ABSTRACT
Objetivo: analisar o grau de orientação oferecida por unidades primárias em relação ao atributo acesso de primeiro contato na perspectiva de usuários hipertensos. Método: estudo transversal de avaliação com uso do Primary Care Assessment Tool-Brasil. Os dados foram coletados com 373 hipertensos maiores de 20 anos, no município de Macaé, Brasil. Resultados: verificou-se a predominância das seguintes características individuais: 49% tinham entre 40 a 59 anos; 74% pertenciam ao gênero feminino; 38,1% apresentaram ensino fundamental incompleto; 59,5% tinham renda de até 2 salários mínimos. Obteve-se escore de 7,65 para acesso de primeiro contato, superior à média de 6,6 do escore padrão, e um escore de 2,40 para acessibilidade. Conclusão: os resultados apontam utilização satisfatória das unidades no que refere ao acesso de primeiro contato e insatisfatória quanto à acessibilidade aos serviços, o que mostra necessidade de investimentos na reorganização do processo de atendimento às demandas e prioridades dos usuários.
Objective: to analyze the degree of orientation offered by primary units in relation to the attribute first contact access from the perspective of hypertensive users. Methods: cross-sectional study using Primary Care Assessment Tool-Brazil. Data were collected with 373 hypertensive patients over 20 years of age, in the city of Macaé, Brazil. Results: the predominance of the following individual characteristics was verified: 49% were between 40 and 59 years old; 74% were female; 38.1% had incomplete elementary education; 59.5% had income of up to 2 minimum wages (about US$548.00). A score of 7.65 was obtained for first contact access, superior to the mean of 6.6 of the standard score, and a score of 2.40 for accessibility. Conclusion: the results indicate a satisfactory use of the units in relation to first contact access and unsatisfactory related to accessibility to services, which shows the need for investments in the reorganization of the process of meeting the demands and priorities of users.
Objetivo: analizar el grado de orientación ofrecida por unidades primarias en relación al atributo acceso de primer contacto en la perspectiva de usuarios hipertensos. Método: estudio transversal de evaluación con uso de Primary Care Assessment Tool-Brasil. Los datos fueron recolectados con 373 hipertensos mayores de 20 años, en el municipio de Macaé, Brasil. Resultados: se verificó la predominancia de las siguientes características individuales: el 49% tenía entre 40 a 59 años; el 74% pertenecía al género femenino; 38,1% presentaron enseñanza fundamental incompleta; el 59,5% tenía ingresos de hasta 2 salarios mínimos (alrededor de US$ 548.00). Se obtuvo una puntuación de 7,65 para acceso de primer contacto, superior a la media de 6,6 de la puntuación estándar, y una puntuación de 2,40 para accesibilidad. Conclusión: los resultados apuntan utilización satisfactoria de las unidades en lo que se refiere al acceso de primer contacto e insatisfactorio en cuanto a la accesibilidad a los servicios, lo que muestra necesidad de inversiones en la reorganización del proceso de atención a las demandas y prioridades de los usuarios.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Primary Health Care , Family Health , Health Services Accessibility , Health Services Research , HypertensionABSTRACT
BACKGROUND: Bilioduodenal (BD) and biliojejunal (BJ) derivation induce enterobiliary reflux and bile stasis. Decompression of the excluded loop of the Roux-en-Y (BJD) was proposed to minimize these effects. The aim of this study was to compare the influence of these three modalities of biliary bypass on hepatic lesion repair in rats with secondary biliary fibrosis. MATERIALS AND METHODS: Rats with 15 d of biliary obstruction underwent BD, BJ, and BJD drainage and were compared with a group submitted to simulated operation (SO) and biliary obstruction (CBO). The serum values of total and fractional bilirubin, alkaline phosphatase (ALP), and aminotransferases (AST and ALT), as well as hepatobiliointestinal excretion determined with (99m)Tc-Disida, were used for comparison. In addition, we used morphometric analyses to estimate the mass of the hepatocytes, bile ducts, and liver fibrosis. We also counted hepatic stellate cells (SC). RESULTS: For each of the three modalities of biliary drainage, there were significant reductions in bilirubin, AST, ALP, and the number of SCs. The recovery of the estimated mass of all histologic components occurred only after BJ and BJD; in the BD group, the estimated hepatocyte mass was reduced compared with the SO group. The residual hepatic radioactivity of (99m)Tc-Disida was greater in the BJD group than in the SO group. CONCLUSIONS: The interposition of the jejunal loop between the biliary tree and the intestine may slow hepatobiliary clearance of radioactivity, even though it provides the resolution of cholestasis and is effective in recovering from hepatic lesions.
Subject(s)
Bile Ducts/surgery , Cholestasis/surgery , Digestive System Surgical Procedures/methods , Liver Cirrhosis/surgery , Liver/pathology , Liver/surgery , Alkaline Phosphatase/metabolism , Anastomosis, Roux-en-Y/methods , Animals , Cholestasis/metabolism , Cholestasis/pathology , Disease Models, Animal , Duodenum/surgery , Hepatic Stellate Cells/pathology , Jejunum/surgery , Liver/metabolism , Liver Cirrhosis/metabolism , Liver Cirrhosis/pathology , Male , Rats , Rats, Wistar , Transaminases/metabolismABSTRACT
OBJETIVO: Criar um atlas de cintilografia de perfusão miocárdica e verificar sua aplicabilidade no auxílio computadorizado à detecção de defeitos perfusionais miocárdicos em pacientes portadores de cardiopatia isquêmica. MATERIAIS E MÉTODOS: O atlas foi criado com imagens de cintilografia de perfusão miocárdica, em condições de repouso e estresse, de 20 pacientes de ambos os gêneros com baixa probabilidade de doença arterial coronariana e julgadas normais por dois observadores experientes. Técnicas de registro de imagens e operações matemáticas sobre imagens foram utilizadas para obtenção de modelos de média e desvio-padrão da captação miocárdica percentual de cada gênero e condição fisiológica. RESULTADOS: Imagens de um paciente masculino e um feminino foram alinhadas com os atlas correspondentes, e os voxels apresentando valores de captação percentual dois desvios-padrão abaixo da média da respectiva região do atlas foram destacados nos cortes tomográficos e confirmados como defeitos de perfusão por dois observadores experientes. CONCLUSÃO: Demonstramos a criação de um atlas de cintilografia de perfusão miocárdica e obtivemos resultados promissores na sua utilização para auxílio à detecção de defeitos perfusionais. Entretanto, uma validação prospectiva com um número mais representativo de casos é necessária.
OBJECTIVE: To develop an atlas of myocardial perfusion scintigraphy and evaluating its applicability in computer-aided detection of myocardial perfusion defects in patients with ischemic heart disease. MATERIALS AND METHODS: The atlas was created with rest-stress myocardial perfusion scintigraphic images of 20 patients of both genders with low probability of coronary artery disease and considered as normal by two experienced observers. Techniques of image registration and mathematical operations on images were utilized for obtaining template images depicting mean myocardial uptake and standard deviation for each gender and physiological condition. RESULTS: Myocardial perfusion scintigraphy images of one male and one female patient were aligned with the corresponding atlas template image, and voxels with myocardial uptake rates two standard deviations below the mean voxel value of the respective region in the atlas template image were highlighted on the tomographic sections and confirmed as perfusion defects by both observers. CONCLUSION: The present study demonstrated the creation of an atlas of myocardial perfusion scintigraphy with promising results of this tool as an aid in the detection of myocardial perfusion defects. However, further prospective validation with a more representative sample is recommended.
