Burden of leishmaniasis in Brazil and federated units, 1990-2016: Findings from Global Burden of Disease Study 2016.

BACKGROUND: The study presents estimates for the burden of visceral leishmaniasis (VL) and cutaneous and mucocutaneous leishmaniasis (CML) in Brazil and its 27 federated units using data from the Global Burden of Disease Study (GBD) 2016. METHODOLOGY: We report the incidence, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY) for leishmaniasis in Brazil from 1990 to 2016. The metrics are presented as age-standardized rates per 100,000 inhabitants with their respective uncertainty intervals (95%UI) and relative percentages of change. PRINCIPAL FINDINGS: The age-standardized incidence rate of leishmaniasis decreased 48.5% from 1990 (71.0, 95%UI 24.3-150.7) to 2016 (36.5, 95%UI 24.7-50.9), whereas the age-standardized DALY increased 83.6% over the studied period from 12.2 (95%UI 7.9-18.8) to 22.4 (95%UI 13.3-36.2). The age-standardized incidence rate and YLL for VL increased by 52.9% and 108% from 1990 to 2016, respectively. Considering CML, the age-standardized incidence rate and YLD decreased by 51% and 31.8% respectively for the same period. For VL, similar profiles for male and female were observed, with YLL and DALY increasing over time; with males presenting slightly higher values. The highest YLL rates were among "under 1-year old" children, which increased 131.2% from 1990 to 2016. Regarding CML, the highest values of YLD and DALY were verified among males, and YLD values showed a similar profile, with rates increasing with age. The VL burden increased in some states in the Northeast and Southeast regions and decreased for CML in some Northern states. CONCLUSION: The increase of VL burden over the study period might be associated with the difficulties in controlling the disease spread. Information regarding the weight of VL and CML, including the death and disability tolls that they cause, highlights the impact of these neglected diseases on public health and the importance of effective prevention and treatment

REORGANIZATION OF THE WORK PROCESS IN PRIMARY HEALTH CARE IN COPING WITH COVID-19

Objective: to assess the work process of Primary Health Care professionals in coping with COVID-19.Method: a qualitative study that used the health work process as conceptual basis and qualitative research as methodological framework. The collection procedure was carried out with 23 health professionals from July to September 2021, in the basic health units from a municipality in northwestern Paraná, Brazil. For the analysis, the data were organized by means of the MAXQDA software, and each data segment was organized according to the meanings.Results: two categories emerged, namely: Difficulties faced in reorganization of the ambience, programmatic activities and staffing of Primary Health Care professionals; and Organization of the care flow for users with COVID-19 in Primary Health Care.Conclusion: this study reinforces the indispensability of assessing the work process for health care improvement, especially in conditions of a public health emergency

Caracterização física de diferentes substratos e solo, após simulação de compactação em campo de polo, com grama bermuda ‘Tifway 419’ / Physical characterization of different substrates and soil, after simulation of polo field compaction, with bermudagrass 'Tifway 419'

A grama bermuda ‘Tifway 419’ é amplamente utilizada em campos esportivos de alta performance, como o polo equestre. Entretanto, diferente de outros esportes como futebol e golfe, o polo tem suas especificidades. O peso dos animais somados ao tráfego intenso durante as partidas de polo, submetem o gramado a um desgaste extremo, prejudicial a parte aérea da grama e as características físicas do solo. Dessa forma objetivou-se avaliar a propriedades físicas de diferentes substratos e solo, após dano ocasionado pela simulação de compactação em campo de polo, com grama bermuda ‘Tifway 419’. O experimento foi conduzido a campo com tapetes de grama implantados em contêineres de plástico preto (volume de 11 L), em delineamento inteiramente casualizado em esquema fatorial 3x1 com três repetições, sendo os tratamentos compostos pelos seguintes substratos: S1- 100% solo, S2- 70% solo + 30% areia, S3 60% solo + 20% areia + 20% condicionador de solo. Cada tratamento foi submetido a aplicação da força artificial de 150 Kgf cm-2, por meio de prensa hidráulica simulando da pisada de um cavalo. Foram avaliadas as macro, micro e porosidade total, densidade e umidade dos substratos no local onde foi realizada a compactação (ponto central) e no lateral de cada contêiner. Os resultados demonstraram que S3, à base de 60% solo + 20% areia + 20% condicionador de solo, se mostrou mais eficiente para resistir a carga aplicada, enquanto o uso apenas de solo não é indicado devido à grande compactação gerada.

Sexuality of women submitted to mastectomy: identification of phases affected in the sexual response cycle / Sexualidade de mulheres submetidas à mastectomia: identificação das fases afetadas no ciclo da resposta sexual

Objetivo deste estudo foi analisar a sexualidade das mulheres mastectomizadas, identificando quais as fases do ciclo da resposta sexual são afetadas e quais as disfunções desenvolvidas, utilizando um questionário com dados socioeconômicos e o Questionário Quociente Sexual - versão feminina. Trata-se de uma pesquisa descritiva de cunho quantitativo, com mulheres mastectomizadas em atendimento no ambulatório de Cuidado oncológicos. O desempenho sexual da população estudada apresentou-se heterogêneo, onde 50% apresentou padrão sexual satisfatório e 50% algum tipo de comprometimento na sexualidade, e dentro deste grupo, incluem-se as casadas, com menos de 49 anos e com grau de instrução de nível fundamental. Diante do exposto, os profissionais de saúde em geral devem estar atentos para a ocorrência dessas modificações na vida dessa mulher, diante do todo o processo, desde diagnóstico, no tratamento e readaptação, para dessa forma contribuir para o cuidado integral

Sexuality of women submitted to mastectomy: identification of phases affected in the sexual response cycle / Sexualidade de mulheres submetidas à mastectomia: identificação das fases afetadas no ciclo da resposta sexual

Objetivo deste estudo foi analisar a sexualidade das mulheres mastectomizadas, identificando quais as fases do ciclo da resposta sexual são afetadas e quais as disfunções desenvolvidas, utilizando um questionário com dados socioeconômicos e o Questionário Quociente Sexual - versão feminina. Trata-se de uma pesquisa descritiva de cunho quantitativo, com mulheres mastectomizadas em atendimento no ambulatório de Cuidado oncológicos. O desempenho sexual da população estudada apresentou-se heterogêneo, onde 50% apresentou padrão sexual satisfatório e 50% algum tipo de comprometimento na sexualidade, e dentro deste grupo, incluem-se as casadas, com menos de 49 anos e com grau de instrução de nível fundamental. Diante do exposto, os profissionais de saúde em geral devem estar atentos para a ocorrência dessas modificações na vida dessa mulher, diante do todo o processo, desde diagnóstico, no tratamento e readaptação, para dessa forma contribuir para o cuidado integral

REORGANIZACIÓN DEL PROCESO DE TRABAJO EN LA ATENCIÓN PRIMARIA DE LA SALUD PARA ENFRENTAR EL COVID-19

Objetivo: evaluar el proceso de trabajo de los profesionales de la salud en la atención primaria para enfrentar el Covid-19.Método: estudio cualitativo, que utilizó como base conceptual el proceso de trabajo en salud, y como referente metodológico la investigación evaluativa. La recolección se realizó con 23 profesionales de la salud, entre julio y septiembre de 2021, en unidades básicas de salud de un municipio del noroeste del estado de Paraná, Brasil. Para el análisis, los datos se organizaron utilizando el software MAXQDA, y cada segmento de datos se organizó en función de los significados.Resultados: surgieron dos categorías, a saber: Dificultades enfrentadas al reorganizar el ámbito, actividades programáticas y dimensionamiento de los profesionales de la atención primaria de la salud; y Organización del flujo de atención a usuarios con Covid-19 en la atención primaria de la salud.Conclusión: este estudio refuerza que es indispensable evaluar el proceso de trabajo para mejorar la atención de la salud, especialmente en condiciones de emergencia de salud pública

REORGANIZAÇÃO DO PROCESSO DE TRABALHO NA ATENÇÃO PRIMÁRIA À SAÚDE NO ENFRENTAMENTO À COVID-19

Objetivo: avaliar o processo de trabalho dos profissionais de saúde na atenção primária no enfrentamento à Covid-19.Método: estudo qualitativo, que utilizou como base conceitual o processo de trabalho em saúde, e, como referencial metodológico, a pesquisa avaliativa. A coleta foi realizada com 23 profissionais de saúde, entre julho e setembro de 2021, nas unidades básicas de saúde em um município no noroeste do Paraná-Brasil. Para a análise organizaram-se os dados por meio do software MAXQDA, e cada segmento de dado foi organizado conforme os significados.Resultados: emergiram duas categorias, a saber: Dificuldades enfrentadas na reorganização da ambiência, atividades programáticas e dimensionamento dos profissionais da atenção primária à saúde; e Organização do fluxo de atendimento ao usuário com Covid-19 na atenção primária à saúde.Conclusão: este estudo reforça a indispensabilidade da avaliação do processo de trabalho para melhoria da assistência em saúde, principalmente em condições de emergência de saúde pública

Antigenicity and Immunogenicity of Plasmodium vivax Merozoite Surface Protein-3

A recent clinical trial in African children demonstrated the potential utility of merozoite surface protein (MSP)-3 as a vaccine against Plasmodium falciparum malaria. the present study evaluated the use of Plasmodium vivax MSP-3 (PvMSP-3) as a target antigen in vaccine formulations against malaria caused by P. vivax. Recombinant proteins representing MSP-3 alpha and MSP-3 beta of P. vivax were expressed as soluble histidine-tagged bacterial fusions. Antigenicity during natural infection was evaluated by detecting specific antibodies using sera from individuals living in endemic areas of Brazil. A large proportion of infected individuals presented IgG antibodies to PvMSP-3 alpha (68.2%) and at least 1 recombinant protein representing PvMSP-3 beta (79.1%). in spite of the large responder frequency, reactivity to both antigens was significantly lower than was observed for the immunodominant epitope present on the 19-kDa C-terminal region of PvMSP-1. Immunogenicity of the recombinant proteins was studied in mice in the absence or presence of different adjuvant formulations. PvMSP-3 beta, but not PvMSP-3 alpha, induced a TLR4-independent humoral immune response in the absence of any adjuvant formulation. the immunogenicity of the recombinant antigens were also tested in formulations containing different adjuvants (Alum, Salmonella enterica flagellin, CpG, Quil A, TiterMax (R) and incomplete Freunds adjuvant) and combinations of two adjuvants (Alum plus flagellin, and CpG plus flagellin). Recombinant PvMSP-3 alpha and PvMSP-3 beta elicited higher antibody titers capable of recognizing P. vivax-infected erythrocytes harvested from malaria patients. Our results confirm that P. vivax MSP-3 antigens are immunogenic during natural infection, and the corresponding recombinant proteins may be useful in elucidating their vaccine potential.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)US National Institutes of Health, National Institute for Allergy and Infectious DiseasesSIgNHorizontal Programme on Infectious Diseases under the Agency for Science, Technology and Research (A*STAR, Singapore)Wellcome Trust of Great Britain, as part of the Oxford Tropical Medicine Research Programme of Wellcome Trust-Mahidol UniversityUniv São Paulo, Fac Ciencias Farmaceut, Dept Anal Clin & Toxicol, São Paulo, BrazilUniv Estadual Campinas, Dept Genet Evolucao & Bioagentes, Inst Biol, Campinas, SP, BrazilUniv São Paulo, Inst Ciencias Biomed, Dept Microbiol, BR-05508 São Paulo, BrazilNatl Univ Singapore, Yong Loo Lin Sch Med, Dept Microbiol, Singapore 117595, SingaporeAgcy Sci Technol & Res, Singapore Immunol Network, Biopolis, Singapore, SingaporeChurchill Hosp, Ctr Vaccinol & Trop Med, Oxford OX3 7LJ, EnglandMahidol Oxford Univ Trop Med Res Programme, Shoklo Malaria Res Unit, Mae Sot, ThailandEmory Univ, Emory Vaccine Ctr, Atlanta, GA 30322 USAEmory Univ, Yerkes Natl Primate Res Ctr, Atlanta, GA 30322 USAEmory Univ, Dept Med, Div Infect Dis, Atlanta, GA 30322 USACtr Dis Control & Prevent, Malaria Branch, Div Parasit Dis, Chamblee, GA USAUniversidade Federal de São Paulo, CTCMOL, Dept Microbiol Imunol & Parasitol, Escola Paulista Med, São Paulo, BrazilUniversidade Federal de São Paulo, CTCMOL, Dept Microbiol Imunol & Parasitol, Escola Paulista Med, São Paulo, BrazilFAPESP: 2010/09893-0US National Institutes of Health, National Institute for Allergy and Infectious Diseases: 1R01AI24710Web of Scienc

The burden of tuberculosis and attributable risk factors in Brazil, 1990-2017: results from the Global Burden of Disease Study 2017.

BACKGROUND: Tuberculosis (TB) continues to be an important cause of fatal and non-fatal burden in Brazil. In this study, we present estimates for TB burden in Brazil from 1990 to 2017 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017). METHODS: This descriptive study used GBD 2017 findings to report years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of TB in Brazil by sex, age group, HIV status, and Brazilian states, from 1990 to 2017. We also present the TB burden attributable to independent risk factors such as smoking, alcohol use, and diabetes. Results are reported in absolute number and age-standardized rates (per 100,000 inhabitants) with 95% uncertainty intervals (UIs). RESULTS: In 2017, the number of DALYs due to TB (HIV-negative and HIV-positive combined) in Brazil was 284,323 (95% UI: 240,269-349,265). Among HIV-negative individuals, the number of DALYs was 196,366 (95% UI: 189,645-202,394), while 87,957 DALYs (95% UI: 50,624-146,870) were estimated among HIV-positive individuals. Between 1990 and 2017, the absolute number and age-standardized rates of DALYs due to TB at the national level decreased by 47.0% and 68.5%, respectively. In 2017, the sex-age-specific TB burden was highest among males and in children under-1 year and the age groups 45-59 years. The Brazilian states with the highest age-standardized DALY rates in 2017 were Rio de Janeiro, Pernambuco, and Amazonas. Age-standardized DALY rates decreased for all 27 Brazilian states between 1990 and 2017. Alcohol use accounted for 47.5% of national DALYs due to TB among HIV-negative individuals in 2017, smoking for 17.9%, and diabetes for 7.7%. CONCLUSIONS: GBD 2017 results show that, despite the remarkable progress in reducing the DALY rates during the period, TB remains as an important and preventable cause of health lost to due premature death and disability in Brazil. The findings reinforce the importance of strengthening TB control strategies in Brazil through integrated and multisectoral actions that enable the access to prevention, early diagnosis, and timely treatment, with emphasis on high-risk groups and populations most vulnerable to the disease in the country

Health-related quality of life and functionality in primary caregiver of surviving pediatric COVID-19

ObjectivesTo prospectively assess health-related quality of life (HRQoL), global functionality, and disability in primary caregivers of surviving children and adolescents after COVID-19.MethodsA longitudinal observational study was carried out on primary caregivers of surviving pediatric post-COVID-19 patients (n = 51) and subjects without COVID-19 (n = 60). EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and 12-question WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) were answered for both groups. The univariate regression analysis was carried out using SPSS (v 20) and significance was established at 5%.ResultsThe median duration between COVID-19 diagnosis in children and adolescents and longitudinal follow-up visits was 4.4 months (0.8–10.7). The median age of children and adolescents caregivers with laboratory-confirmed COVID-19 was similar to primary caregivers of subjects without laboratory-confirmed COVID-19 [43.2 (31.6–60.9) vs. 41.5 (21.6–54.8) years, p = 0.08], as well as similar female sex (p = 1.00), level of schooling (p = 0.11), social assistance program (p = 0.28), family income/month U$ (p = 0.25) and the number of household’s members in the residence (p = 0.68). The frequency of slight to extreme problems (level ≥ 2) of the pain/discomfort domain according to EQ-5D-5L score was significantly higher in the former group [74% vs. 52.5%, p = 0.03, OR = 2.57 (1.14–5.96)]. The frequency of disability according to WHODAS 2.0 total score was similar to those without disability and unknown (p = 0.79); however, with a very high disability in both groups (72.5% and 78.3%). Further analysis of primary caregivers of children and adolescents with post-COVID-19 condition (PCC) [n = 12/51 (23%)] compared to those without PCC [n = 39/51(77%)] revealed no differences between demographic data, EQ-5D-5L and WHODAS 2.0 scores in both groups (p > 0.05).ConclusionWe longitudinally demonstrated that pain/discomfort were predominantly reported in approximately 75% of primary caregiver of COVID-19 patients, with high disability in approximately three-quarters of both caregiver groups. These data emphasized the prospective and systematic caregiver burden evaluation relevance of pediatric COVID-19