In Vitro Cytotoxic and Leishmanicidal Activity of Isolated and Semisynthetic ent-Pimaranes from Aldama arenaria.

Two pimaranes ent-pimara-8(14),15-dien-19-oic acid (1: ) and ent-8(14),15-pimaradien-3ß-ol (2: ), isolated from Aldama arenaria, and six semi-synthetic derivatives methyl ester of the ent-pimara-8(14),15-dien-19-oic acid (3: ), ent-pimara-8(14),15-dien-19-ol (4: ), acetate of ent-pimara-8(14),15-dien-19-ol (5: ), ent-pimara-8(14),15-dien-19-ol succinic acid (6: ), acetate of ent-8(14),15-pimaradien-3ß-ol (7: ), ent-8(14),15-pimaradien-3ß-ol succinic acid (8: ) were evaluated in vitro for their cytotoxic activities to childhood leukemia cell lines and leishmanicidal activity against the parasite Leishmania amazonensis. Among these compounds, 1: to 6: presented moderate cytotoxic activity, with compound 4: being the most active (GI50 of 2.6 µM for the HL60 line) and the derivatives 7: and 8: being inactive. Against the parasite Leishmania amazonensis, the most promising derivative was the acetate of ent-pimara-8(14),15-dien-19-ol (5: ), with EC50 of 20.1 µM, selectivity index of 14.5, and significant reduction in the parasite load. Pimarane analogues 1: , ent-pimara-8(14),15-dien-19-oic acid, and 2: , ent-8(14),15-pimaradien-3ß-ol, presented different activities, corroborating the application of such molecules as prototypes for the design of other derivatives that have greater cytotoxic or leishmanicidal potential.

Dihydroartemisinin, an active metabolite of artemisinin, interferes with Leishmania braziliensis mitochondrial bioenergetics and survival.

Leishmaniasis is one of the most neglected parasitic infections of the world and current therapeutic options show several limitations. In the search for more effective drugs, plant compounds represent a powerful natural source. Artemisinin is a sesquiterpene lactone extracted from Artemisia annua L. leaves, from which dihydroartemisinin (DQHS) and artesunic acid (AA)/artesunate are examples of active derivatives. These lactones have been applied successfully on malaria therapy for decades. Herein, we investigated the sensitivity of Leishmania braziliensis, one of the most prevalent Leishmania species that cause cutaneous manifestations in the New World, to artemisinin, DQHS, and AA. L. braziliensis promastigotes and the stage that is targeted for therapy, intracelular amastigotes, were more sensitive to DQHS, showing EC50 of 62.3 ± 1.8 and 8.9 ± 0.9 µM, respectively. Cytotoxicity assays showed that 50% of bone marrow-derived macrophages cultures were inhibited with 292.8 ± 3.8 µM of artemisinin, 236.2 ± 4.0 µM of DQHS, and 396.8 ± 6.7 µM of AA. The control of intracellular infection may not be essentially attributed to the production of nitric oxide. However, direct effects on mitochondrial bioenergetics and H2O2 production appear to be associated with the leishmanicidal effect of DQHS. Our data provide support for further studies of artemisinin and derivatives repositioning for experimental leishmaniasis.

Endophytic fungi from Passiflora incarnata: an antioxidant compound source.

Endophytes are considered one of the most important microbial resources for obtaining biomolecules of therapeutic use. Passiflora incarnata, widely employed by the pharmaceutical industry, shows therapeutic effects on anxiety, nervousness, constipation, dyspepsia and insomnia based on their antioxidant compounds. In this study, from 315 endophytic fungi isolated from P. incarnata leaves, 60 were selected to determinate presence of chemical constituents related with antioxidant activity, based on their production of soluble pigments. The promising fungi were evaluated specifically on their potential to produce phenolic compounds, flavonoids and for antioxidant activity. Five isolates significantly produced flavonoids and phenolic compounds in the ethyl acetate and n-Butanol extracts, also saponins and high antioxidant activity against the DPPH (2.2-diphenyl-1-picrylhydrazyl) free radical. A strain of Aspergillus nidulans var. dentatus (former Emericella dentata) was able to produce tannins as well; its butanolic extract was very similar than the BHT (butylated hydroxytoluene) (94.3% × 94.32%) and Rutin (95.8%) reference substances in the DPPH radical scavenging. Similarly, a Chaetomium strain exhibited 93.6% and 94.7% of antioxidant activity in their ethyl acetate and butanolic fractions, respectively. The chromatographic analysis of the ethyl acetate fraction from the Aspergillus strain revealed the production of orcinol (3.19%). Four-methoxymethylphenol (4.79%), sorbicillin (33.59%) and ergosterol (23.08%) was produced by Trichoderma longibrachiatum and isopropenyl-1,4-dimethyl-1,2,3,3a,4,5,6,7-octahydroazulene were found in two Fusarium oxysporum strains. The phytochemical screening showed that all analyzed fungi were able to produce a kind of secondary metabolite (phenols, flavonoids, tannins and/or saponins). The study shows a great underexplored potential for industrial application of P. incarnata endophytes.

Prospecting and Identifying Phyllanthus amarus Lignans with Antileishmanial and Antitrypanosomal Activity.

Ten lignans (1:  - 10: ) were isolated from the hexane-ethyl acetate extract of Phyllanthus amarus leaves. Three of them, cubebin dimethyl ether (3: ), urinatetralin (4: ), and lintetralin (7: ) are described for the first time in this species, while phyllanthin (1: ), niranthin (2: ), 5-demethoxyniranthin (5: ), isolintetralin (6: ), hypophyllanthin (8: ), nirtetralin (9: ), and phyltetralin (10: ) have been already reported from P. amarus. Among the lignans tested against Trypanosoma cruzi intracellular amastigotes, 2: was the most active with an EC50 of 35.28 µM. Lignans 2, 5, 7: , and 9: showed inhibitory effects against Leishmania amazonensis promastigotes with EC50 of 56.34, 51.86, 23.57, and 43.27 µM, respectively. During in vitro infection assays, 5: reduced amastigotes by 91% at 103.68 µM concentration, whereas 7: and 9: reduced amastigotes by approximately 84% at 47.5 and 86.04 µM, respectively. Lignans 5, 7: , and 9: were more potent in intracellular amastigotes with EC50 of 2.76, 8.30, and 15.83 µM, respectively, than in promastigotes. CC50 for all samples was > 100 µg/mL, thus revealing low cytotoxicity against macrophages, and selectivity against the parasite. L. amazonensis promastigotes treated with compounds 2: and 9: showed decreased respiratory control of 38% and 25%, respectively, suggesting a change in mitochondrial membrane potential and lower ATP production.

In vitro and in vivo evaluation of six artemisinin derivatives against Schistosoma mansoni.

Schistosomiasis is a tropical neglected disease whose socioeconomic impact is surpassed only by malaria. Until recently, praziquantel (PZQ) has been the only available drug, raising concerns that tolerant/resistant strains may appear. Since the discovery of the schistosomicidal potential of artemisinin (ART), new derivatives have been produced and evaluated. In this work, we evaluated the activity of ART derivatives against Schistosoma mansoni, both in vitro and in vivo. In the in vitro assay, worm survival, oviposition, and morphological alterations were evaluated. Further analysis of morphological alterations and membrane integrity was conducted using scanning electron microscopy and a cell-permeable, benzimidazole dye (Hoescht 33258) that binds to the minor groove of double stranded DNA. For the in vivo assay, artesunic acid (AcART) and dihydroartemisinin acetate (AcDQHS) were selected, since they showed the best in vitro results. Infected mice treated 21, 45, or 60 days post-infection (dpi), with a concentration of 100 mg/kg of either AcART or AcDQHS, showed a significant worm reduction (particularly in females), fewer eggs eliminated in feces, and a decrease of immature eggs in the intestinal tissues. Our results indicate that AcART and AcDQHS have some schistosomicidal activity against juvenile and adult stages of S. mansoni.

Schistosoma mansoni: In vivo evaluation of Phyllanthus amarus hexanic and ethanolic extracts.

Human schistosomiasis is an important neglected tropical disease caused by blood flukes of the genus Schistosoma and is responsible for more than 280,000 deaths annually. Treatment for this disease relies currently on a single drug, praziquantel (PZQ). Concerns regarding PZQ resistance and insensitivity of juvenile schistosomes have increased the interest in resorting to medicinal plants for alternative drug therapies. This study aimed to perform an in vivo schistosomicidal activity evaluation of crude hexanic (HE) and ethanolic (EE) extracts obtained from Phyllanthus amarus in mice infected with Schistosoma mansoni (BH strain). Mice were treated orally with a single dose of 100 or 250 mg/kg, on two different infection periods, 30 and 45 days post-infection (dpi). Parameters such as worm recovery, faecal egg count, intestinal tissue egg count and liver histopathology were evaluated. Treatment against young adult (30 dpi) and adult (45 dpi) worms were more effective compared to the control group treated with PZQ. At a concentration of 250 mg/kg (30 dpi) EE showed a 54.4% female reduction and a 61.2% total worm reduction whilst at a concentration of 100 mg/kg (45 dpi) HE showed a 40.6% female worm reduction and a 45.3% total worm reduction. Histopathological examination showed a granuloma decrease in both number and size for groups treated with 250 mg/kg of HE (45 dpi) or EE (30 or 45 dpi). From these results, it can be concluded that both hexanic and ethanolic extracts have antischistosomal activities, however, act differently according to the parasites age. The schistosomicidal activity results in groups treated 30 days post infection is extremely important since praziquantel does not show activity against the juvenile forms of Schistosoma.

The effect of Spondias mombin L. against Strongyloides venezuelensis: An in vitro approach.

Strongyloidiasis is a neglected tropical disease mainly caused by the nematode parasite Strongyloides stercoralis. Current treatment consists in the administration of ivermectin or, alternatively, albendazole (or analogues). Concerns regarding these drugs' irregular cure rates and side effects, raise a need for therapeutic alternatives. In this study, we tested the in vitro effect of Spondias mombin L. ethanolic extract against the laboratory model for strongyloidiasis, Strongyloides venezuelensis. The ethanolic extract was further fractionated and each fraction was also tested. Tested fractions were analyzed through thin layer chromatography and gas chromatography (GC/MS). Our results showed that S. mombin extract and fractions had a better in vitro effect than ivermectin, particularly fraction 4 which showed the better results causing 100% mortality in 4 h after exposure to an extract concentration of 400 µg/mL of RPMI medium and caused 100% mortality 12 h after exposure to an extract concentration of 50 µg/mL. Scanning electron microscopy showed that this fraction caused both wrinkling and peeling of the parasites cuticle, whilst ivermectin only caused wrinkling. GC/MS showed a high percentage of monoaromatic phenolic lipids (3-R phenol and 3-R1 phenol), which were likely responsible for the anti-Strongyloides effect. The use of polyvinylpyrrolidone reduced the efficiency, thus raising a need for alertness when using this excipient. Our results suggest that S. mombin is a potential source of compounds that could be used for stongyloidiasis treatment.

Antimicrobial and anthelmintic activities of the ethanolic extract, fractions and isolated compounds from Manilkara zapota L. P. Royen (Sapotaceae).

OBJECTIVES: To evaluate the antibacterial, antifungal and anthelmintic activities of the ethanolic extract (EEMz), fractions (LPFMz and HPFMz) and compounds isolated from the leaves of Manilkara zapota L. P. Royen. METHODS: Extract and fractions were produced by turbolization. LPFMz fraction was analysed by gas chromatography-mass spectrometry. The isolated compounds from HPFMz were purified by flash and preparative chromatographic methods, and chemically characterised by UPLC-ESITOFMS, optical rotation, and one- and two-dimensional 1H and 13C NMR techniques. Anthelmintic against Strongyloides venezuelensis and antimicrobial activities against Candida albicans, Trichophyton rubrum and Staphylococcus aureus were evaluated. KEY FINDINGS: EEMz showed mainly phenolic compounds and pentacyclic triterpenes from Δ12-oleane/Δ12-ursane series. Chlorogenic acid, myricetin-3-O-ß-D-glucopyranoside, mearnsitrin, germanicol and germanicol acetate were reported to M. zapota leaves for the first time in this work. EEMz, HPFMz, LPFMz showed significative activity against C. albicans (16 µg/mL), while isolated flavonoids were active against S. aureus (<32 µg/mL). EEMz, phenolic-rich compounds (F2), and chlorogenic acid were potentially active against S. venezuelensis at 24 h. CONCLUSIONS: M. zapota and its bioactive compound can be eligible such as a potential phytomedicine for the treatment of microbial and strongyloidiasis drug-resistant infections.

Deep in the Jelly: Histochemical and Functional Aspects of Mucilage-Secreting Floral Colleters in the Orchids Elleanthus brasiliensis and E. crinipes.

Colleters are trichomes or emergencies that produce a sticky exudate consisting of a mixture of mucilage, lipids, terpenes, and phenolic compounds. Colleters occur in at least 60 families of angiosperms; however, reports of them are scarce for the Orchidaceae. Elleanthus brasiliensis is distinguished by the presence of an abundant gelatinous secretion that covers almost all of its inflorescences. We aimed to describe the histology of colleters in inflorescences of E. brasiliensis and Elleanthus crinipes, and to analyze the chemical composition of their secretion to better understand the functions of these secretory structures. Due to the low frequency of colleters and lack of visible secretion in E. crinipes, histochemical tests and chemical analyses were not performed for this species. Colleters are of a brush type and their secretion has, at the same time, hydrophilic and lipophilic components. Histochemical tests further revealed the presence of pectin, mucilage, lipids, terpenes, phenolic compounds, and proteins. The GC-MS analysis confirmed the presence of γ-sitosterol and palmitic, linoleic, and stearic acids in the secretion of E. brasiliensis. Infrared analysis indicated the possible presence of polysaccharides in the secretion. The occurrence of colleters in both species studied and in other orchids described in the literature suggests that these structures are common in the inflorescences of tropical orchids. In these environments, the hydrated polysaccharides in the secretion form a dense matrix that can act as a physical barrier, and terpenes may help to protect against herbivores and pathogenic microorganisms. This information broadens our knowledge of the morphological and chemical diversity of the secretions produced by orchid colleters.

Selective attention: psi performance in children with learning disabilities.

UNLABELLED: Selective attention is essential for learning how to write and read. AIM: The objective of this study was to examine the process of selective auditory attention in children with learning disabilities. MATERIAL AND METHOD: Group I included forty subjects aged between 9 years and six months and 10 years and eleven months, who had a low risk of altered hearing, language and learning development. Group II included 20 subjects aged between 9 years and five months and 11 years and ten months, who presented learning disabilities. A prospective study was done using the Pediatric Speech Intelligibility Test (PSI). RESULT: Right ear PSI with an ipsilateral competing message at speech/noise ratios of 0 and -10 was sufficient to differentiate Group I and Group II. Special attention should be given to the performance of Group II on the first tested ear, which may substantiate important signs of improvements in performance and rehabilitation. CONCLUSION: The PSI - MCI of the right ear at speech/noise ratios of 0 and -10 was appropriate to differentiate Groups I and II. There was an association with the group that presented learning disabilities: this group showed problems in selective attention.

Development of a Gas Chromatography Method for the Analysis of Copaiba Oil.

A rapid, simple, precise and economic method for the quantification of main compounds of copaiba resin and essential oils (Copaifera langsdorffii Desf.) by gas chromatography (GC) has been developed and validated. Copaiba essential oil was extracted by hydrodistillation from the copaiba resin. Resin derivatization allowed the identification of diterpenes compounds. A gas chromatography-mass spectroscopy (GC/MS) method was developed to identify compounds composing the copaiba resin and essential oil. Then the GC/MS method was transposed to be used with a flame ionization detector (FID) and validated as a quantitative method. A good correlation between GC/MS and GC/FID was obtained favoring method transposition. The method showed satisfactory sensitivity, specificity, linearity, precision, accuracy, limit of detection and limit of quantitation for ß-caryophyllene, α-humulene and caryophyllene oxide analyses in copaiba resin and essential oils. The main compounds identified in copaiba essential oil were ß-bisabolene (23.6%), ß-caryophyllene (21.7%) and α-bergamotene (20.5%). Copalic acid methyl ester (15.6%), ß-bisabolene (12.3%), ß-caryophyllene (7.9%), α-bergamotene (7.1%) and labd-8(20)-ene-15,18-dioic acid methyl ester (6.7%) were diterpenes identified from the derivatized copaiba resin. The proposed method is suitable for a reliable separation, identification and quantification of compounds present in copaiba resin and essential oil. It could be proposed as an analytical method for the analysis of copaiba oil fraction in raw and essential oil parent extracts and after they have been incorporate in pharmaceutical formulations.

Sesquiterpenes evaluation on Schistosoma mansoni: Survival, excretory system and membrane integrity.

The main challenge in schistosomiasis control has been the emergence of drug-resistant parasites. Since the 1970's, praziquantel (PZQ) is the single drug for treatment. This fact highlights the importance to research news chemotherapeutic agents. In the last years, S. mansoni excretory system and tegument have been major targets for drug development. The purpose of this study was to evaluate the effect of sesquiterpenes, alpha-humulene and trans-caryophyllene on S. mansoni survival, excretory system and membrane integrity, after in vitro exposure. The in vitro studies, showed that sesquiterpenes reduced egg production and motor activity of worms at sublethal concentrations, and caused death in a concentration-dependent manner (100 and 200µg/mL). Tegumental analysis by Scanning Electron Microscopy (SEM), showed tegument damage. Additionally, it was possible to observe lesions, evidenced by intense marking trough Hoechst probe, in the tegument and suckers of worms exposed to 200µg/mL. In this study, we also showed that resorufin is only capable of identifying the interaction of sesquiterpenes in males excretory system, Pgp expression and inferring that females are more tolerant to treatments. Thus, the present study results contribute to an understanding of alpha-humulene and trans-caryophyllene effect over these targets, contributing for the development of schistosomicidal drugs.

Atividades profissionais do fonoaudiólogo na Atenção Primária à Saúde no Brasil: consenso de especialistas / Speech therapists/ audiologists professional activities in Primary Health Care in Brazil: expert consensus / Actividades profesionales de logopedas en atención primaria de salud en Brasil: consenso de expertos

Introdução: A inserção da Fonoaudiologia na Atenção Primária à Saúde (APS) no Brasil se fortaleceu com a criação dos Núcleos de Apoio à Saúde da Família (NASF), a partir de 2008. No entanto, os NASF, juntamente com a APS e o Sistema Único de Saúde (SUS), têm sido cada vez mais atacados pelo desfinanciamento causado pela conjuntura política atual. Faz-se necessário que os gestores em saúde reconheçam a necessidade de manter tal profissão nesse cenário e, para tanto, precisam conhecer as atividades desenvolvidas pelos fonoaudiólogos na APS. Objetivo: identificar as atividades profissionais do fonoaudiólogo na APS no Brasil. Método: Utilizou-se a e-Delphi para obter consenso, cujo critério foi 70%. Resultados: Participaram 45, 31 e 26 fonoaudiólogos da Saúde Coletiva (nas etapas 1, 2 e 3) e 28 fonoaudiólogos de outras áreas, na etapa 4. As atividades comuns incluíram: trabalho em equipe, atendimento compartilhado, educação permanente, referência/contrarreferência, elaboração de material educativo, vigilância em saúde, emissão de relatórios/pareceres e exercício da gestão. As atividades específicas abrangeram: apoio matricial em Fonoaudiologia, políticas de saúde e ordenamento das redes de atenção voltadas à saúde fonoaudiológica, promoção, prevenção, diagnóstico situacional, acolhimento, orientação e acompanhamento fonoaudiológico, construção e sistematização de dados epidemiológicos, promoção de ambientes saudáveis à comunicação humana, orientações quanto ao escopo da Fonoaudiologia, atendimento individual, coletivo e domiciliar, ações voltadas a grupos populacionais específicos, triagens e gerenciamento fonoaudiológico. Conclusão: As atividades apontadas no estudo encontram-se em consonância com a literatura e tangenciam os atributos da APS.

Introduction: The insertion of Speech-Language Pathology and Audiology in Primary Health Care (PHC) in Brazil took place more strongly with the creation of the Family Health Support Centers (NASF), starting in 2008. However, the NASF, together with the PHC and the Unified Health System (SUS), has been increasingly attacked by the shortfall caused by the current political situation. It is necessary that health managers recognize the importance of maintaining this profession in this scenario and, therefore, they need to know the activities developed by speech therapists in PHC. Objective: Identify the professional activities of the speech therapists/audiologists in PHC in Brazil. Methods: E-Delphi was used to obtain consensus, whose criterion was 70%. Results: 45, 31 and 26 public health speech therapists participated (in stages 1, 2 and 3) and 28 speech therapists/audiologists from other areas in stage 4. Common activities included: teamwork, shared care, continuing education, referral / counter-reference, elaboration of educational material, health surveillance, reporting / advice and management exercise. The specific activities included: matrix support in speech therapy, health policies and planning of care networks focused on speech health, promotion, prevention, situational diagnosis, reception, guidance and follow-up speech therapy, construction and systematization of epidemiological data, promotion of healthy environments to human communication, guidance on the scope of speech therapy, individual, collective and home care, actions aimed at specific population groups, screening and speech management. Conclusion: The activities pointed out in the study are in line with the literature and touch the attributes of PHC.

Introduccion: La inserción de la Logopedia en la Atención Primaria de Salud (APS) en Brasil se produjo con mayor fuerza con la creación de los Centros de Apoyo a la Salud de la Familia (NASF), a partir de 2008. Sin embargo, la NASF, junto con la APS y el Sistema Único de Salud (SUS), ha sido cada vez más atacado por el déficit provocado por la actual situación política. Es necesario que los gestores de salud reconozcan la importancia de mantener esta profesión en este escenario y, por tanto, necesitan conocer las actividades que desarrollan los logopedas en la APS. Objetivo: Identificar las actividades profesionales del logopeda en la APS en Brasil. Metodos: Para obtener el consenso se utilizó E-Delphi, cuyo criterio fue del 70%. Resultados: Participaron 45, 31 y 26 logopedas de salud pública (en las etapas 1, 2 y 3) y 28 logopedas de otras áreas en la etapa 4. Las actividades comunes incluyeron: trabajo en equipo, atención compartida, educación continua, referencia / contra-referencia, preparación de material educativo, vigilancia de la salud, informes/asesoramiento y ejercicio de gestión. Las actividades específicas incluyeron: apoyo matricial en terapia del habla, políticas de salud y planificación de redes de atención enfocadas en la salud del habla, promoción, prevención, diagnóstico situacional, recepción, orientación y seguimiento de la terapia del habla, construcción y sistematización de datos epidemiológicos, promoción de ambientes saludables para comunicación humana, orientación sobre el alcance de la terapia del habla, atención individual, colectiva y domiciliaria, acciones dirigidas a grupos de población específicos, detección y manejo del habla. Conclusión: Las actividades señaladas en el estudio están en línea con la literatura y tocan los atributos de la APS.

Phytochemical Analysis and Antifungal Activity of Extracts from Leaves and Fruit Residues of Brazilian Savanna Plants Aiming Its Use as Safe Fungicides.

The increasing demand for safe food without preservatives or pesticides residues has encouraged several studies on natural products with antifungal activity and low toxicity. In this study, ethanolic extracts from leaves and fruit residues (peel and seeds) of three Brazilian savanna species (Acrocomia aculeata, Campomanesia adamantium and Caryocar brasiliense) were evaluated against phytopathogenic fungi. Additionally, the most active extract was chemically characterized by ESI-MS and its oral acute toxicity was evaluated. Extracts from C. brasiliense (pequi) peel and leaves were active against Alternaria alternata, Alternaria solani and Venturia pirina with minimal inhibitory concentrations between 350 and 1000 µg/mL. When incorporated in solid media, these extracts extended the lag phase of A. alternata and A. solani and reduced the growth rate of A. solani. Pequi peel extract showed better antifungal activity and their ESI-MS analysis revealed the presence of substances widely reported as antifungal such as gallic acid, quinic acid, ellagic acid, glucogalin and corilagin. The oral acute toxicity was relatively low, being considered safe for use as a potential natural fungicide.

An interdisciplinary space of scientific communication in Collective (Public) Health: the journal interface--Communication, Health, Education.

This is a reflection upon 17 years of experience in the production of an interdisciplinary scientific journal, the publication "Interface: Communication, Health, Education," whose scope is in the fields of Collective (Public) Health, Education and Communication. It also examines retrospectively the themes published by the journal, seeking to identify them in different sections of this publication. Finally, the evolution of the journal is analyzed.

Relationship among Medical Student Resilience, Educational Environment and Quality of Life.

CONTEXT: Resilience is a capacity to face and overcome adversities, with personal transformation and growth. In medical education, it is critical to understand the determinants of a positive, developmental reaction in the face of stressful, emotionally demanding situations. We studied the association among resilience, quality of life (QoL) and educational environment perceptions in medical students. METHODS: We evaluated data from a random sample of 1,350 medical students from 22 Brazilian medical schools. Information from participants included the Wagnild and Young's resilience scale (RS-14), the Dundee Ready Educational Environment Measure (DREEM), the World Health Organization Quality of Life questionnaire - short form (WHOQOL-BREF), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). RESULTS: Full multiple linear regression models were adjusted for sex, age, year of medical course, presence of a BDI score ≥ 14 and STAI state or anxiety scores ≥ 50. Compared to those with very high resilience levels, individuals with very low resilience had worse QoL, measured by overall (ß=-0.89; 95% confidence interval =-1.21 to -0.56) and medical-school related (ß=-0.85; 95%CI=-1.25 to -0.45) QoL scores, environment (ß=-6.48; 95%CI=-10.01 to -2.95), psychological (ß=-22.89; 95%CI=-25.70 to -20.07), social relationships (ß=-14.28; 95%CI=-19.07 to -9.49), and physical health (ß=-10.74; 95%CI=-14.07 to -7.42) WHOQOL-BREF domain scores. They also had a worse educational environment perception, measured by global DREEM score (ß=-31.42; 95%CI=-37.86 to -24.98), learning (ß=-7.32; 95%CI=-9.23 to -5.41), teachers (ß=-5.37; 95%CI=-7.16 to -3.58), academic self-perception (ß=-7.33; 95%CI=-8.53 to -6.12), atmosphere (ß=-8.29; 95%CI=-10.13 to -6.44) and social self-perception (ß=-3.12; 95%CI=-4.11 to -2.12) DREEM domain scores. We also observed a dose-response pattern across resilience level groups for most measurements. CONCLUSIONS: Medical students with higher resilience levels had a better quality of life and a better perception of educational environment. Developing resilience may become an important strategy to minimize emotional distress and enhance medical training.

Implantação da residência médica e multiprofissional em saúde da família em um município paulista: percepção de residentes da primeira turma (2014-2016) / Implementation of medical and multi-professional residency in family health in health in a São Paulo municipality: first class residents' perception of (2014-2016)

Introdução: No Sistema Único de Saúde (SUS), a implantação de novos modelos assistenciais, como a Estratégia Saúde da Família, vem demandando uma qualificação dos profissionais. Nessa direção, a Residência em Saúde constitui modalidade de ensino de pós-graduação lato sensu, caracterizada pela formação em serviço. Assim, no município de Sorocaba/SP, foram implantados Programas de Residência Médica e Multiprofissional em Saúde da Família. Objetivos: Identificar e analisar as percepções da primeira turma de residentes (2014-2016) a respeito de sua experiência nos Programas de Residência em Saúde da Família. Método: Foi utilizada a abordagem qualitativa de pesquisa, com a técnica do grupo focal. Foram realizados grupos com residentes de Enfermagem, Medicina e Odontologia. O material foi analisado segundo os princípios da análise temática. Resultados: Foram obtidas quatro categorias: a) as várias mudanças de 2014; b) a preceptoria e a tutoria; c) a estruturação do programa; d) a percepção do aprendizado ao final da residência. Discussão: Os residentes consideraram que a experiência vivida foi interessante e proveitosa. Vários dos pontos críticos apontados por eles são semelhantes às experiências de implantação de residência em Saúde da Família de outros municípios. Conclusão: O estudo aponta um caminho possível para a formação dos profissionais de saúde para o SUS, especialmente para sua principal estratégia de organização da Atenção Básica, que é a Estratégia de Saúde da Família.(AU)

Introduction: In the Brazilian Unified Health System, the implementation of novel healthcare models, such as Family Health Strategy, demands training and qualification of new professionals. In this setting, Healthcare Residency constitutes a lato sensu graduation marked by in-service education. In the city of Sorocaba/ SP, Medical and Multi-professional Family Health Residency Programs were implemented. Objectives: To pinpoint and analyze the perceptions of the first class residents regarding their experience in these Programs. Method: A qualitative research approach, with the focal group technique was used. Groups with residents that made up the Family Health core team (Nursing, Medicine and Dentistry) were created. The material was analyzed according to the principles of thematic analysis. Results: Four categories were obtained: a) the various changes in 2014; b) tutoring and mentoring; c) the structuring of the program; d) the learning perception at the end of the residency. Discussion: Residents have considered the experience they have been through to be very exciting and profitable. Several of the critical points raised by the residents are similar to implementation experiences of residency in Family Health in other cities. Conclusion: The study suggests a possible way to train healthcare professionals to the Unified Health System, especially for its main organization strategy of Basic Attention, which is the Family Health Strategy.(AU)

Incorporando a Competência Cultural para Atenção à Saúde Materna em População Quilombola na Educação das Profissões da Saúde / Incorporating Cultural Competence for Maternal Healthcare in the Quilombola Population into Health Profession Training

RESUMO INTRODUÇÃO: A educação das relações étnico-raciais e a história da cultura afro-brasileira, previstas nas Diretrizes Curriculares Nacionais do curso de graduação em Medicina como temas transversais, representam um desafio para o desenvolvimento curricular no contexto da social accountability, das metodologias de ensino e dos cenários de prática e integração à rede de serviços de saúde. OBJETIVOS: Identificar as necessidades relacionadas à saúde materna em população quilombola, valorizando os valores, conhecimentos, saberes e cultura local. Estabelecer uma estratégia de cuidado, com participação discente, que contemple as necessidades identificadas na comunidade quilombola. Descrever os conhecimentos, habilidades e atitudes necessários ao desenvolvimento de competências culturais relacionadas à saúde materna das mulheres quilombolas. MÉTODOS: Pesquisa-ação para implantação de serviço de atenção interprofissional no pré-natal, com participação discente, tendo por base as necessidades da comunidade quilombola Capoeiras, em Macaíba (RN). Os dados foram analisados qualitativamente, pela técnica de análise de conteúdo temática categorial, com categorias definidas a priori. RESULTADOS: A criação de vínculos (a)efetivos entre usuárias e equipe de saúde e a habilidade de reflexão com ênfase na comunicação se mostraram como principais necessidades para o comportamento culturalmente competente no cuidado à saúde materna quilombola. As oportunidades de o estudante de Medicina conhecer a situação de saúde da população quilombola e vivenciar o trabalho interprofissional se mostraram estratégias efetivas para potencializar o desenvolvimento de competências culturais na formação médica. CONCLUSÕES: A formação de profissionais da saúde hábeis em interagir eficazmente com populações etnicamente diversas requer que estes conheçam os processos que influenciam a saúde e cuidados de saúde das minorias populacionais, além de vivências relacionadas à diversidade cultural, inseridas nos currículos médicos.

ABSTRACT INTRODUCTION: Training in ethnic and race relations and the history of Afro-Brazilian culture, established in the National Curricular Directives for Undergraduate Medical Courses as a transversal theme, represents a challenge for developing curricula in terms of social accountability, teaching methodologies and work experience in practical settings with integration into the health service network. OBJECTIVE: To identify the maternal health care needs among the quilombola population, appreciating the local culture, values and knowledge. To set a care strategy with student participation which contemplates the identified needs in the quilombola community. To describe the knowledge, skills and attitudes required for the development of cultural competencies related to maternal health care of quilombola women. METHODS: Action research for the implantation of interprofessional prenatal care services with student participation, based on the needs of the quilombola community of Capoeiras, in Macaiba (RN). The information gathered was analyzed qualitatively by means of content analysis, with a priori definition of the thematic categories. RESULTS: The formation of affective bonds between users and the health team, and communication skills that help enable reflection were found as the main needs for culturally competent behavior in maternal care of the quilombola community. The medical students' opportunity to learn about the health of the quilombola people and to have an interprofessional work experience proved to be effective strategies to leverage the development of cultural skills in medical training. CONCLUSIONS: The training of health professionals capable of interacting effectively with ethnically diverse populations requires their understanding the processes that influence the health and healthcare of ethnic minorities, as well as experiences related to cultural diversity, included in medical curricula.

Anatomical characters and chemical profile of leaves of three species in Lauraceae family

ABSTRACT The Lauraceae family is widely distributed in tropical and subtropical climates, has more than 2500 species and in the taxonomic point of view, it is one of the most difficult families to identify species. The aim of this study was to analyze the leaf anatomy of three species of Lauraceae (Ocotea indecora (Schott) Mez, Nectandra barbellata Coe-Teix. and Endlicheria paniculata (Spreng.) J.F.Macbr.) and identify the chemical profile of essential oil extracted from the leaves by hydrodistillation method. The leaves of the three species were obtained in "Parque Estadual Intervales", Atlantic Forest, São Paulo state, Brazil. Samples of leaves were fixed, dehydrated, embedded in synthetic resin and sectioned for mounting histological slides for anatomical description of leaf tissues. The essential oil extracted by hydrodistillation method from dried leaves was analyzed by gas chromatography to establish its chemical profile. The leaves are hypostomatic, the epidermis in E. paniculata and N. barbellata present regular cells walls and irregular cells walls in O. indecora in both sides of epidermis. The three species present a dorsiventral mesophyll. Histochemical analyses presented lipid substances in secretory cavity and cuticle; starch, phenolic compounds and mucilage were observed in parenchyma cells of midrib and mesophyll. Ultra structural analyses demonstrated that trichomes in the species E. paniculata and O. indecora are shown only on the abaxial leaf face and species N. barbellata presented trichomes on both sides of the epidermis (abaxial and adaxial). Ocotea indecora essential oil revealed as main compound the bicyclogermacrene and N. barbellata the δ-cadinene. The species showed different morphological characters and different compounds of the essential oil, being these data useful for the differentiation of the species.