Evolução na utilização e nos gastos de uma operadora de saúde

Brazil’s aging population and the rising number of people reliant upon the country’s supplementary healthcare system have elicited the concern of public and private managers regarding the increase in healthcare costs. In this paper, the costs per gender, per type of medical expenses and per age group of a major Brazilian self-managed healthcare provider between 2007 and 2013 were analyzed. This healthcare provider is of interest because, besides portraying a single condition of revenue growth restricted to the existing contributors, it also replicates the demographic profile expected for Brazil in 2050, when approximately one-third of its population will be over 60 years of age. The analyses confirm the current literature as they show an increase in healthcare plan usage by the elderly and the difference between admission rates by gender. They also reveal an increase in average length of stay in hospital and the increase in medical costs far above inflation, especially for materials and medicines. It is hoped that this study will help scholars and others interested in comparisons of medical expense trends, especially by age and sex, and that it encourages further collaboration on the sustainability of health insurance providers in Brazil

AUTOIMAGEM DA MULHER MASTECTOMIZADA: IMPACTOS E REPERCUSSÕES ADVINDOS DO CÂNCER DE MAMA

Introduction: Self-image is defined as the way an individual perceives and feels about their own body. In addition, it is related to the concepts of ‘image’ and ‘body’, whose interpretation goes beyond language and encompasses a broader dimension by taking into account the uniqueness of each being. Objective: To promote reflection on the proposed theme. Methodology: This is a descriptive bibliographic review with a qualitative approach, analyzing scientific literature that refers us to the research object. The bibliographic research is based on already published material with the aim of analyzing different positions on a given subject. Analysis and discussion of results: The Enimar de Paula1; recommended care for mastectomized women are: avoiding sun exposure; not pressing on the side of the operated limb; being careful not to suffer burns, scratches and cuts; not receiving injections, vaccines or blood extraction on the upper limb homolateral to surgery; avoiding cuticle removal; not carrying weight; exercising upper limbs; among others. Conclusion: The nurse also has the duty to follow up on health education activities, which aim to provide information related to necessary care after mastectomy, which assists women in the recovery process.Introdução: A autoimagem é definida como a maneira pela qual um indivíduo se percebe e se sente em relação ao seu próprio corpo. Além disso, está relacionada aos conceitos de ‘imagem’ e ‘corpo’, cuja interpretação vai além da linguagem e abrange uma dimensão mais ampla ao levar em conta a singularidade de cada ser Objetivo: Promover flexão acerca da temática proposta Metodologia: Trata-se de uma revisão bibliográfica de caráter descritivo e abordagem qualitativa, com análise de literaturas científicas que nos remetam ao objeto de pesquisa. A pesquisa bibliográfica é elaborada com base em material já publicado com o objetivo de analisar posições diversas em relação a determinado assunto Análise e discussão dos resultados: A importância de se adotarem as medidas diárias para a diminuição da probabilidade de complicações pós-operatórias. Dentre os cuidados recomendados às mulheres mastectomizadas, estão: evitar a exposição ao sol; não pressionar o lado do membro operado; ter cuidado para não sofrer queimaduras, arranhões e cortes; não receber injeções, vacinas ou extrair sangue no membro superior homolateral à cirurgia; evitar remover cutícula; não carregar peso; exercitar os membros superiores; entre outros Conclusão: O enfermeiro também tem o dever de acompanhar as atividades educativas em saúde, que objetivam fornecer informações relacionadas aos cuidados necessários após a mastectomia, que auxiliam a mulher no processo de recuperação

Omega-9 Oleic Acid, the Main Compound of Olive Oil, Mitigates Inflammation during Experimental Sepsis

The Mediterranean diet, rich in olive oil, is beneficial, reducing the risk of cardiovascular diseases and cancer. Olive oil is mostly composed of the monounsaturated fatty acid omega-9. We showed omega-9 protects septic mice modulating lipid metabolism. Sepsis is initiated by the host response to infection with organ damage, increased plasma free fatty acids, high levels of cortisol, massive cytokine production, leukocyte activation, and endothelial dysfunction. We aimed to analyze the effect of omega-9 supplementation on corticosteroid unbalance, inflammation, bacterial elimination, and peroxisome proliferator-activated receptor (PPAR) gamma expression, an omega-9 receptor and inflammatory modulator. We treated mice for 14 days with omega-9 and induced sepsis by cecal ligation and puncture (CLP). We measured systemic corticosterone levels, cytokine production, leukocyte and bacterial counts in the peritoneum, and the expression of PPAR gamma in both liver and adipose tissues during experimental sepsis. We further studied omega-9 effects on leukocyte rolling in mouse cremaster muscle-inflamed postcapillary venules and in the cerebral microcirculation of septic mice. Here, we demonstrate that omega-9 treatment is associated with increased levels of the anti-inflammatory cytokine IL-10 and decreased levels of the proinflammatory cytokines TNF-alpha and IL-1 beta in peritoneal lavage fluid of mice with sepsis. Omega-9 treatment also decreased systemic corticosterone levels. Neutrophil migration from circulation to the peritoneal cavity and leukocyte rolling on the endothelium were decreased by omega-9 treatment. Omega-9 also decreased bacterial load in the peritoneal lavage and restored liver and adipose tissue PPAR gamma expression in septic animals. Our data suggest a beneficial anti-inflammatory role of omega-9 in sepsis, mitigating leukocyte rolling and leukocyte influx, balancing cytokine production, and controlling bacterial growth possibly through a PPAR gamma expression-dependent mechanism. The significant reduction of inflammation detected after omega-9 enteral injection can further contribute to the already known beneficial properties facilitated by unsaturated fatty acid-enriched diets

INTERFACE, CONTRIBUIÇÕES E REPERCUSSÕES DAS DOENÇAS CRÔNICAS NÃO TRANSMISSÍVEIS PARA O PROCESSO SAÚDE-DOENÇA ONCOLÓGICO

Introduction: Chronic noncommunicable diseases (NCDs) and cancer are public health problems with an increasing incidence worldwide. Although they are distinct entities, there are several interfaces between NCDs and cancer, especially when it comes to modifiable and non-modifiable factors that contribute to the development of these diseases. In this scientific article, we explore the relationship between NCDs and cancer from an oncology perspective, analyzing the risk factors and underlying mechanisms that connect these conditions. In addition, we highlight the importance of early identification and intervention of these factors for the prevention and effective management of these diseases. Methodology: This is a descriptive bibliographical review with a qualitative approach, with analysis of scientific literature that refer us to the research object. Research is a systematic, controlled and critical reflective procedure that allows discovering new facts or data, relationships or laws, in any field of knowledge. Analysis and discussion of results: The purpose of this discussion is to analyze modifiable and non-modifiable factors from the perspective of oncology, specifically in the context of chronic noncommunicable diseases (NCDs). Understanding these factors is essential for developing effective cancer prevention, early detection, and management strategies. Conclusion: the interface of NCDs and modifiable and non-modifiable factors from the perspective of oncology are extremely important in the prevention, diagnosis and treatment of cancer. Continued advances in research, education, and health policy are needed to address this global challenge and improve outcomes for patients with cancer and NCDs.Introdução: As doenças crônicas não transmissíveis (DCNTs) e o câncer são problemas de saúde pública com uma crescente incidência em todo o mundo. Embora sejam entidades distintas, existem diversas interfaces entre as DCNTs e o câncer, principalmente quando se trata dos fatores modificáveis e não modificáveis que contribuem para o desenvolvimento dessas doenças. Neste artigo científico, exploramos a relação entre as DCNTs e o câncer na perspectiva da oncologia, analisando os fatores de risco e os mecanismos subjacentes que conectam essas condições. Além disso, destacamos a importância da identificação e intervenção precoce desses fatores para a prevenção e o manejo eficaz dessas doenças. Metodologia: Trata-se de uma revisão bibliográfica de caráter descritivo e abordagem qualitativa, com análise de literaturas científicas que nos remetam ao objeto de pesquisa. A pesquisa é um procedimento reflexivo sistemático, controlado e crítico, que permite descobrir novos fatos ou dados, relações ou leis, em qualquer campo do conhecimento. Analise e discussão dos resultados: O objetivo desta discussão é analisar os fatores modificáveis e não modificáveis na perspectiva da oncologia, especificamente no contexto das doenças crônicas não transmissíveis (DCNTs). Compreender esses fatores é essencial para desenvolver estratégias efetivas de prevenção, detecção precoce e manejo do câncer. Conclusão: a interface das DCNTs e os fatores modificáveis e não modificáveis na perspectiva da oncologia são de extrema importância na prevenção, diagnóstico e tratamento do câncer. Avanços contínuos na pesquisa, educação e políticas de saúde são necessários para enfrentar esse desafio global e melhorar os resultados para os pacientes com câncer e DCNTs

RECOMENDAÇÕES FRENTE AO CÂNCER DE COLO DE ÚTERO E DE MAMA: a educação em saúde como estratégia de prevenção para a saúde da mulher

  Introduction: Among women worldwide, cervical and breast cancer are among the most prevalent types of cancer. Both cancers have a direct relationship with women's health and are preventable provided preventive measures are taken regularly. Objective: The general objective is to discuss the importance of awareness and care for women's health in the prevention of cervical and breast cancer. Methodology: This is a descriptive and qualitative bibliographic review with an analysis of scientific literature related to the research object. Analysis and discussion of results: Population awareness and health education are essential measures for preventing cervical and breast cancer. Awareness campaigns can contribute to the dissemination of information and reduce the incidence of these types of cancer. It is essential to be aware of the risk factors related to cervical and breast cancer to detect these diseases in early stages. By knowing the signs and symptoms of these neoplasms, women can seek medical help earlier, increasing the chances of cure and reducing mortality. Conclusion: Prevention plays a crucial role in reducing the incidence of cervical and breast cancer. Regular preventive examinations, vaccination, adoption of healthy lifestyles, and health education are some of the main preventive measures for these types of cancer.Introdução: Entre as mulheres em todo o mundo, o câncer de colo de útero e de mama estão entre os tipos de câncer mais prevalentes. Ambos os cânceres têm uma relação direta com a saúde feminina e são passíveis de prevenção, desde que medidas preventivas sejam tomadas de forma regular. Objetivo: tem como objetivo geral discutir a importância da conscientização e do cuidado com a saúde feminina na prevenção do câncer de colo de útero e de mama. Metodologia: Trata-se de uma revisão bibliográfica de caráter descritivo e abordagem qualitativa, com análise de literaturas científicas que nos remetam ao objeto de pesquisa. Analise e discussão dos resultados: A conscientização da população e a educação em saúde são medidas essenciais para a prevenção do câncer de colo de útero e mama. Campanhas de conscientização podem contribuir para a disseminação de informações e para a redução da incidência desses tipos de câncer. É fundamental estar ciente dos fatores de risco relacionados ao câncer de colo de útero e de mama para detectar essas doenças em estágios iniciais. Ao conhecer os sinais e sintomas dessas neoplasias, as mulheres podem procurar ajuda médica mais cedo, aumentando as chances de cura e reduzindo a mortalidade Conclusão: A prevenção desempenha um papel crucial na diminuição da ocorrência de câncer de colo de útero e mama. A realização regular de exames preventivos, a vacinação, a adoção de hábitos de vida saudáveis e a educação em saúde são algumas das principais medidas preventivas para esses tipos de câncer

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ