Fatores determinantes da decisão sobre a prática da cesariana em Natal-RN

O objetivo deste estudo é analisar os fatores que contribuíram para as diferentes decisões para o parto cesáreo e a ligadura de trompas entre as mulheres de 18 a 45 anos de idade no Município de Natal, no Nordeste do Brasil, no ano de 2000. Tratou-se de um estudo longitudinal, originado da base de dados de um Estudo Multicêntrico, envolvendo outras localidades do Brasil, composta de mulheres em idade fértil que procuraram o serviço público ou privado. Foram realizadas três entrevistas: no início da gestação, no mês anterior à data provável do parto e até um mês após o parto, perfazendo um total de 433 entrevistas, sendo finalizada com uma amostra de 269 mulheres. O estudo satisfez a um critério de elegibilidade, abrangendo uma amostra das mulheres de 18 a 40 anos de idade, que residiam em Natal e que estavam grávidas no máximo, na 22a semana de gestação, e procuraram o serviço público ou privado para a realização do pré-natal. Não entraram no estudo, aquelas mulheres que faziam um acompanhamento em ambulatórios especiais (hipertensão ou diabetes gestacional, HIV/AIDS). A análise consistiu, primeiramente, num estudo descritivo, seguido de uma discussão sobre a trajetória do desejo à realização do parto e testou-se a significância estatística dos partos com variáveis socioeconômicas. Sequencialmente adotou-se uma análise bivariada centrada nos testes de associação, onde foi considerada a variável tipo de parto como sendo a variável resposta e as demais variáveis, relacionadas à condição sóciodemográfica e a saúde reprodutiva da mulher, como sendo as variáveis de risco ou independentes. Para o cálculo da razão de chance (OR), foi utilizado o modelo de regressão logística múltipla. Das 269 mulheres entrevistadas, 56,0% foram submetidas ao parto normal. Este tipo de parto foi desejado independente da categoria, por 71% das entrevistadas. Os resultados mostraram como fatores determinantes para cesárea, o serviço ser privado (OR = 5,6), a mulher ter idade acima de 20 anos (OR=2,87), ser primípara (OR=4,56) e a realização de ligadura de trompas (OR=12,94). Independente da parturição, 84% das mulheres do serviço público foram submetidas a um parto normal, enquanto que, 74% das primíparas do serviço privado, fizeram uma cesárea. Os resultados sinalizam um distanciamento efetivo entre o desejo por um tipo de parto e a sua realização, quando os fatores considerados, não foram somente técnicos, podendo, também, refletir a falta de prática do parto normal, pelo obstetra e a necessidade de uma maior consciência ética nos procedimentos obstétricos, de modo a favorecer uma maior abertura na participação da gestante na escolha pelo tipo de parto

Transplantes de córneas no estado do Rio Grande do Norte: aspectos epidemiológicos e clínicos

This study aimed to characterize in a clinical and epidemiological way the patients who are on a waiting list for transplantation and the patients transplanted with corneal tissue in a corneal transplants reference service in the state of Rio Grande do Norte. It is an epidemiological study of a quantitative approach, with cross-sectional, descriptive and analytical cut including all patients on the waiting list for transplantation (population A) and the patients already transplanted with a corneal tissue (population B) in a reference service. In population A, there was a census conducted of patients on the waiting list for corneal transplantation (n=62 patients). In population B, the sample was non-probabilistic and corresponded to all corneal transplants performed in the service in the period from 2010 to 2014 (n=258). This study is approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte, in Opinion 876 177 and CAAE 37533014.8.0000.5537. Data were collected in full in the period from January to April 2015, by two instruments built to systematize the necessary data collection. After being coded and tabulated, data were analyzed using the Statistical Package for Social Sciences software, version 20.0. The definition of variables and their distribution patterns were presented as frequencies and measures of central tendency while, for multivariate analysis, the effect of magnitude measures were applied (prevalence ratio) and measures of association (chi-square test or Fisher's exact test) for a 0.05 significance level. The results are shown in two scientific articles coming from the field survey data. It was found that the epidemiological profile of patients on the waiting list (n=62) showed a prevalence of individuals aged over 50 years old, female (54.84%) and residents of the middle region of East Rio Grande do Norte (66.13%). The clinical profile of patients with corneal transplantation (n=258) was characterized by being male (51.16%) with an average age of 49.33 years old and 57.75% were coming from East Rio Grande do Norte. The average time on the waiting list was 172.63 days in elective transplants and 9.03 days in urgent transplants. Keratoconus was the main indicator condition to perform the transplant. For patients on the waiting list, the variable “type of disorder of the cornea” showed statistically significant association with gender and age. For patients with corneal transplants, the variable "type of disorder of the cornea" was associated with the variables gender, age, previous surgery, failure of previous graft, classification of the eye and glaucoma. By characterizing the clinical and epidemiological profile of corneal transplants, it is possible to question the reality, pointing about the care that should be offered and develop targeted interventions to collective and individual needs intrinsic to patients who need this surgery as a treatment option.

Uma proposta de um controlador adaptativo por posicionamento de pólos e estrutura variável

There are two main approaches for using in adaptive controllers. One is the so-called model reference adaptive control (MRAC), and the other is the so-called adaptive pole placement control (APPC). In MRAC, a reference model is chosen to generate the desired trajectory that the plant output has to follow, and it can require cancellation of the plant zeros. Due to its flexibility in choosing the controller design methodology (state feedback, compensator design, linear quadratic, etc.) and the adaptive law (least squares, gradient, etc.), the APPC is the most general type of adaptive control. Traditionally, it has been developed in an indirect approach and, as an advantage, it may be applied to non-minimum phase plants, because do not involve plant zero-pole cancellations. The integration to variable structure systems allows to aggregate fast transient and robustness to parametric uncertainties and disturbances, as well. In this work, a variable structure adaptive pole placement control (VS-APPC) is proposed. Therefore, new switching laws are proposed, instead of using the traditional integral adaptive laws. Additionally, simulation results for an unstable first order system and simulation and practical results for a three-phase induction motor are shown

Controle de posição com restrição à orientação de um Veículo Aéreo Não-Tripulado tipo Quadrirrotor

Quadrotors aircraft are composed by four propellers mounted on four engines on a cross or x disposition, and, in this structure, the engines on the same arm spin in the same direction and the other arm in the opposite direction. By rotating each helix generates vertical upward thrust. The control is done by varying the rotational speed of each motor. Among the advantages of this type of vehicle can cite the mechanical simplicity of construction, the high degree of maneuverability and the ability to have vertical takeoffs and landings. The modeling and control of quadrirrotores have been a challenge due to problems such as nonlinearity and coupling between variables. Several strategies have been developed to control this type of vehicle, from the classical control to modern. There are air surveillance applications where a camera is fixed on the vehicle to point forward, where it is desired that the quadrotor moves at a fixed altitude toward the target also pointing forward, which imposes an artificial constraint motion, because it is not desired that it moves laterally, but only forwards or backwards and around its axes . This restriction is similar to the naturally existing on robots powered by wheels with differential drive, which also can not move laterally, due to the friction of the wheels. Therefore, a position control strategy similar to that used in this type of robot could be adapted for aerial robots like quadrotor. This dissertation presents and discusses some strategies for the control of position and orientation of quadrotors found in the literature and proposes a strategy based on dynamic control of mobile robots with differential drive, called the variable reference control. The validity of the proposed strategy is demonstrated through computer simulations

Controle feedback de nível baseado em sensor de imagem aplicado ao equipamento misturador-decantador à inversão de fases (MDIF®)

The treatment of wastewaters contaminated with oil is of great practical interest and it is fundamental in environmental issues. A relevant process, which has been studied on continuous treatment of contaminated water with oil, is the equipment denominated MDIF® (a mixer-settler based on phase inversion). An important variable during the operation of MDIF® is the water-solvent interface level in the separation section. The control of this level is essential both to avoid the dragging of the solvent during the water removal and improve the extraction efficiency of the oil by the solvent. The measurement of oil-water interface level (in line) is still a hard task. There are few sensors able to measure oil-water interface level in a reliable way. In the case of lab scale systems, there are no interface sensors with compatible dimensions. The objective of this work was to implement a level control system to the organic solvent/water interface level on the equipment MDIF®. The detection of the interface level is based on the acquisition and treatment of images obtained dynamically through a standard camera (webcam). The control strategy was developed to operate in feedback mode, where the level measure obtained by image detection is compared to the desired level and an action is taken on a control valve according to an implemented PID law. A control and data acquisition program was developed in Fortran to accomplish the following tasks: image acquisition; water-solvent interface identification; to perform decisions and send control signals; and to record data in files. Some experimental runs in open-loop were carried out using the MDIF® and random pulse disturbances were applied on the input variable (water outlet flow). The responses of interface level permitted the process identification by transfer models. From these models, the parameters for a PID controller were tuned by direct synthesis and tests in closed-loop were performed. Preliminary results for the feedback loop demonstrated that the sensor and the control strategy developed in this work were suitable for the control of organic solvent-water interface level

Morfologia em alta resolução espacial de estrelas de tipo Mira e R Corenae Borealis

Mira and R Coronae Borealis (R CrB) variable stars are evolved objects surrounded by circumstellar envelopes (CSE) composed of the ejected stellar material. We present a detailed high-spatial resolution morfological study of the CSE of three stars: IRC+10216, the closest and more studied Carbon-Rich Mira; o Ceti, the prototype of the Mira class; and RY Sagitarii (RY Sgr), the brightest R CrB variable of the south hemisphere. JHKL near-infrared adaptive optics images of IRC+10216 with high dynamic range and Vband images with high angular resolution and high depth, collected with the VLT/NACO and VLT/FORS1 instruments, were analyzed. NACO images of o Ceti were also analyzed. Interferometric observations of RY Sgr collected with the VLTI/MIDI instrument allowed us to explore its CSE innermost regions (»20 40 mas). The CSE of IRC+10216 exhibit, in near-infrared, clumps with more complex relative displacements than proposed in previous studies. In V-band, the majority of the non-concentric shells, located in the outer CSE layers, seem to be composed of thinner elongated shells. In a global view, the morphological connection between the shells and the bipolar core of the nebulae, located in the outer layers, together with the clumps, located in the innermost regions, has a difficult interpretation. In the CSE of o Ceti, preliminar results would be indicating the presence of possible clumps. In the innermost regions (.110 UA) of the CSE of RY Sgr, two clouds were detected in different epochs, embedded in a variable gaussian envelope. Based on a rigorous verification, the first cloud was located at »100 R¤ (or »30 AU) from the centre, toward the east-north-east direction (modulo 180o) and the second one was almost at a perpendicular direction, having aproximately 2£ the distance of the first cloud. This study introduces new constraints to the mass-loss history of these kind of variables and to the morphology of their innermost CSE regions

Recidiva de câncer labial em pacientes atendidos no hospital DR. Luiz Antônio (Natal-RN) entre 1997-2004

Introduction: Cancer of the lip is very common in tropical countries, being noticeable the squamous cell carcinoma as the main histological type. Objective: Evaluate the socialdemographic profile, habits, occupation, clinical characteristics of the cancer lesions and the aftermath of treatment of the patients treated on the Luiz Antônio Hospital (Natal-RN). Design: Retrospective cohort. Methods: We analyzed 181 medical records of patients from the Luiz Antônio Cancer Hospital (Natal-RN) in the period between 1997 and 2004. The statistic evaluation of time between the diagnosis and the relapse or the cure of the patient were done through the Kaplan-Meier method and the comparison of survivor functions were done through the Log-rank test. Later, was estimated the proportional risk model of Cox. Results: The study population were composed by 69,1% males, 95,2% unlettered, the mean age of 66,5 years, 89,0% of smokers and 64,1% had an occupation involving sun exposure. In regard to the clinical characteristics, most lesions were in the lower lip (77,9%), the size of the tumor was smaller than 2 cm (51,8%), 92,6% had localized lesions. Were verified 16,3% of local relapse and 13% of regional. Almost the totally of the cases corresponded to squamous cell carcinoma (97,2%). We observed smaller accumulated probability of not occurrence of local relapse when the base and borders were free of lesions (p=0,041), as well as a smaller probability of regional relapse when the sort of treatment was surgery, associated with other therapeutics modalities (p=0,001). The patients with advanced pathologic stage (p=0,016), treated with surgery associated with other therapeutics modalities (p=0,001) and diameter above 4cm (p=0,019) presented a bigger possibility of any kind of relapse. The multivariable analysis pointed the complex treatments (surgery plus other therapeutics modalities) as a predictor variable for occurrence of new local lesions (p=0,001) and total (p=0,046), besides the age above 70 years to the regional relapse (p=0,050). Conclusion: Cancer of the lip occur in the lower lip, in males, smokers and individuals exposed to Sun light. The relapse was frequent, even being localized and without great consequences to the patient s health. The probability of relapse is related to the size and borders of the lesion and to the histological exam, as well as to the patient s age and complexity of the treatment chosen

Perfil de mortalidade de idosos no Rio Grande do Norte: estudo comparativo entre duas faixas etárias e fatores relacionados

Measures of mortality represent one of the most important indicators of health conditions. For comprising the larger rate of deaths, the study of mortality in the elderly population is regarded as essential to understand the health situation. In this sense, the present study aims to analyze the mortality profile of the population from 60 to 69 (young elders) and older than 80 years old (oldest old) in the Rio Grande do Norte state (Brazil) in the period 2001 to 2011, and to identify the association with contextual factors and variables about the quality of the Mortality Information System (SIM). For this purpose, Mortality Proportional (MP) was calculated for the state and Specific Mortality Rate by Age (CMId) , according to chapters of ICD- 10, to the municipalities of Rio Grande do Norte , through data from the Mortality Information System (SIM) and the Brazilian Institute of Geography and Statistics (IGBE). In order to identify groups of municipalities with similar mortality profiles, Nonhierarchical Clustering K-means method was applied and the Factor Analysis by the Principal Components Analysis was resort to reduce contextual variables. The spatial distribution of these groups and the factors were visualized using the Spatial Analysis Areas technique. During the period investigated, 21,813 younger elders deaths were recorded , with a predominance of deaths from circulatory diseases (32.75%) and neoplasms (22.9 %) . Among the oldest old, 50,637 deaths were observed, which 35.26% occurred because of cardiovascular diseases and 17.27% of ill-defined causes. Clustering Analysis produced three clusters to the two age groups and Factor Analysis reduced the contextual variables into three factors, also the sum of the factor scores was considered. Among the younger elders, the groups are called misinformation profile, development profile and development paradox, which showed a statistically significant association with education and poverty and extreme poverty factors, factorial sum and the variable related to underreporting of deaths. Misinformation profile remained in the oldest old group, accompanied by the epidemiological transition profile and the epidemiological paradox, that were statistically associated with the development and health factor, as well as with the variables that indicate the SIM quality: proportion of blank fields about the schooling and underreporting. It proposed that the mortality profiles of the younger elders and oldest old differ on the importance of the basic causes and that are influenced by different contextual aspects , observing that 60 to 69 years group is more affected by such aspects. Health inequalities can be reduced by measures aimed to improve levels of education and poverty, especially in younger elders, and by optimizing the use of health services, which is more associated to the oldest old health situation. Furthermore, it is important to improve the quality of information for the two age groups

Influência do tipo de abrigo e da frequência de oferta alimentar no comportamento do camarão Macrobrachium rosenbergii (De Man 1879)

Macrobrachium rosenbergii is a freshwater prawn which presents agonistic behavior and heterogeneous growth. It is known that captive conditions can intensify agonism causing injuries and decreased survival, generating a condition of poor welfare. Based on this, we aim to investigate the behavior of M. rosenbergii in the juvenile phase according to different types of shelter and frequencies of feed offer, emphasizing their agonistic behavior. For this, juveniles were observed in the laboratory in three steps. At step I we characterized the behavioral profile; prawns were kept in eight aquariums (27 prawns/m2 ), identified and observed four times along both phases of 24 h light cycle. At step II (2 experiments), we evaluated the use of shelters (brick or polyethylene rolls) and their influence on agonism by the animals. For classification of animals in dominance rank, the method used was David's Score. At step III (3 experiments), we evaluated different frequencies of feed offer on the behavior of individuals, in particular agonism. Results showed that juveniles do not present a pattern activity/inactivity between the phases of the light cycle. We identified a dominance hierarchy among individuals taking advantage of access to food by the dominant, which showed greater weight gain although the frequency of intake did not differ between individuals. The type of shelter influenced the behavior of animals. Brick shelter generated a higher frequency of permanence and a reduction in the frequency of agonistic interactions. The distribution of food more frequently throughout the day, decreased the motivation of animals for food, as well as to fight. Prawns fed four times showed lower frequency of feed intake and agonistic interactions. Thus, we conclude the shelters which reduce animal’s detection by coespecifics and offer the food four times along the day reduce agonistic behavior. This result causes na improvement in life quality of the prawns and also in its quality as final product.

O registro de procedimentos metodológicos em projetos de intervenção arquitetônica no patrimônio edificado: o caso de Natal-RN

In the midst of growing preservationist awareness, regarding methods of architectural intervention of buildings with a recognized heritage value, there are numerous approaches on how the original heritage value can be protected. However, can these intervention projects be differentiated? Is it possible to identify how they differ (if in fact they do) from an architectural project not related to preservation? Although there are numerous theoretical studies regarding methods utilized in architectonical projects, there appear to be a lack of studies focused on an architectural intervention exclusively focused on areas or edifications that have a recognized heritage value, thereby requiring a reflection on which methodological procedures in an architectonical project serve the purpose of the preservation of the historical aspects. This discussion is of even greater importance because, at the national level, some recent discussions on this type of architectural design seem arbitrary and lack methodological rigor. Therefore, this research attempts to focus equally on the theoretical-methodological practices of preservation as well as the architectural project methods. In an attempt to address these aspects, the focus of this research centers on the case studies of the intervention projects of the maritime passenger terminal of Natal (Terminal Marítimo de Passageriros de Natal), the old government hall (Palacio do Governo - EDTAM) and the old central hotel (Hotel Central) which are situated in the area known as the historic downtown of the city of Natal, within the federal heritage protection polygon. The analyses of these is intended to identify what methodological procedures were recorded in the final product (in the graphical representation of the architectural design and other documents) delivered to IPHAN / RN, the body responsible for review and approval of these architectural projects, noting whether such procedures appear, in some way, in the final product, and if an understanding of the complexity of preservation is evident. The analyses of these projects corroborate the hypothesis that there are unique characteristics, which must be addressed in the intervention project for preservation when compared to new project design. The main characteristic to be addressed is related to the very nature of the project. It is inherent in the dialectical relationship between the need to preserve (the identified heritage values) and the need to modernize (making adaptations to contemporary life). This relationship, denominated in this dissertation as "radical restraint", must, or at least should, guide the actions in the project as well as the technical analyses of the preservationist organization. However, this radical restriction appears more evident in the guidelines put forth by legislators than in the decisions of designers. These legislators require the presentation of documents, aimed at identifying and contextualizing intervention (Ordinance No. 420 of December 22, 2010), that grant (or should grant) assistance in the decision making process. It was evident in the analyses of these documents that there existed a disconnect between the documents produced and the decisions made in the project. This fact can be seen in the total absence of dialogue about theoretical-methodological preservationist principles, which, in our view, is an essential element of the methodological procedures of the intervention project needed to guide the legislative and project design discussions.