Outpatient pharmaceutical office: access to medicines in public health

Abstract We evaluated the implementation of the outpatient pharmaceutical office in a teaching hospital regarding the access to medicines available in the Unified Health System - SUS. This is a descriptive-analytical study, based on secondary data analysis of 735 appointments performed by the pharmacist from 2015 to 2017. Of the drugs prescribed to patients attended at the outpatient pharmacist office, 86.39% were listed in the National List of Essential Medicines - RENAME, of which 95.43% belonged to the Specialized Component of Pharmaceutical Assistance. Evaluating the patient's diagnosis against the inclusion criteria of the Clinical Protocols and Therapeutic Guidelines (PCDT), that the most frequent pharmaceutical interventions were: adequacy of the medication request documents (56.4%) and examination requests for pharmacotherapeutic follow up (28.5%). When the prescribed drugs were not included in RENAME/PCDT, the intervention was accepted in 90.3% of the proposals for exchange with available drug in SUS. Still, it was possible to refer the patient to primary care for renewal of continuity of treatment in 95.1% of cases. In conclusion, the role of the clinical pharmacist contributes to the resolution of untreated health problems by promoting access to medicines within the scope of SUS and their rational use in accordance with the PCDT.

Caracterización de los sistemas productores de conejos en el municipio Ciego de Ávila, Cuba / Characterization of rabbit production systems in the Ciego de Ávila municipality, Cuba

Resumen La crianza de conejos contribuye a la obtención de proteína animal, así como de ingresos por la venta de dicha especie. La descripción y caracterización de los sistemas de producción de estos animales arrojan información valiosa para el diseño de planes de intervención y mejoras. El objetivo del presente trabajo fue determinar las principales variables que influyen en la heterogeneidad de los sistemas productores de conejos en el municipio Ciego de Ávila, Cuba. La muestra estuvo formada por 49 fincas. Se obtuvo la información cuantitativa de indicadores productivos, reproductivos y sociales, a través de un análisis de factores, usando componentes principales (CP). Se calcularon las puntuaciones factoriales de cada caso, en cada CP, y los estadísticos descriptivos de los indicadores medidos. En las condiciones del territorio estudiado, la eficiencia estuvo determinada por 6 CP que explicaron el 77.6 % de la varianza: 1) tamaño del rebaño y áreas de forrajes; 2) comportamiento reproductivo; 3) edad del productor y manejo reproductivo; 4) mortalidad; 5) edad al destete y sacrificio y 6) número de montas para gestar las conejas. La caracterización a partir del uso de CP, y el índice factorial de cada caso de estudio en cada CP, sirve de base para interpretar la gran heterogeneidad existente en los indicadores estudiados, así como su similitud, y contribuye a definir relaciones y comportamientos en la caracterización de fincas cunícolas en esta región, lo que permitirá implementar planes de mejora productiva.

Abstract The breeding of rabbits contributes to obtaining animal protein and generating income from the sale of this species. The description and characterization of the production systems of these animals provide valuable information for the design of intervention and improvement plans. The aim of this study was to determine the main variables that influence the heterogeneity of the rabbit production systems in the Ciego de Ávila municipality, Cuba. The sample consisted of 49 farms. Quantitative data on productive, reproductive and social indicators were obtained through factor analysis using principal components (PC). The factor scores of each case were calculated, in each PC, and descriptive statistics of the indicators measured. In the conditions of the studied territory, the efficiency was determined by 6 PC that explained 77.6 % of the variance: 1) size of the herd and forage areas; 2) reproductive behavior; 3) age of the producer and reproductive management; 4) mortality; 5) age at weaning and age at slaughter and 6) number of mounts to gestate the breeders. The characterization from the use of PC, and the factor index for each case study in each PC, serve as the basis for interpreting the great existing heterogeneity in the indicators studied, as well as their similarity. It also contributes to defining relationships and behaviors in the characterization of rabbit farms in this region, which will allow the implementation of productive improvement plans.

Diagnóstico y tratamiento de la rinosinusitis crónica en adultos. Consenso de expertos: Asociación Colombiana de Otorrinolaringología-2021. / Diagnosis and treatment of chronic rhinosinusitis in adults. Expert consensus: Asociación Colombiana de Otorrinolaringología -2021.

Introducción: la Rinosinusitis Crónica se define como la inflamación crónica de la nariz y los senos paranasales por más de 12 semanas. La prevalencia varía entre el 5% - 30% de acuerdo con la zona geográfica según un estudio de carga de enfermedad (2012-2014), la prevalencia de las enfermedades respiratorias crónicas (rinitis y sinusitis crónica) varió entre el 10% y el 25%. Objetivo: establecer un conjunto de consideraciones basadas en consenso de expertos, para el diagnóstico y el tratamiento de la rinosinusitis crónica en pacientes adultos, en el contexto colombiano. Métodos: se llevó a cabo un consenso formal (Delphi y nominal). Se conformó un grupo de expertos, se definieron el alcance y las preguntas. Se realizaron dos rondas de calificación anónimas, y una discusión para las preguntas sin consenso. En las preguntas con opciones de uno a nueve, se consideró consenso con una mediana de uno a tres o de siete a nueve. En las preguntas tipo Likert, se consideró consenso un porcentaje igual o superior al 80% en acuerdos o desacuerdos. Resultados: se definieron y calificaron 18 preguntas, con la participación de 17 otorrinolaringólogos, de 8 ciudades colombianas, todos miembros de la Asociación Colombiana de Otorrinolaringología y con un promedio de experticia de 19.2 años (Desviación estándar [DE]: 10,2). Se obtuvieron 18 recomendaciones para el diagnóstico y el tratamiento de esta patología. Conclusiones: las recomendaciones emitidas por los expertos permiten orientar y estandarizar el diagnóstico y el tratamiento de la rinosinusitis crónica en adultos, en el contexto de los servicios de salud en Colombia.

Introduction: Chronic Rhinosinusitis is defined as chronic inflammation of the nose and paranasal sinuses for more than 12 weeks. The prevalence varies between 5% - 30% depending on the geographical area according to a disease burden study (2012-2014), the prevalence of chronic respiratory diseases (rhinitis and chronic sinusitis) varied between 10% - 25%. Objective: To establish a set of considerations based on expert consensus, for the diagnosis and treatment of chronic rhinosinusitis in adult patients, in the Colombian context. Methods: A formal consensus (Delphi and nominal) was carried out. A group of experts was formed, the scope and questions were defined. Two anonymous grading rounds were conducted, and a discussion for questions without consensus. In the Questions with options from one to nine were considered consensus with a median of one to three or seven to nine. In the Likert-type questions, a percentage equal to or greater than 80% in agreements or disagreements was considered consensus. Results: 18 questions were defined and scored, with the participation of 17 otorhinolaryngologists, from eight Colombian cities, all members of the Colombian Association of Otorhinolaryngology and with an average experience of 19.2 years (Standard desviation [SD]: 10.2). 18 recommendations were obtained for the diagnosis and treatment of this pathology. Conclusions: The recommendations issued by the experts allow to guide and standardize the diagnosis and treatment of chronic rhinosinusitis in adults, in the context of health services in Colombia.

Características sociodemográficas e histopatológicas en pacientes con cáncer gástrico en una población con alto riesgo en Colombia / Sociodemographic and histopathological characteristics of patients with gastric cancer in a high-risk population in Colombia

Resumen Objetivo: describir las características sociodemográficas e histopatológicas en pacientes con diagnóstico de adenocarcinoma gástrico en la Clínica Oncológica Aurora, durante el período 2014-2017 en la ciudad de Pasto, Colombia. Métodos: se realizó un estudio descriptivo en una cohorte de 54 pacientes con diagnóstico de cáncer gástrico sometidos a gastrectomía durante los años 2014 a 2017. La información sociodemográfica se obtuvo a través de la historia clínica. El sistema de Sydney y la clasificación de Lauren se usaron para determinar las características histopatológicas. Resultados: la mayoría de los tumores se presentó en hombres mayores de 50 años (relación hombre mujer de 2,6:1). La ubicación predominante fue la región antropilórica. El histotipo tumoral más frecuente fue el intestinal (80%). La prevalencia de Helicobacter pylori en pacientes fue del 24,07% y fue mayor en el histotipo intestinal. La metaplasia intestinal fue la lesión premaligna más prevalente en todos los histotipos tumorales. Conclusiones: en el presente estudio se encontró que la edad mayor a 50 años y el sexo masculino son condiciones asociadas con el cáncer gástrico; hallazgo ya demostrado en estudios previos. Es perentorio avanzar en el mejoramiento de las condiciones de salud pública, control de la infección por H. pylori y tamizaje temprano de lesiones premalignas, pues son factores determinantes en la carcinogénesis de pacientes con carcinomas no cardiales e histotipos intestinales ubicados en la región antrocorporal. Aunque no se encontraron diferencias significativas entre los histotipos tumorales, el adenocarcinoma de tipo intestinal ubicado en la región antropilórica fue el diagnóstico más frecuente.

Abstract Objective: To describe the sociodemographic and histopathological characteristics of patients diagnosed with gastric adenocarcinoma at the Clínica Oncológica Aurora between 2014 and 2017 in the city of Pasto, Colombia. Methodology: A descriptive study was carried out in a cohort of 54 patients diagnosed with gastric cancer who underwent gastrectomy between 2014 and 2017. Sociodemographic information was taken from the medical records of the patients. The Sydney system and Lauren classification were used to determine histopathological characteristics. Results: Most tumors were found in men older than 50 years (with a male:female ratio of 2.6:1). The predominant location was the antropyloric region. The most frequent tumor histotype was intestinal (80%). The prevalence of Helicobacter pylori in patients was 24.07 % and it was most commonly found in the intestinal histotype. Intestinal metaplasia was the most prevalent premalignant lesion in all tumor histotypes. Conclusions: The present study found that the age of 50 and the male sex are conditions associated with gastric cancer. This finding has already been demonstrated in previous studies. Progress in improving public health conditions, controlling H. pylori infection, and early screening of premalignant lesions is imperative, as they are determining factors of carcinogenesis in patients with non-cardia carcinomas and intestinal histotypes located in the anthrocorporal region. Although no significant differences were found among tumor histotypes, intestinal adenocarcinoma in the antropyloric region was the most frequent diagnosis.

Abscisic acid and in vitro conservation of Manihot wild species / Abscisic acid and in vitro conservation of Manihot wild species

Abscisic acid (ABA) is associated with bud dormancy, leaf abscission, and germplasm growth inhibition in in vitro conservation. We evaluated the effects of ABA in four wild Manihot accessions and one cassava accession (M. esculenta Crantz) to refine in vitro conservation methods for these species. The experiment was performed at the Laboratory for Tissue Culture from Embrapa, Cruz das Almas, Bahia State, Brazil. The statistical design was completely random in a 5 × 5 factorial scheme [(5 ABA dosages (0, 0.25, 0.50, 0.75, and 1 mg L-1) and 5 Manihot species (M. pseudoglaziovii, M. tristis, M. flabellifolia, M. chlorosticta, and M. esculenta)], with 15 replicates. Mini-cuttings of 1 cm were used, each inoculated in 10 mL of modified Murashige and Skoog medium, solidified with Phytagel® (2.4 g L-1) containing the respective ABA dosages. Tubes containing these mini-cuttings were placed in a germplasm conservation room with an irradiance of 30 µmol m-2 s-1, temperature of 22 ± 1°C, and photoperiod of 12 hours. Plant height (cm), the number of living and senescent leaves, shoots, and mini-cuttings (1 cm), and fresh and dry weights of shoots and roots (mg) were evaluated after 150 days. Growth reduction was prominent in M. pseudoglaziovii, M. tristis, and M. flabellifolia during the in vitro conservation period. In the present study, the addition of ABA did not promote the expected re

Abscisic acid (ABA) is associated with bud dormancy, leaf abscission, and germplasm growth inhibition in in vitro conservation. We evaluated the effects of ABA in four wild Manihot accessions and one cassava accession (M. esculenta Crantz) to refine in vitro conservation methods for these species. The experiment was performed at the Laboratory for Tissue Culture from Embrapa, Cruz das Almas, Bahia State, Brazil. The statistical design was completely random in a 5 × 5 factorial scheme [(5 ABA dosages (0, 0.25, 0.50, 0.75, and 1 mg L-1) and 5 Manihot species (M. pseudoglaziovii, M. tristis, M. flabellifolia, M. chlorosticta, and M. esculenta)], with 15 replicates. Mini-cuttings of 1 cm were used, each inoculated in 10 mL of modified Murashige and Skoog medium, solidified with Phytagel® (2.4 g L-1) containing the respective ABA dosages. Tubes containing these mini-cuttings were placed in a germplasm conservation room with an irradiance of 30 µmol m-2 s-1, temperature of 22 ± 1°C, and photoperiod of 12 hours. Plant height (cm), the number of living and senescent leaves, shoots, and mini-cuttings (1 cm), and fresh and dry weights of shoots and roots (mg) were evaluated after 150 days. Growth reduction was prominent in M. pseudoglaziovii, M. tristis, and M. flabellifolia during the in vitro conservation period. In the present study, the addition of ABA did not promote the expected re

Species delimitation reveals an underestimated diversity of Andean catfishes of the family Astroblepidae (Teleostei: Siluriformes)

Catfishes of the family Astroblepidae form a group composed by 82 valid species of the genus Astroblepus inhabiting high-gradient streams and rivers throughout tropical portions of the Andean Cordillera. Little has been advanced in the systematics and biodiversity of astroblepids other than an unpublished thesis, a single regional multilocus study and isolated species descriptions. Here, we examined 208 specimens of Astroblepus that apparently belong to 16 valid species from several piedmont rivers from northern Colombia to southern Peru. Using three single-locus approaches for species delimitation in combination with a species tree analysis estimated from three mitochondrial genes, we identified a total of 25 well-delimited lineages including eight valid and 17 potential undescribed species distributed in two monophyletic groups: the Central Andes Clade, which contains 14 lineages from piedmont rivers of the Peruvian Amazon, and the Northern Andes Clade with 11 lineages from trans- and cis-Andean rivers of Colombia and Ecuador, including the Orinoco, Amazon, and Magdalena-Cauca basins and Pacific coastal drainages. Results of species delimitation methods highlight several taxonomical incongruences in recently described species denoting potential synonymies.(AU)

Los bagres de la familia Astroblepidae son un grupo compuesto por 82 especies válidas del género Astroblepus que habitan quebradas y ríos de alto gradiente a través de la porcion tropical en la Cordillera de los Andes. Poco se ha avanzado en la sistemática y biodiversidad de los astroblepidos aparte de una tesis no publicada, un único estudio multilocus regional y descripciones aisladas de especies. Aquí, examinamos 208 especímenes de Astroblepus que aparentemente pertenecen a 16 especies válidas provenientes de ríos de pie de monte de la cordillera de los Andes, desde el norte de Colombia hasta el sur de Perú. Utilizando tres metodologías de delimitación de especies para un único locus en combinación con análisis de un árbol de especies a partir de tres genes mitocondriales, identificamos un total de 25 linajes bien definidos que incluyen ocho especies válidas y 17 potenciales especies no descritas distribuidas en dos grupos monofiléticos: un clado de los andes centrales, que contiene 14 especies de los ríos de pie de monte de la Amazonía peruana y un clado de los andes del norte con 11 especies de los ríos trans y cisandinos de Colombia y Ecuador, incluyendo las cuencas del Orinoco, Amazonas y Magdalena-Cauca así como drenajes costeros del Pacífico. Los resultados de los métodos de delimitación de especies destacan varias incongruencias taxonómicas en especies recientemente descritas que denotan posibles sinonimias.(AU)

Meningoencefalitis por Cryptococcus gattii en un paciente pediátrico con cirrosis: Reporte de caso / Cryptococcus gattii meningoencephalitis in a pediatric patient with cirrhosis: Case report

Resumen Introducción: En Colombia, la criptococosis es una infección fúngica invasiva poco frecuente. Objetivo: Reportar el caso clínico de un niño con meningoencefalitis por Cryptococcus gattii que tenía como factor de riesgo una disfunción inmune asociada a cirrosis, un factor de riesgo descrito en adultos pero no reportado en niños. Materiales y métodos: Se realizó una revisión no sistemática de la literatura y un resumen de los aspectos más relevantes de la historia clínica. Resultados: Se presenta el caso de un paciente masculino de 16 años con antecedente de cirrosis quien consultó por un cuadro clínico de 8 días de evolución de fiebre, emesis persistente, cefalea frontal, fotofobia y tinitus. Al examen físico no presentaba alteraciones neurológicas. En el estudio del líquido cefalorraquídeo las pruebas moleculares directas fueron positivas para Cryptococcus neoformans/gattii y el cultivo reportó crecimiento de Cryptococcus gattii. Conclusión: En este caso se destaca la importancia de sospechar infecciones oportunistas en pacientes que tienen inmunodeficiencia no solo secundaria a las infecciones por VIH, sino también a la producida por otros factores que alteran la respuesta inmunológica como la cirrosis.

Abstract Introduction: In Colombia, cryptococcosis is a rare invasive fungal infection. Objective: To report the clinical case of a child with Cryptococcus gattii meningoencephalitis whose risk factor was immune dysfunction associated with cirrhosis, a risk factor described in adults which in the reviewed literature has not been reported in children. Materials and methods: A non-systematic review of the literature and a summary of the most relevant aspects of the clinical history were performed. Results: We present the case of a 16-year-old male patient with a history of cirrhosis who came for consultation with a clinical presentation of 8 days of fever, persistent emesis, frontal headache, photophobia and tinnitus. The physical examination did not present neurological alterations. In the study of cerebrospinal fluid, he presented positive direct molecular tests for Cryptococcus neoformans/gattii and the culture reported growth of Cryptococcus gattii. Conclusion: In this case, the importance of suspecting opportunistic infections in patients who have immunodeficiencies not only secondary to HIV infections, but also to those caused by other factors that alter the immune response such as cirrhosis is highlighted.

A política de narratividade na pesquisa-intervenção participativa / Narrative policy in participatory research-intervention

Resumo Este artigo visa discutir a política de narratividade em pesquisas-intervenção participativas relacionadas à gestão autônoma da medicação (GAM). Escutar e legitimar a experiência dos usuários de saúde mental é um ponto-chave para a GAM, assim como para as pesquisas-intervenção participativas. A valorização da experiência dos participantes da pesquisa se desdobra no problema das narrativas como meio de acesso e inclusão da experiência. O artigo se baseia em dois projetos de pesquisa já concluídos, realizados em Centros de Atenção Psicossocial de municípios do interior do Rio de Janeiro. Falamos de política de narratividade na medida em que a produção de narrativas evidencia a legitimação necessária de pontos de vista comumente excluídos. Tal política diz respeito, por um lado, ao funcionamento dos grupos de intervenção com usuários, trabalhadores e pesquisadores como espaços de compartilhamento de experiências e discussão sobre o tema da medicação. Por outro, diz respeito à tradução deste diálogo em textos escritos, relativos ao registro da pesquisa (memórias) e à restituição do conhecimento produzido em grupos narrativos, nos quais os participantes são chamados a produzir o conhecimento em coautoria. Destacaremos que há uma política de narratividade da GAM que se caracteriza por mobilizar e sustentar um diálogo com base na alteridade da experiência.

Abstract This paper aims to discuss the narrative policy in participatory research-intervention related to Gaining Autonomy & Medication Management (GAM). Listening and legitimizing the experience of users of mental health services is a key point for GAM, as well as for participatory research-intervention. The appreciation of the research participants' experience unfolds in the problem of narratives as a medium of access and inclusion of the experience. This article is based on two research projects already completed, carried out in Psychosocial Care Centers of inland cities of the state of Rio de Janeiro. We talk about narrativity policy as the production of narratives evidences the necessary legitimation of commonly excluded points of view. Such policy concerns, on the one hand, the operation of intervention groups with users, workers and researchers as spaces for sharing experiences and discussing about medication. On the other hand, it concerns the translation of this dialogue in the form of written texts, related to the research register (memories) and to the restitution of the knowledge produced in narrative groups, in which the participants are called to produce knowledge in co-authorship. We highlight that there is a narrative policy of GAM characterized by mobilizing and sustaining a dialogue based on the alterity of the experience.

Diallel among soybean genotypes with high oil content and resistance to sudden death syndrome

The objective of this work was to use a partial diallel to evaluate the combining ability of 14 soybean genotypes and recommend superior combinations. Seven of the genotypes had high oil yield; other seven exhibited tolerance to sudden death syndrome and they generated 49 hybrids in a diallel cross without reciprocals. F2plants of each cross and the parents were evaluated for the following traits: number of days to maturity (NDM), oil content in the seeds (OC), grain yield (GY) and oil yield (OY). The results indicated the existence of genetic variability in the parents and progeny for all the traits. The rank of the parents based on the means was similar to the rank based on general combining ability (GCA) for all the traits. The specific combining ability (SCA) and the GCA were significant for all the traits, with a predominance of additive effects. The parent with the highest GCA and mean for OC was the cultivar A 7002; on the other hand, the lowest values were found in PI 520733 and IAC 100. The crosses with the highest oil yields were those involving parent A 7002, except when it was crossed with IAC 100.

O uso da entrevista na pesquisa-intervenção participativa em saúde mental: o dispositivo GAM como entrevista coletiva / The use of interviews in participative intervention and research: the GAM tool as a collective interview

O artigo propõe-se a discutir um modo de fazer entrevista em sintonia com o ideário da Reforma Psiquiátrica brasileira. Na metodologia de uma pesquisa-intervenção participativa da saúde mental, a entrevista é um procedimento menos de coleta do que de colheita de dados; voltada ao cultivo dos princípios da atenção psicossocial, da autonomia como direção do tratamento, do protagonismo do usuário e de sua rede social e de sua participação cidadã. Inspirados na técnica da entrevista de explicitação, entendemos que o manejo da entrevista supõe uma atitude de abertura capaz de promover e acolher diferentes pontos de vista. Tal atitude faz da entrevista uma experiência coletiva, de compartilhamento e de pertencimento, permitindo que os participantes se reposicionem subjetivamente e que haja a contração de grupalidade. Como exemplo do emprego da entrevista como ferramenta metodológica na investigação em saúde mental é citada a pesquisa de adaptação do dispositivo Gestão Autônoma da Medicação (GAM). É uma abordagem de intervenção norteada por princípios que valorizam a autonomia e o protagonismo dos usuários de psicofármacos, a sua qualidade de vida, os seus direitos e o reconhecimento das significações plurais da medicação e entendido aqui como uma prática de entrevista coletiva.

This paper seeks to assess a way of conducting interviews in line with the ideology of Brazilian Psychiatric Reform. In the methodology of participative intervention and research in mental health, the interview is less a data collection than a data harvesting procedure. It is designed to apply the principles of psychosocial care, autonomy as the basis for treatment, the predominance of the users and of their social networks and civic participation. Inspired by the Explicitation Interview technique, the contention is that the handling of the interview presupposes an open attitude able to promote and embrace different viewpoints. This attitude makes the interview a collective experience of sharing and belonging, allowing participants to reposition themselves subjectively in treatment with the emergence of groupality. As an example of using the interview as a methodological tool in mental health research, we examine research into adaptation of the tool of Autonomous Medication Management (GAM). It is an interventionist approach guided by principles that foster autonomy and the protagonist status of users of psychotropic medication, their quality of life, their rights and recognition of the multiple significances of medication, understood here as a collective interview technique.

Autonomia e cogestão na prática em saúde mental: o dispositivo da gestão autônoma da medicação (GAM) / Autonomy and co-management in mental health practice: the autonomous medication management device (AMM)

O artigo aborda a articulação entre autonomia e cogestão nas práticas em saúde mental no Brasil, baseado em estudo multicêntrico. Tal estudo objetivou a elaboração do Guia Brasileiro da Gestão Autônoma da Medicação (Guia GAM-BR), com base na tradução e adaptação do Guia GAM desenvolvido no Quebec - instrumento dirigido a pessoas com transtornos mentais graves. Uma primeira versão do Guia GAM traduzida e adaptada ao contexto brasileiro foi utilizada em Grupos de Intervenção (GI) com usuários de serviços de saúde mental nos campos da pesquisa. A construção da versão final do Guia GAM brasileiro incluiu as modificações propostas pelos GI em cada campo, debatidas em reuniões multicêntricas com a participação de pesquisadores, trabalhadores e usuários integrantes dos GI. No curso da pesquisa, a estratégia GAM assumiu o desafio de propor-se como prática cogestiva, compatibilizando exercício da autonomia, direito e protagonismo dos usuários com o funcionamento e cultura organizacional das instituições de saúde mental.(AU)

The present paper discusses the relation of autonomy and co-management on Brazil´s mental health practices following a previous multicenter approach. That approach aimed at translating, adapting, and testing in Brazil the Autonomous Medication Management Guide (AMMG), a Canadian tool directed for people with severe mental disorders. A first version of the AMMG, translated and adapted to the Brazilian context, was applied through Intervention Groups (IGs) of mental health users at each research center. Resulting on a final version of the Brazilian AMMG including modifications discussed in multicenter meetings where researchers, workers, and users of the IGs attended. The AMM strategy has therefore taken the challenge to propose itself as a co-management mental health practice, combining exercise of autonomy, rights and role of the users with the operation and organizational culture of mental health institutions.(AU)