BOLETIM INFORMATIVO ABRASCO

Presidente da ABRASCO participa do 7th World Ageing & Generations Congress O presidente da ABRASCO, Luiz Augusto Facchini, participou hoje do Painel "Demography Meets Health –The Future of Health Care in the Developed and Developing World" no 7th. World Ageing & Generations Congress. A mesa foi coordenada por Chris Singleton (Director Medical Insurance Europe, Swiss Re, Switzerland), e contou com a participação de Cornelia Meyer (CEO MRL Corporation, London, UK), Sania Nishtar (Founder and President of Heartfile, Pakistan) e Jack Watters (Vice-President for External Medical Affairs at Pfizer, USA). O objetivo da atividade foi discutir a demanda por cuidados, as inovações necessárias e as formas de financiamento dos serviços e sistemas de saúde nas diferentes partes do mundo. O Congresso está sendo realizado na University of St. Gallen (Suíça) até o dia 2 de setembro. O Prof. Luiz Facchini é colaborador do projeto "Estudo Longitudinal de Saúde e Bem-estar dos idosos" (Elsi-Brasil), pesquisa que deve começar a ser implementada em 2012. Veja a programação completa do evento clicando aqui.

ABRASCO participa de ato público pela regulamentação da EC-29 e do lançamento da campanha Primavera da Saúde O vice-presidente da ABRASCO, Luis Eugênio Portela, e a pesquisadora Eli Iola Gurgel representaram a Associação no ato público pela regulamentação da Emenda Constitucional 29, realizado no último dia 24 de agosto, em Brasília. O ato, convocado pelo Conselho Nacional de Saúde (CNS), contou com a participação de aproximadamente 500 militantes do SUS e teve o apoio de diversas entidades que lutam pelo SUS como: AMERESP, ANPG, Cebes, COBAP, CGTB, CONAM, CMP, CNTSS, CONASS, CONASEMS, CONTAG, CUT, FENAFAR, além de conselhos estaduais e municipais de saúde (com destaque para a delegação mineira de Belo Horizonte e Ibirité). Na ocasião foi lançada a campanha "Primavera da Saúde" pretende realizar uma longa jornada de lutas e mobilizações em defesa da saúde pública brasileira, buscando em especial fortalecer o movimento por uma formatação da regulamentação da EC29 que traga mais recursos para a saúde. O primeiro ato da campanha será um abraço ao Palácio do Planalto, na manhã do dia 14 de setembro. Veja a matéria clicando aqui.

Rede de Pesquisa APS comemora o primeiro ano de existência de seu portal e mais de três mil pesquisadores cadastrados Ao completar um ano do lançamento de seu portal, a Rede de Pesquisa em Atenção Primária à Saúde comemora ter ultrapassado a marca de mais de três mil pesquisadores e profissionais de APS cadastrados. "O principal objetivo da Rede é proporcionar o conhecimento e o intercâmbio entre pesquisadores, gestores do SUS, trabalhadores em saúde e demais interessados nas questões atenção primária à saúde. Queremos valorizar os pesquisadores em APS e ampliar o reconhecimento dessa área", afirma a coordenadora da Rede, Inaiara Bragante. No Portal os visitantes podem acessar entrevistas com profissionais de destaque na área, estudos relevantes, editais de pesquisas, notícias, eventos, fóruns de discussão, dentre outros. Visite o site e confira: www.rededepesquisaaps.org.br.

Como fortalecer os acertos e corrigir as fragilidades do Estratégia Saúde da Família Com o objetivo de contribuir no processo de fortalecimento da especialidade e da Estratégia Saúde da Família (ESF), a Sociedade Brasileira de Medicina de Família e Comunidade (SBMFC), em parceria com suas associações estaduais, trouxe ao Brasil os médicos generalistas espanhóis especialistas em APS e reforma da saúde pública, Juan Gérvas Camacho e Mercedes Pérez Fernández, ambos do “Team CESCA”, em Madrid (Espanha). Juntos, desenvolveram o “Projeto para avaliar a Estratégia Saúde da Família (ESF) em ambientes com baixo Índice de Desenvolvimento Humano (IDH) no Brasil”, que consistiu em duas etapas que aconteceram entre abril e junho de 2011(veja o escopo do projeto). Gérvas e Mercedes percorreram as cinco regiões do País, tendo visitado 70 centros de saúde, que em sua maioria, aplicavam o modelo de ESF. Além disto, no âmbito do intercâmbio científico, foram estabelecidas rodas de conversa com os especialistas ligados a ESF, muitas vezes com a presença de representantes das secretarias de saúde e dos departamentos de atenção básica locais. Muitas destas palestras foram registradas em vídeo pelos MFCs e postadas no Youtube (no canal SBMFC Oficial). Assim, com base nas observações e vivências em campo de Gérvas e Mercedes, foi elaborado o "Resumen Técnico para Políticos , Gestores y Profesionales Sanitarios con Responsabilidades en Organización y Docencia", que consiste no relatório final com instruções para aprimorar o sistema e romper o ciclo vicioso que gera a má qualidade do trabalho sanitário, clínico e comunitário em países como o Brasil. O presidente da ABRASCO, Luiz Augusto Facchini, parabenizou a iniciativa destacando que "a Saúde da Família precisa de esforços dessa cepa, que ajudem a torná-la mais efetiva e humana".  Clique nos links para acessar o resumo executivo e o relatório final do Projeto. Mais detalhes aqui.

Saúde, Trabalho e Ambiente em pauta permanente O número de agosto da Revista Ciência & Saúde Coletiva, que tem como tema "Saúde, Trabalho e Ambiente em pauta permanente", já está à disposição dos leitores, nos formatos impresso e eletrônico. Neste número a Revista apresenta um conjunto de textos sobre saúde do trabalhador e ambiente que de certa forma representa a dimensão e a variedade da produção científica da área: pesquisas sobre trabalhadores do setor de serviços como médicos, policiais, administrativos, garis entre outros; do setor agrícola, como o caso de populações expostas a agrotóxicos e de operários da agroindústria sucroalcooleira; do setor industrial como adoecimento de mineradores e exposição a riscos; e do setor artesanal como as lesões por esforço repetitivo entre marisqueiras. Há também vários artigos específicos sobre problemas ambientais relacionados à exposição a agentes químicos, à qualidade da água e à relação entre contaminação e adoecimento. Em quase todos os trabalhos, os problemas de saúde e ambiente são tratados em interação. Sobretudo o artigo de debate aprofunda a questão da interdisciplinaridade e da interprofissionalidade na vigilância em saúde do trabalhador. Nas abordagens, observam-se os influxos das mudanças contemporâneas no âmbito das relações de trabalho, acompanhando um movimento mundial de reestruturação produtiva que se associa, sem eliminá-las, a formas arcaicas de produção. Veja o sumário da Revista clicando aqui.

IEA 4th International Course on Epidemiological Methods The "IEA 4th International Course on Epidemiological Methods" will be hosted by Universidad Peruana Cayetano Heredia (Lima - Peru), May 7-18, 2012. Application Deadline: November 1, 2011. The IEA is offering an intermediate level residential course on  epidemiological methods, which will include lectures, computer-based analyses, exercises, discussion sessions, and practical experience in the design of a research proposal. The course will be of interest to epidemiologists, public health professionals, statisticians, and clinicians. In addition to epidemiological study design and analyses, special one-day modules will cover social epidemiology, genetic epidemiology, causal inference, meta-analyses and how to write and publish scientific articles. The course directors are Cesar Victora (Brazil),  Neil Pearce (UK), Luis Huicho (Peru) and Jaime Miranda (Peru). The faculty also includes Patricia Buffler (USA), George Davey-Smith (UK), Bianca de Stavola (UK), Shah Ebrahim (India), and Matthias Egger (Switzerland). For further information click here.

Uma saída para a crise no setor de saúde O artigo “uma saída para a crise no setor de saúde”, de autoria de Renato Veras, Diretor da Universidade Aberta da Terceira Idade (UNATI/UERJ) aborda a proposta da Agência Nacional de Saúde Suplementar (ANS) de estimular a adesão dos beneficiários de planos de saúde privados a programas de envelhecimento ativo, e incentiva as operadoras a adotarem esses programas. Nesta ação os idosos passariam a receber benefícios pecuniários para aderir a programas de saúde preventiva e detecção precoce de doenças. A população brasileira envelhece aceleradamente, incorporando todo ano 700 mil novos idosos à pirâmide etária brasileira, a maior parte com doenças crônicas, alguns com limitações funcionais. “O aumento da expectativa de vida é positivo, mas é preciso agregar qualidade a esses anos adicionais. Os planos de saúde operam numa espécie de mutualismo, em que os menos saudáveis consomem mais serviços e inflacionam os valores pagos por quem está em boa forma. As empresas terão de se adaptar, pois não é cabível manter a lógica da doença. A proposta da ANS implica reorganizar os serviços de saúde e oferece mecanismos de indução também para os consumidores, cuja adesão é fundamental para o sucesso das ações preventivas. A iniciativa assume as particularidades do idoso e o situa como protagonista no sistema de saúde”, afirma Veras. Para o pesquisador, sem uma abordagem preventiva e integral que associe reflexão epidemiológica e planejamento sistemático de ações de saúde, não há saída possível para a crise de financiamento e reestruturação do setor. Para o presidente da ABRASCO, Luiz Augusto Facchini, “tema é por demais oportuno no âmbito dos serviços de saúde, particularmente para os planos de saúde que não são orientados na lógica da APS e da promoção e da prevenção”. Veja o artigo completo clicando aqui.

Natural Therapies: Cardiologists Examine Alternatives to Halt High Blood Pressure

ScienceDaily (Aug. 30, 2011) — More and more, patients show up to appointments with hypertension expert John Bisognano, M.D., Ph.D. carrying bags full of "natural" products that they hope will help lower their blood pressure. And like most physicians, Bisognano doesn't always know if these products will do any good, or if they will cause any harm.

Mistletoe. Mistletoe extract, used in traditional Chinese medicine to treat hypertension, was identified as a potential treatment. Mistletoe extract reduced blood pressure in animal studies, but experts caution that it may be toxic at high doses. 

"Right now we're seeing a cultural shift where an increasing number of people want to avoid standard pharmaceuticals," said Bisognano, professor of Medicine and director of Outpatient Cardiology at the University of Rochester Medical Center. "We're also seeing a growing number of patients who require a large number of drugs to control their blood pressure and are looking for something else to help manage it."

In an effort to better educate health care professionals and patients, Bisognano and Kevin Woolf, M.D., a cardiology fellow at the Medical Center, conducted the most comprehensive review to date of the evidence behind a wide range of non-drug interventions for the treatment of high blood pressure. The review is featured in the September issue of the Journal of Clinical Hypertension.

Woolf said there is not enough data to recommend any of these alternative options on a routine basis, but on an individual basis he thinks they are useful. "Patients have different backgrounds and different approaches to living their lives," said Woolf. "This is where the art of medicine comes in; getting to know patients and what they will and will not embrace can help physicians identify different therapies that suit their patients' habits and that will hopefully make a difference for them."

Woolf and Bisognano, who is a member of the editorial board of the Journal of Clinical Hypertension, emphasize that all patients with hypertension should adhere to the low-salt DASH diet, which is high in fiber, low in fats and incorporates lots of fruits and vegetables, and follow an exercise and weight loss regimen -- lifestyle modifications recommended by the American Heart Association. Any alternative options should be considered for use in addition to these lifestyle changes.

When it comes to safety, Bisognano adds, "These alternative options are usually harmless, except when they keep patients from taking medications they need to take. If a patient is taking a supplement instead of something that we know is useful, that could be a problem."

Dietary Supplements

The shining star among supplements is coenzyme Q10, an enzyme involved in energy production that also acts as an antioxidant. Patients with hypertension tend to have lower levels of the enzyme, and a meta-analysis -- an overarching analysis of past studies -- found that treatment with coenzyme Q10 supplements significantly reduced blood pressure.

Woolf noted that "Coenzyme Q10 has a pretty profound effect on blood pressure, but whenever research is based on a collection of other data you have to have some skepticism." Woolf said he still thinks the compound is promising.

Woolf also found that potassium helps lower blood pressure, and there is evidence that increasing the amount of potassium we get through the foods we eat could carry some of the same mild benefits as taking supplements.

Herbal Remedies

The potential herbal remedies Woolf identified include mistletoe extract, used in traditional Chinese medicine to treat hypertension. Mistletoe extract reduced blood pressure in animal studies, but Woolf cautions that it may be toxic at high doses. The extract from Hawthorn, a type of tree, is also used, but provides only a slight reduction in blood pressure. Conversely, Woolf uncovered a handful of herbal remedies -- St. John's wort, ephedra/ma huang, yohimbine and licorice -- that may increase blood pressure.

Woolf and Bisognano stress that the Food and Drug Administration does not regulate dietary and herbal supplements the way they regulate traditional pharmaceuticals. They say health care providers and patients need to be aware that the safety of these products is not always rigorously established and that formulations can vary.

Acupuncture/Meditation

Research on both practices is mixed -- the types of patients included, the methods used, and the results, which vary from study to study. While there is no conclusive evidence that either lowers blood pressure, researchers found that acupuncture reduces blood pressure compared to placebo in patients also taking anti-hypertensive medications, while in a meta-analysis, transcendental meditation appeared to lower blood pressure. Other techniques that may provide some benefit include Zen Buddhist meditation and Qi Gong.

Devices

Some devices developed in recent years involve a medical procedure, while others use technology that requires patients to participate in various exercises.

Those that involve a procedure include the implantable Rheos®device, which regulates blood pressure much like a pacemaker regulates heart rhythm, and the Symplicity® catheter system, which ablates or destroys nerves around the kidneys that send inappropriate signals to the brain to increase blood pressure. Both are designed for patients with difficult-to-treat hypertension and led to significant drops in blood pressure in clinical trials. They are only available to research participants at this time.

Two devices that patients can use in the comfort of their own homes are the RESPeRATE breathing device and the Zona Plus hand drip device. The RESPeRATE system uses a breath sensor and gives patients feedback through headphones to help them slow their breathing, which research suggests benefits blood pressure. If used 15 minutes a day, studies show RESPeRATE leads to a modest decrease in hypertension.

The Zona Plus is a device that patients grip in either hand and perform multiple sets of squeezing at different levels in response to electronic cues. Bisognano says there is no good explanation as to why this works, but studies found the device decreased hypertension in patients using it three days a week for at least eight weeks. Patients can buy both devices for between $300 and $400, and Bisognano suggests them to interested patients.

The Pancreas as We’ve Never Seen It Before

ScienceDaily (Aug. 30, 2011) — Professor Ulf Ahlgren and associates at Umeå University in Sweden are a leading research team in the world in the development of optical projection tomography. With the aid of this imaging technology, they have now described aspects of how the pancreas develops during embryonic development and how the so-called islets of Langerhans are distributed in the adult organ. The findings are important for the interpretation of modeling systems for diabetes.

OPT images depicting two views of the embryonic stomach, intestine, and pancreas of a mouse. The newly developed algorithms presented in IEEE Transactions on Medical Imaging allow OPT imaging of biomedical preparations in great detail. The study was performed in collaboration with researchers at the Centre for Genomic Regulation in Barcelona, Spain, as well as the Department of Computer Science at Umeå University and Umeå Centre for Molecular Medicine (UCMM). The two images depict the same preparation; the image on the right is rotated 180 degrees.

New methods for the Optic Projection Tomography (OPT) imaging technology are presented by Umeå researchers in the journal,IEEE Transactions on Medical Imaging. Using these methods, the researchers have also made new discoveries about the developmental biology and adult structure of the pancreas. These discoveries are being published in the journals PLoS ONE and Islets.

OPT is a technique for three-dimensional visualization of gene and protein expression in tissue samples. The technology, which is broadly similar to medical computer tomography, uses ordinary light instead of x-rays and is being used more frequently in basic research fields such as developmental biology, plant biology and pathology. OPT, which was originally limited to analyses of small preparations, has previously been refined by the Umeå scientists to enable analysis of entire organs, such as the pancreas from various rodent model systems to understand diabetes.

In the study now being presented in IEEE Transactions on Medical Imaging the researchers describe a computer-based technique for correcting distortions in the creation of OPT images. The newly developed methods contribute generally to enhanced quantitative and visual OPT analyses in various types of tissues by increasing the sensitivity to small and faintly illuminated objects and by creating a more exact reproduction of the cells depicted in the tissue.

Using the newly developed methods, the scientists present new findings about the developmental biology and structure of the pancreas. The pancreas contains the so-called islets of Langerhans, which produce the hormone insulin. Disrupted insulin production and/or in the ability of the body's cells to respond to insulin signals can lead to diabetes.

In one of the studies, presented in the journal PLoS ONE, the researchers describe the developmental biological conditions for the formation of the so-called gastric lobe of the pancreas in the embryo. The development of this part of the pancreas has not been described in detail. However, the scientists in Umeå have found that this part of the pancreas is dependent on the normal development of the nearby spleen in order to form.

In yet another study, in the journal Islets, the researchers show that the insulin-producing islets are more numerous and considerably more unevenly distributed in the pancreas than was previously thought. For instance, the gastric lobe of the pancreas contains relatively more islets of Langerhans than the rest of the organ does.

Taken together, these studies offer information that is valuable to help evaluate how hereditary and environmental factors affect the number of insulin producing cells in various model systems for diabetes. The studies were made possible by grants from the Kempe Foundations, among others.

Journal of Veterinary Emergency and Critical Care

1. Case Reports

   1. You have full text access to this content
      Mojave toxin-type ascending flaccid paralysis after an envenomation by a Southern Pacific Rattlesnake in a dog

      Sarah R. Hoggan, Amy Carr and Karen A. Sausman

      Article first published online: 24 AUG 2011 | DOI: 10.1111/j.1476-4431.2011.00668.x

      • Abstract
      • Full Article (HTML)
      • PDF(428K)
      • References
      • Request Permissions

2. Retrospective Study

   1. You have full text access to this content
      Outcome and medical management in dogs with lower motor neuron disease undergoing mechanical ventilation: 14 cases (2003–2009)

      Christine R. Rutter, Elizabeth A. Rozanski, Claire R. Sharp, Lisa L. Powell and Marc Kent

      Article first published online: 24 AUG 2011 | DOI: 10.1111/j.1476-4431.2011.00669.x

      • Abstract
      • Full Article (HTML)
      • PDF(190K)
      • References
      • Request Permissions

3. Original Study

   1. You have full text access to this content
      The use of deep oral swabs as a surrogate for transoral tracheal wash to obtain bacterial cultures in dogs with pneumonia

      Catherine M. Sumner, Elizabeth A. Rozanski, Claire R. Sharp and Scott P. Shaw

      Article first published online: 24 AUG 2011 | DOI: 10.1111/j.1476-4431.2011.00670.x

      • Abstract
      • Full Article (HTML)
      • PDF(152K)
      • References
      • Request Permissions

4. Case Reports

   1. You have full text access to this content
      Cholinergic crisis after neostigmine administration in a dog with acquired focal myasthenia gravis

      Daniel S. Foy, Lauren A. Trepanier and G. D. Shelton

      Article first published online: 24 AUG 2011 | DOI: 10.1111/j.1476-4431.2011.00672.x

      • Abstract
      • Full Article (HTML)
      • PDF(145K)
      • References
      • Request Permissions