909 resultados para Intrahousehold allocation


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INTRODUCTION: Open access publishing is becoming increasingly popular within the biomedical sciences. SciELO, the Scientific Electronic Library Online, is a digital library covering a selected collection of Brazilian scientific journals many of which provide open access to full-text articles.This library includes a number of dental journals some of which may include reports of clinical trials in English, Portuguese and/or Spanish. Thus, SciELO could play an important role as a source of evidence for dental healthcare interventions especially if it yields a sizeable number of high quality reports. OBJECTIVE: The aim of this study was to identify reports of clinical trials by handsearching of dental journals that are accessible through SciELO, and to assess the overall quality of these reports. MATERIAL AND METHODS: Electronic versions of six Brazilian dental Journals indexed in SciELO were handsearched at www.scielo.br in September 2008. Reports of clinical trials were identified and classified as controlled clinical trials (CCTs - prospective, experimental studies comparing 2 or more healthcare interventions in human beings) or randomized controlled trials (RCTs - a random allocation method is clearly reported), according to Cochrane eligibility criteria. CRITERIA TO ASSESS METHODOLOGICAL QUALITY INCLUDED: method of randomization, concealment of treatment allocation, blinded outcome assessment, handling of withdrawals and losses and whether an intention-to-treat analysis had been carried out. RESULTS: The search retrieved 33 CCTs and 43 RCTs. A majority of the reports provided no description of either the method of randomization (75.3%) or concealment of the allocation sequence (84.2%). Participants and outcome assessors were reported as blinded in only 31.2% of the reports. Withdrawals and losses were only clearly described in 6.5% of the reports and none mentioned an intention-to-treat analysis or any similar procedure. CONCLUSIONS: The results of this study indicate that a substantial number of reports of trials and systematic reviews are available in the dental journals listed in SciELO, and that these could provide valuable evidence for clinical decision making. However, it is clear that the quality of a number of these reports is of some concern and that improvement in the conduct and reporting of these trials could be achieved if authors adhered to internationally accepted guidelines, e.g. the CONSORT statement.

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OBJETIVO: Analisar a associação entre indicadores socioeconômicos, de provisão de serviços públicos odontológicos e de alocação de recursos financeiros em saúde, e identificar se o sentido das associações ocorre em favor da eqüidade vertical. MÉTODOS: Foi realizado um estudo transversal de abordagem ecológica, com dados do Ministério da Saúde referentes a 399 municípios do estado do Paraná, no período de 1998 a 2005. A condição socioeconômica foi aferida por meio do Índice de Desenvolvimento Humano dos municípios, além de indicadores de renda, educação e saneamento básico, os quais foram obtidos nas bases de dados do Instituto Brasileiro de Geografia e Estatística. Os dados foram submetidos a testes estatísticos não-paramétricos: coeficiente de correlação de Spearman, Friedman e Mann-Whitney. RESULTADOS: Houve tendência redistributiva dos recursos federais transferidos aos municípios para o custeio da atenção básica, intensificada a partir do lançamento da Estratégia Saúde da Família. Observou-se expansão das ações de saúde bucal no período analisado, bem como tendência pró-eqüidade na oferta e utilização dos serviços odontológicos em atenção básica. CONCLUSÕES: Houve tendência redistributiva, ou pró-eqüidade, na provisão de serviços odontológicos no estado do Paraná, com maior provisão per capita de recursos ou serviços para municípios com piores indicadores socioeconômicos. Esta tendência se mostrou compatível com as diretrizes programáticas recentes do Ministério da Saúde.

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Sendo as necessidades de saúde mais amplas que os recursos disponíveis, escolhas têm de ser feitas. Disto resulta ser preciso que se estabeleçam limites, critérios e parâmetros para priorizar o que vai ser ofertado e a quem os serviços e os cuidados de saúde serão oferecidos. Discute-se alternativas éticas para a priorização e racionamento de cuidados de saúde, enfocando os princípios da eqüidade e da utilidade social.

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Continued assessment of temporal trends in mortality and epidemiology of specific cardiovascular diseases in South America is needed to provide a scientific basis for rational allocation of the limited healthcare resources and introduction of strategies to reduce risk and predict the future burden of cardiovascular disease. The epidemiology of cardiomyopathies, adult valve disease and heart failure (HF) in South America is reviewed here. Diseases of the circulatory system are the main cause of death based on data from about 50% of the South American population. Among the cardiovascular causes of death, cerebrovascular disease is predominant followed by ischaemic heart disease, other heart diseases and hypertensive disease. Of note, cerebrovascular disease is the main cause of death in women, and race also influenced cardiovascular mortality rates. HF is the most important cardiovascular reason for admission to hospital due to cardiovascular disease of ischaemic, idiopathic dilated cardiomyopathic, valvular, hypertensive and chagasic aetiologies. Also, mortality due to HF is high, especially owing to Chagas' disease. HF and aetiologies associated with HF are responsible for 6.3% of deaths. Rheumatic fever is the leading cause of valvular heart disease. The findings have important public health implications because the allocation of healthcare resources, and strategies to reduce the risk of HF should also consider controlling Chagas' disease and rheumatic fever in South American countries.

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Background: Detailed analysis of the dynamic interactions among biological, environmental, social, and economic factors that favour the spread of certain diseases is extremely useful for designing effective control strategies. Diseases like tuberculosis that kills somebody every 15 seconds in the world, require methods that take into account the disease dynamics to design truly efficient control and surveillance strategies. The usual and well established statistical approaches provide insights into the cause-effect relationships that favour disease transmission but they only estimate risk areas, spatial or temporal trends. Here we introduce a novel approach that allows figuring out the dynamical behaviour of the disease spreading. This information can subsequently be used to validate mathematical models of the dissemination process from which the underlying mechanisms that are responsible for this spreading could be inferred. Methodology/Principal Findings: The method presented here is based on the analysis of the spread of tuberculosis in a Brazilian endemic city during five consecutive years. The detailed analysis of the spatio-temporal correlation of the yearly geo-referenced data, using different characteristic times of the disease evolution, allowed us to trace the temporal path of the aetiological agent, to locate the sources of infection, and to characterize the dynamics of disease spreading. Consequently, the method also allowed for the identification of socio-economic factors that influence the process. Conclusions/Significance: The information obtained can contribute to more effective budget allocation, drug distribution and recruitment of human skilled resources, as well as guiding the design of vaccination programs. We propose that this novel strategy can also be applied to the evaluation of other diseases as well as other social processes.

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Haplodiploidy results in relatedness asymmetries between colony members of highly eusocial Hymenoptera. As a consequence, queen and reproductive workers are more related to their own sons than to each other's male offspring. Kin selection theory predicts multiple optima in male parentage: either the queen or the workers should produce all the males. Nevertheless, shared male parentage is common in highly eusocial hymenopterans. An inclusive fitness model was used to analyze the effect of the number of reproductive workers on male parentage shared by the queen and laying workers by isolating the male component from an inclusive fitness equation using the equal fitness through male condition for each pairwise combination of the three female classes comprised of the queen, laying workers and non-laying workers. The main result of the theoretical analyses showed that the fraction of males produced by workers increases asymptotically with the number of laying workers at an increasingly diminishing rate, tending to an asymptotic value of 0.67. In addition, as the number of laying workers increases, the share of male parentage converges to that of non-laying workers. The diminishing return effect on male parentage share depending on the number of reproductive workers leads us to expect the number of reproductive workers to be relatively small in a stingless bee colony, even in the absence of productivity costs. The available data confirms this hypothesis, as there is an unusually small number of reproductive workers in stingless bee colonies.

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Background: Sigma factors and the alarmone ppGpp control the allocation of RNA polymerase to promoters under stressful conditions. Both ppGpp and the sigma factor sigma(S) (RpoS) are potentially subject to variability across the species Escherichia coli. To find out the extent of strain variation we measured the level of RpoS and ppGpp using 31 E. coli strains from the ECOR collection and one reference K-12 strain. Results: Nine ECORs had highly deleterious mutations in rpoS, 12 had RpoS protein up to 7-fold above that of the reference strain MG1655 and the remainder had comparable or lower levels. Strain variation was also evident in ppGpp accumulation under carbon starvation and spoT mutations were present in several low-ppGpp strains. Three relationships between RpoS and ppGpp levels were found: isolates with zero RpoS but various ppGpp levels, strains where RpoS levels were proportional to ppGpp and a third unexpected class in which RpoS was present but not proportional to ppGpp concentration. High-RpoS and high-ppGpp strains accumulated rpoS mutations under nutrient limitation, providing a source of polymorphisms. Conclusions: The ppGpp and sigma(S) variance means that the expression of genes involved in translation, stress and other traits affected by ppGpp and/or RpoS are likely to be strain-specific and suggest that influential components of regulatory networks are frequently reset by microevolution. Different strains of E. coli have different relationships between ppGpp and RpoS levels and only some exhibit a proportionality between increasing ppGpp and RpoS levels as demonstrated for E. coli K-12.

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To test whether plant species influence greenhouse gas production in diverse ecosystems, we measured wet season soil CO(2) and N(2)O fluxes close to similar to 300 large (>35 cm in diameter at breast height (DBH)) trees of 15 species at three clay-rich forest sites in central Amazonia. We found that soil CO(2) fluxes were 38% higher near large trees than at control sites >10 m away from any tree (P < 0.0001). After adjusting for large tree presence, a multiple linear regression of soil temperature, bulk density, and liana DBH explained 19% of remaining CO(2) flux variability. Soil N(2)O fluxes adjacent to Caryocar villosum, Lecythis lurida, Schefflera morototoni, and Manilkara huberi were 84%-196% greater than Erisma uncinatum and Vochysia maxima, both Vochysiaceae. Tree species identity was the most important explanatory factor for N(2)O fluxes, accounting for more than twice the N(2)O flux variability as all other factors combined. Two observations suggest a mechanism for this finding: (1) sugar addition increased N(2)O fluxes near C. villosum twice as much (P < 0.05) as near Vochysiaceae and (2) species mean N(2)O fluxes were strongly negatively correlated with tree growth rate (P = 0.002). These observations imply that through enhanced belowground carbon allocation liana and tree species can stimulate soil CO(2) and N(2)O fluxes (by enhancing denitrification when carbon limits microbial metabolism). Alternatively, low N(2)O fluxes potentially result from strong competition of tree species with microbes for nutrients. Species-specific patterns in CO(2) and N(2)O fluxes demonstrate that plant species can influence soil biogeochemical processes in a diverse tropical forest.

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Governmental programmes should be developed to collect and analyse data on healthcare associated infections (HAIs). This study describes the healthcare setting and both the implementation and preliminary results of the Programme for Surveillance of Healthcare Associated Infections in the State of Sao Paulo (PSHAISP), Brazil, from 2004 to 2006. Characterisation of the healthcare settings was carried out using a national database. The PSHAISP was implemented using components for acute care hospitals (ACH) or long term care facilities (LTCF). The components for surveillance in ACHs were surgical unit, intensive care unit and high risk nursery. The infections included in the surveillance were surgical site infection in clean surgery, pneumonia, urinary tract infection and device-associated bloodstream infections. Regarding the LTCF component, pneumonia, scabies and gastroenteritis in all inpatients were reported. In the first year of the programme there were 457 participating healthcare settings, representing 51.1% of the hospitals registered in the national database. Data obtained in this study are the initial results and have already been used for education in both surveillance and the prevention of HAI. The results of the PSHAISP show that it is feasible to collect data from a large number of hospitals. This will assist the State of Sao Paulo in assessing the impact of interventions and in resource allocation. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

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This paper aims to find relations between the socioeconomic characteristics, activity participation, land use patterns and travel behavior of the residents in the Sao Paulo Metropolitan Area (SPMA) by using Exploratory Multivariate Data Analysis (EMDA) techniques. The variables influencing travel pattern choices are investigated using: (a) Cluster Analysis (CA), grouping and characterizing the Traffic Zones (17), proposing the independent variable called Origin Cluster and, (b) Decision Tree (DT) to find a priori unknown relations among socioeconomic characteristics, land use attributes of the origin TZ and destination choices. The analysis was based on the origin-destination home-interview survey carried out in SPMA in 1997. The DT application revealed the variables of greatest influence on the travel pattern choice. The most important independent variable considered by DT is car ownership, followed by the Use of Transportation ""credits"" for Transit tariff, and, finally, activity participation variables and Origin Cluster. With these results, it was possible to analyze the influence of a family income, car ownership, position of the individual in the family, use of transportation ""credits"" for transit tariff (mainly for travel mode sequence choice), activities participation (activity sequence choice) and Origin Cluster (destination/travel distance choice). (c) 2010 Elsevier Ltd. All rights reserved.

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This paper presents a strategy for the solution of the WDM optical networks planning. Specifically, the problem of Routing and Wavelength Allocation (RWA) in order to minimize the amount of wavelengths used. In this case, the problem is known as the Min-RWA. Two meta-heuristics (Tabu Search and Simulated Annealing) are applied to take solutions of good quality and high performance. The key point is the degradation of the maximum load on the virtual links in favor of minimization of number of wavelengths used; the objective is to find a good compromise between the metrics of virtual topology (load in Gb/s) and of the physical topology (quantity of wavelengths). The simulations suggest good results when compared to some existing in the literature.

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This paper presents results of research into the use of the Bellman-Zadeh approach to decision making in a fuzzy environment for solving multicriteria power engineering problems. The application of the approach conforms to the principle of guaranteed result and provides constructive lines in computationally effective obtaining harmonious solutions on the basis of solving associated maxmin problems. The presented results are universally applicable and are already being used to solve diverse classes of power engineering problems. It is illustrated by considering problems of power and energy shortage allocation, power system operation, optimization of network configuration in distribution systems, and energetically effective voltage control in distribution systems. (c) 2011 Elsevier Ltd. All rights reserved.

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This paper presents results of research related to multicriteria decision making under information uncertainty. The Bell-man-Zadeh approach to decision making in a fuzzy environment is utilized for analyzing multicriteria optimization models (< X, M > models) under deterministic information. Its application conforms to the principle of guaranteed result and provides constructive lines in obtaining harmonious solutions on the basis of analyzing associated maxmin problems. This circumstance permits one to generalize the classic approach to considering the uncertainty of quantitative information (based on constructing and analyzing payoff matrices reflecting effects which can be obtained for different combinations of solution alternatives and the so-called states of nature) in monocriteria decision making to multicriteria problems. Considering that the uncertainty of information can produce considerable decision uncertainty regions, the resolving capacity of this generalization does not always permit one to obtain unique solutions. Taking this into account, a proposed general scheme of multicriteria decision making under information uncertainty also includes the construction and analysis of the so-called < X, R > models (which contain fuzzy preference relations as criteria of optimality) as a means for the subsequent contraction of the decision uncertainty regions. The paper results are of a universal character and are illustrated by a simple example. (c) 2007 Elsevier Inc. All rights reserved.

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The paper proposes a methodology and design rules for organisational structures facing higher necessity of rapidly reconfigure themselves to cope with unpredictable situations-new markets, new products, changing mix of production, problems in production process or flows etc. It implies changing and often conflictive criteria for production goals and for the allocation of work. The methodology was developed based on a large field action research and consulting. Their basis is the design of auto-reconfigurable working groups-or groups with variable geometry, depending on the events to face. (C) 2009 Elsevier B.V. All rights reserved.

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Scheduling parallel and distributed applications efficiently onto grid environments is a difficult task and a great variety of scheduling heuristics has been developed aiming to address this issue. A successful grid resource allocation depends, among other things, on the quality of the available information about software artifacts and grid resources. In this article, we propose a semantic approach to integrate selection of equivalent resources and selection of equivalent software artifacts to improve the scheduling of resources suitable for a given set of application execution requirements. We also describe a prototype implementation of our approach based on the Integrade grid middleware and experimental results that illustrate its benefits. Copyright (C) 2009 John Wiley & Sons, Ltd.