Secretaria de Estado de Saúde do Rio de Janeiro

Enteric glial cells were first described at the end of the 19th century, but they attracted more interest from researchers only in the last decades of the 20th. Although, they have a different embryological origin, the enteric GLIA share many characteristics with astrocytes, the main glial cell type of the central nervous system (CNS), such as in their expression of the same markers and in their functions. Here we review the construction of the enteric nervous system (ENS), with a focus on enteric glia, and also the main studies that have revealed the action of enteric glia in different aspects of gastrointestinal tract homeostasis, such as in the intestinal barrier, in communications with neurons, and in their action as progenitor cells. We also discuss recent discoveries about the roles of enteric glia in different disorders that affect the ENS, such as degenerative pathologies including Parkinson's and prion diseases, and in cases of intestinal diseases and injury.

This study analyzes the consistency of the Brazilian national information systems on mortality (SIM) and live births (SINASC) as data sources for evaluating health inequalities according to race/color. Infant mortality rates (IMRs) were obtained according to race/color from death and live birth certificates for the country as a whole and its regions, for the years 1999-2002. The IMR was also estimated according to race/ color, based on the incorporation of deaths and live births with race/color not reported by two criteria. The study compared the IMRs obtained in the study with those estimated by indirect methods. The IMR ratios were also calculated between race/color categories. A substantial reduction was observed during the period in the number of deaths and live births with race/color not recorded. In 2002, infant mortality in black children was 30.0% to 80.0% higher than that of white children and 40.0% to 80.0% higher than that of brown or mixed-race children (pardas); infant mortality in indigenous children was 40.0% to 90.0% higher than that of white or brown children. It is hoped that improved recording in the SIM and SINASC databases will allow a more in-depth discussion of health inequalities according to race, color, and ethnicity in Brazil.

This paper examines the national policy and its antecedents for reorientation of professional health training implemented after 2003. It highlights landmarks and transformations in the course of policies between 1980 and 2010, elements of continuity and change and the connections between past and current policy initiatives. The study involved a review of the literature on the subject and document analysis supported by theoretical analysis of public policies, particularly historical institutionalism. The results point to four different moments during the trajectory of the policy, marked by changes in the initiatives of reorientation of higher education in health: antecedents; initial experiences; university protagonism; broadening and enhancement. As an element of continuity, there is the permanence of objects in the guiding principles advocated in the policies. The evidence of implementation expresses prospects of enhancement, with diversification of mobilized actors and organizations, and more projects implemented. The accumulated experience suggests structural maturity of the structural bases of action and the main changes relate to the enhancement of decision-making bodies of the SUS and the approximation to the process of decentralization and regionalization of national health policy.

Brazil has extremely high cesarean rates. Among related factors, it has been suggested that a "culture of cesarean childbirth" (or a preference for this type of delivery) exists among Brazilian women. Our study investigates this notion. Data were collected from September 1998 to March 1999 in two maternity hospitals in Rio de Janeiro Interviews were conducted and hospital records analyzed for a random representative sample of 909 women who had just given birth (454 vaginal deliveries and 455 cesareans). In the interviews, when asked if they had wanted to have a cesarean, 75.5% replied in the negative, thus indicating that these women cannot be considered as adhering to a "culture of cesarean sections" The main complaints against cesareans were: slower and more difficult recovery (39.2%) and greater pain and suffering (26.8%). However, 17% of the sample had at some point requested a cesarean, 75% of whom during labor. Analysis revealed that the request for a cesarean section is directly proportional to time between admission to the hospital and delivery. This suggests that (in addition to being the usual means of access to tubal ligation) the actual circumstances of birthing are important factors in Brazilian women s requests for cesarean sections.

Cell populations with differing proliferative, stem-like and tumorigenic states co-exist in most tumors and especially malignant gliomas. Whether metabolic variations can drive this heterogeneity by controlling dynamic changes in cell states is unknown. Metabolite profiling of human adult glioblastoma stem-like cells upon loss of their tumorigenicity revealed a switch in the catabolism of the GABA neurotransmitter toward enhanced production and secretion of its by-product GHB (4-hydroxybutyrate). This switch was driven by succinic semialdehyde dehydrogenase (SSADH) downregulation. Enhancing GHB levels via SSADH downregulation or GHB supplementation triggered cell conversion into a less aggressive phenotypic state. GHB affected adult glioblastoma cells with varying molecular profiles, along with cells from pediatric pontine gliomas. In all cell types, GHB acted by inhibiting α-ketoglutarate-dependent Ten-eleven Translocations (TET) activity, resulting in decreased levels of the 5-hydroxymethylcytosine epigenetic mark. In patients, low SSADH expression was correlated with high GHB/α-ketoglutarate ratios, and distinguished weakly proliferative/differentiated glioblastoma territories from proliferative/non-differentiated territories. Our findings support an active participation of metabolic variations in the genesis of tumor heterogeneity.

OBJECTIVE: To evaluate the quality of birth care based on the World Health Organization guidelines. METHODS: A case-control study was carried out in a public and a private maternity hospitals contracted by the Brazilian Health System in the city of Rio de Janeiro, Brazil, from October 1998 to March 1999. The sample comprised 461 women in the public maternity hospital (230 vaginal deliveries and 231 Cesarean sections) and 448 women in the private one (224 vaginal deliveries and 224 Cesarean sections). Data was collected through interviews with puerperal women and review of medical records. A summarization score of quality of delivery care was constructed. RESULTS: There was low frequency of practices that should be encouraged, such as having an accompanying person (1% in the private hospital for both vaginal delivery and C-sections), freedom of movements throughout labor (9.6% of C-sections in the public hospital and 9.9% of vaginal deliveries in the private hospital) and breastfeeding in the delivery room (6.9% of C-sections in the public hospital and 8.0% of C-sections in the private hospital). There was a high frequency of known harmful practices such as enema administration (38.4%); routine pubic shaving; routine intravenous infusion (88.8%); routine use of oxytocin (64.4%), strict bed rest throughout labor (90.1%) and routine supine position in labor (98.7%) in vaginal deliveries. The best summarizing scores were seen in the public maternity hospital. CONCLUSIONS: The two maternity hospitals have a high frequency of interventions during birth care. In spite of providing care to higher risk pregnant women, the public maternity hospital has a less interventionist profile than the private one. Procedures carried out on a routine basis should be pondered based on evidence of their benefits.

INTRODUÇÃO:Em 1998, o Rio de Janeiro era o estado de maior incidência e mortalidade por tuberculose do Brasil. O Sistema de Informação de Agravos de Notificação em Tuberculose (SINAN-TB-RJ) não era confiável. OBJETIVO: Utilizar o estudo dos óbitos por tuberculose como instrumento de avaliação do programa de controle de tuberculose. MÉTODO: Foram realizados estudos descritivos do SINAN-TB-RJ e do Sistema de Informação de Mortalidade em tuberculose do Rio de Janeiro (SIM-TB-RJ) e os dois bancos de dados foram cruzados utilizando-se o programa Reclink. Foi também realizado um estudo baseado em prontuários dos cinco hospitais onde ocorreu o maior número de óbitos por tuberculose. RESULTADOS: Em 1998 foram registrados no SINAN-TB-RJ 16.567 casos de tuberculose em maiores de 14 anos. A forma pulmonar estava presente em 13.989 (84,5%) casos, dos quais 8.223 (56,8%) tiveram baciloscopia positiva. A sorologia anti-HIV, recomendada para todos os pacientes com tuberculose, foi solicitada em apenas 4.141 (25%) casos. No SIM-TB-RJ foram registrados 1.146 óbitos, dos quais 478 (41,7%) casos haviam sido notificados no SINAN-TB-RJ, entre 1995 e 1998. Dos 302 prontuários estudados, em 154 (50,9%) o período de internação foi inferior a 10 dias. O tempo entre o início dos sintomas e o diagnóstico foi superior a 60 dias em 143 (47,3%) pacientes. Dos 125 pacientes em re-tratamento, para apenas 43 (34,4%) foi prescrito o esquema RHZE recomendado pelo Ministério da Saúde. CONCLUSÃO: O estudo demonstra que a tuberculose é sub-notificada, o diagnóstico é tardio, a utilização dos exames laboratoriais recomendados é baixa e as normas do Ministério da Saúde não são cumpridas.

Using a judgment framework, this article analyzes the degree of implementation of the best practices in labor and childbirth care contained in the guidelines of the Rede Cegonha (RC) across Brazil. The study eligibility criteria were public and mixed hospitals located in a health region with a RC action plan in place in 2015, resulting in a total of 606 facilities distributed across the country. Three different data collection methods were used: face-to-face interviews with managers, health professionals and puerperal women; document analysis; and on-site observation. The framework was built around the five guidelines of the Labor and Childbirth component of the RC. Degree of implantation was rated as follows: adequate; partially adequate and inadequate. The performance of maternity facilities was rated as partially adequate for all guidelines except for hospital environment, which was rated as inadequate. A huge variation in degree of implementation was observed across regions, with the South and Southeast being the best-performing regions in most items. The results reinforce the need for an ongoing evaluation of the actions developed by the RC to inform policy-making and the regulation of labor and childbirth care.

Brazil has one of the world's highest cesarean section rates. Contributing factors include the organization of obstetric practice, physicians' attitudes, and women's preferences and decisions. This study aimed to identify factors associated with cesarean sections in a public maternity hospital in Rio de Janeiro. A case-control study was conducted with 231 cesarean sections (cases) and 230 vaginal deliveries (controls). Hierarchical logistic regression analysis was performed, based on a conceptual model. Factors associated with increased odds of cesarean section were: primiparity; mother's age 20-34; last birth by cesarean; cervical dilatation < 3cm at admission; patient request; daytime birth; male attending obstetrician; obstetrician on duty for more than 24 hours a week; obstetrician with private practice; gestational hypertension; non-cephalic presentation; and gestational age > 41 weeks. Factors associated with lower odds of cesarean were: gestational age < 37 weeks; leaving home with signs of labor, use of oxytocin; and amniotomy. In this hospital, interventions aimed to modify the above-mentioned factors can help lower the cesarean rate.

A história pregressa de tentativa de suicídio é um importante preditor do suicídio e de novas tentativas. Este artigo apresenta o perfil dos casos de tentativas de suicídio detectados por meio de um sistema de monitoramento para esses agravos em um hospital geral no Rio de Janeiro, Brasil. Entre abril de 2001 e março de 2002 foram registrados 160 tentativas de suicídio, sendo 68% entre mulheres e 26% entre adolescentes. A ingestão de pesticidas e o abuso de medicamentos foram os principais métodos utilizados. Mulheres utilizaram os dois métodos na mesma proporção, enquanto 2/3 dos homens empregaram pesticidas. Em relação à prevalência dos fatores de risco para tentativas de suicídio, identificou-se que 21% dos pacientes haviam procurado serviços de saúde nos trinta dias anteriores ao evento, 28% referiram tentativas anteriores, 23% fizeram referência a casos de tentativas ou suicídio na família. Ainda que os dados populacionais disponíveis sejam escassos, as tentativas de suicídio parecem ser um evento importante de morbidade, particularmente entre adolescentes e adultos jovens. Sistemas de vigilância para esse agravo podem ser úteis para um melhor conhecimento do problema.

The demands and tensions surrounding evidence-based policy (EBP) as part of results-based management have frequently indicated a gap between these concepts and the complex nature of health promotion interventions. This article discusses the challenges associated with the conceptual field of Health Promotion and the requirements for "proof" of effectiveness and efficiency faced by managers, evaluators, and local agents in the development of inter-sector health programs. The authors identify the limitations of epidemiological trials for the evaluation of social policies and use arguments related to "theories of change" in order to discuss the relationship of the "constructs" in the social policy intervention model and provide the basis for the "analysis of the contribution" of its effects. Systematic reviews of the "realist synthesis" type are discussed, due to their capacity for highlighting the theoretical framework of a specific program and explaining the underlying action mechanisms common to different programs and/or contexts. The authors argue that the expression and maintenance of expected social changes require the construction of collaborative processes, considering the set of (bottom-up) stakeholders involved in all stages of the process of developing and evaluating interventions.

PURPOSE: Glioblastomas (GBM) comprise 17% of all primary brain tumors. These tumors are extremely aggressive due to their infiltrative capacity and chemoresistance, with glial-to-mesenchymal transition (GMT) proteins playing a prominent role in tumor invasion. One compound that has recently been used to reduce the expression of these proteins is shikonin (SHK), a naphthoquinone with anti-tumor properties. Temozolomide (TMZ), the most commonly used chemotherapeutic agent in GBM treatment, has so far not been studied in combination with SHK. Here, we investigated the combined effects of these two drugs on the proliferation and motility of GBM-derived cells. METHODS: The cytotoxic and proliferative effects of SHK and TMZ on human GBM-derived cells were tested using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT), Ki67 staining and BrdU incorporation assays. The migration capacities of these cells were evaluated using a scratch wound assay. The expression levels of β3 integrin, metalloproteinases (MMPs) and GMT-associated proteins were determined by Western blotting and immunocytochemistry. RESULTS: We found that GBM-derived cells treated with a combination of SHK and TMZ showed decreases in their proliferation and migration capacities. These decreases were followed by the suppression of GMT through a reduction of β3 integrin, MMP-2, MMP-9, Slug and vimentin expression via inactivation of PI3K/AKT signaling. CONCLUSION: From our results we conclude that dual treatment with SHK and TMZ may constitute a powerful new tool for GBM treatment by reducing therapy resistance and tumor recurrence.

OBJECTIVE: To describe the prevalence of anemia and of its types in hospitalized patients with pulmonary tuberculosis. METHODS: This was a descriptive, longitudinal study involving pulmonary tuberculosis inpatients at one of two tuberculosis referral hospitals in the city of Rio de Janeiro, Brazil. We evaluated body mass index (BMI), triceps skinfold thickness (TST), arm muscle area (AMA), ESR, mean corpuscular volume, and red blood cell distribution width (RDW), as well as the levels of C-reactive protein, hemoglobin, transferrin, and ferritin. RESULTS: We included 166 patients, 126 (75.9%) of whom were male. The mean age was 39.0 ± 10.7 years. Not all data were available for all patients: 18.7% were HIV positive; 64.7% were alcoholic; the prevalences of anemia of chronic disease and iron deficiency anemia were, respectively, 75.9% and 2.4%; and 68.7% had low body weight (mean BMI = 18.21 kg/m2). On the basis of TST and AMA, 126 (78.7%) of 160 patients and 138 (87.9%) of 157 patients, respectively, were considered malnourished. Anemia was found to be associated with the following: male gender (p = 0.03); low weight (p = 0.0004); low mean corpuscular volume (p = 0.03);high RDW (p = 0; 0003); high ferritin (p = 0.0005); and high ESR (p = 0.004). We also found significant differences between anemic and non-anemic patients in terms of BMI (p = 0.04), DCT (p = 0.003), and ESR (p < 0.001). CONCLUSIONS: In this sample, high proportions of pulmonary tuberculosis patients were classified as underweight and malnourished, and there was a high prevalence of anemia of chronic disease. In addition, anemia was associated with high ESR and malnutrition.

This study aimed to assess whether nurses' presence in delivery care in maternity hospitals linked to the Rede Cegonha program promotes access to best obstetric practices during labor and delivery. We conducted an evaluative study in 2017 in all 606 SUS maternity hospitals that joined this strategic policy in all Brazilian states. We collected data from maternity hospital managers and puerperae. The analysis was performed at two levels: hospital with or without a nurse in delivery care; and professionals that attended vaginal delivery, whether doctors or nurses. We used best practices and interventions for vaginal deliveries and cesarean section rates as dependent variables. We included 5.016 subjects for analyses of vaginal deliveries and 9.692 to calculate cesarean section rates. Multiple regressions were adjusted for geographic region, maternity hospital size, and puerperae skin color and parity. Maternity hospitals with nurses in delivery care used more the partograph and less oxytocin, lithotomy, episiotomy, and cesarean section. Deliveries attended by nurses had more frequent use of the partograph and a lower likelihood of lithotomy and episiotomy. The inclusion of nurses in vaginal delivery care has successfully brought women closer to a more physiological and respectful delivery.

The Global Adult Tobacco Survey (GATS) was conducted in Brazil to provide data on tobacco use in order to monitor the WHO FCTC implementation in the country. It was carried out in 2008 using an international standardized methodology. The instrument included questions about tobacco use prevalence, cessation, secondhand smoke, knowledge, attitudes, media and advertising. Weighted analysis was used to obtain estimates. A total of 39,425 interviews were conducted. The prevalence of current tobacco use was 17.5%, (22.0%, men; 13.3%, women). The majority of users were smokers (17.2%) and their percentage was higher in rural areas (20.4%) than in urban areas (16.6%). About 20% of individuals reported having been exposed to tobacco smoke in public places. Over 70% of respondents said they had noticed anti-smoking information in several media and around 65% of smokers said they had considered quitting because of warning labels. About 30% of respondents had noticed cigarette advertising at selling points and 96% recognized tobacco use as a risk factor for serious diseases. Data in this report can be used as baseline for evaluation of new tobacco control approaches in Brazil, vis-à-vis WHO FCTC demand reduction measures.

A Organização Mundial de Saúde recomenda o aleitamento materno exclusivo nos primeiros 6 meses de vida. Foi realizado um estudo para verificar o impacto de um conjunto de procedimentos e estratégias efetivas de promoção, proteção e apoio à amamentação, realizadas no pré-natal e na pediatria de unidades básicas de saúde, sobre a amamentação exclusiva em bebês menores de 6 meses. Avaliou-se práticas como a realização de grupos de apoio à amamentação e visitas domiciliares, a informação sobre a importância do início precoce da amamentação, da livre demanda e sobre os riscos do uso de mamadeiras e chupetas, a orientação quanto à pega, posição, ordenha e contracepção, e o apoio emocional. Este conjunto de estratégias e procedimentos foi selecionado com base em uma revisão sistemática e gerou uma proposta de "Dez Passos para o Sucesso da Amamentação na Atenção Básica à Saúde" e uma metodologia de avaliação elaborada nos moldes da Iniciativa Hospital Amigo da Criança. Essa metodologia foi aplicada na avaliação de 24 unidades básicas de saúde do Estado do Rio de Janeiro. O desempenho foi considerado regular em 13 unidades e fraco em 11 unidades. Foi encontrada uma expectativa de duração do aleitamento materno exclusivo de 1,6 meses para os bebês menores de 6 meses assistidos pelo bloco de unidades de desempenho regular, e de 1,1 mês para os bebês acompanhados pelo bloco de desempenho fraco. Não foram encontradas diferenças significativas entre as características sociodemográficas das mulheres assistidas pelos 2 blocos. Concluímos que a implementação de uma Iniciativa de Promoção, Proteção e Apoio à Amamentação na Atenção Primária à Saúde contribui para intensificar a prática do aleitamento materno exclusivo entre os lactentes menores de 6 meses.

Brazil has developed policies for the prevention and control of obesity through the Brazilian Unified National Health System. This study analyzed the characteristics of proposed "models of care" reported by health professionals in primary care in the state of Rio de Janeiro. The methods included interviews and focus groups with professionals and managers in primary care and the thematic areas of food and nutrition in the 92 municipalities (counties) of Rio de Janeiro state and document analysis of federal and state legislation and guidelines. The analysis was oriented by the organizational and technical dimensions of care and the principles of comprehensive healthcare. The main challenges reported by health professionals pertained to adherence to the therapeutic process and feelings of frustration and powerlessness; multidisciplinary teamwork; and unpreparedness for dealing with the complexity of the health-disease process related to obesity. Some principles and guidelines based on the government policy documents are strategic for addressing these challenges, especially: shared responsibility between health professionals and users, which can help avoid the extremes of blaming and/or victimization; appreciation of other gains besides weight loss, which can redefine treatment adherence; and multidisciplinary teamwork to develop a contextualized understanding of the health-disease process and its multiple conditioning factors and for the health professionals to be able to cope with their own feelings and stigmas towards the person with obesity.

Este estudo comparou as informações contidas nos bancos de dados do Sistema de Informações Hospitalares (SIH-SUS) e do Sistema de Informações de Agravos de Notificação (Sinan) para estimar a subnotificação de casos de Aids no Município do Rio de Janeiro. Foi observado um elevado grau de subnotificação (42,7%) entre pacientes com a síndrome que tiveram acesso a unidades hospitalares relacionadas ao SUS. Análises bivariadas apontaram para a associação entre notificação no Sinan e faixa etária do paciente, diagnóstico principal e natureza jurídica do hospital.

Este artigo analisa a política nacional de reorientação da formação profissional em saúde, desenvolvida a partir de 2003, e seus antecedentes. Destaca marcos e transformações no percurso temporal da política de 1980 a 2010, elementos de continuidade e mudanças e conexões existentes entre iniciativas anteriores e a política atual. O estudo envolveu revisão de literatura sobre o tema e análise documental apoiados no referencial teórico de análise das políticas públicas, em especial o institucionalismo histórico. Os resultados apontam quatro distintos momentos da trajetória da política, demarcados por inflexões nas iniciativas de reorientação da formação superior em saúde: antecedentes; experiências iniciais; protagonismo universitário; ampliação e aprimoramento. Como elemento de continuidade, nota-se permanência dos eixos norteadores nos objetos preconizados nas políticas. As evidências de implementação expressam perspectiva de ampliação, com diversificação dos atores e organizações mobilizados, e mais projetos implantados. A experiência acumulada sugere amadurecimento das bases estruturantes das ações e as principais mudanças referem-se à valorização das instâncias decisórias do SUS e à aproximação com o processo de descentralização e regionalização da política nacional de saúde.

Buscou-se analisar a estrutura da representação social da autonomia profissional construída por enfermeiros na cidade de Petrópolis. Adotou-se como referencial a Teoria das Representações Sociais, de acordo com a abordagem estrutural. A coleta de dados foi realizada através da técnica de evocação livre ao termo autonomia profissional com 83 enfermeiros, 42 da rede básica e 41 da rede hospitalar. Os dados foram analisados através da construção do quadro de quatro casas. Os resultados indicam como possíveis elementos centrais da representação os termos conhecimento, conquista e responsabilidade e como elementos periféricos limitada, pouca e utopia.