This article presents results of a research carried out with the objective of analyzing the participation of Social Control in the sphere of Public Health Policy of a small municipality, located in ...the Extreme West of Santa Catarina. This is a qualitative study, carried out with the participation of twelve directors, six representatives of non-governmental entities and six of governmental entities. Data were collected between August and December 2019, through interviews with open and closed questions. The research was approved by the Ethics and Research Committee. All requirements contained in the Resolution of the National Health Council - CNS 466/2012 were observed and respected. The limits for the participation of members in the Council, time and lack of knowledge in the health area were found as limits, and with regard to the possibilities, a broader view of the health services offered, and within this, the prioritization of actions and actions. It is observed that Social Control is very important and necessarily needs to be maintained and strengthened. The Federal Constitution of 1988 consolidated and predicted in its devices the participation of citizens in the formulation and implementation of Social Control, public health policies. It is hoped that the result of the research can boost proposals that are configured as responses to the strengthening of participation in Social Control, recognizing the Health Councils are deliberative and permanent collegiate organs of the SUS, existing in each sphere of government and members of the basic structure of the health system.
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The optimal strategy for identification of hemodynamically stable patients with acute pulmonary embolism (PE) at risk for death and clinical deterioration remains undefined.
We aimed ...to assess the performances of currently available models/scores for identifying hemodynamically stable patients with acute, symptomatic PE at risk of death and clinical deterioration.
This was a prospective multicenter cohort study including patients with acute PE (NCT03631810). Primary study outcome was in-hospital death within 30 days or clinical deterioration. Other outcomes were in-hospital death, death, and PE-related death, all at 30 days. We calculated positive and negative predictive values, c-statistics of European Society of Cardiology (ESC)-2014, ESC-2019, Pulmonary Embolism Thrombolysis (PEITHO), Bova, Thrombo-embolism lactate outcome study (TELOS), fatty acid binding protein, syncope and tachicardia (FAST), and National Early Warning Scale 2 (NEWS2) for the study outcomes.
In 5036 hemodynamically stable patients with acute PE, positive predictive values for the evaluated models/scores were all below 10%, except for TELOS and NEWS2; negative predictive values were above 98% for all the models/scores, except for FAST and NEWS2. ESC-2014 and TELOS had good performances for in-hospital death or clinical deterioration (c-statistic of 0.700 and 0.722, respectively), in-hospital death (c-statistic of 0.713 and 0.723, respectively), and PE-related death (c-statistic of 0.712 and 0.777, respectively); PEITHO, Bova, and NEWS2 also had good performances for PE-related death (c-statistic of 0.738, 0.741, and 0.742, respectively).
In hemodynamically stable patients with acute PE, the accuracy for identification of hemodynamically stable patients at risk for death and clinical deterioration varies across the available models/scores; TELOS seems to have the best performance. These data can inform management studies and clinical practice.
Hydroxyapatite (HAp) presents similarities with the human bone structure and presents properties such as biodegradability, biocompatibility, and osteoconductivity, which favors its use in prostheses ...implants and enables its use as a vehicle for the delivery of photosensitizers (PS) from systems of release (DDS) for photodynamic therapy applications Methods: In this work was to synthesized hydroxyapatite microspheres (meHAp), encapsulated with chloroaluminium phthalocyanine (ClAlPc), for DDS. meHAp was synthesized using vaterite as a template. The drug was encapsulated by mixing meHAp and a 50.0 mg.mL
ClAlPc solution. Photochemical, photophysical, and photobiological studies characterized the system.
The images from the SEM analysis showed the spherical form of the particles. All spectroscopic results showed excellent photophysical parameters of the drug studied when served in the meHAp system. The incorporation efficiency was 57.8 %. The trypan blue exclusion test results showed a significant reduction (p < 0.05) in cell viability for the groups treated with PDT at all concentrations above 250 μg.mL
. In 9 L/lacZ gliosarcoma cells, PDT mediated at concentrations from 250 to 62.5 µg.mL
reduced cell viability by more than 98 %. In the cell internalization study, it was possible to observe the internalization of phthalocyanines at 37 °C, with the accumulation of PS in the cytoplasm and inside the nucleus in the two tested concentrations.
From all the results presented throughout the article, the meHAp system shows promise for use as a modified release system (DSD) in photodynamic therapy.
This is a retrospective, cross-sectional, documentary study aimed at analyzing the behavior of health professionals who perform prenatal care in pregnant women in the basic network of the ...Municipality of Catanduvas SC, from January to December 2016. We analyzed 97 medical records. The results show that the average age of pregnant women was 28 years, and 47.4% were aged between 20 and 29 years. The onset of prenatal care occurred in the second trimester in 55.7% of pregnant women; 50.5% performed 1 to 3 nursing consultations and 45.5% performed 7 or more medical visits. It was also observed that 91.8% of the pregnant women performed laboratory tests and three rapid tests for the diagnosis of Syphilis, Viral Hepatitis, and HIV, being a test in each gestational trimester. During the analyzed period two pregnant women with syphilis were diagnose , which gives us a prevalence rate of 2.1%, which were treated properly, but one of the partners did not accept the treatment. It should be pointed out that data referring to the characteristics of the pregnant women did not have a 100% completion which leads us to suggest that the professionals involved in the prenatal care receive continuous education about the importance of correct filling of the pregnant woman's chart, emphasizing that this is a legal procedure and that the non-fulfillment can jeopardize the continuity of the assistance and the carrying out of researches in the area.
To investigate in vivo relationships between segmental wall shear stress (WSS), endothelium-dependent vasoreactivity and arterial remodelling.
Twenty-four patients with minor angiographic coronary ...arterial disease (≤30% stenosis severity) underwent intracoronary (IC) salbutamol provocation during intravascular ultrasound (IVUS)-upon-Doppler guidewire imaging. Macrovascular response (change in segmental lumen volume SLV at baseline and following IC salbutamol), plaque burden (percent atheroma volume PAV), remodelling indices (RI), eccentricity indices (EI) and WSS were evaluated in 179 consecutive 5 mm coronary segments. Baseline WSS was directly related to endothelium-dependent epicardial coronary vasomotion (% change SLV, coefficient 17.2, p=0.004), and inversely related to RI (coefficient -0.23, p=0.02) and EI (coefficient -10.0, p=0.001). Baseline WSS was lower in segments displaying endothelial dysfunction (defined as any change in SLV ≤0) compared with preserved function (0.66±0.33 vs. 0.71±0.22 N/m2, p=0.046). Independent of plaque burden, segments with the lowest tertile of WSS displayed less vasodilatation, or vasoconstriction, than segments with the highest tertile of WSS. Higher plaque burden segments harbouring the lowest tertiles of WSS displayed vasoconstriction, expansive arterial remodelling and greater plaque eccentricity.
In patients with stable coronary syndromes and minor angiographic coronary disease, coronary segments with lower in vivo WSS values display functional and morphological features of plaque vulnerability.
Total knee replacement (TKR) procedures have evolved in the last 40 years to guarantee improvements implants life and an excellent joint function. The goals for the future evolutions are make easier ...prosthesis implantation and promote precision. The demand for TKR will rise for the life length increase and for the risk factors impact increase. Design evolution in total knee replacement has to satisfy these new necessities: anatomic congruence, range of motion, less material wear and better resistance to the weight bearing and to the stresses. This paper analyzes design evolution, materials development and future purposes in total knee arthroplasty. At the beginning, TKR history is treated; then we compare several prosthetic designs developed during years. At last the paper speak about recent innovations, like CAD (computer aided design) for example, born to reach the most important goal in the future: better TKR design, is the one that better imitate natural knee characteristics, and that is able to integrate it-self with capsule-ligaments and muscle-tendons patient structures.
Despite the highest levels of evidence on cardiac rehabilitation (CR) effectiveness, its translation into practice is compromised by low participation.
This study aimed to investigate CR utilisation ...and effectiveness in South Australia.
This retrospective cohort study used data linkage of clinical and administrative databases from 2016 to 2021 to assess the association between CR utilisation (no CR received, commenced without completing, or completed) and the composite primary outcome (mortality/cardiovascular re-admissions within 12 months after discharge). Cox survival models were adjusted for sociodemographic and clinical data and applied to a population balanced by inverse probability weighting. Associations with non-completion were assessed by logistic regression.
Among 84,064 eligible participants, 74,189 did not receive CR, with 26,833 of the 84,064 (31.9%) participants referred. Of these, 9,875 (36.8%) commenced CR, and 7,681 of the 9,875 (77.8%) completed CR. Median waiting time from discharge to commencement was 40 days (interquartile range, 23–79 days). Female sex (odds ratio OR 1.12; 95% CI 1.01–1.24; p=0.024), depression (OR 1.17; 95% CI 1.05–1.30; p=0.002), and waiting time >28 days (OR 1.15; 95% CI 1.05–1.26; p=0.005) were associated with higher odds of non-completion, whereas enrolment in a telehealth program (OR 0.35; 95% CI 0.31–0.40; p<0.001) was associated with lower odds of non-completion. Completing CR (hazard ratio HR 0.62; 95% CI 0.58–0.66; p<0.001) was associated with a lower risk of 12-month mortality/cardiovascular re-admissions. Commencing without completing was also associated with decreased risk (HR 0.81; 95% CI 0.73–0.90; p<0.001), but the effect was lower than for those completing CR (p<0.001).
Cardiac rehabilitation (CR) attendance is associated with lower all-cause mortality/cardiovascular re-admissions, with CR completion leading to additional benefits. Quality improvement initiatives should include promoting referral, women’s participation, access to telehealth, and reduction of waiting times to increase completion.
High-sensitivity troponin T (hs-TnT) assays promise greater discrimination of evolving myocardial infarction, but the impact of unguided implementation on the effectiveness of care is uncertain.
We ...evaluated the impact of hs-TnT reporting on care and outcome among chest pain patients presenting to 5 emergency departments within a multicenter randomized trial. Patients were allocated to hs-TnT reporting (hs-report) or standard reporting (std-report; Roche Elecys). The primary end point was death and new or recurrent acute coronary syndrome by 12 months. A total of 1937 patients without ST-segment elevation were enrolled between July 2011 and March 2013. The median age was 61 (interquartile range, 48-74) years, and 46.3% were women. During the index hospitalization, 1466 patients (75.7%) had maximal troponin <30 ng/L within 24 hours. Randomization to hs-report format did not alter the admission rate (hs-report: 57.7% versus std-report: 58.0%; P=0.069). There was no difference in angiography (hs-report: 11.9% versus std-report: 10.9%; P=0.479). The hs-reporting did not reduce 12-month death or new/recurrent acute coronary syndrome in the overall population (hs-report: 9.7% versus std-report: 7.2% hazard ratio, 0.83 (0.57-1.22); P=0.362). However, among those with troponin levels <30 ng/L, a modest reduction in the primary end point was observed (hs-report: 2.6% versus std-report: 4.4%, hazard ratio, 0.58; 95% confidence interval, 0.34-0.1.00; P=0.050).
High-sensitivity troponin reporting alone is associated with only modest changes in practice. Clinical effectiveness in the adoption of high-sensitivity troponin may require close coupling with protocols that guide interpretation and care.
URL: http://www.ANZCTR.org.au. Unique identifier: ACTRN12611000879965.
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