Percep����o do estado de sa��de de doentes com anticoagula����o oral

RESUMO - O aumento da incid��ncia das doen��as cr��nicas representa um desafio enorme para todos os Sistemas de Sa��de, pelo que a assist��ncia de Sa��de a doentes cr��nicos se tornou num problema das sociedades ocidentais. Os pa��ses mais pobres s��o os que mais sofrem, embora nos pa��ses desenvolvidos tamb��m se verifique um aumento not��vel das doen��as cr��nicas. Estima-se que estas representem mais de 60% do total das doen��as mundiais no ano 2020 (WHO, 2001). A adapta����o dos actuais modelos de sa��de aos doentes cr��nicos n��o atingiu os objectivos, o que conduziu a que, de h�� alguns anos a esta parte, se procure alternativas mais eficazes e eficientes. Uma das press��es do mercado que se fazem sentir ser�� caracterizada por uma maior aposta na Promo����o da Sa��de e Preven����o da doen��a. O conceito de ���Sa��de��� migrou de ���n��o exist��ncia de doen��a��� para ���Bem-estar F��sico e Psicol��gico���. Desta forma, o foco dos cuidados de sa��de teve que ser adaptado, o que conduziu a uma situa����o em que o ��mbito da presta����o de cuidados de sa��de �� um cont��nuo de servi��os que vai desde a promo����o da sa��de, medicina preventiva e medicina curativa aos cuidados continuados e cuidados paliativos. As tecnologias de informa����o e comunica����o desempenhar��o um importante papel nesta tend��ncia, permitindo estabelecer liga����es cont��nuas entre os consumidores e prestadores de cuidados de sa��de. Por outro lado, as potencialidades da Internet, das comunica����es m��veis, dispositivos port��teis e do instrumental electr��nico, tornam-se evidentes no desenvolvimento de servi��os de e-Sa��de: para monitoriza����o, seguimento e controlo dos doentes extra hospitalar - servi��os estes centrados no doente. O objectivo geral do presente estudo consiste no desenho de um projecto de investiga����o para posterior avalia����o da percep����o do estado de sa��de dos doentes seguidos na consulta de hipocoagula����o do Hospital de Santa Marta. Devido �� escassez de investiga����o na tem��tica deste trabalho em Portugal, procedeu-se a um trabalho explorat��rio, descritivo, de car��cter comparativo e enquadrado na abordagem quantitativa. O campo de an��lise consiste em comparar doentes que fazem anticoagula����o oral, seguidos na consulta de cardiologia (consulta convencional), com os doentes seguidos no programa Airmed (atrav��s das comunica����es m��veis). 4 Para avalia����o da percep����o do estado de sa��de foi utilizado o question��rio SF-36.----ABSTRACT - The increasing incidence of chronic diseases represents an enormous challenge to the Health Systems and on cause of that, the Health Assistance to chronic patients became a concern of the Occidental society. The Countries with lower economical resources are the ones that suffers the most, but also the Developed countries have a noticeable increase of chronic diseases. It is estimated these will represent over 60% of total diseases world wide in 2020 (WHO,2001). The adaptation of the actual Health Models to chronic patients did not achieved it���s goals, what leaded to look for more effective and efficient alternatives. One of the more sensitive market pressure factor is to look for a better Health Promotion and Disease Prevention. The concept of ���Health��� merged from ���Disease absence��� to ���Physic and Psychic Wellness���. In this way the Health Care focus had to be adapted, what drove to a status where the scope of the Health care is a continuum of services that goes from the Health Promotion, Preventive and Curative to Continued and Palliative Medical Care. The Information and Communication Technologies will play a crucial role in this trend, allowing to establish continued connections between patients and Health Care providers. In parallel the potential of the Internet, mobile communications, portable devices and electronic instruments became evident to deploy e-Health services: to monitor, follow-up and control of patients outside the Hospital. The overall objective of the present study is an Investigation Project Design to further evaluate the health status perception of the patients followed in the consultation for Hypocoagulation in the ���Hospital de Santa Marta���. Due to lack of investigation in this thematic, in Portugal, this study is developed in an exploratory way, descriptive, comparative, within a scope of a quantified approach. The analysis field consists on comparing patients prescribed with oral anticoagulants and followed-up at the

Possible oral transmission of acute Chagas' disease in Brazil

In October, 1986, 7 to 22 days after a meeting at a farm in Para��ba state, 26 individuals presented with a febrile illness associated with bilateral eyelid and lower limb edema, mild hepatosplenomegaly, lymphadenopathy and, occasionally a skin rash. A 11-year-old boy exhibited atrial premature complexes and a 74-year-old patient developed acute heart failure. In two patients hospitalized in S��o Paulo city, acute Chagas' disease was diagnosed by the demonstration of circulating Trypanosoma cruzi. At autopsy in a fatal case, acute Chagas' cardiomyopathy was demonstrated. Xenodiagnosis were positive in 9 out of 14 tested patients. A specific IgG immune response was found in all patients and specific IgM antibodies were identified in 20 out of 22 tested patients. A epidemiological survey showed the existence of Triatoma brasiliensis in the outbuildings of this farm, but none in the house where most of the guests stayed. A high rate of infection with Trypanosoma cruzi was found in opossums. These observations together with those related to the food consumed by the patients, lead the authors to suggest that the human infections resulted from oral contamination probably originating from naturally infected marsupials in the area or crushed infected bugs.

Hepatitis B vaccine - proposal for a standardized assessment of immune response

The authors developed a comparative study of the various methods of assessment of immune response to Hepatitis B vaccine. Eighty-six health care professionals underwent a vaccination programme with three doses of plasma-derived vaccine against Hepatitis B (H-B-Vax, Merck, Sharp & Dohme) given intra-muscularly. Assessment of immune response was carried out three months after the end of the programme, by radioimmunoassay (RIA) and enzymeimmunoassay (EIA). The results showed that the semi-quantitative assessment of Anti-HBs antibodies by RIA or EIA was perfectly comparable to the reference method (quantitative determination of antibodies by RIA). In view of these findings, the authors suggest a standardization of assessment of immune response to the vaccine, thus permitting correct planning of booster doses and easier comparison between different studies

Supply chain optimization of residual forestry biomass for bioenergy production: the case study of Portugal

Within a large set of renewable energies being explored to tackle energy sourcing problems, bioenergy can represent an attractive solution if effectively managed. The supply chain design supported by mathematical programming can be used as a decision support tool to the successful bioenergy production systems establishment. This strategic decision problem is addressed in this paper where we intent to study the design of the residual forestry biomass to bioelectricity production in the Portuguese context. In order to contribute to attain better solutions a mixed integer linear programming (MILP) model is developed and applied in order to optimize the design and planning of the bioenergy supply chain. While minimizing the total supply chain cost the production energy facilities capacity and location are defined. The model also includes the optimal selection of biomass amounts and sources, the transportation modes selection, and links that must be established for biomass transportation and products delivers to markets. Results illustrate the positive contribution of the mathematical programming approach to achieve viable economic solutions. Sensitivity analysis on the most uncertain parameters was performed: biomass availability, transportation costs, fixed operating costs and investment costs. (C) 2015 Elsevier Ltd. All rights reserved.

Immunization aganist hepatitis B in children from endemic zone: evaluation of the antibody response against the DNA recombinant vaccine (Engerix B-20 mcg)

A previous seroepidemiological study in the rural zone of Vargem Alta (ES) SouthEast of Brazil, showed a prevalence of up to 9% of hepatitis B surface antigen (HBsAg) in some areas. One hundred susceptible children aging 1 to 5 years old were selected and immunized with a recombinant DNA hepatitis B vaccine (Smith-Kline 20 mcg) using the 0-1-6 months vaccination schedule. Blood samples were collected at the time of the first vaccine dose (month 0) in order to confirm susceptible individuals and 1,3,6 and 8 months after the first dose , to evaluate the antibody response. Our results showed that two and five months after the second dose, 79% and 88% of children seroconverted respectively, reaching 97% after the third dose. The levels of anti-HBs were calculated in milli International Units/ml (mIU/ml) and demonstrated the markedly increase of protective levels of antibodies after the third dose. These data showed a good immunogenicity of the DNA recombinant hepatitis B vaccine when administered in children of endemic areas.

Reduced schedule of human anti-rabies immunization with Fuenzalida & Palacios vaccine: additional data

It was reevaluated a reduced schedule for anti-rabies post-exposure immunization with newborn mice nervous tissue vaccine (Fuenzalida 8c Palacios) in a group of 30 non exposed volunteers. The vaccine was administered by intramuscular injections on days zero, 2, 4, 16 and 27, in the deltoid area. Antibody levels were determinated by a simplified serum neutralization microtest on days zero, 16 and 37. On days 16 and 37 the antibody levels of the whole group was >0.5 IU/ml and >1.0 IU/ml, respectively. The cell mediated immunity was precociously detected (on day 4) by the delayed type hipersensitivity skin test. Our results show that this reduced schedule elicited an early and effective humoral and cellular immune response. However it is necessary other studies with larger groups of vaccinees in order to obtain definitive conclusion.

Reversible current power supply for fast-field cycling nuclear magnetic resonance equipment

The Fast Field-Cycling Nuclear Magnetic Resonance (FFC-NMR) is a technique used to study the molecular dynamics of different types of materials. The main elements of this equipment are a magnet and its power supply. The magnet used as reference in this work is basically a ferromagnetic core with two sets of coils and an air-gap where the materials' sample is placed. The power supply should supply the magnet being the magnet current controlled in order to perform cycles. One of the technical issues of this type of solution is the compensation of the non-linearities associated to the magnetic characteristic of the magnet and to parasitic magnetic fields. To overcome this problem, this paper describes and discusses a solution for the FFC-NMR power supply based on a four quadrant DC/DC converter.

Um estudo sobre o rito de tradi����o oral AI-HULUN e as suas actuais pr��cticas religiosas e m��gicas no suco de Mauchiga

Disserta����o de Mestrado em Ensino do Portugu��s como L��ngua Segunda e Estrangeira

Arritmia card��aca com uso de oxamniquine oral no tratamento de esquistossomose mans��nica

Os autores relatam caso cl��nico de paciente com esquistossomose mans��nica, tratado com oxamniquine oral em dose ��nica de 15 mg/kg, que apresenta como efeito colateral um bloqueio ��trio-ventricular incompleto tipo Mobitz I, com parada sinusal e escape ventricular. Concluem que, apesar de a oxamniquine ser eficaz e segura, pode ser determinante de cardiotoxicidade

Studies on human anti-rabies immunization in Brazil: II - Preliminary evaluation of the 2-1-1 schedule for human pre-exposure anti-rabies immunization, employing suckling mouse brain vaccine

This study reports preliminary results of virus neutralizing antibody (VNA) titers obtained on different days in the course of human anti-rabies immunization with the 2-1-1 schedule (one dose is given in the right arm and one dose in the left arm at day 0, and one dose is apllied on days 7 and 21), recommended by WHO for post-exposure treatment with cell culture vaccines. A variant schedule (double dose on day zero and another on day 14) was also tested, both employing suckling mouse brain vaccine. A complete seroconversion rate was obtained after only 3 vaccine doses, and almost all patients (11 of 12) presented titers higher than 1.0 IU/ml. Both neutralizing response and seroconversion rates were lower in the group receiving only 3 doses, regardless of the sample collecting day. Although our results are lower than those found with cell culture vaccines, the geometry mean of VNA is fully satisfactory, overcoming the lower limit recommended by WHO of 0.5 IU/ml. The 2-1-1 schedule could be an alternative one for pre exposure immunization, shorter than the classical 3+1 regimen (one dose on days 0, 2, 4 and 30) with only three visits to the doctor, instead of four.

Serological findings during a measles outbreak occurring in a population with vaccine coverage

From March 1991 to April 1992, serum samples for IgM detection were collected from 112 clinical measles cases reported to the Health Department of Niter��i, State of Rio de Janeiro. The positivity exceeded 90% for specimens collected from the 5th to the 29th day after the onset of the disease. After day 30 a decline in IgM detection was observed, although positivity has been detected up to 90 days after the onset of the symptoms. Forty-four patients (48.9%) with an IgM response had a history of prior measles vaccination. In 5 of the 22 measles-IgM negative cases the infection was due to other agents (rubella: 4 cases, dengue: 1 case). These results show that sensitivity of the test employed for confirming suspected measles cases is high, even in vaccinated patients.

IMMUNOGENICITY OF LOW-DOSE INTRAMUSCULAR AND INTRADERMAL VACCINATION WITH RECOMBINANT HEPATITIS B VACCINE

The study is a randomized trial using recombinant DNA vaccine to determine whether an intramuscular 10 ��g dose or intradermal 2 ��g induces satisfactory anti-HBs levels compared to the standard dose of intramuscular 20 ��g. participants were 359 healthy medical and nurse students randomly allocated to one of the three groups: Group I - IM 20 ��g; Group II - IM 10 ��g; Group III - ID 2 ��g at 0, 1 and 6 months. Anti-HBs titres were measured after complete vaccine schedule by ELISA/Pasteur. Baseline variables were similar among groups and side effects were mild after any dose. Vaccinees in the IM-10 ��g group had seroconversion rate and geometric mean titre (GMT 2344 IU L-1), not significant different from the IM-20 ��g group (GMT 4570 IU L-1). On the contrary, 21.4% of the ID - 2 ��g recipients mount antibody concentration below 10 IU L1 and GMT of 91 IU L-1, a statiscally significant difference compared with the standard schedule IM-20 ��g (p < 0.001). A three dose regimen of half dosse IM could be considered an appropriate schedule to prevent hepatitis B in young health adults which is of relevance to the expansion of hepatitis B vaccine programme

PRELIMINARY REPORT OF THE USE ON ADULTS OF A RECOMBINANT YEAST-DERIVED HEPATITIS B VACCINE MANUFACTURED BY INSTITUTO BUTANTAN

Three 10 ��g doses of the recombinant hepatitis B vaccine, manufactured by Instituto Butantan by original technology, were administered in a adult population, mean age 30 years old, following the 0, 1 and 6 months schedule immunization. The clinical trial was considered satisfactory in terms of immunogenicity (anti-HBs titers between 17.5-29500 IU/l, seroconversion 95.3%) and reactogenicity (no incapacitating side effects)