Desenvolvimento de um programa computacional destinado à unidade móvel de ensaio na barra de tração (umeb) para a avaliação do desempenho de tratores

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Complicações intra-operatórias das anestesias do neuroeixo realizadas de maio de 1990 a maio de 2008 na FMB-UNESP: análise retrospectiva

Pós-graduação em Anestesiologia - FMB

Elaboração de um dicionário terminológico onomasiológico dos neônimos da biotecnologia: tratamento dos dados em português e busca de equivalentes em inglês

Pós-graduação em Estudos Linguísticos - IBILCE

A systematic review of economic evaluations for interventions of cardiovascular diseases

Background. Cardiovascular disease (CVD) exhibits the most striking public health significance due to its high prevalence and mortality as well as huge economic burdens all over the world, especially in industrialized countries. Major risk factors of CVDs have been the targets of population-wide prevention in the United States. Economic evaluations provide structured information in regard to the efficiency of resource utilization which can inform decisions of resource allocation. The main purpose of this review is to investigate the pattern of study design of economic evaluations for interventions of CVDs. ^ Methods. Primary journal articles published during 2003-2008 were systematically retrieved via relevant keywords from Medline, NHS Economic Evaluation Database (NHS EED) and EBSCO Academic Search Complete. Only full economic evaluations for narrowly defined CVD interventions were included for this review. The methodological data of interest were extracted from the eligible articles and reorganized in Microsoft Access database. Chi-square tests in SPSS were used to analyze the associations between pairs of categorical data. ^ Results. One hundred and twenty eligible articles were reviewed after two steps of literature selection with explicit inclusion and exclusion criteria. Descriptive statistics were reported regarding the evaluated interventions, outcome measures, unit costing and cost reports. The chi-square test of the association between prevention level of intervention and category of time horizon showed no statistical significance. The chi-square test showed that sponsor type was significantly associated with whether new or standard intervention being concluded as more cost effective. ^ Conclusions. Tertiary prevention and medication interventions are the major interests for economic evaluators. The majority of the evaluations were claimed from either a provider’s or a payer’s perspective. Almost all evaluations adopted gross costing strategy for unit cost data rather than micro costing. EQ-5D is the most commonly used instrument for subjective outcome measurement. More than half of the evaluations used decision analytic modeling techniques. The lack of consistency in study design standards in published evaluations appears in several aspects. Prevention level of intervention is not likely to be a factor for evaluators to decide whether to design an evaluation in a lifetime horizon or not. Published evaluations sponsored by industry are more likely to conclude that new intervention is more cost effective than standard intervention.^

Syndromic surveillance at a long term shelter for persons displaced by hurricanes Katrina and Rita conducted by the San Antonio Metropolitan Health District

Background. Beginning September 2, 2005, San Antonio area shelters received approximately 12,700 evacuees from Hurricane Katrina. Two weeks later, another 12,000 evacuees from Hurricane Rita arrived. By mid-October, 2005, the in-shelter population was 1,000 people. There was concern regarding the potential for spread of infectious diseases in the shelter. San Antonio Metropolitan Health District (SAMHD) established a syndromic surveillance system with Comprehensive Health Services (CHS) who provided on-site health care. CHS was in daily contact with SAMHD to report symptoms of concern until the shelter closed December 23, 2005. ^ Study type. The objective of this study was to assess the methods used and describe the practical considerations involved in establishing and managing a syndromic surveillance system, as established by the SAMHD in the long-term shelter clinic maintained by CHS for the hurricane evacuees. ^ Methods. Information and descriptive data used in this study was collected from multiple sources, primarily from the San Antonio Metropolitan Health District’s 2006 Report on Syndromic Surveillance of a Long-Term Shelter by Hausler & Rohr-Allegrini. SAMHD and CHS staff ensured that each clinic visit was recorded by date, demographic information, chief complaint and medical disposition. Logs were obtained daily and subsequently entered into a Microsoft Access database and analyzed in Excel. ^ Results. During a nine week period, 4,913 clinic visits were recorded, reviewed and later analyzed. Repeat visits comprised 93.0% of encounters. Chronic illnesses contributed to 21.7% of the visits. Approximately 54.0% were acute care encounters. Of all encounters, 17.3% had infectious disease potential as primarily gastrointestinal and respiratory syndromes. Evacuees accounted for 86% and staff 14% of all visits to the shelter clinic. There were 782 unduplicated individuals who sought services at the clinic, comprised of 63% (496) evacuees and 36% (278) staff members. Staff were more likely to frequent the clinic but for fewer visits each. ^ Conclusion. The presence of health care services and syndromic surveillance provided the opportunity to recognize, document and intervene in any disease outbreak at this long-term shelter. Constant vigilance allowed SAMHD to inform and reassure concerned people living and working in the shelter and living outside the shelter.^

Creating local bibliographic databases: new tools for evidence-based health care*

The Internet has created new opportunities for librarians to present literature search results to clinicians. In order to take full advantage of these opportunities, libraries need to create locally maintained bibliographic databases. A simple method of creating a local bibliographic database and publishing it on the Web is described. The method uses off-the-shelf software and requires minimal programming. A hedge search strategy for outcome studies of clinical process interventions is created, and Ovid is used to search MEDLINE. The search results are saved and imported into EndNote libraries. The citations are modified, exported to a Microsoft Access database, and published on the Web. Clinicians can use a Web browser to search the database. The bibliographic database contains 13,803 MEDLINE citations of outcome studies. Most searches take between four and ten seconds and retrieve between ten and 100 citations. The entire cost of the software is under $900. Locally maintained bibliographic databases can be created easily and inexpensively. They significantly extend the evidence-based health care services that libraries can offer to clinicians.

Control en la gestión de las Unidades de Radiofarmacia Hospitalarias: revisión de las variables a considerar en el uso de Cuadros de Mando Integrales

Objetivos: Listar las variables imprescindibles en los cuadros de mando integrales para abarcar todas las áreas básicas de trabajo en una Unidad de Radiofarmacia hospitalaria, cuya adecuada gestión puede ser clave para optimizar los recursos disponibles. En segundo lugar, enumerar los beneficios que redundan en la práctica de trabajo diario tras su integración. Métodos: Revisión de la bibliografía publicada sobre cuadros de mando integrales, seleccionando las variables para que el radiofarmacéutico asuma un papel activo en la mejora de su área de trabajo. Se utilizan programas construídos en Microsoft Access para la gestión integral. Se administran en varios módulos toda la información desde la prescripción y citación de los pacientes (asignándoles un código) hasta que se les realiza la exploración. Se recogen también variables como: fecha y hora límites de tramitación de radiofármaco al proveedor; fecha prueba médica; gestión de eluciones de generadores y kits fríos; turnos de trabajo del personal; registro de incidencias tipificadas y de datos de recepción, marcaje, control de calidad y dispensación de cada radiofármaco (asegurando la trazabilidad); detección de desviaciones entre actividad calibrada y medida; la actividad dispensada y la disponible a tiempo real; gestión de eliminación de residuos radiactivos, de existencias y caducidades; fechas de próximas revisiones de equipos; archivado de PNT; sistemas conversores de unidades y registro de informes clínicos. Resultados: Los programas especializados gestionan la información que se maneja en la Unidad de Radiofarmacia, facilitando tomar decisiones coste-efectivas. Los parámetros analizados son: número de preparaciones elaboradas y actividad manejada; posibles incidencias en cualquiera de los procesos cotidianos; porcentaje de resolución satisfactoria sin que derive en falta de disponibilidad; correcta trazabilidad de los radiofármacos; porcentaje de controles de calidad satisfactorios; evolución en el consumo por tipo de radiofármaco, etc. La mejora en la gestión de pedidos asegura la presencia del radiofármaco necesario para cada exploración. Conclusiones: Estos nuevos cuadros de mando integrales son útiles para optimizar pedidos y radiofármacos, asegurar trazabilidad, gestionar inventario, informes clínicos, residuos radiactivos y para evaluar la eficiencia de la Unidad de radiofarmacia, permitiendo la integración de estos datos con otros softwares de gestión sanitaria. Esta metodología puede aplicarse en Centros Sanitarios de Atención Primaria para enfocar al personal en sus funciones asistenciales y operativas.

A microbiology study of the surgical site infection, at a hospital in northern Portugal

Surgical site infections (SSIs) remain a major clinical problem in terms of morbidity, mortality, time spent in hospital and overall direct and indirect costs. Objectives: To measure the prevalence of the SSI, by type of surgery and microbiologically characterization, in adult patients undergoing surgery during 2015 at a public hospital in northern Portugal. Methods: A prospective study, attended by 609 adult patients, undergoing surgery. The sociodemographic and clinical data of the population, as well as the surgical procedure and microbiological study were analyzed using Microsoft Access 2013. Results: In the sample of 609 adults undergoing surgery, it was found that 62.89% of surgical wound were cleaned, 15.8% were clean-contaminated, 8.70% were contaminated and 9.36% infected. About 62.52% of the intervened patients had antibiotic prophylaxis prior to surgery. Out of all surgeries, 33.3% were laparoscopic. The percentage of SSI was 5.74%; In these positive cases, only 3.61% was identiied the responsible bacteria. The urgent surgeries have more infections when compared to the programmed ones. In colon surgery the number of infections was 60% after cholecystectomy (22.86%). In hernioplasty, infection occurred in only 2.86% of the patients. The most isolated bacteria was Escherichia coli with 59%, in which 30% are -producing-lactamases of extended spectrum, followed by Pseudomonas aeruginosa (13.6%) and Serratia marcescens (13.6%). The mortality rate was 14.8%. Pseudomonas aeruginosa was isolated in 3 of 4 patients who died. Conclusions: The most microorganisms belong to the group of Gram-negative and are usually linked to infections associated with health care.

Base de dados relacional de controlos de segurança da informação

No desenvolvimento deste Trabalho de Investigação Aplicada, pretende-se responder à questão: Quais os requisitos necessários a implementar numa base de dados relacional de controlos de segurança da informação para Unidades, Estabelecimentos ou Órgãos militares do Exército Português? Deste modo, para se responder a esta questão central, houve necessidade de subdividir esta em quatro questões derivadas, sendo elas: 1. Quais as principais dimensões de segurança da informação ao nível organizacional? 2. Quais as principais categorias de segurança da informação ao nível organizacional? 3. Quais os principais controlos de segurança da informação a implementar numa organização militar? 4. Quais os requisitos funcionais necessários a implementar numa base de dados de controlos de segurança da informação a implementar numa organização militar? Para responder a estas questões de investigação, este trabalho assenta numa investigação aplicada, com o objetivo de desenvolver uma aplicação prática para os conhecimentos adquiridos, materializando-se assim numa base de dados. Ainda, quanto ao objetivo da investigação, este é descritivo, explicativo e exploratório, uma vez que, tem o objetivo de descrever as principais dimensões, categorias e controlos da segurança da informação, assim como o objetivo de explicar quais são os requisitos funcionais necessários a implementar numa base de dados de controlos de segurança da informação. Por último, tem ainda o objetivo de efetuar um estudo exploratório, comprovando a eficácia da base de dados. Esta investigação assenta no método indutivo, partindo de premissas particulares para chegar a conclusões gerais, isto é, a partir de análise de documentos e de inquéritos por entrevista, identificar-se-ão quais são os requisitos funcionais necessários a implementar, generalizando para todas as Unidades, Estabelecimentos ou Órgãos militares do Exército Português. No que corresponde ao método de procedimentos, usar-se-á o método comparativo, com vista a identificar qual é a norma internacional de gestão de segurança de informação mais indicada a registar na base de dados. Por último, como referido anteriormente, no que concerne às técnicas de investigação, será usado o inquérito por entrevista, identificando os requisitos necessários a implementar, e a análise de documentos, identificando as principais dimensões, categoriasou controlos necessários a implementar numa base de dados de controlos de segurança da informação. Posto isto, numa primeira fase da investigação, através da análise de documentos, percecionam-se as principais dimensões, categorias e controlos de segurança da informação necessários a aplicar nas Unidades, Estabelecimentos ou Órgãos militares do Exército Português, por forma a contribuir para o sucesso na gestão da segurança da informação militar. Ainda, através de entrevistas a especialistas da área de segurança da informação e dos Sistemas de Informação nas unidades militares, identificar-se-ão quais os requisitos funcionais necessários a implementar numa base de dados de controlos de segurança da informação a implementar numa organização militar. Por último, numa segunda fase, através do modelo de desenvolvimento de software em cascata revisto, pretende-se desenvolver uma base de dados relacional, em Microsoft Access, de controlos de segurança da Informação a fim de implementar em Unidades, Estabelecimentos ou Órgãos militares do Exército Português. Posteriormente, após o desenvolvimento da base de dados, pretende-se efetuar um estudo exploratório com vista a validar a mesma, de modo a comprovar se esta responde às necessidades para a qual foi desenvolvida.

Platform Architectures for Policy-Based Network Access Control

Tämä diplomityö käsittelee sääntöpohjaisen verkkoon pääsyn hallinnan (NAC) ratkaisuja arkkitehtonisesta näkökulmasta. Työssä käydään läpi Trusted Computing Groupin, Microsoft Corporationin, Juniper Networksin sekä Cisco Systemsin NAC-ratkaisuja. NAC koostuu joukosta uusia sekä jo olemassa olevia teknologioita, jotka auttavat ennalta määriteltyyn sääntökantaan perustuen hallitsemaan suojattuun verkkoon pyrkivien laitteiden tietoliikenneyhteyksiä. Käyttäjän tunnistamisen lisäksi NAC pystyy rajoittamaan verkkoon pääsyä laitekohtaisten ominaisuuksien perusteella, esimerkiksi virustunnisteisiin ja käyttöjärjestelmäpäivityksiin liittyen ja paikkaamaan tietyin rajoituksin näissä esiintyviä puutteita verkkoon pääsyn sallimiseksi. NAC on verraten uusi käsite, jolta puuttuu tarkka määritelmä. Tästä johtuen nykymarkkinoilla myydään ominaisuuksiltaan puutteellisia tuotteita NAC-nimikkeellä. Standardointi eri valmistajien NAC-komponenttien yhteentoimivuuden takaamiseksi on meneillään, minkä perusteella ratkaisut voidaan jakaa joko avoimia standardeja tai valmistajakohtaisia standardeja noudattaviksi. Esitellyt NAC-ratkaisut noudattavat standardeja joko rajoitetusti tai eivät lainkaan. Mikään läpikäydyistä ratkaisuista ei ole täydellinen NAC, mutta Juniper Networksin ratkaisu nousee niistä potentiaalisimmaksi jatkokehityksen ja -tutkimuksen kohteeksi TietoEnator Processing & Networks Oy:lle. Eräs keskeinen ongelma NAC-konseptissa on työaseman tietoverkolle toimittama mahdollisesti valheellinen tietoturvatarkistuksen tulos, minkä perusteella pääsyä osittain hallitaan. Muun muassa tähän ongelmaan ratkaisuna voisi olla jo nykytietokoneista löytyvä TPM-siru, mikä takaa tiedon oikeellisuuden ja koskemattomuuden.

[access To Basic Health Services And Associated Factors: A Population-based Study].

This study sought to identify factors involved in access to the services of a basic health unit. It is a cross-sectional, population-based study involving 101 randomly-selected families residing in the area covered by the health unit. An adult resident of each household was interviewed. The response variable was whether or not the resident frequented the health unit if he/she or anyone in the family required assistance to resolve a health issue. The independent variables investigated were service provision aspects, demographic and socio-economic characteristics, individual habits, morbidities and use of the health unit. In addition to descriptive and univariate analysis, logistic regression was applied in the multivariate analysis. The results show that access to the basic health unit is associated with the treatment received previously (OR = 3,224) with accessibility (OR = 0,146) and micro-area of residence (OR = 10,918). These findings suggest that access is related to the impressions created by the care received at the health unit and is based on experiences with the service, but can also be strongly modulated by individual aspects and factors related to the territory.

Equity Of Access To Pap Smears: Population-based Study In Campinas, São Paulo, Brazil.

To determine the prevalence of the Papanicolaou exam among women aged 20 to 59 years in the city of Campinas (state of São Paulo, Brazil) and to analyze associations between this test and affiliation to private health insurance plans as well as socioeconomic/demographic variables and health-related behavior. To do so, a population-based, cross-sectional study was carried out. Statistical analyses took the study design into account. Despite the significant socioeconomic differences between women with and without private health plans, no differences between these groups were found regarding having been submitted to the Papanicolaou test. In fact no differences were found as to socioeconomic and health variables analyzed. Among all variables analyzed, only marital status was significantly associated with having undergone the test. The Brazilian public health system accounted for 55.7% of the exams. The present findings indicate social equity in the city of Campinas regarding the preventive exam for cervical cancer in the age group studied.

[access To Information About How To Prevent Oral Problems Among School Children In The Public School Network].

The scope of this study is to identify the prevalence of access to information about how to prevent oral problems among schoolchildren in the public school network, as well as the factors associated with such access. This is a cross-sectional and analytical study conducted among 12-year-old schoolchildren in a Brazilian municipality with a large population. The examinations were performed by 24 trained dentists and calibrated with the aid of 24 recorders. Data collection occurred in 36 public schools selected from the 89 public schools of the city. Descriptive, univariate and multiple analyses were conducted. Of the 2510 schoolchildren included in the study, 2211 reported having received information about how to prevent oral problems. Access to such information was greater among those who used private dental services; and lower among those who used the service for treatment, who evaluated the service as regular or bad/awful. The latter use toothbrush only or toothbrush and tongue scrubbing as a means of oral hygiene and who reported not being satisfied with the appearance of their teeth. The conclusion drawn is that the majority of schoolchildren had access to information about how to prevent oral problems, though access was associated with the characteristics of health services, health behavior and outcomes.

Inequalities in access and utilization of dental services: a cross-sectional study in an area covered by the Family Health Strategy

This cross-sectional study aimed to investigate the presence of inequalities in the access and use of dental services for people living in the coverage area of the Family Health Strategy (FHS) in Ponta Grossa, Paraná State, Brazil, and to assess individual determinants related to them. The sample consisted of 747 individuals who answered a pre-tested questionnaire. Data analysis was performed by chi-square test and Poisson regression analysis, obtaining explanatory models for recent use and, by limiting the analysis to those who sought dental care, for effective access. Results showed that 41% of the sample had recent dental visits. The lowest visit rates were observed among preschoolers and elderly people. The subjects who most identified the FHS as a regular source of dental care were children. Besides age, better socioeconomic conditions and the presence of a regular source of dental care were positively associated to recent dental visits. We identified inequalities in use and access to dental care, reinforcing the need to promote incentives to improve access for underserved populations.

Insight into Anopheles (Nyssorhynchus) (Diptera: Culicidae) species from Brazil full access

Anopheles (Nyssorhynchus) benarrochi s.l., Anopheles (Nyssorhynchus) oswaldoi s.l., and Anopheles (Nyssorhynchus) konderi s.l. collected in Acrelândia, state of Acre, Brazil, were identified based on morphological characters of the male genitalia, fourth-instar larvae, and pupae. Morphological variation was observed in the male genitalia of these species in comparison with specimens from other localities in Brazil. DNA sequence from the nuclear ribosomal second internal transcribed spacer of individuals identified as An. benarrochi s.l. by using male genitalia characteristics showed that the various morphological forms are conspecific but are distinct from An. benarrochi B from Colombia. Anopheles konderi s.l. and An. oswaldoi s.l. both misidentified as An. oswaldoi s.s. (Peryassú) throughout Brazil, may actually comprise at least two undescribed species. Diagnostic morphological characteristics of the male genitalia are provided to distinguish Anopheles benarrochi s.l., Anopheles oswaldoi s.l., and Anopheles konderi s.l. from morphologically similar species. Incrimination of An. oswaldoi s.s. in malaria transmission in Brazil needs further investigation because other undescribed species from Acre may have been confounded with this taxon