Factors shaping faculty online teaching competencies during the Covid-19 pandemic.

In the rush for the Covid-19 pandemic's online transition, the pursuit of quality online learning was frequently overshadowed by the urgency of emergency instruction online. As blended and online teaching became an integral part of education, there emerged a need to investigate how faculty coped with this transition and what competencies they might be acquiring. In this paper, we report on international research about higher education faculty's elicited dispositions and needs while they engaged with online teaching (OT), as these shape aspects of teacher competencies for integrating technology. This study aims to identify factors that shaped faculty competencies as pandemic restrictions forced transitions to OT. Snapshot surveys were conducted at two different phases of the pandemic, i.e. during the acceleration phase and the stasis one, approximately twelve months later. The surveys inquired about internal (e.g. enthusiasm and resolutions) and external (e.g. support) factors of faculty's OT perceptions during two phases of the Covid-19 pandemic, enabling monitoring of the phenomenon beyond the assessment of the first response to the emergency. Results revealed different patterns of dispositions and diverse uses of technological affordances to foster online learning. These patterns were also found to differ over time, highlighting conditions possibly enabling or hindering the development of competencies for OT during different phases of the pandemic. One important finding is that there was a change from internal confidence to institutional support being a strong predictor of intentions to continue OT, over the course of the Covid-19 pandemic.

Modifiable risk factors for cardiovascular diseases and quality of life among first-year nursing students.

OBJECTIVE: To describe the risk factors for cardiovascular diseases and the quality of life of first-year college students. METHODS: A cross-sectional study conducted with first-year undergraduate nursing students attending a public university located in São Paulo, Brazil. The students completed nine questionnaires and the students'cervical and abdominal circumferences were measured along with their weight and height, blood pressure, lipid profile, and capillary blood glucose. RESULTS: 67 undergraduate students were included. Half of the students were physically inactive (73.1%), 7.5% reported smoking, 40.3% alcohol consumption, 25.4% overweight, and 16,4% increased total cholesterol. Depressive symptoms, anxiety, and stress were also reported, as well as excessive daytime sleepiness, risk of sleep apnea, and risky and harmful consumption of alcohol. As for the quality of life, the domains with the lowest scores were vitality and emotional aspects. CONCLUSION: The most prevalent risk factors found in undergraduates were sedentary lifestyle, excessive daytime sleepiness and stress.

Modifiable risk factors for cardiovascular diseases and quality of life among first-year nursing students / Factores de riesgo modificables para enfermedades cardiovasculares y calidad de vida de los graduados de enfermeira / Fatores de risco modificáveis para doenças cardiovasculares e qualidade de vida de ingressantes da graduação de enfermagem

ABSTRACT Objective To describe the risk factors for cardiovascular diseases and the quality of life of first-year college students. Methods A cross-sectional study conducted with first-year undergraduate nursing students attending a public university located in São Paulo, Brazil. The students completed nine questionnaires and the students'cervical and abdominal circumferences were measured along with their weight and height, blood pressure, lipid profile, and capillary blood glucose. Results 67 undergraduate students were included. Half of the students were physically inactive (73.1%), 7.5% reported smoking, 40.3% alcohol consumption, 25.4% overweight, and 16,4% increased total cholesterol. Depressive symptoms, anxiety, and stress were also reported, as well as excessive daytime sleepiness, risk of sleep apnea, and risky and harmful consumption of alcohol. As for the quality of life, the domains with the lowest scores were vitality and emotional aspects. Conclusion The most prevalent risk factors found in undergraduates were sedentary lifestyle, excessive daytime sleepiness and stress.

RESUMEN Objetivo describir los factores de riesgo de enfermidades cardiovasculares y la calidad de vida de los estudiantes universitários de primer año. Métodos estúdio transversal realizado con estudiantes de primer año de enfermeira de uma universidad pública ubicada em São Paulo, Brasil. Los estudiantes completaron nueve cuestionarios y se midieron las circunferencias cervical y abdominal de los estudiantes junto con su peso y altura, presión arterial, perfil de lípidos y glucosa en sangue capilar. Resultados se incluyeron 67 estudiantes. La mitad de los estudiantes eran fisicamente inactivos (73,1%), el 7,5% informó que fumaba, el 40,3% consumía alcohol, el 25,4% tenía sobrepeso y el 16,4% aumentaba el colesterol total. También se informaron síntomas depresivos, ansiedad y estrés, así como somnolencia diurna excesiva, riesgo de apnea del sueño y consumo peligroso y nocivo de alcohol. Em cuanto a la calidad de vida, los dominios com puntuaciones más bajas fueron vitalidad y aspectos emocionales. Conclusión Los factores de riesgo más prevalentes encontrados em los universitários fueron el estilo de vida sedentário, la somnolencia diurna excessiva y el estrés.

RESUMO Objetivo Descrever os fatores de risco para doenças cardiovasculares e a qualidade de vida de alunos ingressantes no curso de enfermagem. Métodos Estudo transversal realizado com ingressantes no curso de enfermagem de uma Universidade Pública de São Paulo, Brasil. Os alunos responderam a nove questionários e as circunferências cervical e abdominal foram medidas, juntamente com peso e altura, pressão arterial, perfil lipídico e glicemia capilar. Resultados 67 alunos foram incluídos. Alguns estudantes apresentaram inatividade física (73,1%), 7,5% reportaram tabagismo, 40,3% consumiam álcool, 25,4% estavam acima do peso e 16,4% tinham aumento do colesterol total. Sintomas de depressão, ansiedade e estresse também foram reportados, assim como sonolência diurna excessiva, risco de apneia do sono e uso de risco ou nocivo de álcool. Quanto a qualidade de vida, os domínios com menor pontuação foram vitalidade e aspecto emocional. Conclusão Os fatores de risco mais prevalentes encontrados nos alunos foram sedentarismo, sonolência diurna excessiva e estresse.

Efficacy of a video during bed bath simulation on improving the performance of psychomotor skills of nursing undergraduates: A randomized clinical trial.

BACKGROUND: Studies have shown the efficacy of videos used in isolation to retain knowledge, acquire skills, and establish students' self-confidence. A few studies have investigated the efficacy of videos associated with simulations, while none of these studies have addressed bed bathing, one of the first procedures learned by nursing students. OBJECTIVE: To test the efficacy of a video-assisted bed bath simulation on improving the performance of psychomotor skills of undergraduate nursing students. DESIGN: A randomized clinical trial. SETTING: A Teaching Skills and Simulation Center at a Federal University in Brazil. PARTICIPANTS: All students regularly enrolled in the second year of the nursing undergraduate program at a Federal University, aged 18 years old, who had never performed a bed bath and had attended a theoretical class addressing the procedure (n = 56). METHODS: The students were randomized into two groups: the Control group (n = 28) simulated a bed bath with the instructions of a tutor, while the Intervention group (n = 28) watched a video during the bed bathing simulation, under the supervision of a tutor. The performance of students concerning bed bathing was assessed twice (before and after the simulation) using a previously validated instrument. RESULTS: The psychomotor skills of both groups significantly improved in the second assessment, and the Intervention group scored higher (p = 0.003). CONCLUSIONS: The use of a video during bed bath simulations was efficacious for improving the performance of psychomotor skills of undergraduate nursing students.

Fluctuating Elasticity Mode in Transient Molecular Networks.

Transient molecular networks, a class of adaptive soft materials with remarkable application potential, display complex, and intriguing dynamic behavior. By performing dynamic light scattering on a wide angular range, we study the relaxation dynamics of a reversible network formed by DNA tetravalent nanoparticles, finding a slow relaxation mode that is wave vector independent at large q and crosses over to a standard q^{-2} viscoelastic relaxation at low q. Exploiting the controlled properties of our DNA network, we attribute this mode to fluctuations in local elasticity induced by connectivity rearrangement. We propose a simple beads and springs model that captures the basic features of this q^{0} behavior.

Nonpharmacological interventions to improve quality of life in heart failure: an integrative review. / Intervenções não farmacológicas para melhor qualidade de vida na insuficiência cardíaca: revisão integrativa.

OBJECTIVE:: to identify articles that assessed the effectiveness or efficacy of nonpharmacological interventions to improve quality of life of people with heart failure in the literature. METHOD:: an integrative literature review was performed in Lilacs, MedLine and SciELO databases, including randomized or nonrandomized clinical trials and quasi-experimental studies published between 2003 and 2014, in Portuguese, English or Spanish. RESULTS:: twenty-three studies were included. The categories of nonpharmacological interventions that improved quality of life of people with heart failure were: Remote health monitoring, Instructions on health practices, Physical activity follow-up and Traditional Chinese Medicine practices. CONCLUSION:: these results can guide the selection of interventions to be implemented by health professionals that treat people with heart failure. Future systematic reviews with meta-analyses are needed in order to identify the most effective interventions for improving these individuals' quality of life.

Intervenções não farmacológicas para melhor qualidade de vida na insuficiência cardíaca: revisão integrativa / Intervenciones no farmacológicas para una mejor calidad de vida en la insuficiencia cardíaca: revisión integrativa / Nonpharmacological interventions to improve quality of life in heart failure: an integrative review

RESUMO Objetivo: identificar, na literatura, artigos que avaliaram a efetividade ou eficácia de intervenções não farmacológicas para melhorar a qualidade de vida de pessoas com insuficiência cardíaca. Método: revisão integrativa de literatura realizada nas bases de dados Lilacs, MedLine e SciELO, incluindo ensaios clínicos randomizados ou não randomizados e estudos quase-experimentais publicados entre 2003 e 2014, em português, inglês e espanhol. Resultados: foram incluídos 23 estudos. As categorias de intervenções não farmacológicas que melhoraram a qualidade de vida de pessoas com insuficiência cardíaca foram: Monitoramento remoto da saúde, Orientação sobre práticas de saúde, Acompanhamento de atividade física e Práticas de Medicina Tradicional Chinesa. Conclusão: estes resultados podem direcionar a seleção de intervenções a serem implementadas por profissionais de saúde que cuidam de pessoas com insuficiência cardíaca. Futuras revisões sistemáticas com metanálise são necessárias para identificar as intervenções mais eficazes para melhorar a qualidade de vida desses indivíduos.

RESUMEN Objetivo: identificar, en la literatura, artículos que evaluaron la efectividad o eficacia de intervenciones no farmacológicas para mejorar la calidad de vida de personas con insuficiencia cardíaca. Método: revisión integrativa de literatura realizada en las bases de datos Lilacs, MedLine y SciELO, incluyendo ensayos clínicos aleatorios o no aleatorios y estudios casi experimentales publicados entre 2003 y 2014, en portugués, inglés y español. Resultados: fueron incluidos 23 estudios. Las categorías de intervenciones no farmacológicas que mejoraron la calidad de vida de personas con insuficiencia cardiaca fueron: Monitoreo remoto de la salud, Orientación sobre prácticas de la salud, Acompañamiento de actividad física y Prácticas de Medicina China Tradicional. Conclusión: estos resultados pueden direccionar la selección de intervenciones a ser implantadas por profesionales de la salud que tratan de personas con insuficiencia cardiaca. Futuras revisiones sistemáticas con meta-análisis son necesarias para identificar las intervenciones más eficaces para mejorar la calidad de vida de estos individuos.

ABSTRACT Objective: to identify articles that assessed the effectiveness or efficacy of nonpharmacological interventions to improve quality of life of people with heart failure in the literature. Method: an integrative literature review was performed in Lilacs, MedLine and SciELO databases, including randomized or nonrandomized clinical trials and quasi-experimental studies published between 2003 and 2014, in Portuguese, English or Spanish. Results: twenty-three studies were included. The categories of nonpharmacological interventions that improved quality of life of people with heart failure were: Remote health monitoring, Instructions on health practices, Physical activity follow-up and Traditional Chinese Medicine practices. Conclusion: these results can guide the selection of interventions to be implemented by health professionals that treat people with heart failure. Future systematic reviews with meta-analyses are needed in order to identify the most effective interventions for improving these individuals’ quality of life.

[Mobbing: ten-year evaluation experience in a University Hospital]. / Mobbing: esperienza decennale di valutazione in un Policlinico Universitario.

OBJECTIVES: Bullying is a manifestation of occupational stress and can therefore be considered as a real "organizational pathology." Include the activities of the surgery dedicated to Mobbing, Unit of Occupational Medicine Sant'Andrea Hospital, which began operations in June 2001. METHODS: In over ten years of operation (July 2012), the sample, consisting of 50.7% for men and 49.3% women, is heterogeneous in age. The schooling of the sample is medium-high as more than 82% have higher education level. The business sector is the service sector accounted for most (84%) than in industry (9%) and agriculture (2%). RESULTS: Of the 1545 patients seen, 1320 completed the diagnostic path, while 225 have stopped. 814 users have been certified for compatibility bullying (63% of cases) with a net reduction of the awards from 2007 onwards. CONCLUSIONS: Considerations are expressed about the possible intervention strategies: the presence of dedicated experts at the counters of listening and professionals as the trusted advisor, to which workers in distress can call on for advice and guidance on how to defend itself from, in accordance with the implemented for years at the Ministry of Health, the establishment of such figures as the manager rehability that in other European countries, are scheduled for some time in work organization.

[The inclusion of the subject safety in the school curriculum;checking the validity of the hypothesis in schools in three provinces]. / L'inserimento della materia sicurezza nei programmi scolastici: verifica della validità dell'ipotesi nelle scuole di tre province.

According to Italian Legislative Decree no. 81/2008, workplace safety will have to be introduced in school and university curricula. The main objectives of this study of the Italian Ministry of Labour were to verify knowledge about workplace safety among primary and secondary school students and evaluate the effectiveness of a training course in improving students' knowledge. Three provinces with an above average workforce/injuries ratio (with respect to the national average) were identified. An evaluation questionnaire was administered to students in the three provinces. Students then attended training courses about workplace safety and were then administered the same questionnaire. Primary school students improved by an average of 35.5%, middle school students by 33.3%, high school students by 18.6%. Results suggests that the training intervention was effective.

Quality of life and functional capacity after long-term right ventricular pacing in pediatrics and young adults with congenital atrioventricular block.

BACKGROUND: Although several studies have demonstrated deleterious consequences of chronic right ventricular (RV) pacing on ventricular function and synchronicity, its effects on health-related quality of life (HRQoL) and functional exercise capacity remain uncertain. We aimed to evaluate the effect of RV pacing on HRQoL and functional capacity of children and young adults with congenital complete atrioventricular block (CCAVB). METHODS: We included 66 consecutive subjects with RV cardiac pacemaker due to CCAVB and under clinical follow-up for more than 1 year. Multidimensional HRQoL scores were evaluated by Short Form-36 Health Survey (SF-36) and Child Health Questionnaire-Parent Form 50 (CHQ-PF50). Functional capacity was tested by a 6-minute walk distance test (6MWDT). Association analysis was performed to examine if any demographic and clinical characteristics were associated with lower HRQoL scores and shorter distances at the 6MWDT. RESULTS: Domains presenting lower HRQoL scores were vitality (64.0 ± 17.3), mental health (67.3 ± 8.0), role emotional (69.7 ± 35.8) in the SF-36 questionnaire; general health perceptions (61.3 ± 8.3), general behavior (61.9 ± 15.6), parental impact-emotional (67.7 ± 28.7) in the CHQ-PF50. Female gender (P = 0.009), left ventricular ejection fraction lower than 55% (P = 0.013), cardiovascular drugs (P = 0.003) were significantly associated with lower HRQoL scores. Average distance traveled during the 6MWDT was 539.8 ± 82.9 m. The 6MWDT showed significant association with age (P = 0.006) and cardiovascular drugs (P = 0.024). CONCLUSIONS: Chronic RV pacing did not affect the HRQoL and physical capacity of pediatrics and young subjects. Female gender, ventricular function, and cardiovascular drugs were associated with lower HRQoL scores. Older subjects walked shorter distances in the 6MWDT, as well as subjects who were taking cardiovascular drugs.

Propagation of chirality in mixtures of natural and enantiomeric DNA oligomers.

Concentrated solutions of ultrashort duplex-forming DNA oligomers may develop various forms of liquid crystal ordering among which is the chiral nematic phase, characterized by a macroscopic helical precession of molecular orientation. The specifics of how chirality propagates from the molecular to the mesoscale is still unclear, both in general and in the case of DNA-based liquid crystals. We have here investigated the onset of nematic ordering and its chiral character in mixtures of natural D-DNA oligomers forming right-handed duplex helices and of mirror symmetric (L-DNA) molecules, forming left-handed helices. Since the nematic ordering of DNA duplexes is mediated by their end-to-end aggregation into linear columns, by controlling the terminals of both enantiomers we could study the propagation of chirality in solutions where the D and L species form mixtures of homochiral columns, and in solutions of heterochiral columns. The two systems behave in markedly different fashion. By adopting a simple model based on nearest-neighbor interactions, we account for the different observed dependence of the chirality of these two systems on the enantiomeric ratio.

[Musculoskeletal diseases among musicians of the "teatro dell'Opera" of Rome]. / Patologie muscolo-scheletriche nei musicisti del "teatro dell'Opera" di Roma.

Musculo-skeletal injuries represent a significant medical problem in professional musicians for which was coined the following acronym PRMDs (that stands for Playing Related Musculoskeletal disorders). A little osteo-articular problem in the professional musicians can impact on a real decreasing performance activity. The purpose of this study is to quantify prevalence of PRMDs syntoms among the professional musicians and to verify their relative impact on quality lives. This study has investigated the orchestral staff of the principal lyric theatre of Rome to which it was distributed DASH OUTCOME and SF-36 questionnaires to identify the presence of musculoskeletal complaints for cervical brachial syndrome and the general quality of life respectively. The employment of the above methodology furnish statistically significant results, pointing out that the musicians quality life suffering from musculo-skeletal symptomatology (DASH SF > or = 15) was lower than ones without a clinical symptomatology. Subsequently these results were compared with the Italian population benchmarking values.

Keratinocyte growth factor protected cultured human keratinocytes exposed to oxidative stress.

PURPOSE: To evaluate effects of oxidative stress and supplementation of keratinocyte growth factor (KGF) on cultivated human keratinocytes. METHODS: Oxidative stress was produced through addition of hydrogen peroxide (H(2)O(2)) to the culture medium. Cultivated human keratinocytes were divided in 4 groups: Group control (G C), Group KGF (G KGF), Group H(2)O(2) (G H(2)O(2)), Group H(2)O(2) and KGF (G H(2)O(2)-KGF). Each experiment was accomplished with the same lineage cultivated keratinocytes, in triplicate. Cell viability was evaluated by trypan blue exclusion assay. RESULTS: The results showed that the culture medium supplemented with KGF presented a small rate of cell viability when compared to cells only in culture medium (p<0,001). It demonstrated that only the growth factor does not have protector effects for cells in vitro. However, in front of the oxidative stress produced by addition of hydrogen peroxide to the medium, KGF showed a beneficial effect, protecting cells when compared to the group that suffered hydrogen peroxide action but had not been exposed to KGF (p<0,001). CONCLUSION: KGF determined protection to the primary human keratinocytes exposed to oxidative stress.

Keratinocyte growth factor protected cultured human keratinocytes exposed to oxidative stress / Fator de crescimento de queratinócitos protegeu queratinócitos humanos cultivados expostos ao estresse oxidativo

PURPOSE: To evaluate effects of oxidative stress and supplementation of keratinocyte growth factor (KGF) on cultivated human keratinocytes. METHODS: Oxidative stress was produced through addition of hydrogen peroxide (H2O2) to the culture medium. Cultivated human keratinocytes were divided in 4 groups: Group control (G C), Group KGF (G KGF), Group H2O2 (G H2O2), Group H2O2 and KGF (G H2O2-KGF). Each experiment was accomplished with the same lineage cultivated keratinocytes, in triplicate. Cell viability was evaluated by trypan blue exclusion assay. RESULTS: The results showed that the culture medium supplemented with KGF presented a small rate of cell viability when compared to cells only in culture medium (p<0,001). It demonstrated that only the growth factor does not have protector effects for cells in vitro. However, in front of the oxidative stress produced by addition of hydrogen peroxide to the medium, KGF showed a beneficial effect, protecting cells when compared to the group that suffered hydrogen peroxide action but had not been exposed to KGF (p<0,001). CONCLUSION: KGF determined protection to the primary human keratinocytes exposed to oxidative stress.

OBJETIVO: Avaliar os efeitos do estresse oxidativo e da suplementação do fator de crescimento de queratinócitos (KGF) em queratinócitos humanos cultivados. MÉTODOS: O estresse oxidativo foi produzido através da adição de peróxido de hidrogênio (H2O2) ao meio de cultura. Os queratinócitos humanos cultivados foram divididos em quatro grupos: grupo controle (G C), grupo KGF (G KGF), grupo H2O2 (G H2O2), grupo H2O2 e KGF (G H2O2-KGF). Cada experimento foi realizado com a mesma linhagem celular, em triplicata. A viabilidade celular foi avaliada pelo ensaio da exclusão do azul de tripan. RESULTADOS: Os resultados mostraram que o meio de cultura suplementado com o KGF apresentou menor taxa de viabilidade celular quando comparado às células do grupo controle (p<0,001). Isso mostra que somente o fator de crescimento de queratinócitos não apresentou efeito protetor às células em cultura. Entretanto, frente ao estresse oxidativo produzido pela adição do peróxido de hidrogênio ao meio de cultura, o KGF mostrou efeito benéfico, protegendo as células quando comparado ao grupo que sofreu a ação do estresse oxidativo, mas que não foi exposta ao KGF (p<0,001). CONCLUSÃO: O KGF determinou a proteção aos queratinócitos humanos primários cultivados expostos ao estresse oxidativo.

Evaluation of prenatal care at basic health units in the city of Sao Paulo / Evaluación de la asistencia prenatal en unidades básicas del municipio de San Pablo / Avaliação da assistência pré-natal em unidades básicas do município de São Paulo

The aim of this study was to evaluate the quality of prenatal care offered in 12 Basic Health Units (BHU) in the city of Sao Paulo, Brazil, through a review of medical and nurse charts, before and after the municipalization of the public health system. The indicator used considered excellence in care as: starting prenatal care in the first quarter of pregnancy; at least six medical visits; at least two results of blood screening for syphilis and one for HIV; returning to BHU up to 42 days after delivery. This indicator was not present in any care delivered in 2000, and only 7.7 percent of the care delivered in 2004 obtained it (1.1 percent to 30 percent of the care per unit assessed). Although there was an evident improvement in care during the period, the low proportion of excellent prenatal care shows an urgent need to improve this care in the BHU of São Paulo city.

El objetivo de este estudio fue evaluar la calidad de la asistencia prenatal ofrecida en doce Unidades Básicas de Salud (UBS) del municipio de San Pablo a través de la revisión de los registros médicos y de enfermería antes y después de la municipalización del sistema de salud. Fue utilizado un indicador que consideraba como atención de excelencia aquella con: inicio del acompañamiento prenatal en el primer trimestre de la gestación; con un mínimo de seis consultas; registro de por lo menos dos resultados de exámenes serológicos para sífilis y una prueba para el VIH; retorno a la UBS hasta 42 días después del parto. Ese indicador no fue obtenido en ninguna atención realizada en el 2000 y apenas en 7,7 por ciento de las atenciones en el 2004 (1,1 por ciento a 30 por ciento de las atenciones por unidad evaluada). A pesar de que con evidente mejoría de la atención en el período, la baja proporción de atención prenatal de excelencia, revela una urgente necesidad de mejorar esa asistencia en las UBS en el Municipio de San Pablo.

O objetivo deste estudo foi avaliar a qualidade da assistência pré-natal oferecida em doze Unidades Básicas de Saúde (UBS) do município de São Paulo, através da revisão dos prontuários médicos e de enfermagem antes e após a municipalização do sistema de saúde. Foi utilizado um indicador que considerava como atendimento de excelência aquele com início do acompanhamento pré-natal no primeiro trimestre da gestação, no mínimo seis consultas, registro de pelo menos dois resultados de exames sorológicos para sífilis e um teste para o HIV, retorno à UBS até 42 dias pós-parto. Esse indicador não foi obtido em nenhum atendimento realizado em 2000 e apenas em 7,7 por cento dos atendimentos em 2004 (1,1 a 30 por cento dos atendimentos por unidade avaliada). Embora com evidente melhora do atendimento no período, a baixa proporção de atendimento pré-natal de excelência revela urgente necessidade de melhorar essa assistência nas UBS no Município de São Paulo.

Evaluation of prenatal care at basic health units in the city of Sao Paulo.

The aim of this study was to evaluate the quality of prenatal care offered in 12 Basic Health Units (BHU) in the city of Sao Paulo, Brazil, through a review of medical and nurse charts, before and after the municipalization of the public health system. The indicator used considered excellence in care as: starting prenatal care in the first quarter of pregnancy; at least six medical visits; at least two results of blood screening for syphilis and one for HIV; returning to BHU up to 42 days after delivery. This indicator was not present in any care delivered in 2000, and only 7.7% of the care delivered in 2004 obtained it (1.1% to 30% of the care per unit assessed). Although there was an evident improvement in care during the period, the low proportion of excellent prenatal care shows an urgent need to improve this care in the BHU of São Paulo city.