284 resultados para Evaluation of the results of therapeutic interventions
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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OBJETIVOS: avaliar a qualidade do cuidado pré-natal desenvolvido na atenção primária, comparando os modelos tradicional e Estratégia Saúde da Família. MÉTODO: estudo de avaliação de serviço, pautado nas políticas públicas de saúde. Os dados foram obtidos por meio de entrevista com gerentes, observação nas unidades de saúde e análise de prontuários de gestantes, selecionados aleatoriamente. Diferenças nos indicadores de estrutura e processo foram avaliadas pelo teste qui-quadrado, adotando-se p<0,05 como nível crítico, cálculo dos odds ratio e intervalos de confiança de 95%. RESULTADOS: foram evidenciadas estruturas semelhantes em ambos os modelos de atenção. Indicadores-síntese de processo, criados neste estudo, e os indicados pelas políticas públicas apontaram situação mais favorável nas Unidades de Saúde da Família. Para o conjunto de atividades preconizadas para o pré-natal, o desempenho foi deficiente em ambos os modelos, embora pouco melhor nas Unidades de Saúde da Família. CONCLUSÃO: os resultados indicam a necessidade de ações para melhoria da atenção pré-natal nos dois modelos de atenção básica no município avaliado.
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Intestinal parasitic infections are currently a source of concern for Public Health agencies in developing and developed countries. Since three ovum-and-parasite stool examinations have been demonstrated to provide sensitive results, we designed a practical and economical kit (TF-Test) that is now commercially available (Immunoassay Com. Ind. Ltda., S (a) over tildeo Paulo, Brazil). This kit allows the separate collection of three fecal specimens into a preservative solution. The specimens are then pooled, double-filtered, and concentrated by a single rapid centrifugation process. The TF-Test was evaluated in four different laboratories in a study using 1,102 outpatients and individuals living in an endemic area for enteroparasitosis. The overall sensitivity found using the TF-Test (86.2-97.8%) was significantly higher (P<0.01) than the sensitivity of conventional techniques such as the Coprotest (NIL Comercio Exterior Ltda, São Paulo, Brazil) and the combination of Lutz/Hoffman, Faust, and Rugai techniques (De Carli, Diagnostico Laboratorial das Parasitoses Humanas. Metodos e Tecnicas, 1994), which ranged from 48.3% to 75.9%. When the above combined three specimen technique was repeated with three specimens collected on different days, its sensitivity became similar (P > 0.01) to that of the TF-Test. The kappa index values of agreement for the TF-Test were consistent (P < 0.01), being higher and ranking in a better position than conventional techniques. The high sensitivity, cost/benefit ratio, and practical aspects demonstrate that the TF-Test is suitable for individual diagnosis, epidemiological inquiries, or evaluation of chemotherapy in treated communities. (C) 2004 Wiley-Liss, Inc.
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The aim of this study was to evaluate and compare the quantitative and qualitative inflammatory responses and bone formation potential after implantation of polyethylene tubes filled with a new calcium hydroxide containing sealer (MBPc) and Prolloot mineral trioxide aggregate (MIA). There were 48 Wistar rats divided in three groups: Group I (control group) empty polyethylene tubes were implanted in the extraction site; group II and III, polyethylene tubes were implanted filled with ProRoot mineral trioxide aggregate (MIA) and MBPc, respectively. At 7, 15, and 30 days after tube implantation, the animals were killed, the hemi-maxillas were removed and prepared to light microscopic analyses. The scores obtained were submitted to Kruskal-Wallis statistical test (p < 0.05). Significant differences between the materials were not observed. The results showed that both materials had similar biological response.
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Objective. To use the Pediatric Rheumatology International Trials Organization (PRINTO) core set of outcome measures to develop a validated definition of improvement for the evaluation of response to therapy in juvenile systemic lupus erythematosus (SLE).Methods. Thirty-seven experienced pediatric rheumatologists from 27 countries, each of whom had specific experience in the assessment of juvenile SLE patients, achieved consensus on 128 patient profiles as being clinically improved or not improved. Using the physicians' consensus ratings as the gold standard measure, the chi-square, sensitivity, specificity, false-positive and false-negative rates, area under the receiver operating characteristic curve, and kappa level of agreement for 597 candidate definitions of improvement were calculated. Only definitions with a kappa value greater than 0.7 were retained. The top definitions were selected based on the product of the content validity score multiplied by its kappa statistic.Results. The definition of improvement with the highest final score was at least 50% improvement from baseline in any 2 of the 5 core set measures, with no more than 1 of the remaining worsening by more than 30%.Conclusion. PRINTO proposes a valid and reproducible definition of improvement that reflects well the consensus rating of experienced clinicians and that incorporates clinically meaningful change in core set measures in a composite end point for the evaluation of global response to therapy in patients with juvenile SLE. The definition is now proposed for use in juvenile SLE clinical trials and may help physicians to decide whether a child with SLE responded adequately to therapy.
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The in vitro activity of cefepime was compared to that of ceftazidime, ceftriaxone, and cefotaxime in a multicenter study involving 10 clinical microbiology laboratories and clinical isolates from 18 Brazilian hospitals from 7 cities (4 states). A total of 982 isolates consecutively collected between December 1995 and March 1996 were susceptibility tested by using Etest and following the NCCLS procedures for agar diffusion tests. The cefepime spectrum was broader than that of the other broad-spectrum cephalosporins against both Gram-negative rods and Gram-positive cocci. Cefepime tons particularly move active against Enterobacter sp. (MIC90, 2 mu g/ml), Serratia sp. (MIC90, 2 mu g/ml) and oxacillin-susceptible Staphylococcus aureus (MIC90, 3 mu g/ml). Against Pseudomonas aeruginosa, cefepime (MIC90 16 mu g/ml) was slightly more active than ceftazidime (MIC90 32 mu g/ml) and 8- to 16-fold more active than ceftriaxone or cefotaxime (MIC90 >256 mu g/ml). Our results show that nosocomial bacteria, especially Gram-negative rods, have a high rate of cephalosporin resistance in Brazil. However, part of these resistant bacteria remains susceptible to cefepime. The Etest was shown to be an excellent method for multicenter studies of the in vitro evaluation of new antimicrobial agents. (C) 1997 Elsevier B.V.
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The oxidation of a reactive dye, Reactive Blue 4, RB4, (C.I. 61205), widely used in the textile industries to color natural fibers, was studied by electrochemical techniques. The oxidation on glassy carbon electrode and reticulated vitreous carbon electrode occurs in only one step at 2.0 < PH < 12 involving a two-electron transfer to the amine group leading to the imide derivative. Dye solution was not decolorized effectively in this electrolysis process. Nevertheless, the oxidation of this dye on Ti/SnO2/SbOx (3% mol)/RuO2 (1% mol) electrode showed 100% of decolorization and 60% of total organic carbon removal in Na2SO4 0.2 M at PH 2.2 and potential of +2.4 V. Experiments on degradation photoelectrocatalytic were also carried out for RB4 degradation in Na2SO4 0.1 K PH 12, using a Ti/TiO2 photoanode biased at +1.0 V and UV light. After 1 h of electrolysis the results indicated total color removal and 37% of mineralization. (c) 2004 Elsevier Ltd. All rights reserved.
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Iridium-, Ru-, and W-coated platforms were prepared by thermal treatment of the transversely heated graphite atomizer and investigated for the simultaneous determination of As, Bi, Pb, Sb, and Se in tap water by electrothermal atomic absorption spectrometry. The maximum pyrolysis temperature for As and Bi increased in a modifier sequence W < Ru < Ir. For Pb, Sb, and Se, this sequence was W < Ru, It. Calculated characteristic masses in the presence of It, Ru, and W were 35, 33, and 35 pg for As; 63, 51, and 52 pg for Bi; 50, 32, and 34 pg for Pb; 40, 35, and 31 pg for Sb; and 39, 39, and 93 pg for Se, respectively. Ruthenium was elected as the optimum modifier.Repeatability of the measurements was typically < 6%. Recoveries of As, Bi, Pb, Sb, and Se added to tap water samples varied from 79 to 109%. Accuracy was also checked by analysis of five certified reference materials (CRMs) from the National Institute of Standards and Technology (NIST1640 - Trace Elements in Natural Water; NIST 1643d Trace Elements in Water) and High Purity Standards (Trace Metals in Drinking Water Standards, lots #812708, #591107, and #710710). A paired t-test showed that the results for the CRMs were in agreement at the 95% confidence level with the certified values. The graphite tube lifetime was about 650 firings. multi-element determination is particularly challenging due to the necessity of carefully optimizing compromise conditions.Based on the considerations listed above, the aim of this paper was to evaluate the behavior of Ir, Ru, and W as permanent modifiers for the simultaneous determination of As, Bi, Pb, Sb, and Se. The performance of the proposed procedure was also verified after the ETAAS analysis of tap waters and reference materials.
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Discoloration of non-vital teeth is an esthetic deficiency frequently requiring bleaching treatment. The purpose of this study was to evaluate in vitro the cervical base efficacy in order to prevent or to minimize the leakage along the root canal filling and into the dentinal tubules. Thirty-eight extracted single-root human teeth were used, which were biomechanically prepared, filled, and divided into three experimental groups: G1, a cervical base was applied (3 mm of thickness) below the cemento-enamel junction, with resin-modified glass-ionomer cement (Vitremer); G2, the base was done with glass-ionomer cement (Vidrion R); and G3 (Control), did not receive any material as base. A mixture of sodium perborate and hydrogen peroxide 30% was placed inside the pulp chamber for 3 days, and the access opening was sealed with Cimpat. This procedure was repeated thrice. Soon after this, a paste of calcium hydroxide was inserted into the pulp chamber for 14 days. All teeth were covered with two layers of sticky wax, except the access opening, and immersed in blue India Ink for 5 days. The results did not show statistically significant differences between the three groups concerning the leakage inside the dentinal tubules. Regarding the apical direction, a statistical difference (ANOVA P < 0.05) was observed among the experimental group G1 and control group G3. No statistically significant difference was observed between G2 and G3 groups. Therefore, the placement of a cervical base before internal bleaching procedures is still recommended.
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Different methods and tests have been used to evaluate the pathogenic potential of distinct Y. enterocolitica serotypes and biotypes. We tested a total of 60 Y. enterocolitica strains, being 25 of human origin (serotype O3 biotype 4 and serotype O5 biotype 1); 6 of animal origin (serotype O3 biotype 4); 19 isolated from the environment (serotype O5.27 biotypes 1 and 2); and 8 isolated from food (serotype O5 biotype 1 and serotype 05.27 biotype 1). The methods used were based on plasmid gene expression (autoagglutination, calcium-dependence at 37 degrees C and Congo Red absorption tests), chromosomal gene expression (assays for pyrazinamidase activity, salicin fermentation and esculin hydrolysis), and invasion of HEp-2 cells. All but one of the Y. enterocolitica O3 strains, were found to be potentially pathogenic when submitted to the pyrazinamidase-salicin-esculin tests. In contrast, the results obtained with the assays related to plasmidial gene expression were not so uniform, probably due to plasmid loss. The least homogeneous results were obtained with the HEp-2 cell invasion test. Y. enterocolitica O5 behaved in a uniform manner when tested with the first two groups of tests (based on chromosomal and plasmidial gene expression), but not when tested with the HEp-2 invasion assay. The strains of serotype O5.27 biotype 1 presented a uniform behavior hen submitted to the chromosomic-related tests, showing no pathogenicity. However, they did not provide conclusive results with the tests related to plasmidial gene expression or HEp-2 cell invasion. We conclude that the tests related to chromosomal gene expression (esculin-salicin-pyrazinamidase) are simple and highly effective for the detection of potentially pathogenic Y. enterocolitica isolated from clinical cases.
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Statement of problem. Titanium has physical and mechanical properties, which have led to its increased use in dental prostheses despite casting difficulties due to high melting point and formation of oxide layers which affect the metal-ceramic bond strength.Purpose. This in vitro study evaluated the shear bond strength of the interface of 2 dental porcelains and pure titanium injected into a mold at 3 different temperatures.Material and methods. Using commercially pure (cp) titanium bars (Titanium, Grade I) melted at 1668degreesC and cast at mold temperatures of 430degreesC, 700degreesC or 900degreesC, 60 specimens were machined to 4 x 4 mm, with a base of 5 x 1 mm. The 4-mm surfaces were airborne-particle abraded with 100 mum aluminum oxide before applying and firing the bonding agent and evaluating the 2 porcelains (Triceram/Triline ti and Vita Titankeramik). Ten specimens were prepared for each temperature and porcelain combination Shear bond testing was performed in a universal testing machine, with a 500-kg load cell and crosshead speed of 0.5 mm/min. The specimens were loaded until failure. The interfaces of representative fractured specimens of each temperature were examined with a scanning electron microscope (SEM) and energy dispersive spectrometer (EDS). Data for shear bond strength (MPa) were statistically analyzed by 2-way ANOVA and the Tukey test (alpha = .05).Results. The results showed significant differences for the metal/porcelain interaction effect (P = .0464). There were no significant differences for the 2 porcelains (P = .4250). The Tukey test showed a significant difference between the pair cp Ti 430degreesC Triceram and cp Ti 900degreesC Triceram, with respective mean values and SDs of 59.74 +/- 11.62 and 34.03 +/- 10.35 MPa.Conclusion. Triceram porcelain showed a bond strength decrease with an increase in the mold temperature for casting titanium. The highest bond strength for Vita porcelain and the best metal-ceramic interface observed with the SEM were found with the mold temperature of 700degreesC.
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Objective-To evaluate the isoflurane-sparing effects of lidocaine and fentanyl administered by constant rate infusion (CRI) during surgery in dogs.Design-Randomized prospective study.Animals-24 female dogs undergoing unilateral mastectomy because of mammary neoplasia.Procedures-After premedication with acepromazine and morphine and anesthetic induction with ketamine and diazepam, anesthesia in dogs (n = 8/group) was maintained with isoflurane combined with either saline (0.9% NaCl) solution (control), liclocaine (1.5 mg/kg [0.68 mg/lb], IV bolus, followed by 250 mu g/kg/min [113 mu g/lb/min], CRI), or fentanyl (5 mu g/kg [2.27 mu g/lb], IV bolus, followed by 0.5 mu g/kg/min [0.23 mu g/lb/min], CRI). Positive-pressure ventilation was used to maintain eucapnia. An anesthetist unaware of treatment, endtidal isoflurane (ETiso) concentration, and vaporizer concentrations adjusted a nonprecision vaporizer to maintain surgical depth of anesthesia. Cardiopulmonary variables and ETiso values were monitored before and after beginning surgery.Results-Heart rate was lower in the fentanyl group. Mean arterial pressure did not differ among groups after surgery commenced. In the control group, mean +/- SD ETiso values ranged from 1.16 +/- 0.35% to 1.94 +/- 0.96%. Fentanyl significantly reduced isoflurane requirements during surgical stimulation by 54% to 66%, whereas the reduction in ETiso concentration (34% to 44%) observed in the lidocaine group was not significant.Conclusions and Clinical Relevance-Administration of fentanyl resulted in greater isoflurane sparing effect than did liclocaine. However, it appeared that the low heart rate induced by fentanyl may partially offset the improvement in mean arterial pressure that would be expected with reduced isoflurane requirements.
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This study aims to evaluate the effect of using anionic collagen membranes in guided tissue regeneration treatment of Class II furcation lesions in dogs. The defects were created in the buccal furcation of 16 mandibular premolars of four dogs. After 56 days without plaque control, the sites were scaled and divided into two groups according to the treatment applied: control sites, open flap debridement; and test sites, guided tissue regeneration treatment. The animals were killed after 3 months. Histological and histometrical analyses showed that the collagen membrane was better than open flap debridement in terms of newly formed cementum and epithelial migration prevention. It provided effective blockade of epithelial tissue and promoted regeneration of lost periodontal tissues, suggesting that the membrane warrants further study. (C) 1997 Elsevier B.V. Limited. All rights reserved.
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Despite the fact that chromium electrodeposition results in protection against wear and corrosion, combined with chemical resistance and good lubricity, the reduction in fatigue strength of base metal and environmental requirements causes one to search for possible alternatives. To improve the fatigue and corrosion resistance of AISI 4340 steel, an experimental study has been made for an intermediate electroless nickel layer deposited on base metal. The objective of this study was to analyze the effect of nickel underplate on the fatigue and corrosion strength of hard-chromium-plated AISI 4340 steel. Deposition of the conventional wear-resistant hard chromium plating leads to a decrease in mechanical properties of the base metal, especially the fatigue strength. Rotating bending fatigue tests results indicate better performance for conventional hard chromium plating. Good corrosion resistance in salt fog exposure was obtained for the accelerated hard chromium plating. Experimental data showed higher fatigue and corrosion resistance for samples prepared with accelerated hard chromium plate over electroless nickel plate, when compared with samples without electroless nickel underplate.
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This study reports the photodegradation of 4-chlorophenol (4-CP) in aqueous solution by the photo-Fenton process using solar irradiation. The influence of solution path length, and Fe(NO3)(3) and H2O2 concentrations on the degradation of 4-CP is evaluated by response surface methodology. The degradation process was monitored by the removal of total organic carbon (TOC) and the release of chloride ion. The results showed a very important role of iron concentration either for TOC removal or dechlorination. on the other hand, a negative effect of increasing solution path length on mineralization was observed, which can be compensated by increasing the iron concentration. This permits an adjustment of the iron concentration according to the irradiation exposure area and path length (depth of a tank reactor). Under optimum conditions of 1.5 mM Fe(NO3)(3), 20.0 mM H2O2 and 4.5 cm solution path length, 17 min irradiation under solar light were sufficient to reduce a 72 mg C L-1 solution of 4-CP by 91 (c) 2006 Elsevier B.V. All rights reserved.