24 resultados para Inappropriate use

em Repositório Institucional UNESP - Universidade Estadual Paulista "Julio de Mesquita Filho"


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

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Streptococcus pneumoniae is the predominant bacterial agent that affects the human population with pneumonia. This disease is an important cause of death in the elderly and the children under five years old. In this study, 29 strains of invasive S. pneumoniae were isolated from 29 patients of pneumonia, bacteremia and meningitis in the laboratory of the Municipal Hospital in Paulinia, Brazil, from May 2006 to October 2007. Patients' age ranged from 8 months old to 60 years old. These strains of S. pneumoniae were isolated from blood, pleural fluid and cerebrospinal fluid (CSF) of patients. After typing of encapsulated strains of S. pneumoniae through quellung reaction, their resistance to antimicrobial agents was gauged through Disc Diffusion Technique followed by determination of minimum inhibitory concentration (MIC). Among the 29 strains analyzed, 23 were methicillin-sensitive and six were methicillin-resistant and penicillin intermediate resistant. No strain presented full resistance to penicillin. Serotyping was performed only in two samples, which belonged to serotype 18. Our data may alert ambulatory regarding the incidence of pneumococcal strains resistant to the most common drugs due to inappropriate use of antimicrobials and also collaborate to the elaboration of pneumococcal conjugate vaccines specific to each region.

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The inappropriate use of antimicrobials in hospitals presents a negative impact on patient outcome and is associated with the emergence and spread of multidrug-resistant microorganisms. Antimicrobial stewardship programs (ASPs) have been instituted in order to improve the quality of prescriptions in hospitals. In this setting, the identification of patterns of inappropriate antimicrobial prescription is a valuable tool that allows ASPs to identify priorities for directing educative/restrictive policies. With this purpose, a study was conducted in the Bauru State Hospital, a teaching hospital with 285 beds affiliated to the Botucatu Medical School, São Paulo State University. The hospital maintains an active ASP since it was opened, in 2002. We selected 25% of the requests for parenteral antimicrobials (RPAs) from 2005 for analysis. Prescriptions for prophylactic purposes were excluded. All other RPAs were classified according to a modified Kunin and Jones categories. Univariate and multivariable analyses were performed to identify predictors of general inappropriateness and of specific prescription errors. Prescriptions classified as "appropriate'' or "probably appropriate" were selected as controls in all stages of the study. Among 963 RPAs included in our study, 34.6% were inappropriate. General predictors of inappropriateness were: prescription on weekends/holidays (OR = 1.67, 95% CI = 1.20-2.28, p = 0.002), patient from intensive care unit (OR = 1.57, 95% CI = 1.11-2.23, p = 0.01), peritoneal (OR = 2.15, 95% CI = 1.27-3.65, p = 0.004) or urinary tract infection (OR = 1.89, 95% CI = 1.25-2.87, p = 0.002), combined therapy with two or more antimicrobials (OR = 1.72, 95% CI = 1.15-2.57, p = 0.008) and prescriptions including penicillin (OR = 2.12, 95% CI = 1.39-3.25, p = 0.001) or first-generation cephalosporins (OR = 1.74, 95% CI = 1.01-3.00, p = 0.048). Previous consultation with an infectious diseases (ID) specialist had a protective effect against inappropriate prescription (OR = 0.34, 95% CI = 0.24-0.50, p < 0.001). Factors independently associated with specific prescription errors varied. However, consultation with an ID specialist was protective against both unnecessary antimicrobial use (OR = 0.04, 95% CI = 0.01-0.26, p = 0.001) and requests for agents with insufficient spectrum (OR = 0.14, 95% CI = 0.03-0.30, p = 0.01). In conclusion, the analysis of factors predictive of inappropriateness in antimicrobial prescription allowed us to identify issues requiring intervention. Also, it provided a positive feedback of the ASP efficacy, demonstrating the importance of previous consultation with an ID specialist to assure the quality of antimicrobial prescriptions.

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Rhythmite samples from Varvite Quarry and Park of Itu (SP), and well cores from Rafard (SP), were analyzed by optical microscopy to describe the petrographic characteristics of their light-colored (siltstone) and dark-colored (shale) laminae. The light-colored ones are essentially siltstones, commonly with traces of sands; the mineralogical composition is mainly quartz, with traces of feldspar and scarce mica; quartz or calcite cementation occurs in variable intensity, the first one being more intense in the Itu rhythmites; parallel laminations, internally normal graded or massive are the most common sedimentary structures in these rocks; bioturbations and dropstones are commonly observed in Itu rhythmites; contacts between siltstone laminae, and siltstone beds and shale laminae are commonly non-erosive and sharp. Considering this study and the macroscopic description of these rhythmites it was possible to clarify many questions about their composition, as the grain-size of the light-colored beds composed by silt with subordinate dropped sand, and the inappropriate use of the term varvite to the most of the Itu rhythmites. It was also important to reinforce their proglacial lacustrine origin, with random freezing of lacustrine surface water, and only sporadic ice-contact.

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Despite efforts to the contrary, some cosmetic products can cause undesirable side effects in the users. These may often be due to individual factors or inappropriate use of the product. Thus, biological assays to assess the safety of a new cosmetic must precede its being placed on the market. Historically, these tests have always been carried out in vivo, in animals, since such tests can be used to evaluate many of the potential risks, such as irritation, allergy or systemic effects; but, recently, some research centers have been adopting in vitro alternatives, in order to replace the animal tests. This review emphasizes the need to employ biological assays to test the safety of cosmetic products, and reviews the main in vivo and in vitro tests used, focusing on the need to develop and use alternatives to the in vivo assays of product safety, so as to offer the consumers the maximum safety with the least possible risk, while ensuring the best conditions of use of the product.

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The aim of this work was to critically assess the Brazilian regulations on fruit juices, with emphasis on ready-to-drink fruit juice. According to the Brazilian regulations, bottled fruit juices must follow specific regulations. They should be in accordance with the definition and designation that identify them, with the quality parameters established, and especially, follow the Brazilian food labeling regulations. The Brazilian regulations on bottled fruit juices have some gaps that promote their misunderstanding and marketing of substandard juices. Frequent changes, divergent labeling regulations and inappropriate use of expressions on the label can also lead to misinterpretation. Food regulations need to be clear and updated frequently if they are to be known and followed. Additionally, their wide dissemination should contribute to informed choices when buying.

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The drift is intimately linked to inappropriate use of pesticides and an important factor for reducing it, is the correct selection of spray nozzles and adjuvants. The objective of this work was to evaluate the drift potential in wind tunnel with different spray nozzles and different concentrations of adjuvants. The experiment was composed by six spray solutions (vegetable oil (in three concentrations), mineral oil, surfactant and reducing drift), which were applied with two nozzles, one pre-orifice flat fan (DG 8003 VS) and other with air induction (AI 8003 VS), totaling 12 treatments, with three repetitions. The equipment used was a wind tunnel, where the drift collections were made at different points. The treatments averages were compared using Confidence Interval at 5% probability. The analysis of the percentage of drift showed that the treatments had different behaviors. The nonylphenol ethoxylate adjuvant presented the highest drift when applied with the nozzle of pre-orifice and the lowest drift when applied with the air induction. The behavior of these nozzles when the oil-based adjuvant was used showed apposite results to those obtained for the surfactant. For the DG nozzles the lowest percentage of drift, at all analyzed distances, was observed to the treatment with vegetable oil (1.0%) and with the AI nozzles the lower drift was found for the treatment with nonylphenol ethoxylate (0.0625%), for the four distances in the collection. The result showed that both the spray nozzles and adjuvants alter directly the drift potential. There was no proportionately between the concentration of the oil-based adjuvant and the drift percentage.

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Pós-graduação em Ciência da Informação - FFC

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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Pós-graduação em Agronomia (Produção Vegetal) - FCAV

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Almost forty years computed tomography (CT) has been one of the most powerful tools in diagnostic imaging. However, this modality delivers relatively high doses to their patients. It is known that the inappropriate use and unnecessary radiation may be associated with a significant risk of cancer, especially in pediatric patients. Moreover, the quality assurance in CT, provided and required by Portaria 453/98 and the guide of the RE 1016/05, ensures that the images generated by computer tomography provide reliable diagnostic information with doses as low as reasonably achievable. This research aimed to make the quality control (QC) of CT equipment; establish a better relationship between dose and noise on the image to protocols of skull CT according to the study of optimization proposed in 2005 by Daros; and assess the dose distribution in different cranial organs for protocols of adult and pediatric use in the routine of the Department of Diagnostic Imaging of HCFMB-UNESP. The equipment used for testing QC, optimization and dosimetry was a third generation tomograph GE Sytec 3000i