (225 evaluable). Mesna was given at the same total dose as the ifosfamide in all arms. On arm A, mesna was given i. v. in equal doses 15 min before and 4 h and 8 h following the ifosfamide dose. On arm B, mesna was given in three equivalent doses 15 min before (i.v.) and 4 h (i.v.) and 8 h (p.o., double dose) following ifosfamide. On arm C, mesna was given i.v. in two equal doses given 15 min before and 4 h following. The incidence of urotoxicity was very low (lower than 15%) in the three arms, 0% in A, 1.36% in B and 2.70% in C. All three arms were equally efficient. Schedule C was considered superior to the others, since it was equally effective, simpler and more convenient.

This article aimed to describe and analyze the training process of health community agents (HCA) by family health strategy nurses. It is a qualitative research with 17 individuals. Data collection was performed through semi-structured interviews and the analysis was made through the data analysis technique. A category was established: The organization of the educational process in the family health units, in which the themes selected were: nurses as reference team leaders, permanent education, traditional methodologies and education centered on the HCA needs. Through this study we were able to understand that the nurses have less familiarity with permanent education, performing HCA capacitating activities based on traditional teaching methodologies. Investments for capacitating nurses in permanent education are required to allow them to teach HCAs better.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:44:47Z No. of bitstreams: 1 S1983-14472012000100008.pdf: 52230 bytes, checksum: 2dbdd5fc8eda8945efd65443c323be06 (MD5) Made available in DSpace on 2013-08-22T18:44:47Z (GMT). No. of bitstreams: 1 S1983-14472012000100008.pdf: 52230 bytes, checksum: 2dbdd5fc8eda8945efd65443c323be06 (MD5) Previous issue date: 2012-03-01 Made available in DSpace on 2013-09-30T19:33:13Z (GMT). No. of bitstreams: 2 S1983-14472012000100008.pdf: 52230 bytes, checksum: 2dbdd5fc8eda8945efd65443c323be06 (MD5) S1983-14472012000100008.pdf.txt: 36636 bytes, checksum: 01d07190385e432f9101cdb4a5ce61ba (MD5) Previous issue date: 2012-03-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:35:08Z No. of bitstreams: 2 S1983-14472012000100008.pdf: 52230 bytes, checksum: 2dbdd5fc8eda8945efd65443c323be06 (MD5) S1983-14472012000100008.pdf.txt: 36636 bytes, checksum: 01d07190385e432f9101cdb4a5ce61ba (MD5) Made available in DSpace on 2014-05-20T13:35:08Z (GMT). No. of bitstreams: 2 S1983-14472012000100008.pdf: 52230 bytes, checksum: 2dbdd5fc8eda8945efd65443c323be06 (MD5) S1983-14472012000100008.pdf.txt: 36636 bytes, checksum: 01d07190385e432f9101cdb4a5ce61ba (MD5) Previous issue date: 2012-03-01 Este artigo teve por objetivo descrever e analisar o processo de educação dos Agentes Comunitários da Saúde (ACS) utilizado pelos enfermeiros na Estratégia Saúde da Família. Trata-se de uma pesquisa qualitativa, e contou com 17 sujeitos. Para a coleta de dados, utilizou-se entrevista semiestruturada, e a análise dos dados foi realizada por meio da técnica de análise de conteúdo. Identificou-se a categoria: organização do processo de educação nas unidades de saúde da família, cujas temáticas elencadas foram: enfermeiros como líderes da equipe de referência, educação permanente, metodologias tradicionais e educação centrada nas necessidades dos ACS. Através deste estudo, pudemos compreender que os enfermeiros têm pouco contato com a ferramenta da Educação Permanente, realizando as atividades de capacitação fundamentadas na metodologia tradicional de ensino, sendo necessário um investimento dos gestores no sentido de capacitá-los, no que se refere à educação permanente, possibilitando-lhes a atuação com os ACS. This article aimed to describe and analyze the training process of Health Community Agents (HCA) by Family Health Strategy nurses. It is a qualitative research with 17 individuals. Data collection was performed through semi-structured interviews and the analysis was made through the data analysis technique. A category was established: The organization of the educational process in the Family Health Units, in which the themes selected were: nurses as reference team leaders, permanent education, traditional methodologies and education centered on the HCA needs. Through this study we were able to understand that the nurses have less familiarity with permanent education, performing HCA capacitating activities based on traditional teaching methodologies. Investments for capacitating nurses in permanent education are required to allow them to teach HCAs better. Este artículo objetivó describir y analizar el proceso de educacional de los Agentes Comunitarios de Salud (ACS), usan todo el enfermeros en la estrategia de la Salud de la Familia. Acerca de una pesquisa cualitativa, contó con 17 sujetos. Para la colección de datos, eligió-se la entrevista semi-estructurada y el análisis través la técnica del análisis del contenido .Fue identificada una categoría: la organización del proceso educacional en las unidades de la Salud de la Familia, cuyas temáticas elegidas fueron: enfermeros como líderes del equipo de referencia, educación permanente, metodologías tradicionales y educación centrada en las necesidades de los ACS. Través de este estudio pudimos comprender que los enfermeros poseen poca aproximación con la herramienta de educación permanente, realizando las actividades de capacitación de los ACS basadas en la metodología tradicional de enseñanza, necesitando investimento gerencial en la capacitación de los enfermeros en educación permanente, posibilitándolos en la actuación con los ACS. Universidade Estadual Paulista Programa de Pós-Graduação em Saúde Coletiva Hospital das Clínicas Unidade II Materno Infantil UNESP Departamento de Ginecologia e Obstetrícia Faculdade de Medicina de Marília Hospital das Clínicas Serviço de Enfermagem Unidade I Clínico Cirúrgico Universidade Estadual Paulista Programa de Pós-Graduação em Saúde Coletiva UNESP Departamento de Ginecologia e Obstetrícia

Objective. To identify reasons why women look for early health care attention at the end of pregnancy. Methodology. Qualitative study based in socio-existential phenomenology proposed by Al­fred Schütz. Nine pregnant women who consulted to the maternity service without being in real labor were interviewed. Results. The following analysis categories emerged: Having different symptoms or signals from the ones they had felt or been informed about, not being able to identify real labor, fear to fetal complications for being close to the probable labor date, feeling calmer when being seen by professionals of the institution, lack of problem solving by other services of the health institution, fearing out of hospital delivery, imitating real labor, looking for tranquility in the idealization of labor and mo­difying behaviors to guarantee attention. Conclusion. Women are insecure and fear because of a fragmented health care, where they do not perceive themselves linked to the prenatal control program anymore, and at the same time they don’t find the health care assistance they want.

Seventy-six patients underwent preoperative vocal evaluation and were randomized into 3 groups: (1) those with the superior thyroid pole dissected by the first author, with the external branch of the superior laryngeal nerve (EBSLN) identified by means of a nerve stimulator; (2) those patients whose dissection was executed by a resident, with no nerve search; and (3) those whose dissection was undertaken by the first author, without any nerve search. Postoperative analysis consisted of voice evaluation and electromyography of the cricothyroid muscle. No lesion occurred in patients in group 1. Twenty-eight percent of patients in group 2 and 12% in group 3 experienced a complete lesion of the EBSLN (p = 0.0123). When the patients in group 1 were compared with the patients with 62 nerves corresponding to nonoperated thyroid lobes, patients in group 1 exhibited no increased risk, whereas a significantly increased hazard was evident in both groups 2 (p = 0.0002776) and 3 (p = 0.0346393). In this study, effective prevention of iatrogenic EBSLN lesions during thyroidectomies was achieved only by the intraoperative identification of the nerve with the nerve stimulator.

This is a convergent care research, developed in 2004, carried out with a group of 105 workers of the textile industry, whose objective was to investigate and analyze the cytological diagnosis and the risk of cervical cancer. Most of women were married, had one sexual partner, 60% of them had around one and two children. As for the result of the cytology 9.5% presented class I and 87.6% class II. From the total 2.9% presented intraepithelial neoplasm, and 2.0% showed cytological changes induced by HPV infection. The risk factors observed for the development of gynecological cancer were: multiplicity of partners, smoking, and history of STD, multiparity, sexual precocity and presence of intraepithelial neoplasia.

This study aimed at identifying women's knowledge concerning HPV as well as at understanding the meaning that they attribute to a positive diagnosis. It is a qualitative study, and the theoretical framework for analysis was that of the collective subject discourse. It was carried out at the Teaching Healthcare Unit (CSE) of the Botucatu School of Medicine - UNESP, with a population of 25 women aged 25 to 53 years old. Data were collected by interviews containing guiding questions after approval by the Research Ethics Committee. The core ideas in the discourse showed the representation of feelings of disappointment and concern about the cure, which indicated the need for HPV treatment, the fear of continuing having a sexual relationship, the need to take care of oneself and to be optimistic in order to face the disease and the perception of a cervical cancer threat. In view of such representations, differentiated performance by healthcare professionals is necessary in the permanent search for strategies aimed at women's awareness development as regards the necessary care for a safe sexual life. A performance which includes involvement, availability to listen to patients about their intimacy, privacy and right to knowing and talking about the disease and their health is required.

The results are presented of disease-free interval and overall survival in 53 elderly patients with colon or rectum adenocarcinoma treated with curative surgery. The average age was 75.3 years (median = 75.0); 21 patients were male and 32 were female. Tumor location was as follows: rectum 18 (34%), sigmoid 17 (32.1%), right colon 14 (26.4%), and transverse colon 4 (7.5%) All patients were surgically treated following the classical patterns for tumor resection. After pathological examination, which included the histological grade differentiation, the disease stage was reevaluated following the pTNM system. Overall and disease-free survival at 5 years, for all patients, independent of histological grade differentiation and disease stage, were 75.3% and 55.5%, respectively. Overall survival at 5 years for patients with grades I and II histological differentiation was 74.1% and 85.0%, respectively. None of the grade III patients (2 cases) survived more than I year. The 5 years disease-free survival for patients with histological grade differentiation I and II was 56.8% and 60%, respectively. There was no statistically significant difference in overall survival for patients with stages SI, SII, and SIII, but the disease-free survival at 5 years by stages was found to be significant with rates of 100%, 67.6%, and 22.6%. Postoperative mortality was 4 (7.5%). The postoperative mortality and survival rates obtained in this group of patients encourage us not to consider age as a limiting factor for curative surgical treatment. © 1992 Wiley-Liss, Inc.