Applicability of 'Toolkit for Safety Assessment' tool to interventional radiology using probabilistic risk assessment techniques.

Interventional radiology brings extensive benefits to patients. Nevertheless, certain procedures may result in high doses of radiation, leading to health risks to occupationally exposed individuals (OEIs). Therefore, a more comprehensive risk analysis is essential to ensuring safety and minimising radiation exposures for all OEIs. The Toolkit for Safety Assessment (TOKSA) tool performs risk assessments based on the concepts described in 'General Safety Requirements' Part 3 (Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards) and Part 4 (Safety Assessment for Facilities and Activities). This tool was developed based on the 'Ibero-American Forum of Radiological and Nuclear Regulatory Agencies' risk models and can promote the use of the risk assessment processes by OEIs. The aim of this study was to experimentally analyse the applicability of the TOKSA tool in interventional radiology with the use/support of probabilistic risk assessment techniques. The results were used to reduce the risks associated with a hemodynamics room in a hospital in Belo Horizonte, Brazil.

Th17/Regulatory T cells ratio evolution: A prospective study in a group of healthy pregnant women.

During pregnancy, the maternal immune system is challenged to tolerate a semi-allogenic fetus. A shift toward a tolerogenic profile is essential to ensure a healthy fetal and placental development. One of the most important mechanisms involved in the maternal immune tolerance towards the fetal antigens is expressed in the activity of the regulatory T (Treg) and Th17 cells. The behavior and equilibrium of these two T lymphocyte populations were rarely studied in normal healthy pregnancies through the beginning of gestation to the postpartum period. We conducted a prospective longitudinal observational study where peripheral blood lymphocyte subsets were analyzed in each trimester of pregnancy and postpartum period in a group of healthy pregnant women. Our study observed a consistent reduction in peripheric Treg cell count through all pregnancy while the Th17 cell count remained stable. The Th17/Treg ratio increases significantly throughout pregnancy to the postpartum period. These changes could be justified by the migration of the immunotolerant Treg cells to the maternal decidua and lead to the establishment of a systemic pro-inflammatory profile by the end of pregnancy. This data could explain why systemic syndromes like preeclampsia develop in susceptible women during the second half of pregnancy or why many autoimmune disorders flourish in the first weeks postpartum.

Antibiotic consumption in developing countries defies global commitments: an overview on Brazilian growth in consumption.

Faster spread of epidemics has turned local concerns into global crises; antimicrobial resistance (AMR) is being considered a major threat to public health in the twenty-first century. Antibiotic misuse plays a great role in accelerated AMR; thus, understanding and discussing consumption patterns has been a trend topic over the past years. Developing countries, such as Brazil, have high growth rates in antibiotic consumption, potentially impacting global environmental safety. This study presents the compiled information from the Brazilian Health Regulatory Agency (ANVISA) on antibiotic dispensation across the country and maps the consumption trends between the years of 2013 and 2016. The most consumed substances were beta-lactams (amoxicillin and cephalexin) and macrolides (azithromycin). National relative growth consumption in the mentioned period was 18%. At the local level, growth of consumption ranged from 4 to 85%, with rampage growth concentrated in the North and Northeast regions. Brazilian laws, such as restriction of over-the-counter sales and mandatory report on dispensation, seem to have little effect on the national antibiotic consumption growth. This phenomenon growth is still elevated if compared with developed countries, demonstrating the need for further surveillance as well as coordinated efforts aiming at antibiotic use and AMR prevention.

Children's perceptions regarding functional limitations due to oral problems.

AIM: To evaluate factors associated with difficulty eating and speaking due to oral problems according to the reports of children. METHODS: A cross-sectional study was conducted with 769 5-year-old children at preschools in a city in northeast Brazil. Parents/caretakers answered a questionnaire addressing socio-demographic data and a history of dental pain. The children answered the scale of oral health outcomes for 5-year-old children, which was used to evaluate the dependent variables. Clinical examinations of the children were performed by examiners who had undergone calibration exercises. Data analysis involved descriptive statistics and Poisson regression analysis (α = 5%). RESULTS: The prevalence of the perception of functional limitations on the part of the children was 35.5% for difficulty eating and 22.9% for difficulty speaking. Difficulty eating was associated with a history of dental pain (PR = 1.68; 95% CI 1.27-2.22) and the occurrence of traumatic dental injury (TDI) (PR = 1.23; 95% CI 1.01-1.52). Difficulty speaking due to oral problems was associated with studying at a public preschool (PR = 1.71; 95% CI 1.19-2.46), a history of dental pain (PR = 1.54; 95% CI 1.07-2.20), and the occurrence of TDI (PR = 1.52; 95% CI 1.12-2.06). CONCLUSIONS: Pain symptoms and the occurrence of TDI can exert an influence on the development of functional limitations. With regard to socioeconomic factors, studying at a public preschool can influence difficulty speaking in children.

Self-Perceptions of the Impact of Oral Problems on the Social Behavior of Preschoolers.

INTRODUCTION: Investigating preschool children's social behaviors and the association with oral health variables helps to understand child development. Besides that, different perceptions need to be explored regarding the impact of oral problems on the social behavior between the child's self-report and parent's/caregiver's proxy report. OBJECTIVE: To determine which socioeconomic and oral factors are associated with difficulty sleeping and playing and the avoidance of smiling in preschoolers. METHODS: A cross-sectional study was conducted with a representative random sample of 769 pairs of parents/caregivers and 5-y-old preschoolers. The preschoolers answered a questionnaire on difficulty sleeping, difficulty playing, and the avoidance of smiling for reasons related to oral problems. The parents/caregivers answered a questionnaire addressing socioeconomic characteristics as well as the use of dental services. Two calibrated dentists examined the children for the determination of dental caries, traumatic dental injury (TDI), malocclusion, and bruxism. Descriptive and Poisson regression analysis for complex samples with robust variance was used to test the associations (α = 5%). RESULTS: The variables associated with difficulty sleeping were low household income (confidence interval [CI]: 1.40-3.01), number of untreated dental caries (CI, 1.02-1.04), dental pain (CI, 1.76-3.59), TDI (CI, 1.08-2.11), and anterior open bite (CI, 1.11-2.20). Difficulty playing also was associated with the low household income (CI, 1.34-3.15), number of untreated dental caries (CI, 1.01-1.04), dental pain (CI,1.42-3.61), and TDI (CI, 1.13-2.33). The number of untreated dental caries (CI, 1.02-1.05), dental pain (CI, 1.03-2.88), anterior open bite (CI, 1.30-3.26), and not using dental services (CI, 1.13-2.73) were determinant factors for the avoidance of smiling. CONCLUSION: Socioeconomic, symptomatic, and/or oral esthetic problems exerted an impact on the social behavior of the preschoolers analyzed, such as playing, sleeping, and smiling. KNOWLEDGE TRANSFER STATEMENT: The results of the present study may help parents and clinicians to understand better the association of oral problems with the social behavior of preschool children. Moreover, this study shows the importance of listening to children in clinical decisions. These results also can help in the elaboration of oral health policies.

Development of a Patient-specific Guide for High Cervical Spine Fixation.

OBJECTIVE: High cervical spine fixation represents a challenge for spine surgeons due to the complex anatomy and the risks of vascular and medullar injury. The recent advances in 3-D printing have unfolded a whole new range of options for these surgeons. METHODS: In the present study, a guide for the placement of the lateral mass screw in the C1 vertebra was developed using 3-D printing. Eight real-size models of the high cervical spine and their respective screw guides were built using computed tomography (CT) scan images. The guidewires were inserted with the help of the printed guides and then the models were analyzed with the help of CT scan images. RESULTS: All of the guidewires in the present study obtained a safe placement in the models, avoiding the superior and inferior articular surfaces, the vertebral foramen, and the vertebral artery. CONCLUSION: The present study demonstrated the efficiency of the guide, a reliable tool for aiding the insertion of guidewires for screws in lateral masses of the C1.

Intraspecific Cuticular Chemical Profile Variation in the Social Wasp Mischocyttarus consimilis (Hymenoptera, Vespidae).

Chemical compounds present on the cuticle of social insects are important in communication, as they are used in recognition of nestmates and sexual partners as well as in caste distinction, varying according to several factors, such as genetic and environmental. In this context, some studies have explored the cuticular chemical profile as a tool for assessing intra- and interspecific differences in social insects, although few studies have investigated this in social wasps. This study aimed to assess the differences in cuticular chemical profiles among different geographic samples of the wasp Mischocyttarus consimilis Zikán. Our hypothesis was that environmental factors are decisive to compose the cuticular chemical profiles of colonies of these social wasps and that there are differences regarding the geographic distribution among colonies. We used Fourier Transform Infrared-Photoacoustic Spectroscopy (FTIR-PAS) to assess the chemical profiles of samples. Our results show that despite there are differences between the cuticular chemical composition of the wasps' samples from different populations, there is no significant correlation compared to the spatial distribution of the colonies nor with the environment. Thus, our hypothesis was refuted, and we can infer that in this species neither exogenous nor genetic factors stand out to differentiate the chemical signature of their colonies, but a combination of both.

Development of a Patient-specific Guide for High Cervical Spine Fixation / Desenvolvimento de um guia paciente-específico para fixação de coluna cervical alta

Abstract Objective High cervical spine fixation represents a challenge for spine surgeons due to the complex anatomy and the risks of vascular and medullar injury. The recent advances in 3-D printing have unfolded a whole new range of options for these surgeons. Methods In the present study, a guide for the placement of the lateral mass screw in the C1 vertebra was developed using 3-D printing. Eight real-size models of the high cervical spine and their respective screw guides were built using computed tomography (CT) scan images. The guidewires were inserted with the help of the printed guides and then the models were analyzed with the help of CT scan images. Results All of the guidewires in the present study obtained a safe placement in the models, avoiding the superior and inferior articular surfaces, the vertebral foramen, and the vertebral artery. Conclusion The present study demonstrated the efficiency of the guide, a reliable tool for aiding the insertion of guidewires for screws in lateral masses of the C1.

Resumo Objetivos A fixação de coluna cervical alta pode representar um desafio para os cirurgiões de coluna devido à anatomia complexa e aos riscos de lesão vascular e medular. Os recentes avanços com a tecnologia de impressão 3 D abriram um novo leque de opções para os cirurgiões. Métodos Desenvolveu-se umguia para a adaptação de parafusos demassa lateral em C1 comauxílio de impressão 3 D. Foram confeccionados oitomodelos em tamanho real de coluna cervical alta e seus respectivos guias com base em tomografias computadorizadas. Os fios-guia foram introduzidos com o auxílio dos guias; os modelos foram analisados com auxílio de tomografia computadorizada. Resultados Todos os fios-guia avaliados no estudo apresentaram um trajeto seguro nos modelos, respeitaram as superfícies articulares superiores e inferiores, o canal vertebral e a artéria vertebral. Conclusão O estudo demonstrou que o guia tem boa eficácia, é uma ferramenta confiável para auxiliar a adaptação de fios-guia para parafusos em massas laterais de C1.

Detection and genetic characterization of diverse Bartonella genotypes in the small mammals of Singapore.

Bartonella species are arthropod-borne bacterial pathogens that infect numerous mammalian species. Small mammals play an important role as natural reservoirs of many Bartonella species, maintaining the greatest diversity of Bartonella described to date. Although Bartonella research has been conducted in Southeast Asia, no studies have been undertaken on small mammals in Singapore. Here, we report the detection and description of Bartonella in small mammals in Singapore during the period of November 2011 to May 2014. BartonellaDNA was detected in 20.8% (22/106) of small mammal spleens with a PCR amplifying the beta subunit of bacterial RNA polymerase (rpoB) gene. Commensal species Rattus norvegicus and Rattus tanezumi had the highest prevalence, 75% (3/4) and 34,5% (10/29), followed by Suncus murinus 30% (6/20), Tupaia glis 16,7% (1/6) and Mus castaneus 13.3% (2/15). Phylogenetic analysis of 18 rpoB gene sequences revealed five Bartonella genotypes circulating in the small mammals of Singapore. Bayesian tip-significance testing demonstrated strong structuring in the geographical signal, indicating that distribution of Bartonella species is correlated to the distribution of their hosts. Major deforestation and fragmentation in Singapore favour synanthropic species that traverse habitats and increase the possibility of spillover to incidental hosts.

High diversity of medically important gastrointestinal rodent-borne helminths in Singapore.

Small mammals are important reservoirs of zoonotic diseases and are definitive hosts for medically important parasitic helminths. Several rodent and shrew species are peridomestic, bringing them into close contact with both humans and the intermediate hosts that maintain the transmission cycle. Here, we screened DNA extracted from large intestine tissue homogenate from 108 individuals comprised of 10 species. We detected two species known to infect humans, Dicrocoelium dendriticum and Moniliformis moniliformis. We also report the first detection of a second Angiostrongylus species in Singapore. This study demonstrates the diversity of helminths that are parasitizing the small mammals in Singapore.

Cuidado à criança com asma: o discurso de familiares / Caring for the child with asthma: relatives’ discourse

Objetivo: descrever os cuidados desenvolvidos pelos familiares à criança com asma. Método: utilizou-se o método criativo sensível desenvolvendo-se a dinâmica de criatividade e sensibilidade mapa falante. Os participantes foram familiares/cuidadores de crianças com diagnóstico de asma. Os dados foram submetidos à análise de discurso Pechetiana. Resultados: o cuidado era cotidiano e desenvolvido prioritariamente por mulheres da família, com ênfase na prevenção das crises. As marcas discursivas nas falas das cuidadoras foram: a preocupação, a insegurança e os mitos sobre a doença. Considerações finais: o cotidiano de cuidados dessas crianças é permeado pelo medo de uma nova crise asmática. Como implicação para a prática clínica, sugere-se realizar atividades educativas com as famílias em uma perspectiva emancipatória, promovendo uma aliança de saberes.

Objective: to describe the care developed by relatives to the child with asthma. Method: thesensitive creative method was carried out by developing the dynamics of creativity and sensitivityof the speaking map. Participants were relatives/ caregivers of children diagnosed with asthma. Thedata were submitted to Pechetiana discourse analysis. Results: care was daily and developedprimarily by women in the family, with an emphasis on crisis prevention. The discursive marks in thespeeches of caregivers were: the concern, the insecurity and the myths about the disease. Finalconsiderations: the daily care of these children is permeated by the fear of a new asthmatic crisis.As an implication for clinical practice, it is suggested to carry out educational activities with familiesin an emancipatory perspective, promoting an alliance of knowledge.

Persistent effects of pre-Columbian plant domestication on Amazonian forest composition.

The extent to which pre-Columbian societies altered Amazonian landscapes is hotly debated. We performed a basin-wide analysis of pre-Columbian impacts on Amazonian forests by overlaying known archaeological sites in Amazonia with the distributions and abundances of 85 woody species domesticated by pre-Columbian peoples. Domesticated species are five times more likely than nondomesticated species to be hyperdominant. Across the basin, the relative abundance and richness of domesticated species increase in forests on and around archaeological sites. In southwestern and eastern Amazonia, distance to archaeological sites strongly influences the relative abundance and richness of domesticated species. Our analyses indicate that modern tree communities in Amazonia are structured to an important extent by a long history of plant domestication by Amazonian peoples.

Identification of a Lineage D Betacoronavirus in Cave Nectar Bats (Eonycteris spelaea) in Singapore and an Overview of Lineage D Reservoir Ecology in SE Asian Bats.

Coronaviruses are a diverse group of viruses that infect mammals and birds. Bats are reservoirs for several different coronaviruses in the Alphacoronavirus and Betacoronavirus genera. They also appear to be the natural reservoir for the ancestral viruses that generated the severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus outbreaks. Here, we detected coronavirus sequences in next-generation sequence data created from Eonycteris spelaea faeces and urine. We also screened by PCR urine samples, faecal samples and rectal swabs collected from six species of bats in Singapore between 2011 and 2014, all of which were negative. The phylogenetic analysis indicates this novel strain is most closely related to lineage D Betacoronaviruses detected in a diverse range of bat species. This is the second time that coronaviruses have been detected in cave nectar bats, but the first coronavirus sequence data generated from this species. Bat species from which this group of coronaviruses has been detected are widely distributed across SE Asia, South Asia and Southern China. They overlap geographically, often share roosting sites and have been witnessed to forage on the same plant. The addition of sequence data from this group of viruses will allow us to better understand coronavirus evolution and host specificity.

Acute and chronic malnutrition and their predictors in children aged 0-5 years in São Tomé: a cross-sectional, population-based study.

OBJECTIVE: Undernutrition is an important cause of morbidity and mortality in infants and children worldwide. The aim of this study was to evaluate the nutritional status and their predictors in children from 0 to 5 years of age in São Tomé. STUDY DESIGN: A cross-sectional study was conducted in São Tomé Island. METHODS: A total of 1285 individuals were enrolled between January and May 2011. Children were measured, and height for age (HAZ), weight for height (WHZ) and body mass index (BAZ) Z-score were computed. Global acute undernutrition is defined as weight for height <-1 Z-score (wasting < -2 Z-scores) and global chronic undernutrition as length/height for age <-1 Z-score (stunting < -2 Z-scores). Relevant information was collected from individual health bulletins, namely gestational age and birth weight, as well as weight at 6, 12, 18 and 24 months for all individual above these ages. Mothers were invited to answer a specific questionnaire. RESULTS: A high percentage of global acute undernutrition (30.9% in <24 months and 21.9% in ≥24 months) and global chronic undernutrition (32.5% in <24 months and 41.1% in ≥24 months) was observed. Appropriate birth weight for gestational age (AGA) is significantly associated with lower odds for both acute (OR 0.485 [95% CI 0.299-0.785]) and chronic undernutrition (OR 0.427 [95% CI 0.270-0.675]) in children >12 months. Weight gain above 0.67 Z-score in the first semester of life was strongly related to lower odds for both acute (OR 0.109 [95% CI 0.040-0.291]) and chronic undernutrition (OR 0.379 [95% CI 0.187-0.770]) in children >12 months of age. Similarly, mother's education seems to protect against acute (>12 months: OR 0.448 [95% CI 0.244-0.825]; >24 months: OR 0.186 [95% CI 0.064-0.540]) and chronic undernutrition (>12 months: OR 0.389 [95% CI 0.232-0.653]; >24 months: OR 0.324 [95% CI 0.171-0.625]). All logistic regressions were adjusted for all children (gender, age, gestational age, birth weight, breastfeeding, begin consumption alcohol), mothers (age, height, body mass index, educational level, number of previous pregnancies, smoking during pregnancy, alcohol consumption during pregnancy) and household (number of siblings and persons at home) variables included in the protocol. CONCLUSIONS: Birth weight, nutritional status, and the mother's education and weight gain particularly in the first year of life were important factors protecting against undernutrition during infancy and childhood. These results emphasize the importance of women's nutrition and of adequate birth weight and particularly weight gain during the first year of life in order to prevent wasting and stunting in childhood.

Perfil de atenção ao parto em um hospital público: contribuições da enfermagem / Profile of attention to the delivery in a public hospital: nursing assistance / Perfil de atención al parto en un hospital público: contribuciones de la enfermería

Objetivo:realizar diagnóstico situacional da atenção ao parto em uma maternidade pública da baixada litorânea do Estado do Rio de Janeiro.Método: estudo descritivo com abordagem quantitativa. Foram aplicados dois instrumentos para coleta de dados, do tipo checklist,no primeiro semestre de 2014, tendo como recorte temporal os 9 anos de funcionamento de uma maternidade. Para a análise dos dados, foram utilizados os referenciais teóricos do Inquérito Nacional sobre Parto e Nascimento/Nascer no Brasil, Ministério da Saúde e as Recomendações da Organização Mundial de Saúde. Resultados: foi prescrita dieta zero para 69,4% das parturientes durante todo trabalho de parto. A infusão de ocitocina contínua foi prescrita na admissão para 38,9% parturientes. Conclusão:constatou-se alto índice de partos cirúrgicos em detrimento dos partosvia vaginal. Evidenciando também a realização de intervenções obstétricas, tais como jejum, ocitocina, litotomia e episiotomia sendo efetuadas de modo rotineiro e sem indicação adequada.(AU)

Objective: to perform situational diagnosis of delivery care at a public maternity of the coast of the State of Rio de Janeiro. Method: descriptive study with a quantitative approach, applying two instruments for data collection, checklist type in the first half of 2014 with time cutting of nine years running of a a maternity hospital. For data analysis the theoretical reference of the National Survey on Labor and Delivery/Childbirth in Brazil, Ministry of Health and the Recommendations of the World Health Organization. Results: zero diet was prescribed for 69.4% of pregnant women throughout labor. The continuous infusion of oxytocin was prescribed at admission to 38.9% pregnant women. Conclusion: it was found a high rate of surgical deliveries than vaginal births. It was also observed the performance of obstetric interventions such as fasting, oxytocin, lithotomy and episiotomy carried out routinely and without proper indication.(AU)

Objetivo: realizar diagnóstico situacional de la atención al parto en una maternidad pública del litoral del Estado de Rio de Janeiro. Método: estudio descriptivo con enfoque cuantitativo, habiendo aplicado dos instrumentos para recolección de datos, del tipo checklist, en el primer semestre de 2014 con recorte temporal de 9 años de funcionamiento de una maternidad. Para el análisis de los datos, los referenciales teóricos de la Encuesta Nacional sobre Parto y Nacimiento/Nacer en Brasil, Ministerio de la Salud y las Recomendaciones de la Organización Mundial de la Salud. Resultados: fue prescrita dieta cero para 69,4% de las parturientes durante todo trabajo de parto. La infusión de oxitocina continua fue prescrita en la admisión para 38,9% parturientes. Conclusión: se constató alto índice de partos quirúrgicos en comparación con los partos vaginales. Se evidenció también la realización de intervenciones obstétricas, tales como ayuno, oxitocina, litotomía y episiotomía siendo realizadas de modo rutinero y sin indicación adecuada.(AU)

EMAS position statement: The ten point guide to the integral management of menopausal health.

With increased longevity and more women becoming centenarians, management of the menopause and postreproductive health is of growing importance as it has the potential to help promote health over several decades. Women have individual needs and the approach needs to be personalised. The position statement provides a short integral guide for all those involved in menopausal health. It covers diagnosis, screening for diseases in later life, treatment and follow-up.