Two-Generation Toxicity Study of the Antioxidant Compound Propyl-Propane Thiosulfonate (PTSO).

Propyl-propane thiosulfonate (PTSO), an antioxidant organosulfur compound present in the genus Allium, has become a potential natural additive for food and feed, as well as a possible biopesticide for pest control in plants. A toxicological assessment is necessary to verify its safety for livestock, consumers, and the environment. As part of the risk assessment of PTSO, this study was designed to explore its potential reproductive toxicity in mice following the OECD 416 guideline. The investigation spans two generations to comprehensively evaluate potential reproductive, teratogenic, and hereditary effects. A total of 80 CD1 mice per sex and generation were subjected to PTSO exposure during three phases (premating, gestation, and lactation). This evaluation encompassed three dose levels: 14, 28, and 55 mg PTSO/kg b.w./day, administered through the feed. No clinical changes or mortality attributed to the administration of PTSO were observed in the study. Some changes in the body weight and food consumption were observed, but not related to sex or in a dose-dependent manner. The two parental generations (F0, F1) exhibited normal reproductive performance, and the offspring (F1 and F2) were born without any abnormalities. The serum sexual hormone levels (progesterone -P-, testosterone -T-, estradiol -E2-, follicular stimulating hormone -FSH-, and luteinizing hormone -LH-) were in a normal range. Although significant changes were observed in the sperm analysis in the case of F0 group, no variation was found for F1 group, and no alterations in fertility were recorded either. The absolute organ weights and relative organ weight/body weight and organ weight/brain weight ratios, and the complete histopathological study, showed no significant alterations in males and females for all the generations considered. Considering all the results obtained, PTSO is not considered a reproductive or developmental toxicant in mice under the assayed conditions. These results support the good safety profile of PTSO for its potential application in the agrifood sector.

Risk assessment and environmental consequences of the use of the Allium-derived compound propyl-propane thiosulfonate (PTSO) in agrifood applications.

The organosulfur compound propyl-propane thiosulfonate (PTSO), mainly found in Allium cepa, has a promising use in the agrifood industry. To confirm its safety for livestock, consumers, and environment, toxicological assessment is needed. In this regard, endocrine-disrupting chemicals (EDCs) are in the spotlight of research. Therefore, as part of the risk assessment of PTSO, in the present work, an in vivo study was performed in mice exposed to PTSO to investigate its potential reproductive toxicity considering fertility, genetic and endocrine endpoints. Five-weeks-old CD1 mice (80 males, 80 females) were exposed for 11 or 16 weeks (males or females, respectively) to different doses of PTSO (0, 14, 28 and 55 mg PTSO/kg b.w./day; 20 animals per group and sex) through the food pellets. No clinical observations or mortality and no changes in absolute organ weights and relative organ weights/body weight or brain ratios occurred during the study. The estrous cycle did not undergo any significant toxicologically relevant change. Most of the sex hormones displayed normal values. Some alterations in the expression of some genes related to reproduction is only observed in females, but they do not appear to have consequences in the development of sex organs. Docking results showed the impossibility of stable binding to estrogen and androgen receptors. Considering all the results obtained, the safe profile of PTSO can be confirmed for different agrifood applications at the conditions assayed.

Cytotoxic Effects and Oxidative Stress Produced by a Cyanobacterial Cylindrospermopsin Producer Extract versus a Cylindrospermopsin Non-Producing Extract on the Neuroblastoma SH-SY5Y Cell Line.

The incidence and interest of cyanobacteria are increasing nowadays because they are able to produce some toxic secondary metabolites known as cyanotoxins. Among them, the presence of cylindrospermopsin (CYN) is especially relevant, as it seems to cause damage at different levels in the organisms: the nervous system being the one most recently reported. Usually, the effects of the cyanotoxins are studied, but not those exerted by cyanobacterial biomass. The aim of the present study was to assess the cytotoxicity and oxidative stress generation of one cyanobacterial extract of R. raciborskii non-containing CYN (CYN-), and compare its effects with those exerted by a cyanobacterial extract of C. ovalisporum containing CYN (CYN+) in the human neuroblastoma SH-SY5Y cell line. Moreover, the analytical characterization of potential cyanotoxins and their metabolites that are present in both extracts of these cultures was also carried out using Ultrahigh Performance Liquid Chromatography-Mass Spectrometry, in tandem (UHPLC-MS/MS). The results show a reduction of cell viability concentration- and time-dependently after 24 and 48 h of exposure with CYN+ being five times more toxic than CYN-. Furthermore, the reactive oxygen species (ROS) increased with time (0-24 h) and CYN concentration (0-1.11 µg/mL). However, this rise was only obtained after the highest concentrations and times of exposure to CYN-, while this extract also caused a decrease in reduced glutathione (GSH) levels, which might be an indication of the compensation of the oxidative stress response. This study is the first one performed in vitro comparing the effects of CYN+ and CYN-, which highlights the importance of studying toxic features in their natural scenario.

Identification of in vitro metabolites of an Allium organosulfur compound and environmental toxicity prediction as part of its risk assessment.

Propyl-propane-thiosulfonate (PTSO) is an organosulfur compound found inAllium spp. Due to its antioxidant and antimicrobial activities, PTSO has been proposed for applications in the agri-food sector, such as feed additive. However, its use with commercial purposes depends on its toxicity evaluation. The present work aimed to perform a pilot-study of toxicokinetic profile of PTSO combining in silico and in vitro techniques, important steps in the risk assessment process. In silico ecotoxicity studies were also performed considering the importance of the environmental impact of the compound before its commercial use. First, an analytical method has been developed and validated to determine the original compound and its metabolites by ultra-performance liquid chromatography-tandem mass spectrometry. The phase I and II metabolism of PTSO was predicted using Meta-Pred Web Server. For the phase I metabolism, rat (male and female) and human liver microsomes were incubated with PTSO and NADPH regeneration system. Furthermore, in the phase II, microsomes were incubated with PTSO and glutathione or uridine 5'- diphosphoglucuronic acid. The analysis revealed the presence of propylpropane thiosulfinate (PTS) originated by redox reaction in phase I, and two conjugates from the phase II: S-propylmercaptoglutathione (GSSP) and S-propylmercaptocysteine (CSSP). Additionally, considering the environmental fate of PTSO and its metabolites, the ADME parameters and the potential ecotoxicity were also predicted using in silico softwares. The results of the ecotoxicity in silico study evidenced that the metabolism induced the formation of detoxified metabolites from the parent compound, except for dimercaprol and 3-mercaptopropane1,2-diol. Further in vivo assays are needed to confirm this prediction.

In Vitro Toxicity Studies of Bioactive Organosulfur Compounds from Allium spp. with Potential Application in the Agri-Food Industry: A Review.

Organosulfur compounds (OSCs) are secondary metabolites produced by different Allium species which present important biological activities such as antimicrobial, antioxidant, anti-inflammatory antidiabetic, anticarcinogenic, antispasmodic, etc. In recent years, their use has been promoted in the agri-food industry as a substitute for synthetic preservatives, increasing potential accumulative exposure to consumers. Before their application in the food industry, it is necessary to pass a safety assessment as specified by the European Food Safety Authority (EFSA). This work reviews the scientific literature on OSCs regarding their in vitro toxicity evaluation following PRISMA guidelines for systematic reviews. Four electronic research databases were searched (Web of Science, Scopus, Science Database and PubMed) and a total of 43 works were selected according to predeterminate inclusion and exclusion criteria. Different data items and the risk of bias for each study were included. Currently, there are very few in vitro studies focused on investigating the potential toxicity of OSCs. Most research studies aimed to evaluate the cytotoxicity of OSCs to elucidate their antiproliferative effects focusing on their therapeutic aspects using cancer cell lines as the main experimental model. The results showed that diallyl disulfide (DADS) is the compound most studied, followed by diallyl trisulfide (DATS), diallyl sulfide (DAS), Allicin and Ajoene. Only 4 studies have been performed specifically to explore the safety of OSCs for agri-food applications, and genotoxicity studies are limited. More toxicity studies of OSCs are necessary to ensure consumers safety and should mainly be focused on the evaluation of genotoxicity and long-term toxicity effects.

Acute and subchronic 90-days toxicity assessment of propyl-propane-thiosulfinate (PTS) in rats.

The organosulfur compounds (OSC) extracted from Allium spp. exhibit antibacterial, antifungal, and antioxidant properties. The agri-food industry is taking advantage of these properties by using them as natural feed and food additives. In the present work, an acute and a subchronic 90-days toxicity studies have been conducted for the first time to assess the safety of the OSC propyl-propane-thiosulfinate (PTS). Both studies were carried out following the Organization for Economic Co-operation and Development test guidelines (425 and 408, respectively). The acute study provided a maximum tolerated dose (MTD) of 175 mg/kg and the subchronic study established the Non Observed Adverse Effect Level (NOAEL) ≥ 55 mg/kg body weight (b.w.)/day in both sexes. In addition, the subchronic study performed on rats exposed to 14, 28 and 55 mg/kg b.w./day PTS, revealed no changes in any of the hematological parameters measured as well as no differences in body weight and water/food consumption. However, biochemical parameters were altered in some groups, although they were not biologically significant (Ca2+ in female rats, and the thyroids hormones T3 and T4 in rat males). Furthermore, the histopathological assessment evidenced no abnormality on the gastrointestinal, respiratory, lymphoid, urinary, circulatory, nervous, musculoskeletal, and reproductive systems.

Simultaneous determination of Allium compounds (Propyl propane thiosulfonate and thiosulfinate) in animal feed using UPLC-MS/MS.

Propyl-propane-thiosulfonate (PTSO) and Propyl-propane-thiosulfinate (PTS) are organosulfur compounds used to supplement the diet of livestock because of their beneficial effects on feed palatability, their antibacterial, anti-inflammatory, and antimethanogenic activities. Besides, antibiotic residues in the environment can be reduced by using these natural bioactive compounds. The objective of this study was to optimize the extraction parameters for the analysis of PTSO and PTS in feed matrices by performing a solid-liquid extraction and quantification by Ultra performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS). Optimization was performed using the Response Surface Methodology on a Box-Behnken experimental design, optimizing the following parameters: solvent:sample ratios and evaporation temperature set for the rotary evaporator. The method was validated for 3 concentration levels for both PTSO (100, 500, 1000 ng g-1) and PTS (500, 1150, 2300 ng g-1). The highest recoveries of PTSO and PTS were obtained using 12.5 mL of 100% acetonitrile, stirring for 15 min, and an evaporation temperature of 20 °C. The validated method was further applied to detect and quantify these compounds in different feed matrices. In conclusion, this is the first study to simultaneously analyze PTSO and PTS at low concentrations, employing a sensitive technique such as UPLC-MS/MS.

Genotoxicity Evaluation of Propyl-Propane-Thiosulfinate (PTS) from Allium genus Essential Oils by a Combination of Micronucleus and Comet Assays in Rats.

Propyl-propanethiosulfinate (PTS) is a component of Allium essential oils. This organosulfur molecule can be used as a feed additive to decrease the appearance of bacterial resistances caused by the residues of antibiotics. In previous in vitro genotoxicity studies, contradictory results were reported for PTS. In this work, the in vivo genotoxicity of PTS in male and female rats was assessed for the first time, following OECD (Organisation for Economic Co-operation and Development) guidelines. After oral administration (doses: 5.5, 17.4, and 55.0 mg/kg PTS body weight), a combination of the micronucleus (MN) assay (OECD 474) in bone marrow and the standard and enzyme-modified comet assay (OECD 489) was performed. After necropsy, histopathological studies were also carried out. The results did not show the in vivo genotoxicity of PTS at any doses assayed, revealed by the absence of increased MN, and DNA strand breaks or oxidative DNA damage in the standard and enzyme-modified comet assays. The histopathological study revealed that only the highest dose tested (55.0 mg/kg) in the liver and all dose groups in the stomach presented minimal pathological lesions in the organs studied. Consequently, the present work confirms that PTS is not genotoxic at the doses assayed, and it is a promising natural alternative to synthetic preservatives and antibiotics in animal feed.

Efeito de um programa de aprimoramento das habilidades de comunicação oral na ansiedade e no estresse autorreferidos / Effect of a program to improve oral communication skills on self-reported anxiety and stress

RESUMO Objetivo Verificar os efeitos de um programa fonoaudiológico de aprimoramento das habilidades de comunicação oral, por meio da mensuração dos índices autorreferidos de ansiedade e estresse. Métodos Trata-se de um ensaio clínico randomizado controlado. Os participantes da pesquisa foram divididos aleatoriamente em dois grupos: grupo intervenção (GI) e grupo controle (GC). O GI participou de seis oficinas de aprimoramento das habilidades de comunicação oral. O GC participou de uma única oficina sobre saúde vocal. Foram aplicados, antes da primeira e após a última oficina, os protocolos: Questionário de caracterização da amostra, Self Statements During Public-Speaking Scale (SSPS), Perceived Stress Scale (PSS) e o Cuestinário de Ansiedad Social para Adultos (CASO). Após seis meses, foi realizado um follow-up. Resultados O GI apresentou, após o aprimoramento, redução significativa dos escores de ansiedade no CASO, de forma geral, e em todos os parâmetros do protocolo. Os valores da PSS referentes ao estresse demonstraram aumento da autoavaliação positiva e diminuição da autoavaliação negativa. Já na autoavaliação ao falar em público, foi verificado, na SSPS, aumento da pontuação geral, em relação ao GC. Conclusão O programa de aprimoramento fonoaudiológico das habilidades de comunicação oral promoveu a diminuição nos índices de ansiedade e estresse autorreferidos, aumentando a autopercepção positiva ao falar em público. O presente estudo foi registrado no Registro Brasileiro de Ensaios Clínicos (ReBEC), sob o identificador primário RBR-37r3S2.

RESUMO Objetivo Verificar os efeitos de um programa fonoaudiológico de aprimoramento das habilidades de comunicação oral, por meio da mensuração dos índices autorreferidos de ansiedade e estresse. Métodos Trata-se de um ensaio clínico randomizado controlado. Os participantes da pesquisa foram divididos aleatoriamente em dois grupos: grupo intervenção (GI) e grupo controle (GC). O GI participou de seis oficinas de aprimoramento das habilidades de comunicação oral. O GC participou de uma única oficina sobre saúde vocal. Foram aplicados, antes da primeira e após a última oficina, os protocolos: Questionário de caracterização da amostra, Self Statements During Public-Speaking Scale (SSPS), Perceived Stress Scale (PSS) e o Cuestinário de Ansiedad Social para Adultos (CASO). Após seis meses, foi realizado um follow-up. Resultados O GI apresentou, após o aprimoramento, redução significativa dos escores de ansiedade no CASO, de forma geral, e em todos os parâmetros do protocolo. Os valores da PSS referentes ao estresse demonstraram aumento da autoavaliação positiva e diminuição da autoavaliação negativa. Já na autoavaliação ao falar em público, foi verificado, na SSPS, aumento da pontuação geral, em relação ao GC. Conclusão O programa de aprimoramento fonoaudiológico das habilidades de comunicação oral promoveu a diminuição nos índices de ansiedade e estresse autorreferidos, aumentando a autopercepção positiva ao falar em público. O presente estudo foi registrado no Registro Brasileiro de Ensaios Clínicos (ReBEC), sob o identificador primário RBR-37r3S2.

Safety assessment of propyl-propane-thiosulfonate (PTSO): 90-days oral subchronic toxicity study in rats.

Propyl-propane-thiosulfonate (PTSO) is one of the main organosulfur compounds present in Allium essentials oil. Different applications in the food sector have been proposed for PTSO, such as food and feed additive and as active packaging. However, the authorization of its use depends on its toxicity profile. Thus, as a part of its safety assessment, in this work a repeated dose 90-day oral toxicity study has been conducted for the first time in rats following the OECD guideline 408. PTSO was administered to groups of 10 male and 10 female rats at dose levels of 0, 14, 28, and 55 mg/kg/day. No clinical signs or mortality and no changes in body weight, food consumption and feed conversion efficiency were detected through the study. Moreover, no treatment-related changes in hematological and biochemical parameters were observed, for either sex or dose groups. The histopathology study performed revealed no differences in organ weights, and no morphological and histopathological changes were observed. Based on these results, the no-observed-adverse-effect level (NOAEL) of PTSO was judged to be ≥ 55 mg/kg/day for both sexes.

In vitro assessment of cyanotoxins bioaccessibility in raw and cooked mussels.

The oral route by ingestion of water and food contaminated with cyanotoxins is the main route of exposure to these toxins. This study addresses for the first time the bioaccessibility of some of the most common Microcystins (MC-LR, MC-RR and MC-YR) and Cylindrospermopsin (CYN) simultaneously in raw and steamed mussels spiked at 250 ng/g fresh weight of each cyanotoxin, after an in vitro digestion, including the salivary (incubation with artificial saliva, 30s), gastric (with pepsin, 2h, pH 2), duodenal (with pancreatin and bile salts, 2h, pH 6.5) and colonic phases (with lactic-acid bacteria, 48h, pH 7.2). The results obtained suggest that the potential absorption of these cyanotoxins by consumption of contaminated mussels is lower than expected. After the total effect of cooking and digestion, the mean bioaccessibility levels recorded were 24.65% (CYN), 31.51% (MC-RR), 17.51% (MC-YR) and 13.20% (MC-LR). Moreover, toxins were transferred to the steaming waters at 3.77 ± 0.24 µg L-1 CYN, 2.29 ± 0.13 µg L-1 MC-LR, 6.60 ± 0.25 µg L-1 MC-RR and 3.83 ± 0.22 µg L-1 MC-YR. These bioaccessibility results should be considered for a more accurate risk assessment related to these cyanotoxins in mussels, including the fact that the steaming waters could also represent a risk after human consumption.

External validation of the unified model of information systems continuance (UMISC): An international comparison.

CONTEXT: The Unified Model of Information Systems Continuance (UMISC) is a metamodel for the evaluation of clinical information systems (CISs) that integrates constructs from five models that have previously been published in the literature. UMISC was developed at the Georges Pompidou University Hospital (HEGP) in Paris and was partially validated at the Saint Joseph Hospital Group (HPSJ), another acute care institution using the same CIS as HEGP. OBJECTIVE: The aim of this replication study was twofold: (1) to perform an external validation of UMISC in two different hospitals and country contexts: the Italian Hospital of Buenos Aires (HIBA) in Argentina and the Hospital Sirio Libanes in Sao Paulo, Brazil (HSL); (2) to compare, using the same evaluation model, the determinants of satisfaction, use, and continuance intention observed at HIBA and HSL with those previously observed at HEGP and HPSJ. METHODS: The UMISC evaluation questionnaires were translated from their original languages (English and French) to Brazilian Portuguese and Spanish following the translation/back-translation method. These questionnaires were then applied at each target site. The 21 UMISC-associated hypotheses were tested using structural equation modeling (SEM). RESULTS: A total of 3020 users, 1079 at HIBA and 1941 at the HSL, were included in the analysis. The respondents included 1406 medical staff and 1001 nursing staff. The average profession-adjusted use, overall satisfaction and continuance intention were significantly higher at HIBA than at HSL in the medical and nursing groups. In SEM analysis, UMISC explained 23% and 11% of the CIS use dimension, 72% and 85% of health professionals' satisfaction, and 41% and 60% of continuance intention at HIBA and HSL, respectively. Twenty of the 21 UMISC-related hypotheses were validated in at least one of the four evaluation sites, and 16 were validated in two or more sites. CONCLUSION: The UMISC evaluation metamodel appears to be a robust comparison and explanatory model of satisfaction, use and continuance intention for CISs in late post adoption situations.

Self-assessment of communication resources used by sales representatives and its relation with sales performance. / Autoavaliação dos recursos comunicativos por representantes comerciais e sua relação com o desempenho em vendas.

PURPOSE: To analyze the self-assessment of communication resources used by sales representatives and its relation with their sales performance. METHODS: The study counted with 55 sales representatives, 46 men and 9 women, between 24 and 56 years old. In the first phase of the study, participants answered questions related to identification data, self-assessment protocols of vocal behavior and communicative resources; besides that, they were asked to select the positive and negative communication resources of their own speech during the sales. In the next phase, the participants were divided into two groups according to their sales performance: Group A (GA), individuals with better sales performance and Group B (GB), individuals with worst sales performance. The data were statistically analyzed. RESULTS: Regarding the vocal behavior self-assessment, the sales representatives considered their voice quality as normal, their vocal pitch, loudness and speech rate as regular and as having an expressive voice. Regarding the communicative behavior, there was low presence of regionalism, use of gesture and use of other support resources during the sales; contrarily, there was high occurrence of precise articulation of speech sounds, visual contact, lack of inhibition to talk, time monitoring and objectivity of the speech. CONCLUSION: The sales representatives' self-assessment was positive for the objectivity of the speech, knowledge of the subject and use of proper vocabulary; it was negative for, lack of subject domain, criticism and prejudgment, and improper vocabulary. The self-assessment was similar in GA and GB.

OBJETIVO: Analisar a autoavaliação dos recursos comunicativos utilizados por representantes comerciais e sua relação com o desempenho em vendas. MÉTODO: A amostra foi composta de 55 representantes comerciais, dos quais 46 eram homens e 9 eram mulheres, com idade entre 24 e 56 anos. Na primeira etapa, foi aplicado um protocolo com questões referentes aos dados de identificação, autoavaliação do comportamento vocal e dos recursos comunicativos e seleção de recursos comunicativos de influência positiva e negativa no seu próprio discurso na situação de venda. Na etapa seguinte, os participantes foram separados em dois grupos em função do desempenho em vendas: grupo A (GA), com melhor desempenho em vendas, e grupo B (GB), com pior desempenho em vendas. Tal divisão foi realizada de acordo com informações fornecidas pela empresa. Os resultados foram submetidos à análise estatística. RESULTADOS: Na autoavaliação do comportamento vocal, os representantes consideraram sua qualidade vocal normal, frequência, intensidade de voz e velocidade de fala regulares, além de voz expressiva. Com relação aos recursos comunicativos, houve baixa ocorrência de regionalismo, de uso de gestos e de recursos de apoio nas vendas e alta ocorrência de articulação precisa dos sons da fala, de contato visual, de desinibição na comunicação, de controle do tempo e de objetividade do discurso. CONCLUSÃO: Representantes de vendas autoavaliaram de forma positiva a objetividade no discurso, o domínio do assunto e o uso de vocabulário adequado e de forma negativa a falta de domínio do assunto, as críticas e os preconceitos e o uso de vocabulário inadequado. Os grupos A e B se autoavaliaram de forma semelhante.

Autoavaliação dos recursos comunicativos por representantes comerciais e sua relação com o desempenho em vendas / Self-assessment of communication resources used by sales representatives and its relation with sales performance

RESUMO Objetivo Analisar a autoavaliação dos recursos comunicativos utilizados por representantes comerciais e sua relação com o desempenho em vendas. Método A amostra foi composta de 55 representantes comerciais, dos quais 46 eram homens e 9 eram mulheres, com idade entre 24 e 56 anos. Na primeira etapa, foi aplicado um protocolo com questões referentes aos dados de identificação, autoavaliação do comportamento vocal e dos recursos comunicativos e seleção de recursos comunicativos de influência positiva e negativa no seu próprio discurso na situação de venda. Na etapa seguinte, os participantes foram separados em dois grupos em função do desempenho em vendas: grupo A (GA), com melhor desempenho em vendas, e grupo B (GB), com pior desempenho em vendas. Tal divisão foi realizada de acordo com informações fornecidas pela empresa. Os resultados foram submetidos à análise estatística. Resultados Na autoavaliação do comportamento vocal, os representantes consideraram sua qualidade vocal normal, frequência, intensidade de voz e velocidade de fala regulares, além de voz expressiva. Com relação aos recursos comunicativos, houve baixa ocorrência de regionalismo, de uso de gestos e de recursos de apoio nas vendas e alta ocorrência de articulação precisa dos sons da fala, de contato visual, de desinibição na comunicação, de controle do tempo e de objetividade do discurso. Conclusão Representantes de vendas autoavaliaram de forma positiva a objetividade no discurso, o domínio do assunto e o uso de vocabulário adequado e de forma negativa a falta de domínio do assunto, as críticas e os preconceitos e o uso de vocabulário inadequado. Os grupos A e B se autoavaliaram de forma semelhante.

ABSTRACT Purpose To analyze the self-assessment of communication resources used by sales representatives and its relation with their sales performance. Methods The study counted with 55 sales representatives, 46 men and 9 women, between 24 and 56 years old. In the first phase of the study, participants answered questions related to identification data, self-assessment protocols of vocal behavior and communicative resources; besides that, they were asked to select the positive and negative communication resources of their own speech during the sales. In the next phase, the participants were divided into two groups according to their sales performance: Group A (GA), individuals with better sales performance and Group B (GB), individuals with worst sales performance. The data were statistically analyzed. Results Regarding the vocal behavior self-assessment, the sales representatives considered their voice quality as normal, their vocal pitch, loudness and speech rate as regular and as having an expressive voice. Regarding the communicative behavior, there was low presence of regionalism, use of gesture and use of other support resources during the sales; contrarily, there was high occurrence of precise articulation of speech sounds, visual contact, lack of inhibition to talk, time monitoring and objectivity of the speech. Conclusion The sales representatives' self-assessment was positive for the objectivity of the speech, knowledge of the subject and use of proper vocabulary; it was negative for, lack of subject domain, criticism and prejudgment, and improper vocabulary. The self-assessment was similar in GA and GB.

Transparência no Sistema Único de Saúde: inciativas e desafios na divulgação eletrônica das listas de espera / Transparency in the Sistema Único de Saúde: initiatives and challenges in the electronic dissemination of waiting lists

Este trabalho analisou o processo de implantação da transparência e divulgação das listas de espera por procedimentos assistenciais eletivos na saúde pública do Brasil, entendendo a transparência como estratégia potencial de promover maior equidade no acesso aos serviços de saúde. Metodologia: Foi realizada uma cuidadosa revisão de literatura e levantamento documental normativo. Resultados: Identificou-se iniciativas e mudanças provocadas pela obrigatoriedade da publicização destas listas no Brasil e em experiências internacionais. Conclusão: É notória a importância da transparência na saúde, por meio da divulgação eletrônica das filas de espera para procedimentos eletivos no Sistema Único de Saúde (SUS), como estratégia de promover a equidade no acesso e possibilitar a ampla fiscalização e acompanhamento pelos pacientes, além do controle exercido por todos os órgãos de controle da Administração Pública e da sociedade. (AU)

This work analyzed the process of implementation of transparency and dissemination of waiting lists for elective health care procedures in Brazil, understanding transparency as a potential strategy to promote greater equity in acess to health services. Methodology: It was verified on a careful review of the literature and a normative survey. Results: Initiatives and changes was identified as mandatory publication of these lists in Brazil and international experiences. Conclusion: The importance of transparency in health is evident throught the electronic dissemination of queues for elective procedures in the Sistema Único de Saúde (SUS), as a strategy to promote equity in acess and make possible the extensive supervision and monitoring by patients, in addition to the control exercised by the public administration and society. (AU)

El estudio hizo un análisis del proceso que estableció la divulgación transparente de las listas de espera por los procedimientos médicos electivos de salud pública en Brasil, creyendo que la transparencia tiene el potencial de promover oportunidades iguales para obtenerse los tratamientos en establecimientos de salud. Metodología: Fue hecho una revisión exhaustiva de la literatura y la norma, Resultados: Se identificaron iniciativas y cambios provocados por la obligación de publicarse las listas de espera en Brasil, así como ocurre en otros países. Conclusión: Es muy importante la divulgación de las listas de espera por los procedimientos médicos electivos del Sistema Único de Salud de Brasil (SUS) como estrategia para lograr equidad en la obtención de los tratamientos, así como para que los pacientes, la sociedad y la administración pública hagan el control y la fiscalización del acceso (AU)

Transparência no Sistema Único de Saúde: inciativas e desafios na divulgação eletrônica das listas de espera / Transparency in the Sistema Único de Saúde: initiatives and challenges in the electronic dissemination of waiting lists / Transparencia en el Sistema Único de Saúde: inciativas y desafíos en la divulgación electrónica de las listas de espera

Objetivo: Este trabalho analisou o processo de implantação da transparência e divulgação das listas de espera por procedimentos assistenciais eletivos na saúde pública do Brasil, entendendo a transparência como estratégia potencial de promover maior equidade no acesso aos serviços de saúde. Metodologia: Foi realizada uma cuidadosa revisão de literatura e levantamento documental normativo. Resultados: Identificou-se iniciativas e mudanças provocadas pela obrigatoriedade da publicização destas listas no Brasil e em experiências internacionais. Conclusão: É notória a importância da transparência na saúde, por meio da divulgação eletrônica das filas de espera para procedimentos eletivos no Sistema Único de Saúde (SUS), como estratégia de promover a equidade no acesso e possibilitar a ampla fiscalização e acompanhamento pelos pacientes, além do controle exercido por todos os órgãos de controle da Administração Pública e da sociedade.

Objective: This work analyzed the process of implementation of transparency and dissemination of waiting lists for elective health care procedures in Brazil, understanding transparency as a potential strategy to promote greater equity in acess to health services. Methodology: It was verified on a careful review of the literature and a normative survey. Results: Initiatives and changes was identified as mandatory publication of these lists in Brazil and international experiences. Conclusion: The importance of transparency in health is evident throught the electronic dissemination of queues for elective procedures in the Sistema Único de Saúde (SUS), as a strategy to promote equity in acess and make possible the extensive supervision and monitoring by patients, in addition to the control exercised by the public administration and society. Keywords: Health Care Coordination and Monitoring. Health services accessibility. Clinical governance. Equity in acess to health services. Waiting lists.

Objetivo: El estudio hizo un análisis del proceso que estableció la divulgación transparente de las listas de espera por los procedimientos médicos electivos de salud pública en Brasil, creyendo que la transparencia tiene el potencial de promover oportunidades iguales para obtenerse los tratamientos en establecimientos de salud. Metodología: Fue hecho una revisión exhaustiva de la literatura y la norma, Resultados: Se identificaron iniciativas y cambios provocados por la obligación de publicarse las listas de espera en Brasil, así como ocurre en otros países. Conclusión: Es muy importante la divulgación de las listas de espera por los procedimientos médicos electivos del Sistema Único de Salud de Brasil (SUS) como estrategia para lograr equidad en la obtención de los tratamientos, así como para que los pacientes, la sociedad y la administración pública hagan el control y la fiscalización del acceso.

Results of a venous thromboembolism prophylaxis program for hospitalized patients.

INTRODUCTION: Venous thromboembolism (VTE) is the leading cause of preventable death in hospitalized patients. However, existing prophylaxis guidelines are rarely followed. OBJECTIVE: The aim of the study was to present and discuss implementation strategies and the results of a VTE prophylaxis program for medical and surgical patients admitted to a large general hospital. PATIENTS AND METHODS: This prospective observational study was conducted to describe the strategy used to implement a VTE prophylaxis program in hospitalized medical and surgical patients and to analyze the results in terms of the risk assessment rate within the first 24 hours after admission, adequacy of the prophylaxis prescription, and prevalence of VTE in the discharge records before and after program implementation. We used the Mantel-Haenszel chi-square test for the linear trend of the data analysis and set the significance level to P<0.05. RESULTS: With the support of an institutional VTE prophylaxis committee, a multiple-strategy approach was used in the implementation of the protocol, which included continuing education, complete data recording using computerized systems, and continuous auditing of and feedback to the medical staff and multidisciplinary teams. Approximately 90% of patients were evaluated within the first 24 hours after admission, and no significant difference in this percentage was observed among the years analyzed. A progressive increase in adherence to protocol recommendations, from 63.8% in 2010 to 75.0% in 2014 (P<0.001), was noted. The prevalence of symptomatic VTE in the discharge records of patients decreased from 2.03% in 2009 to 1.69% in 2014 (P=0.033). CONCLUSION: The implementation of a VTE prophylaxis program targeting adult patients admitted to a large hospital employing a multiple-strategy approach achieved high rates of risk assessment within 24 hours of admission, improved the adherence to prophylaxis recommendations in high-risk patients, and reduced the rate of VTE events in the discharge records.

Performance evaluation of hospitals that provide care in the public health system, Brazil.

OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System. METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction. RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed. CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.