Parasitism, productivity, and population growth: response of Least Bell's Vireos (Vireo bellii pusillus) and Southwestern Willow Flycatchers (Empidonax traillii extimus) to cowbird (Molothrus spp.) control

USGS Publications Warehouse

Kus, Barbara E.; Whitfield, Mary J.

2005-01-01

Cowbird (Molothrus spp.) control is a major focus of recovery-oriented management of two endangered riparian bird species,the Least Bell's Vireo (Vireo bellii pusillus) and Southwestern Willow Flycatcher (Empidonax traillii extimus). During the past 20 years, annual trapping of cowbirds at Least Bell's Vireo and Southwestern Willow Flycatcher breeding sites has eliminated or reduced parasitism in comparison with pretrapping rates and, thereby, significantly increased seasonal productivity of nesting pairs. Enhanced productivity, in turn, has resulted in an 8-fold increase in numbers of Least Bell's Vireos; Southwestern Willow Flycatcher abundance, however, has changed little, and at some sites has declined despite cowbird control. Although generally successful by these short-term measures of host population response, cowbird control poses potential negative consequences for long-term recovery of endangered species. As currently employed, cowbird control lacks predetermined biological criteria to trigger an end to the control, making these species' dependence on human intervention open-ended. Prolonged reliance on cowbird control to manage endangered species can shift attention from identifying and managing other factors that limit populations--in particular, habitat availability. On the basis of our analysis of these long-term programs, we suggest that cowbird control be reserved for short-term crisis management and be replaced, when appropriate, by practices emphasizing restoration and maintenance of natural processes on which species depend. /// El manejo orientado hacia la recuperación de dos especies de aves ribereñas Vireo belli pusillus y Empidonax trailli extimus se ha focalizado principalmente en el control de los Molothrus spp parásitos. Durante los pasados 20 años, la captura anual de los Molothrus en las áreas de nidificación de Vireo belli pusillus y Empidonax trailli extimus ha eliminado o reducido el parasitismo en comparación con las tasas

Falls in long-term care institutions for elderly people: protocol validation.

PubMed

Baixinho, Cristina Rosa Soares Lavareda; Dixe, Maria Dos Anjos Coelho Rodrigues; Henriques, Maria Adriana Pereira

2017-01-01

To validate the content of a fall management risk protocol in long-term institutions for elderly people. Methodological, quanti-qualitative study using the Delphi technique. The tool, based on the literature, was sent electronically to obtain consensus among the 14 experts that meet the defined inclusion criteria. The 27 indicators of the protocol are organized in three dimensions: prepare for the institutionalization (IRA=.88); manage the risk of falls throughout the institutionalization (IRA=.9); and lead the communication and formation (IRA=1), with a CVI=.91. Two rounds were performed to get a consensus superior to 80% in every item. The values obtained in the reliability test (>0.8) show that the protocol can be used to meet the intended goal. The next step is the clinic validation of the protocol with residents of long-term care institutions for elderly people. Validar o conteúdo de um protocolo para a gestão do risco de queda em Instituições de Longa Permanência para Idosos. Estudo metodológico, de abordagem quantiqualitativa, utilizando a técnica de Delphi. O instrumento, construído com base na literatura, foi enviado por via electrónica, para obter consenso entre os 14 peritos que respeitam os critérios de inclusão definidos. Os 27 indicadores do protocolo estão organizados em três dimensões: Preparar a Institucionalização (IRA=,88); Gerir o Risco de Queda ao longo da Institucionalização (IRA=,9) e Liderar a comunicação e formação (IRA=1), com um CVI=,91. Foram efetuadas duas rodadas para se obter consenso superior a 80% em todos os itens. Os valores obtidos no teste de fidedignidade (>0,8) atestam que o protocolo pode ser utilizado para atingir o fim que se pretende. A próxima etapa é a validação clínica do protocolo com idosos residentes em Instituições de Longa Permanência para Idosos.

Contribution of Systematic Reviews to Management Decisions

PubMed Central

COOK, CARLY N; POSSINGHAM, HUGH P; FULLER, RICHARD A

2014-01-01

Decisiones de Manejo Resumen Las revisiones sistemáticas resumen integralmente la evidencia sobre la efectividad de las intervenciones de conservación. Investigamos la contribución de las decisiones de manejo hechas por este creciente cuerpo de literatura. Identificamos 43 revisiones sistemáticas de evidencia de conservación, 23 de las cuales hicieron algunas conclusiones concretas relevantes al manejo. La mayoría de las revisiones se dirigían a intervenciones de conservación relevantes a las decisiones políticas; sólo el 35% consideraba intervenciones de manejo sobre-la-causa prácticas. La mayoría de las revisiones cubrieron solo una pequeña fracción de la amplitud geográfica y taxonómica a la que buscaban dirigirse (mediana = 13% de los países relevantes y 16% de los taxones relevantes). La probabilidad de que las revisiones tuvieran por lo menos algunas implicaciones para el manejo tendió a incrementar conforme la cobertura geográfica incrementaba y a declinar conforme aumentaba la amplitud taxonómica. Estos resultados sugieren que la amplitud de una revisión taxonómica requiere de una consideración cuidadosa. Las revisiones identificaron una media de 312 estudios primarios relevantes pero excluyeron 88% de estos por deficiencias en el diseño o fallas para coincidir con otros criterios de inclusión. Las revisiones resumieron en promedio 248 juegos de datos y 112 años de actividad de investigación, pero la probabilidad de que sus resultados tuvieran por lo menos algunas implicaciones para el manejo no incrementaron mientras la cantidad de investigación primaria resumida aumentaba. En algunos casos, las conclusiones fueron elusivas a pesar de la inclusión de cientos de conjuntos de datos y años de actividad de investigación acumulada. Las revisiones sistemáticas son una parte importante del juego de herramientas en la toma de decisiones de conservación, aunque consideramos que los beneficios de las revisiones sistemáticas podrían ser

The Need to Disentangle Key Concepts from Ecosystem-Approach Jargon

PubMed Central

WAYLEN, K A; HASTINGS, E J; BANKS, E A; HOLSTEAD, K L; IRVINE, R J; BLACKSTOCK, K L

2014-01-01

Argot Ambiente-Estrategia Resumen La estrategia ambiental – como es promocionada por la Convención Biológica sobre Diversidad en 2000 – es una estrategia para un manejo holístico, sustentable y equitativo de recursos naturales, que habrá de implementarse por vía de los 12 Principios de Malawi. Estos principios describen la necesidad de manejar la naturaleza en términos de ecosistemas dinámicos, mientras se compromete totalmente con las personas locales. Es un concepto ambicioso. Hoy en día, el término es común en la investigación y la literatura de políticas sobre el manejo ambiente. Sin embargo, se han relacionado múltiples significados con el término, lo que resulta en confusión. Revisamos referencias a la estrategia ambiental de 1957 a 2012 e identificamos tres usos principales: como una alternativa para manejo ambiental o basado en ecosistemas; en referencia a una estrategia integrada y equitativa para el manejo de recursos según la CBD; y como un término que indica un enfoque en el entendimiento y la valuación de los servicios ambientales. Aunque los usos de este término y sus variantes pueden traslaparse en su significado, típicamente no reflejan en su totalidad los valores de la estrategia ambiental como fue definida por la CBD. Por ejemplo, actualmente hay un énfasis creciente en los servicios ambientales, pero enfocarse solamente en estos no promueve la descentralización del manejo o el uso de todas las formas de conocimiento, siendo ambas integrales para el concepto de la CBD. Resaltamos que los Principios de Malawi están en riesgo de ser olvidados. Para entender mejor estos principios, se requiere de más esfuerzo para implementarlos. Dichos esfuerzos deben ser evaluados, idóneamente con estrategias comparativas, antes de permitir que el concepto de la CBD de manejo holístico y comprometido socialmente sea abandonado o reemplazado. Es posible que los intentos por implementar los 12 principios juntos enfrentarán muchos obst

Achieving Conservation Science that Bridges the Knowledge–Action Boundary

PubMed Central

Cook, Carly N; Mascia, Michael B; Schwartz, Mark W; Possingham, Hugh P; Fuller, Richard A

2013-01-01

both advances scientific understanding and contributes to decision making. Logrando que la Ciencia de la Conservación Trasponga la Frontera Conocimiento-Acción Resumen Hay muchas barreras para utilizar ciencia para informar a la política y práctica de la conservación. Los científicos de la conservación que desean producir ciencia relevante para el manejo deben equilibrar esta meta con el imperativo de demostrar novedad y rigor en su ciencia. Los tomadores de decisiones que buscan que sus decisiones se basen en evidencias deben equilibrar el deseo de conocimientos con la necesidad de actuar a pesar de la incertidumbre. La generación de ciencia que informe efectivamente a las decisiones de manejo requiere que la producción de información (los componentes del conocimiento) sea sobresaliente (relevante y oportuna), creíble (autoritativa, verosímil y confiable) y legítima (desarrollada mediante un proceso que considera los valores y perspectivas de todos los actores relevantes) a la vista tanto de investigadores como de tomadores de decisiones. Percibimos tres retos clave para quienes desean generar ciencia de la conservación que logre estas tres características de la información. Primero, las audiencias científicas y de manejo pueden tener percepciones contrastantes sobre la relevancia de la investigación. Segundo, la credibilidad se puede lograr a costa de la relevancia y legitimidad a la vista de los tomadores de decisiones y tercero, los diferentes actores pueden tener percepciones conflictivas sobre los que constituye información legítima. Resaltamos cuatro marcos institucionales que pueden facilitar que la ciencia informe al manejo: organizaciones de frontera (organizaciones ambientales que trasponen la frontera entre la ciencia y el manejo), investigadores científicos insertados en agencias de manejo de recursos, vínculos formales entre tomadores de decisiones y científicos en instituciones enfocadas a la investigación, y programas de

Documentation and Testing of the WEAP Model for the Rio Grande/Bravo Basin

DTIC Science & Technology

2006-08-01

border between Texas and the Mexican states of Coahuila, Nuevo Leon and Tamaulipas (Appendix B, Figure 32). There are four reservoirs of interest in this...Camargo - Ciudad Acuna - Ciudad Anhuac - Ciudad Juarez - Matamoros - Metropolitan Monterrey - Nuevo Laredo - Reynosa - Piedras Negras...Rivera, and Jorge A. Hidalgo. (2001). “Sistema de apoyo a la toma de decisions para el manejo integral del agua en cuencas.” IMTA/CNA, Proyecto

[Not Available].

PubMed

Torres Díaz, Cristina V; Martín Peña, Gonzalo; Ezquiaga, Elena; Navas García, Marta; García de Sola, Rafael

2016-07-19

Gracias a los avances técnicos en técnicas neuroquirúrgicas, y debido a que el diagnóstico y la clasificación de las enfermedades psiquiátricas han evolucionado significativamente a lo largo de las últimas décadas, se están desarrollando tratamientos a nivel experimental para aquellos pacientes resistentes al manejo conservador.La anorexia nerviosa es una enfermedad de prevalencia creciente, con la tasa de mortalidad más elevada dentro de los trastornos psiquiátricos, y con aproximadamente un 20% de pacientes que presentan una evolución tórpida. Para estos pacientes que no responden a manejo conservador, la estimulación cerebral profunda ha surgido como una alternativa terapéutica, si bien la literatura especializada al respecto es escasa.A continuación presentamos una revisión de la fisiopatología de la anorexia nerviosa, así como de los distintos tratamientos neuroquirúrgicos realizados a lo largo de la historia. Se detalla la perspectiva de tratamiento quirúrgico actual, así como los aspectos éticos que se han de considerar en relación con el surgimiento de estas nuevas terapias.

Production and quality assurance in the SIT Africa Mediterranean fruit fly (Diptera: Tephritidae) rearing facility in South Africa

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barnes, B.; Rosenberg, S.; Arnolds, L.

machos esteriles de moscas para el proyecto de la tecnica del insecto esteril (TIE) en huertos de frutos y vinas comerciales en la provincia del Cabo Occidental del Sudafrica. El procedimiento de criar en masa fue en su mayor parte basado en los sistemas desarrollados por el Laboratorio de Agricultura y Biotecnologia de la FAO/IAEA, Seibersdorf, Austria. Un numero de razas que separara los sexos geneticamente fueron utilizadas para producir solo machos para la liberacion. La congestionada condicion inicial para criar las moscas y su manejo de calidad fueron aliviadas en 2001 con la construccion de un nuevo cuarto de cria para adultos y un laboratorio de control de calidad. En 2002, un Sistema de Manejo de Calidad comprensivo fue implementado, y en 2003 una raza mejorada que separa los sexos geneticamente, VIENNA 8, fue proveido por el Laboratorio de la FAO/IAEA en Seibersdorf. En la mayor parte de los primeros 3 anos la facilidad no pudo suplir el numero requerido de machos esteriles de la mosca mediterranea de la fruta para el programa de TIE sin la necesidad para importar machos esteriles de otra facilidad. Desde medio del ano de 2002, despues que el sistema de manejo de calidad fue implementado, la produccion y la calidad mejoraron pero aun quedaron por debajo del nivel optimo. Despues de la introduccion de la raza VIENNA 8 que separa los sexos geneticamente, y junto con el equipo mejorado de control de clima, la estabilidad y los parametros de seguridad de calidad mejoraron substancialmente. Los factores criticos que influyeron en la produccion y la calidad fueron la infraestructura inadecuada para criar las moscas, problemas con la calidad de la dieta para las larvas y la ausencia inicial de un sistema de manejo de calidad. Los resultados muestran claramente la importancia de un manejo efectivo de la calidad, el valor de una raza productiva que separa los sexos geneticamente y la necesidad de contar con una base solida de financimiento para la infraestructura de una

Quantifying Loss of Acoustic Communication Space for Right Whales in and around a U.S. National Marine Sanctuary

DTIC Science & Technology

2012-01-01

buscan mejorar el manejo de los efectos acumulativos del ruido sobre especies marinas y sus hábitats. Palabras Clave: área marina protegida, especies...dependientes del sonido para comunicarse están poco entendidos. Buscamos desarrollar métodos para cuantificar los efectos del enmascaramiento de la comu... tiempo ( tiempo pico de alimentación). Utilizamos un conjunto de grabadoras acústicas autónomas, temporales, montadas en el fondo en el Santuario

Genetic Structure of Anopheles (Nyssorhynchus) marajoara (Diptera: Culicidae) in Colombia

DTIC Science & Technology

2010-01-01

South America . J Infect Dis 186: 999 – 1006 . 2. Mendoza M , Nicholls R , Olano V , Cortés L , 2000 . Situación de la malaria en ...Colombia . Manual de Manejo integral de la malaria. Instituto Nacional de Salud Ed . Bogotá, Columbia: Instituto Nacional de Salud . 3. Herrera...S , Suárez M , Sánchez G , Quiñones M , Herrera M , 1987 . Uso de la técnica inmunoradiometrica (IRMA) en Anopheles de Colombia para la

Riego y fertirriego

Treesearch

R. Kasten Dumroese; Thomas D. Landis; Kim M. Wilkinson

2012-01-01

El agua es el factor que más puede afectar el crecimiento y la sanidad de las plantas por sí solo. Es esencial para casi todos los procesos vegetales: la fotosíntesis, el transporte de nutrientes, el crecimiento y el desarrollo celular. De hecho, del 80 al 90% del peso de un plantín es agua, por lo cual el manejo del riego es una de las tareas más trascendentes dentro...

MASCARA (Manejo del Síndrome Coronario Agudo. Registro Actualizado) study. General findings.

PubMed

Ferreira-González, Ignacio; Permanyer-Miralda, Gaietà; Marrugat, Jaume; Heras, Magda; Cuñat, José; Civeira, Emilia; Arós, Fernando; Rodríguez, Juan J; Sánchez, Pedro L; Bueno, Héctor

2008-08-01

To investigate the clinical characteristics and treatment of acute coronary syndromes (ACS), and to determine the effects of an early invasive strategy (EIS) in non-ST-elevation ACS (NSTEACS) and of primary percutaneous coronary intervention (PCI) in ST-elevation ACS (STEACS). Data were collected prospectively for 9 months during 2004-2005 from 50 hospitals, which were randomly selected according to the level of care provided. In addition, follow-up data on mortality and readmission for ACS were collected for 6 months. The adjusted effects of different reperfusion strategies were analyzed. After checking data quality, the analysis included data from 32 hospitals, which covered 7923 coronary events (4431 [56%] STEACS, 3034 [38%] NSTEACS and 458 [6%] unclassified ACS) in 7251 patients. Compared with previous studies, the use of primary PCI in STEACS had increased markedly (from 10.7% to 36.8% of patients undergoing reperfusion), as had the use of EIS in NSTEACS (from 11.1% to 19.6%). Overall in-hospital mortality was 5.7% (95% confidence interval [CI], 5.1%-6.2%); for STEACS it was 7.6% (95% CI, 6.7%-8.7%), for NSTEACS 3.9% (95% CI, 3.3%-4.6%), and for unclassified ACS 8.8% (95% CI, 6.2%-12.2%). In the population as a whole, there was no association between prognosis (i.e., 6-month mortality) and EIS in NSTEACS (hazard ratio [HR]=0.94; 95% CI, 0.66-1.3) or between prognosis and primary PCI in STEACS (HR=1; 95% CI, 0.7-1.5). Findings for mortality and rehospitalization for ACS at 6 months were similar. Data for 2004-2005 demonstrated a marked increase in the use of invasive procedures. However, the procedures employed were poorly matched to the patients' baseline risk.

PNAUM: integrated approach to Pharmaceutical Services, Science, Technology and Innovation

PubMed Central

Gadelha, Carlos Augusto Grabois; Costa, Karen Sarmento; do Nascimento, José Miguel; Soeiro, Orlando Mário; Mengue, Sotero Serrate; da Motta, Márcia Luz; de Carvalho, Antônio Carlos Campos

2016-01-01

ABSTRACT This paper describes the development process of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines) based on an integrated approach to pharmaceutical services, science, technology and innovation. It starts by contextualizing health and development in Brazil and features elements of the National Policy for Science, Technology and Innovation in Health in Brazil and the National Policy for Pharmaceutical Services. On presenting pharmaceutical policy guidelines, it stresses the lack of nationwide data. This survey, commissioned by the Brazilian Ministry of Health, has two components: household survey and evaluation of pharmaceutical services in primary care. The findings point to perspectives that represent, besides the enhancement of public policy for pharmaceutical services and public health, results of government action aimed at developing the economic and industrial health care complex to improve the health conditions of the Brazilian population. PMID:27982379

Accelerating Adaptation of Natural Resource Management to Address Climate Change

PubMed Central

Cross, Molly S; McCarthy, Patrick D; Garfin, Gregg; Gori, David; Enquist, Carolyn AF

2013-01-01

Abstract Natural resource managers are seeking tools to help them address current and future effects of climate change. We present a model for collaborative planning aimed at identifying ways to adapt management actions to address the effects of climate change in landscapes that cross public and private jurisdictional boundaries. The Southwest Climate Change Initiative (SWCCI) piloted the Adaptation for Conservation Targets (ACT) planning approach at workshops in 4 southwestern U.S. landscapes. This planning approach successfully increased participants’ self-reported capacity to address climate change by providing them with a better understanding of potential effects and guiding the identification of solutions. The workshops fostered cross-jurisdictional and multidisciplinary dialogue on climate change through active participation of scientists and managers in assessing climate change effects, discussing the implications of those effects for determining management goals and activities, and cultivating opportunities for regional coordination on adaptation of management plans. Facilitated application of the ACT framework advanced group discussions beyond assessing effects to devising options to mitigate the effects of climate change on specific species, ecological functions, and ecosystems. Participants addressed uncertainty about future conditions by considering more than one climate-change scenario. They outlined opportunities and identified next steps for implementing several actions, and local partnerships have begun implementing actions and conducting additional planning. Continued investment in adaptation of management plans and actions to address the effects of climate change in the southwestern United States and extension of the approaches used in this project to additional landscapes are needed if biological diversity and ecosystem services are to be maintained in a rapidly changing world. Acelerando la Adaptación del Manejo de Recursos Naturales para

[Anorexia nervosa as a cause of acute liver failure. Report of a case].

PubMed

Voltas-Arribas, Beatriz; Artero-Fullana, Ana; Ferrer-García, Juan Carlos; Sánchez-Juan, Carlos; Marco-Alacid, Cristian; Sanz-Revert, Pablo; García-Blasco, Lourdes

2018-01-10

Caso clínico: presentamos una paciente de 33 años con anorexia nerviosa de 15 años de evolución con uno de los pocos casos reportados de fallo hepático agudo severo secundario a la desnutrición.Discusión: tras el soporte nutricional protocolizado para evitar el síndrome de realimentación y un adecuado manejo multidisciplinar, la paciente evoluciona favorablemente logrando normalizar los electrolitos, la función hepática y las alteraciones en la coagulación.

Right hepatic artery aneurysm.

PubMed

Bernal, Astrid Del Pilar Ardila; Loures, Paulo; Calle, Juan Cristóbal Ospina; Cunha, Beatriz; Córdoba, Juan Camilo

2016-01-01

We report a case of an aneurysm of the right hepatic artery and its multidisciplinary management by general surgery, endoscopy and radiology services. Being a case of extremely low incidence, it is important to show its diagnostic and therapeutic approach. RESUMO Relatamos um caso de aneurisma da artéria hepática direita conduzido de forma multidisciplinar pelos Serviços de Cirurgia Geral, Endoscopia e Radiologia. Em se tratando de caso de incidência baixíssima, é importante mostrar o enfoque diagnóstico e terapêutico usado em seu manejo.

PNAUM: integrated approach to Pharmaceutical Services, Science, Technology and Innovation.

PubMed

Gadelha, Carlos Augusto Grabois; Costa, Karen Sarmento; Nascimento, José Miguel do; Soeiro, Orlando Mário; Mengue, Sotero Serrate; Motta, Márcia Luz da; Carvalho, Antônio Carlos Campos de

2016-12-01

This paper describes the development process of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines) based on an integrated approach to pharmaceutical services, science, technology and innovation. It starts by contextualizing health and development in Brazil and features elements of the National Policy for Science, Technology and Innovation in Health in Brazil and the National Policy for Pharmaceutical Services. On presenting pharmaceutical policy guidelines, it stresses the lack of nationwide data. This survey, commissioned by the Brazilian Ministry of Health, has two components: household survey and evaluation of pharmaceutical services in primary care. The findings point to perspectives that represent, besides the enhancement of public policy for pharmaceutical services and public health, results of government action aimed at developing the economic and industrial health care complex to improve the health conditions of the Brazilian population. RESUMO O artigo apresenta o processo de construção da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamento a partir de uma concepção integradora da Assistência Farmacêutica, Ciência, Tecnologia e Inovação. Inicia-se contextualizando a saúde e o desenvolvimento no País e apresenta elementos da Política Nacional de Ciência Tecnologia e Inovação em Saúde no Brasil e da Política Nacional de Assistência Farmacêutica. Ao apresentar as diretrizes das Políticas Farmacêuticas, destaca-se a carência de dados de abrangência nacional. A presente pesquisa, encomendada pelo Ministério da Saúde, foi estruturada em dois componentes: inquérito domiciliar e avaliação dos serviços de assistência farmacêutica na atenção básica. As perspectivas dos resultados representam, além do incremento das políticas públicas farmacêuticas e de saúde p

[Consensus on Systemic Arterial Hypertension In México].

PubMed

Rosas-Peralta, Martín; Palomo-Piñón, Silvia; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Almeida-Gutiérrez, Eduardo; Galván-Oseguera, Héctor; Magaña-Serrano, José Antonio; Saturno-Chiu, Guillermo; Ramírez-Arias, Erick; Santos-Martínez, Efrén; Díaz-Díaz, Enrique; Salgado-Pastor, Selene Janette; Morales-Mora, Gerardo; Medina-Concebida, Luz Elena; Mejía-Rodríguez, Oliva; Pérez-Ruiz, Claudia Elsa; Chapa-Mejía, Luis Raúl; Álvarez-Aguilar, Cleto; Pérez-Rodríguez, Gilberto; Castro-Martínez, María Guadalupe; López-Bárcena, Joaquín; Paniagua-Sierra, José Ramón

2016-01-01

This Consenso Nacional de Hipertensión Arterial Sistémica (National Consensus on Systemic Arterial Hypertension) brings together experiences and joint work of 79 specialists who have been in contact with the patient affected by systemic arterial hypertension. All concepts here presented were outlined on the basis of the real world practice of Mexican hypertensive population. The consensus was developed under strict methodological guidelines. The Delphi technique was applied in two rounds for the development of an appropriate statistical analysis of the concepts exposed by all the specialists, who posed key questions, later developed by the panel of experts of the Hospital de Cardiología, and specialists from the Centro Médico Nacional. Several angles of this illness are shown: detection, diagnosis, pathophysiology, classification, treatment and prevention. The evidence analysis was carried out using PRISMA method. More than 600 articles were reviewed, leaving only the most representative in the references. This document concludes with practical and useful recommendations for the three levels of health care of our country.

Modelo de Integracion Practica del Componente Educativo en los Planes de Manejo de Emergencia

ERIC Educational Resources Information Center

Martinez Jimenez, Magna M.

2012-01-01

Education is a basic human right for all people, according to the Universal Declaration of Human Rights. Article 22 of the Children's' Rights Convention stipulates that the Nations are obligated to guarantee that any child requesting refuge receive appropriate protection, humanitarian assistance and full enjoyment of all the rights contemplated in…

PubMed

Fumis, María Agustina; Bidabehere, María Belén; Moyano, Yohana; Sardoy, Agustina; Gubiani, María Laura; Boldrini, María Pía; Pinardi, Beatriz Alicia

2017-09-08

La fascitis necrotizante por estrepotococo del grupo A es una infección infrecuente del tejido subcutáneo  y de la fascia, con una tasa de mortalidad elevada debido a su rápida progresión a shock y fallo multiorgánico. Se desarrolla generalmente en extremidades tras un traumatismo o lesión previa. El diagnóstico temprano es esencial así como también el manejo rápido y agresivo. Presentamos un caso de fascitis necrotizante de evolución rápida a pesar del diagnóstico precoz y tratamiento específico instaurado.

Malformaciones arteriovenosas revisión y análisis descriptivo de 52 mavs tratadas durante el periodo de 2000-2010

PubMed Central

Rinaldi, Mariano; Mezzano, Emilio; Berra, Matias S.; Parés, Herald R.; Olocco, Ricardo V.; Papalini, Francisco R.

2015-01-01

Objetivo: Describir nuestra experiencia en el manejo de las Mavs analizando las características clínicas de los pacientes y los resultados postoperatorios. Método de análisis: Realizamos un análisis retrospectivo de 52 pacientes admitidos en el Servicio de neurocirugía para manejo quirúrgico: La información de referencia incluyo síntomas al inicio, diagnostico de admisión, hallazgos neurológicos y hallazgos en estudio por imágenes tales como tomografía cerebral, IRM cerebral y angiografía por sustracción digital. Los hallazgos postoperatorios de interés fueron: Mortalidad, examen neurológico postoperatorio y complicaciones asociadas. Presentamos nuestro análisis estadístico. Resultados: Edad promedio: 37,7 años. Distribución: Hombres: 61,5%. Motivos de consulta más frecuentes: Cefalea 63,5%, evento hemorrágico 59,6%, convulsiones 26,9%. Localización: Supratentorial: 92,9%, Infratentorial: 7,2%. 30,8%, de las Mavs fueron grado 2 y grado 3 Cincuenta por ciento del total presentaron aneurismas, del total de la MAVs, 59,6% debutó con sangrado, 26,9% con Crisis Convulsivas y 13,5% con déficit neurológico. Recibieron tratamiento endovascular previo a cirugía 30,7%. Durante el postoperatorio 23,1% presentaron mejoría clínica, 57,7% no presento modificación, 19,2% empeoraron en el postoperatorio. La mortalidad fue 13,5%. Conclusión: Creemos que el subgrupo de Mavs grados III a V representan una entidad que requiere una compleja toma de decisiones dada la alta incidencia de aneurismas asociados que presentan y su asociación con eventos de sangrado. Nuestra mortalidad postoperatoria coincide con la bibliografía. Palabras clave, Mavs- aneurismas asociados- Acv hemorrágico- convulsiones. PMID:26600984

Quality management systems for fruit fly (Diptera: Tephritidae) sterile insect technique

DOE Office of Scientific and Technical Information (OSTI.GOV)

Caceres, C.; Robinson, A.; McInnis, D.

The papers presented in this issue are focused on developing and validating procedures to improve the overall quality of sterile fruit flies for use in area-wide integrated pest management (AW-IPM) programs with a sterile insect technique (SIT) component. The group was coordinated and partially funded by the Joint FAO/IAEA Programme of Nuclear Techniques in Food and Agriculture, International Atomic Energy Agency, Vienna, Austria, under a five-year Coordinated Research Project (CRP) on 'Quality Assurance in Mass-Reared and Released Fruit Flies for Use in SIT Programmes'. Participants in the CRP from 16 countries came from both basic and applied fields of expertisemore » to ensure that appropriate and relevant procedures were developed. A variety of studies was undertaken to develop protocols to assess strain compatibility and to improve colonization procedures and strain management. Specific studies addressed issues related to insect nutrition, irradiation protocols, field dispersal and survival, field cage behavior assessments, and enhancement of mating competitiveness. The main objective was to increase the efficiency of operational fruit fly programs using sterile insects and to reduce their cost. Many of the protocols developed or improved during the CRP will be incorporated into the international quality control manual for sterile tephritid fruit flies, standardizing key components of the production, sterilization, shipment, handling, and release of sterile insects. (author) [Spanish] Los articulos presentados en este numero se enfocan en el desarrollo y la validacion de procedimientos para mejorar la calidad total de moscas de las frutas esteriles para su uso en programas de manejo integrado de plagas en donde la tecnica del insecto esteril (TIE) es uno de los componentes clave. El grupo fue coordinado y parcialmente financiado por la Division Conjunta de Tecnicas Nucleares para la Alimentacion y la Agricultura de la FAO/OIEA, Viena, Austria, por un periodo

Etologia aplicada al manejo de especies amenazadas: el caso del turon de patas negras (Mustela nigripes)

USGS Publications Warehouse

Vargas, A.; Biggins, D.; Miller, B.

1999-01-01

de esta especie de un modo más eficaz y rentable. Black-footed ferrets are considered one of the world's most endangered mammals. The last wild population was discovered in 1981 in Meteetsee, Wyoming, and, in 1985 it collapsed due to an epizootic of canine distemper in combination with sylvatic plague. Prior to the extinction of the last remnant population, 18 wild black-footed ferrets were captured to initiate captive propagation efforts. Captive breeding has been successful and, during the last 11 years, more than 2600 black-footed ferrets have been born in captive breeding centers. Since 1991, approximately 870 ferrets have been reintroduced in 5 areas located within the ferret's original geographic distribution, including sites in Wyoming, Montana, South Dakota, and Arizona. Scientific research has been, and continues to be, a critical tool to direct recovery efforts. Studies in applied ethology conducted on captive and reintroduced ferret populations have demonstrated that a naturalistic captive environment, particularly during early developmental periods, enhances the expression of behaviors necessary for survival in nature. Ferrets raised in a naturalistic environment develop better predatory skills, are able to recognize prairie dog burrows as a home and shelter from predators, and are more physically fit. Results from these studies have been adapted into management strategies to help implement a more cost-effective road to black-footed ferret recovery.

Social and behavior change communication in the fight against malaria in Mozambique.

PubMed

Arroz, Jorge Alexandre Harrison

2017-03-23

Long-lasting insecticide-treated nets and/or indoor residual spraying, associated with case management, are key interventions in the control of malaria in Africa. The objective of this study is to comment on the role of social and behavior change communication as a potential key intervention in the control of malaria in Mozambique. RESUMO As redes mosquiteiras impregnadas com insecticidade de longa duração e/ou pulverização intra-domiciliária, associada ao manejo de casos são intervenções-chave no controlo da malária em África. O objetivo deste estudo foi comentar o papel da comunicação para a mudança social e de comportamento como intervenção potencialmente chave no controlo da malária em Moçambique.

National Survey on Access, Use and Promotion of Rational Use of Medicines: methods

PubMed Central

Álvares, Juliana; Alves, Maria Cecilia Goi Porto; Escuder, Maria Mercedes Loureiro; Almeida, Alessandra Maciel; Izidoro, Jans Bastos; Guerra, Augusto Afonso; Costa, Karen Sarmento; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Leite, Silvana Nair; Karnikowski, Margô Gomes de Oliveira; Acurcio, Francisco de Assis

2017-01-01

ABSTRACT The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos –Serviços (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services) aimed to characterize the organization of pharmaceutical services in the Primary Health Care of the Brazilian Unified Health System (SUS). PNAUM – Services is a cross-sectional and evaluative study, with planned sample of 600 cities, held between 2014 and 2015, composed of a remote phase, with telephone interviews with health managers. Of these 600 cities, 300 were selected for a survey on health services. We selected the 27 capitals, the 0.5% largest cities of each region, and the remaining cities were drawn. The estimate of the representative national sample size considered three levels: cities, medicine dispensing services, and patients. The interviews were carried out with a structured questionnaire specific for: municipal secretaries of health, professionals responsible for pharmaceutical services in the city, professionals responsible for the dispensing of medicines, physicians, and patients. The secondary data were obtained in official databases, in the latest update date. PNAUM – Services was the first nationwide research aimed at the assessment and acquisition of national and regional indicators on access to medicines, as well as use and rational use, from the perspective of various social subjects. PMID:29160446

Factors associated with low adherence to medicine treatment for chronic diseases in Brazil

PubMed Central

Tavares, Noemia Urruth Leão; Bertoldi, Andréa Dâmaso; Mengue, Sotero Serrate; Arrais, Paulo Sergio Dourado; Luiza, Vera Lucia; Oliveira, Maria Auxiliadora; Ramos, Luiz Roberto; Farias, Mareni Rocha; Pizzol, Tatiane da Silva Dal

2016-01-01

ABSTRACT OBJECTIVE To analyze factors associated with low adherence to drug treatment for chronic diseases in Brazil. METHODS Analysis of data from Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - Brazilian Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based cross-sectional household survey, based on a probabilistic sample of the Brazilian population. We analyzed the association between low adherence to drug treatment measured by the Brief Medication Questionnaire and demographic, socioeconomic, health, care and prescription factors. We used Poisson regression model to estimate crude and adjusted prevalence ratios, their respective 95% confidence interval (95%CI) and p-value (Wald test). RESULTS The prevalence of low adherence to drug treatment for chronic diseases was 30.8% (95%CI 28.8-33.0). The highest prevalence of low adherence was associated with individuals: young adults; no education; resident in the Northeast and Midwest Regions of Brazil; paying part of the treatment; poor self-perceived health; three or more diseases; reported limitations caused by a chronic disease; using five drugs or more. CONCLUSIONS Low adherence to drug treatment for chronic diseases in Brazil is relevant, and regional and demographic differences and those related to patients’ health care and therapy regime require coordinated action between health professionals, researchers, managers and policy makers. PMID:27982378

Assessment of Management to Mitigate Anthropogenic Effects on Large Whales

PubMed Central

Van Der Hoop, Julie M; Moore, Michael J; Barco, Susan G; Cole, Timothy VN; Daoust, Pierre-Yves; Henry, Allison G; McAlpine, Donald F; McLellan, William A; Wimmer, Tonya; Solow, Andrew R

2013-01-01

provide managers with direction for modifying regulated measures and can be applied globally to mortality-driven conservation issues. Evaluación del Manejo para Mitigar Efectos Antropogénicos sobre Ballenas Mayores Resumen Los gobiernos de Estados Unidos y Canadá han respondido a requerimientos legales para reducir la mortalidad de ballenas inducida por humanos por medio de impacto con embarcaciones y enmarañamiento en artes de pesca mediante la implementación de un conjunto de acciones reguladoras. Analizamos los patrones espaciales y temporales de la mortalidad de ballenas mayores en el Atlántico Noroccidental (23.5°N a 48.0°N), de 1970 a 2009, en el contexto de cambios de manejo. Utilizamos un modelo logístico multinomial ajustado por la máxima probabilidad de detección de tendencias en mortalidades por causa específica en el tiempo. Comparamos el número de muertes provocadas por humanos con los niveles de remoción biológica potencial (i.e., mortalidad específica provocada por humanos sustentable). De 1970 a 2009, hubo 1762 muertes (conocidas) y lesiones serias (casi fatales) involucrando 8 especies de ballenas mayores. Determinamos la causa de 43% de todas las muertes; de ellas, 67% (502) resultaron de interacciones humanas. El enmarañamiento en artes de pesca fue la causa principal de muerte en todas las especies (n = 323), seguida de causas naturales (n = 248) e impacto de embarcaciones (n = 171). Los niveles sustentables de mortalidad establecidos fueron excedidos consistentemente hasta en 650% en 2 especies. Las probabilidades de muerte por enmarañamiento y por impacto de embarcaciones incrementaron significativamente de 1990 a 2009. No hubo cambio significativo en la intensidad local de mortalidad por todas las causas o por impacto de embarcaciones antes y después de 2003, año en el que se implementaron numerosos esfuerzos de mitigación. Hasta ahora, los esfuerzos regulatorios no han reducido los efectos letales de las actividades humanas

The role of agri-environment schemes in conservation and environmental management

PubMed Central

Batáry, Péter; Dicks, Lynn V; Kleijn, David; Sutherland, William J

2015-01-01

la Conservación y el Manejo Ambiental Batáry et al. Resumen Más de la mitad de las tierras europeas está bajo manejo agrícola y así ha sido durante milenios. Muchas especies y ecosistemas de interés de conservación en Europa dependen del manejo agrícola y están mostrando una declinación continua. Los esquemas agro-ambientales (EAA) están diseñados en parte para encarar esto. Los esquemas son una gran fuente de financiamiento para la conservación dentro de la Unión Europea (UE) y el mayor gasto de conservación en Europa. Revisamos la estructura de los EAA actuales a lo largo del continente. Desde que en 2003 una revisión cuestionó la efectividad general de los EAA para la biodiversidad, ha habido una plétora de estudios de caso y meta-análisis que examinan su efectividad. La mayoría de las síntesis demuestran un incremento general en la biodiversidad de las tierras de cultivo en respuesta a los EAA, con la magnitud del efecto dependiente de la estructura y el manejo del terreno circundante. Esto es importante a la luz del crecimiento sucesivo de la UE y las continuas reformas a los EAA. Examinamos el cambio en la magnitud del efecto a través del tiempo al fusionar los conjuntos de datos de tres meta-análisis recientes y encontramos que los esquemas implementados después de la revisión de los programas agro-ambientales de la UE en 2007 no fueron más efectivos que los esquemas implementados antes de la revisión. Además, los esquemas enfocados en las áreas fuera de producción (como los márgenes de campo y los setos vivos) son más efectivos en el mejoramiento de la riqueza de especies que aquellos enfocados en las áreas productivas (como los cultivos arables y los pastizales). Las preguntas sobresalientes de la investigación incluyen si los EAA mejoran los servicios ambientales, si son más efectivos en las áreas agrícolas marginales que en las áreas de cultivo intensivo, si son más o menos rentables para la biodiversidad de las

RETOS EN LA INTERVENCIÓN CON ADOLESCENTES PUERTORRIQUEÑOS/AS QUE MANIFIESTAN COMPORTAMIENTO SUICIDA*

PubMed Central

Vélez, Yovanska Duarté; Dávila, Paloma Torres; Hernández, Samariz Laboy

2015-01-01

Presentamos un estudio de caso de una adolescente puertorriqueña con comportamiento suicida. Esta comenzó una Terapia Socio Cognitivo-Conductual para el Comportamiento Suicida (TSCC-CS) de tipo ambulatorio luego de una hospitalización por intento suicida. La TSCC-CS incorpora una perspectiva ecológica y de desarrollo a la terapia cognitivo-conductual. Inicialmente mostró baja autoestima y severos síntomas depresivos y de ansiedad. Al finalizar el tratamiento, manifestó un cambio significativo en su sintomatología clínica y evidenció una mejoría en sus destrezas de manejo. No presentó ideas suicidas durante meses previos, ni durante el seguimiento. El análisis de este caso permitió realizar cambios en el protocolo de tratamiento, particularmente en las sesiones de familia y de comunicación con el fin de aumentar la viabilidad del tratamiento. PMID:26702337

A importância de reconhecer a síndrome antifosfolípide na medicina vascular

PubMed Central

Funke, Andreas; Danowski, Adriana; de Andrade, Danieli Castro Oliveira; Rêgo, Jozelia; Levy, Roger Abramino

2017-01-01

Resumo A síndrome antifosfolipíde (SAF) é uma doença autoimune sistêmica caracterizada por trombose arterial ou venosa recorrente e/ou morbidade gestacional e pela presença dos anticorpos antifosfolipídeos, podendo apresentar outras manifestações vasculares, como microangiopatia, arteriopatia crônica e SAF catastrófica. Determinados testes laboratoriais para a síndrome (por exemplo, o anticoagulante lúpico) podem sofrer interferência do uso de medicações anticoagulantes, dificultando o diagnóstico. A fisiopatologia da SAF é complexa, sendo enumerados no texto diversos mecanismos patogênicos relacionados à coagulação, ao endotélio e às plaquetas. Por fim, discutimos o tratamento da SAF de acordo com a presença e o tipo de manifestações clínicas, o uso dos anticoagulantes orais diretos e o manejo perioperatório de pacientes com SAF. PMID:29930638

Cultural Adaptation and Reliability of the Compliance with Standard Precautions Scale (CSPS) for Nurses in Brazil.

PubMed

Pereira, Fernanda Maria Vieira; Lam, Simon Ching; Gir, Elucir

2017-03-02

this study aimed to carry of the cultural adaptation and to evaluate the reliability of the Compliance with Standard Precautions Scale (CSPS) for nurses in Brazil. the adaptation process entailed translation, consensus among judges, back-translation, semantic validation and pretest. The reliability was evaluated by internal consistency (Cronbach alpha) and stability (test-retest). The instrument was administered to a sample group of 300 nurses who worked in a large hospital located in the city of São Paulo/SP, Brazil. through the semantic validation, the items from the scale were considered understandable and deemed important for the nurse´s clinical practice. The CSPS Brazilian Portuguese version (CSPS-PB) revealed excellent interpretability. The Cronbach`s alpha was 0.61 and the intraclass correlation coefficient was 0.85. the initial study showed that CSPS-PB is appropriate to assess compliance with standard precautions among nurses in Brazil. The reliability was considered acceptable. Furhter study is necessary to evaluate its comprehensive psychometric properties. adaptar culturalmente y evaluar la confiabilidad de la Compliance with Standard Precautions Scale (CSPS) para enfermeros en Brasil. el proceso de adaptación abarcó la traducción, consenso entre jueces, retrotraducción, validación semántica y pretest. La confiabilidad fue evaluada mediante la consistencia interna (alfa de Cronbach) y estabilidad (test-retest). El instrumento fue administrado a una muestra de 300 enfermeros actuantes en un gran hospital ubicado en la ciudad de São Paulo/SP, Brasil. a través de la validación semántica, los ítems de la escala fueron considerados comprensibles e importantes para la práctica clínica enfermera. La versión en portugués de Brasil de la CSPS (CSPS-PB) reveló excelente posibilidad de interpretación. El alfa de Cronbach correspondió a 0.61 y el coeficiente de correlación intraclase fue 0.85. el estudio inicial mostró que la CSPS-PB es

Translation and cross-cultural adaptation of the Clinical Competence Questionnaire for use in Brazil.

PubMed

Kwiatkoski, Danielle Ritter; Mantovani, Maria de Fátima; Pereira, Evani Marques; Bortolato-Major, Carina; Mattei, Ângela Taís; Peres, Aida Maris

2017-06-05

translating and transculturally adapting the Clinical Competence Questionnaire to Brazilian senior undergraduate Nursing students, as well as measuring psychometric properties of the questionnaire. a methodological study carried out in six steps: translation of the Clinical Competence Questionnaire instrument, consensus of the translations, back-translation, analysis by an expert committee, pre-testing and then presentation of the cross-cultural adaptation process to the developers. Psychometric properties were measured using Cronbach's alpha, intraclass correlation coefficient and content validity index. the instrument was translated, transculturally adapted and its final version consisted of 48 items. Cronbach's alpha coefficient was 0.90, and the agreement index of the items was 99% for students and 98% for evaluators. the Clinical Competence Questionnaire was translated and adapted to Brazilian students, and the psychometric properties of the Portuguese version of the questionnaire presented satisfactory internal consistency regarding the studied sample. traduzir e adaptar transculturalmente o Clinical Competence Questionnaire aos estudantes brasileiros concluintes da graduação em enfermagem, bem como mensurar as propriedades psicométricas do questionário. estudo metodológico realizado em seis etapas: tradução do instrumento Clinical Competence Questionnaire, consenso das traduções, retrotradução, análise pelo comitê de especialistas, pré-teste e apresentação do processo de adaptação transcultural para os desenvolvedores. As propriedades psicométricas foram mensuradas utilizando-se o alfa de Cronbach, coeficiente de correlação intraclasse e índice de validade de conteúdo. o instrumento foi traduzido, adaptado transculturalmente e sua versão final foi constituída de 48 itens. O coeficiente alfa de Cronbach foi de 0,90, e o índice de concordância dos itens foi de 99% para os estudantes e de 98% para os avaliadores. o Clinical Competence

Factors associated with low adherence to medicine treatment for chronic diseases in Brazil.

PubMed

Tavares, Noemia Urruth Leão; Bertoldi, Andréa Dâmaso; Mengue, Sotero Serrate; Arrais, Paulo Sergio Dourado; Luiza, Vera Lucia; Oliveira, Maria Auxiliadora; Ramos, Luiz Roberto; Farias, Mareni Rocha; Pizzol, Tatiane da Silva Dal

2016-12-01

To analyze factors associated with low adherence to drug treatment for chronic diseases in Brazil. Analysis of data from Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - Brazilian Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based cross-sectional household survey, based on a probabilistic sample of the Brazilian population. We analyzed the association between low adherence to drug treatment measured by the Brief Medication Questionnaire and demographic, socioeconomic, health, care and prescription factors. We used Poisson regression model to estimate crude and adjusted prevalence ratios, their respective 95% confidence interval (95%CI) and p-value (Wald test). The prevalence of low adherence to drug treatment for chronic diseases was 30.8% (95%CI 28.8-33.0). The highest prevalence of low adherence was associated with individuals: young adults; no education; resident in the Northeast and Midwest Regions of Brazil; paying part of the treatment; poor self-perceived health; three or more diseases; reported limitations caused by a chronic disease; using five drugs or more. Low adherence to drug treatment for chronic diseases in Brazil is relevant, and regional and demographic differences and those related to patients' health care and therapy regime require coordinated action between health professionals, researchers, managers and policy makers. Analisar fatores associados à baixa adesão ao tratamento farmacológico de doenças crônicas no Brasil. Análise de dados oriundos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), inquérito domiciliar de base populacional, de delineamento transversal, baseado em amostra probabilística da população brasileira. Analisou-se a associação entre baixa adesão ao tratamento medicamentoso mensurado pelo Brief Medication Questionnaire e fatores demográficos, socioeconômicos, de saúde, assist

Terapia fibrinolítica sistêmica no tromboembolismo pulmonar

PubMed Central

Ceresetto, José Manuel; Marques, Marcos Arêas

2017-01-01

Resumo O tromboembolismo pulmonar permanece como um grande desafio terapêutico para os médicos especialistas, pois, apesar de todo investimento e desenvolvimento em seu diagnóstico, profilaxia e tratamento, essa condição continua sendo a principal causa de morte evitável em ambiente hospitalar. Ainda restam muitas dúvidas em relação a qual perfil de paciente vai se beneficiar de fato da terapia fibrinolítica sistêmica, sem ficar exposto a um grande risco de sangramento. A estratificação de risco e a avaliação do prognóstico do evento, através de escores clínicos de insuficiência ventricular direita, marcadores de dilatação e disfunção do ventrículo direito e avaliação da massa trombótica, associados ou de forma isolada, são ferramentas que podem auxiliar na identificação do paciente que irá se beneficiar dessa terapia. Os únicos consensos em relação à terapia fibrinolítica no tratamento do tromboembolismo pulmonar são: não deve ser indicada de forma rotineira; nenhum dos escores ou marcadores, isoladamente, devem justificar seu uso; e os pacientes com instabilidade hemodinâmica são os mais beneficiados. Além disto, deve-se avaliar cada caso em relação ao risco de sangramento, especialmente no sistema nervoso central. PMID:29930636

Medición de placas astrométricas obtenidas con el telescopio Astrográfico de La Plata

NASA Astrophysics Data System (ADS)

di Sisto, R. P.; Orellana, R.

El Observatorio de La Plata cuenta con un gran número de placas de asteroides y cometas obtenidas con el telescopio astrográfico, que cubren gran parte del cielo del hemisferio sur. En 1996 se recopilaron y clasificaron 2187 placas (Beca para estudiantes de la AAA 1996) de las cuales 2031 corresponden a asteroides. Los datos de cada placa se volcaron en una base de datos creada para facilitar su manejo y preservar la información. A partir de este trabajo se revisaron los MPC electrónicos y se identificaron aquellas placas de asteroides pertenecientes a nuestra base de datos cuyos resultados no fueron publicados en los mismos. De un total de 400 placas que no aparecían publicadas sobresalía un paquete constituído por 40 placas obtenidas en 1977. Estas últimas fueron reducidas utilizando las posiciones y movimientos propios de las estrellas de referencia obtenidas del catálogo SAO 2000 dadas para el sistema FK5. Las posiciones calculadas fueron enviadas y publicadas en los Minor Planet Circulars (MPC).

Indicators related to the rational use of medicines and its associated factors

PubMed Central

Lima, Marina Guimarães; Álvares, Juliana; Guerra, Augusto Afonso; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Leite, Silvana Nair; Karnikowski, Margô Gomes de Oliveira; Costa, Karen Sarmento; Acurcio, Francisco de Assis

2017-01-01

ABSTRACT OBJECTIVE To evaluate indicators related to the rational use of medicines and its associated factors in Basic Health Units. METHOD This is a cross-sectional study carried out in a representative sample of Brazilian cities included in the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). The data were collected by interviews with users, medicine dispensing professionals, and prescribers; and described by prescription, dispensing, and health services indicators. We analyzed the association between human resources characteristics of pharmaceutical services and dispensing indicators. RESULTS At national level, the average number of medicines prescribed was 2.4. Among the users, 5.8% had antibiotic prescription, 74.8% received guidance on how to use the medicines at the pharmacy and, for 45.1% of users, all prescribed medicines were from the national list of essential medicines. All the indicators presented statistically significant differences between the regions of Brazil. The dispensing professionals that reported the presence of a pharmacist in the unit with a working load of 40 hours or more per week presented 1.82 more chance of transmitting information on the way of using the medicines in the dispensing process. CONCLUSION The analysis of prescription, dispensing, and health services indicators in the basic health units showed an unsatisfactory proportion of essential medicines prescription and limitations in the correct identification of the medicine, orientation to the patients on medicines, and availability of therapeutic protocols in the health services. PMID:29160461

Asociación de la adherencia a la dieta mediterránea al inicio del embarazo y riesgo de gastrosquisis en la descendencia: un estudio de casos-controles

PubMed Central

Cánovas-Conesa, A.; Gomariz-Peñalver, V.; Sánchez-Sauco, M.F.; Vega, D.C. Jaimes; Ortega-García, J.A.; García, M.J. Aranda; Marín, J.L. Delgado; Ascanio, A. Trujillo; Hernández, F. López; Jimenez, J.I. Ruiz; de Paco Matallana, C.; Soldin, O.P.; Solís, M. Sánchez

2016-01-01

Resumen Objetivos El objetivo de este estudio fue estudiar la asociación de la adherencia a la dieta mediterránea materna al inicio del embarazo y el riesgo de gastrosquisis en la descendencia. Métodos Estudio de casos-control. 11 casos incidentes de gastrosquisis en la Región de Murcia de 2007 a 2012 y 34 controles concurrentes. Cuestionario validado de Frecuencia Alimentaria (CFA) sobre la dieta periconcepcional de 98 ítems realizado ‘cara a cara’ en el momento del diagnóstico. Factores confundidores: tabaquismo, expositión a cannabis/marihuana, edad materna y paterna, índice de masa corporal, ingresos económicos y nivel de estudios. Estudio descriptivo y regresión logística multivariable. Resultados Las madres de niños con gastrosquisis son más jóvenes (20,8 años; IC 95% 17,3–24,2) y su dieta tiene un menor aporte calórico, de grasas saturadas y monoinsaturadas y de proteínas que los controles. Odds Ratio (OR) en el modelo multivariable controlado por los factores confundidores: edad materna (años) 0,70 (IC95% 0,51–0,96); ácidos grasos monoinsaturados (oleico, g) 0,79 (IC95% 0,65–0,97) y consumo de vegetales (raciones/semana) 0,70 (IC95% 0,48–1,00). Conclusiones Una dieta materna rica en ácido oleico y productos vegetales podría contribuir a prevenir el riesgo de oclusión vascular de las arterias onfalomesentéricas, disminuyendo el riesgo de gastrosquisis. PMID:23833926

Sociodemographic profile of medicines users in Brazil: results from the 2014 PNAUM survey.

PubMed

Bertoldi, Andréa Dâmaso; Pizzol, Tatiane da Silva Dal; Ramos, Luiz Roberto; Mengue, Sotero Serrate; Luiza, Vera Lucia; Tavares, Noemia Urruth Leão; Farias, Mareni Rocha; Oliveira, Maria Auxiliadora; Arrais, Paulo Sergio Dourado

2016-12-01

To analyze the prevalence of medicine use by the Brazilian population and its distribution according to sociodemographic factors. Study using data from the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), a nationwide household survey of a representative sample of the Brazilian urban population. The data were collected between September 2013 and February 2014. The overall use of medicines, defined as the use of any medicine, use of medicines for treating chronic medical conditions and for acute health conditions, was evaluated. The independent variables included gender, age group, socioeconomic position, and region of Brazil. Analyzes included prevalence calculations, 95% confidence intervals (95%CI) and Pearson Chi-square tests to evaluate the differences between groups, considering a 5% level of significance. The prevalence of medicines use was 50.7% (95%CI 49.3-52.2), with 39.3% (95%CI 37.5-41.1) accounting for men and 61.0% (95%CI 59.3-62.6) for women. Medicines use was observed to increase with increasing age, except among children within the zero to four years age group. The lowest prevalence for medicines use was found among those with a low socioeconomic position and those who reside in the North region of Brazil. The prevalence of medicine use to treat chronic diseases was 24.3% (95%CI 23.3-25.4), whereas it was 33.7% (95%CI 32.1-35.4) for treating acute diseases. We found extensive variability in the prevalence of medicines use across regions of Brazil. The poorest regions (North, Northeast, and Midwest) have a lower prevalence of medicines use to treat chronic diseases, indicating the need to minimize inequalities in access to medicines within the country. Analisar a prevalência do uso de medicamentos pela população brasileira e sua distribuição segundo aspectos sociodemográficos. Estudo com dados da Pesquisa Nacional de Acesso

Incentivizing Monitoring and Compliance in Trophy Hunting

PubMed Central

BUNNEFELD, NILS; EDWARDS, CHARLES T T; ATICKEM, ANAGAW; HAILU, FETENE; MILNER-GULLAND, E J

2014-01-01

enfocan más en los conductores del comportamiento humano y en las implicaciones de varias fuentes de incertidumbre en la toma de decisiones de manejo. La cacería de trofeos ha sido sugerida como una herramienta de conservación porque le otorga valor económico a la vida silvestre, pero ejemplos recientes muestran que la sobrecolecta es un problema sustancial y que las limitaciones de datos son abundantes. Usamos el estudio de caso de la cacería de trofeos de un antílope en peligro, el nyala de las montañas (Tragelaphus buxtoni), para explorar como las incertidumbres generadas por el monitoreo de poblaciones y el tráfico de especies interactúan con la toma de decisiones de 2 actores clave: las compañías de safari y el gobierno. Construimos un modelo de evaluación de estrategia de manejo que incluye la dinámica poblacional del nyala de las montañas, un modelo de monitoreo y un modelo de toma de decisiones de una compañía. Investigamos escenarios de inversión en el combate del tráfico de especies y el monitoreo por el gobierno y las compañías de safari. La estrategia de colecta fue robusta hacia la incertidumbre en los estimados de población obtenidos del monitoreo, pero el tráfico de especies tuvo un efecto más fuerte sobre la cuota y la sustentabilidad; por esto, reducir el tráfico de especies está dentro de los intereses de compañías que desean incrementar la rentabilidad de las empresas, por ejemplo al hacer participar a los miembros de la comunidad como guías de caza. Hay un nivel umbral de incertidumbre en los estimados de población más allá del cual la variación anual en la cuota de trofeos previene la planeación por parte de las compañías de safari. Esto sugiere un papel para el gobierno asegurando que un nivel base de monitoreo de población se lleve a cabo para que este nivel no sea excedido. Nuestros resultados ilustran la importancia de considerar los incentivos de partes interesadas múltiples al designar marcos de trabajo para

Improving supplementary feeding in species conservation

PubMed Central

Ewen, John G; Walker, Leila; Canessa, Stefano; Groombridge, Jim J

2015-01-01

ón suplementaria con frecuencia es una reacción instintiva a la declinación de poblaciones y su aplicación no se evalúa críticamente, lo que lleva a opiniones polarizadas sobre su uso entre los manejadores. Aquí abogamos por una estrategia más decisiva para la alimentación suplementaria para que la opción de usarla esté claramente justificada sobre, o en combinación con, otras acciones de manejo y las consecuencias pronosticadas sean entonces evaluadas críticamente después de su implementación. Proponemos combinar métodos de otro conjunto de disciplinas especialistas que permitirán la evaluación crítica de la necesidad, el beneficio y los riesgos de la alimentación suplementaria. Por medio del uso de la ecología nutricional, la ecología de poblaciones y la toma de decisiones estructuradas, quienes manejan la conservación pueden tomar mejores decisiones sobre qué y cómo alimentar al estimar las consecuencias de la recuperación poblacional a través de un rango de acciones posibles. Esta estrategia estructurada también informa al monitoreo enfocado y permite con mayor claridad la integración de la alimentación suplementaria a los planes de recuperación y reduce el riesgo de decisiones ineficientes. En Nueva Zelanda, los manejadores del hihi (Notiomystis cincta) que se encuentra en peligro de extinción, con frecuencia dependen de la alimentación suplementaria para apoyar a las poblaciones reintroducidas. En la isla de Kapiti, la población reintroducida de hihis ha respondido de buena manera a la alimentación suplementaria, pero la logística de proporcionar a una demanda en crecimiento recientemente sobrepasó la capacidad de manejo. Para decidir si el régimen alimentario debería revisarse y cómo hacerlo, los manejadores usaron una estrategia estructurada de toma de decisiones con información sobre las respuestas de la población a regímenes alternativos de alimentación. La decisión se hizo para reducir la distribución espacial de los

PubMed

Duque, Andrés Eduardo

2018-05-01

El cáncer de páncreas es la cuarta causa de muerte por cáncer en los Estados Unidos; en el mundo se asocia con 227.000 muertes anuales, aproximadamente. Es producto de múltiples factores, siendo el tabaquismo el principal factor de riesgo.La punción-aspiración con aguja fina guiada por ultrasonido endoscópico es una técnica muy eficaz en el diagnóstico de lesiones neoplásicas del páncreas. El diagnóstico citológico mediante esta técnica debe hacerse según los lineamientos para el sistema pancreático-biliar de la Papanicolaou Society of Cytopathology. Dichos lineamientos incluyen las indicaciones, las técnicas, la terminología y la nomenclatura, así como los estudios auxiliares, el manejo posterior al procedimiento y los criterios citológicos para el diagnóstico.La especificidad de una interpretación positiva o maligna para la punción-aspiración pancreática con aguja fina, es de 90 a 95 % en la mayoría de los estudios.

Fire ecology and management in grasslands of the American Southwest (Ecologia a de fuego y manejo de pastizales en el Sudoeste Norteamericano)

Treesearch

Guy R. McPherson

2006-01-01

Many ecologists have indicated that fire is as important as wind or precipitation in shaping North American ecosystems. There is little question that fire is prevalent in grasslands and that it contributes to the structure and function of such systems in the Southwest. In this paper I outline pre-settlement fire regimes, then describe post-settlement regimes and...

Adaptación al español y validación de criterio de una escala para la tamización de problemas emocionales y del comportamiento en la primera infancia.

PubMed

Cano, Luz Helena; Acosta, María Natalia; Pulido, Adriana

2018-05-01

Introducción. La detección temprana del riesgo de problemas emocionales y del comportamiento en niños puede contribuir al desarrollo de estrategias que promuevan la salud mental desde la primera infancia. En Colombia no existe una herramienta validada para dicha detección.Objetivos. Seleccionar, adaptar y establecer la validez de criterio de una escala de tamización de problemas emocionales y del comportamiento en niños menores de seis años.Materiales y métodos. A partir de una revisión de la literatura y un consenso de expertos, se seleccionó la herramienta Early Childhood Screening Assessment (ECSA). Posteriormente, se llevó a cabo su adaptación lingüística y se determinó la validez de criterio mediante una curva de características de recibidor-operador (Receiver Operating Characteristic, ROC), y se la comparó con el cuestionario Child Behavior Checklist (CBCL 1,5-5). En el estudio participaron 206 cuidadores de niños entre el año y medio y los seis años de edad de la ciudad de Tunja y el municipio de Sopó.Resultados. La puntuación del ECSA presentó una buena correlación con la puntuación t total del CBCL 1,5-5 (ro de Spearman=0,75; p<0,01). La escala ECSA tuvo una sensibilidad de 86 % y una especificidad de 82 % al establecer un punto de corte de 24 para la población estudiada.Conclusión. En este primer estudio de adaptación y validación de la versión en español de la escala ECSA, se detectaron buenos valores de sensibilidad y especificidad para la tamización de problemas emocionales y del comportamiento en la primera infancia.

Polypharmacy: a challenge for the primary health care of the Brazilian Unified Health System

PubMed Central

do Nascimento, Renata Cristina Rezende Macedo; Álvares, Juliana; Guerra, Augusto Afonso; Gomes, Isabel Cristina; Silveira, Micheline Rosa; Costa, Ediná Alves; Leite, Silvana Nair; Costa, Karen Sarmento; Soeiro, Orlando Mario; Guibu, Ione Aquemi; Karnikowski, Margô Gomes de Oliveira; Acurcio, Francisco de Assis

2017-01-01

ABSTRACT OBJECTIVE To characterize the polypharmacy in primary health care patients and to identify its associated factors. METHODS This is a cross-sectional, exploratory, and evaluative study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). The variable of interest was polypharmacy, defined as the use of five or more medicines. We sought to identify the association of sociodemographic variables and indicators of health conditions to polypharmacy. For group comparison, the Pearson’s Chi-square test was used. The association between polypharmacy and explanatory variables was evaluated by logistic regression model (p < 0.05). The quality of the adjustment was verified by Hosmer-Lemeshow test. RESULTS The prevalence of polypharmacy among medicine users was 9.4% (95%CI 7.8–12.0) in the general population and 18.1% (95%CI 13.6–22.8) in older adults above 65 years old. We found statistically significant association between polypharmacy and age above 45 years, lower self-perception of health, presence of chronic diseases, having health insurance, care in emergency services, and region of the Country. South users presented the highest chances to polypharmacy. The most used medicines were those of the cardiovascular system, being compatible with the national epidemiological profile. CONCLUSIONS Polypharmacy is a reality in the population met within the primary care of Brazilian Unified Health System and may be related to excessive or inappropriate use of medicines. The main challenge to qualify health care is to ensure that prescription of multiple medicines be appropriate and safe. PMID:29160460

Management of pharmaceutical services in the Brazilian primary health care

PubMed Central

Gerlack, Letícia Farias; Karnikowski, Margô Gomes de Oliveira; Areda, Camila Alves; Galato, Dayani; de Oliveira, Aline Gomes; Álvares, Juliana; Leite, Silvana Nair; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Costa, Karen Sarmento; Guerra, Augusto Afonso; Acurcio, Francisco de Assis

2017-01-01

ABSTRACT OBJECTIVE To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). METHODS This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. RESULTS We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. CONCLUSIONS Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening. PMID:29160449

Health-related quality of life of patients of Brazilian primary health care

PubMed Central

Ascef, Bruna de Oliveira; Haddad, João Paulo Amaral; Álvares, Juliana; Guerra, Augusto Afonso; Costa, Ediná Alves; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair; Silveira, Micheline Rosa

2017-01-01

ABSTRACT OBJECTIVE To analyze the Health-Related Quality of Life (HRQoL) of patients of the primary health care of the Brazilian Unified Health System (SUS) and its associated factors. METHODS This is a cross-sectional study with data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). Data were collected with a questionnaire that included the EuroQol 5 Dimensions (EQ-5D) instrument. Patients from the five regions of Brazil were interviewed. Multiple linear regression was used to analyze their Health-Related Quality of Life and its associated factors. RESULTS Of the total of 8,590 patients, the most frequent dimensions were pain/discomfort (50.7%) and anxiety/depression (38.8%). About 10% of the patients reported extreme problems in these dimensions. The following factors were significantly associated with a worse quality of life: being female; having arthritis, osteoarthritis, or rheumatism; cerebrovascular accident; heart disease; depression; health self-assessment as poor or very poor; drinking alcoholic beverages once or more per month; dieting to lose weight, avoiding salt consumption, and reducing fat intake. Significant association was observed between a better quality of life and: living in the North and Southeast regions of Brazil; practicing physical activities; and having a higher educational level. No association was observed with factors related to the health services. CONCLUSIONS The Health-Related Quality of Life of patients was influenced by demographic and socioeconomic factors that were related to health conditions and lifestyle, being useful to guide specific actions for promoting health and the integral care to patients of the Brazilian Unified Health System. PMID:29160458

Characterization of the institutionalization of pharmaceutical services in Brazilian primary health care.

PubMed

Souza, Gisélia Santana; Costa, Ediná Alves; Barros, Rafael Damasceno de; Pereira, Marcelo Tavares; Barreto, Joslene Lacerda; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Álvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair

2017-11-13

To characterize the current stage of the institutionalization of pharmaceutical services in Brazilian cities. This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), a cross-sectional, exploratory, and evaluative study composed by an information survey in a representative sample of cities, stratified by Brazilian regions. We interviewed municipal secretaries of health, responsible for pharmaceutical services, and pharmacists responsible for the dispensing of medicines. The variables selected from the interviews were grouped into five dimensions that defined three stages of pharmaceutical services institutionalization: incipient (0%-34.0%), partial (35.0%-69.0%), and advanced (70.0%-100%), estimated based on the interviewees' answers. Frequencies were estimated with 95% confidence intervals. For the statistical association analysis, the Chi-square test was applied, with significance level of p<0.05. Our results show a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazil, and an advanced stage in formal structures, such as the municipal health plans and the existence of a standardized list of medicines. The analysed variables in the "organization, structure, and financing" dimension configured stages that range from partial to advanced. The management presented partial institutionalization, positively showing the existence of computerized system, but also disparate results regarding the autonomy in the management of financial resources. Indispensable items related to the structure expressed disparities between the regions, with statistically significant differences. The study showed a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazilian cities, showing regional disparities. Variables related to the normative aspects of institutionalization

Management of pharmaceutical services in the Brazilian primary health care.

PubMed

Gerlack, Letícia Farias; Karnikowski, Margô Gomes de Oliveira; Areda, Camila Alves; Galato, Dayani; Oliveira, Aline Gomes de; Álvares, Juliana; Leite, Silvana Nair; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Costa, Karen Sarmento; Guerra, Augusto Afonso; Acurcio, Francisco de Assis

2017-11-13

To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening.

Workforce in the pharmaceutical services of the primary health care of SUS, Brazil

PubMed Central

Carvalho, Marselle Nobre; Álvares, Juliana; Costa, Karen Sarmento; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Karnikowski, Margô Gomes de Oliveira; Leite, Silvana Nair

2017-01-01

ABSTRACT OBJECTIVE To characterize the workforce in the pharmaceutical services in the primary care of the Brazilian Unified Health System (SUS). METHODS This is a cross-sectional and quantitative study, with data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). For the analysis, we considered the data stratification into geographical regions. We analyzed the data on workers in the municipal pharmaceutical services management and in the medicine dispensing units, according to the country’s regions. For the statistical association analysis, we carried out a Pearson correlation test for the categorical variables. RESULTS We analyzed 1,175 pharmacies/dispensing units, 507 phone interviews (495 pharmaceutical services coordinators), and 1,139 professionals responsible for medicine delivery. The workforce in pharmaceutical services was mostly constituted by women, aged from 18 to 39 years, with higher education (90.7% in coordination and 45.5% in dispensing units), having permanent employment bonds (public tender), being for more than one year in the position or duty, and with weekly work hours above 30h, working both in municipal management and in medicine dispensing units. We observed regional differences in the workforce composition in dispensing units, with higher percentage of pharmacists in the Southeast and Midwest regions. CONCLUSIONS The professionalization of municipal management posts in primary health care is an achievement in the organization of the workforce in pharmaceutical services. However, significant deficiencies exist in the workforce composition in medicine dispensing units, which may compromise the medicine use quality and its results in population health. PMID:29160455

Characterization of the institutionalization of pharmaceutical services in Brazilian primary health care

PubMed Central

Souza, Gisélia Santana; Costa, Ediná Alves; de Barros, Rafael Damasceno; Pereira, Marcelo Tavares; Barreto, Joslene Lacerda; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Álvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair

2017-01-01

ABSTRACT OBJECTIVE To characterize the current stage of the institutionalization of pharmaceutical services in Brazilian cities. METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a cross-sectional, exploratory, and evaluative study composed by an information survey in a representative sample of cities, stratified by Brazilian regions. We interviewed municipal secretaries of health, responsible for pharmaceutical services, and pharmacists responsible for the dispensing of medicines. The variables selected from the interviews were grouped into five dimensions that defined three stages of pharmaceutical services institutionalization: incipient (0%-34.0%), partial (35.0%-69.0%), and advanced (70.0%-100%), estimated based on the interviewees’ answers. Frequencies were estimated with 95% confidence intervals. For the statistical association analysis, the Chi-square test was applied, with significance level of p<0.05. RESULTS Our results show a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazil, and an advanced stage in formal structures, such as the municipal health plans and the existence of a standardized list of medicines. The analysed variables in the “organization, structure, and financing” dimension configured stages that range from partial to advanced. The management presented partial institutionalization, positively showing the existence of computerized system, but also disparate results regarding the autonomy in the management of financial resources. Indispensable items related to the structure expressed disparities between the regions, with statistically significant differences. CONCLUSION The study showed a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazilian cities, showing regional disparities. Variables

Variabilidad de la Estación de Crecimiento en la Región Sur de Tamaulipas en condiciones climaticas actuales y futuras.

NASA Astrophysics Data System (ADS)

Medina-Barrios, M.; Conde-Alvarez, C.; Gay-Garcia, C.

2007-05-01

El impacto de la variabilidad y cambio climáticos, afectan el potencial agrícola de la Región Sur de Tamaulipas. Además de los cambios estacionales, bajos rendimientos agrícolas, el manejo de los cultivos y las políticas locales de producción, existe la incertidumbre del mercado regional para los pequeños y grandes productores. La diversificación agrícola ha sido una alternativa para enfrentar las condiciones imperantes en esta región. Pero ésta ha provocado la fragmentación territorial, por lo que sólo algunos productores logran competir en un mercado nacional. Existe una preocupación generalizada por buscar soluciones que permitan que la población que es afectada por la inseguridad de la producción agrícola y económica, pueda adaptarse a las variaciones climáticas que afectan el proceso productivo. La seguridad alimentaría queda sujeta a la fluctuación de las importaciones para los sectores básicos y a las estrategias mercantiles de empresas trasnacionales. La percepción local sugiere un número creciente de eventos climatológicos extremos, constantes y severos en los últimos 20 años, con el aumento creciente de pérdidas económicas. El análisis se centra en la disponibilidad de agua, agregándose un aspecto de capital importancia como es la variabilidad interanual de la lluvia, que condiciona muy fuertemente el riesgo agrícola en el trópico seco, siendo ésta la que determina el momento de inicio de la estación favorable para el crecimiento y su duración. En este trabajo se han obtenido modelos de la distribución espacial de la precipitación y temperaturas, para el escenario base 1961-1990, el escenario actual 1971-2000, para algunos años El Niño y La Niña, así como para los escenarios de Cambio Climático HADLEY, ECHAM y GFDL, con escenarios A2 y B2, para las décadas de los 20s y 50s, para establecer el inicio y duración de la Estación de Crecimiento, utilizando Sistemas de Información Geográfica (ArcView). Estos

Cultivo y Manejo de Estanques Pesqueros de Agua Fresca (Freshwater Fish Pond Culture and Management). Appropriate Technologies for Development. Manual M-1D.

ERIC Educational Resources Information Center

Chakroff, Marilyn; Druben, Laurel, Ed.

This is the Spanish translation of a "how-to" manual, designed as a working and teaching tool for extension agents as they establish and/or maintain local fish pond operations. The manual presents information to facilitate technology transfer and to provide a clear guide for warm water fish pond construction and management. Major topic…

Actitudes Éticas de los estudiantes y egresados en carrera de medicina con metodologías activas

PubMed Central

Novaes, Maria Rita Carvalho Garbi; Novaes, Luiz Carlos Garcez; Guilhem, Dirce; Stepke, Fernando Lolas; Silveira, Carla Cristina Costa; Komatsu, Ricardo Shoiti; Trindade, Eliane Mendonça Vilar; Guiotti, Murilo Galvão

2010-01-01

El presente estudio tiene por objeto desarrollar un diagnostico de la inserción integrada de la ética en la carrera de medicina brasileña con una metodología de aprendizaje basada en problemas y describir las percepciones de actitudes éticas de los estudiantes y egresados. El diseño metodológico es un estudio de caso, descriptivo y documental, con abordaje cualitativo y cuantitativo. La muestra de esta investigación ha sido constituida por 120 estudiantes y 40 egresados de dos promociones del Curso de Medicina de la ESCS. Este proyecto fue aprobado por el Comité de Ética en Investigación - SES/DF. Los estudiantes y egresados de la ESCS demostraron un buen manejo en el abordaje de los conflictos éticos y respeto a los pacientes. Sin embargo, el análisis de sensibilidad ética mostró una fragilidad en las percepciones y aptitudes inapropiadas de los estudiantes de la carrera de medicina, identificada básicamente en los años iniciales, que necesitan más discusiones sistematizadas sobre los aspectos éticos y bioéticos integrados a las actividades prácticas para estimular y fortalecer la reflexión ética de los estudiantes. PMID:20981242

Translation, adaptation and validation the contents of the Diabetes Medical Management Plan for the Brazilian context

PubMed Central

Torres, Heloísa de Carvalho; Chaves, Fernanda Figueredo; da Silva, Daniel Dutra Romualdo; Bosco, Adriana Aparecida; Gabriel, Beatriz Diniz; Reis, Ilka Afonso; Rodrigues, Júlia Santos Nunes; Pagano, Adriana Silvina

2016-01-01

ABSTRACT Objective: to translate, adapt and validate the contents of the Diabetes Medical Management Plan for the Brazilian context. This protocol was developed by the American Diabetes Association and guides the procedure of educators for the care of children and adolescents with diabetes in schools. Method: this methodological study was conducted in four stages: initial translation, synthesis of initial translation, back translation and content validation by an expert committee, composed of 94 specialists (29 applied linguists and 65 health professionals), for evaluation of the translated version through an online questionnaire. The concordance level of the judges was calculated based on the Content Validity Index. Data were exported into the R program for statistical analysis: Results: the evaluation of the instrument showed good concordance between the judges of the Health and Applied Linguistics areas, with a mean content validity index of 0.9 and 0.89, respectively, and slight variability of the index between groups (difference of less than 0.01). The items in the translated version, evaluated as unsatisfactory by the judges, were reformulated based on the considerations of the professionals of each group. Conclusion: a Brazilian version of Diabetes Medical Management Plan was constructed, called the Plano de Manejo do Diabetes na Escola. PMID:27508911

Adaptive comanagement of a marine protected area network in Fiji.

PubMed

Weeks, Rebecca; Jupiter, Stacy D

2013-12-01

Adaptive management of natural resources is an iterative process of decision making whereby management strategies are progressively changed or adjusted in response to new information. Despite an increasing focus on the need for adaptive conservation strategies, there remain few applied examples. We describe the 9-year process of adaptive comanagement of a marine protected area network in Kubulau District, Fiji. In 2011, a review of protected area boundaries and management rules was motivated by the need to enhance management effectiveness and the desire to improve resilience to climate change. Through a series of consultations, with the Wildlife Conservation Society providing scientific input to community decision making, the network of marine protected areas was reconfigured so as to maximize resilience and compliance. Factors identified as contributing to this outcome include well-defined resource-access rights; community respect for a flexible system of customary governance; long-term commitment and presence of comanagement partners; supportive policy environment for comanagement; synthesis of traditional management approaches with systematic monitoring; and district-wide coordination, which provided a broader spatial context for adaptive-management decision making. Co-Manejo Adaptativo de una Red de Áreas Marinas Protegidas en Fiyi. © 2013 The Authors. Conservation Biology published by Wiley Periodicals, Inc., on behalf of the Society for Conservation Biology.

The construction and validation of an instrument for the assessment of graduates of undergraduate nursing courses.

PubMed

Vieira, Maria Aparecida; Ohara, Conceição Vieira da Silva; Domenico, Edvane Birelo Lopes de

2016-06-14

to construct an instrument for the assessment of graduates of undergraduate nursing courses and to validate this instrument through the consensus of specialists. methodological study. In order to elaborate the instrument, documental analysis and a literature review were undertaken. Validation took place through use of the Delphi Conference, between September 2012 and September 2013, in which 36 specialists from Brazilian Nursing participated. In order to analyze reliability, the Cronbach alpha coefficient, the item/total correlation, and the Pearson correlation coefficient were calculated. the instrument was constructed with the participation of specialist nurses representing all regions of Brazil, with experience in lecturing and research. The first Delphi round led to changes in the first instrument, which was restructured and submitted to another round, with a response rate of 94.44%. In the second round, the instrument was validated with a Cronbach alpha of 0.75. the final instrument possessed three dimensions related to the characterization of the graduate, insertion in the job market, and evaluation of the professional training process. This instrument may be used across the territory of Brazil as it is based on the curricular guidelines and contributes to the process of regulation of the quality of the undergraduate courses in Nursing. construir um instrumento para a avaliação de egressos de cursos de graduação em enfermagem e validar esse instrumento pelo consenso de especialistas. estudo metodológico. Para a elaboração do instrumento, realizou-se análise documental e revisão de literatura. A validação ocorreu por Conferência Delphi, entre setembro de 2012 e setembro de 2013, da qual participaram 36 especialistas da Enfermagem brasileira. Para a análise de confiabilidade, calculou-se o coeficiente alfa de Cronbach, a correlação item/total e o coeficiente de correlação de Pearson. o instrumento foi construído com a participação de

Avaliação do conhecimento de pacientes diabéticos sobre medidas preventivas do pé diabético em Maringá (PR)

PubMed Central

Carlesso, Guilherme Pereira; Gonçalves, Mariana Helena Barboza; Moreschi, Dorival

2017-01-01

Resumo Contexto O atual envelhecimento da população tem gerado maior predominância de doenças crônicas, como o diabetes, a qual está associada a um risco elevado de complicações crônicas e agudas. Entre essas, o pé diabético (PD) destaca-se por possuir alta incidência e grande poder mutilador. Objetivo Avaliar o conhecimento da população diabética das Unidades Básicas de Saúde (UBS) de Maringá (PR) sobre a prevenção do PD. Métodos Estudo descritivo, quantitativo, tipo inquérito por entrevista. A população estudada foi composta por 80 portadores de diabetes, cadastrados em UBS de Maringá (PR). A coleta de dados buscou levantar dados sociodemográficos e epidemiológicos, bem como as atitudes de controle do diabetes e do autocuidado para prevenção do PD. Resultados Do total de entrevistados, nove não realizavam qualquer tipo de exame para controle do diabetes e a renda mensal predominante foi de até um salário mínimo. O grau de escolaridade e a renda mensal não se mostraram relevantes em relação ao conhecimento de cuidados preventivos do PD e nem uma maior adesão a hábitos de vida saudáveis. O cuidado com o PD tende a melhorar à medida que exista uma compreensão mais clara dos fatores que conduzem à perda do membro e um crescente consenso sobre a gestão de vários aspectos clínicos do cuidado com o pé. Conclusão Existe uma falta de aprendizado das medidas preventivas, mesmo nos pacientes com algum nível de instrução, o que induz a uma prática deficiente de cuidados.

Elder-friendly emergency services in Brazil: necessary conditions for care.

PubMed

Santos, Mariana Timmers Dos; Lima, Maria Alice Dias da Silva; Zucatti, Paula Buchs

2016-01-01

To identify and analyze the aspects necessary to provide an elder-friendly emergency service (ES) from the perspective of nurses. This is a descriptive, quantitative study using the Delphi technique in three rounds. Nurses with professional experience in the ES and/or researchers with publications and/or conducting research in the study area were selected. The first round of the Delphi panel had 72 participants, the second 49, and the third 44. An online questionnaire was used based on a review of the scientific literature with questions organized into the central dimensions of elder-friendly hospitals. A five-point Likert scale was used for each question and a 70% consensus level was established. There were 38 aspects identified as necessary for elderly care that were organized into central dimensions. The study's results are consistent with the findings in scientific literature and suggest indicators for quality of care and training for an elder-friendly ES. Identificar e analisar aspectos necessários para um atendimento amigo do idoso nos serviços de emergência (SE), na perspectiva de enfermeiros. Estudo descritivo, quantitativo, com utilização da Técnica Delphi, em três rodadas. Foram selecionados enfermeiros com experiência profissional em SE e/ou pesquisadores com publicações e/ou desenvolvendo pesquisas na área de estudo. A primeira rodada do painel Delphi contou com 72 participantes, a segunda com 49 e a terceira com 44. Foi utilizado questionário on-line, baseado na revisão da literatura científica, com questões organizadas em dimensões centrais de hospitais amigos do idoso. Foi utilizada uma escala de Likert de 5 pontos para cada questão e estabelecido nível de consenso de 70%. Foram identificados 38 aspectos necessários para o atendimento ao idoso, organizados em dimensões centrais. Os resultados do estudo são consistentes com os achados na literatura científica e sugerem indicadores para qualidade do cuidado e para formação de SE

II Brazilian Consensus on the use of human immunoglobulin in patients with primary immunodeficiencies.

PubMed

Goudouris, Ekaterini Simões; Rego Silva, Almerinda Maria do; Ouricuri, Aluce Loureiro; Grumach, Anete Sevciovic; Condino-Neto, Antonio; Costa-Carvalho, Beatriz Tavares; Prando, Carolina Cardoso; Kokron, Cristina Maria; Vasconcelos, Dewton de Moraes; Tavares, Fabíola Scancetti; Silva Segundo, Gesmar Rodrigues; Barreto, Irma Cecília; Dorna, Mayra de Barros; Barros, Myrthes Anna; Forte, Wilma Carvalho Neves

2017-01-01

In the last few years, new primary immunodeficiencies and genetic defects have been described. Recently, immunoglobulin products with improved compositions and for subcutaneous use have become available in Brazil. In order to guide physicians on the use of human immunoglobulin to treat primary immunodeficiencies, based on a narrative literature review and their professional experience, the members of the Primary Immunodeficiency Group of the Brazilian Society of Allergy and Immunology prepared an updated document of the 1st Brazilian Consensus, published in 2010. The document presents new knowledge about the indications and efficacy of immunoglobulin therapy in primary immunodeficiencies, relevant production-related aspects, mode of use (routes of administration, pharmacokinetics, doses and intervals), adverse events (major, prevention, treatment and reporting), patient monitoring, presentations available and how to have access to this therapeutic resource in Brazil. RESUMO Nos últimos anos, novas imunodeficiências primárias e defeitos genéticos têm sido descritos. Recentemente, produtos de imunoglobulina, com aprimoramento em sua composição e para uso por via subcutânea, tornaram-se disponíveis em nosso meio. Com o objetivo de orientar o médico no uso da imunoglobulina humana para o tratamento das imunodeficiências primárias, os membros do Grupo de Assessoria em Imunodeficiências da Associação Brasileira de Alergia e Imunologia produziram um documento que teve por base uma revisão narrativa da literatura e sua experiência profissional, atualizando o I Consenso Brasileiro publicado em 2010. Apresentam-se novos conhecimentos sobre indicações e eficácia do tratamento com imunoglobulina nas imunodeficiências primárias, aspectos relevantes sobre a produção, forma de utilização (vias de administração, farmacocinética, doses e intervalos), efeitos adversos (principais efeitos, prevenção, tratamento e notificação), monitorização do

TECNOLOGÍAS DE INFORMACIÓN Y COMUNICACIÓN PARA LA PREVENCIÓN Y CONTROL DE LA INFECCIÓN POR EL VIH Y OTRAS ITS*

PubMed Central

Curioso, Walter H.; Blas, Magaly M.; Kurth, Ann E.; Klausner, Jeffrey D.

2010-01-01

Avances tecnológicos innovadores como Internet, computadoras personales de bolsillo, teléfonos celulares y otros equipos son un arsenal en crecimiento en el esfuerzo de impedir y controlar el VIH y otras infecciones de transmisión sexual (ITS). A pesar que existe una diversidad de tecnologías de información y comunicación en diferentes etapas de desarrollo para la prevención del VIH e ITS, la investigación en esta área se encuentra aún en crecimiento, y el impacto en la incidencia de enfermedad, las evaluaciones con diseños rigurosos y los estudios económicos todavía son muy limitados. Sin embargo, algunas de estas evidencias son prometedoras y poseen un gran potencial para su uso en nuestro medio. En este artículo hemos realizado una revisión sistemática de la literatura relacionada con el uso de la tecnología aplicada a la prevención y control del VIH e ITS. De ser usada apropiadamente, esta tecnología podría mejorar la vigilancia del VIH y otras ITS, diagnóstico, notificación de parejas, prevención, manejo clínico, y capacitación de profesionales de la salud. PMID:26339254

Availability of essential medicines in primary health care of the Brazilian Unified Health System.

PubMed

Nascimento, Renata Cristina Rezende Macedo do; Álvares, Juliana; Guerra, Augusto Afonso; Gomes, Isabel Cristina; Costa, Ediná Alves; Leite, Silvana Nair; Costa, Karen Sarmento; Soeiro, Orlando Mario; Guibu, Ione Aquemi; Karnikowski, Margô Gomes de Oliveira; Acurcio, Francisco de Assis

2017-11-13

To characterize the availability of tracer medicines in pharmaceutical services in primary health care of the Brazilian Unified Health System (SUS). This is a cross-sectional and evaluative study, part of the Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). To analyze the availability of medicines, we verified 50 items selected from the Relação Nacional de Medicamentos Essenciais (Rename - National List of Essential Medicines) of 2012. Observation scripts were applied to medicine dispensing services in the primary health care. Interviews were carried out with patients, health care professionals, and public managers, using semi-structured questionnaires. The availability index was presented as the percentage of health units where the medicines were available. For statistical analysis, absolute, relative, and mean frequencies were presented (with 95% confidence intervals). The comparison of groups was carried out by Pearson Chi-square tests or variance analysis, when needed. One thousand, one hundred, and seventy-five observation scripts were filled in a national representative sample composed by 273 cities. Statistically significant differences were observed regarding the type of unit, infrastructure, and presence of a pharmacist between regions of Brazil. The average availability of tracer medicines in primary health care was 52.9%, with differences between regions and sampling strata. This index increased to 62.5% when phytotherapic medicines were excluded. We found limited availability of medicines for treatment of chronic and epidemiological diseases, such as tuberculosis and congenital syphilis. The low availability of essential medicines purchased centrally by the Brazilian Ministry of Health indicates deficiencies in supply chain management. The different views on the availability of tracer

Availability of essential medicines in primary health care of the Brazilian Unified Health System

PubMed Central

do Nascimento, Renata Cristina Rezende Macedo; Álvares, Juliana; Guerra, Augusto Afonso; Gomes, Isabel Cristina; Costa, Ediná Alves; Leite, Silvana Nair; Costa, Karen Sarmento; Soeiro, Orlando Mario; Guibu, Ione Aquemi; Karnikowski, Margô Gomes de Oliveira; Acurcio, Francisco de Assis

2017-01-01

ABSTRACT OBJECTIVE To characterize the availability of tracer medicines in pharmaceutical services in primary health care of the Brazilian Unified Health System (SUS). METHODS This is a cross-sectional and evaluative study, part of the Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). To analyze the availability of medicines, we verified 50 items selected from the Relação Nacional de Medicamentos Essenciais (Rename – National List of Essential Medicines) of 2012. Observation scripts were applied to medicine dispensing services in the primary health care. Interviews were carried out with patients, health care professionals, and public managers, using semi-structured questionnaires. The availability index was presented as the percentage of health units where the medicines were available. For statistical analysis, absolute, relative, and mean frequencies were presented (with 95% confidence intervals). The comparison of groups was carried out by Pearson Chi-square tests or variance analysis, when needed. RESULTS One thousand, one hundred, and seventy-five observation scripts were filled in a national representative sample composed by 273 cities. Statistically significant differences were observed regarding the type of unit, infrastructure, and presence of a pharmacist between regions of Brazil. The average availability of tracer medicines in primary health care was 52.9%, with differences between regions and sampling strata. This index increased to 62.5% when phytotherapic medicines were excluded. We found limited availability of medicines for treatment of chronic and epidemiological diseases, such as tuberculosis and congenital syphilis. CONCLUSIONS The low availability of essential medicines purchased centrally by the Brazilian Ministry of Health indicates deficiencies in supply chain management. The

Technical issues and conservation conditions of medicines in the primary health care of the Brazilian Unified Health System

PubMed Central

Costa, Ediná Alves; Araújo, Patrícia Sodré; Pereira, Marcelo Tavares; Souto, Ana Cristina; Souza, Gisélia Santana; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Alvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair

2017-01-01

ABSTRACT OBJECTIVE To characterize the technical issues and conditions of medicines conservation in Primary Health Care of Brazilian regions, responsible for pharmacy/dispensing unit profile; environmental, storage, and dose fractioning conditions; inventory control and waste management; fire and electrical failure safety items; transportation problems; advertising regulation; and pharmacovigilance. METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços (National Survey on Access, Use and Promotion of Rational Use of Medicines – Services)–, a cross-sectional and exploratory study, of evaluative nature, consisting of an information survey within a representative sample of municipalities, stratified by Brazilian regions, which constitute the study domains, and a sample of Primary Health Care services. Pharmaceutical services (PS) were directly observed with photographic record and face-to-face interviews with those responsible for the dispensing of medicines and over the telephone with those responsible for pharmaceutical services. Data were processed with the SPSS® software version 21. RESULTS The investigated dimensions showed relevant deficiencies and inequalities between the regions, generally more favorable in the Southeast and Midwest regions and weaker in the Northeast and North regions. We verified non-compliance with technical requirements and conditions essential to the conservation of medicines, which may interfere with the maintenance of stability and, thus, on their quality, efficacy, and safety. The regulation of advertising/promotion of medicines is still incipient and there is some progress in the structuring of mechanisms regarding pharmacovigilance. CONCLUSIONS The sanitary situation of medicines in Brazilian Primary Health Care is alarming due to the violation of the specific sanitary legislation for dispensing establishments and due to a wide range of

Infrastructure of pharmacies of the primary health care in the Brazilian Unified Health System: Analysis of PNAUM – Services data

PubMed Central

Leite, Silvana Nair; Manzini, Fernanda; Álvares, Juliana; Guerra, Augusto Afonso; Costa, Ediná Alves; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mário; Farias, Mareni Rocha

2017-01-01

ABSTRACT OBJECTIVE To characterize the infrastructure of the primary health care pharmacies of the Brazilian Unified Health System, aiming at humanizing the offered services. METHODS This is a cross-sectional study, of quantitative approach, from data obtained in the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). Information on 1,175 pharmacies/dispensing units were gathered from direct observation and assessment of dispensing units installations conducted by trained researchers who used a standardized form. The analyzed variables refer to the physical structure of pharmacies or medicine dispensing units of the health units under research. RESULTS The pharmacy area was greater than 14 m2 in 40.3% of the sampled units, highlighting those from Midwest (56.9%) and Southeast (56.2%) regions and those of Northeast, with only 23.3%. About 80.2% units had waiting rooms with chairs for patients, 31.8% of them had dispensing areas inferior to 5m2, while in 46.2% these areas were superior to 10m2. Bars were found in service counters in 23.8% of health units, thus separating the patient from the professional; 44.1% had internet access. In most units, the area of medicine storage had no refrigerator or freezer for their exclusive storage and 13.7% had a specific room for pharmaceutical consultation. CONCLUSION Aiming at achieving care humanization and improving working conditions for professionals, the structuring of the environment of pharmacy services is necessary. This would contribute to the better qualification of pharmacy services, comprising more than medicine delivery. Data on the Northeast region indicated less favorable conditions to the development of adequate dispensing services. Based on the panorama pointed out, we suggest the expansion of stimulus concerning the physical structure of pharmaceutical

Infrastructure of pharmacies of the primary health care in the Brazilian Unified Health System: Analysis of PNAUM - Services data.

PubMed

Leite, Silvana Nair; Manzini, Fernanda; Álvares, Juliana; Guerra, Augusto Afonso; Costa, Ediná Alves; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mário; Farias, Mareni Rocha

2017-11-13

To characterize the infrastructure of the primary health care pharmacies of the Brazilian Unified Health System, aiming at humanizing the offered services. This is a cross-sectional study, of quantitative approach, from data obtained in the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Information on 1,175 pharmacies/dispensing units were gathered from direct observation and assessment of dispensing units installations conducted by trained researchers who used a standardized form. The analyzed variables refer to the physical structure of pharmacies or medicine dispensing units of the health units under research. The pharmacy area was greater than 14 m2 in 40.3% of the sampled units, highlighting those from Midwest (56.9%) and Southeast (56.2%) regions and those of Northeast, with only 23.3%. About 80.2% units had waiting rooms with chairs for patients, 31.8% of them had dispensing areas inferior to 5m2, while in 46.2% these areas were superior to 10m2. Bars were found in service counters in 23.8% of health units, thus separating the patient from the professional; 44.1% had internet access. In most units, the area of medicine storage had no refrigerator or freezer for their exclusive storage and 13.7% had a specific room for pharmaceutical consultation. Aiming at achieving care humanization and improving working conditions for professionals, the structuring of the environment of pharmacy services is necessary. This would contribute to the better qualification of pharmacy services, comprising more than medicine delivery. Data on the Northeast region indicated less favorable conditions to the development of adequate dispensing services. Based on the panorama pointed out, we suggest the expansion of stimulus concerning the physical structure of pharmaceutical services, considering regional specificities.

Characterization of the selection of medicines for the Brazilian primary health care.

PubMed

Karnikowski, Margô Gomes de Oliveira; Galato, Dayani; Meiners, Micheline Marie Milward de Azevedo; Silva, Emília Vitória da; Gerlack, Letícia Farias; Bós, Ângelo José Gonçalves; Leite, Silvana Nair; Álvares, Juliana; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Costa, Karen Sarmento; Costa, Ediná Alves; Guerra, Augusto Afonso; Acurcio, Francisco de Assis

2017-11-13

To characterize the process of selection of medicines for primary health care in the Brazilian regions. This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS) (n = 506), professionals responsible for the dispensing of medicines (n = 1,139), and physicians (n = 1,558). To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05. The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC) (12.5%). They claimed to have an updated (80.4%) list of Essential Medicines (85.3%) and being active participants of this process (88.2%). However, in the perception of respondents, the list only partially (70.1%) meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%), the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%). For 13.0% of them, the list meets the health demands. As this is the first national survey of characterization of the process of selection of medicines within

Conceptions on pharmaceutical services in Brazilian primary health care

PubMed Central

Costa, Ediná Alves; Araújo, Patrícia Sodré; Penaforte, Thais Rodrigues; Barreto, Joslene Lacerda; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Alvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair

2017-01-01

ABSTRACT OBJECTIVE To identify and discuss the conceptions of pharmaceutical services in Brazilian Primary Health Care, according to different subjects. METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015), which is composed of an information survey in a representative sample of cities, stratified according to Brazilian regions, and a subsample of primary health care services. Municipal secretaries of health, those responsible for pharmaceutical services, and those responsible for medicine delivery in pharmacies/dispensing units of the selected services were interviewed. The questionnaires included one question about the understanding of the interviewee regarding pharmaceutical services. The content analysis technique was used to apprehend, in the statements, the meanings attributed to pharmaceutical services, which were subsequently classified into categories according to their main conceptions. RESULTS Among the wide diversity of conceptions on pharmaceutical services (PS), we highlight the ones focused on 1) logistic control of medicines with activities concerning guidance or information on their use and 2) guidance or information to users on the use of medicine. The findings reveal a shifting tendency from a medicine-focused conception to one that considers the users and their needs as the final recipient of these actions. However, the lack of references to conceptions regarding care management and integrality point out the slowness of this change; after all, this is a social and historical process that comprises the production of meanings that transcend legal, logistic, and technical arrangements in pharmaceutical services. CONCLUSIONS The diversity of conceptions expresses the several meanings attributed to pharmaceutical services; we also identified, in their

Sociodemographic profile of medicines users in Brazil: results from the 2014 PNAUM survey

PubMed Central

Bertoldi, Andréa Dâmaso; Pizzol, Tatiane da Silva Dal; Ramos, Luiz Roberto; Mengue, Sotero Serrate; Luiza, Vera Lucia; Tavares, Noemia Urruth Leão; Farias, Mareni Rocha; Oliveira, Maria Auxiliadora; Arrais, Paulo Sergio Dourado

2016-01-01

ABSTRACT OBJECTIVE To analyze the prevalence of medicine use by the Brazilian population and its distribution according to sociodemographic factors. METHODS Study using data from the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a nationwide household survey of a representative sample of the Brazilian urban population. The data were collected between September 2013 and February 2014. The overall use of medicines, defined as the use of any medicine, use of medicines for treating chronic medical conditions and for acute health conditions, was evaluated. The independent variables included gender, age group, socioeconomic position, and region of Brazil. Analyzes included prevalence calculations, 95% confidence intervals (95%CI) and Pearson Chi-square tests to evaluate the differences between groups, considering a 5% level of significance. RESULTS The prevalence of medicines use was 50.7% (95%CI 49.3–52.2), with 39.3% (95%CI 37.5–41.1) accounting for men and 61.0% (95%CI 59.3–62.6) for women. Medicines use was observed to increase with increasing age, except among children within the zero to four years age group. The lowest prevalence for medicines use was found among those with a low socioeconomic position and those who reside in the North region of Brazil. The prevalence of medicine use to treat chronic diseases was 24.3% (95%CI 23.3–25.4), whereas it was 33.7% (95%CI 32.1–35.4) for treating acute diseases. CONCLUSIONS We found extensive variability in the prevalence of medicines use across regions of Brazil. The poorest regions (North, Northeast, and Midwest) have a lower prevalence of medicines use to treat chronic diseases, indicating the need to minimize inequalities in access to medicines within the country. PMID:27982375

[Treatment of type 2 diabetes mellitus in patients with chronic kidney disease. Grupo de Trabajo para el Documento de Consenso sobre el tratamiento de la diabetes tipo 2 en el paciente con enfermedad renal crónica].

PubMed

Gómez-Huelgas, Ricardo; Martínez-Castelao, Alberto; Artola, Sara; Górriz, José Luis; Menéndez, Edelmiro

2014-01-21

Chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) are highly prevalent chronic diseases, which represent an important public health problem and require a multidisciplinary management. T2DM is the main cause of CKD and it also causes a significant comorbidity with regard to non-diabetic nephropathy. Patients with diabetes and kidney disease represent a special risk group as they have higher morbi-mortality as well as higher risk of hypoglycemia than diabetic individuals with a normal kidney function. Treatment of T2DM in patients with CKD is controversial because of the scarcity of available evidence. The current consensus report aims to ease the appropriate selection and dosage of antidiabetic treatments as well as the establishment of safety objectives of glycemic control in patients with CKD. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Building sustainability indicators in the health dimension for solid waste management.

PubMed

Veiga, Tatiane Bonametti; Coutinho, Silvano da Silva; Andre, Silvia Carla Silva; Mendes, Adriana Aparecida; Takayanagui, Angela Maria Magosso

2016-08-08

to prepare a list of sustainability indicators in the health dimension, for urban solid waste management. a descriptive and exploratory study performed jointly with 52 solid waste specialists, using a three-steps Delphi technique, and a scale measuring the degree of importance for agreement among the researchers in this area. the subjects under study were 92,3% PhD's concentrated in the age group from 30 to 40 years old (32,7%) and 51% were men. At the end of the 3rd step of the Delphi process, the average and standard deviation of all the proposed indicators varied from 4,22 (±0,79) to 4,72 (±0,64), in a scale of scores for each indicator from 1 to 5 (from "dispensable" to "very important"). Results showed the level of correspondence among the participants ranging from 82% to 94% related to those indicators. the proposed indicators may be helpful not only for the identification of data that is updated in this area, but also to enlarge the field of debates of the environmental health policies, directed not only for urban solid waste but for the achievement of better health conditions for the Brazilian context. elaborar uma lista de indicadores de sustentabilidade na dimensão da saúde para gestão de resíduos sólidos urbanos. estudo descritivo e exploratório, realizado com 52 especialistas na área de resíduos sólidos, utilizando a técnica Delphi em três etapas, com o uso da escala de mensuração do grau de importância para obtenção de consenso entre pesquisadores da área da investigação. dos sujeitos estudados , 92,3% eram doutores, com maior concentração na faixa etária entre 30 e 40 anos (32,7%) e 51,0% do sexo masculino. Ao final da 3ª etapa de aplicação da técnica Delphi, a média e o desvio-padrão de todos os indicadores propostos variaram de 4,22 (±0,79) a 4,72 (±0,64), em uma escala de pontuação atribuída para cada indicador de 1 a 5 (Respectivamente, de "dispensável" a "muito importante"). Os resultados demonstraram nível de

Transcultural adaptation of the Johns Hopkins Fall Risk Assessment Tool.

PubMed

Martinez, Maria Carmen; Iwamoto, Viviane Ernesto; Latorre, Maria do Rosário Dias de Oliveira; Noronha, Adriana Moreira; Oliveira, Ana Paula de Sousa; Cardoso, Carlos Eduardo Alves; Marques, Ifigenia Augusta Braga; Vendramim, Patrícia; Lopes, Paula Cristina; Sant'Ana, Thais Helena Saes de

2016-08-29

to perform the transcultural adaptation and content validity analysis of the Johns Hopkins Fall Risk Assessment Tool to assess both fall risk and fall-related injury risk for hospitalized elderly in Brazil. the transcultural adaptation consisted of translating the scale to Portuguese (Brazil), back-translating it into its language of origin, establishing a consensus version, and having an expert committee verify its transcultural equivalence. Content assessment was conducted by a committee of judges, ending with the calculation of the items and scales' content validity index. Nurses tested the tool. the scale's translated version went through two evaluation rounds by the judges, based on which, the items with unsatisfactory performance were changed. The content validity index for the items was ≥80.0% and the global index 97.1%. The experimental application showed the scale is user-friendly. the scale presents valid content for the assessment of fall risk and risk of fall-related injuries and is easy to use, with the potential to contribute to the proper identification of risks and the establishment of care actions. realizar a adaptação transcultural para uso no Brasil e a avaliação da validade de conteúdo da Johns Hopkins Fall Risk Assessment Tool para avaliação de risco de quedas e de danos por quedas em pacientes adultos hospitalizados. adaptação transcultural consistiu na tradução da escala para a língua portuguesa (Brasil), retrotradução para a língua de origem, versão de consenso e análise da equivalência transcultural por um comitê de especialistas. A avaliação do conteúdo foi realizada por meio de um comitê de juízes, finalizando com o cálculo do índice de validade de conteúdo dos itens e da escala. Foi realizada a aplicação experimental do instrumento por enfermeiros. a versão traduzida da escala passou por duas rodadas de avaliação pelos juízes, a partir das quais os itens com desempenho insatisfatório foram modificados

Qualitative Description of Global Health Nursing Competencies by Nursing Faculty in Africa and the Americas.

PubMed

Wilson, Lynda; Moran, Laura; Zarate, Rosa; Warren, Nicole; Ventura, Carla Aparecida Arena; Tamí-Maury, Irene; Mendes, Isabel Amélia Costa

2016-06-07

por um comitê. a análise revelou dez novas categorias de competências em saúde global. Os docentes também se mostraram preocupados com a forma e o momento de integrar essas competências nos currículos de enfermagem. as categorias adicionais devem ser consideradas para inclusão nas competências em saúde global identificadas anteriormente. Essas, além das orientações para fins de integração nos currículos existentes, podem ser usadas para direcionar o refinamento da lista original de competências em saúde global. São necessárias outras investigações em busca de consenso sobre essas competências para formulação de recomendações e padrões que orientem o desenvolvimento dos currículos de enfermagem. analizar los comentarios cualitativos de cuatro encuestas entre docentes de enfermería, a los que se solicitò evaluar la importancia de 30 competencias de salud global para cursos de pregrado en enfermería. investigación cualitativa-descriptiva con 591 individuos que contestaron la encuesta en inglés (49 de África y 542 de las Américas), 163 que contestaron la encuesta en español (todos de América Latina), y 222 docentes brasileños que contestaron la encuesta en portugués. Los comentarios cualitativos fueron registrados al final de las encuestas por 175 respondientes en inglés, 75 en español y 70 en portugués. El análisis de los datos consistió en una descripción cualitativa y aproximación a través de un comité. el análisis reveló diez nuevas categorías de competencias de salud global. Los docentes también se mostraron preocupados con la forma y el momento de integrar esas competencias en los currículos de enfermería. las categorías adicionales deben ser consideradas para inclusión en las competencias de salud global identificadas anteriormente. Esas, además de las orientaciones para integración en los currículos existentes, pueden ser usadas para dirigir la lista original de competencias en salud global. Son

Polypharmacy and Polymorbidity in Older Adults in Brazil: a public health challenge.

PubMed

Ramos, Luiz Roberto; Tavares, Noemia Urruth Leão; Bertoldi, Andréa Dâmaso; Farias, Mareni Rocha; Oliveira, Maria Auxiliadora; Luiza, Vera Lucia; Pizzol, Tatiane da Silva Dal; Arrais, Paulo Sérgio Dourado; Mengue, Sotero Serrate

2016-12-01

priority in the planning agenda of the Brazilian Unified Health System (SUS). Analisar as variações da prevalência do uso crônico de medicamentos por idosos no Brasil segundo sua possível associação com as doenças crônicas mais prevalentes, fatores sociodemográficos e de saúde, e identificar fatores de risco para polifarmácia. Estudo com dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos, de caráter transversal e amostra probabilística populacional em municípios brasileiros urbanos. A variável independente foi o número de medicamentos de uso crônico por idosos, vinculados às oito doenças crônicas investigadas. As variáveis intervenientes foram sexo, faixa etária, situação conjugal, escolaridade, nível socioeconômico, região do País, índice de massa corporal, hábito de fumar, percepção da própria saúde, internação no último ano e posse de plano de saúde privado, além das doenças crônicas referidas. Uma análise multivariável identificou os fatores de risco para polifarmácia. A prevalência de pelo menos um medicamento de uso crônico entre idosos foi de 93,0%. Do total de idosos, 18,0% utilizavam pelo menos cinco medicamentos (polifarmácia). A polifarmácia foi maior entre os mais idosos (20,0%), na região Sul (25,0%), nos que avaliaram a própria saúde como ruim (35,0%), nos obesos (26,0%), nos que referiram ter plano de saúde (23,0%) ou internação no último ano (31,0%) e entre os que referiram qualquer uma das doenças investigadas, particularmente diabetes (36,0%) e doenças cardíacas (43,0%). No modelo final de risco para polifarmácia permaneceram idade, região, percepção de saúde, posse de plano de saúde, internação no último ano e todas as doenças investigadas exceto acidente vascular cerebral. Idosos com doenças específicas têm fatores de risco para polifarmácia modificáveis por ações que visem o uso racional de medicamentos. Com o envelhecimento

Use of generic medicines by the Brazilian population: an evaluation of PNAUM 2014.

PubMed

Bertoldi, Andréa Dâmaso; Arrais, Paulo Sergio Dourado; Tavares, Noemia Urruth Leão; Ramos, Luiz Roberto; Luiza, Vera Lucia; Mengue, Sotero Serrate; Dal-Pizzol, Tatiane da Silva; Farias, Mareni Rocha; Oliveira, Maria Auxiliadora

2016-12-01

To analyze the existence of differences in the use of generic medicines in Brazil according to demographic and socioeconomic variables and acquisition sources of the medicines. Population-based cross-sectional study, conducted with data from the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines). Data collection took place between September, 2013 and February, 2014 in homes of Brazilian cities (urban area). The use of medicines has been investigated in relation to the treatment of chronic diseases and, in the case of acute events, regarding use over the previous 15 days. Generics were identified by visualization of packaging presented by the users of the medicines. The independent variables used were sex, age, education level, economic class, and region of the Country. The statistical significance of differences between the groups was evaluated by Pearson's Chi-squared test, considering a 5% significance level. The prevalence of generic medicines use was 45.5% (95%CI 43.7-47.3). There was no difference considering education level. The prevalence was higher in females (47.0%; 95%CI 44.9-49.0) than in males (43.1%; 95%CI 40.5-45.8), and were higher with increasing age. Generic medicines were more used in the economic class C (47.0%; 95%CI 44.9-49.1) and in the South (50.6%; 95%CI 46.6-54.6) and Southeast (49.9%; 95%CI 46.8-53.0) regions. Generics accounted for 37.3% of the medicines provided by the Brazilian Unified Health System. Currently, there is a choice of purchase or free provision by the Brazilian Unified Health System, characterized by quality assurance and reduced price regarding branded medicines considered as reference. In the private market, a considerable part of the population is choosing generic medicines thanks to the availability of this option for virtually all medicines most used by the population. Analisar se há diferença no

EVALUATION OF LYMPHATIC SPREAD, VISCERAL METASTASIS AND TUMORAL LOCAL INVASION IN ESOPHAGEAL CARCINOMAS.

PubMed

Tustumi, Francisco; Kimura, Cintia Mayumi Sakurai; Takeda, Flavio Roberto; Sallum, Rubens Antônio Aissar; Ribeiro-Junior, Ulysses; Cecconello, Ivan

2016-01-01

Knowing esophageal tumors behavior in relationship to lymph node involvement, distant metastases and local tumor invasion is of paramount importance for the best esophageal tumors management. To describe lymph node involvement, distant metastases, and local tumor invasion in esophageal carcinoma, according to tumor topography and histology. A total of 444 patients with esophageal squamous cell carcinoma and 105 adenocarcinoma were retrospectively analyzed. They were divided into four groups: adenocarcinoma and squamous cell carcinoma in the three esophageal segments: cervical, middle, and distal. They were compared based on their CT scans at the time of the diagnosis. Nodal metastasis showed great relationship with of primary tumor site. Lymph nodes of hepatogastric, perigastric and peripancreatic ligaments were mainly affected in distal tumors. Periaortic, interaortocaval and portocaval nodes were more commonly found in distal squamous carcinoma; subcarinal, paratracheal and subaortic nodes in middle; neck chains were more affected in cervical squamous carcinoma. Adenocarcinoma had a higher frequency of peritoneal involvement (11.8%) and liver (24.5%) than squamous cell carcinoma. Considering the local tumor invasion, the more cranial neoplasia, more common squamous invasion of airways, reaching 64.7% in the incidence of cervical tumors. Middle esophageal tumors invade more often aorta (27.6%) and distal esophageal tumors, the pericardium and the right atrium (10.4%). Esophageal adenocarcinoma and squamous cell carcinoma in different topographies present peculiarities in lymph node involvement, distant metastasis and local tumor invasion. These differences must be taken into account in esophageal cancer patients' care. Conhecer o comportamento das neoplasias esofágicas em relação à disseminação linfonodal, distribuição de metástases e invasão local do tumor, pode auxiliar o manejo dos pacientes. Descrever o envolvimento linfonodal, disseminação metast

Chrysomelids American diabroticines Hosts and natural enemies. Biology-feasibility for control of pest species (Crisomelidos Diabroticinos americanos Hospederos y enemigos naturales Biologia y factibili manejo especies plagas

USDA-ARS?s Scientific Manuscript database

The chrysomelids in the Diabroticites include some of the most important pest species of the American continent. The chemical and management techniques used to date to control them are: crop rotation to prevent re-infection of host crops, especially in the species that display an egg diapause; insec...

Classroom Management: A Persistent Challenge for Pre-Service Foreign Language Teachers (Manejo del salón de clase: un reto persistente para docentes practicantes de lenguas extranjeras)

ERIC Educational Resources Information Center

Macías, Diego Fernando; Sánchez, Jesús Ariel

2015-01-01

This qualitative descriptive study aimed to ascertain the extent to which classroom management constituted a problem among pre-service foreign language teachers in a teacher education program at a public university in Colombia. The study also sought to identify classroom management challenges, the approaches to confronting them, and the…

Física e Arte nas Estações do Ano

NASA Astrophysics Data System (ADS)

Pessôa Queiroz, Glória; da Conceição Barbosa Lima, Maria; Navarro Vasconcellos das Mercês, Maria

2004-12-01

The paper deals with the subject of the Four Seasons, exploring elements of Science and the Art in order to motivate students or public of museums of science and technology to understand it from their current cultural experiences and of old times. Physics joins to Astronomy to explain the phenomenon, while the use of Music and Painting make possible the immersion in the subject in way to many trips to the imagination capable to awake emotions.A proposal didactic is presented and justified for some consensus of the research in the area of teaching-learning of science, since that related to the persistent alternative conceptions concerning the causes of the changes observed at the different times of the year until the qualitative modelling of phenomena that appeals three-dimensional pedagogical models. Such proposal was developed in the activity named " Hiper interesting Talk: The Four Seasons, Science and Art" in the first Sunday of August/2003 in the Museum of Astronomy, MAST. O artigo trata do tema das Estações do Ano, explorando elementos da Ciência e da Arte como forma de motivar estudantes ou público de museus de ciência e tecnologia a compreendê-lo a partir de vivências culturais atuais e de outras épocas. A Física se junta à Astronomia para explicar o fenômeno, enquanto a Música e a Pintura possibilitam a imersão no tema em meio a muitas viagens à imaginação capazes de despertar emoções.Uma proposta didática é apresentada e justificada por consensos das muitas pesquisas na área de ensino-aprendizagem de ciências, desde os que se referem às persistentes concepções alternativas acerca das causas das mudanças observadas nas diferentes épocas do ano até à modelagem qualitativa de fenômenos que recorre a modelos pedagógicos tridimensionais. Tal proposta foi desenvolvida na atividade "Bate papo Hiperinteressante: As Quatro Estações, Ciência e Arte" realizada no primeiro domingo do mês de agosto de 2003 no Museu de Astronomia.

Financing of Pharmaceutical Services in the municipal management of the Brazilian Unified Health System

PubMed Central

Faleiros, Daniel Resende; Acurcio, Francisco de Assis; Álvares, Juliana; do Nascimento, Renata Cristina Rezende Macedo; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Leite, Silvana Nair; Karnikowski, Margô Gomes de Oliveira; Costa, Karen Sarmento; Guerra, Augusto Afonso

2017-01-01

ABSTRACT OBJECTIVE To discuss factors related to the financing of the Basic Component of Pharmaceutical Services within the municipal management of the Brazilian Unified Health System. METHODS The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil – Serviços (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services) is a cross-sectional, exploratory, and evaluative study that performed an information survey in a representative sample, stratified by Brazilian regions It considered different study populations in the sampling plan, which represent primary health care services in the cities. Data were collected in 2015 by two methods: in person, by applying direct observation scripts and interviews with users, physicians, and professionals responsible for the dispensing of medicines in primary care services; by telephone interviews with municipal health managers and municipal professionals responsible for Pharmaceutical Services. The results were extracted from the questionnaires applied by telephone. RESULTS Of the sample of 600 eligible cities, we collected 369 interviews (61.5%) with secretaries and 507 (84.5%) with pharmaceutical services managers. 70.8% of the cities have a computerized management system; and 11.9% have qualification/training of professionals. More than half (51.3%) of the cities received funds for the structuring of pharmaceutical services, and almost 60% of these cities performed this type of spending. In 35.4% of cases, municipal secretaries of health said that they use resources of medicines from the Componente Básico da Assistência Farmacêutica (CBAF – Basic Component of Pharmaceutical Services) to cover demands of other medicines, but only 9.7% believed that these funds were sufficient to cover the demands. The existence of a permanent bidding committee exclusively for acquiring medicines was reported in 40.0% of the cities. CONCLUSIONS We found

Access to medicines by patients of the primary health care in the Brazilian Unified Health System

PubMed Central

Álvares, Juliana; Guerra, Augusto Afonso; de Araújo, Vânia Eloisa; Almeida, Alessandra Maciel; Dias, Carolina Zampirolli; Ascef, Bruna de Oliveira; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Leite, Silvana Nair; Karnikowski, Margô Gomes de Oliveira; Costa, Karen Sarmento; Acurcio, Francisco de Assis

2017-01-01

ABSTRACT OBJECTIVE To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients’ perspective. METHODS This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Services, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators. RESULTS For the “availability” dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For “accessibility,” 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For “accommodation,” UBS was evaluated as very good/good for the items “comfort” (74.2%) and “cleanliness” (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For “acceptability,” 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units’ service was very good/good. For “affordability,” 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines. CONCLUSIONS Results show 70%–90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential

Use of medicines by patients of the primary health care of the Brazilian Unified Health System

PubMed Central

Costa, Clarisse Melo Franco Neves; Silveira, Micheline Rosa; Acurcio, Francisco de Assis; Guerra, Augusto Afonso; Guibu, Ione Aquemi; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair; Costa, Ediná Alves; do Nascimento, Renata Cristina Rezende Macedo; de Araújo, Vânia Eloísa; Álvares, Juliana

2017-01-01

ABSTRACT OBJECTIVE To characterize the use of medicines by patients of the primary health care of the Brazilian Unified Health System (SUS). METHODS This is a cross-sectional, exploratory, and descriptive study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). Interviews were carried out with patients present in the services by semi-structured questionnaires. Sociodemographic, clinical, and use of medicines variables were assessed and the use of medicines in the 30 days prior to the interview was also verified. The population was stratified into three age groups: 18 to 44, 45 to 64, and 65 years or more. The differences between the age groups were verified using the Student’s t-test for continuous variables and chi-square test for the categorical ones. The complex samples analysis plan was employed. The medicines were classified according to the Anatomical Therapeutic Chemical Classification System. RESULTS Of the 8,803 patients interviewed, 6,511 (76.2%) reported to have used medicines in the 30 days prior to the interview. On average, each patient used 2.32 medicines, without difference between the sexes. Among medicine users, 18.2% were aged 65 years or more. Compared to the other age groups, older adults presented more comorbidities, used more medicines, and self-reported worse health conditions. They were also less educated, reported worse economic situation, and lived alone. The medicines that were mostly used were “other analgesics and antipyretics” (3rd ATC level) and Losartan (5th ATC level). CONCLUSIONS Most medicine users had lower education level and presented comorbidities. The most used medicines were the antihypertensive ones. Self-medication was higher among young people. Most patients reported to use generic medicines. The average number of medicines and the

Use of generic medicines by the Brazilian population: an evaluation of PNAUM 2014

PubMed Central

Bertoldi, Andréa Dâmaso; Arrais, Paulo Sergio Dourado; Tavares, Noemia Urruth Leão; Ramos, Luiz Roberto; Luiza, Vera Lucia; Mengue, Sotero Serrate; Dal-Pizzol, Tatiane da Silva; Farias, Mareni Rocha; Oliveira, Maria Auxiliadora

2016-01-01

ABSTRACT OBJECTIVE To analyze the existence of differences in the use of generic medicines in Brazil according to demographic and socioeconomic variables and acquisition sources of the medicines. METHODS Population-based cross-sectional study, conducted with data from the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines). Data collection took place between September, 2013 and February, 2014 in homes of Brazilian cities (urban area). The use of medicines has been investigated in relation to the treatment of chronic diseases and, in the case of acute events, regarding use over the previous 15 days. Generics were identified by visualization of packaging presented by the users of the medicines. The independent variables used were sex, age, education level, economic class, and region of the Country. The statistical significance of differences between the groups was evaluated by Pearson’s Chi-squared test, considering a 5% significance level. RESULTS The prevalence of generic medicines use was 45.5% (95%CI 43.7–47.3). There was no difference considering education level. The prevalence was higher in females (47.0%; 95%CI 44.9–49.0) than in males (43.1%; 95%CI 40.5–45.8), and were higher with increasing age. Generic medicines were more used in the economic class C (47.0%; 95%CI 44.9–49.1) and in the South (50.6%; 95%CI 46.6–54.6) and Southeast (49.9%; 95%CI 46.8–53.0) regions. Generics accounted for 37.3% of the medicines provided by the Brazilian Unified Health System. CONCLUSIONS Currently, there is a choice of purchase or free provision by the Brazilian Unified Health System, characterized by quality assurance and reduced price regarding branded medicines considered as reference. In the private market, a considerable part of the population is choosing generic medicines thanks to the availability of this option for virtually all

Main characteristics of patients of primary health care services in Brazil

PubMed Central

Guibu, Ione Aquemi; de Moraes, José Cássio; Guerra, Augusto Afonso; Costa, Ediná Alves; Acurcio, Francisco de Assis; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair; Álvares, Juliana

2017-01-01

ABSTRACT OBJECTIVE To characterize patients of primary health care services according to demographic and socioeconomic aspects, habits and lifestyle, health condition, and demand for health services and medicines. METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services), a cross-sectional study carried out between 2014 and 2015. Interviews were conducted with patients over the age of 17 years, with a standardized questionnaire, in primary health care services of a representative sample of cities, stratified by regions of Brazil. The analysis was performed for complex samples and weighted according to the population size of each region. RESULTS A total of 8,676 patients were interviewed, being 75.8% women, most of them aged from 18 to 39 years; 24.2% men, most of them aged from 40 to 59 years; 53.7% with elementary school; 50.5% reported to be of mixed race ethnicity, 39.7%, white, and 7.8%, black. Half of patients were classified as class C and 24.8% received the Bolsa Familia benefit. Only 9.8% had health insurance, with higher proportion in the South and lower in the North and Midwest. The proportion of men who consumed alcohol was higher than among women, as well as smokers. The self-assessment of health showed that 57% believed it to be very good or good, with lower proportion in the Northeast. The prevalence of chronic diseases/conditions, such as hypertension (38.6%), dyslipidemia (22.7%), arthritis/rheumatism (19.4%), depression (18.5%), diabetes (13.6%), and others are higher in these patients them among the general population. Medicines were predominantly sought in the health care service or in pharmacies of the Brazilian Unified Health System. CONCLUSIONS It was possible to characterize the profile of patients of Primary Health Care, but the originality of the research and its

Financing of Pharmaceutical Services in the municipal management of the Brazilian Unified Health System.

PubMed

Faleiros, Daniel Resende; Acurcio, Francisco de Assis; Álvares, Juliana; Nascimento, Renata Cristina Rezende Macedo do; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Leite, Silvana Nair; Karnikowski, Margô Gomes de Oliveira; Costa, Karen Sarmento; Guerra, Augusto Afonso

2017-11-13

To discuss factors related to the financing of the Basic Component of Pharmaceutical Services within the municipal management of the Brazilian Unified Health System. The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil - Serviços (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services) is a cross-sectional, exploratory, and evaluative study that performed an information survey in a representative sample, stratified by Brazilian regions It considered different study populations in the sampling plan, which represent primary health care services in the cities. Data were collected in 2015 by two methods: in person, by applying direct observation scripts and interviews with users, physicians, and professionals responsible for the dispensing of medicines in primary care services; by telephone interviews with municipal health managers and municipal professionals responsible for Pharmaceutical Services. The results were extracted from the questionnaires applied by telephone. Of the sample of 600 eligible cities, we collected 369 interviews (61.5%) with secretaries and 507 (84.5%) with pharmaceutical services managers. 70.8% of the cities have a computerized management system; and 11.9% have qualification/training of professionals. More than half (51.3%) of the cities received funds for the structuring of pharmaceutical services, and almost 60% of these cities performed this type of spending. In 35.4% of cases, municipal secretaries of health said that they use resources of medicines from the Componente Básico da Assistência Farmacêutica (CBAF - Basic Component of Pharmaceutical Services) to cover demands of other medicines, but only 9.7% believed that these funds were sufficient to cover the demands. The existence of a permanent bidding committee exclusively for acquiring medicines was reported in 40.0% of the cities. We found serious deficiencies in the public financing of

Pharmaceutical care in Brazil’s primary health care

PubMed Central

Araújo, Patricia Sodré; Costa, Ediná Alves; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Álvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair

2017-01-01

ABSTRACT OBJECTIVE To characterize the activities of clinical nature developed by pharmacists in basic health units and their participation in educational activities aiming at health promotion. METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015), a cross-sectional and exploratory study, of evaluative nature, consisting of a survey of information in a representative sample of cities, stratified by the Brazilian regions that constitute domains of study, and a subsample of primary health care services. The interviewed pharmacists (n=285) were responsible for the delivery of medicines and were interviewed in person with the use of a script. The characterization of the activities of clinical nature was based on information from pharmacists who declared to perform them, and on participation in educational activities aiming at health promotion, according to information from all pharmacists. The results are presented in frequency and their 95% confidence intervals. RESULTS From the interviewed subjects, 21.3% said they perform activities of clinical nature. Of these, more than 80% considered them very important; the majority does not dispose of specific places to perform them, which hinders privacy and confidentiality in these activities. The main denominations were “pharmaceutical guidance” and “pharmaceutical care.” The registration of activities is mainly made in the users’ medical records, computerized system, and in a specific document filed at the pharmacy, impairing the circulation of information among professionals. Most pharmacists performed these activities mainly along with physicians and nurses; 24.7% rarely participated in meetings with the health team, and 19.7% have never participated. CONCLUSIONS Activities of clinical nature performed by pharmacists

Teamwork in nursing: restricted to nursing professionals or an interprofessional collaboration?

PubMed

Souza, Geisa Colebrusco de; Peduzzi, Marina; Silva, Jaqueline Alcântara Marcelino da; Carvalho, Brígida Gimenez

2016-01-01

To understand the nursing professionals' conceptions of teamwork and their elements. A qualitative study conducted in an oncological hospital using a semi-structured interview with 21 nursing professionals. Two conceptions emerged from the accounts: teamwork restricted to nursing professionals and teamwork with interprofessional collaboration with particular importance for interactive dimensions: communication, trust and professional bonds, mutual respect and recognition of the other's work, collaboration, and conflict, with this last subcategory considered as an obstacle to teamwork. Nursing conceives teamwork as an interprofessional practice, which is a result of the quality of interaction among professionals from different areas and involves the recognition and handling of conflicts. Compreender as concepções dos profissionais de enfermagem sobre trabalho em equipe e seus elementos constituintes. Pesquisa qualitativa, realizada em hospital oncológico, por meio de entrevista semiestruturada com 21 profissionais de enfermagem. Duas concepções emergiram dos relatos, trabalho em equipe circunscrito à enfermagem e trabalho em equipe com colaboração interprofissional, com destaque para dimensão interativa: comunicação, confiança e vínculo, respeito mútuo e reconhecimento do trabalho do outro, colaboração e conflito. Esta última subcategoria foi apontada como obstáculo para o trabalho em equipe. A enfermagem concebe majoritariamente o trabalho em equipe como ação interprofissional, e isto decorre da qualidade da interação entre os profissionais das diferentes áreas e o reconhecimento e manejo de conflitos.

Reduction in hospitalisations and emergency department visits for frail patients with heart failure: Results of the UMIPIC healthcare programme.

PubMed

Cerqueiro, J M; González-Franco, A; Montero-Pérez-Barquero, M; Llácer, P; Conde, A; Dávila, M F; Carrera, M; Serrado, A; Suárez, I; Pérez-Silvestre, J; Satué, J A; Arévalo-Lorido, J C; Rodríguez, A; Herrero, A; Jordana, R; Manzano, L

2016-01-01

Heart failure (HF) is a disease with high morbidity and mortality. We evaluated the usefulness of the Comprehensive Management Units for Patients with HF (Unidades de Manejo Integral para Pacientes con IC [UMIPIC]) programme. We analysed the patient data from the UMIPIC programme, which was recorded in the HF registry (RICA) of the Spanish Society of Internal Medicine. We compared emergency department visits and hospitalisations for any cause and for HF during the year prior to inclusion in the programme against those that occurred during the subsequent follow-up year, using the chi-squared test. A total of 258 patients (mean age, 80years; 51.9% women) were included in the study. During the previous year, there were 693 hospitalisations for all causes and 174 hospitalisations during the follow-up (75% reduction, P<.001). There were 613 hospitalisations for HF during the previous year and 92 during the follow-up (85% reduction, P<.001); 655 vs. 302 in terms of emergency department visits for any cause (53.9% reduction, P<.001); and 440 vs. 120 for emergency department visits for HF (72% reduction, P<.001). There were no significant differences in the number of hospitalisations or emergency department visits for causes other than HF. The UMIPIC programme based on the comprehensive care of elderly patients with HF and comorbidity reduces the rate of hospital readmissions and emergency department visits during the first year of follow-up. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Alternative approaches to pollution control and waste management: Regulatory and economic instruments. Planteamientos alternos para el control de la contaminacion y el manejo de desechos: instrumentos regulatorios y economicos

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bernstein, J.D.

1993-01-01

The paper examines ways in which developed and developing countries control pollution and manage urban wastes. It addresses pollution issues of concern to local, provincial, and national governments, as well as nongovernmental organizations. Two approaches to pollution management are discussed: direct regulation and economic incentives. Direct regulation sets standards and enforces them through permits, licenses, and controls on land or water use. Economic incentives encourage polluters to adopt control measures and are more flexible and cost effective. Such incentives include charging fees to enterprises for pollution discharges or providing government subsidies for pollution control technology. The author tells how economicmore » incentives can supplement direct regulation and why such incentives, when properly used, offer advantages over direct regulation. The author discusses how governments have used economic incentives to deal with specific environmental issues and what factors policymakers must address when they plan pollution controls.« less

Free access to medicines for the treatment of chronic diseases in Brazil.

PubMed

Tavares, Noemia Urruth Leão; Luiza, Vera Lucia; Oliveira, Maria Auxiliadora; Costa, Karen Sarmento; Mengue, Sotero Serrate; Arrais, Paulo Sergio Dourado; Ramos, Luiz Roberto; Farias, Mareni Rocha; Pizzol, Tatiane da Silva Dal; Bertoldi, Andréa Dâmaso

2016-12-01

To analyze the free access to medicines for the treatment of chronic diseases in the Brazilian population, according to demographic and socioeconomic factors. We also analyzed the most used pharmacological groups, according to funding source: free-of-charge or out-of-pocket paid. Analysis of data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based household survey, of cross-sectional design, based on probabilistic sample of the Brazilian population. We analyzed as outcome the prevalence of free access (free-of-charge) to all medicines for treatment of the reported chronic diseases, in the last 30 days. We studied the following independent variables: sex, age group, education in complete years of school, economic class, health plan, and geographical region of residence. We estimated the prevalences and 95% confidence intervals (95%CI) and applied the Pearson's Chi-squared test to assess the differences between the groups, considering a 5% significance level. About half of adults and older adults who have had full access to the treatment of chronic diseases in Brazil obtained all needed medicines for free (47.5%; 95%CI 45.1-50.0). The prevalences of free access were higher among men (51.4%; 95%CI 48.1-54.8), age group of 40-59 years (51.1%; 95%CI 48.1-54.2), and in the poorest social classes (53.9%; 95%CI 50.2-57.7). The majority of medicines that act on the cardiovascular system, such as diuretics (C03) (78.0%; 95%CI 75.2-80.5), beta-blockers (C07) (62.7%; 95%CI 59.4-65.8), and the agents that work in the renin-angiotensin system (C09) (73.4%; 95%CI 70.8-75.8), were obtained for free. Medicines that act on the respiratory system, such as agents against obstructive airway diseases (R03) (60.0%; 95%CI 52.7-66.9) were mostly paid with own resources. Free access to medicines for treatment of chronic diseases occurs to a

Tropheryma whipplei endocarditis in Spain

PubMed Central

García-Álvarez, Lara; Sanz, María Mercedes; Marín, Mercedes; Fariñas, MªCarmen; Montejo, Miguel; Goikoetxea, Josune; Rodríguez García, Raquel; de Alarcón, Arístides; Almela, Manuel; Fernández-Hidalgo, Núria; Alonso Socas, María del Mar; Goenaga, Miguel Ángel; Navas, Enrique; Vicioso, Luis; Oteo, José Antonio

2016-01-01

Abstract Tropheryma whipplei endocarditis is an uncommon condition with very few series and <90 cases reported in the literature. The aim of the study was to analyze the epidemiological, clinical, and outcome characteristics of 17 cases of T. whipplei endocarditis recruited in our country from a multicentric cohort from 25 Spanish hospitals from the Spanish Collaboration on Endocarditis—Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España. From a total of 3165 cases included in the cohort, 14.2% were diagnosed of blood culture negative endocarditis (BCNE) and 3.5% of these had T. whipplei endocarditis. This condition was more frequent in men. The average age was 60.3 years. Previous cardiac condition was present in 35.3% of the cases. The main clinical manifestation was cardiac failure (76.5%) while fever was only present in the 35.3%. Ecocardiography showed vegetations in 64.7% of patients. Surgery was performed in all but 1 cases and it allowed the diagnosis when molecular assays were performed. A broad range rRNA 16S polymerase chain reaction was used for first instance in all laboratories and different specific targets for T. whipplei were employed for confirmation. A concomitant Whipple disease was diagnosed in 11.9% of patients. All patients received specific antimicrobial treatment for at least 1 year, with no relapse and complete recovery. T. whipplei endocarditis is an uncommon condition with an atypical presentation that must be considered in the diagnosis of BCNE. The prognosis is very good when an appropriate surgical management and antimicrobial-specific treatment is given. PMID:27368042

Free access to medicines for the treatment of chronic diseases in Brazil

PubMed Central

Tavares, Noemia Urruth Leão; Luiza, Vera Lucia; Oliveira, Maria Auxiliadora; Costa, Karen Sarmento; Mengue, Sotero Serrate; Arrais, Paulo Sergio Dourado; Ramos, Luiz Roberto; Farias, Mareni Rocha; Pizzol, Tatiane da Silva Dal; Bertoldi, Andréa Dâmaso

2016-01-01

ABSTRACT OBJECTIVE To analyze the free access to medicines for the treatment of chronic diseases in the Brazilian population, according to demographic and socioeconomic factors. We also analyzed the most used pharmacological groups, according to funding source: free-of-charge or out-of-pocket paid. METHODS Analysis of data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based household survey, of cross-sectional design, based on probabilistic sample of the Brazilian population. We analyzed as outcome the prevalence of free access (free-of-charge) to all medicines for treatment of the reported chronic diseases, in the last 30 days. We studied the following independent variables: sex, age group, education in complete years of school, economic class, health plan, and geographical region of residence. We estimated the prevalences and 95% confidence intervals (95%CI) and applied the Pearson’s Chi-squared test to assess the differences between the groups, considering a 5% significance level. RESULTS About half of adults and older adults who have had full access to the treatment of chronic diseases in Brazil obtained all needed medicines for free (47.5%; 95%CI 45.1–50.0). The prevalences of free access were higher among men (51.4%; 95%CI 48.1–54.8), age group of 40-59 years (51.1%; 95%CI 48.1–54.2), and in the poorest social classes (53.9%; 95%CI 50.2–57.7). The majority of medicines that act on the cardiovascular system, such as diuretics (C03) (78.0%; 95%CI 75.2–80.5), beta-blockers (C07) (62.7%; 95%CI 59.4–65.8), and the agents that work in the renin-angiotensin system (C09) (73.4%; 95%CI 70.8–75.8), were obtained for free. Medicines that act on the respiratory system, such as agents against obstructive airway diseases (R03) (60.0%; 95%CI 52.7–66.9) were mostly paid with own resources. CONCLUSIONS Free

A protocol for eliciting nonmaterial values through a cultural ecosystem services frame

PubMed Central

Gould, Rachelle K; Klain, Sarah C; Ardoin, Nicole M; Satterfield, Terre; Woodside, Ulalia; Hannahs, Neil; Daily, Gretchen C; Chan, Kai M

2015-01-01

Servicios Ambientales Culturales Resumen Los deseos, necesidades y valores no materiales de los accionistas influyen frecuentemente sobre el éxito de los proyectos de conservación. Estas consideraciones son difíciles de articular y caracterizar, lo que resulta en entendimiento limitado en el manejo y la política. Concebimos un protocolo de entrevista diseñado para mejorar el entendimiento de los servicios ambientales culturales (SAC). El protocolo inicia con la discusión de actividades relacionadas con ecosistemas (p. ej.: recreación, cacería) y manejo; después señala a los SAC, dando pie a los valores que encierran conceptos identificados en la Evaluación Ambiental del Milenio (2005) y explorado en otras investigaciones sobre SAC. Hicimos pruebas piloto del protocolo en Hawái y Columbia Británica. En cada localidad entrevistamos a 30 individuos de diversos entornos. Analizamos los resultados de las dos localidades para determinar la efectividad del protocolo de entrevista en la obtención de valores no materiales. Los componentes cualitativos y espaciales del protocolo nos ayudaron a caracterizar los valores culturales, sociales y éticos asociados con el ecosistema de múltiples maneras. Los mapas y las preguntas de situación, o de tipo viñeta, ayudaron a los encuestados a articular valores difíciles de discutir. Las preguntas abiertas permitieron a los encuestados expresar una diversidad de valores ambientales y demostraron ser suficientemente flexibles para que los encuestados comunicaran valores que el protocolo no buscaba explícitamente. Finalmente, los resultados sugieren que ciertos valores, aquellos mencionados frecuentemente en la entrevista, son particularmente prominentes para poblaciones particulares. El protocolo puede proporcionar datos eficientes, contextuales y basados en lugar sobre la importancia de atributos ambientales particulares para el bienestar humano. Los datos cualitativos son complementarios para las evaluaciones cuantitativas y

Mapping opportunities and challenges for rewilding in Europe

PubMed Central

Ceaușu, Silvia; Hofmann, Max; Navarro, Laetitia M; Carver, Steve; Verburg, Peter H; Pereira, Henrique M

2015-01-01

de la vida silvestre (“rewilding”) representa una estrategia alternativa a esto. Desarrollamos un marco de trabajo para evaluar las oportunidades de reintroducción en diferentes dimensiones de naturaleza a lo largo de Europa. Mapeamos la luz artificial, la accesibilidad para humanos con base en la infraestructura de transporte, la proporción de productividad primaria (es decir, la productividad del ecosistema incautado por los humanos por medio de la agricultura o la silvicultura) y la divergencia de vegetación natural potencial en áreas que se proyecta estarán abandonadas para el 2040. A nivel continental, los niveles de luz artificial fueron bajos y la divergencia de vegetación natural potencial fue alta en las áreas de abandono. La importancia relativa de las medidas de naturaleza difirió regionalmente y estuvieron conectadas fuertemente a los contextos ambientales y socio-económicos locales. Las grandes áreas de abandono proyectado estuvieron localizadas frecuentemente en o alrededor de sitios Natura 2000. Con base en estos resultados, argumentamos que el manejo debería ser fabricado para restaurar los aspectos de la naturaleza que son carentes en cada región. Todavía quedan muchos obstáculos con respecto a la biodiversidad en Europa, pero las especies de megafauna ya se están recuperando. Para potenciar aún más la reintroducción a gran escala, el manejo de Natura 2000 necesitaría incorporar estrategias de reintroducción. Nuestro marco de trabajo puede aplicarse a la evaluación de las oportunidades de reintroducción y a los obstáculos en otras regiones del mundo, y nuestros resultados pueden guiar la redirección de los subsidios para manejar los sistemas socio-ecológicos. PMID:25997361

PubMed

López, Ana Cristina; Cecchetto, Eugenio; Aguirre, Ana Noemí; Ontiveros, Marina Celeste; Roitter, Claudia Valentina; Garcia, Adelaida Judith; Bernet, Jorgelina; Aguirre, Jorge Alberto

2018-03-23

El objetivo del estudio fue describir características clínicas, sociodemográficas y hábitos en adultos con diabetes mellitus y estudiar su asociación con la calidad de vida relacionada con la salud. Se seleccionó una muestra de 311 pacientes del Programa de Diabetes de una obra social universitaria, de la provincia de Córdoba. Se analizaron los datos a como proporciones y los componentes físico y mental del cuestionario SF-36® . El 57,4% alcanzó un nivel de instrucción terciario o universitario. La hipertensión arterial fue el factor de riesgo cardiovascular más prevalente (86,8%), seguida por dislipemia (50,6%) y obesidad (46,5%). El 24,8% tenía complicación macrovascular y el 29% microvascular. En el componente físico (CF) de calidad de vida las mujeres tuvieron una chance 4,2 veces mayor de reportar un valor inferior en relación a los varones. Entre los 50 y los 70 años se triplicó y los mayores de  70 años tuvieron 4 veces peor una puntuación en el CF respecto a los más jóvenes. Las complicaciones macro y microvasculares y los que reportaron menos de 2 hábitos de vida saludables tuvieron el doble de chances de puntuar por debajo del promedio general en el CF. La asociación entre complicaciones y peor calidad de vida es un motivo más para alcanzar un buen control metabólico, optimizar el manejo de factores de riesgo, evitando o retrasando la aparición de complicaciones.

Soil management effect on soil quality indicators in vineyards of the Appellation of Origin "Montilla-Moriles" in southern Spain

NASA Astrophysics Data System (ADS)

Guzmán, Gema; Cabezas, José Manuel; Bauer, Thomas; Strauss, Peter; Winter, Silvia; Zaller, Johann; Gómez, José Alfonso

2017-04-01

The effect soil management on several indicators frequently used in the assessment of soil quality it is not always reflected unambiguously when measured at the field although it is normally assumed that this relation is straightforward. Within the European project VineDivers (www.vinedivers.eu), sixteen commercial vineyards belonging to the Appellation of Origin "Montilla-Moriles" (Córdoba) and covering a wide range of textural classes were selected. These farms were classified 'a priori' under two soil management categories: temporal cover crop and bare soil during the whole year. In each of the vineyards one representative inter-row was selected in order to characterise different physical, chemical and biological parameters to evaluate some aspects related to soil quality. Results indicate that the studied indicators respond clearly to soil textural class and vegetation cover biomass. However, there was no clear difference in above-ground biomass of the two management categories (Guzmán et al., 2016). These results suggest that the interpretation and extrapolation of the indicators evaluated should incorporate complementary information to characterise small variations of soil management intensity among vineyards that are apparently managed under the same management category. The communication presents this analysis based on the number and type of soil disturbance events of all vineyards. The high variability found among vineyards under the same management highlights the relevance of measuring these soil parameters used as quality indicators, instead of extrapolating from other vineyards or agricultural systems, and interpreting them according to baseline levels. References: Guzmán G., Cabezas J.M., Gómez J.A. 2016. Evaluación preliminar del efecto del manejo del suelo en indicadores que determinan su calidad en viñedos de la Denominación de Origen Montilla Moriles. II Jornadas de Viticultura SECH. Madrid.

Enfermedad diarreica aguda por Escherichia coli patógenas en Colombia

PubMed Central

Gómez-Duarte, Oscar G.

2014-01-01

Resumen Las cepas de E. coli patógenas intestinales son causas importantes de la enfermedad diarreica aguda (EDA) en niños menores de 5 años en América Latina, África y Asia y están asociadas a alta mortalidad en niños en las comunidades más pobres de África y el Sudeste Asiático. Estudios sobre el papel de las E. coli patógenas intestinales en la EDA infantil en Colombia y otros países de América Latina son limitados debido a la carencia de ensayos para detección de estos patógenos en los laboratorios clínicos de centros de salud. Estudios recientes han reportado la detección de E. coli patógenas intestinales en Colombia, siendo la E. coli enterotoxigénica la cepa más frecuentemente asociada a diarrea en niños menores de 5 años. Otros patógenos detectados en estos pacientes incluyen las E. coli enteroagregativa, enteropatógena, productora de toxina Shiga, y de adherencia difusa. Con base en estudios que reportan la presencia de E. coli productora de toxina Shiga y E. coli enteroagregativa en carnes y vegetales en supermercados, se cree que productos alimentarios contaminados contribuyen a la transmisión de estos patógenos y a la infección del huésped susceptible. Más estudios son necesarios para evaluar los mecanismos de transmisión, el impacto en la epidemiologia de la EDA, y las pautas de manejo y prevención de estos patógenos que afectan la población pediátrica en Colombia. PMID:25491457

Use of technologies in intravenous therapy: contributions to a safer practice.

PubMed

Moreira, Ana Paula Amorim; Escudeiro, Cristina Lavoyer; Christovam, Bárbara Pompeu; Silvino, Zenith Rosa; Carvalho, Márglory Fraga de; Silva, Roberto Carlos Lyra da

2017-01-01

To identify what are the difficulties of the nursing staff in the management of technologies during intravenous therapy (IVT) and discuss the difficulties identified under the perspective of patient's safety. Descriptive study of qualitative approach with data collected by semi-structured interview and analyzed by the Alceste software. The greatest difficulty of cognitive and technical emphasis was the lack of training; and regarding administrative emphasis, the greatest difficulty was the lack of material and human resources. Infusion pumps and their proper use were highlighted as the technological resource that most contributed to patient safety. The lack of training is presented as the greatest difficulty of nursing professionals and permeates safety issues of both patient and professional when using the hard technologies in IVT. Training is essential to the development of techniques, considered nursing tools. Identificar quais são as dificuldades da equipe de Enfermagem no manejo das tecnologias durante a terapia intravenosa (TIV) e discutir as dificuldades identificadas sob a perspectiva da segurança do paciente. abordagem qualitativa, do tipo descritivo com dados coletados por entrevista semiestruturada e analisados pelo programa Alceste. A maior dificuldade de ênfase cognitiva e técnica foi a falta de treinamento; e de ênfase administrativa, foi a falta de recursos materiais e humanos. As bombas de infusão e sua utilização adequada foram destacadas como o recurso tecnológico que mais contribuiu para a segurança do paciente. A falta de treinamento é apresentada como a maior dificuldade dos profissionais de Enfermagem e permeia as questões de segurança do paciente e do profissional ao utilizar as tecnologias duras na TIV. O treinamento é imprescindível para o desenvolvimento das técnicas, consideradas como ferramentas do fazer da Enfermagem.

Comparison of longevity between a laboratory strain and a natural population of Anastrepha Fraterculus (Diptera: Tephritidae) under field cage conditions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gomez Cendra, P.; Vilardi, J.; Segura, D.

The South American fruit fly Anastrepha fraterculus (Wiedemann) is one of the most destructive fruit pests in this region, infesting major fruit crops. Implementation of the sterile insect technique (SIT) as part of an area-wide integrated approach against this species requires information on the survival of mass-reared and sterilized insects in the field and their ability to mate with wild females. The survival rates in field cages of both non-irradiated and irradiated laboratory flies were compared with that of wild flies. Both types of laboratory flies survived longer than their wild counterparts over the 8 days under the experimental conditions.more » The irradiation dose (70 Gy) did not affect survival of the laboratory reared flies. Our results improve the prospect of integrating the SIT into the control of A. fraterculus populations in Argentina. (author) [Spanish] Anastrepha fraterculus (Wiedemann), la mosca sudamericana de la fruta, es una de las plagas mas destructivas en la region que infesta a los principales cultivos de frutas. La implementacion de la Tecnica del Insecto Esteril (TIE) como parte de un manejo integrado en areas extensivas contra esta especie requiere ensayos que demuestren que los insectos producidos en forma masiva y esterilizados son capaces de sobrevivir en el campo y aparearse con las hembras silvestres. Se comparo la supervivencia de individuos de una linea de laboratorio, tanto irradiados como no irradiados con la de individuos de una poblacion natural. Los dos tratamientos de moscas de laboratorio sobrevivieron mas tiempo que las salvajes durante los 8 dias y en las condiciones ensayadas. La dosis de radiacion (70 Gy.) no afecto la supervivencia de las moscas criadas en laboratorio. Nuestros resultados mejoran las perspectivas de integrar la TIE en el control de las poblaciones argentinas de A. fraterculus. (author)« less

Use of and access to oral and injectable contraceptives in Brazil.

PubMed

Farias, Mareni Rocha; Leite, Silvana Nair; Tavares, Noemia Urruth Leão; Oliveira, Maria Auxiliadora; Arrais, Paulo Sergio Dourado; Bertoldi, Andréa Dâmaso; Pizzol, Tatiane da Silva Dal; Luiza, Vera Lucia; Ramos, Luiz Roberto; Mengue, Sotero Serrate

2016-12-01

To analyze the prevalence of current use of oral and injectable contraceptives by Brazilian women, according to demographic and socioeconomic variables and issues related to access to those medicines. A cross-sectional, population-based analytical study with probability sampling based on data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), carried out between September 2013 and February 2014 in 20,404 Brazilian urban households. Prevalence was calculated based on reports from non-pregnant women aged 15-49 on the use of oral or injectable contraceptives. The independent variables were gender, age, level of education, socioeconomic class, Brazilian region and marital status. Also analyzed were access, means of payment, sources, and reported medicines. Statistical analyses considered 95% confidence intervals (95%CI) and Pearson Chi-square test to evaluate the statistical significance of differences between groups, considering a 5% significance level. Prevalence of use was 28.2% for oral contraceptives (OC) and 4.5% for injectable contraceptives (IC). The highest prevalence of oral contraceptives was in the South region (37.5%) and the lowest in the North region (15.7%). For injectable contraceptives there was no difference between regions. Access was higher for oral contraceptive users (90.7%) than injectable contraceptives users (81.2%), as was direct payment (OC 78.1%, IC 58.0%). Users who paid for contraceptives acquired them at retail pharmacies (OC 95.0% and IC 86.6%) and at Farmácia Popular (Popular Pharmacy Program) (OC 4.8% and IC 12.7%). Free of charge contraceptives were mostly obtained from the Brazilian Unified Health System - SUS (OC 86.7%; IC 96.0%). Free samples were reported by 10.4% of users who did not pay for oral contraceptives. Most of paying users did not try to obtain contraceptives from SUS. Monophasic

Access to and use of high blood pressure medications in Brazil.

PubMed

Mengue, Sotero Serrate; Bertoldi, Andréa Dâmaso; Ramos, Luiz Roberto; Farias, Mareni Rocha; Oliveira, Maria Auxiliadora; Tavares, Noemia Urruth Leão; Arrais, Paulo Sergio Dourado; Luiza, Vera Lucia; Pizzol, Tatiane da Silva Dal

2016-12-01

To analyze the access to and use of medicines for high blood pressure among the Brazilian population according to social and demographic conditions. Analysis of data from Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), a nationwide cross-sectional, population-based study, with probability sampling, carried out between September 2013 and February 2014 in urban households in the five Brazilian regions. The study evaluated the access and use of medicines to treat people with high blood pressure. The independent variables were gender, age, socioeconomic status and Brazilian region. The study also described the most commonly used drugs and the percentage of people treated with one, two, three or more drugs. Point estimations and confidence intervals were calculated considering the sample weights and sample complex plan. Prevalence of high blood pressure was 23.7% (95%CI 22.8-24.6). Regarding people with this condition, 93.8% (95%CI 92.8-94.8) had indication for drug therapy and, of those, 94.6% (95%CI 93.5-95.5) were using the medication at the time of interview. Full access to medicines was 97.9% (95%CI 97.3-98.4); partial access, 1.9% (95%CI 1.4-2.4); and no access, 0.2% (95%CI 0.1-0.4). The medication used to treat high blood pressure, 56.0% (95%CI 52.6-59.2) were obtained from SUS (Brazilian Unified Health System), 16.0% (95%CI 14.3-17.9) from Popular Pharmacy Program, 25.7% (95%CI 23.4-28.2) were paid for by the patients themselves and 2.3% (95%CI 1.8-2.9) were obtained from other locations. The five most commonly used drugs were, in descending order, hydrochlorothiazide, losartan, captopril, enalapril and atenolol. Of the total number of patients on treatment, 36.1% (95%CI 34.1-37.1) were using two medicines and 13.5% (95%CI 12.3-14.9) used three or more. Access to medicines for the treatment of high blood pressure may be considered high

Aspetti deontologici e giuridici della Responsabilità professionale del chirurgo in Italia. Evoluzione storica a partire dal '900.

PubMed

Picardi, Nicola

2018-01-01

operativamente nel documento del "consenso informato". Per altro verso le leggi innovative del Codice Civile definito nel 1942, che al posto delle pene del codice penale introduceva il criterio della risarcibilità economica del danno in caso di riconosciuta "responsabilità professionale", ha determinato il coinvolgimento di altre figura professionali, e cioè di avvocati e di medici legali, oltre che delle organizzazioni assicurative, con detrimento alla serenità nell'espletamento delle professioni sanitarie e con l'insorgenza per reazione della cosidetta "medicina difensiva". La concretezza di queste problematiche hanno richiesto l'interessamento attivo della Giurisprudenza con una serie di sentenze, ed una formulazione di decreti e nuove leggi parlamentari, ancora in pieno assestamento nel corso del 2017, lasciano in qualche modo ancora irrisolti alcuni nodi.

Use of and access to oral and injectable contraceptives in Brazil

PubMed Central

Farias, Mareni Rocha; Leite, Silvana Nair; Tavares, Noemia Urruth Leão; Oliveira, Maria Auxiliadora; Arrais, Paulo Sergio Dourado; Bertoldi, Andréa Dâmaso; Pizzol, Tatiane da Silva Dal; Luiza, Vera Lucia; Ramos, Luiz Roberto; Mengue, Sotero Serrate

2016-01-01

ABSTRACT OBJECTIVE To analyze the prevalence of current use of oral and injectable contraceptives by Brazilian women, according to demographic and socioeconomic variables and issues related to access to those medicines. METHODS A cross-sectional, population-based analytical study with probability sampling based on data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), carried out between September 2013 and February 2014 in 20,404 Brazilian urban households. Prevalence was calculated based on reports from non-pregnant women aged 15-49 on the use of oral or injectable contraceptives. The independent variables were gender, age, level of education, socioeconomic class, Brazilian region and marital status. Also analyzed were access, means of payment, sources, and reported medicines. Statistical analyses considered 95% confidence intervals (95%CI) and Pearson Chi-square test to evaluate the statistical significance of differences between groups, considering a 5% significance level. RESULTS Prevalence of use was 28.2% for oral contraceptives (OC) and 4.5% for injectable contraceptives (IC). The highest prevalence of oral contraceptives was in the South region (37.5%) and the lowest in the North region (15.7%). For injectable contraceptives there was no difference between regions. Access was higher for oral contraceptive users (90.7%) than injectable contraceptives users (81.2%), as was direct payment (OC 78.1%, IC 58.0%). Users who paid for contraceptives acquired them at retail pharmacies (OC 95.0% and IC 86.6%) and at Farmácia Popular (Popular Pharmacy Program) (OC 4.8% and IC 12.7%). Free of charge contraceptives were mostly obtained from the Brazilian Unified Health System – SUS (OC 86.7%; IC 96.0%). Free samples were reported by 10.4% of users who did not pay for oral contraceptives. Most of paying users did not try to obtain

Access to and use of high blood pressure medications in Brazil

PubMed Central

Mengue, Sotero Serrate; Bertoldi, Andréa Dâmaso; Ramos, Luiz Roberto; Farias, Mareni Rocha; Oliveira, Maria Auxiliadora; Tavares, Noemia Urruth Leão; Arrais, Paulo Sergio Dourado; Luiza, Vera Lucia; Pizzol, Tatiane da Silva Dal

2016-01-01

ABSTRACT OBJECTIVE To analyze the access to and use of medicines for high blood pressure among the Brazilian population according to social and demographic conditions. METHODS Analysis of data from Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a nationwide cross-sectional, population-based study, with probability sampling, carried out between September 2013 and February 2014 in urban households in the five Brazilian regions. The study evaluated the access and use of medicines to treat people with high blood pressure. The independent variables were gender, age, socioeconomic status and Brazilian region. The study also described the most commonly used drugs and the percentage of people treated with one, two, three or more drugs. Point estimations and confidence intervals were calculated considering the sample weights and sample complex plan. RESULTS Prevalence of high blood pressure was 23.7% (95%CI 22.8–24.6). Regarding people with this condition, 93.8% (95%CI 92.8–94.8) had indication for drug therapy and, of those, 94.6% (95%CI 93.5–95.5) were using the medication at the time of interview. Full access to medicines was 97.9% (95%CI 97.3–98.4); partial access, 1.9% (95%CI 1.4–2.4); and no access, 0.2% (95%CI 0.1–0.4). The medication used to treat high blood pressure, 56.0% (95%CI 52.6–59.2) were obtained from SUS (Brazilian Unified Health System), 16.0% (95%CI 14.3–17.9) from Popular Pharmacy Program, 25.7% (95%CI 23.4–28.2) were paid for by the patients themselves and 2.3% (95%CI 1.8–2.9) were obtained from other locations. The five most commonly used drugs were, in descending order, hydrochlorothiazide, losartan, captopril, enalapril and atenolol. Of the total number of patients on treatment, 36.1% (95%CI 34.1–37.1) were using two medicines and 13.5% (95%CI 12.3–14.9) used three or more. CONCLUSIONS Access to

A multi-state approach to black-tailed prairie dog conservation and management in the United States (Enfoque multi-estatal para la Conservacion y manejo del perro llanero de cola negra en los Estados Unidos)

Treesearch

Robert J. Luce

2006-01-01

The black-tailed prairie dog (Cynomys ludovicianus) is unusual among species proposed for Endangered Species Act (ESA) listing in that several million individuals currently exist across a large area in the wild. The National Wildlife Federation's 1998 listing petition estimated the current area occupied by the species at 283,500-324,000 ha. Although widespread,...

Mental health in the Family Health Strategy as perceived by health professionals.

PubMed

Souza, Jacqueline de; Almeida, Letícia Yamawaka de; Luis, Margarita Antonia Villar; Nievas, Andreia Fernanda; Veloso, Tatiana Maria Coelho; Barbosa, Sara Pinto; Giacon, Bianca Cristina Ciccone; Assad, Francine Baltazar

2017-01-01

to analyze the management of mental health needs in primary care as perceived by Family Health Strategy professionals. this was a qualitative descriptive exploratory study developed within the coverage area of five family health teams. The data were collected using observation, group interviews, individual semi-structured interviews, and focus groups. Content analysis was conducted using text analysis software and interpretation was based on the corresponding analytical structures. numerous and challenging mental health demands occur in this setting, for which the teams identified care resources; however, they also indicated difficulties, especially related to the operationalization and integration of such resources. there is a need for a care network sensitive to mental health demands that are better coordinated and more effectively managed. analisar o manejo das necessidades de saúde mental na atenção primária à saúde de acordo com a percepção dos profissionais da Estratégia Saúde da Família. estudo qualitativo, descritivo exploratório, desenvolvido no território de abrangência de cinco equipes de saúde da família. Os participantes foram cinco enfermeiras, cinco coordenadores e 17 agentes comunitários de saúde. Os dados foram coletados utilizando observação, entrevistas grupais, entrevistas individuais semiestruturadas e grupos focais. Fez-se a análise de conteúdo com o auxílio de um Software de análise textual, e a interpretação baseou-se nas estruturas analíticas correspondentes. inúmeras e desafiadoras demandas de saúde mental têm sido acolhidas nesse setting, para as quais as equipes identificaram recursos de atendimento; no entanto, apontaram dificuldades, sobretudo relacionadas à operacionalização e integração destes recursos. destaca-se a necessidade de uma rede de cuidados sensível a tais demandas, mais articulada e gerida de modo eficaz.

Effects of knowledge of an endangered species on recreationists' attitudes and stated behaviors and the significance of management compliance for ohlone tiger beetle conservation.

PubMed

Cornelisse, Tara M; Duane, Timothy P

2013-12-01

Recreation is a leading cause of species decline on public lands, yet sometimes it can be used as a tool for conservation. Engagement in recreational activities, such as hiking and biking, in endangered species habitats may even enhance public support for conservation efforts. We used the case of the endangered Ohlone tiger beetle (Cicindela ohlone) to investigate the effect of biking and hiking on the beetle's behavior and the role of recreationists' knowledge of and attitudes toward Ohlone tiger beetle in conservation of the species. In Inclusion Area A on the University of California Santa Cruz (U.S.A.) campus, adult Ohlone tiger beetles mate and forage in areas with bare ground, particularly on recreational trails; however, recreation disrupts these activities. We tested the effect of recreation on Ohlone tiger beetles by observing beetle behavior on trails as people walked and road bikes at slow and fast speed and on trails with no recreation. We also surveyed recreationists to investigate how their knowledge of the beetle affected their attitudes toward conservation of the beetle and stated compliance with regulations aimed at beetle conservation. Fast cycling caused the beetles to fly off the trail more often and to fly farther than slow cycling or hiking. Slow cycling and hiking did not differ in their effect on the number of times and distance the beetles flew off the trail. Recreationists' knowledge of the beetle led to increased stated compliance with regulations, and this stated compliance is likely to have tangible conservation outcomes for the beetle. Our results suggest management and education can mitigate the negative effect of recreation and promote conservation of endangered species. Efectos del Conocimiento de una Especie en Peligro sobre las Actitudes y Comportamientos Declarados de los Recreacionistas y el Significado del Manejo de la Conformidad para la Conservación del Escarabajo Tigre de Ohlone. © 2013 Society for Conservation Biology.

PubMed

Alvarez Padilla, Facundo Nicolás; Schiavoni, Emiliano Nestor; Bustos, Mario Eduardo Francisco

2018-04-20

INTRODUCCIONEl derrame pleural neoplásico (DPN) implica una enfermedad oncológica avanzada. La biopsia pleural por cirugía torácica endoscópica permite el diagnóstico en más del 90% de los casos y la instrumentación del espacio pleural complicado, mejorando los resultados de la técnica.MATERIAL Y METODOSe realizó un análisis retrospectivo de pacientes con DPN operados para la realización de una pleurodesis química con talco. Se formaron dos grupos, uno con derrame pleural neoplásico complicado (DPNC) y otro con derrame pleural neoplásico no complicado (DPNNC). En el grupo con DPNC se realizó "maniobras de liberación - expansión". Se compararon las variables entre ambos grupos para el análisis pertinente.RESULTADOSSe analizaron 28 pacientes con DPN tratados con pleurodesis química por cirugía torácica endoscópica. La edad promedio fue de 62,64 años. El compromiso pleural por patología mamaria fue la forma más frecuente (46,4%). No se hubo diferencia en cuanto a complicaciones (p= 0,31) y riesgo de defunción a los 30 días (p=1,09) con el manejo agresivo del espacio pleural. La demora en la indicación de pleurodesis se relacionó con un mayor índice de complicaciones (p=0,002) y mayor probabilidad de defunción dentro de los 30 días (p=0,008). La mayoría de pacientes se reinsertó a sus tareas diarias, con buena tolerancia a la disnea luego del procedimiento.  CONCLUSIONEn los pacientes con DPNC, las "maniobras de liberación - expansión pulmonar" descriptas, aumentarían las chances de mejorar los resultados con bajo riesgo. La pleurodesis química temprana mejora la calidad de vida de los pacientes portadores de un DPN.

Infective Endocarditis in Patients With Bicuspid Aortic Valve or Mitral Valve Prolapse.

PubMed

Zegri-Reiriz, Isabel; de Alarcón, Arístides; Muñoz, Patricia; Martínez Sellés, Manuel; González-Ramallo, Victor; Miro, Jose M; Falces, Carles; Gonzalez Rico, Claudia; Kortajarena Urkola, Xabier; Lepe, José Antonio; Rodriguez Alvarez, Regino; Reguera Iglesias, Jose Maria; Navas, Enrique; Dominguez, Fernando; Garcia-Pavia, Pablo

2018-06-19

There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions. This study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions. This analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group; n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group; n = 1,839), and IE with BAV (n = 54) or MVP (n = 89). BAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0%; all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients. IE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PubMed

De Abajo Larriba, Ana Beatriz; Méndez Rodríguez, Enrique; González-Gallego, Javier; Capón Álvarez, Jessica; Díaz Rodríguez, Ángel; Peleteiro Cobo, Beatriz; Mahmoud Atoui, Omar; De Abajo Olea, Serafín; Martínez de Mandojana Hernández, Juan; Lumbreras González, Víctor

2016-11-29

Objetivos: estimar el porcentaje de pacientes con EPOC adiestrados en la consulta para el manejo de inhaladores en la provincia de León.Métodos: estudio epidemiológico, transversal, multicéntrico (30 centros de salud de la provincia de León). Incluyó pacientes mayores de 35 años diagnosticados y tratados de EPOC. Variables a estudio: edad, sexo, hábitat, datos antropométricos, estado nutricional, tabaquismo, espirometría postboroncodilatadora, disnea (mMRC), reagudizaciones, gravedad (Índice Bodex), hospitalizaciones, tratamiento, seguimiento y caracterización del fenotipo (GesEOPC 2014). Los resultados se expresan con sus IC al 95,5%.Resultados: se incluyeron 833 pacientes, el 85,8% varones, con edad media de 64,69 (53,66-75,61) años y 20,65 (4,47-36,8) años evolución de la EPOC. Empleaban 1,88 (1,64-2,16) dispositivos inhaladores de media, p = 0,006, (57% de forma correcta, 23% regular y el 20% incorrecta). El 20,9% no recibieron adiestramiento para usar inhaladores frente al 79,1% adiestrados, p < 0,001, (9,4% por neumólogos, 20,3% enfermeras y 43,5% médicos familia, p = 0,002). Los pacientes bien adiestrados realizan mejor el tratamiento, en el 60,60% (58,91-62,29), p = 0,002. No hubo diferencias significativas en el adiestramiento por tabaquismo, gravedad, ingresos hospitalarios, ni calidad de vida, obteniendo una reducción significativa del número de agudizaciones, siendo de 1,59 (1,12-2,15) reagudizaciones medias en el grupo adiestrado frente a 3,29 (2,50-4,11) en los no adiestrados, p = 0,002.Conclusiones: el nivel de adiestramiento en el uso de inhaladores en los pacientes con EPOC es insuficiente en nuestro medio. La mejor formación de los profesionales y la simplificación de los dispositivos contribuirán a que un mayor número de pacientes realicen el tratamiento de forma adecuada.

Factors influencing tropical island freshwater fishes:Species, status, and management implications in puerto rico [Factores que influencian a los peces tropicales de agua dulce: Especies, estado actual e implicaciones para el manejo en Puerto Rico

USGS Publications Warehouse

Wesley, Neal J.; Lilyestrom, Craig G.; Kwak, T.J.

2009-01-01

Anthropogenic effects including river regulation, watershed development, contamination, and fish introductions have substantially affected the majority of freshwater habitats in Europe and North America. This pattern of resource development and degradation is widespread in the tropics, and often little is known about the resources before they are lost. This article describes the freshwater resources of Puerto Rico and identifies factors that threaten conservation of native fishes. The fishes found in freshwater habitats of Puerto Rico represent a moderately diverse assemblage composed of 14 orders, 29 families, and 82 species. There are fewer than 10 species of native peripherally-freshwater fish that require a link to marine systems. Introductions of nonindigenous species have greatly expanded fish diversity in freshwater systems, and native estuarine and marine species (18 families) also commonly enter lowland rivers and brackish lagoons. Environmental alterations, including land use and development, stream channelization, pollution, and the impoundment of rivers, combined with nonnative species introductions threaten the health and sustainability of aquatic resources in Puerto Rico. Six principal areas for attention that are important influences on the current and future status of the freshwater fish resources of Puerto Rico are identified and discussed.

Identification of policies for a sustainable legal trade in rhinoceros horn based on population projection and socioeconomic models

PubMed Central

Di Minin, Enrico; Laitila, Jussi; Montesino-Pouzols, Federico; Leader-Williams, Nigel; Slotow, Rob; Goodman, Peter S; Conway, Anthony J; Moilanen, Atte

2015-01-01

policy. El Grano de los Datos de Costo Económico con Referencia Espacial y de Beneficio a la Biodiversidad y la Efectividad de una Estrategia de Determinación de Costos Resumen Entre 1990 y 2007, en promedio fueron cazados ilegalmente cada año 15 rinocerontes sureños blancos (Ceratotherium simum simum) y negros (Diceros bicornis) en Sudáfrica. Desde 2007 la caza ilegal de rinocerontes sureños blancos por su cuerno ha escalado a más de 950 individuos al año en 2013. Llevamos a cabo un análisis ecológico-económico para determinar si el comercio legal de cuerno de rinoceronte sureño blanco podría facilitar la protección del rinoceronte. Se usaron modelos lineales generalizados para examinar a los conductores socio-económicos de la caza furtiva, con base en datos colectados desde 1990 hasta 2013, y también para proyectar el número total de rinocerontes con probabilidad de ser cazados ilegalmente desde 2014 hasta 2023. Las dinámicas poblacionales de los rinocerontes fueron entonces modeladas bajo ocho escenarios políticos diferentes que podrían implementarse para controlar la caza furtiva. También estimamos los costos económicos y los beneficios de cada escenario solamente bajo la ejecución aumentada del plan de manejo y el comercio legal de cuerno de rinoceronte y usamos un marco de trabajo de apoyo a decisiones para ordenar los escenarios con el objetivo de mantener la población de rinocerontes por encima de su tamaño actual mientras se generan ganancias para los accionistas locales. Se predijo que la población de rinocerontes sureños blancos se extinguiría en menos de 20 años bajo el manejo actual. El escenario óptimo para mantener la población de rinocerontes por encima de su tamaño actual fue el de proporcionar un incremento mediano en el esfuerzo contra la caza furtiva e incrementar la multa monetaria de la condena. Sin legalizar el mercado, implementar tal escenario requeriría cubrir costos de aproximadamente $147, 000, 000 al año. Con

Translation, adaptation and validation the contents of the Diabetes Medical Management Plan for the Brazilian context.

PubMed

Torres, Heloísa de Carvalho; Chaves, Fernanda Figueredo; Silva, Daniel Dutra Romualdo da; Bosco, Adriana Aparecida; Gabriel, Beatriz Diniz; Reis, Ilka Afonso; Rodrigues, Júlia Santos Nunes; Pagano, Adriana Silvina

2016-08-08

to translate, adapt and validate the contents of the Diabetes Medical Management Plan for the Brazilian context. This protocol was developed by the American Diabetes Association and guides the procedure of educators for the care of children and adolescents with diabetes in schools. this methodological study was conducted in four stages: initial translation, synthesis of initial translation, back translation and content validation by an expert committee, composed of 94 specialists (29 applied linguists and 65 health professionals), for evaluation of the translated version through an online questionnaire. The concordance level of the judges was calculated based on the Content Validity Index. Data were exported into the R program for statistical analysis. the evaluation of the instrument showed good concordance between the judges of the Health and Applied Linguistics areas, with a mean content validity index of 0.9 and 0.89, respectively, and slight variability of the index between groups (difference of less than 0.01). The items in the translated version, evaluated as unsatisfactory by the judges, were reformulated based on the considerations of the professionals of each group. a Brazilian version of Diabetes Medical Management Plan was constructed, called the Plano de Manejo do Diabetes na Escola. traduzir, adaptar e validar o conteúdo do Diabetes Medical Management Plan para o contexto brasileiro, protocolo elaborado pela Associação Americana de Diabetes, que orienta a conduta dos educadores para o cuidado das crianças e adolescentes com diabetes mellitus nas escolas. trata-se de estudo metodológico, realizado em quatro etapas: tradução inicial, síntese da tradução inicial, retrotradução e validação de conteúdo por um Comitê de Juízes, composto por 94 especialistas (29 linguistas aplicados e 65 profissionais da área da Saúde), para avaliação da versão traduzida por meio de um questionário online. O nível de concordância dos juízes foi

Wet and Wild: A Multidisciplinary Marine Education Teacher Guide, Grades K-6. Unit II. Ocean Management: Who Owns the Sea? =Humedo y Salvaje. Segund Unidad. El Manejo de los Oceanos: Quien Es el Dueno de los Mares?

ERIC Educational Resources Information Center

Murphy, Richard C.

Topics and activities related to ocean management are the focus of this multidisciplinary, marine education teaching guide for students in kindergarten through grade 6. The guide is divided into four sections (labeled A through D). The first three sections consist of various kinds of activities, with the appropriate grade levels (K-6, K-3, or 4-6)…

Examining adherence among challenging patients in public and private HIV care in Argentina

PubMed Central

Jones, Deborah; Cook, Ryan; Cecchini, Diego; Sued, Omar; Bofill, Lina; Weiss, Stephen; Waldrop-Valverde, Drenna; Lopez, Maria R; Spence, Andrew

2015-01-01

Treatment engagement, retention and adherence to care are required for optimal HIV outcomes. Yet, patients may fall below the treatment recommendations for achieving undetectable viral load or not be retained in care. This study examined the most challenging patients in Buenos Aires, Argentina, those non-adherent to HIV care. Men (n = 61) and women (n = 59) prescribed antiretrovirals (ARVs) and non-adherent to treatment in the prior 3 to 6 months were enrolled and assessed regarding adherence, knowledge, motivation and attitudes regarding treatment. Private clinic patients had lower viral load and higher self-reported adherence than public clinic patients. Motivations to be adherent and positive beliefs regarding ARVs were associated with increased adherence in public clinic participants. Increased self-efficacy was associated with increased adherence among participants from both clinics. Results support patient and provider interventions that strengthen the characteristics supporting adherence, engagement and retention in public and private clinic settings. Resumen El compromiso, la retención en el cuidado y adherencia al tratamiento son esenciales para el manejo óptimo del paciente con VIH. Sin embargo, muchos pacientes con VIH no siguen las el tratamiento para lograr tener una carga viral indetectable, o no permanecen bajo cuidado médico. Este estudio examina los pacientes más difíciles de retener en el cuidado médico en Buenos Aires, Argentina. Hombres (n = 61) y mujeres (n = 59) a los que se les habían recetado antiretrovirales pero seguían el tratamiento en los últimos 3 - 6 meses participaron en el estudio. Adherencia, conocimiento, motivación y actitudes frente al tratamiento fueron evaluados. Los pacientes en la clínica privada tenían menor carga viral y mejor adherencia que los de la clínica pública. Motivación y pensamientos positivos con respecto a antiretrovirales estaban asociados con mejor adherencia en los pacientes de la clínica p

Health education with older adults: action research with primary care professionals.

PubMed

Mendonça, Francielle Toniolo Nicodemos Furtado de; Santos, Álvaro da Silva; Buso, Ana Luisa Zanardo; Malaquias, Bruna Stephanie Sousa

2017-01-01

To assess the development and implementation of permanent education action. Quantitative-qualitative research based on action research in three phases (diagnosis of reality, implementation of activity and evaluation), performed with health professionals and managers of basic health units. The evaluation was on the perception of changes immediately following the activity and after 120 days. In the first phase, 110 professionals took part, 36.4% of whom indicated the existence of groups for older adults at work. In the second phase, 98 professionals participated, pointing out interferences of the group in the life of older adults, items of importance and facilitation in forming groups and developing reality-based activities. The third phase showed, in the quantitative analysis, positive impact of the training, and in the qualitative analysis, reassessment of groups, greater knowledge and confidence in managing groups and increased respect for older adults. Permanent education opens pathways for the construction of differentiated care for older adults based on respect and health promotion. Avaliar o desenvolvimento e implementação de uma ação de educação permanente. Pesquisa quantitativo-qualitativa baseada na pesquisa-ação em 3 fases (diagnóstico da realidade, implementação de atividade e avaliação), realizada com profissionais de saúde e gerentes de unidades básicas. A avaliação se deu pela percepção de mudanças imediatamente à atividade e após 120 dias. Na 1ª fase, participaram 110 profissionais, dos quais 36,4% apontaram a existência de grupos para idosos no trabalho. Na 2ª fase, participaram 98 profissionais, que apontaram interferências do grupo na vida do idoso, itens de importância e facilitação para construção de grupos e atividade baseada na realidade. A 3ª fase mostrou, na análise quantitativa, impacto positivo do treinamento; e, na qualitativa, releitura dos grupos e manejo com mais conhecimento, segurança e respeito ao

Preparación de los adultos mayores en los Estados Unidos para hacer frente a los desastres naturales: encuesta a escala nacional*

PubMed Central

Al-rousan, Tala M.; Rubenstein, Linda M.; Wallace, Robert B.

2015-01-01

Objetivos. Nos propusimos determinar el grado de preparación frente a los desastres naturales de los adultos mayores en los Estados Unidos y evaluar los factores que pueden afectar negativamente la salud y la seguridad durante este tipo de incidentes. Métodos. Obtuvimos una muestra de adultos de 50 años en adelante (n = 1 304) de la encuesta del 2010 del Estudio de la Salud y la Jubilación (HRS por su sigla en inglés). La encuesta recogió datos sobre las características demográficas generales, el estado de discapacidad o las limitaciones funcionales, y también sobre factores y comportamientos relacionados con la preparación frente a los desastres. Calculamos una puntuación global de preparación mediante indicadores individuales a fin de evaluar el grado de preparación general. Resultados. La media de la edad de los participantes (n = 1 304) fue de 70 años (desviación estándar [DE] = 9,3). Solo 34,3% informaron que habían participado en un programa formativo o que habían leído materiales sobre la preparación para los desastres. Casi 15% indicaron que usaban dispositivos médicos eléctricos que podían correr riesgo de no funcionar si se interrumpiera el suministro eléctrico. La puntuación de preparación indicó que la edad más avanzada, la discapacidad física y el menor nivel de escolaridad y de ingresos se asociaban independiente y significativamente a un grado de preparación general inferior. Conclusiones. A pesar de la mayor vulnerabilidad ante los desastres y del número cada vez mayor de adultos mayores en los Estados Unidos, muchos de los problemas sustanciales que encontramos son remediables y requieren atención en los sectores de la sociedad dedicados a la atención clínica, a la salud pública y al manejo de situaciones de emergencia.

NCD Prevention and Control in Latin America and the Caribbean: A Regional Approach to Policy and Program Development.

PubMed

Hospedales, C James; Barcelo, Alberto; Luciani, Silvana; Legetic, Branka; Ordunez, Pedro; Blanco, Adriana

2012-03-01

This article describes efforts from the Pan American Health Organization (PAHO) that have supported progress in country-driven planning and implementing of actions to address noncommunicable diseases (NCD), as well as mechanisms that PAHO has supported for countries in the Americas to share and build on each other's experiences. The Regional Strategy and Plan of Action for NCD, approved by all member states in 2006, is the major frame for this work. The strategy has 4 lines of action: policy and advocacy; surveillance; health promotion and disease prevention; and integrated management of NCD and risk factors. Cross-cutting strategies include resource mobilization, communication, training, and networks and partnerships. The strategy is operationalized through biannual work plans for which countries link and commit to achieving specific objectives. PAHO then provides technical support toward achieving these plans, and countries report progress annually. The CARMEN (Collaborative Action for Risk Factor Prevention and Effective Management of NCD [Conjunto de Acciones para la Reducción y el Manejo de las Enfermedades No transmisibles]) Network provides a major platform for sharing, and the multisector Pan American Forum for Action on NCD has been launched to extend the network to include business and civil society. PAHO also supported civil society capacity building. Almost all member states have made substantial progress in implementing their national chronic disease programs, in most instances reporting exceeding the indicators of the strategic plan related to chronic diseases. From the Caribbean countries, leadership has been provided to achieve the historic UN High-Level Meeting on NCD in September 2011. The region is on track to meet the mortality reduction target set for 2013, though much remains to be done to further increase awareness of and resources for scaling up NCD prevention and control programs, given the huge health and economic burden, increasing costs

Desarrollo y validación de una nueva tecnología, basada en arginina al 1.5%, un compuesto de calcio insoluble y fluoruro, para el uso diario en la prevención y tratamiento de la caries dental.

PubMed

Cummins, D

2013-10-22

este artículo discute brevemente la prevalencia de caries, la naturaleza multifactorial de su etiología, el riesgo de caries y el papel y eficacia del fluoruro. Resalta también la investigación sobre el metabolismo bacteriano, que ha aportado conocimientos sobre la defensa natural oral contra la caries y la base para el desarrollo de una nueva tecnología para la prevención diaria y el tratamiento de la caries. Por último, se resume la evidencia que respalda que la tecnología complementa y mejora la eficacia anti-caries de la crema dental con fluoruro. los datos globales muestran que a pesar de la exitosa introducción del fluoruro, la caries dental es una enfermedad prevalente. La experiencia de caries depende del balance entre el consumo de azúcares, la higiene oral y el uso del fluoruro. Hay tres conceptos científicos que son fundamentales en las nuevas mediciones para detectar, tratar y monitorear la caries: (1) la caries dental es un proceso dinámico, (2) la caries dental es un proceso continuo de etapas que van desde reversible (pre-clínica) hasta irreversible (lesiones clínicamente detectables), y (3) el proceso de la caries es un balance de factores patológicos y protectores que pueden modularse para el manejo de la caries. El fluoruro funciona como factor protector al detener y revertir el proceso de la caries, pero el fluoruro no previene los factores patológicos que inician el proceso. Se ha identificado una tecnología novedosa, basada en arginina y un compuesto insoluble de calcio, que está dirigida a la placa dental para prevenir la iniciación del proceso de caries al reducir los factores patológicos. Como los mecanismos de acción de la arginina y el fluoruro son altamente complementarios, se ha desarrollado un nuevo dentífrico que combina la arginina y el fluoruro, y se ha probado clínicamente que brinda una prevención superior contra la caries. Copyright © 2013 Elsevier Ltd. All rights reserved.

Hepcidin: an important iron metabolism regulator in chronic kidney disease.

PubMed

Antunes, Sandra Azevedo; Canziani, Maria Eugênia Fernandes

2016-01-01

Anemia is a common complication and its impact on morbimortality in patients with chronic kidney disease (CKD) is well known. The discovery of hepcidin and its functions has contributed to a better understanding of iron metabolism disorders in CKD anemia. Hepcidin is a peptide mainly produced by hepatocytes and, through a connection with ferroportin, it regulates iron absorption in the duodenum and its release of stock cells. High hepcidin concentrations described in patients with CKD, especially in more advanced stages are attributed to decreased renal excretion and increased production. The elevation of hepcidin has been associated with infection, inflammation, atherosclerosis, insulin resistance and oxidative stress. Some strategies were tested to reduce the effects of hepcidin in patients with CKD, however more studies are necessary to assess the impact of its modulation in the management of anemia in this population. Resumo Anemia é uma complicação frequente e seu impacto na morbimortalidade é bem conhecido em pacientes com doença renal crônica (DRC). A descoberta da hepcidina e de suas funções contribuíram para melhor compreensão dos distúrbios do metabolismo de ferro na anemia da DRC. Hepcidina é um peptídeo produzido principalmente pelos hepatócitos, e através de sua ligação com a ferroportina, regula a absorção de ferro no duodeno e sua liberação das células de estoque. Altas concentrações de hepcidina descritas em pacientes com DRC, principalmente em estádios mais avançados, são atribuídas à diminuição da excreção renal e ao aumento de sua produção. Elevação de hepcidina tem sido associada à ocorrência de infecção, inflamação, aterosclerose, resistência à insulina e estresse oxidativo. Algumas estratégias foram testadas para diminuir os efeitos da hepcidina em pacientes com DRC, entretanto, serão necessários mais estudos para avaliar o impacto de sua modulação no manejo da anemia nessa população.

Implementación de un modelo de capacitación multimedial para brindar orientación alimentaria a los beneficiarios de un programa de ayuda social en México.

PubMed

Amaya-Castellanos, Maritza Alejandra; Morales-Ruan, María Del Carmen; Uribe-Carvajal, Rebeca; Jiménez-Aguilar, Alejandra; Salazar-Coronel, Araceli Apolonia; Martínez-Tapia, Brenda; Shamah-Levy, Teresa

2018-03-01

Introducción: Se implementó un modelo de capacitación en orientación alimentaria para la población beneficiaria y el personal operativo del Programa de Abasto Rural (PAR) de Diconsa, el cual es una iniciativa social de ayuda alimentaria que abastece productos básicos y complementarios, además de brindar capacitación en localidades de alta marginación en México. Objetivo: Documentar la utilización de la Metodología de Capacitación Multimedial (MCM) en el desarrollo de un esquema de capacitación sobre orientación alimentaria y su implementación en la población beneficiaria del PAR, a través de la propia estructura operativa del PAR. Metodología: El modelo se fundamenta en la MCM, integrada por cuatro elementos didácticos e indivisibles que conforman el paquete pedagógico multimedial (PPM), compuesto a su vez por tres videos y rotafolios, material impreso, prácticas y las relaciones interpersonales. Los ejes temáticos fueron: alimentación correcta para una vida saludable, alimentación materno-infantil, elecciones saludables y gasto familiar. El modelo fue replicado en cascada en los tres niveles operativos del PAR (responsables de capacitación, supervisores operativos y beneficiarios del PAR), con un componente de multiplicación horizontal, e implementado como piloto en cuatro estados de México. Resultados: Se observó un cambio positivo sobre los conocimientos en alimentación correcta en todos los niveles de capacitación, principalmente en los beneficiarios del PAR. La evaluación del proceso mostró conocimientos previos de los responsables de capacitación en los temas, buen desempeño como facilitadores, y habilidades de presentación y manejo del grupo de los supervisores operativos. A partir de las evaluaciones y del acompañamiento en la prueba piloto, fueron modificados las actividades, las estrategias y los materiales educativos del PPM. Conclusiones: La capacitación multimedial y la educación nutricional promueven procesos de

A Simple But Comprehensive Methodology To Determine Gas-Phase Emissions Of Motor Vehicles With Extractive FTIR Spectrometry

NASA Astrophysics Data System (ADS)

Reyes, F. M.; Jaczilevich, A.; Grutter, M. A.; Huerta, M. A.; Rincón, P.; Rincón, R.; González, R.

2004-12-01

In this contribution, a methodology to acquire valuable information on the chemical composition and evolution of vehicular emissions is presented. With this innovative experimental set-up, it is possible to obtain real-time emissions of the combustion products without the need of dilution or sample collection. Key pollutants such as CO, CO2, H2CO, CH4, NO, N2O, NH3, SO2, CH3OH, acetylene, ethylene, ethane and total hydrocarbons, most of which are not regulated nor measured by current emissions control programs, can be accurately monitored with a single instrument. An FTIR spectrometer is used for the analysis of a constant flow of sample gas from the tail-pipe into a stainless-steel cylindrical cell of constant volume.(1) The cell is heated to 185 °C to avoid condensation, the pressure is kept constant and a multi-pass optical arrangement(2)is used to transmit the modulated infrared beam several times to improve the sensitivity. The total flow from the exhaust used for calculating the emission can be continuously determined from the differential pressure measurements from a "Pitot" tube calibrated against a hot-wire devise. This simple methodology is proposed for performing state-of-the-art evaluations on the emission behavior of new technologies, reformulated fuels and emission control devices. The results presented here were performed on a dynamometer running FTP-75 and driving cycles typical for Mexico City.(3,4) References 1. Grutter M. "Multi-Gas Analysis using FTIR Spectroscopy over Mexico City." Atmosfera 16, 1-16 (2003). 2. White J.U. "Long optical paths of large aperture. J. Opt. Soc. Am., 32, 285-288 (1942). 3. Santiago Cruz L. and P.I. Rincón. "Instrumentation of the Emission Control Laboratory at the Engineering School of the National Autonomous University of Mexico." Instrumentation and Development 4, 19-24, (2000). 4. González Oropeza R. and A. Galván Zacarías. "Desarrollo de ciclos de manejo característicos de la Ciudad de México." Memorias

[Not Available].

PubMed

Baladia, Eduard; Frutos Pérez-Surio, Alberto; Martínez-Rodríguez, Rodrigo

2016-06-30

Objetivos: dar a conocer las recomendaciones relacionadas con la Nutrición Humana y Dietética (NHyD) de la Guía de Práctica Clínica para el manejo de la enfermedad de Parkinson del Sistema Nacional de Salud (GPC-EP/SNS) y favorecer su difusión e implementación en la práctica. El objetivo secundario es presentar la implicación de los profesionales de la NHyD en la elaboración de la guía.Material y métodos: siguiendo el Manual Metodológico de Elaboración de Guías de Práctica Clínica en el Sistema Nacional de Salud, se formularon las preguntas clínicas, se realizó una búsqueda sistemática para cada pregunta en bases de datos (PubMed/Medline, Embase, Cochrane Library, CRD, LILACS, IBECS y ClinicalTrials), se definieron los criterios de elegibilidad, al menos dos investigadores seleccionaron los estudios, se realizó lectura crítica de la literatura se resumió en tablas de síntesis de evidencia y se establecieron las recomendaciones.Resultados: se propusieron 14 preguntas relacionadas directamente con NHyD-Parkinson, de las cuales solamente 3 pudieron incluirse. Se formuló una pregunta relacionada con la terapia de logopedia aplicada en personas con EP que presentan problemas de deglución, tratamiento donde se imbrican los profesionales de la NHyD. De 642 artículos localizados, únicamente 2 pudieron ser incluidos para contestar las correspondientes preguntas. De las evidencias halladas, se derivaron 11 recomendaciones directa o indirectamente relacionados con la NHyD.Conclusiones: la implicación de profesionales sanitarios en equipos multidisciplinares mejora el resultado final de las guías y la atención sanitaria de los pacientes. Es necesario que los profesionales sanitarios de la NHyD (los/las dietistas-nutricionistas) se impliquen en iniciativas basadas en la mejor evidencia científica disponible y que formen parte de los equipos de trabajo multidisciplinares.

Prevention of chronic complications of diabetes mellitus according to complexity.

PubMed

Salci, Maria Aparecida; Meirelles, Betina Hörner Schlindwein; Silva, Denise Maria Vieira Guerreiro da

2017-01-01

To assess the prevention by primary health care providers of chronic complications of diabetes mellitus according to the complex thinking theoretical approach. Evaluative research based on the complex thinking theoretical approach. The following techniques for data collection were used: interviews with 38 participants; observation in collective and individual appointments; and analysis of medical records of people with diabetes. The triangulation applied for data analysis was the ATLAS.ti software. The prevention and management of chronic complications of diabetes did not meet the requirements set forth by ministerial public policies aimed at this population. Systematic monitoring to prevention of chronic complications showed significant gaps. Primary health care did not consider preventive actions for diabetes mellitus complications. This context was marked by disjunctive, fragmented, and dissociated practices types of care targeted to the totality of the assisted people. Avaliar a prevenção de complicações crônicas do diabetes mellitus a luz do referencial teórico do Pensamento Complexo por integrantes da atenção primária à saúde. Pesquisa avaliativa, que teve como referencial teórico o Pensamento Complexo. Como técnicas de coleta de dados foram utilizadas: entrevista com 38 participantes; observação nos atendimentos coletivos e individuais;e análise em 25 prontuários de pessoas com diabetes. A triangulação subsidiou a análise de dados que teve auxílio do software ATLAS.ti. A prevenção e o manejo das complicações crônicas do diabetes não atendiam ao estabelecido nas políticas públicas ministeriais destinadas a esse público. O acompanhamento sistematizado para controle da prevenção das complicações crônicas apresentou importantes lacunas. A assistência na atenção primária não contemplava ações de prevenção de complicação do diabetes mellitus. Esse contexto era por marcado por práticas disjuntivas, fragmentadas e

PROPOSAL OF A REVISIONAL SURGERY TO TREAT SEVERE NUTRITIONAL DEFICIENCY POST-GASTRIC BYPASS.

PubMed

Sampaio-Neto, José; Branco-Filho, Alcides José; Nassif, Luis Sérgio; Nassif, André Thá; Masi, Flávia David João De; Gasperin, Graciany

ástrico. Como estratégia adicional, é realizada ressecção do fundo gástrico, visando intensificar a supressão da grelina e evitando reganho excessivo de peso. Após estabilização inicial com suporte hidroeletrlítico e nutricional, o procedimento foi realizado em dois pacientes como tratamento definitivo do quadro de desnutrição. Bons resultados foram observados em seguimento de um ano. Como opção de melhora e/ou resolução da defasagem nutricional, a terapia cirúrgica é uma das alternativas. Ainda não há consenso quanto à técnica a ser utilizada. O procedimento aqui apresentado é baseado em fatores fisiopatológicos para o tratamento desta condição, com bons resultados iniciais, sem efeitos colaterais significativos. Seguimento de mais longo prazo é necessário para determinação de sua eficácia.

Hazard Evaluation in Valparaíso: the MAR VASTO Project

NASA Astrophysics Data System (ADS)

Indirli, Maurizio; Razafindrakoto, Hoby; Romanelli, Fabio; Puglisi, Claudio; Lanzoni, Luca; Milani, Enrico; Munari, Marco; Apablaza, Sotero

2011-03-01

The Project "MAR VASTO" (Risk Management in Valparaíso/Manejo de Riesgos en Valparaíso), funded by BID/IADB (Banco InterAmericano de Desarrollo/InterAmerican Development Bank), has been managed by ENEA, with an Italian/Chilean joined partnership and the support of local institutions. Valparaíso tells the never-ending story of a tight interaction between society and environment and the city has been declared a Patrimony of Humanity by UNESCO since 2003. The main goals of the project have been to evaluate in the Valparaíso urban area the impact of main hazards (earthquake, tsunami, fire, and landslide), defining scenarios and maps on a geo-referenced GIS database. In particular, for earthquake hazard assessment the realistic modelling of ground motion is a very important base of knowledge for the preparation of groundshaking scenarios which serve as a valid and economic tool to be fruitfully used by civil engineers, supplying a particularly powerful tool for the prevention aspects of Civil Defense. When numerical modelling is successfully compared with records (as in the case of the Valparaíso, 1985 earthquake), the resulting synthetic seismograms permit the generation of groundshaking maps, based upon a set of possible scenario earthquakes. Where no recordings are available for the scenario event, synthetic signals can be used to estimate ground motion without having to wait for a strong earthquake to occur (pre-disaster microzonation). For the tsunami hazard, the available reports, [e.g., SHOA (1999) Carta de Inundacion por Tsunami para la bahia de Valparaíso, Chile, http://www.shoa.cl/servicios/citsu/citsu.php], have been used as the reference documents for the hazard assessment for the Valparaíso site. The deep and detailed studies already carried out by SHOA have been complemented with (a) sets of parametric studies of the tsunamigenic potential of the 1985 and 1906 scenario earthquakes; and (b) analytical modelling of tsunami waveforms for different

[Not Available].

PubMed

Germán Díaz, Marta; Moreno Villares, José Manuel; Gomis Muñoz, Pilar

2016-07-19

Introducción: la nutrición parenteral domiciliaria se ha convertido en un punto clave en el tratamiento de pacientes con fracaso intestinal crónico. A pesar de los importantes avances que se han producido en las últimas décadas, tanto en los accesos vasculares, como en las soluciones empleadas, las infecciones asociadas a catéter venoso central siguen constituyendo una de las complicaciones más importantes. Dentro de las estrategias para la prevención o el tratamiento de estas infecciones se encuentra el empleo de sellados con antisépticos, como el etanol o la taurolidina, o de antibióticos.Objetivo: el objetivo de este artículo es revisar la evidencia disponible sobre el empleo de sellados con antisépticos o antibióticos en el manejo de pacientes pediátricos con nutrición parenteral domiciliaria.Material y métodos: el uso de sellados con etanol o taurolidina para prevenir el desarrollo de infecciones asociadas a catéter central estaría indicado en pacientes con nutrición parenteral domiciliaria que hayan tenido más de una infección en el año anterior o que se consideren pacientes de riesgo. Los sellados con antibióticos están indicados en el tratamiento de bacteriemias asociadas a catéter central producidas por S. coagulasa-negativo o gramnegativos, asociados a un tratamiento sistémico, siempre que sea posible, con el fin de salvar el catéter. Se debería llevar a cabo la retirada del mismo cuando existan signos de infección del punto de entrada o del trayecto subcutáneo, o cuando el germen responsable de la infección sea S. aureus o Cándida.Conclusión: a pesar de que la fuerza de la evidencia sobre la eficacia del sellado en la prevención o el tratamiento de infecciones asociadas al catéter es limitada, tanto en el niño como en el adulto, cada vez existen más datos a usar esta alternativa en pacientes con nutrición parenteral domiciliaria en los que la atención y salvaguarda de los catéteres es primordial.

Myocardial Viability on Cardiac Magnetic Resonance.

PubMed

Souto, Ana Luiza Mansur; Souto, Rafael Mansur; Teixeira, Isabella Cristina Resende; Nacif, Marcelo Souto

2017-05-01

The study of myocardial viability is of great importance in the orientation and management of patients requiring myocardial revascularization or angioplasty. The technique of delayed enhancement (DE) is accurate and has transformed the study of viability into an easy test, not only for the detection of fibrosis but also as a binary test detecting what is viable or not. On DE, fibrosis equal to or greater than 50% of the segmental area is considered as non-viable, whereas that below 50% is considered viable. During the same evaluation, cardiac magnetic resonance (CMR) may also use other techniques for functional and perfusion studies to obtain a global evaluation of ischemic heart disease. This study aims to highlight the current concepts and broadly emphasize the use of CMR as a method that over the last 20 years has become a reference in the detection of infarction and assessment of myocardial viability. Resumo O estudo de viabilidade miocárdica é de grande importância para a orientação e manejo de pacientes que necessitam de cirurgia de revascularização miocárdica ou angioplastia. A técnica de realce tardio (RT) é precisa e transformou o estudo de viabilidade em um teste fácil, não só para a detecção de fibrose, mas também como um modelo binário para a detecção do que é ou não é viável. Uma fibrose identificada pelo RT é considerada como não viável quando igual ou maior do que 50% da área segmentar e como viável quando menor que 50%. A ressonância magnética cardíaca (RMC) também pode lançar mão de outras técnicas para estudo funcional e de perfusão para uma avaliação global da doença isquêmica do coração no mesmo exame. Este estudo tem como objetivo destacar os conceitos atuais e enfatizar amplamente o uso da RMC como um método que nos últimos 20 anos se tornou referência na detecção de infarto e avaliação de viabilidade miocárdica.

Educación sobre sexualidad y prevención del VIH: un diagnóstico para América Latina y el Caribe

PubMed Central

DeMaria, Lisa M.; Galárraga, Omar; Campero, Lourdes; Walker, Dilys M.

2016-01-01

RESUMEN Objetivo Mostrar, a través de un diagnóstico en América Latina y el Caribe, el panorama legislativo y curricular sobre sexualidad y prevención contra el virus de inmunodeficiencia humana (VIH) en el ámbito escolar, contrastándolo con los comportamientos sexuales reportados en encuestas demográficas y de salud. Métodos En mayo de 2008 se realizó, con el apoyo del Fondo de Población de las Naciones Unidas (UNFPA), una encuesta a informantes clave en 34 países de la Región. El cuestionario autoaplicado solicitó información sustantiva de agentes de las diferentes partes interesadas, como ministerios de educación y de salud, sobre los programas de prevención contra el VIH/Sida que se están aplicando en las escuelas. Resultados Respondieron a la encuesta 27 países que representan 95,5% de la población objetivo (6 a 18 años de edad). La mayoría de los países informó tener al menos un libro de texto o un capítulo específico para enseñar los temas de educación sobre sexualidad y prevención del VIH. En la escuela secundaria se cubren la mayor parte de los temas pertinentes relevantes para la educación sobre sexualidad, pero no todos. Por ejemplo, el problema de la discriminación por orientación o preferencia sexual no se incluye en los programas escolares. Conclusiones El material educativo sobre sexualidad debe ser revisado y actualizado periódicamente de modo que refleje los avances en los temas y en la forma de tratar los contenidos. En cada país el currículo debe abordar el tema del respeto a la diversidad sobre orientación, preferencia e identidad sexuales, y en particular el manejo apropiado de la educación para prevenir infecciones de transmisión sexual (ITS) en hombres que tienen sexo con hombres. Los esfuerzos de evaluación de la efectividad de los programas deben contemplar desenlaces tales como marcadores biológicos (incidencia y prevalencia de ITS y embarazo) y no únicamente indicadores de conocimiento y

Professionals and interfamily violence against children and adolescents: in between legal and conceptual precepts.

PubMed

Schek, Gabriele; Silva, Mara Regina Santos da; Lacharité, Carl; Bueno, Maria Emilia Nunes

2016-01-01

To identify the conceptions of professionals regarding interfamily violence against children and adolescents. A qualitative study conducted with 15 professionals who had taken children and adolescents under their care as a result of interfamily violence. Data were collected between November, 2013, and March, 2015, through semi-structured interviews. Data were organized and analyzed using the Textual Discourse Analysis technique. The professional discourse highlighted that some legal aspects regarding the handling of interfamily violence against children and adolescents are neglected; an omission supported by the justification of professionals to preserve the family. We highlight the confrontation between the concept of family as a caregiver and the family that commits violence against children, in addition to the positioning of professionals, which does not include the family or the aggressor in the intervention process in facing situations of interfamily violence attended to by the services. Acting against interfamily violence requires professionals to do away with some pre-established concepts in ordee to put the actual needs of victims and families into evidence. Identificar, com base no discurso dos profissionais, suas concepções a respeito da violência intrafamiliar contra crianças e adolescentes. Estudo qualitativo, realizado com 15 profissionais, que tiveram sob seus cuidados crianças e adolescentes atendidas em decorrência da violência intrafamiliar. Os dados foram coletados entre novembro de 2013 e março de 2015, por meio de entrevistas semiestruturadas. Os dados foram organizados e analisados utilizando a técnica de Análise Textual Discursiva. O discurso dos profissionais colocou em evidência que alguns aspectos legais em relação ao manejo da violência intrafamiliar contra crianças e adolescentes são negligenciados, omissão respaldada pela justificativa dos profissionais de preservar a família. Destaca-se o confronto entre a concep

Analyzing the concept of disruptive behavior in healthcare work: an integrative review.

PubMed

Oliveira, Roberta Meneses; Silva, Lucilane Maria Sales da; Guedes, Maria Vilani Cavalcante; Oliveira, Adriana Catarina de Souza; Sánchez, Rosario Gómez; Torres, Raimundo Augusto Martins

2016-01-01

ízos laborais, rompimento da comunicação, da colaboração e do trabalho em equipe. A análise do conceito comportamento destrutivo no trabalho em saúde evidenciou, em sua fase teórica, um constructo que abrange diferentes condutas desrespeitosas adotadas por trabalhadores de saúde no contexto hospitalar, merecendo atenção de lideranças da área para maior reconhecimento e manejo adequado dos casos e suas consequências.

Cross-cultural adaptation of the Chilean version of the Voice Symptom Scale - VoiSS.

PubMed

Ruston, Francisco Contreras; Moreti, Felipe; Vivero, Martín; Malebran, Celina; Behlau, Mara

cinco fonoaudiólogos, que llegaron a un consenso de donde surgió la denominada Escala de Síntomas Vocales - ESV, compuesta de 30 preguntas y 5 respuestas: "Nunca", "Casi nunca", "A veces", "Casi siempre", "Siempre". Con el objetivo de lograr la equivalencia cultural, la ESV fue aplicada a 15 individuos con problemas vocales. A cada pregunta se le agregó la opción "No aplicable" en las elecciones de respuesta, con el fin de identificar preguntas incomprendidas o inapropiadas para la población en cuestión. Dos de los individuos tuvieron dificultades en el momento de contestar dos preguntas, haciéndose necesario adaptar solamente la traducción de una de ellas. La ESV modificada fue aplicada a tres personas más con problemas vocales, no encontrándose preguntas incomprendidas o inapropiadas para la cultura Chilena. La ESV refleja la versión original de inglés, tanto en la cantidad de preguntas como en la limitación de los dominios emocional y físico. Existe una equivalencia cultural del VoiSS para el Español Chileno, que recibe el nombre de ESV. La validación de la ESV para el Español Chileno está en proceso de conclusión.

ASSESSMENT FORM - NEW IMPROVEMENT OF ACTIONS: CONCENTRATION AND RESEARCH AREAS / CURRICULUM STRUCTURE / FUNDRAISING.

PubMed

Calderon, Iracema Mp

2015-01-01

AC, LP e PP, com substancial vínculo entre atividades e competências do corpo de docentes permanentes e embasamento da grade curricular na formação do aluno. A Proposta do Programa interfere, e muito, na qualificação de um programa. A estrutura curricular deverá dar subsídio à formação do pesquisador, por meio das disciplinas nucleares, e ao desenvolvimento dos PP, de competência das disciplinas de apoio às linhas e aos projetos de pesquisa. Os fomentos devem ser indicados nos projetos de pesquisa e no CV-Lattes dos beneficiados/responsáveis pelos projetos. A área recomenda que, no mínimo, 40 a 50% dos docentes permanentes apresentem captação de recursos e que o mínimo de 20 a 25% desses docentes tenham bolsa de produtividade PQ/CNPq durante o triênio. Há que se promover ampla discussão e encontrar um denominador de consenso para essas questões. As ações deverão contribuir para o aprimoramento das fichas de avaliação e, certamente, para a qualificação dos programas de pós-graduação.

Teaching and learning the geological knowledge as a part of the science education general field

NASA Astrophysics Data System (ADS)

Aguirre-Pérez, Constancio

2010-05-01

space sciences" emphasizes still further such character receiving the contributions of physics, chemistry, biology and environmental science in a kind of scientific-technical mixture which enriches the discipline itself and constitutes a fundamental basis for the evolution of knowledge in its broadest sense (Martinez Frias et al. 2008). In this paper we propose to show some of the experiences and didactic innovations in the teaching of geology found in the scientific literature in recent years and likewise part of an author's own work on the establishment of analogies on the time variable based on Carl Sagan's cosmic calendar. With these analogies we try to approximate geologic times to the understanding of high school and first university courses students (Aguirre-Perez, C. 2008) REFERENCES ALIBERAS, J. GUTIÉRREZ, R. and IZQUIERDO, M. (1989). La Didáctica de las Ciencias: Una empresa racional. Enseñanza de las Ciencias, 7 (3), pp. 227-284. GUTIÉRREZ, R. (1987). Psicología y aprendizaje de las Ciencias. El modelo de Ausubel. Enseñanza de las Ciencias, 5 (2), pp. 118-128. MARTÍNEZ FRÍAS, J. LUNAR, R. RODRÍGUEZ-LOSADA, J.A. EFF-DARWICH, A. and MADERO JARABO, J. (2008)"La Geología en la exploración planetaria (Geology inplanetary exploration). Geo-temas 10, pp. 1621-1624. PEDRINACI, E. (2000): La Enseñanza y el aprendizaje del conocimiento geológico. Didáctica de las Ciencias Experimentales. Teoría y Práctica de la Enseñanza de las ciencias, pp. 479-503. Ed. Marfil.

Risk management in providing specialized care for people living with AIDS.

PubMed

Leadebal, Oriana Deyze Correia Paiva; Medeiros, Leidyanny Barbosa de; Morais, Kalline Silva de; Nascimento, João Agnaldo do; Monroe, Aline Aparecida; Nogueira, Jordana de Almeida

2016-01-01

Analyzing the provision of actions related to managing clinical risk in managing specialized care for people living with AIDS. A cross-sectional study carried out in a reference outpatient clinic in Paraíba, with a sample of 150 adults with AIDS. Data were collected through primary and secondary sources using a structured questionnaire, analyzed using descriptive statistics, multiple correspondence analysis and logistic regression model to determine the association between "providing care" and "clinical risk." Actions with satisfactory provision express a biological care focus; the dimensions that most contributed to a satisfactory assessment of care provision were "clinical and laboratory evaluations" and "prevention and self-care incentivization"; 45.3% of participants were categorized into high clinical risk, 34% into average clinical risk, and 20.7% into low clinical risk; a positive association between providing care and clinical risk was found. The need to use risk classification technologies to direct the planning of local care provision became evident considering its requirements, and thus qualifying the care provided in these areas. Analisar a oferta de ações relacionadas ao manejo de risco clínico na gestão do cuidado especializado a pessoas vivendo com aids. Estudo transversal realizado em ambulatório de referência na Paraíba, com amostra de 150 adultos com aids. Os dados foram coletados por meio de fontes primárias e secundárias utilizando-se de formulário estruturado, e analisados através de estatística descritiva, análise de correspondência múltipla e modelo de regressão logística para averiguar a associação entre "oferta" e "risco clínico". As ações de oferta satisfatória expressam foco biologicista do cuidado; as dimensões que mais contribuíram para o julgamento satisfatório da oferta foram "avaliação clínica e laboratorial" e "prevenção e estímulo ao autocuidado"; 45,3% dos participantes foram categorizados em risco

Voting Systems for Environmental Decisions

PubMed Central

BURGMAN, MARK A; REGAN, HELEN M; MAGUIRE, LYNN A; COLYVAN, MARK; JUSTUS, JAMES; MARTIN, TARA G; ROTHLEY, KRIS

2014-01-01

propiedades difíciles de los sistemas de votación sobresalen en las tomas de decisiones rutinarias cuando hay criterios múltiples y alternativas de manejo. Ya que ambos métodos tienen fallas, no apoyamos a uno sobre el otro. En lugar de esto le pedimos urgentemente a los organizadores ser transparentes con respecto a las propiedades de los sistemas de votación y ofrecer a los participantes la oportunidad de aprobar el sistema de votación como parte de las reglas básicas para la operación de un grupo. PMID:24423154

Cardiac Amyloidosis and its New Clinical Phenotype: Heart Failure with Preserved Ejection Fraction.

PubMed

Mesquita, Evandro Tinoco; Jorge, Antonio José Lagoeiro; Souza, Celso Vale; Andrade, Thais Ribeiro de

2017-07-01

esta etiologia em casos suspeitos. Deve-se aumentar a suspeição clínica de amiloidose diante dos casos de ICFEP onde os métodos de cardioimagem sejam compatíveis com o quadro de cardiomiopatia infiltrativa. Os avanços nos métodos de cardioimagem aliados à possibilidade de realização de testes genéticos e identificação do tipo do material amiloide permitem a realização do diagnóstico. O manejo dos pacientes diagnosticados pode ser feito em parceria com centros especializados no estudo de amiloidose, que, aliados às novas tecnologias, investigam a possibilidade de transplante de órgãos ou medula óssea e também o envolvimento dos pacientes em estudos clínicos que avaliam a ação das novas drogas emergentes.

EFFECT OF SIZE OF INTESTINAL DIVERSIONS IN OBESE PATIENTS WITH METABOLIC SYNDROME SUBMITTED TO GASTRIC BYPASS.

PubMed

Ramos, Rafael Jacques; Mottin, Cláudio Corá; Alves, Letícia Biscaino; Benzano, Daniela; Padoin, Alexandre Vontobel

There is no consensus on the ideal size of intestinal loops in gastric bypass of bariatric surgeries. To evaluate the metabolic outcome of patients submitted to gastric bypass with alimentary and biliopancreatic loops of different sizes. Was conducted a retrospective cohort study in diabetic obese patients (BMI≥35 kg/m2) with metabolic syndrome submitted to gastric bypass. The patients were divided into three groups according to the size of the intestinal loop: group 1, biliopancreatic limb 50 cm length and alimentary limb 100 cm length; group 2 , biliopancreatic limb 50 cm length and alimentary limb 150 cm length; and group 3, biliopancreatic limb 100 cm length and alimentary limb 150 cm length. The effect of gastric bypass with different sizes of intestinal loops in relation to the parameters that define metabolic syndrome was determined. Sixty-three patients were evaluated, and they had a mean age of 44.7±9.4 years. All were diabetics, with 62 (98.4%) being hypertensive and 51 (82.2%) dyslipidemic. The three groups were homogeneous in relation to the variables. In 24 months, there was a remission of systemic arterial hypertension in 65% of patients in group 1, 62.5% in group 2 and 68.4% in group 3. Remission of diabetes occurred in 85% of patients in group 1, 83% in group 2 and 84% in group 3. There was no statistical difference in %LEW between the groups, and waist measurements decreased in a homogeneous way in all groups. The size of loops also had no influence on the improvement in dyslipidemia. Variation in size of intestinal loops does not appear to influence improvement in metabolic syndrome in this group of patients. Não há consenso sobre o tamanho ideal das alças intestinais no bypass gástrico em Y-de-Roux em cirurgias bariátricas. Avaliar os desfechos metabólicos de pacientes submetidos ao bypass gástrico com alça intestinal alimentar e biliopancreática de tamanhos diferentes. Realizou-se coorte retrospectiva em pacientes obesos (IMC≥35 kg

EFFECTIVE INDICATORS FOR SCIENCE INTERNATIONALIZATION.

PubMed

Cunha-Melo, José Renan da

2015-01-01

ções, explorando o potencial para cooperação internacional interdisciplinar de cada laboratório, departamento, universidade ou instituto. Procura de indicadores que possam avaliar o grau de internacionalização das universidades e institutos de pesquisa em vários níveis interconectados: organizacional, regional, setorial e global e para definição de políticas nas áreas de ciência, tecnologia inovação e educação superior. A pesquisa científica ainda é realizada individualmente, mas está atualmente muito mais intimamente integrada a outros processos sociais. O cientista não é mais um estranho que tem permissão para entregar-se ao seu passatempo de fazer aquilo que bem entende. Internacionalização da pesquisa e da educação médica, embora esteja entre os tópicos de maior reconhecimento como sendo necessidade do mundo globalizado, é atividade difícil de ser avaliada. Os governantes parecem ter entendido que as sociedades do conhecimento, induzindo a política econômica baseada no conhecimento pode resultar em progresso econômico e social das nações. Esse fato tem motivado de forma crescente o incentivo às ações que visam a abordagem de problemas globais (e.g. saúde, mudanças climáticas) pelo financiamento da pesquisa que gera conhecimento novo. É consenso que a internacionalização da ciência é desejável e necessária para o desenvolvimento sustentável das nações. Entretanto ela não pode ser feita somente incentivando e fomentando a ida de estudantes e pesquisadores para o exterior. É preciso, em adição, oferecer condições a professores pesquisadores e estudantes estrangeiros para que possam atuar em colaboração com os brasileiros e elevar o país aos padrões científicos internacionais.

Evaluation of clinical information modeling tools.

PubMed

Moreno-Conde, Alberto; Austin, Tony; Moreno-Conde, Jesús; Parra-Calderón, Carlos L; Kalra, Dipak

2016-11-01

un marco para la evaluación de herramientas informáticas diseñadas para dar soporte en la en los procesos de definición, gestión e implementación de estos modelos. El marco de evaluación propuesto se basa en una investigación previa para obtener consenso en la definición de requisitos esenciales en esta área. A partir de los 20 requisitos funcionales acordados, un conjunto de 50 criterios de conformidad fueron definidos y aplicados en la evaluación de las herramientas existentes. Un total de 9 de las 11 iniciativas identificadas desarrollando herramientas para el modelado de información clínica fueron evaluadas. Los resultados muestran que las funcionalidades relacionadas con la gestión de tipos de datos, especificaciones, metadatos y mapeo con terminologías u ontologías tienen un buen nivel de adopción. Se identifican posibles mejoras en áreas relacionadas con los procesos de modelado de información. Otros criterios relacionados con presentar las relaciones semánticas entre conceptos y la comunicación con servidores de terminología tienen un bajo nivel de adopción. El marco de evaluación propuesto fue probado y validado satisfactoriamente contra un conjunto representativo de las herramientas existentes. Los resultados identifican la necesidad de mejorar el soporte de herramientas a los procesos de modelado de información y desarrollo de software, especialmente en las áreas relacionadas con gobernanza, participación de profesionales clínicos y la optimización de la validación técnica en los procesos de pruebas técnicas. Esta investigación ha confirmado el potencial de este marco de evaluación para dar soporte a los usuarios en la toma de decisiones sobre que herramienta es más apropiadas para su organización. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

LAPAROSCOPICALLY ASSISTED ANORECTOPLASTY AND THE USE OF THE BIPOLAR DEVICE TO SEAL THE RECTAL URINARY FISTULA.

PubMed

Dutra, Robson Azevedo; Boscollo, Adriana Cartafina Perez

2016-01-01

dentro do complexo muscular do elevador do ânus com mínima dissecção. Não há consenso na literatura sobre o melhor tratamento dessa fístula. Avaliar a anorretoplastia laparoscópica e o selamento bipolar da fístula retourinária. Ela foi realizada de acordo com a descrição original de Georgeson1. Utilizou-se o acesso infraumbilical com portal de 10 mm para a ótica de 30º. O pneumoperitônio foi estabelecido com pressão de 8-10 cm de H2O. Dois trocárteres adicionais de 5 mm foram colocados à direita e à esquerda da cicatriz umbilical. A dissecção foi iniciada na reflexão peritoneal usando Ligasure(r). Com a redução do calibre do reto distalmente, foi identificada a fístula para a o trato urinário. O local do novo ânus foi definido por meio da localização do complexo muscular do esfíncter anal externo, utilizando-se estimulador eletro muscular externamente. Por fim, foi confeccionada uma anastomose entre o reto e o novo local do ânus. Uma sonda uretral de Foley foi deixada durante sete dias. Sete meninos foram operados, seis com fístula retoprostática e um retovesical. O período de seguimento variou de um a quatro anos. Os dois últimos pacientes operados foram submetidos ao selamento bipolar da fístula entre o reto e a uretra, sem suturas ou ligadura cirúrgica com pontos. No seguimento em longo prazo não houve evidências de fístulas urinárias. Há benefícios da anorretoplastia laparoscópica para o tratamento de anomalia anorretal. O uso de uma fonte de energia bipolar que promova o selamento da fístula retourinária propiciou redução significativa do tempo cirúrgico e tornou o procedimento mais elegante.

Prevalence of self-medication in Brazil and associated factors.

PubMed

Arrais, Paulo Sérgio Dourado; Fernandes, Maria Eneida Porto; Pizzol, Tatiane da Silva Dal; Ramos, Luiz Roberto; Mengue, Sotero Serrate; Luiza, Vera Lucia; Tavares, Noemia Urruth Leão; Farias, Mareni Rocha; Oliveira, Maria Auxiliadora; Bertoldi, Andréa Dâmaso

2016-12-01

To analyze the prevalence and associated factors regarding the use of medicines by self-medication in Brazil. This cross-sectional population-based study was conducted using data from the PNAUM (National Survey on Access, Use and Promotion of Rational Use of Medicines), collected between September 2013 and February 2014 by interviews at the homes of the respondents. All people who reported using any medicines not prescribed by a doctor or dentist were classified as self-medication practitioners. Crude and adjusted prevalence ratios (Poisson regression) and their respective 95% confidence intervals were calculated in order to investigate the factors associated with the use of self-medication by medicines. The independent variables were: sociodemographic characteristics, health conditions and access to and use of health services. In addition, the most commonly consumed medicines by self-medication were individually identified. The self-medication prevalence in Brazil was 16.1% (95%CI 15.0-17.5), with it being highest in the Northeast region (23.8%; 95%CI 21.6-26.2). Following the adjusted analysis, self-medication was observed to be associated with females, inhabitants from the North, Northeast and Midwest regions and individuals that have had one, or two or more chronic diseases. Analgesics and muscle relaxants were the therapeutic groups most used for self-medication, with dipyrone being the most consumed medicines. In general, most of the medicines used for self-medication were classified as non-prescriptive (65.5%). Self-medication is common practice in Brazil and mainly involves the use of non-prescription medicines; therefore, the users of such should be made aware of the possible risks. Analisar a prevalência e os fatores associados à utilização de medicamentos por automedicação no Brasil. Este estudo transversal de base populacional foi realizado com dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de medicamentos (PNAUM

Main natural hazards and vulnerability studies for some historical constructions and urban sectors of Valparaiso City (Chile)

NASA Astrophysics Data System (ADS)

Romanelli, F.

2009-04-01

The Project "MAR VASTO" ("Risk Management in Valparaíso/Manejo de Riesgos en Valparaíso, Servicios Técnicos", 2007) started in March 2007, with coordination of ENEA (Italian Agency for New Technologies, Energy and Environment), participation of several partners (Italy: University of Ferrara, Faculties of Architecture and Engineering; University of Padua, Faculty of Engineering; Abdus Salam International Centre for Theoretical Physics of Trieste; Chile: Valparaíso Technical University Federico Santa Maria, Civil Works Department; Santiago University of Chile, Division Structures Constructions Geotechnics), and support of local stakeholders. Being Valparaíso included since 2003 in the UNESCO Word Heritage List of protected sites, the project main goals are the following: to collect, analyze and elaborate the existing information, with a satisfying evaluation of main hazards; to develop a GIS digital archive, well organized, user-friendly and easy to be implemented in the future, providing maps and scenarios of specific and multiple risk; to provide a vulnerability analysis for three historical churches (San Francisco del Baron, Las Hermanitas de la Providencia, La Matríz, made by various materials - masonry, concrete, wood and adobe - and located in different city sites) and for a building stock in the Cerro Cordillera (partially inside the UNESCO area), analyzing more than 200 constructions; to suggest guidelines for future urban planning and strengthening interventions. In the framework of the MAR VASTO Project, the most important hazards have been investigated carried out. With regard to seismic hazard, "state-of-the-art" information has been provided by Chilean partners and stakeholders, using materials of several studies and stored in original earthquake reports, local newspapers and magazines. The activities performed by the Italian team regarded the definition, for the city of Valparaiso, of earthquake scenarios and maps based on the neo

Compliance with the Prescription of Antihypertensive Medications and Blood Pressure Control in Primary Care.

PubMed

Novello, Mayra Faria; Rosa, Maria Luiza Garcia; Ferreira, Ranier Tagarro; Nunes, Icaro Gusmão; Jorge, Antonio José Lagoeiro; Correia, Dayse Mary da Silva; Martins, Wolney de Andrade; Mesquita, Evandro Tinoco

2017-02-01

, suas doses e frequências, bem como a pressão arterial (PA) dos indivíduos. A taxa de conformidade das prescrições foi de 80%. Diuréticos foram as medicações mais prescritas e a terapia dupla foi o tratamento mais utilizado. As não conformidades mais comuns foram subdoses e subfrequências. A meta de PA para todos os casos foi < 140/90 mmHg, exceto para diabéticos, que foi < 130/80 mmHg. As taxas de controle de acordo com essas metas foram de 44,9% e 38,6%, respectivamente. Não houve correlação entre conformidade da prescrição e controle pressórico. O grau de conformidade foi considerado satisfatório. O alcance das metas foi compatível com estudos nacionais e internacionais, sugerindo que o modelo de saúde da família é efetivo no manejo da PA, embora ainda necessite aprimoramento. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0).

Linking Indices for Biodiversity Monitoring to Extinction Risk Theory

PubMed Central

Mccarthy, Michael A; Moore, Alana L; Krauss, Jochen; Morgan, John W; Clements, Christopher F

2014-01-01

Biodiversity indices often combine data from different species when used in monitoring programs. Heuristic properties can suggest preferred indices, but we lack objective ways to discriminate between indices with similar heuristics. Biodiversity indices can be evaluated by determining how well they reflect management objectives that a monitoring program aims to support. For example, the Convention on Biological Diversity requires reporting about extinction rates, so simple indices that reflect extinction risk would be valuable. We developed 3 biodiversity indices that are based on simple models of population viability that relate extinction risk to abundance. We based the first index on the geometric mean abundance of species and the second on a more general power mean. In a third index, we integrated the geometric mean abundance and trend. These indices require the same data as previous indices, but they also relate directly to extinction risk. Field data for butterflies and woodland plants and experimental studies of protozoan communities show that the indices correlate with local extinction rates. Applying the index based on the geometric mean to global data on changes in avian abundance suggested that the average extinction probability of birds has increased approximately 1% from 1970 to 2009. Conectando Índices para el Monitoreo de la Biodiversidad con la Teoría de Riesgo de Extinción Resumen Los índices de biodiversidad combinan frecuentemente los datos de diferentes especies cuando se usan en los programas de monitoreo. Las propiedades heurísticas pueden sugerir índices preferidos, pero carecemos de medios objetivos para discriminar a los índices con propiedades heurísticas similares. Los índices de biodiversidad pueden evaluarse al determinar qué tan bien reflejan los objetivos de manejo que un programa de monitoreo busca apoyar. Por ejemplo, la Convención sobre la Diversidad Biológica requiere reportar las tasas de extinción, así que los �

Aortopexy for the treatment of tracheomalacia in children: review of the literature

PubMed Central

2012-01-01

delicate is represented by those with associated gastro-esophageal reflux, in whom a fundoplication should be performed. Other treatments of tracheomalacia, particularly tracheal stenting, were associated with a higher rate of failure, severe morbidity and mortality. Non english abstract La tracheomalacia severa rappresenta una sfida per Pediatri, Intensivisti, Pneumologi, Otorinolaringoiatri, Chirurghi Pediatri. Il trattamento della tracheomalacia è tuttora controverso. L’aortopessi è considerata da molti la migliore opzione terapeutica. Abbiamo condotto una revisione della letteratura di lingua inglese su tale argomento. Di 125 lavori, 40 sono stati inclusi nella revisione. Tra 758 pazienti (62% maschi) affetti da tracheomalacia, 581 sono stati sottoposti ad aortopessi tra il 1968 e il 2008. In 659 pazienti alcune comorbidità erano presenti. L’associazione più frequente era con l’atresia esofagea (44%), l’anello vascolare o un’anomalia dei grossi vasi (18%), la compressione da parte dell’arteria innominata (16%); nel 9% la tracheomalacia era idiopatica. I sintomi riportati sono stati variabili, ma l’indicazione più importante all’aortopessi sono stati eventi di ALTE, osservati nel 43% dei pazienti. Lo studio diagnostico preoperatorio principale è stato la broncoscopia. L’approccio chirurgico è avvenuto attraverso una toracotomia anteriore sinistra nel 72% dei pazienti, mentre un approccio mediano è stato scelto nel 14% e nell’1.3% dei casi è stato eseguito un approccio toracoscopico. Al follow-up (mediana di 47 mesi) la maggioranza dei pazienti sono migliorati significativamente, ma l’8% di essi non è migliorato, il 4% è peggiorato e il 6% è morto. Complicazioni sono state riportate nel 15% dei pazienti, nell’1% un nuovo intervento di aortopessi è stato necessario. In questa revisione abbiamo trovato che non c’è un consenso generale sulla valutazione e sulla descrizione dei sintomi, sulle indicazioni chirurgiche ed esami

Use of medicines and other products for therapeutic purposes among children in Brazil.

PubMed

Pizzol, Tatiane da Silva Dal; Tavares, Noemia Urruth Leão; Bertoldi, Andréa Dâmaso; Farias, Mareni Rocha; Arrais, Paulo Sergio Dourado; Ramos, Luiz Roberto; Oliveira, Maria Auxiliadora; Luiza, Vera Lucia; Mengue, Sotero Serrate

2016-12-01

átrica brasileira e testar se fatores demográficos, socioeconômicos e médicos estão associados ao uso. Estudo transversal de base populacional (Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - PNAUM), incluindo 7.528 crianças com 12 anos ou menos de idade, residentes na zona urbana do território brasileiro. O uso de medicamentos para tratar doenças crônicas ou agudas foi referido pelo principal cuidador da criança presente na entrevista domiciliar. Associações entre as variáveis independentes e o uso de medicamentos foram investigadas por meio de regressão de Poisson. A prevalência de uso global de medicamentos foi de 30,7% (IC95% 28,3-33,1). A prevalência de uso de medicamentos para doenças crônicas foi de 5,6% (IC95% 4,7-6,7) e para condições agudas, 27,1% (IC95% 24,8-29,4). Os fatores significativamente associados com o uso global foram ter no máximo cinco anos de idade, residir na região Nordeste, ter plano de saúde e utilizar serviços de saúde nos últimos 12 meses (consultas de emergência e internações). Associaram-se ao uso de medicamentos para doenças crônicas: idade ≥ 2 anos, regiões Sudeste e Sul e utilização de serviços de saúde. Para o uso de medicamentos em condições agudas, foram identificados os seguintes fatores associados: ≤ 5 anos, Norte, Nordeste ou Centro-Oeste, plano de saúde e uma ou mais consultas de emergência. Os medicamentos com maior prevalência de uso pelas crianças menores de dois anos foram paracetamol, ácido ascórbico e dipirona; nas crianças com 2 ou mais anos, foram dipirona, paracetamol e amoxicilina. O uso de medicamentos na população infantil é substancial, principalmente no tratamento de condições médicas agudas. As crianças usuárias de medicamentos para doenças crônicas apresentam perfil demográfico diferente das usuárias de medicamentos para condições agudas, em relação ao sexo, à idade e à região geográfica.

Biorefinery Technologies for Biomass Conversion Into Chemicals and Fuels Towards Zero Emissions (Review) / Nulles Emisiju Princips Biomasas Konversijas Tehnoloģijās Aizstājot Fosilos Resursus (Pārskata Raksts)

NASA Astrophysics Data System (ADS)

Gravitis, J.; Abolins, J.

2013-10-01

ģijām, bet ražošanas sistēmu projektēšanai - biomasas konversijas tehnoloģiju klasterizācijā. Aplūkojot virkni konkrētu tehnoloģisko risinājumu, TSA - biomasas autohidrolīzi tvaika sprādzienā tai skaitā, iztirzātas ar biomasas konversiju, izmantošanu un augstas pievienotās vērtības produktiem - ķīmiskiem savienojumiem un degvielām, saistītās ekololoģiskās un energoefektivitātes problēmas. Uzsverot biomasas TSA pirmapstrādes universālo nozīmi dažādo tehnoloģisko kompleksu struktūrā, aplūkota TSA ietekme uz vidi, demonstrējot eMerģijas (enerģētiskās atmiņas) pieeju un "ilgtspējas" indeksu izmantošanu. Lai gan pie sasniegtā tehnoloģiskās attīstības līmeņa un patreizējiem fosilo enerģijas nesēju patēriņa tempiem nav iespējams tos pilnībā aizstāt ar bioenerģiju, bioenerģijas sektora tehnoloģiju pilnveidošana ir svarīga arī bioresursu racionālas izmantošanas un citos aspektos. Latvijas enerģētiskās neatkarības kontekstā būtiska nozīme ir tradicionālo bioenerģijas resursu izmantošanas efektivitātes celšanai un inovatīvo bioenerģijas tehnoloģiju valstiskam atbalstam.u nulles

[The origin of informed consent].

PubMed

Mallardi, V

2005-10-01

historical viewpoint to be considered as conceptual elements and doctrinal and socio-cultural products, even if at that time, of little practical importance, which belong to the European culture and, in particular, and almost paradoxically, in the light of what happened, to the German culture. The United States of America is held to be the country of origin of informed consent, the initial aim of which was make sure that the correct dignity of the patient's independence be reserved at the time of decision making and choice of medical options. Reports on this topic, in fact, first appeared in the USA, at the beginning of the 18th Century, with problems focusing on and limited to only the simple rights of the patient in giving his/her approval of the health intervention later to be conceptually developed, along the lines of an itinerary with, at intervals, famous legal actions, until in the 20th Century, informed consent was reached, a criterion that, as is well known, foresees and includes not only the important and fundamental autonomy of the patient to decide, which stems ones personal rights, but also the essential objective element, which is, information. The expression informed consent has simply been transposed in Italian and roughly translated in an ambiguous fashion into "consenso informato" when, on the contrary, it should be referred to as "informazione per il consenso" "information for consensus" not only to respect the concept but, surely, for a more correct deciphering and a more precise interpretation related to the numerous concepts it presupposes and implies. Information and consent may be compared to the two sides of the same coin. These are the two important pillars that coincide and are joined giving weight to the medical responsibility, as far as concerns consent to the health intervention: on the one hand, having obtained consent,following correct and sincere information interpreted and deciphered as an important phase and an essential indicator of

Effects of Wind Energy Development on Nesting Ecology of Greater Prairie-Chickens in Fragmented Grasslands

PubMed Central

McNew, Lance B; Hunt, Lyla M; Gregory, Andrew J; Wisely, Samantha M; Sandercock, Brett K

2014-01-01

ólica sobre la ecología reproductiva de las gallinas en un estudio de 5 años. Ubicamos 59 y 185 nidos antes y después del desarrollo, respectivamente, de una instalación de energía eólica de 201 MW en el hábitat de anidación de las gallinas y estudiamos la selección de sitio de anidación y la supervivencia de nidos en relación con la proximidad a la infraestructura y las condiciones de hábitat. La proximidad con las turbinas no afectó negativamente a la selección de sitios de anidación (β = -0.3, 95% CI = -0.6–0.1). En su lugar, la selección de sitios de anidación y la supervivencia estuvieron fuertemente relacionadas con la cobertura vegetal y otras condiciones locales determinadas por el manejo de la producción de ganado. La integración de los resultados de nuestro proyecto con reportes previos de la evitación conductual de instalaciones de petróleo y gas por otras especies de pastizales sugiere nuevas vías para que la investigación mitigue los impactos del desarrollo energético. PMID:24628394

Brazilian guidelines for the diagnosis and treatment of cystic fibrosis.

PubMed

Athanazio, Rodrigo Abensur; Silva Filho, Luiz Vicente Ribeiro Ferreira da; Vergara, Alberto Andrade; Ribeiro, Antônio Fernando; Riedi, Carlos Antônio; Procianoy, Elenara da Fonseca Andrade; Adde, Fabíola Villac; Reis, Francisco José Caldeira; Ribeiro, José Dirceu; Torres, Lídia Alice; Fuccio, Marcelo Bicalho de; Epifanio, Matias; Firmida, Mônica de Cássia; Damaceno, Neiva; Ludwig-Neto, Norberto; Maróstica, Paulo José Cauduro; Rached, Samia Zahi; Melo, Suzana Fonseca de Oliveira

2017-01-01

cenário dessa doença, com aumento expressivo da sobrevida e qualidade de vida. Atualmente, o Brasil dispõe de um programa de ampla cobertura para a triagem neonatal de FC e centros de referência distribuídos na maior parte desses estados para seguimento dos indivíduos. Antigamente confinada à faixa etária pediátrica, tem-se observado um aumento de pacientes adultos com FC tanto pelo maior número de diagnósticos de formas atípicas, de expressão fenotípica mais leve, assim como pelo aumento da expectativa de vida com os novos tratamentos. Entretanto, ainda se observa uma grande heterogeneidade no acesso aos métodos diagnósticos e terapêuticos para FC entre as diferentes regiões brasileiras. O objetivo dessas diretrizes foi reunir as principais evidências científicas que norteiam o manejo desses pacientes. Um grupo de 18 especialistas em FC elaborou 82 perguntas clínicas relevantes que foram divididas em cinco categorias: características de um centro de referência; diagnóstico; tratamento da doença respiratória; tratamento gastrointestinal e nutricional; e outros aspectos. Diversos profissionais brasileiros atuantes na área da FC foram convidados a responder as perguntas formuladas pelos coordenadores. A literatura disponível foi pesquisada na base de dados PubMed com palavras-chave, buscando-se as melhores respostas às perguntas dos autores.

Como Lo Hago Yo: Mielomeningocele En Bolivia

PubMed Central

Dabdoub, Carlos F.; Dabdoub, Carlos B.; Villavicencio, Ramiro; Quevedo, Germán

2014-01-01

ón: En esta serie, el diagnóstico prenatal del MMC fue ocasional y la derivación al HUJ de los recién nacidos con esta malformación fue generalmente tardía. No hubo predominio de género y la mayoría de los casos presentaron sus lesiones en la región lumbar y lumbosacra. La mortalidad general y postoperatoria fue similar a la reportada en la literatura. Pocos enfermos realizaron controles posteriores al alta hospitalaria. Igual que otros países de Sudamérica, las falencias en el sistema público de salud y el nivel sociocultural, son factores determinantes para un mal pronóstico en estos niños. Por sus múltiples complicaciones, el MMC requiere de una especial atención gubernamental, sobre todo de carácter preventivo mediante el uso de ácido fólico en mujeres fértiles, como también de un equipo profesional multidisciplinario, a fin de realizar un tratamiento adecuado y oportuno. Al mismo tiempo, trabajos multicéntricos en hospitales de América Latina, ayudarán al mejor manejo de estos pacientes. PMID:24791220

The impact of the use of different types of gloves and bare hands for preparation of clean surgical instruments.

PubMed

Bruna, Camila Quartim de Moraes; Souza, Rafael Queiroz de; Massaia, Irineu Francisco Silva; Cruz, Áurea Silveira; Graziano, Kazuko Uchikawa

2016-10-10

implica em aumento dos custos do processo e da geração de resíduos, além do potencial risco alergênico ao látex. determinar si existen diferencias en la seguridad de la preparación del instrumental quirúrgico relacionadas con el uso de diferentes tipos de guantes y de las manos desnudas y evaluar la carga microbiológica de estos preparados sin guantes. experimento de laboratorio con enfoque pragmático, en el que las muestras fueron manejadas con diferentes tipos de guantes y las manos desnudas. Además, un ensayo de citotoxicidad se llevó a cabo mediante el método de difusión en agar. Otras muestras fueron sometidas a análisis microbiológico después de haber sido manipuladas sin guantes. ninguna de las muestras presentó efecto citotóxico. Todos los cultivos microbiológicos mostraron crecimiento de microorganismos, pero ningún microorganismo ha sido recuperado después de la esterilización en autoclave. no hubo diferencias en las respuestas citotóxicas con respecto al uso de diferentes tipos de guantes y de las manos desnudas en el manejo del instrumental quirúrgico limpio, lo que podría conllevar riesgo de yatrogenia. Es de destacar que el uso de guantes implica un aumento de los costos del proceso y la generación de residuos, además del potencial riesgo alergénico al látex.

Hydrochemistry of waters from five cenotes and evaluation of their suitability for drinking-water supplies, northeastern Yucatan, Mexico

NASA Astrophysics Data System (ADS)

Alcocer, Javier; Lugo, Alfonso; Marín, Luis E.; Escobar, Elva

recreativas, para determinar su potencial de uso como fuente de abastecimiento de agua potable. La mayor parte de los parámetros excedieron los criterios establecidos en la Norma Mexicana para Agua Potable (NMAP), sin embargo, como éstas no representan una riesgo para la salud, el agua de cuatro de los cinco cenotes puede ser emplada como fuente de abastecimiento de agua potable. Los contaminantes comúnes del agua subterránea de la península de Yucatán, coliformes fecales y nitratos, se encuentran en la mayoría de los casos por debajo de la NMAP (0-460 NMP/ 100ml y 0.31-1.18mg/l, respectivamente). A pesar de que estos cuatro cenotes cumplen con la NMAP, es necesario desarrollar una política de manejo adecuada del agua subterránea para evitar la contaminación de este recurso (fecal y por nitratos), así como la intrusión de agua salina.

Spatial Distribution and Coexisting Patterns of Adults and Nymphs of Tibraca limbativentris (Hemiptera: Pentatomidae) in Paddy Rice Fields.

PubMed

Alves, Tavvs M; Maia, Aline H N; Barrigossi, José A F

2016-12-01

adultos e ninfas de T. limbativentris e determinar a coexistência espacial entre os estágios de desenvolvimento. As densidades de adultos e ninfas foram estimadas em quinze campos de arroz irrigado. A amostragem foi realizada em grades regulares com pontos de amostragem separados por ∼50 m. Moran's I e semivariogramas foram usados para determinar os padrões de distribuição espacial. A coexistência espacial foi explorada pela análise de processos pontuais. Foi observado que adultos e ninfas tiveram padrões contrastantes de distribuição espacial dentro do mesmo campo; no entanto, a frequência de agregação não foi diferente entre esses estágios de desenvolvimento. Adultos e ninfas estavam agregados em sete campos e distribuídos aleatoriamente nos outros oito campos. Não foi observada a distribuição uniforme de adultos ou ninfas. O alcance médio dos semivariogramas foi de ∼40 m para os adultos e ∼55 m para as ninfas. Ninfas e adultos coexistiram espacialmente em 67% dos campos. Os padrões de coexistência foram classificados usando um dos seguintes processos: independente do estágio de desenvolvimento, atração bilateral, atração unilateral, inibição bilateral, ou inibição unilateral. Nosso estudo poderá contribuir para o desenvolvimento de planos de amostragem para tomada de decisão e implementação de táticas para o manejo de sítios específicos. © The Authors 2016. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Seismic and tsunami hazard investigation in Valparaiso in the framework of the project "MAR VASTO"

NASA Astrophysics Data System (ADS)

Romanelli, F.; Razafindrakoto, H.

2009-04-01

In the framework of the MAR VASTO Project ("Risk Management in Valparaíso/Manejo de Riesgos en Valparaíso"), completed in 2008 and funded by BID/IDB (Banco InterAmericano de Desarrollo/ InterAmerican Development Bank), managed by ENEA (Italian Agency for New Technologies, Energy and Environment), with the participation of Italian and Chilean partners and the support of local stakeholders, the most important hazards have been investigated carried out. Valparaíso represents a distinctive case of growth, inside a remarkable landscape, of an important Pacific Ocean seaport (over the 19th and 20th centuries), up to reaching a strategic importance in shipping trade, declined after the Panama Canal opening (1914). Thus, Valparaíso tells the never-ending story of a tight interaction between society and environment, stratifying different urban and architectonic layers, sometimes struck by disasters and always in danger. Certainly, the city has been subjected to various natural hazards (seismic events, but also tsunamis, landslides, etc.) and anthropic calamities (mainly wild and human-induced fires). These features make Valparaíso a paradigmatic study case about hazard mitigation, and risk factors must be very well evaluated during the restoration phases to be planned in the future. Seismic Hazrad. The major goal is to provide a dataset of synthetic time series representative of the potential ground motion at the bedrock of Valparaiso, especially at selected sites (e.g. the three important churches located in the Valparaiso urban area: La Matriz, San Francisco, Las Hermanitas de la Providencia), for different scenarios; the characteristics of the calculated signals (e.g. amplitude, frequency content and duration of shaking) are determined by the earthquake source process and the wave propagation effects of the path between the source and the site. The synthetic signals, to be used as seismic input in a subsequent engineering analysis, have been produced at a very low

Management changes resulting from hospital accreditation.

PubMed

Oliveira, João Lucas Campos de; Gabriel, Carmen Silvia; Fertonani, Hosanna Pattrig; Matsuda, Laura Misue

2017-03-02

contenido, modalidad temática, a la luz del referencial de la Evaluación en Salud de Avedis Donabedian. fue aprendida una gran categoría temática (family), llamada "Cambios Gerenciales Resultantes de la Acreditación: perspectivas de gestores y trabajadores" y cinco subcategorías (codes), relacionadas a los cambios gerenciales en las esferas operacional; estructural; financiera y de costo; en la alta gestión hospitalaria; y en la gestión de calidad. los cambios gerenciales en las organizaciones hospitalarias, resultantes de la Acreditación, fueron amplias, polifacéticas y coherentes con las mejoras en la calidad de los servicios. analisar as percepções de gestores e trabalhadores sobre as mudanças no gerenciamento hospitalar advindas da Acreditação. estudo descritivo com abordagem qualitativa. Participaram cinco gestores da qualidade hospitalar e outros 91 trabalhadores das mais diversas categorias profissionais, níveis hierárquicos e áreas de atuação de quatro hospitais do sul do Brasil certificados pela Acreditação nacional de diferentes níveis, que responderam à questão "Fale-me sobre o gerenciamento deste hospital, antes e depois da Acreditação". Os dados foram gravados, transcritos na íntegra e transportados para acesso e manejo no software ATLAS.ti, versão 7.1. Após isso, procedeu-se a análise de conteúdo, modalidade temática, sustentada à luz do referencial da Avaliação em Saúde de Avedis Donabedian. apreendeu-se uma grande categoria temática (family), denominada "Mudanças Gerenciais Advindas da Acreditação: perspectivas de gestores e trabalhadores" e cinco subcategorias (codes), relacionadas às mudanças gerenciais no âmbito operacional; estrutural; financeiro e de custo; na alta gestão hospitalar; e na gestão da qualidade. as mudanças gerenciais nas organizações hospitalares, advindas da Acreditação, se mostraram amplas, multifacetadas e coadunam às melhorais da qualidade nos serviços.

Access to medicines for chronic diseases in Brazil: a multidimensional approach.

PubMed

Oliveira, Maria Auxiliadora; Luiza, Vera Lucia; Tavares, Noemia Urruth Leão; Mengue, Sotero Serrate; Arrais, Paulo Sergio Dourado; Farias, Mareni Rocha; Pizzol, Tatiane da Silva Dal; Ramos, Luiz Roberto; Bertoldi, Andréa Dâmaso

2016-12-01

non-communicable diseases in Brazil is high and presents significant differences for age group, region of the country, number of non-communicable diseases, and for medicines prescribed and self-assessment of health. The major barriers to access to medicines were identified in the dimensions analyzed. Analisar o acesso a medicamentos para tratar doenças crônicas não transmissíveis no Brasil segundo fatores socioeconômicos, demográficos e de saúde, sob perspectiva multidimensional. Análise de dados da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), inquérito domiciliar, plano amostral por conglomerados com representatividade da população brasileira e grandes regiões do País, segundo domínios de sexo e idade. Dados coletados em 2013-2014 com amostra constituída por adultos (≥ 20 anos) que referiram ter doenças crônicas não transmissíveis e indicação médica para usar medicamentos (n = 12.725). Avaliou-se a prevalência de acesso aos medicamentos para doenças crônicas não transmissíveis autorreferidas, considerando quatro dimensões: disponibilidade, acessibilidade geográfica, aceitabilidade e capacidade aquisitiva. Aplicou-se teste Qui-quadrado de Pearson para avaliar a significância estatística das diferenças entre os estratos, considerando o nível de significância de 5%. Foram encontradas prevalências de 94,3%, 5,2% e 0,5% para acesso total, parcial e nulo, respectivamente. Maiores prevalências ocorreram entre os idosos, na região Sul comparada à região Nordeste; naqueles que referiram ter uma doença crônica não transmissível comparados aos que referiram ter duas ou mais; naqueles que precisavam de um medicamento comparados aos que precisavam de três ou mais; e naqueles que autoavaliaram sua saúde como boa ou muito boa. A acessibilidade geográfica foi semelhante no Sistema Único de Saúde e nas farmácias privadas (72,0%). A disponibilidade total de medicamentos foi de 45

Assessing ecological correlates of marine bird declines to inform marine conservation

PubMed Central

Vilchis, L Ignacio; Johnson, Christine K; Evenson, Joseph R; Pearson, Scott F; Barry, Karen L; Davidson, Peter; Raphael, Martin G; Gaydos, Joseph K

2015-01-01

identificación de los conductores del cambio ambiental en los grandes ecosistemas marinos es esencial para su conservación y manejo efectivo. Esto es un reto bastante grande, particularmente en los ecosistemas que trascienden fronteras internacionales, cuando el monitoreo y la conservación de especies migratorias de amplio rango y sus hábitats son logística y financieramente problemáticos. En este caso, usando herramientas tomadas de la epidemiología, elucidamos conductores comunes subyacentes en la declinación de especies dentro de un ecosistema marino, muy similar a cómo los análisis epidemiológicos evalúan los factores de riesgo para los resultados de salud negativos e informar mejor sus decisiones. Con esto, identificamos los rasgos ecológicos y las especializaciones de dieta asociados con la declinación de especies en una comunidad de depredadores marinos que podría ser un reflejo de cambios ambientales. Para lograr esto, integramos datos de conteo de programas de censos de invierno recolectados a lo largo de monitoreos a largo plazo de aves marinas llevados a cabo en el mar Salish – un gran ecosistema marino que trasciende fronteras en el noroeste del Océano Pacífico. Encontramos que las declinaciones por década en los conteos de invierno fueron más prevalentes entre los pescadores de persecución, como los álcidos (Alcidae) y los zambullidores (Podicipedidae), que tienen dietas especializadas basadas en peces forrajeros y que las especies con distribución amplia y sin colonias reproductivas locales estaban más predispuestas a estas declinaciones. Mientras que una combinación de factores posiblemente esté causando las declinaciones de especialistas de peces forrajeros, proponemos que los cambios en la disponibilidad de presas de niveles tróficos bajos pueden estar forzando cambios en la extensión invernal de aves pescadoras en el mar Salish. Dicha síntesis de tendencias a largo plazo en una comunidad de depredadores marinos no s

Learning about the Sky from the Environment: An Experience Working Along One Year with Students of Elementary Education. (Spanish Title: Aprendiendo sobre EL Cielo Desde el Entorno: Una Experiencia Trabajando Durante un Año Junto a Estudiantes del Primario.) Aprendendo sobre o Céu a Partir do Entorno: Uma Experiência de Trabalho ao Longo de um Ano com Alunos de Ensino Fundamental

NASA Astrophysics Data System (ADS)

Longhini, Marcos Daniel; Gomide, Hanny Angeles

2014-12-01

percepción limitada que los estudiantes tienen de su alrededor la cual, sin embargo, se expandió debido a las actividades llevadas a cabo, sobre todo en relación con la Luna. Trabajar con medidas sistemáticas revela el manejo cuidadoso de los datos para que sean comprensibles para los estudiantes, así como el trabajo con las sombras para que comprendan primero como se forman estas para después trabajarlas en Astronomía. Por último, llegamos a la conclusión de que el proceso desarrollado consistió en una etapa inicial de una obra que debe ser profundizado en los años posteriores de la formación de estos estudiantes. Projeto de pesquisa desenvolvido com 95 alunos do 6º ano do Ensino Fundamental de uma escola pública estadual de Uberlândia, Minas Gerais. Foi um trabalho contínuo, de fevereiro a dezembro de 2013, o qual levou os alunos a participarem de atividades de observação do entorno, dentre ele, o céu, analisando as mudanças ocorridas. Focamos no estudo das variações de temperaturas, chuvas, duração do dia, variações do tamanho das sombras e mudanças nos aspectos da Lua. Nosso foco de análise centrou-se em discutir os conhecimentos que os referidos alunos tinham acerca dos temas indicados no início e ao término da implementação da proposta. Os resultados mostraram a percepção limitada que os estudantes possuem de seu entorno, todavia, ampliada em função das atividades desenvolvidas, principalmente no que se refere à Lua. O trabalho com medidas sistemáticas revela o cuidado no tratamento dos dados para que eles se tornem compreensíveis aos alunos, assim como o trabalho com as sombras sinaliza para que os alunos primeiramente compreendam como as sombras são formadas para depois trabalhar isso em Astronomia. Por fim, concluímos que o processo vivido constituiu-se em uma etapa inicial de um trabalho que deve ser estimulado para os anos subsequentes da formação desses alunos.

ANATOMIC VARIATIONS OF HEPATIC ARTERY: A STUDY IN 479 LIVER TRANSPLANTATIONS.

PubMed

Fonseca-Neto, Olival Cirilo Lucena da; Lima, Heloise Caroline de Souza; Rabelo, Priscylla; Melo, Paulo Sérgio Vieira de; Amorim, Américo Gusmão; Lacerda, Cláudio Moura

2017-01-01

ão especialmente importantes no contexto do transplante ortotópico hepático, visto que, além de representar oportunidade ideal para seu estudo anatômico cirúrgico, a sua precisa identificação é determinante para o sucesso do procedimento. Identificar as variações anatômicas no sistema arterial hepático em transplantes hepáticos. Foram analisados retrospectivamente, no período de 13 anos, 479 prontuários de pacientes adultos transplantados, sendo coletados dados referentes à anatomia arterial hepática do doador falecido. Identificou-se anatomia arterial hepática normal em 416 doadores (86,84%). Os outros 63 indivíduos (13,15%) apresentaram alguma variação. De acordo com a classificação de Michels, as anomalias mais frequentes foram: artéria hepática direita ramo da artéria mesentérica superior (Tipo III, n=27, 5,63%); artéria hepática esquerda ramo da artéria gástrica esquerda (Tipo II, n=13, 2,71%); artéria hepática direita ramo da artéria mesentérica superior associada à artéria hepática esquerda ramo da artéria gástrica esquerda (Tipo IV, n=4, 0,83%). Do mesmo modo, em relação à Classificação de Hiatt, as variações mais prevalentes foram: artéria hepática direita acessória ou substituta da artéria mesentérica superior (Tipo III, n=28, 6,05%), seguida da artéria hepática esquerda acessória ou substituta da artéria gástrica esquerda (Tipo II, n=16, 3,34%). Quatorze pessoas (2,92%) apresentaram alterações anatômicas sem classificação definida, sendo a de maior frequência o tronco hepatomesentérico, identificado em cinco (1,04%). O conhecimento detalhado das variações da anatomia arterial hepática é de grande importância aos cirurgiões que realizam abordagens nessa região, em especial no transplante hepático, visto que sua identificação e correto manejo são fundamentais para o êxito do procedimento.

Farmyard Manure and Fertilizer Effects on Seed Potato (Solanum tuberosum L.) Yield in Green House Production

NASA Astrophysics Data System (ADS)

László, M.

2009-04-01

cultura da batata podem ser de ordem agronómica, economica e comercial. Como exemplos destes podem ser citados: o uso racional de matérias orgânicos, esterco de curral e inorgânico fertilizantes. Efeito de materias orgnicânicos e N, P, K elementos minerais para produção da batata As necessidades em N, P, e K elementos minerais da batata são superidas pela aplicação apropriada de matérias orgânicos, esterco de currals, fertilizantes ao solo, combinada com a ambiente (Márton 2001a., 2001b.), época adequada e posição ideal de aplicá- lo. Efeito da materias orgânicos O suprimento de N á batateira provém principalmente da matéria orgânica do solo e do fertilizante aplicado (László 2000a., Márton et all. 2000.). Embora não seja muito praticado no Brasíl, a incorporação de esterco ao solo é fator de aumento da produção de tuberculos. Este resultado favorável poderia ser atribuído ao melhoramento da estrutura do solo, á maior retenção de água pelo e mesmo favorecendo o melhor desenvolvimento do sistema radicular da planta. A batata pode ser cultivada em todo tipo de solo desde que tenha boa drenagem e seja bem estruturado. Isto é tem que ser bem aerado e permitir o bom desenvolvimento dos órgãos subterráneos da batateira. Sem de matéria orgânicos e esterco de curral a tendencia de determinados solos formar crosta, oferecendo uma alta resisténcia mecánica á emergéncia das plantas, pode ser um determinante de stands desuniformes. A cause primaria da formação de crostas é a destruição dos agregados do solo pela excessiva manipulação mecánica resultando em aeração reduzida e aumento da densidade e coesão das particulas do solo. O encrostamento do solo pode ser reduzido através com matérias orgânicos. De maneira geral, a produção de tuberculos em solo de baixa potencialidade (aqueles em que a penetração das raizes é dificultada pela compactação, textura argilosa ou com camadas no solo) será menor do que nagueles com

DIETARY MANAGEMENT FOR DYSLIPIDEMIA IN LIVER TRANSPLANT RECIPIENTS.

PubMed

Pinto, Andressa S; Chedid, Marcio F; Guerra, Léa T; Cabeleira, Daiane D; Kruel, Cleber D P

2016-01-01

os efeitos de uma intervenção dietética no perfil lipídico de pacientes transplantados hepáticos dislipidêmicos em acompanhamento ambulatorial. Foram incluídos todos os pacientes adultos transplantados hepáticos com dislipidemia e em acompanhamento ambulatorial em nossa instituição. Avaliação antropométrica, anamnese alimentar, composição corporal (bioimpedância) e cálculo do metabolismo basal (calorimetria indireta) foram realizados. Pacientes foram atendidos por uma nutricionista e uma dieta individualizada baseada no metabolismo basal e consistindo de 25% do valor energético em gorduras totais e menos de 200 mg/dia de colesterol foi prescrita. Colesterol total (CT), HDL-colesterol (HDL), LDL-colesterol (LDL), triglicerídeos (TG) e medidas antropométricas foram medidos antes do início da dieta, sendo repetidos seis meses após o início da intervenção dietética. Cinquenta e três pacientes concluíram o seguimento e tinham idade 59±10 anos e 29 eram homens (51,8%). CT pré-intervenção=238,9±30; pós-intervenção=165,1±35, p<0.001; LDL pré-intervenção=154±33; pós-intervenção=90±29, p<0.001 e TG pré-intervenção=168, IQR=151-200; pós-intervenção=137, IQR=94-177, p=<0.001 sofreram modificações significativas seis meses após a intervenção. Antes do estudo, nenhum dos pacientes apresentava níveis séricos normais para o CT, e apenas 12 pacientes (22,7%) tinham níveis séricos ótimo ou quase ótimos para o LDL. Seis meses após o início da intervenção, 45 pacientes (84,9%) alcançaram níveis séricos normais de CT e 50 (94,4%) níveis séricos ótimos ou quase ótimos de LDL. Os níveis séricos de HDL e as medidas antropométricas não sofreram modificações significativas. Aconselhamento dietético com prescrição de dieta individualizada baseada no cálculo do metabolismo basal mostrou-se efetivo no manejo da dislipidemia em pacientes transplantados hepáticos em seguimento ambulatorial. Assim, todos os

Achieving Open Access to Conservation Science

PubMed Central

Fuller, Richard A; Lee, Jasmine R; Watson, James E M

2014-01-01

disciplina de crisis en la que los resultados del cuestionamiento científico deben hacerse disponibles de manera rápida para quienes están implementando el manejo. Evaluamos la extensión a la cual está disponible para el público la investigación científica publicada desde el año 2000 en 20 revistas de ciencia de la conservación. De los 19, 207 artículos publicados, 1, 667 (8.68%) están libres para descargar de un repositorio oficial. Además, sólo 938 artículos (4.88%) cumplen con la definición estándar de acceso abierto en la cual el material puede reutilizarse libremente siempre y cuando se le dé atribución a los autores. Esto se compara pobremente con un conjunto comparable de 20 revistas de biología evolutiva, donde 31.93% de los artículos están libres para descargar y el 7.94% son de acceso abierto. Diecisiete de las 20 revistas de conservación ofrecen una opción de acceso abierto, pero menos del 5% de los artículos están disponibles por medio del acceso abierto. El costo de acceder al cuerpo completo de la ciencia de la conservación llega a estar entre los miles de dólares por año para suscriptores institucionales, y muchos practicantes de la conservación no pueden acceder a la ciencia de paga en sus lugares de trabajo. Sin embargo, iniciativas importantes como Research4Life están poniendo a la ciencia a disponibilidad de organizaciones en países en desarrollo. Urgimos a los autores de la ciencia de la conservación que paguen por acceso abierto en una base por artículo o que escojan publicar en revistas de acceso abierto, tomando en consideración asegurar que la licencia permita reutilizar siempre y cuando se proporcione atribución. Actualmente, costaría $51 millones hacer que toda la ciencia de la conservación publicada desde 2000 esté disponible libremente al pagar las cuotas de acceso abierto que actualmente impuestas a los autores. Los publicadores de revistas de la conservación pueden considerar modelos más rentables para el

Groundwater socio-ecology and governance: a review of institutions and policies in selected countries

NASA Astrophysics Data System (ADS)

Mukherji, Aditi; Shah, Tushaar

2005-03-01

. Finalmente los autores proponen que existe la necesidad de cambiar el paradigma en lo referente a la percepción y al manejo del agua subterránea desde su administración hasta su gobierno. En este intento, con el objeto de alcanzar un mejor gobierno, se debe implementar un número de instrumentos simultáneamente i.e la regulación directa, la política indirecta, la adaptación de las actividades de subsistencia y la participación de los usarios.

Dispositional optimism among American and Jordanian college students: are Westerners really more upbeat than Easterners?

PubMed

Khallad, Yacoub

2010-02-01

risque et d'auto-protection (e.g., la ceinture de sécurité, la vitesse au volant, l'usage de tabac), sur les facteurs sociaux et démographiques (e.g., le sexe, le statut socio-économique, la religiosité). Les résultats ont indiqué que l'optimisme dispositionnel était plus fort chez les américains en comparaison aux participants jordaniens. Des analyses séparées de l'optimisme versus le pessimisme ont montré que les participants jordaniens n'étaient pas pessimistes mais pas moins optimistes que leurs homologues américains. Il n'y avait pas de corrélations significatives entre l'optimisme dispotionnel et le sexe, le statut socio-économique et la religiosité. Les niveaux d'optimisme dispotionnel affichés par les jordaniens dans cette étude sont inconsistents avec les affirmations passées d'un occident optimiste et d'un orient pessimiste et suggèrent que les processus d'auto-amélioration pourraient ne pas être restreints aux occidentaux ou aux groupes hautement individualistes. Les résultats n'ont pas dévoilé une association entre l'optimise dispotionnel et les comportements de risque ou les comportements d'auto-protection. Des analyses de régression multiples ont indiqué que le contexte culturel et le sexe sont les meilleurs prédicteurs de ces comportements. Les implications de ces résultats sont discutées. El presente estudio se basó en la evaluación de algunas conclusiones de investigaciones anteriores, basadas principalmente en comparaciones de habitantes de norteamericanos con habitantes del Asia del este, en las que se proponía que mientras los occidentales tienden a ser optimistas, los orientales tienden a ser pesimistas. En dos muestras de estudiantes de la escuela superior europeo-americanos y jordanos se administró un cuestionario que consiste en preguntas que miden el optimismo disposicional junto con preguntas que evalúan conductas de riesgo y de autoprotección (p.e., uso de cinturón de seguridad, velocidad de manejo, fumar

The evolution of groundwater rights and groundwater management in New Mexico and the western United States

NASA Astrophysics Data System (ADS)

DuMars, Charles T.; Minier, Jeffrie D.

coherente con las necesidades de bienestar social, pero protegidos por los principios de la ley de propiedad. Hasta el momento, cinco sistemas reguladores básicos han evolucionado en los Estados Unidos de América en relación a los derechos en las aguas subterráneas. Los problemas surgidos por las diferencias hidrológicas entre las aguas subterráneas conectadas a corrientes superficiales y las aguas subterráneas en acuíferos sobreexplotados han sido resueltos hasta cierto punto por un par de casos judiciales notables. La modelación numérica y otras metodologías técnicas han evolucionado también para evaluar aspectos científicos asociados a diversas circunstancias hidrológicas, pero no son inmunes a las críticas. El papel actual de los acuíferos está evolucionando hacia el de instalaciones de almacenamiento de agua reciclada y su utilización de esta forma puede expandirse incluso más en el futuro. Las implicaciones políticas de las decisiones relativas a la gestión conjunta de las aguas superficiales y subterráneas no pueden ser exageradas. Como este artículo demuestra, una administración proactiva de las extracciones futuras de aguas subterráneas con efectos en los ecosistemas superficiales es esencial para la capacidad final de planificar la explotación, gestión y utilización de los recursos hídricos de forma racional, coordinando las demandas presentes y futuras con la realidad de la escasez de suministro. Los ejemplos empleados en este artículo demuestran la necesidad de construir capacidad y no únicamente de desarrollar buenas técnicas de medida, o la de educar reguladores y jueces de talento que redacten buenas leyes, pero también de gestores profesionales y aplicados del agua que mantengan el proceso en un compromiso entre evitar la explotación ilimitada del recurso y ejercer un proteccionismo conservador que impida su uso para siempre.

Approaches to optimal aquifer management and intelligent control in a multiresolutional decision support system

NASA Astrophysics Data System (ADS)

Orr, Shlomo; Meystel, Alexander M.

2005-03-01

por lo tanto, estocasticidad o aleatoriedad ha incrementado la profundidad y resaltado relaciones importantes entre la incertidumbre, confiabilidad, riesgo, y su efecto en la función de costo, la adición también ha permitido (a) introducir complejidad adicional que resulta en potencia computacional excesiva aún para un solo parámetro incierto/aleatorio; y (b) llevar a reconocer nuestra discapacidad para evaluar la incertidumbre completa aún cuando se incluyen todos los parámetros inciertos. Se introduce un cambio paradigmático: una adaptación de nuevos métodos de control de inteligencia que relajarála dependencia en PDE estocásticas, rígidas y de uso computacional intensivo, cambiando el énfasis hacia un sistema de apoyo de decisiones de propósitos múltiples (MRDS) adaptivo, flexible, y orientadoa objetivos con fuerte aprendizaje sin supervisión (orientado a la anticipación más que a la predicción) con fuerte capacidad de optimización eficiente, lo cual podría aportar las soluciones necesarias a los problemas de manejo reales con los acuíferos. El artículo resalta los vínculos entre desarrollos pasados y control/planificación/optimización futura de sistemas hidrogeológicos.

Prevalence and correlates of treatment failure among Kenyan children hospitalised with severe community-acquired pneumonia: a prospective study of the clinical effectiveness of WHO pneumonia case management guidelines

PubMed Central

Agweyu, Ambrose; Kibore, Minnie; Digolo, Lina; Kosgei, Caroline; Maina, Virginia; Mugane, Samson; Muma, Sarah; Wachira, John; Waiyego, Mary; Maleche-Obimbo, Elizabeth

2014-01-01

traitements alternatifs sont nécessaires. Objetivo Determinar la extensión y el patrón del fallo en el tratamiento (FT) en niños hospitalizados con una neumonía adquirida en la comunidad, ingresados en un gran hospital terciario de Kenia. Métodos Hemos seguido a niños con edades entre los 2-59 meses con una neumonía severa (NS) y neumonía muy severa (NMS) según definición de la OMS de hasta cinco días para FT utilizando dos definiciones: (a) documentación de signos clínicos pre-definidos que resultaron en un cambio de tratamiento (b) decisión del clínico principal de cambiar el tratamiento con o sin documentación de los mismos signos clínicos pre-definidos. Resultados Incluimos a 385 niños. El riesgo de FT varió entre un 1.8% (IC 95% 0.4 a 5.1) y 12.4% (IC 95% 7.9 a 18.4) para NS y 21.4% (IC 95% 15.9 a 27) y 39.3% (IC 95% 32.5 a 46.4) para NMS dependiendo de la definición que se aplicase. Unas mayores tasas estaban asociadas con cambios tempranos en la terapia por el clínico y en ausencia de un razonamiento clínico obvio. Se observaba una no adherencia a las guías de tratamiento en 70/169 (41.4%) y 67/201 (33.3%) de los niños con NS y NMS respectivamente. Entre los niños con SP, la adherencia a las guías de tratamiento estaba asociada con la presencia de sibilancias en la evaluación inicial (P=0.02) mientras que la no adherencia del clínico a los tratamientos recomendados por las guías para NMS tendían a ocurrir en niños con un estado alterado de consciencia (P<0.001). Utilizando el pareamiento por puntaje de propensión para equilibrar los grupos en la distribución de las características clínicas de base de los niños con NMS, se observó que no existían diferencias en FT entre aquellos tratados con el régimen recomendado por las guías versus alternativas más costosas de amplio espectro (diferencias de riesgo 0.37 (IC 95% -0.84 a 0.51). Conclusión Antes de revisar las actuales guías de manejo de casos de neumonía, se requieren

The future of stochastic and upscaling methods in hydrogeology

NASA Astrophysics Data System (ADS)

Nœtinger, Benoît; Artus, Vincent; Zargar, Ghassem

2005-03-01

las influencias respectivas de varios fenómenos relevantes geológicos y físico-químicos que ocurren en varios rangos de escalas espaciales y escalas temporales así como entender y utilizar modelos geoestadísticos complejos y cada vez más acaudalados para aportar simulaciones realisticas de los condiciones del subsuelo. La simulación en escalas múltiples del transporte de fluidos en estas formaciones debería de ayudar a los ingenieros a enfocarse en fenómenos cruciales que controlan el flujo. Esto aporta un marco natural para integrar datos, resolver problemas inversos que involucran gran cantidad de datos, resultando en una reducción de las incertidumbres de la descripción del subsuelo que tiene que evaluarse. Esto permite a la vez tomar más decisiones practicas relevantes. En este artículo se presentan algunas perspectivas sobre el desarrollo de los enfoques de escala alta, resaltando algunos conceptos de escalas múltiples recientes, descartando el caso de medio fracturado. La escala alta puede utilizarse como un marco útil para manejar simultáneamente problemas dependientes de escala, enfoques estocásticos y problemas inversos. Se enfatiza las aplicaciones reales y potenciales de escala alta para la elaboración de modelos subsuperficiales confrontados con datos observados, y el manejo de incertidumbres y estudios de sensitividad en un marco global de escalas múltiples. En particular, la escala a lta puede ayudar a encontrar los parámetros que controlan el comportamiento global del flujo. Finalmente, los enfoques de escala alta de ecuaciones de transporte no lineal aparecen como una nueva frontera en esta área de la investigación.