Neutrophilic leukocytosis and erythema nodosum leprosum in leprosy: insights from a retrospective observational study.

Background: Leprosy reactions represent immunologically mediated episodes of acute inflammation that, if not diagnosed and treated promptly, can cause irreversible impairment of nerve function and permanent disabilities. A frequent type of reaction experienced by patients with lepromatous leprosy (LL) and borderline lepromatous leprosy (BL) is erythema nodosum leprosum (ENL), an inflammatory complication that may become chronic or recur in multiple episodes. Although ENL is commonly described as a neutrophil-mediated immune disease, the role of neutrophils is not fully understood. In this study, we assess neutrophilic leukocytosis in a retrospective cohort of patients affected by BL or LL leprosy. Materials and methods: A retrospective observational study was performed using data from 146 patients with BL and LL leprosy diagnosed and treated at the Souza Araújo Outpatient Clinic, Fiocruz, Rio de Janeiro, Brazil. Clinical, demographic, and hematological data were extracted from medical records. Skin biopsy samples obtained from patients for ENL diagnosis were used for histopathological evaluations. Results: Most patients were male (75%) and had a reactional episode (85%), of which 65% were ENL. Multiple episodes were common, 55% of the 80 patients with ENL presented more than 2 episodes (average of 2.6 episodes). In treatment-naive BL/LL patients, the median blood neutrophil counts of patients who developed ENL at some points of their disease course were higher than those who did not experience any reaction (median= 4,567 cells/mm3 vs 3,731 cells/mm3 respectively, p=0.0286). A correlation between the increase in median neutrophil counts and ENL severity was confirmed (6,066 cells/mm3 for mild ENL vs 10,243 cells/mm3 for moderate/severe ENL, p=0.0009). A longitudinal assessment was also performed in 34 patients, confirming the neutrophilic leukocytosis (BL/LL: 4896 cells/mm3 vs ENL: 8408 cells/mm3, p<0.0001). Moreover, increased NLR was associated with a greater neutrophilic infiltration in ENL lesions. Conclusion: We demonstrate that ENL episodes in patients affected by leprosy are associated with elevated blood leukocyte and neutrophil counts and an increased NLR. These findings highlight the significant involvement of neutrophils in the ENL immunological/inflammatory process.

Challenges to implementing planning processes in Brazilian health regions.

OBJECTIVE: To recognize elements that facilitated or hindered the PlanificaSUS implementation stages. METHODS: A multiple case study was carried out in four pre-selected health regions in Brazil-Belo Jardim (PE), Fronteira Oeste (RS), Sul-Mato-Grossense (MT) and Valença (BA) using systemic arterial hypertension and maternal and child care as tracer conditions. Participant observation (in regional interagency commissions) and in-depth interviews with key informants from state and municipal management and primary health care and specialized outpatient care service professionals within the project were carried out in these four regions. Analysis was built according to political, technical-operational, and contextual dimensions. RESULTS: The political dimension evinced that the regions found the project an opportunity to articulate states and municipalities and an important political bet to build networks and lines of care but that there remained much to be faced in the disputes related to building the Unified Health System (SUS). In the technical operational dimension, it is important to consider that primary health care stimulated a culture of local planning and favored traditional tools to organize and improve it, such as organizing registrations, agendas, and demands. However, centralized training and planning-inducing processes fail to always respond to local needs and can produce barriers to implementation. CONCLUSIONS: It is worth considering the central and regional role of state managers in the commitment related to the project and the effect of mobilizing primary health care and expanding its power. There remains much to be faced in the disputes at stake in bullring SUS.

Making science public: a review of journalists' use of Open Access research.

Science journalists are uniquely positioned to increase the societal impact of open research outputs by contextualizing and communicating findings in ways that highlight their relevance and implications for non-specialist audiences. Yet, it is unclear to what degree journalists use open research outputs, such as open access publications or preprints, in their reporting; what factors motivate or constrain this use; and how the recent surge in openly available research seen during the COVID-19 pandemic has affected this. This article examines these questions through a review of relevant literature published from 2018 onwards-particularly literature relating to the COVID-19 pandemic-as well as seminal articles outside the search dates. We find that research that explicitly examines journalists' engagement with open access publications or preprints is scarce, with existing literature mostly addressing the topic tangentially or as a secondary concern, rather than a primary focus. Still, the limited body of evidence points to several factors that may hamper journalists' use of these outputs and thus warrant further exploration. These include an overreliance on traditional criteria for evaluating scientific quality; concerns about the trustworthiness of open research outputs; and challenges using and verifying the findings. We also find that, while the COVID-19 pandemic encouraged journalists to explore open research outputs such as preprints, the extent to which these explorations will become established journalistic practices remains unclear. Furthermore, we note that current research is overwhelmingly authored and focused on the Global North, and the United States specifically. We conclude with recommendations for future research that attend to issues of equity and diversity, and more explicitly examine the intersections of open access and science journalism.

Do we need a concept to address the influence of technologies in health? The proposal of Digital Determinants of Health / ¿Necesitamos un concepto para la influencia de las tecnologías? La propuesta de los Determinantes Digitales de la Salud / Precisamos de um conceito para a influência massiva das novas tecnologias na saúde? A proposta dos Determinantes Digitais da Saúde

Recognizing the significant effects of the New Information and Communication Technologies (NICTs), the work reports the experience of a reflection group on the following question: does the massive and pervasive use of technologies in life, and therefore in health, deserve its own concept for analytical and sociopolitical emphasis? Through the experience systematization proposed by Holliday (2006), we propose the concept of Digital Determinants of Health (DDH) as it reflects the need to better highlight NICTs' actions in the production of health - both from an epistemological and sociopolitical point of view. By suggesting the DDH concept, we urge the academic community to a more specific debate on the consequences of NICTs in contemporary life, in order to guide actions capable of mitigating negative effects and leveraging the benefits of new technologies in healthcare.

Reconociendo los efectos significativos de las Nuevas Tecnologías de la Información y la Comunicación (NTIC), este artículo relata la experiencia de un grupo sobre la cuestión: ¿merece el uso masivo y omnipresente de las tecnologías en la vida, y en consecuencia en la salud, un concepto propio para su prominencia analítica y sociopolítica? Utilizando la sistematización de Holliday (2006), el grupo propuso el concepto de Determinantes Digitales de la Salud (DDS) por la necesidad de destacar la acción de las NTIC en la salud, tanto desde el punto de vista epistemológico como sociopolítico. Con el concepto de DDS, instamos a la comunidad académica a mantener un debate más específico sobre las consecuencias de las NTIC en la vida contemporánea para orientar acciones capaces de mitigar los efectos negativos y maximizar los beneficios de las nuevas tecnologías en la salud.

Reconhecendo os efeitos significativos das Novas Tecnologias de Informação e Comunicação (NTICs), o trabalho relata a experiência de um grupo de reflexão sobre a seguinte questão: a utilização de tecnologias de modo massivo e pervasivo na vida e, consequentemente, na saúde, merece conceito próprio para destaque analítico e sociopolítico? Por meio da sistematização de experiências de Holliday (2006), o grupo propõe o conceito de Determinantes Digitais da Saúde (DDS) por entender a necessidade de evidenciar com mais força a ação das NTICs na produção da saúde ­ tanto do ponto de vista epistemológico, quanto do sociopolítico. Com a sugestão do conceito de DDS, exortamos a comunidade acadêmica a um debate mais específico sobre as consequências das NTICs na vida contemporânea para a orientação de ações capazes de mitigar os efeitos negativos e potencializar os benefícios das novas tecnologias na saúde.

Legado da epidemia de Zika vírus: o impacto da associação causal para além da ciência de laboratório / Zika virus epidemic legacy: the impact of causal association beyond laboratory science

Resumo Passados mais de quatro anos da epidemia de Zika vírus, tem-se a tarefa de continuar a investigar o seu legado. Aqui, descreve-se o impacto da associação causal entre o Zika vírus e as alterações observadas em fetos e bebês, uma busca que marcou a pauta dos cientistas e da imprensa entre 2015 e 2017. Por meio dos estudos Sociais de Ciência e Tecnologia, que vê o fato científico como coproduzido pela ciência e pela sociedade, realizamos 17 entrevistas semiestruturadas entre cientistas, gestores, professionais de saúde e famílias de crianças em oito cidades brasileiras. Vê-se que a causalidade teve impacto parcial e dúbio na organização dos serviços - com a sobreposição entre vigilância e atenção, gerando, inicialmente, assimetrias no Sistema Único de Saúde. Entre as famílias e profissionais de saúde, nota-se demandas por pesquisas de intervenções e de cuidado, consideradas como não sendo prioridade entre os cientistas. Já entre os pesquisadores, observa-se distanciamento entre estudo e enfrentamento, com o social sendo constituído por demandas não integradas ao campo científico. Para que demandas sociais encontrem fluxo no fazer científico, sugere-se para crises futuras de saúde pública a multiplicação do número de perguntas da ciência e a maior diversidade dos desenhos de pesquisa.

Abstract More than four years after the Zika virus epidemic, we are left with the task of investigating its legacy. Here, we describe the impact of the causal association between the Zika virus and the abnormalities seen in fetuses, a search that marked the scientific and press agenda at the time. By using the Social Studies of Science and Technology, which establishes the scientific fact as co-produced by science and society, we carried out 17 semi-structured interviews between scientists, managers, health professionals and families of the children in eight Brazilian cities. We observed that causality had a partial and dubious impact on the organization of services - with the overlap between surveillance and care initially generating asymmetries in the Brazilian Unified Health System. Between families and health professionals, there are demands for research on interventions and care, considered as not being prioritized among scientists. Among the researchers, we notice a gap between study and coping, with the social being constituted by demands that are not integrated into the scientific field. For future public health crises, we point to multiplying the number of research questions and study designs, so that social demands find flow in scientific doing.

Challenges to implementing planning processes in Brazilian health regions / Desafios para a implementação de processos de planificação em regiões de saúde

ABSTRACT OBJECTIVE To recognize elements that facilitated or hindered the PlanificaSUS implementation stages. METHODS A multiple case study was carried out in four pre-selected health regions in Brazil—Belo Jardim (PE), Fronteira Oeste (RS), Sul-Mato-Grossense (MT) and Valença (BA) using systemic arterial hypertension and maternal and child care as tracer conditions. Participant observation (in regional interagency commissions) and in-depth interviews with key informants from state and municipal management and primary health care and specialized outpatient care service professionals within the project were carried out in these four regions. Analysis was built according to political, technical-operational, and contextual dimensions. RESULTS The political dimension evinced that the regions found the project an opportunity to articulate states and municipalities and an important political bet to build networks and lines of care but that there remained much to be faced in the disputes related to building the Unified Health System (SUS). In the technical operational dimension, it is important to consider that primary health care stimulated a culture of local planning and favored traditional tools to organize and improve it, such as organizing registrations, agendas, and demands. However, centralized training and planning-inducing processes fail to always respond to local needs and can produce barriers to implementation. CONCLUSIONS It is worth considering the central and regional role of state managers in the commitment related to the project and the effect of mobilizing primary health care and expanding its power. There remains much to be faced in the disputes at stake in bullring SUS.

RESUMO OBJETIVO Reconhecer elementos que facilitaram ou dificultaram as etapas do processo de implementação do PlanificaSUS. MÉTODOS Foi realizado um estudo de casos múltiplos em quatro regiões de saúde pré-selecionadas - Belo Jardim (PE), Fronteira Oeste (RS), Sul-Mato-Grossense (MT), Valença (BA) -, utilizando como condições traçadoras a hipertensão arterial sistêmica e a atenção materno infantil. Foi realizada observação participante na Comissão Intergestora Regional (CIR), bem como entrevistas em profundidade nas quatro regiões estudadas, com informantes-chave da gestão estadual e municipal e com profissionais dos serviços da atenção primária à saúde e atenção ambulatorial especializada envolvidos no projeto. Construiu-se análise em três dimensões: política, técnico operacional e contexto. RESULTADOS Na dimensão política, ficou evidenciado que, de alguma forma, as regiões identificaram no projeto uma oportunidade de articulação entre estados e municípios e uma aposta política importante para a construção de redes e linhas de cuidado, mas ainda com muitos caminhos a percorrer para enfrentar as barreiras identificadas nas disputas em jogo na construção do Sistema Único de Saúde (SUS). Na dimensão técnico operacional, é importante considerar que foi estimulada uma cultura de planejamento local na APS, além do favorecimento do uso de ferramentas tradicionais, no sentido de organizá-la e qualificá-la, como a organização dos cadastros, da agenda e da demanda. No entanto, os processos centralizados formativos e indutores da planificação nem sempre respondem às necessidades singulares dos territórios e podem produzir barreiras à implementação. CONCLUSÕES Cabe considerar o papel do gestor estadual na aposta relacionada ao projeto, tanto no nível central quanto no nível regional, e o efeito de processos de mobilização da atenção primária à saúde e amplificação de sua potência, mas ainda com muitos caminhos a percorrer para enfrentar as barreiras identificadas nas disputas em jogo na construção do SUS.

Disputas epistemológicas na associação causal entre Zika vírus e síndrome congênita: uma análise de controvérsia / Epistemological disputes in the causal link between Zika virus and congenital syndrome: a controversy analysis

Resumo Um aumento de más-formações em crianças em 2015 no Brasil é associado ao vírus Zika que circulara meses antes, deixando disputas que ainda possui ecos. Usando elementos de um campo das ciências sociais que se dedica ao mapeamento de controvérsias científicas, este trabalho realizou 15 entrevistas semiestruturadas com pesquisadores e gestores envolvidos na associação causal. Investigou-se como esses atores observam o papel de condicionantes sociais no desfecho da Síndrome Congênita por Vírus Zika (SCZ) e os caminhos trilhados para mitigá-los após a epidemia. Há uma preocupação de todos com variáveis sociais e sua relevância no desfecho da SCZ, com uma decepção generalizada sobre o encaminhamento dessas questões após o pico de casos, mas esses fatores não entraram em uma narrativa mais central sobre a causalidade. Nota-se também disputas epistêmicas sobre esse desfecho. Uns atrelam à responsabilidade ao poder público ou se resignam com o resultado; outros cobram posturas ativas de pesquisadores que participaram de centros do poder, com divergências sobre o posicionamento da ciência. O artigo pontua a necessidade de ciências reflexivas que atentem para sua agência no mundo, bem como para articulações de narrativas interdisciplinares e multicausais para crises de saúde pública no Brasil.

Abstract An increase in child malformations in 2015 in Brazil is associated with a Zika virus spread months earlier, leaving disputes that still echo. Using elements from a sociology field dedicated to scientific controversy mapping, the present study conducted 15 semi-structured interviews with researchers and administrators involved in this causal association. Our work investigated how actors from different areas observe the role of social conditions in the outcome of the Congenital Zika Syndrome (SCZ) and the paths taken to mitigate them after the epidemic. Concern with social variables and their relevance in the SCZ outcome was observed, with a widespread disappointment about the referral of these issues after the case's peak; however, these factors have not entered the core narrative about causality. There are epistemic disputes about this outcome. Some attach responsibility to the public power or resign themselves to the result; others demand more active positions from researchers who had access to the decision-making process, with disagreements about the positioning of science. The article points out the need for reflective sciences that dialogue with their agency on the phenomena, as well as for interdisciplinary and multicausal articulations for public narratives on public health crises in Brazil.

Epistemological disputes in the causal link between Zika virus and congenital syndrome: a controversy analysis. / Disputas epistemológicas na associação causal entre Zika vírus e síndrome congênita: uma análise de controvérsia.

An increase in child malformations in 2015 in Brazil is associated with a Zika virus spread months earlier, leaving disputes that still echo. Using elements from a sociology field dedicated to scientific controversy mapping, the present study conducted 15 semi-structured interviews with researchers and administrators involved in this causal association. Our work investigated how actors from different areas observe the role of social conditions in the outcome of the Congenital Zika Syndrome (SCZ) and the paths taken to mitigate them after the epidemic. Concern with social variables and their relevance in the SCZ outcome was observed, with a widespread disappointment about the referral of these issues after the case's peak; however, these factors have not entered the core narrative about causality. There are epistemic disputes about this outcome. Some attach responsibility to the public power or resign themselves to the result; others demand more active positions from researchers who had access to the decision-making process, with disagreements about the positioning of science. The article points out the need for reflective sciences that dialogue with their agency on the phenomena, as well as for interdisciplinary and multicausal articulations for public narratives on public health crises in Brazil.

Um aumento de más-formações em crianças em 2015 no Brasil é associado ao vírus Zika que circulara meses antes, deixando disputas que ainda possui ecos. Usando elementos de um campo das ciências sociais que se dedica ao mapeamento de controvérsias científicas, este trabalho realizou 15 entrevistas semiestruturadas com pesquisadores e gestores envolvidos na associação causal. Investigou-se como esses atores observam o papel de condicionantes sociais no desfecho da Síndrome Congênita por Vírus Zika (SCZ) e os caminhos trilhados para mitigá-los após a epidemia. Há uma preocupação de todos com variáveis sociais e sua relevância no desfecho da SCZ, com uma decepção generalizada sobre o encaminhamento dessas questões após o pico de casos, mas esses fatores não entraram em uma narrativa mais central sobre a causalidade. Nota-se também disputas epistêmicas sobre esse desfecho. Uns atrelam à responsabilidade ao poder público ou se resignam com o resultado; outros cobram posturas ativas de pesquisadores que participaram de centros do poder, com divergências sobre o posicionamento da ciência. O artigo pontua a necessidade de ciências reflexivas que atentem para sua agência no mundo, bem como para articulações de narrativas interdisciplinares e multicausais para crises de saúde pública no Brasil.

Actions during the COVID-19 pandemic to protect the most vulnerable population: what is the potency amid chaos?

By 30 May 2021, Brazil had 16 471 600 COVID-19 cases and 461 142 deaths, ranking second in the world in number of deaths and third in number of cases. Preliminary research results in Brazil and around the world show the impact of COVID-19 on more vulnerable communities. However, despite the adverse circumstances of their territories, leaders have mobilized to face the challenges. Between April and June 2020, the authors of this article interviewed informants in eight Brazilian state capitals, addressing the five points of discussion (intersectoriality, sustainability, empowerment and public participation, equity and the life cycle perspective) recently presented by EUPHA-HP, IUHPE and UNESCO Chair Global Health & Education. Official actions and documents from the Ministry of Health and Municipal Health Departments (SMS) of each capital were also analyzed. No records were found of official actions aimed at COVID-19 that addressed the territories' specificities. In total, 15 promotional actions by the communities were identified. The selection of local actors to take on specific responsibilities during the pandemic is highlighted as a relevant action. This action alone weaves together at least three of the five HP principles (equity, life cycles and empowerment). We consider that previous forms of political empowerment, such as the recognition of territories and educational initiatives, have contributed to the subjects who are leading these inventive initiatives. However, although there is scope for promotional actions, there are infrastructural limitations that only public policies could mitigate. Such actions would demand deliberate coordination between the government and social movements, which is absent in the current context of national governance.

Transitional care of nurses to older adults with artificial pacemaker / Atención transitoria de enfermeras a ancianos con marcapasos artificial / Cuidado transicional de enfermeiras ao idoso com marcapasso artificial

ABSTRACT Objective: to understand how the transitional care of nurses to olde adults with artificial pacemaker occurs. Method: a qualitative research, carried out in a philanthropic hospital in the city of Salvador, Bahia, Brazil. Fourteen nurses working in surgical and cardiac inpatient units participated. Data were collected between August and November 2020, through semi-structured interviews, and analyzed using the methodological framework Discourse of the Collective Subject and discussed in the light of Afaf Meleis' theory of transitions. Results: nurses' incipient knowledge about transitional care was identified. It was observed that the nursing discharge report is a facilitating instrument for transitional care. Final considerations: the study pointed out that the transitional care of nurses to older adults with artificial pacemakers does not have a theoretical foundation, reporting as a priority the care with the pacemaker identification card and with the surgical wound.

RESUMEN Objetivo: comprender cómo se produce el cuidado transitorio del enfermero al anciano con marcapasos artificial. Método: investigación cualitativa, realizada en un hospital filantrópico de la ciudad de Salvador, Bahía, Brasil. Participaron 14 enfermeros que laboran en las unidades de internación quirúrgica y cardíaca. Los datos fueron recolectados entre agosto y noviembre de 2020, a través de entrevistas semiestructuradas, y analizados utilizando el marco metodológico Discurso del Sujeto Colectivo y discutidos a la luz de la teoría de las transiciones de Afaf Meleis. Resultados: se identificó el conocimiento incipiente de las enfermeras sobre los cuidados transicionales. Se observó que el informe de alta de enfermería es un instrumento facilitador para la transición asistencial. Consideraciones finales: el estudio señaló que el cuidado transicional de enfermeras al anciano con marcapasos artificiales no tiene un fundamento teórico, reportando como prioridad el cuidado con la tarjeta de identificación del marcapasos y con la herida quirúrgica.

RESUMO Objetivo: apreender como ocorre o cuidado transicional da enfermeira ao idoso com marcapasso artificial. Método: pesquisa qualitativa, realizada em um hospital filantrópico, na cidade de Salvador, Bahia, Brasil. Participaram 14 enfermeiras atuantes nas unidades de internação cirúrgica e cardiológica. Os dados foram coletados entre agosto e novembro de 2020, por meio de entrevista semiestruturada, e analisados pelo referencial metodológico Discurso do Sujeito Coletivo e discutidos à luz da teoria das transições de Afaf Meleis. Resultados: foi identificado conhecimento insipiente das enfermeiras acerca do cuidado transicional. Observou-se que o relatório de alta de enfermagem constitui um instrumento facilitador para a transição do cuidado. Considerações finais: o estudo apontou que o cuidado transicional de enfermeiras ao idoso com marcapasso artificial não possui fundamentação teórica, relatando como prioridade o cuidado com a carteira de identificação do marcapasso e com a ferida operatória.

Transitional care of nurses to older adults with artificial pacemaker.

OBJECTIVE: to understand how the transitional care of nurses to olde adults with artificial pacemaker occurs. METHOD: a qualitative research, carried out in a philanthropic hospital in the city of Salvador, Bahia, Brazil. Fourteen nurses working in surgical and cardiac inpatient units participated. Data were collected between August and November 2020, through semi-structured interviews, and analyzed using the methodological framework Discourse of the Collective Subject and discussed in the light of Afaf Meleis' theory of transitions. RESULTS: nurses' incipient knowledge about transitional care was identified. It was observed that the nursing discharge report is a facilitating instrument for transitional care. FINAL CONSIDERATIONS: the study pointed out that the transitional care of nurses to older adults with artificial pacemakers does not have a theoretical foundation, reporting as a priority the care with the pacemaker identification card and with the surgical wound.

Molecular cytogenetics in the study of repetitive sequences helping to understand the evolution of heterochromatin in Melipona (Hymenoptera, Meliponini).

The eukaryote genome is enriched by different types of repetitive DNA sequences and is most abundant in heterochromatin regions. Historically, no function has been assigned to these sequences, which makes them the target of studies that have demonstrated their structural and functional importance in the genome. Despite having a constant chromosome number, the genus Melipona has species with wide variation in heterochromatin content, from 8 to 73%, which is an important feature to be investigated regarding its origin and evolution. In the present study, a repetitive DNA sequence of Melipona mondury was isolated by restriction enzyme digestion. This sequence was used to hybridize chromosomes of eight Melipona species that include representatives of the four subgenera and present divergent characteristics in relation to the heterochromatin content. Considering that rDNA localization has shown differences in Melipona, 16 species of this genus were analyzed with 18S rDNA probe. Our data suggest that heterochromatin growth occurred independently in the Michmelia and Melikerria subgenera, considering that the isolated repetitive DNA sequence was shared only by the Michmelia species. Amplification possibly occurred from the centromeric region, causing the displacement of the rDNA sites to the ends of the chromosomes. The repetitive DNA sequence used is a constituent of Michmelia heterochromatin, which that arose from the common ancestor of the species of this subgenus.

A relação de causalidade entre Zika vírus e síndrome congênita: análise de uma controvérsia em meio a uma crise de saúde pública / The causal link between Zika virus and congenital syndrome: controversy analysis in the midst of a public health crisis

Introdução ­ Um vírus recém-chegado ao Brasil, o Zika, é tido como causa do aumento de más-formações congênitas em 2016 com evidências consideradas frágeis (correlação temporal, análises laboratoriais e estudos de caso). Objetivo ­ Analisa-se dissensos e consensos em torno da causalidade Zika-microcefalia entre 2015 e 2017 no Brasil, com o intuito de entender o porquê das disputas, reconstruir a narrativa a partir de atores diversos e investigar seu impacto. Métodos ­ Com metodologia inspirada na Teoria Ator-Rede e no mapeamento de controvérsias ­ em que se seguem conexões diversas a partir do entendimento de que evidências científicas são coproduzidas por ciência e sociedade, humanos e não humanos ­ foram feitas 50 entrevistas e uma roda de conversa com 13 mães em 8 estados brasileiros: Bahia (Salvador), Brasília (Distrito Federal), Pará (Ananindeua e Belém), Paraíba (Campina Grande), Pernambuco (Recife), Rio de Janeiro (RJ), Rio Grande do Norte (Natal) e São Paulo (Jundiaí, São Paulo e Campinas), além de visitas a instituições como a Fiocruz e universidades. Resultados ­ Como contribuição principal, a análise propõe que a explicação para as más-formações foi apresentada à narrativa pública com uma perspectiva unicausal atrelada ao Zika vírus ­ como uma hipótese-fato e não uma hipótese-pergunta ­ apesar de evidências multicausais e de cofatores associados ao desfecho. O trabalho denomina a narrativa da causalidade das anomalias observadas entre 2015 e 2017 como uma causa constrita de efeito cosmológico, em que a relação "A (Zika), logo B (Microcefalia)" é transladada como um problema central no fenômeno, sobrepondo-se a outras hipóteses multicausais e necessidades de estudos científicos para outros objetos ­ como intervenções em crianças e determinantes sociais. A análise destaca que, embora evidências epidemiológicas apontem para diferenças de risco no território brasileiro, a pergunta sobre a possibilidade de cofatores não deflagrou a mesma mobilização que a procura do agente etiológico. Atravessada por discussões globais e um modelo padrão de governança de risco, a controvérsia foi estabilizada por uma aliança cientistasimprensa- gestores, com a mobilização de uma ontologia única e purificada de não humanos ­ e não porque acabaram-se as perguntas ­, o que invisibilizou dinâmicas locais. Nota-se que a opção pela simplicidade do discurso teve por base um modelo deficitário e pouco participativo de divulgação pública, que reforça a unicausalidade e atrela o Zika à ontologia da dengue, com consequências para a prevenção e para a própria ciência, que experimenta os efeitos recursivos da narrativa proposta. Apontase que cientistas têm preocupações sociais, mas pouca reflexividade sobre sua agência para além da produção de evidências. Conclusões ­ Considera-se a necessidade de discursos multicausais de epidemias na narrativa pública brasileira, vindos de cientistas e de instituições de pesquisa centrais, de modo a conferir variadas vias de ação de enfrentamento, bem como a formulação de perguntas científicas reflexivas e dinâmicas com capacidade de refazer hipóteses a partir da produção de novas evidências ao longo do tempo.

Introduction ­ A virus then newly arrived in Brazil, Zika, is believed to be the cause of an increase in congenital malformations in 2016 with evidence considered fragile for a causal relationship (temporal correlation, laboratory analyses and case studies). Purpose ­ This work analyzes dissents and consensuses around the causality link between Zika and microcephaly from 2015 to 2017 in Brazil, with the aim of understanding the reasons for the disputes, reconstructing the narrative through different actors and investigating its impact. Methods ­ With a methodology inspired by Actor-Network Theory and controversy mapping ­ in which the researcher follows connections based on the comprehension that scientific evidence is co-produced by science and society, human and non-human ­ data was collected through 50 interviews and a conversation circle (13 mothers), in 8 Brazilian states: Bahia (Salvador), Brasília (Distrito Federal), Pará (Ananindeua e Belém), Paraíba (Campina Grande), Pernambuco (Recife), Rio de Janeiro (RJ), Rio Grande do Norte (Natal) and São Paulo (Jundiaí, São Paulo and Campinas), in addition to visits to institutions such as Fiocruz and universities. Results ­ As a main contribution, the analysis proposes the explanation for malformations was presented to the public narrative as an unicausal perspective linked to Zika virus ­ as a hypothesis-fact and not a hypothesis-question ­ despite multi-causal evidence and cofactors associated with the outcome. The work describes the causality narrative of anomalies observed between 2015 and 2017 as a constricted cause of cosmological effect, in which the relationship "A (Zika), then B (Microcephaly)" is translated as a central problem, surpassing other multicausal hypotheses and the needs for scientific studies for other objects, such as interventions in children and social determinants. The analysis highlights that although epidemiological evidence points to differences in risk across the Brazilian territory, the question about the possibility of cofactors did not trigger the same mobilization as the search for the etiological agent. Traversed by global discussions and a standard risk governance model, the controversy was stabilized by a scientists-press-managers alliance, with the mobilization of a single, purified ontology of non-humans ­ and not because the questions were over ­, which made local dynamics invisible. It is noted that the option for discourse simplicity was based on a deficient participatory model of public disclosure, which reinforces the unicausality and links Zika to the dengue ontology, with consequences for prevention and for science itself, which experiences the recursive effects of the proposed narrative. It is pointed out that scientists have social concerns, but little reflexivity concerning their agency beyond evidence production. Conclusions ­ The need for multi-causal epidemic discourses in the Brazilian public narrative is considered, coming from scientists and central research institutions, in order to allow for diverse coping strategies, as well as the formulation of reflexive and dynamic scientific questions with the capacity to remodel their hypotheses based on new evidence over time.

Prevalência da tentativa de suicídio e os fatores associados em pacientes com transtorno psíquico

Introdução: O suicídio é de grande relevância para a saúde pública, sendo um fenômeno multifatorial que frequentemente é antecedido por comportamentos suicidas, tendo como fatores de risco os transtornos psíquicos. Objetivo: Descrever a prevalência da tentativa de suicídio e os fatores associados em pacientes com transtorno psíquico acompanhados no Centro de Atenção Psicossocial (CAPS) II. Métodos: Estudo quantitativo, descritivo e analítico com dados secundários de 416 prontuários de pacientes atendidos entre janeiro de 2005 e julho de 2017 no CAPS II de Petrolina, Pernambuco, Brasil. Resultados: O gênero feminino predominou na amostra (59,5%), a maioria dos pacientes era casada (62,5%) e não alfabetizados ou com ensino fundamental (52,7%). A média de idade dos usuários que tentaram suicídio era 39,8 anos. Os fatores que estiveram associados às tentativas de suicídio foram sexo, as mulheres apresentaram mais tentativas de suicídio (65,2%); a internação extra CAPS (p=0,008) e a ideação suicida (p <0,0001). Conclusão: A população estudada foi composta predominantemente de mulheres, não alfabetizadas ou com fundamental, com história de internamento psiquiátrico, ideação suicida e tentativa de suicídio. Ainda, houve associação estatística com o histórico de internação em hospitais psiquiátricos e ideação suicida com a tentativa de suicídio. Conhecer os fatores associados à tentativa de suicídio pode ser um passo importante para o planejamento de estratégias de prevenção.

Synthesis of Reduced Graphene Oxide as a Support for Nano Copper and Palladium/Copper Catalysts for Selective NO Reduction by CO.

Copper and palladium/copper nanoparticles supported on reduced graphene oxide catalysts were synthesized and evaluated for the selective NO reduction by CO. The catalysts were characterized by XRD, nitrogen adsorption-desorption, TGA, XPS, TPR, in situ XRD, STEM, and HRTEM. The STEM and HRTEM results showed high metal oxide dispersions on the rGO. XPS results showed the presence of Cu and Pd oxide species. The reduction of copper supported on the rGO occurred in two steps for CuO x /rGOc, while that for CuO x -PdO y /rGOc occurred in one step for temperatures lower than 350 °C. Noteworthy is that the in situ XRD results showed that the rGO structure was not affected after reduction at 350 °C. The in situ XRD of reduction revealed the appearance of new phases for copper during the reduction. The catalysts were evaluated in NO reduction by CO. The tests showed that the reduced catalysts presented high performance with NO conversions and N2 selectivity above 85% at 350 °C.

Glycemic homeostasis and hepatic metabolism are modified in rats with global cerebral ischemia.

Cerebral ischemia-induced hyperglycemia has been reported to accentuate neurological damage following focal or global cerebral ischemia. Hyperglycemia found in rats following focal brain ischemia occurs in the first 24 h and has been claimed to be caused by increased liver gluconeogenesis and insulin resistance. However, liver gluconeogenesis and the mechanisms leading to hyperglycemia after global cerebral ischemia remain uncertain. This study investigated the glycemic homeostasis and hepatic metabolism in rats after transient four-vessel occlusion (4-VO)-induced global cerebral ischemia, an event that mimics to a certain degree the situation during cardiac arrest. Several metabolic fluxes were measured in perfused livers. Activities and mRNA expressions of hepatic glycolysis and glyconeogenesis rate-limiting enzymes were assessed as well as respiratory activity of hepatic isolated mitochondria. Global cerebral ischemia was associated with hyperglycemia and hyperinsulinemia 24 h after ischemia. Insulin resistance developed later and was prominent after the 5th day. Hepatic anabolism and catabolism were both modified in a complex and time-dependent way. Gluconeogenesis, ß-oxidation, ketogenesis and glycolysis were diminished at 24 h after ischemia. At 5 days after ischemia glycolysis had normalized, but gluconeogenesis, ketogenesis and ß-oxidation were accelerated. The overall metabolic modifications suggest that a condition of depressed metabolism was established in response to the new conditions generated by the cerebral global ischemia. Whether the modifications in the liver metabolism found in rats after the ischemic insult can be translated to individuals following global brain ischemia remains uncertain, but the results of this study are hoped to encourage further investigations.

O autocultivo de Cannabis e a tecnologia social / Cannabis self-cultivation and social technology

Resumo O objetivo deste trabalho é analisar o autocultivo de Cannabis para fins medicinais no Brasil, avaliando em que medida a prática poderia ser enquadrada como uma tecnologia social, na formulação de Renato Dagnino. Com base em dados coletados em trabalho de campo (entrevistas semiestruturadas) em dois centros urbanos no Brasil (São Paulo, Rio de Janeiro) e de uma participante nos Estados Unidos, identificam-se características dessas práticas que as aproximam de uma tecnologia social, como a adaptação a pequena escala, o atendimento a demandas sociais por meio de trabalho cognitivo, a participação ativa de produtores e usuários em seu desenvolvimento, e a ausência de diferenciação entre patrão e empregado. Pondera-se, entretanto, que a noção de tecnologia social está bastante ligada a um objetivo de transformação do setor produtivo, o que talvez limite a aplicação desse conceito em situações de produção não-comercial, para atendimento de necessidades diretas; e que a consideração dos riscos na produção de medicamentos talvez torne pouco aconselhável a generalização de práticas caseiras como a do autocultivo. Propõe-se que essa situação poderia ser remediada com o emprego de estratégias de ciência aberta e cidadã, envolvendo o diálogo com instituições públicas do campo tecnológico e científico.

Abstract The objective of this study is to analyze Cannabis self-cultivation for medicinal purposes in Brazil, evaluating to what extent the practice may fit into the framework of what Renato Dagnino termed a social technology. Based on data collected during fieldwork (semi-structured interviews) carried out in two Brazilian urban centers (São Paulo and Rio de Janeiro) and from a participant in the United States, we identified characteristics of these practices that make them akin to a social technology: adaptation to small-scale production, use of cognitive labor to meet social demands, active participation of producers and users in the practice's development, and lack of differentiation between boss and employee. It is worth noting, however, that the notion of social technology is closely linked to the objective of transforming the productive sector. This may limit the application of this concept to non-commercial production aimed at satisfying direct needs. Moreover, given the risks involved in the production of medicines, the generalization of homemade practices such as self-cultivation may not be advisable. These issues could be remedied by the use of open, democratic and citizen-oriented scientific strategies, involving dialogue with public institutions in the technological and scientific field.

Bioceramic cement in the filling of bone defects in rats.

PURPOSE: To evaluate PBS®MCIMMO cement in the filling of bone defects. METHODS: Thirty-six adult male Wistar rats were divided into three groups of twelve individuals each (group 1, group 2 and group 3). In all groups, a bone failure in the femur was induced, 2.0 mm wide and 7.0 mm deep. In group 1, the PBS®MCIMMO cement was applied to the bone defect produced and a titanium implant (CONNECTION®) 1.5 mm thick and 6 mm long was installed. In group 2, only the PBS® CIMMO cement was installed. In group 3, only bone failure was performed. Kruskal Wallis tests were performed to compare the mean area among the three groups. RESULTS: In all comparisons, significance was observed for group 2 (p = 0.0014-0.0026). CONCLUSION: The PBS®CIMMO cement induced bone neoformation, and integration between the newly formed bone, cement, and implant was observed.

Fatty acids uptake and oxidation are increased in the liver of rats with adjuvant-induced arthritis.

Severe rheumatoid cachexia is associated with pronounced loss of muscle and fat mass in patients with advanced rheumatoid arthritis. This condition is associated with dyslipidemia and predisposition to cardiovascular diseases. Circulating levels of triglycerides (TG) and free fatty acids (FFA) have not yet been consistently defined in severe arthritis. Similarly, the metabolism of these lipids in the arthritic liver has not yet been clarified. Aiming at filling these gaps this study presents a characterization of the circulating lipid profile and of the fatty acids uptake and metabolism in perfused livers of rats with adjuvant-induced arthritis. The levels of TG and total cholesterol were reduced in both serum (10-20%) and liver (20-35%) of arthritic rats. The levels of circulating FFA were 40% higher in arthritic rats, possibly in consequence of cytokine-induced adipose tissue lipolysis. Hepatic uptake and oxidation of palmitic and oleic acids was higher in arthritic livers. The phenomenon results possibly from a more oxidized state of the arthritic liver. Indeed, NADPH/NADP+ and NADH/NAD+ ratios were 30% lower in arthritic livers, which additionally presented higher activities of the citric acid cycle driven by both endogenous and exogenous FFA. The lower levels of circulating and hepatic TG possibly are caused by an increased oxidation associated to a reduced synthesis of fatty acids in arthritic livers. These results reveal that the lipid hepatic metabolism in arthritic rats presents a strong catabolic tendency, a condition that should contribute to the marked cachexia described for arthritic rats and possibly for the severe rheumatoid arthritis.

Bioceramic cement in the filling of bone defects in rats

Abstract Purpose To evaluate PBS®MCIMMO cement in the filling of bone defects. Methods Thirty-six adult male Wistar rats were divided into three groups of twelve individuals each (group 1, group 2 and group 3). In all groups, a bone failure in the femur was induced, 2.0 mm wide and 7.0 mm deep. In group 1, the PBS®MCIMMO cement was applied to the bone defect produced and a titanium implant (CONNECTION®) 1.5 mm thick and 6 mm long was installed. In group 2, only the PBS® CIMMO cement was installed. In group 3, only bone failure was performed. Kruskal Wallis tests were performed to compare the mean area among the three groups. Results In all comparisons, significance was observed for group 2 (p = 0.0014-0.0026). Conclusion The PBS®CIMMO cement induced bone neoformation, and integration between the newly formed bone, cement, and implant was observed.