RESUMO Diante da tendência mundial de crescimento da população e da consequente geração de resíduos sólidos urbanos, surge a necessidade da utilização de ferramentas para avaliação da sustentabilidade dos sistemas de gerenciamento, visando à tomada de decisão mais consciente. A chegada do conceito de economia circular, assim como a promulgação da Política Nacional de Resíduos Sólidos, consistiu em substancial quebra de paradigmas que despertou discussões e maior preocupação com o ciclo de vida dos produtos e com a redução da geração de resíduos. Sendo assim, o presente trabalho objetivou avaliar economicamente o planejamento estratégico do sistema de gerenciamento de resíduos sólidos urbanos de Campo Grande, Mato Grosso do Sul, complementando a análise de impactos ambientais anteriormente realizada e visando embasar a tomada de decisão sustentável. Os resultados demonstraram que o aterro sanitário com recuperação energética, apesar de ambientalmente favorável, não se apresenta economicamente viável para a realidade local. Já o investimento na melhoria da eficiência da coleta seletiva e da triagem dos recicláveis, bem como de uma unidade de compostagem, são benéficos e lucrativos ambientalmente, apesar do representativo custo envolvido. Concluiu-se, então, que o Plano de Coleta Seletiva de Campo Grande possui metas realistas e viáveis ambiental e economicamente, que devem ser efetivadas com urgência buscando a melhoria da qualidade de vida da população e a redução dos impactos ambientais tanto locais quanto globais.

ABSTRACT The worldwide trend of population growth and municipal solid waste generation suggests the application of tools to assess the sustainability of management systems, aiming at more conscious decision-making. The arrival of the circular economy concept and the Brazilian National Solid Waste Policy aroused discussions and greater concern with the products’ life cycle and waste reduction. Thus, the present study aimed to economically evaluate the strategic planning of the urban solid waste management system in Campo Grande, Mato Grosso do Sul, complementing the analysis of environmental impacts previously carried out, aiming to support sustainable decision making. Results showed that the landfill with energy recovery, despite being environmentally favorable, is not economically viable for the local reality. Investments in improving the efficiency of selective collection and sorting of recyclables, as well as a composting unit, are environmentally beneficial and profitable, despite the significant costs involved. It was concluded, then, that the Campo Grande Selective Collection Plan has realistic and environmentally and economically feasible goals that must be implemented urgently in order to improve the quality of life of the population and reduce environmental impacts, both locally and globally.

Abstract The treatment of epilepsy is complex and a matter of concern is the interchangeability among different formulations available for antiepileptic drugs. To evaluate the effects of interchangeability among carbamazepine formulations on patients with epilepsy. This is a prospective cohort study that included adult outpatients diagnosed with epilepsy and under pharmacological treatment with carbamazepine. Before switching the brand/manufacturer, the “Interchangeable Pharmaceutical Product in the Treatment of Epilepsies” questionnaire was applied. The questionnaires “Adverse Events Profile” and Quality of Life in Epilepsy-31, so as the plasma carbamazepine concentrations, were evaluated before and after the brand/ manufacturer switch. Physical-chemical tests aiming to assess tablets quality were performed in accordance with the Brazilian Pharmacopoeia 5th edition. The study population was composed by 14 patients (mean age: 44.6 years), with 10 of females. From those interviewed, 10 had no knowledge about the three antiepileptic drugs formulations available. The frequency of adverse event “problems with skin” incresead (p=0.023) and “upset stomach” decreased (p=0.041) after the changeover. The adverse events profile was associated with only two quality of life domains: “energy/fatigue” (p=0.048) and “total score” (p=0.018). Divergent results between generic and reference formulations were observed in purity-water test (reference: 1.96%, generic: 4.84%) and dissolution test, in which the generic formulation presented 66.27 to 85.77% of carbamazepine dissolved after the third level. Conclusions: Objective differences before and after the brand/manufacturer switch were not observed, in spite of patients’ perceptions. Despite that, more studies in the field are necessary, especially on the interchangeability among generic antiepileptics, in order to better elucidate switching consequences on patients’ life.

Resumo Introdução: A Paralisia Cerebral é definida como um grupo de distúrbios não progressivos de movimento e de postura. Existem diferentes métodos de reabilitação para crianças e adolescentes com Paralisia Cerebral. Dentre eles, o uso do Kinesio Taping vem se tornando comum. Objetivo: O objetivo da presente revisão sistemática é sumarizar evidências relativas a métodos de aplicação do Kinesio Taping e seus efeitos em crianças e adolescentes com Paralisia Cerebral. Métodos: Foi realizada uma busca da literatura científica nas bases de dados Medline, Scielo e PEDro sem restrição de idioma. Para esta pesquisa foram utilizadas as palavras-chave “Kinesio taping”, “Kinesiology Taping”, “Taping” e “Bandages” combinadas à “Cerebral Palsy”. A busca aconteceu entre Maio de 2015 a Novembro de 2016. Resultados: Foram selecionados onze estudos, sendo seis ensaios clínicos controlados e aleatorizados, quatro ensaios clínicos não controlados e um estudo de caso. Os estudos no geral seguem os modelos de aplicação do taping propostos pelo criador da técnica, utilizando técnicas corretivas e técnicas de facilitação/inibição da contração muscular. Há pobre evidência de efeitos e estes variam com os métodos de aplicação utilizados e os desfechos escolhidos. Conclusão: Há evidência forte a insuficiente quanto aos efeitos do KT desfechos relacionados às funções motoras. São necessários estudos com maior qualidade metodológica para justificar o uso do KT na prática clínica.

Abstract Introduction: Cerebral Palsy is a group of non-progressive movement and posture disorders. There are many rehabilitation methods for children and adolescents with these disorders. Kinesiology Taping(KT) is becoming a popular as an option of rehabilitation method for these children. Objective: The aim of this systematic review is to summarize evidence regarding the methods of Kinesiology Taping use in children and adolescents with Cerebral Palsy and its effects. Materials: A search of scientific papers in the databases Medline, Scielo and PEDro was conducted with no data or language restriction. For this search the keywords “Kinesio taping”, “Kinesiology Taping”, “Taping”, and “Bandages” combined with “Cerebral Palsy” were used. The search was conducted between May of 2015 and November of 2016. Results: Eleven studies were included in the review, six were randomized controlled clinical trials, four were quasi-experimental studies, and one was a case study. In general, the studies followed the guidelines proposed by the Kinesiology Taping creator; they used corrective techniques and muscle contraction facilitation/inhibition techniques. Results varied according to techniques used and outcomes chosen. Conclusion: There is strong to insufficient evidence of KT effects in motor function related outcomes. Stronger quality level studies are necessary to support use of KT in clinical practice.

Objetivo Avaliar o perfil de utilização de fármacos antiepilépticos em uma população de pacientes adultos com epilepsia refratária atendidos em um centro terciário. Método Análises descritivas dos dados obtidos dos registros médicos de 112 pacientes. Também foram consideradas as características clínicas e demográficas. Resultados Foram prescritas politerapias com ≥3 antiepilépticos a 60,7% dos pacientes. Em relação aos fármacos de primeira geração, carbamazepina e clobazam foram os mais frequentemente prescritos (a 72,3% e 58,9% dos pacientes, respectivamente). Dentre os novos antiepilépticos, a lamotrigina foi o mais prescrito (36,6% dos pacientes). Ao menos um antiepiléptico de primeira geração foi encontrado em 103 das 104 politerapias; ao menos um novo antiepiléptico foi prescrito a 70,5% da população. A combinação mais prevalente foi carbamazepina+clobazan+lamotrigina. A carga média de antiepilépticos foi 3.3 (0.4 a 7.7). Conclusão O padrão de utilização de antiepilépticos, embora concordante com guias atuais, é fortemente influenciado pelo sistema público de saúde.

Objective To evaluate the utilization profile of antiepileptic drugs in a population of adult patients with refractory epilepsy attending a tertiary center. Method Descriptive analyses of data were obtained from the medical records of 112 patients. Other clinical and demographic characteristics were also registered. Results Polytherapies with ≥3 antiepileptic drugs were prescribed to 60.7% of patients. Of the old agents, carbamazepine and clobazam were the most commonly prescribed (72.3% and 58.9% of the patients, respectively). Among the new agents, lamotrigine was the most commonly prescribed (36.6% of the patients). At least one old agent was identified in 103 out of the 104 polytherapies, while at least one new agent was prescribed to 70.5% of the population. The most prevalent combination was carbamazepine + clobazam + lamotrigine. The mean AED load found was 3.3 (range 0.4–7.7). Conclusion The pattern of use of individual drugs, although consistent with current treatment guidelines, is strongly influenced by the public health system.