ABSTRACT Introduction: The objective of this result is to contribute theoretically and methodologically to solving problems of coastal risk management, aggravated by the impact of climate change on coastal island and continental states, from an integrated and interdisciplinary governance perspective. Methods: It made use of scientific research methodology and science-specific methods and its triangulation. Results: It is concluded that the integration of scientific knowledge favors the understanding of the complexity that risk management implies for coastal governance; also that the training, communication and participation of social actors allow for progress to be made at higher levels of governance. The new knowledge generated contributed to making these processes more effective by promoting scenarios of resilience and sustainability in insular and continental coastal nations.

RESUMEN Introducción: El objetivo de este resultado es contribuir teórica y metodológicamente a resolver los problemas sobre gestión del riesgo costero, agravados por el impacto del cambio climático en estados insulares y continentales costeros, desde una perspectiva integrada e interdisciplinaria de la gobernabilidad y gobernanza. Métodos: Se utilizaron métodos específicos de las diferentes ciencias involucradas y su triangulación. Resultados: Se concluye que la integración del conocimiento científico interdisciplinario favorece entender la complejidad que supone la gestión del riesgo para la gobernabilidad costera, así como que la formación, comunicación y participación de los actores sociales permite avanzar a niveles mayores de gobernanza. Los nuevos conocimientos generados aportaron a hacer más efectivos estos procesos favoreciendo escenarios de resiliencia y sostenibilidad.

ABSTRACT Introduction: Acute graft-versus-host disease (GVHD) is one of the major causes of morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (AHSCT) and has become the subject of several studies to understand and treat it. Objective: This study does a descriptive analysis of the apoptotic index (AI) evaluation and intestinal permeability (IP) alterations in association with the clinical, endoscopic and histopathological data on patients undergoing AHSCT, with emphasis on acute intestinal graft-versus-host disease (GVHD) diagnosis. Methods: Thirty-one patients were divided into two groups—one of patients with a clinical GVHD diagnosis and one of those without GVHD diagnosis. Results: Thirteen deaths (41.9%) occurred during the study period, thereby reaffirming the severity of the alterations found in the patients. Fifteen patients subjected to 21 esophagogastroduodenoscopy procedures prior to D + 90 post-transplant had visible endoscopic alterations and 19 biopsies revealed histological alterations to the stomach and duodenum. Higher apoptotic indices, not reaching statistical significance, were observed in patients who died of graft versus host disease (GVHD), in the more acute forms of GVHD and where clinical GVHD was present. The intestinal permeability evaluation was performed on nine patients able to undergo it in the three proposed study periods, which showed alterations, some of which were pronounced even during pre-transplant and, therefore, the pre-conditioning phase. Conclusion: Clinical judgment remains a fundamental tool in the diagnosis of GVHD. This study points to the known limitations of traditional diagnostic aids (endoscopy and histology) and points to new methods not usually employed in clinical practice.

RESUMO Objetivo: validar por conteúdo e usabilidade o aplicativo “NASF em Rede” direcionado para as equipes dos Núcleos Ampliados de Saúde da Família e Atenção Básica (NASF-AB). Métodos: estudo metodológico, no qual participaram 18 especialistas, pesquisadores e profissionais, com diferentes áreas de formação, com vistas à validação de conteúdo e de usabilidade do APP. Realizado em quatro etapas: adaptação do instrumento; aplicação do instrumento de Avaliação de Adequação de Materiais (SAM); validação de conteúdo por meio do cálculo do Índice de Validade de Conteúdo (IVC) e avaliação da usabilidade por meio do System Usability Scale (SUS), respectivamente. Resultados: os participantes classificaram o material como válido, tanto no que concerne ao conteúdo quanto à usabilidade. Obteve-se índice de 83,5% para o instrumental SAM, pois 04 dos 06 tópicos constantes no instrumento apresentaram valores de 0,78, os quais foram considerados excelentes e dois deles foram avaliadas como bons, sendo acolhidas as recomendações dos juízes especialistas. O índice de usabilidade (5,5%) também foi considerado relevante. Conclusão: o aplicativo desenvolvido para profissionais do NASF- AB foi considerado válido quanto ao conteúdo e à usabilidade.

ABSTRACT Purpose: to validate the content and usability of the “Network NASF” application, intended for the teams of the Extended Family Health and Primary Care Center (NASF-AB). Methods: eighteen specialists, researchers, and professionals from different fields of study participated to validate the content and usability of the application, carried out in four stages: adjustment of the instrument; administration of the Suitability Assessment of Materials (SAM); validation of the content by calculating the content validity index (CVI); and usability evaluation through the System Usability Scale (SUS), in this order. Results: the participants classified the material as valid regarding both its content and usability. The index achieved in the SAM was 83.5%, as four, out of the six topics in the instrument, had values over 0.78. Hence, these four were considered excellent, while the other two were considered good. The recommendations given by the specialized judges were accepted and the usability index (5.5%) was considered relevant. Conclusion: the application developed for NASF-AB professionals was considered valid regarding its content and usability.

Resumo O objetivo deste artigo é identificar um método de triagem nutricional específico para utilização em idosos brasileiros domiciliados. Artigo de revisão sistemática utilizando as bases de dados PubMed, Lilacs e Web of Science para a obtenção de artigos. Os critérios de elegibilidade foram: artigos sobre métodos de triagem nutricional para idosos. Os artigos foram lidos por avaliadores que selecionaram os métodos de triagem e classificaram, segundo evidência de dados de validade, reprodutibilidade e aceitabilidade. O programa EndNote foi utilizado para gerenciamento dos artigos. Foram identificados 12 métodos de triagem nutricional, 3 desenvolvidos para população estadunidense e nenhum para população brasileira. Em 7 métodos o modo de preenchimento foi autorrespondido, sendo que 4 apresentavam dados antropométricos. A reprodutibilidade e a validade foram identificadas em 8 e em 1 método, respectivamente, contudo apenas o método Determine Your Nutritional Health® – DNH, apresentou dados de aceitabilidade, aspecto fundamental na escolha de método para adaptação e utilização em outro país. Dentre os métodos analisados, o DNH apresentou-se como o mais apropriado para adaptação transcultural e utilização em idosos brasileiros domiciliados.

Abstract The scope of this article is to identify a specific method of nutritional screening for use on elderly Brazilians living at home. It is a systematic review article using the PubMed, LILACS and Web of Science databases. The eligibility criterion was articles about nutritional screening methods for the elderly. The articles were read by evaluators who selected the methods and classified them according to evidence of validity, reproducibility and acceptability. EndNote software was used for scrutiny of the articles. Twelve methods of nutritional screening were identified, 3 being developed for use in the US population (n = 4), though none for the Brazilian population. In seven methods, the forms were filled out by the elderly themselves, and 4 of these presented anthropometric measures. Only one method produced information on acceptability. Reproducibility and validity was identified in 1 and 8, respectively, however only the Determine Your Nutritional Health® - DNH method presented acceptability data, which is a fundamental aspect in the choice for adaptation and use of the method in another country. Among the methods studied, the DNH was the most appropriate for cross-cultural adaptation and use on elderly Brazilians living at home.

Resumo O objetivo deste artigo é identificar um método de triagem nutricional específico para utilização em idosos brasileiros domiciliados. Artigo de revisão sistemática utilizando as bases de dados PubMed, Lilacs e Web of Science para a obtenção de artigos. Os critérios de elegibilidade foram: artigos sobre métodos de triagem nutricional para idosos. Os artigos foram lidos por avaliadores que selecionaram os métodos de triagem e classificaram, segundo evidência de dados de validade, reprodutibilidade e aceitabilidade. O programa EndNote foi utilizado para gerenciamento dos artigos. Foram identificados 12 métodos de triagem nutricional, 3 desenvolvidos para população estadunidense e nenhum para população brasileira. Em 7 métodos o modo de preenchimento foi autorrespondido, sendo que 4 apresentavam dados antropométricos. A reprodutibilidade e a validade foram identificadas em 8 e em 1 método, respectivamente, contudo apenas o método Determine Your Nutritional Health® – DNH, apresentou dados de aceitabilidade, aspecto fundamental na escolha de método para adaptação e utilização em outro país. Dentre os métodos analisados, o DNH apresentou-se como o mais apropriado para adaptação transcultural e utilização em idosos brasileiros domiciliados.

Abstract The scope of this article is to identify a specific method of nutritional screening for use on elderly Brazilians living at home. It is a systematic review article using the PubMed, LILACS and Web of Science databases. The eligibility criterion was articles about nutritional screening methods for the elderly. The articles were read by evaluators who selected the methods and classified them according to evidence of validity, reproducibility and acceptability. EndNote software was used for scrutiny of the articles. Twelve methods of nutritional screening were identified, 3 being developed for use in the US population (n = 4), though none for the Brazilian population. In seven methods, the forms were filled out by the elderly themselves, and 4 of these presented anthropometric measures. Only one method produced information on acceptability. Reproducibility and validity was identified in 1 and 8, respectively, however only the Determine Your Nutritional Health® - DNH method presented acceptability data, which is a fundamental aspect in the choice for adaptation and use of the method in another country. Among the methods studied, the DNH was the most appropriate for cross-cultural adaptation and use on elderly Brazilians living at home.

RESUMO: O interesse no chá verde comercial (Camellia sinensis) (L.) Kuntze (Theaceae) tem aumentado nos últimos anos devido suas propriedades medicinais. No presente estudo utilizamos a microextração em fase sólida, em combinação com a cromatografia gasosa acoplada com espectrometria de massas, como um eficiente método de caracterização de compostos voláteis e efetuamos o controle de qualidade de C. sinensis. Comparamos também a anatomia das folhas de diferentes amostras comerciais de chá verde, as informações de seus rótulos e determinamos a presença de matérias estranhas, de microrganismos, o teor de umidade e de cinzas totais. Entre as trinta amostras analisadas, seis foram identificadas como C. sinensis de acordo com o estudo anatômico; 83,4% não estavam de acordo com os limites especificados para matérias estranhas e 6,6% para o teor de umidade. Todas as amostras apresentaram cinzas totais de acordo com a legislação vigente. As análises evidenciaram diversos compostos orgânicos voláteis distintos, sendo majoritários terpenos, hidrocarbonetos e álcoois. As análises microbiológicas mostraram que 13,3 e 16,6% das amostras excedeu os limites de contagem para bolores e leveduras, e para bactérias mesófilas, respectivamente. Por fim, 73,3% das amostras apresentou Escherichia coli acima dos limites sanitários estabelecidos.

ABSTRACT: The interest in the use of green tea (Camellia sinensis) (L.) Kuntze (Theaceae) products have increased in the last few years due to its medicinal properties. In the present study, we proposed that headspace solid phase microextraction, in combination with gas chromatography coupled to mass spectrometric could be an efficient method to assess the volatile compounds and to ensure the quality control of C. sinensis. We have also compared the anatomical leaf of different commercial green tea samples, analyzed the information in their labels and determined the presence of foreign materials, moisture content, total ashes and microorganisms. Among the 30 analyzed samples, six were identified as C. sinensis according to the anatomical study; 83.4% were not in accordance with the specified limits for foreign matter and 6.6% for moisture content. All samples presented total ashes in accordance with the current legislation. The analysis indicated the presence of several different volatile organic compounds, being terpenes, hydrocarbons and alcohols the major ones. Microbiological analysis showed that 13.3% and 16.6% of the samples exceeded the limits for counts of molds and yeasts, and for mesophilic bacteria, respectively. 73.3% presented E. coli above the established sanitary limits.

ABSTRACT Introduction: Teaching performance is the behavior of the professor during the teaching process with a conscious and individual character, which demonstrates the professional, personal, and social development of this specialist. The characterization of performance allows to identify the problems and potentialities in order to develop activities that favor their improvement. Objective: To characterize the teaching performance of the Professors of Pediatrics in Postgraduate Education in “Salvador Allende” Medical Faculty from January to July 2016. Material and methods: The research sample consisted of 21 of 32 professors, 2 directors, and 7 of 13 residents. Characterization of teaching performance started with the parametrization process. Teaching performance focused on competence was selected as the main variable. Five dimensions, 16 subdimensions, and 55 indicators were defined. Empirical inquiries consisted of interviews, surveys, performance observation, and document reviews. Descriptive statistics and the mode were used as the measures of central tendency. Results: Methodological triangulation allowed to identify the following problems: insufficient planning of the autonomous work; deficient use of the information and communication technologies (ICTs) and foreign language; limited scientific production; insufficient professional and self-improvement in the specialty and in medical education. The following potentialities were identified: educational work carried out by the professors, proven dedication; and contribution to the formation of residents as citizens and professionals. Conclusions: The characterization of the teaching performance of the professors in postgraduate education allowed to identify problems in the following dimensions: methodological work, research and innovation work, and professional improvement. The teaching-learning process is being developed and the political-ideological work is considered a potentiality.

RESUMEN Introducción: El desempeño docente es el comportamiento del profesor durante la conducción del proceso formativo, con un carácter consciente e individual que demuestra su desarrollo personal, profesional y social. La caracterización del desempeño permite identificar los problemas y potencialidades para desarrollar actividades que propicien su mejoramiento. Objetivo: Caracterizar el desempeño docente en la formación académica de posgrado, de los profesores de pediatría de la Facultad de Ciencias Médicas “Salvador Allende” en el período de enero-julio de 2016. Material y métodos: La muestra estuvo constituida por 21 de 32 profesores, dos directivos y 7 de 13 residentes. La caracterización del desempeño docente se realizó a partir del proceso de parametrización. Se estableció como variable fundamental el desempeño docente con enfoque de competencias con cinco dimensiones, 16 subdimensiones y 55 indicadores. Las indagaciones empíricas fueron entrevistas, encuestas, observación del desempeño y revisiones documentales. Se utilizó la estadística descriptiva y la moda como medida de tendencia central. Resultados: La triangulación metodológica permitió identificar como problemas: insuficiente planificación del trabajo autónomo, deficiente aprovechamiento de las TICs y el idioma extranjero, limitada producción científica, insuficiente superación profesional y autosuperación en la especialidad y la educación médica. Como potencialidades se identificaron: el trabajo educativo del profesor, dedicación demostrada y contribución a la formación de los residentes como ciudadanos y profesionales. Conclusiones: La caracterización del desempeño docente de los profesores en la formación académica de posgrado identificó problemas en las dimensiones de Trabajo Metodológico, Trabajo de Investigación e innovación y en la Superación. En desarrollo se encuentra el Trabajo Docente educativo y como potencialidad el Trabajo Político Ideológico.

BACKGROUND Candida glabrata ranks second in epidemiological surveillance studies, and is considered one of the main human yeast pathogens. Treatment of Candida infections represents a contemporary public health problem due to the limited availability of an antifungal arsenal, toxicity effects and increasing cases of resistance. C. glabrata presents intrinsic fluconazole resistance and is a significant concern in clinical practice and in hospital environments. OBJECTIVE The aim of this study was to characterise the azole resistance mechanism presented by a C. glabrata clinical isolate from a Brazilian university hospital. METHODS Azole susceptibility assays, chemosensitisation, flow cytometry and mass spectrometry were performed. FINDINGS Our study demonstrated extremely high resistance to all azoles tested: fluconazole, voriconazole, posaconazole and itraconazole. This isolate was chemosensitised by FK506, a classical inhibitor of ABC transporters related to azole resistance, and Rhodamine 6G extrusion was observed. A mass spectrometry assay confirmed the ABC protein identification suggesting the probable role of efflux pumps in this resistance phenotype. MAIN CONCLUSIONS This study emphasizes the importance of ABC proteins and their relation to the resistance mechanism in hospital environments and they may be an important target for the development of compounds able to unsettle drug extrusion.

Resumo:Este artigo propõe analisar a compreensão mútua como faceta dos comportamentos diádicos em um encontro de serviço, elemento discursivo pouco estudado, conforme a literatura de marketing e gestão de pessoas aponta (MA; DUBÉ, 2011). Especificamente, investiga-se como a compreensão mútua é ou não construída entre clientes e atendentes de um serviço telefônico a partir da aplicação dos scripts e regras de atendimento (elemento textual) criadas pela gestão de pessoas. Utilizando a Análise da Conversa (SACKS; SCHEGLOFF; JEFFERSON, 1974), analisam-se dados reais de interações de maneira microetnográfica. O corpus deste artigo constitui-se de 126 interações gravadas em áudio na central de atendimento do Disque Saúde em Brasília. Os resultados revelam que somente o seguimento das regras não garante o estabelecimento da compreensão mútua, ao contrário, deixa margem para ações interacionais distintas, como o abandono da compreensão mútua quando os atendentes deparam-se com demandas da interação que não podem ser previstas pelo script.

Abstract:This article aims to analyze mutual understanding as an aspect of dyadic behaviors in a service encounter, since it is a little-explored discursive element as the literature on Marketing and People Management shows (MA; DUBÉ, 2011). Specifically, we investigate how mutual understanding may or may not be constructed between callers and call-takers of a helpline in accordance to the guidelines (textual element) made by People Management that call-takers must follow in the process. We use the Conversation Analysis approach (SACKS; SCHEGLOFF; JEFFERSON, 1974) to analyze naturally-occurring interactions in a micro ethnographic way. The data comprise 126 audio-recorded interactions from Disque Saúde call center in Brasilia. The results reveal that simply following the guidelines does not guarantee the construction of mutual understanding and, on the contrary, leaves room for distinct social actions, like abandoning mutual comprehension when call-takers face interactional demands that cannot be predicted by a script.

Resumen:Este artículo propone analizar la comprensión mutua como una faceta de los comportamientos diádicos en un encuentro de servicio, elemento discursivo poco estudiado, conforme la literatura de marketing y gestión de personas apunta (MA; DUBÉ, 2011). Específicamente, se investiga cómo la comprensión mutua es o no es construida entre clientes y asistentes de un servicio telefónico desde la aplicación de los scripts y reglas de atendimiento (elemento textual) criadas por la gestión de personas. Utilizando el Análisis de la Conversación (SACKS; SCHEGLOFF; JEFFERSON, 1974), se analizan datos reales de interacciones de manera micro-etnográfica. El corpus de este artículo es constituido de 126 interacciones gravadas en audio en el centro de llamadas Disque Saúde en Brasília. Los resultados revelan que sólo el seguimiento de las reglas no garantiza el estabelecimiento de la comprensión mutua, al contrario, deja margen para interacciones distintas, como el abandono de la comprensión mutua cuando los asistentes se deparan con demandas en la interacción que no pueden ser previstas por el script.

The social assignment of the Cuban Medical Sciences University is to train and qualify health professionals. From the very beginning of the Cuba's Virtual Health University (VHU) has responded to the challenges imposed by developments in medical education and by the insertion of information and communications technologies. The networking- learning model developed in the VHU has a pedagogic- technological conception that integrates teaching with health care provision. Virtualization of graduate teaching has occurred in virtual, blended and support classroom teaching methods, designed for virtual environments from the beginning or from a redesigned classroom course. The aim of this paper is was to analyze some factors that would influence greater virtualization graduated education through the VHU. Given the premise that knowledge is good and the product in modern society, we propose that virtualization could be favored by factors such as enhancing the knowledge economy; make intensive use of technologies; develop new literacies as info-literacy, techno-literacy, middle-literacy and social literacy; promote universal personalized education, lifelong and; enhance connectivism.

La Universidad de Ciencias Médicas Cubana tiene por encargo social la formación, superación y recalificación de los profesionales de la salud. La Universidad Virtual de Salud de Cuba (UVS), desde sus inicios, ha dado respuesta a los retos impuestos por el desarrollo de la educación médica y la inserción de tecnologías de la información y la comunicación. El modelo de aprendizaje en red que se construye en la UVS cubana se sustenta en una concepción pedagógico-tecnológica que favorece la integración de las actividades docentes, presenciales o no, con la práctica en salud. La virtualización del posgrado en la UVS ha ocurrido en las modalidades completamente virtual, semipresencial y de apoyo a la docencia presencial, diseñadas para los entornos virtuales desde el inicio, o rediseñadas a partir de un curso presencial. La creación, utilización y reutilización de recursos educativos en distintas figuras docentes ha sido otra de las formas de virtualización. El objetivo de este trabajo es analizar algunos factores que influirían en una mayor virtualización del posgrado a través de la UVS, teniendo como premisa que el conocimiento es bien y producto en las sociedades modernas, se propone que la virtualización pudiera verse favorecida por factores tales como potenciar la economía del conocimiento; hacer un uso intensivo de las tecnologías; desarrollar nuevos alfabetismos como la infoalfabetización, tecnoalfabetización, medioalfabetización y socioalfabetización; propiciar la educación personalizada, vitalicia y universal y; potenciar el conectivismo.

Introduction: in primary health care, teaching rounds take the form of community rounds. In secondary health care, they take the form of ward rounds. Most contents in surgical specialties have always been taught through interviews with hospitalized patients. Various changes in curricular design and in the organization of surgical services have had an impact on undergraduate surgical teaching rounds. Objective: characterize undergraduate teaching rounds for surgical specialties. Methods: a cross-sectional study was conducted of undergraduate ward rounds for surgical specialties at Dr. Carlos J. Finlay Central Military Hospital during the first semester of academic year 2010-2011. The sample was composed of 31 teachers and 35 interns. The survey designed for teachers included items such as teaching category, years of experience, academic degree and data on ward rounds. The survey for students, which was applied at the end of the general surgery rotation of their internship, inquired about the frequency and quality of ward rounds. Results: 48.4 % of the teachers stated that ward rounds for their subjects were performed daily, and 45.2 % agreed that the number of participant students was adequate. Most students evaluated the quality of ward rounds as good. Their opinions were specially favorable when they referred to the subject general surgery (82.8 %). Conclusions: most teachers viewed undergraduate ward rounds for contents from surgical specialties as the main in-service training activity, and most students expressed their satisfaction with their quality.

Introducción: el pase de visita docente-asistencial de pregrado se desarrolla en la actualidad en la atención primaria de salud como pase de vista comunitario, y en la atención secundaria con el hospitalario. La enseñanza de la mayoría de las asignaturas de las especialidades quirúrgicas, se ha realizado con pacientes hospitalizados. Diversos cambios en el diseño curricular y en la organización de los servicios quirúrgicos han incidido en el pase de visita docente-asistencial de pregrado en las asignaturas de especialidades quirúrgicas. Objetivo: caracterizar el pase de visita de pregrado en las asignaturas de especialidades quirúrgicas. Métodos: estudio transversal en el campo de la educación médica de pregrado sobre el pase de visita hospitalario de las asignaturas de especialidades quirúrgicas en el Hospital Militar Central "Dr. Carlos J. Finlay" durante el primer semestre del curso 2010-2011. La muestra quedó constituida por 31 profesores y 35 internos. La encuesta dirigida a los educadores incluyó aspectos como: categoría docente, años de experiencia, grado académico y aspectos sobre el pase de visita, y una segunda encuesta dirigida a estudiantes al término de la rotación por Cirugía General del internado, exploró la frecuencia y la calidad de este. Resultados: el 48,4 % de los profesores refirió que en su asignatura el pase de visita docente se realizaba diariamente, el 45,2 % coincidió en que la cantidad de educandos que participaba era adecuada. Los alumnos en general catalogaron como buena la calidad de los pases de visita y la asignatura de Cirugía General fue la más favorecida en sus opiniones (82,8 %). Conclusiones: los profesores, en su mayoría, consideraron el pase de visita de pregrado en las asignaturas de las especialidades quirúrgicas como la actividad principal de educación en el trabajo y la mayoría de los alumnos expresó su satisfacción con la calidad de este.