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farmale · 5 years

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A Consulta Pública Nº 45 está aberta desde o dia 31 de julho para manifestação da sociedade civil a respeito da recomendação da CONITEC no SUS relativa à proposta de incorporação do vedolizumabe para tratamento de pacientes com retocolite ulcerativa moderada a grave. ATENÇÃO PESSOAL! Sim, parece confuso, mas temos 2 consultas públicas abertas para o tratamento de pacientes com colite ulcerativa. Já conversamos aqui sobre a Consulta Pública Nº 44 (leiam aqui: https://bit.ly/2YKHjGT), hoje vamos conversar sobre a Nº 45. 📌Medicamento analisado: vedolizumabe A Takeda Pharma Ltda solicitou à Conitec a incorporação do medicamento vedolizumabe para o tratamento de pacientes adultos com RCU no SUS. Esse medicamento está registrado na Anvisa para tratamento de RCU e Doença de Crohn em pacientes que não apresentam melhora com o tratamento convencional ou com um antagonista de fator de necrose tumoral alfa. Possui apresentação para uso injetável e atua diminuindo a inflamação e acelerando a cicatrização da mucosa em pacientes com RCU. A Conitec analisou os estudos que avaliavam as evidências científicas sobre eficácia, segurança, custo-efetividade e impacto orçamentário do vedolizumabe para tratamento da RCU. Os estudos mostraram que o vedolizumabe teve melhores resultados comparado ao placebo na cicatrização da mucosa e na diminuição dos sinais e sintomas da doença. Porém, os estudos apresentaram qualidade de evidência moderada. Na análise do impacto orçamentário, a inclusão do vedolizumabe para RCU moderada a grave após falha da terapia convencional ocasionaria um acréscimo de R$ 90,8 milhões no primeiro ano e R$ 460 milhões acumulado em cinco anos. 📌Recomendação inicial da Conitec: Os membros do plenário da Conitec presentes na 79ª reunião ordinária, realizada nos dias 3 de julho e 4 de julho de 2019, consideraram que há pacientes que não apresentam resultados positivos ao tratamento disponível no SUS para esta doença, sendo que o vedolizumabe foi avaliado como o biológico mais apropriado para tratamento da RCU. Assim, o plenário da Conitec recomendou inicialmente a incorporação no SUS do vedolizumabe para retocolite ulcerativa moderada a grave, mas a incorporação estaria vinculada a uma condição: que os custos do tratamento com este biológico sejam iguais ou inferiores ao tratamento anual com infliximabe (R$27.098,88 no primeiro ano). ⚠ATENÇÃO! A recomendação foi disponibilizada em consulta pública por 20 dias – último dia para contribuir: 19 de agosto! 📌Como contribuir então? ➡Acessando o site: http://conitec.gov.br/index.php/consultas-publicas ➡Encontre a Consulta Pública Nº 44 (imagem 2) ➡Leia o Relatório Técnico se você for profissional da saúde e dê a sua contribuição no formulário “Técnico Científico”. ➡Leia o Relatório para a Sociedade se você for paciente, familiar, amigo e dê a sua contribuição no formulário “Experiência ou Opinião”. 📌Interessante ler: O que é uma consulta pública? www.farmale.com.br/o-que-e-consulta-publica/ Fonte: Conitec #farmaleachoudii #retocolite #coliteulcerativa #RCU #CP45ColiteUlcertiva #SUS #CONITEC #MinisteriodaSaude #juntossomosmaisfortes 📩E-mail: [email protected] 🚩www.farmale.com.br 📌instagram.com/farmaleachou 👍facebook.com/farmaleachou 🎥Canal: www.youtube.com/user/Farmale 📌O Farmale é o blog oficial da @alemdii - Associação do Leste Mineiro de DII

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ecotone99 · 5 years

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[NF] Good neighbors are worth a lot

I grew up on a central Wisconsin dairy farm. We were smaller than most. Many times machines or tractors got loaned to neighbors when the need arose. We were careful with our machinery. Many of our neighbors were not as careful, and sometimes loaned out machines came back with some damage. I would complain to Dad that he should charge for repairs, but he always said, "Good neighbors are worth a lot". I never understood that and thought he was being taken advantage of. But it was his farm, so I would just curse under my breath as I welded cracked frames, beat bent sheet metal back in place or replaced bearings burned out for lack of grease. And vow things would be different when the farm was mine.

But one day I learned what he meant. On The day retailers in the US now refer to as 'Black Friday'.

We had just lost a my cousin to a traffic accident. His funeral had been the day before Thanksgiving. His parents, Melvin and Tanya, always had the big family Thanksgiving gathering at their farm. My parents and all of my Aunts and Uncles pleaded with them to be allowed to move the gathering elsewhere to make it easier on them. But they would not hear of it. In spite of it all, they insisted that the annual gathering be held there as always. Simply saying that it was too late to change plans now.

The gathering was always the same. People would begin showing up around 11AM to visit. The big meal was about 12:30. After witch everyone visited and enjoyed each others company. About 4 PM there would be a serving of coffee and more pie. Then everyone went home to their own farms for evening chores.

To say this Thanksgiving dinner was 'subdued' would be an understatement. Almost no one talked during dinner. After the table was cleared, some of my uncles had a card game (sheepshead) on the side table. The women chatted in the living room. The men watched a game on the TV in the corner of the finished basement. My twin cousins, Pete and Paul (about 13 years old at the time) had a rolling pool game going on in the corner by the pool table and younger cousins joined it from time to time. Younger children drifted in and out of the corner table area playing various board games.

I noticed my Dad approaching Uncles individually to talk quietly with them, but I did not hear what he said, I just remember seeing them nod in agreement. After the coffee and pie, everyone left quietly.

Friday morning dawned overcast with temperatures hovering just below freezing. But it was predicted to warm and clear up later in the day. When I came down the stairs, Dad was at the kitchen table and told me to get a bowl of cereal. This meant that we would not be stopping for breakfast. A clear sign that a long day was planned.

As soon as we had the cows fed, he had me milk alone while he cleaned the out and fed the young stock and calves. he then cleaned the dairy barn and bedded the cows while they stood in their stalls. They would not get out for exercise that day. We rolled their manger full of Hay for the day and were done in the barn before 9 am.

He had me hitch the Farmall M on the saw rig and pull it up to the shop so he could mount the saw blade and sharpen it. This confused me as we had no wood piled for cutting with this saw and had I assumed that all of our firewood this year would be made with the chainsaws and put directly into the basement. ( we had been experiencing a wet fall and no one had yet made firewood). But I knew we were busy and I knew better than to question him.

I then checked the oil in the Oldsmobile and pulled it up to the gas barrel to fuel it up. Mom and my little sister had a long planned shopping trip. They, along with my grandmother, Aunt (mom's sister) and two cousins were going the 60 miles to Eau Claire to the latest thing in our area, A SHOPPING MALL. The new London Square mall had just opened and to boasted you could do all of your shopping in comfort without going from store to store all over town in cold, snowy weather.

After my Aunt, Grandma and cousins arrived, and they all piled into the Olds and left, Dad had me put the belt pully on the M and gas it up. He then told me to load all of the woodcutting tools into the back of the pickup and hitch it to a wagon. Then he and my little brother, Tom (about 9 at the time), got in the pickup and he said, "follow me". He headed out the driveway and up the road to Melvin's place with me on the M pulling the saw rig following.

Within minutes of arriving at Melvin's place, all of my other Uncles on my fathers side of the family arrived with Pete and Paul and a host of younger cousins, along with the two brothers of Tanya. Melvin and the family were not there. Tanya's mother and a sister had flown for the for the funeral, And they would be gone for the day taking them to the airport in Minneapolis.

We went into Melvin's machine shed and got out and gassed up his Farmall M and 300 utility. We took the upright muffler off of the M to make it get around in the woods better. We then took all of the trucks, tractors and wagons down the lane to Melvin's biggest woodlot.

The woodlot was nearly 40 acres with a small clearing in one corner where a homestead had been 100 years before. Dad showed me where to park the saw rig, on the edge of the clearing near the brush pile. We staked it down and belted our M on to it. I hated the saw rig. The exposed blade was a grave danger. It emitted an almost evil whine at speed and could cut through 8 inches of hardwood in less than 2 seconds. It could take off a finger or a whole arm even faster. I was never so happy as the day better and lighter chainsaws relegated this thing to the scrap iron pile.

I assumed, if cutting wood, my job would be 'bucker', the person who grabbed the wood as it is cut off and throws it on the wagon, as that had always been my job. But Dad took me to the tailgate of the pickup and gave me my assignment. I was to walk through the woods, find and cut down dead trees. I would need to cut the larger ones between the trunk and the top so the tractors could pull them out. When I had enough cut, they would let me know. It was a job I had done, but I was far from comfortable with it yet. I was given 'Old Blue'. Our oldest and most decrepit, and there fore our most expendable saw for this somewhat dangerous job.(several saws 'bought the farm' at this job over the years when trees went the wrong way when felling). Armed with the saw, A small screwdriver to adjust the fuel settings on Old Blue, as he was in constant need of adjustment, a can of gas, an old pint glass whiskey bottle full of chain oil in my hip pocket. felling wedges and a single bitted ax to drive them, I walked over a small rise and into the woods.

As I entered the woods, I was suddenly in a world all my own, insulated from the activity at the clearing and punctuated only by the visits of Pete and Paul, driving the wood skidding tractors. The first tree to fall to my saw was a big old maple. followed by a white oak. After that they were falling so fast that I only took note if they were hardwoods.

Soon two more tractors joined the fray. A International 460 diesel utility and a 165 Massey Ferguson. that I did not recognize. They came in no recognizable order, but always driven by Pete and Paul.

When I was not keeping up, my twin cousins would double back and collect larger limbs that had broken off of tops during skidding or collect up windfalls.

Sometime around noon, a turkey sandwich wrapped in wax paper and a pint jar of lemonade was thrust at me. I wolfed it down as quickly as I could and returned to cutting.

I didn't realize it at the time, but something, for lack of a better phrase 'magical' happened that day. Not once did a tree pinch the saw. Every tree fell cleanly as I intended it to. Not once did one hang up on another tree. Even the normally cantankerous Old Blue happily gurgled all day long, sans any form of adjustment, and never emitted so much as a hiccup.

Sometime around 2, Pete leaned over the back of the M and pointing at the tree I had just cut, yelled 'LAST ONE ", over the din of the unmuffled engine. I put the axe on the platform and hung the gas can on the PTO lever, then hitched his chain to the log. After he pulled out I hitched Paul to the tree top. Then I trudged out of the woods behind them.

I rounded a patch of brush and toped a little rise as the sun finally defeated the clouds for good. The sight I beheld in the clearing froze me in my tracks and Old Blue slipped from my startled grasp to plop into the slush at my feet. The little clearing was overflowing with men, boys and woodworking tools!. It had been turned into an efficient woodcutting operation! Treetops would be pulled up to the brush pile, that now had grown to a massive size. Pete or Paul would leap from the seat and younger tractor handlers took their place. Then men and boys with small chainsaws and axes attacked the top removing the small brush and throwing it on the pile. Then it was pulled over to where my Dad and Uncles were running the saw rig and more men would cut it into pieces small enough to be placed on the saw rig. My dad was cutting the wood into pieces faster than I have ever seen that saw used. My uncle was Bucker, and my little brother was in charge of a crew of boys about his age piling the wood up on the edges of the wagon rack to form a fence to get more wood on the wagon. The trunks bypassed this completely, they were taken to an area where they were cut by chainsaws into furnace length pieces and split to fit the furnace. The tractor handlers then returned the tractors to the brush pile where my cousins then took them back over.

That's the first time I saw a powered wood splitter. It was a home made smoke belching bemouth with a engine and hydraulic pump scavenged form a wrecked combine and a ram from an end loader. It was capable of reducing the most stubborn piece of hardwood to toothpicks.

I collected my wits and my saw and entered the clearing. I was determined to help, but by that time the saws were falling silent and the saw rig was shut down. I was only able to help pack up the rig.

An Uncles pickup appeared with cases of beer in the back. The men, and some of the older boys with their fathers permission partook. My father and uncles made a point to thank everyone. As I sat on the tailgate of the pickup heading up the lane for the farmyard, I remembered I had left the oil bottle on the last stump. Not a big deal. We would replace it, but I made a mental note to retrieve it the next time I came to Uncle Melvin's woods.

I could see the wagon tires squat and the bed pieces bow under load as we pulled them into the farmyard. There was another crew here as well. They had long since filled the wood racks in the basement. 8 rows of wood piled as high as a man could reach were along the back side of the house. 10 more were full width if the end of the machine shed. The old hog barn, unused for decades was filled to the ceiling. Weather by happenstance or design, the last 3 loads were on Melvin's wagons. One was covered with a tarp behind the machine shed. The other two were pushed into the upstairs barn bay.

More beer arrived for this crew, and another round of thank you's from my Dad and uncles. Then we replaced the M's muffler and put Melvin's tractors back in the shed and everyone unceremoniously packed up their tools and went home.

By the time we had everything put away, it was time for evening chores. We worked straight through and had our meal later. When we were done and got back in the house, Mom and everyone else was back. They had brought roasted chicken and we had I nice meal together. Mom and Grandma, and my aunt and cousins could not stop talking about their experience. Mom asked Dad, "how did your day go?". Dad just said, "Alright".

I suddenly realized how tired I was and excused myself, and headed up to bed. As I drifted off to sleep, I suddenly realized that I now understood what Dad meant when he has said, "Good neighbors are worth a lot". It is something I would go on to see many more times in my career as a farmer.

I later learned that Mom had stopped at a store in town to get some treats for the long road trip for my sister and cousins. She ran into a neighbor lady in the store and mentioned what was going on at Melvin's place that day. Well, that neighbor must have burned up the old telephone wires getting the news out. in about a half hour, every single neighbor within a 3 mile radius, and a significant number outside of that, upon hearing the news, individually and of their own volition chose to forgo their own work for the day and help out.

Melvin and Tanya did not get home until later, everyone was gone by then. No one ever admitted to being there (no one wanted him to feel obligated). But I am sure her had his suspicions.

With his only son gone, Melvin dropped out of our hunting circle. With the daughters growing up and getting outside interests, he enjoyed the farm less and less. When the youngest daughter started high school he sold the farm and bought a house in town and got work in a feed mill. But all the time he was on that farm he never had to cut another stick of firewood. And some was even sold on his auction.

Melvin's oldest daughter got a job in south Florida. She loved it so much down there that the other 3 girls followed her after graduation. Melvin and Tanya soon followed. Melvin's wide range of experiences made him a valuable employee at a home improvement center and he developed a interest in golf, a respectable tan and an absolute love of deep sea fishing. He also developed a bad habit of calling to discus Florida weather whenever we had a major cold or snow event.

Dad even spent a winter in his retirement there, but found the crowds to be too much for him. But Melvin never returned to Wisconsin, except for a visit or two in the summer.

I never did make it back to retrieve that oil bottle. I sometimes imagined over the years, some poor kid or hunter finding it and, thinking they had found something good to imbibe, took a big swig, only to get a mouth full of heavy oil. But most likely it was knocked into the grass and destroyed by wildlife or livestock.

And on a snowy winter night, my Father passed away quietly in his sleep, in the same room he had been born in, nearly 100 years before.

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