ResumoA partir da análise da literatura sobre a abordagem do empoderamento do paciente no campo da diabetologia, discute-se o impacto dessa perspectiva sobre os significados das transformações nas relações de cuidado, explorando as implicações para a posição ocupada por profissionais da saúde e pacientes. Consideram-se as dificuldades e os incômodos apontados pelos profissionais da saúde frente às mudanças requeridas pelo empoderamento do paciente. Esses dados são problematizados por meio de um enfoque antropológico, apoiando-se nas elaborações sobre o contraste entre a lógica da escolha e a lógica do cuidado, e considerando a diferença entre as representações dos agentes da biomedicina e dos pacientes a partir da oposição entre os modelos indivíduo/pessoa. O percurso analítico é concluído com a constatação da necessidade de relativizar a ideia de que o empoderamento do paciente representa o incremento do individualismo nas relações de assistência à saúde, o que contribui para matizar as reflexões que os cientistas sociais têm desenvolvido acerca da tendência atual de atribuir ao indivíduo a responsabilidade pela própria saúde.

Introduction:The urinary tract infections, after respiratory infections, are the most common in the community. The knowledge about the prevalence of microbial strains and their antibiotic susceptibility is crucial to establish an effective empirical therapy. The aim of this study was to determine the antibiotic susceptibility patterns of bacterial strains isolated from positive urine cultures performed in patients from the central region of Portugal. Material and Methods:We carried out a documental analysis of 6008 urine bacteriological exams, to be made available to physicians, most of which run through the automated system VITEK 2, bioMérieux. The majority (80%) of the urine bacteriological exams were from female. Escherichia coli was the most prevalent bacterial pathogen (65.9%), followed by Klebsiella spp (12%). Results: Nitrofurantoin showed high levels of activity (96%) for Escherichia coli, as well as Fosfomycin (96.6%). Amoxicillin-clavulanic acid presents an activity level of only 81.1% for the same germ. Quinolones exhibit efficacy to only 78% of the strains of Escherichia coli, below the Fosfomycin and Nitrofurantoin. Nitrofurantoin showed high levels of activity (96%) for E. coli as well as Fosfomycin (96.6%). Amoxicillin-Clavulanic Acid presents a level of activity of only 81.1% for the same germ. The quinolones have a efficacy for only 78% of strains of E. coli, lower than Fosfomycin. Discussion: Escherichia Coli was the most prevalent uropathogen (65.9%). High efficacy against this pathogenic agent was found for Fosfomycin (96.6%) and Nitrofurantoin (96%). Conclusion:Further antimicrobial surveillance studies should be developed, in order to formulate local empirical therapy recommendations for optimized therapeutical choices.

Twenty-one adult patients with urinary tract infections caused by penicillinresistant bacteria completed treatment with amoxicillin alone or amoxicillin plus clavulanic acid in a randomized double-blind clinical trial. Of the 13 patients treated with amoxicilhin plus clavulanic acid, the absence of bacteriuria within 7 days of therapy was observed in 85%, as compared with only 25% of the 8 patients receiving amoxicillin only. There were no significant side effects nor any clinical, biochemical, or hematological abnormalities related to either treatment. It was concluded that the combination of clavulanic acid and amoxicillin could be useful in the treatment of uncomplicated urinary tract infection caused by penicillinresistant bacteria.Clavulanic acid, a natural product of Streptomyces clavuligerus, is a potent, irreversible inhibitor of a wide variety of 8-lactamase enzymes (5, 7). Although it has little inherent antibacterial activity, it protects the labile penicillins and cephalosporins from destruction by bacterial ,8-lactamase (4, 6, 8, 9, 13). In vitro studies have demonstrated that clavulanic acid possesses a very wide spectrum of inhibition (3), which results in marked enhancement of,-lactam antibiotics against many 8-lactamase-producing organisms (3, 9, 13), including staphylococci and enterobacteria.Urinary tract infections caused by ,8-lactamase-producing species are common and often require treatment with antibiotics which are potentially toxic. Since clavulanic acid protects the ,8-lactam-sensitive antibiotics from enzymatic destruction, it should serve as a useful adjunct to therapy with those agents. Therefore, the purpose of this initial clinical trial was to determine the efficacy and safety of amoxicilhin plus clavulanic acid in the treatment of uncomplicated urinary tract infection caused by penicillin-resistant organisms. MATERIALS AND METHODSTwenty-one patients presenting with uncomplicated urinary tract infections caused by bacteria resistant to both ampicillin and amoxicillin were considered suitable for this trial. Urinary tract infection was defined as the presence of at least 105 bacteria per ml in patients complaining of dysuria, urgency, frequency, and back pain, or by two consecutive urine cultures containing 105 or more bacteria per ml of the same species in asymptomatic patients. There was no attempt to differentiate between upper and lower urinary tract infection for the purpose of this trial. All bacterial isolates were identified by standard procedures (2) and tested for susceptibility with a 10-,.g ampicillin disk by the Bauer-Kirby method (1). If the isolate was found to be resistant to ampicillin, a tube dilution minimum inhibitory concentration (MIC) to amoxicilhin was determined. All patients who were found to have infecting strains with amoxicillin MICs above 10 ug/ml were considered for enrollment in the study. In addition, a further MIC of amoxicilhin was obtained in the presence of 10 ug of clavulanic acid per ml. This concentration of clavulanic acid has been shown to...

A partir da pesquisa de campo em uma associação de diabéticos na cidade de São Paulo, Brasil, o artigo problematiza o fato de que nas situações de comensalidade no âmbito familiar, o cuidado de si representa um desafio para as práticas sociais do grupo pesquisado - homens e mulheres entre 53 e 90 anos. A prática do cuidado de si confronta as representações de gênero em torno do papel feminino de cuidadora, apontando para a quebra do circuito de troca familiar nos momentos de comensalidade.

O artigo analisa o modo como os grupos de educação em saúde que congregam pessoas com diabetes promovem o empoderamento de seus membros, estimulando processos de reestruturação das relações mais tradicionais de assistência à saúde. A pesquisa que originou o texto apoia-se em metodologia qualitativa, envolvendo a etnografia dos “grupos de saúde” de uma associação de diabéticos no município de São Paulo e de um Centro de Saúde no município de Campinas (SP). Foram realizadas entrevistas com seus membros, sobretudo mulheres, com idades entre 53 e 87 anos e pertencentes às camadas populares, com o intuito de explorar características de sociabilidade desenvolvidas nesses grupos. Para tanto, considerou-se a amizade uma categoria relevante à compreensão do modo como se caracterizam as novas práticas de cuidado com a saúde, contrastando com relações mais tradicionais como as de caráter familiar. O quadro aponta a dinâmica de reencantamento das relações no espaço público, no contexto da modernidade reflexiva.