Previne brasil e financiamento da atenção primária: facilidades e dificuldades de gestores municipais de saúde / Previne Brasil and primary care financing: facilities and difficulties for municipal health managers / Previne Brasil y financiamiento de la atención primaria: facilidades y dificultades para los gestores municipales de salud

Objetivo: compreender as facilidades e dificuldades enfrentadas por gestores municipais de saúde com o novo modelo de financiamento da Atenção Primária à Saúde. Método: estudo qualitativo, tipo Pesquisa Convergente Assistencial, fundamentado na Política Nacional de Atenção Básica. Participaram 77 gestores ou seus representantes, de 47 municípios de uma Macrorregião de saúde de Santa Catarina, Brasil. Foram realizadas três oficinas nas Gerências Regionais de Saúde, em agosto e setembro de 2022. Os dados foram analisados pela análise de conteúdo. Resultados: apresentam-se como facilidades do Previne Brasil informatização, comprometimento dos profissionais, e qualificação do cuidado. Foram descritas como dificuldades falta de informações, sistema informatizado e denominador estimado e, equipe de trabalho. Conclusão: o programa apresenta facilidades que qualificam o processo de trabalho e cuidado à saúde da população. Contudo, persistem dificuldades que devem ser consideradas pela gestão municipal para avanços na atenção integral e no financiamento da Atenção Primária à Saúde.

Objective: understand the facilities and difficulties faced by municipal health managers with the new Primary Health Care financing model. Method: this is a qualitative study, of the Convergent Care Research type, based on the National Primary Care Policy. The participants were 77 managers or their representatives from 47 municipalities in a health Macroregion in Santa Catarina, Brazil. Three workshops were held in the Regional Health Departments in August and September 2022. The data was analyzed using content analysis. Results: Previne Brasil's facilities include computerization, commitment of professionals, and qualification of care. Difficulties were described as lack of information, computerized system and estimated denominator, and work team. Conclusion: the program offers facilities that improve the work process and health care for the population. However, there are still difficulties that must be considered by municipal management in order to make progress in comprehensive care and Primary Health Care financing.

Objetivo: comprender las facilidades y dificultades que enfrentan los gestores municipales de salud con el nuevo modelo de financiamiento de la Atención Primaria de Salud. Método: estudio cualitativo, tipo Investigación Convergente Asistencial, basado en la Política Nacional de Atención Primaria. Participaron 77 gestores o sus representantes, de 47 municipios de una Macrorregión de salud de Santa Catarina, Brasil. Se realizaron tres talleres en las Gerencias Regionales de Salud, en agosto y septiembre de 2022. Los datos fueron analizados mediante análisis de contenido. Resultados: las instalaciones de Previne Brasil incluyen informatización, compromiso de los profesionales y calificación de la atención. Las dificultades fueron descritas como falta de información, sistema informatizado y denominador estimado y equipo de trabajo. Conclusión: el programa presenta facilidades que cualifican el proceso de trabajo y la atención de la salud de la población. Sin embargo, aún hay dificultades que la gestión municipal debe considerar para lograr avances en la atención integral y el financiamiento de la Atención Primaria de Salud.

Origin of sandy substrates controlling the distribution of open vegetation ecosystems in Amazonia.

Understanding the role of open vegetation, particularly in white-sand ecosystems (WSE) and savannas, is crucial for elucidating their role in Amazonian biotic diversification. These ecosystems predominantly develop on sandy terrains, suggesting that the geological substrate significantly influences the vegetation upon it. Therefore, the interaction between landscape changes and biotic diversification is closely tied to the dynamics and resilience of these sandy substrates. Current WSE and savannas in lowland Amazonia colonized fluvial sediments deposited during the past 120 ka, with marked synchronicity over the last 23 ka, as shown by optically stimulated luminescence (OSL) and radiocarbon ages of such sandy substrates. In contrast, sandy substrates supporting open vegetation in highland areas, unsuitable for Quaternary sand accumulation, would have persisted beyond the Quaternary, as ancient sedimentary rocks in these areas are prone to developing sandy soils. The current distribution of open vegetation ecosystems in lowland Amazonia is coupled with the deposition and erosion of sandy sediments by Quaternary fluvial systems, while weathering sandy substrates in highland areas serve as long-term and resilient refugia beyond the Quaternary. The contrasting spatiotemporal dynamics of landscape changes in lowland and highland areas has implications for biodiversification or extinction events leading to current biogeography patterns in Amazonia.

Tabular review of contemporary fenestrated-branched endovascular aortic repair experiences for treatment of thoracoabdominal aortic aneurysms.

INTRODUCTION: Repair of thoracoabdominal aortic aneurysms (TAAAs) represents a technical challenge regardless of which technique is used. Open surgical repair (OSR) is the time-tested option against which novel techniques must be compared and it is still considered the gold standard option for younger, fit patients with heritable aortic diseases. Endovascular repair offers a less-invasive alternative in patients with suitable anatomy. This article aims to present a tabular review of the contemporary published data on endovascular repair of TAAAs using fenestrated-branched techniques. EVIDENCE ACQUISITION: The published literature for single-center and multicenter studies evaluating the outcomes of FB-EVAR for TAAAs was searched using MEDLINE and Embase databases. Studies published between January 1st 2010 and July 11th 2024, in the English language which provided data on FB-EVAR of TAAAs with more than fifty reported cases were included. EVIDENCE SYNTHESIS: The average patient age at time of repair was 71 years old with majority of males (65.5%). Most patients presented with a Crawford Extent II TAAAs (21.6%), followed by Extent III (21.2%). Early mortality was 4.9% for the entire cohort. The most prevalent adverse event was acute kidney injury (9.4%), followed by spinal cord injury (8.0%). CONCLUSIONS: FB-EVAR of TAAAs continues to evolve. Pooled analysis of early mortality and morbidity is lower in this tabular review than historical outcomes of open TAAA repair.

Habitat specificity modulates the bacterial biogeographic patterns in the Southern Ocean.

Conceptual biogeographic frameworks have proposed that the relative contribution of environmental and geographical factors on microbial distribution depends on several characteristics of the habitat (e.g. environmental heterogeneity, species diversity, proportion of specialist/generalist taxa), all of them defining the degree of habitat specificity, but few experimental demonstrations exist. Here, we aimed to determine the effect of habitat specificity on bacterial biogeographic patterns and assembly processes in benthic coastal ecosystems of the Southern Ocean (Patagonia, Falkland/Malvinas, Kerguelen, South Georgia and King George Islands), using 16S rRNA gene metabarcoding. The gradient of habitat specificity resulted from a 'natural experimental design' provided by the Abatus sea urchin model, from the sediment (least specific habitat) to the intestinal tissue (most specific habitat). The phylogenetic composition of the bacterial communities showed a clear differentiation by site, driven by a similar contribution of geographic and environmental distances. However, the strength of this biogeographic pattern decreased with increasing habitat specificity: sediment communities showed stronger geographic and environmental divergence compared to gut tissue. The proportion of stochastic and deterministic processes contributing to bacterial assembly varied according to the geographic scale and the habitat specificity level. For instance, an increased contribution of dispersal limitation was observed in gut tissue habitat. Our results underscore the importance of considering different habitats with contrasting levels of specificity to better understand bacterial biogeography and assembly processes over oceanographic scales.

hACE2 upregulation and participation of macrophages and clear cells in the immune response of epididymis to SARS-CoV-2 in K18-hACE2 mice.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus caused the coronavirus disease 2019 pandemic, and the prevalence of deaths among men is higher than among women. The epididymis, divided into caput, corpus, and cauda, shows a region-specific immunity. The K18-hACE2 mouse expresses human angiotensin-converting enzyme 2 (hACE2), the receptor that allows SARS-CoV-2 infection. However, studies using this transgenic mouse to evaluate the impact of this viral infection in epididymis have not yet been performed. OBJECTIVES: We evaluated the expression of hACE2 in the epididymis of SARS-CoV-2-infected K18-hACE2 mice, and assessed the epididymal immune response, focusing on F4/80+ mononuclear phagocytes and tumor necrosis factor-alpha expression. MATERIALS AND METHODS: The following analyses were performed in the epididymal sections of infected mice: epithelial height and duct diameter, birefringent collagen, Terminal deoxynucleotidyl Transferase-mediated dUTP Nick End Labelling, immunoreactions for detection of hACE2, spike, FGF, V-ATPase, F4/80, tumor necrosis factor-alpha, and iNOS. Viral particles were identified under electron microscopy. hACE2, Rigi, Tgfb1 and Tnfa expression were also evaluated by real-time quantitative polymerase chain reaction. RESULTS: All epididymal regions expressed hACE2, which increased in all epididymal regions in the infected mice. However, the caput appeared to be the most infected region. Despite this, the caput region showed minimal changes while the cauda showed significant epithelial changes associated with increased iNOS immunoexpression. The F4/80+ mononuclear phagocyte area increased significantly in both stroma and epithelium. In addition to the epithelial and stromal mononuclear phagocytes, tumor necrosis factor-alpha was also detected in clear cells, whose cytoplasm showed a significant increase of this cytokine in the infected animals. DISCUSSION AND CONCLUSION: The K18-hACE2 mouse is a useful model for evaluating the impact of SARS-CoV-2 infection in the epididymis. The infection induced hACE2 upregulation, favoring the virulence in the epididymis. The epididymal regions responded differentially to infection, and the activation of F4/80+ mononuclear phagocytes associated with the increased tumor necrosis factor-alpha immunolabeling in clear cells indicates a role of clear cells/mononuclear phagocytes immunoregulatory mechanisms in the epididymal immune response to SARS-CoV-2 infection.

SPINE20 Recommendations 2024 -Spinal Disability: Social Inclusion as a Key to Prevention and Management.

Spine disorders are the leading cause of disability worldwide. To promote social inclusion, it is essential to ensure that people can participate in their societies by improving their ability, opportunities, and dignity, through access to high-quality, evidence-based, and affordable spine services for all.To achieve this goal, SPINE20 recommends six actions.- SPINE20 recommends that G20 countries deliver evidence-based education to the community health workers and primary care clinicians to promote best practice for spine health, especially in underserved communities.- SPINE20 recommends that G20 countries deliver evidence-based, high-quality, cost-effective spine care interventions that are accessible, affordable and beneficial to patients.- SPINE20 recommends that G20 countries invest in Health Policy and System Research (HPSR) to generate evidence to develop and implement policies aimed at integrating rehabilitation in primary care to improve spine health.- SPINE20 recommends that G20 countries support ongoing research initiatives on digital technologies including artificial intelligence, regulate digital technologies, and promote evidence-based, ethical digital solutions in all aspects of spine care, to enrich patient care with high value and quality.- SPINE20 recommends that G20 countries prioritize social inclusion by promoting equitable access to comprehensive spine care through collaborations with healthcare providers, policymakers, and community organizations.- SPINE20 recommends that G20 countries prioritize spine health to improve the well-being and productivity of their populations. Government health systems are expected to create a healthier, more productive, and equitable society for all through collaborative efforts and sustained investment in evidence-based care and promotion of spine health.

Purinergic signaling in liver disease: calcium signaling and induction of inflammation.

Purinergic signaling regulates many metabolic functions and is implicated in liver physiology and pathophysiology. Liver functionality is modulated by ionotropic P2X and metabotropic P2Y receptors, specifically P2Y1, P2Y2, and P2Y6 subtypes, which physiologically exert their influence through calcium signaling, a key second messenger controlling glucose and fat metabolism in hepatocytes. Purinergic receptors, acting through calcium signaling, play an important role in a range of liver diseases. Ionotropic P2X receptors, such as the P2X7 subtype, and certain metabotropic P2Y receptors can induce aberrant intracellular calcium transients that impact normal hepatocyte function and initiate the activation of other liver cell types, including Kupffer and stellate cells. These P2Y- and P2X-dependent intracellular calcium increases are particularly relevant in hepatic disease states, where stellate and Kupffer cells respond with innate immune reactions to challenges, such as excess fat accumulation, chronic alcohol abuse, or infections, and can eventually lead to liver fibrosis. This review explores the consequences of excessive extracellular ATP accumulation, triggering calcium influx through P2X4 and P2X7 receptors, inflammasome activation, and programmed cell death. In addition, P2Y2 receptors contribute to hepatic steatosis and insulin resistance, while inhibiting the expression of P2Y6 receptors can alleviate alcoholic liver steatosis. Adenosine receptors may also contribute to fibrosis through extracellular matrix production by fibroblasts. Thus, pharmacological modulation of P1 and P2 receptors and downstream calcium signaling may open novel therapeutic avenues.

Reaction-Free Energies for Complexation of Carbohydrates by Tweezer Diboronic Acids.

The accurate calculation of reaction-free energies (ΔrG°) for diboronic acids and carbohydrates is challenging due to reactant flexibility and strong solute-solvent interactions. In this study, these challenges are addressed with a semiautomatic workflow based on quantum chemistry methods to calculate conformational free energies, generate microsolvated solute structural ensembles, and compute ΔrG°. Workflow parameters were optimized for accuracy and precision while controlling computational costs. We assessed the accuracy by studying three reactions of diboronic acids with glucose and galactose, finding that the conformational entropy contributes significantly (by 3-5 kcal/mol at room temperature). Explicit solvent molecules improve the computed ΔrG° accuracy by about 4 kcal/mol compared to experimental data, though using 13 or more water molecules reduced precision and increased computational overhead. After fine-tuning, the workflow demonstrated remarkable accuracy, with an absolute error of about 2 kcal/mol compared to experimental ΔrG° and an average interquartile range of 2.4 kcal/mol. These results highlight the workflow's potential for designing and screening tweezer-like ligands with tailored selectivity for various carbohydrates.

Satellitome analysis on the pale-breasted thrush Turdus leucomelas (Passeriformes; Turdidae) uncovers the putative co-evolution of sex chromosomes and satellite DNAs.

Do all birds' sex chromosomes follow the same canonical one-way direction of evolution? We combined cytogenetic and genomic approaches to analyze the process of the W chromosomal differentiation in two selected Passeriform species, named the Pale-breasted Thrush Turdus leucomelas and the Rufous-bellied thrush T. rufiventris. We characterized the full catalog of satellite DNAs (satellitome) of T. leucomelas, and the 10 TleSatDNA classes obtained together with 16 microsatellite motifs were in situ mapped in both species. Additionally, using Comparative Genomic Hybridization (CGH) assays, we investigated their intragenomic variations. The W chromosomes of both species did not accumulate higher amounts of both heterochromatin and repetitive sequences. However, while T. leucomelas showed a heterochromatin-poor W chromosome with a very complex evolutionary history, T. rufiventris showed a small and partially heterochromatic W chromosome that represents a differentiated version of its original autosomal complement (Z chromosome). The combined approach of CGH and sequential satDNA mapping suggest the occurrence of a former W-autosomal translocation event in T. leucomelas, which had an impact on the W chromosome in terms of sequence gains and losses. At the same time, an autosome, which is present in both males and females in a polymorphic state, lost sequences and integrated previously W-specific ones. This putative W-autosomal translocation, however, did not result in the emergence of a multiple-sex chromosome system. Instead, the generation of a neo-W chromosome suggests an unexpected evolutionary trajectory that deviates from the standard canonical model of sex chromosome evolution.

The Prevalence of Shoulder and Elbow Pathology in Major League Baseball Prospects From the Dominican Republic.

BACKGROUND: Rates of shoulder and elbow pathology are well documented among competitive baseball players in the United States; however, little is known about the prevalence of these pathologies in the Dominican Republic (DR). PURPOSE: To report the epidemiology of shoulder and elbow pathology among participants at a Major League Baseball scouting event in Santo Domingo, DR. STUDY DESIGN: Retrospective descriptive study. LEVEL OF EVIDENCE: 3. METHODS: All pitchers and position players who attended the 2021 scouting event were reviewed. Those with complete medical history, physical examination, imaging series, and radiology reports were included. All participants underwent shoulder and elbow radiography, while pitchers also underwent magnetic resonance imaging (MRI). All pathologic findings on imaging studies were recorded and compared among position players and pitchers. RESULTS: Seventy-five participants (average age, 17.9 years) were reviewed (42 position players, 33 pitchers); 72% and 32% had ≥1 abnormal finding on elbow and shoulder radiographs, respectively. Position players had significantly higher numbers of elbow radiographic findings compared with pitchers (81% vs 57.6%, P = 0.03) but similar numbers on shoulder radiograph (28.6% vs 33.3%, P = 0.66). Position players had high numbers of acromioclavicular separation (14.3%) and little leaguer's shoulder (14.3%) on shoulder radiograph, with olecranon osteophytes (23.8%) and medial epicondyle nonunions (11.9%) prevalent on elbow radiograph. Pitchers had high numbers of rotator cuff pathology (93.9%), labral tears (75.8%), and Bennett lesions (51.5%). On elbow imaging, pitchers had high numbers of ulnar collateral ligament (UCL) abnormalities (81.8%), olecranon osteophytes (69.7%), osteochondral lesions (18.2%), and medial epicondyle nonunions (12.1%). Two pitchers had complete UCL disruption (6.1%), while 8 had partial tears (24.2%). CONCLUSION: Dominican baseball prospects had high numbers of asymptomatic shoulder and elbow pathology on imaging studies. Knowledge of the prevalence of these pathologies can guide injury prevention programs in Dominican youth baseball.

Electrophysiology lab efficiency using cryoballoon for pulmonary vein isolation in Latin America: A sub-analysis of the Cryo Global Registry Study.

Objective: Cryoballoon ablation for pulmonary vein isolation is a time-efficient procedure that can alleviate stress on electrophysiology lab resources. This analysis modeled the impact of cryoballoon ablation on electrophysiology lab operation using data from Latin America. Methods: Data from centers in Argentina, Mexico, Colombia, and Chile of the were used as inputs for an electrophysiology lab efficiency simulation model. The model used the assumption that either two (today's electrophysiology lab operations) or three (including electrophysiology lab operational changes) cryoballoon ablation procedures could be performed per day. The endpoints were the percentage of days that resulted in 1) overtime and 2) time left for an extra non-ablation electrophysiology procedure. Results: Data from a total of 232 procedures from six Latin American centers were included in the analysis. The average electrophysiology lab occupancy time for all procedures in Latin America was 132 ± 62 minutes. In the Current Scenario (two procedures per day), 7.4% of simulated days resulted in overtime, and 81.4% had enough time for an extra electrophysiology procedure. In the Enhanced Productivity Scenario (three procedures per day), 16.4% of days used overtime, while 67.4% allowed time for an extra non-ablation electrophysiology procedure. Conclusions: Using real-world, Latin American-specific data, we found that with operational changes, three ablation procedures could feasibly be performed daily, leaving time for an extra electrophysiology procedure on more than half of days. Thus, use of cryoballoon ablation is an effective tool to enhance electrophysiology lab efficiency in resource-constrained regions such as Latin America.

Objetivos: La ablación con criobalón para el aislamiento de venas pulmonares es un procedimiento que ahorra tiempo y puede ahorrar recursos del laboratorio de electrofisiología. Este análisis modeló el impacto de la ablación con criobalón en el funcionamiento del laboratorio de electrofisiología utilizando datos de América Latina. Métodos: Los datos de los centros de Argentina, México, Colombia y Chile del se utilizaron como datos de entrada para un modelo de simulación de la eficiencia del laboratorio de electrofisiología. El modelo partió del supuesto de que se podían realizar dos (operaciones actuales del laboratorio de electrofisiología) o tres (incluidos los cambios operativos del laboratorio de electrofisiología) procedimientos de ablación con criobalón por día. Los criterios de valoración eran el porcentaje de días en los que se producían 1) horas extraordinarias y 2) tiempo restante para un procedimiento electrofisiológico adicional no relacionado con la ablación. Resultados: Se incluyeron en el análisis los datos un total de 232 procedimientos de seis centros latinoamericanos. El tiempo medio de ocupación del laboratorio de electrofisiología para todos los procedimientos en Latinoamérica fue de 132 ± 62 minutos. En el escenario actual (dos procedimientos por día), el 7,4% de los días simulados resultaron en horas extras, y el 81,4% tuvo tiempo suficiente para un procedimiento de electrofisiología adicional. En el escenario de productividad mejorada (tres procedimientos por día), el 16,4% de los días utilizó horas extraordinarias, mientras que el 67,4% dispuso de tiempo suficiente para un procedimiento electrofisiológico extra sin ablación. Conclusiones: Utilizando datos del mundo real específicos de América Latina, descubrimos que, aplicando cambios operativos, es factible realizar tres procedimientos de ablación al día, lo que deja tiempo para un procedimiento de electrofisiología adicional en más de la mitad de los días. Por lo tanto, el uso de la ablación con criobalón es una herramienta eficaz para mejorar la eficiencia de los laboratorios de electrofisiología en regiones con recursos limitados como América Latina.

Satellite DNAs and the evolution of the multiple X1X2Y sex chromosomes in the wolf fish Hoplias malabaricus (Teleostei; Characiformes).

Multiple sex chromosomes usually arise from chromosomal rearrangements which involve ancestral sex chromosomes. There is a fundamental condition to be met for their long-term fixation: the meiosis must function, leading to the stability of the emerged system, mainly concerning the segregation of the sex multivalent. Here, we sought to analyze the degree of differentiation and meiotic pairing properties in the selected fish multiple sex chromosome system present in the wolf-fish Hoplias malabaricus (HMA). This species complex encompasses seven known karyotype forms (karyomorphs) where the karyomorph C (HMA-C) exhibits a nascent XY sex chromosomes from which the multiple X1X2Y system evolved in karyomorph HMA-D via a Y-autosome fusion. We combined genomic and cytogenetic approaches to analyze the satellite DNA (satDNA) content in the genome of HMA-D karyomorph and to investigate its potential contribution to X1X2Y sex chromosome differentiation. We revealed 56 satDNA monomers of which the majority was AT-rich and with repeat units longer than 100 bp. Seven out of 18 satDNA families chosen for chromosomal mapping by fluorescence in situ hybridization (FISH) formed detectable accumulation in at least one of the three sex chromosomes (X1, X2 and neo-Y). Nine satDNA monomers showed only two hybridization signals limited to HMA-D autosomes, and the two remaining ones provided no visible FISH signals. Out of seven satDNAs located on the HMA-D sex chromosomes, five mapped also to XY chromosomes of HMA-C. We showed that after the autosome-Y fusion event, the neo-Y chromosome has not substantially accumulated or eliminated satDNA sequences except for minor changes in the centromere-proximal region. Finally, based on the obtained FISHpatterns, we speculate on the possible contribution of satDNA to sex trivalent pairing and segregation.

Ultrasound-guided infiltration with hyaluronic acid compared with corticosteroid for the treatment of Morton's neuroma.

Aims: A local injection may be used as an early option in the treatment of Morton's neuroma, and can be performed using various medications. The aim of this study was to compare the effects of injections of hyaluronic acid compared with corticosteroid in the treatment of this condition. Methods: A total of 91 patients were assessed for this trial, of whom 45 were subsequently included and randomized into two groups. One patient was lost to follow-up, leaving 22 patients (24 feet) in each group. The patients in the hyaluronic acid group were treated with three ultrasound-guided injections (one per week) of hyaluronic acid (Osteonil Plus). Those in the corticosteroid group were treated with three ultrasound-guided injections (also one per week) of triamcinolone (Triancil). The patients were evaluated before treatment and at one, three, six, and 12 months after treatment. The primary outcome measure was the visual analogue scale for pain (VAS). Secondary outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) score, and complications. Results: Both groups showed significant improvement in VAS and AOFAS scores (p < 0.05) after 12 months. The corticosteroid group had a significantly greater reduction in VAS and increase in AOFAS scores compared with the hyaluronic acid group, at one, three, and six months, but with no significant difference at 12 months. There were no complications in the hyaluronic acid group. There were minor local complications in six patients (six feet) (25.0%) in the corticosteroid group, all with discolouration of the skin at the site of the injection. These minor complications might have been due to the three weekly injections of a relatively high dose of corticosteroid. No patient subsequently underwent excision of the neuroma. Conclusion: An ultrasound-guided corticosteroid injection showed statistically significantly better functional and pain outcomes than an ultrasound-guided injection of hyaluronic acid for the treatment of a Morton's neuroma at many timepoints. Thus, a corticosteroid injection should be regarded as a primary option in the treatment of these patients, and the only indication for an injection of hyaluronic acid might be in patients in whom corticosteroid is contraindicated.

A Survey of Perspectives and Educational Needs of Canadian Oncology Residents on Artificial Intelligence.

This study evaluated the perspectives and educational needs of Canadian oncology residents with regard to artificial intelligence (AI) in medicine, exploring the influence of factors such as program of choice, gender, and tech literacy on their attitudes towards AI. An ethics-approved survey collected anonymous responses from Canadian oncology residents from December 2022 to July 2023. Comparisons by demographics were made using Chi-square and Mann-Whitney U tests. A total of 57 residents and fellows responded out of an expected 182, with representation from each oncology training program in Canada. Over half of the participants were male (63.2%), with radiation oncology programs being better represented than medical oncology programs (68.4% vs. 31.6%). There was balanced representation across all years of training. Most trainees (73%) were interested in learning more about AI, and many believed the topic should be formally taught during residency (63%), preferably through workshops (79%). Among evaluated factors, tech literacy showed the most impact over AI perspectives, driving a perception shift towards viewing AI as an improvement tool, rather than as a threat to professionals. In conclusion, Canadian oncology residents anticipate AI's growing influence in medicine but face educational deficiencies. Gender, oncology discipline, and self-reported tech literacy impact attitudes toward AI, highlighting the need for inclusive education.

Diet quality and blood lead levels in Uruguayan first graders.

OBJECTIVE: Foods are a potential source of lead but also contain nutrients that counteract the intestinal absorption of lead. Translatable evidence is needed to better understand the relationship between whole diets and blood lead levels (BLLs) in children. In this cross-sectional study we investigated the association between dietary variety, adequacy, moderation, and overall diet quality with children's BLLs. METHODS: First graders (~ 7 years) from Montevideo, Uruguay were evaluated in years 2009-13 (Phase I, n = 303) and 2015-19 (Phase II, n = 443). Lead was measured in fasting blood via atomic absorption spectrometry and primary caregivers completed two non-consecutive 24-h recalls. Indices of dietary variety (maximum score of 20), adequacy (maximum 40), moderation (maximum 30), and overall diet quality were calculated from food and nutrient intakes averaged over two recall days. The indices were adapted from the Diet Quality Index-International based on dietary recommendations for children. Missing covariate data were imputed. The associations between diet quality measures and BLLs were modeled separately in Phase I and II with multivariable linear models, testing for sex differences via interaction terms and stratified models. RESULTS: The median[IQR] BLLs were 3.8[2.6, 4.9] and 1.3[0.7, 3.6] µg/dL in study Phases I and II, respectively. All diet quality scores were <60 % of the maximum values and daily intakes of key food groups fell below recommended levels. There was little evidence of an association between measures of diet quality and children's BLLs overall. On the other hand, higher diet variety, adequacy, and overall diet quality were associated with slightly higher BLLs among girls in Phase I only. CONCLUSIONS: In the context of low lead exposure and food consumption patterns that fall short of recommended levels, the relation of diet quality to children's BLLs may depend on lead exposure levels.

Soluble epoxide hydrolase inhibition impairs triggering receptor expressed on myeloid cells-1 in periodontal tissue.

AIMS: Periodontitis is a prevalent inflammatory disorder affecting the oral cavity, driven by dysbiotic oral biofilm and host immune response interactions. While the major clinical focus of periodontitis treatment is currently controlling oral biofilm, understanding the immune response is crucial to prevent disease progression. Soluble epoxide hydrolase (sEH) inhibition has shown promise in preventing alveolar bone resorption. Triggering receptors expressed on myeloid cells (TREMs) play pivotal roles in regulating inflammation and bone homeostasis, and dysregulation of TREM signaling is implicated in periodontitis. Here, we investigated the impact of sEH inhibition on TREM 1 and 2 expression, associated with inflammatory cytokines, and histologically assessed the inflammatory infiltrate in periodontal tissue. METHODS: The experimental periodontitis model was induced by placing a ligature around the upper second molar. For 14 days, animals were treated daily with a sEH inhibitor (TPPU) or vehicle. The alveolar bone loss was examined using a methylene blue stain. Gingival tissues were used to measure the mRNA expression of TREM-1, TREM-2, IKKß, NF-κB, IL-1ß, IL-6, IL-8, and TNF-α by RT-qPCR. Another set of experiments was performed to determine the histological inflammatory scores. RESULTS: In a ligature-induced periodontitis model, sEH inhibition prevented alveolar bone loss and reduced TREM1 expression, albeit with a slight elevation compared to the disease-free group. In contrast, TREM2 expression remained elevated, suggesting sustained immunomodulation favoring resolution. The inhibition of sEH reduced the expression of NF-κB, IL-1ß, and TNF-α, while no differences were found in the expression of IL-6, IL-8, and IKKß. In histological analysis, sEH inhibition reduced the inflammatory leukocyte infiltrate in periodontal tissues close to the ligature. CONCLUSION: These findings underscore the potential of sEH inhibition to modulate periodontal inflammation by regulating TREM-1 alongside decreased IL-1ß and TNF-α expression, highlighting a promising therapeutic approach for periodontitis management.

Co-occurrence and spatial distribution of organic micropollutants in surface waters of the River Aconcagua and Maipo basins in Central Chile.

Organic Micropollutants (OMPs) might pose significant risks to aquatic life and have potential toxic effects on humans. These chemicals typically occur as complex mixtures rather than individually. Information on their co-occurrence and their association with land use is largely lacking, even in industrialized countries. Furthermore, data on the presence of OMPs in freshwater ecosystems in South America is insufficient. Consequently, we assessed the co-occurrence and distribution of OMPs, including pharmaceuticals, pesticides, personal care products, surfactants, and other industrial OMPs, in surface waters of two river basins in central Chile. We focused on identifying and ranking quantified chemicals, classifying their mode of actions, as well as correlating their occurrence with distinct land uses. We identified and quantified 311 compounds that occurred at least once in the River Aconcagua and River Maipo basins, encompassing compounds from urban, agricultural, industrial, and pharmaceutical sectors. Pharmaceuticals were the most frequently occurring chemicals, followed by pesticides, personal care and household products. OMPs with neuroactive properties dominated surface waters in Central Chile, along with OMPs known to alter the cardiovascular and endocrine systems of humans and aquatic animals. Finally, we observed positive correlations between agricultural and urban land uses and OMPs. Our findings represent a step forward in extending current knowledge on the co-occurrence patterns of OMPs in aquatic environments, particularly in developing countries of the southern hemisphere.

Sleep disorder syndromes of post-acute sequelae of SARS-CoV-2 (PASC) / Long Covid.

INTRODUCTION: COVID-19 infection has resulted in a high prevalence of a post-infectious syndrome, known as post-acute sequelae of SARS-CoV-2 (PASC) or "Long COVID". PASC is a heterogeneous disease with a high prevalence of sleep disturbances, varying from an insomnia disorder to excessive daytime sleepiness. METHODS: Patients seen in the Covid Survivorship Program at the Beth Israel Deaconess Medical Center Boston, USA, were screened for sleep disorders as part of a comprehensive multi-system evaluation. Those who screened positive were referred for a comprehensive sleep evaluation in a dedicated COVID-19-Sleep clinic, followed by diagnostic sleep testing and treatment. This report summarizes patients who completed an American Academy of Sleep Medicine (AASM) accredited facility-based diagnostic evaluation. International Classification of Sleep Disorders 3rd Edition-Revised criteria were met for all diagnoses. RESULTS: In 42 patients with PASC, five categories of sleep disorder syndromes were observed following a sleep clinic evaluation, including obstructive sleep apnea, chronic insomnia disorder, primary hypersomnia, REM behavior disorder (RBD), and new onset circadian phase delay. Seven patients met criteria for idiopathic hypersomnia, and two had narcolepsy type 2. RBD patients were infected in three different waves; circadian disturbance patients were all infected in the winter wave of 2020/21, and the primary hypersomnolence group occurred during all waves, predominantly the initial wave of 2020. A peculiar form of insomnia was a persistent loss of sleep regularity. CONCLUSIONS: Specific sleep symptoms/syndromes are reported in this select group of patients with PASC/Long Covid. As new onset sleep complaints are prevalent in PASC, we recommend a complete clinical and investigative sleep evaluation for persistent severe sleep symptoms following COVID-19 infection.

Cultural shifts: an examination of cervical cancer stigma across age groups in the Caribbean.

BACKGROUND: Cervical cancer-related stigma is common but understudied in the Caribbean. This study aims to describe the age difference of cervical cancer stigma and to evaluate the influence on the prevention practices among the Caribbean nonpatient population in Jamaica, Grenada, and Trinidad and Tobago. METHODS: A cross-sectional study involving 1209 participants was conducted using a culturally trans-created Cancer Stigma Scale for the Caribbean context and supplemented with questions on cervical cancer and human papillomavirus (HPV) and HPV vaccine knowledge and beliefs. Descriptive analyses and χ2 tests were conducted. RESULTS: The χ2 tests showed age is statistically significantly related to participants' response to stigma items such as "community members believe cervical cancer is viewed as shameful" (P = .0001); "women with cervical cancer are treated with less respect than usual by others" (P < .0001); "women with cervical cancer are rejected by family members" (P = .0007); "women with cervical cancer are rejected by intimate partners" (P < .0001); and "intimate partners blame women for having cervical cancer" (P = .0032). Additionally, age has statistically significant associations with endorsements of negative views of cervical cancer from the community (P < .0001) and family (P < .0001) as key barriers to cervical cancer care (item: "discourage women from seeking and obtaining screening and treatment"). Notably, younger respondents (18-25 years) are more sensitized to the unfair stigma and hold more stigma. CONCLUSIONS: Among Caribbeans, age influences cervical cancer stigma. Younger persons acknowledged greater stigma within families and communities. This study can guide age-informed interventions and programs to reduce stigma and improve cervical cancer screening and care seeking to reduce cervical cancer burden and disparities.

Pathways to suicide for children and youth in Guyana: A life charts analysis.

BACKGROUND: Suicide is the third leading cause of death among youth aged 15 to 29 years old globally. Guyana has the highest rate of youth suicide in the world, yet only limited research exists. AIM: The aim of this study is to identify key features of the suicide pathway for Guyanese children and youth and to distinguish meaningful subgroups. METHOD: The psychological autopsy (PA) method was used to generate life charts for 15 Guyanese children and youth (10-29 years) who died by suicide. Nineteen close contacts of these individuals were interviewed about the life events of the decedent between 6 months and 5 years after their death. Semi-structured interviews lasting 30 to 150 min took place between November 2021 and January 2022. The interview data were converted into life charts and these were reviewed to uncover meaningful subgroups of suicide pathways. RESULTS: Three groups with distinct suicide pathways were identified: hard life (46%), mental illness (20%) and interpersonal stress (20%). There were also two male youths for whom the suicidal antecedents and pathways were unclear. Interpersonal stress, alcohol, exposure to suicide and family history of suicide were common factors identified across groups. CONCLUSIONS: The findings emphasise the role of both acute and protracted interpersonal stress for child and youth suicide in Guyana. The structure and dynamics of Indo-Guyanese families are discussed. Interventions recommended include enhancing child and youth community engagement, improving mental health and suicide literacy, alcohol restriction, increasing access to support services, and reducing stigma.