Human resources in primary health care: investments and the driving force of production

O presente estudo descreve a composição, a qualificação, o investimento salarial, o produto da força de trabalho e discute o acesso dos usuários na perspectiva do tempo em Unidades Básicas de Saúde (UBS). A pesquisa foi realizada em duas UBS no período de janeiro a dezembro de 2008 e desenvolvida por meio da análise de documentos administrativos. Em ambas, a composição de profissionais por grau de escolaridade revelou: 21% de nível universitário, 27% de nível médio e 50% de nível básico; observando-se variação salarial positiva. As consultas médicas e de enfermagem foram majoritárias em ambas. Os indicadores de produção constataram: 25 e 37 min/habitante/mês para o acesso, respectivamente para UBS A e B; R$8,43 e R$ 12,11/habitante/mês para o investimento salarial nas duas UBS e 0,07 consultas/habitante/mês nas duas UBS. O tempo disponível dos profissionais é escasso quando confrontado com o potencial de demanda. A produção indicou oportunidade de cuidado < 1 por habitante/mês sob custo reduzido.Se describe composición, calificación, inversión salarial, producto de la fuerza del trabajo, y se discute el acceso de usuarios en perspectiva temporal en Unidades Básicas de Salud (UBS). Investigación realizada en dos UBS entre enero y diciembre 2008, desarrollada mediante análisis de documentos administrativos.. En ambas, la composición de profesionales por grado de escolaridad expuso: 21% de nivel universitario, 27% de nivel medio y 50% de nivel básico; observándose variación salarial positiva. Las consultas médicas y de enfermería fueron mayoritarias en ambas. Los indicadores de producción constataron 25 y 37 min/habitante/mes en el acceso, respectivamente para UBS A y B; R$8,43 y R$ 12,11/habitante/mes para inversión salarial en las dos UBS y 0,07 consultas/habitante/mes para ambas UBS. El tiempo disponible de los profesionales es escaso frente al potencial de demanda. La producción indicó oportunidad de cuidadoThe present study describes the composition, the qualification, the salary investment, the workforce produce, and discusses users' accessibility in terms of time at Basic Health Units (BHUs). The study was performed at two BHUs from January to December 2008, and developed by analyzing administrative documents. In both, the composition of professionals according to education level revealed: 21% with a university degree, 27% with a secondary education, and50% with a primary education; showing a positive salary variation. The medical and nursing conducts were the majority at both. The production indicators confirmed: 25 and 37 min/person/month for accessibility, respectively for BHU A and B; R$8.43 and R$ 12.11/person/month for the salary investment at both BHUs, and 0.07 appointments/person/month at both BHUs. The professionals' available time is scarce compared to the potential of the demand. The production indicated an opportunity of care < 1 per person/month at a reduced cost

Potential tactics with certain gut microbiota for the treatment of unresectable hepatocellular carcinoma

Hepatocellular carcinoma (HCC) constitutes an extremely malignant form of primary liver cancer. Intricate connections linking to the immune system might be associated with the pathogenesis of HCC. Meanwhile, immunotherapy with immune checkpoint inhibitors has been established to be a favorable therapeutic possibility for advanced HCC. Although curative opportunities for advanced HCC are restricted, the immune checkpoint immunotherapy has developed as the main choice for treating HCC. However, patients with metabolic-associated fatty liver disease (MAFLD)-linked HCC might be less likely to benefit from the immunotherapy alone. The limitation of the effect of the immunotherapy might be owing to the impaired T cell activation in MAFLD patients, which could be well explained by a dysfunctional gut-liver axis. Gut microbiota and their metabolites including several bile acids could contribute to modulating the responses of the immune checkpoint immunotherapy. Roles of gut microbiota in the development of cancers have expected great interest in the latest studies. Here, an interplay between the gut and liver has been presented, which might suggest to affect the efficacy of immune checkpoint immunotherapy against HCC

Potential tactics with vitamin D and certain phytochemicals for enhancing the effectiveness of immune-checkpoint blockade therapies

Immunotherapy strategies targeting immune checkpoint molecules such as programmed cell death-1 (PD-1) and cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) are revolutionizing oncology. However, its effectiveness is limited in part due to the loss of effector cytotoxic T lymphocytes. Interestingly, supplementation of vitamin D could abolish the repressive effect of programmed cell death-ligand 1 (PD-L1) on CD8+ T cells, which might prevent the lymphocytopenia. In addition, vitamin D signaling could contribute to the differentiation of T-regulatory (Treg) cells associated with the expression of Treg markers such as forkhead box P3 (FOXP3) and CTLA-4. Furthermore, vitamin D may be associated with the stimulation of innate immunity. Peroxisome proliferator-activated receptor (PPAR) and estrogen receptor (ESR) signaling, and even the signaling from phosphoinositide-3 kinase (PI3K)/AKT pathway could have inhibitory roles in carcinogenesis possibly via the modulation of immune checkpoint molecules. In some cases, certain small molecules including vitamin D could be a novel therapeutic modality with a promising potential for the better performance of immune checkpoint blockade cancer therapies

Instrumentos de evaluación de necesidades en salud utilizados en la estrategia de Salud de la Familia

Este estudo, descritivo e exploratório, teve como objetivo geral conhecer os instrumentos utilizados para o reconhecimento das necessidades de saúde da população no âmbito da Estratégia de Saúde da Família. Abrangeu dois Distritos do Município de São Paulo. A base teórico-metodológica consistiu da Teoria de Intervenção Práxica de Enfermagem em Saúde Coletiva. Os dados foram coletados junto a unidades de saúde e equipes de saúde da família. Os resultados mostraram a inexistência de instrumentos específicos para o reconhecimento das necessidades em saúde da população. Discutem-se três contradições presentes no fenômeno estudado: a polaridade estrutural na conceituação de necessidade contida no SUS; o princípio da integralidade postulado pelo SUS e a possibilidade operacional das unidades de saúde e a antinomia teoria-prática no processo de trabalho das equipes da ESF. Conclui-se que é imperativo superar as contradições para redirecionar as políticas e as práticas rumo ao enfrentamento das necessidades em saúde.The main objective of this exploratory and descriptive study was to acknowledge the instruments used to assess health needs of the population in the Family Health Strategy. Two districts of Sao Paulo Municipality, Brazil, were taken as the scenario. The theoretical and methodological basis was the Theory of Praxical Intervention in Collective Health. Data were collected in Heath Care Units, with Family Health teams' members. The results showed the inexistence of specific instruments to assess health needs. The discussion addresses the three contractions identified: the structural polarity in the conceptualization of health needs in the Brazilian Unified Health Care System, the principle of integrality postulated by this System and the possibility of its implementation by the health care teams, and also the theory-practice antinomy in their labor process. The conclusion is that these contradictions must be overcome in order to redirect policies and practices towards health needs assessment.Estudio, descriptivo y exploratorio, cuyo objetivo general fue conocer los instrumentos utilizados para el reconocimiento de las necesidades de salud de la población en el ámbito de la ESF. Comprendió dos Distritos del Municipio de Sao Paulo. La base teórico-metodológica fue la Teoría de Intervención Práctica de Enfermería en Salud Colectiva. La recolección fue junto a las unidades y equipos de salud de la familia. Es evidente la inexistencia de instrumentos específicos para el reconocimiento de las necesidades en salud. Fueron discutidas tres contradicciones: la polaridad estructural al conceptuar las necesidades contenidas en el SUS; el principio de la integralidad postulado por el SUS, la posibilidad operacional de las unidades de salud y la antinomia teoría-práctica en el proceso de trabajo de los equipos de la ESF. Se concluye ser prioritario superar las contradicciones para redireccionar las políticas y las prácticas rumbo al enfrentamiento de las necesidades en salud.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Reviewing health needs assessment approaches in the Family Health strategy

Este estudo, descritivo e exploratório, teve como objetivo geral conhecer os instrumentos utilizados para o reconhecimento das necessidades de saúde da população no âmbito da Estratégia de Saúde da Família. Abrangeu dois Distritos do Município de São Paulo. A base teórico-metodológica consistiu da Teoria de Intervenção Práxica de Enfermagem em Saúde Coletiva. Os dados foram coletados junto a unidades de saúde e equipes de saúde da família. Os resultados mostraram a inexistência de instrumentos específicos para o reconhecimento das necessidades em saúde da população. Discutem-se três contradições presentes no fenômeno estudado: a polaridade estrutural na conceituação de necessidade contida no SUS; o princípio da integralidade postulado pelo SUS e a possibilidade operacional das unidades de saúde e a antinomia teoria-prática no processo de trabalho das equipes da ESF. Conclui-se que é imperativo superar as contradições para redirecionar as políticas e as práticas rumo ao enfrentamento das necessidades em saúde.Estudio, descriptivo y exploratorio, cuyo objetivo general fue conocer los instrumentos utilizados para el reconocimiento de las necesidades de salud de la población en el ámbito de la ESF. Comprendió dos Distritos del Municipio de Sao Paulo. La base teórico-metodológica fue la Teoría de Intervención Práctica de Enfermería en Salud Colectiva. La recolección fue junto a las unidades y equipos de salud de la familia. Es evidente la inexistencia de instrumentos específicos para el reconocimiento de las necesidades en salud. Fueron discutidas tres contradicciones: la polaridad estructural al conceptuar las necesidades contenidas en el SUS; el principio de la integralidad postulado por el SUS, la posibilidad operacional de las unidades de salud y la antinomia teoría-práctica en el proceso de trabajo de los equipos de la ESF. Se concluye ser prioritario superar las contradicciones para redireccionar las políticas y las prácticas rumbo al enfrentamiento de las necesidades en salud.The main objective of this exploratory and descriptive study was to acknowledge the instruments used to assess health needs of the population in the Family Health Strategy. Two districts of Sao Paulo Municipality, Brazil, were taken as the scenario. The theoretical and methodological basis was the Theory of Praxical Intervention in Collective Health. Data were collected in Heath Care Units, with Family Health teams' members. The results showed the inexistence of specific instruments to assess health needs. The discussion addresses the three contractions identified: the structural polarity in the conceptualization of health needs in the Brazilian Unified Health Care System, the principle of integrality postulated by this System and the possibility of its implementation by the health care teams, and also the theory-practice antinomy in their labor process. The conclusion is that these contradictions must be overcome in order to redirect policies and practices towards health needs assessment

Metabolic Associated Fatty Liver Disease as a Risk Factor for the Development of Central Nervous System Disorders

MAFLD/NAFLD is the most ordinary liver disease categorized by hepatic steatosis with the increase of surplus fat in the liver and metabolic liver dysfunction, which is associated with bigger mortality and a high medical burden. An association between MAFLD/NAFLD and central nervous system disorders including psychological disorders has been demonstrated. Additionally, MAFLD/NAFLD has been correlated with various types of neurodegenerative disorders such as amyotrophic lateral sclerosis or Parkinson&rsquo;s disease. Contrasted to healthy controls, patients with MAFLD/NAFLD have a greater prevalence risk of extrahepatic complications within multiple organs. Dietary interventions have emerged as effective strategies for MAFLD/NAFLD. The PI3K/AKT/mTOR signaling pathway involved in the regulation of Th17/Treg balance might promote the pathogenesis of several diseases including MAFLD/NAFLD. As extrahepatic complications may happen across various organs including CNS, cooperative care with individual experts is also necessary for managing patients with MAFLD/NAFLD