OBJECTIVE Analyze the quality of the National Program for Primary Care Access and Quality Improvement variables to evaluate the coordination of primary care.METHODS A cross-sectional study based on data from 17,202 primary care teams that participated in the National Program for Primary Care Access and Quality Improvement in 2012. Based on the Item Response Theory, Samejima’s Gradual Response Model was used to estimate the score related to the level of coordination. The Cronbach’s alpha and Spearman’ coefficients and the point-biserial correlation were used to analyze the internal consistency and the correlation between the items and between the items and the total score. We evaluated the assumptions of unidimensionality and local independence of the items. Cloud-type word charts aided in the interpretation of coordination levels.RESULTS The Program items with the greatest discrimination in coordination level were: telephone/Internet existence, institutional communication flows, and matrix support actions. The specialists’ contact frequency with the primary care and integrated electronic medical record required a greater level of coordination among the teams. The Cronbach’ alpha was 0.8018. The institutional communication flows and telephone/Internet items had a higher correlation with the total score. Coordination scores ranged from -2.67 (minimum) to 2.83 (maximum). More communication, information exchange, matrix support, health care in the territory and the domicile had a significant influence on the levels of coordination.CONCLUSIONS The ability to provide information and the frequency of contact among professionals are important elements for a comprehensive, continuous and high-quality care.

Primary vesicoureteric reflux (VUR) diagnosed on investigation of foetal hydronephrosis accounts for many antenatally detected uropathies. In order to study foetal VUR and its consequences, newborns with foetal hydronephrosis were investigated by ultrasound, micturating cystourethrogram and 99mTechnetium-dimercapto-succinic acid (DMSA), after beginning of chemoprophylaxis. Twenty-eight infants with VUR (bilateral in 15 cases) were identified giving a total 43 renal units for study. There was a predominance of males (86%), moderate/severe reflux (84%) and renal damage (51%). Presence of renal damage was correlated with the severity of reflux. VUR should be investigated in cases of foetal hydronephrosis and our results support that renal damage is frequently congenital and not secondary to urinary tract infection.

The present study assessed the competing behavior between metals and extractants applied to the solvent extraction of calcium and/or nickel present in sulfuric solutions using the extractants Cyanex 272 (bis-2,4,4-trimethylpentyl phosphinic acid) and/or D2EHPA (di-2-ethylhexyl phosphoric acid). Tests were designed to allow equivalent competing conditions between metals and extractants. Considering metal competition in the aqueous phase, calcium extraction remained unaffected in the presence of nickel, while nickel extraction curves with pH displaced to the right in the presence of calcium when D2EHPA (ΔpH 1/2 = 1.4) or Cyanex 272 + D2EHPA (ΔpH 1/2 = 0.9) were used. Considering extractant competition in the organic phase, metal extractions with Cyanex 272 + D2EHPA closely followed the curves obtained with D2EHPA, thus evidencing that it acts as the main extractant agent, synergism or antagonism effects being attributed to the presence of Cyanex 272. A synergistic increase in the calcium extraction occurred at pH ≥ 4.5, being unaffected in the presence of nickel, whereas rejection for nickel occurred in the whole pH range in the absence of calcium, and at pH < 5.5 in the presence of calcium. For the operating conditions investigated, Ca/Ni separation reached a maximum at pH = 4.5 (calcium extraction > 80%, nickel extraction < 0.25%, β Ca/Ni = 2159).