Social and economic impacts of congenital Zika syndrome in Brazil: Study protocol and rationale for a mixed-methods study

Global concern broke out in late 2015 as thousands of children in Brazil were born with microcephaly, which was quickly linked to congenital infection with Zika virus (ZIKV). ZIKV is now known to cause a wider spectrum of severe adverse outcomes—congenital Zika syndrome (CZS)—and also milder impairments. This study aimed to explore the social and economic impacts of CZS in Brazil. Data was collected through mixed methods across two settings: Recife City and Jaboatão dos Guararapes in Pernambuco State (the epicentre of the epidemic), and the city of Rio de Janeiro (where reports of ZIKV infection and CZS were less frequent). Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. In-depth qualitative interviews were conducted with: mothers and other carers of children with CZS (approximately 30 per setting), pregnant women (10-12 per setting), men and women of child-bearing age (16-20 per setting), and health professionals (10-12 per setting). Thematic analysis was undertaken independently by researchers from at least two research settings, and these were shared for feedback. A case-control study was undertaken to quantitatively explore social and economic differences between caregivers of a child with CZS (cases) and caregivers with an unaffected child (controls). We aimed to recruit 100 cases and 100 controls per setting, from existing studies. The primary caregiver, usually the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, stress, social support, family quality of life, health care and social service use, and costs incurred by families. Multivariable logistic regression analyses were used to compare outcomes for cases and controls. Costs incurred as a result of CZS were estimated from the perspective of the health system, families and society. Modelling was undertaken to estimate the total economic burden of CZS from those three perspectives

Saúde Integral na Terceira Idade: A Contribuição da Abordagem Holística

The article addresses aging as a global phenomenon that demands new caregiving paradigms, especially given the rapid growth of the elderly population in Brazil and worldwide. It emphasizes the importance of a holistic approach in promoting comprehensive elderly health, considering not only physical but also emotional, mental, social, and spiritual aspects. The central objective is to analyze how this approach can prevent and treat diseases, thereby enhancing the quality of life for this demographic. The study methodology involves a critical review of literature on elderly health policies in Brazil, highlighting historical evolution and current challenges. It discusses the shift from a paternalistic model to a more integrative and humanized approach, crucial for ensuring dignity and well-being among the elderly. Practical examples are provided, including the need for multidisciplinary teams and the integration of digital technologies for personalized and effective care. The discussion reflects on the necessity of reformulating public health policies, emphasizing the importance of social inclusion, physical environment, and community practices as essential elements for healthy aging. It concludes that adopting a holistic approach not only improves the quality of life for the elderly but also prepares societies to tackle future challenges related to aging populations with greater humanity and effectiveness.O artigo aborda o envelhecimento como um fenômeno global que demanda novos paradigmas de cuidado, especialmente em face do rápido crescimento da população idosa no Brasil e no mundo. Destaca-se a importância da abordagem holística na promoção da saúde integral dos idosos, considerando não apenas os aspectos físicos, mas também os emocionais, mentais, sociais e espirituais. O objetivo central é analisar como essa abordagem pode prevenir e tratar doenças, melhorando a qualidade de vida dessa parcela da população. A metodologia do estudo envolve uma revisão crítica da literatura sobre políticas de saúde do idoso no Brasil, destacando a evolução histórica e os desafios atuais. É discutida a transição do modelo assistencialista para um enfoque mais integrativo e humanizado, essencial para garantir a dignidade e o bem-estar dos idosos. Exemplos práticos são apresentados, incluindo a necessidade de uma equipe multidisciplinar e a integração de tecnologias digitais para um cuidado mais personalizado e eficaz. A discussão reflete sobre a necessidade de reformular as políticas públicas de saúde, enfatizando a importância da inclusão social, do ambiente físico e das práticas comunitárias como elementos essenciais para um envelhecimento saudável. Conclui-se que a adoção de uma abordagem holística não apenas melhora a qualidade de vida dos idosos, mas também prepara as sociedades para enfrentar os desafios futuros relacionados ao envelhecimento populacional com mais humanidade e eficácia

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Os mártires e a cristianização do território na América portuguesa, séculos XVI e XVII

O artigo investiga um grupo de atores sociais bastante relevante para viabilizar a cristianização na América portuguesa: os mártires cristãos, indivíduos muito especiais, dispostos a regar a terra com seu próprio sangue, de forma a tornar definitiva e irreversível a ocupação cristã do território. Os mártires - e principalmente a narrativa em torno deles - parecem ter sido bastante acionados para integrar a América portuguesa e seus habitantes nativos à temporalidade e territorialidade cristã. Os mártires dos séculos XVI e XVII, principalmente missionários, reeditavam os martírios do início da cristandade, que espalharam o cristianismo rumo a diversas partes do mundo na antiguidade. Dessa forma, viabilizaram a cristianização das novas fronteiras, consagrando o solo com seu sangue divino e viabilizando posteriores processos de urbanização. Além da função estratégica dos mártires para os cristãos, o texto mostra que eles também tiveram significado peculiar na interlocução com as culturas ameríndias, que tinha como um de seus principais personagens o grande guerreiro, disposto a perder seu sangue em prol de seu grupo.This paper looks into a group of social agents who played a significant role in the Christianization of Portuguese America, namely, the Christian martyrs - very special individuals who were ready to wet the land with their own blood in order to make possible a definitive and irreversible occupation of the territory by Christian settlers. The martyrs, and above all the stories told about them, seem to have been called upon to integrate Portuguese America and its native inhabitants into the temporalities and territory of Christendom. Mostly made up of missionaries, this group of 16th and 17th-century martyrs reedited the martyrdom of early Christians, who spread their creed across numerous parts of the Ancient World. They enabled the Christianization of new frontiers by consecrating the soil with their divine blood and paving the way for subsequent processes of urban development. In addition to their strategic significance for Christianity, the text also shows that their martyrdom played a specific role in the Christian settlers' interaction with Amerindian culture, whose main cults included the figure of the great warrior, ever ready to shed his own blood for his group

Combined fit to the spectrum and composition data measured by the Pierre Auger Observatory including magnetic horizon effects

The measurements by the Pierre Auger Observatory of the energy spectrum and mass composition of cosmic rays can be interpreted assuming the presence of two extragalactic source populations, one dominating the flux at energies above a few EeV and the other below. To fit the data ignoring magnetic field effects, the high-energy population needs to accelerate a mixture of nuclei with very hard spectra, at odds with the approximate E$^{-2}$ shape expected from diffusive shock acceleration. The presence of turbulent extragalactic magnetic fields in the region between the closest sources and the Earth can significantly modify the observed CR spectrum with respect to that emitted by the sources, reducing the flux of low-rigidity particles that reach the Earth. We here take into account this magnetic horizon effect in the combined fit of the spectrum and shower depth distributions, exploring the possibility that a spectrum for the high-energy population sources with a shape closer to E$^{-2}$ be able to explain the observations

Studies of the mass composition of cosmic rays and proton-proton interaction cross-sections at ultra-high energies with the Pierre Auger Observatory

In this work, we present an estimate of the cosmic-ray mass composition from the distributions of the depth of the shower maximum (Xmax) measured by the fluorescence detector of the Pierre Auger Observatory. We discuss the sensitivity of the mass composition measurements to the uncertainties in the properties of the hadronic interactions, particularly in the predictions of the particle interaction cross-sections. For this purpose, we adjust the fractions of cosmic-ray mass groups to fit the data with Xmax distributions from air shower simulations. We modify the proton-proton cross-sections at ultra-high energies, and the corresponding air shower simulations with rescaled nucleus-air cross-sections are obtained via Glauber theory. We compare the energy-dependent composition of ultra-high-energy cosmic rays obtained for the different extrapolations of the proton-proton cross-sections from low-energy accelerator data

Study of downward Terrestrial Gamma-ray Flashes with the surface detector of the Pierre Auger Observatory

The surface detector (SD) of the Pierre Auger Observatory, consisting of 1660 water-Cherenkov detectors (WCDs), covers 3000 km2 in the Argentinian pampa. Thanks to the high efficiency of WCDs in detecting gamma rays, it represents a unique instrument for studying downward Terrestrial Gamma-ray Flashes (TGFs) over a large area. Peculiar events, likely related to downward TGFs, were detected at the Auger Observatory. Their experimental signature and time evolution are very different from those of a shower produced by an ultrahigh-energy cosmic ray. They happen in coincidence with low thunderclouds and lightning, and their large deposited energy at the ground is compatible with that of a standard downward TGF with the source a few kilometers above the ground. A new trigger algorithm to increase the TGF-like event statistics was installed in the whole array. The study of the performance of the new trigger system during the lightning season is ongoing and will provide a handle to develop improved algorithms to implement in the Auger upgraded electronic boards. The available data sample, even if small, can give important clues about the TGF production models, in particular, the shape of WCD signals. Moreover, the SD allows us to observe more than one point in the TGF beam, providing information on the emission angle