Epidemiology of tongue squamous cell carcinoma: A retrospective cohort study.

OBJECTIVE: To analyze the epidemiological profile and the specific survival of patients diagnosed with tongue squamous cell carcinoma at the National Cancer Institute (INCA). MATERIALS AND METHODS: Hospital Cancer Registry System Data and Mortality Information from 2007 to 2009 were retrieved in a retrospective cohort study of patients diagnosed with tongue squamous cell carcinoma. Specific survival was estimated using the Kaplan-Meier method. The association between independent variables and the risk of death was explored in a Cox proportional hazards regression model. RESULTS: A total of 346 patients were eligible, mostly male (77.5%), smokers (87.6%), with alcohol consumption (80.9%), with low education (65.6%), advanced staging at the time of diagnosis (71.1%), and presenting a high mortality rate (72.5%). In total, 44.5% of patients underwent a surgical approach alone or associated with another treatment modality, of which 85.1% of patients underwent neck dissection and 90.1% had free surgical margins. Specific survival was 40.6% in two years and 31.2% in five years. CONCLUSION: The 5-year specific survival was considered worse in individuals over 60 years, and who did not undergo surgical treatment or had surgery associated with another treatment, compared to patients undergoing isolated surgery.

Nyssorhynchus darlingi genome-wide studies related to microgeographic dispersion and blood-seeking behavior.

BACKGROUND: In Brazil, malaria is concentrated in the Amazon Basin, where more than 99% of the annual cases are reported. The main goal of this study was to investigate the population structure and genetic association of the biting behavior of Nyssorhynchus (also known as Anopheles) darlingi, the major malaria vector in the Amazon region of Brazil, using low-coverage genomic sequencing data. METHODS: Samples were collected in the municipality of Mâncio Lima, Acre state, Brazil between 2016 and 2017. Different approaches using genotype imputation and no gene imputation for data treatment and low-coverage sequencing genotyping were performed. After the samples were genotyped, population stratification analysis was performed. RESULTS: Weak but statistically significant stratification signatures were identified between subpopulations separated by distances of approximately 2-3 km. Genome-wide association studies (GWAS) were performed to compare indoor/outdoor biting behavior and blood-seeking at dusk/dawn. A statistically significant association was observed between biting behavior and single nucleotide polymorphism (SNP) markers adjacent to the gene associated with cytochrome P450 (CYP) 4H14, which is associated with insecticide resistance. A statistically significant association between blood-seeking periodicity and SNP markers adjacent to genes associated with the circadian cycle was also observed. CONCLUSION: The data presented here suggest that low-coverage whole-genome sequencing with adequate processing is a powerful tool to genetically characterize vector populations at a microgeographic scale in malaria transmission areas, as well as for use in GWAS. Female mosquitoes entering houses to take a blood meal may be related to a specific CYP4H14 allele, and female timing of blood-seeking is related to circadian rhythm genes.

Development of an independent MU calculation software for radiotherapy treatments with stereotactic cones.

PURPOSE: Development of an independent MU calculator (StereoCalc) with and without heterogeneity corrections for stereotactic treatments, in a Varian TrueBeam STx LINAC using stereotactic cones, with flattening filter-free photon energies. METHODS: Multiple depth curves and output factors were measured, following the dosimetry formalism for small fields proposed by the TRS-483. The developed StereoCalc imports and processes the beam data files and calculates the patient plans with and without heterogeneity correction. Validation of the developed software was carried out using phantoms. The accuracy of the StereoCalc software was verified in stereotactic patient plans. RESULTS: A maximum difference of 2.47% and 2.07% was obtained in the phantom validation tests with and without heterogeneity correction, respectively. The mean percentual difference of StereoCalc from cone dose calculation (CDC) in the clinical testing was 2.86% ±1.27% and 0.78% ±0.48% with and without heterogeneity correction, respectively. The largest differences found were 7.34% and 1.98%, respectively. CONCLUSIONS: The results obtained in this work show that the MU calculated with StereoCalc software is in good agreement with the values calculated by the treatment planning systems, both in static fields and arcs. We have also improved the software to consider heterogeneity corrections calculations. As expected, and as a major achievement of this work, some differences were observed when heterogeneities were considered. StereoCalc proved to be a powerful tool that can be integrated into the specific quality assurance program in a medical physics department for independent verification in stereotactic treatment with cones.

Retinopatia hipertensiva maligna secundária a lúpus eritematoso sistêmico em adolescente / Malignant hypertensive retinopathy secondary to systemic lupus erythematous in adolescent

RESUMO O lúpus eritematoso sistêmico é uma doença que pode apresentar comprometimento oftalmológico geralmente benigno, sendo as alterações mais encontradas a síndrome do olho seco e a catarata. Nos pacientes com a doença estável, o dano oftalmológico parece estar relacionado ao tratamento sistêmico a longo prazo, o que enfatiza a importância do exame oftalmológico completo de rotina. Porém, quando a doença está em franca atividade e, em especial, quando há o envolvimento renal, deve-se iniciar o tratamento precoce com corticoterapia sistêmica e com medidas de suporte, para se evitarem repercussões mais complexas, como as crises hipertensivas que podem levar ao óbito.

ABSTRACT Systemic lupus erythematosus may present ophthalmological involvement, usually benign, and the most common changes are dry eye syndrome and cataract. In patients with stable disease, ophthalmologic damage appears to be related to long-term systemic treatment, emphasizing the importance of routine complete ophthalmologic examination. However, in full-blown disease, especially when there is renal involvement, early treatment should start with systemic steroid therapy and supportive measures, to avoid major repercussions, such as hypertensive crises that may lead to death.

Cloth masks in public places: an essential intervention to prevent COVID-19 in Brazil. / Máscaras de tecido em locais públicos: intervenção essencial na prevenção da COVID-19 no Brasil.

There is increasing evidence that the use of masks is an indispensable protective measure against COVID-19, given the high transmissibility of the new coronavirus through the respiratory system, including by asymptomatic individuals. The use of cloth masks in public places has been established as a protective measure to be adopted alongside social distancing and hand hygiene. This narrative review aims to systematize the scientific evidence that informs the widespread use of cloth masks as a preventive measure against COVID-19 and to describe the evolution of positions contrary to or in favor of its use outside the home, in view of the advance of the new coronavirus pandemic globally. The scientific articles, technical notes, governmental decrees and other documents analyzed indicate that widespread use of masks has the potential to reduce the spread of the new coronavirus. We recommend that the Brazilian government adopt strategies to increase the supply of reusable cloth masks to the public, especially to vulnerable populations and to support studies on the impact of this measure to control the pandemic in the country. Finally, it is imperative to ensure that use of masks does not exacerbate stigmatization of racial groups that already face prejudice.

Acumulam-se evidências de que o uso de máscaras é uma medida indispensável de proteção à COVID-19, devido ao alto poder de transmissão do novo coronavírus por via respiratória, inclusive por indivíduos assintomáticos. Por sua vez, o uso das máscaras de tecido em locais públicos tem se consolidado como medida adicional de proteção às medidas de distanciamento social e higienização das mãos. Objetivou-se sistematizar as evidências científicas que justificam o amplo uso de máscaras de tecido como prevenção à COVID-19 e descrever a evolução dos posicionamentos contrários ou favoráveis ao seu uso em ambientes extradomiciliares, diante do avanço da pandemia do novo coronavírus pelo mundo. A triagem de artigos e documentos oficiais do Brasil e de outros países indica que o uso de máscaras em locais públicos tornou-se uma intervenção essencial graças ao potencial de reduzir a velocidade de propagação do novo coronavírus. Recomenda-se que o poder público adote estratégias para aumentar a oferta deste produto e fomente estudos para avaliação do impacto da medida no controle da pandemia no Brasil. É imperativo assegurar disponibilidade de máscaras a grupos socioeconomicamente desfavorecidos e garantir que determinados grupos raciais não sejam estigmatizados diante do uso de máscaras em ambientes extradomiciliares.

Máscaras de tecido em locais públicos: intervenção essencial na prevenção da COVID-19 no Brasil / Cloth masks in public places: an essential intervention to prevent COVID-19 in Brazil

Resumo Acumulam-se evidências de que o uso de máscaras é uma medida indispensável de proteção à COVID-19, devido ao alto poder de transmissão do novo coronavírus por via respiratória, inclusive por indivíduos assintomáticos. Por sua vez, o uso das máscaras de tecido em locais públicos tem se consolidado como medida adicional de proteção às medidas de distanciamento social e higienização das mãos. Objetivou-se sistematizar as evidências científicas que justificam o amplo uso de máscaras de tecido como prevenção à COVID-19 e descrever a evolução dos posicionamentos contrários ou favoráveis ao seu uso em ambientes extradomiciliares, diante do avanço da pandemia do novo coronavírus pelo mundo. A triagem de artigos e documentos oficiais do Brasil e de outros países indica que o uso de máscaras em locais públicos tornou-se uma intervenção essencial graças ao potencial de reduzir a velocidade de propagação do novo coronavírus. Recomenda-se que o poder público adote estratégias para aumentar a oferta deste produto e fomente estudos para avaliação do impacto da medida no controle da pandemia no Brasil. É imperativo assegurar disponibilidade de máscaras a grupos socioeconomicamente desfavorecidos e garantir que determinados grupos raciais não sejam estigmatizados diante do uso de máscaras em ambientes extradomiciliares.

Abstract There is increasing evidence that the use of masks is an indispensable protective measure against COVID-19, given the high transmissibility of the new coronavirus through the respiratory system, including by asymptomatic individuals. The use of cloth masks in public places has been established as a protective measure to be adopted alongside social distancing and hand hygiene. This narrative review aims to systematize the scientific evidence that informs the widespread use of cloth masks as a preventive measure against COVID-19 and to describe the evolution of positions contrary to or in favor of its use outside the home, in view of the advance of the new coronavirus pandemic globally. The scientific articles, technical notes, governmental decrees and other documents analyzed indicate that widespread use of masks has the potential to reduce the spread of the new coronavirus. We recommend that the Brazilian government adopt strategies to increase the supply of reusable cloth masks to the public, especially to vulnerable populations and to support studies on the impact of this measure to control the pandemic in the country. Finally, it is imperative to ensure that use of masks does not exacerbate stigmatization of racial groups that already face prejudice.

Neonates Born to Mothers With COVID-19: Data From the Spanish Society of Neonatology Registry.

OBJECTIVES: To describe neonatal and maternal characteristics of the largest prospective cohort of newborns from mothers with coronavirus disease 2019 (COVID-19), the data of which were prospectively collected from the nationwide registry of the Spanish Society of Neonatology. METHODS: Between March 8, 2020, and May 26, 2020, the data of 503 neonates born to 497 mothers diagnosed with COVID-19 during pregnancy or at the time of delivery were collected by 79 hospitals throughout Spain. RESULTS: Maternal symptoms were similar to that of the general population, with 5% of severe forms. In 45.8% of asymptomatic women at the time of delivery, severe acute respiratory syndrome coronavirus 2 infection was detected because of recommendations established in Spain to perform COVID-19 screening in all women admitted to the hospital for labor. The rate of preterm deliveries was 15.7% and of cesarean deliveries, 33%. The most common diagnostic test was detection of viral RNA by polymerase chain reaction of nasopharyngeal swabs at a median age of 3 hours after delivery (1-12 hours). Almost one-half of neonates were left skin-to-skin after delivery, and delayed clamping of umbilical cords was performed in 43% of neonates. Also, 62.3% of asymptomatic neonates were managed with rooming-in. Maternal milk was received by 76.5% of neonates, 204 of them as exclusive breastfeeding. CONCLUSIONS: The current study indicates that there is no need for separation of mothers from neonates, allowing delayed cord clamping and skin-to-skin contact along with maintenance of breastfeeding in a high percentage of newborns from mothers with COVID-19.

As práticas de terapia ocupacional no primeiro ano da pandemia de COVID-19 ­ revisão bibliográfica / Occupational therapy practices in the first year of COVID-19 pandemic ­ literatura review

Em 2020 a COVID-19 chega ao Brasil e logo se confirma transmissão comunitária. São realizados debates que, em meio à falta de coordenação nacional, produzem respostas diferentes em cada nível de governo. Há ênfase na atenção hospitalar, necessária para o atendimento dos casos graves. As mudanças na assistência refletem-se em todos os níveis de atenção em Saúde, Educação e Assistência Social em que terapeutas ocupacionais atuam. Objetivou-se conhecer e agrupar as comunicações cientificas de terapeutas ocupacionais no primeiro ano da pandemia. Em março de 2021 realizou-se uma revisão bibliográfica na Biblioteca Virtual de Saúde que inclui a base Scientific Eletronic Library Online, Portal de Periódicos da Coordenadoria de Aperfeiçoamento de Pessoal de Nível Superior, além do rastreio nas páginas eletrônicas de sete periódicos ibero-americanos de Terapia Ocupacional. Foram utilizados os descritores "occupational therapy" combinado com os descritores "COVID-19", "coronavirus", "pandemics", "quarantine", "syndemics". Foram incluídos títulos com práticas implementadas durante a pandemia, escritos por ao menos um terapeuta ocupacional, cujo texto estava integralmente disponível, perfazendo 17 artigos agrupados por campo, nível de atenção, população. Predomina a atenção hospitalar com práticas adaptadas à biossegurança, seguida da Atenção Básica, e ampla adoção da Telessaúde

In 2020, COVID-19 arrives in Brazil and community transmission is soon confirmed. Debates are held in the midst of a lack of national coordination, which produces different responses at each level of government. There is an emphasis on hospital care, necessary for the care of severe cases. Changes in care occur in all levels of Health, Education and Social Assistance in which occupational therapists work. The objective was to know and group the scientific communications of occupational therapists in the first year of the pandemic. In March 2021, a bibliographic review was carried out in the Virtual Health Library, which includes the Scientific Electronic Library Online database, the Journal Portal of the Coordination for the Improvement of Higher Education Personnel, in addition to screening the electronic pages of seven Ibero-American journals of Occupational therapy. The descriptors "occupational therapy" were used combined with the descriptors "COVID-19", "coronavirus", "pandemics", "quarantine", "syndemics". Items with practices implemented during the pandemic, written by at least one occupational therapist, whose text was fully available, were included, totaling 17 articles grouped by field, level of care, population. Hospital care with practices adapted to containment of biohazards predominates, followed by Primary Care, and wide adoption of Telehealth.

Neonatal Infection Due to SARS-CoV-2: An Epidemiological Study in Spain.

Objective: Coronavirus disease 2019 (COVID-19) cases caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to increase worldwide. Although some data from pediatric series are available, more evidence is required, especially in neonates, a group with specific characteristics that deserve special attention. This study aimed to describe general and clinical characteristics, management, and treatment of postnatal-acquired (community and nosocomial/hospital-acquired) COVID-19 neonatal cases in Spain. Methods: This was a national prospective epidemiological study that included cases from a National Registry supported by the Spanish Society of Neonatology. Neonates with postnatal SARS-CoV-2 infection were included in this study. General data and infection-related information (mode and source of transmission, age at diagnosis, clinical manifestations, need for hospitalization, admission unit, treatment administered, and complementary studies performed, hospital stay associated with the infection) were collected. Results: A total of 40 cases, 26 community-acquired and 14 nosocomial were registered. Ten were preterm newborns (2 community-acquired and 8 nosocomial COVID-19 cases). Mothers (in both groups) and healthcare workers (in nosocomial cases) were the main source of infection. Hospital admission was required in 22 community-acquired cases [18 admitted to the neonatal intermediate care unit (NIMCU) and 4 to the neonatal intensive care unit (NICU)]. Among nosocomial COVID-19 cases (n = 14), previously admitted for other reasons, 4 were admitted to the NIMCU and 10 to the NICU. Ten asymptomatic patients were registered (5 in each group). In the remaining cases, clinical manifestations were generally mild in both groups, including upper respiratory airways infection, febrile syndrome or acute gastroenteritis with good overall health. In both groups, most severe cases occurred in preterm neonates or neonates with concomitant pathologies. Most of the cases did not require respiratory support. Hydroxychloroquine was administered to 4 patients in the community-acquired group and to 2 patients in the nosocomial group. Follow-up after hospital discharge was performed in most patients. Conclusions: This is the largest series of COVID-19 neonatal cases in Spain published to date. Although clinical manifestations were generally mild, prevention, treatment, and management in this group are essential.

Manejo Terapêutico das Lesões Cariosas em Pacientes com a Doença do Enxerto contra o Hospedeiro Crônica: Relato de Caso / Therapeutic Management of Carious Injuries in Chronic Graft-Versus-Host Disease Patients: Case Report / Manejo Terapéutico de Lesiones Cariosas en Pacientes con Enfermedad del Huésped Injerto contra Huésped Crónica: Reporte de un Caso

Introdução: A doença do enxerto contra o hospedeiro crônica (DECHc) é a principal causa de morbimortalidade após o transplante alogênico de células-tronco hematopoiéticas (TCTH-alo). Relato do Caso: Acompanhamento odontológico de paciente do sexo masculino, 59 anos, com diagnóstico inicial de leucemia mieloide aguda, submetido ao TCTH-alo em maio de 2017. No D+ 224, o paciente evoluiu para um quadro de DECHc acometendo a pele, a cavidade oral e o trato gastrointestinal, porém com dentes ainda hígidos. No D+ 392, o paciente queixou-se de boca seca, e foram observadas lesões orais, sialometria de 0,024 mL/min e evolução de lesões cariosas nos dentes 17, 15, 22, 25, 27, 38, 45 e 46. No D+ 560, o paciente ainda estava com DECHc oral e houve progressão das cáries em inúmeros dentes. Tratamento e Resultados: O manejo terapêutico adotado consistiu na utilização de diamino fluoreto de prata pela propriedade cariostática com redução da odontalgia e, posteriormente, foram realizadas as restaurações dentárias. Além disso, o paciente foi orientado em relação à dieta, à manutenção da higiene oral e ao uso de lubrificante oral na tentativa de amenizar a xerostomia. Conclusão: Observou-se, neste caso clínico, que o diamino fluoreto de prata foi eficaz no controle da evolução da cárie e redução da odontalgia no paciente adulto. É evidente a importância da capacitação dos cirurgiões-dentistas no que diz respeito ao conhecimento sobre a utilização de cariostáticos em pacientes com alterações na qualidade e quantidade de saliva como os pacientes com DECHc oral. Palavras-chave: Cariostáticos;Doença Enxerto-Hospedeiro; Manifestações Bucais; Relatos de Casos

Introduction: Chronic graft-versus-host disease (cGVHD) is the main cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT-alo). Case Report: Dental follow-up of a 59-year-old male patient, with initial diagnosis of acute myeloid leukemia, who underwent HSCT-alo in May 2017. At D+ 224, the patient developed a condition of GVHD affecting the skin, oral cavity and gastrointestinal tract, but with still healthy teeth. On D+ 392, the patient complained of dry mouth, oral lesions were observed, and sialometry was 0.024mL/min, with evolution of carious lesions on teeth 17, 15, 22, 25, 27, 38, 45 and 46. At D+ 560, the patient still had oral GVHD and the progression of caries was observed in numerous teeth. Treatment and Results: The therapeutic management adopted consisted of the use of silver diamine fluoride due to its cariostatic property with reduced tooth pain and later dental restorations were performed. In addition, the patient received guidance about diet, maintenance of oral hygiene and - use of oral lubricant to ease xerostomia. Conclusion: It was observed in this clinical case that silver diamine fluoride was effective in controlling the evolution of caries and reducing tooth pain in adult patients. It is evident the importance of training dentists on the knowledge about the use of cariostatic resources in patients with changes in the quality and quantity of saliva, such as patients with oral GVHD

Introducción: La enfermedad crónica del huésped versus el injerto (cGVHD) es la principal causa de morbilidad y mortalidad después del trasplante alogénico de células madre hematopoyéticas (HSCT-alo). Relato del Caso: Seguimiento dental de un paciente masculino de 59 años, con diagnóstico inicial de leucemia mieloide aguda, que se sometió a un HSCT-alo en mayo de 2017. En D+ 224, el paciente desarrolló una condición de EICH que afecta la piel, la cavidad oral y el tracto gastrointestinal, pero con dientes aún sanos. En D+ 392, el paciente se quejó de sequedad en la boca y se observaron lesiones orales y con sialometría de 0,024 ml/min. También presentó evolución de lesiones cariosas en los dientes 17, 15, 22, 25, 27, 38, 45 y 46. En D+ 560, el paciente todavía tenía EICH oral y se observó la progresión de la caries en numerosos dientes. Tratamiento y Resultados: El tratamiento terapéutico adoptado consistió en el uso de diamino fluoruro de plata debido a su propiedad cariostática con reducción del dolor dental y posteriormente se realizaron restauraciones dentales. Además, el paciente recibió instrucciones sobre la dieta, el mantenimiento de la higiene bucal y el uso de lubricante oral en un intento por aliviar la xerostomía. Conclusión: Se observó en este caso clínico que el diamino fluoruro de plata fue efectivo para controlar la evolución de la caries y reducir el dolor dental en pacientes adultos. Es evidente la importancia de capacitar a los dentistas con respecto al conocimiento sobre el uso de recursos cariostáticos en pacientes con cambios en la calidad y cantidad de saliva, como los pacientes con EICH oral

Conhecimento dos utentes com hipertensão arterial de uma unidade de saúde familiar sobre a sua patologia / Knowledge about high blood pressure among hypertensive individuals in a family health unit / Conocimiento de los pacientes con hipertensión arterial en una unidad de salud familiar sobre su patología

Enquadramento: A hipertensão arterial (HTA) é o fator de risco de doença cardiovascular com maior prevalência. O conhecimento básico em saúde é a primeira dimensão da literacia em saúde (LS), que, em Portugal, apresenta um nível problemático considerando-o um problema de saúde pública. Objetivo: Avaliar o nível de conhecimentos sobre HTA dos utentes hipertensos e identificar variáveis com as quais possam estar relacionados. Metodologia: Estudo descritivo-exploratório transversal. De 3050 utentes hipertensos inscritos numa unidade de saúde familiar (USF), 307 constituíram a amostra, determinada de forma não probabilística e por conveniência. Como instrumento de colheita de dados utilizou-se um questionário que avalia conhecimentos e atitudes destes utentes face à sua patologia. Resultados: Vinte e sete por cento apresentam conhecimentos de nível muito bom. Verificou-se relação estatisticamente significativa entre nível de conhecimentos e grupo etário (p = 0,002), escolaridade (p = 0,000) e atitude face ao tratamento (p = 0,004); e atitude face ao tratamento e controlo da doença (p = 0,050). Conclusão: Os enfermeiros devem trabalhar a capacitação dos utentes, intervindo de forma incisiva na população mais idosa.

Background: High blood pressure (HBP) is the dominant risk factor for cardiovascular diseases. Basic health knowledge is the first dimension of health literacy (LS), which in Portugal presents a disturbing level, thus becoming a public health problem. Objective: To assess the level of knowledge about HBP among individuals with this condition and identify potentially related variables. Methodology: Cross-sectional descriptive study conducted in a non-probabilistic sample of 307 individuals selected by convenience from 3050 hypertensive patients registered in a family health unit (USF). For data collection, a questionnaire was used to assess the knowledge and attitudes of individuals with HBP regarding their condition. Results: Twenty-seven percent possess a very good level of knowledge. A statistically significant relationship was found between level of knowledge and age group (p = 0.002), education level (p = 0.000), and attitude toward treatment (p = 0.004); and between attitude toward treatment and control of disease (p = 0.050). Conclusion: Nurses should persist in empowering patients and intervene more closely in the oldest population.

Marco contextual: La hipertensión arterial es el factor de riesgo de enfermedad cardiovascular (HTA) con mayor prevalencia. El conocimiento básico de la salud es la primera dimensión de la alfabetización en la salud, la cual en Portugal presenta un nivel problemático y se la considera un problema de salud pública. Objetivo: Evaluar el nivel de conocimiento de los pacientes hipertensos sobre HTA e identificar variables que puedan estar relacionados. Metodología: Estudio descriptivo-exploratorio transversal. De los 3050 pacientes hipertensos, 307 constituyeron la muestra, no probabilística y por conveniencia. Se utilizó un cuestionario para evaluar conocimiento y actitudes. Resultados: Veintisiete por ciento tiene muy buen nivel de conocimiento. Se verificó una relación estadísticamente significativa entre nivel de conocimiento y grupo de edad (p = 0,002), escolaridad (p = 0,000) y actitud hacia el tratamiento (p = 0,004); y actitud hacia el tratamiento y control de la enfermedad (p = 0,050). Conclusión: Los enfermeros deben trabajando en la formación de los pacientes, con más empeño en la población de edad avanzada.

Species richness and functional structure of fish assemblages in three freshwater habitats: effects of environmental factors and management.

In this study, the inverted trophic hypothesis was tested in the freshwater fish communities of a reservoir. The distribution of fish species in three freshwater habitats in the Jurumirim Reservoir, Brazil, was examined using both species richness and the relative proportions of different trophic groups. These groups were used as a proxy for functional structure in an attempt to test the ability of these measures to assess fish diversity. Assemblage structures were first described using non-metric multidimensional scaling (NMDS). The influence of environmental conditions for multiple fish assemblage response variables (richness, total abundance and abundance per trophic group) was tested using generalised linear mixed models (GLMM). The metric typically employed to describe diversity; that is, species richness, was not related to environmental conditions. However, absolute species abundance was relatively well explained with up to 54% of the variation in the observed data accounted for. Differences in the dominance of trophic groups were most apparent in response to the presence of introduced fish species: the iliophagous and piscivorous trophic groups were positively associated, while detritivores and herbivores were negatively associated, with the alien species. This suggests that monitoring functional diversity might be more valuable than species diversity for assessing effects of disturbances and managements policies on the fish community.

Pessoas com Deficiência e a Construção de Estratégias Comunitárias para Promover a Participação no Mundo do Trabalho / People with Disabilities and the Development of Community Strategies To Promote Participation in the Labor Market

RESUMO: Este artigo trata de um estudo retrospectivo sobre estratégias comunitárias para inclusão de Pessoas com Deficiência (PcD) no trabalho, realizadas por projeto de extensão universitária em parceria com a Unidade Básica de Saúde, entre 2012 e 2016. A pesquisa documental identificou o perfil dos atendidos e as ações compreenderam o apoio em grupo (34 encontros) e individual/familiar (172 atendimentos/20 visitas ao local de trabalho). Houve investimento na constituição de rede comunitária de suporte com atores públicos e privados. Dentre os 22 participantes, 10 iniciaram atividade remunerada, 6 estavam desempregados e 6 não iniciaram atividade remunerada nem tinham experiência prévia; tinham em média 29 anos e, majoritariamente, apresentavam deficiência intelectual, pouca escolaridade ou experiência de trabalho. O grupo possibilitou conhecer as necessidades dos participantes, abordar questões coletivas sobre o tema e compartilhar informações. Os apoios individuais foram essenciais para tratar necessidades singulares, considerando a inexistência de política de apoio à permanência de PcD nas empresas. A criação de rede entre os envolvidos possibilitou interlocução entre serviços para enfrentamento das questões. Houve diálogo com a proposta do Emprego Apoiado e Reabilitação Baseada na Comunidade. Esses aspectos facilitaram processos personalizados, demonstrando a importância e a viabilidade de iniciativas comunitárias que poderiam indicar políticas públicas de acesso a direitos.

ABSTRACT: This paper is about a retrospective study on community strategies for inclusion of People with Disabilities (PwD) at work, carried out by a university extension project in partnership with the Basic Health Unit between 2012 and 2016. The documentary research identified the profile of those served and the actions included support in group (34 encounters) and individual/family (172 assistance meetings/20 visits to the workplace). There was investment in the constitution of a community support network with public and private actors. Among the 22 participants, 10 started paid work, 6 were unemployed and 6 did not start paid work or had previous experience; the average age was 29 years and, mostly, had intellectual disability, little schooling or work experience. The group made it possible to meet the needs of the participants, to address collective issues and share information. Individual support was essential to address unique needs, considering the lack of a policy to support the permanence of PwD in companies. The creation of a network among those involved allowed the interlocution between services to deal with the issues. There was dialogue with the proposal of Supported Employment and Community Based Rehabilitation. These aspects facilitated personalized processes, demonstrating the importance and feasibility of community initiatives that may indicate public policies of access to rights.

Health related quality of life in individuals at high risk for familial hypercholesterolemia undergoing genetic cascade screening in Brazil.

BACKGROUND AND AIMS: Familial hypercholesterolemia (FH) is a genetic disorder associated with high risk of early major cardiovascular events (MACE) that can impact the health related quality of life (HRQoL), however, this association is unclear. This study evaluated HRQoL in index cases (IC) and first-degree relatives (FDR) of individuals at high risk of FH undergoing genetic cascade screening. METHODS: Data collection was performed before awareness of molecular diagnosis results. Individuals were divided into four groups according to the molecular diagnosis: IC with (IC+) and without (IC-) identified mutations (n = 93 and n = 175, respectively), and affected (FDR+, n = 231) and non-affected (FDR-, n = 159) FDR of IC+. HRQoL measurements, mental (MCS) and physical component (PCS) scores were carried out with SF-12 questionnaire. Associations were tested by generalized linear models. RESULTS: The mean age was 49 ±â€¯15 years, 42.2% were men, MACE had occurred in 30.7%. Overall, both PCS and MCS did not differ between FH and non-FH individuals, however, IC trended to have lower PCS independent of FH presence (p=0.003). Lower PCS were associated with female sex (p=0.018), lower education (p<0.001), professional inactivity (p=0.028), previous MACE occurrence (p<0.001), hypertension (p=0.016), depression (p<0.001) and obesity (p<0.001). Lower MCS were associated with female sex (p=0.009), previous MACE occurrence (p=0.034), depression (p<0.001) and smoking (p=0.009). Neither the presence of FH causing mutations nor pharmacological lipid lowering treatment was associated with HRQoL. CONCLUSIONS: HRQoL is not reduced in both IC and FDR FH individuals in comparison with their non-affected counterparts. Previous MACE and co-morbidities are associated with reduced HRQoL.

Technical issues and conservation conditions of medicines in the primary health care of the Brazilian Unified Health System.

OBJECTIVE: To characterize the technical issues and conditions of medicines conservation in Primary Health Care of Brazilian regions, responsible for pharmacy/dispensing unit profile; environmental, storage, and dose fractioning conditions; inventory control and waste management; fire and electrical failure safety items; transportation problems; advertising regulation; and pharmacovigilance. METHODS: This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços (National Survey on Access, Use and Promotion of Rational Use of Medicines - Services)-, a cross-sectional and exploratory study, of evaluative nature, consisting of an information survey within a representative sample of municipalities, stratified by Brazilian regions, which constitute the study domains, and a sample of Primary Health Care services. Pharmaceutical services (PS) were directly observed with photographic record and face-to-face interviews with those responsible for the dispensing of medicines and over the telephone with those responsible for pharmaceutical services. Data were processed with the SPSS® software version 21. RESULTS: The investigated dimensions showed relevant deficiencies and inequalities between the regions, generally more favorable in the Southeast and Midwest regions and weaker in the Northeast and North regions. We verified non-compliance with technical requirements and conditions essential to the conservation of medicines, which may interfere with the maintenance of stability and, thus, on their quality, efficacy, and safety. The regulation of advertising/promotion of medicines is still incipient and there is some progress in the structuring of mechanisms regarding pharmacovigilance. CONCLUSIONS: The sanitary situation of medicines in Brazilian Primary Health Care is alarming due to the violation of the specific sanitary legislation for dispensing establishments and due to a wide range of requirements essential to the conservation of medicines. We observed a disconnection between the efforts made in the Brazilian Unified Health System to promote access to medicines for all population and the organization and qualification of pharmaceutical services.

Myocardial Viability on Cardiac Magnetic Resonance.

The study of myocardial viability is of great importance in the orientation and management of patients requiring myocardial revascularization or angioplasty. The technique of delayed enhancement (DE) is accurate and has transformed the study of viability into an easy test, not only for the detection of fibrosis but also as a binary test detecting what is viable or not. On DE, fibrosis equal to or greater than 50% of the segmental area is considered as non-viable, whereas that below 50% is considered viable. During the same evaluation, cardiac magnetic resonance (CMR) may also use other techniques for functional and perfusion studies to obtain a global evaluation of ischemic heart disease. This study aims to highlight the current concepts and broadly emphasize the use of CMR as a method that over the last 20 years has become a reference in the detection of infarction and assessment of myocardial viability. Resumo O estudo de viabilidade miocárdica é de grande importância para a orientação e manejo de pacientes que necessitam de cirurgia de revascularização miocárdica ou angioplastia. A técnica de realce tardio (RT) é precisa e transformou o estudo de viabilidade em um teste fácil, não só para a detecção de fibrose, mas também como um modelo binário para a detecção do que é ou não é viável. Uma fibrose identificada pelo RT é considerada como não viável quando igual ou maior do que 50% da área segmentar e como viável quando menor que 50%. A ressonância magnética cardíaca (RMC) também pode lançar mão de outras técnicas para estudo funcional e de perfusão para uma avaliação global da doença isquêmica do coração no mesmo exame. Este estudo tem como objetivo destacar os conceitos atuais e enfatizar amplamente o uso da RMC como um método que nos últimos 20 anos se tornou referência na detecção de infarto e avaliação de viabilidade miocárdica.

Myocardial Viability on Cardiac Magnetic Resonance / Viabilidade Miocárdica pela Ressonância Magnética Cardíaca

Abstract The study of myocardial viability is of great importance in the orientation and management of patients requiring myocardial revascularization or angioplasty. The technique of delayed enhancement (DE) is accurate and has transformed the study of viability into an easy test, not only for the detection of fibrosis but also as a binary test detecting what is viable or not. On DE, fibrosis equal to or greater than 50% of the segmental area is considered as non-viable, whereas that below 50% is considered viable. During the same evaluation, cardiac magnetic resonance (CMR) may also use other techniques for functional and perfusion studies to obtain a global evaluation of ischemic heart disease. This study aims to highlight the current concepts and broadly emphasize the use of CMR as a method that over the last 20 years has become a reference in the detection of infarction and assessment of myocardial viability.

Resumo O estudo de viabilidade miocárdica é de grande importância para a orientação e manejo de pacientes que necessitam de cirurgia de revascularização miocárdica ou angioplastia. A técnica de realce tardio (RT) é precisa e transformou o estudo de viabilidade em um teste fácil, não só para a detecção de fibrose, mas também como um modelo binário para a detecção do que é ou não é viável. Uma fibrose identificada pelo RT é considerada como não viável quando igual ou maior do que 50% da área segmentar e como viável quando menor que 50%. A ressonância magnética cardíaca (RMC) também pode lançar mão de outras técnicas para estudo funcional e de perfusão para uma avaliação global da doença isquêmica do coração no mesmo exame. Este estudo tem como objetivo destacar os conceitos atuais e enfatizar amplamente o uso da RMC como um método que nos últimos 20 anos se tornou referência na detecção de infarto e avaliação de viabilidade miocárdica.

Technical issues and conservation conditions of medicines in the primary health care of the Brazilian Unified Health System / Situação sanitária dos medicamentos na atenção básica no Sistema Único de Saúde

OBJECTIVE To characterize the technical issues and conditions of medicines conservation in Primary Health Care of Brazilian regions, responsible for pharmacy/dispensing unit profile; environmental, storage, and dose fractioning conditions; inventory control and waste management; fire and electrical failure safety items; transportation problems; advertising regulation; and pharmacovigilance. METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços (National Survey on Access, Use and Promotion of Rational Use of Medicines - Services)-, a cross-sectional and exploratory study, of evaluative nature, consisting of an information survey within a representative sample of municipalities, stratified by Brazilian regions, which constitute the study domains, and a sample of Primary Health Care services. Pharmaceutical services (PS) were directly observed with photographic record and face-to-face interviews with those responsible for the dispensing of medicines and over the telephone with those responsible for pharmaceutical services. Data were processed with the SPSS® software version 21. RESULTS The investigated dimensions showed relevant deficiencies and inequalities between the regions, generally more favorable in the Southeast and Midwest regions and weaker in the Northeast and North regions. We verified non-compliance with technical requirements and conditions essential to the conservation of medicines, which may interfere with the maintenance of stability and, thus, on their quality, efficacy, and safety. The regulation of advertising/promotion of medicines is still incipient and there is some progress in the structuring of mechanisms regarding pharmacovigilance. CONCLUSIONS The sanitary situation of medicines in Brazilian Primary Health Care is alarming due to the violation of the specific sanitary legislation for dispensing establishments and due to a wide range of requirements essential to the conservation of medicines. We observed a disconnection between the efforts made in the Brazilian Unified Health System to promote access to medicines for all population and the organization and qualification of pharmaceutical services.

OBJETIVO Caracterizar a situação sanitária dos medicamentos na Atenção Básica, nas regiões brasileiras, quanto a requisitos técnico-sanitários, responsável pela farmácia/unidade de dispensação, condições ambientais, de armazenamento, e de fracionamento, controle de estoque e gerenciamento de resíduos, itens de segurança contra incêndio e pane elétrica, problemas no transporte, regulamentação da propaganda e farmacovigilância. MÉTODOS Artigo integrante da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, um estudo transversal, exploratório, de natureza avaliativa, composto por um levantamento de informações numa amostra representativa de municípios, estratificada pelas regiões brasileiras, que constituem domínios do Estudo, e uma amostra de serviços de Atenção Básica. Realizou-se observação direta dos serviços farmacêuticos com registro fotográfico e entrevistas presenciais com os responsáveis pela entrega de medicamentos e por telefone com o responsável pela assistência farmacêutica. Os dados foram processados com o software SPSS® versão 21. RESULTADOS As dimensões investigadas mostraram deficiências relevantes e desigualdades entre as regiões, em geral mais favoráveis nas regiões Sudeste e Centro-Oeste e mais deficitárias nas regiões Nordeste e Norte. Constatou-se descumprimento de requisitos técnicos e sanitários imprescindíveis à conservação dos medicamentos que podem interferir na manutenção da estabilidade e, assim, na sua qualidade, eficácia e segurança. A regulação da propaganda/promoção de medicamentos ainda é incipiente e existe algum avanço na estruturação de mecanismos em relação à farmacovigilância. CONCLUSÕES A situação sanitária dos medicamentos na Atenção Básica no Brasil desperta preocupações pelo descumprimento da legislação sanitária específica para os estabelecimentos de dispensação e de um amplo conjunto de requisitos imprescindíveis à conservação dos medicamentos. Constatou-se um descompasso entre os esforços no âmbito do Sistema Único de Saúde para promover o acesso aos medicamentos para toda a população e a organização e qualificação dos serviços farmacêuticos.