Physiological and Technological Properties of Probiotic Lacticaseibacillus rhamnosus GG Encapsulated with Alginate-Chitosan Mixture and Its Incorporation in Whole Milk.

This study developed and evaluated chitosan-sodium alginate capsules containing the probiotic Lacticaseibacillus rhamnosus GG using extrusion and emulsification techniques. The encapsulated L. rhamnosus GG cells were also evaluated for technological and probiotic-related physiological functionalities, as well as when incorporated in UHT and powdered milk. Extrusion (86.01 ± 1.26%) and emulsification (74.43 ± 1.41%) encapsulation techniques showed high encapsulation efficiency and high survival rates of L. rhamnosus GG during 28 days of refrigeration and room temperature storage, especially emulsification capsules (> 81%). The encapsulated L. rhamnosus GG cells showed high survival rates during exposure to simulated gastrointestinal conditions (72.65 ± 1.09-114.15 ± 0.44%). L. rhamnosus GG encapsulated by extrusion and emulsification performed satisfactorily in probiotic-related physiological (pH and bile salts tolerance) and technological properties (positive proteolytic activity, diacetyl and exopolysaccharides production, high NaCl tolerance (> 91%), besides having high heat tolerance (> 76%)). L. rhamnosus GG in extrusion and emulsification capsules had high survival rates (> 89%) and did not significantly affect physicochemical parameters in Ultra-High Temperature (UHT) and powdered milk during storage. The results demonstrate that L. rhamnosus GG can be successfully encapsulated with alginate-chitosan as a protective material through extrusion and emulsification techniques. UHT and powdered milk could serve as appropriate delivery systems to increase the intake of this encapsulated probiotic by consumers.

Unrevealing the in vitro impacts of Cereus jacamaru DC. cladodes flour on potentially probiotic strains, selected bacterial populations, and metabolic activity of human intestinal microbiota.

This study investigated the potential impacts of the flour from Cereus jamacaru cactus cladodes (CJF), a cactus native to the Brazilian Caatinga biome, on the growth and metabolism of different potentially probiotic strains, as well as on the abundance of selected intestinal bacterial populations and microbial metabolic activity during in vitro colonic fermentation with a pooled human fecal inoculum. Cultivation of the probiotics in a medium with C. jamacaru cladodes flour (20 g/L) resulted in viable cell counts of up to 9.8 log CFU/mL, positive prebiotic activity scores (0.73-0.91), decreased pH and sugar contents, and increased lactic, acetic, and propionic acid production over time, indicating enhanced probiotic growth and metabolic activity. CJF overall increased the relative abundance of Lactobacillus spp./Enterococcus spp. (2.12-3.29%) and Bifidobacterium spp. (4.08-4.32%) and decreased the relative abundance of Bacteroides spp./Prevotella spp. (8.35-6.81%), Clostridium histolyticum (6.91-3.59%), and Eubacterium rectale/Clostridium coccoides (7.70-3.95%) during 48 h of an in vitro colonic fermentation using a pooled human fecal inoculum. CJF stimulated the microbial metabolic activity, with decreased pH, sugar consumption, lactic and short-chain fatty acid production, alterations in overall metabolic profiling and phenolic compound contents, and maintenance of high antioxidant capacity during colonic fermentation. These results show that CJF stimulated the growth and metabolic activity of distinct potential probiotics, increased the relative abundance of beneficial intestinal bacterial groups, and stimulated microbial metabolism during in vitro colonic fermentation. Further studies using advanced molecular technologies and in vivo experimental models could forward the investigation of the potential prebiotic properties of CJF.

Revealing the beneficial effects of a dairy infant formula on the gut microbiota of early childhood children with autistic spectrum disorder using static and SHIME® fermentation models.

This study evaluated the impact of the Milnutri Profutura® (MNP) dairy infant formula on the gut microbiota of early childhood children (three to five years) with Autistic Spectrum Disorder (ASD) using static fermentation (time zero, 24, and 48 h) and the Simulator of the Human Intestinal Microbiol Ecosystem (SHIME®) (time zero, 72 h, and 7 days). The relative abundance of selected intestinal bacterial groups, pH values, organic acids, and sugars were verified at time zero, 24, and 48 h using flow cytometry and measurements. In addition, the diversity and changes in the gut microbiota, and the amounts of acetic, butyric, and propionic acids and ammonium ions (NH4+) in fermentation using the SHIME® were measured at time zero, 72 h, and 7 days. MNP increased Lactobacillus/Enterococcus and Bifidobacterium populations and decreased Bacteroides/Prevotella, Clostridium histolyticum and Eubacterium rectale/Clostridium coccoides populations (p < 0.05) at 24 and 48 h of static fermentation, showing a positive prebiotic activity score (65.18 ± 0.07). The pH, fructose and glucose decreased, while lactic, butyric, and propionic acids increased (p < 0.05) at 48 h of static fermentation. MNP increased (p < 0.05) the Firmicutes phylum during the fermentation in SHIME®. MNP decreased the diversity at 72 h of fermentation, mostly by the increase (p < 0.05) in the Lactobacillus genus. Microbial groups considered harmful such as Lachnospiraceae, Negativicoccus, and Lachnoclostridium were inhibited after administration with MNP. Propionic and butyric acids increased at 72 h and NH4+ decreased (p < 0.05) at the end of fermentation with MNP. The results indicate MNP as an infant formula which may benefit the gut microbiota of children with ASD.

Investigating the effects of conventional and unconventional edible parts of red beet (Beta vulgaris L.) on target bacterial groups and metabolic activity of human colonic microbiota to produce novel and sustainable prebiotic ingredients.

This study investigated the effects of freeze-dried red beet root (FDBR) and freeze-dried red beet stem and leaves (FDBSL) on target bacterial groups and metabolic activity of human colonic microbiota in vitro. The capability of FDBR and FDBSL to cause alterations in the relative abundance of different selected bacterial groups found as part of human intestinal microbiota, as well as in pH values, sugar, short-chain fatty acid, phenolic compounds, and antioxidant capacity were evaluated during 48 h of in vitro colonic fermentation. FDBR and FDBSL were submitted to simulated gastrointestinal digestion and freeze-dried prior to use in colonic fermentation. FDBR and FDBSL overall increased the relative abundance of Lactobacillus spp./Enterococcus spp. (3.64-7.60%) and Bifidobacterium spp. (2.76-5.78%) and decreased the relative abundance of Bacteroides spp./Prevotella spp. (9.56-4.18%), Clostridium histolyticum (1.62-1.15%), and Eubacterium rectale/Clostridium coccoides (2.33-1.49%) during 48 h of colonic fermentation. FDBR and FDBSL had high positive prebiotic indexes (>3.61) during colonic fermentation, indicating selective stimulatory effects on beneficial intestinal bacterial groups. FDBR and FDBSL increased the metabolic activity of human colonic microbiota, evidenced by decreased pH, sugar consumption, short-chain fatty acid production, alterations in phenolic compound contents, and maintenance of high antioxidant capacity during colonic fermentation. The results indicate that FDBR and FDBSL could induce beneficial alterations in the composition and metabolic activity of human intestinal microbiota, as well as that conventional and unconventional red beet edible parts are candidates to use as novel and sustainable prebiotic ingredients.

Development of an Educational Gamification Strategy to Enhance the Food Safety Practices of Family Farmers in Public Food Markets of Northeast Brazil: A Case Study.

This study aimed to develop an educational gamification strategy to enhance the food safety practices of family farmers in public food markets in a city in Northeastern Brazil (João Pessoa, PB, Brazil). A good manufacturing practices (GMP) checklist was used to verify hygienic-sanitary conditions in the food markets. Educational game tools addressing foodborne diseases and GMP with information about the prevention of foodborne diseases, good food handling practices, and safe food storage were developed. Pre- and post-training assessments were done to evaluate food handlers' knowledge and food safety practices. Microbiological parameters of food samples were analyzed before and two months after the training. Results indicated unsatisfactory hygiene conditions in the examined food markets. There was a very strong positive correlation between "implementation of GMP" and "production and process controls" (R = 0.95; p ≤ 0.05) and between "production and process controls" and "hygiene habits of handlers" (R = 0.92; p ≤0.05). There was no homogeneity between answers before and after the training for the knowledge of family farmers regarding "prevention of foodborne diseases" and "safe food handling". There were improvements in the measured microbiological parameters of foods sold by family farmers after the application of the developed educational gamification training. These results showed the developed educational game-based strategy as being effective in raising awareness of hygienic sanitary practices, helping to promote food safety, and reducing risks for the consumers of street foods at family farmers' markets.

Green Extraction of Annatto Seed Oily Extract and Its Use as a Pharmaceutical Material for the Production of Lipid Nanoparticles.

This work developd nanomaterials formulated from annatto seed oily extract (ASE), myristic acid (tetradecanoic acid), and their fatty acid esters. The annatto seed oily extract was obtained using only soybean oil (ASE + SO) and Brazil nut oil (ASE + BNO). The UV/VIS analysis of the oily extracts showed three characteristic peaks of the bixin molecule at 430, 456 and 486 nm. The lipid nanoparticles obtained using myristic acid and ASE + BNO or only BNO showed better results than the oil soybean extract, i.e., the particle size was <200 nm, PDI value was in the range of 0.2−0.3, and had no visual physical instability as they kept stable for 28 days at 4 °C. Lipid nanoemulsions were also produced with esters of myristic acid and ASE + BNO. These fatty acid esters significantly influenced the particle size of nanoemulsions. For instance, methyl tetradecanoate led to the smallest particle size nanoemulsions (124 nm), homogeneous size distribution, and high physical stability under 4 and 32 °C for 28 days. This work demonstrates that the chemical composition of vegetable oils and myristic acid esters, the storage temperature, the chain length of fatty acid esters (FAE), and their use as co-lipids improve the physical stability of lipid nanoemulsions and nanoparticles from annatto seed oily extract.

In vitro colonic fermentation and potential prebiotic properties of pre-digested jabuticaba (Myrciaria jaboticaba (Vell.) Berg) by-products.

Jabuticaba (Myrciaria jaboticaba (Vell.) Berg) by-products (JB) are rich sources of dietary fiber and phenolic compounds, which can be fermented by intestinal microbiota to promote health benefits. This study evaluated the effects of a 48 h-in vitro colonic fermentation of pre-digested JB on the contents of phenolic compounds and sugars, production of organic acids, and abundance (%) of bacterial groups found as part of the human intestinal microbiota. JB reduced the pH (4.35) and promoted changes on phenolic compounds (profile and contents) and sugars, as well as production of short-chain fatty acids during the fermentation. JB increased the abundance of Lactobacillus spp./Enterococcus spp. (4.32-6.25%) and Bifidobacterium spp. (4.60-10.03%) during the fermentation, and decreased the abundance of Bacteroides spp./Prevotella spp. (7.50-10.71%), Eubacterium rectale/Clostridium coccoides (1.37-3.70%), and C. histolyticum (0.91-2.30%), resulting in positive prebiotic indexes (8.61-11.92). JB should contribute to beneficial changes in the human intestinal microbiota, with effects compatible with prebiotic ingredients.

Pelvic floor dysfunction in primiparous women up to 6 months after delivery: cohort study.

OBJECTIVE: To analyze pelvic floor muscular strength (PFMS), urinary (UI) and anal (AI) incontinence and dyspareunia in primiparous women up to 6 months after normal or cesarean delivery. METHODS: this is a prospective cohort with 169 women (128 normal births, 41 cesarean sections), followed between 50-70 and 170-190 days postpartum, when PFMS was measured using perineometry, and UI and AI and dyspareunia, through interview. RESULTS: PFMS, UI and dyspareunia were similar between types of delivery. The difference was significant only for the time elapsed, with improvement in the studied period (2 and 6 months postpartum). Regarding AI, there was a significant difference between 2 and 6 months postpartum, with an interaction between type of delivery and time (p=0.022). CONCLUSION: the type of delivery did not show any influence on pelvic floor dysfunctions, except for AI. For all outcomes, there was an improvement in the period studied.

A voz do cantor Roberto Carlos: avaliação perceptivo-auditiva de canções de diferentes décadas / The voice of Brazilian singer Roberto Carlos: auditory-perceptual assessment of songs from different decades / La voz del cantante brasileño Roberto Carlos: evaluación perceptivo auditiva de canciones de diferentes décadas

Objetivo: Descrever a voz do cantor Roberto Carlos por meio de avaliação perceptivo-auditiva de parâmetros determinados em canções escolhidas que foram lançadas ao longo das décadas de 60 a 90. Métodos: Oito canções representativas da carreira do cantor foram selecionadas para a avaliação perceptivo-auditiva descritiva da voz, sendo duas delas de cada década. Resultados: Roberto Carlos manteve a coordenação pneumofonoarticulatória, loudness variou de adequada para forte; pitch variou de médio para agudo a médio; articulação precisa; ataque vocal variou de brusco para suave; voz sem brilho; a ressonância laringofaríngea teve maior variação, sendo esta com foco nasal compensatório, com foco nasal acentuado e com foco nasal discreto, registro vocal modal peito, sem projeção, vibrato ausente, tessitura restrita, qualidade vocal adaptada, adaptada com tensão, e adaptada com discreta soprosidade. Conclusão: Na avaliação perceptivo-auditiva algumas características se mantiveram inalteradas, como coordenação pneumofonoarticulatória, a articulação precisa, o registro vocal modal de peito, a voz sem brilho e sem projeção, a ausência de vibrato e a tecitura restrita. Houve variação em relação ao pitch, a loudness, o ataque vocal a ressonância foi caracterizada laringofaríngea com variações em relação ao foco nasal. As maiores mudanças observadas na voz do cantor no decorrer das décadas recaem sobre a variação de gêneros musicais cantados pelo cantor.

Purpose: To describe the voice of the singer Roberto Carlos through auditory-perceptual assessment of certain parameters in selected songs that were released between the 1960s and 1990s. Methods: Eight songs representative of the singer's career, two of them from each decade, were selected for the descriptive auditory-perceptual assessment of the voice. Results: As noticed in the study, Roberto Carlos maintained pneumophonoarticulatory coordination; loudness ranged from adequate to strong; pitch ranged from medium to high to medium; precise articulation; vocal attack ranged from abrupt to mild; dull voice; laryngopharyngeal resonance had a greater variation, including compensatory nasal focus, with increased nasal focus and discrete nasal focus, modal chest record, without projection, no vibrato, restricted tension, adapted vocal quality, adapted with tension, and adapted with slight breathiness. Conclusion: In the auditory-perceptual evaluation, some characteristics remained unchanged, such as pneumophonoarticulatory coordination, the precise articulation, the modal vocal registration of the chest, without projection, the absence of vibrato and the restricted tension. There was variation in relation to pitch, loudness, vocal attack and resonance was characterized as laryngopharyngeal with variations in relation to nasal focus. The main changes noticed in the singer's voice over the decades have been reported in the variation of musical genres presented by the singer.

Objetivo: Evaluación perceptiva auditiva de la voz de Roberto Carlos en canciones seleccionadas a lo largo de los años 60 y 90. Métodos: Para la evaluación se seleccionaron ocho canciones representativas de la trayectoria del cantante, dos canciones de cada década. Resultados: Roberto Carlos mantuvo la coordinación fonatoria, el volumen varió de adecuado a fuerte, el tono varió de medio a agudo a medio; articulación precisa; el ataque vocal varió de repentino a leve; voz apagada; la resonancia laringofaríngea tuvo mayor variación, con enfoque nasal compensatorio, con enfoque nasal acentuado y enfoque nasal discreto, registro vocal modal, sin proyección, vibrato ausente, tensión, calidad vocal adaptada, adaptada con tensión, adaptada con ligera soprosidade. Conclusión: En la evaluación auditivo-perceptual, algunas características se mantuvieron sin cambios, como la coordinación fhonatoria, la articulación precisa, el registro vocal modal del tórax, la voz apagada y sin proyección, la ausencia de vibrato y el tejido restringido. Hubo variación en relación al tono, volumen, ataque vocal y la resonancia se caracterizó como laringofaríngea con variaciones en relación al enfoque nasal. Las más grandes variaciones observadas en la voz del cantante se relacionan con las variaciones de los estilos musicales cantados entre las décadas.

A review on bioactive compounds of beet (Beta vulgaris L. subsp. vulgaris) with special emphasis on their beneficial effects on gut microbiota and gastrointestinal health.

This review discusses the available literature concerning the bioactive compounds of beet (Beta vulgaris L.) and their ability to modulate the gut microbiota and parameters indicative of gastrointestinal health. Data of published literature characterize beet as a source of a variety of bioactive compounds (e.g. diet fiber, pectic-oligosaccharides, betalains and phenolics) with proven beneficial effects on human health. Beet extracts and pectin and pectic-oligosaccharides from beet have shown able to modulate positively gut microbiota composition and activity, with noticeable bifidogenic effects, in addition to stimulate the growth and metabolism of probiotics. Beet betalains and phenolics seem to increase the production of metabolites (e.g. short chain fatty acids) by gut microbiota and probiotics, which are linked with different beneficial effects on host health. The outstanding contents of betalains and phenolics with antioxidant, anti-inflammatory and anti-carcinogenic properties have been linked to the positive effects of beet on gastrointestinal health. Beet should be a healthy choice for use in domestic meal preparations and a source of ingredients to formulate added-value functionalized food products.

Biomimetic Mechanism of Action of Fluoridated Toothpaste Containing Proprietary REFIX Technology on the Remineralization and Repair of Demineralized Dental Tissues: An In Vitro Study.

OBJECTIVES: This in vitro study aimed to characterize the mineral content and surface and cross-sectional morphology of enamel and dentin tissues treated with a 1450 ppm fluoride-containing toothpaste with REFIX technology. MATERIALS AND METHODS: Bovine enamel blocks (n = 5) were obtained (4 × 4 × 6 mm), demineralized (artificial caries lesion), and treated (pH cycling and brushing with the toothpaste). During the pH cycling, which lasted for 7 days (demineralization and remineralization took 6 and 18 hours, respectively), the enamel was brushed for 5 minutes using an electric toothbrush before being immersed in a remineralizing solution. The dentin blocks were acid-etched for 2 minutes (0.05 M citric acid, pH 1.8) to expose the dentinal tubules (n = 5). Morphological analysis of the dentin was performed immediately and after 7 days of brushing with the dentifrice, and compared with the control group. The specimens were then cross-sectioned. The surface and cross-sectional micromorphology were assessed using scanning electron microscopy (SEM). The elemental analyses (weight%) were determined with an energy-dispersive X-ray spectroscopy (EDS). RESULTS: The toothpaste with REFIX technology remineralized and repaired the surface enamel effectively. The elemental analysis also demonstrated that treating the enamel with the toothpaste formed a silicon-enriched mineral layer on the enamel surface. Elemental analysis of the enamel cross-sections showed that the toothpaste induced a mineral change. The results were also consistent in the dentin, where the dentinal tubules were progressively occluded until there was complete occlusion after 7 days. CONCLUSIONS: We prove the biomimetic mechanism of action of fluoridated toothpaste containing proprietary REFIX technology for obtaining silicon-enriched, remineralized and repaired dental tissues.

Pelvic floor dysfunction in primiparous women up to 6 months after delivery: cohort study / Disfunctión del suelo pélvico en primíparas hasta 6 meses después del parto: estudio de cohort / Disfunções do assoalho pélvico em primíparas até 6 meses após o parto: estudo de coorte

ABSTRACT Objective: To analyze pelvic floor muscular strength (PFMS), urinary (UI) and anal (AI) incontinence and dyspareunia in primiparous women up to 6 months after normal or cesarean delivery. Methods: this is a prospective cohort with 169 women (128 normal births, 41 cesarean sections), followed between 50-70 and 170-190 days postpartum, when PFMS was measured using perineometry, and UI and AI and dyspareunia, through interview. Results: PFMS, UI and dyspareunia were similar between types of delivery. The difference was significant only for the time elapsed, with improvement in the studied period (2 and 6 months postpartum). Regarding AI, there was a significant difference between 2 and 6 months postpartum, with an interaction between type of delivery and time (p=0.022). Conclusion: the type of delivery did not show any influence on pelvic floor dysfunctions, except for AI. For all outcomes, there was an improvement in the period studied.

RESUMEN Objetivo: Analizar fuerza muscular del suelo pélvico (FMSP), incontinencia urinaria (IU) y anal (IA) y dispareunia en mujeres primíparas hasta 6 meses después del parto normal o por cesárea. Métodos: Cohorte prospectiva con 169 mujeres (128 partos normales y 41cesáreas), seguidas entre 50-70 y 170-190 días posparto, cuando se midió la FMSP mediante perineometría, y se evaluó la IU, IA y dispareunia, mediante entrevista. Resultados: FMSP, IU y dispareunia fueron similares entre los tipos de parto. La diferencia fue significativa solo para el tiempo transcurrido, com mejoría em el período estudado, com mejoría em el período estudiado (2 y 6 meses posparto). Em cuanto a la IA, hubo una diferencia significativa entre los 2 y 6 meses posparto, com uma interacción entre el tipo de parto y el tiempo (p=0,022). Conclusión: El tipo de parto no mostro influencia em las disfunciones del suelo pélvico, excepto em la IA. Para todos los resultados, hubo uma mejora em el período estudiado.

RESUMO Objetivo: Analisar a força muscular do assoalho pélvico (FMAP), a incontinência urinária (IU) e anal (IA) e a dispareunia em primíparas até 6 meses após o parto normal ou cesariana. Métodos: Coorte prospectiva com 169 mulheres (128 parto normal, 41 cesariana), acompanhadas entre 50-70 e 170-190 dias pós-parto, quando foi mensurada a FMAP, mediante a perineometria, e avaliadas a IU e IA e a dispareunia, mediante entrevista. Resultados: A FMAP, a IU e a dispareunia foram similares entre os tipos de parto. A diferença foi significativa apenas para o tempo decorrido, com melhora no período estudado (2 e 6 meses pós-parto). Em relação à IA, houve diferença significante entre 2 e 6 meses pós-parto, com interação entre tipo de parto e tempo (p=0,022). Conclusão: O tipo de parto não mostrou influência nas disfunções do assoalho pélvico, exceto na IA. Para todos os desfechos, houve melhora no período estudado.

Violência na Estratégia de Saúde da Família: riscos para a saúde dos trabalhadores e ao atendimento / Violence in the Family Health Strategy: risks to workers' health and care / Violencia en la estrategia de salud de la familia: riesgos para la salud de los trabajadores y la atención

Objetivo: identificar a ocorrência da violência na Estratégia de Saúde da Família e analisar as repercussões para a saúde dos trabalhadores e ao atendimento. Método: estudo qualitativo, descritivo, realizado com 27 trabalhadores de uma unidade de Estratégia de Saúde da Família localizada no município do Rio de Janeiro em 2018. Trabalhou-se com a técnica de entrevista semiestruturada mediante roteiro e para a categorização dos depoimentos a análise de conteúdo temática. Projeto de pesquisa aprovado pelo Comitê de Ética em Pesquisa. Resultados: identificou-se a violência psicológica perpetrada por usuários através de ameaças, xingamentos e intimidações e a urbana com a exposição dos profissionais a tiros, assaltos e brigas durante as visitas domiciliares ocasionando repercussões na saúde mental dos trabalhadores e prejuízos para a qualidade do atendimento. Conclusão: a violência ocupacional é um risco a integridade física e psíquica dos trabalhadores e a qualidade do atendimento.

Objective: to identify the occurrence of violence in Brazil's Family Health Strategy and to analyze the repercussions on workers' health and on care. Method: this qualitative, descriptive study was conducted in 2018 with 27 workers from a Family Health Strategy unit in the city of Rio de Janeiro, using the semi-structured, scripted interview technique, and thematic content analysis to categorize interviewee discourse. The project was approved by the research ethics committee. Results: the violence identified was psychological, as perpetrated by users in threats, name calling and intimidation, and urban, in health personnel's exposure to gunfire, robbery, and fights during home visits, which had repercussions on the workers' mental health and impaired the quality of care. Conclusion: occupational violence is a risk to health workers' physical and mental integrity and to the quality of care.

Objetivo: identificar la ocurrencia de violencia en la Estrategia de Salud de la Familia de Brasil y analizar las repercusiones en la salud y la atención de los trabajadores. Método: este estudio cualitativo descriptivo se realizó en 2018 con 27 trabajadores de una unidad de Estrategia de Salud de la Familia en la ciudad de Río de Janeiro, utilizando la técnica de entrevista semiestructurada, guionizada y análisis de contenido temático para categorizar el discurso del entrevistado. El proyecto fue aprobado por el comité de ética en investigación. Resultados: la violencia identificada fue psicológica, perpetrada por los usuarios en amenazas, insultos e intimidación, y urbana, en la exposición del personal de salud a disparos, robos y peleas durante las visitas domiciliarias, lo que repercutió en la salud mental de los trabajadores y perjudicó la calidad de atención. Conclusión: la violencia laboral es un riesgo para la integridad física y mental de los trabajadores de la salud y para la calidad de la atención.

High-risk Human Papillomavirus Testing for Triage of Women with Previous Cytological Abnormalities from the Vale do Ribeira Region.

OBJECTIVE: To evaluate the performance of the hybrid capture 2 (HC2) high-risk papillomavirus (hrHPV) assay and cytological test in women with previous abnormalities, to detect cervical intraepithelial neoplasia grade 2 or worse (≥ CIN 2). METHODS: A cytological test and HC2 (Qiagen, Gaithersburg, Maryland, EUA) for hrHPV were conducted in 359 liquid-based (Sure Path, Becton Dickinson, TriPath Imaging, Burlington, NC, USA) samples collected from women from the Vale do Ribeira Region, during July 2013 and September 2015 with previous cytology classified as atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (ASC-H), and atypical glandular cells (AGC). The histopathological examination was conducted in 179 women. The performance evaluations were calculated using the "exact" Clopper-Pearson 95% confidence interval (CI) test by MEDCALC (Medcalc Software Ltd, Ostend, Belgium). RESULTS: The ≥ CIN 2 frequency was 11.7% (21/179). The HC2 for hrHPV and repeat cytology to detect ≥ CIN 2 obtained, respectively, a sensitivity of 90.5% (95%CI = 69.6-98.8) and 90.5%, (95%CI = 69.6-98.8), a specificity of 65.8% (95% CI = 57.9-73.2) and 43.7% (95%CI = 35.8-51.8), a positive predictive value of 26.0% (95% CI = 21.4-31.3) and 17.6%, (95%CI = 14.9-20.6), and a negative predictive value of 98.1% (95%CI = 93.3-99.5) and 97.2% (95% CI = 90.1-99.2). CONCLUSION: Hybrid capture 2 for hrHPV improves the performance of the detection of ≥ CIN 2, without compromising sensitivity, and provides a greater safety margin to return to the triennial screening of women undergoing follow-up due to previous abnormalities, without underlying ≥ CIN 2.

OBJETIVO: Avaliar o desempenho da captura híbrida 2 (CH2) para papilomavírus humano de alto risco (HPVar) e repetição do exame citopatológico em mulheres com anormalidades em citologia anterior, para detectar neoplasia intraepitelial cervical grau 2 ou pior (≥ NIC 2). MéTODOS: Foi realizado exame citopatológico e CH2 para HPVar (Qiagen, Gaithersburg, Maryland, EUA) em 359 amostras em meio líquido (Sure Path, Becton Dickinson, TriPath Imaging, Burlington, NC, USA) coletadas de mulheres da região do Vale do Ribeira, durante julho de 2013 e setembro de 2015 com citologia anterior classificada como células escamosas atípicas de significado indeterminado (ASC-US), lesão intraepitelial de baixo grau (LSIL), células escamosas atípicas, não podendo excluir lesão de alto grau (ASC-H) e células glandulares atípicas (AGC). O exame histopatológico foi realizado em 179 mulheres. As avaliações de desempenho foram calculadas usando o teste de intervalo de confiança (IC) "exato" de Clopper-Pearson de 95% pelo software MEDCALC (Medcalc Software Ltd, Ostend, Bélgica). RESULTADOS: A frequência de ≥ NIC 2 foi 11,7% (21/179). A CH2 para o HPVar e a citologia de repetição para a detecção ≥ NIC 2 obteve, respectivamente, sensibilidade de 90.5% (IC 95% = 69,6­98,8) e 90,5% (IC 95% = 69,6­98,8), especificidade de 65,8% (IC 95% = 57,9­73,2) e 43,7%, (IC 95% = 35,8­51,8), valor preditivo positivo de 26,0% (IC 95% = 21,4­31,3) e 17,6%, (IC95% = 14,9­20,6), e valor preditivo negativo de 98,1% (IC 95% = 93,3­99,5) e 97,2%, (IC 95% = 90,1­99,2). CONCLUSãO: No geral, a CH2 para HPVar aprimora o desempenho para detecção de ≥ NIC 2, sem comprometer a sensibilidade e proporciona maior margem de segurança do retorno ao rastreio trienal de mulheres com anormalidades citológicas prévias, sem ≥ NIC 2 subjacente.

A Educação Popular em Saúde como mediação pedagógica da gestão e práticas colaborativas na Atenção Básica à Saúde / The Popular Education in Health as pedagogical mediation of management and collaborative practices in Primary Health Care

Esta é uma sistematização de experiências, na perspectiva de Oscar Jara (2012), sobre a gestão compartilhada de uma Clínica de Família, no bairro de Manguinhos, Rio de Janeiro - RJ, Brasil. Objetivou-se refletir como a Educação Popular em Saúde (EPS) pode mediar o processo de gestão compartilhada na qualificação das ações de prevenção do câncer de colo do útero junto aos profissionais, numa ação colaborativa com o Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Tomou-se como reflexão, o trabalho na Atenção Básica, a mediação da EPS e a gestão e práticas colaborativas. Concluiu-se que o diálogo com o contexto local, mediado por uma parceria colaborativa sob a proposta crítico-reflexiva, transformou em práxis a coleta de preventivo, qualificando o processo de cuidado.

This is a systematization of experiences, in the perspective of Oscar Jara (2012), on the shared management of a Family Clinic , in the neighborhood of Manguinhos, Rio de Janeiro ­ RJ, Brazil. The objective was to reflect how the Popular Health Education (PHE) can mediate the shared management process in the qualification of cervical cancer prevention actions with the professionals, in a collaborative action with the Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). It was taken as reflection, the work in primary health care, the mediation of the PHE and the management and collaborative practices. It was concluded that the dialogue with the local context, mediated by a collaborative partnership under the critical­ reflexive proposal, transformed into praxis the collection of preventive, qualifying the care process.

High-risk human papillomavirus testing for triage of women with previous cytological abnormalities from the Vale do Ribeira region / Teste de papilomavírus humano para triagem de mulheres com alterações em citologia anterior provenientes da região do Vale do Ribeira

Abstract Objective To evaluate the performance of the hybrid capture 2 (HC2) high-risk papillomavirus (hrHPV) assay and cytological test in women with previous abnormalities, to detect cervical intraepithelial neoplasia grade 2 or worse (≥ CIN 2). Methods A cytological test and HC2 (Qiagen, Gaithersburg, Maryland, EUA) for hrHPV were conducted in 359 liquid-based (Sure Path, Becton Dickinson, TriPath Imaging, Burlington, NC, USA) samples collected from women from the Vale do Ribeira Region, during July 2013 and September 2015 with previous cytology classified as atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (ASC-H), and atypical glandular cells (AGC). The histopathological examination was conducted in 179 women. The performance evaluations were calculated using the "exact" Clopper-Pearson 95% confidence interval (CI) test by MEDCALC (Medcalc Software Ltd, Ostend, Belgium). Results The ≥ CIN 2 frequency was 11.7% (21/179). The HC2 for hrHPV and repeat cytology to detect ≥ CIN 2 obtained, respectively, a sensitivity of 90.5% (95% CI = 69.6-98.8) and 90.5%, (95%CI = 69.6-98.8), a specificity of 65.8% (95% CI = 57.9-73.2) and 43.7% (95%CI = 35.8-51.8), a positive predictive value of 26.0% (95% CI = 21.4-31.3) and 17.6%, (95%CI = 14.9-20.6), and a negative predictive value of 98.1% (95%CI = 93.3-99.5) and 97.2% (95% CI = 90.1-99.2). Conclusion Hybrid capture 2 for hrHPV improves the performance of the detection of ≥ CIN 2, without compromising sensitivity, and provides a greater safety margin to return to the triennial screening of women undergoing follow-up due to previous abnormalities, without underlying ≥ CIN 2.

Resumo Objetivo Avaliar o desempenho da captura híbrida 2 (CH2) para papilomavírus humano de alto risco (HPVar) e repetição do exame citopatológico em mulheres com anormalidades em citologia anterior, para detectar neoplasia intraepitelial cervical grau 2 ou pior (≥ NIC 2). Métodos Foi realizado exame citopatológico e CH2 para HPVar (Qiagen, Gaithersburg, Maryland, EUA) em 359 amostras em meio líquido (Sure Path, Becton Dickinson, TriPath Imaging, Burlington, NC, USA) coletadas de mulheres da região do Vale do Ribeira, durante julho de 2013 e setembro de 2015 com citologia anterior classificada como células escamosas atípicas de significado indeterminado (ASC-US), lesão intraepitelial de baixo grau (LSIL), células escamosas atípicas, não podendo excluir lesão de alto grau (ASC-H) e células glandulares atípicas (AGC). O exame histopatológico foi realizado em 179 mulheres. As avaliações de desempenho foram calculadas usando o teste de intervalo de confiança (IC) "exato" de Clopper-Pearson de 95% pelo software MEDCALC (Medcalc Software Ltd, Ostend, Bélgica). Resultados A frequência de≥ NIC 2 foi 11,7% (21/179). A CH2 para o HPVar e a citologia de repetição para a detecção ≥ NIC 2 obteve, respectivamente, sensibilidade de 90.5% (IC 95% = 69,6-98,8) e 90,5% (IC 95% = 69,6-98,8), especificidade de 65,8% (IC 95% = 57,9-73,2) e 43,7%, (IC 95% = 35,8-51,8), valor preditivo positivo de 26,0% (IC 95% = 21,4-31,3) e 17,6%, (IC95% = 14,9-20,6), e valor preditivo negativo de 98,1% (IC 95% = 93,3-99,5) e 97,2%, (IC 95% = 90,1-99,2). Conclusão No geral, a CH2 para HPVar aprimora o desempenho para detecção de ≥ NIC 2, sem comprometer a sensibilidade e proporciona maior margem de segurança do retorno ao rastreio trienal de mulheres com anormalidades citológicas prévias, sem≥ NIC 2 subjacente.

Pasta Enrichment with an Amaranth Hydrolysate Affects the Overall Acceptability while Maintaining Antihypertensive Properties.

BACKGROUND: Alcalase-treated amaranth proteins generate angiotensin-1-converting enzyme (ACE-1) inhibitory peptides, which could be useful for functional foods development. Our aim was to evaluate the technological, sensory, and antihypertensive properties of pasta enriched with an amaranth hydrolysate. METHODS: Pasta with 11% (A; control), 15% (B), and 20% (C) of protein content were formulated. Pastas B and C were supplemented with an alcalase-treated amaranth protein concentrate. Cooking time, cooking lost, color, and texture were assessed. An untrained panel (n = 30) evaluated sensory attributes. The antihypertensive effect was evaluated in hypertensive rats. RESULTS: The hydrolysate IC50 was 0.014 mg/mL. Optimum cooking time and cooking loss decreased in products B and C vs. A (p < 0.05). The L* values decreased in pasta C. Firmness increased in pasta C vs. A (p < 0.05). Adhesiveness was different among groups (p < 0.05). Pasta A had the highest acceptability (p < 0.05). The products B and C, and captopril (positive control) showed antihypertensive properties after 3 h of supplementation (p < 0.05). This effect remained after 7 h, 8 h, or 9 h. CONCLUSIONS: The addition of amaranth hydrolysates to pasta negatively impacts on the overall acceptability and, to a lesser extent, on pasta taste. However, it is possible to maintain the antihypertensive properties of the supplemented pasta under physiological conditions.

[Access to diagnosis of tuberculosis in Brazilian medium-sized municipality]. / Acesso ao diagnóstico da tuberculose em município brasileiro de médio porte.

OBJETIVO: Evaluating access to tuberculosis diagnosis, from the perspective of patients. METHODS: Cross-sectional study with 108 tuberculosis patients. Data were collected using the brazilian instrument Primary Care Assessment Tool - PCAT-Brazil, adapted for attention to tuberculosis, including socio-economic and demographic indicators, location of diagnosis and diagnostic access tuberculosis. The analysis of the data was of frequency, average, standard deviation, confidence interval and Chi-square test. RESULTS: Most cases were diagnosed in hospitals (52.8%). The patient sought the Health Unit on average three times until receiving medical care. The indicators of difficulty of displacement, expenditure on motorized transport and consultation within 24 hours to discover the disease were not satisfactory and regular. The chi-square test showed a statistical association between diagnosis location and seeking the nearest health unit from home. CONCLUSIONS: There are weaknesses in the early diagnosis of tuberculosis in primary care. There are many challenges to be faced to strengthen this level of health care, with organizational capacity to overcome the shortcomings related to the patient and the service that make it difficult to access the diagnosis of the disease.

Implementation of evidence-based practices in normal delivery care.

OBJECTIVE: to evaluate the impact of the implementation of evidence-based practices on normal delivery care. METHOD: quasi-experimental, before-and-after intervention study conducted in a public maternity hospital, Amapá. Forty-two professionals and 280 puerperal women were interviewed and data from 555 medical records were analyzed. The study was developed in three phases: baseline audit (phase 1), educational intervention (phase 2) and post-intervention audit (phase 3). RESULTS: after the intervention, there was an increase of 5.3 percentage points (p.p.) in the normal delivery rate. Interviews with the women revealed a significant increase of the presence of companions during labor (10.0 p.p.) and of adoption of the upright or squatting position (31.4 p.p.); significant reduction of amniotomy (16.8 p.p.), lithotomy position (24.3 p.p.), and intravenous oxytocin (17.1 p.p.). From the professionals' perspective, there was a statistical reduction in the prescription/administration of oxytocin (29.6 p.p.). In the analysis of medical records, a significant reduction in the rate of amniotomy (29.5 p.p.) and lithotomy position (1.5 p.p.) was observed; the rate of adoption of the upright or squatting position presented a statistical increase of 2.2 p.p. CONCLUSIONS: there was a positive impact of the educational intervention on the improvement of parturition assistance, but the implementation process was not completely successful in the adoption of scientific evidence in normal delivery care in this institution.