Barriers to research in family medicine-interviews with Portuguese family physician researchers.

BACKGROUND: There is a need for a deeper understanding of the barriers to research in family medicine (FM) and to consider the perceptions and perspectives of professionals. Our study aims to provide a strategic view for research capacity building in FM. We included the perspective of family physician researchers (FPR) on the existing barriers to investigation in this context. OBJECTIVES: To understand and characterize the barriers to research in FM (personal and structural), from the perspective of Portuguese family physicians who are researchers. METHODS: A qualitative study, of phenomenological nature, was performed, through the conduction of semi-structured interviews with FPR, from 2019 to 2022. Data analysis and thematic coding were done on MAxQDA®, with inductive and deductive approaches, until data saturation was reached. RESULTS: A total of 12 family physicians/researchers were interviewed. Seven main themes were identified as barriers to research: time, professional valorization, funding, ethics committees, infrastructure, management/institutions, and participants. Each theme is divided into subthemes that make it possible to assess how a barrier can affect researchers in performing research activities. CONCLUSION: Our study highlights the identification of 7 main barriers. Structuring them into sub-themes not only improved the organization of our results but also provided robust support for the next phase, namely the application of a survey with the aim of gaining a deeper insight into the repercussions that these barriers to FPR have at a national level. This research is crucial to laying the foundations for a policy document that offers well-defined and tailored recommendations to address the barriers we have uncovered.

Strategies for the Promotion of Primary Health Care Research in Portugal: A Qualitative Study.

INTRODUCTION: There are several barriers discouraging clinicians from undertaking research, including insufficient funding, lack of time, organizational issues and lack of support. The strengthening of research capacity is perceived from three levels: characteristics of the researcher, the environment, and organizational issues. To date, Portugal is lacking studies on this subject. The aim of this study was to identify the best practices to promote research in Portuguese Primary Health Care. METHODS: We conducted a qualitative study using semi-structured interviews with family doctors with broadly recognized research work and other stakeholders. We selected a sample by convenience and snowball sampling. From a total of 14 doctors invited by email, 12 responded positively, and we subsequently included two other stakeholders. We conducted the interviews in digital or face-to-face formats. Two team members handled the coding of interviews independently. We kept all recordings and transcripts confidential, only accessible to researchers. RESULTS: We identified 16 strategies: 1) increasing institutional support; 2) creating support structures; 3) redefining the residency program; 4) investing in research training; 5) redefining curriculum evaluation; 6) establishing dedicated time for research; 7) increasing funding; 8) improving access to research data; 9) being a research driver; 10) establishing a research culture; 11) working in collaboration; 12) creating formally organized research groups; 13) creating autonomous research centers; 14) improving the definition of the research subjects and study designs; 15) reviewing procedures for ethics' committees; and 16) reviewing the current selection of articles for publication. CONCLUSION: Overall, a greater proportion of interviewees identified the following as the most relevant strategies for research promotion: institutional support, including technical and scientific support from public institutions, private entities and academic centers; the reorganization of working hours with protected time for research; increased funding directed towards research and breaking isolation in research, promoting teamwork with clinicians within the same area or from different professional backgrounds.

O planeamento da conferência familiar em cuidados paliativos: perceção dos profissionais de saúde / Family conference planning in palliative care: health professionals' perceptions

Atualmente, defrontar o fim de vida e o sofrimento, parece continuar a ser algo difícil. Os profissionais de saúde, nomeadamente os enfermeiros, devem cuidar de forma holística também na fase final de vida evitando o sofrimento. Cuidar da pessoa em fim de vida e família exige a participação ativa e competência do enfermeiro, no sentido de satisfazer as suas necessidades, privilegiando o direito de morrer com dignidade e o direito de receber bons cuidados, fundamentada no imperativo do respeito pela vida. Este relatório surge no âmbito do Estágio de Natureza Profissional, do Curso de Mestrado em Enfermagem à Pessoa em Situação Paliativa, e procura descrever de forma crítica e reflexiva todo o processo de aprendizagem e desenvolvimento de competências especializadas nesta área de intervenção em Enfermagem. Para o desenvolvimento de competências procuramos reunir o máximo de experiências e basear a prática clínica em evidência científica, envolvendo as dimensões da prestação de cuidados à pessoa e família em situação paliativa, da formação, da gestão e da investigação. Nesse sentido, o Estágio de Natureza Profissional desenrolou-se numa Unidade de Cuidados Paliativos, no qual emergiu a problemática de investigação sobre o planeamento da conferência familiar em cuidados paliativos na perceção dos profissionais de saúde. A pertinência do estudo de investigação decorreu do facto das conferências familiares em cuidados paliativos serem de extrema importância para todos os intervenientes no processo de doença, uma vez que, o planeamento da conferência familiar, surge essencialmente para a prestação de cuidados e apoio à família. Neste sentido tendo em conta o objetivo de investigação, optamos por uma scoping review, em que os resultados evidenciaram que o planeamento é fundamental para a realização das Conferências Familiares, de modo a permitir a sistematização e tratamento da informação. Os profissionais de saúde consideram como fundamental realizar a conferência familiar. Da experiência de estágio, salienta-se o desenvolvimento de competências e habilidades especializadas fundamentais para cuidar da pessoa em situação paliativa e família. Permitiu-nos ainda constatar o papel preponderante do enfermeiro especialista na formação profissional para o aprofundamento de competências, num contínuo de aprendizagem ao longo da vida, refletir sobre as práticas e sobre a importância da interação com a equipa multidisciplinar e a família. Percebemos que emerge a necessidade de oferecer a máxima qualidade à pessoa em fim de vida e família para a qual os cuidados paliativos são uma resposta mais adequada.

Currently, facing the end of life and suffering seems to continue to be something difficult. Health professionals, namely nurses, should also provide holistic care at the end-of-life stage, thus avoiding suffering. Caring for an end-of-life person and family requires the active participation and competence of nurses, in order to meet their needs, emphasising the right to die with dignity and the right to receive good care, based on the imperative respect for life. This report arises within the scope of the Professional Internship of the Master's Degree in Palliative Care Nursing and seeks to describe the entire learning process and development of specialised skills critically and reflectively in this area of Nursing intervention. In order to develop competencies, we seek to gather as many experiences as possible and base clinical practice on scientific evidence, regarding the extents of providing care to the person and family in a palliative situation, training, management, and research. On that note, the Internship of Professional Nature took place in a Palliative Care Unit, in which emerged the research issue concerning the planning of the family conference in palliative care in the perception of health professionals. The relevance of this research study was due to the fact that family conferences in palliative care are extremely important to all participants in the disease process, since family conference planning is essentially aimed at providing care and support to the family. To this effect, considering the research objective, we opted for a scoping review, upon which the results showed that planning is essential for the implementation of Family Conferences, so as to allow the systematisation and process of information. Health professionals consider it essential to hold the family conference. From the internship experience, the development of competencies and specialized skills fundamental to the palliative patient and family's care is highlighted. It has also allowed us to ascertain the preponderant role of the specialist nurse in professional training for the deepening of skills, in a lifelong learning constant, to reflect on the practices and on the importance of interaction with the multidisciplinary team and the family. We became aware that the need to offer the highest quality to the person at the end of life and the family emerges, for which palliative care is a more appropriate response.

Sensors Network as an Added Value for the Characterization of Spatial and Temporal Air Quality Patterns at the Urban Scale.

Within the scope of the Aveiro STEAM City project, an air quality monitoring network was installed in the city of Aveiro (Portugal), to evaluate the potential of sensors to characterize spatial and temporal patterns of air quality in the city. The network consists of nine sensors stations with air quality sensors (PM10, PM2.5, NO2, O3 and CO) and two meteorological stations, distributed within selected locations in the city of Aveiro. The analysis of the data was done for a one-year measurement period, from June 2020 to May 2021, using temporal profiles, statistical comparisons with reference stations and Air Quality Indexes (AQI). The analysis of sensors data indicated that air quality variability exists for all pollutants and stations. The majority of the study area is characterized by good air quality, but specific areas-associated with hotspot traffic zones-exhibit medium, poor and bad air quality more frequently. The daily patterns registered are significantly different between the affected and non-affected road traffic sites, mainly for PM and NO2 pollutants. The weekly profile, significative deltas are found between week and weekend: NO2 is reduced on the weekends at traffic sites, but PM10 is higher in specific areas during winter weekends, which is explained by residential combustion sources.

Effects of sodium valproate on the chromatin of Triatoma infestans (Klug, 1834) (Hemiptera, Reduviidae) under in vitro culture conditions.

Sodium valproate (VPA) is a classic anticonvulsive, a histone deacetylase inhibitor, and a chromatin remodeling inducer. When injected into specimens of Triatoma infestans, a vector of Chagas disease, VPA affects the chromatin supraorganization of chromocenter heterochromatin in only a few cells of the Malpighian tubules. To test whether this result was explained by the inaccessibility of all of the organ's cells to the drug, we investigated the nuclear phenotypes and global acetylation of lysine 9 in histone H3 (H3K9ac) in Malpighian tubules cultivated in vitro for 1-24 h in the presence of 0.05 mM-1 mM VPA. The present results revealed that the chromatin decondensation event in the chromocenter body, which was detected only under low VPA concentrations up to a 4-h treatment, was not frequent during organ culture, similar to the results for injected insects. Cultivation of T. infestans Malpighian tubules in vitro for 24 h revealed inadequate for cell preservation even in the absence of the drug. Immunofluorescence signals for H3K9ac following VPA treatment showed a slightly increased intensity in the euchromatin, but were never detected in the chromocenter bodies, except with great intensity at their periphery, where the 18S rDNA is located. In conclusion, when VPA affects the chromocenter heterochromatin in this animal cell model, it occurs through a pathway that excludes a classic global H3K9ac mark. Investigation of nonhistone proteins associated with histone methylation marks is still required to further explain the differential response of T. infestans chromatin to VPA.

Spatial Distribution of Heterochromatin Bodies in the Nuclei of Triatoma infestans (Klug).

Constitutive heterochromatin typically exhibits low gene density and is commonly found adjacent or close to the nuclear periphery, in contrast to transcriptionally active genes concentrated in the innermost nuclear region. In Triatoma infestans cells, conspicuous constitutive heterochromatin forms deeply stained structures named chromocenters. However, to the best of our knowledge, no information exists regarding whether these chromocenters acquire a precise topology in the cell nuclei or whether their 18S rDNA, which is important for ribosome function, faces the nuclear center preferentially. In this work, the spatial distribution of fluorescent Feulgen-stained chromocenters and the distribution of their 18S rDNA was analyzed in Malpighian tubule cells of T. infestans using confocal microscopy. The chromocenters were shown to be spatially positioned relatively close to the nuclear periphery, though not adjacent to it. The variable distance between the chromocenters and the nuclear periphery suggests mobility of these bodies within the cell nuclei. The distribution of 18S rDNA at the edge of the chromocenters was not found to face the nuclear interior exclusively. Because the genome regions containing 18S rDNA in the chromocenters also face the nuclear periphery, the proximity of the chromocenters to this nuclear region is not assumed to be associated with overall gene silencing.

Impact of harbour activities on local air quality: A review.

Several harbour activities cause negative environmental impacts in the harbours' surrounding areas, namely the degradation of air quality. This paper intends to comprehensively review the status of the air quality measured in harbour areas. The published studies show a limited number of available air quality monitoring data in harbours areas, mostly located in Europe (71%). Measured concentrations of the main air pollutants were compiled and intercompared, for different countries worldwide allowing a large spatial representativeness. The higher NO2 and PM10 concentrations were found in Europe - ranging between 12 and 107 µg/m3 and 2-50 µg/m3, respectively, while the higher concentrations of PM2.5 were found in Asia (25-70 µg/m3). In addition, the lower levels of SO2 monitored in recent years suggest that current mitigation strategies adopted across Europe were very efficient in promoting the reduction of SO2 concentrations. Part of the reviewed studies also estimated the contributions from ship emissions to PM concentration through the application of source apportionment methods, with an average of 5-15%. In some specific harbour areas in Asia, ships can contribute up to 7-26% to the local fine particulate matter concentrations. This review confirms that emissions from the maritime transport sector should be considered as a significant source of particulate matter in harbour areas, since this pollutant concentrations are frequently exceeding the established standard legal limit values. Therefore, the results from this review boost the implementation of mitigation measures, aiming to reduce, in particular, particulate matter emissions.

Assessment of source contribution to air quality in an urban area close to a harbor: Case-study in Porto, Portugal.

Several harbors, like the Port of Leixões (Porto, Portugal), are located near urban and industrial areas, places where residential urban areas, highways and the refinery industry coexist. The need for assessing the contribution of the port to the air quality in its vicinity around the port is the motivation for the present study. This contribution was investigated using a numerical modelling approach based on the web-based research screening tool C-PORT. The impact of the meteorological conditions (namely atmospheric stability and wind direction) was first evaluated, and the most critical conditions for pollutants dispersion were identified. The dominant wind direction, from WSW, was responsible for the transport of pollutants over the surrounding urban area, which was potentiated by the diurnal sea breeze circulation. Multiple scenario runs were then performed to quantify the contribution of each emission sector/activity (namely maritime emissions; port activities; road traffic and refinery) to the ambient air quality. The multiple scenario runs indicated that land-based emission sources at the Port (including trucks, railways, cargo handling equipment and bulk material stored) were the major contributors (approximately 80%) for the levels of surface PM10 concentrations over the study area. Whereas, the main drivers of NOX concentrations were docked ships, responsible for 55-73% of the total NOX concentrations.

Histone acetylation and methylation marks in chromatin of Panstrongylus megistus (Hemiptera, Reduviidae).

Panstrongylus megistus, a potential vector of Chagas disease, currently occupies a wider geographic distribution in Brazil than Triatoma infestans, another member of the hemipteran Reduviidae family and a vector of the same disease. A small heterochromatic body (chromocenter) formed by the Y chromosome is evident in the somatic cells of P. megistus, differing in size and chromosome type contribution from the well-studied chromocenters present in T. infestans. While the overall distribution of histone epigenetic marks differ when comparing the heterochromatin and euchromatin territories in T. infestans, no similar data have been established for other hemipteran reduviids, including P. megistus. In the present work, histone acetylation and methylation marks were investigated in cells of Malpighian tubules of P. megistus 5th instar nymphs using immunocytochemical assays and compared to previously published data for T. infestans. Although similarities between these species were found regarding absence of acetylated H3K9, H4K8 and H4K16, and H3K9me and H3K9me2 in the chromocenter, presence of these marks in euchromatin, and presence of H3K9me3 in the chromocenter, no intimate association of acetylated H4K8 and 18S rDNA was revealed in the chromocenter of P. megistus. The elevated abundance of H3K9me2 marks at the nuclear periphery in P. megistus cells, differing from data for T. infestans, is suggested to reflect differences in the interaction of lamina-associated chromatin domains with the nuclear lamina, methyl-transferase modulation and/or association with the last DNA endoreplication step in 5th instar nymphs, which is a matter for further investigation.

Use of noninvasive 'bug-eggs' to enable comparative inferences on genetic mating system with and without parental information: A study in a cattle egret colony.

Colonial waterbirds such as herons, egrets and spoonbills exhibit ecological characteristics that could have promoted the evolution of conspecific brood parasitism and extra-pair copulation. However, an adequate characterization of the genetic mating systems of this avian group has been hindered by the lack of samples of elusive candidate parents which precluded conducting conventional parentage allocation tests. Here, we investigate the genetic mating system of the invasive cattle egret using hematophagous insects contained in fake eggs to collect blood from incubating adults in a wild breeding colony. We tested a protocol with a previously unused Neotropical Triatominae, Panstrongylus megistus, obtained blood samples from males and females in 31 nests built on trees, drew blood from 89 nestlings at those nests, and genotyped all samples at 14 microsatellite loci, including six new species-specific loci. We comparatively addressed the performance of parentage allocation versus kinship classification of nestlings to infer the genetic mating system of cattle egrets. In line with previous behavioral observations, we found evidence in support of a non-monogamous genetic mating system, including extra-pair paternity (EPP) and conspecific brood parasitism (CBP). Parentage allocation tests detected a higher percentage of nests with alternative reproductive tactics (EPP: 61.7%; CBP: 64.5%) than the kinship classification method (EPP: 50.0%; CBP: 43.3%). Overall, these results indicate that rates of alternative reproductive tactics inferred in the absence of parental genetic information could be underestimated and should be interpreted with caution. This study highlights the importance of incorporating samples from candidate parents to adequately determine the genetic mating system of a species. We expand knowledge on the reproductive tactics of colonial waterbirds, contributing novel data on the genetic mating system of the cattle egret, valuable for the design of management strategies for this invasive bird.

Genetic characterization of residual Triatoma infestans populations from Brazil by microsatellite.

In spite of long-term efforts to eliminate Triatoma infestans (Klug 1834) from Brazil, residual foci still persist in the states of Bahia and Rio Grande do Sul. Data on the genetic variability and structuring of these populations are however lacking. Using nine microsatellite loci, we characterized one residual T. infestans population from Bahia and four from Rio Grande do Sul, and compared them with bugs originally from an older focus in São Paulo; 224 bugs were genotyped. The number of alleles per locus ranged from 5 to 11. Observed and expected heterozygosities per locus ranged, respectively, from 0 to 0.786 and from 0 to 0.764. Significant departures from Hardy-Weinberg equilibrium, mainly due to heterozygote deficits, were detected in all loci and in most populations. Global indices estimated by AMOVA were: Fis was 0.37; Fst was 0.28; and Fit was 0.55; overall indices with p = 0.00 indicated substantial differentiation. Inter-population Fst ranged from 0.118 to 0.562, suggesting strong genetic structuring and little to no gene flow among populations. Intra-population Fis ranged from 0.301 to 0.307. Inbreeding was apparent in all populations except that from Bahia-which might be either linked by gene flow to nearby unsampled populations or part of a relatively large local population. The overall pattern of strong genetic structuring among pyrethroid-susceptible residual T. infestans populations suggests that their persistence is probably due to operational control failures. Detection and elimination of such residual foci is technically feasible and must become a public health priority in Brazil.

Histone epigenetic marks in heterochromatin and euchromatin of the Chagas' disease vector, Triatoma infestans.

Triatoma infestans, a vector of Chagas' disease, shows several particular cell biology characteristics, including the presence of conspicuous heterochromatic bodies (chromocenters) where DNA methylation has not been previously detected. Whether histone modifications contribute to the condensed state of these bodies has not yet been studied. Here, we investigated epigenetic modifications of histones H3 and H4 and presence of the non-histone heterochromatin protein (HP1-α) in the chromocenters and euchromatin of T. infestans cell nuclei, using immunocytochemistry. The effect of different concentrations of the histone deacetylase inhibitors valproic acid (VPA) and sodium butyrate (NaBt) on chromocenter condensation was visually examined; in VPA-treated specimens, this effect was also analyzed by image analysis. Trimethylated H3K9 signals, which were revealed in chromocenter and non-chromocenter areas, were strongest in chromocenters, whereas selected acetylated histone marks and mono- and dimethylated H3K9 and H4K20 signals were detected only in euchromatin. Weak trimethylated H4K20 signals and variable distribution of HP1-α were detected in chromocenters of part of the cellular population analyzed. Although specific VPA and NaBt treatment conditions affected the heterochromatin condensation pattern, they did not induce a decrease in survival and molting rates of the T. infestans nymphs. The VPA-induced chromatin remodeling was not accompanied by induction of H3K9 acetylation in chromocenters. Present findings regarding histone modifications and effects following VPA or NaBt treatments did not yet solve the question of which factors are responsible for maintenance of the condensed state of chromocenters in T. infestans. A possibility requiring further investigation remains on histone methylation marks and/or non-histone proteins.

Colonization of palm trees by Rhodnius neglectus and household and invasion in an urban area, Araçatuba, São Paulo State, Brazil.

The objective of this study is to report on the colonization of palm trees by Rhodnius neglectus, its invasion in an urban area, in Araçatuba - São Paulo, and the control and surveillance measures that have been put in place. Domiciliary triatomine searches occurred in apartments upon the inhabitants' notification. The collected insects were identified and examined for natural infection and food sources with a precipitin test. To search the palm trees, tarps were used to cover the floor, and a "Munck" truck equipped with a tree-pruning device was utilized. Chemical control was performed with the utilization of a manual compression. In 2009, 81 specimens of Rhodnius neglectus were collected from the domiciles by the population. The precipitin test revealed a presence of human blood in 2.7% of the samples. Entomological studies were carried out in these domiciles and in those located within a radius of 200 meters. The search performed in the palm trees resulted in the capture of 882 specimens of triatomines, negative for tripanosomatids. Mechanical and chemical controls were carried out. New searches conducted in the palm trees in the same year resulted in the capture of six specimens. The mechanical and chemical controls of the palm trees, together with the population's work, proved to be effective, therefore preventing these insects' colonization of the city's domiciles.

Vigilância epidemiológica da doença de Chagas no estado de São Paulo no período de 2010 a 2012 / Epidemiological Surveillance of Chagas disease in the State of São Paulo, Brazil, 2010-2012

Objetivo: descrever os indicadores da vigilância epidemiológica da doença de Chagas no estado de São Paulo, Brasil. Métodos: foi realizado estudo descritivo dos indicadores entomológicos e epidemiológicos obtidos a partir das atividades desenvolvidas pela Superintendência de Controle de Endemias (Sucen) no período de 2010 a 2012. Resultados: foram realizadas 3.867 notificações de insetos, dos quais 72,0 por cento eram triatomíneos; das 2.785 notificações de triatomíneos recebidas, as pesquisas realizadas nos atendimentos resultaram no encontro do vetor em 746 domicílios; onde foram coletados 15.634 exemplares de triatomíneos, 3,4 por cento deles positivos para Trypanosoma cruzi; a espécie mais coletada foi a Triatoma sordida, predominantemente no peridomicílio; não foi constatada reação positiva para T. cruzi em qualquer das amostras de morador examinadas. Conclusão: apesar do elevado número de notificações de triatomíneos e da constatação de positividade para T. cruzi nesses vetores, não foram encontradas evidências de transmissão da doença de Chagas.

Objective: to describe epidemiological surveillance indicators of Chagas disease in the State of São Paulo, Brazil. Methods: this was a descriptive study of entomological and epidemiological indicators obtained based on activities undertaken by the Endemic Disease Control Department (SUCEN) between 2010-2012. Results: there were 3,867 notifications of insects, of which 72.0 per cent were triatomines. Of the 2,785 triatomine notifications received, the vector was subsequently found in 746 households visited, 15,634 specimens of triatomines were collected, 3.4 per cent were positive for Trypanosoma cruzi. Triatoma sordida was the most collected species and was predominantly found in housebold surroundings. Sample household residents had no positive reaction for T. cruzi. Conclusion: despite the high number of triatomine notifications and T. cruzi positive results in these vectors, no evidence was found of Chagas’ disease transmission.

COLONIZATION OF PALM TREES BY Rhodnius neglectus AND HOUSEHOLD AND INVASION IN AN URBAN AREA, ARAÇATUBA, SÃO PAULO STATE, BRAZIL / Colonização de palmeiras por Rhodnius neglectus e invasão domiciliar em área urbana, Araçatuba, São Paulo, Brasil

The objective of this study is to report on the colonization of palm trees by Rhodnius neglectus, its invasion in an urban area, in Araçatuba - São Paulo, and the control and surveillance measures that have been put in place. Domiciliary triatomine searches occurred in apartments upon the inhabitants' notification. The collected insects were identified and examined for natural infection and food sources with a precipitin test. To search the palm trees, tarps were used to cover the floor, and a “Munck” truck equipped with a tree-pruning device was utilized. Chemical control was performed with the utilization of a manual compression. In 2009, 81 specimens of Rhodnius neglectus were collected from the domiciles by the population. The precipitin test revealed a presence of human blood in 2.7% of the samples. Entomological studies were carried out in these domiciles and in those located within a radius of 200 meters. The search performed in the palm trees resulted in the capture of 882 specimens of triatomines, negative for tripanosomatids. Mechanical and chemical controls were carried out. New searches conducted in the palm trees in the same year resulted in the capture of six specimens. The mechanical and chemical controls of the palm trees, together with the population's work, proved to be effective, therefore preventing these insects' colonization of the city's domiciles.

O objetivo deste trabalho é relatar a colonização de palmeiras por Rhodnius neglectus, sua invasão em área urbana, na cidade de Araçatuba - São Paulo, o controle e as medidas de vigilância instituídas. As pesquisas de triatomíneos nos domicílios ocorreram nos apartamentos quando da notificação pelo morador. Os insetos coletados foram identificados, examinados quanto à infecção natural e teste de precipitina. Na pesquisa das palmeiras foram utilizados lonas para forração do chão e caminhão Munck equipado com moto poda. O controle químico foi realizado com a utilização de compressor manual. No ano de 2009, foram coletados pela população 81 exemplares de Rhodnius neglectus em domicílios. O teste de precipitina acusou presença de sangue humano em 2,7% das amostras. Pesquisas entomológicas foram realizadas nestas edificações e naquelas situadas em um raio de 200 metros onde ocorreram as invasões. A pesquisa realizada nas palmeiras resultou na captura de 882 exemplares de triatomíneos, negativos para tripanosomatídeos. Foi realizado controle mecânico e químico. Novas pesquisas realizadas nas palmeiras avaliadas no mesmo ano resultaram na coleta de seis exemplares. Os controles mecânicos e químicos das palmeiras aliado ao trabalho de participação popular mostraram-se factíveis impedindo a colonização destes insetos nos domicílios da cidade.

Biological and molecular characterization of a Trypanosoma cruzi isolate obtained from Panstrongylus megistus captured in Sao Paulo State, Brazil.

An isolate of Trypanosoma cruzi obtained from P. megistus captured in the peridomicile area of a home in Santo Antonio do Jardim city in the State of Sao Paulo, denominated T. cruzi Mogi, was characterized biologically and molecularly. The RFLP analysis of the D7 divergent domain in the 24Sα rDNA and of the mini-exon positioned the T. cruzi isolate within the TcI group. Phylogenetic analysis performed with the trypanosomatid barcode confirmed that the isolate belongs to the TcI group, with high homology to the 3014 c1 T.cruzi strain. The biological characterization of the isolate in rats showed a prepatent period of about 8 days, low parasitemia and tropism for cardiac, skeletal and colonic muscles. In Swiss mice the T. cruzi Mogi isolate showed a prepatent period of about 22 days, intermittent parasitemia in some animals, and tropism for cardiac and colonic muscles. Despite the inherent difficulty of identifying correlations amongst the molecular and biological characteristics of different T. cruzi groups, the tropism for colonic muscle demonstrated by T. cruzi Mogi represented a peculiarity of this isolate within the TcI group.

Aleitamento materno e excesso de peso em crianças na idade escolar / Breastfeeding and overweight in school-aged children

Objetivos: Avaliar a associação entre a duração do aleitamento materno e o risco de sobrepeso e obesidade em crianças de idade escolar.Métodos: Estudo transversal com 125 crianças entre 5 e 10 anos de idade, atendidas em um centro de saúde de Lisboa, Portugal. Foram aferidos altura e peso em consulta de rotina. As variáveis peso ao nascer, duração do aleitamento materno, estilo de vida da criança, hábitos tabágicos na gravidez, estado nutricional e escolaridade da mãe foram obtidas em questionários preenchidos pelos pais. Definiu-se sobrepeso e obesidade como índice de massa corporal igual ou superior ao percentil 85 nas tabelas do ano 2000 do Center for Disease Control and Prevention. Utilizaram-se modelos de regressão logística para avaliar a associação entre duração do aleitamento materno e risco de sobrepeso e obesidade.Resultados: A prevalência de sobrepeso e obesidade foi 23,2%. Entre as 125 crianças, 28,8% foram amamentadas durante pelo menos seis meses e 25,6% nunca foram amamentadas. Identificaram-se como fatores de risco para sobrepeso e obesidade: hábitos alimentares inadequados, exercício físico insuficiente e sobrepeso materno. Verificou-se um claro efeito dose-resposta entre a duração do aleitamento materno e o risco de sobrepeso e obesidade. Após controle das variáveis de confundimento, o aleitamento materno, durante pelo menos seis meses, apresentou um efeito protetor contra o sobrepeso e obesidade (odds ratio: 0,016; intervalo de confiança 95%: 0,001-0,67).Conclusões: Neste estudo, maior duração do aleitamento materno associou-se à diminuição do risco de sobrepeso e obesidade em idade escolar. Estes resultados realçam a importância do aleitamento materno no risco de obesidade infantil.

Aims: To analyze the association of breastfeeding and the risk of overweight and obesity in school-aged children.Methods: Cross-sectional study with 125 children, aged 5 to 10 years old, enrolled in a primary health care center in Lisbon. Height and weight were measured during routine consultation. Other variables? breastfeeding duration, birth weight, lifestyle factors, smoking habits during pregnancy, mother nutritional state and education ? were collected based on questionnaires completed by parents. Overweight and obesity were defined as body mass index equal or above the 85th percentile based on the 2000 Center for Disease Control and Prevention growth charts. Association between breastfeeding and overweight and obesity was performed using logistic regression models.Results: Prevalence of overweight and obesity was 23.2%. Among the 125 children, 28.8% were breastfed for six or more months and 25.6% were never breastfed. Inadequate diet, insufficient physical activity and mother´s overweight were identified as risk factors for children´s overweight and obesity. A doseresponse effect was identified between the duration of breastfeeding and the risk of overweight and obesity. After adjusting for confounding variables, breastfeeding for at least six months remained a significant protective factor against the development of overweight (odds ratio: 0.016; 95% confidence interval: 0.001-0.67).Conclusions: In this study, prolonged breastfeeding was associated with a reduced risk of overweight and obesity in school-aged children. These results emphasize the importance of breastfeeding on the risk of childhood obesity.

Gravidade da doença arterial coronariana e síndrome metabólica: exste associação? / Severity of coronary artery disease and metabolic syndrome: is there an association?

Fundamentos: A síndrome metabólica é um transtorno complexo representado por um conjunto de fatores de risco cardiovascular, usualmente relacionados à resistência à insulina.Objetivo: Avaliar a associação entre a síndrome metabólica e a gravidade da doença arterial coronariana. Métodos: Estudo transversal com 322 pacientes submetidos à cineangiocoronariografia eletiva. Avaliaram-se dados laboratoriais e fatores de risco para a doença arterial coronariana, assim como informações obtidas na cineangiocoronariografia. A síndrome metabólica foi identificada segundo os critérios doNCEP-ATPIII. Para a gravidade da doença arterial coronariana consideraram-se dois aspectos: o número de vasos acometidos e o grau de oclusão da artéria. Investigou-se a associação entre as variáveis estudada se a síndrome metabólica utilizando-se o teste do qui-quadrado; a determinação dos fatores de risco por meio do OR e associação com a gravidade pela regressão de Poisson. Considerou-se significativo p<0,05.Resultados: A prevalência da síndrome metabólica foi 58,07 %, sendo 59,13 % nos portadores de doença arterial coronariana, sem significado estatístico. A síndrome metabólica não se constituiu fator de risco independente para a presença de doença arterial coronariana. Tanto na avaliação do número de vasos acometidos quanto no grau de oclusão observou-se, nos pacientes com síndrome metabólica, tendência de maior gravidade, porém sem significância estatística. Na avaliação dos componentes da síndrome metabólica, apenas a hipertensão arterial se apresentou como fator de risco para doença arterial coronariana. Conclusão: Não se observou associação entre a síndrome metabólica e a gravidade da doença arterial coronariana.

Background: Metabolic syndrome is a complex disorder with a set of cardiovascular risk factors, usually related to insulin resistance.Objective: To assess the association between metabolic syndrome and the severity of coronary artery disease. Methods: Cross sectional study with 322 patients undergoing elective coronary angiography. Laboratory data and risk factors were evaluated for coronary artery disease, as well as information obtained during the angiography. Metabolic syndrome was diagnosed according to the NCEP ATPIII criteria, using two aspects to rate CAD severity: the number of vessels involved and the level of occlusion in the artery. The association between these variables and metabolic syndrome was investigated, using the chi-square test; risk factors were defined through the OR and the association with severity was measured through the Poisson regression, with p<0.05 considered as significant. Results: The prevalence of metabolic syndrome reached 58.07%, and 59.13% in patients with coronary artery disease, with no statistical difference. Metabolic syndrome was not an independent risk fact for the presence of coronary artery disease. When assessing occlusion levels and the number of vessels involved, a trend towards greater severity was notedin patients with metabolic syndrome, but with no statistical significance. Among the metabolic syndrome components, hypertension was the only risk factor for coronary artery disease. Conclusion: No association was noted between metabolic syndrome and the severity of coronary artery disease.