Imaging associations enhance the understanding of ECG abnormalities in male Brazilian football players: findings from the B-Pro Foot ECG study.

OBJECTIVES: To evaluate the prevalence of abnormal ECG findings and their association with imaging results in male Brazilian football players. METHODS: The 'B-Pro Foot ECG' is a multicentre observational study conducted in 82 Brazilian professional clubs. It analysed 6125 players aged 15-35 years (2496 white, 2004 mixed-race and 1625 black individuals) who underwent cardiovascular screening from 2002 to 2023. All ECGs were reviewed by two experienced cardiologists in the athlete's care. Those with abnormal findings underwent further investigations, including a transthoracic echocardiogram (TTE). Cardiac magnetic resonance (CMR) was subsequently performed based on TTE findings or clinical suspicion. RESULTS: In total, 180 (3%) players had abnormal ECGs and 176 (98%) showed normal TTE results. Athletes aged 26-35 years had a higher prevalence of abnormal ECGs than younger athletes (15-25 years). Black players had a higher prevalence of T-wave inversion (TWI) in the inferior leads than white players (2.6% vs 1.4%; p=0.005), as well as in V5 (2.9%) and V6 (2.1%) compared with white (1.2% and 1.0%; p<0.001) and mixed-race (1.5% and 1.2%; p<0.05) players, respectively. TTE parameters were similar across ethnicities. However, four out of 75 players with inferolateral TWI showed abnormal TTEs and CMR findings consistent with cardiomyopathies. CMR also showed cardiomyopathies or myocarditis in four players with inferolateral TWI and normal TTEs. In total, nine (0.1%) athletes were diagnosed with cardiac diseases and were followed for 40±30 months, with no cardiac events documented. CONCLUSION: This study found a 3% prevalence of abnormal ECGs in male Brazilian football players. Inferolateral TWI was associated with cardiac pathologies confirmed by CMR, even in athletes with a normal TTE.

Global phylogeography of ridley sea turtles (Lepidochelys spp.): evolution, demography, connectivity, and conservation.

Globally distributed marine taxa are well suited for investigations of biogeographic impacts on genetic diversity, connectivity, and population demography. The sea turtle genus Lepidochelys includes the wide-ranging and abundant olive ridley (L. olivacea), and the geographically restricted and 'Critically Endangered' Kemp's ridley (L. kempii). To investigate their historical biogeography, we analyzed a large dataset of mitochondrial DNA (mtDNA) sequences from olive (n = 943) and Kemp's (n = 287) ridleys, and genotyped 15 nuclear microsatellite loci in a global sample of olive ridleys (n = 285). We found that the ridley species split ~ 7.5 million years ago, before the Panama Isthmus closure. The most ancient mitochondrial olive ridley lineage, located in the Indian Ocean, was dated to ~ 2.2 Mya. Both mitochondrial and nuclear markers revealed significant structure for olive ridleys between Atlantic (ATL), East Pacific (EP), and Indo-West Pacific (IWP) areas. However, the divergence of mtDNA clades was very recent (< 1 Mya) with low within- clade diversity, supporting a recurrent extinction-recolonization model for these ocean regions. All data showed that ATL and IWP groups were more closely related than those in the EP, with mtDNA data supporting recent recolonization of the ATL from the IWP. Individual olive ridley dispersal between the ATL, EP, and IN/IWP could be interpreted as more male- than female-biased, and genetic diversity was lowest in the Atlantic Ocean. All populations showed signs of recent expansion, and estimated time frames were concordant with their recent colonization history. Investigating species abundance and distribution changes over time is central to evolutionary biology, and this study provides a historical biogeographic context for marine vertebrate conservation and management. Supplementary Information: The online version contains supplementary material available at 10.1007/s10592-022-01465-3.

Divergence and hybridization in sea turtles: Inferences from genome data show evidence of ancient gene flow between species.

Reconstructing past events of hybridization and population size changes are required to understand speciation mechanisms and current patterns of genetic diversity, and ultimately contribute to species' conservation. Sea turtles are ancient species currently facing anthropogenic threats including climate change, fisheries, and illegal hunting. Five of the seven extant sea turtle species are known to currently hybridize, especially along the Brazilian coast where some populations can have ~32%-42% of hybrids. Although frequently observed today, it is not clear what role hybridization plays in the evolutionary diversification of this group of reptiles. In this study, we generated whole genome resequencing data of the five globally distributed sea turtle species to estimate a calibrated phylogeny and the population size dynamics, and to understand the role of hybridization in shaping the genomes of these ancient species. Our results reveal discordant species divergence dates between mitochondrial and nuclear genomes, with a high frequency of conflicting trees throughout the nuclear genome suggesting that some sea turtle species frequently hybridized in the past. The reconstruction of the species' demography showed a general decline in effective population sizes with no signs of recovery, except for the leatherback sea turtle. Furthermore, we discuss the influence of reference bias in our estimates. We show long-lasting ancestral gene flow events within Chelonioidea that continued for millions of years after initial divergence. Speciation with gene flow is a common pattern in marine species, and it raises questions whether current hybridization events should be considered as a part of these species' evolutionary history or a conservation issue.

Judicialization of access to medicines in four Latin American countries: a comparative qualitative analysis.

BACKGROUND: The valuation of medicines as health needs vary depending on the stakeholders involved (users, prescribers, managers, etc.) and their expectations. These factors modulate the role of medicines as a health need and influence access to medicines, and could be useful to explain the rising of Judicialization of access to medicines. AIM: To conduct a comparative analysis of the causes and consequences of judicialization of access to medicines in Argentina, Brazil, Colombia and Chile from the perspective of medicines as health needs. METHODS: A qualitative, cross-country study was carried out in these 4 countries. Semi-structured interviews were conducted with 50 representatives of the different stakeholders involved in the judicialization of access to medicines, including Executive branch, Judiciary, health system managers, patient organizations. The interviews were audio-recorded and transcribed verbatim. Thematic analysis used a framework approach based on the theoretical model for medicines as health needs. FINDINGS: Representatives from Argentina, Brazil and Colombia considered judicialization of access to medicines as a widespread phenomenon in their respective countries. Meanwhile in Chile, the respondents highlighted that most lawsuits related to the right to health were filed against private insurers because of unjustified increases in the insurance premiums. The comparative analysis showed that judicialization of access to medicines emerged in the four countries regardless of the constitutional protection or the health system population coverage. Among the causes were mentioned difficulties in guaranteeing access to covered medicines and the influence of pharmaceutical marketing on needs assessment and prescription behaviours. The interviewees highlighted the pressure to health system managers to fulfil their responsibilities as a positive impact of litigation. In contrast, the funding of medicines without evidence of efficacy or safety was considered a negative impact. Only in Brazil, judicialization has had impact on R&D policies. In Colombia, litigation also encouraged the recognition of the right to health as a fundamental right and the development of policies for controlling medicines prices. CONCLUSION: The results suggest that applying the adopted theoretical model creates the possibility of identifying critical points to guide policy makers to improve the health systems performances and to control lawsuits for access to medicines.

Spatio-temporal variation in the incubation duration and sex ratio of hawksbill hatchlings: implication for future management.

Climate change poses a unique threat to species with temperature dependent sex determination (TSD), such as marine turtles, where increases in temperature can result in extreme sex ratio biases. Knowledge of the primary sex ratio of populations with TSD is key for providing a baseline to inform management strategies and to accurately predict how future climate changes may affect turtle populations. However, there is a lack of robust data on offspring sex ratio at appropriate temporal and spatial scales to inform management decisions. To address this, we estimate the primary sex ratio of hawksbill hatchlings, Eretmochelys imbricata, from incubation duration of 5514 in situ nests from 10 nesting beaches from two regions in Brazil over the last 27 years. A strong female bias was estimated in all beaches, with 96% and 89% average female sex ratios produced in Bahia (BA) and Rio Grande do Norte (RN). Both inter-annual (BA, 88 to 99%; RN, 75 to 96% female) and inter-beach (BA, 92% to 97%; RN, 81% to 92% female) variability in mean offspring sex ratio was observed. These findings will guide management decisions in Brazil and provide further evidence of highly female-skew sex ratios in hawksbill turtles.

"'It is very difficult in this business if you want to have a good conscience': pharmaceutical governance and on-the-ground ethical labor in Ghana": a letter to editors.

Establishing effective pharmaceutical governance is a challenge for government agencies, private enterprises, and professionals working on the ground, demanding complex ethical decisions from the actors involved, especially in a lower-middle-income country like Ghana. This letter aims to share the author's perspectives and additional considerations on the analyses of the reports in the paper "It is very difficult in this business if you want to have a good conscience": pharmaceutical governance and on-the-ground ethical labor in Ghana by Hampshire et al. The letter's authors discuss the need to advance universal health coverage in Ghana, the everyday ethics, and the disparities between the collective and individual moral consciousness of the participants, as well as other aspects of governance in the pharmaceutical sector.

Nuclear markers reveal a complex introgression pattern among marine turtle species on the Brazilian coast.

Surprisingly, a high frequency of interspecific sea turtle hybrids has been previously recorded in a nesting site along a short stretch of the Brazilian coast. Mitochondrial DNA data indicated that as much as 43% of the females identified as Eretmochelys imbricata are hybrids in this area (Bahia State of Brazil). It is a remarkable find, because most of the nesting sites surveyed worldwide, including some in northern Brazil, presents no hybrids, and rare Caribbean sites present no more than 2% of hybrids. Thus, a detailed understanding of the hybridization process is needed to evaluate natural or anthropogenic causes of this regional phenomenon in Brazil, which could be an important factor affecting the conservation of this population. We analysed a set of 12 nuclear markers to investigate the pattern of hybridization involving three species of sea turtles: hawksbill (E. imbricata), loggerhead (Caretta caretta) and olive ridley (Lepidochelys olivacea). Our data indicate that most of the individuals in the crossings L. olivacea × E. imbricata and L. olivacea × C. caretta are F1 hybrids, whereas C. caretta × E. imbricata crossings present F1 and backcrosses with both parental species. In addition, the C. caretta × E. imbricata hybridization seems to be gender and species biased, and we also found one individual with evidence of multispecies hybridization among C. caretta × E. imbricata × Chelonia mydas. The overall results also indicate that hybridization in this area is a recent phenomenon, spanning at least two generations or ~40 years.

A Sociotechnical Approach to Analyze Pharmaceutical Policy and Services Management in Primary Health Care in a Brazilian Municipality.

The decentralization of the Brazilian health system required that municipalities took responsibility for the local Pharmaceutical Policy and Services (PPS) system. This article presents and analyses an innovative experience of diagnosis of municipal PPS as a sociotechnical system. We adopted a multi-methods approach and various data sources. Sociotechnical theory was the framework of the methodology of evaluation and design of systems, analyzing the External System (health system, stakeholders, financing) and Internal System (goals, management, workforce, infrastructure, processes, technology and culture). The "objective" component of the PPS system was identified as the central element. The lack of a unified objective and of a central coordination and unmanaged pharmaceutical services prevented integrated internal planning and planning with other sectors. Stakeholders and documents referred only to technical elements of the system: Infrastructure, technical process, and technology. The social components of the workforce and culture were not mentioned. The organizational culture established was the culture of isolation: "Each one does his own". The pharmacists working in the municipal health system did not know each other. There was no integration strategy between pharmacists and their work processes. Consequently, the municipal PPS had limited scope as a public policy. It had constrained the characteristics of PPS as a complex and open system. Understanding the municipal PPS as a sociotechnical system can push the development of a new level of policy and practice to ensure the population's right to the access to and rational use of medicines.

Impact of a Pharmacy Management Course for Pharmacists Working Within Brazil's Public Health System.

Objective. To assess the impact of a continuing education course that focused on the development of management competencies on pharmacists working in Brazil's public health system.Methods. A specialization blended in-service course (360 hours) entitled Pharmaceutical Service and Access to Medicine Management was offered to pharmacists working within the Brazilian public health system. Data on course outcomes were collected through individual interviews with pharmacists who worked in the Brazilian public health system, as well as from focus groups and records of researchers' observations. The analysis was based on models of learning and training evaluation theory.Results. The findings showed proximal outcomes on students' knowledge, skills, and attitudes; behavioral changes; and programmatic outcomes in the organization and management of health services, promoting the recognition and integration of the "pharmaceutical services division" - a dedicated sector within the health departments in municipalities and states. The inputs (course content, structure, and in-service hands-on activities) were directly linked to the outcomes reported by participants and helped them to overcome some of the barriers to using knowledge and skills in the workplace.Conclusion. A well-structured course including leaning activities to intervene in the workplace had a positive impact on pharmacists' behavior and contributed to the capacity building of the organizations in which they operate.

Vaccines in Brazil: historical analysis of the Sanitary registration and vaccine availability in the Brazilian Unified Health System. / Vacinas no Brasil: análise histórica do registro sanitário e a disponibilização no Sistema de Saúde.

Given the COVID-19 pandemic and the importance of public social protection policies, health issues, including immunizations, have gained prominence. This paper aims to analyze the dynamics of vaccine registration in Brazil and the vaccines made available through the National Immunization Program (PNI in Portuguese), with emphasis on the 2004-2018 vaccination schedule. This descriptive, exploratory, documentary research analyzed vaccine registration procedureswith the Brazilian Health Regulatory Agency (ANVISA, in Portuguese) and the incorporation of vaccine products into the PNI. The study drew on information from the national sanitary registration database, made available by ANVISA; a document analysis of official/normative publications; and data from published literature. The data shows the incorporation of vaccines into the PNI, evidencing that Brazil is a country with industrial potential for vaccine production but that is still focused on the transfer of technologies and in need of public attention and investments for developing new technologies as a way to ensure the sector's independence.

Com a pandemia da COVID-19 e a importância das políticas públicas de proteção social, questões sanitaristas incluindo as imunizações se tornaram destaque. O estudo tem o objetivo de analisar a dinâmica dos registros sanitários de vacinas no país e as vacinas disponibilizadas por meio do Programa Nacional de Imunização (PNI), com destaque para o calendário vacinal no período entre 2004 e 2018. Realizou-se um estudo descritivo, documental e exploratório dos processos de registro sanitário na Agência Nacional de Vigilância Sanitária (Anvisa) e a incorporação dos produtos no PNI. Como base da pesquisa foram utilizados o banco de dados de registro sanitário disponibilizado pela Anvisa, a análise documental de publicações oficiais/normativas e os dados da literatura. Os dados demonstram a incorporação das vacinas no PNI, assim como um país com potencial industrial para a produção das vacinas, no entanto ainda centrado na transferência de tecnologias, necessitando de investimentos e atenção pública no desenvolvimento de novas tecnologias, garantindo a independência do setor.

It is Possible to Achieve Tablets With Good Tabletability From Solid Dispersions - The Case of the High Dose Drug Gemfibrozil.

BACKGROUND: Solid Dispersions (SDs) have been extensively used to increase the dissolution of poorly water-soluble drugs. However, there are few studies exploring SDs properties that must be considered during tablet development, like tabletability. Poorly water-soluble drugs with poor compression properties and high therapeutic doses, like gemfibrozil, are an additional challenge in the production of SDs-based tablets. OBJECTIVE: This study evaluates the applicability of SDs to improve both tabletability and dissolution rate of gemfibrozil. A SD-based tablet formulation was also proposed. METHODS: SDs were prepared by ball milling, using hydroxypropyl methylcellulose (HPMC) as a carrier, according to a 23 factorial design. The formulation variables were gemfibrozil:HPMC ratio, milling speed, and milling time. The response in the factorial analysis was the tensile strength of the compacted SDs. Dissolution rate and solid-state characterization of SDs were also performed. RESULTS: SDs showed simultaneous drug dissolution enhancement and improved tabletability when compared to corresponding physical mixtures and gemfibrozil. The main variable influencing drug dissolution and tabletability was the gemfibrozil:HPMC ratio. Tablets containing gemfibrozil- HPMC-SD (1:0.250 w/w) and croscarmellose sodium showed fast and complete drug release, while those containing the same SD and sodium starch glycolate exhibited poor drug release due to their prolonged disintegration time. CONCLUSION: SDs proved to be effective for simultaneously improving tabletability and dissolution profile of gemfibrozil. Tablets containing gemfibrozil-HPMC-SD and croscarmellose sodium as disintegrating agent showed improved drug release and good mechanical strength, demonstrating the potential of HPMC-based SDs to simultaneously overcome the poor dissolution and tabletability properties of this drug.

Analysis of a Blended, In-Service, Continuing Education Course in a Public Health System: Lessons for Education Providers and Healthcare Managers.

Introduction: To train pharmacists working in the public health system, the Brazilian Ministry of Health developed a specialization course called Pharmaceutical Service and Access to Medicine Management (PSAMM) between 2010 and 2016. The course was free of charge and used e-learning as its main approach. In the end, 2,500 pharmacists were trained. The purpose of this study was to identify and analyze the strengths, weaknesses, opportunities, and threats of an in-service and e-learning course for pharmacists working in a public health system. Materials and Methods: Three workshops involving 67 participants were conducted at the conclusion of the course to analyze the perspective of the PSAMM course's faculty (tutors, regional coordinators, professors, and management committee) and students (pharmacists). Strengths, weaknesses, opportunities, and threats analysis and qualitative analysis methods were used. Results and Discussion: The strength dimension had the greatest number of items. The qualitative analysis resulted in six categories: the category "E-learning in continuing education" had the most cited items. Internal elements such as in-service hands-on activities directly related to the professionals' roles, course contents, faculty, and the methods to offer the course (the mixed methods and materials) were positively assessed. Nonetheless, external elements were considered critical for the course's outcomes such as investments in the infrastructure of pharmaceutical services, access to the internet, local managers' support for continuing education and innovation implementation, practice of interprofessional collaboration, and political stability. The continuing education course in the public health system was affected by internal elements such as its project and structure as well as external elements such as the sociopolitical scenario. Continuing education investment must be accompanied by infrastructure investment and coordination of services.

Genetic diversity and origin of leatherback turtles (Dermochelys coriacea) from the Brazilian coast.

The leatherback sea turtle (Dermochelys coriacea) population that nests in Brazil is restricted to a few individuals, but high densities of pelagic individuals are observed along the southern and southeastern Brazilian coast. We investigated the diversity of the mitochondrial DNA (mtDNA) control region in order to understand the relationship between nesting and pelagic leatherbacks from Brazil and elsewhere. High-quality 711-bp sequences were generated, analyzed, and compared with published data from worldwide populations. We detected the presence of shared haplotypes between nesting and pelagic aggregates from Brazil, as well as haplotypes shared with other nesting areas from the Atlantic and Pacific. Furthermore, the use of longer control region sequences allowed the subdivision of the common Atlantic haplotype A into 3 different haplotypes (A1, A3, and A4), thus improving the resolution of mtDNA-based leatherback phylogeography. The use of longer sequences partially supported a closer association between nesting and pelagic individuals from Brazil and pointed to a complex origin for the pelagic individuals in the Brazilian coast.

Construção de aplicativo móvel como estratégia para adesão medicamentosa de idosos / Construction of a mobile application as a strategy for medication adherence in the elderly population

Objetivo: Descrever o processo de desenvolvimento de um aplicativo como estratégia para promover a adesão medicamentosa de idosos. Métodos: Pesquisa metodológica de produção tecnológica. Foram seguidas as etapas de levantamento de dados, montagem de banco de dados e desenvolvimento do software. Realizou-se uma revisão narrativa da literatura sobre o tema. Resultados: Para o desenvolvimento da ferramenta tecnológica realizou-se inicialmente um protótipo do aplicativo. O objetivo central foi criar um programa de aplicação para lembrar o horário de medicamentos através de avisos sonoros e informações na tela, com foco na autonomia do processo saúde-doença do público idoso, utilizando-se de uma linguagem acessível, com fontes grandes e legíveis, com cores específicas para a tela de fundo e os Ooblets adequados para o entendimento do público-alvo. Conclusão: O aplicativo contribui na adesão medicamentosa por parte dos idosos, além de auxiliar os cuidadores sobre o uso correto, horário adequado e dosagem correta. A tecnologia proposta proporciona a corresponsabilização dos longevos no seu processo saúde-doença e adesão à terapêutica prescrita. Descritores: Tecnologia; Saúde do Idoso; Polimedicação; Cuidados de Enfermagem.

Objective: To describe the process of developing an application as a strategy to promote medication adherence in the elderly population.Methods:Methodological research of technological production. The steps of data survey, database assembly and software development were followed. A narrative review of the literature on the theme was performed.Results:In order to develop the technological tool, a prototype of the application was initially made. The central objective was to create an application program to remember the medication schedule through sound warnings and on-screen information, focusing on theautonomy of the health-disease process of the elderly population, using an accessible language, with large and legible fonts, with specific colors for the background screen and Ooblets suitable for the understanding of the target audience.Conclusion: Theapplication contributes to medication adherence by the elderly patients, in addition to helping caregivers regarding the correct use, appropriate time, and correct dosage. The proposed technology provides the co-responsibility of the elderly citizens in their health-disease process and adherence to the prescribed therapy. Descriptors:Technology; Health of the Elderly; Polypharmacy; Nursing Care.

Mulheres em situação de violência: reflexões sobre a atuação da enfermagem / Women in situations of violence: reflections on the performance of nursing / Mujeres en situación de violencia: reflexiones sobre la actuación de enfermería

O estudo objetiva discutir, a partir da análise reflexiva, o papel dos profissionais de enfermagem na assistência à mulher em situação de violência doméstica. Trata-se de uma reflexão ancorada a partir de pesquisas sobre a violência contra a mulher e a assistência de enfermagem no cuidado a essas mulheres. Evidenciou-se que os enfermeiros costumam ocupar um papel de destaque no atendimento à violência contra mulher, por seremum dos primeiros profissionais que as mulheres têm contato nos serviços de saúde. A enfermagem,nesse cenário,exerce açõesde acolhimento, escuta qualificada, rastreamento e prevenção de danos causados pela agressão, bem como busca a reinserção dessas mulheres na sociedade, garantindo o equilíbrio biopsicossocial.Espera-se, mediante as reflexões, contribuir para que os protocolos e diretrizes abordados neste estudo sejam colocados em prática de forma exitosa. Ademais, que esses questionamentos se transformem em discussões mais abrangentes, possibilitando, no futuro, que tais reflexões sejam alavanco para melhorias nas práticas assistenciais.

The study aims to discuss, based on reflective analysis, the role of nursing professionals in assisting women in situations of domestic violence. It is a reflection based on research on violence against women and nursing care in the care of these women. It was evident that nurses usually occupy a prominent role in the care of violence against women, as they are one of the first professionals that women have contact with in health services. Nursing, in this scenario, performs actions of reception, qualified listening, tracking and prevention of damage caused by aggression, as well as seeking the reintegration of these women into society, guaranteeing biopsychosocial balance. It is hoped, through reflections, to contribute to the successful implementation of the protocols and guidelines discussed in this study. In addition, these questions are transformed into more comprehensive discussions, allowing, in the future, that such reflections are leverage for improvements in care practices.

El estudio tiene como objetivo discutir, a partir del análisis reflexivo, el papel de los profesionales de enfermería en la asistencia a las mujeres en situación de violencia doméstica. Se trata de una reflexión a partir de investigaciones sobre la violencia contra la mujer y los cuidados de enfermería en el cuidado de estas mujeres. Se evidenció que las enfermeras suelen ocupar un papel destacado en la atención de la violencia contra la mujer, ya que son uno de los primeros profesionales con los que las mujeres tienen contacto en los servicios de salud. Enfermería, en ese escenario, realiza acciones de acogida, escucha calificada, seguimiento y prevención de los daños causados por la agresión, además de buscar la reinserción de estas mujeres a la sociedad, garantizando el equilibrio biopsicosocial. Se espera, a través de reflexiones, contribuir a la implementación exitosa de los protocolos y directrices discutidos en este estudio. Además, esas preguntas se transforman en discusiones más comprensivas, permitiendo, en el futuro, que tales reflexiones sean palanca para mejoras en las prácticas de cuidado.

Medicine dispensing service in primary health care of SUS.

OBJECTIVE: To characterize the medicine dispensing services in the primary health care network in Brazil and in its different regions, aiming to promote the access and rational use of medicines. METHODS: This is a cross-sectional, quantitative study with data obtained from the Pesquisa Nacional sobre Acesso, Utilização e Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), 2015. Observation visits were carried out in 1,175 dispensing units, and interviews were held with 1,139 professionals responsible for the dispensation of medicines in the dispensing units and 495 municipal coordinators of pharmaceutical services. RESULTS: More than half (53%) of the units presented a space smaller than 10 m2 for dispensing of medicines; 23.8% had bars or barriers between users and dispenser; 41.7% had computerized system; and 23.7% had counters for individual care. Among those responsible for dispensation, 87.4% said they always or repeatedly inform users how to use the medicines, and 18.1% reported developing some type of clinical activity. Isolated pharmacies presented a more developed physical and personal structure than those belonging to health units, but we found no significant differences regarding the information provided and the development of clinical activities. CONCLUSIONS: There are major differences in the organization models of dispensation between cities, with regional differences regarding the physical structure and professionals involved. The centralization of medicine dispensing in pharmacies separated from the health services is associated with better structural and professional conditions, as in the dispensing units of the South, Southeast, and Midwest regions. However, the development of dispensation as health service does not prevail in any pharmacy or region of the Country yet.

Towards a theoretical model on medicines as a health need.

Medicines are considered one of the main tools of western medicine to resolve health problems. Currently, medicines represent an important share of the countries' healthcare budget. In the Latin America region, access to essential medicines is still a challenge, although countries have established some measures in the last years in order to guarantee equitable access to medicines. A theoretical model is proposed for analysing the social, political, and economic factors that modulate the role of medicines as a health need and their influence on the accessibility and access to medicines. The model was built based on a narrative review about health needs, and followed the conceptual modelling methodology for theory-building. The theoretical model considers elements (stakeholders, policies) that modulate the perception towards medicines as a health need from two perspectives - health and market - at three levels: international, national and local levels. The perception towards medicines as a health need is described according to Bradshaw's categories: felt need, normative need, comparative need and expressed need. When those different categories applied to medicines coincide, the patients get access to the medicines they perceive as a need, but when the categories do not coincide, barriers to access to medicines are created. Our theoretical model, which holds a broader view about the access to medicines, emphasises how power structures, interests, interdependencies, values and principles of the stakeholders could influence the perception towards medicines as a health need and the access to medicines in Latin American countries.

Involvement of the nitric oxide/soluble guanylate cyclase pathway in the anti-oedematogenic action of Pfaffia glomerata (Spreng) Pedersen in mice.

Pfaffia glomerata is used in southern American countries against inflammatory diseases. We have explored the ability of a crude hydroalcoholic extract of P. glomerata root (HEPG) to prevent the oedematogenic action of several inflammatory agents in mice. We have examined also the duration of its effects and the mechanisms involved. The oral or intraperitoneal treatment of mice with HEPG (1, 10, 30, 100 or 300 mg kg(-1)) reduced, in a dose-dependent manner, carrageenan-induced paw oedema in the early (1-4 h) and late (48 h) periods. In the early period, the ID50 value (the median dose that caused 50% inhibition) of HEPG was 60.5 (28.5-128.71) and 20.4 (14.8-28.3) mg kg(-1) after oral and intraperitoneal administration, respectively. This effect was still evident when HEPG was administered up to 6 h before carrageenan. HEPG inhibited also paw oedema induced by histamine, serotonin, bradykinin, substance P and bacterial lipopolysaccharide. In addition, oral administration of HEPG increased the levels of nitrate and nitrite in the blood of mice. Further, its anti-oedematogenic action against carrageenan was prevented fully by N(G) nitro-L-arginine-methyl-ester (10 mg kg(-1), s.c.), as well as by methylene blue (20 mg kg(-1), s.c.) or 1H-[1,2,4]oxadiazolo[4,3-alpha]quinoxalin-1-one (2 mg kg(-1), s.c.). The results indicated that stimulation of endogenous production of nitric oxide, followed by soluble guanylate cyclase activation, was implicated in the anti-oedematogenic action of HEPG.

Vacinas no Brasil: análise histórica do registro sanitário e a disponibilização no Sistema de Saúde / Vaccines in Brazil: historical analysis of the Sanitary registration and vaccine availability in the Brazilian Unified Health System

Resumo Com a pandemia da COVID-19 e a importância das políticas públicas de proteção social, questões sanitaristas incluindo as imunizações se tornaram destaque. O estudo tem o objetivo de analisar a dinâmica dos registros sanitários de vacinas no país e as vacinas disponibilizadas por meio do Programa Nacional de Imunização (PNI), com destaque para o calendário vacinal no período entre 2004 e 2018. Realizou-se um estudo descritivo, documental e exploratório dos processos de registro sanitário na Agência Nacional de Vigilância Sanitária (Anvisa) e a incorporação dos produtos no PNI. Como base da pesquisa foram utilizados o banco de dados de registro sanitário disponibilizado pela Anvisa, a análise documental de publicações oficiais/normativas e os dados da literatura. Os dados demonstram a incorporação das vacinas no PNI, assim como um país com potencial industrial para a produção das vacinas, no entanto ainda centrado na transferência de tecnologias, necessitando de investimentos e atenção pública no desenvolvimento de novas tecnologias, garantindo a independência do setor.

Abstract Given the COVID-19 pandemic and the importance of public social protection policies, health issues, including immunizations, have gained prominence. This paper aims to analyze the dynamics of vaccine registration in Brazil and the vaccines made available through the National Immunization Program (PNI in Portuguese), with emphasis on the 2004-2018 vaccination schedule. This descriptive, exploratory, documentary research analyzed vaccine registration procedureswith the Brazilian Health Regulatory Agency (ANVISA, in Portuguese) and the incorporation of vaccine products into the PNI. The study drew on information from the national sanitary registration database, made available by ANVISA; a document analysis of official/normative publications; and data from published literature. The data shows the incorporation of vaccines into the PNI, evidencing that Brazil is a country with industrial potential for vaccine production but that is still focused on the transfer of technologies and in need of public attention and investments for developing new technologies as a way to ensure the sector's independence.

Uso de aplicativos móveis no processo de ensino-aprendizagem na graduação em enfermagem / Uso de aplicaciones móviles en el proceso de enseñanza-aprendizaje en la graduación en enfermería / Use of mobile applications in the teaching-learning process in nursing graduation

Objetivo identificar os aplicativos móveis disponíveis para o ensino de exame-físico e procedimentos de enfermagem e como estes têm contribuído com o processo de ensino-aprendizagem na graduação de enfermagem. Método revisão integrativa da literatura, realizada em abril de 2020, conforme protocolo pré-definido e recomendações PRISMA. Resultados os aplicativos Oiva®, Vital Easy®, Whatsapp®, Facebook® e e-mails foram identificados como utilizáveis no processo de ensino-aprendizagem na graduação em enfermagem, contribuindo com maior interação entre estudantes e professores, esclarecimento de dúvidas e como fonte de informação para consultas. Conclusão a utilização de aplicativos móveis é pertinente no processo de ensino-aprendizagem na graduação de enfermagem, por oportunizar a troca de experiências e informações entre indivíduos pertencentes a diferentes realidades, ampliando o acesso ao conteúdo, possibilitando o engajamento, limitando barreiras geográficas e adequando-se a realidades específicas.

Objetivo identificar las aplicaciones móviles disponibles para la enseñanza de los procedimientos de examen físico y procedimientos de enfermería y cómo han contribuido al proceso de enseñanza-aprendizaje en la graduación en enfermería. Método revisión integrativa de la literatura, realizada en abril de 2020, de acuerdo con el protocolo predefinido y las recomendaciones PRISMA. Resultados las aplicaciones Oiva®, Vital Easy®, Whatsapp®, Facebook® y correos electrónicos fueron identificados como utilizables en el proceso de enseñanza-aprendizaje en la graduación enfermería, contribuyendo con una mayor interacción entre estudiantes y profesores, aclarando dudas y como fuente de información para consultas. Conclusión el uso de aplicaciones móviles es relevante en el proceso de enseñanza-aprendizaje en la graduación en enfermería, ya que proporciona oportunidades para el intercambio de experiencias e información entre personas pertenecientes a diferentes realidades, ampliando el acceso a los contenidos, permitiendo el compromiso, limitando las barreras geográficas y adaptándose a realidades específicas.

Objective to identify the mobile applications available for the teaching of physical examination and nursing procedures and how they have contributed to the teaching-learning process in nursing graduation. Method integrative literature review, conducted in April 2020, according to predefined protocol and PRISMA recommendations. Results the applications Oiva®, Vital Easy®, Whatsapp®, Facebook® and e-mails were identified as usable in the teaching-learning process in nursing graduation, contributing to greater interaction between students and professors, clarification of doubts and as a source of information for lookup. Conclusion the use of mobile applications is relevant in the teaching-learning process in nursing graduation, because they provide opportunities for the exchange of experiences and information between individuals belonging to different realities, expanding access to content, enabling engagement, limiting geographical barriers and adapting to specific realities.