Autogenic biofeedback training improves autonomic responses in a participant with cervical motor complete spinal cord injury- case report.

STUDY DESIGN: Single-subject case design OBJECTIVE: To evaluate the Autogenic Feedback Training Exercise (AFTE) on autonomic nervous system responses. INTRODUCTION: AFTE combines specific autogenic exercises with biofeedback of multiple physiological responses. Originally developed by the National Aeronautics and Space Administration (NASA), AFTE is used to improve post-flight orthostatic intolerance and motion sickness in astronauts. Individuals with cervical or upper thoracic spinal cord injury (SCI) often present symptoms of autonomic dysfunction similar to astronauts. We hypothesize that AFTE challenges nervous system baroreflex, gastric and vascular responses often impaired after SCI. METHODS: Using a modified AFTE protocol, we trained a hypotensive female participant with cervical motor complete (C5/6-AIS A) SCI, and a male non-injured control participant (NI) and measured blood pressure (BP), heart rate (HR), gastric electrical activity, and microvascular blood volume before, during and after AFTE. The participants were instructed to complete breathing and imagery exercises to help facilitate relaxation. Subsequently, they were instructed to use stressful imagery and breathing exercises during arousal trials. RESULTS: Both participants completed 8 sessions of approximately 45 min each. Microvascular blood volume decreased 23% (SCI) and 54% (NI) from the beginning to the end of the stimulation cycles. The participant with SCI became progressively more normotensive and improved levels of gastric electrical activity, while the NI participant's changes in HR, gastric electrical activity, and BP were negligible. CONCLUSIONS: AFTE may offer a novel non-pharmacologic intervention to minimize symptoms of dysautonomia in people with SCI.

Attitudes about COVID-19 Testing among Black Adults in the United States.

Purpose: Black Americans are disproportionately affected by coronavirus disease 2019 (COVID-19) hospitalizations and deaths. Decreasing health disparities requires widespread uptake of COVID-19 testing, but attitudes about COVID-19 testing among Black Americans have not been studied. We aimed to characterize knowledge, attitudes, and beliefs about COVID-19 testing among Black parents. Methods: Semi-structured interviews were conducted and analyzed using a phenomenology approach with 26 self-identified Black parents after telemedicine visits with a children's health center. Interviews were recorded and transcribed; 65% were double coded with a resultant free-marginal interrater kappa score of 86.8%. Results: Most participants were women, spent time inside the homes of friends or family members, and almost half knew someone diagnosed with COVID-19. Three central themes emerged regarding COVID-19 testing decision making, including: 1) perceived COVID-19 disease susceptibility; 2) barriers to testing, with subthemes including trust in test accuracy and safety, perceived stigma of a positive test result, and impact of racism on self-efficacy; and 3) cues to action. Conclusions: When considering these themes as constructs of the Health Belief Model, we are better able to understand Black Americans' views of COVID-19 testing and motivations for accessing testing. Culturally responsive educational campaigns delivered by trusted community members should aim to improve understanding about disease transmission and types of tests available. Importantly, framing testing as a means to ensure safety may improve self-efficacy to obtain testing. Lastly, the health community should learn from these conversations with Black Americans so that disease prevention and mitigation strategies prioritize health equity.

Meningococcal disease and vaccination in college students.

Neisseria meningitidis is a bacterial pathogen capable of causing rapidly progressing illness from nonspecific symptoms to end-organ failure or death in a matter of hours to days. Despite the availability of meningococcal vaccines, there remains a notable disease incidence peak among individuals aged 18-19 years, with college students at increased risk for disease relative to non-college students. Between 2007 and 2017, as many as one in five colleges in the United States experienced an outbreak of meningococcal disease at their own or a nearby institution. Evidence-based strategies to promote meningococcal vaccination among students can be adapted for the college setting, but barriers exist that limit widespread implementation of these strategies by colleges. In this article, we review meningococcal disease characteristics and epidemiology among US college students, vaccination indications and coverage levels among US college students, as well as college vaccination policies and practices that can impact students' vaccine uptake.

Vaccination coverage among young homeless children compared to US national immunization survey data.

INTRODUCTION: Comprehensive vaccination coverage among homeless children in the United States (US) is largely unknown although a few studies suggest low coverage with single vaccinations. This study compared vaccination coverage with a combined 7-vaccines series among homeless children in the District of Columbia (DC) to coverage among other US children. MATERIALS AND METHODS: A cross-sectional survey of homeless children in DC was conducted from 2018 to 2019. Recruitment occurred at housing shelters, social services centers, and a diaper dispensary, and through limited chain referral. English-speaking parents of a child aged 19 to 35 months who spent the majority of the last 30 nights homeless were recruited. Participants consented for their child's healthcare providers to submit vaccination records. The vaccination coverage estimate of this sample was compared with estimates of three populations in the 2018 National Immunization Survey (NIS): children in DC (NIS DC), children in the US (NIS US), and children in the US below the federal poverty level (NIS poor). RESULTS: Most of the 135 children had experienced at least two lifetime episodes (63.7%) and 12 months (57%) of homelessness. The estimated percent up to date was 52.6% (95% CI: 43.8%, 61.3%). This estimate was 20.4 (95% CI: 11.9, 28.8, p < .0001), 20 (95% CI: 11.5, 28.4, p < .0001), and 11.5 (95% CI: 3.1, 20, p < .01) percentage points lower than estimates for the NIS DC, NIS US and NIS poor populations, respectively. After adjusting for child's age and race/ethnicity, vaccination coverage of the NIS DC sample was below that of NIS US (p < .01) and NIS poor samples (p < .05). CONCLUSION: Children experiencing homelessness may be at risk of under-vaccination, even when compared to a general population of children in poverty. Awareness of this heightened risk may allow for more precise targeting of vaccination delivery support specifically to children experiencing homelessness.

Implementing the Asthma Scripts to School Programs to Facilitate Student Access to Albuterol.

Inability to access an albuterol inhaler at school increases risk to students of severe asthma attack. Students typically must bring their own albuterol for use at school. In this program, albuterol is sent from a pharmacy to the school at no cost to families following a child's hospitalization or health care encounter.

Parental Beliefs, Logistical Challenges, and Improvement Opportunities for Vaccination among Children Ages 19-35 Months Experiencing Homelessness.

OBJECTIVES: To examine parental beliefs and logistical challenges to early childhood vaccination completion as well as opportunities to support improved vaccine uptake among families experiencing homelessness. STUDY DESIGN: A cross-sectional survey was conducted between February 2018 and October 2019 with parents of children ages 19-35 months old experiencing homelessness. Participants were recruited from 10 locations that serve families experiencing homelessness in Washington, DC and by referral from other participants. Vaccination records were obtained from health care providers to determine the child's up-to-date (UTD) status with a combined 7-vaccine series. RESULTS: Of 135 children of participants, only 69 (51.1%) were UTD. Most participants had at least 1 concern about childhood vaccines and at least 1 logistical barrier to completing vaccination (57% and 85.9%, respectively). The most frequent barriers were getting a convenient appointment time (46.3%), remembering appointments (44.8%), and commuting to appointments (44.4%). Although only 53.3% of the participants' children attended a licensed daycare center and only 43.7% received benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), use of either of these programs that routinely assess vaccination status was associated with over 3 times higher adjusted odds of being UTD (aOR 3.4, 95% CI 1.6-7.3, and aOR 3.1, 95% CI 1.4-6.5, respectively). CONCLUSIONS: Logistical barriers to accessing primary care services are common among children experiencing homelessness, underscoring the importance of health care providers offering vaccines at every opportunity. Government-regulated programs are useful for promoting vaccination, and enrollment should be encouraged because many children experiencing homelessness may not access them.

Serogroup B meningococcal vaccination practice patterns on college campuses.

BACKGROUND: Most Neisseria meningitidis involved in invasive disease among American college students express serogroup B antigen. The Advisory Committee on Immunization Practices (ACIP) recommends healthcare providers (HCPs) share clinical decision making with patients to determine individual value of meningococcal serogroup B vaccination (MenB) rather than routinely recommend vaccination as with the meningococcal A,C,W,Y vaccine (MenACWY). This study examines the attitudes and practices of HCPs working in college student health centers (SHCs) regarding the recommendation and administration of MenB to students. METHODS: The study was conducted as an online and phone survey of SHC HCPs from a sample of colleges across the United States between May 2017 and July 2018. Items compared college SHC policies and practices for MenB to those for MenACWY. It also assessed perceived barriers to and facilitators of MenB delivery to students. RESULTS: Among the 147 respondents, almost 50% more reported their SHC stocked and administered MenACWY (54.1%) than MenB (37%) (p = .004). Almost five times as many colleges required their students receive MenACWY as MenB (53.5% vs. 10.5%, p < .001). A greater percentage requested students to submit records for MenACWY than MenB (77.3% vs. 46.9%, p < .001), and over three times as many tracked student-body coverage rates for MenACWY than MenB (55.6% vs. 15.8%, p < .001). Nearly three quarters of respondents estimated their college's student body MenB coverage rate to be ≤ 10% or were unable to provide any estimate. Factors perceived by over half of the participants as moderate to extreme barriers to administering MenB included high upfront costs for SHCs to purchase and stock MenB (68.7%), and high out-of-pocket costs for students to receive it (82.8%). CONCLUSIONS: A minority of college SHCs require, offer or track Men B vaccination on their campuses. Financial concerns are common barriers to SHCs' stocking and administering MenB to students.

Falhas na gestão da Assistência Farmacêutica para Medicamentos Judicializados, em 16 municípios da região Sudeste brasileira / Failures in Pharmaceutical Services management for Judicialized Medicines, in 16 municipalities of the Brazilian Southeast

RESUMO Desde a década de 1990, as solicitações de medicamentos por via judicial vêm se intensificando. Vários estudos têm traçado o panorama destas demandas. Buscou-se descrever a existência de organização própria da gestão da Assistência Farmacêutica (AF) Municipal para o atendimento de medicamentos demandados judicialmente. Um conjunto de 16 municípios incluiu 4 de cada estado da região Sudeste brasileira. Para a descrição do perfil da gestão da AF, foi estruturada uma matriz de indicadores que contemplou suas dimensões de recursos humanos, financeiros e suas atividades. Em nove municípios, a gestão dos medicamentos solicitados por via judicial coube ao gestor local da AF. Os indicadores com os piores desempenhos em todas as respostas foram aqueles que versaram sobre as despesas com Medicamentos Judicializados. Somente seis gestores informaram que realizavam análise técnica das prescrições e contato regular com o judiciário. Em sete municípios, os gestores não souberam especificar a modalidade de aquisição dos medicamentos demandados. A gestão municipal tem papel preponderante sobre a gestão da AF e precisa ser revista, havendo a necessidade de amplo questionamento a respeito do seu papel e de eventuais mudanças pelas quais possa passar.

ABSTRACT Since the 1990s, judicial demands for medicines have intensified. Several studies have outlined these demands. We describe the organization of the management of Municipal Pharmaceutical Services (PS) for the provision of medicines demanded through litigation. The sample included 16 municipalities, four for each state in the Brazilian Southeast. To describe the management profile of PS, a matrix of indicators was developed including dimensions of human and financial resources, and PS activities. In nine municipalities, management of medicines acquired through litigation was the responsibility of the local manager of PS. Indicators on expenditures with litigated medicines were the ones with the worst performance. Only six managers informed using technical analysis of prescriptions and regular contact with the judiciary. In seven municipalities, managers were unable to specify the modality of acquisition of medicines. Municipal management plays a major role in the management of PS and must be reviewed, with the need for a thorough questioning regarding its role and possible changes it needs to implement.

Essential Medicines List Implementation Dynamics: A Case Study Using Brazilian Federal Medicines Expenditures.

The aim was to analyse the implementation dynamics of the essential medicines list (EML). We used the government expenditures on medicines and Brazil as a case study. Drug purchases were considered as a proxy for utilization. The essential medicines (EMs) expenditures were followed over time by Brazilian National EMLs life-time and defined by broad therapeutic categories and by specific medicines. Brazil increased the number of the medicines during the last four editions of Brazilian National EMLs and the federal government expenditures on them. The EML implementation dynamics changed the distribution of expenditures on EMs. We identified a common set of 404 EMs present in all four editions of the Brazilian National EMLs. There was a proportional decrease in expenditures on anti-infectives for systemic use, blood and blood-forming organs and alimentary tract and metabolism, and increase in expenditures on antineoplastic and immunomodulating agents. The expenditures distribution per specific medicines revealed that a small set of EMs was responsible for 50% or more of expenditures considering Brazilian National EML life-time for all four periods. The increase in expenditures on EMs in Brazil was a consequence of the newer medicines incorporated over time in the Brazilian National EMLs. The use of the medicines expenditures as a source of data and the definition of an EML life-time permitted follow-up of the implementation dynamics of different versions of the Brazilian National EMLs. Our results have implications for policymakers and stakeholders to gain a better understanding of the role EMLs play in health system sustainability and in the provision of the most beneficial heath care.

Trends in medicines procurement by the Brazilian federal government from 2006 to 2013.

The costs of medicines pose a growing burden on healthcare systems worldwide. A comprehensive understanding of current procurement processes provides strong support for the development of effective policies. This study examined Brazilian Federal Government pharmaceutical procurement data provided by the Integrated System for the Administration of General Services (SIASG) database, from 2006 to 2013. Medicine purchases were aggregated by volume and expenditure for each year. Data on expenditure were adjusted for inflation using the Extended National Consumer Price Index (IPCA) for December 31, 2013. Lorenz distribution curves were used to study the cumulative proportion of purchased therapeutic classes. Expenditure variance analysis was performed to determine the impact of each factor, price and/or volume, on total expenditure variation. Annual expenditure on medicines increased 2.72 times, while the purchased volume of drugs increased 1.99 times. A limited number of therapeutic classes dominated expenditure each year. Drugs for infectious diseases drove the increase in expenditures from 2006 to 2009 but were replaced by antineoplastic and immunomodulating agents beginning in 2010. Immunosuppressants (L04), accounted for one third of purchases since 2010, showing the most substantial growth in expenditures during the period (250-fold increase). The overwhelming price-related increase in expenditures caused by these medicines is bound to have a relevant impact on the sustainability of the pharmaceutical supply system. We observed increasing trends in expenditures, especially in specific therapeutic classes. We propose the development and implementation of better medicine procurement systems, and strategies to allow for monitoring of product price, effectiveness, and safety. This must be done with ongoing assessment of pharmaceutical innovations, therapeutic value and budget impact.

[Essential medicines and the selection process in management practices of pharmaceutical services in Brazilian states and municipalities]. / Medicamentos essenciais e processo de seleção em práticas de gestão da Assistência Farmacêutica em estados e municípios brasileiros.

The selection of medicines is a skilled process that produces an essential medicines list (EML) and substantiates rational management of pharmaceutical services. This paper presents the selection of essential medicines in Brazilian states and municipalities. It discusses the perception of pharmaceutical services managers regarding the concept of essential medicines and strategies adopted for their implementation, in addition to investigating how the National Essential Medicines List was adopted and is supporting local pharmaceutical services actions. A nationwide study was carried out adopting a qualitative methodological approach in health. State and municipal managers from the five Brazilian regions were interviewed. The findings point to weaknesses in local selection procedures and in the use of the National Essential Medicines List (Rename). Barriers such as lack of formalization of pharmaceutical services at regional levels, difficulties in drafting and maintaining a pharmacy and therapeutics committee and the acritical incorporation of drugs on the EML were identified. States and municipalities have distortions that exclude the EML form the concept of essential medicines.

Adesão às listas de medicamentos essenciais por médicos brasileiros em atuação no sistema único de saúde / Adherence to the essential medicines lists by brazilian physicians in the unified health system

OBJETIVO: Investigou-se a adesão de médicos brasileiros em atuação no SUS a listas de medicamentos essenciais (LME), buscando conhecer o papel das LME na prática prescritiva e identificar a aceitação e barreiras para sua utilização no Brasil. MÉTODOS: O estudo, de âmbito nacional, entrevistou médicos da Atenção Primária e da hospitalar de 30 unidades públicas de saúde de municípios com e sem LME definida. Na análise dos dados foram utilizadas técnicas da pesquisa qualitativa em saúde. As categorias finais de análise foram: (i) contato com diferentes LME; (ii) utilização das LME na prática clínica; (iii) percepção do conceito de medicamentos essenciais. RESULTADOS: Foram ouvidos 58 médicos, sendo 11 do Nordeste e do Centro-Oeste e 12 do Sudeste, Norte e Sul. Apenas 17 dos 58 médicos entrevistados informaram contato anterior com uma LME, a maior parte referindo-se à lista municipal. Quando perguntados se utilizavam a Rename em sua prática clínica, todos os entrevistados responderam que não. Dentre os motivos citados, estão (i) a indisponibilidade dos medicamentos (da lista) no momento requerido; (ii) a falta de orientação necessária para o uso; (iii) a impressão de que a composição da lista é inadequada à demanda clínica. CONCLUSÕES: Os resultados das falas expõem desconhecimento e baixa adesão a LME. Ainda que tenham tido algum contato prévio com uma LME, esta não é valorizada como fonte de informações para a prescrição baseada em evidências.

OBJECTIVE: To investigate the adherence to the essential medicines lists (EML) by Brazilian physicians practicing in the public health system and the role of the EML in prescribing practices, identifying barriers to their use in Brazil. METHODS: A nationwide study interviewed physicians from diverse public healthcare settings in 30 facilities, in municipalities with different statuses in regard to the existence of EMLs. Research data was analyzed through content analysis and perception analysis techniques. The final analytical categories were (i) physician's contact with different EMLs, (ii) use of EMLs in clinical practice and (iii) physician's perceptions regarding the essential medicines concept. RESULTS: A total of 58 physicians were interviewed, from all five Brazilian regions: eleven from the Northeast, eleven from the Mid-West, and twelve each from the Southeast, the North and the South. Seventeen of the 58 physicians reported previous contact with an EML, most of which had occurred with municipal lists. All physicians informed that they did not use the Brazilian Essential Medicines List (RENAME) in their clinical practices. Among the main reasons for this were: (i) unavailability of listed medicines at required moment, (ii) the lack of necessary information and training for adequate use of EML, and (iii) the perception that the composition of the EML is inadequate for clinical demands. CONCLUSIONS: Results from content analysis exposed low awareness regarding EMLs and the essential medicines concept, in addition to a low level of adherence to EMLs. Even though some physicians reported having previous contact with an EML, this tool is not valued as an evidence-based information source for writing prescriptions.

Medicamentos essenciais e processo de seleção em práticas de gestão da Assistência Farmacêutica em estados e municípios brasileiros / Essential medicines and the selection process in management practices of pharmaceutical services in Brazilian states and municipalities

A seleção é um processo qualificado que produz uma Lista de Medicamentos Essenciais (LME) e dá racionalidade à gestão da Assistência Farmacêutica (AF). O artigo apresenta a seleção de medicamentos em estados e municípios brasileiros, discute a percepção de gestores da AF com relação ao conceito de Medicamentos Essenciais (ME) e às estratégias adotadas na gestão, além de investigar se e de que forma a Relação Nacional de Medicamentos Essenciais (RENAME) foi adotada e está apoiando as ações locais de AF. O estudo de âmbito nacional foi realizado com base no referencial teórico-metodológico da pesquisa qualitativa em saúde. Foram entrevistados gestores de estados e municípios das cinco regiões brasileiras. Os resultados indicam fragilidades no processo de seleção e na utilização da RENAME. Foram identificadas barreiras como a falta de formalização da AF nas esferas subnacionais, as dificuldades em se compor e manter uma comissão de farmácia e terapêutica e a incorporação acrítica de medicamentos na LME. Estados e Municípios apresentam distorções que afastam a LME do conceito de ME.

The selection of medicines is a skilled process that produces an essential medicines list (EML) and substantiates rational management of pharmaceutical services. This paper presents the selection of essential medicines in Brazilian states and municipalities. It discusses the perception of pharmaceutical services managers regarding the concept of essential medicines and strategies adopted for their implementation, in addition to investigating how the National Essential Medicines List was adopted and is supporting local pharmaceutical services actions. A nationwide study was carried out adopting a qualitative methodological approach in health. State and municipal managers from the five Brazilian regions were interviewed. The findings point to weaknesses in local selection procedures and in the use of the National Essential Medicines List (Rename). Barriers such as lack of formalization of pharmaceutical services at regional levels, difficulties in drafting and maintaining a pharmacy and therapeutics committee and the acritical incorporation of drugs on the EML were identified. States and municipalities have distortions that exclude the EML form the concept of essential medicines.

Avaliação dos serviços de farmácia dos hospitais estaduais do Rio de Janeiro, Brasil / An evaluation of the services of state hospital pharmacies in Rio de Janeiro, Brazil

Este artigo apresenta o resultado de avaliação das farmácias dos hospitais próprios do Estado do Rio de Janeiro. Para a avaliação normativa foram empregados 62 indicadores de estrutura e processo, que permitiram verificar a adequação das atividades da farmácia hospitalar. Em seguida, os serviços foram estratificados por nível de complexidade do hospital. Em cada estrato foi aplicado um algoritmo de pontuação escalonada de acordo com as atividades executadas. Os hospitais foram então hierarquizados em cada estrato, sendo escolhidos para o estudo de casos múltiplos o pior e o melhor serviço de cada nível de complexidade, perfazendo um total de seis unidades. Nestas, foram aplicados 16 indicadores de resultados. Os dados foram analisados por síntese de casos cruzados. A avaliação do desempenho mostrou que apenas uma unidade realizava a contento as atividades de gerenciamento e programação. Quatro realizavam inadequadamente a aquisição de medicamentos. Os piores resultados de desempenho nos seis hospitais estudados foram relacionados ao componente armazenamento, e os melhores à atividade de distribuição. Os dados são preocupantes, por serem as atividades avaliadas consideradas centrais da farmácia hospitalar.

This article presents an evaluation of state-run hospital pharmacies in Rio de Janeiro. For the regulatory evaluation, 62 indicators of structure and procedures were used in order to establish the adequacy of the activities of the hospital pharmacy. The services were then stratified by level of complexity of the hospital. A scaled rating algorithm was applied to each stratum in accordance with the activities carried out. The hospitals were then hierarchically grouped for each stratum and the best and worst services at each level of complexity were chosen for the multiple case study, resulting in a total of six units. In these units 16 result indicators were applied and analysis of the resulting data was conducted by cross-case synthesis. The performance evaluation revealed that only one unit performed management and forecasting activities satisfactorily. Four units administered medication procurement inadequately. The worst results in terms of performance in the six hospitals studied were related to stock management and the best to distribution activities. The data are a cause for concern, since these are considered the core activities of the hospital pharmacy.

[An evaluation of the services of state hospital pharmacies in Rio de Janeiro, Brazil]. / Avaliação dos serviços de farmácia dos hospitais estaduais do Rio de Janeiro, Brasil.

This article presents an evaluation of state-run hospital pharmacies in Rio de Janeiro. For the regulatory evaluation, 62 indicators of structure and procedures were used in order to establish the adequacy of the activities of the hospital pharmacy. The services were then stratified by level of complexity of the hospital. A scaled rating algorithm was applied to each stratum in accordance with the activities carried out. The hospitals were then hierarchically grouped for each stratum and the best and worst services at each level of complexity were chosen for the multiple case study, resulting in a total of six units. In these units 16 result indicators were applied and analysis of the resulting data was conducted by cross-case synthesis. The performance evaluation revealed that only one unit performed management and forecasting activities satisfactorily. Four units administered medication procurement inadequately. The worst results in terms of performance in the six hospitals studied were related to stock management and the best to distribution activities. The data are a cause for concern, since these are considered the core activities of the hospital pharmacy.

Estruturação da assistência farmacêutica: plano de ação para a seleção de medicamentos essenciais / Structuring of pharmaceutical care: an operational plan for the selection of essential medicines

A adoção da lista de medicamentos essenciais favorece o acesso e contribui com o uso racional de medicamentos à medida em que são incluídos apenas fármacos necessários, com comprovada eficácia, segurança, menor custo tratamento/dia e apresentação mais adequada ao manejo. O texto apresenta um plano de ação para execução da seleção de medicamentos essenciais em esferas governamentais, que pode ser também empregado como instrumento para nortear o processo em instituições de saúde. O desenho metodológico abrigou revisão documental das experiências de seleção de medicamentos da União e dos estados e o exame do caso do estado do Rio de Janeiro. O plano, à luz do referencial teórico da avaliação de serviços, foi organizado em três momentos. A partir do objetivo de cada um, metas e ações necessárias ao seu alcance foram listadas, totalizando 8 metas e 16 ações interligadas e sequenciais. Cada ação é acompanhada pelo detalhamento de sua contribuição para o objetivo, proposta metodológica para realização, recursos necessários, período estimado de execução e indicadores para mensurar se os objetivos específicos foram alcançados. Estima-se que o produto possa subsidiar os processos de seleção em municípios e estados, bem como as revisões periódicas das listas de medicamentos.

The adoption of the essential medicines list (EML) enables access to essential medicines and their rational use as only necessary medicines with proven efficacy and safety, favorable cost and dosage forms are included. This work presents an action plan for essential medicines selection in the public health system, which may also be employed as a management tool in health facilities. Methodological design involved a complete review of state experiences in medicines selection, and the analysis of the case in the State of Rio de Janeiro. The plan was developed based on the theoretical framework of health-systems evaluation and organized in a step-wise fashion. For each step, objectives, goals and necessary actions were compiled, totaling three objectives, eight goals and sixteen interlaced actions. Each action, in turn, is accompanied by the detailing of its contribution to the objective, methods, necessary resources, estimated timeframe for completion and indicators for measurement of achievement of objective. We propose that this plan may help subsidize the development of the selection process in states and municipalities, as well as reviews of the EML.

[Building evaluation criteria: experts and user satisfaction with pharmaceutical delivery services for HIV/Aids]. / Construindo Critérios de Julgamento em Avaliação: especialistas e satisfação dos usuários com a dispensação do tratamento do HIV/Aids.

A criterion is a typical tool in the evaluation field that can be defined as a standard-dimension under which the object of an evaluation receives qualitative or quantitative judgments. During an evaluation, several rigorous methodological procedures are involved in development and application of suitable criteria to determine the value of the object being evaluated. This article presents a set of criteria to evaluate user satisfaction with HIV/Aids-related pharmaceutical delivery services. The criteria construction process involved consensus amongst different experts, from academia, NGOs, management, by means of the Delphi technique. This technique prescribes a series of formal steps towards a consensus of experts, based on pre-structured methodology and processes. The findings were systematically organized in a structure under which the resulting satisfaction criteria are hierarchically organized. Results suggest the importance of developing a methodological strategy in evaluation that involves participation of different actors and of enhancing knowledge on user satisfaction and pharmaceutical delivery services for HIV/Aids.

Construindo Critérios de Julgamento em Avaliação: especialistas e satisfação dos usuários com a dispensação do tratamento do HIV/Aids / Building Evaluation Criteria: experts and user satisfaction with pharmaceutical delivery services for HIV/Aids

Critério é uma ferramenta típica da avaliação e pode ser definido como uma dimensão-padrão em função da qual a realidade do objeto da avaliação receberá julgamento qualitativo e/ou quantitativo. Em uma avaliação, o procedimento de elaborar, esclarecer, negociar e aplicar critérios para determinar o valor (ou mérito) do objeto avaliado faz parte de um exercício metodológico que deve ser cuidadoso. Este artigo apresenta critérios de julgamento para avaliar a satisfação dos usuários com a dispensação dos medicamentos para o tratamento do HIV/Aids e seu processo de construção por meio de consenso entre diferentes atores sociais. Para estabelecer o consenso utilizou-se técnica de Delfos, uma técnica formal utilizada para consenso de especialistas com metodologia e processos estruturados. Neste estudo, foram considerados especialistas aqueles com experiência acadêmica e em gestão, bem como ativistas informados e comprometidos com a questão. Os achados foram sistematizados sob a forma de uma nova estrutura de satisfação, sob a qual os critérios construídos são articulados hierarquicamente. Buscou-se contribuir para o desenvolvimento de uma estratégia metodológica participativa em avaliação e ampliar o conhecimento sobre a satisfação dos usuários e a dispensação dos medicamentos para HIV/Aids.

A criterion is a typical tool in the evaluation field that can be defined as a standard-dimension under which the object of an evaluation receives qualitative or quantitative judgments. During an evaluation, several rigorous methodological procedures are involved in development and application of suitable criteria to determine the value of the object being evaluated. This article presents a set of criteria to evaluate user satisfaction with HIV/Aids-related pharmaceutical delivery services. The criteria construction process involved consensus amongst different experts, from academia, NGOs, management, by means of the Delphi technique. This technique prescribes a series of formal steps towards a consensus of experts, based on pre-structured methodology and processes. The findings were systematically organized in a structure under which the resulting satisfaction criteria are hierarchically organized. Results suggest the importance of developing a methodological strategy in evaluation that involves participation of different actors and of enhancing knowledge on user satisfaction and pharmaceutical delivery services for HIV/Aids.