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No description available.

Purpose: This study assessed effectiveness of five tools recommended by the US Preventive Services Task Force (USPSTF), designed to help primary care clinicians determine which unaffected patients to refer to genetics specialists for breast cancer risk assessment based on concerning family history. Design: This descriptive secondary analysis included 85 women aged 40-74. All participants had a first-degree female relative previously diagnosed with breast cancer who also had uninformative negative BRCA1/2 tests. Methods: Each pedigree was evaluated using the five tools including the Family History Screen-7 (FHS-7), Pedigree Assessment Tool (PAT), Manchester Scoring System, Referral Screening Tool (RST), and Ontario-Family History Assessment Tool (Ontario-FHAT). All five tools were applied to each study participant. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to describe each tool’s ability to identify women with elevated risk as calculated by the Claus model. Receiver operating curves (ROC) were also plotted. Differences between areas under the curve (AUCs) for all possible pairs of tools were estimated through logistic regression to assess for differences in tool performance. Results: Claus calculations identified 14 women out of 85 whose lifetime risk of breast cancer was elevated at > 15%. Only two tools, the Ontario-FHAT and FHS-7, identified all 14 women with elevated risk, a sensitivity of 100%. The FHS-7 tool flagged all 85 participants, meaning its specificity was zero. The Ontario-FHAT flagged 59 participants as needing referral (specificity 36.2%) and had a negative predictive value (NPV) of 100%, indicating that if a woman was not found to need a referral to a genetics professional, it is likely she did not have an elevated lifetime risk of developing breast cancer. AUC values were not significantly different between tools (all p values > .05), and thus were not helpful in discriminating between the tools. Conclusion: In this population, the Ontario-FHAT out-performed other tools in terms of sensitivity and negative predictive value; however, low specificity and positive predictive value must be balanced against these findings. Thus, the Ontario-FHAT can help determine which women would benefit from referral to a genetics specialist.

O conceito de humanização é muito amplo e abrange um conjunto de conhecimentos, práticas, atitudes e relações. Envolve a efetiva participação de profissionais, gestores, usuários e movimentos sociais para que as experiências compartilhadas possam proporcionar melhorias na qualidade do atendimento na área da saúde. O objetivo foi analisar, à luz da bioética e políticas de humanização, a percepção de médicos e enfermeiros sobre humanização nos serviços de saúde. Optamos pela pesquisa qualitativa, de corte transversal, realizada mediante entrevistas com questões abertas, iniciada após prévia aprovação do Comitê de Ética em Pesquisa. O critério de representatividade da amostra para o encerramento da coleta de dados foi o da saturação do discurso. A interpretação do material coletado seguiu os preceitos da análise de conteúdo. Os sujeitos foram médicos e enfermeiros de unidades com Estratégia Saúde da Família (ESF) e Assistência Médica Ambulatorial (AMA) da região da Capela do Socorro, município de São Paulo. De acordo com os resultados encontrados, os entrevistados apreendem a humanização em aspectos comuns como integralidade, direito dos usuários, dificuldades nas relações, valorização profissional e ambiência. Demonstram, porém, que essa percepção sofre influência quando considerado o serviço onde prestam atendimento, surgindo então novas categorias particulares a cada serviço. Alteridade, trabalho em equipe, acesso ininterrupto, avaliação de risco e respeito à autonomia na AMA e prevenção e promoção à saúde, cuidado, vínculo e respeito à privacidade na ESF. Concluímos que a percepção sobre humanização dos profissionais tem distintos sentidos e significados variados. Situações comuns e particulares a cada tipo de serviço são vividas no cotidiano, influenciando a percepção sobre humanização. Essas ocorrências podem afetar a preservação dos direitos de usuários e profissionais, tornando-se fundamental a efetiva participação de todos para a consolidação de políticas públicas que busquem melhorias na área da saúde e amplo respeito aos direitos / The concept of humanization is very wide and comprehends a group of knowledge, practices, attitudes and relationships. It involves the effective participation of professionals, managers, users and social movements so that the shared experiences are able to offer improvements to the quality of reception on the healthcare area. The objective was to analyze, in light of bioethics and policies of humanization, the perception of doctors and nurses on humanization in healthcare services. We decided to apply a qualitative research, cross-sectional, carried out through interviews with open questions, started after prior approval of the Research Ethics Committee. The representativeness criterion of the sample for the closure of data collection was the saturation of the discourse. The interpretation of collected material was based on the precepts of content analysis. The subjects were doctors and nurses of units with Family Health Strategy (ESF) and Outpatient Medical Care Units (AMA) in the region of Capela do Socorro, municipality of São Paulo. According to the results found, the respondents perceive the humanization in common aspects such as integrality, right from the users, difficulties in relationships, professional value and ambience. They demonstrate, however, that this perception is influenced when the service is considered according to the place they are done, emerging, then, new particular categories to each service. Alterity, team work, uninterrupted access, risk analysis and respect to the AMA autonomy and prevention and health promotion, care, bond, and respect for privacy in the ESF. We conclude that the perception of the humanization of professionals have different senses and varying meanings. Common and particular situations to each type of service are experienced in daily life, influencing the perception of the humanization. These occurrences can affect the preservation of the rights of users and professionals, becoming essential to the effective participation of all for the consolidation of public policies that seek improvements in the area of health and broad respect for the rights.

O conceito de humanização é muito amplo e abrange um conjunto de conhecimentos, práticas, atitudes e relações. Envolve a efetiva participação de profissionais, gestores, usuários e movimentos sociais para que as experiências compartilhadas possam proporcionar melhorias na qualidade do atendimento na área da saúde. O objetivo foi analisar, à luz da bioética e políticas de humanização, a percepção de médicos e enfermeiros sobre humanização nos serviços de saúde. Optamos pela pesquisa qualitativa, de corte transversal, realizada mediante entrevistas com questões abertas, iniciada após prévia aprovação do Comitê de Ética em Pesquisa. O critério de representatividade da amostra para o encerramento da coleta de dados foi o da saturação do discurso. A interpretação do material coletado seguiu os preceitos da análise de conteúdo. Os sujeitos foram médicos e enfermeiros de unidades com Estratégia Saúde da Família (ESF) e Assistência Médica Ambulatorial (AMA) da região da Capela do Socorro, município de São Paulo. De acordo com os resultados encontrados, os entrevistados apreendem a humanização em aspectos comuns como integralidade, direito dos usuários, dificuldades nas relações, valorização profissional e ambiência. Demonstram, porém, que essa percepção sofre influência quando considerado o serviço onde prestam atendimento, surgindo então novas categorias particulares a cada serviço. Alteridade, trabalho em equipe, acesso ininterrupto, avaliação de risco e respeito à autonomia na AMA e prevenção e promoção à saúde, cuidado, vínculo e respeito à privacidade na ESF. Concluímos que a percepção sobre humanização dos profissionais tem distintos sentidos e significados variados. Situações comuns e particulares a cada tipo de serviço são vividas no cotidiano, influenciando a percepção sobre humanização. Essas ocorrências podem afetar a preservação dos direitos de usuários e profissionais, tornando-se fundamental a efetiva participação de todos para a consolidação de políticas públicas que busquem melhorias na área da saúde e amplo respeito aos direitos / The concept of humanization is very wide and comprehends a group of knowledge, practices, attitudes and relationships. It involves the effective participation of professionals, managers, users and social movements so that the shared experiences are able to offer improvements to the quality of reception on the healthcare area. The objective was to analyze, in light of bioethics and policies of humanization, the perception of doctors and nurses on humanization in healthcare services. We decided to apply a qualitative research, cross-sectional, carried out through interviews with open questions, started after prior approval of the Research Ethics Committee. The representativeness criterion of the sample for the closure of data collection was the saturation of the discourse. The interpretation of collected material was based on the precepts of content analysis. The subjects were doctors and nurses of units with Family Health Strategy (ESF) and Outpatient Medical Care Units (AMA) in the region of Capela do Socorro, municipality of São Paulo. According to the results found, the respondents perceive the humanization in common aspects such as integrality, right from the users, difficulties in relationships, professional value and ambience. They demonstrate, however, that this perception is influenced when the service is considered according to the place they are done, emerging, then, new particular categories to each service. Alterity, team work, uninterrupted access, risk analysis and respect to the AMA autonomy and prevention and health promotion, care, bond, and respect for privacy in the ESF. We conclude that the perception of the humanization of professionals have different senses and varying meanings. Common and particular situations to each type of service are experienced in daily life, influencing the perception of the humanization. These occurrences can affect the preservation of the rights of users and professionals, becoming essential to the effective participation of all for the consolidation of public policies that seek improvements in the area of health and broad respect for the rights.

This essay is an analysis of the Swedish crisis management, as a policy subsystem using the Advocacy Coalition Framework. By applying a Causal Process Tracing method, the main issues of division within the policy subsystem will be examined, and the effects of the 2004 South East Asian tsunami as an incitement of policy change. The major finding is that the reforms that followed the tsunami investigations, to a large extent were planned prior to the tragic event, the main changes seem to have been halted by the 2006 election and change of Office. The cross-party coalitions that were found have theoretical implications for the ACF research.

Thesis addresses the physiological role of formyl tetrahydrofolate synthetase (Fhs) and bifunctional folate dehydrogenase (FolD) in folate mediated one carbon metabolism in bacteria. Thesis consists of 5 chapters. First chapter provides the details of the literature on folate metabolism, enzymes involved the synthesis and physiological roles various folate co-factors. Second chapter discusses the study of Clostridium perfringens Fhs generation of folD deletion in the support of fhs. Third chapter explores the characterization of the folD deletion strain. Fourth chapter presents the characterization of monofunctional versions of FolD from Clostridium perfringens. Fifth chapters talks about anti-correlation existence of Fhs and PurT (phosphoribosyl glycinamide formyl transferase II) The detailed experimental study is discussed below i. Characterization of Clostridium perfringens Formyl Tetrahydrofolate Synthetase (Fhs) In this chapter we have characterized Fhs from pathogenic Clostridium perfringens. Fhs catalyzes the formation of N10-formyl THF from THF and formate. Previously Fhs has been characterized from various non-pathogenic species of Clostridium. In addition, the detailed kinetic parameters are not known. In this report we have characterized the Fhs Clostridium perfringens and detailed kinetic parameters were determined. We have also shown the biological function by rescue of UV photorepair sensitive strain. ii. One-carbon metabolic pathway rewiring in Escherichia coli reveals an evolutionary advantage of 10-formyltetrahydrofolate synthetase (Fhs) in survival under hypoxia In cells, N10-formyltetrahydrofolate (N10-formyl THF) required for formylation of eubacterial/organeller initiator tRNA and purine biosynthesis is produced by methylene- tetrahydrofolate dehydrogenase/cyclohydrolase (FolD) and/or 10-formyltetrahydrofolate synthetase (Fhs). folD is present in all organisms, where as fhs shows mixed distribution. We show that in E. coli, which naturally lacks fhs, essential function of folD could be replaced with fhs of Clostridium perfringens when provided on a medium copy plasmid or integrated as single copy gene in the chromosome of the ∆folD strains, for their growth in a complex medium. However, these strains require purines and glycine as supplements for growth in M9 minimal medium. The in vivo levels of N10-formyl THF in the ∆folD strains (harboring fhs) were limiting despite their high enzymatic capacity to synthesize the same. Auxotrophy for purines could be alleviated by adding formate to the medium, and that for glycine by engineering THF import into the cells. The ∆folD strains showed high NADP+/NADPH ratio and were hypersensitive to trimethoprim (TMP). Further, the presence of fhs was disadvantageous to E. coli under aerobic growth. However, under hypoxia, E. coli strains harboring fhs outcompeted those lacking it. And, the computational analysis revealed a predominant natural occurrence of fhs in anaerobic and facultative anaerobic bacteria. We also propose that inhibitors aimed at folD could potentiate the effect TMP drugs. iii. 5, 10-methylene-THF dehydrogenase (DH) and 5, 10-methenyl-THF cyclohydrolase (CH) activities of FolD are essential to maintain folate homeostasis and anti-folate resistance While E. coli and many other organisms have folD alone or folD and fhs, Clostridium species possess an annotated bi-functional FolD and an annotated methenyl tetrahydrofolate cyclohydrolase (FchA). Simultaneous presence of 3 enzymes for the synthesis of N10-formyl THF was intriguing. To understand this unusual feature we have cloned Clostridium perfringens CpeFolD and CpeFchA, over expressed and purified to near homogeneity. Biochemical analyses revealed that CpeFolD possess only dehydrogenase activity as opposed to in silico prediction, while CpeFchA possess cyclohydrolase activity as expected. We also show that expression of both proteins together allowed folD deletion in E. coli. From this study we found that presence of dehydrogenase and cyclohydrolase functions are very important in the maintenance of folate homeostasis and anti-folate resistance. iv. Analysis of distribution of fhs and purT genes in the organisms While analysing distribution of fhs across genomes, serendipitously we also found that large number of organism which have fhs lack purT(phosphoribosyl glycinamide formyl transferase II), in short where ever purT was present fhs was absent. This kind of anti-correlation was strictly conserved in Bacillus genes as well. Growth competition experiments were done to address anti-correlation between fhs and purT. Growth competition experiments revealed that simultaneous presence of both purT and fhs is disadvantageous, when compared to presence of either one gene.