Qualidade de vida de pessoas com úlcera venosa: associação dos aspectos sociodemográficos, de saúde, assistência e clínicos da lesão

Venous ulcer (VU) is a lower limbs injury resulting from inadequate return of venous blood in feet or legs. Although it is not a deadly disease, it causes chronic wounds, which seriously undermine patients´ quality of life (QOL) and sometimes leads to drastic family, social, economic and psychological changes. In this sense, there are several aspects that may influence the venous ulcers patients´ QOL. The study´s objective aimed on the association of socio-demographic and health, health care and clinical injury on UV patients‟ QOL. Analytical studies, which consider the complexity of factors involved in changes in UV patients‟ QOL has a cross-sectional and quantitative approach. The HUOL Ethics Committee approved this project (n.279/09). The collection of data lasted a period of 3 months in 2010 and it took place at the clinic of Angiology at Hospital Universitário Onofre Lopes (HUOL). The data sample consisted of 60 patients treated by UV angiologists in the HUOL Surgical Clinic. The results were analyzed with SPSS 15.0 by descriptive and inferential statistics. The study was based on UV patients that were predominantly female, average age of 61.4 years, that had low education level and low family income, with occupations requiring long periods of standing or sitting, but mostly retired, unemployed or laid off due to the disease and/or due to chronic diseases associated with the UV. The study took also into consideration patients that used inappropriate products, that were improperly treated by a professional caregiver, that lacked of adequate guidance and compression therapy, that performed no lifting of the lower limbs and regular exercise, that the time of injury were greater than or equal to six months, that were missing specific laboratory tests. The study‟s reference were on recurrent lesions, medium to large lesions area, bed of the lesion (injuries) with fibrin and/or necrosis, with amount of exudate with medium to large, odorless and no signs of infection, with tissue loss between 1st and 2nd degree, without collecting swab or biopsy and with pain. In general, QOL of researched individuals were considered low, the maximum score was 69 points, which the areas that were mostly influenced were the total scores of QOL functional capacity (0.021), emotional (0.000) and social functioning (0.080). Of the 60 individuals, 53.3% had scores between 40 and 69 points in SF-36, and they had the best scores in sociodemographic and health variables (ρ = 0.049). In respect to the assistance and injury characteristics, patients who scored between 40 and 69 points in SF-36 had better scores on these characteristics. By combining the socio-demographic variables, health, and handling characteristics of the injury, we observed a significant difference (ρ = 0.032) when linking them with the QOL total scores. When analyzing separately the domains of the SF-36 scores on the quality of life, we find that the areas that showed statistical significance were functional ability (ρ = 0.035), appearance (ρ = 0.019), emotional (ρ = 0.000), and mental health (ρ = 0.050). Among the socio-demographic characteristics studied, gender and marital status contributed more to the reduction of QOL and among the variables of assistance and the injury, orientation, reference and area of UV contributed the most. By analyzing these five variables all together in accordance with the overall score obtained in the quality of life, we found a significant correlation (ρ = 0.002); with 6.23 times more chances of patients have better QOL in the presence of these five positive factors. By conducting the Mann Whitney U test between all the five demographic variables, health, and clinical care, we found that this combination also proved to be significant (ρ = 0.006). Therefore, patients with these five variables positive tend to have a better QOL. Based on these results, we reject the null hypothesis (H0) and accept the alternative hypothesis (H1) proposed in this study because we noted that the QOL of patients with UV is associated with sociodemographic and health, health care and clinical aspects of the injury

Trajetória do hospital dia Dr. Elger nunes: um recorte histórico da psiquiatria e saúde mental no Rio Grande do Norte

In Brazil, the mental health network proposed by the Psychiatric Reform inserts the intermediate and replacement services in the pursuit of alignment or resocialization of patients with mental and behavioral disorder in the community. Was adopted, among other services, the Center for Psychosocial Care, Home Therapy, Sheltered Home, Day Hospital and psychiatric beds in general hospital. In this context, the State of Rio Grande do Norte implanted the Day Hospital Dr. Elger Nunes (HDEN) in Natal / RN in 1996, linked to State Department of Public Health. At HDEN happened a multi and interdisciplinary therapeutic work, besides being the scene of disciplinary practices, and extension projects for graduate courses in Higher Education Institutions in the city. However, with the process of decentralization of local services, the hospital was terminated by an administrative state act in 2006, leaving damage to the activities provided to users, disciplinary practices and extension activities. From this breakdown, the objective was to narrate the trajectory of HDEN through a multidisciplinary team of professionals and teachers who used it as a field of disciplinary practices. It is characterized as a documental and qualitative, backed in the technique of thematic oral history, following the phases: authorization of the interviewee, interview recording, transcription, textualization and transcreation of the material obtained. We used documents, ordinances, general reports of activities, among others, plus interviews to fifteen employees who used this service, being thirteen part of the multidisciplinary team of professionals and two graduation professors of health care area, nursing and medicine. The stories collected were organized according to the technique chosen, respecting its steps. In preparing the body subjected to ALCESTE computer program, priority was given to the vital tone for the formation of categories and classes elected by the program, structured in three thematic areas. In the first axis, called Trajectory of HDEN, were recalled the beginning of its activities, the steps of that time, their activities, and its actors - users, families, professionals, and teaching practices. The second axis has dealt with the process of extinction of HDEN, rescuing the feelings of employees, the main reasons given at the time and immediate postextinction scenario. And the third axis revealed in an articulated form the situation of mental health in Natal / RN, listing to the challenges and prospects for the psychosocial care, starting from the trajectory of HDEN with emphasis on activities. Moreover, the trajectory of HDEN provides recognition of the historical basis outlined in the constitution of the network of substitute services present in the current scenario of psychosocial care in the city of Natal and in RN.

Qualidade da assistência e o conhecimento sobre o direito à saúde das pessoas com úlcera venosa crônica

The study aimed to identify the quality of care and knowledge of health rights of people with chronic venous ulcers (VU) in Brasilian National Health Care System (SUS). It is a cross-sectional study, with quantitative approach, performed at the University Hospital Onofre Lopes (HUOL). The study was approved by the Ethics Committee of HUOL (CAAE nº 0148.0.051.000-10). The sample by accessibility was composed for 30 people with VU treated at the outpatient surgical clinic of HUOL. For data collection we used a structured questionnaire composed of two parts: sociodemographic characteristics and of health, of care and the clinical course of VU; and knowledge of people with VU about the rights of health. The results were processed using SPSS 15.0 and analyzed by descriptive statistics. Given the characterizations sociodemographic and health presented, we identified a clientele of users with VU predominantly female (76,7%), aged from 60 years (66,7%), married/ stable union (60,0%), low education level (83,3%), family income lower than a minimum wage (73,3%), unemployeds and with chronic diseases (53,3%), sleep greater than or equal to 6 hours (76,7%) and were not alcoholics or smokers (93,3%). In relation to clinical conditions, were shown the presence of one or more relapses of VU (73,3%), predominance of granulation tissue/epithelialization in the bed of VU (60,0%), exudate serosanguineous (43,3%), in quantity medium/large (60,0%), with no predominance of presence or absence of odor (50,0%), all patients with tissue loss in grade III / IV, no signs of infection (73,3%) and presence of intense pain (50,0%). In the last 30 days the main venue of achievement of dressing was the HUOL (100,0%), the main compression therapy used was the Unna boot (60,0%) and on inability to perform the dressing on the unit were the own patients who made the exchange at home (40,0%). The majority of respondents listed out more positive factors associated with quality of care (56,7%) were satisfied with the care of SUS (76,7%), claimed to have knowledge about their rights (70,0%), but at the same time did not know the meaning of the acronym SUS (90,0%) and classified their level of information as inappropriate (70,0%). We realize that people with VU identified as good the quality of care and demonstrated inadequate knowledge about their rights to health in the SUS, but showed interest in acquiring more information. The basic rights to entry in the SUS are constitutionally guaranteed and need to be disseminated in order to make them known to the population, so it can be implemented and ensured a greater resolution assistance in treating this type of injury

Úlceras de pressão: um estudo com pacientes de unidade de terapia intensiva

To characterize patients according to gender, age category, internment time, diagnostical hypothesis and location of the pressure ulcer; to identify the susceptibility conditions, intrinsical and extrinsical factors present on ICU patients and to verify on the existence of association between the susceptibility conditions and the intrinsecal and extrinsecal factors on the occurrence of PU. Methods: It is a descriptive study, of longitudinal design of the panel type, with quantitative approach, performed on two ICU s of a private hospital located in Natal/RN, with 40 patients interned at these units. The data collection was performed on all three shifts through a structured observation and physical exam of the patients' skin form seeking to identify the presence of PU. Results: The greatest occurence of PU was on individuals of the male gender (70%) when compared to the female gender (30%), that difference being statistically significant (p=0,0267), with the male gender presenting 4,3 times greater chance of developing PU than the female; the predominant age category was from 60 years of age on (85%), 60,0% presented 1 to 2 PU s after 7 (seven) days of permanence in the ICU s, the predominant diagnostical hypothesis on the patients with PU were the respiratory diseases (42,3%) and the most frequent locations of PU were the sacral region (40,0%) and heels (36,0%). 25 PU s of stage I were diagnosed on 50,0% of the followed patients, with general incidence of 50,0% on both ICUs. from the 88 variables researched, 75 were identified on the patients from the study, being the predominant conditions (anemia, hypotension, leukocytosis, other diseases hypertension blood pressure, cardiac insuffience, pneumonia - and ansiolythic), the intrinsecal factors (diminished muscular strenght and/or mass, discrete edema, totally compromised mobile coordination and total inability for movement on the bed) and the extrinsecal factors (inadequate mattress type, permanence on a single position for >2 hours, shearing/friction force, bed clothes with folds that leave marks on the body, pressure force) predominated on patients with PU. The male gender variables (p=0,0267,OR=4,3), sedation (p=0,0006,OR=4,1), psychomotive agitation (p=0,0375,OR=5,8) and leukocytosis (p=0,0285,OR=5,0) presented a significant statistical diference when analyzed independently. We verified an association of 17,3%, statistically significant (p=0,0384), between the susceptibility conditions (anemia, leukocytosis and hypotension), the intrinsecal factors (age equal or above 60 years, diminished/absent pain sensibility and smooth, fine or delicate skin) and the extrinsecal factors (inadequate mattress, pressure forces, shearing/friction force, permanence on a single position for more than 2 hours, elevation between 30 to 45 degrees and inadequate bed clothes' conditions), with a chance ratio of 4,6 times the risk of occurrence of PU on the patients that presented the referred association. Conclusion: The incidence of PU detected on the ICU-interned patients was high and we made evident the existence of association between the susceptibility conditions, the intrinsecal and extrinsecal factors on the occurrence of PU s on the ICUinterned patients, and thus we accept the alternative hypothesis proposed on the study

Efeito da adição de agentes tróficos na dieta de leitões desmamados sobre a estrutura e ultraestrutura do intestino delgado e sobre o desempenho

Foram estudados os efeitos da glutamina, dos ácidos graxos poli-insaturados e da parede celular de levedura (PCL) sobre a estrutura e ultraestrutura do intestino delgado e o desempenho de leitões. Foram utilizados 45 leitões, desmamados aos 21 dias de idade, para testar os seguintes tratamentos: T1 - dieta basal; T2 - dieta basal + 1% de glutamina; T3 - dieta basal + 0,2% de PCL; T4 - dieta basal + 5% de óleo de peixe. Nos dias sete e 14 pós-desmame, foram abatidos cinco leitões de cada tratamento. Os aditivos testados não alteraram a altura e a densidade dos vilos nem a profundidade das criptas do intestino delgado. Foi observado efeito de idade, mostrando redução na altura e na densidade dos vilos e na profundidade das criptas após o desmame. No duodeno e jejuno, foram observados maiores valores de relação vilo:cripta, que aumentaram com a idade pós-desmame. Ocorreram redução da altura dos microvilos do duodeno aos sete dias e aumento da largura dos microvilos do jejuno aos 14 dias pós-desmame. A área de superfície apical dos enterócitos não foi alterada pelos fatores estudados. Os aditivos estudados não foram eficientes em prevenir a atrofia da mucosa intestinal do jejuno, ao não interferir na sua ultraestrutura. Os aditivos incluídos na dieta não influenciaram o desempenho dos leitões no pós-desmame.

Análise dos custos assistenciais de uma operadora de plano de saúde no Brasil

The relevance of rising healthcare costs is a main topic in complementary health companies in Brazil. In 2011, these expenses consumed more than 80% of the monthly health insurance in Brazil. Considering the administrative costs, it is observed that the companies operating in this market work, on average, at the threshold between profit and loss. This paper presents results after an investigation of the welfare costs of a health plan company in Brazil. It was based on the KDD process and explorative Data Mining. A diversity of results is presented, such as data summarization, providing compact descriptions of the data, revealing common features and intrinsic observations. Among the key findings was observed that a small portion of the population is responsible for the most demanding of resources devoted to health care

Classificação de distúrbios na rede elétrica usando redes neurais e wavelets

Post dispatch analysis of signals obtained from digital disturbances registers provide important information to identify and classify disturbances in systems, looking for a more efficient management of the supply. In order to enhance the task of identifying and classifying the disturbances - providing an automatic assessment - techniques of digital signal processing can be helpful. The Wavelet Transform has become a very efficient tool for the analysis of voltage or current signals, obtained immediately after disturbance s occurrences in the network. This work presents a methodology based on the Discrete Wavelet Transform to implement this process. It uses a comparison between distribution curves of signals energy, with and without disturbance. This is done for different resolution levels of its decomposition in order to obtain descriptors that permit its classification, using artificial neural networks

Fontes e níveis de proteína em rações iniciais para leitões desmamados aos 21 dias de idade

Foi conduzido um experimento com o objetivo de avaliar fontes e níveis de proteína em rações iniciais para leitões desmamados aos 21 dias de idade. Utilizou-se um delineamento inteiramente casualizado em esquema fatorial 2 x 2 x 2, onde foram estudados os fatores: tipos de dieta (soro de leite em pó e farinha de peixe + lactose), níveis de proteína bruta (20,0% e 24,0%) e pesos dos leitões ao desmame (< 6,0 e > 6,0 kg), totalizando oito tratamentos com quatro repetições cada. O desempenho de leitões desmamados aos 21 dias de idade alimentados com rações contendo farinha de peixe + lactose foi superior ao dos leitões que consumiram apenas o soro de leite em pó. O nível de 24% de proteína bruta nas rações foi mais eficiente, sobretudo com a combinação farinha de peixe + lactose. Concluiu-se que os tipos de dietas estudados não exerceram efeito sobre os parâmetros histológicos e que a altura das vilosidades é uma função direta do peso do leitão.

Fontes de lactose, níveis de lisina dietéticos e peso dos leitões ao desmame

Desenvolveu-se um experimento com o objetivo de avaliar o uso de fontes de lactose (soro de leite em pó e lactose) e níveis de lisina em rações (1,20 e 1,50%), além do peso ao desmame (<6,0 e >6,0 kg), sobre o desempenho e a morfologia intestinal de 384 leitões desmamados com diferentes pesos e idade de 21 dias. Os leitões foram distribuídos em delineamento inteiramente casualizado em esquema fatorial 2 x 2 x 2, totalizando oito tratamentos em quatro repetições cada. Três leitões de cada tratamento foram abatidos aos 42 dias de idade, quando foram coletadas amostras do duodeno para estudo da morfologia intestinal. Foram avaliadas as características de desempenho ganho de peso, consumo de ração e conversão alimentar. Altura das vilosidades, profundidade de criptas duodenais e a relação altura de vilosidades/profundidade de criptas, bem como a relação peso do pâncreas/peso da carcaça, foram as características morfológicas avaliadas. O uso de lactose em rações à base de milho e farelo de soja proporcionou melhor desempenho dos leitões quando combinado a um nível de 1,5% de lisina. Concluiu-se ainda que os tipos de dietas estudados não exerceram efeito sobre a morfologia do duodeno e a relação peso do pâncreas/peso corporal e que a altura das vilosidades é uma função direta do peso do leitão.

Revisitando o problema de visibilidade para visualização tridimensional

We revisit the problem of visibility, which is to determine a set of primitives potentially visible in a set of geometry data represented by a data structure, such as a mesh of polygons or triangles, we propose a solution for speeding up the three-dimensional visualization processing in applications. We introduce a lean structure , in the sense of data abstraction and reduction, which can be used for online and interactive applications. The visibility problem is especially important in 3D visualization of scenes represented by large volumes of data, when it is not worthwhile keeping all polygons of the scene in memory. This implies a greater time spent in the rendering, or is even impossible to keep them all in huge volumes of data. In these cases, given a position and a direction of view, the main objective is to determine and load a minimum ammount of primitives (polygons) in the scene, to accelerate the rendering step. For this purpose, our algorithm performs cutting primitives (culling) using a hybrid paradigm based on three known techniques. The scene is divided into a cell grid, for each cell we associate the primitives that belong to them, and finally determined the set of primitives potentially visible. The novelty is the use of triangulation Ja 1 to create the subdivision grid. We chose this structure because of its relevant characteristics of adaptivity and algebrism (ease of calculations). The results show a substantial improvement over traditional methods when applied separately. The method introduced in this work can be used in devices with low or no dedicated processing power CPU, and also can be used to view data via the Internet, such as virtual museums applications

Localização de faltas em linhas de transmissão de múltiplos terminais a partir de registros oscilográficos sincronizados via transformada wavelet

The electric energy is essential to the development of modern society and its increasing demand in recent years, effect from population and economic growth, becomes the companies more interested in the quality and continuity of supply, factors regulated by ANEEL (Agência Nacional de Energia Elétrica). These factors must be attended when a permanent fault occurs in the system, where the defect location that caused the power interruption should be identified quickly, which is not a simple assignment because the current systems complexity. An example of this occurs in multiple terminals transmission lines, which interconnect existing circuits to feed the demand. These transmission lines have been adopted as a feasible solution to suply loads of magnitudes that do not justify economically the construction of new substations. This paper presents a fault location algorithm for multiple terminals transmission lines - two and three terminals. The location method is based on the use of voltage and current fundamental phasors, as well as the representation of the line through its series impedance. The wavelet transform is an effective mathematical tool in signals analysis with discontinuities and, therefore, is used to synchronize voltage and current data. The Fourier transform is another tool used in this work for extract voltage and current fundamental phasors. Tests to validate the location algorithm applicability used data from faulty signals simulated in ATP (Alternative Transients Program) as well as real data obtained from oscillographic recorders installed on CHESF s lines.

Enxertia em figueira 'Roxo de Valinhos' por borbulhia e garfagem

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação da secagem do bagaço de cajá usando planejamento fatorial composto central

This work deals with the kinetics assay of Cajá (Spondias mombin L.) bagasse drying by an experimental design using a tray dryer. In order to add-value to this product a kinetic study has been carried out. A central composite experimental design has been carried out to evaluate the influence of the operational variables: input air temperature (55; 65 e 75ºC); the drying air velocity (3.2; 4.6 e 6.0 m/s) and the fixed bed thickness (0.8; 1.2 e 1.6 cm) and as response variable the the moisture content (dry basis). The results showed that the diffusional Fick model fitted quite well the experimental data. The best condition found has been input air temperature of 75ºC, drying air velocity of 6.0 m/s as well as fixed bed thickness of 0.8 cm. The experimental design assay showed that the main effects as well as the second ones were significant at 95% confindance level. The best operational condition according to statistical planning was 75 oC input air temperature, 6.0 m.s-1 drying air velocity and 0.8 cm fixed bed thickness. In this case, the equilibrium moisture content (1.3% dry basis) occured at 220 minutes

Levantamento de plantas aquáticas no reservatório de Salto Grande, Americana-SP

O objetivo deste estudo foi determinar a frequência relativa e o nível de infestação de cada espécie da flora aquática presente no reservatório de Salto Grande, Americana-SP. O levantamento e a identificação das plantas aquáticas foram realizados percorrendo-se as margens do reservatório em uma embarcação. Ao longo dele foram estabelecidos 20 pontos de avaliação, sendo todos eles fotografados e georreferenciados. Foram atribuídos valores de 0 a 100% tanto para as espécies presentes como para os espaços livres de macrófitas aquáticas que eventualmente pudessem ocorrer dentro dos pontos amostrados. Com os dados referentes ao número de indivíduos e pontos avaliados, foi determinada a frequência relativa de cada espécie. Foram identificadas 13 espécies em todo o reservatório, sendo 12 vasculares e uma de alga-verde (Chlorella spp.). Entre as espécies vasculares, nove eram plantas emersas flutuantes, as quais poderiam estar ou não ancoradas no leito do reservatório: Alternanthera philoxeroides, Brachiaria subquadripara, Cyperus difformis, Echinochloa polystachia var. spectabilis, Eichhornia crassipes, Panicum rivulare, Pistia stratiotes, Salvinia auriculata e Typha angustifolia. Outras três espécies foram encontradas somente em solo firme alagado: Aeschynomene sensitiva, Hedychium coronarium e Mimosa pigra.

Estudo da movimentação de plantas aquáticas imersas presentes no reservatório da UHE Eng. Souza Dias - Jupiá

O objetivo deste estudo foi desenvolver um método para determinação de pontos de reprodução e de suas respectivas importâncias na disseminação das espécies E. densa, E. najas e C. demersum no reservatório de Jupiá. Foram monitorados dez locais nos quais se encontrou registro de altas infestações dessas espécies. Dois desses locais situam-se no rio Paraná, nas lagoas denominadas de Ferradura e Pernilongo; os outros oito sítios estão localizados no rio Tietê, nas lagoas marginais Testemunha, Barrenta, Vírgula e Flórida, e no leito do rio nos pontos Acima da Ponte dos Barrageiros, Abaixo da Ponte, Baía ao Lado da Ponte e em frente da Praia de Itapura. em cada um desses sítios de reprodução foram liberados e monitorados dez blocos de plantas aquáticas imersas por mês. Os blocos possuíam volume de 0,14 cm³ e receberam uma etiqueta plástica de identificação externa e uma bóia de cor laranja, com o objetivo de serem facilmente localizadas ou visualizadas à distância. Após a soltura, cada bloco foi georreferenciado por meio de um aparelho GPS, sendo o seu deslocamento avaliado a cada 15 dias. Os sítios Lagoa Vírgula, Lagoa Testemunha e Lagoa Barrenta destacaram-se quanto ao número de blocos (30, 20 e 19 blocos, respectivamente), que percorreram distâncias superiores a 500 m e, conseqüentemente, saíram de seus respectivos locais de reprodução. A grande maioria dos blocos permaneceu dentro da Lagoa Flórida; somente 12 blocos saíram e alcançaram o leito do rio Tietê. O sítio denominado Leito Acima da Ponte foi o que mais se destacou dentre os três localizados no leito do rio Tietê, pois forneceu 18 blocos de plantas, enquanto os sítios Abaixo da Ponte e Baía ao Lado da Ponte forneceram 15 e 14 blocos, respectivamente. O sítio Praia de Itapura foi o que apresentou menor importância em relação ao fornecimento de plantas imersas no rio Tietê, sendo localizadas apenas 11 bóias com deslocamento superior a 500 m. Os sítios de reprodução localizados no rio Paraná também contribuíram para o fornecimento de plantas imersas ao reservatório de Jupiá; nove blocos saíram da Lagoa Pernilongo e apresentaram deslocamentos superiores a 500 m. Entretanto, os sítios Lagoa Barrenta e Lagoa Ferradura foram aqueles que mais contribuíram com a chegada de plantas na tomada de água da UHE Eng. Souza Dias, uma vez que foram recolhidos, respectivamente, seis e quatro blocos de plantas provenientes desses locais de dispersão. A metodologia utilizada mostrou-se eficaz quanto à avaliação da movimentação de plantas aquáticas imersas dentro do reservatório de Jupiá.