La Réforme des soins en santé mentale en Belgique: analyse d'un modéle

RESUMO: O relatório anual de 2001 da Organização Mundial de Saúde (OMS), anunciou o interesse social dos problemas crescentes em matéria de saúde mental e relativo à necessidade urgente de uma extensão, como também, para uma melhor organização da oferta de tratamento. Sob proposta da Bélgica, esta observação foi traduzida em uma resolução « Mental health :responding to the call for action » (déclaração de intenção do 18 de maio de 2002). Nós notamos que certos países, como os Estados Unidos ou a Grã Bretanha transformam sistematicamente o tratamento residencial em um tratamento mais dirigido para a comunidade. Eles também se concentram na descoberta prematura dos problemas psiquiátricos. Este fenômeno de désinstitutionalisação obteve resultados concretos e traz um ganho certo, tanto para os atores do campo da saúde mental, como também para os candidatos a um tratamento. O tratamento das pessoas dentro do seu meio de vida é muito claramente reconhecido. As evoluções que marcaram os tratamentos em saúde mental na Bélgica durante estes utimos 40 anos mostram que vários paços importantes já foram feitos. A reforma tem como objetivo converter a oferta hospitalar e montar tratamentos dirigidos para e dentro da comunidade pela criação de equipas móveis que se inscrevem no dispositivo comunitário, historicamente muito activo bem que sub-financiado. A reorganização dos sistemas de tratamento está baseada na criação de redes, para construir um dispositivo flexível e contínuo que considera as necessidades dos pacientes. Esta reforma é, ao mesmo tempo, ambiciosa e complexa,. É uma visão nova, uma mudança de cultura, não só, para todos os atores da saúde mental, mas também para os pacientes e suas famílias. A reforma está baseada numa visão global e integrada que associa no mesmo movimento todas as autoridades competentes relativamente a saúde que elas sejam federais, regionais ou comunitárias.-----------ABSTRACT: The World Health Organization’s (WHO) annual report of 2001 identified a social interest for the increasing problems related to mental health and the urgent need of an extension and a better organization of mental health care. On a proposal of Belgium this statement was transformed into a resolution « Mental health: responding to the call for action» (Declaration of Intent, May 18th, 2002). Some countries such as the USA or the UK systematically dismantled in-patient residential care in favor of more community-based care and a focus on early detection of psychiatric problems. This de -institutionalization has clearly and concretely paid off and the value of bringing mental health care to claimants and treating them in their own residence was acknowledged. In Belgium, the evolutions which have shaped mental health care in the last forty years indicate that a number of important steps are already taken. The Reform aims to convert the supply of hospital care into community-based mental health care services through the creation of mobile teams which offer services in everyday life of the user. These teams take place in the community, historically highly active howbeit underfunded. The reorganization of health care system relies upon the creation of networks in order to build a flexible and continuous device which take into account user’s needs. This Reform can be seen as both ambitious and complex. It is a completely new vision, a major cultural shift for all mental health care stakeholders, but also for users and their relatives. The Reform is based on a global and integrated approach which links I, a same movement all relevant health authorities whether they be federal, regional or community. de-institutionalization – community mental health – recovery - users and families involvement - networking.

Characterization of microbial populations in a wastewater treatment plant focusing on Staphylococcus aureus and Pseudomonas aeruginosa

Dissertação de mestrado em Bioengenharia

Controle das parasitoses gastrintestinais em ovinos e caprinos na região semiárida do Nordeste do Brasil

Neste artigo são revisados alguns conceitos importantes a serem considerados para o controle de parasitas gastrintestinais em caprinos e ovinos. Descrevem-se as características epidemiológicas desta parasitose no semiárido e o aparecimento de resistência aos anti-helmínticos na região. São propostas alternativas para o controle da doença levando em consideração, principalmente, a adoção de técnicas de controle integrado de parasitas com uma mudança nos sistemas de tratamento preventivo para sistemas que permitam a sobrevivência de parasitas susceptíveis na refugia. São discutidas as diferenças entre caprinos e ovinos, considerando que os caprinos são mais susceptíveis e que para maioria das drogas devem ser tratados com doses maiores.

A eficiência desinfetante do hipoclorito de sódio em efluentes de pequenas comunidades

Esse trabalho apresenta os resultados obtidos através de ensaios realizados com diferentes tipos de efluentes tratados de diferentes formas de tratamento de esgotos. Foi selecionado um tipo de desinfetante, o Hipoclorito de Sódio para testar sua capacidade como agente desinfetante desses esgotos tratados e avaliar a sanidade das águas após sua aplicação. Foram avaliados quatro diferentes tipos de sistemas de tratamento de esgotos: lodos ativados de aeração extendida, lagoas de estabilização, reator anaeróbio de manto de lodos de fluxo ascendente e reator seqüencial em batelada. O experimento foi dividido basicamente em duas etapas; na primeira foram realizados testes de batelada em laboratório, tentado verificar os resultados quando os esgotos são submetidos à desinfecção na forma estática. A segunda etapa, constituiu-se no teste de desinfecção utilizando uma estação piloto tentando dessa forma simular a desinfecção quando o material é submetido a um regime hidrodinâmico. Foi mensurada a eficiência do desinfetante através do teste de coliformes fecais e totais nos diferentes tipos de esgotos e em variados tipos de dosagens. Simultaneamente verificou-se a formação de Trihalometanos, subproduto da Hipocloração. Eficiências de inativação de 99,99% foram obtidas em tempos de detenção e doses típicas de sistemas de tratamento em escala real. Nos tempos de detenção e dosagens adotadas não houve formação considerável de Trihalometanos.

Sistema modular de gestão de águas residuárias domiciliares : uma opção mais sustentável para a gestão de resíduos líquidos

Sistemas convencionais de coleta e tratamento de esgotos domiciliares apresentam níveis de eficiência técnica e econômica nem sempre compatíveis com a realidade de alguns assentamentos humanos. A observação da história e da atualidade dos sistemas de tratamento e disposição dos esgotos, mostra uma permanente deficiência do tratamento dos resíduos líquidos. O estudo do uso da água e do ciclo hidrológico, ressalta a importância de que a intervenção humana neste ciclo se dê de forma sustentável. Um sistema que trate as águas servidas no local, e permita o aproveitamento dos poluentes destas águas na forma de insumos para a produção vegetal, devolvendo-as, purificadas para o ciclo hidrológico, pela evapotranspiração e infiltração no solo, certamente é mais sustentável que a maioria das soluções hoje adotadas. Neste trabalho, a partir de uma revisão bibliográfica sobre alternativas tecnológicas, é apresentado um estudo comparativo de diferentes sistemas de coleta e tratamento de esgotos tendo como variáveis de análise os custos de construção, operação e manutenção, a área necessária para a implantação do sistema, os volumes dos lodos e dos gases produzidos, e a qualidade do efluente do tratamento. O tratamento, em separado, das águas residuárias residenciais, apoia-se em vários estudos realizados nos últimos anos, em especial da microbiologia dos esgotos. Destacam-se os que apontam a eficiência do tratamento diretamente relacionada à concentração dos esgotos e justificam a separação das águas negras (descargas hídricas dos vasos sanitários), das cinzas (demais águas servidas) Os estudos para o tratamento das águas cinzas, especificamente, onde se demonstra que estas últimas não têm os elevados índices de poluição das águas negras, permitem tratamentos mais simplificados e econômicos. Estes fundamentos estão aplicados em um sistema modular com separação das águas (SMSA), proposto neste trabalho, um sistema de construção simples, que utiliza materiais comuns, que requer pouca manutenção e não necessita de energia externa para o seu funcionamento. Este sistema proporciona um tratamento final seguro, pela disposição dos efluentes previamente tratados, no leito de evapotranspiração e infiltração que, bem operado, pode oferecer um tratamento a nível terciário. Palavras-chave: saneamento; tratamentos

Diagnóstico ecotoxicológico dos efluentes lançados no complexo estuarino do Jundiaí/Potengi, Natal/RN

Untreated effluents that reach surface water affect the aquatic life and humans. This study aimed to evaluate the wastewater s toxicity (municipal, industrial and shrimp pond effluents) released in the Estuarine Complex of Jundiaí- Potengi, Natal/RN, through chronic quantitative e qualitative toxicity tests using the test organism Mysidopsis Juniae, CRUSTACEA, MYSIDACEA (Silva, 1979). For this, a new methodology for viewing chronic effects on organisms of M. juniae was used (only renewal), based on another existing methodology to another testorganism very similar to M. Juniae, the M. Bahia (daily renewal).Toxicity tests 7 days duration were used for detecting effects on the survival and fecundity in M. juniae. Lethal Concentration 50% (LC50%) was determined by the Trimmed Spearman-Karber; Inhibition Concentration 50% (IC50%) in fecundity was determined by Linear Interpolation. ANOVA (One Way) tests (p = 0.05) were used to determinate the No Observed Effect Concentration (NOEC) and Low Observed Effect Concentration (LOEC). Effluents flows were measured and the toxic load of the effluents was estimated. Multivariate analysis - Principal Component Analysis (PCA) and Correspondence Analysis (CA) - identified the physic-chemical parameters better explain the patterns of toxicity found in survival and fecundity of M. juniae. We verified the feasibility of applying the only renewal system in chronic tests with M. Juniae. Most efluentes proved toxic on the survival and fecundity of M. Juniae, except for some shrimp pond effluents. The most toxic effluent was ETE Lagoa Aerada (LC50, 6.24%; IC50, 4.82%), ETE Quintas (LC50, 5.85%), Giselda Trigueiro Hospital (LC50, 2.05%), CLAN (LC50, 2.14%) and COTEMINAS (LC50, IC50 and 38.51%, 6.94%). The greatest toxic load was originated from ETE inefficient high flow effluents, textile effluents and CLAN. The organic load was related to the toxic effects of wastewater and hospital effluents in survival of M. Juniae, as well as heavy metals, total residual chlorine and phenols. In industrial effluents was found relationship between toxicity and organic load, phenols, oils and greases and benzene. The effects on fertility were related, in turn, with chlorine and heavy metals. Toxicity tests using other organisms of different trophic levels, as well as analysis of sediment toxicity are recommended to confirm the patterns found with M. Juniae. However, the results indicate the necessity for implementation and improvement of sewage treatment systems affluent to the Potengi s estuary

Aperfeiçoamento no projeto de um protótipo de misturador-decantador à inversão de fases visando aplicação na indústria do petróleo

In the oil industry the mixture oil/water occurs in the operations of production, transportation and refining, as well as during the use of its derivatives. The amount of water produced associated with the oil varies and can reach values of 90% in volume in the case of mature phase of the production fields. The present work deals with the development of new design of the Mixer Settler based on Phase Inversion (MDIF) in a laboratory scale. We envisage this application in industrial scale so the phases of project, construction and operation are considered. The modifications most significant, in comparison with the original prototype, include the materials of construction and the substitution of the equipment used in the mixing stage of the process. It was tested the viability of substitution of the original system of mechanical mixing by a static mixer. A statistical treatment by means of an experimental design of composed central type was used in order to evaluate the behavior of the main variables of the separation process as function of the efficiency of separation for the new device. This procedure is useful to delimit an optimal region of operation with the equipment. The variables of process considered on the experimental design were: oil concentration in the feeding water (mg/L); Total volumetric flow rate (L/h); Ratio organic/water on volumetric basis (O/A). The separation efficiency is calculated by comparison of the content of oil and greases in the inlet and outlet of the equipment. For determination of TOG (Total Oil and Grease), the method used was based in the absorption of radiation in the infra-red region. The equipment used for these determinations was InfraCal® TOG/TPH Model HATR-T2 of the Wilks Enterprise, Incorporation. It´s important to stand out that this method of measure has being used by PETROBRAS S.A. Results of global efficiency of separation oil/water varied from 75.3 to 97.7% for contaminated waters containing up to 1664,1 mg/L of oil. By means of tests carried out with a real sample of contaminated water supplied by PETROBRAS we have got an effluent specified in terms of the legal standards required for discharging. Thus, the new design of equipment constitutes a real alternative for the conventional systems of treatment of produced water in the oil industry

Preparação e caracterização de um material híbrido, à base de vermiculita modificada com quitosana, para a remoção de íons de chumbo presentes em efluentes sintéticos

Actually, surveys have been developed for obtaining new materials and methodologies that aim to minimize environmental problems due to discharges of industrial effluents contaminated with heavy metals. The adsorption has been used as an alternative technology effectively, economically viable and potentially important for the reduction of metals, especially when using natural adsorbents such as certain types of clay. Chitosan, a polymer of natural origin, present in the shells of crustaceans and insects, has also been used for this purpose. Among the clays, vermiculite is distinguished by its good ion exchange capacity and in its expanded form enhances its properties by greatly increasing its specific surface. This study aimed to evaluate the functionality of the hybrid material obtained through the modification of expanded vermiculite with chitosan in the removal of lead ions (II) in aqueous solution. The material was characterized by infrared spectroscopy (IR) in order to evaluate the efficiency of modification of matrix, the vermiculite, the organic material, chitosan. The thermal stability of the material and the ratio clay / polymer was evaluated by thermogravimetry. To evaluate the surface of the material was used in scanning electron microscopy (SEM) and (BET). The BET analysis revealed a significant increase in surface area of vermiculite that after interaction with chitosan, was obtained a value of 21, 6156 m2 / g. Adsorption tests were performed according to the particle size, concentration and time. The results show that the capacity of removal of ions through the vermiculite was on average 88.4% for lead in concentrations ranging from 20-200 mg / L and 64.2% in the concentration range of 1000 mg / L. Regarding the particle size, there was an increase in adsorption with decreasing particle size. In fuction to the time of contact, was observed adsorption equilibrium in 60 minutes with adsorption capacity. The data of the isotherms were fitted to equation Freundlich. The kinetic study of adsorption showed that the pseudo second- order model best describes the adsorption adsorption, having been found following values K2=0,024 g. mg-1 min-1and Qmax=25,75 mg/g, value very close to the calculated Qe = 26.31 mg / g. From the results we can conclude that the material can be used in wastewater treatment systems as a source of metal ions adsorbent due to its high adsorption capacity

Avaliação da eficiência de filtros anaeróbios na remoção de coliformes fecais e ovos de helmintos

The technology of anaerobic reactors for sanitary wastewater treatment has been extensively developed in Brazil, and today it is practically consolidated. They present several advantages, such as low construction and operating costs, and low sludge production, the anaerobic reactors are an attractive alternative to minimize problematic lack of basic sanitation in urban areas, and also of the rural areas. The anaerobic filters have been widely used in Brazil. It produces an effluent with low concentration of organic matter and solids suspended, besides conserving the nutrients, therefore, it is good for use in irrigation, but the practice must be associated with knowledge of the pathogens presence. The main objective of this study was to evaluate the efficiency of anaerobic filters in removal faecal coliforms and helminth eggs, and to verify if the effluent can be used for agricultural purposes, according to the World Organization of Health (WHO, 1989). The protocol used to enumerate helminths eggs was the modified Bailenger method, (Ayres and Mara, 1996) recommended by WHO for evaluation of raw effluent and treated effluent. The membrane filtration method was utilized to determine the concentrations of faecal coliforms. Three different systems of sewer treatment composed by anaerobic filters were analyzed. The results, in a general analysis, showed that all the researched systems reached a larger removal than 93% to helminth eggs, resulting in an effluent with smaller average than 1 egg/L. One of these systems, Sistema RN, reached a larger removal than 99%, confirming the good performance of the anaerobic filters in removal helminths eggs. Even with low concentrations of eggs in the influent, the filters were capable to remove this parameter efficiently. About faecal coliforms, it was observed for all the researched systems an effluent with 106 CFU/100mL. The high concentrations to faecal coliforms in the effluent just allow reuse for restricted irrigation, in agreement with the guidelines of WHO. Although the researched systems have not removed faecal coliforms efficiently, the results indicated a good efficiency of the anaerobic filters in removal helminth eggs

Decaimento bacteriano em lagoas de estabilização no Nordeste brasileiro

Stabilization pond system consisting in more sewage treatment used in Rio Grande do Norte (RN), Brazil, representing about 90% of all systems. Fecal bacteria are removed mainly facultative ponds and in maturation ponds. Many factors influence bacterial decay, such as the levels of pH and DO, temperature, light intensity, HDT and nutrient availability. The bacterial decay rate (Kb) is calculated considering many variables, but the hydraulic regime is a significant influence for microorganisms removal, and the dispersed flow which best characterizes a stabilization pond. However, some authors developed equations for the Kb accordant plug flow and complete mixing. This research study aimed to evaluate the bacterial decay of fecal coliform and Enterococcus sp. in stabilization ponds designed to treat domestic sewage, full-scale, in RN. All systems have assessed pretreatment, a facultative pond (LF) followed by two maturation (LM1 and LM2). The parameters availed were: temperature, pH, DO, BOD5, COD, fecal coliform, Enterococcus sp., Chlorophyll a, total suspended solids, fixed and volatile. In general, there were not significant differences for pH, DO and temperature in the ponds, except for the new systems, since they have low flow and hydraulic loads. The removal of organic matter in the ponds was low, about 70%, and nearly all are overloaded organic and operational problems. The bacterial removals were low, with average 96% for LF for fecal coliform, and 98% for Enterococcus sp.; LM1 were in itself a removal for fecal coliform about 71%, and 81% for Enterococcus sp.; LM2 have efficiency of 69% for fecal coliform, and 68% for Enterococcus sp. The equation proposed by Von Sperling (1999), according to the dispersed flow regime, generated empirical values of Kb more approximate to calculated values of Kb. On average, the calculated Kb to coliforms in the LF was 0.31 d-1, and for both maturation ponds were 0.35 d-1. For Enterococcus sp. the average was 0.40 d-1 for LF, 0.55 d-1 for LM1, and 0.58 d-1 for LM2. These results also showed that the Kb obtained in full-scale systems are smaller than those found in pilot-scale ponds. Moreover, one can say that the equation proposed by Marais (1974), according to the complete-mix regime, overestimates Kb. Actual results of Kb indicated that fecal coliforms are more resistant to adverse conditions present in stabilization ponds than Enterococcus sp., therefore, an indicator of microbiological safety and efficiency. The factors significant interventions in the rate of bacterial decay were concentrations of COD, the organic loading and HDT. The few Kb relationship between pH, DO and temperature were not significant. Finally, we conclude that it s essential to correct operation and maintenance, for not performing these activities is one of the main factors contributing to low rates of bacterial decay.

Determinação do coeficiente de decaimento bacteriano em wetland - alagado construído

Wetlands systems are considered nowadays as a treatment method that uses simple, easy operation and low cost technology, which has been used in various parts of the world and also in Brazil. Used alone or as a complement to other types of treatment systems, once it effectively removes nutrients, pathogens and other pollutants in the water. Due to the high complexity found in wetlands, making it difficult to predict the response of the system to treat wastewater, one should consider as ideal to base the sizing of the wetland system over the necessary removal of this parameter instead of scaling it from empiricism. The study was conducted to determine the coefficient of bacterial decrease in the Wetland unit located at Ponta Negra Station Sewage Treatment, located in Natal, the coastal region of Rio Grande do Norte. The most representative model to determine the bacterial decrease in this system was the one from Chick for hydraulic piston system. Kb of 0.37 d-1 were found for the flow rate of 15m³/d, while for the system operating at maximum design flow, 30m³/d, the Kb of 0.98 d-1 was found

Eficiência de uma ETE em escala real composta por reator UASB seguido de lodo ativado

In the state of Rio Grande do Norte (RN), Brazil, there are about 80 sewage treatment systems being the predominant technology waste stabilization ponds. The Baldo s WWTP , due to its location and low availability of area, was designed as a hybrid conventional system (UASB reactor followed by activated sludge with biodiscs) at a tertiary level, being the most advanced WWTP in the State and also with the larger treatment capacity (1620 m3/h) .The paper presents the results of its performance based on samples collections from May to December 2012. Composite samples of the effluent of the grit chamber, UASB reactors, anoxic chambers, aeration tanks and treated effluent were collected weekly, every 4 hours for 24 hours. The results showed that the WWTP effluent presented adequate ranges of temperatures, pH and DO, however removal efficiencies of BOD and TSS were below the predicted by design. The UASB reactors also showed removals of BOD and TSS less than expected, due to the accumulation of sludge in the reactors, which eventually, was washed out in the effluent. The nitrification process was not satisfactory mainly due to problems in the oxygen distribution in the aeration tanks. The removal of ammonia and TKN were high, probably by the assimilation process

Diagnóstico operacional de lagoas de estabilização

This work intends to develop an approach based through scientific criteria in the operational diagnosis of ponds of stabilization, starting from analyses accomplished in loco and in laboratory of 78 systems of sewer treatment through ponds of stabilization in the State of Rio Grande do Norte. The objectives of the research are: to map, to evaluate and to diagnose the operational acting of the ponds of stabilization of the state of Rio Grande do Norte, through visits in loco and analyses laboratory; to build a SIG, through the map rain, locate the points of releases of sewages of the systems of existent ponds in Rio Grande do Norte, as well as operational data and his/her respective efficiency diagnosis in the removal of BOD and Coliforms Termotolerantes; to evaluate, in real scale, three systems of ponds of stabilization of RN in the operational efficiency for the parameters BOD5, COD, pH, Temperature, OD and Coliforms Termotolerantes. Of 78 ETEs of appraised RN just, 9% or 7 had maximum concepts in what concerns the removal of BOD and Coliforms Termotolerantes and 41% or 32, they had the worst concepts in term of operational efficiency. The flowing concentrations ETEs of RN of BOD and Coliforms were of 410mg/L and 2,50x107UFC/100ml, the predominant configuration is of the type F1+M1+M2, the relationship BOD/COD revealed for the sewer tributary characteristic biodegradable high. For the study of case of 3 ETEs, the best operational efficiencies in decreasing order were: Cidade (Municipal district), it Roça (State) and São Miguel (SAAE). The removals of final BOD were 51,6mg/L; 108,27mg/L and 62,6mg/L, tends efficiency of 82%; 74% and 81%. In term of coliforms removal in the final effluentes were 1,90x103UFC/100ml; 1,50x104UFC/100ml and 3,10x104UFC/100ml, tends efficiencies of 99,99%; 99,95% and 99,90%. In what it concerns the practice of agricultural reúso of cultures consumed raw, none of 3 ETEs assisted the parameters of the Resolution CONAMA 357/05, for other reúso practices, all assisted the categories B and C of OMS. For release in body receiving ETE Cidade just, they assist the demands of the resolution of CONAMA 357/05, by study of purification solemnity of the receiving body. The maintenance lack and operation; exclusive operator in ETEs and operation knowledge was the contributory factors for the operational fall in appraised ETEs of RN

Estudos de adsorção de tetraciclina em partículas de quitosana

Due to its physico-chemical and biological properties, related to the abundance and low cost of raw material, chitosan has been recognized as a material of wide application in various fields, such as in drug delivery systems. Many of these properties are associated with the presence of amino groups in its polymer chain. A proper determination of these amino groups is very important, in order to properly specify if a given chitosan sample can be used in a particular application. Thus, in this work, initially, a comparison between the determination of the deacetylation degree by conductometry and elemental analysis was carried out using a detailed analysis of error propagation. It was shown that the conductometric analysis resulted in a simple and safe method for the determining the degree of deacetylation of chitosan. Subsequently, experiments were performed to monitor and characterize the adsorption of tetracycline on chitosan particles through kinetic and equilibrium studies. The main models of kinetics and adsorption isotherms, widely used to describe the adsorption on wastewater treatment systems and the drug loading, were used to treat the experimental data. Firstly, it was shown that an apparent linear t/q(t) × t relationship did not imply in a pseudo-second-order adsorption kinetics, differently of what has been repeatedly reported in the literature. It was found that this misinterpretation can be avoided by using non-linear regression. Finally, the adsorption of tetracycline on chitosan particles was analyzed using insights obtained from theoretical analysis, and the parameters generated were used to analyze the kinetics of adsorption, the isotherm of adsorption and to ropose a mechanism of adsorption

Efficiency of aquatic macrophytes to treat Nile tilapia pond effluents

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