Informação em mortalidade: o uso das regras internacionais para a seleção da causa básica

A análise da mortalidade tem sido muito usada em saúde pública, e a causa básica da morte é uma variável bastante estudada. Na maioria dos países, há obrigatoriedade de o médico preencher a declaração de óbito (DO), informando às autoridades a ocorrência do evento, características do falecido e causas da morte. Quando há dois ou mais diagnósticos na declaração das causas da morte, surge a questão da seleção da causa básica. As normas para o preenchimento das causas de morte pelos médicos nas DO e as regras para a seleção da causa básica, quando mais de uma causa é declarada, estão definidas pela OMS, visando à comparabilidade internacional. O objetivo deste trabalho é avaliar se a aplicação das Regras Internacionais de Classificação da causa básica permite a seleção da real causa básica, mesmo se declarada incorretamente pelo médico. O material pertence ao "Estudo sobre a mortalidade de mulheres em idade fértil", sendo que 1.315 casos satisfizeram os requisitos de inclusão. Para cada morte foi realizada uma investigação através de entrevistas domiciliárias, consultas aos prontuários hospitalares e assemelhados. Médicos treinados e calibrados preenchiam uma DO nova, após a leitura de toda a informação, e selecionavam a "verdadeira" causa básica da morte. Esta era comparada com a causa básica da DO original, obtida por meio das Regras Internacionais. Entre as DO, em 1.192 (90,6%) houve concordância com a verdadeira causa básica obtida após a investigação. Concluiu-se que as Regras Internacionais permitem selecionar a real causa básica, mesmo quando o médico preenche inadequadamente a DO

Clarice Lispector - the hour of the star: the speech in the exhibition pamphlet

This work attempts to discuss, in the light of the French Analysis of the Discourse, how the concept of memory and heterogeneity in language actions can contribute to a reflection on information and documentation studies. Starting from cuttings of Clarice Lispector - the hour of the star exhibition pamphlet, accomplished in the second semester of 2007 by the Portuguese Language Museum (Luz train station, Sao Paulo), we interpreted the several voices that surround and sustain the subject and the sense.

Tc-99m-labeled dextran for mammary lymphoscintigraphy in dogs

Lymphoscintigraphy is the technique of choice for sentinel lymph node detection in women with early breast cancer, but there is limited information evaluating the value of this technique in animals. We investigated mammary lymphatic drainage in 25 young female mongrel dogs by intramammary injection of 18.5 MBq of Tc-99m-dextran (70,000 Da). Lymph node anatomical referencing was obtained using an external marker, bone scintigraphy, or scintiscanning the body contour. Cranial and caudal thoracic mammary glands drained into the cranial sternal lymph node and axillary lymph center. The cranial thoracic mammary gland also drained into the superficial cervical lymph node in two of five animals. The cranial abdominal gland was drained by the axillary lymph center. The caudal abdominal mammary gland was drained by the superficial inguinal lymph node in all animals and simultaneously by medial iliac lymph nodes in four of five animals. In one dog, this mammary gland was also drained by the mediastinal and the superficial cervical lymph nodes. The inguinal mammary gland was drained by superficial inguinal lymph nodes and simultaneously via the medial iliac lymph node in one animal. Lymphatic communications between lymph nodes were identified in 11 of 25 (44%) animals. Tc-99m-dextran mammary lymphoscintigraphy was easy and rapid to perform and may provide valuable information for further studies.

Dispersal patterns in a regional koala population in south-east Queensland

Koala dispersal was investigated as part of a detailed ecological study of a nationally significant koala population located 20 km south-east of Brisbane, Queensland. From 1996 to 2000, 195 koalas from three sites were captured and fitted with radio-collars. A total of 40 koalas ( 23 males and 17 females) dispersed from these sites. Most (93%) dispersing individuals were 20 - 36 months of age. Three adult females ( more than 36 months old) dispersed and no adult males dispersed during the study. A significantly higher proportion of young males dispersed than females. Dispersal occurred between June and December, with most dispersal of males commencing in July and August and that of females commencing between September and November prior to, and early in, the annual breeding season. The mean straight-line distance between the natal and breeding home ranges for males and females was similar and was measured at 3.5 km ( range 1.1 - 9.7 km) and 3.4 km ( range 0.3 - 10.6 km) respectively. Dispersing males and females tended to successfully disperse south and west of their natal home ranges and were generally unable to successfully disperse to urban areas within the study area, as a high proportion of the mortality of dispersing koalas was associated with attacks by domestic dogs and with collisions with vehicles on roads. Information from other studies indicates that most young koalas disperse from their natal areas. It is likely that the social behaviour and mating systems of koala populations provide mechanisms for young koalas to disperse. The potential role of dispersal in the dynamics of regional koala populations is discussed.

INTEGRATED MANAGEMENT SYSTEMS: CRITICAL SUCCESS FACTORS

The purpose of this paper is to, in a holistic way, identify and explore the critical success factors (CSFs) that are considered in the context of the growing discussions, movements, proposed models, and case studies about the integration of management systems (MSs). This work is an investigation focused on the integration of MSs into an integrated management system (IMS) and the proposed approach takes into account the literature review as well as the experience gained by the authors on researches about Portuguese enterprises. This qualitative and empirical research, investigated the integration of MSs from existing scientific publications for the period 1999 to 2014, on-going case studies and one inquiry conducted by the authors. This research contributes to a better understanding of the CSFs regarding the integration of MSs and thus provides an insight on the preventive management. This research shows an evident lack of information regarding case studies on CSFs for integrated management systems (IMSs) and has identified a set of relevant CSFs, for MSs integration and associated guidelines that organizations should take as a priority, in order to be able to manage, on a preventive way, the implementation of IMSs, and consequently to become more competitive with added value for the stakeholders.

Learning in higher education: the ISEGI case

Comunicação apresentada na IRMA Information Resources Management Association International Conference, San Diego, CA, 15 19 May

Knowledge magement: a rewarding challenge for SME's?

Paper presented at Information Resources Management Association International Conference, in Philadelphia (PA), 18-21 May 2003

Diagnosis of Tinea pedis and onychomycosis in patients from Portuguese National Institute of Health: a four-year study

ABSTRACT - Tinea pedis and onychomycosis are two rather diverse clinical manifestations of superficial fungal infections, and their etiologic agents may be dermatophytes, non-dermatophyte moulds or yeasts. This study was designed to statistically describe the data obtained as results of analysis conducted during a four year period on the frequency of Tinea pedis and onychomycosis and their etiologic agents. A questionnaire was distributed from 2006 to 2010 and answered by 186 patients, who were subjected to skin and/or nail sampling. Frequencies of the isolated fungal species were cross-linked with the data obtained with the questionnaire, seeking associations and predisposing factors. One hundred and sixty three fungal isolates were obtained, 24.2% of which composed by more than one fungal species. Most studies report the two pathologies as caused primarily by dermatophytes, followed by yeasts and lastly by non-dermatophytic moulds. Our study does not challenge this trend. We found a frequency of 15.6% of infections caused by dermatophytes (with a total of 42 isolates) of which T. rubrum was the most frequent species (41.4%). There was no significant association (p >0.05) among visible injury and the independent variables tested, namely age, gender, owning pet, education, swimming pools attendance, sports activity and clinical information. Unlike other studies, the variables considered did not show the expected influence on dermatomycosis of the lower limbs. It is hence necessary to conduct further studies to specifically identify which variables do in fact influence such infections.

Hospitalizations for ambulatory care-sensitive conditions, Minas Gerais, Southeastern Brazil, 2000 and 2010

OBJECTIVE To analyze hospitalization rates and the proportion of deaths due to ambulatory care-sensitive hospitalizations and to characterize them according to coverage by the Family Health Strategy, a primary health care guidance program. METHODS An ecological study comprising 853 municipalities in the state of Minas Gerais, under the purview of 28 regional health care units, was conducted. We used data from the Hospital Information System of the Brazilian Unified Health System. Ambulatory care-sensitive hospitalizations in 2000 and 2010 were compared. Population data were obtained from the demographic censuses. RESULTS The number of ambulatory care-sensitive hospitalizations declined from 20.75/1,000 inhabitants [standard deviation (SD) = 10.42) in 2000 to 14.92/thousand inhabitants (SD = 10.04) in 2010 Heart failure was the most frequent cause in both years. Hospitalizations rates for hypertension, asthma, and diabetes mellitus, decreased, whereas those for angina pectoris, prenatal and birth disorders, kidney and urinary tract infections, and other acute infections increased. Hospitalization durations and the proportion of deaths due to ambulatory care-sensitive hospitalizations increased significantly. CONCLUSIONS Mean hospitalization rates for sensitive conditions were significantly lower in 2010 than in 2000, but no correlation was found with regard to the expansion of the population coverage of the Family Health Strategy. Hospitalization rates and proportion of deaths were different between the various health care regions in the years evaluated, indicating a need to prioritize the primary health care with high efficiency and quality.

Spatial analysis of avoidable hospitalizations due to tuberculosis in Ribeirao Preto, SP, Brazil (2006-2012)

ABSTRACT OBJECTIVE To describe the spatial distribution of avoidable hospitalizations due to tuberculosis in the municipality of Ribeirao Preto, SP, Brazil, and to identify spatial and space-time clusters for the risk of occurrence of these events. METHODS This is a descriptive, ecological study that considered the hospitalizations records of the Hospital Information System of residents of Ribeirao Preto, SP, Southeastern Brazil, from 2006 to 2012. Only the cases with recorded addresses were considered for the spatial analyses, and they were also geocoded. We resorted to Kernel density estimation to identify the densest areas, local empirical Bayes rate as the method for smoothing the incidence rates of hospital admissions, and scan statistic for identifying clusters of risk. Softwares ArcGis 10.2, TerraView 4.2.2, and SaTScanTM were used in the analysis. RESULTS We identified 169 hospitalizations due to tuberculosis. Most were of men (n = 134; 79.2%), averagely aged 48 years (SD = 16.2). The predominant clinical form was the pulmonary one, which was confirmed through a microscopic examination of expectorated sputum (n = 66; 39.0%). We geocoded 159 cases (94.0%). We observed a non-random spatial distribution of avoidable hospitalizations due to tuberculosis concentrated in the northern and western regions of the municipality. Through the scan statistic, three spatial clusters for risk of hospitalizations due to tuberculosis were identified, one of them in the northern region of the municipality (relative risk [RR] = 3.4; 95%CI 2.7–4,4); the second in the central region, where there is a prison unit (RR = 28.6; 95%CI 22.4–36.6); and the last one in the southern region, and area of protection for hospitalizations (RR = 0.2; 95%CI 0.2–0.3). We did not identify any space-time clusters. CONCLUSIONS The investigation showed priority areas for the control and surveillance of tuberculosis, as well as the profile of the affected population, which shows important aspects to be considered in terms of management and organization of health care services targeting effectiveness in primary health care.

Indizar, clasificar y organizar las colecciones de las bibliotecas escolares: herramientas en lengua española y portuguesa

La biblioteca escolar es un servicio de información básico para todos los miembros de una comunidad educativa, que forma parte de los espacios docentes de los centros y de los procesos pedagógicos que tienen lugar en ellos. Las bibliotecas escolares funcionan como centros de recursos para las actividades de enseñanza-aprendizaje, están constituidas por un conjunto sistematizado y dinámico de servicios y fondos documentales que permiten a los usuarios desarrollar hábitos lectores y buscar y valorar las fuentes de información, entre otras relevantes funciones. Los recursos de información que albergan son uno de sus principales activos, pero si colección documental no está organizada, las tareas de búsqueda y localización de la información resultarán complicadas y la calidad de los recursos obtenidos, cuestionable. Los bibliotecarios deben conocer en profundidad las características específicas del fondo documental y las fuentes disponibles; las técnicas y herramientas adecuadas para procesar y tratar el fondo bibliográfico, así como los métodos de recuperación de la información más convenientes. En este contexto, el objetivo de este trabajo es analizar de forma pormenorizada los procesos de indización y clasificación que se realizan en las bibliotecas escolares para procesar y recuperar la información que albergan su colecciones, así como describir las características más relevantes de las herramientas específicas que se usan en las bibliotecas escolares españolas, brasileñas y portuguesas, adaptadas a las características de los usuarios que utilizan sus servicios y acuden a ellas para resolver necesidades de información. Para lograr este propósito, se analiza el concepto de biblioteca escolar de forma crítica, se estudian sus funciones y se examinan las técnicas y los instrumentos que permiten organizar la información. Entre otras herramientas, se estudian listas de encabezamientos de materia como los Encabezamientos de materia para libros infantiles y juveniles y la Lista de Encabezamientos de materia para las bibliotecas públicas; sistemas de clasificación, como la Clasificación Decimal Universal (edición de bolsillo) o la clasificación por centros de interés y tesauros especializados como el Tesauro de la Educación UNESCO-OIE y el Tesauro Europeo de la Educación, entre otros.

Optimization of Generation and Aggregated Consumption Shifting for Demand Response Programs Definition

The concept of demand response has drawing attention to the active participation in the economic operation of power systems, namely in the context of recent electricity markets and smart grid models and implementations. In these competitive contexts, aggregators are necessary in order to make possible the participation of small size consumers and generation units. The methodology proposed in the present paper aims to address the demand shifting between periods, considering multi-period demand response events. The focus is given to the impact in the subsequent periods. A Virtual Power Player operates the network, aggregating the available resources, and minimizing the operation costs. The illustrative case study included is based on a scenario of 218 consumers including generation sources.

O acesso ao tratamento em saúde Mental na microregião de Itajubá/MG-Brasil

RESUMO: A integração da saúde mental à atenção básica é a recomendação feita para facilitar o acesso ao tratamento. A pesquisa teve por objetivo mapear e analisar os facilitadores e as barreiras ao acesso ao tratamento em saúde mental da Microrregião de Itajubá, estado de Minas Gerais, Brasil, composta por 15 municípios. A metodologia pautou-se na triangulação dos métodos, combinando a abordagem quantitativa e qualitativa de pesquisa. Para tal foi feito o mapeamento da capacidade instalada dos recursos existentes e identificação das principais lacunas com base nos parâmetros da saúde pública, a partir de roteiros de entrevistas e grupos focais com os principais atores sociais implicados. Constatou-se que o maior facilitador ao acesso ao tratamento tem sido a atuação das equipes de PSF (Programa Saúde da Família), que atuam diretamente nas comunidades. Outros facilitadores foram: a atuação dos CRAS (Centro de Referência de Assistência Social); a existência de um CAPS (Centro de Atenção Psicossocial), embora não credenciado ao SUS (Sistema Único de Saúde); Colegiados de Saúde Mental que promovem discussões, informação, educação, e pressionam os municípios para a implantação de serviços de saúde mental. A falta de “vontade política”, isto é, uma intervenção mais clara da gestão pública da saúde, com estabelecimento de prioridades para prover a ampliação do acesso, foi identificada como a maior barreira a ser enfrentada na microrregião, especialmente por falta de organização e planejamento das ações em saúde mental. Serviços que trabalham de forma isolada, sem a construção de uma rede; pouca participação política dos usuários dos serviços de saúde mental; e falta de recursos humanos, e profissionais pouco preparados para a função compõem as outras barreiras de acesso. Vê-se que diante dos facilitadores e barreiras expostos é preciso que os municípios realizem um levantamento sistemático, a fim de criar um plano de ação em saúde mental para compartilhar informações, recursos, serviços, disponibilidade, disposição e ações em rede.-------------- ABSTRACT: Integrating mental health care in primary-care services is recommended in order to improve access to treatment. Access to mental health treatment has been a worldwide debated theme. In Brazil, with the Psychiatric Reform, there has been a change of paradigm in the way of treating persons with mental disorders. Various health devices were created, building a net of treatment and care that replaces the asylum system and where human rights are respected and defended and the offered treatment is the closest possible to their social space. The research aims to map and analyse the barriers and the facilitators to mental health treatment in the micro-region of Itajubá, state of Minas Gerais/Brazil, made up of 15 counties. The methodology was based on the triangulation of methods, combining quantitative and qualitative research. For that, a mapping of the installed capacity of the existent resource was carried out; identification of the main voids based on the parameters of public health through scripts of interviews and focus groups with the social actors involved. It was found that the main facilitator to treatment has been the performance of PSF, who act directly in the communities. Other facilitators also stand out: the work of CRAS; the existence of CAPS, although not accredited to SUS; Mental Health Collegiate, promoting discussions, information, education, and forcing pressure on the counties for the implantation of mental health services. The lack of political will was identified as the major barrier to be faced in the micro-region, especially due to lack of organization and planning in the actions towards mental health. The services working isolatedly, without a communication net, and the lack of human resources as well as poorly prepared professional, are the main difficulties faced by access to mental health treatment. Becomes clear that the counties need to undertake a systematic survey towards creating a plan of action in mental health, in order to share information, resources, services, availability, disposition and networking.

O cancioneiro musical português no ensino das ciências musicais

Relatório de estágio de mestrado em Ensino de Música

A mobilidade da informação na Polícia de Segurança Pública. uma estratégia para a gestão operacional

Dissertação de Mestrado em Estratégia