Lei n.�� 11.889/2008: avan��o ou retrocesso nas compet��ncias do t��cnico em sa��de bucal?

O objetivo deste estudo foi analisar as compet��ncias que, desde a aprova����o da lei n.�� 11.889/08, incumbem ao t��cnico em sa��de bucal (TSB) no Brasil, incluindo os termos definidos para sua supervis��o. Foi realizada an��lise documental, comparando-se as compet��ncias definidas no referido instrumento legal com as previstas no parecer n.�� 460/75 do Conselho Federal de Educa����o e na resolu����o n.�� 63/2005 do Conselho Federal de Odontologia. Foram empregadas t��cnicas de an��lise tem��tica considerando-se as habilidades em termos de a����es diretas e indiretas distribu��das em quatro ��reas de compet��ncia: planejamento e administra����o em sa��de, promo����o da sa��de, preven����o de doen��as e de assist��ncia individual. Embora as compet��ncias aprovadas na lei tenham sido distribu��das em um n��mero menor de itens, comparado aos dois outros documentos, do ponto de vista qualitativo, os resultados da an��lise permitiram concluir que v��rios avan��os foram obtidos com a regulamenta����o da profiss��o, nos termos aprovados, em todas as ��reas de compet��ncia. Houve impacto positivo para o processo de trabalho em sa��de, tanto com rela����o �� coopera����o interprofissional quanto �� supervis��o t��cnica das atividades, representando uma conquista relevante dos trabalhadores da ��rea e tamb��m uma contribui����o significativa para avan��ar na amplia����o do acesso aos servi��os odontol��gicos

A qualidade das refei����es de empresas cadastradas no Programa de Alimenta����o do Trabalhador na cidade de S��o Paulo

OBJETIVO: Avaliar a qualidade global das refei����es oferecidas por Unidades de Alimenta����o e Nutri����o de empresas benefici��rias do Programa de Alimenta����o do Trabalhador, na cidade de S��o Paulo. M��TODOS: Estudo transversal realizado com 72 empresas cadastradas no programa. Foram coletadas informa����es de tr��s dias consecutivos das refei����es oferecidas no almo��o, no jantar e na ceia. A qualidade das refei����es oferecidas foi avalia pelo ��ndice de Qualidade da Refei����o, e sua an��lise foi feita de forma estratificada segundo o perfil da empresa obtido pela an��lise de cluster. RESULTADOS: A m��dia do ��ndice de Qualidade da Refei����o para as grandes refei����es foi de 66,25. Foram obtidos dois grupos de empresas na an��lise de cluster. As empresas do primeiro, composto em sua maioria por empresas do setor de com��rcio de micro e pequeno porte, cadastradas na modalidade de autogest��o e sem supervis��o de nutricionista, obtiveram pior qualidade da refei����o (��ndice=56,23). As empresas do segundo cluster, constitu��do principalmente por empresas de m��dio e grande porte do setor industrial, com gest��o terceirizada e supervis��o de nutricionista, obtiveram pontua����o m��dia do ��ndice de 82,95. CONCLUS��O: As refei����es oferecidas pelas empresas participantes do Programa de Alimenta����o do Trabalhador n��o estavam adequadas, segundo o ��ndice de Qualidade da Refei����o. As empresas de menor porte e estrutura tiveram refei����es de pior qualidade quando comparadas com as demais, demonstrando que empresas deste perfil s��o priorit��rias para interven����es dentro do Programa de Alimenta����o do Trabalhador.

Efetividade de programa de agentes comunit��rios na promo����o da sa��de bucal

OBJETIVO:Avaliar mudan��as em conhecimentos, atitudes e acesso/utiliza����o de servi��os odontol��gicos decorrentes de um programa de promo����o da sa��de bucal com agentes comunit��rios de sa��de. M��TODOS:Um projeto de capacita����o combinando ensino-aprendizagem, apoio e supervis��o, foi desenvolvido entre os meses de julho de 2003 a agosto de 2004. As mudan��as foram avaliadas por meio de entrevistas estruturadas em que participaram 36 agentes comunit��rios de sa��de e uma amostra de 91 mulheres e m��es, representativa de donas de casa com 25 a 39 anos de idade, alfabetizadas e residentes em domic��lios de tr��s a seis c��modos no munic��pio de Rio Grande da Serra (SP). Foram colhidos dados sobre conhecimentos de sa��de-doen��a bucal, pr��ticas e capacidades auto-referidas em rela����o ao auto-exame, higiene bucal, n��mero de residentes e de escovas dentais individuais e coletivas em cada domic��lio e acesso e uso de servi��os odontol��gicos. Por meio do teste t de Student pareado, foram comparadas as m��dias dos valores obtidos antes e depois do programa para cada um dos grupos estudados. As respostas foram analisadas adotando-se um n��vel de signific��ncia de 5%. RESULTADOS: Foram observadas diferen��as estatisticamente significativas para quest��es relativas ao conhecimento de sa��de bucal entre os agentes e entre as mulheres antes e depois da capacita����o (p<0,05). Desequil��brio entre o n��mero de escovas e de indiv��duos em cada fam��lia diminuiu. A freq����ncia da escova����o e do uso do fio dental se elevou depois da atua����o dos agentes. Os valores de auto-avalia����o da higiene bucal aumentaram. Modifica����o nas pr��ticas e capacidades auto-referidas mostrou significativa eleva����o da auto-confian��a. O acesso ao servi��o foi mais f��cil (p<0,000) e seu uso mais regular (p<0,000) entre mulheres. CONCLUS��ES: Houve mudan��as positivas na percep����o em rela����o a aspectos de sa��de bucal, na auto-confian��a e no acesso e uso de servi��os odontol��gicos. Tais mudan��as po

Evaluation of the Incidence of Bladder Perforation After Transurethral Bladder Tumor Resection in a Residency Setting

Purpose: To evaluate prospectively the actual bladder perforation incidence during transurethral resection of bladder tumor (TURB) performed by residents and to identify possible predisposing factors to such condition. Patients and Methods: Thirty-four patients with bladder tumor were submitted to TURB in our academic institution in April 2006, and were prospectively studied. Procedures were all done by senior residents under an attending direct supervision. All patients had a cystograms performed after the procedure by the injection of 400 mL of saline-diluted contrast solution with low-pressure infusion through the Foley catheter. The cystograms were evaluated blindly by a single radiologist. All patients were examined by cystoscopy and/or CT every 3 months for the first 2 years postoperatively. Results: The cystogram showed contrast leaking compatible with bladder perforation in 17 (50%) cases. None of the perforations were recognized intraoperatively by the surgeon. All perforations were extraperitoneal and managed conservatively. There was no significant correlation between the incidence of bladder perforation and the patient age (p = 0.508), the tumor stage (p = 0.998), the tumor grade (p = 0.833), the number of lesions (p = 0.394), and the tumor size (p = 0.651). The only factor that had impact on the development of bladder perforation was tumor localization at the bottom of the bladder (p = 0.035; OR, 6750; 95% CI, 1.14, 39.8). Conclusion: Asymptomatic perforations of the bladder wall occur very frequently after a TURB procedure performed by residents in training and, most of the time, are not noticed by the surgeon. Localization of the tumor at bladder dome was the only factor that negatively influenced perforation rates.

Remote control of CNC machines using the CyberOPC communication system over public networks

During the last few years, the evolution of fieldbus and computers networks allowed the integration of different communication systems involving both production single cells and production cells, as well as other systems for business intelligence, supervision and control. Several well-adopted communication technologies exist today for public and non-public networks. Since most of the industrial applications are time-critical, the requirements of communication systems for remote control differ from common applications for computer networks accessing the Internet, such as Web, e-mail and file transfer. The solution proposed and outlined in this work is called CyberOPC. It includes the study and the implementation of a new open communication system for remote control of industrial CNC machines, making the transmission delay for time-critical control data shorter than other OPC-based solutions, and fulfilling cyber security requirements.

Avalia����o do desempenho ambiental de obras de recupera����o de rodovias

This paper features a tool to carry out environmental performance evaluation in highway rehabilitation works, as a component of environmental supervision activities. The procedure involves (i) evidence gathering by conducting technical inspections and reviewing environmental compliance reports, (ii) ranking nonconformities according to a proposed weighting framework, and (iii) calculation of an environmental conformity index. For the sake of testing and calibration, the procedure was applied to five road segments that were submitted to rehabilitation works in Sao Paulo State and the results were treated qualitatively.

Thesis summary: Standardized dried extracts of Brazilian medicinal plants: Assessment of technical and economic feasibility of spouted bed drying

This study is an integral part of a research project which seeks the establishment of protocols for the production of standardized herbal dried extracts emphasizing the spouted bed drying. This thesis was conducted at faculty of Pharmaceutical Science of Ribeiro Preto/University of So Paulo, Brazil, under supervision of Prof. Dr. Wanderley Pereira Oliveira*, defended on September 28, 2007.

Long-Term Prospective, Randomized, Controlled Study Using Repetitive Education at Six-Month Intervals and Monitoring for Adherence in Heart Failure Outpatients The REMADHE Trial

Background-The effectiveness of heart failure disease management proarams in patients under cardiologists` care over long-term follow-up is not established. Methods and Results-We investigated the effects of a disease management program with repetitive education and telephone monitoring on primary (combined death or unplanned first hospitalization and quality-of-life changes) and secondary end points (hospitalization, death, and adherence). The REMADHE [Repetitive Education and Monitoring for ADherence for Heart Failure] trial is a long-term randomized, prospective, parallel trial designed to compare intervention with control. One hundred seventeen patients were randomized to usual care, and 233 to additional intervention. The mean follow-up was 2.47 +/- 1.75 years, with 54% adherence to the program. In the intervention group, the primary end point composite of death or unplanned hospitalization was reduced (hazard ratio, 0.64; confidence interval, 0.43 to 0.88; P=0.008), driven by reduction in hospitalization. The quality-of-life questionnaire score improved only in the intervention group (P<0.003). Mortality was similar in both groups. Number of hospitalizations (1.3 +/- 1.7 versus 0.8 +/- 1.3, P<0.0001), total hospital days during the follow-up (19.9 +/- 51 versus 11.1 +/- 24 days, P<0.0001), and the need for emergency visits (4.5 +/- 10.6 versus 1.6 +/- 2.4, P<0.0001) were lower in the intervention group. Beneficial effects were homogeneous for sex, race, diabetes and no diabetes, age, functional class, and etiology. Conclusions-For a longer follow-up period than in previous studies, this heart failure disease management program model of patients under the supervision of a cardiologist is associated with a reduction in unplanned hospitalization, a reduction of total hospital days, and a reduced need for emergency care, as well as improved quality of life, despite modest program adherence over time. (Circ Heart Fail. 2008;1:115-124.)

Outcomes and safety of drug provocation tests

Drug provocation tests (DPTs) are considered the gold standard for identifying adverse drug reactions (ADRs). The aim of this study was to analyze DPT results and discuss severe systemic reactions associated with them. This was a retrospective analysis of 500 patients with ADRs who sought treatment and were submitted to DPTs when indicated between 2006 and 2010. We performed DPTs according to the European Network for Drug Allergy recommendations. Single-blind, placebo-controlled DPTs were performed with antibiotics, local anesthetics, and nonsteroidal anti-inflammatory drugs, as well as with other drugs. Patient characteristics, DPT results, and reactions were analyzed. The sample comprised 198 patients (80.8% of whom were female patients) submitted to 243 DPTs. Ages ranged from 9 to 84 years (mean, 39.9 years). The 243 DPTs were performed with local anesthetics (n = 93), antibiotics (n = 19), acetaminophen (n = 44), benzydamine (n = 33), COX-2 inhibitors (n = 26), dipyrone (n = 7), aspirin (n = 4), or other drugs (n = 17). The results of 4 tests (1.6%) were inconclusive, whereas those of 10 (4.1%) revealed positive reactions to antibiotics (2/19), COX-2 inhibitors (2/26), acetaminophen (3/44), and local anesthetics (3/93). Two severe reactions were observed: cephalexin-induced anaphylactic shock and bupivacaine-induced anaphylaxis without shock. Four patients (2.0%) reacted to the placebo before administration of the drug. Drug provocation tests are safe for use in clinical practice but they should be placebo-controlled and should be performed under the supervision of an allergist. To confirm a presumptive diagnosis and to manage allergies appropriately, it is crucial to perform DPTs. (Allergy Asthma Proc 32:301-306, 2011; doi: 10.2500/aap.2011.32.3450)

Child psychiatry takes to the streets: A developmental partnership between a university institute and children and adolescents from the streets of Sao Paulo, Brazil

Objective: High levels of domestic violence, mental illness, and alienation from authorities are associated with high incidence of children/adolescents living on the streets in low and middle income countries. The Equilibrium Project (Programa Equilibrio) was created to facilitate social reintegration through a virtual partnership between an academic psychiatric institute and highly vulnerable children and adolescents living on the streets, in group shelter with supervision, and in other high risk situations. Methods: Descriptive presentation of qualitative data and analysis of preliminary empirical data collected over a 24-month period. Results: Dialogue between academic professionals, street children, and city officials shaped The Equilibrium Project over the last 2 years. The program has progressively moved from a professional clinic setting to a community-based but protected activity center with recreational and professional services and an emphasis on linkage with social service agencies, city government and law enforcement officials in an academic research context. A total of 351 patients have been served of whom virtually all were neglected by their parents, 58.4% report physical or sexual abuse, 88.89% have been diagnosed with a psychiatric disorder, 40.4% drug use. After 2 years of operation, 63.5% (n = 223) successfully completed or continue in treatment and 34.8% (n = 122) were reunited with their families. Conclusions and Practice implications: Program development guided by consumer input led to a successful program offering professional services in a protected community setting that facilitates social reintegration by providing ""go between"" services integrating relationships between alienated consumers and formal psychiatric, pediatric, social service, and criminal justice systems. (C) 2011 Elsevier Ltd. All rights reserved.

Risk factors associated with leptospirosis in dairy goats under tropical conditions in Brazil

Serum samples from 248 adult dairy goats from 13 flocks with lowered fertility farmed in the Rio de Janeiro region of Brazil were examined for Leptospira antibodies by MAT with 24 serovars, cut off 100. A questionnaire was completed for each herd. Antibodies were detected in 20.8% of these goats, mainly to serovar Hardjo. Risk factors associated with seroprevalence to leptospirosis were the frequency of professional veterinary supervision (OR = 2.35), climate (OR = 2.63) and grazing for more than 2 h a day. Flock factors as size, type of milking and offering of food supplementation, as well as the location and topography, the type of animal housing or the presence of silos did not significantly affect seroprevalence. We suggest that a successful control program for goat leptospirosis should include a complete investigation of herd management practices, which could influence in the occurrence of the infection. (C) 2007 Elsevier Ltd. All rights reserved.

An integrated database on ticks and tick-borne zoonoses in the tropics and subtropics with special reference to developing and emerging countries

Tick-borne zoonoses (TBZ) are emerging diseases worldwide. A large amount of information (e.g. case reports, results of epidemiological surveillance, etc.) is dispersed through various reference sources (ISI and non-ISI journals, conference proceedings, technical reports, etc.). An integrated database-derived from the ICTTD-3 project (http://www.icttd.nl)-was developed in order to gather TBZ records in the (sub-)tropics, collected both by the authors and collaborators worldwide. A dedicated website (http://www.tickbornezoonoses.org) was created to promote collaboration and circulate information. Data collected are made freely available to researchers for analysis by spatial methods, integrating mapped ecological factors for predicting TBZ risk. The authors present the assembly process of the TBZ database: the compilation of an updated list of TBZ relevant for (sub-)tropics, the database design and its structure, the method of bibliographic search, the assessment of spatial precision of geo-referenced records. At the time of writing, 725 records extracted from 337 publications related to 59 countries in the (sub-)tropics, have been entered in the database. TBZ distribution maps were also produced. Imported cases have been also accounted for. The most important datasets with geo-referenced records were those on Spotted Fever Group rickettsiosis in Latin-America and Crimean-Congo Haemorrhagic Fever in Africa. The authors stress the need for international collaboration in data collection to update and improve the database. Supervision of data entered remains always necessary. Means to foster collaboration are discussed. The paper is also intended to describe the challenges encountered to assemble spatial data from various sources and to help develop similar data collections.

Nutritional information of meals supplied by companies, participating in the workers` meal program in Sao Paulo, Brazil

Objective. To compare the nutritional value of meals provided by companies participating in the Workers` Meal Program in the city of Sao Paulo, Brazil, to the nutritional recommendations and guidelines established by the Ministry of Health for the Brazilian population. Methods. The 72 companies studied were grouped according to economic sector (industrial, services, or commerce), size (micro, small, medium, or large), meal preparation modality (prepared on-site by the company itself, on-site by a hired caterer, or off-site by a hired caterer), and supervision by a dietitian (yes or no). The per capita amount of food was determined based on the lunch, dinner, and supper menus for three days. The nutritional value of the meals was defined by the amount of calories, carbohydrates, protein, total fat, polyunsaturated fat, saturated fat, trans fat, sugars, cholesterol, and fruits and vegetables. Results. Most of the menus were deficient in the number of fruits and vegetables (63.9%) and amount of polyunsaturated fat (83.3%), but high in total fat (47.2%) and cholesterol (62.5%). Group 2, composed of mostly medium and large companies, supervised by a dietician, belonging to the industrial and/or service sectors, and using a hired caterer, on averaged served meals with higher calorie content (P < 0.001), higher percentage of polyunsaturated fat (P < 0.001), more cholesterol (P = 0.015), and more fruits and vegetables (P < 0.001) than Group 1, which was composed of micro and small companies from the commercial sector, that prepare the meals themselves on-site, and are not supervised by a dietitian. Regarding the nutrition guidelines set for the Brazilian population, Group 2 meals were better in terms of fruit and vegetable servings (P < 0.001). Group I meals were better in terms of cholesterol content (P = 0.05). Conclusions. More specific action is required targeting company officers and managers in charge of food and nutrition services, especially in companies without dietitian supervision.