Application of multiple criteria decision analysis (MCDA) for the selection of pharmacological treatments / Aplicação da análise de decisão baseada em múltiplos critérios para seleção de tratamentos farmacológicos

Introduction: Health Technology Assessment (HTA) is a tool that assists in the management of health systems, in which economic assessments are frequently applied. It is possible that the use of multicriteria analysis (MCDA) increases the quality of decisions. Objective: Identify the potentialities of the application of Multiple Criteria Decision Analysis (MCDA) in studies that used this type of method for the selection of treatments. Methods: An integrative review was executed based on articles where MCDA methods had been applied for the selection of treatments between February and April 2017 in the following databases: Pubmed (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Embase, Science Direct, Scopus, Web of Science and Wiley Online Library. Results: Eighteen studies published between 1998 and 2017 in which different MCDA techniques were applied were selected. Growth in the number of published studies was observed, showing increasing interest in the use of this type of method in health decision making. Conclusion: MCDA may guide more adequate decisions compared to the traditional Health Technology Assessment (HTA) methods and has the potential to help in the selection of treatments and the construction of medicines’ lists

VIVÊNCIAS DA EQUIPE DE ENFERMAGEM NO COTIDIANO DO SISTEMA PENAL

Objetivo: compreender o cotidiano vivido pela equipe de Enfermagem no sistema penal. Método: pesquisa qualitativa realizada com quatro enfermeiros e dois técnicos de Enfermagem de um Centro de Remanejamento Prisional, em Minas Gerais, Brasil. Os dados foram coletados por meio de entrevista entre junho e julho de 2018, e analisados com base no referencial de Minayo. Resultados: emergiram quatro categorias temáticas: “percepção do cuidado de Enfermagem à pessoa privada de liberdade”; “dificuldades para prestar assistência no presídio”; “sensação de invisibilidade do cuidado de Enfermagem no sistema prisional”; e “ambiguidade de sentimentos ao cuidar da saúde no sistema prisional.” Conclusão: o ambiente prisional não favorece ações concretas de promoção da saúde e prevenção de agravos. O enfrentamento viria com educação permanente, reuniões clínico-administrativas, além da construção de protocolos e diretrizes que sistematizem e sustentem as práticas.Descritores: Assistência à saúde. Enfermagem. Prisões. Prisioneiros. Descritores: Assistência à saúde. Enfermagem. Prisões. Prisioneiros.

Basic knowledge about visceral leishmaniasis before and after educational intervention among primary health care professionals in Midwestern Brazil

Health education and training of primary health care (PHC) professionals are highly recommended to reduce the occurrence and lethality of visceral leishmaniasis (VL). This study assessed the impact of an educational intervention on the basic knowledge about visceral leishmaniasis (VL) among PHC professionals from the Brazilian municipality of Rondonopolis, an important endemic area for VL. Responses provided by physicians, nurses, nursing technicians and community health agents from 12 PHC facilities were recorded through the application of self-completed and semi-structured questionnaires before (n=92) and after (n=64) an in-person health training course covering various aspects of VL. Closed- and open-ended responses were compared by the chi-square test and analyses of word clouds, respectively. The proportion of professionals aware of the correct etiological agent (p<0.001) and transmission route (p<0.001) of VL increased post-intervention. In addition, they increased their ability to recognize fever (p<0.001), weakness (p<0.001), weight loss (p<0.001), pallor (p<0.001) and abdominal distention (p=0.013) as clinical manifestations of human VL, and weakness (p<0.001), alopecia (p<0.001) and weight loss (p=0.019) as signs of canine VL. Analyses of word clouds suggested that the participants became more aware of the role of dogs in VL transmission and the role of environmental management in the prevention of VL. In conclusion, the intervention positively impacted the baseline knowledge concerning VL among the professionals. This can support the planning of educational activities for the PHC team regarding early case detection, prevention and control of VL in endemic areas

Proposta construtivista de metodologia de aprendizagem em natação dos cinco aos quatorze anos

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Effect of pH and volume in the hatching of resistance cysts of the species Dendrocephalus brasiliensis Pesta, 1921 (Crustacea, Anostraca)

Branchoneta is an option as live food for aquaculture and it is necessary to develop more studies to get information that makes possible its culture on a large scale. Our aim was to establish a method that results in a higher percentage hatching of D. brasiliensis. We analyzed if the cyst density could cause any significant difference in hatching; for that test we use 2 different conditions: (I) 15 ml glass tube (T1, T2, and T3) with 25 (twenty-five) cysts/repetition; and (II)  Erlenmeyer of 150 ml (T4, T5, and T6) with 25 cysts/repetition totaling 75 cysts/treatment, with triplicates to all treatments. We also tested 3 different pH conditions: acid (pH 3), neutral (pH~7/distilled water) and alkaline (pH 8), all in natural light and temperature. We conclude that there is no difference between the treatments, for none of the conditions tested. But other results have to be considered as Hatching Speed index and the Average Hatching Time with best results for the treatments T3, T1, and T2, respectively. The density of 0.6 ml/cyst (glass tube) resulted in faster hatching, which shows the necessity of further studies to analyze the speed of hatching under different conditions of density. The relative frequency showed that the hatchings peak occurs in the second day. We conclude that pH and density, in this study, not influenced the beginning of the hatching process

Infectious Causes of Abortion, Stillbirth and Neonatal Death in Bitches

Problems in gestational development in dogs can be determined by infectious and non‐infectious causes. Among the non‐infectious causes, trauma during pregnancy, genetic characteristics of the animal, deficit nutrition, thyroid dysfunction, maternal problems and hormonal disorders are found. The majority of the cases are in relation to infectious diseases, one should consider viral, bacterial, fungal and protozoal, which can interfere directly or indirectly in the foetal development. The progression of foetal development may be affected by the direct action of the microorganisms to overcome the placenta, but they are also able to affect pregnancy and release placental toxins by inflammatory processes and, may still cause maternal pathologies, which entail problems such as hyperthermia, hypoxia and endotoxemia, which can result in abortion. Several diseases can trigger pregnancy loss in dogs. This action can be direct by microorganisms, as well as indirectly triggering other problems that lead to abortion. This chapter discusses the infectious aetiologies of reproductive failures (abortion, stillbirth and neonatal death) in bitches

Aplicação exógena de tiamina ameniza os efeitos da baixa saturação de bases do solo sobre plantas de pimentão?

O uso intensivo do solo para a produção de hortaliças resulta em elevada degradação do solo e da área de cultivo. A utilização de técnicas e recursos que viabilizem a produção sob condições desfavoráveis pode ser decisiva para agricultura. Desta maneira, o objetivo deste trabalho foi avaliar os efeitos isolados e conjuntos da correção do solo e da aplicação de tiamina sobre o desenvolvimento das plantas de pimentão. Os tratamentos foram compostos por três diferentes saturações de base do solo (36, 60 e 80%), combinadas à aplicação de tiamina via foliar (com e sem) na concentração de 100 mg L-1. Verificou-se que a tiamina ameniza os efeitos da baixa saturação por base do solo sobre as características fisiológicas das plantas de pimentão. Os incrementos relativos à eficiência do uso da água e da eficiência instantânea de carboxilação, possibilitaram maior desenvolvimento das plantas tratadas com tiamina. Em complemento, a aplicação da tiamina é vantajosa para casos em que o plantio é realizado em condições de baixa saturação por bases, seguida da oferta adequada de nutrientes ou sistemas em que há parcial ou total correção das características químicas do solo, promovendo o desenvolvimento das plantas e aumento da atividade fisiológica.The intensive use of land to produce vegetables results in high soil degradation and cultivated area. The use of techniques and resources that make production possible under unfavorable conditions can be decisive for agriculture. Thus, this study aimed to evaluate the isolated and joint effects of liming and thiamine application on the development of bell pepper plants. The treatments consisted of three different soil base saturation (36, 60, and 80%), combined with foliar application of thiamine (with and without) at a concentration of 100 mg L-1. It was found that thiamine mitigates the effects of low base saturation on the physiological traits of bell pepper plants. The increments related to the water use efficiency and instantaneous carboxylation efficiency allowed greater development of plants treated with thiamine. In addition, the application of thiamine is advantageous in cases where planting is carried out under conditions of low base saturation, followed by an adequate supply of nutrients or systems in which there is a partial or total correction of the soil chemical characteristics, promoting the development of plants and increased physiological activity

Evaluation of Nanostructured Lipid Carriers Produced with Interesterified Buriti Oil

Pozadina istraživanja. Ulje buritija, izolirano iz pulpe amazonskog ploda, bogato je mikroelementima s antioksidativnim svojstvima i velikom biološkom vrijednošću. Nekoliko dostupnih istraživanja pokazuju da bi ovo ulje moglo imati široki spektar primjene, međutim nijedno istraživanje nije se dosad bavilo poboljšanjem njegovih značajki za komercijalnu primjenu. Enzimska interesterifikacija je jedna od dostupnih metoda za poboljšanje svojstava ulja i masti, a rezultati naših nedavnih ispitivanja pokazuju da lipaza specifično djeluje na ulje buritija, pri čemu nastaju strukturirani lipidi bogati oleinskom kiselinom, a istodobno se očuva većina spojeva prisutnih u manjim količinama u ulju. U ovom smo radu, tragajući za dodatnim načinima proširenja primjene sirovog ulja buritija, proučavali ponašanje strukturiranog ulja u nanostrukturiranim lipidnim nosačima. Eksperimentalni pristup. Nanostrukturirani lipidni nosači proizvedeni su iz interesterificiranog ulja buritija, a njhova stabilnost, veličina kapljica, električni naboj, mikrostruktura, polimorfizam i antioksidativno djelovanje procijenjeni su pomoću metoda ORAC (engl. oxygen radical absorbance capacity) i FRAP (engl. ferric reducing antioxidant power). Rezultati i zaključci. Rezultati pokazuju da je interesterifikacijom nastalo više nezasićenih triacilglicerola, a nanostrukturirani lipidni nosači pripremljeni s interesterificiranim uljem buritija imali su manje kapljice od onih dobivenih iz sirovog ulja buritija. Čestice su ostale stabilne tijekom skladištenja, a nanostrukturirani lipidni nosači pokazali su složeni polimorfizam uz prisutnost triju kristalnih oblika. ORAC vrijednost bila je približno 23 % veća u nanolipidnim nosačima sa strukturiranim lipidima nego u nanolipidnim nosačima sa sirovim uljem buritija, a FRAP vrijednost bila je 16 % veća, što potvrđuje utjecaj interesterifikacije na antioksidacijsku aktivnost nanonosača. Može se zaključiti da su nanostrukturirani lipidni nosači pripremljeni s interesterificiranim uljem buritija imali male kapljice, veliku stabilnost i antioksidativni kapacitet, te da se mogu koristiti u prehrambenim proizvodima i biološkim pripravcima. Novina i znanstveni doprinos. Ovo istraživanje pokazuje da je interesterifikacija pozitivno utjecala na fizikalno-kemijska svojstva nanostrukturiranih lipidnih čestica, a nastalo ulje bilo je bogato oleinskom kiselinom, imalo veliku stabilnost i izražen antioksidativni kapacitet. Stoga je zaključeno da postoji interes za daljnju primjenu tih nanočestica kao učinkovitog sustava nosača.Research background. Extracted from the pulp of an Amazonian fruit, buriti oil is rich in micronutrients with antioxidant properties and high biological value. The few studies available indicate that this oil could be used in a wide range of applications; however, there are no studies that work on the improvement of the characteristics of this oil for commercial application. The enzymatic interesterification is one of the tools available to improve the properties of oils and fats and our recent studies have demonstrated that the lipase could specifically act on buriti oil to produce structured lipids rich in oleic acid, while preserving most of the minor compounds present in this oil. Still looking for ways to expand the applicability of this raw oil, in this work, we are interested in studying the behaviour of this structured oil in nanostructured lipid carriers (NLCs). Experimental approach. The NLCs were produced with interesterified buriti oil and the stability, droplet size, electrical charge, microstructure, polymorphism and antioxidant activity of the samples were evaluated by oxygen radical absorbance capacity (ORAC) and ferric reducing antioxidant power (FRAP) methods. Results and conclusions. The results showed that the interesterification formed more unsaturated triacylglycerols (TAGs), and NLCs prepared with interesterified buriti oil had smaller droplets than NLCs with crude buriti oil. Particles remained stable throughout the storage period and NLCs exhibited complex polymorphism with the presence of three crystalline forms. The ORAC value was approx. 23 % higher in nanolipid carries with structured lipids than in the nanolipid carriers with crude buriti oil, and the FRAP value 16 % higher, demonstrating the influence of interesterification on the antioxidant activity of nanocarriers. Thus, NLCs prepared with interesterified buriti oil had small droplets, high stability and antioxidant capacity, and have a potential for nutritional and biological applications. Novelty and scientific contribution. This research showed that interesterification positively influenced the physicochemical properties of NLCs, producing the oil rich in oleic acid, high stability and antioxidant capacity. Therefore, it may be interesting to use these nanocarriers to obtain efficient carrier systems for future applications

Análise Ergonômica do Trabalho em uma empresa prestadora de serviços de reparo e manutenção de veículos automotores localizada no Centro Oeste mineiro / Ergonomic Analysis of Work in a company providing automotive vehicle repair and maintenance services located in the Midwest of Minas Gerais

O trabalho no setor de serviços mecânicos possui muitas atividades que exigem esforço físico para transportar peças e realizar tarefas. Um dos segmentos corporais que sofre maior exigência em trabalhos com estas características é o segmento lombar da coluna vertebral. O presente estudo foi realizado em uma empresa prestadora de serviços de reparo e manutenção em veículos automotores localizada em uma cidade do centro-oeste mineiro. Deste modo, aplicou-se métodos de análise ergonômica do trabalho como OWAS e o questionário nórdico, e a partir dos dados coletados, analisou-se o grau de riscos físicos dos trabalhadores da oficina mecânica ao realizarem manutenção e/ou orçamentos em veículos com problemas nos motores. Além disso, identificou-se uma série de necessidades de melhorias relativas ao ambiente de trabalho, incluído a variabilidade da temperatura, iluminação, ruídos, gerenciamento das operações, organização e limpeza do interior da empresa. A partir dos diagnósticos levantados, foi possível propor intervenções que propiciem melhorias no posto de trabalho estudado

Description of the collective health diagnosis held by the Extension Project Jornada Universitária da Saúde (JUS) in the city of Jambeiro-SP

O diagnóstico coletivo de saúde, proposto pelo modelo de planejamento normativo de ações em saúde como a etapa inicial, é parte essencial no processo de elaboração e execução de intervenções [1], que visem acolher necessidades de saúde da população de determinada localidade. Entretanto, o conhecimento necessário para a realização de diagnósticos coletivos de saúde nem sempre é trabalhado de maneira adequada e efetiva durante a formação de profissionais da saúde. Essa lacuna do ensino pode ser suprida por atividades de extensão acadêmica, tais como a Jornada Universitária da Saúde (JUS). A JUS é um projeto interprofissional e interdisciplinar de extensão da Universidade de São Paulo, que objetiva a promoção e educação em saúde mediante ações desenvolvidas em uma cidade do interior paulista, em um ciclo trienal. O presente trabalho tem como principal objetivo descrever o primeiro ano da JUS em uma nova cidade de atuação, Jambeiro, apresentando o processo realizado para o macro diagnóstico coletivo de saúde desse município.The collective diagnosis in health, proposed by the normative planning model as the initial step, is an essential part in developing and implementing interventions1, whose purpose is to receive demands from a specific place. Although essential, the necessary knowledge for conducting collective diagnoses in health is not always taught properly and effectively during professional’s health graduation. This gap can be filled with academics extensions, as well as the project “Jornada Universitária da Saúde” (JUS). The JUS is an interprofessional and interdisciplinary project from the University of São Paulo that aims the promotion and education in health through actions that are implemented in an inner city in São Paulo state, on a three year cycle. This article has as it is main goal, describing the project’s first year in a new city named Jambeiro, presenting the process of accomplishment for the collective diagnosis in health from this city