Uso y efectividad de los fitofarmacos. Policlínico Hermanos Cruz. Pinar del Río. 2004. Use and effectiveness of herbal medicine. “Hermanos Cruz” Outpatient Clinic. Pinar del Río-2004

Las plantas medicinales son una fuente de sabiduría milenaria. Se realizó un estudio descriptivo en los meses de noviembre del 2003 a enero del 2004, con el objetivo de evaluar el uso y efectividad de los fitofármacos, de una población de 468 pacientes se tomó una muestra de 200, pertenecientes al consultorio 58 del policlínico Hermanos Cruz de Pinar del Río, se aplicó una encuesta donde las principales variables fueron: conocimiento y utilización de los fitofármacos, frecuencia de uso, afecciones para las cuales se emplean, fitofármacos más utilizados y criterio de efectividad. La información se obtuvo a partir de dicha encuesta y entrevistas previo consentimiento y aprobación de los participantes. A los resultados se les aplicó el método porcentual aritmético. Dentro de ellos se pueden mencionar que el 100 % de la población conoce y usa los fitofármacos, las afecciones respiratorias e hipertensión arterial, los trastornos nerviosos y las diarreas son las enfermedades donde más se usan los medicamentos elaborados a partir de plantas medicinales. El mayor número de pacientes encuestados consideran efectivo este método de tratamiento. Palabras clave: FITOFÁRMACOS, PLANTAS MEDICINALES. ABSTRACT A descriptive study was aimed at assessing the use and effectiveness of the herbal medicine was conducted during November 2003 to January 2004. From a population 0f 486 patients a sample composed by 200 who belonged to Doctor's Office No. 58 at Hermanos Cruz Outpatient Clinic was taken. A survey was applied where the main variates were: experience and use of herbal medicine, frequency of use, diseases treated and criteria of effectiveness. Information was recorded taking into consideration the results of the survey and the interview to the patients previously requested. An arithmetical percentage method was used to process the results obtained, concluding the 100 % of the population studied knew and used herbal medicine. Respiratory diseases, hypertension, nervous system disorders and diarrhea were among the entities more treated using this therapy. The majority of the patients inquired considered the effectiveness of this method of treatment. Key words: HERBAL MEDICINE, HERBS

Uso y efectividad de los fitofarmacos. Policlínico Hermanos Cruz. Pinar del Río. 2004. Use and effectiveness of herbal medicine. “Hermanos Cruz” Outpatient Clinic. Pinar del Río-2004

Las plantas medicinales son una fuente de sabiduría milenaria. Se realizó un estudio descriptivo en los meses de noviembre del 2003 a enero del 2004, con el objetivo de evaluar el uso y efectividad de los fitofármacos, de una población de 468 pacientes se tomó una muestra de 200, pertenecientes al consultorio 58 del policlínico Hermanos Cruz de Pinar del Río, se aplicó una encuesta donde las principales variables fueron: conocimiento y utilización de los fitofármacos, frecuencia de uso, afecciones para las cuales se emplean, fitofármacos más utilizados y criterio de efectividad. La información se obtuvo a partir de dicha encuesta y entrevistas previo consentimiento y aprobación de los participantes. A los resultados se les aplicó el método porcentual aritmético. Dentro de ellos se pueden mencionar que el 100 % de la población conoce y usa los fitofármacos, las afecciones respiratorias e hipertensión arterial, los trastornos nerviosos y las diarreas son las enfermedades donde más se usan los medicamentos elaborados a partir de plantas medicinales. El mayor número de pacientes encuestados consideran efectivo este método de tratamiento. Palabras clave: FITOFÁRMACOS, PLANTAS MEDICINALES. ABSTRACT A descriptive study was aimed at assessing the use and effectiveness of the herbal medicine was conducted during November 2003 to January 2004. From a population 0f 486 patients a sample composed by 200 who belonged to Doctor's Office No. 58 at Hermanos Cruz Outpatient Clinic was taken. A survey was applied where the main variates were: experience and use of herbal medicine, frequency of use, diseases treated and criteria of effectiveness. Information was recorded taking into consideration the results of the survey and the interview to the patients previously requested. An arithmetical percentage method was used to process the results obtained, concluding the 100 % of the population studied knew and used herbal medicine. Respiratory diseases, hypertension, nervous system disorders and diarrhea were among the entities more treated using this therapy. The majority of the patients inquired considered the effectiveness of this method of treatment. Key words: HERBAL MEDICINE, HERBS

Agricultura familiar e políticas públicas: o impacto do Pronaf no Rio Grande do Sul.

A aparição do Programa Nacional de Fortalecimento da Agricultura Familiar (PRONAF) marca um momento singular na trajetória do processo de intervenção estatal na agricultura e no mundo rural do Brasil. Apesar de avanços no aperfeiçoamento e ampliação do universo de cobertura, o programa permanece ancorado numa ambigüidade básica tanto em termos do público-alvo a ser beneficiado quanto aos objetivos essenciais que persegue, onde, na retórica oficial, mesclam-se orientações tipicamente produtivistas com compromissos mais amplos, como a geração de empregos, a inclusão social e o desenvolvimento territorial. O artigo em questão desenvolve uma análise do PRONAF à luz de recente pesquisa realizada no Estado do Rio Grande do Sul, inserida no contexto de um convênio firmado entre o PCT/IICA-PRONAF e a Fundação de Economia de Campinas - FECAMP para montar um sistema de acompanhamento das ações do Ministério do Desenvolvimento Agrário e avaliar os impactos deste programa. Os dados finais mostram fortes evidências de diferenciação social dentre os produtores familiares

Prevalence of vertebral fractures and their prognostic significance in the survival in patients with chronic kidney disease stages 3-5 not on dialysis

The prevalence of vertebral fractures (VF) and their association with clinical risk factors and outcomes are poorly documented in chronic kidney disease (CKD) cohorts. The aim of the study was to evaluate the prevalence of VF in patients with non-dialysis dependent CKD (NDD-CKD), their value in predicting mortality and its correlation with parameters of bone mineral metabolism and vascular calcification. 612 NDD 3-5 stage CKD patients participating in the OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into two groups according to presence or absence of VF at enrollment. VF were assessed with lateral radiographs and Genant semi-quantitative method was applied. Three radiologists specialized in musculoskeletal radiology performed consensual reading of individual images obtained using a Raim DICOM Viewer and a Canon EOS 350 camera to measure with Java Image software in those who had traditional acetate X-ray. Factors related to VF were assessed by logistic regression analysis. Association between VF and death over a 3-year follow-up was assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. VF were detected in 110patients(18%). Serumphosphatelevels(OR0.719,95%CI0.532to0.972,p = 0.032),ankle-brachial index 3 and serum phosphate, the presence of VF (HR 1.983, 95% CI 1.009-3.898, p = 0.047) were an independent predictor of all-cause mortality. In our study 18% of patients with NDD-CKD have VF. Factors associated with VF were age, low serum phosphate levels and peripheral vascular disease. The presence of VF was an independent risk factor for mortality in stages 3-5 NDD-CKD patients. Clinical trials are needed to confirm whether this relationship is causal and reversible with treatment for osteoporosis

Queixas musculoesqueléticas em uma Unidade Básica de Saúde: implicações para o planejamento das ações em saúde e fisioterapia

OBJETIVO: O objetivo deste estudo foi analisar a prevalência de queixas musculoesqueléticas em adultos em uma Unidade Básica de Saúde. MÉTODO: Foram avaliados os usuários atendidos na recepção espontânea no período de março de 2010 a maio de 2011. Ao todo, foram estudados 1.023 indivíduos. A caracterização das queixas foi realizada por meio de questionário com dados sociodemográficos e motivo da procura por atendimento. RESULTADOS: Os dados mostraram que a maioria dos usuários pertence ao sexo feminino (71,2%), está na faixa etária de 31 a 60 anos (50,0%), é solteira (31,6%), aposentada (14,2%) e apresenta queixas em vários sistemas (77,1%). O sistema musculoesquelético é o mais acometido (14,4%), representando o segundo motivo de procura por atendimento (31,0%). Analisando as razões de chance de ocorrência de queixas musculoesqueléticas com relação às variáveis estudadas, verificou-se que pessoas com idade entre 40 e 59 anos apresentaram 3,49 (IC95% 2,17-5,57) vezes mais chances de associação com essas dores do que as demais. Não houve associação entre outros sistemas e variáveis. CONCLUSÃO: A alta prevalência de queixas musculoesqueléticas requer um novo olhar de gestores em saúde para o atendimento destas demandas, pensando em incluir o fisioterapeuta na atenção básica para tratamento de dores de menor complexidade

Association of MC1R Variants and host phenotypes with melanoma risk in CDKN2A mutation carriers: a GenoMEL study

<p><b>Background</b> Carrying the cyclin-dependent kinase inhibitor 2A (CDKN2A) germline mutations is associated with a high risk for melanoma. Penetrance of CDKN2A mutations is modified by pigmentation characteristics, nevus phenotypes, and some variants of the melanocortin-1 receptor gene (MC1R), which is known to have a role in the pigmentation process. However, investigation of the associations of both MC1R variants and host phenotypes with melanoma risk has been limited.</p> <p><b>Methods</b> We included 815 CDKN2A mutation carriers (473 affected, and 342 unaffected, with melanoma) from 186 families from 15 centers in Europe, North America, and Australia who participated in the Melanoma Genetics Consortium. In this family-based study, we assessed the associations of the four most frequent MC1R variants (V60L, V92M, R151C, and R160W) and the number of variants (1, ≥2 variants), alone or jointly with the host phenotypes (hair color, propensity to sunburn, and number of nevi), with melanoma risk in CDKN2A mutation carriers. These associations were estimated and tested using generalized estimating equations. All statistical tests were two-sided.</p> <p><b>Results</b> Carrying any one of the four most frequent MC1R variants (V60L, V92M, R151C, R160W) in CDKN2A mutation carriers was associated with a statistically significantly increased risk for melanoma across all continents (1.24 × 10−6 ≤ P ≤ .0007). A consistent pattern of increase in melanoma risk was also associated with increase in number of MC1R variants. The risk of melanoma associated with at least two MC1R variants was 2.6-fold higher than the risk associated with only one variant (odds ratio = 5.83 [95% confidence interval = 3.60 to 9.46] vs 2.25 [95% confidence interval = 1.44 to 3.52]; Ptrend = 1.86 × 10−8). The joint analysis of MC1R variants and host phenotypes showed statistically significant associations of melanoma risk, together with MC1R variants (.0001 ≤ P ≤ .04), hair color (.006 ≤ P ≤ .06), and number of nevi (6.9 × 10−6 ≤ P ≤ .02).</p> <p><b>Conclusion</b> Results show that MC1R variants, hair color, and number of nevi were jointly associated with melanoma risk in CDKN2A mutation carriers. This joint association may have important consequences for risk assessments in familial settings.</p&gt

Primary healthcare and the construction of thematic health networks: what role can they play?

The enhancement of primary healthcare has been a core strategy for the empowerment of the Brazilian Unified Health System (SUS). Recent guidelines issued by OPAS and the Ministry of Health highlight the role it has played as a thematic communication network center, a regulating agent for the access and use of services required for comprehensive healthcare. Sponsored by PPSUS/Fapesp, this study examines the possibilities of the primary healthcare network exercising such a strategic function. Life narratives involving 15 regular users were produced in two cities of ABC Paulista, which have adopted the Family Health Strategy for the organization of their primary healthcare networks. The study presents three main findings: the primary healthcare network serves as an outpost of SUS by producing user values even for high complexity service users; the primary network is perceived is a place for simple care needs; there is shared impotence between users and teams when it comes to the network functioning as the coordinator of care, indicating that it does not possess the technological, operational and organizational material conditions or symbolic conditions (values, meanings, and representations) to be in a central position in the coordination of thematic healthcare networks.O fortalecimento da atenção básica tem sido valorizado como estratégia central para a construção do SUS. Diretrizes recentes emanadas pela OPAS e pelo MS destacam seu papel como centro de comunicação de redes temáticas, como reguladora do acesso e utilização dos serviços necessários para a integralidade do cuidado. O presente estudo, financiado com recursos PPSUS/Fapesp, problematiza as possibilidades da rede básica exercer tal função estratégica. Foram produzidas narrativas de vida de 15 usuários altamente utilizadores de serviços de saúde em dois municípios do ABC paulista, que adotaram a Estratégia de Saúde da Família para organização de suas redes básicas. O estudo apresenta três achados principais: a rede básica funciona como posto avançado do SUS, produzindo valores de uso mesmo para os pacientes utilizadores de serviços de alta complexidade; a rede básica é vista como lugar de coisas simples; há uma impotência compartilhada entre usuários e equipes quando se trata da rede básica funcionar como coordenadora do cuidado, indicando como ela não reúne condições materiais (tecnológicas, operacionais, organizacionais) e simbólicas (valores, significados e representações) de deter a posição central da coordenação das redes temáticas de saúde.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Medicina PreventivaInstituto Superior de Ciências do Trabalho e da Empresa Instituto Universitário de Lisboa Faculdade de Ciências Médicas Departamento de Saúde ColetivaUniversidade Estadual de Campinas Faculdade de Ciências Médicas Departamento de Saúde ColetivaUNIFESP, EPM, Depto. de Medicina PreventivaSciEL

A proposed prognostic 7-day survival formula for patients with terminal cancer

<p>Abstract</p> <p>Background</p> <p>The ability to identify patients for hospice care results in better end-of-life care. To develop a validated prognostic scale for 7-day survival prediction, a prospective observational cohort study was made of patients with terminal cancer.</p> <p>Methods</p> <p>Patient data gathered within 24 hours of hospital admission included demographics, clinical signs and symptoms and their severity, laboratory test results, and subsequent survival data. Of 727 patients enrolled, data from 374 (training group) was used to develop a prognostic tool, with the other 353 serving as the validation group.</p> <p>Results</p> <p>Five predictors identified by multivariate logistic regression analysis included patient's cognitive status, edema, ECOG performance status, BUN and respiratory rate. A formula of the predictor model based on those five predictors was constructed. When probability was >0.2, death within 7 days was predicted in the training group and validation group, with sensitivity of 80.9% and 71.0%, specificity of 65.9% and 57.7%, positive predictive value of 42.6% and 26.8%, and negative predictive value (NPV) of 91.7% and 90.1%, respectively.</p> <p>Conclusion</p> <p>This predictor model showed a relatively high sensitivity and NPV for predicting 7-day survival among terminal cancer patients, and could increase patient satisfaction by improving end-of-life care.</p