The medicine selection process in four large university hospitals in Brazil: Does the DTC have a role?

Knowledge about evidence-based medicine selection and the role of the Drug and Therapeutics Committee (DTC) is an important topic in the literature but is scarcely discussed in Brazil. Our objective, using a qualitative design, was to analyze the medicine selection process performed in four large university hospitals in the state of Rio de Janeiro. Information was collected from documents, interviews with key informants and direct observations. Two dimensions were analyzed: the structural and organizational aspects of the selection process and the criteria and methods used in medicine selection. The findings showed that the DTC was active in two hospitals. The structure for decision-making was weak. DTC members had little experience in evidence-based selection, and their everyday functions did not influence their participation in DTC activities. The methods used to evaluate evidence were inadequate. The uncritical adoption of new medicines in these complex hospital facilities may be hampering pharmaceutical services, with consequences for the entire health system. Although the qualitative approach considerably limits the extent to which the results can be extrapolated, we believe that our findings may be relevant to other university hospitals in the country

Reactions of azovinylphosphonates with nucleophilic alkenes and heterocycles: synthesis of Tetrahydropyridazine-3-phosphonate and 2-Substituted-1-hydrazonoethylphosphonate derivatives

Transient azovinylphosphonates, generated in situ by base induced dehydrohalogenation of the corresponding 2-bromo- and 2-chloro-acetylphosphonate- tertbutoxycarbonyl hydrazones are intercepted by electron rich alkenes and heterocycles in hetero Diels-Alder reactions, producing tetrahydopyridazine-3-phosphonates or open chain α-hydrazono phosphonates

A transformação do sofrimento em adoecimento: do nascimento da clínica à psicodinâmica do trabalho The transformation process of suffering into illness: from the birth of the clinic to the psychodynamic work

Tem-se como pressuposto que o processo de transformação do sofrimento em adoecimento, na gestão do trabalho, está relacionado não apenas com a produção e reprodução de discursos originários da medicina científica, mas também com um conjunto de práticas sustentadas, na atualidade, pela medicina ocupacional. Partindo da diferenciação conceitual entre sofrimento, dor e adoecimento, buscou-se na literatura e em entrevistas com trabalhadores e gestores elementos para demonstrar a existência deste processo. Constatou-se uma tentativa de silenciamento do sofrimento e uma cultura da promoção do adoecimento no espaço da empresa, envolvendo trabalhadores, profissionais da saúde e os gestores com a cumplicidade de famílias de trabalhadores identificados como pacientes. No entanto, alguns casos oferecem resistência ao processo, constituindo um verdadeiro movimento do contra-adoecimento. Conclui-se que, nesses dois séculos de "medicina científica", embora houvesse desejo de mudança, renovação das práticas e investimentos das mais diversas ordens, atos iatrogênicos e violências foram e são cometidos ainda em nome da ciência, da saúde e do bem-estar dos trabalhadores<br>Starting from the conceptual differentiation of suffering, pain and illness, we tried to find, through previous literary works and interviews with workers and managers, elements to demonstrate the existence of a transformation process that turns suffering into illness in the work management area. This process is not only related with the production and reproduction of discourses originally from the scientific medicine, but also with a set of practices supported, in the present time, by the occupational medicine. The evidences of our research point to the attempt of silencing this suffering and to the existence of an illness promotion culture in the company space. This situation involves workers, health professionals, and managers with the complicity of the families whose workers are identified as patients. However, some cases have shown resistance to this process, which constitutes a real counter-illness movement. After these elements we came to the conclusion that, during these two centuries of scientific medicine, despite the desire of changing and renewing practices and investments, iatrogenic acts and violence still have been done in the name of science, of health, and of workers well-being

Risco e saúde reprodutiva: a percepção dos homens de camadas populares Reproductive health and risk as perceived by low-income Brazilian men

Os estudos desenvolvidos na saúde reprodutiva discutem, entre outras coisas, as lacunas existentes nos modelos tradicionais de pesquisa, os quais negligenciam aspectos sócio-culturais e também ético-filosóficos. Estes aspectos atravessam a definição de temas essenciais à pesquisa em saúde reprodutiva, tais como: sexualidade, reprodução e gênero. A busca da articulação entre as duas disciplinas (Ciências Sociais e Saúde Pública) ajuda a pensar como as pessoas e os grupos sociais delimitam e percebem os riscos que enfrentam. Neste estudo, analisamos a percepção de risco em saúde reprodutiva de um grupo de homens de camadas populares do Rio de Janeiro, entrevistados no âmbito de uma pesquisa sobre contracepção. Visamos identificar as situações e os contextos em que o problema emerge e o conteúdo atribuído ao mesmo. A partir desses depoimentos, é possível concluir que existe uma hierarquia de riscos entre os entrevistados, a qual é modificada dependendo de valores culturais, contextos relacionais, institucionais e sociais.<br>Studies in the field of reproductive health discuss existing gaps in traditional research models, which neglect not only social and cultural aspects but also ethical and philosophical ones. Such aspects cut cross over the definition of essential themes for reproductive health research, like sexuality, reproduction, and gender. The search for connections between the two disciplines (Social Science and Public Health) relates to how people and social groups limit and deal with the risks they face. In this study, we analyze the perception of risk in reproductive health among a group of low-income men from Rio de Janeiro. The group was interviewed during a study on male contraception. The objective was to identify the situations and contexts from which the problem (and the contents ascribed to it) emerge. One can conclude from the interviews that there is a risk hierarchy which is modified according to cultural values and relational, institutional, and social contexts