Local climate change velocities and evolutionary history explain multidirectional range shifts in a North American butterfly assemblage.

Species are often expected to shift their distributions either poleward or upslope to evade warming climates and colonise new suitable climatic niches. However, from 18-years of fixed transect monitoring data on 88 species of butterfly in the midwestern United States, we show that butterflies are shifting their centroids in all directions, except towards regions that are warming the fastest (southeast). Butterflies shifted their centroids at a mean rate of 4.87 km year-1. The rate of centroid shift was significantly associated with local climate change velocity (temperature by precipitation interaction), but not with mean climate change velocity throughout the species' ranges. Species tended to shift their centroids at a faster rate towards regions that are warming at slower velocities but increasing in precipitation velocity. Surprisingly, species' thermal niche breadth (range of climates butterflies experience throughout their distribution) and wingspan (often used as metric for dispersal capability) were not correlated with the rate at which species shifted their ranges. We observed high phylogenetic signal in the direction species shifted their centroids. However, we found no phylogenetic signal in the rate species shifted their centroids, suggesting less conserved processes determine the rate of range shift than the direction species shift their ranges. This research shows important signatures of multidirectional range shifts (latitudinal and longitudinal) and uniquely shows that local climate change velocities are more important in driving range shifts than the mean climate change velocity throughout a species' entire range.

How does climate change impact social bees and bee sociality?

Climatic factors are known to shape the expression of social behaviours. Likewise, variation in social behaviour can dictate climate responses. Understanding interactions between climate and sociality is crucial for forecasting vulnerability and resilience to climate change across animal taxa. These interactions are particularly relevant for taxa like bees that exhibit a broad diversity of social states. An emerging body of literature aims to quantify bee responses to environmental change with respect to variation in key functional traits, including sociality. Additionally, decades of research on environmental drivers of social evolution may prove fruitful for predicting shifts in the costs and benefits of social strategies under climate change. In this review, we explore these findings to ask two interconnected questions: (a) how does sociality mediate vulnerability to climate change, and (b) how might climate change impact social organisation in bees? We highlight traits that intersect with bee sociality that may confer resilience to climate change (e.g. extended activity periods, diet breadth, behavioural thermoregulation) and we generate predictions about the impacts of climate change on the expression and distribution of social phenotypes in bees. The social evolutionary consequences of climate change will be complex and heterogeneous, depending on such factors as local climate and plasticity of social traits. Many contexts will see an increase in the frequency of eusocial nesting as warming temperatures accelerate development and expand the temporal window for rearing a worker brood. More broadly, climate-mediated shifts in the abiotic and biotic selective environments will alter the costs and benefits of social living in different contexts, with cascading impacts at the population, community and ecosystem levels.

Unraveling the Impact of miR-146a in Pulmonary Arterial Hypertension Pathophysiology and Right Ventricular Function.

Pulmonary arterial hypertension (PAH) is a chronic disorder characterized by excessive pulmonary vascular remodeling, leading to elevated pulmonary vascular resistance and right ventricle (RV) overload and failure. MicroRNA-146a (miR-146a) promotes vascular smooth muscle cell proliferation and vascular neointimal hyperplasia, both hallmarks of PAH. This study aimed to investigate the effects of miR-146a through pharmacological or genetic inhibition on experimental PAH and RV pressure overload animal models. Additionally, we examined the overexpression of miR-146a on human pulmonary artery smooth muscle cells (hPASMCs). Here, we showed that miR-146a genic expression was increased in the lungs of patients with PAH and the plasma of monocrotaline (MCT) rats. Interestingly, genetic ablation of miR-146a improved RV hypertrophy and systolic pressures in Sugen 5415/hypoxia (SuHx) and pulmonary arterial banding (PAB) mice. Pharmacological inhibition of miR-146a improved RV remodeling in PAB-wild type mice and MCT rats, and enhanced exercise capacity in MCT rats. However, overexpression of miR-146a did not affect proliferation, migration, and apoptosis in control-hPASMCs. Our findings show that miR-146a may play a significant role in RV function and remodeling, representing a promising therapeutic target for RV hypertrophy and, consequently, PAH.

Biosensors for natriuretic peptides in cardiovascular diseases. A review.

Heart failure (HF) is a complex clinical syndrome associated with high rates of morbidity and mortality. Over the years, it has been crucial to find accurate biomarkers capable of doing a precise monitor of HF and provide an early diagnosis. Of these, it has been established an important role of natriuretic peptides in HF assessment. Moreover, the development of biosensors has been garnering interest as new diagnostic medical tools. In this review we first provide a general overview of HF, its pathogenesis, and diagnostic features. We then discuss the role of natriuretic peptides in heart failure by characterizing them and point out their potential as biomarkers. Finally, we adress the evolution of biosensors development and the available natriuretic peptides biosensors for disease monitoring.

Corticotropin-releasing hormone and obesity: From fetal life to adulthood.

Obesity is among the most common chronic disorders, worldwide. It is a complex disease that reflects the interactions between environmental influences, multiple genetic allelic variants, and behavioral factors. Recent developments have also shown that biological conditions in utero play an important role in the programming of energy homeostasis systems and might have an impact on obesity and metabolic disease risk. The corticotropin-releasing hormone (CRH) family of neuropeptides, as a central element of energy homeostasis, has been evaluated for its role in the pathophysiology of obesity. This review aims to summarize the relevance and effects of the CRH family of peptides in the pathophysiology of obesity spanning from fetal life to adulthood.

The Ketone Bridge Between the Heart and the Bladder: How Fast Should We Go?

Metabolic syndrome (MS) is associated with both cardiovascular and bladder dysfunction. Insulin resistance (IR) and central obesity, in particular, are the main risk factors. In these patients, vicious pathological cycles exacerbate abnormal carbohydrate metabolism and sustain an inflammatory state, with serious implications for both the heart and bladder. Ketone bodies serve as an alternative energy source in this context. They are considered a "super-fuel" because they generate adenosine triphosphate with less oxygen consumption per molecule, thus enhancing metabolic efficiency. Ketone bodies have a positive impact on all components of MS. They aid in weight loss and glycemic control, lower blood pressure, improve lipid profiles, and enhance endothelial function. Additionally, they possess direct anti-inflammatory, antioxidant, and vasodilatory properties. A shared key player in dysfunction of both the heart and bladder dysfunction is the formation of the NLRP3 inflammasome, which ketone bodies inhibit. Interventions that elevate ketone body levels-such as fasting, a ketogenic diet, ketone supplements, and sodium-glucose cotransporter 2 inhibitors-have been shown to directly affect cardiovascular outcomes and improve lower urinary tract symptoms derived from MS. This review explores the pathophysiological basis of the benefits of ketone bodies in cardiac and bladder dysfunction.

Long-term therapy with itolizumab is safe and effective for patients with moderate to severe psoriasis: Results from an expanded-access program.

Itolizumab is a humanized monoclonal antibody that selectively targets the CD6-ALCAM pathway. This article reports on the safety and efficacy of itolizumab in the treatment of moderate-to-severe plaque psoriasis in a clinical study conducted in Cuba in the setting of an expanded-access program (EAP). The study included 84 patients who had previously received conventional anti-psoriatic systemic therapies but were either intolerant, had an inadequate response, or had contraindications to these therapies. It consisted of multiple phases, including a 12-week induction phase, a 40-week maintenance phase, and a 24-week off-treatment follow-up phase, using either a 0.4 or 1.6 mg/Kg dose. The results showed that itolizumab monotherapy was safe and effective during 52 weeks of continuous treatment and the subsequent 24 follow-up weeks. Itolizumab treatment resulted in a significant improvement (PASI 75) in 80 % of patients at the end of the induction phase, and this effect was sustained till week 52 during the maintenance phase. Moreover, 24 weeks after treatment stopped nearly two-thirds of patients still showed a PASI ≥ 75. The observed effects were dose-dependent, with 1.6 mg/kg being the most convenient dose. This study further supports the strategy of targeting the CD6-ALCAM signaling pathway for the treatment of psoriasis and the use of itolizumab as a valuable asset in the armamentarium of anti-psoriasis drugs.

Combination therapy of Epidermal Growth Factor and Growth Hormone-Releasing Hexapeptide in acute ischemic stroke: a phase I/II non-blinded, randomized clinical trial.

Objective: This study tested the hypothesis that a neuroprotective combined therapy based on epidermal growth factor (EGF) and growth hormone-releasing hexapeptide (GHRP6) could be safe for acute ischemic stroke patients, admitting up to 30% of serious adverse events (SAE) with proven causality. Methods: A multi-centric, randomized, open-label, controlled, phase I-II clinical trial with parallel groups was conducted (July 2017 to January 2018). Patients aged 18-80 years with a computed tomography-confirmed ischemic stroke and less than 12 h from the onset of symptoms were randomly assigned to the study groups I (75 µg rEGF + 3.5 mg GHRP6 i.v., n=10), II (75 µg rEGF + 5 mg GHRP6 i.v., n=10), or III (standard care control, n=16). Combined therapy was given BID for 7 days. The primary endpoint was safety over 6 months. Secondary endpoints included neurological (NIHSS) and functional [Barthel index and modified Rankin scale (mRS)] outcomes. Results: The study population had a mean age of 66 ± 11 years, with 21 men (58.3%), a baseline median NIHSS score of 9 (95% CI: 8-11), and a mean time to treatment of 7.3 ± 2.8 h. Analyses were conducted on an intention-to-treat basis. SAEs were reported in 9 of 16 (56.2%) patients in the control group, 3 of 10 (30%) patients in Group I (odds ratio (OR): 0.33; 95% CI: 0.06-1.78), and 2 of 10 (20%) patients in Group II (OR: 0.19; 95% CI: 0.03-1.22); only two events in one patient in Group I were attributed to the intervention treatment. Compliance with the study hypothesis was greater than 0.90 in each group. Patients treated with EGF + GHRP6 had a favorable neurological and functional evolution at both 90 and 180 days, as evidenced by the inferential analysis of NIHSS, Barthel, and mRS and by their moderate to strong effect size. At 6 months, proportion analysis evidenced a higher survival rate for patients treated with the combined therapy. Ancillary analysis including merged treated groups and utility-weighted mRS also showed a benefit of this combined therapy. Conclusion: EGF + GHRP6 therapy was safe. The functional benefits of treatment in this study supported a Phase III study. Clinical Trial Registration: RPCEC00000214 of the Cuban Public Registry of Clinical Trials, Unique identifier: IG/CIGB-845I/IC/1601.

Real-world effectiveness of the heterologous SOBERANA-02 and SOBERANA-Plus vaccine scheme in 2-11 years-old children during the SARS-CoV-2 Omicron wave in Cuba: a longitudinal case-population study.

Background: Increased pediatric COVID-19 occurrence due to the SARS-CoV-2 Omicron variant has raised concerns about the effectiveness of existing vaccines. The protection provided by the SOBERANA-02-Plus vaccination scheme against this variant has not yet been studied. We aimed to evaluate the scheme's effectiveness against symptomatic Omicron infection and severe disease in children. Methods: In September 2021, Cuba implemented a mass pediatric immunization with the heterologous SOBERANA-02-Plus scheme: 2 doses of conjugated SOBERANA-02 followed by a heterologous SOBERANA-Plus dose. By December, before the Omicron outbreak, 95.4% of 2-18 years-old had been fully immunized. During the entire Omicron wave, we conducted a nationwide longitudinal post-vaccination case-population study to evaluate the real-world effectiveness of the SOBERANA-02-Plus scheme against symptomatic infection and severe disease in children without previous SARS-CoV-2 infection. The identification of COVID-19 cases relied on surveillance through first line services, which refer clinical suspects to pediatric hospitals where they are diagnosed based on a positive RT-PCR test. We defined the Incidence Rate ratio (IRR) as IRvaccinated age group/IRunvaccinated 1-year-old and calculated vaccine effectiveness as VE = (1-IRR)∗100%. 24 months of age being the 'eligible for vaccination' cut-off, we used a regression discontinuity approach to estimate effectiveness by contrasting incidence in all unvaccinated 1-year-old versus vaccinated 2-years-old. Estimates in the vaccinated 3-11 years-old are reported from a descriptive perspective. Findings: We included 1,098,817 fully vaccinated 2-11 years-old and 98,342 not vaccinated 1-year-old children. During the 24-week Omicron wave, there were 7003/26,241,176 person-weeks symptomatic COVID-19 infections in the vaccinated group (38.2 per 105 person-weeks in 2-years-old and 25.5 per 105 person-weeks in 3-11 years-old) against 3577/2,312,273 (154.7 per 105 person-weeks) in the unvaccinated group. The observed overall vaccine effectiveness against symptomatic infection was 75.3% (95% CI, 73.5-77.0%) in 2-years-old children, and 83.5% (95% CI, 82.8-84.2%) in 3-11 years-old. It was somewhat lower during Omicron BA.1 then during Omicron BA.2 variant circulation, which took place 1-3 and 4-6 months after the end of the vaccination campaign. The effectiveness against severe symptomatic disease was 100.0% (95% CI not estimated) and 94.6% (95% CI, 82.0-98.6%) in the respective age groups. No child death from COVID-19 was observed. Interpretation: Immunization of 2-11 years-old with the SOBERANA-02-Plus scheme provided strong protection against symptomatic and severe disease caused by the Omicron variant, which was sustained during the six months post-vaccination follow-up. Our results contrast with the observations in previous real-world vaccine effectiveness studies in children, which might be explained by the type of immunity a conjugated protein-based vaccine induces and the vaccination strategy used. Funding: National Fund for Science and Technology (FONCI-CITMA-Cuba).

Biopsia de ganglio centinela con azul patente más impronta en el estadiaje axilar de cáncer de mama en un hospital de alta complejidad / Sentinel lymph node biopsy with blue patent more imprinted in the axillary stage of breast cancer in a hospital of high complexity

Objetivo: Analizar las principales características clínicopatológicas de pacientes con carcinoma de mama en quienes se realizó biopsia de ganglio centinela con azul patente más impronta en el estadiaje axilar. El estudio. Serie descriptiva, evaluó una serie de 20 casos con diagnóstico anatomopatológico de carcinoma ductal infiltrante atendidas en el área de Cirugía Oncológica del Hospital de Alta Complejidad "Virgen de la Puerta" EsSalud, La Libertad - Perú, durante el periodo febrero 2017 - enero 2018. Hallazgos: La sensibilidad y especificidad de la impronta de ganglio centinela fue de 75% respectivamente. El valor predictivo positivo y negativo fue de 67% y 82%. El cociente de probabilidad positivo y negativo fue de 3,0 y 0,33. El índice de Kappa fue 0,2 de considerado como un índice de concordancia. Conclusiones: La técnica del ganglio centinela es una buena alternativa para el manejo de cáncer de mama, ya que evita intervenciones quirúrgicas innecesarias.

Objetive:To analyze the main clinical-pathological characteristics of patients with breast carcinoma in whom a sentinel lymph node biopsy was performed with patent blue plus imprint in the axillary staging. . The studyThis descriptive series evaluated a series of 20 cases of patients with an anatomopathological diagnosis of infiltrating ductal carcinoma treated in the area of Oncological Surgery of the Hospital of High Complexity "Virgen de la Puerta" EsSalud, La Libertad - Peru, during the period February 2017 until January 2018. : The sensitivity and specificity of the sentinel lymph Findingsnode imprint was 75% respectively. The positive and negative predictive value was 67% and 82% respectively. The positive and negative likelihood ratio was 3.0 and 0.33. The Kappa index was 0.2 of considered as a concordance index. Conclusions. The sentinel lymph node technique is a good alternative for the management of breast cancer, since it avoids unnecessary surgical interventions

Animación interactiva en la administración segura de medicamentos / Interactive animation in secure administration of medications

Introducción: El objetivo de esta investigación fue fortalecer a estudiantes de enfermería en temática de la administración segura de medicamentos a través de una animación interactiva, orientado a maximizar el bienestar del sujeto de cuidado que requiera atención terapéutica en los diferentes servicios de salud. Metodología: Estudio cualitativo-cuantitativo (mixto), de cohorte transversal, con revisión de literatura en la primera fase y en la segunda fase ejecución cuasi experimental, aplicando consideraciones éticas como son: Validación de herramienta de recoleccion de datos pretest y postest por expertos. Resultados: La aplicabilidad de animación interactiva proporciona fortalecimiento en la percepción de los estudiantes de enfermería sobre la importancia de la adherencia en la práctica de manejo y la responsabilidad ético legal en administración segura de medicamentos en los servicios de salud. Aplicando en esta fase una herramienta tipo encuesta a estudiantes que cursan 8 semestres de enfermería en la jornada mañana y tarde. Resultados: se evidenció en la jornada mañana un 51.7% tenían conocimiento teórico y posterior a la socialización del video, el postest mejoró al 86.2%, en cuanto a la responsabilidad ético legal en el pretest un 62 % tenian adherencia a la ética en administración segura de medicamentos y que con el postest cambio a un 93 % mejorando la percepción de la adherencia a la ética en administración segura de medicamentos. En los resultados de estudiantes de la jornada tarde, el 52.6% tienen conocimiento teórico en el pre-test y con resultado del 89.4% en el post ­test; en cuanto a la responsabilidad ético legal se obtuvo en el pre-test un 68.4 % y un resultado en el post-test el 89.4%. Lo anteriormente descrito se mejoró con la animación interactiva, fortaleciendo los conocimientos teóricos y éticos en administración segura de medicamentos por vía intravenosa al sujeto que requiera atención terapéutica. Conclusión: Se concluye que la animación interactiva es un programa que ayuda a que la formación de enfermería reconozca y comprenda la labor y el deber de administrar tratamientos farmacológicos aplicando ética en la práctica de la misma, ya que el usuario que requiere un tratamiento tiene derecho a que se le proteja su integridad orgánica y sistémica. Adicionalmente, en relación al estudio realizado se evidencia que por medio de animación interactiva se logró fortalecer los conocimientos teóricos y prácticos en administración segura de medicamentos.

Introduction: The objective of this research was to strengthen the nursing staff in the safe administration of medicines through an interactive animation, oriented towards the welfare of the subject of care that requires therapeutic attention in the different health services. Methodology: Qualitative-quantitative cross-sectional study (mixed), with literature review in the first phase and in the second phase quasi-experimental execution, applying ethical considerations such as: Pre-test and post-test validation by experts. Results: The applicability of interactive animation provides strengthening in the perception of nursing staff about the importance of adherence in the practice of ethics in safe administration of medicines in health services. Applying in this part, the quantitative phase with quasi-experimental design type to the nursing student population of the University Foundation of the Andean Area, who study 8 semester and which is taken as a sample in the morning session 29 students and in the afternoon session 19 nursing students. Where it was evidenced in the day tomorrow with the students of nursing that 51.7% had theoretical knowledge and that with the realization of the posttest improved to 86.2%, as for the ethical ethical responsibility in the pretest 62% have adherence to the ethics in safe administration of medications and that with the post-test changed to 93% improving the perception of adherence to ethics in safe administration of medicines. In the pretest and posttest results made to the students of the afternoon session, 52.6% have theoretical knowledge in the pre-test and with a result of 89.4% in the post-test; in the part of ethical legal responsibility, 68.4% was obtained in the pre-test and 89.4% in the post-test. The above described was improved with interactive animation, strengthening the theoretical and ethical knowledge in safe administration of intravenous medications to the subject that requires therapeutic attention. Conclution: It is concluded that interactive animation is a program that helps the nursing profession know that it has the task and duty to administer pharmacological treatments applying ethics in the practice of the same, since the user that requires a treatment has the right to have its organic and systemic integrity protected. Additionally, in relation to the study carried out, it is evident that through interactive animation, the theoretical and practical knowledge in safe drug administration was strengthened.

Vivências de uma gestante em tratamento de hemodiálise no SUS / Experiences of a pregnant woman undergoing hemodialysis treatment in SUS

Este estudo pretendeu mostrar que a doença não é vista como sintoma, senão como alteração sistêmica do organismo que se expressa como sintoma, de modo que há um conjunto de doenças, dentre elas a renal crônica, nas quais tanto o modo de vida da pessoa, como a sua capacidade para lidar com seus conflitos são decisivos para sua prevenção e controle

O processo de planejamento de uma proposta de intervenção educativa utilizando a Caderneta da Criança como ferramenta pedagógica para a qualificação profissional na Atenção Primária / The planning process of an education intervention proposal applying the Child's Health Booklet as a pedagogical tool for professional qualification in Primary Health

A Caderneta da Criança se destina ao acompanhamento do crescimento e desenvolvimento infantil pela sistematização das ações de cuidado integral, vigilância e diagnóstico precoce de problemas de desenvolvimento. Entretanto, a literatura revela a sua subutilização, despreparo técnico, lacunas no conhecimento e comprometimento dos profissionais de saúde. A emergência da síndrome congênita de Zika vírus, entre 2015 e 2017, afetou um número expressivo de crianças em puericultura no estado do Rio de Janeiro e reforçou a necessidade de estratégias para a qualificação do cuidado em rede. A Covid-19 mudou o paradigma metodológico para oferta de capacitações apoiadas por tecnologias de informação e comunicação visando maior capilaridade de qualificação nos territórios. O objetivo do estudo foi descrever o processo de planejamento de uma proposta educativa da Secretaria de Saúde do Estado do Rio de Janeiro para vigilância do crescimento e desenvolvimento infantil, utilizando a Caderneta da Criança para qualificação profissional na Atenção Primária à Saúde (APS). Elegeu-se o estudo de caso através de uma abordagem qualitativa, utilizando a pesquisa documental de um processo intrasetorial, inserido no planejamento estadual, entre 2017 e 2021, centrado na contextualização temática e conjuntural de surgimento e de condução político-administrativa do processo. A classificação de 145 documentos resultou em 34 unidades principais, cuja análise crítica permitiu mapear o "vai e vem" deste processo em correspondência com os processos administrativos e a mudança da proposta educativa inicial no molde semipresencial para o Ensino à distância, associada a um dispositivo digital, para orientar e potencializar o uso do instrumento. Os resultados evidenciaram a realidade de um processo submetido a uma instituição tradicional, vertical, de natureza burocrática com dificuldades traduzidas em desafios enfrentados em função da Crise pandêmica, inserção do modo remoto de trabalho, desabastecimento da Caderneta da Criança no Rio de Janeiro, crises de governo e de governabilidade institucional. Além disso, hipertrofia documental, lentidão na origem em contraponto com a celeridade de tramitação no Sistema eletrônico de informação, frágil integração do planejamento estratégico e do trabalho intrasetorial para executar ações educativas. Exigências formais e imprevisibilidade de execução impuseram o cancelamento da proposta digital e transferência de parte das ações para 2022. Constatou-se a limitação do método na impossibilidade de complementação de entrevistas com informantes-chave. Considera-se que o estudo possa inspirar novas pesquisas sobre processos de planejamento e estratégias de educação mediadas por tecnologias de inovação e comunicação no âmbito da Secretaria, criando uma cultura de inovação nos processos de qualificação profissional da APS do Rio de Janeiro.

The Child's Health Booklet is intended for monitoring children's growth and development through the systematization of comprehensive care actions, attentiveness and early detection of developmental problems. However, the literature reveals its underutilization, technical unpreparedness, gaps in knowledge and commitment of health professionals. The emergence of congenital Zika syndrome, between 2015 and 2017, affected a significant number of children in childcare in the state of Rio de Janeiro and reinforced the need for strategies aspiring the excellence of network care. Covid-19 changed the methodological paradigm for offering training supported by information and communication technologies, aiming at greater capillarity of qualification in the territories. The objective of the study was to describe the planning process of an educational proposal of the Health Secretariat of the State of Rio de Janeiro to monitor child growth and development, using the Child's Health Booklet for professional qualification in Primary Health Care (PHC). The case study was chosen through a qualitative approach, using the documentary research of an intra-sectoral process, inserted in the state planning, between 2017 and 2021, focused on the thematic and conjunctural contextualization of the emergence and political-administrative conduction of the process. The classification of 145 documents resulted in 34 main units, whose critical analysis allowed to map the "back and forth" of this process in correspondence with the administrative processes and the change from the initial educational proposal of blended learning to distance learning, associated with a digital device, to guide and enhance the use of the instrument. The results evidenced the reality of a process submitted to a traditional, vertical, of a bureaucratic nature institution with difficulties translated into challenges faced due to the Pandemic crisis, adoption of remote work, shortage of the Child's Health Booklet in Rio de Janeiro, government and institutional governance crises. In addition, documental hypertrophy, slowness at the origin in contrast to the fast processing in the electronic information System, fragile integration of strategic planning and of intra-sectoral work to carry out educational actions. Formal requirements and unpredictability of execution imposed the cancellation of the digital proposal and the transfer of part of the actions to 2022. The limitation of the method was noted considering the impossibility of completing interviews with key informants. It is considered that the study can inspire new research on planning processes and education strategies mediated by innovation and communication technologies within the Secretariat, creating a culture of innovation in the professional qualification processes of PHC in Rio de Janeiro.

El self adolescente desde la perspectiva contextual: pobreza, viviendas sociales, apoyo parental y participación / The adolescent self from a contextual framework: Poverty, public housing, parental supportand participation / O self adolescente a partir da perspectiva contextual: Pobreza, residências sociais, apoioparental e participação

La presente revisión de tema ofrece una reflexión descriptiva, desde una perspectiva contextual, sobre la manera probable en la que un contexto de pobreza y de viviendas sociales básicas afecta el self o identidad adolescente. Se piensa que la falta de oportunidades de canalización de intereses, segregación y estigmatización impactan negativamente en el nivel aspiracional, la amplitud de ámbitos de metas, y estrategias de logro de los y las adolescentes, según estándares socialmente hegemónicos (“mainstream”). La autorrepresentación de sí se verá afectada por la estigmatización socioespacial en caso de comparación con un exogrupo socialmente más prestigioso. Los efectos del barrio deficitario pueden ser moderados por prácticas parentales, y espacios de participación social tendientes a la construcción de identidad positiva. El tema es relevante para una teoría contextual del self y la acción de políticas públicas.

This topical review offers a descriptive reflection within a contextualframework in relation to the probable effects of poverty and public housing on the adolescent self andadolescent identity. The author hypothesizes that the lack of opportunities to channel the interestsof adolescent youth, as well as the social segregation and stigmatization that they suffer from, havenegative effects on their aspirations, goals and plans for realizing their aspirations in accordance with mainstream social standards. Self-representation will be affected by socio-spatial stigmatizationin case of unfavorable comparisons with social groups that have higher status. The negative effectsof living in a deficient neighborhood can be mitigated by parental practices and social participationspaces that contribute to the construction of positive identities. This topic is relevant as a contributionto contextual self theory and public policy.

Apresente revisão de tema oferece uma reflexão descritiva a partir de uma perspectiva contextual sobre a forma provável como um contexto de pobreza e de residências sociais básicas afeta o self ou identidade adolescente. Parte-se da hipótese de que a falta de oportunidades de canalização de interesses, segregação e da estigmatização social impactam negativamente as aspirações, prazos e âmbitos de metas, as estratégias de logros de aspirações do adolescentes, de acordo com o padrão hegemônico. A auto representação se verá afetada pela estigmatização socioespacial no caso de comparação com um grupo externo socialmente mais prestigioso. Os efeitos do bairro deficitário podem ser moderados pelas práticas dos pais, e pelos espaços de participação social tendendo a construção de uma identidade positiva. O tema é relevante para a teoria do self compreendido contextualmente, e para considerá-lo nas políticas sociais.

Characterization of the communication resources used by patients in palliative care - an integrative review / Caracterização dos recursos de comunicação utilizados por pacientes em cuidados paliativos - revisão integrativa

ABSTRACT The aim of this study was to integrative review of publications concerning the role of speech and language therapists in regards to communication strategies in palliative care, as well as the characterization of the types of communication used in these cases. The search was conducted in the databases SciELO, LILACS and PubMed from 2001 to 2016. The studies selected included abstracts or full articles addressing aspects of communication in palliative care, especially those related to speech and language therapy, with an emphasis on communication. Ten articles focused on communication, and published after 2004, were selected, half being literature reviews, two, case reports, two others, quantitative exploratory studies, and one, a qualitative exploratory study, with only 3 specifically describing the communication strategies used by speech and language therapists in patients in palliative care. The descriptors found were: palliative care, communication, speech and language therapy, quality of life, dysphagia, swallowing and elderly. Four of the ten articles showed the importance of patients communication in palliative care. When described, it is up to the speech and language therapist to provide family support, evaluate the patient, favore patient-family and patient-team intervention, manage and intervene in communication and swallowing. Finally, the most used communication strategies were non-verbal communication, communication board, electronic equipment, verbal communication and speech valve. The analysis of the characterization of the communication in palliative care over the past 15 years allowed concluding that the attention to communication is recent and is only described in a few reports, includes non-verbal communication in different ways as the most frequent resource, but provides oral communication as an important factor for maintaining dignity and comfort in this scenario. Speech and language therapist are the main interlocutors for the maintenance, mediation and adaptation of communication, within the multidisciplinary team as well as among patients, their family and the care team.

RESUMO O objetivo foi realizar uma revisão integrativa das publicações referentes ao papel do fonoaudiólogo em relação às estratégias de comunicação em cuidados paliativos, bem como a caracterização das formas de comunicação utilizadas nesses casos. As buscas foram realizadas nos bancos de dados da SciELO, LILACS e PubMed no período de 2001 a 2016. Foram selecionados os estudos cujos resumos, ou textos na íntegra, abordavam aspectos da comunicação em cuidados paliativos, principalmente os relacionados com a atuação fonoaudiológica, com ênfase em comunicação. Foram selecionados 10 artigos, com enfoque em comunicação, a partir de 2004, sendo metade de revisão bibliográfica, dois relatos de caso, outros dois exploratórios quantitativos e um exploratório qualitativo, com apenas 3 deles descrevendo especificamente as estratégias de comunicação utilizadas por um fonoaudiólogo com pacientes em cuidados paliativos. Os descritores encontrados foram: cuidados paliativos (Palliative care), comunicação (communication), fonoaudiologia, qualidade de vida, disfagia, deglutição e idoso. Quatro dos dez artigos apontaram a importância da comunicação dos pacientes em cuidados paliativos. Quando descrito, compete ao fonoaudiólogo: oferecer suporte familiar, avaliar o paciente, favorecer a intervenção paciente-família e paciente-equipe, gerenciar e intervir na comunicação e deglutição. Finalmente, as estratégias de comunicação mais utilizadas foram: comunicação não verbal, prancha de comunicação, equipamentos eletrônicos, comunicação verbal e válvula de fala. A análise da caracterização da comunicação em cuidados paliativos nos últimos 15 anos permitiu concluir que a atenção à comunicação é recente, com poucos relatos ainda descritos, inclui a comunicação não verbal de diferentes maneiras como o recurso mais frequente, mas prevê a comunicação oral como um importante fator para a manutenção da dignidade e conforto nesse cenário. O fonoaudiólogo é o principal interlocutor para a manutenção, mediação e adaptação da comunicação, tanto entre equipe multiprofissional, quanto entre o paciente, sua família e a equipe de cuidado.

Ebola virus – from neglected threat to global emergency state / Vírus ébola – de ameaça negligenciada ao estado de emergência global

SUMMARY Objective: This review aims to update knowledge about Ebola virus disease (EVD) and recent advances in its diagnosis, treatment and prevention. Method: A literature review was performed using the following databases: ISI Web of Knowledge, PubMed, IRIS, Scopus and the websites of the CDC and the WHO. Additionally, we have included articles and reports referenced in the basic literature search, and news that were considered relevant. Results: The Ebola virus, endemic in some parts of Africa, is responsible for a severe form of hemorrhagic fever in humans; bats are probably its natural reservoir. It is an extremely virulent virus and easily transmitted by bodily fluids. EVD's complex pathophysiology, characterized by immunosuppression as well as stimulation of an intense inflammatory response, results in a syndrome similar to septic shock. The diagnosis is difficult due to the initial symptoms that mimic other diseases. Despite the high mortality rates that can amount to 90%, a prophylaxis (chemical or vaccine) or effective treatment does not exist. Two vaccines and experimental therapies are being developed for the prevention and treatment of EVD. Conclusion: Although the virus is known for about 40 years, the lack of knowledge obtained and the disinterest of government authorities in the countries involved justify the state of emergency currently exists regarding this infectious agent. Only the coordination of multiple entities and the effective commitment of the international community will facilitate the control and effective prevention of EVD.

RESUMO Objetivo: esta revisão tem como objetivo atualizar os conhecimentos sobre a doença do vírus ébola (DVE) e sobre os recentes avanços nos métodos de diagnóstico, tratamento e prevenção. Método: foi realizada uma revisão de literatura, utilizando as seguintes bases de dados: ISI Web of Knowledge, PubMed, IRIS, Scopus e os sites do Centers for Disease Control and Prevention (CDC) e da Organização Mundial da Saúde (OMS). Adicionalmente, foram incluídos artigos e relatórios referenciados na pesquisa bibliográfica de base e notícias consideradas relevantes. Resultados: o vírus ébola, endêmico de algumas regiões da África, é responsável por uma forma grave de febre hemorrágica no homem, e os morcegos são provavelmente o seu reservatório natural. É um vírus extremamente virulento e de fácil transmissão pelos fluidos corporais. A complexa fisiopatologia da doença, caracterizada pela imunossupressão e pelo estímulo a uma intensa resposta inflamatória, resulta em uma síndrome semelhante ao choque séptico. O seu diagnóstico é difícil, por causa da sintomatologia inicial, que mimetiza outras doenças. Apesar das altas taxas de mortalidade, que podem alcançar os 90%, não existe profilaxia (química ou vacinal) ou tratamento eficaz. Encontram-se em desenvolvimento duas vacinas e terapias experimentais para a prevenção e o tratamento da DVE. Conclusão: apesar de ser um vírus conhecido há cerca de 40 anos, o escasso conhecimento obtido e o desinteresse das entidades governamentais de países envolvidos justificam o estado de emergência que se vive atualmente em relação a esse agente infeccioso. A coordenação por múltiplas entidades e o empenho efetivo da comunidade internacional facilitarão o seu controle e a prevenção eficaz.

Seguridad de la aplicación intravenosa del cigb-300 en pacientes con hemopatías malignas. Estudio EHPMA / Red blood cell antigens and antibodies in patients awaiting renal transplantation

Introducción: el CIGB-300 es un péptido sintético capaz de producir apoptosis en células tumorales. Objetivos: explorar la seguridad del CIGB-300 administrado por vía intravenosa en pacientes con hemopatías malignas. Metodología : se realizó un ensayo clínico fase I, multicéntrico, no aleatorizado, adaptativo, con un solo grupo de tratamiento y escalado de dosis en el mismo paciente (Registro No. 05.013.12.B). Los eventos adversos se clasificaron según la versión 4.03 de Terminología de los Criterios Comunes para Eventos Adversos. Se seleccionaron pacientes con edad igual o mayor a 18 años, no candidatos a trasplante de médula ósea, con leucemias agudas refractarias o en recaída, leucemia aguda mielobástica del anciano y síndromes mielodisplásticos con exceso de blastos, que tuvieron ECOG ≤ 3 y aceptaron participar en la investigación. Se consideraron como criterios de exclusión: la leucemia promielocítica, enfermedades crónicas descompensadas, antecedentes alérgicos graves, embarazo, puerperio y lactancia. Para las variables cuantitativas, se estimaron medidas de tendencia central y para las cualitativas la distribución de frecuencias. Resultados: de 10 pacientes incluidos, 6 realizaron el tratamiento con los cinco niveles de dosis. Se presentaron 94 tipos de eventos adversos, la mayoría de carácter sistémico, con 619 notificaciones. El prurito y el eritema localizados fueron los eventos más comunes, seguidos de la hipertensión arterial. Los eventos se presentaron con mayor frecuencia el primer día de cada ciclo y no se detectó su aumento al incrementar la dosis del producto. El 87,7 por ciento se consideraron eventos leves y el 61,6 por ciento con causalidad muy probable. Se presentaron 15 eventos adversos graves, pero solo uno fue relacionado con la administración del CIGB 300. Conclusiones: la administración intravenosa del CIGB-300 fue segura y bien tolerada. El escalado de dosis no aumentó la toxicidad del producto(AU)

Introduction: CIGB-300 is a synthetic peptide capable of producing apoptosis in tumor cells. Objectives: To explore the safety of CIGB-300 administered intravenously in patients with hematological malignancies (Registry No. 05.013.12.B). Methodology : A multicenter, non-randomized, adaptive, with an only treatment group (intravenous administration of the investigational product and dose escalation in the same patient), phase I clinical trial was conducted. Adverse events were classified according to the version 4.03 of Common Terminology Criteria for Adverse Events . Patients aged 18 years or older were selected, not candidates for bone marrow transplantation, with refractory or relapsed acute leukemias, acute myeloblastic leukemia of elderly, and myelodysplastic syndromes with blast excess, who had ECOG ≤ 3 and agreed to participate in the investigation. We considered as exclusion criteria: acute promyelocytic leukemia, decompensated chronic diseases, severe allergic history, pregnancy, postpartum and breastfeeding. For quantitative variables, measures of central tendency and qualitative distribution of frequencies were estimated. Results: Of 10 patients included 6 received treatment with five dose levels. Ninety four types of adverse events were present, most systemic, with 619 notifications. Localized itching and rash were the most common events, followed by high blood pressure. The events occurred more frequently on the first day of each cycle and no increase was detected when the dose of the product was rised. Minor events were 87,7 percent and 61,6 percent with probable causality. Fifteen serious adverse events occurred, but only one was related to the administration of CIGB 300. Conclusions: Intravenous administration of CIGB-300 was safe and well tolerated. Dose escalation did not increase the toxicity of the product(AU)

Empoderamiento en el movimiento estudiantil durante 2011 y 2012 en Chile / Empowerment in Chilean Student Movement during 2011 and 2012

El presente trabajo indaga sobre un debilitamiento del empoderamiento de grupos frente a poderes macroeconómico-políticos (identificado en situaciones antecedentes) en el Movimiento Estudiantil chileno durante 2011 y 2012, según la percepción subjetiva de los jóvenes participantes. Mediante una metodología cualitativa, se realizaron 18 entrevistas individuales y tres grupos focales (N= 31) con jóvenes de universidades y colegios. Los resultados indicaron que los participantes experimentan empoderamiento en la mayoría de las dimensiones: análisis crítico, organización, acciones, y apoyo ciudadano. Su percepción de efectividad frente a la institucionalidad política es más débil. Se discuten las implicaciones de los hallazgos en relación al tema de la fortaleza, permanencia-erosión del movimiento, distinciones teórico conceptuales y políticas públicas.

Previous findings show weakened empowerment of groups facing macroeconomical and political powers, so this study explores movement participants' perceptions of empowerment in the Chilean student movement, years 2011-2012. A qualitative method with 18 individual interviews and three focus groups was used in students of universities and schools (N= 31). Results show empowerment in most dimensions: critical consciousness, organization, actions/behavior and contextual citizens' support. However, the sense of control in the face of the political institution is week. Implications regarding strength, movements' continuity-erosion, theoretical aspects and public policies are discussed.

Prevalencia de microfilaria en aves silvestres de Venezuela / Prevalence of microfilaria in wild birds of Venezuela

La megadiversidad de las aves es ampliamente conocida en el Neotrópico, ocupando Venezuela el sexto lugar a escala mundial. Sin embargo, existen pocos estudios de enfermedades causadas por hemoparásitos, dentro de los cuales se encuentran las filarias, que son nematodos altamente especializados, que pueden alojarse en casi cualquier órgano o tejido de los vertebrados terrestres. Las microfilarias son sus formas larvarias, y son capaces de producir inflamación de venas y arterias. Su presencia en sangre confirma el diagnóstico positivo de esa parasitosis. El objetivo de este estudio, fue el de estimar la prevalencia de microfilarias en aves silvestres de Venezuela entre 2012 y 2014. Para ello, se seleccionaron cuatro áreas de interés de conservación de aves, con características de pasos migratorios, ecológicamente diferentes, pertenecientes a los estados Aragua, Falcón, Zulia y Guárico. Se muestrearon aves silvestres, utilizando para su captura redes de neblinas. La clasificación taxonómica del ave se basó en los caracteres físicos en campo y en los registros fotográficos de laboratorio. La población estudiada consistió de 1970 individuos de 119 especies y 18 familias. Se tomaron muestras sanguíneas de la vena ulnar, para la posterior realización de extendidos que fueron coloreados con la solución de Giemsa. Se hicieron tres extendidos por ave. El diagnóstico parasitológico se realizó por microscopía de luz (1000x), identificándose los caracteres morfológicos propios de las microfilarias. Los resultados del estudio demostraron la presencia de infección en 24 aves de 14 especies, para una prevalencia global del 1,22%, siendo el Campylorhynchus griseus, el hospedador con mayor prevalencia, con un 66,67%. Las variables ecológicas y de comportamiento ornitológico no demostraron ser factores de riesgo para la prevalencia a microfilarias; sin embargo, existen aspectos que favorecen la infección, como los ambientes cálidos y la vegetación densa.

Birds megadiversity is well known in the Neotropics and Venezuela is ranked sixth worldwide. However, there are very few studies of diseases caused by blood parasites, within which highlight the filariae, which are highly specialized nematodes that house in almost any organ or tissue of terrestrial vertebrates. Their larval forms are the microfilariae, capable of producing inflammation of veins and arteries, and their presence in peripheral blood smears confirms a positive diagnosis of that parasitosis. The aim of this study was to estimate the prevalence of microfilariae in wild birds in Venezuela during the period 2012-2014. Four areas of interest for bird conservation and the ecological characteristics of different migration paths belonging to the States of Aragua, Falcón, Zulia, and Guárico were selected. To accomplish this, wild birds were captured using mist nets. The taxonomic classification of birds was performed based on their physical characteristics in the field and in laboratory photographic records. The study population consisted of 1970 individuals of 119 species and 18 families. Blood samples from the ulnar vein were withdrawn and three Giemsa-stained blood smears were obtained from each bird. The parasitological diagnosis was made under light microscopy (1000x), identifying the specific morphological characteristics typical of microfilariae. The study results showed infection in 24 birds of 14 species, for an overall prevalence of 1.22 %, being Campylorhynchus griseus, the host with the highest prevalence, with 66.67 %. The ecological and the ornithological behavior variables did not prove to be risk factors for the prevalence of microfilariae; however, there are aspects that favor infection, such as warm environments and dense vegetation.