RESUMO
OBJECTIVE: to describe discarded wasted immunobiological products provided by the National Im-munization Program (PNI) to the State of Ceará between 2014 and 2016, and the costs of discarded doses. METHODS: this was a descriptive study using data from suspect im-munobiological product evaluation forms and data from disposal approval forms. RESULTS: a total of 317 forms were included, 72.0% of which had a disposal approval form, and 160,767 discarded doses were identified, at a total cost of BRL 1,834,604.75; wastage accounted for 0.45%, 0.93% and 0.53% of the total cost of vaccines in 2014, 2015 and 2016, respectively; the main reason for the wastage identified was electric power shortage (54.9%). CONCLUSION: we identified a large number of discarded wasted doses, with high absolute cost; tighter control is necessary, as failures in conservation dynamics may interfere with the supply of immunobiologicals.
Assuntos
Fatores Imunológicos/economia , Vacinas/economia , Resíduos/estatística & dados numéricos , Brasil , Fontes de Energia Elétrica/estatística & dados numéricos , Falha de Equipamento , Humanos , Programas de Imunização/economia , Fatores Imunológicos/provisão & distribuição , Vacinas/provisão & distribuição , Resíduos/economiaRESUMO
In 2017, Cuba was pummeled by Hurricane Irma, one of the strongest and most devastating Atlantic basin hurricanes in history. Twelve of Cuba's 15 provinces and 90 percent of the population were affected, and there was island-wide loss of electrical power. Despite the significant damage, ongoing economic hardships, and the political realities that required Cuba to handle the situation without response support from other nations, Cuba's recovery was swift and effective. Cuba's disaster self-sufficiency and timely response to Hurricane Irma was grounded on 5 decades of disaster planning coupled with ongoing evolution of disaster risk reduction and management strategies. While the central command center, with local dispatch response teams, and mandated citizen engagement are features unique to Cuba's political structure, in this study, we highlight 5 defining attributes of Cuba's hurricane response that can constructively inform the actions of other island and coastal nations vulnerable to Atlantic tropical cyclones. These attributes are: (1) actively learning and incorporating lessons from past disaster events, (2) integrating healthcare and public health professionals on the frontlines of disaster response, (3) proactively engaging the public in disaster preparedness, (4) incorporating technology into disaster risk reduction, and (5) infusing science into risk planning. In terms of hurricane response, as a geopolitically isolated nation, Cuba has experienced particular urgency when it comes to protecting the population and creating resilient infrastructure that can be rapidly reactivated after the onslaught of storms of ever-increasing intensity. This includes planning for worsening future disaster scenarios based on a clear-eyed appreciation of the realities of climate change.
Assuntos
Participação da Comunidade/métodos , Tempestades Ciclônicas/estatística & dados numéricos , Saúde Pública/métodos , Defesa Civil/métodos , Participação da Comunidade/psicologia , Cuba , Fontes de Energia Elétrica/normas , Fontes de Energia Elétrica/estatística & dados numéricos , Eletricidade , Falha de Equipamento , Humanos , Saúde Pública/tendênciasRESUMO
ABSTRACT INTRODUCTION: To attain an accurate otoscopic diagnosis, a functioning device with adequate capacity must be used. OBJECTIVE: Evaluate the light intensity of otoscopes, comparing it utilizing the batteries present at the moment of calibration and after new batteries were supplied. METHODS: Cross-sectional study of a historical cohort, which assessed 38 otoscopes, measuring the light intensity with the batteries present at the moment of assessment compared to the intensity with new batteries, as well as charge of the test batteries and the new batteries. RESULTS: The mean of the sum of new batteries' charge was 3.19 V, and of the test batteries was 2.70 V, representing a decrease of 18.02% in charge. The mean luminosity with the new batteries was 366.89 lumens, whereas in the test batteries it was 188.32 lumens, representing a decrease of 83.75% in the light intensity. Student's t-test was applied for data comparison, showing a statistical difference between the light intensity with the original batteries and the new batteries (p = 0.0001; CI = 0.95). CONCLUSION: There was a statistically significant difference between the proportions of light intensity in the otoscopes. A small variation in battery charge results in a great variation in light.
RESUMO Introdução: Para a realização de um diagnóstico otoscópico preciso deve-se utilizar um aparelho funcionando com uma capacidade adequada. Objetivo: Avaliar a intensidade luminosa dos otoscópios comparando a intensidade da luz comas pilhas encontradas no momento da aferição e com pilhas novas. Método: Estudo de coorte histórica com corte transversal, onde foram analisados 38 otoscópios, sendo realizada a aferição da qualidade luminosa com a pilha utilizada e comparado com uma pilha nova, e a aferição da carga das pilhas novas e em utilização no momento do exame. Resultados: A média da soma das cargas das pilhas novas foi de 3,19 V, e a das pilhas testes foi de 2,70 V, representando decréscimo de 18,02% na carga das pilhas. A média da luminosidade comas pilhas novas foi de 366.89 lúmens, e com a pilha teste foi de 188.32 lúmens, representando decréscimo de 83,75% na intensidade luminosa. Foi aplicado o teste T para comparação entre os dados, onde percebe-se diferença estatística entre a intensidade luminosa com pilhas testes e novas (p = 0,0000; IC = 0,95). Conclusão: Houve diferença estatisticamente significativa entre a proporção de intensidade da luz dos otoscópios. Uma pequena variação da pilha proporciona uma grande variação na luz.
Assuntos
Humanos , Fontes de Energia Elétrica/normas , Iluminação/normas , Otoscópios/normas , Otoscopia/normas , Estudos Transversais , Fontes de Energia Elétrica/estatística & dados numéricos , Hospitais de EnsinoRESUMO
INTRODUCTION: To attain an accurate otoscopic diagnosis, a functioning device with adequate capacity must be used. OBJECTIVE: Evaluate the light intensity of otoscopes, comparing it utilizing the batteries present at the moment of calibration and after new batteries were supplied. METHODS: Cross-sectional study of a historical cohort, which assessed 38 otoscopes, measuring the light intensity with the batteries present at the moment of assessment compared to the intensity with new batteries, as well as charge of the test batteries and the new batteries. RESULTS: The mean of the sum of new batteries' charge was 3.19V, and of the test batteries was 2.70V, representing a decrease of 18.02% in charge. The mean luminosity with the new batteries was 366.89lumens, whereas in the test batteries it was 188.32lumens, representing a decrease of 83.75% in the light intensity. Student's t-test was applied for data comparison, showing a statistical difference between the light intensity with the original batteries and the new batteries (p=0.0001; CI=0.95). CONCLUSION: There was a statistically significant difference between the proportions of light intensity in the otoscopes. A small variation in battery charge results in a great variation in light.
Assuntos
Fontes de Energia Elétrica/normas , Iluminação/normas , Otoscópios/normas , Otoscopia/normas , Estudos Transversais , Fontes de Energia Elétrica/estatística & dados numéricos , Hospitais de Ensino , HumanosRESUMO
OBJECTIVE: Immunoglobulin E (IgE) plays a key role in allergy disease pathogenesis, but little is known about the environmental factors associated with higher IgE levels in infants. The aim of this study was to determine the risk factors for elevated serum total IgE infants living in Havana. METHODS: Eight hundred and seventy-seven infants provided blood samples. Data on allergic disease symptoms and a wide range of exposures were collected. RESULTS: The median IgE was 35 IU/ml (interquartile range 13-96). The risk of having an IgE level above the median was higher for children who had been breastfed for 4 months or more (adjusted odds ratio (OR) 1.28; 95% confidence interval (CI): 1.02-1.61) and for children who reported cockroaches in their home (OR 1.30; 95% CI: 1.03-1.63). The risk was lower for children whose mother was in paid employment (OR 0.73; 95% CI: 0.54-0.97 compared with those who did not), for children living in homes where gas and electricity were used for cooking (OR 0.45; 95% CI: 0.32-0.62 compared with electricity only) and for children with domestic pets at birth (OR 0.83; 95% CI: 0.70-1.00). There was no association between paracetamol use and serum IgE levels. CONCLUSIONS: Associations between gas fuel use and maternal employment indicate that IgE levels in early life are lower in children who may be living in relative affluence. The discrepancy in the effect of early exposure to pets or cockroaches may reflect differences in these allergens, or be confounded by relative affluence. Further investigation of this cohort will determine how these effects translate into the expression of allergic disease in later life.
Assuntos
Alérgenos/análise , Exposição Ambiental/análise , Exposição Ambiental/estatística & dados numéricos , Hipersensibilidade/sangue , Hipersensibilidade/imunologia , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , Poluição do Ar em Ambientes Fechados/análise , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Alérgenos/imunologia , Animais , Aleitamento Materno/estatística & dados numéricos , Baratas/imunologia , Cuba , Fontes de Energia Elétrica/estatística & dados numéricos , Emprego/estatística & dados numéricos , Feminino , Calefação/métodos , Calefação/estatística & dados numéricos , Humanos , Lactente , Masculino , Mães/estatística & dados numéricos , Gás Natural , Razão de Chances , Animais de Estimação/imunologia , Fatores de RiscoRESUMO
BACKGROUND: In developing economies, there are patients in whom pacemaker implantation is delayed because they cannot afford one. Reused devices have been a solution. To address concerns about safety, a cohort of consecutive patients implanted with a reused pacemaker was compared with a control group. METHODS AND RESULTS: A cohort of 603 consecutive patients from 2000 to 2010 was studied in an ambispective noninferiority study. The study group patients (n=307) received resterilized pacemakers, and the control group patients (n=296) received a new pacemaker. A combined end point of 3 major outcomes-unexpected battery depletion, infection, and device dysfunction-was analyzed. A total of 85 pacemakers had to be explanted, 31 in the control group (10.5%) and 54 in the study group (17.6%; relative risk, 1.68; 95% confidence interval, 1.1-2.5; P=0.02). Forty-three reached the primary end point, 16 in the control group (5.5%) and 27 in the study group (7.2%; relative risk, 1.3; 95% confidence interval, 0.70-2.45; P=0.794). In terms of individual outcomes, 5 new pacemakers (1.7%) and 11 resterilized pacemakers (3.6%) had unexpected battery depletion (relative risk, 2.12; 95% confidence interval, 0.75-6; P=0.116); 3.7% new pacemakers and 3.2% reused pacemakers had a procedure-related infection (relative risk, 0.87; 95% confidence interval, 0.38-2.03; P=0.46); and 1 pacemaker in the study group malfunctioned. CONCLUSIONS: Pacemaker reuse is feasible and safe and is a viable option for patient with bradyarrhythmias. Other than the expected shorter battery life, reuse of pacemaker generators is not inferior to the use of new devices.
Assuntos
Bradicardia/terapia , Falha de Equipamento/estatística & dados numéricos , Marca-Passo Artificial/efeitos adversos , Marca-Passo Artificial/estatística & dados numéricos , Adulto , Idoso , Estudos de Coortes , Fontes de Energia Elétrica/estatística & dados numéricos , Reutilização de Equipamento , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Fatores de TempoRESUMO
A statistical analysis of a used battery collection campaign in the state of Tlaxcala, Mexico, is presented. This included a study of the metal composition of spent batteries from formal and informal markets, and a critical discussion about the management of spent batteries in Mexico with respect to legislation. A six-month collection campaign was statistically analyzed: 77% of the battery types were "AA" and 30% of the batteries were from the informal market. A substantial percentage (36%) of batteries had residual voltage in the range 1.2-1.4 V, and 70% had more than 1.0 V; this may reflect underutilization. Metal content analysis and recovery experiments were performed with the five formal and four more frequent informal trademarks. The analysis of Hg, Cd and Pb showed there is no significant difference in content between formal and informal commercialized batteries. All of the analyzed trademarks were under the permissible limit levels of the proposed Mexican Official Norm (NOM) NMX-AA-104-SCFI-2006 and would be classified as not dangerous residues (can be thrown to the domestic rubbish); however, compared with the EU directive 2006/66/EC, 8 out of 9 of the selected battery trademarks would be rejected, since the Mexican Norm content limit is 20, 7.5 and 5 fold higher in Hg, Cd and Pb, respectively, than the EU directive. These results outline the necessity for better regulatory criteria in the proposed Mexican NOM in order to minimize the impact on human health and the environment of this type of residues.
Assuntos
Fontes de Energia Elétrica , Programas Governamentais/estatística & dados numéricos , Metais/análise , Cádmio/análise , Fontes de Energia Elétrica/estatística & dados numéricos , Chumbo/análise , Mercúrio/análise , MéxicoRESUMO
Analisa o estado nutricional, bem como alguns de seus condicionantes, de 257 escolares, com 7 a 13 anos de idade, matriculados nos Centros Integrados de Educaçäo Pública - CIEP's em Americana, estado de Säo Paulo. Considera a altura do escolar, adotando classificaçäo com base nas unidades de desvio-padräo (escore Z de altura para idade). Avalia o consumo alimentar de 244 crianças da amostra utilizando-se o registro dos alimentos ingeridos pela criança, durante três dias näo consecutivos da semana. Analisa a adequaçäo de energia e nutritientes de acordo com o padräo nutricional definido para a populaçäo brasileira. Observa proporçäo de 15,6 por cento de crianças desnutridas crônicas (ZAI < -2). Detecta a influência estatisticamente significativa das variáveis rendimento familiar per capita e freqüência à creche durante a idade pré-escolar, sobre o escore Z de altura para idade da criança. Observa que o consumo alimentar revela-se deficiente em energia para 28,3 por cento dos escolares, evidenciando problema relativo à quantidade dos alimentos ingeridos. Verifica percentuais de proteínas e lipídios, acima dos níveis recomendados. Para os carboidratos, os percentuais médios revelam-se abaixo da recomendaçäo; 68,9 por cento dos escolares apresentaram alimentaçäo com conteúdo protéico acima do preconizado