Perfil sociodemográfico e padrão de utilização dos serviços de saúde do Sistema Único de Saúde (SUS), 2003- 2008

O objetivo foi analisar a evolução do perfil de utilização de serviços de saúde, entre 2003 e 2008, no Brasil e nas suas macrorregiões. Foram utilizados dados da PNAD. A utilização de serviços de saúde foi medida pela proporção de pessoas que procuraram e foram atendidas nas 2 semanas anteriores e pelos que relataram internação nos últimos 12 meses, segundo SUS e não SUS. Foram analisadas as características socioeconômicas dos usuários, o tipo de atendimento e de serviço e os motivos da procura. A proporção de indivíduos que procuraram serviços de saúde não se alterou, assim como a parcela dos que conseguiram atendimento (96%), entre 2003 e 2008. O SUS respondeu por 56,7% dos atendimentos, realizando a maior parte das internações, vacinação e consultas e somente 1/3 das consultas odontológicas. Em 2008, manteve-se o gradiente de redução de utilização de serviços de saúde SUS conforme o aumento de renda e escolaridade. Houve decréscimo da proporção dos que procuraram serviços de saúde para ações de prevenção e aumento de procura para problemas odontológicos, acidentes e lesões e reabilitação. O padrão de utilização do SUS por região esteve inversamente relacionado à proporção de indivíduos com posse de planos privados de saúde.

Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003- 2008

Os objetivos do estudo foram: estimar as prevalências de doenças crônicas na população brasileira em 2008, comparando-as com as de 2003; avaliar o impacto da doença crônica no uso de serviços e nas restrições das atividades; e, analisar os diferenciais nas prevalências de doenças crônicas específicas, segundo nível de escolaridade e filiação a plano privado de saúde. Os dados foram obtidos do suplemento saúde das PNAD-2008 e 2003. As análises (prevalências e razões de prevalências brutas e ajustadas) foram feitas com o aplicativo Stata 11. A prevalência de ter ao menos uma doença crônica foi mais elevada em: idosos, mulheres, cor/raça preta ou indígena, menor escolaridade, migrantes, moradores em áreas urbanas e na região Sul do país. As condições crônicas mais prevalentes foram: hipertensão, doença de coluna, artrite e depressão. Houve, entre 2003 e 2008, aumento da prevalência de diabetes, hipertensão, câncer e cirrose, e redução de insuficiência renal crônica e tuberculose. A maioria das doenças estudadas foram mais prevalentes nos segmentos de menor escolaridade e sem plano de saúde. As maiores diferenças entre os segmentos sociais foram observadas nas prevalências de cirrose, insuficiência renal crônica, tuberculose e artrite/reumatismo.

Periodontal outcomes and social, racial and gender inequalities in Brazil: a systematic review of the literature between 1999 and 2008

The objective of this study was to review the Brazilian epidemiologic literature on periodontal outcomes and socio-demographic factors, assessing bibliographic and methodological characteristics of this scientific production, as well as the consistency and statistical significance of the examined associations. A systematic review was carried out in six bibliographic sources. The review was limited to the period between 1999 and 2008, without any other type of restriction. Among the 410 papers identified, 29 were included in the review. An increasing number of articles, specifically in the last four years of study, was observed. However, there is a concentration of studies in the South and Southeast regions of Brazil, and many of them are not closely connected to theoretical formulations in the field. In spite of these shortcomings, the review findings corroborate the idea that poor socioeconomic conditions are associated with periodontal outcomes, as demonstrated primarily by income and schooling indicators.

Doença pulmonar obstrutiva crônica e fatores associados em São Paulo, SP, 2008-2009

OBJETIVO: Estimar a prevalência e fatores associados à doença pulmonar obstrutiva crônica. MÉTODOS: Estudo transversal, de base populacional com 1.441 indivíduos de ambos os sexos e com 40 anos de idade ou mais no município de São Paulo, SP, entre 2008 e 2009. As informações foram coletadas por meio de entrevistas domiciliares e os participantes foram selecionados a partir de amostragem probabilística, estratificada por sexo e idade, e por conglomerados em dois estágios (setores censitários e domicílios). Foi realizada regressão múltipla de Poisson na análise ajustada. RESULTADOS: Dos entrevistados, 4,2% (IC95% 3,1;5,4) referiram doença pulmonar obstrutiva crônica. Após análise ajustada, identificaram-se os seguintes fatores independentemente associados ao agravo: número de cigarros fumados na vida (> 1.500/nenhum) RP = 3,85 (IC95%: 1,87;7,94), cansar-se com facilidade (sim/não) RP = 2,61 (IC95% 1,39;4,90), idade (60 a 69 anos/50 a 59 anos) RP = 3,27 (IC95% 1,01;11,24), idade (70 anos e mais/50 a 59 anos) RP = 4,29 (IC95% 1,30;14,29), problemas de saúde nos últimos 15 dias (sim/não) RP = 1,31 (IC95% 1,02;1,77), e atividade física no tempo livre (sim/não) RP = 0,57 (IC95% 0,26;0,97). CONCLUSÕES: A prevalência da doença pulmonar obstrutiva crônica é elevada e está associada ao uso do tabaco e idade acima de 60 anos. Os problemas de saúde freqüentes e redução da atividade física no tempo livre podem ser considerados conseqüências dessa doença.

Fatores de risco e proteção para doenças crônicas não transmissíveis entre beneficiários da saúde suplementar: resultados do inquérito telefônico Vigitel, Brasil, 2008

O objetivo deste artigo é descrever a distribuição dos principais fatores de risco (FR) e proteção para doenças crônicas não transmissíveis (DCNT) entre os beneficiários de planos de saúde. Foi utilizada amostra aleatória de adultos com 18 ou mais anos de idade nas capitais brasileiras, analisando-se frequências de FR em 28.640 indivíduos em 2008. Homens mostraram alta prevalência dos seguintes fatores de risco: tabaco, sobrepeso, baixo consumo de frutas e legumes, maior consumo de carnes gordurosas e álcool, enquanto mulheres mostraram maior prevalência de pressão arterial, diabetes, dislipidemia e osteoporose. Homens praticam mais atividade física e mulheres consomem mais frutas e vegetais. Homens com maior escolaridade apresentam maior frequência de sobrepeso, consumo de carnes com gorduras e dislipidemia. Entre mulheres, tabaco, sobrepeso, obesidade e doenças autorreferidas decrescem com aumento da escolaridade, enquanto o consumo de frutas e legumes, atividade física, mamografia e exame de papanicolau aumentam com a escolaridade. CONCLUSÃO: a população usuária de planos de saúde constitui cerca de 26% da população brasileira, e o estudo atual visa acumular evidências para atuação em ações de promoção da saúde para esse público.

Lei n.º 11.889/2008: avanço ou retrocesso nas competências do técnico em saúde bucal?

O objetivo deste estudo foi analisar as competências que, desde a aprovação da lei n.º 11.889/08, incumbem ao técnico em saúde bucal (TSB) no Brasil, incluindo os termos definidos para sua supervisão. Foi realizada análise documental, comparando-se as competências definidas no referido instrumento legal com as previstas no parecer n.º 460/75 do Conselho Federal de Educação e na resolução n.º 63/2005 do Conselho Federal de Odontologia. Foram empregadas técnicas de análise temática considerando-se as habilidades em termos de ações diretas e indiretas distribuídas em quatro áreas de competência: planejamento e administração em saúde, promoção da saúde, prevenção de doenças e de assistência individual. Embora as competências aprovadas na lei tenham sido distribuídas em um número menor de itens, comparado aos dois outros documentos, do ponto de vista qualitativo, os resultados da análise permitiram concluir que vários avanços foram obtidos com a regulamentação da profissão, nos termos aprovados, em todas as áreas de competência. Houve impacto positivo para o processo de trabalho em saúde, tanto com relação à cooperação interprofissional quanto à supervisão técnica das atividades, representando uma conquista relevante dos trabalhadores da área e também uma contribuição significativa para avançar na ampliação do acesso aos serviços odontológicos

Highlights from the I international symposium of thrombosis and anticoagulation in internal medicine, October 23–25, 2008, Sao Paulo, Brazil

Abstract The importance of thrombosis and anticoagulation in clinical practice is rooted firmly in several fundamental constructs that can be applied both broadly and globally. Awareness and the appropriate use of anticoagulant therapy remain the keys to prevention and treatment. However, to assure maximal efficacy and safety, the clinician must, according to the available evidence, choose the right drug, at the right dose, for the right patient, under the right indication, and for the right duration of time. The first International Symposium of Thrombosis and Anticoagulation in Internal Medicine was a scientific program developed by clinicians for clinicians. The primary objective of the meeting was to educate, motivate and inspire internists, cardiologists and hematologists by convening national and international visionaries, thought-leaders and dedicated clinician-scientists in Sao Paulo, Brazil. This article is a focused summary of the symposium proceedings

Yellow Fever Virus in Haemagogus leucocelaenus and Aedes serratus Mosquitoes, Southern Brazil, 2008

Yellow fever virus (YFV) was isolated from Haemagogus leucocelaenus mosquitoes during an epizootic in 2001 in the Rio Grande do Sul State in southern Brazil In October 2008 a yellow fever outbreak was reported there with nonhuman primate deaths and human cases This latter outbreak led to intensification of surveillance measures for early detection of YFV and support for vaccination programs We report entomologic surveillance in 2 municipalities that recorded nonhuman primate deaths Mosquitoes were collected at ground level identified and processed for virus isolation and molecular analyses Eight YFV strains were isolated (7 from pools of Hg leucocelaenus mosquitoes and another from Aedes serratus mosquitoes) 6 were sequenced and they grouped in the YFV South American genotype I The results confirmed the role of Hg leucocelaenus mosquitoes as the main YFV vector in southern Brazil and suggest that Ae serratus mosquitoes may have a potential role as a secondary vector

The peculiar nova V1309 Scorpii/nova Scorpii 2008 A candidate twin of V838 Monocerotis

Aims. Nova Scorpii 2008 was the target of our Director Discretionary Time proposal at VLT+UVES in order to study the evolution, origin and abundances of the heavy-element absorption system recently discovered in 80% of classical novae in outburst. Methods. The early decline of nova Scorpii 2008 was monitored with high resolution echelle spectroscopy at 5 different epochs. The analysis of the absorption and the emission lines show many unusual characteristics. Results. Nova Scorpii 2008 is confirmed to differ from a common classical nova as well as a symbiotic recurrent nova, and it shows characteristics which are common to the so called, yet debated, red-novae. The origin of this new nova remains uncertain.

An overview of the Amazonian Aerosol Characterization Experiment 2008 (AMAZE-08)

The Amazon Basin provides an excellent environment for studying the sources, transformations, and properties of natural aerosol particles and the resulting links between biological processes and climate. With this framework in mind, the Amazonian Aerosol Characterization Experiment (AMAZE-08), carried out from 7 February to 14 March 2008 during the wet season in the central Amazon Basin, sought to understand the formation, transformations, and cloud-forming properties of fine-and coarse-mode biogenic aerosol particles, especially as related to their effects on cloud activation and regional climate. Special foci included (1) the production mechanisms of secondary organic components at a pristine continental site, including the factors regulating their temporal variability, and (2) predicting and understanding the cloud-forming properties of biogenic particles at such a site. In this overview paper, the field site and the instrumentation employed during the campaign are introduced. Observations and findings are reported, including the large-scale context for the campaign, especially as provided by satellite observations. New findings presented include: (i) a particle number-diameter distribution from 10 nm to 10 mu m that is representative of the pristine tropical rain forest and recommended for model use; (ii) the absence of substantial quantities of primary biological particles in the submicron mode as evidenced by mass spectral characterization; (iii) the large-scale production of secondary organic material; (iv) insights into the chemical and physical properties of the particles as revealed by thermodenuder-induced changes in the particle number-diameter distributions and mass spectra; and (v) comparisons of ground-based predictions and satellite-based observations of hydrometeor phase in clouds. A main finding of AMAZE-08 is the dominance of secondary organic material as particle components. The results presented here provide mechanistic insight and quantitative parameters that can serve to increase the accuracy of models of the formation, transformations, and cloud-forming properties of biogenic natural aerosol particles, especially as related to their effects on cloud activation and regional climate.

Design of concrete-filled steel tubular columns under axial loading according to NBR 8800:2008 and Eurocode 4:2004: tests results and comparisons

In this paper results of tests on 32 concrete-filled steel tubular columns under axial load are reported. The test parameters were the concrete compressive strength, the column slenderness (L/D) and the wall thickness (t). The test results were compared with predictions from the codes NBR 8800:2008 and EN 1994-1-1:2004 (EC4). The columns were 3, 5, 7 and 10 length to diameter ratios (L/D) and were tested with 30MPa, 60MPa, 80MPa and 100MPa concrete compressive strengths. The results of ultimate strength predicted by codes showed good agreement with experimental results. The results of NBR 8800 code were the most conservative and the EC4 showed the best results, in mean, but it was not conservative for usual concrete-filled short columns.

Structural behaviour of three-pile caps subjected to axial compressive loading

This work presents a comparative analysis about the behaviour of pile caps supported by 3 piles subjected to axial loading. Piles with 20 cm and 30 cm diameters were analysed. The main reinforcement was maintained in all the specimens, however, the arrangement of the secondary reinforcement varied. The main reinforcement consisted of steel bars connecting the piles. The secondary reinforcement was made up of: (a) bars going through the piles and through the projection of the column, (b) bars forming a network, and (c) vertical and horizontal stirrups. The main objective was the observation of the pile cap behaviour regarding the cracks and the modes of rupture. The real scale specimens were subjected to experimental tests until failure by rupture. Instruments were placed with the aim to obtain the displacement of the bases, the strains in the main and secondary reinforcement bars, in the compression struts, in the lower and upper nodal zones and in the sides of the caps. None of the caps reached failure by rupture with a load less than 1.12 times the theoretical load. The specimens ruptured due to the cracking of the compression strut and/or the yielding of the reinforcement bars in one direction.

Stepping-motor-driven constant-shear-rate rotating viscometer

Despite the frequent use of stepping motors in robotics, automation, and a variety of precision instruments, they can hardly be found in rotational viscometers. This paper proposes the use of a stepping motor to drive a conventional constant-shear-rate laboratory rotational viscometer to avoid the use of velocity sensor and gearbox and, thus, simplify the instrument design. To investigate this driving technique, a commercial rotating viscometer has been adapted to be driven by a bipolar stepping motor, which is controlled via a personal computer. Special circuitry has been added to microstep the stepping motor at selectable step sizes and to condition the torque signal. Tests have been carried out using the prototype to produce flow curves for two standard Newtonian fluids (920 and 12 560 mPa (.) s, both at 25 degrees C). The flow curves have been obtained by employing several distinct microstep sizes within the shear rate range of 50-500 s(-1). The results indicate the feasibility of the proposed driving technique.

Exergy-based method for analyzing the composition of the electricity cost generated in gas-fired combined cycle plants

The proposed method to analyze the composition of the cost of electricity is based on the energy conversion processes and the destruction of the exergy through the several thermodynamic processes that comprise a combined cycle power plant. The method uses thermoeconomics to evaluate and allocate the cost of exergy throughout the processes, considering costs related to inputs and investment in equipment. Although the concept may be applied to any combined cycle or cogeneration plant, this work develops only the mathematical modeling for three-pressure heat recovery steam generator (HRSG) configurations and total condensation of the produced steam. It is possible to study any n x 1 plant configuration (n sets of gas turbine and HRSGs associated to one steam turbine generator and condenser) with the developed model, assuming that every train operates identically and in steady state. The presented model was conceived from a complex configuration of a real power plant, over which variations may be applied in order to adapt it to a defined configuration under study [Borelli SJS. Method for the analysis of the composition of electricity costs in combined cycle thermoelectric power plants. Master in Energy Dissertation, Interdisciplinary Program of Energy, Institute of Eletro-technical and Energy, University of Sao Paulo, Sao Paulo, Brazil, 2005 (in Portuguese)]. The variations and adaptations include, for instance, use of reheat, supplementary firing and partial load operation. It is also possible to undertake sensitivity analysis on geometrical equipment parameters. (C) 2007 Elsevier Ltd. All rights reserved.

Tocopherols, tocotrienols, and gamma-oryzanol contents in Japonica and Indica subspecies of rice (Oryza sativa L.) cultivated in Brazil

Whole rice contains several fat-soluble phytochemicals such. as tocopherols, tocotrienols, and gamma-oryzanol which have been reported to possess beneficial health properties. This study was conducted to determine whether brown rice belonging to indica and japonica subspecies were distinguishable from each other regarding the concentration of these compounds by analyzing 32 genotypes. The fat-soluble compounds were analyzed by normal-phase HPLC in a single run. The variability of the compounds analyzed was high, but the mean content of gamma-oryzanol across all samples was significantly higher (P < 0.01) in japonica (246.3 mg/kg) than in indica rice (190.1 mg/kg). Similar differences were found for total vitamin E contents which were 24.2 mg/kg injaponica and 17.1 mg/kg in indica rice, respectively. In japonica rice, alpha-tocopherol, alpha-tocotrienol, and gamma-tocotrienol were the most abundant homologs, while in indica rice the most abundant were gamma-tocotrienol, alpha-tocopherol, and alpha-tocotrienol. A significant Pearson coefficient (0.80, P < 0.001) between alpha-tocopherol and alpha-tocotrienol levels was found, independent of the subspecies. Both compounds were positively correlated to total tocols and gamma-oryzanol contents. Although more studies are needed to evaluate the interference of growing rice in different environments and multiple years, the present study provided information on natural variations of the vitamin E isomers and the gamma-oryzanol contents in different rice genotypes.