The More Doctors Program was created in 2013 to address challenges that constrained the expansion and development of PC, mainly the insufficiency and maldistribution of physicians and the inadequate training profile related to the needs of the population. The program consists of three axes: emergency provision, improvement of infrastructure and changes in training. This paper performs documentary and literature review as well as analysis of official databases with the objective of evaluating the results achieved up to 2015 with regards to physicians supply. We identified important advances in the allocation of physicians with equity; in the expansion of PC coverage; in expanding access to basic health care for the population; its impact on health indicators; and the positive evaluation made by users, physicians and managers regarding the program. As a conclusion, challenges faced by the program to effectively achieve its objectives are pointed out.
Quality of Life in Hypertensive Patients and Concurrent Validity of Minichal-BrazilAna Carolina Melchiors, Cassyano Januário Correr, Roberto Pontarolo, Felipe de Oliveira de Souza Santos, Rodrigo Augusto de Paula e Souza Universidade Federal do Paraná, Curitiba, PR -Brazil extrapolations to be made from one patient to another 4 . Also, interpretations from patients, family and the health team may vary, thus creating assessment disparities, and this reinforces the importance of the patient himself assessing his health condition 4 .According to the World Health Organization, quality of life is defined as "individuals' perceptions of their position in life in the context of the culture and value system in which they live and in relation to their goals, expectations, standards and concerns" 5 .Instruments for the measurement of quality of life were created so that health professionals could effectively measure the impact of health interventions on the quality of life and, more specifically, the health-related quality of life. For that purpose, valid measurement questionnaires are required 6 . In Brazil, there are several studies of cultural adaptation of health-related quality of life instruments. The most widely used generic instrument for the hypertensive population is the Medical Outcomes Study 36-Item Short Form (SF-36) 7,8 . Recently, a study of cultural adaptation and validation of Minichal for Brazilian Portuguese was published. It evaluated criteria of content, construct and internal consistency of the instrument, by comparing results in hypertensive patients and normotensive individuals. Data on concurrent validity comparing Minichal to other QoL measurement instruments were not obtained, thus making further studies necessary 9,10 .The objective of the present study was to describe the quality of life profile of hypertensive patients and to assess the concurrent validity of the Minichal-Brazil instrument, by comparing its performance to that of the generic QoL assessment instrument known as WHOQOL-Bref. MethodsCross-sectional, non-randomized study conducted in the public health system in Southern Brazil by means of interviews carried out by trained professionals with proper skills for the study. All patients included were diagnosed with SH according to local diagnostic criteria; they attended the primary health care units where the study was conducted, were taking at least one medication to control hypertension, and were 18 years old or older.By convenience, the sample was composed in an independent manner by all patients who agreed to participate in the research and attended the primary health care unit in the days of the interviews.Patients with secondary hypertension, pregnant women or individuals with severe acute or chronic mental disorders were excluded. The study period extended from January to October 2007.Araucária was the town chosen for the study; it belongs in the Metropolitan Region of the city of Curitiba and has a per capita income of 136.45 dollars (242.06 real) as analyzed in 2000, th...
Background Investing in human resources for health (HRH) is vital for achieving universal health care and the Sustainable Development Goals. The Programa Mais Médicos (PMM) (More Doctors Programme) provided 17,000 doctors, predominantly from Cuba, to work in Brazilian primary care. This study assesses whether PMM doctor allocation to municipalities was consistent with programme criteria and associated impacts on amenable mortality. Methods Difference-in-differences regression analysis, exploiting variation in PMM introduction across 5565 municipalities over the period 2008–2017, was employed to examine programme impacts on doctor density and mortality amenable to healthcare. Heterogeneity in effects was explored with respect to doctor allocation criteria and municipal doctor density prior to PMM introduction. Results After starting in 2013, PMM was associated with an increase in PMM-contracted primary care doctors of 15.1 per 100,000 population. However, largescale substitution of existing primary care doctors resulting in a net increase of only 5.7 per 100,000. Increases in both PMM and total primary care doctors were lower in priority municipalities due to lower allocation of PMM doctors and greater substitution effects. The PMM led to amenable mortality reductions of − 1.06 per 100,000 (95%CI: − 1.78 to − 0.34) annually – with greater benefits in municipalities prioritised for doctor allocation and where doctor density was low before programme implementation. Conclusions PMM potential health benefits were undermined due to widespread allocation of doctors to non-priority areas and local substitution effects. Policies seeking to strengthen HRH should develop and implement needs-based criteria for resource allocation.
Our results show compelling evidence that losartan countered diet-induced obesity in mice by enhancing energy expenditure through beige adipocytes induction. Reduced body mass, increased insulin sensitivity, decreased adipocyte size and marked expression of uncoupling protein 1 by ectopic multilocular adipocytes support these findings. The use of losartan as a coadjutant medicine to tackle obesity and its related disorders merits further investigation.
BACKGROUND Obesity has been associated with hepatic overexpression of the renin-angiotensin system (RAS). AIM To evaluate the action of two angiotensin II (ANGII) receptor blockers (losartan or telmisartan) on the modulation of local hepatic RAS and the resulting metabolic effects in a diet-induced obesity murine model. METHODS Twenty C57BL/6 mice were randomly divided into two nutritional groups for 10 wk: control group (C, n = 5, 10% of energy as fat) or high-fat group (HF, n = 15, 50% of energy as fat). After treatment started, the HF group was randomly divided into three groups: untreated HF group ( n = 5), HF treated with losartan (HFL, n = 5) and HF treated with telmisartan (HFT, n = 5). The treatments lasted for 5 wk, and the dose was 10 mg/kg body mass. RESULTS HF diet induced body mass gain (+28%, P < 0.0001), insulin resistance (+69%, P = 0.0079), high hepatic triacylglycerol (+127%, P = 0.0004), and overexpression of intrahepatic angiotensin-converting enzyme (ACE) 1/ ANGII type 1 receptor (AT1r) (+569.02% and +141.40%, respectively, P < 0.0001). The HFL and HFT groups showed higher ACE2/rMAS gene expression compared to the HF group (ACE2: +465.57%, P = 0.0002 for HFL and +345.17%, P = 0.0049 for HFT; rMAS: +711.39%, P < 0.0001 for HFL and +539.75%, P < 0.0001 for HFT), followed by reduced insulin/glucose ratio (-30% for HFL and -33% for HFT, P = 0.0181), hepatic triacylglycerol levels (-28%, P = 0.0381 for HFL; and -45%, P = 0.0010 for HFT, and Plin2 expression. CONCLUSION Modulation of the intrahepatic RAS, with favored involvement of the ACE2/rMAS axis over the ACE1/AT1r axis after losartan or telmisartan treatments, caused hepatic and metabolic beneficial effects as demonstrated by reduced hepatic triacylglycerol levels coupled with reduced PLIN 2 expression and improved glycemic control.
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