O cuidado na atenção primária à saúde: preliminares de um estudo comparativo Brasil/Canadá

O texto aborda os processos de constituição e institucionalização da Atenção Primária à Saúde no Brasil e no Canadá; os pontos de interseção e de distanciamento entre os dois países; e a inserção profissional dos fisioterapeutas brasileiros e canadenses nas equipes multidisciplinares. A primeira parte deste estudo focaliza a atenção primária no Brasil, os caminhos e estratégias de reorientação do modelo assistencial e o papel que coube nesse modelo, de modo crescente, ao fisioterapeuta. Após situar o contexto nacional, o tópico seguinte trata da atenção primária à saúde no Canadá e da atuação deste profissional nas equipes primárias de saúde. No exercício absolutamente preliminar de contrastar as duas experiências nacionais, a brasileira e a canadense, foi utilizada a literatura nacional e estrangeira sobre a temática central, além de documentos e discussion papers. O texto procurou chamar a atenção para a necessidade e importância da participação de fisioterapeutas nas equipes multiprofissionais e as diferenças na atuação deste profissional tanto no Brasil quanto no Canadá. Desnecessário acrescentar que os autores intentaram não uma "análise" comparativa, mas, sim, uma breve exposição sobre constrastes e semelhanças nos rumos da atenção primária, ao longo da história mais recente desses dois países

A Field Guide to Pandemic, Epidemic and Sporadic Clones of Methicillin-Resistant Staphylococcus aureus

In recent years, methicillin-resistant Staphylococcus aureus (MRSA) have become a truly global challenge. In addition to the long-known healthcare-associated clones, novel strains have also emerged outside of the hospital settings, in the community as well as in livestock. The emergence and spread of virulent clones expressing Panton-Valentine leukocidin (PVL) is an additional cause for concern. In order to provide an overview of pandemic, epidemic and sporadic strains, more than 3,000 clinical and veterinary isolates of MRSA mainly from Germany, the United Kingdom, Ireland, France, Malta, Abu Dhabi, Hong Kong, Australia, Trinidad & Tobago as well as some reference strains from the United States have been genotyped by DNA microarray analysis. This technique allowed the assignment of the MRSA isolates to 34 distinct lineages which can be clearly defined based on non-mobile genes. The results were in accordance with data from multilocus sequence typing. More than 100 different strains were distinguished based on affiliation to these lineages, SCCmec type and the presence or absence of PVL. These strains are described here mainly with regard to clinically relevant antimicrobial resistance- and virulence-associated markers, but also in relation to epidemiology and geographic distribution. The findings of the study show a high level of biodiversity among MRSA, especially among strains harbouring SCCmec IV and V elements. The data also indicate a high rate of genetic recombination in MRSA involving SCC elements, bacteriophages or other mobile genetic elements and large-scale chromosomal replacements

A Field Guide to Pandemic, Epidemic and Sporadic Clones of Methicillin-Resistant Staphylococcus aureus

In recent years, methicillin-resistant Staphylococcus aureus (MRSA) have become a truly global challenge. In addition to the long-known healthcare-associated clones, novel strains have also emerged outside of the hospital settings, in the community as well as in livestock. The emergence and spread of virulent clones expressing Panton-Valentine leukocidin (PVL) is an additional cause for concern. In order to provide an overview of pandemic, epidemic and sporadic strains, more than 3,000 clinical and veterinary isolates of MRSA mainly from Germany, the United Kingdom, Ireland, France, Malta, Abu Dhabi, Hong Kong, Australia, Trinidad & Tobago as well as some reference strains from the United States have been genotyped by DNA microarray analysis. This technique allowed the assignment of the MRSA isolates to 34 distinct lineages which can be clearly defined based on non-mobile genes. The results were in accordance with data from multilocus sequence typing. More than 100 different strains were distinguished based on affiliation to these lineages, SCCmec type and the presence or absence of PVL. These strains are described here mainly with regard to clinically relevant antimicrobial resistance- and virulence-associated markers, but also in relation to epidemiology and geographic distribution. The findings of the study show a high level of biodiversity among MRSA, especially among strains harbouring SCCmec IV and V elements. The data also indicate a high rate of genetic recombination in MRSA involving SCC elements, bacteriophages or other mobile genetic elements and large-scale chromosomal replacements

O ensino da saúde pública no Brasil: os primeiros tempos no Rio de Janeiro Public health education in Brazil: beforetime in Rio de Janeiro

Busca-se neste artigo recuperar as primeiras décadas do ensino da saúde pública no Rio de Janeiro, uma vez que a antiga capital federal revelou-se importante centro formador de profissionais sanitaristas. No Rio de Janeiro, o governo federal implantou centros de saúde pioneiros e contou com o auxílio técnico e os recursos humanos da Fundação Rockefeller. Partindo do contexto socioeconômico e político da década de 1920, o trabalho abrange o ensino da saúde pública durante a Primeira República, estende-se aos tempos de Vargas e Capanema e se encerra, aproximadamente, no início da década de 1960. Analisa-se a trajetória dos cursos de saúde pública e higiene no Rio de Janeiro, desde os tempos de médicos empreendedores de renome — como Carlos Chagas, Afrânio Peixoto, João de Barros Barreto e José Paranhos Fontenelle ainda no primeiro quartel do século XX. Esses nomes ligaram-se intimamente à história dos primeiros cursos para formação de profissionais na área de saúde pública, na capital da República e em todo o Brasil.<br>This paper aims to recover the first decades of public health education in Rio de Janeiro, since the former Federal Capital was an important graduating center of sanitarian professionals. In Rio de Janeiro, the Federal Government established pioneers health centers and count on the technical aid and on the human resources of "Fundação Rockefeller". Concerning to socioeconomic and political structure of the 1920's, the work includes the public health education during the First Republic, and goes through Vargas and Capanema eras and finishes, approximately in the beginning of the 1960's. This paper analyses the trajectory of public health and hygiene courses in Rio de Janeiro, since the era of well-known physicians who were also entrepreneurs — such as Carlos Chagas, Afrânio Peixoto, João de Barros Barreto and José Paranhos Fontenelle —, still in the first quarter of century XX. These names were closely bound to the first courses of Professional graduation in public health area, in the Republic's Capital and in all Brazilian Territory