Melhoria na atenção à saúde da mulher: ênfase na prevenção e detecção de câncer de colo de útero e de mama Clínica da Família Rodrigo Roig: Equipe Fênix, Rio de Janeiro/RJ

Considerando que a atenção primária à saúde é o primeiro nível de acesso ao sistema de saúde, caracterizada, principalmente pela longitudinalidade, integralidade da atenção e a ordenação do cuidado e que o Câncer de Mama e o Câncer de Colo de Útero são duas patologias responsáveis por grande morbimortalidade da população feminina com prevalência relevante e, quando precocemente diagnosticadas, têm grandes chances de cura. A equipe Fênix de Estratégia de Saúde da Família da Clínica da Família Rodrigo Yamawaki Aguilar Roig, no Rio de Janeiro, buscando obter uma melhoria na atenção à Saúde da Mulher com ênfase na Prevenção e Detecção de Câncer de colo de útero e de mama para as mulheres da área de abrangência da equipe, resolveu qualificar a ação programática de prevenção do câncer de colo de útero e mama.Esperávamos cadastrar durante as 16 Semanas de intervenção 1.303 mulheres da faixa etária de 25 a 64 anos de idade para detecção precoce do câncer de colo uterino e 386 mulheres entre 50 a 69 anos de idade para prevenção de câncer de mama. Infelizmente, devido a inúmeras tribulações e problemas, ao final da intervenção cadastramos 93 mulheres na faixa etária de 25 a 64 anos de idade e todas elas tiveram colhidos o material para o exame para prevenção de câncer de colo de útero, mas se considerarmos o total de mulheres nesta faixa etária residentes na área temos como resultado que, alcançamos o percentual de 7,1% de cobertura neste indicador. Infelizmente, neste período das 16 semanas da intervenção das 386 melheres estimadas na faixa etraia de 50 a 69 anos de idade foram cadastradas apenas 21 mulheres, e apenas 5 destas estavam com a mamografia em dia, o que corresponde ao percentual de 23,8% das mulheres nesta faixa etária que foram cadastradas durante a intervenção. A equipe acredita que os resultados encontrados após o fim da intervenção, foram satisfatórios mesmo não sendo um resultado expressivo em relação às metas de Cobertura pactuadas pela equipe.Os indicadores avaliados revelaram a melhoria na atenção à saúde das mulheres para prevenção de Ca de colo de útero e para Câncer de Mama. Houve melhoria nos indicadores de qualidade. Melhoramos as formas de registros dos resultados dos exames na ficha espelho ou prontuário possibilitando uma organização interna da equipe assim auxiliando na coleta de dados, na organização das agendas dos profissionais e na sistematização do processo de trabalho. Também aumentamos o índice de coletas satisfatórias das amostras. Ressaltamos que durante os atendimentos na UBS todas as mulheres tiveram orientações sobre os fatores de risco para o Câncer de mama e de útero, bem como foram orientadas sobre os sinais e sintomas característicos e as formas de prevenção destes agravos. As novas rotinas introduzidas no serviço devido ao projeto de intervenção foram incorporadas e estão sendo aprimoradas.

Bioactivity And Chemical Composition Of The Essential Oil From The Leaves Of Guatteria Australis A.st.-hil.

Essential oil from the leaves of Guatteria australis was obtained by hydrodistillation, analyzed by Gas Chromatography coupled to Mass Spectromery (GC-MS) and their antiproliferative, antileishmanial, antibacterial, antifungal and antioxidant activities were also evaluated. Twenty-three compounds were identified among which germacrene B (50.66%), germacrene D (22.22%) and (E)-caryophyllene (8.99%) were the main compounds. The highest antiproliferative activity was observed against NCI-ADR/RES (TGI = 31.08 μg/ml) and HT-29 (TGI = 32.81 μg/ml) cell lines. It also showed good antileishmanial activity against Leishmania infantum (IC50 = 30.71 μg/ml). On the other hand, the oil exhibited a small effect against Staphylococcus aureus ATCC 6538, S. aureus ATCC 14458 and Escherichia coli ATCC 10799 (MIC = 250 μg/ml), as well as small antioxidant activity (457 μmol TE/g) assessed through ORACFL assay. These results represent the first report regarding chemical composition and bioactivity of G. australis essential oil.

25 anos de quimiometria no Brasil

Chemometric activities in Brazil are described according to three phases: before the existence of microcomputers in the 1970s, through the initial stages of microcomputer use in the 1980s and during the years of extensive microcomputer applications of the ´90s and into this century. Pioneering activities in both the university and industry are emphasized. Active research areas in chemometrics are cited including experimental design, pattern recognition and classification, curve resolution for complex systems and multivariate calibration. New trends in chemometrics, especially higher order methods for treating data, are emphasized.

Administração limpa e enxuta em sistemas hidráulicos de colhedoras de cana-de-açúcar

Among the important changes in the production processes, it is necessary to guarantee the sustainability of the human enterprises, what makes us to foresee changes in the managerial administration to adapt to a new model, with the insert of the concepts of Clean Production, Cleaner, Lean and Total Productive Maintenance (TPM). The main focus of this work was to elaborate a methodology that made it possible to guarantee the reliability in the waterworks of the sugarcane harvester, identifying and analyzing the manners of flaws, in order to result in the improvement of the environmental and socioeconomic quality in the atmosphere of an industry of sugarcane through the significant decrease of hydraulic oil spill. Through the existent report in ERP (Enterprise Resource Planning), used in a Sugarcane Industry Plant, it was possible to accompany of the operational acting of the sugarcane harvester used during 03 crops, regarding the manners of flaws in the waterworks of the same ones, and, in one of the crops it was elaborated the total control of the waterworks of 5 harvesters. Based on the obtained data and the developed methodology it was possible to develop a software that specifies the electric outlet of decisions.

Qualidade da carne de suínos de três linhagens genéticas comerciais em diferentes pesos de abate

O objetivo deste trabalho foi determinar as características de qualidade da carne de suínos de diferentes linhagens genéticas, em diferentes pesos de abate. Neste estudo foram utilizados 88 suínos por linhagem, fêmeas e machos castrados, com idade e peso médio iniciais de 74 dias e 30kg, respectivamente, pertencentes a três linhagens genéticas distintas, designadas de AgroceresPic, Dalland e Seghers. A etapa experimental foi dividida em quatro fases (Crescimento I, Crescimento II, Terminação I e Terminação II). Ao final de cada etapa, foram abatidos 60 animais (10 por linhagem/sexo), para as análises de qualidade da carne. O pH e a temperatura foram determinados a 1 e 24 horas post mortem. Foram retiradas amostras para as determinações de cor, perda de água por exsudação (PAE), perda de água por cocção (PAC) e força de Cisalhamento. As amostras provenientes das carcaças dos animais da linhagem AgroceresPic e Dalland apresentaram valores médios de PAE superiores aos da linhagem Seghers. Os valores médios de PAC foram diferentes entre as diferentes fases. Na fase Crescimento II, as carnes provenientes das carcaças das fêmeas Dalland foram mais duras, ou seja, com maiores valores de força de cisalhamento, que as carnes dos machos. Entretanto, na linhagem Seghers, as carnes dos machos foram mais duras. Observou-se diferença de L* entre os sexos da linhagem AgroceresPic nas fases Terminação I e II e, na linhagem Dalland, na Terminação II. As linhagens Dalland e Seghers apresentaram carnes com resultados superiores de a*, parâmetro característico da cor vermelha (a*>0). Pode-se concluir, portanto, que as características de qualidade da carne de suínos (pH, perda de água por exsudação, cor e maciez) podem variar entre grupos genéticos, entre sexos e entre diferentes pesos ao abate.

Renda familiar, preço de alimentos e aquisição domiciliar de frutas e hortaliças no Brasil

OBJETIVO: Analisar a influência da renda familiar e do preço de alimentos sobre a participação de frutas e hortaliças dentre os alimentos adquiridos pelas famílias brasileiras. MÉTODOS: Foram utilizados dados da Pesquisa de Orçamentos Familiares realizada pelo Instituto Brasileiro de Geografia e Estatística, com amostra probabilística de 48.470 domicílios brasileiros entre 2002 e 2003. A participação de frutas e hortaliças no total de aquisições de alimentos foi expressa como percentual do total de calorias adquiridas e como calorias provenientes desses alimentos ajustadas para o total de calorias adquirido. Empregaram-se técnicas de análise de regressão múltipla para estimação de coeficientes de elasticidade, controlando-se variáveis sociodemográficas e preço dos demais alimentos. RESULTADOS: Observou-se aumento da participação de frutas e hortaliças no total de aquisições de alimentos com a diminuição de seu próprio preço ou com o aumento da renda. A diminuição do preço de frutas e hortaliças em 1 por cento aumentaria sua participação em 0,79 por cento do total calórico; o aumento de 1 por cento na renda familiar aumentaria essa participação no total calórico em 0,27 por cento. O efeito da renda tendeu a ser menor nos estratos de maior renda. CONCLUSÕES: A redução do preço de frutas e hortaliças, tanto pelo apoio à cadeia de produção dos alimentos quanto por medidas fiscais, é um promissor instrumento de política pública capaz de aumentar a participação desses alimentos na dieta brasileira

Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA Study

Introduction: Work disability is a major consequence of rheumatoid arthritis (RA), associated not only with traditional disease activity variables, but also more significantly with demographic, functional, occupational, and societal variables. Recent reports suggest that the use of biologic agents offers potential for reduced work disability rates, but the conclusions are based on surrogate disease activity measures derived from studies primarily from Western countries. Methods: The Quantitative Standard Monitoring of Patients with RA (QUEST-RA) multinational database of 8,039 patients in 86 sites in 32 countries, 16 with high gross domestic product (GDP) (>24K US dollars (USD) per capita) and 16 low-GDP countries (<11K USD), was analyzed for work and disability status at onset and over the course of RA and clinical status of patients who continued working or had stopped working in high-GDP versus low-GDP countries according to all RA Core Data Set measures. Associations of work disability status with RA Core Data Set variables and indices were analyzed using descriptive statistics and regression analyses. Results: At the time of first symptoms, 86% of men (range 57%-100% among countries) and 64% (19%-87%) of women <65 years were working. More than one third (37%) of these patients reported subsequent work disability because of RA. Among 1,756 patients whose symptoms had begun during the 2000s, the probabilities of continuing to work were 80% (95% confidence interval (CI) 78%-82%) at 2 years and 68% (95% CI 65%-71%) at 5 years, with similar patterns in high-GDP and low-GDP countries. Patients who continued working versus stopped working had significantly better clinical status for all clinical status measures and patient self-report scores, with similar patterns in high-GDP and low-GDP countries. However, patients who had stopped working in high-GDP countries had better clinical status than patients who continued working in low-GDP countries. The most significant identifier of work disability in all subgroups was Health Assessment Questionnaire (HAQ) functional disability score. Conclusions: Work disability rates remain high among people with RA during this millennium. In low-GDP countries, people remain working with high levels of disability and disease activity. Cultural and economic differences between societies affect work disability as an outcome measure for RA.

E-Learning Used in a Training Course on Atraumatic Restorative Treatment (ART) for Brazilian Dentists

The purpose of this study was to assess the benefits of using e-learning resources in a dental training course on Atraumatic Restorative Treatment (ART). This e-course was given in a DVD format, which presented the ART technique and philosophy. The participants were twenty-four dentists from the Brazilian public health system. Prior to receiving the DVD, the dentists answered a questionnaire regarding their personal data, previous knowledge about ART, and general interest in training courses. The dentists also participated in an assessment process consisting of a test applied before and after the course. A single researcher corrected the tests, and intraexaminer reproducibility was calculated (kappa=0.89). Paired t-tests were carried out to compare the means between the assessments, showing a significant improvement in the performance of the subjects on the test taken after the course (p<0.05). A linear regression model was used with the difference between the means as the outcome. A greater improvement on the test results was observed among female dentists (p=0.034), dentists working for a shorter period of time in the public health system (p=0.042), and dentists who used the ART technique only for urgent and/or temporary treatment (p=0.010). In conclusion, e-learning has the potential of improving the knowledge that dentists working in the public health system have about ART, especially those with less clinical experience and less knowledge about the subject.

FLOWS WITHOUT WANDERING POINTS ON COMPACT CONNECTED SURFACES

Given a compact 2 dimensional manifold M we classify all continuous flows phi without wandering points on M. This classification is performed by finding finitely many pairwise disjoint open phi-invariant subsets {U(1), U(2), ..., U(n)} of M such that U(i=1)(n) (U(i)) over bar = M and each U(i) is either a suspension of an interval exchange transformation, or a maximal open cylinder made up of closed trajectories of phi.

EIS study of Ti-23Ta alloy in artificial saliva

Although titanium and Ti-6Al-4V alloy have been widely used as dental materials, possible undesirable effects such as cytotoxic reactions and neurological disorder due to metal release led to the development of more corrosion resistant and V and Al free titanium alloys, containing Nb, Zr, Mo and Ta atoxic elements. Fluoride containing products used in the prevention of plaque formation and dental caries can affect the stability of the passive oxide films formed on the Ti alloys. In this work, the corrosion behaviour of the new Ti-23Ta alloy has been evaluated in artificial saliva of different pH and fluoride concentration using electrochemical impedance spectroscopy. Electrochemical impedance spectroscopy study showed that the oxide film formed on the alloy in artificial saliva consists of an inner compact film and an outer porous layer. The corrosion resistance of Ti-23Ta alloy which is reduced by increasing F concentration or decreasing pH is related to the resistance of the inner compact layer. The presence of fluoride and low pH of the saliva enhance the porosity of the oxide film and its dissolution.

Effects of elastic indenter deformation on spherical instrumented indentation tests: the reduced elastic modulus

Although the Hertz theory is not applicable in the analysis of the indentation of elastic-plastic materials, it is common practice to incorporate the concept of indenter/specimen combined modulus to consider indenter deformation. The appropriateness was assessed of the use of reduced modulus to incorporate the effect of indenter deformation in the analysis of the indentation with spherical indenters. The analysis based on finite element simulations considered four values of the ratio of the indented material elastic modulus to that of the diamond indenter, E/E(i) (0, 0.04, 0.19, 0.39), four values of the ratio of the elastic reduced modulus to the initial yield strength, E(r)/Y (0, 10, 20, 100), and two values of the ratio of the indenter radius to maximum total displacement, R/delta(max) (3, 10). Indenter deformation effects are better accounted for by the reduced modulus if the indented material behaves entirely elastically. In this case, identical load-displacement (P - delta) curves are obtained with rigid and elastic spherical indenters for the same elastic reduced modulus. Changes in the ratio E/E(i), from 0 to 0.39, resulted in variations lower than 5% for the load dimensionless functions, lower than 3% in the contact area, A(c), and lower than 5% in the ratio H/E(r). However, deformations of the elastic indenter made the actual radius of contact change, even in the indentation of elastic materials. Even though the load dimensionless functions showed only a little increase with the ratio E/E(i), the hardening coefficient and the yield strength could be slightly overestimated when algorithms based on rigid indenters are used. For the unloading curves, the ratio delta(e)/delta(max), where delta(e) is the point corresponding to zero load of a straight line with slope S from the point (P(max), delta(max)), varied less than 5% with the ratio E/E(i). Similarly, the relationship between reduced modulus and the unloading indentation curve, expressed by Sneddon`s equation, did not reveal the necessity of correction with the ratio E/E(i). The most affected parameter in the indentation curve, as a consequence of the indentation deformation, was the ratio between the residual indentation depth after complete unloading and the maximum indenter displacement, delta(r)/delta(max) (up to 26%), but this variation did not significantly decrease the capability to estimate hardness and elastic modulus based on the ratio of the residual indentation depth to maximum indentation depth, h(r)/h(max). In general, the results confirm the convenience of the use of the reduced modulus in the spherical instrumented indentation tests.

A critical reassessment of elastic unloading in sharp instrumented indentation experiments and the extraction of mechanical properties

This work examines the extraction of mechanical properties from instrumented indentation P-h(s) curves via extensive three-dimensional finite element analyses for pyramidal tips in a wide range of solids under frictional and frictionless contact conditions. Since the topography of the imprint changes with the level of pile-up or sink-in, a relationship is identified between correction factor beta in the elastic equation for the unloading indentation stage and the amount of surface deformation effects. It is shown that the presumption of a constant beta significantly affects mechanical property extractions. Consequently, a new best-fit function is found for the correlation between penetration depth ratios h(e)/h(max), h(r)/h(max) and n, circumventing the need for the assumption of a constant value for beta, made in our prior investigation [Acta Mater. 53 (2005) pp. 3545-3561]. Simulations under frictional contact conditions provide sensible boundaries for the influence of friction on both h(e)/h(max) and h(r)/h(max). Friction is essentially found to induce an overestimation in the inferred n. Instrumented indentation experiments are also performed in three archetypal metallic materials exhibiting distinctly different contact responses. Mechanical property extractions are finally demonstrated in each of these materials.