Carlos Eduardo Aguilera Campos

O desafio da integralidade segundo as perspectivas da vigilância da saúde e da saúde da família

Multiplos aspectos relacionados a formulacao de politicas, a construcao do conhecimento e a implementacao das praticas no setor saude interagem mutuamente e tem como produto a maneira como se prestam os servicos de saude em determinado contexto historico ou ainda resultam na disponibilidade ou na escassez de um determinado conjunto de acoes e servicos de saude. Compreender essas relacoes e fundamental para se avaliar a trajetoria da politica de saude no pais. Tomando-se como referencia o principio constitucional da integralidade da atencao a saude e os desafios de sua implementacao, analisam-se as formulacoes teoricas relacionadas ao conceito de Vigilância da Saude e as mudancas implementadas pelo Ministerio da Saude no campo da Atencao Basica e da Saude da Familia. Busca-se ainda analisar em que medida essas proposicoes contribuem atualmente para o desenvolvimento do Sistema Unico de Saude.

Avaliação da atenção básica pela perspectiva dos usuários: adaptação do instrumento EUROPEP para grandes centros urbanos brasileiros

Satisfaction with health care is a multidimensional concept that considers aspects such as access, organization and professional-user interaction. The aim of this study was to adapt and apply an instrument in the Family Health Strategy (FHS) to assess user satisfaction with Primary Health Care (PHC) based on the European Task Force on Patient Evaluation of General Practice Care (EUROPEP), which refers to user satisfaction wth general and family medicine services. The instrument consists of five dimensions of satisfaction: relationship and communication, medical care, information and support, continuity and cooperation, and organization of services. The study was divided into phases: review and adjustment of the instrument and application to a representative sample of users of the FHS in Rio de Janeiro. The averages of the proportions of answers for each indicator were calculated to analyze the results. Relationship and communication between professionals and users received the best evaluation and Organization of Services eceived the worst appraisal. Regarding education level, good self-perceived health and more elderly were more satisfied. The instrument proved to be easy to apply, can be routinely used for monitoring of the FHS, and is a tool for the institutionalization of evaluation.

Estratégias de avaliação e melhoria contínua da qualidade no contexto da Atenção Primária à Saúde

Recent governmental initiatives allowed for quality assessment proposals to Primary Healthcare in Brazil. This is a new field but a priority in the current strengthening of Family Health strategy following a decade of expansion and consolidation. This article focuses on assessment and quality improvement strategies in the context of Primary Healthcare.

Os inquéritos de saúde sob a perspectiva do planejamento

This study examines the importance of household surveys for evaluating the implementation of district-based health systems for the delivery of health services. The concepts underlying health surveys and the literature on health surveys in the Third World are reviewed, and significant methodological problems are also discussed. Although many authors dealing with this issue consider household health surveys of capital importance for the planning of health services, that was not the situation encountered by the author, who rarely found examples of the applicability of such studies. The potential use of less complex and quicker studies was a solution proposed by some authors to increase the presence of surveys in health planning. Finally, national health surveys are also analyzed.

Exercise-induced neuroprotective effects on neurodegenerative diseases: the key role of trophic factors

ABSTRACT Age-related neurodegenerative disorders, like Alzheimer’s or Parkinson’s disease, are becoming a major issue to public health care. Currently, there is no effective pharmacological treatment to address cognitive impairment in these patients. Here, we aim to explore the role of exercise-induced trophic factor enhancement in the prevention or delay of cognitive decline in patients with neurodegenerative diseases. There is a significant amount of evidence from animal and human studies that links neurodegenerative related cognitive deficits with changes on brain and peripheral trophic factor levels. Several trials with elderly individuals and patients with neurodegenerative diseases report exercise induced cognitive improvements and changes on trophic factor levels including BDNF, IGF-I, among others. Further studies with healthy aging and clinical populations are needed to understand how diverse exercise interventions produce different variations in trophic factor signaling. Genetic profiles and potential confounders regarding trophic factors should also be addressed in future trials.

As origens da rede de serviços de atenção básica no Brasil: o Sistema Distrital de Administração Sanitária

There exists an interaction between multiple issues involving policy making, the building of knowledge and the implementation of practices in the health sector, which results in the particular way health services are provided in different historical contexts. The emergence and consolidation of sanitation organization was the result of a political process based on an idea of meeting the needs perceived in a given historical context. The historical course taken by the basic healthcare system in Brazil is analyzed from the perspective of its organizational and welfare principles, its expansion in physical terms, and its function within the public health system between 1918 and 1942. The article seeks to describe in detail the antecedents and initiatives taken in the establishment of a district system of sanitation administration, first in Rio de Janeiro and later across Brazil, which was a precursor of the basic healthcare system in Brazil.

Transgenerational Inheritance of Paternal Neurobehavioral Phenotypes: Stress, Addiction, Ageing and Metabolism

Epigenetic modulation is found to get involved in multiple neurobehavioral processes. It is believed that different types of environmental stimuli could alter the epigenome of the whole brain or related neural circuits, subsequently contributing to the long-lasting neural plasticity of certain behavioral phenotypes. While the maternal influence on the health of offsprings has been long recognized, recent findings highlight an alternative way for neurobehavioral phenotypes to be passed on to the next generation, i.e., through the male germ line. In this review, we focus specifically on the transgenerational modulation induced by environmental stress, drugs of abuse, and other physical or mental changes (e.g., ageing, metabolism, fear) in fathers, and recapitulate the underlying mechanisms potentially mediating the alterations in epigenome or gene expression of offsprings. Together, these findings suggest that the inheritance of phenotypic traits through male germ-line epigenome may represent the unique manner of adaptation during evolution. Hence, more attention should be paid to the paternal health, given its equivalently important role in affecting neurobehaviors of descendants.

Can transcranial direct current stimulation on the dorsolateral prefrontal cortex improves balance and functional mobility in Parkinson’s disease?

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique increasingly explored for Parkinsons disease (PD). Although evidence is still inconsistent, there are preliminary findings suggesting its efficacy to improve motor function in individuals with PD, as the role of secondary motor areas remains unclear. The goal of this study was to investigate the effects of left dorsolateral prefrontal cortex (DLPFC) tDCS on balance and functional mobility of individuals with PD. Seventeen individuals with PD, on-medication, aged between 40 and 90 years were recruited to enroll in a double-blind, randomized, cross-over trial. Each participant completed two conditions at least 48h apart, namely anodal-tDCS and sham-tDCS (placebo). The a-tDCS condition targeted the left DLPC (F3) and was applied during 20min using a 2mA current intensity. In the sham-tDCS condition, electrode position remained the same but the stimulator was turned off after 30s. Functional mobility and balance were assessed using the Berg Balance Scale, Dynamic Gait Index and Timed Up and Go. There were significant differences between conditions on all outcome measures, as the a-tDCS condition was associated with better performance in comparison to the sham condition (p<0.05). Our findings suggest that a-tDCS on the left DLPFC improves balance and functional mobility in comparison to sham-tDCS. Compensatory mechanisms that support motor function in individuals with PD may have been enhanced by a-tDCS on the DLPFC, leading to improved functional mobility and balance. Future trials should explore left DLPFC stimulation with larger samples and compare t-DCS protocols targeting several brain regions.

Neuroplastic Changes Following Social Cognition Training in Schizophrenia: A Systematic Review

Social cognitive impairment is a key feature of schizophrenia and social cognition training (SCT) is a promising tool to address these deficits. Neurobiological dysfunction in schizophrenia has been widely researched, but neuronal changes induced by SCT have been scarcely explored. This review aims to assess the neuroplastic effects of SCT in patients with schizophrenia spectrum disorders. PubMed and Web of Science databases were searched for clinical trials testing the effects of SCT in functional and structural brain measurements of adult patients with schizophrenia or schizoaffective disorders. A total of 11 studies were included: five used fMRI, two used EEG and ERP, one used ERP only, two used MEG and one study used MRI. Data extracting and processing regarding sociodemographic and clinical variables, intervention characteristics, neuroimaging procedures, neuroplastic findings, effect sizes and study quality criteria was completed by two raters. Results indicate a wide range of structural and functional changes in numerous regions and circuits of the social brain, including early perceptual areas, the limbic system and prefrontal regions. Despite the small number of trials currently available, evidence suggests that SCT is associated with neuroplastic changes in the social brain and concomitant improvements in social cognitive performance. There is a lack of extensive knowledge about the neural mechanisms that underlie social cognitive enhancement after treatment, but the reported findings may shed light on the neural substrates of social cognitive impairment in schizophrenia and how improved treatment procedures can be developed and applied.

Estudo sobre dimensões da avaliação da Estratégia Saúde da Família pela perspectiva do usuário

A satisfacao dos usuarios e um dos componentes basicos da qualidade de qualquer servico de saude. Tem sido crescente a incorporacao desse aspecto em estudos avaliativos de unidades e equipes de Atencao Basica a Saude. No Brasil, esse processo ainda e incipiente, com poucos instrumentos disponiveis, adequados e validados. O objetivo deste trabalho foi investigar as dimensoes mais valorizadas pelos usuarios. Sua metodologia contou com a realizacao de dois grupos focais em duas unidades basicas de saude (UBS) com contextos distintos para ampliar as possibilidades de resposta. Foram feitas analise de conteudo e categorizacao das falas em dimensoes e subdimensoes da satisfacao. Chegou-se a um total de 17 dimensoes, sendo as mais citadas: 1) acesso e disponibilidade do servico de saude; 2) organizacao dos processos de trabalho; 3) relacao com os profissionais de saude; 4) longitudinalidade do cuidado e estabelecimento de vinculo entre profissionais e usuarios; e 5) coordenacao do cuidado. Conclui-se que conhecer as dimensoes da satisfacao mais valorizadas pelo usuario e essencial para a construcao de instrumentos mais adequados ao contexto da ESF no pais.