Abstract Introduction: Sustainable management of oases needs knowledge of the conditions of composition and diversity of the species living there. Objective: Estimating and comparing the diversity and structure of vegetation in the tree, shrub and herbaceous strata of the San Ignacio oasis, Baja California Sur, Mexico. Materials and methods: A total of 140 circular sites (500 m2) were randomly located, where 20 m2 and 1 m2 sites were nested to record the vegetation in the herbaceous, shrub and tree strata. Species richness, Shannon-Wiener, Simpson, Pielou and species importance value indices were used to estimate plant diversity in the strata and to characterize their structure. Results and discussion: A total of 53 taxa were distributed in 17 orders, 25 families and 47 genera. Richness, diversity and homogeneity were higher in the herbaceous stratum (S = 41, H´ = 3.21, J´ = 8.64, respectively) and lower in the arboreal stratum (S = 21, H´ = 2.01, J´= 0.688). Regarding the importance value index, the species with the highest ecological weight was Prosopis articulata S. Watson (33.35 %) for the herbaceous stratum, Cylindropuntia alcahes (F. A. B. Weber) F. M. Kunth (65.60 %) for shrub and Phoenix dactylifera L. (92.94 %) for the arboreal stratum. Conclusions: Vegetation richness and diversity were higher in the herbaceous stratum. This study represents a baseline of indicators useful for the evaluation of changes generated by natural or anthropogenic events in the San Ignacio oasis.

Resumen Introducción: El manejo sustentable de los oasis requiere conocimiento de las condiciones de composición y diversidad de las especies que lo habitan. Objetivo: Estimar y comparar la diversidad y estructura de la vegetación en los estratos arbóreo, arbustivo y herbáceo del oasis San Ignacio, Baja California Sur, México. Materiales y métodos: Se ubicaron 140 sitios circulares (500 m2) de manera aleatoria, sobre los cuales se anidaron sitios de 20 m2 y 1 m2 para el registro de la vegetación en los estratos herbáceo, arbustivo y arbóreo. Los índices riqueza de especies, Shannon-Wiener, Simpson, Pielou y valor de importancia de las especies se utilizaron para estimar la diversidad vegetal en los estratos y caracterizar su estructura. Resultados y discusión: Se contabilizaron 53 taxones distribuidos en 17 órdenes, 25 familias y 47 géneros. La riqueza, diversidad y homogeneidad fueron mayores en el estrato herbáceo (S = 41, H´ = 3.21, J´ = 8.64, respectivamente) y menores en el estrato arbóreo (S = 21, H´ = 2.01, J´= 0.688). En lo que respecta al índice del valor de importancia, la especie con mayor peso ecológico en el estrato herbáceo fue Prosopis articulata S. Watson (33.35 %), en el arbustivo Cylindropuntia alcahes (F. A. B. Weber) F. M. Kunth (65.60 %) y en el arbóreo Phoenix dactylifera L. (92.94 %). Conclusiones: La riqueza y diversidad de la vegetación fueron superiores en el estrato herbáceo. Este estudio representa una línea base de indicadores útil para la evaluación de los cambios generados por eventos naturales o antropogénicos en el oasis San Ignacio.

ABSTRACT Fusarium falciforme and Lasiodiplodia theobromae are the main root and stem fungal pathogens in soursop trees (Annona muricata L.) in Nayarit, Mexico. Regional fruit producers do not have effective strategies to control this pathology. Therefore, the main objective of the research was to evaluate the in vitro biocontrol potential of strains of Trichoderma antagonists and the efficacy of conventional fungicides. Twelve Trichoderma strains were evaluated in vitro against F. falciforme and L. theobromae. Also, the in vitro sensitivity of both fungal pathogens to eight commercial fungicides was evaluated. The strains of T. hamatum and T. asperellum inhibited the in vitro mycelial growth of F. falciforme up to 75.31%. On the other hand, Mancozeb was the only fungicide that completely inhibited the in vitro mycelial growth of both phytopathogens. Obtained data suggest the potential use of both control strategies for the suppression of root and stem diseases in soursop. It is recommended to conduct additional studies on the possible synergistic effects of the combination of both strategies in preventing and controlling this fungal disease in A. muricata.

RESUMEN Fusarium falciforme y Lasiodiplodia theobromae, son los principales patógenos fúngicos en raíz y tallo en árboles de guanábana (Annona muricata L.) en Nayarit, México. A la fecha los productores de este frutal en la región no cuentan con estrategias efectivas para el control de esa patología. Por lo que, el objetivo de la investigación fue evaluar el potencial de biocontrol in vitro de cepas de antagonistas de Trichoderma y la eficacia de fungicidas convencionales. Se evaluaron in vitro 12 cepas de Trichoderma contra F. falciforme y L. theobromae. Así mismo, se evaluó la sensibilidad in vitro de ambos patógenos fúngicos a ocho fungicidas comerciales. Las cepas de T. hamatum y T. asperellum inhibieron el crecimiento micelial in vitro de F. falciforme hasta un 75.31 %. Por otra parte, Mancozeb fue el único fungicida que inhibió por completo el crecimiento micelial in vitro de ambos fitopatógenos. Los resultados sugieren el potencial uso de ambas estrategias de control para la supresión de estas enfermedades radiculares y del tallo en guanábana. Se sugiere conducir estudios adicionales relacionados con los posibles efectos sinérgicos de la combinación de ambas estrategias en la prevención y control de esta enfermedad fúngica en A. muricata.

Abstract Objective: To know the epidemiological behavior and associations of AF in Mexican population. Material and methods: 8,686 patients from 38 cardiologists participating in REMECAR were analyzed. They were divided by gender and age, the comorbidities studied were obesity, chronic kidney disease (CKD), high blood pressure (HBP), diabetes mellitus (DM), dyslipidemia, stroke, chronic obstructive pulmonary disease (COPD), hypothyroidism, heart failure (HF) and ischemic heart disease (IHD). Program used: IBM SPSS Statistic. Results: AF was diagnosed in 498 patients (5.7%), with higher prevalence in men (6.1% vs. 5.3%) and older age in women (74.3 ± 12.1 vs. 70.5 + -12.3 years, p<0.0001). In those under 60 years, AF was associated in women with HF, in men with CKD, DM, stroke, hypothyroidism and HF. In women older than 60 years, AF was associated with CKD, dyslipidemia, stroke, chronic COPD and HF, in men with CKD, stroke, COPD, hypothyroidism, HF and IHD. AF in women increase the probability 1.13 for obesity, 1.13 for HBP, 2.8 for CKD, 2.9 for COPD, 4.3 for stroke and 6.5 for HF, in men increase the probability 1.05 for HBP, 1.4 for DM, 2.1 for CKD, 2.4 for COPD, 3.0 for hypothyroidism, 4.7 for stroke and 6.0 for HF. Conclusions: AF is a very common arrhythmia, with a higher prevalence in patients attending the cardiology consultation, in men and with an older age of presentation in women. The older the age, the higher the prevalence of AF and comorbidities, HF is the most frequent condition associated with AF.

Resumen Objetivo: Conocer el comportamiento epidemiológico y asociaciones de la FA en población mexicana. Material y métodos: Analizamos 8,686 pacientes de 38 cardiólogos inscritos en REMECAR, divididos por edad y sexo. Comorbilidades estudiadas: obesidad, ERC, HTA, DM, dislipidemia, EVC, EPOC, hipotiroidismo, IC y CI. Programa: IBM SPSS. Resultados: FA en 498 pacientes (5.7%), mayor prevalencia en hombres (6.1 vs. 5.3%), mayor edad en mujeres (74.3 ± 12.1 vs. 70.5 ± 12.3 años, p < 0.0001). En mujeres menores de 60 años la FA se asoció con IC (p = 0.041), en hombres con ERC (p = 0.43), DM (p = 0.009), EVC (p = 0.001), hipotiroidismo (p = 0.001) e IC (p = 0.001). En mujeres mayores de 60 años se asoció con ERC (p = 0.001), dislipidemia (p = 0.001), EVC (p = 0.001), EPOC (p = 0.001) e IC (p = 0.001), en hombres con ERC (p = 0.002), EVC (p = 0.001), EPOC (p = 0.002), hipotiroidismo (p = 0.002), IC (p = 0.001) y CI (p = 0.033). En mujeres la FA se asoció con 1.13 veces mayor probabilidad de obesidad, 1.13 de HTA, 2.8 de ERC, 2.9 de EPOC, 4.3 de EVC y 6.5 de IC, en hombres la FA se asoció con 1.05 veces mas probabilidad de HTA, 1.4 de DM, 2.1 de ERC, 2.4 de EPOC, 3 de hipotiroidismo, 4.7 de EVC y 6 de IC. Conclusiones: La FA es una arritmia muy frecuente, con mayor prevalencia en pacientes que acuden a consulta de cardiología, en hombres y mayor edad de presentación en las mujeres. A mayor edad, mayor prevalencia de FA y de comorbilidades, la IC es la condición más frecuente con la que se asoció la FA.

Resumen Se evaluó el efecto del tratamiento térmico en los desechos de caolín de la minería sobre el comportamiento estructural y térmico de la poli (ε-caprolactona) (PCL). Los compuestos PCL/DC (desechos de caolín) y PCL/DCT (desechos de caolín tratados térmicamente) se procesaron en un mezclador interno y luego se caracterizaron por difracción de rayos X (DRX) y calorimetría de barrido diferencial (DSC). El residuo de caolín tenía caolinita y cuarzo en su composición, mientras que el tratamiento térmico a 1200 °C lo cambio a mullita, cuarzo y fase amorfa rica en sílice. Por XRD, hubo un aumento en la intensidad del pico 29 = 23,9° de los compuestos PCL/DC, en comparación con el PCL puro. Por el contrario, los compuestos PCL/DCT tendieron a reducir la intensidad máxima 2θ = 23,9°, especialmente con el 5 % de DCT. La temperatura de fusión cristalina y el grado de cristalinidad de los compuestos PCL/DC y PCL/DCT se mantuvieron prácticamente sin cambios, en relación al PCL. Sin embargo, el proceso de cristalización fue más eficiente con residuo de caolín (DC) sin tratamiento térmico, lo que indica que la fase amorfa del DCT inhibió la cristalización. El desarrollo de los PCL/DC promovió un aumento en la temperatura de cristalización, cristalinidad relativa y velocidad de cristalización, superando a la PCL y al sistema de los PCL/ DCT. Como resultado, el residuo de caolín tiene el potencial de acelerar el proceso de cristalización de la PCL, contribuyendo a agregar valor a un material que de otra manera sería descartado y minimizando los impactos ambientales.

Abstract The heat treatment effect on kaolin waste from mining was evaluated on the structural and thermal behavior of poly(ε-caprolactone) (PCL). The PCL/KW (kaolin waste) and PCL/HTKW (heat-treated kaolin waste) composites were processed in an internal mixer and subsequently characterized by X-ray diffraction (XRD) and differential scanning calorimetry (DSC). The kaolin waste showed kaolinite and quartz in its composition, while the heat treatment at 1200°C modified it to mullite, quartz and silica-rich amorphous phase. By XRD, there was an increase in the intensity of the peak 2θ = 23.9° of the PCL/KW composites compared to neat PCL. In contrast, PCL/HTKW composites tended to reduce the intensity of the peak 29 = 23.9°, especially at 5% HTKW. The crystalline melting temperature and the degree of crystallinity of PCL/KW and PCL/HTKW composites were practically unchanged, compared to PCL. However, the crystallization process was more effective with the kaolin waste (KW) without heat treatment, indicating that the HTKW amorphous phase inhibited crystallization. The PCL/KW development promoted an increase in crystallization temperature, relative crystallinity, and crystallization rate, surpassing PCL and the PCL/HTKW system. In view of this, kaolin waste has the potential to accelerate the PCL crystallization process, contributing to add value to a material that would otherwise be discarded and minimizing environmental impacts.

Resumen Objetivo: Evaluar la aparición de reflujo gastroesofágico (RGE) posterior a gastrectomía en manga como manejo para la obesidad, con el Gastroesophageal Reflux Disease Questionnaire (GerdQ). Método: Estudio retrospectivo de pacientes llevados a gastrectomía en manga durante 2016 y 2017, habiendo descartado RGE con endoscopia digestiva alta prequirúrgica, y evaluación posoperatoria con la escala GerdQ. Resultados: Se incluyeron en el estudio 129 pacientes, con un promedio de edad de 45 años, el 77.5% de sexo masculino y como comorbilidad más frecuente hipotiroidismo (25.6%) e hipertensión arterial (23.3%). El 12.4% tenían un puntaje ≥ 8, 14 eran mujeres y 2 hombres, y no hubo relación estadísticamente significativa con el índice de masa corporal preoperatorio. Conclusiones: Estandarizar la técnica de manga gástrica en los servicios de cirugía bariátrica, teniendo en cuenta los factores técnicos asociados a RGE posoperatorio de novo, disminuye la aparición de RGE según lo evaluado por la escala GerdQ.

Abstract Objective: To evaluate the appearance of gastroesophageal reflux in our population after sleeve gastrectomy as management for obesity, with the Gastroesophageal Reflux Disease Questionnaire (GerdQ). Method: Retrospective study of patients undergoing sleeve gastrectomy during 2016 and 2017, having ruled out gastroesophageal reflux (GER) with pre-surgical upper digestive endoscopy, and post-operative evaluation with the GerdQ scale. Results: 129 patients were included in the study, average age was 45 years, gender of greater male appearance was 77.5%, the most frequent comorbidities were hypothyroidism 25.6% and hypertension 23.3%. 12.4% had a score greater than or equal to 8, 14 were women and 2 men, there was no statistically significant relationship with the preoperative mass index. Conclusions: Standardizing the gastric sleeve technique in the bariatric surgery services, taking into account the technical factors associated with post-operative GERD de novo, decreases its appearance as evaluated by the GerdQ scale.

Abstract Background Bariatric surgery is an effective way to lose weight and the laparoscopic gastric sleeve is one of the techniques currently used. Portosplenomesenteric venous thrombosis is a complication that occurs in patients undergoing this surgical technique. At the moment there are no protocols to reduce the risk of this thrombotic event, so we show our experience and propose an algorithm. Case report A total of 620 patients were evaluated, six of whom presented between postoperative days 10 to 20 abdominal pain, nausea and dehydration. Therefore, a double contrast abdominal computed tomography scan was carried out, which demonstrated portomesenteric and portoesplenomesenteric thrombosis, in addition to two patients with signs of intestinal ischemia, which required reoperation. One of the patients died of pulmonary thromboembolism.

Resumen Antecedentes La cirugía bariátrica es una forma eficaz de perder peso, y la manga gástrica laparoscópica es una de las técnicas usadas actualmente. La trombosis venosa portoesplenomesénterica es una complicación que se presenta en los pacientes sometidos a esta técnica quirúrgica. En el momento no existen protocolos para disminuir el riesgo de este evento trombótico, por lo cual mostramos nuestra experiencia y proponemos un algoritmo. Casos clínicos Se evaluaron 620 pacientes, de los cuales seis, entre los días 10 y 20 de posoperatorio, presentaron dolor abdominal, náuseas y deshidratación. Se les realizó tomografía computarizada de abdomen con doble contraste, que demostró trombosis portomesentérica y portoesplenomesentérica; además, dos pacientes tuvieron signos de isquemia intestinal y requirieron reintervención quirúrgica. Uno de los pacientes falleció por tromboembolia pulmonar.

Abstract Background: Giant paraesophageal hernias have a surgical indication in case of symptoms. Since twenty years ago robot-assisted repair was incorporated to overcome the limitations of the laparoscopic surgery, and to offer new advantages. Objective: To report the experience on repairing giant paraesophageal hernias assisted by robot in a fourth level hospital in Bogotá, Colombia, Shaio Clinic. Method: Retrospective and descriptive study of five cases of giant paraesophageal hernia type III or IV, taken to robotic correction during August 2016 to June 2018. Evaluation of post-surgery outcomes. Results: Five paraesophageal robot-assisted repair were performed. Mean surgical time was 146 minutes, one conversion to open surgery, the average intraoperative bleeding was 100 mL, hospital stay time of 2.2 days. Morbidity, mortality and recurrence percentages in the short time were equal to 0%. Conclusions: Robot-assisted repair of giant paraesophageal hernias, has shown advantages that overcome the limitations of the laparoscopic approach such as dissections in difficult-to-reach angles, increased accuracy, ergonomics, three-dimensional, and closer view of the workspace. In addition, robot-assisted repair promotes better surgical and postoperative outcomes; these advantages have been demonstrated mainly in the repair of giant paraesophageal hernias.

Resumen Antecedentes: Las hernias paraesofágicas gigantes tienen indicación quirúrgica en caso de ser sintomáticas. Hace 20 años se incorporó la reparación asistida por robot debido a las ventajas que ofrece sobre las limitantes de la laparoscopia. Objetivo: Reportar la experiencia en reparación de hernias paraesofágicas gigantes asistida por robot en un hospital de cuarto nivel en Bogotá, Colombia, Fundación Clínica Shaio. Método: Estudio retrospectivo, descriptivo, de cinco casos de hernia paraesofágica gigante tipo III o IV, llevados a corrección robótica, de agosto de 2016 a junio de 2018, con evaluación de los desenlaces posoperatorios. Resultados: Cinco pacientes fueron sometidos a reparación asistida por robot, el tiempo quirúrgico fue de 146 minutos, se realizó una sola conversión a cirugía abierta, la media de sangrado fue de 100 ml, el tiempo de estancia hospitalaria de 2.2 días, y los porcentajes de morbilidad, mortalidad y recurrencia a 1 año fueron del 0%. Conclusión: La reparación de este tipo de hernias asistida por robot ha mostrado ventajas sobre el abordaje laparoscópico, como realizar disecciones en ángulos de difícil acceso, precisión aumentada, ergonomía y vista tridimensional y más cercana del espacio de trabajo. Además, promueve mejores desenlaces quirúrgicos y posoperatorios, ventajas evidenciadas principalmente en la reparación de hernias paraesofágicas gigantes.

RESUMO: Descreve-se um surto de enterite necro-hemorrágica em um confinamento de bovinos de corte no município de Nova Crixás, Estado de Goiás, Brasil, com ênfase nos aspectos epidemiológicos, lesionais e laboratoriais. Foram realizadas visitas à propriedade e todos os cadáveres bovinos (N=57) foram submetidos ao exame necroscópico, os quais apresentaram alterações macroscópicas semelhantes. Foram compilados dados epidemiológicos, sobretudo referentes ao manejo alimentar dos animais e amostras de tecido foram submetidas a exame histopatológico. Foram colhidas, também, amostras de fezes e conteúdo intestinal para isolamento bacteriano e genotipagem por PCR para detecção do agente etiológico, sendo confirmadas estirpes de Clostridium perfringens tipo A em 100% das amostras. Ainda, 33,3% das cepas de Clostridium perfringens isoladas no conteúdo intestinal e 40% daquelas isoladas nas fezes foram positivas para o gene codificador da toxina beta-2. Considerando o histórico, os achados macroscópicos e microscópicos, o isolamento bacteriano e o PCR, foi estabelecido o diagnóstico de enterite necro-hemorrágica por C. perfringens tipo A.

ABSTRACT: This study described an outbreak of necrohemorrhagic enteritis in a beef cattle feedlot in Nova Crixás, State of Goiás, Brazil, with emphasis on epidemiological, lesional, and laboratory aspects. Visits to the property were carried out and a necroscopic examination was performed on the bovine cadavers (N=57), which presented similar macroscopic alterations. Epidemiological data were collected, mainly referring to the feeding management of animals, and tissue samples were submitted to histopathological examination. Samples of feces and intestinal contents were also collected for bacterial isolation and PCR genotyping to detect the etiological agent, being confirmed Clostridium perfringens type A strains in 100% of the samples. Furthermore, 33.3% of strains isolated from intestinal contents and 40% of those isolated from feces were positive for beta-2 encoding gene. Considering the history, macroscopic and microscopic findings, as well as bacterial isolation and PCR, the diagnosis of bovine necrohemorrhagic enteritis was determined.

Pneumonic plague is one of the clinical forms of plague, of low frequency and high mortality, transmitted by direct inhalation of Yersinia pestis coming from an animal or from person to person. Objective. To describe the clinical and epidemiological characteristics of the cases of primary pneumonic plague in an outbreak in the north of Peru. Materials and methods. The clinical records of the confirmed cases of primary pneumonic plague presenting in an outbreak occurring in La Libertad, in July 2010, were reviewed, also the search and contact investigation was performed. Results. The index case was identified, as well as three additional cases, out of these, two were nosocomial infections related to the index case. The initial clinical presentation was characterized by sudden onset of fever, chills, myalgia and chest pain, which in less than 24 hours evolved to hypotension and cyanosis. The initiation of specific treatment varied from 2 to 12 days, and cases with prompt initiation of treatment had a better clinical outcome. The lethality was 50% (2/4). Conclusion. Nosocomial transmission of pneumonic plague in Peru is evidenced, with severe clinical manifestations and high lethality.

La peste neumónica es una forma clínica de peste, de baja frecuencia y alta letalidad, transmitida por la inhalación directa de Yersinia pestis proveniente de un animal o de persona a persona. Objetivo. Describir las características clínicas y epidemiológicas de los casos de un brote de peste neumónica primaria humana en el norte de Perú. Materiales y métodos. Se revisaron las historias clínicas de los casos confirmados de peste neumónica primaria presentados en un brote ocurrido en la región de La Libertad, en el mes de julio de 2010, asimismo, se efectuó la búsqueda e investigación de contactos. Resultados. Se identificó el caso índice y tres casos adicionales, de estos últimos, dos fueron infecciones intrahospitalarias relacionadas con el caso índice. La presentación clínica inicial se caracterizó por fiebre de inicio súbito, escalofríos, mialgias y dolor torácico y evolución en menos de 24 horas a hipotensión arterial y cianosis. El inicio del tratamiento específico varió de 2 a 12 días, observándose que los casos con inicio precoz de tratamiento tuvieron un mejor resultado clínico. La letalidad fue de 50% (2/4). Conclusión. Se evidenció la transmisión intrahospitalaria de peste neumónica en el Perú con manifestaciones graves y alta letalidad.

Pneumonic plague is one of the clinical forms of plague, of low frequency and high mortality, transmitted by direct inhalation of Yersinia pestis coming from an animal or from person to person. Objective. To describe the clinical and epidemiological characteristics of the cases of primary pneumonic plague in an outbreak in the north of Peru. Materials and methods. The clinical records of the confirmed cases of primary pneumonic plague presenting in an outbreak occurring in La Libertad, in July 2010, were reviewed, also the search and contact investigation was performed. Results. The index case was identified, as well as three additional cases, out of these, two were nosocomial infections related to the index case. The initial clinical presentation was characterized by sudden onset of fever, chills, myalgia and chest pain, which in less than 24 hours evolved to hypotension and cyanosis. The initiation of specific treatment varied from 2 to 12 days, and cases with prompt initiation of treatment had a better clinical outcome. The lethality was 50% (2/4). Conclusion. Nosocomial transmission of pneumonic plague in Peru is evidenced, with severe clinical manifestations and high lethality.

La peste neumónica es una forma clínica de peste, de baja frecuencia y alta letalidad, transmitida por la inhalación directa de Yersinia pestis proveniente de un animal o de persona a persona. Objetivo. Describir las características clínicas y epidemiológicas de los casos de un brote de peste neumónica primaria humana en el norte de Perú. Materiales y métodos. Se revisaron las historias clínicas de los casos confirmados de peste neumónica primaria presentados en un brote ocurrido en la región de La Libertad, en el mes de julio de 2010, asimismo, se efectuó la búsqueda e investigación de contactos. Resultados. Se identificó el caso índice y tres casos adicionales, de estos últimos, dos fueron infecciones intrahospitalarias relacionadas con el caso índice. La presentación clínica inicial se caracterizó por fiebre de inicio súbito, escalofríos, mialgias y dolor torácico y evolución en menos de 24 horas a hipotensión arterial y cianosis. El inicio del tratamiento específico varió de 2 a 12 días, observándose que los casos con inicio precoz de tratamiento tuvieron un mejor resultado clínico. La letalidad fue de 50% (2/4). Conclusión. Se evidenció la transmisión intrahospitalaria de peste neumónica en el Perú con manifestaciones graves y alta letalidad.

Desenvolver modelos de avaliação de satisfação que permitam comparar sistemas de saúde de diversos países é um esforço recente no Brasil. Esse tipo de avaliação representa importante ferramenta para desenvolver estratégias de gestão para o setor. Objetivo: identificar fatores e avaliar diferenças regionais do grau de satisfação dos usuários do sistema de saúde brasileiro, analisando os resultados da Pesquisa Mundial de Saúde (PMS) e Pesquisa Mundial de Saúde com foco na Atenção Básica (PMS-AB). Foi realizado estudo avaliativo de corte transversal, onde as amostras foram selecionadas de forma aleatória. Foram incluídas pessoas maiores de 18 anos que utilizaram o sistema de saúde em períodos anteriores às coletas de dados. Enquadraram-se nos critérios de inclusão 3.932 usuários da PMS e 591 da PMS-AB. Aplicou-se modelo logístico multivariado, tendo como variável dependente a satisfação e, como variáveis independentes, sexo, idade, escolaridade, forma de pagamento de serviço, situação conjugal, autopercepção de saúde, doença de longa duração, diagnóstico de depressão, tristeza, número de moradores por domicílio, tipo de construção, estratos geográficos e indicador de bens. Os resultados revelaram que ser jovem, usuário exclusivo do SUS, ter baixa escolaridade e autopercepção de saúde ruim gerou mais chances de insatisfação dos usuários com o sistema de saúde brasileiro. Os moradores da Região Sul do país estão mais satisfeitos com o atendimento em saúde, enquanto para pernambucanos as chances de satisfação são menores quando se avalia a qualidade dos serviços de saúde. Os moradores desse estado apresentaram maior insatisfação na resolução de seus problemas de saúde quando precisaram de internação.

Developing evaluation models of satisfaction that allow comparing health systems in different countries is a recent effort in Brazil. This is an important tool for building management strategies for the health sector. Objective: To evaluate regional variations related to the degree of user satisfaction with the Brazilian healthcare system, analyzing the results of the World Health Survey (WHS) and World Health Survey Focusing on Primary Health Care (WHS-PHC). The evaluation was done, based on a cross-sectional study with a random sample. People over 18 years of age who used the health system in periods before data collection were included. There were 3,932 users of WHS and 591 of WHS-PHC that fit these criteria. A multivariate logistic model was applied using satisfaction as the dependent variable and as independent variables: sex, age, educational level, service payment type, marital status, self-perception of health, long-term illness, diagnosis of depression, sadness, number of residents per household, type of house building, geographical stratum, and household goods index. The results revealed that being young and an exclusive user of the public National Health System, having low schooling and poor self-perception of health increased the chances of lower user satisfaction. Residents of the Southern Region of the country were more satisfied with their healthcare, while in Pernambuco, chances of satisfaction were lower when evaluating the quality of health services. The residents of this state showed greater satisfaction in solving their health problems when inpatient care was needed.

Desenvolver modelos de avaliação de satisfação que permitam comparar sistemas de saúde de diversos países é um esforço recente no Brasil. Esse tipo de avaliação representa importante ferramenta para desenvolver estratégias de gestão para o setor. Objetivo: identificar fatores e avaliar diferenças regionais do grau de satisfação dos usuários do sistema de saúde brasileiro, analisando os resultados da Pesquisa Mundial de Saúde (PMS) e Pesquisa Mundial de Saúde com foco na Atenção Básica (PMS-AB). Foi realizado estudo avaliativo de corte transversal, onde as amostras foram selecionadas de forma aleatória. Foram incluídas pessoas maiores de 18 anos que utilizaram o sistema de saúde em períodos anteriores às coletas de dados. Enquadraram-se nos critérios de inclusão 3.932 usuários da PMS e 591 da PMS-AB. Aplicou-se modelo logístico multivariado, tendo como variável dependente a satisfação e, como variáveis independentes, sexo, idade, escolaridade, forma de pagamento de serviço, situação conjugal, autopercepção de saúde, doença de longa duração, diagnóstico de depressão, tristeza, número de moradores por domicílio, tipo de construção, estratos geográficos e indicador de bens. Os resultados revelaram que ser jovem, usuário exclusivo do SUS, ter baixa escolaridade e autopercepção de saúde ruim gerou mais chances de insatisfação dos usuários com o sistema de saúde brasileiro. Os moradores da Região Sul do país estão mais satisfeitos com o atendimento em saúde, enquanto para pernambucanos as chances de satisfação são menores quando se avalia a qualidade dos serviços de saúde. Os moradores desse estado apresentaram maior insatisfação na resolução de seus problemas de saúde quando precisaram de internação.

Developing evaluation models of satisfaction that allow comparing health systems in different countries is a recent effort in Brazil. This is an important tool for building management strategies for the health sector. Objective: To evaluate regional variations related to the degree of user satisfaction with the Brazilian healthcare system, analyzing the results of the World Health Survey (WHS) and World Health Survey Focusing on Primary Health Care (WHS-PHC). The evaluation was done, based on a cross-sectional study with a random sample. People over 18 years of age who used the health system in periods before data collection were included. There were 3,932 users of WHS and 591 of WHS-PHC that fit these criteria. A multivariate logistic model was applied using satisfaction as the dependent variable and as independent variables: sex, age, educational level, service payment type, marital status, self-perception of health, long-term illness, diagnosis of depression, sadness, number of residents per household, type of house building, geographical stratum, and household goods index. The results revealed that being young and an exclusive user of the public National Health System, having low schooling and poor self-perception of health increased the chances of lower user satisfaction. Residents of the Southern Region of the country were more satisfied with their healthcare, while in Pernambuco, chances of satisfaction were lower when evaluating the quality of health services. The residents of this state showed greater satisfaction in solving their health problems when inpatient care was needed.

PURPOSE: To evaluate alanine aminotransferase levels before and after a hemodialysis session and to correlate these values with the hematocrit rate and weight loss during hemodialysis. PATIENTS AND METHODS: The serum alanine aminotransferase levels, hematocrit rate and body weight were measured and correlated before and after a single hemodialysis session for 146 patients with chronic renal failure. An receiver operating characteristic (ROC) curve for the serum alanine aminotransferase levels collected before and after hemodialysis was plotted to identify hepatitis C virus-infected patients. RESULTS: The mean weight loss of the 146 patients during hemodialysis was 5.3% (p < 0.001). The mean alanine aminotransferase levels before and after hemodialysis were 18.8 and 23.9 IU/, respectively, denoting a significant 28.1% increase. An equally significant increase of 16.4% in the hematocrit rate also occurred after hemodialysis. The weight loss was inversely correlated with the rise in both the alanine aminotransferase level (r = 0.3; p < 0.001) and hematocrit rate (r = 0.5; p < 0.001). A direct correlation was found between the rise in alanine aminotransferase levels and the hematocrit during the hemodialysis session (r = 0.4; p < 0.001). Based on the ROC curve, the upper limit of the normal alanine aminotransferase level should be reduced by 40% relative to the upper limit of normal if the blood samples are collected before the hemodialysis session or by 60% if blood samples are collected after the session. CONCLUSION: In the present study, significant elevations in the serum alanine aminotransferase levels and hematocrit rates occurred in parallel to a reduction in body weight after the hemodialysis session. These findings suggest that one of the factors for low alanine aminotransferase levels prior to hemodialysis could be hemodilution in patients with chronic renal failure.

A avaliação da satisfação com o sistema de saúde sob a ótica do usuário recoloca antigos questionamentos quanto à qualidade dos serviços oferecidos à população brasileira. Este trabalho analisa os resultados sobre satisfação com a assistência de saúde prestada (ambulatorial e internação) da Pesquisa Mundial de Saúde, realizada no Brasil no ano de 2003. Com o objetivo de explicar a satisfação com o atendimento em seus aspectos por meio de um pequeno número de fatores, foi utilizada a técnica de análise fatorial por componentes principais (ACP). Modelos de regressão múltipla permitiram identificar associações dos escores de satisfação com diferentes variáveis sócio-demográficas. O tempo de espera foi o item que demonstrou menor grau de satisfação, no caso de atendimento ambulatorial, e a liberdade de escolha do profissional de saúde, no caso de internação. Na ACP foram extraídos três componentes, que se relacionaram à satisfação com os profissionais, serviços e resolução do problema de saúde. A regressão múltipla revelou que ter sofrido algum tipo de discriminação (por sexo, idade, pobreza, classe social, raça ou tipo de doença) e ser usuário exclusivo do SUS implica o menor grau de satisfação dos usuários com o atendimento recebido.

Evaluation of users' satisfaction with the health system brings back longstanding questions concerning the quality of services provided to the Brazilian population. The current study analyzes satisfaction with outpatient and inpatient care based on the results of the World Health Survey, conducted in Brazil in 2003. To explain satisfaction with various aspects of care through a small number of factors, the factor analysis technique was used, through principal components analysis (PCA). Multiple regression models identified associations between satisfaction scores and different sociodemographic variables. For outpatient care, waiting time showed the lowest degree of satisfaction, and in the case of hospitalization, freedom to choose the physician was the worst evaluated aspect. Three components were extracted from the PCA, related respectively to satisfaction with health professionals, health services, and health problem solution. Multiple regression analysis showed that having experienced some type of discrimination (on the basis of gender, age, poverty, social class, skin color, or type of disease) and being an exclusive user of the public National Health System involved a lower degree of users' satisfaction.

A avaliação da satisfação com o sistema de saúde sob a ótica do usuário recoloca antigos questionamentos quanto à qualidade dos serviços oferecidos à população brasileira. Este trabalho analisa os resultados sobre satisfação com a assistência de saúde prestada (ambulatorial e internação) da Pesquisa Mundial de Saúde, realizada no Brasil no ano de 2003. Com o objetivo de explicar a satisfação com o atendimento em seus aspectos por meio de um pequeno número de fatores, foi utilizada a técnica de análise fatorial por componentes principais (ACP). Modelos de regressão múltipla permitiram identificar associações dos escores de satisfação com diferentes variáveis sócio-demográficas. O tempo de espera foi o item que demonstrou menor grau de satisfação, no caso de atendimento ambulatorial, e a liberdade de escolha do profissional de saúde, no caso de internação. Na ACP foram extraídos três componentes, que se relacionaram à satisfação com os profissionais, serviços e resolução do problema de saúde. A regressão múltipla revelou que ter sofrido algum tipo de discriminação (por sexo, idade, pobreza, classe social, raça ou tipo de doença) e ser usuário exclusivo do SUS implica o menor grau de satisfação dos usuários com o atendimento recebido.

Evaluation of users' satisfaction with the health system brings back longstanding questions concerning the quality of services provided to the Brazilian population. The current study analyzes satisfaction with outpatient and inpatient care based on the results of the World Health Survey, conducted in Brazil in 2003. To explain satisfaction with various aspects of care through a small number of factors, the factor analysis technique was used, through principal components analysis (PCA). Multiple regression models identified associations between satisfaction scores and different sociodemographic variables. For outpatient care, waiting time showed the lowest degree of satisfaction, and in the case of hospitalization, freedom to choose the physician was the worst evaluated aspect. Three components were extracted from the PCA, related respectively to satisfaction with health professionals, health services, and health problem solution. Multiple regression analysis showed that having experienced some type of discrimination (on the basis of gender, age, poverty, social class, skin color, or type of disease) and being an exclusive user of the public National Health System involved a lower degree of users' satisfaction.