Resumo Para construir uma Atenção Primária à Saúde de qualidade deve-se considerar atributos essenciais e participação social. Este estudo, norteado pelo compromisso da saúde coletiva de fomentar processos de cogestão a partir de estratégias participativas, teve como objetivo compreender a percepção dos usuários sobre o atendimento recebido e o funcionamento de sua Unidade Básica de Saúde. O estudo transversal, qualitativo, de caráter exploratório-descritivo realizou a coleta de dados em 25 unidades de saúde urbanas e rurais do Distrito Federal, entre agosto de 2018 e fevereiro de 2019. Para elaborar este artigo, foram utilizadas as respostas a uma pergunta aberta de um questionário semiestruturado. Nelas, os usuários fizeram sugestões ou queixas a respeito dos serviços de saúde prestados. As respostas foram analisadas utilizando o software AtlasTI e sistematizadas em categorias temáticas. Ao final, foram organizadas nas seguintes categorias: elenco de profissionais, turnos de funcionamento, serviços disponíveis e infraestrutura. A escuta qualificada dos usuários permite conhecer as singularidades dos serviços para o planejamento e a construção de um modelo de atenção comprometido com o ato de cuidar, na perspectiva dos atores que compõem os territórios de saúde.

Abstract Quality in Primary Health Care can only be endured by considering essential attributes and social participation. This study, guided by collective health and its commitment to foster co-management processes based on participatory strategies, examined user perception regarding the care received and the functioning of their Basic Health Unit. A cross-sectional, qualitative, descriptive exploratory study was conducted with data collected at 25 urban and rural Primary Health Units in the Federal District, between August 2018 and February 2019, using a validated semi-structured questionnaire. Answers were analyzed using the AtlasTI software and grouped into the following thematic categories: professional staff, working shifts, available services and infrastructure. Qualified listening to users allows us to know the singularities of the services for planning and building a care model committed to the act of caring, from the perspective of health care users.

Abstract Quality in Primary Health Care can only be endured by considering essential attributes and social participation. This study, guided by collective health and its commitment to foster co-management processes based on participatory strategies, examined user perception regarding the care received and the functioning of their Basic Health Unit. A cross-sectional, qualitative, descriptive exploratory study was conducted with data collected at 25 urban and rural Primary Health Units in the Federal District, between August 2018 and February 2019, using a validated semi-structured questionnaire. Answers were analyzed using the AtlasTI software and grouped into the following thematic categories: professional staff, working shifts, available services and infrastructure. Qualified listening to users allows us to know the singularities of the services for planning and building a care model committed to the act of caring, from the perspective of health care users.

Resumo Para construir uma Atenção Primária à Saúde de qualidade deve-se considerar atributos essenciais e participação social. Este estudo, norteado pelo compromisso da saúde coletiva de fomentar processos de cogestão a partir de estratégias participativas, teve como objetivo compreender a percepção dos usuários sobre o atendimento recebido e o funcionamento de sua Unidade Básica de Saúde. O estudo transversal, qualitativo, de caráter exploratório-descritivo realizou a coleta de dados em 25 unidades de saúde urbanas e rurais do Distrito Federal, entre agosto de 2018 e fevereiro de 2019. Para elaborar este artigo, foram utilizadas as respostas a uma pergunta aberta de um questionário semiestruturado. Nelas, os usuários fizeram sugestões ou queixas a respeito dos serviços de saúde prestados. As respostas foram analisadas utilizando o software AtlasTI e sistematizadas em categorias temáticas. Ao final, foram organizadas nas seguintes categorias: elenco de profissionais, turnos de funcionamento, serviços disponíveis e infraestrutura. A escuta qualificada dos usuários permite conhecer as singularidades dos serviços para o planejamento e a construção de um modelo de atenção comprometido com o ato de cuidar, na perspectiva dos atores que compõem os territórios de saúde.

Abstract Background Our aim was to compare the efficacy of rituximab, tocilizumab, and abatacept in individuals with rheumatoid arthritis (RA) refractory to treatments with MTX or TNFi agents. Methods We searched 6 databases until January 2023 for phase 2–4 RCTs evaluating patients with RA refractory to MTX or TNFi therapy treated with rituximab, abatacept, and tocilizumab (intervention arm) compared to controls. Study data were independently assessed by two investigators. The primary outcome was considered as achieving ACR70 response. Results The meta-analysis included 19 RCTs, with 7,835 patients and a mean study duration of 1.2 years. Hazard ratios for achieving an ACR70 response at six months were not different among the bDMARDs, however, we found high heterogeneity. Three factors showing a critical imbalance among the bDMARD classes were identified: baseline HAQ score, study duration, and frequency of TNFi treatment in control arm. Multivariate meta-regression adjusted to these three factors were conducted for the relative risk (RR) for ACR70. Thus, heterogeneity was attenuated (I2 = 24%) and the explanatory power of the model increased (R2 = 85%). In this model, rituximab did not modify the chance of achieving an ACR70 response compared to abatacept (RR = 1.773, 95%CI 0.113–10.21, p = 0.765). In contrast, abatacept was associated with RR = 2.217 (95%CI 1.554–3.161, p < 0.001) for ACR70 compared to tocilizumab. Conclusion We found high heterogeneity among studies comparing rituximab, abatacept, and tocilizumab. On multivariate metaregressions, if the conditions of the RCTs were similar, we estimate that abatacept could increase the chance of reaching an ACR70 response by 2.2-fold compared to tocilizumab. Key messages Abatacept could increase the chance of reaching an ACR70 response by 2.2-fold compared to tocilizumab.

ABSTRACT Purpose: To evaluate the long-chain fatty acid and major compounds levels in the feces after prophylactic oral use of Lacticaseibacillus casei in an experimental model of intestinal mucositis. Methods: Fifteen Swiss mice were randomly divided into three groups (n=5/group): The negative or positive control groups (n = 5) received saline orally for 18 days and an the intraperitoneal (i.p.) of saline or 5 Fluorouracil (450 mg/kg) in 15th day, respectability. L. casei group received oral concentration of L. casei (1x109 CFU/mL) for 18 days, the i.p. injection of 5-fluorouracil (450 mg/kg) in 15th days. Tissue samples from colon and each small intestine segment were collected for histopathological analysis. Stool samples were collected. Fecal composition of long-chain fatty acids and sterols were analysed by gas chromatography-mass spectrometry on the 15th and the 18th day. Results: The mucosa layer of all small intestine segments of animals from L. casei showed well preserved epithelium and glands, without necrosis signs, but Goblet cells number decreased. Several long-chain fatty acids and sterols have been identified before and after in the groups. L. casei administration after 5-FU treatment reduced concentrations of linoleic acid (18:2) (p < 0.001) and oleic acid (18:1) (p < 0.001) in feces. Conclusions: L. casei prevented the mucosal damage associated with 5-FU-induced intestinal mucositis reduced long-chain fatty acid levels in the feces.

Resumo O objetivo deste estudo foi avaliar as perdas gestacionais entre 30 e 120 dias de gestação e reconcepção em vacas de corte submetidas à inseminação artificial em tempo fixo (IATF). Foram analisadas 18.462 informações do arquivo zootécnico de animais submetidos a IATF no período da estação de monta de novembro de 2019 a abril de 2020 na região do semiárido de Minas Gerais. Os parâmetros avaliados foram perda gestacional, categoria animal, presença do bezerro ao pé da vaca, escore de condição corporal (ECC) e situação final da estação de monta das fêmeas que perderam gestação após a IATF, os dados foram analisados pelo teste qui-quadrado de Person (χ2) e teste de Kruskal-Wallis, com nível de significância de 5% com uso do programa SPSS. A taxa de prenhez final foi de 58,52%. A taxa de perdas entre o primeiro e segundo diagnóstico gestacional foi de 3,6%. Observou-se dependência entre as variáveis categoria e perda gestacional (X2= 12,374, p<0,05). A presença do bezerro ou não ao pé da vaca, não teve influência em relação a perda gestacional (p>0,05). A diferença do ECC entre as categorias foi significativa (p<0,05). A situação final foi influenciada (p<0,05) pela categoria animal. A ordem de parição e o escore de condição corporal influenciam significativamente a taxa de perda gestacional.

Abstract The objective of this study was to evaluate gestational losses between 30 and 120 days of gestation and reconception in beef cows submitted to fixed-time artificial insemination (FTAI). The 18,462 information from the zootechnical file of animals submitted to FTAI in the period of the breeding season from November 2019 to April 2020 in the semiarid region of Minas Gerais were analyzed. The parameters evaluated were gestational loss, animal category, presence of the calf with the cow, body condition score (BCS) and final situation of the breeding season of the females that lost gestation after FTAI, the data were analyzed by Person's chi-square test (χ²) and Kruskal-Wallis test, with a significance level of 5% with use of the SPSS program. The final pregnancy rate was 58.52%. The loss rate between the first and second gestational diagnosis was 3.6%. Dependence was observed between the variables category and gestational loss (χ²= 12.374, p<0.05). The presence of the calf or not at the foot of the cow had no influence in relation to gestational loss (p>0.05). The difference in BSC between the categories was significant (p<0.05). Final situation was influenced (p<0.05) by animal category. Calving order and body condition score significantly influenced the gestational loss rate.

Abstract Curcumin, contained at Turmeric (Curcumalonga), can exert many beneficial pleiotropic activities in the gastrointestinal tract. This study evaluated the antioxidant and anti-inflammatory activity of C. longa on 5-fluorouracil (5-FU)-induced oral mucositis (OM) in hamsters. Phytochemical analysis of crude C. longa extract (CLE) was performed to detect the presence of curcumin by TLC and HPLC. Golden Syrian hamsters were orally pre-treated with CLE (5, 50, or 100mg/kg). Cheek pouch samples were subjected to macroscopic and histopathological evaluation. ELISA was performed to quantify the inflammatory cytokines IL-1β and TNF-α. Superoxide dismutase (SOD), glutathione (GSH) and malondialdehyde (MDA) levels were assessed by ultraviolet-visible spectroscopy analysis. Behavior analysis was conducted by the open field test. Curcumin content in the CLE was 0.55%m/m ± 0.0161 (2.84%). The group treated with 5mg/kg CLE showed healing evidence with macroscopic absence of ulceration (p<0.05) and microscopic aspect of re-epithelialization, discrete inflammatory infiltrate and absence of edema. Treatment with 5mg/kg CLE significantly increased GSH levels, and reduced MDA levels and SOD activity (p˂0.05), and decreased IL-1β (p˂0.05) and TNF-α (p˂0.01) levels. A significant reduction in walking distance, ambulation, speed, and rearing was observed for motor activity. Curcumin reduced oxidative stress, inflammation, and motor activity in hamsters with 5-FU-induced OM.

ABSTRACT OBJECTIVE To describe feeding practices and the risk factors for the mixed breastfeeding and early weaning in the neonatal period. METHODS Cohort study, which we collected socioeconomic, demographic, health care and feeding data from 415 mother/child binomials born in four public maternity hospitals in Natal/Brazil. They were followed-up at 48 hours, 7 and 28 days after birth. The association was established using Pearson’s Chi-square test and Poisson’s regression, after adjusting it to other variables. RESULTS The prevalence of mixed breastfeeding in the first 2 days was 47,2% and early weaning in 7 and 28 days was 8,4% and 16,2% in that order. The main reasons for mixed breastfeeding and early weaning were: colostrum deficiency (33.8%), difficulty in latching/sucking (23.5%) and “little milk” (70.0%). The use of formula/milk/porridge remained associated with maternal age ≤ 20 years (RR = 0.64; 95%CI: 0.47–0.86), age 20–29 years (RR = 0,70; 95%CI: 0,57–0,87), primiparity (RR = 1.37; 95%CI: 1.11–1.60) and cesarean delivery (RR = 1.20; 95%CI: 1.00–1.45) at 2 days; absence of paternal support (RR = 4.98; 95%CI: 2.54–9.79) and pacifier use (RR = 3.21; 95%CI: 1.63–6.32) at 7 days; and only pacifier use (RR = 2.48; 95%CI: 1.53–4.02) at 28 days. CONCLUSIONS Early weaning was associated with maternal and health care factors, thus suggesting the need to readjust good practices and educational actions to achieve the exclusive offer to the maternal breast in the neonatal period.

ABSTRACT OBJECTIVE To describe feeding practices and the risk factors for the mixed breastfeeding and early weaning in the neonatal period. METHODS Cohort study, which we collected socioeconomic, demographic, health care and feeding data from 415 mother/child binomials born in four public maternity hospitals in Natal/Brazil. They were followed-up at 48 hours, 7 and 28 days after birth. The association was established using Pearson’s Chi-square test and Poisson’s regression, after adjusting it to other variables. RESULTS The prevalence of mixed breastfeeding in the first 2 days was 47,2% and early weaning in 7 and 28 days was 8,4% and 16,2% in that order. The main reasons for mixed breastfeeding and early weaning were: colostrum deficiency (33.8%), difficulty in latching/sucking (23.5%) and “little milk” (70.0%). The use of formula/milk/porridge remained associated with maternal age ≤ 20 years (RR = 0.64; 95%CI: 0.47–0.86), age 20–29 years (RR = 0,70; 95%CI: 0,57–0,87), primiparity (RR = 1.37; 95%CI: 1.11–1.60) and cesarean delivery (RR = 1.20; 95%CI: 1.00–1.45) at 2 days; absence of paternal support (RR = 4.98; 95%CI: 2.54–9.79) and pacifier use (RR = 3.21; 95%CI: 1.63–6.32) at 7 days; and only pacifier use (RR = 2.48; 95%CI: 1.53–4.02) at 28 days. CONCLUSIONS Early weaning was associated with maternal and health care factors, thus suggesting the need to readjust good practices and educational actions to achieve the exclusive offer to the maternal breast in the neonatal period.

Resumo Trata-se de estudo transversal, com o objetivo de analisar a satisfação de usuários em relação ao atendimento em unidades de Atenção Primária à Saúde do Distrito Federal e fatores associados. Foram incluídos 4.476 usuários das 62 equipes da ESF existentes na Região de Saúde Leste; utilizou-se questionário testado previamente com perguntas abertas e fechadas. Quanto ao nível geral de satisfação, encontrou-se 54,9% dos usuários Satisfeitos e 23,0% Muito Satisfeitos. Para este desfecho Nível Geral de Satisfação houve menor satisfação nos casos que o usuário não conseguiu ser atendido (OR 12,1 p=0,01); não recebeu visita domiciliar (OR 1,7 p=0,01); é do sexo feminino (OR 1,2 p=0,01) e declarou cor/etnia não branco (OR 0,77 p=0,021). Já a “Chance do Usuário Recomendar a UBS” foi: Alta (43,4%) e Muito Alta (17,7%). De modo similar, a menor chance de recomendar foi associada a casos de não atendimento (OR 5,1 p=0,01) e ausência de visita domiciliar (OR 1,5 p=0,01); não houve associação com variáveis sociodemográficas. Evidencia-se a percepção que os serviços são satisfatórios para a maioria dos usuários. O estudo também trouxe evidências para a importância de contar com a equipe ESF completa e de expandir a visita domiciliar.

Abstract The aim of this cross-sectional study was to analyze user satisfaction in relation to Primary Health Care services in the Federal District and its associated factors. A total of 4,476 users of the 62 existing Family Health Strategy Teams from the Eastern Health Region were included; a pre-tested questionnaire with open and closed questions was applied. As for the “General Satisfaction Level” 54.9% of users were Satisfied and 23.0% Very Satisfied. For this outcome there was less satisfaction in cases that the user didn´t receive the care he sought for (OR 12.1 p=0.01); did not receive a home visit (OR 1.7 p=0.01); is female (OR 1.2 p=0.01) and declared to be non-white (OR 0.77 p=0.021). The “Chance to recommend the Health Unit” was: High (43.4%) and Very High (17.7%). Similarly, the lower chance to recommend was associated with no care received (OR 5.1 p=0.01) and absence of home visit (OR 1.5 p=0.01); there was no association with sociodemographic variables. Evidence showed that health services are satisfactory for most users. The study provides evidence regarding the importance of having the complete Family Health Strategy team and of expanding home visit.

Resumo Trata-se de estudo transversal, com o objetivo de analisar a satisfação de usuários em relação ao atendimento em unidades de Atenção Primária à Saúde do Distrito Federal e fatores associados. Foram incluídos 4.476 usuários das 62 equipes da ESF existentes na Região de Saúde Leste; utilizou-se questionário testado previamente com perguntas abertas e fechadas. Quanto ao nível geral de satisfação, encontrou-se 54,9% dos usuários Satisfeitos e 23,0% Muito Satisfeitos. Para este desfecho Nível Geral de Satisfação houve menor satisfação nos casos que o usuário não conseguiu ser atendido (OR 12,1 p=0,01); não recebeu visita domiciliar (OR 1,7 p=0,01); é do sexo feminino (OR 1,2 p=0,01) e declarou cor/etnia não branco (OR 0,77 p=0,021). Já a “Chance do Usuário Recomendar a UBS” foi: Alta (43,4%) e Muito Alta (17,7%). De modo similar, a menor chance de recomendar foi associada a casos de não atendimento (OR 5,1 p=0,01) e ausência de visita domiciliar (OR 1,5 p=0,01); não houve associação com variáveis sociodemográficas. Evidencia-se a percepção que os serviços são satisfatórios para a maioria dos usuários. O estudo também trouxe evidências para a importância de contar com a equipe ESF completa e de expandir a visita domiciliar.

Abstract The aim of this cross-sectional study was to analyze user satisfaction in relation to Primary Health Care services in the Federal District and its associated factors. A total of 4,476 users of the 62 existing Family Health Strategy Teams from the Eastern Health Region were included; a pre-tested questionnaire with open and closed questions was applied. As for the “General Satisfaction Level” 54.9% of users were Satisfied and 23.0% Very Satisfied. For this outcome there was less satisfaction in cases that the user didn´t receive the care he sought for (OR 12.1 p=0.01); did not receive a home visit (OR 1.7 p=0.01); is female (OR 1.2 p=0.01) and declared to be non-white (OR 0.77 p=0.021). The “Chance to recommend the Health Unit” was: High (43.4%) and Very High (17.7%). Similarly, the lower chance to recommend was associated with no care received (OR 5.1 p=0.01) and absence of home visit (OR 1.5 p=0.01); there was no association with sociodemographic variables. Evidence showed that health services are satisfactory for most users. The study provides evidence regarding the importance of having the complete Family Health Strategy team and of expanding home visit.

A pesquisa-ação é um método de pesquisa qualitativa que cada vez mais se destaca como estratégia de pesquisa adotada em engenharia de produção. Contudo, esse método sofre com preconceitos a respeito do seu mérito científico, bem como com uma indefinição de como sua condução pode ser validada. Visando minimizar essas lacunas da literatura, a partir de uma pesquisa de cunho conceitual-teórico, o presente trabalho visa propor um processo para o planejamento e condução de pesquisas na engenharia da produção por meio da pesquisa-ação. Consideram-se como contribuições científicas do presente trabalho a discussão acerca das formas de iniciação e das etapas de validação das pesquisas que empregam o método da pesquisa-ação. Conclui-se que, dentro do paradigma científico do realismo, os critérios mais adequados para a validação da pesquisa-ação são a adequação ontológica, a validade contingente, a percepção múltipla dos participantes, a fidedignidade metodológica, a generalização analítica e a validade do construto.

Action research is a qualitative method that is increasingly achieving a place of prominence as a technical procedure used in production engineering research. However, this method is discriminated in its scientific merit and lacks conduction validation. In an attempt to fill in these gaps in the literature, this paper proposes a process for conducting research in production engineering by means of action research. The scientific contributions of this work are the discussion about the forms of initiation and the implementation of validation phases employing the action research method. It was concluded that, within the scientific paradigm of realism, the most appropriate criteria for the validation of action research method are the ontological appropriateness, contingent validity, multiple perception of participants, methodological trustworthiness, analytic generalization, and construction validity.

O tema deste trabalho é o estudo da integração do projeto para manufatura e montagem com a prototipagem rápida, em uma abordagem de engenharia reversa, como ferramenta de suporte ao reprojeto de produtos. A partir de uma fundamentação teórica sobre esses conceitos, o presente trabalho visa analisar a aplicação de um modelo para a utilização integrada do projeto para manufatura com a prototipagem rápida em uma abordagem da engenharia reversa no processo de reprojeto de produtos eletromecânicos e analisar os resultados da aplicação do referido modelo para a redução do tempo de produção/montagem e dos custos de manufatura/montagem no reprojeto desse produto que está, há mais de 30 anos, no mercado. O método de pesquisa empregado foi a pesquisa-ação, uma vez que o pesquisador buscava resolver um problema identificado dentro do objeto de estudo em parceria com a equipe de profissionais da empresa. Os resultados das recomendações para o reprojeto do produto apresentam uma redução no tempo de montagem, do número de processos e de componentes e no custo-meta do produto, propiciando a oportunidade de melhorar a sua competitividade no mercado.

The purpose of this work was the study of the integration between design for manufacturing and assembly with rapid prototyping, in a reverse engineering approach, such as some tools to support product redesign. Based on a literature review of these concepts, this paper aimed at examining the application of a model that integrates the design for manufacture and assembly with rapid prototyping in reverse engineering approach in the redesign of an electromechanical device. The objective was to analyze the results of the application of this model in order to reduce the time of manufacture/assembly and the cost of assembly in the redesign of the product, which has been marketed for more than 30 years. The research method employed was action-research, because the researcher wanted to address a problem identified within the object of study, in partnership with the company's research team. The results were recommendations for the redesigning of the product, which showed a reduction in the assembly time, in the number of processes and components, and also in the targeted cost of the product - providing the opportunity to improve the competitiveness of the company in the market.

O tema deste artigo é o estudo da integração da engenharia reversa (ER) e o projeto para manufatura e montagem (DFMA) como ferramentas de suporte ao projeto conceitual de produtos. A partir de uma fundamentação teórica sobre esses conceitos, o presente trabalho visa analisar a adequação de um modelo para a utilização integrada do DFMA com a prototipagem rápida em uma abordagem de ER no projeto de um novo sistema de fechadura para forno industrial e recomendar melhorias no projeto conceitual do novo sistema de fechadura. O método de pesquisa empregado foi a pesquisa-ação, uma vez que o pesquisador buscava resolver um problema identificado dentro do objeto de estudo em parceria com a equipe de profissionais da empresa. Os resultados das recomendações para o projeto conceitual apresentam redução, especialmente, no custo, no tempo para fabricação e no tempo para montagem. Conclui-se que o modelo de integração estudado foi adequado para apoiar o processo de projeto do sistema de fechadura proposto por meio da ER.

This study focuses on investigating the integration between reverse engineering (RE) and design for manufacture and assembly (DFMA) as tools to support the conceptual design of products. From a literature review of these concepts, this research aims to examine the adequacy of a model for the integrated use of DFMA and rapid prototyping in an ER approach in the design of a new locking system for an industrial oven and recommend improvements in conceptual design of a new lock system. The research method employed was action-research since the aim was to solve a problem identified in the company, object of study, in partnership with the company team. The results of the conceptual design indicate reductions, especially in cost, time to manufacture, and assembly time. It was concluded that the integration model studied was adequate to support the design process of the locking system proposed by the ER approach.