Necesidades de salud en la atención primaria: percepción de profesionales que actúan en la educación permanente

OBJETIVO: Conhecer o conceito de necessidades em saúde, segundo a percepção dos preceptores que integram uma equipe de Educação Permanente na Atenção Primária em Saúde de uma organização social. MÉTODOS: Utilizou-se entrevista semiestruturada com cinco preceptores vinculados à Educação permanente dessa Instituiçao e os achados foram categorizados e analisados, conforme a Taxonomia de Necessidades de Saúde e a luz da Teoria da Determinação Social do Processo Saúde-Doença. Os cinco profissionais da equipe de preceptoria de uma organização social da zona Leste paulistana participaram da pesquisa. RESULTADOS: Os participantes abordaram as quatro categorias propostas pela taxonomia, além de discorrerem sobre a identificação das necessidades e sua satisfação. CONCLUSÃO: Os profissionais acreditam que as necessidades de saúde da população não são atendidas em razão de questões relacionadas às condições de vida, políticas públicas e visão de mundo dos profissionais.OBJECTIVE: To know the concept of necessities in health, according to the perception of the mentors who integrate a team of Permanent Education in Primary Attention of Health, in a social organization. METHODS: It was used the semi-structured interview with five mentors linked to the constant Education of that Institution; the findings were categorized and analyzed according to the Taxonomy of Health Necessities, using the Social Determination Theory of the Health-Disease Process. The five mentors of the team of preceptors of a social organization in the Sao Paulo's Eastern zone participated of the inquiry. RESULTS: The participants examined the four categories proposed by the taxonomy, besides analyzing the identification of the necessities and its fulfillment. CONCLUSION: The professionals think that the populations' health necessities are not attended due to: 1) life conditions, 2) public policies, and 3) mentors' world vision.OBJETIVO: Conocer el concepto de necesidades de la salud, según la percepción de los instructores que integran un equipo de Educación Permanente en la Atención Primaria de la Salud de una organización social. MÉTODOS: Se utilizó la entrevista semiestructurada con cinco instructores vinculados a la Educación permanente de esa Institución; lo encontrado fue categorizado y analizado, conforme la Taxonomía de Necesidades de la Salud utilizando la Teoría de la Determinación Social del Proceso Salud-Enfermedad. Los cinco profesionales del equipo de instructores de una organización social de la zona Leste paulistana participaron de la investigación. RESULTADOS: Los participantes examinaron las cuatro categorías propuestas por la taxonomía, además de analizar la identificación de las necesidades y su satisfacción. CONCLUSIÓN: Los profesionales piensan que las necesidades de la salud de la población no son atendidas debido a cuestiones relacionadas a: 1) condiciones de vida, 2) políticas públicas, y 3) visión de mundo de los profesionales

A Política de Cooperação como Estratégia para a Inclusão de Pessoas com Deficiência Visual na Educação a Distância

This research aims to highlight the importance of the adoption of inclusive strategies in distance education (E-learning), in order to offer a quality learning for everyone. This study, based on a qualitative and exploratory approach, presents the results of interviews with 21 visual impaired volunteers, related to the reasons to adopt e-learning and their perceptions on accessibility in this modality. Furthermore, we analyzed the importance of cooperation between all those in teaching-learning process and in the development of a distance course (such as students, teachers, IT professionals, among others) to promote accessible communication. From the obtained data, we concluded that the policy of cooperation is a powerful strategy of inclusion for visual impaired people in e-learning settings as it decreases communicational barriers and increases the knowledge exchange between all the participants.     Keywords: Visual impairing. E-learning. Inclusion. Cooperation policy. Assistive technology.Esta pesquisa aborda a importância da adoção de estratégias inclusivas na educação a distância (EAD), com o objetivo de oferecer uma aprendizagem de qualidade para todos. O presente estudo, de abordagem qualitativa e exploratória, apresenta os resultados de entrevistas com 21 voluntários com deficiência visual, em relação as razões para escolher a EAD e suas percepções sobre a acessibilidade nessa modalidade educativa. Também analisamos a contribuição da cooperação entre todos os envolvidos no processo de ensino-aprendizagem e desenvolvimento de um curso a distância (como por exemplo alunos, professores, profissionais de informática, entre outros) para a promoção de uma comunicação acessível. A partir dos dados obtidos, concluímos que a política de cooperação é uma potente estratégia de inclusão de pessoas com deficiência visual na EAD, ao promover a diminuição de barreiras comunicacionais e aumentar a troca de conhecimento entre todos.    Palavras-chave: Deficiência visual. Educação a distância. Inclusão. Política de cooperação. Tecnologia assistiva.

Salmonella infection as a trigger for Polyarteritis Nodosa

Polyarteritis nodosa is a systemic necrotizing vasculitis that typically affects medium-sized muscular arteries, with occasional involvement of small muscular arteries. Most cases of polyarteritis nodosa are idiopathic but multiple infectious agents have been associated with this disease. We present a clinical case of a 72-year-old male with fever, diarrhoea and haemodynamic instability, diagnosed with a bacterial infection caused by Salmonella Typhi. One week after clinical resolution of the infection, the patient developed purpuric lesions with ulcers, pustules and necrotic areas accompanied by testicular pain and weight loss of 5 kg over the previous 15 days. A skin biopsy was performed and it revealed typical histologic signs of polyarteritis nodosa. The aetiologic association between bacteria of the genus Salmonella and polyarteritis nodosa has been previously described in the scientific literature but seldom meeting classification criteria and with histologic confirmation

Development and characterization of biointeractive gelatin wound dressing based on extract of Punica granatum Linn

Punica granatum Linn (pomegranate) extracts have been proposed for wound healing due to their antimicrobial, antioxidant, and anti-inflammatory properties. In this work, we designed biointeractive membranes that contain standard extracts of P. granatum for the purpose of wound healing. The used standard extract contained 32.24 mg/g of gallic acid and 41.67 mg/g of ellagic acid, and it showed high antioxidant activity (the concentration of the extract that produces 50% scavenging (IC50) 1.715 µg/mL). Compared to the gelatin-based membranes (GEL), membranes containing P. granatum extracts (GELPG) presented a higher maximal tension (p=0.021) and swelling index (p=0.033) and lower water vapor permeability (p=0.003). However, no difference was observed in the elongation and elastic modulus of the two types of membranes (p > 0.05). Our wound-healing assay showed that a GELPG-treated group experienced a significant increase compared to that of the control group in their wound contraction rates on days 3 (p < 0.01), 7 (p < 0.001), and on day 14 (p < 0.001). The GELPG membranes promoted major histological changes in the dynamics of wound healing, such as improvements in the formation of granular tissue, better collagen deposition and arrangement, and earlier development of cutaneous appendages. Our results suggest that a biointeractive gelatin-based membrane containing P. granatum extracts has a promising potential application for dressings that are used to treat wounds.The research was funded by FAPITEC/SE (Fundação de Apoio à Pesquisa e Inovação Tecnológica do Estado de Sergipe) and by the Brazilian Bureau of Research. T. Pashirova received the financial support from the government assignment for the FRC Kazan Scientific Center of Russian Academy of Sciences. E.B. Souto received the support from the projects M-ERA-NET-0004/2015-PAIRED and UIDB/04469/2020, granted by the Portuguese Science and Technology Foundation, Ministry of Science and Education (FCT/MEC) through national funds and co-financed by FEDER under the Partnership Agreement PT2020.info:eu-repo/semantics/publishedVersio

A influência da dupla tarefa no controle postural de adultos jovens

The aim of this study was to investigate the influence of dual-tasking on postural balance in young adults. Participants were 20 college students (10 men and 10 women) with a mean age of 25 years. Postural balance was evaluated by the Sensory Organization Test (SOT), using the Smart Equitest(tm) NeuroCom(r) International, which evaluates the individual's ability to use the different systems of postural control (somatosensory, vestibular and visual) to keep in balance in the 6 conditions of sensory conflict presented by the system. The subjects were evaluated while single-tasking (maintaining balance) and dual-tasking (maintaining balance in conjunction with cognitive mental calculation task) in randomized order. Balance was measured by using the balance score, comparing the angular differences between the maximum anterior and posterior displacements. The Wilcoxon test with significance level of p(0.05 was used to compare the mean scores of balance between the situation with and without dual task. The balance scores in SOT conditions were analyzed and demonstrated statistically significant differences in condition 1 (eyes open, fixed platform and visual surroundings; p=0.018) and condition 6 (eyes open, platform swings and fixed visual surroundings; p=0.008), with reduced balance when dual-tasking in both conditions. The results showed that while performing dual tasks, consisted of four arithmetic operations, the posture control is negatively affected, resulting in a greater oscillation of the subjects. Thus, the complexity of the secondary task may have been the main reason for the lower balance scores found.Este artículo tuvo por objetivo verificar la influencia de doble tarea en el equilibrio postural de adultos jóvenes. Se han hecho parte del estudio 20 universitarios (10 hombres y 10 mujeres) con promedio de edad de 25 años. El equilibrio postural se evaluó por el Sensory Organization Test (SOT), con uso del Smart Equitest(tm) de la NeuroCom(r) International, el que evalúa la habilidad del sujeto en el uso de los distintos sistemas de control postural (somatosensorial, vestibular y visual) con el fin de mantenerse en equilibrio en las 6 condiciones de conflicto sensorial presentadas por el sistema. Se han evaluados los sujetos en una sola tarea (manutención del equilibrio) y de doble tarea (manutención del equilibrio en relación con la tarea cognitiva de cálculo mental), del modo aleatorizado. Se midió el equilibrio a través de la puntuación de equilibrio, al comparar diferencias angulares entre el desplazamiento anterior y posterior máximos. Se ha hecho la prueba de Wilcoxon con el nivel de significancia p(0,05 para comparar las medias de las puntuaciones de equilibrio entre la situación sin o con doble tarea. Las puntuaciones de equilibrio en las condiciones del SOT han mostrado diferencias estadísticas significativas en la Condición 1 (ojos abiertos, plataforma y entorno visual fijos; p=0,018) y en la Condición 6 (ojos abiertos, plataforma que oscila y entorno visual fijo; p=0,008), con la reducción de equilibrio con doble tarea en ambas las condiciones. Los resultados mostraron que durante la doble tarea, que consiste en las cuatro operaciones aritméticas, el control se influyó negativamente con mayor oscilación de los sujetos. De esa manera, la complejidad de la tarea secundaria puede ser la principal razón para las menores puntuaciones de equilibrio encontradas.O objetivo deste estudo foi verificar a influência da dupla tarefa no equilíbrio postural de adultos jovens. Fizeram parte do estudo 20 universitários (10 homens e 10 mulheres) com idade média de 25 anos. O equilíbrio postural foi avaliado pelo Sensory Organization Test (SOT), utilizando o Smart Equitest(tm) da NeuroCom(r) International, que avalia a habilidade do indivíduo para usar os diferentes sistemas do controle postural (somatossensorial, vestibular e visual) para se manter em equilíbrio nas 6 condições de conflito sensorial apresentadas pelo sistema. Os sujeitos foram avaliados em tarefa única (manutenção do equilíbrio) e dupla tarefa (manutenção do equilíbrio em conjunto com tarefa cognitiva de cálculo mental), de modo randomizado. O equilíbrio foi mensurado através do escore de equilíbrio, comparando diferenças angulares entre os deslocamentos anterior e posterior máximos. Foi utilizado o teste de Wilcoxon com nível de significância p(0,05 para comparar as médias dos escores de equilíbrio entre a situação sem e com dupla tarefa. Os escores de equilíbrio nas condições do SOT evidenciaram diferença estatisticamente significativa na condição 1 (olhos abertos, plataforma e entorno visual fixos; p=0,018) e na condição 6 (olhos abertos, plataforma oscila e entorno visual fixo; p=0,008), com redução do equilíbrio com a dupla tarefa em ambas. Os resultados mostraram que durante a dupla tarefa, composta pelas quatro operações aritméticas, o controle postural é influenciado negativamente com maior oscilação dos sujeitos. Assim, a complexidade da tarefa secundária pode ter sido o principal motivo para os menores escores de equilíbrio encontrados

Tracking the Origin of a Rabbit Haemorrhagic Virus 2 Outbreak in a Wild Rabbit Breeding Centre in Portugal; Epidemiological and Genetic Investigation

As key prey, the wild rabbit downsize constitutes a major drawback on the endangered Iberian lynx (Lynx pardinus) re-introduction in the Iberia. Several captive breeding units mostly located in Alentejo, endeavour the wild rabbit repopulation of depleted areas assigned for the lynx re-introduction. Here we report an RHDV2 outbreak that occurred in early 2016 in a wild rabbit captive breeding unit located in Barrancos municipality. The estimated mortality rate between March and April 2016 was approximately 8.67%. Anatomopathologic examination was carried out for 13 victimized rabbits. Molecular characterization was based on the complete vp60 capsid gene. The 13 rabbit carcasses investigated showed typical macroscopic RHD lesions testing positive to RHDV2- RNA. Comparison of the vp60 nucleotide sequences obtained from two specimens with others publically available disclosed similarities below 98.22% with RHDV2 strains originated in the Iberia and Azores and revealed that the two identical strains from Barrancos-2016 contain six unique single synonymous nucleotide polymorphisms. In the phylogenetic analysis performed, the Barrancos-2016 strains clustered apart from other known strains, meaning they may represent new evolutionary RHDV2 lineages. No clear epidemiological link could be traced for this outbreak where the mortalities were lower compared with previous years. Yet, network analysis suggested a possible connection between the missing intermediates from which the strains from Barrancos 2013, 2014 and 2016 have derived. It is therefore possible that RHDV2 has circulated endemically in the region since 2012, with periodic epizootic occurrences. Still, six years after its emergence in wild rabbits, RHDV2 continues to pose difficulties to the establishment of natural wild rabbit populations that are crucial for the self-sustainability of the local ecosystems

What is the role of apelin regarding cardiovascular risk and progression of renal disease in type 2 diabetic patients with diabetic nephropathy?

Aims. To evaluate the association of different apelin levels with cardiovascular mortality, hospitalization, renal function, and cardiovascular risk factors in type 2 diabetic patients with mild to moderate CKD. Methods. An observational, prospective study involving 150 patients divided into groups according to baseline apelin levels: 1 = 329 pg/mL. Baseline characteristics were analyzed and compared. Multivariate Cox regression was used to find out predictors of cardiovascular mortality, and multivariate logistic regression was used to find out predictors of hospitalization and disease progression. Simple linear regressions and Pearson correlations were used to investigate correlations between apelin and renal disease and cardiovascular risk factors. Results. Patients' survival at 83 months in groups 1, 2, and 3 was 39%, 40%, and 71.2%, respectively (P = 0.046). Apelin, age, and eGFR were independent predictors of mortality, and apelin, creatinine, eGFR, resistin, and visfatin were independent predictors of hospitalization. Apelin levels were negatively correlated with cardiovascular risk factors and positively correlated with eGFR. Patients with lower apelin levels were more likely to start a depurative technique. Conclusions. Apelin levels might have a significant clinical use as a marker/predictor of cardiovascular mortality and hospitalization or even as a therapeutic agent for CKD patients with cardiovascular disease

Effect of Age on NK Cell Compartment in Chronic Myeloid Leukemia Patients Treated With Tyrosine Kinase Inhibitors

Natural killer (NK) cells are a very important component of the innate immune response involved in the lysis of virus infected and tumor cells. Aging has a profound impact in the frequency, phenotype and function of NK cells. Chronic Myeloid Leukemia (CML) is caused by the BCR-ABL gene formation encoding aberrant oncoprotein tyrosine kinase. Treatment with tyrosine kinase inhibitors (TKIs) induces durable deep molecular response. The response to treatment and life expectancy is lower in older patients with chronic phase of CML than in younger patients. In this work we analyse NK cells from TKI-treated CML patients and healthy controls stratified according to age. We have analyzed the expression of NK receptors, activation markers, NK cell differentiation in CD56bright and CD56dim NK cell subsets and the expression of CD107a and IFN-γ in NK cells stimulated with K562. Whereas significant differences on the phenotype and function of NK cells were found between middle-aged (35–65 years old) and elderly (older than 65) healthy individuals, NK cells from TKI-treated CML patients do not show significant differences related with age in most parameters studied, indicating that age is not a limitation of the NK cell recovery after treatment with TKI. Our results also revealed differences in the expression of NK receptors, activation markers and functional assays in NK cells from TKI-treated CML patients compared with age-matched healthy controls. These results highlight the relevance of NK cells in TKI-treated patients and the need of an extensive analysis of the effect of aging on NK cell phenotype and function in these patients in order to define new NK-cell based strategies directed to control CML progression and achieve long-term disease remission after TKI cessation

Neutrophils in Leprosy

Leprosy is an infectious disease caused by the intracellular bacillus Mycobacterium leprae that mainly affects the skin and peripheral nerves. One of the most intriguing aspects of leprosy is the diversity of its clinical forms. Paucibacillary patients are characterized as having less than five skin lesions and rare bacilli while the lesions in multibacillary patients are disseminated with voluminous bacilli. The chronic course of leprosy is often interrupted by acute episodes of an inflammatory immunological response classified as either reversal reaction or erythema nodosum leprosum (ENL). Although ENL is considered a neutrophilic immune-complex mediated condition, little is known about the direct role of neutrophils in ENL and leprosy disease overall. Recent studies have shown a renewed interest in neutrophilic biology. One of the most interesting recent discoveries was that the neutrophilic population is not homogeneous. Neutrophilic polarization leads to divergent phenotypes (e.g., a pro- and antitumor profile) that are dynamic subpopulations with distinct phenotypical and functional abilities. Moreover, there is emerging evidence indicating that neutrophils expressing CD64 favor systemic inflammation during ENL. In the present review, neutrophilic involvement in leprosy is discussed with a particular focus on ENL and the potential of neutrophils as clinical biomarkers and therapeutic targets