Avaliação de usuários da atenção básica sobre a implantação de protocolo de assistência integral odontológica

Objective: To evaluate the perception of basic attention healthcare users as to the implantation of the Integral Dental Assistance Protocol (PAIO, in Portuguese) and the effect of this program on the oral health condition, oral hygiene, access to and resolubility of the service, in a public basic health unit of João Pessoa-PB. Method: The sample was composed of 32 volunteers, for whom a sixphase intervention was programed: diagnosis of dental needs; resolution of urgencies; restorative interventions; application of promotional measures; evaluation of the health level obtained; and periodic follow-up visits. Data were collected by means of a semistructured interview and a questionnaire, applied before and after PAIO implantation. The interviews were transcribed and analyzed according to the content analysis technique. The effect of PAIO implantation was evaluated by using an increasing scoring system ranging from 1 to 10. The Wilcoxon test was applied with a confidence level of 95%. Results: For the participants that attended the PAIO (n=20), the program contributed to improve oral health condition (100%) and knowledge (100%). The users reported satisfaction (n=12) and had a positive evaluation (n=12), achieved by means of the improvement of oral health condition (n=8), faster and easier access to treatment (n=7), scheduling of dental appoints and warrant of being treated (n=6), welcoming (n=5), motivation for oral care (n=5), and perspective of continuity of PAIO (n=6). The initial evaluation of the users received scores between 5.7 and 7.6. After PAIO implantation, the users' perception was improved (p<0.01), with scores between 9.6 and 9.9. Conclusion: According to the users, the implantation of PAIO contributed to the qualification of health service and oral health care, being a favorable aspect to increase the access to and resolubility of the service.

Rational use of residential digesters for sewage treatment with Carbon Credits

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Estimation of the metabolic equivalent (MET) of an exercise protocol based on indirect calorimetry

Objective: This study aimed to determine the energy expenditure (EE) in terms of caloric cost and metabolic equivalents (METs) of two sessions of an exercise protocol. Methods: Fifteen subjects (51.0 ± 5.5years) performed the exercise sessions (80min), which were composed by (warming, walking and flexibility exercises; Session A) and (warming, walking and local muscular endurance exercises; Session B). Heart hate (HR) was measured during each part of the sessions. In laboratory environment, maximal oxygen consumption (VO2max) and oxygen uptake in rest and exercise conditions (using mean HR obtained in classes) were measured on different days, using indirect calorimetry. Exercise METs were obtained by dividing VO2 in exercise (mL.kg-1.min-1) by VO2 in rest (mL.kg-1.min-1). The EE of the exercises was calculated by the formula: MET x Weight(kg) x Time(min)/60. The results were analyzed by ANOVA with Tuckey post hoc test (p < 0.05). Results: One MET for this group was 2.7 ± 0.1mL.kg-1.min-1. The mean METs of exercises were 4,7 ± 0,8 (warming), 5,8 ± 0,9 (walking) and 3,6 ± 0,7 (flexibility) on session A, and 4,6 ± 1,2 (warming), 5,6 ± 1,0 (walking) and 4.8 ± 1,0 (local muscular endurance exercises) on Session B. The training sessions showed similar energy cost (A: 398 ± 86.72 kcal and B: 404 ± 38.85 kcal; p > 0,05). None of activities were classified into vigorous intensity (> 7 METs). There were no differences on VO2 between walking (15,6 ± 2,8 or 15,4 ± 2,6 mL.kg-1.min-1) and local muscular endurance exercises (13,2 ± 2,9 mL.kg-1.min-1), although both were higher (p > 0.05) than flexibility exercises (10.1 ± 2.2 mL.kg-1.min-1). Conclusion: The proposed protocol achieves the physical activity needed by healthy adults to improve and maintain health, by their structure, moderate intensity, duration, frequency and caloric expenditure.

Case report: Disseminated Mycobacterium tuberculosis infection in a dog

An uncommon disseminated Mycobacterium tuberculosis infection is described in a 12-year-old female dog presenting with fever, dyspnea, cough, weight loss, lymphadenopathy, melena, epistaxis, and emesis. The dog had a history of close contact with its owner, who died of pulmonary tuberculosis. Radiographic examination revealed diffuse radio-opaque images in both lung lobes, diffuse visible masses in abdominal organs, and hilar and mesenteric lymphadenopathy. Bronchial washing samples and feces were negative for acid-fast organisms. Polymerase chain reaction (PCR)-based species identification of bronchial washing samples, feces, and urine revealed M. tuberculosis using PCR-restriction enzyme pattern analysis-PRA. Because of public health concerns, which were worsened by the physical condition of the dog, euthanasia of the animal was recommended. Rough and tough colonies suggestive of M. tuberculosis were observed after microbiological culture of lung, liver, spleen, heart, and lymph node fragments in Löwenstein-Jensen and Stonebrink media. The PRA analysis enabled diagnosis of M. tuberculosis strains isolated from organs. Copyright © 2013 by The American Society of Tropical Medicine and Hygiene.

Cost-effectiveness comparison between pituitary down-regulation with a gonadotropin-releasing hormone agonist short regimen on alternate days and an antagonist protocol for assisted fertilization treatments

Objective: To compare cost-effectiveness between pituitary down-regulation with a GnRH agonist (GnRHa) short regimen on alternate days and GnRH antagonist (GnRHant) multidose protocol on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcome. Design: Prospective, randomized. Setting: A private center. Patient(s): Patients were randomized into GnRHa (n = 48) and GnRHant (n = 48) groups. Intervention(s): GnRHa stimulation protocol: administration of triptorelin on alternate days starting on the first day of the cycle, recombinant FSH (rFSH), and recombinant hCG (rhCG) microdose. GnRHant protocol: administration of a daily dose of rFSH, cetrorelix, and rhCG microdose. Main Outcome Measure(s): ICSI outcomes and treatment costs. Result(s): A significantly lower number of patients underwent embryo transfer in the GnRHa group. Clinical pregnancy rate was significantly lower and miscarriage rate was significantly higher in the GnRHa group. It was observed a significant lower cost per cycle in the GnRHa group compared with the GnRHant group ($5,327.80 ± 387.30 vs. $5,900.40 ± 472.50). However, mean cost per pregnancy in the GnRHa was higher than in the GnRHant group ($19,671.80 ± 1,430.00 vs. $11,328.70 ± 907.20). Conclusion(s): Although the short controlled ovarian stimulation protocol with GnRHa on alternate days, rFSH, and rhCG microdose may lower the cost of an individual IVF cycle, it requires more cycles to achieve pregnancy. Clinical Trial Registration Number: NCT01468441. © 2013 by American Society for Reproductive Medicine.

Timing of prostaglandin F2α treatment in an estrogen-based protocol for timed artificial insemination or timed embryo transfer in lactating dairy cows

Objectives were to investigate progesterone concentrations and fertility comparing 2 different intervals from PGF2α treatment and induced ovulation in an estrogen-based ovulation synchronization protocol for timed artificial insemination (TAI) or timed embryo transfer (TET) in lactating dairy cows. A total of 1,058 lactating Holstein cows [primiparous (n=371) and multiparous (n=687)], yielding 34.1±0.33 kg of milk/d at various days in milk were randomly assigned to receive treatment with PGF2α on either d 7 or 8 of the following protocol: d 0: 2mg of estradiol benzoate + controlled internal drug release device; d 8: controlled internal drug release device removal + 1.0mg of estradiol cypionate; d 10: TAI or d 17: TET. Only cows with a corpus luteum at d 17 received an embryo and all cows received GnRH at TET. Pregnancy diagnoses were performed by detection (transrectal ultrasonography) of an embryo on d 28 or a fetus on d 60. Fertility [pregnancy per artificial insemination (P/AI) or pregnancy per embryo transfer (P/ET)] was affected by breeding technique (AI vs. ET) and time of PGF2α treatment (d 7 vs. 8) at the 28-d pregnancy diagnosis for TAI [32.9% (238) vs. 20.6% (168)] and TET cows [47% (243) vs. 40.7% (244)] and at the 60-d pregnancy diagnosis for TAI [30% (238) vs. 19.2% (168)] and TET cows [37.9% (243) vs. 33.5% (244)]. The progesterone (P4) concentration at d 10 altered fertility in TAI cows, with higher P/AI in cows with P4 concentration <0.1 ng/mL compared with cows with P4 concentration ≥0.1 ng/mL, and in ET cows, with higher P/ET in cows with P4 concentration <0.22 ng/mL compared with cows with P4 concentration ≥0.22 ng/mL. Prostaglandin F2α treatment at d 7 increased the percentage of cows with P4 <0.1 ng/mL on d 10 [39.4 (85) vs. 23.2 (54)]. Reducing the period between PGF2α and TAI from 72 to 48h in dairy cows resulted in a clear reduction in fertility in cows bred by TAI and a subtle negative effect in cows that received TET. The earlier PGF2α treatment benefits are most likely mediated through gamete transport, fertilization, or early embryo development and a more subtle effect of earlier PGF2α treatment that may be mediated through changes in the uterine or hormonal environment that manifests itself after ET on d 7. © 2013 American Dairy Science Association.

Simulation in NS-2 of DNP3 protocol encapsulated over TCP/IP in smart grid applications

In dealing with computer networks, these allow the flow of information through the resources of various equipment's. This work describes the implementation through the encapsulation of Protocol DNP3, usually employed in Smart Grid communication, in a simulator of discrete events. The NS-2 is a simulator in open source of network events, that facilitate the development of communication networks scenarios considering the protocols involved, in wireless or wired technologies. The objective of this work is to develop the DNP3 protocol encapsulation over a TCP/IP in the in the discrete event Simulator NS-2, allowing an analysis of behavior of a middle or large network sized in Smart Grid applications. © 2013 IEEE.

Performance analysis of smart grid communication protocol DNP3 over TCP/IP in a heterogeneous traffic environment

This paper presents simulation results of the DNP3 communication protocol over a TCP/IP network, for Smart Grid applications. The simulation was performed using the NS-2 network simulator. This study aimed to use the simulation to verify the performance of the DNP3 protocol in a heterogeneous LAN. Analyzing the results it was possible to verify that the DNP3 over a heterogeneous traffic network, with communication channel capacity between 60 and 85 percent, it works well with low packet loss and low delay, however, with traffic values upper 85 percent, the DNP3 usage becomes unfeasible because the information lost, re-transmissions and latency are significantly increased. © 2013 IEEE.

Relationship between running intensity, muscle activation, and stride kinematics during an incremental protocol

Objective: To analyze the effect of running intensity on stride length (SL), stride frequency (SF), stride time (ST) and the electromyographic signal of the rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), tibialis anterior (TA), biceps femoris (BF) and gastrocnemius lateralis (GL) muscles. Methods: Nine well-trained runners performed an incremental protocol with an initial velocity of 10km.h-1, and increments of 1km.h-1 every 3minutes until exhaustion. The electromyographic activity, SL, SF, ST, inter-stride coefficient of variation, and association between kinematic and electromyographic parameters were calculated at 60%, 80% and 100% of maximum running velocity. Results: SL, SF and electromyographic activity of the RF, VM, VL and GL increased and the ST decreased with increased running speed. Electromyographic variability of VL and VM was higher than GL, and variability was lower in TA than all other muscles. The inter-stride variability of muscle activation was associated with kinematic parameters, and their variability, differently as running speed increased. Conclusion: The incremental protocol increased electromyographic activity differently among lower limb muscles; increased SF and SL, and decreased ST, without changing the variability of these variables. Muscle activation variability was correlated with kinematic parameters, but the relationships among these measures varied with running intensity. © 2013 .

Timed artificial insemination programs during the summer in lactating dairy cows: Comparison of the 5-d Cosynch protocol with an estrogen/progesterone-based protocol

The objective of this study was to compare a GnRH-based to an estrogen/progesterone (E2/P4)-based protocol for estrous cycle synchronization and fixed timed artificial insemination (TAI), both designed for synchronization of ovulation and to reduce the period from follicular emergence until ovulation in cows with a synchronized follicular wave. A total of 1,190 lactating Holstein cows (primiparous: n = 685 and multiparous: n = 505) yielding 26.5 ± 0.30 kg of milk/d at 177 ± 5.02 d in milk were randomly assigned to receive one of the following programs: 5-d Cosynch protocol [d -8: controlled internal drug release (CIDR) + GnRH; d -3: CIDR removal + PGF2α; d -2: PGF2α; d 0: TAI + GnRH] or E2/P4 protocol (d -10: CIDR + estradiol benzoate; d -3: PGF2α; d -2: CIDR removal + estradiol cypionate; d 0: TAI). Rectal temperature and circulating progesterone (P4) were measured on d -3, -2, 0 (TAI), and 7. The estrous cycle was considered to be synchronized when P4 was ≥1.0 ng/mL on d 7 in cows that had luteolysis (P4 ≤0.4 ng/mL on d 0). To evaluate the effects of heat stress, cows were classified by number of heat stress events: 0, 1, and 2-or-more measurements of elevated body temperature (≥39.1°C). Pregnancy success (pregnancy per artificial insemination, P/AI) was determined at d 32 and 60 after TAI. The cows in the 5-d Cosynch protocol had increased circulating P4 at the time of PGF2α injection (2.66 ± 0.13 vs. 1.66 ± 0.13 ng/mL). The cows in the E2/P4 protocol were more likely to be detected in estrus (62.8 vs. 43.4%) compared with the cows in the 5-d Cosynch protocol, and expression of estrus improved P/AI in both treatments. The cows in the 5-d Cosynch protocol had greater percentage of synchronized estrous cycle (78.2%), compared with cows in the E2/P4 protocol (70.7%). On d 60, the E2/P4 protocol tended to improve P/AI (20.7 vs. 16.7%) and reduced pregnancy loss from 32 to 60 d (11.0 vs. 19.6%), compared with the 5-d Cosynch protocol. In cows with their estrous cycle synchronized, the E2/P4 protocol had greater P/AI (25.6 vs. 17.7%) on d 60 and lower pregnancy loss from 32 to 60 d (6.7 vs. 21.7%) compared with cows in the 5-d Cosynch protocol. Follicle diameter affected pregnancy loss from 32 to 60 d only in the cows in the 5-d Cosynch protocol, with smaller follicles resulting in greater pregnancy loss. Pregnancy per AI at d 60 was different between protocols in the cows with 2 or more measurements of heat stress (5-d Cosynch = 12.2% vs. E2/P4 = 22.8%), but not in the cows without or with 1 heat stress measurement. In conclusion, the 5-d Cosynch protocol apparently produced better estrous cycle synchronization than the E2/P4 protocol but did not improve P/AI. The potential explanation for these results is that increased E2 concentrations during the periovulatory period can improve pregnancy success and pregnancy maintenance, and this effect appears to be greatest in heat-stressed cows when circulating E2 may be reduced. © 2013 American Dairy Science Association.

Validation of the lactate minimum test as a specific aerobic evaluation protocol for table tennis players

The purpose of this study was to validate the lactate minimum test as a specific aerobic evaluation protocol for table tennis players. Using the frequency of 72 balls·min-1 for 90 sec, an exercise-induced metabolic acidosis was determined in 8 male table tennis players. The evaluation protocol began with a frequency of 40 balls·min-1 followed by an increase of 8 balls·min-1 every 3 min until exhaustion. The mean values that corresponded to the subjects' lactate minimum (Lacmin) were equal to 53.1 ± 1.5 balls·min-1 [adjusted for the time test (Lacmin_time)] and 51.6 ± 1.6 balls·min-1 [adjusted for the frequency of balls (Lacmin_Freq)], which resulted in a high correlation between the two forms of adjustment (r = 0.96 and (P = 0.01). The mean maximum lactate steady state (MLSS) was 52.6 ± 1.6 balls·min-1. Pearson's correlations between Lacmin_time vs. MLSS and Lacmin_freq vs. MLSS were statistically significant (P = 0.03 and r = 0.86, P = 0.03 and r = 0.85, respectively). These findings indicate that the Lacmin test predicts MLSS. Therefore, it is an excellent method to obtain the athletes' anaerobic threshold. Also, there is the advantage that it can be performed in 1 day in the game area. However, the Lacmin value does not depend on the Lacpeak value.

Saúde bucal de pacientes com desordens neurológicas e nutrição enteral: análise microbiológica, bioquímica e protocolo de prevenção

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeitos da higienização brônquica nas variáveis cardiorrespiratórias de pacientes em ventilação mecânica

INTRODUCTION: During mechanical ventilation (MV), the airways may accumulate secretions. Patients are submitted to Respiratory Therapy (RT) and tracheal aspiration when in MV, alone or associated, to eliminate these secretions. OBJECTIVE: The objective was to compare the effects of different protocols of bronchial hygiene in blood pressure, heart rate, oxygen saturation and respiratory rate of patients undergoing MV. MATERIALS AND METHODS: We conducted a prospective, randomized, controlled crossover, with intentional non-probabilistic sample in the Medical School Hospital of Marília. We included patients in invasive MV who were submitted to three different bronchial hygiene protocols: PP - physiotherapy protocol (manual chest compression and manual hyperinflation); AP - aspiration protocol; and PP + AP. Respiratory rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation and heart rate were evaluated in three moments: before (M1), immediately after (M2) and 30 minutes after (M3) for each protocol. The differences among protocols and times were assessed using ANOVA and post hoc Student Newman-Keus (p < 0.05). RESULTS: We studied eighteen 71.2 ± 13.9 year-old patients with 15.1 ± 17.7 days of MV. There were no differences among protocols. There was a significant decreasing in SBP (p = 0.0261) and DBP (p = 0.0119) from M2 to M3 in the aspiration protocol. CONCLUSION: There was a decrease of blood pressure on MV patients after 30 minutes of aspiration and no change in the other variables, and there was no difference among protocols.

Procedures to Evaluate the Efficiency of Protective Clothing Worn by Operators Applying Pesticide

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)