Índices de qualidade de serviço em sistemas de drenagem e tratamento de águas residuais

O abastecimento de água, o saneamento de águas residuais urbanas e a gestão integrada de resíduos sólidos urbanos constituem serviços públicos de carácter estrutural, essenciais ao bem-estar geral, à saúde pública e à segurança colectiva das populações, às actividades económicas e à protecção do ambiente. A Entidade Reguladora dos Serviços de Águas e Resíduos (ERSAR) implementou um sistema de avaliação de desempenho das entidades gestoras (EG) baseado em indicadores de desempenho (ID). Estes indicadores incidem sobre aspectos parcelares do desempenho duma dada EG, tendo por objectivo o aumento dos padrões de eficiência e de eficácia dos serviços prestados. Este trabalho tem como principal objectivo contribuir para a melhoria do modelo de avaliação de desempenho existente, através da definição e cálculo de índices (sectoriais e global) de qualidade de serviço em sistemas de drenagem e tratamento de águas residuais, com base numa metodologia de análise multicritério. O seu valor resulta duma criteriosa combinação das pontuações normalizadas de cada ID. Além de facilitarem a aplicação de estratégias de benchmarking, a integração destes índices em sistemas de suporte à decisão, associados à gestão patrimonial de infra-estruturas de saneamento básico poderá ser um instrumento muito útil para as EG na definição das suas prioridades de investimento e de planos operacionais de reabilitação

Sectoral indices to evaluate the sustainability of wastewater utilities

Wastewater systems are a structural part of public utilities and as such are vital to the general wellbeing, public health, economic activities and environment protection. These services, with the primary objective of protecting the interests of users, shall be governed by principles of universality of access, continuity and quality of service, efficiency, equity and sustainability of price. The aim of this paper is to contribute for the improvement of the Portuguese performance assessment system, through the development and application of a complementary methodology to define sectoral and global indices of sanitation service performance in order to evaluate the sustainability of a given wastewater utility. This methodology allows a truly quantitative evaluation in which each performance indicator represents a criterion to be considered and judiciously weighted. The sectoral indices are calculated as a weighted linear combination of the normalized scores of each performance indicator, which is one of the most common aggregation procedures available in the context of multicriteria evaluation. The criteria normalization process essentially based on fuzzy sets defined for each indicator. A sensitivity analysis of indices values to different weighting methods was also performed.Fundação para a Ciência e a Tecnologia (FCT

Relationship between mandibular fracture and impacted lower third molar

Many studies have shown that the greatest risk of fracture of the mandibular angle is related to the presence of an unerupted lower third molar, based on the hypothesis that there is a decrease in the area of bone and absorption of the impact in this area, leading some surgeons to indicate its prophylactic removal in patients most exposed to the risk factors of facial trauma. On the other hand, other authors have observed a greater frequency of condylar fractures in patients without an impacted lower third molar.Purpose: The aim of this study was to relate the condylar and angle fracture with an unerupted lower third molar, taking into account the position of the tooth.Material and Methods: Panoramic radiographs were used to determine if the presence or absence of the third molar is related to the occurrence of mandibular fractures, such as angle and condylar fractures.Results: In a total of 43 patients with angle fractures, the greatest percentage had erupted teeth, and 41.9% had impacted teeth; however there was no significant difference between the fractured side and the tooth condition (p=0.350). There were 91 condylar fractures and in 42.9% the third molar was absent and in 40.7% the tooth was erupted . There was no significant difference between the fractured side and the tooth condition (p=0.852).Conclusion: The absence of an impacted third molar may increase the risk of condylar fractures and decrease the prevalence of mandibular angle fractures

Multifunctional targeted solid lipid nanoparticles for combined photothermal therapy and chemotherapy of breast cancer

Photothermal therapy has emerged as a new promising strategy for the management of cancer, either alone or combined with other therapeutics, such as chemotherapy. The use of nanoparticles for multimodal therapy can improve treatment performance and reduce drug doses and associated side effects. Here we propose the development of a novel multifunctional nanosystem based on solid lipid nanoparticles co-loaded with gold nanorods and mitoxantrone and functionalized with folic acid for dual photothermal therapy and chemotherapy of breast cancer. Nanoparticles were produced using an economically affordable method and presented suitable physicochemical properties for tumor passive accumulation. Upon Near-Infrared irradiation (808 nm, 1.7 W cm -2, 5 min), nanoparticles could effectively mediate a temperature increase of >20 ◦C. Moreover, exposure to light resulted in an enhanced release of Mitoxantrone. Furthermore, nanoparticles were non-hemolytic and well tolerated by healthy cells even at high concentrations. The active targeting strategy was found to be successful, as shown by the greater accumulation of the functionalized nanoparticles in MCF-7 cells. Finally, the combined effects of chemotherapy, light-induced drug release and photothermal therapy significantly enhanced breast cancer cell death. Overall, these results demonstrate that the developed lipid nanosystem is an efficient vehicle for breast cancer multimodal therapy.info:eu-repo/semantics/publishedVersio

Occupational stress among Brazilian oral-maxillofacial surgeons

Purpose: The aim of the present study was to assess the stress level of oral-maxillofacial surgeons, based on the Demand-Control Model. Methods: A cross-sectional study was carried out with 128 oral-maxillofacial surgeons who participated in the Brazilian Congress of Oral-Maxillofacial Surgery held in the city of Florianópolis, State of Santa Catarina, Brazil. Data was obtained using a questionnaire that incorporated the Demand-Control Model (Job Content Questionnaire), which evaluates psychosocial experiences at work. Information on age, gender and professional qualification was also collected. The data was displayed in contingency tables. The following statistical tests were used with a 5% level of significance: chi-square test and ?Fisher exact test?. Results: Oralmaxillofacial surgeons were classified according to the Demand-Control Model as follows: High Demand (28%), Low Demand (28%); Passive Work (27%), Active Work (16.4%). Conclusion: The majority of oral-maxillofacial surgeons exercise their profession in unsatisfactory working conditions, as less than 1/3 of the population studied worked under the ideal condition of low demand

The concept and practice of comprehensiveness in Primary Health Care: nurses' perception

O objetivo deste estudo é debater o discurso das enfermeiras sobre o conceito da integralidade em saúde e como operacionalizar na prática a integralidade na Atenção Básica. Considerando a integralidade como um dos pilares do SUS e tomando a força de trabalho em enfermagem como um contingente considerável de pessoas para operar na construção do SUS, considerou-se importante identificar as bases conceituais e práticas que direcionam o trabalho das enfermeiras para a construção da integralidade na saúde. Neste estudo qualitativo exploratório, foram entrevistadas 10 enfermeiras que atuam na atenção básica em três municípios do interior do estado de São Paulo. Os dados foram coletados através de entrevistas semiestruturadas e analisados segundo a técnica do discurso do sujeito coletivo. Os resultados mostraram que as concepções que as enfermeiras possuem sobre integralidade estão diretamente relacionadas à prestação de assistência e que estas profissionais colocam a integralidade em prática ao executar seu processo de trabalho cotidiano.Se objetivó discutir el discurso de enfermeras sobre el concepto de integralidad en salud y cómo operacionalizar en la práctica la integralidad en Atención Básica. Constituyéndose la integralidad como uno de los pilares del SUS y tomando la fuerza laboral de enfermería como un contingente razonable de personas para operar en la construcción del SUS, se consideró importante identificar las bases conceptuales y prácticas que orientan el trabajo de enfermeras para la constitución de la integralidad en salud. Estudio cualitativo, exploratorio. Fueron entrevistadas 10 enfermeras actuantes en Atención Básica en tres municipios del estado de São Paulo. Se recolectaron datos a través de entrevistas semiestructuradas, analizadas según técnica del Discurso del Sujeto Colectivo. Los resultados mostraron que las concepciones de las enfermeras acerca de la integralidad están directamente relacionadas a la prestación de atención y que estas profesionales colocan a la integralidad en práctica al ejecutar su laboral cotidiano.The objective of this study is to debate on the nurses' discourse on the concept of health comprehensiveness and how to implement it in primary health care practice. Considering that comprehensiveness is one of the pillars of the Brazilian public health system (SUS) and taking nursing work force as a considerable commission of people to work for the construction of the SUS, the authors considered important to identify the conceptual bases and practices that guide nurses' work towards in the construction of health comprehensiveness. In this qualitative, exploratory study interviews were performed with 10 nurses working in primary health care centers in three cities in the interior state of São Paulo. Data collection was performed through semi-structured interviews and analyzed according to the collective subject discourse technique. Results showed that the nurses' conceptions on comprehensiveness are directly relates with providing care, and that these professionals put comprehensiveness into practice through their everyday work

Alcohol abusive use increases facial trauma?

Trauma is among the main death causes and morbidity in the world and is often related to the use of alcohol and its abuse has reached massive proportions, no matter if the country is developed or not, being considered as public health problem. Since there are very few randomized and prospective studies in literature about the association of facial trauma and the use of alcohol, this study aims to investigate the impact of alcohol use in facial trauma. This was a prospective and cross sectional study, involving facial trauma patients attended at Oral Maxillofacial Surgery Division of a State Hospital. Variables included patient´s profile, trauma etiology, facial region involved, type of injury and treatment and days of hospitalization. AUDIT test was applied to identify risks and damages of alcohol use and chemical dependence. Absolute distribution, uni and mutilvaried percentages were made for data evaluation. Pearson´s qui-squared and Fisher´s Exact tests were also used. One hundred patients were evaluated. The patient´s mean age was 33.50 years-old, 48% had between 17 and 29 years old, 28% had 30 to 39, and 24% 40 or more. Most of them were male (86%). The most frequent etiology was traffic accident (57%), the extraoral area was most committed (62%), the most frequent type of injury was fractures (78%) and the most affected bone was the mandible (36%). More than half of the patients (53%) had surgical treatment. 38% had their discharge from hospital right after the first attendance. The AUDIT most frequent answer was ?moderate use? (46%) and use at risk (39%). There was significant difference between the use of alcohol (AUDIT) and hematoma (0.003) and number of days of hospitalization (p=0.005). In this study it was not observed association between alcohol consumption using the AUDIT and trauma etiology, but patient victims of traffic accidents were classified as with risk in the scale. Most of the trauma were caused by traffic accidents using motorcycles and occurred in young aged men