Aten����o domiciliar como mudan��a do modelo tecnoassistencial

OBJETIVO: Analisar pr��ticas de aten����o domiciliar de servi��os ambulatoriais e hospitalares e sua constitui����o como rede substitutiva de cuidado em sa��de. PROCEDIMENTOS METODOL��GICOS: Estudo qualitativo que analisou, com base na metodologia de caso tra��ador, quatro servi��os ambulatoriais de aten����o domiciliar da Secretaria Municipal de Sa��de e um servi��o de um hospital filantr��pico do munic��pio de Belo Horizonte, MG, entre 2005 e 2007. Foram realizadas entrevistas com gestores e equipes dos servi��os de aten����o domiciliar, an��lise de documentos e acompanhamento de casos com entrevistas a pacientes e cuidadores. A an��lise foi orientada pelas categorias anal��ticas integra����o da aten����o domiciliar na rede de sa��de e modelo tecnoassistencial. AN��LISE DOS RESULTADOS: A implanta����o da aten����o domiciliar foi precedida por decis��o pol��tico-institucional tanto com orienta����o racionalizadora, buscando a diminui����o de custos, quanto com vistas �� reordena����o tecnoassistencial das redes de cuidados. Essas duas orienta����es encontram-se em disputa e constituem dificuldades para concilia����o dos interesses dos diversos atores envolvidos na rede e na cria����o de espa��os compartilhados de gest��o. P��de-se identificar a inova����o tecnol��gica e a autonomia das fam��lias na implementa����o dos projetos de cuidado. As equipes mostraram-se coesas, construindo no cotidiano do trabalho novas formas de integrar os diferentes olhares para transforma����o das pr��ticas em sa��de. Foram observados desafios na proposta de integrar os diferentes servi��os de car��ter substitutivo do cuidado ao limitar a capacidade da aten����o domiciliar de mudar o modelo tecnoassistencial. CONCLUS��ES: A aten����o domiciliar possui potencial para constitui����o de uma rede substitutiva ao produzir novos modos de cuidar que atravessam os projetos dos usu��rios, dos familiares, da rede social e dos trabalhadores da aten����o domiciliar. A aten����o domiciliar como modalidade substitutiva de aten����o �� sa��de requer sustentabilidade pol��tica, conceitual e operacional, bem como reconhecimento dos novos arranjos e articula����o das propostas em curso.

O dif��cil acesso a servi��os de m��dia complexidade do SUS: o caso da cidade de S��o Paulo, Brasil

O acesso aos servi��os de m��dia complexidade tem sido apontado, por gestores e pesquisadores, como um dos entraves para a efetiva����o da integralidade do SUS. Este artigo teve o objetivo de avaliar mecanismos utilizados pela gest��o do SUS, no munic��pio de S��o Paulo, para garantir acesso �� assist��ncia de m��dia complexidade, durante o per��odo de 2005 a 2008. Optou-se pela estrat��gia de estudo de caso, utilizando as seguintes fontes de evid��ncia: entrevistas com gestores; grupo focal com usu��rios e observa����o participante. Utilizouas t��cnica de an��lise tem��tica, a partir do referencial te��rico da integralidade da assist��ncia, na dimens��o da organiza����o de servi��os. Buscou-se descrever os caminhos percorridos pelos usu��rios para acessar os servi��os da m��dia complexidade, a partir da vis��o dos gestores e dos pr��prios usu��rios. A m��dia complexidade foi identificada, pelos gestores, como o "gargalo" do SUS e um dos principais obst��culos para a constru����o da integralidade. Para enfrentar essa situa����o, o gestor municipal investiu na informatiza����o dos servi��os, como medida isolada e, ainda, sem considerar a necessidade dos usu��rios. Sendo assim, essa incorpora����o tecnol��gica teve pouco impacto na melhoria do acesso, o que se confirmou no relato dos usu��rios. Discute-se que para o enfrentamento de um problema t��o complexo s��o necess��rias a����es articuladas, tanto no ��mbito da pol��tica de sa��de, quanto da organiza����o dos servi��os, bem como a (re)organiza����o do processo de trabalho em todos os n��veis do sistema de sa��de.

Gestores do SUS: apoio e resist��ncias �� Homeopatia

Este artigo apresenta parte dos resultados de pesquisa que investigou caracter��sticas do movimento de aproxima����o e afastamento entre homeopatas e m��dicos da Biomedicina, segundo o ponto de vista dos profissionais n��o homeopatas. Foram entrevistados 48 profissionais de sa��de (docentes, gestores e m��dicos que trabalham na rede publica). Toma-se para an��lise apenas os resultados das entrevistas com gestores. Foram usadas como refer��ncias as concep����es de: campo social e cient��fico de Bourdieu; racionalidades m��dicas de Madel Luz; arranjos tecnol��gicos do trabalho em sa��de de Mendes-Gon��alves e de identidade profissional de m��dico de Donnangelo e de Schraiber. Os resultados indicam que o apoio de gestores �� presen��a da Homeopatia no SUS relaciona-se �� percep����o da demanda social, �� defesa do direito de escolha dos usu��rios e �� constata����o de tratar-se de uma pr��tica m��dica que resgata a dimens��o humanista da medicina, contribuindo assim para a satisfa����o do usu��rio. As dificuldades e resist��ncias apontadas pelos gestores ressaltam que a falta de informa����es sobre os procedimentos homeop��ticos limita as possibilidades de utiliza����o da Homeopatia porque gera inseguran��a sobre esta medicina.

H��bitos relacionados ao descarte p��s-consumo de aparelhos e baterias de telefones celulares em uma comunidade acad��mica

Cada vez mais a sociedade contempor��nea incorpora em seu cotidiano equipamentos el��tricos e eletr��nicos, muitos deles contendo subst��ncias perigosas, que representam amea��as ao meio ambiente e riscos �� sa��de humana. Este artigo apresenta os resultados de uma pesquisa explorat��ria com o objetivo de relacionar comportamento de descarte p��s-consumo de aparelhos e baterias de celulares, em um grupo de consumidores de telefonia m��vel, que tem proximidade em seu cotidiano de trabalho e de estudo com informa����es sobre sa��de p��blica e ambiental. Os resultados da pesquisa indicam que informa����o pode aproximar as pessoas do problema, por��m n��o levam por si s�� �� produ����o de altera����es significativas sobre o que e como fazer com o descarte p��s-consumo. Os participantes do estudo possibilitaram identificar, que al��m da informa����o e acesso a coletores espec��ficos, outros aspectos e crit��rios pessoais ou coletivos interferem no procedimento de descarte: percep����o sobre risco, valor econ��mico disponibilizado na compra do aparelho e v��nculos afetivos, entre outros. Esses fatores podem produzir diferentes respostas dos usu��rios sobre como lidar com as inova����es tecnol��gicas de uso pessoal.

Occurrence and molecular characterization of Cryptosporidium spp. isolated from domestic animals in a rural area surrounding Atlantic dry forest fragments in Teodoro Sampaio municipality, State of S��o Paulo, Brazil

The aim of this study was to assess the occurrence of Cryptosporidium in domestic animals in rural properties surrounding rain forest fragments within the municipality of Teodoro Sampaio, southeastern Brazil. Conventional sucrose flotation method followed by molecular characterization of the parasites by sequencing PCR products amplified from SSU rRNA gene were used. Stool samples were collected from domestic animals raised as pets and livestock in all rural properties surrounding three forest fragments. Samples from cattle (197), equine (63), pigs (25), sheep (11), and dogs (28) were collected from 98 rural properties. The frequency of occurrence of Cryptosporidium within each animal species was 3.0% (6/197) among cattle and 10.7% (3/28) among dogs. Cryptosporidium was not detected in stool samples from equine, sheep, and pigs. All sequences obtained from the six samples of calves showed molecular identity with Cryptosporidium andersoni while all sequences from dog samples were similar to C. canis. The frequency of occurrence of Cryptosporidium in these domestic animal species was low. The absence of C. parvum in the present study suggests that the zoonotic cycle of cryptosporidiosis may not be relevant in the region studied. The presence of Cryptosporidium species seldom described in humans may be, otherwise, important for the wild fauna as these animals are a source of infection and dissemination of this protozoan to other animal species. The impact and magnitude of infection by C. andersoni in wild ruminants and C. canis in wild canids have to be assessed in future studies to better understand the actual importance of these species in this region.

Energy and amino acid content in phase 1 nursery diet: piglet performance and body chemical composition

It was evaluated the effects of metabolizable energy (ME) and digestible lysine (dLYS) densities on performance and body composition of weaned piglets. The study used 114 piglets weaned at 7.4 �� 0.80 kg, out of which 108 were allotted in the nursery and 6 were slaughtered on the weaning day to determine comparative data of body chemical composition. Six nutrients densities were stipulated from a previous study based on the highest nitrogen retention, maintaining the following ME:LYS relationship in the experimental diets: 3,390:1.291; 3,450:1.409; 3,650:1.411; 3,780:1.461; 3,940:1.507; and 4,109 kcal/kg ME:1.564% dLYS. The experimental diets were offered for 13 days when the piglets reached 12.986 �� 1.449 kg of body weight. The probable residual effects of nutritional density on the subsequent performance of the piglets were evaluated. At the end of initial phase 1, six piglets from each density were slaughtered to determine their chemical composition in body fractions and empty body. There was no significant influence of nutritional levels on the performance of the piglets at the end of the evaluation. The results of food conversion and body composition confirm the level indicated in the previous study, 4 g dLYS/Mcal of ME. The increase of energy and lysine densities confirms the need for a correct relationship among both of them to assure better performance of the piglets at the beginning of the growing phase.

O dif��cil acesso a servi��os de m��dia complexidade do SUS

O acesso aos servi��os de m��dia complexidade tem sido apontado, por gestores e pesquisadores, como um dos entraves para a efetiva����o da integralidade do SUS. Este artigo teve o objetivo de avaliar mecanismos utilizados pela gest��o do SUS, no munic��pio de S��o Paulo, para garantir acesso �� assist��ncia de m��dia complexidade, durante o per��odo de 2005 a 2008. Optou-se pela estrat��gia de estudo de caso, utilizando as seguintes fontes de evid��ncia: entrevistas com gestores; grupo focal com usu��rios e observa����o participante. Utilizouas t��cnica de an��lise tem��tica, a partir do referencial te��rico da integralidade da assist��ncia, na dimens��o da organiza����o de servi��os. Buscou-se descrever os caminhos percorridos pelos usu��rios para acessar os servi��os da m��dia complexidade, a partir da vis��o dos gestores e dos pr��prios usu��rios. A m��dia complexidade foi identificada, pelos gestores, como o "gargalo" do SUS e um dos principais obst��culos para a constru����o da integralidade. Para enfrentar essa situa����o, o gestor municipal investiu na informatiza����o dos servi��os, como medida isolada e, ainda, sem considerar a necessidade dos usu��rios. Sendo assim, essa incorpora����o tecnol��gica teve pouco impacto na melhoria do acesso, o que se confirmou no relato dos usu��rios. Discute-se que para o enfrentamento de um problema t��o complexo s��o necess��rias a����es articuladas, tanto no ��mbito da pol��tica de sa��de, quanto da organiza����o dos servi��os, bem como a (re)organiza����o do processo de trabalho em todos os n��veis do sistema de sa��de

Vigil��ncia em sa��de no Brasil: os desafios dos riscos sanit��rios do s��culo XXI e a necessidade de cria����o de um sistema nacional de vigil��ncia em sa��de

The technological development experienced in the contemporary world are transforming society and relations between State and people. The mobility of human being has reached levels never before imagined and a person can move from one side of the world to the other side in less than 24 hours. This mobility also includes goods and services, giving the keynote of the globalized world of the XXI Century. In this context, the risks of diseases and others health problems are intensely amplified. Nowadays, an epidemic that begins in China can arrive in Brazil the following day. Brazil recognizes health as a universal right and also consider it a State's obligation. Therefore, the State of Brazil is obligated to organize itself to eliminate or control health risks. Today, the organization of the Brazilian State regarding the surveillance of risks of diseases and other health problems is fragmented and includes sanitary surveillance (focused on goods, products and services), epidemiological surveillance (diseases and investigations of other risks) and environmental surveillance in health (the environment in general, including the workplace). This fragmentation causes problems for the management and consolidation of strategic information for health protection. Brazil has the need to think about an other model of organization that put together all "kinds" of surveillances within a single coordinated system, called the National System of Health Surveillance, which would be able to coordinate the various specialties of health surveillance that exists in the country in order to provide a effective system of information and health surveillance, able to face emergency situations of public health

Toll-like receptor 4 (TLR4) expression in human and murine pancreatic beta-cells affects cell viability and insulin homeostasis

Background: Toll-like receptor 4 (TLR4) is widely recognized as an essential element in the triggering of innate immunity, binding pathogen-associated molecules such as Lipopolysaccharide (LPS), and in initiating a cascade of pro-inflammatory events. Evidence for TLR4 expression in non-immune cells, including pancreatic beta-cells, has been shown, but, the functional role of TLR4 in the physiology of human pancreatic beta-cells is still to be clearly established. We investigated whether TLR4 is present in beta-cells purified from freshly isolated human islets and confirmed the results using MIN6 mouse insulinoma cells, by analyzing the effects of TLR4 expression on cell viability and insulin homeostasis. Results: CD11b positive macrophages were practically absent from isolated human islets obtained from nondiabetic brain-dead donors, and TLR4 mRNA and cell surface expression were restricted to beta-cells. A significant loss of cell viability was observed in these beta-cells indicating a possible relationship with TLR4 expression. Monitoring gene expression in beta-cells exposed for 48h to the prototypical TLR4 ligand LPS showed a concentration-dependent increase in TLR4 and CD14 transcripts and decreased insulin content and secretion. TLR4-positive MIN6 cells were also LPS-responsive, increasing TLR4 and CD14 mRNA levels and decreasing cell viability and insulin content. Conclusions: Taken together, our data indicate a novel function for TLR4 as a molecule capable of altering homeostasis of pancreatic beta-cells.

Turbulence in collisionless plasmas: statistical analysis from numerical simulations with pressure anisotropy

In recent years, we have experienced increasing interest in the understanding of the physical properties of collisionless plasmas, mostly because of the large number of astrophysical environments (e. g. the intracluster medium (ICM)) containing magnetic fields that are strong enough to be coupled with the ionized gas and characterized by densities sufficiently low to prevent the pressure isotropization with respect to the magnetic line direction. Under these conditions, a new class of kinetic instabilities arises, such as firehose and mirror instabilities, which have been studied extensively in the literature. Their role in the turbulence evolution and cascade process in the presence of pressure anisotropy, however, is still unclear. In this work, we present the first statistical analysis of turbulence in collisionless plasmas using three-dimensional numerical simulations and solving double-isothermal magnetohydrodynamic equations with the Chew-Goldberger-Low laws closure (CGL-MHD). We study models with different initial conditions to account for the firehose and mirror instabilities and to obtain different turbulent regimes. We found that the CGL-MHD subsonic and supersonic turbulences show small differences compared to the MHD models in most cases. However, in the regimes of strong kinetic instabilities, the statistics, i.e. the probability distribution functions (PDFs) of density and velocity, are very different. In subsonic models, the instabilities cause an increase in the dispersion of density, while the dispersion of velocity is increased by a large factor in some cases. Moreover, the spectra of density and velocity show increased power at small scales explained by the high growth rate of the instabilities. Finally, we calculated the structure functions of velocity and density fluctuations in the local reference frame defined by the direction of magnetic lines. The results indicate that in some cases the instabilities significantly increase the anisotropy of fluctuations. These results, even though preliminary and restricted to very specific conditions, show that the physical properties of turbulence in collisionless plasmas, as those found in the ICM, may be very different from what has been largely believed.

EVALUATING VIBRATIONS ON A SMALL-SCALE MODEL OF A TIMBER FOOTBRIDGE

In Brazil, the study of pedestrian-induced vibration on footbridges has been undertaken since the early 1990s, for concrete and steel footbridges. However, there are no recorded studies of this kind for timber footbridges. Brazilian code ABNT NBR 7190 (1997) gives design requirements only for static loads in the case of timber footbridges, without considering the serviceability limit state from pedestrian-induced vibrations. The aim of this work is to perform a theoretical dynamic, numerical and experimental analysis on simply-supported timber footbridges, by using a small-scale model developed from a 24 m span and 2 m width timber footbridge, with two main timber beams. Span and width were scaled down (1:4) to 6 m e 0.5 in, respectively. Among the conclusions reached herein, it is emphasized that the Euler-Bernoulli beam theory is suitable for calculating the vertical and lateral first natural frequencies in simply-supported timber footbridges; however, special attention should be given to the evaluation of lateral bending stiffness, as it leads to conservative values.

Two dimensional analysis of inflatable structures by the positional FEM

This paper presents a, simple two dimensional frame formulation to deal with structures undergoing large motions due to dynamic actions including very thin inflatable structures, balloons. The proposed methodology is based on the minimum potential energy theorem written regarding nodal positions. Velocity, acceleration and strain are achieved directly from positions, not. displacements, characterizing the novelty of the proposed technique. A non-dimensional space is created and the deformation function (change of configuration) is written following two independent mappings from which the strain energy function is written. The classical New-mark equations are used to integrate time. Dumping and non-conservative forces are introduced into the mechanical system by a rheonomic energy function. The final formulation has the advantage of being simple and easy to teach, when compared to classical Counterparts. The behavior of a bench-mark problem (spin-up maneuver) is solved to prove the formulation regarding high circumferential speed applications. Other examples are dedicated to inflatable and very thin structures, in order to test the formulation for further analysis of three dimensional balloons.

Chaotic Patterns in Aeroelastic Signals

This work presents the analysis of nonlinear aeroelastic time series from wing vibrations due to airflow separation during wind tunnel experiments. Surrogate data method is used to justify the application of nonlinear time series analysis to the aeroelastic system, after rejecting the chance for nonstationarity. The singular value decomposition (SVD) approach is used to reconstruct the state space, reducing noise from the aeroelastic time series. Direct analysis of reconstructed trajectories in the state space and the determination of Poincare sections have been employed to investigate complex dynamics and chaotic patterns. With the reconstructed state spaces, qualitative analyses may be done, and the attractors evolutions with parametric variation are presented. Overall results reveal complex system dynamics associated with highly separated flow effects together with nonlinear coupling between aeroelastic modes. Bifurcations to the nonlinear aeroelastic system are observed for two investigations, that is, considering oscillations-induced aeroelastic evolutions with varying freestream speed, and aeroelastic evolutions at constant freestream speed and varying oscillations. Finally, Lyapunov exponent calculation is proceeded in order to infer on chaotic behavior. Poincare mappings also suggest bifurcations and chaos, reinforced by the attainment of maximum positive Lyapunov exponents. Copyright (C) 2009 F. D. Marques and R. M. G. Vasconcellos.

Eccentric Hip Muscle Function in Females With and Without Patellofemoral Pain Syndrome

Context: Patellofemoral pain syndrome (PFPS) is a common knee condition in athletes. Recently, researchers have indicated that factors proximal to the knee, including hip muscle weakness and motor control impairment, contribute to the development of PFPS. However, no investigators have evaluated eccentric hip muscle function in people with PFPS. Objective: To compare the eccentric hip muscle function between females with PFPS and a female control group. Design: Cross-sectional study. Setting: Musculoskeletal laboratory. Patients or Other Participants: Two groups of females were studied: a group with PFPS (n = 10) and a group with no history of lower extremity injury or surgery (n = 10). Intervention(s): Eccentric torque of the hip musculature was evaluated on an isokinetic dynamometer. Main Outcome Measure(s): Eccentric hip abduction, adduction, and external and internal rotation peak torque were measured and expressed as a percentage of body mass (Nm/kg x 100). We also evaluated eccentric hip adduction to abduction and internal to external rotation torque ratios. The peak torque value of 5 maximal eccentric contractions was used for calculation. Two-tailed, independent-samples t tests were used to compare torque results between groups. Results: Participants with PFPS exhibited much lower eccentric hip abduction (t(18) = -2.917, P = .008) and adduction (t(18) = -2.764, P =.009) peak torque values than did their healthy counterparts. No differences in eccentric hip external (t(18) = 0.45, P = .96) or internal (t(18) = -0.742, P =.47) rotation peak torque values were detected between the groups. The eccentric hip adduction to abduction torque ratio was much higher in the PFPS group than in the control group (t(18) = 2.113, P = .04), but we found no difference in the eccentric hip internal to external rotation torque ratios between the 2 groups (t(18) = -0.932, P = .36). Conclusions: Participants with PFPS demonstrated lower eccentric hip abduction and adduction peak torque and higher eccentric adduction to abduction torque ratios when compared with control participants. Thus, clinicians should consider eccentric hip abduction strengthening exercises when developing rehabilitation programs for females with PFPS.

Crowbar System in Doubly Fed Induction Wind Generators

In the last 15 years, the use of doubly fed induction machines in modern variable-speed wind turbines has increased rapidly. This development has been driven by the cost reduction as well as the low-loss generation of Insulated Gate Bipolar Transistors (IGBT). According to new grid code requirements, wind turbines must remain connected to the grid during grid disturbances. Moreover, they must also contribute to voltage support during and after grid faults. The crowbar system is essential to avoid the disconnection of the doubly fed induction wind generators from the network during faults. The insertion of the crowbar in the rotor circuits for a short period of time enables a more efficient terminal voltage control. As a general rule, the activation and the deactivation of the crowbar system is based only on the DC-link voltage level of the back-to-back converters. In this context, the authors discuss the critical rotor speed to analyze the instability of doubly fed induction generators during grid faults.