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Virtual reality (VR) technology has been widely adopted for several professional and recreational applications. Despite rapid innovation in hardware and software, one of the long prevailing issues for end users of VR is the experience of VR sickness. Females experience stronger VR sickness compared to males, and previous research has linked susceptibility to VR sickness to the menstrual cycle (Munafo et al., Exp Brain Res 235(3):889-901). Here we investigated the female versus male experience in VR sickness while playing an immersive VR game, comparing days of the menstrual cycle when hormones peak: day 15 (ovulation-peak estrogen) and day 22 (mid-luteal phase-peak progesterone). We found that immersion duration was greater in the second session than the first, and discomfort was lessened, suggesting a powerful adaptation with repeated exposure. Due to the estrogen levels changing along with the exposure, there was no clear independent impact of that; note, though, that there was a significant difference between self-report and physiological measures implying that GSR is potentially an unreliable measure of motion sickness. Although prior work found a delay over 2 days between session would not allow adaptation and habituation to reduce VR sickness susceptibility, we found that a week delay has potential success.
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Enjoo devido ao Movimento , Realidade Virtual , Humanos , Masculino , Feminino , Caracteres Sexuais , Interface Usuário-Computador , EstrogêniosRESUMO
This integrative review rearticulates the notion of human aesthetics by critically appraising the conventional definitions, offerring a new, more comprehensive definition, and identifying the fundamental components associated with it. It intends to advance holistic understanding of the notion by differentiating aesthetic perception from basic perceptual recognition, and by characterizing these concepts from the perspective of information processing in both visual and nonvisual modalities. To this end, we analyze the dissociative nature of information processing in the brain, introducing a novel local-global integrative model that differentiates aesthetic processing from basic perceptual processing. This model builds on the current state of the art in visual aesthetics as well as newer propositions about nonvisual aesthetics. This model comprises two analytic channels: aesthetics-only channel and perception-to-aesthetics channel. The aesthetics-only channel primarily involves restricted local processing for quality or richness (e.g., attractiveness, beauty/prettiness, elegance, sublimeness, catchiness, hedonic value) analysis, whereas the perception-to-aesthetics channel involves global/extended local processing for basic feature analysis, followed by restricted local processing for quality or richness analysis. We contend that aesthetic processing operates independently of basic perceptual processing, but not independently of cognitive processing. We further conjecture that there might be a common faculty, labeled as aesthetic cognition faculty, in the human brain for all sensory aesthetics albeit other parts of the brain can also be activated because of basic sensory processing prior to aesthetic processing, particularly during the operation of the second channel. This generalized model can account not only for simple and pure aesthetic experiences but for partial and complex aesthetic experiences as well.
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Beleza , Cognição , Encéfalo , Estética , Humanos , PercepçãoRESUMO
Cross-cultural research has repeatedly demonstrated sex differences in the importance of partner characteristics when choosing a mate. Men typically report higher preferences for younger, more physically attractive women, while women typically place more importance on a partner's status and wealth. As the assessment of such partner characteristics often relies on visual cues, this raises the question whether visual experience is necessary for sex-specific mate preferences to develop. To shed more light onto the emergence of sex differences in mate choice, the current study assessed how preferences for attractiveness, resources, and personality factors differ between sighted and blind individuals using an online questionnaire. We further investigate the role of social factors and sensory cue selection in these sex differences. Our sample consisted of 94 sighted and blind participants with different ages of blindness onset: 19 blind/28 sighted males and 19 blind/28 sighted females. Results replicated well-documented findings in the sighted, with men placing more importance on physical attractiveness and women placing more importance on status and resources. However, while physical attractiveness was less important to blind men, blind women considered physical attractiveness as important as sighted women. The importance of a high status and likeable personality was not influenced by sightedness. Blind individuals considered auditory cues more important than visual cues, while sighted males showed the opposite pattern. Further, relationship status and indirect, social influences were related to preferences. Overall, our findings shed light on the availability of visual information for the emergence of sex differences in mate preference.
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Sinais (Psicologia) , Comportamento Sexual , Cegueira , Comportamento de Escolha , Feminino , Humanos , Masculino , Personalidade , Caracteres SexuaisRESUMO
The hippocampus is well known for its roles in spatial navigation and memory, but it is organized into regions that have different connections and functional specializations. Notably, the region CA2 has a role in social and not spatial cognition, as is the case for the regions CA1 and CA3 that surround it. Here, we investigated the evolution of the hippocampus in terms of its size and organization in relation to the evolution of social and ecological variables in primates, namely home range, diet and different measures of group size. We found that the volumes within the whole cornu ammonis coevolve with group size, while only the volume of CA1 and subiculum can also be predicted by home range. On the other hand, diet, expressed as a shift from folivory towards frugivory, was shown to not be related to hippocampal volume. Interestingly, CA2 was shown to exhibit phylogenetic signal only against certain measures of group size, but not with ecological factors. We also found that sex differences in the hippocampus are related to body size sex dimorphism. This is in line with reports of sex differences in hippocampal volume in non-primates that are related to social structure and sex differences in behaviour. Our findings support the notion that in primates, the hippocampus is a mosaic structure evolving in line with social pressures, where certain subsections evolve in line with spatial ability too.
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Dieta , Hipocampo/anatomia & histologia , Primatas/fisiologia , Animais , Primatas/anatomia & histologia , Caracteres Sexuais , Lobo TemporalRESUMO
Sex differences in mate preferences are ubiquitous, having been evidenced across generations and cultures. Their prevalence and persistence have compellingly placed them in the evolutionarily adaptive context of sexual selection. However, the psycho-biological mechanisms contributing to their generation and maintenance remain poorly understood. As such a mechanism, sexual attraction is assumed to guide interest, desire, and the affinity toward specific partner features. However, whether sexual attraction can indeed explain sex differences in partner preferences has not been explicitly tested. To better understand how sex and sexual attraction shape mate preferences in humans we assessed how partner preferences differed across the spectrum of sexual attraction in a sample of 479 individuals that identified as asexual, gray-sexual, demisexual or allosexual. We further tested whether romantic attraction predicted preference profiles better than sexual attraction. Our results show that sexual attraction accounts for highly replicable sex differences in mate preferences for high social status and financial prospects, conscientiousness, and intelligence; however, it does not account for the enhanced preference for physical attractiveness expressed by men, which persists even in individuals with low sexual attraction. Instead, sex differences in physical attractiveness preference are better explained by the degree of romantic attraction. Furthermore, effects of sexual attraction on sex differences in partner preferences were grounded in current rather than previous experiences of sexual attraction. Taken together, the results support the idea that contemporary sex differences in partner preferences are maintained by several psycho-biological mechanisms that evolved in conjunction, including not only sexual but also romantic attraction.
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Caracteres Sexuais , Comportamento Sexual , Humanos , Feminino , Masculino , Parceiros SexuaisRESUMO
Global soil acidification is increasing, enlarging aluminum (Al) availability in soils, leading to reductions in plant growth. This study investigates the effect of Al stress on the leaf growth zones of Rye (Secale cereale, cv Beira). Kinematic analysis showed that the effect of Al on leaf growth rates was mainly due to a reduced cell production rate in the meristem. Transcriptomic analysis identified 2272 significantly (log2fold > |0.5| FDR < 0.05) differentially expressed genes (DEGs) for Al stress. There was a downregulation in several DEGs associated with photosynthetic processes and an upregulation in genes for heat/light response, and H2O2 production in all leaf zones. DEGs associated with heavy metals and malate transport were increased, particularly, in the meristem. To determine the putative function of these processes in Al tolerance, we performed biochemical analyses comparing the tolerant Beira with an Al sensitive variant RioDeva. Beira showed improved sugar metabolism and redox homeostasis, specifically in the meristem compared to RioDeva. Similarly, a significant increase in malate and citrate production, which are known to aid in Al detoxification in plants, was found in Beira. This suggests that Al tolerance in Rye is linked to its ability for Al exclusion from the leaf meristem.
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Alumínio , Secale , Secale/genética , Secale/metabolismo , Alumínio/toxicidade , Malatos/metabolismo , Malatos/farmacologia , Peróxido de Hidrogênio/metabolismo , Oxirredução , Folhas de Planta/metabolismo , AçúcaresRESUMO
The neuronal composition of the insula in primates displays a gradient, transitioning from granular neocortex in the posterior-dorsal insula to agranular neocortex in the anterior-ventral insula with an intermediate zone of dysgranularity. Additionally, apes and humans exhibit a distinctive subdomain in the agranular insula, the frontoinsular cortex (FI), defined by the presence of clusters of von Economo neurons (VENs). Studies in humans indicate that the ventral anterior insula, including agranular insular cortex and FI, is involved in social awareness, and that the posterodorsal insula, including granular and dysgranular cortices, produces an internal representation of the body's homeostatic state.We examined the volumes of these cytoarchitectural areas of insular cortex in 30 primate species, including the volume of FI in apes and humans. Results indicate that the whole insula scales hyperallometrically (exponent=1.13) relative to total brain mass, and the agranular insula (including FI) scales against total brain mass with even greater positive allometry (exponent=1.23), providing a potential neural basis for enhancement of social cognition in association with increased brain size. The relative volumes of the subdivisions of the insular cortex, after controlling for total brain volume, are not correlated with species typical social group size. Although its size is predicted by primate-wide allometric scaling patterns, we found that the absolute volume of the left and right agranular insula and left FI are among the most differentially expanded of the human cerebral cortex compared to our closest living relative, the chimpanzee.
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Córtex Cerebral/fisiologia , Primatas/fisiologia , Comportamento Social , Animais , Feminino , Humanos , Masculino , Especificidade da EspécieRESUMO
The lateral geniculate nucleus (LGN) of catarrhine primates - with the exception of gibbons - is typically described as a 6-layered structure, comprised of 2 ventral magnocellular layers, and 4 dorsal parvocellular layers. The parvocellular layers of the LGN are involved in color vision. Therefore, it is hypothesized that a 6-layered LGN is a shared-derived trait among catarrhines. This might suggest that in gibbons the lack of further subdivisions of the parvocellular layers is a recent change, and could be related to specializations of visual information processing in this taxon. To address these hypotheses, the lamination of the LGN was investigated in a range of catarrhine species, including several taxa not previously described, and the evolution of the LGN was reconstructed using phylogenetic information. The findings indicate that while all catarrhine species have 4 parvocellular leaflets, two main patterns of LGN parvocellular lamination occur: 2 undivided parvocellular layers in some species, and 4 parvocellular leaflets (with occasional subleaflets) in other species. LGN size was not found to be related to lamination pattern. Both patterns were found to occur in divergent clades, which is suggestive of homoplasy within the catarrhines in LGN morphology.
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Cercopithecidae/anatomia & histologia , Corpos Geniculados/anatomia & histologia , Vias Visuais/anatomia & histologia , Animais , FilogeniaRESUMO
BACKGROUND: Intermittent preventive treatment in infants (IPTi) is a new malaria control strategy coupled with the delivery of routine immunizations recommended by the World Health Organization since 2009 for countries with moderate to high endemicity. To evaluate its safety profile and identify potential new adverse events (AEs) following simultaneous administration of sulfadoxine-pyrimethamine (SP-IPTi) with immunizations, we measured AE incidence and evaluated spontaneous AE reporting. METHODS: A cohort event monitoring study was conducted on 24 000 infants in 2 countries after administration of SP-IPTi during routine immunizations. Additional pharmacovigilance training and supervision were conducted to stimulate AE passive reporting in 6 African countries. RESULTS: No serious AEs were found by active follow-up, representing 95% probability that the rate does not exceed 1 per 8000. No serious AEs were found by retrospective review of hospital registers. The rate of moderate AEs probably linked to immunization and/or SP-IPTi was 1.8 per 1000 doses (95% confidence interval, 1.50-2.00). Spontaneous reporting of AEs remained <1% of cases collected by active follow-up. CONCLUSIONS: Simultaneous administration of SP-IPTi and immunizations is a safe strategy for implementation with a low risk of serious AEs to infants. Strategies toward strengthening spontaneous reporting in Africa should include not only the provider but also beneficiaries or their caregivers.
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Antimaláricos/efeitos adversos , Imunização , Vacinas Antimaláricas/efeitos adversos , Malária/prevenção & controle , Farmacovigilância , Pirimetamina/efeitos adversos , Sulfadoxina/efeitos adversos , Sistemas de Notificação de Reações Adversas a Medicamentos , África , Combinação de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Humanos , Lactente , MasculinoRESUMO
An absolutely and relatively large brain has traditionally been viewed as a distinctive characteristic of the Homo genus, with anatomically modern humans presented at the apex of a long line of progressive increases in encephalization. Many studies continue to focus attention on increasing brain size in the Homo genus, while excluding measures of absolute and relative brain size of more geologically recent, smaller brained, hominins such as Homo floresiensis, and Homo naledi and smaller brained Homo erectus specimens. This review discusses the benefits of using phylogenetic comparative methods to trace the diverse changes in hominin brain evolution and the drawbacks of not doing so.
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Hominidae , Animais , Humanos , Filogenia , Evolução Biológica , Tamanho do Órgão , FósseisRESUMO
INTRODUCTION: Clinical reasoning (CR) is a key competence for physicians and a major source of damaging medical errors. Many strategies have been explored to improve CR quality, most of them based on knowledge enhancement, cognitive debiasing and the use of analytical reasoning. If increasing knowledge and fostering analytical reasoning have shown some positive results, the impact of debiasing is however mixed. Debiasing and promoting analytical reasoning have also been criticised for their lack of pragmatism. Alternative means of increasing CR quality are therefore still needed. Because emotions are known to influence the quality of reasoning in general, we hypothesised that emotional competence (EC) could improve physicians' CR. EC refers to the ability to identify, understand, express, regulate and use emotions. The influence of EC on CR remains unclear. This article presents a scoping review protocol, the aim of which will be to describe the current state of knowledge concerning the influence of EC on physicians' CR, the type of available literature and finally the different methods used to examine the link between EC and CR. METHOD AND ANALYSIS: The population of interest is physicians and medical students. EC will be explored according to the model of Mikolajczak et al, describing five major components of EC (identify, understand, express, regulate and use emotions). The concept of CR will include terms related to its processes and outcomes. Context will include real or simulated clinical situations. The search for primary sources and reviews will be conducted in MEDLINE (via Ovid), Scopus and PsycINFO. The grey literature will be searched in the references of included articles and in OpenGrey. Study selection and data extraction will be conducted using the Covidence software. Search and inclusion results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review model (PRISMA-ScR). ETHICS AND DISSEMINATION: There are no ethical or safety concerns regarding this review. REGISTRATION DETAILS: OSF Registration DOI: https://doi.org/10.17605/OSF.IO/GM7YD.
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Médicos , Estudantes de Medicina , Humanos , Raciocínio Clínico , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Literatura de Revisão como AssuntoRESUMO
The process of brain folding is thought to play an important role in the development and organisation of the cerebrum and the cerebellum. The study of cerebellar folding is challenging due to the small size and abundance of its folia. In consequence, little is known about its anatomical diversity and evolution. We constituted an open collection of histological data from 56 mammalian species and manually segmented the cerebrum and the cerebellum. We developed methods to measure the geometry of cerebellar folia and to estimate the thickness of the molecular layer. We used phylogenetic comparative methods to study the diversity and evolution of cerebellar folding and its relationship with the anatomy of the cerebrum. Our results show that the evolution of cerebellar and cerebral anatomy follows a stabilising selection process. We observed two groups of phenotypes changing concertedly through evolution: a group of 'diverse' phenotypes - varying over several orders of magnitude together with body size, and a group of 'stable' phenotypes varying over less than 1 order of magnitude across species. Our analyses confirmed the strong correlation between cerebral and cerebellar volumes across species, and showed in addition that large cerebella are disproportionately more folded than smaller ones. Compared with the extreme variations in cerebellar surface area, folial anatomy and molecular layer thickness varied only slightly, showing a much smaller increase in the larger cerebella. We discuss how these findings could provide new insights into the diversity and evolution of cerebellar folding, the mechanisms of cerebellar and cerebral folding, and their potential influence on the organisation of the brain across species.
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Encéfalo , Cerebelo , Animais , Filogenia , Cerebelo/anatomia & histologia , Mamíferos , Tamanho CorporalRESUMO
This chapter utilizes genomic concepts and evolutionary perspectives to further understand the possible links between typical brain aging and neurodegenerative diseases, focusing on the two most prevalent of these: Alzheimer's disease and Parkinson's disease. Aging is the major risk factor for these neurodegenerative diseases. Researching the evolutionary and molecular underpinnings of aging helps to reveal elements of the typical aging process that leave individuals more vulnerable to neurodegenerative pathologies. Very little is known about the prevalence and susceptibility of neurodegenerative diseases in nonhuman species, as only a few individuals have been observed with these neuropathologies. However, several studies have investigated the evolution of lifespan, which is closely connected with brain size in mammals, and insights can be drawn from these to enrich our understanding of neurodegeneration. This chapter explores the relationship between the typical aging process and the events in neurodegeneration. First, we examined how age-related processes can increase susceptibility to neurodegenerative diseases. Second, we assessed to what extent neurodegeneration is an accelerated form of aging. We found that while at the phenotypic level both neurodegenerative diseases and the typical aging process share some characteristics, at the molecular level they show some distinctions in their profiles, such as variation in genes and gene expression. Furthermore, neurodegeneration of the brain is associated with an earlier onset of cellular, molecular, and structural age-related changes. In conclusion, a more integrative view of the aging process, both from a molecular and an evolutionary perspective, may increase our understanding of neurodegenerative diseases.
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Doença de Alzheimer , Doenças Neurodegenerativas , Humanos , Animais , Doenças Neurodegenerativas/patologia , Envelhecimento/metabolismo , Doença de Alzheimer/metabolismo , Encéfalo/metabolismo , Genômica , MamíferosRESUMO
We sought to understand how the perception of personal space is influenced by different levels of social density, spatial density, and type of window-view in South Korean and United Kingdom workplaces. We employed virtual reality to simulate shared and single occupancy offices. We obtained personal space estimations using a virtual disc around the participant which could be extended and retracted, inside the simulation, to indicate perceived amount of personal space, and compared this measure to questionnaire-based estimations. We found that in both cultures participants experienced greater perceived personal space (1) when in a sparse rather than dense office and (2) having a view of the city outside the office. However, British, but not Korean, participants had significantly higher personal space estimations in single occupancy offices than in shared offices. These results suggest subtle cross-cultural differences in workplace experience, that could only be investigated using virtual reality.
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Alzheimer's disease (AD) is characterized by brain plaques, tangles, and cognitive impairment. AD is one of the most common age-related dementias in humans. Progress in characterizing AD and other age-related disorders is hindered by a perceived dearth of animal models that naturally reproduce diseases observed in humans. Mice and nonhuman primates are model systems used to understand human diseases. Still, these model systems lack many of the biological characteristics of Alzheimer-like diseases (e.g., plaques, tangles) as they grow older. In contrast, companion animal models (cats and dogs) age in ways that resemble humans. Both companion animal models and humans show evidence of brain atrophy, plaques, and tangles, as well as cognitive decline with age. We embrace a One Health perspective, which recognizes that the health of humans is connected to those of animals, and we illustrate how such a perspective can work synergistically to enhance human and animal health. A comparative biology perspective is ideally suited to integrate insights across veterinary and human medical disciplines and solve long-standing problems in aging.
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Doença de Alzheimer , Animais , Gatos , Cães , Humanos , Camundongos , Envelhecimento , Encéfalo , Animais de Estimação , Placa AmiloideRESUMO
Fossil endocasts record features of brains from the past: size, shape, vasculature, and gyrification. These data, alongside experimental and comparative evidence, are needed to resolve questions about brain energetics, cognitive specializations, and developmental plasticity. Through the application of interdisciplinary techniques to the fossil record, paleoneurology has been leading major innovations. Neuroimaging is shedding light on fossil brain organization and behaviors. Inferences about the development and physiology of the brains of extinct species can be experimentally investigated through brain organoids and transgenic models based on ancient DNA. Phylogenetic comparative methods integrate data across species and associate genotypes to phenotypes, and brains to behaviors. Meanwhile, fossil and archeological discoveries continuously contribute new knowledge. Through cooperation, the scientific community can accelerate knowledge acquisition. Sharing digitized museum collections improves the availability of rare fossils and artifacts. Comparative neuroanatomical data are available through online databases, along with tools for their measurement and analysis. In the context of these advances, the paleoneurological record provides ample opportunity for future research. Biomedical and ecological sciences can benefit from paleoneurology's approach to understanding the mind as well as its novel research pipelines that establish connections between neuroanatomy, genes and behavior.
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Encéfalo , Fósseis , Filogenia , Arqueologia , ArtefatosRESUMO
OBJECTIVE: To explore the policies for, and implementation of, the community case management (CCM) of childhood illnesses in the 68 countries that were prioritized by the "Countdown to 2015" initiative in 2008. METHODS: In 2009-2010, community approaches concerning CCM policy and implementation, the roles of community health workers (CHWs) and the availability of medicines for the treatment of malaria, diarrhoea, pneumonia and neonatal infections were investigated by sending questionnaires to implementers and policy-makers and through telephone discussions with appropriate researchers and experts. FINDINGS: Of the 59 countries that responded, 81%, 75%, 54% and 14% had a policy for the CCM of diarrhoea, malaria, pneumonia and neonatal infections, respectively. Only three (6%) of the 53 malaria-endemic countries providing responses had policies for all four of these conditions, although 17 (32%) had CCM policies for malaria, diarrhoea and pneumonia. Some CCM of childhood illnesses was being implemented--more commonly for diarrhoea and malaria than for pneumonia or neonatal infections--in 88% of the countries providing responses. According to the responses received, CHWs administered the recommended treatments for diarrhoea, malaria or pneumonia in 34% (17/50), 100% (41/41) and 100% (34/34) of the countries implementing CCM of these conditions, respectively. Common programme concerns were drug supplies, quality of care and CHW incentives, training and supervision. CONCLUSION: Despite progress, further efforts are needed towards policy reform and the expansion of CCM programmes. Ensuring the availability of recommended medicines and operational research, to assure quality, remain priorities.
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Administração de Caso/organização & administração , Saúde Global , Promoção da Saúde/métodos , Internacionalidade , Pediatria/métodos , Prática de Saúde Pública , Adolescente , Criança , Proteção da Criança , Pré-Escolar , Educação em Saúde/métodos , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Organizações , Nações UnidasRESUMO
OBJECTIVE: Intermittent preventive treatment in infants (IPTi) is a malaria control strategy currently recommended by WHO for implementation at scale in Africa, consisting of administration of sulphadoxine-pyrimethamine (SP) coupled with routine immunizations offered to children under 1 year. In this study, we analysed IPTi acceptability by communities and health staff. METHODS: Direct observation, in-depth interviews (IDIs) and focus group discussions (FGDs) were conducted in Benin, Madagascar and Senegal during IPTi pilot implementation. Villages were stratified by immunization coverage. Data were transcribed and analysed using NVivo7 software. RESULTS: Communities' knowledge of malaria aetiology and diagnosis was good, although generally villagers did not seek treatment at health centres as their first choice. Perceptions and attitudes towards IPTi were very positive among communities and health workers. A misconception that SP was an antipyretic that prevents post-vaccinal fever contributed to IPTi's acceptability. No refusals or negative rumours related to IPTi coupling with immunizations were identified, and IPTi did not negatively influence attitudes towards other malaria control strategies. Healthcare decisions about children, normatively made by the father, are starting to shift to educated and financially independent mothers. DISCUSSION: Intermittent preventive treatment in infants is well accepted by providers and communities, showing a synergic acceptability when coupled with routine immunizations. However, a misconception that SP alleviates fever should be addressed when scaling up implementation.
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Antimaláricos/uso terapêutico , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Programas de Imunização , Malária/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Pirimetamina/uso terapêutico , Sulfadoxina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antimaláricos/administração & dosagem , Antipiréticos , Vacinas Bacterianas , Benin , Serviços de Saúde Comunitária/estatística & dados numéricos , Tomada de Decisões , Combinação de Medicamentos , Feminino , Humanos , Lactente , Madagáscar , Masculino , Vacina contra Sarampo , Pessoa de Meia-Idade , Pais , Percepção , Pirimetamina/administração & dosagem , Características de Residência , Senegal , Sulfadoxina/administração & dosagem , Vacinação , Organização Mundial da Saúde , Adulto JovemRESUMO
BACKGROUND: Primary Health Care (PHC) is a strategy endorsed for attaining equitable access to basic health care including treatment and prevention of endemic diseases. Thirty four years later, its implementation remains sub-optimal in most Sub-Saharan African countries that access to health interventions is still a major challenge for a large proportion of the rural population. Community-directed treatment with ivermectin (CDTi) and community-directed interventions (CDI) are participatory approaches to strengthen health care at community level. Both approaches are based on values and principles associated with PHC. The CDI approach has successfully been used to improve the delivery of interventions in areas that have previously used CDTi. However, little is known about the added value of community participation in areas without prior experience with CDTi. This study aimed at assessing PHC in two rural Malawian districts without CDTi experience with a view to explore the relevance of the CDI approach. We examined health service providers' and beneficiaries' perceptions on existing PHC practices, and their perspectives on official priorities and strategies to strengthen PHC. METHODS: We conducted 27 key informant interviews with health officials and partners at national, district and health centre levels; 32 focus group discussions with community members and in-depth interviews with 32 community members and 32 community leaders. Additionally, official PHC related documents were reviewed. RESULTS: The findings show that there is a functional PHC system in place in the two study districts, though its implementation is faced with various challenges related to accessibility of services and shortage of resources. Health service providers and consumers shared perceptions on the importance of intensifying community participation to strengthen PHC, particularly within the areas of provision of insecticide treated bed nets, home case management for malaria, management of diarrhoeal diseases, treatment of schistosomiasis and provision of food supplements against malnutrition. CONCLUSION: Our study indicates that intensified community participation based on the CDI approach can be considered as a realistic means to increase accessibility of certain vital interventions at community level.
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Serviços de Saúde Comunitária/métodos , Pesquisa Participativa Baseada na Comunidade , Doenças Endêmicas/prevenção & controle , Ivermectina/uso terapêutico , Oncocercose/diagnóstico , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Serviços de Saúde Rural , África Subsaariana , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/estatística & dados numéricos , Terapia Diretamente Observada , Indicadores Básicos de Saúde , Humanos , Entrevistas como Assunto , Malaui , Oncocercose/tratamento farmacológico , Oncocercose/epidemiologia , Atenção Primária à Saúde , Pesquisa Qualitativa , Fatores SocioeconômicosRESUMO
Research on the origin of vision and vision loss in naturally "blind" animal species can reveal the tasks that vision fulfills and the brain's role in visual experience. Models that incorporate evolutionary history, natural variation in visual ability, and experimental manipulations can help disentangle visual ability at a superficial level from behaviors linked to vision but not solely reliant upon it, and could assist the translation of ophthalmological research in animal models to human treatments. To unravel the similarities between blind individuals and blind species, we review concepts of "blindness" and its behavioral correlates across a range of species. We explore the ancestral emergence of vision in vertebrates, and the loss of vision in blind species with reference to an evolution-based classification scheme. We applied phylogenetic comparative methods to a mammalian tree to explore the evolution of visual acuity using ancestral state estimations. Future research into the natural history of vision loss could help elucidate the function of vision and inspire innovations in how to address vision loss in humans.