Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self-report and physician assessment.

BACKGROUND: Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment. METHODS: This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0-100). RESULTS: A total of 193 patients (72% female; median [P25-P75] age 28 [19-41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0-71]%; 1 month: 18 [0-48]%) than patient self-report (80 [60-95]) and physician assessment (82 [51-94]) (p < 0.001). A negligible non-significant correlation was found between the app and subjective measurements (ρ 0.118-0.156, p > 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001). CONCLUSIONS: Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.

Tracking pollutants in a municipal sewage network impairing the operation of a wastewater treatment plant.

This work provides a screening of organic contaminants and characterization of the dissolved organic matter in the sewer network until the municipal wastewater treatment plant (WWTP), identifying the network areas with a higher degree of contamination and their impact on the WWTP performance, particularly in the activated sludge reactor. Three monitoring campaigns were carried out at six selected locations of the sewage system (PVZ-1, PVZ-2, PS-F, PS-VC, CP-VC, and PS-T), influent (WWTPINF) and effluent (WWTPEFF) of the WWTP. Advanced analytical techniques were employed, namely excitation/emission matrix fluorescence-parallel factor analysis (EEM-PARAFAC), size exclusion chromatography with organic carbon detector (SEC-OCD), and liquid chromatography with high-resolution-mass spectrometric detection (LC-HRMS). EEM-PARAFAC showed higher fluorescence intensity for the protein-like component (C2), particularly at CP-VC (near seafood industries) associated with the presence of surfactants (~50 mg/L). SEC-OCD highlighted the WWTP efficiency in removing low molecular weight acids and neutrals. LC-HRMS tentatively identified 108 compounds of emerging concern (CEC) and similar detection patterns were obtained for all wastewater samples, except for PVZ-2 (lower detection), many of which occurred in the effluent. Eight CECs included on relevant Watch-Lists were detected in all WWTPEFF samples. Furthermore, 111 surfactants were detected, the classes more frequently found being alcohol ethoxylates (AEOs), nonylphenol polyethoxylates (NPEOs) and linear alkylbenzene sulphonates (LAS). The continuous presence of LAS and NPEOs allied to surfactants concentrations in the WWTPINF of 15-20 mg/L, with CP-VC location (linked with food industries) as an important contributor, explain the morphological changes in the activated sludge and high LAS content in the dewatered sludge, which may have impacted WWTP performance.

Mobile pre-hospital care reorganization during the COVID-19 pandemic: experience report.

OBJECTIVE: To describe the reorganization of Belo Horizonte's Mobile Emergency Care Service during the new coronavirus pandemic using the Plan Do-Check-Act quality tool. METHODS: Descriptive study, of the experience report type, on the reorganization of care in a mobile pre-hospital care service during the new coronavirus pandemic, from March to July 2020. The Plan-Do-Check-Act quality tool was applied for the process. RESULTS: Preparation of care protocol, meetings, training, addition of ambulances, hiring of professionals, and other actions were carried out, with subsequent evaluation and monitoring. When failures or new needs were identified, actions and changes were implemented while keeping monitoring and evaluation during the work routine. FINAL CONSIDERATIONS: The reorganization of the service through the construction of a protocol and using the Plan-Do-Check-Act as a management tool was essential to promote safe care for professionals and patients.

Bromate removal from water intended for human consumption by heterogeneous photocatalysis: Effect of major dissolved water constituents.

This study focuses on the influence of major dissolved constituents naturally found in waters intended for human consumption on bromate (BrO3-) reduction by heterogeneous photocatalysis. The individual and combined effect of chloride (Cl-), bicarbonate/carbonic acid (HCO3-/H2CO3), nitrate (NO3-), sulphate (SO42-) and humic acids (HAs) on BrO3- reduction was evaluated in synthetic waters (SWs). Additionally, freshwaters (FWs) from a drinking water treatment plant (DWTP) were tested and directly compared to SWs. Cl- was beneficial for contents in the range 0.47-1.4 mM, with negligible influence for lower and higher contents. NO3- had a null effect regardless of its content (0.024-0.81 mM). HCO3-/H2CO3 (0.061/0.45 mM), SO42- (0.12-2.6 mM) and HAs (0.11-1.0 mM C) had a negative effect in the tested contents. The BrO3- reduction rate was 2.8 times lower in SW with a mixture of water constituents compared to SW without constituents addition. This decline on BrO3- reduction rate corresponded to the sum of the individual species contribution and so there was no evidence of synergetic effects. By contrast, the use of FWs provided BrO3- reduction rates only slightly lower than that found for SW without constituents addition (∼1.2-fold), which can be attributed to: (i) the distinct characteristics of the organic matter of FWs (HAs, fulvic acids and humins with distinct molecular weights and functional groups) compared to that of SW (pure HAs), and/or (ii) the presence in FWs of other inorganics in addition to those here addressed. The heterogeneous TiO2 photocatalysis proved to be a promising process for BrO3- reduction in DWTPs.

Bioremediation of bezafibrate and paroxetine by microorganisms from estuarine sediment and activated sludge of an associated wastewater treatment plant.

The present work aimed to explore the potential of autochthonous microorganisms from an urban estuary and from activated sludge of an associated wastewater treatment plant (WWTP), for biodegradation of an antidepressant drug, paroxetine, and on a cholesterol-lowering agent, bezafibrate. These compounds were chosen as representatives of extensively used pharmaceuticals. Autochthonous microorganisms from the indicated sources were exposed to the target pharmaceuticals (1 mg/L) in co-metabolism with sodium acetate (500 mg/L) along a two-weeks period, for a total of 7 two-weeks periods (here referred as cycles). Exposures were carried out in batch mode, under different incubation conditions (agitation vs. static). Removal of pharmaceuticals was monitored at the end of each cycle, by analysing the culture medium. For paroxetine, fluoride ion release was also followed as an indicator of defluorination of the molecule. The structure of the bacterial communities was analysed by ARISA (Automated rRNA Intergenic Spacer Analysis), at the beginning of the experiment and at the end of the first and the last cycles to identify substantial changes associated with the time of exposure, the incubation conditions and the presence and type of pharmaceuticals. Incubation conditions affected not only the bacterial community structure, but also the biodegradation efficiency. At the beginning of the experiment, removal of target pharmaceuticals was found to be lower under agitation than under static conditions, but at the end of the experiment, results showed high removal of the pharmaceuticals from the culture medium (>97%) under both conditions, mainly by microbiological processes. For paroxetine, adsorption and abiotic processes also had an important influence on its removal, but defluorination only occurred in the presence of microorganisms. These results highlight that autochthonous microorganisms from estuarine sediments and WWTP sludge have high ability to remove the selected pharmaceuticals with relevant implications for the development of new bioremediation tools for environmental restoration.

Perfil de mulheres atendidas em hospital de alta complexidade devido a agressão por queimadura pelo parceiro / Profile of women attended at a high complexity hospital due to assumption due to burning by the partner / Perfil de mujeres atendidas a un hospital de alta complejidad por asunción por quemaduras por parte de la pareja

Objetivo: Descrever o perfil dos atendimentos a mulheres que foram agredidas pelo parceiro íntimo e sofreram queimaduras em hospital de referência em trauma, urgência e emergência do Estado de Minas Gerais. Método: estudo transversal, que analisou prontuários de 19 mulheres vítimas de agressão por queimadura realizadas pelo parceiro íntimo em um hospital de referência em trauma, urgência e emergência no período de 2016 a 2019. Resultados: A maioria das vítimas era parda, casada, com filhos, trabalhava informalmente e foi agredida na residência. O atendimento incluiu prioridade muito urgente/laranja, queimaduras graves de 2º grau, internação, procedimentos cirúrgicos, complicações e acompanhamento ambulatorial pós-alta. Conclusão: Os resultados indicam atendimentos de alta complexidade, o que implica necessidade de os serviços de saúde estabelecerem mecanismos de rastreamento e investigação da violência contra a mulher, bem como preparo da equipe, prevenindo agravamentos e oferecendo suporte adequado

Objective: To describe the epidemiological profile of women who suffered assault due to burns by their intimate partner and were treated at a referral hospital for trauma emergencies in the State of Minas Gerais, Brazil. Method: This cross-sectional study analyzed the medical records of 19 women who were victims of assault due to burns by their intimate partner from 2016 to 2019in a referral hospital for trauma emergencies in Minas Gerais. Results: Most victims were Brown, married, with children, worked informally, and were assaulted at home. Care included very urgent/orange priority treatment, severe second-degree burns, hospitalization, surgical procedures, complications, and post-discharge outpatient follow-up. Conclusion: Health services must establish mechanisms to track and investigate violence against women, preventing the worsening of their condition and offering adequate support. Professionals must be prepared at all levels of care and use surveillance and promotion strategies

Describir el perfil de atención a mujeres que sufrieron agresión por quemaduras por parte de su pareja íntima, atendidas en un hospital de referencia para trauma, urgencia y emergencia en el estado de Minas Gerais (Brasil). Método: estudio transversal, que analizó las historias clínicas de 19 mujeres víctimas de agresión por quemaduras por parte de su pareja íntima atendidas en un hospital de referencia de trauma, urgencia y emergencia en Minas Gerais, en el periodo de 2016 a 2019. Resultados: La mayoría de las víctimas eran pardas, casadas, con hijos, trabajaban informalmente y fueron agredidas en su casa. La atención incluyó prioridad muy urgente/naranja, quemaduras graves de segundo grado, hospitalización, procedimientos quirúrgicos, complicaciones y seguimiento ambulatorio posterior al alta. Conclusión: Los resultados muestran una atención de alta complejidad, lo que requiere que los servicios de salud establezcan mecanismos para el seguimiento e investigación de la violencia contra la mujer, así como una mejor preparación de los profesionales para prevenir los agravamientos y ofrecer una adecuada asistencia

Mobile pre-hospital care reorganization during the COVID-19 pandemic: experience report / Reorganización de la atención prehospitalaria móvil en la pandemia de Covid-19: relato de vivencia / Reorganização da assistência pré-hospitalar móvel na pandemia de Covid-19: relato de experiência

ABSTRACT Objective: To describe the reorganization of Belo Horizonte's Mobile Emergency Care Service during the new coronavirus pandemic using the Plan Do-Check-Act quality tool. Methods: Descriptive study, of the experience report type, on the reorganization of care in a mobile pre-hospital care service during the new coronavirus pandemic, from March to July 2020. The Plan-Do-Check-Act quality tool was applied for the process. Results: Preparation of care protocol, meetings, training, addition of ambulances, hiring of professionals, and other actions were carried out, with subsequent evaluation and monitoring. When failures or new needs were identified, actions and changes were implemented while keeping monitoring and evaluation during the work routine. Final considerations: The reorganization of the service through the construction of a protocol and using the Plan-Do-Check-Act as a management tool was essential to promote safe care for professionals and patients.

RESUMEN Objetivo: Describir la reorganización del Servicio de Atención Móvil de Urgencia de Belo Horizonte durante la pandemia del nuevo coronavirus, utilizando la herramienta de calidad Plan-Do-Check-Act. Métodos: Estudio descriptivo, del tipo relato de vivencia, sobre la reorganización de la atención en un servicio de atención prehospitalaria móvil durante la pandemia del nuevo coronavirus, entre marzo a julio de 2020. Fue aplicada la herramienta de la calidad Plan-Do-Check-Act para conducción del proceso. Resultados: Elaboración de protocolo asistencial, reuniones, entrenamientos, incremento de ambulancias, contratación de profesionales y otras acciones fueron realizadas, con subsecuente evaluación y monitoreo. Al ser identificados fallos o nuevas necesidades, acciones y cambios fueron implementados manteniéndose el monitoreo y evaluación en la rutina laboral. Consideraciones finales: La reorganización del servicio por medio de la construcción de un protocolo y teniendo como herramienta de gestión el Plan-Do-Check-Act fue esencial para promover una atención segura a los profesionales y pacientes.

RESUMO Objetivo: Descrever a reorganização do Serviço de Atendimento Móvel de Urgência de Belo Horizonte durante a pandemia do novo coronavírus, utilizando a ferramenta de qualidade PlanDo-Check-Act. Métodos: Estudo descritivo, do tipo relato de experiência, sobre a reorganização da assistência num serviço de atendimento pré-hospitalar móvel durante a pandemia do novo coronavírus, no período de março a julho de 2020. Foi aplicada a ferramenta da qualidade Plan-Do-Check-Act para condução do processo. Resultados: Elaboração de protocolo assistencial, reuniões, treinamentos, acréscimo de ambulâncias, contratação de profissionais e outras ações foram realizadas, com subsequente avaliação e monitoramento. Ao serem identificadas falhas ou novas necessidades, ações e mudanças foram implementadas mantendo-se o monitoramento e avaliação na rotina do trabalho. Considerações finais: A reorganização do serviço por meio da construção de um protocolo e tendo como ferramenta de gestão o Plan-Do-Check-Act foi essencial para promover uma assistência segura aos profissionais e aos pacientes.

Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation.

OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU) of Belo Horizonte. METHOD: this is a retrospective, epidemiological study which analyzed 1,165 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%. RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p<0.05; CI 95%), "cardiac arrest witnessed by Mobile Emergency Medical Services teams" (OR=2.99; p<0.05; CI95%), "only the carry out of basic life support" (OR=0.142; p<0.05; CI95%), and "initial cardiac rhythm of asystole" (OR=0.33; p<0.05; CI 95%). CONCLUSION: early access to cardiopulmonary resuscitation was related to a favorable outcome, and the non-undertaking of advanced support, and asystole, were associated with worse outcomes. Basic and advanced life support techniques can alter survival in the event of cardiac arrest.

Quality of unprocessed cooled fresh coconut water manually extracted by street vendors / Qualidade de águas de coco não pasteurizadas, in natura, resfriadas, extraídas artesanalmente por ambulantes

Coconut water is a versatile beverage that is rich in nutrients, has few calories, and presents functional and therapeutic characteristics, improving the well-being and health of consumers. However, the growth of deteriorating microorganisms is facilitated by its water activity and high nutrient content; and when combined with improper handling, this product may become a carrier of foodborne diseases. Therefore, the objective of this work was to evaluate the quality of unprocessed cooled fresh coconut water manually extracted by street vendors. Twelve samples of coconut water were collected and subjected to physicochemical (total titratable acidity, pH, and total soluble solids) and microbiological (mesophilic, and psychrotrophic microorganisms, molds, yeasts, and thermotolerant and total coliforms) analyses. The physicochemical analysis showed variations of 4.3-5.4 for pH, 0.01-0.03 for total titratable acidity, and 2.8-6.3 for total soluble solids. The microbiological analysis showed high contamination in the samples by deteriorating microorganisms, with 58% of the samples contaminated with pathogenic microorganisms. Therefore, regular use of good hygiene practices for handling manually extracted coconut water is necessary to physicochemically and microbiologically standardize this product. Thus, ensuring the quality of the coconut water when it is manually extracted by street vendors and trade as an unprocessed, cooled, and fresh beverage and consequently minimize consumer's health risks.(AU)

A água de coco é uma bebida bastante versátil, pois, além de apresentar grande riqueza nutricional e poucas calorias, tem características funcionais e terapêuticas, auxiliando no bem-estar e na saúde de seus consumidores. Porém, devido a sua atividade de água e nutrientes elevados, o crescimento de micro-organismos deteriorantes é facilitado e, com a manipulação inadequada do produto, a água de coco pode se tornar um veículo de doenças transmitidas por alimentos. Portanto, o presente trabalho objetivou avaliar a qualidade das águas de coco não pasteurizadas, in natura, resfriadas, extraídas artesanalmente por ambulantes. Para tanto, coletaram-se 12 amostras distintas de água de coco, as quais foram submetidas às análises físico-química (acidez total titulável, pH e sólidos solúveis) e microbiológica (micro-organismos mesófilos, psicrotróficos, bolores e leveduras, coliformes totais e termotolerantes). As análises físico-químicas demonstraram variações de 4,3-5,4 para o pH das amostras, de 0,01-0,03 para a acidez total titulável e de 2,8-6,3 para os sólidos solúveis totais. Quanto ao perfil microbiológico, verificou-se elevada contaminação por micro-organismos deteriorantes e 58% das amostras estavam contaminadas com micro-organismos patogênicos. Portanto, sugere-se aplicação regular de boas práticas de higiene e manipulação da água de coco artesanal para uma melhor padronização físico-química e microbiológica desse produto. Desse modo, garantindo melhor qualidade a essa bebida quando comercializada na forma não pasteurizada, in natura, resfriada, extraída artesanalmente por ambulantes e, consequentemente, minimizando os riscos à saúde de seus consumidores.(AU)

Representações sociais de término de relacionamentos amorosos em músicas do sertanejo universitário / Social representations of romantic relationship breakups in country music songs / Representaciones sociales de conclusión de relaciones románticas en canciones del sertanejo universitário

Das etapas de um relacionamento amoroso, o término da relação constitui-se como uma das mais difíceis, e é, muitas vezes, expressa por meio de composições musicais que tratam dos sentimentos provenientes desse rompimento. Dentre os ritmos musicais que abordam esse tema, destaca-se o sertanejo universitário, cujas letras elucidam, em especial, relacionamentos amorosos descompromissados e de curta duração. Diante disso, a investigação das representações sociais difundidas por meio dessas letras se torna relevante para a compreensão do pensamento social acerca dos términos de relacionamentos amorosos. O objetivo deste estudo é investigar as representações sociais de término de relacionamentos amorosos e presentes em canções do estilo musical sertanejo universitário. Foram analisadas 211 letras musicais, submetidas à análise lexical no software ALCESTE. Os resultados e análises apontam diferentes sentimentos e comportamentos derivados desse rompimento afetivo, devido a distintos estágios vivenciados desse sofrimento, tanto por parte de quem rompeu a relação quanto de quem foi abandonado, trazendo elementos que vão desde dor, sofrimento, incerteza e desilusão até resignação, felicidade e satisfação com o fim da relação

When it comes to the stages of a romantic relationship, the breakup moment is one of the most difficult for people to experience, and is often expressed through musical compositions, which talk about feelings related to this rupture. Among the musical rhythms that talk about this theme one particularly stands out the Country & Western , whose lyrics elucidate, especially, love relationships and uncommitted short-lived. Therefore, the research of social representations disseminated through these lyrics is relevant to social understand about loving relationship breakups. The aim of this study was to investigate the social representations of romantic relationship breakups present in songs of the musical style called Country & Western. For this study, 211 lyrics were analyzed, submitted to lexical analysis in the ALCESTE software. The results and analysis demonstrate varied feelings and behaviors derived from this breakup, owing to the different stages of the suffering, experienced either by both, the one who terminated the relationship and who was abandoned, bringing elements ranging from pain, suffering, uncertainty and disappointment to resignation, happiness and satisfaction with the relationship which was terminated

En las etapas de una relación amorosa, el término de la relación es una de las experiencias más difíciles, y a menudo se expresa a través de composiciones musicales, que tratan sobre los sentimientos de esta interrupción. Entre los ritmos musicales que abordan este tema destaca el sertanejo universitario, cuyas letras tratan, especialmente, las relaciones amorosas sin compromiso y de corta duración. El propósito de este estudio fue investigar las representaciones sociales del término de las relaciones amorosas, presentes en canciones del estilo musical sertanejo universitario. Se analizaron 211 letras, presentada al análisis de léxico del software ALCESTE. Los resultados y los análisis muestran diferentes sentimientos y comportamientos derivados de este rompimiento afectivo, debido a las diferentes etapas experimentadas en ese sufrimiento, tanto por los que rompieron la relación, cuanto por quien fue abandonado, con elementos que van desde el dolor, el sufrimiento, la incertidumbre y la decepción, hasta la resignación, la felicidad y la satisfacción con el fin de la relación

Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation / Parada cardíaca extra-hospitalar: fatores determinantes da sobrevida imediata após manobras de ressuscitação cardiopulmonar / Parada cardíaca extrahospitalaria: factores determinantes de la sobrevida inmediata después de maniobras de resucitación cardiopulmonar

OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU) of Belo Horizonte. METHOD: this is a retrospective, epidemiological study which analyzed 1,165 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%. RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p<0.05; CI 95%), "cardiac arrest witnessed by Mobile Emergency Medical Services teams" (OR=2.99; p<0.05; CI95%), "only the carry out of basic life support" (OR=0.142; p<0.05; CI95%), and "initial cardiac rhythm of asystole" (OR=0.33; p<0.05; CI 95%). CONCLUSION: early access to cardiopulmonary resuscitation was related to a favorable outcome, and the non-undertaking of advanced support, and asystole, were associated with worse outcomes. Basic and advanced life support techniques can alter survival in the event of cardiac arrest. .

OBJETIVO: analisar fatores determinantes da sobrevida imediata de pessoas que receberam manobras de ressuscitação cardiopulmonar pelas equipes de suporte avançado do Serviço de Atendimento Móvel de Urgência, de Belo Horizonte. MÉTODO: trata-se de estudo epidemiológico, retrospectivo, no qual foram analisadas 1.165 fichas de atendimento, do período de 2008 a 2010. Os dados coletados seguiram o estilo Utstein, sendo submetidos à estatística descritiva e analítica com testes de nível de significância de 5%. RESULTADOS: a maioria era do sexo masculino, a mediana da idade foi de 64 anos e a do tempo de deslocamento, nove minutos. A sobrevida imediata foi observada em 239 pessoas. Verificou-se associação desse desfecho com a "parada cardiorrespiratória presenciada por pessoas treinadas em suporte básico de vida" (OR=3,49; p<0,05; IC95%), a "parada cardiorrespiratória presenciada por equipes do Serviço de Atendimento Móvel de Urgência" (OR=2,99; p<0,05; IC95%), "a realização de suporte básico de vida" (OR=0,142; p<0,05; IC95%), "o ritmo cardíaco inicial de assistolia" (OR=0,33; p<0,05; IC95%). CONCLUSÃO: o acesso precoce às manobras de ressuscitação cardiopulmonar foi relacionado a um desfecho favorável e a não realização de suporte avançado e a assistolia foram associadas a pior desfecho. Manobras de suporte básico e avançado podem alterar a sobrevida na parada cardiorrespiratória. .

OBJETIVO: analizar factores determinantes de la sobrevida inmediata de personas que recibieron maniobras de resucitación cardiopulmonar por los equipos de soporte avanzado del Servicio de Atención Móvil de Urgencia de Belo Horizonte. MÉTODO: se trata de estudio epidemiológico, retrospectivo en el cual fueron analizadas 1.165 fichas de atención, en el período de 2008 a 2010. Los datos recolectados siguieron el estilo Utstein, siendo sometidos a la estadística descriptiva y analítica con pruebas de nivel de significancia de 5%. RESULTADOS: la mayoría era del sexo masculino, la mediana de la edad fue de 64 años y el de tiempo de traslado, nueve minutos. La sobrevida inmediata fue observada en 239 personas. Se verificó asociación de ese resultado con la "parada cardiorrespiratoria presenciada por personas entrenadas en soporte básico de vida" (OR=3,49; p<0,05; IC95%), la "parada cardiorrespiratoria presenciada por equipos del Servicio de Atención Móvil de Urgencia" (OR=2,99; p<0,05; IC95%), "la realización de soporte básico de vida" (OR=0,142; p<0,05; IC95%), y "el ritmo cardíaco inicial de asistolia" (OR=0,33; p<0,05; IC95%). CONCLUSIÓN: el acceso precoz a las maniobras de resucitación cardiopulmonar fue relacionado a un resultado favorable y la no realización de soporte avanzado y asistolia fueron asociados a un resultado peor. Maniobras de soporte básico y avanzado pueden alterar la sobrevida en la PCR. .

Representações sociais do envelhecimento entre diferentes gerações no Brasil e na Itália / Social representations of aging between different generations in Brazil and Italy

As representações sociais do envelhecimento podem ser diferentes de acordo com a cultura. O objetivo deste estudo foi comparar as representações do envelhecimento no Brasil e na Itália. Participaram 360 sujeitos distribuídos igualmente entre as nacionalidades, sexo e grupo etário. O questionário apresentou questões fechadas e abertas. Os resultados indicam associação das variáveis sociais (sexo, grupo etário e contexto cultural) com duas representações de envelhecimento: uma, na qual as relações sociais e a atividade completam a ideia de um momento exitoso, em que experiência de vida produziu sabedoria diante da vida, e outra como um processo que, embora traga experiência e sabedoria, resulta em declínio, doenças, inatividade e incapacidades, indicando o fim da vida.

The social representations of aging may differ according to culture. The aim of this study was to compare the representations of aging in Brazil and in Italy. The participants were 360 subjects equally distributed between nationalities, sex and age group. The questionnaire presented closed and open ended questions. The results indicate the association of social variables (sex, age group and cultural context) with two representations of aging: one, where social relations and activity complete the idea of a successful moment in which life experience produced wisdom toward life, and another as a process that, although bring experience and wisdom, results in decline, illness, inactivity and incapacity, indicating the end of life.

Ocorrências de acidentes de trânsito atendidas pelo serviço de atendimento móvel de urgência em Belo Horizonte / Ocurrencias de accidentes de tráfico atendidas por el servicio de emergencia móvil en Belo Horizonte / Occurrences of traffic accidents registered by the mobile emergency service in Belo Horizonte

O Serviço de Atendimento Móvel de Urgência de BeloHorizonte (SAMU/BH) conta com profissionais para atender asdiversas situações de urgência/emergência; dentre esses atendimentos, os acidentes de trânsito. Este estudo foidesenvolvido com o objetivo de descrever as ocorrências de acidentes de trânsito atendidas pelo SAMU/BH/MinasGerais, no ano de 2009. Para a coleta de dados, foirealizado um estudo epidemiológico, observacionaldedelineamento transversal sobre as ocorrências atendidas pelas unidades de suporte avançado (USA). A pesquisa foifeita mediante a avaliação de 1295 fichas de atendimento pré-hospitalar (FAPH), nas quais houve relatode acidentede trânsito. O tempo médio da chegada ao local foide 10 minutos. O principal veículo envolvido foi amotocicleta(319 - 24,7%), em seguida, os automóveis (306 - 23,7%). A maioria dos atendimentos ocorreu no períodonoturno e nosfinais de semana, com uma média de 70 atendimentos/mês. O maior percentual (902 - 69,7%) foi do sexo masculino,com destaque para a faixa etária adulto jovem (20 a39 anos). Das 1295 ocorrências, 150 (11,6%) vítimas foram aóbito, um número elevado de vítimas (1030 - 79,6%)manteve sobrevida. Os resultados comprovaram a eficiência detoda a equipe do SAMU e mostrou a importância do seu papel exercido na sociedade.

he Service Mobile Emergency Care in Belo Horizonte(SAMU / BH) with professionals to meet the diversesituations ofurgency/emergency, these services from traffic accidents. This study was carried out in order to describe theoccurrences of traffic accidents attended by the SAMU / BH / Minas Gerais, in 2009. For data collection was carriedout an epidemiological study, observational cross-sectional design on events attended by the units advanced support(USA). The survey was conducted by reviewing medical records of 1295 pre-hospital (FAPH), in which there werereports of traffic accidents. The average time of arrival on site was 10 minutes. The main vehicle wasinvolved in themotorcycle (319 to 24.7%) then the car (306 to 23.7%). Most of the visits were at night and on weekends, with anaverage of 70 calls / month. The highest percentages (902 to 69.7%) were male, with emphasis on the young adult agegroup (20-39 years). Of the 1295 occurrences, 150 (11.6%) victims died, a large number of casualties (1030 to 79.6%)continued survival. The results proved the efficiency of the entire team of SAMU and showed the importance of theirrole played in society.

El Servicio de Atendimiento Móvil de Urgencia en Belo Horizonte (SAMU/BH) los profesionales de la cuenta pararesponder a situaciones diversas emergencias, estosservicios debido a los accidentes de tráfico. Esteestudio se llevóa cabo con el fin de describir las ocurrencias de los accidentes de tránsito atendidos por el SAMU Gerais/BH/Minas, en2009. Para la recolección de datos se llevó a caboun estudio epidemiológico, observacional y transversal en el diseñode los eventos atendidos por las Unidades de Soporte Avanzado (USA). La encuesta se realizó la revisión de registros...

Parada cardiorrespiratória em ambiente pré-hospitalar: ocorrências atendidas pelo Serviço de Atendimento Móvel de Urgência de Belo Horizonte / Out-of-hospital cardiac arrest: cases assisted by the mobile emergency service of Belo Horizonte

Justificativa e objetivos: O Serviço de Atendimento Médico de Urgência de Belo Horizonte (SAMUBH), implantado em 2003, possui equipe preparada e ambulâncias equipadas para atendimento pré-hospitalar. Dentre os atendimentos, a parada cardiorrespiratória (PCR) é a ocorrência mais grave. O objetivo deste estudo foi analisar os casos de PCR pré-hospitalar em BH. Método: Estudo epidemiológico, descritivo e retrospectivo. Foram avaliadas as fichas de atendimento de pessoas que tiveram PCR atendidas pelo SAMU/BH em 2005. Utilizou-se instrumento com variáveis baseadas no estilo Utstein para a coleta de dados. Tratamento estatístico descritivo e de associação dos dados foi realizado. Resultados: No período foram atendidas 5.058 ocorrências, sendo 1.548 (30,2%) casos de PCR (68,8% masculinos), idade 0 a 106 anos, com predomínio de causas clínicas (62,2%). No município de BH, o tempo médio para atendimento (tempo-resposta) foi de 10,3 minutos e, em cidades da região metropolitana, de 18 minutos. Em 1.197 (77,3%) atendimentos a equipe apenas constatou o óbito. Manobras de RCP foram realizadas em 351 (22,7%) pessoas, e, 117 (33,3%) destas apresentavam fibrilação ventricular ou taquicardia ventricular sem pulso na avaliação inicial da equipe de atendimento. Sobrevida imediata ocorreu em 83 (23,6%) pessoas, sendo encaminhadas para diversos hospitais. Entre os fatores que influenciaram a sobrevida imediata pós-RCP destacam-se: tempo-resposta da ambulância, "PCR presenciada pela equipe" e ritmo cardíaco. Porém, na regressão logística, somente as duas últimas variáveis foram significativas. Conclusão: Os resultados mostram que o SAMU tem um papel significativo e de impacto positivo no atendimento a vítimas de PCR na comunidade.

Background and objectives: The Mobile Emergency Service of Belo Horizonte (SAMU/BH), initiated in 2003, has trained staff members and ambulances equipped for out-of-hospital (OH) healthcare, and cardiac arrest (CA) is the most stressful event faced. The aim of the study was to analyze out-of-hospital CA cases attended by the SAMU-BH. Method: Retrospective, descriptive and epidemiological study. All OH-CA patients' charts attended by the SAMU-BH in 2005 were reviewed, and data were collected by using an instrument elaborated in Utstein style. Descriptive and associations statistical analysis were performed to treat data. Results: During the period 5,058 patients were attended with 1,548 (30.2%) cases of OH-CA (68.8% males), age 0-106 years, and clinical causes were prevalent (62.2%). The ambulance time-response in BH city was of 10.3 minutes, and of 18 minutes in the great metropolitan area. The majority of patients (1,197; 77.3%) were already dead when the ALS team arrived. CPR-maneuvers were performed in 351 (22.7%) patients and 117 (33.3%) of them have shown ventricular fibrillation or pulseless ventricular tachycardia at the initial evaluation by the ALS team. Immediate recovery was obtained in 83 (23.6%) patients, and they were taken to a hospital. Ambulance time-response, witnessed CA-CPR by ALS team and initial cardiac rhythm were the main factors influencing the immediate CPR survival. Logistic regression, however, indicated only the last two variables as significant factors in short-term survival. Conclusion: Our results highlighted the importance of SAMU for increasing CPR survival in out-of-hospital cardiac arrest.

Atendimentos a vítimas de parada cardíaca extra-hospitalar com desfibrilador externo automático em unidades de suporte básico / Victims attendances of out-of-hospital cardiac arrest with automatic external defibrillator in basic support units

O uso de Desfibriladores Externos Automáticos (DEAs) pode ser benéfico para pacientes com Parada Cardiorrespiratória (PCR), mesmo se utilizado por indivíduos treinados a manuseá-lo ou leigos. Este estudo teve o objetivo de caracterizar atendimentos às vítimas de PCR, de provável etiologia cardíaca realizados pelas equipes do Serviço de Atendimento Móvel de Urgência de Belo Horizonte após a incorporação do DEA nas Unidades de Suporte Básico (USB). Trata-se de um estudo epidemiológico, retrospectivo. As variáveis utilizadas foram baseadas no estilo Utstein e os dados submetidos à estatística descritiva. Dos 543 atendimentos, 58,4% das vítimas eram do sexo masculino e a mediana da idade foi de 56 anos. Em 39,0% das ocorrências houve o acionamento e atendimento conjunto de uma USB e uma Unidade de Suporte Avançado (USA) e, em 86,6% destes as USBs chegaram, em média, 15,5 minutos primeiro. Em 46,6% dos atendimentos houve indicação de manobras de Ressuscitação Cardiopulmonar (RCP). Das 112 pessoas que receberam manobras de RCP com um desfibrilador, a maioria (75,0%) delas foi pelo DEA. O choque foi indicado para 14,3% e mais da metade (58,3%) teve retorno da circulação espontânea. Esse resultado demonstra a importância do DEA, permitindo acesso à desfibrilação precoce às vítimas de PCR.

The use of automated external defibrillators (AED) may be beneficial for patients with cardiopulmonary arrest (CPA), even if used by individuals trained to handle it or lay. This study aimed to characterize care to victims of cardiac arrest, probable cardiac etiology conducted by teams of the Mobile Emergency Care Service in BeloHorizonte after the incorporation of AED in the Basic Support Unit (BSU). This is a retrospective, epidemiological study. The variables used were based on the Utstein style data submitted to descriptive statistics. Of the543 calls, 58.4% of victims were male and the median age was 56 years. Asystole was identified in 86.7% of cases. In 39,0% of cases a BSU and an Advanced Support Unit were engaged, and in 86.6% of those, the BSU arrived firstin 15,5 minutes on average. In 46.6% of the calls there was no indication of cardiopulmonary resuscitation (CPR). Of the 112 people who received CPR measures with a defibrillator, the majority (75.0%) of them was with the AED. Shock was given to 14.3% and more than half (58.3%) had a return of spontaneous circulation. This result demonstrates the importance of the AED, allowing access to early defibrillation to victims of cardiac CPR

Ressuscitação cardiopulmonar pré-hospitalar: fatores determinantes da sobrevida / Out-of-hospital cardiopulmonary resuscitation: determinants of survivorship

As doenças cardiovasculares constituem o mais importante grupo de causas de morte no país e dentre essas, destacam-se as isquêmicas do coração, responsáveis pela maioria dos episódios de parada cardiorrespiratória. Cerca de 80,0% dessas ocorrem em ambiente pré-hospitalar. Vários fatores pré e intra-hospitalares podem influenciar nos resultados do atendimento ao paciente. Esse estudo foi desenvolvido com o objetivo de analisar os fatores determinantes da alta hospitalar com vida de pessoas que receberam manobras de ressuscitação cardiopulmonar em ambiente pré-hospitalar. Trata-se de um estudo longitudinal, realizado a partir de 1.165 fichas de atendimento pré-hospitalar de pessoas que receberam manobras de ressuscitação cardiopulmonar por equipes das unidades de suporte avançado doServiço de Atendimento Móvel de Urgência de Belo Horizonte, no período de 01/01/2008 a 17/10/2010. Os dados foram submetidos a tratamento estatístico (análise descritiva e de associação). Verificou-se que a maioria das pessoas (685- 58,9%) era do sexo masculino, a mediana da idade foi de 64 anos. O maior empenho de ambulâncias foi no período matutino (342-37,1%) e a mediana do tempo de seu deslocamento foi de nove minutos. O retorno da circulação espontânea foi observado em 239 (20,5%) pessoas que foram encaminhadas paraunidades hospitalares. Verificou-se associação desse desfecho com a "PCR presenciada por pessoas treinadas em suporte básico de vida" (OR=3,49; p<0,05; IC95%), a "PCR presenciada por equipes do SAMU" (OR=2,99; p<0,05; IC95%), "a realização de suporte básico de vida" (OR=0,142; p<0,05; IC95%), "o ritmo cardíaco inicial de assistolia" (OR=0,33; p<0,05; IC95%). No ambiente hospitalar, foi possível acessar 111 (68,5%) prontuários. A maioria dos pacientes (106-95,5%) foi admitida na sala de emergência, 21 (23,6%) tiveram uma nova PCR à admissão e desses 10 (47,6%) foram a óbito. Receberam alta hospitalar com vida 14 pacientes e encontrou-se associação com esse...

Cardiovascular diseases are the most important group of causes of death in the country, and among these stand out the ischemic heart, responsible for most cases of cardiac arrest. Approximately 80.0% of these occur in the prehospital environment. Numerous factors pre and intra-hospital could influence the results of patient care. The aim of this study was to analyze the determinants of patient discharged aliveamong those who received cardiopulmonary resuscitation in the prehospital environment. This was a longitudinal study, carried out with 1165 records of prehospital care of people who received cardiopulmonary resuscitation by teams of Advanced Support Units of Mobile Emergency Care Service in Belo Horizonte, from 01/01/2008 to 17/10/2010. The statistical analysis was made using descriptivestatistics and association measures. It was found that most people (685, or 58.9%) were male, median age was 64 years. The ambulance was used mainly in the morning (342, or 37.1%) and the median time of its displacement was 9 minutes. The return of spontaneous circulation was verified in 239 (20.5%) patients, those were referred to hospitals. That outcome was associated with the "PCR witnessed by people trained in basic life support” (OR=3,49; p<0,05; 95%CI), the "PCR attended by SAMU teams” (OR=2,99; p<0,05; 95%CI), "the carry out basic life support”(OR=0,14; p<0,05; 95%CI), "the initial cardiac rhythm of asystole" (OR=0,33; p<0,05; CI95%). In the hospital, was possible to evaluate 111 (68.5%) records. Most patients (106, or 95.5%) were admitted to the emergency room, 21 (23.6%) had a new PCR on admission and 10 (47.6%) of these died. Were discharged alive 14 patients and factors associated with this outcome were the "spontaneous ventilation within 72hours" and the "sedation." It was possible to visit 11 (91.6%) patients who stayed aware, being independent in activities of daily living. Only one patient did not perform working activities and another had...