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Fortes M.T.,Escola Nacional de Saude Publica ENSP | de Mattos R.A.,University Estadual Do Rio Of Janeiro Uerj | Baptista T.W.F.,FIOCRUZ
Revista da Associacao Medica Brasileira | Year: 2011

This article analyzes the dynamics and changes in the accreditation process in three different places - France, UK and Cataluña (Spain) - based on documents about their health systems organizations, funding sources and regulations. The objective was to find out about the relevant aspects of the strategies of these countries' institutions that adapted accreditation to national circumstances in the healthcare policy arena. Although there are similarities in the basic approaches and standards used, there are different models of accreditation. Setting standards raises the question of who should define them and how they should be monitored; accreditation's methodology cannot be seen only as a voluntary process for assessing quality in healthcare or perceived as tool for certification and regulation. Interests in accreditation can be driven by a number of different forces, which depend upon the model adopted. Therefore, it can only be understood in the policy arena of each country.

Pilling S.,University of Paraiba Valley | Baptista L.,University Estadual Do Rio Of Janeiro Uerj | Boechat-Roberty H.M.,Federal University of Rio de Janeiro | Andrade D.P.P.,University of Paraiba Valley
Astrobiology | Year: 2011

Despite the extensive search for glycine (NH 2CH 2COOH) and other amino acids in molecular clouds associated with star-forming regions, only upper limits have been derived from radio observations. Nevertheless, two of glycine's precursors, formic acid and acetic acid, have been abundantly detected. Although both precursors may lead to glycine formation, the efficiency of reaction depends on their abundance and survival in the presence of a radiation field. These facts could promote some favoritism in the reaction pathways in the gas phase and solid phase (ice). Glycine and these two simplest carboxylic acids are found in many meteorites. Recently, glycine was also observed in cometary samples returned by the Stardust space probe. The goal of this work was to perform theoretical calculations for several interstellar reactions involving the simplest carboxylic acids as well as the carboxyl radical (COOH) in both gas and solid (ice) phase to understand which reactions could be the most favorable to produce glycine in interstellar regions fully illuminated by soft X-rays and UV, such as star-forming regions. The calculations were performed at four different levels for the gas phase (B3LYP/6-31G*, B3LYP/6-31++G**, MP2/6-31G*, and MP2/6-31++G**) and at MP2/6-31++G** level for the solid phase (ice). The current two-body reactions (thermochemical calculation) were combined with previous experimental data on the photodissociation of carboxylic acids to promote possible favoritism for glycine formation in the scenario involving formic and acetic acid in both gas and solid phase. Given that formic acid is destroyed more in the gas phase by soft X-rays than acetic acid is, we suggest that in the gas phase the most favorable reactions are acetic acid with NH or NH 2OH. Another possible reaction involves NH 2CH 2 and COOH, one of the most-produced radicals from the photodissociation of acetic acid. In the solid phase, we suggest that the reactions of formic acid with NH 2CH or NH 2CH 2OH are the most favorable from the thermochemical point of view. Key Words: Interstellar molecules-Interstellar environments-Abiotic organic synthesis-Extraterrestrial organic compounds-Prebiotic chemistry. © 2011, Mary Ann Liebert, Inc.

Ayres A.R.G.,University Estadual Do Rio Of Janeiro Uerj | Azevedo e Silva G.,State University of Rio de Janeiro
Revista de Saude Publica | Year: 2010

Objective: To assess the prevalence of human papillomavirus (HPV) infection in women in Brazil. Methods: A systematic literature review was conducted with an active search in PubMed and Virtual Health Library databases using the terms "human papillomavirus,""HPV,""prevalence," and "Brazil". Of 155 articles retrieved, 82 were selected after reading their title and abstract. After a thorough examination, 14 articles were included in the study. Results: The 14 articles selected were published between 1989 and 2008 and comprised studies from four Brazilian macroregions (Southeast - 43%; South - 21.4%; Northeast - 21.4%; and North - 7.1%). Nine were crosssectional studies. Eight articles used polymerase chain reaction and seven used hybrid capture for HPV detection. The study samples ranged from 49 to 2,329 women. The overall prevalence of HPV cervical infection was between 13.7% and 54.3%; and women with cytologically normal results had 10% to 24.5% prevalence of HPV cervical infection. Four articles described the most common HPV types. Conclusions: The cytology techniques available use different classifications leading to different HPV prevalence estimates. However, considering the studies individually according to the detection technique used, the HPV prevalence has increased. HPV16 was the most prevalent type among women, regardless of the cytology result. The concentration of studies in the Southeast region, especially in metropolitan regions, evidences that further investigations are needed to improve information coverage of Brazilian women.

Vidal E.I.O.,Sao Paulo State University | Moreira-Filho D.C.,University of Campinas | Pinheiro R.S.,Federal University of Rio de Janeiro | Souza R.C.,Health Science Center | And 5 more authors.
Osteoporosis International | Year: 2012

Summary: The relationship between surgical timing and hip fracture mortality is unknown in the context of developing countries where large delays to surgery are common. We observed that delay from fracture to hospital admission is associated with decreased survival after a hip fracture. Introduction: To examine the relationship between the time interval from fracture to surgery as well as its subcomponents (time from fracture to hospital admission and time from admission to surgery) and hip fracture survival. Methods: The medical records of all patients aged 60 years and older admitted to a public university hospital in the city of Rio de Janeiro with a primary diagnosis of hip fracture between 1995 and 2000 were reviewed. Survival to hospital discharge and at 1 year were examined. Results: Among 343 patients included in the study, there were 18 (5.3%) in-hospital deaths, and 297 (86.6%) patients remained alive 1 year after surgery. Very long delays from the time of fracture to hospital admission (mean 3 days) and from hospital admission to surgery (mean 13 days) were identified. Increased time from fracture to hospital admission was associated with reduced survival to hospital discharge (hazard ratio [HR] 1.09, 95% CI 1.03-1.15, p00.005) and reduced survival at 1 year after surgery (HR 1.07, 95% CI 1.03-1.10, p< 0.001). The interval of time from hospital admission to surgery was not associated with reduced survival to hospital discharge (HR 1.03, 95% CI 0.96-1.10, p00.379) or at 1 year after surgery (HR 1.03, 95% CI 0.99-1.07, p00.185). Conclusions: If the association estimated in our study is causal, our results provide evidence that some hip fracturerelated deaths could be prevented by improved patient access to appropriate and timely hospital care in the context of a developing country. © International Osteoporosis Foundation and National Osteoporosis Foundation 2012.

Fantuzzi F.,Federal University of Rio de Janeiro | Baptista L.,University Estadual Do Rio Of Janeiro Uerj | Rocha A.B.,Federal University of Rio de Janeiro | Boechat-Roberty H.M.,Federal University of Rio de Janeiro
International Journal of Quantum Chemistry | Year: 2012

The structure and stability of several C2H4O 2 +· and C2H4O 2 2+ isomers were studied by quantum chemical methods in an attempt to elucidate their most stable molecular arrangements and infer their contribution to the ion chemistry of astrophysical environments. The geometry optimizations were performed at B3LYP/6-311G** and MP2/6-311G** level. Single-point calculations at equilibrium geometries were performed at left eigenstate completely renormalized coupled cluster method, CR-CCL(2,3). Ninety minimum structures for the ions at the MP2 level were found: 38 related to C2H4O2 +·, 33 to C2H4O2 2+, and 19 to ion-neutral complexes. The more stable C 2H4O2 +· isomers have enolic structures, in agreement with the McLafferty rearrangement mechanism of straight chain aliphatic acids. In contrast, the most stable C2H 4O2 2+ isomer has an acyclic OCCO nonplanar linear chain structure, with terminal +OH2 and Ci-O + linkages. In addition, acetic acid and methyl formate analogue structures were found only for the monopositive ion, with higher energies though. Both global minima are significantly different from the more stable neutral isomers and, therefore, could not be found in a geometry optimization procedure starting from the neutral structures. Dissociative recombination reaction pathways of C2H4O2 +· and its application to the formation of astrophysical neutral molecules are also discussed. © 2012 Wiley Periodicals, Inc.

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