A pilot observational study to identify reference values for the 6-minute walk test in Brazilian people with hypertension / Um estudo observacional piloto para identificar valores de referência para o teste de caminhada de 6 minutos em hipertensos brasileiros

Abstract Introduction Systemic arterial hypertension (SAH) is responsible for 9.5 million deaths in the global popu-lation. Lifestyle factors, including physical inactivity, are important modifiable risk factors in the development of SAH. Thus, physical exercise has been shown to be effective to control SAH and before the prescription, the six-minute walk test (6-MWT) has been commonly used to assess the physical capacity. Objective To propose reference values for the 6-MWT test in Brazilian people with SAH. Methods A cross-sectional observational study was conducted with 302 hypertensive subjects (62.61 + 10.93 years) admitted to a cardiac rehabilitation program. Participants were divided into different age quartiles and submitted to 6-MWT. The walking distance data was compared between the quartiles and adjusted by mul-tiple linear regression analysis. Results The hypertensive subjects walked 388.07 + 115.03 m during the 6-MWT. No significant difference between the genders was found. However, when the age quartiles were compared, for the 46-59 age group, the women walked less than the men. Intra-group comparisons showed that the distance walked in the 6-MWT decreased with the increase in age, in both men and women. Conclusion The present study provides reference values for the 6-MWT, both for Brazilian men and women of different age groups. This data may be an important parameter for future clinical studies, prevention strategies, and clinical intervention.

Resumo Introdução A hipertensão arterial sistêmica (HAS) é respon-sável por 9,5 milhões de mortes na população mundial. Con-dições do estilo de vida, incluindo a inatividade física, são importantes fatores de risco modificáveis no desenvolvimento da HAS. Desse modo, o exercício físico tem se mostrado eficaz no controle da HAS e, antes da prescrição, o teste de caminhada de seis minutos (TC6) tem sido comumente utilizado para ava-liar a capacidade física. Objetivo Propor valores de referência para o teste de TC6 em brasileiros com HAS. Métodos Realizou-se um estudo observacional transversal com 302 hipertensos (62,61 + 10,93 anos) admitidos em um programa de reabilitação cardíaca. Os participantes foram divididos em diferentes quartis de idade e submetidos ao TC6. Os dados de distância percorrida foram comparados entre os quartis e ajustados por análise de regressão linear múltipla. Resultados Os hipertensos caminharam 388,07 + 115,03 m durante o TC6. Não encontrou-se diferença significativa entre os gêneros. No entanto, quando comparados os quartis de idade, para a faixa etária de 46 a 59 anos, as mulheres caminharam menos do que os homens. As comparações intragrupo mostraram que a distância percorrida no TC6 diminuiu com o aumento da idade, tanto em homens quanto em mulheres. Conclusão O presente estudo fornece valores de referência para o TC6, tanto para homens quanto para mulheres brasileiras de diferentes faixas etárias. Esses dados podem ser um parâmetro importante para futuros estudos clínicos, estratégias de prevenção e intervenção clínica.

Coevolved Positions Represent Key Functional Properties in the Trypsin-Like Serine Proteases Protein Family.

Trypsin-like serine proteases are a group of homologous enzymes which exert multiple roles in both vertebrate and invertebrate organisms. Key properties of these enzymes include their activation from an inactive zymogen form to their active form by cleavage of residues in their N-terminus, the presence of a conserved catalytic triad of residues, and the existence of different patterns of substrate selectivity for residue cleavage between the various members of this protein family. In this article, we apply the decomposition of residue coevolution networks computational method to find sets of residues related to some of these key properties, especially to zymogen activation. Positive selection detection, normal modes analysis, and the calculation of thermal couplings between the bovine trypsinogen and bovine trypsin structures residues yielded further information for understanding the zymogen activation process and highlighted the importance of some of the coevolved set residues during these transitions.

Sequence, structure and function relationships in flaviviruses as assessed by evolutive aspects of its conserved non-structural protein domains.

Flaviviruses are responsible for serious diseases such as dengue, yellow fever, and zika fever. Their genomes encode a polyprotein which, after cleavage, results in three structural and seven non-structural proteins. Homologous proteins can be studied by conservation and coevolution analysis as detected in multiple sequence alignments, usually reporting positions which are strictly necessary for the structure and/or function of all members in a protein family or which are involved in a specific sub-class feature requiring the coevolution of residue sets. This study provides a complete conservation and coevolution analysis on all flaviviruses non-structural proteins, with results mapped on all well-annotated available sequences. A literature review on the residues found in the analysis enabled us to compile available information on their roles and distribution among different flaviviruses. Also, we provide the mapping of conserved and coevolved residues for all sequences currently in SwissProt as a supplementary material, so that particularities in different viruses can be easily analyzed.

[Overbooking in an outpatient healthcare facility in the Brazilian Unified National Health System]. / Técnica de overbooking no atendimento público ambulatorial em uma unidade do Sistema Único de Saúde.

Management issues like resource optimization, cost cuts, quality gains, and improvements in care have become increasingly important and are essential to the sustainability of healthcare organizations. This study analyzed the efficiency of public outpatient care, where the high rate of patient no-show leads to low use of resources, while paradoxically the demand for medical care clearly exceeds the supply. A quantitative and descriptive approach analyzed the use of "overbooking" to reduce the effects of patient no-show in a public outpatient clinic. Using statistical and mathematical methods and based on patient and appointment data collected from a survey, an interesting comparison was made between levels of overbooking and the respective resource utilization rates and service levels for each scenario. The findings point to important gains in efficiency, thus demonstrating the potential of increasing the number of services in the same asset base.

Técnica de overbooking no atendimento público ambulatorial em uma unidade do Sistema Único de Saúde / Overbooking in an outpatient healthcare facility in the Brazilian Unified National Health System / Práctica de overbooking en la atención ambulatoria pública dentro de una unidad del Sistema Único de Salud

Aspectos como otimização de recursos, redução de custos, ganhos de qualidade e melhoria no atendimento receberam importância e são fundamentais para a sustentabilidade das organizações. Este trabalho analisa a eficiência no atendimento público ambulatorial, onde a alta taxa de absenteísmo por parte dos usuários implica baixa utilização de recursos, enquanto que, paradoxalmente, a demanda por atendimento médico é nitidamente superior à oferta. A abordagem, quantitativa e de caráter descritivo, analisa a utilização da técnica de overbooking para reduzir os efeitos do absenteísmo em um ambulatório da rede pública. Mediante o uso de métodos estatísticos e matemáticos, com base em dados de pacientes e agendamentos coletados em pesquisa, desenhou-se um interessante comparativo entre níveis de overbooking e respectivas taxas de utilização de recursos e níveis de serviço para cada cenário analisado. Os resultados obtidos apontam ganhos expressivos de eficiência, demonstrando o potencial de aumento do número de atendimentos para uma mesma base de ativos.

Management issues like resource optimization, cost cuts, quality gains, and improvements in care have become increasingly important and are essential to the sustainability of healthcare organizations. This study analyzed the efficiency of public outpatient care, where the high rate of patient no-show leads to low use of resources, while paradoxically the demand for medical care clearly exceeds the supply. A quantitative and descriptive approach analyzed the use of “overbooking” to reduce the effects of patient no-show in a public outpatient clinic. Using statistical and mathematical methods and based on patient and appointment data collected from a survey, an interesting comparison was made between levels of overbooking and the respective resource utilization rates and service levels for each scenario. The findings point to important gains in efficiency, thus demonstrating the potential of increasing the number of services in the same asset base.

Aspectos de gestión, tales como la optimización de recursos, reducción de costes, mejora de la calidad y servicio han adquirido cada vez más importancia y son fundamentales para mantener organizaciones sosteniblemente. Esta investigación analiza la eficiencia del servicio médico ambulatorio público, donde no se presenta una alta tasa de pacientes, lo que lleva a una baja utilización de los recursos existentes, mientras que, paradójicamente, la demanda de servicios médicos es claramente superior a su disponibilidad. El enfoque cuantitativo y descriptivo analiza la utilización de un exceso de reservas técnicas, con el fin de reducir el efecto de pacientes que no se dirigen, finalmente, a un servicio médico público ambulatorio. Se aplicaron métodos estadísticos y matemáticos en la información proporcionada por pacientes y en la recogida de información de la base de datos de consultas, que dieron lugar a una interesante comparación entre los niveles de exceso de reservas y su tasa de utilización, respecto a los recursos y niveles de servicio dentro de cada uno de los escenarios analizados. Los resultados obtenidos muestran un aumento significativo en la eficiencia.

[Transport of mucoid mucus in healthy individuals and patients with chronic obstructive pulmonary disease and bronchiectasis]. / Transporte de secreções mucóides de indivíduos saudáveis e pacientes com doença pulmonar obstrutiva crónica e bronquiectasias.

OBJECTIVE: To characterise and compare the in vitro transport properties of respiratory mucoid secretion in individuals with no lung disease and in stable patients with chronic obstructive pulmonary disease (COPD) and bronchiectasis. METHODOLOGY: Samples of mucus were collected, from 21 volunteers presenting no lung disease who had undergone surgery, from 10 patients presenting chronic COPD, and from 16 patients with bronchiectasis. Mucociliary transport (MCT), transport by cough (SCM), and contact angle (CAM) were evaluated. RESULTS: MCT was found to be greater in healthy individuals (1.0±0.19) than in COPD (0.91±0.17) and bronchiectasis (0.76±0.23) patients (p<0.05), whereas SCM was greater in COPD patients (16.31±7.35 cm) than in patients with bronchiectasis (12.16±6.64 cm) and healthy individuals (10.50±25.8 cm) (p<0.05). No significant differences were observed between the groups regarding CAM. CONCLUSION: Mucus from healthy individuals allows better mucociliary transport compared to that from patients with lung diseases. However, the mucus from COPD patients allows a better transport by coughing, demonstrating that these individuals have adapted to a defence mechanism compared to patients with bronchiectasis, who have impairment in their ciliary and cough transport mechanisms.

A política de treinamento dos servidores técnico-administrativos da Universidade Federal de Viçosa (UFV) na percepção dos treinados e dos dirigentes da instituição / Training policy for the technical-administrative staff at the Federal University of Viçosa (UFV) as perceived by trained employees and managers

Desde a década de 1990, o setor público brasileiro tem buscado modificar sua atuação perante a sociedade. Em um contexto de reformas, a área de recursos humanos tornase essencial, pois são as pessoas que colocam em prática tais mudanças. Uma política de recursos humanos imprescindível para o êxito das reformas é o treinamento, que possibilita a capacitação do funcionário para um melhor desempenho na prestação de serviços aos cidadãos. Este artigo identifica o modo como o treinamento dos servidores técnico-administrativos (STAs) influencia a realização das atividades na Universidade Federal de Viçosa (UFV), na percepção dos treinados e dos dirigentes da instituição. As informações foram obtidas por meio de uma revisão da literatura, de visita à diretoria de recursos humanos da UFV, e de entrevistas com alguns treinados e dirigentes da instituição. De acordo com os resultados, existem diversos fatores que interferem positiva e negativamente no processo de treinamento. A falta de uma política de aperfeiçoamento formalizada e a legislação contribuem para essa realidade. Como o processo não é bem estruturado, não existe um planejamento para as atividades de treinamento, nem mesmo uma avaliação do STA que o fez.

Diarrhea and reduced levels of antiretroviral drugs: improvement with glutamine or alanyl-glutamine in a randomized controlled trial in northeast Brazil.

The effects of therapy with glutamine and alanyl-glutamine on diarrhea and antiretroviral drug levels in patients with acquired immune deficiency syndrome (AIDS) were examined in a randomized, double-blinded, placebo-controlled study in northeast Brazil. Patients with AIDS and with diarrhea and/or wasting were randomized into 4 groups to determine the efficacy of glutamine or high- or low-dose alanyl-glutamine given for 7 days, compared with isonitrogenous glycine given to control subjects. All patients in whom baseline antiretroviral drug levels were determined had low levels 2 h after dosing. Gastrointestinal symptom scores improved with receipt of high-dose alanyl-glutamine (P<.05) or glutamine (P<.01). Antiretroviral drug levels increased in patients given alanyl-glutamine (P=.02) or glutamine (P=.03) by 113% (P=.02) and 14% (P=.01), respectively. Antiretroviral drug resistance mutations were common in all groups. The dose-related efficacy of alanyl-glutamine and glutamine in treating diarrhea and in increasing antiretroviral drug levels shows that these supplements may help to improve therapy for patients with AIDS who have diarrhea and/or wasting in developing, tropical areas.