Potential of vermicomposting with mixtures of animal manure and vegetable leaves in the development of Eisenia foetida, microbial biomass, and enzymatic activity under semi-arid conditions.

Vermicomposting is the bio-oxidation and stabilization of organic matter involving relationships between the action of earthworms and microorganisms and the activation and dynamics of several enzyme activities. Semi-arid farmers to make (extra) money and organic production, produce their vermicompost using plant residues and animal manure, but there is no information about the final product generated. Thus, this study aimed to analyze the potential of vermicomposting with mixtures of animal manure and vegetable leaves in the development of Eisenia foetida, microbial biomass, and enzymatic activity in the semi-arid region, Brazil. The experimental design applied was randomized block in a 6 × 4 factorial scheme with four replicates, with six treatments (mixtures of cattle manure, goat manure, cashew leaves, and catanduva leaves) and evaluated at four-time intervals (30, 60, 90, and 120 days of vermicomposting). The treatments were placed in polyethylene pots in the same site, environmental conditions, and residues proportions as used by farmers. The characteristics analyzed were the number of earthworms (NE), total earthworm biomass (TEB) and earthworm multiplication index (MI), microbial biomass carbon (MBC), and activities of enzymes ß-glucosidase, dehydrogenase, alkaline and acid phosphatases. The cattle manure vermicomposted shows the highest average values observed for NE, MI, TEB, MBC, and enzymatic activity, regardless of the plant leaves mix. In general, the enzymes activities were found in the descending order of ß-glucosidase > alkaline phosphatase > dehydrogenase > acid phosphatase. The maturation dynamics of vermicompost were characterized by a decline in the microbial population and number and biomass of earthworms in the substrate and consequently a decrease in new enzyme synthesis and degradation of the remaining enzyme pool. Microbial biomass and enzymatic activity were indicators for changes in the quality of vermicompost.

Profile of judicialization in access to antineoplastic drugs and their costs: a cross-sectional, descriptive study based on a set of all lawsuits filed between 2016 and 2018 in a state in the Northeast Region of Brazil.

BACKGROUND: The judicialization of the acquisition of medication for healthcare is not restricted to Brazil but can also be found in other Latin American countries, despite the existence of a universal health system in the case of Brazil, the Unified Health System (known as the SUS). Right-to-medicines litigation has existed ever since the emergence of a high demand for treatment of Acquired Immuno-deficiency Syndrome (AIDS) but the current focus is on cancer. Pharmaceutical Assistance (PA) is the area within the SUS that is responsible for ensuring access to medication and the aim of this article is thus to draw up a profile of litigation related to PA in one economically significant state in the Northeast Region of Brazil, in terms of the following characteristics of lawsuits: the plaintiff filing the lawsuit; medical and health information; the cost of acquiring the requested medications; and the proportion accounted for by spending on antineoplastic drugs. METHODS: A cross-sectional, descriptive study was conducted of lawsuits filed between 2016 and 2018 at the Litigation Center of the State of Pernambuco Department of Health. RESULTS: A total of 2,947 lawsuits containing at least one requested medication were analyzed. The majority of the plaintiffs were male (51.7%); 49.8% of the requests originated in the Unified Health System (SUS), and plaintiffs were primarily patients in the Metropolitan region of the State capital, Recife. The most frequent cancers involved were those classified by the ICD as C61, C71 and C50. The median general expense on medications for the actions was U$1,734.94. Considering antineoplastic drugs alone, the cost exceeded U$7,500 per lawsuit over the three years, given that the median unit price for antineoplastic drugs is approximately US$65 compared to US$4 for non-antineoplastic drugs. CONCLUSION: The present study is of relevance to the field of public health and examines how a profile of such healthcare litigation can be used as a tool for managing and improving decision-making in times of economic austerity.

Conditions associated with worse acceptance of a simplified accelerated recovery after surgery protocol in laparoscopic colorectal surgery.

BACKGROUND: Enhanced Recovery Surgical Programs were initially applied to colorectal procedures and used as multimodal approach to relieve the response to surgical stress. An important factor that negatively impacts the success of these programs is the poor tolerance of these patients to certain items in the adopted protocol, especially with regard to post-operative measures. The identification of these factors may help to increase the success rate of such programs, ensuring that benefits reach a greater number of patients and that resources are better allocated. Thus, the aims of this study were to assess the results of the implementation of a Simplified Accelerated Recovery Protocol (SARP) and to identify possible factors associated with failure to implement postoperative protocol measures in patients submitted to laparoscopic colorectal surgery. METHODS: 161 patients were randomly divided into two groups. The SARP group (n = 84) was submitted to the accelerated recovery program and the CC group (n = 77), to conventional postoperative care. The SARP group was further divided into two subgroups: patients who tolerated the protocol (n = 51) and those who did not (n = 33), in order to analyze factors contributing to protocol nontolerance. RESULTS: The groups had similar sociodemographic and clinical characteristics. The SARP group had a shorter hospital stay, better elimination of flatus, was able to walk and to tolerate a diet sooner (p < 0.0001). Complications rates and readmissions to emergency room were similar between groups. Multivariate analysis revealed that prolonged operating time, stoma creation and rates of surgical complications were independently associated with poor adherence to SARP (p < 0.0001). CONCLUSIONS: The use of our SARP resulted in improved recovery from laparoscopic colorectal surgery and proved to be safe for patients. Extensive surgeries, occurrence of complications, and the need for ostomy were variables associated with poor program adhesion. Trial registration Trial Registry: RBR2b4fyr-Date of registration: 03 October 2017.

Internet das Coisas e blockchain no Sistema Único de Saúde: a proteção dos dados sensíveis diante da Lei Geral de Proteção de Dados / Internet of Things and blockchain used in the Brazilian Unified Health System: how to protect sensitive data considering the imminence of the Data Protection Law / Internet de las cosas y cadena de bloques utilizado en el Sistema Único de Salud brasileño: cómo proteger los datos confidenciales ante la Ley General de Protección de Datos

Objetivo: O Sistema Único de Saúde (SUS) vem investido nas tecnologias da internet das coisas ­ Internet of Things (IoT), em inglês ­ para coletar dados dos pacientes. Esse artigo aponta as fragilidades quanto à privacidade de usuários do SUS e propor uma solução teórica, ainda a ser testada a partir de uma infraestrutura pautada em armazenamento pessoal de dados ­ personal data stores (PDS), em inglês ­ ou, a partir da segurança da blockchain. Metodologia: realizou-se revisão narrativa da literatura nacional e internacional relacionados a instrumentos, políticas e casos voltados a tecnologias de informação e comunicação na saúde a fim de apontar as fragilidades quanto à privacidade de usuários desse sistema. Resultados: percebeu-se que ainda existe uma falta de transparência no tratamento dos dados pessoais e pouco accountability por parte dos cidadãos, se fazendo necessária uma mudança de estratégia tecnológica e de governança. Conclusão: o PDS, de fato, empodera o usuário na medida que dá maior controle e transparência sobre o tratamento de seus dados. No entanto, essa solução, em um sistema como o utilizado pelo Departamento de Informática do SUS, pode comprometer a precisão dos dados usados nas políticas públicas, ao mesmo tempo que pode comprometer alguns direitos dos cidadãos, pois são dados salvos em registros e os metadados estão disponíveis publicamente. A implementação do PDS ainda não possui perspectiva de resultado ótimo. Ainda existem algumas restrições metodológicas quanto aos direitos dos cidadãos ou à eficiência do Estado, mas é um passo no empoderamento civil e uma melhoria exigida por lei quanto à privacidade e à proteção de dados pessoais.

Objective: Brazilian Unified Health System (SUS, in Portuguese) has invested in Internet of Things (IoT) technologies to collect data from patients. This article aims to point out the weaknesses regarding the privacy of users of the SUS and to propose a theoretical solution, yet to be evaluated, and based on a Personal Data Storages (PDS) infrastructure or on blockchain security. Methods: aA narrative review of national and international literature related to instruments, policies, and cases related to information and communication technologies in health was conducted to point out the weaknesses regarding the privacy of users of this system. Results: there is still a lack of transparency in the treatment of personal data and little accountability on the part of citizens, making it necessary to change the technological and governance strategy. Conclusion: PDS empowers users as it gives greater control and transparency over the treatment of data. However, this solution, in a system like the one used by their Computer Department, can compromise the accuracy of the data used in public policies, while it can compromise some citizens' rights, as this data is saved in records and the metadata is publicly available. The implementation of a solution like this does not yet have the prospect of an optimal result, without any methodological restriction on citizens' rights or the efficiency of the State, but it is a step in civil empowerment and an improvement required by law concerning privacy and protection of personal data. The implementation of the PDS does not yet have the prospect of an optimal result. There are still methodological restrictions regarding the rights of citizens or the efficiency of the State. But it is a step in civil empowerment and an improvement required by law in terms of privacy and the protection of personal data.

Objetivo: el Sistema Único de Salud de Brasil (SUS) ha invertido en tecnologías de Internet de las cosas (IoT) para recopilar datos de los pacientes. Este artículo tiene como objetivo señalar las debilidades con respecto a la privacidad de los usuarios del SUS y proponer una solución teórica, aún por probar basada en una infraestructura basada en Personal Data Storages (PDS) o almacenamiento personal de datos, basado en la seguridad de blockchain. Metodología: se realizó una revisión narrativa de la literatura nacional e internacional relacionada con instrumentos, políticas y casos relacionados con las tecnologías de la información y la comunicación en salud con el fin de señalar las debilidades en cuanto a la privacidad de los usuarios de este sistema. Resultados: se notó, entonces, que aún existe falta de transparencia en el tratamiento de estos datos personales y poca rendición de cuentas por parte de la ciudadanía, por lo que es necesario cambiar la estrategia tecnológica y de gobernanza. Conclusión: se concluye que PDS, de hecho, empodera a los usuarios ya que brinda un mayor control y transparencia sobre el tratamiento de sus datos. Sin embargo, esta solución, en un sistema como el utilizado por el Departamento de Computación del SUS, puede comprometer la precisión de los datos utilizados en las políticas públicas, al mismo tiempo que puede comprometer algunos derechos civiles, ya que estos datos se guardan en registros y metadatos están disponibles públicamente. La implementación de una solución como esta todavía no tiene la perspectiva de un resultado óptimo, sin ninguna restricción metodológica sobre los derechos de los ciudadanos o la eficiencia del Estado, pero es un paso en el empoderamiento civil y una mejora requerida por la ley con respecto a la privacidad y protección de datos personales. La implementación del PDS aún no tiene la perspectiva de un resultado óptimo. Aún existen algunas restricciones metodológicas en cuanto a los derechos de los ciudadanos o la eficiencia del Estado. Pero es un paso en el empoderamiento civil y una mejora requerida por la ley en términos de privacidad y protección de datos personales.

Judicialização do acesso aos serviços de saúde: análise de caso da Secretaria de Saúde de Pernambuco / Health's Judicialization: a case study of the Health Secretariat of Pernambuco / Judicialización de la Salud: análisis de caso de la Secretaría de Salud de Pernambuco

Objetivo: Este artigo objetivou analisar a judicialização do acesso aos serviços de saúde na Secretaria Estadual de Saúde de Pernambuco no ano de 2016. Métodos: Tratou-se de estudo transversal, quantitativo e analítico com dados do Núcleo de Ações Judiciais da Secretaria Estadual de Saúde de Pernambuco em 2016. As variáveis foram: o produto; o estabelecimento de atendimento; CID-10; municípios da comarca; município de residência; sexo; grupo do produto e condutor da ação. Resultados: Dos 2.560 processos, os medicamentos corresponderam a 63,5% das ações. 42% das demandas concentraram-se na 1ª Região de Saúde; 39,3% e 31,5% foram provenientes de unidades públicas de saúde e filantrópicas, respectivamente. Os dados corroboram com achados da literatura quanto ao item mais demandado judicialmente e à tendência de concentração em regiões metropolitanas. Difere quanto à natureza do órgão demandante por ter sido neste caso o próprio poder público e as unidades de saúde pública. Conclusões: Incorporar os objetos das demandas judiciais na oferta regular dos serviços de saúde pode contribuir para a redução de processos e aumentar o acesso dos cidadãos aos direitos legais. Em alguns casos, garantir o cumprimento das normas já editadas favorece a tendência de diminuição da judicialização, sendo necessário para esta análise os estudos longitudinais.

Objective: This article aimed to analyze the judicialization of access to health services in the State Department of Health of Pernambuco in the year 2016. Methodology: This was a cross-sectional, quantitative and analytical study with data from the Judicial Actions Center of the State Health Secretariat of Pernambuco in 2016. The variables were: the product; the establishment of care; ICD-10; municipalities of the region; municipality of residence; sex; product group and action driver. Results: Of the 2,560 cases, the medications corresponded to 63.5% of the actions. 42% of the demands were concentrated in the 1st Health Region; 39.3% and 31.5% came from public health and philanthropic units, respectively. The data corroborate with findings from the literature regarding the item most sued in court and the trend of concentration in metropolitan regions. It differs as to the nature of the complainant organ because in this case it was the public authority itself and the public health units. Conclusions: Incorporating the objects of lawsuits into the regular provision of health services can contribute to the reduction of processes and increase citizens' access to legal rights. In some cases, ensuring compliance with the standards already published favors the tendency to decrease the judicialization, being necessary for this analysis the longitudinal studies.

Objetivo: Este artículo objetivó analizar la judicialización del acceso a los servicios de salud en la Secretaría Estatal de Salud de Pernambuco en el año 2016. Metodología: Se trató de estudio transversal, cuantitativo y analítico con datos del Núcleo de Acciones Judiciales de la Secretaría Estatal de Salud de Pernambuco en 2016. Las variables fueron: el producto; el establecimiento de atención; ICD-10; municipios de la comarca; municipio de residencia; el sexo; grupo del producto y conductor de la acción. Resultados: De los 2.560 procesos, los medicamentos correspondieron al 63,5% de las acciones. El 42% de las demandas se concentró en la 1ª Región de Salud; 39,3% y 31,5% provenían de unidades públicas de salud y filantrópicas, respectivamente. Discusión: Los datos corroboran con hallazgos de la literatura en cuanto al ítem más demandado judicialmente ya la tendencia de concentración en regiones metropolitanas. Difiere en cuanto a la naturaleza del órgano demandante por haber sido en este caso el propio poder público y las unidades de salud pública. Conclusiones: Incorporar los objetos de las demandas judiciales en la oferta regular de los servicios de salud puede contribuir a la reducción de procesos y aumentar el acceso de los ciudadanos a los derechos legales. En algunos casos, garantizar el cumplimiento de las normas ya editadas favorece la tendencia de disminución de la judicialización, siendo necesario para este análisis los estudios longitudinales.

Morphometric evaluation of the repair of critical-size defects using demineralized bovine bone and autogenous bone grafts in rat calvaria.

OBJECTIVE: To evaluate the repair of critical-size bone defects in rats treated with demineralized bovine bone (DBB) compared with autogenous bone (AB). MATERIAL AND METHOD: A bone defect of 8 mm in diameter was created in the calvaria of 50 Rattus norvegicus, treated either with DBB or AB. Sub-groups of five rats of each group were killed at 7, 14, 21, 30 and 90 days post-operatively, and the skulls were removed and processed histologically. Histological sections were stained with hematoxylin and eosin. RESULT: Histological analysis showed complete closure of the defects with new bone at 90 days in group AB, and substitution of the biomaterial by fibrotic connective tissue in the DBB group at 21 days. Morphometric analysis showed that DBB was rapidly absorbed at 14 days, with its volume density decreasing from 47%+/-0.8% at 7 days to 1.2%+/-0.41% at 14 days. Subsequently, volume densities of the connective tissue and neoformed bone increased from 51.1%+/-11.17% to 86.8%+/-7.92% and from 1.9%+/-1.13% to 12%+/-8.02%, respectively, for the same time interval. The volume density of AB particles did not change throughout the experimental periods, but the amount of new bone increased markedly between 7 and 90 days, from 4.5%+/-1.57% to 53.5%+/-6.42% (P<0.05). CONCLUSION: DBB did not provide complete repair of the defects, with significantly less new bone formation than in the AB group.