Integrated Health Service Delivery Networks And Tuberculosis Avoidable Hospitalizations: Is There A Relation Between Them In Brazil?

The early identification of the Breathing Symptoms within the scope of Primary Health Care is recommended, and is also one of the strategies of national sanitary authorities for reaching the elimination of tuberculosis. The purpose of this study is to consider which attributes and which territories have shown the most significant progress in Primary Health Care, in terms of coordination of Health Care Networks, and also check if those areas of Primary Health Care that are most critical regarding coordination, there were more or less cases of avoidable hospitalizations for tuberculosis. Methods: This is an ecological study that uses primary and secondary data. For analysis, coropletic maps were developed through the ArcGIS software, version 10.2. There was also the calculation of gross annual and Bayesian rates for hospitalizations for tuberculosis, for each Primary Health Care territory. Results: There were satisfactory results for attributes such as Population (n = 37; 80.4 %), Primary Health Care (n = 43; 93.5 %), Support System (n = 45; 97.8 %); the exceptions were Logistics System (n = 32; 76.0 %) and Governance System, with fewer units in good condition (n = 31; 67.3 %). There is no evidence of any connection between networks' coordination by Primary Health Care and tuberculosis avoidable admissions. Conclusion: The results show that progress has been made regarding the coordination of the Health Care Networks, and a positive trend has been shown, even though the levels are not excellent. It was found no relationship between the critical areas of Primary Health Care and tuberculosis avoidable hospitalizations, possibly because other variables necessary to comprehend the phenomena. © 2016 Popolin et al.16

Análise da produção científica sobre a tuberculose em Portugal: revisão Integrativa da literatura

Em 2017, foram notificados 1741 casos de tuberculose em Portugal, dos quais 1607 são novos. Esses dados representam uma taxa de incidência estimada em 15,6 por 100.000 habitantes. Comparativamente ao início do milênio, que possuía taxa de incidência de 40%, estes resultados indicam uma evolução positiva do país no controle da tuberculose. O objetivo deste estudo foi analisar a produção científica sobre a tuberculose em Portugal. Trata-se de uma Revisão Integrativa da Literatura, com pesquisa de artigos atendendo a critérios pré-definidos, considerando o período temporal entre 2006 a 2017, acedidos por meio das bases de dados PubMed e CINAHL. Foram identificados 23 artigos cujos resultados são diversificados, fornecendo um panorama sobre a realidade nacional, especialmente no que concerne a prevalência de casos, fatores de risco e resultados do tratamento, multirresistência e testes de rastreio em profissionais de saúde. Os resultados podem ser úteis para a melhoria de medidas tanto dos programas de luta contra a tuberculose, quanto das outras esferas organizacionais responsáveis por fornecer ações de saúde

Characterization of eucalyptus clones subject to wind damage

<div><p>Abstract: The objective of this work was to test a new methodology to assess the resistance of trees to wind damage and determine the characteristics that increase clone resistance to winds. Tree resistance to breakage, basic density, ultrastructure, anatomy, mechanical properties, and wood growth stress have been evaluated in seven Eucalyptus grandis × Eucalyptus urophylla clones, collected from a region with a high incidence of wind damage. The Pearson correlation coefficient between the tree resistance to breakage and the ratio between the area damaged by the winds and the total planted area was -0.839, showing the efficiency of the methodology adopted and that high breaking strength results in a smaller area affected by wind damage. Trees with a high basic density, cell wall fraction, modulus of elasticity of the middle lamella and fibers, fiber hardness, modulus of rupture, growth stress and low microfibril angle and height and width of the rays showed greater resistance to wind damage. Therefore, the selection of clones with these features may reduce the incidence of damage by winds in Eucalyptus plantations.</p></div

An International Adult Guideline for Making Clozapine Titration Safer by Using Six Ancestry-Based Personalized Dosing Titrations, CRP, and Clozapine Levels.

This international guideline proposes improving clozapine package inserts worldwide by using ancestry-based dosing and titration. Adverse drug reaction (ADR) databases suggest that clozapine is the third most toxic drug in the United States (US), and it produces four times higher worldwide pneumonia mortality than that by agranulocytosis or myocarditis. For trough steady-state clozapine serum concentrations, the therapeutic reference range is narrow, from 350 to 600 ng/mL with the potential for toxicity and ADRs as concentrations increase. Clozapine is mainly metabolized by CYP1A2 (female non-smokers, the lowest dose; male smokers, the highest dose). Poor metabolizer status through phenotypic conversion is associated with co-prescription of inhibitors (including oral contraceptives and valproate), obesity, or inflammation with C-reactive protein (CRP) elevations. The Asian population (Pakistan to Japan) or the Americas' original inhabitants have lower CYP1A2 activity and require lower clozapine doses to reach concentrations of 350 ng/mL. In the US, daily doses of 300-600 mg/day are recommended. Slow personalized titration may prevent early ADRs (including syncope, myocarditis, and pneumonia). This guideline defines six personalized titration schedules for inpatients: 1) ancestry from Asia or the original people from the Americas with lower metabolism (obesity or valproate) needing minimum therapeutic dosages of 75-150 mg/day, 2) ancestry from Asia or the original people from the Americas with average metabolism needing 175-300 mg/day, 3) European/Western Asian ancestry with lower metabolism (obesity or valproate) needing 100-200 mg/day, 4) European/Western Asian ancestry with average metabolism needing 250-400 mg/day, 5) in the US with ancestries other than from Asia or the original people from the Americas with lower clozapine metabolism (obesity or valproate) needing 150-300 mg/day, and 6) in the US with ancestries other than from Asia or the original people from the Americas with average clozapine metabolism needing 300-600 mg/day. Baseline and weekly CRP monitoring for at least four weeks is required to identify any inflammation, including inflammation secondary to clozapine rapid titration