Guia Para Categorização De Serviços De Alimentação Prático / Practical Food Service Categorization Guide

A proposta de Categorização dos serviços de alimentação foi baseada no Projeto Piloto da Copa do Mundo FIFA®2014 que por sua vez inspirou-se nas experiências bem-sucedidas de cidades como Los Angeles, Nova York e Londres (BRASIL, 2013). A Categorização é uma proposta para classificar os serviços de alimentação com base em um instrumento de avaliação, pontuado, segundo critérios de risco sanitário, com base na Resolução de Diretoria Colegiada (RDC) nº 216/2004 (BRASIL, 2004). A classificação ou Categorização do serviço de alimentação fica visível ao consumidor, dando a oportunidade de que este conheça a qualidade sanitária do local que utiliza. A metodologia preconiza o uso de uma lista de avaliação reduzida e com foco nos itens de maior risco sanitário para DTA. Além de melhorar a qualidade sanitária dos estabelecimentos, conscientiza o cidadão e compromete os responsáveis legais pela garantia do cumprimento das Boas Práticas de Manipulação (BPM). Este Guia é um documento não normativo, de caráter recomendatório, norteador para Categorização dos serviços de alimentação no estado do Rio de Janeiro e outros locais interessados. Tem como objetivo orientar as equipes e gestores das Visa estaduais e municipais na implantação da Categorização e nas inspeções sanitárias, bem como orientar os responsáveis legais dos serviços de alimentação na realização da autoavaliação, etapa fundamental da Categorização.

Planilha De Cálculo Do Risco Sanitário Manual Do Usuário Prático / Health Risk Calculation Worksheet Practical User Manual

Este documento traz o detalhamento sobre a utilização da planilha em Microsoft Excel®, Versão 2017, elaborada para facilitar o cálculo da pontuação de risco, da lista de avaliação para a Categorização dos serviços de alimentação.

Use of medication and associated factors in adults living in Rio Branco, Acre. Use of medication in adults

Abstract We analyzed use of medication and associated factors in adults aged 18-59 years living in Rio Branco, Acre. This is a cross-sectional and population-based study that used a probabilistic sample of the population from rural and urban areas of the city of Rio Branco, Acre. The Prevalence Ratio (PR) was calculated with 95% confidence intervals and associations were estimated by Poisson regression. This study found a 29.4% prevalence ratio of use of medication among individuals aged from 18 to 59 years (685 adults: 473 women and 212 men; producing estimates for 211,902 adults: 110,769 women and 101,133 men). After adjusted analysis, their use was associated with: age (50-59 years, PR: 2.36; 95%CI: 2.29-2.43); women (PR: 1.25; 95%CI: 1.23-1.27); up to elementary school (PR: 1.13; 95%CI: 1.11-1.15); and poor or very poor self-rated health (PR: 1.47; 95%CI: 1.43-1.51). The health conditions associated with use of medication were: number of comorbidities, hypertension, diabetes, insomnia, depression, number of health complaints and use of health services. The most frequently used drugs were those belonging to the following ATC categories: alimentary tract and metabolism, cardiovascular system, nervous system, and the musculoskeletal system.

A global call for talaromycosis to be recognised as a neglected tropical disease.

Talaromycosis (penicilliosis) is an invasive mycosis that is endemic in tropical and subtropical Asia. Talaromycosis primarily affects individuals with advanced HIV disease and other immunosuppressive conditions, and the disease disproportionally affects people in low-income and middle-income countries, particularly agricultural workers in rural areas during their most economically productive years. Approximately 17 300 talaromycosis cases and 4900 associated deaths occur annually. Talaromycosis is highly associated with the tropical monsoon season, when flooding and cyclones can exacerbate the poverty-inducing potential of the disease. Talaromycosis can present as localised or disseminated disease, the latter causing cutaneous lesions that are disfiguring and stigmatising. Despite up to a third of diagnosed cases resulting in death, talaromycosis has received little attention and investment from regional and global funders, policy makers, researchers, and industry. Diagnostic and treatment modalities remain extremely insufficient, however control of talaromycosis is feasible with known public health strategies. This Viewpoint is a global call for talaromycosis to be recognised as a neglected tropical disease to alleviate its impact on susceptible populations.

Defining and classifying public health systems: a critical interpretive synthesis.

BACKGROUND: The introduction of the determinants of health has caused a shift towards understanding health from a holistic perspective as well as increased recognition of public health's contributions to the health of the population. Several frameworks exist to conceptualise healthcare systems, highlighting the stark contrast of frameworks unique to public health systems. The objectives of this study were to define public health systems and assess differences between healthcare systems and public health systems within established health systems frameworks. METHODS: A critical interpretive synthesis was conducted. Databases searched included EBSCOhost, OVID, Scholars Portal, Web of Science, Cochrane Library and Health Systems Evidence. Data extraction, coding and analysis followed a best-fit framework analysis method. Initial codes were based on a current leading health systems and policy classification scheme - health systems arrangements (governance, financial and delivery arrangements). RESULTS: A total of 5933 unique documents were identified and 67 were included in the analysis. Definitions of public health and public health systems varied significantly as did their roles and functions across jurisdictions. Public health systems arrangements generally followed those of health systems, with the addition of partnerships (community and inter-sectoral) and communication playing a larger role in public health. A public health systems framework and conceptualisation of how public health currently fits within health systems are presented. CONCLUSIONS: Public health systems are unique and vital entities within health systems. In addition to examining how public health and public health systems have been defined within the literature, this review suggests that establishing the scope of public health is crucial to understanding its role within the larger health system and adds to the discourse around the relationship between public health, healthcare and population health. More broadly, this study addresses an important gap in understanding public health systems and provides conceptual and practical contributions as well as areas for future research.

3Ts of low cure rate: taxonomy, themes and theory of low cure rate in Pakistan's TB control programme and gathering a 360-degree perspective through qualitative, in-depth interviewing approach.

OBJECTIVE: WHO recommends cure of tuberculosis (TB) as the best prevention strategy; however, information about factors associated with low cure rate in patients with drug-susceptible TB is limited in Pakistan. Therefore, the purpose of this study was to explore the factors that account for low TB cure rate. METHODOLOGY: The present qualitative study recruited diverse informants through purposive sampling to explore low cure rate situation in Badin between March and June 2017. Data were collected from clinicians, paramedics, lab technicians, district field supervisors, patients and treatment supporters through indepth and face-to-face interviews. Interviews were conducted in local languages (Urdu and Sindhi) and transcribed into English. Coding structure was developed inductively and applied on textual data to draw output at the levels of taxonomy, themes and theory, as proposed by Bradley et al. FINDINGS: Thirty-seven individuals consented to participate in this study and provided detailed account of the subject under enquiry. Review of interview data collected from a variety of informants resulted in the identification of four broad factors (taxonomy) that contributed to the situation of low cure rate in one of the districts implementing the public-private mix intervention. These factors were (1) health-seeking behaviour, (2) technical capacity of the healthcare provider, (3) managerial capacity of the healthcare provider, and (4) access to healthcare facility and services. Each factor is deconstructed into key dimensions (themes) that emerged from the dialogue between the interviewer and the respondents. Moreover, dimensions were exemplified through underlying concepts that correspond to theories for low cure rate. CONCLUSION: Change in programme reporting requirement has demeaned the significance of having cure as treatment outcome. Therefore, returning the focus to achieving cure status for TB cases will be beneficial for assessing the effectiveness of TB control efforts. In parallel to the care delivery system, a mechanism for disseminating disease-related and treatment-related information should be introduced.

Feasibility of describing community strengths relative to Omaha system concepts.

OBJECTIVES: The purpose was to determine the feasibility of using a standardized language, the Omaha System, to describe community-level strengths. The objectives were: (a) to evaluate the feasibility of using the Omaha System at the community level to reflect community strengths and (b) to describe preliminary results of community strengths observations across international settings. DESIGN AND SAMPLE: A descriptive qualitative design was used. The sample was a data set of 284 windshield surveys by nursing students in 5 countries: Mexico, New Zealand, Norway, Turkey, and the United States. MEASURES: An online survey included a checklist and open-ended questions on community strengths for 11 concepts of the Omaha System Problem Classification Scheme: Income, Sanitation, Residence, Neighborhood/workplace safety, Communication with community resources, Social contact, Interpersonal relationship, Spirituality, Nutrition, Substance use, and Health care supervision. Themes were derived through content analysis of responses to the open-ended questions. RESULTS: Feasibility was demonstrated: Students were able to use the Omaha System terms and collect data on strengths. Common themes were described among the five countries. CONCLUSIONS: The Omaha System appears to be useful in documenting community-level strengths. Themes and exemplar quotes provide a first step in developing operational definitions of strengths at a more granular level.

Naming and the Public Health Roles of Physicians.

Resources from the American Medical Association (AMA) Archives facilitate historical consideration of how physicians' authority has been exercised in naming diseases, epidemics, and other health-related issues of national importance. Selected images emphasize physicians' roles in motivating public health initiatives through public service posters, advertisements, and minutes of the AMA House of Delegates meetings.

Satisfação aos atendimentos odontológicos no SUS: a visão do usuário / Public oral and dental Heakth Service: user satisfaction

O objetivo deste trabalho foi avaliar o nível de satisfação do usuário do SUS das unidades básicas de saúde (UBS) da cidade de São José dos Campos- SP, caracterizando-o segundo questionário socioeconômico e utilizando pesquisa do tipo inquérito a partir do questionário para Avaliação da Satisfação dos Usuários com Serviços Públicos de Saúde Bucal (QASSaB). Foram entrevistadas 390 pessoas de todas as UBS que possuem atendimento odontológico da cidade de São José dos Campos, numa escolha aleatória, com erro amostral de 5%, nível de confiança de 95%, distribuição mais heterogênea. Como resultado final, observou-se uma avaliação positiva nos aspectos questionados, sendo que 89,7 % dos entrevistados consideram como sendo bom o atendimento odontológico oferecido pelo sistema. Estatisticamente, observou-se o valor final de QASSaB de 3,33, numa escala de 1 a 5, sendo um o pior resultado e 5 o melhor resultado. Houve alto percentual de satisfação com o serviço de saúde oferecido nas UBS, evidenciando a avaliação positiva do usuário sobre o atendimento, o que permite concluir que a avaliação pode estar mais relacionada à humanização nos serviços do que às características sociodemográficas da população. Espera-se que os resultados apresentados no estudo possam contribuir para práticas e políticas de saúde bucal(AU)

Abstract: The objective of this paper is to evaluate user satisfaction level at the primary health care clinics in the city of São José dos Campos, state of São Paulo. This was done using Dental Health Services Quality Questionnaire (known in Brazil as QASSaB) created specifically for the Brazilian reality and validated for use with public health patient's perception of problem resolution and quality of service provided. Three hundred and ninety patients were interviewed in all public primary health clinics in São José dos Campos providing dental and oral- health services. Interviewees were randomly selected, with a sample error of 5%, statistical confidence level of 95% and more heterogeneous distribution. We observed that all aspects of the survey were rated positively by patients. 89.7% of those surveyed evaluated the dental and oral-health services provided as good. We observed, statistically, a final result of the Dental Health Services Quality Questionnaire (known in Brazil as QASSaB) of 3.33 in a scale of 1 to 5. In this scale 1 represents the worst result and 5 the best result. The services offered at the UBS received a high satisfaction score, which demonstrates the positive evaluation of the treatment by the user. This high result allows us to conclude that the perception of quality may be more closely linked to the humanization of services than with the socio-demografics of the population (AU)

Economía informal, un problema de salud laboral / The informal economy: an occupational health issue

La economía informal se debe diferenciar de conceptos tales como empleo informal y sector informal, cada uno con sus propias características. Existen varios tipos de trabajadores informales que se agrupan en varias categorías según su labor. Los familiares de estos trabajadores se agrupan dentro del empleo vulnerable, que no se benefician tampoco de coberturas sanitarias. El empleo informal condiciona una gran morbimortalidad que se traduce en pérdidas económicas y gran número de años de vida perdidos por discapacidad, especialmente entre poblaciones jóvenes y mujeres. Son necesarias políticas sanitarias encaminadas a disminuir las desigualdades socioeconómicas, mejorando la capacitación de profesionales sanitarios y la accesibilidad a los servicios sanitarios de estos trabajadores

Informal economy must be differentiated from concepts such as informal employment and the informal sector, each with its own characteristics. There are several types of informal workers that are grouped into several categories according to their work. The families of these workers are grouped into vulnerable job, which is also not beneficial for health coverage. Informal working conditions mean great morbidity resulting in economic losses and a large number of quality-adjusted life year, especially among young populations and women. Health policies are needed to reduce socio-economic inequalities, improve the training of health professionals and the accessibility of health services to these workers

Turn back crime: medicamentos ilegales y papel del farmacéutico comunitario / Turn back crime: illicit products and the role of the community pharmacist

El objetivo del presente trabajo fue describir y analizar la situación en España de los productos de venta ilícita, tanto medicamentos como complementos alimenticios, poniendo en conocimiento las principales acciones realizadas en los últimos meses y su contextualización a nivel mundial. Asimismo, servir de alerta sobre la magnitud del problema y la importancia del papel del farmacéutico comunitario. Se realizó una búsqueda de información tanto a nivel nacional como internacional y se realizó un análisis descriptivo de las Notas Informativas de la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) (medicamentos ilegales, uso humano, 2015). Los productos de venta ilícita representan un problema grave para la salud pública que no ha parado de aumentar. En España, en 2015 se publicaron 20 notas donde se prohibió y retiró un total de 35 productos. Dichos productos estaban comercializados como complemento alimenticio y presentaban un principio activo en cantidad suficiente para conferirle legalmente la condición de medicamento. El 86% se dirigía a la disfunción eréctil. Para minimizar este problema, es imprescindible la colaboración internacional, siendo la última y más importante operación PANGEA VIII, en junio del 2015, implicando a 115 países. En enero del 2016 entró en vigor la Convención Medicrime, tratado internacional sobre la falsificación de productos médicos y delitos similares. Por otro lado, también es necesario concienciar a la ciudadanía y dotarla de mecanismos para identificar el riesgo potencial. Los productos adquiridos fuera de los canales legales de distribución no aseguran el cumplimiento de las normas de correcta fabricación, distribución, ni posterior conservación y carecen de la información adecuada (AU)

The objective of this article was to describe and analyze the situation of illicit products in Spain, both medicines and dietary supplements, notifying main actions taken in recent months and their worldwide contextualization. Also serve as a warning about the magnitude of the problem and the importance of the role of the community pharmacist. Searches of information were looked at a national and international level. A descriptive analysis of the Information Notes published by the Spanish Agency of Medicines and Medical Devices (AEMPS, Illegal Drugs, Human Use, 2015) was also conducted. Illicit sale products constitute a major problem for public health that has not stopped increasing. Specifically, in Spain, 20 Notes were published in 2015. These included the prohibition and withdrawal of a total of 35 products. Marketed as dietary supplement, they contained an active ingredient enough to be legally considered as a medicine. 86% were aimed at treating erectile dysfunction. It is essential international collaboration to minimize this issue. The last and most important operation was PANGEA VIII in June 2015, which involved 115 countries. In January 2016, the «Medicrime Convention» entered into force, an international agreement on counterfeiting of medical products and similar crimes. In addition, it is necessary to raise awareness and provide the citizens with mechanisms to identify potential risks inherent to the illicit sale products. Products purchased outside the permitted distribution channels do not ensure compliance with good manufacturing practice, distribution or subsequent storage, and they lack of adequate information (AU)

Feasibility of Describing Wellbeing and Strengths at the Community Level Utilizing the Omaha System.

Capturing strengths at the community level offers an emergent perspective to a strength-based approach for population health. The Omaha System standardized terminology has been found feasible to describe individual strengths in patient care planning. This study depicts results of using the Omaha System to capture strengths at the community level. Descriptive statistics and visualization were used to examine patterns of strengths and signs/symptoms by Omaha System Problem concept based on the secondary data analysis from 118 student-generated community assessments. Results suggest that it is feasible to use the Omaha System as a method classifying strengths and problems at the community level. The relationship between strengths and signs/symptoms is consistent with the pattern observed at the individual-level. Utilizing a strength-based model may provide robust information about community strengths leading to new approaches to population health management in support of community wellbeing.

[Same words, different meanings: How epidemiological terminology struggles with population health intervention research]. / À mêmes mots, sens différents--les difficultés de la terminologie épidémiologique avec la recherche en interventions en santé des populations.

Public health research differs from clinical epidemiological research in that its focus is primarily on the population level social and structural determinants of individual health and the interventions that might ameliorate them, rather than having a primary focus on individual-level risks. It is typically concerned with the proximal and distal causes of health problems, and their location within complex systems, more than with single exposures. Thus, epidemiological terms and concepts may have very different implications when used in the context of population health. This paper considers some key differences in relation to terms like 'population', 'baseline', 'control group' 'outcome' and 'adverse effects'. Even the concept of an 'intervention' often needs careful handling. The paper concludes that there is a need for an expanded, and more realistic use of these terms in the population health intervention research context.

[Development of valorization of physical activity: the role of HIV associations]. / La construction de la valorisation de l'activité physique : le rôle des associations VIH.

With the arrival of triple combination therapy in 1996-1997, HIV infection, considered up until then to be a life-threatening condition, changed statuses within the realm of public health actions Progressively likened to a "chronic illness", the discourse on HIV prevention targeting people living with HIV (PLHIV) began to evolve. A review of the scientific literature and the journals of four national HIV associations published between 1990 and 2010 shows that physical activities, previously discouraged because considered to be dangerous, have become increasingly presented as a means of improving quality of life and are increasingly recommended for PLHIV. This article studies this reconfiguration of the discourse on HIV prevention, as well as its effects on the discourse conveyed by HIV associations. The article shows how the new classification of HIV as a "chronic illness", on the basis of scientific expertise, has led to a modified discourse on prevention, including the recommendation of regular and controlled physical activity. This new orientation has contributed to the restructuring of HIV associations which relay this discourse and modify their organization and services, increasingly offering access to physical activities. However, this raises the question of the effects of this new representation of physical activities, as there has been little conside-ration of the difficulties encountered by PLHIV to respond to these repeated encouragements to modify their lifestyles in order to be "good" chronically ill patients. .

Tratamiento de la obesidad en la consulta de endocrinología de un hospital. Influencia del índice de masa corporal de los padres / Treatment of obesity in a hospital endocrinology clinic. Influence of parental body mass index

Introducción: El objetivo del estudio es conocer si tener padres obesos influye en la adherencia y el éxito del tratamiento frente a la obesidad en la consulta de endocrinología infantil de un hospital. Material y métodos: Estudio analítico, prospectivo y longitudinal en obesos de 4-14 años. En ellos se determinó el IMC inicial y 6 meses después de que recibieran pautas higiénico-dietéticas saludables. Se consideró éxito significativo la disminución de 0,5 DE del IMC y adherencia que los pacientes acudieran a la revisión semestral. Se calculó el IMC de los padres para identificar a los obesos. Se utilizó el test de la χ2 para comparar las variables cualitativas y el test de la t de Student para las variables cuantitativas (significativo: p<0,05). Resultados: Cien niños (52 varones), edad media ± DE: 9,9±2,7 años, IMC 28,1±4,5kg/m2 y Z-score del IMC 3,11 ± 0,98 (el 85% tenía un Z-score del IMC > 3). Eran obesos 41 padres y 38 madres (el 59% tenía uno o los 2 padres obesos). No se adhirieron al tratamiento 25. La adherencia era peor si los 2 padres eran obesos, OR 3,65 (1,3-10,5) (p = 0,01) y era mejor si la madre no era obesa, aunque el padre lo fuera (p=0,01). El tratamiento tuvo éxito significativo en 40 pacientes. Si la madre era la única obesa en la familia la posibilidad de no tener éxito era mayor, OR 5,6 (1,4-22,4) (p<0,01). Conclusiones: Un alto porcentaje de niños con obesidad severa tienen padres obesos. La madre tiene gran influencia en la adherencia y respuesta al tratamiento frente a la obesidad del hijo muy obeso (AU)

Introduction: Parental obesity is a risk factor for childhood obesity. The aim of this study was to determine if parental obesity influences the adherence and success of obesity treatment in a hospital paediatric endocrinology clinic. Material and methods: An analytical, prospective, longitudinal study was conducted on obese children aged 4-14. An initial body mass index (BMI), and again at 6 months after receiving health, hygiene and dietary recommendations. Success was considered as a decrease of 0.5 in the BMI Z-score, and adherence to attending the 6-month review. Parental BMI was determined to identify overweight. The χ2 test was used for qualitative variables and the T-Student test for quantitative (significance, p<<.05). Results: The study included 100 children (52 male), 9.9±2.7 years old, BMI 28.1± 4.5kg/m2 and BMI Z-Score 3.11±0.98. (85% had a BMI Z-score>3). More than half (59%) of the children had one or both parents obese (41 fathers and 37 mothers were obese). Treatment was not adhered to by 25 children. Adherence was worse if both parents were obese OR 3.65 (1.3 to 10.5) (P<=.01) and adherence was better if the mother was not obese, although the father was (P=.01). The treatment had significant success in 40 patients. If the mother was the only obese one in the family, the possibility of treatment failure was greater OR 5.6 (1.4 to 22.4)(P<.01). Conclusions: A high percentage of children with severe obesity have obese parents. The mother has an important influence on adherence and response to treatment for the severely obese child (AU)

Análisis del Impacto Presupuestario del tratamiento mediante quimiohipertermia neoadyuvante en el cáncer vesical no músculo invasivo / Analysis of Budgetary Impact of moderate and high risk non muscle-invasive bladder cancer by means of neoadjuvant hyperthermia chemotherapy compared to the standard adjuvant treatment with BCG

OBJETIVO: Estudiar la relación de coste-efectividad e impacto presupuestario de una pauta de quimiohipertermia (QHT) neoadyuvante en pacientes con cáncer vesical no musculo invasivo (NMI) comparándolo con un tratamiento estándar de BCG y aplicando valores de recidiva y progresión basadas en tablas de riesgo internacionalmente aceptadas. MÉTODOS: Para ello, se diseñó un modelo desde la perspectiva de un sistema público de salud tras un seguimiento de 3 años para comparar los costes de aplicar quimiohipertermia neoadyuvante a los pacientes del ensayo clínico (8 instilaciones semanales de 80 mg Mitomicina C recirculando a 43 ºC durante 1 hora previas a la realización de una resección transuretral del tumor vesical) con los costes de tratar a 15 pacientes con el mismo perfil de riesgo con el tratamiento estándar adyuvante de BCG (grupo control). Se incluyeron los costes reales disponibles correspondientes a fármacos y desechables y los publicados relativos a la resección transuretral (RTU) de vejiga, biopsia fría y riesgo de recidiva tumoral. Se descartaron del modelo los costes de pruebas diagnósticas y de seguimiento por no variar entre ambos grupos. RESULTADOS: El modelo construido con datos de costes reales y publicados establece una diferencia favorable para el tratamiento neoadyuvante con quimiohipertermia en términos de coste a 3 años con un ahorro mínimo global de 10.300€ y de 687€ por paciente, todo ello con una mejora de la efectividad del tratamiento. Estos valores pueden pasar a 25.960€ de ahorro mínimo y 1.731€ de ahorro por paciente, si se asume un cambio de protocolo después de la neoadyuvancia que utilice la biopsia fría para comprobar el resultado. De los 15 pacientes pretratados con quimiohipertermia, 11 de riesgo alto y 4 de riesgo medio, 9 han respondido de forma completa (ausencia de tumor residual) y 6 de forma parcial (reducción del tumor). El número de recurrencias esperadas se ha reducido de 8 a 2 y de progresiones de 3 a 0. CONCLUSIONES: El tratamiento neoadyuvante con quimiohipertermia constituye una estrategia terapéutica coste-efectiva

OBJECTIVES: To study the relationship between cost-effectiveness and budgetary impact the application of a neoadjuvant chemo-hyperthermia treatment on 15 patients with NMI multi-recurrent bladder cancer and/or whose risk of recurrence and progression is medium-high, compared with the standard neoadjuvant BCG treatment, has had on the Hospital Comarcal de Monforte de Lemos (Lugo). METHODS: A model was designed from an SNS perspective with a temporary horizon of three years to compare the costs of applying neoadjuvant chemohyperthermia on the patients of the clinical test (8 instillations weekly of 80 mg Mitomycin C recirculating at 43° C for an hour prior to carrying out a transurethral resection of the bladder tumor) with the costs of treating 15 patients with the same risk profile with the standard adjuvant treatment of BCG (control group). The effective available costs corresponding to drugs, disposables and those relative to TURBT, cold biopsy and tumor relapse were included. The costs of diagnostic tests and followup were discarded from the model because they did not vary between groups. RESULTS: The model built with effective and published cost data establishes a favourable difference in favour of the neoadjuvant treatment with chemo hyperthermia in terms of 3 year costs with a minimum global savings of 10,300€ and 687€ per patient, together with an improvement in the effectiveness of the treatment. These values could reach a minimum savings of 25,960€ and 1,731€ per patient, if a change in protocol is made after the neoadjuvant treatment, which uses the cold biopsy to check the results. Of the 15 patients pre-treated with chemo-hyperthermia, 11 high-risk and 4 medium-risk, 9 have responded completely (absence of residual tumor) and 6 partially (shrinking of the tumor). The number of expected relapses has been reduced from 8 to 2 and progression from 3 to 0. CONCLUSIONS: The neoadjuvant treatment with chemo hyperthermia constitutes a cost-effective therapeutic strategy

Claves para avanzar hacia un rol más activo por parte del paciente con diabetes mellitus tipo 2 en España / Key aspects to moving towards a more active role for the patient with diabetes mellitus type 2 in Spain

OBJETIVOS: La diabetes mellitus tipo 2 (DM2) es un problema de salud pública de primer orden que preocupa a gestores, a profesionales sanitarios y a la sociedad en su conjunto. Contar con un paciente con DM2 más activo y responsable con su salud se perfila como una de las soluciones. Por ello la importancia de impulsar un debate multidisciplinar que aporte ideas y soluciones que contribuyan a conseguir un paciente con DM2 involucrado en su salud. En este artículo se presentan una serie de recomendaciones consensuadas por el Grupo Paciente Activo y Diabetes (PAyDInet). MATERIAL Y MÉTODOS: Se constituyó el grupo de trabajo PAyDInet, en el que participaron diferentes agentes del sistema. Siguiendo la técnica de grupo nominal, se identificaron y priorizaron las barreras, los elementos facilitadores así como iniciativas concretas que fomenten una actitud preventiva y de autocuidado en el paciente con DM2. RESULTADOS: El grupo llegó a un consenso sobre las 3 barreras, 3 elementos facilitadores y 3 iniciativas clave en la consecución de un paciente con DM2 más activo en el manejo de su enfermedad. La configuración actual del sistema sanitario, la necesidad de mejorar la coordinación interprofesional y el desarrollo de la educación diabetológica estructurada constituyen los puntos esenciales identificados por el grupo. CONCLUSIÓN: Es una necesidad ineludible seguir avanzando para situar al paciente como centro del sistema. Un paciente formado e informado en DM2 es una tarea compleja que solo se logrará con nuevas alianzas y la colaboración de todos los agentes. En cualquier caso, el debate y las recomendaciones del grupo PAyDInet aportan una buena aproximación al tema y un excelente punto de partida

OBJECTIVES: Diabetes mellitus type 2 (DM2) is a public health problem of the first order of concern to managers, health professionals and society as a whole. Having a more active and responsible patient with DM2 is emerging as one of the solutions. Hence the importance of promoting a multidisciplinary discussion that provides ideas and solutions that contribute to an active and involved patient with DM2. In this article some consensual recommendations are provided by the working group called Active Patient and Diabetes(PAyDInet by its Spanish initials). METHODS: PAyDInet team was established by gathering agents from different fields of the system. Following the nominal group technique, barriers, facilitators and specific initiatives to promote a preventive attitude and self-care in patients with DM2, were identified and prioritized. RESULTS: The team reached a final consensus on 3 key barriers, 3 enablers and 3 key initiatives to achieve patients with DM2 more active in managing their disease. The configuration of the healthcare system, the need to improve interprofessional coordination, and development of structured diabetes education, are the key points identified by the group. CONCLUSION: It is an inescapable need to move forward to put the patient at the centre of the system. Training and informing a patient on DM2 is a complex task that can only be achieved with new partnerships and collaboration of all stakeholders. In any case, the discussion and recommendations of the group PAyDInet give us a good approach to the subject and an excellent starting point

Variabilidad clínica en la cirugía de la catarata / Clinical practice variation in cataract surgery

PROPÓSITO: Las tasas de la cirugía de la catarata han aumentado de forma espectacular en las últimas dos décadas. Sin embargo, las variaciones en la práctica clínica en esta cirugía no han sido estudiadas en profundidad. El objetivo de esta revisión es el análisis de dicha variabilidad, incluyendo los factores que la originan y las consecuencias sobre la calidad asistencial y la planificación sanitaria. Asimismo se resalta la importancia de reducirla y se exponen diversas estrategias que permiten su control. Hallazgos recientes: A lo largo del artículo se presentan las últimas investigaciones en las que se considera que el desarrollo y la implementación de guías de práctica clínica constituyen la mejor herramienta para estandarizar los procesos de cuidados. CONCLUSIÓN: El control del componente injustificado o no deseado de las variaciones, además de mejorar la calidad asistencial, puede suponer un importante ahorro en el gasto sanitario

PURPOSE: Cataract surgery rates have dramatically increased in the last two decades. However, clinical practice variation in cataract surgery has not been thoroughly studied. The aim of this review is to analyze clinical practice variation, including the causes and consequences of this phenomenon. Then, its role in health care planning and health care quality is focused, emphasizing the importance of reducing it and providing several practical strategies to accomplish it. Recent findings: The latest researches are presented in this article. They identify the development and implementation of clinical practice guidelines as the best tool to standardize care processes. CONCLUSION: Managing unwarranted or unwanted variation would improve quality of care and may lead to a significant saving in health care spending

¿Es el sistema tiempos quirúrgicos estándar (TQE) aplicable a la oftalmología actual del sistema sanitario público? / Is the standard operating times system applicable to ophthalmology in the public health system?

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