As ações de controle da tuberculose na atenção primária à saúde: a visão do doente

Tuberculosis is a disease of great impact on the world context today. In Brazil, the disease management was directed to the Primary Health Care, due to the determination of the Ministry of Health to decentralize health actions for primary care. Thus, since the actions of diagnosis, treatment and control of the disease should happen in this context, however, there are still many barriers that may hinder the realization of these determinations. This study aims to analyze the development of tuberculosis control activities conducted in the services of primary health care from the patient's vision. This is a descriptive, cross-sectional and quantitative study. The population consists of 517 tuberculosis patients treated in units of Primary Health Care in the city of Natal-RN; the sample consists of 93 TB patients. The collect instrument is structured, based in The Primary Care Assessment Tool (PCAT), validated in Brazil and adapted to assess attention to TB in Brazil, with modifications. This instrument was divided into blocks: the first one describes the socio-demographic information of patients with TB and the second one describes the health services working in control, diagnosis and treatment of TB, and includes issues related to the dimensions of primary care: access, bond, services, coordination of care, guidance to the community and family focus. For quantitative analysis, were built indicators for each item of the instrument. The response patterns are followed according to the Likert scale, which was assigned a value between one and five meant that the degree of preference relation (or agreement) of the statements. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. The results indicate that 62.37% of patients are male, 27.96% aged 41 to 50 years old, and 34.41% unemployed, with low education and low family income. It was found that the reference hospital services are the front door to the patient (59.14%), and are also the local diagnosis of the disease (72.04%). On access, the conditions satisfactory found are: the number of times the patients need to pick up the health care issue, the marking and the facility to get a consultancy in the HS, assistance provided without harm to the individual's attendance labor and facilities related to the proximity between the residence and services; were considered unsatisfactory conditions related to travel to the HS, and on hours and days of operation of services. As for the cast of services were satisfactory and regular actions related to the request for examination to become viable in the first HS, the availability of pot to perform smear and medicines for the treatment, as well as consultations control and receiving information about the disease and the treatment performed; it is considered unsatisfactory the performance of the home care for patients with TB by the HS that acts as a front door, for implementation of the Directly Observed Treatment (DOT), home visits during treatment, the provision of transportation allowance to the patient and the existence of groups for TB patients. Regarding the coordination of care, resulted in regular the action of referring the patient to other HS to obtain examinations, and as unsatisfactory referral to obtain medications. The relationship bond between patient and health team were considered satisfactory in the majority or regular. As for the family and community focus, is satisfactory only the indicator relating to questions from professionals to the patient about the existence of respiratory symptoms in the family. It is considered that there is need for greater commitment from government entities to the incentives required to TB control, as well as the availability of necessary inputs and training of human resources working in the PHC in the ongoing quest to strengthen primary care, as a place of broader host needs to contact the user with the actions and health professionals. It is recommended the adoption of management mechanisms possible to expand the capacity of the health PHC, promoting the service delivery to the user and ensuring attention to population health.

Incommensurate spin-density-wave and metal-insulator transition in the one-dimensional periodic Anderson model

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Energy education: breaking up the rational energy use barriers

Human development is associated directly or indirectly with the energy use, and because of this the energetic sources were dealt with in the recent past, as fully available to human necessities. The reality shows that the energy availability, considering the nonrenewable sources, is limited, and beyond that, the exploration, the processing and the use of energy impose considerable impacts on the environment. There is not a system which operates with no losses and without imposing changes to the environment. Therefore, the energy conservation incorporates the concepts and the actions applied to the research of sustainable balance between nature and the energy availability and use. Such actions can be presented both in the short term, in which the energy system is close to a collapse, or in the medium/long term, in which those responsible for the energy policies are concerned with the structure of the socioeconomic development. Such a situation requires more responsibility in the treatment of energy questions, mainly through education, which represents long-term investments. This paper discusses barriers that are present in the projects applied to energy conservation, by making clear that education is one of the best ways to transform the human behavior in for the rational use of energy. (C) 2003 Elsevier B.V. Ltd. All rights reserved.

A novel voltage step-down/up ZCS-PWM Zeta converter

This paper presents an analysis of a novel pulse-width-modulated (PWM) voltage step-down/up Zeta converter, featuring zero-current-switching (ZCS) at the active switches. The applications in de to de and ac to de (rectifier) operation modes are used as examples to illustrate the performance of this new ZCS-PWM Zeta converter. Regarding to the new ZCS-PWM Zeta rectifier proposed, it should be noticed that the average-current mode control is used in order to obtain a structure with high power-factor (HPF) and low total harmonic distortion (THD) at the input current.Two active switches (main and auxiliary transistors), two diodes, two small resonant inductors and one small resonant capacitor compose the novel ZCS-PWM soft-commutation cell, used in these new ZCS-PWM Zeta converters. In this cell, the turn-on of the active switches occurs in zero-current (ZC) and their turn-off in zero-current and zero-voltage (ZCZV). For the diodes, their turn-on process occurs in zero-voltage (ZV) and their reverse-recovery effects over the active switches are negligible. These characteristics make this cell suitable for Insulated-Gate Bipolar Transistors (IGBTs) applications.The main advantages of these new Zeta converters, generated from the new soft-commutation cell proposed, are possibility of obtaining isolation (through their accumulation inductors), and high efficiency, at wide load range. In addition, for the rectifier application, a high power factor and low THD in the input current ran be obtained, in agreement with LEC 1000-3-2 standards.The principle of operation, the theoretical analysis and a design example for the new de to de Zeta converter operating in voltage step-down mode are presented. Experimental results are obtained from a test unit with 500W output power, 110V(dc) output voltage, 220V(dc) input voltage, operating at 50kHz switching frequency. The efficiency measured at rated toad is equal to 97.3%for this new Zeta converter.Finally, the new Zeta rectifier is analyzed, and experimental results from a test unit rated at 500W output power, 110V(dc) output voltage, 220V(rms) input voltage, and operating at 50kHz switching frequency, are presented. The measured efficiency is equal to 96.95%, the power-factor is equal to 0.98, and the input current THD is equal to 19.07%, for this new rectifier operating at rated load.

Remission status follow-up in children with juvenile idiopathic arthritis

Objective: To characterize articular and systemic inflammatory activity in juvenile idiopathic arthritis (JIA), identifying remission status with and without medication.Methods: A total of 165 JIA cases, followed for a mean period of 3.6 years, were reviewed in order to characterize episodes of inactivity and clinical remission on and off medication. The resulting data were analyzed by means of descriptive statistics, survival analysis, by comparison of Kaplan-Meier curves, log rank testing and binary logistic regression;analysis in order to identify predictive factors for remission or persistent activity.Results: One hundred and eight of the cases reviewed fulfilled the inclusion criteria: 57 patients (52.7%) exhibited a total of 71 episodes of inactivity, with a mean of 2.9 years per episode; 36 inactivity episodes (50.7%) resulted in clinical remission off medication, 35% of which were of the persistent oligoarticular subtype. The probability of clinical remission on medication over 2 years was 81, 82, 97 and 83% for cases of persistent oligoarticular, extended oligoarticular, polyarticular and systemicJIA, respectively. The probability of clinical remission off medication 5 years after onset of remission was 40 and 67% for patients with persistent oligoarticular and systemic JIA, respectively. Persistent disease activity was significantly associated with the use of an anti-rheumatic drug combination. Age at JIA onset was the only factor that predicted clinical remission (p = 0.002).Conclusions: In this cohort, the probability of JIA progressing to clinical remission was greater for the persistent oligoarticular and systemic subtypes, when compared with polyarticular cases.

Follow-up of the Development of Femoral Degeneration Lesions in Broilers

A study was carried out in the experimental facilities of FMVZ/UNESP-Botucatu, with the aim of following-up the development and the incidence of femoral degeneration (FD). A total of 305 one-day-old male broilers were housed in six pens of 5m(2) each. Histological analyses of femur head collected when broilers were 0, 7, 14, 21, 28, 35, and 42 days of age were carried out. At 42 days of age, 30 birds were taken to the experimental processing plant of FMVZ for leg gross examination. Ten legs per FD score where selected, and histologically analyzed to determine the most probable age at the beginning of the lesions, and to standardize femoral degeneration lesion scores. The histological results showed that cell architecture started to disorganize at 21 days of age in the resting and proliferation zones, and that angiogenesis increased, invading the joint cartilage, The gross lesion indexes due to femoral degeneration were 22.5%, 42.5%, and 65% at 28, 35, and 42 days of age, respectively.

Shortening of primary dentin etching time and its implication on bond strength

Objective. The aim of this study was to investigate the influence of shortening the etching time on the bond strength of a conventional and a self-etching primer adhesive system used in primary tooth dentin.Methods. Flat dentin surfaces were obtained from 24 primary molars, randomly assigned to 4 experimental groups. The adhesive systems Single Bond and Clearfil SE Bond were applied in two groups according to the manufacturers' recommendations. In the other two groups, the adhesives were applied after half-time of acid etching, 7 s for Single Bond and 10 s for Clearfil SE Primer. Resin crowns were built up and after 24 h storage in water at 37 ° C, the teeth were sectioned to produce beams with cross-sectional area of approximately 0.49 mm(2). Specimens were tested in tension at 0.5 mm/min until failure. Fractured specimens were analyzed to determine the failure mode.Results. Tensile bond strengths for Single Bond in primary dentin were higher than for Clearfil SE Bond. Shortening of acid etching time improved bond strength only for Single Bond, while no statistically significant difference was observed for Clearfil SE Bond when both etching times were compared.Significance. No detrimental effect on bond strength was observed when the time of acid etching was shortened in 50%. Shortening the time for a procedure in a small child without compromising the quality of the work is a very important finding for the practicing pediatric dentist. © 2004 Elsevier Ltd. All rights reserved.

Bond Strength of Two-Step Etch-and-Rinse Adhesive Systems to the Dentin of Primary and Permanent Teeth

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Chlorhexidine increases the longevity of in vivo resin-dentin bonds

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Effect of chlorhexidine on bond strength of two-step etch-and-rinse adhesive systems to dentin of primary and permanent teeth

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Scaling-Up of Dental Pulp Stem Cells Isolated from Multiple Niches

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

EFFECT of METAL PRIMERS on BOND STRENGTH of RESIN CEMENTS TO BASE METALS

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Peel bond strength of resilient liner modified by the addition of antimicrobial agents to denture base acrylic resin

In order to prolong the clinical longevity of resilient denture relining materials and reduce plaque accumulation, incorporation of antimicrobial agents into these materials has been proposed. However, this addition may affect their properties. Objective: This study evaluated the effect of the addition of antimicrobial agents into one soft liner (Soft Confort, Dencril) on its peel bond strength to one denture base (QC 20, Dentsply). Material and Methods: Acrylic specimens (n=9) were made (75x10x3 mm) and stored in distilled water at 37 degrees C for 48 h. The drug powder concentrations (nystatin 500,000U - G2; nystatin 1,000,000U - G3; miconazole 125 mg - G4; miconazole 250 mg - G5; ketoconazole 100 mg - G6; ketoconazole 200 mg - G7; chlorhexidine diacetate 5% - G8; and 10% chlorhexidine diacetate - G9) were blended with the soft liner powder before the addition of the soft liner liquid. A group (G1) without any drug incorporation was used as control. Specimens (n=9) (75x10x6 mm) were plasticized according to the manufacturers' instructions and stored in distilled water at 37 degrees C for 24 h. Relined specimens were then submitted to a 180-degree peel test at a crosshead speed of 10 mm/min. Data (MPa) were analyzed by analysis of variance (alpha=0.05) and the failure modes were visually classified. Results: No significant difference was found among experimental groups (p=0.148). Cohesive failure located within the resilient material was predominantly observed in all tested groups. Conclusions: Peel bond strength between the denture base and the modified soft liner was not affected by the addition of antimicrobial agents.

Shear Bond Strength of Different Repair Systems to Titanium After Water Aging

This study evaluated the shear bond strength (SBS) and stability of commercially pure titanium (CP Ti)/repair material interfaces promoted by different repair systems. One hundred CP Ti cast discs were divided into five repair system groups: 1) Epricord (EP); 2) Bistite 11 DC (BT); 3) Cojet (CJ); 4) Scotchbond Multi-Purpose Plus (SB) (control group); and 5) Cojet Sand plus Scotchbond Multi-Purpose Plus (CJSB). The specimens were stored in distilled water for 24 hours at 37 degrees C, thermal cycled (5000 cycles, 5 degrees-55 degrees C) and stored under the same conditions for either 24 hours or six months (n=10). SBS was tested and the data were analyzed by two-way analysis of variance (ANOVA) and Tukey test (alpha=.05). Failure mode was determined with a stereomicroscope (20x). The repair system, storage time, and their interaction significantly affected the SBS (p<0.001). At 24 hours, CJSB exhibited the highest SBS value, followed by CJ. At six months, these two groups had similar mean SBS (p>0.05) and higher means in comparison to the other groups. For both storage times, BT presented the lowest SBS, while the EP and SB groups did not differ significantly from one another (p>0.05). There were no significant differences in SBS between the storage times for the groups EP and CJ (p>0.05). The groups BT, SB, and CJSB showed 100% adhesive failure, irrespective of storage time. The CJSB group showed the highest SBS at both storage times. At six months, the CJ group exhibited a similar SBS mean value when compared to the CJSB group. Water storage adversely affected the groups BT, SB (control group), and CJSB. Considering SBS values, stability, and the failure mode simultaneously, the CJ group showed the best CP Ti repair performance.

Microtensile bond strength of different adhesive systems in dentin irradiated with Er : YAG laser

The objective this study was to evaluate in vitro the bond strength of two etch-and-rise and one self-etching adhesive system after dentin irradiation with Er:YAG (erbium: yttrium aluminum garnet) laser using microtensile test. The results revealed that the groups treated with laser Er:YAG presented less tensile bond strength, independently to the adhesive system used. The prompt L-pop adhesive presented less microtensile bond strength compared to the other adhesives evaluated. There was no difference between single bond and excite groups. The adhesive failures were predominant in all the experimental groups. The Er:YAG laser influenced negatively bond strength values of adhesive systems tested in dental substrate.