Oceans of stimuli: an individual-based model to assess the role of olfactory cues and local enhancement in seabirds' foraging behaviour.

Oceans are extremely dynamic environments, which poses challenges for top-predators such as seabirds to find food resources. Yet, seabirds evolved sensorial abilities (olfactory senses) along with complex behaviours (social information transfer through local enhancement) to improve foraging efficiency. Using the Cory's shearwater (Calonectris borealis) as a model species, we developed an individual-based model to explore the complementary role of different searching mechanisms (olfactory foraging and local enhancement) for the optimal foraging behaviour of pelagic seabirds during 1-day foraging trips around breeding colonies. Model outputs were compared with observed patterns of Cory's shearwaters distribution during local foraging trips. Also, the foraging efficiency of virtual individuals was analysed considering hypothetical scenarios of foraging conditions and densities of foraging individuals around breeding colonies. The results support the use of a combination of searching strategies by Cory's shearwaters, which produced representative patterns of space use from tracked individuals, including spatial foraging segregation of neighbouring sub-colonies. Furthermore, while the mechanisms underpinning local enhancement played a key role in mitigating sub-optimal foraging conditions, the use of olfactory senses conferred great adaptive foraging advantages over a wide range of environmental conditions. Our results also indicate a synergistic effect between the two strategies, which suggests that a multimodal foraging strategy is useful to forage in extremely dynamic environments. The developed model provides a basis for further investigation regarding the role of foraging mechanisms in the population dynamics of colonial animals, including the adaptive foraging behaviour of marine top predators to dynamic environmental conditions.

Dynamic models in research and management of biological invasions.

Invasive species are increasing in number, extent and impact worldwide. Effective invasion management has thus become a core socio-ecological challenge. To tackle this challenge, integrating spatial-temporal dynamics of invasion processes with modelling approaches is a promising approach. The inclusion of dynamic processes in such modelling frameworks (i.e. dynamic or hybrid models, here defined as models that integrate both dynamic and static approaches) adds an explicit temporal dimension to the study and management of invasions, enabling the prediction of invasions and optimisation of multi-scale management and governance. However, the extent to which dynamic approaches have been used for that purpose is under-investigated. Based on a literature review, we examined the extent to which dynamic modelling has been used to address invasions worldwide. We then evaluated how the use of dynamic modelling has evolved through time in the scope of invasive species management. The results suggest that modelling, in particular dynamic modelling, has been increasingly applied to biological invasions, especially to support management decisions at local scales. Also, the combination of dynamic and static modelling approaches (hybrid models with a spatially explicit output) can be especially effective, not only to support management at early invasion stages (from prevention to early detection), but also to improve the monitoring of invasion processes and impact assessment. Further development and testing of such hybrid models may well be regarded as a priority for future research aiming to improve the management of invasions across scales.

Structural differences on cell wall polysaccharides of brewer's spent Saccharomyces and microarray binding profiles with immune receptors.

Brewing practice uses the same yeast to inoculate the following fermentation (repitching). Saccharomyces pastorianus, used to produce Lager beer, is widely reused, not changing its fermentation performance. However, S. cerevisiae, used to produce Ale beer, is partial or not even reused, due to its poor performance. It is hypothesized that cells modulate their wall polysaccharides to increase the cell-wall strength. In this work industrial S. cerevisiae and S. pastorianus brewer's spent yeasts with different repitching numbers were studied. Glucans were the main component of S. cerevisiae whereas mannoproteins were abundant in S. pastorianus. The major changes were noticed on glucans of both species, ß1,3-glucans decrease more pronounced in S. cerevisiae. The increase of α1,4-Glc, related with osmotolerance, was higher in S. cerevisiae while ß1,4-Glc, related with cell-wall strength, had a small increase. In addition, these structural details showed different binding profiles to immune receptors, important to develop tailored bioactive applications.

Feasibility of Brewer's Spent Yeast Microcapsules as Targeted Oral Carriers.

Brewer's spent yeast (BSY) microcapsules have a complex network of cell-wall polysaccharides that are induced by brewing when compared to the baker's yeast (Saccharomyces cerevisiae) microcapsules. These are rich in (ß1→3)-glucans and covalently linked to (α1→4)- and (ß1→4)-glucans in addition to residual mannoproteins. S. cerevisiae is often used as a drug delivery system due to its immunostimulatory potential conferred by the presence of (ß1→3)-glucans. Similarly, BSY microcapsules could also be used in the encapsulation of compounds or drug delivery systems with the advantage of resisting digestion conferred by (ß1→4)-glucans and promoting a broader immunomodulatory response. This work aims to study the feasibility of BSY microcapsules that are the result of alkali and subcritical water extraction processes, as oral carriers for food and biomedical applications by (1) evaluating the resistance of BSY microcapsules to in vitro digestion (IVD), (2) their recognition by the human Dectin-1 immune receptor after IVD, and (3) the recognition of IVD-solubilized material by different mammalian immune receptors. IVD digested 44-63% of the material, depending on the extraction process. The non-digested material, despite some visible agglutination and deformation of the microcapsules, preserved their spherical shape and was enriched in (ß1→3)-glucans. These microcapsules were all recognized by the human Dectin-1 immune receptor. The digested material was differentially recognized by a variety of lectins of the immune system related to (ß1→3)-glucans, glycogen, and mannans. These results show the potential of BSY microcapsules to be used as oral carriers for food and biomedical applications.

Brewer's yeast polysaccharides - A review of their exquisite structural features and biomedical applications.

Recent advances on brewer's yeast cell wall polysaccharides have unraveled exquisite structural features and diverse composition with (ß1→3), (ß1→6), (α1→4), (ß1→4)-mix-linked glucans that are recognized to interact with different cell receptors and trigger specific biological responses. Herein, a comprehensive showcase of structure-biofunctional relationships between yeast polysaccharides and their biological targets is highlighted, with a focus on polysaccharide features that govern the biomedical activity. The insolubility of ß-glucans is a crucial factor for binding and activation of Dectin-1 receptor, operating as adjuvants of immune responses. Contrarily, soluble low molecular weight ß-glucans have a strong inhibition of reactive oxygen species production, acting as antagonists of Dectin-1 mediated signaling. Soluble glucan-protein moieties can also act as antitumoral agents. The balance between mannoproteins-TLR2 and ß-glucans-Dectin-1 receptors-activation is crucial for osteogenesis. Biomedical applications value can also be obtained from yeast microcapsules as oral delivery systems, where highly branched (ß1→6)-glucans lead to higher receptor affinity.

Contribution of Home Gardens to Sustainable Development: Perspectives from A Supported Opinion Essay.

Home gardening has a long history that started when humans became sedentary, being traditionally considered an accessible source of food and medicinal plants to treat common illnesses. With trends towards urbanization and industrialization, particularly in the post-World War II period, the importance of home gardens as important spaces for growing food and medicinal plants reduced and they began to be increasingly seen as decorative and leisure spaces. However, the growing awareness of the negative impacts of agricultural intensification and urbanization for human health, food quality, ecosystem resilience, and biodiversity conservation motivated the emergence of new approaches concerning home gardens. Societies began to question the potential of nearby green infrastructures to human wellbeing, food provisioning, and the conservation of traditional varieties, as well as providers of important services, such as ecological corridors for wild species and carbon sinks. In this context. and to foster adaptive and resilient social-ecological systems, our supported viewpoint intends to be more than an exhaustive set of perceptions, but a reflection of ideas about the important contribution of home gardens to sustainable development. We envision these humble spaces strengthening social and ecological components, by providing a set of diversified and intermingled goods and services for an increasingly urban population.

Isolation and identification of an arabinogalactan extracted from pistachio external hull: Assessment of immunostimulatory activity.

This work studies the extraction and purification of a novel arabinogalactan from pistachio external hull. It was extracted with a simple method from pistachio hull which is considered as unexploited waste. Based on the results of sugar analysis by GC-FID, glycosidic linkage by GC-MS, NMR spectroscopy, and molecular weight by Size Exclusion Chromatography, pistachio hull water soluble polysaccharides (PHWSP) were identified as a type II arabinogalactan (AG), with characteristic terminally linked α-Araf, (α1 â†’ 5)-Araf, (α1 â†’ 3,5)-Araf, terminally linked ß-Galp, (ß1 â†’ 6)-Galp, and (ß1 â†’ 3,6)-Galp. DEPT-135, HSQC, HMBC and COSY NMR data suggested the presence of (ß1 â†’ 3)-Galp mainly branched at O-6 with (ß1 â†’ 6)-Galp chains, α-Araf chains, and terminally linked α-Araf. These AG from pistachio external hulls showed in vitro stimulatory activity for B cells, suggesting their possible use as an immunological stimulant in nutraceutical and biomedical applications.

Structural elucidation and interfacial properties of a levan isolated from Bacillus mojavensis.

A strain with high exopolysaccharide (EPS) production was isolated from soil and identified as Bacillus mojavensis based on the 16S rRNA gene sequencing and biochemical properties. The EPS produced simultaneously with the growth phase reached a maximum of 22 g/L after attaining a stationary phase with sucrose used as sole carbon source. B. mojavensis EPS (BM-EPS) was recovered, fractionated by ethanol precipitation and analysed by NMR and methylation analyses. The BM-EPS was found to be composed of (ß2 â†’ 6)-Fruf residues, characteristic of a levan, with an average molecular weight of 2.3 MDa. A homogeneous micro-porous and rough structure matrix was observed by SEM of the freeze-dried powdered sample. A concentration-dependent water-soluble nature was observed, with good water (5.3 g/g) and oil (36 g/g) holding capacities. The levan displayed good emulsification activity with excellent stability against food grade oil, thus favoring it as a promising emulsifying agent to food industries.

Microwave hydrodiffusion and gravity as a sustainable alternative approach for an efficient apple pomace drying.

Apple pomace valuation has been impaired by its high perishability and absence of fast drying approaches demanded by industry. This work aimed to assess the feasibility of Microwave Hydrodiffusion and Gravity (MHG) process applied for apple pomace drying using discrete delivery powers (300-900 W) and comparison with hot-air drying (40-100 °C). To dry 0.4 kg of apple pomace (81% moisture), hot-air drying required 3.6-9.9 h with estimated water evaporation flux of 1.0-3.5 mL/min. For MHG, which processed 1.2 kg, these corresponded to 1.0-2.6 h and 5.1-13.9 mL/min. Furthermore, MHG allowed water recovery containing part of apple pomace phenolic compounds and carbohydrates. The dried pomace was stable for 2 years, after which phenolic compounds and polysaccharides were still recoverable by hot water extractions. These results pave the way for MHG to be used for apple pomace and other by-products preservation, boosting their conversion into valuable co-product for valuation of its components.

[Prevalence of chronic kidney disease, stages 3, 4 and 5 in adults]. / Prevalência da doença renal crônica nos estágios 3, 4 e 5 em adultos.

INTRODUCTION: Strategies that optimize early diagnosis of chronic kidney disease (CKD) are paramount to decrease progression of the disease and the burden of patients needing renal replacement therapy. OBJECTIVE: The aim of this study was to determine the prevalence of CKD stage 3, 4 and 5 in people submitted to dosage of serum creatinine due to different causes, employing a dataset from a private laboratory of the city of Juiz de Fora comprising the years 2004 and 2005. METHODS: Diagnosis and staging of CKD were based upon glomerular filtration rate (GFR) estimated from serum creatinine as recommended by the KDOQI of the National Kidney Foundation and the Brazilian Society of Nephrology. RESULTS: Prevalence of CKD stage 3, 4 and 5 was of 9.6%, with 12.2%, 5.8%, 25.2% and 3.7% among women, men, people >60 and < 60 years of age, respectively. CONCLUSION: Prevalence of CKD found in our study may not only be interpreted as an epidemiologic indicator, but also discloses an alternative operational strategy to identify the disease. Furthermore it supports a proposal to include the estimation of GFR from serum creatinine in the laboratory report as an important and simple tool for early diagnosis of CKD.

Revisiting the chemistry of apple pomace polyphenols.

Hot water is an easily implementable process for polyphenols extraction. To evaluate the effect of this process on apple pomace, the overall polyphenolic composition was assessed before and after hot water extraction, followed by extractions with aqueous/organic solutions. As determined by UHPLC-DAD, flavan-3-ols were the main apple native polyphenols. Their amount decreased 50% after hot water extraction, while the other classes remained unchanged. Dihydrochalcones and hydroxycinnamic acid oxidation products, were also observed, alongside with non-extractable oxidised procyanidins that represented more than 4-fold the amount of native apple polyphenols in the pomace. Microwave superheated-water extraction of the insoluble cell wall material in water/acetone solutions and the high amounts of polyphenols that were insoluble in water/ethanol solutions suggested that oxidised procyanidins could be covalently linked to polysaccharides. These complexes represented up to 40% of the available polyphenols from apple pomace, potentially relevant for agro-food waste valuation.

Apple Pomace Extract as a Sustainable Food Ingredient.

Apple pomace is a by-product of apple processing industries with low value and thus frequent disposal, although with valuable compounds. Acidified hot water extraction has been suggested as a clean, feasible, and easy approach for the recovery of polyphenols. This type of extraction allowed us to obtain 296 g of extract per kg of dry apple pomace, including 3.3 g of polyphenols and 281 g of carbohydrates. Ultrafiltration and solid-phase extraction using C18 cartridges of the hot water extract suggested that, in addition to the apple native polyphenols detected by ultra-high-pressure liquid chromatography coupled to a diode-array detector and mass spectrometry UHPLC-DAD-ESI-MSn, polyphenols could also be present as complexes with carbohydrates. For the water-soluble polyphenols, antioxidant and anti-inflammatory effects were observed by inhibiting chemically generated hydroxyl radicals (OH•) and nitrogen monoxide radicals (NO•) produced in lipopolysaccharide-stimulated macrophages. The water-soluble polyphenols, when incorporated into yogurt formulations, were not affected by fermentation and improved the antioxidant properties of the final product. This in vitro research paves the way for agro-food industries to achieve more diversified and sustainable solutions towards their main by-products.

How informative is the response of Ground Beetles' (Coleoptera: Carabidae) assemblages to anthropogenic land use changes? Insights for ecological status assessments from a case study in the Neotropics.

Ground Beetles (Carabidae) have been suggested to be used as indicators of ecological status under the effects of anthropogenic land use and land cover changes in highly biodiverse regions such as the Neotropics. In this study Ground Beetles' assemblages from a region in the Brazilian Amazon were investigated for evaluating their applicability as disturbance indicators. Differences in assemblages between ecosystems, discriminated by complimentary methodologies, demonstrate a sensitive reaction from the most pristine forests to increasingly disturbed systems. Besides capturing the influence of different prevailing conditions between ecosystems, Ground Beetles are easy to communicate and to link with the other components of the system, being effortless and routinely measurable using standard methodologies. This study represents a step forward in using Ground Beetles for the purposes of planning, management and public reporting on the ecological status of Neotropical ecosystems. Additionally, the methods depicted could support projections for trends of relevant ecosystem attributes under realistic social-ecological change scenarios, which can be used to guide effective conservation planning.

Physicochemical characterization, antioxidant capacity, total phenolic and proanthocyanidin content of flours prepared from pequi (Caryocar brasilense Camb.) fruit by-products.

The potential of pequi by-products as substrates for the production of flours rich in antioxidant dietary fibers was evaluated. Dietary fiber contents ranged from 39.8 to 43.3g/100g with pectic polysaccharide fraction constituted of rhamnogalacturonans and hemicellulose fraction consisted of arabinogalactans, xylans and glucomannans. Total polyphenols, non-extractable proanthocyanidins (NEPA) and carotenoid contents of the flours were determined (respectively, 15.5-17.4g GAE/100g, 215.54-346.84mg/100g and 2116.52-3499.03µg/100g). The antioxidant capacities of pequi by-product flours (986.94-1154.42µM TE/g ABTS; 44.43-48.02g/g DPPH; and 3027.31-3216.27µmol Fe2SO4/g FRAP) were found to be exceptionally higher than those of fruits and fruits by-products reported in the literature. Exocarp removal promoted no significant changes in the technological properties of the flour, except for color. Results showed promising prospects for future exploitation of pequi peel as a potential source of dietary fiber and natural antioxidants.

A stochastic dynamic model to assess land use change scenarios on the ecological status of fluvial water bodies under the Water Framework Directive.

This method development paper outlines an integrative stochastic dynamic methodology (StDM) framework to anticipate land use (LU) change effects on the ecological status of monitored and non-monitored lotic surface waters under the Water Framework Directive (WFD). Tested in the Alto Minho River Basin District in North West Portugal, the model is an innovative step towards developing a decision-making and planning tool to assess the influence impacts such as LU change and climate change on these complex systems. Comprising a series of sequential steps, a Generalized Linear Model based, competing model Multi Model Inference (MMI) approach was used for parameter estimation to identify principal land use types (distal factors) driving change in biological and physicochemical support elements (proximal factors) in monitored water bodies. The framework integrated MMI constants and coefficients of selected LU categories in the StDM simulations and spatial projections to simulate the ecological status of monitored and non-monitored lotic waterbodies in the test area under 2 scenarios of (1) LU intensification and (2) LU extensification. A total of 100 simulations were run for a 50year period for each scenario. Spatially dynamic projections of WFD metrics were obtained, taking into account the occurrence of stochastic wildfire events which typically occur in the study region and are exacerbated by LU change. A marked projected decline to "Moderate" ecological status for most waterbodies was detected under intensification but little change under extensification; only a few waterbodies fell to "moderate" status. The latter scenario describes the actual regional socio-economic situation of agricultural abandonment due to rural poverty, partly explaining the projected lack of change in ecological status. Based on the WFD "one out all out" criterion, projected downward shifts in ecological status were due to physicochemical support elements, namely increased phosphorus levels. Little or no change in status was driven by Intercalibrated Biological Quality Elements, indicating innate resilience and raising questions concerning uncertainty, the effect of pressures other than land use and metric redundancy and the WFD classification process.

Strengths of primary healthcare regarding care provided for chronic kidney disease.

OBJECTIVE: to assess the structure and results obtained by the "Chronic Renal Patients Care Program" in a Brazilian city. METHOD: epidemiological, cross-sectional study conducted in 14 PHC units and a secondary center from 2010 to 2013. The Donabedian Model was the methodological framework used. A total of 14 physicians, 13 supervisors, and 11 community health agents from primary healthcare were interviewed for the assessment of structure and process and 1,534 medical files from primary healthcare and 282 from secondary care were consulted to assess outcomes. RESULTS: most units lacked sufficient offices for physicians and nurses to provide consultations, had incomplete staffing, and most professionals had not received proper qualification to provide care for chronic renal disease. Physicians from PHC units classified as capable more frequently referred patients to the secondary care service in the early stages of chronic renal disease (stage 3B) when compared to physicians of units considered not capable (58% vs. 36%) (p=0.049). Capable PHC units also more frequently presented stabilized glomerular filtration rates (51%) when compared to partially capable units (36%) and not capable units (44%) (p=0.046). CONCLUSION: patients cared for by primary healthcare units that scored higher in structure and process criteria presented better clinical outcomes. OBJECTIVE: to identify the coping strategies of family members of patients with mental disorders and relate them to family member sociodemographic variables and to the patient's clinical variables. METHOD: this was a descriptive study conducted at a psychiatric hospital in the interior of the state of São Paulo, with 40 family members of hospitalized patients over the age of 18, and who followed the patient before and during hospitalization. We used tools to characterize the subjects and the Folkman and Lazarus Inventory of Coping Strategies. RESULTS: the coping strategies most often used by family members were social support and problem solving. Mothers and fathers used more functional strategies (self-control p=0.037, positive reappraisal p=0.037, and social support p=0,021). We found no significant differences between the strategies and other variables examined. CONCLUSION: despite the suffering resulting from the illness of a dear one, family members make more use of functional strategies, allowing them to cope with adversities in a more well-adjusted way. OBJETIVO: avaliar estrutura, processo e resultado do "Programa de Atenção a Doentes Renais Crônicos" em um município brasileiro. MÉTODO: estudo epidemiológico, transversal, realizado em 14 unidades de atenção primária e um centro de atenção secundária, no período de 2010-2013. Utilizou-se o referencial metodológico de Donabedian. Para avaliação de estrutura e processo, foram entrevistados 14 médicos, 13 supervisores e 11 agentes comunitários de saúde da atenção primária. Para avaliação de resultado, foram utilizados 1.534 prontuários de saúde na atenção primária e 282 na atenção secundária. RESULTADOS: na maioria das unidades faltam consultórios para atendimento médico e de enfermagem, as equipes estavam incompletas e a maioria dos profissionais não participou de capacitação para atenção à doença renal crônica. Médicos das unidades primárias, classificadas como capacitadas, encaminharam usuários à atenção secundária em estágios mais precoces da doença renal crônica (estágio 3B) quando comparados aos médicos das unidades não capacitadas (58% vs 36%) (p=0,049). As unidades de atenção primária, classificadas como capacitadas, apresentaram melhores taxas de estabilização da filtração glomerular (51%) quando comparadas às unidades parcialmente capacitadas (36%) e não capacitadas (44%) (p=0,046). CONCLUSÃO: usuários atendidos nas unidades de atenção primária com pontuação mais elevada em critérios de estrutura e processo apresentaram melhores resultados clínicos. OBJETIVO: evaluar la estructura, el proceso y los resultados del "Programa de Atención a Enfermos Renales Crónicos" en un municipio brasileño. MÉTODO: estudio epidemiológico, transversal, realizado en 14 unidades de atención primaria y en un centro de atención secundario, en el período de 2010 a 2013. Se utilizó el referencial metodológico de Donabedian. Para evaluación de estructura y proceso; fueron entrevistados 14 médicos, 13 supervisores y 11 agentes comunitarios de salud de la atención primaria. Para evaluación del resultado, fueron utilizadas 1.534 fichas médicas en la atención primaria y 282 en la atención secundaria. RESULTADOS: en la mayoría de las unidades faltaban consultorios para la atención médica y de enfermería, los equipos estaban incompletos y la mayoría de los profesionales no participó de capacitaciones sobre la atención a la enfermedad renal crónica. Los médicos de las unidades primarias, clasificados como capacitados, encaminaron usuarios para la atención secundaria en etapas más precoces de la enfermedad renal crónica (etapa 3B) cuando comparados a los médicos de las unidades no capacitadas (58% vs 36%) (p=0,049). Las unidades de atención primaria, clasificadas como capacitadas, presentaron mejores tasas de estabilización de la filtración glomerular (51%) cuando comparadas a las unidades parcialmente capacitadas (36%) y no capacitadas (44%) (p=0,046). CONCLUSIÓN: los usuarios atendidos en las unidades de atención primaria, con puntuación más elevada en criterios de estructura y proceso, presentaron mejores resultados clínicos.

Modifications of Saccharomyces pastorianus cell wall polysaccharides with brewing process.

The cell wall polysaccharides of brewers spent yeast Saccharomyces pastorianus (BSY) and the inoculum yeast (IY) were studied in order to understand the changes induced by the brewing process. The hot water and alkali extractions performed solubilized mainly mannoproteins, more branched for BSY than those of IY. Also, (31)P solid state NMR showed that the BSY mannoproteins were 3 times more phosphorylated. By electron microscopy it was observed that the final residues of alkali sequential extraction until 4M KOH preserved the yeast three-dimensional structure. The final residues, composed mainly by glucans (92%), showed that the BSY, when compared with IY, contained higher amount of (1→4)-linked Glc (43% for BSY and 16% for IY) and lower (1→3)-linked Glc (17% for BSY and 42% for IY). The enzymatic treatment of final residue showed that both BSY and IY had (α1→4)-linked Glc and (ß1→4)-linked Glc, in a 2:1 ratio, showing that S. pastorianus increases their cellulose-like linkages with the brewing process.

Hospitalizations for ambulatory care-sensitive conditions, Minas Gerais, Southeastern Brazil, 2000 and 2010.

OBJECTIVE To analyze hospitalization rates and the proportion of deaths due to ambulatory care-sensitive hospitalizations and to characterize them according to coverage by the Family Health Strategy, a primary health care guidance program. METHODS An ecological study comprising 853 municipalities in the state of Minas Gerais, under the purview of 28 regional health care units, was conducted. We used data from the Hospital Information System of the Brazilian Unified Health System. Ambulatory care-sensitive hospitalizations in 2000 and 2010 were compared. Population data were obtained from the demographic censuses. RESULTS The number of ambulatory care-sensitive hospitalizations declined from 20.75/1,000 inhabitants [standard deviation (SD) = 10.42) in 2000 to 14.92/thousand inhabitants (SD = 10.04) in 2010 Heart failure was the most frequent cause in both years. Hospitalizations rates for hypertension, asthma, and diabetes mellitus, decreased, whereas those for angina pectoris, prenatal and birth disorders, kidney and urinary tract infections, and other acute infections increased. Hospitalization durations and the proportion of deaths due to ambulatory care-sensitive hospitalizations increased significantly. CONCLUSIONS Mean hospitalization rates for sensitive conditions were significantly lower in 2010 than in 2000, but no correlation was found with regard to the expansion of the population coverage of the Family Health Strategy. Hospitalization rates and proportion of deaths were different between the various health care regions in the years evaluated, indicating a need to prioritize the primary health care with high efficiency and quality.

[Hospitalizations for primary care-sensitive conditions in a Southern Brazilian municipality]. / Internações por condições sensíveis à atenção primária em município do sudeste do Brasil.

OBJECTIVE: To study the most frequent causes of hospitalizations for primary care-sensitive conditions (HPCSC) in the city of Juiz de Fora, MG, Brazil, by age group and gender, over the periods of 2002 to 2005 and of 2006 to 2009. METHODS: This was a descriptive study, with data collected from the Hospital Information System of the Unified Health System (Sistema de Informação Hospitalar do Sistema Único de Saúde - SIH-SUS) and from population projections by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE). HPCSC rates were calculated for 1,000 inhabitants, and the most frequent causes were studied by gender and age group, comparing both periods. RESULTS: HPCSP showed rates of 7.74/1,000 between 2002 and 2005 and 8.81/1,000 between 2006 and 2009. The main causes were heart failure, cerebrovascular diseases, angina pectoris, pulmonary diseases, and kidney and urinary tract infections, which together represented 4.9/1,000 in the first period and 5.6/1,000 in the second period. The evolution of the rates between both periods occurred differently by age group and gender. CONCLUSION: The study did not exhibit any remarkable differences in HPCSC rates between the periods. Regarding the most frequent causes, reduced hospitalization rates for gastroenteritis, asthma, high blood pressure, and cerebrovascular diseases were observed, as well as increased hospitalizations for heart failure, pulmonary diseases, epilepsies, and kidney and urinary tract infections; these hospitalizations occurred differently by gender and age group. The results showed that a deep reflection regarding the determinants of hospitalizations for avoidable causes is needed.

Strengths of primary healthcare regarding care provided for chronic kidney disease / Potencialidades da atenção primária à saúde no cuidado à doença renal crônica / Potencialidades de la atención primaria a la salud en el cuidado de enfermedad renal crónica

ABSTRACT Objective: to assess the structure and results obtained by the "Chronic Renal Patients Care Program" in a Brazilian city. Method: epidemiological, cross-sectional study conducted in 14 PHC units and a secondary center from 2010 to 2013. The Donabedian Model was the methodological framework used. A total of 14 physicians, 13 supervisors, and 11 community health agents from primary healthcare were interviewed for the assessment of structure and process and 1,534 medical files from primary healthcare and 282 from secondary care were consulted to assess outcomes. Results: most units lacked sufficient offices for physicians and nurses to provide consultations, had incomplete staffing, and most professionals had not received proper qualification to provide care for chronic renal disease. Physicians from PHC units classified as capable more frequently referred patients to the secondary care service in the early stages of chronic renal disease (stage 3B) when compared to physicians of units considered not capable (58% vs. 36%) (p=0.049). Capable PHC units also more frequently presented stabilized glomerular filtration rates (51%) when compared to partially capable units (36%) and not capable units (44%) (p=0.046). Conclusion: patients cared for by primary healthcare units that scored higher in structure and process criteria presented better clinical outcomes. Objective: to identify the coping strategies of family members of patients with mental disorders and relate them to family member sociodemographic variables and to the patient's clinical variables. Method: this was a descriptive study conducted at a psychiatric hospital in the interior of the state of São Paulo, with 40 family members of hospitalized patients over the age of 18, and who followed the patient before and during hospitalization. We used tools to characterize the subjects and the Folkman and Lazarus Inventory of Coping Strategies. Results: the coping strategies most often used by family members were social support and problem solving. Mothers and fathers used more functional strategies (self-control p=0.037, positive reappraisal p=0.037, and social support p=0,021). We found no significant differences between the strategies and other variables examined. Conclusion: despite the suffering resulting from the illness of a dear one, family members make more use of functional strategies, allowing them to cope with adversities in a more well-adjusted way.

resumo Objetivo: avaliar estrutura, processo e resultado do "Programa de Atenção a Doentes Renais Crônicos" em um município brasileiro. Método: estudo epidemiológico, transversal, realizado em 14 unidades de atenção primária e um centro de atenção secundária, no período de 2010-2013. Utilizou-se o referencial metodológico de Donabedian. Para avaliação de estrutura e processo, foram entrevistados 14 médicos, 13 supervisores e 11 agentes comunitários de saúde da atenção primária. Para avaliação de resultado, foram utilizados 1.534 prontuários de saúde na atenção primária e 282 na atenção secundária. Resultados: na maioria das unidades faltam consultórios para atendimento médico e de enfermagem, as equipes estavam incompletas e a maioria dos profissionais não participou de capacitação para atenção à doença renal crônica. Médicos das unidades primárias, classificadas como capacitadas, encaminharam usuários à atenção secundária em estágios mais precoces da doença renal crônica (estágio 3B) quando comparados aos médicos das unidades não capacitadas (58% vs 36%) (p=0,049). As unidades de atenção primária, classificadas como capacitadas, apresentaram melhores taxas de estabilização da filtração glomerular (51%) quando comparadas às unidades parcialmente capacitadas (36%) e não capacitadas (44%) (p=0,046). Conclusão: usuários atendidos nas unidades de atenção primária com pontuação mais elevada em critérios de estrutura e processo apresentaram melhores resultados clínicos.

RESUMEN Objetivo: evaluar la estructura, el proceso y los resultados del "Programa de Atención a Enfermos Renales Crónicos" en un municipio brasileño. Método: estudio epidemiológico, transversal, realizado en 14 unidades de atención primaria y en un centro de atención secundario, en el período de 2010 a 2013. Se utilizó el referencial metodológico de Donabedian. Para evaluación de estructura y proceso; fueron entrevistados 14 médicos, 13 supervisores y 11 agentes comunitarios de salud de la atención primaria. Para evaluación del resultado, fueron utilizadas 1.534 fichas médicas en la atención primaria y 282 en la atención secundaria. Resultados: en la mayoría de las unidades faltaban consultorios para la atención médica y de enfermería, los equipos estaban incompletos y la mayoría de los profesionales no participó de capacitaciones sobre la atención a la enfermedad renal crónica. Los médicos de las unidades primarias, clasificados como capacitados, encaminaron usuarios para la atención secundaria en etapas más precoces de la enfermedad renal crónica (etapa 3B) cuando comparados a los médicos de las unidades no capacitadas (58% vs 36%) (p=0,049). Las unidades de atención primaria, clasificadas como capacitadas, presentaron mejores tasas de estabilización de la filtración glomerular (51%) cuando comparadas a las unidades parcialmente capacitadas (36%) y no capacitadas (44%) (p=0,046). Conclusión: los usuarios atendidos en las unidades de atención primaria, con puntuación más elevada en criterios de estructura y proceso, presentaron mejores resultados clínicos.