Tropical Fruit Pulps: Processing, Product Standardization and Main Control Parameters for Quality Assurance

ABSTRACT Fruit pulp is the most basic food product obtained from fresh fruit processing. Fruit pulps can be cold stored for long periods of time, but they also can be used to fabricate juices, ice creams, sweets, jellies and yogurts. The exploitation of tropical fruits has leveraged the entire Brazilian fruit pulp sector due mainly to the high acceptance of their organoleptic properties and remarkable nutritional facts. However, several works published in the last decades have pointed out unfavorable conditions regarding the consumption of tropical fruit pulps. This negative scenario has been associated with unsatisfactory physico-chemical and microbiological parameters of fruits pulps as outcomes of little knowledge and improper management within the fruit pulp industry. There are protocols for delineating specific identity and quality standards (IQSs) and standardized good manufacturing practices (GMP) for fruit pulps, which also embrace standard operating procedures (SOPs) and hazard analysis and critical control points (HACCP), although this latter is not considered mandatory by the Brazilian legislation. Unfortunately, the lack of skilled labor, along with failures in complying established protocols have impaired quality of fruit pulps. It has been necessary to collect all information available with the aim to identify the most important hazards within fruit pulp processing lines. Standardizing methods and practices within the Brazilian fruit pulp industry would assurance high quality status to tropical fruit pulps and the commercial growth of this vegetal product towards international markets

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

A saúde na escola: um breve resgate histórico Health at school: a brief history

Discute o nascimento histórico da saúde escolar no mundo e no Brasil. Apresenta a Iniciativa Regional Escolas Promotoras de Saúde - um discurso de múltiplos olhares e trabalho articulado entre a educação, saúde e sociedade -, como modelo alternativo de atenção à saúde na escola recomendado, pela Organização Pan-Americana de Saúde, para os países do Caribe e da América Latina. Considera que o olhar atento aos Parâmetros Curriculares Nacionais é condição fundamental para que os profissionais de saúde sensíveis à questão da educação em saúde na escola contribuam para que a mesma compareça na educação fundamental com um enfoque crítico, interdisciplinar e transversal e, finalmente, apresenta as diretrizes da nova política nacional de saúde na escola pública.<br>It involves the historical birth of school health in the world and Brazil. It shows a regional initiative of Health Promoting Schools - a discourse of multiple viewings and joint work among education, health and society -, as an alternative model of attention to school health, recommended by Pan American Health Organization, to the Caribbean and Latin American Countries. Finally, it takes into account that a detailed observation of the National Curriculum Parameters is an essential condition so that health professionals, who are sensitive to the school health education issue, can contribute to its inclusion in the fundamental education with a critical, interdisciplinary and transversal approach, presenting the guidelines of a new national health polices at public schools