Does patient and public involvement impact public health decision-making? A 10 year retrospective analysis of public consultation in Brazil.

BACKGROUND:  The aim of this work is to characterize the processes associated with patient and public involvement (PPI) in the form of public consultations (PC) during the first 10 years of operation of the National Committee for Health Technology Incorporation in the Unified Health System (Conitec) of Brazil, and to identify factors associated with changes in Conitec's recommendations following these PC. METHODS:  This cross-sectional study analysed all processes related to the adoption of technologies that took place in Brazil between 2012 and 2021 based on technical reports and self-reported information collected from PC participants. A multiple logistic regression model identified factors associated with changes in Conitec's recommendations following PC. RESULTS:  A total of 479 technical reports were published, of which 83% (n = 400) were submitted to PC. Demands were made mainly by applicants from the government (n = 262; 55%), regarding the adoption of medicines (n = 366; 76%), in which context neoplasms and infectious diseases were the most frequent indications (n = 66; 14% for each). A total of 264 (55%) processes resulted in a final recommendation in favour of introducing the technology. Over the period of 10 years, 196 483 contributions were received in response to PC. The largest volume of contributions was made by patients and their families or representatives (n = 99 082; 50%), females (122 895; 67%), white individuals (129 165; 71%) and individuals between the ages of 25 and 59 years (145 364; 80%). Alteration of the preliminary recommendation occurred in 13% (n = 53) of the PC, with a higher proportion of recommendations being altered from 2017 onwards. Increased participation by patients had a significant impact on the alteration of the preliminary recommendation (odds ratio 3.87, 95% CI 1.33-13.35, p = 0.02). CONCLUSIONS: Increased engagement of patients and their families and caregivers in PC was associated with changing the preliminary recommendation of Conitec about the adoption of technologies into the public health system in Brazil.

Schoolteachers with voice handicap are twice as likely to report depressive symptoms.

This study aimed to examine the association between voice disorder and depressive symptoms in schoolteachers. A cross-sectional survey was conducted with elementary and secondary schoolteachers. Voice disorders and depressive symptoms were assessed with the Voice Handicap Index-10 and the Beck Depression Inventory-II, respectively. Logistic and linear regressions models were adjusted for confounding variables. In the 389 schoolteachers studied, the prevalence of voice handicap and depressive symptoms was 18.8 and 38.8%, respectively. Voice handicap was associated with depressive symptoms on all models tested. The logistic regression showed an odds ratio of 2.21 (95% confidence interval: 1.19, 4.08; p value < 0.05), while in the linear regression each point increase on the voice disorder scale increased the Beck Depression Inventory-II score by 0.39 points (95% confidence interval: 0.26, 0.54; p value < 0.05). This study showed that teachers of public schools with voice handicap are twice as likely to report depressive symptoms.

An updated systematic review on the association between Cd exposure, blood pressure and hypertension.

BACKGROUND: Since the first report by Perry et al. (1955), most studies affirmed the hypertensive effects of cadmium (Cd) in humans. Nonetheless, conclusions between studies remain inconsistent. OBJECTIVE: The aim of this study was to reevaluate the evidence for a potential relationship between Cd exposure and altered blood pressure and/or hypertension, focusing on studies published between January 2010 and March 2020. METHODS: We reviewed all observational studies from database searches (PubMed and SCOPUS) on Cd exposure and blood pressure or hypertension. We extracted information from studies that provided sufficient data on population characteristics, smoking status, exposure, outcomes, and design. RESULTS: Thirty-eight studies met our inclusion criteria; of those, twenty-nine were cross sectional, three case control, five cohort and one interventional study. Blood or urinary Cd levels were the most commonly used biomarkers. CONCLUSIONS: A positive association between blood Cd levels and blood pressure and/or hypertension was identified in numerous studies at different settings. Limited number of representative population-based studies of never-smokers was observed, which may have confounded our conclusions. The association between urinary Cd and blood pressure and/or hypertension remains uncertain due to conflicting results, including inverse relationships with lack of strong mechanistic support. We point to the urgent need for additional longitudinal studies to confirm our findings.

Blood cadmium levels and sources of exposure in an adult urban population in southern Brazil.

BACKGROUND: Cadmium (Cd) is a toxic metal that is widely present in the environment due to geologic and anthropogenic sources. Exposures to high Cd levels may cause nephrotoxicity, carcinogenicity, pulmonary and cardiovascular disease, among others. The goal of this study was to investigate in an adult urban population whether an association exists between sources and levels of Cd exposure and blood Cd concentrations. METHODS: Using a census-based design, a total of 959 adults, aged 40 years or older, were randomly selected. Information on socio-demographics, dietary, and lifestyle background was obtained by household interviews. Blood Cd levels were measured by inductively coupled-plasma mass spectrometry. Geometric means (GM) (95% CI) and the 50th percentile were determined, stratified by sex, age, race, education, income class, smoking status, consumption of vegetables, red meat and milk, occupation and blood pressure. To assess the association between Cd exposure and the aforementioned variables, we estimated the geometric mean ratio (GMR) (95%CI) of blood Cd concentrations. RESULTS AND CONCLUSION: The geometric mean (95%CI) of blood Cd levels in the total population was 0.25 (0.22, 0.27) ug/dL. In a univariate analysis, significantly higher blood Cd levels were found in men (p < 0.001), current and former smokers (p < 0.001), alcohol drinkers (p < 0.001), those who never or almost never consumed milk (p < 0.001), and in subjects with higher diastolic blood pressure (p = 0.03). Significant correlations were found between the number of cigarettes consumed daily and blood Cd levels. Multivariate analysis confirmed higher blood Cd concentrations were associated with alcohol consumption (GMR 95%CI = 1.28, 1.04-1.59) and in former and current smokers (GMR 95% IC = 1.33, 1.06-1.67 and 4.23, 3.24-5.52, respectively). Our results shed novel information on variables associated with blood Cd levels in an urban Brazilian population, and should encourage additional research to prevent environmental Cd exposure, both in Brazil and globally.

Health technology assessment of biosimilars worldwide: a scoping review.

BACKGROUND: Health technology assessment (HTA) should provide an assessment of a technology's effects on health and of the related social, economic, organisational and ethical issues. HTA reports on biosimilars can specifically assess their immunogenicity, their extrapolation to one or more conditions, and the risks of interchangeability and substitution. We aimed to complete a scoping review within the context of HTA organisations to synthesise HTA reports on biosimilars and to map the extension, scope and methodological practices. MAIN BODY: A scoping review methodology was applied. The sources for biosimilars HTA reports were database searches and grey literature from HTA organisation websites up to June 2019. HTA reports of biosimilars were classified as full HTA, mini-HTA or rapid reviews. Data were extracted and recorded on a calibrated predefined data form. We identified 70 HTA reports of biosimilars of 16 biologic products (65.71% in 2015-2018) produced by 13 HTA organisations from 10 countries; 2 full HTAs, 4 mini-HTAs and 64 rapid reviews met the inclusion criteria. Almost all the rapid reviews gave no information regarding any evidence synthesis method and approximately half of the rapid reviews did not appraise the risk of bias of primary studies or the overall quality of evidence. All full-HTAs and mini-HTAs addressed organisational, ethical, social and legal considerations, while these factors were assessed in less than half of the rapid reviews. The immunogenicity and extrapolation of one or more conditions were often considered. The majority of full-HTAs and mini-HTAs contained an assessment of switching and a discussion of an educational approach about biosimilars. No HTA report rejected the adoption/reimbursement of the biosimilar assessed. CONCLUSION: HTA of biosimilars are emerging in the context of HTA organisations and those that exist often duplicate reports of the same biosimilar. Most HTA reports of biosimilars do not conduct a systematic literature review or consider economic issues. No report has rejected the adoption/reimbursement of biosimilars. There is a need to standardise the minimum criteria for the development of HTA on biosimilars to ensure a better understanding and better decision-making.

A systematic review and evidence-based guideline for diagnosis and treatment of Menkes disease.

Menkes disease is a rare X-linked neurodegenerative disorder caused by defect in copper metabolism. Parenteral copper supplementation has been used as a potential disease-modifying treatment of Menkes disease for decades. However, recent evidence suggests its efficacy only when treatment is started within days after birth, which also has important implications related to the techniques that enable early diagnosis. We aim at proposing a guideline for prenatal and neonatal diagnosis and for disease-modifying treatment of Menkes disease, guided by a systematic review of the literature, and built in conjunction with medical experts, methodologists and patient representatives. Thirteen articles were used for our recommendations that were based on GRADE system. Reviewed evidence suggests that prenatal genetic diagnosis in families with previous diagnosis of Menkes disease is feasible; analysis of plasma catecholamine levels is accurate for neonatal diagnosis of Menkes disease; treatment with copper-histidine is effective to increase survival and reduce neurologic burden of the disease if initiated in the neonatal period; and, treatment indication should not be guided by patient's genotype. In conclusion, our guideline can contribute to standardize some aspects of the clinical care of patients with Menkes disease, especially reducing disease burden and mortality and providers' and families' anxiety.

Association of lead, cadmium and mercury with paraoxonase 1 activity and malondialdehyde in a general population in Southern Brazil.

Metal exposure is associated with increased oxidative stress (OS), which is considered an underlying mechanism of metal-induced toxicity. Malondialdehyde (MDA) is a final product of lipid peroxidation, and it has been extensively used to evaluate metal-induced OS. Pro-oxidant effects produced by metals can be mitigated by paraoxonase 1 (PON1), an antioxidant enzyme known to prevent cardiovascular disease and atherosclerosis. Among other factors, the Q192R polymorphism and the exposure to heavy metals have been known to alter PON1 activity. Here, we evaluated the association of blood lead (Pb), cadmium (Cd) and mercury (Hg) levels with PON1 activity, and with MDA concentrations in a randomly selected sample of Brazilian adults aged 40 years or older, living in an urban area in Southern Brazil. A total of 889 subjects were evaluated for blood Pb and Cd levels, and 832 were tested for Hg. Geometric mean of blood Pb, Cd and Hg was 1.93µg/dL, 0.06µg/L and 1.40µg/L, respectively. PON1 activity was significantly different among various genotypes: QQ (PON1=121.4U/mL), QR (PON1=87.5U/mL), and RR (PON1=55.2U/mL), p<0.001. PON1 genotypes were associated only with Cd blood levels. Those with QR genotype had Cd concentrations higher (0.07µg/L) than those with the RR genotype (0.04µg/L) with p=0.034. However, PON1 activity was not significantly associated with metal concentrations. Cluster analysis showed that men who reported to be current smokers and drinkers with higher blood Pb and Cd levels, had significantly lower PON1 activity than non-smokers or -drinkers, and women with lower Pb and Cd levels. RR genotype carriers had lower PON1 activity than those with the QR genotype, and had higher levels of Pb and Cd compared with other genotype carriers. For blood Hg, no association with PON1 activity or genotype was noted. We found low levels of Pb, Cd and Hg in environmentally exposed Brazilian adults. Cd concentrations were increased in subjects with QR genotype. Those with RR genotype had lower PON1 activity and higher levels of Pb and Cd than other genotype carriers. The results of cluster analysis suggested that smoking status exerts a significant influence on PON1 activity. Other studies with environmentally exposed populations are required to further clarify whether low blood levels of metals influence OS biomarkers.

Association between blood lead and blood pressure: a population-based study in Brazilian adults.

BACKGROUND: Environmental lead exposure among adults may increase blood pressure and elevate the risk of hypertension. The availability of data on blood lead levels (BLL) in adult Brazilian population is scarce and population-based studies are important for screening the population exposure and also to evaluate associations with adverse health effects. The goal of this study was to examine the association of BLL with blood pressure and hypertension in a population-based study in a city in Southern Brazil. METHODS: A total of 948 adults, aged 40 years or older, were randomly selected. Information on socioeconomic, dietary, lifestyle and occupational background was obtained by orally administered household interviews. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured according to the guidelines VI Brazilian Guidelines on Hypertension. BLL were measured by inductively coupled plasma mass spectrometry technique. Multiple linear and logistic regression models were performed to evaluate associations of BLL with SBP and DBP, and with the chance of hypertension and of elevated SBP and DBP. RESULTS: The geometric mean of BLL was 1.97 µg/dL (95%CI:1.90-2.04 µg/dL). After multivariable adjustment, participants in the quartile 4 of blood lead presented 0.06 mm/Hg (95%CI, 0.04-0.09) average difference in DBP comparing with those in quartile 1. Participants in the 90th percentile of blood lead distribution had 0.07 mmHg (95% CI, 0.03 to 0.11) higher DBP compared with those participants in the 10th percentile of blood lead. The adjusted OR for hypertension was 2.54 (95% CI, 1.17-5.53), comparing the highest to the lowest blood lead quartiles. Compared with participants in the 10th percentile of blood lead, participants in the 90th percentile presented higher OR for hypertension (OR: 2.77; 95% CI, 1.41 to 5.46). CONCLUSION: At low concentrations, BLL were positively associated with DBP and with the odds for hypertension in adults aged 40 or older. It is important to enforce lead exposure monitoring and the enactment of regulatory laws to prevent lead contamination in urban settings.

Blood manganese levels and associated factors in a population-based study in Southern Brazil.

Manganese (Mn) is an essential dietary nutrient for human health serving as a cofactor for many enzymes; however, exposure to excessive quantities of Mn may lead to toxicity with symptoms analogous to Parkinson's disease (PD). Population-based biomonitoring is an effective tool for characterizing the body burden of environmental or occupational pollutants, including Mn. The objective of this cross-sectional study was to (1) estimate reference values (RV) for blood Mn in an adult population and (2) assess the variables that were associated with higher blood metal levels. A total of 947 adults, aged 40 years or older, were randomly selected in a city in Southern Brazil. Information on socioeconomic, dietary, lifestyle, and occupational background was collected by trained interviewers. Blood Mn levels (µg/L) were analyzed by inductively coupled plasma-mass spectrometer (ICP-MS). The RV for blood Mn concentrations were obtained from the upper limits of the 95% confidence intervals (CI) of the 95th percentile distributions. Cluster analysis was performed to identify variables associated with high or low blood Mn concentrations. The RV for blood Mn levels in this study were 18.54 and 20.15 µg/L for men and women, respectively. Mn blood concentrations decreased with age and were higher in females compared to males. No marked association was noted between blood Mn and smoking or drinking habits, education levels and socioeconomic status. Diastolic blood pressure was higher in a group of women approximately 54 years of age associated with elevated blood Mn levels. Important reference data stratified by demographic and lifestyle factors that may prove useful for future surveillance of environmental exposure to Mn and health risks associated with this metal are presented.

Lead Exposure and Oxidative Stress: A Systematic Review.

Lead is an environmental toxicant that can induce oxidative stress (OS) via reactive oxygen species (ROS) generation, which has been reported as an important mechanism underlying lead toxicity (Gurer and Ercal 2000; Pande and Flora 2002; Kasperczyk et al. 2004a; Farmand et al. 2005; Verstraeten et al. 2008; Wang et al. 2009; Martinez-Haro et al. 2011). OS occurs when the generation of ROS exceeds the antioxidant system's ability to defend cells against oxidized molecules. ROS is a term generally used to refer to free radicals derived from O2 (e.g., superoxide anions [O2-] and hydroxyl radicals [OH-]) or to non-radical species (e.g. hydrogen peroxide [H2O2]) (Halliwell and Cross 1994).

Risk factors for lead exposure in adult population in southern Brazil.

In Brazil there is no systematic evaluation to access blood lead levels (BLL) in the general population and few studies with adults have been published. The aim of this study was to examine the socioeconomic, environmental, and lifestyle determinants of BLL in the adult Brazilian population. In total, 959 adults, aged 40 years or more, were randomly selected in a city in southern Brazil. Information on socioeconomic, dietary, lifestyle, and occupational background was obtained by interviews. A spatial analysis was conducted to discern whether there were any identifiable sources of exposure. BLL were measured by inductively coupled plasma-mass spectrometry. There was an adjustment for gender, age, race, education, income class, smoking status, alcohol consumption, occupation, and red meat or cow milk consumption (Model 1), and for occupation and gender (Model 2). The geometric mean of BLL was 1.97 µg/dl (95% CI: 1.9-2.04 µg/dl). In Model 1, BLL were positively associated with male gender, older age, and drinking and smoking habits, and less frequently with milk consumption. In Model 2, data showed higher BLL in non-white than white participants, in former smokers and individuals with current or former employment in lead (Pb) industries. The participants living in the area with more Pb industries had higher BLL (3.3 µg/dl) compared with those residing in other areas with no or fewer Pb industries (1.95 µg/dl). Despite the low BLL found in adults living in an urban area, Pb industries need to be monitored and regulatory laws implemented to prevent metal contamination in urban settings.

Nanoencapsulation of Ruthenium Complex Ru(ThySMet): A Strategy to Improve Selective Cytotoxicity Against Breast Tumor Cells in 2D and 3D Culture Models.

BACKGROUND: Ruthenium complexes have shown promise in treating many cancers, including breast cancer. Previous studies of our group have demonstrated the potential of the trans-[Ru(PPh3)2(N,N-dimethylN'-thiophenylthioureato-k2O,S)(bipy)]PF6 complex, the Ru(ThySMet), in the treatment of breast tumor cancers, both in 2D and 3D culture systems. Additionally, this complex presented low toxicity when tested in vivo. AIMS: Improve the Ru(ThySMet) activity by incorporating the complex into a microemulsion (ME) and testing its in vitro effects. METHODS: The ME-incorporated Ru(ThySMet) complex, Ru(ThySMet)ME, was tested for its biological effects in two- (2D) and three-dimensional (3D) cultures using different types of breast cells, MDA-MB-231, MCF-10A, 4T1.13ch5T1 and Balb/C 3T3 fibroblasts. RESULTS: An increased selective cytotoxicity of the Ru(ThySMet)ME for tumor cells was found in 2D cell culture, compared with the original complex. This novel compound also changed the shape of tumor cells and inhibited cell migration with more specificity. Additional 3D cell culture tests using the non-neoplastic S1 and the triple-negative invasive T4-2 breast cells have shown that Ru(ThySMet)ME presented increased selective cytotoxicity for tumor cells compared with the 2D results. The morphology assay performed in 3D also revealed its ability to reduce the size of the 3D structures and increase the circularity in T4-2 cells. CONCLUSION: These results demonstrate that the Ru(ThySMet)ME is a promising strategy to increase its solubility, delivery, and bioaccumulation in target breast tumors.

Economic evaluations of colorectal cancer screening: A systematic review and quality assessment.

Colorectal Cancer (CRC) is the third most common type of cancer worldwide and ranks second in mortality. Screening programs for early detection and treatment have been implemented in several countries. Economic evaluations are an important tool to support decision-making about reimbursement and coverage decisions in health systems and, therefore, to support efficient resource allocation. The article aims to review the up-to-date evidence on economic evaluations of CRC screening strategies. MEDLINE, EMBASE, Web of Science, SCOPUS, SciELO, Lilacs, CRD databases, and lists of references were reviewed to identify relevant literature regarding full economic evaluations of CRC screening in asymptomatic average-risk individuals over 40 years old. Searches were conducted with no restriction to language, setting, or date. Qualitative syntheses described CRC screening strategies and comparators (baseline context), study designs, key parameter inputs and incremental cost-effectiveness ratios. Seventy-nine articles were included. Most of the studies were from high-income countries and a third-party payer perspective. Markov models were predominantly used, although microsimulation has been increasingly adopted in the last 15 years. The authors found 88 different screening strategies for CRC, which differed in the type of technique, the interval of screening, and the strategy, i.e., isolated or combined. The annual fecal immunochemical test was the most predominant screening strategy. All studies reported cost-effective results in their scenarios compared to no screening scenarios. One-quarter of the publications reported cost-saving results. It is still necessary to develop future economic evaluations in Low- and Middle-Income Countries (LMICs), which account for the high burden of disease.

Nutritional status in perianal Crohn's disease: are we underestimating the impact?

Symptomatic perianal disease is common in patients with Crohn's disease (CD), and perianal fistulas represent the primary form of anal involvement. This type of involvement is associated with a poor prognosis and a disabling course. The treatment is challenging and involves both surgical and medical approaches. Despite combined therapy, a significant portion of patients may still require proctectomy to control the symptoms. Consequently, investigating factors that may influence the outcome of perianal disease remains a priority area of research in CD. Nutritional deficiencies are well documented among CD patients with luminal forms of involvement and are closely related to poor clinical outcomes, therapy response, and postoperative complications. As a result, leading guidelines recommend regular nutritional assessment and correction of nutritional deficiencies in patients requiring a surgical approach. Despite these recommendations and the high rate of surgeries among CD patients with perianal disease, there is a shortage of studies addressing the real impact of nutritional status on the course and outcomes of perianal disease. This knowledge gap underscores the importance of further research to understand better and improve the management of perianal CD. This narrative review aims to provide an overview of nutritional status assessment and the influence of nutritional status on the outcomes of patients with perianal CD.

Distinct Agents Induce Streptococcus mutans Cells with Altered Biofilm Formation Capacity.

Dental caries is a multifactorial biofilm- and sugar-dependent disease. This study investigated the influence of different agents on the induction of surviving Streptococcus mutans cells after successive treatment cycles and characterized the biofilms formed by these cells recovered posttreatment. The agents (with their main targets listed in parentheses) were compound 1771 (lipoteichoic acids), 4' hydroxychalcone (exopolysaccharides), myricetin (exopolysaccharides), tt-farnesol (cytoplasmatic membrane), sodium fluoride (enolase-glycolysis), chlorhexidine (antimicrobial), and vehicle. Recovered cells from biofilms were generated from exposure to each agent during 10 cycles of consecutive treatments (modeled on a polystyrene plate bottom). The recovered cell counting was different for each agent. The recovered cells from each group were grown as biofilms on saliva-coated hydroxyapatite discs (culture medium with sucrose/starch). In S. mutans biofilms formed by cells recovered from biofilms previously exposed to compound 1771, 4' hydroxychalcone, or myricetin, cells presented higher expression of the 16S rRNA, gyrA (DNA replication and transcription), gtfB (insoluble exopolysaccharides), and eno (enolase-glycolysis) genes and lower quantities of insoluble dry weight and insoluble exopolysaccharides than those derived from other agents. These findings were confirmed by the smaller biovolume of bacteria and/or exopolysaccharides and the biofilm distribution (coverage area). Moreover, preexposure to chlorhexidine increased exopolysaccharide production. Therefore, agents with different targets induce cells with distinct biofilm formation capacities, which is critical for developing formulations for biofilm control. IMPORTANCE This article addresses the effect of distinct agents with distinct targets in the bacterial cell (cytoplasmatic membrane and glycolysis), the cell's extracellular synthesis of exopolysaccharides that are important for cariogenic extracellular matrix construction and biofilm buildup in the generation of cells that persisted after treatment, and how these cells form biofilms in vitro. For example, if preexposure to an agent augments the production of virulence determinants, such as exopolysaccharides, its clinical value may be inadequate. Modification of biofilm formation capacity after exposure to agents is critical for the development of formulations for biofilm control to prevent caries, a ubiquitous disease associated with biofilm and diet.

[Construction and evaluation of educational software on urinary indwelling catheters]. / Construção e avaliação de software educacional sobre cateterismo urinário de demora.

Since this is an era in which information is open concerning the benefits it brings, the field of nursing informatics earns its moment. The objective of this study was to design educational software for teaching and learning the technique of urinary indwelling catheterization and compare the acquisition of knowledge regarding the technique before and after the implementation of the educational software. This is a descriptive study using a quantitative approach. The pedagogical foundations for designing the software were the theories of Piaget and Vygotsky. The teaching-learning process was evaluated through a questionnaire consisting of 10 multiple choice questions which the 60 participants completed before and after using the software. The results showed the software made significant contributions after its application, thus being very useful in the teaching-learning process.

Compounds with Distinct Targets Present Diverse Antimicrobial and Antibiofilm Efficacy against Candida albicans and Streptococcus mutans, and Combinations of Compounds Potentiate Their Effect.

Candida albicans and Streptococcus mutans interact synergistically in biofilms associated with a severe form of dental caries. Their synergism is driven by dietary sucrose. Thus, it is necessary to devise strategies to hinder the development of those biofilms and prevent cavities. Six compounds [tt-farnesol (sesquiterpene alcohol that decreases the bacterium acidogenicity and aciduricity and a quorum sensing fungal molecule), myricetin (flavonoid that interferes with S. mutans exopolysaccharides production), two 2'-hydroxychalcones and 4'-hydroxychalcone (intermediate metabolites for flavonoids), compound 1771 (inhibitor of lipoteichoic synthase in Gram-positive bacteria)] with targets in both fungus and bacterium and their products were investigated for their antimicrobial and antibiofilm activities against single-species cultures. The compounds and concentrations effective on single-species biofilms were tested alone and combined with or without fluoride to control initial and pre-formed dual-species biofilms. All the selected treatments eliminated both species on initial biofilms. In contrast, some combinations eliminated the bacterium and others the fungus in pre-formed biofilms. The combinations 4'-hydroxychalcone+tt-farnesol+myricetin, 4'-hydroxychalcone+tt-farnesol+fluoride, and all compounds together with fluoride were effective against both species in pre-formed biofilms. Therefore, combinations of compounds with distinct targets can prevent C. albicans and S. mutans dual-species biofilm build-up in vitro.

Patient and public involvement in health technology decision-making processes in Brazil.

OBJECTIVE: The study aims to characterize and discuss the processes of patient and public involvement (PPI) in the Brazilian Health Regulatory Agency (Anvisa), the National Committee for Health Technology Incorporation (Conitec), and the National Agency for Supplementary Health (ANS) in Brazil. METHODS: This is an exploratory, descriptive, and comparative study, conducted by analyzing the public documents and regulation of the three institutions. RESULTS: The mechanisms for PPI included public consultations, public hearings, participation in advisory committees, and health technology evaluation requests. Anvisa conducted 187 public consultations between 1999 and 2018, gathering 10,699 contributions. In total, 76 (41%) public consultations did not present information about the contributions received. Conitec carried out 234 public consultations and received 53,174 contributions between 2011 and 2018. It was identified that 70 (23%) recommendations from Conitec did not go through public consultation, and 26 (8%) recommendations changed after public consultation. Recommendation changes seemed to have occurred especially in cases with a greater number of contributions in the public consultation process. ANS conducted eight public consultations regarding the list of health procedures and events covered by health insurances between 2000 and 2018, and it received 31,498 contributions. For three public consultations, there was no information about the number of contributions received. CONCLUSIONS: There are regulatory advances and institutional activity supporting PPI in highly technical decision-making processes in Brazil, although heterogeneously among the analyzed institutions. The power of PPI to influence health technology deliberative processes still requires in-depth studies, including the characterization of stakeholders and the legitimacy of decisions.

Vagotomy influences the lung response to adrenergic agonists and muscarinic antagonists.

Mammals airways are extensively innervated by the vagus nerve, which controls the airway diameter and bronchial tone. However, very few studies described the respiratory function and lung morphology after vagal section. In the present study, we evaluated the respiratory mechanics after aerosolization of vehicle (to obtain control values), a muscarinic agonist (methacholine), a ß2-adrenergic agonist (salbutamol) or a muscarinic antagonist (ipratropium bromide) in intact (Vi) and bilaterally vagotomized (Vx) Swiss male mice. Different group was established for morphometric analyze. The total lung resistance, airway resistance, elastance, compliance, lung tissue damping, lung tissue elastance, and morphological parameters (collagen and elastic fibers) were significantly different in the Vx group compared to the Vi group. Bronchoconstrictor and bronchodilators change the respiratory function of the Vx group. In conclusion, the vagus nerve modulates the lung function in response to bronchoconstriction and bronchodilation, as well as lung architecture of mice.