UNIVERSALIDADE DO ATENDIMENTO À SAÚDE NO BRASIL: impasses e perspectivas

O artigo discute sobre o acesso universal e o seu impedimento no âmbito do sistema de saúde brasileiro. Considera que o SUS tem sido atingido por ações administrativas comprometidas com a gestão capitalista, o que inviabiliza sua plena implementação. Destaca que o acesso universal enfrenta problemas como a dicotomia entre as ações curativas e as ações preventivas, e que as alterações na Lei Orgânica da Saúde e na Constituição de 1988, para introdução do capital estrangeiro, promovem atrasos que fazem com que o sistema seja derrotado, inclusive em seu sentido simbólico. Mostra que o aumento da participação da iniciativa privada na saúde, além de retardar todo processo de construção plena do SUS, traz ainda consequências políticas, pois as empresas de saúde são financiadoras de campanhas eleitorais. O Estado prioriza o repasse de dinheiro público para o setor privado. Conclui que os gastos públicos com a saúde, representados no PIB, não chegam à metade dos gastos totais em saúde. Mesmo assim, os recursos são gastos somente com a parcela mais pobre da população.Palavras-chave: Sistema Único de Saúde (Brasil), Financiamento da Assistência à Saúde, Acesso Universal aos Serviços de Saúde.HEALTH SERVICES ACCESSIBILITY IN BRAZIL: impasses and perspectives Abstract: The article discusses on the universal access to the Brazilian health system and its impediment. The Unified Health System (Sistema Único de Saúde; SUS) has been administrated by actions committed to capitalist management which impedes its full implementation. The universal access face problems as the dichotomy between the curative and preventive actions. The changes in the Health Law and in the Constitution (1988), for the introduction of the foreign capital, promote delays that cause failure in the system and leads to a defeated in the hearts and minds of the Brazilians. The increase in the private sector participation brings political consequences to the health system, because healthcare companies finance election campaigns. The state prioritizes the transfer of public money to the private sector. It concludes that public spending with health represented in the Gross National Product (Produto Interno Bruto, PIB) do not reach half of the total spending on health. Nevertheless, resources are expended only with the poorest part of the population. Key words: Unified Health System, Health care Financing, Universal access to Health Care services

Diverticulite aguda: aspectos fisiopatológicos, métodos diagnósticos e condutas terapêuticas

A Diverticulite Aguda (DA) é uma patologia causada pela inflamação das articulações formadas através de pontos frágeis na parede do intestino. Quanto à epidemiologia, a diverticulose afeta cerca de 40% dos pacientes acima dos 60 anos e, aproximadamente 20% destes, apresentarão DA. Sua prevalência é maior em pessoas com fatores de risco, como sedentarismo, obesidade, má alimentação e história familiar positiva para a diverticulite. Quanto às manifestações clínicas, a doença apresenta dor abdominal como principal sintoma, mas também pode estar associada a febre, náuseas, vômitos e mudanças no hábito intestinal, como diarréia ou constipação. Sua identificação depende de uma anamnese minuciosa, um exame físico bem detalhado e exames complementares. No que tange ao diagnóstico clínico, sensibilidade e defesa abdominal à palpação, em quadrante inferior esquerdo, associada ou não a alterações dos hábitos intestinais, são essenciais para identificação da patologia. Para diagnóstico definitivo, lança-se mão da Ultrassonografia (US), Ressonância Nuclear Magnética (RNM) e Tomografia Computadorizada (TC), fornecendo detalhes com maior acurácia para, juntamente com os dados clínicos, obter o diagnóstico. Acerca da abordagem terapêutica, apresenta-se através do manejo farmacológico e cirúrgico. Na abordagem farmacológica, lança-se mão da dieta conforme tolerada, hidratação, analgesia e antibioticoterapia. A abordagem cirúrgica utiliza a técnica Hartmann ou reconstrução com anastomose primária com desvio proximal (APDP). Lavagem Laparoscópica (LL) e Drenagem percutânea são alternativas utilizadas para a abordagem da DA

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others

Trabalhadores estatutários e a Empresa Brasileira de Serviços Hospitalares

Percepção dos trabalhadores estatutários sobre a implantação da EBSERH no HUCAMPerceptions of statutarian workers about the EBSERH’s implementation in HUCAMRESUMO A nova abordagem da gestão pública traz consequências ruins para os trabalhadores. A pesquisa teve por objetivo analisar o impacto da implantação da Empresa Brasileira de Serviços Hospitalares – EBSERH - na saúde dos trabalhadores contratados pelo Regime Jurídico Único – RJU - do Hospital Universitário Cassiano Antônio de Morais – HUCAM. O método qualitativo incluiu: entrevistas com trabalhadores e gestores, utilizando um instrumento semiestruturado; dados institucionais de atendimentos psicológicos e absenteísmo. Emergiram as categorias: Consolidação da EBSERH: Implantação, Principais Mudanças e Processo de (Des) integração; Trabalho: Processo de Trabalho, Metas Pactuadas com o SUS e Conflitos; Adoecimento no Trabalho: Insegurança, Desrespeito, Falta de Reconhecimento e Exclusão. Os trabalhadores desenvolveram diferentes estratégias de resistência: do embate, contestar, ao silêncio, só observar. Eles não conseguiram desenvolver uma resistência coletiva às imposições, o que gerou conflitos entre os trabalhadores contratados pela EBSERH e os do RJU, transformando o local de trabalho em um lugar adoecedor.   ABSTRACT The new public management approach brings bad consequences for the workers. The main objective of the research was to analyze the impact of the Empresa Brasileira de Serviços Hospitalares – EBSERH – implementation, on the labour health of workers hired with “Regime Jurídico Único”,  from Hospital Universitário Cassiano Antônio de Morais.   The qualitative method included interviews of workers and managers with a semi-structured instrument, psychological counselling data and absenteeism data. The categories raised was: EBSERH’s Consolidation: Implementation, Main Changes, and the (Des)Integration Process; Work: Work Process, Goals contracted with the SUS, Conflict; Work Ilness: Insecure, Disrespect, Lack of Recognizing and Exclusion. The workers developed different resistances:  conflict, like contesting, silence, like only observing.  They didn’t develop a collective resistance against the requirements, and conflicts between EBSERH workers against RJU workers took place, changing the work space in a place of sickness. 

Trabalhadores estatutários e a Empresa Brasileira de Serviços Hospitalares

Percepção dos trabalhadores estatutários sobre a implantação da EBSERH no HUCAMPerceptions of statutarian workers about the EBSERH’s implementation in HUCAMRESUMO A nova abordagem da gestão pública traz consequências ruins para os trabalhadores. A pesquisa teve por objetivo analisar o impacto da implantação da Empresa Brasileira de Serviços Hospitalares – EBSERH - na saúde dos trabalhadores contratados pelo Regime Jurídico Único – RJU - do Hospital Universitário Cassiano Antônio de Morais – HUCAM. O método qualitativo incluiu: entrevistas com trabalhadores e gestores, utilizando um instrumento semiestruturado; dados institucionais de atendimentos psicológicos e absenteísmo. Emergiram as categorias: Consolidação da EBSERH: Implantação, Principais Mudanças e Processo de (Des) integração; Trabalho: Processo de Trabalho, Metas Pactuadas com o SUS e Conflitos; Adoecimento no Trabalho: Insegurança, Desrespeito, Falta de Reconhecimento e Exclusão. Os trabalhadores desenvolveram diferentes estratégias de resistência: do embate, contestar, ao silêncio, só observar. Eles não conseguiram desenvolver uma resistência coletiva às imposições, o que gerou conflitos entre os trabalhadores contratados pela EBSERH e os do RJU, transformando o local de trabalho em um lugar adoecedor.   ABSTRACT The new public management approach brings bad consequences for the workers. The main objective of the research was to analyze the impact of the Empresa Brasileira de Serviços Hospitalares – EBSERH – implementation, on the labour health of workers hired with “Regime Jurídico Único”,  from Hospital Universitário Cassiano Antônio de Morais.   The qualitative method included interviews of workers and managers with a semi-structured instrument, psychological counselling data and absenteeism data. The categories raised was: EBSERH’s Consolidation: Implementation, Main Changes, and the (Des)Integration Process; Work: Work Process, Goals contracted with the SUS, Conflict; Work Ilness: Insecure, Disrespect, Lack of Recognizing and Exclusion. The workers developed different resistances:  conflict, like contesting, silence, like only observing.  They didn’t develop a collective resistance against the requirements, and conflicts between EBSERH workers against RJU workers took place, changing the work space in a place of sickness. 

Resumos concluídos - Saúde Coletiva

Resumos concluídos - Saúde Coletiv

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt