Risk classification and door-to-antibiotic time in patients with suspected sepsis. / Clasificación de riesgo y tiempo puerta-antibiótico en pacientes con sospecha de sepsis.

OBJECTIVE: to evaluate the association between risk classification and door-to-antibiotic time in patients with suspected sepsis. METHOD: retrospective cohort study, with a sample of 232 patients with suspected sepsis treated at the emergency department. They were divided into 2 groups: with and without risk classification. Once the door-to-antibiotic time was identified, one-way analysis of variance was performed with Bonferroni post hoc test or independent Student's t-test for continuous quantitative variables; Pearson correlation tests, point-biserial correlation or biserial correlation for association analyses; and bootstrap procedure when there was no normal distribution of variables. For data analysis, the Statistical Package for the Social Sciences software was used. RESULTS: the door-to-antibiotic time did not differ between the group that received risk classification compared to the one that was not classified. Door-to-antibiotic time was significantly shorter in the group that received a high priority risk classification. CONCLUSION: there was no association between door-to-antibiotic time and whether or not the risk classification was performed, nor with hospitalization in infirmaries and intensive care units, or with the length of hospital stay. It was observed that the higher the priority, the shorter the door-to-antibiotic time.

Clasificación de riesgo y tiempo puerta-antibiótico en pacientes con sospecha de sepsis / Risk classification and door-to-antibiotic time in patients with suspected sepsis / Classificação de risco e tempo porta-antibiótico no paciente com suspeita de sepse

Objetivo: evaluar la asociación entre la clasificación de riesgo y el tiempo puerta-antibiótico en pacientes con sospecha de sepsis. Método: estudio de cohorte retrospectivo, con una muestra de 232 pacientes con sospecha de sepsis atendidos en el departamento de emergencias. Se dividieron en 2 grupos: con y sin clasificación de riesgo. Una vez identificado el tiempo puerta-antibiótico, se realizó un análisis de varianza de un factor con la prueba post hoc de Bonferroni o la prueba t de Student independiente para variables cuantitativas continuas; pruebas de correlación de Pearson, correlación biserial puntual o correlación biserial para análisis de asociación; y procedimiento de bootstrap cuando no había distribución normal de variables. Para el análisis de los datos se utilizó el software Statistical Package for the Social Sciences. Resultados: el tiempo puerta-antibiótico no difirió entre el grupo que recibió clasificación de riesgo en comparación con el que no fue clasificado. El tiempo puerta-antibiótico fue significativamente más corto en el grupo que recibió una clasificación de riesgo de alta prioridad. Conclusión: no hubo asociación entre el tiempo puerta-antibiótico y si se realizó o no la clasificación de riesgo, ni con la hospitalización en enfermería y en unidad de cuidados intensivos, ni con la duración de la estancia hospitalaria. Se observó que cuanto mayor era la prioridad, más corto era el tiempo puerta-antibiótico.

Objective: to evaluate the association between risk classification and door-to-antibiotic time in patients with suspected sepsis. Method: retrospective cohort study, with a sample of 232 patients with suspected sepsis treated at the emergency department. They were divided into 2 groups: with and without risk classification. Once the door-to-antibiotic time was identified, one-way analysis of variance was performed with Bonferroni post hoc test or independent Student's t-test for continuous quantitative variables; Pearson correlation tests, point-biserial correlation or biserial correlation for association analyses; and bootstrap procedure when there was no normal distribution of variables. For data analysis, the Statistical Package for the Social Sciences software was used. Results: the door-to-antibiotic time did not differ between the group that received risk classification compared to the one that was not classified. Door-to-antibiotic time was significantly shorter in the group that received a high priority risk classification. Conclusion: there was no association between door-to-antibiotic time and whether or not the risk classification was performed, nor with hospitalization in infirmaries and intensive care units, or with the length of hospital stay. It was observed that the higher the priority, the shorter the door-to-antibiotic time.

Objetivo: avaliar a associação entre a realização de classificação de risco e o tempo porta-antibiótico no paciente com suspeita de sepse. Método: estudo de coorte retrospectivo, com amostra de 232 pacientes com suspeita de sepse atendidos no pronto atendimento. Foram distribuídos em 2 grupos: com e sem classificação de risco. Identificado o tempo porta-antibiótico, realizou-se análise de variância de um fator com post hoc de Bonferroni ou teste T-Student independente para variáveis quantitativas contínuas; testes de correlação de Pearson, correlação bisserial por pontos ou correlação bisserial para análises de associação; e procedimento de bootstrap quando não havia distribuição normal de variáveis. Para a análise dos dados foi utilizado o software Statistical Package for the Social Sciences. Resultados: o tempo porta-antibiótico não diferiu entre o grupo que recebeu classificação de risco comparado ao que não foi classificado. O tempo porta-antibiótico foi significativamente menor no grupo que recebeu classificação de risco de alta prioridade. Conclusão: não houve associação entre o tempo porta-antibiótico e a realização ou não da classificação de risco, tampouco com internação em enfermaria e em unidade de terapia intensiva, ou com o tempo de internação hospitalar. Observou-se que quanto maior a prioridade, menor o tempo porta-antibiótico.

Circumfusicillium cavernae gen. et sp. nov. (Bionectriaceae, Hypocreales) Isolated from a Hypogean Roman Cryptoporticus.

Stone monuments and relics are prone to biodeterioration processes prompted by microbial proliferation and activity. Among the distinct microbes capable of stone colonization, fungi are known to strongly contribute to stone biodeterioration. During the ongoing efforts aiming to study fungi thriving in dolomitic limestone walls of the Coimbra's hypogean Roman cryptoporticus (Portugal), two unknown Bionectriaceae isolates were retrieved. The aim of this work was to depict the molecular and phenotypic characteristics of these microorganisms. The phylogenetic analyses revealed that the studied strains could not be assigned to any of the currently known Bionectriaceae genera. Moreover, the isolates exhibited distinctive and peculiar characteristics, such as the packing of conidia by surrounding hyphal segments and the formation of rope-like microsclerotia with a textura globose. Taking into account all the data obtained, a novel genus and species, Circumfusicillium cavernae gen. et sp. nov. in Bionectriaceae (Hypocreales), is proposed here.

Phototrophic and fungal communities inhabiting the Roman cryptoporticus of the national museum Machado de Castro (UNESCO site, Coimbra, Portugal).

Caves are oligotrophic environments, characterized by constant temperatures, high humidity and low natural light. However, microbial shifts can still happen in such environments, especially with the increase in tourist activity and implementation of artificial lights, making caves even more susceptible to environmental changes. As a result, proliferation of phototrophic organisms can increase dramatically, leading to their settlement on stone surfaces, which in turn facilitates the development of heterotrophic organisms, such as fungi and bacteria. The Roman Cryptoporticus of the National Museum Machado de Castro, erected by the Romans in the 1st or second century, is one of the most emblematic buildings in the city of Coimbra. However, the majority of the rooms that constitute this monument show signs of biodeterioration by microalgae and cyanobacteria as well as of fungi. The aim of this study was to characterize the phototrophic and fungal communities at this site, employing culture-dependent and-independent methodologies. Culture-dependent results showed that the phototrophic communities were mainly composed of green microalgae, whereas the culture-independent showed that cyanobacteria were the most dominant. As to the fungal communities, both approaches identified various entomopathogenic fungal species. In addition, the culture-independent analysis also allowed to verify the presence of animal reads, suggesting the hypothesis that animal vectored dispersion can play an important role in the development of fungi at this environment.

The National Student Performance Examination and the quality of Brazilian higher education in health. / Exame Nacional de Desempenho dos Estudantes e a qualidade do ensino superior em saúde brasileiro.

OBJECTIVE: to analyze higher education in the health area in Brazil according to the results of the students' performance in the 2019 National Student Performance Examination. METHOD: a cross-sectional and retrospective study with a quantitative approach and online data referring to 192,715 students from 3,712 health courses, collected in 2020. The students' performance was expressed in concepts, ordered on a scale of one to five. Box-plots were prepared, prevalence values of the concepts were estimated, and the differences were evaluated through statistical tests (α=5%) according to the administrative and management characteristics, as well as those of the cities where the courses were offered. RESULTS: there was a satisfactory level of higher education in health (70.0% with a score ≥3). The Medicine courses were the most satisfactorily evaluated while Speech Therapy and Nursing obtained the worst scores. Public, face-to-face and university education were associated with better teaching quality. Lower levels were found in the North region states, in small towns, outside metropolitan areas and in those under private management. CONCLUSION: heterogeneity in the quality of higher education across the health courses was verified, indicating its association with the characteristics of the teaching institutions and with the infrastructure of the cities where the courses are offered, pointing out challenges to the quality of health education in Brazil.

Privatization and geographic inequalities in the distribution and expansion of higher nursing education in Brazil.

OBJECTIVES: to analyze the influence of privatization and geographic inequalities in the distribution and expansion of higher education in nursing in Brazil. METHODS: a cross-sectional study, with online data of 1,244 courses and 190,610 nursing vacancies, started between 1890 and 2019. Proportions were estimated and differences were verified with statistical tests (α=5%), vacancy rate per 10,000 inhabitants and private ratio/public. RESULTS: there was an accelerated, disorderly and heterogeneous growth in the number of courses and vacancies for nursing over 129 years, with strong private influence, favoring their concentration in large urban centers, capitals and richer states. CONCLUSIONS: the significant expansion of higher education in nursing in Brazil occurred with excessive private supply and unequal distribution between its locations, indicating the need for state regulation in the opening of new courses and vacancies, which can minimize the negative repercussions on the quality of education, health care and workforce imbalances.

Introducing Petrachlorosaceae fam. nov., Petrachloros gen. nov. and Petrachloros mirabilis sp. nov. (Synechococcales, Cyanobacteria) Isolated from a Portuguese UNESCO monument.

The Synechococcales is a large cyanobacterial order comprising both unicellular and filamentous forms, with parietal thylakoid arrangement. Previously, this order has been the subject of taxonomic revisions with new families being erected. During studies of the phototrophic communities on the limestone walls of the Old Cathedral of Coimbra (UNESCO monument), a coccoid Aphanocapsa-like cyanobacterium was isolated. It was characterized using a polyphasic approach, based on morphology, 16S rRNA phylogenetic and phylogenomic analyses, internal transcribed spacer (ITS) secondary structure, and ecology. The 16S rRNA phylogenetic analyses showed that this strain is placed in a separate and highly supported family-level clade, as part of a large group comprising the families Prochlorococcaceae and Prochlorotrichaceae, with Lagosinema as the closest (although quite distant) taxon. Additionally, the phylogenomic analysis also placed this strain in a separate lineage, situated distantly apart from the family Thermosynechococcaceae, but with strains assigned to Acaryochloris marina MBIC 11017 and Aphanocapsa montana BDHKU210001 as the closest taxa. Based on these data, as well as on the results from the secondary ITS structure, morphology, and ecology, we here propose the establishment of Petrachlorosaceae fam. nov., along with the description of Petrachloros gen. nov. and Petrachloros mirabilis sp. nov. We also address additional considerations regarding some cyanobacterial taxa within the order Synechococcales, which we believe deserve further revisions.

Could emotional and sensitization status affect postural sway in adults with knee osteoarthritis?

BACKGROUND AND PURPOSE: The manipulation of sensory conditions and attentional demand affect the postural sway in older adults with knee osteoarthritis (KOA). However, it is not known if emotional and sensitization status affects postural sway in this population. This study aimed to test if older adults with mild and moderate knee osteoarthritis with symptoms of depression and high sensitization would change the profile of postural sway. METHODS: Design: A cross-sectional study was undertaken. PARTICIPANTS: The center of pressure parameters of 30 older adults with mild and moderate knee osteoarthritis and 15 healthy controls were evaluated under different conditions manipulating the visual and attentional demand. We used the pressure pain threshold to measure the sensitization status. Furthermore, we applied the Beck Depression Inventory index to assess emotional status. RESULTS: Manipulating the visual demand affected the center of pressure parameters for both groups, without differences between them. Compared to the healthy control group, the knee osteoarthritis group presented with worse scores on the Beck Depression Inventory, lower pressure pain threshold scores, and the correlations between the symptoms of depression and sensitization status ranged from weak to moderate. Finally, in the knee osteoarthritis group, we observed few and weak significant associations between the center of pressure parameters and the Beck Depression Inventory and the pressure pain threshold scores. DISCUSSION: Emotional and sensitization status seem not to be more associated with the center of pressure of older adults with mild to moderate KOA than healthy adults. Thus, it suggests that this population can safely maintain postural sway, irrespective of depression symptoms and high sensitization.

Exame Nacional de Desempenho dos Estudantes e a qualidade do ensino superior em saúde brasileiro / The National Student Performance Examination and the quality of Brazilian higher education in health / Examen Nacional de Rendimiento Estudiantil y calidad de la educación superior brasileña en salud

Resumo Objetivo: analisar o ensino superior da área da saúde no Brasil segundo os resultados do desempenho dos estudantes no Exame Nacional de Desempenho dos Estudantes de 2019. Método: estudo transversal, retrospectivo, de abordagem quantitativa com dados on-line referentes a 192.715 estudantes de 3.712 cursos da saúde, coletados em 2020. O desempenho dos estudantes foi expresso em conceitos, ordenados em escala de um a cinco. Foram elaborados box-plot e estimadas prevalências dos conceitos e avaliadas diferenças segundo as características administrativas, de gestão e das cidades sede dos cursos por meio de teste estatísticos (α=5%). Resultados: observou-se nível satisfatório do ensino superior de saúde (70,0% com conceito ≥3). Cursos de medicina foram os mais satisfatoriamente avaliados, fonoaudiologia e enfermagem os piores. O ensino público, presencial e em universidades estiveram associados à maior qualidade do ensino. Níveis mais baixos foram verificados nos estados da região Norte, nas cidades pequenas e fora de áreas metropolitanas e naqueles sob gestão privada. Conclusão: verificou-se heterogeneidade na qualidade do ensino superior entre os cursos de saúde, indicando sua associação com características das instituições de ensino e à infraestrutura das cidades sedes dos cursos, apontando desafios para a qualidade da formação em saúde no Brasil.

Abstract Objective: to analyze higher education in the health area in Brazil according to the results of the students' performance in the 2019 National Student Performance Examination. Method: a cross-sectional and retrospective study with a quantitative approach and online data referring to 192,715 students from 3,712 health courses, collected in 2020. The students' performance was expressed in concepts, ordered on a scale of one to five. Box-plots were prepared, prevalence values of the concepts were estimated, and the differences were evaluated through statistical tests (α=5%) according to the administrative and management characteristics, as well as those of the cities where the courses were offered. Results: there was a satisfactory level of higher education in health (70.0% with a score ≥3). The Medicine courses were the most satisfactorily evaluated while Speech Therapy and Nursing obtained the worst scores. Public, face-to-face and university education were associated with better teaching quality. Lower levels were found in the North region states, in small towns, outside metropolitan areas and in those under private management. Conclusion: heterogeneity in the quality of higher education across the health courses was verified, indicating its association with the characteristics of the teaching institutions and with the infrastructure of the cities where the courses are offered, pointing out challenges to the quality of health education in Brazil.

Resumen Objetivo: analizar la educación superior en el área de la salud en Brasil en función de los resultados del desempeño de los estudiantes en el Examen Nacional de Rendimiento de los Estudiantes de 2019. Método: estudio transversal, retrospectivo con enfoque cuantitativo con datos online referentes a 192.715 estudiantes de 3.712 carreras de salud, recolectados en 2020. El desempeño de los estudiantes se expresó en conceptos, ordenados en una escala de uno a cinco. Se elaboraron box-plots y se estimaron y las prevalencias de los conceptos y se evaluaron las diferencias según las características administrativas, de gestión y de las ciudades sede de las carreras a través de pruebas estadísticas (α=5%). Resultados: se observó un nivel satisfactorio de educación superior en salud (70,0% con concepto ≥3). Las carreas de Medicina obtuvieron las mejores calificaciones, las de Fonoaudiología y Enfermería las peores. Se asoció la educación pública, presencial y universitaria con una educación de mayor calidad. Los niveles más bajos se encontraron en los estados de la región Norte, en los pueblos pequeños y fuera de las áreas metropolitanas, y en las carreras de gestión privada. Conclusión: se verificó que había heterogeneidad en la calidad de la educación superior en las carreras de salud, lo que indica que hay una asociación entre las características de las instituciones educativas y la infraestructura de las ciudades donde se dictan las carreras, y señala que la calidad de la educación en salud en Brasil enfrenta desafíos.

Privatization and geographic inequalities in the distribution and expansion of higher nursing education in Brazil / Privatización y desigualdades geográficas en la distribución y expansión de la educación superior en enfermería en Brasil / Privatização e desigualdades geográficas na distribuição e expansão do ensino superior de enfermagem no Brasil

ABSTRACT Objectives: to analyze the influence of privatization and geographic inequalities in the distribution and expansion of higher education in nursing in Brazil. Methods: a cross-sectional study, with online data of 1,244 courses and 190,610 nursing vacancies, started between 1890 and 2019. Proportions were estimated and differences were verified with statistical tests (α=5%), vacancy rate per 10,000 inhabitants and private ratio/public. Results: there was an accelerated, disorderly and heterogeneous growth in the number of courses and vacancies for nursing over 129 years, with strong private influence, favoring their concentration in large urban centers, capitals and richer states. Conclusions: the significant expansion of higher education in nursing in Brazil occurred with excessive private supply and unequal distribution between its locations, indicating the need for state regulation in the opening of new courses and vacancies, which can minimize the negative repercussions on the quality of education, health care and workforce imbalances.

RESUMEN Objetivos: analizar la influencia de la privatización y las desigualdades geográficas en la distribución y expansión de la educación superior en enfermería en Brasil. Métodos: estudio transversal, con datos en línea de 1.244 cursos y 190.610 vacantes de enfermería, iniciado entre 1890 y 2019. Se estimaron proporciones y se verificaron diferencias con pruebas estadísticas (α = 5%), tasa de vacantes por 10,000 habitantes y razón privado/público. Resultados: hubo un crecimiento acelerado, desordenado y heterogéneo en el número de cursos y vacantes de enfermería a lo largo de 129 años, con fuerte influencia privada, favoreciendo la concentración de estos en grandes centros urbanos, capitales y estados más ricos. Conclusiones: la expresiva expansión de la educación superior en enfermería en Brasil ocurrió con una oferta privada excesiva y una distribución desigual entre sus ubicaciones, lo que indica la necesidad de una regulación estatal en la apertura de nuevos cursos y vacantes, que puede minimizar las repercusiones negativas en la calidad de la enseñanza, la asistencia a los desequilibrios en salud y fuerza laboral.

RESUMO Objetivos: analisar a influência da privatização e as desigualdades geográficas na distribuição e expansão do ensino superior de enfermagem no Brasil. Métodos: estudo transversal, com dados online de 1.244 cursos e 190.610 vagas para enfermagem, iniciados entre 1890 e 2019. Estimaram-se proporções e verificaram-se diferenças com testes estatísticos (α=5%), taxa de vagas por 10.000 habitantes e razão privada/pública. Resultados: ocorreu acelerado, desordenado e heterogêneo crescimento no número de cursos e vagas para enfermagem ao longo de 129 anos, com forte influência privada, favorecendo a concentração desses em grandes centros urbanos, capitais e estados mais ricos. Conclusões: a expressiva expansão do ensino superior de enfermagem no Brasil ocorreu com excessiva oferta privada e desigual distribuição entre suas localidades, indicando a necessidade de regulação estatal na abertura de novos cursos e vagas, o que pode minimizar as repercussões negativas na qualidade do ensino, assistência à saúde e desequilíbrios na força de trabalho.

Talaromyces saxoxalicus sp. nov., isolated from the limestone walls of the Old Cathedral of Coimbra, Portugal.

Fungi are one of the main agents of stone biodeterioration worldwide, since they strongly interfere with its integrity, aesthetical and structural natural properties. During an experimental survey aimed to isolate fungal species contributing to the biodeterioration of the limestone walls of the Old Cathedral of Coimbra (Portuguese unesco World Heritage site), a Talaromyces species that could not be identified to any currently known species in this genus was isolated. Molecular phylogenetic analysis of the internal transcribed spacer, ß-tubulin and RNA polymerase II subunit 2, placed this fungus in Talaromyces sect. Purpurei, while also pointing at its phylogenetic distinction from the remaining species in this section. Thus, a novel species, Talaromyces saxoxalicus sp. nov., is here proposed. Moreover, considering the isolation source of this fungus and in an attempt to understand its contribution to the overall stone monument biodeterioration, the species's in vitro biodeteriorative potential was also evaluated. The results highlighted that the species exhibited an in vitro biodeteriorative ability (calcium oxalate crystal formation), highlighting its potential deteriorative profile.

Alborzia kermanshahica gen. nov., sp. nov. (Chroococcales, Cyanobacteria), isolated from paddy fields in Iran.

In Iran, polyphasic studies of unicellular cyanobacteria are still scarce, with more emphasis being placed on filamentous cyanobacteria in paddy fields and fresh water regions. In an effort to increase the knowledge of the diversity of unicellular cyanobacteria from paddy fields in Iran, we have isolated and characterized a new unicellular cyanobacterium strain. The strain was studied using a polyphasic approach based on morphological, ecological and phylogenetic analyses of the 16S-23S ITS rRNA gene region. Complementarily, we have searched for the presence of cyanotoxin genes and analysed the pigment content of the strain. Results showed that the strain was morphologically indistinguishable from the genus Chroococcus, but phylogenetic analyses based on the Bayesian inference and maximum-likelihood methods placed the strain in a separated monophyletic and highly supported (0.99/98, posterior probability/maximum-likelihood) genus-level cluster, distant from Chroococcus sensu stricto and with Chalicogloea cavernicola as sister taxa. The calculated p-distance for the 16S rRNA gene also reinforced the presence of a new genus, by showing 92 % similarity to C. cavernicola. The D1-D1', Box-B and V3 ITS secondary structures showed the uniqueness of this strain, as it shared no similar pattern with closest genera within the Chroococcales. For all these reasons, and in accordance with the International Code of Nomenclature for Algae, Fungi and Plants, we here proposed the description of a new genus with the name Alborzia gen. nov. along with the description of a new species, Alborzia kermanshahica sp. nov. (holotype: CCC1399-a; reference strains CCC1399-b; MCC 4116).

Bacterial and Archaeal Structural Diversity in Several Biodeterioration Patterns on the Limestone Walls of the Old Cathedral of Coimbra.

The "University of Coimbra-Alta and Sofia" area was awarded the UNESCO World Heritage Site distinction in 2013. The Old Cathedral of Coimbra, a 12th-century limestone monument located in this area, has been significantly impacted during the last 800 years by physical, chemical, and biological processes. This led to the significant deterioration of some of its structures and carvings, with loss of aesthetical, cultural, and historical values. For this work, deteriorated spots of the walls of three semi-open chapels from the cloister of the Cathedral were sampled to ascertain their bacterial and archaeal structural diversity. Based on Next-Generation Sequencing (NGS) result analysis, we report the presence of microbial populations that are well adapted to an ecosystem with harsh conditions and that can establish a diverse biofilm in most cases. While it was possible to determine dominant phylogenetic groups in Archaea and Bacteria domains, there was no clear connection between specific core microbiomes and the different deterioration patterns analyzed. The distribution of these archaeal and bacterial communities within the analyzed biodeterioration spots suggests they are more influenced by abiotic factors (i.e., water availability, salinity, etc.), although they influence (and are influenced by) the algal and fungal population composition in this ecosystem. This work provides valuable information that can assist in establishing future guidelines for the preservation and conservation of this kind of historic stone monuments.

Cenário da educação superior à distância em saúde no Brasil: a situação da Enfermagem / Escenario de la educación superior a distancia en salud en Brasil: situación de la Enfermería / Scenario of distance higher education in health in Brazil: the situation of Nursing

Resumo Objetivo Analisar a oferta dos cursos de graduação em saúde na modalidade de Ensino a Distância no Brasil, destacando suas principais características para Enfermagem. Método Estudo transversal baseado em dados on line de cursos de graduação em saúde a distância, criados entre 2005 e 2020. Para doze graduações em saúde, destacaram-se características da criação e distribuição do ensino a distância, enfatizando-se a situação da Enfermagem. Realizaram-se testes de significância estatística (α=5%) e mapa. Resultados Verificaram-se 431 cursos de graduação em saúde, sendo a maioria deles criados entre 2017 e 2020 (≥61,4%). Para Enfermagem, o período de maior criação foi anterior (entre 2013 e 2016; 72,7%) (p=0,001). Todos os cursos eram vinculados a instituições privadas, que ofertavam 82.000 vagas, distribuídas em 1.363 Polos por todos os estados. Verificou-se predomínio em São Paulo (23,9%) e nas cidades localizadas no interior dos estados (64,3%) (p=0,001). Conclusão e implicações para prática Houve aumento significativo de cursos de graduação em saúde no ensino a distância no Brasil. Para Enfermagem, estes se caracterizaram por oferta privada e localizada no interior dos estados. Contudo, a distribuição regional ainda é desigual, concentrando Polos nas regiões mais ricas e centrais do país, e longe das áreas com maiores necessidades de saúde.

Resumen Objetivo Analizar la oferta de estudios superiores en salud bajo la modalidad de Educación a Distancia en Brasil, destacando sus principales características para Enfermería. Método Estudio transversal a partir de datos en línea de las carreras de grado en salud a distancia, creadas entre 2005 y 2020. Para doce titulaciones de salud se destacaron características de la creación y distribución de la educación a distancia, destacando la situación de Enfermería. Se realizaron pruebas de significación estadística (α = 5%) y mapa. Resultados Se detectaron 431 carreras de grado en salud, la mayoría de las cuales se crearon entre 2017 y 2020 (≥61,4%). Para Enfermería, el período de mayor creación fue anterior (entre 2013 y 2016; 72,7%) (p = 0,001). Todos los cursos estuvieron vinculados a instituciones privadas, que ofrecieron 82.000 plazas, distribuidas en 1.363 centros en todos los estados. Se registró predominio de cursos en São Paulo (23,9%) y en ciudades del interior de los estados (64,3%) (p = 0,001). Conclusión e implicaciones para la práctica Se advierte un aumento significativo en los cursos de pregrado en salud en educación a distancia en Brasil. Para Enfermería, estos se caracterizaron por una oferta privada ubicada en el interior de los estados. Sin embargo, la distribución regional sigue siendo desigual, concentrada en las regiones más ricas y céntricas del país, y lejos de las áreas con mayores necesidades de salud.

Abstract Objective To analyze the offer of undergraduate health courses in the Distance Learning modality in Brazil, highlighting its main characteristics for Nursing. Method This is a cross-sectional study based on distance health undergraduate courses online data, created between 2005 and 2020. For twelve health degrees, characteristics of the creation and distribution of distance learning were highlighted, emphasizing Nursing courses. Statistical significance tests (α = 5%) and mapping were performed. Results There were 43 undergraduate courses in health, most of which were created between 2017 and 2020 (≥61.4%). For Nursing, most courses were created in earlier years (2013 and 2016; 72.7%) (p = 0.001). The courses were linked to private institutions, which offered 82,000 seats and are distributed in 1,363 hubs across all states. Courses predominated in São Paulo (23.9%) and non-capital cities (64.3%) (p = 0.001). Conclusion and implications for the practice There has been a significant increase in distance education in Brazil's undergraduate health courses. For Nursing, the courses were characterized by private offers located in non-capital cities. However, the regional distribution is still uneven, concentrating hubs in the country's richest and most central regions and away from areas with the greatest health needs.

High-Quality Draft Genome Sequences of Three Cyanobacteria Isolated from the Limestone Walls of the Old Cathedral of Coimbra, Portugal.

The recently described species Myxacorys almedinensis and two other cyanobacteria were isolated from the limestone walls of the Old Cathedral of Coimbra, Portugal (UNESCO World Heritage Site). The high-quality genome sequences presented here will be essential for characterization purposes and description of the novel taxa.

Novo regime fiscal frente à garantia constitucional de financiamento adequado das políticas públicas de saúde / New tax regime in face of constitutional guarantee of adequate financing of public health politics / Nuevo sistema de gastos bajo a garantía de financiación adecuada de las políticas públicas de salud

Objetivos: analisar a constitucionalidade da Emenda Constitucional (EC) nº 95/2016, em especial, cotejando os pisos de aplicação mínima nas ações e serviços públicos de saúde frente às disposições constitucionais garantidoras de financiamento adequado. Especificamente, foram confrontadas as projeções de financiamento do Sistema Único de Saúde (SUS) em face do princípio de vedação ao retrocesso dos direitos sociais. Metodologia: foram realizadas pesquisas teóricas e análises documentais, com base na revisão da literatura e dos dispositivos legais pertinentes, aos quais se agregou a dados empíricos, de maneira a observar indiretamente o fenômeno analisado, através do procedimento técnico da revisão documental. Resultados: a EC nº 95/2016 afronta as diretrizes constitucionais da integralidade e universalidade que regem o SUS, já que tende a agravar o déficit de financiamento do Sistema, impedindo o oferecimento adequado e progressivo de ações e serviços públicos de saúde (ASPS) para a população. Discussão: o novo regime fiscal instituído pela Emenda deve viger por duas décadas, valendo até 2036. O discurso oficial argumentava pela necessidade de um novo sistema de despesas públicas, sob a tônica da limitação de gastos e investimentos públicos, sobretudo nos bens e serviços sociais, como medida capaz de retomar o crescimento da economia. Conclusões: os limites de gastos público previstos na EC nº 95/2016 agravam a inefetividade do direito à saúde e afrontam premissa constitucional de garantia de financiamento adequado e progressivo das ASPS, subvertendo a lógica de instrumentalidade dos orçamentos e dos recursos públicos em nome da austeridade fiscal. Para além disso, afronta o princípio da vedação ao retrocesso ao impor uma regressividade ao custeio do Sistema.

Objectives: to analyze the constitutionality of the Constitutional Amendment n. 95/2016, focusing especially on the minimum standard of public investments on health care provisions, in light of the constitutional norms that impose its adequate financing, by confronting the financing projections of the Brazilian Unified Health System (SUS) with the non-regression clause on social rights. Methodology: theoretical research and documentary analysis were made, based on literature and corresponding legal norms review, alongside with empirical data, so as to indirectly observe the analyzed phenomenon, through the technical procedure of documentary review. Results: the Constitutional Amendment n. 95/2016 transgresses the guidelines of integrality and universality, which rules the Brazilian Unified Health System (SUS) as it tends to increase the System's financing deficit, which prevents the population from having access to adequate and progressive public health care provisions. Discussion: the new fiscal regime implemented by the Amendment will go on for two decades, until 2036. Official discourse pleas the need for a new public expenditure system, stressed by the limitation of public expenses and investments mostly on social services and provisions, as a way of achieving economy growth. Conclusions: public expenditure limits established by the Constitutional Amendment n. 95/2016 increases the ineffectiveness of the right to health and violates the constitutional premise of guaranteeing adequate and progressive financing for public health care provisions, subverting the instrumental aspect of public budgets and resources for the sake of fiscal austerity. Besides, it violates the non regression clause of social rights, as it imposes a regression on the financing instruments to the System's.

Objetivos: analizar la constitucionalidad de la Enmienda Constitucional n. 95/2016, cotejándose especialmente los límites mínimos de aplicación en las acciones y servicios de la salud pública (ASPS) frente a las disposiciones constitucionales que garantizan el funcionamiento del Sistema Único de Salud (SUS) y al principio de no retroceso de los derechos sociales. Metodología: se realizaron investigaciones teóricas y análisis documentales, teniendo por base la revisión de la literatura y de las disposiciones legales pertinentes, lo que se agregó a datos empíricos, para observarse indirectamente el fenómeno analizado, a través del procedimiento técnico de revisión documental. Resultados: la Enmienda Constitucional n. 95/2016 afronta a las directivas constitucionales de integralidad y universalidad, que rigen el SUS, pues tiende a agravar el déficit de financiación del sistema, lo que impide la oferta adecuada y progresiva de ASPS a la población. Discusión: el nuevo régimen fiscal instituído por la Enmienda deve vigorar por dos décadas, hasta el 2036. El discurso oficial argumentaba acerca de la necesidad de un nuevo sistema de gastos públicos, bajo la tónica de la limitación de los gastos e inversiones públicas, especialmente en lo que toca a los bienes y servicios sociales, en cuanto medida capaz de retomar el crecimiento de la economía. Conclusiones: los límites a los gastos públicos previstos por la Enmienda Constitucional n. 95/2016 agravan la inefectividad del derecho a la salud y afrontan la premisa constitucional de garantía de financiación adecuada y progresiva de las ASPS, subvirtiendo la lógica instrumental de los presupuestos y recursos públicos, en nombre de la austeridad fiscal. Más allá, afronta al principio de no retroceso, al imponer regresividad a la financiación del Sistema.

What is the influence of severity levels of knee osteoarthritis on gait initiation?

BACKGROUND: The anticipatory postural adjustments required for gait initiation have not yet been investigated in older adults with different levels of severity of knee osteoarthritis. This study aimed to evaluate the anticipatory postural adjustments adopted by older adults with different severity levels of knee osteoarthritis during gait initiation. METHODS: Sixty-seven older adults with knee osteoarthritis (mild, moderate, and severe levels) and 11 healthy older adults control were evaluated bilaterally with a force plate to analyze gait initiation. The center of pressure trajectory during gait initiation was divided into four phases: three anticipatory postural adjustments, and a locomotor phase. The length, duration, and velocity of each phase were calculated. FINDINGS: The results showed that during the right and left limbs swing forward, the severe and moderate knee osteoarthritis groups presented a significant reduction in the length of anticipatory postural adjustment phases, locomotion, duration, and velocity (P < 0.05). The severe knee osteoarthritis group presented a significantly higher body mass index (P < 0.003) than the other groups. However, just the healthy group presented a correlation between body mass index and anticipatory postural adjustments. INTERPRETATION: Our results demonstrated that older adults with severe and moderate levels of knee osteoarthritis adopt longer lasting and slower anticipatory postural adjustment phases, lower locomotion, and lower center of pressure displacement during gait initiation, suggesting that this population has adaptive strategy in performing gait initiation, which is significantly changed by the knee osteoarthritis severity level.

Social inequality and pneumonia hospitalization in children under five years of age in Maranhão, Brazil / Desigualdade social e hospitalizações por pneumonia em crianças menores de cinco anos no Estado do Maranhão, Brasil

Abstract Objectives: to describe the characteristics of pneumonia hospitalizations in children under five years of age across the State of Maranhão, Brazil, and explore patterns of spatial distribution of admissions. Methods: ecological study using data on occurrences (age, gender, skin color/race, month of occurrence, and municipality of residence) between 2012 and 2017 taken from the Unified Health System's Hospital Information System and municipal level socioeconomic indicators for 2010. Each respiratory disease, including pneumonia, was presented as a percentage of overall admissions for respiratory tract diseases, together with the monthly distribution of admissions as a percentage of total annual cases, and annual rate of admissions by gender. The General G* statistic was calculated to identify significant clustering of municipalities with similar proportions of hospital admissions for pneumonia relative to overall hospital admissions. Results: pneumonia was the leading cause of admissions for respiratory disease, accounting for 57% of all cases and occurring with greater frequency in the rainy season (February to June) and in cities with lower socioeconomic indicator values. The rate of admissions decreased over the study period. Significant clusters (p<0.05) of municipalities with high proportions of hospital admissions for pneumonia relative to overall hospital admissions occurred predominantly in the south of the state, while clusters with low propor-tions were located mainly in and around the metropolitan region of the state capital São Luís. Conclusions: pneumonia was shown to be a key cause of hospitalization in children and its distribution was associated with contextual socioeconomic factors, reflecting the quality of life and health status of children in Maranhão.

Resumo Objetivos: descrever as características das hospitalizações por pneumonia entre crianças menores de cinco anos de idade no estado do Maranhão e verificar seu padrão de distribuição geoespacial. Métodos: estudo ecológico, com dados ocorridos entre 2012 e 2017, coletados do Sistema de Informações Hospitalares segundo idade, sexo, cor/raça, mês de ocorrência e município de residência. Utilizaram-se também medidas socioeconômicas contextuais dos municípios em 2010. Apresentaram-se as características percentuais das causas de hospitalização do aparelho respiratório e por pneumonia, sua variação temporal ao longo dos meses e as taxas nos anos de estudo. Aplicou-se a estatística G* para verificar a formação de significativos clusters de municípios com similares níveis de hospitalizações. Resultados: a pneumonia foi a principal causa da hospitalização (57%), ocorrendo, frequentemente, nos meses de intensas chuvas (fevereiro a junho) e em cidades com piores indicadores socioeconômicos. As taxas de internação decresceram no período. Significativos agrupamentos (p<0,05) de municípios com maiores proporções de pneumonia ocorreram no sul do estado e com menores na região metropolitana da capital São Luís. Conclusões: a pneumonia foi importante causa de hospitalização de crianças e sua distribuição está associada a características socioeconômicas contextuais, refletido o nível de qualidade de vida e saúde no Maranhão.

Novel coumarins active against Trypanosoma cruzi and toxicity assessment using the animal model Caenorhabditis elegans.

BACKGROUND: Chagas disease (CD) is a tropical parasitic disease. Although the number of people infected is very high, the only drugs available to treat CD, nifurtimox (Nfx) and benznidazole, are highly toxic, particularly in the chronic stage of the disease. Coumarins are a large class of compounds that display a wide range of interesting biological properties, such as antiparasitic. Hence, the aim of this work is to find a good antitrypanosomal drug with less toxicity. The use of simple organism models has become increasingly attractive for planning and simplifying efficient drug discovery. Within these models, Caenorhabditis elegans has emerged as a convenient and versatile tool with significant advantages for the toxicological potential identification for new compounds. METHODS: Trypanocidal activity: Forty-two 4-methylamino-coumarins were assayed against the epimastigote form of Trypanosoma cruzi (Tulahuen 2 strain) by inhibitory concentration 50% (IC50). Toxicity assays: Lethal dose 50% (LD50) and Body Area were determined by Caenorhabditis elegans N2 strain (wild type) after acute exposure. Structure-activity relationship: A classificatory model was built using 3D descriptors. RESULTS: Two of these coumarins demonstrated near equipotency to Nifurtimox (IC50 = 5.0 ± 1 µM), with values of: 11 h (LaSOM 266), (IC50 = 6.4 ± 1 µM) and 11 g (LaSOM 231), (IC50 = 8.2 ± 2.3 µM). In C. elegans it was possible to observe that Nfx showed greater toxicity in both the LD50 assay and the evaluation of the development of worms. It is possible to observe that the efficacy between Nfx and the synthesized compounds (11 h and 11 g) are similar. On the other hand, the toxicity of Nfx is approximately three times higher than that of the compounds. Results from the QSAR-3D study indicate that the volume and hydrophobicity of the substituents have a significant impact on the trypanocidal activities for derivatives that cause more than 50% of inhibition. These results show that the C. elegans model is efficient for screening potentially toxic compounds. CONCLUSION: Two coumarins (11 h and 11 g) showed activity against T. cruzi epimastigote similar to Nifurtimox, however with lower toxicity in both LD50 and development of C. elegans assays. These two compounds may be a feasible starting point for the development of new trypanocidal drugs.

Satisfaction of users of Psychosocial Care Centers.

OBJECTIVE: evaluate the satisfaction of users with the care provided at the Psychosocial Care Centers and its association with clinical and sociodemographic factors. METHOD: this cross-sectional study was conducted with 55 users from 5 Psychosocial Care Centers. The sociodemographic and clinical characteristics were obtained through an individual structured interview. The abbreviated version of the Mental Health Services Satisfaction Scale (SATIS-BR) was used for data collection. RESULTS: were descriptively analyzed and simple and multiple logistic regression models were adjusted for analysis of associations, estimating the gross and adjusted odds ratio, with the respective confidence intervals of 95%. Results: the age average of the sample was 40.1 (±12.4) years and the degree of satisfaction average was 4.56 (±0.45). Users with less education (primary school) had 5 times more chance of having less satisfaction (p<0.05). Users with frequency of intensive monitoring were 5 times more likely to have less satisfaction than users who receive monthly monitoring (p<0.05). CONCLUSION: the majority of users are satisfied with the service and factors such as low education and higher frequency of monitoring influenced the satisfaction.