Validação de protocolo de assistência para pessoas com úlcera venosa na atenção primária

People with venous ulcers constitute as an important public health problem, its treatment is onerous and require assistance provided by trained professionals, systematized through protocols, however what lies in the assistance is that the management of this group of people differs from that preconized in the scientific literature, interfering with wound healing and quality of life of affected. In this sense, the construction of a assistance protocol specific to people with venous ulcers (VU) can help professionals of the Family Health Strategy both in patient assessment as and in establishment of quality assistance. Thus, this study aimed to analyse the validity of a multiprofessional assistance protocol for people with venous ulcers in primary care by health professionals using Delphi technique. This is a quantitative study, the methodological type conducted in two steps: first step related to integrative literature review to subsidize the development of the protocol, then these aspects were organized and proposed to the judges of the study through the Delphi technique. The study was initiated after approval by the Research Ethics Committee. The first step was performed between August and September 2012, in the virtual library of health, in the page of the Coordination of Improvement of Higher Education Personnel, of Municipal Health Secretariat and international guidelines of associations and in the subsequent step carried out between September 2012 to January 2013, was performed search by Lattes platform of the National Council of Technological and Scientific Development, in order to identify health professionals in Brazil who act as judges of the instrument and then, via online, the form was submitted to them.The sample for the second step was 51 judges in the first round and 35 for the second round Delphi. The analysis was done by adopting Kappa index ≥ 0.81 and Content Validity Index (CVI)> 0.80. In the first submission for the judges, items that did not reach Kappa and CVI established were: request / realization / test results, demographic data, medical history, risk factors, verification of pain / vital signs / pulse / infection signs / lesion location/ edema and pain treatment. After removal of items which have not obtained Kappa or CVI index established, it was found achieving optimal levels of these index for the categories. In the next step was the ressubmissão of protocol to judges through the Delphi technique in it was found that, of the 15 categories of the protocol, 12 presented higher scores in Delphi 2 phase and the other three categories remained the same Kappa and IVC of the previous phase. As for the average of evaluation requirements of the protocol was found that the scores assigned by the judges were higher in the second phase in nine of the 10 items, remaining the same in only one of the items indicating validity of the instrument before the consensus of the judges. Thus, we accepted the alternative hypothesis in this study, as they were obtained in the second Delphi phase the validity index greater than or equal to the Delphi 1 phase. The formulation of this assistance protocol valid and reproducible will enable a reorganization and redesign of assistance, with standardization of actions and continuity of care for persons with venous ulcers in primary health care

Efficiency of a constructed wetland for wastewaters treatment

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

A pessoa idosa com doença crônica não transmissível atendida em serviços de média complexidade na cidade de Natal/RN

The demographic and epidemiological transition process caused by a declining in birth rates and in mortality, also changes occurred in morbidity and mortality is represented by the increasing of the aging population and the raising of chronic diseases. These diseases are characterized by multiple etiologies, risk factors, long latency period, a prolonged evolution, non-infectious origin and it has association with functional impairment and disability. Thus, elderly with chronic non-communicable disease has priority because they belong to a vulnerable group to get affection of comorbidities in aging, with increased demand and spending on health services. This study is aimed to analyse the understanding of elderly people with chronic non comunicable disease in the medium complexity service as a contribution to the improvement of health care in the city of Natal / RN. This is a descriptive and exploratory study with a quantitative approach, carried out at the Specialized Center for Elderly Health Care and at the Pescadores Hospital. The population was composed of 4,180 persons with a sample of 124 elderly aged above 60 years, attended in these medium complexity services. The instrument, a structured form, adapted from a questionnaire for monitoring risk and protective factors for chronic disease of the Ministry of Health. To collect data was was used the interview form containing demographic data, habits, health status and health care services. The results were processed using the Statistical Package for Social Science, version 18.0, analyzed by simple statistics. It was found that most seniors were female, predominantly between 70 and 74 years old, married, with a brown skin tone and Catholic religion, more than half had incomplete basic education, family income between one to two minimum wages and living with their families. Regarding the interviewers lifestyle, 94.4%, of them ate chicken and 97.6%, fruits, it was observed a reduction in smoking, alcoholism habits and physical activity according to the increasing age, 58.1 and 18.5% had insomnia18,5 % used sleeping pills. The elderly (51.6%) reported using services in times of sickness, seeking primary care at first (30.6%), 52% did not receive referral and was looking for free demand (38.7%). The most reported morbidity was hypertension, followed by musculoskeletal disorders. Regarding the difficulties in seeking health services, the delay in treatment and the waiting line were the most cited by the elderly. Almost all of them reported no activities to promote health in these services and those who received individual counseling on chronic diseases. Almost always, the health professionals who care of them, were mostly doctors followed by nurses. Based on the results presented, it is considered that the health services of medium complexity must undergone a more continuous dialogue with other attention level and focus on actions of health promotion and prevention. It is also recommended the necessity for qualified professionals to delivery health care to elderly and the implementation of protocols by a multidisciplinary health team, intending to provide better and continous care for the elderly with chronic diseases. The healthcare professionals who served them, were mostly physicians, followed by nurses. Through the results presented, it is considered that the medium complexity healthcare services need to perform a more continuous dialogue with the other levels of attention focusing attention to the health promotion and prevention actions. It is also recommended the necessity for qualified professionals to delivery healthcare for the elderly, in addition, a protocol implementation for the multidisciplinary health care team, to provide better care, and also the care continuity to elderly with chronic diseases

Conquistas e desafios do processo de trabalho de enfermagem: o caso dos CAPS em Natal/RN

The Brazilian Psychiatric Reform proposes creating linkages / interactions of the mentally ill with civil society , through promoting citizenship and assistance to the mentally ill. The deinstitutionalization of mental health advocates from the guidelines decreased supply of hospital beds and consequently the creation of substitute services for psychosocial care, especially with regard to therapeutic practices emancipatory. From this scenario, the present study aims to investigate the relevance and challenges of the process of nursing work in CAPS III in Natal / RN. It is descriptive research with a qualitative and exploratory. The subjects are employees of the nursing team in CAPS III East of Natal / RN. This service has actions for the psychosocial care of the subjects treated with daily multidisciplinary care by behaving the length of treatment and follow-up activities, industrial and cultural activities. Employ the semi-structured interview as a tool for data collection. The data analysis was done by means of thematic analysis proposed by Bardin. Thus, this sought to bring to the discussion of how this process is consolidated in the daily service. Thus, purposed to contribute to the debate on deinstitutionalization in psychosocial care as a guideline in the process of mental health nursing work in a CAPSIII, Natal / RN

Trauma em idosos atendidos pelo serviço pré-hospitalar móvel

O The aim of this study was to characterize the occurrence of trauma in the elderly population served by the mobile pre-hospital service, in Natal, Rio Grande do Norte. This is a descriptive, transversal and quantitative approach and whose population consisted of 2,080 trauma victims. The sample, of systematic random type, consisted of 400 elderly people, aged from 60 years old, assisted by the Office of Mobile Emergency in Natal / RN, between January 2011 and December 2012. Data collection began after consent and assent of the institution of a Research Ethics Committee under No. 309 505. It was proceeded to documentary retrospective analysis of records of this service through a form of self-development, validated by expert judges considered reliable (α> 0.75) and valid (CVI = 0.97) in their clarity and relevance. Data were tabulated by the Statistical Package for Social Sciences, version 20.0. The results show that older victims have an average age of 74.19 years old, with a prevalence of female involvement by chronic diseases, especially hypertension, average usage of 2.2 routine medications with vital signs within normal limits. The trauma prevailed during the daytime, in the residence of the victims, north of the city and on weekends. Among the mechanisms of trauma were falls, traffic accidents and physical aggression, whose most common type was brain-cerebral trauma and the main consequences were suture wounds and closed fractures. Basic Support Units were as more driven to pre-hospital care (87.8%) and the main destination place consisted of a referral hospital for emergency of the state (57.5%). Among the most commonly performed procedures by nursing staff immobilization with rigid board and neck collar and the peripheral venipuncture, and the main component used for volume replacement to saline were highlighted. There was a significant relationship between the deaths and the mechanism of injury, mechanism of injury and procedures, except medication administration procedures carried out, except immobilization and unit for service. It is highlighted the prevalence of trauma in the elderly, poor follow-up Pre-Hospital Trauma Life Support protocol and the paucity of records and nursing procedures performed. There is need for a protocol of care specific to elderly trauma victims and education strategies for the prevention of such events

Responsabilidade social e competitividade :um estudo sobre a influência de práticas sociais na decisão de escolha de um destino turístico

The work objective was to investigate the influence of social practices social in the choise decision of a tourist destination. For in such a way, a survey with the aid of a questionnaire, was used as being the research instrument. The study used a simple random sample without replacement, due to elements of the population had a equal probability different of zero, to be selected for forming part of the sample. The used collection method of data was personal interview. The data was collected at Augusto Severo International Airport at the moment in which tourists were embarking in return to the residence place or another tourist destination. For determination of sample size, it was considered the tourist who had visited Natal in November and December, 2004, supplied by the Secretariat of Tourism in the RN. The sample for the research was of 403 people. Results showed that the interviewed express the existence of high level of competitiveness in the tourism industry. It was observed that 42.5% of the interviewed believes to exist a very aggressive competition, and 47.5% believed that the competition is aggressive in the tourism industry. 10.4% of the interviewed expressed much interest in knowing about social practices in the tourism industry and 2.8% had not presented any interest in knowing about social practices in the tourism industry. For the interviewed, the travel agency image is a significant item in the choice for a tourist package, because of 35.6% believed that this factor is very important in the choice. 5% of the interviewed only find that little important or that sometimes the travel agency image can be seen as s decisive factor in the tourist package choice

Desenvolvimento de um sistema de indicadores de desempenho para empreendimentos em construção civil, utilizando a abordagem macroergonômica

This paper presents the validation of the Performance Indicator System for Projects under Construction - SIDECC. The goal was to develop a system of performance indicators from the macroergonômica approach, considering criteria of usefulness, practicality and applicability and the concept of continuous improvement in the construction industry. The validation process SIDECC consisted of three distinct models. Modeling I corresponded to the theoretical development and validation of a system of indicators. Modeling II concerns the development and validation of multi- indicator system. For this modeling, we used the Mother of Use and Importance and Multivariate Analysis. Modeling III corresponded to the validation situated, which consisted of a case study of a work of construction of buildings, which were applied and analyzed the results of modeling II. This work resulted in the development of an applied and tested for the construction of an integrated system of performance indicators methodology, involving aspects of production, quality, environmental, health and safety. It is inferred that the SIDECC can be applied, in full or in part, the construction companies as a whole, as well as in other economic sectors

Desenvolvimento e implementação de um sistema de supervisão e controle residencial

With the technological progress the people are more and more looking for convenience, comfort and safety to your homes. The residential automation is winning space on the market not only by the status and modernity that provide, but also to allow a better use of natural resources, reducing the expense to keep up a residence. This work shows the development of a control system and supervision to be destined to the residential automation. The developed software will be working together with a controller (PLC), acting in the administration, control and supervision all the linked devices, and offering to the user an environment simple and practical for the control residence

Análise do desempenho térmico de um sistema de aquecimento solar utilizando coletor com superfície absorvedora em chapas de PVC

It s presented a solar collector to be used in a system for heating bath water, whose main characteristic is its low cost. The collector consists of five plates of PVC with 10 mm thick, 200 mm in width and 1400mm in length, with an area equal to 1.4 square meters. The plates were connected in parallel to the ends of PVC tubes of  40 mm and 32 mm. The plates were coated on one side with aluminum sheets of soft drinks and beers cans open. The system worked on a thermosiphon and was tested in two configurations: the plates uncoated and coated with aluminum material, to determine the influence of material on the efficiency of the collector. For both configurations was used EPS plates below the surface to minimize heat losses from the botton. The thermal reservoir of the heating system is, also, alternative and low cost, since it was constructed from a polyethylene tank for storing water, with volume of 150 end 200 liters. It will be presented the thermal efficiency, heat loss, water temperature of the thermal reservoir at the end of the process and simulation of baths for a house with four residents. The will be demonstrated thermal, economic and material viability of the proposed collector, whose main innovation is the use of recyclables materials, cans of beer and soft drinks, to increase the temperature of the absorber plate.

Compósito para fabricação de blocos para construção de casas: estudos térmico e de materiais

We present two models of blocks made of composite material obtained from the use of cement, plaster, EPS crushed, shredded tire, mud, sand and water, for the construction of popular housing. Were made metal molds for the manufacture of blocks to be used in the construction of a residence for low-income families. Performed tests of compressive strength of the composite for various formulations that met the specific standard for blocks used in construction. To study the thermal conductivity of the composite for further study of thermal comfort generated in a residence built with the proposed composite. We also determined the mass-specific and water absorption for each formulation studied. Using a home already built with another composite material, made up the closing of a window with the building blocks and found the thermal insulation, measuring external and internal temperatures of the blocks. The blocks had made good thermal insulation of the environment, resulting in differences of up to 12.6°C between the outer and inner faces. It will be shown the feasibility of using composite for the end proposed and chosen the most appropriate wording

Estudo da hidrodinâmica de um novo separador líquido-líquido: aplicação ao sistema óleo-bruto/água produzida

This work aims to use a different hydrodynamic condition applied to a new design of mixer-settler on treating wastewater produced by petroleum industry, called MDIF (Misturador-Decantador à Inversão de Fases/ Mixer-Settler based on Phase Inversion MSPI). The use of this different hydrodynamic behaviour is possible due to vertical disposition of the device and the principle of Phase Inversion that controls the MDIF, providing the generation (creation) of a cascade of drops, into an organic layer, that works as micro-decanters, thus making possible the formation of a bed of non-coalesced drops, called Bed Formation . The use of this new hydrodynamics condition allows to increase the residence time of the oil carrier drops, into an organic layer, and the device can treat a greater volume of wastewater. In view of to get this condition it is necessary to operate at high throughput (58,6 m3.m-2.h-1). By results, the condition of Bed Formation is the best one to be used when MSPI operates with throughput up to 58,6 m3.m-2.h-1. The results using the condition of Bed Formation show that increasing the height of the bed of non-coalesced drops and/or decreasing the volumetric ratio (O/A) an increase of the separation efficiency is detected

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

Ephemeroptera, Plecoptera and Trichoptera assemblages in litter in a mountain stream of the Atlantic Rainforest from Southeastern Brazil

A fauna de Ephemeroptera, Plecoptera e Trichoptera associadas ao folhiço em um riacho do sudeste do Brasil foi estudada com o objetivo de responder às seguintes questões: 1) A riqueza e a composição faunística de EPT difere entre os dois mesohabitats (corredeira-remanso) mesmo quando associadas ao mesmo substrato, folhiço? 2) A similaridade da fauna de EPT entre os dois mesohabitas muda temporalmente? 3) A estrutura funcional de EPT difere entre os dois mesohabitats (corredeira-remanso)? Para responder essas questões, coletas mensais, de novembro de 1999 a junho de 2000, foram feitas no Ribeirão Bocaina com rede D (10 acúmulos de folhas em remanso e 10 em corredeira). A fauna de EPT do Ribeirão Bocaina foi mais diversificada e mais abundante no folhiço em corredeira do que no folhiço em remanso, no entanto, quando a riqueza foi padronizada para o mesmo número de indivíduos essa se tornou similar para as duas condições. A fauna de EPT foi bastante diferente entre os dois mesohabitats, tanto em termos da composição faunística quanto em termos funcionais. Isso provavelmente ocorreu devido às diferenças de velocidade da água, no tempo de residência do folhiço e na taxa de oxigênio da água entre os dois mesohabitats.

Simulações da ação do vento e da dispersão de contaminantes no estuário do Rio Potengi/ Brasil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior