Controle pressórico e adesão/vínculo em hipertensos usuários da Atenção Primária à Saúde

Estudo descritivo e analítico, de base populacional, realizado com uma amostra aleatória e probabilística de 340 hipertensos, representativa da Estratégia Saúde da Família (ESF) de João Pessoa, PB. O estudo compõe a primeira parte de uma coorte iniciada em 2008. O instrumento utilizado foi adaptado do Primary Care Assessment Tool, revalidado no Brasil. A regressão logística avaliou a associação entre o controle pressórico, as variáveis sócio-demográficas e o indicador de adesão/vínculo. Dentre os 340 hipertensos, 32,6% era acompanhado pela ESF e 89,1% apresentou adesão/vínculo satisfatória. Os idosos apresentaram maior chance de controlar a pressão, o que sugere uma percepção melhor do autocuidado e maior adesão ao tratamento. O estudo permitiu dar visibilidade à problemática do controle da hipertensão por meio da avaliação do serviço. Espera-se que esse modelo possa ser adotado em outras localidades, gerando parâmetros para comparações entre municípios distintos.

Efetividade no diagnóstico da tuberculose em Foz do Iguaçu, tríplice fronteira Brasil, Paraguai e Argentina

Objetivou-se avaliar a efetividade dos serviços de saúde no diagnóstico da tuberculose em Foz do Iguaçu-PR. Realizou-se uma pesquisa avaliativa, com desenho epidemiológico transversal. Foram entrevistados 101 doentes de tuberculose em 2009, utilizando um instrumento baseado no Primary Care Assessment Tool . A análise ocorreu a partir de proporções e respectivos intervalos de confiança (95%) e mediana. O Pronto Atendimento (37%) e a Atenção Básica à Saúde (ABS) (36%) foram os locais mais buscados. O acesso à consulta no mesmo dia alcançou 70%, mas a suspeição da doença foi menor que 47%; a baciloscopia realizada em 50% dos doentes. Concluiu-se que apesar desses serviços atenderem rapidamente, isso não determinou alcance do diagnóstico, levando o doente a procurar os serviços especializados, mais efetivos na descoberta dos casos. A busca pela ABS gerou maior tempo e maior número de retornos para o diagnóstico da tuberculose na tríplice fronteira.

Children's health care assistance according to their families: a comparison between models of Primary Care

OBJECTIVE To compare the health assistance models of Basic Traditional Units (UBS) with the Family Health Strategy (ESF) units for presence and extent of attributes of Primary Health Care (APS), specifically in the care of children. METHOD A cross-sectional study of a quantitative approach with families of children attended by the Public Health Service of Colombo, Paraná. The Primary Care Assessment Tool (PCA-Tool) was applied to parents of 482 children, 235 ESF units and 247 UBS units covering all primary care units of the municipality, between June and July 2012. The results were analyzed according to the PCA-Tool manual. RESULTS ESF units reached a borderline overall score for primary health care standards. However, they fared better in their attributes of Affiliation, Integration of care coordination, Comprehensiveness, Family Centeredness and Accessibility of use, while the attributes of Community Guidance/Orientation, Coordination of Information Systems, Longitudinality and Access attributes were rated as insufficient for APS. UBS units had low scores on all attributes. CONCLUSION The ESF units are closer to the principles of APS (Primary Health Care), but there is need to review actions of child care aimed at the attributes of APS in both care models, corroborating similar studies from other regions of Brazil.

Factors influencing adherence to standard precautions among nursing professionals in psychiatric hospitals

OBJECTIVE Evaluate and correlate individual, work-related and organizational factors that influence adherence to standard precautions among nursing professionals of psychiatric hospitals in São Paulo. METHOD An exploratory cross-sectional study conducted with 35 nursing professionals, using the assessment tool for adherence to standard precautions through the Likert scale, ranging from 1 to 5. RESULTS Knowledge of the precautions received a high score (4.69); adherence received (3.86) and obstacles (3.78), while intermediaries and the scales of organizational factors received low scores (2.61). There was a strong correlation between the magnitude adherence scale and the personal protective equipment availability (r = 0.643; p = 0.000). The training scale for prevention of HIV exposure (p = 0.007) was statistically different between the nurses and nursing assistants. CONCLUSION The organizational factors negatively contributed to adherence to standard precautions, indicating that psychiatric institutions lack safe working conditions, ongoing training and management actions to control infections.

Adoption Subsidies and Environmental Impacts of Alternative Energy Crops, March 2007

We provide estimates of the costs associated with inducing substantial conversion of land from production of traditional crops to switchgrass. Higher traditional crop prices due to increased demand for corn from the ethanol industry has increased the relative advantage that row crops have over switchgrass. Results indicate that farmers will convert to switchgrass production only with significant conversion subsidies. To examine potential environmental consequences of conversion, we investigate three stylized landscape usage scenarios, one with an entire conversion of a watershed to switchgrass production, a second with the entire watershed planted to continuous corn under a 50% removal rate of the biomass, and a third scenario that places switchgrass on the most erodible land in the watershed and places continuous corn on the least erodible. For each of these illustrative scenarios, the watershed-scale Soil and Water Assessment Tool (SWAT) hydrological model (Arnold et al., 1998; Arnold and Forher, 2005) is used to evaluate the effect of these landscape uses on sediment and nutrient loadings in the Maquoketa Watershed in eastern Iowa.

Relative and absolute reliability of the clinical version of the Narrow Path Walking Test (NPWT) under single and dual task conditions.

Decline in gait stability has been associated with increased fall risk in older adults. Reliable and clinically feasible methods of gait instability assessment are needed. This study evaluated the relative and absolute reliability and concurrent validity of the testing procedure of the clinical version of the Narrow Path Walking Test (NPWT) under single task (ST) and dual task (DT) conditions. Thirty independent community-dwelling older adults (65-87 years) were tested twice. Participants were instructed to walk within the 6-m narrow path without stepping out. Trial time, number of steps, trial velocity, number of step errors, and number of cognitive task errors were determined. Intraclass correlation coefficients (ICCs) were calculated as indices of agreement, and a graphic approach called "mountain plot" was applied to help interpret the direction and magnitude of disagreements between testing procedures. Smallest detectable change and smallest real difference (SRD) were computed to determine clinically relevant improvement at group and individual levels, respectively. Concurrent validity was assessed using Performance Oriented Mobility Assessment Tool (POMA) and the Short Physical Performance Battery (SPPB). Test-retest agreement (ICC1,2) varied from 0.77 to 0.92 in ST and from 0.78 to 0.92 in DT conditions, with no apparent systematic differences between testing procedures demonstrated by the mountain plot graphs. Smallest detectable change and smallest real change were small for motor task performance and larger for cognitive errors. Significant correlations were observed for trial velocity and trial time with POMA and SPPB. The present results indicate that the NPWT testing procedure is highly reliable and reproducible.

How are "teaching the teachers" courses in evidence based medicine evaluated? A systematic review.

BACKGROUND: Teaching of evidence-based medicine (EBM) has become widespread in medical education. Teaching the teachers (TTT) courses address the increased teaching demand and the need to improve effectiveness of EBM teaching. We conducted a systematic review of assessment tools for EBM TTT courses.To summarise and appraise existing assessment methods for teaching the teachers courses in EBM by a systematic review. METHODS: We searched PubMed, BioMed, EmBase, Cochrane and Eric databases without language restrictions and included articles that assessed its participants. Study selection and data extraction were conducted independently by two reviewers. RESULTS: Of 1230 potentially relevant studies, five papers met the selection criteria. There were no specific assessment tools for evaluating effectiveness of EBM TTT courses. Some of the material available might be useful in initiating the development of such an assessment tool. CONCLUSION: There is a need for the development of educationally sound assessment tools for teaching the teachers courses in EBM, without which it would be impossible to ascertain if such courses have the desired effect.

Eosinophilic esophagitis: overview of clinical management.

A validated disease-specific symptom-assessment tool for eosinophilic esophagitis (EoE) has yet to be approved by regulatory authorities for use in clinical trials. Relevant end points for daily practice include EoE-related symptoms and esophageal eosinophilic inflammation. Endoscopic features should also be taken into account when establishing a therapy plan. A reasonable clinical goal is to achieve a reduction in EoE-related symptoms and esophageal eosinophilic inflammation. Evidence is increasing to support an anti-inflammatory maintenance therapy, as this can reduce esophageal remodeling. In EoE patients in clinical remission, annual disease monitoring with symptom, endoscopic, and histologic assessments of sustained treatment response is recommended.

Projecto de sensibilização e educação ambiental na área da prevenção da produção dos resíduos urbanos : proposta de integração da temática nos currícula do ensino básico de Cabo Verde

This research project has as main objective the design of a project to raise awareness and environmental education in the area of prevention of the urban waste production by focusing on the presentation of a methodological proposal to incorporate this theme in the Course Curriculum of the Basic Education in Cape Verde. The study aimed beyond the project design, the preparation of a guide and a set of activities, instruments to be used by the educational community and more directly by the teachers of the Basic Education (EB) of Cape Verde for knowledge construction in study area and promove the development of skills of those teachers in terms of planning activities for waste prevention. The realized work included visits to various sources of information considered relevant, the application and validation of some activities in the population testing process using the technique of participant observation. This research involved the collaboration of the educational community of Praia namely the BE teachers, Pedagogical team teaching and Promoters of the new BE Curriculum. The study made a contribution in the view of the definition of the methodology of the work project and the assessment tool in order to reflect on the work process and its subsequent correction / improvement of future operations. We also present a proposal of monitoring and evaluation instrument of the project which will be applied during the implementation phase. Its use will enable the school community to improve their practices and will facilitate the involvement of the educational community taking into consideration an environmental sustainability

Projecto de sensibilização e educação ambiental na área da prevenção da produção dos resíduos urbanos : proposta de integração da temática nos currícula do ensino básico de Cabo Verde

O presente trabalho de projecto tem como principal objectivo a concepção de um projecto de sensibilização e educação ambiental na área da prevenção da produção dos resíduos urbanos com enfoque na apresentação de uma proposta metodológica de integração desta temática nos Currícula do Ensino Básico de Cabo Verde. Do estudo desenvolvido resultou, além da concepção do projecto, a elaboração de um guia, bem como um caderno de actividades, instrumentos a serem utilizados pela comunidade educativa e mais directamente pelos professores do Ensino Básico (EB) de Cabo Verde visando o reforço de conhecimentos na área de estudo identificada e o desenvolvimento de competências juntos dos referidos professores, para a planificação de actividades de prevenção da produção dos resíduos urbanos. O trabalho realizado compreendeu visitas a várias fontes de informação consideradas pertinentes assim como a aplicação e validação de algumas actividades numa população-teste com utilização da técnica de observação participante. Deste modo, o estudo contou com a colaboração da comunidade educativa da Cidade da Praia nomeadamente professores do EB, Equipa pedagógica e Promotores do novo Currículo do EB. O estudo permitiu dar um contributo na perspectiva da definição da metodologia do trabalho do projecto e instrumento de avaliação, visando uma reflexão sobre o trabalho desenvolvido e sua consequente correcção/melhoria de futuras acções. Apresentamos ainda uma proposta de instrumentos de acompanhamento e avaliação do projecto cuja aplicação se propõe no decorrer da implementação do mesmo. A sua utilização permitirá à comunidade escolar melhorar as suas práticas e facilitará o envolvimento da comunidade educativa tendo em vista a sustentabilidade ambiental.

Projecto de sensibilização e educação ambiental na área da prevenção da produção dos resíduos urbanos : proposta de integração da temática nos currícula do ensino básico de Cabo Verde

This research project has as main objective the design of a project to raise awareness and environmental education in the area of prevention of the urban waste production by focusing on the presentation of a methodological proposal to incorporate this theme in the Course Curriculum of the Basic Education in Cape Verde. The study aimed beyond the project design, the preparation of a guide and a set of activities, instruments to be used by the educational community and more directly by the teachers of the Basic Education (EB) of Cape Verde for knowledge construction in study area and promove the development of skills of those teachers in terms of planning activities for waste prevention. The realized work included visits to various sources of information considered relevant, the application and validation of some activities in the population testing process using the technique of participant observation. This research involved the collaboration of the educational community of Praia namely the BE teachers, Pedagogical team teaching and Promoters of the new BE Curriculum. The study made a contribution in the view of the definition of the methodology of the work project and the assessment tool in order to reflect on the work process and its subsequent correction / improvement of future operations. We also present a proposal of monitoring and evaluation instrument of the project which will be applied during the implementation phase. Its use will enable the school community to improve their practices and will facilitate the involvement of the educational community taking into consideration an environmental sustainability

French version validation of the psychotic symptom rating scales (PSYRATS) for outpatients with persistent psychotic symptoms.

ABSTRACT: BACKGROUND: Most scales that assess the presence and severity of psychotic symptoms often measure a broad range of experiences and behaviours, something that restricts the detailed measurement of specific symptoms such as delusions or hallucinations. The Psychotic Symptom Rating Scales (PSYRATS) is a clinical assessment tool that focuses on the detailed measurement of these core symptoms. The goal of this study was to examine the psychometric properties of the French version of the PSYRATS. METHODS: A sample of 103 outpatients suffering from schizophrenia or schizoaffective disorders and presenting persistent psychotic symptoms over the previous three months was assessed using the PSYRATS. Seventy-five sample participants were also assessed with the Positive And Negative Syndrome Scale (PANSS). RESULTS: ICCs were superior to .90 for all items of the PSYRATS. Factor analysis replicated the factorial structure of the original version of the delusions scale. Similar to previous replications, the factor structure of the hallucinations scale was partially replicated. Convergent validity indicated that some specific PSYRATS items do not correlate with the PANSS delusions or hallucinations. The distress items of the PSYRATS are negatively correlated with the grandiosity scale of the PANSS. CONCLUSIONS: The results of this study are limited by the relatively small sample size as well as the selection of participants with persistent symptoms. The French version of the PSYRATS partially replicates previously published results. Differences in factor structure of the hallucinations scale might be explained by greater variability of its elements. The future development of the scale should take into account the presence of grandiosity in order to better capture details of the psychotic experience.

Regional variations in ABC transporter expression along the mouse intestinal tract.

The ATP-binding cassette (ABC) family of proteins comprise a group of membrane transporters involved in the transport of a wide variety of compounds, such as xenobiotics, vitamins, lipids, amino acids, and carbohydrates. Determining their regional expression patterns along the intestinal tract will further characterize their transport functions in the gut. The mRNA expression levels of murine ABC transporters in the duodenum, jejunum, ileum, and colon were examined using the Affymetrix MuU74v2 GeneChip set. Eight ABC transporters (Abcb2, Abcb3, Abcb9, Abcc3, Abcc6, Abcd1, Abcg5, and Abcg8) displayed significant differential gene expression along the intestinal tract, as determined by two statistical models (a global error assessment model and a classic ANOVA, both with a P < 0.01). Concordance with semiquantitative real-time PCR was high. Analyzing the promoters of the differentially expressed ABC transporters did not identify common transcriptional motifs between family members or with other genes; however, the expression profile for Abcb9 was highly correlated with fibulin-1, and both genes share a common complex promoter model involving the NFkappaB, zinc binding protein factor (ZBPF), GC-box factors SP1/GC (SP1F), and early growth response factor (EGRF) transcription binding motifs. The cellular location of another of the differentially expressed ABC transporters, Abcc3, was examined by immunohistochemistry. Staining revealed that the protein is consistently expressed in the basolateral compartment of enterocytes along the anterior-posterior axis of the intestine. Furthermore, the intensity of the staining pattern is concordant with the expression profile. This agrees with previous findings in which the mRNA, protein, and transport function of Abcc3 were increased in the rat distal intestine. These data reveal regional differences in gene expression profiles along the intestinal tract and demonstrate that a complete understanding of intestinal ABC transporter function can only be achieved by examining the physiologically distinct regions of the gut.

FRAX(®) Clinical Task Force of the 2010 Joint International Society for Clinical Densitometry & International Osteoporosis Foundation Position Development Conference.

The World Health Organization fracture risk assessment tool, FRAX(®), is an advance in clinical care that can assist in clinical decision-making. However, with increasing clinical utilization, numerous questions have arisen regarding how to best estimate fracture risk in an individual patient. Recognizing the need to assist clinicians in optimal use of FRAX(®), the International Osteoporosis Foundation (IOF) in conjunction with the International Society for Clinical Densitometry (ISCD) assembled an international panel of experts that ultimately developed joint Official Positions of the ISCD and IOF advising clinicians regarding FRAX(®) usage. As part of the process, the charge of the FRAX(®) Clinical Task Force was to review and synthesize data surrounding a number of recognized clinical risk factors including rheumatoid arthritis, smoking, alcohol, prior fracture, falls, bone turnover markers and glucocorticoid use. This synthesis was presented to the expert panel and constitutes the data on which the subsequent Official Positions are predicated. A summary of the Clinical Task Force composition and charge is presented here.

Simulação da produção de sedimentos para a microbacia hidrográfica do Ribeirão dos Marins (SP)

O modelo SWAT (Soil and Water Assessment Tool) foi aplicado para simular a carga de sedimentos produzida pela microbacia hidrográfica do Ribeirão dos Marins, em Piracicaba (SP), no biênio 1999/2000. A aplicação do modelo requer a entrada dos dados na forma espacializada que foi feita com o auxílio de uma interface entre o modelo e um Sistema de Informações Geográficas (SIG's). A microbacia foi discretizada em sub-bacias para determinar os parâmetros de entrada no modelo. Os resultados obtidos na simulação da produção de sedimentos foram comparados aos dados observados em um posto hidrossedimentométrico, localizado no terço superior da microbacia, utilizando o Coeficiente de Eficiência de Nash e Sutcliffe (COE) e o desvio dos dados simulados em relação aos observados (Dv). Para as condições específicas da microbacia do Ribeirão dos Marins, os resultados obtidos na simulação da produção de sedimentos pelo modelo, após a calibração, foram de 0,83, para o COE, e de -3,2 %, para o Dv, indicando um bom ajuste dos dados simulados comparados aos dados observados.