Development of a Small Molecule Downmodulator for the Transcription Factor Brachyury.

Brachyury is an oncogenic transcription factor whose overexpression drives chordoma growth. The downmodulation of brachyury in chordoma cells has demonstrated therapeutic potential, however, as a transcription factor it is classically deemed "undruggable". Given that direct pharmacological intervention against brachyury has proven difficult, attempts at intervention have instead targeted upstream kinases. Recently, afatinib, an FDA-approved kinase inhibitor, has been shown to modulate brachyury levels in multiple chordoma cell lines. Herein, we use afatinib as a lead to undertake a structure-based drug design approach, aided by mass-spectrometry and X-ray crystallography, to develop DHC-156, a small molecule that more selectively binds brachyury and downmodulates it as potently as afatinib. We eliminated kinase-inhibition from this novel scaffold while demonstrating that DHC-156 induces the post-translational downmodulation of brachyury that results in an irreversible impairment of chordoma tumor cell growth. In doing so, we demonstrate the feasibility of direct brachyury modulation, which may further be developed into more potent tool compounds and therapies.

Dissecting the Binding Interface of the Septin Polymerization Enhancer Borg BD3.

The molecular basis for septin filament assembly has begun to emerge over recent years. These filaments are essential for many septin functions which depend on their association with biological membranes or components of the cytoskeleton. Much less is known about how septins specifically interact with their binding partners. Here we describe the essential role played by the C-terminal domains in both septin polymerization and their association with the BD3 motif of the Borg family of Cdc42 effector proteins. We provide a detailed description, at the molecular level, of a previously reported interaction between BD3 and the NC-interface between SEPT6 and SEPT7. Upon ternary complex formation, the heterodimeric coiled coil formed by the C-terminal domains of the septins becomes stabilized and filament formation is promoted under conditions of ionic strength/protein concentration which are not normally permissible, likely by favouring hexamers over smaller oligomeric states. This demonstrates that binding partners, such as Borg's, have the potential to control filament assembly/disassembly in vivo in a way which can be emulated in vitro by altering the ionic strength. Experimentally validated models indicate that the BD3 peptide lies antiparallel to the coiled coil and is stabilized by a mixture of polar and apolar contacts. At its center, an LGPS motif, common to all human Borg sequences, interacts with charged residues from both helices of the coiled coil (K368 from SEPT7 and the conserved E354 from SEPT6) suggesting a universal mechanism which governs Borg-septin interactions.

Adapting and Implementing an Evidence-Based Reentry Intervention for Incarcerated Transgender Women: Lessons Learned.

Incarceration is a significant public health issue that disproportionately impacts transgender (trans) women, particularly those of color. The cycle of incarceration interacts with high levels of substance use, mental illness, and HIV to produce a high disease burden among trans women, but, to date, there are no published studies of trans-specific reentry support interventions. Informed by the Model of Gender Affirmation, we systematically adapted and pilot tested the evidence-based Project START intervention to create Girlfriends Connect (GC), a reentry support intervention for trans women incarcerated in a county jail. Qualitative interviews with trans women (10 prerelease and 6 postrelease) and community social service providers and jail staff (n = 7) who serve justice-involved transgender women, as well as input from a community advisory board, informed our adaptation. We then conducted a pilot randomized controlled trial (n = 14) and a service implementation project (n = 16) of GC to examine its feasibility and acceptability. Lessons learned include the importance of peer facilitators, facilitated referral to gender-affirming community resources, and obtaining programmatic buy-in from jail staff and administration. Results indicate that GC is feasible and acceptable, and holds promise in improving the health of transgender women reentering the community after a period of incarceration.

Randomized Controlled Trial of Healthy Divas: A Gender-Affirming, Peer-Delivered Intervention to Improve HIV Care Engagement Among Transgender Women Living With HIV.

BACKGROUND: Transgender women are disproportionately affected by HIV and are less likely to be optimally engaged in care than other groups because of psychosocial challenges. With community collaboration, we developed Healthy Divas, an individual-level intervention to increase healthcare empowerment and gender affirmation to improve engagement in HIV care. Healthy Divas comprises 6 peer-led individual sessions and one group workshop facilitated by a healthcare provider with expertise in HIV care and transgender health. SETTING/METHODS: To test the intervention's efficacy, we conducted a randomized controlled clinical trial in San Francisco and Los Angeles among transgender women living with HIV; control was no intervention. Transgender field staff conducted recruitment. Assessments occurred at baseline and 3, 6, 9, and 12 months postrandomization. The primary outcome was engagement in HIV care, defined as the sum of (1) self-reported HIV care provider visit, past 6 months, (2) knowledge of most recent CD4 count, (3) self-reported antiretroviral therapy adherence ≥90%, and (4) self-reported antiretroviral therapy adherence ≥80%. RESULTS: We enrolled 278 participants; almost half (46%) were African American/Black and one-third (33%) were Hispanic/Latina. At 6 months, participants in the intervention arm had over twice the odds of being in a higher HIV care engagement category than those in the control arm (aOR = 2.17; 95% CI: 1.06 to 4.45; P = 0.04); there were no significant study arm differences in the outcome at the other time points. CONCLUSIONS: This trial demonstrates the short-term efficacy of an urgently needed behavioral intervention to improve engagement in HIV care among transgender women living with HIV; ongoing intervention may be needed to maintain positive impact over time. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03081559.

School closures and reopenings during the COVID-19 pandemic: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to provide an overview of existing studies and evidence on the impact of school closures and reopenings during the pandemic. INTRODUCTION: The COVID-19 pandemic has necessitated widespread school closures, and reopening schools safely has a pivotal role in the well-being of children and teachers, SARS-CoV-2 transmission control and optimal societal functioning. Widespread school closures in response to the COVID-19 pandemic have caused adverse effects on the education, physical health and mental well-being of children. An understanding of the impact of school closures and reopenings as well as factors influencing school safety is critical to bringing schools' operational status back to normal. Despite the implication of individual concerns and knowledge on disease prevention practices, there is a paucity of research on individual knowledge, needs and behaviours in the context of school reopenings. In the proposed study, we will conduct a scoping review to identify and provide inventory of the current research and evidence on the impact of COVID-19 on K-12 schools (primary and secondary schools) and vice versa. METHODS AND ANALYSIS: Eligible studies/literature include members of K-12 (primary and secondary) schools (students, parents, staff, faculty, COVID-19 coordinator, school nurses) in countries affected by the COVID-19 pandemic. We will exclude university or college students. There will be no exclusion based on methods, timing or school operational status.All concepts regarding school closures and reopenings will be considered, and all types of research will be considered.This scoping review will follow the Joanna Briggs Institute methodology for scoping reviews. Sources of evidence published from 2020 to 31 October 2021 will be included. The search will include PubMed, preprints in EuropePMC, ERIC, Scopus, Web of Science Core Collection, PsycINFO, Embase, CINAHL and VHL. We will cover grey literature in Harvard Think Tank Database, COVID-19 Evidence Hub like COVID-END and Google Scholar. The abstract and title screening, full-text screening and data extraction will be done by two independent reviewers.Disagreements will be resolved by an independent third reviewer. Data extract will be done on Qualtrics form to ensure accurate extraction. Citation chaining will be performed on key articles identified. A critical appraisal will be performed.The scoping review will take place from 1 August 2021 to 15 November 2021. We will perform a final round of updated search and citation chaining. ETHICS AND DISSEMINATION: The review will be based on published works and grey literature, thus it is exempt from formal ethical approval. This protocol cannot be registered in the Prospective Register of Systematic Reviews because this registry is not for scoping reviews. We will register it in OSF Registration. The paper will appear in a peer-reviewed, open-access journal to ensure a broad dissemination.

The Structural Biology of Septins and Their Filaments: An Update.

In order to fully understand any complex biochemical system from a mechanistic point of view, it is necessary to have access to the three-dimensional structures of the molecular components involved. Septins and their oligomers, filaments and higher-order complexes are no exception. Indeed, the spontaneous recruitment of different septin monomers to specific positions along a filament represents a fascinating example of subtle molecular recognition. Over the last few years, the amount of structural information available about these important cytoskeletal proteins has increased dramatically. This has allowed for a more detailed description of their individual domains and the different interfaces formed between them, which are the basis for stabilizing higher-order structures such as hexamers, octamers and fully formed filaments. The flexibility of these structures and the plasticity of the individual interfaces have also begun to be understood. Furthermore, recently, light has been shed on how filaments may bundle into higher-order structures by the formation of antiparallel coiled coils involving the C-terminal domains. Nevertheless, even with these advances, there is still some way to go before we fully understand how the structure and dynamics of septin assemblies are related to their physiological roles, including their interactions with biological membranes and other cytoskeletal components. In this review, we aim to bring together the various strands of structural evidence currently available into a more coherent picture. Although it would be an exaggeration to say that this is complete, recent progress seems to suggest that headway is being made in that direction.

Rapid, reliable, and reproducible cell fusion assay to quantify SARS-Cov-2 spike interaction with hACE2.

COVID-19 is a global crisis of unimagined dimensions. Currently, Remedesivir is only fully licensed FDA therapeutic. A major target of the vaccine effort is the SARS-CoV-2 spike-hACE2 interaction, and assessment of efficacy relies on time consuming neutralization assay. Here, we developed a cell fusion assay based upon spike-hACE2 interaction. The system was tested by transient co-transfection of 293T cells, which demonstrated good correlation with standard spike pseudotyping for inhibition by sera and biologics. Then established stable cell lines were very well behaved and gave even better correlation with pseudotyping results, after a short, overnight co-incubation. Results with the stable cell fusion assay also correlated well with those of a live virus assay. In summary we have established a rapid, reliable, and reproducible cell fusion assay that will serve to complement the other neutralization assays currently in use, is easy to implement in most laboratories, and may serve as the basis for high throughput screens to identify inhibitors of SARS-CoV-2 virus-cell binding and entry.

An Intervention by and for Transgender Women Living With HIV: Study Protocol for a Two-Arm Randomized Controlled Trial Testing the Efficacy of "Healthy Divas" to Improve HIV Care Outcomes.

Introduction: Transgender women (assigned "male" at birth but who do not identify as male) are disproportionately impacted by HIV and experience unique barriers and facilitators to HIV care engagement. In formative work, we identified culturally specific and modifiable barriers to HIV treatment engagement among transgender women living with HIV (TWH), including prioritizing transition-related healthcare over HIV treatment, avoiding HIV care settings due to gender-related and HIV stigma, concerns about potential drug interactions with hormones, and inadequate social support. Grounded in the investigators' Models of Gender Affirmation and Health Care Empowerment, we developed the Healthy Divas intervention to optimize engagement in HIV care among TWH at risk for treatment failure and consequential morbidity, mortality, and onward transmission of HIV. Methods and Analysis: We conducted a 2-arm randomized controlled trial (RCT) of the intervention's efficacy in Los Angeles and San Francisco to improve engagement in care among TWH (N = 278). The primary outcome was virologic control indicated by undetectable HIV-1 level (undetectability = < 20 copies/mL), at baseline and follow-up assessment for 12 months at 3-month intervals. Ethics and Dissemination: This study was approved by University of California, San Francisco Institutional Review Board (15-17910) and Western Institutional Review Board (20181370). Participants provided informed consent before enrolment in the study. We are committed to collaboration with National Institutes of Health officials, other researchers, and health and social services communities for rapid dissemination of data and sharing of materials. The results will be published in peer-reviewed academic journals and scientific presentations. We will make our results available to researchers interested in transgender health to avoid unintentional duplication of research, as well as to others in health and social services communities, including HIV clinics, LGBT community-based organizations, and AIDS service organizations. Clinical Trial Registration: Clinicaltrials.gov, identifier NCT03081559.

Gold mining tailing: Environmental availability of metals and human health risk assessment.

The gold ore from sulfide minerals is, in general, ore dressed by means of nine stages among which stand out flotation and cyanidation. The residues of these steps, containing potentially toxic elements, such as As, Cd, Cr, Mn, Zn and Pb disposed of tailings dams, which might be a source of environmental contamination if not suitably disposed and/or in cases of accidents and overflows. Sequential extraction schemes (SES) have been used to estimate the potential environmental availability of contaminants from environmental matrices and, lately, from residues. This research evaluates the environmental availability of As, Cr, Cd, Mn, Pb, and Zn, by using two different SES, Tessier and Marin (BCR) in cyanidation residues. The analytes were quantified by inductively coupled plasma with optical emission spectrometry (ICP OES). A human health risk assessment was performed considering a scenario of soil contamination by the tailing after failure dam, based on the potential environment availability of metals, resulted from distinct SES studied. The results showed that Mn and Pb are the most labile, and therefore the most dangerous and bioavailable for the surrounding environment (≥75%). Moreover, the scenario simulated demonstrated the risk for human health mostly due to As, Cd and Zn.

A complete compendium of crystal structures for the human SEPT3 subgroup reveals functional plasticity at a specific septin interface.

Human septins 3, 9 and 12 are the only members of a specific subgroup of septins that display several unusual features, including the absence of a C-terminal coiled coil. This particular subgroup (the SEPT3 septins) are present in rod-like octameric protofilaments but are lacking in similar hexameric assemblies, which only contain representatives of the three remaining subgroups. Both hexamers and octamers can self-assemble into mixed filaments by end-to-end association, implying that the SEPT3 septins may facilitate polymerization but not necessarily function. These filaments frequently associate into higher order complexes which associate with biological membranes, triggering a wide range of cellular events. In the present work, a complete compendium of crystal structures for the GTP-binding domains of all of the SEPT3 subgroup members when bound to either GDP or to a GTP analogue is provided. The structures reveal a unique degree of plasticity at one of the filamentous interfaces (dubbed NC). Specifically, structures of the GDP and GTPγS complexes of SEPT9 reveal a squeezing mechanism at the NC interface which would expel a polybasic region from its binding site and render it free to interact with negatively charged membranes. On the other hand, a polyacidic region associated with helix α5', the orientation of which is particular to this subgroup, provides a safe haven for the polybasic region when retracted within the interface. Together, these results suggest a mechanism which couples GTP binding and hydrolysis to membrane association and implies a unique role for the SEPT3 subgroup in this process. These observations can be accounted for by constellations of specific amino-acid residues that are found only in this subgroup and by the absence of the C-terminal coiled coil. Such conclusions can only be reached owing to the completeness of the structural studies presented here.

Sheroes: Feasibility and Acceptability of a Community-Driven, Group-Level HIV Intervention Program for Transgender Women.

Transgender women experience disproportionate risk of HIV acquisition and transmission. We piloted 'Sheroes', a peer-led group-level intervention for transgender women of any HIV status emphasizing empowerment and gender affirmation to reduce HIV risk behaviors and increase social support. Participants (N = 77) were randomized to Sheroes (n = 39) or a time- and attention-matched control (n = 38). Sheroes is 5 weekly group sessions; topics include sexuality, communication, gender transition, and coping skills. Control participants attended 5 weekly group movie sessions. At 6-month follow up, HIV-negative and unknown status Sheroes participants reported reductions in condomless intercourse and improved social support compared to control. Among participants living with HIV, both the control and intervention groups reduced their total number of sex partners; this change was sustained at 6-month follow-up for Sheroes participants but not for control participants relative to baseline. Sheroes was deemed highly feasible and acceptable to participants; findings support preliminary efficacy of Sheroes.

The Contribution of Emergent Literacy Skills for Early Reading and Writing Achievement / Contribuição das Habilidades de Letramento Emergente para as Competências Iniciais de Leitura e Escrita / Contribución de las Habilidades de Alfabetización Temprana a las Competencias Iniciales de Lectura y Escritura

Abstract Studies in the English language suggest that emergent literacy skills promote success in literacy. This longitudinal study investigated whether and which emergent literacy skills contribute to initial reading and writing performance in a sample of 34 Brazilian children from public schools. The participants underwent tests on phonological awareness, oral comprehension, vocabulary and knowledge of letters at the end of Early Childhood Education. The participants' skills in writing and reading words as well as reading comprehension were evaluated in the 1st year of elementary school. Data were analyzed using correlation and regression analysis. Results showed that emergent literacy skills presented significant positive correlations with reading and writing performance. Multiple regression analyses indicated significant and independent contributions of phonological awareness and knowledge of letters for writing, however, only phonological awareness significantly and independently contributed to reading of words and reading comprehension skills. It was concluded that emergent literacy skills related to the coding domain are the most important for literacy.

Resumo Estudos em língua inglesa sugerem que as habilidades de letramento emergente favorecem o sucesso na alfabetização. Este estudo longitudinal investigou se e quais habilidades de letramento emergente contribuem para as competências iniciais de leitura e escrita de uma amostra de 34 crianças brasileiras, alunas da rede pública de ensino. Ao final da Educação Infantil, as crianças foram submetidas a testes de consciência fonológica, compreensão oral, vocabulário e conhecimento das letras. No 1º ano do Ensino Fundamental, foram avaliadas as competências de escrita e leitura de palavras, bem como de compreensão em leitura dos participantes. Os dados foram analisados através de técnicas correlacionais e de análise de regressão. Os resultados mostraram que todas as habilidades de letramento emergente avaliadas apresentaram correlações positivas significativas com o desempenho nos testes de leitura e escrita. Contudo, análises de regressão múltipla indicaram contribuição significativa e independente apenas da consciência fonológica e do conhecimento de letras para a escrita; para as habilidades de leitura de palavras e compreensão em leitura, somente a consciência fonológica contribuiu de forma significativa e independente. Conclui-se que as habilidades de letramento emergente relacionadas ao domínio do código são as mais importantes para a alfabetização.

Resumen Los estudios en inglés sugieren que las habilidades de alfabetización temprana favorecen el éxito en la alfabetización. Este estudio longitudinal investigó si y cuáles habilidades de alfabetización temprana contribuyen a las competencias iniciales de lectura y escritura de una muestra de 34 niños brasileños, alumnos de la red pública de enseñanza. Al final de la educación preescolar, los niños fueron sometidos a pruebas de conciencia fonológica, comprensión oral, vocabulario y conocimiento de las letras. En el primer año de la Enseñanza Fundamental, se evaluaron las competencias de escritura y lectura de palabras, así como de comprensión en lectura de los participantes. Los datos fueron analizados a través de técnicas correlacionales y de análisis de regresión. Los resultados mostraron que todas las habilidades de alfabetización temprana evaluadas presentaron correlaciones positivas significativas con el rendimiento en las pruebas de lectura y escritura. Sin embargo, los análisis de regresión múltiple indicaron una contribución significativa e independiente sólo de la conciencia fonológica y del conocimiento de letras para la escritura; para las habilidades de lectura y comprensión en lectura, solamente la conciencia fonológica contribuyó de forma significativa e independiente. Se concluye que las habilidades de alfabetización temprana relacionadas con el dominio del código son las más importantes para la alfabetización.

Análise de sujidades e matérias estranhas em amostras de farinha de trigo tipo 1 comercializadas no município de Campo Mourão, Paraná / Analysis of light filth and strange matters in samples of wheat flour type 1 marketed in Campo Mourão, Paraná

A farinha de trigo é obtida por moagem e suas características são influenciadas por condições a que são submetidas na producão. A contaminação deste produto pode se dar desde a infestação dos grãos de trigo por pragas do campo até o seu ambiente de armazenagem. Com isso torna-se necessário o uso das boas práticas de produção para garantir a qualidade do produto e evitar riscos ao consumidor. Neste sentido, a ANVISA estabelece um limite de tolerância para avaliação de matérias estranhas macroscópicas e microscópicas em alimentos. Este trabalho buscou coletar, analisar e verificar a qualidade de amostras de farinha de trigo tipo 1, afim de verificar sua adequação frente a legislação vigente, tendo como base o método da “Association of Official of Analytical Chemists International” (AOAC). Os resultados mostraram, presença de matérias estranhas, porém dentro dos limites estabelecidos, demonstrando qualidade em relação à presença de sujidades.

Guidance and Ethical Considerations for Undertaking Transgender Health Research and Institutional Review Boards Adjudicating this Research.

The purpose of this review is to create a set of provisional criteria for Institutional Review Boards (IRBs) to refer to when assessing the ethical orientation of transgender health research proposals. We began by searching for literature on this topic using databases and the reference lists of key articles, resulting in a preliminary set of criteria. We then collaborated to develop the following nine guidelines: (1) Whenever possible, research should be grounded, from inception to dissemination, in a meaningful collaboration with community stakeholders; (2) language and framing of transgender health research should be non-stigmatizing; (3) research should be disseminated back to the community; (4) the diversity of the transgender and gender diverse (TGGD) community should be accurately reflected and sensitively reflected; (5) informed consent must be meaningful, without coercion or undue influence; (6) the protection of participant confidentiality should be paramount; (7) alternative consent procedures should be considered for TGGD minors; (8) research should align with current professional standards that refute conversion, reorientation, or reparative therapy; and (9) IRBs should guard against the temptation to avoid, limit, or delay research on this subject.

Pitaya Extracts Induce Growth Inhibition and Proapoptotic Effects on Human Cell Lines of Breast Cancer via Downregulation of Estrogen Receptor Gene Expression.

Breast cancer is one of the most prevalent cancers in the world and is also the leading cause of cancer death in women. The use of bioactive compounds of functional foods contributes to reduce the risk of chronic diseases, such as cancer and vascular disorders. In this study, we evaluated the antioxidant potential and the influence of pitaya extract (PE) on cell viability, colony formation, cell cycle, apoptosis, and expression of BRCA1, BRCA2, PRAB, and Erα in breast cancer cell lines (MCF-7 and MDA-MB-435). PE showed high antioxidant activity and high values of anthocyanins (74.65 ± 2.18). We observed a selective decrease in cell proliferation caused by PE in MCF-7 (ER+) cell line. Cell cycle analysis revealed that PE induced an increase in G0/G1 phase followed by a decrease in G2/M phase. Also, PE induced apoptosis in MCF-7 (ER+) cell line and suppressed BRCA1, BRCA2, PRAB, and Erα gene expression. Finally, we also demonstrate that no effect was observed with MDA-MB-435 cells (ER-) after PE treatment. Taken together, the present study suggests that pitaya may have a protective effect against breast cancer.

Incorporação de tecnologia do projeto Nossas Crianças: janelas de oportunidades, a perspectiva dos profissionais / Technology incorporation of the project Our Children: windows of oportunities, the professional perspective

Introdução: Muitos programas de intervenção na primeira infância vêm mostrando-se eficazes na melhoria do desenvolvimento das crianças, sendo necessária sua implantação em uma realidade coma a brasileira. A Estratégia Saúde da Família é um espaço que possibilita a ampliação das ações dos profissionais de saúde para além do biológico, pois atua no lócus familiar. Neste contexto a implantação de tecnologias como a do projeto Nossas Crianças: Janelas de Oportunidades torna-se favorável para ampliar e qualificar a atenção à criança, com ênfase no fortalecimento do desenvolvimento infantil. Com a introdução de novas tecnologias na prática dos profissionais de saúde a avaliação das mesmas torna-se necessária, pois é um processo contínuo de análise e síntese de seus benefícios. Objetivo: Avaliar a incorporação das tecnologias do Projeto Janelas pelos profissionais de saúde. Metodologia: Trata-se de uma pesquisa avaliativa com triangulação de métodos utilizando os quatro níveis de avaliação de Kirkpatrick (Reação, Aprendizagem, Comportamento e Resultados). Os sujeitos de estudos foram nove médicos e dezessete enfermeiros de dezoito Equipes das Unidades Básicas de Saúde do Projeto Região Oeste que foram capacitados com a 2a edição do Projeto Nossas Crianças: Janelas de Oportunidades. Resultados: três Equipes incorporaram a tecnologia, nove incorporaram parcialmente e seis não incorporaram a tecnologia. Três enfermeiros e dois médicos incorporaram a tecnologia, nove enfermeiros e cinco médicos incorporaram parcialmente e cinco enfermeiros e dois médicos não incorporaram a tecnologia. Foram identificadas cinco categorias de mudança de comportamento: a) ampliação da clínica dentro da prática da consulta; b) utilização do Caderno da Família em sua prática; c) incorporação em sua prática de conceitos teóricos relacionados a família; d) organização do trabalho e e) estímulo da família para apropriação da tecnologia. Foram também identificadas quatro dimensões relacionadas com a incorporação de tecnologia: a) dimensão ética, técnica, política e econômica da tecnologia em si; b) dimensão aceitação e satisfação do paciente; c) dimensão características do serviço de saúde e d) dimensão processo de trabalho. Conclusões: A incorporação das tecnologias do Projeto Janelas mostrou-se estritamente relacionada com o processo de educação permanente dos profissionais de saúde do Projeto Região Oeste. A análise do cotidiano do trabalho dos profissionais fornece pistas a respeito das tecnologias já em uso pelas Equipes e das necessidades de incorporação do uso de uma nova tecnologia.

Introduction: Many intervention programs in early childhood have proven effective in improving the development of children, in a reality like the Brazilian its implementation is required. The Family Health Strategy is a space that allows the expansion of the actions of health professionals beyond the biological, because it acts in the family locus. In this context the deployment of technologies as from the project Our Children: Windows of Opportunities becomes favorable to widen and improve the care of children, with emphasis on strengthening the child development. With the introduction of new technologies in the practice of health professionals their evaluation becomes necessary, because it is an ongoing process of analysis and synthesis of its benefits. Aims: To evaluate the incorporation of the Technologies of the Windows Project by health professionals. Methodology: This is an evaluation research with triangulation methods using the Kirkpatricks four levels of evaluation (Reaction, Learning, Behavior and Results). The subjects of study were nine physicians and seventeen nurses of eighteen health Teams of the Health Basic Units from Western Region. Results: Three Teams incorporated the technology, nine incorporated partially and six have not incorporate the technology. Three nurses and two physicians incorporated the technology, nine nurses and five physicians incorporated partially and five nurses and two physicians have not incorporated the technology. Were identified five categories of behavior change:a) clinical expanding within the query practice; b) use The Family Booklet in their practice; c) incorporate into their practice the theoretical concepts related to family; d) organization of work and e) stimulus the family for appropriation of technology. Were also identified four dimensions related to the incorporation of technology: a) ethical, technical, political and economic dimension of the technology itself; b) acceptance and patient satisfaction dimension; c) dimension of the health service characteristics and d) working process dimension. Conclusions: The incorporation of technology showed closely linked to the process of permanent education of the health professionals from the Western Region Project. The professional work routine analysis provides clues about the technologies already in use by the Teams and the needs of incorporating the use of a new technology.

Avaliação de programas, serviços e tecnologias na perspectiva da promoção da saúde: uma reflexão teórica / Evaluation of programs, services and technologies from the health promotion perspective: a theoretical reflection / Evaluación de programas, servicios y tecnologías desde La perspectiva de la promoción de la salud: una reflexión teórica

Realizar uma reflexão teórica sobre a utilização dos conceitos de ?avaliação?para a aplicação em tecnologias, programas e serviços de promoção da saúde. Síntesedos dados: Com breve descrição sobre os aspectos conceituais da avaliação em saúde eda promoção da saúde, destaca-se a importância na adoção de modelos avaliativos quecontemplem a complexidade e multiplicidade das práticas. Espera-se, assim, expandir os limites das ciências biomédicas e da epidemiologia tradicional, fundamentando-se também nas ciências sociais e humanas. Como resultado dessa reflexão, propõe-se que as avaliações tenham como princípios: serem participativas; serem introduzidas no início do programa/tecnologia/serviço e tomarem parte de todas as fases de desenvolvimento deste; conterem em seu formato estratégias de partilha dos achados com todos os atores envolvidos. Sugere-se a adoção da triangulação de métodos quanti-qualitativos e técnicas científicas com capacidade para abarcar a complexidade dessa temática, tais como: análise documental, entrevistas individuais, realização de grupos focais, levantamento de dados primários ou secundários em bases de dados, observações diretas ou participantes. Conclusão: A reflexão proposta apontou que privilegiar o aprendizado, a ação e a transformação das práticas sociais deve compor a pauta dos modelos avaliativos da promoção da saúde. O conhecimento produzido em tais avaliações tem potencial de fortalecer a prática da promoção da saúde, a intersetorialidade, a mobilização social, as parcerias, a sustentabilidade e a defesa pública da saúde...

To perform a theoretical reflection concerning the use of the ?evaluation? concepts, for application in health promotion?s technologies, programs and services. Data Synthesis: With a brief description of health assessment and health promotion conceptual aspects, stands out the importance of adopting evaluative models that address the complexity and multiplicity of practices. It is hence expected to expand the limits of the biomedical sciences and traditional epidemiology, also underpinned by the social sciences and humanities. Following these considerations, it is proposed that evaluations have as principles: being participative; being introduced at the beginning of the program/technology/service and taking part in all stages of its development; encompassing strategies for sharing the findings with all actors involved. Is suggested the triangulation of qualitative and quantitative methods and scientific techniques, with capacity to embrace the subject complexity, such as document analysis, individual interviews, focus groups, survey of primary or secondary data in databases, direct or participative observations. Conclusion: The reflection proposed indicated that emphasis on learning, action and transformation of social practices should compose the guidelines of health promotion evaluative models. The knowledge produced has the potential to strengthen the practice of health promotion, the intersectionality, social mobilization, partnerships, sustainability and the advocacy of public health...

Realizar una reflexión teórica sobre la utilización de conceptos de ?evaluación? para la aplicación en tecnologías, programas y servicios de promoción de la salud. Síntesis de los datos: Con breve descripción de los aspectos conceptuales de evaluación en salud y de la promoción de la salud, se destaca la importancia de adopción de modelos evaluativos que contemplen la complejidad y multiplicidad de las prácticas. De ese modo, se espera expandir los límites de las ciencias biomédicas y de la epidemiología tradicional, fundamentándose también en las ciencias sociales y humanas. Como resultado de esa reflexión, se propone que las evaluaciones tengan como principios que sean participativas; que sean introducidas al inicio del programa/tecnología/servicio y que hagan parte de todas las fases de su desarrollo; que tengan en su formato estrategias de partición de los hallazgos con todos los actores involucrados. Se sugiere la adopción de triangulación de métodos cuanti-cualitativos y técnicas científicas con capacidad para abarcar la complejidad de esa temática tales como análisis documental, entrevistas individuales, realización de grupos focales, recogida de datos primarios o secundarios en bases de datos, observaciones directas o participantes. Conclusión: La reflexión propuesta apuntó que privilegiar el aprendizaje, la acción y la transformación de prácticas sociales debe componer la pauta de los modelos evaluativos de promoción de la salud. El conocimiento producido en tales evaluaciones tiene potencial para fortalecer la práctica de promoción de la salud, la intersectorialidad, la movilización social, las sociedades, la sostenibilidad y la defensa pública de salud...

Avaliação das ações de promoção da saúdedesenvolvidas pelos agentes comunitários de saúde / Performance evaluation of health promotion actions taken bycommunity health workers

Com base nas análises que sistematicamente foram realizadas sobre o trabalho do Agente Comunitário de Saúde (ACS), oMinistério da Saúde construiu um programa de formação para esse profissional, no qual foram definidas as competênciasque deveriam compor seu perfil, sendo uma delas a promoção da saúde. O objetivo desta pesquisa foi descrever e representarquantitativamente as ações de promoção da saúde propostas pelo Ministério da Saúde. Trata-se de uma pesquisaquantitativa, que teve como cenário de estudo o Colegiado Gestor Regional (CGR) Alto Capivari, da região de PresidentePrudente-SP. Foram sujeitos desta pesquisa os 97 ACS que trabalhavam nas dezessete equipes de Saúde da Família doCGR. Os dados foram coletados por meio de um formulário tipo Likert, que permitia verificar a ocorrência da realizaçãodas ações de promoção da saúde. As ações de promoção da saúde mais realizadas foram as que visam ao desenvolvimentodo autocuidado, prevenção de agravos e a identificação de problemas; e as ações menos desenvolvidas foram as departicipação social e intersetorialidade, contudo, dentre os desafios para a operacionalização das ações de promoção dasaúde mais emancipatórias pelos ACS, verificou-se a atribuição de ações diferentes das propostas pelo Ministério da Saúde;número de famílias além do preconizado e pouca oferta de capacitação para os ACS. O ACS tem potencial e realizaações importantes de promoção da saúde, contudo essa estratégia deve ser priorizada pelas políticas públicas sociais e desaúde, pois seu desenvolvimento pode impactar positivamente nos indicadores de saúde.

Based on the analyzes that were systematically performed on the work of Community Health Agents (ACS), the Ministry ofHealth constructed a training program for these professionals in which the skills that should compose their profile were defined,health promotion was one of them. The objective of this research was to describe and quantitatively represent healthpromotion actions proposed by the Ministry of Health. This is a quantitative research concerning the Collegiate RegionalManager (CGR) Alto Capivari in the Presidente Prudente-SP region. The subjects of this study were 97 ACS working in the17 teams of Family Health of the CGR. Data were collected through a Likert form that allows verifying the occurrence ofhealth promotion actions. The more frequently performed health promotion actions were the ones aimed at the developmentof self-care, injury prevention, and problems identification, and the less frequently performed actions were the onesof social participation and intersectoral approach. However, among the operationalization challenges of health promotionactions which were more emancipatory by ACS, the attribution of actions different from those proposed by the Ministry ofHealth, a number of families beyond the recommended and little offer of training for ACS were verified. ACS have potentialand perform important actions to promote health, yet this strategy should be prioritized by social and health public policiessince its development can positively impact health indicators.

Qualidade de vida e promoção da saúde: em foco as gestantes / Quality of life and health promotion: focusing pregnant women

O objetivo deste estudo foi avaliar a Qualidade de Vida de gestantes atendidas na Estratégia Saúde da Família e identificaras dimensões da Qualidade de Vida com melhor e pior avaliações. Trata-se de um estudo de caso descritivo e transversal, realizado em uma Unidade de Saúde da Família na periferia de São Bernardo do Campo. Foram avaliadas42 gestantes utilizando o instrumento WHOQOl-bref. Quanto maior o escore, melhor a avaliação da Qualidade de Vida. Os escores dos domínios de Qualidade de Vida foram: Físico 57,65; Psicológico 68,75; Meio Ambiente 59,75;Relações Sociais 77,98; Geral 75,00. Cada domínio é composto por algumas facetas, sendo que estas contribuíram de maneira positiva ou negativa para o escore dos domínios. As facetas com pior avaliação foram: Energia e Fadiga; Pensar, Aprender, Memória e Concentração; Recursos Financeiros; Atividade Sexual. As facetas com melhor avaliação foram: Mobilidade; Sentimentos Positivos; Imagem Corporal e Aparência; Cuidados de Saúde e Sociais; Relações Pessoais. Concluiu-se que o WHOQOL-bref tem pertinência como instrumento de monitoramento e ampliação da assistência pré-natal e que a avaliação da Qualidade de Vida durante o pré-natal se torna uma importante ferramenta para uma abordagem integral e promotora da saúde da gestante.

The aim of this study was to evaluate the Quality of Life of pregnant women attending the Family Health Strategy and identify the dimensions of Quality of Life better and worse evaluated. This is a descriptive, cross sectional study case, done in a Family Health Unit in the outskirts of São Bernardo do Campo. 42 women were evaluated using WHOQOL bref. The higher the score the better the assessment of Quality of Life. The scores of the domains were: Physical 57,65; Psychological 68,75; Environment 59,75; Social Relations 77,98; General 75,00. Each domain consists of a few facets, and these contributed positively or negatively t the score of the domains. The worst facets evaluated were: Energy and Fatigue; Thinking, Learning, Memory and Concentration; Financial Resources; and Sexual Activity. The best aspects evaluated were: Mobility; Positive Feelings, Body Image and Appearance; Health and Social Care; and Personal Relation ships. We concluded that WHOQOL-bref is relevant as a monitoring instrument and it is, for the expansion of prenatal care and the evaluation of quality of life during prenatal care, an important tool for an integral assistence and pregnant woman’s health promotion.

Competência do enfermeiro na atenção básica:em foco a humanização do processo de trabalho / Nursing competence in the primary care: a focus on the humanization of the work process

A possibilidade de se traçar competências para a prática do enfermeiro na Atenção Básica é um recurso importante para subsidiar a formação deste profissional. A Política Nacional de Humanização reafirma a necessidade de assegurar atenção integral à população e ampliar a condição da saúde como direito de cidadania das pessoas. O objetivo deste artigo foi discutir as competências que vêm sendo ensinadas no curso de graduação em enfermagem, apontando aquelas que dão suporte às praticas de humanização em saúde. Trata-se de uma pesquisa qualitativa, cuja opção metodológica foi a utilização da Técnica Delphi, junto a docentes e alunos da Escola de Enfermagem da Universidade de São Paulo para apreciação do rol de competências construídas por Witt. Os resultados mostraram que existe um consenso em relação ao fato de que as competências relativas à prestação de assistência com base na ética, no compromisso e na responsabilização para com a saúde dos cidadãos e com os serviços, bem como competências voltadas para a identificação de problemas e necessidades de saúde são as mais trabalhadas no ensino de graduação da Escola de Enfermagem da Universidade de São Paulo. Concluiu-se que existe uma intencionalidade em se direcionar a formação profissional em enfermagem para o fortalecimento da Atenção Básica e da humanização do cuidado.

The possibility of establishing skills to nursing practice in primary care is an important resource to support the formation of professionals. The National Policy of Humanization reaffirms the need to ensure comprehensive care to the population and enhance the health condition as a right of citizenship ascribed to people. The aim of this paper is to discuss the skills thatare being taught in an undergraduate nursing course, pointing to those that support the practice of humanized health care.This is a qualitative research, whose methodological option was to use the Delphi Technique, with faculty and students at the School of Nursing of University of São Paulo for consideration of the list of skills built by Witt. The results showed that there is a consensus on the fact that the powers relating to the provision of assistance based on ethics, commitment and accountability to the citizens’ health and the services and expertise aimed at identifying problems and health needs are themost developed in this undergraduate Nursing course. We conclude that there is the purpose of making nursing training to look for strengthening of Primary Care and humanization of care.