Existe trade-off entre eficiência e qualidade nas organizações hospitalares?

A mudança do perfil demográfico e epidemiológico das populações, com progressivo envelhecimento populacional e aumento de portadores de doenças crônicas não transmissíveis, somado a necessidade da ampliação da oferta de serviços de saúde e crescentes custos em saúde, impõe enormes desafios aos sistemas e serviços de saúde. A eficiência organizacional dos serviços de saúde tem papel importante tanto na racionalização dos custos quanto na melhoria da qualidade e segurança assistencial. Tendo papel central nos sistemas de saúde como centros difusores de conhecimento, capacitação profissional, incorporação de tecnologias, prestação de serviços de maior complexidade aos pacientes e, consequentemente, elevados custos destes serviços, aos hospitais é fundamental a busca por essa eficiência. Este estudo buscou analisar se existe trade-off entre eficiência e qualidade em organizações hospitalares e identificar quais determinantes poderiam estar associados com maiores ou menores escores de eficiência. Utilizou-se dois modelos de análise de envelopamento de dados (data envelopment analysis, DEA), sem e com variáveis de qualidade, com retornos variáveis de escala e orientados para resultado. Foram estudados 47 hospitais gerais públicos do estado de São Paulo. No modelo sem variáveis de qualidade 14 deles foram considerados eficientes, enquanto que 33 no modelo com estas variáveis. O coeficiente de correlação de Spearman entre os dois modelos foi de 0,470 (correlação moderada). Não há evidências de que haja trade-off entre eficiência e qualidade nestas organizações hospitalares. Hospitais eficientes no modelo sem variáveis de qualidade, também o foram com variáveis de qualidade, assim como houve hospitais ineficientes no modelo sem variáveis de qualidade que foram eficientes com estas variáveis. Não foram encontradas associações estatisticamente significantes (p<0,05) entre eficiência e as características dos hospitais estudados, como acreditação, modelos de gestão, porte hospitalar e atividades de ensino, apesar de alguns achados de maior ou menor escore de eficiência para alguns determinantes. Desta maneira, concluiu-se que a utilização de variáveis de qualidade é um fator fundamental na determinação da eficiência de organizações de saúde, e não podem estar dissociadas. Gestões eficientes também estão relacionadas à obtenção de melhores resultados assistenciais sem a necessidade que se tenha de optar em alcançar melhores resultados econômico-financeiros ou melhores resultados assistenciais.

Sistema supervisório para o método de elevação plunger lift

SOARES, Lennedy C. ; MEDEIROS, Adelardo A. D. de ; PROTASIO, Alan D. D. ; BOLONHINI, Edson H. Sistema supervisório para o método de elevação plunger lift. In: CONGRESSO BRASILEIRO DE PESQUISA E DESENVOLVIMENTO EM PETRÓLEO E GÁS, 5., Fortaleza, CE, 2009. Anais...Fortaleza: CBPDPetro, 2009.

Características limnológicas e estrutura trófica das comunidades de peixes de alguns lagos naturais e artificiais do Rio Grande do Norte

Artificial lakes must differ from natural lakes in important structural and functional aspects that need to be understood so that these ecosystems can be properly managed. The aim of this work was to test the hypothesis that the artificial lakes (impoundments) in the semi-arid region of the Rio Grande do Norte State are more eutrophic and turbid and have different trophic structure when compared to the natural coastal lakes that occur in the humid eastern coast of the State. To test this hypothesis, 10 natural lakes and 8 artificial lakes with about 100 ha were sampled between September and November 2005 for the determination of some limnological variables and the abundance of the main fish species, which were grouped in three trophic guilds: facultative piscivores, facultative planktivores and omnivores. The results show that the artificial lakes had significantly higher concentrations of total nitrogen, total phosphorus, chlorophyll a , total and volatile suspended solids than the natural lakes. Results also show that the values of pH, total alkalinity, electric conductivity, turbidity as well as the coefficient of vertical attenuation of light were significantly higher in the artificial lakes than in the natural lakes. In the artificial lakes, the abundance of facultative planktivores was significantly higher, while the abundance of facultative piscivores significantly lower than in the natural lakes. There was no significant difference in the abundance of omnivorous fish between the two types of lakes. These results suggest that the increase in turbidity together with the other changes in the water quality of the artificial lakes, modifies the trophic structure of the fish communities reducing the importance of piscivores and the length of the food chains

Concreto celular polimérico: influência na adição de resíduo de poliéster insaturado termofixo

This work addresses the production of lightweight concrete building elements, such as plates, prefabricated slabs for pre-molded and panels of fencing, presenting a singular concrete: the Lightweight Concrete, with special properties such low density and good strength, by means of the joint use of industrial waste of thermosetting unsaturated polyesters and biodegradable foaming agent, named Polymeric Lightweight Concrete. This study covered various features of the materials used in the composition of the Polymeric Lightweight Concrete, using a planning of factorial design 23, aiming at studying of the strength, production, dosage processes, characterization of mechanical properties and microstructural analysis of the transition zone between the light artificial aggregate and the matrix of cement. The results of the mechanical strength tests were analyzed using a computational statistics tool (Statistica software) to understand the behavior and obtain the ideal quantity of each material used in the formula of the Polymeric Lightweight Concrete. The definition of the ideal formula has the purpose of obtaining a material with the lowest possible dry density and resistance to compression in accordance with NBR 12.646/92 (≥ 2.5 MPa after 28 days). In the microstructural characterization by scanning electron microscopy it was observed an influence of the materials in the process of cement hydration, showing good interaction between the wrinkled face of the residue of unsaturated polyesters thermosetting and putty and, consequently, the final strength. The attaining of an ideal formula, given the Brazilian standards, the experimental results obtained in the characterization and comparison of these results with conventional materials, confirmed that the developed Polymeric Lightweight Concrete is suitable for the production of building elements that are advantageous for construction

Effect of environmental variables on buffaloes physiology

The objective of this work was to evaluate the effect of environmental variables on dairy buffaloes physiology in two different places after milking, shaded plus artificial ventilation and another one non-shaded, in Ribeira Valley, São Paulo State, Brazil. Data on the respiratory rate (RR) and the surface temperature (ST) at udder, neckmiddle, forehead, back middle and rump were collected in 12 dairy buffaloes at autumn. In the same way, it were recorded the black globe temperature in the sun (GTS) and in the shade (GTNS), air temperature and wind speed at padronized height of 1.60 meters. All data were collected at 10:30am and 1:30pm. The results showed statistical difference among black globe temperature, wind speed, RR and ST (P<0.01) in two treatments.The results showed the necessity of protection against the solar radiation in the buffaloes, even in periods of warm climates.

Sensory aspects of liquid smoking of giant river prawn: comparison with traditional smoking

P>The purpose of this paper is to investigate the impact of liquid smoke on the sensory characteristics of giant river prawn (Macrobrachium rosenbergii). The sensorial profile was plotted using quantitative descriptive analysis and assessment of the acceptability of samples of beheaded and peeled and only beheaded freshwater prawns smoked using the traditional method or liquid smoke (LS). The prawns subjected to LS were characterised by their aroma, artificial flavour and bitter flavour. The beheaded, peeled prawns were found to be more acceptable, confirming that the presence of the shell is a limiting factor in the acceptability of smoked prawns.

Dietas artificiais incorporadas ou não a colmos triturados de variedades de cana-de-açúcar na biologia de Diatraea saccharalis (F.) (Lepidoptera: Crambidae)

It was studied the incorporation or not of shredded stems of sugarcane varieties to artificial diets and their effect in the biology of Diatraea saccharalis (Fabr., 1794) (Lepidoptera: Crambidae) under laboratory conditions. The experiment was carried out at the Department of Plant Protection of FCAV-UNESP, Jaboticabal, São Paulo, Brazil, in 2007, using diets with different amounts of their components (100, 75, 25 e 25% of concentration of the standard diet). The experiment had a complete randomized design in a 4x3 factorial scheme, using 4 concentrations of diets and three treatments, in a total of 12, with 6 replications. The larval, pupal an total periods and viability were evaluated, as well as the larval weight at 15 days, the pupal weight after 24 hours and the longevity of adults without feeding. The diet with 25% concentration of the components compared to the standard diet had a negative effect in the development of D. saccharlis larvae. Shredded dry stalks incorporated or not to the diet affected only the larval and pupal weight whereas the larval weight was more affected when the resistant (RB83-5486) and susceptible (SP80-3280) varieties due to the use of diet with 50% of its components. The diet with 100% concentration of its components are more favorable to the development of D. saccharalis, with 25% while that is less favorable. The diet with 100% concentration of the components associated with the presence of SP80-3280 (susceptible) stem variety provides greater larval weight. The weights of larvae and pupae of insects are negatively affected when RB83-5486 (resistant) shredded dry stem variety is incorporated into the diet. regarding to larval weight the diet with 50% of the concentration of its components provides better discrimination between genotypes resistant and susceptible to sugarcane borer.

Pressão e temperatura da água de lavagem na população microbiana da superfície de carcaças bovinas

The aimm of this study was to evaluate the influence of washing water temperature and pressure on mesophilic and psycluotrophic aerobic bacterial populations, yeasts and molds, total conforms and fecal coliforms population, whereas the cattle carcass surface may become contaminated during the different slaughter procedures and the final carcass washing may reduce microbial population Samples were taken by sponge swabbing in four areas of carcass surface (flank, neck, chest and rump), from which 20 were washed with write, at 25 degrees C and without artificial pressure, 20 with water under a pressure of 3atm, 20 with water at 40 degrees C and without artificial pressure and 20 with water at 40 degrees C under a pressure of 3atm For control purpose and using the same method to collect more 20 carcasses samples were taken without washing., loading 100 samples The results showed that the water at 25 degrees C undo 3atm pressure was more efficient to remove microorganisms from carcass surface than the heated water, although this latter promoter a mote visible clean carcasses

Envelhecer entre pássaros e anjos: um estudo etnográfico sobre o processo saúde doença do idoso no contexto familiar

Study, a descriptive-like one, is guided by ethnographic principles which have analyzed the elderly within the familiar context in his/her process of health and aging, in the neighborhood called Felipe Camarão, located in the western administrative region of Natal, RN, a Northeastern city of Brazil. The participants are elders aging 61 to 84 years old, living in this referring neighborhood, whose majority is constituted of migrants from the rural region of the state of the RN, retired, including widows, widowers and married couples, with low school-educational degree. For the information gathering it was utilized a semi-structured interview, the participant observation and the field diary, being put into effect, in majority, in the houses and in the Family Health Unit, in a period between March and October of 2006. For the results discussion it was utilized an analysis of thematic content and the program ALCESTE (In Portuguese, Análise Léxica por Contexto de um Conjunto de Segmentos de Texto or Lexical Analysis by Context of a Set of Text Segments), which through have emerged two corpus: the corpus I, Family and the elderly, and corpus II, The elderly and the aging within society. The analysis of the results has permitted to conclude that the family, also used by the public policies as a strategy of their practices in health, it is a necessary base support for the elderly citizen in his/her process of aging and of health. The elders familiar contexts have allowed this study to identify the existence of minimal social conditions of life, of new rearrangements of the current families by means of the plurigenerational acquaintanceship and the active presence of the elderly woman as a maintainer of this family; also by means of conflicted relationships among one another but in a bearable level of acquaintanceship. Different conceptions about the aging and the elderly generate disagreement and divergency however the family support and help for the solving of these problems and the attention to health are proceeding from the family components. However, it is noticed that loneliness is something present in these elder s everyday lives. About the attention to health, in a basic level of it, it was noticed that there are still a lot of gaps, mainly concerning promotional and preventing actions, deserving a higher sensitization and effort by the local health institutions

A fragilidade e suas representações para idosos domiciliados no contexto da estratégia de Saúde da Família

This study aims to analyze social representations of elders to their fragile situation at home, with the presence of one or more characteristics, as defined by the Brazilian Ministry of Health. It is a descriptive and qualitative study, based on methodological -principles of the Theory of Social Representations. Setting was the homes of elderly residents in the area ascribed to a Family Health Unit (FHU) in the city of Natal. A total of 10 elderly subjects, whose choice was intentional and according to the need for USF home visit in a period of time, considering the saturation process of the information. As collection procedures were used the semi-structured interview and participant observation in accordance with the ethical rules of Resolution No. 196/96, with the assent of the Ethics and Research UFRN. To analyze the results, it was used the thematic content analysis in the aspect of preparation of representations, focusing on the totality of the discourse of the subjects. The results indicate that most study participants felt difficult to give meaning to the terms weakness and to be weak, although many present one or more aspects of the syndrome of frailty. From the content analysis of participants speeches in this study, we achieved the following categories: fragility as illness and disease as aging, aging and frailty as causes of changes and difficulties in daily life, the presence of family life in the fragile elderly, fragility as weakness and the risk for falls, the perception of being weak like a different person in addition to the absence of fragility in elderly life. Thus, through the processes of anchoring and objectification, the "fragile being" became familiar and concrete, showing that the meaning of weakness, besides the scientific definition found in the reified universes, can be reinterpreted and built within the consensus universes. About the care received by the staff of Family Health, from the viewpoint of older people there seems to be an understanding about the role of professional nurses; on the other hand, older people often mention the role of the Community Health Agent

Temperatura e período de exposição de sementes de milho no teste de envelhecimento acelerado

O teste de envelhecimento acelerado (EA) apresenta possibilidades de uso nos programas de controle de qualidade de sementes de milho. Porém, para uso em rotina, há necessidade de padronização das condições de temperatura e período de exposição das sementes na realização do teste. Esta pesquisa teve por objetivo avaliar o efeito da combinação de duas temperaturas (42 e 45ºC) e dois períodos de envelhecimento (72 e 96h) nos resultados do teste de envelhecimento acelerado em sementes de milho. Para isso, sementes de seis genótipos de milho, tratadas e sem tratamento fungicida, com altos valores de germinação inicial, semelhantes entre si, dentro de cada genótipo, foram submetidas ao EA, de acordo com condições de temperatura e período de exposição pré-estabelecidos. Utilizou-se o delineamento experimental inteiramente casualizado com os tratamentos (lotes x germinação, antes e após o EA) dispostos em esquema fatorial, empregando-se o teste de Tukey a 5% de probabilidade na comparação das médias. Verificou-se que sementes de milho apresentam diferenças de sensibilidade ao envelhecimento acelerado, condicionadas pelo genótipo e tratamento fungicida. Contudo, a combinação 45ºC por 72h possibilita separar lotes de qualidade fisiológica superior e inferior, independentemente do genótipo. O período de exposição das sementes ao envelhecimento acelerado determina o teor de água atingido pelas mesmas.

Manganês e potencial fisiológico de sementes de soja

O trabalho teve por objetivo avaliar a influência de diferentes fontes e modos de aplicação de manganês, em plantas de soja, sobre o potencial fisiológico das sementes produzidas e a massa de mil sementes. Os tratamentos constaram de fontes de manganês aplicadas via solo (MnSO4.4H2O e Oxi-sulfato Mn) e via foliar (MnSO4.4H2O, Quelado Cl-, Quelado NO3- e Quelado SO4(2-)); para as sementes produzidas, determinaram-se a massa de mil sementes, a germinação e o vigor (envelhecimento acelerado e condutividade elétrica). Diante dos resultados obtidos, concluiu-se que a aplicação de manganês exerceu influência positiva sobre a massa das sementes de soja produzidas e que o estado nutricional das plantas, em relação ao manganês, não influenciou o potencial fisiológico das sementes produzidas.

Avaliação do potencial fisiológico de lotes de sementes de soja

Vários procedimentos são utilizados para avaliar o potencial fisiológico de sementes, sendo fundamental a utilização daqueles que reflitam melhor o desempenho em campo. A pesquisa teve como objetivo avaliar o potencial fisiológico de sementes de soja por meio de testes de avaliação rápida, de vigor, de emergência de plântulas em campo e análise computadorizada de imagens (SVIS®), procurando identificar o procedimento mais eficiente na separação de lotes. Cinco lotes das cultivares BRS Valiosa RR e CD 208 foram avaliados em duas épocas (antes e após armazenamento) pelos testes de germinação, de avaliação rápida (embebição em água e pH do exsudato), de vigor (envelhecimento acelerado e condutividade elétrica), de emergência de plântulas em campo e análise computadorizada de imagens (SVIS®). Os testes de germinação em areia, de condutividade elétrica e de embebição em água foram eficientes na separação dos lotes, mas apenas este último possibilitou identificar diferenças consistentes entre os lotes nos dois períodos avaliados. Assim, o teste de embebição em água pode ser considerado promissor na composição de programas de controle de qualidade.

Alternative procedure for the cold test for soybean seeds

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Precocidade na emissão da raiz primária para avaliação do vigor de sementes de milheto

In a program of seed quality assurance, the evaluation of seed vigor is fundamental and necessary to the global production process outcome. The objective of this study was to evaluate the efficiency of the precocity of primary root emission test, for the substrates paper roll, on paper and between papers, on vigor of pearl millet seeds. Ten seed lots evaluated in four replication of 100 pearl millet seeds cultivar ADR 500 were sown in three different humidified substrates: between papers, paper roll and on paper. These were incubated at a temperature of 20-30 degrees C. Fifteen hours after the germination test was established, the emission of seed primary roots started to be observed every 2 hours up to 25 hours and then after 48 hours. For the comparison among lots, seeds were also evaluated by moisture content, weight of 1000 seeds, germination and vigor (first count, electrical conductivity, accelerated aging and seedling emergence). The statistical design was completely randomized, and the means comparisons were accomplished by the Tukey test at 0.05 level of probability. It was concluded that the precocity of primary root emission test on paper is promising for vigor evaluation of pearl millet seeds.