Qualificação profissional e o câncer infantojuvenil na atenção básica / Cualificación profesional y cáncer infantojuvenil en la Atención Básica / Professional qualification and childhood cancer in primary care

Resumo Objetivo Analisar a percepção de profissionais que atuam na Atenção Básica sobre sua formação profissional relacionada ao câncer infantojuvenil. Métodos Trata-se de um estudo exploratório, com abordagem qualitativa, desenvolvido junto aos profissionais da Atenção Básica do município de Campinas-SP. A condução do estudo foi realizada por meio de grupos focais, orientados por questões semiestruturadas. Adotou-se a modalidade temática da Análise de Conteúdo. Resultados Foram identificadas duas categorias: "Experiências e formação profissional frente ao câncer infantojuvenil na Atenção Básica", traduzindo-se em pouco contato com a temática, tanto por experiências, quanto por meio da formação profissional; e, a "Integralidade do cuidado à criança e ao adolescente com câncer na Atenção Básica e a qualificação profissional", sendo desvelado pouco ou o nenhum preparo para garantir a integralidade do cuidado, com questões distintas dos aspectos biológicos da doença. Conclusão A partir das percepções dos profissionais, notou-se pouco contato e preparo insuficiente para elencar ações assertivas relacionadas ao câncer infantojuvenil na Atenção Básica, apontando necessidades de mudanças futuras na inclusão do tema neste nível de atenção e melhorias na qualidade da educação permanente nos serviços.

Resumen Objetivo Analizar la percepción de profesionales que actúan en la Atención Básica sobre su formación profesional relacionada con el cáncer infantojuvenil. Métodos Se trata de un estudio exploratorio, con enfoque cualitativo, llevado a cabo con profesionales de la Atención Básica del municipio de Campinas, estado de São Paulo. El estudio fue conducido por medio de grupos focales, guiados con preguntas semiestructuradas. Se adoptó la modalidad temática del análisis de contenido. Resultados Se identificaron dos categorías: "Experiencias y formación profesional frente al cáncer infantojuvenil en la Atención Básica", que se tradujo en poco contacto con la temática, tanto por experiencias, como mediante la formación profesional, e "Integralidad del cuidado de niños y adolescentes con cáncer en la Atención Básica y la cualificación profesional", que reveló poco o ningún tipo de preparación para garantizar la integralidad del cuidado, con cuestiones distintas a los aspectos biológicos de la enfermedad. Conclusión A partir de las percepciones de los profesionales, se observó poco contacto y preparación insuficiente para enumerar acciones asertivas relacionadas con el cáncer infantojuvenil en la Atención Básica, lo que indica la necesidad de cambios futuros respecto a la inclusión del tema en este nivel de atención y mejoras en la calidad de la educación permanente en los servicios.

Abstract Objective To analyze the perception of professionals working in Primary Care about their professional training related to childhood cancer. Methods This is an exploratory study, with a qualitative approach, developed with professionals in Primary Care in the city of Campinas-SP. The study was conducted through focus groups, guided by semi-structured questions. Thematic modality of Content Analysis was adopted. Results Two categories were identified: "Experiences and professional training in the face of childhood cancer in Primary Care", resulting in little contact with the theme, both through experiences and through professional training; and "Comprehensiveness of care for children and adolescents with cancer in Primary Care and professional qualification", with little or no preparation being unveiled to ensure comprehensive care, with issues different from the biological aspects of the disease. Conclusion From professionals' perceptions, there was little contact and insufficient preparation to list assertive actions related to childhood cancer in Primary Care, pointing out the need for future changes in the inclusion of the theme in this level of care and improvements in the quality of continuing education in the services.

Evaluation of the bioequivalence of two formulations containing the combination of 400 mg of acetaminophen (paracetamol), 4 mg of phenylephrine and 4 mg of chlorpheniramine in capsules: open-label, three-way crossover study, partially replicated in healthy volunteers of both sexes

This study was carried out in order to compare the relative bioavailability of two different formulations containing 400 mg of acetaminophen + 4 mg of phenylephrine hydrochloride + 4 mg of chlorpheniramine maleate, Test formulation (Cimegripe®) and Reference formulation (Resfenol®) in 84 healthy volunteers of both sexes under fasting conditions. The study was conducted in a single dose, randomized, open-label, crossover 3-way and partially replicated. The tolerability was evaluated by the monitoring of adverse events and vital signs, results of clinical and laboratory tests. Plasma concentrations were quantified by validated bioanalytical methods using the ultra-performance liquid chromatography coupled to tandem mass spectrometry. The Cmax, Tmax, AUC0-t, AUC0-inf, T1/2 and Kel pharmacokinetic parameters were calculated from these obtained concentrations. The 90% confidence intervals were constructed for the ratio reference/test from the geometric average of the Cmax and AUC parameters which were comprised between 80% and 125%. Only the Cmax parameter of the phenylephrine was applied the scaled average bioequivalence due to the intraindividual coefficient of variation > 30% obtained, thus extending the acceptance limits of the interval. It can be concluded that the two formulations were bioequivalent in terms of rate and absorption extent and thus interchangeable

Medicalização, diagnóstico clínico e queixa-conduta - redes de significação em jogo / Medicalization, clinical diagnosis, and "treat and street" - networks of meaning at stake / Medicalización, diagnóstico clínico y queja-conducta - redes de significación en juego

Este artigo faz emergir uma rede discursiva entre o processo de medicalização, o funcionamento discursivo do diagnóstico clínico na contemporaneidade e um funcionamento particular de clínica médica sustentado por um atendimento do tipo queixa-conduta. Empreendendo uma Análise Discursiva, percorremos movimentos de sentido constitutivos da história da palavra 'diagnóstico', realizando um gesto analítico que retoma suas condições de produção e funcionamento na atualidade, explicitando efeitos da medicalização. Abordamos o atendimento queixa-conduta, no qual a posição-sujeito médico se insere em condições de produção para que o fármaco assuma o lugar da autoria na relação médico-paciente, impactado pelo próprio funcionamento do diagnóstico na atualidade. Resulta que esse funcionamento do diagnóstico na prática clínica implica um silenciamento do laço social e político pressuposto nessa prática, o que permite o estabelecimento do fármaco como lugar de enunciação dos procedimentos que visem à saúde do paciente.(AU)

The present paper examines a discursive network between the medicalization process, the discursive functioning of clinical diagnoses in the contemporary world, and a specific functioning of medical practice grounded on a "treat and street" type of care. By developing a discursive analysis, the authors track the history of the word "diagnosis" in an analytical movement that reexamines its conditions of production and functioning at present, making the effects of medicalization explicit. The study addresses "treat and street" care, in which the position-subject physician inserts him/herself in a production condition so that the drug takes the authorship role in the relationship between physicians and patients, as a consequence of the functioning of diagnosis. This diagnosis functioning in clinical practice implies a silencing of the social and political bond assumed in this practice, which allows the establishment of drugs as a setting of enunciation of the procedures oriented toward care to patients.(AU)

Este artículo hace surgir una red discursiva entre el proceso de medicalización, el funcionamiento discursivo del diagnóstico clínico en la contemporaneidad y un funcionamiento particular de clínica médica sustentado por una atención del tipo queja-conducta. Realizando un Análisis Discursivo, recorrimos movimientos de sentido constitutivo de la historia de la palabra 'diagnóstico', realizando un gesto analítico que retoma sus condiciones de producción y funcionamiento en la actualidad, explicitando efectos de la medicalización. Abordamos la atención queja-conducta, en la cual la posición sujeto médico se insiere en condiciones de producción para que el fármaco asuma el lugar de la autoría en la relación médico-paciente, impactado por el propio funcionamiento del diagnóstico en la actualidad. Resulta que ese funcionamiento del diagnóstico en la práctica clínica implica en un silenciamiento del vínculo social y político supuesto en esa práctica, lo que permite el establecimiento del fármaco como lugar de enunciación de los procedimientos cuyo objetivo es la salud del paciente.(AU)

Hydroxytyrosol supplementation modulates the expression of miRNAs in rodents and in humans.

Dietary microRNAs (miRNAs) modulation could be important for health and wellbeing. Part of the healthful activities of polyphenols might be due to a modulation of miRNAs' expression. Among the most biologically active polyphenols, hydroxytyrosol (HT) has never been studied for its actions on miRNAs. We investigated whether HT could modulate the expression of miRNAs in vivo. We performed an unbiased intestinal miRNA screening in mice supplemented (for 8 weeks) with nutritionally relevant amounts of HT. HT modulated the expression of several miRNAs. Analysis of other tissues revealed consistent HT-induced modulation of only few miRNAs. Also, HT administration increased triglycerides levels. Acute treatment with HT and in vitro experiments provided mechanistic insights. The HT-induced expression of one miRNA was confirmed in healthy volunteers supplemented with HT in a randomized, double-blind and placebo-controlled trial. HT consumption affects specific miRNAs' expression in rodents and humans. Our findings suggest that the modulation of miRNAs' action through HT consumption might partially explain its healthful activities and might be pharmanutritionally exploited in current therapies targeting endogenous miRNAs. However, the effects of HT on triglycerides warrant further investigations.

Major peptides from amaranth (Amaranthus cruentus) protein inhibit HMG-CoA reductase activity.

The objective of this study was to identify the major peptides generated by the in vitro hydrolysis of Amaranthus cruentus protein and to verify the effect of these peptides on the activity of 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMG-CoA reductase), a key enzyme in cholesterol biosynthesis. A protein isolate was prepared, and an enzymatic hydrolysis that simulated the in vivo digestion of the protein was performed. After hydrolysis, the peptide mixture was filtered through a 3 kDa membrane. The peptide profile of this mixture was determined by reversed phase high performance chromatography (RP-HPLC), and the peptide identification was performed by LC-ESI MS/MS. Three major peptides under 3 kDa were detected, corresponding to more than 90% of the peptides of similar size produced by enzymatic hydrolysis. The sequences identified were GGV, IVG or LVG and VGVI or VGVL. These peptides had not yet been described for amaranth protein nor are they present in known sequences of amaranth grain protein, except LVG, which can be found in amaranth α­amylase. Their ability to inhibit the activity of HMG-CoA reductase was determined, and we found that the sequences GGV, IVG, and VGVL, significantly inhibited this enzyme, suggesting a possible hypocholesterolemic effect.

Grupos de Interação Social (GIS): estratégia de empowerment para pessoas com epilepsia / Social Interaction Group (GIS): a strategy of empowerment for people with epilepsy

INTRODUÇÃO: O manejo da epilepsia vai além de controle das crises e, para uma abordagem integrativa, começamos a trabalhar com os Grupos de Interação Social (GIS) na epilepsia. OBJETIVO: Realizar grupos em profissionais da saúde e educação para que eles possam se apoderar desta dinâmica para depois aplicá-los em suas comunidades, locais de trabalho, com seus pacientes e equipe de trabalho. METODOLOGIA: foram realizados dois GIS - com 21 profissionais da área social, saúde e educação na cidade de Pedreira. Para avaliar mudanças, foram aplicados questionários validados (Questionário de Autoestima, Questionário de Resiliência, Inventário de Habilidades Sociais e Escala de Estigma na Epilepsia) antes e depois dos GIS. RESULTADOS: Os grupos permitiram aprender mais sobre epilepsia, trocar experiências e contribuir para o crescimento pessoal e profissional, reforçando a solidariedade e a prática da cidadania. Além disso, o uso da Medicina Tradicional Chinesa reforçou a visão do ser humano como ser integral. Os questionários aplicados no início dos grupos (pré-teste) e ao final (pós-teste) mostraram mudanças positivas. CONCLUSÕES: Pôde-se observar uma melhora em todos os itens avaliados, mostrando que os sujeitos, mesmo sendo profissionais, puderam melhorar suas habilidades sociais e com isso, seu poder de resiliência. A aplicação do GIS é prática, com baixos custos de operacionalização, o que permite sua utilização em locais diversos e pode ser útil para outras situações ou condições crônicas com impacto semelhante ao da epilepsia.

INTRODUCTION: The management of epilepsy goes beyond seizure control. So, the Social Interaction Groups (GIS) is an alternative to this integrative approach in epilepsy. PURPOSE: To carry out groups dynamics for health allied professional, social workers, and educators in order for them to use GIS in their communities and for patients. METHODOLOGY: We conducted two GIS - with 21 professionals from social, education and health Departments of city Pedreira. We used validated questionnaires (Self-Esteem Questionnaire, Resilience Questionnaire, Social Skills Inventory and Stigma Scale of Epilepsy) before and after the GIS. RESULTS: The groups showed improvement in knowledge about epilepsy and allowed to share experiences and contribute to solidarity and sense of citizenship. In addition, the use of Traditional Chinese Medicine has reinforced the holistic view of human being. The questionnaires used (pre and post-test) showed positive changes. CONCLUSIONS: It was observed an improvement in all items evaluated, showing that subjects could improve their social skills and, consequently, their resilience. The application of GIS is practical, with a low-cost operation and allows performance in other locations within other situations of chronic conditions that have similar epilepsy's impact.

In vivo mapping of vascular inflammation using multimodal imaging.

BACKGROUND: Plaque vulnerability to rupture has emerged as a critical correlate to risk of adverse coronary events but there is as yet no clinical method to assess plaque stability in vivo. In the search to identify biomarkers of vulnerable plaques an association has been found between macrophages and plaque stability--the density and pattern of macrophage localization in lesions is indicative of probability to rupture. In very unstable plaques, macrophages are found in high densities and concentrated in the plaque shoulders. Therefore, the ability to map macrophages in plaques could allow noninvasive assessment of plaque stability. We use a multimodality imaging approach to noninvasively map the distribution of macrophages in vivo. The use of multiple modalities allows us to combine the complementary strengths of each modality to better visualize features of interest. Our combined use of Positron Emission Tomography and Magnetic Resonance Imaging (PET/MRI) allows high sensitivity PET screening to identify putative lesions in a whole body view, and high resolution MRI for detailed mapping of biomarker expression in the lesions. METHODOLOGY/PRINCIPAL FINDINGS: Macromolecular and nanoparticle contrast agents targeted to macrophages were developed and tested in three different mouse and rat models of atherosclerosis in which inflamed vascular plaques form spontaneously and/or are induced by injury. For multimodal detection, the probes were designed to contain gadolinium (T1 MRI) or iron oxide (T2 MRI), and Cu-64 (PET). PET imaging was utilized to identify regions of macrophage accumulation; these regions were further probed by MRI to visualize macrophage distribution at high resolution. In both PET and MR images the probes enhanced contrast at sites of vascular inflammation, but not in normal vessel walls. MRI was able to identify discrete sites of inflammation that were blurred together at the low resolution of PET. Macrophage content in the lesions was confirmed by histology. CONCLUSIONS/SIGNIFICANCE: The multimodal imaging approach allowed high-sensitivity and high-resolution mapping of biomarker distribution and may lead to a clinical method to predict plaque probability to rupture.

Toward a binary interpretation of acupuncture theory: principles and practical consequences.

There is an argument that the universe functions according to binary principles. This paper applies such a system of evaluation to the interpretation of acupuncture principles, the t'ai chi symbol and the I Ching. As a result, it can be shown that a coherent and interesting ordering of some earthly phenomena can be reached. When these same principles are applied to acupuncture theory, a grouping and ordering of the meridians and associated organs and their respective functions are obtained. A suggestion is also presented about how, using a digital device, diagnosis and treatment could be reached in the future if this approach is deepened and proves successful. I call this binary medicine, something that would have some similarities as to how electroacupuncture according to Voll (EAV) works. Basically, diagnosis would be done in terms of excess, balance or deficit (+1, 0 or -1, respectively) and treatment would be done in terms of draining for +1 or filling for -1; 0 means a balanced state that does not need any treatment.

Simultaneous fluorometric determination of chlorophylls a and B and pheophytins a and B in olive oil by partial least-squares calibration.

The resolution of quaternary mixtures of chlorophylls a and b and pheophytins a and b has been accomplished by partial least-squares (PLS) multivariate calibration, applied to the fluorescence signals of these pigments. The total luminescence information of the compounds has been used to optimize the spectral data set to perform the calibration. After preliminary studies, a method is described in acetone media, to avoid emulsions with the olive oil samples. Different scanning paths have been selected for each method. For the simultaneous determination of the pigments in olive oil samples, a comparative study of the results found by using excitation, emission, and synchronous spectral data, as analytical signal, was performed. The excitation spectra were selected as the better analytical signals for the determination of the pigments in olive oil samples. The optimum wavelength range to record the excitation spectra (lambda(em) = 662 nm) was selected to minimize the contribution of pheophytin a and to maximize the contribution of the other pigments, which are the minor constituents in olive oil. Determination of these pigments in olive oil samples was effected from the excitation spectra of dissolutions o suitable aliquots in acetone. Recovery values from olive oil, spiked with chlorophylls a and b and pheophytins a and b, were in the ranges of 70-112, 71-111, 76-105, and 82-109%, respectively.

Protección de los sistemas de medicina tradicional, patentamiento y promoción de las plantas medicinales / Protection of traditional medicine systems, patenting and promotion of medicinal plants

La Medicina Tradicional (MT) sirve las necesidades sanitarias de una vasta población en los países en desarrollo, donde el acceso a los servicios "modernos" de atención sanitaria y a los medicamentos se encuentra limitado por motivos económicos y culturales. En tales países, se utiliza ampliamente la MT, siendo con frecuencia el único tratamiento disponible que la población de escasos recursos puede afrontar en sus remotas comunidades. La importancia de la MT en esos países puede aumentar en el futuro en un contexto d creciente pobreza y marginalización, particularmente en vista a los altos precios a los que se comercializan en general los medicamentos patentados. La MT también juega un papel significativo en los países desarrollados donde la demanda de "hierbas medicinales" ha aumentado en los últimos años. Asimismo, muchos productos farmacéuticos se basan en materiales biológicos que incluyen compuestos extraídos de plantas y algas, así como proteínas humanas obtenidas de la extracción o a través de técnicas de ingeniería genética (por ejemplo, interferon, eritropoietina, hormonas de crecimiento). En particular, las plantas son una fuente importante de medicamentos.