Impacto econômico da implantação das boas práticas agropecuárias relacionadas com a qualidade do leite

Objetivou-se, neste estudo, avaliar o impacto econômico da implantação das boas práticas agropecuárias (BPA), relacionadas com a qualidade higiênica sanitária do leite. A pesquisa consistiu na simulação de nove cenários, compostos por três diferentes níveis de BPA para a melhoria da qualidade do leite (baixo, médio e alto), em três diferentes situações (somente aplicação das BPAs; aplicação das BPAs e construção da sala do leite; e aplicação das BPAs, construção da sala do leite e aquisição do tanque de expansão). O rebanho leiteiro hipotético constava de 30 vacas em lactação, com média de dez litros de leite/animal/dia, ordenhadas duas vezes ao dia, em ordenhadeira tipo "balde ao pé". A receita consistiu na média da bonificação/penalização, praticadas por dez laticínios da região sudeste, considerando-se diferentes intervalos de contagem de células somáticas (CCS) e contagem bacteriana total (CBT). A inclusão das BPAs para a melhoria da qualidade do leite, quando praticadas em seu nível máximo, mostrou-se com rápido retorno do capital investido (payback) e ótima taxa interna de retorno (TIR) apenas para aqueles pecuaristas que já possuíam a sala do leite e o tanque de expansão.

Cardio-respiratory symptoms in panic disorder: a contribution from cognitive-behaviour therapy

Objective: To compare patients with panic disorder with agoraphobia treated with cognitive-behavioural therapy (CBT) associated with the medication with patients treated only with medication and verify the behaviour of the cardio-respiratory symptoms of both groups. Methods: Randomized sample in the Psychiatry Institute of the Federal University of Rio de Janeiro, divided in two groups of 25 participants each. Group 1 undertook 10 weekly sessions of CBT with one hour of duration each together with medication. Group 2, Control, were administered medication that only consisted of tricyclic anti-depressants and selective inhibitors of the re-uptake of serotonin. Evaluation instruments were applied at the beginning and to the end of the interventions. Results: According to the applied scales, group 1 showed statistically more significant results than group 2, with: reduction of panic attacks, cardio-respiratory symptoms, anticipatory anxiety, agoraphobia avoidance and fear of bodily sensations. Conclusion: Exposures (in vivo and interoceptive), especially for induction symptom exercises and relaxation, were considered essential to prepare patients with panic disorder to handle future cardio-respiratory symptoms and panic attacks with agoraphobia.

Cognitive-behavioral therapy for anxiety disorders in children and adolescents: a systematic review of follow-up studies

Objective To conduct a systematic review about the long-term response to cognitive-behavioral therapy (CBT) for anxiety disorders (ADs) in children and adolescents. Methods The PubMed and ISI Web of Science databases were consulted. Search in the databases was performed in November 2012 and included cohort studies after CBT for ADs in children and adolescents with a follow-up period over 12 months. Results A total of 10 papers met the inclusion criteria. The follow-up period ranged from 12 months to 13 years and the results generally showed maintenance of the short-term benefits with CBT. However, the studies presented limitations, especially regarding methods, such as lack of a control group and losses to follow-up. Conclusion The long-term benefits of CBT were identified, however it would be interesting to conduct other studies with more frequent assessment periods, in order to minimize losses to follow-up, in addition to evaluating children and adolescents in the various stages of their development.

Qualidade do leite: utopia sem um programa sério de monitoramento da ocorrência de mastite bovina

As mastites continuam sendo um dos principais problemas a onerar a pecuária leiteira, além dos aspectos de saúde pública, considerando-se a veiculação de patógenos causadores de doença em humanos. Sua múltipla etiologia, com o envolvimento de inúmeros patógenos, requer um programa de controle rigoroso para o seu monitoramento e controle de qualidade do leite, pautado em ações diagnósticas e de vigilância epidemiológica com relação a parâmetros que indiretamente associam-se à ocorrência de mastites nos rebanhos, como California Mastitis Test (CMT) e Contagem de Células Somáticas (CCS/mL de leite), de amostras de leite individuais composta de cada vaca, bem como do tanque de expansão, o que permite ainda o monitoramento da Contagem Bacteriana Total (CBT), que tende a se relacionar com a ocorrência de mastites, principalmente subclínicas. Destacam-se ainda aspectos de exame microbiológico do leite e da importância da ordenha como ponto crucial nas mastites, enfatizando aspectos relevantes do processo de ordenha com fatores de risco para a ocorrência das mastites. Baseando-se nestes aspectos, apresenta-se esta revisão, acreditando-se na possibilidade de obtenção de produtos lácteos de melhor qualidade, com o comprometimento de todos os envolvidos na cadeia produtiva do leite, conscientes de que a qualidade do leite depende de todos, valendo-se também os consumidores, que são os elementos finais da cadeia produtiva do leite.

Qualidade do leite de vacas criadas no sistema silvipastoril no Vale do Cauca, Colômbia

O sistema silvipastoril caracteriza-se por aumentar a produção de leite, com maior número de vacas por hectare devido ao maior aporte de proteína na dieta. Neste sistema as vacas são alimentadas, além do pasto, de pequenas árvores e arbustos. O objetivo do presente estudo foi determinar os principais indicadores de qualidade do leite e agentes causais de mastite em vacas criadas em sistema silvipastoril. Foram avaliadas a composição (teor de gordura, proteína total, lactose, extrato seco, extrato seco desengordurado e nitrogênio uréico), contagem de células somáticas (CCS), contagem bacteriana total (CBT), ocorrência de mastite clínica e subclínica, isolamento microbiológico, perfil de sensibilidade bacteriana "in vitro" e detecção de resíduos antimicrobianos no leite produzido por 100 vacas, bem como do tanque de expansão e latões em propriedades do Vale do Cauca, Colômbia. Os teores médios dos principais constituintes do leite foram 3,24% de gordura, 3,27% de proteína total, 4,40% de lactose, 10,62% de extrato seco, 8,57% de extrato seco desengordurado e 15,82mg/dL de nitrogênio uréico, enquanto do tanque de expansão e latões foi 3,51% de gordura, 3,20% de proteína total, 4,34% de lactose, 11,72% de extrato seco, 8,47% de extrato seco desengordurado e 14,57mg/dL de nitrogênio uréico. A celularidade média dos quartos mamários e do tanque de expansão foi 141.252,75 CS/mL e 363.078,05 CS/mL respectivamente. A CBT média dos quartos mamários e do tanque de expansão foi 4.466,84 UFC/mL e 24.547,01 UFC/mL. Os principais micro-organismos isolados dos quartos mamários foram Corynebacterium bovis, Staphylococcus aureus, Staphylococcus hyicus, Staphylococcus spp., Streptococcus dysgalatiae, enquanto do tanque de expansão foram identificados Streptococcus spp., Enterobacter cloacae, Hafnia alveii, Streptococcus hemolítico e Streptococcus spp., com maior frequência. A presença de resíduos de antimicrobianos em leite de vacas e do tanque ou latão foi detectada em 30% e 86% das amostras, respectivamente. O sistema silvipastoril mostrou ser uma boa alternativa para produção de leite em vacas. No entanto, são necessários cuidados no tratamento mamário para evitar resíduos no leite e a análise de todos os parâmetros de qualidade para garantir um produto diferenciado.

Indicadores de qualidade e composição de leite informal comercializado na região Sudeste do Estado de São Paulo

Resumo:O leite informal é reconhecido como o produto comercializado sem inspeção. Avaliou-se a qualidade microbiológica, constituintes nutricionais e presença de substâncias inibidoras do crescimento bacteriano em 100 amostras informais de leite de vacas, comercializadas na região sudoeste do estado de São Paulo, Brasil. Verificou-se que 77% da Contagem de Células Somáticas (CCS) e 86% da Contagem Bacteriana Total (CBT) das amostras estavam em desacordo com os valores máximos exigidos pela Instrução Normativa 62 do MAPA. Identificaram-se teores em desacordo para sólidos totais (36%), proteína (23%), gordura (38%), extrato seco desengordurado (43%) e nitrogênio uréico (73%). Em 59% das amostras detectou-se a presença de resíduos de inibidores do crescimento bacteriano. Isolaram-se 240 linhagens de micro-organismos com predomínio de enterobactérias, estreptococos, estafilococos e fungos. O leite informal é comercializado na região sem as mínimas condições de higiene e oferece riscos a saúde pública, além de representar sério problema sócio-econômico para região.

Group cognitive behavior therapy for bipolar disorder can improve the quality of life

Bipolar disorder (BD) can have an impact on psychosocial functioning and quality of life (QoL). Several studies have shown that structured psychotherapy in conjunction with pharmacotherapy may modify the course of some disorders; however, few studies have investigated the results of group cognitive behavior therapy (G-CBT) for BD. Our objective was to evaluate the effectiveness of 14 sessions of G-CBT for BD patients, comparing this intervention plus pharmacotherapy to treatment as usual (TAU; only pharmacotherapy). Forty-one patients with BD I and II participated in this study and were randomly allocated to each group (G-CBT: N = 27; TAU: N = 14). Thirty-seven participants completed the treatment (women: N = 66.67%; mean age = 41.5 years). QoL and mood symptoms were assessed in all participants. Scores changed significantly by the end of treatment in favor of the G-CBT group. The G-CBT group presented significantly better QoL in seven of the eight sub-items assessed with the Medical Outcomes Survey SF-36 scale. At the end of treatment, the G-CBT group exhibited lower scores for mania (not statistically significant) and depression (statistically significant) as well as a reduction in the frequency and duration of mood episodes (P < 0.01). The group variable was significant for the reduction of depression scores over time. This clinical change may explain the improvement in six of the eight subscales of QoL (P < 0.05). The G-CBT group showed better QoL in absolute values in all aspects and significant improvements in nearly all subscales. These results were not observed in the TAU control group.

Efficacy of cognitive behavioral therapy in reducing psychiatric symptoms in patients with implantable cardioverter defibrillator: an integrative review

This article is a systematic review of the available literature on the benefits that cognitive behavioral therapy (CBT) offers patients with implanted cardioverter defibrillators (ICDs) and confirms its effectiveness. After receiving the device, some patients fear that it will malfunction, or they remain in a constant state of tension due to sudden electrical discharges and develop symptoms of anxiety and depression. A search with the key words “anxiety”, “depression”, “implantable cardioverter”, “cognitive behavioral therapy” and “psychotherapy” was carried out. The search was conducted in early January 2013. Sources for the search were ISI Web of Knowledge, PubMed, and PsycINFO. A total of 224 articles were retrieved: 155 from PubMed, 69 from ISI Web of Knowledge. Of these, 16 were written in a foreign language and 47 were duplicates, leaving 161 references for analysis of the abstracts. A total of 19 articles were eliminated after analysis of the abstracts, 13 were eliminated after full-text reading, and 11 articles were selected for the review. The collection of articles for literature review covered studies conducted over a period of 13 years (1998-2011), and, according to methodological design, there were 1 cross-sectional study, 1 prospective observational study, 2 clinical trials, 4 case-control studies, and 3 case studies. The criterion used for selection of the 11 articles was the effectiveness of the intervention of CBT to decrease anxiety and depression in patients with ICD, expressed as a ratio. The research indicated that CBT has been effective in the treatment of ICD patients with depressive and anxiety symptoms. Research also showed that young women represented a risk group, for which further study is needed. Because the number of references on this theme was small, further studies should be carried out.

Salvaged single-unit cord blood transplantation for 26 patients with hematologic malignancies not in remission

Treatments for patients with hematologic malignancies not in remission are limited, but a few clinical studies have investigated the effects of salvaged unrelated cord blood transplantation (CBT). We retrospectively studied 19 patients with acute leukemia, 5 with myelodysplastic syndrome (MDS with refractory anemia with excess blasts [RAEB]), and 2 with non-Hodgkin's lymphoma who received 1 CBT unit ≤2 loci human leukocyte antigen (HLA)-mismatched after undergoing myeloablative conditioning regimens between July 2005 and July 2014. All of them were in non-remission before transplantation. The infused total nucleated cell (TNC) dose was 4.07 (range 2.76-6.02)×107/kg and that of CD34+ stem cells was 2.08 (range 0.99-8.65)×105/kg. All patients were engrafted with neutrophils that exceeded 0.5×109/L on median day +17 (range 14-37 days) and had platelet counts of >20×109/L on median day +35 (range 17-70 days). Sixteen patients (61.5%) experienced pre-engraftment syndrome (PES), and six (23.1%) patients progressed to acute graft-versus-host disease (GVHD). The cumulative incidence rates of II-IV acute GVHD and chronic GVHD were 50% and 26.9%, respectively. After a median follow-up of 27 months (range 5-74), 14 patients survived and 3 relapsed. The estimated 2-year overall survival (OS), disease-free survival (DFS), and non-relapse mortality (NRM) rates were 50.5%, 40.3%, and 35.2%, respectively. Salvaged CBT might be a promising modality for treating hematologic malignancies, even in patients with a high leukemia burden.