AVALIAÇÃO DOS SERVIÇOS DE SAÚDE NA ÓTICA DOS USUÁRIOS

A avaliação é uma importante ferramenta da atenção básica, devendo subsidiar a organização e orientação dos serviços de saúde, a partir de lógicas mais centradas no usuário. Esteartigo tem por objetivo apresentar a ótica dos usuários sobre os serviços de saúde inseridos no território de um núcleo de apoio à saúde da família. Os dados provêm de um estudo quantitativo-descritivo desenvolvido com 1023 famílias, cadastradas pela Estratégia Saúde da Família. Os resultados revelaram que 89,3% das famílias utilizam serviços do centro de saúde, tendo como principal motivo a busca por assistência em situação de doença ou dor (76,3%). Já no que tange a resolutividade, somente 9,1% relataram que quase nunca têm seu problema resolvido e 51,1% consideram bom o atendimento no centro de saúde. O artigo destaca, ainda, a satisfação do usuário como dimensão relevante na avaliação da atenção à saúde para o aprimoramento dos serviçose das políticas públicas em saúde.Palavras-chave: Avaliação de Serviços de Saúde; Atenção Primária à Saúde; Satisfação do PacienteEVALUATION OF HEALTH SERVICES IN THE USERS’ VIEWAbstract: The evaluation is an important tool of the primary care that should subsidize the organization and orientation of health services, from logics more centered in the user. This article aims to present the users’ perspective about health services included in the territory of a core of support for family health. The data comes from a quantitative-descriptive study developed with 1023 families registered by the Family Health Strategy. The results revealed that 89,3% of families use services from the health center, having as it’s main reason the searching for assistance in situations of illness or pain (76,3%). Regarding the resolution, only 9,1% reported that they almost never have their problem solved and 51,1% considered good the care at the health center. The article still highlights the user satisfaction as a relevant dimension in the evaluation of health care for the improvement of services and public health policies.Keywords: Evaluation of Health Services, Primary Attention to Health, Patient Satisfact

A influência do conhecimento do paciente sobre o AVC no Brasil: um estudo transversal

Little is known about stroke patients’ awareness about the warning signs of stroke and its therapeutic time window in Brazil.Method We interviewed consecutive patients with acute stroke admitted to a terciary public hospital in Brazil. Data collected included demographics, mode of arrival, National Institutes of Health Stroke Scale (NIHSS) scores and knowledge of stroke warning signs and therapeutic time window. Early arrival was defined as within 4.5 hours of symptoms onset. Results Although 66.2% of patients knew the warning signs of stroke, only 7.8% reported to know that stroke had a limited therapeutic time window. Stroke severity measured by the NIHSS was independently associated with early arrival, but not knowledge of stroke signs and symptoms. Conclusion Knowledge about stroke symptoms was not a predictor of early arrival.Pouco se sabe sobre o conhecimento dos pacientes com acidente vascular cerebral (AVC) acerca dos sinais de alarme da doença e sua janela terapêutica no Brasil.Método Foram entrevistados consecutivamente os pacientes com AVC agudo internados em um hospital público terciário no Brasil. Os dados coletados incluíram dados demográficos, o modo de chegada, escala de AVC do National Institute of Health (NIH) e conhecimento sobre a janela de tempo terapêutica e os sinais de alerta do AVC através de um questionário padronizado. Chegada precoce foi definida como aquela dentro de 4,5 horas do início dos sintomas. Resultados Embora 66,2% dos pacientes sabiam os sinais de alerta do AVC , apenas 7,8% relataram saber que a doença tinha uma janela de tempo terapêutica limitada. A gravidade do AVC avaliada pela escala do NIH foi preditora de chegada precoce, mas conhecimento acerca dos sinais e sintomas do AVC não foram. Conclusão O conhecimento acerca dos sintomas do AVC não foi preditivo de chegada precoce ao hospital.Universidade Federal de São Paulo (UNIFESP) Departamento de Neurologia e NeurocirurgiaHospital Israelita Albert EinsteinUNIFESP, Depto. de Neurologia e NeurocirurgiaSciEL

Acute erythroid leukemia: autopsy report of a rare disease

Acute erythroid leukemia (AEL) is a rare subtype of acute myeloid leukemia(AML), characterized by predominant erythroid proliferation. The 2008 WorldHealth Organization (WHO) classification of AML defined two AEL subtypes:erythroleukaemia (EL), in which erythroid precursors account for 50% or moreof all nucleated bone marrow cells and myeloblasts account for 20% or more ofthe nonerythroid cell population; and pure erythroid leukemia (PEL), in whicherythroid precursors account for 80% or more of all nucleated bone marrowcells. We report the case of an elderly female patient with wasting syndromeand pancytopenia without evidence of blasts in peripheral blood. A diagnosisof PEL was established on the basis of bone marrow biopsy findings. Thepatient died on postadmission day 20, and an autopsy was performed. Wereclassified the disease as EL on the basis of the autopsy findings, whichincluded myeloblasts accounting for more than 20% of the nonerythroid cellsin the bone marrow, as well as leukemic infiltration and myeloid metaplasia insolid organs, such as the liver, spleen, kidneys, adrenal glands, and abdominallymph nodes. A rare disease, AEL accounts for less than 5% of all AMLs and ispractically a diagnosis of exclusion. Autopsy reports of AEL are extremely rarein the literature. We demonstrate that in the case reported here, leukemia cellstended to infiltrate solid organs with myeloid metaplasia. Our findings alsoshow that a larger neoplastic bone marrow sample is crucial to the correctdiagnosis of EL, which is based on morphological and quantitative criteria

Hemophagocytic lymphohistiocytosis of indeterminate cause: a fatal adult case

Hemophagocytic lymphohistiocytosis (HLH) is an uncommon life-threatening disorder characterized by wide spread non-neoplastic proliferation and inappropriate activation of mature macrophages resulting in hypercytokinemia.This uncontrollable and ineffective systemic immune response causes fever, hepatosplenomegaly, cytopenias and subsequently multiorgan failure. The authors report a case of a 41-year-old male patient with a 30-day history of weight loss, fever, icterus, hepatomegaly, and cytopenias. The diagnosticworkup disclosed hypertriglyceridemia, hypofibrinogenemia, and elevated ferritin. Bone marrow examination and clinical course raised the suspicion of HLH and treatment was started with high-dose corticosteroids and immune globulin. The patient underwent multi-organ failure and expired after 58 days ofhospitalization. The autopsy finding included massive bone marrow infiltration by non-neoplastic histiocytes, many of them showing hemophagocytosis, which immunohistochemical study revealed diffuse CD68-positive histiocytes, which were negative for S100 protein. Hemophagocytosis was also observedin the lungs, lymph nodes and liver. The immediate cause of death was attributed to a massive intestinal bleeding due to extensive ischemic necrosis at the duodenum/jejunal transition area.nul

The role of enteric hormone GLP-2 in the response of bone markers to a mixed meal in postmenopausal women with type 2 diabetes mellitus

Abstract\ud \ud Background\ud Type 2 diabetes mellitus (T2D) is a complex disease associated with several chronic complications, including bone fragility and high fracture risk due to mechanisms not yet fully understood. The influence of the gastrointestinal tract and its hormones on bone remodeling has been demonstrated in healthy individuals. Glucagon-like peptide 2 (GLP-2), an enteric hormone secreted in response to nutrient intake, has been implicated as a mediator of nutrient effects on bone remodeling. This study aimed to analyze the dynamics of bone resorption marker C-terminal telopeptide of type I collagen (CTX), bone formation marker osteocalcin, and GLP-2 in response to a mixed meal in diabetic postmenopausal women.\ud \ud \ud Methods\ud Forty-three postmenopausal women with osteopenia or osteoporosis (20 controls – group CO – and 23 diabetic – group T2D) were subjected to a standard mixed meal tolerance test, with determination of serum CTX, plasma osteocalcin and serum GLP-2 concentrations at baseline and 30, 60, 120 and 180 minutes after the meal.\ud \ud \ud Results\ud T2D women had higher body mass index as well as higher femoral neck and total hip bone mineral density. At baseline, luteinizing hormone, follicle-stimulating hormone, osteocalcin and CTX levels were lower in group T2D. In response to the mixed meal, CTX and osteocalcin levels decreased and GLP-2 levels increased in both groups. The expected CTX suppression in response to the mixed meal was lower in group T2D.\ud \ud \ud Conclusions\ud Bone turnover markers were significantly reduced in T2D women at baseline. Confirming the role of nutrient intake as a stimulating factor, GLP-2 increased in response to the mixed meal in both groups. Importantly, CTX variation in response to the mixed meal was reduced in T2D women, suggesting abnormal response of bone remodeling to nutrient intake in T2D.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de nível superior (CAPES

Effect of processing on nutritional value of the mandim fish (Arius spixii)

Com o objetivo de avaliar o efeito do beneficiamento sobre o valor nutricional do peixe mandim (Arius spixii) comercializado em Maceió-AL, determinaram-se nas suas formas in natura e beneficiada (salgado-seco) a composição centesimal, valor calórico, cloretos, perfil de ácidos graxos e colesterol, sendo também analisada a ocorrência de óxidos de colesterol. Os resultados obtidos para o mandim in natura e beneficiado, respectivamente, de umidade (70,13% e 40,31%), proteínas (51,73% e 38,07%, base seca), carboidratos (4,67% e 2,24%, base seca), calorias (486 kcal/100g e 367 kcal/100g, base seca), ácidos graxos (poliinsaturados 14,54% e 15,49%, ômega-3 8,51% e 6,51%), colesterol (82,66 mg/100g e 61,30 mg/100g) e óxidos (7-cetocolesterol 8,31 µg/g e 17,90 µg/g), permitiram concluir que o beneficiamento favoreceu alterações significativas no valor nutricional do mandim.In an attempt to analyze how processing enhances the nutritional value of the mandim fish (Arius spixii) marketed in Maceió-AL, Brazil, the following nutritional components were determined in fresh and processed (salted-dried) fish: centesimal composition, calorie count, chloride, fatty acid and cholesterol profile. The presence of cholesterol oxides was also investigated. Respective results for fresh and processed mandim fish were: moisture (70.13% and 40.31%), proteins (51.73% and 38.07%, dried), carbohyrdrates (4.67% and 2.24%, dried), calories (486 kcal/100g and 367 kcal/100g, dried), fatty acids (polyunsaturared 14,54% and 15,49%, ômega-3 8,51% and 6,51%), cholesterol (82.66 mg/100g and 61.30 mg/100g) and oxides (7-ketocholesterol 8.31 µg/g and 17.90 µg/g). These figures clearly showed that processing led to significant change in the nutritional value of the mandim fish

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio