Coronary artery bypass graft surgery in Brazil from 2008 to 2017.

BACKGROUND: Brazil is an upper middle-income country in South America with the world's sixth largest population. Despite great advances in health-care services and cardiac surgical care in both its public and private health systems, little is known on the volume, outcomes, and trends of coronary artery bypass grafting (CABG) in Brazil's public health system. OBJECTIVE: The aim of this study was to evaluate the outcome of CABG on the public health system from January 2008 to December 2017 through the database DATASUS. METHODS: This study is based on publicly available material obtained from DATASUS, the Brazilian Ministry of Health's data processing system, on numbers of surgical procedures, death rates, length of stay, and costs. Only isolated CABG procedures were included in our study. We used the TabNet software from the DATASUS website to generate reports. The χ2 test was used to compare death rates. A p < .05 was considered statistically significant. RESULTS: We identified 226,697 CABG procedures performed from January 2008 to December 2017. The overall in-hospital mortality over the 10-year period was 5.7%. We observed statistically significant differences in death rates between the five Brazilian macro-regions. Death rates by state ranged from 2.6% to 13.1%. The national average mortality rate remained stable over the course of time. CONCLUSION: Over 10 years, a high volume of CABG was performed in the Brazilian Public Health System, with significant differences in mortality, number of procedures, and distribution of surgeries by region. Future databases involving all centers that perform CABG and carry out risk-adjusted analysis will help improve Brazilian results and enable policymakers to adopt appropriate health-care policies for greater transparency and accountability.

Impact of the COVID-19 pandemic on coronary artery bypass graft surgery in Brazil: A nationwide perspective.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has been a worldwide challenge, and efforts to "flatten the curve," including restrictions imposed by policymakers and medical societies, have forced a reduction in the number of procedures performed in the Brazilian Health Care System. The aim of this study is to evaluate the outcomes of coronary artery bypass graft (CABG) from 2008 to 2020 in the SUS and to assess the impacts of the COVID-19 pandemic in the number of procedures and death rate of CABG performed in 2020 through the database DATASUS. METHODS: This study is based on publicly available material obtained from DATASUS, the Brazilian Ministry of Health's data processing system, on numbers of surgical procedures and death rates. Only isolated CABG procedures were included in our study. We used the TabNet software from the DATASUS website to generate reports. RESULTS: We identified 281,760 CABG procedures performed from January 2008 to December 2020. The average number of procedures until the end of 2019 was of 22,104. During 2020 there was a 25% reduction CABG procedures, to 16,501. There was an increase in the national death rate caused by a statistical significant increase in death rates in Brazil's Southeast and Central-west regions. CONCLUSION: The COVID-19 pandemic remains a global challenge for Brazil's health care system. During the year of 2020 there was a reduction in access to CABG related to an increase in the number of COVID-19 cases. There was also an increase in the national CABG death rate.

Relationship between volume and survival in closed intensive care units is weak and apparent only in mechanically ventilated patients.

BACKGROUND: Recent studies have found an association between increased volume and increased intensive care unit (ICU) survival; however, this association might not hold true in ICUs with permanent intensivist coverage. Our objective was to determine whether ICU volume correlates with survival in the Spanish healthcare system. METHODS: Post hoc analysis of a prospective study of all patients admitted to 29 ICUs during 3 months. At ICU discharge, the authors recorded demographic variables, severity score, and specific ICU treatments. Follow-up variables included ICU readmission and hospital mortality. Statistics include logistic multivariate analyses for hospital mortality according to quartiles of volume of patients. RESULTS: The authors studied 4,001 patients with a mean predicted risk of death of 23% (range at hospital level: 14-46%). Observed hospital mortality was 19% (range at hospital level: 11-35%), resulting in a standardized mortality ratio of 0.81 (range: 0.5-1.3). Among the 1,923 patients needing mechanical ventilation, the predicted risk of death was 32% (14-60%) and observed hospital mortality was 30% (12-61%), resulting in a standardized mortality ratio of 0.96 (0.5-1.7). The authors found no correlation between standardized mortality ratio and ICU volume in the entire population or in mechanically ventilated patients. Only mechanically ventilated patients in very low-volume ICUs had slightly worse outcome. CONCLUSION: In the currently studied healthcare system characterized by 24/7 intensivist coverage, the authors found wide variability in outcome among ICUs even after adjusting for severity of illness but no relationship between ICU volume and outcome. Only mechanically ventilated patients in very low-volume centers had slightly worse outcomes.

Intensive care unit discharge to the ward with a tracheostomy cannula as a risk factor for mortality: a prospective, multicenter propensity analysis.

OBJECTIVE: To analyze the impact of decannulation before intensive care unit discharge on ward survival in nonexperimental conditions. DESIGN: Prospective, observational survey. SETTING: Thirty-one intensive care units throughout Spain. PATIENTS: All patients admitted from March 1, 2008 to May 31, 2008. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: At intensive care unit discharge, we recorded demographic variables, severity score, and intensive care unit treatments, with special attention to tracheostomy. After intensive care unit discharge, we recorded intensive care unit readmission and hospital survival. STATISTICS: Multivariate analyses for ward mortality, with Cox proportional hazard ratio adjusted for propensity score for intensive care unit decannulation. We included 4,132 patients, 1,996 of whom needed mechanical ventilation. Of these, 260 (13%) were tracheostomized and 59 (23%) died in the intensive care unit. Of the 201 intensive care unit tracheostomized survivors, 60 were decannulated in the intensive care unit and 141 were discharged to the ward with cannulae in place. Variables associated with intensive care unit decannulation (non-neurologic disease [85% vs. 64%], vasoactive drugs [90% vs. 76%], parenteral nutrition [55% vs. 33%], acute renal failure [37% vs. 23%], and good prognosis at intensive care unit discharge [40% vs. 18%]) were included in a propensity score model for decannulation. Crude ward mortality was similar in decannulated and nondecannulated patients (22% vs. 23%); however, after adjustment for the propensity score and Sabadell Score, the presence of a tracheostomy cannula was not associated with any survival disadvantage with an odds ratio of 0.6 [0.3-1.2] (p=.1). CONCLUSION: In our multicenter setting, intensive care unit discharge before decannulation is not a risk factor.

[With or without COVID: a Tale on Human Vulnerability]. / Con COVID y sin COVID: La Vulnerabilidad Humana.

The crisis of COVID-19 leaves us a teaching in the form of reminiscence. We do not learn anything new from it, but it reminds us of something we knew and forgot. It shows us in a new light our vulnerability, the impossibility of protecting ourselves perfectly through prediction and control. The sciences do not predict with certainty and the technologies do not manage to have everything under control, although the former and the latter have many other and worthwhile functions. Ideologies do not see the future, no matter how much they pretend to do so. However, we are not without reliable guidance in deciding our actions. This orientation must be sought in being, not in the future. It is fidelity to our common human nature that must advise us. It is the full realization of our personal being, of our peculiar vocation, that guides us. So, the means for self-realization consists in the development of a virtuous character. The same character that has mitigated the ravages of the pandemic, given that, to some degree, it was already present in many of our fellow citizens. The same that would have alleviated the suffering even more if it had been available in more people and to a greater degree.

Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study.

PURPOSE: To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission. METHODS: This prospective observational study included all patients admitted to 39 ICUs in a 45-day period in 2011. We recorded hospitals' characteristics (availability of intermediate care units, usual availability of ICU beds, and financial model) and patients' characteristics (demographics, reason for admission, functional status, risk of death, and LLST on ICU admission (withholding/withdrawing; specific techniques affected)). The primary outcome was 30-day survival for patients with LLST on ICU admission. Statistical analysis included multilevel logistic regression models. RESULTS: We recruited 3042 patients (age 62.5 ± 16.1 years). Most ICUs (94.8%) admitted patients with LLST, but only 238 (7.8% [95% CI 7.0-8.8]) patients had LLST on ICU admission; this group had higher ICU mortality (44.5 vs. 9.4% in patients without LLST; p < 0.001). Multilevel logistic regression showed a contextual effect of the hospital in LLST on ICU admission (median OR = 2.30 [95% CI 1.59-2.96]) and identified the following patient-related variables as independent factors associated with LLST on ICU admission: age, reason for admission, risk of death, and functional status. In patients with LLST on ICU admission, 30-day survival was 38% (95% CI 31.7-44.5). Factors associated with survival were age, reason for admission, risk of death, and number of reasons for LLST on ICU admission. CONCLUSIONS: The frequency of ICU admission with LLST is low but probably increasing; nearly one third of these patients survive for ≥ 30 days.

[Neuroethics and Human Vulnerability in Philosophical Perspective]. / Neuroética y Vulnerabilidad Humana en Perspectiva Filosófica.

This article tries to assess the potentials and limits of neuroethics. It argues that neuroscience and ethics should collaborate each other with mutual respect and preservation of their respective identities, scientific in the first case and philosophical in the second one ( neuroethics as cooperation). The text develops also a criticism in front of any attempt to replace the philosophical ethics by the neurosciences ( neuroethics as substitution). Consequently, the most appropriate ontological and anthropological foundations are explored to develop a cooperative neuroethics. These foundations refer to the Aristotelian hylomorphic conception of the substances. On such foundations it is possible to develop a collaborative neuroethics which includes two aspects: on the one hand, we have an ethics of neuroscience and, on the other one, a neuroscience of ethics. The first one shows us how to conduct neuroscience while preserving human dignity. The second one teaches us about the neurobiological basis of our moral agency. These bases enable our moral behavior without determining it. By studying them our vulnerability as moral agents emerges as evidence. This vulnerability, which is rooted in the very human nature, must be, as it is argued along the last pages of the text, recognized as well as mitigated.

Con covid y sin covid: La vulnerabilidad humana / With or without covid: a tale on human vulnerability

La crisis del COVID-19 deja una enseñanza en forma de reminiscencia. No aprendemos de ella nada nuevo, pero nos recuerda algo que supimos y olvidamos. Nos muestra con nueva luz nuestra vulnerabilidad, la imposibilidad de protegernos perfectamente mediante la predicción y el control. Las ciencias no predicen con certeza y las tecnologías no alcanzan a tenerlo todo bajo control, aunque las primeras y las segundas tengan otras muchas y beneméritas funciones. Las ideologías, no ven el futuro, por más que simulen hacerlo. Y, sin embargo, no carecemos que guía fiable para decidir nuestras acciones. Esta orientación hay que buscarla en el ser, no en el porvenir. Es la fidelidad a nuestra común naturaleza humana la que ha de aconsejarnos, es la realización plena de nuestro ser personal, de nuestra peculiar vocación la que nos guía. Y el medio para la autorrealización consiste en el desarrollo de un carácter virtuoso. El mismo carácter que ha mitigado los estragos de la pandemia, pues en cierto grado estaba ya presente en muchos de nuestros conciudadanos, el mismo que hubiera paliado aun más el sufrimiento de haber estado disponible en más personas y en mayor grado

The crisis of COVID-19 leaves us a teaching in the form of reminiscence. We do not learn anything new from it, but it reminds us of something we knew and forgot. It shows us in a new light our vulnerability, the impossibility of protecting ourselves perfectly through prediction and control. The sciences do not predict with certainty and the technologies do not manage to have everything under control, although the former and the latter have many other and worthwhile functions. Ideologies do not see the future, no matter how much they pretend to do so. However, we are not without reliable guidance in deciding our actions. This orientation must be sought in being, not in the future. It is fidelity to our common human nature that must advise us. It is the full realization of our personal being, of our peculiar vocation, that guides us. So, the means for self-realization consists in the development of a virtuous character. The same character that has mitigated the ravages of the pandemic, given that, to some degree, it was already present in many of our fellow citizens. The same that would have alleviated the suffering even more if it had been available in more people and to a greater degree

[Bioethics common sense]. / El sentido común de la bioética.

Bioethics is a domain in which many academic disciplines and cultural traditions converge. Accordingly, we may wonder whether or not there could be an authentic communication among them. The present article seeks to support the idea that bioethics can effectively develop a common sense by which people of very different backgrounds and cultures can understand each other. This communication can occur only because we share a similar human nature. Therefore, the philosophies that deny human nature, as well as those that reduce the human being to mere nature, do not serve as a basis for a common bioethics, but will probably lead to the fragmentation of the bioethics. Consequently, here I will argue in favour of a concept of human nature that integrates the biological, social and spiritual aspects of human being. According to this concept, every human being is not only an organism of the species Homo sapiens, but mainly a person belonging to the human family, in virtue of which she possesses inherent dignity and inalienable rights.

Neuroética y vulnerabilidad humana en perspectiva filosófica / Neuroethics and human vulnerability in philosophical perspective

El artículo trata de valorar las posibilidades y límites de la neuroética. Defiende que las neurociencias y la ética deben colaborar entre sí desde el mutuo respeto y la preservación de las respectivas identidades, científica en un caso y filosófica en el otro (neuroética en modo-co). El texto formula también una crítica a todo intento de sustitución de la ética filosófica por las neurociencias (neuroética en modo-su). En consecuencia, se exploran los fundamentos ontológicos y antropológicos más apropiados para desarrollar la neuroética, entendida esta como territorio de colaboración entre ética y neurociencias. Dichos fundamentos remiten a la idea aristotélica de sustancia hilemórfica. Sobre tales fundamentos se puede desarrollar una neuroética colaborativa que incluye dos vertientes: por un lado tenemos una ética de la neurociencia y, por otro, una neurociencia de la ética. La primera muestra cómo investigar y aplicar la neurociencia preservando siempre la dignidad humana. La segunda nos enseña cuáles son las bases neurobiológicas posibilitadoras –pero no determinantes– de la agencia moral. Al estudiar las mismas se hace evidente nuestra vulnerabilidad como agentes morales. Esta vulnerabilidad, que arraiga en la propia naturaleza humana, ha de ser, como se argumenta en el último tramo del texto, reconocida y a la vez mitigada (AU)

This article tries to assess the potentials and limits of neuroethics. It argues that neuroscience and ethics should collaborate each other with mutual respect and preservation of their respective identities, scientific in the first case and philosophical in the second one (neuroethics as cooperation). The text develops also a criticism in front of any attempt to replace the philosophical ethics by the neurosciences (neuroethics as substitution). Consequently, the most appropriate ontological and anthropological foundations are explored to develop a cooperative neuroethics. These foundations refer to the Aristotelian hylomorphic conception of the substances. On such foundations it is possible to develop a collaborative neuroethics which includes two aspects: on the one hand, we have an ethics of neuroscience and, on the other one, a neuroscience of ethics. The first one shows us how to conduct neuroscience while preserving human dignity. The second one teaches us about the neurobiological basis of our moral agency. These bases enable our moral behavior without determining it. By studying them our vulnerability as moral agents emerges as evidence. This vulnerability, which is rooted in the very human nature, must be –as it is argued along the last pages of the text– recognized as well as mitigated (AU)

Por qué es buena la biodiversidad?: una visión humanista del valor de la biodiversidad / Why is biodiversity good?: a humanistic view of the value of biodiversity

Las tres ideas centrales del texto son: i) La diversidad cultural y biológica parece ser un valor positivo. Existe actualmente un gran consenso al respecto. Sin embargo no es fácil fundar dicho consenso sobre bases racionales. ii) El presente ensayo distingue varios tipos de diversidad, para centrarse únicamente en la reflexión sobre la diversidad biológica o biodiversidad. El término biodiversidad también se emplea en varios sentidos. Entre ellos el principal parece ser el de la diversidad de especies. Esta observación nos obliga a revisar el propio concepto de especie. Hemos de aceptar que la biología actual requiere un concepto de especie plural, y que cada especie es un concepto abstracto, sin valor intrínseco. iii) Si se acepta esta tesis habrá que aceptar también que el valor de la diversidad específica ha de fundarse en valores indirectos y en gran medida antropocéntricos.

The text presents three main ideas: i) Cultural and biological diversity seems to represent a positive value. There is now a large consensus regarding this point. However, it is not easy to establish this consensus on a rational basis. ii) This essay distinguishes various types of diversity, to focus solely on the reflection on biological diversity or biodiversity. The term biodiversity is also used in many different senses. The most salient among them seems to be the diversity of species. This observation forces us to review the very concept of species. After this review, we must accept that current biology requires a plural species concept, and that each species is an abstract concept with no intrinsic value. iii) If we accept this thesis, we will also accept that the value of the species diversity must be based on largely indirect and anthropocentric values.

Hacia una filosofía práctica de la ciencia: Especie biológica y deliberación ética / Towards a praticcal philosophy of science: biological species and ethical debate / Em uma filosoia prática da ciência: espécies biológicas e debate ético

La filosofía de la ciencia se ha abierto en las últimas décadas hacia cuestiones de carácter práctico. Ha recobrado así, felizmente, el diálogo con el pensamiento social, moral y político. Una muestra significativa de este fenómeno la tenemos en el debate que se está produciendo en torno al concepto de especie. Dicho concepto es clave en biología; recordemos que aparece ya en el título del libro más determinante de la biología contemporánea, El origen de las especies, de Charles Darwin. Constituye un tópico de investigación habitual, por tanto, para los filósofos de la ciencia. Por otra parte, dicho concepto se ha hecho presente recientemente en el centro de la deliberación ética. Por ejemplo, con frecuencia se plantea la preservación de la biodiversidad como cuestión política y moral. Aquí la noción de especie, obviamente, es pieza principal. También lo es en lo referente a nuestras relaciones con el resto de los seres vivos, problema éste que se materializa en debates mucho más concretos y hasta cotidianos, como el de los supuestos derechos de los animales, el del vegetarianismo, el de la tauromaquia o el de la experimentación sobre animales. Cuando se alega que el trato hacia los otros vivientes, o hacia los demás seres sintientes, no ha de estar condicionado por la especie a la que pertenecen -el especismo es injusto, se dice-, se está poniendo en cuestión, de paso, la dignidad y naturaleza del propio ser humano. Apréciese, pues, la actualidad y el hondo calado de los debates dichos, la importancia que hoy cobra en la deliberación práctica la noción de especie, así como lo pertinente que puede ser en este punto la colaboración entre filósofos morales y filósofos de la ciencia. Para contribuir a este diálogo, me propongo, en primer lugar, ampliar un poco la caracterización de la filosofía de la ciencia como filosofía práctica y como interlocutor necesario en la deliberación ética (apartado 1). En segundo lugar, presentaré el estado de la cuestión en lo que hace al debate actual sobre el concepto de especie (apartado 2). En tercer lugar, veremos la importancia que dicho concepto ha cobrado en contextos prácticos a través de un caso concreto, paradigmático en muchos sentidos, el llamado dilema delanti-especista (apartado 3). Cerraré mi aportación con un resumen conclusivo del cual adelanto la tesis principal, a saber, que la noción de especie humana (Homosapiens) debería ser evitada en contextos morales, y reemplazada por otras, como quizá familia humana. Apuntaré también algunas líneas para seguir reflexionando, inspiradas en ideas de Aristóteles, Jonas y MacIntyre (apartado 4).

In the last few decades the philosophy of science has open its view to practical matters. Fortunately, it has recovered the dialogue with social, moral and political thought. We have a significant example of this phenomenon in the present debate on the concept of species. This is a key concept in biology. Let's remember that it appears in the title of the more determinant book of contemporary biology, The Origin of Species by Charles Darwin. Is a common research topic, therefore, for philosophers of science. On the other hand, this concept is becoming present at the very centre of ethical deliberation. For example, we often approach the preservation of biodiversity as a moral and political issue. Here the notion of species is, obviously, a centrepiece. This is also true with regard to our relations with other living beings, a problem that is embodied in more specific discussions and even daily, as the debates on the alleged rights of animals, on the vegetarianism, on the bullfighting, on animal testing... Frequently it is alleged that our treatment to others living beings, or to other sentient beings, should not to be conditioned by the species to which they belong -speciesism is wrong, it is said. This stance, by the way, puts into question, the dignity and nature of human being. Let's appreciate therefore the deep and current consequences of these discussions, the significance of today's deliberation on the notion of species, as well as the relevance of a fair cooperation between moral philosophers and philosophers of science. To contribute to this dialogue, I propose, first, to extend slightly the characterization of philosophy of science as a practical philosophy, as well as a necessary partner in ethical deliberation (section 1). Secondly, I will present the state of affairs regarding the current debate on the concept of species (section 2). Thirdly, we will see the importance that this concept has gained in practical contexts, such in the paradigmatic case of the so-called anti-speciesist's dilemma (section 3). I will close my contribution with a conclusive summary, whose main thesis will be that the notion of human species (Homo sapiens) should be avoided in moral contexts, and replaced by some others, probably like human family. I will add, as well, some suggestions for keeping thinking on these problems, under the inspiration of Aristotle, Jonas and MacIntyre (section 4).

A filosofia da ciência abriu-se nas últimas décadas para questões de caráter prático. Assim, felizmente, tem-se retomado o diálogo com o pensamento social, moral e político. Temos uma mostra significativa deste fenômeno no debate que está sendo produzido em torno do conceito de espécie. Recordemos que este conceito chave em biologia, que aparece no título do livro mais determinante da biologia contemporânea, A Origem das Espécies, de Charles Darwin, constitui-se um tópico de investigação habitual, portanto, para os fílósofos da ciência. Além disso, este conceito tem se feito presente recentemente no centro da deliberação ética. Por exemplo: com frequência se aborda a preservação da biodiversidade como questão política e moral. Aqui a noção de espécie, obviamente, é peça principal. Também o é no que se refere às nossas relações com o resto dos seres vivos, problema este que se materializa em debates muito mais concretos e até cotidianos como o dos pressupostos direitos dos animais, o do vegetarianismo, o das touradas e o da experimentação em animais. Quando se alega que o trato com outros viventes ou com os demais seres sencientes não deve estar condicionado à espécie a qual pertencem - o especismo é injustiço, diz-se - está se colocando em questão, ao mesmo tempo, a dignidade e a natureza do próprio ser humano. Aprecia-se, pois, a atualidade e a profundidade destes debates, a importância que hoje se cobra da deliberação prática da noção de espécie, assim como pode ser pertinente, neste ponto, a colaboração entre filósofos morais e da ciência. Para contribuir com este diálogo, proponho-me, em primeiro lugar, a ampliar um pouco a caracterização da filosofia da ciência como filosofia prática e como interlocutora necessária na deliberação ética (parte 1). Em segundo lugar, apresentarei a questão no que concerne ao debate atual sobre o conceito de espécie (parte 2). Em terceiro lugar, veremos a importância que este conceito tem adquirido em contextos práticos através de um caso concreto, paradigmático em muitos sentidos, o chamado dilema do anti-especista (parte 3). Terminarei minha contribuição com um resumo conclusivo do qual adianto a tese principal, a saber, que a noção de espécie humana (Homo sapiens) deveria ser evitada em contextos morais e substituída por outras como, quiçá, família humana. Apontarei também algumas linhas para seguirmos refletindo, inspiradas em ideias de Aristóteles, Jonas e MacIntyre (parte 4).

El sentido común de la bioética / Bioethics common sense

En la bioética confluyen disciplinas y tradiciones muy diversas. Podemos preguntarnos si entre ellas puede haber auténtica comunicación. Aquí se defiende la idea de que efectivamente puede desarrollarse una bioética con un sentido común, en la que puedan entenderse personas de muy distintas formaciones y culturas. Esta comunicación se puede producir gracias a que compartimos una similar naturaleza humana. Por ello, las filosofías que niegan la naturaleza humana, tanto como las que reducen el ser humano a pura naturaleza, no sirven como fundamento para una bioética común, sino que conducen probablemente al fraccionamiento de la misma. En consecuencia, se argumenta a favor de un concepto de naturaleza humana que integre los aspectos biológicos, sociales y espirituales del ser humano. Según este concepto, cada ser humano es no solo un organismo de la especie Homo sapiens, sino principalmente una persona de la familia humana, en virtud de lo cual posee dignidad inherente y derechos inalienables (AU)

Bioethics is a domain in which many academic disciplines and cultural traditions converge. Accordingly, we may wonder whether or not there could be an authentic communication among them. The present article seeks to support the idea that bioethics can effectively develop a common sense by which people of very different backgrounds and cultures can understand each other. This communication can occur only because we share a similar human nature. Therefore, the philosophies that deny human nature, as well as those that reduce the human being to mere nature, do not serve as a basis for a common bioethics, but will probably lead to the fragmentation of the bioethics. Consequently, here I will argue in favor of a concept of human nature that integrates the biological, social and spiritual aspects of human being. According to this concept, every human being is not only an organism of the species Homo sapiens, but mainly a person belonging to the human family, in virtue of which she possesses inherent dignity and inalienable rights (AU)

A questão do sangue: rumos das políticas públicas de hemoterapia no Brasil e no exterior / The question of blood: development of a blood public policy of hemotherapy in Brazil and abroad

Esta tese discute a historicidade dos antecedentes que caracterizaram a política de sangue que foi praticada no Brasil no período de 1940 a 1980, com objetivo decontextualizar os bancos de sangue do período, a ausência de normas técnicas, o sangue como fonte de lucro, as doações remuneradas, o aparecimento da Aids e o surgimento da politização do sangue. A discussão aborda o surgimento da política pública de sangueque se implantou na década de 80, analisando as características deste novo modelo e também a influência do modelo Francês, a implantação da hemorrede e a transformação para as doações de sangue voluntárias, como repercussão cultural e social do processo.Para entender as dificuldades que acompanham a implantação das boas práticas da hemoterapia, como conseqüência de um ciclo de sangue técnico dentro de umapolítica de sangue adequada, analisou-se o sistema inglês e o sistema francês, neste último analisando o escândalo de contaminação do sangue e a hemovigilância.Como uma proposta de melhoria da qualidade de saúde, o trabalho analisou as características da acreditação, proposta como um modelo de avaliação da qualidade e assuas aplicações na hemoterapia para garantia da qualidade e segurança do sangue

Distribuiçäo dos grupos sanguíneos do sistema ABO/Rh nos doadores de sangue do Hemominas Juiz de Fora, Belo Horizonte e do Hospital Universitário da UFJF / Distribution of blood groups of ABO/Rh system in blood donors of Hemominas Juiz de Fora, Hemominas Belo Horizonte and Universitary Hospital of UFJF

Foi realizado um estudo dos grupos sanguíneos do Sistema ABO/Rh em 40.950 doadores de sangue no Hemominas Juiz de Fora; em 23.144 doadores de sangue do Hemominas Belo Horizonte e em 13.285 doadores de sangue do Serviço de Hemoterapia do Hospital Universitário da UFJF, para detectar a distribuiçäo da frequência dos diversos grupos sanguíneos. Os resultados apresentados mostram uma diferença de percentuais e, quando submetidos a um tratamento estatístico pela análise de variância foram estatisticamente näo significativos. O objetivo do estudo foi dar suporte para estudos da correlaçäo de doenças em determinados grupos sanguíneos do sistema ABO/Rh.

Amenizando a morte / Softening death

Focalizando um tema da área de saúde pouco abordado no curso profissionalizante, uma equipe multiprofissional apresenta de maneira prática todo o processo de tratamento a pacientes com evoluçäo fatal. Enfatiza-se a necessidade de um trabalho conjunto onde a contribuiçäo de cada profissional emprega meios indispensáveis para um bom plano de assistência, tentando obter a suavizaçäo (ou minimizaçäo) do processo.

Manifestações esqueléticas da anemia falciforme / Skeletal manifestations in the sickle cell anemia

A anemia falciforme (A.F) é uma anemia hemolitica caracterizada pela presença anormal da hemoglobina S. Esta revisão tem como objetivo discutir os achados radiográficos do esqueleto em pacientes com A. F. Descrevemos as duas principais causas de alteração óssea, demonstrando a importância do uso da radiologia convencional no diagnóstico destas alterações.

A questão do sangue: rumos das políticas públicas de homoterapia no Brasil e no exterior / The question of blood: development of a blood public policy of hemotherapy in Brazil and abroad

Esta tese discute a historicidade dos antecedentes que caracterizaram a política de sangue que foi praticada no Brasil no período de 1940 a 1980, com objetivo decontextualizar os bancos de sangue do período, a ausência de normas técnicas, o sangue como fonte de lucro, as doações remuneradas, o aparecimento da Aids e o surgimento da politização do sangue. A discussão aborda o surgimento da política pública de sangueque se implantou na década de 80, analisando as características deste novo modelo e também a influência do modelo Francês, a implantação da hemorrede e a transformação para as doações de sangue voluntárias, como repercussão cultural e social do processo.Para entender as dificuldades que acompanham a implantação das boas práticas da hemoterapia, como conseqüência de um ciclo de sangue técnico dentro de umapolítica de sangue adequada, analisou-se o sistema inglês e o sistema francês, neste último analisando o escândalo de contaminação do sangue e a hemovigilância.Como uma proposta de melhoria da qualidade de saúde, o trabalho analisou as características da acreditação, proposta como um modelo de avaliação da qualidade e assuas aplicações na hemoterapia para garantia da qualidade e segurança do sangue(AU)