Changing Clinical Epidemiology of Plasmodium vivax Malaria as Transmission Decreases: Population-Based Prospective Panel Survey in the Brazilian Amazon.

BACKGROUND: Malarial infections are often missed by microscopy, and most parasite carriers are asymptomatic in low-endemicity settings. Whether parasite detectability and its ability to elicit symptoms change as transmission declines remains unclear. METHODS: We performed a prospective panel survey with repeated measurements on the same participants over 12 months to investigate whether Plasmodium vivax detectability by microscopy and risk of symptoms upon infection varied during a community-wide larviciding intervention in the Amazon basin of Brazil that markedly reduced vector density. We screened 1096 to 1400 residents in the intervention site for malaria by microscopy and quantitative TaqMan assays at baseline and twice during intervention. RESULTS: We found that more P vivax infections than expected from their parasite densities measured by TaqMan assays were missed by microscopy as transmission decreased. At lower transmission, study participants appeared to tolerate higher P vivax loads without developing symptoms. We hypothesize that changes in the ratio between circulating parasites and those that accumulate in the bone marrow and spleen, by avoiding peripheral blood microscopy detection, account for decreased parasite detectability and lower risk of symptoms under low transmission. CONCLUSIONS: P vivax infections are more likely to be subpatent and remain asymptomatic as malaria transmission decreases.

Morbimortalidade por pneumonia no estado da Bahia no período pré e durante a pandemia de COVID-19 ­ base de dados do DATASUS / Pneumonia morbidity and mortality in the state of Bahia in the period before and during the COVID-19 pandemic ­ DATASUS database

Introdução: a pneumonia é uma infecção nos pulmões, provocada pela penetração de microrganismos. Outras infeções respiratórias, incluindo a SARS-COV-2, podem agravar a clínica do paciente. Por sua vez, esta é uma doença sistêmica, com foco pulmonar que pode gerar complicações respiratórias, dentre elas a pneumonia. Neste seguimento, estudos evidenciam que 15% dos pacientes com COVID-19 podem apresentar pneumonia leve e 5% evoluir para pneumonia grave. Objetivo: comparar a ocorrência de morbimortalidade por pneumonia no Estado da Bahia, no período pré e durante a pandemia de COVID-19. Metodologia: trata-se de um estudo ecológico, quantitativo, com dados públicos, disponíveis no Sistema Informações em Saúde da plataforma DataSUS/ TABNet, referentes ao Estado da Bahia, no período de jan./2018 a dez./2021. Foram selecionados os dados: internamentos, média de internamento, óbitos e taxa de mortalidade. Os dados foram analisados através da estatística descritiva, frequência relativa, e estatística analítica com o teste de frequências relativas U de Mann-Whitney. Resultados: o Estado da Bahia, registrou um total de 48 mil internações por pneumonia, com média de taxa de permanência de internamento de 6,4 dias e um total de 8 mil óbitos, com média de taxa de mortalidade de 16,91% ao ano. Observa-se que ocorreu redução nas internações e óbitos, e aumento na taxa de mortalidade por pneumonia, no período estudado (P<0,001). Conclusão: contudo, verificou-se que no Estado da Bahia durante o período da pandemia de COVID-19, ocorreram redução no número de internados e óbitos, e aumento na taxa de mortalidade por pneumonia, comparando-se ao mesmo período pré pandemia.

Introduction: pneumonia is an infection in the lungs, caused by exposure to microorganisms. Other respiratory infections, including SARS-COV-2, may aggravate the patient's health condition. In turn, this is a systemic disease, with a pulmonary focus that can lead to respiratory complications, including pneumonia. In this area, studies show that 15% of patients with COVID-19 may have mild pneumonia and 5% progress to severe pneumonia. Objective: to compare the occurrence of morbidity and mortality from pneumonia in the State of Bahia, in the period before and during the COVID-19 pandemic. Methodology: this is an ecological, quantitative study, with public data, available in the Health Information System of the DataSUS/TABNet platform, referring to the State of Bahia, from Jan./2018 to Dec./2021. Selected data: hospitalizations, average hospitalization, deaths and mortality rate. Data were analysed using descriptive statistics, relative frequency, and analytical statistics with the Mann-Whitney U relative frequency test. Results: the State of Bahia recorded a total of 48,000 hospitalizations for pneumonia, with an average hospitalization stay rate of 6.4 days and a total of 8,000 deaths, with an average mortality rate of 16.91% per year. It is observed that there was a reduction in hospitalizations and deaths, and an increase in the mortality rate due to pneumonia, in the studied period (P<0.001). Conclusion: however, it was found that in the State of Bahia during the period of the COVID-19 pandemic, there was a reduction in the number of hospitalizations and deaths, and an increase in the mortality rate due to pneumonia, compared to the same pre-pandemic period.

Investimentos do Sistema Único de Saúde do Brasil em vocologia no período de 2008 a 2022 / Investments of the Brazilian Unified Health System in vocology in the period from 2008 to 2022

RESUMO Objetivo Analisar os investimentos do Sistema Único de Saúde do Brasil destinados à vocologia. Métodos Estudo ecológico, de caráter quantitativo com dados públicos, secundários, disponibilizados na plataforma digital DataSUS/TABNet. Os dados referem-se à quantidade e aos valores dos procedimentos da vocologia, apresentados e aprovados durante o período de 2008 a 2022 no Brasil. Após a coleta e análise descritiva dos dados, foram adotados os valores absolutos, relativos, taxas de crescimento e déficit. Resultados No período analisado foram realizados 4.6 milhões de procedimentos realizados a um custo total de R$18.350 milhões. Destes, 2.4 milhões de procedimentos foram aprovados a receberem o pagamento pelas secretarias de saúde dos estados e municípios a um custo total de R$ 10.617 milhões aos cofres públicos. Estes valores repassados representaram uma taxa de crescimento nos investimentos destinados aos procedimentos da vocologia em até 491%, se comparado ao ano de 2008, porém acumulou-se uma taxa de déficit financeiro de até 360% em todo o período estudado. Conclusão Constatou-se que os investimentos públicos destinados à vocologia passaram por crescimento significativo em todos os índices analisados, apesar de não terem sido repassados a totalidade dos valores referentes aos procedimentos realizados.

ABSTRACT Purpose To analyze the investments of the Unified Health System in Brazil destined to vocology. Methods Ecological, quantitative study with public, secondary data, available on the DataSUS/TABNet digital platform. The data refer to the quantity and values of the vocology procedures, presented and approved during the period from 2008 to 2021 in Brazil. After data collection and descriptive analysis, absolute and relative values, growth rates and deficit were adopted. Results In the analyzed period, 4,6 million procedures were carried out at a total cost of R$18,350 million. Of these, 2,4 million procedures were approved to be paid by state and municipal health departments at a total cost of R$10,617 million to public coffers. These transferred values represented a growth rate in investments destined to vocology procedures of up to 491%, if compared to 2008, however, a financial deficit rate of up to 360% was accumulated throughout the studied period. Conclusion It was verified that the public investments destined to vocology had a significant growth in all the indices analyzed, despite not having been passed on the totality of the values referring to the procedures carried out.

Fotobiomodulação no tratamento do trismo em pacientes tratados por câncer de boca ou orofaringe: um ensaio clínico controlado randomizado / Photobiomodulation in the treatment of trismus in patients treated for oral or oropharyngeal cancer: a randomized controlled clinical trial

RESUMO Objetivo investigar a eficácia da associação entre a fotobiomodulação de baixa frequência e a terapia fonoaudiológica tradicional no tratamento do trismo, em pacientes tratados por câncer de boca ou orofaringe. Métodos ensaio clínico controlado, randomizado, longitudinal e prospectivo, realizado de acordo as normas da declaração CONSORT 2010. Para a coleta de dados, foi utilizado o questionário sociodemográfico, a avaliação clínica, a mensuração da abertura de boca por paquímetro, o protocolo de dor McGuill e o protocolo de qualidade de vida WHOQOL-Bref. A amostra foi composta por 30 participantes, de ambos os gêneros na faixa etária de 35-75 anos, divididos em dois grupos, controle e experimental, de forma controlada, mediante sorteio igualitário no que tange aos critérios de inclusão e exclusão. Resultados por meio dos dados analisados, observou-se que houve aumento da amplitude vertical de mandíbula em ambos os grupos, GC: p<0,005 e GE: p<0,001. Não houve correlação estatística entre os grupos na comparação da abertura de boca, p>0,19, assim como em relação à dor orofacial e à qualidade de vida, p= 0,72, ambas as avaliações após a intervenção fonoaudiológica, porém, com melhores resultados para o GE, p<0,001. Conclusão Conclui-se pela eficácia da intervenção fonoaudiológica tradicional e a associação com a fotobiomodulação de baixa frequência no tratamento do trismo. Para a dor orofacial e qualidade de vida, o tratamento associado é mais benéfico.

ABSTRACT Purpose to investigate the effectiveness of the association between low-frequency photobiomodulation and traditional speech therapy in the treatment of trismus in patients treated for oral or oropharyngeal cancer. Methods controlled, randomized, longitudinal and prospective clinical trial, carried out in accordance with the norms of the CONSORT 2010 declaration. For data collection, a sociodemographic questionnaire, clinical evaluation, measurement of mouth opening by caliper, the protocol of McGuill pain and the WHOQOL-Bref quality of life protocol. The sample consisted of 30 participants, of both genders, aged between 35-75 years, divided into two groups, control and experimental, in a controlled manner, through an equal draw with regard to the inclusion and exclusion criteria. Results through the analyzed data, it was observed that there was an increase in the vertical amplitude of the mandible in both groups, CG: p0.19, as well as in relation to orofacial pain and quality of life, p= 0.72, both assessments after the speech therapy intervention, however, with better results for the EG, p<0.001. Conclusion It is concluded that the traditional speech therapy intervention and its association with low-frequency photobiomodulation are effective in the treatment of trismus. For orofacial pain and quality of life, associated treatment is more beneficial.

Clinically silent Plasmodium vivax infections in native Amazonians of northwestern Brazil: acquired immunity or low parasite virulence?

BACKGROUND: Malaria remains common among native Amazonians, challenging Brazil's elimination efforts. OBJECTIVES: We examined the epidemiology of malaria in riverine populations of the country's main hotspot - the upper Juruá Valley in Acre state, close to the Brazil-Peru border, where Plasmodium vivax accounts for > 80% of cases. METHODS: Participants (n = 262) from 10 villages along the Azul River were screened for malaria parasites by microscopy and genus-specific, cytochrome b (cytb) gene-based polymerase chain reaction. Positive samples were further tested with quantitative TaqMan assays targeting P. vivax- and P. falciparum-specific cytb domains. We used multiple logistic regression analysis to identify independent correlates of P. vivax infection. FINDINGS: Microscopy detected only one P. vivax and two P. falciparum infections. TaqMan assays detected 33 P. vivax infections (prevalence, 11.1%), 78.1% of which asymptomatic, with a median parasitaemia of 34/mL. Increasing age, male sex and use of insecticide-treated bed nets were significant predictors of elevated P. vivax malaria risk. Children and adults were similarly likely to remain asymptomatic once infected. MAIN CONCLUSIONS: Our findings are at odds with the hypothesis of age-related clinical immunity in native Amazonians. The low virulence of local parasites is suggested as an alternative explanation for subclinical infections in isolated populations.

Investimentos do Sistema Único de Saúde em avaliação miofuncional do sistema estomatognático / Investments of the Single Health System in myofunctional assessment of the stomatognatic system

Introdução: o sistema estomatognático é responsável por funções inatas e primordiais ao ser humano, como respiração, sucção, deglutição e fonação. O fonoaudiólogo é o profissional qualificado para realizar avaliação, diagnóstico e reabilitação desse sistema. Dessa forma, tais procedimentos são realizados por serviços de fonoaudiologia, e essa produtividade é lançada na plataforma correspondente do Sistema Único de Saúde (SUS) como "avaliação miofuncional do sistema estomatognático". Objetivo: analisar os investimentos do SUS destinados à avaliação miofuncional do sistema estomatognático no Brasil, no período de 2008 a 2021. Metodologia: trata-se de estudo ecológico, de caráter quantitativo, realizado com dados secundários disponibilizados na plataforma DataSUS/TABNet. Os dados coletados se referem a valores apresentados e aprovados para a avaliação miofuncional do sistema estomatognático, no período supracitado, no Brasil. Após a coleta, realizou-se a análise descritiva dos dados, com exposição dos valores absolutos e relativos, das taxas de crescimento e do déficit de repasses dos recursos financeiros. Resultados: no período estudado, foram realizadas 5,4 milhões de avaliações miofuncionais do sistema estomatognático, a um custo total de R$ 21,5 milhões com taxas de crescimento dos investimentos financeiros de até 64,1% ao longo dos anos. Observou-se que, em todo o período estudado, ocorreu déficit de repasses para procedimentos relacionados aos serviços de fonoaudiologia, chegando a taxas de 17464,6% de pagamentos não efetuados. Conclusão: constatou-se que houve aumento dos investimentos financeiros do SUS destinados ao procedimento de avaliação miofuncional. Contudo, foram notados, também, déficits de pagamentos pelas secretarias de saúde, destinados a uma parcela dos procedimentos realizados nos serviços de fonoaudiologia.

Introduction: the stomatognathic system is responsible for innate and primordial functions for human beings, such as breathing, sucking, swallowing and phonation. The speech therapist is the qualified professional to carry out evaluation, diagnosis and rehabilitation of this system. Thus, such procedures are performed by speech therapy services, and this productivity is released on the corresponding platform of the Unified Health System (SUS) as "myofunctional assessment of the stomatognathic system". Objective: to analyze SUS investments for the myofunctional assessment of the stomatognathic system in Brazil, from 2008 to 2021. Methodology: this is an ecological study, of a quantitative nature, carried out with secondary data available on the DataSUS/TABNet platform. The data collected refer to values presented and approved for the myofunctional assessment of the stomatognathic system, in the aforementioned period, in Brazil. After collection, a descriptive analysis of the data was carried out, with exposure of absolute and relative values, growth rates and the deficit in transfers of financial resources. Results: in the studied period, 5.4 million myofunctional assessments of the stomatognathic system were performed, at a total cost of R$ 21.5 million, with growth rates of financial investments of up to 64.1% over the years. It was observed that, throughout the studied period, there was a deficit in transfers for procedures related to speech therapy services, reaching rates of 17464.6% of payments not made. Conclusion: it was found that there was an increase in SUS financial investments for the myofunctional assessment procedure. However, deficits in payments by the health secretariats were also noted, destined for a portion of the procedures performed in the speech-language pathology services.

Malaria Resilience in South America: Epidemiology, Vector Biology, and Immunology Insights from the Amazonian International Center of Excellence in Malaria Research Network in Peru and Brazil.

The 1990s saw the rapid reemergence of malaria in Amazonia, where it remains an important public health priority in South America. The Amazonian International Center of Excellence in Malaria Research (ICEMR) was designed to take a multidisciplinary approach toward identifying novel malaria control and elimination strategies. Based on geographically and epidemiologically distinct sites in the Northeastern Peruvian and Western Brazilian Amazon regions, synergistic projects integrate malaria epidemiology, vector biology, and immunology. The Amazonian ICEMR's overarching goal is to understand how human behavior and other sociodemographic features of human reservoirs of transmission-predominantly asymptomatically parasitemic people-interact with the major Amazonian malaria vector, Nyssorhynchus (formerly Anopheles) darlingi, and with human immune responses to maintain malaria resilience and continued endemicity in a hypoendemic setting. Here, we will review Amazonian ICEMR's achievements on the synergies among malaria epidemiology, Plasmodium-vector interactions, and immune response, and how those provide a roadmap for further research, and, most importantly, point toward how to achieve malaria control and elimination in the Americas.

Epidemiology of COVID-19 after Emergence of SARS-CoV-2 Gamma Variant, Brazilian Amazon, 2020-2021.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Gamma variant has been hypothesized to cause more severe illness than previous variants, especially in children. Successive SARS-CoV-2 IgG serosurveys in the Brazilian Amazon showed that age-specific attack rates and proportions of symptomatic SARS-CoV-2 infections were similar before and after Gamma variant emergence.

Educação e outros determinantes da participação laboral de adultos mais velhos no Brasil / Education and other determinants of older adults' participation in labor force in Brazil / Educación y otros determinantes de la participación laboral de adultos mayores en Brasil

Resumo A extensão da vida laboral está ligada aos anos acumulados de estudo pelos indivíduos e às características do sistema de previdência social (COILE, 2018; GRUBER; WISE, 1999). No Brasil, ao longo das últimas décadas, as pessoas têm adquirido maior educação formal e entram tardiamente no mercado de trabalho, mas a disponibilidade de programas de aposentadoria faz com que saiam precocemente, mesmo que estejam experimentando ganhos em longevidade (QUEIROZ; FERREIRA, 2021). O presente estudo busca caracterizar as transformações, ao longo do tempo, da participação laboral de indivíduos em idades avançadas, considerando as mudanças na composição educacional. Para tanto, foram utilizados os microdados dos Censos Demográficos (1980, 1991, 2000 e 2010), obtidos no IPUMS, e da PNAD de 2015. A participação na força de trabalho foi estimada a partir de modelo logístico binário que considera seus potenciais determinantes e também representa as desigualdades que marcam o contexto. Os resultados mostram que a propensão de estar em atividade se relaciona positivamente à escolaridade. No entanto, pouco mudou no que tange às condições de trabalho de pessoas mais velhas. A precariedade enfrentada por essa mão de obra subsiste ao longo do tempo e persistem as desvantagens de mulheres e negros no que se refere à atuação no mercado de trabalho.

Abstract The extension of working life is associated with the accumulated years of schooling of individuals and with the characteristics of the pension system (COILE, 2018; GRUBER; WISE, 1999). In Brazil, people are acquiring years of education and beginning to work later. However, the availability of retirement programs make them leave early, despite increasing longevity (QUEIROZ; FERREIRA, 2021). This paper aims to characterize the changes in the labor force participation of elderly people across time, considering changes in the education composition. Census microdata were used (1980, 1991, 2000 and 2010), collected from IPUMS, and PNAD 2015. The labor force participation was estimated using binary logistic regression that considers potential determinants and represents the inequalities marking the context. Results show that the propensity to work is positively associated with schooling. However, little has changed regarding the working conditions of the elderly. The vulnerability faced by this labor force persists across time as do disadvantages for women and black people.

Resumen La extensión de la vida laboral está ligada a los años de estudio acumulados por los individuos y a las características del sistema de pensión. En Brasil, en las últimas décadas, las personas han adquirido más calificación y entran más tarde al mercado laboral, pero la disponibilidad de programas de jubilación hace que la gente se retire antes mientras que es cada vez más longeva. Este estudio tiene como objetivo caracterizar las transformaciones, en el tiempo, de la participación laboral de individuos en edades avanzadas, considerando los cambios en la composición educacional. Para eso se utilizaron los microdatos de los censos demográficos (1980, 1991, 2000 y 2010), obtenidos de IPUMS y de la PNAD de 2015. La participación en la fuerza de trabajo se estimó a partir de un modelo logístico binario que considera sus potenciales determinantes y que representa también las desigualdades que marcan el contexto. Los resultados muestran que la propensión a estar en actividad se relaciona positivamente con la escolaridad alcanzada. Sin embargo, poco hay cambiado no que se refiere a las condiciones de trabajo de las personas más viejas. La precariedad enfrentada por esa fuerza laboral subsiste a lo largo del tiempo, así como también persisten las desventajas de las mujeres y las personas negras en cuanto a su actuación en el mercado de trabajo.

Impacto da dor orofacial na qualidade de vida de portadores de câncer de boca e orofaringe / Impact of orofacial pain on the quality of life of mouth and oropharynge cancer patients

RESUMO Objetivo investigar o impacto da dor orofacial na qualidade de vida de portadores de câncer de boca e orofaringe. Métodos trata-se de um estudo de corte transversal, observacional, descritivo, com amostra de conveniência. Participaram da pesquisa 30 pacientes de ambos os sexos, na faixa etária de 35 a 75 anos. Para a coleta de dados, foi utilizado questionário sociodemográfico elaborado pelos pesquisadores e o Questionário de Dor McGill. Resultados Os achados experimentais apresentaram resultados relevantes em diversos níveis classificatórios para dor orofacial. As maiores repercussões foram encontradas nos aspectos sociais, como em relação ao sono (40%), apetite/alimentação (78%), higiene pessoal (55%) e lazer (40%), que foram os subitens que tiveram maior impacto da dor na qualidade de vida dos portadores de câncer de boca e orofaringe. Conclusão Portadores de câncer de boca e orofaringe apresentam variados níveis de dor orofacial e sofrem impactos em suas vidas, principalmente nos quesitos relacionados a atividades simples do cotidiano.

ABSTRACT Purpose To investigate the impact of orofacial pain on the quality of life of patients with oral and oropharyngeal cancer. Methods This is a cross-sectional, observational, descriptive study with a convenience sample. Thirty patients of both sexes participated in the research, aged between 35 and 75 years. For data collection, a sociodemographic questionnaire prepared by the researchers, the McGuill pain protocol, was used. Results The experimental findings show us relevant results at different classification levels for orofacial pain. The greatest repercussions were found in social aspects, such as sleep (40%), appetite/food (78%), personal hygiene (55%) and leisure (40%), which were the sub-items that had the greatest impact on pain (or which were the sub-items mostly affected by pain), affecting the the quality of life of patients with oral and oropharyngeal cancer. Conclusion Under these experimental conditions, it is concluded that patients with oral and oropharyngeal cancer present different levels of orofacial pain, and suffer impacts on their lives, especially in matters related to simple daily activities.

Clinically silent Plasmodium vivax infections in native Amazonians of northwestern Brazil: acquired immunity or low parasite virulence?

BACKGROUND Malaria remains common among native Amazonians, challenging Brazil′s elimination efforts. OBJECTIVES We examined the epidemiology of malaria in riverine populations of the country′s main hotspot - the upper Juruá Valley in Acre state, close to the Brazil-Peru border, where Plasmodium vivax accounts for > 80% of cases. METHODS Participants (n = 262) from 10 villages along the Azul River were screened for malaria parasites by microscopy and genus-specific, cytochrome b (cytb) gene-based polymerase chain reaction. Positive samples were further tested with quantitative TaqMan assays targeting P. vivax- and P. falciparum-specific cytb domains. We used multiple logistic regression analysis to identify independent correlates of P. vivax infection. FINDINGS Microscopy detected only one P. vivax and two P. falciparum infections. TaqMan assays detected 33 P. vivax infections (prevalence, 11.1%), 78.1% of which asymptomatic, with a median parasitaemia of 34/mL. Increasing age, male sex and use of insecticide-treated bed nets were significant predictors of elevated P. vivax malaria risk. Children and adults were similarly likely to remain asymptomatic once infected. MAIN CONCLUSIONS Our findings are at odds with the hypothesis of age-related clinical immunity in native Amazonians. The low virulence of local parasites is suggested as an alternative explanation for subclinical infections in isolated populations.

Chromosome Evolution in the Genus Partamona (Apidae: Meliponini), with Comments on B Chromosome Origin.

The genus Partamona includes 33 species of stingless bees, of which 11 were studied cytogenetically. The main goal of this study was to propose a hypothesis about chromosomal evolution in Partamona by combining molecular and cytogenetic data. Cytogenetic analyses were performed on 3 Partamona species. In addition, the molecular phylogeny included mitochondrial sequences of 11 species. Although the diploid number was constant within the genus, 2n = 34, B chromosomes were reported in 7 species. Cytogenetic data showed karyotypic variations related to chromosome morphology and the amount and distribution of heterochromatin and repetitive DNA. The molecular phylogenetic reconstruction corroborated the monophyly of the genus and separated the 2 clades (A and B). This separation was also observed in the cytogenetic data, in which species within each clade shared most of the cytogenetic characteristics. Furthermore, our data suggested that the B chromosome in the genus Partamona likely originated from a common ancestor of the species that have it in clade B and, through interspecific hybridization, it appeared only in Partamona rustica from clade A. Based on the above, Partamona is an interesting genus for further investigations using molecular mapping of B chromosomes as well as for broadening phylogenetic data.

Different Levels of Chromatin Condensation in Partamona chapadicola and Partamona nhambiquara (Hymenoptera, Apidae).

Studies in several organisms have contributed to the understanding of heterochromatin and its biological importance. In bees of the tribe Meliponini, the presence of chromosomes with totally heterochromatic arms has been attributed to the mechanism of karyotype evolution in which this group accumulated heterochromatin to maintain telomere stability after centric fission events. In the present study, the use of classical and molecular cytogenetic techniques as well as automated image analysis software for the description of the karyotypes of Partamonachapadicola and P. nhambiquara bee species revealed variability in the compaction and patterns of chromatin structure. Although both species have the same chromosome number as other species in the genus Partamona (2n = 34), C-banding and image analyses indicated the existence of chromosomes with 3 regions of different staining intensities, suggesting a chromatin structure with distinct patterns and characteristics. Repetitive DNA probes hybridized only in the euchromatic regions, whereas the regions with intermediate staining intensity did not show any hybridization signals. This suggests that these regions present features more similar to heterochromatin. Evidence of the existence of a chromatin class with intermediate condensation compared to euchromatin and heterochromatin indicates a potential mechanism for heterochromatin amplification and demonstrates the need for further studies on this topic. This previously unrecognized class of chromatin should be taken into account in the study of all Meliponini chromosomes.

Indivíduos com lesão por pressão na atenção domiciliar e seus cuidadores: um estudo sobre a sobrecarga do cuidado / Individuals with pressure injury in home care and their caregivers: a study on the overload care

O fenômeno da transição demográfica e epidemiológica repercute nas condições de saúde da população e geram demandas de cuidados que requerem uma reorganização do modelo de atenção à saúde. A Atenção Domiciliar(AD), apresenta-se como modalidade de assistência à saúde, prestada no domicílio a partir do pressuposto da desospitalização, como um modo de produção do cuidado. Em diversos contextos de atenção a saúde a Lesão por Pressão (LP) apresenta relevantes taxas de prevalência e constituem um sério problema de saúde, gerando impacto negativo para a qualidade de vida do indivíduo e seus cuidadores. Em decorrência do cuidado, o cuidador sofre repercussões de ordem física, psicológica e/ou social bem como de sobrecarga. Trata-se de um estudo descritivo, exploratório e transversal que teve por objetivos identificar as características sócio-demográficas e clínicas dos indivíduos com LP e de seus cuidadores na assistência domiciliar, investigar a sobrecarga do cuidado dos cuidadores e avaliar a relação entre as características sócio-demográficas e clínicas dos indivíduos com LP e dos cuidadores com a sobrecarga do cuidado. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa, e desenvolvida em duas etapas. Na primeira etapa foi realizada a identificação dos indivíduos com Lesão por Pressão (LP) atendidos em um Serviço de Assistência Domiciliar, do sistema suplementar de saúde. Na segunda etapa foram realizadas as entrevistas com os indivíduos com LP e seus cuidadores, em domicílio, para a avaliação do perfil socio demográfico e da sobrecarga do cuidado por meio da escala de Sobrecarga do Cuidado, validada no Brasil. Dos 29 indivíduos com LP, 58,6% eram do sexo masculino, 89,7% com idade de 60 anos ou mais, 69% casados e 62,1% com escolaridade de até 7 anos de estudo. Em relação ao número de lesões, 58,6% tiveram uma LP, 62,1% com evolução de até 2 anos e 72,4% tiveram como problemas de saúde as sequelas neurológicas e demências. Quanto ao cuidador houve predomínio do sexo feminino, com 89,7%, com idade maior de 50 anos de idade, 86,2% casados, 37,9% reportaram ser do lar e 27,6% aposentados, 62,2% dedicavam-se ao cuidado há menos de 5 anos, 51,2% tinham até 7 anos de estudo e 41,4% referiram ter problemas de saúde. Em relação a sobrecarga do cuidado os aspectos mais afetados foram referentes aos domínios: Isolamento, Tensão geral e Decepção. As características sociodemográficas e clínicas que contribuíram para maior sobrecarga no cuidado foram a idade do indivíduo e o tempo de lesão. Quanto ao cuidador as características sociodemográficas e clínicas que contribuiram para maior sobrecarga foram, o tempo dedicado ao cuidado, o grau de parentesco e os problemas de saúde auto relatados pelos cuidadores. Este estudo favoreceu uma melhor compreensão dos fatores que podem influenciar na sobrecarga do cuidado ao cuidador familiar. A adoção de estratégias que favoreçam uma melhor atenção à díade indivíduo e cuidador, ao que tange o preparo para o cuidado seguro e de qualidade com apoio ao cuidador em suas limitações e dificuldades vivenciadas poderão auxiliar a prevenir a sobrecarga do cuidado

Home care is a modality of health care offered at home, based on the assumption of dehospitalization as a care production method. The development of pressure injury (PI) is a serious problem in several care settings and originates a negative impact on individuals, caregivers, family members, and health systems. The present dissertation is a descriptive, exploratory, and cross-sectional study that had the objectives of identifying the sociodemographic and clinical characteristics of people with PI and their caregivers in home care, examining the care overload of caregivers, and evaluating the relationship between people with PI and caregivers' sociodemographic and clinical characteristics and care overload. The study proposal was approved by the research ethics committee and developed in two steps. The first phase consisted of identifying people with PI assisted in a home care service in the supplementary health service in the municipality of Campinas, state of São Paulo, Brazil. In the second phase, interviews with people with PI and their caregivers were carried out at home to assess their sociodemographic profile and the caregivers' overload by using the Informal Caregiver Burden Assessment Questionnaire, validated in Brazil. Among the 29 people with PI, 58.6% were men, 89.7% were 60 years old or older, 69% were married, and 62.1% had up to seven years of formal education. Regarding the number of injuries, 58.6% had one PI, 1% showed injuries with evolution of up to two years, and 72.4% had neurological sequelae and dementias as health problems. Regarding caregivers, women accounted for 89.7% of the sample, and there was a predominance of people aged over 50 years. Additionally, 86.2% were married, 37.9% reported being homemakers, 27.6% were retired, 62.2% had been dedicating to care for less than five years, 51.2% had up to seven years of formal education, and 41.4% declared to have health issues. Concerning care overload, the most affected aspects regarded the Isolation, General Overload, and Disappointment domains. The patients' sociodemographic and clinical characteristics that most contributed to care overload were age and the time since the development of the injury, whereas the caregivers' sociodemographic and clinical characteristics that showed the highest impact on care overload were the time dedicated to care, degree of kinship, and health problems self-reported by caregivers. Regarding this item, care overload was higher in all the domains and in total overload. In addition, there was a statistically significant difference in the Isolation domain. Concerning the time since the development of the injury, a positive correlation was found in all the domains except for Environment, and the correlation was statistically significant in the Disappointment domain. The present dissertation allowed to better understand the factors that can influence family caregivers' care overload. Adopting strategies that favor an improved care to the pair made up by individual and caregiver, regarding the preparation for safe and high-quality care, with support to caregivers so they can deal with their limitations and the difficulties experienced during the care process, may help prevent care overload

Intake of Polydextrose Alters Hematology and the Profile of Short Chain Fatty Acids in Partially Gastrectomized Rats.

Polydextrose (PDX) ingestion may increase the intestinal absorption of iron. This study evaluated the effects of 7.5% polydextrose supplementation on markers of iron uptake, transport and storage in partially gastrectomized rats. Half of a batch of 40 male Wistar rats (250 g) underwent Billroth II partial gastrectomy with anterior truncal vagotomy (GXT), while the other half underwent sham gastrectomy (SHAM). At 7 postoperative days, the animals were subdivided into four groups (n = 10): Sham Control and GXT Control (no polydextrose); Sham PDX and GXT PDX (with 7.5% PDX). The animals were euthanized after 60 day of PDX treatment. Organ weight, cecal pH, the characterization and quantification of short-chain fatty acids (SCFA), hematological parameters, hepatic iron content and the expression of ferroportin (FPT) in the jejunum, cecum, colon and liver were evaluated. PDX caused changes in the cecum of the supplemented animals, where there was a decrease in pH, increase in cecal wall and marked production of SCFA, especially acetic and propionic acids (p < 0.05). Hepatic iron levels were lower in GXT animals. PDX increased hemoglobin (HGB) values by 29.2% and hematocrit (HCT) by 55.8% in the GXT PDX group compared to the GXT Control group. The GXT PDX group had lower hepatic FPT expression (p < 0.05). PDX led to increased SCFA concentration in the supplemented animals. Considering that SCFAs play a central role in the increasing nutrients uptake, this mechanism may be involved in altering the hematology profile observed in these animals but not enough to reverse iron deficiency anemia in post-gastrectomy rats.

Planejamento em saúde nas equipes de saúde bucal: análise do processo de trabalho e fatores associados / Health planning in oral health teams: analysis of the work process and associated factors

O cirurgião-dentista tem, na Estratégia de Saúde da Família, um amplo campo de atuação, mas deve manter suas práticas orientadas pelos princípios da atenção básica e do SUS. Nesse contexto, dentre as atribuições da equipe de saúde bucal, o planejamento em saúde e a organização do processo de trabalho são tecnologias gerenciais obrigatórias e elementares para alcançar maior qualidade das ações e dos serviços de saúde bucal. Este estudo teve o objetivo geral de analisar as práticas e os fatores associados ao planejamento das ações das equipes de saúde bucal contratualizadas pelo PMAQ-AB. Dessa forma, trata-se de um estudo exploratório desenvolvido em duas fases: 1ª) análise quantitativa de dados secundários da avaliação externa do 2º ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) com as equipes de saúde bucal do Brasil; 2ª) pesquisa qualitativa com cirurgiõesdentistas da Estratégia de Saúde da Família e gestores de saúde do Rio Grande do Norte, Brasil. A primeira fase consistiu em uma análise quantitativa multivariada com dados dos Sistemas de Informações em Saúde agregados com variáveis socioeconômicas do Atlas de Desenvolvimento Humano no Brasil. Na segunda fase, foi realizado um estudo de caso, de caráter exploratório e qualitativo, com quatro municípios do Rio Grande do Norte, sendo utilizada a triangulação de técnicas para a coleta de dados, seguida da análise de conteúdo pelo método de Bardin. Como resultados, na análise fatorial da primeira etapa foram gerados três componentes: Pobreza e edentulismo; Cuidado à saúde bucal; Cobertura de equipe de saúde bucal. Verificou-se expressiva diferença (p<0,001) na distribuição desses componentes entre as regiões brasileiras, estando estes associados (p<0,001), em sua maioria, às questões relacionadas à prática do planejamento em saúde bucal avaliadas pelo PMAQ-AB, que também apresentaram diferenças locorregionais (p<0,001). Quanto ao estudo de caso no Rio Grande do Norte, constatou-se que o planejamento das ações de saúde bucal foi valorizado nos discursos, mas, em geral, na prática ainda é incipiente e pouco sistematizado, assim como os levantamentos epidemiológicos e a reorientação do modelo de atenção à saúde bucal. Apesar dos compromissos firmados com o PMAQ-AB, as melhorias foram pontuais e positivamente influenciadas pelo momento da avaliação externa do Programa. Ademais, identificou-se pouco apoio institucional da gestão, escassa mobilização e protagonismo dos profissionais para a qualificação do cuidado, bem como para o fortalecimento do SUS e a redução das iniquidades de saúde e de acesso (AU).

The dental surgeon has a broad field of action in the Family Health Strategy, but one must maintain the practices guided by the principles of basic care and SUS. In this context, among the attributions of the oral health team, health planning and the organization of the work process are mandatory and elementary management technologies to achieve a higher quality of actions and oral health services. This study had the general objective of analyzing the practices and factors associated with planning the actions of the oral health teams contracted by PMAQ-AB. In this way, it is an exploratory study developed in two phases: 1st) quantitative analysis of secondary data from the external evaluation of the 2nd cycle of the National Program for Improving Access and Quality of Basic Care (PMAQ-AB) with the oral health teams of Brazil; 2nd) qualitative research with dental surgeons of the Family Health Strategy and health supervisors from Rio Grande do Norte, Brazil. The first phase consisted of a multivariate quantitative analysis with data from the Health Information Systems aggregated with socioeconomic variables of the Atlas of Human Development in Brazil. In the second phase, an exploratory and qualitative case study was carried out, with four municipalities in Rio Grande do Norte, using triangulation techniques for data collection, followed by content analysis by the Bardin method. As a result, in the factorial analysis of the first stage three components were generated: Poverty and edentulism; Oral health care; Oral Health Team Coverage. There was a significant difference (p<0,001) in the distribution of these components among the Brazilian regions, this being associated (p<0,001), in the majority, to questions related to the practice of oral health planning evaluated by PMAQ-AB, which also presented locoregional differences (p<0,001). Regarding the case study in Rio Grande do Norte, it was verified that oral health planning was valued in the speeches, but in practice it is still incipient and little systematized, as well as the epidemiological surveys and the reorientation of the model of oral health care. Despite the commitments made with PMAQ-AB, the improvements were punctual and positively influenced by the moment of the external evaluation of the Program. In addition, little institutional support was identified for the management, little mobilization and leadership of professionals for the qualification of care, as well as for the strengthening of the SUS and the reduction of health and access inequities (AU).

Conhecimentos e práticas de saúde bucal por pacientes internados e equipe hospitalar / Knowledge and oral health practices for hospitalized patients and hospital staff

Introdução: Indivíduos hospitalizados mantêm maior atenção para as doenças de base, logo, negligenciam outros cuidados como a higiene bucal. Não obstante, a equipe hospitalar multidisciplinar, na ausência do cirurgião-dentista, em geral não se considera responsável pelos cuidados bucais dos pacientes. A negligência com os cuidados odontológicos favorece a proliferação de microrganismos patogênicos e o desenvolvimento de doenças biofilme dependente associada a causas de doenças sistêmicas. Objetivos: Identificar os conhecimentos e práticas de saúde bucal dos pacientes hospitalizados, além de analisar as ações de promoção e prevenção em saúde bucal prestada pelos profissionais de um Hospital de referência para a Região do Seridó, Rio Grande do Norte. Métodos: Trata-se de uma pesquisa de caráter exploratório e transversal, realizada com 166 pacientes e 50 profissionais da equipe hospitalar. Utilizou-se de entrevistas semiestruturadas como instrumento de coleta de dados. Resultados: No período da internação hospitalar, 85,5% (n=142) dos pacientes estavam com escova e creme dental, porém 15,7% (n=26) não escovaram os dentes e 18,1% (n=30) escovaram apenas uma vez em todo o período da internação. O fio dental não foi utilizado por 97,6% (n=162) dos entrevistados. Ademais, 97,6% (n=162) dos pacientes não receberam quaisquer orientações de saúde bucal pelos profissionais. Por outro lado, 58,0% (n=29) da equipe hospitalar consideram seus conhecimentos sobre saúde bucal insatisfatórios. Conclusão: Em sua maioria, os pacientes negligenciam os hábitos de higiene bucal, situação agravada pela não inclusão da saúde bucal na rotina de cuidados dos profissionais para com os enfermos. Independentemente da presença constante ou não de cirurgiões-dentistas em âmbito hospitalar, é fundamental que os pacientes sejam cercados de práticas integrais de cuidado, de forma a auxiliar na recuperação da sua saúde (AU).

Introduction: Hospitalized individuals keep more attention to the underlying diseases. Consequently, they neglect other care such as oral hygiene. Nevertheless, the multidisciplinary hospital staff, in the absence of dentists in general is not responsible for the oral care of patients. Objective: To identify the knowledge and oral health practices of hospitalized patients, and to analyze the actions of promotion and prevention in oral health professionals provided by a reference hospital for Seridó Region, Rio Grande do Norte. Methods: This is an exploratory and transversal research conducted with 166 patients and 50 professionals from the hospital staff. We used semi-structured interviews as a data collection instrument. Results: In hospital length of stay, 85.5% (n=142) of patients had toothbrush and toothpaste, but 15.7% (n=26) did not brush their teeth and 18.1% (n=30) only brushed once in the entire period of hospitalization. Dental floss was not used by 97.6% (n = 162) of respondents. In addition, 97.6% (n = 162) of patients did not receive any oral health guidelines by the professionals. On the other hand, 58.0% (n=29) of the hospital staff considered unsatisfactory their knowledge about oral health. Conclusions: It is a fact that some patients neglect oral hygiene habits, in addition to not be routine professional care of the oral health of the sick. Regardless of the constant presence or absence of dentists in the hospital environment, it is essential that patients are surrounded by care of integral practices in order to assist in the recovery of his health (AU).

Mitotic activity of the brain ganglia in different subphases of the last larval instar of Melipona quadrifasciata lepeletier (Hymenoptera, apidae, meliponini) / Atividade mitótica do gânglio cerebral em diferentes fases do último instar larval de melipona quadrifasciata (hymenoptera, apidae, meliponini) / MITOTIC ACTIVITY OF THE BRAIN GANGLIA IN DIFFERENT SUBPHASES OF THE LAST LARVAL INSTAR OF MELIPONA QUADRIFASCIATA LEPELETIER (HYMENOPTERA, APIDAE, MELIPONINI)

In recent years, the number of cytogenetic studies on Melipona species has increased considerably. However, most cytogenetic techniques used for these studies require preparations with a great number of metaphase cells for reliable analysis of the karyotypes. The present study seeks to evaluate which subphase of the last larval instar of Melipona quadrifasciata Lepeletier provides the greatest number of metaphases, which is here considered a direct measure of mitotic activity. A total of 25 defecating larvae were selected based on the quantity of feces in their intestines, so as to maintain five larvae in each of the five different developmental subphases. The brain ganglia of each larva were extracted and used for cytogenetic preparation. The number of metaphase mitotic cells per preparation was counted. An analysis of variance (ANOVA) model, with Tukey's post hoc tests, was conducted. It was observed that larvae in the second subphase, defined here as the subphase in which feces were visible below the segment VII, provided the greatest number of metaphases. Therefore, it is the most appropriate developmental subphase for cytogenetic preparations of brain glanglia in M. quadrifasciata and possibly in other Melipona species.

Estudos citogenéticos envolvendo o gênero Melipona vêm aumentando nos últimos anos. Entretanto, a utilização de várias técnicas para o estudo do cariótipo exigem preparações com um grande número de células em metáfase para uma análise confiável das características citogenéticas das espécies. O presente estudo teve como principal objetivo avaliar, para Melipona quadrifasciata, o instar do desenvolvimento larval mais adequado para estudos citogenéticos, no que se refere à atividade mitótica. Foram selecionadas 25 larvas defecantes divididas em cinco subfases de acordo com a quantidade restante de fezes no intestino. Os gânglios cerebrais das larvas foram extraídos e utilizados para a obtenção dos cromossomos mitóticos metafásicos. O número de metáfases por lâmina foi contabilizado para cada indivíduo e os dados submetidos à análise de variância (ANOVA) e ao teste de TUKEY. Foi observado que larvas da segunda subfase, definidas aqui como a subfase na qual as fezes se encontram na altura do VII segmento apresentaram o maior número de metáfases. Logo, esta é a subfase mais indicada para obtenção de grande número de metáfases em células do gânglio cerebral de Melipona quadrifasciata e, possivelmente, para outras espécies do gênero Melipona.

Evidence of separate karyotype evolutionary pathway in Euglossa orchid bees by cytogenetic analyses.

Euglossini are solitary bees considered important pollinators of many orchid species. Information regarding chromosome organization is available for only a small number of species in this group. In the present work, the species Euglossa townsendi and E. carolina were analyzed by cytogenetic techniques to collect information that may aid the understanding of their evolution and chromosomal organization. The chromosome number found was n = 21 for males and 2n = 42 for females in the two species. The distribution and amount of heterochromatin regions differed in the two species analyzed, where they were classified as “high” or “low” heterochromatin content, similarly to what has already been performed in social bee species of the genus Melipona. Banding patterns found in this study suggest that other mechanisms may have occurred in the karyotype evolution of this group, unlike those suggested for social bees and ants. Karyotype evolution of solitary bees appears to have occurred as an event separate from other hymenopterans and did not involve chromosome fissions and heterochromatin amplification.

Occurrence of B chromosomes in Tetragonisca Latreille, 1811 (Hymenoptera, Apidae, Meliponini): A new contribution to the cytotaxonomy of the genus.

Tetragonisca angustula and Tetragonisca fiebrigi have recently been listed as valid species. This study aimed to cytogenetically investigate both species, emphasizing the new registry of B chromosomes in the tribe Meliponini. We analyzed colonies of T. angustula and T. fiebrigi collected at Tangará da Serra, Mato Grosso, Brazil, through conventional Giemsa staining, C-banding, and base-specific fluorochrome staining (CMA(3)/DAPI). T. angustula showed 2n = 34 chromosomes in females and n = 17 in males, with karyotype formula 2K = 34A(M). T. fiebrigi showed numeric variation, with chromosome number varying from 2n = 34 to 2n = 36 in females and from n = 17 to n = 18 in males, with karyotype formula 2K = 32A(M)+2A(Mc) and 2K = 32A(M)+2A(Mc) + 1 or 2 B-chromosomes. The B chromosomes are heterochromatic. In T. fiebrigi, the CMA(3)/DAPI staining revealed four chromosomes with a CMA(3) positive band. All individuals from the same colony showed the same number of B chromosomes. T. angustula and T. fiebrigi showed karyotype divergence, principally due to the presence of B chromosomes, which are found only in T. fiebrigi. Our data corroborate the status of valid species for both T. angustula and T. fiebrigi, as recently proposed.