Avaliação da qualidade da assistência no programa de AIDS: questões para a investigação em serviços de saúde no Brasil

O artigo mostra o desenvolvimento de uma pesquisa que objetivou avaliar a qualidade da assistência ambulatorial do Programa Brasileiro de DST/ AIDS. A investigação, realizada entre 2001-2003, envolveu três projetos: uma análise do padrão tecnológico da assistência realizada em cinco serviços, uma avaliação qualitativa em 27 serviços e, finalmente, uma avaliação estruturada de 322 serviços de sete estados brasileiros. Mediante a descrição de todas as etapas dos projetos, as autoras discutem questões teóricas e metodológicas envolvidas na avaliação da assistência em programas de saúde. Discutem ainda algumas questões relacionadas à aplicabilidade e ao impacto das avaliações em serviços de saúde.

Childbirth care: contributing to the debate on human development

Com a finalidade de subsidiar gestores da área de saúde da mulher, na formulação de políticas públicas, voltadas ao desenvolvimento humano, realizou-se esta investigação, cujo objetivo foi avaliar a estrutura e o processo da atenção ao parto e ao neonato desenvolvido em região do interior paulista. Estudo epidemiológico, voltado para avaliação dos serviços de saúde, baseou-se na observação da assistência prestada pelo Sistema Único de Saúde em 12 maternidades e 134 partos, adotando-se padrões estabelecidos pelo Ministério da Saúde ou Organização Mundial de Saúde para comparação. Os resultados apontam problemas relacionados à estrutura em algumas maternidades, mostrando que práticas úteis ao parto normal ainda são pouco utilizadas, enquanto que outras prejudiciais ou ineficazes ainda são utilizadas rotineiramente. Reverter esse quadro será essencial para oferecer atendimento de qualidade às mulheres, com conseqüente redução nas taxas de mortalidade materna e neonatal, para que a região atinja as metas estabelecidas para ampliação do desenvolvimento humano no milênio.

Antibody response to the 43 kDa glycoprotein of Paracoccidioides brasiliensis as a marker for the evaluation of patients under treatment

Sera of patients with paracoccidioidomycosis contained IgG-, IgA-, and IgM-specific antibodies to a 43 kDa antigen contained in the filtrate of a culture of Paracoccidioides brasiliensis. IgG- and IgA-specific antibodies were present in all observed patients. The IgM response was more frequent in acute cases, and the mean titers of IgG- and IgM-specific antibodies were higher in the acute forms. By the fourth month of chemotherapy, there was a decay of IgG, IgA, and IgM antibody titers to this antigen in acute cases, correlating with clinical improvement. The detection of IgG and IgA antibodies and the sequential determination of antibodies to the 43 kDa glycoprotein may be useful tools for serodiagnosis and evaluation of therapeutic efficacy.

Operational safety: Development of electronic system for dynamic balance evaluation of farm tractors

The present study aimed at the development and evaluation of a low cost electronic device in order to provide safety for farm tractor users. The major accident occurrence in agricultural surroundings is from farm tractor side bending. Therefore, this sensor was designed to detect and alert about it. The results were satisfying. © 2013 Taylor & Francis Group.

Auditoria em Saúde: justificativas de glosas no setor odontológico

Objective – To collecting data about the main explanations for glosses and demonstrating the percentage of production loss in the odontologic procedures. Methods – It is about an epidemiological study of historical series, retrospective and quantitative, based on the data collection of DATASUS information system and reports realized by the city of Aquidauana/MS audit system from 2001 to 2010. Results – The results show that in this period, 921.300 odontologic procedures were presented as production; being 223.226 (24,2%) individual procedures and 698.074 (75,8%) collective. There were 23.881 (2,6%) glosses, being 10.158 (42,5%) in the collective procedures and 13.723 (57,5%) in the individual ones. The main cause for glosses related to individual procedures was the repetition of procedures for the same patient and the same tooth (42,4%). In the collective activities, it was the non-accomplishment of the oral health collective program (68,9%). There was an increase of loss in the individual procedures going from less than 5% in the period of 2001 to 2007; to 5,8 % in 2008; 8,9% in 2009 and 14,1 % in 2010 and in the collective procedures the loss reached 4% in 2010. Conclusion – It was concluded that the most frequent cause of glosses explanation was the repetition of procedures for the same patient and the same tooth in the individual cases and the non-accomplishment of the oral health collective program in the collective activities. The importance of the audit system as a trust-worthy instrument for the managers in the planning and evaluation of health actions with the intention of guarantee the solution of the serv-ices provided.

Evaluation of the genetic diversity of Histoplasma capsulatum var. capsulatum isolates from north-eastern Brazil

Since the beginning of the HIV epidemic, there has been a significant increase in the number of histoplasmosis cases in Ceara, a state in north-east Brazil. The lack of epidemiological data on the genotypes circulating in the north-east region shows the importance of more detailed studies on the molecular epidemiology of Histoplasma capsulatum var. capsulatum in this region. Different molecular techniques have been used to better characterize the genetic profile of H. capsulatum var. capsulatum strains. The aim of this study was to analyse the genetic diversity of H. capsulatum var. capsulatum isolates in Fortaleza, the capital of Ceara, through the sequencing of the internal transcribed spacer (ITS)1-5.8S-ITS2 region, and establish the molecular profile of these isolates, along with strains from south-east Brazil, by RAPD analysis, featuring the different clusters in those regions. The isolates were grouped into two clusters. Cluster 1 included strains from the south-east and north-east regions with separation of isolates into three distinct subgroups (subgroups 1a, 1 b and 1 c). Cluster 2 included only samples from north-east Brazil. Sequencing of the ITS1 -5.8S-ITS2 region allowed the detection of two major clades, which showed geographical correlation between them and their subgroups. Therefore, it can be concluded that the H. capsulatum var. capsulatum isolates from Ceara have a high degree of genetic polymorphism. The molecular data also confirm that populations of this fungus are composed of different genotypes in Brazil and worldwide.

PERFORMANCE EVALUATION OF RESOURCE-AWARE BUSINESS PROCESSES USING STOCHASTIC AUTOMATA NETWORKS

In this work, we study the performance evaluation of resource-aware business process models. We define a new framework that allows the generation of analytical models for performance evaluation from business process models annotated with resource management information. This framework is composed of a new notation that allows the specification of resource management constraints and a method to convert a business process specification and its resource constraints into Stochastic Automata Networks (SANs). We show that the analysis of the generated SAN model provides several performance indices, such as average throughput of the system, average waiting time, average queues size, and utilization rate of resources. Using the BP2SAN tool - our implementation of the proposed framework - and a SAN solver (such as the PEPS tool) we show through a simple use-case how a business specialist with no skills in stochastic modeling can easily obtain performance indices that, in turn, can help to identify bottlenecks on the model, to perform workload characterization, to define the provisioning of resources, and to study other performance related aspects of the business process.

Simulations of physics and chemistry of polar stratospheric clouds with a general circulation model

A polar stratospheric cloud submodel has been developed and incorporated in a general circulation model including atmospheric chemistry (ECHAM5/MESSy). The formation and sedimentation of polar stratospheric cloud (PSC) particles can thus be simulated as well as heterogeneous chemical reactions that take place on the PSC particles. For solid PSC particle sedimentation, the need for a tailor-made algorithm has been elucidated. A sedimentation scheme based on first order approximations of vertical mixing ratio profiles has been developed. It produces relatively little numerical diffusion and can deal well with divergent or convergent sedimentation velocity fields. For the determination of solid PSC particle sizes, an efficient algorithm has been adapted. It assumes a monodisperse radii distribution and thermodynamic equilibrium between the gas phase and the solid particle phase. This scheme, though relatively simple, is shown to produce particle number densities and radii within the observed range. The combined effects of the representations of sedimentation and solid PSC particles on vertical H2O and HNO3 redistribution are investigated in a series of tests. The formation of solid PSC particles, especially of those consisting of nitric acid trihydrate, has been discussed extensively in recent years. Three particle formation schemes in accordance with the most widely used approaches have been identified and implemented. For the evaluation of PSC occurrence a new data set with unprecedented spatial and temporal coverage was available. A quantitative method for the comparison of simulation results and observations is developed and applied. It reveals that the relative PSC sighting frequency can be reproduced well with the PSC submodel whereas the detailed modelling of PSC events is beyond the scope of coarse global scale models. In addition to the development and evaluation of new PSC submodel components, parts of existing simulation programs have been improved, e.g. a method for the assimilation of meteorological analysis data in the general circulation model, the liquid PSC particle composition scheme, and the calculation of heterogeneous reaction rate coefficients. The interplay of these model components is demonstrated in a simulation of stratospheric chemistry with the coupled general circulation model. Tests against recent satellite data show that the model successfully reproduces the Antarctic ozone hole.

Analysis and design of high performance multiphase electric drives for vehicle and aircraft applications

The first part of this thesis has focused on the construction of a twelve-phase asynchronous machine for More Electric Aircraft (MEA) applications. In fact, the aerospace world has found in electrification the way to improve the efficiency, reliability and maintainability of an aircraft. This idea leads to the aircraft a new management and distribution of electrical services. In this way is possible to remove or to reduce the hydraulic, mechanical and pneumatic systems inside the aircraft. The second part of this dissertation is dedicated on the enhancement of the control range of matrix converters (MCs) operating with non-unity input power factor and, at the same time, on the reduction of the switching power losses. The analysis leads to the determination in closed form of a modulation strategy that features a control range, in terms of output voltage and input power factor, that is greater than that of the traditional strategies under the same operating conditions, and a reduction in the switching power losses.

Referral practice among Swiss and non-Swiss walk-in patients in an urban surgical emergency department

To assess the relationship between nationality, gender and age and use of health services among patients visiting an urban university hospital emergency department (ED).

Postmortem radiology of fatal hemorrhage: measurements of cross-sectional areas of major blood vessels and volumes of aorta and spleen on MDCT and volumes of heart chambers on MRI

OBJECTIVE: Autopsy determination of fatal hemorrhage as the cause of death is often a difficult diagnosis in forensic medicine. No quantitative system for accurately measuring the blood volume in a corpse has been developed. MATERIALS AND METHODS: This article describes the measurement and evaluation of the cross-sectional areas of major blood vessels, of the diameter of the right pulmonary artery, of the volumes of thoracic aorta and spleen on MDCT, and of the volumes of heart chambers on MRI in 65 autopsy-verified cases of fatal hemorrhage or no fatal hemorrhage. RESULTS: Most cases with a cause of death of "fatal hemorrhage" had collapsed vessels. The finding of a collapsed superior vena cava, main pulmonary artery, or right pulmonary artery was 100% specific for fatal hemorrhage. The mean volumes of the thoracic aorta and of each of the heart chambers and the mean cross-sectional areas of all vessels except the inferior vena cava and abdominal aorta were significantly smaller in fatal hemorrhage than in no fatal hemorrhage. CONCLUSION: For the quantitative differentiation of fatal hemorrhage from other causes of death, we propose a three-step algorithm with measurements of the diameter of the right pulmonary artery, the cross-sectional area of the main pulmonary artery, and the volume of the right atrium (specificity, 100%; sensitivity, 95%). However, this algorithm must be corroborated in a prospective study, which would eliminate the limitations of this study. Quantitative postmortem cross-sectional imaging might become a reliable objective method to assess the question of fatal hemorrhage in forensic medicine.

Development and simulation of DSP filters for transformer differential protection / by Oskar Reynisson.

Transformer protection is one of the most challenging applications within the power system protective relay field. Transformers with a capacity rating exceeding 10 MVA are usually protected using differential current relays. Transformers are an aging and vulnerable bottleneck in the present power grid; therefore, quick fault detection and corresponding transformer de-energization is the key element in minimizing transformer damage. Present differential current relays are based on digital signal processing (DSP). They combine DSP phasor estimation and protective-logic-based decision making. The limitations of existing DSP-based differential current relays must be identified to determine the best protection options for sensitive and quick fault detection. The development, implementation, and evaluation of a DSP differential current relay is detailed. The overall goal is to make fault detection faster without compromising secure and safe transformer operation. A detailed background on the DSP differential current relay is provided. Then different DSP phasor estimation filters are implemented and evaluated based on their ability to extract desired frequency components from the measured current signal quickly and accurately. The main focus of the phasor estimation evaluation is to identify the difference between using non-recursive and recursive filtering methods. Then the protective logic of the DSP differential current relay is implemented and required settings made in accordance with transformer application. Finally, the DSP differential current relay will be evaluated using available transformer models within the ATP simulation environment. Recursive filtering methods were found to have significant advantage over non-recursive filtering methods when evaluated individually and when applied in the DSP differential relay. Recursive filtering methods can be up to 50% faster than non-recursive methods, but can cause false trip due to overshoot if the only objective is speed. The relay sensitivity is however independent of filtering method and depends on the settings of the relay’s differential characteristics (pickup threshold and percent slope).

Twenty-three per cent of the Swiss adult population are using complementary medicine

Aim of the study: This study investigated the use among the Swiss adult population and the regional dissemination in Switzerland of various methods of complementary medicine (CM). It focused on CM methods that required visiting a physician or therapist and excluded e.g. over-the-counter drugs. Data and Methods: Data of the Swiss Health Survey 2007 were obtained from the Swiss Federal Statistical Office. This survey is performed every 5 years in a sample and is representative of the Swiss resident population from the age of 15 on. It consists of a telephone interview followed by a written questionnaire (2007: 18'760 and 14'432 respondents, respectively) and includes questions about people's state of health, general living conditions, lifestyle, health insurance and usage of health services. Users and non-users of CM were compared using logistic regression models. Results: 23.0 % of the Swiss adult population (women: 30.5 %, men: 15.2 %) used CM during the 12 months before the survey. Homeopathy (6.4 %), osteopathy (5.4 %) and acupuncture (4.9 %) were the most popular methods. The average number of treatments within 12 months for these three methods was 3.1 ± 3.6, 3.5 ± 3.3 and 6.6 ± 5.8, respectively. For treatments with homeopathy and acupuncture, medical practitioners were more commonly consulted than non-medical practitioners, for treatments with osteopathy no difference was found. By means of logistic regression, CM users and non-users were compared. There were significant differences in the use of CM between genders, age groups, levels of education and areas of living. Women, people aged 25 to 64 years, and people with higher levels of education used CM more commonly than men, people below 25 or above 64 years of age, or those with poorer education. Lake Geneva region and central Switzerland had a higher proportion of CM users than the other regions. Discussion: Almost one fourth of the Swiss adult population had used CM within 12 months before the survey. User profiles were comparable to those in other countries. Despite a generally lower self-perceived health status, elderly people were less likely to use CM. Reference: Klein SD, Frei-Erb M, Wolf U. Usage of complementary medicine across Switzerland. Results of the Swiss Health Survey 2007. Swiss Med Wkly. 2012;142:w13666.

Twenty-three per cent of the Swiss adult population are using complementary medicine

Aim of the study Various forms of complementary medicine (CM) play an important role in the Swiss health care system, they are appreciated by a majority of the population and mostly used complementarily rather than alternatively to conventional medicine. This study investigates, how many people in Switzerland are actually being treated with CM, and what the most popular methods of CM are. Data Data of the Swiss Health Survey 2007 were obtained from the Swiss Federal Statistical Office. This survey is performed every 5 years amongst a sample of the Swiss resident population above 15 years of age. It consists of a telephone interview followed by a written questionnaire (2007: 18'760 and 14'432 respondents, respectively) and includes questions about people's state of health, general living conditions, lifestyle, health insurance and usage of health services. Results 23.0% of the Swiss adult population (women: 30.5%, men: 15.2%) used CM during the 12 months before the survey. Homeopathy (6.4%), osteopathy (5.4%) and acupuncture (4.9%) were the most popular methods. The average number of treatments within 12 months for these three methods was 3.1, 3.5 and 6.6, respectively. For treatments with homeopathy and acupuncture, medical practitioners were more commonly consulted than non-medical practitioners, for treatments with osteopathy no difference was found. By means of logistic regression, CM users and non-users were compared. There were significant differences in the use of CM between genders, age groups, levels of education and areas of living. Women, people aged 25 to 64 years, and people with higher education used CM more commonly than men, people below 25 or above 64 years of age, or those with poorer education. Lake Geneva region and central Switzerland had a higher proportion of CM users than the other regions. Discussion While 2 years ago, 67.0% of the Swiss population approved a referendum in favour of CM, we find that 23.0% are in fact using it. Current political discussions focus on effectiveness, cost effectiveness and suitability of CM to decide which methods should be permanently covered by the basic health insurance.

Analysis and visualization of the dynamics of research groups in terms of projects and co-authored publications : A case study of library and information science in Argentina

Objective: The present study offers a novel methodological contribution to the study of the configuration and dynamics of research groups, through a comparative perspective of the projects funded (inputs) and publication co-authorships (output). Method: A combination of bibliometric techniques and social network analysis was applied to a case study: the Departmento de Bibliotecología (DHUBI), Universidad Nacional de La Plata, Argentina, for the period 2000-2009. The results were interpreted statistically and staff members of the department, were interviewed. Results: The method makes it possible to distinguish groups, identify their members and reflect group make-up through an analytical strategy that involves the categorization of actors and the interdisciplinary and national or international projection of the networks that they configure. The integration of these two aspects (input and output) at different points in time over the analyzed period leads to inferences about group profiles and the roles of actors. Conclusions: The methodology presented is conducive to micro-level interpretations in a given area of study, regarding individual researchers or research groups. Because the comparative input-output analysis broadens the base of information and makes it possible to follow up, over time, individual and group trends, it may prove very useful for the management, promotion and evaluation of science