Characterization of the nuclear import of the human CHD4-NuRD complex.

Chromatin remodeling enzymes form large multiprotein complexes that play central roles in regulating access to the genome. Here, we characterize the nuclear import of the human CHD4 protein. We show that CHD4 enters the nucleus by means of several importin-α proteins (1, 5, 6 and 7), but independently of importin ß1. Importin α1 directly interacts with a monopartite 'KRKR'-motif in the N-terminus of CHD4 (amino acids 304-307). However, alanine mutagenesis of this motif only leads to an ∼50% reduction in nuclear localization of CHD4, implying that there are additional import mechanisms. Interestingly, we could show that CHD4 was already associated with the nucleosome remodeling deacetylase (NuRD) core subunits, such as MTA2, HDAC1 and RbAp46 (also known as RBBP7), in the cytoplasm, suggesting an assembly of the NuRD core complex before nuclear import. We propose that, in addition to the importin-α-dependent nuclear localization signal, CHD4 is dragged into the nucleus by a 'piggyback' mechanism using the import signals of the associated NuRD subunits.

Gender and Violence in the Daily Routine of Community Health Workers in Fortaleza, Brazil.

Community Health Workers (CHWs) are the link between the Brazilian primary health care system and the community. Since CHWs live in the same neighborhoods they work, they are involved in what happens in the community, including observants and or potential targets of violence. However, it is not known if female and male CHWs perceive and suffer violence similarly. This study aimed to investigate the violence to which CHWs are exposed and if female CHWs experience and or perceive violence the same way as male CHWs. A structured questionnaire was used to collect information from CHWs. Two periods (2019 [n=1402] and 2021 [n=364]) were compared. The data show that more than 80% of CHWs were exposed to violence, either as victims or witnesses within the community they served. In general, while the occurrence of violence towards CHWs decreased, their perception of community violence increased. Over time, the perception of urban/community violence remained constant among male CHWs, but increased among female CHWs, as shown by the significant rise between 2019 and 2021 in the percentage of female CHWs reporting witnessing or hearing about manifestations of violence (e.g., physical aggression; assault; stabbing; lethal gunshot; non-lethal gunshot; and gang violence). Among male CHWs, perception only increased with regard to the item assault. Given the complexity of violence and its repercussions on the daily routines of CHWs, intersectoral and interdisciplinary partnerships between health workers and other stakeholders are needed to create strategies capable of dealing with expressions of violence in the territories served.

Elucidation of the functional roles of the Q and I motifs in the human chromatin-remodeling enzyme BRG1.

The Snf2 proteins, comprising 53 different enzymes in humans, belong to the SF2 family. Many Snf2 enzymes possess chromatin-remodeling activity, requiring a functional ATPase domain consisting of conserved motifs named Q and I-VII. These motifs form two recA-like domains, creating an ATP-binding pocket. Little is known about the function of the conserved motifs in chromatin-remodeling enzymes. Here, we characterized the function of the Q and I (Walker I) motifs in hBRG1 (SMARCA4). The motifs are in close proximity to the bound ATP, suggesting a role in nucleotide binding and/or hydrolysis. Unexpectedly, when substituting the conserved residues Gln758 (Q motif) or Lys785 (I motif) of both motifs, all variants still bound ATP and exhibited basal ATPase activity similar to that of wildtype BRG1 (wtBRG1). However, all mutants lost the nucleosome-dependent stimulation of the ATPase domain. Their chromatin-remodeling rates were impaired accordingly, but nucleosome binding was retained and still comparable with that of wtBRG1. Interestingly, a cancer-relevant substitution, L754F (Q motif), displayed defects similar to the Gln758 variant(s), arguing for a comparable loss of function. Because we excluded a mutual interference of ATP and nucleosome binding, we postulate that both motifs stimulate the ATPase and chromatin-remodeling activities upon binding of BRG1 to nucleosomes, probably via allosteric mechanisms. Furthermore, mutations of both motifs similarly affect the enzymatic functionality of BRG1 in vitro and in living cells. Of note, in BRG1-deficient H1299 cells, exogenously expressed wtBRG1, but not BRG1 Q758A and BRG1 K785R, exhibited a tumor suppressor-like function.

Controlled trial of an mHealth intervention to promote healthy behaviours in adolescence (TeenPower): Effectiveness analysis.

AIM: To evaluate the effectiveness on lifestyle change of an mHealth intervention to promote healthy behaviours in adolescence (TeenPower) and to analyse the predictors of the mHealth intervention effectiveness. DESIGN: This study is designed as a non-randomized controlled trial with a two-arm structure. METHODS: Adolescents of 12-16-year old were recruited from three school districts, with access to the Internet and smartphone/tablet devices. The intervention group was invited to engage in the mHealth intervention (TeenPower) for 6 months in addition to a school-based intervention. The control group only followed the school-based intervention. A repeated measures factorial ANOVA was used and the main effectiveness outcome was the lifestyle change measured by the adolescent lifestyle profile. RESULTS: The outcomes of the mHealth intervention (TeenPower) show a significant effect on nutrition (ƞ2 p  = 0.03, p = .03), positive life perspective (ƞ2 p  = 0.04, p = .01), and global lifestyle (ƞ2 p  = 0.02, p = .05), with a dropout rate of 62.1%. The analysis of the effectiveness predictors of the mHealth intervention suggested that older adolescents tended to show a significant increase in the rates of stress management (r = .40; p < .05). CONCLUSIONS: Although the considerable dropout rate, the mHealth intervention presented significant impact on multiple lifestyle domains, providing support for the effectiveness of mHealth interventions for health promotion as an add-on to standard interdisciplinary interventions. IMPACT: Adolescents must have the necessary and appropriate knowledge for the correct and responsible decision-making regarding their health and lifestyle. Innovative strategies (mHealth intervention) were used to promote healthy behaviours. This study evaluates the effectiveness of an mHealth intervention (TeenPower) specifically designed for adolescents. We found a significant impact in several lifestyle domains such as health responsibility, nutrition, positive life perspective, and global lifestyle.

CHD3 and CHD4 form distinct NuRD complexes with different yet overlapping functionality.

CHD3 and CHD4 (Chromodomain Helicase DNA binding protein), two highly similar representatives of the Mi-2 subfamily of SF2 helicases, are coexpressed in many cell lines and tissues and have been reported to act as the motor subunit of the NuRD complex (nucleosome remodeling and deacetylase activities). Besides CHD proteins, NuRD contains several repressors like HDAC1/2, MTA2/3 and MBD2/3, arguing for a role as a transcriptional repressor. However, the subunit composition varies among cell- and tissue types and physiological conditions. In particular, it is unclear if CHD3 and CHD4 coexist in the same NuRD complex or whether they form distinct NuRD complexes with specific functions. We mapped the CHD composition of NuRD complexes in mammalian cells and discovered that they are isoform-specific, containing either the monomeric CHD3 or CHD4 ATPase. Both types of complexes exhibit similar intranuclear mobility, interact with HP1 and rapidly accumulate at UV-induced DNA repair sites. But, CHD3 and CHD4 exhibit distinct nuclear localization patterns in unperturbed cells, revealing a subset of specific target genes. Furthermore, CHD3 and CHD4 differ in their nucleosome remodeling and positioning behaviour in vitro. The proteins form distinct CHD3- and CHD4-NuRD complexes that do not only repress, but can just as well activate gene transcription of overlapping and specific target genes.

An mHealth intervention programme to promote healthy behaviours and prevent adolescent obesity (TeenPower): A study protocol.

AIM: This paper describes the design and rationale of multicenter practice-based research that aims to develop and evaluate an innovative mobile health (mHealth) intervention programme directed to promote healthy behaviours and prevent adolescent obesity. DESIGN: This study is designed as a non-randomized controlled trial with a three-arm structure. METHODS: Twelve to 16 years old participants will be recruited from schools, with access to the Internet and smartphone/tablet devices. The intervention group will be invited to engage in the TeenPower mHealth programme and divided into two subgroups: Group A (additionally engaged in a structured school-based intervention programme) and Group B (only engaged in the mHealth programme). The mHealth app includes educational resources, self-monitoring, social support, interactive training modules and motivational tools. The control group will only follow the structured school-based intervention programme. The intervention length will be 3 months, including the direct support of an interdisciplinary team (nursing, nutrition, sports, psychology, among others). This research was approved and funded in August 2017. DISCUSSION: The positive evaluation of the intervention programme will stimulate the inclusion of technologies in the promotion of salutogenic behaviours and obesity prevention. IMPACT: Adolescent obesity reached epidemic proportions. It is urgent to find effective prevention strategies to induce change at the individual, family and community level. If effective, this protocol can be used by health and exercise professionals in improving community interventions tailored to teenagers.

Bioavailability and influence of ¹4C-carbofuran on Eisenia andrei avoidance, growth and reproduction in treated natural tropical soils.

The bioavailability of carbofuran to the compost worms Eisenia andrei and the influence of its residual amounts on the avoidance, reproduction and growth of this species were studied in two natural tropical soils: a Typic Humaquept (GM) and a Typic Hapludox (LVD), as indicated by the Brazilian environmental authorities for ecotoxicological tests. The worms avoided the soil LVD treated with different doses of carbofuran. The pesticide also affected the production of juvenile specimens in both soils, but cocoon production was reduced only in the GM soil. The earthworms' growth and weight loss were affected by carbofuran (2,2-dimethyl-2,3-dihydro-1-1-benzofuran-7-yl methylcarbamate. CAS number 1563-66-2) only in the LVD and the mortality detected at 56 days of contact with the treated soils was not statistically significant in both of them. Fourteen days after the soil treatment with(14) c-carbofuran, most residues detected in the soils were bound residues (approximately 36% and 30% in the GM and LVD, respectively) and neither mortality nor bioaccumulation was detected in the earthworms, even with absorptions of 13% and 43%, respectively. The LVD soil has lower organic matter content, and the effects of carbofuran on different aspects of the earthworms' life were more pronounced in this soil, most likely due to the higher bioavailability of the pesticide in the soil solution. The results for carbofuran clearly demonstrate that even small quantities of residues do not assure lack of toxicity. They also make evident the necessity of studying the effects of pesticides in natural agricultural soils. Furthermore, as the bound residues and the earthworm contamination are not detected by conventional techniques, they are not taken into account and may be underestimated on environmental risk assessments.

Access to health care among female prisoners in a penitentiary in Ceará, Brazil. / Acesso e cuidado a saúde de mulheres privadas de liberdade na penitenciária cearense.

This study investigated access to health care among female prisoners in the state of Ceará, Brazil, and screened for common mental disorders. We conducted an analytical cross-sectional study in the only female prison in the state. Ninety detainees participated in the study. All participants were either pregnant or postpartum women or had one or more of the following health problems: hypertension, diabetes mellitus, tuberculosis, syphilis, hepatitis B, HIV/AIDS. The data were collected using a structured questionnaire. The findings reveal that access to health care was limited, violating the fundamental rights of the prisoners. Screening for diseases on admission to prison was limited, especially among non-pregnant women. Differences in health care were found between health conditions, with priority being given to pregnant and postpartum women. Most of the inmates (68.24%) were found to be at risk for common mental disorders (SRQ score > 7). A positive correlation was found between age and mental health problems (p = 0.0002). Despite legislation guaranteeing access to health care in prisons, the prison system is unprepared to meet the health needs of female prisoners with comorbidities and pregnant and puerperal women.

O estudo analisa o acesso ao cuidado em saúde de mulheres encarceradas no estado do Ceará, rastreando transtornos mentais comuns. Estudo analítico, transversal, de natureza quantitativa, desenvolvido na única penitenciária feminina do Ceará. Participaram 90 detentas, todas com alguma das seguintes questões de saúde: gestantes, puérperas, portadoras de hipertensão arterial sistêmica, diabetes mellitus, tuberculose, sífilis, hepatite B ou HIV/Aids. Os dados foram coletados por entrevista estruturada. Evidenciou-se acesso limitado à atenção à saúde das detentas, violando direitos básicos sob tutela do Estado. Foram constatadas limitações de exames de rastreamento de doenças nas presidiárias na ocasião de seu acesso ao cárcere, principalmente as que não se encontravam grávidas no momento do encarceramento. Houve diferenças entre as distintas condições de saúde analisadas, com prioridade da atenção às gestantes e puérperas. Entre as detentas, 68,24% apresentavam risco de transtornos mentais comuns (SRQ > 7). Houve correlação positiva entre idade e saúde mental (p = 0,0002). Embora exista legislação pertinente de garantia de acesso à saúde no cárcere, o sistema prisional está despreparado para atender às necessidades de portadoras de comorbidades, gestantes e puérperas.

A Comprehensive Review and Bifactor Modeling Analysis of the Brief COPE.

The Brief COPE is a measure of coping strategies that contains 14 factors. The purpose of this research was twofold: (a) examine the psychometric proprieties of the Brief Cope in previous studies; and (b) perform Confirmatory Factor Analyses (CFA) with second-order model and bifactor model specifications that could be used to assess the best model that represents the 14 coping strategies inherent to the instrument. In order to meet the first objective, a bibliographic review of published peer-reviewed studies between 1997 and 2021 was conducted. Results from the review identified 50 studies, of which 21 used exploratory factor analysis, 28 CFA and one study test-retest analysis. Seventeen studies used the entire correlated 14-factor structure. However, only 11 studies conducted a CFA. For the second objective, a sample of 472 working class individuals (female = 278) with a mean work experience of 19.06 years (SD = 11,92) were recruited. We tested several model specifications, convergent and discriminant validity analysis. We found the correlated 14-factor structure of the Brief COPE to have good psychometric properties. The second-order and bifactor model specifications displayed poor fit or did not converge, respectively. The measure showed good convergent and discriminant validity, and the subscales showed adequate internal consistency. We provide further validity and reliability of the correlated 14-factor structure, evidencing that this measure can assess coping mechanisms. Second-order model specifications need further testing and empirical evidence to support such hierarchical categorization.

The Future Looks Good: Examining the Associations Between Coping, Psychological Distress, and Optimism.

The recent pandemic and consequent lockdown had a substantial impact on mental health and optimism regarding the future. Previous research showed that levels of depression, anxiety, and stress had increased throughout the pandemic. Nonetheless, how individuals cope when faced with adversity may be associated with positive expectations regarding the future. A sample of 274 Portuguese workers (female = 54) with a mean age of 40.86 (SD = 0.70) and work experience of 19.68 years (SD = 12.07) met inclusion criteria and agreed to participate in the proposed study. They represented a variety of working classes (i.e., arts, engineering, marketers, transportation and logistic, clerks, personal trainers, managers, lawyers, accountants, directors, journalism, health care). We investigated the associations between depression, stress, anxiety, adaptive and maladaptive coping, and optimism while controlling for working experience, gender, and work type. We found that depression was related to lower levels of optimism. However, for participants scoring high on adaptive coping and anxiety, higher scores of optimism were reported. Gender, work type, and experience did not significantly influence the results. These results provide evidence through which positive mental health can be promoted after the pandemic.

Sequence and functional differences in the ATPase domains of CHD3 and SNF2H promise potential for selective regulability and drugability.

Chromatin remodelers use the energy of ATP hydrolysis to regulate chromatin dynamics. Their impact for development and disease requires strict enzymatic control. Here, we address the differential regulability of the ATPase domain of hSNF2H and hCHD3, exhibiting similar substrate affinities and enzymatic activities. Both enzymes are comparably strongly inhibited in their ATP hydrolysis activity by the competitive ATPase inhibitor ADP. However, the nucleosome remodeling activity of SNF2H is more strongly affected than that of CHD3. Beside ADP, also IP6 inhibits the nucleosome translocation of both enzymes to varying degrees, following a competitive inhibition mode at CHD3, but not at SNF2H. Our observations are further substantiated by mutating conserved Q- and K-residues of ATPase domain motifs. The variants still bind both substrates and exhibit a wild-type similar, basal ATP hydrolysis. Apart from three CHD3 variants, none of the variants can translocate nucleosomes, suggesting for the first time that the basal ATPase activity of CHD3 is sufficient for nucleosome remodeling. Together with the ADP data, our results propose a more efficient coupling of ATP hydrolysis and remodeling in CHD3. This aspect correlates with findings that CHD3 nucleosome translocation is visible at much lower ATP concentrations than SNF2H. We propose sequence differences between the ATPase domains of both enzymes as an explanation for the functional differences and suggest that aa interactions, including the conserved Q- and K-residues distinctly regulate ATPase-dependent functions of both proteins. Our data emphasize the benefits of remodeler ATPase domains for selective drugability and/or regulability of chromatin dynamics.

Acesso e cuidado a saúde de mulheres privadas de liberdade na penitenciária cearense / Access to health care among female prisoners in a penitentiary in Ceará, Brazil

Resumo O estudo analisa o acesso ao cuidado em saúde de mulheres encarceradas no estado do Ceará, rastreando transtornos mentais comuns. Estudo analítico, transversal, de natureza quantitativa, desenvolvido na única penitenciária feminina do Ceará. Participaram 90 detentas, todas com alguma das seguintes questões de saúde: gestantes, puérperas, portadoras de hipertensão arterial sistêmica, diabetes mellitus, tuberculose, sífilis, hepatite B ou HIV/Aids. Os dados foram coletados por entrevista estruturada. Evidenciou-se acesso limitado à atenção à saúde das detentas, violando direitos básicos sob tutela do Estado. Foram constatadas limitações de exames de rastreamento de doenças nas presidiárias na ocasião de seu acesso ao cárcere, principalmente as que não se encontravam grávidas no momento do encarceramento. Houve diferenças entre as distintas condições de saúde analisadas, com prioridade da atenção às gestantes e puérperas. Entre as detentas, 68,24% apresentavam risco de transtornos mentais comuns (SRQ > 7). Houve correlação positiva entre idade e saúde mental (p = 0,0002). Embora exista legislação pertinente de garantia de acesso à saúde no cárcere, o sistema prisional está despreparado para atender às necessidades de portadoras de comorbidades, gestantes e puérperas.

Abstract This study investigated access to health care among female prisoners in the state of Ceará, Brazil, and screened for common mental disorders. We conducted an analytical cross-sectional study in the only female prison in the state. Ninety detainees participated in the study. All participants were either pregnant or postpartum women or had one or more of the following health problems: hypertension, diabetes mellitus, tuberculosis, syphilis, hepatitis B, HIV/AIDS. The data were collected using a structured questionnaire. The findings reveal that access to health care was limited, violating the fundamental rights of the prisoners. Screening for diseases on admission to prison was limited, especially among non-pregnant women. Differences in health care were found between health conditions, with priority being given to pregnant and postpartum women. Most of the inmates (68.24%) were found to be at risk for common mental disorders (SRQ score > 7). A positive correlation was found between age and mental health problems (p = 0.0002). Despite legislation guaranteeing access to health care in prisons, the prison system is unprepared to meet the health needs of female prisoners with comorbidities and pregnant and puerperal women.

Persistence of malathion used in dengue control on household surfaces / Permanência do malathion usado no controle da dengue em superfícies domiciliares

Dengue is a viral infection transmitted by the mosquito Aedes aegypti. In Brazil, one of the insecticides used to control the mosquito is malathion, which can be diluted in vegetable oil (1:2 v/v). The purpose of this study was to understand the persistence of malathion on different surfaces and soil. Surfaces were contaminated by malathion and then washed with water and soap. The water used to clean the surfaces was extracted and analyzed by gas chromatography with an FID detector. Soil samples received malathion 14C-TG diluted in vegetable oil (1:2 v/v) and were analyzed zero, 3, 7, 18, 32, 60, 120, 240, and 360 days after the application in a liquid scintillation analyzer. Results showed a high persistence of malathion on porous surfaces. Moreover, it did not degrade in the soil for the first 120 days.(AU)

A dengue é uma infecção viral transmitida pelo mosquito Aedes aegypti. No Brasil, um dos inseticidas utilizados para controlar o mosquito é o malathion, que pode ser diluído em óleo vegetal (1:2 v/v). O objetivo deste trabalho foi avaliar a permanência do malathion em diferentes superfícies e no solo. As superfícies foram contaminadas com malathion e depois lavadas com água e sabão. A água utilizada para limpar as superfícies foi extraída e analisada por cromatografia gasosa com detector de ionização de chama. O malathion 14C-GT diluído em óleo vegetal (1:2 v/v) foi aplicado em amostras de solo que foram analisadas nos tempos 0, 3, 7, 18, 32, 60, 120, 240 e 360 dias após a aplicação, em um analisador de cintilação líquida. Os resultados mostraram alta permanência de malathion em superfícies porosas. Além disso, o malathion não se degradou no solo nos primeiros 120 dias.(AU)

[Public water supply fluoridation in Brazil according to health sector leaders]. / Fluoretação das águas de abastecimento público no Brasil: o olhar de lideranças de saúde.

Various groups have opposed water supply fluoridation in Brazil, while others have supported the measure based on scientific evidence. This article describes the perceptions of delegates to the 13th National Health Conference on mandatory fluoridation of the country's public water supply. Interviews were processed using collective subject discourse analysis. A certain degree of misinformation persists regarding basic characteristics of water fluoridation, which is frequently confused with chlorination. The delegates' discourses showed a continuing need for public awareness-raising regarding fluoridation and the delegates' desire that the National Congress not take measures impacting public health without consulting society's stakeholders. However, most of the interviewees agreed that to repeal mandatory water fluoridation or loosen the control of its implementation could increase the incidence of tooth decay in the population.

Diagnóstico e tratamento de lesões não cariosas: a visão do cirurgião-dentista do sistema público de saúde / Diagnosis and treatment of non-carious lesions: the vision of the dentist of the public health system

Introdução: as lesões dentárias não cariosas apresentam etiologia multifatorial e, caracterizam-se por ocasionar desgastes irreversíveis na estrutura dentária, sem envolvimento de microrganismos, podendo ser diagnosticadas como erosão (de origem intrínseca ou extrínseca), abfração, atrição ou abrasão. Objetivo: analisar o conhecimento de cirurgiões-dentistas a respeito do diagnóstico e do tratamento dos diferentes tipos de lesões dentárias não cariosas. Métodos: realizou-se estudo observacional, descritivo, de natureza quantitativa, utilizando-se, como instrumento de coleta de informações, um questionário semiestruturado aplicado em cirurgiões-dentistas do município de Fortaleza-CE. Os resultados foram analisados de forma descritiva e foi utilizado o teste de Qui-Quadrado com nível de significância de 5%. Resultados: verificaram-se, entre os cirurgiões-dentistas, os seguintes percentuais de acerto referentes às lesões de abfração, abrasão, atrição, erosão de origem extrínseca, erosão de origem intrínseca e erosão de origem extrínseca associada à abrasão, respectivamente: 51,97%, 20,60%, 78,43%, 81,37%, 71,57% e 7,84%. Observou-se, também, associação estatisticamente significante positiva entre o conhecimento dos profissionais a respeito de lesões de abfração e atrição e o tempo de formado. Conclusão: embora grande parte dos profissionais tenham sido capazes de identificar um plano de tratamento adequado para os casos propostos em questão, o diagnóstico das lesões não cariosas não foi preciso, exceto quando se tratou de erosão de origem intrínseca ou extrínseca e atrição que obtiveram percentual de acertos acima de 70%.

Introduction: non-carious dental lesions present multifatorial etiology, and are characterized by irreversible wear on the tooth structure, without the involvement of microorganisms, and can be diagnosed as erosion (intrinsic or extrinsic), abfraction, attrition or abrasion. Objective: to analyze the knowledge of dental surgeons regarding the diagnosis and treatment of different types of non-carious dental lesions. Methods: a quantitative, observational, descriptive study was carried out using a semistructured questionnaire as a tool for collecting information applied to dentists in the city of Fortaleza-CE. The results were analyzed in a descriptive way and the chi-square test with significance level of 5% was used. Results: the following percentages were found for abfraction, abrasion, attrition, extrinsic erosion, intrinsic erosion, and extrinsic erosion associated with abrasion, respectively: 51.97%, 20.60%, 78.43%, 81.37%, 71.57% and 7.84%. It was also observed a statistically significant positive association between the professionals' knowledge regarding abfraction and attrition lesions and the time of formation. Conclusion: although many professionals were able to choose an adequate treatment plan for the proposed cases, the diagnosis of non-carious lesions was not precise, except for intrinsic or extrinsic erosion, and attrition that obtained a percentage of right answers above 70%.

[Multiple aspects of the use of fluorine in public health from the viewpoint of healthcare leaders]. / Múltiplos aspectos do uso do flúor em saúde pública na visão de lideranças da área de saúde.

The article describes the perceptions of health care leaders on issues relating to the use of fluorine in public health. This is a descriptive study with a qualitative approach, using Collective Subject Discourse (DCS) as technique for processing the statements. The study population was comprised of delegates to the 13th National Health Conference; the sample was defined by convenience and consisted of 310 delegates: 56 at municipal level in Fortaleza (CE), 143 at state level (Ceará) and 111 at national level. Data were collected by semi-structured questionnaires. There were gaps in knowledge about various aspects of the use of fluorine in public health, which indicates the need to improve the level of information of society on issues relating to fluoridation. The lack of knowledge of delegates, together with the data found in the literature about the shortcomings in the monitoring and control of fluorine levels in water, are indicative of the need to reassess the role of social actors and the mechanisms used in social control.

Água e saúde: fluoretação e revogação da lei federal n. 6.050/1974 / Water and health: fluoridation and the repeal of Brazilian Federal Law 6050/74

Ao contrário de muitos países, o Brasil dispõe de um instrumento legal que ampara a fluoretação da água (uma tecnologia de saúde pública eficaz para prevenir a cárie dentária em nível populacional): a Lei Federal n. 6.050/1974. Como não há objeções científicas à medida, o país deveria proteger esse instrumento. Contudo, a Câmara dos Deputados tem acolhido iniciativas parlamentares que pedem a revogação da lei brasileira que torna a medida obrigatória onde haja estação de tratamento de água. Tal é o caso dos projetos de lei n. 510/2003 e n.6.359/2013. Neste artigo, são analisados os argumentos que justificam esses projetos de leis, à luz de evidências científicas. Constatou-se estreita semelhança entre os conteúdos dos dois projetos: os argumentos utilizados para justificar a revogação da lei não têm embasamento científico e se apoiam apenas em crendices e no senso comum. A fluoretação de águas de abastecimento tornou-se, ao longo do século XX, a ação de maior impacto na prevenção da cárie. No Brasil, a referida lei tornou-se um referencial jurídico importante para a implantação da fluoretação em boa parte do território nacional, beneficiando milhões de pessoas de todas as idades e contribuindo para atenuar as limitações de acesso às ações de prevenção individuais e à assistência odontológica. Conclui-se que a revogação da lei implicaria, em muitos casos, a suspensão dessa importante medida sanitária, configurando-se um ato de injustiça, com o aprofundamento de desigualdades decorrente da previsível piora do quadro epidemiológico bucal.(AU)

Unlike many countries, Brazil has a legal instrument that endorses water fluoridation, an effective public health technology to prevent tooth decay of the population: Federal Law 6050/1974. As there are no scientific objections to the measure, the country should protect this instrument. However, the Chamber of Deputies has welcomed parliamentary initiatives calling for the repeal of the Brazilian law which mandates fluoridation wherever there is a water treatment plant. Such were the cases of the Bill 510, in 2003, and the Bill 6359, in 2013. In this article we analyze the arguments justifying these bills, in the light of scientific evidence. It was found close similarity between the contents of the two bills: the arguments used to justify the repeal of the law have no scientific basis and rely only on beliefs and common sense. The supply of water fluoridation has become the action with the greatest impact in preventing tooth decay, throughout the twentieth century. In Brazil, this law has become an important legal frame of reference for its implementation in much of the country, benefiting millions of people of all ages, helping to mitigate the limitations of access to individual preventative actions and dental care. It was concluded that the repeal of this law would imply in the suspension of an important health measure representing an injustice and bringing about inequalities and a foreseeable worsening of the oral epidemiological framework.(AU)

Lack of prognostic significance of survivin in pediatric medulloblastoma.

Medulloblastoma (MDB) is the most common malignant cerebellar tumor in children. Because of the significant rate of mortality and treatment-related morbidity, the identification of prognostic factors could lead to a more accurate selection of patients who can benefit from a less aggressive therapy and improve risk stratification. Survivin is an inhibitor of apoptosis protein (IAP), the expression of which has been associated with worse prognosis in MDB. However, both of its subcellular localizations may contribute to tumor progression, and ultimately, survivin subcellular localization prognostic value depends on tumor type biological features. The goal of this study was to analyze these survivin features in the pediatric MDB tumor samples and its impact on clinical outcome. Survivin expression and subcellular localization were accessed by immunohistochemistry in a series of 41 tumor samples. Kaplan-Meier survival curves were compared using the log-rank test. Survivin expression ranged from completely absent to fully present in a notably higher pattern of nuclear localization than cytoplasmic (19 of 41 versus 4 of 41, respectively). However, survivin expression and subcellular localization were not associated with five-year overall survival or metastasis status at diagnosis, which was the only statistically significant prognostic factor in our series (p = 0.008). Taken together, our results suggest that survivin expression should be further studied in large, multicenter series to determine its accurate impact on prognosis and pathobiology of pediatric MDB.

Fluoretação da água: significados e lei da obrigatoriedade na visão de lideranças em saúde / Public water supply fluoridation and mandatory water fluoridation according to health sector leaders

Desde meados do século XX, estudos epidemiológicos registram declínios nas prevalências da cárie dentária em países industrializados, bem como em alguns países em desenvolvimento. Tal fenômeno tem sido atribuído, em grande parte, à utilização de produtos fluorados, seja por métodos tópicos, seja por meio da fluoretação das águas de abastecimento público. Objetivos - Identificar e analisar o significado da fluoretação da água de abastecimento público, e a sua obrigatoriedade legal no Brasil, para lideranças em saúde, com enfoque nos possíveis benefícios/malefícios e mecanismos de vigilância e controle. Método - Pesquisa descritiva, com abordagem qualitativa, utilizando- se como técnica de processamento de depoimentos o Discurso do Sujeito Coletivo (DSC). A população de estudo foi constituída pelos delegados à 13ª Conferência Nacional de Saúde, sendo a amostra definida por conveniência e composta por 310 delegados: 56 na etapa municipal, em Fortaleza (Ceará), 143 na estadual (Ceará) e 111 na nacional. Os dados foram coletados por meio de questionários semiestruturados. Resultados - Constatou-se que há lacunas de conhecimento e um entendimento equivocado a respeito do papel do flúor na água. Conclusão - Os participantes da pesquisa indicaram a necessidade de terem acesso a mais e melhor informação, para poder participar e reivindicar dos órgãos do Estado, em especial os relacionados com vigilância sanitária, com vistas a assegurar aos brasileiros água de boa qualidade.

Since the mid-twentieth century, epidemiological studies have shown a decline in the prevalence of dental caries in industrialised countries as well as in some developing countries. This phenomenon has been attributed in large part to the use of fluoridated products, either by topical methods, or through the fluoridation of public water supplies. Goals - To identify and analyse the significance of the fluoridation of public water supplies, and its legal obligation in Brazil, for health sector leaders, focusing on the potential benefits/harm and monitoring and control mechanisms. Method - Descriptive research with a qualitative approach, using Collective Subject Discourse (CSD) as a testimonial processing technique. The study population was comprised of delegates to the 13th National Health Conference, and the sample is defined for convenience and composed of 310 delegates: 56 on the municipal stage, in Fortaleza (CE), 143 on the state stage (Ceará) and 111 on the National stage. Data was collected through semi-structured questionnaires. Results - It was found that there are gaps in knowledge and a misunderstanding regarding the role of fluoride in water. Conclusion -The survey participants indicated the need to have access to more and better information, to be able to participate and claim from government agencies, especially those related to health surveillance, in order to ensure Brazilian water quality.

Aspectos éticos e o uso de produtos fluorados na visão de lideranças de saúde / Ethical aspects and the use of fluoride products in the viewpoint of health leaders

O flúor tem sido empregado na prevenção da cárie dentária, principalmente em águas de abastecimento e dentifrícios. Um efeito indesejável, a fluorose leve, tem suscitado preocupações entre especialistas. Este trabalho descreve as percepções dos delegados na 13ª Conferência Nacional de Saúde no que se refere aos aspectos éticos relacionados ao uso de substâncias e produtos fluorados. Realizou-se pesquisa exploratória, descritiva, com abordagem qualitativa, utilizando-se como técnica de processamento de depoimentos o Discurso do Sujeito Coletivo (DSC). A população de estudo foi definida por conveniência, e o critério de escolha foi participar da Conferência como delegado. Ao todo, foram 310 respondentes. Os dados foram coletados por meio de questionários semiestruturados e analisados pela análise do discurso. Nos discursos dos participantes da pesquisa, estiveram presentes aspectos éticos relacionados à falta de liberdade de escolha, à falta de informação disponível aos usuários sobre os produtos fluorados e sobre o controle dos níveis de flúor nesses produtos. Houve também quem acreditasse que o custo-benefício da fluoretação supera qualquer aspecto ético que possa estar presente. Questões éticas são frequentemente vistas pelos participantes da pesquisa como algo desconhecido ou complexo. Existe a crença de que a população em geral está despreparada para discutir o assunto com propriedade, já que este é mais bem compreendido pela parcela da sociedade composta por gestores e profissionais de saúde. Não houve consenso quanto à presença ou não de fatores éticos no uso de produtos fluorados...

Fluoride has been used in the prevention of dental caries, especially in drinking water and toothpaste. An undesirable effect, mild fluorosis, has raised concerns among experts. This paper describes the perceptions of the delegates at the 13th Brazilian National Health Conference concerning ethical issues related to the use of substances and fluorinated products. We conducted exploratory, descriptive study with a qualitative approach, using as processing technique testimonials the Collective Subject Discourse (CSD). The study population was defined by convenience, and the choice criterion was attending the conference as a delegate. In all, there were 310 respondents. Data were collected through semi-structured questionnaires and analyzed by discourse analysis. In the speeches of participants, there were ethical aspects related to the lack of freedom of choice, the lack of information available to users on fluorinated products and the control of fluoride levels in these products. Also there were people who believed that the cost-effectiveness of fluoridation outweighs any ethical aspect that may be present. Ethical issues are often seen by the research participants as something unknown or complex. There is the belief that the general population is unprepared to discuss it properly, as this is best understood by managers and health professionals. There was no consensus as to the presence or absence of ethical factors in the use of fluorinated products...