Avaliação e classificação de risco: tempo de espera dos usuários de baixa gravidade

Aim: to identify if the time between the risk assessment and medical care for less severe patient was in accordance with institutional protocol. Method: cross-sectional descriptive study performed in the emergency department of a scholastic public hospital of high complexity, from March to June 2012. The sample consisted of 172 patients, aged starting from 12 years, ranked in colors: yellow, green and blue, according to protocol of the institution. Results: according to the institutional protocol 66.00% of patients were classified in the color green. It was observed that the average waiting time, measure in minutes, was within the recommended rating of the three colors: Yellow 40.68, green and blue 53.76 and 69.06. Conclusion: the average waiting time for medical care did not exceed that recommended by the emergency service protocol in any of the classification of colorsObjetivo: identificar si el tiempo entre la evaluación del riesgo y la atención médica para el paciente menor de edad está en conformidad con el protocolo institucional. Método: estudio descriptivo transversal. Realizado en el servicio de urgencias de un hospital público, universitario y de alta complejidad, de marzo a junio de 2012. La muestra consistió en 172 pacientes, con edades de 12 años, clasificado en los colores: amarillo, verde y azul, según el protocolo de la institución. Resultados: de acuerdo con el protocolo institucional 66.00% de los pacientes fueron clasificados en el color verde. Se observó que el tiempo medio de espera, en minutos, estaba dentro de la clasificación recomendada de los tres colores: amarillo 40.68, verde y azul 53.76 y 69.06. Conclusión: el tiempo medio de espera para la atención médica no superó la recomendada por el protocolo de servicio de emergencia según la clasificación de los colores.Objetivo: identificar se o tempo transcorrido entre a classificação de risco e o atendimento médico para os pacientes de menor gravidade estava de acordo com o protocolo institucional. Método: estudo transversal descritivo. Realizado no Serviço de Emergência de um hospital público, universitário e de alta complexidade no período de março a junho de 2012. A amostra constituiu de 172 pacientes, com idade a partir dos 12 anos, classificados nas cores: amarela, verde e azul, segundo o protocolo da instituição. Resultados: de acordo com o protocolo institucional 66% dos pacientes foram classificados na cor verde. Observou-se que o tempo médio de espera, dado em minutos, estava dentro do preconizado nas três cores de classificação: amarela 40,68, verde 53,76 e azul 69,06. Conclusão: o tempo médio de espera para o atendimento médico não ultrapassou aquele preconizado pelo protocolo do serviço de emergência em nenhuma das cores de classificação.

Representações sociais de adolescentes sobre saúde-doença e interesses de participação em grupos educativos

Aims: to analyze points of view profiles on health and diseases. Method: exploratory, qualitative research. Data was collected with 134 adolescences from the Unity of Family Health thought free words association technic and open questions. Results: prevalence of 15 to 17 years old female students with until 8th degree, single, familiar gains in between 1 to 2 minimum salaries. Most of them had never participated on educational groups and they had shown interest of participating on Saturdays morning in groups that educate about “health, prevention and care”. The social representations about health are mainly on alimentation, well been and care, concerning diseases they are mainly on pain and medication. Conclusion: the social representations are related with a sense of negativity, but concerning their relation with health it is mainly positive. There are interested of participating on educational groups with meters on sexuality, drugs, health/diseases processes, prevention, sports, educations and professions.Objetivos: conocer las representaciones sociales acerca de la salud y la enfermedad desde el punto de vista de los adolescentes. Método: investigación cualitativa, exploratoria. Datos recogidos, a través de la técnica de asociación libre de palabras y preguntas abiertas, con 134 adolescentes de la Unidad de Salud de Familia y analizados, a través de las representaciones sociales. Resultados: predominó edad 15-17 años, femenino, estudiantes, hasta octavo grado, solteros, ingreso familiar de 1 a 2 sueldos básicos. La mayoría nunca ha participado de grupos educativos. Las representaciones sociales de la salud están centralizadas en alimentación, bienestar y cuidar-cuidando. Con respecto a la enfermedad, están centralizadas en el dolor y la medicación. Conclusión: las representaciones sociales de la enfermedad se asocian con significados negativos, sin embargo, en relación a la salud predominancia positiva. Hay interés en participar en grupos de educación, abordando temas como sexualidad, drogas, proceso salud-enfermedad, prevención, deporte, educación y profesión.Objetivos: conhecer as representações sociais sobre saúde e doença no olhar dos adolescentes. Método: pesquisa qualitativa, exploratória. Dados coletados através da técnica de associação livre de palavras e perguntas abertas, com 134 adolescentes da Unidade Saúde da Família e analisados com o olhar das representações sociais. Resultados: prevaleceu a faixa etária de 15 a 17 anos, do sexo feminino, de estudantes até a 8ª série, solteiros, renda familiar de 1 a 2 salários mínimos. A maioria nunca participou de grupos educativos. As representações sociais sobre saúde têm centralidade em alimentação, bem-estar e cuidar-cuidado, quanto a doença estão centralizadas em dor e medicamento. Conclusões: as representações sociais sobre doença estão relacionadas com sentidos negativos havendo, contudo, com relação à saúde predominância positiva. Há interesse em participar de grupos educativos sobre questões relacionadas com sexualidade, drogas, processo saúde-doença, prevenção, esporte, educação e profissão

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Killer immunoglobulin-like receptor (KIR) genes are associated with the risk of episodes of high-level and detectable viremia among HIV controllers

Different levels of viremia control are observed among HIV-1-infected individuals. Approximately 1% of the HIV-1-seropositive population suppresses viral replication to extremely low or undetectable levels in the absence of antiretroviral therapy and are termed HIV controllers (HICs) or elite controllers (ECs). In this study, we analyzed the distribution of HLA-B and -C, KIR, CCR5 genes, as well as selected SNPs to investigate their impact on the viral control observed in a cohort of Brazilian HICs

Crude protein reduction and digestible methionine+cystine and threonine to digestible lysine ratios in diets for Nile tilapia fingerlings

The objective of the present study was to investigate crude protein reduction and the methionine+cystine and threonine to lysine ratios in diets for reversed Nile tilapia fingerlings (Oreochromis niloticus), Thai strain. Four hundred and twenty Nile tilapia fingerlings with an average initial weight of 1.83 ± 0.02 g were placed in a completely randomized design, with five treatments, seven replications per treatment and 12 fish per experimental unit, for 37-days. Two crude protein (CP) levels were evaluated (32 and 28%). The diet with 32% CP had methionine+cystine:lysine and threonine:lysine ratios of 63 and 74%, respectively. Three diets with 28% CP had methionine+cystine:lysine and threonine:lysine ratios of 63 and 74%, 60 and 74% and 60 and 69%, respectively. The diet with 28% CP and had methionine+cystine:lysine ratio of 63% and threonine:lysine of 74% and was supplemented with 0.3% glutamic acid. The fish were kept in thirty-five 130 L aquariums supplied with single-pass flow-through water, individual aeration and fed ad libitum six times per day. Fish fed the diet with 32% CP had lower protein efficiency ratios and nitrogen efficiency ratios. The diet CP level was 28% and the methionine+cystine and threonine to lysine ratios were 60 and 69%, respectively

Distribution of CCR5 genotypes and HLA Class I B alleles in HIV-1 infected and uninfected injecting drug users from Rio de Janeiro, Brazil

Submitted by Frederico Azevedo ([email protected]) on 2010-11-04T18:27:54Z No. of bitstreams: 1 distribution_of_ccr5.pdf: 128024 bytes, checksum: 496439e13f1d836aee797a30ceb293f3 (MD5)Made available in DSpace on 2010-11-04T18:27:54Z (GMT). No. of bitstreams: 1 distribution_of_ccr5.pdf: 128024 bytes, checksum: 496439e13f1d836aee797a30ceb293f3 (MD5) Previous issue date: 2009Laboratory of AIDS and Molecular Immunology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation - FIOCRUZDepartment of Health Information, Institute of Scientific and Technologic Information and Communication in Health, Oswaldo Cruz Foundation - FIOCRUZDepartment of Health Information, Institute of Scientific and Technologic Information and Communication in Health, Oswaldo Cruz Foundation - FIOCRUZLaboratory of AIDS and Molecular Immunology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation - FIOCRUZHost genetic factors play an important role in the HIV epidemic dynamics, and have been considered in studies assessing susceptibility/resistance to HIV-1 infection as well as clinical evolution. Class I and Class II HLA alleles have been associated with the heterogeneity of HIV-1 infection susceptibility, as protective or risk factors for HIV-1 transmission. Moreover, a 32-base pair deletion in the HIV-1 CCR5 gene-coding region confers resistance to HIV-1 infection in homozygous individuals for the deleted allele. In this study, DNA samples from HIV-1 infected and uninfected injecting drug users (IDUs) from Rio de Janeiro were PCR amplified to determine CCR5 genotypes based on the presence of the CCR5D32 mutation and typed for the HLA-B locus, in an attempt to assess possible associations between these genetic factors and susceptibility/resistance to HIV-1 infection. The distribution of CCR5 genotypes between the two IDU groups did not differ. The homozygous mutant genotype D32/D32 was not found in this study. Except for HLA-B*45 (4.0% vs. 3.0%; p = 0.04) and for B*51 (12.1% vs. 4.4%; p = 0.002), no statistically significant differences were made evident when analyzing the frequencies of each HLA-B allele between Caucasian and non-Caucasian IDUs. The most frequent HLA-B alleles were B*15; B*35; B*44 and B*51. Although some differences in the allele frequencies could be observed between the two IDU groups, none of these was statistically significant. Therefore, no putative association between these geneticmarkers and susceptibility/resistance to HIV-1 infection could be made evident in the present study. So far, the assessment of genetic markers among the IDU population has been restricted to North American, European, and Asian studies and this report represents a pioneer descriptive study of the distribution of CCR5 genotypes and HLA-B alleles in Rio de Janeiro, Brazi