Utilização das urgências hospitalares e acesso aos cuidados de saúde primários : o impacto da implementação das USF na procura dos serviços de urgência : estudo preliminar

RESUMO - A sobrelotação das urgências resultante da utilização inadequada tem como consequências a diminuição na qualidade dos cuidados. As causas da utilização inadequada são várias. Entre elas, a utilização dos Cuidados de saúde Primários merece uma atenção particular. De facto, as barreiras no acesso aos cuidados de saúde primários estão associadas com uma maior inadequação. Assim, ter um prestador regular, acessível, que presta cuidados contínuos e regulares está associado com uma menor utilização inadequada dos csp. Contudo, é necessário ter em conta as características dos utilizadores de forma a desenvolver estratégias que permitam a prestação de cuidados acessíveis. Em Portugal, foi implementada em 2006 uma Reforma dos CSP cuja face mais visíveis são as USF, que deverão prestar cuidados personalizados, garantido a acessibilidade, globalidade e continuidade dos mesmos. Assim, da revisão da literatura e existindo uma associação entre a utilização inadequada das urgências observou-se a variação das urgências hospitalares entre 2005 (ano anterior à implementação das USF) e 2008 (últimos dados disponibilizados) e o nº de USF implementadas. Ao contrário do expectável, verificou-se haver uma associação positiva entre o nº de USF e o nº de urgências hospitalares. Os hospitais com maior nº de USF tiveram um aumento da utilização das urgências hospitalares, enquanto nos hospitais sem nenhuma USF associada, houve uma diminuição das urgências hospitalares. Contudo, existiram factores que não considerados, como criação da Linha Saúde 24, encerramento dos SAP, dimensão dos hospitais, etc., que poderão ter influenciado os resultados. Os resultados em saúde resultantes da implementação das USF não foram considerados. Assim sugere- se futura investigação. ------------------------------ABSTRACT - Crowded emergency department resulting from inappropriate use may compromise the quality of care . Several causes explain the inadequate use of emergency care. Among them, the association between primary care and inappropriate use of emergency departments is of particular interest. Indeed, studies show that fact, barriers in access to Primary Health Care ( PHC) are associated with more inappropriate use. Therefore having a regular, accessible, continuous, source of care is associated with a decrease in inappropriate use of Emergency department. Though, patient’s preferences have to be considered in order to develop strategies that allow accessible care. In Portugal, a reform of primary care has been launched in 2006, through the implementation of Family Health Units ( FHU) that are responsible for giving personalized, accessible, global and continuous care. A vast literature shows an association between inappropriate use of emergency departments and primary health care access. In the present work we observed the variation in emergency department use between 2005 (previous year to Family Health Units implementation) and 2008 (last available data) and the number of Family Health Units implemented. Contrary to our expectations, results showed a positive association between the number of Health Family Units and emergency department use. The Hospitals with more Health Family Units experienced an increase of emergency department use while hospitals with none Health Family units experienced a decrease of emergency department use. Although there were several factors that could have influenced the results (creation of Health 24 Line, SAP closure, Hospital Dimension, etc) .Health outcomes that result fr

O impacto do perfil do utente da USF durante o seu internamento

RESUMO - Introdução: Através da elaboração do presente projeto de investigação pretendeu-se analisar o que poderá influenciar o custo total de um utente internado, inscrito numa USF, que foi seguidamente internado no setor hospitalar. Recorreu-se à base de dados de uma USF e de um hospital, ambos pertencentes à ARS Alentejo do ano de 2010. O objetivo central consiste em estudar a relação do volume de consultas da USF e se o tipo de admissão no hospital, sendo ela programada ou não programada, explica a variância o custo do internamento. Metodologia: Foi efetuado o cruzamento entre os dados dos utentes inscritos na USF e o total de internamento hospitalar, utilizando a sua data de nascimento e respetivo sexo. Após efetuado o cruzamento, através de um procedimento estatístico com base em SPSS, foram estipuladas pressupostos de forma a encontrar uma associação entre o custo do utente internado com as variáveis da base de dados da USF. De seguida, foi verificado se o tipo de admissão do internamento pode ou não influenciar o custo do internamento. Para efetuar tais correlações, optei por separar a amostra consoante alguns dos seus grupos mais frequentes, em que foi desagregado os internamentos referentes ao GCD 14 – Gravidez, Parto e Puerpério e dos utentes pertencentes ao escalão etários dos idosos (mais de 64 anos). Resultados: A variável da idade do utente é a que mais poderá explicar a variância do custo do internamento, apresentando sempre valores significativos para tal relação. As restantes pouco ou nada podem explicar a variância do custo do internamento. Quanto à tipologia de admissão, o facto de ser programado poderá explicar a diminuição dos dias de internamento, que concomitantemente poderá diminuir o custo do internamento, devido a forte correlação existente entre elas (r=0,666). Conclusão: A introdução da integração dos cuidados de saúde a nível primário e secundário poderá ser a solução base para a redução dos gastos desnecessários na saúde. Um maior acompanhamento do utente nos CSP poderá reduzir a frequência hospitalar, como verificamos que as variáveis da USF e o facto de a consulta ser programada podem explicar tal variância.

Functional characterization of transcription factor USF

USF, Upstream Stimulatory Factor, is a family of ubiquitous transcription factors that contain highly conserved basic helix-loop-helix leucine zipper DNA binding domains and recognize the core DNA sequence CACGTG. In human and mouse, two members of the USF family, USF1 and USF2, encoded by two different genes, contribute to the USF activity. In order to gain insights into the mechanisms by which USFs function as transcriptional activators, different approaches were used to map the domains of USF2 responsible for nuclear localization and transcriptional activation. Two stretches of amino acids, one in the basic region of the DNA binding domain, the other in a highly conserved N-terminal region, were found to direct nuclear localization independently of one another. Two distinct activation domains were also identified. The first one, located in the conserved N-terminal region that overlaps the C-terminal nuclear localization signal, functioned only in the presence of an initiator element in the promoter of the reporter. The second, in a nonconserved region, activated transcription in the absence of an initiator element or when fused to a heterologous DNA binding domain. These results suggest that USF2 functions in different promoter contexts by selectively utilizing different activation domains.^ The deletion analysis of USF2 also identified two dominant negative mutants of USF, one lacking the activation domain, the other lacking the basic domain. The latter proved useful for testing the direct involvement of USFs in the transcriptional activation mediated by the viral protein IE62.^ To investigate the biological function of USFs, foci and colony formation assays were used to study the growth regulation by USFs. It was found that USFs had a strong antagonistic effect on cellular transformation mediated by the bHLH/LZ protein Myc. This effect required the DNA binding activity of either USF 1 or USF2. Moreover, USF2, but not USF1 or other mutants of USFs, was also found to have strong inhibitory effect on the cellular transformation by E1a and on the growth of HeLa cells. These results demonstrate that USFs could potentially regulate growth through two mechanisms, one by antagonizing the function of Myc in cellular transformation, the other by mediating a more general growth inhibitory effect. ^

Antiproliferative properties of the USF family of helix-loop-helix transcription factors.

USF is a family of transcription factors characterized by a highly conserved basic-helix-loop-helix-leucine zipper (bHLH-zip) DNA-binding domain. Two different USF genes, termed USF1 and USF2, are ubiquitously expressed in both humans and mice. The USF1 and USF2 proteins contain highly divergent transcriptional activation domains but share extensive homologies in the bHLH-zip region and recognize the same CACGTG DNA motifs. Although the DNA-binding and transcriptional activities of these proteins have been characterized, the biological function of USF is not well understood. Here, focus- and colony-formation assays were used to investigate the potential involvement of USF in the regulation of cellular transformation and proliferation. Both USF1 and USF2 inhibited the transformation of rat embryo fibroblasts mediated by Ras and c-Myc, a bHLH-zip transcription factor that also binds CACGTG motifs. DNA binding was required but not fully sufficient for inhibition of Myc-dependent transformation by USF, since deletion mutants containing only the DNA-binding domains of USF1 or USF2 produced partial inhibition. While the effect of USF1 was selective for Myc-dependent transformation, wild-type USF2 exerted in addition a strong inhibition of E1A-mediated transformation and a strong suppression of HeLa cell colony formation. These results suggest that members of the USF family may serve as negative regulators of cellular proliferation in two ways, one by antagonizing the transforming function of Myc, the other through a more general growth-inhibitory effect.

Avaliação da percepção sobre interdisciplinaridade nas unidades de saúde USF Paranapiacaba, US Vila Helena e CEO Vila Guilherme

É necessário compreender que o indivíduo, no processo saúde-doença, precisa receber atenção completa, que envolva várias disciplinas atuando de forma conjunta, numa visão que envolve integralidade de ações (Saupe et al., 2007; Salvador et al., 2011). Uma das principais características dos serviços de saúde hoje em dia no país é o atendimento feito por equipes multiprofissionais, cujo entrosamento, entendimento e troca de saberes entre seus membros levam à interdisciplinaridade (Salvador et al., 2011), tema central deste trabalho de pesquisa. Atendimento interdisciplinar envolve trabalho recíproco, criando relações sociais horizontais, contrariamente ao que ocorre no modelo de assistência tradicional, hegemônico. Exige que o saber do outro seja ouvido e pensado, inclusive dos indivíduos e das comunidades assistidos (Leite; Veloso, 2008). Este estudo, do tipo quali-quantitativo, tem por objetivo analisar as percepções que trabalhadores e usuários de três unidades de saúde, com estratégias distintas de atendimento, apresentam sobre interdisciplinaridade. Busca-se destacar dificuldades e possíveis meios facilitadores para sua prática diária na perspectiva de profissionais de saúde e usuários dessas três unidades de saúde. Foram aplicados questionários com perguntas fechadas semiestruturadas e abertas, cujos resultados foram submetidos à análise quantitativa, pela técnica descritiva de análise de frequência, e análise qualitativa pela técnica hermenêutica dialética, conforme preconizada por Minayo (2004). À luz dessa modalidade qualitativa de pesquisa aplicada aos profissionais surgiram três categorias: Meios para aumento da interdisciplinaridade; Fatores que afetam a interdisciplinaridade, subdivididos em Incentivadores, Desmotivadores e Ambíguos; e Resultados da interdisciplinaridade. Em relação aos usuários, as categorias emergentes foram: Desinteresse; Visão assistencial individualista e Vantagens da interdisciplinaridade. Os resultados encontrados foram: todas as categorias profissionais sentiram falta de outros profissionais em grupos educativos. A ausência mais sentida foi assistente social (18,75%). A estratégia interdisciplinar mais lembrada foi \"reuniões\" (38,6%). Falta noção de que é necessário trocar informações de forma efetiva, compreensível e satisfatória para todos. Mostrou-se importante aproveitar esses momentos para discutir protocolos e rotinas. Instrumento relevante para aumentar as trocas entre os profissionais foi a capacitação (13,6%) que melhora o relacionamento em equipe ao diminuir inseguranças. Trocas de informações em equipe multidisciplinar podem transformála em interdisciplinar. Pertencimento foi fato importante para a interdisciplinaridade, assim como dialogar, tolerar, respeitar, ouvir, ser flexível e enxergar o que está além de si, com interação social, horizontal. Número reduzido de profissionais, tomar conhecimento dos resultados das decisões em equipe e corresponsabilidade também foram fatores de destaque. Mais de 70% dos usuários relatou não participar de grupos educativos, evidenciando o curativismo. Os usuários valorizaram o atendimento por mais de um profissional. Acolhimento prescinde da ação interdisciplinar. Nenhum modo de atendimento foi sugerido pelos usuários. A interdisciplinaridade favorece a relação entre a equipe e o usuário, diminui espera e aumenta resolução. Na US Vila Helena, a interdisciplinaridade prescindiu de reuniões de equipe para acontecer.

Deteção dos consumos excessivos de álcool nos adultos da USF Sete Caminhos - Gondomar

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Implementação de um Sistema de Gestão da Qualidade na USF Fafe Sentinela

Dissertação de Mestrado em Gestão Integrada da Qualidade, Ambiente e Segurança

Existential experience : the unfolding

This paper reports on a project concerned with the relationship between person and space in the context of achieving a contemplative state. The need for such a study originated with the desire to contribute to the design of multicultural spaces which could be used for a range of activities including prayer and meditation. Given that the words ‘prayer’ and ‘meditation’ are highly value-laden and potentially alienating for some people, it was decided to use the more accessible term ‘contemplative’. While the project is still underway,several findings have emerged that can be reported on and are of relevance to the conference both methodologically and substantively. Informed by phenomenological methodology, data were collected from a diverse group of people using photo-elicitation and interviewing. The technique of photo-elicitation proved to be highly effective in helping people to reveal their everyday lived experience of contemplative spaces. This methodological aspect of the project is described more fully in the paper. The initial stage of analysis produced two categories of data: varying conceptions of contemplation and contemplative space; and, common understandings of contemplation and contemplative space. From this it was found that achieving a state of contemplation involves both the person and the environment in a dialectic process of unfolding. The unfolding has various physical, psycho-social, and existential dimensions or qualities which operate sequentially and simultaneously. In the paper, these are labelled:the unfolding of the core; distinction; manifestation; cleansing; creation; and sharing, and have parallels with Mircea Eliade’s 1959 definition of sacred as 'something that manifests itself, shows itself, as something wholly different from the profane’. It also connects with the views of Nishida Kitaro from the Kyoto School of Philosophy on the theme of ‘absolute nothingness’: ‘the body-mind is dropped off and we are united with the consciousness of absolute nothingness’ (Kitaro in Heisig, 2001, p. 169). According to Marion (2005), ‘nothingness’ is defined by givenness. In the paper, this fold of givenness is interpreted in the context of the qualities of the environment that accomplish the act of coming forward into visibility through the dialectic relationship with a person. (Eliade, 1959, Heisig, 2001, Marion, 2002)

Wireless sensor devices for animal tracking and control

This paper describes some new wireless sensor hardware developed for pastoral and environmental applications. From our early experiments with Mote hardware we were inspired to develop our devices with improved radio range, solar power capability, mechanical and electrical robustness, and with unique combinations of sensors. Here we describe the design and evolution of a small family of devices: radio/processor board, a soil moisture sensor interface, and a single board multi-sensor unit for animal tracking experiments.

ElectricCOW : A simulator for mobile sensors and actuators mounted on herds of cattle

ElectricCOW is a network, animal behaviour and agent simulator designed to allow detailed simulation of an ad-hoc model network built from small mote-like devices called flecks. Detailed radio communications, cattle behaviour and sensor and actuator network modelling allows a closed-loop environment, where the network can influence the behaviour of its mobile platforms.

The NetWorkPlace(TM) Phenomenon: any time and any place - reality or a seductive myth?

A new spatial logic encompassing redefined concepts of time and place, space and distance, requires a comprehensive shift in the approach to designing workplace environments for today’s adaptive, collaborative organizations operating in a dynamic business world. Together with substantial economic and cultural shifts and an increased emphasis on lifestyle considerations, the advances in information technology have prompted a radical re-ordering of organizational relationships and the associated structures, processes, and places of doing business. Within the duality of space and an augmentation of the traditional notions of place, organizational and institutional structures pose new challenges for the design professions. The literature reveals that there has always been a mono-organizational focus in relation to workplace design strategies and the burgeoning trend towards inter-organizational collaboration, enabled the identification of a gap in the knowledge relative to workplace design. The NetWorkPlaceTM© constitutes a multi-dimensional concept having the capacity to deal with the fluidity and ambiguity characteristic of the network context, as both a topic of research and the way of going about it.

Modelling Cued-Target Recall using Quantum Inspired Models of Target Activation

This article presents and evaluates Quantum Inspired models of Target Activation using Cued-Target Recall Memory Modelling over multiple sources of Free Association data. Two components were evaluated: Whether Quantum Inspired models of Target Activation would provide a better framework than their classical psychological counterparts and how robust these models are across the different sources of Free Association data. In previous work, a formal model of cued-target recall did not exist and as such Target Activation was unable to be assessed directly. Further to that, the data source used was suspected of suffering from temporal and geographical bias. As a consequence, Target Activation was measured against cued-target recall data as an approximation of performance. Since then, a formal model of cued-target recall (PIER3) has been developed [10] with alternative sources of data also becoming available. This allowed us to directly model target activation in cued-target recall with human cued-target recall pairs and use multiply sources of Free Association Data. Featural Characteristics known to be important to Target Activation were measured for each of the data sources to identify any major differences that may explain variations in performance for each of the models. Each of the activation models were used in the PIER3 memory model for each of the data sources and was benchmarked against cued-target recall pairs provided by the University of South Florida (USF). Two methods where used to evaluate performance. The first involved measuring the divergence between the sets of results using the Kullback Leibler (KL) divergence with the second utilizing a previous statistical analysis of the errors [9]. Of the three sources of data, two were sourced from human subjects being the USF Free Association Norms and the University of Leuven (UL) Free Association Networks. The third was sourced from a new method put forward by Galea and Bruza, 2015 in which pseudo Free Association Networks (Corpus Based Association Networks - CANs) are built using co-occurrence statistics on large text corpus. It was found that the Quantum Inspired Models of Target Activation not only outperformed the classical psychological model but was more robust across a variety of data sources.

Temperature-dependent stability of stacking faults in Al, Cu and Ni: first-principles analysis

We present comparative analysis of microscopic mechanisms relevant to plastic deformation of the face-centered cubic (FCC) metals Al, Cu, and Ni, through determination of the temperature-dependent free energies of intrinsic and unstable stacking faults along 1 (1) over bar 0] and 1 (2) over bar 1] on the (1 1 1) plane using first-principles density-functional-theory-based calculations. We show that vibrational contribution results in significant decrease in the free energy of barriers and intrinsic stacking faults (ISFs) of Al, Cu, and Ni with temperature, confirming an important role of thermal fluctuations in the stability of stacking faults (SFs) and deformation at elevated temperatures. In contrast to Al and Ni, the vibrational spectrum of the unstable stacking fault (USF1 (2) over bar 1]) in Cu reveals structural instabilities, indicating that the energy barrier (gamma(usf)) along the (1 1 1)1 (2) over bar 1] slip system in Cu, determined by typical first-principles calculations, is an overestimate, and its commonly used interpretation as the energy release rate needed for dislocation nucleation, as proposed by Rice (1992 J. Mech. Phys. Solids 40 239), should be taken with caution.

Wave Sensor Technologies, St Petersburg, Florida, March 7-9, 2007: workshop proceedings

The Alliance for Coastal Technologies (ACT) convened a workshop on "Wave Sensor Technologies" in St. Petersburg, Florida on March 7-9, 2007, hosted by the University of South Florida (USF) College of Marine Science, an ACT partner institution. The primary objectives of this workshop were to: 1) define the present state of wave measurement technologies, 2) identify the major impediments to their advancement, and 3) make strategic recommendations for future development and on the necessary steps to integrate wave measurement sensors into operational coastal ocean observing systems. The participants were from various sectors, including research scientists, technology developers and industry providers, and technology users, such as operational coastal managers and coastal decision makers. Waves consistently are ranked as a critical variable for numerous coastal issues, from maritime transportation to beach erosion to habitat restoration. For the purposes of this workshop, the participants focused on measuring "wind waves" (i.e., waves on the water surface, generated by the wind, restored by gravity and existing between approximately 3 and 30-second periods), although it was recognized that a wide range of both forced and free waves exist on and in the oceans. Also, whereas the workshop put emphasis on the nearshore coastal component of wave measurements, the participants also stressed the importance of open ocean surface waves measurement. Wave sensor technologies that are presently available for both environments include bottom-mounted pressure gauges, surface following buoys, wave staffs, acoustic Doppler current profilers, and shore-based remote sensing radar instruments. One of the recurring themes of workshop discussions was the dichotomous nature of wave data users. The two separate groups, open ocean wave data users and the nearshore/coastal wave data users, have different requirements. Generally, the user requirements increase both in spatial/temporal resolution and precision as one moves closer to shore. Most ocean going mariners are adequately satisfied with measurements of wave period and height and a wave general direction. However, most coastal and nearshore users require at least the first five Fourier parameters ("First 5"): wave energy and the first four directional Fourier coefficients. Furthermore, wave research scientists would like sensors capable of providing measurements beyond the first four Fourier coefficients. It was debated whether or not high precision wave observations in one location can take the place of a less precise measurement at a different location. This could be accomplished by advancing wave models and using wave models to extend data to nearby areas. However, the consensus was that models are no substitution for in situ wave data.[PDF contains 26 pages]

Dissolved oxygen probes: making oxygen measurements routine like temperature, St Petersburg, Florida, January 4-6, 2006: workshop proceedings

The Alliance for Coastal Technologies (ACT) Workshop "Making Oxygen Measurements Routine Like Temperature" was convened in St. Petersburg, Florida, January 4th - 6th, 2006. This event was sponsored by the University of South Florida (USF) College of Marine Science, an ACT partner institution and co-hosted by the Ocean Research Interactive Observatory Networks (ORION). Participants from researcldacademia, resource management, industry, and engineering sectors collaborated with the aim to foster ideas and information on how to make measuring dissolved oxygen a routine part of a coastal or open ocean observing system. Plans are in motion to develop large scale ocean observing systems as part of the US Integrated Ocean Observing System (100s; see http://ocean.us) and the NSF Ocean Observatory Initiative (001; see http://www.orionprogram.org/00I/default.hl). These systems will require biological and chemical sensors that can be deployed in large numbers, with high reliability, and for extended periods of time (years). It is also likely that the development cycle for new sensors is sufficiently long enough that completely new instruments, which operate on novel principles, cannot be developed before these complex observing systems will be deployed. The most likely path to development of robust, reliable, high endurance sensors in the near future is to move the current generation of sensors to a much greater degree of readiness. The ACT Oxygen Sensor Technology Evaluation demonstrated two important facts that are related to the need for sensors. There is a suite of commercially available sensors that can, in some circumstances, generate high quality data; however, the evaluation also showed that none of the sensors were able to generate high quality data in all circumstances for even one month time periods due to biofouling issues. Many groups are attempting to use oxygen sensors in large observing programs; however, there often seems to be limited communication between these groups and they often do not have access to sophisticated engineering resources. Instrument manufacturers also do not have sufficient resources to bring sensors, which are marketable, but of limited endurance or reliability, to a higher state of readiness. The goal of this ACT/ORION Oxygen Sensor Workshop was to bring together a group of experienced oceanographers who are now deploying oxygen sensors in extended arrays along with a core of experienced and interested academic and industrial engineers, and manufacturers. The intended direction for this workshop was for this group to exchange information accumulated through a variety of sensor deployments, examine failure mechanisms and explore a variety of potential solutions to these problems. One anticipated outcome was for there to be focused recommendations to funding agencies on development needs and potential solutions for 02 sensors. (pdf contains 19 pages)