Um estudo da atenção primária à saúde mediante o indicador: Internações por condições sensíveis à atenção ambulatorial (CSAA)

A Atenção Primária à Saúde - APS é reconhecida como o nível fundamental e porta de entrada do sistema de atenção à saúde, sendo o lugar adequado onde pode ser atendida e resolvida a maior parte dos problemas de saúde. É considerada pela OMS como a principal proposta de modelo assistencial. Essa importância da APS leva a necessidade de pesquisas avaliativas dos seus resultados para adequação e melhoria de políticas e planos de ação delineados em relação à mesma. Pesquisas internacionais e nacionais são realizadas, nas quais indicadores relativos às atividades hospitalares estão sendo empregados com o objetivo de medir resultados como efetividade e acesso da APS. Um desses indicadores, desenvolvido por John Billings da Universidade de Nova York, na década de 90, consiste nas condições pelas quais as internações hospitalares por Condições Sensíveis à Atenção Ambulatorial (CSAA) deveriam ser evitadas caso os serviços da APS fossem efetivos e acessíveis. Utilizando-se o SIH-AIH/2008 e a lista brasileira de Internações por Condições Sensíveis a Atenção Primária, publicada em 2008, a proposta do presente trabalho é a de estudar os cuidados primários à saúde baseando-se nas ICSAA, na área urbana da cidade de Juiz de Fora-MG. Buscou-se responder sobre os efeitos que ocorrem nessas internações a partir das características individuais dos pacientes, das características das Unidades Básicas de Saúde-UBS (infraestrutura, produção e modelos assistenciais) e das condições sócio-econômicas/ambientais das áreas cobertas por UAPS e descobertas (sem UAPS), com a utilização de modelos multiníveis logísticos com intercepto aleatório. Buscou-se conhecer, também, a distribuição espacial das taxas padronizadas por idade das ICSAA nessas áreas e suas associações com as variáveis contextuais, utilizando-se ferramentas da análise espacial. Os resultados do presente trabalho mostraram que a porcentagem de internações por CSAA, foi de 4,1%. Os modelos assistenciais ESF e o Modelo Tradicional, base da organização da atenção primária no Brasil, não apresentaram no município, impacto significativo nas ICSAA, somente na forma de áreas descobertas tendo como referência as áreas cobertas. Também não foram significativas as variáveis de infraestrutura e produção das UAPS. Os efeitos individuais (idade e sexo) nas ICSAA foram significativos, apresentando probabilidades de significância menores que 1%, o mesmo acontecendo com o Índice de Desenvolvimento Social-IDS, que contempla as condições sociais, econômicas e ambientais das áreas analisadas. A distribuição espacial das taxas padronizadas por idade apresentou padrão aleatório e os testes dos Multiplicadores de Lagrange não foram significativos indicando o modelo de regressão clássico (MQO) como adequado para explicar as taxas em função das variáveis contextuais. Para a análise conjunta das áreas cobertas e descobertas foram fatores de risco: a variável econômica (% dos domicílios com renda até 2 SM), áreas descobertas tendo como referência as áreas cobertas e a região nordeste do município. Para as áreas cobertas as variáveis de produção das UAPS, econômica e a região nordeste apresentaram como fator de risco para as taxas de internação por CSAA.

I. Studies on bacteriophage DNA's and minicircular DNA's in M. lysodeikticus and E. coli 15. II. Flow dichroism of DNA solutions

Part I

Chapter 1.....A physicochemical study of the DNA molecules from the three bacteriophages, N1, N5, and N6, which infect the bacterium, M. lysodeikticus, has been made. The molecular weights, as measured by both electron microscopy and sedimentation velocity, are 23 x 10⁶ for N5 DNA and 31 x 10⁶ for N1 and N6 DNA's. All three DNA's are capable of thermally reversible cyclization. N1 and N6 DNA's have identical or very similar base sequences as judged by membrane filter hybridization and by electron microscope heteroduplex studies. They have identical or similar cohesive ends. These results are in accord with the close biological relation between N1 and N6 phages. N5 DNA is not closely related to N1 or N6 DNA. The denaturation T_m of all three DNA's is the same and corresponds to a (GC) content of 70%. However, the buoyant densities in CsCl of Nl and N6 DNA's are lower than expected, corresponding to predicted GC contents of 64 and 67%. The buoyant densities in Cs₂SO₄ are also somewhat anomalous. The buoyant density anomalies are probably due to the presence of odd bases. However, direct base composition analysis of N1 DNA by anion exchange chromatography confirms a GC content of 70%, and, in the elution system used, no peaks due to odd bases are present.

Chapter 2.....A covalently closed circular DNA form has been observed as an intracellular form during both productive and abortive infection processes in M. lysodeikticus. This species has been isolated by the method of CsC1-ethidium bromide centrifugation and examined with an electron microscope.

Chapter 3.....A minute circular DNA has been discovered as a homogeneous population in M. lysodeikticus. Its length and molecular weight as determined by electron microscopy are 0.445 μ and 0.88 x 10⁶ daltons respectively. There is about one minicircle per bacterium.

Chapter 4.....Several strains of E. coli 15 harbor a prophage. Viral growth can be induced by exposing the host to mitomycin C or to uv irradiation. The coliphage 15 particles from E. coli 15 and E, coli 15 T^- appear as normal phage with head and tail structure; the particles from E. coli 15 TAU are tailless. The complete particles exert a colicinogenic activity on E.coli 15 and 15 T^-, the tailless particles do not. No host for a productive viral infection has been found and the phage may be defective. The properties of the DNA of the virus have been studied, mainly by electron microscopy. After induction but before lysis, a closed circular DNA with a contour length of about 11.9 μ is found in the bacterium; the mature phage DNA is a linear duplex and 7.5% longer than the intracellular circular form. This suggests the hypothesis that the mature phage DNA is terminally repetitious and circularly permuted. The hypothesis was confirmed by observing that denaturation and renaturation of the mature phage DNA produce circular duplexes with two single-stranded branches corresponding to the terminal repetition. The contour length of the mature phage DNA was measured relative to φX RFII DNA and λ DNA; the calculated molecular weight is 27 x 10⁶. The length of the single-stranded terminal repetition was compared to the length of φX 174 DNA under conditions where single-stranded DNA is seen in an extended form in electron micrographs. The length of the terminal repetition is found to be 7.4% of the length of the nonrepetitious part of the coliphage 15 DNA. The number of base pairs in the terminal repetition is variable in different molecules, with a fractional standard deviation of 0.18 of the average number in the terminal repetition. A new phenomenon termed "branch migration" has been discovered in renatured circular molecules; it results in forked branches, with two emerging single strands, at the position of the terminal repetition. The distribution of branch separations between the two terminal repetitions in the population of renatured circular molecules was studied. The observed distribution suggests that there is an excluded volume effect in the renaturation of a population of circularly permuted molecules such that strands with close beginning points preferentially renature with each other. This selective renaturation and the phenomenon of branch migration both affect the distribution of branch separations; the observed distribution does not contradict the hypothesis of a random distribution of beginning points around the chromosome.

Chapter 5....Some physicochemical studies on the minicircular DNA species in E. coli 15 (0.670 μ, 1.47 x 10⁶ daltons) have been made. Electron microscopic observations showed multimeric forms of the minicircle which amount to 5% of total DNA species and also showed presumably replicating forms of the minicircle. A renaturation kinetic study showed that the minicircle is a unique DNA species in its size and base sequence. A study on the minicircle replication has been made under condition in which host DNA synthesis is synchronized. Despite experimental uncertainties involved, it seems that the minicircle replication is random and the number of the minicircles increases continuously throughout a generation of the host, regardless of host DNA synchronization.

Part II

The flow dichroism of dilute DNA solutions (A₂₆₀≈0.1) has been studied in a Couette-type apparatus with the outer cylinder rotating and with the light path parallel to the cylinder axis. Shear gradients in the range of 5-160 sec.^-1 were studied. The DNA samples were whole, "half," and "quarter" molecules of T4 bacteriophage DNA, and linear and circular λb₂b₅c DNA. For the linear molecules, the fractional flow dichroism is a linear function of molecular weight. The dichroism for linear A DNA is about 1.8 that of the circular molecule. For a given DNA, the dichroism is an approximately linear function of shear gradient, but with a slight upward curvature at low values of G, and some trend toward saturation at larger values of G. The fractional dichroism increases as the supporting electrolyte concentration decreases.

Stationary random response of multidegree-of-freedom systems

An approximate approach is presented for determining the stationary random response of a general multidegree-of-freedom nonlinear system under stationary Gaussian excitation. This approach relies on defining an equivalent linear system for the nonlinear system. Two particular systems which possess exact solutions have been solved by this approach, and it is concluded that this approach can generate reasonable solutions even for systems with fairly large nonlinearities. The approximate approach has also been applied to two examples for which no exact or approximate solutions were previously available.

Also presented is a matrix algebra approach for determining the stationary random response of a general multidegree-of-freedom linear system. Its derivation involves only matrix algebra and some properties of the instantaneous correlation matricies of a stationary process. It is therefore very direct and straightforward. The application of this matrix algebra approach is in general simpler than that of commonly used approaches.

Measuring temporal fluctuation on femtosecond scale in a random medium

We report an observation of femtosecond optical fluctuations of transmitted light when a coherent femtosecond pulse propagates through a random medium. They are a result of random interference among scattered waves coming from different trajectories in the time domain. Temporal fluctuations are measured by using cross-correlated frequency optical gating. It is shown that a femtosecond pulse will be broadened and distorted in pulse shape while it is propagating in random medium. The real and imaginary components of transmitted electric field are also distorted severely. The average of the fluctuated transmission pulses yields a smooth profile, probability functions show good agreement with Gaussian distribution. (c) 2007 Elsevier B.V. All rights reserved.

Primary and secondary threshold intensities of ultraviolet-laser-induced domain nucleation in nearly stoichiometric LiTaO3

The primary and secondary threshold intensities of ultraviolet-laser-induced preferential domain nucleation in nearly stoichiometric LiTaO3 is observed. The primary threshold is the minimum intensity to achieve the instantaneous preferential domain nucleation within the focus by the combined action of irradiation and electric fields. The secondary threshold is the minimum intensity to achieve the memory effect without any irradiation within the original focus. The space charge field created by the photoionization carriers is thought to be responsible for the instantaneous effect. The explanation based on the formation and transformation of extrinsic defect is presented for the memory effect. (c) 2008 American Institute of Physics.

The oculomotor system: (1) Vertical-horizontal interaction and signal recognition, (2) Time delays and power spectra

In the first section of this thesis, two-dimensional properties of the human eye movement control system were studied. The vertical - horizontal interaction was investigated by using a two-dimensional target motion consisting of a sinusoid in one of the directions vertical or horizontal, and low-pass filtered Gaussian random motion of variable bandwidth (and hence information content) in the orthogonal direction. It was found that the random motion reduced the efficiency of the sinusoidal tracking. However, the sinusoidal tracking was only slightly dependent on the bandwidth of the random motion. Thus the system should be thought of as consisting of two independent channels with a small amount of mutual cross-talk.

These target motions were then rotated to discover whether or not the system is capable of recognizing the two-component nature of the target motion. That is, the sinusoid was presented along an oblique line (neither vertical nor horizontal) with the random motion orthogonal to it. The system did not simply track the vertical and horizontal components of motion, but rotated its frame of reference so that its two tracking channels coincided with the directions of the two target motion components. This recognition occurred even when the two orthogonal motions were both random, but with different bandwidths.

In the second section, time delays, prediction and power spectra were examined. Time delays were calculated in response to various periodic signals, various bandwidths of narrow-band Gaussian random motions and sinusoids. It was demonstrated that prediction occurred only when the target motion was periodic, and only if the harmonic content was such that the signal was sufficiently narrow-band. It appears as if general periodic motions are split into predictive and non-predictive components.

For unpredictable motions, the relationship between the time delay and the average speed of the retinal image was linear. Based on this I proposed a model explaining the time delays for both random and periodic motions. My experiments did not prove that the system is sampled data, or that it is continuous. However, the model can be interpreted as representative of a sample data system whose sample interval is a function of the target motion.

It was shown that increasing the bandwidth of the low-pass filtered Gaussian random motion resulted in an increase of the eye movement bandwidth. Some properties of the eyeball-muscle dynamics and the extraocular muscle "active state tension" were derived.