Lead exposure and its relationship with fecal cortisol levels in black howler monkeys (Alouatta pigra).

Efficiently detecting early environmental threats to wildlife is vital for conservation. Beyond obvious dangers like habitat loss or deforestation, our study focuses on one of the most hazardous toxic metals for wildlife: lead (Pb). Pb is a widespread, cumulative, and insidious environmental pollutant that can trigger a wide range of physiological, biochemical, and behavioral disorders. In fact, Pb can cause permanent dysfunction of the major stress system, the hypothalamic pituitary adrenal (HPA) axis. We analyzed Pb and cortisol concentrations in fecal samples from Alouatta pigra in southern Mexico. Fecal samples were collected across six sites categorized as free-ranging (n = 65; conserved and disturbed) and from captive animals (n = 58). Additionally, we collected soil samples (n = 35). We found that Pb was present in 28% of fecal samples and 83% of soil samples. There was a positive relation between fecal and soil Pb levels, and fecal Pb concentration was negatively associated with cortisol levels. However, the claim of Pb being a direct interference with HPA axis requires further investigation. Given our findings, assessing wildlife exposure can be a valuable tool for understanding potential Pb exposure levels in the environment and its possible implications for human health. It can also serve as an early warning system of these consequences.

Trypanosoma cruzi in Mexican Neotropical vectors and mammals: wildlife, livestock, pets, and human population.

OBJECTIVE: To provide primary evidence of Trypanosoma cruzi landscape genetics in the Mexican Neotropics. MATERIALS AND METHODS: Trypanosoma cruzi and discrete typing units (DTU) prevalence were analyzed in landscape communities of vectors, wildlife, livestock, pets, and sympatric human populations using endpoint PCR and sequencing of all relevant amplicons from mitochondrial (kDNA) and nuclear (ME, 18S, 24Sα) gene markers. RESULTS: Although 98% of the infected sample-set (N=2 963) contained single or mixed infections of DTUI (TcI, 96.2%) and TcVI (22.6%), TcIV and TcII were also identified. Sensitivity of individual markers varied and was dependent on host taxon; kDNA, ME and 18S combined identified 95% of infections. ME genotyped 90% of vector infections, but 60% of mammals (36% wildlife), while neither 18S nor 24Sα typed more than 20% of mammal infections. CONCLUSION: Available gene fragments to identify or genotype T. cruzi are not universally sensitive for all landscape parasite populations, highlighting important T. cruzi heteroge- neity among mammal reservoir taxa and triatomine species.

Clear aligners combined with orthognathic surgery: a case series.

The goal of this study was to describe a series of orthognathic surgery cases in which a clear aligner system was used for orthodontic treatment. A total of 16 cases were undertaken. A majority of the patients were female (68.75%), and the mean age of the patients was 26.78 years (SD 10.85 years). The most frequent malocclusion was Class II (56.25%), mainly caused by mandibular retrognathism (80.00%). Most of the patients were treated with single-jaw surgeries (56.15%). Orthodontic buttons and elastics were used for maxillomandibular fixation in 81.25% of the patients. The mean (SD) treatment period was 19.00 (1.11) months, and the postsurgical follow-up varied from 6 months to 10 years. Good results were achieved with orthognathic surgery and the adjunctive use of clear aligners, and no damage was noted during the orthosurgical treatment. Since clear aligners provide an esthetic, removable appliance and may be more acceptable to patients than conventional orthodontic appliances, the use of clear aligners in orthognathic surgery is a promising alternative to traditional orthodontics.

Predictive Accuracy of Progesterone Receptor B in Young Women with Atypical Endometrial Hyperplasia and Early Endometrial Cancer Treated with Hysteroscopic Resection plus LNG-IUD Insertion.

STUDY OBJECTIVE: The immunohistochemical expression of isoform B of the progesterone receptor (PRB) has shown promising results in predicting the response of atypical endometrial hyperplasia (AEH) and early endometrial cancer (EEC) to conservative treatment. We aimed to calculate the accuracy of PRB as a predictive marker of conservative treatment outcome in AEH or EEC. DESIGN: Retrospective cohort study. SETTING: University of Naples Federico II, Naples, Italy. PATIENTS: Thirty-six consecutive premenopausal women <45 years of age with AEH (n = 29) or EEC (n = 7) conservatively treated from January 2007 to June 2018 were retrospectively assessed. INTERVENTIONS: All patients had been treated with hysteroscopic resection plus levonorgestrel-releasing intrauterine device insertion and followed for at least 1 year. The immunohistochemical expression of PRB was separately assessed in the glands and stroma of the lesion and dichotomized as "weak" or "normal." MEASUREMENT AND MAIN RESULTS: The treatment outcomes considered were (1) treatment failure (i.e., a combined outcome including no regression or recurrence); (2) no regression; and (3) recurrence. The predictive accuracy of PRB immunohistochemistry was assessed by calculating sensitivity (SE), specificity (SP), and area under the receiver operating characteristic curve (AUC). A weak glandular PRB expression showed SE = 70%, SP = 77%, and AUC = 0.74 for treatment failure; SE = 66.7%, SP = 70%, and AUC = 0.68 for no regression; and SE = 75%, SP = 68.8%, and AUC = 0.72 for recurrence. A weak stromal PRB expression showed SE = 100%, SP = 53.8%, and AUC = 0.77 for treatment failure; SE = 100%, SP = 46.7%, and AUC = 0.73 for no regression; and SE = 100%, SP = 43.8%, and AUC = 0.72 for recurrence. CONCLUSION: A weak stromal PRB expression is a highly sensitive predictive marker of both no response and recurrence of AEH and EEC conservatively treated.

Determination of plasma lactate in the emergency department for the early detection of tissue hypoperfusion in septic patients.

OBJECTIVE: To determine the validity of plasma lactate in the emergency department for the early detection of tissue hypoperfusion in septic patients. MATERIALS AND METHODS: Longitudinal descriptive study. Non probabilistic sampling for convenience. Plasma lactate levels were determined in patients admitted to the emergency department with systemic inflammatory response data and clinical suspicion or documented infection. Follow-up was seven days. Complications were considered if the patients presented septic shock, severe sepsis, entry to intensive care or death. RESULTS: Ninety patients were included. The mean age was 57.4±20.31. Fifty five percent (n=49) were women. 25% (n=22) of the patients showed complications. Plasma lactate levels were 1.55mmol/L in uncomplicated patients and 3.72mmol/L for complicated patients (p<0.001). The area under the ROC curve was 0.72 (95% CI, 0.575-0.829). The cutoff point that best described the relationship with the probability of complications was that set at 4.2mmol/L. The variables studied that showed a significant association with the probability of complications were edema (p=0.004), and infections of the respiratory tract (p=0.037). A model that included lactate levels, using as adjustment variables edema and the presence of low respiratory tract infection explained between 0.234 and 0.349 of the dependent variant, correctly classifying 80% of the cases. CONCLUSION: Plasma lactate is useful in emergency departments as a predictive test for the early detection of patients with tissue hypoperfusion that evolve to severe sepsis, septic shock or death.

Therapeutic itineraries of quilombola women in northern Minas Gerais, Brazil. / Itinerários terapêuticos de mulheres quilombolas do norte de Minas Gerais, Brasil.

Quilombolas are ethnic-racial groups, of black ancestry, and had their territories consolidated in Brazil in regions with difficult access and far from large centers. The objective of this study is to know the therapeutic itinerary (IT) adopted by quilombola women in traditional communities located in the North of the state of Minas Gerais. This is a qualitative study with the theoretical model using the Arthur Kleinman health care system. The study scenario was 23 quilombola communities in northern Minas Gerais. Forty quilombola women aged between 25 and 89 years were interviewed. Data analysis was performed following the IT. Units of analysis emerged that were grouped into three categories: quilombola women and the meaning of health and care; the professional care system in quilombola communities; and route of care in situations experienced by women. The therapeutic itinerary of the communities is mainly related to the actions of popular medicine. It was also possible to observe that there are weaknesses in relation to health care due to factors such as difficulty of access to institutionalized services.

Os quilombolas são grupos étnico-raciais de ancestralidade negra e tiveram seus territórios consolidados no Brasil em regiões com acesso difícil e distante dos grandes centros. O objetivo desse estudo é conhecer o itinerário terapêutico (IT) adotado por mulheres quilombolas em comunidades tradicionais localizadas no norte do estado de Minas Gerais. Trata-se de um estudo com abordagem qualitativa com o modelo teórico utilizando o sistema de cuidados à saúde de Arthur Kleinman. O estudo se deu em 23 comunidades quilombolas do norte de Minas Gerais. Foram entrevistadas 40 mulheres quilombolas, com idades entre 25 e 89 anos. A análise dos dados foi realizada seguindo os IT. Emergiram unidades de análise que foram agrupadas em três categorias: as mulheres quilombolas e o significado da saúde e do cuidado; o sistema de cuidado profissional nas comunidades quilombolas; e itinerário de cuidados nas situações vivenciadas pelas mulheres. O itinerário terapêutico das comunidades se mostra relacionado principalmente às ações de medicina popular. Foi possível observar ainda que existem fragilidades em relação à atenção à saúde devido a fatores como dificuldade de acesso aos serviços institucionalizados.

Therapeutic itineraries in health care in Quilombola communities. / Itinerários terapêuticos no cuidado em saúde em comunidades quilombolas.

This article aimed to map therapeutic itineraries in health care within rural Quilombola communities in the north of Minas Gerais, Brazil. This is a section of a qualitative research conducted in six visited communities. The data was collected through 18 individual interviews, analyzed using the theoretical-methodological framework of Therapeutic Itineraries, and organized into three empirical themes. The narratives allowed for understanding the paths taken in health care by the Quilombola population, identifying the components of the popular subsystem (natural resources, the use of teas and home remedies), the family subsystem (transmission of knowledge and cultural heritage of care), and the professional subsystem (hospital level, medical care, primary and specialized attention). The difficulties of access are not only due to geographical distances, but also broader aspects of social determination, such as institutional racism, low availability of services, the need for payment for transportation and medical procedures. In this sense, it is necessary to have an approach and interventions from public policies to address ethnic-racial, economic, and access inequalities in health care services.

Este artigo teve como objetivo mapear os itinerários terapêuticos no cuidado em saúde em comunidades quilombolas rurais no norte de Minas Gerais, Brasil. Trata-se de um recorte de uma pesquisa qualitativa realizada em seis comunidades visitadas. Os dados foram produzidos por meio de 18 entrevistas individuais, analisados pelo referencial teórico-metodológico dos itinerários terapêuticos e organizados em três temas empíricos. As narrativas permitiram a compreensão dos percursos trilhados no cuidado em saúde pela população quilombola, a identificação dos componentes do subsistema popular (recursos naturais, o uso de chás e remédios caseiros), do subsistema familiar (transmissão de conhecimentos e herança cultural de cuidados), e do subsistema profissional (nível hospitalar, cuidados médicos, atenção primária e especializada). As dificuldades de acesso não decorrem apenas das distâncias geográficas, envolvem aspectos mais amplos da determinação social, como o racismo institucional, a baixa oferta de serviços, a necessidade de pagamento para deslocamentos e procedimentos médicos. Nesse sentido, fazem-se necessárias uma abordagem e intervenções das políticas públicas frente às desigualdades étnico-raciais, econômicas e de acesso aos serviços de cuidado em saúde.

Polymerase Chain Reaction (PCR) is a Useful and Low-Cost Tool for Molecular Sexing Psittaciformes under Human Care: An Example of a Collaborative Approach in Mexico.

Sex determination in monomorphic birds is a precondition for captive breeding programs and management and conservation strategies for threatened species. Most species of the order Psittaciformes often present complications since these birds lack external sexual phenotypic traits, making it impossible to differentiate males and females. In the present study, we used molecular techniques to determine the sex of 31 individuals belonging to nine species of the order Psittaciformes kept under human care at the Akumal Monkey Sanctuary & Rescued Animals in Quintana Roo, Mexico. This is a useful and low-cost methodology based on the analysis of the conserved region of the CHD1 gene, which was amplified by PCR with two sets of primers: P8/P2 and 2550F/2718 R. All individuals were successfully sexed with the first set of primers, while only 28 out of 31 samples (90%) could be amplified with the second set. Out of the 31 individuals analyzed, fifteen are female, and seventeen are male. This information represents a handy tool for adequately managing birds under human care, resulting in their reproduction and eventual reintegration into their natural habitat.

Efficacy of Flap-based Posterior Trunk Reconstruction after Vertebrectomy and Radiation Therapy: A Retrospective Cohort Study.

Background: Adjuvant radiation therapy following vertebrectomy is a major risk factor for local wound complications such as dehiscence, infection, and skin necrosis. In selected cases, well-vascularized coverage and modification of tension forces on the wound might reduce the risk of postoperative complications and reoperations. We aimed to demonstrate a reduction in general and specific complications in patients undergoing vertebral resection and flap coverage compared with vertebral resection alone. Methods: We retrospectively analyzed and collected data from patients diagnosed with a tumor involving the spine and requiring a total or partial posterior vertebrectomy between January 2012 and October 2022, referred to a single tertiary-level orthopedic and trauma center. We included only patients in whom primary closure of the wound was possible but judged to be under excessive tension. Results: A total of 145 patients underwent partial or total vertebrectomy for oncological reasons at our tertiary-level trauma hospital. Among these, 73 patients were eventually included according to the inclusion and exclusion criteria: 53 in the orthopedic group and 20 in the orthoplastic group. Considering only patients undergoing radiation therapy, the orthoplastic group showed significantly lower rates of overall complications (33% versus 69%) than the orthopedic group. Conclusions: Primary flap coverage, especially in patients receiving RT, reduces the risk of postoperative complications and avoids a second reconstructive operation, consequently reducing patient discomfort, length of hospital stay, and healthcare costs.

[Quilombola men and their work: a mapping of the health of these workers]. / Os homens quilombolas e seu trabalho: uma cartografia da saúde desses trabalhadores.

Quilombola men perform productive activities that require great physical strength in environments conducive to several risks, accidents, and health problems. This study aimed to map the work processes of quilombola men in three locations in Norte de Minas region in the State of Minas Gerais, Brazil, using the methodological framework of Cartography proposed by Gilles Deleuze & Félix Guattari. Data were produced by the observation of work processes, individual interviews, and records of the effects in a mapping diary. Discourse analysis Allowed for the elaboration of a descriptor flowchart and the definition of three thematic categories. In the mapped locations, the intersection of gender, ethnicity, and class collaborates directly for the performance of activities in charcoal furnaces, quarries, and banana plantations. These environments are highly unhealthy due to the presence of heat and smoke, methods that demand great physical effort and produce silica dust, excessive sun exposure, and the use of pesticides. The integration between the workers' health surveillance (VISAT) and the Brazilian Public Labor Prosecutor Office allows for the articulation of an intersectoral network of popular education, technical assistance, and professional training and qualification. These measures will directly affect the health-disease process, the quality of life of workers, and the environmental preservation of the mapped locations.

Os homens quilombolas exercem atividades produtivas que exigem grande força física, em ambientes propiciadores de diversos riscos, acidentes e agravos à saúde. O objetivo deste estudo foi cartografar os processos de trabalho de homens quilombolas em três territórios da região Norte de Minas, no Estado de Minas Gerais, Brasil. Para sua construção, utilizamos o referencial metodológico da Cartografia proposto pelos filósofos Gilles Deleuze & Félix Guattari. Os dados foram produzidos por meio da observação dos processos de trabalho, entrevistas individuais e registros das afetações em um diário cartográfico. A Análise de Discurso possibilitou a elaboração de um fluxograma descritor e a definição de três categorias temáticas. Nos territórios rastreados, a intersecção de gênero, raça e classe colabora diretamente para a execução de atividades na carvoaria, pedreira e bananal. Esses ambientes são altamente insalubres, com presença de calor e fumaça, métodos que geram grande esforço físico e poeira de sílica, exposição excessiva ao sol e uso de agrotóxicos. A integração entre a vigilância em saúde do trabalhador (VISAT) e o Ministério Público do Trabalho permite a articulação de uma rede intersetorial de educação popular, assistência técnica, qualificação e capacitação profissional. Essas medidas terão impacto direto no processo saúde-doença, na qualidade de vida dos trabalhadores e na preservação ambiental dos territórios cartografados.

Los hombres quilombolas realizan actividades productivas que requieren una gran fuerza física, en entornos que conllevan diversos riesgos, accidentes y peligros para la salud. El objetivo de este estudio fue cartografiar los procesos de trabajo de los hombres quilombolas en tres territorios de la región Norte de Minas en el estado de Minas Gerais, Brasil. Para su construcción, hemos utilizado el marco metodológico de la Cartografía propuesto por los filósofos Gilles Deleuze & Félix Guattari. Los datos se produjeron mediante la observación de los procesos de trabajo, las entrevistas individuales y el registro de los efectos en un diario cartográfico. El Análisis del Discurso permitió elaborar un organigrama descriptivo y definir tres categorías temáticas. En los territorios rastreados, la intersección de género, raza y clase colabora directamente con la realización de actividades de producción de carbón vegetal, canteras y plantaciones de plátanos. Estos entornos son altamente insalubres, con presencia de calor y humo, métodos que generan gran esfuerzo físico y polvo de sílice, exposición excesiva al sol y uso de agroquímicos. La integración entre la vigilancia de la salud de los trabajadores (VISAT) y la Fiscalía del Trabajo permite la articulación de una red intersectorial de educación popular, asistencia técnica, calificación profesional y formación. Estas medidas tendrán un impacto directo en el proceso salud-enfermedad, en la calidad de vida de los trabajadores y en la preservación medioambiental de los territorios cartografiados.

Great-tailed Grackles (Quiscalus mexicanus) as a tolerant host of avian malaria parasites.

Great-tailed Grackles (Quiscalus mexicanus) are a social, polygamous bird species whose populations have rapidly expanded their geographic range across North America over the past century. Before 1865, Great-tailed Grackles were only documented in Central America, Mexico, and southern Texas in the USA. Given the rapid northern expansion of this species, it is relevant to study its role in the dynamics of avian blood parasites. Here, 87 Great-tailed grackles in Arizona (a population in the new center of the range) were screened for haemosporidian parasites using microscopy and PCR targeting the parasite mitochondrial cytochrome b gene. Individuals were caught in the wild from January 2018 until February 2020. Haemosporidian parasite prevalence was 62.1% (54/87). A high Plasmodium prevalence was found (60.9%, 53/87), and one grackle was infected with Haemoproteus (Parahaemoproteus) sp. (lineage SIAMEX01). Twenty-one grackles were infected with P. cathemerium, sixteen with P. homopolare, four with P. relictum (strain GRW04), and eleven with three different genetic lineages of Plasmodium spp. that have not been characterized to species level (MOLATE01, PHPAT01, and ZEMAC01). Gametocytes were observed in birds infected with three different Plasmodium lineages, revealing that grackles are competent hosts for some parasite species. This study also suggests that grackles are highly susceptible and develop chronic infections consistent with parasite tolerance, making them competent to transmit some generalist haemosporidian lineages. It can be hypothesized that, as the Great-tailed Grackle expands its geographic range, it may affect local bird communities by increasing the transmission of local parasites but not introducing new species into the parasite species pool.

[Quality of life in Mexican women with breast cancer at different stages and its association with sociodemographic characteristics, comorbidities and procedural factors at the Mexican Institute of Social Security]. / Calidad de vida en mujeres Mexicanas con cáncer de mama en diferentes etapas clínicas y su asociación con características socio-demográficas, estados co-mórbidos y características del proceso de atención en el Instituto Mexicano del Seguro Social.

INTRODUCTION: Quality of life is the most studied PRO (patient reported outcome) in cancer patients. With early diagnosis and better treatments in breast cancer, this entity has been transformed in a chronic disease with longer survival. The joint effects of diseases and treatment on quality of life are each day more important to consider in survival patients. OBJECTIVE: To evaluate quality of life, socioeconomic factors, co-morbidities, and the attendance process impact on quality of life in breast cancer women with different clinical stages attending at the Instituto Mexicano del Seguro Social using the EORCT QLQ-C30 RESULTS: The scores of EORTC QLQ-C30 (v3) were: Global health status / QoL: 73.47 (± 20.81), physical functioning 76.98 (± 20.85), role functioning 76.60 (± 27.57), emotional functioning 64.53 (± 26.81), cognitive functioning 74.47 (± 26.02), social functioning 84.96 (± 23.20), fatigue 31.94 (± 25.45), nausea and vomiting 19.49 (± 26.93), pain 28.95 (± 27.27), dyspnea 15.29 (± 24.62), insomnia 35.13 (± 32.10), appetite lost 18.04 (± 28.75), 18.04 (± 28.75), constipation 19.20 (± 32.11), diarrhea 12.9 (± 24.25), financial difficulties 40.57 (± 37.26). The scores with EORTC QLQ-BR23 were: body image 74.84 (± 31.69), sexual functioning 13.73 (± 22.55), sexual enjoyment 32.86 (± 36.17), future perspectives 51.69 (± 38.00), systemic therapy side effects 30.82 (± 20.71), breast symptoms 22.85 (± 23.49), arm symptoms 27.53 (± 24.75), upset by hair loss 43.80 (± 44.01). CONCLUSIONS: Clinical stage in breast cancer is associated with differences in the scores from fatigue, nausea and vomiting and financial difficulties according to the evolution of the disease and the physical detriment associated. Socio-demographic features were related role functioning, fatigue and pain in single women with higher scores.

Online learning environments to stimulate in students the processes of mutual interaction between digital and analog artefacts to enhance student learning.

In the recent years, numerous papers have discussed the use of concept maps in education. In this paper, we use the Dynamic Concept Maps (DCMs) in online learning environments as tools able to stimulate in students the processes of mutual interaction and hybridization between digital artefacts (DCMs) and analog artefacts (books) so as to encourage the development of significant learning. This method, called "DynaMap Remediation Approach" (DMRA), encourages and stimulates learners to study topics in greater detail, and supports the development of their own learning. The advantages of this method are listed below:•DMRA is significantly effective in terms of reducing study time and improvement of learning outcomes.•DMRA valorises the active role of the learners during their process of knowledge construction and may have significant implications for educators who would like to use innovative and engaging online learning environments to enhance student learning.•DMRA is a simple and highly reproducible method.

Comparative Analysis of Detectors and Feature Descriptors for Multispectral Image Matching in Rice Crops.

Precision agriculture has greatly benefited from advances in machine vision and image processing techniques. The use of feature descriptors and detectors allows to find distinctive keypoints in an image and the use of this approach for agronomical applications has become a widespread field of study. By combining near infrared (NIR) images, acquired with a modified Nikon D80 camera, and visible spectrum (VIS) images, acquired with a Nikon D300s, a proper crop identification could be obtained. Still, the use of different sensors brings an image matching challenge due to the difference between cameras and the possible distortions from each imaging technique. The aim of this paper is to compare the performance of several feature descriptors and detectors by comparing near infrared and visual spectral bands in rice crop images. Therefore, a group of 20 different scenes with different cameras and growth stages in a rice crop were evaluated. Thus, red, green, blue (RGB) and L, a, b (CIE L*a*b*) channels were extracted from VIS images in order to compare the matches obtained between each of them and the corresponding NIR image. The BRISK, SURF, SIFT, ORB, KAZE, and AKAZE methods were implemented, which act as descriptors and detectors. Additionally, a combination was made between the FAST algorithm for the detection of keypoints with the BRIEF, BRISK, and FREAK methods for features description. BF and FLANN matching methods were used. The algorithms were implemented in Python using OpenCV library. The green channel presented the highest number of correct matches in all methods. In turn, the method that presented the highest performance both in time and in the number of correct matches was the combination of the FAST feature detector and the BRISK descriptor.

[The vision of the rural male worker from north Minas Gerais on health care in the context of primary health care]. / A visão do homem trabalhador rural norte-mineiro sobre o cuidado em saúde no contexto da atenção primária à saúde.

This paper aimed to understand the perceptions of rural male workers, residents in a northern territory of Minas Gerais, Brazil, regarding care practices developed during their production process. This is a qualitative research, with the application of the field observation technique, with records on a diary and accomplishment of individual interviews. Data analysis used the hermeneutic-dialectic method, allowing for the construction of three thematic categories. The men surveyed have a vision based on curative care model and on great dependence on the physician. Some related healthcare practices with habits and healthy life style, such as nutrition; hydration and non-consumption of alcohol and/or tobacco. It is important to highlight that most of the men considered the job as a tool for health care, having a direct relationship with the prevention of occupational risks. In this context, the primary healthcare professionals should encourage the distancing from the biomedical, prescriptive and non-preventive model that still predominates in the vision of the Brazilian population and mainly in the male culture and in rural areas, seeking an integral look for health promotion and maintenance.

Este artigo objetivou compreender as percepções de homens trabalhadores rurais, residentes em um território do norte de Minas Gerais, Brasil, frente às práticas de cuidado desenvolvidas durante o seu processo produtivo. Trata-se de pesquisa qualitativa, com aplicação da técnica de observação de campo, registros em um diário e realização de entrevistas individuais. Para a análise dos dados foi utilizado o método da hermenêutica-dialética, possibilitando a construção de três categorias temáticas. Os homens pesquisados possuem uma visão baseada no modelo assistencial curativo e na grande dependência pelo médico. Alguns relacionaram práticas de cuidado em saúde com hábitos e estilo de vida saudável, como a alimentação; hidratação e não consumir álcool e/ou tabaco. Importante destacar que a maioria dos homens considerou o trabalho como uma ferramenta para cuidar da saúde, tendo relação direta com a prevenção dos riscos ocupacionais. Nessa conjuntura, os profissionais da atenção primária à saúde devem incentivar o distanciamento desse modelo dito biomédico, prescritivo e não preventivo que ainda predomina na visão da população brasileira e principalmente na cultura masculina e nos territórios rurais, buscando um olhar integral para a promoção e manutenção da saúde.

[Foot ulceration risk factors in type 2 diabetes mellitus]. / Factores de riesgo de ulceración de los pies en diabéticos tipo 2.

OBJECTIVE: To identify risk factor prevalence for development of foot ulcers in patients with type 2 diabetes (DM2). METHODS: A cross sectional study, of 2067 patients with DM2 from seven primary care units was conducted. A questionnaire exploring age, sex, occupation, time from diabetes mellitus diagnosis (DMD), and data concerning neuropathy, vascular changes, and presence of infections, anthropometry, and gait was applied. RESULTS: We found mean age, 59.96 +/- 11.47 years and time from DMD, 10.2 +/- 8.09 years. From 1360 women, 65.8 % presented the following risk factors: age, 34.7 %; schooling, 49.5 %; time from DMD, 38.8 %; occupation, 20 %; smoking, 24.3 %; alcoholism, 4.6 %; fasting glucose disturbance, 78 %; ulcer history, 10 %. In relation to associated diseases, 67.5 % of patients had one or more antecedent. The presence of risk factors in the sample was 9.716 +/- 2.52, of which 6.259 +/- 1.59 were modifiable. CONCLUSIONS: Patients studied presented high risk factor prevalence for development of foot ulcer. The majority of RF is potentially modifiable by adjusting patients' customs and habits.

Monitoramento e avaliação da cobertura vacinal da vacina contra febre amarela: revisão integrativa / Monitoreo y evaluación de la cobertura vacunal de la vacuna contra la fiebre amarilla: revisión integradora / Monitoring and evaluation of vaccination coverage of the yellow fever vaccine: integrative review

Objetivo: descrever as estratégias de monitoramento e avaliação da cobertura vacinal de vacina contra febre amarela (FA) no Brasil. Método: revisão integrativa nas bases Lilacs, BDENF, Medline e SciELO. Utilizou-se operadores booleanos e de truncamento para construir a estratégia de busca a partir das palavras chaves.: Monitoramento; Avaliação; Cobertura vacinal; Febre amarela. Cinco artigos foram selecionados. Resultados: Identificou-se estratégias de monitoramento da cobertura vacinal da vacina contra FA (ex.: cálculos de cobertura vacinal e de doses aplicadas; Monitoramento Rápido de Coberturas Vacinais, entre outras). Assim como estratégias de avaliação (ex.: alcance de meta da cobertura preconizada; número de casos confirmados de FA, entre outras).Conclusão: Além do alcance do objetivo, com construção de um quadro-síntese, pôde-se observar limitação do número de artigos encontrados e incipiência na elaboração de estudos nesta área.

Objective: to describe strategies for monitoring and evaluating vaccination coverage of yellow fever (YF) vaccine in Brazil. Method: integrative review in the Lilacs, BDENF, Medline and SciELO databases. Boolean and truncation operators were used to build the search strategy based on the keywords: Monitoring; Assessment; Vaccination coverage; Yellow fever. Five articles were selected. Results: strategies for monitoring vaccination coverage of the YF vaccine were identified (e.g. calculations of vaccination coverage and doses applied; Rapid Monitoring of Vaccination Coverage, among others). As well as evaluation strategies (e.g. reaching the coverage target recommended; number of confirmed cases of AF, among others). Conclusion: in addition to achieving the objective, with the construction of a summary table, it was possible to observe a limitation in the number of articles found and a lack of development in studies in this area.

Objetivos:describir estrategias para el seguimiento y evaluación de la cobertura vacunal de la vacuna contra la fiebre amarilla (FA) en Brasil. Método: revisión integrativa en las bases Lilacs, BDENF, Medline y SciELO. Se utilizaron operadores booleanos y de truncamiento para construir la estrategia de búsqueda basada en las palabras clave: Monitoreo; Evaluación; Cobertura de vacunación; Fiebre amarilla. Se seleccionaron cinco artículos. Resultados: se identificaron estrategias para el seguimiento de la cobertura vacunal de la vacuna contra la FA (ej., cálculos de cobertura vacunal y dosis aplicadas; Monitoreo Rápido de la Cobertura Vacunal, entre otros). Así como estrategias de evaluación (ej. alcanzar la meta de cobertura recomendada; número de casos confirmados de FA, entre otros). Conclusión: además de lograr el objetivo, con la construcción de un cuadro resumen, se puede observar una limitación en el número de artículos encontrados y una incipiencia en el desarrollo de estudios en esta área.

Itinerários terapêuticos no cuidado em saúde em comunidades quilombolas / Therapeutic itineraries in health care in Quilombola communities

Resumo Este artigo teve como objetivo mapear os itinerários terapêuticos no cuidado em saúde em comunidades quilombolas rurais no norte de Minas Gerais, Brasil. Trata-se de um recorte de uma pesquisa qualitativa realizada em seis comunidades visitadas. Os dados foram produzidos por meio de 18 entrevistas individuais, analisados pelo referencial teórico-metodológico dos itinerários terapêuticos e organizados em três temas empíricos. As narrativas permitiram a compreensão dos percursos trilhados no cuidado em saúde pela população quilombola, a identificação dos componentes do subsistema popular (recursos naturais, o uso de chás e remédios caseiros), do subsistema familiar (transmissão de conhecimentos e herança cultural de cuidados), e do subsistema profissional (nível hospitalar, cuidados médicos, atenção primária e especializada). As dificuldades de acesso não decorrem apenas das distâncias geográficas, envolvem aspectos mais amplos da determinação social, como o racismo institucional, a baixa oferta de serviços, a necessidade de pagamento para deslocamentos e procedimentos médicos. Nesse sentido, fazem-se necessárias uma abordagem e intervenções das políticas públicas frente às desigualdades étnico-raciais, econômicas e de acesso aos serviços de cuidado em saúde.

Abstract This article aimed to map therapeutic itineraries in health care within rural Quilombola communities in the north of Minas Gerais, Brazil. This is a section of a qualitative research conducted in six visited communities. The data was collected through 18 individual interviews, analyzed using the theoretical-methodological framework of Therapeutic Itineraries, and organized into three empirical themes. The narratives allowed for understanding the paths taken in health care by the Quilombola population, identifying the components of the popular subsystem (natural resources, the use of teas and home remedies), the family subsystem (transmission of knowledge and cultural heritage of care), and the professional subsystem (hospital level, medical care, primary and specialized attention). The difficulties of access are not only due to geographical distances, but also broader aspects of social determination, such as institutional racism, low availability of services, the need for payment for transportation and medical procedures. In this sense, it is necessary to have an approach and interventions from public policies to address ethnic-racial, economic, and access inequalities in health care services.

A new genus and species of pinworm (Nematoda, Oxyuridae) from the gray mouse opossum, Tlacuatzin canescens.

Tlacuatzoxyuris simpsoni n. gen. n. sp. is described from the cecum of the gray opossum, Tlacuatzin canescens, a species endemic to the deciduous dry forest of Mexico. The digestive tracts of four specimens were examined for parasites; three of these were archived in the American Museum of Natural History and one was a live capture. Relative to the other four monotypic genera of pinworms known to infect opossums, the new genus is diagnosed on the basis of a round cephalic plate with a semicircular stoma surrounded by a rim. In addition, males feature a prominent cephalic vesicle not fully developed in females, accounting for sexual dimorphism. The new species includes small worms that feature a conspicuous, not reticulated cephalic vesicle and semicircular stoma and lateral alae with two crests. In addition, the postcloacal cuticle of males features a small area with ornamentation between cloaca and submedial papillae. Finally, both spicule and gubernaculum are relatively short. Although the eggs of Tlacuatzoxyuris n. gen. are unknown, the conspicuous differences in traits used in the diagnosis of genera prompted us to propose a new genus for the new species. This is the first species of Oxyuridae reported in mouse opossums outside South America, and the fifth species of the family occurring in didelphimorph marsupials. This is an example of the usefulness of documenting the diversity of parasites associated with this unique clade of mammals through the examination of preserved tissues.

Itinerários terapêuticos de mulheres quilombolas do norte de Minas Gerais, Brasil / Therapeutic itineraries of quilombola women in northern Minas Gerais, Brazil

Resumo Os quilombolas são grupos étnico-raciais de ancestralidade negra e tiveram seus territórios consolidados no Brasil em regiões com acesso difícil e distante dos grandes centros. O objetivo desse estudo é conhecer o itinerário terapêutico (IT) adotado por mulheres quilombolas em comunidades tradicionais localizadas no norte do estado de Minas Gerais. Trata-se de um estudo com abordagem qualitativa com o modelo teórico utilizando o sistema de cuidados à saúde de Arthur Kleinman. O estudo se deu em 23 comunidades quilombolas do norte de Minas Gerais. Foram entrevistadas 40 mulheres quilombolas, com idades entre 25 e 89 anos. A análise dos dados foi realizada seguindo os IT. Emergiram unidades de análise que foram agrupadas em três categorias: as mulheres quilombolas e o significado da saúde e do cuidado; o sistema de cuidado profissional nas comunidades quilombolas; e itinerário de cuidados nas situações vivenciadas pelas mulheres. O itinerário terapêutico das comunidades se mostra relacionado principalmente às ações de medicina popular. Foi possível observar ainda que existem fragilidades em relação à atenção à saúde devido a fatores como dificuldade de acesso aos serviços institucionalizados.

Abstract Quilombolas are ethnic-racial groups, of black ancestry, and had their territories consolidated in Brazil in regions with difficult access and far from large centers. The objective of this study is to know the therapeutic itinerary (IT) adopted by quilombola women in traditional communities located in the North of the state of Minas Gerais. This is a qualitative study with the theoretical model using the Arthur Kleinman health care system. The study scenario was 23 quilombola communities in northern Minas Gerais. Forty quilombola women aged between 25 and 89 years were interviewed. Data analysis was performed following the IT. Units of analysis emerged that were grouped into three categories: quilombola women and the meaning of health and care; the professional care system in quilombola communities; and route of care in situations experienced by women. The therapeutic itinerary of the communities is mainly related to the actions of popular medicine. It was also possible to observe that there are weaknesses in relation to health care due to factors such as difficulty of access to institutionalized services.