Uma proposta de renovação da seleção de medicamentos no SUS: a regionalização como estratégia e experiência para superação de desafios

A escolha e oferta de medicamentos no SUS caracteriza-se como uma importante etapa da Assistência Farmacêutica, com elevado impacto na resolutividade e eficiência da assistência à Saúde. No formato proposto, esta etapa encontra limitações, principalmente em sua operacionalização, que minimizam seus potenciais benefícios. O presente artigo tem por objetivo relatar e discutir uma experiência desenvolvida no âmbito de uma região de saúde para renovar a proposta de seleção de medicamentos com a introdução de ferramentas da Gestão de Tecnologias em Saúde, do conceito de regionalização e de Redes de Atenção. Para tanto, foram desenvolvidas ações em âmbito regional para normatização da prescrição de medicamentos, definição de um modelo e construção das Relações Municipais de Medicamentos, criação de uma Comissão de Farmácia e Terapêutica Regionalizada e mapeamento de necessidades relacionadas a protocolos clínicos. Constitui-se em experiência com resultados concretos e potencial de aplicabilidade em diferentes contextos de organização do SUS

Next Generation Differential GPS Architecture

The United States Coast Guard is engaged in a project to re-capitalize Reference Station (RS) and Integrity Monitor (IM) equipment used in the Nationwide Differential Global Position System (NDGPS). The Coast Guard in partnership with industry is developing a new software application to run on an open architecture platform as a replacement for legacy equipment. Present commercially available off-the-shelf Differential Global Positioning System (DGPS) RS and IM equipment lacks the open architecture required to support long term goals and future system improvements. The utility of the proposed new hardware architecture and software application is impressive - nearly every aspect of performance and supportability significantly exceeds that of the legacy architecture. The flexibility of the new hardware and software architectures complement each other to offer promising possibilities for the future. For example, the new hardware architecture uses Ethernet for internal and external site equipment communications. Each Local Area Network (LAN) will be equipped with a router and two 24 port switches. Various levels of password protection are provided to manage security both locally and remotely. While the new software application directly supports the legacy RS-232/422 interfaces to devices such as GPS receivers, a system design goal includes the ability to directly address each device from NCS. With the use of TCP/IP to RS-232/422 port server devices, the system can meet these forward reaching goals while supporting legacy equipment. New system capabilities include remote software management, remote hardware configuration management, and flexible options for management of licenses. The new configurable RS and IM architecture is a PCbased emulation of legacy reference station and integrity monitor equipment. It supports fluid growth and exploitation of new signals, formats, and technology as they become available, while remaining backward compatible with legacy architecture and user equipment. Examples of new capabilities include enhanced data management & anomaly analysis, universal On Change Reference Station Integrity Monitor (RSIM) message scheduling, improved satellite clock handling, additional observation interval modes, and Range Rate Correction monitoring in the IM. Engineering initiatives under development such as implementation of pre-broadcast integrity are also presented. This paper details challenges and goals that drove software and hardware design approaches destined to become the backbone of the Next Generation Differential GPS Architecture. Functional differences between legacy and next generation operation are explored. The new DGPS system architecture will allow the USCG radiobeacon system to continue to deliver and improve navigation and positioning services to our nation and its territories. Reprinted with permission from The Institute of Navigation (http://ion.org/) and The Proceedings of the 18th International Technical Meeting of the Satellite Division of The Institute of Navigation, (pp. 816-826). Fairfax, VA: The Institute of Navigation

Conspiracy beliefs, regulatory self-efficacy and compliance with COVID-19 health-related behaviors: The mediating role of moral disengagement

Although recent studies on the 2019 coronavirus disease (COVID-19) have highlighted the negative effects of moral disengagement on intentions to comply with COVID-19 containment measures, little is known about the mediating role of moral disengagement in the relationship between regulatory self-efficacy in complying with the containment measures, beliefs in conspiracy theories and compliance with COVID-19 health-related behaviors. Data were collected from 1164 young adults (women, N = 796; 68.4%; mean age 25.60 ± 4.40 years) who completed an online survey from 15th May to 22nd June 2021. Results of the multi-group path analyses indicated that higher beliefs in conspiracy theories were associated with lower compliance with COVID-19 health-related behaviors, whereas higher self-efficacy beliefs in complying with the containment measures were associated with higher compliance with COVID-19 health-related behaviors. Moral disengagement significantly mediated the associations between beliefs in conspiracy theories, regulatory self-efficacy, and compliance with COVID-19 health-related behaviors. Finally, the tested model was gender-invariant. Findings suggest that public health authorities and social care professionals should promote interventions aimed at improving regulatory self-efficacy, emphasizing the moral significance of respecting or ignoring the recommended COVID-19 measures (e.g., physical distance in public), and enhancing people's concern for the potential harms of their immoral actions

E-SCAPE New tools and new opportunities for the localization of Expo 2015 general interest services along the Canale Cavour, a backbone of the Milan-Turin urban region

Final publication of the Alta Scuola Politecnica project "E-SCAPE New tools and new opportunities for the localization of Expo 2015 general interest services along the Canale Cavour, a backbone of the Milan-Turin urban region"

Facing the Pandemic in Italy: Personality Profiles and Their Associations With Adaptive and Maladaptive Outcomes

The negative impact of the COVID-19 pandemic on individuals’ psychosocial functioning was widely attested during the last year. However, the extent to which individual differences are associated with adaptive and maladaptive outcomes during quarantine in Italy remains largely unexplored. Using a person-oriented approach, the present study explored the association of personality profiles, based on three broad individual dispositions (i.e., positivity, irritability, and hostile rumination) and two self-efficacy beliefs in the emotional area (i.e., expressing positive emotions and regulating anger emotion), with adaptive and maladaptive outcomes during the first Italian lockdown (March–June 2020). In doing so, we focused also on how different age groups (i.e., young adults and adults) differently faced the pandemic. The study was conducted through an online survey from May to June 2020 and included 1341 participants living in Italy, divided into two groups: 737 young adults aged 18–35 and 604 adults aged 36–60 years old. Latent Profile Analysis identified three personality profiles: resilient, vulnerable, and moderate. A subsequent path analysis model showed that the resilient profile was positively associated with prosocial behavior as an indicator of adaptive outcome, and negatively associated with three maladaptive outcomes: interpersonal aggression, depressive symptoms, and anxiety problems. Contrarily, the vulnerable profile resulted negatively associated with prosocial behavior and positively associated with the three maladaptive outcomes. Finally, regarding age group differences, young adults belonging to the vulnerable profile showed a greater association especially with interpersonal aggression, depression, and anxiety problems, as compared to adults belonging to the same profile. Overall, the results of the present study highlighted the importance to analyze individual functioning during an isolation period by using a person-oriented approach. Findings evidenced the existence of three different profiles (i.e., Resilient, Vulnerable, and Moderate) and subsequent path analysis revealed, especially for the vulnerable profile and young adults, a greater maladaptive consequence of the quarantine. The practical implications will be discussed

Smartphone and social network addiction in early adolescents: The role of self-regulatory self-efficacy in a pilot school-based intervention

Background: Youths' online problematic behaviors, such as smartphone or social network sites (SNS) addiction, gained increasing attention nowadays, due to their impact on concurrent and later adjustment, such as emotional and/or behavioral problems, academic impairments, or relational issues. Aims: This study aims to evaluate the effectiveness of a pilot school-based intervention to contrast online addictive behaviors while fostering adolescents' self-regulative abilities. Materials & Methods: The intervention started in January 2022 in an Italian junior high school located in Rome, and consisted of four meetings with students. A total sample of 462 15-year-old adolescents (Mage = 15.2; SD = 0.50; 41% females; Ncontrol = 214; Nintervention = 248) was considered. Within the latent difference score framework, we examined short-term changes from the pre-to-the-postintervention levels of SNS and smartphone addiction, and self-regulatory self-efficacy (SRSE) beliefs as a possible booster of the intervention's effectiveness. Results: Results showed a significant decrease in both online addictions (SNS and smartphone addiction), controlling for age, gender, sexual orientation, and socioeconomic status, because of the short-term efficacy of the project. The buffering effect of SRSE beliefs was further supported. Conclusion: These findings emphasized the usefulness of promoting youths' self-regulative beliefs to contrast problematic tendencies, according to a Positive Youth Development perspective which focused on resources rather than only on the prevention of negative outcomes for youths' adjustment

Exploring the protective function of positivity and regulatory emotional self-efficacy in time of pandemic covid-19

Despite several empirical studies on the 2019 coronavirus disease (COVID-19) pandemic that have highlighted its detrimental effect on individuals’ mental health, the identification of psychological factors that may moderate its impact on individuals’ behavior and well-being remains partly unexplored. The present study was conceived to examine the mediation role of regulatory emotional self-efficacy in the relationship between positivity and anxiety, depression, and perceived self-efficacy in complying with the containment measures to contrast the COVID-19 spread. Furthermore, the moderation role of age was tested. A sample of 1258 participants (64.2% women; Mage = 42.09, SD = 13.62) enrolled from the Italian general population answered an online survey aimed at investigating the role of individual differences in facing the COVID-19 pandemic. We opted for a snowball recruiting procedure to find participants. The online survey was disseminated through email invitation and using social media platforms (i.e., Facebook, Instagram). A multi-group path analysis model was performed using Mplus 8.4 to explore the hypothesized relations among variables. The following criteria were employed to evaluate the goodness of fit: χ2 likelihood ratio statistic, CFI and TLI > 0.95, RMSEA < 0.06 and SRMR < 0.08. The findings corroborated the protective role of both positivity and regulatory emotional self-efficacy in reducing individuals’ anxiety and depressive symptoms, as well as in fostering individuals’ capabilities in complying with the containment measures imposed by the government to reduce the risk of illness and to contain the spread of the virus COVID-19. Specifically, regulatory emotional self-efficacy beliefs partially mediated the relations between positivity and anxiety and depressive symptoms and fully mediated the effect of positivity on perceived self-efficacy beliefs in complying with the containment measures. These paths were equal across ages. The results of the present study appear relevant to implementing psychological interventions aimed to reduce the deleterious effects of the COVID-19 pandemic on mental health through the promotion of individuals’ optimistic orientation and emotion regulation

Outbreak of candidemia caused by fluconazole resistant Candida parapsilosis strains in an intensive care unit

Background: Candidemia is an increasing problem in tertiary care hospitals worldwide. Here, we report the first outbreak of candidemia caused by fluconazole-resistant C. parapsilosis (FRCP) strains in Brazil. Methods: This was a cross-sectional study of clinical and microbiological data of all candidemic episodes diagnosed from July 2011 to February 2012 in a 200-bed tertiary care hospital. Initial yeast identification and susceptibility testing were performed using the VITEK 2 - System. Isolates of Candida spp. resistant to fluconazole were sent to a reference laboratory (LEMI-UNIFESP) for further molecular identification and confirmation of resistance by CLSI microdilution test. A multivariate analysis was conducted to identify factors associated with FRCP infection. Results: We identified a total of 40 critically ill patients with candidemia (15 women) with a median age of 70 years. The incidence of candidemia was 6 cases/1,000 patients admissions, including 28 cases (70 %) of infection with C. parapsilosis, 21 of which (75 %) were resistant to fluconazole. In only 19 % of FRCP candidemia cases had fluconazole been used previously. The results of our study indicated that diabetes is a risk factor for FRCP candidemia (p = 0.002). Overall, mortality from candidemia was 45 %, and mortality from episodes of FRCP infections was 42.9 %. Conclusions: The clustering of incident cases in the ICU and molecular typing of strains suggest horizontal transmission of FRCP. Accurate vigilant monitoring for new nosocomial strains of FRCP is required.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [2012/04767-1]Conselho Nacional de Desenvolvimento Cientifico e Tecnologico, Brazil, (CNPq) [307510/2015-8]FAPESP [2012/04769-4]CNPqEd Amer Off Tower,SCN Q 1 BL F,Sala 1016, BR-70711905 Brasilia, DF, BrazilUniv Fed Sao Paulo, Rua Pedro de Toledo 669, BR-04039032 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Rua Pedro de Toledo 669, BR-04039032 Sao Paulo, SP, BrazilFAPESP:2012/04767-12012/04769-4CNPq:307510/2015-82012/04769-4Web of Scienc