Primary Care in Alagoas: the expansion of the Family Health Strategy, of the Nasf and of the nourishment and nutrition component

The article describes the evolution of Primary Health Care in Alagoas, with emphasis on the enlargement of the Family Health Strategy, of the Support Center for Family Health, and of the nourishment and nutrition component. Descriptive study using information systems datas of the Ministry of Health. The Family Health Strategy has been extended in Alagoas, with simultaneous adherence to the Support Center for Family Health, and increase in the coverage of iron and vitamin A supplementation, and of the Nutritional Alimentary Surveillance System. There was favorable evolution in Primary Care in the state, with regard to the population coverage of the Family Health Strategy, to the Support Center for Family Health, and to the nutrition’s component, highlighting the need for studies that evaluate the quality of these policies.O artigo descreve a evolução da Atenção Básica à Saúde de Alagoas, com ênfase na ampliação da Estratégia Saúde da Família, do Núcleo de Apoio à Saúde da Família e do componente alimentação e nutrição. Estudo descritivo utilizando dados de sistemas de informação do Ministério da Saúde. A Estratégia Saúde da Família se ampliou em Alagoas, com simultânea adesão ao Núcleo de Apoio à Saúde da Família e aumento na cobertura da suplementação de ferro e vitamina A, e do Sistema de Vigilância Alimentar Nutricional. Houve evolução positiva na Atenção Básica no Estado, em relação à cobertura populacional da Estratégia Saúde da Família, do Núcleo de Apoio à Saúde da Família e do componente da nutrição, ressaltando-se a necessidade de estudos que avaliem a qualidade dessas políticas.Universidade Federal de Alagoas Faculdade de NutriçãoUniversidade Federal de PernambucoUniversidade Federal de São Paulo (UNIFESP)Universidade de São PauloUNIFESPSciEL

Mapping of the specialized police station for women in Paraíba: perception of employees in relation to Maria da Penha law

Aim:Study the mapping of employees from the specialized precincts for women (DEMs) and their perception of the Maria da Penha law. Methodology: Quantitative-qualitative study conducted in municipalities of Paraiba that have DEMs. The sample was composed of 30 employees and the instruments used were a form and interviews related to the Maria da Penha law, which were recorded on MP3 and transcribed and analyzed using the Discourse of the Collective Subject. Result: The Maria da Penha Law is important for protecting women against violence. It has led to an increased work load at the precincts because it transformed a civil process into a police inquiry. In general, the employees enjoyed working at the DEM; however, there are human resource and infrastructure problems. Conclusion : The study subjects believe that the law should be enforced more effectively by the state, by providing comprehensive assistance to victims of violence, including shelter and counseling to the families involved in the process.Estudar o Mapeamento dos funcionários das Delegacias Especializadas da Mulher (DEM) e a percepção em relação à Lei Maia da Penha.Metodologia: Pesquisa quanti-qualitativa, realizada nos municípios paraibanos que possuem DEMs. A amostra foi composta por 30 funcionários, sendo os instrumentos utilizados formulário e entrevistas a respeito da Lei Maria da Penha registradas por mp3, as quais foram transcritas e analisadas utilizando a Técnica Discurso do Sujeito Coletivo (DSC). Resultado: A Lei Maria da Penha é importante para inibir a violência contra a mulher. A mesma aumentou o trabalho nas Delegacias porque transformou a forma processual em inquérito policial, no entanto as vítimas desistiam de continuar o procedimento, por serem dependentes emocional e financeiramente do companheiro. Conclusão: Os pesquisados acreditam que a Lei deva ser aplicada de maneira mais efetiva pelo Estado, procurando prestar atendimento completo às vítimas de violência, desde abrigo até recuperação da família envolvida no processo

Who takes part in what? : experiences of shared construction in Brazil-Canada cooperation for the improving management in primary health care

O artigo analisa processos e resultados da construção compartilhada de conhecimento e intervenção no Projeto de Aperfeiçoamento da Gestão da Atenção Primária (AGAP) desenvolvido no âmbito da cooperação Brasil e Canadá em quatro Estados da região Nordeste do País, utilizando metodologia de avaliação com enfoque nos alcances e aprendizagens, que tem como pressuposto a cooperação e participação das partes, preconiza a triangulação mediante a combinação de abordagens e de técnicas qualitativa e quantitativa caracterizada como multimétodos, a partir da identificação dos momentos que significaram encontros de compartilhamento, elementos que dificultaram ou facilitaram este processo e das lições apreendidas. A pesquisa avaliativa compreendeu análise documental, observação de encontros presenciais, oficina com o Comitê Gestor de Avaliação para apresentação e pactuação da proposta, oficinas de avaliação com os projetos locais, observação de unidades de saúde nos municípios, entrevistas semiestruturadas com sujeitos estratégicos dos níveis locais, regionais, nacional e internacional. Os resultados demonstraram que a relação de cooperação Brasil/Canadá é promissora, entretanto precisa ser construída de forma mais cooperada e dialogada em que os objetos da cooperação sejam construídos de forma compartilhada.The article examines processes and outcomes of the shared construction of knowledge and intervention in the Project for Improving Management of Primary Health Care (AGAP) developed cooperatively between Brazil and Canada. It involves four states in the Northeast region, uses the evaluation methodology with focus on achievements and learning and presupposes the cooperation and participation of stakeholders; the project, characterized as using multi methods, advocates triangulation through a combination of quantitative and qualitative approaches and techniques after identifying the moments in which sharing encounters happened, as well as the elements which hinder or facilitate this process and lessons learned. Evaluative research used the following methodology: document analysis; observation of meetings; workshop with the Evaluation Steering Committee for presentation and agreement of the proposal submitted; evaluation workshops on local projects, observation of health care services in the municipalities, semi-structured interviews with strategic interlocutors of local, regional, national and international levels. The results showed that the cooperation relationship between Brazil and Canada is promising, but needs to be built in a more cooperative and dialogical way, in which objects of cooperation are constructed in a shared form

Insecticide susceptibility of Aedes albopictus and Ae. aegypti from Brazil and the Swiss-Italian border region

Aedes aegypti and Ae. albopictus are two highly invasive mosquito species, both vectors of several viruses, including dengue, chikungunya and Zika. While Ae. aegypti is the primary vector in the tropics and sub-tropics, Ae. albopictus is increasingly under the public health watch as it has been implicated in arbovirus-transmission in more temperate regions, including continental Europe. Vector control using insecticides is the pillar of most control programmes; hence development of insecticide resistance is of great concern. As part of a Brazilian-Swiss Joint Research Programme we set out to assess whether there are any signs of existing or incipient insecticide resistance primarily against the larvicide Bacillus thuringiensis svar. israelensis (Bti), but also against currently applied and potentially alternative insecticides in our areas, Recife (Brazil) and the Swiss-Italian border region.; Following World Health Organization guidelines, dose-response curves for a range of insecticides were established for both colonized and field caught Ae. aegypti and Ae. albopictus. The larvicides included Bti, two of its toxins, Cry11Aa and Cry4Ba, Lysinibacillus sphaericus, Vectomax CG®, a formulated combination of Bti and L. sphaericus, and diflubenzuron. In addition to the larvicides, the Swiss-Italian Ae. albopictus populations were also tested against five adulticides (bendiocarb, dichlorodiphenyltrichloroethane, malathion, permethrin and λ-cyhalothrin).; Showing a similar dose-response, all mosquito populations were fully susceptible to the larvicides tested and, in particular, to Bti which is currently used both in Brazil and Switzerland. In addition, there were no signs of incipient resistance against Bti as larvae were equally susceptible to the individual toxins, Cry11Aa and Cry4Ba. The field-caught Swiss-Italian populations were susceptible to the adulticides tested but DDT mortality rates showed signs of reduced susceptibility.; The insecticides currently used for mosquito control in Switzerland and Brazil are still effective against the target populations. The present study provides an important reference as relatively few insecticide susceptibility surveys have been carried out with Ae. albopictus

Controlling ETEC colonization on cultures of an intestinal pig cell line with a T4-like phage

Enterotoxigenic Escherichia coli (ETEC) colonizes the intestine of young pigs causing severe diarrhoea and consequently bringing high producing costs. The rise of antibiotic selective pressure together with on-going limitation on their use demands news strategies to tackle this pathology. The pertinence of using phages to tackle this problematic is being explored, and in this work, the efficacy of a T4-like phage vB_EcoM_FJ1 (FJ1) in reducing the load of ETEC O9:H9 (Sta, F5/F41) was assessed. FJ1 has a 170,053 bp genome, and of the 270 coding sequences none corresponds to identified undesirable proteins, such as integrases or transposases. Envisaging the oral application to piglets, FJ1 was previously encapsulated on CaCO3/alginate. Assays were performed on 15-day cultures of the intestinal pig cell line IPEC-1 seeded in transwell inserts. Phage treatment occurred 2 hours after ETEC infection, when, in average, 5x105 CFU.cm-2 were adhered to cultured cells. Encapsulated phage provided reductions of, approximately, 2.3 Log CFU.cm-2 and 2.8 Log CFU.cm-2 on adhered bacteria, respectively 3 and 6 hours after administration. The repeated exposure of the host to FJ1 led to the emergence of phage-insensitive mutants, phenotype that brought fitness costs to the host strain: they were 70% more vulnerable to the pig complement system and less efficient in adhering to cultured cells (in about 90%). Overall, FJ1 is presented here as promising to fight against ETEC infections through oral administration to piglets.info:eu-repo/semantics/publishedVersio

Epidemiologia das taxas de internação e de mortalidade por acidente vascular cerebral isquêmico no Brasil

Introduction: Ischemic Cerebrovascular Accident (ICVA) is characterized by the occlusion of a blood vessel in the brain with interruption of the oxygen supply, being the most frequent form of stroke, representing 87% of cases. Thus, the aim of the current study is to evaluate the trend of hospitalization (HR) and mortality (MR) rates due to stroke by age group, between 2011 and 2020. Methodology: This is a analytical, observational and retrospective study. The number of hospitalizations and deaths due to stroke was obtained from the Mortality Information System (SIM) and population data from the Brazilian Institute of Geography and Statistics (IBGE). HR and MR per 100,000 inhabitants were calculated, as well as their trends by segmented linear regression. Annual percentage changes (APCs) were obtained with 95% confidence intervals (95%CI). Results: Brazil had 223,210 hospitalizations and 23468 deaths due to stroke in the period. HR and MR were higher according to age in all years. There was a decreasing trend for both HR (APC= -4,5) and MR (APC= -7,9) for the total population. With the exception of the age groups from 1 to 39 years old, the others had decreasing HR. While in MR, only the age group between 1 and 19 years showed a stationary trend. Discussion: The decrease in HR and MR coincided with the period of implementation of the Hiperdia program whose objective is to link patients with systemic arterial hypertension and diabetes mellitus to health units, guaranteeing them systematic treatment which prevents risk factors modifiable factors of great impact on the occurrence of stroke. Conclusion: It is extremely important to raise awareness of the population regarding modifiable factors for stroke, as well as the professional improvement of the service team since a shorter time for the approach is essential to avoid worse outcomes.Introdução: O Acidente Vascular Cerebral Isquêmico (AVCi) é caracterizado pela oclusão de um vaso sanguíneo do cérebro com interrupção do suprimento de oxigênio, sendo a forma mais frequente de AVC, representando 87% dos casos. Dessa forma, o objetivo do presente estudo é avaliar a tendência das taxas de internação (TI) e mortalidade (TM) por AVCi por faixa etária entre 2011 e 2020. Métodos: Trata-se de um estudo analítico, observacional e retrospectivo. Obtiveram-se o número de internações e óbitos por AVCi pelo Sistema de Informações sobre Mortalidade (SIM) e os dados populacionais do Instituto Brasileiro de Geografia e Estatística (IBGE). Calcularam-se a TI e TM por 100.000 habitantes, bem como suas tendências pela regressão linear segmentada. Obtiveram-se as variações percentuais anuais (APCs) com intervalos de 95% de confiança (IC95%). Resultados: O Brasil apresentou 223210 internações e 23468 óbitos por AVCi no período. As TI e TM apresentaram-se maiores conforme a idade em todos os anos. Houve uma tendência decrescente tanto da TI (APC= -4,5) quanto da TM (APC= -7,9) para a população total. Com exceção das faixas etárias de 1 a 39 anos, as demais apresentaram TI decrescentes. Enquanto na TM, apenas a faixa etária entre 1 e 19 anos demonstrou tendência estacionária. Discussão: O decréscimo da TI e da TM coincidiu com o período de implementação do programa Hiperdia cujo objetivo é vincular os portadores de hipertensão arterial sistêmica e diabetes mellitus às unidades de saúde, garantindo-lhes tratamento sistemático, o que previne os fatores de riscos modificáveis de grande impacto na ocorrência de AVCi. Conclusão: É de suma importância a conscientização da população quanto aos fatores modificáveis para AVCi, assim como é necessário o aprimoramento profissional da equipe de atendimento, visto que um menor tempo para a abordagem é essencial para evitar piores desfechos

Aneurysm in the Distal Portion of the Extern Jugular Vein in a Horse

Background: Aneurysm is a vascular disease that causes the partial rupture of arteries and veins and subsequent blood leakage due to the weakening of the vessels elastic middle layer. Venous aneurysms in horses are rare, but the arterial aneurysms are commonly reported. The aim of this paper is to report a rare occurrence of jugular external aneurysm in a horse and propose the inclusion this disease as a differential diagnosis, both because it is rare in this specie and invariably fatal. The medical examination showed a firm well-defined mass, painless, nonpulsatile on palpation and with no changed in the local temperature.Case: The horse was referred to the Veterinarian Hospital of the Federal University of Pelotas (UFPel, RS-Brazil. It was a male, Crioulo breed, 10 years old, used as stallion. The owner reported a swelling in the pectoral region that occurred after a trauma episode that had gradually grown for two years. The patient was clinically stable, and would undergo surgery extirpation for aesthetic matters. Clinical examination showed the swelling was circumscribed and centralized and it presented about 20 centimeters in diameter. The ultrasound of the pectoral area showed an anechoic structure with hyperechoic spots inside limited by an hyperechoic layer similar to a fibrous capsule. Presumptive diagnostics were of: hematoma, subcutaneous abscess, neoplasia, and possible vascular involvement. The use of conventional ultrasound was not enough to set the diagnosis, and the patient was referred to surgical exploration, where the procedures of isolation and anastomosis were performed, however rupture occurred and the patient died. Necropsy revealed sacculation of the ventral region of the neck next to the entrance of the thorax, and the involvement of the external right jugular vein, being the adjacent muscle tissue not involved. Histopathological evaluation showed intense proliferation of sub-endothelial fibrous tissue which infiltrated the tunica media and adventitia and a mild inflammatory infiltrate of lymphocytes and histiocytes, which was diagnosed as an aneurysm of the right external jugular vein.Discussion: The reported patient had a venous aneurysm located superficially, which may have contributed to the absence of symptoms. The ultrasound is a diagnostic method available to most veterinarians nowadays, mainly in the countryside. However, when it is used in the diagnosis of an aneurysm it displays a dilatation with anechoic content, which is com­mon to several other skin diseases. A similar ultrasound image was observed in the case reported, but the diagnosis was difficult because the aneurysm presented intense proliferation of fibrous tissue infiltrated in the media and adventitia of the vascular wall, similar to a capsule of fibrous tissue, which lead to the presumptive diagnostics of hematoma, abscess and neoplasia, with possible vascular involvement. The options for the treatment of the aneurysms consider the location, size and extent of them and it determines the choice between clinical observation and surgery. In veterinary medicine it is difficult to keep the animals still and in the case of a horse, any movement can lead to the spontaneous rupture of the aneurism. Considering the risk of spontaneous rupture and hemorrhage, the surgical resolution, even if risky, emerges as the most suitable treatment. Venous aneurysms although rare, need to be included as a differential diagnosis in skin diseases along with increased volume, as hematomas, abscesses and tumors. The prognosis, however, is poor because of the surgical limitations and risks of imminent rupture in the clinical treatment.Keywords: venous aneurysm, differential diagnosis, equine

AVALIAÇÃO DA FERTILIDADE DE RATOS Wistar SUBMETIDOS A TRATAMENTO CRÔNICO COM DECANOATO DE NANDROLONA: Dados preliminares

The search for the ideal body has been making people appeal increasingly to surgical intervention and medicine which can accelerate the aesthetic transformations that are so desired. Among these medicines, Anabolic-androgenic steroids (AAS) is being used, specially Nandrolone Decanoate (DECA), which has more anabolic than androgenic effects. However, it is not known at which point of the use of AAS can comprise fertility of male users. In this way, the objective of the present study was to evaluate the effects of chronic administration of doses of Nandrolone Decanoate in male Wistar rat fertility. For such a matter was used 20 rats Wistar, which 16 were males and 4 females, adults, with 8 weeks old, weighing 250 to 350g. Males were divided into two groups: Control and DECA group. Based on the data preliminarily obtained, even though observing some macroscopics abnormalities in the testicles of rats treated with DECA, such as testicular atrophy, apparently these steroids do not affect the reproductive male health significatively at the point of comprising the capacity of fertilization.A busca pelo corpo ideal tem feito com que as pessoas recorram cada vez mais à intervenção cirúrgica e à medicina que possam acelerar as tão desejadas transformações estéticas. Dentre esses medicamentos, estão sendo utilizados os esteróides anabólicos androgênicos (EAA), especialmente o Decanoato de Nandrolona (DECA), que possui efeitos mais anabólicos do que androgênicos. No entanto, não se sabe em que ponto do uso de AAS pode comprometer a fertilidade dos usuários do sexo masculino. Desta forma, o objetivo do presente estudo foi avaliar os efeitos da administração crônica de doses de Decanoato de Nandrolona na fertilidade de ratos Wistar machos. Para tal foram utilizados 20 ratos Wistar, sendo 16 machos e 4 fêmeas, adultos, com 8 semanas de idade, pesando 250 a 350g. Os machos foram divididos em dois grupos: grupo controle e grupo DECA. Com base nos dados obtidos preliminarmente, mesmo observando algumas anormalidades macroscópicas nos testículos de ratos tratados com DECA, como atrofia testicular, aparentemente esses esteróides não afetam a saúde reprodutiva masculina de forma significativa a ponto de comprometer a capacidade de fertilização