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RESUMO O artigo tem como objetivo desenvolver um modelo avaliativo das ações de detecção precoce do câncer de mama na atenção primária. Trata-se de um estudo de avaliabilidade, realizado pelas etapas de análise documental, revisão de literatura e reunião de consenso para elaboração da matriz avaliativa. O resultado obtido foi o desenvolvimento da Matriz de Análise e Julgamento, composta por 14 indicadores, agregados em duas dimensões. A aplicação do modelo avaliativo permitirá a identificação das fragilidades e potencialidades das ações de detecção precoce do câncer de mama. ABSTRACT The article aims to develop an evaluative model of actions for the early detection of breast cancer in primary care. This evaluability study was conducted through document analysis, literature review, and consensus meeting stages to prepare the evaluative matrix. The result was the development of the Analysis and Judgment Matrix, composed of 14 indicators aggregated into two dimensions. Applying the evaluative model will allow the identification of the weaknesses and strengths of actions for the early detection of breast cancer.

Supplementary Table 1, Supplementary Figures 1-5 from Small-Molecule Multidrug Resistance–Associated Protein 1 Inhibitor Reversan Increases the Therapeutic Index of Chemotherapy in Mouse Models of Neuroblastoma

O estudo teve o objetivo de investigar medidas de vigilância e biossegurança e acesso em atividades educativas por profissionais de saúde bucal do estado do Rio Grande do Sul durante a pandemia de Covid-19. Este estudo é decorrente da pesquisa denominada “Biossegurança em odontologia para o enfrentamento da Covid-19: análise das práticas e formulações de estratégias”. Para a coleta de dados foi utilizado um questionário online autoaplicável que incluiu as variáveis: sociodemográficas, biossegurança, vigilância e acesso à educação. Participaram 644 profissionais (82,5% dentistas, 13,2% auxiliares de saúde bucal e 4,3% técnicos) destes, 84,8% não apresentavam comorbidades, 51,7% pertenciam à rede pública e 48,3% à privada. As medidas de vigilância mais proeminentes foram o distanciamento e alertas visuais na sala de espera, avaliação de sintomas e orientações sobre a Covid-19. Sobre as medidas de biossegurança, a menor adesão foi relacionada às radiografias intraorais (2,7±1,4; IC 95%: 2,6–2,9), uso de lençol de borracha (2,1±1,4; IC 95%: 2,0–2,2) e disponibilidade de bomba a vácuo (2,5±1,7; IC 95%: 2,3–2,6). Dos participantes, 52,6% receberam orientações sobre medidas a serem adotadas durante o atendimento; mas, a educação permanente foi muito praticada através de documentos não emitidos por órgãos de saúde (77,4%). Medidas gerais de vigilância e biossegurança foram adotadas, mas, atividades que reduzem a disseminação de aerossóis tiveram menor adesão. É necessária uma ação coordenada de educação permanente. Práticas de vigilância, biossegurança e estratégias de educação para a odontologia devem ser consideradas na formulação de políticas, dando suporte aos problemas enfrentados no sistema de saúde. Palavras-chave: SARS-CoV-2. COVID-19. Mão de Obra em Saúde. Educação Odontológica. Odontologia em Saúde Pública.

Resumo Em um contexto de restrição orçamentária e de medidas de austeridade fiscal, discutir aspectos relacionados à gestão eficiente dos recursos públicos é um desafio. O objetivo deste estudo foi avaliar a eficiência técnica de municípios catarinenses nos gastos públicos com saúde e sua relação com as condições para a gestão em saúde nos anos de 2009 e 2015. Para medir a eficiência, optou-se pela Análise Envoltória de Dados. O Índice G foi empregado para analisar a autocorrelação espacial da eficiência. Para a avaliação das condições para a gestão em saúde, adotou-se o modelo proposto por Calvo et al. Do total de municípios analisados, 35,5% e 29% foram considerados eficientes, respectivamente para os anos de 2009 e 2015. Os resultados sugerem não haver associação entre as condições para a gestão em saúde e a eficiência técnica no estado de Santa Catarina. O estudo revelou a necessidade de se avançar na busca por melhores resultados de eficiência em Santa Catarina, devendo ser considerada a distribuição espacial destes resultados sobre o território, com enfoque sobre os clusters de ineficiência que podem explicar o fraco desempenho em saúde de algumas regiões do estado. Abstract In a context of budget constraints and fiscal austerity measures, the discussion of issues related to the efficient management of public resources is a major challenge. The scope of this study was to assess the technical efficiency of municipalities of the State of Santa Catarina in public health expenditures and its relationship with health management conditions in the years 2009 and 2015. In order to measure efficiency, the decision was made to use Data Envelopment Analysis. The G Index was used to analyze the spatial efficiency autocorrelation. For the evaluation of the conditions for health management, the model proposed by Calvo et al. was adopted. Of the total number of municipalities analyzed, 35.5% and 29% were considered efficient, for the years 2009 and 2015, respectively. The results suggest that there is no association between the conditions for health management and technical efficiency in the State of Santa Catarina. The study revealed the need to move forward in the quest for better results in terms of efficiency in the State of Santa Catarina, taking into consideration the spatial distribution of these results over the territory, focusing on clusters of inefficiency that may explain the poor performance in health of some regions of the state.

The objective of this study was to investigate the presence and classes of food additives in packaged foods labeled ‘home-made’. Food identification information was collected by photographing food ...

Amplification of the MYCN oncogene occurs in approximately 25% of primary neuroblastomas and is the single most powerful biological marker of poor prognosis in this disease. MYCN transcriptionally regulates a range of biological processes important for cancer, including cell metabolism. The MYCN-regulated metabolic gene SLC16A1, encoding the lactate transporter monocarboxylate transporter 1 (MCT1), is a potential therapeutic target. Treatment of neuroblastoma cells with the MCT1 inhibitor SR13800 increased intracellular lactate levels, disrupted the nicotinamide adenine dinucleotide (NADH/NAD(+)) ratio and decreased intracellular glutathione levels. Metabolite tracing with 13C-glucose and 13C-glutamine following MCT1 inhibitor treatment revealed increased quantities of tricarboxylic acid (TCA) cycle intermediates and increased oxygen consumption rate. MCT1 inhibition was highly synergistic with vincristine under cell culture conditions, but this combination was ineffective against neuroblastoma xenografts in mice. Post-treatment xenograft tumors had increased expression of the MCT1 homolog MCT4/SLC16A, a known resistance factor to MCT1 inhibition. We found that MCT4 was negatively regulated by MYCN in luciferase reporter assays and its expression in neuroblastoma cells was increased under hypoxic conditions and following hypoxia-inducible factor (HIF1) induction, suggesting that MCT4 may contribute to resistance to MCT1 inhibitor treatment in hypoxic neuroblastoma tumors. Co-treatment of neuroblastoma cells with inhibitors of MCT1 and LDHA, the enzyme responsible for lactate production, resulted in a large increase in intracellular pyruvate and was highly synergistic in decreasing neuroblastoma cell viability. These results highlight the potential of targeting MCT1 in neuroblastoma in conjunction with strategies that involve disruption of pyruvate homeostasis and indicate possible resistance mechanisms.

Members of the ABC transporter family, particularly P-glycoprotein (P-gp, ABCB1), breast cancer resistance protein (BCRP, ABCG2) and multidrug resistance protein 1 (MRP1, ABCC1) are well characterized mediators of multidrug resistance, however their pharmacological inhibition has so far failed as a clinical strategy. Harnessing collateral sensitivity, a form of synthetic lethality where cells with acquired multidrug resistance exhibit hypersensitivity to unrelated agents, may be an alternative approach to targeting multidrug resistant tumour cells. We characterized a novel small molecule modulator that selectively enhanced MRP1-dependent efflux of reduced glutathione (GSH), an endogenous MRP1 substrate. Using cell lines expressing high levels of endogenous MRP1 from three difficult to treat cancer types-lung cancer, ovarian cancer and high-risk neuroblastoma-we showed that the MRP1 modulator substantially lowered intracellular GSH levels as a single agent. The effect was on-target, as MRP1 knockdown abolished GSH depletion. The MRP1 modulator was synergistic with the GSH synthesis inhibitor buthionine sulfoximine (BSO), with the combination exhausting intracellular GSH, increasing intracellular reactive oxygen species (ROS) and abolishing clonogenic capacity. Clonogenicity was rescued by the ROS scavenger N-acetylcysteine, implicating GSH depletion in the effect. The MRP1 modulator in combination with BSO also strongly sensitized cancer cells to MRP1-substrate chemotherapeutic agents, particularly arsenic trioxide, and was more effective than either the MRP1 modulator or BSO alone. GSH-depleting MRP1 modulators may therefore provide an enhanced therapeutic window to treat chemo-resistant MRP1-overexpressing pediatric and adult cancers.

RESUMO Objetivou-se avaliar os Centros de Especialidades Odontológicas (CEO) do Brasil credenciados até o ano de 2014. Trata-se de avaliação do tipo normativa, quantitativa, baseada em indicadores e parâmetros orientados pela construção de um modelo avaliativo. Os CEO do Brasil foram julgados como bom, regular ou ruim. A maioria dos CEO do Brasil (68,1%) foi classificada como regular. Na dimensão estrutural, 78,1% dos CEO foram classificados como bom; na organizacional, 64,6% como regular; e na de produtividade, 48,2% como ruim. Houve associação significativa entre o julgamento final dos CEO e a localização geográfica e o porte populacional dos municípios. A avaliação evidenciou o não cumprimento de diversos indicadores normativos, demonstrando que não estão atendendo plenamente às normas preconizadas. ABSTRACT It is the objective of this study to perform a normative evaluation of the Dental Specialties Centers (CEO) in Brazil accredited until the year 2014. It is a normative evaluation, with a quantitative approach, based on indicators and parameters guided by the construction of an evaluation model. CEO in Brazil were rated as bad, average or good. The majority of CEO in Brazil (68.1%) were classified as average. In the structural dimension, 78.1% of CEOs were classified as good; in the organizational dimension, 64.6% as average; and in productivity, 48.2% as bad. There was a significant association between the CEO’s final judgment and the geographical location and population size of the municipalities. The evaluation evidenced non-compliance with several normative indicators, showing that they are not fully complying with the recommended norms.

Background and purpose In the last decades, an increasing body of scientific studies has shown mindfulness-based interventions as efficacious for reducing stress, including among primary care professionals. Despite the strength of the evidence, mindfulness-based interventions still are not widely adopted as a clinical practice in national health systems. The aim of the present study was to conduct a feasibility evaluation of a mindfulness-based stress reduction program for primary care professionals in Brazilian national health system. Materials and methods A pilot mindfulness program was conducted through the course of four weekly encounters in the municipality of Biguacu with the participation of 26 primary care professionals. Data was collected through direct observations and four self-report questionnaires. The information was used to complete an evaluation matrix and reach a value judgment about the feasibility level of the components of the mindfulness-based program. Results The subdimensions Integration, Demand, and Acceptability were judged as “Highly Feasible”, the subdimension Practicality was judged as “Feasible” and the subdimension Adaptation was judged as “Lowly Feasible”. The results indicated that there is a high demand for stress-reduction interventions within the context of primary care and the acceptability by the stakeholders (participants and management) was excellent. However, the two main barriers found were the need for a brief version of the program to accommodate the restrictive timetable of the primary care professionals and the low retention rates. Conclusion The implementation of a mindfulness-based program for primary care professionals in Brazilian national health system was judged as “Feasible”. Further studies need to conduct the feasibility evaluation in other municipalities and with larger sample sizes to ensure the generalizability of these results.

Resumo Objetivo: Avaliar as condições de estrutura e de processo de trabalho para as ações de alimentação e nutrição na Atenção Primária à Saúde, no Brasil. Métodos: Estudo transversal, sobre dados secundários do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica. Foram descritas as proporções de adequação das unidades básicas de saúde (UBS) e equipes de saúde segundo variáveis organizacionais, pela razão da prevalência e regressão de Poisson. Resultados: Foram analisadas 19.793 UBS e 24.549 equipes; 35,0% (n=6.928) das UBS mostraram-se adequadas na estrutura e 7,9% (n=1.934) das equipes adequadas ao processo de trabalho. Nas análises de associação, destacaram-se as UBS da região Sul (44,7%) e as equipes da região Sudeste (10,9%), além de municípios com mais de 300 mil habitantes. Conclusão: As UBS e equipes analisadas apresentaram baixas proporções de adequação de estrutura e de processo de trabalho para as ações de alimentação e nutrição. Resumen Objetivo: Evaluar las condiciones de estructura y proceso de trabajo de las acciones de alimentación y nutrición en la Atención Primaria de Salud en Brasil. Métodos: Estudio transversal con datos del Programa de Mejoramiento del Acceso y la Calidad en la Atención Primaria. Se describieron las proporciones de adecuación de las Unidades Básicas de Salud (UBS) y equipos de salud según variables organizacionales por la razón de prevalencia y regresión de Poisson. Resultados: Se analizaron 19.793 UBS y 24.549 equipos. El 35,0% (n=6.928) de las UBS se consideraron adecuadas en la estructura y el 7,9% (n=1.934) de los equipos adecuados al proceso de trabajo. En los análisis asociativos se destacaron las UBS de la región Sur (44,7%) y los equipos de la región Sudeste (10,9%), además de los municipios con más de 300 mil habitantes. Conclusión: Las UBS y los equipos analizados presentaron bajas proporciones de adecuación para la estructura y el proceso de trabajo para las acciones de alimentación y nutrición. Abstract Objective: To evaluate the conditions of structure and work process for food and nutrition actions in Primary Health Care in Brazil. Methods: This was a cross-sectional study with secondary data from the Program for Primary Health Care Access and Quality Improvement. The proportions of Primary Health Care Center (PHCC) and health team adequacy were described according to organizational variables, using prevalence ratios and Poisson regression. Results: 19,793 PHCCs and 24,549 teams were analyzed; 35.0% (n=6,928) of PHCCs were considered adequate in relation to structure and 7.9% (n=1,934) of the teams had adequate work process. Standing out in the analyses of association are PHCCs in the Southern region (44.7%) and teams in the Southeastern region (10.9%), in addition to municipalities with more than 300,000 inhabitants. Conclusion: The PHCCs and teams analyzed presented a low proportion of adequacy for structure and work process for food and nutrition actions.

Resumo Este estudo de caso visou caracterizar a organização do Componente Especializado da Assistência Farmacêutica (CEAF) em quatro estados, de diferentes regiões do país. A coleta de dados foi realizada junto a representantes da gestão do CEAF, os quais responderam um questionário com 20 perguntas sobre: abrangência, organização, financiamento, barreiras e facilitadores. Essas informações foram complementadas com dados de inquéritos nacionais de saúde, do DataSUS, os valores investidos e indicadores socioeconômicos. Observaram-se diferenças entre os estados em questões como a proporção de usuários e a descentralização dos serviços. Estas características parecem estar relacionadas com o grau de desenvolvimento em termos dos indicadores socioeconômicos utilizados. Destacaram-se avanços no acesso a medicamentos, apesar das dificuldades para o cumprimento dos objetivos do CEAF, como a insuficiência de recursos, de qualificação da força de trabalho e da oferta de consultas e exames necessários. Os resultados indicam avanços, diferentes formas de organização e destacam a necessidade de estudos mais aprofundados relativos aos resultados clínicos e econômicos alcançados, como uma estratégia para traçar soluções para o atendimento integral e equânime dos usuários. Abstract This case study aimed to characterize the Specialized Component of Pharmaceutical Services (CEAF) organization in four Brazilian states from diverse regions of the country. Data were collected with representatives of CEAF management from states in different regions, who answered a 21-question questionnaire on scope, organization, financing, hurdles, and facilitators. This information was complemented with data from national health surveys, DataSUS, the applied resources, and socioeconomic indicators. Differences were observed between states on issues such as the proportion of users and the decentralization of services. These characteristics seem to be related to the level of development concerning the socioeconomic indicators used. Advances in access to medicines were highlighted, despite the difficulties complying with the CEAF’s objectives, such as insufficient resources, the qualification of human resources, and the provision of necessary visits and exams. The results point to advances, different forms of organization and highlight the need for more in-depth studies on the clinical and economic outcomes achieved as a strategy to outline solutions to achieve the comprehensive and equal care for users.

Resumo: Com a implantação da atenção domiciliar no âmbito do Sistema Único de Saúde (SUS), diante da necessidade de capacitação de gestores e profissionais, criou-se o Programa Multicêntrico de Qualificação Profissional em Atenção Domiciliar a Distância (PMQPAD) numa parceria entre a Universidade Aberta do SUS e a Coordenação Geral de Atenção Domiciliar do Ministério da Saúde. Por meio de cursos de especialização, aperfeiçoamento e autoinstrucionais, o programa teve grande capilaridade e alcance no país, com quase 300 mil matrículas distribuídas em todos os estados brasileiros. O objetivo do presente estudo foi estruturar um modelo avaliativo do PMQPAD, por meio de um estudo de avaliabilidade, com a participação dos gestores do programa. Foi utilizada a metodologia desenvolvida por Thurston & Ramaliu, cujas etapas permitiram descrever o programa, representá-lo por meio de um modelo lógico e desenvolver uma matriz avaliativa. Foram realizadas análise documental, entrevistas semiestruturadas e oficinas de consenso para validação do modelo. O processo resultou no desenvolvimento de três matrizes avaliativas, uma para cada modalidade de curso do programa, com quatro dimensões de análise em comum (Características do curso e recursos educacionais; Aspectos institucionais; Resultados; Impactos). Os indicadores avaliativos tiveram, como fontes de dados primários, os alunos, os tutores e os gestores do curso. O estudo contou com a participação dos stakeholders e mostrou-se apropriado para o desenvolvimento da proposta avaliativa. Destaca-se o potencial de utilização das matrizes avaliativas desenvolvidas para a avaliação de outros programas de formação a distância no âmbito do SUS. Abstract: With the implementation of home care in the Brazilian Unified National Health System (SUS), the need to train administrators and health workers led to the creation of the Multicenter Program for Professional Qualification in Distance Home Care (PMQPAD) in a partnership between the SUS Open University and the General Coordinating Division for Home Care, of the Brazilian Ministry of Health. Through courses in specialization, improvement, and self-instruction, the program achieved wide capillarity and scope in the country, with nearly 300,000 enrollments across all states of Brazil. The current study aimed to structure a model to assess the PMQPAD through an evaluability study with participation by the program’s administrators. We used the methodology developed by Thurston & Ramaliu, the stages of which allowed describing the program, representing it with a log frame model, and developing a evaluation matrix. We conducted document analysis, semi-structured interviews, and consensus workshops for the model’s validation. The process resulted in the development of three evaluation matrices, one for each of the program’s course modalities, with four analytical dimensions in common (Course characteristics and educational resources; Institutional aspects; Results; Impacts). The primary data sources for the evaluation indicators were the students, tutors, and administrators. The study drew on stakeholders’ participation and proved appropriate for the development of the evaluation proposal. The results highlight the potential for use of evaluation matrices developed for the assessment of other distance training programs under the SUS. Resumen: Con la implantación de la atención domiciliaria en el ámbito del Sistema Único de Salud (SUS), ante la necesidad de la capacitación de gestores y profesionales, se creó el Programa Multicéntrico de Cualificación Profesional en Atención Domiciliaria a Distancia (PMQPAD), en una colaboración entre la Universidad Abierta del SUS y la Coordinación General de Atención Domiciliaria del Ministerio de Salud de Brasil. A través de cursos de especialización, perfeccionamiento y de autoaprendizaje, el programa tuvo una gran capilaridad y alcance en el país, con casi 300 mil matrículas, distribuidas por todos los estados brasileños. El objetivo del presente estudio fue estructurar un modelo evaluativo del PMQPAD, a través de un estudio de disponibilidad, con la participación de los gestores del programa. Se utilizó la metodología desarrollada por Thurston & Ramaliu, cuyas etapas permitieron describir el programa, representarlo a través de un modelo lógico, y desarrollar una matriz evaluativa. Se realizó un análisis documental, entrevistas semiestructuradas y talleres de consenso para la validación del modelo. El proceso resultó en el desarrollo de tres matrices evaluativas, una para cada modalidad de curso del programa, con cuatro dimensiones de análisis en común (Características del curso y recursos educacionales; Aspectos institucionales; Resultados; Impactos). Los indicadores evaluativos tuvieron como fuentes de datos primarios los alumnos, los tutores y los gestores del curso. El estudio contó con la participación de los stakeholders, y se mostró apropiado para el desarrollo de la propuesta evaluativa. Se destaca el potencial de utilización de las matrices evaluativas desarrolladas para la evaluación de otros programas de formación a distancia en el ámbito del SUS.

To evaluate the conditions of structure and work process for food and nutrition actions in Primary Health Care in Brazil.This was a cross-sectional study with secondary data from the Program for Primary Health Care Access and Quality Improvement. The proportions of Primary Health Care Center (PHCC) and health team adequacy were described according to organizational variables, using prevalence ratios and Poisson regression.19,793 PHCCs and 24,549 teams were analyzed; 35.0% (n=6,928) of PHCCs were considered adequate in relation to structure and 7.9% (n=1,934) of the teams had adequate work process. Standing out in the analyses of association are PHCCs in the Southern region (44.7%) and teams in the Southeastern region (10.9%), in addition to municipalities with more than 300,000 inhabitants.The PHCCs and teams analyzed presented a low proportion of adequacy for structure and work process for food and nutrition actions.Avaliar as condições de estrutura e de processo de trabalho para as ações de alimentação e nutrição na Atenção Primária à Saúde, no Brasil.Estudo transversal, sobre dados secundários do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica. Foram descritas as proporções de adequação das unidades básicas de saúde (UBS) e equipes de saúde segundo variáveis organizacionais, pela razão da prevalência e regressão de Poisson.Foram analisadas 19.793 UBS e 24.549 equipes; 35,0% (n=6.928) das UBS mostraram-se adequadas na estrutura e 7,9% (n=1.934) das equipes adequadas ao processo de trabalho. Nas análises de associação, destacaram-se as UBS da região Sul (44,7%) e as equipes da região Sudeste (10,9%), além de municípios com mais de 300 mil habitantes.As UBS e equipes analisadas apresentaram baixas proporções de adequação de estrutura e de processo de trabalho para as ações de alimentação e nutrição.Evaluar las condiciones de estructura y proceso de trabajo de las acciones de alimentación y nutrición en la Atención Primaria de Salud en Brasil.Estudio transversal con datos del Programa de Mejoramiento del Acceso y la Calidad en la Atención Primaria. Se describieron las proporciones de adecuación de las Unidades Básicas de Salud (UBS) y equipos de salud según variables organizacionales por la razón de prevalencia y regresión de Poisson.Se analizaron 19.793 UBS y 24.549 equipos. El 35,0% (n=6.928) de las UBS se consideraron adecuadas en la estructura y el 7,9% (n=1.934) de los equipos adecuados al proceso de trabajo. En los análisis asociativos se destacaron las UBS de la región Sur (44,7%) y los equipos de la región Sudeste (10,9%), además de los municipios con más de 300 mil habitantes.Las UBS y los equipos analizados presentaron bajas proporciones de adecuación para la estructura y el proceso de trabajo para las acciones de alimentación y nutrición.

This case study aimed to characterize the Specialized Component of Pharmaceutical Services (CEAF) organization in four Brazilian states from diverse regions of the country. Data were collected with representatives of CEAF management from states in different regions, who answered a 21-question questionnaire on scope, organization, financing, hurdles, and facilitators. This information was complemented with data from national health surveys, DataSUS, the applied resources, and socioeconomic indicators. Differences were observed between states on issues such as the proportion of users and the decentralization of services. These characteristics seem to be related to the level of development concerning the socioeconomic indicators used. Advances in access to medicines were highlighted, despite the difficulties complying with the CEAF's objectives, such as insufficient resources, the qualification of human resources, and the provision of necessary visits and exams. The results point to advances, different forms of organization and highlight the need for more in-depth studies on the clinical and economic outcomes achieved as a strategy to outline solutions to achieve the comprehensive and equal care for users.Este estudo de caso visou caracterizar a organização do Componente Especializado da Assistência Farmacêutica (CEAF) em quatro estados, de diferentes regiões do país. A coleta de dados foi realizada junto a representantes da gestão do CEAF, os quais responderam um questionário com 20 perguntas sobre: abrangência, organização, financiamento, barreiras e facilitadores. Essas informações foram complementadas com dados de inquéritos nacionais de saúde, do DataSUS, os valores investidos e indicadores socioeconômicos. Observaram-se diferenças entre os estados em questões como a proporção de usuários e a descentralização dos serviços. Estas características parecem estar relacionadas com o grau de desenvolvimento em termos dos indicadores socioeconômicos utilizados. Destacaram-se avanços no acesso a medicamentos, apesar das dificuldades para o cumprimento dos objetivos do CEAF, como a insuficiência de recursos, de qualificação da força de trabalho e da oferta de consultas e exames necessários. Os resultados indicam avanços, diferentes formas de organização e destacam a necessidade de estudos mais aprofundados relativos aos resultados clínicos e econômicos alcançados, como uma estratégia para traçar soluções para o atendimento integral e equânime dos usuários.

With the implementation of home care in the Brazilian Unified National Health System (SUS), the need to train administrators and health workers led to the creation of the Multicenter Program for Professional Qualification in Distance Home Care (PMQPAD) in a partnership between the SUS Open University and the General Coordinating Division for Home Care, of the Brazilian Ministry of Health. Through courses in specialization, improvement, and self-instruction, the program achieved wide capillarity and scope in the country, with nearly 300,000 enrollments across all states of Brazil. The current study aimed to structure a model to assess the PMQPAD through an evaluability study with participation by the program's administrators. We used the methodology developed by ThurstonRamaliu, the stages of which allowed describing the program, representing it with a log frame model, and developing a evaluation matrix. We conducted document analysis, semi-structured interviews, and consensus workshops for the model's validation. The process resulted in the development of three evaluation matrices, one for each of the program's course modalities, with four analytical dimensions in common (Course characteristics and educational resources; Institutional aspects; Results; Impacts). The primary data sources for the evaluation indicators were the students, tutors, and administrators. The study drew on stakeholders' participation and proved appropriate for the development of the evaluation proposal. The results highlight the potential for use of evaluation matrices developed for the assessment of other distance training programs under the SUS.Com a implantação da atenção domiciliar no âmbito do Sistema Único de Saúde (SUS), diante da necessidade de capacitação de gestores e profissionais, criou-se o Programa Multicêntrico de Qualificação Profissional em Atenção Domiciliar a Distância (PMQPAD) numa parceria entre a Universidade Aberta do SUS e a Coordenação Geral de Atenção Domiciliar do Ministério da Saúde. Por meio de cursos de especialização, aperfeiçoamento e autoinstrucionais, o programa teve grande capilaridade e alcance no país, com quase 300 mil matrículas distribuídas em todos os estados brasileiros. O objetivo do presente estudo foi estruturar um modelo avaliativo do PMQPAD, por meio de um estudo de avaliabilidade, com a participação dos gestores do programa. Foi utilizada a metodologia desenvolvida por ThurstonRamaliu, cujas etapas permitiram descrever o programa, representá-lo por meio de um modelo lógico e desenvolver uma matriz avaliativa. Foram realizadas análise documental, entrevistas semiestruturadas e oficinas de consenso para validação do modelo. O processo resultou no desenvolvimento de três matrizes avaliativas, uma para cada modalidade de curso do programa, com quatro dimensões de análise em comum (Características do curso e recursos educacionais; Aspectos institucionais; Resultados; Impactos). Os indicadores avaliativos tiveram, como fontes de dados primários, os alunos, os tutores e os gestores do curso. O estudo contou com a participação dos stakeholders e mostrou-se apropriado para o desenvolvimento da proposta avaliativa. Destaca-se o potencial de utilização das matrizes avaliativas desenvolvidas para a avaliação de outros programas de formação a distância no âmbito do SUS.Con la implantación de la atención domiciliaria en el ámbito del Sistema Único de Salud (SUS), ante la necesidad de la capacitación de gestores y profesionales, se creó el Programa Multicéntrico de Cualificación Profesional en Atención Domiciliaria a Distancia (PMQPAD), en una colaboración entre la Universidad Abierta del SUS y la Coordinación General de Atención Domiciliaria del Ministerio de Salud de Brasil. A través de cursos de especialización, perfeccionamiento y de autoaprendizaje, el programa tuvo una gran capilaridad y alcance en el país, con casi 300 mil matrículas, distribuidas por todos los estados brasileños. El objetivo del presente estudio fue estructurar un modelo evaluativo del PMQPAD, a través de un estudio de disponibilidad, con la participación de los gestores del programa. Se utilizó la metodología desarrollada por ThurstonRamaliu, cuyas etapas permitieron describir el programa, representarlo a través de un modelo lógico, y desarrollar una matriz evaluativa. Se realizó un análisis documental, entrevistas semiestructuradas y talleres de consenso para la validación del modelo. El proceso resultó en el desarrollo de tres matrices evaluativas, una para cada modalidad de curso del programa, con cuatro dimensiones de análisis en común (Características del curso y recursos educacionales; Aspectos institucionales; Resultados; Impactos). Los indicadores evaluativos tuvieron como fuentes de datos primarios los alumnos, los tutores y los gestores del curso. El estudio contó con la participación de los stakeholders, y se mostró apropiado para el desarrollo de la propuesta evaluativa. Se destaca el potencial de utilización de las matrices evaluativas desarrolladas para la evaluación de otros programas de formación a distancia en el ámbito del SUS.

A critical issue in the contemporary field of public health is the organizational stress experienced by healthcare professionals. An integrative and complementary therapy that research has shown as efficacious in helping healthcare professionals to cope with stress is mindfulness meditation. An intervention, however, can't merely be efficacious, it also needs to be feasible to be implemented in a specific political and organizational context. This paper proposes a theoretical logical model and evaluation matrix of the feasibility of a mindfulness-based stress reduction program for primary care professionals. The literature review about the topic was the source for the construction of the theoretical logical model and evaluation matrix, and the validation of those was given by consensus methods, gathering data from experts in the field.

Purpose The purpose of this paper is to examine the effects of different menu labelling formats on healthy food choices in a real restaurant setting. Design/methodology/approach This cross-sectional, randomised and controlled parallel-group trial was conducted in Brazil in 2013. In total, 313 university students were randomly assigned to one of three parallel groups with different menu labelling formats. Of these, data from 233 students were analysed. The others did not attend and were excluded. Intervention Group 1 (n=88) received information in the form of a traffic light plus guideline daily amounts, while Intervention Group 2 (n=74) was presented with ingredients list plus highlighted symbols (IL+S). The control group (n=71) received a menu with no menu labelling. Data were collected on one weekday in a restaurant setting. Trial outcomes were assessed by healthy food choices. Findings Healthy food choices of students who received the menu showing IL+S were significantly higher when compared to the other groups. This same menu labelling format positively affected healthy food choices in women, not overweight participants and in participants who often ate out more than twice a week. Originality/value Menu labelling format presenting ingredients list and highlighted symbols was positively associated with healthy food choices among the university students in Brazil. This type of labelling could be adopted in future legislation on menu labelling in Brazil and around the world.

Community-based intervention studies that aim at developing cooking skills have increased in the scientific literature and are related to healthier food practices. However, methodological limitations are observed and only a few studies have university students as the target. The university entrance period has been related to negative changes in eating habits among young people and it represents an important period for developing interventions for health promotion. This study describes the study protocol and the evaluation framework for the Nutrition and Culinary in the Kitchen program. This program aims to develop cooking skills in university students, and is based on the Cooking with a Chef program in the United States. This ongoing, randomized controlled intervention was designed with a six month follow-up study. The intervention consisted of three-hour weekly classes during a six week period with printed materials provided. Five of the classes were hands-on cooking and one was a tour to a popular food market. There were eight primary outcome measures: changes in relation to i) accessibility and availability of fruits and vegetables; ii) cooking attitudes; iii) cooking behaviors at home; iv) cooking behaviors away from home; v) produce consumption self-efficacy; vi) self-efficacy for using basic cooking techniques; vii) self-efficacy for using fruits, vegetables, and seasonings (while cooking); and viii) knowledge of cooking terms and techniques. Secondary outcomes included changes in body mass index and in personal characteristics related to cooking. Repeated measures were collected through the application of an online self-completed survey, at baseline, after intervention and six months after intervention. A sample of 80 university students (40: intervention group; 40: control group) was estimated to detect a mean change of 1.5 points in cooking knowledge, with study power of 80%, and 95% level of confidence, plus 20% for random losses and 10% for confounding factors. The control group participants have continued with their usual activities. Data analyses will evaluate the intervention effect on changes in outcomes within and between groups, as well as explore relations with personal characteristics. This method provides new evidence about whether or not a culinary intervention targeting university students has an impact on the improvement of cooking skills and healthy eating practices. Brazilian Clinical Trials Registry - RBR-8nwxh5 ( http://www.ensaiosclinicos.gov.br/rg/RBR-8nwxh5/ )

Resumo Objetivo: analisar a oferta dos servicos publicos odontologicos na atencao especializada na modalidade Centro de Especialidade Odontologica (CEO) no Brasil em 2014. Metodos: foram analisados dados secundarios da relacao entre CEO e cirurgioes-dentistas por populacao e da adequacao da quantidade de consultorios odontologicos completos para tipo de CEO; da adequacao da relacao entre a carga horaria de auxiliares em saude bucal/tecnicos em saude bucal e dentistas; e da adequacao da oferta das especialidades minimas preconizadas. Possiveis diferencas estatisticas entre as macrorregioes foram verificadas. Resultados: encontrou-se relacao de um CEO para cada 217.797 habitantes e de um dentista para cada 26.811 habitantes; 97% dos CEOs apresentaram a quantidade preconizada de consultorios odontologicos; 26% apresentaram a carga horaria entre auxiliar/tecnico e dentista equivalente; 60% ofertavam as especialidades minimas preconizadas. Conclusao: houve limitacoes na oferta de servicos na atencao especializada em saude bucal no Sistema Unico de Saude, com diferencas regionais.

Copyright © 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Amplification of the MYCN oncogene is associated with an aggressive phenotype and poor outcome in childhood neuroblastoma. Polyamines are highly regulated essential cations that are frequently elevated in cancer cells, and the rate-limiting enzyme in polyamine synthesis, ornithine decarboxylase 1 (ODC1), is a direct transcriptional target of MYCN. Treatment of neuroblastoma cells with the ODC1 inhibitor difluoromethylornithine (DFMO), although a promising therapeutic strategy, is only partially effective at impeding neuroblastoma cell growth due to activation of compensatory mechanisms resulting in increased polyamine uptake from the surrounding microenvironment. In this study, we identified solute carrier family 3 member 2 (SLC3A2) as the key transporter involved in polyamine uptake in neuroblastoma. Knockdown of SLC3A2 in neuroblastoma cells reduced the uptake of the radiolabeled polyamine spermidine, and DFMO treatment increased SLC3A2 protein. In addition, MYCN directly increased polyamine synthesis and promoted neuroblastoma cell proliferation by regulating SLC3A2 and other regulatory components of the polyamine pathway. Inhibiting polyamine uptake with the small-molecule drug AMXT 1501, in combination with DFMO, prevented or delayed tumor development in neuroblastoma-prone mice and extended survival in rodent models of established tumors. Our findings suggest that combining AMXT 1501 and DFMO with standard chemotherapy might be an effective strategy for treating neuroblastoma.