David Buckingham: a Educação Midiática não deve apenas lidar com o mundo digital, mas sim exigir algo diferente

British researcher David Buckingham gave an interview to Revista Comunicação & Educação, via a virtual conference, recently in Brazil. Buckingham analyzes issues of the communication and education interface, the theoretical references shared with cultural studies, and primarily, the understanding that it is necessary to overcome the instrumental bias of the media in favor of a comprehensive understanding of digital capitalism. In the interview, Buckingham answers questions related to teacher training in the field of digital technologies, the development of pedagogical strategies to deal with digital capitalism at school and, above all, the concept of media education.David Buckingham concedeu entrevista exclusiva à Revista Comunicação & Educação. Realizado remotamente, o diálogo tem o intuito de elucidar aspectos práticos e teóricos que marcam a obra do autor. Buckingham analisa questões da interface comunicação e educação, as referências teóricas compartilhadas com os estudos culturais e, sobretudo, o entendimento de que é necessário superar o viés instrumental da mídia em favor de uma compreensão abrangente sobre o capitalismo digital. Na entrevista, o pesquisador responde questões relacionadas à formação docente no campo das tecnologias digitais, ao desenvolvimento de estratégias pedagógicas para lidar com o capitalismo digital no âmbito escolar e, especialmente, ao conceito de educação midiática

Neuropsychiatric drugs expenditure’ trends and drivers in Minas Gerais, Brazil, from 2010 to 2017

Background: Increasing consumption of neuropsychiatric drugs leads to rising expenditure with the potential to compromise public health budgets. This study analyzes public expenditures on neuropsychiatric drugs, its trends and drivers. Methods: Drug Utilization Study based on longitudinal data from the Integrated System for Materials and Services Management (SIAD) database from Minas Gerais’ State (20.8 mi inhab.), Brazil. Volume and inflation-adjusted expenditure were calculated for neuropsychiatric drugs purchased from 2010 to 2017. Procurement trends were estimated. Decomposition analysis was performed to identify the determinants of public expenditure variation (price, volume and / or therapeutic choice). Results: From 2010 to 2017, 168 chemical substances in 565 pharmaceutical products were purchased, totaling 4.03 million drug packages of neuropsychiatric drugs. Purchased quantities decreased by 34.5%, from 472 million in 2010 to 163 million units in 2017. Total accumulated expenditure for the period was USD 256.3 million, also recording a downward trend, falling 36% in 2017 when compared to 2010. Main expenditure variation drivers were volume and therapeutic choice. Conclusion: This study contributes to a better understanding of public expenditures on neuropsychiatric drugs. The observed reduction on expenditures and purchased volumes may have been influenced by the new procurement policy for medicines, adopted in Minas Gerais in 2016, with management centered on the municipalities. It is necessary, however, to further evaluate this policy’s impact on municipalities to avoid the risk of shortage of medicines for their population

Are medicines really available in the Brazilian public health system?

Background: Medicines availability in public healthcare systems varies from 17.6% to 88.6%. However, accurate measures of this indicator taking into account each prescribed medicine and the respective quantity required for the entire treatment are scarce. The aim of this study is to evaluate the availability of medicines in primary care and to identify its associated factors. Methods: Exit survey in 2017 with 1221 primary care users in a medium-sized municipality (234,937 inhab.), Minas Gerais state, Brazil. Each prescribed medicine was considered available if dispensed in adequate quantity for the duration prescribed. Prescriptions were classified as: totally filled, partially filled and unavailable. Pearson’s Chi-Square test was used to examine the association of full prescription availability with individual sociodemographic and health status variables at a significance level of 5%. Results:1186 prescriptions were analyzed, totaling 4039 medicines [mean = 3,4; Min = 1; Max = 11]. Prevalence of prescriptions totally filled was 39.4%, partially filled 48.23% and unavailable, 12.48%. The most and least available therapeutic groups were antiparasitic (100%) and anti-infectious (38,6%), respectively. Significant associations between full availability of the prescription and younger age (p = 0.000); more schooling (p = 0.000); poor perception of health (p = 0.001) and fewer comorbidities (p = 0.000) were identified. Conclusion: This study used a variety of indicators to characterize the availability of prescription medicines. The results show the need of implementing improvements in public policies to promote adequate access to medicines and reduce inequalities, especially among the most vulnerable populations

Do presencial ao remoto emergencial: trânsitos da educação infantil na pandemia

This article aims to take a look at the transit of the early childhood school to the remote emergency mode due to the Covid-19 pandemic. Based on the understanding that this condition cannot be considered child education in its entirety, the uses of technological resources and strategies adopted by schools were analyzed based on theoretical discussion and interviews with managers. The remote circumstantial solution sought to guarantee the maintenance of affective bonds and the school as a project, in addition to connections with culture and knowledge. The analysis revealed possibilities and limits of the relationship with technologies and illuminated aspects of the relationship between school and families.Este artículo tiene como objetivo mirar el tránsito de la escuela de primera infancia al modo emergencial remota debido a la pandemia Covid-19. En el entendido de que esta condición no puede ser considerada educación infantil en su totalidad, se analizaron los usos de los recursos tecnológicos y las estrategias adoptadas por las escuelas a partir de una discusión teórica y de entrevistas con coordinadores y directores. La solución circunstancial remota buscaba garantizar el mantenimiento de los lazos afectivos y de la escuela como proyecto, además de las conexiones con la cultura y el conocimiento. El análisis reveló posibilidades y límites de la relación con las tecnologías e iluminó aspectos de la relación entre la escuela y las familias.Este artigo tem como objetivo lançar um olhar para o trânsito da escola de educação infantil para o modo remoto emergencial em função da pandemia de Covid-19. Partindo da compreensão de que esta condição não pode ser considerada educação infantil em sua integralidade, analisaram-se os usos de recursos tecnológicos e as estratégias adotadas por escolas a partir de discussão teórica e entrevistas com gestoras. A solução circunstancial remota buscou garantir a manutenção de vínculos afetivos e da escola como projeto, além de conexões com a cultura e o conhecimento. A análise revelou possibilidades e limites da relação com as tecnologias e iluminou aspectos das relações entre escola e famílias

Knowledge of prescribed drugs among primary care patients

Background: Patients’ knowledge of their pharmacotherapy impacts the correct use of their drugs and, consequently, is paramount to the effectiveness of the prescribed treatment.Methods:Exit surveys administered to a representative sample of 1221 adult patients (≥18 years) from pharmaceutical services at primary care in a health pole municipality (234,937 inhab.) from the midwest macrorregion in Minas Gerais State, Brazil. Data on medical prescriptions and dispensed medications were collected and one of the prescribed drugs was randomly selected for analysis. Patients’ responses to the following itens: drug name, dosage, frequency of administration, indication, directions of use, treatment duration, warnings (patient’ attitudes when doses are missed, contraindications, side effects and interactions) were compared with prescription and/or literature and scored. Subsequently an overall level of knowledge index was constructed with the following cutoff points: less than 8 points (insufficient), 8 to 10 points (regular) and 11 points or more (good). Results:The level of knowledge of pharmacotherapy was considered insufficient for 30.8% of the patients, regular for 64.0% and good for 5.2% of them. Misinformation was more concentrated on warnings (side effects (96.3%), interactions (91.0%), missed doses (71.1%)) and indication (53.5%). Conclusion:The low level of treatment knowledge indicates the need for investment on redirecting patients’ counseling and monitoring work practices among primary care professionals

Antidepressivos, ansiolíticos, hipnóticos e sedativos : uma análise dos gastos em Minas Gerais

The allocation of financial resources on medicines procurement is one of the greatest challenges to the effectiveness of the Pharmaceutical Services in the Brazilian National Health System. However, there are few studies evaluating this expenditure trends at state level, especially with antidepressants, anxiolytics, hypnotics and sedatives. The study evaluated public expenditure trends and drivers for these therapeutic classes in Minas Gerais state, Brazil, by using data from SIAD database [Sistema Integrado de Administração de Materiais e Serviços] from 2010 to 2015. Total expenditure, volume and also expenditures with medicines not included in the essential lists were estimated. The top 10 medicines in terms of expenditure and drugs accounting for 90% of the total cost were identified. Decomposition analysis was conducted to assess the drivers of expenditure. Expenditure in the period totaled R$ 81 million and increased 2.5 times from 2010 to 2015. Antidepressants accounted for 89% of expenses and 71% of volume. Price contributed positively to the expenditure variation during the period, especially in antidepressants. The results highlight the need of improvement of public procurement procedures adopted by Minas Gerais state

Tendência nos gastos com medicamentos neuropsiquiátricos em Minas Gerais : Há aumento da oferta de antiparkinsonianos?

Introduction: Neuropsychiatric drugs are used for a wide variety of neurological and psychiatric conditions. Aims: To analyze the evolution and determinants of public spending on these medicines in Minas Gerais,2010 to 2017. Methods: Datathe Integrated Materials and Services Administration System (SIAD) database were used to estimate volumes of acquisition and expenses. Decomposition analysis was performed and, for anti-Parkinson drugs, the list of purchased drugs was analyzed and Drug Utilization technique (DU90%) was applied. Results: Annual expenditure decreased by 36%,R$111.7 million in 2010 to R$ 40.9 million in 2017, having as determinant factors the drops in prices and volume, associated with changes in the drug mix, that favored the acquisition of more expensive products, on average. The expenditure increase for anti-parkinsonians stands out, nonetheless, with significant change in the drug mix purchased. Conclusion: This study contributed to a better understanding of public spending on neuropsychiatric drugs. Reduction in volume can increase the risk of shortages. Regarding anti-parkinsonians, there is no evidence to suggest an increase in supply to the population

Haematological and genotoxic profile study of workers exposed to medical waste

Objective: To evaluate the haematological and genotoxic profile of workers exposed to medical waste. Method: Descriptive study of an observational nature, performed with two distinct groups: exposed (20 individuals) and unexposed (20 individuals), which had blood samples collected for analysis. Results: The results revealed an increased erythrocytes, hematocrit and leukocytes of the exposed group compared to the unexposed group. In the group exposed were identified: eosinophilia (45%), atypical lymphocytes (35%) and neutrophil toxic granulation (25%). It revealed a significant genotoxic effect by the content and frequency of major damage in the exposed group. There was no correlation of these results with the habits and life styles reported. Conclusion: It was found that the study group might be undergoing reaction processes caused by some agent, as well as genetic instability. These data highlight the need for greater biomonitoring of these workers in order to prevent neoplastic conditions

Características clínicas associadas a esteatose hepática à ultrassonografia em pacientes com alanina aminotransferase elevada

CONTEXT AND OBJECTIVE: The main causes of hepatic steatosis (HS) are alcoholic liver disease and nonalcoholic fatty liver disease (NAFLD). Although liver biopsy is the gold standard for NAFLD diagnosis, the finding of abnormal aminotransferases in abstinent individuals, without known liver disease, suggests the diagnosis of NAFLD in 80-90% of the cases. Identification of clinical factors associated with HS on abdominal ultrasound may enable diagnoses of fatty liver non-invasively and cost-effectively. The aim here was to identify clinical variables associated with HS in individuals with elevated alanine aminotransferase (ALT) levels. DESIGN AND SETTING: Cross-sectional study in a single tertiary care center. METHODS: Individuals with elevated ALT, serologically negative for hepatitis B and C, were evaluated by reviewing medical files. Patients who did not undergo abdominal ultrasonography were excluded. RESULTS: Among 94 individuals included, 40% presented HS on ultrasonography. Compared with individuals without HS, those with fatty liver were older (P = 0.043), with higher body mass index (BMI) (P = 0.003), diabetes prevalence (P = 0.024), fasting glucose levels (P = 0.001) and triglycerides (P = 0.003). Multivariate analysis showed that BMI (odds ratio, OR = 1.186; 95% confidence interval, CI: 1.049-1.341; P = 0.006) and diabetes mellitus (OR = 12.721; 95% CI: 1.380-117.247; P = 0.025) were independently associated with HS. CONCLUSIONS: Simple clinical findings such as history of diabetes and high BMI may predict the presence of HS on ultrasonography in individuals with elevated ALT and negative serological tests for hepatitis.CONTEXTO E OBJETIVO: Doença hepática alcoólica e doença hepática esteatótica não alcoólica (DHENA) são as principais causas de esteatose hepática (EH). Apesar de a biópsia hepática ser o método de escolha para diagnóstico DHENA, o achado de aminotransferases elevadas em indivíduos abstêmios, sem doença hepática conhecida, sugere o diagnóstico de DHENA em 80-90% dos casos. A identificação de variáveis clínicas associadas à EH na ultrassonografia abdominal pode permitir o diagnóstico de DHENA de forma não invasiva e custo-efetiva. O objetivo foi identificar variáveis clínicas associadas à EH em indivíduos com níveis elevados de alanina aminotransferase (ALT). TIPO DE ESTUDO E LOCAL: Estudo transversal em um único centro de atendimento terciário. MÉTODOS: Indivíduos com ALT elevada e sorologias negativas para os vírus de hepatite B e C foram avaliados por meio de revisão de prontuários. Os pacientes não submetidos à ultrassonografia foram excluídos. RESULTADOS: Foram incluídos 94 indivíduos, 40% deles com EH à ultrassonografia. Quando comparados aos indivíduos sem EH, aqueles com EH apresentaram maior prevalência de diabetes (P = 0,024), maiores idade (P = 0,043) e índice de massa corpórea (IMC) (P = 0,003), glicemia de jejum mais elevada (P = 0,001) e triglicerídeos mais elevados (P = 0,003). A análise multivariada evidenciou que o IMC (odds ratio, OR = 1,186, 95% intervalo de confiança, IC 1,049-1,341, P = 0,006) e o diabetes mellitus (OR = 12,721, 95% IC 1,380-117,247, P = 0,025) foram associadas independentemente à EH. CONCLUSÕES: Achados clínicos simples como história de diabetes e o IMC elevado podem predizer a presença de EH à ultrassonografia de indivíduos com ALT elevada e sorologias negativas para hepatite.Universidade Federal de São Paulo (UNIFESP) Division of Gastroenterology Hepatitis SectionUNIFESP, Division of Gastroenterology Hepatitis SectionSciEL