AVALIAÇÃO DA QUALIDADE NA ATENÇÃO BÁSICA.

El objetivo fue evaluar la calidad de los servicios ofrecidos en Unidades Básicas de Salud de la Familia (UBASF) por medio de la técnica de “entrevista de salida” aplicada en usuarios del servicio. Estudio cualitativo, realizado en octubre de 2002 en dos UBASF’s de un municipio de la III Célula Regional de Salud de Ceará. Fueron entrevistados 20 usuarios. Conforme los resultados revelaron, la busca por el usuario del servicio de salud estaba relacionada con el recibo de medicamentos y la busca de consultas médicas y odontológicas, mientras la mejoría de la calidad del servicio fue asociada al aumento de la oferta de los servicios, a la mejoría de las relaciones humanas profesionales-usuarios y a la ampliación de la estructura física de la UBASF. Se concluye que la “entrevista de salida” con usuarios es una herramienta adecuada para la determinación de la eficiencia de los servicios de la atención básica. Por lo tanto, los gestores municipales y/o los gerentes de unidades pueden aplicarla regularmente para obtener elementos que mejoren el servicio en relación a oferta, relaciones humanas y estructura física.Objetivou-se avaliar a qualidade dos serviços oferecidos em Unidades Básicas de Saúde da Família (UBASF) por meio da técnica de “entrevista de saída” aplicada com usuários do serviço. Estudo qualitativo, realizado em outubro de 2002 em duas UBASFs de um município da III Célula Regional de Saúde do Ceará. Foram entrevistados 20 usuários. Conforme os resultados revelaram, a procura do usuário pelo serviço de saúde estava relacionada ao recebimento de medicamentos e à busca de consultas médicas e odontológicas, enquanto a melhoria da qualidade do serviço foi associada ao aumento da oferta dos serviços, à melhoria das relações humanas profissionais-usuários e à ampliação da estrutura física da UBASF. Conclui-se que a “entrevista de saída” com usuários é ferramenta adequada à determinação da eficiência dos serviços da atenção básica. Portanto, os gestores municipais e/ou gerentes de unidades podem aplicá-la regularmente para obterem elementos para melhorar o serviço quanto à oferta, relações humanas e estrutura física

Identification of a cytokine network sustaining neutrophil and Th17 activation in untreated early rheumatoid arthritis

© 2010 Cascão et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by sustained synovitis. Recently, several studies have proposed neutrophils and Th17 cells as key players in the onset and perpetuation of this disease. The main goal of this work was to determine whether cytokines driving neutrophil and Th17 activation are dysregulated in very early rheumatoid arthritis patients with less than 6 weeks of disease duration and before treatment (VERA). Methods: Cytokines related to neutrophil and Th17 activation were quantified in the serum of VERA and established RA patients and compared with other very early arthritis (VEA) and healthy controls. Synovial fluid (SF) from RA and osteoarthritis (OA) patients was also analyzed. Results: VERA patients had increased serum levels of cytokines promoting Th17 polarization (IL-1b and IL-6), as well as IL-8 and Th17-derived cytokines (IL-17A and IL-22) known to induce neutrophil-mediated inflammation. In established RA this pattern is more evident within the SF. Early treatment with methotrexate or corticosteroids led to clinical improvement but without an impact on the cytokine pattern. Conclusions: VERA patients already display increased levels of cytokines related with Th17 polarization and neutrophil recruitment and activation, a dysregulation also found in SF of established RA. 0 Thus, our data suggest that a cytokine-milieu favoring Th17 and neutrophil activity is an early event in RA pathogenesis.This work was supported by a grant from Sociedade Portuguesa de Reumatologia/Schering-Plough 2005. RAM and RC were funded by Fundação para a Ciência e a Tecnologia (FCT) SFRH/BD/30247/2006 and SFRH/BD/40513/2007, respectively. MMS-C was funded by Marie Curie Intra-European Fellowship PERG-2008-239422 and a EULAR Young Investigator Award

Numerical simulation of blood flow and pressure drop in the pulmonary arterial and venous circulation

A novel multiscale mathematical and computational model of the pulmonary circulation is presented and used to analyse both arterial and venous pressure and flow. This work is a major advance over previous studies by Olufsen et al. (Ann Biomed Eng 28:1281–1299, 2012) which only considered the arterial circulation. For the first three generations of vessels within the pulmonary circulation, geometry is specified from patient-specific measurements obtained using magnetic resonance imaging (MRI). Blood flow and pressure in the larger arteries and veins are predicted using a nonlinear, cross-sectional-area-averaged system of equations for a Newtonian fluid in an elastic tube. Inflow into the main pulmonary artery is obtained from MRI measurements, while pressure entering the left atrium from the main pulmonary vein is kept constant at the normal mean value of 2 mmHg. Each terminal vessel in the network of ‘large’ arteries is connected to its corresponding terminal vein via a network of vessels representing the vascular bed of smaller arteries and veins. We develop and implement an algorithm to calculate the admittance of each vascular bed, using bifurcating structured trees and recursion. The structured-tree models take into account the geometry and material properties of the ‘smaller’ arteries and veins of radii ≥ 50 μ m. We study the effects on flow and pressure associated with three classes of pulmonary hypertension expressed via stiffening of larger and smaller vessels, and vascular rarefaction. The results of simulating these pathological conditions are in agreement with clinical observations, showing that the model has potential for assisting with diagnosis and treatment for circulatory diseases within the lung

π-π stacking tackled with density functional theory

Through comparison with ab initio reference data, we have evaluated the performance of various density functionals for describing π-π interactions as a function of the geometry between two stacked benzenes or benzene analogs, between two stacked DNA bases, and between two stacked Watson–Crick pairs. Our main purpose is to find a robust and computationally efficient density functional to be used specifically and only for describing π-π stacking interactions in DNA and other biological molecules in the framework of our recently developed QM/QM approach "QUILD". In line with previous studies, most standard density functionals recover, at best, only part of the favorable stacking interactions. An exception is the new KT1 functional, which correctly yields bound π-stacked structures. Surprisingly, a similarly good performance is achieved with the computationally very robust and efficient local density approximation (LDA). Furthermore, we show that classical electrostatic interactions determine the shape and depth of the π-π stacking potential energy surface

Computational Analysis of Pulsed Radiofrequency Ablation in Treating Chronic Pain

In this paper, a parametric study has been conducted to evaluate the effects of frequency and duration of the short burst pulses during pulsed radiofrequency ablation (RFA) in treating chronic pain. Affecting the brain and nervous system, this disease remains one of the major challenges in neuroscience and clinical practice. A two-dimensional axisymmetric RFA model has been developed in which a single needle radiofrequency electrode has been inserted. A finite-element-based coupled thermo-electric analysis has been carried out utilizing the simplified Maxwell’s equations and the Pennes bioheat transfer equation to compute the electric field and temperature distributions within the computational domain. Comparative studies have been carried out between the continuous and pulsed RFA to highlight the significance of pulsed RFA in chronic pain treatment. The frequencies and durations of short burst RF pulses have been varied from 1 Hz to 10 Hz and from 10 ms to 50 ms, respectively. Such values are most commonly applied in clinical practices for mitigation of chronic pain. By reporting such critical input characteristics as temperature distributions for different frequencies and durations of the RF pulses, this computational study aims at providing the first-hand accurate quantitative information to the clinicians on possible consequences in those cases where these characteristics are varied during the pulsed RFA procedure. The results demonstrate that the efficacy of pulsed RFA is significantly dependent on the duration and frequency of the RF pulses

Natural selection shaped the rise and fall of passenger pigeon genomic diversity.

The extinct passenger pigeon was once the most abundant bird in North America, and possibly the world. Although theory predicts that large populations will be more genetically diverse, passenger pigeon genetic diversity was surprisingly low. To investigate this disconnect, we analyzed 41 mitochondrial and 4 nuclear genomes from passenger pigeons and 2 genomes from band-tailed pigeons, which are passenger pigeons' closest living relatives. Passenger pigeons' large population size appears to have allowed for faster adaptive evolution and removal of harmful mutations, driving a huge loss in their neutral genetic diversity. These results demonstrate the effect that selection can have on a vertebrate genome and contradict results that suggested that population instability contributed to this species's surprisingly rapid extinction

Influence of inflammation on parasitism and area of experimental amoebic liver abscess: an immunohistochemical and morphometric study

The influence of inflammation on the number of trophozoites and on the murine amoebic liver abscess area following infection with Entamoeba histolytica and E. dispar was evaluated. Immunohistochemistry and digital morphometry were used to identify and quantify the trophozoites, neutrophils, macrophages, and lesions. Positive correlation was observed between the number of trophozoites and inflammatory cells. A significant decrease in parasitism and inflammation in groups treated with dexamethasone was observed. The scarceness or absence of trophozoites in the treated groups suggest the importance of the inflammatory response in the production of amoebic hepatic abscesses in spite of the inherent virulence of the parasite being decisive in the establishment of the lesion