Hospital-dia: para quem e para quê?

OBJETIVO: Estudar prospectivamente a população internada em um hospital-dia (HD) em relação a fatores que poderiam influenciar na melhora e na duração da internação. MÉTODOS: Foram entrevistados, para obtenção de dados sociodemográficos e avaliação da evolução, 34 pacientes internados no Hospital-Dia da Faculdade de Medicina de Botucatu, Unesp, durante um ano. O diagnóstico psiquiátrico foi avaliado pela CIDI (Composite International Diagnostic Interview), a sintomatologia psiquiátrica pela BPRS (Brief Psychiatric Rating Scale) e a incapacitação psicossocial pela DAS (Psychiatric Disability Assessment Schedule). Todos os pacientes foram acompanhados, e seus familiares, entrevistados. RESULTADOS: Predominaram mulheres (76%), jovens (61,8%), sem vínculo conjugal (71%), sem trabalho (82,4%), com diagnóstico de transtornos afetivos (44,1%) e com internações psiquiátricas prévias (44%). Apenas quatro (12%) pacientes apresentavam uma síndrome maior segundo BPRS. Houve considerável incapacitação psicossocial dos pacientes em alguns papéis sociais. Maior renda per capita foi um fator associado à melhor evolução. As internações duraram em média 74 dias. Pacientes com internações prévias tenderam a permanecer menos tempo no HD. CONCLUSÕES: Portadores de transtornos afetivos e quadros não-psicóticos geralmente não necessitam de internação por período integral em hospital psiquiátrico. Contudo, os pacientes deste estudo tiveram um elevado número de internações psiquiátricas prévias, provavelmente por necessitarem de um nível de atendimento além das possibilidades dos ambulatórios. Entretanto, pacientes com maior número de internações -- em tese mais graves -- tenderam a permanecer menos tempo no HD, o que suscita dúvidas quanto à sua adesão a serviços abertos, bem como aos possíveis fatores facilitadores dessa adesão. em um momento de crescimento expressivo no número de serviços de internação parcial no Brasil, como nos últimos anos, mais estudos são necessários a fim de esclarecer para quem e para quê são destinados esses serviços.

NATRIURESIS, NOT SEIZURES, INDUCED BY CHOLINERGIC STIMULATION OF THE LOCUS-CERULEUS IS AFFECTED BY FOREBRAIN LESIONS AND WATER-DEPRIVATION

Two groups of rats with electrolytic lesions of the medial and upper septal area (MUL) or, alternatively, of the anteroventral portion of the third ventricle (AV3V) and a third group of sham-operated rats were water loaded and received three carbachol injections into the locus coeruleus according to the following schedule: 1) prelesion, 2) on the second postlesion day and 3) on the seventh postlesion day. Both MUL and AV3V lesions inhibited the carbachol-induced natriuresis on the second postlesion day. Recovery was almost complete after MUL but not after AV3V lesion on the seventh day. Water deprivation also reduced the carbachol-induced natriuresis but passive hydration of AV3V animals did not avoid the impairment induced by the lesion. Transient seizure phenomena such as clonic convulsions, salivation and analgesia subsequent to carbachol injection were not altered by the lesions.

Diurnal variation in oral temperature, sleepiness and performance of high school girls

Evaluation of rhythmic fluctuations cf physical and mental variables should be of special significance for the understanding of students' performance and setting the schedules of school activities. The present study investigated the pattern of diurnal variation in oral temperature, sleepiness and performance of a group of adolescents undergoing a daytime school schedule. Eighteen girls (mean age 16 years-old), who attended the same class from 0715h to 1645h, were tested on seven days. They measured their oral temperature, quantified their sleepiness level by means of a visual analogue scale, and completed the following tests: letter cancellation test, addition test, and a simple motor task. One-way ANOVA statistics for repeated measures was used in order to verify the effect of test time on oral temperature,sleepiness and performance. Possible correlations between the level of sleepiness and performance were investigated by means of Spearman rank correlation. The results revealed significant time of day effect cn all variables, except for the number of addition errors. Oral temperature values showed an increase from morning to afternoon. Letter cancellation, motor task and addition scores increased from early morning to late afternoon, showing rapid fluctuations throughout the day. Sleepiness level was negatively correlated with letter cancellation scores during the first three tests of the day. In agreement with other work, the diurnal variation of oral temperature, letter cancellation and addition test showed an improvement as the day progressed. Sleepiness, on the other hand, decreased throughout the day, with the highest level associated with the first test of the day, suggesting a circadian pattern of variation rather than a cumulative effect due to school activities.

A single intraoperative sub-Tenon's capsule triamcinolone acetonide injection for the treatment of post-cataract surgery inflammation

Purpose: To compare a single intraoperative sub-Tenon's capsule triamcinolone acetonicle injection with steroid drops in the treatment of ocular inflammation after cataract surgery.Design: Randomized, double-masked controlled trial.Participants: A total of 100 patients were randomized prospectively into 2 groups: 50 patients treated with 1% prednisolone eyedrops (control group A) and 50 patients treated with sub-Tenon's capsule triamcinolone (treatment group B).Methods: All patients underwent phacoemulsification and intraocular posterior lens implantation. After surgery, patients were randomized to receive either (group B) an intraoperative 40 mg triamcinolone acetonicle sub-Tenon's capsule injection or (group A) 1% prednisolone acetate eyedrops, according to the following schedule: 1 drop 4 times daily (week 1), 3 times daily (week 2), 2 times daily (week 3), once daily (week 4). To mask the study, group B received vehicle drops administered on a similar schedule, and group A received an intraoperative sub-Tenon's capsule injection of a 1 ml balanced salt solution.Main Outcome Measures: the main outcome measures included inflammation (cell, flare, ciliary flush), intraocular pressure, and lack of response.Results: Triamcinolone was shown to have anti-inflammatory efficacy clinically equivalent to conventional 1% prednisolone eyedrops in reducing intraocular inflammation, as measured by clinical methods. Triamcinolone was found to be as safe as the prednisolone in terms of adverse effects, changes in visual acuity, intraocular pressure, and biomicroscopic and ophthalmoscopic variables. on the third, seventh, fourteenth, and twenty-eighth postoperative days, a significantly lower intraocular pressure (P<0.01) was noted in the triamcinolone group than in the prednisolone group.Conclusions: A single intraoperative 40-mg triamcinolone acetonide sub-Tenon's capsule injection demonstrated a clinically equivalent therapeutic response and ocular tolerance compared with 1% prednisolone drops in controlling postoperative inflammation after uncomplicated cataract surgery and merits further investigation. (C) 2004 by the American Academy of Ophthalmology.

Work and injuries in dancers: Survey of a professional dance company in Brazil

This study examined the daily life and most important physical injuries suffered and reported by the dancers of a professional (contemporary) dance company in S (a) over tilde $o Paulo, Brazil. Through an observational, cross,sectional, retrospective procedure using a questionnaire that collected qualitative and quantitative data, we were able to gather information on 30 dancers who collaborated with the survey. We determined that the injuries considered as most important by dancers were those that prevented dance activity during some months. These injuries occurred mainly during rehearsals (which is the activity occuppying, the most time on the schedule). Articular injuries were the most frequent and mainly involved the knee and ankle. They were related to classical technique, in which most of the company's artists started their dance careers. Medical care usually was sought within 1 day, and the prescribed treatment resolved the problem, but the injury cause was not identified in all cases.

Developmental lead exposure in rats: is a behavioral sequel extended at F2 generation?

Lead toxicity was studied in rats exposed from conception until weaning and assessed by monitoring offspring behavior in both the open field and elevated plus maze and by determining tissue lead in an assessment schedule extended to first (F1) and second (F2) generations. Dams utilized for the F1 generation were submitted to 750 ppm of lead (acetate) in drinking water during pregnancy and lactation. For F1 pups, behavioral alterations were not detected in the elevated plus maze, while in the open field, spontaneous locomotor activity as well as time of both grooming and rearing increased, while freezing time decreased in 30- and 90-day-old rats. Lead content was higher in tissues of 1- and 30-day-old pups. However, in 90-day-old rats, lead was detected only in the femur. F2 generation was lead-free but still presented alterations in both locomotor activity and grooming in 30- and 90-day-old pups. It appears that developmental lead exposure may cause behavioral effects during the developmental stage of the F1 generation, which remains throughout the animal's adult life as a sequel, regardless of lead accumulation, and is extended to the F2 generation of rats. (C) 2001 Elsevier B.V. All rights reserved.

Feeding habit of the Amazon river prawn Macrobrachium amazonicum larvae

To investigate the feeding habit of Macrobrachium amazonicum, three experiments were carried out assessing the stage at which larvae start exogenous feeding, the acceptance of inert food by different larval stages and the ratio between live and inert diet ingested by larvae at each larval stage. In the first experiment, newly hatched larvae were kept in 500-mL beakers and fed from stages I, II or III onward. Larval survival was not affected by the larval stage at which exogenous feeding started, but mean weight gain was lower when food was offered from stage III onward. In the second experiment, 60 larvae from each stage (I to IX) were fasted for 2 h and then fed on inert diet in excess. Only larvae from stage IV onward accepted this inert diet. In the last experiment, newly hatched larvae were stocked in a larviculture tank and fed daily on both Artemia nauplii and inert diet. After 15 min, food content in the digestive tract of individual larvae was analyzed under stereomicroscopy. Larvae in stage I did not feed, while live food was accepted from stage II onward and inert food from stage III onward. Larvae in stages IV, V and VI accepted both foods with no preference, while inert food was predominant in stages VII to IX In conclusion, to feed M amazonicum larvae on Artemia before stage II or on inert diet before stage IV is unnecessary. It increases production costs and may impair water quality. From stages IV to VI, feeding on Artemia and inert diet is probably necessary, while inert diet should be the main food item from stage VII onward. This schedule may optimize feeding management and production costs. (c) 2007 Elsevier B.V. All lights reserved.

Effect of porcine reproductive and respiratory syndrome virus on subsequent Pasteurella multocida challenge in pigs

This trial was conducted to evaluate the effect of Porcine reproductive and respiratory syndrome virus (PRRSv) on a subsequent challenge with Pasteurella multocida in pigs. Sixteen, 3-4 week-old piglets, from a PRRSv and Aujeszky disease virus (ADV) free herd were used. Animals were equally and randomly allocated in four groups which were treated according the following schedule: Group I: negative controls; Group II: inoculation with only PRRSV; Group III: inoculation with PRRSV and P. multocida; Group IV: inoculation with ADV and multocida (positive controls), PRRSV and ADV were inoculated intranasally, at the doses of 10(4.6) and 10(4.5) TCID50/ml, respectively. Five days later, pigs from groups III and IV were inoculated intranasally, with two ml of a 10(9) CFU/mL suspension of equal parts of P. multocida, strains A52 and A24. No lesions were observed in piglets of group I. Microscopically, interstitial pneumonia was identified in all piglets of groups II and III and 3/4 piglets from group IV. Bronchopneumonia was detected in 3/4 of the piglets from group III and in all animals of group TV which, additionally, showed meningo-encephalitis and purulent rhinitis. Macroscopically, only piglets of groups III and IV had lung consolidation. However, much lower pneumonic scores (2.3%) were observed in group III, where 3 of 4 piglets were affected. on the other hand, all piglets of group IV showed some degree of pulmonary consolidation, with a mean score of 13.7%. Based on these results, it appears that the role of PRRSV as a initiator of secondary diseases is still undefined, but is probably mild, There was no clear interaction between PRRSV and Pasteurella multocida under the conditions and strains tested here. (C) 1997 Elsevier B.V. B.V.

Immunization of bovines using a DNA vaccine (pcDNA3.1/MSP1b) prepared from the jaboticabal strain of Anaplasma marginale

Anaplasma is a tick-borne ehrlichial pathogen of cattle that causes the disease, anaplasmosis. In the present study, a total of 11 Anaplasma marginale seronegative calves were assigned into two groups: one immunized (G1, n = 6) and one nonimmunized-control (G2, n = 5). Six calves were immunized by using a DNA vaccine containing the gene of a major surface protein, MSP1b, encoded by the plasmid identified as pcDNA3.1/MSPIb. Calves received three intramuscular inoculations of 100 mug of pcDNA3.1/MSP1b at a 20-day interval. The control group received buffer phosphate at the same schedule as the experimental group. The immune response elicited by immunization with pcDNA3.1/MSP1b was evaluated in mice and calves. Twenty days following initial immunization, specific serum antibody from four BALB/c mice bound MSP1b in inummoblots. Sixty days after the last immunization, all calves were challenged with cryopreserved A. marginale at a dose of 10(4) parasites/mL/animal by intravenous injection. Results of packed cell volume (PCV) and detection of infected erythrocytes in all experimental groups revealed that the decrease of PCV and detection of infected erythrocytes occurred at 28 to 42 days after challenge. Mean temperature values did not increase over 39.85degreesC. Antibodies developed by immunized bovines from G2 were detected 14 days after challenge. MSP1b was characterized during the immunization period and MSP2 was the most predominant polypeptide at the challenge period. DNA of A. marginale was detected in all groups just after challenge by nested PCR assay. It can be concluded that all immunized bovines were partially protected against homologous challenge.

Stochastic scheduling - A flow shop no wait application and solutions

Minimizing the makespan of a flow-shop no-wait (FSNW) schedule where the processing times are randomly distributed is an important NP-Complete Combinatorial Optimization Problem. In spite of this, it can be found only in very few papers in the literature. By considering the Start Interval Concept, this problem can be formulated, in a practical way, in function of the probability of the success in preserve FSNW constraints for all tasks execution. With this formulation, for the particular case with 3 machines, this paper presents different heuristics solutions: by integrating local optimization steps with insertion procedures and by using genetic algorithms for search the solution space. Computational results and performance evaluations are commented. Copyright (C) 1998 IFAC.

The influence of study schedules and work on the sleep-wake cycle of college students

College students usually exhibit an irregular sleep-wake cycle characterized by great phase delays on weekends and short sleep length on weekdays. As the temporal organization of social activities is an important synchronizer of human biological rhythms, we investigated the role played by study's schedules and work on the sleep-wake cycle. Three groups of female college students were investigated: (1) no-job morning group, (2) no-job evening group, (3) job evening group. The volunteers answered a sleep questionnaire in the classroom. The effects of day of the week and group on the sleep schedules and sleep length were analyzed by a two way ANOVA for repeated measures. The three groups showed delays in the wake up time on weekends. No-job evening and morning groups also delayed bedtime, but the job evening group slept at the same time on weekdays as on weekends. Sleep length increased on weekends for morning group and job evening group, whereas the no-job evening group maintained the amount of sleep from weekdays to weekends. This survey showed that the tendency of phase delay on weekends was differently expressed according to study's schedules and work.

Single dose of a vaccine based on DNA encoding mycobacterial hsp65 protein plus TDM-loaded PLGA microspheres protects mice against a virulent strain of Mycobacterium tuberculosis

The high incidence of tuberculosis around the world and the inability of BCG to protect certain populations clearly indicate that an improved vaccine against tuberculosis is needed. A single antigen, the mycobacterial heat shock protein hsp65, is sufficient to protect BALB/c mice against challenge infection when administered as DNA vaccine in a three-dose-based schedule. In order to simplify the vaccination schedule, we coencapsulated hsp65-DNA and trehalose dimicolate (TDM) into biodegradable poly(DL-lactide-co-glycolide) (PLGA) microspheres. BALB/c mice immunized with a single dose of DNA-hsp65/TDM-1oaded microspheres produced high levels of IgG2a subtype antibody and high amounts of IFN-gamma in the supernatant of spleen cell cultures. DNA-hsp65/TDM-loaded microspheres were also able to induce high IFN-gamma production in bulk lung cells from challenged mice and confer protection as effective as that attained after three doses of naked DNA administration. This new formulation also allowed a ten-fold reduction in the DNA dose when compared to naked DNA. Thus, this combination of DNA vaccine and adjuvants with immunomodulatory and carrier properties holds the potential for an improved vaccine against tuberculosis.

Comparison of embryo yield and pregnancy rate between in vivo and in vitro methods in the same Nelore (Bos indicus) donor cows

To investigate why the preferred means to produce bovine embryos in Brazil has changed from in vivo to in vitro, we compared these two approaches in the same Nelore cows (n = 30) and assessed total embryo production and pregnancy rates. Without a specific schedule, all cows were subjected to ultrasound-guided ovum pick up (OPU)/in vitro production (IVP) and MOET, with intervals ranging from 15 to 45 d between procedures, respectively. To produce in vivo embryos, cows were superovulated and embryos were recovered nonsurgically from 1 to 3 times (1.4 +/- 0.6). whereas OPU/IVP was repeated from 1 to 5 times (3.2 +/- 1.2) in each donor cow during a 12-mo interval. Embryos obtained from both methods were transferred to crossbred heifers. on average. 25.6 +/- 15.3 immature oocytes were collected per OPU attempt. The average number of embryos produced by OPU/IVP (9.4 +/- 5.3) was higher (P < 0.05) than the MOET method (6.7 +/- 3.7). However, pregnancy rates were lower (P < 0.05) following transfer of IVP (33.5%) versus in vivo-derived embryos (41.5%) embryos. Embryonic losses between Days 30 and 60 and fetal sex ratio were similar (P > 0.05) between in vivo and in vitro-derived embryos. We concluded that in Nelore cows, with an interval of 15 d between OPU procedures, it was possible to produce more embryos and pregnancies compared to conventional MOET. (C) 2009 Elsevier B.V. All rights reserved.