Research Progress of Enzyme Replacement Therapy for Rare Diseases Products and Their Pharmaceutical Assessment / 中国药学杂志

OBJECTIVE: To summarize the latest research progress in the development of enzyme replacement therapy drugs for rare diseases at home and abroad and their pharmaceutical assessment. METHODS: Based on the representative literature at home and abroad, this paper propose key points for consideration (such as molecular design, host selection, production process and quality control, etc.), as well as comments and suggestions for researcher of such products from review and evaluation perspective. RESULTS: Due to the complexity and heterogeneity of the drug molecules of enzyme replacement therapy for rare diseases, the quality research is the main difficulty in pharmaceutical development and evaluation. CONCLUSION: In recent years, in order to alleviate the lack of rare disease drugs in China and meet the urgent clinical needs, Chinese government has issued a series of policies to encourage the research and development of rare disease drugs.

Avaliação da assistência às pessoas com transtornos mentais em conflito com a lei / Evaluation of care for people with mental disorders in conflict with the law

Objetivou-se avaliar a assistência às pessoas com transtornos mentais em conflito com a lei. Trata-se de um estudo de avaliação realizado em duas etapas: Estudo Metodológico e Estudo de Caso. O estudo metodológico, desenvolvido de fevereiro a dezembro de 2019, delineou a construção e validação do modelo lógico e da matriz de critérios para avaliação da assistência ao grupo estudado, a partir dos três procedimentos sugeridos pelo referencial da Psicometria de Pasquali: 1) teóricos- composto por ensaio teórico, scoping review e estudo de avaliabilidade, a fim de identificar os conteúdos que compuseram o modelo lógico e a matriz de critérios; 2) empíricos ­ compreenderam a construção do instrumento de coleta através do Google Forms e a seleção de 44 experts para o processo de validação do instrumento de avaliação proposto; e 3) analíticos- realizado a partir de duas etapas Delphi, em que se considerou válido o item avaliado como adequado que obteve 70% de concordância entre os experts. O estudo de caso ocorreu no âmbito do Hospital de Custódia e Tratamento Psiquiátrico do estado do Rio Grande do Norte. Foram entrevistados, em janeiro de 2020, três gestores e sete profissionais de saúde que atuavam no cenário pesquisado. O conteúdo textual decorrente das entrevistas foi submetido à análise textual lexicográfica, com auxílio do software Interface de R pour Analyses Multidimensionnelles de Textes et de Questionneires e a análise dos dados foi realizada a partir de literatura pertinente. O ensaio teórico refletiu sobre a existência de muros (in) visíveis que cerceiam as pessoas com transtornos mentais em conflito com a lei. A scoping review identificou que as pesquisas acerca da assistência à saúde mental ofertada aos internos dos Institutos de Psiquiatria Forense no Brasil eram predominantemente dissertações, com abordagem qualitativa, na área da Psicologia e Direito, publicadas em 2014, realizadas na região sudeste do Brasil, com ênfase nas falas dos profissionais de saúde e sem especificar a metodologia da análise de dados. Ademais, indicou que a assistência ofertada aos internos destas instituições tem caráter punitivo, pauta-se na medicalização excessiva e diverge da legislação vigente, o que dificulta a reintegração social desses sujeitos. O estudo de avaliabilidade resultou: na elaboração e pactuação do modelo lógico; na análise e comparação entre a realidade da política e o modelo lógico; e na elaboração da matriz de critérios. O modelo lógico foi validado pela Técnica de Grupo Nominal. A adequabilidade do conteúdo da matriz de critérios foi avaliada por 16 experts na etapa Delphi 1 e por 12 na etapa Delphi 2. A matriz de critérios teve seu conteúdo validado mediante Coeficiente de Validade de Conteúdo de 0,93. Para gestores e profissionais de saúde entrevistados na etapa de campo, a assistência no cenário estudado é permeada por carências estruturais, mas mudanças no âmbito da gestão institucional têm permitido avanços no processo de desinstitucionalização dos internos. Recomenda-se o estabelecimento de metas exequíveis, bem como que a matriz de critérios proposta nesse estudo direcione a avaliação contínua e sistemática, capaz de incidir em melhorias na assistência prestada a esta clientela (AU).

The objective was to evaluate the assistance to people with mental disorders in conflict with the law. It is an evaluation study carried out in two stages: Methodological Study and Case Study. The methodological study, developed in February 2019, outlines a construction and validation of the logical model and the matrix of criteria for assessing assistance to the studied group, based on the three procedures suggested by Pasquali's psychometric framework: 1) theoristscomposed of theoretical essay, scope review and availability study, in order to identify the contents that make up the logical model and the criteria matrix; 2) empirical - understand the construction of a collection instrument using Google Forms and the selection of 44 specialists for the validation process of the analyzed evaluation instrument; and 3) analytical - carried out using two Delphi steps, in which the item evaluated as adequate is considered valid, which recovered 70% of agreement between the specialists. The case study took place at the Hospital of Custody and Psychiatric Treatment of the State of Rio Grande do Norte. In January 2020, three managers and seven health professionals who worked in the surveyed scenario were interviewed. The textual content resulting from the interviews was subjected to lexicographic textual analysis, with the aid of the software Interface de R pour Analyzes Multidimensionnelles de Textes et de Questionneires and the data analysis was performed from the relevant literature. The theoretical essay reflected on the existence of (in) visible walls that surround people with mental disorders in conflict with the law. The scoping review identified that research on mental health care offered to interns at the Institutes of Forensic Psychiatry in Brazil was predominantly dissertations, with a qualitative approach, in the area of Psychology and Law, published in 2014, carried out in the southeastern region of Brazil, with emphasis on the speeches of health professionals and without specifying the methodology of data analysis. In addition, he indicated that the assistance offered to the interns of these institutions has a punitive character, is based on excessive medicalization and diverges from the current legislation, which hinders the social reintegration of these subjects. The evaluability study resulted in: the elaboration and agreement of the logical model; in the analysis and comparison between the reality of politics and the logical model; and in the elaboration of the criteria matrix. The logical model was validated by the Nominal Group Technique. The content adequacy of the criteria matrix was assessed by 16 experts in the Delphi 1 stage and by 12 in the Delphi 2 stage. The content matrix had its content validated by 0.93 Content Validity Coefficient. For managers and health professionals interviewed in the field stage, assistance in the scenario studied is permeated by structural deficiencies, but changes in the scope of institutional management have allowed advances in the process of deinstitutionalization of inmates. It is recommended to establish achievable goals, as well as the criteria matrix proposed in this study to direct continuous and systematic assessment, capable of focusing on improvements in the assistance provided to this cliente (AU).

Lesions in 224 spleens of splenectomized dogs and evalution of alternative techniques for previous microscopic diagnosis / Lesões em 224 baços de cães esplenectomizados e avaliação de técnicas alternativas para diagnóstico microscópico prévio

When detecting a proliferative splenic lesion, veterinarians usually choose splenectomy before a conclusive diagnosis, which can provide a deleterious effect to the dog. The most appropriate would be to perform splenectomy as a therapeutic procedure only in cases with real surgical indication, which can be established after defining microscopic diagnosis and prognosis. The objectives of this study were: to determine the frequency of different types of lesions in spleens of splenectomized dogs in the period of 12 years (2006-2017); determine the representativity of neoplastic lesions (benign and malignant) and non-neoplastic lesions; to evaluate and compare the safety and efficiency of fine needle aspiration biopsy (FNA) and ultrasound-guided Tru-cut needle biopsy for cytological and histopathological diagnosis, respectively, of splenic nodular lesions. In the studied period 224 cases of lesions were found in splenectomized spleens. The frequency of non-neoplastic lesions (50,45%, 113/224) and neoplastic lesions (49,55%, 111/224) was very similar. Among the neoplastic lesions, the malignant ones were more frequent (79,27%, 88/111), and the hemangiosarcoma was the most common (52,25%, 58/111). The possibility of malignant neoplasm was about 74% greater than a benign one. In summary, it was verified that 60.71% (136/224) of the cases corresponded to benign lesions without indication to splenectomy. FNA techniques and Tru-cut biopsy showed a low risk of complications. Regarding the diagnostic efficacy, the FNA obtained 71.43% (15/21) of conclusive diagnoses, 60% (9/15) of which were compatible with the final result of the histopathological evaluation, after splenectomy (gold standard). The Tru-cut biopsy obtained 71.43% (5/7) of conclusive diagnoses and 28.57% (2/7) of inconclusive diagnoses. Among the conclusive one, in 100% of the cases the diagnosis was compatible with the gold standard. Thus, since the possibility of benign splenic lesions in dogs is 1.52 times greater than malignancies, splenectomy should be recommended as a therapeutic procedure only in cases with proven surgical indication, which can be established after definition of microscopic diagnosis and prognosis. The use of FNA and Tru-cut biopsy should be recommended, especially for small and focal splenic lesions, since such techniques are good alternatives for establishing diagnosis previously to splenectomy, which may reduce the number of unnecessary splenectomies. The importance of recommending such techniques is emphasized, especially for dogs with focal splenic lesions smaller than three centimeters.(AU)

Rotineiramente, frente à detecção de uma lesão proliferativa esplênica, médicos veterinários costumam optar pela esplenectomia antes de se obter o diagnóstico definitivo da lesão esplênica, o que pode trazer consequências deletérias ao cão. O mais apropriado seria, contudo, a sua adoção, como medida terapêutica, apenas nos casos com comprovada indicação cirúrgica, o que pode ser estabelecido após o diagnóstico microscópico e prognóstico definidos. Os objetivos desse estudo foram: determinar a frequência dos diferentes tipos de lesão em baços de cães esplenectomizados no período de 12 anos (2006-2017); determinar a representatividade das lesões neoplásicas (benignas e malignas) e não neoplásicas; avaliar e comparar a segurança e a eficiência da punção aspirativa por agulha fina (PAAF) e da biópsia por agulha Tru-cut guiadas por ultrassom para o diagnóstico citológico e histopatológico, respectivamente, de lesões nodulares esplênicas. No período estudado foram encontrados 224 casos de lesões em baços esplenectomizados. A frequência de lesões não neoplásicas (50,45%, 113/224) e neoplásicas (49,55%, 111/224) esplênicas foi muito semelhante. Entre as neoplásicas, as de caráter maligno foram mais frequentes (79,27%, 88/111) e o hemangiossarcoma o mais comum (52,25%, 58/111). A possibilidade de ocorrência de uma neoplasia maligna foi cerca de 74% maior do que uma benigna. Em suma, verificou-se que em 60,71% (136/224) dos casos estudados, tratava-se de lesões benignas que não teriam indicação de esplenectomia. As técnicas de PAAF e a biópsia por agulha Tru-cut demonstraram ter baixo risco de complicações. Quanto à eficácia diagnóstica, pela PAAF obteve-se 71,43% (15/21) de diagnósticos conclusivos, sendo 60% (9/15) desses compatíveis com o resultado final realizado pela avaliação histopatológica, após a esplenectomia (padrão ouro). Já a biópsia por Tru-cut obteve 71,43% (5/7) de diagnósticos conclusivos e 28,57% (2/7) de inconclusivos. Dentre os conclusivos, em 100% dos casos o diagnóstico foi compatível com o padrão ouro. Desta maneira, visto a possibilidade de ocorrência de lesões esplênicas benignas em cães serem 1,52 vezes maior do que as malignas deve ser recomentado a adoção de esplenectomia, como medida terapêutica, apenas nos casos com comprovada indicação cirúrgica, o que pode ser estabelecido após o diagnóstico microscópico e prognóstico definidos. O uso da PAAF e da biópsia por Tru-cut deve ser recomentado, sobretudo, para lesões esplênicas pequenas e focais, uma vez que tais técnicas representam boas alternativas para o estabelecimento do diagnóstico prévio a esplenectomia, o que pode reduzir o número de esplenectomias desnecessárias. Enfatiza-se a importância da recomendação de tais técnicas, sobretudo para cães com lesões esplênicas focais menores do que três centímetros.(AU)

Performance evaluation for detecting total bilirubin in neonatal cerebrospinal fluid / 国际检验医学杂志

Objective Newborn bilirubin encephalopathy seriously threatens the life and health of newborns, Both the mortality and morbidity are high.Cerebrospinal fluid bilirubin concentration can better reflect the blood-brain barrier function and brain bilirubin levels, which can help the diagnosis of bilirubin encephalopathy.Methods In order to meet the clinical needs, we confirmed the detection performance of the existing serum bilirubin detection system for cerebrospinal fluid bilirubin, including precision, accuracy and analysis of measurement range.Results The results showed that the detection system was linear at 1.0-25.1μmol/L, and the daytime CVat normal and pathological values was less than the precision requirement (6％) .The bias of each sample and the average bias are less than the allowable bias (5％) , the total error is less than the total allowable error (15％) .Conclusion Therefore, the performance of the detection system meet the industry standards, can be used for neonatal cerebrospinal fluid bilirubin detection.

Introduzindo a pesquisa: uma trajetória de encontros / Introducing the research: a trajectory of encounters

Este artigo pretende apresentar o contexto em que surgiu a pesquisa sobre as Mães Órfãs em Belo Horizonte e apontar os caminhos metodológicos que estão sendo utilizados para desenvolver a investigação. Pesquisadores da UFMG, unidos a um coletivo de movimentos sociais, propõem - se in vestigaras normatizações do Ministério Público e Portaria do Judiciário que institui o abrigamento compulsório para mulheres em situação de vulnerabilidade, a partir de ferramentas qualitativas e quantitativas, a genealogia, os efeitos das normas sobre os atores envolvidos, assim como elucidar os seus efeitos na produção do cuidado e indicadores. Neste caminho, apresenta-se como resultados iniciais da pesquisa, duas narrativas de usuárias que tiveram seus filhos abrigados e adotados por outras família se uma narrativade trabalhadoras de saúde. Estas usuárias não se conformam com esta situação e se insurgem contra as autoridades que as forçaram a ficar sem seus filhos. Pela análise das narrativas observa-se uma atuação de cunho discriminatório onde as mulheres não foram consideradas e o seu direito de defesa foi cerceado por processos e decisões muito rápidas. Observa-se a urgência de movimentos que possam tecer uma rede de apoio para se manter mãe e filho juntos. Para isso foi criado na cidade um movimento de resistência que atuou no sentido de suspender a vigência da portaria. Entretanto, a portaria continua sendo aplicada mesmo sem a sua obrigatoriedade, mostrando que está entranhada no imaginário coletivo, apontando para uma disputa de projetos sobre qual lugar mulheres em situação de vulnerabilização social tem na sociedade contemporânea. (AU)

This article intends to present the context in which the research about the orphan mothers in Belo Horizonte arose and to point out the methodological paths that are being used to develop the research. Researchers from the UFMG, together with a group of social movements, propose to investigate, using from qualitative to quantitative tools, the genealogy, the effects of norms on the actors involved in the question of orphan mothers, as well as to elucidate their effects on the care production and indicators. In this way, we present as initial results of the research two narratives of users who had their children sheltered and adopted by other families and a narrative of health workers. These users did not settle for this situation and insurrected against the authorities that forced them to be without their children. Through the analysis of the narratives it is observed a discriminatory performance where the women were not consulted and their right of defense was curtailed by very fast processes and decisions. It was observed the urgency of movements that can weave a network of support to keep mother and son together. For this purpose, a resistance movement was created in the city, which acted to suspend the validity of the ordinance. However, the ordinance continues to be applied even without being mandatory anymore, showing that it is embedded in the collective imagination, pointing to a dispute of projects about which place women have in situations of social vulnerability in contemporary society. (AU)

Comprehensive analysis of the performance of national basic public health service plan in Zhengzhou from 2011 to 2016 / 中华健康管理学杂志

Objective To evaluate the implementation process of a basic public health service in Zhengzhou. Methods The primary data on the trends in the development of basic public health services were obtained from the annual report and the annual health statistics yearbooks from 2011 to 2016 published by the Zhengzhou City Health and Family Planning Commission. The techniques for order preference by similarity to an ideal solution (TOPSIS method) and rank sum ratio method were used to comprehensively study and analyze the implementation effects of 22 indicators in 13 items of a five-year basic public health project in Zhengzhou. Results Judging from the TOPSIS analysis results, the C values from 2011 to 2016 were 0.3757, 0.3228, 0.5212, 0.6292, 0.6494, and 0.6673 respectively. The year with the highest C value was 2016 and the year with the lowest C value was 2012. Using the rank sum ratio method, the RSR values from 2011 to 2016 were 0.4545, 0.4280, 0.5340, 0.6023, 0.7235, and 0.7576 respectively. From this, 2016 was found to be the best year for plan implementation. Further, the implementation of the five-year basic public health service plan can be divided into three levels. When the range of P (percentile) was P84.134-, and the corresponding year was 2016, the implementation level was higher. When the P (percentile) range was P50-, and it corresponded with 2013, 2014, and 2015, implementation was at a medium level. When the P (percentile) range was <P50, and it corresponded with 2011 and 2012, there was a low level of implementation. Conclusion The overall performance of basic public health services demonstrated positive trends in Zhengzhou from 2011 to 2016.

Construction and Empirical Study of Evaluation Model for Essential Medicine Bidding and Procurement Based on Fuzzy Group Decision Making / 中国药房

OBJECTIVE:To establish the essential medicine bidding evaluation model and improve the scientificity and effec-tiveness of essential medicine bidding and procurement. METHODS:Combined with the main objective of essential medicine cen-tralized bidding and procurement,a criteria bidding evaluation index system for essential medicine was established,and a bidding evaluation model for essential medicine was built based on fuzzy group decision making and the feasibility was verified by exam-ples. RESULTS:The essential medicine evaluation model based on fuzzy evaluation and group decision making was established, and empirical analysis for Atorvastatin Calcium tablet was used to show the feasibility of evaluation model. CONCLUSIONS:The essential medicine evaluation model based on fuzzy group decision making can scientifically and effectively accomplish a compre-hensive evaluation of pharmaceutical enterprises,which builds the foundation for promoting the transparency of essential medicine bidding and procurement work and reducing the economic burden for the patients.

Systematic evalution of Fuzheng Huayu Capsule combined with Adefovir Dipivoxil in treatment of chronic hepatitis B with hepatic fibrosis / 中草药

To systemically review the efficacy and safety of Fuzheng Huayu Capsule (FHC) combined with Adefovir Dipivoxil in treatment of chronic hepatitis B with hepatic fibrosis. Wanfang, CNKI, VIP, CBM, PubMed, Cochrane and Embase were retrieved by computers to collect the RCTs of FHC combined with Adefovir Dipivoxil in treatment of chronic hepatitis B with hepatic fibrosis from their inception to March 2017. After two reviewers separately screened literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies, data were analyzed with RevMan 5.3 sofware. Totally 14 RCTs were included with 1 400 patients involved. According to Meta-analysis, compared with Adefovir Dipivoxil alone, FHC combined with Adefovir Dipivoxil was more efficiently in reducing the liver fibrosis indexes HA [MD = -99.66, CI = -129.94 - -69.37], P < 0.000 01]; LN [MD = -40.99, CI = -58.56 - -23.41, P < 0.000 01]; PCIII [MD = -76.40, CI = -108.15 - -44.66, P < 0.000 01]; IV-C [MD = -55.24, CI = -79.19 - -31.29, P < 0.000 01], in improving the liver function ALT [MD = -21.05, CI = -22.58 - -19.52, P < 0.000 01]; AST [MD = -16.74, CI = -25.14 - -8.33, P < 0.000 1]; TBIL [MD = -10.38, CI = 14.17 - 6.59, P < 0.000 01]; ALB [MD = 4.35, CI = -3.48 - 5.23, P < 0.000 01], and improving the ultrasound imaging results. Also, no significant adverse reaction was reported. FHC combined with Adefovir Dipivoxil could significantly improve liver function, reduce liver fibrosis indexes, and had less adverse reactions, but more large sample, high quality clinical trial are required to verify the curative effect.

A consulta de puericultura na perspectiva de mães e profissionais de unidades básicas de saúde de Belo Horizonte

O acompanhamento sistemático do crescimento e desenvolvimento da criança é uma prática fundamental na Atenção Primária à Saúde, com impacto direto nas taxas de morbimortalidade. A puericultura favorece a qualidade de vida infantil, evitando mortes precoces e hospitalizações, contribuindo para que a criança desenvolva todo o seu potencial. Considerando que a média de atendimentos de puericultura encontra-se abaixo do esperado na cidade de Belo Horizonte, este estudo buscou compreender as perspectivas de mães e de profissionais sobre esta consulta, para desvelar aspectos objetivos e subjetivos que possam se relacionar com a baixa média de atendimentos. Trata-se de uma pesquisa qualitativa, que utilizou como referencial a Teoria das Representações Sociais. O cenário do estudo incluiu unidades básicas com elevadas e baixas médias de puericultura. A coleta foi conduzida por meio de grupos focais com profissionais que realizam puericultura, e entrevistas abertas com mães de crianças menores de dois anos, aderentes ou não às consultas. A análise dos dados foi realizada de acordo com o método da Análise Estrutural de Narração (AEN). Participaram dos grupos 28 profissionais: 13 enfermeiros, 11 médicos generalistas e quatro pediatras; as entrevistas foram realizadas com 14 mães. Os profissionais reconheceram a puericultura como instrumento de prevenção de agravos e promoção à saúde. Os resultados mostraram que a realização das ações do 5º dia é fator facilitador da puericultura nas unidades em que esse fluxo é bem organizado, coincidindo com uma média mais elevada de atendimentos. Os profissionais de unidades com menor média de puericultura afirmaram se sentir pouco capacitados em saúde da criança, problema agravado pela falta de pediatras na rede básica. Eles também afirmaram que a adesão das mães à consulta é baixa, relacionando-a à falta de conhecimento da importância da puericultura, ao desinteresse e às dificuldades das mães em saírem do trabalho...

Systematic monitoring of child growth and development is a fundamental practice in Primary Health Care, with a direct impact on morbidity and mortality rates. Childcare promotes children's quality of life, avoiding early deaths and hospitalizations, and allowing the child to develop his full potential. Considering that the average number of childcare services is lower than expected in the city of Belo Horizonte, this study sought to understand the perspectives of mothers and professionals about this consultation, in order to reveal objective and subjective aspects that may be related to the low averages. This is a qualitative research, grounded in the theory of social representations. The study scenario included basic units with high and low childcare averages. The data collect was conducted through focus groups with professionals who make the childcare, and interviews with mothers of children under two years old, frequent or not to consultations. Data analysis was performed according to the structural analysis of narration method. 28 professionals participated: 13 nurses, 11 family physicians and four pediatricians; the interviews were made with 14 mothers. The professionals recognized the childcare as an instrument of prevention of diseases and health promotion. The results demonstrate that the “action of the 5th day” facilitates childcare in the units in which this work process is well organized, coinciding with a higher average of attendance. The professionals of units with lower average said that they don’t feel qualified in the child care, a problem aggravated by the low number of pediatricians in the basic units. They also affirmed that the mothers' frequency to the consultation is low, relating it to the low knowledge of the importance of child care, indifference and difficulties to getting out of work...

Evaluation of scientific research strength in Gansu health institutions based on scientific achievements, papers and their cited frequencies / 中华医学图书情报杂志

Analyzed in this paper are the distribution of the first completed institutions, districts and cooperative projects of the awarded medical achievements, the number of papers published by Gansu health institutions and their cited frequencies from 2006 to 2013 with the scientific research strength of these institutions assessed in order to provide reference for increasing the output of high level medical achievements.

Incidência de extubação gástrica nos grupos pediátrico e adulto em um programa de assistência domiciliar / Incidence of gastric extubation in pediatric and adult groups in a home care program / Incidencia de la extubación gástrica en los grupos pediátrico y adulto en el programa de atención domiciliaria

O objetivo deste estudo foi avaliar a prática assistencial da intubação gástrica para nutrição enteral dos usuários dos grupos pediátrico e adulto/idoso em um Programa de Assistência Domiciliar de um hospital universitário. Trata-se de estudo exploratório-descritivo, de abordagem quantitativa, adotando-se estatística descritiva, teste de significância de 5% e cálculo de indicadores. A população foi composta de 37 sujeitos sendo 81,1% do grupo adulto/idoso. Em relação à idade do cuidador, no grupo pediátrico a média foi de 35,1 anos (dp+7,6) e no grupo adulto/idoso 54,2 anos (dp+11,9), havendo diferença estatisticamente significante (p=0,00). A incidência de extubação não planejada no grupo pediátrico foi de 1,05 e no adulto/idoso 0,73, não havendo diferença estatística significante (p=0,28) entre os grupos. Porém, todas as extubações do grupo pediátrico foram não planejadas. A atenção domiciliar é um campo do conhecimento a ser explorado e o emprego de indicadores permite identificar problemas reais e potenciais, visando implementar ações efetivas para o alcance da qualidade em saúde. No tocante às extubações gástricas mensuradas por meio de indicadores de resultado, verificou-se que os achados permitiram conhecer a realidade dos portadores de intubação gástrica, fornecendo subsídios para o estabelecimento de metas assistenciais e gerenciais para a melhoria contínua da qualidade e as reformulações necessárias dos processos de trabalho no âmbito da assistência domiciliar.

The objective of this study was to evaluate the gastric intubation assistential practice for enteral nutrition of users of the pediatric and adult/elderlygroups in the Home Care Program from a university hospital. This is exploratory-descriptive study with a quantitative approach, using descriptivestatistics with test of significance at 5%, and calculation of indicators. The population was composed of 37 subjects; 81.1% being in the adult/elderlygroup. The age of caregivers showed statistically significant difference between the studied groups and were 35.1 years old (sd+7.6) in the pediatricgroup and 54.2 years old (sd+11.9) in the adult/elderly group The incidence of unplanned extubation in the pediatric group was 1.05 and 0.73 in theadult/elderly group, with no statistically significant difference (p = 0.28) between the groups. However, all extubations in the pediatric group wereunplanned. Home care is a field of knowledge to be exploited; the use of indicators allows the identification of actual and potential problems andimplementation of effective actions to achieve quality in health. The analysis of gastric extubations measured through outcome indicators showedthat the findings brought awareness to the reality of patients with gastric intubation, providing subsidies for the establishment of assistance andmanagerial goals for a continuous improvement in quality and the necessary reformulations of working procedures in the context of home care.

El objetivo de este estudio fue evaluar la práctica asistencial de intubación gástrica para nutrición enteral de usuarios de los grupos pediátrico y adulto/anciano en el programa de atención domiciliaria de un hospital universitario. Se trata de un estudio exploratorio descriptivo, de enfoque cuantitativo con estadística descriptiva, prueba de significancia del 5% y cálculo de indicadores. La muestra constó de 37 sujetos de los cuales el 81,1% pertenecía al grupo adulto/anciano. Con respecto a la edad del cuidador en el grupo pediátrico el promedio fue de 35,1 años (dp+7,6) y en el grupo adulto/anciano de 54,2 años (dp+11,9), con diferencia estadística significativa (p=0,00). La incidencia de extubación no planeada en el grupo pediátrico fue de 1,05 y en el adulto/anciano de 0,73, sin diferencia estadística significativa (p=0,28) entre los grupos. Sin embargo, todas las extubaciones del grupo pediátrico fueron no planeadas. La atención domiciliaria constituye un campo de conocimiento por explorar y el empleo de indicadores permite identificar problemas reales y potenciales con miras a implementar acciones efectivas para lograr calidad en la salud. Con respecto a las extubaciones gástricas medidas a través de indicadores de resultado, se constató que los resultados permitieron conocer la realidad de los pacientes con intubación gástrica, aportando datos para establecer metas asistenciales y gerenciales para la mejora continua de la calidad y la reformulación necesaria de los procesos de trabajo dentro del contexto de la atención domiciliaria.

¿Cuáles son los parámetros para la valoración de la pareja parental? / What are the parameters for the assessment of parental partner?

En este trabajo hemos delineado tres principales áreas de investigación (competencias adquiridas, representaciones e interacciones) para profundizar en el estudio y la evaluación de las funciones parentales. En relación con cada área se describen algunos de los instrumentos utilizados con el fin de ejemplificar el tipo de evaluación que es posible obtener. En general, en la revisión de la bibliografía sobre el tema se evidencia la riqueza de las informaciones que llaman la atención de clínicos e investigadores, pero también la dificultad en obtener una lectura abarcativa. Al mismo tiempo se señalan las numerosas cuestiones que permanecen abiertas.

In this article we showed three main areas of investigation (acquired competences,representation sand interactions) to deep in the study and the evaluation of parental functions. In relation with each area we could describe some of the instruments appliedin order to illustrate the kind of evaluation that it is possible to obtain. In general, in the bibliographic review of the subject it is possible to see the richness of the information that attracts the clinic and investigators attention, but also the difficult to get an abarcative lectur . At the same time the paper stress the quantitiy of the matters that remain open.

Perfil sociodemográfico e de saúde de idosos com sintomas depressivos / Sociodemographic and health profile of elderly patients with depressive symptoms / Perfil sociodemográfico y de salud de ancianos con síntomas depresivos

Estudo quantitativo, do tipo descritivo-exploratório, com o objetivo de traçar o perfil sociodemográfico e de saúde de idosos com sintomas depressivos, residentes na área de abrangência de uma Unidade de Saúde da Família do município de Jequié - Bahia. A amostra foi composta por 125 idosos que foram submetidos à aplicação de formulário estruturado e à Escala de Depressão Geriátrica Abreviada, durante o período de outubro de 2009 a dezembro de 2010. Os resultados revelaram a prevalência de sintomas depressivos em 88,8% das pessoas idosas pesquisadas, que eram predominantemente do sexo feminino, de baixa renda e nível de escolaridade, com idades entre 60 e 69 anos e portadoras de patologias crônicas. O rastreamento de pessoas idosas em risco de depressão e a configuração de seu perfil sociodemográfico constituem subsídios importantes para o planejamento e a implementação de ações preventivas, de diagnóstico e de tratamento precoces da depressão.

Quantitative study, of descriptive-exploratory type aiming at describing the sociodemographic and health profile of elderly with depressive symptoms, living in the ranging area of a Family Health Unit of the municipality of Jequié-BA. The sample consisted of 125 elderly patients who underwent the application of a structured form and to the Short Geriatric Depression Scale, from October 2009 to December 2010. The results revealed the prevalence of depressive symptoms in 88.8% of the older people surveyed, who were predominantly female, of low income and education level, age group between 60 and 69 years old and suffering from chronic diseases. The screening of elderly people at risk of depression and the configuration of their demographic profile are an important support for planning and implementation of preventive actions, early diagnostic and treatment of depression.

Estudio cuantitativo, del tipo descriptivo-exploratorio, con el objetivo de delinear el perfil sociodemográfico y de salud de ancianos con síntomas depresivos, que viven en el área de alcance de una unidad de salud de la familia del municipio de Jequié-BA-Brasil. La muestra consistió de 125 ancianos que se sometieron a la aplicación de unformulario estructurado y a la Escala de Depresión Geriátrica Abreviada, desde octubre de 2009 hasta diciembre de2010. Los resultados revelaron la prevalencia de síntomas depresivos en 88,8% de las personas ancianas encuestadas, que eran predominantemente del sexo femenino, de bajas renta y nivel educativo, grupo de edad entre 60 y 69 años y portadoras de enfermedades crónicas. La selección de las personas ancianas en situación de riesgo para depresióny la configuración de su perfil sociodemográfico son un apoyo importante para la planificación y la implementación de acciones preventivas, de diagnóstico y de tratamiento precoces de la depresión.

Cognitive aspects of fetal alcohol syndrome in young adults: two case studies / Aspectos Cognitivos da Síndrome Fetal Alcoólica em adultos jovens: dois estudos de caso

Fetal Alcohol Syndrome (FAS) includes a specific pattern of cognitive deficits, including language and speech disorders. Two adult participants were studied by means of the Examination of Language Test and a battery of complementary tests to evaluate oral and written language. Our data indicated great results of the participant who had psychopedagogical and speech-language assistance than the other who did not receive none intervention. These findings suggest that early diagnosis and intervention are crucial to minimize sequelae in FAS.

A Síndrome Fetal Alcóolica (SFA) inclui um padrão de déficit cognitivo, incluindo alterações de linguagem e fala. Estudou-se dois participantes adultos que foram diagnosticados com SFA na infância por meio do Teste de Exame de Linguagem e de uma bateria de testes complementares para avaliar aspectos da linguagem oral e escrita. Os dados indicaram que o participante que recebeu uma intervenção psicopedagógica apresentou melhores resultados que aquele que não tinha recebido nenhuma intervenção. Estes achados indicam que um diagnóstico precoce é fundamental para minimizar as sequelas da SFA.

Avaliação ergonômica do posto de urgência em uma unidade mista de saúde na cidade de Natal/Rio Grande do Norte / Evaluación ergonómica del centro de urgencia en una unidad básica de salud en Natal/Rio Grande do Norte / Ergonomic evaluation of the position of urgency in a mixed health in Natal/Rio Grande do Norte

Objetivo: Realizar a análise ergonômica de um posto de urgência em uma unidade mista de saúde na cidade de Natal/RN. Métodos: Trata-se de uma investigação do tipo descritivo-exploratório, com abordagem qualitativa. Constituindo-se de uma avaliação ergonômica do ambiente de trabalho em um posto de urgência de uma unidade de saúde mista, situada em Natal/RN, na qual foram apontados problemas ergonômicos e intervenções para solução destes, tendo em vista a melhoria nas condições laborais dos trabalhadores. Resultados: Os principais problemas encontrados foram de transporte, locais de armazenamento, ferramentas manuais, no design do posto de trabalho, iluminação, risco ambiental, comodidade e bem estar e equipamento de proteção individual. Conclusões: Garantir ambientes ergonomicamente adequados é de extrema importância, melhorando desta forma a produtividade, reduzindo riscos/acidentes e absenteísmo

Objective: to perform an ergonomic analysis of emergency room in a joint health unit in Natal/RN. Methods: this investigation is a descriptive and exploratory with qualitative approach. Constituting an ergonomic evaluation of a workplace environment in a emergency post of a joint health unit, located in Natal, where were pointed ergonomic problems and interventions for the solution of them having in prospect the improvement of the workplace conditions of the workers. Results: the main problems found were transport, storage sites, hand tools, the design of the work post, lighting, environmental risk, commodity and welfare and personal protective equipment. Conclusions: ensuring ergonomically suitable environment extremely important, thus improving the productivity, reducing risks/accidents and absenteeism

Objetivo: realizar un análisis ergonómico de un centro de urgencia en una unidad básica de Natal/RN. Métodos: se trata de una investigación tipo descriptivo y exploratorio, con enfoque cualitativo. Constituyéndose de una evaluación ergonómica del ambiente de trabajo en un centro de urgencia de una unidad de salud básica, ubicado en Natal/RN, en donde fueron señalados problemas ergonómicos e intervenciones para su solución con el fin de mejorar las condiciones laborales de los trabajadores. Resultados: los principales problemas encontrados fueron de transporte, centros de almacenamiento, herramientas de mano en el diseño del puesto de trabajo, la iluminación, los riesgosmedioambientales, la comodidad y el bienestar y el equipo de protección personal. Conclusiones: garantizar ambientes ergonómicos adecuados es de suma importancia, mejorando así la productividad, la reducción de riesgos/accidentes y absentismo

Epidemiological survey of brucellosis in Zibo City Shandong Province from 1954 to 2011 / 中国地方病学杂志

Objective To explore epidemic characteristics and trend of livestock brucellosis in Zibo,and to provide a scientific basis for development of prevention strategies to brucellosis.Methods Epidemiology statistical analysis and forecast was made based on related information such as the active immunization data of human brucellosis,the infection data between people and livestock,and the active immunization data among livestock over the years since 1954.Results From 1954 to 2011,37 years had brucellosis cases reported in Zibo City,with accumulative reports of 380 cases,and the average incidence rate was 0.2512/100 000,distributed in 118 villages 56 counties 3 towns 5 districts of the whole city.From 1954 to 1988,only 14 years had brucellosis cases reported,with accumulative reports of 94 cases,and the average incidence rate was 0.1573/100 000.From 1989 to 2011,each year had brucellosis cases reported,with accumulative reports of 283 cases,and the average incidence rate was 0.3158/100 000,of which the highest incidence was in 2011 (45 cases).From 1958 to 2011,there were a total of 140 154 livestock went through serology monitoring,1162 positives,and the positive rate was 0.83％,while the total immunization number of sheep was 884 900,of which 28 years did not carry out immunization work.Conclusions The incidence rate has decreased year by year since the seventies of last century.But the epidemic is on the rise since 1989,while new epidemic areas are emerging and the history affected areas are still serious,therefore the brucellosis prevention and control situation is still grim.

Epidemiological analysis of the human plague from 2001 to 2011 in Qinghai Province / 中国地方病学杂志

Objective To analyze human plague from 2001 to 2011 in Qinghai Province and to provide a scientific basis for formulating prevention and control measures.Methods Using the descriptive epidemiological methods,epidemiological field survey data and medical records of each case of human plague were collected from 2001 to 2011 in Qinghai Province.Human plague was judged in accordance with the Plague Diagnostic Criteria (WS 279-2008).Results From 2001 to 2011,human plague was reported 14 times,with incidence of 38 cases,17 dead and death rate was 44.74％ in Qinghai Province.Epidemic areas mainly distributed in the 12 townships of 9 counties.Prevalent season was from May to October,September and October accounted for 57.89％ (22/38).There were cases of Tibetan herders and Han farmers,accounting for 76.32％ (29/38) and 23.68％ (9/38),respectively;onset age from 5 to 67 years,mainly around the age of 20-45 [68.42％ (26/38)].The most prevalent clinical types were pneumonic and septicemic plague and initial case was caused by actively contact with infected plague animals.Conclusions Qinghai human plague is mainly caused by approaching the plague infected animals,human plague in Qinghai Province is on the rise,the risk of long-distance transmission of the plague is significantly increased.

Estudo de não conformidades no trabalho de enfermagem: evidências que interferem na qualidade de hospitais em Minas Gerais / Study of non conformities in the work of nursing: evidences that interfere in the quality of hospitals in Minas Gerais

A Secretaria de Estado de Saúde de Minas Gerais (SES-MG) identificou a necessidade de avaliar a qualidade dos hospitais do Programa de Fortalecimento e Melhoria da Qualidade dos Hospitais do Sistema Único de Saúde de Minas Gerais (Pro-Hosp). Neste sentido, viabilizou,a partir de 2009, a realização de Diagnósticos Organizacionais da Organização Nacional de Acreditação (DO-ONA). Este estudo tem por objetivo analisar as não conformidades (NC) relativas ao trabalho de enfermagem apresentadas nos relatórios de DO-ONA dos hospitaisPro-Hosp avaliados em 2009. As NC no trabalho de enfermagem são situações que não atendem aos padrões estabelecidos pela Organização Nacional de Acreditação (ONA), interferindo na qualidade e na segurança hospitalar. Trata-se de uma pesquisa descritiva,documental e retrospectiva, contemplando uma amostra de 37 (82,22%) dos hospitais avaliados em 2009. Os dados foram coletados de fontes secundárias, isto é, os DO-ONA, os sistemas de informação do Ministério da Saúde e as resoluções da SES-MG, e organizados emquadros com distribuição de frequência. As NC foram classificadas em três grupos: não conformidades relacionadas ao processo de trabalho de enfermagem Cuidar/Assistir; não conformidades relacionadas ao processo Administrar/Gerenciar e não conformidades relacionadas ao processo Educar/Pesquisar. Os resultados mostram que no primeiro grupo as NC mais frequentes foram: “ausência de plano seguro multiprofissional de aplicação medicamentosa”, “ausência de metodologia para o planejamento da assistência de enfermagem com base no risco evidenciado. Implantação da Sistematização da Assistência de Enfermagem (SAE)” e “ausência de método para a estratificação de risco da totalidade dos pacientes admitidos na instituição”. As NC mais frequentes no segundo grupo foram: “não evidenciamos a política de gerenciamento de riscos”, “ausência de fluxo de atendimento às emergências nas diversas áreas assistenciais, contemplando profissionais...

The State Department of Health in Minas Gerais has identified the need to assess the qualityof hospitals in the Improvement and Strengthening Program of Hospitals in Minas Gerais(Pro-Hosp). In this sense has made, since 2009, the implementation of OrganizationalDiagnostics National Accreditation Organization (DO-ONA). This study aims to analyze thenon-conformities (NC) related to the nursing work presented in the DO-ONA's reports fromPro-Hosp's hospitals evaluated in 2009. The NC in nursing work are situations that do notmeet the standards set by National Accreditation Organization (ONA), interfering in hospitalquality and safety. It is a descriptive, documentary and retrospective research, contemplating asample of 37 (82.22%) of hospitals evaluated in 2009. Data were collected from a secondarysource, that is, from DO-ONA and the information systems from the Ministry of Health, andorganized in tables, with frequency distribution. The NC were classified into three groups:non-conformities related to the process of nursing work Care/Aid; non-conformities related tothe process Administer/Manage; and non-conformities related to the processEducation/Research. The results show that the NC in the first group were the most frequent:"no safe multi-drug application plan", "lack of methodology for the planning of nursing carebased on demonstrated risk, implementation of SAE" and "lack of method for riskstratification of all patients admitted to the institution". The NC more frequent in the secondgroup were "found no policy of risk management", "lack of flow of emergency response invarious assistance areas, comprising professionals, equipment and drugs" and "policy forguarantee and improvement of filling documents and identification of professionals andpatients in the medical records should be strengthened". In the third group the NC thatappeared most were "lack of definition of the training program for employees with...

Análise do impacto do Estágio Supervisionado sobre o desempenho da Policlínica Odontológica Central da Brigada Militar: enfoque em resultados / Analysis of the impact of supervised internship on the performance of the Dental Central Polyclinic of Brigada Militar: focus on results

O objetivo deste estudo foi analisar o impacto do estágio supervisionado (ES) de alunos da FO-UFRGS, com enfoque nos resultados, no desempenho da Policlínica Odontológica Central (POC) da Brigada Militar (BM) no período de abril de 2008 a dezembro de 2009. Para tanto, foi realizado um levantamento mensal do número de pacientes atendidos (PA) e do número de procedimentos odontológicos (PO) realizados por estagiários (E) e por cirurgiões-dentistas (CD) do serviço no período estudado. A partir da comparação de PA e PO realizados por E e CD, foram criados indicadores de produtividade do ES (IPE) em relação a PA (IPE-pa) e PO (IPE-po), bem como um indicador de produtividade geral do ES (IPE-g). Os resultados demonstraram médias de IPE-pa = 1,63 (±0,74), IPE-po = 1,48 (±0,49) e IPE-g = 1,55 (±0,57), indicando que o ES proporcionou acréscimo de produtividade geral equivalente a mais de um e meio (1,5) CD por mês para o serviço da POC, revelando aumento médio mensal de 10,46% na produtividade geral do serviço.

The aim of this study was to analyze the impact of supervised internship (ES) of students from FO-UFRGS, focusing on results, on the performance of the Dental Central Polyclinic (POC) of Brigada Militar (BM) in the period between April-2008 and December-2009. To do so, a monthly survey of the number of treated patients (PA) and the number of dental procedures (PO) performed by trainees (E) and dentists (CD) of the service during the period was conducted. From the comparison of PA and PO performed by E and CD, productivity indicators of the ES (IPE) for PA (IPE-pa) and PO (IPE-po) were proposed and calculated, as well as an indicator of overall productivity of the ES (IPE-g). The results showed average values of IPE-pa = 1.63 (± 0.74), IPE-po = 1.48 (± 0.49) and IPE-g = 1.55 (± 0.57), indicating that the ES provided a general increase in productivity equivalent to more than one and a half (1.5) CD per month for the service of POC, showing average monthly increase of 10.46% in the overall productivity of the service.

Evaluation of performance of a rapid immunofluorescence method for assaying plasma NT-proBNP / 中华检验医学杂志

Objective To analyze the performance of a rapid immunofluorescence assay for plasma NT-proBNP. Methods Human plasma NT-proBNP was measured by RAMP in 264 healthy cases and 78 patients with heart failure. The precision, stability, linearity and interference factors of RAMP were evaluated according to the protocold from America CLSI. Meanwhile, the results were compared with those obtained by Elecsys. Results Functional sensitivity of RAMP in 20% CV and 10% CV were 48 ng/L and 57 ng/L respectively. The linear range was 18-8 000 ng/L. NT-proBNP in plasma samples detected by RAMP were stable at room temperature for 24 hours, 4 ℃ for 3 days and - 20 ℃ for 20 days. No influences on results were observed throughout three freeze-thaw cycles. The results measured by RAMP were compared between EDTA-K2 anticoagulant plasma and heparin anticoagulant plasma, which showed that YEDTA-K2 =0. 953 9 Xheparin + 0. 365 2 ( R2 = 0. 982, P < 0. 01, n = 40 ). The results of EDTA-K2 and heparin anticoagulant plasma using RAMP and Elecsys showed no significant difference( P ＞0. 05). Slight hemolysis( Hb 2 g/L)had small effect on the results of PAMP and Elecsys assays and deviations of them were below 5%. However median and heavy hemolysis( Hb 3-4 g/L )obviously influenced the results with deviation were more than 15%. The values measured by RMAP fell from 390 ng/L to 82 ng/L, and those measured by Elecsys method fell from 390 ng/L to 178 ng/L when 3 different concentrations of triacylglycerol were added, the values measured by two methods fell from 7 777 ng/L to 7 741 ng/L when bilirubin ( 16-330 μmol/L) was added. The anti-interference ability of RAMP method was similar to Elecsys. Results detected with two methods in 45 EDTA-K2 anticoagulant plasma samples were analyzed with Passing and Bablok regression.The regression equation was YRAMP = 0. 972 8XElecsys - 0. 035 2 (R2 = 0. 994, P ＞ 0. 05, n = 45 ). When heparin anticoagulant plasma samples increased to 78 samples, Passing and Bablok regression equation showed:YRAMP= 0. 983 2XElecsys - 0. 037 6 ( R2 = 0. 991, P ＞ 0. 05, n = 78 ). NT-proBNP levels in healthy adults were elevated along with age and related to the gender. The median value of female[105(60-120) ng/L] was higher than that of male [59 ( 44-91 ) ng/L, Z = 3. 264, P < 0. 01] significantly. Conclusions RAMP method has good repeatability, outstanding stability, and broad linear range. The results detected by RAMP is consistent with results detected by Elecsys.