Internação breve em unidade de emergência psiquiátrica pode prevenir permanência prolongada em instituições psiquiátricas

OBJECTIVE: Characterize and compare acute psychiatric admissions to the psychiatric wards of a general hospital (22 beds), a psychiatric hospital (80) and of an emergency psychiatry unit (6). METHOD: Survey of the ratios and shares of the demographic, diagnostic and hospitalization variables involved in all acute admissions registered in a catchment area in Brazil between 1998 and 2004. RESULTS: From the 11,208 admissions, 47.8% of the patients were admitted to a psychiatric hospital and 14.1% to a general hospital. The emergency psychiatry unit accounted for 38.1% of all admissions during the period, with a higher variability in occupancy rate and bed turnover during the years. Around 80% of the hospital stays lasted less than 20 days and in almost half of these cases, patients were discharged in 2 days. Although the total number of admissions remained stable during the years, in 2004, a 30% increase was seen compared to 2003. In 2004, bed turnover and occupancy rate at the emergency psychiatry unit increased. CONCLUSION: The increase in the number of psychiatric admissions in 2004 could be attributed to a lack of new community-based services available in the area beginning in 1998. Changes in the health care network did affect the emergency psychiatric service and the limitations of the community-based network could influence the rate of psychiatric admissions.OBJETIVO: Caracterizar e comparar internações psiquiátricas agudas em alas psiquiátricas no hospital geral (22 leitos), hospital psiquiátrico (80) e emergência psiquiátrica (6). MÉTODO: Foram analisadas todas as internações agudas entre 1998 e 2004 na região do estudo, com razões e proporções de variáveis demográficas, diagnósticas e das hospitalizações. RESULTADOS: Das 11.208 internações, 47,8% foram no hospital psiquiátrico e 14,1% no hospital geral. A emergência psiquiátrica realizou 38,1% das internações no período, com grande variabilidade da taxa de ocupação e giro leito durante os anos. Cerca de 80% das internações foram menores que 20 dias, com metade destas resolvidas em dois dias. O número total das internações permaneceu estável durante os anos, mas em 2004 ocorreu um aumento de 30% em relação a 2003. O giro leito e a taxa de ocupação na emergência psiquiátrica aumentaram em 2004. CONCLUSÃO: O aumento das internações psiquiátricas em 2004 pode estar ligado ao não surgimento de novos serviços extra-hospitalares desde 1998. O serviço de emergência psiquiátrica refletiu mudanças na rede de saúde e as limitações da rede de saúde extra-hospitalar podem ter influenciado a taxa de internações psiquiátricas

Chumbo: Uma introdução à extração e a fitorremediação

Lead is a commonly used metal in modern industry, because of its useful physico-chemical properties, for instance, to application in eletronic equipment. However, the major concern in the use of the current metal refers to the irregular drop, since 40% in the equipment weight corresponds to the lead. The lead, being a heavy metal, fits between the more toxic elements to the environment, and especially to human beings. The lead contamination is a concern and nowadays researchers are developing Phytoremediation methods for the decontamination of these polluted areas. Phytoextraction is the most recommended technique for heavy metals extraction. Thus this paper aims to make a survey of the main uses and the impacts of the lead on living beings, besides studying the application of the method of Phytoremediation in contaminated areas by this metal.O chumbo é um metal comumente usado na indústria moderna, devido às suas propriedades físico-químicas úteis, por exemplo, para aplicação em equipamentos eletrônicos. No entanto, a principal preocupação no uso do metal atual refere-se à queda irregular, uma vez que 40% no peso do equipamento corresponde ao chumbo. O chumbo, sendo um metal pesado, encaixa-se entre os elementos mais tóxicos para o meio ambiente e, principalmente, para os seres humanos. A contaminação por chumbo é uma preocupação e atualmente os pesquisadores estão desenvolvendo métodos de Fitorremediação para a descontaminação dessas áreas poluídas. A fitoextração é a técnica mais recomendada para extração de metais pesados. Assim, este trabalho tem como objetivo fazer um levantamento dos principais usos e impactos do chumbo nos seres vivos, além de estudar a aplicação do método de Fitorremediação em áreas contaminadas por este metal. &nbsp

An analysis of the essential medicines policy in primary care : findings from MedMinas project

Background: Essential Medicines Policy (EMP) has been adopted in Brazil to improve the provision and use of pharmaceuticals. This mixed methods study aims to bring evidence of the EMP implemented in municipalities in the context of primary care in Minas Gerais (20,997,560 inhabitants), Southeast Brazil. Methods: We analysed the core output of the EMP, i.e., the municipal essential medicines lists (MEML) and the effects of the policy on the procurement and availability of medicines. Data sources included a sample of 1,019 individuals (patients, health managers and health professionals), 995 prescriptions, 2,365 dispensed medicines and policy documents from 26 municipalities. Data were collected between April and October 2019. Document analysis and thematic content analysis were performed, and four availability indexes were estimated. Results: The findings suggest an overall lack of standardised and methodologically sound procedures to elaborate the MEML. Funding and public purchasing processes were found to be the major obstacles to medicine procurement. Only 63% of medicines were available at public community pharmacies and just 46.2% of patients had full access to their pharmaceutical treatment. Conclusion: This study reveals weaknesses in the implementation of EMP and a clear disconnection between medicines selection, procurement, and availability, the three core elements of the supply system. These findings contribute to informing future policy improvement actions to strengthen this system. Other countries aiming to advance towards universal health coverage may learn from the challenges that primary care in Brazil still needs to address

ALIMENTOS TRANSGÊNICOS: PERCEPÇÃO E ACEITABILIDADE DA POPULAÇÃO TOCANTINENSE

Os alimentos transgênicos vêm ganhando mais espaço na agricultura brasileira, principalmente na região do Cerrado. O objetivo deste trabalho foi analisar a percepção e aceitabilidade da população tocantinense a respeito dos alimentos transgênicos. Aplicou-se questionários contendo 29 questões para 119 pessoas residentes em Gurupi-TO e outras cidades da região sul do Estado. Os questionários foram aplicados nos anos de 2016 a 2018 e analisados pelo método estatístico descritivo.  Obteve-se um grau de confiança de 92,9% e margem de erro de 3,15 pontos percentuais. Observou-se que, 74% dos entrevistados conheciam a definição de alimentos transgênicos, 69% afirmaram que optariam por um alimento não transgênico. No entanto, 74% afirmam não leem o rótulo para verificar se o alimento é transgênico. Quanto ao consumo de alimentos transgênicos, 89% acreditam que a população consome sem conhecimento prévio. Portanto, nota-se a necessidade de inserção da população nos debates referentes aos transgênicos, bem como uma maior divulgação científica e midiática a respeito do tema para sanar as dúvidas da população sobre assunto

Performance of a pharmaceutical services regionalization strategy policy in Minas Gerais, Brazil : pre-post analysis from ERAF project

Background: In 2016, the Brazilian state of Minas Gerais (∼20 million people), implemented the ERAF policy ("Regionalization Strategy of Pharmaceutical Services") in an effort to improve medicine procurement and distribution within primary care. We evaluated the impact of the policy on three main goals: price reductions, volume increases, and expansion of therapeutic options. Methods: We analyzed the procurement data from the Integrated System of Management of Pharmaceutical Services database in 2012 and 2018. We estimated the volume, drug mix, and expenditure indicators for all major therapeutic classes, and, in detail, for cardiovascular and nervous system drugs. We evaluated the expenditure drivers using decomposition analyses. Results: Overall, the expenditure increased by 14.5%, drug mix almost doubled, while the volume decreased by a third. Cardiovascular and neurological system drugs followed similar patterns. Decomposition analyses showed that prices and drug mix had positive effects while the volume had negative effects, resulting in an overall increase in expenditure. Conclusion: Our findings suggest that the ERAF policy cannot be considered effective as it has not fulfilled its intended purposes so far. Strategies to address the identified problems and to build a platform for a more sustainable long-lasting policy should be put in place by the government

MedMinas project : design and use of mixed methods in the evaluation of pharmaceutical services in primary health care in Minas Gerais, Brazil

Background: The main purposes of primary care-based pharmaceutical services (PHCPS) in Brazil are to provide free access to medicines and pharmaceutical care to patients. Several obstacles hinder achieving their goals; thus, MedMinas Project aimed to evaluate the PHCPS, the supply system, and the use of medicines. This paper reflects on our experience designing, planning, and conducting the project, describing the issues yielded in the field and lessons learned. Methods: This work consists of a mixed-methods study conducted in Minas Gerais, Southeastern Brazil. We adopted the principles of Rapid Evaluation Methods, employing a multistage stratified sampling for the quantitative and a purposeful sampling for the qualitative components, respectively, and a documentary research. Data sources included individuals (patients and professionals), prescriptions, dispensed medicines, and policy documents collected between April and October 2019. The quantitative data described in this paper were analysed by descriptive statistics and the qualitative by Thematic Content Analysis. Results: A total of 26 municipalities varying from 37,784 to 409,341 inhabitants were included. The field team spent, on average, 16 days in each location. We interviewed 1019 respondents, of which 127 were professionals and 892 patients. The participation rate varied from 92 to 100%, depending on the respondent subgroup. Most interviews lasted between 45 min and one hour. Fieldwork challenges included participants’ enrolment, field team, interview processes, and project budget. The participants provided positive feedback and five main themes emerged from the interview experience (self-awareness, sense of gratitude, research value, access to findings, and benefits of the research). Additionally, we collected copies of 1072 documents and 2070 pieces of data from prescriptions filled and medicines dispensed at the PCP. Conclusion: We demonstrated the viability of conducting the MedMinas Project in an extensive geographic area within effective time frames that provided meaningful, high-quality data from multiple actors. The methods and lessons learned are valuable for researchers across various disciplines in similar urban settings in Brazil and other countries of low- and middle-income (LMIC)

Silvicultural performance of eucaliptus and animal behavior in a silvopastoral system

Silvopastoral system, in which trees and forage species are grown in the same area together with animals, has emerged as a sustainable alternative of agricultural production systems. However, information on different silvicultural arrangements and combinations of forest, animal and grazing components in this system are still scarce. Thus, this study followed the silvicultural performance of the forest component (Eucalyptus urophylla x E. grandis, eucalyptus hybrid, clone I-144) under different population arrangements in a silvopastoral system through periodic dendrometric evaluations and determined the impact of animal component (Nellore females) on tree development and ingestive behavior of animals subjected to rotational grazing in Urochloa brizantha cv. Marandu. The study was conducted at Agropecuária Ouro Branco, located in Bandeirantes, MS, Brazil. Total height, diameter at breast height, and wood volume per hectare were evaluated in three- and five-row ranks. To indicate plant growth, the current and average annual increments were calculated. Animal behavior was evaluated based on the periodic observation of 15 animals randomly selected in the lot. The initial performance of forest component was satisfactory in both populations, but growth indicators indicated greater current and average annual increments in the five-row rank. The presence of forest component does not interfere with the ingestive behavior and wellbeing of animals in the silvopastoral system, as well as, the presence of animal component does not interfere in the plants silvicultural development