potential strategy for assessing health care policies

© The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.BACKGROUND: Tuberculosis (TB) causes pressure on healthcare resources, especially in terms of hospital admissions, despite being considered an ambulatory care-sensitive condition for which timely and effective care in ambulatory setting could prevent the need for hospitalization. Our objectives were to describe the spatial and temporal variation in pulmonary tuberculosis (PTB) hospitalizations, identify critical geographic areas at municipality level and characterize clusters of PTB hospitalizations to help the development of tailored disease management strategies that could improve TB control. METHODS: Ecologic study using sociodemographic, geographical and clinical information of PTB hospitalization cases from continental Portuguese public hospitals, between 2002 and 2016. Descriptive statistics, spatiotemporal cluster analysis and temporal trends were conducted. RESULTS: The space-time analysis identified five clusters of higher rates of PTB hospitalizations (2002-16), including the two major cities in the country (Lisboa and Porto). Globally, we observed a -7.2% mean annual percentage change in rate with only one of the identified clusters (out of six) with a positive trend (+4.34%). In the more recent period (2011-16) was obtained a mean annual percentage change in rate of -8.12% with only one cluster identified with an increase trend (+9.53%). CONCLUSIONS: Our results show that space-time clustering and temporal trends analysis can be an invaluable resource to monitor the dynamic of the disease and contribute to the design of more effective, focused interventions. Interventions such as enhancing the detection of active and latent infection, improving monitoring and evaluation of treatment outcomes or adjusting the network of healthcare providers should be tailored to the specific needs of the critical areas identified.publishersversionpublishe

Lutzomyia longipalpis Saliva Triggers Lipid Body Formation and Prostaglandin E2 Production in Murine Macrophages

After the injection of saliva into the host's skin by sand flies, a transient erythematous reaction is observed, which is related to an influx of inflammatory cells and the release of various molecules that actively facilitate the blood meal. It is important to understand the specific mechanisms by which sand fly saliva manipulates the host's inflammatory responses. Herein, we report that saliva from Lutzomyia (L.) longipalpis, a widespread Leishmania vector, induces early production of eicosanoids. Intense formation of intracellular organelles called lipid bodies (LBs) was noted within those cells that migrated to the site of saliva injection. In vitro and ex vivo, sand fly saliva was able to induce LB formation and PGE2 release by macrophages. Interestingly, PGE2 production induced by L. longipalpis saliva was dependent on intracellular mechanisms involving phosphorylation of signaling proteins such as PKC-α and ERK-1/2 and subsequent activation of cyclooxygenase-2. Thus, this study provides new insights into the pharmacological properties of sand fly saliva and opens new opportunities for intervening with the induction of the host's inflammatory pathways by L. longipalpis bites

Bayesian spatio-temporal models for mapping TB mortality risk and its relationship with social inequities in a region from Brazilian Legal Amazon

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Chemical composition and antimicrobial properties of the essential oils of two Guadua Kunth species (Poaceae-Bambusoideae)

Bamboos are described as one of the most important renewables, easily obtained, and valuable of all forest resources. Brazil is the country with the greatest diversity of bamboo species in the New World [1]. One of the most important bamboo groups growing in South America belongs to the Guadua genus, from which two species, G. angustifolia Kunth. and G. chacoensis (Rojas Acosta) Londoño & P.M. Peterson, are morphologically closely related. Due to the taxonomic difficulties presented by the Guadua complex, the main objective of this work was to evaluate the potential of their volatile oils for distinguishing the closely related species and to evaluate new potential applications for these plants. Leaves of the taxa were collected at an Experimental Unit from the Agronomical Institute from Campinas (IAC) located in Tatuí-SP. The essential oils were obtained by hydrodistillation for 4 h, and component identification was performed by GC/MS [2]. The yields were found to be 0.027% and 0.00079% (w/w), for G. angustifolia and G. chacoensis, respectively. Terpenes and terpene-related compounds accounted for most of the compositions of the two samples. The major compounds of G. angustifolia oil were hexahydrofarnesyl acetone (23.1%) and (Z)-phytol (21.3%), while G. chacoensis oil was characterized by (E)-β-ionone (8.8%), hexadecanoic acid (6.8%), hexadecenoic acid (6.5%), (Z)-phytol (5.3%) and (E)-α-ionone (5.0%). The antimicrobial activity was assayed by a microdilution method in microplates [2] against Aspergillus brasiliensis, Candida albicans, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus; none of the oils exerted any considerable activity (MIC > 250 µg/mL), as only extracts with MIC < 100 µg/mL can be considered as candidates for developing new antimicrobial agents [3]

A Formação Ambiental na Visão dos Graduandos de Licenciatura Plena em Ciências Naturais – Habilitação Química na Universidade do Estado Pará - UEPA

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Female rat sexual behavior is unaffected by perinatal fluoxetine exposure

Serotonin plays an important role in adult female sexual behavior, however little is known about the influence of serotonin during early development on sexual functioning in adulthood. During early development, serotonin acts as neurotrophic factor, while it functions as a modulatory neurotransmitter in adulthood. The occurrence of serotonin release, could thus have different effects on behavioral outcomes, depending on the developmental period in which serotonin is released. Because serotonin is involved in the development of the HPG axis which is required for puberty establishment, serotonin could also alter expression patterns of for instance the estrogen receptor ɑ (ERɑ). The aim of our study was to investigate the effects of increased serotonin levels during early development on adult female rat sexual behavior during the full behavioral estrus in a seminatural environment. To do so, rats were perinatally exposed with the selective serotonin reuptake inhibitor (SSRI) fluoxetine (10 mg/kg FLX) and sexual performance was tested during adulthood. All facets of female sexual behavior between the first and last lordosis (behavioral estrus), and within each copulation bout of the behavioral estrus were analyzed. Besides the length and onset of the behavioral estrus and the sexual behaviors patterns, other social and conflict behavior were also investigated. In addition, we studied the effects of perinatal FLX exposure on ERɑ expression patterns in the medial preoptic nucleus, ventromedial nucleus of the hypothalamus, medial amygdala, bed nucleus of the stria terminalis, and the dorsal raphé nucleus. The results showed that perinatal fluoxetine exposure has no effect on adult female sexual behavior. The behavioral estrus of FLX-females had the same length and pattern as CTR-females. In addition, FLX- and CTR-females showed the same amount of paracopulatory behavior and lordosis, both during the full behavioral estrus and the "most active bout". Furthermore, no differences were found in the display of social and conflict behaviors, nor in ERɑ expression patterns in the brain. We conclude that increases in serotonin levels during early development do not have long-term consequences for female sexual behavior in adulthood.</p

Treatment of first-time traumatic anterior shoulder dislocation:the UK TASH-D cohort study

Background Shoulder dislocations are the most common joint dislocations seen in emergency departments. Most traumatic cases are anterior and cause recurrent dislocations. Management options include surgical and conservative treatments. There is a lack of evidence about which method is most effective after the first traumatic anterior shoulder dislocation (TASD). Objectives To produce UK age- and sex-specific incidence rates for TASD. To assess whether or not surgery within 6 months of a first-time TASD decreases re-dislocation rates compared with no surgery. To identify clinical predictors of recurrent dislocation. Design A population-based cohort study of first-time TASD patients in the UK. An initial validation study and subsequent propensity-score-matched analysis to compare re-dislocation rates between surgery and no surgery after a first-time TASD. Prediction modelling was used to identify potential predictors of recurrent dislocation. Setting UK primary and secondary care data. Participants Patients with a first-time TASD between 1997 and 2015. Interventions Stabilisation surgery within 6 months of a first-time TASD (compared with no surgery). Stabilisation surgery within 12 months of a first-time TASD was also carried out as a sensitivity analysis. Main outcome measures Re-dislocation rate up to 2 years after the first TASD. Methods Eligible patients were identified from the Clinical Practice Research Datalink (CPRD) (1997–2015). Accuracy of shoulder dislocation coding was internally validated using the CPRD General Practitioner questionnaire service. UK age- and sex-specific incidence rates for TASD were externally validated against rates from the USA and Canada. A propensity-score-matched analysis using linked CPRD and Hospital Episode Statistics (HES) data compared re-dislocation rates for patients aged 16–35 years, comparing surgery with no surgery. Multivariable Cox regression models for predicting re-dislocation were developed for the surgical and non-surgical cohorts. Results Shoulder dislocation was coded correctly for 89% of cases in the CPRD [95% confidence interval (CI) 83% to 95%], with a ‘primary’ dislocation confirmed for 76% of cases (95% CI 67% to 85%). Far fewer patients than expected received stabilisation surgery within 6 months of a first TASD, leading to an underpowered study. Around 20% of re-dislocation rates were observed for both surgical and non-surgical patients. The sensitivity analysis at 12 months also showed little difference in re-dislocation rates. Missing data on risk factors limited the value of the prediction modelling; however, younger age, epilepsy and sex (male) were identified as statistically significant predictors of re-dislocation. Limitations Far fewer than the expected number of patients had surgery after a first-time TASD, resulting in an underpowered study. This and residual confounding from missing risk factors mean that it is not possible to draw valid conclusions. Conclusions This study provides, for the first time, UK data on the age- and sex-specific incidence rates for TASD. Most TASD occurs in men, but an unexpected increased incidence was observed in women aged > 50 years. Surgery after a first-time TASD is uncommon in the NHS. Re-dislocation rates for patients receiving surgery after their first TASD are higher than previously expected; however, important residual confounding risk factors were not recorded in NHS primary and secondary care databases, thus preventing useful recommendations. Future work The high incidence of TASD justifies investigation into preventative measures for young men participating in contact sports, as well as investigating the risk factors in women aged > 50 years. A randomised controlled trial would account for key confounders missing from CPRD and HES data. A national TASD registry would allow for a more relevant data capture for this patient group