Bone marrow biopsy in the initial staging of Ewing sarcoma: Experience from a single institution.

BACKGROUND: Ewing sarcoma (ES) is the second most common bone tumor in adolescents and children. Staging workup for ES includes imaging and bone marrow biopsy (BMB). The effective role of BMB is now under discussion. PROCEDURE: A monoinstitutional retrospective analysis reviewed clinical charts, imaging, and histology of patients with diagnosis of ES treated at the Rizzoli Institute between 1998 and 2017. RESULTS: The cohort included 504 cases of ES of bone; 137 (27%) had metastases at diagnosis, while the remaining 367 had localized disease. Twelve patients had a positive BMB (2.4%). Eleven had distant metastases detected at initial workup staging with imaging assessment: six patients presented with bone metastases, five with both bone and lung metastases. Only one patient with ES of the foot (second metatarsus) was found to have bone marrow involvement with negative imaging evaluation (0.3%). CONCLUSIONS: On the basis of our data, we suggest reconsidering the effective role of BMB in initial staging workup for patients with ES with no signs of metastases by modern imaging techniques. In metastatic disease, the assessment of the bone marrow status may remain useful to identify a group of patients at very high risk who could benefit from different treatment strategies.

Extremely rare case of unilateral gigantomastia after hormonal stimulation treated with a modified wise pattern technique: A case report.

INTRODUCTION: Gigantomastia, characterized by excessive breast size (usually heavier than 2.5 kg), can result from various causes and significantly affect patients' lives. Surgical intervention is often required, and over time, several techniques have been developed for its treatment. These techniques aim to address the functional and aesthetic concerns associated with gigantomastia, providing relief to patients and improving their quality of life. PRESENTATION OF THE CASE: A 40-year-old primiparous housewife developed unilateral gigantomastia as a consequence of hormone therapy. To address this, a modified reduction mammoplasty procedure was undertaken, incorporating NAC (Nipple-Areola Complex) grafting. The reduction involved removing 3450 g of tissue, resulting in restored breast symmetry and enabling the patient to reintegrate into normal daily life. DISCUSSION: Compared to the traditional technique, the introduction of some modifications in the design allowed for the absence of complications such as dehiscence of the scar at the intersection of the T, the failure of the nipple graft attachment, and the maintenance of a conical shape over time, enabling complete symmetrization of the two breasts. CONCLUSION: The use of a modified version of the Thorek technique allowed for optimal functional and aesthetic restoration even in the case of a significantly disproportionate breast compared to the contralateral one, with no complications.

Proximal tibial resections and reconstructions: clinical outcome of 225 patients.

BACKGROUND: Previous studies reported variable outcome of proximal tibial resections and reconstructions. Therefore, we evaluated the survival, Musculoskeletal Tumor Society (MSTS) function, and complications of patients and reconstructions in this location. MATERIALS AND METHODS: We reviewed the files of 225 patients with proximal tibial tumors treated with proximal tibial resection, fixed or rotating hinge megaprosthetic reconstruction and extensor mechanism reattachment using sutures, mechanical clamping, artificial ligaments, and/or gastrocnemius flap from 1985 to 2010 (mean follow-up, 90 months; median, 56; range, 2-294). Survival of patients and reconstructions, type of hinge, extensor mechanism reconstruction, MSTS function, and complications were analyzed. RESULTS: Survival of patients with sarcomas was 68% and 62% at 5 and 10 years. Survival of megaprosthetic reconstructions was 82% and 78% at 5 and 10 years, without any difference between fixed and rotating hinge megaprostheses. MSTS function was significantly better in univariate and multivariate analysis for rotating compared to fixed hinge megaprostheses, without any difference between the types of extensor mechanism reconstructions. Most common complications were infection (12%), aseptic loosening (6%), and extensor mechanism rupture (3%). CONCLUSIONS: Rotating hinge proximal tibia megaprosthetic reconstructions have better function compared to fixed hinge, regardless of the type of extensor mechanism reconstruction.

Reducing agents decrease the oxidative burst and improve clinical outcomes in COPD patients: a randomised controlled trial on the effects of sulphurous thermal water inhalation.

BACKGROUND: Inhalation of thermal water with antioxidant properties is empirically used for COPD. AIMS: To evaluate the effects of sulphurous thermal water (reducing agents) on airway oxidant stress and clinical outcomes in COPD. METHODS: Forty moderate-to-severe COPD patients were randomly assigned to receive 12-day inhalation with sulphurous thermal water or isotonic saline. Patients were assessed for superoxide anion (O2 (-)) production in the exhaled breath condensate and clinical outcomes at recruitment, the day after the conclusion of the 12-day inhalation treatment, and one month after the end of the inhalation treatment. RESULTS: Inhalation of reducing agents resulted in a significant reduction of O2 (-) production in exhaled breath condensate of COPD patients at the end of the inhalatory treatment and at followup compared to baseline. A significant improvement in the COPD assessment test (CAT) questionnaire was shown one month after the end of the inhalatory treatment only in patients receiving sulphurous water. CONCLUSION: Thermal water inhalation produced an in vivo antioxidant effect and improvement in health status in COPD patients. Larger studies are required in order to evaluate whether inhalation of thermal water is able to modify relevant clinical outcomes of the disease (the study was registered at clinicaltrial.gov-identifier: NCT01664767).

Tumor response assessment by modified Choi criteria in localized high-risk soft tissue sarcoma treated with chemotherapy.

BACKGROUND: The objective of this study was to compare the prognostic relevance of Response Evaluation Criteria in Solid Tumors (RECIST) versus Choi criteria for the assessment of response in patients with high-risk soft tissue sarcoma of the extremities or trunk wall who received preoperative chemotherapy with or without radiotherapy in a phase 3 trial. METHODS: Patients received 3 cycles of preoperative epirubicin + ifosfamide with or without radiotherapy. The diagnostic concordance between RECIST and Choi criteria and their correlation with overall survival (OS) and freedom from progression (FFP) were evaluated in a univariate Cox regression model. RESULTS: In 243 of 321 eligible patients, RECIST, Choi criteria, and histology were predictive for OS and FFP. In the subgroup of 69 patients who received chemotherapy alone and were evaluable by both RECIST and Choi criteria, Choi criteria were associated significantly with OS and FFP, whereas RECIST predicted only FFP, and the pattern of agreement observed between the 2 criteria was unsatisfactory. On a dichotomous scale, comparing objective response (complete and partial responses) and lack of response (stable and progressive disease) to preoperative chemotherapy according to RECIST and Choi criteria, only Choi criteria were predictive of OS and FFP, and fair agreement between RECIST and Choi criteria was observed. When lack of progression and progression were compared (complete and partial responses + stable disease vs progressive disease), both assessment criteria were significantly predictive of OS and FFP, and there was substantial agreement between the 2 criteria. CONCLUSIONS: Response to chemotherapy with or without radiotherapy was associated with a better outcome in patients with high-risk soft tissue sarcoma. Choi criteria were better predictors than RECIST in patients who received preoperative chemotherapy alone.

Waldenstrom's Macroglobulinemia and Ascites: A Case Report.

Background: Waldenstrom's disease is characterized by the presence of pathological changes in the B lymphocytes that are in the last stages of maturation. One characteristic of WM is the production of an abnormal high amount of IgM and hyper viscosity syndrome. The MW gets worse, symptoms such as fatigue, weight loss, night sweats, fever, recurrent infections and swollen lymph nodes develop in patients who have a known history of MGUS. In this clinical case, our patient without history of MGUS, presents for the first time for medical observation only for ascites and the presence of an interportocaval lymph node package. An atypical presentation of the disease that makes us reflect on the difficulty of making a diagnosis in the elderly patient and on pathogenetic hypotheses of ascites not yet explored. Case Presentation: Seventy-three-year-old patient, hospitalized for the onset of ascites with sloping edema, diffuse left pulmonary opacification. At the ultrasound check, cava and portal vessels patent and of regular caliber, however with inversion of flow in correspondence with the right branch and of the door to the hilum, with a subdiaphragmatic retrocaval focus with a maximum diameter of about 3 cm, which cannot be better viewed. CT scan of the abdomen with confirmation of the presence of an interportocaval lymph node package. After evidence of the electrophoretic protein picture of a double component, probably monoclonal with positive urinary immunofixation for free K chains. IgM dosage equal to 2190 mg. Serum immunofixation practice that confirms the diagnosis of type B lymphoproliferative syndrome as per Waldenstrom's disease, confirmed by bone marrow aspiration with morphological and flow cytometric study. Immediately begin chemotherapy with Bendamustine 120 mg. After 4 weeks of therapy with the reduction of IgM values, the patient no longer presented ascites. Conclusion: This case has an unusual presentation of this disease and we could shed a new light on the possible pathogenesis of portal hypertension in Waldenstrom'disease.

Beneficial Metabolic Effect of a Nutraceuticals Combination (Monacolin K, Yeasted Red Rice, Polyphenolic Extract of Annurca Apple and Berberine) on Acquired Hypercholesterolemia: A Prospective Analysis.

Hypercholesterolemia represents a serious public health problem as it significantly increases the risk of developing cardiovascular diseases. Its treatment with statin is limited by costs, side effects, and drugs interactions. Nutraceuticals appear to have an important metabolic effect on cholesterol reduction as well as on body weight and glycemia. The aim of this study was to evaluate the effect of a nutraceutical combination (Melasterol) in eighty-seven patients with acquired hypercholesterolemia. Clinically relevant parameters were collected at baseline and after three and six months of Melasterol treatment, one tablet per day. The primary endpoint was the change in cholesterol and triglyceride levels. Six months of treatment resulted in a 19.2% decrease in total cholesterol, accompanied by a 19.8% decrease in low-density lipoprotein (LDL) and a 23% reduction in triglycerides (p < 0.001) but not in high-density lipoprotein (HDL) levels (p > 0.05). These results were paralleled by a significative blood glucose (108.3 ± 21.3 vs. 98.4 ± 18.6 mg/dL p < 0.001) and body mass index (BMI) reduction (27.8 ± 4.4 vs. 27.0 ± 4.2 mg/dL, p < 0.001). A subgroup of 12 patients performed flow-mediated dilation, with values increasing by 1.8% (p < 0.05). No significant side effects were reported. Besides its cholesterol-lowering effect, Melasterol was associated with a significant improvement in other relevant metabolic parameters such as BMI and glycemia.

Ultrasound Signs in the Diagnosis and Staging of Small Bowel Obstruction.

Ultrasound (US) is highly accurate in the diagnosis of small bowel obstruction (SBO). Because the indications for and timing of surgical intervention for SBO have changed over the past several decades, there is a widespread assumption that the majority of patients with simple SBO may be conservatively managed; in this scenario, staging SBO is crucial. This study evaluated the association between morphological and functional US signs in the diagnosis and staging (simple, decompensated and complicated), and the associations and prevalence of US signs correlated with clinical or surgical outcome. The US signs were divided into diagnostic (dilated bowel loops and altered kinesis) and staging criteria (extraluminal free fluid, parietal and villi alterations). We performed a retrospective, single-center cohort, observational study examining the prevalence of morphologic and functional US signs in the staging of simple, decompensated and complicated SBO. The most significant US signs were dilated bowel loops (100%), hypokinesis (90.46%), thickened walls (82.54%) and free fluid (74.60%). By linear regression, free fluid was positively correlated to US staging in both univariate and multivariate analysis; that is, the more advanced the stage of SBO, the more probable the presence of free fluid between the bowel loops. In univariate analysis only, we found a positive correlation between US staging/thickened walls and the prominence of valvulae conniventes. Additionally, the multivariate analysis indicated that parietal stratification and bowel jump kinesis were negative predictors for US staging in comparison to other US signs. In addition, we found significant associations between conservative treatment or surgery and hypokinesis (p = 0.0326), akinesis (p = 0.0326), free fluid (p = 0.0013) and prominence of valvulae conniventes (p = 0.011). Free fluid in particular was significantly less present in patients that were conservatively treated (p = 0.040). We conclude that the US staging of SBO may be crucial, with a valuable role in the initial diagnosis and staging of the pathology, saving time and reducing total radiation exposure to the patient.

Guillain-Barré syndrome and other neurological manifestations possibly related to Zika virus infection in municipalities from Bahia, Brazil, 2015. / Síndrome de Guillain-Barré e outras manifestações neurológicas possivelmente relacionadas à infecção pelo vírus Zika em municípios da Bahia, 2015.

Objective: to describe the reported cases of Guillain-Barré Syndrome (GBS) and other neurological manifestations with a history of dengue, chikungunya or Zika virus infections, in the Metropolitan Region of Salvador and in the municipality of Feira de Santana, Brazil. Methods: this is a descriptive study with data of an investigation conducted by the epidemiological surveillance from March to August 2015; to confirm the neurological manifestations, medical diagnosis records were considered, and to prior infection, clinical and laboratory criteria were used. Results: 138 individuals were investigated, 57 reported infectious process up to 31 days before neurological symptoms - 30 possibly due to Zika, 13 to dengue, 8 to chikungunya and 6 were inconclusive -; GBS was the most frequent neurological condition (n=46), with predominance of male sex (n=32) and the median age was 44. Conclusion: most cases reported a clinical picture consistent with acute Zika virus disease, which preceded the occurrence of neurological symptoms.

Rapid infusions of human normal immunoglobulin 50g/l are safe and well tolerated in immunodeficiencies and immune thrombocytopenia.

Intravenous immunoglobulin (IVIg) is accepted as an effective and well-tolerated treatment for primary and secondary immunodeficiencies (ID) and immune thrombocytopenia (ITP). Adverse reactions of IVIg are usually mild, comprising transient flu-like symptoms, change in blood pressure and tachycardia. However IVIg therapy can be burdensome for both patients and healthcare facilities, since the infusion may take up to 4h to administer. The objective of our multicentre, prospective, open-label phase III trial was to evaluate the tolerability and safety of human normal immunoglobulin 50g/l (Ig VENA) at high intravenous infusion rates in adult patients with ID and ITP who had previously tolerated IVIg treatment, by progressively increasing infusion rate up to 8ml/kg/hr. 39 ID patients received three infusions, 5 ITP patients received up to a maximum of 5 infusions for a maximum of 5days. Overall 55 adverse events were reported in 18 patients, and all were mild and self-limiting. Two serious adverse events occurred in ID patients and 1 in an ITP patient; none was fatal or treatment-related. No clinically significant changes or abnormalities were observed in vital signs, laboratory results and HRQoL. In summary, in this study, more rapid IVIg infusions were well tolerated by ID and ITP patients, while maintaining their quality of life, helping to minimise the time spent in outpatient hospital visiting to potentially optimise adherence to treatment.

Adjuvant radiotherapy with brachytherapy boost in soft tissue sarcomas.

PURPOSE: The standard primary treatment for soft tissue sarcoma (STS) is a wide surgical resection, preceded or followed by radiotherapy. Purpose of this retrospective study was to assess the efficacy of perioperative brachytherapy (BRT) plus postoperative external beam radiation therapy (EBRT) in patients with intermediate-high risk STS. MATERIAL AND METHODS: BRT delivered dose was 20 Gy. External beam radiation therapy was delivered with 3D-technique using multiple beams. The prescribed dose was 46 Gy to the PTV. Neoadjuvant and adjuvant chemotherapy (CHT) was used in patients with potentially chemosensitive histological subtypes. The primary aim of the study was to analyze overall survival (OS) and local control (LC) in a large patient population treated with surgery, perioperative BRT, and adjuvant EBRT ± CHT. Secondary objective was to identify prognostic factors for patients outcome in terms of LC, disease-free survival (DFS), and OS. RESULTS: From 2000 to 2011, 107 patients presenting 2-3 grade (FNLCC) primary or recurrent STS were treated with surgery, perioperative BRT, and adjuvant EBRT ± CHT. Five-year LC and OS were 80.9% and 87.4%, respectively. At univariate analysis, a higher LC was recorded in primary vs. recurrent tumors (p = 0.015), and in lower limb tumors vs. other sites (p = 0.027). An improved DFS was recorded in patients with lower limb tumors vs. other sites (p = 0.034). CONCLUSIONS: The combination of BRT and EBRT was able to achieve satisfactory results even in a patients population with intermediate-high risk STS. Patients with recurrent or other than lower limb sited tumors show a worse LC.

How the immune system responds to therapeutic biological agents.

Biological agents target disease mechanisms and have modified the natural history of several immune-mediated disorders. Biological agents are structurally immunogenic, and therefore usually elicit a minor, subclinical and transient phenomenon. Occasionally, however, these drugs induce complete cellular and humoral immune responses, with the main clinical consequences being hypersensitivity reactions or loss of treatment response. This article considers the relative pathogenic mechanisms influencing immunogenicity in biological agents and discusses mechanisms of tolerance and adaptive immune response, including adaptive T-regulatory cell induction and immune response induction. Methods of determining cellular and humoral immune response to biological agents are identified and examined. Assays to detect antidrug antibodies and their isotypes can assist in monitoring immunogenicity and in preventing adverse events. Such strategies also enable resource conservation and may provide regulatory authorities with new insights that can be useful during the process of approving new biological or biosimilar agents.

Síndrome de Guillain-Barré e outras manifestações neurológicas possivelmente relacionadas à infecção pelo vírus Zika em municípios da Bahia, 2015 / Síndrome de Guillain-Barré y otras manifestaciones neurológicas posiblemente relacionadas a la infección por virus Zika en municipios de Bahía, 2015 / Guillain-Barré syndrome and other neurological manifestations possibly related to Zika virus infection in municipalities from Bahia, Brazil, 2015

Objetivo: descrever os casos notificados de síndrome de Guillain-Barré (SGB) e outras manifestações neurológicas com histórico de infecção por dengue, chikungunya ou Zika, na Região Metropolitana de Salvador e no município de Feira de Santana, Brasil. Métodos: estudo descritivo com dados de investigação conduzida pela vigilância epidemiológica, de março a agosto de 2015; para confirmar as manifestações neurológicas, considerou-se o registro de diagnóstico médico, e para infecção prévia, utilizaram-se critérios clínicos e laboratoriais. Resultados: dos 138 casos suspeitos investigados, 57 relataram quadro infeccioso até 31 dias antes dos sintomas neurológicos - 30 prováveis de infecção por Zika, 13 por dengue, 8 por chikungunya e 6 inconclusivos -; SGB foi a condição neurológica mais frequente (n=46); houve predomínio do sexo masculino (n=32), e a mediana de idade foi de 44 anos. Conclusão: a maioria dos casos relatou quadro clínico compatível com doença aguda pelo vírus Zika, que precedeu a ocorrência dos sintomas neurológicos.

Objetivo: investigar los casos notificados de síndrome de Guillain-Barré (SGB) y otras manifestaciones neurológicas con antecedentes de infección por dengue, chikungunya o Zika en la Región Metropolitana de Salvador y Feira de Santana, Brasil. Métodos: estudio descriptivo con datos de la investigación realizada por la vigilancia epidemiológica, de marzo a agosto de 2015. ; para confirmar una manifestación neurológica se consideró el registro de diagnóstico médico y para infección previa, criterios clínicos y de laboratorio. Resultados: de los 138 casos sospechosos investigados, 57 presentaron un cuadro infeccioso, hasta 31 días antes de presentar síntomas neurológicos. - 30 probablemente con infección por zika, 13 dengue, 8 chikungunya y 6 no concluyentes -; de éstos, SGB fue la condición neurológica más frecuente (n=46), hubo un predominio del sexo masculino (n=32) y la mediana de edad fue 44 (rango: 2-83) años. Conclusión: la mayoría de los casos relató un cuadro clínico compatible con enfermedad aguda por virus Zika, que precedió la aparición de síntomas neurológicos.

Objective: to describe the reported cases of Guillain-Barré Syndrome (GBS) and other neurological manifestations with a history of dengue, chikungunya or Zika virus infections, in the Metropolitan Region of Salvador and in the municipality of Feira de Santana, Brazil. Methods: this is a descriptive study with data of an investigation conducted by the epidemiological surveillance from March to August 2015; to confirm the neurological manifestations, medical diagnosis records were considered, and to prior infection, clinical and laboratory criteria were used. Results: 138 individuals were investigated, 57 reported infectious process up to 31 days before neurological symptoms - 30 possibly due to Zika, 13 to dengue, 8 to chikungunya and 6 were inconclusive -; GBS was the most frequent neurological condition (n=46), with predominance of male sex (n=32) and the median age was 44. Conclusion: most cases reported a clinical picture consistent with acute Zika virus disease, which preceded the occurrence of neurological symptoms.

VIGILÂNCIA E ATENÇÃO À SAÚDE DE POPULAÇÕES EXPOSTAS A AGROTÓXICOS: METODOLOGIAS E PRÁTICAS INTEGRADAS / SURVEILLANCE AND ATTENTION TO THE HEALTH OF POPULATIONS EXPOSED TO PESTICIDES: METHODOLOGIES AND INTEGRATED PRACTICES / VIGILANCIA Y ATENCIÓN A LA SALUD DE POBLACIONES EXPUESTAS A LOS PLAGUICIDAS: METODOLOGÍAS Y PRÁCTICAS INTEGRADAS

O alto consumo de agrotóxicos na Bahia e o impacto do uso de agrotóxicos na saúde e no ambiente exigem a aplicação de metodologias integradoras de vigilância e atenção à saúde das populações expostas. O texto relata uma experiência de educação em saúde voltada para a construção de metodologias e práticas integradas de vigilância e atenção à saúde de populações expostas a agrotóxicos, por meio da capacitação de técnicos das secretarias estadual e municipais de saúde, dos âmbitos central, regional e municipal. Nessa experiência, adotou-se a metodologia dialógica, valorizando as experiências individuais. Utilizaram-se instrumentos e mecanismos que permitiram a construção coletiva com base em uma determinada temática, potencializando a reflexão crítica da realidade. A abordagem teve como princípio a articulação intra e interinstitucional, a gestão da informação para a ação e a qualificação das equipes de saúde para atuarem em situações de rotina e em eventos inusitados. O Grupo de Trabalho de Agrotóxicos da Secretaria da Saúde do Estado da Bahia elaborou o plano de ação estadual, identificando estratégias para sua operacionalização, dentre elas o curso para técnicos de municípios definidos como prioritários, das áreas de Vigilância em Saúde e Centro de Referência Regional em Saúde do Trabalhador, bem como das respectivas Diretorias Regionais de Saúde. A experiência vivenciada pelos participantes durante o processo de concepção e realização do curso foi transformadora enquanto metodologia participativa e aprendizado coletivo, possibilitando a reflexão sobre a prática e o agir dos sujeitos.

The high consumption of pesticides in Bahia and the impact of pesticide use on human health and the environment and require the application of integrative methodologies of surveillance and attention to the health of the exposed population. This text reports on a health education experience focused on building methodologies and integrated surveillance and health care practices for populations exposed to pesticides through the capacitation of technicians from state and municipal departments of health, central, regional and municipal areas. For this experience the dialogic methodology was adopted, valuing individual experiences. Tools and mechanisms that allowed the collective construction based on a particular subject, potentiate the critical reflection on reality. The approach has had as principle the articulation intra and inter institutional, the management of information for the action and the qualification of health teams to work in routine situations and in unusual events. The Pesticide Working Group of the Department of Health of the State of Bahia elaborated the state action plan, identifying strategies for its operation, including the course for technicians of the municir municipalities defined as priority areas of Public Health Surveillance and Occupational Health´s Reference Center as well as the respective Regional Health Board. The experience experimented by the participants during the process of conception and execution of the course was exceptional as participative methodology and collective learning, allowing the reflectio on the practice and action of the subjects.

El alto consumo de plaguicidas en Bahia y el impacto del uso de plaguicidas en la salud y el medio ambiente exigen la aplicación de metodologías integradoras de vigilancia y atención a la salud de las poblaciones expuestas. El texto presenta la experiencia de educación para la salud dirigida a la construcción de metodologías y prácticas integradas de vigilancia y atención a la salud de las poblaciones expuestas a los plaguicidas, a través de la capacitación técnica de las secretarías de salud estatal y municipal, de los niveles central, regional y municipal. Por lo tanto, se ha adoptado la metodología dialógica, para valorar las experiencias individuales. Se han utilizado instrumentos y mecanismos que permitieron la construcción colectiva basada en una temática específica, potenciando la reflexión crítica de la realidad. El abordaje tuvo como principio la articulación intrainstitucional e interinstitucional, el manejo de la información para la acción y la calificación de los equipos de salud para actuar en situaciones de rutina y eventos inusuales. El Grupo de Trabajo de Plaguicidas del Departamento de Salud de Bahia ha elaborado el plan de acción estatal identificando estrategias para su operacionalización, entre ellas el curso para técnicos de municipalidades definidas como prioritarias, de las áreas de vigilancia de la salud y de los centros de referencia de salud de los trabajadores, así como de las respectivas Juntas Directivas Regionales de Salud.

[A framework for health surveillance decentralization]. / Imagem-objetivo para a descentralização da vigilância sanitária em nível municipal.

No consensus has been reached concerning the definition of criteria and standards for evaluating the decentralization of actions by municipal health surveillance systems. With the aim of developing and validating an objective image for municipal health surveillance that would correspond to an appropriate system for the population's health care needs, a logical framework was elaborated, from which a matrix containing dimensions and criteria for management and practices was obtained. The framework was submitted to an expert group for validation at a consensus conference. Of the 54 criteria, there was consensus for 59.3%, while 53 items (98%) were considered important, thus validating the matrix. In view of the provisory nature of the consensuses, the resulting instrument, which can be used either in its entirety or in part, enables modification and adaptation. The authors discuss the potential of the evaluation strategy adopted here, which allows various possibilities for redefining the criteria and renewing the consensus.

Imagem-objetivo para a descentralização da vigilância sanitária em nível municipal / A framework for health surveillance decentralization

A descentralização das ações de vigilância sanitária não dispõe de critérios e padrões consensuais para sua avaliação. Objetivando formular e validar uma imagem-objetivo da vigilância sanitária municipal que corresponda à definição de um sistema municipal de vigilância sanitária adequado às necessidades da população, elaborou-se um modelo lógico do qual derivou uma matriz que contém dimensões e critérios para avaliar a gestão e as práticas. A matriz foi submetida a um grupo de especialistas, para validação, mediante conferência de consenso. Dos 54 critérios propostos, 59,3 por cento foram consensuais e 53 (98 por cento) importantes, o que correspondeu a validação da matriz. Considerando a provisoriedade de consensos assim obtidos, o instrumento produzido poderá ser modificado e adaptado. As autoras discutem o potencial da estratégia avaliativa aqui adotada que permite diversas possibilidades de redefinição de critérios e de renovação do consenso.

No consensus has been reached concerning the definition of criteria and standards for evaluating the decentralization of actions by municipal health surveillance systems. With the aim of developing and validating an objective image for municipal health surveillance that would correspond to an appropriate system for the population's health care needs, a logical framework was elaborated, from which a matrix containing dimensions and criteria for management and practices was obtained. The framework was submitted to an expert group for validation at a consensus conference. Of the 54 criteria, there was consensus for 59.3 percent, while 53 items (98 percent) were considered important, thus validating the matrix. In view of the provisory nature of the consensuses, the resulting instrument, which can be used either in its entirety or in part, enables modification and adaptation. The authors discuss the potential of the evaluation strategy adopted here, which allows various possibilities for redefining the criteria and renewing the consensus.

Imagem-objetivo para a descentralização da vigilância sanitária no município / Framework to decentralization of health surveillance on city

Introdução: a descentralização das ações de Vigilância Sanitária, apesar de impulsionada a partir da elaboração do Termo de Ajuste e Metas, não dispõe ainda de critérios e padrões consensuais a serem utilizados pelos Estados para sua avaliação. Objetivo - Formular e validar uma imagem-objetivo da vigilância sanitária no âmbito municipal que corresponda à definição do que seria um Sistema Municipal de Vigilância Sanitária adequado às necessidades da população. Metodologia - Foi realizado um estudo de desenvolvimento segundo tipologia de Contandriopoulos. Para a formulação da Imagem-Objetivo da descentralização da VISA, foi elaborado um modelo lógico a partir do qual se derivou uma matriz, contendo dimensões, critérios e indicadores capazes de avaliar a estrutura, a gestão e os resultados do Sistema Local de Vigilância Sanitária. A seleção dos critérios e indicadores apoiou-se em revisão da literatura, da síntese dos documentos e legislação pertinente. Em seguida, essa proposta foi submetida a um grupo de nove especialistas para validação através de uma técnica denominada Conferência de Consenso. Resultados - Dentre os critérios propostos, 59% apresentaram consenso, enquanto 41% dissenso. Apenas um foi considerado de pouca importância enquanto os 53 foram considerados importantes, o que nos autorizou a considerar que a matriz proposta foi validada pelos especialistas consultados. O consenso obtido, além de poder ser utilizado para a avaliação, poderá servir de referência para a organização e o aperfeiçoamento de sistemas municipais de VISA...