Resumo A regionalização é um dos grandes desafios enfrentados desde a municipalização da saúde no Brasil e, uma vez consolidada, possibilita a estruturação de uma escala regional potencializadora dos territórios. Dentre os arranjos organizativos para a regionalização, está posicionado o Consórcio Público de Saúde (CPS), que deve tratar não apenas da soma de individualidades, mas de uma ação coletiva. Este estudo objetiva analisar a percepção dos gestores de saúde no âmbito municipal da Região de Saúde do Médio Paranapanema do Norte do Paraná acerca do papel do CPS no processo de regionalização. A pesquisa teve abordagem qualitativa, de caráter exploratório, que utilizou entrevistas e grupos focais para coleta de dados, os quais foram submetidos ao método de análise do discurso. Os resultados apresentam tanto as condições que limitam a ação coletiva quanto as condições que a favorecem. Com isso, são desveladas algumas limitações na atuação do consórcio, destacando o confundimento acerca de seu papel e os conflitos de interesses que surgem a partir dessa atuação, além de seu caráter colaborativo e apoiador, o que o posiciona como um espaço para exercitar a cooperação. Com isso, as iniciativas de ação consorciada demonstram o empoderamento dos gestores, resultando no fortalecimento da regionalização.

Abstract Regionalization is one of the great challenges faced since the municipalization of health in Brazil and, once consolidated, it enables the structuring of a regional scale that enhances territories. Among the organizational arrangements for regionalization, the Public Health Consortium (PHC) is positioned, which must deal not only with the sum of individualities, but with collective action. This study aims to analyze the perception of health managers at the municipal level in the Middle Paranapanema Health Region of Northern Paraná, Brazil, regarding the role of the PHC in the regionalization process. The research had a qualitative, exploratory approach, which used interviews and focus groups for data collection, which were submitted to the method of discourse analysis. The results present both the conditions that limit collective action and the conditions that favor it. With this, some limitations in the consortium's performance are unveiled, highlighting the confusion about its role and the conflicts of interest that arise from this performance, in addition to its collaborative and supportive character, which positions it as a space to exercise cooperation. With that, the joint action initiatives demonstrate the empowerment of managers, resulting in the strengthening of regionalization.

Resumo A regionalização é um dos grandes desafios enfrentados desde a municipalização da saúde no Brasil e, uma vez consolidada, possibilita a estruturação de uma escala regional potencializadora dos territórios. Dentre os arranjos organizativos para a regionalização, está posicionado o Consórcio Público de Saúde (CPS), que deve tratar não apenas da soma de individualidades, mas de uma ação coletiva. Este estudo objetiva analisar a percepção dos gestores de saúde no âmbito municipal da Região de Saúde do Médio Paranapanema do Norte do Paraná acerca do papel do CPS no processo de regionalização. A pesquisa teve abordagem qualitativa, de caráter exploratório, que utilizou entrevistas e grupos focais para coleta de dados, os quais foram submetidos ao método de análise do discurso. Os resultados apresentam tanto as condições que limitam a ação coletiva quanto as condições que a favorecem. Com isso, são desveladas algumas limitações na atuação do consórcio, destacando o confundimento acerca de seu papel e os conflitos de interesses que surgem a partir dessa atuação, além de seu caráter colaborativo e apoiador, o que o posiciona como um espaço para exercitar a cooperação. Com isso, as iniciativas de ação consorciada demonstram o empoderamento dos gestores, resultando no fortalecimento da regionalização.

Abstract Regionalization is one of the great challenges faced since the municipalization of health in Brazil and, once consolidated, it enables the structuring of a regional scale that enhances territories. Among the organizational arrangements for regionalization, the Public Health Consortium (PHC) is positioned, which must deal not only with the sum of individualities, but with collective action. This study aims to analyze the perception of health managers at the municipal level in the Middle Paranapanema Health Region of Northern Paraná, Brazil, regarding the role of the PHC in the regionalization process. The research had a qualitative, exploratory approach, which used interviews and focus groups for data collection, which were submitted to the method of discourse analysis. The results present both the conditions that limit collective action and the conditions that favor it. With this, some limitations in the consortium's performance are unveiled, highlighting the confusion about its role and the conflicts of interest that arise from this performance, in addition to its collaborative and supportive character, which positions it as a space to exercise cooperation. With that, the joint action initiatives demonstrate the empowerment of managers, resulting in the strengthening of regionalization.

Resumo Introdução Intoxicação humana é um importante problema de saúde pública, com elevado impacto socioeconômico e de saúde. Objetivo Determinar perfil e tendência dos eventos toxicológicos ocorridos em crianças. Método Estudo de tendência, realizado em crianças (menores de 12 anos, conforme Estatuto da Criança e do Adolescente) notificadas no Centro de Informações e Assistência Toxicológica (CIATox) de Londrina, de 2005-2014. As variáveis foram coletadas através do banco de dados do CIATox-Londrina. Análise de tendência foi realizada por meio de modelos de regressão linear simples. Resultados Identificaram-se 4.726 casos de eventos toxicológicos infantis, predominando de 1 a 3 anos (59,2%) de idade. A maioria foi evento acidental (93,5%), de forma aguda (99,8%), tendo medicamentos (34,6%) como principal agente envolvido. A maioria das crianças (88,1%) não necessitou de internação hospitalar, havendo reduzida taxa de óbito (0,1%). Observa-se elevação na proporção de casos de produtos domissanitários (R2=0,440; p=0,037; β1=0,307) e químicos (R2=0,456; p=0,032; β1=0,345) e redução nos acidentes com raticidas (R2=0,589; p=0,010; β1=-0,246). Conclusão Houve predominância de crianças de 1 a 3 anos, com exposição acidental e aguda, principalmente com medicamentos. Ressaltam-se as tendências significativas de aumento na proporção de casos com produtos domissanitários e produtos químicos, e redução nos casos com raticidas.

Abstract Background Poisoning is an important public health problem with socioeconomic and health impact. Objective This study aimed to determine the profile and trend of toxicological events in children. Method Trend study conducted with children (children under 12 as defined by the Statute of Children and Adolescents) reported by the Toxicological Information Center (CIATox) of Londrina, from 2005 to 2014. The variables were collected through the CIATox-Londrina database. Trend analysis was performed using simple linear regression models. Results We identified 4,726 toxicological events in children, with a predominance of 1 to 3 years (59.2%). The majority (93.5%) was comprised of accidental cases, acute (99.8%) and with medication (34.6%) as toxicological agents. Approximately 88.1% of the patients did not require hospitalization, and the death rate was low (0.1%). There was a significant increase in the proportion of cases involving household products (R2 = 0.440; p = 0.037; β1=0.307) and chemicals (R2 = 0.456; p = 0.032; β1=0.345); and a significant reduction in accidents with rodenticides (R2 = 0.589; p = 0.010; β1=-0.246). Conclusion We observed a prevalence of children from 1 to 3 years old of age, with accidental and acute exposure, mainly involving medications. We highlight a significant increase in the proportion of cases involving household products and chemical products, and a significant reduction in cases with rodenticides.

Abstract Simulation and emulation have been used by researchers to develop new network protocols and to test, modify and optimize existing ones; these experiments must imitate the heterogeneous nature of the Internet in a controllable environment suitable to answer what-if questions. BitTorrent is not the exception. In this paper, we present a simulation platform that allows the interaction of simulated and emulated peers; the BitTorrent protocol is implemented in the simulator with a high degree of detail in which any genuine BitTorrent implementation would seamlessly fit into the platform. To evaluate our platform, several experiments were completed with thousands of peers; then, we compared the results of these tests with two mathematical models to corroborate its correctness.

Abstract The aim of this study was to compare the clinical performance of root caries restorations after a six-month period using two methods, a conventional technique with rotary instruments and an atraumatic restorative technique (ART), in an institutionalized elderly population in the city of Bogotá, Colombia. Root caries represents a multifactorial, progressive, chronic lesion with softened, irregular and darkened tissue involving the radicular surface; it is highly prevalent in the elderly, especially in those who are physically or cognitively impaired. A quasi-experimental, double-blind, longitudinal study was carried out after cluster randomization of the sample. Two different experienced dentists, previously trained, performed the restorations using each technique. After six months, two new investigators performed a blind evaluation of the condition of the restorations. The results showed a significantly higher rate of success (92.9%) using the conventional technique (p < 0.03). However, we concluded that ART may have been the preferred technique in the study population because 81% of those restorations survived or were successful during the observation period.

Streaming systems and the advancement of network infrastructure have enabled multimedia content distribution over the Internet, enabling the consumption of these previously without downloading. This paper shows how a system of this type facilitates handling, data integrity and security of media type. The system consists of a web application developed in Java programming language, using Google Web Toolkit technology for creating user interfaces and Oracle to manage audios and videos. Simultaneously, it use Helix Universal Streaming Server 11 to provide information via website, which is retrieved from an instance of Oracle database which stores all data managed by the system. The application development was guided by the Rational Unified Process methodology. The use of different techniques for sending/receiving content to an instance of Oracle database and the use of the technologies exhibited resulted in the development of a streaming system that allows managing and playing multimedia files stored on a database instance Oracle data more efficiently, centrally and securely.

Los sistemas de streaming y el avance de las infraestructuras de redes han permitido la distribución de contenido multimedia a través de Internet, posibilitando su consumo sin necesidad de descargarlos previamente. El presente trabajo refleja cómo un sistema de este tipo facilita el manejo, integridad y seguridad de datos de tipo media. El sistema consiste en una aplicación web desarrollada en el lenguaje de programación Java, haciendo uso de la tecnología Google Web Toolkit para la creación de las interfaces de usuario y de Oracle para la gestión de audios y videos. Simultáneamente, se ha empleado el servidor de streaming Helix Universal Server 11 para brindar a través de la web información, la cual es recuperada desde una instancia de base de datos Oracle, donde se almacenan todos los datos gestionados por el sistema. El desarrollo de la aplicación fue guiado por la metodología Proceso Unificado de Desarrollo. El uso de distintas técnicas de envío/recepción de contenido a una instancia de base de datos Oracle y el empleo de las tecnologías expuestas, dio como resultado el desarrollo de un sistema de streaming que posibilita gestionar y reproducir archivos multimedia almacenados en una instancia de base de datos Oracle de manera más eficiente, centralizada y segura.

Localized Cutaneous Leishmaniasis (LCL) known as "chiclero's ulcer" in southeast Mexico, was described by SEIDELIN in 1912. Since then the sylvatic region of the Yucatan peninsula has been documented as an endemic focus of LCL. This study of 73 biopsies from parasitological confirmed lesions of LCL cases of Leishmania (Leishmania) mexicana infection was undertaken: 1) to examine host response at tissue level; and 2) to relate manifestations of this response to some characteristics of clinical presentation. Based on Magalhães' classification we found that the most common pattern in our LCL cases caused by L. (L.) mexicana was predominantly characterized by the presence of unorganized granuloma without necrosis, (43.8%). Another important finding to be highlighted is the fact that in 50/73 (68.5%) parasite identification was positive. There was direct relation between the size of the lesion and time of evolution (r s = 0.3079, p = 0.03), and inverse correlation between size of the lesion and abundance of amastigotes (r s = -0.2467, p = 0.03). In view of the complexity of clinical and histopathological findings, cell-mediated immune response of the disease related to clinical and histopathological features, as so genetic background should be studied.

La Leishmaniosis Cutánea Localizada (LCL) mejor conocida como "úlcera del chiclero" en el sureste de México fue descrita por SEIDELIN en 1912. Desde entonces la región selvática de la península de Yucatán ha sido identificada como un área endémica de LCL. En el presente estudio se analizaron 73 biopsias de lesiones de casos de LCL causados por Leishmania (Leishmania) mexicana con el fin de: 1) examinar la respuesta a nivel tisular; y 2) relacionar las manifestaciones de esta respuesta con ciertas características de la presentación clínica. Con base en la clasificación histopatológica de Magalhães el patrón histopatológico más frecuente se caracterizó por la presencia de granuloma desorganizado y ausencia de necrosis (43.83%). Otro hallazgo importante a señalar fue la presencia de parásito en 50/73 (68.5%) de las biopsias estudiadas. Respecto a las posibles relaciones significativas hubo una relación directa entre el tamaño de la lesión y el tiempo de evolución (r s = 0.3079, p = 0.03); una correlación inversa entre el tamaño de la lesión y la abundancia de promastigostes (r s = -0.2467, p = 0.03). Con base en la complejidad de los hallazgos clínicos e histopatológicos, consideramos necesario estudiar la respuesta inmune mediada por células relacionada con los cambios histopatológicos, así como el papel de los factores genéticos.

In the Yucatan Peninsula, Mexico, localized cutaneous leishmaniasis (LCL) caused by Leishmania (Leishmania) mexicana is a typical wild zoonosis restricted to the forest, and humans are only accidentally involved. The transmission of L. (L.) mexicana has been related to the patient's occupation: "chicleros"(gum collectors) and agricultural workers. The objective of this study was to document L. (L.) mexicana seasonally of transmission in endemic areas of LCL in the state of Campeche, Yucatan Peninsula, Mexico. The timing of incidence of LCL in humans during 1993-1994, as well as the rate and time of infection in rodents and sand flies between February 1993 and March 1995 were analyzed. Rodents and sand flies were found infected between November and March, when men carried out their field activities and are exposed. Based on results analyzed, it is concluded that L. (L.) mexicana in the endemic area of LCL in the state of Campeche, Yucatan Peninsula, Mexico, presents a seasonal transmission restricted to the months of November to March. The knowledge of the timing of the transmission cycle in an endemic area of leishmaniasis is very important because intervention measures on the high-risk focus and population might be restricted.

The first case of centipede (Scolopendra gigantea Linneaus 1758) envenomation in a newborn is reported. When first examined, approximately 6 hours after the bite, the 28-day-old girl was irritable, with uncontrollable cry and intense local pain, oedema, local hyperthermia, and blood clots at punctures. Uncontrollable crying in neonates should rise the possibility of an insect or arachnid sting.

Se reporta el primer caso de un envenenamiento por un centípedo (Scolopendra gigantea Linneaus 1758) en un recién nacido. Cuando fue examinada, aproximadamente a las 6 horas de la picadura, la niña de 28 días de nacida, estaba irritable, con un llanto incontrolable e intenso dolor, edema e hipertermia local y presencia de coágulos en los orificios de la picadura. El llanto incontrolable en neonatos, puede plantear la posibilidad de una picadura de insecto o arácnido.

Em uma amostra de 3137 pessoas, residentes no Distrito Federal, foram detectadas as seguintes hemoglobinas: em 3009(95,92%) HbAA; em 91 (2,90%) HbAS; em 20(0,64%) HbAC; em 8 (0,26%) talassemia beta minor; em 5(0,16%) HbAJ alfa; em 3 (0,09%) HbAM e em 1 (0,03%) talassemia major associada com HbAS. A HbAS têm as seguintes freqüências, quanto ao grupo racial: branco - 1,84%; mulato claro 2,55%; mulato médio-3,68%; mulato escuro - 6,80%; negro -10,43% e mestiço de índio -3,85%.

The hemoglobins of 3137 persons from the Federal District, Brazil was studied. The identified types of hemoglobins were: HbAA (3009 - 95,92%); HbAS (91 - 2,90%); HbAC (20 - 0,64%) beta thalassemia minor (8 - 0,26%); HbAJ alpha (5 - 0,16%); HbAM (3 - 0,09%) and beta thalassemia major/HbS (1 - 0,03%). The frequencies of sickle cell trait (HbAS) of each racial class were: white (1,84%); light mulatto (2,55%); medium mulatto (3,68%); dark mulatto(6,80%), negro (10,43%)and indian mestizo (3,85%).