Transformações de um ambulatório de medicina integral com vistas a um programa de atenção médica primária: a experiência do Hospital de Clínicas da Universidade do Estado do Rio de Janeiro, Brasil

Após breve discussão de aspectos da assistência médica ambulatorial, são apresentadas as propostas de reorganização dos serviços ambulatoriais do Hospital de Clínicas da Universidade do Estado do Rio de Janeiro com vistas ao estabelecimento de um programa de medicina integral. Também são apresentados os dados de uma pesquisa sobre padrões de utilização do ambulatório. Alguns aspectos docentes do programa são discutidos.

Centros de Educação e Alimentação do Pré-Escolar: solução alternativa de atendimento integral ao pré-escolar

São resumidas as bases filosóficas e operacionais do programa de Educação e Alimentação do Pré-Escolar (CEAPE), que inclui: a educação e a participação ativa da mãe do pré-escolar; a promoção do treinamento de multiplicadores locais da ação programada; a avaliação da eficiência e da eficácia do programa por meio de indicadores pré-testados. São evidenciadas as vantagens do programa, a saber: é econômico porque usa a infra-estrutura local, utiliza a cooperação das mães dos pré-escolares e a supervisão do pessoal ligado ao ensino; é eficiente porque oferece e amplia o atendimento aos pré-escolares; é eficaz porque propicia realmente melhor desenvolvimento integral da criança; é preventivo porque melhora as condições físicas e de aprendizado do pré-escolar; é comunitário porque por meio da "mãe" envolve a comunidade onde a criança vive.

Pensar uma saúde integral a partir de uma prática teatral em comunidades: o teatro como território da experiência

Esta investigação debruça-se sobre dois universos: o do Teatro e Comunidade e o da Saúde a fim de refletir sobre uma interação entre essas duas áreas de conhecimento. O trabalho dedica-se à reflexão do conceito de comunidade a partir da análise de três “S” propostos pelo filósofo Agostinho da Silva: Sustento, Saber e Saúde. Para tanto, o estudo faz um contraponto entre o Saber e a Ciência sob a ótica do conhecimento cartesiano e o Saber adquirido a partir da experiência, das narrativas. Defende o Saber libertador enquanto possibilidade de autonomia dos sujeitos. O indivíduo, então protagonista de sua própria vida, passa a ter um melhor conhecimento sobre saúde, na visão integral da mesma, promovendo-a, consequentemente. Para fundamentar tal argumento, esse trabalho analisa os conceitos da promoção da saúde e da saúde integral, abordando aspectos históricos da medicina preventiva, sanitarista e analisando práticas da educação em saúde. Como possibilidade para se chegar a esse Saber e à Saúde Integral, o estudo propõe a linguagem teatral como uma alternativa. O binômio saúde e arte, portanto, encontra na conceituação de Teatro e Comunidade o campo de conhecimento que mais fundamenta essa interação. O estudo se propõe a contextualizar o surgimento e as práticas desse teatro e a analisar quatro grupos que têm esse binômio como premissa comum. Por fim, o trabalho levanta as características fundamentais de uma prática teatral nessa linha, a fim de promover o teatro como uma alternativa para se pensar a arte como saúde.

Synthesis and Coordination Chemistry of a New N-4-Polydentate Class of Pyridyl-Functionalized Scorpionate Ligands: Complexes of Fe-II, Zn-II, V-IV, Pd-II and Use for Heterobimetallic Systems

The new potentially N-4-multidentate pyridyl-functionalized scorpionates 4-((tris-2,2,2-(pyrazol-1-ypethoxy)methyl)pyridine (TpmPy, (1)) and 4-((tris-2,2,2-(3-phenylpyrazol-1-yl)ethoxy)methyl)pyridine (TpmPy(Ph), (2)) have been synthesized and their coordination behavior toward Fe-II, Ni-II, Zn-II, Cu-II, Pd-II, and V-III centers has been studied. Reaction of (1) with Fe(BF4)(2)center dot 6H(2)O yields [Fe(TpmPy)(2)](BF4)(2) (3), that, in the solid state, shows the sandwich structure with trihapto ligand coordination via the pyrazolyl arms, and is completely low spin (LS) until 400 K. Reactions of 2 equiv of (1) or (2) with Zn-II or Ni-II chlorides give the corresponding metal complexes with general formula [MCl2(TpmPy*)(2)] (M = Zn, Ni; TpmPy* = TpmPy, TpmPy(Ph)) (4-7) where the ligand is able to coordinate through either the pyrazolyl rings (in case of [Ni(TpmPy)(2)Cl-2 (5)) or the pyridyl-side (for [ZnCl2(TpmPy)(2)] (4), [ZnCl2(TpmPy(Ph))(2)] (6) and [NiCl2(TpmPy(Ph))(2)] (7)). The reaction of (1) with VCl3 gives [VOCl2(TpmPy)] (8) that shows the N-3-pyrazolyl coordination-mode. Moreover, (1) and react with cis-[PdCl2(CH3CN)(2)] to give the disubstituted complexes [PdCl2(TprnPy)(2)] (9) and [PdCl2(TpmPy(Ph))(2)] (10), respectively, bearing the scorpionate coordinated via the pyridyl group. Compounds (9) and (10) react with Fe(BF4)(2) to give the heterobimetallic Pd/Fe systems [PdCl2(mu-TpmPy)(2)-Fe](BF4)(2) (11) and [PdCl2(mu-TpmPy(Ph))(2)Fe-2(H2O)(6)]BF4)(4) (13), respectively. Compound (11) can also be formed from reaction of (3) with cis-[PdCl2(CH3CN)(2)], while reaction of (3) with Cu(NO3)(2).2.5H(2)O generates [Fe(mu-TpmPy)(2)-Cu(NO3)(2)](BF4)(2) (12), confirming the multidentate ability of the new chelating ligands. The X-ray diffraction analyses of compounds (1), (3), (4), (5), and (9) are also reported.

Renormalization-group constraints on Yukawa alignment in multi-Higgs-doublet models

We write down the renormalization-group equations for the Yukawa-coupling matrices in a general multi-Higgs-doublet model. We then assume that the matrices of the Yukawa couplings of the various Higgs doublets to right-handed fermions of fixed quantum numbers are all proportional to each other. We demonstrate that, in the case of the two-Higgs-doublet model, this proportionality is preserved by the renormalization-group running only in the cases of the standard type-I, II, X, and Y models. We furthermore show that a similar result holds even when there are more than two Higgs doublets: the Yukawa-coupling matrices to fermions of a given electric charge remain proportional under the renormalization-group running if and only if there is a basis for the Higgs doublets in which all the fermions of a given electric charge couple to only one Higgs doublet.

A Pitch Control Malfunction Analysis for Wind Turbines with Permanent Magnet Synchronous Generator and Full-power Converters: Proportional Integral Versus Fractional-order Controllers

A transient analysis for two full-power converter wind turbines equipped with a permanent magnet synchronous generator is studied in this article, taking into consideration, as a new contribution to earlier studies, a pitch control malfunction. The two full-power converters considered are, respectively, a two-level and a multi-level converter. Moreover, a novel control strategy based on fractional-order controllers for wind turbines is studied. Simulation results are presented; conclusions are in favor of the novel control strategy, improving the quality of the energy injected into the electric grid.

Assessment of fungal contamination in a group of Lisbon's gymnasiums with a swimming pool

The study’s main purpose was the assessment of the environmental fungal contamination, the exploration of possible associations between related environmental variables and the study of the relationship between fungal contamination of air and surfaces. A descriptive study was developed based upon air and surfaces monitoring for fungal contamination in ten indoor gymnasiums with a swimming pool located in Lisbon’s urban area. Fifty 200 litres air samples and 120 surface swabs were collected. Surfaces samples were collected before and after cleaning and disinfection and temperature and relative humidity values were registered during the collection period. Twenty five different species of fungi were identified in the air samples, being the three most commonly isolated genera the following: Cladosporium (36.6%), Penicillium (19.0%) and Aspergillus (10.2%). Thirty-seven different species of fungi were identified in the surface samples. Fusarium sp. was the most frequent genera before (19.1%) and after (17.2%) cleaning and disinfection. There was a significant association between the numbers of visitors and the fungal contamination determined in the surface samples (p<0.05). There was no significant association (p>0.05) between the contamination encountered in the air samples and the one registered in the surface samples and between the fungal contamination and the temperature or relative humidity measured on location. The data obtained enabled the assessment of the establishment’s fungal contamination and led the authors to conclude, consequently, that physical activity, which generally promotes health, can in fact be challenged by this factor.

Cognitive deficit and depressive symptoms in a community group of elderly people: a preliminary study

Since the number and proportion of old people increases worldwide, health professionals and systems should be made aware and prepared to deal with their problems. Cognitive deficit and symptoms of depression are commom among the elderly, and may occur in relation to various risk factors such as health conditions and psychosocial variables. In order to study cognitive deficit and the presence of signs and symptoms of depression, 62 elderly community subjects enrolled at a Community Health Unit in Porto Alegre, southern Brazil, were interviewed. They were evaluated by means of the Mini Mental State Exam, the Montgomery-Asberg Depression rating scale, and a questionnaire on health conditions, living arrangements and social variables. Higher levels of symptoms of depression were observed among subjects exposed to major risk factors for cerebrovascular diseases (diabetes and coronary disease), while impaired cognitive performance was seen among individuals who could not count on the presence of a confidant (social network variable). The results suggest that the early identification of major risk groups among old people can help to prevent institutionalization and keep individuals in the community.

From efficiency to optimality in proportional reinsurance under group correlation

Based on our recent discovery of closed form formulae of efficient Mean Variance retentions in variable quota-share proportional reinsurance under group correlation, we analyzed the influence of different combination of correlation and safety loading levels on the efficient frontier, both in a single period stylized problem and in a multiperiod one.

Children visual screening protocol: validation by a focus group panel of experts

Screening programs, particularly the inclusion of specific orthoptic tests to detect visual abnormalities, varies among countries. This study aims to: 1) describes expert perception of issues related with children visual screening; 2) identify specific orthoptic tests to detect visual abnormalities in children visual screening.

Comparative analysis of the ground reaction forces, during the support phase, in a group of pregnant women on their 3rd trimester of pregnancy and in a group of not pregnant women

PURPOSE: To analyze and compare the Ground Reaction Forces (GRF), during the stance phase of walking in pregnant women in the 3rd trimester of pregnancy, and non pregnant women. METHODS: 20 women, 10 pregnant and 10 non pregnant, voluntarily took part in this study. GRF were measured (1000 Hz) using a force platform (BERTEC 4060-15), an amplifier (BERTEC AM 6300) and an analogical-digital converter of 16 Bits (Biopac). RESULTS: The study showed that there were significant differences among the two groups concerning absolute values of time of the stance phase. In what concerns to the normalized values the most significant differences were verified in the maximums values of vertical force (Fz3, Fz1) and in the impulse of the antero-posterior force (Fy2), taxes of growth of the vertical force, and in the period of time for the antero-posterior force (Fy) be null. CONCLUSIONS: It is easier for the pregnant to continue forward movement (push-off phase). O smaller growth rates in what concerns to the maximum of the vertical force (Fz1) for the pregnant, can be associated with a slower speed of gait, as an adaptation strategy to maintain the balance, to compensate the alterations in the position of her center of gravity due to the load increase. The data related to the antero-posterior component of the force (Fy), shows that there is a significant difference between the pregnant woman’s left foot and right foot, which accuses a different functional behavior in each one of the feet, during the propulsion phase (TS).

Synthesis and structural characterization of iron complexes with 2,2,2-tris(1-pyrazolyl)ethanol ligands: Application in the peroxidative oxidation of cyclohexane under mild conditions

The reactions of FeCl2 center dot 2H(2)O and 2,2,2-tris(1-pyrazolyl) ethanol HOCH2C(pz)(3) (1) (pz = pyrazolyl) afford [Fe{HOCH2C(pz)(3)}(2)][FeCl4]Cl (2), [Fe{HOCH2C(pz)(3)}(2)](2)[Fe2OCl6](Cl)(2)center dot 4H(2)O (3 center dot 4H(2)O), [Fe{HOCH2C(pz)(3)}(2)] [FeCl{HOCH2C(pz)(3)}(H2O)(2)](2)(Cl)(4) (4) or [Fe{HOCH2C(pz)(3)}(2)]Cl-2 (5), depending on the experimental conditions. Compounds 1-5 were isolated as air-stable crystalline solids and fully characterized, including (1-4) by single-crystal X-ray diffraction analyses. The latter technique revealed strong intermolecular H-bonds involving the OH group of the scorpionate 2 and 3 giving rise to 1D chains which, in 3, are further expanded to a 2D network with intercalated infinite and almost plane chains of H-interacting water molecules. In 4, intermolecular pi center dot center dot center dot pi interactions involving the pyrazolyl rings are relevant. Complexes 2-5 display a high solubility in water (S-25 degrees C ca. 10-12 mg mL(-1)), a favourable feature towards their application as catalysts (or catalyst precursors) for the peroxidative oxidation of cyclo-hexane to cyclohexanol and cyclohexanone, with aqueous H2O2/MeCN, at room temperature (TON values up to ca. 385). (C) 2011 Elsevier B. V. All rights reserved.

Synthesis, Antimicrobial and Antiproliferative Activity of Novel Silver(I) Tris(pyrazolyl)methanesulfonateand 1,3,5-Triaza-7-phosphadamantane Complexes

Five new silver(I) complexes of formulas [Ag(Tpms)] (1), [Ag(Tpms)-(PPh3)] (2), [Ag(Tpms)(PCy3)] (3), [Ag(PTA)][BF4] (4), and [Ag(Tpms)(PTA)] (5) {Tpms = tris(pyrazol-1-yl)methanesulfonate, PPh3 = triphenylphosphane, PCy3 = tricyclohexylphosphane, PTA = 1,3,5-triaza-7-phosphaadamantane) have been synthesized and fully characterized by elemental analyses, H-1, C-13, and P-31 NMR, electrospray ionization mass spectrometry (ESI-MS), and IR spectroscopic techniques. The single crystal X-ray diffraction study of 3 shows the Tpms ligand acting in the N-3-facially coordinating mode, while in 2 and 5 a N2O-coordination is found, with the SO3 group bonded to silver and a pendant free pyrazolyl ring. Features of the tilting in the coordinated pyrazolyl rings in these cases suggest that this inequivalence is related with the cone angles of the phosphanes. A detailed study of antimycobacterial and antiproliferative properties of all compounds has been carried out. They were screened for their in vitro antimicrobial activities against the standard strains Enterococcus faecalis (ATCC 29922), Staphylococcus aureus (ATCC 25923), Streptococcus pneumoniae (ATCC 49619), Streptococcus pyogenes (SF37), Streptococcus sanguinis (SK36), Streptococcus mutans (UA1S9), Escherichia coli (ATCC 25922), and the fungus Candida albicans (ATCC 24443). Complexes 1-5 have been found to display effective antimicrobial activity against the series of bacteria and fungi, and some of them are potential candidates for antiseptic or disinfectant drugs. Interaction of Ag complexes with deoxyribonucleic acid (DNA) has been studied by fluorescence spectroscopic techniques, using ethidium bromide (EB) as a fluorescence probe of DNA. The decrease in the fluorescence of DNA EB system on addition of Ag complexes shows that the fluorescence quenching of DNA EB complex occurs and compound 3 is particularly active. Complexes 1-5 exhibit pronounced antiproliferative activity against human malignant melanoma (A375) with an activity often higher than that of AgNO3, which has been used as a control, following the same order of activity inhibition on DNA, i.e., 3 > 2 > 1 > 5 > AgNO3 >> 4.

VirtualECare: group decision supported by idea generation and argumentation

In the last years there has been a considerable increase in the number of people in need of intensive care, especially among the elderly, a phenomenon that is related to population ageing (Brown 2003). However, this is not exclusive of the elderly, as diseases as obesity, diabetes, and blood pressure have been increasing among young adults (Ford and Capewell 2007). As a new fact, it has to be dealt with by the healthcare sector, and particularly by the public one. Thus, the importance of finding new and cost effective ways for healthcare delivery are of particular importance, especially when the patients are not to be detached from their environments (WHO 2004). Following this line of thinking, a VirtualECare Multiagent System is presented in section 2, being our efforts centered on its Group Decision modules (Costa, Neves et al. 2007) (Camarinha-Matos and Afsarmanesh 2001).On the other hand, there has been a growing interest in combining the technological advances in the information society - computing, telecommunications and knowledge – in order to create new methodologies for problem solving, namely those that convey on Group Decision Support Systems (GDSS), based on agent perception. Indeed, the new economy, along with increased competition in today’s complex business environments, takes the companies to seek complementarities, in order to increase competitiveness and reduce risks. Under these scenarios, planning takes a major role in a company life cycle. However, effective planning depends on the generation and analysis of ideas (innovative or not) and, as a result, the idea generation and management processes are crucial. Our objective is to apply the GDSS referred to above to a new area. We believe that the use of GDSS in the healthcare arena will allow professionals to achieve better results in the analysis of one’s Electronically Clinical Profile (ECP). This attainment is vital, regarding the incoming to the market of new drugs and medical practices, which compete in the use of limited resources.

A study on the authentication method for TAmI in ambient intelligence (secure group decision making toolkit)

It is difficult to get the decision about an opinion after many users get the meeting in same place. It used to spend too much time in order to find solve some problem because of the various opinions of each other. TAmI (Group Decision Making Toolkit) is the System to Group Decision in Ambient Intelligence [1]. This program was composed with IGATA [2], WebMeeting and the related Database system. But, because it is sent without any encryption in IP / Password, it can be opened to attacker. They can use the IP / Password to the bad purpose. As the result, although they make the wrong result, the joined member can’t know them. Therefore, in this paper, we studied the applying method of user’s authentication into TAmI.