The process of building up regional health management in the State of São Paulo: subsidies for analysis

Este artigo apresenta os resultados gerais da pesquisa sobre o processo de construção da gestão regional no estado de São Paulo, durante a discussão do COAP/redes de atenção, com o intuito de fornecer subsídios para a compreensão deste processo de pactuação regional da saúde, com enfoque nas regiões de saúde de Bauru, Baixada Santista, Grande ABC e Vale do Ribeira, no estado de São Paulo. Além dos resultados apresentados sobre as regiões de saúde estudadas, a metodologia utilizada no desenvolvimento da construção dos perfis das regiões constitui em si uma proposta metodológica de análise de perfis regionais de saúde. A primeira parte do artigo apresenta a metodologia geral adotada para a análise das regiões de saúde; a segunda, abrange os resultados e a discussão da pesquisa, organizados em dois itens. O primeiro destes itens refere-se à análise dos perfis das cinco regiões de saúde pesquisadas no Estado. O segundo, analisa os principais aspectos do processo de pactuação regional da saúde em São Paulo, destacando potencialidades e limites, a partir de entrevistas realizadas com gestores municipais e apoiadores do Conselho de Secretários Municipais de Saúde de São Paulo dessas regiões.This article presents the main results of the survey on the regional management building process in the State of São Paulo, during the discussion of the COAP / Care Networks, in order to provide a basis for understanding this process of regional health pact, focusing on the metropolitan areas of Bauru, Santos, Grande ABC and the Ribeira Valley. In addition to the results presented on the health regions studied, the methodology used in the development of the construction of profiles of the regions is itself a proposal for a methodology of analyzing regional health profiles. The first section presents the general methodology for analyzing health regions. The second part covers the results and discussion of the research, organized into two items. The first refers to the analysis of the profiles of the five São Paulo health regions surveyed. The second item analyzes the main aspects of the process of regional health pact in São Paulo, highlighting strengths and limitations, based on interviews with municipal managers and supporters of the Council of Municipal Health Secretaries of São Paulo in these regions

Hypothalamic inflammation is reversed by endurance training in anorectic-cachectic rats

<p>Abstract</p> <p>Aim</p> <p>We tested the effects of a cancer cachexia-anorexia sydrome upon the balance of anti and pro-inflammatory cytokines in the hypothalamus of sedentary or trained tumour-bearing (Walker-256 carcinosarcoma) rats.</p> <p>Methods</p> <p>Animals were randomly assigned to a sedentary control (SC), sedentary tumour-bearing (ST), and sedentary pair-fed (SPF) groups or, exercised control (EC), exercised tumour-bearing (ET) and exercised pair-fed (EPF) groups. Trained rats ran on a treadmill (60%VO_2max) for 60 min/d, 5 days/wk, for 8 wks. We evaluated food intake, leptin and cytokine (TNF-α, IL1β) levels in the hypothalamus.</p> <p>Results</p> <p>The cumulative food intake and serum leptin concentration were reduced in ST compared to SC. Leptin gene expression in the retroperitoneal adipose tissue (RPAT) was increased in SPF in comparison with SC and ST, and in the mesenteric adipose tissue (MEAT) the same parameter was decreased in ST in relation to SC. Leptin levels in RPAT and MEAT were decreased in ST, when compared with SC. Exercise training was also able to reduce tumour weight when compared to ST group. In the hypothalamus, IL-1β and IL-10 gene expression was higher in ST than in SC and SPF. Cytokine concentration in hypothalamus was higher in ST (TNF-α and IL-1β, p < 0.05), compared with SC and SPF. These pro-inflammatory cytokines concentrations were restored to control values (p < 0.05), when the animals were submitted to endurance training.</p> <p>Conclusion</p> <p>Cancer-induced anorexia leads towards a pro-inflammatory state in the hypothalamus, which is prevented by endurance training which induces an anti-inflammatory state, with concomitant decrease of tumour weight.</p