Percepções dos profissionais da atenção básica em saúde sobre a responsabilidade no cuidado integral às pessoas com transtornos mentais / Perceptions of primary care professionals about responsibility for comprehensive health care for people with mental disorders

A Reforma Psiquiátrica Brasileira possibilitou a reinserção das pessoas com transtornos mentais na sociedade. Isso acarretou a necessidade de implementar outras formas de olhar e acompanhar essa população, instigando a construção do cuidado em liberdade. Assim, objetivou-se identificar as percepções dos profissionais da atenção básica em saúde sobre a responsabilidade no cuidado integral à pessoa com transtorno mental e/ou sofrimento mental. Trata-se de um estudo descritivo, de abordagem qualitativa, realizado com sete profisionais de uma equipe de Saúde da Família, na região metropolitana de Porto Alegre, Sul do Brasil. Os dados foram coletados por meio de entrevistas individuais e analisados conforme análise de conteúdo. Evidenciou-se que existe o movimento de tomada de responsabilidade por parte dos profissionais entrevistados, a partir da construção de cuidado e acompanhamento em saúde mental. Influenciam esse movimento aspectos como: a escuta, a construção do vínculo, o estigma como modificador da percepção e os fluxos/encaminhamentos para outros serviços. A enfermagem demonstrou ter um papel fundamental na tomada de responsabilidade na atenção básica, em que o profissional enfermeiro é visto como referência na realização dos cuidados e capacitação da equipe.

The Brazilian Psychiatric Reform enabled the reintegration of people with mental disorders into society. This led to the need to implement other ways of looking at and supporting this population, encouraging the construction of care in freedom. Thus, the aim was to identify the perceptions of primary health care professionals regarding responsibility for comprehensive care for people with mental disorders and/or mental distress. This is a descriptive study with a qualitative approach, conducted with seven professionals from a Family Health Team in the metropolitan region of Porto Alegre, Southern Brazil. Data were collected through individual interviews and analyzed using content analysis. It was evident that there is a movement towards taking responsibility on the part of the interviewed professionals, through the construction of mental health care and monitoring. Aspects influencing this movement include: listening; building rapport; stigma as a modifier of perception; and referrals to other services. Nursing demonstrated a fundamental role in taking responsibility in primary care, where the nurse professional is seen as a reference in providing care and training the team.

Jovens cientistas: enfrentamento às arboviroses e participação juvenil no território / Young scientists: facing arboviruses and youth participation in the territory / Jóvenes investigadores: enfrentamiento a las arbovirosis y participación juvenil en el território

O estudo analisa uma formação em Iniciação Científica sobre arboviroses, a partir da percepção de jovens estudantes, em Ceilândia ­ Distrito Federal. Objetivo: compreender em que medida a Iniciação Científica mobiliza esses jovens a participarem de ações de vigilância e promoção da saúde no território, e entender sua motivação para participar do projeto. Metodologia: abrangeu-se a análise das redações escritas para a seleção ao Curso de Formação para Iniciação Científica na Educação Básica e as Arboviroses; a administração desse curso e; posteriormente, um grupo focal com estudantes para análise do processo educativo da Iniciação Científica que vivenciaram. Resultados: a análise de conteúdo evidenciou a percepção dos alunos sobre a Iniciação Científica, centrada em seis categorias analíticas: motivação dos alunos para Iniciação Científica; processo de formação do saber; formação de jovens cientistas; saúde e meio ambiente; participação e empoderamento juvenil e percepções acerca do Sistema Público de Saúde. Conclusão: o enfrentamento às arboviroses exige políticas e intervenções de amplo espectro, e a Iniciação Científica fortaleceu esses jovens estudantes enquanto sujeitos de direitos, ampliou sua percepção sobre ciência, saúde, relação com o ambiente, com o Sistema Único de Saúde e estimulou o interesse em ações preventivas no combate às arboviroses nesses territórios.

This study analyzes a Scientific Initiation (SI) program on arboviroses, from the perception of young high school students in Ceilândia ­ Distrito Federal. Objective: It aims to understand to what extent the SI mobilizes these young people to participate in surveillance and health promotion actions in the territory and understand their motivation to participate in this project. Methodology: The methodology included the analysis of the essays written for the selection to the Training Course for Scientific Initiation in Basic Education and the Arboviroses, the administration of this course, and later a focus group with students to analyze the SI educational process they experienced. Results: The result of the Content Analysis showed that the students' perception about the SI could be grouped into six categories: students' motivation for the scientific initiation; the learning process; the training of young scientists; health and environment; youth participation and empowerment, and perceptions of the Public health system in Brazil (SUS). Conclusion: Confronting arboviroses requires broad-spectrum policies and interventions, and the SI strengthened these young students as subjects of rights, broadened their perception of science, health, relationship with the environment, with the Sistema Único de Saúde and stimulated interest in preventive actions to combat arboviroses in these territories. Keywords: Health education; Arbovirus infections; Adolescents; Public health.

Analiza una formación en Iniciación Científica (IC) sobre arbovirus, desde la percepción de jóvenes estudiantes de secundaria en Ceilândia, Distrito Federal. Objetivo: el objetivo es comprender en qué medida la IC moviliza a estos jóvenes a participar en acciones de vigilancia y promoción de la salud en el territorio, así como entender su motivación para participar en proyectos de IC. Metodología: la metodología incluyó el análisis de las redacciones escritas para la selección al Curso de Formación para Iniciación Científica en Educación Básica y Arbovirus, la administración de este curso y, posteriormente, un grupo focal con los estudiantes para analizar el proceso educativo de IC que vivieron. Resultados: los resultados del Análisis de Contenido mostraron la percepción de los estudiantes sobre la IC enfocada en seis categorías analíticas: motivación de los estudiantes por la iniciación científica; proceso de formación de conocimientos; formación de jóvenes científicos; salud y medio ambiente; participación y empoderamiento de los jóvenes y percepciones sobre el Sistema Público de Salud (SUS). Conclusiones: Enfrentar los arbovirus requiere políticas e intervenciones de amplio espectro, y la IC fortaleció a estos jóvenes estudiantes como sujetos de derechos, ampliando su percepción sobre ciencia, salud, relación con el entorno, con el Sistema Único de Salud y estimuló el interés en acciones preventivas en la lucha contra los arbovirus en estos territorios.

Vitamin D Deficiency in Patients Hospitalized for Heart Failure Living in the Tropics.

Background and Objectives: Vitamin D, as a steroid hormone, has multiple effects on human body and its deficiency has been associated with an increased risk of heart failure (HF) and unfavorable outcomes. The present study investigated the prevalence of vitamin D deficiency (VDD) and its relationship with cardiometabolic parameters in patients hospitalized for HF living in the city of Recife (latitude 8° South). Methods: Analytical cross-sectional study, with men and women aged 40-64 years. The HF group was recruited during hospitalization due to decompensation. A matched control group was recruited from the general endocrine clinics. Vitamin D status was assessed by measuring serum 25-hydroxyvitamin D (25OHD), considering deficiency when 25OHD <20 ng/mL (<50 nmol/L). Results: A total of 243 patients were evaluated (HF group: 161, control group: 82). Lower serum 25OHD levels were observed in the HF group (25.2±9.4 vs. 30.0±7.7ng/mL; p<0.001), as well as a higher prevalence of VDD (27.3% vs. 9.8%; prevalence ratio, 2.80; 95% confidence interval, 1.38-5.67; p=0.002). In patients with HF, VDD was associated with diabetes mellitus (65.9% vs. 41.0%; p=0.005) and female sex (65.9% vs. 44.4%; p=0.015). In the subgroup with VDD, higher values of hemoglobin A1c (7.9% [6.0-8.9] vs. 6.2% [5.7-7.9]; p=0.006) and dyslipidemia were also observed. Conclusions: We found higher rates of VDD in patients hospitalized for HF and this was associated with deleterious laboratory metabolic parameters.

Food-Based Dietary Guidelines for Infants in Latin America and the Caribbean: A Systematic Review.

Food-based dietary guidelines (FBDGs) are tools for promoting healthy eating habits. For the population of children under two years old in Latin America and the Caribbean (LAC), there is a lack of reviews analyzing the quality of these guidelines. The objective of this systematic review is to evaluate publicly available FBDGs for the population under two years old in LAC until mid-2023. Guidelines aimed at caregivers of children were included, sourced from government websites in LAC countries and the Food and Agriculture Organization (FAO) portal. Documents targeted at healthcare professionals were excluded. For qualitative analysis, the Agree II guidelines assessment tool and the FAO guide principles for developing healthy and sustainable diets were used. The results showed that more recently released and revised FBDGs with a greater number of pages obtained better scores in both assessments. Additionally, out of the 32 LAC countries, only 13 had these FBDGs available on websites for public access. As a limitation, this study faced challenges in standardizing the searches on government websites. The authors emphasize the need to develop FBDGs for the population under two years old that align with current health and sustainability needs and promote health education.

Inhibition of O-GlcNAcylation Reduces Cell Viability and Autophagy and Increases Sensitivity to Chemotherapeutic Temozolomide in Glioblastoma.

Glioblastoma (GB) is the most aggressive primary malignant brain tumor and is associated with short survival. O-GlcNAcylation is an intracellular glycosylation that regulates protein function, enzymatic activity, protein stability, and subcellular localization. Aberrant O-GlcNAcylation is related to the tumorigenesis of different tumors, and mounting evidence supports O-GlcNAc transferase (OGT) as a potential therapeutic target. Here, we used two human GB cell lines alongside primary human astrocytes as a non-tumoral control to investigate the role of O-GlcNAcylation in cell proliferation, cell cycle, autophagy, and cell death. We observed that hyper O-GlcNAcylation promoted increased cellular proliferation, independent of alterations in the cell cycle, through the activation of autophagy. On the other hand, hypo O-GlcNAcylation inhibited autophagy, promoted cell death by apoptosis, and reduced cell proliferation. In addition, the decrease in O-GlcNAcylation sensitized GB cells to the chemotherapeutic temozolomide (TMZ) without affecting human astrocytes. Combined, these results indicated a role for O-GlcNAcylation in governing cell proliferation, autophagy, cell death, and TMZ response, thereby indicating possible therapeutic implications for treating GB. These findings pave the way for further research and the development of novel treatment approaches which may contribute to improved outcomes and increased survival rates for patients facing this challenging disease.

Bone Mineral Density, Trabecular Bone Score and Fractures in Patients Hospitalized for Heart Failure.

BACKGROUND: This study aimed to evaluate the bone mineral density (BMD), trabecular bone score (TBS), and fracture history of middle-aged patients hospitalized for heart failure (HF), as well as analyze the association of these factors with cardiometabolic parameters and muscle strength. METHODS: A cross-sectional study with patients aged 40 to 64 years hospitalized for HF was performed. Dual energy X-ray absorptiometry was performed to obtain BMD and TBS. Fracture history, handgrip strength (HGS), and clinical and laboratory cardiometabolic parameters of the patients were evaluated. RESULTS: Altogether, 109 patients were evaluated (female 50.5%). Medians and interquartile ranges for age and length of hospital stay were 58.0 (53.0-61.0) years and 20.0 (11.0-32.0) days, respectively. Osteoporosis was observed in 15.6% of the patients, low TBS was observed in 22.8%, and 6 patients had a history of fragile fracture. No differences between the sexes regarding BMD (p=0.335) or TBS (p=0.736) classifications were observed. No association was observed between low BMD and HF classification (p>0.05) regarding the ejection fraction, ischemic etiology, or New York Heart Association Functional Classification. However, there was a significant association between high serum parathyroid hormone (PTH) and the presence of osteoporosis (62.5 [37.2-119.0] pg/mL vs. 34.2 [25.0-54.1] pg/mL; p=0.016). There was a negative correlation between serum PTH and TBS (r=-0.329, p=0.038) and a higher frequency of reduced HGS in patients with low TBS (92.3% vs. 50.0%; p=0.009). CONCLUSIONS: We found relevant frequencies of osteoporosis and bone microarchitecture degradation in middle-aged patients with HF, which were related to high serum PTH concentrations.

Evaluating the impacts of Payment for Ecosystem Services (water supplies) in an agricultural system of the Brazilian Cerrado.

In this study, we investigated the effects of the Payment for Ecosystem Services (PES) in an agrisystem located in the Brazilian Midwest. This PES benefits the owners of rural properties that encompass springs that feed the Abóbora River microbasin which supplies water for consumption in the city of Rio Verde, Goiás. We evaluated the percentage of native vegetation cover around the springs of the watercourses and also estimated its change over time (2005, 2011 and 2017). The vegetation cover of the Areas of Permanent Preservation (APP) increased by 2.24% on average, seven years after the implantation of the PES. There was little difference in the change of vegetation cover maintained over the study years (2005, 2011, and 2017), however, the vegetation cover increased for 17 springs, decreased for 11 springs, and was completely degraded for other two. To improve the performance of this PES, we recommend (1) expanding the program to include the APPs surrounding the springs, together with the legal reserves of each property, (2) implementing measures to ensure that properties are environmentally adequate, (3) including the properties in the Brazilian Rural Environment Register (CAR), and (4) obtaining environmental licensing for the activities undertaken within the Abóbora River basin.

Úlceras varicosas: Revisão integrativa acerca de recomendações de cuidado de enfermagem / Úlceras varicosas: Revisión integradora sobre las recomendaciones de atención de enfermería / Varicose ulcers: Integrative review about nursing care recommendations

Objetivo: identificar as recomendações, baseadas em evidências científicas, para o cuidado de enfermagem a pessoas com úlceras varicosas. Método: trata-se de revisão integrativa da literatura, realizada por meio de consulta às bases de dados. Foram incluídos estudos publicados de 2016 a 2021 nos idiomas inglês e português. Resultados: foram encontrados sete artigos originais. Os achados reforçam o uso da terapia compressiva no tratamento das úlceras varicosas, seja elástica, inelástica ou multicamadas. Os resultados trazem novas tecnologias de cuidado, como a compressão ajustável, o manguito de resfriamento e o uso da gaze Petrolatum® com Plasma Rico em Plaquetas. Como orientações para equipe de enfermagem, destaca-se a importância do enfermeiro na visita domiciliar para acompanhamento do tratamento das úlceras, bem como de um planejamento de ações (itinerário terapêutico). Conclusão: Evidenciam a eficácia da terapia compressiva, traz novas tecnologias de cuidado e ressalta a importância do enfermeiro no cuidado da úlcera varicosa.(AU)

Objective: to identify recommendations, based on scientific evidence, for nursing care in people with varicose ulcers. Method: this is an integrative review of the literature, carried out through the consultation of databases. Studies published from 2016 to 2021 in English and Portuguese. Results: seven original articles were found. The findings reinforce the use of compressive therapy in the treatment of varicose ulcers, whether elastic, inelastic or multilayer. The results bring new care technologies, such as adjustable compression, cooling sleeve and the use of petroleum jelly gauze® with PRP. As guidelines for the nursing team, the importance of nurses in the home visit to monitor the treatment of ulcers is highlighted, as well as an action planning (therapeutic itinerary). Final considerations: The findings of this study show the efficacy of compressive therapy, bring new assistive technologies, and highlight the importance of nurses in the care of varicose ulcers.(AU)

Objetivo: identificar las recomendaciones, basadas en evidencia científica, para la atención de enfermería en personas con úlceras varicosas. Método: se trata de una revisión integradora de la literatura, realizada a través de la consulta de bases de datos. Estudios publicados de 2016 a 2021 en inglés y portugués. Resultados: se encontraron siete artículos originales. Los hallazgos refuerzan el uso de la terapia compresiva en el tratamiento de las úlceras varicosas, ya sean elásticas, inelásticas o multicapa. Los resultados traen nuevas tecnologías de cuidado, como la compresión ajustable, el manguito de enfriamiento y el uso de gasa vaselina® con PRP. Como pautas para el equipo de enfermería, se destaca la importancia de las enfermeras en la visita domiciliaria para monitorear el tratamiento de las úlceras, así como una planificación de la acción (itinerario terapéutico).Consideraciones finales: los hallazgos de este estudio muestran la eficacia de la terapia compresiva, aportan nuevas tecnologías asistenciales y destacan la importancia de las enfermeras en el cuidado de las úlceras varicosas.(AU)

RISK FACTORS ASSOCIATED WITH FRACTURE OF THE LUMBOSACRAL SPINE AND ITS COMPROMISE IN THE QUALITY OF LIFE OF CIRRHOTICS.

BACKGROUND: Chronic hepatic disease is associated with osteoporosis, osteopenia or osteomalacia. Osteoporosis and fractures due to bone fragility present high prevalences and are more frequent in patients with liver cirrhosis than in the general population. The search for a diagnosis of osteopenia and osteoporosis in this population may allow early intervention and modify unfavorable outcomes. OBJECTIVE: To know the prevalence of osteopenia or osteoporosis and of fracture due to bone fragility in individuals with liver cirrhosis, the associated risk factors, and its compromise in their quality of life (QoL). METHODS: Observational, transversal study performed with 71 liver cirrhosis patients of the Hepatology Service of the Hospital de Base do Distrito Federal, Brasília, DF, Brazil, between July 2017 and December 2018. The patients were submitted to bone densitometry (DXA) of the lumbar spine and of the femoral neck, to x-ray of the lumbosacral spine and to the Chronic Liver Disease Questionnaire (CLDQ) for the evaluation of quality of life (QoL). The Fracture Risk Assessment (FRAX) major was calculated for patients >50 years old. The analyses were performed for the evaluation of the risk factors associated with lumbosacral spine fracture. RESULTS: The majority (62%) of the 71 evaluated patients was diagnosed with osteoporosis or osteopenia on DXA. Of the 44 patients with osteopenia or osteoporosis, 52.3% were female, with a mean age of 62.6±9.51 years old, with the majority (72.7%) being Child A, cirrhotics of alcoholic etiology (36.4%), and with an intermediate QoL according to the CLDQ (3.3). Regarding the patients with lumbosacral spine fracture, the mean age was 61.6±11.1 years old, 60% were female, most of them Child A (66.7%), of alcoholic etiology (46.7%), and with an intermediary QoL according to the CLDQ (3.5). The presence of osteopenia and/or osteoporosis was associated with lumbosacral fracture (P<0.001), without correlation with the other analyzed variables: age, body mass index, gender, presence and absence of ascites, Child-Pugh classification, vitamin D, calcium, and phosphorus serum concentration, cirrhosis etiology and FRAX major. CONCLUSION: The prevalence of hepatic osteodystrophy was high, and the occurrence of lumbosacral spine fracture was more associated with osteoporosis and/or osteopenia among the cirrhotic patients studied. The QoL was intermediate and with no differences between cirrhotics with and without fracture.

Fatores de risco associados à fratura de coluna lombossacra e seu comprometimento na qualidade de vida em cirróticos / Risk factors associated with fracture of the lumbosacral spine and its compromise in the quality of life of cirrhotics

ABSTRACT Background Chronic hepatic disease is associated with osteoporosis, osteopenia or osteomalacia. Osteoporosis and fractures due to bone fragility present high prevalences and are more frequent in patients with liver cirrhosis than in the general population. The search for a diagnosis of osteopenia and osteoporosis in this population may allow early intervention and modify unfavorable outcomes. Objective To know the prevalence of osteopenia or osteoporosis and of fracture due to bone fragility in individuals with liver cirrhosis, the associated risk factors, and its compromise in their quality of life (QoL). Methods Observational, transversal study performed with 71 liver cirrhosis patients of the Hepatology Service of the Hospital de Base do Distrito Federal, Brasília, DF, Brazil, between July 2017 and December 2018. The patients were submitted to bone densitometry (DXA) of the lumbar spine and of the femoral neck, to x-ray of the lumbosacral spine and to the Chronic Liver Disease Questionnaire (CLDQ) for the evaluation of quality of life (QoL). The Fracture Risk Assessment (FRAX) major was calculated for patients >50 years old. The analyses were performed for the evaluation of the risk factors associated with lumbosacral spine fracture. Results The majority (62%) of the 71 evaluated patients was diagnosed with osteoporosis or osteopenia on DXA. Of the 44 patients with osteopenia or osteoporosis, 52.3% were female, with a mean age of 62.6±9.51 years old, with the majority (72.7%) being Child A, cirrhotics of alcoholic etiology (36.4%), and with an intermediate QoL according to the CLDQ (3.3). Regarding the patients with lumbosacral spine fracture, the mean age was 61.6±11.1 years old, 60% were female, most of them Child A (66.7%), of alcoholic etiology (46.7%), and with an intermediary QoL according to the CLDQ (3.5). The presence of osteopenia and/or osteoporosis was associated with lumbosacral fracture (P<0.001), without correlation with the other analyzed variables: age, body mass index, gender, presence and absence of ascites, Child-Pugh classification, vitamin D, calcium, and phosphorus serum concentration, cirrhosis etiology and FRAX major. Conclusion The prevalence of hepatic osteodystrophy was high, and the occurrence of lumbosacral spine fracture was more associated with osteoporosis and/or osteopenia among the cirrhotic patients studied. The QoL was intermediate and with no differences between cirrhotics with and without fracture.

RESUMO Contexto A doença hepática crônica associa-se com osteoporose, osteopenia ou osteomalácia. A osteoporose e as fraturas por fragilidade óssea têm altas prevalências e são mais frequentes em pacientes com cirrose hepática do que na população geral. A busca por osteopenia e osteoporose nesta população pode permitir a intervenção precoce e modificar os desfechos desfavoráveis. Objetivo Conhecer a prevalência de osteopenia ou osteoporose e de fraturas por fragilidade óssea em portadores de cirrose hepática, fatores de risco associados e seu comprometimento na qualidade de vida. Métodos Estudo observacional e transversal realizado com 71 pacientes portadores de cirrose hepática do Serviço de Hepatologia do Hospital de Base do Distrito Federal, Brasília, DF, Brasil, no período de julho de 2017 a dezembro de 2018. Os pacientes foram submetidos à densitometria óssea de coluna lombar e colo de fêmur, raio-x de coluna lombo sacra e ao questionário Chronic Liver Disease Questionnaire (CLDQ, na sigla em inglês) para avaliação de qualidade de vida. Foi calculado o escore de Fracture Risk Assessment Tool "FRAX Maior" nos pacientes >50 anos. As análises foram realizadas para a avaliação dos fatores de risco associados à fratura de coluna lombo sacra. Resultados Dos 71 pacientes avaliados, a maioria (62%) foi diagnosticada com osteoporose ou osteopenia à densitometria. Dos 44 portadores de osteopenia ou osteoporose, 52,3% eram do sexo feminino, com idade média de 62,6±9,51 anos, sendo a maioria (72,7%) Child A, cirróticos de etiologia alcoólica (36,4%) e com qualidade de vida intermediária ao CLDQ (3,3). Dos pacientes com fratura de coluna lombo sacra, a média de idade foi de 61,6±11,1 anos, 60% eram do sexo feminino, a maioria Child A (66,7%), de etiologia alcoólica (46,7%), e apresentaram qualidade de vida intermediária ao CLDQ (3,5). A presença de osteopenia e/ou osteoporose esteve associada à fratura lombo sacra (P<0,001), sem correlação com as demais variáveis analisadas: idade, índice de massa corporal (IMC), gênero, presença e ausência de ascite, classificação de Child-Pugh, concentrações séricas de vitamina D, cálcio e fósforo, etiologia da cirrose e "FRAX maior". Conclusão A prevalência de osteodistrofia hepática foi elevada, e a ocorrência de fratura de coluna lombo sacra esteve mais associada à osteoporose e/ou osteopenia entre cirróticos estudados. A qualidade de vida se mostrou intermediária e sem diferença entre cirróticos com e sem fratura.

Retenção de objetos intracavitários em procedimentos cirúrgicos: ações de segurança propostas por enfermeiros especialistas / Retention of intracavitary objects in surgical procedures: safety actions proposed by specialist nurses / Retención de objetos intracavitarios en procedimientos quirúrgicos: acciones de seguridad propuestas por enfermeros especialistas

Objetivo: Descrever ações de segurança para mitigar o risco de retenção de objetos intracavitários em procedimentos cirúrgicos, na opinião de enfermei-ros especialistas em assistência perioperatória. Método: Estudo qualitativo. Dados oriundos de reunião científica realizada durante o 14o Congresso da Associação Brasileira de Enfermagem em Centro Cirúrgico, em 2019, em São Paulo. Participaram enfermeiros especialistas em enfermagem perioperatória, divididos alea-toriamente em cinco grupos. Indisponibilidade para participar da reunião na íntegra considerou-se critério de exclusão. Compuseram o corpus de dados: gra-vação da reunião e registros dos grupos. Procedeu-se à análise de conteúdo para avaliar os dados. Seguiu-se a Resolução no 466/2012 do Conselho Nacional de Saúde (CNS). Resultados: Participaram 19 enfermeiros de seis estados brasileiros, a maioria mulheres. Ações propostas pelos participantes do estudo, visando a diminuir a retenção de objetos intracavitários: promover educação permanente e multiprofissional; estabelecer e seguir boas práticas institucionais; seguir proto-colo de cirurgia segura; atuar de forma integrada à equipe do serviço de esterilização; usar processos e tecnologias que contribuem para ampliar a segurança do paciente; contar instrumental e materiais cirúrgicos; e fortalecer o trabalho interdisciplinar. Conclusão: Ações para reduzir a retenção de objetos intracavitários incluem educação permanente, trabalho interdisciplinar e multissetorial, seguimento de fluxos e protocolos que visem à segurança do paciente.

Aims: This study aimed to describe the safety actions to mitigate the risk of retention of intracavitary objects in surgical procedures, in the opinion of perioperative care specialist nurses. Methods: This is a qualitative study. Data from a scientific meeting held during the 14th Congress of the Brazilian Association of Nursing in the Surgical Centre, in 2019, in São Paulo. Participants were nurses specialized in perioperative nursing, randomly divided into five groups. Unavailability to participate in the meeting in full was considered an exclusion criterion. The data corpus comprised meeting recording and group records. Content analysis was used to evaluate the data. Resolution no. 466/2012 of the National Health Council (CNS) was follo-wed. Results: A total of 19 nurses, mostly female, from six Brazilian states participated in this study. Actions proposed by the study participants to reduce the retention of intracavitary objects included promoting continuing and multidisciplinary education; establishing and following good institutional prac-tices; following the safe surgery protocol; integrating with the sterilization service team; using processes and technologies that contribute to increasing patient safety; counting surgical instruments and materials; and strengthening interdisciplinary work. Conclusion: Actions to reduce retention of intra-cavitary objects include permanent education, interdisciplinary work, and multisectoral work, following flows and protocols aimed at patient safety.

Objetivo: describir acciones de seguridad para mitigar el riesgo de retención de objetos intracavitarios en procedimientos quirúrgicos, según la opinión de enfermeros especialistas en cuidados perioperatorios. Método: estudio cualitativo. Datos de una reunión científica realizada durante el 14o Congreso de la Asociación Brasileña de Enfermería del Centro Quirúrgico, en 2019, en São Paulo. Participaron enfermeros especialistas en enfermería perioperatoria, divididos aleatoriamente en cuatro grupos. La falta de disponibilidad para participar en la reunión en su totalidad se consideró un criterio de exclusión. El corpus de datos estuvo compuesto por: grabación de la reunión y actas de los grupos. Se realizó un análisis de contenido para analizar los datos. A esto le siguió la Resolución no 466/2012 del Consejo Nacional de Salud (CNS). Resultados: Participaron 19 enfermeros de seis estados brasileños, la mayoría mujeres. Acciones propuestas por los participantes del estudio, con el objetivo de reducir la retención de objetos intracavitarios: promover la educación permanente y multiprofesional; establecer y seguir buenas prácticas institucionales; seguir un protocolo de cirugía seguro; actuar de manera integrada con el equipo del servicio de esterilización; hacer uso de procesos y tecnologías que contribuyan a aumentar la seguridad del paciente; realizar el conteo de instrumentos y material quirúrgico; fortalecer el trabajo interdisciplinario. Conclusión: las acciones para reducir la retención de objetos intraca-vitarios incluyen educación permanente, trabajo interdisciplinario y multisectorial, monitoreo de flujos y protocolos dirigidos a la seguridad del paciente.

Consensus on the Treatment and Follow-Up for Metastatic Castration-Resistant Prostate Cancer: A Report From the First Global Prostate Cancer Consensus Conference for Developing Countries (PCCCDC).

PURPOSE: To present a summary of the recommendations for the treatment and follow-up for metastatic castration-resistant prostate cancer (mCRPC) as acquired through a questionnaire administered to 99 physicians working in the field of prostate cancer in developing countries who attended the Prostate Cancer Consensus Conference for Developing Countries. METHODS: A total of 106 questions out of more than 300 questions addressed the use of imaging in staging mCRPC, treatment recommendations across availability and response to prior drug treatments, appropriate drug treatments, and follow-up, and those same scenarios when limited resources needed to be considered. Responses were compiled and the percentages were presented by clinicians to support each response. Most questions had five to seven relevant options for response including abstain and/or unqualified to answer, or in the case of yes or no questions, the option to abstain was offered. RESULTS: Most of the recommendations from this panel were in line with prior consensus, including the preference of a new antiandrogen for first-line therapy of mCRPC. Important aspects highlighted in the scenario of limited resources included the option of docetaxel as treatment preference as first-line treatment in several scenarios, docetaxel retreatment, consideration for reduced doses of abiraterone, and alternative schedules of an osteoclast-targeted therapy. CONCLUSION: There was wide-ranging consensus in the treatment for men with mCRPC in both optimal and limited resource settings.

Multi-taxon inventory and landscape characterization in an agrosystem of the Brazilian Midwest targeted for payment for environmental services / Inventário multi-táxon e caracterização da paisagem em um agrossistema no Centro-Oeste brasileiro alvo de pagamento por serviços ambientais

Abstract: The replacement of natural landscapes by anthropic environments has led to habitat loss and consequently, to the decline and extinction of many species populations. Several strategies, such as the creation of protected areas (PAs) and payment for ecosystem services have been adopted to mitigate the consequences of this biodiversity crisis. In Rio Verde, Goiás, Brazil, a Water Producer Program (WPP) was established, which provides payment for ecosystem services for the maintenance of riparian vegetation in the region of the Ribeirão Abóbora, a river which supplies the city and metropolitan area. In the absence of environmental diagnostic studies in the region, this present study contributes to reducing some knowledge gaps, through the: (i) characterization of the landscape in the WPP area, (ii) characterization of species of fauna (amphibians, birds, fish, and medium and large terrestrial mammals) and woody flora that occur in this area, and (iii) comparison of species diversity (fauna and flora) found in our study area with the diversity observed in the Cerrado protected area network. Our results reveal a low native vegetation cover (~21% of total area), but we recorded 300 total species: 20 species of anuran amphibians, 100 birds, 10 fish, 16 terrestrial mammals (medium and large), and 154 woody plants. Our sample comprises species considered endemic to the Cerrado (e.g., Anuran - Barycholos terntezi and Mammal - Callithrix penicillata), threatened species (e.g., Mammals - Herpailurus yagouaroundi, Myrmecophaga tridactyla and Tapirus terrestris), and exotic invasive species (Mammal - Sus scrofa). The results presented in this study are relevant and may help in the proposal of management actions within the scope of this important program of payment for environmental services.

Resumo: A substituição das paisagens naturais por ambientes antropizados tem levado à perda de habitat e, consequentemente, ao declínio populacional e extinção de muitas espécies. Várias estratégias como a criação de Unidades de Conservação (UCs) e o pagamento de serviços ecossistêmicos têm sido adotadas para mitigar as consequências da crise de biodiversidade. Em Rio Verde, estado de Goiás, foi estabelecido um Programa Produtores de Água (PPA) que prevê o pagamento de serviços ecossistêmicos pela manutenção da vegetação ripária na região do ribeirão Abobora que abastece a cidade. Diante da ausência de estudos de diagnóstico ambiental da região, o presente estudo contribui para reduzir algumas lacunas de conhecimento, através da: i) caracterização da paisagem na área deste PPA, ii) caracterização das espécies da fauna (anfíbios, aves, peixes e mamíferos terrestres de médio e grande porte) e flora lenhosa que ocorrem neste local, iii) comparação da diversidade de espécies (fauna e flora) encontrada na área de estudo com aquela observada na rede de áreas protegidas do Cerrado. Nossos resultados revelam baixo índice de cobertura vegetal nativa (~21% da área total), mas por outro lado, registramos 300 espécies, sendo 20 de anfíbios anuros, 100 aves, 10 peixes, 16 mamíferos terrestres (médio e grande porte) e 154 plantas lenhosas. A nossa amostragem compreende espécies que são consideradas endêmicas do Cerrado (p.ex. Anfíbio - Barycholos terntezi e Mamífero - Callithrix penicillata), ameaçadas de extinção (p.ex. Mamíferos - Herpailurus yagouaroundi, Myrmecophaga tridactyla e Tapirus terrestris) ou exótica invasora (Mamífero - Sus scrofa). Os resultados apresentados no presente estudo são relevantes e podem auxiliar na proposição de ações de manejo no âmbito deste importante programa de pagamento por serviços ambientais.

A protocol for rapid monocyte isolation and generation of singular human monocyte-derived dendritic cells.

The monocyte-derived dendritic cells (moDCs) are a subset of dendritic cells widely used in immunological studies as a convenient and easy approach after isolation of mononuclear cells directly from peripheral blood mononuclear cells (PBMC). Both the purification and cell culture of monocytes impact on the differentiation of monocytes into moDCs. The methodology to isolate and differentiate monocytes into moDCs is still controversial. We aimed to compare three different protocols for monocyte isolation from PBMC: 1) Cold-aggregation; 2) Percoll gradient; and 3) Magnetic beads cell-enrichment. Additionally we also compared four different monocyte differentiation and culture techniques: 1) Cell culture media; 2) Serum sources; 3) required GM-CSF and IL-4 concentrations; 4) Cell culture systems. We used flow cytometry analysis of light scattering and/or expression of pan surface markers, such as CD3, CD14 and CD209 to determine isolation/differentiation degree. Purified PBMC followed by two steps of cold aggregation, yielded cell viability around 95% with poor monocyte enrichment (monocytes increase vs. lymphocytes reduction was not statistically significant, p>0.05). Conversely, monocyte isolation from PBMC with discontinuous Percoll gradient generated around 50% cell viability. Albeit, we observed a significant reduction (p≤0.05) of lymphocytes contaminants. The magnetic beads cell-enrichment yield cell viability higher than 95%, as high as a significant lymphocyte depletion (p≤0.005) when compared to all other techniques employed. The moDCs showed better differentiation based on increased CD209 expression, but lower CD14 levels, when cells were cultured in RPMI medium plus 500IU/mL of both GM-CSF and IL-4 in a semi-adherent fashion. Serum sources showed no influence on the culture performance. In conclusion, the magnetic beads cell-enrichment showed superior cell viability, indicating that this approach is a better choice to isolate monocytes, and moDCs cultured afterwards in appropriate medium, serum, cytokines and culture system might influence the monocytes differentiation into moDC.

The induction of host cell autophagy triggers defense mechanisms against Trypanosoma cruzi infection in vitro.

Trypanosoma cruzi causes Chagas disease, a neglected illness that affects millions of people worldwide, especially in Latin America. The balance between biochemical pathways triggered by the parasite and host cells response will ultimately define the progression of a life-threatening disease, justifying the efforts to understand cellular mechanisms for infection restrain. In this interaction, parasite and host cells are affected by different physiological responses as autophagy modulation, which could be under intense cellular stress, such as nutrient deprivation, hormone depletion, or infection. Autophagy is a constitutive pathway that leads to degradation of macromolecules and cellular structures and may induce cell death. In Trypanosoma cruzi infection, the relevance of host autophagy is controversial regarding in vitro parasite intracellular life cycle. In the present study, we evaluated host cell autophagy during T. cruzi infection in phagocytic and non-professional phagocytic cells. We described that the presence of the parasite increased the number of LC3 puncta, a marker for autophagy, in cardiac cells and peritoneal macrophages in vitro. The induction of host autophagy decreased infection in macrophages in early and late time-periods. We suggest that starved phagocytic cells reduced internalization, also confirmed by inert particles and dead trypomastigotes. Whereas, in cardiac cells, starvation-induced autophagy decreased lipid droplets and infection in later time-point, by reducing parasite differentiation/proliferation. In ATG5 knockout MEF cells, we confirmed our hypothesis of autophagy machinery activation during parasite internalization, increasing infection. Our data suggest that host autophagy downregulates T. cruzi infection through impairing parasite intracellular life cycle, reducing the infection in primary culture cells.

Autophagy and Its Interaction With Intracellular Bacterial Pathogens.

Cellular responses to stress can be defined by the overwhelming number of changes that cells go through upon contact with and stressful conditions such as infection and modifications in nutritional status. One of the main cellular responses to stress is autophagy. Much progress has been made in the understanding of the mechanisms involved in the induction of autophagy during infection by intracellular bacteria. This review aims to discuss recent findings on the role of autophagy as a cellular response to intracellular bacterial pathogens such as, Streptococcus pyogenes, Mycobacterium tuberculosis, Shigella flexneri, Salmonella typhimurium, Listeria monocytogenes, and Legionella pneumophila, how the autophagic machinery senses these bacteria directly or indirectly (through the detection of bacteria-induced nutritional stress), and how some of these bacterial pathogens manage to escape from autophagy.

Hospitalizations due to diseases associated with poor sanitation in the public health care network of the metropolitan region of Porto Alegre, Rio Grande do Sul State, Brazil, 2010-2014. / Internações por doenças relacionadas ao saneamento ambiental inadequado na rede pública de saúde da região metropolitana de Porto Alegre, Rio Grande do Sul, 2010-2014.

OBJECTIVE: to describe the occurrence, characteristics and expenditures of hospitalizations due to diseases associated with poor sanitation funded by the Brazilian National Health System (SUS) among residents of the metropolitan region of Porto Alegre-RS, Brazil, from 2010 to 2014. METHODS: descriptive study with data from SUS Hospital Information System (SIH/SUS). RESULTS: out of 13,929 hospitalizations for diseases associated with poor sanitation, 93.7% were related to fecal-oral transmission diseases and 20.4% were children from 1 to 4 years of age (28.1 hospitalizations/10,000 inhabitants/year); hospital fatality rate was of 2.2%, fecal-oral transmission diseases were the main causes of death; intensive care unit (ICU) was used in 2.0% of hospitalizations; total expenditures on hospitalizations was around BRL6.1 million. CONCLUSION: diseases associated with poor sanitation are still an important issue in the metropolitan region of Porto Alegre-RS, although this region presents good development indicators.

Internações por doenças relacionadas ao saneamento ambiental inadequado na rede pública de saúde da região metropolitana de Porto Alegre, Rio Grande do Sul, 2010-2014 / Hospitalizaciones por enfermedades relacionadas con saneamiento ambiental inadecuada en la red pública de la región metropolitana de Porto Alegre, Rio Grande do Sul, Brasil, 2010-2014 / Hospitalizations due to diseases associated with poor sanitation in the public health care network of the metropolitan region of Porto Alegre, Rio Grande do Sul State, Brazil, 2010-2014

OBJETIVO: descrever a ocorrência, as características e os gastos com internações por doenças relacionadas ao saneamento ambiental inadequado (DRSAI) financiadas pelo Sistema Único de Saúde (SUS) entre residentes na Região Metropolitana de Porto Alegre-RS, no período de 2010 a 2014. MÉTODOS: estudo descritivo com dados do Sistema de Informações Hospitalares do SUS (SIH/SUS). RESULTADOS: das 13.929 internações por DRSAI, 93,7% relacionaram-se às doenças de transmissão feco-oral e 20,4% foram de crianças de 1 a 4 anos de idade (28,1 internações/10 mil hab./ano); a letalidade hospitalar foi de 2,2%, tendo as doenças de transmissão feco-oral como principais causas de óbito; em 2,0% das internações, houve utilização de unidade de terapia intensiva (UTI); o gasto total com as internações foi de cerca de R$6,1 milhões. CONCLUSÃO: as DRSAI permanecem como um importante problema na região metropolitana de Porto Alegre-RS, embora esta apresente bons indicadores de desenvolvimento.

OBJETIVO: describir la ocurrencia, las características y los gastos de hospitalización de las enfermedades relacionadas con el saneamiento ambiental inadecuado (DRSAI, en portugués) financiadas por el Sistema Único de Salud (SUS) entre los residentes de la región metropolitana de Porto Alegre-RS (RMPA), Brasil, 2010-2014. MÉTODOS: estudio descriptivo con datos del Sistema de Información Hospitalaria del SUS (SIH/SUS). RESULTADOS: de las 13.929 hospitalizaciones por DRSAI, 93,7% se relacionaron con enfermedades de transmisión oral-fecal (TOF) y 20,4% con niños de 1 a 4 años de edad (28,1 hospitalizaciones/10.000 personas/año); la tasa de mortalidad hospitalaria fue 2,2%, siendo las enfermedades por TOF las principales causas de muerte; en el 2,0% de las hospitalizaciones, se utilizó la unidad de cuidados intensivos; el gasto total en hospitalizaciones fue alrededor de R$ 6,1 millones. CONCLUSIÓN: DRSAI sigue siendo un problema importante en la RMPA, aunque presenta buenos indicadores de desarrollo.

OBJECTIVE: to describe the occurrence, characteristics and expenditures of hospitalizations due to diseases associated with poor sanitation funded by the Brazilian National Health System (SUS) among residents of the metropolitan region of Porto Alegre-RS, Brazil, from 2010 to 2014. METHODS: descriptive study with data from SUS Hospital Information System (SIH/SUS). RESULTS: out of 13,929 hospitalizations for diseases associated with poor sanitation, 93.7% were related to fecal-oral transmission diseases and 20.4% were children from 1 to 4 years of age (28.1 hospitalizations/10,000 inhabitants/year); hospital fatality rate was of 2.2%, fecal-oral transmission diseases were the main causes of death; intensive care unit (ICU) was used in 2.0% of hospitalizations; total expenditures on hospitalizations was around BRL6.1 million. CONCLUSION: diseases associated with poor sanitation are still an important issue in the metropolitan region of Porto Alegre-RS, although this region presents good development indicators.

Intrinsic and Extrinsic Aspects on Campylobacter jejuni Biofilms.

Biofilm represents a way of life that allows greater survival of microorganisms in hostile habitats. Campylobacter jejuni is able to form biofilms in vitro and on surfaces at several points in the poultry production chain. Genetic determinants related to their formation are expressed differently between strains and external conditions are decisive in this respect. Our approach combines phylogenetic analysis and the presence of seven specific genes linked to biofilm formation in association with traditional microbiology techniques, using Mueller Hinton and chicken juice as substrates in order to quantify, classify, determine the composition and morphology of the biomass of simple and mixed biofilms of 30 C. jejuni strains. It also evaluates the inhibition of its formation by biocides commonly used in industry and also by zinc oxide nanoparticles. Genetic analysis showed high heterogeneity with the identification of 23 pulsotypes. Despite the diversity, the presence of flaA, cadF, luxS, dnaJ, htrA, cbrA, and sodB genes in all strains shows the high potential for biofilm formation. This ability was only expressed in chicken juice, where they presented phenotype of a strong biofilm producer, with a mean count of 7.37 log CFU/mL and an ultrastructure characteristic of mature biofilm. The composition of simple and mixed biofilms was predominantly composed by proteins. The exceptions were found in mixed biofilms with Pseudomonas aeruginosa, which includes a carbohydrate-rich matrix, lower ability to sessile form in chicken juice and compact architecture of the biofilm, this aspects are intrinsic to this species. Hypochlorite, chlorhexidine, and peracetic acid were more effective in controlling viable cells of C. jejuni in biofilm, but the existence of tolerant strains indicates exposure to sublethal concentrations and development of adaptation mechanisms. This study shows that in chicken juice C. jejuni presents greater potential in producing mature biofilms.

Protein aggregation as a cellular response to oxidative stress induced by heme and iron.

Hemolytic diseases include a variety of conditions with diverse etiologies in which red blood cells are destroyed and large amounts of hemeproteins are released. Heme has been described as a potent proinflammatory molecule that is able to induce multiple innate immune responses, such as those triggered by TLR4 and the NLRP3 inflammasome, as well as necroptosis in macrophages. The mechanisms by which eukaryotic cells respond to the toxic effects induced by heme to maintain homeostasis are not fully understood, however. Here we describe a previously uncharacterized cellular response induced by heme: the formation of p62/SQTM1 aggregates containing ubiquitinated proteins in structures known as aggresome-like induced structures (ALIS). This action is part of a response driven by the transcription factor NRF2 to the excessive generation of reactive oxygen species induced by heme that results in the expression of genes involved in antioxidant responses, including p62/SQTM1. Furthermore, we show that heme degradation by HO-1 is required for ALIS formation, and that the free iron released on heme degradation is necessary and sufficient to induce ALIS. Moreover, ferritin, a key protein in iron metabolism, prevents excessive ALIS formation. Finally, in vivo, hemolysis promotes an increase in ALIS formation in target tissues. Our data unravel a poorly understood aspect of the cellular responses induced by heme that can be explored to better understand the effects of free heme and free iron during hemolytic diseases such as sickle cell disease, dengue fever, malaria, and sepsis.