Long-Term Protective Effect of Tuberculosis Preventive Therapy in a Medium/High Tuberculosis Incidence Setting.

BACKGROUND: The duration of the protective effect of tuberculosis preventive therapy (TPT) is controversial. Some studies have found that the protective effect of TPT is lost after cessation of therapy among people with human immunodeficiency virus (HIV) in settings with very high tuberculosis incidence, but others have found long-term protection in low-incidence settings. METHODS: We estimated the incidence rate (IR) of new tuberculosis disease for up to 12 years after randomization to 4 months of rifampin or 9 months of isoniazid, among 991 Brazilian participants in a TPT trial in the state of Rio de Janeiro, with an incidence of 68.6/100 000 population in 2022. The adjusted hazard ratios (aHRs) of independent variables for incident tuberculosis were calculated. RESULTS: The overall tuberculosis IR was 1.7 (95% confidence interval [CI], 1.01- 2.7) per 1000 person-years (PY). The tuberculosis IR was higher among those who did not complete TPT than in those who did (2.9 [95% CI, 1.3-5.6] vs 1.1 [.4-2.3] per 1000 PY; IR ratio, 2.7 [1.0-7.2]). The tuberculosis IR was higher within 28 months after randomization (IR, 3.5 [95% CI, 1.6-6.6] vs 1.1 [.5-2.1] per 1000 PY between 28 and 143 months; IR ratio, 3.1 [1.2-8.2]). Treatment noncompletion was the only variable associated with incident tuberculosis (aHR, 3.2 [95% CI, 1.1-9.7]). CONCLUSIONS: In a mostly HIV-noninfected population, a complete course of TPT conferred long-term protection against tuberculosis.

Improving the knowledge management of marine megafauna strandings.

Although the marine megafauna often strands on beaches around the world, such as sea turtles and whales, stranding data are poorly managed and incorporated into management and conservation strategies. Here we use a knowledge value chain framework to call attention for the urgent need to improve our data architecture and knowledge management on marine megafauna strandings. We use Brazil, a continental megadiverse federative republic, as study model. After describing the main components and identifying the strengths and weaknesses of the current Brazilian data architecture, we propose 10 practical measures for its improvement involving researchers, companies, non-governmental organizations, legislators, policy makers, public agents, citizen scientists, and local communities. Although Brazil has notable strengths such as comprehensive environmental legislation, hundreds of scientists and dozens of prestigious research institutions, stranding data is not translated into technical-scientific knowledge; technical-scientific knowledge is not transformed into effective public regulations; deficient regulations lead to bad decisions and limited actions, which in turn result in ineffective management and conservation strategies. In light of the UN Decade of Ocean Science for Sustainable Development (2021-2030), we propose (1) expanding standardized beach monitoring projects to the entire Brazilian coast; (2) creating a governmental database with FAIR principles; (3) encouraging the development of broad citizen science initiatives; (4) funding scientists and research institutions; (5) boosting outreach activities among researchers to popularize the scientific knowledge; (6) raising awareness among legislators and policy makers on the problem of strandings; (7) updating the existing legal provisions on the environmental licensing of activities developed at sea; (8) hiring new environmental analysts and inspectors and improving the infrastructure of executing environmental agencies; (9) strengthening existing conservation networks with multiple stakeholders; and (10) making the results of the management and conservation strategies broadly accessible to society. These recommendations may also apply to other coastal countries around the world.

Climate change should drive mammal defaunation in tropical dry forests.

Human-induced climate change has intensified negative impacts on socioeconomic factors, the environment, and biodiversity, including changes in rainfall patterns and an increase in global average temperatures. Drylands are particularly at risk, with projections suggesting they will become hotter, drier, and less suitable for a significant portion of their species, potentially leading to mammal defaunation. We use ecological niche modelling and community ecology biodiversity metrics to examine potential geographical range shifts of non-volant mammal species in the largest Neotropical dryland, the Caatinga, and evaluate impacts of climate change on mammal assemblages. According to projections, 85% of the mammal species will lose suitable habitats, with one quarter of species projected to completely lose suitable habitats by 2060. This will result in a decrease in species richness for more than 90% of assemblages and an increase in compositional similarity to nearby assemblages (i.e., reduction in spatial beta diversity) for 70% of the assemblages. Small-sized mammals will be the most impacted and lose most of their suitable habitats, especially in highlands. The scenario is even worse in the eastern half of Caatinga where habitat destruction already prevails, compounding the threats faced by species there. While species-specific responses can vary with respect to dispersal, behavior, and energy requirements, our findings indicate that climate change can drive mammal assemblages to biotic homogenization and species loss, with drastic changes in assemblage trophic structure. For successful long-term socioenvironmental policy and conservation planning, it is critical that findings from biodiversity forecasts are considered.

Landscape-scale forest cover drives the predictability of forest regeneration across the Neotropics.

Abandonment of agricultural lands promotes the global expansion of secondary forests, which are critical for preserving biodiversity and ecosystem functions and services. Such roles largely depend, however, on two essential successional attributes, trajectory and recovery rate, which are expected to depend on landscape-scale forest cover in nonlinear ways. Using a multi-scale approach and a large vegetation dataset (843 plots, 3511 tree species) from 22 secondary forest chronosequences distributed across the Neotropics, we show that successional trajectories of woody plant species richness, stem density and basal area are less predictable in landscapes (4 km radius) with intermediate (40-60%) forest cover than in landscapes with high (greater than 60%) forest cover. This supports theory suggesting that high spatial and environmental heterogeneity in intermediately deforested landscapes can increase the variation of key ecological factors for forest recovery (e.g. seed dispersal and seedling recruitment), increasing the uncertainty of successional trajectories. Regarding the recovery rate, only species richness is positively related to forest cover in relatively small (1 km radius) landscapes. These findings highlight the importance of using a spatially explicit landscape approach in restoration initiatives and suggest that these initiatives can be more effective in more forested landscapes, especially if implemented across spatial extents of 1-4 km radius.

Strong floristic distinctiveness across Neotropical successional forests.

Forests that regrow naturally on abandoned fields are important for restoring biodiversity and ecosystem services, but can they also preserve the distinct regional tree floras? Using the floristic composition of 1215 early successional forests (≤20 years) in 75 human-modified landscapes across the Neotropic realm, we identified 14 distinct floristic groups, with a between-group dissimilarity of 0.97. Floristic groups were associated with location, bioregions, soil pH, temperature seasonality, and water availability. Hence, there is large continental-scale variation in the species composition of early successional forests, which is mainly associated with biogeographic and environmental factors but not with human disturbance indicators. This floristic distinctiveness is partially driven by regionally restricted species belonging to widespread genera. Early secondary forests contribute therefore to restoring and conserving the distinctiveness of bioregions across the Neotropical realm, and forest restoration initiatives should use local species to assure that these distinct floras are maintained.

Does genome size increase with water depth in marine fishes?

A growing body of research suggests that genome size in animals can be affected by ecological factors. Half a century ago, Ebeling et al. proposed that genome size increases with depth in some teleost fish groups and discussed a number of biological mechanisms that may explain this pattern (e.g., passive accumulation, adaptive acclimation). Using phylogenetic comparative approaches, we revisit this hypothesis based on genome size and ecological data from up to 708 marine fish species in combination with a set of large-scale phylogenies, including a newly inferred tree. We also conduct modeling approaches of trait evolution and implement a variety of regression analyses to assess the relationship between genome size and depth. Our reanalysis of Ebeling et al.'s dataset shows a weak association between these variables, but the overall pattern in their data is driven by a single clade. Although new analyses based on our "all-species" dataset resulted in positive correlations, providing some evidence that genome size evolves as a function of depth, only one subclade consistently yielded statistically significant correlations. By contrast, negative correlations are rare and nonsignificant. All in all, we find modest evidence for an increase in genome size along the depth axis in marine fishes. We discuss some mechanistic explanations for the observed trends.

Cost-Utility Analysis of Eculizumab for the Treatment of Paroxysmal Nocturnal Hemoglobinuria From the Perspective of the Brazilian Public Health System.

OBJECTIVE: To perform a first cost-utility analysis of eculizumab for the treatment of paroxysmal nocturnal hemoglobinuria from the perspective of the Brazilian Unified Health System. METHODS: A Markov decision model was developed for 35-year-old patients with symptomatic paroxysmal nocturnal hemoglobinuria. We used a cycle length of one month and a time horizon of 20 years. The effectiveness measure was the quality-adjusted life year (QALY). Data were extracted from clinical trials, historical cohorts, and Unified Health System databases. Resource use and costs were estimated from the perspective of the Unified Health System. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: The estimated gain in effectiveness with the use of eculizumab was 1.08 QALY through the incremental cost of R$10,959,375.95. The incremental cost-effectiveness ratio was R$10,139,542.84 per QALY, being 331.92 times greater than the Brazilian gross domestic product per capita. In the deterministic sensitivity analysis, the parameters related to the utilities of health states were associated with greater impact in the model. The results of the probabilistic sensitivity analysis with 1000 simulations evidence that 100% of the simulations were not considered cost-effective with the arbitrated willingness to pay R$30,548.40 and R$91,645.20 per QALY. CONCLUSIONS: The gain in effectiveness with the use of eculizumab was modest, associated with an unjustifiable incremental cost. Therefore, eculizumab is not a cost-effective drug compared with the current standard of care in the treatment of paroxysmal nocturnal hemoglobinuria from the Brazilian Unified Health System perspective.

EQ-5D Brazilian population norms.

BACKGROUND: The EQ-5D-3L is a widely used generic health-related quality of life measure commonly applied to describe health outcomes and to measure disease burden. The aim of this study was to generate Brazilian population norms, stratified by age and gender, based on Brazilian preference weights for EQ-5D-3L. METHODS: A multicenter cross-sectional study was conducted in three Brazilian urban areas. The final sample consisted of 5774 respondents, aged from 18 to 64 years. Amongst other information, respondents were asked to self-report their health status using the EQ-5D-3L descriptive system and visual analog scale (EQ-VAS). Data on socio-demographic characteristics was obtained through specific questionnaires. The Brazilian TTO scoring algorithm was used to derive the utility values. Multivariate logistic regression models were fitted to analyze the influence of age, sex, education status and sample site on the presence of any problem for each dimension of EQ5D. RESULTS: Mean values were computed for both weighted index scores and self-rated health status (EQ-VAS), and stratified by gender and age groups. Health status declines with age, ranging between 0.87 for the youngest group 18-29 year-olds and 0.76 for 60-64-year-old. Men reported higher scores (0.85) than the woman (0.79). Lower education levels were associated with lower EQ-5D index score in most age groups. CONCLUSION: This study provides EQ-5D reference values for the Brazilian population. These values can be used by local decision-makers and researchers in economic evaluations and population health studies.

Deep reefs are not refugium for shallow-water fish communities in the southwestern Atlantic.

The deep reef refugia hypothesis (DRRH) predicts that deep reef ecosystems may act as refugium for the biota of disturbed shallow waters. Because deep reefs are among the most understudied habitats on Earth, formal tests of the DRRH remain scarce. If the DRRH is valid at the community level, the diversity of species, functions, and lineages of fish communities of shallow reefs should be encapsulated in deep reefs.We tested the DRRH by assessing the taxonomic, functional, and phylogenetic diversity of 22 Brazilian fish communities between 2 and 62 m depth. We partitioned the gamma diversity of shallow (<30 m) and deep reefs (>30 m) into independent alpha and beta components, accounted for species' abundance, and assessed whether beta patterns were mostly driven by spatial turnover or nestedness.We recorded 3,821 fishes belonging to 85 species and 36 families. Contrary to DRRH expectations, only 48% of the species occurred in both shallow and deep reefs. Alpha diversity of rare species was higher in deep reefs as expected, but alpha diversity of typical and dominant species did not vary with depth. Alpha functional diversity was higher in deep reefs only for rare and typical species, but not for dominant species. Alpha phylogenetic diversity was consistently higher in deep reefs, supporting DRRH expectations.Profiles of taxonomic, functional, and phylogenetic beta diversity indicated that deep reefs were not more heterogeneous than shallow reefs, contradicting expectations of biotic homogenization near sea surface. Furthermore, pairwise beta-diversity analyses revealed that the patterns were mostly driven by spatial turnover rather than nestedness at any depth. Conclusions. Although some results support the DRRH, most indicate that the shallow-water reef fish diversity is not fully encapsulated in deep reefs. Every reef contributes significantly to the regional diversity and must be managed and protected accordingly.

Characterization of occupational accidents occurred at the Occupational Health Referral Center of the state of Amapá between 2007 and 2016.

INTRODUCTION: Occupational accidents involving biological material have consequences that range from physical damage to public expenses. The study of this topic may help evaluate conducts and form preventive measures. OBJECTIVES: To characterize the notifications of occupational accidents involving biological material that occurred between 2007 and 2016 in the state of Amapá, Brazil. METHODS: This is an observational, retrospective, and descriptive study with a data analysis that quantified occupational accidents with biological material reported between January 2007 and December 2016 and analyzed the most prevalent risk factors. RESULTS: Data were obtained from the Occupational Health Reference Center of the state of Amapá: 938 cases of occupational accidents with biological material were reported in the studied period. The main type of exposure was percutaneous (75.8%), the most common organic material was blood (68.4%), and the main causative agent was the hollow-bore needle (58.6%). Considering the reported cases, 80.8% of 745 individuals were vaccinated against hepatitis B and 2.4% of 252 individuals had positive anti-HIV. Regarding the clinical progression of the injured workers, in 91.9% of the cases these data were unknown or not recorded, and 47.4% of the patients who provided this information were discharged with no serological conversion. CONCLUSIONS: The main causes of occupational accidents were related to the use of sharps for intravenous drug administration and the inadequate disposal of this material, highlighting the need for stronger attention when performing these procedures. The high incidence of unknown/blank data hampered the correct serological follow-up of the patients and the epidemiological characterization of the accidents.

Preserving 40% forest cover is a valuable and well-supported conservation guideline: reply to Banks-Leite et al.

Banks-Leite et al. (2021) claim that our suggestion of preserving ≥ 40% forest cover lacks evidence and can be problematic. We find these claims unfounded, and discuss why conservation planning urgently requires valuable, well-supported and feasible general guidelines like the 40% criterion. Using region-specific thresholds worldwide is unfeasible and potentially harmful.

Why do mesophotic coral ecosystems have to be protected?

Mesophotic coral ecosystems (MCEs; ~30-150 m depth) are among the most biologically diverse and least protected ecosystems in the world's oceans. However, discussions regarding the conservation of these unique ecosystems are scarce. To address this issue, we identified the features of MCEs that demonstrate they should be considered as a global conservation priority. Some MCEs are characterized by their well-preserved and unique seascapes; their narrow environmental tolerance and high vulnerability to anthropogenic effects; and their slow recovery and reduced reproductive performance. The unique biodiversity of MCEs includes depth-adapted specialist species and new species, most of which are threatened or important fishery resources. MCEs also provide refuge against human stressors, valuable ecosystem services, and ecological connectivity. MCEs generally meet the criteria to be classified as Ecologically and Biologically Significant Marine Areas under the Convention on Biological Diversity. However, we highlight that many MCEs worldwide are threatened and not yet adequately protected by fishery regulations, marine protected areas, or considered in marine spatial planning. Establishing MCEs as a global conservation priority requires the designation of national, international, transnational, public, and private policies.

Designing optimal human-modified landscapes for forest biodiversity conservation.

Agriculture and development transform forest ecosystems to human-modified landscapes. Decades of research in ecology have generated myriad concepts for the appropriate management of these landscapes. Yet, these concepts are often contradictory and apply at different spatial scales, making the design of biodiversity-friendly landscapes challenging. Here, we combine concepts with empirical support to design optimal landscape scenarios for forest-dwelling species. The supported concepts indicate that appropriately sized landscapes should contain ≥ 40% forest cover, although higher percentages are likely needed in the tropics. Forest cover should be configured with c. 10% in a very large forest patch, and the remaining 30% in many evenly dispersed smaller patches and semi-natural treed elements (e.g. vegetation corridors). Importantly, the patches should be embedded in a high-quality matrix. The proposed landscape scenarios represent an optimal compromise between delivery of goods and services to humans and preserving most forest wildlife, and can therefore guide forest preservation and restoration strategies.

Exploring the predictors of health valuations of EQ 5D 3L with a mixed-effects linear model.

BACKGROUND: Information about how individual characteristics influence preferences about health states valuation are scare. The purpose of this study is to identify predictors of the EuroQol with five dimensions and 3 levels - EQ 5D-3L time-tradeoff valuation. RESEARCH DESIGN AND METHODS: We analyzed a dataset with a probabilistic sample of 5774 individuals. Two sets of independent variables for testing were defined: a set of forced variables composed of 10 dummy variables for EuroQol levels 2 and 3 of each health dimension and a set of demographic variables. RESULTS: The strongest predictors of health valuation were the self-reported health state and the 'belief in God,' with 0.11 utility units for each VAS unit and 0.11 utility units for 'yes' for the 'belief in God' parameter.Age had an impact of 0.0190 utility units for each 10-year interval. Having children had a small effect (0.0338 utility units for 'yes'), and the other characteristics studied had no significant impact. CONCLUSIONS: People who believe in God (or the afterlife) and those of greater age seem to be less prone to forgoing life years to avoid health problems. In our sample, older individuals valued health state higher than younger individuals.

Cutoff values for HOMA-IR associated with metabolic syndrome in the Study of Cardiovascular Risk in Adolescents (ERICA Study).

OBJECTIVE: The aim of this study was to determine the distribution of homeostatic model assessment of insulin resistance (HOMA-IR) values and define its cutoff associated with metabolic syndrome (MetS) in the participants of the Study of Cardiovascular Risk in Adolescents (Estudo de Risco Cardiovascular em Adolescentes). METHODS: MetS was defined according to the International Diabetes Federation criteria. HOMA-IR values were calculated and tabulated by corresponding percentiles for age and sex. Receiver operating characteristic curves were constructed to identify the optimal cutoff values of HOMA-IR associated with MetS in the total population and by sex. RESULTS: We evaluated 37 815 adolescents ages 12 to 17 y. The highest HOMA-IR medians were found among girls and boys ages 12 and 14 y, respectively. Thereafter, values tended to decrease with age. The optimal cutoff values of the HOMA-IR associated with MetS in the total population, in female adolescents, and in male adolescents were 2.80, 2.32, and 2.87, respectively. Insulin resistance was prevalent in 19.1% (95% confidence interval, 17.7-20.7) of the total population, and the prevalence was higher among girls and overweight Brazilian adolescents. CONCLUSIONS: These findings may serve as new reference points for detecting insulin resistance in Brazilian adolescents.

Species sorting and mass effect along forest succession: Evidence from taxonomic, functional, and phylogenetic diversity of amphibian communities.

Species recovery after forest disturbance is a highly studied topic in the tropics, but considerable debate remains on the role of secondary forests as biodiversity repositories, especially regarding the functional and phylogenetic dimensions of biodiversity. Also, studies generally overlook how alpha and beta diversities interact to produce gamma diversity along successional gradients.We used a metacommunity approach to assess how species sorting (i.e., environmental filtering) and mass effect (i.e., source-sink dynamics) affect 14 complementary metrics of amphibian taxonomic, functional, and phylogenetic diversity along a successional gradient in southern Mexico. As amphibians have narrow environmental tolerances and low dispersal capabilities, we expected that species sorting may be relatively more important than mass effect in structuring amphibian communities.Between 2010 and 2012, we sampled frogs, salamanders, and caecilians in 23 communities distributed in four successional stages: young (2-5 years old) and intermediate (13-28 years old) secondary forests, old-growth forest fragments, and old-growth continuous forest. We assessed 15 ecologically relevant functional traits per species and used a time-calibrated molecular phylogeny.We recorded 1,672 individuals belonging to 30 species and 11 families. Supporting our expectations from the species sorting perspective, from the poorest (younger forests) to the best quality (continuous forest) scenarios, we observed (a) an increase in alpha diversity regardless of species abundances; (b) a clear taxonomic segregation across successional stages; (c) an increase in functional richness and dispersion; (d) an increase in mean phylogenetic distance and nearest taxon index; and (e) a reduction in mean nearest taxon distance. However, 10 species occurred in all successional stages, resulting in relatively low beta diversity. This supports a mass effect, where interpatch migrations contribute to prevent local extinctions and increase compositional similarity at the regional scale.Our findings indicate that amphibian metacommunities along forest successional gradients are mainly structured by species sorting, but mass effects may also play a role if high levels of forest cover are conserved in the region. In fact, secondary forests and forest fragments can potentially safeguard different aspects of amphibian diversity, but their long-term conservation value requires preventing additional deforestation.

Phytopharmacovigilance in the Elderly: Highlights from the Brazilian Amazon.

Practices described as traditional medicine may coexist with formalized, science-based medicine. In this context, the present study aimed to verify the profile of the elderly who consumed herbal medicines concomitantly with medications and to identify suspected adverse drug reactions (ADRs) in the Brazilian Amazon (Macapá, Amapá). The study was carried out in two steps: a cross-sectional study (structured questionnaire) and a clinical study (pharmacotherapeutic follow-up). Out of 208 participants, 78.8% were female with age between 60 and 69 years (58.7%), 59.1% used herbal medicines concurrently with medications, and 40.9% did not report use of herbal medicine. Losartan was the most used medication, and Lippia alba (Mill.) N.E. Br was the most common herbal medicine used. The total prevalence of suspected ADRs, among the elderly who answered the structured questionnaire, was 41.3%, with 27.4% being in the elderly who used herbal medicines and medications, and 13.9% being in the elderly who used only medications. Meanwhile, the total prevalence of suspected ADRs was 71.0% among the elderly patients who underwent pharmacotherapeutic follow-up, 60.5% in elderly who used herbal medicines and medications, and 10.5% in elderly who used only medications. The most reported ADR symptoms were related to disorders that affect the nervous system (38.4%) in the structured questionnaire and related to digestive disorders (36.4%) in the pharmacotherapeutic follow-up. The probability associated with the occurrence of a given ADR in the face of a set of demographic, socioeconomic, and clinical variables was estimated; the results showed that, in the studied population, only sex (p = 0.030) had an influence on the occurrence of ADR. The prevalence of ADRs with probable causality was high in this study population, but it was only sex-related, although more prevalent in the elderly who consume herbal medicines.

Socioeconomic differences among resident, users and neighbour populations of a protected area in the Brazilian dry forest.

Protected areas are an important strategy to safeguard biodiversity. However, if social development is not considered, biological conservation targets may not be achieved. In this empirical study, we assess the relationship between poverty and conservation goals in dry forests within a 62,000-ha Brazilian National Park (Caatinga biome). We conducted 81 structured household interviews between January and July of 2016 to assess socioeconomic, resource management and land-use variables. We used non-parametric analysis of variance to test for differences in socioecological variables among families living inside and outside the Park and both (double dwelling). The majority of families (76%) residing inside the Park were living below the poverty line while less than 14% in outside and double dwelling residences faced the same issue. Families living inside the park had lower socioeconomic conditions such as limited water availability, poor house infrastructure, low income, and high dependence on firewood than outside and double dwelling families. They were also more dependent on external financial support and natural resources. We found that failures in protected areas inception and implementation have driven people towards a mutually reinforcing and declining situation in which negative socioeconomic outcomes are associated with nature degradation. Therefore, our results suggest that the future of dry forests, characterized worldwide by the presence of low-income populations, will be largely dependent on conservation strategies that address poverty alleviation and human well-being.

Films as an Educational Resource in the Teaching of Humanistic Attitudes to Medicine Students / O Cinema como Recurso Educacional no Ensino de Atitudes Humanísticas a Estudantes de Medicina

ABSTRACT Introduction Contemporary medical education prioritizes the development of scientific knowledge and technical skills, associated with professional attitudes. Attitudes are components of affective ability and influence medical practice, so they should be taught systematically during undergraduate training. The use of films as a pedagogical resource in medical training allows reflection on the biopsychosocial context in which the patient is inserted, contributing to the development of humanistic attitudes among students and future physicians. Objective To evaluate the effectiveness of cinema as an educational resource in teaching humanistic attitudes to medical students. Material and Methods A cross-sectional, quasi-experimental, qualitative and quantitative study was carried out with 107 students from the first to sixth year of the medical course of the Federal University of Amapá. The Medical Students Attitude Scale (validated by the author Maria de Fátima Colares, 2002) was used before and after the exhibition of films related to relevant themes in the medical area. This psychometric scale is composed of multiple-choice Likert-type responses and aims to assess the attitudes of medical students regarding the following factors: primary health care; psychological and emotional aspects involved in diseases; ethical aspects in professional practice; mental illness, death-related situations; scientific research. The Wilcoxon Rank Test was used to compare data from paired samples. Results All the factors evaluated by the medical students attitudes scale related to relevant aspects of medical practice showed a significant increase in the frequency of positive attitudes (p < 0.05) among the first- to fourth-year students following the cinema sessions. The fifth- and sixth-year students did not present significant changes in attitudes related to death, mental illness and contribution to the scientific advancement of medicine. Conclusion Cinema is an effective pedagogical tool in teaching humanistic attitudes in the preclinical series of the medical course.

RESUMO Introdução A educação médica contemporânea prioriza o desenvolvimento de conhecimento científico e habilidades técnicas, associados a atitudes profissionais. Atitudes são componentes da habilidade afetiva e influenciam a prática médica, por isso devem ser ensinadas sistematicamente durante a graduação. A utilização de filmes como recurso pedagógico na graduação médica possibilita uma reflexão no contexto biopsicossocial em que o paciente está inserido, contribuindo para desenvolver atitudes humanísticas entre estudantes de Medicina e futuros médicos. Objetivo Avaliar a eficácia do cinema como recurso educacional no ensino de atitudes humanísticas aos discentes do curso de Medicina. Material e Métodos Foi realizado um estudo transversal, exploratório, quantitativo, com 107 estudantes do primeiro ao sexto ano do curso de Medicina da Universidade Federal do Amapá. Foi utilizada a Escala de Atitude de Estudantes de Medicina (validada por Colares et al.1 ) antes e depois da exibição de filmes relacionados a temáticas relevantes na área médica. Esta escala psicométrica é composta de respostas de múltipla escolha do tipo Likert e visa aferir atitudes de estudantes de Medicina em relação aos seguintes fatores: assistência primária à saúde; aspectos psicológicos e emocionais envolvidos nas doenças; aspectos éticos no exercício profissional; doença mental, situações relacionadas à morte; pesquisa científica. Foi empregado o Teste de Wilcoxon (Wilcoxon Rank Test) para comparar dados de amostras pareadas. Resultados Todos os fatores avaliados pela escala de atitudes dos estudantes de Medicina frente a aspectos relevantes da prática médica apresentaram aumento significativo na frequência de atitudes positivas (p < 0,05) após as sessões de cinema entre os alunos do primeiro ao quarto ano da graduação. Os alunos do quinto e sexto ano não apresentaram mudança significativa de atitudes nos fatores relacionados à morte, à doença mental e à contribuição com o avanço científico da medicina. Conclusão O cinema é uma ferramenta pedagógica eficaz no ensino de atitudes humanísticas a estudantes do curso médico.

Perfil epidemiológico dos principais tumores sólidos em uma unidade de alta complexidade em oncologia no estado da Amazônia legal / Epidemiological profile of the main solid tumors in a high complexity unit in oncology in a state of the legal Amazon

Objetivo: Descrever o perfil epidemiológico dos tumores sólidos mais prevalentes em uma unidade de assistência de alta com-plexidade em oncologia em um estado da Amazônia Legal e correlacionar com os dados nacionais. Metodologia: Pesquisa descritiva, transversal e com análise quantitativa, da qual foram amostrados 1568 pacientes atendidos no período de janeiro de 2013 a dezembro de 2017, coletadas variáveis de data nasci-mento, raça/cor, sexo, cidade/estado, data da biópsia, data do óbito e CID-10/diagnóstico. Os dados foram analisados através do teste não paramétrico Qui-quadrado (X2) com 5% de proba-bilidade de erro e variáveis com valor de P estatístico menor que 0,05 foram consideradas estatisticamente significativas. Resultados: Dos principais tumores sólidos, 56% foram do sexo feminino; a faixa etária mais prevalente para ambos os sexos foi de 50 a 59 anos, de maioria proveniente da capital (67,15%). Apenas 8,03% dos pacientes foram a óbito. O câncer de colo de útero foi o mais prevalente com 19,57% e idades entre 40 a 49 anos (24,62%) as mais frequentes para este câncer. Demons-trou-se que o perfil epidemiológico se enquadrou no aguardado para uma cidade da região Norte brasileira, caracterizada por padrões populacionais de baixa renda. Conclusão: Os dados obtidos por meio deste estudo permitiram traçar o perfil epide-miológico de pessoas com câncer atendidas em uma unidade de alta complexidade em oncologia do Amapá, evidenciando disparidades características encontradas na região Norte, em detrimento das outras regiões brasileiras. (AU)

Objective: To describe the epidemiological profile of the most prevalent solid tumors in a high complexity care unit in oncol-ogy in a state of the Legal Amazon and to correlate it with the national data. Methods: Descriptive and cross-sectional survey with quantitative analysis, from 1568 patients which were treated from January 2013 to December 2017, collected variables of birth date, race/color, sex, city / state, date of biopsy, date of death and ICD-10/diagnosis. The data was analyzed using the non-parametric Chi-square test (X2) with 5% of error probability and variables with a statistical P value of less than 0.05 were considered statistically significant. Results: Out of the main solid tumors, 56% were female; the most prevalent age group for both sexes was between 50 and 59 years old, with the majority coming from the capital (67.15%). Only 8.03% of the patients died. Cervical cancer was the most prevalent with 19.57% and ages between 40 to 49 years (24.62%) were more frequent for this cancer. It was demonstrated that the epidemiological profile was expected for a city in the North Brazilian region, characterized by low-income population patterns. Conclusion:The data obtained through this study allowed us to trace the epidemiological profile of people with cancer treated in a high complexity unit in oncology of Amapá, highlighting the charac-teristic disparities found in the Northern region, in detriment of other Brazilian regions. (AU)