The secretome of macrophages has a differential impact on spinal cord injury recovery according to the polarization protocol.

Introduction: The inflammatory response after spinal cord injury (SCI) is an important contributor to secondary damage. Infiltrating macrophages can acquire a spectrum of activation states, however, the microenvironment at the SCI site favors macrophage polarization into a pro-inflammatory phenotype, which is one of the reasons why macrophage transplantation has failed. Methods: In this study, we investigated the therapeutic potential of the macrophage secretome for SCI recovery. We investigated the effect of the secretome in vitro using peripheral and CNS-derived neurons and human neural stem cells. Moreover, we perform a pre-clinical trial using a SCI compression mice model and analyzed the recovery of motor, sensory and autonomic functions. Instead of transplanting the cells, we injected the paracrine factors and extracellular vesicles that they secrete, avoiding the loss of the phenotype of the transplanted cells due to local environmental cues. Results: We demonstrated that different macrophage phenotypes have a distinct effect on neuronal growth and survival, namely, the alternative activation with IL-10 and TGF-ß1 (M(IL-10+TGF-ß1)) promotes significant axonal regeneration. We also observed that systemic injection of soluble factors and extracellular vesicles derived from M(IL-10+TGF-ß1) macrophages promotes significant functional recovery after compressive SCI and leads to higher survival of spinal cord neurons. Additionally, the M(IL-10+TGF-ß1) secretome supported the recovery of bladder function and decreased microglial activation, astrogliosis and fibrotic scar in the spinal cord. Proteomic analysis of the M(IL-10+TGF-ß1)-derived secretome identified clusters of proteins involved in axon extension, dendritic spine maintenance, cell polarity establishment, and regulation of astrocytic activation. Discussion: Overall, our results demonstrated that macrophages-derived soluble factors and extracellular vesicles might be a promising therapy for SCI with possible clinical applications.

Dental caries in the permanent dentition and health-related quality of life among children and adolescents with sickle cell disease.

The aim was to associate living, health and oral health conditions with the quality of life (QL) of children and adolescents (CA) with sickle cell disease (SCD). Of the 120 eligible users of a public hematological service, 106 CA with SCD from 6 to 18 years of age, and their caregivers, answered semi-structured questions about socio-demographic, health and oral health conditions. For QL, we used the validated instrument PedsQLSCD™. The oral clinical examination occurred according to the guidelines of WHO and SB Brazil 2010. The majority of CA were non-white people (88%), mean age of 10.4 (±2.9) years, family income of up to two monthly minimum wages, for 03 to 05 members, with diagnosis of sickle cell anemia by neonatal screening, hospitalizations were due allergic crises, polypharmacy and dental caries (51%) were present. "About the Impact of My Pain" was the best-fit model for the QLSCD (adjusted R²=56%; AIC=28.67; p=0.04). Dental caries in permanent dentition worsened the QLSCD (OR=0.53; IC95%=0.35-0.78; p<0.05) and was associated with the type of school, car ownership, number of family members, of complications and of the medications. To overcome this scenario, programmatic actions are required, and implementation of public policies specifically directed towards these groups.

Dental caries in the permanent dentition and health-related quality of life among children and adolescents with sickle cell disease / Cáries dentárias na dentição permanente e qualidade de vida relacionada à saúde entre crianças e adolescentes com doença falciforme

Abstract The aim was to associate living, health and oral health conditions with the quality of life (QL) of children and adolescents (CA) with sickle cell disease (SCD). Of the 120 eligible users of a public hematological service, 106 CA with SCD from 6 to 18 years of age, and their caregivers, answered semi-structured questions about socio-demographic, health and oral health conditions. For QL, we used the validated instrument PedsQLSCD™. The oral clinical examination occurred according to the guidelines of WHO and SB Brazil 2010. The majority of CA were non-white people (88%), mean age of 10.4 (±2.9) years, family income of up to two monthly minimum wages, for 03 to 05 members, with diagnosis of sickle cell anemia by neonatal screening, hospitalizations were due allergic crises, polypharmacy and dental caries (51%) were present. "About the Impact of My Pain" was the best-fit model for the QLSCD (adjusted R²=56%; AIC=28.67; p=0.04). Dental caries in permanent dentition worsened the QLSCD (OR=0.53; IC95%=0.35-0.78; p<0.05) and was associated with the type of school, car ownership, number of family members, of complications and of the medications. To overcome this scenario, programmatic actions are required, and implementation of public policies specifically directed towards these groups.

Resumo Objetivou-se associar condições de vida, de saúde e de saúde bucal à qualidade de vida (QLV) de crianças e adolescentes (CA) com Doença Falciforme (DF). Dos 120 usuários elegíveis de um serviço público hematológico, 106 CA entre 6 e 18 anos de idade, e seus cuidadores, responderam questões semiestruturadas sobre condições sociodemográficas, de saúde e saúde bucal. Para a QLV, o instrumento validado PedsQL DF® foi aplicado. Na sequência, realizou-se o exame clínico bucal nas CA segundo diretrizes da OMS e do SB Brasil 2010. A maioria das CA era negra (88%), idade média de 10,4 (±2.9) anos, renda familiar de até dois salários mínimos, para 03 a 05 membros, diagnosticadas na triagem neonatal com anemia falciforme, internadas por crises álgicas, em uso de polifarmácia e com cárie dental (51%). O domínio "Sobre o Impacto da Minha Dor" foi preditivo da QLVDF (R² ajustado =56%; AIC=28.67; p=0,04). Nele, a cárie dental na dentição permanente piorou a QLVDF das CA (OR=0.53; IC95%=0.35-0.78; p<0,05), associando-se ao tipo de escola, posse de carro e do número de membros na família, de complicações da DF e de medicamentos. Os achados ratificam a dor como marca da DF e mostram a importância da saúde bucal na QLDF das CA. A implementação de políticas públicas específicas pode superar esse cenário.

An Exploration of Novel Bioactives from the Venomous Marine Annelid Glycera alba.

The immense biodiversity of marine invertebrates makes them high-value targets for the prospecting of novel bioactives. The present study investigated proteinaceous toxins secreted by the skin and proboscis of Glycera alba (Annelida: Polychaeta), whose congenerics G. tridactyla and G. dibranchiata are known to be venomous. Proteomics and bioinformatics enabled the detection of bioactive proteins that hold potential for biotechnological applications, including toxins like glycerotoxins (GLTx), which can interfere with neuromuscular calcium channels and therefore have value for the development of painkillers, for instance. We also identified proteins involved in the biosynthesis of toxins. Other proteins of interest include venom and toxin-related bioactives like cysteine-rich venom proteins, many of which are known to interfere with the nervous system. Ex vivo toxicity assays with mussel gills exposed to fractionated protein extracts from the skin and proboscis revealed that fractions potentially containing higher-molecular-mass venom proteins can exert negative effects on invertebrate prey. Histopathology, DNA damage and caspase-3 activity suggest significant cytotoxic effects that can be coadjuvated by permeabilizing enzymes such as venom metalloproteinases M12B. Altogether, these encouraging findings show that venomous annelids are important sources of novel bioactives, albeit illustrating the challenges of surveying organisms whose genomes and metabolisms are poorly understood.

Proteomic and Metabolic Analysis of Pinus halepensis Mill. Embryonal Masses Induced under Heat Stress.

Understanding the physiological and molecular adjustments occurring during tree stress response is of great importance for forest management and breeding programs. Somatic embryogenesis has been used as a model system to analyze various processes occurring during embryo development, including stress response mechanisms. In addition, "priming" plants with heat stress during somatic embryogenesis seems to favor the acquisition of plant resilience to extreme temperature conditions. In this sense, Pinus halepensis somatic embryogenesis was induced under different heat stress treatments (40 °C for 4 h, 50 °C for 30 min, and 60 °C for 5 min) and its effects on the proteome and the relative concentration of soluble sugars, sugar alcohols and amino acids of the embryonal masses obtained were assessed. Heat severely affected the production of proteins, and 27 proteins related to heat stress response were identified; the majority of the proteins with increased amounts in embryonal masses induced at higher temperatures consisted of enzymes involved in the regulation of metabolism (glycolysis, the tricarboxylic acid cycle, amino acid biosynthesis and flavonoids formation), DNA binding, cell division, transcription regulation and the life-cycle of proteins. Finally, significant differences in the concentrations of sucrose and amino acids, such as glutamine, glycine and cysteine, were found.

Peptidomics Unveils Distinct Acetylation Patterns of Histone and Annexin A1 in Differentiated Thyroid Cancer.

Thyroid cancer is a common malignancy of the endocrine system. Nodules are routinely evaluated for malignancy risk by fine needle aspiration biopsy (FNAB), and in cases such as follicular lesions, differential diagnosis between benign and malignant nodules is highly uncertain. Therefore, the discovery of new biomarkers for this disease could be helpful in improving diagnostic accuracy. Thyroid nodule biopsies were subjected to a precipitation step with both the insoluble and supernatant fractions subjected to proteome and peptidome profiling. Proteomic analysis identified annexin A1 as a potential biomarker of thyroid cancer malignancy, with its levels increased in malignant samples. Also upregulated were the acetylated peptides of annexin A1, revealed by the peptidome analysis of the supernatant fraction. In addition, supernatant peptidomic analysis revealed a number of acetylated histone peptides that were significantly elevated in the malignant group, suggesting higher gene transcription activity in malignant tissue. Two of these peptides were found to be robust malignancy predictors, with an area under the receiver operating a characteristic curve (ROC AUC) above 0.95. Thus, this combination of proteomics and peptidomics analyses improved the detection of malignant lesions and also provided new evidence linking thyroid cancer development to heightened transcription activity. This study demonstrates the importance of peptidomic profiling in complementing traditional proteomics approaches.

O processo de monitoramento, controle e avaliação do Programa Mais Médicos no estado da Bahia / The monitoring, control and evaluation process of the Mais Médicos Program in Bahia / El proceso de seguimiento, control y evaluación del Programa Más Médicos EN EL ESTADO DE Bahía

Este artigo tem o objetivo de avaliar o processo de aprimoramento e acompanhamento das variáveis envolvidas na consolidação do Progama Mais Médicos para o Brasil (PMMB) na Bahia, bem como a gestão da informação associada aos avanços tecnológicos. A pesquisa é de natureza qualitativa e do tipo estudo de caso. Os dados pertinentes ao monitoramento e planejamento estratégico do PMMB, no estado da Bahia, foram coletados mensalmente, a partir das bases de dados do Ministério da Saúde, Ministério da Educação e municípios, para serem agrupados em uma planilha eletrônica do Microsoft Excel, por meio do recurso Power Business Intelligence (Power BI), programa que está em constante modificação, permitindo visualizar a qualquer momento as variáveis desejadas. Assim, a distribuição de médicos atuantes no PMMB, no território baiano, corrobora os estudos que apontam o crescimento do provimento de médicos, sobretudo nas regiões mais isoladas, pobres e vulneráveis. A construção dos painéis, realizada pela captação e sistematização de diferentes fontes de dados relativos à gestão do PMMB na Bahia, permitiu avaliar: a distribuição dos médicos atuantes no PMMB na Bahia, as regiões de maior concentração de médicos, a porcentagem dos municípios contemplados pelo programa, a distribuição da rede de apoio no estado da Bahia, a distribuição dos cursos de medicina no estado e as regiões que realizam teleconsultorias. Por meio desta pesquisa, foi possível concluir que o número de médicos destinados à atenção de saúde nas populações mais carentes e isoladas vem aumentando gradativamente, embora ainda seja insufuciente. Além disso, pode-se concluir que a gestão da informação associada aos avanços tecnológicos podem servir como instrumento de monitoramento e avaliação na área da saúde.

Este estudio tiene como objetivo evaluar el proceso de mejora y seguimiento de las variables involucradas en la consolidación del Programa Más Médicos (PMM) en Bahía (Brasil), así como la gestión de la información asociada a los avances tecnológicos. La investigación es de carácter cualitativo, de tipo estudio de caso. Los datos relevantes para el seguimiento y la planificación estratégica del PMM en el estado de Bahía fueron recopilados mensualmente de las bases de datos del Ministerio de Salud, del Ministerio de Educación y municipios, para ser agrupados en una hoja de cálculo de Microsoft Excel, a través del recurso Power BI que se modifica constantemente, lo que permite ver las variables en cualquier momento. Así, la distribución de los médicos que actúan en el PMM en el amplio territorio de Bahía corrobora estudios que apuntan al crecimiento de la oferta de médicos, especialmente en las regiones más aisladas, pobres y vulnerables. La construcción de los paneles, realizada a partir de la captura y sistematización de diferentes fuentes de datos, relacionados con la gestión del PMM de Bahía, permitió evaluar: la distribución de los médicos que actúan en el PMM de Bahía, las regiones con mayor concentración de médicos, el porcentaje de municipios cubiertos por el programa, la distribución de la red de apoyo en el estado de Bahía, la distribución de los cursos de medicina en el estado, y las regiones que realizan teleconsultas. Esta investigación permite concluir que el número de médicos dedicados a la atención de la salud en las poblaciones más necesitadas y aisladas ha ido aumentando paulatinamente, aunque aún es insuficiente. Además, se concluye que el manejo de la información asociada a los avances tecnológicos puede servir como una herramienta de seguimiento y evaluación en salud.

This qualitative case study evaluates the improvement and monitoring processes concerning the variables involved in the consolidation of the More Doctors Program (PMM) in Bahia, Brazil, as well as the management of information associated with technological advances. Data relevant for monitoring and strategic planning the PMM in the state were collected monthly from the Ministry of Health, Ministry of Education and municipalities databases, and then grouped in a Microsoft Excel spreadsheet using power BI, an everchanging software that allow us to view the desired variables at any time. The results on the distribution of PMM doctors in the broad territory of Bahia corroborate studies that point to an increased supply of physicians, especially in more isolated, poorer and vulnerable regions. The panels developed by capturing and systematizing different data sources regarding PMM management in Bahia allowed to evaluate: the distribution of PMM doctors in the state, the regions with the highest concentration, the percentage of municipalities covered by the program, the distribution of the support network within the state, the distribution of medical undergraduate programs in the state; the regions that offer teleconsultations. In conclusion, the number of physicians offering health care to the poorest and most isolated populations has been increasing gradually, but remains insufficient. Moreover, the management of information associated with technological advances can serve as a monitoring and evaluation instrument in health care.

The Enhanced Efficacy of Intracellular Delivery of Doxorubicin/C6-Ceramide Combination Mediated by the F3 Peptide/Nucleolin System Is Supported by the Downregulation of the PI3K/Akt Pathway.

Targeting multiple cellular populations is of high therapeutic relevance for the tackling of solid tumors heterogeneity. Herein, the ability of pegylated and pH-sensitive liposomes, functionalized with the nucleolin-binding F3 peptide and containing doxorubicin (DXR)/C6-ceramide synergistic combination, to target, in vitro, ovarian cancer, including ovarian cancer stem cells (CSC), was assessed. The underlying molecular mechanism of action of the nucleolin-mediated intracellular delivery of C6-ceramide to cancer cells was also explored. The assessment of overexpression of surface nucleolin expression by flow cytometry was critical to dissipate differences identified by Western blot in membrane/cytoplasm of SKOV-3, OVCAR-3 and TOV-112D ovarian cancer cell lines. The former was in line with the significant extent of uptake into (bulk) ovarian cancer cells, relative to non-targeted and non-specific counterparts. This pattern of uptake was recapitulated with putative CSC-enriched ovarian SKOV-3 and OVCAR-3 sub-population (EpCAMhigh/CD44high). Co-encapsulation of DXR:C6-ceramide into F3 peptide-targeted liposomes improved cytotoxic activity relative to liposomes containing DXR alone, in an extent that depended on the intrinsic resistance to DXR and on the incubation time. The enhanced cytotoxicity of the targeted combination was mechanistically supported by the downregulation of PI3K/Akt pathway by C6-ceramide, only among the nucleolin-overexpressing cancer cells presenting a basal p-Akt/total Akt ratio lower than 1.

Proteome-Wide Analysis of Heat-Stress in Pinus radiata Somatic Embryos Reveals a Combined Response of Sugar Metabolism and Translational Regulation Mechanisms.

Somatic embryogenesis is the process by which bipolar structures with no vascular connection with the surrounding tissue are formed from a single or a group of vegetative cells, and in conifers it can be divided into five different steps: initiation, proliferation, maturation, germination and acclimatization. Somatic embryogenesis has long been used as a model to study the mechanisms regulating stress response in plants, and recent research carried out in our laboratory has demonstrated that high temperatures during initial stages of conifer somatic embryogenesis modify subsequent phases of the process, as well as the behavior of the resulting plants ex vitro. The development of high-throughput techniques has facilitated the study of the molecular response of plants to numerous stress factors. Proteomics offers a reliable image of the cell status and is known to be extremely susceptible to environmental changes. In this study, the proteome of radiata pine somatic embryos was analyzed by LC-MS after the application of high temperatures during initiation of embryonal masses [(23°C, control; 40°C (4 h); 60°C (5 min)]. At the same time, the content of specific soluble sugars and sugar alcohols was analyzed by HPLC. Results confirmed a significant decrease in the initiation rate of embryonal masses under 40°C treatments (from 44 to 30.5%) and an increasing tendency in the production of somatic embryos (from 121.87 to 170.83 somatic embryos per gram of embryogenic tissue). Besides, heat provoked a long-term readjustment of the protein synthesis machinery: a great number of structural constituents of ribosomes were increased under high temperatures, together with the down-regulation of the enzyme methionine-tRNA ligase. Heat led to higher contents of heat shock proteins and chaperones, transmembrane transport proteins, proteins related with post-transcriptional regulation (ARGONAUTE 1D) and enzymes involved in the synthesis of fatty acids, specific compatible sugars (myo-inositol) and cell-wall carbohydrates. On the other hand, the protein adenosylhomocysteinase and enzymes linked with the glycolytic pathway, nitrogen assimilation and oxidative stress response were found at lower levels.

Specific Antiproliferative Properties of Proteinaceous Toxin Secretions from the Marine Annelid Eulalia sp. onto Ovarian Cancer Cells.

As Yondelis joins the ranks of approved anti-cancer drugs, the benefit from exploring the oceans' biodiversity becomes clear. From marine toxins, relevant bioproducts can be obtained due to their potential to interfere with specific pathways. We explored the cytotoxicity of toxin-bearing secretions of the polychaete Eulalia onto a battery of normal and cancer human cell lines and discovered that the cocktail of proteins is more toxic towards an ovarian cancer cell line (A2780). The secretions' main proteins were identified by proteomics and transcriptomics: 14-3-3 protein, Hsp70, Rab3, Arylsulfatase B and serine protease, the latter two being known toxins. This mixture of toxins induces cell-cycle arrest at G2/M phase after 3h exposure in A2780 cells and extrinsic programmed cell death. These findings indicate that partial re-activation of the G2/M checkpoint, which is inactivated in many cancer cells, can be partly reversed by the toxic mixture. Protein-protein interaction networks partake in two cytotoxic effects: cell-cycle arrest with a link to RAB3C and RAF1; and lytic activity of arylsulfatases. The discovery of both mechanisms indicates that venomous mixtures may affect proliferating cells in a specific manner, highlighting the cocktails' potential in the fine-tuning of anti-cancer therapeutics targeting cell cycle and protein homeostasis.

Specific Nutritional Biomarker Profiles in Mild Cognitive Impairment and Subjective Cognitive Decline Are Associated With Clinical Progression: The NUDAD Project.

OBJECTIVES: Nutritional insufficiencies have been associated with cognitive impairment. Understanding whether nutritional biomarker levels are associated with clinical progression could help to design dietary intervention trials. This longitudinal study examined a panel of nutritional biomarkers in relation to clinical progression in patients with subjective cognitive decline (SCD) or mild cognitive impairment (MCI). DESIGN, SETTING AND PARTICIPANTS: We included 299 patients without dementia (n = 149 SCD; age 61 ± 10 years, female 44%, n = 150 MCI; age 66 ± 8 years, female 38%). Median (interquartile range) follow-up was 3 (2-5) years. METHODS: We measured 28 nutritional biomarkers in blood and 5 in cerebrospinal fluid (CSF), associated with 3 Alzheimer's disease pathologic processes: vascular change (lipids), synaptic dysfunction (homocysteine-related metabolites), and oxidative stress (minerals and vitamins). Nutritional biomarker associations with clinical progression to MCI/dementia and cognitive decline based on the Mini-Mental State Examination score were evaluated using Cox proportional hazard models and linear mixed models. We used partial least squares Cox models (PLS-Cox) to examine nutritional biomarker profiles associated with clinical progression. RESULTS: In the total group, high high-density lipoprotein (HDL) levels were associated with clinical progression and cognitive decline. In SCD, high folate and low bilirubin levels were associated with cognitive decline. In MCI, low CSF S-adenosylmethionine (SAM) and high theobromine were associated with clinical progression to dementia and high HDL, cholesterol, iron, and 1,25(OH)2 vitamin D were associated with cognitive decline. PLS-Cox showed 1 profile for SCD, characterized by high betaine and folate and low zinc associated with clinical progression. In MCI, a profile with high theobromine and HDL and low triglycerides and a second profile with high plasma SAM and low cholesterol were associated with risk of dementia. CONCLUSION AND IMPLICATIONS: High HDL was most consistently associated with clinical progression. Moreover, different nutritional biomarker profiles for SCD and MCI showed promising associations with clinical progression. Future dietary (intervention) studies could use nutritional biomarker profiles to select patients, taking into account the disease stage.

Speech-language-hearing therapy and clinical listening in a mental health team: perception of parents of children with autism spectrum disorder / Fonoaudiologia e escuta clínica em equipe de saúde mental: percepção de pais de crianças com transtorno do espectro do autismo

ABSTRACT Purpose: to analyze the effects of clinical listening in the discourse of parents of children with autism about the speech-language-hearing work in the team of a Children and Youth Psychosocial Attention Center (Centro de Atenção Psicossocial Infanto-Juvenil). Methods: a descriptive case study research with nine parents of children with autism. Results: the parents recognize, in the therapeutic experience with the speech-language-hearing therapist, changes in the quality of communication and relationship with their children, becoming more linguistically open and interesting figures to their children, because they understand the communication dynamics and feel ready to develop it. The parents incorporated the idea that it is through a shared playing that their children develop both subjectively and cognitively. They realize that the change and interaction with and between their children, as proposed by the speech-language-hearing therapy, generate care and enlarge the social repertoire of communication. Conclusion: speech-language-hearing therapy was considered as belonging and fundamental to the field of mental health in the work with children with autism, which reinforces the listening offered to the parents by the team.

RESUMO Objetivo: analisar efeitos da escuta clínica no discurso parental de crianças com autismo sobre o trabalho fonoaudiológico em equipe de um Centro de Atenção Psicossocial Infanto-juvenil. Métodos: pesquisa descritiva, estudo de caso com nove pais de crianças com autismo. Resultados: os pais reconhecem, na experiência terapêutica com o fonoaudiólogo, modificações na qualidade da comunicação e da relação com seus filhos, tornam-se figuras linguisticamente mais abertas e interessantes aos filhos porque compreendem os dinamismos da comunicação e sentem-se aptos a trabalha-la. Os pais incorporaram a ideia de que é pelo brincar compartilhado que suas crianças se desenvolvem subjetiva e cognitivamente. Percebem que a troca e a interação com e entre as crianças, propostas pela Fonoaudiologia, são produtoras de cuidado e ampliam os repertórios sociais de comunicação. Conclusão: a Fonoaudiologia foi considerada pertencente e fundamental ao campo da saúde mental no trabalho com crianças com autismo, o que reitera a escuta oferecida aos pais pela equipe.

Pre-analytical stability of novel cerebrospinal fluid biomarkers.

Stability of the cerebrospinal fluid (CSF) composition under different pre-analytical conditions is relevant for the diagnostic potential of biomarkers. Our aim was to examine the pre-analytical stability of promising CSF biomarkers that are currently evaluated for their discriminative use in various neurological diseases. Pooled CSF was aliquoted and experimentally exposed to delayed storage: 0, 1, 2, 4, 24, 72, or 168 h at 4 °C or room temperature (RT), or 1-4 months at -20 °C; or up to 7 freeze/thaw (f/t) cycles, before final storage at -80 °C. Eleven CSF biomarkers were screened using immunoassays, liquid chromatography, or enzymatic methods. Levels of neurogranin (truncP75), chitinase-3-like protein (YKL-40), beta-site amyloid precursor protein cleaving enzyme 1 (BACE1), acetylcholinesterase (AChE) enzymatic activity, theobromine, secreted protein acidic and rich in cysteine-like 1 (SPARCL-1) and homovanillic acid (HVA) levels were not affected by the applied storage conditions. 3-Methoxy-4-hydroxyphenylglycol (MHPG) levels linearly and strongly decreased after 4 h at RT (-10%) or 24 h at 4 °C (-27%), and with 6% after every f/t cycle. 5-Methyltetrahydrofolate (5-MTHF) (-29% after 1 week at RT) and 5-hydroxyindoleacetic acid levels (5-HIAA) (-16% after 1 week at RT) were reduced and 3,4-dihydroxyphenylacetic acid (DOPAC) levels (+22% after 1 week at RT) increased, but only after >24 h at RT. Ten out of eleven potential CSF novel biomarkers showed very limited change under common storage and f/t conditions, suggesting that these CSF biomarkers can be trustfully tested under the pre-analytical conditions present across different cohorts.

Implementação da política de saúde pública e seus desafios na era digital / Implementación de la política de salud pública y sus desafíos en la era digital / Implementation of public health policy and its challenges in the digital age

Resumo Analisa-se a implementação da política pública de regulação de leitos em Unidades de Terapia Intensiva, considerando-se a política formulada, as condições institucionais e as estratégias utilizadas pelo estado e municípios baianos. Realiza-se revisão bibliográfica à luz do neoinstitucionalismo da escola da escolha racional e estudo de natureza qualitativa com três grupos de burocratas de médio escalão. Os resultados evidenciam um gap entre a política formulada e a implementada, a influência dos burocratas na implementação da política pública e uso das tecnologias da informação e comunicação, utilização de semelhantes estratégias de regulação, sendo a estratégia clientelística, associada ao uso do WhatsApp, encontrada na regulação paralela de leitos, indicativo de que, mesmo sob a égide do estado gerencial, persistem as práticas clientelísticas e patrimonialistas.

Resumen Se analiza la implementación de la política pública en materia de regulación de plazas en las unidades de cuidados intensivos, teniendo en cuenta la política formulada, las condiciones institucionales y las estrategias utilizadas por el Estado y los municipios. Se llevó a cabo una revisión de la literatura a la luz del neoinstitucionalismo de la escuela de la elección racional, y estudio cualitativo con tres grupos de burócratas a nivel de calle. Los resultados revelan una brecha entre la política formulada y aplicada, la influencia de burócratas en la implementación de la política pública y el uso de tecnologías de la información y la comunicación, con uso de estrategias de regulación similares. La estrategia clientelista, que se asocia con el uso de WhatsApp, fue encontrada en la regulación paralela de las plazas, lo que indica que, incluso bajo los auspicios del estado gerencial, persisten las prácticas clientelistas y patrimoniales.

Abstract This article analyzes the implementation of public policy on regulation of beds in intensive care units, considering the formulated policy, the institutional conditions and the strategies used by the state and municipalities of Bahia, Brazil. A literature review is carried out, based on the rational choice institutionalism, as well as a qualitative study with three groups of street-level bureaucrats. Results show a gap between the policies formulated and implemented and the influence of bureaucrats in the implementation of public policies in health. In addition, the research observed the use of information and communication technology such as social media (WhatsApp) as regulation strategies. The informal control and assignment of beds using WhatsApp is a clientelistic strategy, indicating that, even under the aegis of the managerial state, clientelistic and patrimonial practices persist.

Fatores relacionados à queda de pacientes em um hospital público: percepção de coordenadores de enfermagem / Factors related to patient's fall in a public hospital: perception of nursing coordinatiors / Factores relacionados con la caída de los pacientes en un hospital público: percepciones de coordinadores de enfermería

O artigo analisa a percepção de coordenadores de enfermagem dos setores assistenciais quanto aos fatores relacionados à queda de pacientes. É um estudo exploratório, descritivo, realizado em hospital público de grande porte e alta complexidade, da Cidade de Salvador (BA). Foram entrevistados 16 coordenadores de enfermagem. Os participantes apontaram, como fatores relacionados à ocorrência de quedas: a) referentes ao paciente: confusão mental e desorientação (44%), não solicitação de auxílio da enfermagem (31%) e sonolência (25%); b) relacionados ao ambiente: uso inadequado de equipamentos ou ausência de grades no leito (50%); c) relacionados à terapêutica medicamentosa: uso de tranquilizantes, sedativos e hipnóticos (44%); e d) relacionados aos cuidados de enfermagem: a falta de ações preventivas (50%), anamnese incompleta (44%). Como consequências das quedas foram citados traumatismos cranianos e exames de alto custo. Tais resultados sugerem que os coordenadores de enfermagem têm clara percepção quanto aos fatores e consequências relacionados à queda de pacientes. Implantar o Programa Nacional de Segurança do Paciente pode contribuir para melhoria dos processos assistenciais e redução do risco de quedas. Além disso, são necessários investimentos em infraestrutura física, a modernização de equipamentos, a implantação e uso de protocolos e a adoção de uma cultura organizacional centralizada na segurança do paciente.

The main objective was to analyze the perception of nursing coordinators of welfare sectors regarding factors related to patient falls. An exploratory and descriptive study was conducted in a big and complex Public Hospital in Salvador (BA). An amount of 16 nursing coordinators were interviewed. The answers indicated as factors related to falls: a) regarding the patient: mental confusion and disorientation (44%), the not request of nursing aid (31%) and somnolence (25%); b) regarding the environment: inappropriate equipment or absence of bed rails (50%); c) regarding drug therapy: use of tranquilizers, sedatives and hypnotics (44%) and d) regarding nursing care: lack of preventive actions (50%), incomplete anamnesis (44%) and inadequate care of patients at risk of falling (6 %). As consequence of the falls were cited head injuries and expensive exams. The results suggest that the nursing coordinators have clear perception on factors and consequences related to the falls. Implementing the National Patient Safety Program can contribute to the improvement of nursing processes and to the reduction of the risk of falls. In addition, investments are needed in physical infrastructure, in modernization of equipment, in deployment and use of protocols and in the adoption of an organizational culture focused on the patient's safety.

El objetivo fue analizar la percepción de los coordinadores de enfermería de los sectores de bienestar con respecto a los factores relacionados con la caída de pacientes. Es estudio exploratorio, descriptivo en un hospital público de grande y alta complejidad, en la ciudad de Salvador (BA). Los encuestados señalaron los factores relacionados con caídas: a) para el paciente: confusión mental y desorientación (44%); no solicitar la asistencia de enfermería (31%) y somnolencia (25%). b) en relación con el entorno: uso inadecuado del equipo o falta de barandillas en la cama (50%). El uso incorrecto del equipo o la ausencia de las barandillas de cama (50%). c) en relación con la terapia con medicamentos: el uso de tranquilizantes, sedantes e hipnóticos (44%) y d) en relación con la atención: la falta de acciones preventivas (50%), anamnesis incompleta (44%) y la atención inadecuada con los pacientes que tienen riesgo de caídas (6%). Como consecuencia de las caídas fueron nombrados lesiones en la cabeza y exámenes de alto costo. Estos resultados sugieren que los coordinadores de enfermería tienen una percepción clara de los factores y consecuencias relacionadas con caídas de pacientes. La implementación del Programa Nacional de Seguridad del Paciente puede contribuir a mejorar los procesos de atención y reducir el riesgo de caídas. Además, se necesitan inversiones en infraestructura física, la modernización del equipo, el despliegue y el uso de protocolos y la adopción de una cultura organizacional enfocada en la seguridad del paciente.

Direitos do paciente, comunicação e a obrigação de informar / Patient rights, communication and reporting obligation / Derechos del paciente, la comunicación y la obligación de presentar informes

Este trabalho discute o direito do usuário à informação, à comunicação e a obrigatoriedade dos serviços de informarem. Apresentam-se os marcos regulatórios sobre a temática no Brasil e a percepção do representante dos usuários no Conselho Municipal de Saúde de Salvador, Bahia. A legislação prevê a participação dos usuários na interlocução com profissionais de saúde, gestores e pesquisadores, como estratégia para adesão ao cuidado e garantia da qualidade da atenção à saúde. O Programa Nacional de Segurança do Paciente preconiza a implantação de instrumentos para a gestão de informações e implementação de fluxos e canais de comunicação que assegurem o direito à informação. Contudo, verifica-se que, apesar da vasta legislação e das Tecnologias de Informação e Comunicação disponíveis, a realidade enfrentada pelos usuários e seus familiares na busca por informações é divergente do normatizado. O acesso à informação é entendido pelo representante dos usuários como precário, e a falta de comunicação, bem como a sonegação de informações são tidas como barreiras a serem enfrentados na busca da atenção à saúde eficaz. A transparência e a disponibilização das informações podem contribuir na adoção de práticas mais seguras e custo efetivas nos serviços de saúde, fazendo cumprir a sua obrigação de informar.

This paper discusses the user's right to information, to communication and the obligation of health care services to report. It presents the regulatory framework on the subject in Brazil and the perception of the representative of the users in the Municipal Health Council of Salvador, Bahia. The legislation provides for the participation of users in the dialogue with health professionals, managers and researchers as a strategy to the adherence to care and to ensure health care quality. The National Patient Safety Program recommends the implementation of tools for managing and implementing information flows and communication channels to ensure the right to information. However, it appears that despite the extensive legislation and the available Information and Communication Technologies, the reality faced by the users and their families in the search for information is divergent from standards. Access to information is understood by the representative of users as precarious, and the lack of communication as well as the withholding of information are seen as barriers to be overcome in the pursuit of attention for effective health. Transparency and availability of information can contribute to the adoption of safer practices and effective cost in health care services, enforcing its obligation to inform.

Este artículo discute el derecho del usuario a la información, la comunicación y la obligación de informar de los servicios de salud. Presenta los marcos regulativos sobre el tema en Brasil y la percepción del representante de los usuarios en el Consejo Municipal de Salud de Salvador, Bahía. La legislación prevé la participación de los usuarios en el diálogo con los profesionales de la salud, gestores e investigadores como una estrategia para la adhesión a la atención y para garantizar la calidad de la atención sanitaria. El Programa Nacional de Seguridad del Paciente recomienda la implantación de herramientas para la gestión y de flujos de información y canales de comunicación para garantizar el derecho a la información. Sin embargo, parece que a pesar de la amplia legislación y de las Tecnologías de la Información disponibles, la realidad que enfrentan los usuarios y sus familias en la búsqueda de información es divergente del estandarizado. El acceso a la información es entendido por el representante de los usuarios como precario, y la falta de comunicación y la retención de información son vistas como obstáculos que se enfrentan en la búsqueda de la atención por una salud eficaz. La transparencia y la disponibilidad de la información pueden contribuir a la adopción de prácticas más seguras y rentables en los servicios de salud, haciendo cumplir su obligación de informar.

Processo de gestão hospitalar em parceria público-privada / Hospital management process within a public-private partnership / Proceso de la gestión hospitalaria en un asociación publico-privada

A Parceria Público-Privada em saúde surge como uma alternativa aos modelos de gestão pública da saúde existentes no Brasil, sendo implantado, pioneiramente, no Hospital do Subúrbio, localizado na cidade de Salvador, Bahia. Nesse modelo de gestão, a relação entre o parceiro público e o privado é regulamentada por contrato e mensurada através de indicadores de desempenho qualitativos e quantitativos. O objetivo do estudo foi analisar o processo de gestão de um hospital da cidade de Salvador (Bahia), por meio da Parceria Público-Privada. Trata-se de estudo descritivo, de abordagem quantitativa e qualitativa. Foram utilizadas como fontes de dados as documentações e as informações oficiais, coletadas nos sites das instituições envolvidas no processo de implantação e operação do hospital em questão. Para a análise em questão, foram utilizados os seguintes indicadores: densidade global de infecção hospitalar; número de atendimento de urgência, emergência e consultas ambulatórias; e número de internação hospitalar, que estão, de forma geral, dentro do contratualizado, ratificando o bom desempenho dessa nova modalidade gerencial. Concluiu-se que a Parceria Público-Privada em saúde, tendo como referência os resultados alcançados pelo Hospital do Subúrbio, mostra-se como alternativa viável aos modelos de gestão existentes, apresentando resultados exitosos, no que tange à qualidade do serviço ofertado aos usuários do Sistema Único de Saúde.

This is a descriptive, quantitative and qualitative study that aimed to analyze the management process of a hospital managed through a Public-Private Partnership. Documentation and official information collected on the websites of the institutions involved in the implementation and operation of the hospital in question were used as data sources. Public-Private Partnership in health emerges as an alternative to the models of public health management existing in Brazil, being implanted, pioneer, in the Hospital of the Suburb, located in the city of Salvador, Bahia. In this management model, the relationship between the public and private partners is regulated by contract and measured through qualitative and quantitative performance indicators. For the analysis in question, the following indicators were used: overall hospital infection density; Number of emergency care, emergency and outpatient consultations; And hospital admission numbers, which are, in general, within the contract, ratifying the good performance of this new management modality. It is understood that the Public-Private Partnership in health, with reference to the results achieved by the Suburb Hospital, is a viable alternative to the existing management models, presenting successful results, regarding the quality of the service offered to the users of Unified Health System.

Se trata de un estudio descriptivo de enfoque cuantitativo y cualitativo que tuvo como objetivo analizar el proceso de gestión de un hospital administrado por una Asociación Publico-Privada. Fueron utilizados como las fuentes de datos de documentación y la información oficial recogida en las páginas web de las instituciones que participan en el proceso de implementación y operación del hospital en cuestión. La salud Asociación Publico-Privada surge como una alternativa a los modelos de gestión públicos de salud existente en Brasil, siendo desplegado, de manera innovadora en el Hospital de los suburbios, que se encuentra en la ciudad de Salvador, Bahia. En este modelo de gestión, la relación entre el socio público y lo privado está regulada por contrato y medido por los indicadores de rendimiento cualitativos y cuantitativos. Para el análisis en cuestión, se utilizaron los siguientes indicadores: densidad global de infección hospitalaria; Número de visitas de atención, de emergencia y ambulatorios urgentes; y el número de hospitalizaciones, que son, en general, dentro de la contratada, lo que confirma el buen desempeño de este nuevo modo de gestión. Aprehende que el Asociación Publico-Privada en materia de salud, con referencia a los resultados obtenidos por el Hospital periferia, que se muestra como una alternativa viable a los modelos de gestión existentes, con resultados exitosos, en cuanto a la calidad del servicio ofrecido a los usuarios del Sistema Único de salud.

Indicadores das infecções associadas aos cuidados e gestão do risco infeccioso: a experiência francesa / Indicators of the infections associated with care and infectious risk management: the french experience / Indicadores de las infecciones asociadas a los cuidados y gestión del riesgo infeccioso: la experiencia francesa

Este artigo apresenta como são organizadas as ações contra as Infecções Associadas aos Cuidados na França e discute os indicadores associados aos cuidados e gestão do risco infeccioso. Trata da reorganização e modernização do sistema de saúde francês no que se refere à política de melhorias contínuas da qualidade, segurança do cuidado, dos dispositivos, funcionamento e estruturas de controle das Infecções Associadas aos Cuidados. A gestão do risco infeccioso está associada à certificação obrigatória, sendo realizada em rede articulada e conforme diretrizes da Política e do Programa de Prevenção das Infecções Associadas aos Cuidados. Os indicadores fazem parte do painel público de infecções hospitalares, podendo o usuário ter acesso pelo site www.scopesante.fr. Os resultados revelam que, apesar dessa política, a França, entre os países da comunidade europeia, é o quarto país que mais utiliza antibióticos em nível hospitalar. A vigilância do consumo de antibióticos nos estabelecimentos de saúde de todo o país é uma estratégia para reduzir o seu uso. Além disso, são necessárias ações específicas para aprender a melhor prescrever antibióticos. Os resultados, com base em objetivos quantificados e indicadores, permitem verificar quais e onde os esforços precisam aumentar.

This article presents how to organize actions against infections associated to care in France and discuss the indicators associated with the care and the management of infectious risk. It talks about the reorganization and the modernization of the French health system with regards to the policy of continuous improvement of quality, safety of care, of devices, of operation and control structures of Care Associated Infections. Infectious Risk management is associated with the mandatory certification, and carried out in an articulated network and according to guidelines of the Policy and Prevention Program of Care Associated Infections. The indicators are part of the public panel of hospital infections, allowing access to the user on the site www.scopesante.fr. The results show that, despite the policy among the countries of the European Community, France is the fourth country using more antibiotics in hospitals. The control of antibiotic consumption in health facilities across the country is a strategy to reduce its use. In addition, specific actions are needed to learn how to best prescribe antibiotics. The results based on quantified targets and indicators evince what and where efforts need to increase.

Este artículo presenta como se organizan las acciones contra las Infecciones Asociadas a los Cuidados en Francia y discute los indicadores asociados a los cuidados y la gestión del riesgo infeccioso. Trata de la reorganización y modernización del sistema de salud francés en lo que se refiere a la política de mejorías contínuas de la calidad, seguridad del cuidado, de los dispositivos, del funcionamiento y de las estructuras de control de las Infecciones Asociadas a los Cuidados. La gestión del riesgo infeccioso está asociada a la certificación obligatoria, siendo realizada en red articulada y según directivas de la Política y del Programa de Prevención de las Infecciones Asociadas a los Cuidados. Los indicadores hacen parte del panel público de infecciones hospitalarias, a que el usuario puede acceso a través del site www.scopesante.fr. Los resultados revelan que, a pesar de esa política, la Francia, entre los países de la Comunidad Europea, es el cuarto país que más utiliza antibióticos en nivel hospitalario. La vigilancia del consumo de antibióticos en los centros sanitarios de todo el país es una estrategia para reducir su uso. Además, son necesarias acciones específicas para aprender a prescribir mejor los antibióticos. Los resultados, con base en objetivos cuantificados e indicadores, permiten verificar cuales y donde los esfuerzos son necesarios.

POLÍTICA DE QUALIDADE, ACREDITAÇÃO E SEGURANÇA DO PACIENTE EM DEBATE / QUALITY POLICY, ACCREDITATION AND PATIENT SAFETY IN DEBATE / POLÍTICA DE CALIDAD, ACREDITACION Y EL DEBATE SOBRE LA SEGURIDAD DEL PACIENTE

O artigo objetiva discutir a tríade qualidade, acreditação hospitalar e segurança. Trata-se de estudo de revisão não sistemática da literatura e reflexão sobre a institucionalização da Política de Qualidade em Serviços de Saúde no Brasil, tomando como referenciais os marcos regulatórios e a corrente teórica do neoinstitucionalismo histórico. Discute a qualidade no âmbito da Política de Saúde no País, suas abordagens e trata a acreditação como uma ferramenta de avaliação da qualidade, enfocando a segurança do paciente. Foram consultados livros, teses, dissertações e artigos científicos relacionados ao tema nas seguintes bases de dados: Medical Literature Analysis and Retrieval System Online (Medline) por meio do Pubmed; Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS); Scientific Eletronic Library Online (SciElo) e Scopus; Web of Science (ISI), incluindo documentos publicados pela Organização Mundial de Saúde (OMS). Foram selecionados os estudos publicados em português, inglês ou espanhol, no período entre 1988 e 2015. As categorias de análise foram: Institucionalização, Política de Qualidade, Acreditação Hospitalar e Segurança do Paciente. Os resultados revelam que, no Brasil, mesmo sem uma Política Nacional de Qualidade em Saúde estabelecida nos marcos regulatórios e formalmente institucionalizada, o Ministério da Saúde define estratégias que estimulam o controle e a garantia de qualidade em serviços de saúde, tais como: projetos de humanização da atenção, programas de acreditação e o Programa Nacional de Segurança do Paciente, que podem contribuir para institucionalização das práticas de qualidade em serviços de saúde no País, embora de modo fragmentado e não linear.

This article aims to discuss the quality triad, quality, hospitalar accreditation and patient safety through literature review and the questioning of the existence of a quality policy in health services in Brazil, taking as reference the regulatory frameworks and the theoretical strand of historical new-institucionalism, which emphasizes the importance of institutions in the formulation and implementation of public policies. We consulted books, theses, dissertations as well as scientific papers related to the subject in the following databases: Medical Literature Analysis and Retrieval System Online (Medline) through Pubmed; Latin American and Caribbean Literature in Health Sciences (LILACS), Scientific Eletronic Library Online (SciElo) and Scopus; Web of Science (ISI), including documents published by the World Health Organization (WHO). We selected studies published in Portuguese, English or Spanish between 1988 and 2015. Data were analyzed according to the categories: institutionalization, Quality Policy, Hospital Accreditation and Patient Safety. The results show that, in Brazil, even without a National Health Quality Policy established in regulatory frameworks and formally institutionalized, the Ministry of Health defines strategies that stimulate control and quality assurance in health services, such as: humanization of care, accreditation programs and the National Patient Safety Program, which may contribute to the institutionalization of quality practices in health services in Brazil, although in a fragmented and non-linear way.

Este artículo tiene como objetivo discutir la tríada calidad, acreditación hospitalaria y seguridad del paciente a través de una revisión no sistemática de la literatura y de la reflexión sobre la institucionalización de una Política de Calidad en Servicios de Salud en Brasil, basándose en los marcos regulatorios y en la corriente teórica del Neoinstitucionalismo histórico. Discute la calidad en el ámbito de la Política de Salud en el País, sus abordajes, y la acreditación como una herramienta de evaluación de la calidad, con enfoque en la seguridad del paciente. Se consultaron libros, tesis, disertaciones y artículos científicos en las siguientes bases de datos: Sistema Literature Analysis and Retrieval médica en línea (Medline) a través de PubMed; Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS); Scientific Electronic Library Online (SciELO) y Scopus; Web of Science (ISI), incluidos los documentos publicados por la Organización Mundial de la Salud (OMS). Se seleccionaron los estudios publicados en portugués, inglés o español, entre 1988 y 2015. Los datos fueron analizados a la luz de las categorías: institucionalización, Calidad, Acreditación de Hospitales y la seguridad del paciente. Los resultados revelan que, en Brasil, a pesar de no haber una Política Nacional de Calidad en Salud establecida en los marcos regulatorios y formalmente institucionalizada, el Ministerio de Salud define estrategias que estimulan el control y la garantía de calidad en servicios de salud, tales como proyectos de humanización de la atención, programas de acreditación y el Programa Nacional de Seguridad del Paciente, que pueden contribuir hacia la institucionalización de las prácticas de calidad en servicios de salud en el País, aunque de modo fragmentario y no linealmente.

QUALIDADE E AVALIAÇÃO EM SERVIÇOS PÚBLICOS FEDERAIS NO BRASIL: PANORAMA HISTÓRICO E NORMATIVO / QUALITY AND EVALUATION IN FEDERAL PUBLIC SERVICES IN BRAZIL: HISTORICAL AND NORMATIVE OVERVIEW / CALIDAD Y EVALUACIÓN DE LOS SERVICIOS PÚBLICOS FEDERALES EN BRASIL: RESUMEN HISTÓRICO Y NORMATIVO Resumen

Este artigo objetiva discutir o binômio "qualidade e avaliação" em serviços públicos federais no Brasil, na perspectiva histórica dos marcos normativo-regulatórios. A pesquisa é uma revisão bibliográfica, sobre a Reforma do Estado, e documental, sobre os marcos legais para qualidade e avaliação em serviços públicos federais brasileiros. Além disso, discutem-se os conceitos das expressões "qualidade" e "avaliação" de serviços públicos, apresentando um rol de princípios que regem a qualidade de serviços públicos e um conjunto de critérios e indicadores da avaliação de tais serviços. Em seguida, são analisadas as principais ferramentas de avaliação de serviços públicos federais vigentes, as quais possibilitam efetuar um julgamento continuado e eficaz a respeito do desempenho do serviço: a pesquisa de satisfação, os padrões de qualidade e a Carta de Serviços ao Cidadão. Estes instrumentos estão previstos no Decreto Presidencial n. 6.932, de 11 de agosto de 2009. Observa-se que, sob a ótica do Estado gerencial, houve extensa produção legislativa sobre o tema, adotando os princípios da Gestão pela Qualidade na Administração Pública e instituindo diversos programas nacionais de melhoria da qualidade dos serviços públicos prestados aos cidadãos (eficiência, eficácia e efetividade), ao lado de vários métodos, técnicas e ferramentas para implantar Programas de Qualidade nos serviços públicos.

This article aims to discuss the binomial "quality and evaluation" in federal public services in Brazil, in the historical and normative-regulatory frameworks perspective. A literature review on the Reform of the State and documentary about the legal frameworks for quality and evaluation in Brazilian public services was carried out. In addition, the concepts of the terms "quality" and "evaluation" of public services are discussed, presenting a set of principles that govern the quality of public services and a set of criteria and indicators for the evaluation of public services. Next, the main current tools for evaluating federal public services are analyzed, which make it possible to carry out a continuous and effective judgment about the performance of the service: the satisfaction survey, the quality standards and the Citizen's Letter of Services. These instruments are provided for Presidential Decree 6.932 of August 11, 2009. It is observed that, from the perspective of managerialist State, there was extensive legislative work on the subject, adopting the principles of Quality Management in Public Administration, establishing various national programs for improving the quality of public services provided to citizens (efficiency and effectiveness), along with several methods, techniques and tools to implement Quality Programs in public services.

Este artículo tiene como objetivo discutir el binomio "calidad y evaluación" en los servicios del gobierno federal en Brasil, en la perspectiva histórica de los marcos legales-reguladores. La investigación es una revisión de literatura sobre la Reforma del Estado y documental sobre los marcos legales para la calidad y la evaluación de los servicios públicos brasileños. Además, se discuten los conceptos de "calidad" y "evaluación" de los servicios públicos, la presentación de una lista de principios que regulan la calidad de los servicios públicos y un conjunto de criterios e indicadores para la evaluación del servicio público. Después, se analizan las principales herramientas de evaluación de servicios públicos federales existentes que permiten hacer un juicio continuo y eficaz sobre el rendimiento del servicio: la encuesta de satisfacción, los estándares de calidad y la Carta de servicios a los ciudadanos. Estos instrumentos se establecen en el Decreto Presidencial n. 6932 del 11 de agosto 2009. Se observa que, desde la perspectiva del Estado gerencialista, hubo un extenso trabajo legislativo sobre el tema, la adopción de los principios de gestión de la calidad en la Administración Pública, instituyendo diversos programas de mejora de la calidad nacional de los servicios públicos prestados a los ciudadanos (eficiencia, eficacia y efectividad), junto con varios métodos, técnicas y herramientas para implementar Programas de Calidad en los servicios públicos.