Avaliação de efetividade de ações de saneamento: análise de gestão Evaluation of effectiveness of sanitation interventions: management assessment

Este texto traz uma transcrição de relatório final de pesquisa promovida pela Fundação Nacional de Saúde - Funasa, Edital 2001, linha de gestão em saúde pública, sobre a efetividade das ações de saneamento no Rio Grande do Norte no período 2002-2003. Esta autora foi coordenadora da pesquisa que, em estudo analítico de base inclusiva e participativa, avaliou a formulação/financiamento; gestão; resultados das ações e apresentou proposições ao setor. Através de estudo ecológico, teve como variável dependente e pressuposto de sua base amostral a hipótese de trabalho, na qual maior volume de financiamento às ações estruturais de saneamento teria maior impacto na redução de indicadores de morbi-mortalidade específicos. A base foi composta de sete municípios das sete regiões de iguais variáveis intervenientes de solo, econômica e administrativa e de controle, sete outros municípios de iguais intervenientes, porém, de zero ou menor volume desses recursos. Dos resultados de cobertura das ações financiadas foi produzido um ranking da co-relação dos Índices de Desenvolvimento Humano (IDH-m) com os de Saneamento Básico e Indicadores Epidemiológicos de igual período.<br>This essay is a transcription of the final report of a survey promoted by the National Health Foundation - FUNASA 2001, on the subject of public health management, and about the effectiveness of federal sanitary policies in the state of Rio Grande do Norte, over the period 2002-2003. This author was in charge of this research who, on analithycal study of inclusive basis and participative, evaluated the policy creation and financing schemes, management, results of the actions, and offered some proposition to the area. Through an ecological study, I had as dependant value and pre-assumption of the sample basis the working hypothesis that larger amounts financing structural sanitation actions would have important impact on curbing down specific morbid-mortality indexes. The range of the sample included seven counties from seven regions with equals intervenient soil, economics and administration values and, as a reference level, seven others regions of the same intervenient pattern, but with zero or small amount of those resources. From the results of effectiveness of the financed actions, was built a ranking of the correlation of Human Development Index (HDI-m) with those of Basic Sanitation and Epidemiological Indexes over the same period

Predictive Factors and Risk Model for Positive Circumferential Resection Margin Rate after Transanal Total Mesorectal Excision in 2653 Patients with Rectal Cancer

The aim of this study was to determine the incidence of, and preoperative risk factors for, positive circumferential resection margin (CRM) after transanal total mesorectal excision (TaTME). Background: TaTME has the potential to further reduce the rate of positive CRM for patients with low rectal cancer, thereby improving oncological outcome. Methods: A prospective registry-based study including all cases recorded on the international TaTME registry between July 2014 and January 2018 was performed. Endpoints were the incidence of, and predictive factors for, positive CRM. Univariate and multivariate logistic regressions were performed, and factors for positive CRM were then assessed by formulating a predictive model. Results: In total, 2653 patients undergoing TaTME for rectal cancer were included. The incidence of positive CRM was 107 (4.0%). In multivariate logistic regression analysis, a positive CRM after TaTME was significantly associated with tumors located up to 1 cm from the anorectal junction, anterior tumors, cT4 tumors, extra-mural venous invasion (EMVI), and threatened or involved CRM on baseline MRI (odds ratios 2.09, 1.66, 1.93, 1.94, and 1.72, respectively). The predictive model showed adequate discrimination (area under the receiver-operating characteristic curve &gt;0.70), and predicted a 28% risk of positive CRM if all risk factors were present. Conclusion: Five preoperative tumor-related characteristics had an adverse effect on CRM involvement after TaTME. The predicted risk of positive CRM after TaTME for a specific patient can be calculated preoperatively with the proposed model and may help guide patient selection for optimal treatment and enhance a tailored treatment approach to further optimize oncological outcomes