Chromosome-length genome assemblies and cytogenomic analyses of pangolins reveal remarkable chromosome counts and plasticity.

We report the first chromosome-length genome assemblies for three species in the mammalian order Pholidota: the white-bellied, Chinese, and Sunda pangolins. Surprisingly, we observe extraordinary karyotypic plasticity within this order and, in female white-bellied pangolins, the largest number of chromosomes reported in a Laurasiatherian mammal: 2n = 114. We perform the first karyotype analysis of an African pangolin and report a Y-autosome fusion in white-bellied pangolins, resulting in 2n = 113 for males. We employ a novel strategy to confirm the fusion and identify the autosome involved by finding the pseudoautosomal region (PAR) in the female genome assembly and analyzing the 3D contact frequency between PAR sequences and the rest of the genome in male and female white-bellied pangolins. Analyses of genetic variability show that white-bellied pangolins have intermediate levels of genome-wide heterozygosity relative to Chinese and Sunda pangolins, consistent with two moderate declines of historical effective population size. Our results reveal a remarkable feature of pangolin genome biology and highlight the need for further studies of these unique and endangered mammals.

Plasmid-Mediated Colistin Resistance Genes mcr-1 and mcr-4 in Multidrug-Resistant Escherichia coli Strains Isolated from a Healthy Pig in Portugal.

Antimicrobial resistance encoded by mobile colistin resistance (mcr) genes is a global and emergent threat. In this study, we report the occurrence of two different populations of colistin-resistant Escherichia coli harboring mcr-1 and mcr-4 variants in the intestinal microbiome of a healthy pig. Following antimicrobial susceptibility determination, the presence of mcr genes in two E. coli strains, isolated according to different selective microbiological procedures, was screened by PCR. Whole-genome sequencing confirmed that both strains were multidrug-resistant; INIAV_002EC was an AmpC producer carrying blaCMY-2, blaTEM-1B, qnrS1, mcr-1.1 genes, and INIAV_001EC carrying blaTEM-1A, tetB, and mcr-4.1 genes, along with mutations in quinolone resistance-determining regions. In addition, both strains harbored sul3, dfrA, and aadA1 determinants. Further genome analysis revealed different plasmid replicons associated with the mcr genes, IncX4 associated with mcr-1.1, and ColE10 with mcr-4.1. In addition, other replicons, including IncFIA, IncI1-Iγ, IncX1, IncY, in INIAV_002EC, and IncX1, IncI1, and p0111, in INIAV_001EC, were identified. Furthermore, both strains belonged to ST215 serotype O68:H12 and ST156 serotype O25:H28, respectively. This finding highlights the pig gut flora as a potential reservoir of mobile colistin resistance genes and reports the presence of the mcr-4.1 gene found for the first time in Portugal.

Selection on genes associated with the evolution of divergent life histories: Gamete recognition or something else?

Gamete compatibility, and fertilization success, is mediated by gamete-recognition genes (GRGs) that are expected to show genetic evidence of a response to sexual selection associated with mating system traits. Changes in the strength of sexual selection can arise from the resolution of sperm competition among males, sexual conflicts of interest between males and females, or other mechanisms of sexual selection. To assess these expectations, we compared patterns of episodic diversifying selection among genes expressed in the gonads of Cryptasterina pentagona and C. hystera, which recently speciated and have evolved different mating systems (gonochoric or hermaphroditic), modes of fertilization (outcrossing or selfing), and dispersal (planktonic larvae or internal brooding). Cryptasterina spp. inhabit the upper intertidal of the coast of Queensland and coral islands of the Great Barrier Reef. We found some evidence for positive selection on a GRG in the outcrossing C. pentagona, and we found evidence of loss of gene function in a GRG of the self-fertilizing C. hystera. The modification or loss of gene functionality may be evidence of relaxed selection on some aspects of gamete interaction in C. hystera. In addition to these genes involved in gamete interactions, we also found genes under selection linked to abiotic stress, chromosomal regulation, polyspermy, and egg-laying. We interpret those results as possible evidence that Cryptasterina spp. with different mating systems may have been adapting in divergent ways to oxidative stress or other factors associated with reproduction in the physiologically challenging environment of the high intertidal. RESEARCH HIGHLIGHTS: Recent speciation between two sea stars was unlikely the result of selection on gamete-recognition genes annotated in this study. Instead, our results point to selection on genes linked to the intertidal environment and reproduction.

Occurrence of a Rare Multidrug Resistant Escherichia coli Coharboring blaCTX-M-32 and blaCTX-M-2 Genes in a Bovine.

In this study, a rare strain of Escherichia coli co-harboring blaCTX-M-32 and blaCTX-M-2 genes was characterized by whole genome sequencing. Escherichia coli strain was recovered from a bovine cecal sample collected at slaughter. The strain was resistant to third and fourth generation cephalosporins, fluoroquinolones, aminoglycosides, tetracycline and sulfamethoxazole, which was in concordance with the genotype: blaCTX-M-32 and blaCTX-M-2, aac(3)-Via and tet(A) and sul1 genes, respectively. The E. coli strain was characterized as pathogenic, and belongs to the ST226 (CC226), serotype O141ab/ac:H5, phylogenetic group A and fumC27/fimH41 types. No virulence genes were found in the genome. According to the plasmid analysis, IncFIB, IncHI2 and p0111 were present. The analysis of the contigs revealed that the blaCTX-M-32 was located in the chromosome, upstream IS5-like/ISKpn26 and IS1380-like/ISEc9 sequences, whereas blaCTX-M-2 was in the p0111 plasmid, within an integron class 1, and flanked by Orf3/qacEΔ1 and IS91/ISCR1. To our knowledge, this is the first report of a multidrug resistant Escherichia coli strain co-harboring two CTX-M enzymes in a healthy bovine from Portugal. This finding allows a better understanding on the dissemination of these resistance mechanism among bacteria of animal origin.

Cloning and Selfing Affect Population Genetic Variation in Simulations of Outcrossing, Sexual Sea Stars.

AbstractMany sea stars are well known for facultative or obligate asexual reproduction in both the adult and larval life-cycle stages. Some species and lineages are also capable of facultative or obligate hermaphroditic reproduction with self-fertilization. However, models of population genetic variation and empirical analyses of genetic data typically assume only sexual reproduction and outcrossing. A recent reanalysis of previously published empirical data (microsatellite genotypes) from two studies of one of the most well-known sea star species (the crown-of-thorns sea star; Acanthaster sp.) concluded that cloning and self-fertilization in that species are rare and contribute little to patterns of population genetic variation. Here we reconsider that conclusion by simulating the contribution of cloning and selfing to genetic variation in a series of models of sea star demography. Simulated variation in two simple models (analogous to previous analyses of empirical data) was consistent with high rates of cloning or selfing or both. More realistic scenarios that characterize population flux in sea stars of ecological significance, including outbreaks of crown-of-thorns sea stars that devastate coral reefs, invasions by Asterias amurensis, and epizootics of sea star wasting disease that kill Pisaster ochraceus, also showed significant but smaller effects of cloning and selfing on variation within subpopulations and differentiation between subpopulations. Future models or analyses of genetic variation in similar study systems might benefit from simulation modeling to characterize possible contributions of cloning or selfing to genetic variation in population samples or to understand the limits on inferring the effects of cloning or selfing in nature.

Nonspecific expression of fertilization genes in the crown-of-thorns Acanthaster cf. solaris: Unexpected evidence of hermaphroditism in a coral reef predator.

The characterization of gene expression in gametes has advanced our understanding of the molecular basis for ecological variation in reproductive success and the evolution of reproductive isolation. These advances are especially significant for ecologically important keystone predators such as the coral-eating crown-of-thorns sea stars (COTS, Acanthaster) which are the most influential predator species in Indo-Pacific coral reef ecosystems and the focus of intensive management efforts. We used RNA-seq and transcriptome assemblies to characterize the expression of genes in mature COTS gonads. We described the sequence and domain organization of eight genes with sex-specific expression and well known functions in fertilization in other echinoderms. We found unexpected expression of genes in one ovary transcriptome that are characteristic of males and sperm, including genes that encode the sperm-specific guanylate cyclase receptor for an egg pheromone, and the sperm acrosomal protein bindin. In a reassembly of previously published RNA-seq data from COTS testes, we found a complementary pattern: strong expression of four genes that are otherwise well known to encode egg-specific fertilization proteins, including the egg receptor for bindin (EBR1) and the acrosome reaction-inducing substance in the egg coat (ARIS1, ARIS2, ARIS3). We also found histological evidence of both eggs and sperm developing in the same gonad in several COTS individuals from a parallel study. These results suggest the occurrence of hermaphrodites, and the potential for reproductive assurance via self-fertilization. Our findings have implications for management of COTS populations, especially in consideration of the large size and massive fecundity of these sea stars.

Saúde mental na atenção básica: uma descrição das competências da equipe Estratégia Saúde da Família / Mental health in primary care: a description of competencies on Family Health Strategy team

A Reforma Psiquiátrica Brasileira culminou na transformação do modelo assistencial em Saúde Mental, o qual era baseado numa prática asilar excludente e agora incorpora novas formas de cuidado visando à reinserção do paciente na sociedade. Buscando atender à demanda deste novo cenário, a construção de um atendimento em rede torna-se essencial, no qual as ações de saúde mental são articuladas aos serviços da atenção primária. Sendo assim, os profissionais do programa de Estratégia de Saúde da Família (ESF) passam a incluir as pessoas com sofrimento psíquico de seu território nas práticas de assistência. O objetivo do presente estudo é descrever as competências necessárias para a equipe da ESF atuar na atenção à saúde mental. O método de pesquisa utilizado foi a revisão integrativa da literatura, com a inclusão de 18 estudos publicados entre 2010 e 2017. Da leitura e análise das obras selecionadas foi possível identificar um conjunto de competências técnicas e um conjunto de competências comportamentais. Para efeito do estudo as competências comportamentais foram agrupadas em: competências de acolhimento; competências de vínculo. Como resultados observou-se que as competências comportamentais apresentam-se em maior número que as técnicas.(AU)

The Brazilian Psychiatric Reform culminated in the transformation of the care model in Mental Health, which was based on an exclusive asylum practice and now incorporates new forms of care aiming reintegration of the patient into society. In order to meet the demands of this new scenario, the construction of a network service becomes essential, in which the mental health actions are articulated to the primary care services. Thus, the professionals of the Family Health Strategy (FHS) program now include into their territory of care practices people with mental illness. The aimed of the present study is to describe the competences necessary for the FHS team to work on mental health care. The research method used was the integrative review of the literature, with the inclusion of 18 studies published between 2010 and 2017. From the reading and analysis of the selected works it was possible to identify a set of technical skills and a set of behavioral skills. For the purpose of the study, behavioral skills were grouped into: reception skills; bonding skills. As results it was observed that the behavioral competences are presented in greater number than the techniques.(AU)

Traditional and complementary medicine as health promotion technology in Brazil.

Conventional medicine-understood as a medicalized and commodified model based on biomedical and natural hard sciences that provide legitimization and institutionalism to its practices-is hegemonic in health systems. This article examines interfaces between health promotion (HP) and traditional and complementary medicine (T&CM), especially as found in the Brazilian Health System (SUS). In order to analyze the tensions between paradigms that strive for scientific authority in public policies and practices, especially those related to SUS, we rely on Bourdieu's concept of scientific field. Our guidelines to identify the principles and values that mark the HP and T&CM movements were official documents (policies) and scientific publications on the subject. Analysis showed that the underlying values and principles of HP and T&CM converge and add complexity to the health model and its praxis-HP with its theoretical advances and T&CM with its conceptually coherent practices. Both movements recognize the multidimensional and indivisible nature of 'being' and its social and environmental determination. Together, they strengthen the possibilities of offering practices based on HP principles, such as holism, integrality, sustainability, empowerment, autonomy, social participation and others. This encounter offers a promising path for strengthening resistance against the individualized and monetized 'out-of-pocket' medicine model, and favors the reorientation of primary health care toward a more democratic and health-promoting model for SUS.

Positive selection on human gamete-recognition genes.

Coevolution of genes that encode interacting proteins expressed on the surfaces of sperm and eggs can lead to variation in reproductive compatibility between mates and reproductive isolation between members of different species. Previous studies in mice and other mammals have focused in particular on evidence for positive or diversifying selection that shapes the evolution of genes that encode sperm-binding proteins expressed in the egg coat or zona pellucida (ZP). By fitting phylogenetic models of codon evolution to data from the 1000 Genomes Project, we identified candidate sites evolving under diversifying selection in the human genes ZP3 and ZP2. We also identified one candidate site under positive selection in C4BPA, which encodes a repetitive protein similar to the mouse protein ZP3R that is expressed in the sperm head and binds to the ZP at fertilization. Results from several additional analyses that applied population genetic models to the same data were consistent with the hypothesis of selection on those candidate sites leading to coevolution of sperm- and egg-expressed genes. By contrast, we found no candidate sites under selection in a fourth gene (ZP1) that encodes an egg coat structural protein not directly involved in sperm binding. Finally, we found that two of the candidate sites (in C4BPA and ZP2) were correlated with variation in family size and birth rate among Hutterite couples, and those two candidate sites were also in linkage disequilibrium in the same Hutterite study population. All of these lines of evidence are consistent with predictions from a previously proposed hypothesis of balancing selection on epistatic interactions between C4BPA and ZP3 at fertilization that lead to the evolution of co-adapted allele pairs. Such patterns also suggest specific molecular traits that may be associated with both natural reproductive variation and clinical infertility.

Participatory construction of the State Health Promotion Policy: a case from Minas Gerais, Brazil. / Construção participativa da Política Estadual de Promoção de Saúde: caso de Minas Gerais, Brasil.

Minas Gerais started the development of the Minas Gerais Health Promotion Policy (POEPS-MG) based on the review of the National Health Promotion Policy (PNPS). This is a case report based on the documentary analysis of the material produced in the 38 workshops with a participation of 1.157 members across the State. The first workshop was intrasectoral and took place at the State Health Secretariat (SDH-MG). The second was an intersectoral workshop with the participation of several State Health Secretariats of Minas Gerais. The final workshop counted on the participation of State Regional Technical References. Another 35 workshops were developed in the 28 State Regional Administrations. Results were systematized and consolidated from the Analytical Matrix used in the PNPS, generating the base document of the POEPS-MG. It is important to highlight that, the specific regional requirements identified during the Policy's construction process reinforce the enriching moments of developing in an innovative, democratic and participative way actions that may provide some meanings to Health Promotion in the State of Minas Gerais. The State Policy seeks to bring life to the PNPS, adapting it to the reality of the territory and strengthening it - with the assurance of budgetary resources.

A partir da Revisão da Política Nacional de Promoção de Saúde (PNPS), Minas Gerais desencadeou a elaboração da Política Estadual de Promoção da Saúde (POEPS - MG). Trata-se de um relato de caso, a partir da análise documental do material produzido nas 38 oficinas com a participação de 1.157 integrantes, em todo o Estado. A primeira oficina foi Intrasetorial, na Secretaria de Estado de Saúde (SES-MG); a segunda foi a Intersetorial, com participação de várias Secretarias de Estado de Minas Gerais e, a última, com a participação das Referências Técnicas Regionais do Estado. Outras 35 oficinas foram desenvolvidas nas 28 regionais do Estado. Os resultados foram sistematizados e consolidados a partir da Matriz Analítica utilizada na PNPS, gerando o documento base da POEPS-MG. É importante destacar que as demandas regionais específicas, identificadas durante o processo de construção da Política, reforçam a riqueza de desenvolver, de forma inovadora, democrática e participativa, ações que possam dar sentido à Promoção da Saúde no Estado de Minas Gerais. A Política Estadual busca tornar viva a PNPS, além de adequá-la à realidade do território e de fortalecê-la com a garantia de recursos orçamentários.

Construção participativa da Política Estadual de Promoção de Saúde: caso de Minas Gerais, Brasil / Participatory construction of the State Health Promotion Policy: a case from Minas Gerais, Brazil

Resumo A partir da Revisão da Política Nacional de Promoção de Saúde (PNPS), Minas Gerais desencadeou a elaboração da Política Estadual de Promoção da Saúde (POEPS - MG). Trata-se de um relato de caso, a partir da análise documental do material produzido nas 38 oficinas com a participação de 1.157 integrantes, em todo o Estado. A primeira oficina foi Intrasetorial, na Secretaria de Estado de Saúde (SES-MG); a segunda foi a Intersetorial, com participação de várias Secretarias de Estado de Minas Gerais e, a última, com a participação das Referências Técnicas Regionais do Estado. Outras 35 oficinas foram desenvolvidas nas 28 regionais do Estado. Os resultados foram sistematizados e consolidados a partir da Matriz Analítica utilizada na PNPS, gerando o documento base da POEPS-MG. É importante destacar que as demandas regionais específicas, identificadas durante o processo de construção da Política, reforçam a riqueza de desenvolver, de forma inovadora, democrática e participativa, ações que possam dar sentido à Promoção da Saúde no Estado de Minas Gerais. A Política Estadual busca tornar viva a PNPS, além de adequá-la à realidade do território e de fortalecê-la com a garantia de recursos orçamentários.

Abstract Minas Gerais started the development of the Minas Gerais Health Promotion Policy (POEPS-MG) based on the review of the National Health Promotion Policy (PNPS). This is a case report based on the documentary analysis of the material produced in the 38 workshops with a participation of 1.157 members across the State. The first workshop was intrasectoral and took place at the State Health Secretariat (SDH-MG). The second was an intersectoral workshop with the participation of several State Health Secretariats of Minas Gerais. The final workshop counted on the participation of State Regional Technical References. Another 35 workshops were developed in the 28 State Regional Administrations. Results were systematized and consolidated from the Analytical Matrix used in the PNPS, generating the base document of the POEPS-MG. It is important to highlight that, the specific regional requirements identified during the Policy's construction process reinforce the enriching moments of developing in an innovative, democratic and participative way actions that may provide some meanings to Health Promotion in the State of Minas Gerais. The State Policy seeks to bring life to the PNPS, adapting it to the reality of the territory and strengthening it - with the assurance of budgetary resources.

Lian Gong em 18 terapias como estratégia de promoção da saúde / Lian Gong in 18 therapies as a health promotion strategy / Lian Gong en 18 terapias como estrategia para la promoción de la salud

Objetivo: Identificar os principais benefícios alcançados pelos praticantes de Lian Gong em 18 terapias, que está vinculado à atenção primária como uma estratégia de promoção da Saúde. Métodos: Trata-se de um estudo transversal realizado no município de Belo Horizonte, com aplicação de 1.091 questionários com os praticantes de lian gong no ano de 2014. Estudaram-se variáveis socioeconômicas relacionadas à dor, uso de medicação e necessidade de serviços de saúde. Os dados foram analisados por meio de análise descritiva e testes de homogeneidade marginal e qui-quadrado de Pearson, considerando-se nível de significância de 5%. Resultados: O perfil predominante dos praticantes são mulheres (89,5%; n= 977), com mais de 60 anos (61,90%; n = 678), indicadas para o lian gong por profissionais da saúde (66,50%; n = 935) e que realizam a prática com uma frequência de 2 vezes por semana (68,31%; n=735) e há mais de 7 meses (75,87%; n=792). Os principais benefícios relacionados a essa pratica foram a redução no quadro de dor, no uso de medicamento (49,6%; n=297) e a diminuição da demanda por serviços da Atenção Primária à Saúde (78,5%; n=715). Conclusão: A prática do Lian Gong como estratégia de promoção da saúde, inserida no ambiente da Atenção Primária à Saúde, promove benefícios para os praticantes, como a redução das dores no corpo, a desmedicalização e a redução da demanda por serviços de saúde.

Objective: To identify the main benefits obtained by practitioners of Lian Gong in 18 therapies, which is included in Primary Care as a Health Promotion strategy. Methods: This is a cross-sectional study carried out in the municipality of Belo Horizonte through the administration of 1,091 questionnaires to Lian Gong practitioners in 2014. Socioeconomic variables relating to pain, use of medication and need for health services were assessed. The data were analyzed using descriptive analysis and marginal homogeneity tests and Pearson's Chi-squared test with significance level set at 5%. Results: Practitioners were predominantly women (89.55%; n=977), over 60 years old (61.90%; n=678), referred to Lian Gong by health professionals (66.50%; n=935); most participants practice twice a week (68.31%; n=735) and have been practicing for more than 7 months (75.87%; n=762). The main benefits provided by the practice were pain reduction, reduced use of medication (49.58%; n=297) and reduced demand for Primary Health Care services (78.49%; n=715). Conclusion: The practice of Lian Gong as a health promotion strategy included in Primary Health Care provides benefits to practitioners, such as body pain reduction, demedicalization and reduced demands for health services.

Objetivo: Identificar los principales beneficios alcanzados por los que practican el lian gong en 18 terapias que está vinculado a la atención primaria como estrategia para la promoción de la salud. Métodos: Se trata de un estudio transversal realizado en el municipio de Belo Horizonte con la aplicación de 1.091 cuestionarios con los que practicaban el lian gong en 2014. Se estudiaron las variables socioeconómicas relacionadas al dolor, al uso de medicación y la necesidad de servicios de salud. Los datos fueron analizados a través de un análisis descriptivo y pruebas de homogeneidad marginal y el chi-cuadrado de Pearson considerándose el nivel de significación del 5%. Resultados: El perfil predominante de los practicantes son mujeres (89,5%; n= 977), con más de 60 años (61,90%; n = 678), indicadas para el lian gong por profesionales de la salud (66,50%; n = 935) y que la practican con una frecuencia de 2 veces a la semana (68,31%; n=735) y hace más de 7 meses (75,87%; n=792). Los principales beneficios relacionados a esa práctica fueron la disminución del dolor, en el uso de medicación (49,6%; n=297) y la disminución de la demanda de los servicios de la Atención Primaria de Salud (78,5%; n=715). Conclusión: La práctica del lian gong como estrategia para la promoción de la salud inserida en al ambiente de la Atención Primaria de Salud promueve beneficios para los que la practican como la reducción de los dolores del cuerpo, la retirada de la medicación y la reducción de la demanda de los servicios de salud.

Finding genes and lineages under selection in speciation.

What are the genes and traits that respond to selection and cause prezygotic reproductive isolation between species? This question has been hard to answer because genomes are large, the targets of selection may be scattered across the genome (Sabeti et al., ) and different genes may respond to the same selective pressure in different populations (Scheinfeldt et al., ). In this issue of Molecular Ecology, Weber et al. () use a clever comparative approach and leading-edge transcriptomic methods to identify the species and genes under positive selection for divergence between brittle stars (the echinoderm class Ophiuroidea) in the Ophioderma longicauda species complex. They found convincing evidence of positive or diversifying selection acting on two genes encoding ion channels that form part of the signal transduction cascade within the sperm in response to pheromones. Evidence for selection was concentrated in genes from one species (called C5, with internal fertilization and female parental care of brooded juveniles and not in the other species (called C3, with more conventional broadcast spawning and planktonic development of embryos and larvae). That analysis greatly extends the range of taxa, life history traits and molecules that are associated with positive selection in speciation. It also illustrates some of the current limitations on the application of RNAseq methods in the search for the targets of selection in nonmodel organisms like brittle stars. From both points of view, the new work by Weber et al. () has important implications for our understanding of speciation in the ocean.

Revitalização da Bacia do Ribeirão do Izidora: educação ambiental como estratégia / Revitalization of the Ribeirão do Izidora Basin: environmental education as a strategy

RESUMO Com a crescente urbanização e aumento da população, a fauna e a flora têm sido amplamente devastadas. Este artigo consiste em estudo descritivo, na forma relato de experiência, de um projeto de extensão da Universidade Federal de Minas Gerais (UFMG) sobre a revitalização da Bacia do Ribeirão do Izidora em Belo Horizonte. Ações intersetoriais de gestão e educação ambiental são realizadas na área de um centro de saúde e em doze escolas municipais que visam contribuir para promoção da saúde e melhoria da qualidade de vida da população assistida, dentro de uma abordagem ecossistêmica de saúde. Espera-se ampliar para outras bacias do município e fomentar a construção de planos municipais de Gerenciamento de Resíduos Sólidos Urbanos.

ABSTRACT The increase in urbanization and population, fauna and flora have been largely devastated. This article consists in a descriptive study, in the form of experience reports, of the actions developed in an UFMG (Federal University of Minas Gerais) extension project on the revitalization of the Ribeirão do Izidora Basin, in Belo Horizonte. Intersectoral actions of management and environmental education are developed and implemented in one health center and twelve municipal schools with the objective to contribute to health promotion and improvements of life quality to the assisted population, within an ecosystemic health approach. It is expected to expand to other municipal basins and encourage the construction of municipal plans of Solid Waste Management.

Hypercalcemia and renal function impairment associated with vitamin D toxicity: case report.

Nowadays vitamin D (25-OHD) deficiency is supposed to be a global epidemic condition. Expectedly, vitamin D measurement and intake exponentially increased in Brazil in this decade. Although the benefit of vitamin D to general health is still in debate, its indiscriminate use potentially may lead to enhance the incidence of vitamin D intoxication, which is considered a rare disorder. We report a case of a 70 year old diabetic male with chronic renal disease (blood creatinine of 1.6 mg/dL) who progressed suddenly to acute kidney injury (blood creatinine of 5.7 mg/dL) associated with hypercalcemia and high blood levels of vitamin D. Vitamin D and calcitriol were discontinued and hypercalcemia was managed by hydration followed by furosemide. Thereafter, disodium pamidronate was administered and the patient did not undergo on dialysis. It took approximately 14 months to normalize 25-OHD levels and blood creatinine returned to basal levels only after 24 months. The indicated labeling dosage was 2000 IU, but most likely the vitamin D manipulated preparation was higher as the vitamin D blood levels were very high. Although rare, vitamin D intoxication is becoming more frequent as the patients use frequently manipulated preparations that could be subject to errors in the manufacturing and labeling of the tablets or capsules. The present report alerts to the potential increase in the incidence of severe vitamin D intoxication due to the frequent use of this secosteroid as a nutritional supplement. At the same time, it is necessary to improve regulation on the nutrient supplement market.

Hypercalcemia and renal function impairment associated with vitamin D toxicity: case report / Hipercalcemia e prejuízo de função renal associados à intoxicação por vitamina D: relato de caso

Abstract Nowadays vitamin D (25-OHD) deficiency is supposed to be a global epidemic condition. Expectedly, vitamin D measurement and intake exponentially increased in Brazil in this decade. Although the benefit of vitamin D to general health is still in debate, its indiscriminate use potentially may lead to enhance the incidence of vitamin D intoxication, which is considered a rare disorder. We report a case of a 70 year old diabetic male with chronic renal disease (blood creatinine of 1.6 mg/dL) who progressed suddenly to acute kidney injury (blood creatinine of 5.7 mg/dL) associated with hypercalcemia and high blood levels of vitamin D. Vitamin D and calcitriol were discontinued and hypercalcemia was managed by hydration followed by furosemide. Thereafter, disodium pamidronate was administered and the patient did not undergo on dialysis. It took approximately 14 months to normalize 25-OHD levels and blood creatinine returned to basal levels only after 24 months. The indicated labeling dosage was 2000 IU, but most likely the vitamin D manipulated preparation was higher as the vitamin D blood levels were very high. Although rare, vitamin D intoxication is becoming more frequent as the patients use frequently manipulated preparations that could be subject to errors in the manufacturing and labeling of the tablets or capsules. The present report alerts to the potential increase in the incidence of severe vitamin D intoxication due to the frequent use of this secosteroid as a nutritional supplement. At the same time, it is necessary to improve regulation on the nutrient supplement market.

Resumo Atualmente, muitos brasileiros têm utilizado vitamina D (25-OHD) como suplemento vitamínico para prevenção de diversas doenças crônicas, apesar da falta de dados científicos consistentes sobre o papel deste secosteroide na prevenção de doenças que não as do metabolismo mineral. A intoxicação por vitamina D é rara, mas devido ao seu uso indiscriminado tem ocorrido com maior frequência. Nesse relato, um homem diabético de 70 anos de idade com doença renal crônica (creatinina sérica de 1,6 mg/dL) passou a fazer uso de colecalciferol e calcitriol para recomposição dos níveis de 25-OHD, que eram de 16 ng/mL. O mesmo desenvolveu quadro de lesão renal aguda (creatinina = 5,7 mg/dL), após 45 dias. Este processo emergiu em paralelo ao surgimento de hipercalcemia e níveis circulantes elevados de vitamina D. Foram suspensas a administração de vitamina D e calcitriol, a hipercalcemia foi tratada com hidratação endovenosa, seguida de diurético de alça e posteriormente pamidronato. O paciente, que havia sido encaminhado para diálise, não necessitou desse tratamento. Os níveis de 25-OHD voltaram ao normal 14 meses após a sua suspensão, e os níveis de creatinina voltaram aos patamares anteriores 24 meses após esse evento. A dose prescrita de vitamina D correspondeu a 2000 UI/dia, a qual não é considerada inadequada segundo recomendações atuais. Existe, no entanto, na literatura controvérsia quanto à sensibilidade individual à vitamina D. Não pode ser descartado o uso inapropriado pelo paciente e nem eventual erro de manipulação. Embora raro, o quadro de intoxicação por vitamina D é grave e potencialmente pode levar a complicações clínicas irreversíveis.

Oficina como um exercício de aprendizagem e de escuta colaborativa: o caso da revisão da política nacional de promoção da saúde / Workshop as an exercise of learning and collaborative listening: the case of the review of national policy of health promotion

INTRODUÇÃO: O objetivo deste artigo é apresentar o relato da Oficina Sudeste como parte do processo de revisão da Política Nacional de Promoção da Saúde (PNPS). RELATO DE EXPERIÊNCIA: Utilizou-se da análise documental dos relatórios produzidos durante o processo de revisão da PNPS, da leitura de artigos e notas de observação dos autores referentes às oficinas de sistematização e de consenso. Uma matriz da região sudeste foi construída com o intuito de reforçar o perfil regional considerando as realidades locais advindas do mundo do trabalho dos diversos atores envolvidos nas oficinas da região sudeste em seus respectivos espaços de prática e implementação de ações de promoção da saúde. A oficina regional possibilitou a participação democrática de atores locais compartilhando saberes e práticas. Ao identificar as ações locais de Promoção da Saúde, elencar os temas a serem trabalhados, por meio de eixos operativos, e, em consonância com os princípios e valores, os participantes da oficina puderam sistematizar as diretrizes que se aproximam dos determinantes e condicionantes de saúde de sua realidade. CONCLUSÃO: A metodologia desenvolvida na oficina aponta para a possibilidade de replicá-la em diferentes dimensões, nos âmbitos estadual, municipal, distrital e local,proporcionando reflexões que podem tornar viva a nova PNPS.

INTRODUCTION: The objective of this paper is to present the report of Southeast Workshop as part of the review process of National Policy of Health Promotion (PNPS). EXPERIENCE REPORT: That used the documentary analysis of the reports of the workshops in the Southeast, reading articles andobservation notes of the authors regarding the systematization workshops and consensus. A matrix of southeastern was built in order to strengthen the regional profile, when considering local realities coming from the world of work of the various actors involved in the southeastern region of workshops in their respective areas of practice and implementation of health promotion actions. The regional workshop enabled the democratic participation of local stakeholders sharing knowledge and practices. By identifying local actions forhealth promotion, list the issues to be worked through operating axes, and, in line with the principles and values, the workshop participants were able to systematize the directives that are close to the determinants and health conditions. CONCLUSION: The methodology developed in the workshop points to the possibility of replicating it in different dimensions, the state levels, municipal, district and local providing reflections to make alive the new PNPS.

Sofrimento do trabalhador contemporâneo: as estratégias de atenção psicossocial no âmbito do SUS

O Ministério da Previdência Social aponta que os transtornos mentais e comportamentais ocupam o terceiro lugar em número de concessões de auxílio-doença acidentários e não vêm acompanhando a tendência de queda no número de acidentes de trabalho no Brasil. O presente estudo busca identificar as estratégias de atenção psicossocial aos trabalhadores em situação de sofrimento empregadas pelos serviços de saúde no âmbito do SUS contemplados na produção intelectual brasileira, no período 2004-2014. Metodologicamente, recorrermos às seguintes fontes: Banco de Dissertações e Teses da Capes, produções do Ibict e da Bireme e o site SciELO. A seleção do material se fez pelos títulos, resumos e palavras chave e pela leitura na íntegra de artigos, teses, dissertações, capítulos e/ou livros. Para análise das informações obtidas, tomamos como base os estudos de Michel Foucault, Claudine Herzlich e Jurandir Freire Costa. Constatamos que as estratégias estão centradas na prevenção; na utilização do instrumento de sondagem SRQ-20; na escuta, nos cuidados clínicos e na inclusão social oferecidos pelos CAPS. Concluímos que a produção intelectual que aborda as estratégias de atenção psicossocial é precária, quando existente, e a fundamentação teórica é frágil e não contempla a especificidade do usuário na sua condição de trabalhador.

Auditoria como instrumento de gestão na atenção primária à saúde / Audit as a tool for management in the Primary Health Care

Descrever a importância da auditoria como ferramenta para gestão, planejamento, monitoramento e avaliação na Atenção Primária à Saúde (APS). Foi realizada uma revisão bibliográfica, capaz de proporcionar uma discussão sobre os conceitos relacionados ao assunto. A análise revelou que a auditoria, por se tratar de um instrumento de verificação e monitoramento da qualidade do serviço por meio do cumprimento de normas e de verificação do funcionamento adequado, pode sinalizar uma segurança adequada nos processos de trabalho. Além de cumprir um papel de análise técnica, a auditoria reorienta os processos gerenciais, regulando a assistência, promovendo a equidade no acesso aos serviços do Sistema Único de Saúde (SUS) e permitindo a oferta assistencial focada nas necessidades dos usuários.