Protocolos clínicos e de regulação para condução da dificuldade visual na rede pública de saúde

PURPOSE: To describe the procedures used in developing Clinical and Regulatory Protocols for primary care teams to use in the management of the most common scenarios of impaired vision in Southern Brazil. METHODS: A retrospective review of 1.333 referral forms from all primary care practitioners was performed in Ribeirão Preto city, during a 30-day period. The major ophthalmic diagnostic categories were evaluated from those referrals forms. The Clinical and Regulatory Protocols development process was held afterwards and involved scientific cooperation between a university and the health care system, in the form of workshops attended by primary care practitioners and regulatory system team members composed of health care administrators, ophthalmologists, and professors of ophthalmology and social medicine. RESULTS: The management of impaired vision was chosen as the theme, since it accounted for 43.6% of the ophthalmology-related referrals from primary care providers of Ribeirão Preto. The Clinical and Regulatory Protocols developed involve distinctive diagnostic and therapeutic interventions that can be performed at the primary care level and in different health care settings. The most relevant clinical and regulatory interventions were expressed as algorithms in order to facilitate the use of the Clinical and Regulatory Protocols by health care practitioners. CONCLUSIONS: These Clinical and Regulatory Protocols could represent a useful tool for health systems with universal access, as well as for health care networks based on primary care and for regulatory system teams. Implementation of these Clinical and Regulatory Protocols can minimize the disparity between the needs of patients with impaired vision and the treatment modalities offered, resulting in a more cooperative health care network.OBJETIVO: Descrever os procedimentos utilizados no desenvolvimento de Protocolos Clínicos e de Regulação, para equipes de atenção primária à saúde, voltados à condução dos cenários clínicos mais comuns de dificuldade visual observados na região sudeste do Brasil. MÉTODOS: Realizou-se a revisão retrospectiva de 1.333 guias de encaminhamento advindas de todos os profissionais da atenção primária da cidade de Ribeirão Preto, durante um período de 30 dias. As principais categorias diagnósticas oftalmológicas foram avaliadas nessas guias de referência. O processo de desenvolvimento dos Protocolos Clínicos e de Regulação ocorreu na sequência e envolveu a cooperação científica entre a universidade e o sistema de saúde, sob a forma de oficinas com médicos da atenção primária e membros da equipe do sistema de regulação, composto por gestores de saúde, oftalmologistas, além de professores de oftalmologia e medicina social. RESULTADOS: A dificuldade visual foi escolhida como tema central, uma vez que representou 43,6% dos encaminhamentos oftalmológicos advindos de serviços de atenção primária de Ribeirão Preto. Os Protocolos Clínicos e de Regulação desenvolvidos envolveram diferentes procedimentos diagnósticos e terapêuticos que podem ser executados na atenção primária e outros níveis ou contextos de cuidados à saúde. As intervenções clínicas e de encaminhamento mais relevantes foram expressas como algoritmos, a fim de facilitar a utilização do protocolo pelos profissionais da saúde. CONCLUSÕES: Os Protocolos Clínicos e de Regulação poderão representar uma ferramenta útil para os sistemas de saúde que contam com acesso universal, bem como para as redes de cuidados de saúde baseadas na atenção primária e nos sistemas de regulação. A implementação de Protocolos Clínicos e de Regulação poderá minimizar a disparidade entre as necessidades dos pacientes com dificuldade visual e as formas de condução de casos oftalmológicos, resultando em uma rede de saúde mais eficiente

TRIAGEM FITOQUÍMICA E DOSEAMENTO DE FENOÍS TOTAIS, FLAVONOÍDES E TANINOS DAS FOLHAS DE Trembleya phlogiformis MART. & SCHR. ex DC

Introdução e objetivos: O gênero Trembleya (Melastomataceae) é endêmico no Brasil e suas espécies ocorrem no Cerrado, em campos rupestres1. Trembleya phlogiformis apresenta-se como pequenos e delicados subarbustos até arbustos com dois metros de altura, com flores de cor branca a rosada2. É utilizada nas comunidades rurais para tingir lã e algodão utilizados nos teares manuais3,4. Objetivou-se neste trabalho realizar a triagem fitoquímica, determinar o teor de água, de cinzas e o doseamento de fenóis totais, flavonoides e taninos das folhas de T. phlogiformis. Metodologia: As folhas foram coletadas em Pirenópolis/GO e uma exsicata foi depositada no Herbário da UFG (nº 47868). As folhas foram dessecadas em estufa e pulverizadas em moinho de facas. Na triagem fitoquímica foram realizadas pesquisas para alcaloides, amido, cumarinas, heterosídeos antraquinônicos, esteroides, triterpenos, heterosídeos digitálicos, heterosídeos flavonoides, heterosídeos saponínicos, taninos e metilxantinas5,6. Para o doseamento de fenóis totais e taninos foi utilizado o método de Hangerman e Butler e para doseamento de flavonóides o método adaptado de Rolim et al.. O teor de água foi determinado utilizando um analisador de umidade; os teores de cinzas solúveis e insolúveis em ácido foram realizados de acordo com a Farmacopeia Brasileira. Resultados e discussões: Foram identificados nas folhas: cumarinas, triterpenos, taninos, flavonóides, heterosídeos saponínicos e amido. O teor de água foi de 9,30%, de cinzas totais 7,08% e de cinzas insolúveis 1,95%. O teor de fenóis totais foi de 25,64%, de taninos 2,16% e de flavonoides 2,04%. Conclusões: Esses resultados se constituem em dados-padrão para droga vegetal constituída por folhas da T. phlogiformis e podem ser utilizados para o controle de qualidade de amostras dessa planta

Metabolic risk factors, physical activity and physical fitness in azorean adolescents: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>The prevalence of metabolic syndrome has increased over the last few decades in adolescents and has become an important health challenge worldwide. This study analyzed the relationships between metabolic risk factors (MRF) and physical activity (PA) and physical fitness (PF) in a sample of Azorean adolescents.</p> <p>Methods</p> <p>A cross-sectional school-based study was conducted on 417 adolescents (243 girls) aged 15-18 from the Azorean Islands, Portugal. Height, weight, waist circumference, fasting glucose, HDL-cholesterol, triglycerides, and blood pressure were measured. A sum of MRF was computed, and adolescents were classified into three groups: no MRF, one MRF and two or more MRF. PA was assessed by a sealed pedometer. PF was assessed using five tests from the Fitnessgram Test Battery. Dietary intake was obtained using a semi-quantitative food frequency questionnaire.</p> <p>Results</p> <p>Mean daily steps for girls and boys were 7427 ± 2725 and 7916 ± 3936, respectively. Fifty-nine percent of the adolescents showed at least one MRF and 57.6% were under the healthy zone in the 20 m Shuttle Run Test. Ordinal logistic regression analysis showed that after adjusting for sex, body mass index, socio-economic status and adherence to a Mediterranean diet, adolescents who were in the highest quartile of the pedometer step/counts (≥9423 steps/day) and those who achieved the healthy zone in five tests were less likely to have one or more MRF (OR = 0.56;95%CI:0.33-0.95; OR = 0.55;95%CI:0.31-0.98, respectively).</p> <p>Conclusions</p> <p>Daily step counts and PF levels were negatively associated with having one or more MRF among Azorean adolescents. Our findings emphasize the importance of promoting and increasing regular PA and PF to reduce the public health burden of chronic diseases associated with a sedentary lifestyle.</p

Gaseous air pollution and emergency hospital visits for hypertension in Beijing, China: a time-stratified case-crossover study

Background: A number of epidemiological studies have been conducted to research the adverse effects of air pollution on mortality and morbidity. Hypertension is the most important risk factor for cardiovascular mortality. However, few previous studies have examined the relationship between gaseous air pollution and morbidity for hypertension. ---------- Methods: Daily data on emergency hospital visits (EHVs) for hypertension were collected from the Peking University Third Hospital. Daily data on gaseous air pollutants (sulfur dioxide (SO2) and nitrogen dioxide (NO2)) and particulate matter less than 10 μm in aerodynamic diameter (PM10) were collected from the Beijing Municipal Environmental Monitoring Center. A time-stratified case-crossover design was conducted to evaluate the relationship between urban gaseous air pollution and EHVs for hypertension. Temperature and relative humidity were controlled for. ---------- Results: In the single air pollutant models, a 10 μg/m3 increase in SO2 and NO2 were significantly associated with EHVs for hypertension. The odds ratios (ORs) were 1.037 (95% confidence interval (CI): 1.004-1.071) for SO2 at lag 0 day, and 1.101 (95% CI: 1.038-1.168) for NO2 at lag 3 day. After controlling for PM10, the ORs associated with SO2 and NO2 were 1.025 (95% CI: 0.987-1.065) and 1.114 (95% CI: 1.037-1.195), respectively.---------- Conclusion: Elevated urban gaseous air pollution was associated with increased EHVs for hypertension in Beijing, China

Evaluation of HBV-Like circulation in wild and farm animals from Brazil and Uruguay.

The origin of the hepatitis B virus is a subject of wide deliberation among researchers. As a result, increasing academic interest has focused on the spread of the virus in different animal species. However, the sources of viral infection for many of these animals are unknown since transmission may occur from animal to animal, human to human, animal to human, and human to animal. The aim of this study was to evaluate hepadnavirus circulation in wild and farm animals (including animals raised under wild or free conditions) from different sites in Brazil and Uruguay using serological and molecular tools. A total of 487 domestic wild and farm animals were screened for hepatitis B virus (HBV) serological markers and tested via quantitative and qualitative polymerase chain reaction (PCR) to detect viral DNA. We report evidence of HBsAg (surface antigen of HBV) and total anti-HBc (HBV core antigen) markers as well as low-copy hepadnavirus DNA among domestic and wild animals. According to our results, which were confirmed by partial genome sequencing, as the proximity between humans and animals increases, the potential for pathogen dispersal also increases. A wider knowledge and understanding of reverse zoonoses should be sought for an effective One Health response

Measurement of the Bs0→J/ψKS0B_s^0\to J/\psi K_S^0 branching fraction

The $B_s^0\to J/\psi K_S^0$ branching fraction is measured in a data sample corresponding to 0.41$fb^{-1}$ of integrated luminosity collected with the LHCb detector at the LHC. This channel is sensitive to the penguin contributions affecting the sin2$\beta$ measurement from $B^0\to J/\psi K_S^0$ The time-integrated branching fraction is measured to be $BF(B_s^0\to J/\psi K_S^0)=(1.83\pm0.28)\times10^{-5}$. This is the most precise measurement to date