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EHR Interoperability is crucial to obtain a set of benefits. This can be achieved by using data standards, like ontologies. The Portuguese Nursing Ontology (NursingOntos) is a reference model describing a set of nursing concepts and their relationships, to represent nursing knowledge in the Electronic Health Records (EHR). The purpose of this work was to define a set of correspondences between Nursing Ontology concepts of NursingOntos and other terminologies, which have the same or similar meaning. In this project, we are using the ISO/TR12300:2016 standard on the principles of mapping between terminological systems. Regarding the domain of "airway clearance", we can say that Portuguese Nursing Ontology has a good level of mapping with other terminologies. In conclusion, we can say that Portuguese Nursing Ontology can be used in EHR with the purpose of a global digitalization of health.
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Registros Eletrônicos de Saúde , Terminologia Padronizada em Enfermagem , Systematized Nomenclature of Medicine , Portugal , Registros de Enfermagem , Processamento de Linguagem Natural , Vocabulário Controlado , HumanosRESUMO
Abstract Objective: To identify the prevalence, severity, hypersensitivity, and distribution of Non-carious cervical lesions (NCCL) among university students in Brazil. Material and Methods: 179 participants answered an anamnesis with twenty questions about the presence or absence of habits associated with NCCL. The participants' teeth were evaluated to identify the presence or absence of the lesion, its classification, involved surfaces, severity, hypersensitivity, and tooth wear index. A hypersensitivity test was performed with ice water. Data were analyzed using the chi-square test and simple logistic regression (p<0.01). Results: 179 participants answered an anamnesis with twenty questions about the presence or absence of habits associated with NCCL. The participants' teeth were evaluated to identify the presence or absence of the lesion, its classification, involved surfaces, severity, hypersensitivity, and tooth wear index. A hypersensitivity test was performed with ice water. Data were analyzed using the chi-square test and simple logistic regression (p<0.01). Conclusion: The prevalence of NCCL was 15.1% and abfraction was the most frequent lesion. Premolars were the teeth most affected by non-carious cervical lesions.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Estudantes , Erosão Dentária/etiologia , Sensibilidade da Dentina/etiologia , Desgaste dos Dentes/etiologia , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Estudos Transversais/métodos , Inquéritos e QuestionáriosRESUMO
Resumo Introdução: O Postgraduate Hospital Educational Environment Measure (PHEEM) é um instrumento validado e confiável para avaliar o ambiente educacional nos programas de residência médica. Objetivo: Este estudo teve como objetivos mapear a aplicação do questionário PHEEM na residência médica e avaliar os resultados, os aspectos positivos e negativos e os pontos passíveis de melhoria. Método: Trata-se de uma revisão de escopo de acordo com a metodologia do Instituto Joanna Briggs de revisões de escopo. Foram incluídos estudos seguindo a estrutura PCC: P (participantes) = médicos residentes de qualquer especialidade; C (conceito) = o PHEEM é um instrumento utilizado para avaliar o ambiente educacional na residência médica, por meio de um questionário de 40 itens divididos em três subescalas que incluem percepção de autonomia, ensino e suporte social; C (cenário) = pesquisas sobre o PHEEM na residência médica de qualquer especialidade. As bases eletrônicas pesquisadas foram: PubMed, Embase e Biblioteca Virtual em Saúde (BVS). Resultado: As estratégias de busca rodadas resultaram em 1.588 estudos, 50 foram lidos na íntegra, e incluíram-se 36. Os estudos foram realizados em 22 países, e a maioria revelou um ambiente educacional mais positivo que negativo, entretanto com espaço para melhorias. Nas subescalas, a percepção de autonomia se mostrou mais positiva que negativa, e a percepção de ensino revelou que a maioria dos programas está caminhando na direção certa. Entretanto, na avaliação do suporte social, os resultados foram divididos entre um ambiente não agradável e um ambiente com mais prós do que contras. Os principais pontos positivos destacados foram baixa discriminação racial e sexual, possibilidade de trabalhar em equipe, nível adequado de responsabilidades, professores acessíveis e com boas habilidades de ensino, oportunidades de aprendizado e participação em eventos educacionais. Os principais pontos negativos foram falta de alimentação e acomodação adequadas durante o plantão, carga horária excessiva, falta de feedback por parte dos preceptores, falta de tempo protegido para estudo e cultura de culpar o residente. Conclusão: A aplicação do PHEEM revelou que, na maioria dos programas de residência médica, o ambiente educacional se mostrou mais positivo que negativo, entretanto com espaço para melhorias. São necessários esforços para a melhoria do ambiente educacional, especialmente do suporte social, nos programas de residência médica.
Abstract Introduction: The PHEEM (postgraduate hospital educational environment measure) is a validated and reliable instrument to assess the educational environment in medical residency programs. Objective: To map the application of the PHEEM questionnaire in medical residency, evaluate the results found, positive and negative aspects and points for improvement. Method: We performed a scoping review according to the Joanna Briggs institution's methodology. Studies that followed the PCC structure were included, as follows: P (participants) = resident physicians of any specialty; C (concept) = The PHEEM is an instrument used to assess the educational environment in medical residency, through a 40-item questionnaire divided into 3 subscales that include perception of autonomy, teaching and social support. C (context)= studies on PHEEM in medical residency of any specialty. PubMed, EMBASE and the Virtual Health Library databases were the data sources. Results: We identified 1588 references, and after reading the title and abstract, 50 references were selected for full reading, and 36 studies were included. The studies were carried out in 22 countries, and most revealed a more positive than negative educational environment, albeit with room for improvement. In the subscales, the perception of autonomy was more positive than negative, and the perception of teaching revealed that most programs are moving in the right direction. However, when evaluating social support, the results were divided between an unpleasant environment and an environment with more pros than cons. The main highlighted positive points were low racial and sexual discrimination, possibility of working in a team, adequate level of responsibilities, accessible teachers with good teaching skills, learning opportunities and participation in educational events. The main negative points were lack of adequate food and accommodation during the shifts, excessive workload, lack of feedback from preceptors and lack of protected time for study and the culture of blaming the resident. Conclusion: The application of PHEEM revealed that in most medical residency programs the educational environment was more positive than negative, albeit with room for improvement. Efforts are needed to improve the educational environment, especially social support, in medical residency programs.
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RESUMO: Objetivo: identificar o conhecimento dos enfermeiros e as práticas relacionadas a úlceras ou infecções em membros inferiores nas pessoas com diabetes mellitus.Método: estudo qualitativo realizado com 24 enfermeiros de equipes de saúde da família de um município do interior do estado de Minas Gerais - Brasil. Entrevistas semiestruturadas foram realizadas nos meses de outubro e novembro de 2022, analisadas pela técnica de análise temática e discutidas pela literatura relativa à temática. Resultados: foram identificadas duas categorias temáticas: "Conhecimento sobre úlceras ou infecções em membros inferiores em pessoas com diabetes mellitus" e "Trabalho do enfermeiro no cuidado às pessoas com diabetes mellitus". Conclusão: o estudo demonstrou que os conhecimentos e as práticas sobre úlceras ou infecções em membros inferiores estão fragilizados, evidenciando a necessidade de construção do conhecimento na área da enfermagem e o incentivo para a adoção de medidas preventivas pelos profissionais de saúde, em especial, os enfermeiros da atenção básica.
ABSTRACT Objective: To identify nurses' knowledge and practices related to lower limb ulcers or infections in people with diabetes mellitus. Method: A qualitative study was conducted with 24 nurses from family health teams in a municipality in the countryside of the State of Minas Gerais - Brazil. Semi-structured interviews were conducted in October and November 2022, analyzed using the thematic analysis technique, and discussed using the literature on the subject. Results: The study's findings revealed two crucial thematic categories: "Knowledge about lower limb ulcers or infections in people with diabetes mellitus" and "The work of nurses in caring for people with diabetes mellitus". These findings underscore the urgent need to improve knowledge and practices about ulcers or infections in the lower limbs, emphasizing the pivotal role of nurses in this process. Conclusion: The study showed that knowledge and practices about ulcers or infections in the lower limbs are fragile, highlighting the need to build knowledge in the nursing field and encourage the adoption of preventive measures by health professionals, especially primary care nurses.
RESUMEN: Objetivo: identificar los conocimientos y prácticas del personal de enfermería relacionados con las úlceras o infecciones de los miembros inferiores en personas con diabetes mellitus. Método: estudio cualitativo realizado con 24 enfermeros de equipos de salud familiar de un municipio del interior del estado de Minas Gerais - Brasil. En octubre y noviembre de 2022 se llevaron a cabo entrevistas semiestructuradas, que se analizaron mediante la técnica del análisis temático y se debatieron a partir de la bibliografía sobre el tema. Resultados: se identificaron dos categorías temáticas: "Conocimientos sobre úlceras o infecciones de los miembros inferiores en personas con diabetes mellitus" y "El trabajo del enfermero en el cuidado de las personas con diabetes mellitus". Conclusión: El estudio demostró que los conocimientos y las prácticas sobre las úlceras o infecciones de los miembros inferiores son frágiles, lo que pone de relieve la necesidad de aumentar los conocimientos en el campo de la enfermería y fomentar la adopción de medidas preventivas por parte de los profesionales sanitarios, especialmente los enfermeros de atención primaria.
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Co-use of marijuana and tobacco products is the second most common drug combination among adolescents. Nicotine (NIC) and cannabinoid use during adolescence induce similar detrimental changes, raising the hypothesis that simultaneous exposure could result in even more severe outcomes. Thus, we investigated whether the co-exposure to NIC and the synthetic cannabinoid WIN 55,212-2 (WIN) in adolescent mice causes behavioral outcomes different from those observed after exposure to a single drug. Male Swiss mice were exposed twice daily to NIC, WIN, or NIC + WIN during adolescence (PND28-47) or adulthood (PND70-89). Drug combination led to a greater reduction in weight gain in adolescent mice, while NIC-induced weight loss was observed in adults. During administration, NIC provoked hypothermia, and WIN produced hyperlocomotion in adolescent and adult mice. Animals exposed to NIC + WIN presented a profile of changes similar to those exposed to NIC. After drug exposure, changes in locomotion, thigmotaxis, social preference, prepulse inhibition, and working and recognition memory were evaluated. Adolescent but not adult mice exposed to NIC showed withdrawal-related hyperlocomotion unaffected by WIN co-administration. An age-specific impairment in object recognition memory was induced only by drug co-exposure during adolescence, which resolved spontaneously before reaching early adulthood. A transient decrease in hippocampal α7 nAChR subunit and CB1 receptor mRNA levels was induced by NIC exposure, which may be involved but is not enough to explain the memory impairment. Our work confirms the potential of NIC and cannabinoids association to aggravate some of the individual drug effects during critical neurodevelopmental periods.
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Canabinoides , Nicotina , Camundongos , Masculino , Animais , Nicotina/farmacologia , Transtornos da Memória , Canabinoides/farmacologia , Reconhecimento Psicológico , Combinação de Medicamentos , Benzoxazinas/farmacologiaRESUMO
OBJECTIVE: To compare effectiveness of counselling program versus counselling program plus jaw exercises to reduce pain and click in patients with temporomandibular joint disc displacement with reduction (DDWR). MATERIALS AND METHODS: Patients were divided into two groups: instructions for temporomandibular disorders (TMD) plus jaw exercises (test, n = 34), only TMD instructions (control, n = 34). Pain was analyzed by palpation (RDC/TMD). It was investigated if the click caused discomfort. Both groups were evaluated at baseline, 24 h, 7 days, and 30 days' post treatment. RESULTS: The click was present in 85.7% (n = 60). In 30-day evaluation, there was a statistically significant difference between groups in the right median temporal muscle (p = 0.041); and there was a statistically significant difference in treatment self-perception (p = 0.002) and click's discomfort (p < 0.001). CONCLUSION: The exercise with recommendations showed better results, resolution of the click, and self-perception of the treatment effectiveness. CLINICAL RELEVANCE: This study presents therapeutic approaches that are easy to perform and that can be monitored remotely. In view of the current stage of the global pandemic, these treatment options become even more valid and useful. CLINICAL TRIAL REGISTER: This clinical trial was registered at Brazilian Clinical Trials Registry (ReBec) under protocol RBR-7t6ycp ( http://www.ensaiosclinicos.gov.br/rg/RBR-7t6ycp/ ), Date of registration: 26/06/2020.
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Terapia por Exercício , Transtornos da Articulação Temporomandibular , Humanos , Aconselhamento , Exercício Físico , Pacientes , Brasil , Dor , Transtornos da Articulação Temporomandibular/terapiaRESUMO
Objective: To describe the development and validation process of an online course on urinary incontinence during pregnancy in Brazil. Materials and methods: This methodological study followed an online course's literature search, development, and validation steps. A total of 22 specialists participated in the validation step, and the content validity index (CVI) was used. Fifty-one Physical Therapy students (target audience) also participated in the Suitability Assessment of Materials. Results: The synthesis reached in the integrative review provided the basis for the course's theoretical content, which was regarded as suitable by the specialists regarding its content, language, presentation, stimulation/motivation, and cultural adequacy (CVI = 0.99). The target audience considered the course organized, easily understandable, engaging, and motivational, with a positive response index ranging from 84.3 % to 100 %. Conclusions: The Brazilian version of the online course was considered sufficiently adequate in content and interface quality by both specialists and the target audience.
Objetivo: descrever o processo de desenvolvimento e validação de um curso on-line sobre incontinência urinária gestacional no Brasil. Materiais e método: trata-se de um estudo metodológico que contemplou as etapas de levantamento bibliográfico, elaboração e validação de um curso on-line. A validação teve a participação de 22 especialistas e foi empregado o índice de validade de conteúdo (IVC). Também participaram 51 estudantes de graduação em Fisioterapia (público-alvo), considerando o Suitability Assessment of Materials. Resultados: a síntese adquirida na revisão integrativa subsidiou o conteúdo teórico do curso, considerado adequado pelos especialistas quanto ao conteúdo, à linguagem, à apresentação, à estimulação/motivação e à adequação cultural (IVC = 0,99), bem como à aparência/interface (IVC = 0,95). O público-alvo considerou o curso organizado, de fácil entendimento, atrativo e motivador, com índice de concordância em repostas positivas a variar de 84,3 % a 100 %. Conclusões: informa-se que a versão brasileira do curso on-line desenvolvido foi considerada suficientemente adequada em termos de conteúdo e qualidade da interface, tanto pelos especialistas quanto pelo público-alvo.
Objetivo: describir el proceso de desarrollo y validación de un curso en línea sobre incontinencia urinaria durante el embarazo en Brasil. Materiales y método: se trata de un estudio metodológico que contempló las etapas de recolección bibliográfica, elaboración y validación de un curso en línea. La validación contó con la participación de 22 expertos y se empleó el índice de validación de contenido (IVC). Además, participaron 51 estudiantes del pregrado en Fisioterapia (público objetivo) en la Evaluación de Idoneidad de los Materiales. Resultados: la síntesis adquirida en la revisión integrativa fundamentó el contenido teórico del curso, considerado adecuado por los expertos en cuanto al contenido, el lenguaje, la presentación, la estimulación/motivación y la adecuación cultural (IVC = 0,99), así como la apariencia/interfaz (IVC = 0,95). El público objetivo consideró el curso organizado, de fácil entendimiento, atractivo y motivador, con un índice de concordancia en respuestas positivas entre 84,3 % y 100 %. Conclusiones: la versión brasileña del curso en línea desarrollado se consideró lo suficientemente adecuada en términos de contenido y calidad de la interfaz, tanto por parte de los expertos como del público objetivo.
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Materiais de Ensino , Educação em Saúde , Tecnologia Educacional , Estudo de Validação , Distúrbios do Assoalho PélvicoRESUMO
Dentre as Doenças Crônicas não Transmissíveis (DCNT), o Diabetes Mellitus (DM) se destaca por sua constante ascensão e taxas de morbimortalidade e aos altos custos sociais, econômicos e psicológicos. Ainda, quando não controlado o DM, propicia o desenvolvimento de complicações altamente incapacitantes, destacando-se as úlceras ou infecções em membros inferiores o que conhecemos como "pé diabético". O objetivo do estudo foi identificar as ações preventivas para úlceras ou infecções em membros inferiores em pessoas com diabetes mellitus realizadas pelos enfermeiros nas equipes de Saúde da Família. Além disso, realizar um produto tecnológico como elaborar um roteiro de rastreamento para úlceras ou infecções em membros inferiores para as pessoas com diabetes mellitus. Pesquisa de abordagem qualitativa realizada com 24 enfermeiros de equipes de saúde da família (eSF) do município de Passos - Minas Gerais. Foram incluídos no estudo os enfermeiros que atuam diretamente na assistência por mais de seis meses e excluídos aqueles que estivessem em cargo de gestão, de férias ou afastados por algum motivo. As entrevistas foram realizadas nas unidades de saúde por meio de um roteiro de perguntas para identificação de conhecimentos acerca da temática. As entrevistas foram audiogravadas e transcritas e analisadas pela técnica de análise temática e discutidas pela literatura científica. Dos 24 enfermeiros que atuam nas eSF, 12,5% eram do sexo masculino e 87,5% do sexo feminino. Apenas 16,6% dos entrevistados possuíam curso sobre o cuidado para pessoa com DM e apresentaram conhecimento limitado sobre a temática das úlceras ou infecções de membros inferiores. As ações de cuidado voltam-se para o controle glicêmico e avaliação da medicação para atendimento do hiperdia. Em relação as práticas preventivas as orientações realizadas versam sobre os cuidados gerais de higiene, uso de calçados, corte das unhas e tratamento local de feridas. Pouco se realiza na consulta de enfermagem a avaliação clínica para o risco de úlceras ou infecções em membros inferiores. Acerca dos recursos que o município dispõe para o atendimento à pessoa com úlceras ou infecções em membros inferiores evidencia-se que o município não dispõe de uma local de referência para o tratamento da diabetes e que o serviço especializado é bastante demorado e falta recursos humanos e materiais. Portanto, destaca-se a necessidade da promoção da educação continuada e permanente como ferramenta para que possa ter conhecimentos e habilidades, bem como, discutir sobre o processo de trabalho para proporcionar cuidados efetivos com conhecimento baseado em evidências. Além disso, é preciso investimentos para qualificar a consulta de enfermagem à pessoa com DM e as práticas preventivas, especialmente, as voltadas para o risco de desenvolvimento de úlceras ou infecções em membros inferiores. No intuito de colaborar para a melhoria das práticas preventivas e identificação de risco no processo de trabalho dos enfermeiros, foi elaborado um roteiro de rastreamento para úlceras ou infecções em membros inferiores para que os enfermeiros possam utilizar nas consultas às pessoas com DM
Among Chronic Noncommunicable Diseases (NCDs), Diabetes Mellitus (DM) stands out for its constant rise and morbidity and mortality rates and the high social, economic and psychological costs. Still, when DM is not controlled, it favors the development of highly disabling complications, especially ulcers or infections in the lower limbs, what we know as "diabetic foot". The objective of the study was to identify preventive actions for ulcers or infections in the lower limbs in people with diabetes mellitus carried out by nurses in the Family Health teams. In addition, making a technological product such as developing a screening script for ulcers or infections in the lower limbs for people with diabetes mellitus. Qualitative research carried out with 24 nurses from family health teams (eSF) in the city of Passos - Minas Gerais. Nurses who work directly in care for more than six months were included in the study, and those who were in management positions, on vacation or on leave for some reason were excluded. The interviews were carried out in the health units through a script of questions to identify knowledge about the theme. The interviews were audio-recorded and transcribed and analyzed using the thematic analysis technique and discussed in the scientific literature. Of the 24 nurses working in the eSF, 12.5% were male and 87.5% were female. Only 16.6% of respondents had taken a course on care for people with DM and had limited knowledge on the subject of ulcers or lower limb infections. Care actions focus on glycemic control and assessment of medication for hyperdia treatment. Regarding preventive practices, the guidelines provided deal with general hygiene care, use of shoes, nail trimming and local treatment of wounds. Little is done in the nursing consultation regarding the clinical assessment of the risk of ulcers or infections in the lower limbs. Regarding the resources that the municipality has for the care of people with ulcers or infections in the lower limbs, it is evident that the municipality does not have a reference place for the treatment of diabetes and that the specialized service is quite time consuming and lacks human resources and materials. Therefore, there is a need to promote continuing and permanent education as a tool to acquire knowledge and skills, as well as to discuss the work process to provide effective care with evidence-based knowledge. In addition, investments are needed to qualify the nursing consultation for people with DM and preventive practices, especially those aimed at the risk of developing ulcers or infections in the lower limbs In order to contribute to the improvement of preventive practices and risk identification in the work process of nurses, a screening script for ulcers or infections in the lower limbs was elaborated so that nurses can use it in consultations with people with DM
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Humanos , Estratégias de Saúde Nacionais , Pé Diabético/prevenção & controle , Diabetes Mellitus/terapia , Cuidados de EnfermagemRESUMO
Anxiety disorders are among the most prevalent mental disorders worldwide. However, anxiety is not exclusive to anxiety disorders. In fact, the nursing discipline approaches anxiety as a human response to health conditions/life processes. Health information systems should primarily contribute to improving the quality of care, patient safety, and the effectiveness of care delivery. Nevertheless, nursing information systems still fail to incorporate evidence-based clinical data models addressing the nursing focus "anxiety." Thus, this study aimed to obtain consensus on the data to be included in a clinical data model addressing the nursing focus "anxiety," its organization, and its interrelationships by using a brainstorming session and a modified e-Delphi technique with a panel of nurse experts from across Portugal. Eight experts participated in the brainstorming session. A total of 59 and 54 participants completed the survey in e-Delphi rounds 1 and 2, respectively. Consensus was achieved to all data presented to the participants, and these data were later included in the clinical data model. This evidence-based clinical data model, grounded on a nursing theory and with standardized nursing language, will substantially contribute to nursing documentation and, consequently, to nursing care targeted at patients with anxiety.
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Transtornos de Ansiedade , Segurança do Paciente , Humanos , Consenso , Técnica Delphi , Inquéritos e QuestionáriosRESUMO
Work is fundamental to an individual's mental health; however, an unfavourable work environment can lead to mental health problems. Despite existing studies addressing workers' mental health, it is essential to understand the reality of specific contexts to design effective tailored interventions. Thus, this study aimed to examine the influence of potential protective and vulnerability factors on municipal workers' depressive symptoms, anxiety and stress levels, and burnout. A cross-sectional study was conducted with data collection performed between July and December 2021 using online self-report measures. The sample comprised 115 municipal workers. The findings revealed that psychological vulnerability is a significant vulnerability factor for the presence of mental health symptoms. In addition, job satisfaction was found to be a significant protective factor for depressive symptoms, anxiety, and burnout of the municipal workers. The results of this study enhance the understanding of factors that influence worker mental health, which may facilitate the proper planning of specific interventions to promote mental health in the workplace.
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Esgotamento Profissional , Saúde Ocupacional , Humanos , Saúde Mental , Estudos Transversais , Local de Trabalho/psicologia , Esgotamento Profissional/psicologiaRESUMO
Objetivo: Avaliar a relação de custo-efetividade dos regimes imunossupressores utilizados em pacientes receptores de transplante renal, no Hospital Santa Casa de Misericórdia de Juiz de Fora, MG, basiliximabe, micofenolato de sódio, tacrolimo e prednisona (Grupo 1 = 93 pacientes), comparados com a associação de timoglobulina, everolimo, tacrolimo e prednisona (Grupo 2 = 91 pacientes). Métodos: Para a análise farmacoeconômica, foi utilizado o modelo de Árvore de Decisão, desenvolvido no software Treeage Suite 2011. Foi considerada uma coorte real de pacientes submetidos ao transplante renal entre janeiro de 2013 e março de 2017, os quais foram acompanhados por um período de um ano, sendo mensurados os benefícios clínicos, bem como os custos associados, na perspectiva do Sistema Único de Saúde. O método de custeio utilizado foi o botton-up. Foram adotados os limiares de custo-efetividade (LCEs) equivalentes a 1 PIB per capita e 1 a 3 PIB, considerando o ano de 2017. Resultados: No que diz respeito à sobrevida, a RCEI foi de cerca de R$ 214.234,12 para 1 ano de vida ganho. Em relação aos eventos adversos, a RCEI foi de cerca de R$ 43.682,98 para 1 ano sem incidência de eventos adversos. Conclusões: Ao avaliar a sobrevida e a incidência de eventos adversos, timoglobulina+everolimo não é considerado custo-efetivo em relação ao esquema contendo basiliximabe+micofenolato de sódio diante do LCE de 1 PIB per capita. No entanto, ao adotarmos o LCE até 3 PIB per capita, o regime contendo moglobulina+everolimo é custo-efetivo, ultrapassando cerca de 38% do PIB per capita.
Objective: Evaluate the cost-effectiveness of immunosuppressive regimens used in kidney transplant recipients at the Santa Casa de Misericórdia, Hospital in Juiz de Fora, MG, compared with basiliximab, mycophenolate sodium, tacrolimus and prednisone (Group 1 = 93 patients) with the association of thymoglobulin, everolimus, tacrolimus and prednisone (Group 2 = 91 patients). Methods: For the pharmacoeconomic analysis, the Decision Tree model was used, developed in the TreeAge Suite 2011 software. A real cohort of patients undergoing kidney transplantation between January 2013 and March 2017 was considered, they were followed up for a period of 1 year, where the clinical benefits were measured, as well as the associated costs, from the perspective
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Transplante de Rim , Farmacoeconomia , Everolimo , Análise de Custo-Efetividade , Imunossupressores , Ácido MicofenólicoRESUMO
Objetivo: Avaliar o impacto das ações judiciais no setor de ortopedia da Santa Casa de Juiz de Fora/MG. Métodos: Foi realizada análise dos prontuários dos pacientes que passaram por cirurgia no setor de ortopedia da Santa Casa de Juiz de Fora no ano de 2016. E, logo após, os pacientes advindos de ação judicial foram identificados, dividindo-se, assim, a amostra em dois grupos. As variáveis analisadas foram: sexo e idade do paciente; tempo de internação, desfecho e custos, os quais foram desmembrados em diárias, honorários, procedimentos e materiais e medicamentos. Resultados: Os resultados demonstraram que os pacientes que realizaram cirurgias por via judicial são, em sua maioria, idosos, com leve predominância do sexo masculino. A maior das demandas é para a garantia de cirurgias do sistema osteomuscular de membros inferiores, representando 65,9% das cirurgias realizadas por ação judicial em 2016, que também são as cirurgias mais demandadas por via convencional. O custo direto das cirurgias por processos judiciais foi estimado em R$ 2.340.301,68. As diárias apresentaram o maior custo, sendo responsáveis por 90,7% de todo o custo estimado. Conclusão: A judicialização neste estudo expõe deficiências do Sistema Único de Saúde quanto à oferta de serviços, uma vez que todas as cirurgias demandadas por meio de ação judicial já são contempladas pelo sistema público de saúde. Assim, os aspectos judiciais da saúde, tais como a individualidade e os prazos para cumprimento, prevalecem sobre o coletivo e os que esperam nas filas.
Objective: Evaluate the impact of legal actions in the orthopedic sector of Santa Casa de Juiz de Fora/MG. Methods: An analysis was carried out of the medical records of patients who underwent surgery in the orthopedic sector of Santa Casa de Juiz de Fora in the year 2016. Soon afterwards, patients from a judicial action were identified, thus dividing the sample into two groups. The analyzed variables were: sex and age of the patient; time of hospitalization, outcome and costs, which were broken down into: daily, fees, procedures and materials and medicines. Results: The results showed that patients who underwent surgeries by judicial means are mostly elderly, with a slight predominance of males. The largest of the demands is to guarantee osteomuscular lower limb surgeries, accounting for 65.9% of surgeries performed by lawsuit in 2016, which are also the most commonly performed surgeries. The direct cost of surgeries for legal proceedings was estimated at R$ 2,340,301.68. The daily costs were those that presented the highest cost, accounting for 90.7% of the estimated cost. Conclusion: The judicialization in this study exposes deficiencies of the Unified Health System regarding the offer of services, once all the surgeries demanded by lawsuit are already contemplated by the public health system. Thus, the judicial aspects of health, such as: individuality and deadlines for compliance prevail over the collective and those waiting in the queues.
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Ortopedia , Direito Sanitário , Judicialização da SaúdeRESUMO
In this paper, we present the results of a 6-year experiment in space that studied the effects of radiation in Gallium Nitride (GaN) electronics in geostationary orbit. Four GaN transistors in a Colpitts oscillator configuration were flown in the Component Technology Test-Bed aboard the Alphasat telecommunication satellite. A heuristic analysis was performed by observing the variation in the power output of the oscillators with the total ionizing dose gathered during the mission. The total ionizing dose was measured with a Radiation Sensing Field Effect Transistors (RadFET) placed close to the GaN devices. The experiment showed that GaN is a robust technology that can be used in the space radiation environment of a geostationary orbit. The work presented here starts with a brief introduction of the subject, the motivation, and the main goal. This is followed by the description of the experimental setup, including the details of the oscillator design and simulations, as well as the implementation of the test-bed and the Components Technology Test-Bed. Finally, the results obtained during the 6 years of experience in space are discussed.
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The term 'mental health literacy' was first introduced in 1997, and it was defined as 'knowledge and beliefs about mental disorders which aid their recognition, management or prevention' [...].
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Letramento em Saúde , Transtornos Mentais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Saúde MentalRESUMO
The decision on retaining or prophylactically removing asymptomatic lower third molars is still discussed in the literature. This study aimed to verify the association between asymptomatic lower third molars and local bone conditions through periapical radiographs. Based on sample size calculations, 288 radiographs were required. Dependent variables were alveolar bone crest status and radiolucency between the distal aspect of the third molar crown and the ascending mandibular ramus. Independent variables were sex, age, Pell and Gregory and Winter's classification, angulation and distance between second and third molars, third molar side. Advanced ages (OR 1.15; CI 1.08-1.24; p < 0.001) and greater third molar angulations (OR 1.03; CI 1.01-1.04; p < 0.001) significantly increased the chance of radiographic alterations in the bone crest between second and third molars. Radiolucency distal to third molars was solely impacted by patient's age (OR 1.05; CI 1.01-1.11; p = 0.036). Older patients and lower third molars with greater angulations about adjacent second molar should be evaluated for third molar removal because of the increased chance of alveolar bone crest alterations. Older patients should also be monitored for wider radiolucent pericoronal spaces distal to lower third molars and its consequences.
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Doenças Ósseas , Dente Serotino , Processo Alveolar , Humanos , Mandíbula/diagnóstico por imagem , Dente Molar/diagnóstico por imagem , Dente Serotino/diagnóstico por imagem , Extração DentáriaRESUMO
Objetivo:Realizar uma comparação entre a prevalência de infecções hospitalares pelo período de 13 meses entre dois grupos: pacientes internados sem assistência odontológica e com assistência odontológica. Métodos:O estudo é considerado do tipo transversal descritivo, através de dados referentes às taxas de infecções hospitalares obtidas em dois grupos, sem e com acompanhamento odontológico, considerando mais especificamente os setores: Centro de Terapia Intensiva (CTI) e Clínica Neurológica. Foram incluídos na amostra pacientes com idade superior a 16 anos, de ambos os gêneros e que apresentaram diagnóstico de infecção hospitalar após o período de 48 horas de internação ou 48 horas após a alta. Resultados:Entre março de 2016 à março de 2017, observou-se uma prevalência de infecção hospitalarde 3.14% em pacientes sem assistência odontológica e no período de março de 2017 à março de 2018, a prevalência foi de 2.85% nos pacientes que tiveram assistência odontológica. Conclusão: O CTI foi o setor de maior ocorrência das infecções. A assistência odontológica não se mostrou associada com as ocorrências de infecções.
Aim: To make a comparison between the prevalence of hospital infections over a period of 13 months between two groups: patients hospitalized without dental care and with dental care. Methods:This was a descriptive cross-sectional study, through data regarding the rates of hospital infections obtained in two groups: with and without dental care, considering more specifically the sectors: Intensive care unit (ICU) and neruological clinic. Patients over 16 years-old, of both genders and who were diagnosed withhospital infection after 48 hours of hospitalization or 48 hours after discharge, were included in the sample. Results: Between March 2016 and March 2017, a prevalence of hospital infection was observed of 3. 14% in patients without dental care and from March 2017 to March 2018, the prevalence was 2. 85% in patients who had dental care. Conclusion: The ICU was the sector with the highest occurrence of infections. Dental care was not associated with the occurrence of infections.
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Jupiter hosts the most hazardous radiation belts of our solar system that, besides electrons and protons, trap an undetermined mix of heavy ions. The details of this mix are critical to resolve because they can reveal the role of Jupiter's moons relative to other less explored energetic ion sources. Here, we show that with increasing energy and in the vicinity of Jupiter's moon Amalthea, the belts' ion composition transitions from sulfur- to oxygen-dominated due to a local source of â³50 MeV/nucleon oxygen. Contrary to Earth's and Saturn's radiation belts, where their most energetic ions are supplied through atmospheric and ring interactions with externally accelerated cosmic rays, Jupiter's magnetosphere powers this oxygen source internally. The underlying source mechanism, involving either Jovian ring spallation by magnetospheric sulfur or stochastic oxygen heating by low-frequency plasma waves, puts Jupiter's ion radiation belt in the same league with that of astrophysical particle accelerators.
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BACKGROUND: Prevalence of Grade C molar incisor periodontitis (C/MIP) in females (F) and males (M) is controversial, although some studies suggest higher prevalence in females. The objective of this study was to evaluate differences in clinical parameters, and levels of cyto/chemokines in gingival crevicular fluid (GCF) and peripheral blood response. METHODS: GCF and blood were collected from 79 C/MIP African-American participants (53F and 26 M) and healthy controls (58F and 38 M), aged 5 to 23. Blood was stimulated with ultrapure LPS from Escherichia coli (Ec) and Porphyromonas gingivalis (Pg) and we quantified levels of 14 cyto/chemokines. Clinical parameters were collected before and 12 months following treatment RESULTS: No clinical parameters or age differences were found between males and females, although age was negatively correlated with response to treatment. GCF levels of TNFα, IFNγ, MIP1α, and MCP1 from diseased and sites and healthy sites IFNγ levels were higher in M (P < 0.05). C/MIP females presented higher Pg and Ec LPS induced levels of Eotaxin, IFNγ, and GMCSF (P < 0.05), whereas healthy males presented higher Ec LPS induced levels of Eotaxin and IFNγ (P < 0.05). Inflammatory profiles were also different among genders in disease (P = 0.004). CONCLUSIONS: Although males seemed to present few elevated inflammatory markers in the GCF in disease and in health, females presented an elevated systemic inflammatory response to LPS in disease, which indicates a possible differential susceptibility to inflammation. Future studies need to determine if sex hormones have a role in the peripheral host response and in the pathogenesis of C/MIP.