O Complexo Regulador em Saúde do Distrito Federal, Brasil, e o desafio da integração entre os níveis assistenciais / The Regulatory Complex for Health Care in the Federal District, Brazil and the challenge for integrating levels of health care

Resumo A integração entre os níveis de atenção é um desafio contínuo mesmo em sistemas de saúde consolidados e de alta performance. A reestruturação do sistema público de saúde do Distrito Federal, baseado no fortalecimento da Atenção Primária à Saúde (APS), na reconfiguração da atenção especializada (ambulatorial e hospitalar) e de sua rede de urgência e emergência, trouxe como desafio a necessidade de integração entre esses níveis. Fez-se necessária a criação de um dispositivo que desempenhasse o papel de "gatekeeper" conduzindo o acesso equânime, transparente e seguro para a atenção especializada e hospitalar. Neste sentido, foi estruturado o Complexo Regulador em Saúde do Distrito Federal (CRDF) e suas Centrais de Regulação (CR), orientados para a execução de um processo regulatório de acesso para os serviços de internação hospitalar, ambulatorial (procedimentos e consultas especializadas), cirurgias eletivas, alta complexidade, transporte sanitário, urgências e transplantes de pacientes do Distrito Federal e de fora dele. Este artigo descreve o processo de implantação e de implementação do CRDF e de suas CR, de forma a refletir sobre as potencialidades e desafios de seu papel enquanto instrumento de integração entre os níveis assistenciais de saúde.

Abstract The integration among levels of care is a continuous challenge even in consolidated and high performance health systems. The reform of public health system of Distrito Federal, based on the strengthening of primary health care associated to the reconfiguration of specialized attention (ambulatory and hospital) and of its of urgency and emergence network brought, as a challenge, the need for integration between these levels. Thus, became necessary to create an instrumentto perform the role of gatekeeper, leading to equanimous, transparent and safe access to specialized and hospital care. Thus, the Regulatory Complex in Health of Distrito Federal (CRDF) and its Regulatory Centers (CR) were created to carry out the regulatory process of access to care services, such as hospitalization, ambulatory care (procedures and specialized consultations), elective surgeries, complex procedures, sanitary transport, urgencies and transplants of patients of the Federal District and outside it. This article describes the process of the CRDF implementation and its CRs, aiming to reflect on the potential and challenges of its role as an instrument of integration among the levels of care.

Chemosensory age discrimination in the snake Boa constrictor (Serpentes: Boidae)

Many snakes are able to use their chemosensory system to detect scent of conspecifics, which is important in many social contexts. Age discrimination based on chemical cues may be especially important to ensure access to sexually mature potential partners. In this study, we used 24 individual Boa constrictor snakes (12 adults mature and 12 non-mature individuals) that had been captured in different areas of Ecuador, and were maintained in captivity at the Vivarium of Quito. We used tongue-flick experiments to examine whether these snakes were able to discriminate between scents from mature and non-mature individuals. Results showed that B. constrictor snakes used chemical cues to recognize conspecifics and that the scent of individuals of different ages elicited chemosensory responses of different magnitudes. The scents from adult conspecifics elicited the quickest and highest chemosensory responses (i.e., short latency times and high tongue-flick rates), although we did not find differential responses to scent of males and females. The magnitude of the responses was lower to scent of sub adult individuals, and then even lower to scent of juvenile snakes, but in all cases the scent of snakes was discriminated from a blank control. We discuss the potential chemical mechanisms that may allow age recognition and its implications for social and sexual behavior of this snake species.

Muchas serpientes son capaces de usar su sistema quimiosensorial para detectar el olor de individuos coespecíficos, lo que es importante en muchos contextos sociales. La discriminación de la edad basada en señales químicas puede ser especialmente importante para asegurar el acceso a parejas potenciales que sean sexualmente maduras. En este estudio, usamos 24 individuos de una especie de boa (Boa constrictor) (12 individuos adultos y 12 inmaduros) que habían sido capturados en diferentes partes de Ecuador y eran mantenidos en cautividad el Vivarium de Quito. Usamos experimentos de protusiones linguales para examinar si esta serpiente es capaz de discriminar entre el olor de individuos maduros y no maduros. Los resultados mostraron que B. constrictor usa señales químicas para reconocer co-específicos y que el olor de individuos de distinta edad provoca respuestas quimiosensoriales de diferente magnitud. El olor de individuos adultos provocó las respuestas más rápidas y elevadas (esto es, tiempos de latencia más cortos y tasas más altas de protusiones linguales), aunque no encontramos diferencias en las respuestas a olores de machos y hembras. La magnitud de las respuestas fue más baja a olores de sub adultos, e incluso más baja a olor de juveniles, pero en todos los casos el olor de una serpiente era discriminado de un control no oloroso. Discutimos los posibles mecanismos químicos que pueden permitir esta discriminación de la edad y sus implicaciones para el comportamiento social y sexual de esta serpiente.

Atividade alelopática de extratos aquosos de plantas medicinais na germinação de Lactuca sativa L. e Bidens pilosa L. / Allelopathic activity of aqueous extracts of medicinal plants on the germination of Lactuca sativa L. and Bidens pilosa L.

O potencial alelopático de quatro diferentes extratos de plantas medicinais (Eclipta alba, Gomphrena globosa, Tabernaemontana catharinensis e Tithonia diversifolia) foi avaliado na germinação de Bidens pilosa e Lactuca sativa. Dentre os resultados obtidos no teste de germinação, notou-se um maior poder inibitório do extrato de G. globosa sobre sementes e plântulas de Bidens pilosa e Lactuca sativa independente da concentração utilizada e aumento da atividade inibitória de extratos T. catharinensis e de T. diversifolia com aumento da concentração destes. Quanto ao Índice de Velocidade de Germinação, os dados demonstraram redução do índice devido a elevada mortalidade das plântulas submetidas aos extratos de G. globosa e de T. catharinensis e a germinação tardia das sementes submetidas ao extrato de T. diversifolia. Quanto ao vigor das sementes, as menores porcentagens de sobrevivência ocorreram extratos à 2,5 por cento para B. pilosa e 10 por cento para L. sativa.

The allelopathic potential of four different extracts of medicinal plants (Eclipta alba, Gomphrena globosa, Tabernaemontana catharinensis and Tithonia diversifolia) was evaluated on the germination of Bidens pilosa and Lactuca sativa. The results obtained in the germination test indicated a greater inhibitory activity of G. globosa extract on Bidens pilosa and Lactuca sativa seeds and seedlings, regardlessof the used concentration, and an increase in the inhibitory activity of T. catharinensis and T. diversifolia extracts with an increase in their concentrations. As to Germination Speed Index, the data demonstrated a reduction due to the high mortality of seedlings subjected to G. globosa and T. catharinensis extracts and a late germination of seeds subjected to T. diversifolia extracts. As to the vigor of seeds, the smallest survival percentages occur at 2.5 percent for B. pilosa and at 10 percent for L.sativa.

Identification of 2u-globulin and bound volatiles in the Indian common house rat (Rattus rattus)

The 2u-globulin (2u) is a pheromone carrier urinary protein believed to be relevant for sexual communication among rats and is characterized in laboratory rats. In the present study 17 kDa protein and the bound pheromones were characterized in a population of wild-type Indian common house rat (Rattus rattus). The protein was purified by two runs of Sephadex G-50 chromatography and analyzed with SDS-PAGE with MALDI-TOF/MS. The results of MASCOT search identified the protein as an 2u and suggested a role for binding pheromones. To confirm the protein bound volatiles, purified 2u was extracted with dichloromethane and volatile molecules were detected using of gas chromatography linked to mass spectrometry (GC-MS). 1-Chlorodecane was detected as the predominant compound and 2-methyl-N-phenyl-2-propenamide, hexadecane and 2,6,11-trimethyl decane as the minor compounds. The simple method of protein purification and the identification of bound volatiles may help in designing efficient pheromone-based rat traps.

The chemical volatiles (Semiochemicals) produced by neotropical stink bugs (Hemiptera: Pentatomidae) / Os voláteis químicos (Semioquímicos) produzidos pelos percevejos neotropicais Hemiptera: Pentatomidae)

Nos últimos anos tem sido crescente a preocupação com as mudanças climáticas e com a utilização auto-sustentável dos recursos naturais, estimulando cada vez mais os estudos para a prospecção de novos produtos naturais visando minimizar o uso de pesticidas. Os percevejos produzem uma variedade de compostos químicos com potencial para o seu manejo. A composição química dos compostos defensivos dos percevejos Chinavia impicticornis (Stål), C. ubica (Rolston), Dichelops melacanthus (Dallas), Euschistus heros (F.), Piezodorus guildinii (Westwod), Thyanta perditor (Westwood) e Tibraca limbativentris (Stål) foi avaliada. Os principais compostos nas glândulas dos percevejos foram: 2-alcenais, principalmente o isômero E, hidrocarbonetos alifáticos saturados; e 4 oxo-(E)-2-alcenal. O primeiro feromônio sexual de percevejo identificado no Brasil foi do Nezara viridula L., que consiste na mistura dos isômeros cis e trans epóxi-bisabolenos; na sequência, o percevejo praga da soja E.. heros também teve seu feromônio sexual identificado. Os machos desta espécie produzem três ésteres: 2,6,10-trimetildecanoato de metila, 2,6,10 trimetildodecanoato de metila e 2E,4Z decadienoato de metila. Recentemente, mais três espécies de percevejos neotropicais tiveram a composição da mistura feromonal elucidada. Machos de T. perditor produzem o éster, 2E,4Z,6Z-decatrienoato de metila. O percevejo P. guildinii tem como feromônio sexual o β-sesquifelandreno, e o percevejo praga do arroz T. limbativentris tem também como feromônio sexual um sesquiterpenóide, o zingiberenol. Nessa revisão serão abordados os avanços obtidos no estudo do comportamento e identificação de feromônios sexuais e de alarme de várias espécies do complexo de percevejos praga da agricultura brasileira. A aplicação desses conhecimentos é discutida.

In recent years the growing concern about environmental changes and how we are using the natural resources have triggered a search for natural products as alternatives to synthetic pesticides. The stink bugs produce a wide variety of chemical compounds (semiochemicals) that show potential to manage these insects. The stink bugs Chinavia impicticornis (Stål), C. ubica (Rolston), Dichelops melacanthus (Dallas), Euschistus heros (F.), Piezodorus guildinii (Westwood), Thyanta perditor (Westwood) and Tibraca limbativentris (Stål) had their blends of defensive compounds evaluated both qualitative and quantitatively. The main compounds identified on the glands of Brazilian stink bugs are: 2-alkenals, mainly the E isomer; saturated aliphatic hydrocarbons; and 4 oxo-(E)-2-alkenals. The first sex attractant determined from a stink bug was obtained from Nezara viridula L., and consists on a mix of two isomers cis - and trans bisabolene-epoxides. Later the soybean stink bug E. heros was also studied and its sex attractant was identified as three esters methyl: 2,6,10-trimethyldecanoate, methyl 2,6,10-trimethyldodecanoate, and methyl E2, Z4-decadienoate. Recently, three new Brazilian sting bugs were studied and had their sex attractant elucidated. Males of T. perditor produce the ester, methyl 2E,4Z,6Z-decatrienoate. Whereas, the stink bug, P. guildinii has as sexual pheromone, the sesquiterpene β-sesquiphellandrene, and the stink bug T. limbativentris produces as sex attractant the zingiberenol. In this review we discuss the advances obtained on the behaviour and identification of sex and defensive compound of stink bugs from Brazilian crops and the application of this knowledge to manage the stink bugs.

Allelotoxicity of Parthenium leaf extracts on cytomorphological behaviour of sunflower (Helianthus annuus).

In recent decades allelopathy has gained much attention in the sustainable agricultural systems. It is necessary to trace out the mechanism of action of allelochemicals of plants on other plants. Allelochemicals of different plants interact differently with each other. In the present context an attempt has been made to study the influence of allelochemicals released by Parthenium on the growth, morphology and cytology of Helianthus annuus, both being strong allelopathic plants. The lower concentration of decomposed Parthenium leaves showed enhancing effect while higher doses depicted suppressive effect on growth and morphology of Helianthus annuus. However, cytological studies of pollen mother cells (PMCs) revealed increase in abnormality percentage with increasing concentration of allelochemicals. This study suggests better understanding of allelochemicals interaction and their incorporation into the betterment of crop.

Identification of alpha-2u globulin in the rat preputial gland by MALDI-TOF analysis.

The low molecular mass proteins found in the pheromonal sources such as urine, saliva, glandular secretion etc have been reported as ligand carriers for the processes of chemocommunication in mammals. The preputial gland plays an important role in the production of olfactory signals for pheromonal communication. Thus, in the present study, alpha-2u globulin having molecular mass of 18 kDa has been identified in the preputial gland of Norway rat (Rattus norvegicus) by in-gel trypsin digestion and analyzing the resulting peptides by MALDI-TOF. Since preputial gland is one of the major pheromonal sources in rat, the results suggest that alpha-2u globulin might act as a carrier for hydrophobic odorants of preputial gland.

Urinary proteins and pheromonal communication in mammals.

Urinary proteins play a significant role as pheromones and pheromone-binders in mammalian reproduction and social behaviour. The present study was carried out to quantify the urinary proteins in five different mammalian species viz mouse, rat, rabbit, bovine and human. The results revealed that the male rodents excrete large amounts of urinary protein as compared to that of other mammals. In addition, the male mammals excrete a higher quantity of protein than do the females., suggesting the role of androgens in excretion of protein. The presence of higher concentration of urinary proteins in rodents suggests that the rodents depend more on urinary proteins for olfactory/social communication.

Chemistry of clitoral gland secretions of the laboratory rat: assessment of behavioural response to identified compounds.

The present investigations were carried out to find out the chemical nature of clitoral gland extracts and their involvement in reproductive and social behaviour. Homogenates of clitoral glands of mature estrous female rats were extracted with n-hexane and dichloromethane (1 : 1 ratio v/v) and analysed by gas chromatography linked mass spectrometry (GC-MS). Three peaks were found to be in higher concentration, which were identified as 6,11-dihydro-dibenz-b,e-oxepin-11-one (I); 2,6,10-dodecatrien-1-ol-3,7,11-trimethyl(Z) (II); and 1,2-benzene-dicarboxylic acid butyl(2-ethylpropyl) ester (III). Odour preference tests demonstrated that the first compound attracted conspecifics of the opposite sex. By contrast, the second and third compounds were found to attract both sexes. The results conclude that the clitoral gland of laboratory rat contains three major chemical compounds which have a unique function in maintaining social and reproductive status.