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Background: Blood transfusion rates are increasing worldwide. This work was a longitudinal retrospective study conducted with data referent to the use of blood components between January 2008 and December 2021 in the local public health network of Belo Horizonte, Minas Gerais, at Hospital Risoleta Tolentino Neves (HRTN), Hospital Metropolitano Dr. Célio de Castro (HMDCC), and Hospital Metropolitano Odilon Behrens (HMOB). Objective: This study sought to describe the time series of the number of blood transfusions and blood transfusion rates per general hospitalization through a time series analysis. Methods: Through data from the Hospital Information System of the Unified Health System (HIS-SUS), this study formulated six monthly time series of the number of blood transfusions and blood transfusion rates per hospitalization. The stationarity, trend, and seasonality of the time series were verified by the unit root test, using the Mann-Kendall and the Fisher tests, respectively. The normality hypothesis of the data was verified by the Shapiro-Wilk test. All of the statistical tests considered a significance level of 5%. Results: The average monthly blood transfusion rates per hospitalization observed in this study were 45.5%, 26.9%, and 26.3% at HRTN, HMDCC, and HMOB, respectively. The highest decrease in the number of blood transfusions was observed at HMDCC and the highest decrease in blood transfusion rates was observed at HRTN. Packed red blood cells were the most commonly used blood component at HRTN, HMOB, and HMDCC (54.6%, 58.3%, and 65.4%, respectively). The time series showed that they were non-stationary, with a downward trend and the presence of a 12-month seasonal component. Conclusion: The decline in the number of blood transfusions should be considered a positive phenomenon in public health due to best use and quality management, since a decrease in blood donation rates was also observed.

ABSTRACT: Objective: To translate, cross-culturally adapt and validate the Sickle Cell Self-Efficacy Scale for application in the Brazilian cultural context. Methods: This is a methodological study performed in 6 steps: 1- Forward translation; 2- Translation synthesis; 3- Back-translation; 4- Assessment by expert committee, with computation of the Content Validity Index (CVI); 5- Cultural adequacy (pre-test); 6- Reproducibility. A pre-test was performed with the participation of 10 adolescents/young adults with sickle cell disease through a telephone call and their responses were recorded on a form in a web platform. The instrument validation step was carried out with 55 adolescents/young adults with sickle cell disease, 43 of them having participated in the retest. The analysis of internal consistency and reproducibility was calculated using the Cronbach's alpha coefficient and the Intraclass Correlation Coefficient (ICC), in the R statistical programming environment. Results: The translated instrument had good acceptance among the experts, reaching an average CVI of 1.0. In assessing reliability, the scale showed acceptable internal consistency, with a Cronbach's alpha of 0.84. In the agreement analysis, the ICC was 0.923 (95% CI: 0.857 to 0.958), which indicates good temporal reproducibility. Conclusions: Following the process of translation, cross-cultural adaptation and validation, we obtained the Brazilian version of the Sickle Cell Self-Efficacy Scale, considered valid and reliable to be applied to adolescents and young adults with sickle cell disease in Brazil.

O ressarcimento ao Sistema Único de Saúde (SUS) é a interface mais visível da relação entre saúde pública e privada, e sua análise pode ampliar o conhecimento sobre o uso do SUS pelo setor suplementar. O presente estudo objetivou caracterizar os beneficiários de planos privados de saúde que realizaram hemodiálise no SUS entre 2012 e 2019 em relação a: sexo, faixa etária, região de residência, características dos planos privados de saúde e das operadoras e a assistência prestada a eles. Visou também comparar características dos planos privados de saúde e modalidade das operadoras daqueles beneficiários com dados dos demais beneficiários do Brasil. Construiu-se uma base centrada no indivíduo a partir de dados da Agência Nacional de Saúde Suplementar (ANS); informações sobre beneficiários do Brasil foram consultadas no Departamento de Informática do SUS (DATASUS). Utilizou-se distribuições de frequências para resumir os dados, padronização por idade e sexo para características dos planos privados de saúde e modalidade das operadoras, e razão para comparar frequências. Um total de 31.941 beneficiários realizou hemodiálise no SUS, 11.147 (34,9%) destes fora de seu município de residência, e 6.423 (20,11%) utilizaram o SUS por 25 meses ou mais. Comparados aos demais beneficiários do Brasil, aqueles que realizaram hemodiálise no SUS estavam vinculados mais frequentemente a planos privados de saúde antigos (razão, r = 2,41), coletivos por adesão (r = 1,76), individuais/familiares (r = 1,36), ambulatoriais (r = 4,66), municipais (r = 3,88) e/ou a filantropias (r = 7,32). Planos privados de saúde com características restritivas podem ter dificultado o acesso dos beneficiários que realizaram hemodiálise no SUS às redes de suas operadoras, e representado mais um fator que pode ter influenciado o uso do SUS por aqueles beneficiários, mesmo com a cobertura prevista em seus contratos.

Resumo Objetivo Analisar a qualidade de vida do cuidador familiar do paciente em hemodiálise e a existência de associação com suas características clínicas e sociodemográficas. Métodos Estudo transversal, realizado com 75 cuidadores familiares em dois centros de diálise. A qualidade de vida do cuidador foi medida por meio do instrumento World Health Organization Quality of Life – BREF, e sua associação com as características sociodemográficas foi avaliada pelo teste de Kruskal-Wallis (nível de significância igual a 5%). Resultados A maioria dos cuidadores familiares era mulher (84%), cônjuge (41,3%), filho (38,7%), do lar (38,7%) e possuía renda familiar de um a três salários mínimos (85,4%). A variável trabalhar fora de casa teve influência positiva na qualidade de vida geral (p=0,014), nos domínios psicológicos (p=0,009) e nas relações sociais (p≤0,001). Ser do sexo masculino (p=0,016), não ter doenças (p=0,002) e não usar medicamentos (p=0,007) interferiram positivamente no domínio físico. A ausência de ajuda financeira de outras pessoas e/ou familiares influenciou de forma negativa nos domínios das relações sociais (p=0,050) e meio ambiente (p=0,001). Conclusão O cuidador familiar do sexo masculino, ou que trabalha fora de casa ou recebe ajuda financeira de outras pessoas e/ou familiares apresentaram melhores níveis de qualidade de vida. Em contrapartida, as condições clínicas tais como fazer uso de algum medicamento ou ter doenças influenciaram de forma negativa nos níveis de qualidade de vida.

Objetivo: analisar o efeito da intervenção breve na motivação para mudança do consumo de bebidas alcoólicas. Método: estudo experimental, de follow-up, realizado com 43 participantes em duas Unidades Básicas de Saúde. Foi aplicado o Alcohol Use Disorders Identification Test, a Régua de Prontidão para Mudança e um questionário socioeconômico. Resultados: o grupo experimental apresentou mediana igual a 10 pontos (fase de manutenção) no início e após 30 dias. No segmento, mediana igual a oito pontos (estágio de ação). O grupo- controle, mediana igual a oito pontos no início e após 30 dias (fase de ação). No segmento, a mediana igual a sete pontos (fase de planejamento). Na avaliação intermediária de 30 dias, notou-se que houve diferença estatística na motivação entre os dois grupos (p=0,029). Conclusão: concluiu-se que a Intervenção Breve foi eficaz para manter a motivação nos estágios de ação e manutenção da mudança no consumo de bebidas alcoólicas.

Objetivo: analizar el efecto de una intervención breve sobre la motivación para el cambio en el consumo de alcohol. Método: Estudio experimental, de seguimiento, realizado con 43 participantes en dos Unidades Básicas de Salud. Se aplicó el Alcohol Use Disorders Identification Test, la Regla de Disposición al Cambio y un cuestionario socioeconómico. Resultados: el grupo experimental mostró una mediana igual a 10 puntos (fase de mantenimiento) al principio y después de 30 días. En el segmento, la mediana era igual a ocho puntos (etapa de acción). El grupo de control tenía una mediana igual a ocho puntos al principio y después de 30 días (etapa de acción). En el segmento, la mediana es igual a siete puntos (fase de planificación). En la evaluación intermedia de 30 días, se observó que había una diferencia estadística en la motivación entre los dos grupos (p=0,029). Conclusión: se concluyó que la Intervención Breve fue eficaz para mantener la motivación en las etapas de acción y mantenimiento del cambio en el consumo de alcohol.

Objective: to analyze the effect of brief intervention on motivation to change alcohol consumption. Method: experimental, follow-up study, conducted with 43 participants in two Basic Health Units. The Alcohol Use Disorders Identification Test, the Change Readiness Ruler, and a socioeconomic questionnaire were applied. Results: The experimental group showed a median equal to 10 points (maintenance stage) at the beginning and after 30 days. In the segment, the median was equal to eight points (action stage). The control group had a median equal to eight points at the beginning and after 30 days (action stage). In the segment, median equal to seven points (planning stage). In the 30-day intermediate evaluation, it was noted that there was a statistical difference in motivation between the two groups (p=0.029). Conclusion: it was concluded that the Brief Intervention was effective in maintaining motivation in the stages of action and maintenance of change in the consumption of alcoholic drinks.

O objetivo deste estudo é investigar se há associação entre as Regiões Ampliadas de Saúde (RAS) de residência de Minas Gerais, Brasil, e o intervalo entre diagnóstico e início de tratamento de mulheres que realizaram tratamento ambulatorial (quimioterapia ou radioterapia) para câncer do colo do útero pelo Sistema Único de Saúde (SUS), entre 2001 e 2015. Trata-se de um estudo transversal, recorte de uma coorte, com 8.857 mulheres. Para avaliar a associação da RAS de residência e o intervalo entre diagnóstico e início de tratamento (em dias), foram utilizados modelos de regressão binomial negativa, considerando nível de significância de 5%. Os modelos foram construídos usando blocos de covariáveis sociodemográficas, clínicas e relacionadas ao tratamento. Foi determinado que a RAS de residência das mulheres está associada ao intervalo entre o diagnóstico e o início de tratamento. A RAS Norte foi a região do estado onde a média de tempo para iniciar o tratamento foi menor, e não residir nessa RAS aumenta a média de tempo para iniciar o tratamento entre 24% e 93% em comparação com outras RAS do estado. Fica evidente a disparidade no intervalo entre diagnóstico e início de tratamento entre as regiões do Estado de Minas Gerais. A disponibilidade de serviços habilitados para o tratamento do câncer nas RAS não reflete necessariamente em maior agilidade para início de tratamento. Compreender os fluxos das Redes de Atenção Oncológica e suas diferenças regionais é fundamental para aprimorar políticas públicas que garantam o cumprimento de leis vigentes, como a Lei nº 12.732/2012, que preconiza o início do tratamento de pacientes com câncer em até 60 dias após o diagnóstico.

Nutrition claims are positive information about foods, which are widely used as a marketing strategy on labels. On the contrary, front-of-package nutritional labeling (FoPNL) aims to make it easier for consumers to understand the nutritional composition of foods and favor healthy food choices. However, the concomitant presence of nutrition claims and FoPNL may hinder the understanding, judgment, and choices of consumers at the moment of purchase. Therefore, the objective of this study was to evaluate the influence of nutrition claims on the efficacy of FoPNL models in the understanding of nutritional information, healthfulness perception, and purchase intention of Brazilian consumers. It was an experimental cross-sectional study carried out using an online questionnaire, with a total of 720 participants randomly divided into four FoPNL conditions: control, octagon, triangle, and magnifying glass. Each participant looked at 12 food packages, which were produced following the factorial design: (i) food category (cereal bar, whole grain cookies, and snacks); (ii) product type (containing one critical nutrient × containing two critical nutrients); and (iii) nutrition claims (present × absent). The comprehension of nutritional information was evaluated through the identification of excessive nutrients, and the healthfulness perception and purchase intention were evaluated using a seven-point scale. The results indicated that the presence of FoPNL increased the understanding of the information and reduced healthfulness perception and purchase intention. The presence of nutrition claims influenced the three outcomes, decreasing the probability of understanding information about food composition by 32% (OR 0.68, 95% confidence interval 0.58–0.78, p < 0.01) and significantly increasing (p < 0.05) average health scores (1.95–2.02) and purchase intention (2.00–2.05). Nonetheless, the interaction “FoPNL × claims” was not significant, which indicated that claims act independently. All FoPNL models were more effective than the control. For the least healthful type of product (two nutrients in excess), the octagon and triangle models were superior to the magnifying glass, regarding the outcome of healthfulness perception. The results prove the efficacy of FoPNL in consumer understanding and judgment. Despite the positive effects of FoPNL, it did not cancel the positivity bias generated by the claims.

ABSTRACT BACKGROUND: Analysis of the literature suggests that changes relating to blood donations and blood component transfusion are occurring due to the aging of the population. OBJECTIVE: To gain better understanding of the demand and supply of these inputs over time, and to identify the main associated demographic characteristics. DESIGN AND SETTING: Systematic review conducted on time series relating to blood donations and blood component transfusions worldwide. METHODS: A systematic review of the literature was conducted based on articles that presented time series relating to blood donation or blood component transfusion. RESULTS: We found 1,814 articles. After the deletion process, only thirteen were read. Overall, these suggested that there is increasing demand for blood components and decreasing donation. The existence of seasonality regarding blood donation was pointed out. Men usually donated more blood and demanded more blood components than women. Approximately 50% of blood transfusions were performed in people aged ≥ 60 years. CONCLUSIONS: This analysis on articles that presented time series relating to blood donations and blood component transfusion showed that aging of the population was the main factor associated with the increasing demand for blood and the decreasing supply of blood.

This study aimed to identify differences in the scope of practice of primary care physicians and find the main factors associated with expanded practice in rural and urban areas of Brazil. Data from an online survey with 2,277 primary care physicians, conducted between January and March 2016, were used. Differences regarding activities and procedures performed by physicians per area were verified using Kruskal-Wallis/Dunn’s post hoc and chi-square tests. Multivariate linear regression analyses were done using a bootstrap technique to identify the main factors associated with an expanded scope of practice. Regardless of the location, the results showed that the practices of the primary care physicians are below their competences. Rural physicians performed a higher number of procedures and activities compared with their peers from intermediate and urban municipalities. Within the overall sample, the variables related to a broader scope of practice included: male gender, work in rural municipalities, participation in training and continuing education programs and consultation of clinical protocols, articles and books. This study contributes with evidence that the medical scope of practice varies according to location. Recognizing and understanding the differences and associated factors for an expanded scope of practice is necessary to determine the skills and resources required for practice in rural and urban areas, collaborating in proposals of strategies to improve quality and access of health care services.

This study aims to evaluate changes in quality of life of cancer patients at the beginning of the first and the second cycle of chemotherapy (CT) in hospitals in Belo Horizonte, Minas Gerais State, Brazil. Longitudinal, prospective, descriptive study with a quantitative approach. We enrolled 230 patients, from a broader cohort, diagnosed with the five most frequent types of cancer (breast, colorectal, cervical, lung, and head and neck), aged 18 years or older, who were initiating CT for the first time. quality of life was assessed with the EORTC QLQ-C30 version 3, applied at the beginning of the first and second chemotherapy cycle. The paired Wilcoxon test was used to identify differences in quality of life between the two time points. A multivariate linear regression analysis was performed using the bootstrap method to investigate potential predictors of global health Status/quality of life. There was a significant increase in patients’ emotional function scores (p < 0.001) as well as symptom scores for pain (p = 0.026), diarrhea (p = 0.018), and nausea/vomiting (p < 0.001) after initiation of CT. Widowhood was associated with improvements in the global health Status/quality of life (p = 0.028), whereas the presence of cervical cancer (p = 0.034) and being underweight (p = 0.033) were related to poorer global health status/quality of life scores. CT has detrimental effects on patients’ physical health but, on the other hand, it leads to improvements in the emotional domain. Patients’ individual characteristics at the beginning of CT are associated with changes in their quality of life. Our study could help identify these characteristics.

RESUMO Objetivo: identificar o estado atual da arte e as tendências de pesquisas que utilizam o aplicativo móvel WhatsApp na área da saúde. Método: revisão integrativa da literatura nas bases de dados PubMed, CINAHL, SCOPUS e LILACS, no período de 2009 a 2019. Resultados: amostra composta de 24 estudos agrupados em três categorias de análise: uso do WhatsApp por profissionais/estudantes da área da saúde como ferramenta de comunicação, ensino e aprendizagem (n=5); uso do WhatsApp pelo profissional no serviço de saúde (n=13); e uso do WhatsApp para educação em saúde/ troca de informação entre profissional e paciente (n=6). Conclusão: evidências científicas mostram que o uso do WhatsApp favorece a comunicação existente entre os profissionais em um serviço de saúde e até mesmo entre profissionais, estudantes da área da saúde e pacientes.

ABSTRACT OBJECTIVE To identify demographic and clinical characteristics of adult patients hospitalized in the Brazilian Unified Health System (SUS) due to viral pneumonia and investigate the association between some comorbidities and death during hospitalization. METHODS This retrospective cohort study was conducted with secondary data of adults admitted to SUS due to viral pneumonia between 2002 and 2015. Patient profile was characterized based on demographic and clinical variables. The association between the ten Elixhauser comorbidities and in-hospital death was investigated using Poisson regression models with robust standard errors. Results were quantified as incidence rate ratio (IRR) with 95% confidence intervals (CI), and we built five models using successive inclusion of variables blocks. RESULTS Hospital admissions for viral pneumonias decreased throughout the study period, and it was observed that 5.8% of hospitalized patients had an in-hospital death. We observed significant differences in demographic and clinical characteristics by comparing individuals who died during hospitalization with those who did not, with the occurrence of one or more comorbidities being more expressive among patients who died. Although not considered risk factors for in-hospital death, chronic pulmonary disease and congestive heart failure were the most common comorbidities. Conversely, IRR for in-hospital death increased with other neurological disorders, diabetes, cancer, obesity, and especially with HIV/AIDS. CONCLUSIONS Individuals presenting with pulmonary and cardiovascular diseases require proper attention during hospitalization, as well as those with other neurological diseases, diabetes, cancer, obesity, and especially HIV/AIDS. Understanding the influence of chronic diseases on viral infections may support the healthcare system in achieving better outcomes.

RESUMO Objetivo: Avaliar as estratégias de educação em grupo e intervenção telefônica em relação às variáveis empoderamento, práticas de autocuidado e controle glicêmico da pessoa com diabetes. Método: Ensaio clínico com oito clusters randomizados, realizado entre 2015 e 2016, com 208 usuários com diabetes mellitus tipo 2 alocados para educação em grupo, intervenção telefônica ou grupo controle. Foram coletados dados sociodemográficos, hemoglobina glicada, empoderamento e práticas de autocuidado. Resultados: A média de idade dos usuários era de 63,5 anos (DP = 8,9 anos), com participação de 124 mulheres, equivalente a 59,6% desses usuários. As estratégias levaram a uma redução estatisticamente significante nos níveis de hemoglobina glicada (p < 0,001). Observou-se também que a intervenção telefônica apresentou resultados estatisticamente significantes quanto às práticas de autocuidado (p < 0,001) e ao empoderamento em diabetes (p < 0,001) quando comparada à educação em grupo. Conclusão: A intervenção telefônica apresentou resultados estatisticamente significantes de empoderamento e de práticas de autocuidado se comparada à educação em grupo. Registro Brasileiro de Ensaios Clínicos RBR-7gb4wm.

Objective: To develop and validate DFConhecimento, an instrument to assess Brazilian healthcare professional providers’ knowledge on sickle cell disease. Method: Study carried out in four stages: (1) instrument development; (2) content validation by an Expert Committee; (3) cultural adequacy check at pre-test; (4) instrument reliability analysis by healthcare professional providers supported by Intraclass Correlation Coefficient calculation. The data for content validation and reliability analyses were collected through the web tool eSurv and analyzed within the statistical software and environment R. Results: The instrument, consisting of 13 multiple-choice questions, showed acceptability, with an average Content Validity Index of 0.88. The reliability analysis showed moderate agreement (0.67) indicating that test-retest reproducibility is acceptable. Conclusion: The instrument DFConhecimento showed reliability and internal consistency, proving suitable for measuring Brazilian healthcare professional providers’ acquisition of knowledge on sickle cell disease. Keywords: Sickle cell disease, Healthcare professional provider, Knowledge acquisition, Validation studies, Brazil

Objective: To assess the impact of the distance education course “Sickle Cell Disease: Primary Health Care Line” on knowledge acquisition of professional healthcare providers. Methods: A cross-sectional study was conducted with a quantitative approach at the Educational and Support Center for Hemoglobinopathies (Cehmob-MG), state of Minas Gerais, Brazil, in 2016. One hundred and fifty-three out of 300 professional healthcare providers were invited to participate in the proposed distance course. Of the participating professional healthcare providers, 72 (47%) successfully concluded the course (Group A), whereas 81 (53%) did not complete their course assignments and did not meet the minimum requirements for regular attendance (Group B). Knowledge acquisition was assessed with the Knowledge of Sickle Cell Disease Instrument, DFConhecimento, applied using the web tool eSurv. Univariate analysis by Poisson regression was employed to assess the influence of sociodemographic variables on the DFConhecimento score and to select variables to compose the initial multivariate regression model (p-value

Abstract Background Control strategies adopted by the Brazilian Visceral Leishmaniasis Surveillance and Control Programme (VLSCP) include identifying and culling seropositive infected dogs, early diagnosis and treatment of human cases, chemical control of the vector and population awareness. This study evaluated the effectiveness of the VLSCP on the prevalence and incidence rates of Leishmania infantum in children residing in areas under different VLSCP intervention times. Methods A quasi-experimental epidemiological study with a panel (two cross-sectional) and a concurrent cohort was performed in three areas of Belo Horizonte, southeast Brazil. The first cross-sectional study (I) was carried out with 1875 children, 478 of which were enrolled in the cohort study. In the second cross-sectional study (II), 413 additional children were included, totalizing 891 children. Laboratory diagnosis was performed by ELISA-rK39. Analyses included multilevel logistic and Poisson regression models. Results The incidence rates of L. infantum infection were: 14.4% in the area where VLSCP intervention was initiated in 2006 (AI2006); 21.1% in the area where intervention was initiated in 2008 (AI2008); and 11.6% in the area where intervention was initiated in 2010 (AI2010 - control area). A follow-up period of 24 months showed that the persons-time incidence rates in AI2006, AI2008, and AI2010 were: 6.2/100, 10/100, and 5.6/100 persons/24 months, respectively. The final prevalence rates of infection (cross-sectional II - in 2012), compared to the initial rates (cross-sectional I - in 2010), increased 83.7% in AI2006, 74.1% in AI2008, and decreased 5% in AI2010. Analysis of the effectiveness revealed that children residing in AI2008 are more likely to be infected (OR = 1.84; 95% CI: 1.06-3.23) and present a higher risk of infection (IRR = 1.76; 95% CI: 1.05-2.95) compared to those in AI2010. No statistically significant differences were observed in asymptomatic infection (OR and IRR) in AI2006 compared to AI2010. Conclusions The VLSCP was not effective at controlling L. infantum infection in areas where interventions had respectively been carried out for six and four years. However, it is unclear what the consequences in terms of human infection and diseases would be in the absence of the VLSCP. Efforts to improve the effectiveness of control measures remain a necessary priority.

ABSTRACT OBJECTIVE To characterize the profile of patients hospitalized for mental and behavioral disorders by the Unified Health System (SUS) in Brazil between 2000 and 2014, and to verify how aspects of the new mental health policy influenced the rate of hospitalized patients in that period. METHODS Non-concurrent prospective cohort study using secondary data from inpatients with a primary diagnosis of mental and behavioral disorders between 01/01/2000 and 12/31/2014. Sociodemographic, clinical, and hospital characteristics variables were selected. Overall rates of hospitalized patients were calculated according to reason for admission, type of hospital, legal nature, and number of admissions per year for each patient. The association between rates of hospitalized patients, number of psychiatric beds per year, and number of Psychosocial Care Centers per year were tested. RESULTS We selected a total of 1,549,298 patients, whose most frequent diagnoses on first admission were psychoactive substance use disorders, followed by schizophrenia and mood disorders. The median of hospitalizations per patient was 1.9 and the length of stay per patient was 29 days. The overall rate of hospitalized patients was reduced by almost half in the period. The number of beds per year was positively associated with the rates of hospitalized patients; the number of CAPS per year was negatively associated with some rates of hospitalized patients. CONCLUSION Even in the face of adversity, the National Mental Health Policy has advanced in its goal of progressively reducing hospital beds and increasing the supply of substitute services such that both strategies were associated with the reduced inpatient rates. But the changes were felt with greater intensity in the first years of the policy’s implementation, becoming less pronounced in recent years.

ABSTRACT COVID-19 is an infectious disease caused by the recently discovered coronavirus SARS-Cov-2. The disease became pandemic affecting many countries globally, including Brazil. Considering the expansion process and particularities during the initial stages of the epidemic, we aimed to analyze the spatial and spatiotemporal patterns of COVID-19 occurrence and to identify priority risk areas in Minas Gerais State, Southeast Brazil. An ecological study was performed considering all data from human cases of COVID-19 confirmed from the epidemiological week (EW) 11 (March 08, 2020) to EW 26 (June 27, 2020). Crude and smoothed incidence rates were used to analyze the distribution of disease patterns based on global and local indicators of spatial association and space-time risk assessment. Positive spatial autocorrelation and spatial dependence were found. Our results suggest that the metropolitan region of the State capital Belo Horizonte (MRBH) and Vale do Rio Doce mesoregions, as major epidemic foci in the beginning of the expansion process, have had important influence on the dispersion of SARS-CoV-2 in Minas Gerais State. Triangulo Mineiro/Alto Paranaiba region presented the highest risk of infection. In addition, six statistically significant spatiotemporal clusters were identified in the State, three at high risk and three at low risk. Our findings contribute to a greater understanding of the space-time disease dynamic and discuss strategies for identification of priority areas for COVID-19 surveillance and control.

RESUMO: Objetivo: O estudo tem como objetivo avaliar o desempenho dos hospitais que participaram do Programa Nacional de Avaliação de Serviços de Saúde (PNASS 2015-2016). Métodos: Estudo descritivo transversal quantitativo, que buscou mensurar o desempenho dos hospitais que participaram do programa com base nos dados do primeiro instrumento avaliativo do PNASS 2015-2016. O questionário de avaliação de processos aplicado aos hospitais contou com 102 itens, 17 critérios, agrupados em quatro blocos ou dimensões. Resultados: Participaram 1.681 hospitais. O escore médio por bloco foi: gestão organizacional (64), apoio técnico e logístico para produção de cuidado (73), gestão da atenção à saúde e do cuidado (64) e serviços/unidades específicas (72). Com relação à esfera administrativa, o melhor desempenho médio foi obtido pela esfera federal, seguido da estadual e da municipal. Os hospitais localizados no Sul e Sudeste obtiveram o melhor desempenho (73,0), seguido do Centro-Oeste (62,7), Nordeste (61,2) e Norte (58,5). Conclusão: Os hospitais que realizam procedimentos de alta complexidade, assim como os de grande porte e especiais, obtiveram melhor desempenho. Hospitais públicos federais, de gestão municipal, também alcançaram os melhores resultados, bem como os hospitais do Sul e Sudeste do país.

Although renal replacement therapy has contributed to the survival of chronic kidney failure (CKF) patients, mortality remains a major concern. This study aimed to identify the factors associated with mortality in a prospective cohort of CKF patients. Sociodemographic, clinical, nutritional, lifestyle and quality of life data were collected from 712 patients. The instruments used were the Short-Form Health Survey (SF-36), Global Subjective Assessment (GSA) and Charlson Comorbidity Index (CCI) questionnaires. A total of 444 patients died during the study. After five years of follow-up, factors such as not being married (hazard ratio - HR = 1.289, 95%CI: 1.001; 1.660), a low frequency of leisure activities (HR = 1.321; 95%CI: 1.010; 1.727) and not being transplanted (HR = 7.246; 95%CI: 3.359; 15.630) remained independently associated with the risk of mortality. At the end of the follow-up period, factors such as not being married (HR = 1.337, 95%CI: 1.019; 1.756), not being transplanted (HR = 7.341, 95%CI: 3.829; 14.075) and having a worse nutritional status (HR = 1.363, 95%CI: 1.002; 1.853) remained independently associated with an increased risk of mortality, whereas a high schooling level (10 to 12 years, HR = 0.578, 95%CI: 0.344; 0.972; and over 12 years, HR = 0.561, 95%CI: 0.329; 0.956) and a better SF-36 physical functioning score (HR = 0.992, 95%CI: 0.987; 0.998) were protective factors associated with survival. The survival of patients with CKF is associated with factors not restricted to the clinical spectrum. The following factors were associated with high mortality: not being married, low schooling level, a limited social routine, a longer time on dialysis, worse nutritional status, and worse physical functioning.

ABSTRACT OBJECTIVE: To estimate the incidence and to evaluate risk factors for antineoplastic nausea and vomiting with high and moderate emetogenic chemotherapy in adult patients in the first treatment cycle. METHODS: Prospective cohort study with follow-up of 269 adults during the first cycle of antineoplastic chemotherapy. The incidence of nausea and vomiting was evaluated in the acute phase (0–24 hours), in the late phase (24 hours–5th day) and in the total phase (0–5th day). RESULTS: In total, 152 patients underwent high emetogenic chemotherapy and 117 moderate emetogenic chemotherapy. The relative frequency of nausea was higher when compared with vomiting in the acute phase (p < 0.001) and in the late phase (p < 0.001). The risk factors identified were: age group ≤ 49 years (odds ratio = 0.47; 95%CI 0.23–0.95) and 50–64 years (odds ratio = 0.45; 95%CI 0.23–0.87), tobacco use (odds ratio = 0.35; 95%CI 0.14–0.88), and high emetogenic chemotherapy (odds ratio 0.55; 95%CI 0.31–0.95). CONCLUSION: The incidence of nausea was higher than that of vomiting, and adverse effects were more frequent in the late phase. The results suggest the risk factors for chemotherapy-induced nausea and vomiting are tobacco, age (young adults), and high emetogenic chemotherapy.

Objective: To develop and to test the validity of content and layout of a multidimensional tool to evaluate maintenance of the cold chain for immunobiological conservation. Method: A methodological study carried out in three steps: integrative review; development of theoretical and logical model for the development of the tool; implementation of the Delphi Technique to test the validity of content and layout. The Content Validity Index (CVI) and Content Validity Ratio (CVR) were calculated considering appropriate those values greater than or equal to 75% and 0.4, respectively. Results: The instrument consisted of 7 questions about structure and 20 about process, subdivided into three components: Transportation/Reception (n=3); Storage/Handling (n=13); Supervision/Permanent education (n=4). The CVI value was 87.4%, with values equal to 85.7% and 89% in the structure and process dimensions, respectively. The process components obtained CVI values equal to 88.9, 88.9 and 89.2%, respectively. The CVR was 0.8, with values equal to 0.7 and 0.8 in the structure and process dimensions. As for the layout validation, the questionnaire was considered intelligible. Conclusion: The study provides an instrument with validity of content and layout for health professionals in charge of the supervision of activities of immunobiological conservation, ensuring the maintenance of the immunogenic quality of the products offered to the population.

The hospitalizations are part of cancer care and has been studied by researchers worldwide. A better understanding about their associated factors may help to achieve improvements on this area. The aims of this study were to investigate the association between demographic and clinical characteristics and hospitalizations, as well as between these characteristics and the length of stay (LOS), within the first year of outpatient treatment, for the most incident cancers in the Brazilian population. In this cohort study, we investigated 417,477 patients aged 19 years or more, who started outpatient cancer treatment, from 2010-2014, for breast, prostate, colorectal, cervix, lung and stomach cancers. The outcomes evaluated were: i) Hospitalizations within the first year of outpatient cancer treatment; and ii) LOS of the hospitalized patients. It was performed a binary logistic regression to evaluate the association between the explanatory variables and the hospitalizations and a negative binomial regression to evaluate their influence on the length of hospital stay. The hospitalizations occurred for 34% of patients, with a median of LOS of 6 days (IQR: 2-15). Female patients were 16% less likely to be hospitalized (OR: 0.84; 95% CI: 0.82-0.86), with lower average of LOS (AR: 0.98; 95% CI: 0.97-0.99), each additional year of age reduced in 2% the hospitalization odds (OR: 0.98; 95% CI: 0.98-0.99) and in 1% the average of LOS (AR: 0.99; 95% CI: 0.98-0.99), patients from South region had twice more chances of hospitalization than from North region (OR: 2.01; 95% CI: 1.93-2.10) and patients with colorectal cancer had greater probability of hospitalization (OR: 4.42; 95% CI: 4.27-4.48), with the highest average of LOS (AR: 1.37; 95% CI: 1.35-1.40). In view of our results, we consider that the government must expand the policies with potential to reduce the number of hospitalizations.

Este trabalho visa a apresentar a técnica de agrupamento hierárquica para análise de padrões semânticos e sintáticos da transitividade no nível oracional. Partindo de uma perspectiva empírica e baseando-se em dados reais da língua em uso, esse tipo de metodologia se mostrou útil na investigação dos padrões linguísticos a que os falantes são expostos, chegando a resultados semelhantes a categorias teoricamente conhecidas. Em um processo de amostragem simples sem reposição, foram selecionadas 690 unidades oracionais de um corpus de 23 entrevistas orais. Essas unidades oracionais foram analisadas em termos de nove parâmetros de transitividade e de sua respectiva sintaxe oracional. O objetivo foi identificar grupos de orações que compartilham semelhanças em termos de um conjunto de traços semânticos e morfossintáticos. Os grupos encontrados revelam um tipo de significado protoconceptual das orações, que inclui traços aspectuais e actanciais que se correlacionam. Os resultados evidenciam três cenários micro-narrativos básicos sobre os quais se desenrola o evento expresso na oração.

RESUMO Objetivo: elaborar, adequar culturalmente e validar o “conhecimento dos agentes comunitários de saúde (ACS) sobre diabetes” – diabetes-ACS – para avaliação do conhecimento dos ACS sobre diabetes mellitus. Métodos: estudo metodológico desenvolvido em três etapas: a) construção do instrumento; b) validação de conteúdo e adequação cultural com médicos de família e ACS, seguidas de avaliação das sugestões por comitê de especialistas; c) validação psicométrica do instrumento a partir de sua aplicação em uma amostra de 102 ACS, por meio da ferramenta e-Surv. As análises de consistência interna e reprodutibilidade foram realizadas no ambiente de programação estatística R. Resultados: o instrumento, constituído de 29 questões de múltipla escolha, apresentou consistência interna satisfatória, com alfa de Cronbach 0,732 (IC 95% 0,652; 0,802) e coeficiente de correlação intraclasse de 0,70 (IC 95% 0,59–0,79), entre os escores do teste e do reteste. Conclusão: considera-se adequado e validado o instrumento diabetes-ACS para avaliação de agentes comunitários de saúde.

Resumo Objetivo: Examinar os recursos de aplicativos para dispositivos móveis destinados ao autocuidado de adolescentes com diabetes mellitus tipo 1. Métodos: Revisão integrativa por meio da busca de artigos nos periódicos indexados nas bases de dados: Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Literatura Latino-Americana em Ciências da Saúde, PubMed (National Library of Medicine), Scopus, e Web of Science no período de 2012 a 2017, utilizando os seguintes descritores: aplicativos móveis, autocuidado e diabetes mellitus tipo 1, bem como respectivos descritores em inglês e espanhol. Resultados: A busca gerou um total de 248 artigos, dos quais 12 artigos atenderam os critérios de seleção. Os recursos dos aplicativos foram examinados a partir das funções de controle glicêmico, insulinoterapia, alimentação, atividade física, abordagem dos sentimentos e relações sociais. Observou-se que nenhum artigo descreveu um aplicativo que integrasse todos os recursos examinados. Conclusão: Os recursos de aplicativos para dispositivos móveis foram apontados como necessários para auxiliar no controle glicêmico de adolescentes com diabetes mellitus tipo 1.

Abstract Background The prevalence of type 2 diabetes mellitus is increasing substantially worldwide, leading to serious economic effects, complications and deaths. This study evaluated the effectiveness of an empowerment program providing support for psychosocial, behavioral, and clinical aspects of diabetes to help Brazilian users of public health services obtain metabolic control of this condition. Methods In this cluster randomized trial, participants aged 30–80 diagnosed with type 2 diabetes were recruited from ten Brazilian public health units in 2014 and 2015. Five units were randomly assigned to receive the empowerment program based on a behavior change protocol, and five continued to receive only conventional treatment. The primary outcome was the biochemical and anthropometric parameters, and the secondary outcomes were self-care, attitude, knowledge and empowerment related to diabetes. The effect of the experiment was defined as the percentage variation between the values at the initial and final periods. To evaluate this effect and to compare it in the two groups, tests were used for paired and independent samples, respectively. Results There were 238 participants: 127 and 111 in the intervention and control group, respectively. For glycated hemoglobin, the mean effect in the control and intervention groups was 3.93 and −5.13, respectively (p

Objective: To analyze the prevalence of integrative and complementary practices in patients undergoing antineoplastic chemotherapy. Method: A quantitative, observational, cross-sectional study was conducted at a Chemotherapy Outpatient Unit of a university hospital in Belo Horizonte, Minas Gerais. The sample consisted of 70 patients with data obtained between October 2017 and May 2018. Data were analyzed using the SPSS program through descriptive and inferential statistics. Results: The predominant cancers were breast and colon/rectal. The prevalence of integrative practices was 77.1%, with spirituality being the most used. The funding for the practices was predominantly not provided by the Brazilian Nation Health System. No associated factors were found regarding the use of integrative practices.Conclusion: The patients reported benefits of using integrative complementary practices. It is relevant that nurses know the prevalence of their use and have knowledge to indicate or contraindicate them, when necessary.

Urban occurrence of human and canine visceral leishmaniasis (VL) is linked to households with characteristics conducive to the presence of sand flies. This study proposes an ad hoc classification of households according to the environmental characteristics of receptivity to phlebotominae and an entomological study to validate the proposal. Here we describe the phlebotominae population found in intra- and peridomiciliary environments and analyse the spatiotemporal distribution of the VL vector Lutzomyia longipalpis of households receptive to VL. In the region, 153 households were classified into levels of receptivity to VL followed by entomological surveys in 40 of those properties. Kruskal-Wallis verified the relationship between the households’ classification and sand fly abundance and Kernel analysis evaluated L. longipalpis spatial distribution: of the 740 sand flies were captured, 91% were L. longipalpis; 82% were found peridomiciliary whilst the remaining 18% were found intradomiciliary. No statistically significant association was found between sandflies and households levels. L. longipalpis counts were concentrated in areas of high vulnerability and some specific households were responsible for the persistence of the infestation. L. longipalpis prevails over other sand fly species for urban VL transmission. The entomological study may help target the surveillance and vector control strategies to domiciles initiating and/or maintaining VL outbreaks.

Abstract OBJECTIVE Check the relationship between the users' contact time in educational programs and self-care and knowledge variables in diabetes mellitus. METHOD A longitudinal study with a quantitative approach with the participation, in the initial phase, of 263 users linked to Basic Health Units in Belo Horizonte, Brazil during the years 2012 and 2013. The data were collected with respect to the total contact time of the users' participation in the educational program as regards knowledge and self-care in acquired diabetes mellitus. The data were analyzed using the Student t-test for comparison of means, considering a 0.05 significance level. RESULTS The final sample included 151 users. The analysis showed that the improvement in self-care scores was statistically higher during an educational intervention of eight hours or more (p-value

RESUMO Objetivo: descrever proposta metodológica para a dinâmica de atuação do comitê de juízes por questionário eletrônico implementada e testada na adaptação cultural do instrumento Diabetes Empowerment Scale-Short Form. Método: estudo metodológico realizado com 38 especialistas das áreas de Letras e Ciências da Saúde que avaliaram o instrumento traduzido via questionário eletrônico, desenvolvido e aplicado por meio da ferramenta web e-Surv. Utilizando as respostas ao questionário, o nível de aceitação dos juízes foi avaliado por meio de frequências absolutas e relativas e o nível de concordância entre os juízes foi avaliado por meio do cálculo do coeficiente de Kappa de Cohen-Fleisss. As análises foram realizadas no ambiente de programação estatística R. Resultados: a colaboração interdisciplinar aliada a uma metodologia de coleta de dados online resultou em uma heterogeneidade de opiniões, o que gerou baixa concordância entre os juízes na adaptação do instrumento traduzido. No entanto, acredita-se que essa diversidade de opiniões tenha gerado sugestões que enriqueceram o processo tradutório. Conclusão: a ferramenta online se mostrou confiável, segura e efetiva na dinâmica do comitê de juízes para avaliar instrumentos em saúde.

Estudo transversal que avalia a integração entre a atenção básica e a rede assistencial do Sistema Único de Saúde (SUS), por meio do Modelo de Resposta Gradual da Teoria de Resposta ao Item. Com base nos dados de 17.202 equipes que participaram do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), 2012, foram mensurados gradientes de integração para identificar o perfil das equipes por nível de integração. Os resultados demonstram que os itens referentes às ações de apoio matricial - consultas médicas; discussão de caso; ação clínica compartilhada; construção conjunta de projetos terapêuticos; atividade de educação permanente; discussão processo trabalho; intervenções no território e realização de visita com profissionais de atenção básica - melhoram o desempenho das equipes de atenção básica. Dispositivos de comunicação entre as equipes reforçam esse entendimento. Contudo, a frequência em torno de 50% de respostas associadas ao pior cenário para alguns itens do estudo, evidenciou a necessidade de qualificação da integração entre as ações de atenção básica e especializada para a consolidação de uma atenção primária à saúde abrangente.

ABSTRACT OBJECTIVE To determine the items of the Brazilian National Program for Improving Access and Quality of Primary Care that better evaluate the capacity to provide mental health care. METHODS This is a cross-sectional study carried out using the Graded Response Model of the Item Response Theory using secondary data from the second cycle of the National Program for Improving Access and Quality of Primary Care, which evaluates 30,523 primary care teams in the period from 2013 to 2014 in Brazil. The internal consistency, correlation between items, and correlation between items and the total score were tested using the Cronbach’s alpha, Spearman’s correlation, and point biserial coefficients, respectively. The assumptions of unidimensionality and local independence of the items were tested. Word clouds were used as one way to present the results. RESULTS The items with the greatest ability to discriminate were scheduling of the agenda according to risk stratification, keeping of records of the most serious cases of users in psychological distress, and provision of group care. The items that required a higher level of mental health care in the parameter of location were the provision of any type of group care and the provision of educational and mental health promotion activities. Total Cronbach’s alpha coefficient was 0.87. The items that obtained the highest correlation with total score were the recording of the most serious cases of users in psychological distress and scheduling of the agenda according to risk stratification. The final scores obtained oscillated between -2.07 (minimum) and 1.95 (maximum). CONCLUSIONS There are important aspects in the discrimination of the capacity to provide mental health care by primary health care teams: risk stratification for care management, follow-up of the most serious cases, group care, and preventive and health promotion actions.

ABSTRACT OBJECTIVE Evaluate the effectiveness of a diabetes mellitus educational program in primary health care. METHODS This cluster randomized trial was conducted in a sample of 470 people with type 2 diabetes mellitus from eight health units, randomly assigned to two groups: intervention (n = 231) and control (n = 239). The intervention group participated in the educational program composed of three strategies: group education, home visit, and telephone intervention. Simultaneously, the control group was monitored individually. Group monitoring took place over nine months in the year 2012. Clinical evaluations were performed at the initial time (T0), three (T3), six (T6) and nine (T9) months after the beginning of the intervention. RESULTS After nine months of follow-up, 341 users remained in the study, 171 in the control group and 170 in the intervention group. The average age of users was 60.6 years. In both groups, statistically significant differences were observed in mean HbA1c levels over the follow-up time (p < 0.05). However, the mean HbA1c level at T3, T6 and T9 times were significantly lower among the people in the intervention group (p < 0.05). CONCLUSIONS The educational program model developed was effective to improve the glycemic control of the intervention group participants.

ABSTRACT Objective: to perform the translation, adaptation and validation of the Diabetes Attitudes Scale - third version instrument into Brazilian Portuguese. Methods: methodological study carried out in six stages: initial translation, synthesis of the initial translation, back-translation, evaluation of the translated version by the Committee of Judges (27 Linguists and 29 health professionals), pre-test and validation. The pre-test and validation (test-retest) steps included 22 and 120 health professionals, respectively. The Content Validity Index, the analyses of internal consistency and reproducibility were performed using the R statistical program. Results: in the content validation, the instrument presented good acceptance among the Judges with a mean Content Validity Index of 0.94. The scale presented acceptable internal consistency (Cronbach’s alpha = 0.60), while the correlation of the total score at the test and retest moments was considered high (Polychoric Correlation Coefficient = 0.86). The Intra-class Correlation Coefficient, for the total score, presented a value of 0.65. Conclusion: the Brazilian version of the instrument (Escala de Atitudes dos Profissionais em relação ao Diabetes Mellitus) was considered valid and reliable for application by health professionals in Brazil.

ABSTRACT Objective: to compare the adherence and empowerment of patients with type 2 diabetes mellitus for self-care practices and glycemic control in group education strategies and home visits. Method: Clinical trial with ten randomized clusters, performed with 238 patients with type 2 diabetes mellitus distributed in group education, home visit, and control group. Socio-demographic data, glycated hemoglobin and those obtained from the self-care and empowerment questionnaires were collected. Statistical analysis was performed separately by educational strategy. Results: the mean age of the patients was 57.8 years old (SD = 9.4 years old), with a predominantly female participation (66.4%). Both strategies presented similar results regarding adherence to self-care practices and patient empowerment. There was also a reduction in glycated hemoglobin levels; however, only in the education group, the difference presented statistical significance (p

RESUMO Objetivo: Avaliar a adesão e o empoderamento do usuário com diabetes mellitus para as práticas de autocuidado e controle glicêmico na educação em grupo. Método: Ensaio clínico randomizado por cluster, com a participação de usuários com diabetes mellitus tipo 2. Todos os usuários estavam vinculados às Unidades de Estratégia de Saúde da Família do município de Divinópolis/MG, Brasil, durante os anos de 2014 e 2015. Foram coletados dados com relação à adesão às práticas de autocuidado, ao empoderamento e à hemoglobina glicada para comparação entre grupos na linha de base, assim como comparação entre o antes e o depois intragrupo. Foi considerado um nível de significância de 0,05. Resultados: Participaram do estudo 183 usuários, sendo que 72 foram alocados no grupo intervenção e 111 no grupo controle. Os resultados revelaram uma redução estatisticamente significativa (< 0,001) para o valor de hemoglobina glicada e um aumento dos escores referentes à adesão ao autocuidado e à escala de empoderamento para os participantes do grupo intervenção (< 0,001). Conclusão: Os efeitos da educação em grupo proporcionaram o aumento nas escalas da adesão e empoderamento às práticas de autocuidado, além de melhora dos níveis glicêmicos, evidenciada pelos resultados da hemoglobina glicada. Registro Brasileiro de Ensaios Clínicos: RBR-92j38t.

INTRODUCTION: The present study was designed to assess the occurrence of co-infection or cross-reaction in the serological techniques used for detecting the anti-Leishmania spp., -Babesia canis vogeli and -Ehrlichia canis antibodies in urban dogs from an area endemic to these parasites. METHODS: The serum samples from dogs were tested for the Babesia canis vogeli strain Belo Horizonte antigen and Ehrlichia canis strain São Paulo by immunofluorescence antibody test (IFAT) and by anti-Leishmania immunoglobulin G (IgG) antibody detection to assess Leishmania infection. We used the following four commercial kits for canine visceral leishmaniasis: ELISA, IFAT, Dual Path Platform (DPP) (Bio Manguinhos(r)/FIOCRUZ/MS) and a rK39 RDT (Kalazar Detect Canine Rapid Test; Inbios). RESULTS : Of 96 serum samples submitted to serological assays, 4 (4.2%) were positive for Leishmania as determined by ELISA; 12 (12.5%), by IFAT; 14 (14.6%) by rK39 RDT; and 20 (20.8%), by DPP. Antibodies against Ehrlichia and Babesia were detected in 23/96 (23.9%) and 30/96 (31.2%) samples, respectively. No significant association was identified between the results of tests for detecting Babesia or Ehrlichia and those for detecting Leishmania (p-value>0.05). CONCLUSIONS: In the present study, we demonstrated co-infection with Ehrlichia or Babesia and Leishmania in dogs from Minas Gerais (Brazil); we also found that the serological tests that were used did not cross-react.

Visceral leishmaniasis (VL) is expanding in Brazil and in other South American countries, a process that has been associated with the urbanization of the disease. This study analyzes the spatial and temporal distribution of VL in the Brazilian state of Minas Gerais and identifies the areas with higher risks of transmission.An ecological study with spatial and time series analyzes of new confirmed cases of VL notified to the Brazilian Notifiable Disease Information System between 2002 and 2013, considering the 12 mesoregions of Minas Gerais. Two complementary methodologies were used: thematic maps of incidence and Poisson (log-linear) generalized linear model. Thematic maps using crude and smoothed cumulative incidences were generated for four trienniums. Poisson Regression measured the variation of the average number of cases from one year to the following, for each mesoregion.The 5,778 cases analyzed revealed a heterogeneous spatial and temporal distribution of VL in Minas Gerais. Six mesoregions (Central Mineira, Jequitinhonha, Metropolitan area of Belo Horizonte, Northwest of Minas, North of Minas, and Vale do Rio Doce) were responsible for the expansion and maintenance of VL, with incidence rates as high as 26/100,000 inhabitants. The Vale do Rio Doce and Jequitinhonha mesoregions showed a considerable increase in the incidence rates in the last period studied. The other six mesoregions reported only sporadic cases and presented low and unsteady incidence rates, reaching a maximum of 1.2/100,000 inhabitants.The results contribute to further the current understanding about the expansion of VL in Minas Gerais and may help guide actions for disease control.

ABSTRACT OBJECTIVE Analyze the quality of the National Program for Primary Care Access and Quality Improvement variables to evaluate the coordination of primary care. METHODS A cross-sectional study based on data from 17,202 primary care teams that participated in the National Program for Primary Care Access and Quality Improvement in 2012. Based on the Item Response Theory, Samejima’s Gradual Response Model was used to estimate the score related to the level of coordination. The Cronbach’s alpha and Spearman’ coefficients and the point-biserial correlation were used to analyze the internal consistency and the correlation between the items and between the items and the total score. We evaluated the assumptions of unidimensionality and local independence of the items. Cloud-type word charts aided in the interpretation of coordination levels. RESULTS The Program items with the greatest discrimination in coordination level were: telephone/Internet existence, institutional communication flows, and matrix support actions. The specialists’ contact frequency with the primary care and integrated electronic medical record required a greater level of coordination among the teams. The Cronbach’ alpha was 0.8018. The institutional communication flows and telephone/Internet items had a higher correlation with the total score. Coordination scores ranged from -2.67 (minimum) to 2.83 (maximum). More communication, information exchange, matrix support, health care in the territory and the domicile had a significant influence on the levels of coordination. CONCLUSIONS The ability to provide information and the frequency of contact among professionals are important elements for a comprehensive, continuous and high-quality care.

Com base na RDC/ANVISA 67/2007, avaliou-se o serviço prestado na dispensação de sinvastatina cápsulas em farmácias magistrais. Vinte e quatro (16%) das 150 farmácias magistrais foram aleatoriamente selecionadas nas regiões de Belo Horizonte-MG, observando a distribuição geográfica. A qualidade do produto, os aspectos da dispensação e o custo foram considerados em estudos de correlação. Os resultados foram submetidos a análises estatísticas descritivas e inferenciais. Em apenas 25% destas farmácias, o fax da prescrição foi solicitado. Todos os pedidos foram entregues no prazo, porém sem comprovação da dispensação. Em uma das entregas, o medicamento era o incorreto. Seis (25%) dos produtos apresentaram rotulagem incompleta (ausência de posologia 16,3% ou de identificação do médico/paciente 8,7%). Apenas 11 (45,8%) das amostras apresentaram qualidade satisfatória. O custo do medicamento manipulado variou entre R$20,40 e R$44,00 com valor médio R$31,18. Não se observou associação entre a qualidade do medicamento e os aspectos do custo, prazo de entrega e localização geográfica. Verifica-se que a maioria das farmácias magistrais ainda precisa adequar-se à legislação para garantir à população uma assistência farmacêutica de qualidade.

O objetivo foi de analisar os fatores associados ao início planejado da diálise dos pacientes diabéticos que iniciaram o tratamento no Município de Belo Horizonte, Minas Gerais, Brasil. Estudo transversal com 250 pacientes diabéticos que iniciaram diálise entre janeiro de 2006 e dezembro de 2007. Iniciar a diálise com fístula arteriovenosa ou em diálise peritoneal foi classificado como início planejado. Foram investigadas as variáveis sociodemográficas, clínicas e de utilização de serviços de saúde por meio de entrevista semiestruturada. Para análise multivariada utilizou-se regressão de Poisson. Setenta por cento dos pacientes começaram a diálise de forma não planejada e 67% dos que consultaram com o nefrologista foram encaminhados com mais de quatro meses. Frequentar o centro de saúde, não ter a primeira consulta com nefrologista paga pelo SUS e ter tido opção de escolha para o tratamento da doença renal foram fatores relacionados ao início planejado da diálise. O início não planejado da diálise é comum no Município de Belo Horizonte e ocorre independentemente do tempo de encaminhamento ao nefrologista.

O objetivo foi de analisar os fatores associados ao início planejado da diálise dos pacientes diabéticos que iniciaram o tratamento no Município de Belo Horizonte, Minas Gerais, Brasil. Estudo transversal com 250 pacientes diabéticos que iniciaram diálise entre janeiro de 2006 e dezembro de 2007. Iniciar a diálise com fístula arteriovenosa ou em diálise peritoneal foi classificado como início planejado. Foram investigadas as variáveis sociodemográficas, clínicas e de utilização de serviços de saúde por meio de entrevista semiestruturada. Para análise multivariada utilizou-se regressão de Poisson. Setenta por cento dos pacientes começaram a diálise de forma não planejada e 67% dos que consultaram com o nefrologista foram encaminhados com mais de quatro meses. Frequentar o centro de saúde, não ter a primeira consulta com nefrologista paga pelo SUS e ter tido opção de escolha para o tratamento da doença renal foram fatores relacionados ao início planejado da diálise. O início não planejado da diálise é comum no Município de Belo Horizonte e ocorre independentemente do tempo de encaminhamento ao nefrologista.El objetivo fue analizar los factores asociados al inicio planificado de la diálisis en los pacientes diabéticos que comenzaron el tratamiento en la ciudad de Belo Horizonte, Minas Gerais, Brasil. Se trata de un estudio transversal con 250 pacientes diabéticos que comenzaron tratamiento de diálisis entre enero de 2006 y diciembre de 2007. Iniciar la diálisis con fístula arteriovenosa o diálisis peritoneal se clasificó como inicio planificado. Se investigaron variables sociodemográficas, clínicas y de utilización de los servicios de salud por medio de una encuesta semi-estructurada. Para la regresión multivariante se utilizó Poisson. El 70% de los pacientes iniciaron diálisis de forma no planificada y un 67% de los que consultaron con el nefrólogo fueron remitidos al mismo tras más de 4 meses de dolencia. Asistir al centro de salud, no tener una primera consulta con un nefrólogo pagado por el SUS y contar con la opción de elección para el tratamiento de la enfermedad renal son factores relacionados con la iniciación prevista de la diálisis. La diálisis no planificada es común en la ciudad de Belo Horizonte y se produce independientemente del momento en el que se deriva al paciente al nefrólogo.The objective was to analyze factors associated with planned initiation of dialysis in diabetic patients in the city of Belo Horizonte, Minas Gerais State, Brazil. This was a cross-sectional study of 250 diabetic patients who began dialysis between January 2006 and December 2007. Initiating dialysis with an arteriovenous fistula or in peritoneal dialysis was classified as planned initiation. The study targeted socio-demographic, clinical, and health services use variables using a semi-structured interview. Multivariate analysis used Poisson regression. Seventy per cent of the patients began dialysis on an unplanned basis, and 67% of those consulted had been referred to a nephrologist more than four months previously. Attending a health center, not having the first nephrology appointment paid for by the Brazilian Unified National Health System, and having a choice of treatment for the kidney disease were associated with planned initiation of dialysis. Unplanned initiation of dialysis is common in the city of Belo Horizonte and occurs regardless of the time since referral to the nephrologist.

Commonly used HPLC acetonitrile solvent has been through a worldwide shortage with a cost increase in 2008 and 2009. In order to get around this situation, a method by RP-HPLC employing methanol and aqueous acid mobile phase was developed and validated to evaluate simvastatin. The quality control assay and dissolution studies of this lipid-lowering drug were performed in diluents methanol and 0.01 M phosphate buffer with 0.5% SDS, pH 7, respectively. Dissolution test aliquots did not go through sample treatment, as described in USP SIM tablets monograph by ultraviolet spectrophotometry. The proposed method is fast, simple, feasible and robust.

Simvastatin is commercially available as tablets and compounded capsules in Brazil. Very few reports regarding these capsules' quality, and consequently their efficacy, are available. The pharmaceutical quality of 30 batches of 20 mg simvastatin capsules from the market was evaluated by weight determination, content uniformity, disintegration (Brazilian Pharmacopeia), assay and dissolution test (USP32 tablet monograph). A HPLC method was developed for assay, content uniformity and dissolution test, and specifications were also established. Out of the 30 batches evaluated, 29 showed capsule disintegration within 45 min and individual weight variation was within ±10% or ±7.5% relative to average weight, for < or > 300 mg, respectively. Only 27 batches met dissolution test criteria with values >80% of the labeled amount in 45 min; 21 batches showed simvastatin content between 90.0-110.0% of the labeled amount and 19 batches had at least 9 out of 10 capsules with content uniformity values between 85.0-115.0% of the labeled amount with RSDNo Brasil, a sinvastatina está comercialmente disponível na forma de comprimidos e cápsulas manipuladas. Poucos relatos estão disponíveis sobre a qualidade e, consequentemente, a eficácia dessas cápsulas. A qualidade de 30 lotes de sinvastatina 20 mg cápsulas do mercado foi avaliada através da determinação de peso, uniformidade de conteúdo, desintegração (Farmacopéia Brasileira), doseamento e teste de dissolução (monografia comprimidos USP32). Método por CLAE foi desenvolvido para o doseamento, uniformidade de conteúdo e teste de dissolução; além disso, especificações foram estabelecidas. Dos 30 lotes avaliados, 29 apresentaram desintegração da cápsula até 45 min e a variação do peso individual foi ± 10% ou ± 7,5% em relação ao peso médio, se < ou > 300 mg, respectivamente. Apenas 27 lotes preencheram os critérios do teste de dissolução com valores > 80% da quantidade rotulada, em 45 min, 21 lotes apresentaram conteúdo de sinvastatina entre 90,0-110,0% do valor rotulado e 19 lotes apresentaram pelo menos 9 em 10 cápsulas, com valores de uniformidade de conteúdo entre 85,0 -115,0% da quantidade rotulada com RSD < 6,0%. Apenas 14 de todos os lotes (30) atenderam completamente os padrões de qualidade farmacopéicos. O estabelecimento das condições para os testes e de especificações para os parâmetros das cápsulas de sinvastatina mostrou que houve diferenças relevantes na qualidade farmacopeica entre os lotes das cápsulas manipuladas por distintas farmácias. A eficácia do tratamento hipercolesterolêmico poderia estar comprometida para 53,33% dos produtos testados.

RAP1 (RAS proximate 1), a small GTP-binding protein of the RAS superfamily, is a putative oncogene that is highly expressed in several malignant cell lines and types of cancers, including some types of squamous cell carcinoma. However, the participation of RAP1 in cervical carcinogenesis is unknown. We conducted a cross-sectional study of paraffin-embedded cervical biopsies to determine the association of RAP1 with cervical intraepithelial neoplasia (CIN). Standard and quantitative immunohistochemistry assessment of RAP1 expression in fixed tissue was performed on 183 paraffin-embedded cervical biopsies that were classified as normal or non-dysplastic mucosa (NDM) (n = 33); CIN grade 1 (n = 84) and CIN grade 2/3 (n = 66). A gradual increase in RAP1 expression in NDM < CIN 1 < CIN 2/3 (p

In Brazil, case-fatality rates attributable to visceral leishmaniasis (VL) are high and knowledge of the risk factors associated with death may help reduce mortality. The aim of this study was to construct and validate a scoring system for prognosis of death from VL by using all cases reported in Brazil from 2007 to 2011.In this historical cohort study, 18,501 VL cases were analyzed; of these, 17,345 cases were cured and 1,156 cases caused death. The database was divided into two series: primary (two-thirds of cases), to develop the model score, and secondary (one-third of cases), to validate the scoring system. Multivariate logistic regression models were performed to identify factors associated with death from VL, and these were included in the scoring system.The factors associated with death from VL were: bleeding (score 3); splenomegaly (score 1); edema (score 1); weakness (score 1); jaundice (score 1); Leishmania-HIV co-infection (score 1); bacterial infection (score 1); and age (≤0.5 years [score 5]; >0.5 and ≤1 [score 2]; >19 and ≤50 [score 2]; >50 and