International validation of a health-related quality-of-life questionnaire for Hodgkin lymphoma: the EORTC QLQ-HL27.

Hodgkin lymphoma (HL) has become 1 of the most curable cancers. Therefore, rigorous assessment of health-related quality of life (HRQoL) and symptom burden of these patients is essential to support informed clinical decisions. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group previously developed the EORTC Quality of Life Questionnaire (QLQ) Hodgkin Lymphoma 27. This paper reports the final results of an international study by the EORTC group to develop a HRQoL disease-specific measure for these patients: the EORTC QLQ-HL27. Patients with a confirmed diagnosis of HL (N = 381) were enrolled from 12 countries and completed the EORTC QLQ-C30, QLQ-HL27, and a debriefing questionnaire at baseline (any time after diagnosis). A subset completed a retest (n = 126) or responsiveness-to-change analyses (RCA) second measurement (n = 98). Psychometrics were evaluated. Confirmatory factor analysis showed an acceptable fit of the 27 items of the QLQ-HL27 on its 4 scales (symptom burden, physical condition/fatigue, emotional impact, and worries about health/functioning). Test-retest reliability, convergent validity, known-group comparisons, and RCA find satisfactory results. Symptom burden and fatigue was higher among patients on treatment (with 36%-83% reporting at least a few problems) compared with those who had completed treatment (19%-61% reporting at least a few problems). Prevalence of worries about health and functioning (reporting at least some worry) was similar for patients on treatment (51%-81%) vs those who had completed treatment (52%-78%). Implementation of the EORTC QLQ-HL27 in research and clinical applications will increase sensitivity of HRQoL assessment in patients with HL. High quality data generated through use of this questionnaire are expected to facilitate clinical decision making in the HL setting.

The teaching of good obstetric practices from the Residency preceptors' perspective. / O ensino das boas práticas obstétricas na perspectiva dos preceptores da Residência.

The aim of this study was to understand how the topic of good obstetric practices is taught in residency programs according to the preceptors' perception. This is a descriptive, exploratory study, with data triangulation, with a qualitative approach. A total of 35 professionals participated in the study, of which 21 were physicians and 14 nurses. Data were collected from March to June 2018. The analysis was supported by NVivo software. The nuclei of meanings and categories were identified in the different stages, in pedagogical projects: the structuring aspects, competence profile and guiding policies for normal childbirth; in the interviews: theoretical-practical approach and the practices present in the training and, in participant observation: aspects related to the structure of the scenarios and the use of practices. Possibilities and limits were observed in the role of preceptors in the training process, constituting an area that requires continuous attention, aimed at the strengthening of the pedagogical processes in order to expand the disruptive potential of new health professionals.

Este trabalho teve como objetivo compreender como o tema das boas práticas obstétricas é ensinado nos programas de residência na percepção dos preceptores. Trata-se de um estudo descritivo, exploratório, com triangulação de dados, de abordagem qualitativa. Participaram da pesquisa 35 profissionais, sendo 21 médicos e 14 enfermeiros. Os dados foram coletados entre março e junho de 2018. A análise teve o suporte do Software NVivo. Os núcleos de sentidos e as categorias foram identificados nas diversas etapas: nos projetos pedagógicos - os aspectos estruturantes, perfil de competências e políticas norteadoras do parto normal; nas entrevistas - abordagem teórico-prática e as práticas presentes na formação; e na observação participante - aspectos relacionados à estrutura dos cenários e à utilização das práticas. Foram observados possibilidades e limites na atuação dos preceptores no processo de formação, configurando-se em uma área que requer atenção contínua e direcionada ao fortalecimento dos processos pedagógicos, de forma a ampliar o potencial disruptivo dos novos profissionais de saúde.

O ensino das boas práticas obstétricas na perspectiva dos preceptores da Residência / The teaching of good obstetric practices from the Residency preceptors' perspective

Resumo Este trabalho teve como objetivo compreender como o tema das boas práticas obstétricas é ensinado nos programas de residência na percepção dos preceptores. Trata-se de um estudo descritivo, exploratório, com triangulação de dados, de abordagem qualitativa. Participaram da pesquisa 35 profissionais, sendo 21 médicos e 14 enfermeiros. Os dados foram coletados entre março e junho de 2018. A análise teve o suporte do Software NVivo. Os núcleos de sentidos e as categorias foram identificados nas diversas etapas: nos projetos pedagógicos - os aspectos estruturantes, perfil de competências e políticas norteadoras do parto normal; nas entrevistas - abordagem teórico-prática e as práticas presentes na formação; e na observação participante - aspectos relacionados à estrutura dos cenários e à utilização das práticas. Foram observados possibilidades e limites na atuação dos preceptores no processo de formação, configurando-se em uma área que requer atenção contínua e direcionada ao fortalecimento dos processos pedagógicos, de forma a ampliar o potencial disruptivo dos novos profissionais de saúde.

Abstract The aim of this study was to understand how the topic of good obstetric practices is taught in residency programs according to the preceptors' perception. This is a descriptive, exploratory study, with data triangulation, with a qualitative approach. A total of 35 professionals participated in the study, of which 21 were physicians and 14 nurses. Data were collected from March to June 2018. The analysis was supported by NVivo software. The nuclei of meanings and categories were identified in the different stages, in pedagogical projects: the structuring aspects, competence profile and guiding policies for normal childbirth; in the interviews: theoretical-practical approach and the practices present in the training and, in participant observation: aspects related to the structure of the scenarios and the use of practices. Possibilities and limits were observed in the role of preceptors in the training process, constituting an area that requires continuous attention, aimed at the strengthening of the pedagogical processes in order to expand the disruptive potential of new health professionals.

Boas práticas para mudança do modelo obstétrico: o que pensam os preceptores da residência? / Good practices for changing the obstetric model: what do the preceptors of the residence think? / Buenas prácticas para cambiar el modelo obstétrico: ¿qué piensan los preceptores de la residencia?

Objetivo: Analisar, a partir do ponto de vista dos preceptores, como o processo de formação na modalidade residência aborda as boas práticas recomendadas pelas diretrizes nacionais e internacionais de assistência ao parto normal. Método: Estudo qualitativo, exploratório-descritivo realizado com trinta e cinco preceptores, sendo 14 enfermeiros e 21 médicos que atuam nos serviços de obstetrícia da Secretaria de Estado de Saúde do Distrito Federal. Os dados foram coletados entre março a junho de 2018 por meio de entrevistas e analisadas de acordo com a Análise de Conteúdo de Bardin com o suporte dos Software NVivo®. Resultados: Foram codificadas cinco temáticas: abordagem das boas práticas de atenção ao parto normal; práticas desnecessárias que permanecem; normas e rotinas na assistência ao parto normal; processos de trabalho no cenário da residência e, busca e atualização das evidências para o ensino das boas práticas clínicas. Conclusão: O estudo evidenciou a necessidade de reorganização do cenário de ensino dos programas de residência com ações contínuas e direcionadas ao fortalecimento dos processos pedagógicos de forma a ampliar o potencial disruptivo dos novos profissionais de saúde. (AU)

Objective: To analyze, from the point of view of the preceptors, how the training process in the residency modality addresses the good practices recommended by the national and international guidelines for assistance in normal childbirth. Methods: Qualitative, exploratory descriptive study carried out with thirty-five preceptors, 14 nurses and 21 doctors who work in the obstetrics services of the State Department of Health of the Federal District. Data were collected between March and June 2018 through interviews and analyzed according to Bardin's Content Analysis with the support of NVivo® Software. Results: Five thematic categories were identified: addressing good practices in care for normal childbirth; unnecessary practices that remain; norms and routines in the assistance to normal childbirth; work processes in the residency setting, and search and update the evidence for teaching good clinical practices. Conclusion: The study showed the need to reorganize the teaching scenario for residency programs with continuous actions aimed at strengthening the pedagogical processes in order to expand the disruptive potential of new health professionals. (AU)

Objetivo: Analizar, desde el punto de vista de los preceptores, cómo el proceso de capacitación en la modalidad de residencia aborda las buenas prácticas recomendadas por las directrices nacionales e internacionales para la asistencia en el parto normal. Métodos: Estudio cualitativo exploratorio descriptivo realizado con treinta y cinco preceptores, 14 enfermeras y 21 médicos que trabajan en los servicios de obstetricia del Departamento de Salud del Estado del Distrito Federal. Los datos se recopilaron entre marzo y junio de 2018 a través de entrevistas y se analizaron de acuerdo con el Análisis de contenido de Bardin con el soporte del software NVivo®. Resultados: Se identificaron cinco categorías temáticas: abordar las buenas prácticas en la atención del parto normal; prácticas innecesarias que quedan; normas y rutinas en la asistencia al parto normal; procesos de trabajo en el entorno de residencia, y buscar y actualizar la evidencia para enseñar buenas prácticas clínicas. Conclusión: El estudio mostró la necesidad de reorganizar el escenario de enseñanza para los programas de residencia con acciones continuas dirigidas a fortalecer los procesos pedagógicos para expandir el potencial disruptivo de los nuevos profesionales de la salud. (AU)

The quality of health governance in Portugal: an evaluation of the Troika's intervention period. / Qualidade da governança da saúde em Portugal: uma avaliação ao período de intervenção da Troika.

This study aims to evaluate the quality of the Portuguese Government's action in the health sector during Troika's intervention period (2011-2015), taking as criterion the concern with the application of Good Governance principles, in terms of degree and diversity. The intention is to understand the extent to which the public action promoted by the Ministry of Health has developed seeking to contribute to the strengthening of Good Governance practices. Fifty measures of the Ministry of Health, distributed by nine intervention areas, were analyzed, based on documental analysis, supported on the law and on other official documents. The principles of Good Governance that demonstrate a more transversal concern are clearly that of "transparency" and of "effectiveness/efficiency", present in eight of the nine intervention areas. The concern with "orientation to consensus" is essentially present in the measures classified as Agreements, "independence" in the Ethics area, the "strengthening of the rule of Law" in the Control area and "equity/inclusion" in the area of the Citizen in the Centre of the NHS.

Este estudo tem como objetivo avaliar a qualidade da ação do Governo Português no sector da saúde, no período de intervenção da Troika (2011-2015), tomando como critério a preocupação com a aplicação dos princípios de Boa Governança, em termos de grau e diversidade. Pretende-se perceber em que medida a ação pública promovida pelo Ministério da Saúde se desenvolveu procurando contribuir para o fortalecimento das práticas de Boa Governança. Com base em análise documental, suportada nos diplomas legais e em outros documentos oficiais, foram analisadas 50 medidas de ação do Ministério da Saúde, que se distribuem por nove áreas de intervenção. Os princípios de Boa Governança que representam uma preocupação mais transversal são claramente o da "transparência" e o da "eficácia/eficiência", presentes em oito das nove áreas de intervenção. A preocupação com a "orientação para consensos" está essencialmente presente nas medidas tipificadas como Acordos, a "independência" na área Ética, o "reforço do Estado de direito" na área Controlo e a "equidade/inclusão" na área Cidadão no Centro do SNS.

Qualidade da governança da saúde em Portugal: uma avaliação ao período de intervenção da Troika / The quality of health governance in Portugal: an evaluation of the Troika's intervention period

Resumo Este estudo tem como objetivo avaliar a qualidade da ação do Governo Português no sector da saúde, no período de intervenção da Troika (2011-2015), tomando como critério a preocupação com a aplicação dos princípios de Boa Governança, em termos de grau e diversidade. Pretende-se perceber em que medida a ação pública promovida pelo Ministério da Saúde se desenvolveu procurando contribuir para o fortalecimento das práticas de Boa Governança. Com base em análise documental, suportada nos diplomas legais e em outros documentos oficiais, foram analisadas 50 medidas de ação do Ministério da Saúde, que se distribuem por nove áreas de intervenção. Os princípios de Boa Governança que representam uma preocupação mais transversal são claramente o da "transparência" e o da "eficácia/eficiência", presentes em oito das nove áreas de intervenção. A preocupação com a "orientação para consensos" está essencialmente presente nas medidas tipificadas como Acordos, a "independência" na área Ética, o "reforço do Estado de direito" na área Controlo e a "equidade/inclusão" na área Cidadão no Centro do SNS.

Abstract This study aims to evaluate the quality of the Portuguese Government's action in the health sector during Troika's intervention period (2011-2015), taking as criterion the concern with the application of Good Governance principles, in terms of degree and diversity. The intention is to understand the extent to which the public action promoted by the Ministry of Health has developed seeking to contribute to the strengthening of Good Governance practices. Fifty measures of the Ministry of Health, distributed by nine intervention areas, were analyzed, based on documental analysis, supported on the law and on other official documents. The principles of Good Governance that demonstrate a more transversal concern are clearly that of "transparency" and of "effectiveness/efficiency", present in eight of the nine intervention areas. The concern with "orientation to consensus" is essentially present in the measures classified as Agreements, "independence" in the Ethics area, the "strengthening of the rule of Law" in the Control area and "equity/inclusion" in the area of the Citizen in the Centre of the NHS.

Community intervention for child tuberculosis active contact investigation and management: study protocol for a parallel cluster randomized controlled trial.

BACKGROUND: There are major gaps in the management of pediatric tuberculosis (TB) contact investigation for rapid identification of active tuberculosis and initiation of preventive therapy. This study aims to evaluate the impact of a community-based intervention as compared to facility-based model for the management of children in contact with bacteriologically confirmed pulmonary TB adults in low-resource high-burden settings. METHODS/DESIGN: This multicenter parallel open-label cluster randomized controlled trial is composed of three phases: I, baseline phase in which retrospective data are collected, quality of data recording in facility registers is checked, and expected acceptability and feasibility of the intervention is assessed; II, intervention phase with enrolment of index cases and contact cases in either facility- or community-based models; and III, explanatory phase including endpoint data analysis, cost-effectiveness analysis, and post-intervention acceptability assessment by healthcare providers and beneficiaries. The study uses both quantitative and qualitative analysis methods. The community-based intervention includes identification and screening of all household contacts, referral of contacts with TB-suggestive symptoms to the facility for investigation, and household initiation of preventive therapy with follow-up of eligible child contacts by community healthcare workers, i.e., all young (< 5 years) child contacts or older (5-14 years) child contacts living with HIV, and with no evidence of TB disease. Twenty clusters representing TB diagnostic and treatment facilities with their catchment areas are randomized in a 1:1 ratio to either the community-based intervention arm or the facility-based standard of care arm in Cameroon and Uganda. Randomization was stratified by country and constrained on the number of index cases per cluster. The primary endpoint is the proportion of eligible child contacts who initiate and complete the preventive therapy. The sample size is of 1500 child contacts to identify a 10% difference between the arms with the assumption that 60% of children will complete the preventive therapy in the standard of care arm. DISCUSSION: This study will provide evidence of the impact of a community-based intervention on household child contact screening and management of TB preventive therapy in order to improve care and prevention of childhood TB in low-resource high-burden settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT03832023 . Registered on 6 February 2019.

A utilização da acupuntura no controlo da dor crónica em usuários com síndrome vertebral com irradiação / The use of acupuncture to control chronic pain in users with irradiated vertebral syndrome

Objetivos: a acupuntura é, cada vez mais, uma técnica utilizada, em usuários portadores de várias patologias, e, em especial, aquelas que são acompanhadas de dor crónica. Esta pesquisa teve como objetivo geral analisar o efeito da terapêutica não farmacológica de acupuntura e eletroacupuntura para o controle da dor crónica, em usuários com diagnóstico médico de síndrome vertebral com irradiação. Métodos: foi realizada uma pesquisa com dois momentos de avaliação ­ antes e após sessões de terapêutica não farmacológica de acupuntura e eletroacupuntura. Utilizou-se um questionário com variáveis de caracterização sociodemográfica e clínica, o Brief Pain Inventory (BPI)e Short Form 6 Dimensions (SF-6D). Resultados: participaram no estudo 43 usuários, tendo sido encontradas diferenças estaticamente significativas, do momento 1 para o momento 2 de avaliação, quer no domínio da severidade da dor (p<0,01), quer no domínio interferência da dor no funcionamento diário (p<0,01), assim como nas diferentes dimensões do SF-6D foram encontradas diferenças estatisticamente significativas. Conclusões: salienta-se que a terapêutica não farmacológica de acupuntura e eletroacupuntura em usuários com diagnóstico de síndrome vertebral com irradiação e dor crónica contribuiu para a diminuição da severidade da dor, da interferência da dor no funcionamento diário e melhoria da qualidade de vida relacionada com a saúde.

Aims: acupuncture is increasingly a technique used in users with various pathologies, and especially those who are accompanied by chronic pain. This research aimed to analyze the effect of non-pharmacological acupuncture and electroacupuncture therapy for the control of chronic pain in users with medical diagnosis of irradiation vertebral syndrome. Methods: a research was conducted with two evaluation moments: before and after non-pharmacological acupuncture and electroacupuncture therapy sessions. A questionnaire with variables of sociodemographic and clinical characterization, the Brief Pain Inventory and Short Form 6 Dimensions (SF-6D) was used. Results: forty-three users participated in the study, and statistically significant differences were found from moment 1 to moment 2 of evaluation, either in the pain severity domain (p<0.01) or in the pain interference domain in daily functioning (p <0.01), as well as in the different dimensions of SF-6D, statistically significant differences were found. Conclusions: non-pharmacological acupuncture and electroacupuncture therapy in users diagnosed with irradiation and chronic pain have contributed to decrease pain severity, pain interference in daily functioning and improvement of health-related quality of life.

Assessment of adherence to best practices in labor and childbirth care by care providers working in public hospitals in the Federal District of Brazil. / Avaliação das boas práticas de atenção ao parto por profissionais dos hospitais públicos do Distrito Federal, Brasil.

OBJECTIVE: To assess adherence to best practices in labor and childbirth care by doctors, nurses, obstetric nursing residents, and obstetric medical residents working in public hospitals in the Federal District of Brazil. METHOD: A cross-sectional study was conducted with care providers working in 11 public hospitals in the Federal District of Brazil between January and March 2015. A questionnaire containing 20 sociodemographic questions and 50 five-point Likert items was administered. The average scores of each group and each hospital were analyzed. RESULTS: Nurses obtained the highest scores for the use of evidence-based practices (57.8 ± 12.9), while doctors achieved the highest scores for the work process dimension (72 ± 8.5). Medical residents obtained the highest scores for organization of labor and childbirth care (56.5 ± 8.5). No statistically significant differences were found between groups. Hospital scores ranged from 55 to 64. No statistically significant differences were found between hospitals. Most professionals encourage natural childbirth. CONCLUSION: It is necessary to strengthen actions to promote greater adherence to best care practices, both in relation to organization of labor and childbirth care and to the attitudes and values of health professionals.

O objetivo deste artigo é avaliar a adesão às boas práticas de atenção ao parto e nascimento, entre médicos, enfermeiros e residentes dos programas de residência em obstetrícia, dos hospitais públicos do Distrito Federal (DF). Estudo transversal do tipo inquérito aplicado a profissionais em 11 hospitais públicos do DF de janeiro a março de 2015. Instrumento com 20 questões sociodemográficas e 39 itens do tipo escala Likert. Para análise estatística, os profissionais foram separados em 4 grupos (enfermeiros, enfermeiro residentes, médicos e médicos residentes). Foram também avaliados os escores de cada hospital estudado. A dimensão processo de trabalho apresentou os maiores escores em relação as demais dimensões. Na comparação entre os grupos e entre os hospitais não foram observadas diferenças significativas em nenhuma das dimensões. A maioria dos profissionais estimula o parto natural. É necessário reforçar as ações para maior adesão às boas práticas de atenção ao parto, tanto na organização da rede de serviços quanto nas atitudes e valores da formação dos novos profissionais de saúde.

Avaliação das boas práticas de atenção ao parto por profissionais dos hospitais públicos do Distrito Federal, Brasil / Assessment of adherence to best practices in labor and childbirth care by care providers working in public hospitals in the Federal District of Brazil

Resumo O objetivo deste artigo é avaliar a adesão às boas práticas de atenção ao parto e nascimento, entre médicos, enfermeiros e residentes dos programas de residência em obstetrícia, dos hospitais públicos do Distrito Federal (DF). Estudo transversal do tipo inquérito aplicado a profissionais em 11 hospitais públicos do DF de janeiro a março de 2015. Instrumento com 20 questões sociodemográficas e 39 itens do tipo escala Likert. Para análise estatística, os profissionais foram separados em 4 grupos (enfermeiros, enfermeiro residentes, médicos e médicos residentes). Foram também avaliados os escores de cada hospital estudado. A dimensão processo de trabalho apresentou os maiores escores em relação as demais dimensões. Na comparação entre os grupos e entre os hospitais não foram observadas diferenças significativas em nenhuma das dimensões. A maioria dos profissionais estimula o parto natural. É necessário reforçar as ações para maior adesão às boas práticas de atenção ao parto, tanto na organização da rede de serviços quanto nas atitudes e valores da formação dos novos profissionais de saúde.

Abstract Objective To assess adherence to best practices in labor and childbirth care by doctors, nurses, obstetric nursing residents, and obstetric medical residents working in public hospitals in the Federal District of Brazil. Method A cross-sectional study was conducted with care providers working in 11 public hospitals in the Federal District of Brazil between January and March 2015. A questionnaire containing 20 sociodemographic questions and 50 five-point Likert items was administered. The average scores of each group and each hospital were analyzed. Results Nurses obtained the highest scores for the use of evidence-based practices (57.8 ± 12.9), while doctors achieved the highest scores for the work process dimension (72 ± 8.5). Medical residents obtained the highest scores for organization of labor and childbirth care (56.5 ± 8.5). No statistically significant differences were found between groups. Hospital scores ranged from 55 to 64. No statistically significant differences were found between hospitals. Most professionals encourage natural childbirth. Conclusion It is necessary to strengthen actions to promote greater adherence to best care practices, both in relation to organization of labor and childbirth care and to the attitudes and values of health professionals.

Metabolite profiling characterises chemotypes of Musa diploids and triploids at juvenile and pre-flowering growth stages.

Bananas (Musa spp.) are consumed worldwide as dessert and cooking types. Edible banana varieties are for the most part seedless and sterile and therefore vegetatively propagated. This confers difficulties for breeding approaches against pressing biotic and abiotic threats and for the nutritional enhancement of banana pulp. A panel of banana accessions, representative of the diversity of wild and cultivated bananas, was analysed to assess the range of chemotypes available globally. The focus of this assessment was banana leaves at two growth stages (juvenile and pre-flowering), to see when during the plant growth metabolic differences can be established. The metabolic data corresponded to genomic trends reported in previous studies and demonstrated a link between metabolites/pathways and the genomes of M. acuminata and M. balbisiana. Furthermore, the vigour and resistance traits of M. balbisiana was connected to the phenolic composition and showed differences with the number of B genes in the hybrid accessions. Differences in the juvenile and pre-flowering data led to low correlation between the growth stages for prediction purposes.

Capturing Biochemical Diversity in Cassava ( Manihot esculenta Crantz) through the Application of Metabolite Profiling.

Cassava ( Manihot esculenta Crantz) is the predominant staple food in Sub-Saharan Africa (SSA) and an industrial crop in South East Asia. Despite focused breeding efforts for increased yield, resistance, and nutritional value, cassava breeding has not advanced at the same rapidity as other staple crops. In the present study, metabolomic techniques were implemented to characterize the chemotypes of selected cassava accessions and assess potential resources for the breeding program. The metabolite data analyzed was applied to describe the biochemical diversity available in the panel, identifying South American accessions as the most diverse. Genotypes with distinct phenotypic traits showed a representative metabolite profile and could be clearly identified, even if the phenotypic trait was a root characteristic, e.g., high amylose content.

Adesão às boas práticas de atenção ao parto e nascimento e análise da confiabilidade de um instrumento pelo alfa de Cronbach / Adherence to good practices of attention to childbirth and birth care and reliability analysis of an instrument by Cronbach's alpha

Conclusões: Há baixa implantação de atributos preconizados pela política nacional de atenção a gestão, parto e nascimento no conjunto das maternidades públicas estudadas, embora com aspectos positivos em parte delas. Os profissionais seguem realizando práticas cujas evidências científicas as condenam, como as manobras de Kristeller e de Valsalva, a hidratação venosa durante o parto, o uso de ocitocina de rotina e a episiotomia. Os resultados apontaram para a necessidade de intervenção efetiva no processo de formação dos profissionais, na organização da rede e na modificação dos processos de trabalho, o que favorecerá o cuidado integral das mulheres durante o parto e nascimento. Quanto ao instrumento, após a exclusão de cinco itens, o instrumento como um todo obteve coeficiente de 0,798, considerado consistente internamente

Good practices in normal childbirth: reliability analysis of an instrument by Cronbach's Alpha.

OBJECTIVES: to analyze the internal consistency of the evaluation instrument of the adherence to the good practices of childbirth and birth care in the professionals, through Cronbach's Alpha Coefficient for each of the dimensions and for the total instrument. METHOD: this is a descriptive and cross-sectional study performed in obstetric centers of eleven public hospitals in the Federal District, with a questionnaire applied to 261 professionals who worked in the delivery care. RESULTS: The study was attended by 261 professionals, 42.5% (111) nurses and 57.5% (150) physicians. The reliability evaluation of the instrument by the Cronbach Alfa resulted in 0.53, 0.78 and 0.76 for dimensions 1, 2 and 3, after debugging that resulted in the exclusion of 11 items. CONCLUSIONS: the instrument obtained Cronbach's alpha of 0.80. There is a need for improvement in the items of dimension 1 that refer to attitudes, knowledge, and practices of the organization of the network of care to gestation, childbirth, and birth. However, it can be applied in the way it is used to evaluate practices based on scientific evidence of childbirth care.

Phytochemical analysis of salal berry (Gaultheria shallon Pursh.), a traditionally-consumed fruit from western North America with exceptionally high proanthocyanidin content.

Salal (Gaultheria shallon Pursh.) is a wild perennial shrub of the Ericaceae and common in coastal forests of western North America, and its berries were an important traditional food for First Nations in British Columbia. Salal berries were investigated for phytochemical content and antioxidant capacity over the course of fruit development. The proanthocyanidin content was extremely high in young berries (280.7 mg/g dry wt) but dropped during development to 52.8 mg/g dry wt. By contrast, anthocyanins accumulated only at the late berry stages. Total antioxidant capacity, as measured by the 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid (ABTS) method, reflected both proanthocyanidin and anthocyanin content, and in mature berries reached 36 mmol Trolox equivalents/100 g dry wt. More detailed phytochemical analysis determined that delphinidin 3-O-galactoside is the dominant anthocyanin, and that the berries are also rich in procyanidins, including procyanidin A2 which has been implicated in anti-adhesion activity for uropathogenic E. coli. Proanthocyanidins were 60% prodelphinidin, and overall concentrations were higher than reported for many Vaccinium species including blueberry, lingonberry, and cranberry. Overall, the phenolic profile of salal berries indicates that these fruit contain a diversity of health-promoting phenolics.

Good practices in normal childbirth: reliability analysis of an instrument by Cronbach's Alpha / Boas práticas no parto normal: análise da confiabilidade de um instrumento pelo Alfa de Cronbach / Buenas prácticas en el parto normal: análisis de la confiabilidad de un instrumento por el Alfa de Cronbach

ABSTRACT Objectives: to analyze the internal consistency of the evaluation instrument of the adherence to the good practices of childbirth and birth care in the professionals, through Cronbach's Alpha Coefficient for each of the dimensions and for the total instrument. Method: this is a descriptive and cross-sectional study performed in obstetric centers of eleven public hospitals in the Federal District, with a questionnaire applied to 261 professionals who worked in the delivery care. Results: The study was attended by 261 professionals, 42.5% (111) nurses and 57.5% (150) physicians. The reliability evaluation of the instrument by the Cronbach Alfa resulted in 0.53, 0.78 and 0.76 for dimensions 1, 2 and 3, after debugging that resulted in the exclusion of 11 items. Conclusions: the instrument obtained Cronbach's alpha of 0.80. There is a need for improvement in the items of dimension 1 that refer to attitudes, knowledge, and practices of the organization of the network of care to gestation, childbirth, and birth. However, it can be applied in the way it is used to evaluate practices based on scientific evidence of childbirth care.

RESUMO Objetivo: analisar a consistência interna do instrumento de avaliação da adesão dos profissionais às boas práticas de atenção ao parto e nascimento por meio do Coeficiente Alfa de Cronbach para cada uma das dimensões e para o instrumento total. Método: estudo descritivo e transversal, realizado em centros obstétricos de onze hospitais públicos do Distrito Federal, com aplicação de questionário a 261 profissionais que atuavam na atenção ao parto. Resultados: participaram do estudo 261 profissionais, sendo 42,5% (111) enfermeiros e 57,5% (150) médicos. A avaliação da confiabilidade do instrumento pelo Alfa de Conbrach resultou em 0,53, 0,78 e 0,76 para as dimensões 1, 2 e 3, após depurações que resultarama na exclusão de 11 itens. Conclusões: o instrumento obteve Alfa de Cronbach de 0,80. Há necessidade de aperfeiçoamento nos itens da dimensão 1 que se referem a atitudes, conhecimentos e práticas de organização da rede de atenção à gestação, parto e nascimento. Todavia, pode ser aplicado na forma como está para avaliação das práticas baseadas em evidências científicas de atenção ao parto.

RESUMEN Objetivos: analizar la consistencia interna del instrumento de evaluación de la adhesión de los profesionales a las buenas prácticas de atención al parto y nacimiento, por medio del Coeficiente Alfa de Cronbach para cada una de las dimensiones y para el instrumento total. Método: estudio descriptivo y transversal, realizado en centros obstétricos de once hospitales públicos del Distrito Federal, con aplicación de cuestionario a 261 profesionales que actuaban en la atención al parto. Resultados: Participaron del estudio 261 profesionales, siendo 42,5% (111) enfermeros y 57,5% (150) médicos. La evaluación de la confiabilidad del instrumento por el Alfa de Conbach resultó en 0,53, 0,78 y 0,76 para las dimensiones 1, 2 y 3, después de depuraciones que resultaron en la exclusión de 11 ítems. Conclusiones: el instrumento obtuvo Alfa de Cronbach de 0,80. Hay necesidad de perfeccioamiento en los ítems de la dimensión 1 que se refieren a actitudes, conocimientos y prácticas de organización de la red de atención a la gestación, parto y nacimiento. Todavía puede ser aplicado en la forma como está para evaluación de las prácticas basadas en evidencias científicas de atención al parto.

The R2R3MYB VvMYBPA1 from grape reprograms the phenylpropanoid pathway in tobacco flowers.

MAIN CONCLUSION: This work shows that, in tobacco, the ectopic expression of VvMYBPA1 , a grape regulator of proanthocyanidin biosynthesis, up- or down-regulates different branches of the phenylproanoid pathway, in a structure-specific fashion. Proanthocyanidins are flavonoids of paramount importance for animal and human diet. Research interest increasingly tilts towards generating crops enriched with these health-promoting compounds. Flavonoids synthesis is regulated by the MBW transcriptional complex, made of R2R3MYB, bHLH and WD40 proteins, with the MYB components liable for channeling the complex towards specific branches of the pathway. Hence, using tobacco as a model, here, we tested if the ectopic expression of the proanthocyanidin regulator VvMYBPA1 from grape induces the biosynthesis of these compounds in not-naturally committed cells. Here, we show, via targeted transcriptomic and metabolic analyses of primary transgenic lines and their progeny, that VvMYBPA1 alters the phenylpropanoid pathway in tobacco floral organs, in a structure-specific fashion. We also report that a modest VvMYBPA1 expression is sufficient to induce the expression of both proanthocyanidin-specific and early genes of the phenylpropanoid pathway. Consequently, proanthocyanidins and chlorogenic acids are induced or de novo synthetised in floral limbs, tubes and stamens. Other phenylpropanoid branches are conversely induced or depleted according to the floral structure. Our study documents a novel and distinct function of VvMYBPA1 with respect to other MYBs regulating proanthocyanidins. Present findings may have major implications in designing strategies for enriching crops with health-promoting compounds.

Discovery of A-type procyanidin dimers in yellow raspberries by untargeted metabolomics and correlation based data analysis.

INTRODUCTION: Raspberries are becoming increasingly popular due to their reported health beneficial properties. Despite the presence of only trace amounts of anthocyanins, yellow varieties seems to show similar or better effects in comparison to conventional raspberries. OBJECTIVES: The aim of this work is to characterize the metabolic differences between red and yellow berries, focussing on the compounds showing a higher concentration in yellow varieties. METHODS: The metabolomic profile of 13 red and 12 yellow raspberries (of different varieties, locations and collection dates) was determined by UPLC-TOF-MS. A novel approach based on Pearson correlation on the extracted ion chromatograms was implemented to extract the pseudospectra of the most relevant biomarkers from high energy LC-MS runs. The raw data will be made publicly available on MetaboLights (MTBLS333). RESULTS: Among the metabolites showing higher concentration in yellow raspberries it was possible to identify a series of compounds showing a pseudospectrum similar to that of A-type procyanidin polymers. The annotation of this group of compounds was confirmed by specific MS/MS experiments and performing standard injections. CONCLUSIONS: In berries lacking anthocyanins the polyphenol metabolism might be shifted to the formation of a novel class of A-type procyanidin polymers.

Carotenoid metabolism during bilberry (Vaccinium myrtillus L.) fruit development under different light conditions is regulated by biosynthesis and degradation.

BACKGROUND: Carotenoids are important pigments and precursors for central signaling molecules associated in fruit development and ripening. Carotenoid metabolism has been studied especially in the climacteric tomato fruit but the content of carotenoids and the regulation of their metabolism have been shown to be highly variable between fruit species. Non-climacteric berries of the genus Vaccinium are among the best natural sources of health-beneficial flavonoids but not studied previously for carotenoid biosynthesis. RESULTS: In this study, carotenoid biosynthetic genes, PSY, PDS, ZDS, CRTISO, LCYB, LCYE, BCH and CYP450-BCH, as well as a carotenoid cleavage dioxygenase CCD1 were identified from bilberry (V. myrtillus L.) fruit and their expression was studied along with carotenoid composition during fruit development under different photoperiod and light quality conditions. Bilberry was found to be a good source of carotenoids among fruits and berries. The most abundant carotenoids throughout the berry development were lutein and ß-carotene, which were accompanied by lower amounts of 9Z-ß-carotene, violaxanthin, neoxanthin, zeaxanthin, antheraxanthin and ß-cryptoxanthin. The expression patterns of the biosynthetic genes in ripening fruits indicated a metabolic flux towards ß-branch of the carotenoid pathway. However, the carotenoid levels decreased in both the ß-branch and ε,ß-branch towards bilberry fruit ripening along with increased VmCCD1 expression, similarly to VmNCED1, indicating enzymatic carotenoid cleavage and degradation. Intense white light conditions increased the expression of the carotenoid biosynthetic genes but also the expression of the cleavage genes VmCCD1 and VmNCED1, especially in unripe fruits. Instead, mature bilberry fruits responded specifically to red/far-red light wavelengths by inducing the expression of both the carotenoid biosynthetic and the cleavage genes indicating tissue and developmental stage specific regulation of apocarotenoid formation by light quality. CONCLUSIONS: This is the first report of carotenoid biosynthesis in Vaccinium berries. Our results indicate that both transcriptional regulation of the key biosynthetic genes and the enzymatic degradation of the produced carotenoids to apocarotenoids have significant roles in the determination of the carotenoid content and have overall effect on the metabolism during the bilberry fruit ripening.

Sexual Dysfunction in Breast Cancer Survivors: Cross-Cultural Adaptation of the Sexual Activity Questionnaire for Use in Portugal.

INTRODUCTION: The increasing survivor population of breast cancer has shifted research and practice interests into the impacts of the disease and treatment in quality of life aspects. The lack of tools available in Portuguese to objectively evaluate sexual function led to the development of this study, which aimed to cross-culturally adapt and validate the Sexual Activity Questionnaire for use in Portugal. MATERIAL AND METHODS: The questionnaire was translated and back-translated, refined following face-to-face interviews with seven breast cancer survivors, and then self-administered by a larger sample at baseline and a fortnight later to test validity and reliability. RESULTS: Following cognitive debriefing (n = 7), minor changes were made and the Sexual Activity Questionnaire was then tested with 134 breast cancer survivors. A 3-factor structure explained 75.5% of the variance, comprising the Pleasure, Habit and Discomfort scales, all yielding good internal consistency (Cronbach's α > 0.70). Concurrent validity with the FACt-An and the BCPT checklist was good (Spearman's r > 0.65; p-value < 0.001) and reliability acceptable (Cohen's k > 0.444). The Sexual Activity Questionnaire allowed the identification of 23.9% of sexually inactive women, for whom the main reasons were lack of interest or motivation and not having a partner. DISCUSSION: Patient-reported outcomes led to a more comprehensive and improved approach to cancer, tackling areas previously abandoned. Future research should focus on the validation of this scale in samples with different characteristics and even in the overall population to enable generalizability of the findings. CONCLUSION: The adapted Sexual Activity Questionnaire is a valid tool for assessing sexual function in breast cancer survivors in Portugal.

Introdução: A crescente população de sobreviventes de cancro da mama tem redireccionado o interesse investigacional e prático para o impacto da doença e do seu tratamento nas várias áreas da qualidade de vida. A falta de questionários para avaliar de forma objectiva a disfunção sexual conduziu à necessidade de adaptar e validar culturalmente o Sexual Activity Questionnaire para utilização em Portugal. Material e Métodos: O Sexual Activity Questionnaire foi traduzido e retrovertido, sua versão de consenso refinada após teste de compreensão, e subsequentemente auto-administrado a uma amostra alargada de sobreviventes de cancro da mama em dois momentos, espaçados 15 dias, para julgar a sua validade e fiabilidade. Resultados: Após alterações minor à versão de consenso, o Sexual Activity Questionnaire foi aplicado a 134 doentes. Obteve-se uma estrutura de três factores (75,5% da variância), compreendendo as escalas do Prazer, Hábito e Desconforto, todas com boa consistência interna (α de Cronbach > 0,70), boa validade concorrente com o FACt-An e a checklist BCPT (r de Spearman > 0,65; p-value < 0,001) e estabilidade temporal aceitável (k de Cohen > 0,44). Foi identificada inactividade sexual em 23,9% das mulheres, devido a falta de interesse ou ao facto de não ter parceiro. Discussão: Os dados reportados pelos doentes conduziram a alterações nos cuidados prestados, que passaram a contemplar a oncosexologia. Estudos futuros deverão focar-se na aplicabilidade deste questionário a amostras com diferentes características e mesmo à população global, para se poderem generalizar os resultados. Conclusão: A versão obtida do Sexual Activity Questionnaire é válida para avaliar a função sexual em sobreviventes de cancro da mama em Portugal.