O direito à saúde e a política nacional de atenção oncológica: uma análise a partir da crescente judicialização dos medicamentos antineoplásicos

The 1988 Federal Constitution of Brazil by presenting the catalog of fundamental rights and guarantees (Title II) provides expressly that such rights reach the social, economic and cultural rights (art. 6 of CF/88) as a means not only to ratify the civil and political rights, but also to make them effective and practical in the life of the Brazilian people, particularly in the prediction of immediate application of those rights and guarantees. In this sense, health goes through condition of universal right and duty of the State, which should be guaranteed by social and economic policies aimed at reducing the risk of disease and other hazards, in addition to ensuring universal and equal access to actions and services for its promotion, protection and recovery (Article 196 by CF/88). Achieving the purposes aimed by the constituent to the area of health is the great challenge that requires the Health System and its managers. To this end, several policies have been structured in an attempt to establish actions and services for the promotion, protection and rehabilitation of diseases and disorders to health. In the mid-90s, in order to meet the guidelines and principles established by the SUS, it was established the Política Nacional de Atenção Oncológica PNAO, in an attempt to sketch out a public policy that sought to achieve maximum efficiency and to be able to give answers integral to effective care for patients with cancer, with emphasis on prevention, early detection, diagnosis, treatment, rehabilitation and palliative care. However, many lawsuits have been proposed with applications for anticancer drugs. These actions have become very complex, both in the procedural aspects and in all material ones, especially due to the highcost drugs more requested these demands, as well as need to be buoyed by the scientific evidence of these drugs in relation to proposed treatments. The jurisprudence in this area, although the orientations as outlined by the Parliament of Supreme Court is still in the process of construction, this study is thus placed in the perspective of contributing to the effective and efficient adjudication in these actions, with focus on achieving the fundamental social rights. Given this scenario and using research explanatory literature and documents were examined 108 lawsuits pending in the Federal Court in Rio Grande do Norte, trying to identify the organs of the Judiciary behave in the face of lawsuits that seeking oncology drugs (or antineoplastic), seeking to reconcile the principles and constitutional laws and infra constitutional involving the theme in an attempt to contribute to a rationalization of this judicial practice. Finally, considering the Rational Use of health demands and the idea of belonging to the Brazilian people SUS, it is concluded that the judicial power requires ballast parameters of their decisions on evidence-based medicine, aligning these decisions housing constitutional principles that the right to health and the scientific conclusions of efficacy, effectiveness and efficiency in oncology drugs, when compared to the treatments offered by SUS

Um estudante cego no curso de licenciatura em musica da ufrn: questões de acessibilidade curricular e física

This work aims to discuss and analyze the process of school inclusion of a blind person in the Bachelor's Degree in Music, at the School of Music at the Federal University of Rio Grande do Norte, as well as reflect on the importance of establishing systems of support and to ensure university inclusive process of people with visual impairments. In pursuit to achieve these objectives, this research chose a qualitative methodological approach, the case study, using as procedures for data construction an interview, observation, analysis of documents and photographs. Joined the group of participants in this study, a blind student in the class of 2009.1of the EMUFRN Bachelor's Degree in Music, teachers from two disciplines complied by the student, two classmates, a monitor support in music theory, the course coordinator and school principal, and two other individuals who contributed to the inclusion process in actions not formalized institutionally. The results indicate UFRN proposed initiatives that contribute to inclusion of students with disabilities in this institution, the main one is the creation of the Standing Committee of Support for Students with Special Educational Needs (CAENE), a group that guides administrative sectors, teachers, principals, coordinators and students on the measures needed to enter and remain in quality education for all. Physical accessibility is still under construction at UFRN, and many access and sectors see it being adapted for students with physical or visual disabilities, and those with mobility impairments, have access to various parts of the university, however, as shown in this study, some points need to be reconsidered, as there are several places where the installation of tactile floor does not fully follow the guidelines proposed in the legislation. The proposals for access to the curriculum, mediated by EMUFRN, are actions that propose the inclusion of the blind student, as the existence of an educational monitor to help in the study of music theory, however, we need to rethink these proposals to not became actions of reactive intervention. Assuming a more proactive posture, the EMUFRN will be prepared to receive the diversity of students that expects. The study also points out that the blind student is part of a group of students that are practical musicians, who must work in events and evening shows, and who have little knowledge in music theory, leading, respectively, in low frequency classes and learning difficulties in certain curricular components, which may cause the closing of such components. In this case, the challenge of EMUFRN, considering the inclusive perspective, it is not specifically fit for the academic host a blind student, but to develop an accessibility project curriculum to consider effectively the diversity of all its students, taking into account mainly the economic and cultural conditions. This implies a process of resizing academic practices that be guided for collaborative and coordinated actions involving the various educational actors at EMUFRN and UFRN

A palavra cantada nos espaços intersubjetivos de um centro de atenção psisossocial do município do Natal/RN

The psychiatric care and mental health are undergoing constant change over the History. The Brazilian Psychiatric Reform, which brings up the deinstitutionalization as a structuring in the restorative care process. The Reform has as one of the mainly substitutive services the Centers for Psychosocial Care (CAPS), which work from the Singular Therapeutic Project (PTS) in order to restore the autonomy and restore the dignity of users. The therapeutic workshop is some of the resources used and work several kinds of activities as: writing, handcraft, music, poetry, and so forth. This study set up to apprehend the social representations of helping of the music workshop carried out in the CAPS II east of Natal/RN, from the reports given by the participants of the workshop, using the focal group as technique. This is a descriptive exploratory study with a qualitative approach. A total of 16 users participated in four musical therapeutic workshops from April to May 2010. The study was approved by the Ethics and Research Committee of UFRN. The discursive material from the workshop was submitted to the informational resource of Analyse Lexicale par Contexte d um Ensemble de Segments de Texte, ALCESTE, and analyzed based on the Theory of Representations and the Central Core Theory. The majority of subjects were men (62.5%), single (62.5%), aged 40-49 years (37.6%) and elementary school level (56.2 %). The reports were transcribed and submitted to the classification system of ALCESTE, which elected the following categories: Category 1 - Experience in the Word Family Sung, Category 2 - Musical Experiences and Approaches, and Category 3 - Feelings and emotions evoked by music. The representation of these individuals is anchored in the experience they have with the CAPS, lived and socialized by common sense, through this particular social group workshop objectified in music therapy as a therapeutic modality enjoyable. The central core revealed the intrinsic relationship between users and the music, establishing a relationship of openness to use the same while its therapeutic use in workshops of substitute services for mental health. Peripherals elements issues are related to listen, share and experience music in the family. Intermediary Elements relate to the feelings and emotions evoked by music, given her close relationship with it. It was found in the study that music can be construed as an artifact of good therapeutic responsiveness to users, configuring it as an invigorating and enjoyable therapy, confirming the need for continuity of this activity, as well as its expansion into the service

Assessment of estrogenic, mutagenic and antimutagenic activity of nemorosone

Currently, a wide range of research involving natural products is focused on the discovery of new drugs in many different therapeutic areas. A great number of the synthetic compounds on the market were derived from natural products, especially plants. Nemorosone is the major constituent of the floral resin of Clusia rosea Jacq., Clusiaceae, and in Cuban propolis. In vitro studies have shown cytotoxic activity in this substance against various tumor cell lines, including those resistant to various cytotoxic drugs, whereas it has low cytotoxicity to non-tumoral cells. Therefore, in order to characterize the biological activity of nemorosone, a substance with potential antitumor activity, and in view of preclinical testing of the toxicity of drug candidate compounds, the main aim of this study was to determine the mutagenic and antimutagenic activity of nemorosone by the Ames test, using the strains TA97a, TA98, TA100 and TA102 of Salmonella typhimurium. Secondly, to characterize the estrogenic activity in an experimental recombinant yeast model (Recombinant Yeast Assay) mutagenic activity was observed at in any of the concentrations in any of the test strains. To evaluate the antimutagenic potential, direct and indirect mutagenic agents were used: 4 nitro-o-phenylenediamine (NPD), mitomycin C (MMC) and aflatoxin B1 (AFL). Nemorosone showed moderate antimutagenic activity (inhibition level 31%), in strain TA100 in the presence of AFL, and strong antimutagenic activity in TA102 against MMC (inhibition level 53%). Estrogenic activity was observed, with an EEq of 0.41±0.16 nM at various tested concentrations.

O jogo das identidades como fator de mobilização político-eleitoral nas campanhas de Dilma Rousseff e Rosalba Ciarlini em 2010

Starting from the premise that we live in the society of spectacle, as proclaimed by Guy Debbord, and, in this context, the media feeds itself off of this spectacularization and constructs a culture of images and production of goods, providing templates from which the subject can identify himself/herself as being male or female, successful or unsuccessful, powerful or powerless. In other words, the culture conveyed by the media produces material for the creation of identities through which individuals insert and recognize themselves in contemporary society. Observing the election campaigns, we can see clearly that this profusion of identities is fairly explored in the advertising propaganda used by the candidates, particularly in the propaganda broadcasted on the Free Electoral Time on TV. Instigated by the explicit relation between the media and politics within the society of the spectacle, this study aims to investigate the main identities that emerge in the discursive practices of the media in the election campaigns of 2010 for president of the Republic and governor of the State of Rio Grande do Norte that had as protagonists the candidates at that moment Dilma Rousseff (PT) for president and Rosalba Ciarline (DEM) for governor. To do so, we based ourselves on the theory of Bakhtin Circle, which considers the statement as a unit of verbal communication and conceives language as a dialogical phenomena and a discursive practice and also in the conceptions of dialogical relationships, social voices and chronotope formulated by the previous mentioned theory. Still in the theoretical field, we have established an interconnection with the theories coming from the Cultural Studies (Hall, Woodward) about the identity, which conceives it as multiple, fragmented, non-fixed, so that, the subject assumes different identities, not always coherent, at different times, depending on the context in which they are approached. The research is situated in the frames of Applied Linguistics, which considers language as the center of its studies and settles on the border of an open number of areas of knowledge expanding its possibilities of investigation by means of the interdisciplinary. Our corpus consists in 20 electoral propaganda videos aired on TV during the Free Election Time in 2010 campaign; among these, 14 videos are Dilma Rousseff s propaganda and 06 videos are Rosalba Ciarline s propaganda. We seek for the purpose of the analysis to identify the identities which emerge from the discourses about the candidates in propaganda videos broadcasted in the referred campaign, as well as realize the dialogical relations established in these discourses and even if the identity construction of these subjects is located in the same axiological axis. The corpus analysis revealed that the multiple cultural identities of the candidates campaigning emerge in the discourses circulating in the electoral propaganda aired on TV such as: the identities of pioneer woman, competent, sensitive, mother, grandmother, religious. And, yet, those are changeable as the electoral demands, in other words, the need to obtain support and votes, outline a fluid identity construction about the candidate to the position in question

Mídia e produção de sentido: a reconfiguração da indústria da música e as estratégias discursivas da associação cultural DoSol

This dissertation aims to analyse discursive strategies from Dosol in order to understand the present elements to keep its audience and the marketing activities. Based on French line of discourse analysis We look into the articles posted on its website at http://www.dosol.com.br within 2010 and We foment dialogues among music, media and communications researchers. Participant observation is slightly used on the critical perception and views of researched object to confront situations and step up, with theorists, the major part of closing remarks. The obtained results indicate a website speech paved on afirmative policies and social capital, trying to keep/seduce its audience with the efect of the intended credibility meaning. The economic factor wanders the speech so often that the speaker assumes a entrepreneur/cultural producer. As a niche market, Dosol assumes a main role in music industry for releasing the regional and local cultural production. On the other hand, it is noticeable that its sustainability and media visibility, as it is seen today, depends on the laws tor promote Culture, what denotes a lack of a regional cultural policies to medium and long term at Rio Grande do Norte

Rheological, Mechanical and Adhesive Properties of Surfactant-Containing Systems Designed as a Potential Platform for Topical Drug Delivery

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

A new approach to the granulation of beta-cyclodextrin inclusion complexes

Cyclodextrins (CDs) are annular oligosaccharides containing 6-12 glucose unities joined together by alpha-1,4 bonds. They have a conical-truncated shape with a lipophilic cavity in which different molecules can be included resulting in a stable inclusion complex. The cyclodextrins have been widely applied in pharmaceutical technology with the objective of increasing the solubility, stability and bioavailability of drugs in different pharmaceutical dosage forms, such as tablets. In order to obtain beta-CD tablets, liquid dispersions of drug/beta-CD are usually submitted to different drying processes, like spray-drying, freeze-drying or slow evaporation, being this dry material added to a number of excipients. However, such drying processes can generate particulate materials showing problems of flow and compressibility, needing their conversion into granulates by means of wetting with granulation liquid followed by additional drying. In this work, the main objective was to evaluate the preparation of tablets without the need of this additional drying step. For this purpose an aqueous dispersion containing acetaminophen/beta-CD complex and cornstarch was dried using a spouted bed and the obtained granules were compressed in tablets. Acetaminophen was used as model drug due to its low water solubility and the inexpensive and widely available cornstarch was chosen as excipient. Acetaminophen powder was added into a beta-cyclodextrin solution prepared in distilled water at 70 degrees C. Stirring was kept until this dispersion cooled to room temperature. Then cornstarch was added and the resulting dispersion was dried in spouted bed equipment. This material was compressed into tablets using an Erweka Korsh EKO tablet machine. This innovative approach allowed the tablets preparation process to be carried out with fewer steps and represents a technological reliable strategy to produce beta-cyclodextrin inclusion complexes tablets. (C) 2010 Elsevier By. All rights reserved.

Darunavir: A Critical Review of Its Properties, Use and Drug Interactions

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

Psicose e toxicomanias: um estudo psicanalítico

This paper is a case study that aims to discuss the effects of drug abuse by a person with psychotic structure from a psychoanalytical perspective. The interest in this subject was born from an internship experience in the Mental Health area in which a psychotic patient had a drug abuse problem and the service treating him had difficulties dealing with this. In order to accomplish the objective of this work four theoretical chapters were written and the case is discussed throughout them articulating the theoretical issues with clinical practice. A literature review revealed that Freud and Lacan did not dedicate themselves to the study of the effect of drug use by psychotic patients but they made important contributions unfolding the theoretical and clinical psychoanalytical practice. Contemporary psychoanalytic authors suggest that the drug use made by psychotics differs from the use by neurotics, because of the particularity of the psychotic structure. It was found that drug use in psychosis can operate in three different ways: the first refers to drug use as substitute of a missing signifier helping the psychotic patient building a social bond. The second function is to intensify psychotic phenomena and the third function is to operate as an attempt to diminish those same phenomena. We conclude that, while the use of drugs in neurosis provides an individualist way of satisfaction, that excludes social aspects. For psychosis such use may operate differently and may play a role in social integration, among others effects. Such discussion can help move forward the direction of treatment of psychosis when the case involves drug use

A experiência da criança com a droga :características do uso e circunstâncias familiares

The study is a reflexion of the use of drugs among children, pointing that as one of the most serious social problem nowadays. Customize the abuse of drugs reflecting on the childhood and the family s influence of the problem of the children that use drugs, is the main objective of this thesis. Choosing the qualitative method of research, the investigation starts with the reports of the children and mothers assisted at Centro de Referência e Apoio à Criança e ao Adolescente Usuários de Drogas, program of specialized assistance of 1ª Vara da Infância e da Juventude de Natal/RN. The research was done through semi-structured interviews, in a total of six subjects: three children and their respective mothers. Through the reports of the subjects, it is brought theorical reflexions that illustrates their perceptions and conceptions about topics like the usage of drugs, the circumstances the usage of drugs was started, the family s structure and dynamic, the situation on the streets, and other factors that affect the development of a child in her/his environment. It is proved that the usage of drugs in Brazil, problem that has been increasing the number of children affected by, is a multi faceted and complex phenomenon but some factors of social and family risks deserve to be pointed out like the manner of support future actions in the prevention area

Membranas de quitosana micro e macroporosas : preparo, caracterização e estudos de permeabilidade

Two methodologies were proposed to obtain micro and macroporous chitosan membranes, using two different porogenic agents. The methodologies proved to be effective in control the porosity as well as the pore size. Thus, microporous membranes were obtained through the physical blend of chitosan and polyethylene oxide (PEO) on an 80:20 (m/m) ratio, respectively, followed by the partial PEO solubilization in water at 80 ◦C. Macroporous chitosan membranes with asymmetric morphology were obtained using SiO2 as the porogenic agent. In this case, chiotsan-silica ratios used were 1:1, 1:3 and 1:5 (m/m). Membranes characterization were carried out by SEM (scanning electronic microscopy), X-ray diffraction, Fourier Transform Infrared Spectroscopy (FTIR), Thermal analysis (TG, DTG , DSC and DMTA). Permeability studies were performed using two model drugs: sodium sulfamerazine and sulfametoxipyridazine. By transmission FTIR it was possible to confirm the complete removal of SiO2. The SEM images confirmed the porous formation for both micro and macroporous membranes and also determined their respective sizes. By thermal analysis it was possible to show differences related with water sorption capacity as well as thermal stability for both membranes. DTG and DSC allowed evidencing the PEO presence on microporous membranes. The absorbance x time curves obtained on permeability tests for micro and macroporous membranes showed a linear behavior for both drugs in all range of concentration used. It was also observed, through P versus C curves, an increase in permeability of macroporous membranes according to the increase in porosity and also a decrease on P with increase in drug concentration. The influences of the drug molecular structure, as well as test temperatures were also evaluated

Injeção inadvertida de metoclopramida no espaço subaracnóideo: relato de caso

JUSTIFICATIVA E OBJETIVOS: Injeção inadvertida de medicamentos de uso não espinhal nos espaços peridural e subaracnóideo é uma complicação anestésica passível de ocorrer. Este relato apresenta um caso de injeção inadvertida de metoclopramida no espaço subaracnóideo. RELATO do CASO: Paciente do sexo feminino, 17 anos, 69 kg, IMC de 26.2, estado físico ASA I, 36 semanas e 4 dias de gestação, com diagnóstico de sofrimento fetal agudo, e indicação de cesariana. Apresentava freqüência cardíaca de 82 bpm, pressão arterial de 130 x 70 mmHg, SpO2 de 97%, ritmo cardíaco sinusal regular. A anestesia foi por via subaracnóidea com a associação de anestésico local e opióide, 15 mg de bupivacaína hiperbárica a 0,5% e 25 µg de fentanil. Após 5 minutos da instalação do bloqueio, a paciente referiu mal estar inespecífico. Aferidas pressão arterial, 190 x 120 mmHg, freqüência cardíaca, 145 bpm, e SpO2, 95%. Verificando-se as ampolas cujos conteúdos foram administrados encontrou-se uma de bupivacaína e uma de metoclopramida. O quadro se apresentou com cefaléia frontal intensa, visão turva, náuseas, vômitos e agitação inicial, que evoluiu para sonolência e torpor, além de hipertensão arterial e taquicardia. Foram administrados tramadol, dipirona, ondansetron e medidas de suporte. Após 30 minutos, a paciente apresentava-se assintomática, com PA de 150 x 100 mmHg e FC de 120 bpm. Recebeu alta para a enfermaria 140 minutos após permanência na SRPA, com total reversão dos bloqueios motor, sensitivo e autonômico, e normalização dos parâmetros hemodinâmicos. Recebeu alta hospitalar 48 horas após, sem apresentar seqüelas neurológicas, juntamente com o recém-nascido. CONCLUSÕES: Máxima atenção deve ser dada a qualquer medicamento administrado, seja qual for à via utilizada. Padronização de cores de ampolas, e dos locais de depósito, com o intuito de diminuir este tipo de acidente é recomendável.

Segmentação Fuzzy de Texturas e Vídeos

The segmentation of an image aims to subdivide it into constituent regions or objects that have some relevant semantic content. This subdivision can also be applied to videos. However, in these cases, the objects appear in various frames that compose the videos. The task of segmenting an image becomes more complex when they are composed of objects that are defined by textural features, where the color information alone is not a good descriptor of the image. Fuzzy Segmentation is a region-growing segmentation algorithm that uses affinity functions in order to assign to each element in an image a grade of membership for each object (between 0 and 1). This work presents a modification of the Fuzzy Segmentation algorithm, for the purpose of improving the temporal and spatial complexity. The algorithm was adapted to segmenting color videos, treating them as 3D volume. In order to perform segmentation in videos, conventional color model or a hybrid model obtained by a method for choosing the best channels were used. The Fuzzy Segmentation algorithm was also applied to texture segmentation by using adaptive affinity functions defined for each object texture. Two types of affinity functions were used, one defined using the normal (or Gaussian) probability distribution and the other using the Skew Divergence. This latter, a Kullback-Leibler Divergence variation, is a measure of the difference between two probability distributions. Finally, the algorithm was tested in somes videos and also in texture mosaic images composed by images of the Brodatz album

Transtornos mentais comuns e uso de psicofármacos: impacto das condições socioeconômicas

OBJETIVO: Avaliar a influência das condições socioeconômicas na associação entre transtornos mentais comuns, uso de serviços de saúde e de psicofármacos. MÉTODOS: Estudo transversal populacional conduzido na cidade de Botucatu, SP, com amostragem probabilística, estratificada e por conglomerados. Foram realizadas entrevistas domiciliares com 1.023 sujeitos de 15 anos ou mais de idade, entre 2001 e 2002. Transtorno mental comum foi avaliado utilizando o Self Reporting Questionnaire (SRQ-20). O uso de serviços foi investigado com relação à quinzena anterior à entrevista e uso de psicotrópicos, nos três dias anteriores. Utilizou-se regressão logística para análise multivariável, considerando o efeito do desenho. RESULTADOS: No total da amostra, 13,4% (IC 95%: 10,7;16,0) procuraram serviços de saúde na quinzena anterior à entrevista. A procura de serviços de saúde se associou ao sexo feminino (OR=2,0) e à presença de transtorno mental comum (OR=2,2). Na amostra 13,3% (IC 95%: 9,2;17,5) referiram ter usado ao menos um psicotrópico, destacando-se os antidepressivos (5,0%) e os benzodiazepínicos (3,1%). Na análise multivariável, sexo feminino e presença de transtorno mental comum mantiveram-se associados ao uso de benzodiazepínicos. Renda per capita mostrou-se direta e independentemente associada ao uso de psicofármacos, conforme aumento da renda. CONCLUSÕES: Menor renda associou-se à presença de transtorno mental comum, mas não ao uso de psicotrópicos. A associação entre transtorno mental comum e uso de psicotrópicos e maior renda reforça a hipótese da existência de iniqüidades no acesso à assistência médica na população estudada.