Avaliação da associação da aderência à oxigenoterapia domiciliar prolongada e marcadores clínicos e mortalidade em cinco anos em pacientes com a doença pulmonar obstrutiva crônica / Evaluation of the association of adherence to long-term home oxygen therapy and clinical markers and five-year mortality in patients with Chronic obstructive pulmonary disease

RESUMO Objetivo Avaliar a relação entre a adesão à oxigenoterapia domiciliar prolongada (ODP) e a mortalidade em pacientes com doença pulmonar obstrutiva crônica (DPOC) e insuficiência respiratória crônica e suas características clínicas. Métodos Análise retrospectiva longitudinal de 254 pacientes com DPOC e insuficiência respiratória crônica no período de 2008 a 2016. No início do estudo, avaliamos o diagnóstico, valores espirométricos, gasometria arterial, hemograma, oximetria de pulso, composição corporal e questionários de saúde (dispnéia, qualidade). vida, ansiedade e depressão). Para a análise de adesão referida ao ODP, foram incluídos 199 pacientes, divididos de acordo com a prescrição de oxigênio: 12h/dia (G1), 15h/dia (G2) e 24h/dia (G3). As causas e datas da morte foram estudadas durante o período de cinco anos. Resultados Em cinco anos, identificamos 124 óbitos (62,3%). Não houve diferença significativa na mortalidade entre os grupos de adesão (p = 0,75) e não encontramos diferenças nos parâmetros clínicos avaliados. A prescrição de ODP não foi associada à mortalidade (p = 0,07). Na análise de regressão de Cox, não houve associação entre mortalidade e não adesão ao ODP (HR: 0,75; IC95%: 0,21-2,70). O risco de mortalidade aumentou no G3 em comparação ao G1 (HR: 7,16; IC 95%: 1,44-35,38) e naqueles com maior escore de depressão (HR: 1,35; IC: 1,14-1,59). Conclusão Não foi encontrada associação entre adesão à ODP e mortalidade em pacientes com DPOC e insuficiência respiratória. Não houve diferenças clínicas entre os grupos de adesão.

ABSTRACT Objective Assess the relationship between adherence to long-term oxygen therapy (LTOT) with mortality in patients with chronic obstructive pulmonary disease (COPD) and chronic respiratory failure and their clinical features. Methods Longitudinal retrospective analysis of 254 patients with COPD and chronic respiratory failure from 2008 to 2016. At baseline, we evaluated the diagnosis, spirometry values, arterial blood gas analysis, blood count, pulse oximetry, body composition and health questionnaires (dyspnea, quality of life, anxiety and depression). For referred adherence analysis to LTOT we included 199 patients, divided according to prescription of oxygen: 12h/day (G1), 15h/day (G2) and 24h/day (G3). The cause of death and dates were studied over the five-year period. Results In five years we identified 124 deaths (62.3%). No significant difference was found in mortality between the adherence groups (p=0.75) nor did we find differences in the clinical parameters evaluated. LTOT prescription was not associated with mortality (p=0.07). In Cox regression analysis, there was no association between mortality and non-adherence to LTOT (HR: 0.75; IC95%: 0.21-2.70). The risk of mortality was increased in G3 compared with G1 (HR: 7.16; IC 95%: 1.44-35.38) and in those with a higher depression score (HR: 1.35; IC: 1.14-1.59). Conclusion No association was found between LTOT adherence and mortality in patients with COPD and respiratory failure. There were no clinical differences between the adherence groups.

O lugar da vigilância no SUS - entre os saberes e as práticas de mobilização social / The 'locus' of health oversight in Brazil's Unified Health System - a place between the knowledge and the practices of social mobilization

Resumo A Vigilância em Saúde pressupõe olhar atento sobre a situação de saúde de populações, de modo que se compreenda a saúde, a doença e o cuidado como manifestações indissociáveis da existência humana. Considerando esta perspectiva, o artigo se propõe a examinar as práticas de saúde a partir de alguns de seus processos comunicacionais, estes marcados por uma lógica profissional-centrada, que privilegia o discurso cientificista, vertical e autoritário, predominante nos espaços do Sistema Único de Saúde. No território, o processo de comunicação é determinante. Por seu intermédio se dá a interação social e o fazer cotidiano que reterritorializam os elementos da totalidade social: homens, empresas, instituições são redimensionadas na lógica: a do localmente vivido, abrindo espaço para uma comunicação mais horizontalizada e democrática.

Abstract Supervision of a health system presupposes keeping an attentive eye on the health situation of populations, so as to understand health, illness and healthcare as indissociable manifestations of human existence. Taking this point of view, this article examines health practices from the basis of some of their processes of communication. These are markedly professional-centered in their logic, with their emphasis on scientific, vertical and authoritarian discourse, predominantly in the spaces of the Unified Health System (SUS). In the territory, the process of communication is determinant. As a result of social interaction in daily life, the communication process reterritorializes the elements of the social totality: people, companies, institutions are re-dimensioned in the logic. It is a characteristic space for activities that aim for a more horizontal and democratic flow of communication.

Peginterferon alfa-2a (40KD) (PEGASYS®) plus ribavirin (COPEGUS®) in retreatment of chronic hepatitis C patients, nonresponders and relapsers to previous conventional interferon plus ribavirin therapy

Peginterferon alfa plus ribavirin is currently the treatment of choice for chronic hepatitis C. Peginterferon alfa-2a (40KD) plus ribavirin has given an overall sustained virological response of 18 percent in F3/F4 previous nonresponder US patients. We evaluated the effectiveness of peginterferon alfa-2a (40KD) plus ribavirin in Brazilian patients who were relapsers or nonresponders to previous interferon-based therapy. One-hundred-thirty-four patients with biopsy-proven chronic hepatitis C, HCV RNA positive, elevated ALT and who were either relapsers (n=37) or nonresponders (n=97) to at least 24 weeks of conventional interferon/ribavirin therapy were retreated with peginterferon alfa-2a (40KD) 180mg/qw and ribavirin 800mg bid for 48 weeks. Efficacy was assessed as virological response (defined as undetectable HCV RNA) at the end of treatment (EoT) and at the end of follow-up (SVR - Sustained Virological Response). Safety assessments consisted of clinical and laboratory evaluations. In the patient sample, 72 percent were genotype 1 and 34 percent were cirrhotic. In an intention-to-treat analysis, relapser patients showed 78 percent EoT response and 51 percent SVR. Nonresponders showed 57 percent EoT response and 26 percent SVR. Positive predictive factors of SVR were non-1 genotype and relapser state. Six percent of the patients interrupted treatment because of adverse events and 45 percent had dose reduction (mainly associated with leucopenia and anemia). Brazilian patient relapsers and nonresponders to conventional interferon and ribavirin treatment can achieve a sustained virological response when retreated with peginterferon alfa-2a (40KD) and ribavirin. The safety profile is similar to that of naive patients.