Processo de criação da Comissão de Saúde de Londrina e região, Estado do Paraná, Brasil / Process of creation of a region Health Commission in the city of Londrina, state of Paraná, Brazil

Este artigo descreve a ação de um grupo de gestores em saúde Londrina-PR e região que se reuniu com o objetivo fortalecer a integração e abordagem sistêmica para os problemas experimentados no Sistema Único de Saúde (SUS). Trata-se de um relato de experiência, estruturado por meio de uma abordagem crítico-reflexiva, descrevendo as fases e ferramentas utilizadas no projeto, que ao longo de 2018 resultou na conformação de 5 (cinco) eixos de atuação: Apostar na Atenção Primária à Saúde; Fortalecer a produção assistencial na média e alta complexidade; Qualificar a capacidade instalada da atenção hospitalar; Aprimorar a integração, regulação e comunicação no cuidado e Garantir o financiamento e alocação eficiente de recursos. A partir destes caminhos, o grupo busca construir uma unidade entorno de uma agenda comum, com soluções inovadoras de médio e longo prazo. (AU)

This article describes the action of a group of health managers in the city of Londrina, state of Paraná, and in the region, who met with the objective of enhancing the integration and systemic approach to problems in the Unified Health System (SUS). This is an experience report, structured through a critical-reflexive approach, describing the phases and tools used in the project in 2018 that resulted in the creation of five axes of action: Invest on Primary Health Care; Strengthen care production in medium and high complexity services; Qualify the installed capacity of hospital assistance; Improve integration, regulation and communication in health care; and Ensure funding and efficient allocation of resources. The group seeks a common agenda to act on the identified axes, with innovative medium- and long-term strategies.(AU)

Uma proposta de renovação da seleção de medicamentos no SUS: a regionalização como estratégia e experiência para superação de desafios / A proposal for renewal of the selection of medicines at SUS (Unified Health System): regionalization as a strategy and experience for overcoming challenges

A escolha e oferta de medicamentos no SUS caracteriza-se como uma importante etapa da Assistência Farmacêutica, com elevado impacto na resolutividade e eficiência da assistência à Saúde. No formato proposto, esta etapa encontra limitações, principalmente em sua operacionalização, que minimizam seus potenciais benefícios. O presente artigo tem por objetivo relatar e discutir uma experiência desenvolvida no âmbito de uma região de saúde para renovar a proposta de seleção de medicamentos com a introdução de ferramentas da Gestão de Tecnologias em Saúde, do conceito de regionalização e de Redes de Atenção. Para tanto, foram desenvolvidas ações em âmbito regional para normatização da prescrição de medicamentos, definição de um modelo e construção das Relações Municipais de Medicamentos, criação de uma Comissão de Farmácia e Terapêutica Regionalizada e mapeamento de necessidades relacionadas a protocolos clínicos. Constitui-se em experiência com resultados concretos e potencial de aplicabilidade em diferentes contextos de organização do SUS.(AU)

The selection and supply of drugs in the Brazilian public health system (SUS) is an important step of Pharmaceutical Care, with a high impact on the resolution and efficiency of health care. In the format proposed, this stage has limitations, mainly in its operation, minimizing its potential benefits. This article aims to report and discuss an experience developed within a health region to renew the proposal of drug selection with the introduction of tools for Health Technology Management, the concept of regionalization, and the Healthcare Networks. Thus, actions were regionally developed to define drug prescription standards and a model and construction of Municipal Drug Lists, the creation of a Pharmaceutical and Therapeutic Regional Committee, and mapping of clinical protocols needs. This experience had concrete results and potential of applicability in different contexts of health system organization.(AU)

Paraoxonase 1 (PON1) Q192R genotypes and their interaction with smoking strongly increase atherogenicity and the Framingham risk score.

OBJECTIVE: Paraoxonase 1 (PON1) polymorphisms are associated with an increased susceptibility to cardiovascular disease. PON1 Q192R polymorphism (rs662) partially determine PON1 hydrolytic activity and protect against oxidation of LDL and HDL. This study aimed to delineate the association of PON1 status (functional 192 genotype and plasma activity levels) and atherogenicity in urbans residents aged 40 years or more. MATERIALS AND METHODS: Anthropometric data, lipid profiles, the atherogenic index of the plasma (AIP) and Framingham score risk were measured. Three kinetic assays were conducted to assay PON1 status using phenylacetate and 4-(chloromethyl)phenyl acetate as substrates. RESULTS: Smoking per se did not significantly impact the AIP but the interaction PON1 genotype by smoking significantly increased the AIP. In subjects with the RR genotype smoking increased the AIP index from (estimated mean ± SEM) -0.038 ± 0.039 to 0.224 ± 0.094. The QR genotype increased the Framingham risk index by around 1.3 points. Smoking by RR genotype carriers significantly increased the Framingham risk score (17.23 ± 2.04) as compared to smoking (13.00 ± 1.06) and non-smoking (7.79 ± 0.70) by QQ+QR genotype carriers. The interaction RR genotype by smoking was a more important predictor (odds ratio = 7.90) of an increased Framingham risk score (> 20) than smoking per se (odds ratio = 2.73). The interaction smoking by RR genotype carriers significantly increased triglycerides and lowered HDL cholesterol. CONCLUSION: Smoking per se has no (AIP) or a mild (Framingham risk score) effect on atherogenicity, while the interaction smoking by PON1 RR genotype has a clinically highly significant impact on atherogenicity.

Paraoxonase 1 (PON1) Q192R genotypes and their interaction with smoking strongly increase atherogenicity and the Framingham risk score

ABSTRACT Objective Paraoxonase 1 (PON1) polymorphisms are associated with an increased susceptibility to cardiovascular disease. PON1 Q192R polymorphism (rs662) partially determine PON1 hydrolytic activity and protect against oxidation of LDL and HDL. This study aimed to delineate the association of PON1 status (functional 192 genotype and plasma activity levels) and atherogenicity in urbans residents aged 40 years or more. Materials and methods Anthropometric data, lipid profiles, the atherogenic index of the plasma (AIP) and Framingham score risk were measured. Three kinetic assays were conducted to assay PON1 status using phenylacetate and 4-(chloromethyl)phenyl acetate as substrates. Results Smoking per se did not significantly impact the AIP but the interaction PON1 genotype by smoking significantly increased the AIP. In subjects with the RR genotype smoking increased the AIP index from (estimated mean ± SEM) -0.038 ± 0.039 to 0.224 ± 0.094. The QR genotype increased the Framingham risk index by around 1.3 points. Smoking by RR genotype carriers significantly increased the Framingham risk score (17.23 ± 2.04) as compared to smoking (13.00 ± 1.06) and non-smoking (7.79 ± 0.70) by QQ+QR genotype carriers. The interaction RR genotype by smoking was a more important predictor (odds ratio = 7.90) of an increased Framingham risk score (> 20) than smoking per se (odds ratio = 2.73). The interaction smoking by RR genotype carriers significantly increased triglycerides and lowered HDL cholesterol. Conclusion Smoking per se has no (AIP) or a mild (Framingham risk score) effect on atherogenicity, while the interaction smoking by PON1 RR genotype has a clinically highly significant impact on atherogenicity.

[Non-adherence to continuous treatment and associated factors: prevalence and determinants in adults 40 years and older]. / Não adesão ao tratamento medicamentoso contí nuo: prevalência e determinantes em adultos de 40 anos e mais.

This study investigates factors associated with non-adherence to continuous drug therapy in individuals 40 years and older. A population-based survey was conducted in Cambé, Paraná State, Brazil. Treatment adherence was assessed with the four-item Morisky et al. medication adherence scale. The study also assessed socio-demographic variables and health services access and use of medication. Among 1,180 interviewees, 78% reported use of medication, with continuous use in 55%. The study analyzed 639 individuals, the majority female, ranging from 40 to 59 years of age, with low schooling, and from socioeconomic stratum C (on a scale from A to E). Prevalence of non-adherence was 63.5%. Mean therapeutic complexity was 8.1. After adjusted analysis, the following factors remained associated with non-adherence: not being assisted by community health workers, discontinuous access to medication, and high frequency of medication throughout the day. The results indicate high prevalence of non-adherence, with potentially negative impacts for individuals and society.

Nao adesao ao tratamento medicamentoso continuo: prevalencia e determinantes em adultos de 40 anos e mais / Non-adherence to continuous treatment and associated factors: prevalence and determinants in adults 40 years and older / Falta de adherencia al tratamiento farmacologico continuo: prevalencia y factores determinantes en adultos mayores de 40 anos

O presente estudo investiga os fatores associados a não adesão à terapia medicamentosa contínua em indivíduos de 40 anos e mais de idade. Foi realizado um inquérito de base populacional em Cambé, Paraná, Brasil. A adesão à terapia foi avaliada pela escala de quatro itens de Morisky et al. e analisaram-se também variáveis sociodemográficas, de utilização dos serviços de saúde e do uso de medicamentos. Foram entrevistados 1.180 indivíduos, dos quais 78% utilizaram medicamentos nos 15 dias anteriores à entrevista e em 55% registrou-se o uso contínuo. A amostra do estudo consistiu em 639 indivíduos, com predominância do sexo feminino, idade entre 40 e 59 anos, baixa escolaridade. A prevalência de não adesão foi de 63,5%. Após análise ajustada, permaneceram associados a não adesão: não ser acompanhado pelo agente comunitário de saúde, ter tido descontinuidade no acesso aos medicamentos e a elevada frequência de utilização dos medicamentos ao longo do dia. Os resultados indicam uma alta prevalência da não adesão com possíveis impactos negativos para os indivíduos e para a sociedade.

This study investigates factors associated with non-adherence to continuous drug therapy in individuals 40 years and older. A population-based survey was conducted in Cambé, Paraná State, Brazil. Treatment adherence was assessed with the four-item Morisky et al. medication adherence scale. The study also assessed socio-demographic variables and health services access and use of medication. Among 1,180 interviewees, 78% reported use of medication, with continuous use in 55%. The study analyzed 639 individuals, the majority female, ranging from 40 to 59 years of age, with low schooling, and from socioeconomic stratum C (on a scale from A to E). Prevalence of non-adherence was 63.5%. Mean therapeutic complexity was 8.1. After adjusted analysis, the following factors remained associated with non-adherence: not being assisted by community health workers, discontinuous access to medication, and high frequency of medication throughout the day. The results indicate high prevalence of non-adherence, with potentially negative impacts for individuals and society.

Este artículo investiga los factores asociados a la falta de adherencia en el tratamiento continuo con personas con 40 años o más de edad. Llevamos a cabo un estudio basado en la población de Cambé, Paraná, Brasil. La adhesión al tratamiento se evaluó mediante la escala de 4 ítems Morisky et al. También se han analizado variables sociodemográficas, uso de servicios de salud y medicamentos. Fueron entrevistadas 1.180 personas, de las cuales el 78% había consumido medicamentos durante los 15 días anteriores a la entrevista y en un 55% se registró un uso continuo. La muestra del estudio consistió en 639 individuos, principalmente mujeres, con edades comprendidas entre los 40 y 59 años y con baja educación. La prevalencia de no-adhesión fue de un 63,5%. Después del ajuste de análisis, la falta en el acceso a los medicamentos y la alta frecuencia de uso de medicamentos durante el día se asoció con el hecho de no estar acompañado por un trabajador comunitario de salud. Los resultados indican una alta prevalencia de falta de adherencia con los consiguientes posibles impactos negativos para los individuos.

Prevalência de fatores de risco cardiovascular em pessoas com 40 anos ou mais de idade, em Cambé, Paraná (2011): estudo de base populacional / Prevalence of cardiovascular risk factors in people aged 40 years or more from the city of Cambé, PR, Brazil (2011): a population-based study

Objetivo: estimar a prevalência de fatores de risco para doenças cardiovasculares segundo sexo e classe econômica. Métodos: estudo transversal de base populacional com indivíduos com 40 anos ou mais de idade, no município de Cambé, Estado do Paraná, Brasil; realizaram-se entrevistas domiciliares, aferições antropométricas e exames laboratoriais, no primeiro semestre de 2011; foram calculadas prevalências, razões de prevalências (RP) e intervalos de confiança de 95 por cento (IC95 por cento). Resultados: entrevistaram-se 1.180 pessoas; os fatores de risco com prevalência mais elevada foram inatividade física no lazer (71,4 por cento), sobrepeso/obesidade (68,3 por cento), hipertensão arterial (55,9 por cento) e baixo consumo de frutas (54,3 por cento) e verduras (35,5 por cento); a prevalência de sobrepeso/obesidade foi inferior entre homens, frente às mulheres (RP 0,82; IC95% 0,73-0,92); inatividade física no lazer, baixo consumo de frutas, verduras e legumes foram mais prevalentes entre homens e mulheres das classes socioeconômicas mais baixas. Conclusão: observaram-se elevadas prevalências de fatores de risco para doenças cardiovasculares, especialmente entre indivíduos menos favorecidos socioeconomicamente.

Objective: to estimate the prevalence of cardiovascular disease risk factors by sex and socioeconomic status. Methods: cross-sectional population-based representative sample of people aged 40 or older, living in Cambé-PR. Household interviews were conducted, collecting anthropometric measurements and laboratory tests in the first half of 2011. Prevalence, prevalence ratios (PR) and 95 por cento confidence intervals (95 per cent CI) were calculated. Results: 1,180people were interviewed. Most prevalent risk factors were physical inactivity during leisure (71.4 per cent), overweight/obesity (68.3 per cent), hypertension (55.9 per cent) and low consumption of fruit (54.3 per cent) and vegetables (35.5 per cent). Overweight/obesity prevalence was lower among men compared to women (PR 0.82, 95 per cent CI 0.73-0.92). Physical inactivity during leisure, as well as low fruit and vegetable consumption were more prevalent among men and women of lower socioeconomic classes. Conclusion: high cardiovascular disease risk factor prevalence was found, especially among individuals from lower socioeconomic classes.