Comparison of safety and effectiveness of micropulse transscleral cyclophotocoagulation and "slow cook" diode laser transscleral cyclophotocoagulation in patients with refractory open-angle glaucoma

ABSTRACT Purpose: This study aimed to compare the safety and effectiveness of intraocular pressure reduction between micropulse transscleral cyclophotocoagulation and "slow cook" transscleral cyclophotocoagulation in patients with refractory primary open-angle glaucoma. Methods: We included patients with primary open angle glaucoma with at least 12 months of follow-up. We collected and analyzed data on the preoperative characteristics and postoperative outcomes. The primary outcomes were a reduction of ≥20% of the baseline value (criterion A) and/or intraocular pressure between 6 and 21 mmHg (criterion B). Results: We included 128 eyes with primary open-angle glaucoma. The preoperative mean intraocular pressure was 25.53 ± 6.40 and 35.02 ± 12.57 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean intraocular pressure was reduced significantly to 14.33 ± 3.40 and 15.37 ± 5.85 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups at the last follow-up, respectively (p=0.110). The mean intraocular pressure reduction at 12 months was 11.20 ± 11.46 and 19.65 ± 13.22 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The median preoperative logMAR visual acuity was 0.52 ± 0.69 and 1.75 ± 1.04 in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean visual acuity variation was −0.10 ± 0.35 and −0.074 ± 0.16 in the micropulse- and "slow cook" transscleral cyclophotocoagulation, respectively (p=0.510). Preoperatively, the mean eye drops were 3.44 ± 1.38 and 2.89 ± 0.68 drugs in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p=0.017), but those were 2.06 ± 1.42 and 1.02 ± 1.46 at the end of the study in the "slow cook" and micropulse transscleral cyclophotocoagulation groups, respectively (p<0.001). The success of criterion A was not significant between both groups. Compared with 11 eyes (17.74%) in the "slow cook" transscleral cyclophotocoagulation group, 19 eyes (28.78%) in the micropulse transscleral cyclophotocoagulation group showed complete success (p=0.171). For criterion B, 28 (42.42%) and 2 eyes (3.22%) showed complete success after micropulse- and "slow cook" transscleral cyclophotocoagulation, respectively (p<0.001). Conclusion: Both techniques reduced intraocular pressure effectively.

Effect of hyperchloremia on mortality of pediatric trauma patients: a retrospective cohort study

ABSTRACT BACKGROUND: Hyperchloremia is often encountered due to the frequent administration of intravenous fluids in critically ill patients with conditions such as shock or hypotension in the pediatric intensive care unit, and high serum levels of chloride are associated with poor clinical outcomes. OBJECTIVES: This study aimed to determine the association between hyperchloremia and in-hospital mortality in pediatric patients with major trauma. DESIGN AND SETTING: This retrospective cohort study was conducted at a tertiary university hospital in Turkey. METHODS: Data were collected between March 2020 and April 2022. Patients aged 1 month to 18 years with major trauma who received intravenous fluids with a concentration > 0.9% sodium chloride were enrolled. Hyperchloremia was defined as a serum chloride level > 110 mmol/L. Clinical and laboratory data were compared between the survivors and nonsurvivors. RESULTS: The mortality rate was 23% (n = 20). The incidence of hyperchloremia was significantly higher in nonsurvivors than in survivors (P = 0.05). In multivariate logistic analysis, hyperchloremia at 48 h was found to be an independent risk factor for mortality in pediatric patients with major trauma. CONCLUSIONS: In pediatric patients with major trauma, hyperchloremia at 48-h postadmission was associated with 28-day mortality. This parameter might be a beneficial prognostic indicator.

The role of ultrasound and mitofusin-2 levels to predict pregnancy outcomes in patients with severe preeclampsia: a case-control study

SUMMARY OBJECTIVE: The aim of this study was to evaluate mitofusin-2 levels and fetal Doppler ultrasonography effects in patients with severe preeclampsia. METHODS: This single-center case-control study was conducted in the gynecology service of the university hospital in Van. A total of 90 pregnant women aged 18-40 years were included in the study. Of these, 30 are normal, 30 have mild preeclampsia, and 30 are pregnant with severe preeclampsia. In this study, especially in severe preeclampsia patients, serum mitofusin-2 levels and important fetal Doppler flows such as uterine arterial pressure, umbilical arterial pressure, and 1st and 5th minute Apgar scores, birth weight, and the relationship between postnatal outcomes such as week of birth and the number of patients in the neonatal intensive care unit were investigated. RESULTS: There was a significant difference between the three groups in terms of mitofusin-2 levels, which was the highest in the group (p<0.05). Maternal serum mitofusin-2 levels were positively correlated with uterine arterial pressure (r=0.543, p=0.007), umbilical arterial pressure (r=0.238, p=0.008), diastolic blood pressure, and systolic blood pressure (p<0.001). Receiver operating characteristic curve of mitofusin-2 in predicting preeclampsia is as follows: optimal cutoff 1.6 ng/mL; area under the curve: 0.861; 95%CI: 0.786-0.917; sensitivity: 83.9%; and specificity: 70.0%, (p≤0.001). A one-unit increase in mitofusin-2 resulted in a statistically significant 4.21-fold increase in preeclampsia risk. CONCLUSION: This study recommends the use of mitofusin-2 together with fetal Doppler ultrasound findings as a reliable indicator of preeclampsia severity.

Facteurs associés à la non-observance des personnes vivant avec le VIH à la thérapie antirétrovirale / Factors associated with non-adherence to antiretroviral therapy among people living with HIV

Le VIH est un fléau le plus meurtrier de l'histoire et les antirétroviraux demeurent une panacée. Cette étude cherche à identifier les facteurs associés à l'inobservance des personnes vivant avec le VIH (PVVIH) à la thérapie antirétrovirale (TARV). Méthodes L'étude transversale analytique a été menée au sein de la structure ActionsCommunautaires SIDA/ Avenir Meilleur pour les Orphelins. Elle a ciblé les PVVIH éligibles. L'échantillonnage non probabiliste du type occasionnel a été utilisé par la technique d'interview. Les analyses bivariée et multivariée ont été utilisées ainsi que la régression logistique par le logiciel SPSS version 16.0. Résultats 72 PVVIH ont été interviewées dont l'âge moyen était de 44 ans, avec un sex ratio de 2 femmes pour 1 homme. L'observance thérapeutique était de 55,6 %. Les facteurs associés à l'inobservance sont l'anxiété (51,4%), le stress, la mauvaise relation avec le soignant (44,4%), l'oubli (37,5%), la démotivation sexuelle (20,8%), la conscience personnelle (19,4%) et le manque de confidentialité (13,9%). Conclusion L'inobservance à la thérapie antirétrovirale constitue une problématique dans le contexte de la RDC. Il est important d'insister sur l'éducation thérapeutique dans le succès de la thérapie antirétrovirale

A retrospective analysis: the outcome of renal replacement therapies in critically ill children

SUMMARY OBJECTIVE: A few pediatric studies were present which focused on renal replacement therapy used for critically ill children. This research aimed to determine the ratio of utilization of intermittent hemodialysis, continuous renal replacement therapy, and peritoneal dialysis, and to study the properties and outcomes of critically ill pediatric patients who underwent renal replacement therapy. METHODS: Critically ill children admitted to the intensive care unit and received renal replacement therapy from February 2020 to May 2022 were included. The children were divided into three groups: hemodialysis, continuous renal replacement therapy, and peritoneal dialysis. RESULTS: A total of 37 patients (22 boys and 15 girls) who received renal replacement therapy met the criteria for this study. Continuous renal replacement therapy was used in 43%, hemodialysis in 38%, and peritoneal dialysis in 19%. In all, 28 (73%) children survived and 9 (27%) died in intensive care unit. The mean systolic blood pressure was significantly lower among children who received continuous renal replacement therapy (p<0.001). The need for inotropic medications and a higher PRISM III score were found to be the greatest indicators of mortality. CONCLUSION: The outcome of children receiving renal replacement therapy seems to be related to their needs for vasoactive drugs and the severity of the underlying disease in the continuous renal replacement therapy group relative to the other groups.

In vitro and in vivo antioxidant potentials of the methanolic crude extract from Inula glomerata Oliv. & Hiern (Asteraceae) and Salacia kraussii (Harv) Harv (Celastraceae) / Potenciales antioxidantes in vitro e in vivo del extracto crudo metanólico de Inula glomerata Oliv. & Hiern. (Asteraceae) y Salacia kraussii (Harv) Harv (Celastraceae)

Reactive oxygen species are implicated in multiple pathological conditions including erectile dysfunction. This study evaluated the in vitro and in vivo antioxidant potential of the methanolic extracts of Inula glomerata and Salacia kraussii. The plant materials were pulverized and extracted with methanol. The phytochemical analysis, ability of the crude extracts to scavenge free radicals (ABTS, DPPH, NO.) in vitroas well as the total phenolic and flavonoid contents was investigated. In vivo, antioxidant potentials of the crude extracts (50/250 mg/kg body weight) were determined in an erectile dysfunction rat model. The phytochemical analysis revealed that both plants contain flavonoids, tannins, terpenoids, and alkaloids. The crude extracts at varying degree of efficiency, scavenged ABTS and DPPH radicals. The crude extracts at low concentrations (50 mg/kg b.w) significantly (p<0.05) diminished the level of malondialdehyde, augmented catalase activities and elevated glutathione levels. However, SOD activities were significantly boosted in a dose-dependent manner by the crude extracts. Therefore, I. glomerataand S. kraussiipossess antioxidant properties, hence, can serve as a therapeutic modality in the treatment of oxidative stress-induced erectile dysfunction.

Las especies reactivas de oxígeno están implicadas en múltiples condiciones patológicas, incluyendo la disfunción eréctil. Este estudio evaluó el potencial antioxidante in vitro e in vivo de extractos metanólicos de Inula glomeratay Salacia kraussii. Los materiales vegetales fueron pulverizados y extraídos con metanol. A estos extractos crudos se les llevó a cabo el análisis fitoquímico junto con el contenido total de fenólicos y flavonoides, así como se les investigó la capacidad in vitro para atrapar radicales (ABTS, DPPH, NO.). Los potenciales antioxidantes in vivo de los extractos crudos (50/250 mg/kg de peso corporal) se determinaron en un modelo en ratas con disfunción eréctil. El análisis fitoquímico reveló que ambas plantas contuvieron flavonoides, taninos, terpenoides y alcaloides. Los extractos crudos con un grado variable de eficiencia, atraparon a los radicales ABTS y DPPH. Los extractos crudos a bajas concentraciones (50 mg/kg p.c) significativamente (p<0.05) disminuyeron el nivel de malondialdehído, aumentaron las actividades de catalasa y elevaron los niveles de glutatión. Sin embargo, las actividades de SOD por los extractos crudos fueron significativamente dosis-dependientes. Así, los extractos de I. glomeratay S. kraussii mostraron propiedades antioxidantes, y por lo tanto, podrían servir como una alternativa terapéutica en el tratamiento de disfunción eréctil inducida por estrés oxidativo.

Research Knowledge of health practitioners regarding mental health integration into human immunodeficiency virus management into primary healthcare level

Background: Mental disorders are common among people living with human immunodeficiency virus (HIV). Human immunodeficiency virus infection is associated with neurological complications, which may negatively affect HIV, leading to virologic as well as immunologic failure. The integration of mental healthcare services into HIV services at a primary healthcare level is vital, as this is the first contact point for most patients accessing healthcare services.Objectives: The aim of this study was to determine the knowledge of healthcare professionals about the integration of mental healthcare services into HIV services at a primary healthcare level.Method: This study was a quantitative descriptive study, designed to determine the knowledge of healthcare professionals towards integrating mental healthcare services into routine services at primary healthcare centres. The purposive sampling method was employed to select the 200 healthcare professionals who participated in this study.Results: The majority of the healthcare professionals (91%) who participated in this study had limited knowledge regarding the integration of mental healthcare services into HIV services at a primary healthcare level. Very few (9%, n = 18) had adequate knowledge about the integration of mental healthcare services into HIV services.Conclusion: Most of the participants had limited knowledge about the subject matter. This, therefore, shows that all stakeholders involved need to implement initiatives to address this knowledge gap

Medicina Tradicional Complementar e Integrativa: desafios para construir um modelo de avaliação do cuidado / Traditional Complementary and Integrative Medicine: challenges in constructing an evaluation model of care

Resumo A complexidade e a diversidade do que se propõe sob a lógica da Medicina Tradicional Complementar e Integrativa (MTCI) constituem um desafio para os interessados em evidências de sua efetividade. Seu crescimento, oferta e uso justificam a necessidade de construir referenciais metodológicos mais complexos e mais adequados para explicitar a singularidade do cuidado e a diversidade de suas técnicas. Este artigo, partindo de uma revisão narrativa da literatura, visa contribuir para a construção de um modelo de avaliação que, centrado na compreensão da singularidade e nas diversas dimensões do cuidado, busca refletir sobre os desafios de se buscar evidências do êxito terapêutico. O modelo proposto tem como base as abordagens qualitativas em saúde em que experiências dos agentes envolvidos (profissionais e usuários) no processo terapêutico ganham centralidade. Avaliar a efetividade do cuidado significa reconhecer a cadeia de processos interligados e suas diversas dimensões: acolhimento, diálogo, diagnóstico, ação e resultados alcançados.

Abstract The complexity and diversity of what is proposed in Traditional and Complementary Medicine constitute a challenge for those seeking evidence of its effectiveness. Its growth, offer and, use justify the need to build more complex and more appropriate methodological frameworks to explicit the uniqueness of this approach to healthcare and the diversity of its techniques. Based on a narrative review of the recent literature, this article aims to contribute to the construction of an evaluation model, focused on understanding the uniqueness and diverse dimensions of this specific care, seeking to reflect on the challenges and evidences of successful therapy. The proposed model is based on qualitative healthcare approaches, in which the experiences of the involved agents (professionals and users) in the therapeutic process become central. Assessing their effectiveness means recognizing the interconnected processes and their multiple dimensions: host practices, dialogue, diagnosis, action, and outcomes achieved.

Referencial teórico sobre práticas intersetoriais em Promoção da Saúde na Escola / A theoretical framework on intersectoral practice in School Health Promotion

Resumo Trata-se de um estudo sobre os referenciais teóricos que influenciaram os programas de saúde escolar no Brasil, apoiada na experiência do Rio de Janeiro. Utiliza da literatura brasileira desde meados do século passado até o presente e da internacional sobre a avaliação em promoção da saúde. Analisam-se as propostas de domesticação de comportamentos a partir de princípios higienistas, outras empenhadas na criação de uma disciplina específica sobre saúde no currículo escolar, e ainda aquelas apoiadas em perspectiva clínico-assistencial. Em período mais recente analisa a reaproximação dos dois setores a partir de um modelo vinculado à promoção da saúde. O artigo demonstra a importância dos diferentes referenciais teóricos para a compreensão das ações e estratégias sintetizadas em uma matriz. Explicita, ainda, a influência dos contextos históricos em que se dá o diálogo e a definição de ações entre educação e saúde em uma difícil articulação de práticas e saberes entre os dois setores.

Abstract This study focuses on the theoretical references that have influenced Brazilian school health programs based on the Rio de Janeiro experience. It draws on Brazilian literature from the mid-20th century to date and international literature on the assessment of health promotion. Proposals for the domestication of student behavior using hygienist principles are analyzed, as well as some engaged in the creation of a specific health course in the school syllabus and other with a clinical and healthcare perspective. Covering a more recent period, the study analyzes how health and educational systems resumed their collaboration from a health promotion-linked model. The paper demonstrates the importance of different theoretical references for the understanding of actions and strategies summarized in a framework. It also explains the influence of historical contexts in which dialogue and definition of actions occur between education and health in the challenging coordination of practice and knowledge involving the two sectors.

Avaliação das práticas de promoção da saúde: um olhar das equipes participantes do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica / Evaluation of health promotion practices: a look from the participating teams of the National Program for Access and Quality Improvement in Primary Care

As práticas de Promoção da Saúde das equipes de Atenção Básica no Brasil e macrorregiões foram analisadas a partir do PMAQ-AB (2012). Foram estudadas as frequências de variáveis nos eixos: Reorientação de Serviços; Ações Comunitárias; Ambientes Saudáveis; Habilidades Pessoais (n=17.202 equipes). A abordagem territorial restringe-se aos aspectos geográficos; reconhece-se a vulnerabilidade de beneficiários do Bolsa Família; na escola há predomínio das ações clínicas (saúde bucal); educação para sexualidade/reprodução; informações do ambiente foram restritas. Conclui-se que as práticas são fragmentadas e focalizadas; urge integrar, equilibradamente, cuidado clínico, prevenção e promoção da saúde.

The Health Promotion practices of the basic attention teams in Brazil and macro-regions were analyzed from the PMAQ-AB (2012). The variable frequency axes were studied: Services Reorientation; Community Actions; Healthy Environments; Personal Skills (n = 17,202 teams). The territorial approach is restricted to geographic aspects; the vulnerability of the "Bolsa Familia Program" beneficiaries; there is a predominance of clinical actions at school (buccal health); sexuality/reproduction education; environmental information were restricted. It is concluded that the practices are still fragmented and focused; an even integration of clinical care, prevention and health promotion shall be urged.

Revisiting the Importance of Childhood Activity

Formalised exercise programmes for children and adolescents are becoming increasingly important. There has been a drastic increase in documented childhood morbidity and mortality relating to poor nutrition and low activity levels in recent years. Regular physical activity decreases the risk of chronic disease and is also a fundamental component in the management of illnesses. Recommendations for the paediatric population remain insufficient and ill-defined. This article revisits the risks of physical inactivity in childhood and provides the latest recommendations for exercise prescription in the paediatric population. Inactive children have a higher risk of developing chronic diseases; such as obesity; type 2 diabetes; high blood cholesterol and hypertension. Other undesirable consequences include orthopaedic problems; cardiovascular disease and various psychological complications. Both aerobic and resistance training should be incorporated into paediatric exercise programmes. The recommended guidelines for childhood activity are 60 minutes of moderate-intensity exercise every day of the week. This article highlights the importance of formalised paediatric exercise programmes in disease prevention and health promotion. A healthy and happy adolescent population ultimately contributes to an adult population with a low risk of ill health

Práticas integrativas e complementares: oferta e produção de atendimentos no SUS e em municípios selecionados / Integrative and complementary health practices: the supply and production of care in the Unified National Health System and in selected municipalities in Brazil

A Medicina Tradicional/Complementar e Alternativa tem crescido no mundo e sua importância vem sendo ressaltada em diversos estudos. No Brasil, a Política Nacional de Práticas Integrativas e Complementares incentiva sua inserção e fortalecimento na atenção primária. Buscou-se identificar a oferta dos serviços e de práticas integrativas e complementares no SUS e a produção de atendimentos entre os anos 2000 e 2011, analisando as informações disponíveis nos bancos de dados nacionais vis-à-vis os dados da atenção primária nos municípios de Campinas (São Paulo), Florianópolis (Santa Catarina) e Recife (Pernambuco). A análise permitiu identificar um descompasso entre o que se registra nos sistemas de informação e o que se pratica nos municípios. Esse descompasso deve-se, em grande parte, à indefinição do escopo do que se compreende como práticas integrativas e complementares na Política Nacional, o que significa uma grande limitação para sua mensuração e avaliação, já que os sistemas de informação atuais não permitem o registro adequado dessas práticas.

The world of Traditional/Complementary and Alternative Medicine has grown and its importance has been emphasized in several studies. In Brazil, the National Policy on Integrative and Complementary Practices encourages their inclusion and empowerment in primary care. This study attempted to identify the provision of services and integrative practices in the Unified National Health System and the production of consultations from 2000 to 2011, contrasting the analysis of available information in national databases with the primary care data collected locally in Campinas (São Paulo State), Florianópolis (Santa Catarina State), and Recife (Pernambuco State). Analysis of the data revealed a mismatch between records in information systems and actual practices in these cities. This mismatch is due largely to lack of definition on the scope of what are understood as integrative and complementary practices in the Brazilian National Policy, thereby posing a major limitation to their measurement and evaluation, since current information does not allow adequate recording of such practices.

Detecção de maculopatia hipotônica subclínica pelo OCT III após cirurgia filtrante / Detection of subclinical hypotony maculopathy with OCT III after filtration surgery

OBJETIVO: Detectar possíveis sinais de maculopatia hipotônica subclínica por meio da OCT III em pacientes submetidos à cirurgia filtrante. MÉTODOS: Pacientes que realizaram procedimento cirúrgico filtrante com pressão intra-ocular menor que 9 mmHg submeteram-se ao exame OCT III. RESULTADOS: Sete (87,50 por cento) pacientes apresentaram diagnóstico prévio de glaucoma crônico simples e 1 (12,50 por cento) de glaucoma agudo de ângulo fechado. Apenas duas pacientes (25,00 por cento) apresentaram maculopatia hipotônica detectada pela OCT III. CONCLUSÃO: A OCT III parece ser um bom método diagnóstico de maculopatia hipotônica subclínica em pacientes submetidos à cirurgia filtrante convencional.

PURPOSE: To detect nondiagnostic hypotony maculopathy by OCT III after filtration surgery. METHODS: After surgery, patients with intraocular pressure less than 9 mmHg were submitted to OCT III examination. RESULTS: Seven (87.50 percent) patients with previous diagnosis of open angle glaucoma and one (12.50 percent) of them with acute angle closure glaucoma. Two patients (25.00 percent) presented hypotony maculopathy on OCT III examination. CONCLUSION: OCT III examination seems to be a good diagnostic method to detect subclinical hypotony maculopathy after filtration surgery.

Trauma ocular aberto: características de casos atendidos no complexo Hospitalar Padre Bento de Guarulhos / Ocular open trauma: characteristics of admitted cases at the Padre Bento Hospital of Guarulhos, SP

OBJETIVOS: Estudos em centros oftalmológicos têm sido realizados com a finalidade de decifrar as principais causas e características epidemiológicas do trauma ocular. Nestes estudos observa-se uma variação na distribuição epidemiológica do trauma ocular e uma carência na educação e conscientização da sociedade sobre as medidas preventivas no Brasil. O objetivo deste estudo é identificar a incidência do trauma ocular aberto no serviço de emergência do Complexo Hospitalar Padre Bento de Guarulhos. MÉTODOS: Este é um estudo transversal descritivo realizado no período de setembro de 2003 a abril de 2004. Foram incluídos no trabalho, todos os pacientes atendidos no PS de Oftalmologia com diagnóstico de trauma ocular aberto. Foram obtidos alguns dados sobre o paciente: idade, sexo, profissão, uso de equipamento de trabalho, uso de óculos, uso de cinto de segurança, tipo de acidente, olho acometido, tempo decorrido até o primeiro atendimento oftalmológico e qual o primeiro local de atendimento. RESULTADOS: A média de idade foi de 34,35 anos, sendo o sexo masculino o mais acometido (87 por cento). O acidente automobilístico foi o mais freqüente. A baixa acuidade visual foi importante fator de procura precoce pelo serviço de emergência, sendo que 92,3 por cento dos pacientes o fizeram em menos de 12 horas de decorrido o trauma. CONCLUSAO: O trauma penetrante corneano foi o tipo de lesão ocular mais observado. Os pacientes mais acometidos são adultos jovens, do sexo masculino, vítimas de acidente automobilístico, sendo o olho direito o mais acometido. A complicação imediata mais observada foi a baixa acuidade visual.

Segurança alimentar em estabelecimentos processadores de alimentos / Food security in food handling establishments

A vida moderna imprimiu um ritmo acelerado no cotidiano dos indivíduos; no aspecto alimentação teve como repercussão a mudança de hábitos alimentares, com a introdução de refeições rápidas e a utilização de alimentação fora do ambiente doméstico. Estes fatores levaram ao crescimento da atenção para com a segurança alimentar. O conceito de que o alimento pode ser o seu próprio remédio ganhou um outro enfoque, ou seja, o alimento pode ser um medicamento, mas também pode ocasionar surtos de Enfermidades Transmitidas por Alimentos – ETA. O surto de ETA é diagnosticado quando duas ou mais pessoas apresentam sintomas semelhantes após a ingestão de um mesmo alimento. A Organização Mundial de Saúde considera as enfermidades transmitidas por alimentos como um problema de saúde pública, uma vez que atinge grande número de indivíduos em todas as partes do mundo, causando prejuízos não somente à saúde do consumidor como também incapacidade laboral temporária, gastos com tratamento médico, perdas emocionais, dentre outros. O controle higiênico-sanitário tanto dos estabelecimentos quanto dos manipuladores de alimentos é essencial para garantir a qualidade dos alimentos, tornando-se o principal instrumento de defesa contra os surtos de enfermidades veiculadas pelos alimentos.

Concepts and approaches in the evaluation of health promotion

Demandas e tensões em torno do uso de evidências em políticas públicas (evidence-based policy - EBP), como parte de uma gestão orientada por resultados, indicam muitas vezes um distanciamento entre as concepções e a natureza complexa das intervenções de promoção da saúde. Este artigo parte dos desafios associados ao campo conceitual da Promoção da Saúde e das exigências de "provas" de efetividade e de eficiência com que têm se confrontado gestores, avaliadores e agentes locais, no desenvolvimento de ações intersetoriais em saúde. São apontadas as limitações dos ensaios epidemiológicos na avaliação de políticas sociais e utiliza-se de argumentos relacionados às "teorias de mudança" com vistas a discutir a relação dos constructs no modelo das intervenções das políticas sociais e fundamentar a "análise da contribuição" de seus efeitos. Revisões sistemáticas do tipo realist synthesis são enfocadas devido sua capacidade de realçar marcos teóricos de um programa específico, explicando os mecanismos subjacentes de ação comuns aos diferentes programas e/ou contextos. Argumenta-se que a explicitação das mudanças sociais esperadas requer processos colaborativos, considerando o conjunto dos atores envolvidos (bottom-up) no processo de desenvolvimento e na avaliação das intervenções.

Atenção básica na agenda da saúde / Primary care in the agenda of public health sector in Brazil

O artigo discute a política de reorganização da atenção básica a partir do processo recente de descentralização do SUS no Brasil. Enfatiza-se o papel indutor do governo central, que, através de um conjunto de medidas e programas específicos (PAB e PACS/PSF, principalmente), transfere para os municípios a responsabilidade com a atenção básica. Assim, é no nível municipal que ocorre o processo de implementação dessa política, gerando efeitos de difícil avaliação, dada a diversidade de contextos locais. A argumentação central enfatiza a importância de se avaliarem processos e resultados intermediários voltados para o desempenho institucional, que podem ser traduzidos em vontade política e compromisso público, capacidade de gestão e maior controle e participação social, mais do que exatamente efeitos ou impactos mais diretos sobre a oferta de serviços. A conclusão é de que apesar de todas as dificuldades e obstáculos o processo tem implicado o fortalecimento da capacidade de gestão municipal no que diz respeito à organização da atenção básica em saúde.