Acesso a atendimento médico continuado : uma estratégia para reduzir a utilização de consultas não urgentes em serviços de emergência

A utilização de uma emergência por pacientes com problemas médicos eletivos contribui para a demanda excessiva e impede de acesso a pacientes com emergência verdadeira. O presente estudo se propôs: (1) investigar as características do usuário da emergência em relação a aspectos demográficos, local de moradia e tempo que apresenta os sintomas que o levaram a consultar; (2) identificar as diferenças da demanda entre o final de semana e durante a semana; (3) investigar a prevalência de saúde mental, alcoolismo, doença coronariana e hipertensão; (4) avaliar como é a utilização e o acesso a serviços de saúde para pacientes que referem ter um médico definido em comparação com quem refere não ter; (5) avaliar a satisfação dos pacientes com o atendimento na emergência e (6) verificar se o atendimento através de um médico definido ou em serviço de atenção primária em saúde diminui o afluxo de casos não urgentes aos serviços de emergência. Foi realizado um estudo transversal na Emergência do Hospital N.S. da Conceição de Porto Alegre (RS) no período de 6 de janeiro a 25 de junho de 1996, tendo sido incluídos 20 dias escolhidos entre o meio-dia de sábado e o meio-dia de domingo, para caracterizar a demanda do final de semana, e o meio-dia de segunda-feira e meio-dia de terça-feira, para a dos outros dias. Fizeram parte da amostra 553 pacientes selecionados através de amostragem aleatória sistemática, com uma taxa de resposta de 88%. A coleta de dados consistiu de questionário de 156 questões aplicado aos pacientes. O registro e análise dos dados foram realizados utilizando-se os programas Epi-Info, EGRET e SPSS. As análises incluíram tabulações simples para determinação de prevalência das condições investigadas e regressão logística para avaliar o efeito conjunto das variáveis independentes sobre cada uma das variáveis dependentes. A população que freqüenta a emergência do HNSC é composta de jovens, predominantemente do sexo feminino, mora em Porto Alegre (especialmente, no bairro Sarandi) e na Grande Porto Alegre (especialmente, Alvorada), desloca-se preferencialmente de ônibus até o serviço de emergência, vem acompanhada, na maioria das vezes, de algum familiar, e a maioria decide consultar por iniciativa própria ou por indicação de algum familiar. Os homens internam com maior freqüência. Os serviços de atenção primária representaram 23% do atendimento habitual dos pacientes. As consultas foram definidas pelos emergencistas como de emergência em 15% dos casos, de urgência em 46%, e programáveis em 39% poderiam ser programadas. A prevalência de hipertensão foi 19%; de angina, 13%; de alcoolismo, 16%; de problema psiquiátrico menor, 32% entre os homens e 51% entre as mulheres (p< 0,0001). Como desfecho da consulta, 73% dos pacientes foram encaminhados para o domicílio ou para um serviço especializado, 10% foram para sala de observação e para apenas 5% foi indicada a internação. A maioria dos pacientes referiram estar satisfeitos com o atendimento. Os que consultaram no final de semana apresentaram, em média, um tempo menor de sintomas até decidir consultar, um menor tempo de deslocamento até o serviço de emergência, maior satisfação, média de idade maior, maior proporção de moradores de Porto Alegre e foram levados de carro até a emergência mais do que aqueles que consultaram durante a semana. O modelo de regressão logística identificou as variáveis independentes determinantes de ter um médico definido: consulta habitual em atenção primária em saúde (RC=3,22 IC95%=2,04-5,09), consulta definida como emergência ou urgência (RC=2,46 IC95%=1,55-3,92) e afastamento do trabalho (RC=1,59 IC95%= 1,03-2,45). Este resultado demonstra que o paciente que habitualmente consulta em serviços de atenção primária tem mais probabilidade para ter a continuidade no atendimento. A consulta ser de emergência ou de urgência apresentou associação significativa com as seguintes variáveis independentes, após ser colocada num modelo de regressão logística: pacientes internados ou em observação (RC=5,80 IC95%=3,33-10,17), costume de consultar com o mesmo médico (RC=2,98 IC95%=1,84-4,80) e ida de carro até a emergência (RC=2,67 IC95%=1,75-4,05). A variável hábito de consultar em serviço de atenção primária deixou de ficar estatisticamente significativa ao ser colocada no modelo de regressão logística. Este resultado revela que pacientes com médico definido têm três vezes mais chances de consultar por um problema de emergência no serviço de emergência do que aqueles que não têm um médico definido. Assim, uma estratégia para reduzir a ocorrência de consultas não urgentes em serviços de emergência é o paciente ter tal vínculo. No entanto, aqueles pacientes que referiram o posto de saúde como local onde habitualmente consultam não evitam, necessariamente, a utilização de um serviço de emergência por motivo considerado como programável. É necessário otimizar o atendimento de pacientes com problemas não urgentes que chegam à emergência através de estratégias no nível de atenção primária – especialmente possibilitando o atendimento médico continuado -, onde uma abordagem integral com ênfase na prevenção garanta um atendimento de melhor qualidade e custo menor.

Redução aluminotérmica do óxido de tântalo usando uma tocha de plasma como ignitor

In this work was used a plasma torch of non transferred arc with argon as work gas, using a power supply with maximum DC current of 250 A and voltage of 30 V to activate the plasma and keep it switched on. The flame temperature was characterized by optical emission spectroscopy, through Boltzmann-plot-method. The torch has been used like igniter in the aluminothermic reduction of the mixture tantalum oxide and aluminum, seeking to obtain metallic tantalum. In heating of the reagents only one particle will be considered to study interactions between plasma-particle, seeking to determinate its fusion and residence time. The early powders were characterized by laser granulometry, scanning electron microscopy (SEM) and X-ray diffraction analysis. The final product of this reaction was characterized by SEM and X-ray diffraction. Crystallite size was calculated by the Scherrer equation and microdeformation was determined using Willamsom-Hall graph. With Rietveld method was possible to quantify the percentile in weight of the products obtained in the aluminothermic reaction. Semi-quantitative chemical analysis (EDS) confirmed the presence of metallic tantalum and Al2O3 as products of the reduction. As was waited the particle size of the metallic tantalum produced, presents values in nanometric scale due the short cooling time of those particles during the process

Estudo da formulação de pré-misturas secas para a cimentação de poços em terra

An economical solution for cementing oil wells is the use of pre-prepared dry mixtures containing cement and additives. The mixtures may be formulated, prepared and transported to the well where is added water to be pumped.Using this method, becomes dispensable to prepare the cement mixes containing additives in the cementing operation, reducing the possibility of error. In this way, the aim of this work is to study formulations of cement slurries containing solid additives for primary cementing of oil wells onshore for typical depths of 400, 800 and 1,200 meters. The formulations are comprised of Special Class Portland cement, mineral additions and solids chemical additives.The formulated mixtures have density of 1.67 g / cm ³ (14.0 lb / gal). Their optimization were made through the analysis of the rheological parameters, fluid loss results, free water, thickening time, stability test and mechanical properties.The results showed that mixtures are in conformity the specifications for cementing oil wells onshore studied depths

Recuperação e purificação de quitosanases usando adsorção em leito expandido com streamline DEAE com modelagem e simulação usando redes neurais

Expanded Bed Adsorption (EBA) is an integrative process that combines concepts of chromatography and fluidization of solids. The many parameters involved and their synergistic effects complicate the optimization of the process. Fortunately, some mathematical tools have been developed in order to guide the investigation of the EBA system. In this work the application of experimental design, phenomenological modeling and artificial neural networks (ANN) in understanding chitosanases adsorption on ion exchange resin Streamline® DEAE have been investigated. The strain Paenibacillus ehimensis NRRL B-23118 was used for chitosanase production. EBA experiments were carried out using a column of 2.6 cm inner diameter with 30.0 cm in height that was coupled to a peristaltic pump. At the bottom of the column there was a distributor of glass beads having a height of 3.0 cm. Assays for residence time distribution (RTD) revelead a high degree of mixing, however, the Richardson-Zaki coefficients showed that the column was on the threshold of stability. Isotherm models fitted the adsorption equilibrium data in the presence of lyotropic salts. The results of experiment design indicated that the ionic strength and superficial velocity are important to the recovery and purity of chitosanases. The molecular mass of the two chitosanases were approximately 23 kDa and 52 kDa as estimated by SDS-PAGE. The phenomenological modeling was aimed to describe the operations in batch and column chromatography. The simulations were performed in Microsoft Visual Studio. The kinetic rate constant model set to kinetic curves efficiently under conditions of initial enzyme activity 0.232, 0.142 e 0.079 UA/mL. The simulated breakthrough curves showed some differences with experimental data, especially regarding the slope. Sensitivity tests of the model on the surface velocity, axial dispersion and initial concentration showed agreement with the literature. The neural network was constructed in MATLAB and Neural Network Toolbox. The cross-validation was used to improve the ability of generalization. The parameters of ANN were improved to obtain the settings 6-6 (enzyme activity) and 9-6 (total protein), as well as tansig transfer function and Levenberg-Marquardt training algorithm. The neural Carlos Eduardo de Araújo Padilha dezembro/2013 9 networks simulations, including all the steps of cycle, showed good agreement with experimental data, with a correlation coefficient of approximately 0.974. The effects of input variables on profiles of the stages of loading, washing and elution were consistent with the literature

Recuperação e purificação de proteínas do soro de queijo tipo coalho usando cromatografia de troca iônica e interação hidrofóbica em leito na forma expandida

Expanded Bed Adsorption plays an important role in the downstream processing mainly for reducing costs as well as steps besides could handling cells homogenates or fermentation broth. In this work Expanded Bed Adsorption was used to recover and purify whey proteins from coalho cheese manufacture using Streamline DEAE and Streamline SP both ionic resins as well as a hydrophobic resin Streamline Phenyl. A column of 2.6 cm inner diameter with 30 cm in height was coupled to a peristaltic pump. Hydrodynamics study was carried out with the three resins using Tris-HCl buffer in concentration of 30, 50 and 70 mM, with pH ranging from 7.0 to 8.0. In this case, assays of the expansion degree as well as Residence Time Distribution (RTD) were carried out. For the recovery and purification steps, a whey sample of 200 mL, was submitted to a column with 25mL of resin previously equilibrated with Tris/HCl (50 mM, pH 7.0) using a expanded bed. After washing, elution was carried out according the technique used. For ionic adsorption elution was carried out using 100 mL of Tris/HCl (50 mM, pH 7.0 in 1M NaCl). For Hydrophobyc interaction elution was carried out using Tris/HCl (50 mM, pH 7.0). Adsorption runs were carried out using the three resins as well as theirs combination. Results showed that for hydrodynamics studies a linear fit was observed for the three resins with a correlation coefficient (R2) about 0.9. In this case, Streamline Phenyl showed highest expansion degree reaching an expansion degree (H0/H) of 2.2. Bed porosity was of 0.7 when both resins Streamline DEAE and Streamline SP were used with StremLine Phenyl showing the highest bed porosity about 0.75. The number of theorical plates were 109, 41.5 and 17.8 and the axial dipersion coefficient (Daxial) were 0.5, 1.4 and 3.7 x 10-6 m2/s, for Streamline DEAE, Streamline SP and Streamline Phenyl, respectively. Whey proteins were adsorved fastly for the three resins with equilibrium reached in 10 minutes. Breakthrough curves showed that most of proteins stays in flowthrough as well as washing steps with 84, 77 and 96%, for Streamline DEAE, Streamline SP and Streamline Phenyl, respectively. It was observed protein peaks during elution for the three resins used. According to these peaks were identified 6 protein bands that could probably be albumin (69 KDa), lactoferrin (76 KDa), lactoperoxidase (89 KDa), β-lactoglobulin (18,3 KDa) e α-lactoalbumin (14 KDa), as well as the dimer of beta-lactoglobulin. The combined system compound for the elution of Streamline DEAE applied to the Streamline SP showed the best purification of whey proteins, mainly of the α-lactoalbumina

Thermal analysis of an enriched flame incinerator for aqueous residues

The use of oxygen to enrich the combustion air can be an attractive technique to increase capacity of an incinerator originally designed to operate with air, If incinerator parameters such as operation temperature, turbulence level and residence time are fixed for a certain fuel supply rate, it is possible to increase the residue consumption rate using enriched air. This paper presents the thermal analysis for operation with enriched air of an aqueous residue experimental incinerator. The auxiliary fuel was diesel oil. The theoretical results showed that there is a considerable increase in the incineration ratio up to approximately 50% of O-2 in the oxidiser. The tendency was confirmed experimentally. Thermal analysis was demonstrated to be an important tool to predict possible incinerator capacity increase. (C) 2005 Published by Elsevier Ltd.

Gastrointestinal transit and disintegration of enteric coated magnetic tablets assessed by ac biosusceptometry

The oral administration is a common route in the drug therapy and the solid pharmaceutical forms are widely used. Although much about the performance of these formulations can be learned from in vitro studies using conventional methods, evaluation in vivo is essential in product development. The knowledge of the gastrointestinal transit and how the physiological variables can interfere with the disintegration and drug absorption is a prerequisite for development of dosage forms. The aim of this work was to employing the ac biosusceptometry (ACB) to monitoring magnetic tablets in the human gastrointestinal tract and to obtain the magnetic images of the disintegration process in the colonic region. The ac biosusceptometry showed accuracy in the quantification of the gastric residence time, the intestinal transit time and the disintegration time (DT) of the magnetic formulations in the human gastrointestinal tract. Moreover, ac biosusceptometry is a non-invasive technique, radiation-free and harmless to the volunteers, as well as an important research tool in the pharmaceutical, pharmacological and physiological investigations. (c) 2005 Elsevier B.V. All rights reserved.

Enteric coated magnetic HPMC capsules evaluated in human gastrointestinal tract by AC biosusceptometry

Purpose. To employ the AC Biosusceptometry (ACB) technique to evaluate in vitro and in vivo characteristics of enteric coated magnetic hydroxypropyl methylcellulose (HPMC) capsules and to image the disintegration process.Materials and Methods. HPMC capsules filled with ferrite (MnFe2O4) and coated with Eudragit (R) were evaluated using USP XXII method and administered to fasted volunteers. Single and multisensor ACB systems were used to characterize the gastrointestinal (GI) motility and to determine gastric residence time (GRT), small intestinal transit time (SITT) and orocaecal transit time (OCTT). Mean disintegration time (t (50)) was quantified from 50% increase of pixels in the imaging area.Results. In vitro and in vivo performance of the magnetic HPMC capsules as well as the disintegration process were monitored using ACB systems. The mean disintegration time (t (50)) calculated for in vitro was 25 +/- 5 min and for in vivo was 13 +/- 5 min. In vivo also were determined mean values for GRT (55 +/- 19 min), SITT (185 +/- 82 min) and OCTT (240 +/- 88 min).Conclusions. AC Biosusceptometry is a non-invasive technique originally proposed to monitoring pharmaceutical dosage forms orally administered and to image the disintegration process.

Enrofloxacin assay validation and pharmacokinetics following a single oral dose in chickens

The pharmacokinetics of enrofloxacin (ENRO), a fluoroquinolone antimicrobial agent, was studied in male broiler chickens (Cobb) after single oral administration of 10 mg of ENRO/kg b.w. A high-performance liquid chromatography-photodiode array detector (DAD) (HPLC-DAD) method was developed and validated and used for quantitation of ENRO and its major metabolite ciprofloxacin in plasma. The HPLC analyses were carried out using a cationic-octadecyl mixed column and 0.05 mol/L phosphate buffer (pH 2.5)/acetonitrile as mobile phase. The sample preparation of plasma consisted of the precipitation of proteins followed by solid phase extraction on cationic-octadecyl mixed cartridges. The method was validated considering linear range, linearity, selectivity, sensitivity, limit of detection (LOD), limit of quantitation (LOQ), intra- and inter-day precisions and accuracy. The LOD and LOQ for both fluoroquinolones were 60 and 200 ng/mL for plasma. The plasma concentration vs. time graph was characteristic of a two-compartment open model. The maximal plasma concentration of 1.5 +/- 0.2 mg/mL was achieved at 9 +/- 2 h. The elimination half-life and the mean residence time of ENRO were 1.5 +/- 0.2 and 15.64 h, respectively. The area under the concentration-time curve was calculated as 35 +/- 4 mg(.)h/mL.

Effect of microwave disinfection on the hardness and adhesion of two resilient liners

Statement of problem. Microwave irradiation has been suggested for denture disinfection. However, the effect of this procedure on the hardness and bond strength between resilient liners and denture base acrylic resin is not known.Purpose. This study evaluated the effect of water storage time and microwave disinfection on the hardness and peel bond strength of 2 silicone resilient lining materials to a heat-polymerized acrylic resin.Material and methods. Acrylic resin (Lucitone 199) specimens (75 X 10 X 3 mm) were stored in water at 37 degrees C (2 or 30 days) before bonding (n = 160). The resilient lining materials (GC Reline Extra Soft and Dentusil) were bonded to the denture base and divided into the following 4 groups (n = 10): Tests performed immediately after bonding (control); specimens immersed in water (200 mL) and irradiated twice, with 650 W for 6 minutes; specimens irradiated daily for 7 total cycles of disinfection; specimens immersed in water (37 degrees C) for 7 days. Specimens were submitted to a 180-degree peel test (at a crosshead speed of 10 mm/min) and the failure values (MPa) and mode of failure were recorded. Pretreatment and posttreatment hardness measurements (Shore A) of the resilient materials were also performed. Three-way analysis of variance, followed by the Tukey HSD test, was performed (alpha=.05).Results. The analysis revealed that, for all conditions, the mean failure strengths of GC Reline Extra Soft (0.95-1.19 MPa) were significantly higher (P<.001) than those of Dentusil (0.45-0.50 MPa). The adhesion of the liners was not adversely affected by water storage time of Lucitone 199 or microwave disinfection. All peel test failures were cohesive. There was a small but significant difference (P<.001) between the pretreatment (34.33 Shore A) and posttreatment (38.69 Shore A) hardness measurements.Conclusion. Microwave disinfection did not compromise the hardness of either resilient liners or their adhesion to the denture base resin Lucitone 199.

Phytoplankton structure in two contrasting cascade reservoirs (Paranapanema River, Southeast Brazil)

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

Phytoplankton assemblages in a reservoir cascade of a large tropical - subtropical river (SE, Brazil)

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

Aplicação da técnica de caminhamento elétrico em área contaminada por derivados de petróleo

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Aplicação de métodos geofísicos no monitoramento de área contaminada sob atenuação natural

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Hydro(radio)chemical relationships in the giant Guarani aquifer, Brazil

This investigation was carried out within the Parana sedimentary basin and involved the sampling of 78 pumped tubular wells for evaluating the hydrochemistry and radioactivity due to the nuclides (238)U, (234)U, (222)Ra, (226)Ra, and (228)Ra in the Brazilian part of Guarani aquifer. Several significant correlations were found involving the geostatic pressure, for instance, specific flow rate, CO(3)(2-), SO(4)(2-) temperature, dissolved O(2), free CO(2), pH, redox potential Eh, conductivity, Na, HCO(3)-, CO(3)(2-) , SI(calcite), Cl(-), F(-), SO(4)(2-), and B. Carbonates precipitation was evidenced by inverse correlation between CO(3)(2-) and Ca, Mg, Sr, and Ba, whereas Na exhibited an opposite trend, dissolving rather than precipitating with increasing CO(3)(2-) concentration. An inverse correlation between 3 and K was found, possibly related to the increasing tendency of K to recombine with the thickness of the clayey layers. HCO(3)-played an important role on Na, Ca, Mg, and Sr dissolution. The dissolved U content and (234)U/(238)U activity ratio data were plotted on a two-dimensional diagram that was successfully utilized on identifying an unreported zone of U accumulation, though not necessarily of economic size and grade. The variability in chemical and radionuclides data indicated an important influence of the underlying Paleozoic sediments in the composition of waters from Guarani aquifer. The available data allowed estimate the groundwater residence time by two U-isotopes disequilibrium methods. Values of 45-61 ka were initially calculated, depending on the adopted porosity (15-20%), but a longer residence time (- 640 ka) was also estimated, which is more compatible with the hydraulic conductivity data in Guarani aquifer and groundwater flow velocity occurring at Milk River aquifer, Alberta, Canada. Such time range agrees with previously reported (14)C ages exceeding 30 ka BP at the more central parts of the Parana sedimentary basin. (c) 2005 Elsevier B.V. All rights reserved.