Ocorrência de infecção hospitalar em idosos internados em hospital universitário

OBJETIVO: A infecção hospitalar é uma importante causa de morbidade e mortalidade na população idosa. O estudo realizado teve como objetivo avaliar a ocorrência e os fatores de risco da infecção hospitalar. MÉTODOS: Realizou-se estudo prospectivo em uma amostra de 322 idosos com 60 anos e mais, internados em um hospital universitário, entre setembro de 1999 e fevereiro de 2000. O cálculo da amostra foi feito pela fórmula de Fisher e Belle, com intervalo de confiança de 0,95%, de um total de 760 idosos internados, proporcionalmente ao número de pacientes em cada unidade de internação, no ano de 1997. Os critérios para definição da infecção hospitalar foram os do Center for Diseases and Prevention Control. Para a análise estatística dos dados foram utilizados o odds ratio e regressão logística. RESULTADOS: A taxa de infecção hospitalar encontrada foi de 23,6%. As topografias prevalentes de infecção hospitalar foram infecção respiratória (27,6%), do trato urinário (26,4%) e do sítio cirúrgico (23,6%). O tempo de internação dos pacientes sem infecção hospitalar foi de 6,9 dias e dos com infecção hospitalar foi de 15,9 (p<0,05). A taxa de mortalidade dos pacientes internados foi de 9,6% e a de letalidade dos pacientes com infecção hospitalar de 22,9% (p<0,05). Os fatores de risco encontrados para infecção hospitalar foram colangiografia (odds ratio (OR)=46,4, intervalo de confiança 95% (IC 95%)=4,4-485); diabetes melito (OR=9,9, IC 95%=4,4-22,3); doença pulmonar obstrutiva crônica (OR=8,3, IC 95%=2,9-23,7); cateterismo urinário (OR=5, IC 95%=2,7-11,8); internação com infecção comunitária (OR=3,9, IC 95%=1,7-8,9) e ventilação mecânica (OR=3,8, IC 95%=1,9-6,3). CONCLUSÕES: A infecção hospitalar apresentou incidência e letalidade elevadas e aumentou o tempo de internação dos idosos estudados.

Gestão ambiental empresarial: um levantamento da produção científica brasileira divulgada em periódicos da área de administração entre 1996 e 2005

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

Recreação hospitalar: o papel do profissional de educação física na equipe multidisciplinar

This qualitative study aimed to investigate the methodological perspective, the contents, possible outcomes and the role of Physical Education professionals in multidisciplinary staff of Recreation in hospitals. The study consisted of a survey applied to 20 adults of both sexes, volunteers, working in multidisciplinary team at a hospital in Leme, SP. Data were descriptively analyzed through content analysis technique, indicating that the time of engagement of that professional in that team was on average 12.8 months. Physical Education Professionals act mainly with joy faced the patients, making them well accepted. In relation to the contents used by these professionals, toys were the most mentioned, followed by books, puppets, role play and music. The team noticed some positive changes in patients after Physical Education Professional performances, and his engagement in the health team was considered very important, highlighting the urgency of new shares to enlarge this Professional participation in health multidisciplinary teams.

Evolução do peso corporal e desenvolvimento da mandíbula de ratos em função da administração de flúor.

The body weights evolution and the development of mandible were analyzed in rats that received 0.25 mg F contained into a commercial product, during 30 and 60 days consecutively, beginning at birth. The study presented the following conclusions: 1. The treated animals showed body weights always inferior to the controls, with more evident difference at 60 days period; 2. Analysis showed a reduction in the horizontal linear measurements, but not in the length of the mandibular diastem. No influence was observed in relation to the verticals.

Infecção hospitalar--aspectos éticos.

The author focuses the question of hospital infection, analysing the background on which the control committees were created. The hospital infection is discussed under bioethical principles and the Medical Ethics Code, examining the aspects related to the government, the Hospital Directorship, the Committee and the Control Service of Hospital Infection, and the assisting physician. A closer integration between the activities of the Program of Control of Hospital Infections and those of the Medical Ethics Committee is proposed, aiming at the patient and at the community, targets of total medical attention.

Atendimento extra-hospitalar a alcoolistas em um municipio do interior Paulista

The purpose of this work is to know the forms of minding to the alcoholics in extra-hospitable services of mental health in Botucatu municipality. This places are: Mental Health Ambulatory and School Health Center both of the Medicine College of the Paulista State University and Mental Health Ambulatory of the NGA-11. For the development of this work was realized a bibliographic raising, presented in the introduction. Four professionals that work in this assistance were interviewed. The data that was collected in the interviews were reported with the literature of the area allowing the knowledge of the main characteristics of the minding to the alcoholist in the three services that were consulted. For example: groupal minding, minding to the family and the kind of therapeutic contract.

Epidemiologia de candidíase hospitalar: Importância da identificação específica

Nosocomial infections with Candida species are recognized as a significant cause of morbidity and mortality in both seriously ill immunocompetent and immunocompromised patients. Infections with Candida albicans and non-albicans Candida species have become a significant cause of infection in humans. Several of the more commonly Candida spp isolates are less susceptible to the antifungal drugs currentlly applied in clinical treatment, a factor that means significant difficulties for effective treatment. The modern mycology laboratory has an important role to play in several aspects relating to these organisms, including therapy, detection, identification and epidemiological analysis. In this study, we have provided an initial comparison of differences in species distribution among Candida isolates from four general hospitals of São Paulo,SP. Overall, 40 isolates of C. albicans, C. parapsilosis and C. tropicalis were isolated respectively in 35%, 50% and 15%, revealed a tendency of higher frequency of non-albicans species. The species distribution in patients with candidemia showed that the most commonly species were C. parapsilosis (45,4%), followed by C. albicans (36,4%) and C. tropicalis (18,2%); thus, we have an increase of non-albicans species. The three different species were include in 6, 3, and 4 different biotypes, respectively C. albicans, C. parapsilosis e C. tropicalis. This study emphasizes the importance of periodic evaluation of Candida species distribution especially in centers caring for patients at risk.

A administração precoce de hormônio de crescimento resulta em efeitos deletérios na remodelação ventricular após o infarto agudo do miocárdio

Objective: To assess the effect of growth hormone (GH) on myocardial remodeling in infarcted rats. Methods: This study comprised 24 Wistar rats divided into 3 groups as follows: 1) AMI-GH group - comprising 8 rats that underwent infarction and were treated with GH; 2) AMI group - comprising 8 rats that underwent infarction and received only the diluent of the GH solution; and 3) control group (C group) - comprising 8 rats that underwent simulated infarction. After 30 days, the animals underwent functional study through echocardiography, and the changes in myocardial contractility of the isolated left ventricular (LV) papillary muscle were studied. Results: The echocardiography identified an increase in the diastolic (C=7.32±0.49; AMI=8.50±0.73; AMI-GH=9.34±0.73; P<0.05) and systolic (C=3.38±0.47, AMI=5.16±1.24; AMI-GH=5.96±1.54; P<0.05) diameters (mm) in the LV of the infarcted animals. The AMI-GH group animals had a lower ejection fraction (%) (C=0.9±0.03; AMI=0.76±0.12; AMI-GH=0.72± 0.14; P<0.05 for C vs AMI-GH) compared with those in controls. The study of the isolated left ventricular papillary muscle showed that the AMI-GH group had changes (C=1.50±0.59; AMI= 1.28±0.38; AMI-GH=1.98±0.41; P<0.05 for C vs AMI-GH) only in the tension at rest (TR - g/mm2) and in the time delta for a 50% decrease in the tension developed (TR50, ms) after stimulation with calcium (C=23.75±9.16; AMI=-16.56±14.82; AMI-GH=-4.69±8.39; P<0.05 for C vs AMI-GH) and in the delta of tension developed (TD, g/mm2) after stimulation with isoproterenol (C=0.99±0.17; AMI=0.54±0.62; AMI-GH=0.08±0.75; P<0.05 for C vs AMI-GH) compared with those in control animals. Conclusion: The early administration of GH in the experimental infarction model in rats may result in adverse effects on the process of ventricular remodeling.

Efeitos sedativo e cardiorrespiratório da administração da metadona, isoladamente ou em associação à acepromazina ou xilazina, em gatos

Six cats weighting 3.3±0.3 kg were randomly allocated to 6 treatments, with at least one-week intervals. The cats received intramuscular administration of physiological saline (control), methadone (0.3 mg/ kg), acepromazine (0,1 mg/kg), xylazine (1.0 mg/kg), acepromazine (0.05 mg/kg) plus methadone (0.3 mg/kg) or xylazine (0.5 mg/kg) plus methadone (0.3 mg/kg). Heart rate (HR), respiratory rate (RR), indirect systolic arterial pressure (SAP), rectal temperature, sedation score and pedal withdrawal reflex were evaluated before (baseline) and at selected intervals after treatment administration for 90 minutes. Respiratory rate, HR and rectal temperature decreased in cats given xylazine or xylazine plus methadone. In 1 out of 6 cats given xylazine and 2 out of 6 cats given xylazine/methadone, pedal withdrawal reflex was absent. In cats given 0.1 mg/kg of acepromazine, SAP decreased compared to baseline. Sedation scores were greater in cats given xylazine or xylazine plus methadone. Methadone alone or in combination with acepromazine did not produce a satisfactory degree of sedation and resulted in signs of excitement in some of the cats. Methadone alone or combination with acepromazine was not considered an effective protocol when moderate to deep sedation is required in cats. Methadone in combination with xylazine produces moderate to deep sedation, being this effect comparable to that achieved with a higher dose of xylazine alone.

Contribuição do uso de medicamentos para a admissão hospitalar

According to the Word Health Organization, adverse drug reactions (ADR) are any harmful and non intentional answer which occurred in doses normally used in human beings. The ADR can be responsible for 2.4% to 11.5% of hospital admissions. Therefore, this study aimed at knowing the admitted patient's demographic profile due to possible ADR, identifying the most frequent drugs and complaints, and evaluating the incidence of hospital admission related to drug use. Patients who were 18 years old or more and were admitted during a period of one month to a medical clinical of a general hospital were interviewed for one month about drug use before being admitted, as well as regarding to the complaint which led them to hospital. These information were analyzed according to official data, like MICROMEDEX® and WHO criteria as well. It was observed that the admission due to drug use occurred in most part of the cases in elderly [47.5% (66/139)] and women [62% (87/139)]. The most frequent drugs used were: omeprazole (16), analgesics (31), antihypertensive (31), simvastatin (7) and formoterol fumarate (6), and the symptoms were normally associated to the digestive (20.5%), circulatory (20.2%), respiratory (18.2%) and central nervous systems (13.9%). It was estimated that 15.5% (139/897) of the hospital admission occurred possibly due to the drug use. The data found by present study suggests some strategies in order to prevent ADR in the context of primary health care services, such as monitoring drug therapy, manly for patients with chronic diseases, elderly and polimedicated people; and pharmaceutical care including dispensation and purchasing of the drugs, a lot of them dispensed over the counter (OTC).

Administração pública: O pacto pela saúde como uma nova estratégia de racionalização das ações e serviços em saúde no Brasil

The health pact arises in the Brazilian scene after a number of attempts for the improvement of the Unified Health System (SUS), so as to consolidate social equity. In this perspective, this paper discusses the pact using documental analysis, in order to help the public administration process in Brazil. This new policy, still in the initial phase of implementation, is a unique reality and highly feasible for the improvement of national practices in public health. Its performance is intimately related to overcoming the political barriers inherent to each rank of the administration.

Sistemas biodegradáveis contendo acetato de prednisolona para administração orbitária

Purpose: The present study aimed to evaluate an injectable extended-release formulation of prednisolone acetate (PA) for orbital administration. Methods: Microspheres (MEs) of poly-ε-caprolactone (PCL) containing PA were developed by the method of solvent evaporation. The MEs obtained were characterized by scanning electron microscopy (SEM), differential scanning calorimetry (DSC), encapsulation efficiency and in vitro release profile. The in vivo release profile was evaluated in rabbits after periocular injection of an aqueous suspension of MEs. The local biocompatibility of the system was verified by histopathologic analysis of the deployment region. Results: After MEs preparation, morphological analysis by SEM showed the feasibility of the employed method. The content of PA encapsulated was 43 ± 7% and can be considered as satisfactory. The system characterization by DSC technique, in addition to confirm the system stability, did not indicate the existence of interaction between the drug and the polymer. The in vitro release study showed the prolonged-release features of the developed system. Preliminary in vivo study showed the absence of local toxicity and confirmed the prolonged release profile of PA from MEs, suggesting the viability of the developed system for the treatment of orbital inflammatory diseases. Conclusion: The results obtained in this work are relevant and accredit the system developed as a possible alternative to the treatment of inflammatory orbitopathy.

Habilidades sociais e administração de tempo no manejo do estresse

Recent searches suggest that social skills and time management as control variables of stress. In order to analyze possible relations between these variables and stress, it was done a descriptive study with a sample of convenience. Eighty three freshmen students, both of gender, of Biology, Civil Engineering and Psychology answered the Stress Inventory (ISSL), Social Skills Inventory (IHS) and a Time Management Inventory adaptation (ADT). It is emphasized that methodology of adaptation, the pro rata system, was not based on high standards of psychometry, which can lead to change of configuration of the instrument and the data it provides. The most of participants were unde rthe media in Social Skills and 72,29% manage badly the time. The stress rate was 48,19%. It was found connection between bad time management and stress and the lack of social skills was associated to bad time management. There wasn't statistic connection between stress and social skills lack. Students in Civil Engineering had the smaller stress rate, as well as the bigger lack of a Social Skills category.

Estudo das respostas bioquímica e muscular da administração de estatina e sua descontinuidade associadas à atividade física em ratos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)