Fatores de risco para morte em pacientes diabéticos e não diabéticos em tratamento hemodialítico

A mortalidade dos pacientes diabéticos, quando iniciam tratamento hemodialítico, ainda é muito elevada, significativamente maior do que a dos pacientes não diabéticos. As doenças cardíacas são a principal causa de morte nestes pacientes. O diabetes, por si só, está associado a uma alta prevalência de hipertensão, doença cardiovascular e insuficiência cardíaca, resultando em morbi-mortalidade significativas. Tradicionalmente, a mortalidade tem sido associada à cardiopatia isquêmica. A mortalidade cardiovascular, entretanto, não está relacionada apenas à isquemia, mas também à insuficiência cardíaca e à morte súbita. O objetivo deste estudo foi analisar o papel da doença cardiovascular como fator prognóstico para a morte de pacientes diabéticos e não diabéticos, que iniciam hemodiálise, levando em consideração outros fatores. Este foi um estudo prospectivo de uma coorte de 40 pacientes diabéticos e 28 não diabéticos, que iniciaram programa de hemodiálise, de agosto de 1996 a junho de 1999, em 5 hospitais de Porto Alegre, Brasil. O tempo total de acompanhamento foi de 4,25 anos. A avaliação inicial, realizada entre o 20 e o 30 mês de hemodiálise, incluiu: um questionário com características demográficas, história do diabetes e suas complicações, história de hipertensão e acidente vascular cerebral; o exame físico incluindo avaliação nutricional e exame oftalmológico; e avaliação laboratorial com medidas de parâmetros nutricionais, bioquímicos, hormonais, perfil lipídico, e controle metabólico do diabetes, além da avaliação da adequação da diálise. Para a avaliação cardiovascular foram utilizados: questionário Rose, ECG em repouso, cintilografia em repouso e sob dipiridamol, e ecocardiograma bi-dimensional e com Doppler. A mortalidade foi analisada ao final dos 51 meses, e as causas de morte, definidas pelos registros médicos, atestados de óbito ou informações do médico assistente ou familiar. Na análise estatística, foram empregados o teste t de Student, o qui-quadrado (χ2) ou teste exato de Fisher. Para a análise da sobrevida, o método de Kaplan-Meier foi utilizado, e, para identificar os principais fatores associados à mortalidade, construiu-se um modelo de regressão múltipla de Cox. O nÍvel de significância adotado foi de 5%. Ao final do estudo, os pacientes diabéticos tiveram um índice de mortalidade significativamente mais elevado do que os pacientes sem diabetes (47,5% vs. 7,1%; P=0,0013, log rank test). Na análise de Cox, o padrão pseudonormal ou restritivo de disfunção diastólica esteve associado a um risco de 3,2 (IC 95%:1,2-8,8; P=0,02), e a presença de diabetes, a um risco de 4,7 (IC 95%:1,03-21,4; P=0,04) para a morte. Concluiu-se que a disfunção diastólica do ventrículo esquerdo foi o principal preditor de mortalidade nesta coorte de pacientes que estão iniciando tratamento hemodialítico.

Análise da segurança no trabalho no setor de mármore e granito do Espírito Santo: proposição de ação para reunião do índice de acidentes no trabalho

O setor de mármore e granito do Espírito Santo constitui-se no maior pala industrial brasileiro do setor, sendo líder na comercialização dos produtos dele derivados, tanto no mercado interno como externo. Apesar do crescimento significativo observado nas exportações nos últimos anos, em peso e valor, bem como de estar comercializando a cada ano, produtos com maior valor agregado, convive com problemas de naturezas diversas, os quais se solucionados, proporcionarão maior participação nos mercados em que atua. Em termos sociais o reflexo será imediato, pois com os investimentos decorrentes, haverá geração de quantidade considerável de novos postos de trabalho, visto que trata-se de atividade altamente geradora de empregos. Por outro lado, os benefícios decorrentes do aumento de produção, proporcionarão a geração de renda e divisas para o país. Entre os problemas a serem solucionados encontra-se o alto índice de acidentes ocorridos no setor, conforme mostram as estatísticas apresentadas na presente dissertação. O estabelecimento de ações que visem a redução desses índices constitui o objetivo deste trabalho, tendo como meta principal, proporcionar a preservação da saú- de e segurança do trabalhador, e a implementação das mesmas, trarão como conseqüência natural, ganhos de produtividade e redução de custos, na medida que os acidentes implicam no surgimento de custos adicionais. A globalização da economia e a política econômica vigente no país, impuseram aos setores econô- micos uma competição cada vez mais acirrada, obrigando-os a buscarem alternativas que os viabilizem. A redução de custos por meio da prevenção de acidentes Vll no trabalho se constitui numa das alternativas. Esta dissertação, apresenta a partir de diagnóstico realizado nas diversas atividades do setor, ou seja, extração, serragem e beneficiamento, as tendências das ocorrências dos acidentes, caso não haja no futuro, nenhum tipo de intervenção. É estabelecida uma comparação com os demais setores da economia capixaba, através das respectivas curvas de tendências, na qual fica caracterizada a gravidade da situação e a importância da redução dos acidentes no setor de mármore e granito do Espírito Santo. Em fun- ção da dimensão com que o problema se apresenta, surge a necessidade de intervenções, as quais são classificadas como imediatas e de médio prazo. A observância à legislação vigente, representada pelas Normas Regulamentadoras, proporcionará maior segurança aos trabalhadores, possibilitando a esses, exercer suas atividades em ambiente onde os riscos referentes a lesões, com ou sem afastamentos, e morte, sejam minimizados, na medida que eles são inerentes ao setor e sempre existirão. Como metodologia é utilizado pesquisa de campo, através de entrevistas com empresários, trabalhadores, sindicatos patronal e dos trabalhadores, representantes da DRT e INSS, com as quais é possível o levantamento estatístico, consultas a revistas especializadas, jornais, Internet, disserta- ções e Normas Regulamentadoras. É ainda utilizado referencial teórico de diversos autores, na busca de dar sustentação conceitual ao tema abordado. Como resultado, é apresentado proposta que se constitui em uma série de ações a serem implementadas, para o atingimento do objetivo procurado.

Integração de características de planta, de dossel e de solo para maior eficiência da adubação nitrogenada em cobertura em milho

O milho é um das culturas mais exigentes em nitrogênio (N). A sua aplicação na dose e época correta pode aumentar a sua eficiência de uso, diminuindo custos e danos ambientais. Foram estudadas características de planta, de dossel e de solo, como indicadores da disponibilidade de N no sistema solo-planta para predição da necessidade deste nutriente em cobertura em milho. Foram conduzidos cinco experimentos a campo e dois em casa de vegetação, nas estações de crescimento de 2002/03 e 2003/04, na Estação Experimental Agronômica e na Faculdade de Agronomia da UFRGS, em Eldorado do Sul e em Porto Alegre-RS, Brasil, respectivamente, e dois experimentos a campo no ano de 2004 no Estern Cereal and Oilseed Research Center, em Ottawa-Ontário, Canadá. Foram avaliadas, em diferentes locais e situações de manejo, características de planta, de dossel e de solo, citando-se: teores de nitrato, amônio e N mineral no solo e na folha; massa seca e área foliar da folha e da planta, teor e acúmulo de N na folha e na planta; teor relativo de clorofila na folha, medido pelo clorofilômetro, reflectância do dossel, medido por dois tipos de radiômetros e fluorescência da folha, medida pelo fluorômetro. Além disso, foram avaliados o rendimento de grãos e seus componentes e parâmetros de eficiência técnica e econômica de uso de N. Dentre as características de planta, o teor relativo de clorofila na folha, e dentre os de solo, o teor de nitrato no solo, destacaram-se entre os demais avaliados. Foram determinados níveis críticos e doses ótimas de N, bem como estabelecidas curvas de calibração para dois níveis de manejo com base nestas características para monitoramento da lavoura. No que diz respeito às características de dossel estudadas, a reflectância apresentou melhores resultados que a fluorescência como indicador do nível de N no sistema solo-planta. Os estudos realizados mostraram que dentre as caracteríticas avaliadas, atualmente, o teor relativo de clorofila na folha tem o maior potencial para auxiliar na determinação da época mais adequada para aplicação de N em cobertura em milho.

Motivating sustainable goal choices and providing effective feedback

Overconsumption of natural resources and the associated environmental hazards are one of today’s most pressing global issues. In the western world, individual consumption in homes and workplaces is a key contributor to this problem. Reflecting the importance of individual action in this domain, this thesis focuses on studying and influencing choices related to sustainability and energy consumption made by people in their daily lives. There are three main components to this work. Firstly, this thesis asserts that people frequently make ineffective consumption reduction goal choices and attempts to understand the rationale for these poor choices by fitting them to goalsetting theory, an established theoretical model of behavior change. Secondly, it presents two approaches that attempt to influence goal choice towards more effective targets, one of which deals with mechanisms for goal priming and the other of which explores the idea that carefully designed toys can exert influence on children’s long term consumption behavior patterns. The final section of this thesis deals with the design of feedback to support the performance of environmentally sound activities. Key contributions surrounding goals include the finding that people choose easy sustainable goals despite immediate feedback as to their ineffectiveness and the discussion and study of goal priming mechanisms that can influence this choice process. Contributions within the design of value instilling toys include a theoretically grounded framework for the design of such toys and a completed and tested prototype toy. Finally, contributions in designing effective and engaging energy consumption feedback include the finding that negative feedback is best presented verbally compared with visually and this is exemplified and presented within a working feedback system. The discussions, concepts, prototypes and empirical findings presented in this work will be useful for both environmental psychologists and for HCI researchers studying eco-feedback.

Distribution of Ra-226, Th-232 and K-40 in soils and sugar cane crops at Corumbatai river basin, São Paulo State, Brazil

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

O direito à saúde e a política nacional de atenção oncológica: uma análise a partir da crescente judicialização dos medicamentos antineoplásicos

The 1988 Federal Constitution of Brazil by presenting the catalog of fundamental rights and guarantees (Title II) provides expressly that such rights reach the social, economic and cultural rights (art. 6 of CF/88) as a means not only to ratify the civil and political rights, but also to make them effective and practical in the life of the Brazilian people, particularly in the prediction of immediate application of those rights and guarantees. In this sense, health goes through condition of universal right and duty of the State, which should be guaranteed by social and economic policies aimed at reducing the risk of disease and other hazards, in addition to ensuring universal and equal access to actions and services for its promotion, protection and recovery (Article 196 by CF/88). Achieving the purposes aimed by the constituent to the area of health is the great challenge that requires the Health System and its managers. To this end, several policies have been structured in an attempt to establish actions and services for the promotion, protection and rehabilitation of diseases and disorders to health. In the mid-90s, in order to meet the guidelines and principles established by the SUS, it was established the Política Nacional de Atenção Oncológica PNAO, in an attempt to sketch out a public policy that sought to achieve maximum efficiency and to be able to give answers integral to effective care for patients with cancer, with emphasis on prevention, early detection, diagnosis, treatment, rehabilitation and palliative care. However, many lawsuits have been proposed with applications for anticancer drugs. These actions have become very complex, both in the procedural aspects and in all material ones, especially due to the highcost drugs more requested these demands, as well as need to be buoyed by the scientific evidence of these drugs in relation to proposed treatments. The jurisprudence in this area, although the orientations as outlined by the Parliament of Supreme Court is still in the process of construction, this study is thus placed in the perspective of contributing to the effective and efficient adjudication in these actions, with focus on achieving the fundamental social rights. Given this scenario and using research explanatory literature and documents were examined 108 lawsuits pending in the Federal Court in Rio Grande do Norte, trying to identify the organs of the Judiciary behave in the face of lawsuits that seeking oncology drugs (or antineoplastic), seeking to reconcile the principles and constitutional laws and infra constitutional involving the theme in an attempt to contribute to a rationalization of this judicial practice. Finally, considering the Rational Use of health demands and the idea of belonging to the Brazilian people SUS, it is concluded that the judicial power requires ballast parameters of their decisions on evidence-based medicine, aligning these decisions housing constitutional principles that the right to health and the scientific conclusions of efficacy, effectiveness and efficiency in oncology drugs, when compared to the treatments offered by SUS

Riscos ocupacionais e acidentes de trabalho em um serviço de atendimento móvel de urgência do Rio Grande do Norte

Exploratory, descriptive and quantitative study with prospective data, performed in the Mobile Emergency Care Service in the metropolitan region of Natal/RN, in order to identify the knowledge of the multidisciplinary team about the rules of standard precautions and worker safety, to identify occupational hazards peculiar to the activities of this service; characterize work-related accidents (WRA) and know the procedures adopted after each WRA. The population consisted of 162 professionals and data were collected between the months of November and December 2010. As for personal and professional characteristics, of the 162 professional, 12,96% were physicians; 6,79%, nurses; 33,95%, nursing technicians, 46,29%, conductors; 74,70% were male; 43,21% were between 31 and 40 years old; 69,33% lived in Natal/RN, 50,00% had completed high school; 58,64% were married; 69,75% had children, 46,91% were between 1 and 4 years of training; 61,73% had improvement courses; 59,25% had 3 to 4 years of service; 54,32%, with 1-4 years experience in emergency; 44,44% received 1-2 minimum wages; 78,40% received insalubrity premium; 67,28% worked in Basic Support Unit (BSU); 83,95% had journey on SAMU Metropolitano of 31-40 hours per week; 52,47% had other employments. As for knowledge of rules of standard precautions, safety and occupational hazards, 99,38% knew what it was WRA; 62,96% gave incomplete answers; 74,07% knew the rules of prevent WRA; 46,67% acquired this knowledge in lectures; 53,09% knew Personal Protective Equipment (PPE); 71,60% gave incorrect answers about the importance of standard precautions; 45,06% never received an educational intervention on this issue; 89,51% said that educational interventions in the prevention of WRA are very important; 90,12% pointed out this as a very important issue in the workplace; 27,00% suggested guidance on the topic in the workplace; regarding the physical hazards, 34,57% considered noise as the most important; about chemical hazards, 78,40% chose the gases and smoke; for biological hazards, 48,77% reported contact with the blood; for mechanical hazards, 80,86% said that were transport accidents; about ergonomic risks, 40,12% say it is the tension/stress in the care of critically ill, psychiatric and aggressive patients; and there was an average of 4,5 to the feeling of safety in the workplace. Regarding the data on the WRAs occurred, 31,48% experienced at least one accident event; 72,55% did not notify it; 60,98% answered that there was no routine for notification; 56,86% were performing patient transportation; 49,02% were hurt in the Basic Support Unit/Rescue Unit (BSU/RH); 60,78% occurred during the day; 96,08% of professionals were in normal work schedule (24 hours on duty); 31,37% had contusion; 58.82% had damage to members/pelvic girdle; 43,14% had traffic accidents. About the evolution of the WRA, 62,75% did not have to take time away from work; 76,47% had no sequelae; 88,24% did not require rehabilitation; no professional had a change of occupation. And by means of univariate logistic regression, showed that the nurses and male sex were risk factors for the occurrence of WRA. We conclude that there were gaps in the knowledge of staff regarding WRA, emphasizing the need for continuing education in biosafety in the service.

Atuação do enfermeiro na rede básica de saúde frente a gestante com infecção do trato urinário

The Urinary Tract Infection (UTI) in pregnancy is important as a consequence of the high incidence during the gestation. It is the third most common clinical complication in pregnancy affecting 10-12% of women whether prevalence is increasing in the first trimester of pregnancy, it may also contribute to maternal and infant mortality. Due the relevance for the results of obstetric and neonatal complications from UTI, these complications must be prevented, because it can lead to health hazards to pregnant women and newborns, producing a direct effect on morbidity and perinatal mortality. On this basis, it was defined as objectives of this research the identification of the profile of nurses from the Family Health Strategy (FHS) in the East and West Health Districts from the city of Natal / RN before the women with UTI and to verify the nurse performance during prenatal consultations. This is an exploratory study with a quantitative approach using a sample of 40 nurses active workers during this survey, it was approved by the Research Ethics Committee of the Universidade Federal do Rio Grande do Norte Protocol n0 232/10 P-CEP/UFRN and opinion n0 080/2011. The tool for data collection was a structured interview. The data collected were organized into an electronic database application Microsoft ® Excel 2007, exported and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0, and coded, tabulated and presented through tables and charts into their respective percentage distributions, using the descriptive and inferential statistical analysis, chi-square test and significance level of 5% (distribution in relative and absolute frequencies) in the independent variables. Therefore, it was observed from these results that the longer action of nurses in the FHS from the East and Weast health districts of the city of Natal/RN contributed to the development of a greater number of activities to control the incidence of UTI in women who are attended in the prenatal care service, proven by significance in statistics

Efeito da qualidade do milho no desempenho de frangos de corte

Este experimento foi realizado para avaliar os efeitos do uso de milho de baixa qualidade nutricional, infestado por insetos ou fungos, sobre o desempenho de frangos de corte em rações para a fase inicial. Um total de 400 pintos não-sexados da linhagem Ross foi distribuído em delineamento inteiramente casualizado com cinco tratamentos e quatro repetições, de acordo com a qualidade dos grãos de milho usado nas rações iniciais (1 a 28 dias). O milho não-infestado foi usado na ração testemunha, e substituido com níveis de 20 ou 40% de grãos de milho infestados por insetos e por 20 ou 40% de grãos de milho infestados por fungos. Ganho de peso, consumo de ração e conversão alimentar, no período de 1 a 28 e 29 a 49 dias e no período total, não foram influenciados pelos tratamentos. As relações entre o peso dos órgãos e o peso corporal foram crescentes para fígado e bursa of Fabricius, à medida que o milho com níveis de infestação por insetos ou fungos aumentaram, principalmente para a fúngica. À necropsia realizada aos 29 e 51 dias de idade dos frangos, identificou-se o aumento da freqüência de problemas de pernas e lesões hepáticas nos tratamentos que continham milho infestado com insetos ou fungos em sua composição. Os níveis de infestação por insetos ou fungos usados não influíram no desempenho dos frangos, porém podem contribuir para aumentar a incidência de problemas metabólicos, fatores que não se refletem no desempenho do frango de corte, mas que aumentam as taxas de condenação de carcaça.

APPLICATION of THE HAZARD ANALYSIS and CRITICAL CONTROL POINT (HACCP) SYSTEM on THE MUSHROOM PROCESSING LINE FOR FRESH CONSUMPTION

The Hazard Analysis and Critical Control Point (HACCP) is a preventive system that intends to guarantee the safety and harmlessness of food. It improves the quality of products as it eliminates possible defects during the process, and saves costs by practically eliminating final product inspection. This work describes the typical hazards encountered on the mushroom processing line for fresh consumption. Throughout the process, only the reception stage of mushrooms has been considered a critical control point (CCP). The main hazards at this stage were: the presence of unauthorised phytosanitary products; larger doses of such products than those permitted; the presence of pathogenic bacteria or thermo-stable enterotoxins. Putting into practice such knowledge would provide any industry that processes mushrooms for fresh consumption with a self-control HACCP-based system for its own productions.

Urinary Mutagenicity in Chemical Laboratory Workers Exposed to Solvents

Solvents represent an important group of environmental pollutants to which people are exposed daily in the workplace. The physico chemical properties of solvents may result in disturbances to cellular structures, including damage to DNA. However, the effects of mixtures of solvents are not well known. Mutations caused by environmental agents are related to cancer development and other degenerative diseases. The work in a research laboratory that uses several types of solvents is equally predisposed to these hazards. In this study, we evaluated the mutagenicity of urine from 29 subjects exposed occupationally to solvents in a chemistry research laboratory and 29 subjects without occupational exposure (controls). Urine samples were collected in polyethylene containers at the end of the work shift. For the concentration and extraction of urine samples the XAD-2 resin was used with acetone as an eluting agent. Several strains of Salmonella typhimurium (TA100, TA98, TA97a, TA1535, YG1024) should be used to assess mutagenic susceptibilities among workers exposed to organic solvents. Different doses of extract (1.5; 3.0; 6.0 and 12.0 m/ equivalents of urine per plate) were tested on S. typhimurium strains TA100 and YG 1024, with and without metabolic activation. The mutagenic activity, measured in Salmonella typhimurium YGI1024 with S9 mix, was significantly greater in urine from workers than from controls (p <= 0.05). These results indicate the relevance of using biomarkers to assess the risk of occupational exposure to organic solvents.

Trends in rheumatic fever: clinical aspects and perspectives in prophylactic treatments

Introduction: Rheumatic fever (RF), a systemic illness that may occur following Group A beta-hemolytic streptococcal (GABHS) pharyngitis in children, is a major problem in countries with limited resources. Because of its long track record and low cost, an injection of benzathine penicillin G (BPG) suspension every 3 or 4 weeks has been used as secondary prophylaxis. Despite its excellent in vitro efficacy, the inability of BPG to eradicate GABHS has been frequently reported.Areas covered: This work reviews the possible causes of failure, as well as the inconvenience of the current prophylactic treatment of acute RF and suggests a new pharmacotherapeutic system that could replace the current one.Expert opinion: RF is a major problem concerning only countries with limited resources and could be considered as a neglected disease. The dose regimen using BPG suspension results in failures, which could be avoided by the use of nanocarrier-based systems. To meet this ultimate goal, the research should be transposed from the laboratory scale to an industrial and clinical application level. This research should be conducted to produce a pharmaceutical dosage form that will be commercially available, consumed by and affordable for patients. However, health, environmental and socioeconomic hazards should be considered.

Fadiga no trabalho: como o psicólogo pode atuar?

As más condições laborais e a forma de organização do trabalho dentro do sistema capitalista frequentemente têm se mostrado nocivas para o trabalhador. Além disso, a chamada síndrome da fadiga crônica é um dos males que acomete a classe trabalhadora. Por meio de revisão teórica buscou-se caracterizar a síndrome, suas possíveis causas e consequências e o papel do psicólogo nas organizações. A fadiga pode ser compreendida como um esgotamento físico e mental, culminando em consequências para a saúde do trabalhador. Excesso de trabalho, pressão por produção, turnos alternados, riscos físicos e falta de autonomia são alguns fatores apontados como prováveis desencadeadores da síndrome, e as consequências encontradas vão desde baixo rendimento e maior risco de acidentes de trabalho até dificuldade para relaxar em momentos de lazer. É papel do psicólogo do trabalho e organizacional realizar ações remediadoras e preventivas que impeçam ou dificultem o aparecimento da fadiga no trabalho.

Avaliação genética da eficiência reprodutiva em vacas pardo-suíças por meio da análise de sobrevivência

Among the traits of economic importance to dairy cattle livestock those related to sexual precocity and longevity of the herd are essential to the success of the activity, because the stayability time of a cow in a herd is determined by their productive and reproductive lives. In Brazil, there are few studies about the reproductive efficiency of Swiss-Brown cows and no study was found using the methodology of survival analysis applied to this breed. Thus, in the first chapter of this study, the age at first calving from Swiss-Brown heifers was analyzed as the time until the event by the nonparametric method of Kaplan-Meier and the gamma shared frailty model, under the survival analysis methodology. Survival and hazard rate curves associated with this event were estimated and identified the influence of covariates on such time. The mean and median times at the first calving were 987.77 and 1,003 days, respectively, and significant covariates by the Log-Rank test, through Kaplan-Meier analysis, were birth season, calving year, sire (cow s father) and calving season. In the analysis by frailty model, the breeding values and the frailties of the sires (fathers) for the calving were predicted modeling the risk function of each cow as a function of the birth season as fixed covariate and sire as random covariate. The frailty followed the gamma distribution. Sires with high and positive breeding values possess high frailties, what means shorter survival time of their daughters to the event, i.e., reduction in the age at first calving of them. The second chapter aimed to evaluate the longevity of dairy cows using the nonparametric Kaplan-Meier and the Cox and Weibull proportional hazards models. It were simulated 10,000 records of the longevity trait from Brown-Swiss cows involving their respective times until the occurrence of five consecutive calvings (event), considered here as typical of a long-lived cow. The covariates considered in the database were age at first calving, herd and sire (cow s father). All covariates had influence on the longevity of cows by Log-Rank and Wilcoxon tests. The mean and median times to the occurrence of the event were 2,436.285 and 2,437 days, respectively. Sires that have higher breeding values also have a greater risk of that their daughters reach the five consecutive calvings until 84 months