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Intermittent and continuous mechanical loads are known to influence osteogenic activity. The present study examines the effects of matched intermittent and continuous load in vitro on bone formation markers. MC3T3 (mouse pre-osteoblasts) were cultured and placed in a bioreactor to undergo continuous, intermittent, or unloading for 1, 3 and 12 days. Loading conditions were matched for magnitude, duration and frequency. Each time point was analysed for alkaline phosphatase (ALP) activity, procollagen 1 N-terminal propeptide (PINP) and alizarin red staining (ARS). Intermittent load caused an increase in ALP activity across all time points compared to continuous loading (↑30%-59%) and unloaded conditions (↑70%-90%). PINP concentrations from intermittent load were lower than continuous load (↓112%) on day 3. However, no differences were observed in PINP concentrations between loading conditions at other time points. No differences were observed for ARS between loading conditions. Intermittent load caused an increase in bone formation marker ALP, but not PINP, when compared to continuous loading and unloaded conditions. These findings further our knowledge in bone formation response and provide additional tools for the analysis of osteogenesis in vitro.
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BACKGROUND: Sarcopenia is an age-related muscle disease that increases the risk of falls, disabilities, and death. It is associated with increased muscle protein degradation driven by molecular signalling pathways including Akt and FOXO1. This study aims to identify genes, gene interactions, and molecular pathways and processes associated with muscle aging and exercise in older adults that remained undiscovered until now leveraging on an artificial intelligence approach called artificial neural network inference (ANNi). METHODS: Four datasets reporting the profile of muscle transcriptome obtained by RNA-seq of young (21-43 years) and older adults (63-79 years) were selected and retrieved from the Gene Expression Omnibus (GEO) data repository. Two datasets contained the transcriptome profiles associated to muscle aging and two the transcriptome linked to resistant exercise in older adults, the latter before and after 6 months of exercise training. Each dataset was individually analysed by ANNi based on a swarm neural network approach integrated into a deep learning model (Intelligent Omics). This allowed us to identify top 200 genes influencing (drivers) or being influenced (targets) by aging or exercise and the strongest interactions between such genes. Downstream gene ontology (GO) analysis of these 200 genes was performed using Metacore (Clarivate™) and the open-source software, Metascape. To confirm the differential expression of the genes showing the strongest interactions, real-time quantitative PCR (RT-qPCR) was employed on human muscle biopsies obtained from eight young (25 ± 4 years) and eight older men (78 ± 7.6 years), partaking in a 6-month resistance exercise training programme. RESULTS: CHAD, ZDBF2, USP54, and JAK2 were identified as the genes with the strongest interactions predicting aging, while SCFD1, KDM5D, EIF4A2, and NIPAL3 were the main interacting genes associated with long-term exercise in older adults. RT-qPCR confirmed significant upregulation of USP54 (P = 0.005), CHAD (P = 0.03), and ZDBF2 (P = 0.008) in the aging muscle, while exercise-related genes were not differentially expressed (EIF4A2 P = 0.99, NIPAL3 P = 0.94, SCFD1 P = 0.94, and KDM5D P = 0.64). GO analysis related to skeletal muscle aging suggests enrichment of pathways linked to bone development (adj P-value 0.006), immune response (adj P-value <0.001), and apoptosis (adj P-value 0.01). In older exercising adults, these were ECM remodelling (adj P-value <0.001), protein folding (adj P-value <0.001), and proteolysis (adj P-value <0.001). CONCLUSIONS: Using ANNi and RT-qPCR, we identified three strongly interacting genes predicting muscle aging, ZDBF2, USP54, and CHAD. These findings can help to inform the design of nonpharmacological and pharmacological interventions that prevent or mitigate sarcopenia.
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New licuri-based kefir beverages were obtained using water kefir grains as fermentation inoculum (1, 2.5, and 5%) under different fermentation times (24 and 48 h). Metagenomic sequencing of the kefir grains adapted to the aqueous licuri extract revealed Lactobacillus hilgardii and Brettanomyces bruxellensis to be predominant in this inoculum. The excellent adaptation of the kefir grains to the licuri extract raised the possibility of prebiotic action of these almonds. The beverages showed acidity values between 0.33 ± 0.00 and 0.88 ± 0.00 mg lactic acid/100 mL and pH between 3.52 ± 0.01 and 4.29 ± 0.04. The viability of lactic acid bacteria in the fermented beverages was equal to or greater than 108 CFU/mL, while yeasts were between 104 and 105 CFU/mL. There were significant differences (p < 0.05) in the proximate composition of the formulations, especially in the protein (1.37 ± 0.33-2.16 ± 0.84) and carbohydrate (5.86 ± 0.19-11.51 ± 1.26) contents. In addition, all the samples showed good stability in terms of acidity, pH, and viability for LAB and yeasts during 28 days of storage (4 °C). Overall, the beverages showed a dominant yellow-green color, non-Newtonian pseudoplastic behavior, and high mean scores in the sensory evaluation. This study provided evidence of the emerging potential of licuri in the plant-based beverage industry.
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Alzheimer's disease (AD) is a stealthy and progressive neurological disorder that is a leading cause of dementia in the global elderly population, imposing a significant burden on both the elderly and society. Currently, the condition is treated with medications that alleviate symptoms. Nonetheless, these drugs may not consistently produce the desired results and can cause serious side effects. Hence, there is a vigorous pursuit of alternative options to enhance the quality of life for patients. Ginkgo biloba (GB), an herb with historical use in traditional medicine, contains bioactive compounds such as terpenoids (Ginkgolides A, B, and C), polyphenols, organic acids, and flavonoids (quercetin, kaempferol, and isorhamnetin). These compounds are associated with anti-inflammatory, antioxidant, and neuroprotective properties, making them valuable for cognitive health. A systematic search across three databases using specific keywords-GB in AD and dementia-yielded 1702 documents, leading to the selection of 15 clinical trials for synthesis. In eleven studies, GB extract/EGb 761® was shown to improve cognitive function, neuropsychiatric symptoms, and functional abilities in both dementia types. In four studies, however, there were no significant differences between the GB-treated and placebo groups. Significant improvements were observed in scores obtained from the Mini-Mental State Examination (MMSE), Short Cognitive Performance Test (SKT), and Neuropsychiatric Inventory (NPI). While the majority of synthesized clinical trials show that Ginkgo biloba has promising potential for the treatment of these conditions, more research is needed to determine optimal dosages, effective delivery methods, and appropriate pharmaceutical formulations. Furthermore, a thorough assessment of adverse effects, exploration of long-term use implications, and investigation into potential drug interactions are critical aspects that must be carefully evaluated in future studies.
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The aims of this study were to determine anti-müllerian hormone (AMH) cutoff values for selecting Gir (Bos taurus indicus) oocyte donors and estimate the impact of using AMH concentrations as a selection criterion. In Exp. 1, Gir heifers (n=120) were sampled for AMH analysis and submitted to ovum pick-up and in vitro embryo production (OPU-IVEP). AMH cutoff values were calculated using ROC analysis or, alternatively, by the successive exclusion of heifers with the lowest AMH values. The correlations between AMH and OPU-IVEP outcomes were significant (P<0.001), though low or moderate (r= 0.34-0.52). We estimated an improvement (P<0.05) after the use of AMH cutoff values to select donors of +15.3% for total oocyes, +19.4% for viable COC, and +23.4% for blastocysts. This selection pressure, however, led to the exclusion of 32.8%, 37.9%, and 50.0% of the initial potential donors, respectively. In Exp. 2, we analyzed data from OPU-IVEP sessions of 658 Gir donors with known genomic values for predicted transmitting ability for milk (GPTAm) and age at first calving (GPTAafc). The selection based on the number of oocytes recovered had no effect (P>0.05) on the average GPTAm nor GPTAafc values of the remaining donors. In summary, plasma AMH ≥700â¯pg/mL is a cutoff value that can be used to select Gir heifers with a greater potential as oocyte donors. Nevertheless, this selection leads to the exclusion of up to 50% of potential donors. Finally, exclusion of poor responders had no effect on mean genomic estimates for milk production or age at first calving in the selected subset of donors.
Subject(s)
Anti-Mullerian Hormone , Fertilization in Vitro , Animals , Anti-Mullerian Hormone/blood , Cattle/blood , Cattle/physiology , Female , Fertilization in Vitro/veterinary , Embryo Culture Techniques/veterinary , Oocytes/physiology , Oocyte Donation/veterinary , Oocyte Retrieval/veterinary , Oocyte Retrieval/methods , Embryo Transfer/veterinaryABSTRACT
BACKGROUND: The drug retail represents the main area of activity for pharmacists worldwide. In Brazil, this sector is responsible for employing around 80% of professionals. Before this reality, the academic training of pharmacists requires specialized skills and knowledge so they can fulfill their tasks. In this sector, considering the influence of managers and mentors on the model of pharmaceutical practice, their perceptions about the demands of the market can help discussions related to the training of pharmacists. AIM: To analyze the academic training of pharmacists for the drug retail market from the perspective of managers and mentors. METHOD: This is a qualitative study conducted with managers and mentors of the drug retail market. A semi-structured interview guide was prepared and applied to the intentionally selected participants. The study was approved by the Research Ethics Committee under the number 4,169,752. The interviews were conducted through videoconference by an experienced researcher. The data obtained were analyzed using Bardin's analysis technique, following the steps of categorical thematic content analysis using the ATLAS.ti software. RESULTS: 19 interviews were carried out. Among the reports, the interviewees highlighted the importance of retail in the employability of pharmacists, as well as inconsistency in the academic training for this sector, originating the following categories: curriculum reform to include the market demands, follow-up and career plan, training for entrepreneurship and sales, practical application of knowledge, and encouragement of experience. CONCLUSION: Pharmaceutical academic training is linked to several challenges, whether organizational, structural, or budgetary. To overcome these challenges, it is necessary to unite the interested parties in the formulation and implementation of a strategy for the professionalization of pharmacists, considering their social role in patient care, aligned with the company's sustainability, so that both coexist.
Subject(s)
Education, Pharmacy , Pharmacists , Qualitative Research , Humans , Brazil , Mentors , Commerce/education , Curriculum , Male , Female , Interviews as TopicABSTRACT
OBJECTIVES: To characterize which strategies of professional identity formation and professionalism are being used in Pharmacy. FINDINGS: We gathered 5004 articles from 5 databases with the descriptors "pharmacy" "professionalism," "professional identity" and their synonyms. The professional identity is a set of values and behaviors common among professionals. Professionalism is the moral compass of these values, used as a strategy to own social authenticity. After excluding duplicate texts, analyzing titles, abstracts, and full articles, 17 studies met the inclusion criteria and presented strategies for the formation of professional identity and professionalism in pharmacy students. We did not find studies with pharmacists. The quality of reports was assessed using 2 instruments recommended by the literature. All studies were conducted from 2007 onwards, and the United States is the country with the most publications. The identified strategies consisted of extracurricular activities, thematic courses, lectures, and counseling sessions and did not follow standards of theoretical reference, method, execution, duration, and effectiveness of evaluation. SUMMARY: The interest of Pharmacy about professional identity and professionalism has grown substantially in recent years. Teaching strategies are essential alternatives to improve professionalism, reinforce its importance, and acknowledge its heterogeneity and differences. For that, they must be in line with the aims of the profession in society. This review highlights the need to develop standardized and reproducible teaching strategies to guarantee the effectiveness of students' professional socialization during graduation, as well as to instruct professionals to deal with the changes in the profession, increasing the influence of Pharmacy in society.
Subject(s)
Education, Pharmacy , Pharmacy , Students, Pharmacy , Humans , Social Identification , Education, Pharmacy/methods , Professionalism/education , CurriculumABSTRACT
Objetivo: compreender por meio da técnica Desenhar, escrever e contar como a condição crônica influencia na qualidade de vida infantojuvenil; e analisar o uso da técnica nessa população. Método: estudo qualitativo, descritivo e exploratório. Participaram onze crianças e adolescentes com condição crônica entre sete e dezessete anos. A coleta de dados ocorreu mediante entrevista semiestruturada, com auxílio da técnica Desenhar, escrever e contar, em um Hospital público. Para análise dos dados utilizou-se a análise de conteúdo temática de Bardin. Resultados: emergiram três categorias que evidenciam diversas alterações na qualidade de vida dessa clientela, com destaque para o comprometimento físico, emocional e social que impacta nas de experiências que compõem a infância e a adolescência. A técnica Desenhar, escrever e contar foi um facilitador e enriqueceu a coleta de dados. Considerações finais: a técnica escolhida possibilitou identificar a qualidade de vida prejudicada da criança e adolescente com condição crônica(AU)
Objective: to understand, through the Draw, Write and Tell interview technique how chronic condition influences pediatric quality of life; To analyze the use of the technique in this population. Method: qualitative, descriptive, exploratory study. Eleven children and adolescents with chronic conditions between seven and seventeen years old participated. Data collection took place through semi-structured interviews, with the aid of the Draw, Write and Tell interview technique, in State University Hospital. For data analysis, thematic content analysis according to Bardin was used. Results: three categories emerged that show several changes in the quality of life of this clientele, with emphasis on the physical, emotional and social impairment that impact on the experiences that make up childhood and adolescence. The Draw, Write and Tell interview technique facilitated and enriched data collection. Final considerations: The chosen technique made it possible to identify the impaired quality of life of children and adolescents with chronic conditions(AU)
Objetivo: comprender, a través de la técnica de entrevista Dibujar, Escribir y Contar, cómo la condición crónica influye en la calidad de vida infantojuvenil; y analizar el uso de la técnica en esta población. Método: estudio cualitativo, descriptivo y exploratorio. Participaron once niños y adolescentes, con condiciones crónicas, de siete a diecisiete años. La recolección de datos ocurrió por medio de entrevistas semiestructuradas, con el auxilio de la técnica de entrevista Dibujar, Escribir y Contar, en un hospital público. En cuanto al análisis de datos, se utilizó el análisis de contenido temático de Bardin. Resultados: surgieron tres categorías que muestran varios cambios en la calidad de vida de esta clientela, con énfasis en el deterioro físico, emocional y social que tiene un gran impacto en las experiencias que componen la infancia y la adolescencia. La técnica Dibujar, Escribir y Contar facilitó y enriqueció la recolección de datos. Consideraciones finales: la técnica elegida permitió identificar la calidad de vida deteriorada de niños y adolescentes con condiciones crónicas(AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Quality of Life/psychology , Child, Hospitalized/psychology , Chronic Disease , Adolescent, Hospitalized/psychology , Qualitative Research , Hospitals, Public , Hospitals, UniversityABSTRACT
INTRODUCTION: There is a need to improve knowledge and understanding of the factors associated with mortality from COVID-19 so that managers and decision-makers can implement strategies to mitigate and control the severe forms of the disease. This study aimed to determine the factors associated with deaths from COVID-19 in the state of Maranhão, in northeastern Brazil. METHODOLOGY: This is a cross-sectional and analytical study with patients with a confirmed diagnosis of COVID-19 who died from March 2020 to January 2022. Simple and multiple logistic regression models were used to assess the association between clinical-epidemiological characteristics and death. The odds ratios were expressed using a 95% confidence interval and a 5% significance level. RESULTS: A total of 386,567 cases of COVID-19 were registered in the period, of which 10,986 died. Risk factors associated with deaths from COVID-19 were male sex, age over 30 years, positive reverse transcriptase-polymerase chain reaction (RT-PCR) result, positive CT scan, and having one or more associated comorbidities. The three comorbidities linked to the highest propensity to die were diabetes mellitus, neurological disease, and obesity. CONCLUSIONS: The study findings support the implementation of strategic actions by health care and surveillance professionals and managers towards reducing the incidence of the risk factors for mortality by COVID-19 in Maranhão.
Subject(s)
COVID-19 , Humans , Male , Adult , Female , SARS-CoV-2 , Brazil/epidemiology , Cross-Sectional Studies , Risk FactorsABSTRACT
MAIN RESULTS: A total of 4,029 leprosy cases were notified. Mean prevalence varied between 2.0 and 11.5 cases/10,000 inhab. Spatial distribution of the cases was heterogeneous and there was a falling prevalence trend over the years studied. IMPLICATIONS FOR SERVICES: These findings point to the need to strengthen active tracing strategies and expand health actions and services targeting leprosy, with the aim of increasing detection and early treatment of cases. PERSPECTIVES: It is important to carry out epidemiological investigations on the spatial distribution and prevalence of leprosy in other health regions in the state, in order to identify other areas with greater vulnerability to leprosy. OBJECTIVE: to analyse the spatial distribution and trend of leprosy in municipalities of a health region in a Northeast Brazilian state. METHODS: this was an ecological time-series study based on compulsory notification of leprosy cases by the municipalities covered by the Imperatriz-MA Regional Health Management Unit, between 2008 and 2017; prevalence and mean prevalence for the period were calculated; spatial analysis of the area was carried out and maps were generated using ArcGis 10.5. Prais-Winsten regression was used for trend analysis. RESULT: 4,029 cases of the disease were identified, and average prevalence ranged from 2.0 to 11.5 cases/10,000 inhabitants-year. The overall trend was downward. Governador Edson Lobão had the highest prevalence, 11.5 cases/10,000 inhabitants, and Lajeado Novo had the lowest prevalence, 2.0 cases/10,000 inhabitants. CONCLUSION: spatial distribution of leprosy cases was heterogeneous in the municipalities studied and prevalence had a falling trend.
Subject(s)
Accidental Falls , Leprosy , Humans , Brazil/epidemiology , Prevalence , Leprosy/epidemiology , Spatial AnalysisABSTRACT
BACKGROUND: Circulating biomarkers of bone formation and resorption are widely used in exercise metabolism research, but their responses to exercise are not clear. This study aimed to quantify group responses and inter-individual variability of P1NP and ß-CTX-1 after prolonged, continuous running (60-120 min at 65-75% VÌO2max) in young healthy adult males using individual participant data (IPD) meta-analysis. METHODS: The protocol was designed following PRISMA-IPD guidelines and was pre-registered on the Open Science Framework prior to implementation ( https://osf.io/y69nd ). Changes in P1NP and ß-CTX-1 relative to baseline were measured during, immediately after, and in the hours and days following exercise. Typical hourly and daily variations were estimated from P1NP and ß-CTX-1 changes relative to baseline in non-exercise (control) conditions. Group responses and inter-individual variability were quantified with estimates of the mean and standard deviation of the difference, and the proportion of participants exhibiting an increased response. Models were conducted within a Bayesian framework with random intercepts to account for systematic variation across studies. RESULTS: P1NP levels increased during and immediately after running, when the proportion of response was close to 100% (75% CrI: 99 to 100%). P1NP levels returned to baseline levels within 1 h and over the next 4 days, showing comparable mean and standard deviation of the difference with typical hourly (0.1 ± 7.6 ng·mL-1) and daily (- 0.4 ± 5.7 ng·mL-1) variation values. ß-CTX-1 levels decreased during and up to 4 h after running with distributions comparable to typical hourly variation (- 0.13 ± 0.11 ng·mL-1). There was no evidence of changes in ß-CTX-1 levels during the 4 days after the running bout, when distributions were also similar between the running data and typical daily variation (- 0.03 ± 0.10 ng·mL-1). CONCLUSION: Transient increases in P1NP were likely biological artefacts (e.g., connective tissue leakage) and not reflective of bone formation. Comparable small decreases in ß-CTX-1 identified in both control and running data, suggested that these changes were due to the markers' circadian rhythm and not the running intervention. Hence, prolonged continuous treadmill running did not elicit bone responses, as determined by P1NP and ß-CTX-1, in this population.
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To evaluate aerobic capacity, strength and other physiological, nutritional, and psychological variables which may influence the performance of transgender women (TW) athletes and compare them to cisgender women (CW) and cisgender men (CM) athletes, as well as changes in TW performance over the course of a year. Prospective cohort study including three groups: TW, CW and CM volleyball athletes. Subjects will be comprehensively assessed at two different moments: baseline and after 6-12 months of adequate hormonal therapy. Evaluation will comprise clinical, medical, nutritional and psychological interviews, incremental treadmill cardiopulmonary exercise testing, hand grip strength test, vertical jump test, analysis of sleep quality (Pittsburgh Sleep Quality Index), hormonal profile, echocardiogram, analysis of resting energy expenditure, assessment of bone mass and body composition through dual-energy X-ray absorptiometry scans, and untargeted metabolomic analysis. CW and CM matched by age, body mass index and level of physical activity will undergo a similar evaluation. The assessment of the strength, aerobic capacity, haematological, nutritional and psychological status of TW using gold-standard tests will contribute to understanding the impact of oestrogen therapy on the exercise performance of these athletes and how they compare with CW and CM.
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INTRODUCTION: The analysis of factors associated with multibacillary leprosy is important for the development of strategies to mitigate the disease, which persists as a public health problem in Brazil and the world. The objective of this study was to verify the associations between sociodemographic and clinical-epidemiological variables and multibacillary leprosy in the state of northeastern Brazil. METHODOLOGY: This is a cross-sectional, analytical, and retrospective study, with a quantitative approach, carried out in 16 municipalities in the southwest of Maranhão State, northeastern Brazil. All cases of leprosy reported between January 2008 and December 2017 were considered. Sociodemographic and clinical-epidemiological variables were analyzed using descriptive statistics. The identification of the risk factors associated with multibacillary leprosy was conducted using Poisson regression models. The prevalence ratios and respective 95% confidence intervals were estimated using regression coefficients at a 5% significance level. RESULTS: A total of 3,903 leprosy cases were analyzed. Individuals older than 15 years, males, with less than 8 years of education, with level I, II, or "not evaluated" disability, and with type 1 or 2 or both reactional states were more likely to have multibacillary leprosy. Therefore, these characteristics may be considered risk factors. No protective factors were identified. CONCLUSIONS: The investigation revealed important associations between risk factors and multibacillary leprosy. The findings can be considered during the creation of strategies to control and combat the disease.
Subject(s)
Leprosy, Multibacillary , Leprosy , Humans , Male , Brazil/epidemiology , Cross-Sectional Studies , Leprosy/epidemiology , Leprosy, Multibacillary/epidemiology , Retrospective Studies , Adolescent , Female , AdultABSTRACT
Patients with comorbidities are more vulnerable to severe clinical cases of acute respiratory distress syndrome (ARDS) and COVID-19 require complex health care. To analyse the association between the individual and combined effects of diabetes, hypertension, and obesity on ARDS mortality rates among patients receiving clinical care. A multicentre study encompassing retrospective data analysis and conducted with 21,121 patients from 6,723 health services across Brazil, during the 2020-2022 time period. The sample group consisted of clinical patients of both sexes and different age groups who received clinical care and showed at least one comorbidity. The data collected were analysed using binary logistic regressions and the Chi-square test. The overall mortality rate was 38.7%, with a higher predominance among males (p < 0.001), mixed-race individuals (p < 0.001), and older adults (p < 0.001). The main comorbidity variables associated with and leading to death from ARDS were arterial hypertension (p < 0.001), diabetes mellitus (p < 0.001), diabetes mellitus and arterial hypertension (p < 0.001), cardiovascular diseases (p < 0.001) and obesity (p < 0.001). Both the patients who progressed to recovery (48.4%) and to death (20.5%) presented only one comorbidity (χ2 (1,749) = 8, p < 0.001), respectively. The isolated comorbidities with the greatest impact on death outcomes were diabetes (95% CI 2.48-3.05, p < 0.001), followed by obesity (95% CI 1.85-2.41, p < 0.001) and hypertension (95% CI 1.05-1.22, p < 0.001), even after adjusting for sex and number of simultaneous comorbidities. Diabetes and obesity, as isolated conditions, had a greater influence on the number of deaths of clinical patients with ARDS compared to those with mutual diagnosis of diabetes, hypertension and obesity.
Subject(s)
COVID-19 , Diabetes Mellitus , Hypertension , Respiratory Distress Syndrome , Male , Female , Humans , Aged , Retrospective Studies , Risk Factors , Diabetes Mellitus/epidemiology , Obesity/epidemiology , Hypertension/epidemiologyABSTRACT
Intraosseous myofibroma is a rare tumor of benign nature, slow growth, and low morbidity. The aim of this article is to report a case of pathologic fracture associated with the incidental diagnosis of myofibroma in the mandible of an adolescent. A 15-year-old girl reported that she experienced a physical assault resulting in facial injuries 1 month previously and had since experienced severe pain, malocclusion, and chewing difficulty. The cone beam computed tomographic examination revealed multiple features suggestive of pathologic fracture associated with a hypodense lesion with lobulated limits, as well as expansion and thinning of the cortical bone in the left mandible. The histopathologic diagnosis of the lesion indicated myofibroma. Treatment consisted of enucleation and curettage of the lesion with reduction and internal fixation of the fracture. After 18 months, the osteosynthesis plates and an impacted mandibular third molar were removed. Curettage of the lesion in association with treatment of the mandibular fracture proved to be effective for both bone consolidation and absence of recurrence while restoring mandibular functionality.
Subject(s)
Fractures, Spontaneous , Mandibular Fractures , Mandibular Neoplasms , Myofibroma , Skin Neoplasms , Female , Adolescent , Humans , Mandibular Neoplasms/diagnostic imaging , Mandibular Neoplasms/surgery , Myofibroma/diagnosis , Myofibroma/surgery , Myofibroma/pathology , Mandibular Fractures/diagnostic imaging , Mandibular Fractures/surgery , Fractures, Spontaneous/diagnostic imaging , Fractures, Spontaneous/etiology , Mandible/pathologyABSTRACT
INTRODUCTION: In recent decades, the professionalization of pharmacy has been debated worldwide. With the advent of industrialization, pharmacist autonomy has weakened, especially in the retail pharmacy market. Manegers and mentors of pharmacy chains serve as links between the profession and drug users. This study sought to understand the perceptions of retail pharmacy stakeholders regarding pharmacist autonomy and how to improve it, and to reflect on theories of professionalism. METHOD: 19 semi-structured interviews were conducted. The interviews were transcribed and analyzed through analyst triangulation and categorical content analysis, using the ATLAS.ti software. RESULTS: Interviews were conducted with nine mentors and ten managers in retail medicine. They reported aspects related to managerial and technical autonomy regulated by law, and strategies for enhancing professional autonomy in retail pharmacy. Autonomy was considered limited by pharmacists' dependence on employability and self-devaluation; and market control exposed the weaknesses in pharmaceutical professionalism. Entrepreneurship and ownership attitude strategies were feasible only in a retail micro-political context. CONCLUSION: The retail medicine continues to have business model centered on the product and controlling the pharmaceutical practice model. To ensure autonomy and professional strengthening, it is necessary that pharmacy recognizes itself as a clinical profession and develops a stable professional identity.
Subject(s)
Community Pharmacy Services , Pharmacy , Humans , Pharmacists , Professionalism , Professional Role , Pharmaceutical Preparations , Attitude of Health PersonnelABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread worldwide, causing a high burden of morbidity and mortality, and has affected the various health service systems in the world, demanding disease monitoring and control strategies. The objective of this study was to identify risk areas using spatiotemporal models and determine the COVID-19 time trend in a federative unit of northeastern Brazil. METHODS: An ecological study using spatial analysis techniques and time series was carried out in the state of Maranhão, Brazil. All new cases of COVID-19 registered in the state from March 2020 to August 2021 were included. Incidence rates were calculated and spatially distributed by area, while the spatiotemporal risk territories were identified using scan statistics. The COVID-19 time trend was determined using Prais-Winsten regressions. RESULTS: Four spatiotemporal clusters with high relative risks for the disease were identified in seven health regions located in the southwest/northwest, north and east of Maranhão. The COVID-19 time trend was stable during the analysed period, with higher rates in the regions of Santa Inês in the first and second waves and Balsas in the second wave. CONCLUSIONS: The heterogeneously distributed spatiotemporal risk areas and the stable COVID-19 time trend can assist in the management of health systems and services, facilitating the planning and implementation of actions toward the mitigation, surveillance and control of the disease.