Resumo A doença renal crônica é um problema de saúde pública global e em seu estágio terminal está associada à necessidade de terapia dialítica. A grande maioria dos pacientes que necessitam realizar a terapia renal substitutiva, a fazem através da hemodiálise. Portanto, o acesso vascular é de extrema importância para a população dialítica, implicando diretamente na qualidade de vida e na morbimortalidade deste grupo de pacientes. Sendo a confecção, gerenciamento e resgate dos acessos vasculares uma das áreas de atuação do cirurgião vascular, é de grande importância a elaboração de uma diretriz que oriente o especialista no manejo mais adequado do acesso vascular para hemodiálise. Assim, o objetivo desta diretriz é apresentar um conjunto de recomendações para guiar as decisões na referenciação, avaliação, escolha, vigilância e gestão das complicações do acesso vascular para hemodiálise. dialítica substitutiva hemodiálise Portanto confecção Assim referenciação avaliação escolha

Abstract Chronic kidney disease is a worldwide public health problem, and end-stage renal disease requires dialysis. Most patients requiring renal replacement therapy have to undergo hemodialysis. Therefore, vascular access is extremely important for the dialysis population, directly affecting the quality of life and the morbidity and mortality of this patient population. Since making, managing and salvaging of vascular accesses falls within the purview of the vascular surgeon, developing guideline to help specialists better manage vascular accesses for hemodialysis if of great importance. Thus, the objective of this guideline is to present a set of recommendations to guide decisions involved in the referral, evaluation, choice, surveillance and management of complications of vascular accesses for hemodialysis. problem endstage end stage Therefore population making surgeon importance Thus referral evaluation choice

ABSTRACT The current structure of the Spanish State of Autonomies is characterized by institutional pluralism and the autonomy of the different public administra tions. In this context, the principle of coordination is fundamental for the co hesion of the system, but experience shows that its implementation is difficult. This paper examines the set of actions carried out by the administrations in re lation to an occupational and public health problem raised in March 2016. The Public Health General Direction of Aragon’s Government was informed of a possible use of brake linings with asbestos to manufacture axles for agricultu ral machinery by a Company from Zaragoza; the collaboration from Aragon’s Institute of Occupational Safety and Health, the Industry Department and the Labour and Social Security Inspectorate were asked; the joint action of the se administrations detected the use of several models of brake linings with a content of 2-5% of Chrysotile. The brake linings came from a Chinese com pany. The axles nated are sold in several Spanish Autonomous Communities. A national alert was activated by the SIRIPQ (System of Rapid Exchange of Information on Chemical Products) which is coordinated by the Ministry of Health, Social Services and Equality. Several measures were taken including: ceasing the work with the brake linings, the replacement of brake linings with asbestos, the immobilization of brake linings in the company by application of the REACH Reglament, etc. This case shows that the cooperation and co-responsibility of public administrations from different territorial, sectoral and competence areas allows improving the occupational risks prevention and the public health.

RESUMEN La actual estructura del Estado de las Autonomías se caracteriza por el pluralismo institucional y la autonomía de las diferentes administraciones públicas. En este contexto el principio de coordinación es fundamental para la cohesión del Estado, pero la experiencia muestra que es difícil su puesta en práctica. En este trabajo se examinó el conjunto de actuaciones realizado por las administraciones en relación a un problema de salud laboral y de salud pública planteado en marzo de 2016. La Dirección General de Salud Pública del Gobierno de Aragón tuvo conocimiento de la posible utilización por una empresa de Zaragoza de zapatas de freno con amianto para fabricar ejes de maquinaria agrícola. Se recabó la colaboración del Instituto Arago nés de Seguridad y Salud Laboral (ISSLA), del Departamento de Industria y de la Inspección de Trabajo y Seguridad Social, dichas administraciones detectaron la utilización de varios modelos de zapatas con un contenido de crisotilo del 2-5%. Las zapatas procedían de una empresa china. Los ejes eran comercializados en varias Comunidades Autónomas. Se activó una alerta nacional a través del SIRIPQ (Sistema de Intercambio Rápido de In formación de Productos Químicos) coordinado por el Ministerio de Sanidad, Servicios Sociales e Igualdad. Se tomaron medidas tales como el cese del trabajo con las zapatas, la sustitución de las ya instaladas mediante la aplica ción de un Plan Único de Trabajo, la inmovilización de las zapatas presentes en la empresa, etc. Este caso muestra que la cooperación y la corresponsabi lidad de administraciones públicas de diferentes ámbitos territoriales, secto riales y competenciales permite mejorar la prevención de riesgos laborales.

ABSTRACT The current structure of the Spanish State of Autonomies is characterized by institutional pluralism and the autonomy of the different public administra tions. In this context, the principle of coordination is fundamental for the co hesion of the system, but experience shows that its implementation is difficult. This paper examines the set of actions carried out by the administrations in re lation to an occupational and public health problem raised in March 2016. The Public Health General Direction of Aragon’s Government was informed of a possible use of brake linings with asbestos to manufacture axles for agricultu ral machinery by a Company from Zaragoza; the collaboration from Aragon’s Institute of Occupational Safety and Health, the Industry Department and the Labour and Social Security Inspectorate were asked; the joint action of the se administrations detected the use of several models of brake linings with a content of 2-5% of Chrysotile. The brake linings came from a Chinese com pany. The axles nated are sold in several Spanish Autonomous Communities. A national alert was activated by the SIRIPQ (System of Rapid Exchange of Information on Chemical Products) which is coordinated by the Ministry of Health, Social Services and Equality. Several measures were taken including: ceasing the work with the brake linings, the replacement of brake linings with asbestos, the immobilization of brake linings in the company by application of the REACH Reglament, etc. This case shows that the cooperation and co-responsibility of public administrations from different territorial, sectoral and competence areas allows improving the occupational risks prevention and the public health.

RESUMEN La actual estructura del Estado de las Autonomías se caracteriza por el pluralismo institucional y la autonomía de las diferentes administraciones públicas. En este contexto el principio de coordinación es fundamental para la cohesión del Estado, pero la experiencia muestra que es difícil su puesta en práctica. En este trabajo se examinó el conjunto de actuaciones realizado por las administraciones en relación a un problema de salud laboral y de salud pública planteado en marzo de 2016. La Dirección General de Salud Pública del Gobierno de Aragón tuvo conocimiento de la posible utilización por una empresa de Zaragoza de zapatas de freno con amianto para fabricar ejes de maquinaria agrícola. Se recabó la colaboración del Instituto Arago nés de Seguridad y Salud Laboral (ISSLA), del Departamento de Industria y de la Inspección de Trabajo y Seguridad Social, dichas administraciones detectaron la utilización de varios modelos de zapatas con un contenido de crisotilo del 2-5%. Las zapatas procedían de una empresa china. Los ejes eran comercializados en varias Comunidades Autónomas. Se activó una alerta nacional a través del SIRIPQ (Sistema de Intercambio Rápido de In formación de Productos Químicos) coordinado por el Ministerio de Sanidad, Servicios Sociales e Igualdad. Se tomaron medidas tales como el cese del trabajo con las zapatas, la sustitución de las ya instaladas mediante la aplica ción de un Plan Único de Trabajo, la inmovilización de las zapatas presentes en la empresa, etc. Este caso muestra que la cooperación y la corresponsabi lidad de administraciones públicas de diferentes ámbitos territoriales, secto riales y competenciales permite mejorar la prevención de riesgos laborales.

Este artigo visa a contribuir com o debate sobre a política de regionalização do SUS e a constituição das regiões de saúde no Brasil. Compreendê-las pressupõe reconhecer a dicotomia entre saúde coletiva e saúde individual - que marca a história da saúde pública brasileira - e identificar as diferentes racionalidades que conduzem esse processo. Tais racionalidades permitem não apenas considerar o legado da municipalização no atual processo de regionalização, como também estabelecer nexos entre dois campos do conhecimento fundamentais para o debate, a epidemiologia e a geografia. A epidemiologia clínica, ao privilegiar a saúde individual, fundamenta um modelo assistencial que prioriza a otimização de recursos. O reconhecimento da saúde no seu conceito ampliado, na epidemiologia social, fundamenta um modelo de atenção voltado para os determinantes sociais. Com a geografia, podem-se formular regiões funcionais, baseadas na teoria de Christaller, ou regiões lablachianas, que reconhecem a estrutura social loco/regional, possibilitando a intervenção nos determinantes ou condicionantes da maneira de adoecer e morrer das populações.

This article aims to contribute to the debate on the SUS regionalization policy and the establishment of health regions in Brazil. Understanding them require to recognize the dichotomy between public health and individual health - which marks the history of Brazilian public health - and identify the different rationalities that lead this process. Such rationalities allow not only to consider the legacy of municipalization in the current regionalization process, as well as to establish links between the two fields of fundamental knowledge to the debate, epidemiology and geography. Clinical epidemiology, privileging individual health, gives basis to a healthcare model that prioritizes the optimization of resources. The recognition of health in its broader concept, in the social epidemiology, bases an attention model aimed at social determinants. With geography, functional regions can be formulated, based on Christaller's theory, or lablachianas regions which recognize the social loco / regional structure, allowing intervention in determining or conditioning the way of illness and death of populations.

Este artigo visa a contribuir com o debate sobre a política de regionalização do SUS e a constituição das regiões de saúde no Brasil. Compreendê-las pressupõe reconhecer a dicotomia entre saúde coletiva e saúde individual - que marca a história da saúde pública brasileira - e identificar as diferentes racionalidades que conduzem esse processo. Tais racionalidades permitem não apenas considerar o legado da municipalização no atual processo de regionalização, como também estabelecer nexos entre dois campos do conhecimento fundamentais para o debate, a epidemiologia e a geografia. A epidemiologia clínica, ao privilegiar a saúde individual, fundamenta um modelo assistencial que prioriza a otimização de recursos. O reconhecimento da saúde no seu conceito ampliado, na epidemiologia social, fundamenta um modelo de atenção voltado para os determinantes sociais. Com a geografia, podem-se formular regiões funcionais, baseadas na teoria de Christaller, ou regiões lablachianas, que reconhecem a estrutura social loco/regional, possibilitando a intervenção nos determinantes ou condicionantes da maneira de adoecer e morrer das populações.

This article aims to contribute to the debate on the SUS regionalization policy and the establishment of health regions in Brazil. Understanding them require to recognize the dichotomy between public health and individual health - which marks the history of Brazilian public health - and identify the different rationalities that lead this process. Such rationalities allow not only to consider the legacy of municipalization in the current regionalization process, as well as to establish links between the two fields of fundamental knowledge to the debate, epidemiology and geography. Clinical epidemiology, privileging individual health, gives basis to a healthcare model that prioritizes the optimization of resources. The recognition of health in its broader concept, in the social epidemiology, bases an attention model aimed at social determinants. With geography, functional regions can be formulated, based on Christaller's theory, or lablachianas regions which recognize the social loco / regional structure, allowing intervention in determining or conditioning the way of illness and death of populations.

Orthophytum mucugense é uma bromélia ornamental endêmica do município de Mucugê-BA que está passível de extinção. O objetivo deste trabalho foi estabelecer um protocolo de regeneração via organogênese direta para a espécie. Os explantes raiz, caule e folha, oriundos de plantas com diferentes idades, foram inoculados em meio de cultura MS½ suplementado com BAP e ANA. Os brotos foram inoculados em meio contendo AIB e carvão ativo. As plantas foram transferidas para substrato composto de vermiculita e terra. A maior taxa de brotação foi obtida com o explante caule com 20 e 40 dias de idade em meio com 0,65mM de ANA. Na fase de enraizamento, a presença de carvão ativo interferiu positivamente no comprimento da parte aérea e do sistema radicular das plantas. As plantas foram aclimatizadas com 100% de sobrevivência.

Orthophytum mucugense is an ornamental bromeliad endemic to the municipality of Mucugê-BA which is vulnerable to extinction. The aim of this study was to establish a regeneration protocol via direct organogenesis for the species. The explants root, stem and leaf from plants of different ages were inoculated in the MS½ culture medium supplemented with BAP and NAA. The shoots were inoculated on medium supplemented with IBA and activated charcoal. The plants were transferred to a substrate composed of vermiculite and soil. The highest rate of sprouting was obtained with stem explants of 20 and 40 days old in medium supplemented with 0.65mM of NAA. For rooting the presence of activated charcoal had a positive influence on the length of shoot and root plants system. The plants were acclimatized with 100% survival.

A conservação in vitro é uma estratégia de conservação ex situ que garante a manutenção da integridade genética e biológica das espécies. O objetivo deste estudo foi avaliar o efeito de agentes osmóticos e temperatura na conservação in vitro de Syngonanthus mucugensis Giul. subsp. mucugensis. Os brotos foram inoculados em meio de cultura MS ½ contendo 7g L-1 de ágar e suplementado com 60g L-1 de sacarose, e com as concentrações de sacarose 15, 30 e 45g L-1 combinados com 0 e 15g L-1 de sorbitol ou manitol. As culturas foram mantidas em duas temperaturas (18 e 25°C). A porcentagem de sobrevivência das plantas foi avaliada mensalmente e ao final de 180 dias foram analisados o comprimento da parte aérea e da raiz, a porcentagem de folhas verdes, a porcentagem de explantes com brotos, o número de brotos por explante e o comprimento dos brotos. Os agentes osmóticos promoveram um decréscimo no crescimento das plantas, no entanto reduziram a sua viabilidade. Os resultados observados nos experimentos mantidos a 18°C foram significativamente superiores aos encontrados a 25°, para todas as variáveis analisadas. A conservação de S. mucugensis subsp. mucugensis pode ser feita à 18°C em meio de cultura MS ½ contendo 15g L-1 de sacarose, por até 180 dias, sem subcultivo.

The in vitro conservation is an ex situ conservation strategy that ensures the maintenance of genetic and biological integrity of species. The present study evaluated the effects of, osmotic agents and different temperature regimes on the in vitro conservation of Syngonanthus mucugensis Giul. subsp. mucugensis. The shoots were inoculated into half salt strength Murashige and Skoog culture medium (MS ½) containing 7g L-1 of agar. The culture medium was supplemented with 60gL-1 sucrose and with the sucrose concentrations 15, 30 and 45g L-1 combined with 0 and 15g L-1 of sorbytol or mannitol. Two different temperatures were used in these experiments (18 and 25°C). The percentage of plant survival was evaluated monthly and at 180 days were analyzed length of shoot and root, the percentage of green leaves, the percentage of explants with shoots and number of shoots per explants and shoot length. The addition of osmotic agents resulted in decreased growth of the plants and therefore reduced their viability. The averages observed in the experiments undertaken at 18°C were significantly superior to those observed at 25°C for all of the variables analyzed. S. mucugensis subsp. mucugensis can be cultured at 18°C in MS½ culture medium containing 15g L-1 of sucrose, for up to 180 days, without subculturing.

Background: Tuberculosis continues to be a major public health problem. Knowing the incidence, trend and geographical spread of reported tuberculosis may serve to evaluate the prevention and control measures implemented and point to further needs. Methods: Retrospective study of the reported cases of tuberculosis in the province of Leon, broken down by years, Health Care Areas and Basic Health Care Districts for the 1992-1999 period. Results: The average annual incidence rates were 40.3, 38.6 and 44.4 per 100,000 inhabitants/year (10(5) inhabitants/year) for the province of Leon, Leon Health Care Area and Bierzo Health Care Area, respectively. Seventy percent (70%) were males and thirty percent (30%) females. The specific rates by sex in the province of Leon were 55.5 for males and 22.9 per 10(5) for females. The specific rates by age and sex were similar for males and females up to age 25, the incidence among males being much greater as of this age. The geographical spread of tuberculosis in the province of Leon was heterogeneous, the highest incidence being in mining areas. In the Leon Health Care Area, cases among the oldest adults prevailed, no differences being found among young adults and adults over age 55 in the Basic Health Care District. Conclusions: The province of Leon has an incidence of tuberculosis greater than that estimated for Spain as a whole. It would be necessary to step up epidemiological surveillance and control measure systems as directly-monitored cases detected and systematic study of contacts in order to achieve a greater efficiency regarding the control of this disease.

Fundamento: La tuberculosis continúa constituyendo un importante problema de salud pública. Conocer la incidencia, evolución y distribución de la tuberculosis declarada puede servir para valorar la influencia de las medidas de prevención y control puestas en marcha y apuntar nuevas necesidades. Métodos: Estudio retrospectivo de los casos declarados de TB pulmonar en la provincia de León, recogidos por año, Áreas de Salud (AS) y Zonas Básicas de Salud (ZBS) en el periodo comprendido entre los años 1992 a 1999, ambos inclusive. Resultados: Las tasas de incidencia media anual fueron de 40,3; 38,6 y 44,4 por 100.000 habitantes y año (10(5) h/a) para la provincia de León (PL), Área de Salud de León (ASL) y Área de Salud del Bierzo (ASB) respectivamente. El 70% fueron varones y el 30% mujeres. Las tasas específicas por sexo en la provincia de León fueron de 55,5 en los varones y 22,9 por 10(5) en las mujeres. Las tasas específicas por edad y sexo fueron similares para varones y mujeres hasta los 25 años, partir de esa edad la incidencia en los varones fue mucho mayor. La distribución de la TB pulmonar en la provincia de León fue heterogénea siendo más elevada la incidencia en zonas mineras. En el ASL hubo un predominio de casos en las edades más avanzadas de la vida y en el ASB no se encontraron diferencias entre adultos jóvenes y los mayores de 55 años. Conclusiones: La provincia de León padece una incidencia de TB superior a la estimada para España. Sería necesario intensificar los sistemas de vigilancia epidemiológica y de medidas de control como tratamientos directamente observados y estudio sistemático de contactos para conseguir una mayor efectividad en el control de esta enfermedad.

Background: Tuberculosis continues to be a major public health problem. Knowing the incidence, trend and geographical spread of reported tuberculosis may serve to evaluate the prevention and control measures implemented and point to further needs. Methods: Retrospective study of the reported cases of tuberculosis in the province of Leon, broken down by years, Health Care Areas and Basic Health Care Districts for the 1992-1999 period. Results: The average annual incidence rates were 40.3, 38.6 and 44.4 per 100,000 inhabitants/year (10(5) inhabitants/year) for the province of Leon, Leon Health Care Area and Bierzo Health Care Area, respectively. Seventy percent (70%) were males and thirty percent (30%) females. The specific rates by sex in the province of Leon were 55.5 for males and 22.9 per 10(5) for females. The specific rates by age and sex were similar for males and females up to age 25, the incidence among males being much greater as of this age. The geographical spread of tuberculosis in the province of Leon was heterogeneous, the highest incidence being in mining areas. In the Leon Health Care Area, cases among the oldest adults prevailed, no differences being found among young adults and adults over age 55 in the Basic Health Care District. Conclusions: The province of Leon has an incidence of tuberculosis greater than that estimated for Spain as a whole. It would be necessary to step up epidemiological surveillance and control measure systems as directly-monitored cases detected and systematic study of contacts in order to achieve a greater efficiency regarding the control of this disease.

Fundamento: La tuberculosis continúa constituyendo un importante problema de salud pública. Conocer la incidencia, evolución y distribución de la tuberculosis declarada puede servir para valorar la influencia de las medidas de prevención y control puestas en marcha y apuntar nuevas necesidades. Métodos: Estudio retrospectivo de los casos declarados de TB pulmonar en la provincia de León, recogidos por año, Áreas de Salud (AS) y Zonas Básicas de Salud (ZBS) en el periodo comprendido entre los años 1992 a 1999, ambos inclusive. Resultados: Las tasas de incidencia media anual fueron de 40,3; 38,6 y 44,4 por 100.000 habitantes y año (10(5) h/a) para la provincia de León (PL), Área de Salud de León (ASL) y Área de Salud del Bierzo (ASB) respectivamente. El 70% fueron varones y el 30% mujeres. Las tasas específicas por sexo en la provincia de León fueron de 55,5 en los varones y 22,9 por 10(5) en las mujeres. Las tasas específicas por edad y sexo fueron similares para varones y mujeres hasta los 25 años, partir de esa edad la incidencia en los varones fue mucho mayor. La distribución de la TB pulmonar en la provincia de León fue heterogénea siendo más elevada la incidencia en zonas mineras. En el ASL hubo un predominio de casos en las edades más avanzadas de la vida y en el ASB no se encontraron diferencias entre adultos jóvenes y los mayores de 55 años. Conclusiones: La provincia de León padece una incidencia de TB superior a la estimada para España. Sería necesario intensificar los sistemas de vigilancia epidemiológica y de medidas de control como tratamientos directamente observados y estudio sistemático de contactos para conseguir una mayor efectividad en el control de esta enfermedad.

Este trabalho apresenta o número de cromossomos de 17 espécies de Bromeliaceae, pertencentes aos gêneros Encholirium, Bromelia, Orthophytum, Hohenbergia, Billbergia, Neoglaziovia, Aechmea, Cryptanthus e Ananas. A maioria tem cariótipo 2n = 50, mas Bromelia laciniosa, Orthophytum burle-marxii e O. maracasense são poliplóides com 2n = 150, 100 e 150, respectivamente, enquanto Cryptanthus bahianus tem 2n = 34 + 1-4B. Cromossomos B foram observados também em Bromelia plumieri e Hohenbergia aff. utriculosa. O número de cromossomos de todas as espécies foi determinado pela primeira vez, exceto para Billbergia chlorosticta e Cryptanthus bahianus. Os dados obtidos reforçam a hipótese de um número básico x = 25 para a família Bromeliaceae e aneuploidia decrescente no gênero Cryptanthus.

The present study reports chromosome numbers of 17 species of Bromeliaceae, belonging to the genera Encholirium, Bromelia, Orthophytum, Hohenbergia, Billbergia, Neoglaziovia, Aechmea, Cryptanthus and Ananas. Most species present 2n = 50, however, Bromelia laciniosa, Orthophytum burle-marxii and O. maracasense are polyploids with 2n = 150, 2n = 100 and 2n = 150, respectively, while for Cryptanthus bahianus, 2n = 34 + 1-4B. B chromosomes were observed in Bromelia plumieri and Hohenbergia aff. utriculosa. The chromosome number of all species was determined for the first time, except for Billbergia chlorosticta and Cryptanthus bahianus. Our data supports the hypothesis of a basic number of x = 25 for the Bromeliaceae family and decreasing aneuploidy in the genus Cryptanthus.