Satisfação no trabalho e rotatividade dos médicos do Programa de Saúde da Família

Um dos problemas mais graves identificados na implantação do Programa de Saúde da Família no Brasil é a rotatividade do médico generalista. Já que o modelo se fundamenta no vínculo entre profissionais da equipe e população, a alta rotatividade dos médicos pode comprometer a efetividade do modelo. Pesquisa realizada no município de São Paulo para verificar a existência de correlação entre satisfação no trabalho dos médicos do programa e a rotatividade desses profissionais confirmou a hipótese da existência de correlação negativa. O prestígio da instituição parceira do município na implantação do programa foi o fator mais importante na determinação da rotatividade dos médicos. Outros fatores de satisfação no trabalho que apresentaram correlação com a rotatividade foram: capacitação, distância das unidades de saúde e disponibilidade de materiais e equipamentos para realização das atividades profissionais.

Influência do local de nascimento e do transporte sobre a morbimortalidade de recém-nascidos prematuros

OBJETIVO: Verificar a influência do local de nascimento e do transporte sobre a morbimortalidade de recém-nascidos prematuros na Região Sul do Brasil. MÉTODOS: Estudo de coorte com recém-nascidos prematuros transferidos para a unidade de tratamento intensivo de referência (grupo transporte = 61), tendo sido acompanhados até a alta. Os dados sobre o atendimento no hospital de origem e transporte foram obtidos no momento da internação. Esse grupo foi comparado com neonatos da maternidade de referência, pareados por idade gestacional (grupo controle = 123), tendo como desfecho primário o óbito e desfechos secundários as alterações da glicemia, temperatura e saturação de oxigênio no momento da internação e a incidência de enterocolite necrosante, displasia broncopulmonar e sepses. Na associação entre as variáveis e o desfecho, foi utilizado o risco relativo. Foi adotado um nível de significância de α = 5% e β = 90%. RESULTADOS: A distância média percorrida foi de 91 km. A idade gestacional média foi de 34 semanas. Entre os recém-nascidos transferidos, 23% (n = 14) não tiveram atendimento pediátrico na sala de parto. No transporte, 33% dos recém-nascidos foram acompanhados por pediatra, e os equipamentos utilizados foram: incubadora (57%), bomba de infusão (13%), oxímetro (49%) e aparelho para aferição da glicemia (21%). O grupo transporte apresentou maior incidência de hiperglicemia, risco relativo (RR) = 3,2 (2,3-4,4), hipoglicemia, RR = 2,4 (1,4-4,0), hipertermia, RR = 2,5 (1,6-3,9), e hipoxemia, RR = 2,2 (1,6-3,0). Foram observados 18% de óbitos no grupo dos transferidos e 8,9% no grupo controle, RR = 2,0 (1,0-2,6). CONCLUSÕES: A pesquisa expõe deficiências no atendimento e transporte dos recém-nascidos, sendo necessária uma melhor organização do atendimento perinatal e do transporte na região nordeste do Rio Grande do Sul.

Tecnologias para investigação da DAC: relação entre publicações científicas e utilização clínica

FUNDAMENTO: Apesar de algumas evidências sugerirem associação entre a exposição de uma tecnologia na literatura científica e sua difusão na prática clínica, poucos estudos avaliaram essa associação. OBJETIVO: O objetivo deste estudo é analisar se o padrão de publicação científica sobre duas tecnologias competitivas utilizadas na avaliação da doença arterial coronária (DAC) reflete o que ocorre na prática clínica. MÉTODOS: Avaliou-se o número de artigos científicos publicados anualmente na literatura médica (interesse científico global na tecnologia) sobre duas tecnologias utilizadas na avaliação da doença arterial coronária: tomografia computadorizada por feixe de elétrons e tomografia computadorizada com múltiplos detectores. Foi também analisado o número de países que publicam anualmente artigos científicos sobre essas tecnologias (interesse geográfico na tecnologia). RESULTADOS: A tomografia computadorizada por feixe de elétrons (electron beam computed tomography - EBCT) apresentou ápice de "interesse científico global" em 2001, com 127 artigos publicados. Após esse ápice, o "interesse científico global" diminuiu cerca de 50% em 2008. Em oposição, o "interesse científico global" pela tomografia computadorizada com múltiplos detectores (multidetector computed tomography - MDCT) aumentou progressivamente até 2007, com 454 artigos publicados nesse ano. O "interesse científico geográfico" pela EBCT teve ápice em 2002, com 14 países publicando sobre essa tecnologia. Após esse ápice, "o interesse científico geográfico" declinou em quase 25% até 2008, com 11 países publicando artigos sobre essa tecnologia. Em oposição, o "interesse científico geográfico" pela MDCT aumentou progressivamente até 2008, com 37 países publicando artigos sobre ela. CONCLUSÃO: A literatura científica médica é compatível com a substituição da EBCT pela MDCT na avaliação da DAC.

The influence of birthweight on arterial blood pressure of children

Background & aims.This study examined the relationship between birthweight and blood pressure in childhood. Methods.Prospective cohort study involving 472 Brazilian children ranging in age from 5 to 8 years. Birthweight, systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), total cholesterol and fractions (LDL-c, HDL-c), and triglycerides were determined. Total cholesterol, LDL-c, HDL-c, and triglycerides were assessed by automated enzymatic methods. Blood pressure was measured with the HDI/Pulse Wave™ CR-2000 equipment. Multiple regression models were used to investigate the relationship between birthweight and SBP and DBP, controlling for the following variables: gender, age, BMI, total cholesterol, triglycerides, per capita income, and maternal education. Results.When adjusting for gender and BMI, we found a systolic blood pressure increase of 2.9 (95per cent CI = −5.33 to −0.56) mmHg per kilogram birthweight reduction. The unadjusted association was insignificant. Conclusion.Our data suggest that low birthweight is one of the factors contributing to blood pressure elevation at early ages. A way to prevent these diseases is by implementing public policies focused on good nutrition and adequate prenatal care for pregnant women

Saúde bucal e cuidado odontológico: representações sociais de mães usuárias de um serviço público de saúde

Objetivo: identificar as representações sociais de mães de crianças da faixa etária de zero a cinco anos de idade do Núcleo de Saúde da Família IV, em Ribeirão Preto-SP, procurando saber o que pensam sobre saúde bucal e tratamento odontológico. Método: trata-se de pesquisa qualitativa, sendo utilizada a entrevista semi-estruturada para a coleta dos dados e a análise de conteúdo. Resultados: constatou-se grande dificuldade das mães em se expressar a respeito do que é, para elas, saúde. Para essas mães a saúde bucal está relacionada com normas de higiene e dietéticas e também com a ida ao dentista, restringindo-se na preocupação com a estética e pouco com a função. Já em relação ao tratamento odontológico, a grande maioria demonstrou apresentar medo, causado pela sua experiência anterior com o tratamento. A assistência particular está associada à pontualidade e ao atendimento da maneira desejada enquanto o tratamento oferecido pelo setor público à demora e à falta de equipamentos e materiais. A humanização no atendimento e competência do profissional emergiram como dois aspectos importantes, e podem estar determinando a decisão de ir ou não ao dentista. Conclusões: A expressão saúde bucal foi associada à assistência odontológica. O atendimento pelo setor privado foi referido como o que mais se aproxima do tipo ideal de assistência odontológica

Cooperation, interaction and learning in local production systems: Evidence in Brazilian firms

In a local production system (LPS), besides external economies, the interaction, cooperation, and learning are indicated by the literature as complementary ways of enhancing the LPS's competitiveness and gains. In Brazil, the greater part of LPSs, mostly composed by small enterprises, displays incipient relationships and low levels of interaction and cooperation among their actors. The size of the participating enterprises itself for specificities that engender organizational constraints, which, in turn, can have a considerable impact on their relationships and learning dynamics. For that reason, it is the purpose of this article to present an analysis of interaction, cooperation, and learning relationships among several types of actors pertaining to an LPS in the farming equipment and machinery sector, bearing in mind the specificities of small enterprises. To this end, the fieldwork carried out in this study aimed at: (i) investigating external and internal knowledge sources conducive to learning and (ii) identifying and analyzing motivating and inhibiting factors related to specificities of small enterprises in order to bring the LPS members closer together and increase their cooperation and interaction. Empirical evidence shows that internal aspects of the enterprises, related to management and infrastructure, can have a strong bearing on their joint actions, interaction and learning processes.

EFFECT OF FERTILIZATION ON CELL SIZE IN WOOD OF Eucalyptus grandis Hill Ex Maiden

The use of fertilization in forest stands results in yield gains, yet little attention has been directed to its potential effects on the quality of wood produced. Information is scarce about the effect of fertilization on anatomical structures of older Eucalyptus wood. This work aims to study the effect of fertilization on tissue cell size of wood from an Eucalyptus grandis stand at age 21 years, the management system of which is based on selective thinning and fertilizer application at the start of the thinning season. Factors to consider include: presence or absence of fertilizers, two log positions and five radial (pith to bark) positions. Results led to the conclusion that fertilization significantly influenced only vessel frequency. Vessel element length was influenced by tree height. Fiber length, fiber diameter, fiber wall thickness, vessel element length, vessel diameter and vessel frequency were influenced by the radial position of the sample in relation to the log. A positive correlation was observed between fiber length, fiber diameter, fiber wall thickness, vessel element length, vessel diameter, ray width and radial position, while a negative correlation was observed between ray frequency and radial position.

Produção de óleo essencial e balanço nutricional em Corymbia citriodora adubado com lodo de esgoto em diferentes espaçamentos

The Corymbia citriodora is one of the most cultivated species in Brazil for wood and essential oil production. The oil is obtained by the leaves distillation and the yield is around 2%. For the sustainability of leaves extraction is necessary a good nutritional replacement, because the leaves contain a large quantity of nutrients. The sewage sludge application in Corymbia plantations is a way to apply organic fertilizer and is also a good alternative for the final disposal of this residue. In this context, the objective of this study was to evaluate the sewage sludge use as fertilizer for the essential oil production in two different Spacing. The experiment was constituted by 4 blocks and the treatments were: i) Close spacing (1m x 1m) with sewage sludge + K and B; ii) Close spacing with mineral fertilization: iii) Regular spacing (3m x 1m) with sewage sludge + K and B; and iv) Regular spacing with mineral fertilization. When the C. citriodora plots were 12, 18, 24 and 30 months old, leaves and branches biomass and also essential oil production were quantified. It was observed that the system of close planting totalized a higher biomass, 3.8 times more than the conventional system, providing 3 times more essential oil production (363 l ha(-1) at the close spacing and 116 l ha(-1) at the regular Spacing during 30 months). No difference was found in the leaves or oil production with the use of sewage sludge or mineral fertilizer any of spacing studied The use of sewage sludge as fertilizer for Corymbia citriodora plantations may be an interesting alternative. because it supplies large quantities of nutrients and ensures a positive budget of nutrients in the ecosystem.

Myocardial ultrasonic tissue characterization in patients with thyroid dysfunction

Background: Structural myocardial abnormalities have been extensively documented in hypothyroidism. Experimental studies in animal models have also shown involvement of thyroid hormones in gene expression of myocardial collagen. This study was planned to investigate the ability of ultrasonic tissue characterization, as evaluated by integrated backscatter (IBS), to early identify myocardial involvement in thyroid dysfunction. Patients and Methods: We studied 15 patients with hyperthyroidism (HYPER), 8 patients with hypothyroidism (HYPO), 14 patients with subclinical hypothyroidism (SCH) and 19 normal (N) subjects, who had normal LV systolic function. After treatment, 10 HYPER, 6 HYPO, and 8 SCH patients were reevaluated. IBS images were obtained and analyzed in parasternal short axis (papillary muscle level) view, at left ventricular (LV) posterior wall. The following IBS variables were analyzed: 1) the corrected coefficient (CC) of IBS, obtained by dividing IBS intensity by IBS intensity measured in a rubber phantom, using the same equipment adjustments, at the same depth; 2) cardiac cyclic variation (CV) of IBS - peak-to-peak difference between maximal and minimal values of IBS during cardiac cycle; 3) cardiac cyclic variation index (CVI) of IBS - percentual relationship between the cyclic variation (CV) and the mean value of IBS intensity. Results: CC of IBS was significantly larger (p < 0.05) in HYPER (1.57 +/- 0.6) and HYPO (1.53 +/- 0.3) as compared to SCH (1.32 +/- 0.3) or N (1.15 +/- 0.27). The CV (dB) (HYPO: 7.5 +/- 2.4; SCH: 8.2 +/- 3.1; HYPER: 8.2 +/- 2.0) and the CVI (HYPO: 35.6 +/- 19.7%; SCH: 34.7 +/- 17.5%; HYPER: 37.8 +/- 11.6%) were not significantly different in patients with thyroid dysfunction as compared to N (7.0 +/- 2.0 and 44.5 +/- 15.1%). Conclusions: CC of IBS was able to differentiate cardiac involvement in patients with overt HYPO and HYPER who had normal LV systolic function. These early myocardial structural abnormalities were partially reversed by drug therapy in HYPER group. On the other hand, although mean IBS intensity tended to be slightly larger in patients with SCH as compared to N, this difference was not statistical significant.

Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis

Background: Tuberculosis is one of the most prominent health problems in the world, causing 1.75 million deaths each year. Rapid clinical diagnosis is important in patients who have comorbidities such as Human Immunodeficiency Virus (HIV) infection. Direct microscopy has low sensitivity and culture takes 3 to 6 weeks [1-3]. Therefore, new tools for TB diagnosis are necessary, especially in health settings with a high prevalence of HIV/TB co-infection. Methods: In a public reference TB/HIV hospital in Brazil, we compared the cost-effectiveness of diagnostic strategies for diagnosis of pulmonary TB: Acid fast bacilli smear microscopy by Ziehl-Neelsen staining (AFB smear) plus culture and AFB smear plus colorimetric test (PCR dot-blot). From May 2003 to May 2004, sputum was collected consecutively from PTB suspects attending the Parthenon Reference Hospital. Sputum samples were examined by AFB smear, culture, and PCR dot-blot. The gold standard was a positive culture combined with the definition of clinical PTB. Cost analysis included health services and patient costs. Results: The AFB smear plus PCR dot-blot require the lowest laboratory investment for equipment (US$ 20,000). The total screening costs are 3.8 times for AFB smear plus culture versus for AFB smear plus PCR dot blot costs (US$ 5,635,760 versus US$ 1,498, 660). Costs per correctly diagnosed case were US$ 50,773 and US$ 13,749 for AFB smear plus culture and AFB smear plus PCR dot-blot, respectively. AFB smear plus PCR dot-blot was more cost-effective than AFB smear plus culture, when the cost of treating all correctly diagnosed cases was considered. The cost of returning patients, which are not treated due to a negative result, to the health service, was higher in AFB smear plus culture than for AFB smear plus PCR dot-blot, US$ 374,778,045 and US$ 110,849,055, respectively. Conclusion: AFB smear associated with PCR dot-blot associated has the potential to be a cost-effective tool in the fight against PTB for patients attended in the TB/HIV reference hospital.

Photodynamic Therapy Can Be Effective as a Treatment for Herpes Simplex Labialis

Background Data and Objective: Herpes is a common infectious disease that is caused by human herpesviruses. Several treatments have been proposed, but none of them prevent reactivation of the virus. This article describes the use of photodynamic therapy (PDT) as a treatment for herpes lesions, and reports on four cases. Materials and Methods: PDT was used as an adjuvant therapy for the treatment of herpes labialis in four patients. A special type of 0.01% (m/V) of methylene blue solution was applied to the vesicular stage of herpesviral disease and the lesions were irradiated with laser energy (wavelength 660 nm, energy density 120 J/cm(2), output power of 40 mW, 2 min per point, 4.8 J of energy/point, at four points). After 24 h the patients returned and phototherapy was repeated with the same equipment, this time with 3.8 J/cm(2) and 15 mW, for a total dose of 0.6 J. The same procedure was repeated 72 h and 1 wk later. Results: Treatment with low-level laser therapy can be considered as an option in the treatment of herpes labialis, and decreases the frequency of vesicle recurrence and provides comfort for patients. No significant acute side effects were noted and the lesions healed rapidly. Conclusion: Treatment of herpes labialis with PDT was effective, had no side effects, and when associated with laser phototherapy, accelerated the healing process.

Ionic mobility of the solvated proton and acid-base titration in a four-compartment capillary electrophoresis system

Although H(+) and OH(-) are the most common ions in aqueous media, they are not usually observable in capillary electrophoresis (CE) experiments, because of the extensive use of buffer solutions as the background electrolyte. In the present work, we introduce CE equipment designed to allow the determination of such ions in a similar fashion as any other ion. Basically, it consists of a four-compartment piece of equipment for electrolysis-separated experiments (D. P. de Jesus et at, Anal. Chem., 2005, 77, 607). In such a system, the ends of the capillary are placed in two reservoirs, which are connected to two other reservoirs through electrolyte-filled tubes. The electrodes of the high-voltage power source are positioned in these reservoirs. Thus, the electrolysis products are kept away from the inputs of the capillary. The detection was provided by two capacitively coupled contactless conductivity detectors (CD), each one positioned about 11 cm from the end of the capillary. Two applications were demonstrated: titration-like procedures for nanolitre samples and mobility measurements. Strong and weak acids (pK(a) < 5), pure or mixtures, could be titrated. The analytical curve is linear from 50 mu M up to 10 mM of total dissociable hydrogen (r = 0.99899 for n =10) in 10-nL samples. By including D(2)O in the running electrolyte, we could demonstrate how to measure the mixed proton/deuteron mobility. When H(2)O/D(2)O (9 : 1 v/v) was used as the solvent, the mobility was 289.6 +/- 0.5 x 10(-5) cm(2) V(-1) s(-1). Due to the fast conversion of the species, this value is related to the overall behaviour of all isotopologues and isotopomers of the Zundel and Eigen structures, as well as the Stokesian mobility of proton and deuteron. The effect of neutral (o-phenanthroline) and negatively charged (chloroacetate) bases and aprotic solvent (DMSO) over the H(+) mobility was also demonstrated.

Characterization of dynamic solid phase DNA extraction from blood with magnetically controlled silica beads

A novel solid phase extraction technique is described where DNA is bound and eluted from magnetic silica beads in a manner where efficiency is dependent on the magnetic manipulation of the beads and not on the flow of solution through a packed bed. The utility of this technique in the isolation of reasonably pure, PCR-amplifiable DNA from complex samples is shown by isolating DNA from whole human blood, and subsequently amplifying a fragment of the beta-globin gene. By effectively controlling the movement of the solid phase in the presence of a static sample, the issues associated with reproducibly packing a solid phase in a microchannel and maintaining consistent flow rates are eliminated. The technique described here is rapid, simple, and efficient, allowing for recovery of more than 60% of DNA from 0.6 mu L of blood at a concentration which is suitable for PCR amplification. In addition, the technique presented here requires inexpensive, common laboratory equipment, making it easily adopted for both clinical point-of-care applications and on-site forensic sample analysis.

Net greenhouse gas fluxes in Brazilian ethanol production systems

Biofuels are both a promising solution to global warming mitigation and a potential contributor to the problem. Several life cycle assessments of bioethanol have been conducted to address these questions. We performed a synthesis of the available data on Brazilian ethanol production focusing on greenhouse gas (GHG) emissions and carbon (C) sinks in the agricultural and industrial phases. Emissions of carbon dioxide (CO(2)) from fossil fuels, methane (CH(4)) and nitrous oxide (N(2)O) from sources commonly included in C footprints, such as fossil fuel usage, biomass burning, nitrogen fertilizer application, liming and litter decomposition were accounted for. In addition, black carbon (BC) emissions from burning biomass and soil C sequestration were included in the balance. Most of the annual emissions per hectare are in the agricultural phase, both in the burned system (2209 out of a total of 2398 kg C(eq)), and in the unburned system (559 out of 748 kg C(eq)). Although nitrogen fertilizer emissions are large, 111 kg C(eq) ha-1 yr-1, the largest single source of emissions is biomass burning in the manual harvest system, with a large amount of both GHG (196 kg C(eq) ha-1 yr-1). and BC (1536 kg C(eq) ha-1 yr-1). Besides avoiding emissions from biomass burning, harvesting sugarcane mechanically without burning tends to increase soil C stocks, providing a C sink of 1500 kg C ha-1 yr-1 in the 30 cm layer. The data show a C output: input ratio of 1.4 for ethanol produced under the conventionally burned and manual harvest compared with 6.5 for the mechanized harvest without burning, signifying the importance of conservation agricultural systems in bioethanol feedstock production.

Simulation of sugarcane residue decomposition and aboveground growth

Due to the worldwide increase in demand for biofuels, the area cultivated with sugarcane is expected to increase. For environmental and economic reasons, an increasing proportion of the areas are being harvested without burning, leaving the residues on the soil surface. This periodical input of residues affects soil physical, chemical and biological properties, as well as plant growth and nutrition. Modeling can be a useful tool in the study of the complex interactions between the climate, residue quality, and the biological factors controlling plant growth and residue decomposition. The approach taken in this work was to parameterize the CENTURY model for the sugarcane crop, to simulate the temporal dynamics of aboveground phytomass and litter decomposition, and to validate the model through field experiment data. When studying aboveground growth, burned and unburned harvest systems were compared, as well as the effect of mineral fertilizer and organic residue applications. The simulations were performed with data from experiments with different durations, from 12 months to 60 years, in Goiana, TimbaA(0)ba and Pradpolis, Brazil; Harwood, Mackay and Tully, Australia; and Mount Edgecombe, South Africa. The differentiation of two pools in the litter, with different decomposition rates, was found to be a relevant factor in the simulations made. Originally, the model had a basically unlimited layer of mulch directly available for decomposition, 5,000 g m(-2). Through a parameter optimization process, the thickness of the mulch layer closer to the soil, more vulnerable to decomposition, was set as 110 g m(-2). By changing the layer of mulch at any given time available for decomposition, the sugarcane residues decomposition simulations where close to measured values (R (2) = 0.93), contributing to making the CENTURY model a tool for the study of sugarcane litter decomposition patterns. The CENTURY model accurately simulated aboveground carbon stalk values (R (2) = 0.76), considering burned and unburned harvest systems, plots with and without nitrogen fertilizer and organic amendment applications, in different climates and soil conditions.