Drought, desertification and poverty: A geospatial analysis of snakebite envenoming in the Caatinga biome of Brazil.

Epidemiological data on snakebite in the Brazilian state of Ceará are scarce, as the only report on this subject was last published in 1997. However, according to the Brazilian system of recording disease incidents (Sistema de Informação de Agravos de Notificação [SINAN]), more than 13,000 snakebites have been registered since 2001 in the state of Ceará, making this disease an important public health issue. In the present study, we evaluate the influence of environmental changes, including drought and desertification, on the risk of snakebite envenoming in the Brazilian northeastern state of Ceará. We compare public data on snakebites from Brazilian Epidemiological Surveillance System (DATASUS), rainfall records, advanced desertification maps, pastures and socioeconomic information of the 184 municipals in Ceará between 2001 and 2017. During the period of investigation, 8,945 snakebites were recorded, the majority (93.8%) of which involved venomous snakes. Almost half of the municipals (48%) had 100 incidences or more per 100,000 inhabitants. Data collected also highlight month-to-month occurrences of snakebites, with trends to rise shortly after the onset of precipitation, peaking in July and then trending downward as rainfall decreases, reaching the lowest level in December. We deduce an inverse relationship between Human Development Index (HDI) and snakebites per area. Spearman correlation and principal component analysis support the hypothesis that water scarcity and desertification are linked to increased risk of snakebite envenoming. Our study indicates that besides poverty, dry and desertified areas represent risk factors associated with increased incidence of snakebite envenoming in the state of Ceará.

Microsatellite variation revealed panmictic pattern for Triatoma brasiliensis (Triatominae: Reduviidae) in rural northeastern Brazil: the control measures implications.

BACKGROUND: Triatoma brasiliensis Neiva, 1911 is the main vector of Trypanosoma cruzi in the caatinga of Northeastern Brazil. Despite of its epidemiological relevance, there are few studies on its genetic variability. Using microsatellite markers, we characterized the variability and dynamics of infestation and reinfestation of T. brasiliensis after residual insecticide spraying in five surveys conducted in a well-defined rural area located in the municipality of Tauá, Ceará, between 2009 and 2015. We evaluated: (1) general variability among local of captures; (2) variability along the time analysis (2009, 2010 and 2015); (3) and reinfestation process. RESULTS: On the analysis (1) global and pairwise FST values suggested absence of clusters among the area. AMOVA indicated that total variation is mainly represented by individual differences. Absence of clustering indicates a panmitic unit, with free gene flow. For (2), Pairwise FST indicated alterations in the genetic profile of the triatomines along the time. (3) Analysis of the reinfestation process showed that the domiciliary units investigated had different sources of infestation despite of its proximity. CONCLUSIONS: Observed homogeneity can be explained by the great dispersal capacity of T. brasiliensis, overlapping the different environments. Persistent house infestation in Tauá may be attributed to the occurrence of postspraying residual foci and the invasion of triatomines from their natural habitats.

Evaluating the circulation of Ehrlichia canis and Rickettsia spp. in domestic dogs from a semiarid region in Brazil.

Tick-borne diseases are important for animal and human health, because they can cause death if not diagnosed and treated early. Canine monocytic ehrlichiosis (CME) can cause high morbidity in dog populations. Rocky Mountain Spotted Fever (RMSF) is among the most virulent infectious in humans; dogs are also susceptible to infection. The aims of this study were to evaluate the presence of Ehrlichia canis and Rickettsia spp. infections in domestic dogs, and to identify tick species parasitizing dogs among urban areas of two municipalities (Sobral and Alcântaras) in the Ceará State, Northeastern Brazil. A total of 208 domiciled dogs was sampled. After clinical evaluation, blood samples and ticks were collected and submitted to Real-Time Polymerase Chain Reaction (RT-PCR) targeting E. canis DNA. Serum samples were screened by Indirect Immunofluorescence Assays (IFA) for antibodies against different strains of Rickettsia spp. previously recognized in Brazil. The results of this study indicate the molecular detection of E. canis in the state of Ceará, Brazil, where the proportion of canine infection in Sobral (9.9%) was higher than in Alcântaras (5.6%). Rhipicephalus sanguineus sensu lato was the prevalent tick species infesting the dogs in both municipalities (43.5 and 53.3%, respectively). Our serological results indicate that dogs of the study area were at low risk of exposure to these tick-borne Rickettsia spp. of the spotted fever group. Our study offers epidemiological data of these diseases to better understanding Rickettsiales epidemic and enzootic cycles in the Brazilian semiarid region, improving prevention and control measures.

Ecotope effect in Triatoma brasiliensis (Hemiptera: Reduviidae) suggests phenotypic plasticity rather than adaptation.

Triatoma brasiliensis (Hemiptera: Reduviidae) is an important vector of Chagas' disease in both sylvatic and peridomestic ecotopes. Discriminating between these populations of Triatominae has been proposed as a means of investigating re-infestation rates of human dwellings. Geometric morphometrics have been widely applied in the study of Triatominae polymorphisms at species and population levels. This study characterizes morphometric differences between sylvatic and peridomestic populations, as well as between sexes in T. brasiliensis specimens from Jaguaruana, Ceará, in northeastern Brazil. No differences in either the shape or size of the cephalic capsule were apparent between sexes or ecotopes. However, the wings showed differentiation in shape and size. Sexual dimorphism was detected, with females presenting significantly higher values and conformations. Size differentiation was also evident, with sylvatic specimens being generally larger than peridomestic examples. These results indicate that differences in the wings of T. brasiliensis may be related to the existence of phenotypic plasticity, and variations in size and shape may be associated with different ecotopes, possibly as a result of conditions in each micro-habitat, such as temperature, relative humidity, food supply and density.

Novel Borrelia Genotypes from Brazil Indicate a New Group of Borrelia spp. Associated with South American Bats.

The bacterial genus Borrelia comprises vector-borne spirochetes that have been classified into three major groups: the relapsing fever group (RFG), the Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner sensu lato group (Bbsl), and the reptile-monotreme group (RMG). All three groups have been associated mainly with ticks and wild animals, especially rodents, birds, and reptiles. Here, we searched for Borrelia infection among 99 vampire bats [Desmodus rotundus (É. Geoffroy)] (Chiroptera: Phyllostomidae) from the Brazilian semiarid region. Through molecular investigation of bat internal organs, haplotypes of a potentially novel Borrelia organism were detected in 5% (5/99) of the bats. Borrelia DNA was detected in the liver, blood, spleen, kidney and brain, suggesting a systemic infection. Phylogenetic analyses inferred from partial sequences of the borrelial rrs and flaB genes indicated that the vampire bat-associated Borrelia sp. of this study form a monophyletic group with a newly reported Borrelia associated with a Colombia bat, distinct from the three main currently recognized groups of Borrelia spp., Bbsl, RFG, and RMG. These novel bat-associated Borrelia spp. from South America might have arisen through an independent event along the borrelial evolutionary history, since previous molecular reports of Borrelia organisms in bats or bat-associated ticks from Africa, Europe, and North America were all classified in the RFG.

Temporal trends in the epidemiology of inflammatory bowel diseases in the public healthcare system in Brazil: A large population-based study.

Background: Population-based data on epidemiology of Inflammatory Bowel Diseases (IBD) in Brazil are scarce. This study aims to define temporal trends of incidence and prevalence rates of Crohn's disease (CD) and ulcerative colitis (UC) in Brazil. Methods: All IBD patients from the public healthcare national system were included from January 2012 to December 2020. Average Annual Percent Change (AAPC) and 95% confidence intervals (CI) were calculated using log-linear regression for incidence and binomial regression for prevalence. Moran's I autocorrelation index was used to analyse clustering of cities by level of prevalence. Findings: A total of 212,026 IBD patients were included. Incidence of IBD rose from 9.4 in 2012 to 9.6 per 100,000 in 2020 (AAPC=0.8%; 95% CI -0.37, 1.99); for UC, incidence increased from 5.7 to 6.9 per 100,000 (AAPC=3.0%; 95% CI 1.51, 4.58) and for CD incidence decreased from 3.7 to 2.7 per 100,000 (AAPC=-3.2%; 95% CI -4.45, -2.02). Prevalence of IBD increased from 30.0 in 2012 to 100.1 per 100,000 in 2020 (AAPC=14.8%; CI 14.78-14.95); for UC, from 15.7 to 56.5 per 100,000 (AAPC=16.0%; CI 15.94, 16.17); for CD from 12.6 to 33.7 per 100,000 (AAPC=12.1% CI 11.95, 12.02). A south-north gradient was observed in 2020 prevalence rates of IBD [I=0.40 (p<0.0001)], CD [I=0.22 (p<0.0001)] and UC [I=0.42 (p<0.0001)]. Interpretation: Incidence of CD is decreasing whereas of UC is increasing, leading to stabilization in the incidence of IBD from 2012 to 2020 in Brazil. Prevalence of IBD has been climbing with 0.1% of Brazilians living with IBD in 2020. Funding: None.

West Nile Virus in the State of Ceará, Northeast Brazil.

In June 2019, a horse with neurological disorder was diagnosed with West Nile virus (WNV) in Boa Viagem, a municipality in the state of Ceará, northeast Brazil. A multi-institutional task force coordinated by the Brazilian Ministry of Health was deployed to the area for case investigation. A total of 513 biological samples from 78 humans, 157 domestic animals and 278 free-ranging wild birds, as well as 853 adult mosquitoes of 22 species were tested for WNV by highly specific serological and/or molecular tests. No active circulation of WNV was detected in vertebrates or mosquitoes by molecular methods. Previous exposure to WNV was confirmed by seroconversion in domestic birds and by the detection of specific neutralizing antibodies in 44% (11/25) of equids, 20.9% (14/67) of domestic birds, 4.7% (13/278) of free-ranging wild birds, 2.6% (2/78) of humans, and 1.5% (1/65) of small ruminants. Results indicate that not only equines but also humans and different species of domestic animals and wild birds were locally exposed to WNV. The detection of neutralizing antibodies for WNV in free-ranging individuals of abundant passerine species suggests that birds commonly found in the region may have been involved as amplifying hosts in local transmission cycles of WNV.

First record of the suborder Colomastigidea (Amphipoda) from Brazilian waters, with description of a new species of Colomastix Grube, 1861.

The suborder Colomastigidea consists essentially of small commensal amphipods and, to the date, no species are known from Brazilian waters. Here, a new species (Colomastix trispinosa sp. nov.) of the genus Colomastix is described from the Northeastern Brazilian coast, Ceará state. The new species is distinguished from the others in the genus especially by the male morphology of the palm of gnathopod 2 and the apex of inner ramus of uropod 1, as well as for the combination of other characters. In addition, it is the first Atlantic species to have a pleated apex on dactylus of female gnathopod 2.

Feline immunodeficiency virus in Northern Ceará, Brazil.

OBJECTIVES: The objectives of this study were to confirm the prevalence of feline immunodeficiency virus (FIV) infection in domestic cats in the region north of Ceará, Brazil, and to determine the factors associated with infection and the major circulating subtypes of the virus in this area. METHODS: Samples from 148 cats were collected and tested using anti-FIV antibody screening, with confirmation of positive results by PCR. Univariate analysis was performed considering the epidemiological characteristics and FIV status. Sequencing and phylogenetic analysis of the gag and pol genes were performed to confirm the FIV subtype. RESULTS: Nine cats (6.1%) tested positive for FIV - one female (0.7%) and eight males (5.4%). Male cats were significantly more likely to be infected (P <0.05). Phylogenetic analysis of gag and pol gene sequences indicated that the FIV isolates circulating in the study area belonged to subtype B. CONCLUSIONS AND RELEVANCE: In this study, we demonstrated a low prevalence for FIV in the northwest of Ceará, north-eastern Brazil. Male sex is a significant risk factor for FIV infection and the best predictive factor for FIV status. All isolates examined in this study clustered within subtype B, which is the predominant subtype in Brazil. This is the first report of genetic characterization of FIV in the state of Ceará, Brazil.

The origin of the stingless bee species described by Frederick Smith from Brazilian specimens brought to the London International Exhibition of 1862

ABSTRACT For a long time, the provenance of the specimens used by Frederick Smith to describe the species of stingless bees from Brazil remained a mystery. The recent digitalization of 19th century publications has made possible to trace the origin of the material brought to the London International Exhibition of 1862 by the Brazilian delegation. We document that the bee specimens showed at the International Exhibition, and that served as type material of the species described by Smith, were collected by Manuel Ferreira Lagos, head of the Zoology section of the Comissão Científica de Exploração, during their stay in Ceará, from 1859 to 1861. Even if late, it is important to give due credit to the Comissão Científica de Exploração, and more specifically to Lagos, for the contribution to the knowledge of the stingless bee fauna from Brazil.

Epidemiology and control of trachoma in the state of Ceará, Northeast Brazil, 2007-2021

ABSTRACT Background: To analyze the epidemiology, surveillance, and control strategies for trachoma in the state of Ceará, northeast Brazil, from 2007 to 2021. Methods: This ecological study was based on secondary data from the Information System on Notifiable Diseases of the Secretary of Health of the state of Ceará. Data from school and home surveys for trachoma detection obtained during the study period were analyzed, the percentage of positivity was estimated, and sociodemographic and clinico-epidemiological factors were investigated. Results: The coverage of trachoma surveillance and control actions in Ceará municipalities increased from 12.5% in 2007 to 55.9% in 2019, but with an average restriction of 8.0% during the COVID-19 pandemic. The estimated trachoma positivity (mean overall positivity) was less than 5.0% (2.76%, 95% CI 1.2-5.2), with a higher proportion of cases in the 5-9-year age group (45.0%, 95% CI 44.6-45.4), in females (53.2%, 95% CI 52.8-53.6), and rural areas (52.6%, 95% CI 52.2-53.0). Positivity above 10.0% was observed in the Litoral Leste/Jaguaribe and Sertão Central regions, with a higher occurrence of the follicular inflammatory clinical form (98.1%, 95% CI 98.0-98.2). Conclusions: Trachoma remains in the state of Ceará and is likely underreported. Despite recent advances, the fragility of health surveillance activities compromises the recognition of the actual magnitude and distribution of trachoma in the state. Accurate information is fundamental for planning, monitoring, and evaluating surveillance and disease control.

Occurrence of Tungiasis in Ceará State, Northeast Brazil: Results of a Rapid Assessment Method

ABSTRACT Background: Systematic data on the occurrence of tungiasis are scarce. Methods: We analyzed data on tungiasis in humans and animals from all municipalities of Ceará State, Northeast Brazil, using a rapid assessment questionnaire. Results: Among the 184 municipalities, 181 (98.3%) reported tungiasis in the past (before 2021) or currently, 120 (65.2%) reported current occurrence, 155 (84.2%) reported severe cases in the past or currently, 47 (25.5 %) reported severe cases currently, and 132 (71.7%) reported tungiasis in animals. Conclusions: Tungiasis is a significant public health concern in Ceará. A One Health approach is required to reduce the disease burden in humans and animals.

Formal education, previous interaction and perception influence the attitudes of people toward the conservation of snakes in a large urban center of northeastern Brazil.

BACKGROUND: The attitudes and perceptions of people toward animals are influenced by sociodemographic factors, such as formal education and gender, and by personal experience. Understanding these interactions is critical for the establishment of conservation strategies for animals that have conflictual relationships with humans, such as snakes. Our study aims to explain how perceptions and the human fear of snakes vary and are influenced by formal education and gender. In addition, it aims to show how prior interaction with these animals influence these perceptions and the human fear toward snakes and how these perceptions and fear influence the importance of conservation of these animals. METHODS: We collected data from June 2010 to December 2013 using questionnaires given to 1142 visitors of a scientific serpentarium (Núcleo Regional de Ofiologia da Universidade Federal do Ceará) in the municipality of Fortaleza, northeastern Brazil. RESULTS AND DISCUSSION: Negative perceptions toward snakes were less frequent according to an increase in levels of schooling. Women had more negative perceptions and were more afraid of snakes than were men. Prior interaction with snakes decreased the occurrence of negative perceptions and reduced the level of human fear of these animals. People with negative perceptions classified the conservation of snakes as not important and were more afraid of these animals. Understanding the relationship between sociodemographic factors, prior experiences, perceptions, fear, and the importance given to conservation can help to better understand human attitudes toward snakes. CONCLUSIONS: Environmental education activities considering gender differences, involving preliminary interaction with snakes and focusing on priority targets identified in our study, such as people with low formal education, can increase the efficiency of measures for the conservation of these animals.

Neriidae (Diptera: Schizophora) of the Northeastern Brazil: new records and an identification key / Neriidae (Diptera: Schizophora) do Nordeste do Brasil: novos registros e uma chave de identificação

Abstract: Here, we provide a list of seven species collected in the Brazilian states of Ceará, Maranhão and Piauí, housed in the Coleção Zoológica do Maranhão (CZMA), Cerantichir peruana (Hennig, 1937), Glyphidops durus (Cresson, 1926), Glyphidops filosus (Fabricius, 1805), Glyphidops flavifrons (Bigot, 1886), Glyphidops vittatus (Cresson, 1912), Nerius pilifer Fabricius, 1805 and Nerius plurivittatus Bigot, 1886. Representatives of Neriidae are recorded and mapped for the first time in the states of Ceará, Maranhão and Piauí, while the species C. peruana, G. durus, G. flavifrons and G. vittatus represent new records for the Northeast Region of Brazil. A key for the identification and diagnoses of Northeastern Brazilian neriids are provided.

Resumo: Uma lista de sete espécies coletadas nos estados brasileiros do Ceará, Maranhão e Piauí é disponibilizada, baseada em material depositado na Coleção Zoológica do Maranhão (CZMA), Cerantichir peruana (Hennig, 1937), Glyphidops durus (Cresson, 1926), Glyphidops filosus (Fabricius, 1805), Glyphidops flavifrons (Bigot, 1886), Glyphidops vittatus (Cresson, 1912), Nerius pilifer Fabricius, 1805 e Nerius plurivittatus Bigot, 1886. Representantes de Neriidae são registrados e mapeados pela primeira vez nos estados do Ceará, Maranhão e Piauí, enquanto C. peruana, G. durus, G. flavifrons e G. vittatus representam novos registros para a Região Nordeste do Brasil. São apresentados uma chave para a identificação e diagnoses dos neríideos da Região Nordeste brasileira.

Vulnerabilidade socioeconômica à COVID-19 em municípios do Ceará / Vulnerabilidad socioeconómica a la COVID-19 en municipios de Ceará / Socioeconomic vulnerability in the face of COVID-19 in municipalities of Ceará

Resumo Os efeitos da pandemia da COVID-19 têm causado sérios impactos socioeconômicos, expondo a vulnerabilidade de estados e municípios brasileiros. Concebendo-a em sentido amplo, a vulnerabilidade se relaciona à suscetibilidade social e econômica a riscos ou perdas potenciais, causados por eventos extremos. Nesse contexto, este artigo objetiva identificar a vulnerabilidade socioeconômica dos municípios do Ceará, epicentro da região Nordeste, quanto à pandemia da COVID-19. Para tal, realizou-se um estudo exploratório-quantitativo, utilizando-se informações secundárias obtidas em bases de dados públicas governamentais. A vulnerabilidade socioeconômica dos municípios foi avaliada de forma dinâmica, baseando-se em modelo matemático de previsão do número de casos da COVID-19 aplicado à cidade de Wuhan, na China. Os indicadores de vulnerabilidade foram calculados sob duas trajetórias: valor de produção e número de pessoal ocupado, considerando-se características municipais como densidade demográfica, mobilidade interurbana e índice de desenvolvimento humano (IDH). No caso do estado do Ceará, os achados evidenciaram uma série de determinantes demográficos, sociais e econômicos locais que agravam os impactos da crise. Os indicadores de vulnerabilidade construídos na pesquisa podem servir de base para as decisões de governos municipais e estadual na cronologia da abertura econômica do estado por setores, municípios e regiões.

Resumen Los efectos de la pandemia de COVID-19 han causado graves impactos socioeconómicos, exponiendo la vulnerabilidad de los estados y municipios brasileños. Considerándola en un sentido amplio, la vulnerabilidad está relacionada con la susceptibilidad social y económica a los riesgos o pérdidas potenciales causados por eventos extremos. En este contexto, este artículo tiene como objetivo identificar la vulnerabilidad socioeconómica de los municipios de Ceará, el epicentro de la pandemia de COVID-19 en la región noreste. Para ello, se realizó un estudio exploratorio cuantitativo, utilizando información secundaria obtenida a través de bases de datos públicas del gobierno. La vulnerabilidad socioeconómica de los municipios se evaluó dinámicamente, con base en un modelo matemático de pronóstico del número de casos de COVID-19 aplicado a la ciudad de Wuhan, China. Los indicadores de vulnerabilidad se calcularon con base en dos trayectorias: valor de producción y número de personas empleadas, considerando características municipales como densidad demográfica, movilidad interurbana e índice de desarrollo humano. En el caso del estado de Ceará, los resultados mostraron una serie de determinantes demográficos, sociales y económicos locales que agravan los impactos de la crisis. Los indicadores de vulnerabilidad construidos en la encuesta pueden servir como base para las decisiones de los gobiernos municipales y estatal en la cronología de apertura económica del estado por sectores, municipios y regiones.

Abstract The effects of the COVID-19 pandemic have caused serious socioeconomic impacts, exposing the vulnerability of Brazilian states and municipalities. In a broad sense, vulnerability is related to social and economic susceptibility to potential risks or losses caused by extreme events. In this context, this article identifies the municipalities' socioeconomic vulnerability in the State of Ceará, the epicenter of the COVID-19 pandemic in the Northeast of Brazil. This exploratory-quantitative study adopted secondary data from government databases of public access. The socioeconomic vulnerability of the municipalities was assessed dynamically, based on a mathematical model to forecast the number of cases of COVID-19 applied to the city of Wuhan, China. The vulnerability indicators were calculated under two trajectories: production value and the number of employed persons, considering municipal characteristics such as demographic density, local mobility, and human development index. In the case of the state of Ceará, the findings show a series of demographic, social and economic determinants that aggravate the impacts of the crisis. The vulnerability indicators constructed in this research can be used as a basis for decisions by municipal and state governments in the chronology of economic openings by sectors, municipalities, and regions.

O traço do personalismo das instituições assistenciais: doadores, doações e projeção social no Ceará oitocentista / The trait of personalism in charitable institutions: donors, donations, and social projection in nineteenth-century Ceará

Resumo No Brasil oitocentista evidenciou-se a emergência de instituições assistenciais. Por meio delas, os estados provinciais projetaram membros das elites políticas e econômicas nomeando-os grandes benfeitores. Homens de notoriedade local desempenharam papel na construção de determinados espaços asilares por meio de práticas que ratificaram seu prestígio social não apenas entre seus pares e para sua época, mas também para a memória e a história das instituições às quais estavam vinculadas. O artigo problematiza a construção de três instituições assistenciais no Ceará: Asilo de Mendicidade, Colônia Orfanológica Cristina e Asilo de Alienados São Vicente de Paula, cuja tônica discursiva e ações filantrópicas estavam inseridas no cenário da grande seca de 1877-1879.

Abstract In the nineteenth century, Brazil witnessed the emergence of the first welfare institutions. These became the platforms for provincial states to raise the status of their political and economic elite, naming them great benefactors. Men of local repute played active roles in building certain institutional spaces, employing practices that reinforced their social prestige not just among their peers and for their time, but also for the memory and history of the institutions with which they were involved. The building of three welfare institutions in the province of Ceará is problematized: Asilo de Mendicidade, Colônia Orfanológica Cristina, and Asilo de Alienados São Vicente de Paula, whose discourse and philanthropic actions were entangled with the great drought of 1877-1879.

Efeitos intersetoriais e transversais e seus impactos sobre a efetividade das políticas públicas nos municípios do Ceará / Efectos intersectoriales y transversales y sus impactos sobre la efectividad de las políticas públicas en los municipios de ceará / Intersectoral and transversal effects and their impacts on the effectiveness of public policies in Ceara's municipalities

Resumo Identificar em quais circunstâncias a intersetorialidade e a transversalidade ocorrem no âmbito das políticas públicas se mostra fundamental para aumentar sua efetividade. Assim, este estudo integrou dois arcabouços teóricos relacionados à pobreza e à atratividade, visando a captar seus efeitos. A estimação econométrica com dados para os municípios cearenses evidenciou, por exemplo, que o crescimento econômico e as políticas públicas que o estimulam, além de favorecer a redução dos níveis de pobreza, também podem aumentar a atratividade de determinado município. Por outro lado, iniciativas que estimulam a urbanização e a requalificação dos espaços aumentam sua atratividade e, ainda, favorecem a redução da pobreza. Assim, ressalta-se a necessidade de pesquisar como as características do local e de sua população podem afetar a efetividade das políticas públicas.

Resumen Identificar en qué circunstancias la transversalidad y la intersectorialidad se producen en el contexto de las políticas públicas es esencial para aumentar su efectividad. Por ello, este estudio integró dos marcos teóricos relacionados con la pobreza y la atractividad, con el objetivo de captar sus efectos. La estimación econométrica con datos para los municipios de Ceará evidenció, por ejemplo, que el crecimiento económico y las políticas públicas que estimulan y favorecen la reducción de los niveles de pobreza también pueden aumentar la atractividad de un determinado municipio. Por otro lado, las iniciativas que fomentan la urbanización y la recalificación de espacios aumentan su atractividad y también ayudan a reducir la pobreza. Asimismo, se resalta la necesidad de investigar cómo las características del lugar y de su población pueden afectar la efectividad de las políticas públicas.

Abstract Identifying under what circumstances transversality and intersectoriality take place within the scope of public policies is fundamental to increase their effectiveness. Thus, two theoretical frameworks related to poverty and attractiveness were integrated, aiming to capture the existing effects. The econometric estimation with data for Ceara's municipalities showed, for example, that economic growth and the public policies that stimulate it, besides favoring the reduction of poverty levels, can also increase the attractiveness of a given municipality. On the other hand, initiatives that stimulate the urbanization and the requalification of spaces, increase their attractiveness and, also, favor the reduction of poverty. In addition, it was emphasized the need to investigate how the characteristics of the place and its population can affect the effectiveness of policies.

Impacto do estado nutricional e do tempo de jejum nas complicações gastrointestinais e no tempo de hospitalização em pacientes cirúrgicos / Impact of the nutritional status and fasting time in gastrointestinal complications and hospitalization time in surgical patients

Introdução: O estado nutricional e o tempo de jejum pré e pós-cirúrgico impactam na morbimortalidade de pacientes submetidos a cirurgias eletivas. No Brasil, o tempo de jejum prolongado e a elevada prevalência de desnutrição são comuns nos hospitais terciários. Objetivo: Realizar levantamento do tempo de jejum médio praticado em hospital terciário e avaliar o impacto do jejum pré e pós-cirúrgico e do estado nutricional nas complicações gastrointestinais imediatas e no tempo de hospitalização em pacientes cirúrgicos. Material e métodos: Estudo prospectivo, realizado no Hospital Universitário Walter Cantídio, em Fortaleza. Foram avaliados 173 indivíduos submetidos a cirurgias eletivas de médio e grande porte entre agosto de 2016 a janeiro de 2017. Foram coletadas medidas antropométricas, hemograma e informações como tempo de jejum pré e pós-cirúrgico, permanência hospitalar e complicações gastrointestinais. As análises de correlação e associação foram realizadas no Software SPSS®, com nível de significância fixado em p< 0,05. Resultados: A maioria dos pacientes (71,1%) foi submetida à cirurgia de porte II (grande porte). Houve correlação negativa entre tempo de permanência hospitalar e índice de massa corporal [r= -0,223; p= 0,003], circunferência braquial [r= -0,335; p< 0,001], dobra cutânea tricipital [r= -0,320; p< 0,001], área muscular do braço corrigida [r= -0,253; p= 0,001], contagem total de linfócitos [r= -0,223; p= 0,008], hemoglobina [r= -0,243; p= 0,004] e relação linfócito/monócito [r= -0,308; p< 0,001]. Adicionalmente, houve correlação positiva entre tempo de permanência hospitalar com o tempo de jejum pós-cirúrgico [r= 0,456; p< 0,001]. Ausência de complicações gastrointestinais foi associada a valores de triagem (Nutritional Risk Screenin-2002) < 3 (p= 0,034) e entre menor tempo de jejum pós-cirúrgico (p= 0,033). Conclusão: Pacientes desnutridos, com maior risco nutricional e os que se submeteram a um tempo de jejum pós-cirúrgico elevado apresentaram maior tempo de permanência hospitalar e maior incidência de complicações gastrointestinais.

Introduction: The nutritional status and pre and postoperative fasting time impact the morbidity and mortality of patients undergo to elective surgeries. In Brazil, prolonged fasting time and high prevalence of malnutrition are common in tertiary hospitals. Objective: To evaluate the mean preoperative and postoperative fasting time and the impact of fasting, and nutritional status on gastrointestinal complications and on length of hospital stay in surgical patients. Material and methods: A prospective study, conducted at Walter Cantídio University Hospital, in Fortaleza. One hundred and seventy three surgery patients were evaluated between August 2016 and January 2017. The subjects were divided in two groups (medium and large size). Anthropometric measurements, blood count and information about pre and postoperative fasting time, hospital stay and gastrointestinal complications data were collected. Correlation and association test were performed by Software SPSS®. P<0.05 was considered significant. Results: The majority of the patients (71,1%) were included in size II (large) surgery. There was a negative correlation between length of stay in hospital and body mass index [r= -0,223; p= 0,003], brachial circumference [r= -0,335; p<0,001], triceps skinfold thickness [r= -0,320; p<0,001], arm muscle area [r= -0,253; p= 0,001], total lymphocyte count [r= -0,223; p= 0,008], hemoglobin [r= -0,243; p= 0,004] and lymphocyte/monocyte ratio [r= -0,308; p<0,001]. In addition, there was a positive correlation between length of stay in hospital and postoperative fasting time [r= 0,456; p<0,001]. Absence of gastrointestinal complications was associated with Nutrition Risk Screening-2002 <3 (p= 0,034) and shorter post-operative fasting time (p= 0,033). Conclusion: Malnourished patients, higher nutritional risk and higher postoperative fasting time were associated to longer hospital stay and a higher incidence of gastrointestinal complications.

O câncer no Ceará: a conformação de um problema médico-social, 1940-1954 / Cancer in Ceará: shaping a medical and social problem, 1940-1954

Resumo Analisa a conformação do câncer em problema médico-social relevante no Ceará, entre 1940 e 1954. Nos anos 1940, a doença possuía pouca importância na agenda médica e sanitária local, sendo considerada um problema de filantropia. A partir da ação de um grupo de médicos e seus aliados, o câncer foi posto na pauta dos médicos e da saúde pública, levando à Campanha Contra o Câncer, em 1954. Argumentamos que o enquadramento do câncer como um problema médico-social relevante no Ceará esteve ligado à capacidade desses médicos em agregar aliados internos e externos para ampliar o alcance de suas agendas. Utilizamos artigos médicos, documentos institucionais, biografias, jornais e outros documentos produzidos sobre/pelos personagens envolvidos com as ações anticâncer no Ceará.

Abstract This article addresses the shaping of cancer as a relevant medical and social problem in the Brazilian state of Ceará from 1940 to 1954. While this disease initially garnered little importance on the local medical and health agenda, and was considered a problem for philanthropy, a group of physicians and allies brought cancer to the public health agenda and led to the Campaign Against Cancer in 1954. This group's ability to unite internal and external allies with a broader reach portrayed cancer as a relevant medical and social problem in Ceará. We demonstrate this new portrayal in medical articles, institutional documents, biographies, newspapers, and other documents produced on and by the characters involved with anticancer activities in Ceará.

O câncer no Ceará: a conformação de um problema médico-social, 1940-1954 / Cancer in Ceará: shaping a medical and social problem, 1940-1954

Analisa a conformação do câncer em problema médico-social relevante no Ceará, entre 1940 e 1954. Nos anos 1940, a doença possuía pouca importância na agenda médica e sanitária local, sendo considerada um problema de filantropia. A partir da ação de um grupo de médicos e seus aliados, o câncer foi posto na pauta dos médicos e da saúde pública, levando à Campanha Contra o Câncer, em 1954. Argumentamos que o enquadramento do câncer como um problema médico-social relevante no Ceará esteve ligado à capacidade desses médicos em agregar aliados internos e externos para ampliar o alcance de suas agendas. Utilizamos artigos médicos, documentos institucionais, biografias, jornais e outros documentos produzidos sobre/pelos personagens envolvidos com as ações anticâncer no Ceará.