Estratégias para o enfrentamento do absenteísmo em consultas odontológicas nas Unidades de Saúde da Família de um município de grande porte: uma pesquisa-ação / Strategies for tackling absenteeism in dental appointments in the Family Health Units of a large municipality: action research

O objetivo deste trabalho foi analisar os motivos das faltas às consultas odontológicas em Unidades de Saúde da Família (USF) e implementar estratégias para sua redução por meio da pesquisa-ação. O estudo foi realizado em 12 USF de Piracicaba/SP, de 01 de janeiro a 31 de dezembro de 2010. A amostra se consistiu de 385 usuários, entrevistados por telefone, sobre os motivos das faltas, além de 12 cirurgiões-dentistas e 12 enfermeiras. Realizaram-se duas oficinas com os profissionais: uma para problematização dos dados coletados nas entrevistas e elaboração de estratégias; e outra após 4 meses, para avaliação. O maior motivo de faltas foi a coincidência do horário de funcionamento das unidades com o de trabalho dos usuários. Dentre as estratégias ressaltou-se a realização de palestras sobre saúde bucal, educação permanente nas reuniões de equipe, capacitação dos Agentes Comunitários de Saúde, participação em grupos terapêuticos e parcerias entre Equipe de Saúde Bucal e equipamentos sociais da comunidade. A adoção de prontuário único foi a estratégia desafiadora encontrada pelos profissionais. Concluiu-se que as estratégias implementadas levaram à diminuição das faltas em 66,6% e o caráter motivador das oficinas possibilitou a reflexão crítica para o redirecionamento da prática em saúde.

The aim of this study was to analyze the reasons for missed appointments in dental Family Health Units (FHU) and implement strategies to reduce same through action research. This is a study conducted in 12 FHUs in Piracicaba in the State of São Paulo from January, 1 to December, 31 2010. The sample was composed of 385 users of these health units who were interviewed over the phone and asked about the reasons for missing dental appointments, as well as 12 dentists and 12 nurses. Two workshops were staged with professionals: the first to assess the data collected in interviews and develop strategy, and the second for evaluation after 4 months. The primary cause for missed appointments was the opening hours of the units coinciding with the work schedule of the users. Among the strategies suggested were lectures on oral health, ongoing education in team meetings, training of Community Health Agents, participation in therapeutic groups and partnerships between Oral Health Teams and the social infrastructure of the community. The adoption of the single medical record was the strategy proposed by professionals. The strategies implemented led to a 66.6% reduction in missed appointments by the units and the motivating nature of the workshops elicited critical reflection to redirect health practices.

Associação entre fatores de risco cardiovascular e indicadores antropométricos de obesidade em universitários de São Luís, Maranhão, Brasil / The association between cardiovascular risk factors and anthropometric obesity indicators in university students in São Luís in the State of Maranhão, Brazil

O presente artigo tem por objetivo avaliar associação entre fatores de risco cardiovascular (FRCV) e indicadores antropométricos em amostra de base populacional de universitários de São Luís/MA. Estudo transversal com 968 universitários, mediana de 22 anos. Glicemia, triglicerídeos (TGL), HDL-c, tabagismo, consumo de álcool, sedentarismo, síndrome metabólica (SM–critérios do Joint Interim Statement) e resistência insulínica (RI), foram associados e correlacionados com os indicadores antropométricos Índice de Massa Corporal (IMC), Circunferência da Cintura (CC), Relação Cintura Quadril (RCQ) e Relação Cintura Altura (RCA). Encontraram-se associações entre TGL, HAS, SM e maiores valores de todas as variáveis antropométricas. RI associou-se a maiores valores IMC e RCA em homens e mulheres. Baixo HDL-c foi associado a maiores valores de todas as variáveis antropométricas em mulheres. Consumo de álcool associou-se a valores mais elevados de IMC e CC em mulheres e RCQ e RCA em homens. Fumo associou-se a maiores valores de RCA em ambos os sexos. Sedentarismo foi associado a maiores valores de RCQ apenas em homens. As correlações mais altas foram estabelecidas para mulheres entre TGL e IMC, CC, RCQ e RCA. Os indicadores que mais se associaram aos FRCV foram IMC, CC e RCA em mulheres e RCQ e RCA em homens.

The article aims to evaluate the relation between cardiovascular risk factors (CVRF) and anthropometric indicators in a sample of university students from São Luís-MA, Brazil. It is a cross-sectional study conducted with 968 university students, with median age of 22. Glycemia, triglycerides, HDL-c, smoking, alcohol consumption, physical inactivity, metabolic syndrome (Joint Interim Statement criteria) and insulin resistance (IR), were associated and correlated with anthropometric indicators such as BMI, WC, WHR and WHtR. Associations were found between TGL, SH, SM and higher values of all anthropometric variables. The RI was associated with higher BMI values and WHtR in men and women. The low HDL-c was associated with higher values of all anthropometric variables in women. Consumption of alcohol was associated with higher values of BMI and WC in women and WHR in men and WHtR. Smoking was associated with higher values of WHtR in both sexes. Physical inactivity was associated with higher values of WHR in men only. The highest correlations were established for women between TGL and BMI CC, WHR and WHtR. The indicators most associated with CVRF were BMI, WC and WHtR in females and WHR and WHtR in men.

Comer en tiempos de "crisis": nuevos contextos alimentarios y de salud en España / Eating in a time of "crisis": New health and dietary contexts in Spain

En las sociedades industrializadas se está reflexionando cada vez más sobre el impacto de la inseguridad alimentaria, entendida como la dificultad para asegurar la accesibilidad de una parte de la población a los recursos alimentarios suficientes para garantizar su subsistencia y bienestar. Con base en datos recogidos a partir de una investigación en curso en España, este artículo discute, por un lado, si la actual crisis económica está revirtiendo algunas de las tendencias positivas que el sistema agroalimentario industrial había favorecido, como la disminución de las diferencias sociales en el consumo y el derecho a la alimentación. Por otro lado, reflexiona acerca de la creciente precarización en las estrategias alimentarias y en el estado de salud de la población, así como sobre la necesidad de considerar la desigualdad social como variable explicativa de las diversas maneras de alimentarse.

This article analyzes the reasons why food insecurity in Spain must increasingly be understood as lack of access to sufficient food resources to guarantee the survival and wellbeing of part of the population. Using data collected in an ongoing research project, two possible causes for this are explored. First, it is argued that certain positive developments that seemed firmly established, such as recognition of the right to an adequate diet and the leveling out of social differences in food consumption, are now being reversed by the current economic crisis. Second, the analysis focuses on strategies people in precarious circumstances use to obtain food, their relationship to health, and the need to take social inequality into consideration as an explanatory variable in accounting for different ways of procuring daily sustenance.

Partial Purification and Characterization of a Cysteine Protease Inhibitor from the Plerocercoid of Spirometra erinacei

Helminthic cysteine proteases are well known to play critical roles in tissue invasion, nutrient uptake, and immune evasion of the parasites. In the same manner, the sparganum, the plerocercoid of Spirometra mansoni, is also known to secrete a large amount of cysteine proteases. However, cysteine protease inhibitors regulating the proteolytic activities of the cysteine protease are poorly illustrated. In this regard, we partially purified an endogenous cysteine protease inhibitor from spargana and characterized its biochemical properties. The cysteine protease inhibitor was purified by sequential chromatographies using Resource Q anion exchanger and Superdex 200 HR gel filtration from crude extracts of spargana. The molecular weight of the purified protein was estimated to be about 11 kD on SDS-PAGE. It was able to inhibit papain and 27 kDa cysteine protease of spargana with the ratio of 25.7% and 49.1%, respectively, while did not inhibit chymotrypsin. This finding suggests that the cysteine protease inhibitor of spargana may be involved in regulation of endogenous cysteine proteases of the parasite, rather than interact with cysteine proteases from their hosts.

Efecto antiparasitario de inhibidores de cistein proteasas in vitro e in vivo en la enfermedad de Chagas experimental / Trypanocidal effect of cysteine protease inhibitors in vitro and in vivo in experimental Chagas disease

El mal de Chagas, endémico en la mayoría de los países de América, causa una alta morbilidad y mortalidad. Aunque evidencias experimentales y clínica muestran la importancia de la quimioterapia tanto en la fase aguda como crónica de la enfermedad, el tratamiento de los pacientes se ve limitado por la toxicidad de las drogas disponibles. En esta revisión se describe el diseño, evolución de péptidos miméticos capaces de interrumpir el ciclo intracelular de T. cruzi y de curar infecciones experimentales agudas en animales de laboratorio. Los péptido-miméticos inhiben especificamente la actividad enzimática de cruzaína, una cisteín proteasa de T. cruzi, y causan alteraciones en el complejo de Golgi y retículo endoplásmico, acumulación de enzima no procesada en cistemas del complejo de Golgi, y disminución de la enzima acumulada en lisosomas. El compuesto más efectivo, N-Pip-F-hF-VSphi, cura infecciones letales agudas en animales experimentales. No se observan lesiones miocárdicas, infiltración linfocitaria, o nidos de amastigotes intracelulares en animales tratados con el compuesto. Estudios toxicológicos y farmacoquinéticos preliminares indican la ausencia de toxicidad asociada a altas dosis y tratamientos prolongados. Los inhibidores de proteasas podrían constituir en el futuro buenas alternativas quimioterapéuticas para el tratamiento del Chagas agudo y crónico.

Uptake of Z-Tyr{125I}-AlaCHN2, an irreversible cysteine proteinase inhibitor, by lesion amastigotes, axenic amastigotes and promastigotes of Leishmania mexicana

Radioiodinated N-benzyloxycarbonyl-tyrosyl-alanyl diazomethane (Z-Tyr[l25I]-AlaCHN2) was previously shown to selectively label two (28 and 31 kDa) Leishmania mexicana cysteine proteinases common to both the promastigote and the amastigote stages. Here we have confirmed the specificity of the compound towards two similar enzymes of axenic L. mexicana amastigotes and demonstrated that lesion amastigotes, axenic amastigotes and stationary promastigotes internalized the l25I-labeled inhibitor at different rates. Uptake of Z-Tyr[l25I]-AlaCHN2 by the parasites, which was not significantly modified by changing the medium pH, was clearly correlated with the binding of the compound to the 28- and 3l-kDa cysteine proteinases, as judged by the specificity of enzyme labeling in gelatin gels and the recovery of 75 per cent or more parasite-associated radioactivity in TCA-insoluble fractions. For all three developmental stages, uptake markedly increased with time and linearly up to 60 min, but throughout the period examined, radiolabel accumulation occurred more efficiently in amastigotes. By 5 h, when values were near or at saturation, radioactivity (in cpm/mug of total protein) associated with lesion amastigotes was 1.8- and 2.9-times that recovered from axenic amastigotes and stationary promastigotes, respectively. Pulse-chase experiments, in which cysteine proteinases were fully blocked with Z-Phe-AlaCHN2 prior to the pulse with Z-Tyr[l25I]-AlaCHN2, showed that labeling of the amastigote enzymes could be partially restored, whereas labeling of promastigote proteinases could not, after a 5-h chase period in inhibitor-free medium.