Bipolar radiofrequency ablation of genicular nerves in chronic knee pain: A novel technique for more complete sensory denervation.

BACKGROUND: Monopolar radiofrequency ablation (MRFA) of the genicular nerves has been considered the main interventional treatment for chronic knee pain. However, the variable locations of these nerves could suggest that traditional MRFA of genicular nerves may be insufficient to cover the area needed to provide complete sensory denervation. For these reasons, some alternatives have been proposed to achieve an increase in the lesion area that offers better outcomes such a bipolar radiofrequency ablation (BRFA). OBJECTIVE: To describe the efficacy and safety of the bipolar radiofrequency ablation (BRFA) of the genicular nerves in the patients with chronic knee pain. METHODS: A retrospective study was conducted in the Pain Medicine Department. Institutional review board approval from the Hospital Ethical Committee and informed consent were obtained. We reviewed our database for BRFA of genicular nerves from January 2018 to December 2021 for patients with chronic knee pain. The cannulas were placed using ultrasound guidance (10 cm, 22-gauge and 10 mm active curved tip), and each pair of cannulas were subjected to BRFA for 90 seconds at 80∘C. Data analysis was conducted using T-test for paired variables (Visual analogue scale and EuroQol, an instrument intended to complement other forms of quality-of-life measures). RESULTS: Twenty-five patients met inclusion criteria after excluding 7 based on the study design. The mean improvement of our patients according to the VAS was -3.98 (95%CI: -4.37 to -3.59) p< 0.0001 and EuroQol +0.416 (95%CI: 0.364 to 0.468) p< 0.0001. The mean duration of improvement was 8 (6-11) months after BRFA. There were no reported serious adverse events related to the procedure, only local pain for 24 to 48 hours in 3 patients. CONCLUSIONS: We can conclude that BRFA reduces procedural pain and increases the treatment area, providing more complete sensory denervation and improved clinical outcomes.

Antioxidant Activity of Egg Yolk Protein Hydrolysates Obtained by Enzymatic and Sub-Critical Water Hydrolysis.

Obtaining peptides with antioxidant properties by enzymatic hydrolysis has been widely described; however, the use of non-enzymatic methods to obtain peptides with antioxidant capacities has been poorly investigated. In this study, non-soluble proteins obtained from delipidated egg yolk granules were hydrolyzed with trypsin, and with a non-enzymatic method using sub-critical water hydrolysis under a non-oxidizing (nitrogen) and oxidizing (oxygen) atmosphere. The effect of the sub-critical water hydrolysis on the amino acids' composition of the hydrolysates was assessed. Furthermore, the antioxidant capacities of the hydrolysates were evaluated using the ABTS•+ scavenging assay, the DPPH radical scavenging activity assay, and by measuring the reducing power of the peptides, the peptides' ferrous ion chelating capacities, and the antioxidant effect of the peptides on beef homogenates. The hydrolysate obtained by sub-critical water hydrolysis under a nitrogen stream showed similar or better results in the antioxidant tests than those obtained using trypsin hydrolysis, except in the ferrous chelating capacity, where the trypsin hydrolysate showed the best performance. The oxidizing environment promoted by the oxygen in the other sub-critical water hydrolysis method tested produced the peptides with the lowest antioxidant capacities, due to changes in the primary structure of the peptides. These results suggest that the sub-critical water hydrolysis method under a nitrogen stream, in comparison with the enzymatic hydrolysis, is a reliable method to obtain peptides with good antioxidant capacities.

Effect of Birch Sap as Solvent and Source of Bioactive Compounds in Casein and Gelatine Films.

Birch sap consists of a natural water-based solution with valuable compounds such as minerals, sugars, organic acids and phenolic compounds that can be used advantageously in the preparation of edible films. In this study, gelatine- and casein-based films were prepared using birch sap as biopolymer solvent and source of bioactive compounds with the aim of developing new bioactive materials for food packaging. The physical, mechanical, barrier, antioxidant and iron-chelating properties of the obtained films were investigated. Birch sap enhanced the mechanical properties of the films by increasing puncture strength and flexibility, as well as their ultraviolet-visible light barrier properties. In addition, the presence of bioactive compounds endowed the birch sap films with an antioxidant capacity of almost 90% and an iron-chelating capacity of 40-50% with respect to the control films. Finally, to test these films as food packaging material, a photosensitive curcumin solution was packed and exposed to ultraviolet light. Tested films were able to protect curcumin against photodegradation, and the presence of bioactive compounds inside the birch-sap-enriched materials offered an additional 10% photoprotective effect compared to control films. Results showed the potential of birch sap as an environmentally friendly biopolymer solvent and plasticizer that can improve the mechanical and photoprotective properties of the prepared materials.

Egg Yolk Oil as a Plasticizer for Polylactic Acid Films.

Polylactic acid (PLA) is known to be one of the most extensively used biodegradable thermoplastic polyesters, with the potential to replace conventional petroleum-based packaging materials; however, the low flexibility of films prepared using PLA has limited the applications of this biopolymer. In this study, in order to improve the mechanical properties of PLA films and to provide them with antioxidant properties, egg yolk oil was used as a biobased plasticizer. For this purpose, PLA films with increasing concentrations of egg yolk oil were prepared and the effects of this oil on the light transmission, transparency, colour, water vapour permeability, solubility, antioxidant activity and mechanical properties of the films were characterized. In addition, electron microscopy of the structure of the transverse section of the films was also performed. Results showed that the formulations with higher concentrations of egg yolk oil increased the films' elasticity, and their light barrier and antioxidant properties. Finally, in order to test the films as a packaging material for food applications, extra virgin olive oil and resveratrol, both photosensitive compounds, were packed and exposed to ambient light. Overall, the results show the potential of egg yolk oil as an environmentally friendly plasticizer that can improve the flexibility of PLA films and provide them with additional photoprotective properties.

Tabaquismo y aspergilosis broncopulmonar alérgica: una mala combinación / Smoking habit and allergic bronchopulmonary aspergilosis: a bad combination

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Diseño y validación de la escala para la detección de violencia en el noviazgo en jóvenes en la Universidad de Sevilla / Design and validation of the scale for the detection of violence in courtship in young people in the Sevilla University (Spain)

Objetivo: Diseñar y validar un instrumento específico para detectar la violencia ejercida y padecida en las relaciones de parejas jóvenes, la Escala Multidimensional de Violencia en el Noviazgo (EMVN). Método: Estudio descriptivo de validación clinimétrica. Muestreo aleatorio estratificado por sexo y área de conocimiento, en el que se adoptó como criterio de inclusión tener o haber tenido alguna relación de pareja. La muestra estuvo compuesta por 447 sujetos. Resultados: Se ha obtenido la EMVN de 32 ítems con tres dimensiones: agresiones físicas y sexuales, conductas de control (ciberacoso, vigilancia y acoso) y abuso psicoemocional (denigración y dominación), como víctima o como agresor/a. No se han encontrado diferencias estadísticamente significativas entre la violencia ejercida y la padecida, pero sí en función del sexo. Conclusión: La EMVN es una escala válida y fiable que mide los distintos elementos de la violencia en parejas de jóvenes y puede suponer un recurso para la detección integral de conductas violentas en las relaciones de noviazgo que se establecen entre jóvenes (AU)

Objective: To design and validate a specific instrument to detect exercised and suffered in the relations of young couples in violence. Method: Descriptive study of validation clinimetric. Stratified by sex and area of knowledge, which was adopted as inclusion criteria have or have had any relationship. The sample consisted of 447 subjects. Results: We obtained the Multidimensional Scale Dating Violence (EMVN), 32 items with three dimensions: physical and sexual assault, behavior control (cyberbullying, surveillance and harassment) and abuse psicoemocional (disparagement and domination), as a victim or as aggressor. No statistically significant differences were found between the violence exerted and the violence suffered, but it was based on sex. Conclusion: The EMVN is a valid and reliable scale that measures the different elements of violence in couples of young people and you can suppose a resource for the comprehensive detection of violent behaviors in dating relationships that are established among young people (AU)

[Design and validation of the scale for the detection of violence in courtship in young people in the Sevilla University (Spain)]. / Diseño y validación de la escala para la detección de violencia en el noviazgo en jóvenes en la Universidad de Sevilla.

OBJECTIVE: To design and validate a specific instrument to detect exercised and suffered in the relations of young couples in violence. METHOD: Descriptive study of validation clinimetric. Stratified by sex and area of knowledge, which was adopted as inclusion criteria have or have had any relationship. The sample consisted of 447 subjects. RESULTS: We obtained the Multidimensional Scale Dating Violence (EMVN), 32 items with three dimensions: physical and sexual assault, behavior control (cyberbullying, surveillance and harassment) and abuse psicoemocional (disparagement and domination), as a victim or as aggressor. No statistically significant differences were found between the violence exerted and the violence suffered, but it was based on sex. CONCLUSION: The EMVN is a valid and reliable scale that measures the different elements of violence in couples of young people and you can suppose a resource for the comprehensive detection of violent behaviors in dating relationships that are established among young people.

Blood Infusion and the Risk of Haemorrhage in Patients Undergoing Cardiac Surgery with Extracorporeal Circulation.

PURPOSE: Patients undergoing cardiac surgery with extracorporeal circulation (ECC) frequently present haemorrhages as a complication associated with high morbidity and mortality. One of the factors that influences this risk is the volume of blood infused during surgery. The objective of this study was to determine the optimal volume of autologous blood that can be processed during cardiac surgery with ECC. We also determined the number of salvaged red blood cells to be reinfused into the patient in order to minimize the risk of haemorrhage in the postoperative period. METHODS: This was an observational retrospective cross-sectional study performed in 162 ECC cardiac surgery patients. Data regarding the sociodemographic profiles of the patients, their pathologies and surgical treatments, and the blood volume recovered, processed, and reinfused after cell salvage were collected. We also evaluated the occurrence of postoperative haemorrhage. RESULTS: The volume of blood infused after cell salvage had a statistically significant effect (p < 0.01) on the risk of post-operative haemorrhage; the receiver operating characteristic sensitivity was 0.813 and the optimal blood volume cut-off was 1800 ml. The best clinical outcome (16.7% of patients presenting haemorrhages) was in patients that had received less than 1800 ml of recovered and processed autologous blood, which represented a volume of up to 580 ml reinfused red blood cells. CONCLUSION: The optimum thresholds for autologous processed blood and red blood cells reinfused into the patient were 1800 and 580 ml, respectively. Increasing these thresholds augmented the risk of haemorrhage as an immediate postoperative period complication.

Comparison of mortality of ESRD patients with lupus by initial dialysis modality.

BACKGROUND AND OBJECTIVES: Little is known regarding whether mortality among ESRD patients with SLE differs between those initiating with peritoneal dialysis (PD) versus hemodialysis (HD). This study compared the mortality risk of ESRD patients with SLE initiating with PD versus HD after matching their baseline sociodemographic and clinical factors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Of 11,023 ESRD patients with SLE initiating dialysis with PD or HD between 1995 and 2006 with complete records in the US Renal Data System, 1352 pairs were matched on 13 predictors utilizing a predicted probability of group membership into the PD group using propensity score matching. The primary outcome was overall mortality. Secondary outcomes were cardiovascular-related and infection-related mortality. Outcomes were compared between groups with survival statistics. The period of observation ended on December 31, 2009. The median follow-up was 3 years. RESULTS: Matched pairs were predominantly women (86%) with a median age of 39 years. Matched pairs had a balance (P ≥ 0.05) of all baseline factors. Matched pairs had a similar risk of overall mortality (hazard ratio, 0.96 [95% confidence interval, 0.82 to 1.13]; mortality, 21.4% [290 to 1352] versus 22.5% [304 to 1352] for PD versus HD) within the first 3 years of observation. Matched pairs also had similar cardiovascular-related mortality (10.5% versus 9.5% for PD versus HD) and infection-related mortality (3% versus 4.4% for PD versus HD). CONCLUSIONS: In ESRD patients with SLE, the mortality was similar among those initiating with PD versus HD after predictors were matched between groups.

Catastrophic antiphospholipid syndrome with severe acute thrombotic microangiopathy and hemorrhagic complications.

The catastrophic antiphospholipid syndrome (CAPS) is a rare life-threatening form of the antiphospholipid syndrome characterized by disseminated vascular thrombosis resulting in multiorgan failure. On an exceedingly rare occasion, CAPS can be associated with severe hemorrhagic manifestations. We report a young woman with a history of several spontaneous miscarriages who presented with menorrhagia and hemoptysis. The patient developed respiratory failure due to diffuse alveolar hemorrhage. Laboratory tests demonstrated severe hemolytic anemia, profound thrombocytopenia, markedly elevated fibrin degradation products, and renal failure. Blood films revealed numerous schistocytes. Serologic tests disclosed hypocomplementemia and autoantibodies directed against several nuclear antigens. Coagulation studies revealed lupus anticoagulant. Echocardiography demonstrated reduced ejection fraction and moderate to severe mitral and tricuspid regurgitation. The patient was diagnosed with CAPS with hemorrhagic manifestations in the setting of new-onset SLE. The patient was treated with hemodialysis, high-dose glucocorticoids, plasma exchange, intravenous cyclophosphamide, and rituximab. Over the ensuing four weeks, the combination therapy led to hematological, cardiopulmonary, and renal recovery. This exceedingly rare case emphasizes that hemorrhagic manifestations, severe microangiopathic hemolytic anemia, and profound thrombocytopenia can dominate the clinical picture in CAPS.

3ª Conferência Municipal de Saúde de Várzea Paulista: a participação da sociedade no processo de priorização e compromisso político / 3rd Varzea Paulista's Municipal Conference of Health: the participation of society in prioritizing proposals and political commitment

O artigo apresenta o relato de experiência da 3ª Conferência Municipal de Saúde de Várzea Paulista, ocorrida em 2008, cuja organização teve como objetivos envolver a sociedade na análise da situação de saúde do município, de forma a priorizar necessidades em saúde e transformar o relatório final em uma carta de compromisso político. Foram realizadas Plenárias Locais, Pré-Conferências Regionais e a Conferência Municipal, com fluxo ascendente de propostas e delegados, nas quais o tema "Garantindo o Direito à Saúde" foi debatido através de cinco eixos temáticos correspondentes aos blocos do Pacto pela Saúde. Inovou-se com a atividade de priorização, através da limitação do número de propostas de cada região a serem encaminhadas para a Conferência Municipal. O Relatório Final foi encaminhado aos candidatos a prefeito, solicitando-se o compromisso com as deliberações. A realização da Conferência de forma ascendente, com etapas locais e regionais, garantiu a participação da comunidade, a representatividade dos delegados eleitos e das propostas aprovadas. A "priorização coletiva" qualificou o debate garantindo a pactuação com a sociedade de um projeto viável. O debate acerca da governabilidade ampliou-se para a intersetorialidade, gerando moções de apelo a outras secretarias municipais. A grande contribuição deste processo para o município foi a oferta de espaços de debate entre os diversos olhares, que favoreceu o ensino-aprendizagem e a formação política dos participantes. O comprometimento político obtido dos candidatos à sucessão municipal evidenciou o empenho dos atores na transformação da política municipal de saúde em uma política de estado, não de governo.

3ª Conferência Municipal de Saúde de Várzea Paulista: a participação da sociedade no processo de priorização e compromisso político / 3rd Varzea Paulista's Municipal Conference of Health: the participation of society in prioritizing proposals and political commitment

O artigo apresenta o relato de experiência da 3ª Conferência Municipal de Saúde de Várzea Paulista, ocorrida em 2008, cuja organização teve como objetivos envolver a sociedade na análise da situação de saúde do município, de forma a priorizar necessidades em saúde e transformar o relatório final em uma carta de compromisso político. Foram realizadas Plenárias Locais, Pré-Conferências Regionais e a Conferência Municipal, com fluxo ascendente de propostas e delegados, nas quais o tema "Garantindo o Direito à Saúde" foi debatido através de cinco eixos temáticos correspondentes aos blocos do Pacto pela Saúde. Inovou-se com a atividade de priorização, através da limitação do número de propostas de cada região a serem encaminhadas para a Conferência Municipal. O Relatório Final foi encaminhado aos candidatos a prefeito, solicitando-se o compromisso com as deliberações. A realização da Conferência de forma ascendente, com etapas locais e regionais, garantiu a participação da comunidade, a representatividade dos delegados eleitos e das propostas aprovadas. A "priorização coletiva" qualificou o debate garantindo a pactuação com a sociedade de um projeto viável. O debate acerca da governabilidade ampliou-se para a intersetorialidade, gerando moções de apelo a outras secretarias municipais. A grande contribuição deste processo para o município foi a oferta de espaços de debate entre os diversos olhares, que favoreceu o ensino-aprendizagem e a formação política dos participantes. O comprometimento político obtido dos candidatos à sucessão municipal evidenciou o empenho dos atores na transformação da política municipal de saúde em uma política de estado, não de governo.(AU)

Neck pain from a rheumatologic perspective.

This article provides a comprehensive review of rheumatologic considerations for a clinician when evaluating a patient with neck pain. Clearly, anatomic derangements of the cervical spine should be considered when a patient complains of cervicalgia. However, one must also entertain the possibility of a systemic illness as the cause of the pain. Examples of diseases that may present with a prominent feature of neck pain are discussed, including rheumatoid arthritis, ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, myositis, and fibromyalgia. Evidence of an underlying rheumatic illness may guide the clinician in a different therapeutic direction.

O aterro sanitário como fator de risco para doenças respiratórias em crianças / Landfills as risk factors for respiratory disease in children

OBJETIVO: Avaliar a relação entre a exposição a um aterro sanitário fechado há 6 anos e os sintomas respiratórios em crianças de até 13 anos de idade. MÉTODO: Estudo transversal realizado em Várzea Paulist a, estado de São Paulo, Brasil. Um adulto cada um dos domicílios localizados no bairro próximo ao aterro sanitário e de uma amostra aleatorizada de domicílios de outro bairro com características socioeconômicas semelhantes foram entrevistados, perguntando-se sobre sintomas respiratórios, bem como sobre outras variáveis em crianças de até 13 anos de idade. O modelo de regressão logística foi utilizado para estudar essa relação. RESULTADOS: A chance de uma criança apresentar sintoma respiratório foi função de: -2,36 + 0,43 se a criança tem menos de 2 anos de idade; + 0,24 se a criança morar no bairro em que fica o aterro sanitário; -0,67 se, no domicílio, houver computador; + 0,54 se houvesse consumo de lenha no último ano; + 0,94 se a criança fora diagnosticada com asmática; + 0,87 foi ao serviço de saúde nos últimos 30 dias. CONCLUSÃO: Os autores concluem que morar próximo a um aterro sanitário fechado há 6 anos pode ser um fator de risco para doenças respiratórias em crianças.

OBJECTIVE: To investigate the relationship between exposure to a landfill site closed 6 years previously and respiratory symptoms in children aged up to 13 years. METHOD: This was a cross-sectional study conducted in Várzea Paulista, in the state of São Paulo, Brazil. One adult in every household in a neighborhood close to the landfill and from a randomized sample of households in another neighborhood with similar socioeconomic characteristics but no landfill were interviewed and asked about respiratory symptoms and other variables relating to children aged up to 13. A logistic regression model was used to study this relationship. RESULTS: The likelihood of a child having respiratory symptoms was a function of -2.36 + 0.43 if the child was less than 2 years old; + 0.24 if the child lived in the landfill area; -0.67 if there was a computer at home; + 0.54 if firewood was burnt in the home in the last year; + 0.94 if the child was diagnosed with asthma; + 0.87 if the child visited a health service in the previous 30 days. CONCLUSION: The authors conclude that living near to a landfill closed 6 years previously may be a risk factor for respiratory disease in children.

Landfills as risk factors for respiratory disease in children.

OBJECTIVE: To investigate the relationship between exposure to a landfill site closed 6 years previously and respiratory symptoms in children aged up to 13 years. METHOD: This was a cross-sectional study conducted in Várzea Paulista, in the state of São Paulo, Brazil. One adult in every household in a neighborhood close to the landfill and from a randomized sample of households in another neighborhood with similar socioeconomic characteristics but no landfill were interviewed and asked about respiratory symptoms and other variables relating to children aged up to 13. A logistic regression model was used to study this relationship. RESULTS: The likelihood of a child having respiratory symptoms was a function of -2.36 + 0.43 if the child was less than 2 years old; + 0.24 if the child lived in the landfill area; -0.67 if there was a computer at home; + 0.54 if firewood was burnt in the home in the last year; + 0.94 if the child was diagnosed with asthma; + 0.87 if the child visited a health service in the previous 30 days. CONCLUSION: The authors conclude that living near to a landfill closed 6 years previously may be a risk factor for respiratory disease in children.

O pacto pela saúde e o fundo municipal de saúde de Várzea Paulista / Health pact and the municipal health fund of Várzea Paulista

A reestruturação do Fundo Municipal de Saúde de Várzea Paulista teve como objetivos: reorganizar o orçamento municipal de acordo com o Pacto pela Saúde, integrar ações do planejamento e gestão orçamentário-financeira, atualizar a legislação municipal e implantar sistema de monitoramento. Inicialmente foi preenchido o Termo do Limite Financeiro do Município, dividindo os recursos para custeio em 2006 por cinco blocos: Gestão, Atenção Básica, Média e Alta Complexidade, Assistência Farmacêutica e Vigilância em Saúde. Esse cálculo permitiu o planejamento do orçamento para 2007, subdividindo-se cada bloco em cinco itens de despesa (pessoal, obras, serviços de terceiros, material de consumo e permanente) acrescentando-se projetos novos. Foi aprovada lei que alterou o Plano Plurianual (PPA), compatibilizando-o com a Lei Orçamentária Anual para 2007, instituindo cinco planos de trabalho com as respectivas dotações para os itens de despesa, subsidiando a elaboração da Programação Anual para 2007. Em setembro de 2007, já com o acompanhamento financeiro-orçamentário em andamento, elaborou-se a partir de um processo de Planejamento Ascendente a proposta de prioridades para 2008 que, revertidas em necessidades financeiras, transformou-se em proposta orçamentária e converteu-se na Lei Orçamentária 2008. A reorganização do Fundo Municipal de Saúde de Várzea Paulista em cinco blocos de financiamento tem propiciado uma maior interface entre o planejamento e a gestão, com previsão, programação, monitoramento e execução orçamentário-financeira condizentes com as diretrizes e metas estabelecidas no Plano Municipal de Saúde e nas Programações Anuais.

The restructuring of the Municipal Health Fund of Várzea Paulista aimed to reorganize the municipal budget according to the Health Pact, to integrate planning and financial management, to modernize the municipal law and to implement a monitoring system. First, the Municipal Financial Limit Document was filled in, dividing the financial resources of 2006 among five groups: Management, Primary Care, Specialized Care, Pharmaceutical Care and Health Surveillance. This calculation helped in budget planning for 2007, and each group was subdivided into five expenditure items (personnel, construction, outsourced services, equipment and consumption materials), besides new projects. A law that altered the Pluriannual Plan according to the Annual Budget Law for 2007 was passed, introducing five work plans and subsidizing the development of the Annual Program for 2007. In September 2007, in an Ascendant Planning process, a priority list was converted into cost needs for the Budget Law for 2008. The reorganization of the Municipal Health Fund of Várzea Paulista into five groups has made planning and management comply with the objectives of the Municipal Health Plan and Annual Programs.

O pacto pela saúde e o fundo municipal de saúde de Várzea Paulista / Health pact and the municipal health fund of Várzea Paulista

A reestruturação do Fundo Municipal de Saúde de Várzea Paulista teve como objetivos: reorganizar o orçamento municipal de acordo com o Pacto pela Saúde, integrar ações do planejamento e gestão orçamentário-financeira, atualizar a legislação municipal e implantar sistema de monitoramento. Inicialmente foi preenchido o Termo do Limite Financeiro do Município, dividindo os recursos para custeio em 2006 por cinco blocos: Gestão, Atenção Básica, Média e Alta Complexidade, Assistência Farmacêutica e Vigilância em Saúde. Esse cálculo permitiu o planejamento do orçamento para 2007, subdividindo-se cada bloco em cinco itens de despesa (pessoal, obras, serviços de terceiros, material de consumo e permanente) acrescentando-se projetos novos. Foi aprovada lei que alterou o Plano Plurianual (PPA), compatibilizando-o com a Lei Orçamentária Anual para 2007, instituindo cinco planos de trabalho com as respectivas dotações para os itens de despesa, subsidiando a elaboração da Programação Anual para 2007. Em setembro de 2007, já com o acompanhamento financeiro-orçamentário em andamento, elaborou-se a partir de um processo de Planejamento Ascendente a proposta de prioridades para 2008 que, revertidas em necessidades financeiras, transformou-se em proposta orçamentária e converteu-se na Lei Orçamentária 2008. A reorganização do Fundo Municipal de Saúde de Várzea Paulista em cinco blocos de financiamento tem propiciado uma maior interface entre o planejamento e a gestão, com previsão, programação, monitoramento e execução orçamentário-financeira condizentes com as diretrizes e metas estabelecidas no Plano Municipal de Saúde e nas Programações Anuais.(AU)