Sistema Único de Saúde: de que sistema se trata?

Constata-se que a reforma sanitária brasileira representa um avanço na direção de uma concepção avançada de sistema de saúde. Entretanto o SUS, com toda a materialidade das reformas ao nível macro induzidas a partir dos avanços na legislação, a implantação da regionalização e hierarquização da assistência, e dos instrumentos de gestão, assim como todas as grandes organizações modernas, padece de problemas de coordenação na operação de suas ações. Este trabalho pretende discutir as possibilidades e limites das mudanças organizacionais induzidas pela implementação do SUS na configuração dos sistemas locoregionais de saúde, à luz das experiências internacionais e das contribuições mais recentes das teorias organizacionais, no contexto da transição do fordismo à acumulação flexível. A partir do referencial da teoria dos sistemas, considera-se a contribuição das teorias organizacionais fordistas, pós-fordistas e pós-modernistas na especificidade do campo da saúde coletiva, para discutir a efetividade dos seus subsistemas cibernéticos do SUS: controle, avaliação, regulação, auditoria e vigilância em saúde, no complexo contexto da configuração do poder deste setor. Verifica-se que o SUS, constituído a partir de culturas organizacionais fordistas, do antigo INAMPS e da Saúde Pública tradicional, não tem obtido êxito em configurar estruturas organizacionais competentes, na medida em que reproduz os modelos tradicionais nos seus sistemas de controle. Esta dificuldade em parte deve-se ao momento histórico, que fez coincidir o momento dos avanços na legislação, em direção à ampliação do direito à saúde, com o momento das reestruturações dos aparelhos estatais decorrente da crise global do modo de produção fordista, e com as profundas transformações demográficas, epidemiológicas e da tecnologia da assistência médica. Por outro lado, a disponibilidade de soluções pósfordistas propicia um padrão para a conformação de novas regras e novos modos de regulação do sistema de saúde, que induzam a comportamentos auto-reguladores por parte dos prestadores de serviços de saúde, considerando as metas de equidade e de melhoria da saúde da população. Conclui-se que a necessária reforma do setor saúde demanda o fortalecimento de uma tecno-burocracia protegida contra injunções político-partidárias, que possibilite a incubação uma cultura organizacional profissional em todas as esferas de governo e níveis de gestão, que incentive um trabalho em saúde competente e moralmente comprometido com as finalidades do SUS nesse país.

Serviços de terapia renal substitutiva em Volta Redonda: estrutura e adequação às normas de funcionamento

O número de pacientes com doença renal crônica está aumentando, em todo o mundo, em escala alarmante. Como resultado, observamos um elevado quantitativo de indivíduos que dependem do acesso e do tratamento dialítico para garantir sobrevida e qualidade de vida. Esse cuidado, entretanto, apresenta significativos problemas em diversas localidades do país. Ainda que uma estrutura adequada seja condição necessária, mas não suficiente, para um cuidado de qualidade, pode-se supor que aumente a probabilidade da assistência prestada ter um potencial de promover resultados em saúde mais positivos. Este estudo, descritivo e de caráter normativo, objetivou mapear os serviços de terapia dialítica existentes no município de Volta Redonda que oferecem procedimentos para o SUS e examinar sua conformidade com os padrões mínimos presentes nas diversas resoluções e demais legislações a respeito, focando em aspectos da estrutura e processo. Para tal, utilizou-se de três estratégias complementares: (a) busca de dados secundários presentes nas bases de dados nacionais e municipais; (b) entrevistas com os responsáveis técnicos pelas duas unidades existentes no município, com o responsável pela Superintendência de Controle, Avaliação e Auditoria da SMS/VR e pela Vigilância Sanitária Estadual, e (c) exame das cópias dos relatórios de vistoria sanitária realizada nos serviços nos anos de 2010 e 2011. Os resultados são apresentados em seis categorias: (1) conhecimento sobre o processo de admissão e preparo dos pacientes para entrada em Terapia Renal Substitutiva; (2) conformidade dos serviços de diálise existentes em Volta Redonda às exigências legais, desdobrando em estrutura física, parque de equipamentos, modalidades de diálise oferecida, controle e qualidade da água utilizada na diálise, atividades de controle de infecções e de proteção à saúde dos trabalhadores; (3) fluxo de encaminhamento dos pacientes em tratamento dialítico para transplante; (4) monitoramento dos indicadores de avaliação periódica dos serviços de Diálise; (5) produção assistencial desses serviços; e, por fim,(6) ações de controle e avaliação desenvolvidas junto às Unidades de Terapia Renal Substitutiva. O estudo permitiu identificar que, em diversos aspectos, os serviços de diálise de Volta Redonda estão fora de conformidade às exigências legais expressas nas diversas portarias e resoluções que tratam da estrutura e condições de funcionamento dos serviços de terapia renal substitutiva. Isso é grave e pode estar significando que os pacientes que se utilizam destes serviços possam, de alguma maneira, estar recebendo um cuidado longe do adequado. Foi também mostrada a dificuldade do serviço de Controle, Avaliação e Auditoria da SMS/VR em montar trabalho conjunto de monitoramento no cumprimento das exigências realizadas pelo órgão de vigilância estadual, que pode contribuir para melhorar a qualidade da assistência recebida pelos pacientes renais crônicos em Volta Redonda.

Protein functionalized ZnO thin film bulk acoustic resonator as an odorant biosensor

ZnO thin film bulk acoustic resonators (FBARs) with resonant frequency of ∼1.5 GHz have been fabricated to function as an odorant biosensor. Physical adsorption of an odorant binding protein (AaegOBP22 from Aedes aegypti) resulted in frequency down shift. N,N-diethyl-meta-toluamide (DEET) has been selected as a ligand to the odorant binding protein (OBP). Alternate exposure of the bare FBARs to nitrogen flow with and without DEET vapor did not cause any noticeable frequency change. However, frequency drop was detected when exposing the OBP loaded FBAR sensors to the nitrogen flow containing DEET vapor against nitrogen flow alone (control) and the extent of frequency shift was proportional to the amount of the protein immobilized on the FBAR surface, indicating a linear response to DEET binding. These findings demonstrate the potential of binding protein functionalized FBARs as odorant biosensors. © 2012 Elsevier B.V. All rights reserved.

Molecular cloning and expression of a Relish gene in Chinese mitten crab Eriocheir sinensis

P>NF-kappa B is a B-cell specific transcription factor that plays crucial roles in inflammation, immunity, apoptosis, development and differentiation. In the present study, a novel NF-kappa B-like transcription factor Relish was cloned from Chinese mitten crab Eriocheir sinensis (designated as EsRelish) by rapid amplification of cDNA ends (RACE) technique based on expressed sequence tag (EST). The full-length cDNA of EsRelish was of 5034 bp, consisting of a 5' untranslated region (UTR) of 57 bp, a 3' UTR of 1335 bp with two mRNA instability motifs (ATTTA), a polyadenylation signal sequence (AATAAA) and a poly (A) tail, and an open reading frame (ORF) of 3645 bp encoding a polypeptide of 1214 amino acids with a calculated molecular mass of 134.8 kDa and a theoretical isoelectric point of 5.26. There were a typical Rel homology domain (RHD), two nuclear localization signal (NLS) sequences (KR), an inhibitor kappa B (I kappa B)-like domain with six ankyrin repeats, a PEST region and a death domain in the deduced amino acid sequence of EsRelish. Conserved domain, higher similarity with other Rel/NF-kappa Bs and phylogenetic analysis suggested that EsRelish was a member of the NF-kappa B family. Quantitative real-time RT-PCR was employed to detect the mRNA transcripts of EsRelish in different tissues and its temporal expression in hemocytes of E. sinensis challenged with Pichia methanolica and Listonella anguillarum. The EsRelish mRNA was found to be constitutively expressed in a wide range of tissues. It could be mainly detected in the hemocytes, gonad and hepatopancreas, and less degree in the gill, muscle and heart. The expression level of EsRelish mRNA in hemocytes was up-regulated from at 3, 6, 9 and 12 h after P. methanolica challenge. In L. anguillarum challenge, it was up-regulated at 9, 12 and 24 h. The results collectively indicated that EsRelish was potentially involved in the immune response against fungus and bacteria.

Cloning and expression of glucose regulated protein 78 (GRP78) in Fenneropenaeus chinensis

GRP78 (78 kDa glucose-regulated protein), also known as BiP (immunoglobulin heavy-chain-binding protein), is an essential regulator of endoplasmic reticulum (ER) homeostasis because of its multiple functions in protein folding, ER calcium binding, and controlling of the activation of transmembrane ER stress sensors. In this report, we cloned the full length cDNA of GRP78 (FcGRP78) from Chinese shrimp Fenneropenaeus chinensis. This cDNA revealed a 2,325 bp with 1,968 bp open reading frame encoding 655 amino acids. This is the first reported GRP78 gene in Crustacea. The deduced amino acid sequence of FcGRP78 shared high identity with previously reported insect GRP78s: 86, 87 and 85% identity with GRP78s of Drosophila melanogaster, Aedes aegypti and Bombyx mori, respectively. Northern blot analysis shows that FcGRP78 is ubiquitously expressed in tissues of shrimp. Heat shock at 35A degrees C significantly enhanced the expression of FcGRP78 at the first hour, reached the maximum at 4 h post heat shock, dropped after that and resumed to the normal level until 48 h of post recovery at 25A degrees C. Additionally, differential expression of FcGRP78 was detected in haemocytes, hepatopancreas and lymphoid organ when shrimp were challenged by white spot syndrome virus (WSSV). We inferred that FcGRP78 may play important roles in chaperoning, protein folding and immune function of shrimp.

The cDNA cloning and mRNA expression of cytoplasmic Cu, Zn superoxide dismutase (SOD) gene in scallop Chlamys farreri

Cu, Zn superoxide dismutases (SODs) are rnetalloenzymes that represent one important line of defence against reactive oxygen species (ROS). A cytoplasmic Cu. Zn SOD cDNA sequence was cloned from scallop Chlamys farreri by the homology-based cloning technique. The full-length cDNA of scallop cytoplasmic Cu, Zn SOD (designated CfSOD) was 1022 bp with a 459 bp open reading frame encoding a polypeptide of 153 amino acids. The predicted amino acid sequence of CfSOD shared high identity with cytoplasmic Cu. Zn SOD in molluscs, insects, mammals and other animals, such as cytoplasmic Cu, Zn SOD in oyster Crassostrea sostrea gigas (CAD42722), mosquito Aedes aegypti (ABF18094), and cow Bos taurus (XP_584414). A quantitative reverse transcriptase real-time PCR (qRT-PCR) assay was developed to assess the mRNA expression of CfSOD in different tissues and the temporal expression of CfSOD in scallop challenged with Listonella anguillarum, Micrococcus luteus and Candida lipolytica respectively. Higher-level mRNA expression of CfSOD was detected in the tissues of haemocytes, gill filaments and kidney. The expression of CfSOD dropped in the first 8-16 h and then recovered after challenge with L. anguillarum and M. litteus, but no change was induced by the C. lipolytica challenge. The results indicated that CfSOD was a constitutive and inducible acute-phase protein, and could play an important role in the immune responses against L. anguillarum and M. luteus infection. (C) 2007 Elsevier Ltd. All rights reserved.

A key gene of the RNA interference pathway in the black tiger shrimp, Penaeus monodon: Identification and functional characterisation of Dicer-1

RNA interference (RNAi) is an evolutionarily conserved mechanism by which double-stranded RNA (dsRNA) initiates post-transcriptional silencing of homologous genes. Here we report the amplification and characterisation of a full length cDNA from black tiger shrimp (Penaeus monodon) that encodes the bidentate RNAase III Dicer, a key component of the RNAi pathway. The full length of the shrimp Dicer (Pm Dcr1) cDNA is 7629 bp in length, including a 51 untranslated region (UTR) of 130 bp, a 3' UTR of 77 bp, and an open reading frame of 7422 bp encoding a polypeptide of 2473 amino acids with an estimated molecular mass of 277.895 kDa and a predicted isoelectric point of 4.86. Analysis of the deduced amino acid sequence indicated that the mature peptide contains all the seven recognised functional domains and is most similar to the mosquito (Aedes aegypti) Dicer-1 sequence with a similarity of 34.6%. Quantitative RT-PCR analysis showed that Pm Dcr1 mRNA is most highly expressed in haemolymph and lymphoid organ tissues (P 0.05). However, there was no correlation between Pm Dcr1 mRNA levels in lymphoid organ and the viral genetic loads in shrimp naturally infected with gill-associated virus (GAV) and Mourilyan virus (P > 0.05). Treatment with synthetic dsRNA corresponding to Pm Dcr1 sequence resulted in knock-down of Pm Dcr1 mRNA expression in both uninfected shrimp and shrimp infected experimentally with GAV. Knock-down of Pm Dcr1 expression resulted in more rapid mortalities and higher viral loads. These data demonstrated that Dicer is involved in antiviral defence in shrimp. (c) 2007 Elsevier Ltd. All rights reserved.

Molecular cloning, expression of a peroxiredoxin gene in Chinese shrimp Fenneropenaeus chinensis and the antioxidant activity of its recombinant protein

Peroxiredoxin (Prx) is known to be an antioxidant protein that protects the organisms against various oxidative stresses and functions in intracellular signal transduction. A Prx gene was firstly isolated in the crustacean, Chinese shrimp Fenneropenaeus chinensis. The full-length cDNA consists of 942 bp with a 594 bp open reading frame, encoding 198 amino acids. The molecular mass of the deduced amino acid is 22041.17 Da with an estimated pI of 5.17. Sequence comparison showed that Prx of F. chinensis shares 76%, 73% and 72% identity with that of Aedes aegypti, Branchiostoma belcheri tsingtaunese and Drosophila melanogaster, respectively. Northern blot analysis revealed the presence of Prx transcripts of F chinensis in all tissues examined. Real-time PCR analysis indicated that the Prx showed different expression profiles in shrimp hemocytes and hepatopancreas after artificial infection with Vibrio anguillarum. In addition, a fusion protein containing Prx was produced in vitro. LC-ESI-MS analysis showed that four peptide fragments of the recombinant protein were identical to the corresponding sequence of F. chinensis Prx. And the purified recombinant proteins were shown to reduce H2O2 in the presence of dithiothreitol. (c) 2007 Elsevier Ltd. All rights reserved.

中国明对虾免疫系统中抗氧化相关基因的克隆与表达分析

对虾病害在世界范围内的广泛传播，给水产养殖和沿海农村经济造成了重大损失。深入开展对虾免疫机制研究并在此基础上寻找对虾疾病防治的有效方法已成为当务之急。研究表明，当对虾等甲壳动物受到外界病原刺激时，其体内的吞噬细胞在吞噬活动中会激活磷酸己糖支路的代谢，引起呼吸爆发，产生多种活性氧分子。另外，受到病原侵染的对虾还会产生其他多种免疫反应，这些免疫反应将消耗大量的能量（ATP），产能的呼吸链会加速运转，由此也会引发大量活性氧的产生。这些活性氧分子可以杀灭入侵的病原微生物，但同时由于活性氧分子反应的非特异性，它们也会对宿主的细胞、组织和器官造成严重伤害，进而导致对虾生理机能的损伤和免疫系统的破坏。所以，消除对虾体内因过度免疫反应产生的过量氧自由基将能够增强其抵御病原侵染的能力，提高免疫力。本论文从中国明对虾体内克隆了线粒体型超氧化物歧化酶（mMnSOD）、胞质型超氧化物歧化酶（cMnSOD）、过氧化氢酶（Catalase）和过氧化物还原酶（Peroxiredoxin）等四种与免疫系统相关的抗氧化酶基因，分析了它们的分子结构特征，组织分布及应答不同病原刺激的表达变化模式，并对其中的mMnSOD基因和Peroxiredoxin基因进行了体外重组表达、分离纯化和酶活性分析。 采用RACE技术从中国明对虾血细胞中克隆了两个超氧化物歧化酶（SOD）基因，通过序列比对分析发现，其中一个为mMnSOD基因，另一个为cMnSOD基因。mMnSOD基因的cDNA全长为1185个碱基，其中开放阅读框为660个碱基，编码220个氨基酸，其中推测的信号肽为20个氨基酸。多序列比对结果显示中国明对虾mMnSOD基因的推导氨基酸序列与罗氏沼虾、蓝蟹的推导氨基酸序列同源性分别为88%和82%。Northern blot结果表明，该基因在对虾的肝胰脏、血细胞、淋巴器官、肠、卵巢、肌肉和鳃等组织中均有表达。半定量RT-PCR结果显示，对虾感染病毒3 h时，该基因在血细胞和肝胰脏中的转录水平显著升高。此外，通过构建原核表达载体，本研究对该基因进行了体外重组表达，并对纯化的重组蛋白进行了质谱鉴定和酶活分析。cMnSOD基因的cDNA全长为1284个碱基，其中开放阅读框为861个碱基，编码287个氨基酸。多序列比对结果显示中国明对虾cMnSOD基因的推导氨基酸序列与斑节对虾和凡纳滨对虾的同源性高达98%和94%。组织半定量结果显示，cMnSOD基因在对虾被检测的各个组织中均有表达。 另外，半定量RT-PCR结果表明，对虾感染病毒23h时，该基因在肝胰脏中的转录上升到正常水平的3.5倍；而感染后59 h时，该基因在血细胞中的转录上升到正常水平的2.5倍。 利用根据其他生物过氧化氢酶保守氨基酸序列设计的简并引物，结合RACE技术，从中国明对虾肝胰脏中克隆到了过氧化氢酶基因的部分片段，片段长1725个碱基。多序列比对结果发现目前所得中国明对虾Catalase基因部分片段的推导氨基酸序列与罗氏沼虾和皱纹盘鲍Catalase氨基酸序列的同源性分别达到95%和73%。通过实时荧光定量PCR技术对中国明对虾Catalase基因在各个组织中的分布情况及病毒感染后该基因在血细胞和肝胰脏中的转录变化进行了研究。结果发现，该基因在肝胰脏、鳃、肠和血细胞中表达水平较高，在卵巢、淋巴器官和肌肉中的表达水平相对较弱；感染病毒23 h和37 h时，对虾血细胞和肝胰脏中该基因mRNA的表达量分别出现显著性上升。 依据中国明对虾头胸部cDNA文库提供的部分片段信息，结合SMART-RACE技术，从中国明对虾肝胰脏中克隆到了过氧化物还原酶基因（Peroxiredoxin）， 该基因的cDNA全长为942个碱基，其中开放阅读框为594个碱基，编码198个氨基酸。中国明对虾Peroxiredoxin基因的推断氨基酸序列与伊蚊、文昌鱼和果蝇等Peroxiredoxin基因的推断氨基酸序列同源性分别为77%、76%和73%。其蛋白理论分子量为22041.17 Da，pI为5.17。Northern blot结果表明，Peroxiredoxin基因在对虾的肝胰脏、血细胞、淋巴器官、肠、卵巢、肌肉和鳃等组织中均有表达。实时荧光定量PCR结果显示，弧菌感染后，该基因在对虾血细胞和肝胰脏中的转录水平都有明显变化并且表达模式不同。另外，对该基因进行了体外重组表达，并对纯化的重组蛋白进行了质谱鉴定和酶活性分析。酶活性分析表明，复性后的重组蛋白能在DTT存在的条件下还原H2O2。

Multi-function oxidases are responsible for the synergistic interactions occurring between repellents and insecticides in mosquitoes

Background: With the spread of pyrethroid resistance in mosquitoes, the combination of an insecticide (carbamate or organophosphate) with a repellent (DEET) is considered as a promising alternative strategy for the treatment of mosquito nets and other relevant materials. The efficacy of these mixtures comes from the fact that they reproduce pyrethroid features and that positive interactions occur between insecticides and repellent. To better understand the mechanisms involved and assess the impact of detoxifying enzymes (oxidases and esterases) in these interactions, bioassays were carried out in the laboratory against the main dengue vector Aedes aegypti. Methods: Topical applications of DEET and propoxur (carbamate), used alone or as a mixture, were carried out on female mosquitoes, using inhibitors of the two main detoxification pathways in the insect. PBO, an inhibitor of multi-function oxidases, and DEF, an inhibitor of esterases, were applied one hour prior to the main treatment. Results: Results showed that synergism between DEET and propoxur disappeared in the presence of PBO but not with DEF. This suggests that oxidases, contrary to esterases, play a key role in the interactions occurring between DEET and cholinesterase inhibitors in mosquitoes. Conclusion: These findings are of great interest for the implementation of "combination nets" in the field. They support the need to combine insecticide with repellent to overcome insecticide resistance in mosquitoes of public health importance.

Advances in protein kinase B signalling: AKTion on multiple fronts

The role of the serine/threonine protein kinase B (PKB, also known as Akt) is becoming increasingly more evident to researchers investigating diverse cellular processes such as glucose uptake, cell-cycle progression, apoptosis and transcriptional regulation. New roles for PKB/Akt have been described in various organisms and biological processes. From the regulation of ovarian ecdysteroid production in the humble mosquito (Aedes aegypti), through the seasonal, tissue-specific regulation of PKB/Akt during the hibernation of yellow-bellied marmots (Marmota flaviventris), to the control of glucose metabolism and insulin signalling in the mouse (Mus musculus), our knowledge of the function of this protein kinase has expanded greatly in recent years. Significant advances in all aspects of PKB/Akt signalling have occurred in the past 2 years, including biological insights, novel substrates and newly discovered regulatory mechanisms of PKB/Akt. Collectively, these data expand the current models of PKB/Akt signalling and highlight potential directions for PKB/Akt research in the future.

Quimioterapia da dengue: fármacos disponíveis e perspectivas de novas terapêuticas

Dissertação de mestrado, Ciências Farmacêuticas, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2015

Producción y formulación de un bioinsecticida de Bacillus thuringiensis subsp. israelensis H-14 para el control de mosquitos culicidos en el noreste de México

Tesis (Doctorado en Ciencias con Especialidad en Biotecnología) UANL

El virus de la fiebre amarilla “un virus científicamente olvidado”

La fiebre amarilla es una enfermedad viral propia de regiones subtropicales que afecta principalmente el hígado produciendo hemorragias agudas y daños graves a nivel del tejido; es causada por un virus perteneciente al género Flavivirus, y es transmitida en el núcleo urbano por el mosquito Aedes aegypti, y selváticamente, por mosquitos del género Haemagogus. En Colombia, se presentaron 20 casos en el 2005 de los cuales el 65% fue letal (OMS, 2006) (*). Sobre la fiebre amarilla, se logró un control importante, sin embargo, actualmente es considerada como una enfermedad reemergente debido a múltiples factores que han venido aumentando a través de los últimos veinte años, tales como la amplia diseminación del vector, la deforestación, el aumento de la población susceptible no vacunada, diversos fenómenos climáticos (Fenómeno del Pacífico, por ejemplo), y la falta de programas de vigilancia epidemiológica. En países como el nuestro, la situación se agudiza con el desplazamiento forzado de la población, la explotación de las zonas selváticas vírgenes, la violencia y el narcotráfico. A pesar de la disponibilidad de una vacuna con una alta eficacia, la fiebre amarilla continúa siendo una causa importante de morbilidad y mortalidad en regiones tropicales de África y de América del Sur (OMS, 2006) (**). La metodología de producción de la vacuna está muy bien definida, es eficiente, e incluye un estricto control de calidad sobre los efectos neurológicos del virus, induce un periodo de protección de diez años con una sola dosis y es, además, barata. No obstante, desde 1996 se han reconocido casos de la enfermedad, la cual no sólo es neurológica, sino, también, viscerotrópica (afección hepática principalmente), como consecuencia de la vacunación. Los efectos adversos producidos por la vacuna, y que hoy en día se conocen gracias a la implantación de programas de seguimiento postvacunal, no tienen una explicación científica, en parte, por la aceptación absoluta que hubo sobre su eficacia y su seguridad desde que se inició su utilización en seres humanos; sin embargo, el problema mismo ha despertado un interés mundial por el desarrollo de una vacuna que no presente ningún riesgo para el hombre, lo cual conlleva a la necesidad de conocer científicamente las causas que originan esta situación, como un prerrequisito para abordar adecuadamente cualquier estrategia de mejoramiento de la vacuna actual. Atendiendo a esta necesidad, el grupo de Bioquímica y Biotecnología en Salud de la Facultad de Medicina de la Universidad del Rosario ha tomado el virus de la fiebre amarilla como modelo de investigación, buscando dilucidar, por qué la vacuna está produciendo la enfermedad.

Efectividad del uso de los conceptos y estrategias comunitarias en empresas del sector de servicios sociales y de salud.

Este estudio analiza la existencia de conceptos y estrategias comunitarias en relación de cómo una empresa en el sector de servicios sociales y salud entienden las estrategias de mercadeo y la influencia en el desempeño que pueden tener en su relación con el entorno. Para esto, se utilizo un enfoque de estudio de caso seleccionando un caso representativo con una empresa dentro del sector. Se definieron proposiciones y protocolos. Varias fuentes de evidencia fueron utilizadas como documentos, reportes de desempeño financiero y otra información de diferentes sectores relacionados; los mismos fueron analizados en el marco de la evidencia lógica. Se concluye que la empresa en el sector de servicios sociales y salud no utilizan conceptos ni estrategias comunitarias y que se podrían beneficiar del uso apropiado de estrategias comunitarias en su relación con la comunidad.