Impact of health legislation on the sale of anorectics in a city in the Amazon region

OBJETIVOS: O International Narcotics Control Board publicou em 2005 sua pesquisa anual que demonstrou que a população brasileira são um dos maiores consumidores de anorexígenos. No Brasil, a Agência Nacional de Vigilância Sanitária publicou a resolução RDC 58/2007 com o objetivo de controlar a prescrição e comercialização deste tipo de medicamento. Em Belém, a maior cidade da Amazônia brasileira, esta resolução entrou em vigor em 2008, levando à inspeções em drogarias e farmácias. Este trabalho propõe avaliar o consumo de psicotrópicos anorexígenos e o impacto da RDC 58/2007 na prescrição e dispensação de anorexígenos nas drogarias e farmácias magistrais de Belém. METODOLOGIA: foi realizado um estudo retrospectivo, quantitativo e descritivo, com dados coletados do Departamento de Vigilância Sanitária de Belém, de 2005 a 2008. Os dados foram considerados quando p < 0,05. RESULTADOS: Um total de 1.641 balanços foram analisados oriundos de drogarias e farmácias magistrais. Anfepramona foi o medicamento mais dispensado, seguido do femproporex e manzidol. O maior consumo de anorexígenos ocorreu nas farmácias magistrais. Em 2008, houve uma redução significativa na dispensação de anorexígenos, tanto em drogarias quanto em farmácias magistrais. CONCLUSÕES: Este estudo demonstrou que houve uma diminuição na dispensação de anorexígenos após a entrada em vigor da RDC 58/2007, e as farmácias magistrais foram responsáveis por um elevado número na dispensação destes medicamentos. Esta resolução é um marco divisor no controle sanitário, para enorme benefício da saúde pública, contribuindo substancialmente para o uso racional de medicamentos no Brasil.

Preliminary risk analysis applied to the handling of health-care waste

Between 75% and 90% of the waste produced by health-care providers no risk or is "general" health-care waste, comparable to domestic waste. The remaining 10-25% of health-care waste is regarded as hazardous due to one or more of the following characteristics: it may contain infectious agents, sharps, toxic or hazardous chemicals or it may be radioactive. Infectious health-care waste, particularly sharps, has been responsible for most of the accidents reported in the literature. In this work the preliminary risks analysis (PRA) technique was used to evaluate practices in the handling of infectious health-care waste. Currently the PRA technique is being used to identify and to evaluate the potential for hazard of the activities, products, and services from facilities and industries. The system studied was a health-care establishment which has handling practices for infectious waste. Thirty-six procedures related to segregation, containment, internal collection, and storage operation were analyzed. The severity of the consequences of the failure (risk) that can occur from careless management of infectious health-care waste was classified into four categories: negligible, marginal, critical, and catastrophic. The results obtained in this study showed that events with critics consequences, about 80%, may occur during the implementation of the containment operation, suggesting the need to prioritize this operation. As a result of the methodology applied in this work, a flowchart the risk series was also obtained. In the flowchart the events that can occur as a consequence of a improper handling of infectious health-care waste, which can cause critical risks such as injuries from sharps and contamination (infection) from pathogenic microorganisms, are shown.

Prevalence of health promotion programs in primary health care units in Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The pain and pleasure of being what one is: Viewpoints of health professionals and patients about being overweight/obese

The objective of this article is to discuss the meanings that health professionals and patients in treatment attribute to obesity. The research consisted of a qualitative survey in health, based on in-depth interviews with patients and professionals at an out-patient clinic at the University Hospital in Barcelona, Spain. Here, we discuss the concept of obesity, the meanings of diagnoses, the singularities involved in managing treatment, and the process of becoming ill, all in the light of the anthropology of health that has a sociocultural orientation. Obesity is usually seen by the professionals as a risk-factor disease. For patients, the incorporation of this rationality is procedural and is mixed in with other meanings attributed to being overweight/obese that have been gradually developed throughout life. A patient's autonomy in choosing to be fat, or obese, and to adhere to treatment, is defined as a process that requires support in order to come to joint proposals in caring for these problems.

Regionalization of health in Brazil: an analytical perspective

This article aims to contribute to the debate on the SUS regionalization policy and the establishment of health regions in Brazil. Understanding them require to recognize the dichotomy between public health and individual health - which marks the history of Brazilian public health - and identify the different rationalities that lead this process. Such rationalities allow not only to consider the legacy of municipalization in the current regionalization process, as well as to establish links between the two fields of fundamental knowledge to the debate, epidemiology and geography. Clinical epidemiology, privileging individual health, gives basis to a healthcare model that prioritizes the optimization of resources. The recognition of health in its broader concept, in the social epidemiology, bases an attention model aimed at social determinants. With geography, functional regions can be formulated, based on Christaller's theory, or lablachianas regions which recognize the social loco / regional structure, allowing intervention in determining or conditioning the way of illness and death of populations.

The impact of physical activity on mitigation of health care costs related to diabetes mellitus: findings from developed and developing settings Diabetes mellitus and physical exercise

Over the last decades, the prevalence of diabetes mellitus (DM) has been increasing globally such that nowadays the disease constitutes an important outcome related to early mortality among adults. In parallel with the high prevalence, healthcare costs related to DM treatment have increased significantly, exacerbating its burden on modern society. The scientific literature points out that obesity and physical inactivity have a central role in the development of most DM cases. In fact, either physical exercise practice or an increase in the level of physical activity, constitute relevant tools in the guidelines for treatment of the disease. On the other hand, the effect of physical activity on the economic consequences of DM is not completely clear. The identification of the actual burden of lifestyle changes on the reduction of healthcare costs related to DM is relevant, primarily for developing nations, where it could represent a cheaper strategy for treating the disease and its complications than paying for drug treatment, which is commonly related to collateral effects. That being said, the prevention of DM and other diseases and consequently the mitigation of the costs related to these outcomes seem to depend essentially on the promotion of healthy habits. The aim of the present review was therefore to discuss recent evidence on the effects of physical activity/exercise on mitigation of health care cost related to DM.

Assessment of health-related quality of life and related factors in patients with chronic liver disease

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Pedagogical practices carried out during an in-service teachers education project: approaching history and philosophy of science to physics teaching

We report here part of a research project developed by the Science Education Research Group, titled: "Teachers’ Pedagogical Practices and formative processes in Science and Mathematics Education" which main goal is the development of coordinated research that can generate a set of subsidies for a reflection on the processes of teacher training in Sciences and Mathematics Education. One of the objectives was to develop continuing education activities with Physics teachers, using the History and Philosophy of Science as conductors of the discussions and focus of teaching experiences carried out by them in the classroom. From data collected through a survey among local Science, Physics, Chemistry, Biology and Mathematics teachers in Bauru, a São Paulo State city, we developed a continuing education proposal titled “The History and Philosophy of Science in the Physics teachers’ pedagogical practice”, lasting 40 hours of lessons. We followed the performance of five teachers who participated in activities during the 2008 first semester and were teaching Physics at High School level. They designed proposals for short courses, taking into consideration aspects of History and Philosophy of Science and students’ alternative conceptions. Short courses were applied in real classrooms situations and accompanied by reflection meetings. This is a qualitative research, and treatment of data collected was based on content analysis, according to Bardin [1].

Using the National Institute of Health Stroke Scale to Predict Dysphagia in Acute Ischemic Stroke

Background and Purpose: Oropharyngeal dysphagia is a common manifestation in acute stroke. Aspiration resulting from difficulties in swallowing is a symptom that should be considered due to the frequent occurrence of aspiration pneumonia that could influence the patient's recovery as it causes clinical complications and could even lead to the patient's death. The early clinical evaluation of swallowing disorders can help define approaches and avoid oral feeding, which may be detrimental to the patient. This study aimed to create an algorithm to identify patients at risk of developing dysphagia following acute ischemic stroke in order to be able to decide on the safest way of feeding and minimize the complications of stroke using the National Institutes of Health Stroke Scale (NHISS). Methods: Clinical assessment of swallowing was performed in 50 patients admitted to the emergency unit of the University Hospital, Faculty of Medicine of Ribeirao Preto, Sao Paulo, Brazil, with a diagnosis of ischemic stroke, within 48 h after the beginning of symptoms. Patients, 25 females and 25 males with a mean age of 64.90 years (range 26-91 years), were evaluated consecutively. An anamnesis was taken before the patient's participation in the study in order to exclude a prior history of deglutition difficulties. For the functional assessment of swallowing, three food consistencies were used, i.e. pasty, liquid and solid. After clinical evaluation, we concluded whether there was dysphagia. For statistical analysis we used the Fisher exact test, verifying the association between the variables. To assess whether the NIHSS score characterizes a risk factor for dysphagia, a receiver operational characteristics curve was constructed to obtain characteristics for sensitivity and specificity. Results: Dysphagia was present in 32% of the patients. The clinical evaluation is a reliable method of detection of swallowing difficulties. However, the predictors of risk for the swallowing function must be balanced, and the level of consciousness and the presence of preexisting comorbidities should be considered. Gender, age and cerebral hemisphere involved were not significantly associated with the presence of dysphagia. NIHSS, Glasgow Coma Scale, and speech and language changes had a statistically significant predictive value for the presence of dysphagia. Conclusions: The NIHSS is highly sensitive (88%) and specific (85%) in detecting dysphagia; a score of 12 may be considered as the cutoff value. The creation of an algorithm to detect dysphagia in acute ischemic stroke appears to be useful in selecting the optimal feeding route while awaiting a specialized evaluation. Copyright (C) 2012 S. Karger AG, Basel

THE PERCEPTION AND UNDERSTANDING OF HEALTH PROFESSIONALS AND UNDERGRADUATE STUDENTS REGARDING AGING AND THE ELDERLY

This qualitative study was developed with 117 healthcare professionals and undergraduate students who were participants of a non-verbal communication training program in gerontology, with the objective to identify the perception and understanding of healthcare undergraduates and graduates regarding aging and the elderly. The results allowed the construction of the following categories: an evolution of life that brings a variety of experiences; natural, mysterious and with accumulated experiences; a decrease in overall happiness due to an increase in isolation; a time of valuing affection and respect; an inevitable stage including distress, prejudice, and limitations worthy of attention; a natural consequence of life; and the presence of disease and the global physiological process. Regarding perceptions of the elderly, the answers were classified as positive, negative, mixed and neutral. We considered that the understanding regarding the elderly and aging was limited and pessimist, indicating a need to become aware that one's views affect the way we relate to others.

The role of evaluation in decision-making in the management of health services

The management of health services is a complex administrative practice due to the breadth of the field of health and the need to reconcile individual, corporate and collective interests that are not always convergent. In this context, the evaluation needs to have specific characteristics in order to fulfill its role. The scope of this study was to establish the characteristics that the evaluation for the management of health services should have to contribute to decision-making. Usefulness, opportunity, feasibility, reliability, objectivity and directionality represent the set of principles upon which the evaluation should be based. Evaluations should lead to decisions that guarantee not only their efficiency and effectiveness but also their implementation. The evaluation process should ensure that decisions involve all stakeholders in order to render the implementation of decisions feasible, and take into account the health needs of the population and the goals set for the services. The scope of this article is to elicit a debate among different stakeholders in the evaluation in the hope that it can contribute to the reflection on the real usefulness of evaluations in which the political component in management has been increasingly prevalent.

Methodological contributions towards the study of health care production: lessons from a research study on barriers and access in mental health

This article presents methodological contributions and a conceptual innovation for thinking about the production of health care, stemming from a study on access and barriers in mental health carried out in the municipality of Campinas (Sao Paulo, Brazil). The study used a cartographic approach and, after an initial identification of the most complex cases (on the part of the teams of workers), adopted the users as guides to explore the different levels of production of their lives and to evaluate the possibility of forming a network of existential connections that produce life as a fundamental analyzer of access or barriers to care.