Análise da Transmissão de Leishmaniose Visceral no Nordeste Brasileiro, no Período 2001-2015

A Leishmaniose Visceral (LV) representa um grave problema de saúde pública, considerada pela Organização Mundial de Saúde (OMS, 2016) como uma das doenças tropicais negligenciadas pelo poder público. A LV tem como fatores de exposição a sua expansão geográfica, as condições sociodemográficas da população e as condições climáticas. Diante desse cenário, o objetivo deste estudo é identificar possíveis fatores climáticos e sociodemográficos que influenciam na transmissão da LV no Nordeste brasileiro (NEB). Os dados climáticos foram coletados a partir de informações disponibilizadas pelo Climate Prediction Center / National Oceanic and Atmospheric Administration (CPC/NOAA), de janeiro de 2001 a dezembro de 2015. As informações sociodemográficas foram obtidas dos censos 2000 e 2010, enquanto as estimativas populacionais foram disponibilizadas pelo Instituto Brasileiro de Geografia e Estatística (IBGE). As notificações dos casos registrados de LV foram disponibilizadas pelo Departamento de Informática do SUS (DATASUS). Para análise espacial dos dados, aplicou-se o Índice de Moran, para as médias trianuais 2001-2003 e 2013-2015. Detectou-se correlação espacial significativa tanto no triênio de 2001-2003 quanto no 2013-2015 ). Além disso, utilizou-se o teste estatístico de Mantel-Haenszel para análise da relação entre o tipo de transmissão e as variáveis (Estimativa populacional, grau de urbanização, Índice de Desenvolvimento Humano Municipal - IDHM, saneamento inadequado, temperatura mínima, temperatura média, temperatura máxima, precipitação acumulada, umidade relativa do ar e altitude). Através do teste Mantel-Haenszel detectou-se associação significativa para os dois períodos estudados entre as variáveis: população residente estimada, grau de urbanização, IDHM e saneamento inadequado versus o tipo de transmissão de LV. O teste Mantel-Haenzsel mostrou associação significativa para tipo de transmissão e as variáveis climáticas, Temperatura Média, Temperatura Mínima, Temperatura Máxima, Precipitação Acumulada e Umidade Relativa do ar, principalmente no período 2013-2015. Além disso, foi usado o teste estatístico de Mantel-Haenszel para análise da relação entre o tipo de transmissão de LV e algumas variáveis (estimativa populacional, grau de urbanização, Índice de Desenvolvimento Humano Municipal - IDHM, saneamento inadequado, temperatura mínima, temperatura média, temperatura máxima, precipitação acumulada, umidade relativa do ar, altitude). Através deste teste foi verificada associação significativa, para os dois períodos estudados, entre as variáveis: população residente estimada, grau de urbanização, IDHM e saneamento inadequado versus o tipo de transmissão de LV. O teste Mantel-Haenszel também mostrou associação significativa para tipo de transmissão e as variáveis climáticas tais como temperatura (média, mínima e máxima), precipitação acumulada e umidade relativa do ar, principalmente no período 2013-2015

Conociendo a los tutores de Medicina Interna: nuevas necesidades para la formación

Introducción y objetivos Los tutores son los responsables de planificar el aprendizaje de los residentes. El objetivo de este trabajo es conocer la situación de los tutores de Medicina Interna en España y detectar áreas de mejora que puedan facilitar su trabajo. Material y métodos Encuestas online a tutores de Medicina Interna de mayo a julio de 2017 con análisis posterior de los datos. Resultados Respondieron 110 tutores, de 13 comunidades autónomas y hospitales de todos los niveles con docencia en Medicina Interna. Sesenta y tres fueron hombres (57, 3%), la media de edad fue de 48 años y tenían una experiencia como tutores de 8, 5 años. En el 88, 2% de los casos se respeta la ratio de cinco residentes por tutor; un 46% piensa que debería disminuirse esta ratio para optimizar su labor. Un tercio había sido elegido por el responsable del servicio y el 30% nunca ha realizado cursos sobre formación. La entrevista tutor-residentes es utilizada por la mayoría de los tutores (96, 4%) como herramienta de comunicación. En relación a las rotaciones, la cuarta parte no son planificadas por los tutores y, solo la mitad, contacta con los centros donde los residentes realizan las rotaciones externas. El 61% cree que no se realiza bien la evaluación de residentes, con muy escasa utilización de las nuevas herramientas de evaluación. Conclusiones Disminuir la ratio tutor/residente y la formación en técnicas de evaluación y desarrollo del aprendizaje podría mejorar la calidad de la tutorización. Introduction and objectives: Mentors are responsible for planning the residents’ learning. The aim of this study was to determine the situation of internal medicine mentors in Spain and detect areas of improvement that can facilitate their work. Material and methods: Online surveys were sent to internal medicine mentors from May to July 2017, the results of which were subsequently analysed. Results: A total of 110 mentors from 13 autonomous communities and from hospitals of all levels with courses in internal medicine responded to the survey. Of these mentors, 63 were men (57.3%), and the mean age was 48 years. The mean experience as mentors was 8.5 years. Some 88.2% of the cases had a ratio of 5 residents to 1 mentor; 46% of the mentors believed this ratio should be decreased to optimize their work. A third of the mentors were chosen by the heads of the department, and 30% had not previously taken courses on training. The mentor-resident interview was used by most mentors (96.4%) as a communication tool. A quarter of the rotations were not planned by the mentors, and only half had contact with the centres where the residents performed the external rotations. Sixty-one percent of the mentors were of the opinion that resident assessments were not conducted properly, with very little use of the new assessment tools. Conclusions: Reducing the mentor-resident ratio and adding training in assessment techniques and learning development could improve the quality of the mentoring

Factors contributing to attrition behavior in diabetes self-management programs: A mixed method approach

<p>Abstract</p> <p>Background</p> <p>Diabetes self-management education is a critical component in diabetes care. Despite worldwide efforts to develop efficacious DSME programs, high attrition rates are often reported in clinical practice. The objective of this study was to examine factors that may contribute to attrition behavior in diabetes self-management programs.</p> <p>Methods</p> <p>We conducted telephone interviews with individuals who had Type 2 diabetes (n = 267) and attended a diabetes education centre. Multivariable logistic regression was performed to identify factors associated with attrition behavior. Forty-four percent of participants (n = 118) withdrew prematurely from the program and were asked an open-ended question regarding their discontinuation of services. We used content analysis to code and generate themes, which were then organized under the Behavioral Model of Health Service Utilization.</p> <p>Results</p> <p>Working full and part-time, being over 65 years of age, having a regular primary care physician or fewer diabetes symptoms were contributing factors to attrition behaviour in our multivariable logistic regression. The most common reasons given by participants for attrition from the program were conflict between their work schedules and the centre's hours of operation, patients' confidence in their own knowledge and ability when managing their diabetes, apathy towards diabetes education, distance to the centre, forgetfulness, regular physician consultation, low perceived seriousness of diabetes, and lack of familiarity with the centre and its services. There was considerable overlap between our quantitative and qualitative results.</p> <p>Conclusion</p> <p>Reducing attrition behaviour requires a range of strategies targeted towards delivering convenient and accessible services, familiarizing individuals with these services, increasing communication between centres and their patients, and creating better partnerships between centres and primary care physicians.</p

Diversity, Phylogeny and Expression Patterns of Pou and Six Homeodomain Transcription Factors in Hydrozoan Jellyfish Craspedacusta sowerbyi

Formation of all metazoan bodies is controlled by a group of selector genes including homeobox genes, highly conserved across the entire animal kingdom. The homeobox genes from Pou and Six classes are key members of the regulation cascades determining development of sensory organs, nervous system, gonads and muscles. Besides using common bilaterian models, more attention has recently been targeted at the identification and characterization of these genes within the basal metazoan phyla. Cnidaria as a diploblastic sister group to bilateria with simple and yet specialized organs are suitable models for studies on the sensory organ origin and the associated role of homeobox genes. In this work, Pou and Six homeobox genes, together with a broad range of other sensory-specific transcription factors, were identified in the transcriptome of hydrozoan jellyfish Craspedacusta sowerbyi. Phylogenetic analyses of Pou and Six proteins revealed cnidarian-specific sequence motifs and contributed to the classification of individual factors. The majority of the Craspedacusta sowerbyi Pou and Six homeobox genes are predominantly expressed in statocysts, manubrium and nerve ring, the tissues with sensory and nervous activities. The described diversity and expression patterns of Pou and Six factors in hydrozoan jellyfish highlight their evolutionarily conserved functions. This study extends the knowledge of the cnidarian genome complexity and shows that the transcriptome of hydrozoan jellyfish is generally rich in homeodomain transcription factors employed in the regulation of sensory and nervous functions

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Genetic characterization of an arctic zooplankter: insights into geographic polyploidy

Species of Bosmina from the temperate regions of North America and Europe are diploid and reproduce by cyclical parthenogenesis. By contrast, this study provides evidence that the dominant bosminid taxon in High Arctic lakes reproduces by obligate parthenogenesis and is a polyploid derived from interspecific hybridization. Sinobosmina liederi, a species common in temperate North America, is likely to have been one parent of these hybrids, but the other parent is unknown. As neither parent was detected in the Arctic, it seems unlikely that the hybrid clones that now occupy arctic lakes were synthesized locally. Most habitats contained only one or two clones, despite a total of 38 clones in the region, suggesting that priority effects have been important in restricting diversity within single lakes. The high regional diversity of arctic bosminids could reflect either repeated hybridization between the parent taxa or the genetic instability of newly formed polyploid lineages. These processes would produce hybrid polyploids that are considerably more diverse than their sexual parent taxa, and this difference in genetic diversity may confer an advantage to the polyploid biotype. As many zooplankton taxa from the arctic possess genetic characteristics similar to those of bosminids, these processes may provide a general explanation for the widespread occurrence of polyploids in the Arctic

Expanding access to contraceptive choice in Canada

Every woman should possess the power to decide whether or not she chooses to become pregnant at any given point in her life. Unplanned pregnancy may have a huge impact on a woman’s health, economic, and social well-being, and yet an estimated 41% of pregnancies worldwide are unintentional. There are a multitude of reversible contraceptive options available and many factors that contribute to a woman’s decision regarding which method is right for her. Efficacy, effort and side effect profile are important considerations and vary widely between methods. Surprisingly, condoms and the oral contraceptive pill, which have relatively high typical use failure rates at 21% and 9% respectively and require frequent user action, are the most popular reversible contraceptive options in Canada. In contrast, intrauterine contraceptive devices, with failure rates of &lt;0.8% and almost no user action, have extremely poor uptake. Recognizing that the variation of side effect profiles will also impact use, this disconnect between efficacy, effort and use suggests that forces beyond the intrinsic merits of a contraceptive system play a role in these decisions. Cost and accessibility can both inhibit the use of intrauterine systems, which are a large upfront investment and require physician insertion. Peers, the media and providers all influence contraceptive decision-making and may also contribute their own bias. We advocate for providing public funding for all contraceptive options as well as engaging in open discussion with both patients and the public to improve our delivery of reproductive health care