Increased risk of bladder cancer recurrence due to bacillus Calmette-Guérin shortage in Brazil.

OBJECTIVE: Our study aimed to evaluate the impact of bacillus Calmette-Guérin shortage on recurrence and progression in patients with non-muscle invasive bladder cancer in a Brazilian cohort. METHODS: We retrospectively reviewed the clinicopathological data of 409 patients who had their first transurethral resection of the bladder tumor for intermediate or high-risk non-muscle invasive bladder cancer between June 2014 and May 2021 in a tertiary public hospital in Brazil. Patients included had non-muscle-invasive urothelial carcinoma of the bladder resected completely for the first time, regardless of bacillus Calmette-Guérin use. Low-risk disease patients were excluded from the analysis. Demographic, clinicopathological, and bacillus Calmette-Guérin use data were collected from our database. Recurrence and progression data were obtained from patient records or through telephone interviews. Recurrence-free survival and progression-free survival were calculated from the date of transurethral resection of the bladder tumor until the events of recurrence, progression, last office visit, or phone interview. RESULTS: Within a median follow-up period of 26.7 months, 168 (41.1%) patients experienced a recurrence in a median time of 27 months (95%CI 16.1-38). Bacillus Calmette-Guérin was administered to 57 (13.9%) individuals after transurethral resection of the bladder tumor. Patients with ≥3 lesions (p<0.001), those with lesions >3 cm (p=0.02), and those without bacillus Calmette-Guérin treatment (p<0.001) had shorter recurrence-free survival. According to a Cox multivariate regression model, bacillus Calmette-Guérin use was independently associated with a reduced recurrence rate, with an HR of 0.43 (95%CI 0.25-0.72). Out of the patients studied, 26 (6.4%) experienced progression. T1 stage (p<0.001) and high-grade (p<0.001) were associated with shorter progression-free survival. Bacillus Calmette-Guérin did not influence bladder cancer progression. In the Cox multivariate analysis, high-risk disease was independently associated with progression (p<0.001). CONCLUSION: Our study confirms that non-muscle invasive bladder cancer exhibits a high recurrence rate. The use of adjuvant bacillus Calmette-Guérin in intermediate and high-risk patients significantly reduces this rate. Furthermore, the bacillus Calmette-Guérin shortage could have negatively impacted these patients.

Capacidade de comunicação das entidades do CNS nos meios digitais: há assimetrias expressivas entre os segmentos? / Communication capacity of NHC entities in digital media: are there significant asymmetries among segments?

Resumo Apresentamos os resultados de uma pesquisa inédita que analisou os processos e as estratégias de comunicação das entidades titulares do Conselho Nacional de Saúde, gestão 2018-2021. A produção autônoma de comunicação alternativa pela sociedade civil consiste num dos princípios fundamentais dos regimes democráticos para um importante autor norte-americano institucionalista (Robert Dahl). A emergência da Internet e das redes sociais trouxe novas necessidades para essas organizações divulgarem suas ideias e se fazerem presentes na sociedade em rede (Castells). O estudo teve como objetivo analisar em que medida essas entidades estão inseridas no meio digital e verificar se havia diferenças expressivas na capacidade de comunicação entre os segmentos representados no Conselho. Um inquérito foi aplicado às áreas de comunicação de 42 entidades do CNS de setembro de 2019 a fevereiro de 2020. Foram obtidas 34 respostas (81%). Os resultados mostram a existência de 3 níveis de desenvolvimento no trabalho de comunicação entre essas entidades, independentemente das categorias macro institucionais. Ao final, discute-se os resultados à luz dos modelos da poliarquia e da democracia digital, e são apontados novos passos para uma comunicação e participação efetivamente democráticas.

Abstract This work presents the results of a study that analyzed the processes and communication strategies by the entities represented in the National Health Council (NHC), 2018-2021 administration. The production of alternative communication by civil society constitutes one of the fundamental principles of democratic regimes for an important American institutionalist author (Robert Dahl). The emergence of the Internet and social networks has brought new demands for these organizations to disseminate their ideas and be present in this network society (Castells). Our study aimed to analyze the extent to which these entities are present in the digital media and to verify if there were significant differences in the communication capacity among the segments represented in the NHC. A survey was applied to the communication departments of the 42 NHC entities from September 2019 to February 2020. Thirty-four answers were obtained (81%). The results show the existence of 3 different levels of development in communication within these entities, regardless of the macro-institutional categories. Our article ends by discussing the results in light of the polyarchy and the digital democracy models and highlighting new steps towards effective democratic communication policies and participation.

Representações sociais de papeleiros acerca do trabalho e moradia: o caso da Vila Chocolatão / Las representaciones sociales de los "colectores de reciclables" sobre el trabajo y la vivienda: el caso de la "Vila Chocolatão" / The social representations of "recyclable collectors" of work and housing: the case of "Vila Chocolatão"

Representações sociais acerca da esfera pública e privada e do significado do trabalho foram investigadas em adultos, catadores de lixo reciclável, residentes na "Vila Chocolatão", localizada na região central de Porto Alegre/RS. O método de abordagem utilizado foi a descrição etnográfica, seguida da análise de conteúdo de registros de diálogos informais, diários de campo e entrevistas. Os resultados evidenciaram que o contexto pesquisado emerge como metáfora das contradições e do "apagamento" entre as esferas pública e privada na sociedade contemporânea. As representações sociais acerca das categorias "trabalho" e "moradia" estão ancoradas na complexidade de seu cotidiano. Quanto às ações políticas as dissonâncias entre os órgãos públicos envolvidos na comunidade refletiu a ausência de um projeto comum e a falta de comunicação tanto entre os setores como entre os moradores, dificultando a implementação de diversas políticas públicas pretendidas, aprofundando, deste modo, a insegurança e os conflitos locais.

Representaciones sociales de la esfera pública y privada y el significado del trabajo se investigaron en adultos, colectores de materiales reciclables en "Vila Chocolatão", ubicado en el centro de Porto Alegre/RS. Como método de enfoque se utilizó la descripción etnográfica, seguido de un análisis de contenido de los registros de diálogos informales, diarios y entrevistas. Los resultados mostraron que el contexto de la investigación surge como una metáfora de las contradicciones y el "borrado" entre las esferas pública y privada en la sociedad contemporánea. Representaciones sociales de las categorías "trabajo" y "vivienda" están anclados en la complejidad de su vida cotidiana. En las acciones políticas, la disonancia entre los organismos públicos que participan en la comunidad refleja la ausencia de un proyecto común y la falta de comunicación tanto entre sectores como entre los residentes, por lo que es dificultada la implementación de diversas políticas necesarias, profundizando así la inseguridad y los conflictos locales.

Social representations about the public and private sphere and the meaning of work were investigated in adult collectors of recyclables, residents' Chocolatão Village "located in central Porto Alegre / RS. The ethnographic description was used as a method of approach to research, then a content analysis of the informal dialogues, diaries and interviews. The results showed that the researched context emerges as a metaphor of the contradictions and the "blurring" between the public and private spheres in contemporary society. Social representations of the categories "work" and "home" are rooted in the complexity of everyday life. As for the actions of political dissonance between the various agencies involved with the community reflected the absence of a common project and lack of communication both between sectors and between the villagers, hindering the implementation of various policies intended, deepening, thus, mistrust and conflict in the community.