Glucosylpolyphenols as Inhibitors of Aß-Induced Fyn Kinase Activation and Tau Phosphorylation: Synthesis, Membrane Permeability, and Exploratory Target Assessment within the Scope of Type 2 Diabetes and Alzheimer's Disease.

Despite the rapidly increasing number of patients suffering from type 2 diabetes, Alzheimer's disease, and diabetes-induced dementia, there are no disease-modifying therapies that are able to prevent or block disease progress. In this work, we investigate the potential of nature-inspired glucosylpolyphenols against relevant targets, including islet amyloid polypeptide, glucosidases, and cholinesterases. Moreover, with the premise of Fyn kinase as a paradigm-shifting target in Alzheimer's drug discovery, we explore glucosylpolyphenols as blockers of Aß-induced Fyn kinase activation while looking into downstream effects leading to Tau hyperphosphorylation. Several compounds inhibit Aß-induced Fyn kinase activation and decrease pTau levels at 10 µM concentration, particularly the per-O-methylated glucosylacetophloroglucinol and the 4-glucosylcatechol dibenzoate, the latter inhibiting also butyrylcholinesterase and ß-glucosidase. Both compounds are nontoxic with ideal pharmacokinetic properties for further development. This work ultimately highlights the multitarget nature, fine structural tuning capacity, and valuable therapeutic significance of glucosylpolyphenols in the context of these metabolic and neurodegenerative disorders.

A experiência de pacientes assistidos por um serviço de atenção domiciliar (sad) / La experiencia de pacientes asistidos por um servicio de atención domiciliaria (sad) / Patients experience assisted by a home care service (hcs)

RESUMO. Apresentam-se os resultados de uma pesquisa de doutorado em psicologia, que buscou compreender, fenomenologicamente, a experiência de pacientes assistidos por um Serviço de Atenção Domiciliar (SAD), vinculado ao Sistema Único de Saúde (SUS), num município do Estado de São Paulo. A pesquisadora realizou encontros dialógicos individuais, mediados por uma questão norteadora, com sete pacientes adultos de ambos os sexos e a partir de suas impressões, escreveu narrativas compreensivas sobre a experiência de cada participante. Excertos dessas narrativas serão aqui apresentados, assim como os elementos essenciais da experiência de ser cuidado em casa. Concluiu-se que a vivência do cuidado em domicílio favorece a autonomia do paciente, possibilitando o convívio com os familiares e a manutenção de elementos identitários presentes na moradia. Como contribuição deste estudo, aponta-se que o espaço da casa, enquanto contexto de cuidado em saúde favorece relações interpessoais positivas entre a equipe de profissionais de saúde, pacientes e familiares, tornando-o potencialmente mais humanizador.

RESUMEN. Presenta los resultados de una investigación doctoral en psicología, que intentó comprender, por intermedio del método fenomenológico, la experiencia de pacientes asistidos por un Servicio de Atención Domiciliaria (SAD) vinculado al Sistema Unificado de Salud (SUS), en una Ciudad en el estado de São Paulo-Brasil. Encuentros dialógicos individuales ocurrió, mediada por la pregunta orientadora, con 7 pacientes adultos de ambos sexos. A partir de sus impresiones, escribió narrativas comprensivas sobre la experiencia de cada participante. Los extractos de estas narrativas se presentarán aquí, así como los elementos esenciales de la experiencia de ser cuidado en el hogar. Se concluyó que la vivencia del cuidado en domicilio favorece la autonomía del paciente, posibilitando la convivencia con los familiares y el mantenimiento de elementos identitarios presentes en la vivienda. Como contribución de este estudio, se señala que el espacio de la casa, en cuanto contexto de cuidado en salud, favorece relaciones interpersonales positivas entre el equipo de profesionales de salud, pacientes y familiares, haciéndolo potencialmente más humanizador.

ABSTRACT. This paper presents the results of a doctoral research in Psychology, which sought to understand, through the phenomenological method, the experience of patients assisted by a Home Care Service - HCS (Known in Brazil as Serviço de Atenção Domiciliar - SAD), that is part of the Unified Health System- UHS (Known in Brazil as Sistema Único de Saúde - SUS), in a city in the State of São Paulo-Brazil. Dialogical meetings took place, mediated by guiding questions, with seven adults, patients of both sexes. Then, based on the authors' perceptions, comprehensive narratives were written on each participant's experience. Excerpts of these narratives will be presented here as well as the essential elements of the experience of being in a care home. It was concluded that the experience of home care favors the autonomy of the patient, enabling the coexistence with family members and the maintenance of identity elements present in the housing. As a contribution of this study, it is pointed out that the home space, as a context of health care, favors positive interpersonal relationships among the team of health professionals, patients and family members, making it potentially more humanizing.

Tendências da participação no SUS: a ênfase na instrumentalidade e na interface interestatal / Trends of participation in SUS: the emphasis on instrumentality and on interstate interface

RESUMO Diante da conjuntura de austeridade fiscal, da regressividade dos direitos sociais e da gestão pública de base democrática, o presente manuscrito teve por objetivo analisar as tendências da participação na saúde. Para tanto, realizou-se estudo de documentos emitidos pela OMS/Opas/Brasil, Banco Mundial e registros do seminário internacional sobre o futuro dos sistemas universais de saúde, promovido por entidade de gestores públicos (Conass). A pesquisa bibliográfica contemplou estudos publicados em periódicos da área da saúde vinculados a entidades acadêmico-cientificas que constituíram as bases político-organizativas do movimento de reforma sanitária brasileira, além de outros periódicos nacionais que dedicaram número especial aos 30 anos do Sistema Único de Saúde (SUS). O estudo encontrou nos documentos internacionais referências a uma participação instrumental, despolitizada e do tipo parceria Estado-sociedade-mercado, quando comparada com as bases democráticas de articulação política do movimento de reforma sanitária. A ênfase dos documentos é para uma gestão e uma participação com base na interface interestatal na qual o Estado é mais um sujeito na realização dos serviços de saúde. No entanto, há uma tímida valorização da institucionalidade participativa no evento do Conass e um silenciamento quanto ao tema nos periódicos da área, nas publicações comemorativas dos 30 anos do SUS.

ABSTRACT Given the conjuncture of fiscal austerity, regression of social rights and democratic public management, this manuscript aims to analyze the current trends of participation in the field of health. To this end, a study was carried out on documents issued by WHO/Paho/Brazil, the World Bank, and records from the international seminar on the future of universal health systems, promoted by public managers (Conass). Literature research included studies published in health journals linked to academic-scientific entities that constituted the political and organizational bases of the brazilian sanitary reform movement, as well as other national journals that dedicated special issue to the 30 years of the Unified Health System (SUS). The study found in the international documents references to an instrumental, depoliticized participation of the State-society-market partnership type, when compared with the democratic bases of political articulation of the sanitary reform movement. The emphasis of the documents lies on management and participation, based on interstate interface, in which the state is just another subject in the delivery of health services. However, there is a timid appreciation of the participatory institutionality in the Conass event, and a silence on the subject in the field's periodicals, in the commemorative publications of the 30 years of the SUS.

Hospitalisations with burns in children younger than five years in Portugal, 2011-2015.

INTRODUCTION: Paediatric population still represents a high burden of hospitalisations among burns inpatients. Children under five years old have a distinct aetiology distribution comparing to other age groups, representing in Portugal a fifth of all hospitalisations with burns. We aimed to describe the demographic and clinical burden of burns requiring hospitalization, as well as hospitalization charges, among this age group in Portugal. METHODS: We performed a retrospective study including inpatients younger than five years-old and discharged between 2011 and 2015 in a public Portuguese hospital with a main or secondary diagnosis of burns (ICD-9-CM: 940.xx-949.xx). Clinical and demographics characteristics were assessed, as well as hospital reimbursement charges. RESULTS: A total of 1217 hospitalisations with burns were found, with a hospitalization rate of 54.6 hospitalisations/100,000 inhabitants/year, higher among boys. Ninety percent of them were due to hot liquid or objects. There were three in-hospital deaths. There was a median length of stay of 9days and a mean hospitalization reimbursed charge of 3073 Euros (4918 I$). Non-rural: rural hospitalization rate ratio was of 0.42:1. Évora and Bragança were the districts with higher hospitalization rate with 116 and 107, respectively. DISCUSSION: This Portuguese nation-wide study on hospitalisations with burns highlights that 90% of all burns were due to hot liquid or object and a major impact of patients younger than 2years old in this age group. Urban vs rural difference in hospitalization rate should also be considered for further health inequalities' studies. As conclusion, ongoing attention needs to be dedicated to paediatric burn prevention and safety cost-effective strategies, particularly in relation to scalds, to further reduce the incidence of burn hospitalisations in children and the associated hospital costs.

Appetite-Related Eating Behaviours: An Overview of Assessment Methods, Determinants and Effects on Children's Weight.

Identifying the underlying child-eating behaviours that contribute to weight differences across growth has been a constant challenge. This report reviews the various literature approaches for assessing appetite regulation. In doing so, it attempts to understand how appetite control develops and determines the eating habits in early childhood, and its effects on children's weight status. The interaction between homeostatic and hedonic mechanisms largely explains the appetite regulation process. Homeostatic mechanisms are mediated by the biological need to maintain the body's energy reserves, increasing the motivation to eat. On the contrary, the hedonic mechanisms are mediated by food reward, increasing the craving for high-palatable foods and triggering the release of dopamine and serotonin. There are many biological methods (plasma measurements of hormones, like leptin, ghrelin and insulin) and behavioural evaluation methods of appetite. The Children's Eating Behaviour Questionnaire is most commonly used, due to its adequate psychometric properties tested in several population settings. The development of eating behaviours begins in utero, and several determinants may contribute to a decrease in the ability to self-regulate dietary intake. Examples include genetic predisposition, the first taste experiences and the family environment, a key determinant in this process. Several eating behaviours contribute most to childhood obesity. Among them, are the external eating (eating by external stimuli, such as the mere presence of the food or its smell), food restriction (which may potentiate the uninhibited increased intake of the restricted foods) and emotional eating (intake due to emotional variations, especially negative feelings). These eating behaviours have been linked to childhood obesity.

Association of maternal characteristics and behaviours with 4-year-old children's dietary patterns.

This study examined the association of family and maternal characteristics with preschool children's dietary patterns. Trained interviewers evaluated subsample 3422 mothers and children enrolled in the population-based birth cohort Generation XXI (Porto, Portugal, 2005-2006). Maternal characteristics and behaviours (exercise, smoking habits, diet and child-feeding practices) and family characteristics were evaluated. Maternal diet was classified by a dietary score, and children's dietary patterns were identified by latent class analysis. Odds ratios (OR) and confidence intervals (95% CI) were estimated by multinomial regression models. The analysis was based on a framework with four conceptual levels: maternal socio-economic position (SEP) at 12 years, maternal socio-economic and demographic characteristics at child's delivery, family characteristics and maternal behaviours at child's 4 years. Three dietary patterns were identified in children: high in energy-dense foods (EDF); low in foods typically consumed at main meals and intermediate in snacks (Snacking); higher in healthy foods; and lower in unhealthy ones (Healthier, reference). Lower maternal SEP had an overall effect on children's diet (low vs. high SEP; EDF, OR = 1.76, 95% CI: 1.42-2.18; Snacking, OR = 1.73, 95% CI: 1.27-2.35), while maternal education was directly associated with it (≤9 vs. >12 schooling years, EDF, OR = 2.19, 95% CI: 1.70-2.81; Snacking, OR = 2.22, 95% CI: 1.82-3.55). Children whose mothers had worse dietary score were significantly more likely to follow unhealthier patterns (first vs. fourth quartile; EDF, OR = 9.94, 95% CI: 7.35-13.44, P-trend < 0.001; Snacking, OR = 4.21, 95% CI: 2.94-6.05, P-trend < 0.001). Maternal diet was the key factor associated with children's diet, above and beyond socio-economic and demographic characteristics, accounting for one-third of the determination coefficient of the fully adjusted model. At preschool age, interventions should give a particular focus on maternal diet and low SEP groups.

Early Life Characteristics Associated with Appetite-Related Eating Behaviors in 7-Year-Old Children.

OBJECTIVE: To assess early life characteristics associated with appetite-related eating behaviors in 7-year-old children. STUDY DESIGN: The participants are children from the population-based birth cohort Generation XXI. Data on sociodemographics, health, and lifestyles and anthropometrics were collected at birth, and 4- and 7-year-old evaluations. A Portuguese version of the Children's Eating Behavior Questionnaire was completed by mothers (n = 3562 children) with children aged 7 years old. A 2-factor solution was identified: factor 1-appetite restraint and factor 2-appetite disinhibition. Associations were estimated through generalized linear models adjusted for maternal age, education, body mass index (BMI) before birth, family structure, number of siblings, and child's sex (ß regression coefficients and 95% CIs). RESULTS: Higher appetite restraint at 7 years old was associated with higher maternal age and educational level, families with both parents (1- vs 2-parent: ß = -0.074, 95% CI -0.140, -0.007) and no siblings (≥2 vs 0: ß = -0.152, 95% CI -0.224, -0.081), and more sedentary lifestyles at 4 years old. It was also associated with lower child and maternal BMI and waist circumference at 4 years old. In contrast, higher appetite disinhibition was associated with lower maternal educational background, having a 1-parent family, more sedentary behaviors (≥120 vs <120 min/d of media: ß = 0.055, 95% CI 0.018, 0.093), and higher BMI and waist circumference at 4 years old. CONCLUSIONS: Higher maternal age and education, and a family with both parents at 4 years old seem to influence higher appetite restraint, but less appetite disinhibition at 7 years old. More sedentary lifestyles at 4 years old were associated with higher appetite restraint and appetite disinhibition scores later in childhood. These results can be useful for the development of prevention guidelines and educational strategies aimed at improving healthy eating behaviors.

Burden of burns in Portugal, 2000-2013: A clinical and economic analysis of 26,447 hospitalisations.

INTRODUCTION: There is a lack of recent and nation-wide epidemiological studies of burns in Europe, mainly in southern Europe. There are no recent studies describing the clinical and economic burden of burns in this European area. Hence, this research aimed to describe the clinical and economic burden of burn hospitalisations in Portugal. METHODS: A retrospective observational study was performed and the Portuguese hospitalisation database of public hospitals was used; all inpatients, discharged between 2000 and 2013, with a main or secondary diagnosis of burns (ICD-9-CM: 940.xx-949.xx) were taken into account. Furthermore, admissions to hospitals with and without burn centres were compared. RESULTS: A total of 26,447 burn hospitalisations were registered (mean of 1889burn admissions/year). The total hospitalisation rate was of 18.9hospitalisations/100,000inhabitants/year, and there was a higher incidence of male patients. Burn hospitalisations and hospitalisation rates are significantly decreasing - mostly in 0-14-year-old patients - and children below the age of 5 years represented a fifth of all admissions. Besides the important morbidity, the in-hospital mortality rate was of 4.4%. With a total annual charge of almost 13million Euros, the average cost per burn admission is increasing, and reached 8032Euros in 2013. Additionally, more than half of the patients admitted to hospitals without burn centres were not transferred to hospitals with burn centres, not following the European Burns Association transferral criteria. CONCLUSIONS: As the largest southern European nation-wide epidemiological study of burn patients, this research highlights that burn admissions, as well as hospitalisation rates, are decreasing significantly. This was particularly obvious among the youngest patients despite the fact that the numbers still remain very high. Moreover, the in-hospital mortality rate is still excessively high and the burn transferral criteria are not being followed. Thus, it is important to improve preventive measures, reach out to and educate providers about the burn transferral criteria, and develop specific health care strategies for children with these injuries.

Social and health behavioural determinants of maternal child-feeding patterns in preschool-aged children.

Parental child-feeding attitudes and practices may compromise the development of healthy eating habits and adequate weight status in children. This study aimed to identify maternal child-feeding patterns in preschool-aged children and to evaluate their association with maternal social and health behavioural characteristics. Trained interviewers evaluated 4724 dyads of mothers and their 4-5-year-old child from the Generation XXI cohort. Maternal child-feeding attitudes and practices were assessed through the Child Feeding Questionnaire and the Overt/Covert Control scale. Associations were estimated using linear regression [adjusted for maternal education, body mass index (BMI), fruit and vegetables (F&V) intake and child's BMI z-score]. Principal component analysis defined a three-factor structure explaining 58% of the total variance of maternal child-feeding patterns: perceived monitoring - representing mothers with higher levels of monitoring, perceived responsibility and overt control; restriction - characterizing mothers with higher covert control, restriction and concerns about child's weight; pressure to eat - identifying mothers with higher levels of pressure to eat and overt control. Lower socioeconomic status, better health perception, higher F&V intake and offspring cohabitation were associated with more 'perceived monitoring' mothers. Higher maternal F&V intake and depression were associated with more 'restrictive' mothers. Younger mothers, less educated, with poorer health perception and offspring cohabiting, were associated with higher use of 'pressure to eat'. Maternal socioeconomic indicators and family environment were more associated with perceived monitoring and pressure to eat, whereas maternal health behavioural characteristics were mainly associated with restriction. These findings will be helpful in future research and public health programmes on child-feeding patterns.

Could the Food Neophobia Scale be adapted to pregnant women? A confirmatory factor analysis in a Portuguese sample.

BACKGROUND: The Food Neophobia Scale (FNS) is widely used in different countries, however appropriate psychometric analyses are required to allow cross-cultural comparisons. To our knowledge, most studies have been conducted among children and adult populations, with no reference to pregnant women. The objective of this study was to translate and test the psychometric properties of a Portuguese version of the FNS, and to identify clusters of food neophobia during pregnancy. METHODS: The FNS was translated into Portuguese by three health researchers, and back-translated into English by an independent native English speaker and professional translator. The scale was self-administered in a sample of 219 women from the baseline evaluation of the Taste intervention study (HabEat project: http://www.habeat.eu/), who attended medical visits in two hospitals from Porto, Portugal, reporting food neophobia during the last trimester of pregnancy. The FNS consists of 10 items with a 7-point rating scale. An exploratory analysis was performed to evaluate the scale's dimensionality, followed by a confirmatory factor analysis to test the fit of the previous model by using different indexes. Cronbach's alpha coefficient was calculated to evaluate the internal reliability of the scale. The construct validity was assessed by comparing the FNS scores by categories of education, age and fruit and vegetables intake by ANOVA. A Model-based clustering was used to identify patterns of food neophobia; the number of latent classes was defined according to the Bayesian information criterion. RESULTS: A two-factor model solution was obtained (after excluding item 8 with a factor loading <0.4), explaining 51% of the total variance. Cronbach's alpha was 0.75 for factor 1 (5 items) and 0.71 for factor 2 (4 items). Items 1, 4, 6, 9 and 10 loaded into the first factor (i.e. more willingness to try new foods; less neophobic traits) and items 2, 3, 5 and 7 loaded into a second factor (i.e. more neophobic traits). A good global of fitness of the model was confirmed by fit indexes: TLI=0.876, CFI=0.911, RMSEA=0.088 and SRMR=0.051. The higher the education, age, and fruit and vegetables intake the lower the neophobic tendency, measured by the Portuguese FNS. Three patterns (i.e. clusters) of food neophobia, characterizing neophobia traits of pregnant women were identified: Moderate Neophilic, Moderate Neophobic, and Extreme Neophilic (cut-off points were provided). CONCLUSION: The Portuguese version of the FNS has the basic requirements of a valid and reliable measure of food neophobia and permits the identification of clusters of neophobic traits during pregnancy.

Saturated fatty acids intake in relation to C-reactive protein, adiponectin, and leptin: a population-based study.

OBJECTIVE: Evidence on the relation of saturated fatty acids (SFA) with inflammatory markers and adipokines is scarce and inconsistent. This study aimed to evaluate the association of the intake of total SFA, their subtypes (lauric, myristic, palmitic, and stearic acids), and SFA to polyunsaturated fatty acids (PUFA) ratio (SFA/PUFA ratio) with serum concentrations of high-sensitivity C-reactive protein (hs-CRP), adiponectin, and leptin among Portuguese adults. METHODS: We studied 395 non-institutionalized inhabitants of Porto (52.2% women; age range: 26-64 y) who were evaluated in 2010-2011, as part of EPIPorto study. Fatty acids intake was assessed with a validated semi-quantitative food frequency questionnaire. Blood was sampled after an overnight fast and serum concentrations of hs-CRP (through particle-enhanced immunonephelometry), adiponectin, and leptin (through radioimmunoassay) were determined. Regression coefficients (ß) and 95% confidence intervals (CI) were obtained from linear regression models, stratified by sex. RESULTS: After adjusting for age, education, regular physical exercise, smoking, and central body fat percentage, hs-CRP was significantly and positively associated with lauric (ß = 0.218; 95% CI, 0.071-0.365) and myristic acids (ß = 0.220; 95% CI, 0.073-0.368) and with SFA/PUFA ratio (ß = 0.171; 95% CI, 0.022-0.320) in men, but not in women. For adiponectin and leptin, no significant associations with SFA intake were observed in either sex. CONCLUSIONS: A detrimental role of lauric and myristic acids and of high SFA/PUFA ratio is suggested by their association with elevated hs-CRP concentrations in men. Our findings may be helpful in the planning of dietary modifications aimed at the modulation of inflammatory activity that could be an intermediate step to coronary events.

Organização sociopolítica de Psicólogas(os) na Bahia: formação das suas entidades de classe / Social and political organization of psychologists in Bahia: formation of their class entities / Organización sociopolítica de Psicólogas(los) en Bahia:: formación de sus entidades de clase

O presente artigo teórico propõe-se a debater sobre o processo de organização sociopolítica dos psicólogos na Bahia, trazendo como objetivo uma reflexão sobre o papel das entidades representativas da classe nesse processo. Com esse fim, foi realizada uma revisão de literatura que tratou da conjuntura histórica da regulamentação e do desenvolvimento da Psicologia no Brasil, assim como sobre a sua organização sociopolítica. Além disso, devido à escassez de estudos que abordam esse tema, foram incluídos depoimentos coletados durante a realização deste artigo, e, para isso, foram feitas entrevistas semiestruturadas com alguns membros envolvidos com as entidades representativas dos psicólogos no Estado da Bahia. Este estudo buscou discutir, principalmente, a atuação e a função do Conselho Regional de Psicologia - Região 03 e do Sindicato dos(as) Psicólogos(as) no Estado da Bahia - SINPSI-BA. Ao final, são levantadas algumas reflexões sobre a atuação e o engajamento das (os) psicólogas (os) bem como a análise do papel desse profissional na sociedade baiana.

The present theoretical article proposes to discuss about Bahia's psychologists socio-political organization process, having as objective the reflection about the class representative entities role in this process. With this aim a literature review about the historic conjuncture on psychology regulation and development in Brazil has been done, as well as on its socio-political organization. Furthermore, due to the scarcity of works about this issue, interviews done while during the execution of this article were included. With this target, semi-structured interviews with some members involved in the psychologists representative entities in Bahia state have been made. This study aimed at discussing primarily Psychology Regional Council - Third Region and Bahia State Psychology Labor Union - SINPSI BA performance and function. In the end, some thoughts about psychologist's action and engagement are listed, as well as an analysis of this professional's role in Bahia's society.

El presente artículo teórico se propone debatir sobre el proceso de organización sociopolítica de los psicólogos en Bahía, trayendo como objetivo una reflexión sobre el papel de las entidades representativas de la clase en ese proceso. Con ese fin, fue realizada una revisión de la literatura que trató la coyuntura histórica de la reglamentación y del desarrollo de la Psicología en Brasil, así como sobre su organización sociopolítica. Además, debido a la escasez de estudios que abordan ese tema, fueron incluidas declaraciones recolectadas durante la realización de este artículo, y, para eso, se realizaron entrevistas semiestructuradas con algunos miembros involucrados con las entidades representativas de los psicólogos en el Estado de Bahía. Este estudio buscó discutir, principalmente, la actuación y la función del Consejo Regional de Psicología - Región 03 y del Sindicato de los (las) Psicólogos (las) en el Estado de Bahía - SINPSI-BA. Al final, son realizadas algunas reflexiones sobre la actuación y el compromiso de los psicólogos así como el análisis del papel de ese profesional en la sociedad bahiana.

Singularidades do trabalho gerencial em um hospital acreditado / The hospital accreditation: management

A sobrevivência dos hospitais, de natureza pública ou privada, tem sido um grande desafio. Percebe-se que os gerentes da saúde têm envidado esforços na busca de melhorias de qualidade e nos processo gerenciais, sendo a acreditação hospitalar- AH um processo para a prestação de assistência torne-se mais adequada com aprimoramentos contínuos. A acreditação consiste em uma importante ferramenta para organizar o processo de trabalho com eficiência e eficácia, levando os hospitais a passarem por diversas mudanças, dentre as quais o desenvolvimento de melhorias contínuas da qualidade do atendimento aos pacientes e avanços no desempenho organizacional, oferecendo confiança à comunidade no serviço. Este estudo objetivou compreender o trabalho do gerente intermediário em um hospital de grande porte Acreditado com Excelência pela metodologia da ONA. Trata-se de estudo de caso qualitativo realizado em um hospital privado de grande porte em Belo Horizonte. Os dados foram coletados por meio de entrevista, com roteiro semi-estruturado, com 12 gerentes de diferentes categorias profissionais. A amostra foi definida pelo critério de saturação dos dados. Os aspectos éticos foram respeitados com aprovação de Comitê de Ética em Pesquisa da UFMG, do Hospital e assinatura do TCLE. A partir da análise de dados utilizou-se a análise de conteúdo. Com a análise de dados elaborou-se o perfil gerencial e foram construídas quatro categorias temáticas, as quais sejam: participação do gerente enfermeiro no processo da acreditação hospitalar; as duas faces da acreditação hospitalar; os instrumentos da qualidade na AH e os “novos” desafios da função gerencial; e gestão de pessoas: estratégias dos gerentes no alcance da acreditação com excelência. Os resultados evidenciaram que com a inserção da organização no processo de acreditação hospitalar ocorreram mudanças na organização e conseqüentemente nas atividades diárias do gerente. Os gerentes se sentiram desafiados e perceberam que a...

The survival of hospitals, either public or private, has been a great challenge. It is felt that health managers have attempted to search for quality improvements and process management, and the AH-hospital accreditation process for the provision of assistance to become more suited to continuous improvements. The accreditation is an important tool to organize the work efficiently and effectively, leading hospitals to go through several changes, among which the development of continuous improvement of the quality of patient care and improvements in organizational performance, providing confidence to community service. This study aimed to understand the work of the middle manager in a large hospital with Excellence Accredited by the methodology of the ONA. This is a qualitative case study conducted in a large private hospital in Belo Horizonte. Data were collected through interviews with semi-structured, with 12 managers of different professional categories. The sample was defined by the saturation criterion data. The ethical aspects were met with approval by the Research Ethics Committee of UFMG Hospital and signing the WIC. From the data analysis used the content analysis. With the data analysis produced the profile of managers and were built four thematic categories, which are: participation of the nurse manager in the process of hospital accreditation, the two sides of the hospital accreditation, quality instruments in the AH and the "new "challenges of management function, and people management: strategies of managers in achieving accreditation with excellence. The results showed that the insertion of the organization in the process of hospital accreditation changes occurred in the organization and consequently in the daily activities of the manager. The managers felt challenged and realized that the management became more complex, which lnes required more knowledge and skills. From the perspective of managers, accreditation has...

Chemical assessment and in vitro antioxidant capacity of Ficus carica latex.

Ficus species possess latex-like material within their vasculatures, affording protection and self-healing from physical attacks. In this work, metabolite profiling was performed on Ficus carica latex. Volatiles profile was determined by HS-SPME/GC-IT-MS, with 34 compounds being identified, distributed by distinct chemical classes: 5 aldehydes, 7 alcohols, 1 ketone, 9 monoterpenes, 9 sesquiterpenes and 3 other compounds. Sesquiterpenes constituted the most abundant class in latex (ca. 91% of total identified compounds). Organic acids composition was also characterized, by HPLC-UV, and oxalic, citric, malic, quinic, shikimic and fumaric acids were determined. Malic and shikimic acids were present in higher amounts (ca. 26%, each). The antioxidant potential of this material was checked by distinct in vitro chemical assays. A concentration-dependent activity was noticed against DPPH, nitric oxide and superoxide radicals. Additionally, acetylcholinesterase inhibitory capacity was evaluated, but a weak effect was found.

Global burden of disease attributable to diabetes mellitus in Brazil.

Type II diabetes mellitus accounts for 90% of all cases of diabetes, and its inclusion in health evaluation has shown that its complications have a considerable impact on the population's quality of life. The current article presents the results of the Global Burden of Disease Study in Brazil for the year 1998, with an emphasis on diabetes mellitus and its complications. The indicator used was disability-adjusted life years (DALY), using a discount rate of 3%. In Brazil, ischemic heart disease, stroke, and diabetes accounted for 14.7% of total lost DALYs. Brazil showed a higher proportion of years lived with disability (YLDs) among total DALYs for diabetes as compared to other countries. Retinopathy and neuropathy were the complications that contributed most to YLDs. According to forecasts, diabetes mellitus will have an increasing impact on years of life lost due to premature death and disability in the world, shifting from the 11th to 7th cause of death by 2030. It is thus urgent to implement effective measures for prevention, early diagnosis, counseling, and adequate follow-up of patients with diabetes mellitus.

Global burden of disease attributable to diabetes mellitus in Brazil / Carga global de doença devida e atribuível ao diabetes mellitus no Brasil

Type II diabetes mellitus accounts for 90 percent of all cases of diabetes, and its inclusion in health evaluation has shown that its complications have a considerable impact on the population's quality of life. The current article presents the results of the Global Burden of Disease Study in Brazil for the year 1998, with an emphasis on diabetes mellitus and its complications. The indicator used was disability-adjusted life years (DALY), using a discount rate of 3 percent. In Brazil, ischemic heart disease, stroke, and diabetes accounted for 14.7 percent of total lost DALYs. Brazil showed a higher proportion of years lived with disability (YLDs) among total DALYs for diabetes as compared to other countries. Retinopathy and neuropathy were the complications that contributed most to YLDs. According to forecasts, diabetes mellitus will have an increasing impact on years of life lost due to premature death and disability in the world, shifting from the 11th to 7th cause of death by 2030. It is thus urgent to implement effective measures for prevention, early diagnosis, counseling, and adequate follow-up of patients with diabetes mellitus.

O diabetes mellitus tipo II é responsável por 90 por cento de todos os casos de diabetes, e sua inclusão na avaliação de saúde evidencia que as suas complicações têm um considerável impacto na qualidade de vida de uma população. O presente artigo apresenta os resultados do Estudo de Carga Global de Doença, realizado no Brasil para o ano de 1998, com ênfase no diabetes mellitus e suas complicações. O indicador utilizado foi o disability-adjusted life years (DALY), ao qual aplicou-se a taxa de desconto de 3 por cento. No Brasil, doenças isquêmicas do coração, doenças cardiovasculares e diabetes contribuíram com 14,7 por cento do total de DALY. Observou-se uma maior participação do years lived with disability (YLD) no total de DALY para o diabetes quando comparado a outros países. As complicações retinopatias e neuropatias foram as que mais contribuíram para o YLD. Projeções indicam que o diabetes mellitus terá crescente impacto sobre a perda de anos de vida por morte prematura e incapacidade no mundo, e que se deslocará de 11ª para 7ª causa de morte em 2030. Faz-se urgente a implantação e implementação de medidas efetivas para prevenção, diagnóstico precoce, aconselhamento e adequado acompanhamento dos pacientes com diabetes mellitus.

The disease burden attributable to smoking in the state of Rio de Janeiro, Brazil in 2000.

INTRODUCTION: Smoking is one of the main risk factors for morbidity and mortality. An estimated 59 million (4.4%) disability-adjusted life years were lost due to smoking throughout the world in 2000. OBJECTIVE: To estimate the disease burden attributable to smoking in the State of Rio de Janeiro, Brazil, for the year 2000. METHODS: Based on estimates of smoking prevalence and relative death risks, the smoking-attributable fraction was calculated for each selected cause, by age and gender. The disease burden attributable to smoking was estimated by multiplying the fractions by the corresponding disability-adjusted life years. RESULTS: In the State of Rio de Janeiro, 7% of all disability-adjusted life years were due to smoking. For individuals 30 or more years old, the fraction increased to 10.6% (13.6% in males and 7.5% in females). Chronic obstructive pulmonary disease, ischemic heart disease, cerebrovascular disease, and tracheal, bronchial, and lung cancer accounted for 32.2%, 15.7%, 13.2%, and 11.1% of the estimated total DALYs, respectively, amounting to 72.2% of the smoking-attributable disease burden. DISCUSSION: Limitations related to parameter estimates were not unique to this study, and therefore should not compromise the comparability of our results. Outcomes were similar to those obtained in other countries, despite methodological differences. CONCLUSION: Smoking is an important risk factor and places a significant disease burden on Rio de Janeiro, Brazil, showing a pattern similar to that observed in high income countries.

Premature thelarche: clinical and laboratorial assessment by immunochemiluminescent assay.

In order to establish cut-off limits and to distinguish isolated premature thelarche (IPT) from precocious puberty (PP), we evaluated data from 79 girls with premature thelarche, comparing basal and stimulated LH and FSH serum concentrations with those from 91 healthy girls. A GnRH stimulation test was performed in 10 normal girls and in 42 with premature thelarche. Comparison among groups was performed by Kruskal-Wallis and Dunns tests. LH values were significantly greater in girls with IPT than in control groups. Basal gonadotropin concentrations were higher in patients with PP than in controls, but not different from patients with IPT. Peak LH levels after GnRH stimulation distinguished those two groups, with a cut-off value of 4.0 IU/L, but still with minimal overlap. In conclusion, a girl with premature thelarche and LH peak value above 4.5 IU/L has, indeed, PP, but values between 3.5 and 4.5 IU/L point to careful follow-up.

Premature thelarche: clinical and laboratorial assessment by immunochemiluminescent assay

In order to establish cut-off limits and to distinguish isolated premature thelarche (IPT) from precocious puberty (PP), we evaluated data from 79 girls with premature thelarche, comparing basal and stimulated LH and FSH serum concentrations with those from 91 healthy girls. A GnRH stimulation test was performed in 10 normal girls and in 42 with premature thelarche. Comparison among groups was performed by Kruskal-Wallis and Dunn’s tests. LH values were significantly greater in girls with IPT than in control groups. Basal gonadotropin concentrations were higher in patients with PP than in controls, but not different from patients with IPT. Peak LH levels after GnRH stimulation distinguished those two groups, with a cut-off value of 4.0 IU/L, but still with minimal overlap. In conclusion, a girl with premature thelarche and LH peak value above 4.5 IU/L has, indeed, PP, but values between 3.5 and 4.5 IU/L point to careful follow-up.

Com o objetivo de estabelecer o valor de corte e distinguir telarca precoce isolada (TPI) de puberdade precoce (PP), avaliamos 79 meninas com telarca precoce, comparando as dosagens basais e pós-estímulo de LH e FSH com grupo-controle. O teste de estímulo com GnRH foi realizado em 10 meninas normais e em 42 com telarca precoce. Os testes de Kruskal-Wallis and Dunn foram usados na comparação dos grupos. Os níveis de LH foram significativamente mais elevados no grupo com TPI, quando comparados com controles. As gonadotrofinas basais foram mais elevadas naquelas com PP que nos controles, mas não diferiram do grupo com TPI. O pico de LH após GnRH distinguiu estes dois grupos, com valor de corte de 4,0 UI/L, apesar de pequena sobreposição. Concluímos que uma menina com telarca precoce e LH pós-estímulo acima de 4,5 UI/L apresenta PP, mas valores entre 3,5 e 4,5 UI/L requerem seguimento cuidadoso.