Monitoramento do processo de assistência pré-natal entre as usuárias do Sistema Único de Saúde em município do Sudeste brasileiro

OBJETIVOS: avaliar a evolução da adequação do processo de atendimento às gestantes usuárias do Sistema Único de Saúde (SUS) e consolidar metodologia para monitoramento da assistência pré-natal. MÉTODOS: estudo de séries temporais múltiplas, com auditoria em cartões de gestantes que realizaram pré-natal em município do Sudeste brasileiro (Juiz de Fora, Minas Gerais) nos semestres iniciais de 2002 e 2004 (370 e 1.200 cartões, respectivamente) e utilizaram o SUS no atendimento ao parto a termo (p < 0,05). Obedeceu-se a uma sequência em três níveis complementares: utilização do pré-natal (início e número de atendimentos) no nível 1; utilização do pré-natal e procedimentos clínico-obstétricos obrigatórios em uma consulta pré-natal [aferições de pressão arterial (PA), peso, altura uterina (AU), idade gestacional (IG), batimentos cardiofetais (BCFs) e apresentação fetal] no nível 2; e utilização, procedimentos clínico-obstétricos obrigatórios e exames laboratoriais básicos, segundo o Programa de Humanização no Pré-natal e Nascimento/PHPN [tipagem ABO/Rh, hemoglobina/hematócrito (Hb/Htc), VDRL, glicemia e exame comum de urina] no nível 3. RESULTADOS: confirmou-se a alta cobertura pré-natal (99%), aumento da média de consultas/gestante (6,4 versus 7,2%) e decréscimo da idade gestacional na primeira consulta (17,4 versus 15,7 semanas). Aumentaram significativamente os registros adequados dos procedimentos e exames (exceções: apresentação fetal e tipagem sanguínea): PA (77,8 versus 83,9%); peso (75,4 versus 83,5%); AU (72,7 versus 81,3%); IG (58,1 versus 71,5%); BCFs (79,5 versus 86,7%); Hb/Htc (14,9 versus 29%), VDRL (11,1 versus 20,7%), glicemia (16,5 versus 29,0%) e urinálise (13,8 versus 29,8%). Consequentemente, ocorreu melhoria significativa (p < 0,001) da adequação entre 2002 e 2004: 27,6 versus 44,8% (nível 1); 7,8 versus 15,4% (nível 2); 1,1 versus 4,5% (nível 3). O atendimento na maioria dos serviços/equipes municipais apresentou evolução semelhante. CONCLUSÕES: a persistência da baixa adequação, apesar da boa cobertura e da implantação do PHPN, confirmou a necessidade de incrementar a adesão dos gestores, profissionais de saúde e usuárias às normas/rotinas do atendimento, incluindo a institucionalização de um programa de monitoramento da assistência pré-natal.

Qualidade da assistência pré-natal nos serviços públicos e privados

OBJETIVO: Analisar assistência pré-natal nos serviços de saúde públicos e privados. MÉTODOS: Trata-se de um estudo transversal, retrospectivo, analítico a partir da auditoria dos cartões das gestantes que tiveram partos em um hospital de referência para atendimento de baixo risco na região dos Campos Gerais Estado do Paraná, no primeiro semestre de 2011. Para verificar associação do não registro dos cartões da gestante segundo assistência pré-natal no atendimento público e privado, foi utilizado o teste qui-quadrado de Yates corrigido ou teste exato de Fisher com nível de significância p≤0,05. A qualidade da assistência pré-natal foi baseada no percentual dos não registros dos cartões da gestante. RESULTADOS: Foram analisados 500 cartões de pré-natal. A frequência de seis ou mais consultas de pré-natal foi significativa e com predomínio no serviço privado, com 91,9%. Quanto aos exames laboratoriais e obstétricos mais frequentemente não registrados, estes foram respectivamente para o público e para o privado: sorologia de hepatite B (79,3 e 48,4%), hemoglobina e hematócrito (35,6 e 21,8%), sorologia anti-HIV (29,3 e 12,9%), movimentação fetal (84,3 e 58,9%), estatura (60,4 e 88,7%), verificação de edema (60,9 e 54,8%) e apresentação fetal (52,4 e 61,3%). A auditoria dos cartões das gestantes permitiu examinar a qualidade da assistência pré-natal e confirmou diferenças da assistência segundo o local de atendimento, mostrando qualidade excelente e boa no serviço privado e regular no público para ultrassonografia e tipo sanguíneo/fator Rh; qualidade regular no privado e ruim no público para exames de urina e peso e, para os demais exames laboratoriais, exames obstétricos e esquema vacinal, qualidade ruim ou muito ruim nos dois sistemas. CONCLUSÃO: As diferenças entre os serviços demonstraram necessidade de ações destinadas à melhoria da assistência pré-natal prestada principalmente pelo serviço público.

Adequação do processo da assistência pré-natal segundo os critérios do Programa de Humanização do Pré-natal e Nascimento e Rede Cegonha

OBJETIVO: Avaliar a adequação do processo de assistência pré-natal segundo os parâmetros do Programa de Humanização do Pré-natal e Nascimento (PHPN), acrescido dos procedimentos previstos pela Rede Cegonha, no Sistema Único de Saúde (SUS) de uma microrregião do Espírito Santo, Brasil. MÉTODOS: Foi realizado um estudo transversal, em 2012-2013, por meio de entrevistas e de análise do Cartão da Gestante e do prontuário do recém-nascido, com 742 puérperas em 7 maternidades da região escolhida para a pesquisa. As informações foram coletadas, processadas e submetidas aos testes do χ2 e exato de Fisher para testar a diferença de proporção entre os critérios adotados pelo PHPN mais a Rede Cegonha e o local de moradia, renda familiar mensal e modalidade de cobertura do serviço pré-natal. Foi considerado um nível de significância de 5%. RESULTADOS: Os parâmetros que apresentaram as menores taxas de adequação foram os testes rápidos e os exames de repetição, com frequências em torno de 10 e 30%, respectivamente, além das atividades educativas (57,9%) e da imunização antitetânica (58,7%). Já os parâmetros manejo do risco (92,6%) e exame de glicemia de jejum (91,3%) apresentaram os melhores resultados. Foi encontrada adequação de 7,4% para o PHPN, de 0,4% para a Rede Cegonha, no que diz respeito aos parâmetros da gravidez de risco habitual, e de 0 para os de alto risco. Houve diferença estatisticamente significante entre as puérperas segundo local de moradia para realização de sorologia para sífilis (VDRL), teste anti-HIV e repetição de glicemia de jejum, e a renda familiar mensal influenciou a realização dos exames tipagem sanguínea/fator Rh, VDRL, hematócrito e teste anti-HIV. CONCLUSÃO: A assistência pré-natal no SUS mostrou-se inadequada, de acordo com os procedimentos previstos pelo PHPN e Rede Cegonha na microrregião de um estado do Sudeste brasileiro, principalmente para as mulheres de menor renda, usuárias do PACS e residentes na zona rural.

Toxoplasma gondii in semen of experimentally infected swine

Eight reproductive boars were divided into three groups and inoculated with Toxoplasma gondii [GI (n=3) 1.5x10(4) oocysts strain P; GII (n=3) 1.0x10(6) tachyzoites strain RH; and GIII (n=2) non-inoculated control]. Clinical, hematological, parasitemia and serological tests and studies of the parasite in the semen through bioassay and PCR, and in reproductive organs (Bioassay and immunohistochemical analyses) were conducted to evaluate the toxoplasmic infection. Blood and semen were collected on day -2, -1, 1, 3, 5, 7, 9, 11, 14 and weekly up to 84 days post-inoculation (DPI). No clinical or hematimetric alteration was observed in the boars. Parasitemia was detected in one boar inoculated with oocysts at the 7th DPI and in another boar infected with tachyzoites (GII) at the 3rd and 49th DPI. Serological tests revealed antibodies against T. gondii in animals inoculated with oocysts or tachyzoites at the 7th DPI with dilutions of 1:256 and 1:64, which reached peaks of 1:4096 at day 11 and 9, respectively. The bioassays revealed the presence of the parasite in semen samples of a boar inoculated with oocysts (GI) at 3, 49 and 56 DPI and from two boars infected with tachyzoites (GII), one animal at 5 and two animals at 49 days DPI. Mice inoculated with semen from the control group (GIII) remained serologically negative. PCR analysis showed T. gondii DNA in the semen of Boar 1 and Boar 3 inoculated with tachyzoites and oocysts, respectively. The immuno-histochemical tests showed T. gondii in the reproductive organs of Boar 1 and Boar 2, inoculated with tachyzoites and oocysts, respectively. These findings suggest the possible occurrence of venereal transmission of T. gondii in swine.

Toxoplasma gondii in experimentally infected Bos taurus and Bos indicus semen and tissues

Eighteen young steers were inoculated with Toxoplasma gondii and randomly distributed into three groups of six animals each: GI, 2.5x10(5) "P" strain oocysts, GII, 5.0x10(6) "RH" strain tachyzoites, and GIII (Control). Clinical, serological and parasitemia exams were realized. Parasite investigation by bioassay and PCR was realized on semen and fragments of skeletal musculature, lymph nodes, brain, retina, spleen, liver, lung, testicle, epididymis and seminal vesicle. Blood and semen samples were collected on days -2, -1, 1, 3, 5, 7, 14 and weekly thereafter, up to postinfection day (PID) 84. The inoculated steers (GI and GII) presented hyperthermia from PID 3 to 16. Antibodies against T. gondii were detected through the indirect fluorescence antibody test (IFAT) on PID 5 (1:16) in both inoculated groups (oocysts and tachyzoites), reaching peaks of 1:4096 on PID 7. Parasitemia outbursts occurred in all infected bovines, principally from PID 7 to 28, independent of the strain and inoculate used. Bioassays revealed the presence of parasites in semen samples of animals infected with oocysts (GI) and tachyzoites (GII) on several experimental days between PID 7 and 84. Tissue parasitism by T. gondii was diagnosed by bioassay and the PCR technique in several organ and tissue fragments. These findings suggest the possibility of sexual transmission of T. gondii in the bovine species.

Factors affecting immunoglobulin concentration in colostrum of healthy Holstein cows immediately after delivery

This study analyzed the influence of the number of milkings, number of births, and udder quarter in immunoglobulin (Ig) concentration in the colostrum of healthy Holstein cows. It was collected two samples of colostrum by manual milking, getting the first jets to completion of bacteriological examination and immunoglobulin levels by radial immunodiffusion test in agar gel. Positive samples for bacteriological examination were excluded from this investigation. Medians of immunoglobulin's G, A and M in the colostrum collected before the first and second milking were respectively 9,200 and 6,400mg/dL (p=0.0029); 400 and 200mg/dL (p=0.0018); 800 and 400mg/dL (p=0.0001). Median immunoglobulin concentration in animals that calved once, twice or three times or in cows that calved 4 to 6 times were 6,400; 6,400; 3,200 and 11,200mg/dL IgG; 100, 200, 100 and 800mg/dL IgA ; and 400, 400, 100 and 800mg/dL IgM, respectively. Concentrations of IgG, IgA and IgM were greater in animals that calved more than 4 times (p<0.05). Medians of IgG, IgA and IgM in the right fore quarter (RF), right hind quarter (RH), left fore quarter (LF) and left hind quarter (LH) were, respectively, 7,800; 6,400; 7,800 and 6,400mg/dL; 200, 200, 200 and 200mg/dL; and 400, 400, 400 and 400mg/dL. Ig concentrations in the colostrum of Holstein cows were influenced by the number of milkings after delivery and number of lactations. These variations may be considered risk factors to passive immunity transfer to newborn calves, predisposing them to diseases and causing economic losses to dairy production.

Jalometallien pelkistyskemikaalit

Tässä työssä esitellään kirjallisuudesta löytyneitä vaihtoehtoja jalometallien (Au, Ag, Pt, Pd, Is, Os, Rh, Ru, Re) homogeeniseen pelkistämiseen ja tekijöitä, jotka vaikuttavat pelkistimen valintaan. Jalometallien korkea hinta tekee niiden talteenoton pienistäkin pitoisuuksista kiinnostavaksi. Pelkistäminen on talteenoton viimeinen vaihe, jota voidaan käyttää myös puhdistusaskeleena. Pelkistimen valinnalla on suuri merkitys pelkistystulokseen. Myös pH:lla ja lämpötilalla on merkittävä vaikutus pelkistykseen. Ideaalinen pelkistyskemikaali on edullinen, selektiivinen, sillä on kohtuullinen pelkistysaika, se ei ole haitallinen, ei muodosta haitallisia sivutuotteita ja tarvittava prosessi on yksinkertainen. Lupaavia pelkistyskemikaaleja ovat esimerkiksi askorbiinihappo, vetyperoksidi ja muurahaishappo.

Subacute effects of a maximal exercise bout on endothelium-mediated vasodilation in healthy subjects

We evaluated vascular reactivity after a maximal exercise test in order to determine whether the effect of exercise on the circulation persists even after interruption of the exercise. Eleven healthy sedentary volunteers (six women, age 28 ± 5 years) were evaluated before and after (10, 60, and 120 min) a maximal exercise test on a treadmill. Forearm blood flow (FBF) was measured by venous occlusion plethysmography before and during reactive hyperemia (RH). Baseline FBF, analyzed by the area under the curve, increased only at 10 min after exercise (P = 0.01). FBF in response to RH increased both at 10 and 60 min vs baseline (P = 0.004). Total excess flow for RH above baseline showed that vascular reactivity was increased up to 60 min after exercise (mean ± SEM, before: 526.4 ± 48.8; 10 min: 1053.0 ± 168.2; 60 min: 659.4 ± 44.1 ml 100 ml-1 min-1 . s; P = 0.01 and 0.02, respectively, vs before exercise). The changes in FBF were due to increased vascular conductance since mean arterial blood pressure did not change. In a time control group (N = 5, 34 ± 3 years, three women) that did not exercise, FBF and RH did not change significantly (P = 0.07 and 0.7, respectively). These results suggest that the increased vascular reactivity caused by chronic exercise may result, at least in part, from a summation of the subacute effects of successive exercise bouts.

High incidence of adverse reactions to initial antiretroviral therapy in Brazil

A concurrent prospective study was conducted from 2001 to 2003 to assess factors associated with adverse reactions among individuals initiating antiretroviral therapy at two public referral HIV/AIDS centers in Belo Horizonte, MG, Brazil. Adverse reactions were obtained from medical charts reviewed up to 12 months after the first antiretroviral prescription. Cox proportional hazard model was used to perform univariate and multivariate analyses. Relative hazards (RH) were estimated with 95% confidence intervals (CI). Among 397 charts reviewed, 377 (95.0%) had precise information on adverse reactions and initial antiretroviral treatment. Most patients received triple combination regimens including nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors. At least one adverse reaction was recorded on 34.5% (N = 130) of the medical charts (0.17 adverse reactions/100 person-day), while nausea (14.5%) and vomiting (13.1%) were the most common ones. Variables independently associated with adverse reactions were: regimens with nevirapine (RH = 1.78; 95% CI = 1.07-2.96), indinavir or indinavir/ritonavir combinations (RH = 2.05; 95% CI = 1.15-3.64), female patients (RH = 1.93; 95% CI = 1.31-2.83), 5 or more outpatient visits (RH = 1.94; 95% CI = 1.25-3.01), non-adherence to antiretroviral therapy (RH = 2.38; 95% CI = 1.62-3.51), and a CD4+ count of 200 to 500 cells/mm³ (RH = 2.66; 95% CI = 1.19-5.90). An independent and negative association was also found for alcohol use (RH = 0.55; 95% CI = 0.33-0.90). Adverse reactions were substantial among participants initiating antiretroviral therapy. Specially elaborated protocols in HIV/AIDS referral centers may improve the diagnosis, management and prevention of adverse reactions, thus contributing to improving adherence to antiretroviral therapy among HIV-infected patients.

Alternative chromatographic system for the quality control of lipophilic technetium-99m radiopharmaceuticals such as [99mTc(MIBI)6]+

Knowledge of the radiochemical purity of radiopharmaceuticals is mandatory and can be evaluated by several methods and techniques. Planar chromatography is the technique normally employed in nuclear medicine since it is simple, rapid and usually of low cost. There is no standard system for the chromatographic technique, but price, separation efficiency and short time for execution must be considered. We have studied an alternative system using common chromatographic stationary phase and alcohol or alcohol:chloroform mixtures as the mobile phase, using the lipophilic radiopharmaceutical [99mTc(MIBI)6]+ as a model. Whatman 1 modified phase paper and absolute ethanol, Whatman 1 paper and methanol:chloroform (25:75), Whatman 3MM paper and ethanol:chloroform (25:75), and the more expensive ITLC-SG and 1-propanol:chloroform (10:90) were suitable systems for the direct determination of radiochemical purity of [99mTc(MIBI)6]+ since impurities such as99mTc-reduced-hydrolyzed (RH),99mTcO4- and [99mTc(cysteine)2]-complex were completely separated from the radiopharmaceutical, which moved toward the front of chromatographic systems while impurities were retained at the origin. The time required for analysis was 4 to 15 min, which is appropriate for nuclear medicine routines.

Effect of ambient conditions on dimensional stability and stiffness of commercial paperboard and paperboard trays

The objective of this study was to develop laboratory test methods for characterizing the effects of changed moisture content on paperboard trays produced by press-forming process. Influence of moisture on the properties of unconverted paperboard such as bending stiffness, bursting strength, and curling was studied. Paperboard and tray samples were tested after storing in different relative humidity conditions (35, 50, 65, 80 and 95% RH). The effect of PE and PET extrusion coatings on these properties was also studied. It was found that increase in moisture content of paperboard decreases bending and bursting strength, dimensional stability and stiffness of paperboard trays. Such physical and mechanical properties as bending stiffness and curling of paperboard seem to define the stiffness of ready-made trays and their dimensional stability. Paperboards and trays with extruded PE and PET one sided coatings demonstrated higher strength properties but at the same time had lower dimensional stability comparing to uncoated paperboards. Samples with smaller polymer coat weight had better dimensional stability than respective samples with higher coat weight. It was also found that preconditioning of paperboard in lower humidity environment before press-forming could improve dimensional stability and stiffness of ready-made tray.

Effect of controlled atmosphere on postharvest quality of 'Douradão' peaches

This study was carried out with one of the most important cultivar grown in the State of Sao Paulo, Brazil, which has gained the preference of consumers, due to its sweet taste, intense skin color and large size; however, these fruits are susceptible to chilling injury when cold stored for long periods. The use of controlled atmosphere (CA) with elevated CO2 and reduced O2 concentrations prevent the onset of the chilling symptom. Thus, the effect of three different conditions of controlled atmosphere (CA1, CA2, CA3 and Control) was evaluated in order to extend the storage life of 'Douradão' peaches. After 14, 21 and 28 days, samples were withdrawn from CA and kept in fresh air at 25 ± 1 °C and 90 ± 5% RH to complete ripening. On the day of removal and after 4 days, were the peaches quality characteristics were evaluated. The results showed that the use of CA during cold storage reduced weight loss and prevented postharvest decay. CA2 and CA3 treatments were effective in keeping good quality of 'Douradão' peaches during 28 days of cold storage, the ripe fruits showed reduced incidence of woolliness, adequate juiciness and flesh firmness. CA1 and Control treatments did not present marketable conditions after 14 days of cold storage.

Volatile profile and physical, chemical, and biochemical changes in fresh cut watermelon during storage

Existing data about the aroma of fresh-cut watermelon and the metabolic changes that occur with minimal processing are scarce. Given the close relationship that exists between aroma, texture, and quality characteristics, it is necessary to investigate the changes in the volatile profile and texture of watermelon, a fruit extensively sold in supermarket chains throughout Brazil. The objective of this work was to analyze the volatile profile using solid phase microextraction (SPME) as well as texture changes in fresh-cut watermelon stored at 5 °C for ten days. Chromatography associated with sensory analysis (sniffing) led us to conclude that 9-carbon (C9) alcohols and aldehydes are the major responsible for the flavor and aroma of minimally processed watermelon stored at 5 ± 1 °C/90 ± 5% RH for ten days, and also that the aroma diminishes in intensity with storage, but it does not affect the final quality of the product. It was noted that the amount of drained liquid, soluble pectin, and weight loss increased during storage concurrently with a reduction in firmness and a structural breakdown of the cells. Pectin methyl esterase activity remained constant and polygalacturonase activity was not detected.

Histochemistry and morphoanatomy study on guava fruit during ripening

Guava (Psidium guajava L.) is a highly perishable fruit due to its intense metabolism during ripening. Information on the enzyme activities that degrade pectic substances, as well as the amount of pectin, is very contradictory and not clearly defined. Thus, this study aimed to monitor the changes occurred in the fruit during ripening through histochemical, physical, and scanning microscopy processes. Guavas were picked at the half-mature stage and stored for 9 days at 22 ± 1 °C and 78 ± 1% RH. The analyses conducted on the day of harvest (0) and each day of storage (1, 2, 3, 4, 5, 6, 7, and 8 days) were: firmness and histochemical analyses (ferric chloride, lugol, comassie blue, vanillin hydrochloric, and ruthenium red) observed under an optic microscope and a scanning electron microscope. Ruthenium red showed a high amount of pectin in the cell wall on day zero as well as its decrease in the wall during ripening and its accumulation in the central area of the cell. Scanning microscopy showed loss of the cell structure during ripening. Those observations suggest that the pectin is the main polymer responsible for firmness maintenance in the guava fruit.

Application of carnauba-based wax maintains postharvest quality of 'Ortanique' tangor

This study aimed at evaluating compositional changes in the quality of 'Ortanique' tangor after coating with the carnauba-based waxes Aruá Tropical® or Star Light®. The storage conditions studied simulated those of local marketing (22 ± 2 °C, 60 ± 5% RH). Non-destructive analysis, mass loss, peel color, and sensory evaluation, were performed upon coating and every three days up to the fifteenth day of storage. Destructive analysis, peel moisture content, chlorophyll of the peel, pulp color, juice content, soluble solids (SS), titratable acidity (TA), pH, and soluble solids to titratable acidity ratio, were performed upon coating and every four days up to the sixteenth day of storage. The assay was conducted using an entirely randomized design, with three replications (destructive analyses) or ten replications (non-destructive analyses), in a split plot scheme. Wax-coating, especially Aruá Tropical®, maintained fruit freshness by reducing mass loss and peel dehydration and retaining green color. Peel moisture content, chlorophyll content, and juice content had lower rates in the wax coated fruits. Puncture force, soluble solids, titratable acidity, pH, and soluble solids to titratable acidity ratio varied vary little over the course of storage. Sensory evaluation showed that the application of Aruá Tropical keeps 'Ortanique' tangor fresher for 6 days longer for commercialization.