A adesão terapêutica ao tratamento da tuberculose: estratégia biopolítica de promoção da saúde / Therapeutic adherence to the treatment of tuberculosis: biopolitical strategy for health promotion

Dentre os fatores relacionados à ocorrência dos casos de tuberculose, doença infectocontagiosa considerada como um problema de saúde pública, destacam-se as condições socioeconômicas da população que vive em situações de pobreza e vulnerabilidade. Tais situações influenciam negativamente a Adesão Terapêutica, o que traz como consequência a manutenção do atual cenário epidemiológico, no qual as altas taxas de incidência impedem o alcance do controle da doença. Para dar conta de tal cenário, são elaboradas recomendações, publicadas no formato de Manuais, que visam servir como ferramentas de apoio aos profissionais de saúde no atendimento da tuberculose. Esta dissertação, através da problematização do conceito de Adesão como um processo de negociação e colaboração, objetivou investigar de que forma as recomendações presentes nos Manuais se constituem em estratégias biopolíticas de Promoção da Saúde na lógica neoliberal. Trata-se de uma pesquisa documental de abordagem qualitativa, inspirada nas metodologias pós-críticas e no referencial teórico-metodológico de Michel Foucault. Foram analisados cinco Manuais publicados pelo Ministério da Saúde no período de 2002 a 2019. A análise das recomendações dos Manuais enquanto práticas discursivas foi realizada a partir da articulação de três eixos teóricos: os saberes, as relações de poder e a biopolítica. Os resultados apontam, em relação ao primeiro eixo analítico, para os sucessivos deslocamentos da capacitação de recursos humanos na área da saúde, da vigilância em saúde, da medicalização e da multifuncionalidade do enfermeiro no enfrentamento dos determinantes sociais da saúde para a superação da pobreza como saberes capazes da Adesão. No segundo eixo analítico, identifico relações de saber/poder que constituem uma forma de se realizar o cuidado à tuberculose, através da função e dever de determinadas categorias profissionais ­ em particular, da Enfermagem-, em articulação com poderes locais institucionais na sua microcapilaridade. Sinalizo que a normalização de uma forma adequada de controlar a tuberculose coloca em funcionamento disciplinas que são identificadas a partir de um micropoder sobre o corpo e sobre o modo de comportamento da pessoa em tratamento, nas quais a supervisão do enfermeiro no tratamento diretamente observado se destaca como importante dispositivo disciplinar de vigilância. Em relação ao último eixo analítico, foi possível identificar cinco estratégias biopolíticas de Promoção da Saúde: "fazer viver" determinadas vidas, a segurança da população saudável, a formação da "população vulnerável", a superação da pobreza como ordenadora do discurso de controle da tuberculose e a Adesão Terapêutica como empreendimento de si. Por fim, destaco que essa dissertação se configura como uma possibilidade de que outras verdades acerca da Adesão Terapêutica ao tratamento da tuberculose possam ser consideradas, além daquelas já naturalizadas pelos profissionais de saúde.

Among the factors related to the occurrence of cases of tuberculosis, an infectious disease considered as a public health problem, the socioeconomic conditions of the population that live in situations of poverty and vulnerability stand out. Such situations negatively influence Therapeutic Adherence, which leads to the maintenance of the current epidemiological scenario, in which high incidence rates prevent the control of the disease. To cope with this scenario, recommendations are made, published in the format of Manuals, which aim to serve as support tools for health professionals in the care of tuberculosis. This dissertation, through the problematization of the concept of Adherence as a process of negotiation and collaboration, aimed to investigate how the recommendations present in the Manuals constitute biopolitical strategies for Health Promotion in the neoliberal logic. It is a documentary research with a qualitative approach, inspired by post-critical methodologies and Michel Foucault's theoreticalmethodological framework. Five Manuals published by the Ministry of Health from 2002 to 2019 were analyzed. The analysis of the Manuals' recommendations as discursive practices was carried out based on the articulation of three theoretical axes: knowledge, power relations and biopolitics. The results point, in relation to the first analytical axis, to the successive shifts in the training of human resources in the area of health, health surveillance, medicalization and the multifunctionality of nurses in addressing the social determinants of health to overcome poverty as knowledge capable of Adhesion. In the second analytical axis, I identify knowledge/power relationships that constitute a way to carry out tuberculosis care, through the function and duty of certain professional categories - in particular, Nursing -, in conjunction with local institutional powers in their microcapillarity. I signal that the normalization of an adequate way to control tuberculosis puts into operation disciplines that are identified from a micropower on the body and on the behavior of the person being treated, in which the supervision of the nurse in the directly observed treatment stands out as an important disciplinary surveillance device. In relation to the last analytical axis, it was possible to identify six biopolitical strategies for Health Promotion: "making live" certain lives, the safety of the healthy population, the formation of the "vulnerable population", the overcoming of poverty as the organizer of the discourse of control of tuberculosis and Therapeutic Adherence as an enterprise of its own. Finally, I highlight that this dissertation is configured as a possibility that other truths about Therapeutic Adherence to the treatment of tuberculosis can be considered, in addition to those already naturalized by health professionals.

Implication of fast-track surgery in radical cystectomy / 国际外科学杂志

Fast-track surgery (FTS) protocols was introduced to reduce surgical stress and facilitate postoperative recovery.It has been more than 20 years since it had been proposed and it was successfully used in many special subjects such as orthopedic,upper gastrointestinal,gynecological,thoracic,vascular,endocrine et al,but the implication in radical cystectomy was insufficient.The propose of this article was to summarize the implication of FTS in radical cystectomy and to promote the development of the protocol in radical cystectomy.

Synopsis of Prescriptions of the Golden Chamber with Differentiation Treatment of Tumor / 浙江中医药大学学报

Objective] Summarizing the diagnosis and treatment about the tumor-related disease from “Synopsis of Prescriptions of the Golden Chamber”, thus to better use classic in clinic. [Method] Sort out the book that involves tumor-related diseases pathogenesis, therapeutic treatment and syndrome differentiation treatment, combine with each of the clinical words, analyze and summarize all the clinical experience of physicians. [Results]The book is not equipped with tumor article, many cancer-related clinical manifestations of the disease description can be seen in each chapter, although not forming a system, its pulse and symptoms are involved in different parts of the tumors. And the symptoms of lung cancer, stomach cancer, and gynecological tumors also have been mentioned.[Conclusion] Visible in the book, the etiology and pathogenesis of tumor related diseases have a certain understanding. In the aspect of treatment, pay attention to combining disease syndrome differentiation, treatment and syndrome differentiation. Then concluding all the physicians clinical experience we can see that “Synopsis of Prescriptions of the Golden Chamber”for the treatment of tumors has great significance. And classic of traditional Chinese medicine for modern TCM clinical still have important reference value and guiding significance.