A regulação assistencial e a produção do cuidado: um arranjo potente para qualificar a atenção

A produção do cuidado integral e a eqüidade são desafios na gestão do SUS. Analisou-se um arranjo da gestão municipal para a produção do cuidado implantado por meio da regulação assistencial com o objetivo de enriquecer as reflexões sobre o tema. Foi realizado estudo de caso em que os dados foram obtidos mediante observação, entrevistas, narrativas escritas e análise documental. Os sujeitos da pesquisa foram gestores e trabalhadores da Secretaria de Saúde. Como resultado destaca-se um conceito de rede viva, produzida ativamente pela construção de relações entre os trabalhadores dos diferentes serviços. Destacam-se as ações de apoio ao cuidado produzido pelas equipes, com base na regulação assistencial e na gestão dos processos de trabalho. Os resultados foram expressivos na qualificação do cuidado, na redução das filas às especialidades e na satisfação dos profissionais. Como marca do processo, evidencia-se a necessidade de enriquecer, em ato, os saberes técnicos com as tecnologias leves e os saberes produzidos em movimentos ativos da gestão para a produção do cuidado.

Acidentes de trânsito causando vítimas: possível reflexo da lei seca nas internações hospitalares

Os acidentes de trânsito no Brasil se constituem em relevante problema para a área da saúde. Nesse sentido, julgou-se importante investigar qual o efeito da lei 11.705 de 19 de junho de 2008, a chamada Lei seca. A metodologia do trabalho constitui analisar os dados do Sistema de Informações Hospitalares do SUS, para o Brasil, em 2008, comparando as internações nos dois semestres do ano, segundo algumas variáveis consideradas importantes. Os resultados mostraram que houve uma queda de 28,3 por cento nas internações do segundo semestre, com reflexos consideráveis em todas as variáveis estudadas. Quanto à qualidade da vítima, a maior queda ocorreu entre os ocupantes de automóvel, principalmente do sexo masculino. Em relação às idades, houve declínio em todas as faixas, destacando-se as de 40 a 59 anos e 20 a 39 anos, pela ordem. O tempo de permanência na instituição foi menor no segundo semestre,quando a mortalidade hospitalar declinou 13,6 por cento em relação ao primeiro semestre, o que significa que deixaram de morrer 917 pessoas (cerca de 5 mortes/dias). O gasto governamental para o atendimento dos feridos no segundo semestre foi 35,5 por cento menor do que no primeiro

The Effects of Commercially Available Preservative-Free FDA-Approved Triamcinolone (Triesence (R)) on Retinal Cells in Culture

Purpose: To evaluate the effects of Triesence (R) (TRI), a new preservative-free triamcinolone approved by the U. S. Food and Drug Administration (FDA) for intraocular use, on human retina pigment epithelial (ARPE-19) and rat neurosensory (R28) cells in culture. Methods: ARPE-19 and R28 cell cultures were treated 24 h with 1,000, 500, 200, or 100 mu g/mL of crystalline (cTRI) or 1,000, 500, or 200 mu g/mL of solubilized (sTRI). TRI was solubilized by centrifuging the drug, discarding the supernatant containing the vehicle and then resuspending the drug pellet in an equivalent amount of Dimethyl sulfoxide to achieve the same concentration as the commercial preparation. Percentage of cell viability (CV) was evaluated by a trypan blue dye-exclusion assay. The mitochondrial membrane potential (Delta Psi m) was analyzed with the JC-1 assay. The caspase-3/7 activity was measured by a fluorochrome assay. Results: In the ARPE-19 cultures, the cTRI caused a decrease in CV at 1,000 mg/mL (13.03 +/- 6.51; P < 0.001), 500 mu g/mL (28.87 +/- 9.3; P < 0.001), 200 mu g/mL (54.93 +/- 5.61; P < 0.001), and 100 mu g/mL (82.53 +/- 0.65; P < 0.005) compared with the untreated controls (96.98 +/- 0.16). In R28 cultures, the cTRI treatment also reduced CV values significantly (P < 0.001) for the 1,000 mu g/mL (22.73 +/- 2.44), 500 mu g/mL (34.63 +/- 1.91), 200 mu g/mL (58.70 +/- 1.39), and 100 mu g/m (75.33 +/- 2.47) compared with the untreated controls (86.08 +/- 3.54). Once the TRI was solubilized (sTRI), the CV and Delta Psi m remained similar to the untreated controls for both ARPE-19 and R28 cells. The sTRI treatment with 1,000, 500, and 200 mu g/mL increased in caspase-3/7 activity in ARPE-19 cells (P < 0.01) and in R28 cells (P < 0.05) compared with dimethyl sulfoxide equivalent controls. Conclusion: The crystalline form of TRI (cTRI) can cause a significant decrease in CV to cultured retinal cells. Once the TRI is solubilized (sTRI), at the same concentrations, the cells remain viable with no decrease in CV or Delta Psi m. The sTRI can, however, increase caspase-3/7 activity, thus suggesting some degree of apoptosis.

Photodynamic Therapy Can Be Effective as a Treatment for Herpes Simplex Labialis

Background Data and Objective: Herpes is a common infectious disease that is caused by human herpesviruses. Several treatments have been proposed, but none of them prevent reactivation of the virus. This article describes the use of photodynamic therapy (PDT) as a treatment for herpes lesions, and reports on four cases. Materials and Methods: PDT was used as an adjuvant therapy for the treatment of herpes labialis in four patients. A special type of 0.01% (m/V) of methylene blue solution was applied to the vesicular stage of herpesviral disease and the lesions were irradiated with laser energy (wavelength 660 nm, energy density 120 J/cm(2), output power of 40 mW, 2 min per point, 4.8 J of energy/point, at four points). After 24 h the patients returned and phototherapy was repeated with the same equipment, this time with 3.8 J/cm(2) and 15 mW, for a total dose of 0.6 J. The same procedure was repeated 72 h and 1 wk later. Results: Treatment with low-level laser therapy can be considered as an option in the treatment of herpes labialis, and decreases the frequency of vesicle recurrence and provides comfort for patients. No significant acute side effects were noted and the lesions healed rapidly. Conclusion: Treatment of herpes labialis with PDT was effective, had no side effects, and when associated with laser phototherapy, accelerated the healing process.

Improvement in Quality of Life of An Oncological Patient by Laser Phototherapy

Objective and Background Data: Common side effects of radiotherapy (RT) to the head and neck include oral mucositis, xerostomia, and severe pain. The aim of this study is to report improvement in the quality of life of an oncological patient by laser phototherapy (LPT). Clinical Case and Laser Phototherapy Protocol: The patient, a 15-year-old girl diagnosed with mucoepidermoid carcinoma, underwent surgical excision of a tumor of the left palatomaxilla. After that, she was subjected to 35 sessions of RT (2 Gy/d). Clinical examination revealed the spread of severe ulcerations to the jugal mucosa, gums, lips, hard palate, and tongue (WHO mucositis score 3). She had difficulty in moving her tongue and she was unable to eat any solid food. Oral hygiene orientation and LPT were performed throughout all RT sessions. A continuous diode laser, 660 nm, 40 mW, 6 J/cm(2), 0.24 J per point in contact mode, with spot size of 0.04 cm(2) was used in the entire oral cavity. A high-power diode laser at 1 W, 10 sec per cm of mucositis, approximately 10 J/cm(2), was used in defocused mode only on ulcerative lesions. After the first laser irradiation session, decreases in pain and xerostomia were reported; however, a more significant improvement was seen after five sessions. At that point although the mucositis score was still 2, the patient reported that she was free of pain, and consequently a palatine plate could be made to rehabilitate the entire surgical area. Seventeen laser irradiation sessions were necessary to eliminate all oral mucositis lesions. Conclusion: Normal oral function and consequent improvements in the quality of life of this oncologic patient were observed with LPT.

Effect of Er:YAG Laser Parameters on Ablation Capacity and Morphology of Primary Enamel

Objective: The purpose of this study was to evaluate the ablation capacity of different energies and pulse repetition rates of Er:YAG laser energy on primary molar enamel, by assessing mass loss and by analyzing the surface morphology with scanning electron microscopy. Background Data: Previous studies have demonstrated the capacity of the Er:YAG laser to ablate enamel substrate. Methods: Forty-two sound primary molars were bisected in a mesiodistal direction. The enamel surfaces were flattened and their initial mass (in milligrams) was obtained. An area of 4 mm(2) was delimited. The specimens were randomly assigned to 12 groups according to the combination of energy (160, 200, 250, and 300 mJ) and pulse repetition rate (2, 3, and 4 Hz). Er: YAG laser irradiation was performed on each specimen for 20 sec. After irradiation, the final mass was obtained and specimens were prepared for examination with scanning electron microscopy. The data obtained by subtracting the final mass from the initial mass were statistically analyzed using ANOVA and the Tukey test (p < 0.05). Results: The pulse repetition rate of 4 Hz provided greater mass loss, different from that seen with 2 Hz, and similar to that seen with 3 Hz. The energy level of 300 mJ resulted in greater mass loss, similar to that seen with 200 and 250 mJ. Scanning electron photomicrographs showed that there was non-selective enamel removal, with fused and cracked areas in all specimens. Conclusion: The parameters of 200 mJ and 2 Hz produced a good ablation rate with fewer surface alterations in primary molar enamel.

Observational evidences on the modulation of the South American Low Level Jet east of the Andes according the ENSO variability

The differences on the phase and wavelength of the quasi-stationary waves over the South America generated by El Nino (EN) and La Nina (LN) events seem to affect the daily evolution of the South American Low Level Jet east of the Andes (SALLJ). For the austral summer period of 1977 2004 the SALLJ episodes detected according to Bonner criterion 1 show normal to above-normal frequency in EN years, and in LN years the episodes show normal to below-normal frequency. During EN and LN years the SALLJ episodes were associated with positive rainfall anomalies over the La Plata Basin, but more intense during LN years. During EN years the increase in the SALLJ cases were associated to intensification of the Subtropical Jet (SJ) around 30 degrees S and positive Sea Level Pressure (SLP) anomalies over the western equatorial Atlantic and tropical South America, particularly over central Brazil. This favored the intensification of the northeasterly trade winds over the northern continent and it channeled by the Andes mountain to the La Plata Basin region where negative SLP are found. The SALLJ cases identified during the LN events were weaker and less frequent when compared to those for EN years. In this case the SJ was weaker than in EN years and the negative SLP anomalies over the tropical continent contributed to the inversion of the northeasterly trade winds. Also a southerly flow anomaly was generated by the geostrophic balance due to the anomalous blocking over southeast Pacific and the intense cyclonic transient over the southern tip of South America. As result the warm tropical air brought by the SALLJ encounters the cold extratropical air from the southerly winds over the La Plata basin. This configuration can increase the conditional instability over the La Plata basin and may explain the more intense positive rainfall anomalies in SALLJ cases during LN years than in EN years.

Enzymatic Hydrolysis of Chemithermomechanically Pretreated Sugarcane Bagasse and Samples with Reduced Initial Lignin Content

Chemithermomechanical (CTM) processing was used to pretreat sugarcane bagasse with the aim of increasing cell wall accessibility to hydrolytic enzymes. Yields of the pretreated samples were in the range of 75-94%. Disk refining and alkaline-CTM and alkaline/sulfite-CTM pretreatments yielded pretreated materials with 21.7, 17.8, and 15.3% of lignin, respectively. Hemicellulose content was also decreased to some extent. Fibers of the pretreated materials presented some external fibrillation, fiber curling, increased swelling, and high water retention capacity. Cellulose conversion of the alkaline-CTM- and alkaline/sulfite-CTM-pretreated samples reached 50 and 85%, respectively, after 96 h of enzymatic hydrolysis. Two samples with low initial lignin content were also evaluated after the mildest alkaline-CTM pretreatment. One sample was a partially delignified mill-processed bagasse. The other was a sugarcane hybrid selected in a breeding program. Samples with lower initial lignin content were hydrolyzed considerably faster in the first 24 h of enzymatic digestion. For example, enzymatic hydrolysis of the sample with the lowest initial lignin content (14.2%) reached 64% cellulose conversion after only 24 h of hydrolysis when compared with the 30% observed for the mill-processed bagasse containing an initial lignin content of 24.4%. (C) 2011 American Institute of Chemical Engineers Biotechnol. Prog., 27: 395-401, 2011

Maternal decision on obtaining prenatal care: a study in Brazil

Objective: to address the social aspects of pregnancy and the views of pregnant women regarding prenatal assistance in Brazil. Design: this qualitative study was focused on describing the Social Representations of prenatal care held by pregnant women. The discourse of the collective subject (DCS) framework was used to analyse the data collected, within the theoretical background of social representations, as proposed and developed by Serge Moscovici. Participants and setting: 21 pregnant women who were users of the publicly funded Brazilian unified health-care system and resided in the area served by its family health programme in a low- to middle-income neighbourhood on the outskirts of Campo Grande, the capital of the state of Mato Grosso do Sul, in southwestern Brazil. Data were collected by conducting in-depth, face-to-face interviews from January to October 2006. Findings: all participants were married. Formal education of the participants was less than five years in four cases, between five and eight years in six cases, and greater than 11 years in 10 cases. Nine participants had informal jobs and earned up to US$ 200 per month, four paricipants had administrative jobs and earned over US$ 500 per month, and eight participants did not work. No specific racial/ethnic background predominated. Lack of adherence to prenatal care allowed for the identification of two DCS themes: `organisation of prenatal care services` and `lifestyle features`. Key conclusions: the respondents were found to have negative feelings about pregnancy which manifest as many fears, including the fear of harming their children`s health, of being punished during labour, and of being reprimanded by health-care professionals for overlooking their prenatal care, in addition to the insecurity felt towards the infant and self. Implications for practice: the findings reveal that communication between pregnant women and healthcare professionals has been ineffective and that prenatal care has not been effective for the group interviewed-features that are likely to be found among other low- to middle-income groups living elsewhere in Brazil. (C) 2009 Elsevier Ltd. All rights reserved.

Limiting factors for phytoplankton growth in subtropical reservoirs: the effect of light and nutrient availability in different longitudinal compartments

Limited information is available on the interactions between environmental factors and algal growth in tropical and subtropical aquatic systems. We investigated the relationships between algal biomass (measured as chlorophyll, Chl-a) and light, total phosphorus (TP) and total nitrogen (TN) in longitudinal zones of subtropical reservoirs. We studied the seasonal variation of water variables in Itupararanga Reservoir (Brazil) and compared the results with 16 other subtropical lakes and reservoirs. The longitudinal zones in Itupararanga Reservoir were considered statistically different (p 0.05, MANOVA). From the riverine zone to the dam region of the reservoir, Spearman Correlation Test suggested that light limitation and TP limitation tended to decrease and increase, respectively. Although nitrate concentrations were high (400 g/L), the Spearman coefficients between Chl-a and TN and the TN:TP ratios (11:1 TN:TP 35:1) indicated that nitrogen may be co-limiting algal growth in the studied water body. Putting Itupararanga in a regional context allowed assessment of potential influences of land use on trophic state. Within the subtropical dataset, TP explained a greater percentage of variance in Chl-a (R2 = 0.70) than TN (R2 = 0.17). The main land use type within the reservoirs drainage area significantly influenced the concentrations of TP, TN, and Chl-a (p 0.05, MANOVA), with different relationships between nutrients and chlorophyll in forested (R2 = 0.12-0.33), agricultural (R2 = 0.50-0.68) and urban (R2 = 0.09-0.64) watersheds. Comparisons with literature values and those from reservoirs with less altered watersheds indicated that Itupararanga Reservoir is reaching the mesotrophic-eutrophic boundary, and further nutrient enrichment could cause water quality degradation.

AN ASSESSMENT ON THE USE OF THE DEBYE-HUCKEL EQUATION FOR THE THERMODYNAMIC MODELING OF AQUEOUS SYSTEMS CONTAINING POLYMERS AND SALTS

In this work, a study on the role of the long-range term of excess Gibbs energy models in the modeling of aqueous systems containing polymers and salts is presented. Four different approaches on how to account for the presence of polymer in the long-range term were considered, and simulations were conducted considering aqueous solutions of three different salts. The analysis of water activity curves showed that, in all cases, a liquid-phase separation may be introduced by the sole presence of the polymer in the long-range term, regardless of how it is taken into account. The results lead to the conclusion that there is no single exact solution for this problem, and that any kind of approach may introduce inconsistencies.

CLIMATOLOGICAL HYDRIC BALANCE, EFFECTIVE SOIL WATER STORAGE AND TRANSPIRATION IN COFFEE CULTURE

The climatic water balance is one of the most used tools to assess, indirectly the amount of water present in the soil is capable of meeting the water needs of the plant. This study analyzed the climatologic hydric balance, the effective soil water storage and coffee plant transpiration in dry regimen cultivation. Daily climatologic hydric balance was calculated for coffee from January 2003 to May 2006. It was concluded that even in the most rainy months of the year, there is a hydric deficit in coffee plants grown in a dry regimen; effective soil water storage varied greatly through the years evaluated, and September was the most critical month, when this value remained below 30%; relative transpiration can not be taken as the single evaluation method for yield losses of coffee, grown in a dry regimen.

Cyclophosphamide levels in sites of preparation and administration of antineoplastic drugs

The extensive use of antineoplastic agents in chemotherapy may be at risk to health care workers involved in the preparation and administration of these drugs. In this study cyclophosphamide, a drug classified as a human carcinogen, was quantified by adapting a previous analytical method using gas chromatography coupled to mass spectrometry (GC-MS) after solid phase extraction with diatomaceous earth. The drug was measured by analysis in surfaces (wipe samples) and gloves, collected from four different hospitals, before and after the practice of cleaning procedures, and the use of a closed-system device for the preparation and administration. Validation results were satisfactory and cyclophosphamide levels ranging from below the quantification limit to 141000 ng. Our findings demonstrated that surfaces and materials contamination was found in all hospitals during the traditional open technique for preparation and administration of cyclophosphamide and a significant reduction in contamination when a closed-system device was used. However, some values were considered unexpected, especially those obtained from samples collected after the cleaning surfaces.

Antioxidant activity of flavonoids in isolated mitochondria

Mitochondria are important intracellular sources and targets of reactive oxygen species (ROS), while flavonoids, a large group of secondary plant metabolites, are important antioxidants. Following our previous study on the energetics of mitochondria exposed to the flavonoids quercetin, taxifolin, catechin and galangin, the present work addressed the antioxidant activity of these compounds (1-50 mu mol/L) on Fe2+/citrate-mediated membrane lipid peroxidation (LPO) in isolated rat liver mitochondria, running in parallel studies of their antioxidant activity in non-organelle systems. Only quercetin inhibited the respiratory chain of mitochondria and only galangin caused uncoupling. Quercetin and galangin were far more potent than taxifolin and catechin in affording protection against LPO (IC50 = 1.23 +/- 0.27 and 2.39 +/- 0.79 mu mol/L, respectively), although only quercetin was an effective scavenger of both 2,2-diphenyl-1-picrylhydrazyl (DPPH) and superoxide radicals. These results, together with the previous study, suggest that the 2,3-double bond in conjugation with the 4-oxo function in the flavonoid structure are major determinants of the antioxidant activity of flavonoids in mitochondria, the presence of an o-di-OH structure on the B-ring, as occurs in quercetin, favours this activity via superoxide scavenging, while the absence of this structural feature in galangin, favours it via a decrease in membrane fluidity and/or mitochondrial uncoupling. Copyright (c) 2008 John Wiley & Sons, Ltd.