Análise da atenção prestada aos pacientes portadores de hipertensão arterial no município de Piraí com bases nos registros dos prontuários ambulatoriais e hospitalares

O controle da Hipertensão Arterial é central para que seja alcançada maior eficiência na redução de eventos adversos secundários ao descontrole crônico da pressão arterial. Os resultados de uma atenção integral aos portadores não se esgotam no acesso e disponibilização de fármacos eficazes no controle da pressão arterial. Ela envolve a rede integrada de serviços, orientada pela atenção primária, com serviços especializados e hospitalares na atenção das intercorrências. O cuidado aos portadores destes agravos crônicos exige dos serviços e profissionais da atenção primária a implantação de estratégias de acolhimento, efetivação de vínculos e projetos terapêuticos e uma intervenção que abrange a promoção, prevenção, assistência e reabilitação. Com esta questão em mente é que este projeto buscou analisar a atenção prestada aos portadores de Hipertensão Arterial no município de Piraí com base nos registros dos prontuários ambulatoriais e hospitalares. Foram computados e analisados os prontuários de pacientes internados por agravos que, direta ou indiretamente, estão relacionados ao descontrole da pressão arterial. Identificaram-se um total de 61 pacientes internados com diagnóstico de internação de Crise Hipertensiva e Acidente Vascular Encefálico no ano de 2010, no Hospital Flávio Leal. A partir dos registros hospitalares foram selecionados 35 pacientes. Estes eram moradores do município de Piraí, adscritos a equipes básicas no município e tiveram seus diagnósticos de internação confirmados na alta hospitalar. A segunda etapa do estudo analisou, na Unidade de Saúde da Família, os prontuários familiares dos casos de internação. Foi observado que não havia uniformidade na forma de registro e de arquivamento dos prontuários entre as unidades básicas. Nos prontuários clínicos não havia campos destinados aos registros de aspectos psicossociais, mudança de comportamento ou adesão. As anotações eram centradas na doença e nos tratamentos farmacológicos. A participação de profissionais não médicos nos registros clínicos era escassa. A Ficha B do SIAB (Ficha de Acompanhamento do Paciente Hipertenso) que contém os dados sobre comportamento e risco cardiovascular foi encontrada apenas em 3 das 8 unidades visitadas. Segundo os dados dos prontuários analisados a distribuição de consultas e visitas domiciliares foi muito irregular. Com um total de 10 prontuários sem registros de consultas no ano em que o pacientes foi internado. A gravidade dos pacientes internados pode ser identificada pelo elevado número de óbitos entre os casos analisados. Muitos dos casos apresentavam sequelas neurológicas e comorbidades que provavelmente dificultava suas idas às unidades de saúde da família. Aspectos psicossociais, familiares e da comunidade estavam, em sua maioria, ausente dos prontuários familiares analisados dos pacientes internados. Também não foram encontrados anotações sobre projetos terapêuticos multidisciplinares que individualizassem e hierarquizassem os agravos e os riscos físicos e psicossociais dos pacientes. A análise evidencia que os registros nos prontuários não traduzem a abrangência de uma atenção integral aos portadores de Hipertensão Arterial no âmbito da Atenção Primária.

社区宽带综合业务网服务质量保证的研究

社区宽带综合业务网络系统使用交换式以太网技术，在一个物理网络上为社区用户提供Internet接入、数字电视、IP电话等服务，对三网融合进行了实践性探讨。提出并实现了一套保证系统服务质量的方法，并在测试中取得了满意的效果。

Load Profiling for Efficient Route Selection in Multi-Class Networks

High-speed networks, such as ATM networks, are expected to support diverse Quality of Service (QoS) constraints, including real-time QoS guarantees. Real-time QoS is required by many applications such as those that involve voice and video communication. To support such services, routing algorithms that allow applications to reserve the needed bandwidth over a Virtual Circuit (VC) have been proposed. Commonly, these bandwidth-reservation algorithms assign VCs to routes using the least-loaded concept, and thus result in balancing the load over the set of all candidate routes. In this paper, we show that for such reservation-based protocols|which allow for the exclusive use of a preset fraction of a resource's bandwidth for an extended period of time-load balancing is not desirable as it results in resource fragmentation, which adversely affects the likelihood of accepting new reservations. In particular, we show that load-balancing VC routing algorithms are not appropriate when the main objective of the routing protocol is to increase the probability of finding routes that satisfy incoming VC requests, as opposed to equalizing the bandwidth utilization along the various routes. We present an on-line VC routing scheme that is based on the concept of "load profiling", which allows a distribution of "available" bandwidth across a set of candidate routes to match the characteristics of incoming VC QoS requests. We show the effectiveness of our load-profiling approach when compared to traditional load-balancing and load-packing VC routing schemes.

Evaluation of a Load Profiling Approach to Routing Guaranteed Bandwidth Flows

To support the diverse Quality of Service (QoS) requirements of real-time (e.g. audio/video) applications in integrated services networks, several routing algorithms that allow for the reservation of the needed bandwidth over a Virtual Circuit (VC) established on one of several candidate routes have been proposed. Traditionally, such routing is done using the least-loaded concept, and thus results in balancing the load across the set of candidate routes. In a recent study, we have established the inadequacy of this load balancing practice and proposed the use of load profiling as an alternative. Load profiling techniques allow the distribution of "available" bandwidth across a set of candidate routes to match the characteristics of incoming VC QoS requests. In this paper we thoroughly characterize the performance of VC routing using load profiling and contrast it to routing using load balancing and load packing. We do so both analytically and via extensive simulations of multi-class traffic routing in Virtual Path (VP) based networks. Our findings confirm that for routing guaranteed bandwidth flows in VP networks, load balancing is not desirable as it results in VP bandwidth fragmentation, which adversely affects the likelihood of accepting new VC requests. This fragmentation is more pronounced when the granularity of VC requests is large. Typically, this occurs when a common VC is established to carry the aggregate traffic flow of many high-bandwidth real-time sources. For VP-based networks, our simulation results show that our load-profiling VC routing scheme performs better or as well as the traditional load-balancing VC routing in terms of revenue under both skewed and uniform workloads. Furthermore, load-profiling routing improves routing fairness by proactively increasing the chances of admitting high-bandwidth connections.

Correlates of HIV testing among abused women in South Africa.

Gender-based violence increases a woman's risk for HIV but little is known about her decision to get tested. We interviewed 97 women seeking abuse-related services from a nongovernmental organization (NGO) in Johannesburg, South Africa. Forty-six women (47%) had been tested for HIV. Caring for children (odds ratio [OR] = 0.27, 95% confidence interval [CI] = [0.07, 1.00]) and conversing with partner about HIV (OR = 0.13, 95% CI = [0.02, 0.85]) decreased odds of testing. Stronger risk-reduction intentions (OR = 1.27, 95% CI = [1.01, 1.60]) and seeking help from police (OR = 5.51, 95% CI = [1.18, 25.76]) increased odds of testing. Providing safe access to integrated services and testing may increase testing in this population. Infection with HIV is highly prevalent in South Africa where an estimated 16.2% of adults between the ages of 15 and 49 have the virus. The necessary first step to stemming the spread of HIV and receiving life-saving treatment is learning one's HIV serostatus through testing. Many factors may contribute to someone's risk of HIV infection and many barriers may prevent testing. One factor that does both is gender-based violence.

Child Protection Work and Family Support Practice in Five Family Centres

Academic interest in the work of family centres in the United Kingdom has largely been concerned with categorising the work of such centres in terms of issues of childcare ideology, working practices and degree of service user control. Meanwhile, the re-focusing of child protection services in order to develop child welfare services has largely dominated childcare social work in recent years, with scant attention paid to the role of family centres in relation to this debate. This study is concerned with examining the perspectives of staff and service users in five 'client focussed' family centres in Northern Ireland in relation to how child protection issues are understood and dealt with. It was found that staff enter into negotiations with both referrers and service users to conceptually reframe child protection work as family support practice. This leads to the development of partnership relationships between staff and service users based upon mutual high regard. The work of such centres leaves them well placed to provide integrated services to children in need in line with current government priorities, but could leave some children vulnerable where child protection issues are not amenable to conceptual reframing along family support lines.

Working across boundaries to improve health outcomes: a case study of a housing support and outreach service for homeless people living with HIV

This paper reports the findings of an evaluation of the ‘Housing Support, Outreach and Referral’ service developed to support people living with HIV who were homeless or at risk of homelessness. The service was set up as part of the Supporting People Health Pilot programme established to demonstrate the policy links between housing support services and health and social care services by encouraging the development of integrated services. The paper considers the role of housing support in improving people's health, and considers the challenges of working across housing, health and social care boundaries. The evaluation of the health pilot employed two main sources of data collection: quarterly project evaluation reports, which collected process data as well as reporting progress against aims and objectives, and semi-structured interviews with professionals from all key stakeholder groups and agencies, and with people who used services. Over the course of 15 months, 56 referrals were received of which 27 were accepted. Fifteen people received tenancy support of whom 12 were helped to access temporary accommodation. At the end of the 15 months, all of the tenancies had been maintained. In addition, 18 people registered with a general practitioner and 13 registered with an HIV clinic. Interviews with professionals emphasised the importance of the local joint working context, the involvement of the voluntary sector and the role of the support workers as factors that accounted for these outcomes. Those using services placed most emphasis on the flexibility of the support worker role. Importantly, interviews with professionals and those using services suggest that the role of support worker incorporates two dimensions – those of networker/navigator as well as advocate – and that both dimensions are important in determining the effectiveness of the service.

The challenges of joint working: lessons from the Supporting People Health Pilot evaluation

Purpose: This paper reports the findings of the evaluation of the Supporting People Health Pilots programme, which was established to demonstrate the policy links between housing support services and health and social care services by encouraging the development of integrated services. The paper highlights the challenges Method: The evaluation of the six health pilots rested on two main sources of data collection: Quarterly Project Evaluation Reports collected process data as well as reporting progress against aims and objectives. Semi-structured interviews—conducted across all key professional stakeholder groups and agencies and with people who used services—explored their experiences of these new services. Results: The ability of pilots to work across organisational boundaries to achieve their aims and objectives was associated not only with agencies sharing an understanding of the purpose of the joint venture, a history of joint working and clear and efficient governance arrangements but on two other characteristics: the extent and nature of statutory sector participation and, whether or not the service is defined by a history of voluntary sector involvement. In particular the pilots demonstrated how voluntary sector agencies appeared to be less constrained by organisational priorities and professional agenda and more able to respond flexibly to meet the complex needs of individuals. Conclusion and discussion: The pilots demonstrate that integrating services to support people with complex needs works best

Einige Probleme bei der Einführung digitaler Nebenstellenanlagen

Innerhalb digitaler Nebenstellenanlagen können kurzfristig die verbesserten Kommunikationsmöglichkeiten eines „Integrated Services Digital Network" unabhängig von der Existenz eines nur langfristig realisierbaren, durchgehend digitalen öffentlichen Netzes angeboten werden. Beim Anschluß an die bestehenden öffentlichen Netze ergeben sich jedoch einige Probleme: Z. B. müssen die Bedingungen des bestehenden Dämpfungsplans eingehalten werden, auch im ungünstigsten Fall sind ausreichend hohe Signal-Quantisierungsgeräusch-Abstände sicherzustellen, für die Text- und Datenkommunikation mit den derzeit bestehenden öffentlichen Netzen sind u. U. zusätzliche Einrichtungen in der Nebenstellenanlage erforderlich. Diese Einführungsprobleme werden diskutiert und Lösungsmöglichkeiten hierzu vorgeschlagen.

Explorador integrado de serviços de armazenamento na cloud: cloud cockpit

Projeto para obtenção do grau de Mestre em Engenharia Informática e de Computadores

Prevalencia de los síntomas otorrinolaringológicos y factores asociados en los trabajadores de una central de llamadas en la ciudad de Bogotá Colombia

La industria de las centrales de llamadas es uno de los sectores de más rápido crecimiento en el mundo desarrollado, gracias a los avances tecnológicos han permitido su uso cada vez más generalizado desarrollando servicios integrales que son accesibles las 24 horas del día. Los operadores telefónicos o tele-operadores de esta industria se ven enfrentados a jornadas laborales en las que se exponen al uso constante de la voz, utilización permanente de auriculares de comunicación, confinamiento en estaciones de trabajo delimitadas pero no aisladas; aumentando así la prevalencia de síntomas como los otorrinolaringológicos. Este estudio tiene como objeto identificar la prevalencia de síntomas otorrinolaringológicos dados por alteraciones de la voz, compromiso auditivo y síntomas de la vía respiratoria superior durante la jornada laboral de los trabajadores de una central de llamadas de una prestigiosa empresa aseguradora de la ciudad de Bogotá Colombia, así como también identificar la asociación de factores demográficos organizacionales y biológicos con los síntomas otorrinolaringológicos y analizar el medio ambiente laboral de dicha empresa y la relación de los síntomas otorrinolaringológicos con mediciones de ruido, temperatura y humedad. La población estudiada fue de 81 tele operadores de los cuales 61 (75.3%) fueron mujeres, se evidencio que las enfermedades respiratorias altas tienen una prevalencia del 36%, también se reporto una prevalencia del 85% (69) tele operadores reportaron por lo menos un síntoma de voz y solo 12 tele operadores 15% no reportaron ningún síntoma. En cuanto a la hipoacusia solo 5 (6.2%) reportaron disminución de la agudeza auditiva

Current developments in the transport sector and future prospects

Over the past three years, talks conducted at the subregional level have led to the signing of multimodal transport agreements, and these have been implemented by Mercosur and reviewed by the Andean Community; multimodal transport is only now starting to come into its own in South America but is already a common practice in the region covered by NAFTA. These trends continued in 1997, with consolidation being the dominant theme; on the one hand, consolidation occurred in business, with integrated services increasingly on offer, while on the other the authorities became aware of the need to promote linkages between different modes of transport. Highlights of 1998 may well include major plans for investments in intermodal infrastructure and greater interaction between users and service providers in both the public and private sectors, in order to develop regional intermodal transport systems.

Diseño e implementación de una solución de VoIP en un entorno empresarial

El desarrollo de las redes IP ha marcado un creciente interés por unificar todas las comunicaciones sobre una misma infraestructura aprovechando así el cableado existente. Con esta idea nació la tecnología conocida como VoIP (Voice Over Internet Protocol) que consiste en la trasmisión de la voz sobre paquetes IP. El objetivo principal de este proyecto es el diseño e implementación de una infraestructura de voz sobre IP que utilice una red de datos existente. La primera parte del proyecto estará formada por un estudio detallado de los factores que influyen en esta tecnología: codecs, protocolos y otros factores a tener en cuenta. Tras esta parte, aprovechando la experiencia adquirida durante casi tres años en una empresa integradora de servicios, se realizará un caso de estudio en el que, bajo las premisas impuestas por un supuesto cliente, se diseñará una solución que cumpla todos los requisitos y aporte un valor añadido sobre el sistema de telefonía que posee el cliente. El diseño de la mejor solución se hará utilizando productos del fabricante Cisco Systems y, además del coste económico, se valorarán los esfuerzos personales que costará montar dicha solución, incluyendo un valor añadido como es el dotar de buzón de voz y mensajería a todos los usuarios. La última parte del caso de estudio consistirá en la implementación de la infraestructura anteriormente diseñada adquiriendo conocimientos sobre virtualización de servidores utilizando productos de la compañía VMWare (especialista en virtualización), instalación y parametrización de aplicativos de Cisco y, finalmente, la interconexión con la red pública a través de gateways para poder hacer llamadas al exterior. El proyecto finalizará con la presentación de unas conclusiones finales y la exposición de unas líneas futuras de trabajo. ABSTRACT. The IP network development has marked a growing interest in unifying all communications over the same infrastructure taking advantage of the existing wiring. From this idea, a technology was born known as VoIP (Voice Over Internet Protocol) which consists of the transmission of voice packets over the IP network. The main goal of this project is the design and implementation of a VoIP infrastructure for transmitting voice packets over the existing wired network infrastructure on the client. The first part of the project will consist of a detailed study of the factors influencing this technology: codecs, protocols, and other factors to consider. After this part, drawing on the experience gained during nearly three years in an integrated services company, a case study will be made under the premises imposed for a supposed client. A solution that serves all the requirements will be designed and provide an added value on the customer’s telephone system. The design of the best solution will be done using Cisco Systems products and besides the economic cost of the whole solution, the personal effort cost will be valued. The added value named before will be provided with two important applications such as voice mail and instant messaging for all users. The last part of the case study will consist in the implementation of an infrastructure designed to acquire knowledge about virtualization, using VMWare company products (specialist in virtualization), installation and configuration of applications from Cisco Systems and finally the interconnection with the public network through gateway routers in order to make external calls. The project will end with the presentation of final conclusions and exposing future working lines.

Methods and procedures to reduce motorist delays in European work zones /

"HPIP/10-00(10M)EW"--P. [4] of cover.

Access the Army : digital information on demand and on line.

Mode of access: Internet.