Uma experiência precursora do SUS com a participação de Paulo Freire / A precursor experience of the SUS with the participation of Paulo Freire

Resumo O texto desenvolve-se a partir de uma mesa redonda realizada na Faculdade de Educação (FE) da Universidade Estadual de Campinas (Unicamp), como uma das atividades de comemorações do Centenário de Paulo Freire (2021). Objetiva registrar parte da sua passagem por essa universidade, nos anos de 1980 a 1991, a partir do trabalho realizado com a FE e Faculdade de Ciências Médicas (FCM) por meio de atividades de formação e extensão no Centro de Saúde Escola de Paulínia-SP. Descreve e analisa as pautas do processo de redemocratização do país, os embates em torno das políticas públicas na Assembleia Nacional Constituinte e o processo de constituição de um sistema integrado e universal de educação e saúde pública coletiva a partir de uma perspectiva participativa.

Abstract The text is based on a round table held at the Faculty of Education (FE) of the State University of Campinas (Unicamp) as one of the activities to commemorate Paulo Freire's Centenary (2021). It aims to record part of his time at the university, from 1980 to 1991, based on the work conducted with FE and the Faculty of Medical Sciences (FCM) through training and extension activities at the Paulínia-SP School Health Center. It also describes and analyses the agendas of the country's re-democratization process, the clashes over public policies in the National Constituent Assembly, and the process of setting up an integrated and universal system of education and collective public health from a participatory perspective.

A precursor experience of the SUS with the participation of Paulo Freire. / Uma experiência precursora do SUS com a participação de Paulo Freire.

The text is based on a round table held at the Faculty of Education (FE) of the State University of Campinas (Unicamp) as one of the activities to commemorate Paulo Freire's Centenary (2021). It aims to record part of his time at the university, from 1980 to 1991, based on the work conducted with FE and the Faculty of Medical Sciences (FCM) through training and extension activities at the Paulínia-SP School Health Center. It also describes and analyses the agendas of the country's re-democratization process, the clashes over public policies in the National Constituent Assembly, and the process of setting up an integrated and universal system of education and collective public health from a participatory perspective.

O texto desenvolve-se a partir de uma mesa redonda realizada na Faculdade de Educação (FE) da Universidade Estadual de Campinas (Unicamp), como uma das atividades de comemorações do Centenário de Paulo Freire (2021). Objetiva registrar parte da sua passagem por essa universidade, nos anos de 1980 a 1991, a partir do trabalho realizado com a FE e Faculdade de Ciências Médicas (FCM) por meio de atividades de formação e extensão no Centro de Saúde Escola de Paulínia-SP. Descreve e analisa as pautas do processo de redemocratização do país, os embates em torno das políticas públicas na Assembleia Nacional Constituinte e o processo de constituição de um sistema integrado e universal de educação e saúde pública coletiva a partir de uma perspectiva participativa.

The effects of performance status one week before hospital admission on the outcomes of critically ill patients.

PURPOSE: To assess the impact of performance status (PS) impairment 1 week before hospital admission on the outcomes in patients admitted to intensive care units (ICU). METHODS: Retrospective cohort study in 59,693 patients (medical admissions, 67 %) admitted to 78 ICUs during 2013. We classified PS impairment according to the Eastern Cooperative Oncology Group (ECOG) scale in absent/minor (PS = 0-1), moderate (PS = 2) or severe (PS = 3-4). We used univariate and multivariate logistic regression analyses to investigate the association between PS impairment and hospital mortality. RESULTS: PS impairment was moderate in 17.3 % and severe in 6.9 % of patients. The hospital mortality was 14.4 %. Overall, the worse the PS, the higher the ICU and hospital mortality and length of stay. In addition, patients with worse PS were less frequently discharged home. PS impairment was associated with worse outcomes in all SAPS 3, Charlson Comorbidity Index and age quartiles as well as according to the admission type. Adjusting for other relevant clinical characteristics, PS impairment was associated with higher hospital mortality (odds-ratio (OR) = 1.96 (95 % CI 1.63-2.35), for moderate and OR = 4.22 (3.32-5.35), for severe impairment). The effects of PS on the outcome were particularly relevant in the medium range of severity-of-illness. These results were consistent in the subgroup analyses. However, adding PS impairment to the SAPS 3 score improved only slightly its discriminative capability. CONCLUSION: PS impairment was associated with worse outcomes independently of other markers of chronic health status, particularly for patients in the medium range of severity of illness.

Impact of parecoxib on hospital discharge: retrospective analysis of Brazilian health insurance / Impacto de parecoxibe na desospitalização: análise retrospectiva da saúde suplementar no Brasil

ABSTRACT BACKGROUND AND OBJECTIVES: Adequate postoperative pain and renal colic control is critical for patients' recovery and to decrease hospitalization costs and the use of resources. So, this study aimed at evaluating hospitalization time of patients treated with parecoxib sodium versus other non-steroid anti-inflammatory drugs to manage postoperative pain of appendectomy or fractures and renal colic. METHODS: This is a retrospective data analysis of Brazilian private hospitals medical bills, including patients treated with non-steroid anti-inflammatory drugs to decrease post-appendectomy pain (n=1618), post orthopedic fracture pain (n=2858 and renal colic (n=6555), between January and June 2014. Mean hospitalization time was evaluated according to each group of drugs. Mean difference among groups was calculated by the Kruskal-Wallis method. RESULTS: Mean hospitalization time for patients submitted to appendectomy was 1.95 days with parecoxib versus 2.20 with other non-steroid anti-inflammatory drugs (p= 0.006). For patients submitted to orthopedic fracture surgery, mean time was 1.75 days with parecoxib versus 1.93 days with other anti-inflammatory drugs (p=0.008). Parecoxib has also significantly decreased hospitalization time for renal colic as compared to other drugs (25.2h versus 32.9h; p<0.001). CONCLUSION: Parecoxib sodium has provided shorter hospitalization time with possible decrease in use of resources and costs and should be considered a choice for such painful conditions.

RESUMO JUSTIFICATIVA E OBJETIVOS: O controle adequado da dor pós-operatória e cólica renal é fundamental para a recuperação do paciente e redução de custos relacionados à hospitalização e utilização de recursos. Assim, o objetivo deste estudo foi avaliar o tempo de hospitalização entre pacientes tratados com parecoxibe sódico versus outros fármacos anti-inflamatórios não esteroides, no manuseio da dor pós-operatória associada à apendicectomia ou fraturas e cólica renal. MÉTODOS: Uma análise retrospectiva de dados de contas médicas de hospitais privados no Brasil foi realizada, incluindo pacientes tratados com anti-inflamatório não esteroide para redução da dor pós-apendicectomia (n=1.618), dor pós-fratura ortopédica (n=2.858) e cólica renal (n=6.555), entre janeiro e junho de 2014. O período médio de internação foi avaliado de acordo com cada grupo de fármacos. A diferença média entre os grupos foi avaliada utilizando o método de Kruskal-Wallis. RESULTADOS: O tempo médio de permanência hospitalar para pacientes submetidos à apendicectomia foi de 1,95 dias com parecoxibe versus 2,20 com outros anti-inflamatórios não esteroides (p = 0,006). Para pacientes submetidos a cirurgias de fraturas ortopédicas, o tempo médio foi de 1,75 dias com parecoxibe versus 1,93 dias para outros anti-inflamatórios (p=0,008). Parecoxibe também apresentou redução significativa no tempo de internação hospitalar para cólica renal em comparação com outros fármacos (25,2h versus 32,9h; p<0,001). CONCLUSÃO: Parecoxibe sódico demonstrou menor tempo de permanência hospitalar com possível redução na utilização de recursos e custos, devendo ser considerado como uma escolha para estas condições dolorosas.

O direito humano à mobilidade: dois textos e dois contextos / tThe human right to mobility: two texts and two contexts

O artigo objetiva discutir duas perspectivas de direito humano à mobilidade a partir da análise de textos escritos em diferentes contextos. São eles: a Declaração Universal de Direitos Humanos (1948) e a Diretiva de Retorno (2008). O referencial teórico adotado sugere que a mobilidade é uma prática humana milenar que tem alcançado visibilidade crescente contando com a sofisticação das tecnologias da informação, comunicação e dos transportes, globalização dos processos de produção, circulação e consumo de bens materiais e imateriais e a financeirização do capital. Entende que a migração nacional e internacional deve ser analisada considerando as múltiplas determinações do real que afetam crianças e adultos; homens e mulheres; documentados e indocumentados; países desenvolvidos e em desenvolvimento. O artigo sugere que a Declaração Universal de Direitos Humanos esboça uma perspectiva de direito humano à mobilidade baseada num devir de cidadania igualitária, enquanto que a Diretiva propõe normas e procedimentos comuns aos Estados de controle de entrada e condições de retorno dos migrantes não documentados, apoiados em retrações econômicas e ações xenofóbicas da sociedade civil. Aponta que países signatários da Declaração Universal dos Direitos Humanos, em 1948, são hoje, partidários da Diretiva e que esta inflexão reflete uma tendência mundial a uma perspectiva mais fechada, excludente e restritiva de governabilidade do direito humano à mobilidade.(AU).

This paper discusses two perspectives of human right to mobility from the analysis of texts written in different contexts. They are: The Universal Declaration of Human Rights (1948) and the Return Directive (2008). The theoretical reference adopted suggests that mobility is an ancient human practice that has achieved increased visibility based on the development of information technology, transportation and the globalization processes of production, circulation and consumption of goods, financialization and worldlization of culture. It considers that the national and international migration should be analyzed considering the multiple real determinations that affect children and adults, men and women, regular and irregular migrants, developed and developing countries. Using content analysis this article suggests that The Universal Declaration of Human Rights outlines a human right to mobility based on an equal citizenship perspective, the Return Directive proposes the criminalization of migration by the State supported by xenophobic actions from the civil society. It shows that signatory and proponent countries of The Universal Declaration of Human Rights in 1948 are today supporters of the Return Directive and that this inflection reflects a global trend towards a more closed, excluding and restrictive governance of the human right to mobility.(AU).

Brazilian recommendations of mechanical ventilation 2013. Part 2.

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

Recomendações brasileiras de ventilação mecânica 2013. Parte 2 / Brazilian recommendations of mechanical ventilation 2013. Part 2

O suporte ventilatório artificial invasivo e não invasivo ao paciente grave tem evoluído e inúmeras evidências têm surgido, podendo ter impacto na melhora da sobrevida e da qualidade do atendimento oferecido nas unidades de terapia intensiva no Brasil. Isto posto, a Associação de Medicina Intensiva Brasileira (AMIB) e a Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) - representadas por seu Comitê de Ventilação Mecânica e sua Comissão de Terapia Intensiva, respectivamente, decidiram revisar a literatura e preparar recomendações sobre ventilação mecânica, objetivando oferecer aos associados um documento orientador das melhores práticas da ventilação mecânica na beira do leito, com base nas evidências existentes, sobre os 29 subtemas selecionados como mais relevantes no assunto. O projeto envolveu etapas que visaram distribuir os subtemas relevantes ao assunto entre experts indicados por ambas as sociedades, que tivessem publicações recentes no assunto e/ou atividades relevantes em ensino e pesquisa no Brasil, na área de ventilação mecânica. Esses profissionais, divididos por subtemas em duplas, responsabilizaram-se por fazer uma extensa revisão da literatura mundial. Reuniram-se todos no Fórum de Ventilação Mecânica, na sede da AMIB, na cidade de São Paulo (SP), em 3 e 4 de agosto de 2013, para finalização conjunta do texto de cada subtema e apresentação, apreciação, discussão e aprovação em plenária pelos 58 participantes, permitindo a elaboração de um documento final.

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

Brazilian recommendations of mechanical ventilation 2013. Part I.

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumonia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

Recomendações brasileiras de ventilação mecânica 2013. Parte I / Brazilian recommendations of mechanical ventilation 2013. Part I

O suporte ventilatório artificial invasivo e não invasivo ao paciente crítico tem evoluído e inúmeras evidências têm surgido, podendo ter impacto na melhora da sobrevida e da qualidade do atendimento oferecido nas unidades de terapia intensiva no Brasil. Isto posto, a Associação de Medicina Intensiva Brasileira (AMIB) e a Sociedade Brasileira de Pneumonia e Tisiologia (SBPT) - representadas pelo seus Comitê de Ventilação Mecânica e Comissão de Terapia Intensiva, respectivamente, decidiram revisar a literatura e preparar recomendações sobre ventilação mecânica objetivando oferecer aos associados um documento orientador das melhores práticas da ventilação mecânica na beira do leito, baseado nas evidencias existentes, sobre os 29 subtemas selecionados como mais relevantes no assunto. O projeto envolveu etapas visando distribuir os subtemas relevantes ao assunto entre experts indicados por ambas as sociedades que tivessem publicações recentes no assunto e/ou atividades relevantes em ensino e pesquisa no Brasil na área de ventilação mecânica. Esses profissionais, divididos por subtemas em duplas, responsabilizaram-se por fazer revisão extensa da literatura mundial sobre cada subtema. Reuniram-se todos no Forum de Ventilação Mecânica na sede da AMIB em São Paulo, em 03 e 04 de agosto de 2013 para finalização conjunta do texto de cada subtema e apresentação, apreciação, discussão e aprovação em plenária pelos 58 participantes, permitindo a elaboração de um documento final.

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumonia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

Intercâmbios acadêmicos internacionais: bolsas Capes, CNPq e Fapesp / International academic exchange programs: Capes, CNPq and Fapesp fellowships

Este artigo é parte de pesquisa que atenta para o peso crescente que a circulação internacional de pessoas, saberes e práticas tem alcançado nos processos de escolarização e formação profissional de determinados setores sociais. Considerando os recursos públicos que a Capes, o CNPq e a Fapesp destinam à formação de pesquisadores com vistas ao fomento à pesquisa e aos investimentos em ciência e tecnologia no horizonte da circulação internacional, recortamos para este artigo a descrição e a análise preliminares da base de dados de bolsistas no exterior dessas agências de fomento, no período de 1970 a 2000. O movimento de fluxos, a partir da metodologia quantitativa de correlação de variáveis, desenha as tendências dos intercâmbios acadêmicos internacionais promovidos pelas três agências e nas diversas áreas do conhecimento, sendo que se procura contextualizá-las nas políticas de desenvolvimento científico-tecnológico desenvolvidas pelo Estado brasileiro no período.(AU)

This article is part of a study considering the growing importance of the international transit of people, knowledge, and practices in the schooling and professional education processes of some social segments. Considering the public funds made available by the Coordination for the Improvement of Higher Education Personnel - Capes -, the National Council for Scientific and Technological Development - CNPq - and the State of São Paulo Research Foundation - Fapesp - to support researchers' fellowships abroad, aming to improve research and investments on Science and Technology on the context of international exchanges, we have dedicated this article to the preliminary description and analysis of the database of fellows funded abroad by these research agencies from 1970 to 2000. The movement of flows based on the quantitative methodology of the correlation of variables draws the trends of international academic exchange programs in the three research institutions and in the different areas of knowledge, and we intend to analyse them taking into account the scientific and technological development policies adopted by Brazilian State on the period.(AU)

Evaluation of blood transfusion effects on mixed venous oxygen saturation and lactate levels in patients with SIRS/sepsis.

PURPOSE: To evaluate the effects of red blood cell transfusion in patients with SIRS/sepsis who presented hemoglobin levels under 9.0 g/dL at intensive care unit admission, using two parameters of organ perfusion: mixed venous oxygen saturation and serum lactate levels. METHODS: All patients admitted to the intensive care unit with SIRS/sepsis, as defined by Consensus Conference in 1992, and hemoglobin levels under 9.0 g/dL were included. Hemoglobin levels, mixed venous oxygen saturation, and lactate levels were collected before red blood cell transfusion (pre-T) and up to 1 hour after transfusion (post-T). These variables were analyzed through a paired t test, and results were considered significant if P < .05. RESULTS: Twenty-nine patients (17 male, 12 female) with ages of 61.9 +/- 15.1 (mean +/- SD) years (range, 21-85 years) and a mean APACHE II score of 12.5 +/- 3.75 (7-21) were transfused with a mean of 1.41 packed red cell units. A significant increase in hemoglobin levels was reached by blood transfusion, from 8.14 +/- 0.64 g/dL (pre-T) to 9.4 +/- 0.33 g/dL (post-T), with P <.001. However, this was not accompanied by a significant change in lactate levels, from 1.87 +/- 1.22 mmol/l (pre-T) to 1.56 +/- 0.28 mmol/l (post-T), with P =.28, or in mixed venous oxygen saturation, from 64.3 +/- 8.52% (pre-T) to 67.4 +/- 6.74% (post-T), with P = .13. The results were similar even in patients with hemoglobin levels under 8.0 g/dL (n = 9). These results suggest that red blood cell transfusions, in spite of leading to a significant increase in hemoglobin levels, are not associated with an improvement in tissue oxygenation in patients with SIRS/sepsis and hemoglobin levels < 9 g/dL.

Evaluation of blood transfusion effects on mixed venous oxygen saturation and lactate levels in patients with SIRS/sepsis

OBJETIVOS: Avaliar o efeito da transfusão de hemáceas em pacientes com SIRS/sepse que apresentaram níveis de hemoglobina abaixo de 9,0g/dL durante internação em unidade de terapia intensiva, usando dois parâmetros de perfusão orgânica, a saturação venosa mista de oxigênio e os níveis de lactato sérico. MÉTODOS: Todos os pacientes admitidos na Unidade de Terapia Intensiva com SIRS/sepse, como definido pela Conferência de Consenso de 1992, e níveis de hemoglobina abaixo de 9,0g/dL foram incluídos. Os níveis de hemoglobina, saturação venosa mista de oxigênio e lactato sérico foram coletados antes (pré-T) e após uma hora da transfusão de hemáceas (pós-T). Essas variáveis foram analisadas através do teste T de Student pareado e os resultados considerados significativos se p<0,05. RESULTADOS: Vinte e nove pacientes (17 homens e 12 mulheres) com idade média de 61,9±15,1 anos (21-85anos) e índice APACHE II de 12.5±3.75 (7-21) foram transfundidos com uma média de 1,41 unidades de hemáceas. Um aumento significativo dos níveis de hemoglobina foi atingido com a transfusão: 8,14g/dL±0,64 (pré-T) e 9,4±0,33g/dL (pós-T), com p<0,0001. Entretanto, isso não foi acompanhado por mudança significativa dos níveis de lactato: 1,87±1,22mmol/l (pre-T) e 1,56±0,28mmol/k (pós-T), com p=0,28, ou da saturação venosa mista de oxigênio: 64,3±8,52% (pre-T) e 67,4±6,74% (pós-T), com p=0,13. Os resultados foram semelhantes mesmo nos pacientes com hemoglobina abaixo de 8,0g/dL. Todos os resultados estão expressos em média ± desvio padrão. Esses resultados sugerem que transfusões de hemácias, apesar de levarem a aumento significativo dos níveis de hemoglobina, não estão associadas à melhora da oxigenação tecidual em pacientes com SIRS/sepse e hemoglobina abaixo de 9,0g/dL.