Perspectives of healthcare professionals on training for quantitative G6PD testing during implementation of tafenoquine in Brazil (QualiTRuST Study).

Effective radical cure of Plasmodium vivax malaria is essential for malaria elimination in Brazil. P. vivax radical cure requires administration of a schizonticide, such as chloroquine, plus an 8-aminoquinoline. However, 8-aminoquinolines cause hemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, requiring prior screening to exclude those at risk. Brazil is pioneering the implementation of tafenoquine, a single-dose 8-aminoquinoline indicated for P. vivax patients with >70% of normal G6PD activity. Tafenoquine implementation in Manaus and Porto Velho, two municipalities located in the western Brazilian Amazon, included comprehensive training of healthcare professionals (HCPs) on point-of-care quantitative G6PD testing and a new treatment algorithm for P. vivax radical cure incorporating tafenoquine. Training was initially provided to higher-level facilities (phase one) and later adapted for primary care units (phase two). This study analyzed HCP experiences during training and implementation and identified barriers and facilitators. In-depth interviews and focus discussion groups were conducted 30 days after each training for a purposive random sample of 115 HCPs. Thematic analysis was employed using MAXQDA software, analyzing data through inductive and deductive coding. Analysis showed that following the initial training for higher-level facilities, some HCPs did not feel confident performing quantitative G6PD testing and prescribing the tafenoquine regimen. Modifications to the training in phase two resulted in an improvement in understanding the implementation process of the G6PD test and tafenoquine, as well as in the knowledge acquired by HCPs. Additionally, knowledge gaps were addressed through in situ training, peer communication via a messaging app, and educational materials. Training supported effective deployment of the new tools in Manaus and Porto Velho and increased awareness of the need for pharmacovigilance. A training approach for nationwide implementation of these tools was devised. Implementing quantitative G6PD testing and tafenoquine represents a significant shift in P. vivax malaria case management. Consistent engagement with HCPs is needed to overcome challenges in fully integrating these tools within the Brazilian health system.

Performance of Pantaneira breed cows in precision grazing system.

Use of a grazing system that takes into account the ingestive behavior of animals and the physiological characteristics of plants maximizes land use and promotes positive effects on the environment. In this sense, the objective of this study was to evaluate the performance of Pantaneira breed cows, kept in rotated grazing in Mombasa grass (Megathyrsus maximum), with different grazing times. Fifty animals were divided into two treatments: Continuous T1: 24 h and T2-Inverted: 12 h. The experiment lasted 98 days, being determined the production and nutritional quality of the forage, digestibility, intake, and performance of the animals. The design was randomized blocks at 5% probability, with the means compared by the F test. The design used was completely randomized at 5% probability by the T test. There was no significant difference for biomass production (P > 0.05). However, after grazing the Inverted group, the forage showed a lower percentage of leaves and an increase in neutral detergent fiber and acid contents and total carbohydrates, and a reduction in crude protein and ether extract values, as well as a higher digestibility (P < 0.05). The animals of the Continuous group intaked more forage (P < 0.05). The Inverted group had a higher average daily weight gain, in addition to a lower feed conversion (P < 0.001). The animals in the Control group spent more time eating (P < 0.0001) and sleeping (P < 0.0001), while the animals of the Inverted group spent more time in idleness (P < 0.0001) and interacting (P < 0.05). There was no difference in rumination time between treatments (P > 0.05). It was concluded that Inverted grazing improved the quality of Mombasa grass and the performance of cows.

The prevalence of skin lesions and associated factors in hospitalised adult patients with cancer.

OBJECTIVE: To assess the prevalence of skin lesions and evaluate the clinical and sociodemographic factors associated with their presence in hospitalised patients. METHOD: This descriptive, cross-sectional, correlational study was performed in inpatient units and intensive care units of a cancer hospital in São Paulo, Brazil, after approval by the Institutional Research Ethics Committee. Data from hospitalised adult patients with cancer were collected during physical examinations and from medical records. A Chi-squared test, univariate analysis, a logistic regression model with results expressed as odds ratio (OR) and 95% confidence intervals (CI), and Classification and Regression Tree (CART) analysis were used to evaluate the data. RESULTS: Of 341 patients, 80 had skin lesions, equating to an overall prevalence of 23.5%. The skin lesions included pressure injuries (10%), incontinence-associated dermatitis (6.7%), skin tears (6.5%), malignant wounds (3.8%) and complicated surgical wounds (3.2%). The factors associated with skin lesions in cancer patients were the use of disposable nappies (OR: 4.436) and age (59.1±15.1 years), according to the CART analysis, and the wearing of nappies (OR: 4.466, p<0.001), presence of ecchymosis (OR: 2.532, p<0.001) and infection (OR: 6.449, p=0.040), according to multiple regression analysis. CONCLUSION: This study contributed to knowledge about prevalence and associated factors of skin lesions in hospitalised patients with cancer, allowing the implementation of preventive measures.