Osteoporosis management in patients with chronic kidney disease (ERCOS Study): A challenge in nephrological care.

Fracture risk assessment in patients with chronic kidney disease (CKD) has been included in the CKD-MBD ("Chronic Kidney Disease-Mineral and Bone Disorders") complex in international and national nephrology guidelines, suggesting for the first time the assessment of bone mineral density (BMD) if the results can influence therapeutic decision-making. However, there is very little information on actual clinical practice in this population. The main objective of the ERCOS (ERC-Osteoporosis) study is to describe the profile of patients with CKD G3-5D with osteoporosis (OP) and/or fragility fractures treated in specialized nephrology, rheumatology and internal medicine clinics in Spain. Fifteen centers participated and 162 patients (mostly women [71.2%] postmenopausal [98.3%]) with a median age of 77 years were included. Mean estimated glomerular filtration rate (eGFR) was 36 mL/min/1.73 m2 and 38% of the included patients were on dialysis. We highlight the high frequency of prevalent fragility fractures [37.7%), mainly vertebral (52.5%) and hip (24.6%)], the disproportionate history of patients with glomerular disease compared to purely nephrological series (corticosteroids) and undertreatment for fracture prevention, especially in nephrology consultations. This study is an immediate call to action with the dissemination of the new, more proactive, clinical guidelines, and underlines the need to standardize a coordinated and multidisciplinary care/therapeutic approach to these patients in an efficient way to avoid current discrepancies and therapeutic nihilism.

Carcinoma basocelular de vulva: relato de caso / Basal cell carcinoma of the vulva: case report

Introdução: O carcinoma basocelular (CBC) de vulva é uma condição rara que corresponde a menos de 0,4% dos casos de CBC e de 2% a 4% das neoplasias de vulva. O CBC de vulva é mais comum entre mulheres brancas, multíparas e na pósmenopausa, especialmente na sétima década de vida. O objetivo é relatar um caso de CBC de vulva no qual discutiram-se os aspectos do diagnóstico e tratamento. Relato de Caso: Mulher de 63 anos de idade, G1P1A0, chega ao consultório em janeiro de 2022 para tratamento de lesão persistente em vulva. Realizou-se biópsia incisional que mostrou tratar-se de provável carcinoma basocelular nodular com invasão da derme. A paciente submeteu-se a uma ressecção do tumor com margens macroscópicas livres e sutura primária. A cirurgia não teve complicações no pré-operatório e no pós-operatório. O histopatológico da peça cirúrgica mostrou tratar-se de carcinoma basocelular nodular com área irregular, plana, branco, medindo 0,7x0,4cm, com as margens laterais distando 7,0 e 5,0mm e profundas, 5,9mm; todas livres. Conclusão: O caso relatado é raro, tendo sido o tratamento de ressecção cirúrgica do CBC de vulva com margens bem-sucedido. Catorze meses após a cirurgia, a paciente encontra-se sem evidências de recidiva local ou regional.

Introduction: Basal cell carcinoma (BCC) of the vulva is a rare condition that accounts for less than 0.4% of BCC cases and 2% to 4% of vulvar neoplasms. BCC of the vulva is more common among white, multiparous and postmenopausal women, especially in the seventh decade of life. The aim is to report a case of BCC of the vulva in which aspects of diagnosis and treatment were discussed. Case report: A 63-year-old woman, G1P1A0, arrives at the office in January 2022 for treatment of a persistent lesion on her vulva. An incisional biopsy was performed and showed that it was likely nodular basal cell carcinoma with invasion of the dermis. The patient underwent tumor resection with free macroscopic margins and primary suture. The surgery had no complications preoperatively or postoperatively. The histopathology of the surgical specimen showed that it was a nodular basal cell carcinoma with an irregular, flat, white area, measuring 0.7x0.4cm, with the lateral margins 7.0 and 5.0mm apart and 5.9mm deep; all free. Conclusion: The reported case is rare, with surgical resection of BCC of the vulva with margins being successful. Fourteen months after surgery, the patient has no evidence of local or regional recurrence.

Biological and glucocorticoids treatment impair the medium-term immunogenicity to SARS-CoV-2 mRNA vaccines in autoimmune inflammatory rheumatic diseases.

BACKGROUND: This study aims to assess the sustained immunological response to the SARS-CoV-2 vaccine in patients with autoimmune inflammatory rheumatic diseases (AIRD) undergoing different treatment regimens. METHODS: We conducted a prospective observational study involving 157 AIRD patients without prior COVID-19 infection. Treatment regimens included non-treatment or glucocorticoid-only (not-treated/GCs), non-biological drugs, biological therapy, and JAK inhibitors. All participants completed the two-dose vaccine schedule, and 110 of them received an additional booster dose. Serum samples were collected approximately 3-6 months after the second and third vaccine doses to measure antibodies against the Spike protein (antiS-AB) and neutralizing antibodies (nAB) targeting six SARS-CoV-2 variants. RESULTS: Following the third dose, all patients exhibited a significant increase in antiS-AB (FC = 15, p < 0.0001). Patients under biological therapy had lower titres compared to the non-biological (66% decrease, p = 0.038) and the not-treated/GCs group (62% decrease, p = 0.0132), with the latter persisting after the booster dose (86% decrease, p = 0.0027). GC use was associated with lower antiS-AB levels in the biological group (87% decrease, p = 0.0124), although not statistically significant after confounders adjustment. nABs showed the highest positivity rates for the wild-type strain before (50%) and after the booster dose (93%), while the Omicron variant exhibited the lowest rates (11% and 55%, respectively). All variants demonstrated similar positivity patterns and good concordance with antiS-AB (AUCs from 0.896 to 0.997). CONCLUSIONS: The SARS-CoV-2 vaccine booster strategy effectively elicited a sustained antibody immune response in AIRD patients. However, patients under biological therapies exhibited a reduced response to the booster dose, particularly when combined with GCs.

The impact of intestinal microbiota imbalance on the development of obesity / O impacto do desequilíbrio da microbiota intestinal no desenvolvimento da obesidade

Objective: review current databases to identify the impacts of intestinal dysbiosis on obesity, as well as serve as a pillar for carrying out preventive, diagnostic and therapeutic measures. Methodology: this is an integrative review carried out from the collection of data obtained from the SciELO, PubMed, VHL, and LILACS platforms using the descriptors "dysbiosis", "obesity" and "gastrointestinal microbiome"; Inclusion criteria were: articles published in the last five years (from 2017 to 2022), original articles, meta-analyses, and observational studies (clinical trials and cohort study) and written in Portuguese, English, or Spanish. Results: Western diet and use of sweeteners cause anthropometric changes, blood pressure, glucose intolerance, among others, in addition to leading to the prevalence of deleterious bacteria in the body, culminating in obesity and diabetes mellitus; on the other hand, a diet rich in fiber and administration of probiotics can generate beneficial changes in the diversity of the intestinal flora, in addition to combating the inflammatory state generated by obesity (AU).

Objetivo: revisar as bases de dados atuais para identificar os impactos da disbiose intestinal na obesidade, bem como servir de pilar para realização de medidas preventivas, diagnósticas e terapêuticas. Metodologia: trata-se de revisão integrativa realizada a partir de coleta de dados obtidos nas plataformas SciELO, PuBMed, BVS e LILACS usando os descritores "dysbiosis", "obesity" and "gastrointestinal microbiome"; os critérios de inclusão foram: artigos publicados nos últimos cinco anos (de 2017 a 2022), artigos originais, metanálises e estudos observacionais (ensaios clínicos e estudo de coorte) e escritos em português, inglês ou espanhol. Resultados: dieta ocidental e uso de adoçante provocam alterações antropométricas, de pressão arterial, intolerância à glicose, entre outras, além de levar à prevalência de bactérias deletérias ao organismo, culminando em obesidade e diabetes mellitus; em contrapartida, dieta rica em fibras e administração de probióticos podem gerar mudanças benéficas na diversidade da flora intestinal, ademais combatem o estado inflamatório gerado pela obesidade (AU).

Calcifediol in the management of vitamin D deficiency-related skeletal and extraskeletal diseases: overview and clinical cases.

As well as being essential for musculoskeletal health, vitamin D is involved in numerous other physiological processes. Poor vitamin D status is linked to a wide range of diseases, including cardiovascular disease, autoimmune conditions, pulmonary disorders and upper respiratory tract infections. While optimal target concentrations of serum 25-hydroxyvitamin D (25(OH)D) for health maintenance or therapeutic purposes are still the subject of debate, there is reasonable agreement that serum 25(OH)D levels <50 nmol/L (20 ng/mL) constitute vitamin D deficiency and that severe deficiency states (serum 25(OH)D levels <25-30 nmol/L ≈ 10-12 ng/mL) should be avoided. Main strategies to maintain or improve vitamin D status are food supplementation and therapeutic use of medicinal forms of vitamin D. In this review, we examine evidence that implicates vitamin D deficiency in diverse conditions in the clinical settings of endocrinology, rheumatology, pneumology and reproductive health. Cholecalciferol (vitamin D3) is the most frequently used vitamin D supplement worldwide, though calcifediol (25-hydroxyvitamin D3) has recently become more widely available. Calcifediol is one step closer than cholecalciferol in the metabolic pathway to biologically active vitamin D. Pharmacokinetic differences between these vitamin D metabolites confer putative advantages for calcifediol in certain clinical situations. The clinical use of calcifediol is explored more closely through case studies, which illustrate its adjunctive role in the treatment of several vitamin D deficiency-related skeletal and extraskeletal diseases.

Osteoporosis and Fragility Fractures in Patients with Liver Cirrhosis: Usefulness of FRAX® as a Screening Tool.

PURPOSE: The purpose of this study is to assess the prevalence of osteoporosis and fragility fractures in patients with liver cirrhosis (LC) and determine the associated risk factors, evaluating the usefulness of FRAX® as a screening method to identify patients at a higher risk of fracture. METHODS: This was a cross-sectional study. Demographic, clinical, and analytical data were collected in a randomized sample of LC patients attending the Hepatology Department of a university hospital. We assessed the absolute risk of fracture at 10 years (FRAX®) and based on the bone mineral density (BMD), the presence of morphometric vertebral fracture with a vertebral fracture assessment (VFA), or a thoracic and lumbar X-ray and bone microarchitecture with a trabecular bone score (TBS). RESULTS: Ninety-two patients were included (71% male); the mean age was 63 ± 11.3 years. The main etiology of LC was alcoholism (52.2%), and most patients were Child-Pugh A (80.4%), with a mean model for end-stage liver disease (MELD) score of 10.1 ± 3.6. Sixteen patients (17.4%) had osteoporosis, and fifty-four (58.7%) had osteopenia. Eight patients (8.7%) had suffered at least one fragility fracture. The absolute risk of a major fracture according to FRAX without the BMD was 5.7 ± 4.5%. Risk factors associated with osteoporosis were age and the female sex. BMI > 30 was a protective factor. A FRAX cut-off point for a major fracture > 6.6% had a sensitivity of 69% and a specificity of 85% for a diagnosis of osteoporosis. CONCLUSIONS: The prevalence of osteoporosis and fractures in patients with LC is high, particularly in older women. FRAX® may be a useful method to identify candidates for bone densitometry. A FRAX value below 6.6% without the BMD can avoid unnecessary testing.

Evaluation of autonomic cardiac modulation and body composition in elderly submitted to the protocol of exercise and the gametherapy: A clinical trial protocol (SPIRIT compliant).

INTRODUCTION: Aging affects the cardiovascular system by impairing the amount and strength of cardiac pumping. Heart rate variability (HRV) is a safe parameter to assess variations in the cardiovascular system, providing data on sympathetic and parasympathetic activations. OBJECTIVES: Our primary aim is to investigate the cardiac autonomic modulation and body composition of active older adults participating in a physical exercise protocol and gametherapy. Our secondary aim is to assess their functional capacity, cognitive function, balance, respiratory pressures, and functional autonomy. METHOD: This randomized clinical trial will include 100 active older adults aged 60 to 80 years. The exercise group (EG) will perform 24 supervised training sessions (strength and aerobic) for 12 weeks (2 60-minutes sessions per week). The gametherapy group (GG) will exercise using gametherapy. Assessments will occur on the first week, after the 12th week, after wash out and in the end of cross over. The primary outcome will be HRV and body composition (bioimpedance). Secondary outcomes will be functional capacity (6-minute walk test), cognitive function (mini-mental state examination), risk of falls and balance (berg balance scale and timed up and go test), inspiratory and expiratory pressures (manovacuometry) and functional autonomy (functional reach test and group of Latin American development to maturity [GDLAM] protocol). DISCUSSION: This study will provide relevant information about the effects of physical training (physical exercises and gametherapy) on HRV and other variables in active older adults.

Biomarker candidates for progression and clinical management of COVID-19 associated pneumonia at time of admission.

COVID-19 pathophysiology is currently not fully understood, reliable prognostic factors remain elusive, and few specific therapeutic strategies have been proposed. In this scenario, availability of biomarkers is a priority. MS-based Proteomics techniques were used to profile the proteome of 81 plasma samples extracted in four consecutive days from 23 hospitalized COVID-19 associated pneumonia patients. Samples from 10 subjects that reached a critical condition during their hospital stay and 10 matched non-severe controls were drawn before the administration of any COVID-19 specific treatment and used to identify potential biomarkers of COVID-19 prognosis. Additionally, we compared the proteome of five patients before and after glucocorticoids and tocilizumab treatment, to assess the changes induced by the therapy on our selected candidates. Forty-two proteins were differentially expressed between patients' evolution groups at 10% FDR. Twelve proteins showed lower levels in critical patients (fold-changes 1.20-3.58), of which OAS3 and COG5 found their expression increased after COVID-19 specific therapy. Most of the 30 proteins over-expressed in critical patients (fold-changes 1.17-4.43) were linked to inflammation, coagulation, lipids metabolism, complement or immunoglobulins, and a third of them decreased their expression after treatment. We propose a set of candidate proteins for biomarkers of COVID-19 prognosis at the time of hospital admission. The study design employed is distinctive from previous works and aimed to optimize the chances of the candidates to be validated in confirmatory studies and, eventually, to play a useful role in the clinical practice.

Necessidade e dinâmica da força de trabalho na Atenção Básica de Saúde no Brasil / Needs and dynamics of the Primary Healthcare workforce in Brazil

Resumo A Atenção Básica e a Força de Trabalho em Saúde podem ser consideradas os grandes desafios do SUS, principalmente nas duas últimas décadas. Este artigo teve como objetivo descrever o crescimento e a distribuição regional das profissões de nível superior cadastradas em UBS. Estudo descritivo, de abordagem quantitativa, sobre as catorze profissões de nível superior nas cinco regiões brasileiras, de 2008 a 2013. Entre as categorias profissionais com as maiores taxas de crescimento nacional estão os professores de educação física, os nutricionistas, os terapeutas ocupacionais, os fisioterapeutas e os farmacêuticos. No Norte, a fisioterapia, o serviço social e a fonoaudiologia se destacaram com as maiores taxas de crescimento; no Nordeste, a educação física, a fisioterapia e a terapia ocupacional; no Centro-Oeste, os destaques são a nutrição e a fisioterapia; no Sudeste, nutrição e farmácia; e a educação física apresentou crescimento proeminente no Sul. As maiores perdas ocorreram nas profissões biólogo e médico veterinário, em todas as regiões. De modo geral, as categorias profissionais que podem compor o NASF apresentaram crescimento superior aos enfermeiros e médicos.

Abstract Primary care and the healthcare workforce can be considered the greatest challenges of SUS (Sistema Único de Saúde), principally in recent decades. This article aims to describe the growth and regional distribution of the professions requiring higher education registered in the primary healthcare units. This descriptive study with a quantitative approach is concerned with the 14 accredited professions in the five major regions of Brazil from 2008 to 2013. The data was collected from the national database of the Ministry of Health. Among the professional categories with the greatest rates of national growth are physical education teachers, nutritionists, occupational therapists, physiotherapists, and pharmacists. In the North region of Brazil, physiotherapy, social work, and speech therapy stand out as having the greatest growth rates; in the Northeast, physical education, physiotherapy, and occupational therapy; and in the Center-West, nutrition and physiotherapy; in the Southeast, nutrition and pharmacology; and physical education showed prominent growth in the South. The major losses occurred in the professions of biologist and veterinary doctors in all regions. In general, the professional categories that comprise the Family Health Support Nuclei, NASF, demonstrate greater growth rates than nurses and doctors.

Needs and dynamics of the Primary Healthcare workforce in Brazil. / Necessidade e dinâmica da força de trabalho na Atenção Básica de Saúde no Brasil.

Primary care and the healthcare workforce can be considered the greatest challenges of SUS (Sistema Único de Saúde), principally in recent decades. This article aims to describe the growth and regional distribution of the professions requiring higher education registered in the primary healthcare units. This descriptive study with a quantitative approach is concerned with the 14 accredited professions in the five major regions of Brazil from 2008 to 2013. The data was collected from the national database of the Ministry of Health. Among the professional categories with the greatest rates of national growth are physical education teachers, nutritionists, occupational therapists, physiotherapists, and pharmacists. In the North region of Brazil, physiotherapy, social work, and speech therapy stand out as having the greatest growth rates; in the Northeast, physical education, physiotherapy, and occupational therapy; and in the Center-West, nutrition and physiotherapy; in the Southeast, nutrition and pharmacology; and physical education showed prominent growth in the South. The major losses occurred in the professions of biologist and veterinary doctors in all regions. In general, the professional categories that comprise the Family Health Support Nuclei, NASF, demonstrate greater growth rates than nurses and doctors.

A Atenção Básica e a Força de Trabalho em Saúde podem ser consideradas os grandes desafios do SUS, principalmente nas duas últimas décadas. Este artigo teve como objetivo descrever o crescimento e a distribuição regional das profissões de nível superior cadastradas em UBS. Estudo descritivo, de abordagem quantitativa, sobre as catorze profissões de nível superior nas cinco regiões brasileiras, de 2008 a 2013. Entre as categorias profissionais com as maiores taxas de crescimento nacional estão os professores de educação física, os nutricionistas, os terapeutas ocupacionais, os fisioterapeutas e os farmacêuticos. No Norte, a fisioterapia, o serviço social e a fonoaudiologia se destacaram com as maiores taxas de crescimento; no Nordeste, a educação física, a fisioterapia e a terapia ocupacional; no Centro-Oeste, os destaques são a nutrição e a fisioterapia; no Sudeste, nutrição e farmácia; e a educação física apresentou crescimento proeminente no Sul. As maiores perdas ocorreram nas profissões biólogo e médico veterinário, em todas as regiões. De modo geral, as categorias profissionais que podem compor o NASF apresentaram crescimento superior aos enfermeiros e médicos.

Expansão e diversificação da força de trabalho de nível superior nas Unidades Básicas de Saúde no Brasil, 2008 - 2013 / Expansion and diversification of university level workforce in Primary Health Care Units Brazil: 2008 - 2013

RESUMO Este artigo objetiva identificar os trabalhadores de nível superior cadastrados nas Unidades Básicas de Saúde (UBS) entre 2008 e 2013, visando contribuir com o debate sobre o planejamento da força de trabalho na Atenção Básica em saúde. Trata-se de estudo descritivo, retrospectivo e de abordagem quantitativa. Embora médicos, enfermeiros e cirurgiões-dentistas componham as ocupações de nível superior tradicionalmente hegemônicas nas UBS, constatou-se a ampliação da participação de outras categorias profissionais, o que se atribui à implantação de equipes do Núcleo de Apoio à Saúde da Família em todo o País.

ABSTRACT This article aims to identify the university level workforce enrolled in the Primary Health Care Units (UBS) between 2008 and 2013, to contribute to the debate on the primary health care workforce planning. It is a descriptive and retrospective study of quantitative approach. Although physicians, nurses and dentists comprise the traditionally hegemonic university level workforce in UBS, there was observed an increasing participation of other professional categories, which may be due to the implementation of health supporting teams throughout the Country.

A 3-Arm Randomized Trial for Achilles Tendinopathy: Eccentric Training, Eccentric Training Plus a Dietary Supplement Containing Mucopolysaccharides, or Passive Stretching Plus a Dietary Supplement Containing Mucopolysaccharides.

BACKGROUND: Tendinopathy is an overuse tendon injury that occurs in loaded tendons and results in pain and functional impairment. Although many treatments for painful tendons are described, the scientific evidence for most of the conservative and surgical treatments is not always conclusive. OBJECTIVES: This study was designed to evaluate the efficacy of 3 different interventions in patients with Achilles tendinopathy. The interventions include the combination of 2 physical therapy programs (eccentric training [EC] or passive stretching [PS]) with a supplement containing mucopolisaccharides. The efficacy of the interventions was evaluated depending on the stage of the disease. METHODS: Fifty-nine patients were randomly assigned to 1 of 3 treatment groups, and classified according to the disease stage: reactive versus degenerative tendinopathy. Treatment groups were EC; EC + a dietary supplement containing mucopolisaccharides, type I collagen, and vitamin C (MCVC); and a passive stretching program + MCVC. Patients were evaluated at baseline, 6 weeks, and 12 weeks with the Victorian Institute of Sports Assessment-Achilles questionnaire for function, a visual analog scale for pain, and ultrasound characterization for the evolution of tendon structure. RESULTS: A significant improvement in Victorian Institute of Sports Assessment-Achilles questionnaire score, pain at rest, and pain during activity were detected in all 3 treatment groups at 6 and 12 weeks' follow-up when compared with baseline. In patients with reactive tendinopathy, the reduction in pain at rest was greater in the groups who took the supplemental MCVC than in the EC alone group (P < 0.05). CONCLUSIONS: MCVC seems to be therapeutically useful for management of tendinopathies, providing some additional benefit to physical therapy. This is especially evident in early stages of the disease, when the tendon does not present severe matrix and vascular changes. CLINICALTRIALSGOV IDENTIFIER: NCT01691716.

Interações medicamentosas potencias em unidades de terapia intensiva de um hospital do Sul do Brasil / Potential drug-drug interactions in intensive care units of a hospital in Southern Brazil

As interações medicamentosas são importantes causas de reações adversas em unidades de saúde. O elevado consumo de medicamentos em unidades de terapia intensiva predispõe os pacientes a um risco potencial de ocorrência de interações medicamentosas. O objetivo deste estudo foi determinar a frequência e as características das interações medicamentosas potenciais em unidades de terapia intensiva do Hospital Universitário da Universidade Estadual de Londrina Foram analisadas as prescrições de pacientes maiores de 18 anos internados no período de janeiro a maio de 2010, com permanência de pelo menos quatro dias.A análise das interações medicamentosas foi realizada utilizando-se o sistema Micromedex Drug-Reax®. As interações foram classificadas por gravidade, tempo necessário para o início dos efeitos adversos, mecanismo de ação e qualidade da evidência científica. Além disso, foram analisados os possíveis eventos adversos relacionados às interações, bem como as estratégias de manejo e monitoramento recomendadas. Ao todo foram identificadas 198 diferentes interações medicamentosas potenciais com a ocorrência de 1242 episódios. Destes, 43% foram caracterizados por interações de gravidade moderada, 35% graves,16% leves e 6% contra-indicadas. A ineficácia terapêutica foi o possível evento adverso mais frequente(18%) e a principal estratégia de manejo recomendada foi o ajuste de dose (35,6%). As interações mais frequentes foram: fentanil + midazolam (8,6%), fenitoína + ranitidina (5,5%) e midazolam + ranitidina(4,8%). Os resultados identificados demonstram a importância das interações medicamentosas como evento adverso significativo em unidades de terapia intensiva e, portanto, medidas preventivas são necessárias para minimizar este problema. .

Drug-drug interactions are important causes of adverse reactions in health units. The high consumption of medicines in intensive care units predisposes patients to potential drug-drug interactions. The aim of this study was to examine the frequency and the characteristics of drug-drug interactions in intensive care units of University Hospital of State University of Londrina. We analyzed the prescriptions of patients over 18 years, admitted from January to May 2010, who remained hospitalized for at least four days. The analysis of drugdrug interactions was carried out using the Micromedex Drug-Reax® system. The interactions were classified by severity, time required for the onset of adverse effects, mechanism of action and quality of scientific evidence. Moreover, the possible adverse events were analyzed, as well as the recommended strategies of management and monitoring. Altogether, 198 different potential drug-drug interactions were identified with the occurrence of 1242 episodes. Of these, 43% were characterized by moderate interactions, 35% major,16% minor and 6% contraindicated. The therapeutic inefficacy was the most frequent possible adverse event(18%) and the main recommended strategy of management was the dose adjustment (35.6%). The most frequent interactions were: fentanyl + midazolam (8.6%), phenytoin + ranitidine (5.5%) and midazolam + ranitidine (4.8%). These results demonstrate the importance of drug-drug interactions as a significant adverseevent in intensive care units and thus, preventive measures are required to minimize this problem.

Participação do fisioterapeuta na auditoria em saúde / Participation of the physical therapists in health audit

A auditoria consiste num exame sistemático de documentos como objetivo de verifi car se as atividades de uma organização estão deacordo com as disposições estabelecidas. O Sistema Nacional deAuditoria enfatiza a importância do trabalho em equipe, porémmédicos e enfermeiros assumem grande parte das atividades deauditoria em saúde e farmacêuticos e odontólogos incorporaramessa atividade recentemente, conforme regulamentações de seusConselhos de Classe. Mas ainda existem profi ssões que não atuamna área, como a Fisioterapia. Esta pesquisa descritiva analisoufatores que justifi cam a participação do fi sioterapeuta nas equipesde auditoria. Foram consultadas as bases de dados Lilacs e Scielo,livros texto e documentos eletrônicos do Ministério da Saúde eConselhos de Classe de profi ssões da saúde relacionados com aatividade de auditoria, no período de 1996 a 2008. A importânciada equipe multidisciplinar em auditoria, a formação profi ssionaldo fi sioterapeuta e os gastos públicos destinados à assistência emFisioterapia parecem motivos sufi cientes para o entendimento daparticipação deste profi ssional nas equipes, pois o conhecimentotécnico é essencial para uma auditoria criteriosa. Espera-se que estasinformações possam promover uma refl exão na busca de estratégiasque possam incluir o fi sioterapeuta nas equipes de auditoria de saúde...

Th e audit consists of a systematic examination aiming to verifyif the activities of an organization are in accordance to the establishedlaws. Th e National Audit System emphasizes the importanceof teamwork, however doctors and nurses assume most of theactivities of audit in health, and pharmacists and dentists have justincorporated this activity, as per their Classroom Counsel Rules.Th ough, still some professions, such as physical therapy, who didnot perform this function. Th is descriptive research analyzed factorsthat justify the participation of physical therapist in the audit teams.Databases Lilacs and Scielo were consulted as well as book textsand electronic documents related to the activity of audit in healthfrom 1996 to 2008. Th e importance of multidisciplinary team inaudit, the professional formation of physical therapist and publicexpenses assigned to physical therapy assistance seem to be enoughto understand the need of participation of this professional in theaudit teams, as technical knowledge is essential for a discerningaudit. One expects that this information can promote a refl ectionin the search of strategies that can include the physical therapist inthe teams of health audit...

Análise descritiva quantitativa do palmito de pupunheira / Quantitative descriptive analysis of pejibaye palm heart

Este estudo foi conduzido para descrever o perfil sensorial do palmito de pupunha. A análise descritiva quantitativa (ADQ) foi utilizada para descrever os atributos sensoriais relacionados à aparência, aroma, e textura de três marcas comerciais de palmito de pupunha. As amostras foram avaliadas por uma equipe selecionada com onze provadores e foram definidos nove atributos sensoriais: cor amarela, aparência uniforme e úmida, aroma e sabor não característicos, sabor acido, residual acido e textura macia. Houve diferenças significativas em seis atributos entre as três marcas testadas. Os provadores descreveram os palmitos de pupunha como: cor amarela clara, aparência uniforme e úmida, aroma e sabor não característicos e sabor ácido com valores intermediários, residual acido e amargor final com valores de pouco e textura muito macia a uma textura intermediária.

This research was carried out to establish the sensory profile of pejibaye palm heart. The quantitative descriptive analysis was used to establish the sensory attributes related to appearance, flavor, taste and texture of tree commercial marks of pejibaye palm heart. These samples were evaluated by eleven trained panelists who described nine sensory attributes: yellow color, uniform and humid appearance, non-characteristic aroma and flavor, acid flavor, residual acid taste, and soft texture. There were significant differences in six attributes among the three tested marks. Panelists described the pejibaye palm heart as: light yellow color, uniform and humid appearance, non-characteristic aroma and flavor, acid flavor with medium values, acid residual taste and bitterness final taste from little values and high soft texture to an medium value texture.

Treinamento de manipuladores de alimentos: uma revisão de literatura / Training of food handling: a review literature

As empresas produtoras de alimentos e refeições vêm se preocupando em investir no aperfeiçoamento de técnicas que promovam o fornecimento de alimentos com qualidade higiênco-sanitária, entre elas o treinamento de manipuladores de alimentos. Considerando o grande desafio que essa atividade educativa representa, o presente trabalho teve como objetivo identificar o conteúdo e as estratégias pedagógicas normalmente empregadas as dificuldades enfrentadas na implementação dos cursos e as soluções propostas. Para isso, realizou-se uma revisão bibliográfica entre 1994-2003. Verificou-se que o tema relacionado à higiene na manipulação de alimentos prevaleceu como conteúdo empregado. A estratégia de ensino predominante foi a utilização de aulas expositivas aliadas á atividades de dinâmicas de grupo. Para monitoramento foram consideradas, pela maioria dos autores pesquisados e pela OMS, a implementação e a manutenção de Boas Práticas na Produção de Alimentos e do sistema APPCC (Análise de Perigos e Pontos Críticos de Controle). As principais dificuldades citadas foram: o nível de escolaridade dos manipuladores de alimentos, sua indisponibilidade de horário para realização do treinamento e a ausência de participação da gerência. As soluções propostas se resumiram em implementar a fiscalização e a orientação para cumprimento da legislação específica, preparar os responsáveis pelo treinamento para a atividade pedagógica e envolver a gerência nesse projeto.

O treinamento de merendeiras: análise do material instrucional do Instituto de Nutriçäo Annes Dias: Rio de janeiro (1956-94) / The training of public school cafeteria staff: an analysis of the instructional material developed by Instituto de Nutriçäo Annes Dias: Rio de Janeiro (1956-1994)

Analisa a concepçäo educacional do treinamento de merendeiras nos anos de 1956 a 1994, a partir de 17 boletins instrumentais produzidos pelo Instituto de Nutriçäo Annes Dias, no município do Rio de Janeiro. A análise documental considerou dois períodos: de 1956 a 1971, caracterizado pela criaçäo do instituto e pelo esboço das primeiras atividades de treinamento; e de 1972 a 1994, caracterizado pela consolidaçäo da estrutura organizacional do instituto e da concepçäo educativa da atividade de treinamento. Ficou evidenciado que o treinamento teve como foco a dimensäo técnica do trabalho das merendeiras e a recorrência dos temas de higiene e organizaçäo do serviço. A discussäo sobre a formaçäo das merendeiras passa pela definiçäo de que trabalhadora se quer formar, o que antecede a preocupaçäo com as competências (saberes e habilidades) que devem desenvolver.

[The training of public school cafeteria staff: an analysis of the instructional material developed by Instituto de Nutrição Annes Dias - Rio de Janeiro (1956-1994)]. / O treinamento de merendeiras: análise do material instrucional do Instituto de Nutrição Annes Dias - Rio de Janeiro (1956-94).

The present study aims at analyzing educational approaches in the training of public school cafeteria staff members from 1956 to 1994 through the study 17 instructions brochures developed by Instituto de Nutrição Annes Dias in the municipality of Rio de Janeiro. The analysis of the documents has considered two periods: the first one, from 1956 to 1971, is characterized by the foundation of the institute and its first training activities; the second period goes from 1972 to 1994, which is characterized by the consolidation of the institute's organizational structure and the presence of educational concepts in its training activities. Training focused on technical aspects and recurrently alluded to hygiene and organization. Discussions on the training of school cafeteria staff members should define what kind of workers is expected before defining what skills and abilities they are expected to develop.

Reflexões sobre a coerência discurso-prática no processo de interação usuário e equipe de enfermagem: uma experiência no Centro de Saúde Escola de Botucatu / Reflexions about coherence between speech and practice among users and nursing staff: an experience at Centro de Saúde Escola de Botucatu

Esse estudo analisa a capacidade de comunicação da equipe de enfermagem perante os usuários do Centro de Saúde Escola de Botucatu, em São Paulo. O eixo norteador da análise é refletir sobre a coerência entre o entre o discurso/prática e o sistema de linguagem utilizado pela equipe de enfermagem como uma das ferramentas na interação junto aos usuários desse serviço. A partir dos resultados obtidos, as autoras apontam a possibilidade de viabilizar a coerência entre discuros e prática. As conclusões deste trabalho sinalizam a necessidade de maior exploração do tema voltada para os efeitos de diversas formas de comunicação, como co-responsáveis pelas ações de saúde junto à população.

Estudo de internaçöes hospitalares do Sistema Único de Saúde, em municípios em gestäo semi plena, no Estado de Säo Paulo, entre 1994-1999 / Study of hospital admissions in the Single Health System (SUS), in partial administration countries in the State of São Paulo, between 1994 and 1999

Objetivo: O trabalho estuda o processo de implantação do Sistema Único de Saúde (SUS) com base na estratégia definida na Norma Operacional Básica do SUS 01/93. É feito uma síntese do seu eixo principal - a descentralização, desde a sua relação com a democracia no Continente Americano, no Brasil, e em especial na saúde destacando-se conceitos, fases, experiências, avanços e retrocessos até a unidade de analise que se pretende atingir: a questão municipal. São apresentadas as várias condições previstas na norma, sua evolução e responsabilidades dentre outras enfocou-se a gestão semi plena sobre os serviços hospitalares em particular sobre suas internações. Método: O universo do estudo constituiu-se de onze municípios no Estado de São Paulo, trabalhados através do Estudo de Casos, onde foram analisados quanto a evolução na oferta de leitos hospitalares, volume de internações, permanência, procedimentos e mortalidade entre outras variáveis, utilizando-se como fonte de dados as Autorizações de Internações Hospitalares (AIHs) pagas pelo SUS entre 1994 a 1999 considerando os períodos antes e depois. Resultados: Foram identificados aspectos relacionados a alterações de indicadores, assim como seus efeitos sobre a mudança pretendida. Conclusões: O estudo mostra a ocorrência de mudanças importantes nas internações hospitalares pagas pelo SUS no período da gestão semi plena como indicativo que pode e deve ser complementado com outros estudos que avaliem mais profundamente as mudanças encontradas nesses municípios