A critical issue in the contemporary field of public health is the organizational stress experienced by healthcare professionals. An integrative and complementary therapy that research has shown as ...efficacious in helping healthcare professionals to cope with stress is mindfulness meditation. An intervention, however, can't merely be efficacious, it also needs to be feasible to be implemented in a specific political and organizational context. This paper proposes a theoretical logical model and evaluation matrix of the feasibility of a mindfulness-based stress reduction program for primary care professionals. The literature review about the topic was the source for the construction of the theoretical logical model and evaluation matrix, and the validation of those was given by consensus methods, gathering data from experts in the field.
Resumo Objetivo: Avaliar as condições de estrutura e de processo de trabalho para as ações de alimentação e nutrição na Atenção Primária à Saúde, no Brasil. Métodos: Estudo transversal, sobre dados ...secundários do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica. Foram descritas as proporções de adequação das unidades básicas de saúde (UBS) e equipes de saúde segundo variáveis organizacionais, pela razão da prevalência e regressão de Poisson. Resultados: Foram analisadas 19.793 UBS e 24.549 equipes; 35,0% (n=6.928) das UBS mostraram-se adequadas na estrutura e 7,9% (n=1.934) das equipes adequadas ao processo de trabalho. Nas análises de associação, destacaram-se as UBS da região Sul (44,7%) e as equipes da região Sudeste (10,9%), além de municípios com mais de 300 mil habitantes. Conclusão: As UBS e equipes analisadas apresentaram baixas proporções de adequação de estrutura e de processo de trabalho para as ações de alimentação e nutrição.
Resumen Objetivo: Evaluar las condiciones de estructura y proceso de trabajo de las acciones de alimentación y nutrición en la Atención Primaria de Salud en Brasil. Métodos: Estudio transversal con datos del Programa de Mejoramiento del Acceso y la Calidad en la Atención Primaria. Se describieron las proporciones de adecuación de las Unidades Básicas de Salud (UBS) y equipos de salud según variables organizacionales por la razón de prevalencia y regresión de Poisson. Resultados: Se analizaron 19.793 UBS y 24.549 equipos. El 35,0% (n=6.928) de las UBS se consideraron adecuadas en la estructura y el 7,9% (n=1.934) de los equipos adecuados al proceso de trabajo. En los análisis asociativos se destacaron las UBS de la región Sur (44,7%) y los equipos de la región Sudeste (10,9%), además de los municipios con más de 300 mil habitantes. Conclusión: Las UBS y los equipos analizados presentaron bajas proporciones de adecuación para la estructura y el proceso de trabajo para las acciones de alimentación y nutrición.
Abstract Objective: To evaluate the conditions of structure and work process for food and nutrition actions in Primary Health Care in Brazil. Methods: This was a cross-sectional study with secondary data from the Program for Primary Health Care Access and Quality Improvement. The proportions of Primary Health Care Center (PHCC) and health team adequacy were described according to organizational variables, using prevalence ratios and Poisson regression. Results: 19,793 PHCCs and 24,549 teams were analyzed; 35.0% (n=6,928) of PHCCs were considered adequate in relation to structure and 7.9% (n=1,934) of the teams had adequate work process. Standing out in the analyses of association are PHCCs in the Southern region (44.7%) and teams in the Southeastern region (10.9%), in addition to municipalities with more than 300,000 inhabitants. Conclusion: The PHCCs and teams analyzed presented a low proportion of adequacy for structure and work process for food and nutrition actions.
Histaminergic neurons are exclusively located in the hypothalamic tuberomammillary nucleus, from where they project to many brain areas including the nucleus accumbens (NAc), a brain area that ...integrates diverse monoaminergic inputs to coordinate motivated behaviours. While the NAc expresses various histamine receptor subtypes, the mechanisms by which histamine modulates NAc activity are still poorly understood. Using whole‐cell patch‐clamp recordings, we found that pharmacological activation of histamine 2 (H2) receptors elevates the excitability of NAc medium spiny neurons (MSNs), while activation of H1 receptors failed to significantly affect MSN excitability. The evoked firing of MSNs increased after seconds of local H2 agonist administration and remained elevated for minutes. H2 receptor (H2R) activation accelerated subthreshold depolarization in response to current injection, reduced the latency to fire, diminished action potential afterhyperpolarization and increased the action potential half‐width. The increased excitability was protein kinase A‐dependent and associated with decreased A‐type K+ currents. In addition, selective pharmacological inhibition of the Kv4.2 channel, the main molecular determinant of A‐type K+ currents in MSNs, mimicked and occluded the increased excitability induced by H2R activation. Our results indicate that histaminergic transmission in the NAc increases MSN intrinsic excitability through H2R‐dependent modulation of Kv4.2 channels. Activation of H2R will significantly alter spike firing in MSNs in vivo, and this effect could be an important mechanism by which these receptors mediate certain aspects of goal‐induced behaviours.
Key points
Histamine is synthesized and released by hypothalamic neurons of the tuberomammillary nucleus and serves as a general modulator for whole‐brain activity including the nucleus accumbens.
Histamine receptors type 2 (HR2), which are expressed in the nucleus accumbens, couple to Gαs/off proteins which elevate cyclic adenosine monophosphate levels and activate protein kinase A.
Whole‐cell patch‐clamp recordings revealed that H2R activation increased the evoked firing in medium spiny neurons of the nucleus accumbens via protein kinase A‐dependent mechanisms.
HR2 activation accelerated subthreshold depolarization in response to current injection, reduced the latency to fire, diminished action potential medium after‐hyperpolarization and increased the action potential half‐width. HR2 activation also reduced A‐type potassium current.
Selective pharmacological inhibition of the Kv4.2 channel mimicked and occluded the increased excitability induced by H2R activation.
figure legend Pharmacological activation of histamine receptor type 2 (H2R) elevates the frequency of evoked firing in medium spiny neurons (MSNs) of the nucleus accumbens (NAc). The mechanism underling this effect requires protein kinase A‐dependent phosphorylation and downregulation of Kv4.2 channels, the molecular determinant of A‐type K+ currents.
Although major depressive disorder (MDD) is highly prevalent, its pathophysiology is poorly understood. Recent evidence suggests that glycogen-synthase kinase 3β (GSK3β) plays a key role in memory ...formation, yet its role in mood regulation remains controversial. Here, we investigated whether GSK3β activity in the nucleus accumbens (NAc) is associated with depression-like behaviors and synaptic plasticity. We performed whole-cell patch-clamp recordings of medium spiny neurons (MSNs) in the NAc and determined the role of GSK3β in spike timing-dependent long-term potentiation (tLTP) in the chronic unpredictable mild stress (CUMS) mouse model of depression. To assess the specific role of GSK3β in tLTP, we used in vivo genetic silencing by an adeno-associated viral vector (AAV2) short hairpin RNA against GSK3β. In addition, we examined the role of the voltage-gated potassium Kv4.2 subunit, a molecular determinant of A-type K⁺ currents, as a potential downstream target of GSK3β. We found increased levels of active GSK3β and augmented tLTP in CUMS mice, a phenotype that was prevented by selective GSK3β knockdown. Furthermore, knockdown of GSK3β in the NAc ameliorated depressive-like behavior in CUMS mice. Electrophysiological, immunohistochemical, biochemical, and pharmacological experiments revealed that inhibition of the Kv4.2 channel through direct phosphorylation at Ser-616 mediated the GSK3β-dependent tLTP changes in CUMS mice. Our results identify GSK3β regulation of Kv4.2 channels as a molecular mechanism of MSN maladaptive plasticity underlying depression-like behaviors and suggest that the GSK3β–Kv4.2 axis may be an attractive therapeutic target for MDD.
It has been recently established that GPR158, a class C orphan G protein-coupled receptor, serves as a metabotropic glycine receptor. GPR158 is highly expressed in the nucleus accumbens (NAc), a ...major input structure of the basal ganglia that integrates information from cortical and subcortical structures to mediate goal-directed behaviors. However, whether glycine modulates neuronal activity in the NAc through GPR158 activation has not been investigated yet. Using whole-cell patch-clamp recordings, we found that glycine-dependent activation of GPR158 increased the firing rate of NAc medium spiny neurons (MSNs) while it failed to significantly affect the excitability of cholinergic interneurons (CIN). In MSNs GPR158 activation reduced the latency to fire, increased the action potential half-width, and reduced action potential afterhyperpolarization, effects that are all consistent with negative modulation of potassium M-currents, that in the central nervous system are mainly carried out by Kv7/KCNQ-channels. Indeed, we found that the GPR158-induced increase in MSN excitability was associated with decreased M-current amplitude, and selective pharmacological inhibition of the M-current mimicked and occluded the effects of GPR158 activation. In addition, when the protein kinase A (PKA) or extracellular signal-regulated kinase (ERK) signaling was pharmacologically blocked, modulation of MSN excitability by GPR158 activation was suppressed. Moreover, GPR158 activation increased the phosphorylation of ERK and Kv7.2 serine residues. Collectively, our findings suggest that GPR158/PKA/ERK signaling controls MSN excitability via Kv7.2 modulation. Glycine-dependent activation of GPR158 may significantly affect MSN firing in vivo, thus potentially mediating specific aspects of goal-induced behaviors.
RESUMO Foi analisada a utilização dos recursos transferidos de outras instâncias federativas aos blocos de financiamento da saúde pelos municípios de Santa Catarina. Trata-se de um estudo descritivo ...dos anos de 2009 e 2015. Observou-se que os municípios investem recursos próprios em saúde muito além do recomendado legalmente, no entanto, não conseguem fazer uso integral dos recursos de transferência direta efetuados pelo estado e pela União aos blocos de financiamento da saúde. Nota-se, porém, diminuição expressiva no montante de recurso subutilizado no período analisado, o que sinaliza a melhoria da capacidade de gestão dos recursos de transferência direta.
The purpose of this study was to determine the effects of the Nutrition and Culinary in the Kitchen (NCK) Program to evaluate the improvement of cooking skills and healthy eating of university ...students.
A randomized controlled trial with six months follow-up was used incorporating an intervention group (IG) and a control group (CG). The IG participated in the NCK program over a six-week period, three hours weekly, based on five hands-on cooking classes and one food market visit, while CG continued their usual activities. Outcome measures included changes in relation to a) accessibility and availability of fruits and vegetables (AAFV); b) cooking attitudes (CA); c) cooking behaviors at home (CBH); d) cooking behaviors away from home (CBAH) e) produce consumption self-efficacy (SEPC); f) self-efficacy for using cooking techniques (SECT); g) self-efficacy for using fruits, vegetables, and seasonings (while cooking) (SEFVS); and h) knowledge of cooking terms and techniques (CTT). An online self-completed validated survey was answered, at three time points: baseline (T1), after intervention (T2) and six months after intervention (T3). Statistical analyses were conducted to evaluate changes in outcomes within and between groups over time.
76 students completed the online questionnaire at the 3 time points. Findings revealed a statistically significant increase (p < 0.05) in all outcomes evaluated in the IG, except for CBH and CBAH. This effect was sustained at T3 (p < 0.001). Results were similar to the adjusted model (p < 0.001), thus, indicating that IG changes, when compared to CG, were due to the intervention effect.
NCK culinary intervention program demonstrated efficacy for the increased on AAFV, CA, SEPC, SECT, SEFVS and CTT with university students.
•No study to date has focused on sustained impact (6 months) of cooking intervention with university students.•Significant changes on attitudes, confidence and knowledge related cooking were found in the intervention group.•There was sustained impact on cooking skills and healthy eating practices of university students in the intervention group.•The Nutrition and Culinary in the Kitchen Program was found to be effective in the long term for the outcomes investigated.
This validation study seeks to check the accuracy of an evaluation model. In an evaluation, it is necessary to validate the precision and reliability of the data collection instrument. In this study, ...the Management Assessment of Oral Health in Primary Care in Santa Catarina was used as a benchmark to calculate the indicators. Its model analyzes primary data, collected via an electronic form, and secondary data, available in the Unified Health System (SUS) database. For this study, the form was applied in the cities of Santa Catarina's Coal Region at two different moments to check its reproducibility, followed by a discussion over the answers with the researcher. The results obtained were analyzed and debated in a consensus workshop with specialists in the field, detecting inaccuracies relating to the concept, the source used and the profile of the respondents themselves. The gross agreement rate in the two data collections was 87%, and the inaccuracies amounted to 36% of the answers. Preferential source suggestions, question modifications and guidelines for the correct filling out of the form were some of the proposed changes, improving the original matrix and the data collection instrument.
The objective of this study was to investigate the presence and classes of food additives in packaged foods labeled 'home-made'. Food identification information was collected by photographing food ...labels (n = 5,620); the ingredients lists were subsequently transcribed for analysis. The ingredients list (foods labeled 'home-made' and similar foods) were compared regarding the presence and classes of additives (function) using the chi-square test and regarding the median number of additives using the Mann-Whitney test. For all tests, p < .05 was used as the significance level. We evaluated 65 products labeled 'home-made' and 172 comparable conventional products. Seventy-nine percent (n = 188) of all products (n = 237) contained additives. There was no significant difference between the percentage of foods with the 'home-made' claim (81%) and those without (78%) regarding the presence of additives (p = .605). No significant difference was observed in the median number of additives (p = .61) and in the number of classes of additives (p = .79) between foods with and without the claim. It can contribute globally to the reflection and the creation of public policies for the elaboration of criteria for the use or prohibition of the use of "home-made" claims on labels.
In the last decades, an increasing body of scientific studies has shown mindfulness-based interventions as efficacious for reducing stress, including among primary care professionals. Despite the ...strength of the evidence, mindfulness-based interventions still are not widely adopted as a clinical practice in national health systems. The aim of the present study was to conduct a feasibility evaluation of a mindfulness-based stress reduction program for primary care professionals in Brazilian national health system.
A pilot mindfulness program was conducted through the course of four weekly encounters in the municipality of Biguaçu with the participation of 26 primary care professionals. Data was collected through direct observations and four self-report questionnaires. The information was used to complete an evaluation matrix and reach a value judgment about the feasibility level of the components of the mindfulness-based program.
The subdimensions Integration, Demand, and Acceptability were judged as “Highly Feasible”, the subdimension Practicality was judged as “Feasible” and the subdimension Adaptation was judged as “Lowly Feasible”. The results indicated that there is a high demand for stress-reduction interventions within the context of primary care and the acceptability by the stakeholders (participants and management) was excellent. However, the two main barriers found were the need for a brief version of the program to accommodate the restrictive timetable of the primary care professionals and the low retention rates.
The implementation of a mindfulness-based program for primary care professionals in Brazilian national health system was judged as “Feasible”. Further studies need to conduct the feasibility evaluation in other municipalities and with larger sample sizes to ensure the generalizability of these results.
•The mindfulness program for primary care professionals in Brazil is feasible.•There is a high demand for stress-reduction interventions.•A brief mindfulness intervention is preferred to accommodate time restrictions.•The acceptability of the intervention by the manager/participants was excellent.
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