Estratégia de cuidado na Atenção Especializada Ambulatorial: qualificação e ampliação do acesso / Care strategy in Secondary Care: qualification and increasing of access

A expansão da Estratégia Saúde da Família (ESF) e a introdução de novos programas de atenção à saúde produziram aumento significativo no acesso da população à Atenção Básica(AB). A Atenção Especializada (AE), entretanto, não se ampliou de forma proporcional. Este artigo teve o objetivo de contextualizar a AE e propor um novo modelo. A AE caracteriza-se pela desarticulação entre os serviços, com modelo centrado nas especialidades, baixo uso de Tecnologias da Informação (TI) e financiamento por procedimentos. Propõe-se a discussão de um novo modelo de AE regionalizada, com critérios territoriais, multiprofissional, centrada nas necessidades do paciente, com uso de ferramentas de TI e nova forma de financiamento.

The expansion of the Family Health Strategy (ESF) and the introduction of new health care programs produced significant increase in the population’s access to Primary Care (AB). The Secondary Care (AE), however, was not increased proportionally. The objective of this study is to contextualize the AE and propose a new care model. The AE is characterized by dismemberment between services, focusing on specialties, low use of Information Technology (IT) and with a funding model based on individual medical procedure payment. It is proposed to discuss a new model of regionalized AE, centered on the patient’s needs, using IT tools and a new form of financing.

Immunological changes in canine peripheral blood leukocytes triggered by immunization with first or second generation vaccines against canine visceral leishmaniasis.

In this study, we summarized the major phenotypic/functional aspects of circulating leukocytes following canine immunization with Leishvaccine and Leishmune®. Our findings showed that Leishvaccine triggered early changes in the innate immunity (neutrophils and eosinophils) with late alterations on monocytes. Conversely, Leishmune(®) induced early phenotypic changes in both, neutrophils and monocytes. Moreover, Leishvaccine triggered mixed activation-related phenotypic changes on T-cells (CD4+ and CD8+ and B-lymphocytes, whereas Leishmune(®) promoted a selective response, mainly associated with CD8+ T-cell activation. Mixed cytokine profile (IFN-γ/IL-4) was observed in Leishvaccine immunized dogs whereas a selective pro-inflammatory pattern (IFN-γ/NO) was induced by Leishmune® vaccination. The distinct immunological profile triggered by Leishvaccine and Leishmune® may be a direct consequence of the distinct biochemical composition of these immunobiological, i.e. complex versus purified Leishmania antigen along with Bacillus Calmette-Guérin (BCG) versus saponin adjuvant. Both immunobiologicals are able to activate phagocytes and CD8+ T-cells and therefore could be considered as a putative vaccines against canine visceral leishmaniasis (CVL).