Burden of Disease and Cost of Illness of Inflammatory Bowel Diseases in Portugal.

Background: Inflammatory bowel diseases' (IBD) increasing incidence and prevalence place a heavy health and economic burden on society. Objectives: This study assesses the burden and cost of IBD in Portugal to support the definition of health policies, resource allocation, and patient care. Methods: The burden of disease was expressed using disability-adjusted life years (DALY). Costs were estimated considering the societal perspective, using a prevalence-based model and prices established by law. An expert panel composed of 5 expert Portuguese gastroenterologists and a patient-reported study were conducted to support the cost analysis and fill in information gaps. Results: In Portugal, with a prevalence of 24,069 IBD patients and an incidence of 15/100,000, the burden of disease was estimated at 6,067 DALYs: 507 resulting from premature deaths and 5,560 from disability. Total cost was estimated at EUR 146 million per year, with direct costs representing 59%. Average yearly cost per IBD patient is EUR 6,075, where 60% is related to Crohn's disease and 40% to ulcerative colitis (UC). Conclusion: This study estimates the annual health burden and cost of IBD in Portugal, thus generating information with the intent to raise awareness of the need to advance health policies as well as better clinical and economic decisions in this pathology.

Contexto: A crescente incidência e prevalência das Doenças Inflamatórias Intestinais (DII) representam um pesado fardo para a saúde e economia na sociedade. Objetivos: Este estudo avalia o custo e a carga da DII em Portugal, com o objetivo de suportar a definição de políticas de saúde, alocação de recursos e cuidados com o doente. Métodos: A carga da doença foi calculada utilizando anos de vida ajustados à incapacidade (DALY). Os custos foram estimados tendo em conta a perspetiva da sociedade, utilizando um modelo baseado na prevalência e preços estabelecidos por lei. Foi realizado um painel de peritos, composto por 5 gastroenterologistas portugueses, assim como um estudo de mercado a doentes, de forma a suportar a análise de custos e colmatar lacunas de informação. Resultados: Em Portugal, com uma prevalência de 24,069 doentes e uma incidência de 15/100,000, o peso das DII foi estimado em 6.067 DALYs: 507 dos quais resultantes de mortes prematuras e 5.560 de incapacidade. O custo total foi estimado em 146 milhões de euros por ano, com os custos diretos a representarem 59% do total. O custo médio anual por doente de DII é de 6.075 EUR, onde 60% está relacionado com Doença de Crohn (DC) e 40% com Colite Ulcerosa. Conclusão: Este estudo estima os encargos anuais para a saúde e o custo da DII em Portugal, gerando informação relevante, com o intuito de alertar para a necessidade de uma evolução nas políticas de saúde, assim como como suportar melhores decisões clínicas e económicas nesta patologia.

EpiGe: A machine-learning strategy for rapid classification of medulloblastoma using PCR-based methyl-genotyping.

Molecular classification of medulloblastoma is critical for the treatment of this brain tumor. Array-based DNA methylation profiling has emerged as a powerful approach for brain tumor classification. However, this technology is currently not widely available. We present a machine-learning decision support system (DSS) that enables the classification of the principal molecular groups-WNT, SHH, and non-WNT/non-SHH-directly from quantitative PCR (qPCR) data. We propose a framework where the developed DSS appears as a user-friendly web-application-EpiGe-App-that enables automated interpretation of qPCR methylation data and subsequent molecular group prediction. The basis of our classification strategy is a previously validated six-cytosine signature with subgroup-specific methylation profiles. This reduced set of markers enabled us to develop a methyl-genotyping assay capable of determining the methylation status of cytosines using qPCR instruments. This study provides a comprehensive approach for rapid classification of clinically relevant medulloblastoma groups, using readily accessible equipment and an easy-to-use web-application.t.

Fitness, behavioral, and energetic trade-offs of different migratory strategies in a partially migratory species.

Alternative migratory strategies can coexist within animal populations and species. Anthropogenic impacts can shift the fitness balance between these strategies leading to changes in migratory behaviors. Yet some of the mechanisms that drive such changes remain poorly understood. Here we investigate the phenotypic differences, and the energetic, behavioral, and fitness trade-offs associated with four different movement strategies (long-distance and short-distance migration, and regional and local residency) in a population of white storks (Ciconia ciconia) that has shifted its migratory behavior over the last decades, from fully long-distance migration toward year-round residency. To do this, we tracked 75 adult storks fitted with GPS/GSM loggers with tri-axial acceleration sensors over 5 years, and estimated individual displacement, behavior, and overall dynamic body acceleration, a proxy for activity-related energy expenditure. Additionally, we monitored nesting colonies to assess individual survival and breeding success. We found that long-distance migrants traveled thousands of kilometers more throughout the year, spent more energy, and >10% less time resting compared with short-distance migrants and residents. Long-distance migrants also spent on average more energy per unit of time while foraging, and less energy per unit of time while soaring. Migratory individuals also occupied their nests later than resident ones, later occupation led to later laying dates and a lower number of fledglings. However, we did not find significant differences in survival probability. Finally, we found phenotypic differences in the migratory probability, as smaller sized individuals were more likely to migrate, and they might be incurring higher energetic and fitness costs than larger ones. Our results shed light on the shifting migratory strategies in a partially migratory population and highlight the nuances of anthropogenic impacts on species behavior, fitness, and evolutionary dynamics.

Metastatic hidradenocarcinoma: a report of two rare cases.

BACKGROUND: Hidradenocarcinoma is a rare malignant sweat gland tumour, characterized by a slow but aggressive course, with high rates of local recurrence and metastasis. Due to its rarity, histological criteria and therapeutic guidelines are poorly defined, posing a major challenge for clinicians and pathologists. OBJECTIVES: To present two new cases of metastatic hidradenocarcinoma as well as a review of the literature. MATERIALS & METHODS: We describe two case studies and a review of the literature based on a search using the MEDLINE (PubMed) electronic database. RESULTS: The first patient was a 61-year-old woman with a perimamillary hidradenocarcinoma that arose from the malignant transformation of a benign childhood lesion and developed regional lymph node metastases after wide excision and adjuvant radiotherapy. The second patient was a 63-year-old man who developed cutaneous and renal metastases several years after the complete excision of a lumbar hidradenocarcinoma. As far as we can ascertain, kidney metastasis from hidradenocarcinoma has not previously been described. CONCLUSION: Most authors recommend wide excision as the treatment of choice for hidradenocarcinoma, however, optimal adjuvant therapy remains to be determined. Our cases add to the limited knowledge available, but high-quality studies to find new effective treatments are needed.

Small Bowel Adenocarcinoma in a Patient with Crohn's Disease: The Role of Balloon-Assisted Enteroscopy.

Introduction: Small bowel adenocarcinoma is a rare but well-known complication of Crohn's disease. Diagnosis can be challenging, as clinical presentation may mimic an exacerbation of Crohn's disease and imaging findings may be indistinguishable from benign strictures. The result is that the majority of cases are diagnosed at the time of operation or postoperatively at an advanced stage. Case Presentation: A 48-year-old male with a previous 20-year history of ileal stenosing Crohn's disease presented with iron deficiency anemia. The patient reported melena approximately 1 month earlier but was currently asymptomatic. There were no other laboratory abnormalities. Anemia was refractory to intravenous iron replacement. The patient underwent computerized tomography enterography, which revealed multiple ileal strictures with features suggesting underlying inflammation and an area of sacculation with circumferential thickening of adjacent bowel loops. Therefore, the patient underwent retrograde balloon-assisted small bowel enteroscopy, where an area of irregular mucosa and ulceration was found at the region of ileo-ileal anastomosis. Biopsies were performed and histopathological examination revealed tubular adenocarcinoma infiltrating the muscularis mucosae. The patient underwent right hemicolectomy plus segmental enterectomy of the anastomotic region where the neoplasia was located. After 2 months, he is asymptomatic and there is no evidence of recurrence. Discussion: This case demonstrates that small bowel adenocarcinoma may have a subtle clinical presentation and that computed tomography enterography may not be accurate enough to distinguish benign from malignant strictures. Clinicians must, therefore, maintain a high index of suspicion for this complication in patients with long-standing small bowel Crohn's disease. In this setting, balloon-assisted enteroscopy may be a useful tool when there is raised concern for malignancy, and it is expected that its more widespread use could contribute to an earlier diagnosis of this severe complication.

Introdução: O adenocarcinoma do intestino delgado é uma complicação rara mas bem estabelecida da doença de Crohn. O seu diagnóstico pode ser desafiante, na medida em que a apresentação clínica pode mimetizar uma agudização da doença de Crohn e os achados imagiológicos podem ser indistinguíveis de estenoses benignas. Em consequência, a maioria dos casos são diagnosticados durante ou após a cirurgia em estadio avançado. Descrição do caso: Um homem de 48 anos com antecedentes de doença de Crohn ileal estenosante, com 20 anos de evolução, apresentou-se com anemia ferropénica. O doente referia melenas aproximadamente um mês antes, mas encontrava-se atualmente assintomático. Não apresentava outras alterações laboratoriais de relevo. A anemia era refratária a suplementação com ferro endovenoso. Foi submetido a enterografia por tomografia computorizada, que revelou múltiplas estenoses ileais com caraterísticas sugestivas de atividade inflamatória e uma área de saculação com espessamento circunferencial das ansas de intestino delgado adjacentes. Assim, foi submetido a enteroscopia assistida por balão, onde se identificou uma área de mucosa irregular e ulceração na região da anastomose ileo-ileal. Biópsias desta área revelaram a presença de adenocarcinoma tubular com infiltração até à muscularis mucosae. O doente foi submetido a hemicolectomia direita com enterectomia segmentar da região da anastomose onde a neoplasia se encontrava localizada. Ao fim de 2 meses, o doente encontra-se assintomático e sem evidência de recorrência. Discussão: Este caso demonstra que o adenocarcinoma do intestino delgado pode ter uma apresentação clínica subtil e que a enterografia por tomografia computorizada pode não ter precisão suficiente para distinguir estenoses benignas de neoplasias malignas. Os clínicos devem, portanto, manter um elevado índice de suspeição diagnóstica para esta complicação em doentes com doença de Crohn ileal de longa duração. Neste contexto, a enteroscopia assistida por balão pode ser uma ferramenta útil em casos de suspeita de neoplasia maligna, esperando- se que possa contribuir para um diagnóstico mais precoce desta complicação severa.

Mortality in a swiftly repurposed hospital in northeast Brazil during the first and second COVID-19 waves: A retrospective cohort study.

Background: The first months of the coronavirus disease 2019 (COVID-19) pandemic demanded rapid re-organization of available local resources. This study evaluated the performance of a private hospital in the Brazilian state of Ceará that was swiftly repurposed into a public tertiary COVID-19 centre during the first wave of the COVID-19 pandemic, and how it improved in the second wave. Methods: This retrospective cohort study included 2492 patients with COVID-19 at Hospital Estadual Leonardo da Vinci (HELV) during the first and second waves. Demographic, clinical and laboratory data were collected using a dedicated web platform (ResCOVID). A Poisson regression model was used to estimate factors associated with in-hospital mortality. Results: Differences in demographics and clinical features were found between the two waves. There was reduced in-hospital mortality during the second wave (36.2%) in comparison with the first wave (48.8%). Invasive mechanical ventilation showed the strongest association with increased risk of death in both waves {first wave: relative risk (RR) 4.28 [95% confidence interval (CI) 2.86-6.41], P<0.001; second wave: RR 12.94 (95% CI 3.4-49.12), P<0.001}. Conclusions: HELV was a pillar in the strategic public health plan to respond to COVID-19 in Ceará, helping to assist a group of moderate-to-severe cases and reduce the pressure on emergency and primary care facilities. Although mortality in intubated individuals remained high, there was an overall decrease in the in-hospital mortality rate in the second wave.

Tephrosia toxicaria (Sw.) Pers. extracts: Screening by examining aedicidal action under laboratory and field conditions along with its antioxidant, antileishmanial, and antimicrobial activities.

An increase in the incidence of arboviral, microbial and parasitic infections, and to disorders related to oxidative stress has encouraged the development of adjuvant therapies based on natural formulations, such as those involving plant extracts. Thus, to expand the repertoire of the available therapeutic options, this study aimed to describe the versatility of Tephrosia toxicaria (Sw.) (Pers., 1807) extracts for the control of arbovirus vectors, as well as their antioxidant, antileishmanial, and antimicrobial potential. Among the aqueous and hydroethanolic extracts obtained, the hydroethanolic extract from roots (RHA) was identified as the most active larvicide extract demonstrating, respectively, the lowest lethal concentration (mg/mL) for 50%, 90% and 99% of Aedes aegypti (L., 1762) and Aedes albopictus (S., 1894) larvae, observed at 24 h (0.33, 0.84 and 1.80; 0.32, 0.70 and 1.32) and 48 h (0.17, 0.51 and 1.22; 0.26, 0.47 and 0.78) post-exposure. Field assays revealed that RHA (0.84 mg/mL) is a potential oviposition deterrent, reducing egg-laying by approximately 90%. RHA (0.1 mg/mL) also exhibited antioxidant activity for the following tests: total antioxidant capacity (286.86 mg AAE/g), iron (87.16%) and copper (25.64%) chelation, and superoxide scavenging (10%). In the cell culture assays, RHA (0.1 mg/mL) promoted regeneration of metabolic activity (92% cell viability) in cells exposed to oxidative stress. Furthermore, RHA displayed weak antileishmanial activity (IC50 = 3.53 mg/mL) against Leishmania amazonensis and not exhibit antimicrobial activity. The extraction favored the concentration of carbohydrates in RHA, in addition to lectins and protease inhibitors, with molecular masses estimated between 10 and 24 kDa. Cytotoxicity and phytotoxicity analyses of RHA suggested its biosecurity. Thus, RHA is a multivalent extract with insecticide and antioxidant properties at low and safe concentrations. However, others studies on its indirect toxic effects are ongoing to ensure the complete safety of RHA.

Long-term management practices successfully reduce bird-related electrical faults in a transmission grid increasingly used by white storks for nesting.

Bird nests on transmission lines can cause electrical faults which reduce service reliability. To address this problem, since the mid-90s, the Portuguese Transmission System Operator (TSO) has undertaken management actions to discourage white storks Ciconia ciconia from nesting in hazardous locations of the pylons. Here, we compiled and analyzed an 18-year series of data on electrical faults, TSO management actions to tackle these, and stork nests on transmission pylons in Portugal to: (a) determine the relative importance of bird-related faults over the total number of faults; (b) describe variations in bird-related faults across time (season of the year and time of the day); (c) describe spatial variations in bird-related faults and their association with the occurrence of white stork nests on pylons; and (d) analyze the trends, over the years, of the number of white stork nests on pylons, the TSO management actions and their effectiveness in reducing bird-related fault rates. Overall, birds accounted, on average, for 25.3% of the electrical faults in the transmission network, with the vast majority being attributed to white storks. The seasonal pattern of bird-related faults showed higher rates in April and in October-November. Faults occurred more often during the night period, when storks spend more time on the pylons. We found a positive spatial relationship between the electrical fault rate and the proportion of pylons with stork nests (and the correlated number of nests per 100 km of line). There was, however, considerable variation in the fault rates not explained by the stork nest variables, particularly during the non-breeding season. The TSO management actions (namely removal/translocation of nests in hazardous locations of the pylons, installation of anti-perching devices and provision of alternative nesting platforms) significantly reduced, as a whole, the annual number of bird-related faults between 2001 and 2018, despite the three-fold increase in the number of white stork nests on transmission pylons. A deeper understanding of how white storks use the transmission pylons outside the breeding season is needed, so that targeted management actions can be taken to reduce the remaining bird-related fault rates to residual levels.

On-demand cell-autonomous gene therapy for brain circuit disorders.

Several neurodevelopmental and neuropsychiatric disorders are characterized by intermittent episodes of pathological activity. Although genetic therapies offer the ability to modulate neuronal excitability, a limiting factor is that they do not discriminate between neurons involved in circuit pathologies and "healthy" surrounding or intermingled neurons. We describe a gene therapy strategy that down-regulates the excitability of overactive neurons in closed loop, which we tested in models of epilepsy. We used an immediate early gene promoter to drive the expression of Kv1.1 potassium channels specifically in hyperactive neurons, and only for as long as they exhibit abnormal activity. Neuronal excitability was reduced by seizure-related activity, leading to a persistent antiepileptic effect without interfering with normal behaviors. Activity-dependent gene therapy is a promising on-demand cell-autonomous treatment for brain circuit disorders.

Canopy arthropod declines along a gradient of olive farming intensification.

Arthropod declines have been linked to agricultural intensification. However, information about the impacts of intensification is still limited for many crops, as is our understanding of the responses of different arthropod taxa and trophic groups, thus hindering the development of effective mitigation measures. We investigated the impacts of olive farming intensification on canopy-dwelling arthropods in the Mediterranean region. Intensification involves the increased use of agrochemicals, mechanisation and irrigation, but also structural changes from traditional orchards with low densities of large and old trees, to intensive and superintensive orchards with high to very high densities of smaller and younger trees, respectively. Canopy arthropods were vacuum-sampled at 53 sites representing the three orchard intensification levels, in spring, summer and autumn 2017. We evaluated how the arthropod community varied across intensification levels, and in response to orchard structure, management and landscape context. We found no changes in the diversity of arthropod taxa across intensification levels after correcting for sample coverage, but arthropod abundance declined markedly along the intensification gradient. Decreased abundance was associated with changes in orchard structure, lower herbaceous cover, and higher herbicide and insecticide use. The abundance of a specialized olive pest was lower in landscapes with higher woodland cover. The negative effects of intensification were stronger in spring and summer than in autumn, and parasitoids and predators were particularly affected. Overall, results suggest that retaining herbaceous cover, reducing agrochemical inputs and preserving natural woody elements in the landscape, may contribute to mitigate impacts of olive farming intensification on canopy arthropods, particularly on beneficial species.

Protect European green agricultural policies for future food security.

European green agricultural policies have been relaxed to allow cultivation of fallow land to produce animal feed and meet shortfalls in exports from Ukraine and Russia. However, conversion of semi-natural habitats will disproportionately impact long term biodiversity and food security.

Gravidade respiratória e fatores sociodemográficos associados ao desfecho clínico de pacientes com COVID-19 no Ceará / Respiratory severity and sociodemographic factors associated with the clinical outcome of patients with COVID-19 in Ceará

A COVID-19 causa complicações pulmonares importantes, oferecendo risco à vida. Objetivou-se compreender como a gravidade respiratória e os fatores sociodemográficos interferem no desfecho clínico de pacientes com COVID-19. Pesquisa descritiva, transversal, de abordagem quantitativa, realizada em hospital de referência em Fortaleza-Ceará, Brasil. Os dados foram coletados de novembro/2020 a setembro/2021, totalizando 470 pacientes com testagem positiva, sendo analisados pelo programa Microsoft Office Excel 2019. Quanto ao gênero, 56,8% eram do sexo masculino, com média de idade de 57,32 anos e 67,1% dos pacientes que evoluíram com alta hospitalar não apresentaram suporte de oxigênio à internação. Indivíduos residentes em regiões com Índice de Desenvolvimento Humano muito baixo foram mais suscetíveis à contaminação e maior mortalidade (46,1%), e as doenças crônicas degenerativas foram preditivas de letalidade. Os perfis sociodemográfico e clínico influenciaram os aspectos fisiopatológicos de desenvolvimento da doença e a evolução preditiva relacionada à permanência hospitalar e ao desfecho.

COVID-19 causes major, life-threatening lung complications. This study aimed to understand how respiratory severity and sociodemographic factors affect the clinical outcome of patients with COVID-19. It was a descriptive, cross-sectional research with quantitative approach conducted in a referral hospital in Fortaleza-Ceará, Brazil. Data collection occurred from November 2020 to September 2021, totaling 470 patients who tested positive for COVID-19, being analyzed in Microsoft Office Excel 2019. Regarding gender, 56.8% were male, with a mean age of 57.32 years and 67.1% of patients who evolved to hospital discharge did not have oxygen support at admission. Individuals living in regions with very low Human Development Index were more susceptible to contamination and higher mortality (46.1%), and chronic degenerative diseases were predictive of lethality. Sociodemographic and clinical profiles influenced the pathophysiological aspects of disease development and the predictive evolution related to hospital stay and outcome.

A homozygous MED11 C-terminal variant causes a lethal neurodegenerative disease.

PURPOSE: The mediator (MED) multisubunit-complex modulates the activity of the transcriptional machinery, and genetic defects in different MED subunits (17, 20, 27) have been implicated in neurologic diseases. In this study, we identified a recurrent homozygous variant in MED11 (c.325C>T; p.Arg109Ter) in 7 affected individuals from 5 unrelated families. METHODS: To investigate the genetic cause of the disease, exome or genome sequencing were performed in 5 unrelated families identified via different research networks and Matchmaker Exchange. Deep clinical and brain imaging evaluations were performed by clinical pediatric neurologists and neuroradiologists. The functional effect of the candidate variant on both MED11 RNA and protein was assessed using reverse transcriptase polymerase chain reaction and western blotting using fibroblast cell lines derived from 1 affected individual and controls and through computational approaches. Knockouts in zebrafish were generated using clustered regularly interspaced short palindromic repeats/Cas9. RESULTS: The disease was characterized by microcephaly, profound neurodevelopmental impairment, exaggerated startle response, myoclonic seizures, progressive widespread neurodegeneration, and premature death. Functional studies on patient-derived fibroblasts did not show a loss of protein function but rather disruption of the C-terminal of MED11, likely impairing binding to other MED subunits. A zebrafish knockout model recapitulates key clinical phenotypes. CONCLUSION: Loss of the C-terminal of MED subunit 11 may affect its binding efficiency to other MED subunits, thus implicating the MED-complex stability in brain development and neurodegeneration.

Individual variability in space use near power lines by a long-lived territorial raptor.

Evaluating species responses to anthropogenic infrastructures and other habitat changes is often used to assess environmental impacts and to guide conservation actions. However, such studies are generally carried out at the population level, disregarding inter-individual variability. Here, we investigate population- and individual-level responses toward power lines of a territorial raptor, the Bonelli's eagle Aquila fasciata. We used GPS-PTT tracking data of 17 adult eagles to model space use as a function of distance to transmission and distribution lines, while accounting for other habitat features known to affect this species. At population level, eagles increased the intensity of space use in the proximity of power lines (up to 1,000 m), suggesting an attraction effect. At individual level, some eagles shared the general population attraction pattern, while others showed reduced intensity of space use in the proximity of power lines. These differential responses were unrelated to the sex of individuals, but were affected by the characteristics of the power grid, with a tendency for apparent attraction to be associated with individuals occupying home ranges with a denser network of transmission lines and transmission pylons. However, the study could not rule out the operation of other potentially influential factors, such as individual idiosyncrasies, the spatial distribution of prey availability, and the availability of natural perches and nesting sites. Overall, these results suggest that power lines may drive different behaviors and have differential impacts across individuals, with those attracted to the proximity of power lines potentially facing increased risk of mortality through electrocution and collision, and those avoiding power lines being potentially subject to exclusion effects. More generally, our results reinforce the need to understand individual variability when assessing and mitigating impacts of anthropogenic infrastructures.

Indigo Carmine Hemodynamic Studies to Treat Vasoplegia Induced by Compound 48/80 in a Swine Model of Anaphylaxis.

INTRODUCTION: There are many reasons to believe that the nitric oxide/guanosine 3'5' - cyclic monophosphate (or NO/cGMP) pathway on vasoplegic states is underestimated. To study indigo carmine (IC) as an alternative to methylene blue was the investigation rationale. METHODS: The IC (3mg/kg intravenous infusion) study protocol included five experimental groups; 1) Control group - saline was injected at 0 and 10 minutes; 2) IC group - IC was injected at 0 and saline at 10 minutes; 3) compound 48/80 (C48/80) group - C48/80 was injected at 0 minute and saline at 10 minutes; 4) C48/80 + IC group - C48/80 was injected at 0 minute and IC at 10 minutes; and 5) IC + C48/80 group - IC was injected at 0 minute and C48/80 at 10 minutes. The studies were carried out by registering and measuring hemodynamic and blood gasometric parameters, including continuous cardiac output. RESULTS: 1) The effects of the drugs (IC and C48/80) were more evident in the first 20 minutes of recording; 2) hypotensive responses were more pronounced in the C48/80 groups; 3) IC isolated or applied before C48/80 caused transient pulmonary hypertension; and 4) after the first 20 minutes, the pressure responses showed stability with apparent hypotension more pronounced in the C48/80 groups. Clinical observations showed significant hemodynamic instability and catastrophic anaphylactic reactions (agitation, pulmonary hypertension, severe bronchospasm, urticaria, high-intensity cyanosis, violent gastric hypersecretion, and ascites). CONCLUSION: A global results analysis showed differences between groups only in the first 20 minutes of the experiments.

Biophysical controls over fire regime properties in Central Portugal.

The concept of fire regime can be used to describe, with different degrees of complexity, the spatial and temporal patterns of fires and their effects within a given area and over a given period. In this work, we explore the relations between fire regime and a set of potential biophysical controls at a local scale, for 972 civil parishes in central Portugal. The fire regime was characterized with reference to a 44-year period (1975-2018) using three properties: cumulative percentage of parish area burned, area-weighted total number of wildfires, and the Gini concentration index of burned area over time. Potential control variables included topography, seasonal temperature and rainfall, and land use/land cover type and patch fragmentation. Ordinal logistic regression was used to model the relations between the fire regime properties and the potential control factors. Results show that the fire regime properties have important spatial contrasts within the study area, and that land use/land cover distribution, spring rainfall and summer temperatures are the major controls over their variability. The percentage of each parish occupied by shrubland and spontaneous herbaceous vegetation is the single most important factor influencing cumulative percentage of parish area burned and the Gini concentration index of burned area, whereas spring rainfall is the foremost factor regarding area-weighted total number of wildfires. Along with the role of spring rainfall in promoting fuel availability later in the year, our results highlight the importance of the speed of regrowth of shrubland and spontaneous herbaceous vegetation after burning, pointing out the need of tailoring fuel management strategies to the properties of each parish.

Estudos sobre a formação em pesquisa na educação médica: um estado da questão / Studies on research training in medical education: a state of the question

Resumo: Introdução: É notória a crescente importância dada à formação em pesquisa na educação médica por todo o mundo, o que é refletido na crescente produção científica com essa temática. Nesse cenário, o estado da questão (EQ) surge como uma ferramenta de produção bibliográfica que promove um panorama das pesquisas produzidas sobre um determinado tema, sendo capaz de proporcionar uma maior aproximação ao objeto de pesquisa e uma estimativa dos avanços que a pesquisa naquele campo pode alcançar. Objetivo: Este estudo teve como objetivos identificar as investigações feitas sobre a formação em pesquisa na educação médica e classificá-las considerando o local, o tipo e as intencionalidades delas. Método: Trata-se de um EQ cujo objeto de estudo é a formação em pesquisa na educação médica. Utilizaram-se descritores relacionados à formação em pesquisa e à educação médica nos idiomas português, espanhol e inglês. Foram pesquisadas duas bases de dados para dissertações e teses nacionais (Biblioteca Digital de Teses e Dissertações e Catálogos de Teses e Dissertações da Capes) e duas bases de dados para periódicos científicos internacionais (Portal de Periódicos da Capes e PubMed). Resultado: Identificaram-se 33 artigos científicos de 17 países de cinco continentes. Quatro trabalhos (12%) apresentavam-se como artigos de opinião em que os autores teorizavam sobre a importância da inserção de elementos da pesquisa nos níveis curricular e disciplinar. Sete artigos (21%) retrataram, por meio de relatos de casos, as modificações estruturais e os percursos traçados em suas instituições, assim como as implicações dessas ações na educação médica e no processo educativo. Os demais 22 artigos (67%) documentavam pesquisas empíricas com diversas intencionalidades, sendo a temática mais recorrente a identificação dos fatores que influenciam a busca do corpo discente pela participação em pesquisa. Conclusão: A formação em pesquisa na educação médica conta com um corpo de pesquisadores qualificados e periódicos especializados para sua veiculação em nível global. Ressaltamos que, a partir das buscas realizadas, não foram encontrados estudos no contexto de teses e dissertações, tornando este um campo aberto para pesquisadores aprofundarem e acumularem conhecimento.

Abstract: Introduction: The growing importance given to research training in medical education globally is notorious and reflects the growing scientific production on this topic. In this scenario, the state of the question (EQ) emerges as a bibliographic production tool that promotes an overview of the re-search produced on a given topic, being able to provide a closer approach to the research object and to estimate the possible advances that research in that field can reach. Objective: This study aimed to identify what has been studied about research training in medical education and classify them considering the location, type, and intentions of the research. Method: This is a EQ whose object of study is research training in medical education. Descriptors related to research training and medical education in Portuguese, Spanish, and English were used. Two databases for national dissertations and theses (Biblioteca Digital de Teses e Dissertações and Catálogos de Teses e Dissertações da Capes) and two databases for international scientific journals (Portal de Periódicos da Capes and PubMed) were searched. Result: We identified 33 scientific articles from 18 countries on all continents. Four articles (12%) were presented as opinion articles where the authors theorized about the importance of inserting research elements at the curricular and disciplinary level. Seven articles (21%) portrayed, through case reports, the structural changes and the paths traced in their institutions, as well as the implications of these actions in medical education and the educational process. The remaining 22 articles (67%) documented empirical research with different intentions, with the most recurrent theme being the identification of factors that influence the student body's search for participation in research. Conclusion: Research training in medical education has a body of qualified researchers and spe-cialized periodicals for its dissemination on a global level. We emphasize that no studies were found in the context of theses and dissertations, making this an open field for researchers to deepen and accumulate knowledge.

NASF-AB no campo e nas águas: o cuidado em torno do trabalho, ambiente e saúde de famílias agricultoras e pescadoras / NASF-AB in the field and in the waters: the care around work, environment and health of farming and fishing families / NASF-AB en el campo y en las aguas: el cuidado acerca del trabajo, el medio ambiente y la salud de las familias campesinas y pesqueras

Resumo O Núcleo Ampliado de Saúde da Família e Atenção Básica foi criado no Brasil para apoiar e ampliar a atenção e a gestão na Saúde da Família. Analisa-se a sua atuação quanto à saúde do trabalhador e saúde e ambiente em territórios do campo e das águas com as famílias que vivem da pesca artesanal e da agricultura camponesa. Pesquisa qualitativa que se ancorou em referenciais da Sociologia das Ausências e da Saúde Coletiva, na abordagem particular que esta faz das relações entre saúde, ambiente e trabalho. A pesquisa valeu-se do emprego de grupos focais na produção de narrativas de profissionais do Núcleo Ampliado de Saúde da Família e Atenção Básica em municípios do semiárido e do litoral do Nordeste. Evidenciaram-se singularidades socioeconômicas e culturais das populações do campo e das águas; invisibilidades e potencialidades sobre seus modos de vida e trabalho; cargas e doenças relacionadas ao trabalho; e aspectos da atuação do Núcleo Ampliado de Saúde da Família e Atenção Básica mediante interações com o trabalho e o ambiente nesses territórios. Os cuidados oferecidos a estas populações consideram parcialmente suas especificidades socioculturais, produtivas, ambientais e de saúde, sendo preciso ampliar o reconhecimento de seus modos de vida e trabalho visando intervenções mais exitosas sobre os problemas e necessidades de saúde - o que aponta desafios à formação em saúde para o Sistema Único de Saúde.

Abstract The Extended Family Health and Primary Care Center (Núcleo Ampliado de Saúde da Família e Atenção Básica - NASF-AB) was created in Brazil to support and expand Family Health care and management. Its performance regarding workers' health and health and environment in rural and water territories is analyzed with families that live from artisanal fishing and peasant agriculture. This is a qualitative research that was anchored in references from the Sociology of Absences and Collective Health, in the latter's particular approach to the relations between health, environment, and work. The research used focus groups to produce narratives of professionals from the Extended Center for Family Health and Primary Care in municipalities in the semiarid and coastal regions of the Northeast. The socioeconomic and cultural singularities of the rural and water populations were evidenced; invisibilities and potentialities about their ways of life and work; work-related burdens and diseases; and aspects of the performance of the Extended Family Health Center and Primary Care through interactions with work and the environment in these territories. The care offered to these populations partially considers their sociocultural, productive, environmental, and health specificities, and it is necessary to expand the recognition of their ways of life and work, aiming at more successful interventions on health problems and needs; which poses challenges to health education for the Unified Health System.

Resumen El Núcleo Ampliado de Salud de la Familia y Atención Básica fue creado en Brasil para apoyar y ampliar la atención y gestión en Salud de la Familia. Se analiza su desempeño en materia de salud de los trabajadores y salud y medio ambiente en territorios del campo y de las aguas con las familias que viven de la pesca artesanal y de la agricultura campesina. Investigación cualitativa que se basó en referentes de la Sociología de las Ausencias y de la Salud Colectiva, en el particular abordaje que esta hace de la relación entre salud, medio ambiente y trabajo. La investigación se basó en la utilización de grupos focales en la producción de narrativas por parte de profesionales del Núcleo Ampliado de Salud de la Familia y Atención Básica en municipios de la región semiárida y del litoral del Nordeste. Se evidenciaron singularidades socioeconómicas y culturales de las poblaciones del campo y de las aguas; invisibilidades y potencialidades sobre sus formas de vida y trabajo; cargas y enfermedades relacionadas con el trabajo; y aspectos de la actuación del Núcleo Ampliado de Salud de la Familia y Atención Primaria a través de interacciones con el trabajo y el medio ambiente en estos territorios. La atención ofrecida a estas poblaciones considera parcialmente sus especificidades socioculturales, productivas, ambientales y de salud, siendo necesario ampliar el reconocimiento de sus modos de vida y de trabajo, visando intervenciones más exitosas sobre los problemas y necesidades de salud; lo que apunta desafíos a la formación en salud para el Sistema Único de Salud.

Duração de sintomas por COVID-19 em pacientes pós-internamento em hospitais terciários no Ceará / Duration of symptoms caused by COVID-19 in patients discharged from tertiary hospitals in Ceará

Apesar do avanço no conhecimento sobre COVID-19, pouco ainda se sabe sobre o percurso da doença e seus desfechos a longo prazo. Assim, surge a investigação pós pandemia centrada nas sequelas e complicações causadas pelo Coronavírus. Desse modo, objetivou-se investigar vestígios sintomatológicos e tempo de duração em pacientes pós internamento por COVID-19 advindos de três hospitais regionais cearenses. Trata-se de um estudo descritivo, analítico do tipo transversal com abordagem quantitativa realizado no período de agosto a outubro de 2021 por meio da telepesquisa. A amostra final foi constituída de 49 pacientes na primeira onda e 153 na segunda, totalizando 202 participantes. Os dados foram tabulados em planilha eletrônica Excel® e analisados conforme estatística descritiva. Apresenta-se uma prevalência de pacientes do sexo masculino, 31 (63,3%) no primeiro período investigado, e 86 (56,2%) no segundo período. Na investigação de sintomas físicos destacou-se fadiga/cansaço, apresentando 23 (46,9%) e 69 (45,1%) conforme onda, seguido de inapetência 13 (26,5%) e (40,5%). Falta de ar teve destaque na segunda onda com 39 (25,5%). Sintomas como perda de memória, tosse e dor no peito aparecem como sendo os mais duradouros, sendo prevalentes por até 4 meses após a alta hospitalar. Enquanto na 2ª onda dor no peito é citada com duração de até 6 meses. Neste contexto, este estudo expõe os principais sintomas relatados, apontando para a necessidade iminente de estratégias públicas de serviços de acompanhamento e intervenção junto a estes pacientes.

Despite advances in knowledge about COVID-19, little is known about the course of the disease and its long-term outcomes. Therefore, post-pandemic research has focused on the sequelae and complications caused by the Coronavirus. Thus, the objective was to investigate symptomatological remains and their duration of discharged patients hospitalized for COVID-19 from three regional hospitals in Ceará. This is a descriptive, analytical cross-sectional study with a quantitative approach carried out from August to October 2021 through telesurvey. The final sample consisted of 49 patients in the first wave of the pandemic and 153 in the second, totaling 202 participants. Data were tabulated in an Excel® spreadsheet and analyzed according to descriptive statistics. There is a prevalence of male patients, 31 (63.3%) in the first period investigated, and 86 (56.2%) in the second wave. In the investigation of physical symptoms, fatigue/tiredness stood out, identified in 23 (46.9%) and 69 (45.1%) individuals according to the wave, followed by a lack of appetite in 13 (26.5%) and (40.5%). Shortness of breath was highlighted in the second period among 39 (25.5%) individuals. Symptoms such as memory loss, cough, and chest pain appear to be the most lasting, and were prevalent for up to 4 months after hospital discharge. While in the 2nd wave chest pain was cited lasting up to 6 months. In this context, this study exposes the main symptoms reported, pointing to the imminent need for public strategies for monitoring and intervention services with these patients.