Questionnaire to avoid transfers to healthcare: a Brazilian experience.

Purpose The purpose of this paper is to test whether training correctional facility (CF) officers in the admission process would identify risk factors for inmates' unscheduled transfers to healthcare units in the first 24 hours. Design/methodology/approach Correctional officers (COs) were trained to use a questionnaire with ten closed questions, which seeks to identify occupational or nosocomial risk, applied upon the admission of inmates to a CF. Findings There were 1,288 admissions in six CFs in Ribeirão Preto and Serra Azul/Brazil from March 2010 to May 2011. Of those admissions, 21.2 percent were in penitentiaries and 78.9 percent in provisional detention centers. Of the questionnaires applied, 580 answered affirmatively (45 percent) for one or more of the questions, with nearly 60 percent related to drug use in the last 12 hours, 37.7 percent use of medications while the most frequently mentioned diseases were respiratory diseases (37 percent) and mental disorders (19 percent).The number of positive responses per evaluation presented an odds ratio of 3.6 (CI 95% - 1.6, 10.5) for unscheduled transfers for external clinical evaluation. Research limitations/implications The lack of a control group and the fact that morbidities described by prisoners could not be confirmed are study limitations. The research does, however, still contribute to the goal of achieving appropriate medical care within CFs. Originality/value The training of COs to identify risk factors that predict the need for unplanned transfers to healthcare units was feasible. These findings have important implications for CFs that do not provide ongoing medical service, a universal reality in Brazil.

The need to improve health care in prisons.

OBJECTIVE: To analyze physical structure, working conditions of health professionals and outline of the procedures established in prisons. METHODS: We analyzed 34 provisional detention centers and 69 male and six female prison units in the state of Sao Paulo, Southeastern Brazil, in 2009. A self-applied instrument was developed to collect quantitative data on the characteristics of health care structure, equipment and personnel in prisons. Analysis of variance (ANOVA) or equivalent non-parametric tests and Chi-square or Fisher's tests were used to compare categorical and continuous variables, respectively, between the groups. RESULTS: The main problems were delays in the results of laboratory tests and imaging. With respect to the teams, it was observed that a large majority were in conditions close to those proposed by the Bipartite Commission 2013 but without improvement being reflected in the indicators. With respect to the process, more than 60.0% of prisons located in small towns do not have the structural conditions to ensure secondary or tertiary health care for the continuity of treatment. CONCLUSIONS: This profile of prisons in the country can be used for planning and monitoring future actions for the continuous improvement of healthcare processes.

Modeling and simulation of the transient response of temperature and relative humidity sensors with and without protective housing.

Based on the necessity for enclosure protection of temperature and relative humidity sensors installed in a hostile environment, a wind tunnel was used to quantify the time that the sensors take to reach equilibrium in the environmental conditions to which they are exposed. Two treatments were used: (1) sensors with polyvinyl chloride (PVC) enclosure protection, and (2) sensors with no enclosure protection. The primary objective of this study was to develop and validate a 3-D computational fluid dynamics (CFD) model for analyzing the temperature and relative humidity distribution in a wind tunnel using sensors with PVC enclosure protection and sensors with no enclosure protection. A CFD simulation model was developed to describe the temperature distribution and the physics of mass transfer related to the airflow relative humidity. The first results demonstrate the applicability of the simulation. For verification, a sensor device was successfully assembled and tested in an environment that was optimized to ensure fast change conditions. The quantification setup presented in this paper is thus considered to be adequate for testing different materials and morphologies for enclosure protection. The results show that the boundary layer flow regime has a significant impact on the heat flux distribution. The results indicate that the CFD technique is a powerful tool which provides a detailed description of the flow and temperature fields as well as the time that the relative humidity takes to reach equilibrium with the environment in which the sensors are inserted.

Necessidade de aprimoramento do atendimento à saúde no sistema carcerário / The need to improve health care in prisons

OBJETIVO Analisar a estrutura física, as condições de trabalho dos profissionais da saúde e o delineamento de processos estabelecidos em unidades prisionais. MÉTODOS Foram analisados 34 centros de detenção provisória e 69 unidades prisionais masculinas e seis femininas do Estado de São Paulo, Brasil, em 2009. Foi desenvolvido instrumento autoaplicativo para coleta de dados quantitativos sobre as características de estrutura, equipamento e pessoal para atendimento à saúde nas unidades prisionais. A análise de variância (ANOVA) ou equivalente não paramétrico e os testes de Qui-quadrado ou Fisher foram utilizados para comparação de variáveis contínuas ou categóricas, respectivamente, entre os grupos estudados. RESULTADOS Os principais problemas foram o retardo nos resultados de exames laboratoriais e de imagem. Quanto às equipes, grande maioria apresentou condições próximas da proposta pela Comissão InterGestores Bipartite 2013, mas sem que isso se refletisse em melhoria dos indicadores. Com relação ao processo, observou-se que mais de 60,0% das unidades prisionais estão localizadas em cidades pequenas, sem condições estruturais de saúde para garantir o atendimento secundário ou terciário para continuidade do processo de tratamento. CONCLUSÕES O perfil apresentado das unidades prisionais do País poderá ser utilizado para planejamento e acompanhamento de ações futuras para melhoria contínua das condições estruturais de saúde. .

OBJECTIVE To analyze physical structure, working conditions of health professionals and outline of the procedures established in prisons. METHODS We analyzed 34 provisional detention centers and 69 male and six female prison units in the state of Sao Paulo, Southeastern Brazil, in 2009. A self-applied instrument was developed to collect quantitative data on the characteristics of health care structure, equipment and personnel in prisons. Analysis of variance (ANOVA) or equivalent non-parametric tests and Chi-square or Fisher’s tests were used to compare categorical and continuous variables, respectively, between the groups. RESULTS The main problems were delays in the results of laboratory tests and imaging. With respect to the teams, it was observed that a large majority were in conditions close to those proposed by the Bipartite Commission 2013 but without improvement being reflected in the indicators. With respect to the process, more than 60.0% of prisons located in small towns do not have the structural conditions to ensure secondary or tertiary health care for the continuity of treatment. CONCLUSIONS This profile of prisons in the country can be used for planning and monitoring future actions for the continuous improvement of healthcare processes. .

In vitro study of solubilization ability of bovine pulp tissue using different irrigating solutions

Introduction and Objective: The aim of this study was to evaluate in vitro the capacity of solubilization of bovine pulp tissue, promoted by the following auxiliary chemical solutions: 2.5% sodium hypochlorite at pH 9, 5.25 % sodium hypochlorite at pH 9, 2% chlorhexidine gel at pH 6, 17% EDTA at pH 7, and Smear-Clear®. Material and methods: A total of ten specimens of bovine pulp tissue, weighing 1.65 g each, were placed into flasks connected to a device developed for the study in order to reproduce irrigation dynamics. The flasks with the specimens received a volume of 80 ml of irrigating solution and the experimental times were 15, 30, 45 and 60 minutes. Results: The results were analyzed statistically by Kruskal-Wallis test to compare the different experiment times (15, 30, 45 and 60 minutes) of each irrigating solution. To compare the variation among the times of one solution, Kolmogorov-Smirlov test (Lilliefors) was used. Conclusion: Considering the results obtained and the limitations of the study, it can be concluded that 5.25% sodium hypochlorite exhibited the greatest solubilization ability, followed by 2.5% sodium hypochlorite, Smear-Clear®, 17% EDTA and 2% chlorhexidine gel.

The nature of focal areas of hyperfluorescence or hot spots imaged with indocyanine green angiography.

PURPOSE: To clarify the frequency and nature of ICG angiographic "hot spots" seen in patients with neovascular age-related macular degeneration (ARMD). METHODS: A consecutive series of newly diagnosed patients with neovascular ARMD and fluorescein angiographic evidence of occult choroidal neovascularization (occult CNV) was imaged with ICG angiography. Eyes with ICG angiographic "hot spots" were identified and further classified. A hot spot was defined as any area of abnormal hyperfluorescence, in the mid to late stages of ICG angiography, measuring less than 1 disk area in size. RESULTS: From a total of 190 patients (220 eyes) with neovascular ARMD, 30 patients and 34 eyes (16%) with hot spots were identified. Hot spots were noted to be of three distinct patterns: polypoidal choroidal neovascularization (polypoidal CNV) in 21 of 34 eyes, or 62%; retinal angiomatous proliferation (RAP) in 11 of 34 eyes, or 30%; and focal occult CNV in 2 of 34 eyes, or 8%. CONCLUSIONS: A focal area of intense hyperfluorescence or so-called hot spot seen on ICG angiography in neovascular ARMD is due to one of three possible forms of neovascularization: most frequently polypoidal CNV, less commonly RAP, and infrequently nonspecific, focal occult CNV. Since neovascular ARMD may be caused by different types of neovascularization, each with distinct clinical manifestations, natural course, visual prognosis, and response to treatment, it is important to identify the precise nature of hot spots to establish an accurate diagnosis and, when appropriate, a specific form of management.

Uso de membrana amniótica no tratamento de complicaçöes pós-trabeculectomia / Amniotic membrane in the treatment of post-trabeculectomy complications

Métodos: Quatro olhos de 4 pacientes que apresentavam complicaçöes pós-trabeculectomia com mitomicina-A (vazamento de humor aquoso com teste de Seidel +, 3 olhos, e bolha hiperfiltrante, 1 olho) foram submetidos à cirurgia para reconstruçäo da bolha filtrante com uso de membrana amniótica. Resultados: A média do tempo de seguimento foi de 5,75 meses (variaçäo de 2 a 9 meses). Conseguiu-se resoluçäo do quadro em todos os casos, sendo que em 1 caso necessitou-se de aplicaçäo de cola e lente de contato para resoluçäo do quadro. Em média, a epitelizaçäo ocorreu em 14,75 dias (variaçäo de 8 a 21 dias). A acuidade visual melhorou em apenas 1 paciente e manteve-se inalterada nos outros 3 casos. Após as cirurgias, a pressäo intra-ocular manteve-se sob controle com uso de medicaçäo antiglaucomatosa tópica em todos os pacientes. Conclusäo: O uso de membrana amniótica constitui uma opçäo viável para o tratamento do vazamento do humor aquoso e bolha hiperfiltrante pós-trabeculectomia resistentes ao tratamento convencional. Mais casos säo necessários para melhor avaliar e refinar a técnica operatória.